Growth, Development, Fluids, Electrolytes, Respiratory, Acid-Base Balance, and Endocrine Conditions

These flashcards cover key concepts related to growth and development milestones, fluid and electrolyte imbalances, respiratory conditions, acid-base balance, and endocrinological disorders.

What are the main symptoms of diabetes mellitus type I?

Polyuria, polydipsia, polyphagia, presence of ketones.

What are the signs of Cushing's syndrome?

Moon face, buffalo hump, truncal obesity, striae, hyperglycemia.

What is Erikson stages in infancy?

Infants- Trust v. Mistrust

What is Erikson stages in Toddlerhood?

Autonomy v. Shame and Doubt,

Safety considerations of toddlers?

● Temper tantrums

● On the move (safety)

● Diaper to potty transition

● Development stage theory

● Loves to say “NO” ● Eating plan

● Rrr (rituals, rivalry, regressions)

Infant safety considerations? 

Car Seat:

● Appropriate installation

● Back seat and rear-facing

Shaken baby syndrome: permanent brain damage

● Period of Purple Cry- 3 months

● Never shake a baby

● Stay calm, lay infant down in a safe place and take a break

Burns: (bath water)

● Adjust water temperatures for water heater

● Block off electrical outlets

SIDS (sudden infant death syndrome):

● Sleep: Back is best

● Dress infant appropriately: don’t over dress

● Avoid exposure to tobacco smoke

● Remove extra items from sleep areas

● Sleep- if in same room, different bed

Choking:

● Even newborns can choke: milk or mucus (small respiratory tract)

● Bulb suction and suggest CPR class

● AVOID small, hard round food items when starting foods (around 6 months)

● Never leave unattended on surfaces

● Stop swaddling once baby can roll over

Toddler safety considerations?

On the move

• DANGERS

• Drowning

• Automobile accident

• Nose-dives (falls)

• Getting burned

• Eating toxic substances

• Revolver/ rifles…unsecured firearms

• Suffocate/ chokes

Erikson school age stages?

Industry v. inferiority

Safety considerations for school age children?

Safety:

● Bike/ scooters/ skateboards

● Swimming

● Strangers

● Dangerous objects

● Car/ traffic

● Bullying

● Self confidence

Milestones school age children?

• Gain 4.5-7lbs/ year,

• Grow 2.5 inches/ year,

• Baby teeth -> permanent teeth

Infant milestones?

Infant milestones 6 months-

● Sit up with support

● Stranger danger

● Babbles with early vowel sounds

● Has fun looking at self in mirror Infant milestones

12 months-

● Begins walking

● Follows simple commands

● Says simple words like “mama” or “dada”

Preschool milestones? 

• 5lbs/ year,

• 3 inches/ year,

• Begin losing baby teeth

What is Hypokalemia and what is it caused by?

• < 3.5

• Causes- losing K or gaining fluid

Differnet sx’s of hypokalemia 

• constipation,

• paralytic ileus,

• fatigue,

• resp compromise,

• EGK- flat T wave and present U wave (low and slow)

Tx for hypokalemia?

• add potassium PO and IV (don’t bolus), too much fluid- decrease fluid= K sparring diuretic

• Isotonic (0.9% NS + KCl)

Sx’s of hyperkalemia and hypokalemia

• hypotension

• Arrhythmias

• muscle weakness

Interventions for hypokalemia? 

• monitor heart and bowel

What is Hyperkalemia and what causes it?

• > 5

• Causes-gaining K or losing fluids

Different sx’s for hyperkalemia? 

• diarrhea,

• EKG- peak T- wave,

• wide QRS and

• wide PVC/VF waves,

• restlessness,

• parentheses,

• irritability (high and big)

Tx for hyperkalemia?

• too much K=

• remove K via dialysis/diuretics,

• insulin + glucose albuterol,

• kayexalte- X the K,

• calcium gluconate

What is Hypernatremia and what causes it?

• >145 (too much Na and losing fluid)

• burns,

• nausea and vomiting,

• dehydration,

• sweating,

• heatstroke,

• meds- steroids,

• getting too much hypertonic fluids/feeds

Sx of hypernatremia and hyponatremia same?

confusion, lethargy, coma, irritability, seizures

Different sx’s of hypernatremia?

• muscle twitching,

• altered DTR,

• resp compromise

• dry mucus membranes

• thirst 

Tx of hypernatremia?

• Too much Na- diuretics,

• Too little H20- increase fluids PO or isotonic IV

• Hypotonic (0.45% NS, D5W)

What causes hyponatremia and what is it?

• <135

• Losing Na causes- diarrhea, wound/burn losses, diuretics.

• Gaining too much fluid- too much water, renal failure, delusional overload, meds- ADH,

• SSRIs don’t pee.

Different Sx’s of hyponatremia?

• muscle cramps,

• decreased DTR 

• nausea/ vomiting

Tx of hyponatremia?

• Tx- Not enough Na- add Na via PO or  hypertonic saline solutions- Hypertonic (3% NS)

• Too much H20= fluid restriction or drugs blocking ADH= vasopressin (adjust slowly or else seizure could occur)

What is Hypovolemia and cause?

• dehydration

• loss of H20 and Na

• loss of Na,

• loss of H20

S/S of hypovolemia and hypervolemia?

• tachycardia

• tachypnea

• weakness

S/S of hypovolemia?

• hypo/hyperthermia 

• weak pulse,

• hypotension,

• tachypnea, 

• hypoxia,

• dizziness

• syncope, 

• confusion,

• weakness,

• fatigue,

• oliguria,

• thirst,

• dry tongue,

• nausea,

• vomiting,

• anorexia, 

• acute weight loss,

• slow cap refill,

• FLAT neck veins,

• sunken eyes

• poor skin turgor

• Tenting

Labs for hypovolemia?

• ↑ BUN,

• ↑ serum sodium,

• ↑ blood osmolarity,

• ↑ hematocrit,

• ↑ urine specific gravity.

Tx of hypovolemia?

● Rehydrate PO or IV- 0.9% NS, D5W, lactated ringer

● Monitor I & Os, VS, LOC, weight q 8 hr

● Assess gait and use call light

● Slow change of positions

● Educate hydration promotion and cause of dehydration

What is hypervolemia and what causes it? 

Fluid overload- too much water,

Causes-

● excess H20 and Na (hypervolemia)

● Gain of H20

Labs for hypervolemia ?

• ↓ hemoglobin and hematocrit,

• ↓blood osmolarity,

• ↓ urine sodium,

• ↓specific gravity,

• ↓BUN.

S/S of hypervolemia? 

●Vision changes

●altered LOC

●hypertension

●Paresthesia

●Seizures

●Asities

●Liver enlargement

●Increased GI motility

●Crackles

●Cough

●Dyspnea

●JVD

●Polyuria

●Weight gain

●Peripheral edema

Tx of hypervolemia?

● Monitor I&Os

● Monitor edema

● Diuretics (watch K levels)

● Monitored serum sodium, potassium levels, breath sounds, skin turgor

● Na restriction

● Fluid restrictions

● Semi fowlers or fowlers for breathing

● Encourage rest

Complications of hypervolemia?

● Pulmonary edema= emergency

● Heart failure

● Water intoxication

What is COPD?

● Patho- chronic bronchitis and emphysema most commonly caused by smoking or exposure to irritants.

What are early manifestations of COPD?

• dyspnea,

• cough,

• sputum production,

• wheezing and

• chest tightness

Advanced signs of COPD?

• Advanced barrel chest,

• weight loss/weight gain,

• clubbing,

• decreased O2 sats,

• altered ABGs,

• R-sided HF.

S/S of chronic bronchitis?

●Blue bloater: cyanosis

●cough

●chronic hypoxia

●clubbing

●right HF= JVD, ascites, ankle edema

● hepatosplenomegaly

Tx of COPD?

• beta 2 agonist- DuoNeb: albuterol + ipratropium bromide,

• methylprednisolone,

• antibiotics

• antiviral

Nursing interventions for COPD?

• respiratory assessments

• assess skin color

• vitals

• decrease anxiety

• smoking cession

• oxygen management

• energy conservation

• manage stress

• medication management

What is emphysema? 

• air cannot get out due to impaired gas exchange due to distended and non recoiling alveoli (retention of air)

• pink puffer

S/S of emphysema?

● Prolonged exhalation

● Barrel chest

● Hypercapnia

● Shallow respirations

What do we do specifically of emphysema?

pursed lip breathing

What is the patho of asthma?

• inflammation of the airway and increased mucus from allergens causes decreased O2= impaired gas exchange and difficulty breathing.

S/S of asthma?

●difficulty breathing

●Chest tightness

●Restlessness

●Wheezing

●Retractions

●Tripod breathing 

●Sweating

●Persistent cough

●Irritability

Tx of asthma?

• SABA,

• LABA,

• ICS,

• O2 therapy or mechanical ventilation if no oxygen.

Interventions of asthma? 

mange triggers

Patho of pneumonia?

- lung infection caused by bacteria, virus, or aspiration

S/S of pneumonia?

● Cough

● Dyspnea

● Fever

● Malaise

● Myalgia

● decreased appetite

● adventitious lung sounds= crackles and rales

Interventions for pneumonia?

• encourage coughing,

• titrate O2,

• raise HOB for ventilation,

• increase fluids intake and IVs,

• antibiotics,

• manage airway,

• smoking cession,

• have clients walk around.

Tx of pneumonia?

Antibiotics

What is patho of RSV?

caused by virus causes bronchiolitis= lining of bronchi becomes inflamed.

S/S of RSV? 

• tachypnea,

• hypoxia,

• tachycardia,

• wheezing,

• crackles,

• restricted airflow,

• increased mucus,

• bronchospasm resulting in severe coughing.

Interventions and Tx for RSV?

What is croup and what is it caused by?

• upper and middle airway swelling causing restricted airflow 

• caused by virus- parainfluenza, bacteria, or allergen.

S/S for croup?

• barky cough,

• stridor,

• fever,

• hoarseness,

• nasal congestion and

• discharge,

• increased RR with prolonged inspiratory phase.

Tx/ interventions for croup?

• cool humidified air

• steroids- IV,

• injectable steroids,

• PO,

• racemic epinephrine

• shower steam

• cold air

• nasal cannula.

Risk factors for croup? 

• 6m-3 years, male, fall or winter (virus season)

What is pulmonary edema and cause? 

• fluid in lungs

• getting fluids too fast and cardiac problems

S/S of pulmonary edema?

• anxiety, Premature Ventricular Contractions, lethargy, tachycardia, tachypnea, dyspnea at rest, change LOC, crackles, cough, frothy pink sputum, acute respiratory distress

Tx of pulmonary edema? 

• sit patient upright,

• IV morphine,

• IV loop diuretics (furosemide)- to remove fluids,

• high flow O2- face mask, non-rebreather, intubation, and

• mechanical ventilation.

Interventions of pulmonary edema?

• monitor labs- ABGs,

• electrolytes,

• fluid restrict- stop or slow IVs,

• frequent monitoring.

Cause of Metabolic Alkalosis?

• increased HCO3 and increased acid loss= constipation,

• serve vomiting,

• ingesting too much HCO3- tums

• non K sparing diuretics.

• ph> 7.45

• HCO3- >26

Sx’s of metabolic and respiratory alkalosis?

• lightheadedness,

• tinnitus,

• numbness,

• tingling,

• inability to concentrate

How body compensates for metabolic alkalosis?

• Body comp- lungs will increase CO2,

• causing slow and shallow RR.

• Kidneys- hold onto H+

Medical interventions for metabolic alkalosis?

• restore fluid volume, monitor I &Os and EKG,

• give KCl and NaCl,

• treat underlying cause

What are causes of metabolic acidosis?

• loss of HCO3, too much acid and chloride,

• decreased acid secretion= diarrhea,

• kidney failure- causes elimination of HCO3,

• diabetes,

• too much alcohol.

• ph <7.35

• HCO3= <22

S/S of metabolic and respiratory acidosis?

• headache,

• confusion,

• increased RR,

• hypotension,

• shock,

• hypotension,

• dysrhythmias,

• palpations,

• decreased CO.

Medical interventions of metabolic acidosis?

• airway management,

• IV infusion of HCO3 or

• oral HCO3.

How body compensates for metabolic acidosis?

• kidneys will make HCO3 high

• body will increase respirations and depth of respirations 

Medical interventions of Metabolic Acidosis?

airway management, IV infusion of HCO3 or oral HCO3.

Nursing management of DM type I?

insulin for hyperglycemia,

Patho of DM I?

autoimmune disease where no insulin is being produced because beta cells in pancreas are attacked

S/S of Type 1 DM?

quick and onset, young/thin, polyuria, polydipsia, polyphagia, ketone in urine, frequent urination, weakness, weak pulse, dry mucous membranes. Presents with hyperglycemia usually.

Patho of DM type II?

insulin resistance cells don’t respond to insulin.

S/S of DM type II?

adults & obesity

Nursing management of Type II DM?

oral meds to increase insulin sensibility like metformin, sulfonylurea, secretagogues, diet and exercise, and sometimes insulin.

S/S of hypoglycmia?

Pallor, sweaty, excessive hunger, irritability, sleepiness, tachycardia, dizziness, restless, cold/clammy

rapid

<70

Tx for hypoglycemia?

Glucose IV if extremely low <40, <70= Give 15 G of fast acting sugar like cracker, juice, soda. Recheck in 15 minutes if still low give 15 G of more sugar.

S/S hyperglycemia?

polyphagia , polydipsia, polyuria, dry skin, blurred vision, weakness, headache

gradual

>150

Tx for hyperglycemia?

Give insulin: short acting, and adjust insulin if they have pump

priority action of hyperglycemia? 

Check blood sugar, give insulin, monitor for DKA

priority action of hypoglycemia? 

Give glucose (oral or IV) to raise blood sugar.

Cushing syndrome?

● Cause (endogenous or exogenous): Exogenous is the most common due to use of glucocorticoid. Endogenous- comes from inside the body, so the body is making too much cortisol. ● 3 Classic symptoms: round face, buffalo hump, large abdomen. ● Labs you'd expect: ○ Cortisol: ↑ ○ Glucose: ↑ ○ Potassium: ↓ ● Nursing interventions: monitor vital sigs and electrolytes. Also monitor I and Os. Medications to decrease cortisol. Ketoconazole- corticosteroid inhibitor, Mitotane-selective destruction of adrenocortical cells (must monitor for hepatotoxicity and hypotension), chemotherapy or radiation for adrenal gland. ● Mnemonic for symptoms: CUSHINGOID or create your own: C: cortisol high, (↑ glucose, ↑ sodium, ↓ potassium, ↓ calcium) U: Urine cortisol increased S: Striae H:ump on back I:Increased body hair N:Na retention/ hypertension G:Gland removal for treatment O:Overuse of glucocorticoids I:Immune suppression D:Dangers of adrenal crisis (if cortisol suddenly withdrawn or glands removed → Addisonian crisis)

Addison’s disease?

Hormones deficient: decrease of mineralocorticoids and glucocorticoids= decreased cortisol and aldosterone.

● Symptoms (at least 3): bronze skin, hypotension, weakness.

● Nursing actions in crisis: Tx- IV steroids, For hyperkalemia- insulin + glucose, thiazide diuretics, heart monitoring. For metabolic acidosis= sodium bicarbonate is for homeostasis.

● Patient teaching (med alert? steroids?):

Don’t suddenly stop glucocorticoid medications because it can lead to adrenal crisis, must been weaned off steroids.

Addison = Add-a-steroid

S/S of Addisonian crisis?

fever, syncope, convulsions, hypoglycemia, hyponatremia, severe vomiting, and diarrhea.

What is Respiratory Acidosis and what causes it? 

(pH ↓, CO2 ↑)= (Can’t Catch My Breath)

hypoventilation from brain injury, obstructive breathing disorders, muscular dystrophy diseases

ph= <7.35

CO2= >45

How body compensates for respiratory acidosis?

get rid of excess H+ so fast and deep respirations

kidney will cause high HCO3.

Medical interventions for respiratory acidosis?

respiratory support, hydration, positions for better breathing.

Medical interventions for Respiratory Alkalosis?

breathing exercises, anxiety medication and other treatments, stress reduction.

How the body compensates for Respiratory Alkalosis? 

kidneys will cause low HCO3, lungs- hold onto CO2= slow breathing 

What is Respiratory Alkalosis and what causes it? 

(pH ↑ , CO2 ↓)

● Causes: hyperventilation (breathing too much)= high altitude, anxiety, asthma with high RR.

ph>7.45

CO2= <35