NRS 233 exam 3 study guide

7.35-7.45

What is the normal range of pH?

35-45

What is the normal range of CO2?

22-26

What is the normal range of HCO3?

high CO2

low pH

hypercapnia, low RR

increasing metabolic bicarb

What is respiratory acidosis?

low CO2

high pH

hypocapnia, hyperventilation

increasing metabolic alkalosis

What is respiratory alkalosis?

Acid: 7.35

Alk: 7.45

What pH is acidic? alkalosis?

excessive loss or inadequate intake of fluid

leads to decreased volume, cardiac output

cause- vomiting or diarrhea

What are characteristics of fluid volume deficit? cause?

greater than 26 HCO3

vomiting or increased bicarb

compensate= decreased RR

What is metabolic alkalosis?

weak pulse

hypotension

dry mucous membrane

What are signs and symptoms of a fluid deficit?

H2O and salt are lost

isotonic deficit

What is hypovolemia?

water is lost in excess of sodium

hypertonic deficit

What is dehydration? is it hyper/hypo-tonic?

increase in fluids- increase work on heart

metabolism and O2 transport

What are characteristics of fluid volume excess?

edema

crackles

JVD

SOB

weight gain

What are signs and symptoms of fluid excess?

There is 1 L of fluid in the body--> in dependent areas, interstitial space

Caused by a fluid excess

What happens if you gain 1 kg (2.2 lbs)?

1100-1400 mL

How much should you be drinking (fluid intake) per day?

800-1000 mL

How much fluid intake do you usually take when eating?

100-200 mL

In feces, how much water do you excrete?

0.45-0.5% NS

0.33% NS

2.5% dextrose in 0.45% saline

water

osmolarity less than body fluids <275

What are examples of hypotonic solutions?

0.9% normal saline

lactated ringers

D5W= avoid with increased intracranial pressure

What are examples of isotonic solutions?

3.5% to fix sodium levels

fluid moves from ICS to ECS

osmolarity pulls water out of cells= shrivel

avoid with kidney/heart failure

What are examples of hypertonic solutions?

blood and blood components the remain intact until able to pass through capillary membrane

use for a loss of a lot of volume in the vascular space

What are colloids?

IV administration of highly concentrated solution containing nutrients and electrolytes

What is parenteral nutrition?

inflammation of a vein

S&S: red, tender, warm, swelling

What are signs and symptoms of phlebitis? S&S?

Leakage of non-vesicant into the extravascular tissue that becomes dislodged or vein ruptures and IV fluid enter subcutaneous tissue

S&S: blanching of skin, decreased temp, fluid leak from IV, swelling/discomfort

In an IV, what is infiltration? S&S?

Leakage of a vesicant IV solution or medication into the extravascular tissue

S&S: same as infiltration PLUS numbness/tingling, blistering, slough, necrosis, deep pitting edema

In an IV, what is an extravasian? S&S?

extravastion

If IV fluids release cause damage to tissue then it is...

local infection

IV site has redness, heat, swelling it is....

135-145

What is the normal levels of sodium?

S: skin flushed

A: agitation (decreased LOC)

L: low-grade fever

T: thirst

E: edema

D: dehydration

What are signs and symptoms of hypernatremia?

Diuretics

Dehydration/diarrhea

Diabetes insipidus

Causes of hypernatremia?

S: stupor/come

A: anorexia

L: lethargy

T: decreased tendon reflexes

L: limp muscles

O: orthostatic hypotension

S: stomach cramp

S: seizure

What are signs and symptoms of hyponatremia?

SIADH

antidepressant

renal fail

hypothyroidism

Causes of hyponatremia?

3.5-5.0

What is the normal level of potassium?

Tight and contracted--

M: muscle weakness

U: urine output decreased (abdomen cramps/diarrhea)

R: resp fail

D: decreased cardiac contract

E: early muscle twitches/cramps

R: rhythm changes: Tall T waves, prolonged PR intervals

What are the signs and symptoms of hyperkalemia?

C: cell movement (burns/tissue damage)

A: adrenal insuff.

R: renal fail

E: excessive K+

D: K+ sparing diuretics

What are causes of hyperkalemia?

hypokalemia

constipation

decreased bowel sounds

abdominal distention

weakness

dysrhythmias

Sloooooow--> 7 L's

Lethargy

Low respirations

lethal arrhythmias: ST depression, depressed T waves, project U

lots of urine output

leg cramp

limp muscle

low BP

What are the signs and symptoms of hypokalemia?

D: drugs--> diuretics

I: inadequate K+ intake

T: too much water

C: Cushing's

H: heavy fluid loss

What are causes of hypokalemia?

8.5 to 10

What is the normal range of calcium?

anorexia

kidney stones

constipation

decreased reflexes

decreased LOC

confusion

cardiac arrest

What are the signs and symptoms of hypercalcemia?

numbness/tingling of fingers and toes

Circumoral tingling

chvostek/Trousseau's sign

hyperactive reflexes

muscle cramps

spasms/tetany

seizures

What are the signs and symptoms of hypocalcemia?

1.5-2.5

What are the normal levels of magnesium?

Strict law an order (everyone is quiet)

lethargy

hypoactive reflexes

bradycardia

hypotension

What are the signs and symptoms of hypermagnesemia?

positive chvostek/Trossueau's sign

hyperactive reflexes

tachycardia

hypertension

muscle cramps

dysphagia

tetany/seizures

dysrhythmias

What are signs and symptoms of hypomagnesemia?

Monitor LOC and ensure safety,

monitor I&O and alert the doc about urinary output

provide oral hygiene

Diet (low sodium, no added salt),

How to care for hypernatremia?

hypotonic and isotonic IV fluids

encourage water intake and discourage sodium intake

diuretics if impaired fluid excretion is the cause of hypernatremia

What fluids/meds would you give with hypernatremia?

monitor I&O, fluid restrictions

weigh the client daily

monitor vital signs and LOC

encourage the client to change positions slowly

monitor resp status if muscle weakness is present

encourage foods and fluids high in sodium (cheese, milk)

How to care for hyponatremia?

fluid overload restrict water intake as prescribed

administer a hypertonic oral and IV fluids as prescribed

What IV fluids/meds to admin with hypernatremia?

implement continuous ECG monitoring, decrease potassium intake (stop infusion of IV potassium, withhold oral potassium, provide a potassium restricted diet)

monitor cardiac rhythm, maintain IV access,

How to care for hyperkalemia?

dialysis might be required, administer IV fluids with dextrose and regular insulin as prescribed,

loop diuretics, sodium polystyrene sulfonate is given orally or as an enema, calcium gluconate, albuterol, and patiromere

What IV fluids/meds to admin with hyperkalemia?

treat the underlying cause, replace potassium (encourage foods high in K: avocados, dried fruit, cantaloupe, bananas, potatoes, spinach, oral potassium supplements,

How to care for hypokalemia?

iv potassium administration must be diluted and administered slowly by intermittent infusion, never IV bolus!

What meds/IV fluids to admin with hypokalemia?

potassium (K+)

What electrolyte do you NEVER bolus?

restricting calcium and increasing fluid intake, monitor client for pathological fractures

How to care for hypercalcemia?

administer oral or IV calcium supplements and vitamin D supplements, initiate seizure and fall precautions, keep emergency equipment on standby, encourage foods high in calcium (dairy products and dark green vegetables)

How to care for hypocalcemia?

perform frequent focused assessment, administer loop diuretics and magnesium free IV fluids if kidney function is adequate, administer calcium gluconate for severe cardiac changes

How to care for hypermagnesemia?

discontinue magnesium-losing medications, magnesium replacement can be required orally or IV, encourage foods high in magnesium (whole grains and dark green vegetables)

How to care for hypomagnesemia?

force of the fluid pressing outward against a surface when hydrostatic pressure is increased edema is caused by moving excess fluid into the interstitial space

What is hydrostatic pressure?

inward pulling force caused by blood proteins that helps move fluid from the interstitial area back to capillaries

What is oncotic pressure?

inward pulling force caused by particles in the fluid

What is osmotic pressure?

OLDCART

consider life span, gender, culture, ethnicity, religion, disability

How to assess for pain? Considerations?

predictable

occurs when: walking, coughing, dressing changes

What is a breakthrough incident of pain?

pain that occurs toward the end of the usual dosing interval of a regularly scheduled analgesic

What is an end of dose failure meaning?

unpredictable

any activity

What is a spontaneous breakthrough pain?

pain is short duration and localized. It is usually a sharp sensation

ex: needlestick

What is cutaneous pain? ex?

pain is diffuse and radiates in several directions

duration varies, but it usually lasts longer than superficial pain pain is sharp, dull, or unique to the organ involved

ex: angina= crushing

gastric ulcer= burning

What is a deep or visceral pain? ex?

chronic pain in the absence of an identifiable physical or psychological cause or pain perceived as excessive for the extent of an organic pathological condition

What is idiopathic pain?

normally nociceptive resulting from stimulus of an undamaged nerve and/or neuropathic, arising from abnormal or damaged pain nerves

What is cancer pain?

protective, usually with an identifiable cause, is short duration, and has limited tissue damage and emotional response

What is acute pain?

prolonged pain sensation after injury has healed (duration of 6 months)

What is chronic pain?

occurs when pain receptors in tissues (including the skin, muscles, skeleton, joints, and connective tissues)

What is somatic pain?

nociceptors in tissues send pain signals to the CNS

What is nociceptive pain?

abnormal processing of stimuli

What is neuropathic pain?

-deafferentation pain= injury to either peripheral or CNS

-sympathetically maintained pain= impaired regulation of ANS

What are characteristics of centrally generated pain?

-painful polyneuropathies= along peripheral nerves: diabetic neuropathy

-painful mononeuropathies= peripheral nerve injruy

What are characteristics of peripherally generated pain?

allow the patient to alter affective-motivational and cognitive perception. Relaxation is mental and physical freedom from tension or stress that provides individuals a sense of self-control

How does relaxation and guided imagery work?

the reticular activating system inhibits painful stimuli if a person receives sufficient or excessive sensory input. With sufficient stimuli, a person ignores or becomes unaware of pain

How does distraction work with pain?

diverts a person's attention away from the pain and creates a relaxation response. Music creates positive changes in mood and emotional state and allows patients to actively participate in treatment

How does music therapy work with pain?

patient if they are taking any prescribed analgesics because they might interact

What is important to ask if a client is using herbals?

no anti-inflammatory effects

s/e= hepatotoxicity

What are characteristics of acetaminophen?

aspirin and ibuprofen

mild-moderate pain

s/e= GI bleeding and renal insufficiency

What are characteristics of NSAIDs?

pain is a 3 or less

identifies related factors

uses pain relief

doesn't interfere with ADLs

What should be some general outcomes for pain?

oral meds can be long or short

IV are fastest

patches last longest

transdermal when patients can't take drugs orally

What are characteristics of narcotics?

sedation

respiratory depression

n/v

constipation

urinary retention

addicted

DON'T use intramuscular route

What are some risk factors or side effects of narcotics?

The patient controls when they get pain meds

patients need to understand and be able to press the button

PCA basal doses not recommended for opioid-naive patients

check IV line

prevent errors

What is a PCA (patient controlled analgesia)?

moving gases in and out of lungs

What is ventilation?

cardiovascular system to pump oxygenated blood to tissues

and deoxygenated blood into lungs

What is perfusion?

chemical produced in the lungs to maintain the surface tension of the alveoli and keep them from collapsing

What is surfactant?

a collapse of the alveoli that prevents normal exchange of oxygen and carbon dioxide

What is atelectasis?

fluid in lungs/pleural space

What do chest x-rays look for?

ultrasound specific to heart

ST elevation

What do echocardiogram look for?

catheter is inserted into coronary artery to look for abnormalities

What does an angiogram look for?

-Activity intolerance

-Decreased cardiac output

-Fatigue

-Impaired gas exchange

-Impaired verbal communication

-Ineffective airway clearance

-Ineffective breathing pattern -Risk for aspiration

What are some nursing diagnosis of decreased O2 levels?

pneumothorax and after chest surgery or trauma

inserted through the thorax to remove air from the pleural space

When are chest tubes inserted?

supply oxygen

on all crash carts

properly trained

When are bag valve masks used?

a simple, comfortable device used for precise oxygen delivery

24-44%, 1-6L

What is a nasal cannula?

short term oxygen

35-50%, 6-12 L

What is a simple mask?

plastic face mask with reservoir bag

60-90%, 10-15 L

if deflated then large amount of CO2 exhaled

What is a partial rebreather mask?

delivers high concentration oxygen with humidity

24-60%, 4-12 L

What is a venturi mask?

when arterial partial pressure is of 55 mm Hg or less or an arterial oxygen saturation of 88% or less at room air or rest. (Ex: COPD)

When should you use home oxygen therapy?