NURS 344- exam iii

What is BUN used for?

kidney function

What is used CO2 for?

blood bicarbonate level

What is creatinie used for?

creatinine, kidney function

What is calcium lab value used for?

liver function

What is bilirubin lab value used for?

liver function

What is albumin lab value used for?

liver function

expected reference range of serum osmolality is?

285 to 295 mOsm/kg

expected reference range for urine osmolality is?

500 to 1,200 mOsm/kg for a random specimen

intracellular space, holds?

67% of the body’s water

extracellular space: comprise the interstitial space, which

contains 25% of the body’s water

and the intravascular space, which holds ?

the remaining 8% of body water

hypothalamus stimulates the posterior pituitary to release, antidiuretic hormone (ADH), which increases?

increases absorption of kidneys

Expected value of potassium?

3.5 to 5 mEq/L

Expected value of sodium?

136 to 145 mEq/L 

EXpected value of calcium?

9 to 10.5 mg/dL 

Expected value of magnesium?

1.3 to 2.1 mEq/L 

Hypokalemia can occur from several causes (Lewis, 2020g)

Metabolic alkalosis

Medications: amphrotericin B, penicillin, theophylline

• Certain cardiac conditions

• Gastrointestinal losses- diarrhea, vomitting

• Decreased oral intake of potassium

• Excessive alcohol use

• Chronic kidney disease

• Excessive sweating

• Folic acid deficiency

A client has potassium level less than 3 mEq/L, what would he manifest?

hypokalemia of less than 3 mEq/L include muscle weakness, cardiac arrhythmias, constipation, and fatigue

The most common cause of hyperkalemia is?

renal failure

Meds that cause hyperkalemia:

1. NSAIDs

2. ACE

high potassium levels may cause ?

life-threatening cardiac dysrhythmias, muscle weakness, or paralysis

complications of hyperkalemia, defined as a potassium level greater than 7 mEq/L?

paralysis and heart failure are possible; if severe hyperkalemia is untreated, death can occur

hyponatremia causes?

• Medications- thalazides

• Drinking excess amounts of water

• Chronic or severe vomiting or diarrhea

• Excess alcohol intake

• Heart, kidney, and liver problems

• Severe burns

nausea and a feeling of general unwellness can occur with even mild hyponatremia. The neurologic manifestations are related to fluid shifts in the brain, which lead to cerebral edema.

Moderate hyponatremia often manifests first with lethargy and confusion. Other neurologic changes may include headache, restlessness, and irritability

n for neuro

Hyponatremia becomes more severe, muscle twitching, further decreases in level of consciousness, seizures, and coma can occur. If hyponatremia is not reversed, a client can become unrousable and death can occur.

It is important to raise sodium levels slowly to prevent further neurologic complication

Hypernatremia can occur from the following causes:

• Loss of body water

• Impaired thirst response

• Medications

• Gastroenteritis

• Vomiting

• Prolonged suction

• Burns

• Excessive sweating

• Chronic kidney disease

• Diabetes

Drink too much, you’ll be hyponatremic.

Drink too little, you’ll be hypernatremic

Hypernatremia becomes more severe, muscle twitching and further changes in level of conscious with seizures and coma can occur. If not corrected, hypernatremia will eventually lead to death.

Treatment for hypernatremia includes identifying the cause and initiating intravenous fluid replacement containing water and a small amount of sodium. In treating hypernatremia, it is important to decrease the sodium level slowly to prevent cerebral edema.

A nurse is caring for a client who has hyponatremia. Which of the following findings or interventions should the nurse expect? (Select all that apply.)

a. Sodium level of 127 mEq/L

b. A prescription for the client to drink as much water as possible

c. Client reporting headache and fatigue

d. Sodium level of 147 mEq/L

e. A prescription for a urine sodium test

a. Sodium level of 127 mEq/L

c. Client reporting headache and fatigue

e. A prescription for a urine sodium test

Hypocalcemia can occur from several causes:

Hypoparathyroidism

• Inadequate amount of vitamin D

• Hormonal changes (menopause)

• Electrolyte imbalances of magnesium or phosphate

• Low albumin levels

• Medications that decrease the body’s absorption of calcium

• Renal disease

• Multiple blood transfusions

• Sepsis

Medications that can lead to hypocalcemia:

1. stimulant laxatives, which decrease the absorption of calcium;

2. long-term use of glucocorticoids, which can deplete calcium stores by increasing a client’s risk of developing osteoporosis

3. loop diuretics, which can lead to excess calcium excretion by the kidneys. 

4. Medications used to decrease the body’s gastric acid—for example, proton-pump inhibitors

5. histamine-2 blockers—can also lead to hypocalcemia by decreasing the breakdown of fat, a factor that is important for calcium absorption.

Two distinct findings can be elicited if hypocalcemia is suspected:

the Chvostek sign and the Trousseau sign

Chvostek sign, use the fingertips to tap the facial nerve, which is located 2 cm in front of the tragus of the ear

Trousseau sign, place a blood pressure cuff on the client’s arm and inflate it 20 mm Hg above the client’s systolic blood pressure for 3 to 5 minutes, which will cause irritability of the nerves in the arm. A positive result occurs with flexion of the wrist, thumb,

When will Trousseau be seen?

Hypocalcemia and Hypomagnesemia

Elevated serum calcium levels can lead to development of kidney stones, weaken bones, and affect the function of the heart and brain. Hypercalcemia is most commonly caused by the following factors:

• Prolonged Bed Rest

• Vitamin D toxicity

• Hyperparathyroidism

• Medications: Vit D+A, lithium carbonate, thalazide

• Cancer

• Renal failure

The most common cause of hypercalcemia:

Hyperparathyroidism

Hypercalcemia can be caused by  medications such as calcium, vitamin D and A supplements, thiazide diuretics, and lithium carbonate. 

prolonged bed rest can result in elevated serum calcium levels.

Mild hypercalcemia rarely produces symptoms. Gastrointestinal manifestations such as constipation and abdominal pain, nausea and vomiting, and anorexia are usually the first indications that a client will notice. As calcium levels increase, confusion and behavioral changes can occur, along with thirst, polyuria, bone pain, and muscle weakness. If hypercalcemia reaches critical levels, arrhythmias, delirium, coma, and renal failure can occur. If left untreated, hypercalcemia is potentially life-threatening.

phosphate by mouth is prescribed to decrease calcium levels by blocking absorption. To promote excretion of calcium, an intravenous saline bolus, followed by a loop diuretic, may be prescribed. This treatment can also be prescribed for moderate hypercalcemia. 

Hypomagnesemia may be caused by several different factors:

• Medications

• Decreased intake

• Decreased absorption by the intestines (Crohn’s disease, celiac disease)

• Electrolyte imbalances (hypokalemia, hypocalcemia)

• underlying bowel conditions can cause decreased gastrointestinal motility

• Increased excretion by the gastrointestinal tract (diarrhea, pancreatitis)

• Increased excretion by the kidneys

• Excessive alcohol use

• Diabetes mellitus type 2

• Undernutrition

• Severe burns

When magnesium levels drop further, manifestations become more severe and may include neuromuscular changes such as muscle cramps and spasticity, numbness and tingling, seizures, tetany, and personality changes. Cardiac dysrhythmias and spasms are also frequently observed in such clients

magnesium replacement is initiated if the client is experiencing manifestations of hypomagnesemia

IV administration of magnesium can cause flushing, sweating, and potentially respiratory depression if the medication is administered too quickly.

Hypermagnesmia

• Acidotic states

• Hypothyroidism

• Kidney disease (acute and chronic)

• Excessive intake

• Medications

• Trauma

As hypovolemia becomes more severe, tachycardia occurs as the body attempts to maintain the circulating blood volume and perfuse vital organs. If hypovolemia goes untreated, serious symptoms may develop, including confusion, tachypnea, chest pain with palpitations, oliguria, and increasing hypotension.

The most common cause of hypermagnesemia is acute or chronic kidney disease, as the impaired kidneys fail to excrete enough magnesium through the urine. 

While hypermagnesemia is not likely to occur from dietary intake, underlying bowel conditions can cause decreased gastrointestinal motility and lead to increased magnesium absorption

When magnesium levels exceed 7 mg/dL, moderate neurologic manifestations may occur, such as increasing confusion, sleepiness, blurred vision, and headache. Decreasing reflexes, bladder paralysis, flushing, and constipation may also be present.

Hypermagnesemia levels greater than 12 mg/dL cause severe reactions such as muscle flaccid paralysis, decreased respiratory rate, hypotension, bradycardia, and dysrhythmias. If the imbalance is not corrected, seizures, coma, cardiac arrest, and death can occur.

More severe case of hypermagnesemia, the provider may prescribe?

intravenous calcium gluconate or calcium chloride and may also prescribe intravenous diuretics to promote urination to rid the body of the extra magnesium.

Tomato- high potassium

Cereal, Spinach, Almond: high-magnesium

Yogurt, Cheese- high calcium

Chicken, eggs, lemon- low sodium

 If the client is unable to drink or if dehydration is severe, what would be admin IV

dextrose 5% in water (D5W) should be administered intravenously, as it contains no sodium and the glucose in the solution is quickly metabolized by the body.

Hypovolemia

Blood loss

• Gastrointestinal losses

• Severe burns

• Third spacing

• Excessive sweating

• Fever

• Medications

• Trauma

 BUN/CR ratio of greater than 20:1 indicates a lack of blood flow to the kidneys elevated hematocrit level, indicating volume loss.

As hypovolemia becomes more severe, tachycardia occurs as the body attempts to maintain the circulating blood volume and perfuse vital organs. If hypovolemia goes untreated, serious symptoms may develop, including confusion, tachypnea, chest pain with palpitations, oliguria, and increasing hypotension.

Oral rehydration with electrolytes can be used for clients with mild hypovolemia. For clients with moderate or severe hypovolemia from fluid loss, 0.9% normal saline or Ringer’s lactate should be administered by IV infusion. If the hypovolemia is the result of trauma and blood loss blood replacement products may be necessary, including packed red blood cells (PRBCs), platelets, and/or blood plasma.

Hypervolemia is a fluid condition in which the body has too much water and sodium in the extracellular space, particularly the interstitial compartment. It can result from the following factors:

• Heart failure

• Kidney failure

• Nephrotic syndrome- daibetes,

• Cirrhosis or end-stage liver disease

Pregnancy alters the balance of a woman’s hormones, resulting in hypervolemia. Medications used to treat hypertension, such as vasodilators and calcium channel blockers, as well as glitazones used to treat type 2 diabetes, can cause sodium and water retention, leading to hypervolemia.

Hypervolemia interventions:

Monitor weight and check for edema

Diuretics are commonly used to increase urine output and reduce the body’s fluid volume

the nurse should monitor the client for the presence of jugular vein distention, hypertension, bounding pulse, dyspnea, adventitious lung sounds, and intake and output, along with daily weight measurements.

In what direction does hypotonic move from?

• Water moves from extracellular space into cells  

In what way does hypertonic move from? What is hypertonic contraindicated in?

• Water leaves the cells and interstitial fluid moves into the plasma 

• Hypertonic solutions may be contraindicated in cases of cardiac or renal disease. 

0.45% Sodium chloride

• Treats hypernatremia and diabetic ketoacidosis.

• Monitor for hypotension.

• Contraindicated in clients with burns, liver disease, increased intracranial pressure, and trauma.

3% Sodium chloride 

Used as volume expander for emergent replacement of solutes

Dextrose 5% in 0.45% sodium chloride solution (D51/2NS) 

Used as a maintenance IV fluid and to treat hypovolemia. Monitor for fluid overload. 

Dextrose 10% in water (D10W) 

Used to treat hypoglycemia. Provides calories and water. Use a central line if possible; may cause phlebitis or thrombosis. Infuse slowly to avoid hyperglycemia, fluid overload, or pulmonary edema. Monitor for new onset of confusion or loss of consciousness. 

0.9% Sodium chloride solution (NaCl) 

Used to promote hydration in the following conditions: vomiting, diarrhea, hemorrhage, and shock. Only solution used with blood product administraon

Lactated Ringer’s (LR) 

Commonly used for burn and trauma clients. Used for hypovolemia, acute blood loss, electrolyte imbalances, and metabolic acidosis. Use with caution in clients who have renal failure. 

Dextrose 5% in water (D₅W) 

Administered for hypernatremia. Dilutes osmolarity of extracellular fluid. After the cells absorb the dextrose, the remaining water and electrolytes become an isotonic solution. Provides limited nutrition due to dextrose being a form of glucose. Contraindicated in resuscitation, early postoperative period, renal and early postoperative period, renal and cardiac issues, and and increased intracranial pressure

Colloidal solutions

Colloidal solutions, often referred to as plasma or volume expanders, contain large molecules that are too large to pass through the semi-permeable membrane that forms the capillaries’ walls

Adverse effects associated with the administration of colloidal solutions include allergic reactions, renal failure, and blood clotting disorders. Prior to administering colloids, the nurse should ensure that an 18-gauge central IV line or peripheral line is present and patent.

Albumin 5% (309 mOsm/L) 

Albumin 25% (312 mOsm/L) 

Albumin 5%: Hypovolemic shock (surgery or trauma) 

Both 

·Interstitial edema (draws fluid into the intravascular space) 

Replacement for low albumin levels 

Must be transfused within 4 hours of opening 

Monitor for circulatory overload (especially with 25% albumin) and pulmonary edema 

Adverse reactions: Urticaria, flushing, chills, fever, headache 

Contraindications: Severe anemia, heart failure 

Dextran 40 (low-molecular-weight: 280 to 324 mOsm/L) 

Dextran 70 (high-molecular-weight: 280 to 324 mOsm/L) 

Monitor pulse, blood pressure and urinary output per facility policy or prescriber’s prescription (every 5 to 15 minutes for the first hour). 

Monitor for circulatory overload. 

Increased risk for bleeding. 

Adverse reactions: Anaphylaxis 

Contraindications: Low platelet level, hemorrhagic shock 

Hetastarch (308 mOsm/L) 

Used for Hypovolemia 

Monitor for circulatory overload. 

Monitor hematocrit/hemoglobin levels. 

Monitor for bleeding. 

Adverse reactions: Metabolic acidosis, anaphylaxis 

Contraindications: Liver, cardiac, or renal disorders 

Male RBC:

4.7 to 6.1 RBC × 10¹²/L 

Female RBC

4.2 to 5.4 RBC

Male hemoglobin

14 to 18 g/dL 

Think about the age of people in HS

Female hemoglobin

12 to 16 g/dL 

Male hematocrit

42% to 52%  

Female hematocrit

37% to 47% 

Female/Male WBC

5,000 to 10,000/mm³ 

Female/Male platelet

150,000 to 400,000

Indications for the transfusion of RBCs include surgery, anemia, trauma, blood loss, cancer, and blood disorders such as sickle cell disease. 

Transfusions of platelets are usually administered when the platelet count goes below 20,000/mcL.

Plasma transfusions are most often given to clients who have experienced trauma, who have a major burn, or who are in shock.

Clients who have bleeding or clotting disorders such as disseminated intravascular coagulation (DIC) frequently receive plasma transfusions, as do clients who are experiencing cancer or liver disease. 

An autologous blood transfusion is performed with the client’s own blood that was previously donated. Indications for autologous donation include a scheduled, elective surgery that has increased risk for a large blood loss, such as a total hip arthroplasty, and anticipation of a high likelihood for blood transfusion.

Blood Type	Donate To	Receive From
A–	A-, AB-, A+, AB+	A–, O–

Blood Type	Donate To	Receive From
A+	A+, AB+	A–, A+, O–, O+

Blood Type	Donate To	Receive From
B–	B–, B+, AB–, AB+	B–, O–

Blood Type	Donate To	Receive From
B+	B+, AB+	B–, B+, O–, O+

Blood Type	Donate To	Receive From
AB–	AB–, AB+	A–, B–, AB–, O–

Blood Type

Donate To

Receive From

AB+

AB+

A–, A+, B–, B+, AB–, AB+, O–, O+

Blood Type	Donate To	Receive From
O–	A–, A+, B–, B+, AB–, AB+, O–, O+	O–

Blood Type	Donate To	Receive From
O+	A+, B+, AB+, O+	O–, O+

Universal donor blood type:

Universal recipient blood type:

Universal donor blood type: O–

Universal recipient blood type: AB+

If agglutination of the mixed sample occurs, the blood is incompatible.

The client should have an 18 to 20-gauge IV access that is patent and already in place before the nurse retrieves the blood product. At the bedside, two nurses must check and compare the blood unit label with the client’s identification information and ensure compatibility of the unit with the client’s blood type. 

 Transfusion should be completed within 4 hours of leaving controlled temperature storage.

 If a reaction is suspected, the priority is to stop the transfusion while keeping IV access open using?

infusion of 0.9% sodium chloride