NSG 170 Fluid and Electrolytes and Perfusion

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169 Terms

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Hypotonic
more solvent than solute

0\.45% saline
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Isotonic
equal solute and solvent
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hypertonic
more solutes than solvent

3-5% saline
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Potassium normal
3\.5-5.0mEq/dL
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Sodium Normal
135-145 mEq/dL
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Calcium normal
9\.0-10.5 mEq/dL
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Magnesium normal
1\.3-2.1 mEq/dL
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Hyponatremia cause
diuretic, heart failure, adrenal insufficiency, water retention, hyperglycemia
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Hypernatremia cause
fluid deprivation, heat stroke, external dysnatremia, burns, hyperventilation, diarrhea, diabetes inspidus
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Hypokalemia cause
alkalosis, %%diuretics%%, anorexia nervosa, alcoholic, vomiting, diarrhea,
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Hyperkalemia cause
renal failure, K sparing diuretics, K supplements, acidosis, pseudohyperkalemia
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Hypocalcemia cause
hypoparathyroidism, blood transfusions, pancreatitis, %%increased phosphate%%, %%inadequate vit D%%, alcoholism, medicattions
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Hypercalcemia cause
malignancy, hyperparathyroidism, %%bone demineralization%%, %%hypophasphatemia%%
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Hypomagnesemia cause
gastric suctioning, fistulas, diarrhea, steattorrhea, alcoholism, malnutrition, insulin, DKA
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Hypermagnesemia cause
pseudohypermagnesemia, %%renal failure%%, DKA, Addisons disease, overuse of antacids,
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Hyponatremia sx
anorexia, n/v, dizziness, headache, confusion, %%seizures%%, Increased pulse, decreased BP, poor skin turgor, dry mucous membranes, cerebral edema
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Hypernatremia sx
thirst, stick mucous membranes, hyperreflexiam pulmonary edema, hallucinations, irritability, anorexia, n/v, increased HR + BP
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Hypokalemia sx
anorexia, n/v, muscle weakness, decreased bowel motility, %%paresthesia%%, leg cramps, hypoactive reflexes, %%EKG changes, cardiac arrest%%
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Hyperkalemia sx
muscle weakness, %%tachy(early) brady(late)%%, paralysis, %%intestinal colic and cramps%%, irritability, anxiety, %%EKG changes%%
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Hypocalcemia sx
%%C: c%%onvulsion %%A: a%%rrhythmia %%T: t%%etany %%S:%% %%s%%pasms

tingling, %%Trosseaus Chvostek sign%%, seizures, %%hyperactive reflexes%%, anxiety, bronchospams/stridor, %%cardiac arrythmias%%
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Hypercalcemia sx
muscle weakness, anorexia, n/v, polyuria, polydipsia, blood clots, %%hypoactive reflexes,%% bone pain, %%pathologic fractures,%% %%EKG changes%%
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Hypomagnesemia sx
%%Trosseaus Chvostek%%, %%neruomuscular irritability%%, mood changes, insomnia, anorexia, n/v, %%EKG changes%%
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Hypermagnesemia sx
%%CNS depression,%% muscle weakness, drowsiness, %%respiratory depression%%, %%EKG changes, Cardiac arrest%%
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hyponatremia management
supplement, water restriction, detection, control, education
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hypernatremia management
I+O, weight, VS, hypotonic electrolytes, prevention
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hypokalemia management
cardiac monitoring, increased intake, prevention, education
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hyperkalemia management
%%EKG monitor%%, restrict intake, %%albuterol, insulin%%, sodium polysterene, %%calcium gluconate%%, sodium bicarb, prevention, education
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hypocalcemia management
cardiac monitoring, Ca admin, nutrition
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hypercalcemia management
%%cardiac monitoring%%, fluid admin, restrict intake, mobilization, %%IV phosphate%%, %%calcitonin%%, IV fluids
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hypomagnesemia management
dietary, Mg admin, VS, cardiac monitoring, education
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hypermagnesemia management
%%cardiac monitoring%%, prevention, %%calcium gluconate%%, dialysis
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What electrolytes are Heart centered?
Magnesium, Potassium, calcium
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what electrolytes is most impactful on the heart
POTASSIUM
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More Magnesium
more Mellow
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reversal for magnesium and potassium
CALCIUM GLUCONATE
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never push
POTASSIUM cardiac death
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vitamin D
helps absorption of calcium2
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hypovolemia causes
vomiting, diarrhea, draining wounds, sweating, 3rd spacing, hemorrhage, burns, diabetes inspidus, hyperventilation
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hypovolemia sx
weight loss, skin turgor, decreased capillary refill, cool clammym increased HR, decreased BP, sunken eyes, increased hemoglobin and hematocrit, increased urine specific gravity, increased BUN creatinine, serum electrolyte changes
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hypervolemia
most often related to increased Na content
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hypervolemia causes
fluid overload decreased function measure for homeostasis excessive salt consumption
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hypervolemia sx
%%weight gain%%, %%peripheral edema, ascites, JVD, SOB, crackles,%% increased urine output, increased HR RR BP, %%decreased Hb Hct,%% decreased osmolarity, electrolytes diluted
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hypervolemua treatment
diuretic, dialysis, nutrition therapy
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major ecf electrolyte
sodium
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major icf electrolyte
potassium
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BUN
7-20
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Creatinine
0\.6-1.2

1\.3 no pee pee bad kidney
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urine specific gravity
1\.010-1.030
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1 kg gained
1 liter retained
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hypokalemia wave
inverted t wave
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hyperkalemia wave
elevated t wave
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normal blood pH
7\.35-7.45
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afterload
pressure/resistance ventricles must overcome to eject blood through semilunar valves into peripheral blood vessels
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preload
the degree of myocardial fiber stretch at end of diastole
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stroke volume
amount of blood ejected by L vent during each contraction
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ECG
info about cardiac troubles
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ankle brachial index
measurement of arterial insufficiency based on ratio of ankle vs brachial systolic pressure
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RAAS
renin >angiotensin 1>angiotensin 2(vasoconstrictor controlling aldosterone(aldosterone reabsorb Na. Sodium retention prevents fluid loss and increases blood volume and BP
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If BP is up then renin should be
down because reduced arteriolar pressure usually inhibits renin secretion
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Atherosclerosis
involves formation of plaque within arterial vessel wal;
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Risk factor for athersclerosis
Diabetes
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Athersclerosis cause
blood vessel damage> inflammation> plaque forms obstructing blood flow
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Unstable plaque
more severe possible blood vessel blockage
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PAD
result of systemic arthersclerosis
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Inflow obstruction
involve distal end of aorta and the common internal and external iliac artery
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Outflow obstruction
femoral popliteal tibial arteries below superficial femoral arteries
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PAD stages

1. asymptomatic
2. claudication
3. rest pain
4. gangrene necrosis
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Hyperlipidemia is a risk factor for
atherosclerosis
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L coronary artery
widowmaker
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ejection fraction
echo, % comes out vs dumped in normal 60-70%
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ejection fracture heart failure
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what foods are high in cholesterol
animal based
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omega 3
healthy fats that get rid of cholesterol
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symptoms CVD
chest pain, SOB, peripheral edema, palpitations, fatigue, dizziness, diaphoresis
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taking orthostatic BP
supine 3-5 mins take

sit up 1 min take

stand 1 min take
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chest pain
rapid response
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how long do you have to get an ekg after rapid response for chest pain
10 minutes
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How long do you have to get to the cath lab if having cardiac event STEMI
90mins
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Nitroglycerin (isosorbide) action
reduces preload and afterload and vasodilates increasing oxygen
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Nitroglycerin (isosorbide) route
sublingual(acute), translingual spray (acute), transmucosal tab (acute), topical ointment (acute/chronic), transdermal patch (chronic can’t wear at night), PO(chronic), IV (ACUTE!)
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Nitroglycerin monitor
hypotension, tachycardia headache, tolerance
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ECG
12 lead (10 stickers) treat the patient not the monitor
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creatinine kinase, creatinine kinase isoenzymes, and myoglobin
smooth muscles damage markers NOT specific
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Troponin
specific to cardiac function
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Stable chest pain
1 stop activity

2 take 1 nitroglyceride
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unstable chest pain
if taking >1 nitroglycerin call 911!!!
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nitroglycerin dosing
3 tablets 5 minutes apart
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Cardiac cath implications
NPO if scheduled, bed rest post procedure
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Cardiac cath monitor
arrythmias, vital sign, bleeding, neurovascular
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Cardiac cath pre procedure
informed consent, kidney function, allergies, metformin, mark distal pulse, education
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What must you ensure the patient hasn’t taken before cardiac cath
metformin, cant have after dye hold 48 hours before and after
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cardiac cath post procedure
positioning, immobilize, pressure, chest pain, VS, extremity must be flat, heart rhythm neuro checks
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Stent (percutaneous coronary intervetion)
device that hold blood vessel open
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Coronary artery bypass graft
if stent is not enough, new high way is made
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Hypertension stage 1
Systolic >140
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Hypertension stage 2
Systolic >160
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Hypertensive crisis
rapid vasoconstriction, decreased organ perfusion, big uh oh
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Hypertension secondary
usually related to disease esp kidney
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Calcium channel blockers common side effect
may increase heart failure risk
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Ace inhibitors common side effect
angioedema, hypotension