Med surg

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laurenparrott
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121278
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Med surg
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2011-12-06 14:33:06
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Fluid Electrolytes
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fluid and electrolytes flash cards
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  1. output of ECF exceeds intake of fluid
    hypovolemia
  2. Risk factors for hypovolemia
    diabetes insioudus, adrenal insufficiency, osmotic diuresis, hemorrhage, coma, 3rd spacing,
  3. causes of hypovolemia
    vomit, diarrhea, gi suctioning, sweating alot, decreased intake
  4. clincal manifestations of hypovolemia
    acute wt loss, lassitude, decreased skin turgor, cool clamy skin r/t peripheral vasosonstriction, thirst, anorexia, nausea, high temp, flattened neck viens, postural hypotension, weak rapid heart, oliguria, concentrated urine, muscle weakness, cramps
  5. where should you assess skin turgor in hypovolemia?
    sternum and forehead
  6. elderly monitored closlely bc of ?
    decreased thirst mechanisms
  7. tongue will be small and have an additional longitudinal furrow
    hypovolemia
  8. when fluid moves out of the intravascular space but not into the intracellular space... can go into the abdominal cavity, pleural cavity, or pericardial sac
    3rd spacing - hypovolemia
  9. assessment for hypovolemia
    I&O, CVP, daily wt, lab values, skin turgor, oral mucosa, mental status, monitor resp and cardiac status
  10. fluid overload, diminished homeastatic functions
    hypervolemia
  11. risk factors for hypervolemia
    heart failure, RF, cirrhosis of liver, excess sodium salt consumption
  12. clinical manefestations of hypervolemia
    edema, distended neck viens, crackles, tachycardia, increased BP, pulse pressure and CVP, increased wt, increased urine output, SOB, wheezing
  13. edema in hypervolemia is caused by
    expansion of ECF
  14. symptomatic treatment for hypervolemia
    diuretics and restrict fluids and sodium
  15. assessment of hypervolemia
    • Bun and hematocrit levels- may be low bc plasma dilution, low protien intake and anemia, check for pitting edema
    • in CRF - serum osmolality and sodium wil be low dt excessive retention of water
  16. to promote rest use semi fowlers postition for?
    orthopnea - hypervolemia
  17. occurs as a result of sodium loss or water gain
    hyponatremia
  18. risk factors for hyponatremia
    adrenal insufficieny, water intoxication, SIADH, losses by vomit, diarrhea, sweating, diuretic
  19. water intoxication, sodium level diluted by increased ratio of water to sodium. results from increas ECF volume and normal or increased total body sodium
    dilutional hyponatremia
  20. clinical manefestations of hyponatremia
    poor skin turgor, dry mucosa, headache, decreased salivation, decreased BP, nausea, cramping, neuro changes
  21. safer than sodium replacement for hyponatremia
    fluid restriction - as low as 800ml/ 24hr
  22. assesment for hyponatremia
    monitor dietary sodium and fluid intake, I&O, labs, daily wt, CNS changes, skin turgor, signs of circulatory overload
  23. signs of circulatory overload
    cough, dypsnea, puffy eyelids, dependant edema, wt gain
  24. comes from overcorrection of hyponatremia
    circulatory overload
  25. what can hyponatremia be treated with
    LR, NS, - ICU pt hypertonic (3% ns)
  26. occurs as a result of sodium gain or water loss
    hypernatremia
  27. water loss causes serum sodium to increase and causes fluid to be pulled out of the cell, so cell shrinks
    hypernatremia
  28. risk factors for hypernatremia
    diabetes insipudis, heat stroke, hypertonic iv solution
  29. clinilcal manefestations of hypernatremia
    thirst, increased temp, decreased urine output, dry swollen tongue, sticky mucosa, neuro symp, restelessness, weakness, Extracellular effects (bounding pulse, increased bp, edema, wt gain, venous distention)
  30. med managment of hypernatremia
    gradually lower sodium level to prevent overcorrection of problem, hypotonic electrolyte solution, D5W
  31. nursing management of hypernatremia
    clean water at bedside, discourage caffiene, offer fluids at regular intervals, check osmolality of feeding in enteral feeding - higher the osmolality the more need for water supplements
  32. K+ losses via gi tract or kidneys, shift of k+ from ecs to ics, may have normal levels of k+ in alkalosis due to shift
    hypokalemia
  33. causes of hypokalemia
    gi loss, alterations of acid base balance, hyperaldosteronism, poor dietary intake, meds
  34. clincal man of hypokalemia
    neuromuscular problems, muscle weakness, cramps, parathesthesias (numbness and tingling), decreased deep tendon reflexes, fatigue, dysrhythmias, nausea, vomiting, glucose intolerance
  35. effects muscle contractions and is needed for glucose and glycogen
    potassium
  36. med management of hypokalemia
    increased dietary potassium, potassium replacement, and iv for severe defecit
  37. assessment for hypokalemia
    monitor vs, esp bp and pulse, orthostatic hypotension, monitor ECG - tachycardia, flattened T wave and u wave, ABGs and resp status - notify md if resp are shallow and rapid
  38. what do you monitor with oral potassium?
    gi bleeding
  39. stop infusion for hpokalemia if urine output is?
    less then 20/ml hr for two consecutive hrs.
  40. excessive k intake, impaired renal excreation, shift of k from ics to ecs
    hyperkalemia
  41. can cause cardiac arrest
    hyperkalemia
  42. risk factors for hyperkalemia
    decreased renal excretion, addisons disease, tissue trauma (burns), acidosis, meds
  43. what meds can cause hyperkalemia
    k sparing diuretics, potassium chloride, heparin, ace inhibitors, capitopril, nsaids, salt substitutes
  44. clincal man of hyperkalemia
    most important on heart (decreased hr, irregular pulse, decreased co, hypotension, cardiac arrest, tall t wave, flattened p wave, long pr, depressed st), muscle weakness, flaccid paralysis of resp and speech muscle, nausea, diarrhea
  45. hyperkalemia is assoc with what ABG?
    metabolic acidosis
  46. medications for hyperkalemia
    • reg insulin and glucose sol - few hours
    • iv calcium gluconate - decreases cardiac symptoms 30mn
    • iv sodium bicarbonate - few hrs
    • beta 2 agonist- temporary, may cause tachycardia and chest discomfort
  47. decreased prod of PTH, abnormal binding with ca, low ca diet, ca loss via gi tract
    hypocalcemia
  48. risk for hypocalcemia
    hypoparathyroidism, malabsorption, pancreatitits, alkalosis, massive transfusion of ciltrated blood, rf, meds, caffiene, steroids, loop diuretics, antacids
  49. clinical man of hypocalcemia
    tetany, numbness, hyperactive dtr's, touseaus, chovsteks, seizure, irritability of CNS, mental changes, resp symptoms of dypsnea and laryngospasm, abnormal clotting and anxiety, long QT, torsades
  50. encourage weight bearing excercises to decrease bone ca loss in?
    hypocalcemia
  51. hyperparathyroidism, malignancy related, litium or thiazide diuretics
    hypercalcemia
  52. risk factors for hypercalcemia
    hyperparathyroidism, cancer, bone loss r/t immobility, lithium, and thiazide diuretics
  53. clinical man of hypercalcemia
    n/v, dehydration, incoordination, abdominal and bone pain, polyuria, thirst, mental changes, ecg changes, dysrhythmias, muscle weakness, anorexia, constipation
  54. have poor perfusion of subcu tissues
    hypercalcemia
  55. alcoholism, gi losses, rapid admin of ciltrated blood, enteral or parenteral feeding
    hypomg
  56. risk factors for hypomg
    alcoholism, blood transfusions
  57. clinical man of hypomg
    chovstek, toussea, neuromuscular irritability, tremors, muscle weakness, seizures, tetany, laryngeal stridor, mood changes, psychosis, torsades, v fib
  58. promote enzyme reaction, help prod and use atp, dna and protien synthesis, vasodilation and irritability and contractility of heart, neurotransmission and hormone receptor binding, prod of pth, helps na and k cross membrane, muscle contraction
    mg
  59. often accompanied by hypocalcemia
    hypomg
  60. excessive intake/ admin of mg, decreased renal fcn, lithium toxicity, decrease gi motility
    hypermg
  61. risk for hypermg
    renal failure, diabetis ketoacidosis, excessive mg admin, hypothermia, adrenocortical insufficiency, lithium tox, excessive use of antacids, laxatives, or meds that decreas gi motility
  62. clinical man of hypermg
    hot flashes, facial flushing, drowsy, decreased bp, n/v, hypoactive reflex, decreased resp, muscle weakness, difficulty with speech
  63. dont give magnesium to who?
    pt with RF
  64. alcoholism, diuretic and antacid abuse, refeeding pt after starvation
    hypophosphatemia
  65. risk for hypophosphatemia
    alcoholism, pain, heat stroke, resp alkalosis, hyperventilation, diabetic ketoacidosis, decreased mg, decreased k, vit d def, diuretic or antacid use
  66. clinical man of hypophosphatemia
    neuro symp, confusion, muscle weakness, tissue hypoxia, muscle and bone pain, increase risk for infection
  67. decreased renal function, excess phosphorus
    hyperphosphatemia
  68. risk factors of hyperphosphatemia
    RF, increased vit d, acidosis, hypoparathyroisism, diabetic ketoacidosis, chemo
  69. clinical man of hyperphosphatemia
    symp assoc with hypocalcemia (tetany, bone pain, anorexia, muscle weakness, hyperreflexia, tachycardia, troussea, chovstek, soft tissure calcium dep cause visual disturbances, decreases urinary output, and palpitations
  70. surgery may be needed to remove large ca deposits
    hyperphosphatemia

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