NP2 F&E

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134069
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NP2 F&E
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2012-02-09 14:56:43
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F&E NP2
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  1. Pressure exerted by plasma protein (albumin)
    Osmotic pressure
  2. Pulling force of albumin in the intravascular space
    • COP (colloidal osmotic pressure)
    • stops osmotic flow of H2o
  3. What releases ADH?
    Posterior Pituitary
  4. Antidiuretic Hormone responds to changes in what?
    • Blood osmolarity
    • Solutes (Protein) in a solution
  5. Aldosterone is secreted by what
    adernal cortex
  6. Natriuretic peptide?
    Secreted by special cells in the heart lining of the atria
  7. How does the kidneys participate in fluid regulation?
    Renin-angiotensin system
  8. Total intake and output a day?
    2500ml a day
  9. What is one thing to keep in consideration when a patient is recieving hyperosmolar tube feedings?
    Can easily be dehydrated. Always flushe with water (D5W)
  10. Most important way to keep track of fluid status?
    Daily weights
  11. What ways to assess fluid status
    • weights (usually twice a day)
    • I&Os
    • vitals
    • BP and Pulse
    • Urine amount and appearance
    • laboratory values
  12. Secondary things to assess for fluid status
    • skin turgor
    • mucous membranes
    • breath sounds
    • mental status
  13. Water and electrolytes are both lost
    What does it lead to?
    • Isotonic dehydrations
    • Hypovolemia
  14. Excessive fulid in the extracellular space
    What does it lead to?
    • Isotonic overhydration
    • hypervolemia
  15. Signs and symptoms of FVD
    • Decreased BP
    • Increased HR
    • Weak thready pulse
    • Changes in mental status
    • Weakness
    • Thirst
    • Dry Skin
    • Low Urine output with increased specific gravity
    • Increased Respirations
  16. Signs and symptoms of FVE
    • Edema
    • Increased BP
    • Bounding Pulse
    • Weight Gain
    • JVD
    • Dyspnea
    • Moist Crackles
    • Headache
    • Skin Pale and Cool
  17. People at risk of FVE
    • CHF
    • Renal Failure
    • Steriods
    • Cushings Disease
  18. Possible Treatments for FVD
    • Typical IV fluids
    • Isotonic fluids for isotonic dehydration
    • Oral fluids if able to take PO
    • Transfusions if bleeding
    • Oxygen therapy
    • Support CV status
  19. Possible treatments of FVE
    • Restrict Fluids
    • Diuretics ( Loop or Osmotic)
    • Sodium restriction
    • Dialysis
    • Support CV status
  20. Why would you use osmotic diuretics ( Mannitol)?
    • It doesnt waste K+
    • Circulatory or Neurological disease
  21. Some nursing diagnosis for FVD
    • Constipation
    • FVD
    • Decreased CO
    • Impaired Mucous Membranes
    • Risk for injury or falls
    • Altered tissue perfusion
    • Risk for impaired skin integrity
  22. Some nursing diagnosis for FVE
    • FVE
    • Risk for impaired skin integrity
    • inadequate gas exchange
    • Knowledge deficit (eating too much salt-renal failure pts)
    • Ineffective breathing pattern
    • Altered tissure perfusion
  23. Normal Urine specific gravity
    1.010-1.025
  24. Negatively charged ions
    Anions
  25. Positive Charged Ions
    Cations
  26. Anions
    • Bicarbonate
    • Chloride
    • Phosphorus
  27. Cations
    • Calcium
    • Magnesium
    • Potassium
    • Sodium
  28. ECF electrolytes
    • Sodium
    • Chloride
    • Bicarbonate
  29. ICF electrolytes
    • Potassium
    • Phosphate
    • Magnesium
  30. Na normal
    135-145 mEq/L
  31. Major ECF cation
    Na+
  32. Major functions of Na+
    • Water Balance
    • Transmission of Nerve impulses
  33. What controls the regulation of Na at the cellular level
    Sodium-potassium pump
  34. What is Na+ retention and secretion controlled by what?
    Aldosterone
  35. What could cause sodium excess ?
    • Corticosteriod use
    • Hypertonic tube feedings
    • Cushing disease
    • Diabetes inspidios
    • HHNK- side effect for type 2 diabetes
  36. Signs and Symptoms of hyponatremia?
    • Headache
    • Abdominal Cramps
    • Nausea and vomiting
    • lethargy and confusion
    • Poor skin tuguor and dry mucous membranes
    • no edema!
  37. Signs and symptoms of hypernatremia
    • Dry swollen tongue
    • postural hypotension
    • tachycardia
    • increased specific gravity
    • edema (depending of fluid status)
    • Confused
    • Lower BP
  38. Treatment for hyponatremia?
    If severe?
    • Restrict fluids
    • Oral Supplements
    • Normal saline IV
    • High Sodium fluids
    • Severe cases: hypertonic saline IV (3%)
    • VERY CRITICAL TO WATCH FLUID STATUS!
    • COULD GO INTO PULMONARY EDEMA
  39. Treatment of hypernatremia
    • treatment of the cause
    • salt-free iv solutions (D5W)
    • Restrict sodium intake
    • Diuretics
  40. Nursing Interventions for sodium defient or excess
    • vitals and tugor
    • Urine output and specific gravity
    • Monitor IV therapy
    • Assess mucous membranes
    • Monitor Labs: Na, Cl-, serum osmolality (protein levels in blood)
    • Weight
    • Teaching causative factors
  41. Major Cation in ICF
    Potassium
  42. Normal K+
    3.5-5.0 mEq/L
  43. K+ major function
    • Nerve impulses.
    • Cardiac Conduction
  44. Serium K+ is maintained by what?
    • Kidneys
    • The have the ablity to retain extra K if needed.
  45. What affects acid base balance by maintaing electrical neurality and osmalality
    K+
  46. The body is more sensitive to small changes of what electrolyte over any other electrolyte.
    K+
  47. What should people on diuretics consume everyday?
    a bananna
  48. What are some causes of potassium deficit
    • Diuretics
    • -Loop
    • Corticosteriods
    • Starvation
    • Renal Failure
    • Prolonged and excessive NGT drainage
    • Gastrointestinal: would drainage and vomiting
  49. What are possible causes of potassium excess?
    • Diuretics
    • -Potassium sparing
    • Overingestion of salt subsitutes
    • Transfusion of whole blood
    • Excessive intake of potassium po or iv
    • renal failure
    • tissue damage (burns, trama)
  50. If someone is on a sodium and uses substitutes, what electrolyte should you monitor?
    Potassium
  51. Symptoms of hypokalemia
    • Serum <3.5
    • Leg cramps and muscle weakness
    • Decreased bowel motility
    • -paralytic ileus
    • Anorexia
    • Flat T waves on EKG
    • -also a U wave
    • -depressed ST segment
    • Lethargy
  52. Symptoms of hyperkalemia
    • Serum k>5.0
    • Numbness
    • Muscle irritability leading to paralysis
    • TALL TENTED T'S
    • flat p wave, wide QRS
    • Bradycardia
    • Heart Blocks
    • Nausea
    • Depressed reflexes
  53. Alkalosis
    Shallow respirations
    irritability
    Confusion
    Weakness
    Arrhythmias
    Lethargy
    Theady Pulse
    • A SIC WALT
    • HYPOKALEMIA
  54. Muscle Cramps-> Weakness-> Paralysis
    Drowsiness
    Decreased BP
    EKG changes
    Dysththemias
    Abdominal Cramping
    Diarrhea
    Oliguria
    Hyperkalemia
  55. Postassium rich foods
    • Banannas
    • tomatoes
    • oj
    • broccoli
  56. ALDACTONE
    K+ sparing diuretic
  57. Treatments for hypokalemia
    • Administer potassium
    • -po
    • -iv (burns)
    • Encourages foods high in K+
    • Administer K+ sparing diuretics
    • Cardiac monitoring
  58. Treatments of hyperkalemia
    • Administer electrolyte binding or electrolyte excreting resins
    • Dextrose 50% and regular insulin
    • Avoid K sparing duretics
    • Dialysis if severe
    • Cardiac Monitoring
  59. When administering K+ via IV ?
    20 mEq in a 100ml per hour ON A PUMP
  60. Anything with aluminum, calcium, or magnesium can mess up what levels
    Ca+
  61. Major function of Ca++
    • Normal skeletal muscle, smooth muscle, and cardiac muscle contraction
    • Blood clotting, maintains cell structure and impulse transmissions (in heart excpecially )
  62. Normal value of Ca+
    8.5-10.5 mg/dl
  63. Ca+ needs what to be absorbed
    Vitamin D
  64. How does the parathyroid contribute to the regulation of Ca?
    it triggers Ca release from bone and/or inhibits rnal exctetion: Raises serum levels!
  65. How does the thyroid gland contribut to the regulation of Ca?
    It releases Calcitonin which causes EFC levels to decrease by inhibition of bone resorption (release); inhibits Vitamin D absorption, and increases renal excretion
  66. If someone takes Ca channels blockers what should you expect with HR and BP?
    Decreased heart rate and blood pressure
  67. What causes calcium deficits?
    • Dietary
    • acute pancreatitis
    • decreased production of PTH
    • Reduced activity
    • Post menopausal
    • GI malabsorption- alcoholism, malnourished, pancreas problems
    • Low serum albumin
    • alkalosis
  68. What causes calcium excess?
    • Excessive oral intake
    • Thiazide diuretics
    • Bone malignacy
    • Overuse of antacids
    • Hyperthyroidism
    • Paget's disease
    • Acidosis
    • Hypophosphatemia
  69. Symptoms of hypocalcemia
    • serum ca<8.5
    • Chvostek's sign
    • Trousseau's sign
    • Muscle tremors
    • EKG long QT interval
    • Numbness and tingling
    • Hyperactive DTR's
    • Cramping
  70. Chvostek's sign
    a cheek goes up when you touch it

    low Ca+
  71. Trousseau's sign
    Put a BP cuff around arm and arm will cramp up
  72. Decreased Ca may indicate a problem with what?
    Thyroid or parathyroid
  73. Symptoms of hypercalcemia
    • Serum Ca >10.5
    • Lethargy
    • Depressed DTR's
    • Renal stones
    • EKG short QT intervals
    • Constipation
    • Anorexia
    • Disorientation
  74. Treatments for hypocalcemia
    • Treat cause
    • Calcium replacement
    • -calcium glconate or calcium cholroide
    • Give Calcium after 4 units of blood
    • Vit. D supplements
    • Added protein in diet
    • Biphosphonates
  75. If administering calcium gluconate or calcium choloride iv what should you remember?
    IV over a period of time with close monitoring
  76. Treatments for hypercalcemia
    • Treat cause
    • Hydration
    • -fluids large amounts
    • Diuretics
    • -Loops and edecrine
    • Dialysis
    • Increase acid ash fluid
    • -cranberry juice
  77. If patient recieves biphosphonates, what is expected with calcium levels?
    • Increases calcium
    • phosphate and ca have an inverse relationship
  78. if patient is having renal failure what should you expect them to recieve?
    Biphosphonates and ca
  79. Nursing interventions fo Ca+ imbalances?
    • I&O's
    • Monitor for Chvostek and Trousseaus signs
    • Assess GI and renal status
    • monitor for safety
    • teach diet and exercise
    • move slowly with malignancies
    • Watch for stress or pathological fractures
    • Monitor cardiac rhythems
  80. Normal Phosphorus value
    2.4-4.4 mg/dL
  81. Primary anion in the ICF
    Phosphorus
  82. Faclitates oxygen delivery from RBC's to tissues
    Forming and activating ATP
    Assists in cell division
    CHO, protein, and lipid metabolism
    Phosphorus
  83. What may cause phosphorus deficiet>
    • Malnutirition
    • Overuse of alminum hydroxide based antacids
    • Hyperparathyroid
    • Hyperglycemia
    • Overuse of laxatives
  84. What may cause Phosphorus excess/
    • Renal failure
    • chemotherapy
    • excess intake of vitamin d supplements
    • respiratory acidosis and DKA
    • Trama
  85. Symptoms of hypophosphatemia
    • phosphorus <2.4
    • Muscle weakness
    • Double vision
    • malaise
    • anorexia
    • loss of bone density
    • hypercalcemia
  86. Symptoms of hyperphosphatemia
    • Phosphorus >4.5
    • Hypocalcemia
    • Muscle spasms. cramps
    • Hyperreflexia
    • EKG long QT
    • Nausea and vomiting
  87. Treatments fo hypophosphatemia
    • Treat cause
    • discontinue medications causing hypo
    • IV phosphorus
    • Decrease calcium foods
  88. Treatments of hyperphosphatemia
    • Treat cause
    • increase calcium foods
    • reduce phophorus intake
    • give phosphate binders
    • iv saline boluses
  89. Normal Chloride values
    96-106 mEq/L
  90. Major anion in efc
    chloride
  91. Role of Cl
    functions with na to regulate serum osmolality, water balance and blood volume
  92. Major componet of gastric juice and CSF
    Helps regulate acid-base balance
    Acts as a buffer in exchange of O2 and CO2 in RBC
    Chloride
  93. Chloride deficits cause
    • Poor intake
    • Increased lossess (sweating)
    • Salt restricted diet
    • Prolonged GI loses
    • -NG loss, vomiting
    • -Gastric surgery
    • Cystic fibrosis
  94. Chloride excess causes
    • increased intake of NaCl
    • Increased water loss
    • Carbonic anhydrase inhibitors
    • Altered acid base metabolic acidosis
    • Rarely occurs alone
    • Near drownings
  95. Symptoms of hypochoremia
    • Chloride <96
    • more excitable nerves
    • Hyperactive DTR's
    • Hyponatremia symptoms
    • hypokalemia symptoms
    • Hypotension
    • NERVES
  96. Symptoms of hyperchloremia
    • Cl >108
    • Symptoms primarily of metabolic acidosis
    • -lethargy, weakness
    • -kussmaul's respirations
    • Fluid retention
    • Hypertension
    • Acidosis
  97. Treatments of hypochloremia
    • Treat cause
    • replace losses thru IV thearpy
    • Salty broth
    • Give potassium chloride iv
  98. Treatment of Hyperchloremia
    • treat the underlying cause
    • restore fluid balances
    • iv lactated ringers
    • Na bicabonate IV
    • Diuretics
  99. One thing to remember with Na bicarbonate IV?
    It is the only thing that can go into the line. will turn into concrete if mixed
  100. Monitor fluid volume status
    Monitor vital signs and urine output
    assess neuromuscular integrity
    administer medications per indications
    monitor weight
    monitor skin intergrity
    assess lung and heart sounds
    Nursing interventions with hypo/hyperchloremia
  101. Biggest value to watch on a heart floor?
    Magnesium
  102. Normal value for magnesium
    1.3-2.1mg/dL
  103. Most abundant cation in the ICF
    Magnesium
  104. skeletal muscle contraction
    carbohydrate metabolism
    atp formation and use
    cardiac contractility, irritablility and vasodilation
    DNA and protein synthesis
    Helps Na and K cross cell membrane
    Magnesium
  105. What causes Mg deficits?
    • Lack of intake
    • malabsorption
    • excessive loss thru gi tract or urinary tract
    • Chronic alcoholism
    • Diabetics
    • Acute Pancreatitis
    • malnoutrition
  106. What may cause Mg excess
    • Increase mg intake
    • decreased renal excretion of mg
    • addison's disease
    • untreated dka
    • corticosteriod abuse
    • magnesium antacid overuse
    • renal failure
  107. symptoms of hypomagnesemia
    • <1.8
    • ataxia
    • confusion, hallucinations
    • tremors twitches and tetany
    • hyperactive dtr's
    • anorexia, vomiting
    • dysphagia
    • myocardial irritablility
    • muscles
  108. Symptoms of hypermagnesemia
    • >2.5
    • decreased muscle activity
    • hypoactive dtrs
    • facial numbness
    • weak hand grips
    • nausea and vomiting
    • slow heart rate
    • hypotension
    • ekg wide qrs and long pr interval
  109. If monitoring a heart patient, what 2 values would you want to monitor
    • k+
    • mg
  110. Treatments of hypermagnesemia
    • treat underlying cause
    • loop diuretics
    • calcium iv to reduce cardiac effects (reduce irritability)
    • dietary limitations
    • IV fluid
  111. Treatment of hypomagnesemia
    • treat underlying cause
    • increase dietary intake
    • give IV or IM magnesium
    • eliminated alcohol
    • drug limitations
  112. Monitor vitals and i&o's
    monitor cardiac status
    seizure precautions
    teaching dietary intake and eliminate antacid abuse
    monitor neuromuscular status
    assess skin integrity
    Nursing interventions for Mg problems
  113. What controls water?
    plasma protiens

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