EXAM 3

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farevalo2
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80958
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EXAM 3
Updated:
2011-04-27 02:26:00
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Fluids electrolytes hazards pain
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Fluids and electrolytes
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  1. Urine Osmolality
    affected by urea, creatine and uric acid
  2. FVE
    • Hypervolemia- excess fluid which can cause edema (water is pulled from cells) causing accumulation of fluids in interstitial spaces.
    • may be caused by malfunctioning kidneys, failure of heart to pump
    • cells shrink
    • Edema can be around eyes, finers, ankles, sacral area and in or around organs
  3. HYPOtonic solutions
    • More water than Na...
    • 0.33% NaCl
    • 0.45% NaCl (1/2 strength of NS)
    • D5W hypotonic in BODY
  4. Osmosis
    WATER moves From lOw solute concentration to high solute concentration
  5. HypoNAtremia
    • NEURO
    • Caused by; GI losses, water intox. psychogenic polydipsia, hypoglycemia, SIADH, use of diuretics.
    • S/S: coma, cerebral edema, muscle twiches, R & W
    • TTT: Na replacement: water restriction, 0.9 NS LR ISO, lasix for SIADH.
  6. increased Aldosterone causes?
    Sodium & Water retention, K+ Loss
  7. Parathyroid Gland
    Secretes parathyroid hormone--> regulates Ca and Phosphorus
  8. Osmotic pressure
    "PULLING force" back into capillaries
  9. FVD
    • HYPOvolemia
    • Caused by: GI loss, decreased fluid intake. Risk factors; DI, adrenal insufficiency, hemorrhage, coma
    • water out of cells, cells shrink
    • osmolarity >300 mOsm/L
  10. Osmolality
    reflects the concentration of fluids that affects the movement of water between fluid compartments by osmosis
  11. Hydrostatic pressure
    "pusHing force" out of capillaries into interstitial tissues.
  12. Major Anions?
    Chloride, bicarb, phosphate, and sulfate
  13. isotonic solutions
    • 0.9% NaCl (NS)
    • D5W (5% DEXTROSE IN WATER)
    • LR
  14. HYPERtonic solutions
    • Higher concentration of solutes.
    • 5% Dextrose in .45% NaCl
    • 10% Dextrose in water
    • 5% dextrose in 0.9% NaCl (NS)
  15. Regular insulin
    ONLY insulin you can give IV
  16. Antimetics
    • Antinausea
    • Ex: ZOFRAN
  17. Antipiuretic
    Anti- fever
  18. Calcium Normals
    8.6-10.2 mg/dL
  19. Magnesium Normals
    1.3-2.3 mEq/L
  20. Chloride normals
    97-107 mEq/L
  21. Bicarbonate normals
    25-29 mEq/L
  22. Phosphate normals
    1.8-2.6 mEq/L
  23. Efficacy
    drugs ability to INITIATE BIOLOGIC ACTIVITY as a result of binding to receptor site.
  24. Agonist
    combines with recpetors and initiates biochemical and physiologic changes.
  25. Treatment for allergic reactions?
    Epi- stimulates alpha and beta-adrenergic receptors causing bronchial dilation and relieving congestion in bronchial mucosa and pulmonary vessels.
  26. what drugs must be always be checked with a second nurse?
    • Heparin
    • Insulin
  27. thirst factor driven by?
    • decreased BVol & intracellular dehydration
    • located in hypothalamus (makes ADH)
  28. Electrolyte Distribution
    • Plasma-Interstital-Intracellular
    • Na-142- 146- 15
    • K- 5- 5- 150
    • Ca- 5- 3- 27
    • Mg- 2- 1- 27
  29. HyperNAtremia
    • Caused by: excess water loss (water deprivation) or excess NA intake (hypertonic), DI, excess insensible water loss (heatstroke).
    • S/S: NEURO, seizures, H/A, increased Temp & Thirst, r & w
    • TTT: 0.3 NaCl, D5W
  30. HypoKalemia
    • Caused by: GI losses, starvation, DEcrease in Mg++, polyuria, Hyperaldosteronism, digoxin tox., use of diuretics.
    • S/S: MUSCLE weakness/cramps, fatigue, dysrhythmias, DTRs.
    • TTT: K replacement (IV PO), K diet: milk, eggs, grain, coffee, tea, fruits, veggies. Ca Gluconate (severe), monitor EKG & ABGs
  31. HyperKalemia
    • Caused by renal failure, hypoaldosteronism, Addisons Disease, Burns, meds such as K Cl-, ACE inhibitors, NSAIDs, K sparing diuretics. Pseudohyperkalemia, acidosis.
    • S/S: muscle weakness and paralysis, dysrhythmias, anxiety
    • occurs < hypokalemia, but this is more dangerous.
    • TTT: Kayexalase, EKG, Dialysis, Limit K diet, IV Ca gluconate
  32. HypoCalcemia
    • EFC < 8.6 mg/dL
    • Caused by: Malabsorption, deficient Vit D, hypoparathyroidism, excess Ca loss, pancreatitis.
    • S/S: NM. Numbness/tingling of fingers, mouth, feet. Trousseau & Chevosteks sign, seizures, mental changes, muscle cramps.
    • TTT: Vit D, Ca Gluconate in D5W Bolus, weight bearing excerises.
    • Severe is life threatning
  33. Hypercalcemia
    • EFC >10.5 mg/dL
    • Caused by: cancer and hyPERparathyroidism, bone loss due to immolbilization, Excess Vit D & Ca
    • S/S: (NM) Cardiac arrest, muscle weakness, slurred speech/confusion, deep bone pain, polyuria, N & V
    • TTT: 0.9 NaCl, Lasix, PO4++, encourage walking, 3-4 L/daily fluids, monitor EKG.
  34. Hypomagnesemia
    • < 1.5 mEq/L
    • Caused by: GI losses, Chronic alcoholism, AMI, Decreased K and Ca, HYPER: parathyroidism & aldosteronism, malabsoption, diuretics
    • S/S: NM irritability, muscle weakness, seizures, heart block, DTRs, resp paralysis, Trousseau & Chevostecks, Increased BP
    • TTT: Diet high in Mg: green leafy veggies, nuts, grains, seafood.
  35. Hypermagnesemia
    • > 2.5 mEq/L
    • Caused by: renal failure, excessive Mg intake, DKA, hypothyroidism, loss of DTRs
    • S/S: NM. N&V, weakness, Dc BP, resp depression, coma, cardiac arrest. Flushed skin.
    • TTT: Ca Gluconate, NaCl LR, Lasix
  36. Hypophosphatemia
    • < 1.8 mEq/L
    • caused by: Decreased K, Mg, Vit D, hyperventilation, alcohol withdrawl, DKA, refeeding
    • S/S: NM. Cardiomyopathy, resp failure, seizures, confusion, bone pain, muscle weakness
    • TTT: Sodium Phosphase, potassium phosphate, milk
  37. Hyperphospatemia
    • > 2.6 meq/L
    • Caused by: renal failure, excess Vit D & phosphate, chemotherapy
    • S/S: tetany, muscle spasms/weakness, tachycardia
    • TTT: Renegel (binds to phosphate to excrete it in GI), avoid laxatives and enemas.
  38. Hypochloremia
    • < 96 mEq/L
    • Caused by: Addisons disease, Loss of Na & K cause Cl loss, diuretics
    • S/S: NM, muscle cramps, tetany, seizures, coma, shallow resp
    • TTT: 0.45 NS, avoid free water, Cl- diet
  39. Hyperchloremia
    • > 108 mEq/L
    • caused by: Ic Na (Cl- follows Na), Head injury, dehydration, diuretics
    • S/S: NM, Dc cardiac output, tachycardia, coma, edema, dysrhythmias.
    • TTT: diuretics (lower Na, lowers Cl), hypotonic IV LR, sodium bicarb
  40. K replacement: peripherally & centrally?
    • NEVER GIVE K+ IV PUSH
    • No more than 40 mEq/L peripherally
    • No more than 60 mEq/L centrally
    • Max 10 mEq/Hr peripherally
    • Max 20 mEq/Hr centrally

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