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If serum calcium is 10.5 mg/dl what would phosphorus be?
2.5 mg/dl
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If Phosphorus is 4.7 mg/dl serum calcium would be?
9.0 mg/dl b/c calcium and phosphorus have an inverse relationship
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Hyperkalemia causes?
Muscle weakness and cardiac arryhthmias
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Hypokalemia causes?
- Skeletal muscle weakness
- Uwave
- Constipation (Ileus)
- Toxic effect of drugs
- Irregular weak pulse
- Ortho hypotension
- Numbness
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Skin to flush
- Agitation in pt
- Low grade fever
- Thirst
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Hyponatremia causes?
Cells to swell in the CNS
CNS issues normally indicate Sodium Imbalance
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A pt's pH is < 7.35
PaCO2 >45mmHg
Hyperkalemic
- This would indicate Respiratory Acidosis
- the RN will teach slow deep breathing to get rid of CO2 and decrease acid
- provide low does O2 if needed
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Respiratory Alalosis would mean?
pH ^ >7.45 pco2 < 22
- Symptoms:
- Tingling in extremities
- Confusion
- Deep rapid breathing
- seizures
- lightheaded/dizziness
- weak/thready pulse
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RN Interventions for Resp. Alkalosis are?
- Treat Cause (Hyperventilation, Mechanical Vent, extreme anxiety)
- Sedatives
- Check electrolyte levels
- K, Ca, & Phosphate are commonly decreased
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Resp Acidosis would mean?
- pH < 7.35 pco2 > 45
- Symptoms:
- Rapid shallow breathing
- dyspnea
- disorientation
- muscle weakness
- ^ Pulse
- ^ BP & RR
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RN Interentions for resp. acidosis are?
- Vitals
- Treat cause ( hypoventilation/ inadequate ventilation, acute pneumonia, COPD)
- semi fowlers position
- quite enviornment
- bronchodiolators
- antibiotics
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Metabolic Alkalosis would mean?
- ^ pH > 7.45 ^HCO3 >26
- Symptoms:
- confusion
- belligerence
- tetany
- hypertonic muscles
- slow shallow RR
- possible apnea
- nausea & vomiting
- diarrhea
- restlessness
- arrythmias
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RN interventions for metabolic alkalosis are?
- treat cause ( N&V, excessive antacid intake, hypokalemia, hyperventilation)
- VS
- lab values
- promote hydration
- safety
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Metabolic acidosis would mean?
- pH < 7.35 HCO3 < 22
- Symptoms:
- Disorientation
- Kussmaul respirations (deep labored breathing)
- muscle twitching
- changes in LOC
- headache
- drowsiness
- ^ RR
- hypotension
- abd. pain
- cold clammy skin
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RN interventions for Metabolic Acidosis are?
- VS
- Monitor:
- Cap. refill
- warmth & color of extremities
- LOC
- GI
- Sodium Bicarb maybe ordered by the doc.
- as well as fluids
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BUN measures what?
- amt of urea nitrogen in the blood
- urea is a waste product of protein metabolism
- norm is 10-20 mg/dl
- ^ could mean poor renal perfusion or damage, dehydration, ^ protein diet, GI bleed
- low could mean low protein diet, starvation, liver disease, over hydration, ^ ADH
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Osmolality measures?
# of active particles in a solution
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Serum Osmolality measures?
280-300 mOsm/kg H2O
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Urine Osmolality measures?
- 50-1400 mOsm/kg H20 & concentration of urine
- ^ indicates dehydration or fluid vol. deficit
- low indicates excess fluid
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Specific Gravity measures?
- kidney's ability to secrete or conserve H2O range of 1.001-1.040
- low idicates dilute urine
- ^ indicates concentrated urine which could mean lack of fluids, ^ ADH secretion (caused by trauma/stress) which causes decrease in urine
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Creatinine measures?
- waste product of creatinine phosphate
- ^ nephron damage
- low atrophy of muscle tissue
- Norm 0.6-1.5
- Best indicator of renal function
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Hct measures
- vol of RBCs in whole blood
- 40-54% for males
- 37-47% for females
- ^ in dehydration
- low in over hyrdration or anemia
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Hypovolemia is?
- an abnormal loss of vol.
- caused by inadequate intake, loss during surgery, vomiting, diarrhea, fever, hemorrhage, 3rd spacing
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Symptoms of Hypovolemia?
restlessness, decreased skin turgor, concentrated urine, oliguria, ^ HR, ^ RR, thirst, clammy skin r/t peripheral vasoconstriction, decreased temp, dizziness, decreased CVP, dry mucous membranes, wt loss, lethargy
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What labs would indicate hypovolemia?
- ^ HCT (concentrated in decreased plasma vol)
- ^ BUN due to decreased renal perfusion
- ^ specific gravity
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RN interventions for Hypovolemia?
- Isotonic solutions (LR .9 NaCl) to expand plasma volume
- Monitor:
- I&Os
- CVP
- VS
- LOC
- Breath sounds
- skin turgor
- mucous membranes
- color & perfusion
- fluid vol challenges
- admin blood if loss is r/t blood
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Hypervolemia is?
- expansion of ECF due to abnorm retention of H20 & Na
- Causes:
- CHF
- Renal faliure
- cirrhosis
- excessive salt intake
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Findings in hypervolemia?
physical: edema, neck vein distention, tachycardia, crackles, ^ BP, ^ CVP, weight gain, SOB, ^ output, bounding pulses, ployurea
labs: decreased BUN and Hct (due to plasma dilution), decreased serum and urine osmolality and SG, CXR may slow pulmonary congestion
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RN interventions for hypervolemia are?
- treat cause
- monitor:
- I&Os
- daily weights
- edema
- vein distention
- breath sounds
- labs
- diuretics
- fluid restrictions
- Na restricted diets
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Signs of edema are?
- pitting
- 1+ slight indentation
- 2+ moderate pitting
- 3+ 6mm indent
- 4+ 8mm indent, severe
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RN interventions for edema are?
- monitor
- I&Os
- JVD
- pulses
- BP
- HR
- Lung sounds
- Daily weights
- skin assessment
- mucous membranes
- LOC
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Sx: wt loss, oliguria, postural hypotension..
signs of hypovolemia
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Sx: altered level of consciousness, peripheral edema, periorbital edema, elevated BP...
signs of hypervolemia
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S&S of electrolyte disorder?
- numbness & tingling
- muscle weakness
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Mjr. extracellular electrolyte
135-145 mOsm/L
primary determinant of ECF osmolality
gain or loss associated with H2O
stablizes electrochemical state needed for muscle contraction and nerve impulses in the body
Sodium
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Hypernatremia (^sodium) > 145 mOsm/L
- S&S
- ^ thirst
- dry/sticky mucous membranes
- restlessness
- ^ temp
- disorientation
- oliguria
- flushed skin
- agitation
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RN interventions for Hypernatremia are?
- Monitor:
- I&Os
- adequate H2O intake
- pts at risk
- IV fluids
- Labs
- VS
- daily weights
- skin turgor
- CVP
- LOC
- pupillary reaction
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Hyponatremia ( low sodium) < 135
- S&S:
- nausea
- muscle/abd cramps
- lethargy
- cerebral edema
- confusion
- muscle twitching
- hemi paresis or seizures
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Na lose, ex. excessive vomiting, diuretics, NG suctioning, burns, wound drainage
H20 gain, ex. IV fluid, ^ secretion of ADH, tumor, head injury, pitocin, vincristine
causes of hyponatermia
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RN intervention for hyponatermia are?
- treat cause
- Na replacement ( P.O. if possible, lactated ringers, 0.9 NaCl, 100 meq/day
- H20 restriction if norm or excess fluid vol
- Hypertonic NaCl solutions if neuro effects
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Early asthma would correspond with?
- resp alkalosis
- RN dx: ineffectie airway clearance/ irreg. breathing pattern r/t bronchoconstriction & mucous.
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Late asmtha would be related to?
resp. acidosis
RN dx: impaired gas exchange
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Albuterol is?
an emergency "quick" med
steriods are used for long term results
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