Med Surg

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Author:
30acre
ID:
81804
Filename:
Med Surg
Updated:
2011-05-16 07:08:59
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Nursing Test
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Description:
Test 2
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  1. If serum calcium is 10.5 mg/dl what would phosphorus be?
    2.5 mg/dl
  2. If Phosphorus is 4.7 mg/dl serum calcium would be?
    9.0 mg/dl b/c calcium and phosphorus have an inverse relationship
  3. Hyperkalemia causes?
    Muscle weakness and cardiac arryhthmias
  4. Hypokalemia causes?
    • Skeletal muscle weakness
    • Uwave
    • Constipation (Ileus)
    • Toxic effect of drugs
    • Irregular weak pulse
    • Ortho hypotension
    • Numbness
  5. Hypernatremia causes?
  6. Skin to flush
    • Agitation in pt
    • Low grade fever
    • Thirst
  7. Hyponatremia causes?
    Cells to swell in the CNS

    CNS issues normally indicate Sodium Imbalance
  8. 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
  9. Respiratory Alalosis would mean?
    pH ^ >7.45 pco2 < 22

    • Symptoms:
    • Tingling in extremities
    • Confusion
    • Deep rapid breathing
    • seizures
    • lightheaded/dizziness
    • weak/thready pulse
  10. RN Interventions for Resp. Alkalosis are?
    • Treat Cause (Hyperventilation, Mechanical Vent, extreme anxiety)
    • Sedatives
    • Check electrolyte levels
    • K, Ca, & Phosphate are commonly decreased
  11. Resp Acidosis would mean?
    • pH < 7.35 pco2 > 45
    • Symptoms:
    • Rapid shallow breathing
    • dyspnea
    • disorientation
    • muscle weakness
    • ^ Pulse
    • ^ BP & RR
  12. RN Interentions for resp. acidosis are?
    • Vitals
    • Treat cause ( hypoventilation/ inadequate ventilation, acute pneumonia, COPD)
    • semi fowlers position
    • quite enviornment
    • bronchodiolators
    • antibiotics
  13. 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
  14. RN interventions for metabolic alkalosis are?
    • treat cause ( N&V, excessive antacid intake, hypokalemia, hyperventilation)
    • VS
    • lab values
    • promote hydration
    • safety
  15. 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
  16. 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
  17. 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
  18. Osmolality measures?
    # of active particles in a solution
  19. Serum Osmolality measures?
    280-300 mOsm/kg H2O
  20. Urine Osmolality measures?
    • 50-1400 mOsm/kg H20 & concentration of urine
    • ^ indicates dehydration or fluid vol. deficit
    • low indicates excess fluid
  21. 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
  22. Creatinine measures?
    • waste product of creatinine phosphate
    • ^ nephron damage
    • low atrophy of muscle tissue
    • Norm 0.6-1.5
    • Best indicator of renal function
  23. Hct measures
    • vol of RBCs in whole blood
    • 40-54% for males
    • 37-47% for females
    • ^ in dehydration
    • low in over hyrdration or anemia
  24. Hypovolemia is?
    • an abnormal loss of vol.
    • caused by inadequate intake, loss during surgery, vomiting, diarrhea, fever, hemorrhage, 3rd spacing
  25. 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
  26. What labs would indicate hypovolemia?
    • ^ HCT (concentrated in decreased plasma vol)
    • ^ BUN due to decreased renal perfusion
    • ^ specific gravity
  27. 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
  28. Hypervolemia is?
    • expansion of ECF due to abnorm retention of H20 & Na
    • Causes:
    • CHF
    • Renal faliure
    • cirrhosis
    • excessive salt intake
  29. 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
  30. RN interventions for hypervolemia are?
    • treat cause
    • monitor:
    • I&Os
    • daily weights
    • edema
    • vein distention
    • breath sounds
    • labs
    • diuretics
    • fluid restrictions
    • Na restricted diets
  31. Signs of edema are?
    • pitting
    • 1+ slight indentation
    • 2+ moderate pitting
    • 3+ 6mm indent
    • 4+ 8mm indent, severe
  32. RN interventions for edema are?
    • monitor
    • I&Os
    • JVD
    • pulses
    • BP
    • HR
    • Lung sounds
    • Daily weights
    • skin assessment
    • mucous membranes
    • LOC
  33. Sx: wt loss, oliguria, postural hypotension..
    signs of hypovolemia
  34. Sx: altered level of consciousness, peripheral edema, periorbital edema, elevated BP...
    signs of hypervolemia
  35. S&S of electrolyte disorder?
    • numbness & tingling
    • muscle weakness
  36. 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
  37. Hypernatremia (^sodium) > 145 mOsm/L
    • S&S
    • ^ thirst
    • dry/sticky mucous membranes
    • restlessness
    • ^ temp
    • disorientation
    • oliguria
    • flushed skin
    • agitation
  38. 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
  39. Hyponatremia ( low sodium) < 135
    • S&S:
    • nausea
    • muscle/abd cramps
    • lethargy
    • cerebral edema
    • confusion
    • muscle twitching
    • hemi paresis or seizures
  40. 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
  41. 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
  42. Early asthma would correspond with?
    • resp alkalosis
    • RN dx: ineffectie airway clearance/ irreg. breathing pattern r/t bronchoconstriction & mucous.
  43. Late asmtha would be related to?
    resp. acidosis

    RN dx: impaired gas exchange
  44. Albuterol is?
    an emergency "quick" med

    steriods are used for long term results

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