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NUR 111 Test 6

NUR 111 Test 6 Mod 26 - 38

Why are infants more prone to volume deficits ECF is more easily lost from the body than ICF
Why is there a risk for fluid imbalance in the elderly? Higher fat:muscle results in reduced total body water. >60yo, total body water 45% body weight.
Desirable I/O 2-3 L/day
Electrolytes Na+, Cl-, K+, HCO-, Mg+2, Ca+2, SO4-2, PO4-3,
Define solvent/solute Simplistic: dissolve solute (solid part) into solvent (liquid part). Ex: dissolving sugar into water.
Primary solutes in the body Electrolytes, proteins, glucose
Major ECF electrolytes Plasma electrolytes minus proteins, (things filtered out by capillary walls) Na+ Cl- K+ HCO3- Ca+2
Major IVF electrolytes K+ Mg+2 PO4-3 proteins
Normal lab values Na+=140mEq/L. K+=4mEq/L Cl-=100mEq/L. HCO3-=
What is the func. of sodium? Control & regulate ECF. Affects serum osmolality. Participates in muscle contraction & transmission of nerve impulses. Regulation of acid base balance & HCO3-. Loss or gain of sodium usu accompanied by loss or gain of water.
What is the func of potassium? Helps control ICF osmolality. Chief regulator of cellular NZ activity. Vital in electrical transmissions of the body
Sources / losses Na+ / K+ In: Na+ diet - salt, processed foods . K+ diet - fruits/veg/whole grain milk/meat Outs: skin, GI, renal.
Ca function Nerve impluses, coagulation, bone mineralization. NZ cofactor
Sources/losses Ca+2 Absorbed from foods with stomach acid/vit D. Sources: Dairy, beans (legumes), fortified foods (OJ), green/leafy vegetables, small fish (eat bones)
Define: Diffusion random movement of particles to reach equilibrium.
Define: Perfusion Perfusion: delivery of blood/oxygen to tissues
Ventilation. Oxygenation. CO2 exchange in lungs. O2 exchange in lungs.
Colloid osmotic pressure Pressure inside a compartment due to water movement secondary to osmosis.
"Thirst center" of the body Hypothalamus - through ADH control
Define: DRG Diagnostic related group. DRG's are used to pay hospitals for care given. Same pay for DRG regardless of what's done. Initiated for Medicare.
Define capitation Capitation is a prearranged payment for a given service
Resource utilization group RUG Billing group used for nursing home residents based on functional status.
Managed care a system of payment for healthcare designed to reduce costs. May require pt to used PCP to access other resources.
Define: Case management Case management refers to the coordination of services on behalf of a client. Multidisciplinary teams the collaborate to manage care w/ an emphasis on collaboration.
Define: client focused care All services & care providers come to the pt; requires cross-training (e.g. a nurse draws their own labs.
Define: differentiated practice Focuses on best use of nursing staff based on skill sets & education (e.g. CNA, LPN, & RN all have different skill sets & education, therefore they perform different duties.
Define: shared governance Encourages participation of nurses in a levels of communication (e.g. the nurse helps set budget & resources available.
Define: case method of nursing One nurse is responsible for providing total care for a group of clients for an 8-12 hr shift.
Define: functional nursing When the RN performs the more complex tasks & less complex task are assigned to the CNA & LPN; can cause fragmentation.
Define: team nursing A team of providers led by RN.
Define: primary nursing One RN is responsible for a group of pts 24/7 until they are discharged w/ RN performing total care for pts.
Define: Holmes-Rahe scale Answer questions assigning numeric values to stressors. Assigns numeric score to stress.
General Adaptation Syndrome Biochemical model of body's response to stress. 3 Phases: I-Alarm. II-Resistance. III-Exhaustion.
Local Adaptation Syndrome Localized response of the body to stress. i.e. tissue or organ. Short-term adaptive response. Example: Reflex pain response / inflammatory response.
Body's emergency response Sympathetic response (epinephrine). ATP, Glucose.
Coping crying, laughing, sleeping, cursing, physical activity, smoking/drinking, lack of eye contact, withdrawl, limiting relationships to those w/ similar values and interests
Compensation over achieve in another area. Example: When a person says, “I may not know how to cook, but I can sure do the dishes!
Denial denies that condition exist. Ex: a person who is a functioning alcoholic will often simply deny they have a drinking problem, pointing to how well they function in their job and relationships.
Displacement transfer reaction to another object or person. Example: A man who gets angry at his boss, but can’t express his anger to his boss for fear of being fired. He instead comes home and kicks the dog or starts an argument with his wife.
Projection person's thoughts or weakness is attributed to someone else. Example: a spouse may be angry at their significant other for not listening, when in fact it is the angry spouse who does not listen.
Introjection insert qualities or values from mentor into his own ego structure. Opposite of projection. Example: Children take in attitudes of teachers, heros, and significant people in their lives.
Rationalization justification of behavior or action. Example: a woman who starts dating a man she really, really likes and thinks the world of is suddenly dumped by the man for no reason. She reframes the situation in her mind with, “I suspected he was a loser all along"
Reaction formation develops behavior pattern opposite to true feelings. Example: a woman who is very angry with her boss and would like to quit her job may instead be overly kind and generous toward her boss and express a desire to keep working there forever.
Regression return to earlier state of behavior or development. Ex: an adolescent who is overwhelmed with fear, anger and growing sexual impulses might become clingy and start exhibiting earlier childhood behaviors he has long since overcome, such as bedwetting.
Repression exclusion of anxiety producing event. can't remember accident. Repression is the unconscious blocking of unacceptable thoughts, feelings and impulses.
Sublimation substitute acceptable behavior for problem behavior. Example: When a person has sexual impulses they would like not to act upon, they may instead focus on rigorous exercise.
Undoing positive action to make up for bad action. Example: After realizing you just insulted your significant other unintentionally, you might spend then next hour praising their beauty, charm and intellect.
Define: Anxiety A vague, uneasy feeling of discomfort or dread from an unknown source.
Define: Mild Anxiety An increase in mental alertness & perceptual fields; Characterized by restlessness & increased curiosity/questioning things.
Define: Moderate Anxiety Narrows perceptual field to focus on immediate concerns; Characterized by quivering of voice, muscle tension, tremors, nausea, & a slight increase in VS.
Define: Severe Anxiety Creates a narrow focus on specific details, causing all behaviors to be geared towards getting relief; Characterized by inability to communicate, erratic motor activity, H/A, nausea, an increase in VS, tachy, hyperventilation, & facial expression.
Define Panic: Causes a person to lose control & experience dread & terror; can lead to exhaustion & death; Characterized by inability to communicate, lack of control, dread, & terror.
Define Coping Mechanisms An unconscious or conscious means to manage or alter a problem causing distress that may be positive, negative & learned based on experiences. - crying, laughing, sleeping, cusing, physical activity, exercise, smoking, drinking, lack of eye contact, etc.
Define: Defense Mechanisms Unconscious reactions to stress that typically occur w/ mild to moderate anxiety to protect self-esteem.
Define: Loss Occurs when a valued person, object, or situation is changed, or inaccessible so that its value is diminished or removed. (Actual, Perceived, Physical, Psychological, Situational, Anticipatory
Define: Grief The total repose to the experience related to loss; a natural response that should occur. It can look like helplessness, loneliness, anger, or depression, & should be shared.
Define: Mourning Behavior process through which grief is eventually resolved or altered.
Define: Bereavement Subjective response experienced by the surviving loved ones after the death of a person w/ whom they have shared a significant relationship.
Engel's Stages of Grief 1) Shock & Disbelief 2) Developing Awareness 3) Restitution 4) Resolving loss 5) Idealization 6) Outcome
Kubler-Ross Stages of Grief 1) Denial & Isolation 2) Anger 3) Bargaining 4) Depression 5) Acceptance
Define: Death An individual who has sustained either 1) irreversible cessation of all circulatory & respiratory func. or 2) irreversible cessation of all func of the entire brain, including the brainstem.
Signs of Impending Death Loss muscle tone jaw sag, eyes roll back, decr GI func, prob swallow, total incont, loss mvmnt in UE & LE. Slowing circulat decr HR. Resp chg irregular, incr/decr rate, "death rattle", cheyne stokes. Decr senses, blur vision, restless, agitation, nausea.
Body Changes After Death Rigor mortis- stiffening of body 2-4 hr post death. Algor mortis- grad decr of body temp to room temp. Liver mortis- discoloration of tissues on dependent areas. Loss of elasticity- skin tears easily. Liquefaction of body due to bacteria fermentation.
Post Death Issues Death certificate- required by law & must be signed by physician. Organ donation. Autopsy- performed only to discover cause of death & may be done w/ blood work or actually opening chest &/or brain cavity.
Cultural/Faith Based Considerations Vigils- sitting w. person, waiting for impending death. Rites & rituals- cultural & spiritual preferences. Inward Grieving vs. Outward Displays.
Define: Open Awareness Pt. & family know of impending death
Define: Mutual Pretense Terminal prognosis known by pt. & family but is not discussed.
Define: Closed Awareness Pt. is unaware of impending death.
Urine Specific Gravity Specific Gravity of Urine 1.005-1.035
BUN Normal Values 8-20 mg/dL
Creatinine Normal Values Female: 0.6-0.9 mg/dL Male: 0.8-1.2 mg/dL
Sodium Normal Values 135-145 mEq/L
Potassium Normal Value 3.5-5 mEq/L
Calcium Normal Value 8.6-10.2 mg/dL
Explain: Peripheral IV Brief access only; must be changed every 72-96 hrs. *Length: 0.75-1.25" *Gauge: 14-18 for blood admin; trauma & surgery pts. 20-22 for most PIVs, larger for caustic or viscous solutions. 22-24 for elderly.
Explain: Midline Peripheral Catheter For therapy lasting 2-6 wks. Threads into basilica or cephalic vein
Explain: Central Venous Access Device Device allowing TPN, vesicant or irritating solutions/meds, antibiotics, & CVP to be admin directly into the superior vena cava. *For long-term therapy *X-rays used to confirm placement before infusion
Explain: PICC Peripherally inser centr cath: thread arm to superior or inferior vena cava. Watch ultrasound while inser, plcmnt checked w/ x-ray after inser. Easy to care for; pt usu go home w/ these. Line >20 cm long, only replaced if site infected or line occluded.
Explain: Non-tunneled Central Venous Catheter Used in emergent situation & threaded through the jugular, subclavian, or femoral veins. *Sutured ito place & can remain 3-10 days *Very high rsk for infection *May have 3 or 4 lumens
Explain: Tunneled Central Catheter Surgically inserted catheter that is tunneled under the skin to the superior vena cava. *Can last indefinitely *May have multiple lumens
Explain: Implanted ports Surgically implanted ports in the subcutaneous tissue w/ a line that ends directly above the right atrium. *Has the lowest risk for infection. *Can remain in place indefinitely.
Isotonic Fluids D5W, NS: not used for pt w/ HF, pulmonary edema, kidney impairment, or sodium retention; contains sodium., LR: replaces sodium & potassium depleted by vomiting.
Hypotonic Fluids Total osmolality < ECF. Solutions: 0.33% NS, 0.45% NS Use: hypernatremia *Too much can cause fluid depletion, hypotension, & cell damage.
Hypertonic Fluids Total osmolality > ECF; any solution w/ more than 5% Dextrose. Solutions: D10W, D5+1/2NS, D5NS Use: hypovolemia *Too much can cause FVE
Blood Products PRBCs, Platelets, Clotting Factors (for pt w/ a clotting disorder), Plasma (e.g. FFP [fresh frozen plasma] admin to pt prone to bleeding before invasive procedure.
What is the Normal Blood Osmolality? Normal blood osmolality: 280-300
Describe: Infiltration Unintent admin of NON-VESICANT into surrounding tissue. S/S: (local) pallor, edema, coolness, leak fluid, discomfort, & decr IV flow rate. Treat: stop IV infusion, place warm compress, & elevate extremity. Prevent: inspect IV site, appro needle gauge
Describe: Extravasation Unintent admin of VESICANT into surrounding tissue. S/S: 1-4 scale of blanching/edema, temp, pain. Treat: may leave in IV to admin antidote, or remove; warm compress, elevate, check sensation, movement, pulse, cap refill, & temp. Alter site IV reinsert
Describe: Embolism An air bubble from the IV line (air embolism) or foreign body such as the catheter tip in the vein. S/S: SOB, chest pain, cardiac arrest, loss of consciousness. Treat: If cath tip, place tourniquet above site, call HCP ASAP! Prevent: Prime line.
Describe: Hematoma Blood leaking into surrounding tissue. Cause: perforation of vein wall, slippin of iv in vein, insufficient pressure to site after IV removal. S/S: bruising, swelling, leaking of blood. Treat: remove IV, apply ice, pressure, elevate, assess site.
Describe: Phlebitis Inflammation of vein; can be chemical, mechanical, or bacterial. S/S: PRISH at site & along vein. Treat: apply warm compress & restart IV in other vein. Prevent: hand hygiene, aseptic technique, observe site hourly, dilute irritating meds/solutions.
Define: Chemical Phlebitis Caused by vesicant, rapid infusion rate, incompatible meds/fluids.
Define: Mechanical Phlebitis IV stays in too long, cath in area of flexion, cath guage > vein size, improperly secured IV.
Define: Bacterial Phlebitis Infection caused by prolonged phlebitis going undetected or untreated, improper aseptic technique, poor hand hygiene.
Describe: Thrombophlebitis A blood clot + inflammation. S/S: PRISH, fever, sluggish flow rate, increased WBC. Treat: Stop IV fluids, apply cold then warm compress, elevate extremity, DONT flush line. Culture the cath, clean site w/ alcohol, & restart IV in other vein.
Created by: mojoshare