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Fundamentals Final

Ch. 18, 21, 26, 30 EKG/ABG/Fluid&electrolytes packet

What is sensible fluid? What organs are involved? You know you’ve lost it & you can measure it. It can be seen, felt, & measured! Bladder, Colon, Wounds
What is insensible fluid? What organs are involved? fluid lost on a daily basis from the lungs, skin, respiratory tract, and water excreted in the feces. (Don’t know you lost it & cant measure how much you’ve lost) Lungs, Skin
Signs and symptoms of Hyperkalemia Bilateral muscle weakness, transient abdominal cramps, diarrhea, dysrhythmias; cardiac arrest if severe
Signs and symptoms of Hypokalemia Bilateral muscle weakness, abdominal distention, decreased bowel sounds, constipation, dysrhythmias
Signs and symptoms of Hypernatremia Decreased level of consciousness (confusion, lethargy, coma), perhaps thirst; seizures if develops rapidly or is very severe
Signs and symptoms of Hyponatremia Decreased level of consciousness (confusion, lethargy, coma); seizures if develops rapidly or is very severe
Signs and symptoms of Hypermagnesium Lethargy, hypoactive deep tendon reflexes, bradycardia, hypotension
Signs and symptoms of Hypomagnesium Positive Chvostek's sign, hyperactive deep tendon reflexes, muscle twitching and cramping, grimacing, dysphagia, tetany, seizures, insomnia, tachycardia, hypertension, dysrhythmia
Signs and symptoms of Hypercalcemia Anorexia, nausea and vomiting, constipation, diminished reflexes, lethargy, decreased level of consciousness, personality change; cardiac arrest if severe
Signs and symptoms of Hypocalcemia Numbness & tingling of fingers & circumoral (around mouth) region, positive Chvostek's sign (contraction of facial muscles when facial nerve is tapped), hyperactive reflexes, muscle twitching and cramping, tetany, seizures, dysrhythmias
Normal Lab Value of Na 135-145
Normal Lab Value of K 3.5-5
Normal Lab Value of Mg 1.5-2.5
Normal Lab Value of Ca 8.9-10.1
Normal Lab Value of Bicarbonate 22-26
Normal Lab Value of Phosphate 2.7-4
Normal Lab Value of pH 7.35-7.45
Normal Lab Value of PaCo2 35-45
Normal Lab Value of PaO2 80-100
Normal Lab Value of SaO2 95%-100%
Normal Lab Value of Base +/- 2 mmol/ L
What does increase sodium cause with fluid balance? Water Retention
Respiratory Acidosis also called respiratory failure or ventilatory failure, is a condition occurs when the lungs can’t remove enough of the CO2 produced by the body. Excess CO2 causes the pH of blood and other bodily fluids to decrease, making them too acidic
Respiratory Alkalosis occurs when carbon dioxide levels drop too low. This causes the pH of the blood to rise and become too alkaline
Metabolic Acidosis A condition in which too much acid accumulates in the body.
Metabolic Alkalosis when your body loses too much acid or gains too much base.
What is PN & when is it used? Nutritionally adequate solution consisting of glucose, other nutrients, and electrolytes May be the only option. Some pts don’t have a working GI tract or have had surgery and cant eat properly
Phlebitis Inflammation of a vein. w/ redness, tenderness, & warmth along the site
Infiltration occurs when IV fluids leak into the subQ tissue around the site because the catheter tip no longer is in the vein. causes swelling, paleness, and coolness (from decreased circulation) around the venipuncture site
Types of grief Normal, Anticipatory, Complicated, Disenfranchised
Describe Normal Grief consists of commonly expected emotional and behavioral reactions to a loss (e.g., resentment, sorrow, anger, crying, loneliness, and temporary withdrawal from activities)
Describe Anticipatory Grief process of “letting go” before an actual loss or death has occurred
Describe Complicated Grief when a person has difficulty progressing through the loss experience. The person does not accept the reality of the loss, and the intense feelings associated with acute grief do not go away
Describe Disenfranchised Grief People often experience disenfranchised grief when a loss is deeply private or secretly experienced (e.g., early miscarriage or death of a family member as a result of alcoholism
What is Kubler Ross's 5 stages of grief? Denial, Anger, Bargaining, Depression, Acceptance
Describe Denial Act like nothing has changed. Cannot believe or understand what has happened.
Describe Anger resists the loss, angry about the situation, becomes angry with god.
Describe Bargaining postpones awareness of the loss & tries to prevent it from happening by making deals & promises
Describe Depression Realizes full significance of the loss. Feels overwhelmingly sad or lonely & withdraws from interactions w/ others
Describe Acceptance begins to accept the reality & inevitability of loss & looks to the future
What are the types of loss? Necessary, Actual, Perceived, Maturational, Situational
Describe Necessary Often losses are replaced by something different or better. For example, a person leaves behind family members to begin
Describe Actual Loss when they can no longer touch, hear, see, or have near them valued people or objects. Examples include the loss of a body part, pet, friend, life partner, or job
Describe Perceived Loss very real to the person who has had the loss. For example, a person perceives that she is less loved by her parents and experiences a loss of self-esteem. Other people often misunderstand perceived losses
Describe Maturational Loss when a child goes to school for the first time he or she spends less time with his or her parents, leading to a change in the parent-child relationship. Grieving maturational losses help a person cope with the change
Describe Situation Loss result of an unpredictable life event. Often involves multiple losses. Ex: a divorce begins with the loss of a wife & leads to financial strain, changes in living, less contact with kids, and loss of friends who were part of the couple's married life
What are the phases of Bowlby Mourning? (4) Numbing, Yearning & Searching, Disorganization & Despair, Reorganization
Describe Numbing person has extremely intense emotion & feels “stunned” or “unreal”
Describe Yearning & Searching emotional outburst, tearful sobbing, & actue distress. Lasts for months to years.
Describe Disorganization & Despair spends time thinking about how & why the loss happened. often expresses anger at anyone he or she believes to be responsible
Describe Reorganization requires a year or more, the person accepts unaccustomed roles, acquires new skills, and builds new relationships
Whats the Difference between Agnostic & Atheist • Agnostic – believe that any ultimate reality is unknown or unknowable • Atheist – do not believe in the existence of God
Self Transcendence refers to connecting to your inner self, which allows one to go beyond oneself to understand the meanings of experiences.
Transcendence is the belief that there is a positive force outside of and greater than oneself that allows one to develop new perspectives that are beyond physical boundaries
Definition of Faith a cultural or institutional religion such as Buddhism, Christianity, or Islam. It also is a relationship with a divinity, higher power, authority, or spirit that incorporates a reasoning faith (belief) and a trusting faith (action)
How is oxygen carried through the body? RBCs
What causes pain in the patient when they are having a heart attack Muscles dying, lack of oxygen
Symptoms of Right Sided HF Distended jugular veins, Peripheral edema
Symptoms fo Left Sided HF Decreased cardiac output, Pulmonary congestion, crackles on auscultation and patient complaints of fatigue, dyspnea, and orthopnea
Recite normal electrical pathway of the heart. SA node–atria–AV node–bundle of His–Purkinje fibers–ventricles
Recite Normal Blood Flow tough the Heart Superior & Inferior Vena Cava – Right Atrium – Tricuspid – Right Ventricle – P Valve- P Artery – Lungs – P Vein - Left Atrium – Bicuspid(mitral) – Left Ventricle – Aortic Valve - Aorta
Describe a Pneumothorax. What is Treatment? collection of air or other gas in the pleural space. The gas causes the lung to collapse because it destroys the negative intrapleural pressure.goal in treating a pneumothorax is to relieve the pressure on your lung, allowing it to re-expand.
Describe a Hemothorax.. What is Treatment? accumulation of blood in the pleural cavity between the parietal and visceral pleurae, usually as the result of trauma Disposable chest drainage systems are one-piece molded plastic units that evacuate any volume of air or fluid with controlled suction
What is Chvostek's Sign? twitching of the facial muscles in response to tapping over the area of the facial nerve.
What does each letter in FICA stand for? F—Faith or belief I—Importance of spirituality C—Individual's spiritual Community A—Interventions to Address spiritual needs
What is Hypoxia? hypoxia is inadequate oxygen at the cellular level.
After load is defined as? The resistance of the ejection of blood from the left ventricle.
What is VAP (ventilator-associated pneumonia) pneumonia that develops 48 hours after mechanical ventilation via an endotracheal tube or respiratory tract and lung parenchyma
Preload is? amount of blood at the end of ventricular diastole, or measured as end-diastolic pressure.
What is Ventilation? Movement of air in & out of the lungs
What is Diffusion? Movement of gases between air spaces and the bloodstream
What is Respiration? Exchange of oxygen and carbon dioxide during cellular metabolism
What is Perfusion? Movement of blood into and out of the lungs to the organs and tissues of the body.
P wave atrial Depolarization
QRS Wave Ventricular Depolarization
T Wave Ventricular Repolarization
What are some aging changes in Muscle contraction Ventricular wall thickened, collagen increased, and elastin decreased in the heart muscle -- Decreased Cardiac Output
What are some aging changes in Blood Flow Heart valves, especially the mitral and aortic valves, become thicker and stiffen -- Systolic ejection murmur
What are some aging changes in Conduction System SA node becomes fibrotic from calcification; decrease in number of pacemaker cells in the SA node -- Increased PR, QRS, and Q/T intervals; decreased amplitude of the QRS complex
What are some aging changes in Arterial Vessel Compliance Vessels become calcified; loss of arterial distensibility, decreased elastin in the vessel walls, more tortuous vessels -- Hypertension, with an increase in systolic blood pressure
What are some aging changes in Breathing Mechanics decreased muscle mass & stength
What are some aging changes in Oxygenation decreased alveolar surface area & decreased CO2 diffusion capacity --Decreased PaO2 Decreased cardiac output Slightly increased PaO2
What are some aging changes in Breathing Control/pattern Decreased responsiveness of central and peripheral chemoreceptors to hypoxemia and hypercapnia -- Decreased tidal volume Increased respiratory rate
What are some aging changes in Lung Defense Mechanisms Decreased immunoglobulin A (IgA) production and humoral and cellular immunity -- Decreased airway clearance Increased risk for infection
What are some aging changes in Sleep & Breathing Decreased respiratory drive & tone of upper airway muscles -- Increased risk for arterial desaturation Increased risk for aspiration and infection Snoring/obstructive sleep apnea
What is hope? something a person looks forward to or lives for. Something a person uses to feel better about as if everyting will be okay. Nurse cant promises anything but can say “You are in good hands and we're going to do the best we can” It gives a person hope
Diffusion Passive movement of electrolytes or other particles from an area of higher concentration to one of lower concentration
Osmosis Movement of water across a semipermeable membrane from a compartment of lower particle concentration to one that has a higher particle concentration
Aldosterone A Steroid hormone, "the main mineralocorticoid hormone", produced by the outer section of the adrenal cortex in the adrenal gland.
ADH Regulates osmolality of body fluids by influencing how much water is excreted in urine
Acidosis Increased Acidity in blood
Alkalosis Opposite of excess acid
Major extracellular electrolyts Na+, Cl-, Ca+, & HCO3-
Major Intracellular Electrolytes K+, Mg+, P-
Hypertonic Has higher solution concentration than another. Water is drawn out of cells & into ECF compartment Cells can shrink if too much fluid is pulled out of the cell
Hypotonic Lower solute concentration that another solution Hypo Hippo. Cells can swell & burst if you cause too much fluid to move into cells
Colloids Act as plasma expanders to help maintain protein balance & colloid osmotic pressure
Crystaloids Solution with small molecules that flow easily from the bloodstream into cells & tissues. May be iso, hypo, or hyper. Least expensive & used for volume resuscitation
The respiratory system compensates for changes in the pH level by responding to changes in the levels of: CO2
The kidneys compensate for acid-base imbalances by excreting or retaining: A. Hydrogen ions B. Carbonic acid C. Sodium bicarbonate D. Water C - Sodium Bicarb
All of the following might be a cause of respiratory acidosis except: A. Sedation B. Head trauma C. COPD D. Hyperventilation D - Hyperventilation
A patient with a prolonged episode of nausea, vomiting and diarrhea has an ABG ordered on admission. You might expect the results to show: A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosi A - Metabolic Acidosis
A calculated ABG value that indicates excess of insufficiency of sodium bicarbonate in the system is: A. HCO3 B. Base excess C. PaO2 D. pH B - Base Excess
Which of the following may be a reason to order an ABG on a patient? A. The patient suddenly develops shortness of breath B. An asthmatic is starting to show signs of tiring C. A diabetic has developed Kussmaul respirations D. All of the above D- all of the above
You are reviewing the results of an ABG. When the pH and the PaCO2 values are moving in opposite directions, the primary problem is: A. Respiratory B. Renal C. Metabolic D. Compensation A - Respiratory
When an acid-base imbalance is caused by a metabolic disturbance, the pH and the HCO3 will move: A. In opposite directions B. Totally independent of each other C. In the same direction C - In the dame direction
The oxyhemoglobin dissociation curve represents the relationship between the: A. O2 saturation and hemoglobin level B. O2 saturation and PaO2 C. PaO2 and the HCO3 D. PaO2 and the pH B
On the normal oxyhemoglobin curve, if the O2 saturation is 88%, it would correlate with a PaO2 of approximately: A. 60mm Hg B. 80mm Hg C. 90mm Hg D. 100mm Hg A
Clincal Dehydration Loss of body water, with or without salt, at a rate greater than the body can replace it
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