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Geriatrics and fluid
| Question | Answer |
|---|---|
| An older patient is demonstrating signs of dehydration. Which action should the nurse initiate first? | Initiate monitoring and recording of fluid intake and output |
| An older patient asks the nurse what he can about nausea that occurs after eating because of delayed gastric emptying. What advice should the nurse provide to the patient? | Eating several small meals throughout the day rather than three larger ones |
| A 89-year-old client whose total protein level is 5 (abnormally low). Which of the following physiological changes should the nurse interpret as a potential pathological process rather than a normal age-related change? | Decreased teeth and chewing ability |
| The nurse teaches a group of older adults about diet. Which of following recommendations made by the nurse is most likely to result in the promotion of gastrointestinal (GI) health? | It's important to emphasize fiber and fluid intake |
| Which of the following statements most accurately captures an aspect of dental health among older adults? | The presence of dental problems can be indicative of a variety of other diseases. |
| An older patient is receiving oxycodone for cancer pain. For which side effect should the nurse assess the patient | Delirium |
| Which assessment finding indicates that an older patient is experiencing congestive heart failure? | Moist lung crackles are audible on auscultation with shortness of breath on exertion |
| Which interventions would be appropriate for the nurse to use to improve the tissue perfusion of an older patient? | A) Reminding about frequent position changes B) Ensuring an adequate body temperature C) Encouraging physical activity when possible D) Assessing for and preventing sources of pressure on the bod |
| A newly admitted older patient has severe edema in the lower extremities and no hair on the legs. What do these manifestations most likely indicate to the nurse? | Circulatory problems related to age and a chronic illness |
| An older patient is recovering from hip replacement surgery. Which risk factor would most likely affect tissue perfusion in this older patient? | Prolonged immobility after surgery |
| The nurse is planning care for an older patient with class 3 congestive heart failure (CHF) being admitted to a skilled nursing facility. Which action would be appropriate for this patient during the first week of hospitalization? | Assist to a chair on day 1 and progressively increase ambulation each day |
| An older adult is brought to the emergency department experiencing extreme confusion. Which action should the emergency department staff take first? | Review the drugs being taken |
| The nurse is planning interventions for an older patient who is prone to developing constipation. Which intervention would be appropriate for the nurse to implement with this patient? | Increase fluids and encourage activity. |
| An 80-year-old patient who has just spent 2 days at the beach with his family is demonstrating confusion, dry skin, a brown tongue, sunken cheeks, and concentrated urine. What health problem do the patient's symptoms most likely indicate | Dehydration |
| An 80-year-old patient is admitted to the hospital for dehydration related to flu symptoms and receives intravenous fluids. What is the major risk factor for the patient during this hospitalization? | Fluid overload |
| An older patient takes over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) for self treatment of arthritis. For which nutritional health problems will the nurse include when assessing this patient? | 1.Nausea 2.Diarrhea 3.Vomiting 4.Constipation |
| The nurse is concerned that an older patient with renal failure is developing malnutrition. What did the nurse assess in this patient? (Select all that apply) | 1. Hema`tocrit level 30% 2. Hemoglobin level 7g/dL 3.Serum albumin level2.5 g/100 ml 4.Weight loss of over 6% over the last month |
| What dietary advice should the nurse provide to an older patient who is experiencing pain and inflammation due to rheumatoid arthritis? | Cutting back on your consumption of meat, fatty dairy products and oils might have a positive effect on your pain. |
| During an assessment the nurse learns that an older patient uses flavonoids to help reduce joint inflammation caused by osteoarthritis. Which dietary item should the nurse ensure the patient receives to maintain this patient's practice? | 1. Green tea 2. Chocolate 3. Blueberries 4.Raspberries |
| What are common presenting signs of chronic dehydration? | Worsening allergies Asthma Worsening acne Fatigue Headaches |
| What are signs and symptoms of severe dehydration? | Lethargy Weak and rapid pulse Marked hypotension Very dry mucous membranes |
| What are the signs and symptoms of mild dehydration? | Increased thirst Moist to slightly dry mucous membranes |
| In mild to moderate dehydration what lab evaluation can be helpful? | Urine dipstick to check for specific gravity and ketones |
| In a high osmotic and low hydrostatic state, what is likely to occur? | FLUID INTO THE CAPILLARIES: - Dehydration - Low amounts of water in the blood vessels but high amounts of protein/albumin, movement of water from the interstitial compartment to the intravascular space |
| What can dehydration be due to? | 1. Water loss dehydration (hypertonic hypovolemia) 2. Salt loss dehydration (isotonic hypovolemia) |
| What are the signs and symptoms of dehydration? | - Orthostatic hypotension - Decreased skin turgor (subclavian and forearm) - Tachycardia - Dry oral mucosa - Dry axilla - Sunken eyes - Extremity weakness - Speech incoherence - Recent change in consciousness - Concentrated urine |
| Which of the following factors would most likely increase the joint symptoms of osteoarthritis? | Obesity |
| A patient with multiple draining wounds is admitted for hypovolemia. Which assessment would be the most accurate way for the nurse to evaluate fluid balance? | DAILY WEIGHT |
| The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan? | Encourage fluid intake up to 4000 mL every day. |
| A patient diagnosed with osteoarthritis would present with which of the following assessment findings? | Subcutaneous nodules |
| A patient who was involved in a motor vehicle crash has a tracheostomy placed to allow for continued mechanical ventilation. How should the nurse interpret the following arterial blood gas results: pH 7.48, PaO2 85 PaCO2 32 mm Hg, and HCO3 25 mEq/L? | Respiratory alkalosis |
| A patient who is lethargic and exhibits deep, rapid respirations has the following arterial blood gas (ABG) results: pH 7.32, PaO2 88 mm Hg, PaCO2 37 mm Hg, and HCO3 16 mEq/L. How should the nurse interpret these results? | Metabolic Acidosis |
| Total Parenteral Nutrition (TPN) is effective when which of the following occurs? The patient | maintains a stable albumin level |
| Which action should the nurse take first when a patient complains of acute chest pain and dyspnea soon after insertion of a centrally inserted IV catheter? | Auscultate the patient's breath sounds. |
| When assessing a patient who has just arrived after an automobile accident, the emergency department nurse notes tachycardia and absent breath sounds over the right lung. For which intervention will the nurse prepare the patient? | Chest tube connected to suction |
| Which of the following clinical manifestations would be noted in a patient who has hypoxemia? | Restlessness |
| Diet teaching for a patient who has Gout has been effective when the patient states, "I will limit my intake of | Liver |
| A patient has a diagnosis of gout. You note the presence of tophi. These nodules are caused by presence of | urate crystals in the joints |
| Severe generalized edema. | Anasarca |
| Abnormal accumulation of fluids in tissue or body cavities. | Edema |
| If anasarca is present removing some of the Adema from the Abdominal cavity with a trocar can relieve some of the pressure | False |
| What are symptoms of backward failure? | Blood backs up before the heart Pedal edema Jugular distention Ascites Weight gain Hepatosplenomegaly Anasarca Polyuria |
| Right heart is inefficiently pumping blood to the lungs | Right Heart Failure |
| What are the pharmacological therapies available for improving contractility in RHF? | Dopamine Milrinone (PDE3 inhib) Epinephrine Levosimendan Digoxin |
| What is anasarca? | Extreme generalized edema that affects the whole body; skin and its underlying tissues will retain salt and water causing swelling |
| What is the symptomatology of anasarca? | Pitting edema BP d/o HR d/o Organ failure esp liver and kidneys Immobility Visual impairments |
| What are the most common causes of anasarca? | Liver failure Kidney failure RHF Severe malnutrition Allergic reactions |
| What are the tests necessary for determining etiology of anasarca? | Blood tests CT ECHO Allergy tests |
| What is the general treatment for anasarca? | Hospitalization Severe cases - diuretics Albumin - in liver failure Treatment depends on underlying cause! |
| Most important causes of anasarca? | Liver failure Kidney failure Low oncotic pressure states - Kwashiorkor - Nephrotic syndrome - Protein losing enteropathy Allergic reactions Inappropriate dihydropyridine use |
| FACTORS THAT CONTRIBUTE TO IMBALANCES IN OLD/YOUNG | * inability to obtain fluid w/o help * inability to express feelings of thirst * inaccurate assessment of output; (diaper) * fluid loss via perspiration - fever * fluid loss via diarrhea/vomiting |
| Tx OF DEHYDRATION | * begin emergency Tx if - impaired mental status, seizures, or coma * ADM IV fluids to severely dehydrated pt using hypotonic, low-sodium solutions such as Dex 5% in H2O |
| Tx OF DEHYDRATION | * Assess for S/S - cerebral edema = IV ADM to fast * Monitor VS & I/O * Record daily weight (most important) * Assess for thrombophlebitis & pulmonary emboli * Monitor Na+ level, urine osmolality & urine SG |
| S/S HYPERVOLEMIA | - tachypnea & dyspnea - crackles - rapid, bounding pulse - HTN (unless heart is failing) - Increased CVP, PAP, & PAWP ** Central Venous Pressure ** Pulmonary Artery Pressure ** Pulmonary Artery Wedge Pressure |
| S/S HYPERVOLEMIA | - distended jugular & hand veins - acute weight gain - peripheral edema - S3 gallop (third heart sound) - pulmonary edema (prolonged hypervolemia) |
| WHAT TESTS SHOW HYPERVOLEMIA | * low HCT (hemodilution) * Normal serum Na+ level * lower serum K+ & BUN (hemodilution) - - higher levels in renal failure or impaired renal perfusion * low O2 level * pulmonary congestion on chest X-rays |
| Tx HYPERVOLEMIA | * restrict Na+ & fluid intake * ADM diuretics (prescribed) * provide O2 therapy * Tx HF w/Digoxin & bed rest * Tx pulmonary edema w/drugs that dilate blood vessels (morphine & |
| WHAT HAPPENS IN HYPOVOLEMIA WITH THIRD SPACE SHIFTING | osmotic pressure decreases * fluid moves out of intravascular space * fluid shifts into ABD, pleura cavities or pericardial sac * reduced fluid intake may exacerbate the fluid shift * weight loss, mental stat changes, orthostatic hypotension occur |
| CAUSES HYPOVOLEMIA | * Third Space Fluid Shifts - acute intestinal obstruction - acute peritonitis - burns (during the initial phase) - crush injuries, heart & liver failure - hip fracture, hypoalbuminemia - pleural effusion |
| S/S HYPOVOLEMIA | mental STATUS (restlessness & anxiety > unconsciousness) - thirst, dizziness, nausea, tachycardia - delayed capillary refill - orthostatic hypotension - urine output 30ml/hr > drops to 10 ml/hr - cool, pale skin over the arms & legs - weight loss, |
| Tx HYPOVOLEMIA | replacing lost fluids w/isotonic fluids - infusion of plasma proteins - blood transfusion if hemorrhaging - vasopressor (dropamine) to support BP until fluid levels are normal - Initiate O2 therapy - surgery may be required to control bleeding |
| The hormone responsible for the retention of salt is know as: | Aldosterone |
| Third spacing may be defined as: | Decreased circulating blood volume Excess fluid in a body cavity Shift of fluid out of blood |
| Tissue swelling as a result of excess amounts of tissue fluid can be caused by: | Decreased capillary osmotic pressure |
| The release of aldosterone has been linked to | |
| Burns, causing inflammation and increased capillary permeability would result in: | Decreased osmotic pressure |
| Above normal osmotic pressure of the blood would cause fluid shift: | From the interstitial space into the blood |
| Firm subcutaneous tissue, dry rough mucous membranes and weakness with agitation could result from? | Hypernatremia |
| Why is insulin used to treat hyperkalemia in patients? | Insulin causes potassium to enter into cells |
| The hormone directly responsible for water retention is: | ADH |
| Signs and symptoms of metabolic alkalosis includes: | Trousseau's signs Decreased respiration rate Hypertonic muscle contraction |
| A patient is recorded as having an elevated pCO2, an elevated HCO3, and is suffering from acidosis. From the information given above, what condition is the patient suffering from? | Respiratory Acidosis |
| Manifestations of Edema - Brain | Associated with infections or trauma - Cerebral edema is life threatening - Signs include headache, altered LOC or coma, abnormal pupil size or reflexive response, changes in patterns of respiration and changes in muscle tone and abnormal posturing |
| Manifestations of Edema - Airway | Acute, life-threatening condition - May result in difficulty swallowing, anxiety, stridor, possible airway obstruction, and asphyxia |
| Manifestations of Edema - Lungs | Fluid accumulates around the alveoli resulting in decreased gas exchange and a decrease in the ability of the lungs to inflate - Manifestations may vary but include dyspnea |
| Manifestations of Edema - Abdomen | - Ascites: fluid that collects in the peritoneal cavity (example of third spacing) - May be due to increased intravascular hydrostatic pressure or significant inflammatory response |
| Manifestations of Edema - Peripheral Edema | - Often due to obstruction of venous blood flow (increases hydrostatic pressure) or to obstruction in lymphatic drainage - Can occur in the lower extremities in ambulatory patients --> dependent edema - Pitting edema: edema related to salt retention |
| Treatment of Edema | Diuretic therapy is commonly used when there is increased extracellular fluid volume - Implementation of supportive measures - Wearing supportive stockings for those with peripheral edema (increases interstitial fluid pressure) |
| Risk for Fluid Imbalances - Elderly | Aging kidneys experience a decrease in the glomerular filtration rate - Decrease in ability to concentrate urine - Decreased response to ADH and decrease in secretion of aldosterone - Thirst sensation decreases with age (may be drinking poorly) |
| Which type of tube is commonly used in the surgical process to promote GI rest? | NG tubes are used for the: 1) prevention of gastric bleeding 2) intestinal obstruction. 3) promote gastrointestinal (GI) rest and heal the lower GI tract. |
| How often should a postoperative patient be repositioned to prevent complications associated with immobility?Every ___ hours | Assisting and repositioning the patient every 2 hours reduces the risk for complications related to immobility. |
| What are the respiratory complications associated with surgery? | Atelectasis Pneumonia Laryngeal edema |
| A nurse is caring for a patient in the postanesthesia care unit (PACU). Arrange the order in which the patient returns to consciousness after general anesthesia. | first experiences muscular irritability followed by restlessness and delirium. The patient then recognizes the presence of pain. Anesthetic effect wears off completely, the patient is able to think clearly, reason, and control his or her own behavior. |
| What pain management does a patient who has been admitted to the postanesthesia care unit typically receive? | Intravenous opioid analgesics |
| At what time interval is lung functioning assessed in a postoperative patient during the first 24 hours after surgery?Every ___ hours | 24 hrs = Lung functioning should be assessed at least every 4 hours in the first 24 hours after surgery, and every 8 hours thereafter. |
| What nursing interventions can be implemented to improve perfusion to a surgical wound in order to promote healing? | Using hypoallergenic tape Controlling the patient's room temperature Providing adequate rest throughout the day pt should be lifted during repositioning 02 greater than 93% |
| A patient who works in a warehouse has successfully undergone abdominal surgery. After how many weeks can this patient return to work? | 6 weeks |
| What condition is indicated by the presence of a pulse deficit when assessing the vital signs of a postoperative patient | Dysrhythmia; A pulse deficit is a difference between the apical and peripheral pulses. |
| Which conditions can contribute to impaired wound healing following surgery? | Incisions made during the surgical process typically heal in about 2 weeks. Conditions such as 1) obesity 2) diabetes 3) a weak immune system |
| How often does the nurse assess wound healing in a postoperative patient after the health care provider removes the initial dressing? Record your answer using a whole number. Every ___ hours | Every 8 hrs |
| Which condition can cause increased pain in postoperative patients | Excretion of anesthetic |
| What possible cardiovascular complications can arise following a surgery? | The possible cardiovascular complications that can develop in patients after surgery are: *1) sepsis 2) dysrhythmias.* |
| Which type of airway may be used in a postoperative patient who has had oral surgery? | A nasal airway may be used in patients who have undergone *oral surgeries. |
| A patient has wounds on several areas of the body. The nurse expects that the wound in which site will heal more quickly than the others? | head and facial wounds heal more quickly than abdominal and leg wounds because of the better blood flow to the head and neck. |
| Which antimicrobial solutions are used for soaking gauze in the dressing of open and infected wounds? | Open and infected wounds should be treated with dressing and antimicrobial therapy. 1) Neomycin 2) gentamicin 3) iodoform 3) povidone-iodine |
| Which condition may arise due to nasogastric tube drainage? | Nasogastric tube drainage and vomitus lead to the elimination of hydrochloric acid, resulting in metabolic alkalosis. |
| Which drug is often administered via an epidural to manage pain in the postoperative patient? | Drugs given by epidural catheter include the opioids 1) fentanyl 2) preservative-free morphine 3) bupivacaine. |
| Ketorolac and ibuprofen are | non-opioid analgesic nonsteroidal anti-inflammatory drugs (NSAIDs). |
| If wound dehiscence occurs, a sterile non-adherent dressing may be applied on the wound. Which sterile non-adherent dressing is typically used for this | When this happens, a *sterile non-adherent dressing such as 1) Telfa 2) saline dressing * may be applied to the wound. |
| Which dietary modifications are often suggested to postoperative patients to help promote wound healing? Select all that apply. | A diet high in 1) protein 2) calories 3) vitamin C promotes wound healing. |
| A patient is scheduled for abdominal surgery. Which operative stage is most suitable for inserting the patient's nasogastric tube? | A nasogastric (NG) tube is placed after the induction of anesthesia in the patient undergoing abdominal surgery |
| What is the color of normal nasogastric drainage in patients with nasogastric (NG) tubes? | Normal NG drainage is greenish-yellow in color tinge; whereas, pink- or red-colored drainage indicates active bleeding. |
| Which information must be provided to the patient when obtaining informed consent for surgery? | understand the reason for the surgery the steps of the surgical procedure 3) the risks associated with the use of anesthesia, 4) the available surgical options and the risks associated with each option as well as the risks associated with the surgical |
| A postoperative patient has a Jackson-Pratt drain in place. After the nurse empties and compresses the reservoir to restore suction, the drain is secured to the patient's gown. What is this action meant to prevent? | prevent pulling and stress on the surgical wound. Absorbent pads are placed under Penrose drains to prevent skin irritation or wound contamination. |
| Which information is most appropriate to communicate to the next shift nurse about a 74-year-old patient who is recovering from right hip surgery? | Patients who have undergone hip surgery are at greater risk for venous thromboembolism (VTE) and subsequent pulmonary embolism, characterized by decreased lung sounds. |
| hich condition does the nurse suspect in a patient who received spinal anesthesia and is in the postoperative care unit with a body temperature above 101° F, an inability to move the neck, and acute confusion? | Meningitis is a risk factor associated with spinal or epidural anesthesia. |
| Which postoperative nursing intervention is most important to perform to reduce the risk of deformities in older patients? | Teaching patients about turning and positioning will help prevent the complications of immobility. |
| The anesthesia provider delivers a clear understanding of a patient's status to the postanesthesia care unit (PACU) nurse. What information does the anesthesia provider include in the postoperative hand-off report? | 1) type and degree of surgical procedure conducted for the patient. 2) the type of anesthesia administered and the duration for which it was administered. 3) the primary language of the patient for effective communication 4) . the estimated blood loss |
| Why are prophylactic antibiotics discontinued within 24 hours after a gastric surgery? | Antimicrobial resistance Risk for clostridium infection Risk outweighs the benefits of the drug |
| Which preoperative medication may lead to urinary retention in a patient after surgery? | Preoperative may induce urinary retention even after surgery medications such as 1) atropine 2) anesthetics |
| A patient is administered codeine sulfate for pain. What does the nurse monitor for in this patient? | Fluid and electrolyte imbalance because n/v can occur with this medication. The nurse should also monitor 1) respiratory status 2) food intolerance 3) GI motility for constipation |
| butorphanol tartrate. | Changes in the level of consciousness should be monitored in the patient receiving |
| The patient receiving ibuprofen should have | coagulation studies monitored. |
| The patient receiving aspirin components is monitored for | GI bleeding. |
| A patient has undergone chest surgery. Which conditions are likely responsible for altered arterial blood gas levels in the patient? | Altered blood gas levels may be caused by 1) hypoxemia 2) acid-base imbalances, and the surgeon should be notified immediately. |
| A nurse is preparing an 82-year-old patient to undergo a graft for an abdominal aortic aneurysm. Which assessment is important for the nurse to report to the surgeon? | Establishing a patient's baseline mental status is imperative to patient-centered care. If a patient has altered mental status, alternate sources such as next of kin or power of attorney should be consulted in order for informed consent to be obtained be |
| Which clinical manifestations in a patient indicate poor fluid or nutritional status? | 1) Dull hair is a direct result of lack of nutrients 2) Brittle nails 3) Common causes for muscle wasting are improper intake of nutrients and low activity levels. 4) A decrease in skin turgor would be a late sign of dehydration. |
| A decrease in skin turgor would be a late sign of dehydration. In this case when the skin is pulled up for a few seconds, it does not return to its original state, due to | reduced elasticity in the skin |
| A patient with back pain is scheduled for spinal surgery. What examinations does the nurse anticipate in the preoperative order set for this patient? | Computed tomography (CT) scan Magnetic resonance imaging (MRI) |
| baseline arterial blood gas (ABG) values are assessed before surgery for patients with | |
| Cardiac problems that increase surgical risks include coronary artery disease, angina,and myocardial infarction (MI) within "X" months before surgery , | 6 months |
| which supplements are often prescribed to a patient before surgery to increase red blood cell formation? | Iron, folic acid, vitamin B 12, and vitamin C |
| A herb that should be avoided because long-term use can damage the eyes, skin, liver, and spinal cord. | Kava |
| Supplemental vitamin C, iron, zinc, and other vitamins are often prescribed after surgery to aid in | wound healing and red blood cell formation. |
| Drugs for ______are commonly allowed with a sip of water before surgery | 1) cardiac disease 2) respiratory disease 3) seizures, 4) hypertension |
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