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metabolic exam 2
| Question | Answer |
|---|---|
| What are age-related considerations in fluid imbalance for older adults? | - decreased muscle mass, less total body water than younger adults - decreased turgor - decreased glomerular filtration - reduced thirst reflex - adrenal atrophy |
| what are dietary considerations for clients following a low potassium diet | -limit foods high in potassium such as bananas, oranges, dried fruits, potatoes, tomatoes, salt substitutes containing potassium -encourage low potassium options like apples, grapes, berries, leafy greens, and lean meats. |
| clinical manifestations of hyponatremia | - cerebral changes -neuromuscular changes -intestinal changes - cardiovascular changes |
| Causes of Hyponatremia | -GI fluid loss -vomiting -diarrhea -excessive diaphoresis -diuretics - large burns -psychiatric disorders with polydipsia |
| risk factors for hyponatremia | -can occur with actual loss of sodium OR dilution via fluid excess -liver cirrhosis -use of antidiuretics |
| what is the normal value for sodium? | 136-145 |
| What lab value indicates hyponatremia ? | <136 |
| What lab value indicates Hypernatremia | >145 |
| Treatment for hyponatremia | -drug therapy : reduce meds that increase sodium loss like diuretics. -nutrition therapy: increase oral sodium intake and restrict oral fluid intake. |
| nursing considerations/actions for hyponatremia | - monitor patients response to therapy -prevent hypernatremia and fluid overload |
| What are older adult considerations for hyponatremia? | older adults are prone to hyponatremia due to decreased renal function, impaired thirst reflex, and use of medications like diuretics. |
| clinical manifestations of hypernatremia | -altered cerebral function -muscle twitching -decreased cardiac contractility |
| what are causes of hypernatremia ? | -hyperaldosteronism -kidney failure -corticosteroids -cushing syndrome/disease -excessive oral intake of sodium -excessive admin of sodium containing IV fluids |
| Risk factors for hypernatremia | -older adults / infants - those with decreased fluid intake or excessive fluid loss (vomiting/diarrhea) -pts on meds like diuretics, laxatives -excessive burns -kidney disease |
| treatment for hypernatremia ? | drug therapy- if caused by fluid loss, restore fluids. If caused by inadequate kidney excretion of sodium, diuretics like furosemide that promote sodium loss are needed. nutrition therapy- adequate water intake, sodium restrictions. |
| complication of hypernatremia? | -confusion -hypotension -tachycardia -acute kidney injury |
| older adult considerations for hypernatremia | - use of medications like diuretics that cause fluid loss -decreased thirst reflex -renal impairment -decreased total body water content making them more susceptible to changed in serum sodium |
| Normal lab value for potassium ? | 3.5-5 |
| what lab value indicates hypokalemia ? | <3.5 |
| clinical manifestations of hypokalemia? | -cardiac dysrhythmias -respiratory deficiency -abdominal distention |
| Causes of hypokalemia? | -inappropriate or excessive use of drugs: diuretics/corticosteroids -increased secretion of aldosterone -vomiting/diarrhea -wound drainage (esp GI) -water intoxication |
| risk factors for hypokalemia | -meds: loop diuretics, thiazides, corticosteroids, -metabolic alkalosis -magnesium deficiency impairing potassium reabsorption |
| treatment for hypokalemia? | drug therapy: small volume infusion of hypertonic saline (3%) Nutrition therapy: increase oral sodium intake via supplement and diet |
| older adult considerations for hypokalemia? | -older adults are more likely to use meds like loop diuretics which cause potassium loss |
| treatment for hypokalemia ? | drug/nutrition therapy: ka+ oral supplements, or high ka+ diet. for severe hypokalemia, Ka+ can be given through IV, NEVER IV PUSH, SUBCUT, OR IM. When giving ka+ through IV recheck solution to ensure proper dilution, assess site hourly for burning/pain |
| nursing considerations for hypokalemia | -assess respiratory status hourly -assess IV site hourly if giving ka+ iv -implement safety measures for weakened clients - determine fall risk |
| complications of hypokalemia | -respiratory acidosis -polyuria -Afib -V Tach |
| Lab value indicative of hyperkalemia | >5 |
| Clinical manifestations of hyperkalemia? | -palpitations, skipped heartbeats -cardiac irregularities -muscle twitching -leg weakness, tingling or numbness -diarrhea |
| causes of hyperkalemia | -excessive intake of potassium: salt substitutes, potassium chloride -rapid ka+ infusion -kidney failure -transfusions of whole blood / packed cells -adrenal insufficiency |
| risk factors for hyperkalemia | -tissue damage -acidosis -hyperuricemia -uncontrolled diabetes mellitus |
| treatments for hyperkalemia ? | Drug therapy: PATIROMER is used to decrease absorption of potassium, aiding in decreasing potassium levels. Nutrition therapy: low potassium diet, stop potassium supplements, |
| nursing considerations for hyperkalemia | -cardiac monitoring allows for early detection of dysrhythmias and other symptoms of hyperkalemia on the cardiac muscle. -health teaching is key to prevention of hyperkalemia and early detection of complications. |
| complications of hyperkalemia | -life-threatening arrythmias -paralysis of respiratory muscles (extreme cases) -hyperactive bowels |
| older adult considerations | -decreased kidney function -dehydration -conditions like diabetes mellitus, heart failure, adrenal insufficiency |
| normal lab value for magnesium | 1.3-2.1 |
| lab value indicative of hypomagnesemia | <1.3 |
| clinical manifestations of hypomagnesemia ? | -cardiac changes: hypertension, atherosclerosis, dysrhythmias -increased nerve impulse transmission, hyperactive deep tendon reflexes -GI changes, decreased motility, constipation, anorexia |
| causes of hypomagnesemia | -malnutrition -starvation -diarrhea -steatorrhea -acute pancreatitis -celiac/crohns disease -alcohol use disorder -uncontrolled diabetes |
| treatments for hypomagnesemia | -drugs that promote magnesium loss are stopped (loop diuretics osmotic diuretics, aminoglycoside antibiotics, drugs containing phosphorus) -magnesium is replaced via IV in severe cases with magnesium sulfate |
| nursing considerations for hypomagnesium | -assess deep tendon reflexes hourly |
| complications of hypomagnesemia | -tetany -seizures |
| older adult considerations for hypomagnesemia | -decreased dietary intake -impaired absorption -malnutrition |
| lab value indicative of hypermagnesemia | >2.1 |
| clinical manifestations of hypermagnesemia | cardiac changes: bradycardia, hypotension, cardiac arrest (severe) -depressed nerve impulse transmission: pt may be drowsy /lethargic. reduced or absent deep tendon reflexes |
| treatment for hypermagnesemia | -treat cause of imbalance -reduce serum levels -magnesium free iv fluid -furosemide can help reduce levels -if pt has severe cardiac issues, giving calcium may reverse cardiac effects |
| causes of hypermagnesemia ? | -increased magnesium intake: magnesium antacids / laxatives -IV magnesium replacement -decreased kidney excretion of magnesium as a result of kidney disease |
| risk factors for hypermagnesemia | -chronic kidney disease -excessive magnesium intake -medications like lithium -adrenal insufficiency /hypoparathyroidism affecting magnesium regulation |
| complications of hypermagnesemia | -loss of deep tendon reflexes -muscle weakness, extreme cases respiratory depression -electrolyte imbalances: hypocalcemia, hypokalemia |
| normal lab value of calcium | 9-10.5 |
| lab value indicative of hypocalcemia | <9 |
| clinical manifestations of hypocalcemia | -frequent, painful muscle spasm in calf or foot -paresthesia (numbness/tingling) -cardiac changes: slower or faster weak thready pulse. hypotension intestinal and skeletal changes. |
| causes of hypocalcemia | -inadequate oral intake -lactose intolerance -malabsorption syndromes: celiac/crohns -inadequate vitamin d intake -end stage kidney disease |
| risk factors of hypocalcemia | -hypoparathyroidism or parathyroid gland dysfunction -vitamin d deficiency - pancreatitis -renal failure impairing calcium reabsorption |
| treatments for hypocalcemia | drug therapy: direct calcium replacement (IV or Oral), and drugs that enhance absorption like vitamin d. nutrition therapy: promote calcium rich diet like milk, yogurt cheese, leafy greens, orange juice, cereal |
| nursing considerations | -Assess for hypocalcemia by testing for trousseau and chvosteck signs - reduce stimulation by providing a quiet environment, dimming lights, limiting visitors. hypocalcemia causes overstimulation |
| complications of hypocalcemia | -osteopenia -irritability -muscle cramps |
| older adult considerations for hypocalcemia | -decreased dietary intake of calcium -impaired absorption -meds like diuretics |
| lab value indicative of hypercalcemia | >10.5 |
| clinical manifestations of hypercalcemia | -cardiovascular changes: bradycardia, poor perfusion -muscle weakness, decreased deep tendon reflexes -decreased peristalsis, constipation |
| causes of hypercalcemia | -excessive oral intake of calcium - excessive oral intake of vitamin d - chronic kidney disease -use of thiazide diuretics |
| risk factors for hypercalcemia | -hyperparathyroidism -immobilization (excessive bedrest) - hyperthyroidism - malignancy -dehydration |
| treatments for hypercalcemia | drug therapy: stop drugs that raise calcium. Give 0.9% normal saline, which helps kidneys excrete calcium. discontinue thiazide diuretics, start furosemide (diuretic that promotes excretion) drugs to prevent calcium resorption : phosphorus |
| nursing considerations for hypercalcemia | -cardiac monitoring is needed to identify dysrhythmias and decreased cardiac output |
| complications of hypercalcemia | -polyuria --polydipsia -kidney stones -arrythmias -bone pain |
| older adult considerations for hypercalcemia | -impaired renal function -increased bone resorption -release of calcium from bones |
| clinical manifestations of fluid deficit / hypovolemia | -thirst, dry mucous membranes -decreased urine output -dizziness, weakness, fatigue -TACHYCARDIA, HYPOTENSION -confusion, lethargy (severe cases) -decreased skin turgor |
| causes of fluid volume deficit /hypovolemia | -excessive fluid loss (vomiting, diarrhea, sweating, burns) -inadequate fluid intake -Meds (diuretics, laxatives) - underlying medical conditions (diabetes, conditions) |
| treatment for fluid volume deficit/ hypovolemia | -fluid replacement (oral or IV) -electrolyte correction - treatment of underlying condition - monitoring intake/output -adjust meds -patient educations |
| what fluid is most commonly used in treatment of hypovolemia | crystalloid normal saline (0.9%) <-- THIS IS TOP OPTION lactated ringers is also used |
| nursing interventions/considerations for hypovolemia? | MOST IMPORTANT- monitor pulse rate/quality and urine output -assess for dehydration -monitor vitals, weight, I/O -encourage oral fluid intake -Administer oral fluids/electrolytes as prescribed -provide skincare/mouthcare -educate pt/family on fluid |
| expected lab values for hypovolemia | -electrolyte imbalances -increased hematocrit and hemoglobin -decreased intravascular volume |
| complications of hypovolemia | -electrolyte imbalance -acute kidney injury -seizures, coma -hypovolemic shock -organ failure |
| causes of hypervolemia | -excessive fluid intake -impaired renal function -heart failure -liver disease -sodium retention -medications (corticosteroids) |
| treatment of hypervolemia | -fluid restriction -diuretics -sodium restriction -treatment of underlying cause -oxygen therapy -positioning -compression stockings -monitor I/O |
| nursing considerations/interventions | -assess signs of fluid overload -monitor vitals, I/O, weight -administer diuretics and fluid restrictions -provide skincare , reposition frequently -educate on sodium and fluid restrictions -collaborate with interprofessional team |
| clinical manifestations of fluid volume excess / hypervolemia | -weight gain -edema (peripheral, pulmonary) -distended neck veins (JVD) -shortness of breath -hypertension -decreased urine output |
| complications of hypervolemia | -pulmonary edema -congestive heart failure -electrolyte imbalance -impaired gas exchange -skin breakdown -increased risk of infections |
| expected lab values for hypervolemia | -increased intravascular volume -dilution of electrolytes -decreased hematocrit and hemoglobin |
| what are some health promotion / interventions to promote normal elimination pattern? | -adequate nutrition / hydration -high fiber diet - toilet or void promptly - bulk-forming agents / stool softeners - exercise |
| what causes non-mechanical bowel obstructions (paralytic ileus) | -decrease / absence of intestinal motility (peristalsis) - commonly occurs after surgery -electrolyte disturbances (hypokalemia) put pt at risk -intestinal ischemia (vascular insufficiency) |
| prevention for non-mechanical bowel obstruction (paralytic ileus) | prevent constipation: -high fiber diet -adequate fluid intake -regular exercise -stool softener (if necessary) |
| clinical manifestations of non-mechanical bowel obstruction (paralytic ileus) | -abdominal distention -abdominal pain/discomfort -nausea/vomiting - lack of gas and stool - absent/diminished bowel sounds |
| nursing interventions/considerations for paralytic ileus | -monitor abdominal distention, bowel sounds, I/O, nausea vomiting -restrict oral intake until bowel function returns -encourage early ambulation to promote peristalsis -monitor fluid/electrolyte status -maintain IV therapy |
| pathophysiology of benign prostatic hyperplasia | -glandular units in the prostate undergo nodular tissue hyperplasia (abnormal tissue growth) |
| clinical manifestations of benign prostatic hyperplasia | -difficulty in starting urination (hesitancy) and continuing - weak urine stream -sensation of incomplete bladder emptying -straining to begin urination -postvoid dribbling or leaking -possible hematuria |
| etiology and genetic risk of benign prostatic hyperplasia | unmodifiable : race, genetic susceptibility, family history of cancer. (family history of bladder cancer are at risk) modifiable: -obesity -metabolic syndrome (hypertension + hyperlipidemia etc) -beverage consumption - physical activity |
| complications of BPH | -urinary retention -hematuria -bladder stones -kidney damage -bladder muscle damage |
| pharmacological treatments for BPH | ALPHA-BLOCKER: Flomax/tamsulosin, Cardura/doxazosin alpha-blockers have side effect of orthostatic hypotension 5 alpha-reductase inhibitors : Propecia/finasteride |
| surgical treatments for BPH | TURP: transurethral resection of the prostate. -3 way bladder irrigation. urine will appear pink hued -bag needs emptied VERY often -if dark blood is present that is serious but if blood is color of ketchup that indicates arterial bleed URGENT matter. |
| What meds do you NOT give a BPH patient and why? | -anticholinergic -antihistamine -antipsychotics -muscle relaxants *THESE MEDS CAUSE URINARY RETENTION so don't give to someone with urinary retention duh |
| Lab and diagnostic tests for BPH? | PSA: prostate specific antigen TRUS: transrectal ultrasound |
| What is intussusception in children? | -intestine telescopes/folds into another portion causing intestinal obstruction. symptoms: -abdominal pain -vomiting -bloody stool -sausage shaped mass may be palpable |
| causes of urinary retention ? | -BPH -UTIs -urethral obstruction -medications (anticholinergics, antipsychotics, antidepressants, opioids ) |
| complications of urinary retention? | -UTI -bladder stones -bladder muscle damage -overflow incontinence -kidney damage -urinary tract rupture |
| clinical manifestations of diverticulosis? | -small pouches (diverticula) in lining of digestive system -may have no symptoms -may have abdominal pain, fever, tachycardia, nausea, vomiting |
| causes of diverticulosis | -inadequate fiber, resulting in hardened stools + constipation - aging |
| risk factors for diverticulosis | -older age -obesity - inadequate fiber intake |
| complications of diverticulosis | DIVERTICULITIS: inflammation of the pouches (diverticula) resulting in abdominal pain, fever, tachycardia, hypotension |
| pharmacological treatment of diverticulitis | If infection is present broad spectrum antimicrobials like Metronidazole, trimethoprim/sulfamethoxazole, and ciprofloxacin are given. laxatives and enemas are contraindicated (not given) due to causing motility |
| surgical treatments for diverticulosis / diverticulitis | laparotomy can be performed in serious cases with addition of colostomy |
| what dietary differences are made between diverticulosis and diverticulitis | Diverticulitis: LOW FIBER, we want to decrease motility, it is painful for pt Diverticulosis: HIGH FIBER, we want to promote regular bowel movements |
| Calcium regulation/ absorption part 1 | - enters via dietary intake, absorbed in intestinal tract -absorption requires active vitamin d -body calcium stored in bones -PTH released from parathyroid releases body calcium from bone -stimulating vitamin d activation |
| calcium regulation /absorption part 2 | -inhibiting kidney excretion of vitamin d -stimulating kidney calcium reabsorption |
| dietary considerations for patients needing calcium | -increase intake of milk, cheese, yogurt -leafy greens -calcium rich beans -almonds ,sesame seeds vitamin d from foods like : fatty fish, egg yolks, or supplements |
| Common causes of dehydration in children ? | -diarrhea -vomiting -poor oral intake (breastmilk, formula) -hot weather / sweating |
| what are clinical manifestations of mild/moderate dehydration in infants ? | -<6 wet diapers in 24hrs -dark colored urine -tearless crying -dry-sticky mouth/lips -irritability, more sleepy than usual |
| what are clinical manifestations of severe dehydration in infants? | -sunken eyes, fontanel (soft spot), or cheeks -cold or splotchy hands/feet -rapid breathing or heart rate -no wet diapers for 3hrs or more -unresponsive or extremely drowsy, difficult to wake |
| what is the fluid overload intervention acronym ? | DRAIN D-Diuretics R-restrict fluids / salt A-assess daily weights I- intake/output (strict measurements) N-Na (sodium) levels monitored |
| Antidiarrheal medication | -Imodium/loperamide -by mouth/oral -antidiarrheal agent -indication: control/relieve diarrhea -side effects: nausea/vomiting, bloating, blood in stool |
Created by:
Katelynsw27
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