Ch. 18, 21, 26, 30 EKG/ABG/Fluid&electrolytes packet
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| 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
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| 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
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| Signs and symptoms of Hyperkalemia | Bilateral muscle weakness, transient abdominal cramps, diarrhea, dysrhythmias; cardiac arrest if severe
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| Signs and symptoms of Hypokalemia | Bilateral muscle weakness, abdominal distention, decreased bowel sounds, constipation, dysrhythmias
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| Signs and symptoms of Hypernatremia | Decreased level of consciousness (confusion, lethargy, coma), perhaps thirst; seizures if develops rapidly or is very severe
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| Signs and symptoms of Hyponatremia | Decreased level of consciousness (confusion, lethargy, coma); seizures if develops rapidly or is very severe
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| Signs and symptoms of Hypermagnesium | Lethargy, hypoactive deep tendon reflexes, bradycardia, hypotension
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| 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
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| Signs and symptoms of Hypercalcemia | Anorexia, nausea and vomiting, constipation, diminished reflexes, lethargy, decreased level of consciousness, personality change; cardiac arrest if severe
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| 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
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| Normal Lab Value of Na | 135-145
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| Normal Lab Value of K | 3.5-5
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| Normal Lab Value of Mg | 1.5-2.5
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| Normal Lab Value of Ca | 8.9-10.1
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| Normal Lab Value of Bicarbonate | 22-26
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| Normal Lab Value of Phosphate | 2.7-4
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| Normal Lab Value of pH | 7.35-7.45
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| Normal Lab Value of PaCo2 | 35-45
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| Normal Lab Value of PaO2 | 80-100
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| Normal Lab Value of SaO2 | 95%-100%
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| Normal Lab Value of Base | +/- 2 mmol/ L
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| What does increase sodium cause with fluid balance? | Water Retention
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| 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
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| Respiratory Alkalosis | occurs when carbon dioxide levels drop too low. This causes the pH of the blood to rise and become too alkaline
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| Metabolic Acidosis | A condition in which too much acid accumulates in the body.
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| Metabolic Alkalosis | when your body loses too much acid or gains too much base.
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| 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
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| Phlebitis | Inflammation of a vein. w/ redness, tenderness, & warmth along the site
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| 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
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| Types of grief | Normal, Anticipatory, Complicated, Disenfranchised
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| 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)
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| Describe Anticipatory Grief | process of “letting go” before an actual loss or death has occurred
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| 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
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| 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
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| What is Kubler Ross's 5 stages of grief? | Denial, Anger, Bargaining, Depression, Acceptance
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| Describe Denial | Act like nothing has changed. Cannot believe or understand what has happened.
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| Describe Anger | resists the loss, angry about the situation, becomes angry with god.
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| Describe Bargaining | postpones awareness of the loss & tries to prevent it from happening by making deals & promises
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| Describe Depression | Realizes full significance of the loss. Feels overwhelmingly sad or lonely & withdraws from interactions w/ others
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| Describe Acceptance | begins to accept the reality & inevitability of loss & looks to the future
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| What are the types of loss? | Necessary, Actual, Perceived, Maturational, Situational
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| Describe Necessary | Often losses are replaced by something different or better. For example, a person leaves behind family members to begin
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| 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
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| 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
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| 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
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| 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
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| What are the phases of Bowlby Mourning? (4) | Numbing, Yearning & Searching, Disorganization & Despair, Reorganization
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| Describe Numbing | person has extremely intense emotion & feels “stunned” or “unreal”
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| Describe Yearning & Searching | emotional outburst, tearful sobbing, & actue distress. Lasts for months to years.
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| Describe Disorganization & Despair | spends time thinking about how & why the loss happened. often expresses anger at anyone he or she believes to be responsible
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| Describe Reorganization | requires a year or more, the person accepts unaccustomed roles, acquires new skills, and builds new relationships
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| 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
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| Self Transcendence | refers to connecting to your inner self, which allows one to go beyond oneself to understand the meanings of experiences.
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| 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
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| 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)
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| How is oxygen carried through the body? | RBCs
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| What causes pain in the patient when they are having a heart attack | Muscles dying, lack of oxygen
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| Symptoms of Right Sided HF | Distended jugular veins, Peripheral edema
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| Symptoms fo Left Sided HF | Decreased cardiac output, Pulmonary congestion, crackles on auscultation and patient complaints of fatigue, dyspnea, and orthopnea
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| Recite normal electrical pathway of the heart. | SA node–atria–AV node–bundle of His–Purkinje fibers–ventricles
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| 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
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| 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.
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| 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
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| What is Chvostek's Sign? | twitching of the facial muscles in response to tapping over the area of the facial nerve.
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| 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
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| What is Hypoxia? | hypoxia is inadequate oxygen at the cellular level.
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| After load is defined as? | The resistance of the ejection of blood from the left ventricle.
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| What is VAP (ventilator-associated pneumonia) | pneumonia that develops 48 hours after mechanical ventilation via an endotracheal tube or respiratory tract and lung parenchyma
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| Preload is? | amount of blood at the end of ventricular diastole, or measured as end-diastolic pressure.
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| What is Ventilation? | Movement of air in & out of the lungs
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| What is Diffusion? | Movement of gases between air spaces and the bloodstream
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| What is Respiration? | Exchange of oxygen and carbon dioxide during cellular metabolism
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| What is Perfusion? | Movement of blood into and out of the lungs to the organs and tissues of the body.
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| P wave | atrial Depolarization
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| QRS Wave | Ventricular Depolarization
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| T Wave | Ventricular Repolarization
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| What are some aging changes in Muscle contraction | Ventricular wall thickened, collagen increased, and elastin decreased in the heart muscle -- Decreased Cardiac Output
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| What are some aging changes in Blood Flow | Heart valves, especially the mitral and aortic valves, become thicker and stiffen -- Systolic ejection murmur
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| 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
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| 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
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| What are some aging changes in Breathing Mechanics | decreased muscle mass & stength
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| What are some aging changes in Oxygenation | decreased alveolar surface area & decreased CO2 diffusion capacity --Decreased PaO2
Decreased cardiac output
Slightly increased PaO2
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| 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
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| 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
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| 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
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| 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
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| Diffusion | Passive movement of electrolytes or other particles from an area of higher concentration to one of lower concentration
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| Osmosis | Movement of water across a semipermeable membrane from a compartment of lower particle concentration to one that has a higher particle concentration
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| Aldosterone | A Steroid hormone, "the main mineralocorticoid hormone", produced by the outer section of the adrenal cortex in the adrenal gland.
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| ADH | Regulates osmolality of body fluids by influencing how much water is excreted in urine
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| Acidosis | Increased Acidity in blood
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| Alkalosis | Opposite of excess acid
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| Major extracellular electrolyts | Na+, Cl-, Ca+, & HCO3-
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| Major Intracellular Electrolytes | K+, Mg+, P-
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| 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
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| Hypotonic | Lower solute concentration that another solution
Hypo Hippo. Cells can swell & burst if you cause too much fluid to move into cells
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| Colloids | Act as plasma expanders to help maintain protein balance & colloid osmotic pressure
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| 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
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| The respiratory system compensates for changes in the pH level by responding to changes in the levels of: | CO2
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| 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
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| All of the following might be a cause of respiratory acidosis except: A. Sedation B. Head trauma C. COPD D. Hyperventilation | D - Hyperventilation
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| 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
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| Clincal Dehydration | Loss of body water, with or without salt, at a rate greater than the body can replace it
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