GWCC Block 2 nursing
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| Hypotonic solutions do | move water from vascular system into cells
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| Isotonic solutions do | nothing- water stays in the appropriate compartments
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| Hypertonic solutions do | move water from cells into vascular system
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| Hypertonic is ___ mEq/kg | less than body osmolality at less than 250
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| Isotonic is ___ mEq/kg | 285- 295, equal to body osmolality
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| Hypertonic is ___ mEq/kg | more than body osmolality, 375+
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| ADH | a hormone secreted from the pituitary mechanism that causes the kidney to conserve water
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| ANP | atrial natiuretic peptide, a cardiac hormone found in the atria of the heart that is released when atria are stretched by high blood volume
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| Parathyroid hormone | regulates calcium and phosphate balance.
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| Aldosterone | responsible for renal absorption of sodium, which results in retention of chloride and water.
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| Epinephrine | increases blood pressure, dilates blood vessels needed for emergencies and constricts others.
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| Cortisol | produces sodium and fluid retention, and K deficit
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| A ___ mg/Hg fall in systolic BP when shifting from lying to standing position indicates fluid volume deficit | 20
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| What respiratory signs indicate fluid volume excess? | tachypnea and dyspnea
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| HCT and BUN in hypovolemia | normal or high HCT and BUN
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| HCT and BUN in hypervolemia | low
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| Conditions that cause isotonic overhydration | excess administration of IV fluids, excessive irrigation of body cavities/organs, use of hypotonic fluids to replace isotonic fluid loss. Also corticosteriods, renal and heart failure, high aldosterone levels.
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| Conditions that cause hypotonic over-hydration | aka water intoxication- SAIDH (syndrome of inappropriate antidiuretic hormone hypersecretion), excess water intake, CHF
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| A dehydrated pt should have __mL fluid intake per day | 2000
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| candy and gum can ___ mucous membranes | dry
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| normal BUN | 10-20; BUN is normal or high in FVD
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| normal specific gravity of urine | 1.005- 1.030; high in FVD
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| suppression of PTH results in | FVD
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| Potassium | 3.5 -5
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| Sodium | 135-145
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| Magnesium | 1.5 - 2.5
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| Phosphate (HPO4) | 3.0- 4.5
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| Chloride | 95-108
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| Concentrations of K greater than ___ should never be given in a peripheral vein | 60
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| Concentrations of K greater than ___ can cause pain and irritation in peripheral veins, leading to phlebitis | 8mEq/100mL
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| Do not add K to a ____ | hanging container
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| Administer K at a rate not more than ___ through a peripheral vein | 10mEq/hr
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| Calcium and __ have a reciprocal relationship- when one in higher the other is lower. | phosphate
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| The most dangerous sign of hypocalcemia is | laryngospasm
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| Patients with calcium imbalances may need | seizure precautions
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| SAIDH is the most common cause of __ in hospitals | hyponatremia
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| serum osmolality | 285-295; less than 280 is hypovolemia, more than 300 is hypervolemia
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| When K moves out of cells | H moves in and vice versa
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| Roles of K | regulates fluid volume within a cell; promotes nerve impulses, cx of mucles, acid base balance, enzyme function
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| If ECF K becomes depleted | K moves out of cells and into the ECF
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| an increase in aldosterone levels stimulates and increases excretion of | K
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| On an EKG, hypokalemia results in | flattened T wave and appearance of U wave
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| On an ECG, hyperkalemia results in | tall tented T wave, S-T segment depression, wide QRS wave ("shark teeth")
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| Insuline facilitates movement of | K back into cells from ECF. Giving insulin is one treatment of hyperkalemia
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| Calcium | 8.5- 10.5
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| Most common cause of hypocalcemia | inadequate secretion of PTH
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| Symptoms of hypocalcemia | numbness of fingers, cramps, Trousseu's sign, Chvostek's sign, hyperactive deep tenden reflexes
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| A deficiency in chloride reflects a deficiency in | K
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| serum osmolality | 285-295
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| urine specific gravity | 1.003 - 1.030, OR 3-30
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| Hypocalcemia- Check for__ | rapid labored respirations, stridor= tetany/spasms in the airways, Chvosteks's sign- face twitch, test for deep tendon reflexes with hammer, numbness of extremities.
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| How does hypocalcemia affect the body? (2 things) | Impairs clotting; Hypocalcemia causes lowered threshold of muscle excitement --> spasms, tetany
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| Hyperkalemia, check for s/s | Weakness, fatigue, HR (will be lower than normal),Check ability to move muscle groups against resistance and gravity
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| How does hyperkalemia work in the body? | Prolongs re-polarization period, slows HR, reduces BP; Na builds up, K does not leave cells, depolarization is difficult.
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| How is hyperkalemia treated (esp. in renal patients)? | In renal failure K is not excreted effectively, increases blood K level. Treated with drug therapy
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| Continuous cardiac monitoring |
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| What is SIADH? | Syndrome of inappropriate antidiuretic hormone hypersecretion, excessive release of antidiuretic hormone (ADH). The result is hyponatremia, and sometimes fluid overload.
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| How is SIADH treated? | loop diuretic, hypertonic IV solution, restrict fluid intake, I&O, weigh daily, hyperactive bowel and filud build up in abdomen, monitor LOC frequently, monitor for signs of GI involvement
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| 3 ways the body tries to maintain pH levels | 1.blood buffer pH 7.35-7.45
2.lungs: pco2 35-45 (short term but limited). Breathe faster, blow off acid co2.
3.kidneys: hco3 22-26 (long-term)
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| Respiratory acidosis | not enough breathing, retaining acid. Body accomodates by breathing more. anxiety, hyperventilation, exercise, high altitude, pregnancy, diarrhea,hypoventillation, airway obs, COPD, chest trauma, neuro-muscular disease, drug overdose (pass out).
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| Respiratory alkalosis | breathing too much, try to slow down to not blow off too much acid.
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| anxiety, hyperventilation, |
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| Metabolic acidosis | not enough bicarbonate being produced. renal failure, aspirin overdose, (diarrhea, lose it through their "acid"dosis).
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| Metabolic alkalosis | losing acid, vomiting, suction, Alcoholic throws up, alkalosis, diuretics--> urine is acidic.
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| Isotonic IV salines (2) | 0.9% NaCl (normal saline); LR (Lactated Ringers), like Gatorade. For someone who's healthy but dehydrated, or to go to surgery with.
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| Hypotonic IV fluids | pulls fluid from blood vessels into intracellular spaces, rehydrates cells. 0.45% (1/2 normal saline); D5W (5% dextrose in water)
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| Hypertonic IV fluids | Has more salt. 3% saline; TPN (has so much glucose, NA, lipids, etc). Can only do through central line because of caustic veins. Never D/C TPN because will cause PT to crash, must wean down to saline and then D/C.
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| Osmolality | stuff in blood
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| Osmolarity | stuff in IV bags
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| aldosterone - what does it do? | Holds onto sodium! Aldosterone is a hormone that increases the reabsorption of sodium and water and the release (secretion) of potassium in the kidneys. This increases blood volume and, therefore, increases blood pressure.
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| What to give IV for hyper-K? | Glucose IV with insuline. It will take the K with it and lower K levels in the body.
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| Production of aldosterone is triggered by | low blood volume, low Na, high K, low CO, stress
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| When aldosterone is secreted, what happens to Na, K and H? | Na is held onto. K and H are excreted by kidneys.
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| Loss of skin turger means | dehydration
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| regulation of K excretion depends on (3) | amt of Na available for exchange; number of H ions being excreted, aldosterone levels.
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| Low serum K levels associated with (acidosis or alkalosis) | alkalosis
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| Hig serum levels of K associated with (acidosis or alkalosis) | acidosis
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| Ca and __ are antagonistic | Mg
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| Biggest risk of hypocalcemia | tetany
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| Signs of hypercalcemia | muscle weakness, bradycardia
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