NUR 213 > Module 1 > Flashcards

Module 1 Flashcards

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1
Q

Fluid Volume Deficit (FVD): water and electrolytes lost in (BLANK) proportion

A

Same proportion

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2
Q

Dehydration: loss of (BLANK) (BLANK) with increased (BLANK) levels

A

Loss of fluid alone with increased sodium levels

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3
Q

What electrolyte imbalance is always present in dehydration?

A

Hypernatremia

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4
Q

What is third spacing? What does it cause?

3 symptoms

A
  • Fluid shifting from the vascular space to other area
  • Causes edema, reduced cardiac output, and hypotension
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5
Q

What is the most common cause of fluid loss?

A

Loss of GI fluids

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6
Q

What are risk factors for FVD/Dehydration?

11

A
  • NPO status
  • Dysphagia
  • Lack of water
  • Inaccurate fluid replacement compared to loss
  • Fluid shifts d/t burns, DI, etc.
  • N/V/D
  • Burns
  • Acute or chronic renal failure
  • Hemorrhage
  • DKA
  • Diuretic use
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7
Q

What are EARLY manifestations of FVD/dehydration?

5

A

- Thirst
- Dry mucous membranes
- Decreased urine output
- Concentrated urine
- Fatigue/weakness

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8
Q

What are LATE manifestations of FVD/Dehydration

8

A
  • Hypotension
  • Tachycardia
  • Delayed cap refill
  • Poor skin tugor
  • Cool/clammy skin
  • Lethargy/weakness
  • Weight loss
  • Suhnken eyes
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9
Q

What lab values are altered in FVD?

4

A
  • Increased hematocrit
  • Increased BUN
  • Increased Serum Osmolality
  • Increased urine specific gravity
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10
Q

What lab values are altered for dehydration?

5

A
  • Hypernatremia
  • Increased Osmolality
  • Increased hematocrit
  • Increased BUN
  • Increased urine specific gravity
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11
Q

What are interventions for FVD/dehydration?

4

A
  • Replace fluids (oral THEN IV)
  • Monitor VS and electrolytes
  • Treat underlying cause
    **- Fall precautions
  • I&O/Daily Weights**
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12
Q

What is the preferred IV fluid for FVD/dehydration?

A

Lactated Ringers

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13
Q

True or false: manifestations are easy to recognize in older adults with FVD

A

False, manifestations are often hard to recognize

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14
Q

What can cause FVE?

10

A

- Stress responses before, during, and after surgery
- Heart failure
- Cirrhosis of liver
- Renal failure
- Adrenal gland disorders
- Corticosteroids
- Pregnancy
- Excessive intake of sodium-containing foods
- Drugs that cause sodium retention
- Excess amounts of sodium containing IV fluids

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15
Q

What are risk factors of FVE?

7

A
  • Preeclampsia
  • Heart disease
  • Kidney dysfunctions
  • Diabetes with PVD
  • HTN
  • IV therapy
  • Polydipsia
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16
Q

What are manifestations of FVE?

10

A

- Weight gain of >5% of body weight
- Full bounding pulse
- Distended neck/peripheral veins
- Cough, dyspnea, orthopnea
- Moist crackles in lungs
- Polyuria
- Ascites
- Peripheral edema
- Decreased hematocrit and BUN
- Cerebral edema
- Heart failure

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17
Q

What are diagnostic tests for FVE?

8

A
  • BNP (CHF rule out)
  • Echocardiogram
  • ECG
  • CXR for pulmonary edema
  • H/H
  • Serum electrolytes
  • Serum osmolality
  • Tests of renal and liver function
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18
Q

What are interventions for FVE?

4

A
  • Fluid Restrictions
  • Strict I&O/Daily Weight
  • Sodium restricted diet
  • Elevate lower extremities/areas of edema
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19
Q

True or False: when one electrolyte is unbalanced, other electrolytes are normally unbalanced too

A

True

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20
Q

What are risk factors for Hyponatremia?

9

A
  • Excess free water intake (hypotonic IV fluids, polydipsia)
  • SIADH
  • Diuretics
  • GI losses
  • Renal failure
  • Heart failure
  • Liver disease
  • Post-operative state
  • Older adults
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21
Q

What are signs and symptoms of mild/moderate hyponatremia?

7

A
  • N/V
  • Headache
  • Fatigue
  • Muscle cramps
  • Confusion
  • Weakness
  • Decreased reflexes
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22
Q

What are signs and symptoms of severe hyponatremia?

5

A
  • Seizures
  • Altered mental status
  • Coma
  • Respiratory arrest
  • Cerebral edema
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23
Q

What are nursing interventions for hyponatremai?

7

A
  • Seizure precautions
  • Assess neuro status
    - Fluid restriction
  • Administer IV fluids as ordered (isotonic saline 0.9%, hypertonic saline 3 %)
  • Strict I&O/Daily Weights
  • Treat underlying cause (ex. SIADH)
    - Avoid rapid correction (risk of osmotic demyelination)
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24
Q

What labs are altered in hyponatremia?

4

A
  • Decreased serum sodium
  • Decreased serum osmolality
  • Increased urine sodium and osmolality in SIADH
  • Possible decreased BUN/Creatinine
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25
What are diagnostic procedures for hypoanatremia? | 5
- Serum electrolyte panel - Serum osmolality - Urine sodium/osmolality - Neuro assessment - Daily weights
26
What patient education is indicated for hyponatremia? | 6
- Follow prescribed fluid restrictions - Avoid excessive water intake - Recognize recurring symptoms (HA, confusion, N/V) - Medication adhernce (diuretics/SIADH treatment) - Importance of lab monitoring - Seek immediate care for seizure, severe confusion, or sudden mental status changes)
27
What are potential complications of hyponatremia? | 6
- Cerebral edema - Seizures - IICP - Coma - Respiratory failure **- Osmotic demyelination syndrome from rapid correction**
28
What are risk factors for hypernatremia? | 10
- Inadequate water intake (older adults, Infants, NPO status) - Fever - Excessive sweating - N/V/D - Diabetes insipidus - Osmotic diuresis - Diuretics - Burns - Enteral feedings without free water - Excess sodium intake
29
What are early signs of hypernatremia? | 5
- Thirst - Dry mucous membranes - Decreased urine output - Dark, concentrated urine - Restlessness
30
What are signs of moderate/severe hypernatremia? | 10
- Tachycardia - Orthostatic hypotension - Irritability - Muscle twitching - Weakness - Altered mental status - Seizures - Coma - Decreased skin turgor - Signs of dehydration
31
What are nursing interventions for hypernatremia? | 8
- Assess neuro status - Assess hydration status - Replace free water SLOWLY (oral fluids, then IV hypotonic fluids) - Strict I&O/Daily weights - Monitor serum sodium - Treat underlying cause - Avoid rapid sodium correction (cerebral edema) - Seizure precautions if severe
32
What labs are altered in hypernatremia? | 5
- Increased serum sodium - Increased serum osmolality - Increased urine specific gravity - Increased hematocrit - Increased BUN
33
What are diagnostic procedures for hypernatremia? | 5
- Serum electrolyte panel - Serum osmolality - Urine osmolality and specific gravity - I&O/Daily weights - Neuro assessments
34
What patient educations is indicated for hypernatremia? | 6
- Drink fluids regularly, not just when thirsty - Increase water intake during heat exposure, illness, exercise - Proper management of DI - Avoid excessive sodium intake if at risk - Recognize early symptoms (thirst, confusion) - Seek care for severe weakness, altered mental status, seizures
35
What are complications of hypernatremia? | 6
- **Cerebral hemorrhage** - **Seizures** - Coma - Dehydration - AKI - **Cerebral edema**
36
What are risk factors for hypokalemia? | 9
- GI Losses (N/V/D, NG suction) - Diuretic use - Osmotic diuresis - Inadequate potassium intake - Excess insulin - Metabolic alkalosis - Corticosteroid use - Prolonged NPO status - Excessive sweating
37
What are signs of hypokalemia? | 14
- **Muscle weakness** - Fatigue - Leg cramps - Decreased reflexes - Paralysis - **Dysrhythmias** - **Weak, irregular pulse** - ECG changes (**flat T waves**) - Decreased bowel sounds - Constipation - Ileus - N/V - Polyuria - Increased sensitivity to digoxin
38
What are nursing interventions for hypokalemia? | 8
- **Assess cardiac rhythm (continuous ECG)** - Assess neuromuscular status - **Replace potassium (oral, then IV)** - Monitor potassium levels - Monitor renal function - Encourage potassium rich foods - **Hold potassium wasting diuretics** - Implement fall precautions
39
What are safety considerations for IV Postassium? | 3
- Never push IV - Dilute and infuse slowly - Use infusion pump
40
What lab values are altered in hypokalemia? | 3
- Decreased serum potassium - Possible decreased magnesium - Possible metabolic alkalosis
41
What are diagnostic procedures for hypokalemia? | 5
- Serum electrolyte panel - ECG monitoring - Renal function tests - Urine potassium levels - Medication review (diuretics, insulin, etc)
42
What patient education is indicated for hypokalemia? | 6
- Eat potassium rich foods - Take potassium supplements - Report muscle weakness, palpitations, etc. - Proper diuretic use - Avoid excessive laxative use - Importance of follow up lab monitoring
43
What are examples of potassium rich foods? | 5
- Bananas - Oranges - Potatoes - Spinach - Avocados
44
What are complications of hypokalemia? | 6
- **Life-threatening dysrhythmias** - Respiratory muscle weakness - Paralytic ileus - Rhabdomyolysis - Increased digoxin toxicity - Cardiac arrest
45
What are risk factors for hyperkalemia? | 11
- AKI or CKD - Oliguria/anuria - Potassium sparing diuretics - ACE inhibitors/ARBs - NSAIDs - Excessive potassium intake (salt substitutes, supplements, etc.) - Metabolic acidosis - Tissue breakdown (burns, trauma, rhabdomyolysis) - DKA - Blood transfusions - Adrenal insufficiency
46
What are signs and symptoms of hyperkalemia? | 9
- Muscle weakness - Paresthesias - Flaccid paralysis - **Dysrhythmias** - **Bradycardia** - Weak or absent pulse - **ECG changes (tall, peaked T waves; widended QRS; Prolonged PR)** - N/V/D - Abdominal cramping
47
What are nursing interventions for hyperkalemia? | 9
- **Continuous ECG** - **IV calcium gluconate** - **Insulin and glucose** - Loop diuretics - Kayexalate - Hemodialysis - Restrict potassium - Stop potassium-increasing meds - Monitor potassium frequently
48
What labs are altered in hyperkalemia? | 3
- Increased serum potassium - Possible metabolic acidosis - Possible increased BUN/creatinine
49
What diagnostic procedures performed for hyperkalemia? | 6
- Serum electrolyte panel - Continuous ECG monitoring - Renal function tests - ABGs (acidosis ruleout) - Review medications and intakes - Urine output assessments
50
What is patient education for hyperkalemia? | 5
- Avoid high-potassium foods - **Avoid salt substitutes** - Recognize and report palpitations/muscle weakness - Importance of lab monitoring - Seek immediate care for chest pain, severe weakness, or irregular heartbeat
51
What are complications of hyperkalemia? | 5
- **Life-threatening dysrhythmias** - Ventricular fibrillation - Asystole - Cardiac - Sudden death
52
What are risk factors for hypocalcemia? | 11
- Hypoparathyroidism - Thyroid/parathyroid surgery - Vitamin D deficiency - CKD - Acute pancreatitis - Massive blood transfusions - Low magnesium levels - Malabsorption syndromes - Loop diuretics - Anticonvulsants - Biphosphonates
53
What are signs andsymptoms of hypocalcemia? | 11
- **Tingling** - **Muscle cramps** - **Tetany** - Hyperreflexia - **Chvostek's sign** - **Trousseau's sign** - Prolonged QT interval - Dysrhythmias - **Seizures** - Laryngospasm - Bronchospasm
54
What are nursing interventions for hypocalcemia? | 7
- Assess neuro status - **Seizure precations** - **Oral calcium, IV calcium for severe** - ECG monitoring - Vitamin D supplementations - Magnesium replacement - Encourage calcium rich diet
55
What labs are altered in hypocalcemia? | 4
- Decreased serum calcium - Possible decreased PTH - Possible decreased Vit. D - Possible decreased magnesium
56
What diagnostic procedures are performed for hypocalcemia? | 6
- Serum calcium - Serum magnesium and phosphate - Vitamin D levels - PTH levels - ECG monitoring - History of neck surgery/renal disease
57
What patient education is indicated in hypocalcemia? | 5
- Eat calcium-rich foods (dairy products, leafy green vegetables, fortified foods) - Take calcium and vitamin D supplements as prescribed - Recognize early symptoms (tingling, muscle cramps) - Avoid excessive caffience - Seek care for muscle spasms, seizures, difficulty breathing
58
What are complications of hypocalcemia? | 6
- **Tetany** - **Seizures** - Cardiac dysrhythmias - Laryngospasm leading to airway compromise - Heart failure - Osteoporosis
59
What are risk factors of hypercalcemia? | 9
- **Hyperparathyroidism** - **Malignancy** - Prolonged immobility - Excess calcium/vitamin D intake - **Thiazide diuretics** - Lithium therapy - Paget's disease - Dehydration - Adrenal insufficiency
60
What are signs and symptoms of hypercalcemia? | 17
- **Muscle weakness** - Decreased reflexes - Fatigue - **Constipation** - N/V - Abdominal pain - Decreased bowel sounds - **Kidney stones** - Polyuria - Polydipsia - Shortened QT interval - Dysrhythmias - HTN - Confusion - Lethargy - Depression - Coma
61
What are nursing interventions for hypercalcemia? | 9
- Assess neuro status - Cardiac monitoring - **IV isotonic fluids** - Loop diuretics - Promote mobility - Biphosphonates - Calcitonin - Monitor I&O - **Avoid thiazide diuretics**
62
What labs are altered in hypercalcemia? | 4
- Increased serum calcium - Possible decreased PTH - Possible increased phosphate - Possible increased BUN/Creatinine
63
What are diagnostic procedures for hypercalcemia? | 7
- Serum calcium - PTH levels - Phosphate levels - Renal function tests - ECG monitoring - Imaging for malignancies - Bone density tests
64
What patient education is indicated in hypercalcemia? | 6
- Avoid calcium and vitamin supplements - Increase oral fluid intake - Stay active to prevent bone calcium release - Recognize symptoms (constipation, confusion, muscle weakness) - Medication adherence (biphosphonates, calcitonin) - Seek care for severe confusion, palpitations, decreased urine output
65
What are complications of hypercalcemia? | 7
- **Kidney stones** - Cardiac dysrhythmias - AKI - Dehydration - Pathologic fractures - Coma - Cardiac arrest
66
What are risk factors for hypomagnesmia? | 11
- **Chronic alcohol use** - **Malnutrition** - Prolonged NPO - GI losses - Loop and thiazide diuretics - Nephrotoxic drugs - Uncontrolled diabetes leading to osmotic diuresis - Post-op patients - Pancreatitis - Burns - Older adults
67
What are signs and symptoms of hypomagnesmia? | 13
- Tremors - Muscle cramps - Hyperreflexia - Tetany - **Positive Chvostek** - **Positive Trousseau** - Seizures - Palpitations - **Dysrhythmias (torsades de pointes)** - Prolonged QT interval - Irritability - Confusion - Anxiety/Depression
68
What are nursing interventions for hypomagnesmia? | 8
- Cardiac monitoring - **Seizure precautions** - PO or IV magnesium - **Administer IV magnesium SLOWLY (prevent hypotension)** - **Monitor DTRs** - Assess renal function prior to replacement - Correct associated imbalances (hypokalemia, hypocalcemia) - Monitor magnesium levels
69
What labs are altered in hypomagnesmia? | 2
- Decreased serum magnesium - Often **low potassium and calcium**
70
What are diagnostic procedures for hypomagnesmia? | 4
- Serum magnesium level - ECG - Electrolyte panel - Renal function tests
71
What patient education is indicated for hypomagnesmia? | 5
- Increase magnesium rich foods - **Avoid excessive alcohol** - Take supplements as prescribed - Report muscle twitching, palpitations, weakness - Adherence to follow up labs
72
What foods are high in magnesium? | 4
- Leafy greens - Nuts and seeds - Whole grains - Legumes
73
What are potential complications of hypomagnesmia? | 5
- **Life threatening cardiac dysrhythmias** - **Seizurs** - **Tetany** - Persistant hypokalemia/hypocalcemia - Increased mortality in critically ill patients
74
What are risk factors of hypermagnesmia? | 7
- **Renal failure** - **Excessive magnesium intake (antacids, laxatives)** - IV magnesium therapy (preeclampsia tx) - Older adults - Dehydration - Hypothyroidism - Adrenal insufficiency
75
What are signs and symptoms of hypermagnesmia? | 12
- **Decreased or absent DTRs** - Muscle weakness - Flaccid paralysis - **Bradycardia** - **Hypotension** - Heart block - Cardiac arrest - **Respiratory depression** - Lethargy - Drowsiness - Confusion - Coma
76
What are nursing interventions for hypermagnesmia? | 8
- Stop magnesium-containing medications - Continuous cardiac monitoring - **Monitor respiratory status** - **Assess DTRs** - **Administer IV calcium gluconate** - Promote magnesium excretion (IV fluids, loop diuretics) - Dialysis - Monitor magnesium levels
77
What are diagnostic procedures for hypermagnesmia? | 4
- Serum magnesium level - ECG - Renal function tests - ABGs (if respiratory depression)
78
What patient education is indicated in hypermagnesmia? | 4
- **Avoid magnesium-containing antacids/laxatives** - Read OTC medication labels carefully - Report weaknes, drowsiness, slowed HR, difficulty breathing - Importance of routine labs
79
What are potential complications of hypermagnesmia? | 4
- **Respiratory failure** - Life threatening cardiac dysrhythmias - Cardiac arrest - Coma
80
What are risk factors for prerenal AKI? | 6
- Hypovolemia - Hypotension, shock - Heart failure - Sepsis - Overuse of diuretics - NSAIDs, ACE inhibitors
81
What are risk factors for intrarenal AKI? | 5
- Nephrotoxic drugs (aminoglycosides, contrast dye, chemo) - Prolonged ischemia - Glomerulonephritis - Acute tubular necrosis (ATN) - Rhabdomyolosis
82
What are risk factors for postrenal AKI? | 5
- BPH - Kidney stones - Tumors - Urethral stricture - Clot obstruction
83
What are signs and symptoms of AKI? | 14
- Oliguria - Anuria - Dark, concentrated urine - Edema - Weight gain - Pulmonary edema - HTN - Hyperkalemia - Metabolic acidosis - Hyponatremia - Fatigue - Confusion - N/V - Pruritus
84
What are nursing interventions for AKI? | 9
- **Strict I&O/Daily Weights** - Monitor labs - IV fluids for prerenal AKI - **Fluid restriction if overloaded** - Administer diuretics if volume overloaded - Postassium lowering therapies - **Avoid nephrotoxins** - Prepare for dialysis - Monitor cardiac rhythm
85
What labs are altered in AKI? | 5
- **Increased creatinine** - **Increased BUN** - Increased potassium - **Decreased GFR** - Possible metabolic acidosis
86
What are diagnostic procedures for AKI? | 5
- Serum labs - Urinalysis - Renal US - Bladder scan - CT/MRI (structural issue suspected)
87
What patient education is indicated for AKI? | 6
- **Maintain adequate hydration** - **Avoid NSAIDs and nephrotoxic drugs** - Monitor urine output - Report decreased urine, swelling, shortness of breath - Follow lab appointments - Manage chronic conditions
88
What are potential complications of AKI? | 6
- **CKD** - **Life-threatening hyperkalemia** - Fluid overload leading to pulmonary edema - Metabolic acidosis - Uremia - Increased infection risk
89
What are risk factors for CKD? | 12
- **DM** - **HTN** - Cardiovascular disease - Chronic glomerulonephritis - Polycystic kidney disease - Recurrent UTIs or pyelonephritis - **Long-term NSAID use** - Nephrotoxic drug exposure - Older age - Family history of CKD - Obesity - Smoking
90
What are signs and symptoms of CKD? | 16
- **Polyuria, progressing to oliguria** - Proteinuria - Nocturia - Peripheral edema - **Pulmonary edema** - **HTN** - Fatigue - Anorexia - N/V - **Pruritus** - Uremic breath - Confusion - Decreased concentration - **Peripheral neuropathy** - Pallor - Cold intolerance
91
What are nursing interventions for CKD? | 10
- Monitor labs - **Strict I&O/Daily Weights** - Monitor BP - **Fluid restriction as prescribed** - **Low sodium, low potassium, low phosphorus, and moderate protein diet** - Antihypertensives - Phosphate binders - Erythropoiesis-stimulating agents - **Prepare for dialysis** - **Avoid nephrotoxic medications**
92
What labs are altered in CKD? | 9
- **Increased creatinine** - **Increased BUN** - **Decreased GFR (< 60 for >3 months)** - **Hyperkalemia** - Hyperphosphatemia - Hypocalcemia - Metabolic acidosis - Decreased H/H - Proteinuria
93
What are diagnostic procedures for CKD? | 6
- Serum labs - Urinalysis - Urine albumin to creatinine ration - Renal US - Kidney biopsy - GFR estimation
94
What patient eduction is indicated in CKD? | 7
- **Control BP and BG** - **Follow prescribed renal diet** - Avoid NSAIDs and other nephrotoxins - Monitro daily weight - Report decreased urine output, swelling, SOB - Importance of routine labs and follw ups - Dialysis education if indicated
95
What are potential complications of CKD?
- **ESRD** - **Severe hyperkalemia** - Fluid overload leading to pulmonary edema - Metabolic acidosis - **Renal osteodystrophy** - Anemia - Cardiovascular disease - Increased infection risk
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