NRAD 201D > Test 4 > Flashcards

Test 4 Flashcards

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1
Q

Ca2+ is regulated by what?

A

the parathyroid hormone and calcitonin

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2
Q

The PTH stimulates the renal conversion of vitamin D into what?

A

calcitriol

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3
Q

What does calcitriol stimulate?

A

absorption of Ca in the intestines (it is activated in the kidneys)

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4
Q

Breadown of Calcium in blood/cells vs bones

A

blood/body cells = 1%
bones = 99%

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5
Q

40% of Calcium in the blood is bound to what?

A

albumin

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6
Q

What percentage of serum calcium is complexed to phosphorous?

A

25%

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7
Q

What percentage of ionized ca in the blood is free/biologically active?

A

50%

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8
Q

What is the chain of events if calcium levels in the blood get too high?

A

The thyroid releases calcitonin which increases Ca deposition in the bone, decreases uptake in the intestines and decreases reabsorption in the urine.

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9
Q

Chain of events if calcium levels are too low in the blood

A

Parathyroid releases PTH which increases Calcium (and phosphourous) release from the bones, Ca uptake in the intestines and Ca reabsorption (and phosphate excretion) from the urine

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10
Q

What happens in the kidneys when Calcium levels are low in the blood?

A
  1. Increase calcium reabsorption due to PTH
  2. Decreased phoshorous reabsorption
  3. Activates calcitriol
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11
Q

What happens in the small intestine when Calcium levels are too low in the blood?

A

Calcitriol (from the kidneys) stimulate increased Ca absorption and increased phosphate absorption

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12
Q

What causes hypocalcemia?

A
  1. vitamin D deficiency/impaired absorption
  2. kidney disease
  3. hypoparathyroidism
  4. hypoalbumenia
  5. hyperphospahtemia
  6. hypomagnesemia (severe)
  7. diuretics
  8. chronic alcohol use
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13
Q

What are 4 signs/symptoms of hypocalcemia?

A
  1. hyperreflexia
  2. tetany (presence of Chvostek’s/Trousseau’s sign)
  3. Numbness and tingling in extremeties and around the mouth (perioral)
  4. Cardiac dysrhythmias
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14
Q

What are 5 nursing implications for a patient with hypocalcemia?

A
  1. Increase vitamin D and Ca2+ intake
  2. Monitor post-op thyroid/neck surgery
  3. Hold diuretics
  4. Assess sensation, reflexes, cardiac rhythm
  5. Monitor vitamin D, Ca, PO43-, Mg, albumin (possibly PTH)
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15
Q

How does imbalanced blood calcium affect the resting membrane potential and the threshold potential?

A

Hypocalcemia - threshold is closer to resting membrane potential so cell is excitable more easily

Hypercalcemia - threshold is further awat from RMP so it takes more Na+ to initiate action potential

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16
Q

What are three causes of hypercalcemia?

A
  1. hyperparathyroidism
  2. cancer with bone metastasis and other cancers
  3. excess Ca2+ intake and antacids
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17
Q

What are 4 signs/symptoms of hypercalcemia?

A
  1. hyporeflexia
  2. muscle weakness
  3. lethargy, confusion, cardiac dysrhythmias
  4. kidney stones (hypercalciuria)
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18
Q

What are 6 nursing implications for hypercalcemia?

A
  1. Low Ca diet
  2. Increase weight bearing exercise
  3. Assess mentation, reflexes and cardiac rhythm
  4. Maintain adequate hydration
  5. Filter urine if needed
  6. Monitor Ca levels
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19
Q

What is the primary anion found in the ICF?

A

phosphate

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20
Q

What maintains serum phosphate levels and balance?

A

the PTH

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21
Q

If PTH is low, will phosphate excretion be low or high?

A

low

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22
Q

What are three functions of phosphate?

A
  1. Helps convert carbohydrates, proteins and fat into energy
  2. Essential for muscle function, RBCs and nervous system
  3. Acid-base buffering system
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22
Q

What is the primary way we obtain phosphate?

A

Through intake of food

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23
Q

85% of phosphate is where in the body?

A

bound with Calcium in teeth and bones

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24
What are 5 causes of hypophosphatemia?
1. inadequate intake/malabsorption 2. chronic diarrhea 3. vitamin D deficiency 4. increased use of phosphate binding antacids like Magnesium, alumnium and calcium 5. hyperparathyroidism
25
What are 4 signs/symptoms of severe hypophosphatemia? (similar to hypercalcemia)
1. confusion 2. muscle weakness 3. respiratory muscle weakness 4. cardiac dysrhythmias
26
What are the nursing implications for hypophosphatemia?
1. increase vitamin D and phosphate intake 2. assess neuro, respiratory and cardiac rhythm 3. assess use of antacids 4. monitor vitamin d, mg, ca and phosphate
27
What are three causes of hyperphosphatemia?
1. renal failure 2. hypoparathyroidism 3. chronic use of phosphate enemas
28
What are the signs/symptoms of hyperphosphatemia?
1. Decreased free Calcium 2. Inhibition of vitamin D activation 3. hyperreflexia 4. tetany (Chvostek/Trousseau) 5. numbness and tingling to extremeties and around the mouth 6. cardiac dysrhythmias
29
What are the nursing implications for hyperphosphatemia?
1. Restrict foods high in phosphate i.e. dairy products 2. Assess the use of phosphate related meds 3. Assess sensation, reflexes, cardiac rhythm 4. Monitor Ca, Phosphate, Magnesium (possibly PTH) level 5. May need phosphate-binders and diuretics
30
How is BUN produced?
1. Liver breaks down protein and produces NH3 2. Nitrogen is converted to urea 3. Urea travels from the liver to the kidneys
31
BUN levels are an indication of what?
kidney and liver function
32
What causes elevated BUN? (3)
1. increased protein intake 2. kidney disease 3. fluid volume deficit
33
What causes a decreased level of BUN?
1. liver disease 2. low protein diet 3. fluid volume excess
34
What are nursing implications for low/high BUN?
1. Assess protein levels 2. Assess hydration status 3. other liver and kidney function tests
35
What is creatinine?
A waste product from protein digestion and normal muscle breakdown
36
Creatinine is proportional to what?
the mass of skeletal muscle
37
Creatinine is a sensitive indicator of what?
kidney function
38
Elevated levels of creatinine indicate what? (4)
1. kidney damage 2. acute myocardial infarction 3. high protein intake 4. fluid volume deficit
39
What causes decreased levels of creatinine?
inadequate protein levels
40
What are three nursing implications for creatinine?
1. assess hydration 2. assess protein levels 3. monitor urine output and color (darker)
41
When calcium levels are low in the blood, what happens to phosphate in the bones, small intestine and kidneys (in response to release of PTH)?
Bones - increase resorption alongside calcium SI- increase absorption alongside Ca Kidneys - decrease reabsorption (Ca increases)
42
True or False: Mg is the second most abundant extracellular cation
False (intracellular)
43
Where is magnesium stored and what is the breakdown?
50%-60% stored in muscle and bone 30% in cells
44
What organs regulate Magnesium?
kidneys and intestines
45
What are the functions of Magnesium?
1. Transmission of nerve impulses 2. PTH secretion 3. Maintain K+ level via renal channels 4. regulates insulin secretion by pancreatic cells 5. stimulates glucose uptake from skeletal muscle 6. muscle contraction and relaxation
46
What are causes of hypomagnesemia?
1. chronic alcoholism 2. inadequate intake/diarrhea 3. diuretics
47
What are signs/symptoms of hypomagnesemia?
1. Increase excitability due to more calcium release in neurons 2. Decreased PTH release = hypoCa2+ 3. Increased urinary excretion of K+ (hypoK) 4. decreased insulin sensitivity and secretion (Increased glucose) 5. Increased BP, HR and cardiac dysrhythmias
48
What are the nursing implications for hypomagnesemia?
1. Increase Mg2+ intake IV/PO 2. assess Calcium Phosphate, Potassium and glucose levels 3. Assess sensation, reflexes, cardiac rhythm, BP, HR 4. Review meds
49
What is the role of Mg related to excretion of K?
Mg reduces the urinary excretion of K. Depletion of Mg promotes K excretion.
50
What are the symptoms of severe hyperMg2+?
Inhibits release of Ca2+ in the neuron leading to lethargy, muscle weakness, diminished deep tendon reflexes, lowered BP and HR, depresses heart conduction
51
What are the nursing implications for hypermagnesemia?
assess: 1. intake of mg-containing meds 2. kidney function 3. neuromuscular function 4. BP, HR, rhythm 5. possibly diuretics
52
What is the antidote to severe magnesium toxicity?
IV calcium gluconate
53
Excess of glucose is stored as what/where?
Glycogen in the liver and skeletal muscles
54
microscopic clusters of endocrine cells in the pancreas that regulate blood glucose
Islets of Langerhans
55
Function of alpha cells in pancreas?
Secrete glucagon to raise blood glucose levels when glucose is low (hypoglycemia). Glucagon signals the liver to release glycogen, which is then converted to glucose.
56
What is the function of beta cells?
Secrete insulin in response to hyperglycemia so that glucose can be removed from the blood stream and stored in the liver/skeletal muscle.
57
What is the key that unlocks the glucose channel into the cell?
insulin
58
What causes hypoglycemia?
1. insufficient food intake (skipping meals, delaying meals, eating too few carbs) 2. excessive physical exercise 3. hypoglycemic agents/meds 4. Being sick 5. Drinking alcohol without eating enough food
59
What are 8 symptoms of low blood sugar?
1. shaky 2. sweaty 3. dizzy 4. confusion and difficulty speaking 5. hungry 6. weak/tired 7. headache 8. nervous or upset
60
What are the nursing implications for hypoglycemia?
1. assess neurological status 2. monitor glucose 3. consider dietary modifications
61
What causes high blood sugar?
1. Eating more sugar or CHO than usual 2. Less active than usual 3. Skipping a dose of insulin or diabetes pills 4. Being sick/under stress 5. insulin deficiencies 6. corticosteroids 7. parenteral therapy
62
What are the nursing implications for hyperglycemia?
Assess: dietary intake glucose output corticosteroid use wound healing
63
What causes lower than normal Hgb and Hct?
anemia d/t blood loss hemodilution
64
What is Hct?
the percentage of RBCs in TBV
65
True or False: Hct and Hgb are both part of a CBC panel
True
66
What are s/sx of low Hgb and Hct?
fatigue, weakness, pale skin, SOB, dizziness/lightheadedness, irregular HR, chest pain, headache
67
Nursing implications for low Hgb and Hct
Check VS and monitor trends Assess respiratory status Monitor surgical sites and drains
68
What are the three possible elements of parenteral therapy?
water, electrolytes and glucose
69
What are three purposes of parenteral therapy?
1. resuscitation from trauma 2. replacement due to things like surgery or vomiting 3. maintenance due to surgery or NPO status
70
What are crystalloids?
IV solution that contains water, dextrose and electrolytes, small molecules that flow across a semipermeable membrane and can move freely across body compartments
71
What distinguishes crystalloids?
tonicity
72
What is tonicity?
A fluid's ability to change a cell's water content via osmosis
73
Which has the most fluid? ICF, Interstitial fluid or blood plasma?
ICF: 25L Interstitial fluid: 12 L Plasma: 3 L
74
What is the osmolarity of blood plasma?
290 mOsm/L
75
osmolarity for Isotonic fluids
250-375 mOsm/L
76
Where do isotonic fluids go when given intravascularly?
They stay in the ECF (typically blood plasma)
77
What effect do isotonic fluids have on blood volume?
Increases it
78
What IV solutions are considered isotonic?
1. 0.9% NaCl (NS) 2. Lactated Ringers (LR) 3. 5% Dextrose in water (D5W) - in the bag | dextrose is broken down by the body quickly, so then becomes hypotonic
79
What are the indications for isotonic solutions?
resuscitation (NS), replacement, increase blood volume, used with other IV treatments (NS), *maintenance*, mild hyponatremia (NS), hypercalcemia
80
What composes lactated ringers?
electrolytes and lactate
81
Lactate is metabolized where and into what?
the liver; bicarb
82
When is LR contraindicated?
1. liver disease 2. alkalosis
83
Indications for LR
replacement and maintenance (surgery)
84
What effect do isotonic solutions have on the size of body cells?
none
85
What are the nursing implications for isotonic fluids?
1. assess for hypervolemia i.e. pulmonary edema, hemodilution, and peripheral edema 2. assess electrolytes during therapy 3. assess urine output/Is and Os
86
What are hypotonic solutions?
Solutions with a lower tonicity than blood plasma (less electrolytes that can move across the membrane)
87
What do hypotonic fluids cause? (4)
1. Lowered plasma osmolarity 2. Fluids shift from blood to inside cells 3. increased risk of cell swelling 4. (may deplete ECF)
88
What are three types of hypotonic solutions?
1. D5W (out of bag) 2. 0.2% NaCl (1/4NS) 3. 0.45% NaCl (1/2 NS)
89
What are the indications for hypotonic fluids?
1. Hypernatremia 2. Hyperosmolar 3. Hyperglycemia (DM complication)
90
indications for D5W
hypernatremia
91
Nursing implications for hypotonic fluids
1. Decrease in BP 2. monitor for cognitive changes (cerebral edema) 3. Administer for short period of time 4. May cause IV depletion - worsen existing hypovolemia and hypotension 5. Assess urine out put (I/Os)
92
What are the impacts (3) of hypertonic fluids?
1. increases plasma osmolarity 2. draws water away from ICF into ECF 3. volume expander
93
What are the indications for hypertonic fluids?
1. severe hyponatremal (3% NS) 2. Expand intravascular volume 3. Cerebral edema 4. Maintain/replace electrolytes
94
What IV solutions are hypertonic?
1. 3% NS 2. D10 3. D5NS 4. D5LR 5. added electrolytes like K+
95
What are nursing implications for hypertonic fluids?
1. risk for fluid vol. overload - assess for hypervolema, pulmonary edema 2. Caution in cardiac and renal patients 3. Administered short term 4. Assess glucose levels if IVF contains dextrose 5. Assess electrolytes during therapy 6. assess urine output (Is and Os)
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