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MEDSURGE test 1
Flashcards for test 1: Medsurge
160
Medical
Undergraduate 4
09/02/2008

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Term
This is an acid-base balance characterized by an increase in H+ concentration (decreased blood pH). A low arterial pH due to reduced bicarbonate concentration is the metabolic form. A low arterial pH cue to increased PCO2 is the respiratory form.
Definition
Acidosis
Term
A physiologic pump that moves fluid from an area of lower concentration to one of higher concentration; requires STP for energy.
Definition
Active transport
Term
How much does 1L of fluid weigh?
Definition
2.2lbs or 1 kg.
Term
What happens when output of ECF exceeds the intake of fluid?
Definition
Hypovolemia
Term
What type of pulse and heart rate would you expect a patient with hypovolemia to have?
Definition
Fast heartrate, weak pulse.
Term
What type of tonicity does 0.9% NaCl (normal saline) have?
Definition
Isotonic
Term
What type of tonicity does D5NS have?
Definition
Hypertonic
Term
What type of tonicity does Lactated ringers have?
Definition
Isotonic
Term
What are some IV fluids that will commonly be used for Hypovolemia?
Definition
.5% NS, Lactated ringers, and D5W
Term
Why should D5W not be used solely in treatment of fluid volume deficit?
Definition
Because it dilutes plasma electrolyte concentrations.
Term
Describe the significance of the percentage .9% when describing tonicity of normal saline.
Definition
.9% is isotonic. Above this is hypertonic. Below this is hypotonic.
Term
What is the tonicity of D5W?
Definition
Isotonic
Term
What is the purpose of treatment for hypovolemia?
Definition
To expand fluid volume
Term
When should you weigh a patient who is at risk for hypovolemia?
Definition
At the same time every day.
Term
What will the lab values for specific gravity if a patient is hypovolemic?
Definition
It will be elevated because the kidneys will be trying to increase the syrum osmolality.
Term
What will lab values look like for sodium when assessing a patient with hypovolemia?
Definition
It could be either normal or high depending on the process.
Term
If a high BUN is brought down by a fluid bolus, what does this indicate?
Definition
Indicates that there is no kidney problem, just hypovolemia.
Term
If you assess the lungs then give a fluid bolus of normal saline, then come back to check their lung sounds 2 hours later and they are gurgling, what do you do?
Definition
Shut off the fluids and call the physician.
Term
What is one of the time that older patients are susceptible to hypovolemia and what is one easy way to combat this?
Definition
Right after surgery. They should be encouraged to drink.
Term
What are some of the main causes of hypervolemia?
Definition
Heart failure, liver failure, too much sodium
Term
What causes edema in hypervolemia?
Definition
Hydrostatic pressure pushing fluid into tissues.
Term
With hypervolemia, do you hear wheezes or crackles 1st?
Definition
You'll probably hear wheezes early, then crackles later when hypervolemia gets worse.
Term
Why can't salt substitute be used when a patient has liver disease?
Definition
The ammonia content will complicate the liver disease.
Term
Why can't salt substitute be used with a patient taking a diuretic?
Definition
Because it contains too much potassium and could cause hyperkalemia.
Term
If you drink too much water when trying to pass a drug test, what can this cause?
Definition
Dilutional hyponatremia-Water intoxication
Term
What are some clinical manifestations of hyponatremia?
Definition
Brain cell swelling will cause irritability, confusion, and headaches. Also, decreased blood pressure and nausea will result. Incorrect neuro-muscular junction activity is also a concern. Patient will be lethargic.
Term
At which sodium level does ICP get too high?
Definition
Below 115, neuro problems will be seen.
Term
What are some interventions for Fluid volume excess?
Definition
Water restriction and sodium replacement.
Term
What are the guidelines for sodium replacement?
Definition
You don't want to increse more than 12 mEq/L in 24 hours. If brain cells are swollen, you don't want to increse too fast.
Term
For a patient in ICU, how often are sodium levels assessed?
Definition
Every 6 hours.
Term
What must the sodium level be to suggest hypernatremia?
Definition
Above 135mEq
Term
What IV solution will be used for Hypernatremia?
Definition
D5W is usually used.
Term
What are normal potassium levels?
Definition
3.5-5.0
Term
Where is most potassium lost?
Definition
In the GI system. With chronic diarrhea, check potassium levels. Laxatives can cause low potassium.
Term
What is one cellular function is potassium used for?
Definition
Depositing glucose and glycogen in the liver.
Term
When is it okay to give potassium IV push or IM?
Definition
Never. This is very dangerous.
Term
What is the preferred IV site for giving potassium?
Definition
It is very damaging to the vein. Therefore, the hand is not preferred. Call the doctor for a PIC or central line.
Term
When monitoring I&O, what notifies you of kidney problems when giving potassium placement to a patient.
Definition
Less than 20cc of output in 2 consecutive hours. They could develop hyperkalemia if the kidneys aren't secreting potassium.
Term
What level must potassium be above for the nurse to suspect hyperkalemia?
Definition
5.0mEq
Term
What are some of the main risk factors for hyperkalemia?
Definition
Tissue trauma (burns), Metabolic or respiratory acidosis (think about hydrogen), PO potassium, ACE inhibitors, and NSAIDs
Term
Where do we see mucle weakness 1st in hyperkalemia?
Definition
In the leg.
Term
What GI symptoms will we see in hyperkalemia?
Definition
Nausea and diarrhea, because potassium causes smooth muscle activity.
Term
What value must calcium level be lower than to suggest hypocalcemia?
Definition
8.6mg/dl or less
Term
Calcium levels are inversly related to what?
Definition
Phosphate levels. Correct.
Term
How is chvoztek's sign tested?
Definition
Tapping the zygomatic arch in front of the ear. Muscle spasms in the face are a positive sign.
Term
For hypercalcemia, what level must calcium be above?
Definition
10.2mg/dl
Term
If someone is recieving a blood transfusion and the blood is administered too quickly, what is the patient at risk for?
Definition
Hypomagnesemia
Term
How often should magnesium levels be checked when a patient is going through withdrawals?
Definition
Every 2-3 days.
Term
In acute respiratory acidosis, what will the finding be for HC03?
Definition
It will be normal.
Term
For chronic respiratory acidosis, what will be the finding for HCO3.
Definition
It will be elevated.
Term
What is the main treatment for respiratory acidosis?
Definition
Improve alveolar ventilation.
Term
Explain CO2 narcosis.
Definition
Chronic levels of CO2 causes a decreased sensitivity to CO2 as stimulant to breathe, leaving hypoxemia as the major stimulus to breathe. When O2 is given, hypoxemia is resolved leaving no drive to breathe. It's very important to monitor O2 administration closely.
Term
Why must you monitor K+ in respiratory alkalosis?
Definition
Because hydrogen will be pulled out of cells in exchange for potassium, causing serum potassium to fall.
Term
What are the clinical manifestations of respiratory alkalosis?
Definition
Lethargy, light headedness, confusion, nausea, vomiting, tachycardia, signs of hypocalcemia, numbness, tingling.
Term
In metabolic acidosis, what does hyperventilation do?
Definition
It decreases CO2 as a compensatory action.
Term
Why might hyperkalemia occur in metabolic acidosis?
Definition
It may occur as potassium shifts out of the cell, to correct the surplus of hydrogen outside. The potassium switches places with H+. As acidosis is corrected, K+ shifts back into the cell and K+ levels decrease.
Term
What are the clinical manifestations of metabolic acidosis?
Definition
Increased resp rate and depth, decreased BP, decreased cardiac output, shock, drowsiness, confusion, H/A, coma, hypotension, arrhythmias, N/V/D, abdominal pain
Term
What are the correct nursing management actions when dealing with a patient who has metabolic acidosis?
Definition
Monitor K+ closely, monitor ABG's and electrolytes. Medication could be bicarbonate and possibly K+ if the potassium level decreases as acidosis resolves.
Term
What are the clinical manifestations of metabolic alkalosis?
Definition
Dizziness, irritability, nervousness, confusion, tachycardia, N/V, tremors, hypertonic muscles, tetany, tingling, and seizures.
Term
What are the appropriate nursing management actions for a patient with metabolic alkalosis?
Definition
Monitor I&O, ABG and Electrolytes, VS, IV fluids, medications- K+ ifhypokalemic, H2 receptor antagonist (tagament) to reduce gastric HCL.
Term
What am I?:

pH: 7.30
PaCO2: 67
PaO2: 47
HCO3: 37
Definition
Term
What is the normal value for serum pH?
Definition
7.35-7.45
Term
What is the normal value for PaCo2 partial pressure?
Definition
35-45mmhg
Term
What is the normal value for serum HCO3?
Definition
22-26mEq/L
Term
In respiratory acidosis, and most cases of metabolic acidosis, what will the kidneys do to correct it?
Definition
They will excrete H+ ions and conserve bicarbonate ions to help restore balance.
Term
In respiratory and metabolic acidosis, what will the kidneys do to try to correct the problem?
Definition
They will retain H+ ions and excrete bicarbonate ions to help restore balance.
Term
How will the kidneys compensate for the metabolic acidosis created by renal failure?
Definition
The kidneys cannot compensate for the metabolic acidosis created by renal failure.
Term
If metabolic acidosis is caused by a lack of bicarbonate, what will the lungs do to compensate?
Definition
The lungs will increase the rate of breathing, which blows off carbon dioxide and helps to raise the pH to normal.
Term
If metabolic acidosis is caused by a lack of bicarbonate, what will the lungs do to compensate?
Definition
The lungs will increase the rate of breathing, which blows off carbon dioxide and helps to raise the pH to normal.
Term
If metabolic alkalosis is is caused by an excess of bicarbonate, what will the lungs do to compensate?
Definition
The lungs will decrease the rate of breathing, which retains carbon dioxide and helps lower pH.
Term
When PaCO2 is high, how will the kidneys react?
Definition
The kidneys retain bicarbonare and excrete more acid to raise the pH.
Term
How does bicarbonate level move in relation to pH level?
Definition
It moves in the same direction as pH.
Term
What are the interventions for dilutional hyponatremia?
Definition
Water restriction and sodium replacement.
Term
What is the 24-hour limit for increasing serum sodium levels in a pt with dilutional hyponatremia?
Definition
You don't want to increase more than 12mEq/L in 24 hours. The ICP will most likely already be high, and you don't want to decrease the swelling of brain cells too quickly.
Term
How often must sodium levels be assessed in a patient being treated with 3% saline for dilutional hyponatremia?
Definition
Every 6 hours!
Term
For a patient with hypernatremia, will you expect to see an increase or a decrease in urine output?
Definition
A decrease.
Term
What is the goal of treating hypernatremia?
Definition
To lower sodium and prevent overcorrection.
Term
When is D5W mainly used?
Definition
In treating hypernatremia.
Term
Where is most potassium lost?
Definition
In the GI system.
Term
What fluid/elec imbalance are laxatives most likely to cause?
Definition
Low potassium.
Term
Which electrolyte is used for for the cellular activity of depositing glucose and glycogen in the liver?
Definition
Potassium
Term
When hydrogen moves into a cell, what happens to K+?
Definition
It gets pushed out of the cell.
Term
Hypervolemia is related to what electrolyte imbalance other than hypernatremia?
Definition
Hyperkalemia (potassium)
Term
How would severe hypokalemia usually cause death?
Definition
Through cardiac and respiratory arrest.
Term
What electrolyte imbalance are patients with persistent insulin hypersecretion at risk for?
Definition
Hypokalemia, because inculin promotes entry of potassium into skeletal muscle and hepatic cells.
Term
Why must you look for GI bleeding when giving patients oral potassium?
Definition
Because oral potassium can cause lesions in the small bowel.
Term
A burn patient is experiencing metabolic respatory acidosis, and taking ACE inhibitors. What electrolyte imbalance would you expect them to experience?
Definition
Hyperkalemia
Term
What will the t-wave look like with hyperkalemia?
Definition
Tall and tinted. It will look like a QRS wave.
Term
What will the QRS wave look like in hyperkalemia?
Definition
It will be fat.
Term
Where will you see muscle weakness 1st in hyperkalemia?
Definition
The legs 1st.
Term
Why does nausea and diarrhea occur with hyperkalemia?
Definition
Because of smoothe muscle activity in the GI tract caused by K+.
Term
When would you not want to give kayexelate to a patient with hyperkalemia?
Definition
You wouldn't want to give kayexalate to a patient with a paralytic ileus because you can perforate their bowel.
Term
When giving IV sodium bicarb to a patient, which shift in electrolyte would you expect?
Definition
Shift of potassium into cells. It is temporary.
Term
What does a beta-2 agonist cause in terms of potassium levels?
Definition
A shift of potassium into the cell.
Term
What serum level of calcium denotes hypocalcemia?
Definition
8.6mg/dl or less.
Term
A patient is recovering from a thyroidectomy. What elec. imbalance would you monitor for?
Definition
Hypocalcemia
Term
How is truseaud's sign checked?
Definition
Inflate blood pressure cuff 20mmHg above normal for 5 min and if the hand curls, it's positive.
Term
Why don't you use .9% NS when giving calcium replacements to a patient with hypocalcemia?
Definition
Because it increases renal bicarb loss and can cause toxicity.
Term
Paroxysmal atrial tachycardia is normally associated with what?
Definition
Hypocalcemia.
Term
What level denotes hypomagnesemia?
Definition
less than 1.8mEq/dL
Term
Which electrolyte affects enzyme reactions within the cell and carbohydrate metabolism?
Definition
Magnesium
Term
I take part in DNA and protein synthesis. I also influence vasodilation, irritability and excitability of cardiac muscles. What electrolyte am I?
Definition
Magnesium
Term
Are chvostek and trouseau's sign useful in diagnosing hypermagnesemia?
Definition
Yes. It will be positive.
Term
What are some foods that are high in magnesium?
Definition
Green, leafy veggies, grains and peanut butter.
Term
How can Mag sulfate be given on an IV?
Definition
On a slow pump.
Term
A chronic antacid-abusing alcoholic is on diuretics to treat his edema. What is he at risk for?
Definition
Hypophosphatemia
Term
An anorexic is being refed after nearly starving herself to death. What is one major elec embalance she is at risk for?
Definition
Hypophosphatemia
Term
A patient is experiencing hypoventilation. What are they at risk of developing?
Definition
Respiratory acidosis.
Term
What are the clinical manifestations of respiratory acidosis?
Definition
Increased respiration, increased pulse, increased blood pressure; drowsiness, disorientation, dizziness, headache, and seizure.
Term
If a patient is hyperventilating, what are they at risk for developing?
Definition
Respiratory alkalosis
Term
What happens to the cell as serum potassium levels decrease?
Definition
The hydrogen moves out of the cell. Therefore, the pH of the blood will increase.
Term
What are the signs and symptoms of respiratory alkalosis?
Definition
Lethargy, light headedness, confusion, tachycardia, numbness, tingling, nausea, vomiting, and maybe some signs of hypocalcemia.
Term
What acid-base imbalance can potassium depletion cause?
Definition
Metabolic alkalosis
Term
What are the clinical manifestations of metabolic alkalosis?
Definition
Dizziness, irritability, nervousness, confusion, increased heartrate, nausea and vomiting, tremors, tetany, seizures, and hypertonic muscles.
Term
What are some nursing diagnoses that would be given for someone with metabolic alkalosis?
Definition
Risk for injury due to NM irritability and tetany; altered breathing pattern; risk for irregular cardiac output/arrhythmias.
Term
In metabolic alkalosis, what can you give to reduce hydrochloric acid?
Definition
Tagament
Term
A patients ABG reading is:

pH-7.18
paCO2-38
PaO2-70
HcO3-15

What state are they in?
Definition
Metabolic acidosis.
Term
What are two main general rules when selecting an IV site?
Definition
Avoid bends in arms, and start from the hands and work up.
Term
What is the rule regarding IV site selection in a patient who has had a mastectomy?
Definition
You don't want to use the arm from the same side as the mastectomy because of the removal of lymph nodes.
Term
What is a unit nurse's first responsibility?
Definition
Vital signs
Term
What does most preoperational anxiety arise from?
Definition
Knowledge deficit
Term
What is preoperative fear usually regarding?
Definition
Death or permanent disability.
Term
What system are you assessing when you assess a patient's ability to follow commands?
Definition
Neuro
Term
If you find out a patient has an upper airway infection just before surgery, what would you expect to be the significance of this?
Definition
The surgery will be rescheduled
Term
How long before surgery are oral medications usually given?
Definition
60-90 minutes before
Term
How long before surgery are IM and sub Q meds given?
Definition
20 minutes
Term
A patient has just returned from surgery. What is the nurse's first priority?
Definition
Maintain a patent airway
Term
A patient just had abdominal surgery and is refusing to wear antiembolism stockings. What si the patient at risk for?
Definition
Pulmonary embolism
Term
The PACU nurse is caring for a patient that is still unconscious. The patient is bluish an ddusty. The patient is not breathing. What is the nurse's initial reaction?
Definition
Check for laryngeal obstruction and tilt the head back and push the jaw forward.
Term
When signing a consent form the nurse must make sure which of the following is met?
Definition
Both parents must sign consent form if child is not emancipated.
Term
Which is true of the sterile field in th OR?
Definition
Only table top is sterile. bacteria can travel on airborne particles, and if a sterile item comes into contact with an unsterile item, it is contaminated.
Term
Patient identification prior to the ER: Select all that apply.
Definition
Name of the physician performing procedure, have patient state first and last name, compare patient ID with the chart.
Term
A 16 year old pregnant married female is admitted for a C-section. Who should sign the consent from?
Definition
The patient (not the girl's parents or husband)
Term
A teenage female patient is admitted to the ER for an appendectomy. The nurse notices protruding chest and bones in the ribs. The girl's mother states that she is undergoing treatment for anorexia. What should the nurse do?
Definition
Notify the surgeon and check electrolyte levels.
Term
A patient admitted for surgery wants to know why he is not allowed to eat for 8hrs prior to his surgery. The nurse's best response is?
Definition
Pts should be NPO for 8hrs to decrease the risk for aspirtaion.
Term
Select all that apply to the circulating nurse.
Definition
Documenting, Keep track of all sponges and drains.
Term
A patient in the PACU has not viuded for the past 7hrs. As a nurse, what is the first thang that you need to do?
Definition
Palpate the bladder.
Term
A 38 yr old pt that is in recovery from surgery is apprehensive, restless, and thirsty. The pt asks if he can have a drink of water. Upon assessment you notice the pt's skin is cool, moist, and pale. What should you be concerned for?
Definition
Hemorrhage and shock
Term
A pt is taking potassium sparing diuretics. What side effects might you expect from hyperkalemia?
Definition
Fatigue and muscle weaknes.
Term
A patient has been admitted with hyponatremia. What would the nurse frequently assess?
Definition
Breath sounds.
Term
A pt has just received anesthesia and wants to use the restroom. What should you use as the nurse do?
Definition
Give them a bedpan and don't let them get up
Term
A patient asks why they can't wear their dentures during surgery. Why?
Definition
It could obstruct their airway.
Term
A pt having a hysterectomy does not need further explanation before signing informed consent when she states?
Definition
The doctor has explained the risks of hemorrhage.
Term
Latex allergy foods?
Definition
Kiwi!
Term
A pt has tea (60z), nukd (240cc), an orange, a cup of broth and 200 ml parenteral fluids. What should the nurse put as input?
Definition
860ccs
Term
A pt states that they don't understand what the surgery entails. What should the nurse do?
Definition
Call the pysician.
Term
What is a patient who took several antacid tablets at risk for?
Definition
Metabolic alkalosis
Term
A pt who is NPO the night before surgery has a BP tablet to take. What should the pt do?
Definition
Take the tablet w/ a sip of water.
Term
What should the nurse expect from a pt with hypomagnesia?
Definition
Tremors
Term
A pt with an abdominal incision is experiencing dehisence with evisceration. What action should the nurse take 1st?
Definition
Cover the wound with gauze and saline.
Term
A pt states his grandmother spiked a fever of 104 for no reason during surgery. Why is this information important to the surgical team?
Definition
Malignant hyperthermia.
Term
What is the best way to measure a pt for fluid imbalance?
Definition
Daily weights.
Term
If a pt who weighed 178 lbs 2 days ago now weighs 170 lbs, how much water did they lose?
Definition
8-lbs/2.2=3.6kg
1kg=1L
3.6kg=1L=4L
Term
A patient's labs come back with a diagnosis of respiratory alkalosis. The patient's vitals are normal except for a respiration rate of 24. The patient complains of pain at the incision site. What should the nurse do 1st?
Definition
Give pt prn pain meds
Term
A pt recently in for heart failure is currently takin digitalis. The pt complains to the home health nurse about weakness and heart flutters. What should the nurse do?
Definition
Tell the pt to stop taking digitalis and call physician
Term
A pt with COPD is most at risk for developing which one of the following?
Definition
Respiratory acidosis
Term
Which labs indicate respiratory acidosis?
Definition
pH=7.36, PaCO2=50
Term
For a dx of hyperkalemia and met acidosis, which do you correct 1st?
Definition
correct metabolic acidosis 1st.
Term
What does the ECG look like with hyperkalemia?
Definition
peaked narrowed T waves and widened QRS
Term
A pt doesn't want to take their pain meds because they fear it will slow down the healing process. What should you tell them?
Definition
Pain medicines help you heal faster because you're able to get up sooner and only prolonged use can cause addiction.
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