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Test 2
Unit 5
211
Nursing
Undergraduate 1
09/01/2012

Additional Nursing Flashcards

 


 

Cards

Term
True or False: The CDC mandates that a nurse be on the premises when an IV infusion is in process.
Definition
True. The MS Board of Nursing states that a RN must be on the premises when an IV infusion is in process.
Term
Who must be aware of the scope of practice for an IV certified LPN?
Definition
The RN
Term
Who is ultimately responsible for the care given by an LPN under the supervision of an RN?
Definition
The RN
Term
How many ml of fluid should most adults consume?
Definition
1500*2000 ml/24hrs
Term
Should fluid intake be equal?
Definition
No, fluids are lost in sweat, respirations, defecation etc. Urine output should be about 1/3 to 1/2 of fluid intake.
Term
Intake
Definition
Oral fluids, IV fluids, enteral feedings
Term
Output
Definition
Urine, wound drainage, tube drainage, diarrhea, vomiting
Term
What do all IV patients need?
Definition
Accurate I&O
Term
What should a patient know about recording I&O?
Definition
- Write down everything they drink and the amount
- Show them how to measure urine or instruct them to call to have it measured
- Ask the family and visitors not to eat off the patient's tray
Term
Hematoma
Definition
mass of partially clotted blood that has infiltrated into the tissues, usually accompanied by ecchymosis (bruising)
Term
How can you prevent problems associated with IV's?
Definition
Hold direct pressure on IV site for 2-3 minutes with a sterile gauze pad, elevate arm over patient's head or on a pillow. Apply ice packs.
Term
What can poorly regulated IV's lead to?
Definition
Fluid overload, overdosing, underdosing, clogged catheters, phlebitis, and infiltration.
Term
Phlebitis
Definition
Inflammation of the vein due to mechanical or chemical causes.
Term
What are the mechanical causes of phlebitis?
Definition
Using a large catheter in a small vein, improper securing of the IV, over-manipulation of the IV catheter, prolonged use of the same IV site.
Term
What are the chemical causes of phlebitis?
Definition
Irritating or vesicant medications that are acidic or alkaline or that have high osmolarity (Erythromycin, Nafcillin, Vancomycin, Amphotericin B, Potassium)
Term
What is the treatment for extravasation?
Definition
Stop the infusion immediately, do not remove the catheter because it may be needed to administer antidote into the tissues.
Term
Where is extravasation rated on the infiltration scale?
Definition
Grade 4
Term
Infiltration
Definition
A localized complication that occurs when the IV catheter is improperly placed or secured or becomes dislodged or because the veins are too thin and fragile. Fluids leak into surrounding tissues.
Term
What are the signs and symptoms of infiltration?
Definition
swelling, discomfort, burning, tightness, cool skin, and blanching.
the iv stops running or slows down
Can lead to nerve and muscle damage if severe.
Term
What are the general rules for site selection for an IV?
Definition
When choosing a site for insertion of an IV you should start distally and work proximally and avoid the patient's dominant hand.
Term
Which vein is the first choice for an IV site?
Definition
The dorsal metacarpal veins are the first choice when choosing a site for inserting an IV.
Term
What is the main symptom of hypernatremia?
Definition
Thirst
Term
What is hypernatremia?
Definition
a) High sodium level > 145
b) Caused by water loss, excessive sodium intake, endocrine disorders that cause fluid loss or hyperventilation
Term
What issues you may face when starting an IV in a geriatric patient?
Definition
The skin of most geriatric patients lack skin turgor and has limited subcutaneous tissue. Superficial veins are weaker and more prone to infiltration. IV infusions must be monitored carefully to avoid fluid overload.
Term
Compatibility
Definition
The ability of components of an IV solution to be mixed and administered with no chemical or physical changes and no loss of therapeutic effect.
Term
What factors influence drug IV compatibility?
Definition
Order of mixing, drug concentration, length of time drugs are in contact with other drugs and solutions, temperature, exposure to light, and pH
Term
Centers for Disease Control and Prevention (CDC)
Definition
Works to prevent and control infectious and chronic diseases, injuries, workplace hazards-collects information about infections that occur as a result of IV therapy
Term
OSHA
Definition
Protects the safety of employees
Was responsible for the Needlestick Safety and Prevention act (2001) that mandated the use of safety devices to reduce needle stick injuries in clinical settings
Term
What are the purposes of IV therapy?
Definition
a) Provide water, electrolytes, and nutrients to meet daily requirements.
b) To replace water and correct electrolyte imbalances
c) To administer medications and blood products
Term
Homeostasis
Definition
the body's attempt to maintain a steady state
Term
What percentage of an adult body is fluid?
Definition
60%
Term
What percentage of an infant's body is fluid?
Definition
80%
Term
What are body fluids made up of?
Definition
Water and solutes (electrolytes & proteins)
Term
What is the purpose of body fluids?
Definition
Regulate body temperature, transport nutrients throughout the body, transport wastes to excretion sites, preserve cell shape.
Term
Sodium (Na+)
Definition
a) Most abundant extracellular electrolyte
b) Normal range= 135-145 mEq/L
c) Holds fluid in ECF
d) Necessary for muscular contractions and nerve impulses
Term
Hyponatremia
Definition
a) Low sodium level < 135
b) Caused by excessive water retention (dilutes the sodium)- losses may be caused by diuretic therapy, renal disease, adrenal insufficiency, loss of GI fluids, inadequate intake of sodium, inappropriate oral or IV fluids
Term
What are the signs and symptoms of hyponatremia?
Definition
Anorexia, nausea, abdominal muscle cramps, neurologic dysfunctions including headaches, delirium, lethargy, seizures, coma, respiratory arrest, death, papilledema (swollen optic disc), sternal edema
Term
What are the major body fluid electrolytes?
Definition
sodium (Na+), potassium (K+), calcium (Ca++), chloride(Cl-), phosphate (PO4-3), magnesium (Mg++)
Term
Electrolytes
Definition
Electrically charged particles that conduct electricity necessary for normal cell function.
Term
Cations
Definition
positively charged ions
Term
Anions
Definition
negatively charged ions
Term
What are the signs and symptoms of hypernatremia?
Definition
Thirst, dry mucus membranes, flushed dry skin, hypotension, neurological changes (weakness, lethargy, irritability, twitching, spasticity, seizures, coma, death)
Term
What is the normal range for potassium (K+)?
Definition
Normal range = 3.5-5.0 mEq/L
Term
What is the purpose of potassium?
Definition
Influences cardiac and skeletal muscle function; cardiac rhythm.
Major intracellular electrolyte.
Term
What alters the level of potassium in the body?
Definition
Depends on the kidneys to maintain homeostasis. Also passed in sweat, gastric juices and bowel.
Term
What is hypokalemia?
Definition
Low potassium level < 3.5
Term
What causes hypokalemia?
Definition
Decreased intake of potassium, alcoholism, excessive excretion due to diuretics, vomiting, diarrhea, renal disease, GI suctioning, sweating, endocrine disorders, alkalosis
Term
What are the signs and symptoms of hypokalemia?
Definition
a) Malaise, muscle weakness, paresthesias, diminished tendon reflexes, hypotension, cardiac dysrhythmias, chest pain, palpitations, leg cramps, hyperglycemia
Term
What are the food sources of potassium?
Definition
bananas, oranges, baked potatoes with skin, beets, turnips, rutabagas, peaches, avocado, melons, tomatoes, squash, beans
Term
What hormones help to manage the fluid balance of the body?
Definition
ADH, kidneys, and adrenal glands
Term
Intake
Definition
orally through liquids and food, administration of IV
Term
Output
Definition
respiration, perspiration, urine, and feces
Term
When does extravasation occur?
Definition
When vesicant drugs infiltrate into the patient's IV site and surrounding tissue.
Term
What are some common problems associated with IV's?
Definition
Difficult insertion, IV will not infuse at correct rates, the IV site develops problems after the IV catheter is removed.
Term
What is hypocalcemia?
Definition
A calcium level <9.0.
Term
What causes hypocalcemia?
Definition
Dysfunction of parathyroid glands either from accidental surgical removal, hypothyroidism, or impaired vitamin D metabolism.
Term
What are the signs and symptoms of hypocalcemia?
Definition
Dysrhythmias, hypotension, tetany (muscle spasms), parestesias, altered mental status, confusion seizures
Term
What is hypercalcemia?
Definition
A calcium level >10.5
Term
What causes hypercalcemia?
Definition
Cancer, hyperparathyroidism, disorders that cause bone reabsorption such as immobility, endocrine disorders, medications, and abnormal vitamin D metabolism
Term
What are the signs and symptoms of hypercalcemia?
Definition
Dysrhythmias, hypertension, muscle weakness, depressed reflexes, altered states of consciousness (coma)
Term
Magnesium
Definition
a) Important in cellular processes, including enzyme reactions, neuromuscular transmission and cardiovascular tone.
b) Normal level 1.8-3.0
Term
What are the signs and symptoms of hypomagnesemia?
Definition
Hyperexcitability with muscle weakness, tremors, seizures, dysrhythmias.
Term
What causes hypermagnesemia?
Definition
Increased intake of antacids and laxatives.
Term
What is the antidote for hypermagnesemia?
Definition
Calcium gluconate.
Term
What are the signs and symptoms of hypermagnesemia?
Definition
Hypotension with vasodilation (flushing)
Term
Peripheral Edema
Definition
seen in the feet and lower legs
Term
Generalized Edema
Definition
all over (anasarca)
Term
Ascites (edema)
Definition
localized to abdomen due to liver failure
Term
Sacral Edema
Definition
edema around the sacrum from lying on back
Term
Pulmonary Edema
Definition
lungs (crackles or rhonchi) pink frothy sputum, SOB
Term
Fluid Volume Excess
Definition
Overhydration
Retention of water and sodium
Term
What causes fluid volume excess?
Definition
Excess intake of sodium, increased fluid intake, IVF's infusing too quickly, decreased urine output due to kidney/liver problems, heart failure, stress from surgery or trauma.
Term
What are the signs and symptoms of fluid volume excess?
Definition
Edema, shortness of breath, bounding pulse, anxiety, wet cough, hypertension.
Term
Fluid Overload
Definition
IV infuses too rapidly or patient cannot tolerate increased amounts of fluids
Term
What are the signs and symptoms of fluid overload?
Definition
Respiratory distress, neck vein distention, increased BP
Term
What is the treatment for fluid overload?
Definition
slow the IV rate to KVO and notify physician, place patient in Semi-Fowler’s position, MD may order diuretics to pull off excess fluid and order O2 to improve respiratory status
Term
Your facility recently changed IV infusion pumps. You were not on duty when in-service training was provided. You have been asked to prepare an IV infusion via pump for Mr. Jamison. What should you do?
Definition
You should not attempt to prepare the IV by yourself. You should ask for the assistance of someone familiar with this piece of equipment.
Term
What are the advantages of IV medications?
Definition
 Direct access to circulation
 Available if patient is unable to take oral meds
 Less painful
 Rapid onset of action and therapeutic response
 Control over infusion rate
 Can discontinue immediately if adverse reaction occurs
Term
What are the disadvantages of IV medications?
Definition
 Possibility of incompatibilities
 Possibility of absorption by the IV bag or administration set
 Possibility of errors in mixing
 Speed shock
 Phlebitis
 Extravasation by vesicant drugs
Term
Type O
Definition
Universal donor – because this type has no antigens, it can be transfused in an emergency into anyone regardless of blood type
Term
What type blood can type O receive?
Definition
Can only receive type O blood
Term
Albumin
Definition
- A plasma expander
- Natural plasma protein obtained from blood
- Expands circulating volume and increases plasma protein volume
Term
What are the uses for albumin?
Definition
 Treatment of shock due to circulating volume deficit
 Provide protein
 Bind bilirubin
Term
What are the complications associated with albumin?
Definition
 Fluid overload
 Anemia
 Bleeding
 Dilution or depletion of electrolytes
 Allergic reactions
Term
Rh (Rhesus) Factor
Definition
Major inherited blood antigen
Term
Why should donors be matched for Rh factor?
Definition
• Initial exposure of a Rh-negative recipient to Rh-positive blood generally does not cause a reaction
• Future exposures to Rh-positive blood may result in a hemolytic reaction
Term
What are the three categories of IV solutions, and what is their relationship to serum?
Definition
• Isotonic – same osmolarity or concentration as serum
• Hypertonic – higher osmolarity or concentration than serum
• Hypotonic – lower osmolarity or concentration than serum
Term
What is the purpose of an infusion of blood or blood products?
Definition
• Restore circulating volume
• Improve the ability of the blood to carry oxygen
• Replace blood components such as clotting factors
Term
What is the liquid component of blood?
Definition
Plasma
Term
What are the cellular components of blood?
Definition
 Erythrocytes (red blood cells or RBCs)
 Leukocytes (white blood cells or WBCs)
 Thrombocytes (platelets)
Term
What are the blood components that can be infused?
Definition
 Whole blood
 Packed red blood cells (PRBCs)
 Leukocyte-poor RBCs
 Platelets
 Fresh frozen plasma (FFP)
Term
What type blood can a type A patient receive?
Definition
Type A or type O in an emergency.
Term
What type blood can a type B patient receive?
Definition
Type B or type O in an emergency.
Term
What type blood can a type AB patient receive?
Definition
Type A, B, AB, or O in an emergency.
Term
What is a type AB person known as?
Definition
A universal recipient.
Term
What are the symptoms of a hemolytic reaction?
Definition
- Rash/Hives
- Headache
- Chest pain
- Chills and fever
- Back pain/flank pain
- Shortness of breath
Term
What should documentation of IV discontinuation include?
Definition
 The date and time of discontinuation
 The reason for discontinuation
 The condition of the catheter
 Whether the catheter was intact
 Follow-up measures
 Any S/S of infection or inflammation
Term
What affects IV flow rate?
Definition
- Raising the height of the container will improve a sluggish flow.
- Flow is directly proportional to the diameter of the IV tubing, IV catheter, and vein.
- The longer the tubing, the slower the flow.
- Thicker solutions like blood require a larger cannula.
- Higher BP makes the infusion go slower
- Warmer solutions go faster than cold solutions
Term
How should you treat infiltration?
Definition
- Stop the IV from infusing and remove the catheter. Elevate the arm and apply cool compresses for the first 24 hours.
- Determine the level of infiltration using the INS Infiltration Scale
- Some healthcare institutions require that an occurrence form (incident report) be filed.
- A new IV should be started in the patient’s other arm if possible.
Term
How do you prevent phlebitis?
Definition
- Slow down the infusion rate
- Dilute the medication
- Start with smallest catheter that will be appropriate for the solution.
- Replace IV catheters every 72-96 hours.
Term
What are the signs and symptoms of phlebitis?
Definition
erythema (redness), tenderness at the site, warm to touch, elevated temperature, can go into local infection and/or sepsis
Term
What is the treatment for phlebitis?
Definition
stop the infusion and remove the device, elevate, apply cool compresses
Term
What is the first choice for venipuncture?
Definition
Forearm veins
Term
What is the order of preferred venipuncture sites for pediatrics?
Definition
• 1st choice – forearm veins
• 2nd choice – tributaries of cephalic and basilic veins, dorsal venous arch
• 3rd choice – ventral surface of wrist on inner aspect of wrist
Term
What is important to know when about accessing alternate sites for venipuncture in pediatrics?
Definition
The facility's policy.
Term
What are alternate sites for venipuncture in pediatrics?
Definition
- Scalp veins for infants less than 1 year old
- Saphenous vein – last resort site
Term
What is a hypersensitivity reaction also known as?
Definition
Allergic reaction
Term
Where should you check for information about allergic reactions?
Definition
Check with patient and medical record for information about allergies or family history of allergies.
Term
What are the signs and symptoms of a hypersensitivity reaction?
Definition
rash, itching, tearing eyes, runny nose, bronchospasm (constriction of the airways), wheezing, anaphylaxis
Term
What is the treatment for a hypersensitivity reaction?
Definition
Stop the infusion, notify the MD, Maintain the IV device by hanging a continuous IV of saline or saline lock, maintain a patent airway, support respirations, May need epinephrine, antihistamines, steroids
Term
What is an air embolus?
Definition
Air that has entered the vein and then enters the heart and causes it to work harder.
Term
What is important to know about air embolus risk?
Definition
- Air can enter anytime the IV system when the tubing or catheter become separated.
- More common in central lines than peripheral lines
- Can lead to decreased cardiac output, shock, and death.
Term
What are the signs and symptoms of air embolus?
Definition
respiratory distress, mid-chest and shoulder pain, nausea, lightheadedness
Term
What is the treatment for an air embolus?
Definition
Close off the catheter immediately by closing the clamp or kinking the tubing, place the patient on their left side, head down, start oxygen and notify MD
Term
What conditions may lead to difficult venous access?
Definition
skin lesions, rashes, sclerosing (hard) veins, obesity, edema, elderly fragile veins, dark skin
Term
What can make accessing a vein easier and safer?
Definition
Use smallest catheter necessary for intention, stabilize the vein by holding the skin taut, remove tourniquets after 1-2 minutes, displace edema by pressing downward, for obese patients you may need a longer cannula, do not apply tourniquet tightly
Term
Before beginning an IV what allergies are important to look for?
Definition
 Medications
 Tape
 Latex
 Alcohol or povidone iodine
Term
What conditions affect IV placement/location?
Definition
 Do not start distal to edema, cellulitis, burns, injury, etc.
 Do not use arm with fistula for dialysis
 Do not use extremity with paralysis or poor circulation
Term
What should a safe needle system involve?
Definition
 Be needleless
 Have the needle built into the device.
 Require no activation by the user (a passive device) if user activation is necessary, the safety feature should be activated without exposing the user to the sharp point and should easily enable the user to tell that it is activated.
 Be easy to use and practical.
 Be safe and effective for patient care.
Term
What are the 3 types of needleless systems?
Definition
- Blunt cannula and resealable ports
- Luer-activated devices
- Pressure –activated safety valve devices
Term
What is the are the uses of dextrose solutions?
Definition
 Provide free water
 Treat hyperkalemia (high serum potassium)
 Treat dehydration
Term
What are the cautions associated with high concentrations of dextrose?
Definition
 can cause cellular dehydration by pulling fluid from the cells into the ECF space
 must be decreased slowly over 48 hours to prevent an excess of insulin production by the pancreas
Term
What are the uses of multiple electrolyte solutions?
Definition
- Trauma and burns
- GI tract losses and dehydration
- Sodium loss
- Acidosis
- Maintain the patient’s fluid and electrolyte balance
- Replace fluids and electrolytes for losses due to dehydration, hemorrhage, vomiting or diarrhea
Term
What is the normal potassium level?
Definition
3.5-5 mEq/L
Term
What is the normal sodium level?
Definition
136-145 mEq/L
Term
What is the normal chloride level?
Definition
98-106 mEq/L
Term
What is the normal calcium level?
Definition
8.4-10.2
Term
Multiple Electrolyte Solutions
Definition
aka Ringer’s or Lactated Ringer’s
Isotonic
May contain lactate or acetate in order to prevent or treat disruption of the body’s acid/base balance (metabolic acidosis)
Term
What is important to keep in mind with NaCl and Dextrose Combination Solutions?
Definition
- Prevent some of the adverse effects that occur when each is administered separately
- Observe for fluid overload in patients with heart, kidney, or liver disease
Term
What are the uses for NaCl and dextrose combination solutions?
Definition
Fluid replacement due to sweating, vomiting, and gastric suction.
Term
What are the uses of a hypertonic solution?
Definition
- Treat patients with low serum electrolyte levels
- Stabilize blood pressure
- Assist in regulating urine output
- Reverse gastric fluid loss from diarrhea, vomiting, NG suctioning
- Reverse the effects of dehydration caused by overuse of hypotonic solutions
Term
What are the cautions of hypertonic solutions?
Definition
- Observe for circulatory overload
- Do not use if patient has cardiac or renal disease
Term
What are examples of hypertonic solutions?
Definition
D10W, D5 1/2NS, D5NS
Term
What are the types of incompatibility?
Definition
Chemical, physical, and therapeutic
Term
Chemical incompatibility
Definition
May or may not be visible
• Change in color
Term
Physical Incompatibility
Definition
Forms a precipitate that may or may not be visible
• Solution may become hazy or cloudy or form gas bubbles
Term
Therapeutic Incompatibility
Definition
Undesirable reaction that occurs when two or more drugs are given together
• One inhibits or increases the effects of the other
Term
What is the difference between peripheral parenteral nutrition and total parenteral nutrition solutions?
Definition
PPN is used for short-term therapy and provides a minimum of caloric and protein needs. PPN solutions are less concentrated than TPN solutions. TPN restores or maintains nutritional status, can be used for long-term therapy, and must be infused via a central line.
Term
What happens when solutions are incompatible?
Definition
Incompatibility is a reaction or interaction of additives with each other or with the solution that changes the expected action of the medication or solution and may cause loss of the therapeutic effect.
Term
How can you avoid problems associated with incompatibility?
Definition
 Change solutions every 24 hours
 Carefully check bags before hanging
 Do not infuse if solution is cloudy or has a precipitate
 Select correct diluent to reconstitute the drug
 Do not mix drugs needing a special diluent with other drugs
 Select the correct solution for the infusion
 Flush IV line between infusions of incompatible medications
 Follow manufacturer’s recommendations
Term
What is dextran?
Definition
Synthetic plasma expander
Term
What is dextran used for?
Definition
• Trauma
• Burns
• Hemorrhage
Term
What complications are associated with dextran?
Definition
• Anaphylaxis
• Fluid overload
• Dilution of electrolytes
Term
What is mannitol?
Definition
synthetic plasma expander
sugar alcohol substitute
Term
What are the uses of mannitol?
Definition
• Diuresis – remove excess body fluids
• Excretion of toxic substances
• Treatment of increased intracranial pressure and cerebral edema
Term
What are the complications associated with mannitol?
Definition
• Fluid and electrolyte imbalances
• Cellular dehydration
• Fluid overload
• Nervous system toxicity
Term
What is hetastarch?
Definition
synthetic plasma expander
similar to albumin
causes fluid to be pulled into the intravascular space
Term
What is hetastarch used for?
Definition
treat shock due to decreased circulating volume
Term
What complications are associated with hetastarch?
Definition
• Anaphylaxis
• Altered platelet function
• Volume overload
• Fluid and electrolyte imbalances
Term
What are the uses of isotonic solutions?
Definition
 Hydration when the patient is dehydrated
 Replacement of extracellular fluid loss, such as blood loss
 Treatment of hypernatremia (excess serum sodium)
Term
What are the cautions associated with isotonic solutions?
Definition
 Watch for fluid overload
 Isotonic solutions do not provide adequate calories
 They may lead to protein loss
Term
What are common isotonic solutions?
Definition
 D5W
 Normal saline (NS)
 Lactated Ringer’s (RL)
Term
What are the uses and example of a hypotonic solution?
Definition
- Reverse dehydration caused by overuse of diuretics
- Treat patients with high serum electrolyte levels
- Example: 0.45 NS
Term
What are the cautions associated with a hypotonic solution?
Definition
Should not be used for patient with
 Cerebral edema
 Increased intracranial pressure
 Burns
 Trauma
 Low protein levels from malnutrition or liver disease
Term
What is the isotonic concentration of NaCl?
Definition
0.9% NaCl
Term
What is the hypotonic concentration of NaCl?
Definition
0.45% NaCl
(normal saline)
Supplies normal daily amounts of Na and water
Term
What is the hypertonic concentration of NaCl?
Definition
3% or 5% NaCl
Use to correct severe Na loss % water overload.
Term
What are the uses of NaCl solutions?
Definition
 Treatment of shock
 Treatment of hyponatremia (low serum sodium)
 Fluid challenges
 Replacement in diabetic ketoacidosis
 Resuscitation in trauma emergencies
 Infused with blood transfusions
Term
What are the cautions associated with NaCl solutions?
Definition
- Can lead to fluid overload
- Observe patients with CHF, edema, and hypernatremia carefully
Term
What is the nurses role in the transfusion process?
Definition
 Verification
 Patient identification
 Hanging/starting transfusions of blood or blood products
 Monitoring for reaction
Term
What is the nurses part in the Needlestick Safety and Prevention Act?
Definition
- Avoid the use of needles when possible.
- Correctly use the safe alterations provided.
- Not recap needles.
- Dispose of used needles promptly and in appropriate sharps containers.
- Report hazards from needles that you observe in the workplace.
- Report needlestick injuries promptly to ensure that you receive appropriate follow-up care.
- Attend training and follow infection control policies and procedures.
Term
What are the signs and symptoms of a blood reaction?
Definition
sudden spike in temperature, hives, rash, shortness of breath, rapid change in BP and/or pulse
Term
What should you do if you notice the S/S of a blood reaction?
Definition
Notify MD and lab
Hang an IV of 9%NS
Follow facility P&P after reaction
Term
What is the use of vitamin C?
Definition
promotes healing
Term
What is the use for folic acid?
Definition
macrocytic (large RBCs) anemia
Term
What are folic acid and thiamine used for?
Definition
vitamin deficiencies associated with alcoholism.
Term
What are B vitamins used for?
Definition
needed for metabolism of carbohydrates and maintenance of GI function
Term
Is vitamin K included in a banana bag?
Definition
No
Term
What causes metabolic alkalosis?
Definition
excess ingestion or administration of sodium bicarbonate (baking soda), TPN solutions, blood transfusions, GI loss of HCl via vomiting, GI suctioning, bulimia, diuretic therapy, loss of chloride and body fluids
Term
What are the signs and symptoms of metabolic alkalosis?
Definition
↑ pH, ↑ HCO3, confusion, hyperactive reflexes, tetany, convulsions, hypotension, dysrhythmias
Term
What is the treatment for metabolic alkalosis?
Definition
Restore KCL or NaCL, watch for S/S of hypocalcemia or hypophosphatemia
Term
What causes metabolic acidosis?
Definition
diabetes mellitus, fasting and starvation (anorexia & bulimia), lactic acidosis, salicylate poisoning (aspirin overdose), alcohol poisoning, kidney dysfunction and failure, loss of intestinal secretions (diarrhea & GI suctioning)
Term
What are the signs and symptoms of metabolic acidosis?
Definition
↓ pH, ↓HCO3, diarrhea, nausea, vomiting, anorexia, weakness, lethargy, malaise, altered mental status, coma, peripheral vasodilation, shock, bradycardia, cardiac dysrhythmias, warm flushed skin, Kussmaul’s respirations
Term
What is the treatment of metabolic acidosis?
Definition
Administer bicarbonate (HCO3) via IV or PO
Term
What does the blood transport?
Definition
 Oxygen
 Nutrients
 Hormones
Term
What does infusing blood or blood products accomplish?
Definition
 Restores circulating volume
 Improves the ability of the blood to carry oxygen
 Replaces blood components such as clotting factors
Term
How many liters of blood does an adult normally have?
Definition
5 liters
Term
What causes respiratory acidosis?
Definition
Respiratory center depression (sedative overdose, head trauma), lung disorders (pneumonia, emphysema, asthma, pulmonary edema, respiratory distress syndrome, airway obstruction, airway injury, injury to thorax), extreme obesity, respiratory muscle paralysis, kyphoscoliosis
Term
What are the signs and symptoms of respiratory acidosis?
Definition
↓pH, ↑PCO2, hypoventilation, shallow respirations, headache, weakness, altered mental status, behavioral changes (disorientation, confusion, depression, paranoia, hallucinations), tremors, paralysis, stupor, coma, warm dry skin, drowsiness, nausea and vomiting, diarrhea, fruity smelling breath, acidic blood, acidic urine
Term
What is the treatment for signs and symptoms of respiratory acidosis?
Definition
treat the cause, may need Narcan to reverse sedation
Term
What causes respiratory alkalosis?
Definition
hysteria, hyperventilation, high fever, salicylic poisoning (aspirin), elevated ammonia, encephalitis, and mechanical ventilation
Term
What are the signs and symptoms of respiratory alkalosis?
Definition
↑pH, ↓ PCO2, deep respirations, rapid breathing, panic, irritability, light-headedness, dizziness, paresthesias, + Chvostek’s sign and + Trousseau’s sign, seizures, nausea & vomiting, diarrhea, muscle twitching, tetany, alkaline urine, ECG changes
Term
What is the treatment for signs and symptoms of respiratory alkalosis?
Definition
Slow down breathing. Get patient to concentrate on breathing slowly and deeply. Have them breathe into a paper bag- re-breathing CO2 will increase CO2 in blood and decrease pH to more normal levels
Term
What is the normal pH of cells?
Definition
7.35-7.45
Term
What controls the acid-base balance?
Definition
cellular buffers, lungs (blows of CO2), kidneys (reabsorb bicarbonate or excrete more bicarb as needed)
Term
What are cellular buffers?
Definition
proteins, hemoglobin, bicarbonate, phosphates which attempt to “soak up” acids
Term
What role of the fluid regulation process do the kidneys play?
Definition
retain or excrete urine as well as metabolic waste products
Term
What role of the fluid regulation process does the heart and the blood vessels play?
Definition
circulate fluid to kidneys- osmoreceptors detect fluid levels
Term
What role of the fluid regulation process do the lungs play?
Definition
remove water from body during exhalation
Term
What role of the fluid regulation process does the endocrine system play?
Definition
produces hormones that reg. fluid volume and concentration (ADH & aldosterone) ADH reg. water retention; Aldosterone reg. retention of sodium
Term
Tenting
Definition
the fold stays up when released-a sign of dehydration- count the number of seconds it stays tented
Term
Pitting Edema
Definition
push finger into tissue over a bone and count number of seconds it stays pitted
Term
Pulmonary Edema
Definition
listen with stethoscope over all lung fields- crackles or rhonchi indicates fluid excess
Term
What is normal urine specific gravity?
Definition
1.01-1.25
Term
What is the normal proportion of output from intake?
Definition
urine will be 1/3-1/2 of intake due to losses through respiration, sweating, etc
Term
Diffusion
Definition
solutes move from high concentration to area of lower concentration
Term
Osmosis
Definition
fluids move from high concentration to area of lower concentration
Term
Diaphoresis
Definition
heavy sweating
Term
Non-pitting edema
Definition
does not indent with slight pressure
Term
dependent edema
Definition
occurs when part hangs down as in hanging legs down or sitting long periods
Term
What can low serum protein levels cause?
Definition
fluid to leave vascular system and leak into tissues
Term
pitting edema
Definition
rated +1(mild) to +4 (severe)
Term
What are common diuretics?
Definition
- Lasix (furosemide)
- Bumex (Bumetanide)
- Demadex (Toresemide)
- Microzide or Diuril (Chlorothiazide)
- Hydrodiuril (hydrochlorothiazide) HCTZ
- Aldactone (spironlactone)
Term
What are the signs and symptoms of dehydration?
Definition
- Dry mucus membranes
- Dry skin
- Poor skin turgor-tenting
- Decreased urine output < 30 cc/hr
- Rapid weak pulse
- Hypotension- ↓BP
Term
What is the treatment for dehydration?
Definition
- Restore the fluids- IV, push fluids, TPN
- Good skin care- moisturizers, gentle handling of skin
- Reposition at least every 2 hours
- Strict I&O and daily weight
Term
What can cause fluid volume deficit (dehydration)?
Definition
- Inadequate fluid intake or starvation
- Loss of body fluids through sweating, diarrhea, vomiting, excessive urine output (diuresis), excessive drainage from wounds or burns, GI suctioning
- Fever
- Endocrine disorders/renal problems
Term
What is the treatment for fluid volume excess?
Definition
- Put patient in semi-Fowlers or Fowlers position to facilitate easier breathing
- Elevate feet and legs above the level of the heart to edema
- Decrease IVF rate (MD order)
- Administer O2 (MD order)
- Reduce sodium in diet (MD order)
Term
What should you do for IV administration in pediatrics?
Definition
- Explain carefully if patient is old enough to understand
- Appropriate language
- Be honest
- DO NOT have parent restrain child
- Immobilization – hold or wrap
Term
What should you include in the patient chart when starting an IV?
Definition
size and type of catheter, the number of attempts, the date and time, the site of insertion, the type of solution and additives or medications, the flow rate, the pump information, the type of dressing applied, your name and initials. Include any patient education that you provide.
Term
What two techniques might help if you are unable to access a vein?
Definition
If you are unable to locate a vein, you might try tapping gently over the vein to elicit a mechanical reflex dilation of vein walls or use a warm, moist compress over the site.
Term
When should you check the physician’s orders before administering IV medications or solutions?
Definition
You should check the physician’s orders three times before administering IV medications or solutions:
• When you obtain the medication or solution from the pharmacy or from the supply area
• During preparation
• Immediately prior to starting the infusion
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