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Med Surg 3- Quiz 4 study guide
What is the purpose of a specific gravity test? - To check fluid status. What causes Resp. Acidosis? - pH less than 7.35 with a paCO2 >45mmhg. caused by an accumulation of co2 which combines with water in the body to produce carbonic acid which lowers the pH of the blood. ex:Pulmonary embolism, Hypoventilation, atelectasis, pneumonia, pneumothorax, pulmonary edema, bronchial obstruction, impaired resp muscle function, cns depression r/t head injury or meds. S/S of Resp. Acidosis? - dyspnea, resp distress, shallow resp, ha, restlessness, confusion, tachycardia, dysrhythmias What causes Resp. Alkalosis? - pH > 7.45 with a pa co2 < 35mmhg. ex: hyperventilation, pain, cns lesions, meds (resp stimulants), fever, sepsis, pregnancy, thyrotoxicosis, fear or anxiety S/S of Resp. Alkalosis? - light-headedness, confusion, numbness, tingling, blurred vision, inability to concentrate, palpitations, diaphoresis, dysrhythmias, dry mouth, tetanic spasms of arms and legs What causes Metabolic Acidosis? - bicarbonate <22 mEq/L, pH < 7.35. A deficit of base in the bloodstream or and excess of acids, other than co2. ex: diarrhea, intestinal fistulas, renal failure, DKA, anaerobic metabolism, starvation, salicylate intoxication S/S of Metabolic Acidosis? - kussmal's resp, nausea, vomiting, warm flushed skin, dysrhythmias, ha, confusion, restlessness, lethargy, stupor, coma What causes Metabolic Alkalosis? - bicarbonate > 26 mEq/L pH >7.45. excess of base or a loss of acid within the body. Excess base occurs from ingestion of antacids, excess use of bicarbonate, or use of lactate in dialysis. Loss of acids occur secondary to protracted vomiting, gastric suction, hypochloremia, high levels of aldosterone, excess administration of diuretics. s/s of metabolic alkalosis? - resp depression, dizziness, lethargy, coma, seizures, disorientation, nausea, vomiting, tetany, weakness, muscle twitching, muscle cramps
complications of infiltration? - caused by nonvesicant solution or med administered into surrounding tissue. the iv dislodges or perforates the wall of the vein. s/sx: edema around site, coolness, discomfort, leakage of iv fluid from site, significant decrease in the flow rate. tx: stop infusion, d/c iv, apply sterile dressing, warm/cold compress is applied and elevate arm to promote absorption What are the local complications of phlebitis? - inflammation of a vein. can be cuased by and irritating med, rapid infusion rate, med imcompaibilities. s/sx: reddened, warm area around site, pain or tenderness at site tx: d/c iv, restart in another site, apply warm, moist compress What is third spacing? - loss of ECF into space that does not contribute to equilibrium s/sx: early evidence of third spacing is a decrease in urine output despite adequate fluid intake. increased hr, decreased bp, decreased central venous pressure, edema, increased body wt, imbalances in i&o. who: hypocalcemia, decreased iron intake, severe liver diseases, alcoholism, cancer, burns, immobility, malabsorption, hypothyroidism What does third spacing cause? - Hypovolemia What is the purpose of Chvoctek & Trousseau testing? Interpretation of positive test? - to test for hypocalcemia chvoctek: tapping over the facial nerve and causing spasms trousseau: spasm caused by the blood flow to the arm is occluded using a bp cuff, and hand will turn upwards. What acid based imbalance does an NG tube cause? - Metabolic alkalosis (from vomiting & gastric suctioning) What is the normal pH range? - 7.35 to 7.45 (below 7.35 = acidosis ; above 7.45 = alkalosis)
-Fat: 20-30%, with >10% from saturated fat and < 300 mg cholesterol; -Fiber: may improve blood glucose levels What activities affect level of insulin? - encourage regular daily exercise, Gradual, slow increase in exercise period is encouraged, Exercise with elevated blood sugar levels (above 250 mg/dL) and ketones in urine should be avoided, Rapid acting insulin - humalog: onset: 10-15min; peak: 1hr; duration: 2-4hr novolog:onset: 5-15 min; peak 40-50 min; duration:2-4hr glulisine:onset:5-15min; peak: 30-60 min; duration:2 hr Manifestations of Hyperglycemic hyperosmolar nonketotic syndrome? - hypotension, profound dehydration, tachycardia, and variable neuro signs(seizures, hemiparesis) What are some nursing considerations & priorities for Hyperglycemic hyperosmolar nonketotic syndrome? - -More common in type 2 diabetes w/ BS over 600 -Hypotension, dehydration(dry mucous membranes & poor skin turgor), tachycardia, & neuro changes. -Tx w/ fluid replacement (0.9 or 0.45 NS) & insulin administration. Most pt.'s are older and are at risk for fluid overload, HF, & dysrhythmias What are some ways to manage Hyperglycemic hyperosmolar nonketotic syndrome? - fluid replacement, correction of electrolyte imbalances, and insulin administration What is a nursing diagnosis for Hyperglycemic hyperosmolar nonketotic syndrome? - -risk for fluid volume deficit related to polyuria and dehydration -fluid and electrolyte imbalance related to fluid loss or shifts -deficient knowledge about diabetes self care skills or info -anxiety related to loss of control, fear of inability to manage diabetes, misinformation related to diabetes, fear of diabetes complication Foot care considerations for diabetics? - inspect your feet everyday. Use a mirror to check the bottom of your feet or ask someone to look if you have trouble. Wash your feet everyday, in warm not hot water.
Dry you feet well and in between toes.keep skin soft and smooth, trim your toenails weekly. Wear socks and shoes at all times. protect feet from hot and cold and keep blood flow to feet. call doctor if a cut, blister, etc you have doesn't start to heal in one day If a patient has had a thyroid or parathyroidectomy, what are some potential complications? - - Hemorrhage, hematoma formation, edema of the glottis, & injury to the laryngeal nerve. What are some post-op managements for a patient with a thyroid or parathyroidectomy? - -Assess surgical dressing -Monitor pulse & BP -Complaints of pressure or fullness at surgical site -Difficultly breathing (keep tracheostomy set at bedside) -Administer IV fluids -Administer pain meds -Keep in semi-fowler's position w/ head supported by pillows. -Advise pt. to refrain from speaking What are some surgical managements & nursing assessments for an adrenalectomy? - -Monitor BP & blood volumes -Maintain hydration to prevent hypotension -IV admin. of corticosteroids if bilateral adrenalectomy -Monitor for hypotension & hypoglycemia -Monitor EGC, pressures, fluid & electrolyte balance, & Blood glucose. What are some manifestations of Addison's disease(adrenocortical insufficiency)? - -Muscle weakness -Anorexia -GI symptoms -Fatigue -Emaciation -Dark pigmentation of the mucous membranes & skin (Esp. knuckles, knees & elbows)
Nursing process for Pt. w/ Hyperthyroidism - Assess- accelerated metabolism, irritability, anxiety, sleep disturbances, apathy, lethargy & increased emotional reactions. Diagnosis- 1)Imbalance nutrition, less than body requirements. 2)Ineffective coping related to irritability, hyperexcitability, apprehension & emotional instability. 3) Low self-esteem related to changes in appearance, excessive appetite & weight loss. 4)Altered body temp. Hypercalcemia - -Serum level above 10. -Caused by malignancy and hyperparathyroidism, bone loss related to immobility. -S/S muscle weakness, in-coordination, anorexia, constipation, nausea and vomiting, abdominal and bone pain, polyuria, thirst, ECG changes, dysrhythmias. Hypocalcemia - -Serum level less than 8. -Caused by hypoparathyroidism, malabsorption, pancreatitis, alkalosis, massive transfusion of citrated blood, renal failure, medications, other. -S/S : tetany, circumoral numbness, paresthesias, hyperactive DTRs, Trousseau's sign, Chovstek's sign, seizures, respiratory symptoms of dyspnea and laryngospasm, abnormal clotting, anxiety -Tx w/ IV of calcium gluconate, calcium and vitamin D supplements; diet Hyperkalemia - -Serum potassium greater than 5. -Causes: usually treatment related, impaired renal function, hypoaldosteronism, tissue trauma, acidosis -S/S: cardiac changes and dysrhythmias, muscle weakness with potential respiratory impairment, paresthesias, anxiety, GI manifestations -Tx: : monitor ECG, limitation of dietary, potassium, cation-exchange resin (Kayexalate), IV sodium bicarbonate, IV calcium gluconate, regular insulin and hypertonic dextrose IV, -2 agonists, dialysis. Hypokalemia - -Potassium below 3. -Causes: GI losses, medications, alterations of acid-base balance, hyperaldosterism, poor dietary intake -S/S:: fatigue, anorexia, nausea, vomiting, dysrhythmias, muscle weakness and cramps, paresthesias, glucose intolerance, decreased muscle strength, DTRs. Tx: increased dietary potassium, potassium replacement, IV for severe deficit.
Hypermagnesia - -Serum level less than 1. -Causes: alcoholism, GI losses, enteral or parenteral feeding deficient in magnesium, medications, rapid administration of citrated blood; contributing causes include diabetic ketoacidosis, sepsis, burns, hypothermia -S/S: neuromuscular irritability, muscle weakness, tremors, athetoid movements, ECG changes and dysrhythmias, alterations in mood and level of consciousness -Tx: diet, oral magnesium, magnesium sulfate IV. Hypomagnesia - -Serum level more than 2. -Causes: renal failure, diabetic ketoacidosis, excessive administration of magnesium -S/S: Manifestations: flushing, lowered BP, nausea, vomiting, hypoactive reflexes, drowsiness, muscle weakness, depressed respirations, ECG changes, dysrhythmias Tx: IV calcium gluconate, loop diuretics, IV NS of RL, hemodialysis Hypernatremia - -Serum sodium greater than 145 -Causes: excess water loss, excess sodium administration, diabetes insipidus, heat stroke, hypertonic IV solutions -S/S: thirst; elevated temperature; dry, swollen tongue; sticky mucosa; neurologic symptoms; restlessness; weakness -Tx: hypotonic electrolyte solution or D5W Hyponatremia - -Serum sodium less than 135 -Causes: adrenal insufficiency, water intoxication, SIADH or losses by vomiting, diarrhea, sweating, diuretics. -S/S: poor skin turgor, dry mucosa, headache, decreased salivation, decreased BP, nausea, abdominal cramping, neurologic changes. -TX: water restriction, sodium replacement Hyperventilation results in? - Respiratory alkalosis When should you take Prednisone? - First thing in the morning.
