EXAM1, SPRING07, DIAGNOSTICS, ELECTROLYTES, Dee 2

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Immobility, bone Ca, excess intake, incr. parathyroid hormone & thiazide diuretics are all causes of ___________.: causes of hypercalcemia
Actual excess: overuse of salt substitutes, rapid IV LR, multiple blood transfusions can cause _________. relative excess: CRF, overuse of K-sparing diuretics, tissue damage, acidosis: hyperkalemia
Renal failure & excess use of magnesium-containing antacids can cause _____________.: hypermagnesemia (rare)
Excess IV saline, hypertonic tube feeds w/o enough water can cause __________.: hypernatremia (Na+)
A pancreatic or small intestine disease, acute renal failure, vit D deficiency, hypoparathyroidism, & hyperphosphatemia can lead to ____________.: hypocalcemia
A loss of intestinal fluids, malnutrition, renal probs, loop diuretics, parathyroid hormone deficiency can cause __________.: hypomagnesemia
In regards to fluid movement between extracellular & intracellular; A water __________ (increased ECF) is associated w/symptoms that result from cell shrinkage as water is pulled ____ the vascular system.: deficit

into
Macro-vascular disease is most common with which type of diabetes?: type II
Phosphate imbalance is assoc. with _____ and parathyroid probs: Ca++
s/s of hypercalcemia: constiptaion, N/V, polyurea, renal stones
decreased muscle tone
deep bone pain
decreased reflexes
lethargy
coma
s/s of hyperkalemia: diarrhea
abd cramps
muscle twitch
cardiac irregularities
resp. failure
s/s of hypermagnesemia: hypotension
cardiac arrest
resp. depression
decreased reflexes
s/s of hypernatremia: thirst & elevated temp
restlessness
seizures
muscle twitch
rubbery skin
dry MMs
tachycardia
fast thready pulse
decr. urine output
s/s of hypocalcemia: tetany
tingling/numbness in xtrmitys
facial muscle spasm (Chovstek's sign)
carpopedal spasm
(Trousseau's sign)
laryngospasm
dyspnea
hyperactive reflexes
seizures, arrhythmias
s/s of hypokalemia: muscle weakness & leg cramps
constipation
irritability & confusion
irregular pulse, heart block
orthostatic BP
shallow resp
s/s of hypomagnesemia: confusion
hallucinations
seizures
increased reflexes
parasthesias
tremors, spasms
arrhythmias
s/s of hyponatremia: anorexia, N/V, cramps, muscle weakness, lethargy, confusion, seizures, Na+ <135 mEq/L
Those with type II diabetes are often...: overweight

dyslipidemic (high cholstrol)

hypertensive
Type I is characterized by a lack of _______ and a relative excess of _______: lack of insulin and excess of glucose
What accompanies macro-vascular disease?: coronary arterty disease
stroke
peripheral vascular disease
What accompanies micro-vascular disease?: retinopathy- retna ascempia
diabetic nephropathy- destruction of kidneys due to damage of glumaria
What are the symptoms associated with type I?: hyperglycemia
loss of glucose in urine
polyuria
polydipsia
What does insulin do in type I?: reduces the blood glucose level
What does sulfonylureas do?: stimulates insulin release from pancreatic beta cells
what is ketoacidosis?: increased glucose and ketones and makes breath smell fruity and sweet
what is macro-vascular disease?: athrosclerosis, thickening of arteries
What is the classic symptom of type I?: weight loss
What is the diagnosis for Diabetes Mellitus?: -More than one fasting glucose level greater or equal to 126.
-Plasma glucose level in the 2nd hr of the standard oral glucose tolerance test (OGTT) is greater or equal to 200, confirmed on subsequent day
-random plasma glucose level greater than 200, confirmed with classic symptoms of polyuria, polydipsia, and polyphagia
Alcoholism can cause what?: hypophosphatemia, hypomagnesemia, hypokalemia, and hypocalcemia
What are the 3 functions of phosphate: 1-acid base balance
2-muscle contractions
3-nerve conduction
Phosphate has a relationship with what other electrolyte?: Calcium, also vit D
Phosphate is found more abundant in which fluid?: ICF
Why is it important to monitor I & O of a patient with hypermagnesemia?: may indicate renal failure, also may be hypokalemic
What would ask a hypermagnesemic patient to avoid?: antacids w/ magnesium
Clinical manifestations of hypermagnesemia would include:: weakness
lethargy
weak/absent deep reflex
hypotension
flushing
slow arrythmia(Cardiac arrest)
respiratory depression
hypokalemia, hypocalcemia, poor GI absorption, alcoholism, can cause what?: hypomagnesemia
What are the 4 main functions of Magnesium?: 1-neuromuscular activity
2-heart contractions
3-transport Na + K across membrane
4-activates many enzymes for metabolism of carbs, proteins, vit b
Magnesium is the 2nd most abundant electrolyte in what fluid?: ICF
If you correct the potassium levels this usually corrects what other electrolytes?: calcium and magnesium
Which type of diuretics can cause hyperkalemia?: Potassium sparing/Aldactone
Which diuretics can cause hypokalemia?: loop diuretics(lasix)
Thiazide diuretics
What two meds are given with severe hyperkalemia in order to rid the body of K+ and replentish k+ absorption in cells?: Kayexlate and insulin/dextrose
When the hormone aldosterone is secreted the kidneys reabsorb _______ and excrete ______?: kidneys reabsorb Na+
and excrete K+
If a patient has a K+ of 2.5 what will happen to the patients heart?: Arrythmias
What hormone controls glucose levels and also causes K+ to move into the cells?: Insulin
Name some food high in potassium: Bananas/fruit
Nuts
Meat
If the kidneys are damaged or there is a markedly decrease in urine output what happens to potassium?: k+ concentration increases in the ECF
What are the functions of Potassium?: 1-contraction of skeletal/smooth muscle
2-transmission/conduction of nerve muscles
3-strengthens heart muscle contraction/conduction
Potassium is predominantly in what fluid?: ICF
Sodium is found predominantly in what fluid?: ECF
What are the clinical manifestations of Hypervolemia ??: Edema
Full bounding pulses
Moist breath sounds (crackles, rhonchi)
Distended neck veins
Moist skin
What happens in Hypervolemia?: retain water & Na+ so serum lab values remain normal
Manifests as edema & increase in fluid volume.
Condition usually secondary to elevated Na+ content in the body from
excessive intake of Na+ Cl-Na+ containing IV fluids
renal failure, cirrhosis,
heart failure & Cushings
What are the clinical findings of Hyperphosphatemia?: Hyperphosphatemia can be caused by damage to cells which forces PO- into ECF,

overuse of laxatives PO4

infants fed cowâ€™s milk

causes numbness & tingling in fingers & around mouth

muscle spasms & tetany
Phosphate Imbalances in the body are usually related to??: Imbalances are usually related to treatment for other disorders such as glucose or insulin administration which forces phosphate into the cells from the ECF
What are the clinical signs of Hypochloremia??: Hypochloremia-related to loss from GI tract
causes muscle twitching, tetany and tremors
Imbalances are usually related to: Imbalances are usually related to changes in the sodium(Na+) level.
What is Sodiums job in the body?: and major contributor to serum osmolality
Controls and regulates water balance
â€œWhere Na+goes; H2O followsâ€-maintains ECF volume
Caution about clients and Magnesium...: Any one who cannot take in Magnesium orally or parenterally is at risk for Magnesium deficiency.

Clients with altered renal function are at risk for hypermagnesemia
What is Magnesium used for in the body?: Needed for DNA and protein synthesis, ATP production, neuromuscular and cardiac function
Where is Magnesium found in the body?: Found mostly in the skeleton and intracellular fluid
What are the Magnesium-norm values in a adult?:: 1.5-2.5
What is the Physical Assessment of the Client with Fluid Volume Imbalance findings?: HEENT/Integument

Cardiovascular System

Respiratory System

Gastrointestinal System

Genitourinary

Musculoskeletal
What is the minimum expected amount of hourly urinary output for a healthy adult?: 30cc/hr
What supports and maintains bones and teeth in conjunction with Ca++?: Phosporus
you have a pt who is experiencing parasthesia and muscle weakness. What are they suffering from?: Hyperkalemia
you have a pt who is taking loop diuretics and they are experiencing leg cramps and muscle weakness. What are they suffering from?: Hypokalemia
What is the purpose of stimulating the release of aldosterone with low BP, in general or low pressure through the kidney, specifically?: To conserve water in order to increase plasma volume.
What electrolye imbalance usually results from kidney dysfunction, and also results in cardiac dysfunction from hypoaldosterone secretion?: hyperkalemia
(high plasma postassium)
Does aldosterone directly regulate plasma postassium concentration?: yes
What stimulates the release of aldosterone?: low plasma sodium/
high plasma potassium
What does aldosterone act on?: The renal cortical collecting duct cells to promote the movement of sodium from the filtrate back into the blood
Why are diabetics always thirsty?: Because there is an increased plasma osmolarity because of the increased glucose so the regulators are always being stimulated
What is the principal regulator of water intake?: Thirst
How is fluid balance regulated?: By regulating intake (thirst) and output (kidneys)
What is water indirectly regulated by and how is it regulated?: Aldosterone- because it regulates sodium and wherever sodium goes water follows
What are the two components of extracelluar fluid?: Plasma and interstitial fluid
What are the two most important intracellular solutes?: Potassium and protein
What are the two most important extracellular solutes?: Sodium and protein
Elevated osmolarity is indicative of what?: Increased solute (sodium) and decreased fluid (water)
A nurse is assigned to care for a group of clients. On review of the clients' medical records, the nurse determines that which client is at risk for a fluid volume excess?: Client w/renal failure.
The causes of fluid vol. excess include decr. kidney fxn, CHF, the use of hypotonic fluids to replace isotonic fluid losses, excessive irrigation of wounds & body cavities, excessive ingest of Na+. Client w/an ileostomy, client on diuretics, & client on GI suctioning are at risk for fluid volume deficit.
Treatment for Mg+ deficit: Seizure and safety precautions
monitor airway
aspiration precautions
increase Mg+ rich foods
Mg sulfate IV
Characteristics for Mg+ deficit: mental changes, disorientation, mood changes, intense confusion, hallucinations
PO4 Helps acidify ______ to decrease stones & has an inverse relationship w/_____ If blood Ca++ is _____, phosphorus level is high Regulated by ___________.: urine

Ca++

low

PTH (parathyroid hormone)
Hypophostemia is caused by _____ & ______ administration in addition to _______ alcohol _________, & diuretic use.: Glucose and insulin

withdrawal
Treatment for hypophostemia is to ___________.:  Encourage phosphorus foods
Causes for hyperphosphotemia are ______therapy, _____ failure, ______ enemas, & a large intake of Vitamin __: Chemo

Renal

Phosphate

Too much Vit D
Your patient presents w/ cardiac irregularities, hyperreflexia (Chvostekâ€™s & Trousseauâ€™s sign), is eating poorly, exhibits muscle weakness, parethesia, oliguria & numbness. You suspect hyper________.: Hyperphosphotemia
Treatment for Hyperphosphotemia is?: Monitor for signs of hypocalcemia

Adequate hydration
When Mg is out of balance THINK _______ problems & the effect that could occur on the ______ system. Mg & ___ levels tend to increase and decrease together. Mg makes the vascular system _________.: muscle

nervous

K+

vasodilate
Causes of hypomagnesaemia are ________, ________, _______, & bulemia.: Diarrhea

alcoholism

anorexia

bulimia
Treatment for hypomagnesaemia is to administer ___ Sulfate, keep _______ gluconate & ____ tray at bedside, assess ______ reflex & take _______ precautions: Mg

Calcium

trach

swallow

seizure
Causes of hypermagnesaemia are _______ use, ______ failure, & hyper____________.: laxative

renal

hyperparathyroidism
THINK Hypermagnesaemia THINK _____________?: think Sedative
S & S of Hypermagnesaemia are reflexes ________, EKG changes, _______ & vomiting, _______ appearance caused by __________ & lethargy. Treatment is ______Calcium gluconate: decreased

nausea

flushed

vasoldilation

Calcium
The parathyroid pulls _______from bones & is found in bones & ______.: calcium

teeth
____________ keeps calcium in the bones.: Calcitonin
Ca+ has an inverse relationship w/ ____. You must have vitamin ___ to utilize calcium.: PO4

D
Ca+ functions are ______ impulse transmission (muscle contraction and relaxation), helps w/blood ______, is needed for vitamin ____ absorption, & must have for strong bones & teeth.: nerve

clotting

B12
Causes for hypocalcemia are hypo __________, radical neck, thyroidectomy, _________, & ___________. removal.  Alcoholism, parathyroid removal: HYPOparathyroidism

alcoholism

parathyroid removal
S & S of hypocalcemia are muscle tone; ______ & Trousseus sign, Arrhythmias, deep _______ relfexes, mind changes, & _____ difficulties.: Chvostekâ€™s

tendon

swallowing
Treatment for Hypocalcemia is Vitamin __, Amphogel, IV ___ gluconate, __________ tray, ____ bag.: D

Ca+

Tracheostomy

ambu
Hypercalcemia is caused by Hyper___________, thiazides, & ___________.: Hyperparathyroidism

immobilization
THINKING Sedative? THINK ___________?: Hypercalcemia
S & S of Hypercalcemia are kidney ______, deep tendon _______, muscle tone, LOC, change in ______ _______. Treatment is fluids, phospho____, Lasix, & get patient __ & mobile ASAP! Must have _______ gluconate & _____ tray at ___: stones

reflexes

vital signs

soda

up

Calcium

trach

bed
When Na is retained so is ______Chloride.: Chloride (Cl-)
__________ is associated with Na.: Chloride
Causes of Hypochloremia are ____ salt intake, exclusive D5W, Diuresis, ________ N&V, diarrhea, ____ suctioning & ______ fibrosis: low

prolonged

NG

Cystic
S & S of Hypochloremia are agitation & ___________, hyperactive deep-tendon reflexes, muscle ______ & ________ tetany, weakness & _______: irritability

cramps

tetany

seizures
Treatment for Hypochloremia is IV chloride & ___ replacements. Use NS NOT _____ water to irrigate NG: K+

tap
Causes of Hyperchloremia are __________Increased intake, excess _____, metabolic ________, & _______ renal failure: Increased

salt

acidosis

renal
S & S of Hyperchloremia are ____ & lethargy, hyper _____, Kussmaulâ€™s _____, tachycardia & _____.: weakness

natremia

breathing

edema
Treatment for Hyperchloremia is to _______ vital signs, & _______ considerations: monitor

safety
With hyperchloremia DO NOT not use _______ water.: tap
When Na+ is ___ , ___ is down.: up

K+
If Ca+ is up then ___ is down.: PO4
Mg decreases _______ pressure, causes vaso_____, is found in ____, & causes ___________ in pregnant women.: blood pressure

vasodilation

bone

hypertension
If a patient presents a positive Chetwicks sign, check _______ & _________ reflex.: gag & swallow
If Ca+ is down, ___ is up.: PO4
Treatment for hyperkalemia (excess K+) is ________ which is usually given by enema b/c it binds to K+ in the ____________intestine to decrease K+ level: Kaexelate

large
The number one cause for hypophostemia is _________. What foods should the RN order in the patients diet in response?: alcohol

Vitamin D rich foods

yogurt

milk
With fluid volume overload what electrolytes would a patient be low on?: Na+

also:
Cl- imbalances are affected by Na+ imbalance due to their
close relationship
A symptom of fluid volume overload would be a ________ because ingesting too much water in a short period of time flushes ___ out of ECF thus causing water to move into ICF. Cells swell within confines of the ______.: severe headache

Na+

skull
Sedimentation reveals the __________ of a disease.: progression
When a urine specimen is required the RN should consider the patients _______ to participate in the collection.: ability
If a urine specmen cannot be delivered to the lab within 15-20 minutes it should be ________.: refrigerated
If a urine specimen has been refrigerated for 25 hours the RN ________.: discards it

a new specimen will be necessary
What test is used t determine renal fxn & proteinuria in diabetics?: Timed Urine Specimen
The RN needs a urine specimen from a non-toilet trained child. What method will she use to collect the specimen?: Pedi bag
The proceedure for a Timed urine specimen is to wear _____ & discard the ___ specimen. Documentation would indicate the ___ & ___ the test was started. The RN would have the patient drink an adequate amount of fluid. The RN would place a sign in: gloves

1st

date & time

bathroom

door

volume

each
Occult blood in stool measures for microscopic __________ in feces.: amount of blood
What could interfere with an occult blood test?: red meat

a woman on her period
Red meat can result in a ________ result in an occult blood test.: false positive
A specimen collected to aid in the diagnosis & treatment of bronchitis & lung cancer is a ?: sputum specimen
What are the 3 types of sputum specimens?: cystolgy

culture & sensitivity

TB (acid fast bacilli)
A TB (acid fast bacilli) test requires 3 consequtive ________ samples & cultures for up to _______ weeks: morning

8
When collecting a sputum sample the patient should be in _______ position & instructed not to _______. Is instructed to take 3-4 ____ breaths, exhale _____, & cough after full _______ & then expectorate sputum into container.: semi fowlers

touch the inside of the container

deep

slowly

inhalation
A sputum test should be taken before ________ & the patient should be instructed not to use ________ or _________ before the specimen is collected.: breakfast

mouthwash or toothpaste
The best time to collect a specimen from a wound is _______.: during a dressing change
Conditions that can interfere with testing for Occult Blood in Stool are ?: ⬢ Menstrual period
⬢ Hemorrhoids
⬢ Diet
⬢ Drugs
An occult blood test is usually comprised of ___ specimens once ______ for 3 days: 3

every
Guidelines for a diagnostic procedure are to assess patientâ€™s ________, determine patientâ€™s knowledge for _____ findings, for prolonged ____ time, previos history of problems w/_____ & allergies, special instructions. â€¢ Example: Patient mu: base line VS

abnormal

clotting

anesthesia
Removal of fluid from the peritoneal area is called?: Abdominal Paracentesis
The accumulation of serous fluid in the peritoneal or abd cavity as a result of portal hypertension is called?: ⬢ Ascites
For abdominal paracentesis the RN should always Measure the ______ _____ before & after.: abdominal girth
Maximum fluid withdrawn from a abdominal paracentesis is _______.: 1500mL.
The RN's responsibility for a abd paracentesis procedure is set up ____ w/supplies, position patient in ___________or in chair w/feet supported, _____ procedure to patient as physician procedes & take VS __ during procedure & ___ for an hr post p: sterile tray

Semi-fowlers or sitting upright on side of bed

describe

q 15 min

q 15 min

hypovolemic

dressings
A patient who experiences acute abdominal pain during or after a ABD paracentesis may indicate ___________.: perforation of the bowl
A radiographic visualization of the vasculature of the heart and arterial system after injection of radiopaque contrast material is called a __________. In this procedure a small radiopaque ________ is threaded through the artery to the site & a ____: Angiography

catheter

contrast
When an Angiography is ordered the RN assesses patientâ€™s ________ of the procedure, takes ___, locate & mark peripheral _____, arranges NPO for ____hrs, assess for _____ allergy: understanding

VS

pulses

6-8 hours

iodine
Medications administered for a Angiography are: _____ to decrease salivary secretions _____to decrease allergic response _____to reduce anxiety and promote relaxation: Atropine

Benadryl-prophylactically

Sedative
During a Angiography the patient is in ______ sedation but the RN teaches the patient that during the injection of the dye they may experience _________.: IV Conscious sedation

some chest pain and hot flash that twill last a few minutes
After a Angiography the patient presents with decreased peripheral pulses, coolness, mottling, pallor, pain, numbness & tingling in the affected extremity. The RN knows these are signs of signs of __________ tissue perfusion & calls the Dr. _____: decreased

immediately
When a patient experiences decreased tissue perfusion & calls the Dr. immediately, she will also apply a _______ dressing to the vascular access site & keep the patient at bedrest for _____hrs, & ________ the extremity for _____hrs after the: pressure

4-8hrs

immobilize

6-8hrs

1-2 liters of fluids post procedure
Examination of the tracheobronchial tree through a lighted tube with mirrors via the mouth is called a ________?: Bronchoscopy
Assessment of a patient for a Bronchoscopy includes patientâ€™s understand of procedure, VS & ____OX, _____ to anesthesia, spraying throat w/_______, ___ for 8 hours, & may use _____: pulse

allergy

lidocaine

NPO

IVCS
Procedure for a Bronchoscopy the RN instructs patient not to ______ local anesthetic & provides ____ basin, asseses _____ status thru out procedure, & Post procedure does not allow the patient to ___or___ until ___ is present. (2 hours, Test: swallow

emesis

respiratory

eat or drink

gag reflex

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Deck Info

Number of cards 156