Nurs 3632 Exam 5- Ndee Study Guide

NURS 3632 EXAM 5- NDEE STUDY GUIDE Terms: 1. concentration of particles in a solution, or a solution’s pulling power Osmolarity 2. substance capable of breaking into ions and developing an electric charge when dissolved in solution Electrolyte 3. ion that carries a positive electric charge Cation 4. ion that carries a negative electric charge 5. substance dissolved in a solution 6. liquid holding a substance in solution Anion Solute 7. abnormal buildup of fluid in the abdomen Solvent Ascites 8. passage of a solvent through a semipermeable membrane from an area of lesser concentration to an area of greater concentration until equilibrium is established Osmosis 9. movement of ions or molecules across cell membranes, usually against a pressure gradient and with the expenditure of metabolic energy Active Transport 10. tendency of solutes to move freely throughout a solvent from an area of higher concentration to an area of lower concentration until equilibrium is established Diffusion 11. having about the same concentration as the solution with which it is being compared Isotonic 12. two solutions that have the same osmotic pressure across a semipermeable membrane Hypertonic 13. having a lesser concentration than the solution with which it is being compared 14. the action or process of filtering something 15. accumulation of fluid in extracellular spaces Hypotonic Filtration Edema FLUID A. Describe the location and functions of body fluids, their distribution, including the factors that affect variations in fluid compartments. 40 20 16. (Fat/muscle) holds more fluid. muscle B. Describe the basic concepts of body fluids, electrolytes, and maintenance of homeostasis. 17. What is the primary body fluid? a. water 18. What is the total body percentage of fluid in the average adult? a. 60% 19. What factors influence the percentage of body fluid in an individual? a. Age, body fat, sex 20. How are body fluid levels maintained? a. Fluid intake is regulated by the mechanism. Within the the thirst center is stimulated by dehydration thirst, hypothalamus, intracellular 21. the loss of or deprivation of water from the body or tissues Intracellular dehydration 22. substances that are capable of breaking into particles called ions Electrolytes 23. Sodium, potassium, calcium, hydrogen, and magnesium are major (anions/cations) in the body, and chloride, bicarbonate, and phosphate are the major (anions/cations). Cations, anions 24. Major electrolytes in the potassium, phosphorus, and magnesium, while major electrolytes in the include sodium, chloride, calcium, and bicarbonate C. Describe the function of water in the body 25. What is the function of water in the body? a. Regulates body temperature b. Transports: i. Nutrients ii. waste iii. Energy to sites of activity c. Lubrication of: i. joint spaces ii. tissue d. Solvent for electrolytes and non-electrolytes e. Facilitates digestion & elimination f. Maintains hydrostatic pressure in cardiovascular system 26. Why do fluids move? a. To remove waste b. Cells to feed themselves c. Send and receive messages d. Chemical substances Explain regulatory mechanisms of fluid balance 27. What are the regulatory mechanisms of fluid and electrolyte homeostasis? a. Hormones 28. What hormones regulate fluid and electrolyte homeostasis? a. ADH (vasopressin) b. ANP c. d. RAAS Anti-diuretic hormone, Atrial natriuretic peptide, Aldosterone, Renin- Aldosterone-Angiotensin System 29. What three mechanisms in the body help to regulate blood volume/blood pressure? a. The stimulates fluid retention via the stretch receptors in the atria and blood vessels heart b. The secretes aldosterone which causes Na and water to be reabsorbed and K excreted Adrenal gland/cortex c. The stores and releases ADH, which causes the reabsorption of water Pituitary gland 30. What factors trigger the hypothalamus to initiate the compensatory mechanism for dehydration? a. Increased serum osmolarity b. Decreased blood volume Describe the signs and symptoms of fluid imbalance & Interventions 31. What are the signs and symptoms associated with fluid imbalance? a. The pt. may have a low grade fever b. ↑HR & RR, ↓BP, ortho hypo, weak /thread pulse, dizzy, light-headed, flat neck veins c. Skin - Color, moisture, turgor d. Oral Mucosa - dry, cracks, fissures, deep furrows; thick, sticky coating. 32. What observations can the nurse visualize during assessment that indicate dehydration? a. Dry oral mucosa, furrowed tongue, cracked lips, poor skin turgor, skin tenting Explain assessment of fluid status 33. How is fluid status assessed? a. A pt’s fluid status is assessed by examining lab values 34. What lab values are associated with dehydration/overhydration? a. BUN, Creatinine, plasma osmolarity, hemoglobin, hematocrit, specific gravity, urine osmolarity 35. Lab values a. 10-20 mg/dL b. 0.5-1.2 36. What is creatinine? BUN (blood urea nitrogen) Creatinine a. Creatinine is a byproduct of muscle and protein breakdown 37. How is GFR calculated? a. Age, ethnicity, gender, weight, height, creatine *If the body is not excreting waste products there is damage to the kidney* b. 285-295 c. 12-16 gm/dL d. 35-47 gm/dL plasma osmolarity hemoglobin hematocrit e. 1.005- 1.030 f. 300-900 mOsm/L 38. What lab provides insight to the quality of kidney functioning? a. Glomerular filtration rate 39. T/F: Increased BUN and HCT is indicative of dehydration specific gravity urine osmolarity True D. Discuss and define the processes involved in fluid and electrolyte balance. 40. Through what sources does the body receive water? a. The body receives water from: i. Ingested liquids, food, and as a byproduct of metabolism 41. What are processes involved in fluid and electrolyte balance? a. The processes involved in maintain fluid and electrolyte balance are i. ii. iii. iv. v. Organs & body system, osmosis, diffusion, active transport, capillary filtration 42. What are some risk factors for the development of fluid & electrolyte imbalance? a. Acute illness i. Vomiting and diarrhea ii. Severe burns iii. Serious injury or trauma, chronic kidney disease b. Surgery c. Poor nutritional intake 43. What are the physiological consequences of fluid deficit and its effect on the body? a. A deficient fluid volume results in . When a pt. is hypotensive they are not receiving proper perfusion to their organs and tissues. To compensate the heart will become to increase perfusion. This leads to a and pulse. Hypotension, tachycardic, weak & thready b. For pt’s with severe dehydration they may experience due to the lack of water in their body. Older adults may experience due to lack of blood flow to the brain Fever, delirium E. Identify the normal distribution of normal body water in both an infant and an adult. Consider risk factors and differences between the ages and the implications of fluid loss in the age groups. 44. What is the normal composition of water in the body across the lifespan? a. 73-75% b. 65% c. 60-70% d. 50-58% Neonate, 6 month old, 2 yr old, adult 45. T/F: Infants have more total body fluid and ECF than adults, and ECF is easily lost, therefore they can become dehydrated quickly and are at risk for fluid volume deficits. True 46. Why is there a decrease in body fluid in the older adult, compared to the average adult? a. There is a greater fluid loss seen in the older adult because there generally a substantial drop in muscle mass, and accumulation of body fat 47. What additional factors put the older adult at risk for dehydration/fluid imbalance? a. Decreased thirst sensation, mobility issues, medications Extracellular and intracellular fluid compartments 48. (Intracellular/Extracellular) fluid is composed of intravascular fluid, and (Intracellular/Extracellular) is composed of interstitial and plasma. Intracellular, Extracellular 49. (Intracellular/Extracellular) constitutes 70 % of the total body water, while (Intracellular/Extracellular) constitutes 30 of the total body water Intracellular, Extracellular 50. What is intracellular fluid? a. Intracellular fluid id fluid within the cells. 51. T/F: Intracellular fluid make up the bulk of the body fluid levels Discuss examples of body fluid movement 52. How does the body maintain fluid balance? a. movement of water from an area of lesser to one of greater concentration through a semipermeable membrane Osmosis b. movement of molecules (ions) across a membrane against osmotic pressure to an area of higher pressure; Requires expenditure of metabolic energy. Active Transport c. movement of a solute (particles) across a permeable membrane from an area of higher concentration to an area of lower concentration Diffusion d. movement of fluid (water) across a permeable membrane, under pressure, from higher to lower pressure 53. Where are the major electrolytes found? a. ICF, ECF Filtration ECF ICF • Sodium • Calcium • Potassium • Magnesium • Calcium 54. major extracellular cation, regulated by RAAS system 55. major intracellular cation, regulated by aldosterone Sodium Potassium 56. 2nd most abundant ICF ion after K, regulated by parathyroid hormone Magnesium 57. ion found in both the ICF and ECF, regulated by parathyroid gland and Calcitonin Calcium 58. regulated by parathyroid hormone and Vit D, inversely proportional to Ca 59. regulated by aldosterone, and has a positive correlation with Potassium Chloride F. Identify the routes of fluid loss. Types of Fluid loss 60. fluid loss that can be measured i.e. via urination, defecation, wounds sensible 61. fluid loss that cannot be measured or seen and include fluid lost from evaporation through the skin, and water vapor from the lungs during respiration insensible 62. How is fluid lost from the body? a. Kidneys b. Skin c. Lungs d. GI tract e. Insensible loss f. Sensible loss G. Explain the role of daily weights and intake (I) and output (O) measurement in the determination of fluid balance. Discuss what is included in fluid I & O. 63. Daily weight allows the nurse to determine how much water the pt is retaining or eliminating. I’s & O’s allow the nurse to determine if the quantity of fluid ingested matches the amount expelled. Electrolytes Describe the function of K+, Na+, Ca++, Mg++, Cl-, P-, HCO3- Function Potassium (K+) • Causes depolarization of excitable tissues • Generates action potentials Sodium (Na+) • Generates muscle contraction, cardiac contraction • Nerve impulse transmission Calcium (Ca2+) • Maintains bone strength and density • Activates enzymes • Allow contraction of skeletal and cardiac muscle • Control nerve impulse transmission • Allow blood clotting Magesium (Mg2+) • Important for skeletal muscle contraction • Carbohydrate metabolism • Generation of energy stores • Vitamin activation • Blood coagulation • Cell growth Cloride (Cl-) Regulates acid–base balance; maintains osmotic pressure Phosphate (PO4) • Plays a role in acid base balance • Cell energy and calcium balance • Promotes energy storage, carb, protein, and fat metabolism • Bone and teeth formation • Plays a role in muscle and RBC formation Bicarbonate (HCO3- ) Regulates acid base balance List the signs & symptoms of electrolyte imbalances Know the normal ranges of these electrolytes: 64. 135 – 145 mEq/L 65. 3.5 – 5 mEq/L 66. 8.6 – 10.2 mg/dL Na+ K + 67. 1.3 – 2.3 mEq/L Ca 2+ Mg 2+ 68. 97 – 107 mEq/L 69. 2.5 – 4.5 mg/dL 70. 25 – 29 mEq/L Cl - PO4 - HCO3- Describe electrolyte imbalances What causes electrolyte imbalances? Sodium Hyponatremia Actual- increased Na excretion, excessive diaphoresis, diuretics, decreased secretion of Aldosterone, renal disease Relative – loss of total body Na, movement of Na from blood to other fluid spaces, dilution from water intoxication Potassium Hypernatremia Hypokalemia Actual- water intoxication, Dehydration, Kidney disease, Hypercortisolism Relative – dehydration, fever, NPO Actual- starvation, malabsorption, diuretics, IV insulin, water intoxication Relative - Calcium Hyperkalemia Hypocalcemia Actual- excessive K intake, decreased K secretion, rapid infusion of K containing IV solutions Relative – tissue damage, acidosis, uncontrolled DM Actual-inadequate oral intake of calcium and/or vitamin D, malabsorption, lactose intolerance, diarrhea Relative -drugs, acute pancreatitis, immobility, removal/destruction of parathyroid glands Magnesium Hypercalcemia Hypomagnesemia Actual- excess PO intake of Ca/Vit D, kidney failure, thiazide diuretics Relative – Hyperthyroidism, hyperparathyroidism, immobility, malignancies Actual-inflammatory bowel syndrome, starvation/malnutrition, NG suction, diarrhea, sepsis, burns Relative - Hypermagnesemi a Actual- over placement of IV magnesium, excessive intake of magnesium containing antacids Relative - 71. What are the effects of Hypokalemia? a. Hypokalemia reduces the excitability of the cells, thereby weakening the contraction of the heart 72. What are the effects of Hyperkalemia? a. Increased excitability of the cells 73. What are the effects of Hypocalcemia? a. Hypocalcemia increases excitability 74. What electrolyte is INVERSELY related to Ca? a. Phosphate 75. What tests indicate a person is hypercalcemic? a. Trousseau sign b. Chvostek sign (tap on face) 76. How does immobility cause hypercalcemia? a. When a person is immobile there is an increase in bone loss and the calcium from the bone is circulated in blood serum leading to hypercalcemia 77. What is the physiological result of hypermagnesemia? a. Hypermagnesemia results in decreased muscle cell activity (including the heart) 78. What are the signs and symptoms associated with electrolyte imbalances? a. Calcium b. Potassium c. Sodium d. Magnesium State appropriate nursing diagnoses, Goals, interventions, and outcomes for electrolyte & Fluid imbalances Diagnosis Goals Interventions Outcomes Fluid & Electrolyte imbalances Fluid Volume Deficit R/T loss of GI fluids AEB vomiting and reduced fluid intake. Fluid Volume The client’s fluid volume will be restored within normal limits within 12 hours. Isotonic Normal saline Lactated Ringers Hypotonic D5W Equilibrium in osmotic flow Excess R/T increased body fluids AEB edema. Hypertonic D5 ½ NS Explain the role of sodium and potassium in relationship to fluid and electrolyte balance and where these cations are most abundant. 79. What is the role of Sodium & potassium in relationship to fluid and electrolyte balance? a. levels in the ECF determine whether water is retained, excreted, or moved from one fluid space to another Sodium b. levels in the ICF regulate serum Potassium levels via the Na-K pump Potassium 80. (Sodium/Potassium) is mainly found in the ICF, while (Sodium/Potassium) is mainly found in the ECF. Potassium, Sodium Identify normal changes in fluid/electrolyte status in regard to the aging process. 81. Compare isotonic, hypertonic and hypotonic dehydration (including assessment data and clinical manifestations of each). 82. Describe the nursing assessment and physical examination of clients to determine actual or potential fluid, electrolyte, or acid/base disturbances. 83. Discuss common health problems and client situations in which a greater risk occurs for imbalances. 84. Prioritize nursing care for a client with potassium, sodium, calcium and magnesium imbalances. Interpret laboratory data to assess imbalances for each. 85. Identify the following types of fluid imbalance and list at least 3 nursing measures to correct: i. Nausea/vomiting, gastroenteritis and diarrhea ii. Dehydration (fluid volume deficit) iii. Overhydration (fluid volume excess) 86. Discuss how to develop a dietary plan to help resolve fluid and electrolyte disturbances and discuss the types of foods that should be added to a diet to correct imbalances. 87. Describe how thirst and the organs of homeostasis (kidneys, heart and blood vessels, lungs, adrenal glands, pituitary gland, parathyroid glands) function to maintain fluid homeostasis. Organs and body systems 88. Normally filter plasma & excrete urine. 89. Pumps & carries nutrients & water in body 90. Regulate O2 and CO2 of blood. kidneys Cardiovascular Lungs 91. Help body conserve Na, CL and H20 and excrete K+ Adrenal Glands 92. -Releases ADH to retain water 93. Normally filter plasma & excrete urine 94. Pumps & carries nutrients & water in body 95. Regulate O2 and CO2 of blood Pituitary Kidneys Cardiovascular Lungs 96. Help body conserve Na, CL and H20 and excrete K+ Adrenal Glands 97. Releases ADH to retain water. Pituitary Review how the renin-angiotensin mechanism plays a role in the indirect renal mechanism and blood pressure control. 98. What is a short-term regulator of blood pressure in the body? a. The RAAS system 99. What is the purpose of the RAAS system? a. The RAAS system stimulates an increase in blood pressure and by constricting blood vessels, increasing blood volume 100. What is the sequence of RAAS system activation? 101. What conditions signal cause the release of renin from the juxtaglomerular apparatus? a. LOW: i. BP ii. Blood volume iii. Blood sodium iv. Blood oxygen a. Discuss the osmolarity of solutions (isotonic, hypertonic, hypotonic) and how this affects osmosis. b. Equal amounts of salt and water on both sides isotonic c. more salt on outside than inside; more H2O inside; H2O wants to rush out; cell shrinks hypertonic d. more salt on inside than outside; more H2O outside; H2O wants to rush in; cells swell Hypotonic e. situated or taking place outside a cell or cells f. located or occurring within a cell or cells extracellular intracellular g. situated or occurring within a vessel, or blood vascular system Intravascular h. the process through which water passes through an area of low concentration to high concentration Osmosis 102. A solution that has the same osmolarity as is a solution. In an isotonic solution fluid remains in the intravascular compartment without any net flow across the semipermeable membrane. In contrast a solution has greater osmolarity than plasma, thus causing water to move outside of the cell. A solution has less osmolarity than plasma Isotonic, hypertonic, hypotonic 103. T/F: In both isotonic and osmosis solutes pass from low to high concentrations True i. Identify different types of intravenous fluids and their role in rehydration therapy. 104. What is hypovolemia? a. Hypovolemia is loss of both solvent and solute 105. Isotonic fluid loss is synonymous for Hypovolemia j. Identify medications that influence electrolyte levels and nursing management of these clients. Increase excretion Decrease excretion Sodium Diuretics such as: • Furosemide (Lasix) • Bumex High Na diet Potassium Diuretics such as: • Furosemide (Lasix) • Bumex • Thiazide diuretics Potassium Calcium Diuretics such as: • Furosemide (Lasix) • Plicamycin • penicillamine Calcium, Vitamin D Magnesium • High ceiling loop & osmotic diuretics • Aminoglycoside antibiotics • Drugs containing phosphorus Magnesium sulfate k. Describe how diuretics such as Lasix (Furosemide) work in the kidneys and how they lower blood pressure and fluid volume. 106. How does Lasix(Furosemide) work? a. Lasix works by inhibiting and reabsorption at the proximal and distal tubules, and the ascending LOH Sodium, chloride l. Describe how diuretics such as Aldactone (Spironolactone) affect electrolyte balance. 107. Aldactone (Spironolactone) is a potassium diuretic, which causes the body to retain Potassium. However it is Sodium thus water wasting sparring