Exam 1 Study Guide NR 226 new. (100% VERIFIED)

Exam 1 Study Guide- Fundamentals 226 Sleep & Rest Ch. 42 What is circadian rhythm and how does it affect our day and how does it affect our day and night if we change our sleeping habits/job? • Circadian rhythm: 24hr, day/night cycle -Circadian rhythms= influence pattern of major biological & behavioral functions; predictable changing of body temp., HR, BP, hormone secretion, sensory acuity & mood depend on maintenance of 24hr. circadian cycle. -When sleep-wake cycle becomes disrupted ( working rotating shifts) = other physiological functions change  anxiety, restlessness, irritability, impaired judgment are common s/s of sleep cycle disturbances. *Failure to maintain and individual’s usual sleep- wake cycle= negatively influences PT’s overall health Identify the stages of sleep & what happens in each stage: • NREM= NON-rapid eye movement REM= rapid eye movement • Stage 1: NREM o Stage lasts a few minutes; it includes lightest level of sleep. o Decrease physiological activity begins with gradual fall in vital signs and metabolism. o Sensory stimuli (ex. Noise) easily arouses person. o Awakened person feels as though daydreaming has occurred. *You don’t always remember dreams; ONLY when you are awoken by a disturbance (ex: alarm) • Stage 2: NREM o Stage lasts 10-20 minutes o A period of sound sleep o Relaxation progresses o Body functions continue to slow o Arousal remains relatively easy • Stage 3 NREM o Stage lasts 15-30 minutes o Involves initial stages of deep sleep o Muscles are completely relaxed o Vital signs decline but remain regular o Sleeper is difficult to arouse and rarely moves • Stage 4 NREM o Stage lasts approximately 15-30 minutes o Deepest stage of sleep o If sleep loss has occurred, sleeper spends a majority of the night in this stage o Vital signs are significantly lower than during waking hours o Sleep walking and enuresis (bed-wetting) sometimes occur o It is very difficult to arouse sleeper • REM Sleep: o Begins about 90 minutes after sleep has begun; *Very difficult to arouse the sleeper o Duration increases with each sleep cycle and averages 20 min. o Vivid, full-color dreaming occurs; less-vivid dreaming occurs in other stages o Characterized by: rapidly moving eyes, fluctuating heart & respiration rates, Increased or fluctuating BP, Decreased skeletal muscle tone, and increase of gastric secretions. *REM sleep necessary for brain tissue restoration & important for cognitive restoration What bedtime rituals would prevent a person from falling asleep? o Going to bed fully awake & thinking about other things causes insomnia o Trying to finish work or resolve family problems before bedtime o If pt. doesn’t fall asleep within 30 min. Advise pt. to get out of bed and do a quiet activity until sleepy enough for bed o Limit caffeine to morning coffee and limit alcohol intake o Avoid heavy meals for 3 hours before bedtime What are healthy bedtime rituals? o Comfortable room temp., proper ventilation, minimal sources of noise, comfortable bed, proper lighting, sometimes extra pillows are important; Important for person to go to sleep when they feel fatigued or sleepy; Avoid excessive mental stimulation before bedtime. Relaxation (deep breathing, guided imagery, reading, soft music); Wear loose-fitting nightwear; Void before bed When performing a sleep assessment, what are some questions you might want to ask? o What time do you usually get in bed each night? o How much time does it usually take to fall asleep? Do you do anything special to help you fall asleep? o How many times do you awaken during the night? Why? o What time do you typically wake up in the morning? o How many hours do you sleep each night? What are sleep assessments? o Description of sleep problems; Usual sleep patterns; Physical and psychological illness; Current lifestyle events; Emotional and mental status; bedtime routines; bedtime environment; behaviors of sleep deprivation; Meds, medical history, observation Tools for sleep assessment: o Epworth sleepiness scale (evaluates severity) o Pittsburgh sleep quality index (assesses quality and sleep patterns) o Visual analogue scale (best night/worst night sleep) o Numeric scale (0-10 sleep rating) Looking at the following sleep diagnosis, what nursing diagnosis would you choose for each patient? **(Be able to define each disorder, along with appropriate outcomes for each as well!!) o Insomnia: Chronic difficulty falling asleep, frequent awakenings from sleep, and/or a short sleep/nonrestorative sleep, associated with poor sleep hygiene- the most common sleep- related complaint. o Narcolepsy: Dysfunction of mechanisms that regulate sleep and wake states ▪ Excessive daytime sleepiness is most common complaint associated with this disorder ▪ During day, patient suddenly feels overwhelming sleepiness and falls asleep; REM occurs within 15 min. **Nursing Diagnoses for Insomnia and narcolepsy: 1. Disturbed sleep pattern R/T excessive daytime sleeping AEB difficulty falling or remaining asleep. 2. Disturbed sleep pattern R/T lifestyle disruptions in finance AEB patient states, “I lay awake all night worrying about how to pay the bills.” 3. Disturbed sleep pattern R/T discomfort resulting from current injury (Strained calf muscle) AEB patient rating pain as an 8 on a 0-10 scale, frequent yawning, and dark circles under eyes. Obstructive sleep apnea: o Disorder; lack of airflow through nose and mouth for periods of 10 seconds or more during sleep; can last up to 30 sec. o Major risk factors= Obesity and hypertension o Occurs when muscles/ structures of oral cavity/throat relax during sleep. o Airway becomes partially/ completely blocked= decreased nasal airflow (hypopnea) or stopped airflow (apnea). Attempts to breathe b/c chest & abdominal movement continue results in loud snoring and snorting sounds. S/S  Illnesses, emotional stress, meds, environment disturbed and timing of sleep b/c of work shifts. Sleep Deprivation: Problem many patients experience b/c of dyssomnia (disturbance of the body’s natural resting & waking pattern); disorder of getting to sleep, staying asleep, OR excessive sleepiness. What are the sleep needs of children, adolescents and older adults? Neonates: ** 16hours Sleep almost constantly during 1st week 50% REM sleep= stimulates higher brain centers for development Infants: **12 hours o Sleep through night and take daily naps= 2y/o o Give up daytime naps= 3 y/o and up o Common to awaken during the night o % of REM sleep continues to fall o May be unwilling to go to bed at night b/c need autonomy/fear of separation from their parents Preschoolers: **12 hours o Rarely takes daytime naps when 5 y/o 20% REM sleep o Difficulty relaxing/quieting down= after long, active days o During night= awakens/ has nightmares o Exhibits brief crying, walking around, unintelligible speech, sleepwalking, or bed-wetting. School-age children: ** 11-12 hours6 y/o **9-10 hours 11 y/o o A 6-7 y/o goes to bed with encouragement or activity; older child resists sleeping b/c fatigue or independence Adolescents: ** 7 ½ hours o Subject to # of changes  school demands, after-school social activities, and part-time jobs o Reduced time spent sleeping o Shortened sleep time often results in Excessive Daytime Sleepiness (EDS) o EDS= Decreased performance in school, vulnerability to accidents, behavior/mood problems, and increase use of alcohol Young Adults: ** 6-8 ½ hours o Remains consistent throughout life  20% REM sleep o Stress of jobs, family relationships, & social activities= leads to insomnia/use of sleep meds o Daytime sleepiness= Increase # of accidents, Decrease productivity, & interpersonal problems o Pregnancy Increase sleep and rest; 3rd trimester= insomnia, periodic limb movements, restless leg syndrome (RLS) and sleep-disordered breathing Middle Adults: ** Not specified o Time spent sleeping begins to decrease o Amount of stage 4 sleep begins to decline; continues with advancing age o Insomnia common; b/c changes & stresses of middle age o Anxiety, depression, or certain physical illnesses cause sleep disturbances o Women w/ menopausal symptoms experience insomnia Older Adults **NOT Specified o Sleeping difficulties = Increase with age; more than 50% report sleep problems o Experience weakening, desynchronized circadian rhythm alter sleep-wake cycle o Shorter REM sleep o Progressive decrease in stages 3 &4 NREM sleep; some have almost no stage 4 (deep sleep) o Awaken more often during the night; takes more time to fall asleep. Tendency to nap increases with age b/c of awakenings o Chronic illness= results in sleep disturbances (EX: arthritis = painful joints) o Changes in sleep pattern= caused by changes in CNS that affect the regulation of sleep o Sensory impairment decreases sensitivity to time cues (maintain circadian rhythms) What are the signs and symptoms of lack of sleep? o Psychological Symptoms: Confused, disoriented, increase sensitivity to pain, irritable, withdrawn, apathetic, agitated, hyperactive, decrease motivation, increase sleepiness o Physiological: Ptosis, blurred vision, fine-motor clumsiness, decreased reflexes, decreased response time, decreased reasoning/judgment, decreased auditory/visual alertness, and cardiac arrhythmias What is the purpose of sleep? o Sleep provide healing, restoration, and contributes to physiological as well as psychological restoration NREM sleep: o Contributes to body tissue restoration: restore biological processes o Body releases Human growth hormone for repair/renewal of epithelial and specialized cells (EX: brain cells) o Protein synthesis and cell division for renewal of tissues occur during rest and sleep o Ex: skin, bone marrow, gastric mucosa, or brain REM sleep: o Necessary for brain tissue restoration & important for cognitive restoration o Associated with changes in cerebral blood flow, increased cortical activity, increased 02 consumption and epinephrine release How does physical illness affect our sleep patterns? o Patient who’s living with bipolar disorder sleep more when depressed than when manic o Patient who’s depressed= experiences an inadequate amount of sleep o Chronic diseases such as COPD and painful disorders s/s arthritis interfere with sleep o Patient who has recently had surgery= expect them to experience some sleep disturbance Why is a sleep diary used? o Patient completes sleep-wake log daily to provide info on day to day changes in sleep/ wake patterns over time o Entries in log often include 24 hr. info about waking /sleeping health behaviors o Ex: Physical activities, meal times, type/amount intake (alcohol & caffeine), time/length of daytime naps, evening & bedtime routines, time patient tries to fall asleep, nighttime awakenings & time of morning awakening. o Compare patient data with their pattern before sleep problem or with pattern found for other patients of same age o On the basis of this comparison: Assess for identifiable patterns (ex: insomnia) Older Adult Ch. 14 What is the best method to teach an older adult? o Use past experiences to connect new learning to previous knowledge o Make sure patient is ready to learn o Face patient (see lips) use slow and normal tone of voice How do we handle the family of an older adult? o Nurses help older adults and their families by providing information and answering questions as they make choices among care options o Help in the decision to enter a nursing home o Nurses help give info & care options (ex. Hospice, nursing home, etc…) What is the skin like of an older adult? o Loss of skin elasticity with fat loss o Pigmentation changes o Glandular atrophy (oil, sweat glands, moisture) o Thinning/ gray- white hair o Slower nail growth o Facial hair decrease in men and increase in women Healthy people 2020 o Increase the # of older adults with one or more chronic conditions who report confidence in maintaining their conditions o Decrease # of emergency department visits resulting from fall among older adults o Increase the proportion of older adults with reduced physical or cognitive functions who engage in light, moderate, vigorous leisure- term physical activities Is loss of taste and smell normal? o Yes. Both diminish; fewer taste buds What are normal and abnormal cognitive changes? o Reduction of brain cells, deposition of liposfuscin and amyloid in cells and changes in neurotransmitter levels occur with or without cognitive impairments  reducing brain cells and neuro levels ▪ Disorientation, loss of language skills, loss of ability to calculate, poor judgement is not normal ▪ Deliriumm dementia, depression What are normal and abnormal physiological changes in older adults? Normal: *Loss of skin elasticity, pigmentation changes, glandular atrophy, thinning hair white/gray *Decrease cough reflex, (Increase chest diameter, Increase airway resistance, Increase risk respiratory infections) *Thicker blood vessels, narrowing vessel lumen, loss of vessel elasticity, decreased cardiac output, decreased peripheral circulation, decreased renal blood flow, decreased bladder capacity, enlarged prostate (men), reduced sphincter tone (female) *Male: Sperm count decreased, testes smaller *Female: Decreased estrogen, atrophy of vagina/ovaries/uterus, breasts shrink *Alterations in hormone production *Decrease in saliva, gastric secretions, peristalsis, increase stomach pH * Decrease muscle mass/strength, decalcification of bones *Degeneration of nerve cells, decrease in neurotransmitters/ impulses  Decrease in vision, hearing, tastes, touch, and smell (Everything decreases except stomach pH and respiratory) Abnormal: *Pain, Memory impairment (dementia), Heart disease, HTN, Cancer, Stroke What are normal and abnormal functional changes in older adults? o Functional status  includes day-to-day ADL’s involving physical, psychological, cognitive, & social domains. o Decline in function: linked to illness or disease and its degree of chronicity (how chronic it is) o Functional status the capacity & safe performance of ADL’s & instrumental activities of daily living (IADLs) o Indicators of health/illness  ADLs ( bathing, dressing, and toileting) & IADLs (ability to write a check, shop, prepare meals, or make phone calls) Essential to independent living o Assess whether or not patient has changed the way he completes these tasks o A sudden change in function (decline in patient’s ability to perform one or more ADL’s) = sign of acute illness (Ex: pneumonia, UTI or electrolyte imbalance) or a chronic problem (Ex. DM or CVD- cardiovascular disease) What is our goal with the health of an older adult? o Focus interventions on maintaining & promoting PT’s function & quality of life o Help older adults become empowered to make their own health care decisions and realize their optimum level of health, function, and quality of life How do we promote physical well-being? o Participation in screening activities *ex. BP, mammography, pap-smears, depression, vision & hearing testing, colonoscopy o Regular exercise o Weight reduction if overweight  Eating a low-fat well- balanced diet o Moderate alcohol use o Regular dental visits o Smoking cessation o Immunization for seasonal influenza, tetanus, diphtheria, pertussis, shingles, and pneumococcal disease For older adults that live alone… think of important outcomes… o Alcohol abuse (loneliness, depression) o Loss of vision o Nutrition (may not have access to food, may not be able to cook) o Fall risks, mobility issues (withering- atrophy of muscles over time with discontinued use) o Mental health (loneliness, depression, dementia, medications, ect…) What are the variabilities among older adults? o Aging does not lead to disability or dependence o Strengths and abilities o Dependence vs. Independence o Variation of physiological, cognitive, and psychosocial health o Some are involved in their community o Small # of older adults lose the ability to care for themselves  b/c they are confused o Most live in a non-institutional setting What are the stereotypes for older adults? o Physical, cognitive, psychosocial health o That they are ill, disabled, and unattractive o That they are forgetful, confused, rigid, boring, and unfriendly o That they are not interested in sex or sexual activities o Finances and living arrangements o That they are unable to understand or learn new info o Ageism: discrimination against people b/c of increasing age What are the theories of aging? o Stochastic: View aging as a result of … o Nonstochastic: genetically programmed o Disengagement: Oldest theory; aging patient’s withdraw from (no longer do) customary roles  engage in more introspective, self-focused activities o Activity: Continuing activities performed during middle age as necessary for successful aging o Continuity/ Developmental: Personality remains same but behavior changes o Gerotranscendence; Shif t of perspective with age (how an older adult looks at things changes); change from a materialistic to a natural view. What are therapeutic interventions to assist with the aging process? o Touch, reality orientation, validation therapy, reminiscence, body-image interventions ▪ Reality Orientation: Bring back to reality ex: think they are home; remind them they are in the hospital Fluid & Electrolytes Ch. 41 & 31 Active transport: requires energy of adenosine triphosphate (ATP) to move electrolytes across cell membrane against the concentration gradient (from areas of lower concentration to areas of higher concentration) Ex: sodium-potassium pump  moves Na+ out of a cell and K+ into it Osmosis: Water (or other solute) moves from area of lesser concentration to greater concentration Filtration: Movement across a membrane (under pressure) from higher to lower pressure o Fluid moves in & out of capillaries (Between vascular & interstitial compartments) o Filtration  caused by the effect of 4 forces: 2= move fluid out of capillaries/small venules and then 2= Move fluid back in Capillary hydrostatic pressure: Strong outward-pushing force moves fluid from capillaries to interstitial area Interstitial fluid hydrostatic pressure: Weaker opposing force tends to push fluid back into capillaries Blood colloid osmotic pressure (oncotic pressure): Inward-pulling force caused by blood proteins that help move fluid from interstitial are back into capillaries. Interstitial fluid colloid osmotic pressure: Normally is a very small opposing force Diffusion: Passive movement of electrolytes or other particles down the concentration gradient (from areas of increased concentration to areas of decreased concentration Solutions (Hypotonic, hypertonic, isotonic: o Hypotonic: Solution has more solute than solvent, is more dilute than blood, more fluid in cell than outside; swell o Hypertonic: Solution has more solvent than solute, more concentrated than blood, more fluid outside cell than inside shrink o Isotonic: Having same concentration of solutes as blood no change in amount of fluid inside or outside cell Calcium/ phosphorus relationship: o IF calcium is increased THEN phosphorous is decreased o IF calcium is decreased THEN phosphorous is increased How do we assess fluid status? o Assess postural BP and pulse o Inspect oral mucous membrane for degree of moisture o Obtain daily weight measurements o Measure urine output & observe color; if available  measure specific gravity of urine o Test skin turgor (NOT reliable for older adults, who naturally have a decreased skin elasticity) What do we do with this info? o Select individualized nursing interventions to maintain or restore fluid, electrolyte, acid-base balance o Consult with pharmacists, registered dieticians, IV therapy specialists o Involve the patient/family in designing culturally appropriate interventions Traumatic brain injury and fluids: o Hemorrhage from any trauma  causes ECV (extracellular fluid volume) deficit from blood loss o Trauma from a crash injury destroys cell structure  resulting in massive release of intracellular K+ into blood o Head injury  typically alters ADH secretion o May cause diabetes insipidus ( the secretion of too little ADH)  PT’s excrete large volume of very dilute urine and develop hypernatremia o In contrast, head injury  may cause the syndrome of inappropriate antidiuretic hormone (SIADH) excess secretion of ADH causes hyponatremia by retaining too much water and concentrating urine CHF and dehydration- what intervention is in common: o PTs with chronic heart failure = have diminished cardiac output that reduces kidney perfusion & activates RAAS o The action of aldosterone on the kidneys causes ECF excess and risk of hypokalemia o Most diuretics used to treat heart failure, increase risk of hypokalemia while reducing the ECF excess o Dietary sodium restriction important with heart failure b/c Na+ holds water in the ECF, making ECF excess o In severe heart failure= restriction of both fluid and sodium is prescribed to decrease the workload of the heart by reducing excess circulating fluid volume. Sensible vs. insensible water loss o Sensible water loss: Water loss is visible (Ex: Sweating) o Insensible water loss: Water loss that is not visible (Ex: fever, recent burn to skin) What does TPN do for a patient? (Severe vomit diarrhea) *Via I.V. o TPN  total parental nutrition o IV administration of a complex, highly-concentrated solution containing nutrients & electrolytes that are formulated to meet a PT’s needs o Used after surgery if pt. isn’t going to eat for awhile Interventions for vomiting/diarrhea: o When replacing fluids by mouth in a pt. with ECV deficit  choose fluids that contain sodium (Ex. Pedialyte and Gastrolyte  think “-lyte” as in electrolyte) o Liquids with lactose, caffeine, or low sodium  NOT appropriate when pt. has diarrhea. o Some PT’s unable to tolerate solid foods are still able to ingest fluids. Strategies to encourage fluid intake include offering small sips of fluid frequently, popsicles, and ice chips. o Fluid & Electrolytes can be replaced thru infusion of fluids into vein (IV) rather than via digestive system. o Isotonic solutions have the same effective osmolality as body fluids o Sodium-containing isotonic solutions such as 0.9 normal saline are indicated for ECV replacement to prevent or treat ECV deficit What do we do when and IV hurts? o Discontinue IV, clean site, elevate extremity (if edema) start new line. IV complication and what to do? o Fluid overload: IV solution infused too rapidly or in too great an amount ▪ Signs: swelling, crackles in lungs o Infiltration: IV fluid entering subcutaneous tissue around venipuncture site (fluid leakage outside vein) ▪ Signs: edema, shiny, tight skin, coolness, pain o Extravasation: term used when a vesicant (tissue-damaging) drug enters tissue (causing damage to tissue) o Phlebitis: Inflammation of inner layer of a vein ▪ Signs: Warm, red streak  stop IV, start new line, apply moist heat o Local infection: Infection at catheter- skin entry point, during infusion or after removal of IV catheter ▪ Signs: red, warm, swelling at site o Bleeding at infusion site: Oozing or slow, continuous seepage of blood from venipuncture site Potassium is closely related to what body system? Muscular system o The body relies on potassium for a regularly contracting heart o It regulates the water balance and the acid-base balance in blood and tissues along with sodium o Known as the Sodium/Potassium pump Be able to identify normal and abnormal labs: o Normal: ▪ Specific Gravity  1.0053-1.030 ▪ HCT  Men: 42-52 Women: 37-47 ▪ Osmolarity  230-800 ▪ BUN  10-20 ▪ Sodium (Na)  135-145 ▪ Hemoglobin (Hg)  Men: 14-18 Women: 13-16 Why would a patient have edema of cardiac origin? o Venous congestion from weakened heart which no longer pumps effectively, Increase capillary hydrostatic pressure, causing edema by moving excessive fluid into interstitial space. o PT’s who have chronic heart failure have diminished cardiac output, which reduces kidney perfusion and activates RAAS edema. Action of aldosterone on the kidneys causes ECV excess & risk of hypokalemia. o Most diuretics used to treat heart failure increase risk of hypokalemia while reducing the ECV excess, Dietary sodium restriction is important with heart failure because Na+ holds water in the ECF, making the ECV excess worse. In severe heart failure restriction of both fluid and sodium is prescribed to decrease workload of heart by reducing excess circulating fluid volume. Know the foods for electrolytes- o Sodium: table salt, processed/canned food, deli foods (lunch meat) o Potassium: Bananas, citrus, melon, apricots, broccoli, potatoes, instant coffee, molasses, Brazil nuts o Magnesium: grains, beans, green leafy vegetables, seafood, meat, chocolate (undigested fat prevents absorption) o Calcium: Dairy, canned fish, broccoli, oranges (needs vitamin D for absorption, undigested fat prevents absorption) What are colloids? o Colloids: proteins in blood. Proteins are larger than electrolytes, glucose, & other molecules that dissolve easily. Most colloids are too large to leave capillaries in the fluid that is filtered, so they remain in the blood. B/c they are particles; colloids exert osmotic pressure. o Albumin: Maintains osmotic pressure in blood, is the main protein in blood. o Hespan: A volume expander, used if person needs blood but doesn’t want blood transfusion (Jehovah’s Witness) o Mannitol: Promotes diuresis of kidneys help lose water through osmosis o Blood & blood products Know the electrolyte imbalance such as hypo/hypernatremia (not limited to): o Hyponatremia: Water excess or water intoxication, is a hypotonic condition. It arises from gain of relatively more water than salt, or loss of relatively more salt than water o Physical symptoms: Extreme thirst, dry and flushed skin, postural hypotension, fever, restlessness, confusion, agitation, coma, seizures if develops rapidly or is very severe o Hypernatremia: Water deficit, is a hypertonic condition, two causes make body fluids too concentrated: -Loss of relatively more water than salt ▪ Gain of relatively more salt than water o Physical symptoms: Apprehension, nausea & vomiting, headaches, decreased level of consciousness (Confusion, lethargy, muscle weakness, coma) Seizures if develops rapidly or is very severe o Extracellular Fluid Volume Deficit: Sodium and water intake less than output, causing isotonic loss o Cause: Severely decreased oral intake of water and salt. ▪ Increased GI output: Diarrhea, vomiting, laxative overuse, or drainage from fistulas or tubes ▪ Increased renal output: Use of diuretics, adrenal insufficiency, salt-wasting renal disorders ▪ Loss of blood or plasma: Hemorrhage, burns ▪ Massive sweating without water and salt replacement o Physical symptoms: Sudden weight loss (e.g. overnight), postural hypotension, tachycardia, thread pulse, neck veins flat or collapsing with inhalation when supine, slow vein filling, oliguria (,30 mL/hr), dark yellow urine, dry mucous membranes, inelastic skin turgor, absence of tears and sweat, longitudinal furrows in tongue, thirst, restlessness, confusion, cold clammy skin, hypotension, hypovolemic shock. o Laboratory findings: Increased hematocrit; BUN greater than 25 mg/dL (8.9 mmol/L) caused by hemoconcentration; urine specific gravity greater than 1.030 o Extracellular Fluid Volume Excess: Sodium and water intake greater than output, causing isotonic gain o Cause: Excessive administration of sodium-containing isotonic parental fluids o Excessive oral intake of salty foods and water o Decreased renal output caused by elevated aldosterone: Chronic heart failure, cirrhosis, aldosterone-secreting tumor o Decreased renal output from other causes: Oliguric acute kidney disease, end-stage chronic renal disease, glucocorticoid excess o Physical symptoms: Sudden weight gain (e.g. overnight) edema (especially in dependent areas) neck veins full when upright or semi-upright, crackles in dependent portion of lungs, pulmonary edema o Laboratory findings: Decreased hematocrit; BUN less than 10 mg/dL (3.6 mmol/L) caused by hemodilution Hypovolemia vs dehydration Hypovolemia: Loss of fluids and electrolytes, Ex. Decreased vascular volume due to hemorrhage o Water& electrolyte losses about equal Dehydration: Extracellular fluid volume (ECV) deficit & hypernatremia (water deficit) occurring at the same time, common with severe diarrhea and vomiting, gastroenteritis o More water lost than electrolytes Clinical Dehydration (Extracellular fluid volume deficit plus hypernatremia: Sodium and water intake less than output, with loss of relatively more water than salt o Causes: No water intake, often with increased insensible water output through skin with fever o Physical symptoms/laboratory findings: Combination of those ECV deficit plus those for hypernatremia Parts of blood: o PRBC’s: Packed red blood cells, have been collected, processed, and stored in bags as blood product units available for blood transfusion, have antigens in their membranes o Platelets: Thrombocytes plumping, clotting at injury site o Plasma: Yellow portion of blood, 55% of total volume, a protein, contains antibodies against specific RBC antigens o WBC: Leukocytes, immune system ▪ If incompatible blood is transfused (i.e. a patient’s RBC antigens differ from those transfused), the patient’s antibodies trigger RBC destruction in a potentially dangerous transfusion reaction IV infusion: o Bolus: Drip force of gravity, drips into IV over length of time o Push: Use a syringe to push meds directly into blood through IV o Volume Controlled infusions: ▪ Piggy backs, volume control machine, mini infusers ▪ Small amounts (50-100 mL) ▪ Pumps are safer o Micro drips: 60 gtts/mL o Macro drips: 10 or 15 gtts.mL Delegation: o NAP: ▪ Safety of patient ▪ Measure I’s&O’s ▪ Take vitals ▪ Report swelling/pain at IV site o Nurse: ▪ Start/discontinue IV fluids ▪ Check IV sites ▪ Evaluate IV sites for clinical manifestations ▪ Discuss info on electrolyte imbalances with patient Jeopardy Review Questions 1) This type of loss results from normal life transitions such as leaving the family home for college: a. Maturational loss 2) This type of grief occurs when a person prepares himself/herself for loss a. Anticipatory grief 3) According to Bowlby’s Attachment Theory, this phase of grief is characterized by tearing, sobbing, or screaming a. Yearning and seeking 4) What are the Kubler- Ross’s stages of Dying? DABDA a. Denial, Anger, Bargaining, depression, acceptance 5) Name at least two ways a nurse can facilitate mourning: a. Spend time with family, listen to patient/family’s needs, encourage patient/family to speak about feelings, give careful explanations. 6) What is an example of isotonic solution? a. 0.9 NS, Lactated Ringers 7) What is the most effective way to assess volume status in a patient? a. Daily weights 8) What is the movement of water or another solute from an area of lesser to an area of greater concentration? a. Osmosis 9) Tetany, tingling in extremeties & muscular twitching (positive Chvostek sign) are all symptoms of what electrolyte imbalance? a. Hypocalcemia 10) What electrolyte needs to be closely monitored when caring for a patient being under diuresis? a. Potassium 11) A patient with persistent vomiting would be expected to receive what type of IV solution? a. Isotonic 12) This occurs when water and electrolyte losses are about equal: a. Hypovolemia 13) Name at least 2 signs/symptoms of an infiltrated IV site: a. Cool, edematous, discolored, and pain 14) This type of loss (ex. Death of a loved one, divorce) is a part of life and requires adaptation through the grieving process a. Necessary loss 15) Name at least 2 psychosocial changes an older adult can experience a. Retirement, social isolation, sexuality, housing and environment changes, death 16) Why might a patient have a Peripherally inserted central catheter (PICC line) in place? a. Long-term antibiotic therapy 17) What indicates an appropriate IV site/vein? a. Minimal curvature, not a bifurcation, no contraindications, in an adult: in the arm or hand 18) What is the purpose of TPN? a. To replace fluid, electrolytes and nutrients 19) A patient is to receive 100 mL/hr of IV fluid. Using microdrip tubing, what is the rate in gtts/min? a. 100gtt/min 20) Explain how you would administer an IV PUSH medication: a. Inject air into vial, pull back amount of med to be administered, replace cap (using sweep method) b. Check patient identifiers and 6 rights of med administration c. Clean IV port, flush IV site, inject medication slowly, flush IV site 21) What is the best teaching strategy to use for an older adult? a. Encouraging them to talk about past experiences 22) The idea that older adults are disabled, ill, forgetful, unable to learn, unfriendly and unattractive is called what? a. Ageism 23) What are some integumentary changes that occur with aging? a. Loss of elasticity, pigmentation changes, decreased moisture, thinning hair 24) Name 3 cognitive disorders that may occur in the older adult: a. Delirium, dementia, depression 25) Name at least 3 of the health promotion activities the nurse can suggest for the older adult: a. Screenings, exercise, weight maintenance, diet, moderate alcohol use, regular dental visits, smoking cessation, immunizations. 26) During which stage of sleep does vivid dreaming vivid? a. REM sleep 27) What is the most important to monitor in a patient with sleep apnea? a. Respiratory Status 28) What is the most important nursing intervention for a patient that suffers from sleep pattern disturbance? a. Synchronizing medications, treatments & vitals around a schedule for the patient 29) What is the best way to assess sleep in a patient? a. Ask how they are sleeping (open ended questions) 30) Name 5 factors that affect sleep: a. Physical illness, drugs & substances, lifestyle, social activity, work schedule, emotional stress, environment, exercise, fatigue, food & calorie intake 31) 31) ABG’s pH (acidosis) 7.35 (Alkalosis) 7.45 Respiratory- Lungs CO2 35-45 (alkalosis) 35 45 (acidosis) (Carbon dioxide) Metabolic- Kidneys HCO3 22-26 (acidosis) 22 26 (alkalosis) (Bicarbonate) ** Oxygen: 80-100% Coagulants: INR: 2-3 seconds (Coumadin) PT(Prothromin time): 11-16 Blood level= Fluid loss  Low BP, High HR PTT: 25-35 seconds (Heparin) HCt: Female 35-47% Male: 39-50% Hgb: Female: 11.6-16 Male: 13.2-17.3 RBC: Female: 3.8-5.1 Male: 4.3-5.7 Anemia Fatigue Show Less