FCCN level 1 Exam With Complete Solutions.

FCCN level 1 Exam With Complete Solutions. minimum urine output for adult 0.5mL/kg/hr ADH (antidiuretic hormone) - water retainer - vasoconstrictor (also called Vasopressin) - produced by hypothalamus - store and released from posterior pituitary ADH pathway - hypothalamus senses low blood volumed and increased serum osmolality - signal pituitary to release ADH - ADH causes kidney to retain water - water retention increases blood volume and decreases serum osmolality ANP (atrial natriuretic peptide) - cardiac hormone stored in atria - released when atrial pressure increases *works opposite of RAAS by decreasing BP and reducing intravascular volume - important diagnostic marker in CHF hydrostatic pressure - forces fluids and solutes through the capillary wall and into the tissue spaces colloid osmotic pressure - pulling force of albumin in the intravascular spaces - pull fluid into vasculature maintenance fluid therapy - replaces normal ongoing losses of water and electrolytes (urine, sweat, respiration, stool) replacement therapy - corrects any existing water and or electrolyte deficits isotonic fluids - tonicity equal to plasma in the body - no fluid shifts because the solutions are equally concentrated - LR - NS - D5W hypotonic fluids - lower concentration of solutes in the vasculature than in the cell - fluid shifts into the cell to dilute the electrolytes (CELL SWELLS) - 0.45NS hypertonic fluid - higher concentration of solutes in the vasculature than in the cell - pulls fluid out of cells and into the vessels (CELL SHRINKS) - D5 .45NS - D5NS - D5LR - 3%, 7%, 23.4% NaCl colloids - pull fluid into bloodstream Albumin - 5% is osmotically equal to plasma - 25% draws 4 times the normal volume into the circulation blood - not a risk free fluid replacement - this is liquid transplant third spacing - fluid is not lost from the body but the fluid is not available for use in the intracellular or extracellular compartments (fluid is in between tissues/cells) - this patient is intravascularly dry and still needs more fluid - can you give platelets through the ranger - no it will aggreggate the platelets hyponatremia - less than 135 -145 - weakness - abdominal cramping/leg cramps - dizzy - change in LOC - seizures different ways to treat hyponatremia - hypovolemic (give IV fluid) - euvolemic (fluid restriction) - hypervolemic (diuretic) severe hyponatremia - EMERGENCY - below 115 - give hypertonic saline if patient is symptomatic - in ICU setting infused slowly in small amounts....be prepared to handle seizures hypokalemia ECG changes - prolonged QT - ST depression U WAVE is hallmark sign if you see a U wave then YOU need K+ hypokalemia - 3.5 to 5 - muscle weakness hyperkalemia ECG changes - tall tented T waves is the earliest sign - AV blocks treating hyperkalemia - Calcium chloric or gluconate to antagonize cardiac abnormalities - Bicarbonate for pt with acidosis - IV insulin and 50% dextrose to shift K into cells - kayexelate (fecal excretion of K) - dialysis for ARF hypocalcemia 8.5 - 10.2 - tetany - muscle cramps - trousseau's and chvosteks sign - colicky abdominal pain treating hypocalcemia - IV calcium gluconate or calcium chloride (CENTRAL LINE) - consider seizure precautions - replace Mg in addition to Ca because pt might not respond to Ca treatment hypercalcemia caused by - cancers and hyperparathyroidism - excessive Ca and Vit. D supplements - muscle weakness - depressed CNS (confusion) - dysrhythmias (prolong QT, AV block) - abdominal pain treating hypercalcemia - administer IV NS to promote diuresis - administer loop diuretics - corticosteroids to decrease absorption from GI - phosphates to decrease breakdown of bones by inhibiting release - dialysis hypomagnesemia - tetany - weakness - confusion - ECG changes (wide QRS, prolong PR/QT) treating hypomagnesemia - CPR - magnesium - shock hypomagnesemia and digoxin - low MG increases pharmacologic action of digoxin - look for N/V, bradycardia, AV block, yellow tinged vision hypermagenesemia - take too many antacids or laxatives - respiratory depression - muscle relaxation hypophosphatemia - cause by hyperparathyroidism, chronic diarrhea, long term diuretic use, malnutrition and severe burns - muscle weakness - impaired cardiac function - poor tissue oxygenation - failure to wean from mechanical ventilation - depressed CNS - confusion treating low phosphorus - increase intake of phos rich food - IV - assess for hypercalcemia - consider Mg replacement simultaneously hyperphosphatemia - this is rare except for people with severe kidney dysfunction - stroke - heart attack - poor circulation - calcium combines with phosphate to form crystals that calcify on walls of vessels and heart - crystals can form on skin too causing severe itching