NR 226 Fundamentals 2025 Exam 2

NR 226 Fundamentals 2025 Exam 2 Ph normal range - -7.35-7.45 Causes of respiratory acidosis - -COPD, asthma, bronchitis, barbiturate or sedative overdose, acute airway obstruction, weakness of the respiratory muscles Nursing interventions for respiratory acidosis - -place semi-Fowler's position, maintain patent airway, turn cough, and deep breathe, administer fluids to help liquefy, administer low oxygen, monitor ABG Causes of respiratory alkalosis - -hyperventilation and mechanical overventilation, panic attack, anxiety, encephalitis Nursing interventions for respiratory alkalosis - -encourage breathing into a paper bag or voluntary breath holding Causes of metabolic acidosis - -diabetic ketoacidosis, dehydration, diarrhea, renal tubular Nursing interventions for metabolic acidosis - -administer sodium bicarb as ordered, monitor for signs of hyperkalemia, measure intake and output, monitor ABG Causes of metabolic alkalosis - -nausea & vomiting, after chemotherapy, NG tube Nursing interventions for metabolic alkalosis - -replace fluid and electrolyte losses (potassium chloride), measure intake and output, monitor for hypokalemia, monitor ABG Ph = 7.31, PCO2 = 49, HCO3 = 24 - -respiratory acidosis Ph = 7.5, PCO2 = 37, HCO3 = 29 - -metabolic alkalosis Ph = 7.6, PCO2 = 21, HCO3 = 22 - -respiratory alkalosis Ph = 7.15, PCO2 = 44, HCO3 = 19 - -metabolic acidosis Ph = 7.45, PCO2 = 36, HCO3 = 25 - -normal Ph = 7.47, PCO2 = 26, HCO3 = 20 - -respiratory alkalosis Ph = 7.34, PCO2 = 30, HCO3 = 20 - -metabolic acidosis with partial compensation Ph = 7.23, PCO2 = 61, HCO3 = 40 - -respiratory acidosis with partial compensation NUR 226 NUR 226 Arterial blood gas - -ph A 7.35 7.45 B Lungs - -PCO2 B 35 45 A Kidney - -HCO3 A 22 26 B Main causes of electrolytes imbalance - -changes in diet, GI malfunction, renal problems, medications, procedures or an entire disease process (all of these can cause either hypo or hyper in elecctrolytes) Normal sodium (Na) levels - -136-145 meq/L Hypernatremia (hypertonic body fluids) - -abnormally high sodium ion concentration in the blood Causes of hypernatremia - -excessive/rapid IV administration of normal saline, inadequate water intake and kidney disease Signs and symptoms of hypernatremia - -confusion, dry mucous membranes, neck vein is flat, dry skin, furrows in tongue (common in the older population), skin tenting, intense thirst, oliguria to anuria, dark urine, orthostatic hypotension, tachycardia with thready pulse, tachypnea, hypoxia, weight loss, specific gravity of urine is high, HCT is high Treatment for hypernatremia - -weigh patient daily, monitor intake & output, monitor weight, and monitor vitals; assess skin turgor, place patient on sodium-restricted diet, and administer hypotonic IV fluids or isotonic IV fluids (NS) Hyponatremia (hypotonic body fluids) - -abnormally low sodium ion concentration in the blood Causes of hyponatremia - -decreased sodium intake, increased sodium excretion due to suctioning Signs and symptoms of hyponatremia - -confusion, nausea and vomiting, abdominal cramping, weight gain, cold clammy skin, sticky and moist mucous membrane, fatigue, dyspnea, shortness of breath, crackles, periorbital edema, distended JVD, polyuria, restlessness, irritability, muscle weakness, spasms or cramps, seizures, coma, specific gravity of urine is low, HCT is low Treatment for hyponatremia - -provide high sodium foods, auscultate lungs (crackles), administer hypertonic IV fluids or isotonic IV fluids (NS), monitor intake and output, monitor weight, and monitor vital signs, note that body weight is the best indicator that shows if patient is losing or gaining weight, monitor daily weight at the same time of the day, patient should should wear the same gown, use the same weighing scale and use the same calibrations (use pounds or kg be consistent) NUR 226 NUR 226 Normal value of potassium - -3.5 - 5.0 meq/L (think the heart, dysrhythmias in both hypo and hyperkalemia and use 12 leads ECG or EKG) Hyperkalemia - -abnormally high potassium ion concentration in the blood Causes of hyperkalemia - -increased potassium intake and absorption, shift of potassium from cells into the ECF, and decreased potassium output; people who have renal issues such as oliguria (decreased urine output) are at high risk of hyperkalemia; understanding this principle helps you remember to check urine output before you administer IV solutions containing potassium Signs and symptoms of hyperkalemia - -muscle weakness, potentially life-threatening cardiac dysrhythmias, cardiac arrest, nausea, vomiting, diarrhea, numbness, tingling, irritability, and flaccid paralysis Treatment for hyperkalemia - -include sodium polystyrene (remove excess potassium via bowel) and Keyaxalate enema removes excess potassium via stool). Diet: no potassium foods; no use of salt supplements, monitor acid base balance because too much potassium in the body can cause the blood to become acidic; monitor ECG or EKG with vital signs Hypokalemia - -abnormally low potassium ion concentration in the blood Causes of hypokalemia - -patient on NG tube will lose potassium due to suctioning of the gastric content hence is at risk for hypokalemia; also patient on diuretics such as furosemide may lose potassium; vomiting and diarrhea Signs and symptoms of hypokalemia - -cardiac dysrhythmias, thready/rapid/weak pulse, decreased blood pressure, muscle weakness, shallow respirations, weight loss, lethargy Treatment for hypokalemia - -diet: increase potassium food intake; administer potassium supplements; monitor ECG or EKG with vital signs Normal range of calcium - -8.4 - 10.5 mg/dl (think bone) Hypercalcemia - -abnormally high calcium concentration in the blood Causes of hypercalcemia - -decreased calcium output due to renal problems, patients with cancer often develop hypercalcemia because some cancer cells secrete chemicals into the blood that are related to parathyroid hormone; when these chemicals reach the bones, they cause shift of calcium from bones into the ECF; this weakens bones, and the person sometimes develops pathological fractures (i.e., bone breakage caused by forces that would not break a healthy bone); patients with immobility, osteoporosis, osteomalacia, and patient that had eaten too much calcium foods can also experience hypercalcemia NUR 226 NUR 226 Signs and symptoms of hypercalcemia - -lethargy, stupor, decreased muscle tone, deep bone pain, headaches, GI symptoms such as nausea and vomiting, anorexia, and constipation Treatment for hypercalcemia - -encourage ambulation, reduce calcium intake, administer diuretics to increase excretion of calcium Hypocalcemia - -abnormally low calcium concentration in the blood Causes of hypocalcemia - -diarrhea and acute pancreatitis; another cause is the surgery thyroidectomy, the disease hypothyroidism, and lack of calcium in diet Signs and symptoms of hypocalcemia - -increases neuromuscular excitability, which is the basis for its signs and symptoms; it includes numbness, tingling in hands, soles of feet, around lips 24 to 48 hours after surgery, muscle tremors and cramps which can lead to tetany and convulsions; positive chovestek's sign (twitching of the facial muscle upon tapping); positive trousseau's sign (carpal spasm) Treatments for hypocalcemia - -increase dietary calcium intake, administer IV calcium chloride or gluconate; provide padded side rails in case patient has convulsions or seizures Normal ranges for magnesium - -1.5 - 2.5 meq/L (think reflexes) Hypomagnesemia - -abnormally low magnesium concentration in the blood Causes of hypomagnesemia - -decreased magnesium intake and absorption and increased magnesium output Signs and symptoms of hypomagnesemia - -paresthesia's, confusion, hallucinations, convulsions, ataxia, tremors, hyperactive deep tendon reflexes, muscle spasm, flushing of the face, diaphoresis (S/S are similar to those of hypocalcemia because hypomagnesemia also increases neuromuscular excitability Treatment for hypomagnesemia - -provide good dietary sources of magnesium Hypermagnesemia - -abnormally high magnesium concentration in the blood Causes of hypermagnesemia - -renal diseases, dehydrations, excessive use of magnesium Signs and symptoms of hypermagnesemia - -decreased neuromuscular excitability, with lethargy and decreased deep tendon reflexes being most common; nausea and vomiting, muscle weakness, confusion NUR 226 NUR 226 Treatment of hypermagnesemia - -withhold magnesium containing foods, increase fluid intake Normal ranges of phosphate - -2.7 - 4.5 mg/dl Normal ranges of chloride - -98 - 106 meq/L An _______ fluid or ______ medication can be infused via an IV pump or by counting IV drops/min (drip rate) - -IV; IV Why does a patient need IV therapy? - -for fluid and electrolyte balance, replacement of fluid and electrolytes loss, provision of nutrients, provision of route for medications. Used when medication is too irritating to the GI tract, used to avoid giving IM shots Used in life threatening situation to give medications directly into the blood stream to ensure quick onset of medication Used when patient is unable to take medication by mouth or take oral therapy by mouth Used when medication will be destroyed by the GI tract What are the different types of IV hydrating fluids? - -isotonic, hypotonic, hypertonic, blood transfusions, and total parenteral nutrition (TPN) Isotonic - -0.9% NS or nacl or NS, Lactated ringer's (LR) and 5% Dextrose in water (D5W) Uses of isotonic fluid - -(it has the same concentration of solutes as plasma so remains in the vascular compartment as a volume expander) NS is the only fluid used with blood transfusion; NS is compatible with most IV meds (Example: you cannot give IV potassium by itself) Hypotonic - -0.45% sodium chloride (1/2 NS), 0.225% sodium chloride (1/4 NS) Uses for hypotonic fluid - -treatment of dehydration; for patients with no fluids in the vascular compartment Hypertonic - -5% dextrose in NS (D5NS), 5% dextrose in 0.45% NS (D5 1/2 NS, 5% dextrose in LR) Uses for hypertonic fluid - -in patients with hypotonic solution in the vascular compartment Blood transfusion - -the administration of whole blood or blood components What are the nurses' responsibilities when administering IV fluids and electrolytes? - follow the physician's prescriptions, select the correct solution, note the expiration date and clarity of the solution, calculate the flow rate and obtain an IV pump, assess infusion rate, assess IV site for patency, inspect the tubing for kinds, leaks, and NUR 226 NUR 226 damages, instruct client to notify nurse if there is pain or redness or discomforts at the site, use infusion pump especially when giving sensitive medications such as insulin, heparin, potassium, aminophylline, monitor intake and output, document (!!!!!), provide tubing changing and site change per hospital policy, Nurses Society Standards recommend IV site and tubing change every 48 hours Priming the tube - -getting all of the air bubbles out What are the different types of IV lines? - -peripheral line, intermittent infusion, central venous access (central line), peripherally inserted central catheter (PICC), implantable venous access devices or ports Peripheral line - -IV inserted in the peripheral veins; changed every 3 days (short term use for long hospital stays); used for short term IV fluids, IV meds, or IV antibiotic infusion Intermittent infusion - -type of peripheral IV line inserted for clients who do not require IV replacement therapy but requires an IV access; inserted using an IV catheter of either 16G, 18G, 20G, 22G, and 24 G needle; nurses do not need doctor's prescription to insert an IV catheter Central venous access (central line) - -empties into the superior vena cava for administering TPN, used when peripheral is not accessible or can be used for long term of ABT therapy, used for chemotherapy (examples are PICC line and implantable ports [long term use: more than a week]); example: if a patient needs IV antibiotics for two weeks then we can put in a PICC and not a regular peripheral IV line Peripherally inserted central catheter (PICC) - -uses long term IV meds or IV fluid infusion, frequent blood draw, and long term ABT therapy; inserted in the upper arm or subclavian region; it foes in the heart and can easily cause septic infection; therefore as a nurse we need to maintain a sterile field around a PICC line; to change the PICC line dressing also uses a sterile technique Implantable venous access devices or ports - -inserted in the upper chest using local anesthesia accessed using a Huber needle; used for chemo or infusion of irritating and strong IV meds; Do not take blood pressure on the arm with a ________ line; do not let water touch the site - -PICC IV tubings - -primary and secondary tubings, Y tubings for blood transfusion; primary IV tubing is the main IV line, secondary is the piggy back usually placed at a higher level than the primary; used to administer small bag of IV abts How to calculate IV flow rate - -total infusion volume (ml) X drop factor / total time of infusion in minutes = drops/min (gtts/mins) NUR 226 NUR 226 Dial a flow - -dial for ml/hour and prime IV pump helps - -regulate rate and will beep when there's an error Don't have to have a doctor's order to ___________ and IV - -start Objectives for administering blood transfusions include - -increasing circulating blood volume after surgery, trauma, or hemorrhage; increasing the number of rbcs and maintaining hemoglobin levels in patients with severe anemia; providing selected cellular components as replacement therapy (e.g., clotting factors, platelets, albumin) Complications of IV therapy - -circulatory overload of IV solution, infiltration or extravasation, phlebitis, local infection, bleeding at venipuncture site, air embolism, hypersensitivity reaction Phlebitis - -inflammation of inner layer of a vein Infiltration - -IV fluid entering subcutaneous tissue around venipuncture site Extravasation - -technical term used when a vesicant (tissue-damaging) drug (e.g., chemotherapy) enters tissues Circulatory overload of IV solution - -IV solution infused too rapidly or in to great an amount Hours of sleep for neonates - -16 hours a day Hours of sleep for infants - -8 to 10 hours at night for a total of 15 hours per day Hours of sleep for toddlers - -12 total hours a day Hours of sleep for preschoolers - -12 hours a night Hours of sleep for school age children - -9 to 10 hours Hours of sleep for adolescents - -get approx. 7.5 hours Hours of sleep for young adults - -get 6 to 8.5 hours Hours of sleep for middle and older adults - -total number of hours declines When adding up liquids, what is the equation for oz to ml? - -30 ml X (however many) oz Normal range of oral fluids ingested - - ml NUR 226 NUR 226 Normal range of food fluid ingested - -800-1000 ml Normal range of metabolism fluid intake - -300 ml Normal range of intake/output per day - - ml Normal range of skin fluid output per day - -500-600 ml Normal range of insensible lung output per day - -400 ml Normal range of gastrointestinal fluid output per day - -100-200 ml Normal range of urine fluid output per day - - ml Intake and absorption of potassium - -fruits, potatoes, instant coffee, molasses, brazil nuts, and absorbs easily Intake and absorption of calcium - -dairy products, canned fish with bones, broccoli, oranges, requires vitamin D for best absorption, undigested fat prevents absorption Intake and absorption of magnesium - -dark green leafy veggies, whole grains, Mg2+ containing laxatives and antacids, undigested fat prevents absorption Intake and absorption of phosphate - -milk, processed foods, aluminum antacids prevent absorption Cause of increased potassium output (hypokalemia) - -acute or chronic diarrhea; vomiting, other GI losses (NG or fistula drainage), use of potassium wasting diuretics, aldosterone excess, polyuria, glucocorticoid therapy Cause of decreased potassium output (hypokalemia) - -excessive use of potassium free IV solutions Cause of increased potassium intake (hyperkalemia) - -iatrogenic administration of large amounts of IV potassium, rapid infusion of stored blood, excess ingestion of potassium salt substitutes Cause of decreased potassium output (hyperkalemia) - -acute or chronic oliguria (severe ECV deficit, end stage renal disease); use of potassium sparing diuretics, adrenal insufficiency (deficit of cortisol and aldosterone) Cause of decreased calcium intake and absorption (hypocalcemia) - -calcium-deficit diet, vitamin D deficiency (includes end stage renal disease); chronic diarrhea, laxative misuse, steatorrhea NUR 226 Cause of increased calcium output (hypocalcemia) - -chronic diarrhea, steatorrhea Cause of increased calcium intake and absorption (hypercalcemia) - -milk-alkali syndrome Cause of decreased calcium output (hypercalcemia) - -use of thiazide diuretics Cause of decreased magnesium intake and absorption (hypomagnesemia) - malnutrition, chronic alcoholism, chronic diarrhea, laxative misuse, and steatorrhea Cause of increased magnesium output (hypomagnesemia) - -chronic diarrhea, steatorrhea, other GI losses (NG or fistula drainage, vomiting), use of thiazide or loop diuretics, and aldosterone excess Cause of increased magnesium intake and absorption (hypermagnesemia) - -excessive use of Mg2+ containing laxatives and antacids, parenteral overload of Mg Cause of decreased magnesium outp