Nclex Hurst Study Guide

NCLEX HURST STUDY GUIDE o Calcium has an inverse relation to phosphorus • When Calcium goes up, Phosphorus goes down (Hypophosphatemia) and vice versa o Sodium has an inverse relation to Potassium • When sodium goes up, Potassium goes down and vice versa ⟶ HyperParathyroidsm = HYPERCALCEMIA = HYPOPHOSPATEMIA Every time you see Hyperparathyroidism that’s the same exact thing as Hypercalcemia o Epinephrine is secreted – vasoconstrictor When Hypovolemic (blood volume deficit), ADH and aldosterone will be secreted so keep blood volume up **Weight is the best indicator for fluid status EXCEPT for Burns, Its Urine Output** Also for ventilator alarms HOLD High alarm- Obstruction due to incr. secretions, kink, pt. coughs, gag or bites Low press alarm- Disconnection or leak in ventilator or in pt. airway cuff, pt. stops spontaneous breathing To remember blood sugar: hot and dry-sugar high (hyperglycemia) cold and clammy-need some candy (hypoglycemia) Eu = Normal for example: Euthyroid is normal thyroid Increase of LDL, THINK Coronary Artery Disease Increase secretion of PTH makes serum calcium go up Decrease secretion of PTH makes serum calcium go down You dangle artery problems and you elevate vein issue problems IMPORTANT WHEN IT ASKS FOR PRIOIRTY, ASK YOURSELF YOURE GOING TO DO THAT OVER AND OVER AGAIN AND NOTHING ELSE  EXAMPLE: client is hemorrhaging, do you check for vital signs or call the HCP Hypervolemia: Too much fluid in the vascular space (too much water in the hose) Will Cause: HF  Weak Heart  low Cardiac output  Low Urine Perfusion  Low Urine Output Heart Failure Renal Failure S/S: Bounding Pulse SOB; Dyspnea Crackles/ wet lung sounds (listen to the low area in the back) Distended Neck (JVD) and Peripheral Veins Peripheral Edema (sacrum area) and Third spacing Rapid Weight gain Low urine output (specific gravity of 1.010 or less) Central Venous Pressure (CVP): More volume (Hypervolemia) = More Pressure CVP normal is 2-8 Low volume (Hypovolemia) = Low Pressure Position: Semi Fowler; BED REST FOR THESE PATIENTS (hyper & Hypo) Diet: Hypertension, heart failure, CAD—low sodium, calorie-restricted, Low fat Treatment: Hydrochlorothiazide: Will make you lose Potassium Furosemide: Will make you lose Potassium Bumetanide: Will make you lose Potassium • Give SPIRONOLACTONE to retain Potassium but watch for Hyperkalemia o KEEP CLIENT ON BED REST (helps reduce sodium and water) Teaching: Check Daily weights and Input and Output ***clients with History of HF and Kidney, give fluids slow and watch for Hypervolemia*** HYPOVOLEMIA: Fluid not in the vascular space  SHOCK (COLD AND CLAMMY) Look for Hypovolemia in (anything that causes losing fluid): Trauma SURGERY patients NG tube Paracentesis  you losing fluid Vomiting and diarrhea Ascites: fluid in the abdomen; Edema: Fluid in the wrong spot so check for Hypovolemia Polyuria: Fluid in the wrong spot so check for Hypovolemia Will Cause: Third spacing: When fluid goes somewhere else other than Other than the vascular space Ascites: fluid in the abdomen  People with liver Disease will have this Edema Polyuria: When you see this, THINK Shock First ** When you go into HYPOVOLEMIC STATE (Hemorrhage, vomiting, or anything that causes you to lose water), the ALDOSTERONE hormone secretion will increase to preserve/retain sodium and water*** S/S: Increased temp Decreased skin Turgor Low mucous COLD AND CLAMMY Rapid/weak/thready pulse, High pulse (tachycardic) and Tachypnea Increased Respirations Hypotension (Orthostatic/postural mainly) Anxiety, weight loss Decreased Urine output Urine specific gravity 1.030 Low CVP pressure Vessels are vasoconstricted *Concentrated makes labs go up like hematocrit and dilute makes it go down* Position/Nursing Intervention for SHOCK: THINK DIZZINISS Bedrest with extremities elevated 20 degrees Knees straight Head slightly elevated (modified Trendelenburg) Treatment: Give Fluids Safety precautions (high risk for falls) Monitor IV fluids (weight check and I and O) TYPES OF IV FLUIDS ISOTONIC (0.9%) - *D5W - Normal Saline - Lactated Ringers - D5 ¼ NS (used for Peds) **Contraindicated: Hypertensive, Renal, and heart disease** HYPOTONIC SOLUTION (0.33%) - D2.5W - ½ NS OR 0.33 NS ***Use for: Hypertension, Heart problem, Renal Disease*** **Watch for Cellular Edema** Hypertonic Solution (TPN): - D10W, 3% NS, 5% NS - D5 LR, D1/2 NS, D5NS - **TPN (most common) - Albumin **Watch for pulmonary edema, Fluid volume excess, Hypertension** Aldosterone = Steroids aka Mineralocorticoids retains sodium and water Cushing’s Syndrome: Too much Aldosterone (steroids) Hyperaldosteronism (Conn’s Syndrome): Too much Aldosterone (steroids) S/S: HyperNa: If you are obese, you have to much sodium HypoK Hyperglycemia, Prone to infection, Muscle wasting; weakness, Edema; Obesity HTN, Hirsutism, Moon face Buffalo hump Diet: Low sodium, High potassium diet. Increase protein, Increase Calcium ***Cushing: Everything is High Except Potassium*** CLIENT NEEDS QUITE ROOM Risk for osteoporosis Protein means kidney damage Glucose and ketones are for long term use which will show in urine sample Uric acid is kidney stones ADDison disease is ABSENT of steroids.  think of a bodybuilder who’s on steroids, he’s very big vs the other guy who is not taking steroids. He will be SMALL, AND WEAK AND TAN With Addison disease, they have Absent of steroids meaning LOW so everything will be LOW except 2 things LOW BP (CRITICAL)  Shock LOW weight (water loss) LOW sodium (hyponatremia) LOW glucose (Hypoglycemia) LOW or slow periods (amenorrhea) LOW resistance to stress Fractures Alopecia Weight loss GI distress HIGH Potassium (hyperKalemia) HIGH pigmentation “Bronze Pigment”  don’t get this confused with the Acanthosis nigricans Loss of libido and decreased axillary and pubic hair are common in Addison's disease due to lower levels of androgens. Diet: Increased sodium, low potassium diet. Addisonian Crisis: N/V Confusion Abdominal pain Extreme weakness Hypoglycemia Dehydration Decreased BP - Treatment: Meds:  NEVER STOP TAKING MEDS ABRUPTLY ▪ Prednisolone: 2x a day in split days ▪ Fluicosteriods: this is Aldosterone SIADH: too much ADH  potential complication of head injury Syndrome of inappropriate antidiuretic hormone (SIADH) is potential complication of head injury or Pituitary (located right through the bridge of the nose so any nose/sinus injury can also be it too) or a TRANSSPHENOIDAL HYPOPHYSCEMETY and INTERCRANIAL PRESSURE. In SIADH, the extra ADH leads to excessive water absorption by the kidneys. IF YOU HAVE ICP, ABSERVE FOR ADH PROBLEMS DO NO GIVE YOUR PATIENT FLUIDS IF THEY HAVE SIADH.  KEEP THEM ON FLUID RESTRICTIONS S/S OF SIADH: Low urine output (cuz their brain is absorbing it all so no point in giving them more unless you tryna kill your patient!! HAH ROT IN JAIL) Increased urine gravity Decrease in urine osmolality (if one is increased the other one is obviously decreased Ex: high urine output so low urine osmolality) BASICALLY REMEMBER OPPOSITES ATTRACT - ALSO WILL BE HYPONATERMIA!! - Changes in LOC - Decreased deep Tendon Reflexes - Tachycardia - N/V - • Side note: all these are bullshit, just know SIADH has to do with LOW URINE OUTPUT which obviously means Increase in urine gravity o The higher the urine output, the lower urine gravity o The lower the urine output, the higher urine gravity Treatment: Administer Desmopressin Diuretics Declomycin Lab work: Urine specific Gravity Sodium Hematocrit SIADH: causes include central nervous system disorders (eg, stroke, trauma, neurosurgery) and some commonly used medications (eg, desmopressin, carbamazepine Diabetes insipidus (DI): think D for dehydrated so they are Dry Inside  Diabetes Insipidus R N Y S I ***WHEN YOU SEE DI, REMEMBER D FOR DIURESES*** D E • High Urine Output (because they are peeing everything out, so they are dry inside) • Low urine gravity which automatically means they’ll have high osmolality • HyperNatremia  this goes with the High Osmolality, if you have high osmolality, you’ll have high sodium and vice versa • Polydipsia aka DIURESIS (since they are dry inside, they’ll be thirsty • Dry mucous membranes CUZ they DRY INSIDE DUHH! • HYPOTENSION REMEMBER CARDIAC, when you have a low fluid inside, you turn HYPOTENSIVE  SHOCK • DESMOPRESSION AKA VASOPRESSIN gets your BP up AND decreases Urine output  can cause deadly headaches because it also decreases sodium ***BIGGEST COMPLICATION IS SHOCK FOR DI*** TREATMENT: Any Med with -RESSIN (desmopressin, Pitressin) Hyper Magnesium and Hyper Calcium: Think Act like Sedatives Everything goes Down!!! Magnesium: normal: 1.5-2.5 mEq/L HYPER magnesium: Excreted through Kidneys and GI - Causes of Hyper magnesium: ▪ Kidney Failure  if you can’t excrete it, then it will cause this ▪ Antacids  has too much magnesium ⟶ S/S: (vasodilation)  Hyper Magnesia: will make everything go down o Depresses the CNS/ LOC o Hypotension o Facial flushing/warmth  vasodilation o Muscle weakness o Absent deep tendon reflexes o Shallow/Decreased respirations o Arrhythmias o Emergency ** Sometimes Magnesium is given to Preeclampsia patients to prevent seizures because magnesium relaxes everything** ⟶ Treatment: o Ventilator if O2 is 10 breathe o Dialysis: kidneys not working o Calcium Gluconate  antidote o Safety precautions: HYPERCalcemia: ⟶ Causes of Hypercalcemia: ▪ Too much PTH (parathyroid Hormone) ▪ Thiazides: makes you retain calcium ▪ Immobilization: If you’re immobile, calcium goes into the blood which makes PTH go up • ^Intervention: client must be weight bearing and mobile ⟶ S/S: (same s/s as hyper magnesium but these 2 added) o Brittle Bones o Kidney Stones ⟶ Treatment: o Move o Fluids – To prevent Kidney stones o Increase Phosphorus (diet)  Calcium has an inverse relation to phosphorus o Steroids: decreases calcium levels so increase in steroids o Safety precautions • Meds: o Biphosphate – Adrenalin and Calcitonin ▪ Calcitonin treats osteoporosis Hypo Magnesium and Hypo Calcium: Not enough Sedatives Everything goes Down!!! HYPO magnesium: Excreted through Kidneys and GI - Causes of Hypo magnesium: ▪ Diarrhea ▪ Alcoholic – Suppresses the release of ADH so Decrease of ADH mean client will Diuresis (Urinate more) more - S/S: (not sedated so everything down) o Rigid and tight muscles o Possible seizures o Stridor/ Laryngospasm and Tetany (spasms of the hands and feet, cramps, spasm of the voice box (larynx)) o POSTIVIE CHVOSETK’S (hyper irritability) AND TROUSSEAU o Arrythmias o Increase deep tendon reflex o Mind changes (wild, see things, depression, etc) o Swallowing problems (dysphagia) - Treatment: o Give Magnesium ▪ Check kidney function before giving IV Mg ⟶ Diet: High in Mg (Remember Vegetables , seeds, and peppermint) o Spinach o Greens o Squash o Broccoli o Halibut o Turnip o Pumpkin seeds o Peppermint o Cucumber o Green beans o Celery o Kale o Sunflower seeds o Sesame seeds o Flax seeds HYPOCalcemia: ⟶ Causes of Hypocalcemia: ▪ Not enough Parathyroid Hormone (PTH)  Hypoparathyroidism ▪ Radical Neck ▪ Thyroidectomy ⟶ S/S: SAME AS HYPOMAGNESIUM o Rigid and tight muscles o Possible seizures o Stridor/ Laryngospasm and Tetany (spasms of the hands and feet, cramps, spasm of the voice box (larynx)) o POSTIVIE CHVOSETK’S (hyper irritability) AND TROUSSEAU o Arrythmias o Increase deep tendon reflex o Mind changes (wild, see things, depression, etc) o Swallowing problems (dysphagia) ⟶ Treatment: o Give Calcium: Make sure client has heart monitor on when giving calcium ▪ Give IV calcium slowly b/c too fast will cause widened QRS aka Arrythmias o Vitamin D: This Utilizes the calcium for better absorption o Phosphate binders to excrete phosphate: Calcium acetate (hydrochloride) ⟶ Diet: o Decrease in Phosphate foods Sodium: Think Neuro changes!!! Hypernatremia: Dehydration ⟶ Causes of HyperNatremia: Think what causes Dehydration ▪ Hyperventilation: When you exhale too much, you lose water ▪ Heat stroke ▪ DI ▪ Vomiting ▪ Diarrhea ⟶ S/S: o Thirsty o Dehydration o Swollen Tongue o Neuro Changes (disorientation/delusions) o Increased temp o Weakness o Hypotension o Tachycardia ⟶ Treatment: ▪ Restrict Sodium ▪ IV fluids (Hypotonic Solutions) ▪ DAILY WEIGHTS AND I&O ▪ Lab work ***Clients on Tube feedings, Check Sodium levels*** HYPO Natremia: Too much water and not enough sodium ⟶ Causes of HypoNatermia: • Psychogenic polydipsia (drinking too much water) • Too much water • SIADH ⟶ S/S: o Headache o Seizures o Coma o Nausea o Muscle cramps o Increased ICP; Hypertension o Muscular twitching ⟶ Treatment: ▪ Not water, but give Sodium (Hypertonic Solution) ▪ 3% NS or 5% NS Potassium: Excreted by kidney HyperKalemia: Excreted by Kidney ⟶ Causes of HyperKalemia: • Kidney Trouble • Drugs such as Spironolactone ⟶ S/S: Early to Late (severe) sign -Mnemonic is (FMURDER) o Muscle Weakness and twitching o Flaccid Paralysis o Urine (oliguria/anuria) o Respiratory depression o Decreased cardiac contractility o ECG changes o Reflexes ⟶ Treatment: o Dialysis: Kidneys not working o Calcium Gluconate o Glucose and insulin  Watch for Hypokalemia and Hypoglycemia o Sodium Polystyrene (kayexalate)  used only for clients who are hyperkalemic ONLY ▪  given as enema o Push Fluids HypoKalemia: ⟶ Causes of HypoKalemia  They are all losing potassium ▪ NG Suction ▪ Vomiting ▪ Diuretics ▪ Not eating ⟶ S/S: Early to Severe o Muscle Cramps o Muscle Weakness o Arrhythmias ⟶ Treatment: o Give potassium Spironolactone o Increase K Foods ▪ Raisins ▪ Bananas ▪ Apricots ▪ Oranges ▪ Beans ▪ Potatoes ▪ Carrots ▪ Celery ⟶ Safety Issues with Potassium: o Oral Potassium causes GI upsets – Give with foods o **Assess Urinary Output before/during IV Potassium** o Always put IV Potassium on a Pump o Mix well o Never give potassium PUSH o Burns during infusion? Yes, very common Acid/ Base Solution (Listen to MARK!!) From the a** (diarrhea)= metabolic acidosis From the mouth (vomitus)=metabolic alkalosis s Burns: ⟶ Safety Considerations: o Electrical sockets covered o Smoke alarm o Heating elements: Only one heating element per socket o Dryers o Practice escape plan o Pot handles o Stove attached to walls o No tablecloths if toddlers present o Watch for small appliances (iron) o Water heater 120 F*  Elderly with neuropathy: use Antiscald devices with devices with showerheads and faucet fixtures ⟶ S/S: They can go in SHOCK  HYPOTENSION: vessels are leaking o Hypotension  SHOCK o Tachycardia o Hypothermia o Low hemoglobin o Low urine Output: volume deficit so low urine output o Low kidney perfusion: kidneys aren’t working properly OR needs to hold water o Epinephrine is secreted – vasoconstrictor o ADH and aldosterone are secreted: Will make blood volume go up ⟶ Rule of nine o Head = 9% o Each arm = 9% o Each Leg = 18% o Stomach = 18% o Back = 18% o Genitals = 1% ⟶ BURNS o 1st Degree - Red and Painful o 2nd Degree – Blisters o 3rd Degree - No Pain because of blocked and burned nerves ⟶ Diet: o high protein o high caloric, o Increase in Vitamin C ⟶ Treatment: o Fluid replacement: 2 large bore IVs  Lactated ringers or Albumin (colloids)…. Give half of fluid for the first 8 hrs, The remaining half is given over the next 16 hrs. o Oxygen o Make sure to time what time the burn occurred ⟶ Management: o Wrap client in blanket  Helps with hypothermia o Cool Water: No more than 10 min – NO ICE o Remove Jewelry o Remove non-adherent clothing o Do not remove stuck Clothes o Inhalation injury  Give 100% oxygen b/c low hemoglobin o Intubate if airway is compromised **Weight is the best indicator for fluid status EXCEPT for Burns, Its Urine Output** ⟶ Immunizations: o Tetanus  If client doesn’t know he had it, give Immunoglobulin ⟶ Oncology: KNOW ALL THESE!! ⟶ Risk Factors: ▪ Tobacco and alcohol ▪ Obesity ▪ Low fiber diet: you retain more carcinogens ▪ Increased red meat consumption ▪ Increased animal fat ▪ Nitrates: processed sandwich meats. Salt cured or smoke meats ▪ Preservatives and additives ▪ Aging ▪ African Americans ▪ Radiation ▪ Stress ▪ Chronic Irritations  GERD ▪ History ⟶ Diet: o High fiber: Increase in fruits o High Calorie o High Protein ⟶ Cancer  Primary Prevention: Teaching o No smoking o Exercise o Lose weight o Vaccines – Heb B, and HPV o Wear sunscreen, and avoid sun, and secondhand smoking ⟶ Secondary Prevention  Screening ⟶ Tertiary Prevention  Treatment (support group and Rehab) o ⟶ The warning signs of cancer can be remembered with the acronym CAUTION: • Change in bowel or bladder habits • A sore that does not heal • Unusual bleeding or discharge from a body orifice • Thickening or a lump in the breast or elsewhere • Indigestion or difficulty in swallowing • Obvious change in a wart or mole • Nagging cough or hoarseness ⟶ Bone Marrow cancer leads to ▪ Anemia: Low RBC (hypotension) and Hypoxic; increase in pulse (Tachycardic) ▪ Leukopenia ▪ Thrombocytopenia