Fluid and Electrolytes
List the following electrolyte ranges
Na, K, Ca, Mg, Ph
Na:135-145 ; K:3.5-5.0 ; Ca: 9.0-10.5 ; Mg:1.3-2.1 ; Ph 3.0-4.5
what are the two types of COPD (nicknames and condition names)
Pink Puffers - emphysema
Blue Bloaters - chronic bronchitis
Cardiac system is heavily dependent on the kidneys. Explain how the RAAS system works/ how does an over active RAAS cause chronic hypertension?
overactive RAAS leads to increased sodium and water retention in the kidneys, which increases blood volume, and also causes vasoconstriction (narrowing of blood vessels) leading to elevated blood pressure.
pH 7.3, PaCO2 68 mm Hg, HCO3 28 mmol/L, and PaO2 60 mm Hg.
Respiratory Acidosis, Partially Compensated
how many kg's are in 4 liters of water?
bonus - how many pounds
1kg = 1 liter of water
8.8lb
A nursing intervention for FVE is DRAIN explain was each letter sends for
Diuretics, Restrict sodium and fluid, Assess daily weight, Intake/outake, Na monitoring
True or false: TB's fast acid staining stains blue
True or false: TB is aerobic
False - mycobacterium TB stains RED
True - it loves oxygen - why its in the lungs
what is a failure to rescues for carotid artery disease?
HF, Sudden cardiac death, stroke, aneurysm, Angina pectoris
pH 7.0, PaO2 90 mm Hg, PaCO2 23 mm Hg, and HCO3 12 mmol/L
Metabolic Acidosis, Partially Compensated
1000mL of normal saline is hung at 08:00 and is running at a rate of 125mL/hr. how many mLs would be left in the bag at 13:00
375mL
13:00 - 08:00 = 5 (bag has been running for 5 hours)
5 x 125 =625
1,000 - 625 = 375
Define isotonic, hypotonic, hypertonic. Give an example of each (IV Fluids) and when you would use them.
Isotonic: Same as blood no cell changes ex: Normal Saline 0.9% NaCl or Lactated ringers both can be used to restore fluid volume incases of dehydration or blood loss
Hypotonic: solution is lower in solute concentration than the cells - water moves into the cell ex. half normal saline 0.45% NaCl and dextrose used to rehydrate the cells
Hypertonic: Solution is higher in solute concentration than the cells - water moves out of the cells ex 3% NaCl can be used for sever edema - intracranial pressure
list potential complications of COPD
what is the difference between controlled Afib and uncontrolled Afib?
Bouns what's the tell tale difference between Afib and Aflutter
Controlled AFib - <100bpm Uncontrolled >100bpm
fluTTer - has sawTooTh like waves
pH 7.6, PaO2 120 mm Hg, PaCO2 31 mm Hg, and HCO3 25 mmol/L
Respiratory Alkalosis, Uncompensated
client is prescribed 200mg of magnesium split into two doses. The available solution is 150mg/5mL. How many mL's should the client be taking per dose. (round answer to closest whole number)
3 mL
200mg/1 x 5mL/150mg =6.667 mL
6.667/2=3.334
Client is in fluid volume overload. What would happen to the following labs?
hemoglobin and hematocrit, sodium level, BUN, serum osmolality (concentration of substances in the blood), urine specific gravity and osmolality (measure solutes/ electrolytes concentration in urine)
All will decrease
Too much fluid is going to DILUTE everything: blood and urine diluted….many things are going to be “watered down” which decreases it concentration (remember D for dilute and decreased)
Who's at risk for TB?
TB RISK:
Tight living quarters, Below or at the poverty line )
Refugees, Immunocompromised, Substance abusers (IV), Kids less than the age of 4-5
Client complains of sudden increased pain in their legs when they are walking into work as they have to park in the back or the lot. Pain alleviated with rest. On further inspection they were sores on their feet.
Is the PAD or PVD? Also explain how the sores would look for this condition.
PAD wound would be round and smooth with black eschar cool to the touch and would be present on the toes or sole of the feet.
if they had PVD sores would be yellow slough, red skin, irregular boarders, and warm typically on ankles -- DVT RISK
pH 7.5, PaO2 85 mm Hg, PaCO2 40 mm Hg, and HCO3 34 mmol/L
Metabolic Alkalosis, Uncompensated
800 ml of blood is to be given to a patient over 5 hours. What is the flow rate if the drop factor is 15?
40gtt/min
800mL/5hr =160 mL/hr
60/15 =4
160mL/hr /4 =40
explain the use of the following medications in the treatment of hyperkalemia.
IV Calcium Gluconate
IV D50/ insulin
Albuterol neb
IV Calcium Gluconate: stabilizes the cell membrane to prevent K from leaving the cells
IV D50/ insulin: drives K back into the cells
Albuterol neb: drives K back into the cells
List the medications used to treat TB
bonus - what do they each do
RIPE:
Rifampin: kills the bacteria by stopping RNA-polymerase
Isoniazid (INH): kills the bacteria and stops it growth
Pyrazinamide: bactericidal effect (kills the bacteria)
Ethambutol: stop RNA synthesis and is bacteriostatic (stops the bacteria from reproducing)
A client with heart failure has fatigue, ascites, hepatomegaly, splenomegaly, and polyuria. What side heart failure do they have?
Right sided - back flows into the peripheral system causing venous congestion and edema --> for pulmonate is in RHF
a client who has left sided may present with paroxysmal nocturnal dyspnea, crackles in the lungs, tachypnea, blood tinged sputum, displaced apical pulse, oliguria, ect.
pH 7.39, PaCO2 27 mmHg, and HCO3 19 mEq/L
Metabolic Acidosis, Fully Compensated
A physician orders 1000 ml of Ringer's Lactate to infuse over 12 hours. At 16:00 there is 500mLs left in the bag. When was the bag started?
10:00
1,000mL/12hr =83.3333mL/hr
500mLs/1 x 1hr/83.3333mL = 6 hrs
16:00 - 6 = 10:00