Electrolytes
What are the signs and symptoms of hyperkalemia?
What are the risk factors for hyperkalemia? name 2
HYPERkalemia (over 5.0)
Heart - TIGHT & CONTRACTED
-ST elevation and Peaked T waves Wide QRS Prolong QT intervals
-Severe = Vfib or Cardiac Arrest
- Hypotension, Bradycardia
GI TRACT - TIGHT & CONTRACTED
-Diarrhea
-Hyperactive bowel sounds
NEUROMUSCULAR
- TIGHT & CONTRACTED
-Paralysis in Extremities
-Numbness and tingling in the extremities
-Profound Muscle Weakness, hyperreflexia, or areflexia (flaccid)
-(General Feeling of heaviness)
Lethargy and fatigue
Urine: Oliguria, anuria
Respiratory distress
RISK FACTORS FOR HYPERKALEMIA
Renal Failure
Acidosis (such as DKA) which shifts potassium from the cell into the ECF
Burns: The acute phase of a burn injury causes massive cell destruction and potassium shift to from the cell to the ECF. Immediately after burn injury, hyperkalemia (excessive potassium) may result from massive cell destruction. Hypokalemia (potassium depletion) may occur later with fluid shifts and inadequate potassium replacement. During burn shock, serum sodium levels vary in response to fluid resuscitation.
What is Megaloblastic anemia?
What medications are used to treat Metaplastic anemia?
What foods are high in B12?
MEGALOBLASTIC ANEMIAS
• FOLIC ACID DEFICIENCY
• DIETARY DEF OR ETOH ABUSE
• VITAMIN B12 DEFICIENCY
Low RBC and high MVC with nutritional deficit Characterized by the production of abnormally large erythrocytes called megaloblasts. Because these cells are abnormal, many are sequestered (trapped) while still in the bone marrow, and their rate of release is decreased.
Megaloblastic anemia is a form of macrocytic anemia. Macrocytic anemia is a blood disorder that causes your bone marrow to make abnormally large red blood cells. It's also a type of vitamin deficiency anemia.
Medications: Folate and B12
Foods high in B12:
Animal Liver and Kidneys
Clams
Sardines
Beef
Fortified Cereals
Tuna
Fortified nutritional yeast
Trout
Salmon
Fortified non-dairy milk
Milk and dairy
eggs
What are the first signs of hypoxia?
There is inadequate gas exchange depends on an adequate ventilation-perfusion ratio therefore S/SX include restlessness, agitation, change in LOC
What is Acute Respiratory Distress Syndrome (ARDS) & Acute Respiratory Failure (ARF)?
What is the medical management for ARDS?
Diffuse inflammatory damage to alveolar capillary membranes, inflammatory exudate builds up in alveoli and causes collapse. Shunting of blood. decreased perfusion, increased capillary pressure. hypoxemia. Impaired gas exchange leads to multisystem organ failure. It is a secondary disorder caused by something such as sepsis, trauma, or shock.
ARF- Hypoxemic failure (Low O2 and High Co2)
MANAGEMENT
Identify the primary disorder. Aggressive respiratory support including PEEP (improve alveoli function). increase FiO2 to keep PaO2>60 mm Hg; Spo2>90%
Balance fluid resuscitation. treat shock.
MORTALITY RATE- 35-60%
What is spironolactone?
Potassium-sparing diuretics can cause hyperkalemia, especially if given with an ACE inhibitor. It would be extremely important to assess the bedside telemetry monitor for changes to the T waves and identify risks for lethal cardiac dysrhythmias
What are the values?
Potassium
Sodium
chloride
magnesium
phosphate
Potassium 3.5-4.5
Sodium 135-145
chloride 97-107
magnesium 1.3-2.1
Phosphate 3.0- 4.5
calcium 9.0-10.5
What are the signs and symptoms of Emphysema?
PINK PUFFER- damage to alveoli results in loss of lung elasticity & loss of inflation of lung tissue. results in loss of lung tissue recoil and air trapping.
P-pink skin, pursed lip breathing
I Increased chest-barrel chest
N= Minimal or NO chronic cough
K- Keep tripoding
What are the assessment findings for hypervolemia?
Assessment findings consistent with hypervolemia include: (CV): HR (bounding pulse quality), hyperTN, peripheral edema, JVD, elevated CVP; (Resp): SOB, pulmonary congestion/crackles, cough; (General): weight gain (acute)
measuring intake and output,
monitoring weight,
assessing breath sounds,
monitoring edema, and promoting rest.
he most important intervention in the list involves monitoring the respiratory status for any signs of pulmonary congestion. Breath sounds must be assessed at regular intervals.
Cardiovascular
• Bounding, increased pulse rate, elevated blood pressure, distended neck
and hand veins, elevated central venous pressure, dysrhythmias
What is neutropenia?
What are the nursing interventions- name 2
Bone marrow doesn't make enough neutrophils.
Place a notice on your door. Before entering your room, everyone needs to follow certain steps to protect you. This notice explains what they should do.
Wash their hands. The staff will wash their hands with soap and water before entering and leaving your room. They’ll also wear gloves.
Leave reusable equipment in your room. Thermometers and other reusable devices will be kept in your room. You’ll be the only person who uses them.
Give you specific foods. When you’re neutropenic, you can’t eat foods that might have bacteria, like unwashed fruit or rare-cooked meat. The staff might put you on a neutropenic diet.
Avoid rectal medical procedures. The rectal area is extremely sensitive, so the staff won’t give you suppositories or enemas.
When entering a patient's room and you notice the o2 sats is 88%, what are 2 nursing interventions?
Assess:
can the patient speak in full sentences
Assess lungs
Is the reading accurate?
Normal level of oxygen is usually 95% or higher if lower start with 02 nasal cannulas at 2 liters.
If the patient decompensates and has COPD use a Venturi mask because it can accurately provide an appropriate level of supplemental oxygen, thus avoiding the risk of suppressing the hypoxic drive.
The nasal cannula is a low-flow oxygen delivery method that gives the patient 24% - 44% FiO2 at a rate of 1 – 6 lpm, each additional 1 lpm of oxygen increases FiO2 by 4%; a venture mask is an accurate high-flow oxygen delivery system
What are the different types of Pneumonia?
Community-Acquired (CAP)- <48 hrs after hosp admission.Pneumonia's most common etiology; increasing age and comorbidity are risk factors.
Healthcare Acquired (HCAP)- nonhospital but extensive healthcare contact; previous hosp in past 90 days; family member with multi-drug infection.
Hospital Acquired (HAP)- Diagnosed 48 hrs or more after hospital admission but not prior to admission.Pneumoniae, Enterbactorer, E.Coli, influenxa, Klebsiella infections. risk factors are comorbidity, prolonged hosp, increased exposure, and elderly.
Ventilator Associated (VAP)- Endotracheally intubated, ventilated 48 + hrs. The risk factor is the length of mechanical ventilation. High mortality rate.
What is magnesium citrate?
magnesium citrate is an effective laxative but would be a poor choice for a patient with end stage renal failure and impaired renal function because the patient has reduced renal function to excrete the magnesium; this makes the patient at risk for hypermagnesemia to develop
What is a CBC and what are the general ranges for a CBC? What is the function?
WBC 5-10,00 fight infection
Hemoglobin 12-18 carries 02
Hematocrit 36-54 blood volume
Platelets 140,00-400,000 clotting
RBC 4-6 million
What are the signs and symptoms of Chronic Bronchitis?
Inflammation of the bronchi and excessive mucus production result in a chronic hacking cough and recurrent infection.
B- big and blue skin- cyanosis (hypoxia)
L- long term chronic cough and sputum
U- Unusual lung sounds- crackles and wheezes
E- Edema peripherally due to cor pulmonale
What are the symptoms of hypercalcemia?
What are the symptoms of hypocalcemia? name 2
Anorexia, nausea, vomiting, and constipation
Abdominal and bone pain may also be present, especially with bone metastasis.
STONES Renal Calculi (kidney stones)
DEEP TENDON REFLEXES Decreased DTR Severe muscle weakness
HYPOCALCEMIA
Symptoms of hypocalcemia are related to increased neural excitability, alterations in muscle function;
Positive Chvostek & Trousseau signs,
(Neuro): tetany (increased neuro excitability), seizures, hyperreflexia, paresthesia, irritability, anxiety, confusion;
(CV): HypoTN, prolonged QT, impaired clotting; (Resp): dyspnea, laryngospasm/bronchospasm
Diarrhea
Circumoral tingling
Weak bones
What is Sickle Cell Disease?
Name 2 collaborative problems or complications with Sickle cell disease.
Congenital hemolytic disease that results from a defective hemoglobin (Hb) molecule (HbS) that causes red blood cells (RBCs) to become sickle or crescent shaped
Impairment of circulation (vaso-occlusive crisis), resulting in chronic ill health (pain, fatigue, dyspnea on exertion, swollen joints), periodic crises, long-term complications, and premature death
No cure existsCollaborative Problems and Potential Complications of Sickle Cell Disease
•Hypoxia, ischemia, infection
•Dehydration
•CVA
•Anemia
•Acute and chronic kidney disease
•Heart failure
•Impotence
•Poor compliance
•Substance abuse
Name 2 Causes of Metabolic Acidosis
Name 3 signs/Symptoms of Metabolic Acidosis.
Acid increase: Keto Acidosis, starvation, Lactic Acidosis: Shock hypoxemia
Decreased Bicarbonate: severe diarrhea, renal failure
S/SX
Headache, lethargy, Kussmauls's respiration, Nausea, vomiting, confusion. coma
What is the medical management of Pneumonia?
What are the nursing interventions for pneumonia?
Broad spectrum antibiotics for bacterial infection.
Supportive care- hydration and rest
Supportive care can include expectorants (not suppressants), cough medicines like Mucinex or Robitussin decongestants, or nasal sprays.
NOT COUGH SUPPRESSANTS and antitussives: Codeine.
Always culture to determine the bacterial source
NURSING INTERVENTIONS
Turn cough and deep breathing,
Rest
avoid cough suppressants and antitussives- codeine
fluids 2-3L day, high Fowler's, turning- good lung down for hypoxia, infected lung up. Early ambulation, Incentive spirometer;
Antibiotic Therapy
Respiratory assessment- may begin as a URI & progresses to lower resp tract. High fever is typically bacterial pneumonia (101 plus chills), and viral is low grade.
Assess respirations for tachypnea, progressive dyspnea, orthopnea, productive cough, pleuritic chest pain with cough, fatigue, malaise, diaphoresis, and anorexia.
Anticipate- Chest X-ray, sputum culture, blood culture, infiltrates, consolidations on chest x-ray. Sputum culture BEFORE antibiotics
What is furosemide?
loop diuretic
It can treat fluid retention (edema) and swelling caused by congestive heart failure, liver disease, kidney disease, and other medical conditions
monitor Potassium level
side effects: muscle cramps, weakness, unusual tiredness, confusion, severe dizziness, fainting, drowsiness, unusual dry mouth/thirst, nausea, vomiting, fast/irregular heartbeat
How is TB diagnosed?
Positive INTRADERMAL Mantoux testing over 15mm duration= positive TST AND
Chest x-ray and positive sputum cultures
3 sterile positive sputum cultures in 3 consecutive days
What is pleurisy? What are the priority nursing interventions for pleurisy?
What medication is given?
Pleurisy is inflammation of the pleural membrane causing sharp pain with inspiration.
Nursing interventions focus on the avoidance of pneumonia. Need to give opioids for pain management before coaching patient to cough & deep breath, use an incentive spirometer.
Medication:
The pain and inflammation associated with pleurisy is usually treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others). Occasionally, healthcare providers may prescribe steroid medication
What are the assessment findings for hypernatremia?
What medications can cause hypernatremia?
Hypernatremia (over 145)
HYPERNATREMIA = BIG & BLOATED
1. SKIN FLUSH ‘’Red & Rosy’’ EDEMA ‘’waterbed skin’’ LOW GRADE FEVER
2. POLYDIPSIA EXCESS THIRST
3. LATE SERIOUS SIGN
SWOLLEN dry tongue
GI = nausea & vomiting
INCREASED muscle tone
Drug Induced Hypernatraemia
What are 2 nursing interventions for THROMBOCYTOPENIC Precautions?
• Avoid non-steroidal anti-inflammatory drugs, such as Indocin, Advil and Motrin, unless prescribed by the physician who is aware of your platelet count.
• If you are on any blood thinning medication, such as Coumadin or Heparin, notify your physician.
• Do not take any medications by injection into your muscle (IM injection). • Do not take any medication or temperature rectally.
• Do not use rectal dilators. Avoid straining, bending at the waist or lifting heavy objects.
• Avoid activities that can cause injury to your skin (e.g., peeling crawfish, opening oysters and crabs, yard work, etc.).
Use a soft bristled toothbrush. Avoid flossing.
• Do not blow your nose forcefully. • Avoid constipation and straining to have a bowel movement.
Drink plenty of fluids.
Increase fiber in your diet.
Use stool softeners.
Do not use enemas or suppositories.
If unable to relieve constipation with the above suggestions, notify your physician.
• Avoid all beverages containing alcohol.
• Use an electric razor (no razor blades).
• Avoid any activity that can put you at risk of injury (contact sports, etc.).
• Avoid all aspirin or medication containing aspirin.
Name 3 signs and symptoms of Respiratory Acidosis.
Name 2 causes for Respiratory Acidosis.
bradycardia
Hypotension
Agitation-altered metal status trouble staying awake, retaining Co2
Confusion
Lethargy
Coma
CAUSES
Hypoventilation
Respiratory Depression
Asthma
COPD
Pneumonia
Pulmonary Edema
What are essential discharge instructions for a patient with pneumonia?
Discharge instructions- avoid cough suppressants or antitussives, cool mist humidifier, increase fluids, incentive spirometer, ambulation; finish oral antibiotics, pneumonia vaccine, smoking cessation, handwashing, follow up chest x-ray, report increasing or worsening symptoms.
What is a glucocorticoid? How can glucocorticoids affect the electrolytes?
Glucocorticoids (GCs) are steroid hormones widely used for the treatment of inflammation, autoimmune diseases, and cancer.
Most patients who need to be treated with glucocorticoids are in a hypercatabolic state characterized by respiratory failure and sepsis; glucocorticoid therapy may accentuate the pathological mechanism of urea diuresis in these patients and can cause hypernatremia as a consequence.
What is the priority nursing action if a patient is suspected of TB?
What are the signs and symptoms of TB?
Airborne precautions; private room
Proper PPE everytime you enter the patient's room.
Signs and symptoms
Night sweats, anorexia/ weight loss, cough and hemoptysis- blood-tinged sputum
dyspnea and SOB
fever and chills.
What signs show that the chest tube does not function correctly or needs attention?
1. Suction chamber- vigorous bubbling or no bubbling.
2. Water seal/air monitoring- Continuous bubbling may be an air leak. Tidaling has stopped may indicate the lung has re-expanded (not necessarily bad but should be reported)
3. Collection Chamber- over 100ml/hr of bright red blood may indicate bleeding and needs to be reported.
What are the signs and symptoms of hypokalemia?
What are the causes of hypokalemia?
ECG: Flattened T waves, ST segment depression, Frequent PVC, weak and irregular pulse
leg cramps
Extreme fatigue
Muscle weakness and spasms
tingling and numbness
Flaccid paralysis extremities
GI: Decreased motility, hypoactive to absent bowel
sounds, Constipation
Abdominal distension
Paralytic ileus, paralyzed intestines!
*PRIORITY* for SB0 (small bowel obstruction)
The most common cause is excessive potassium loss in urine due to prescription medications that increase urination.
NG suctioning
vomiting
diarrhea
excessive sweating
alcohol use disorder
Medications such as insulin and corticosteroids
Adrenal disorders
Low Magnesium levels
-
What is Disseminated intravascular coagulation?
What is happening?
•In disseminated intravascular coagulation, abnormal clumps of thickened blood (clots) form inside blood vessels. These abnormal clots use up the blood's clotting factors, which can lead to massive bleeding in other places. Causes include inflammation, infection, and cancer.
•Symptoms include blood clots and bleeding, possibly from many sites in the body.
•The goal is to treat the underlying cause and provide supportive care through intravenous fluids and blood transfusions.
•Triggers may include sepsis, trauma, shock, cancer, abruptio placentae, toxins, and allergic reactions
•Not a disease but a sign of an underlying disorder
Name 2 signs and symptoms of Respiratory Alkalosis.
Name 3 causes of Respiratory Alkalosis.
Tachycardia
anxiety
confusions
diaphoresis
dizziness
coma
CAUSES:
Hyperventilation
Hypermetabolic states: Fever, anemia, septicemia
Anxiety
fret
pain
pneumothorax
What are the nursing priorities and interventions for patients with COPD?
Proper positioning- sit patient upright/high Fowler's
May need BiPAP- to decrease hypercapnia
Avoid opioids & benzodiazepines because they decrease breathing which may worsen oxygenation status/respiratory acidosis.
Anxiety- COPD patients are frequently anxious due to the inability to breathe. Assist with relaxation techniques and pursed lip breathing to prevent air trapping and airway collapse during expiration
What is Albuterol?
Name 2 side effects that can be serious.
What is Atrovent (Ipratropium bromide)?
Name 2 side effects that can be serious.
Albuterol is used to prevent and treat wheezing, difficulty breathing, chest tightness, and coughing caused by lung diseases such as asthma and chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways). Albuterol is in a class of medications called bronchodilators. It works by relaxing and opening the air passages to the lungs to make breathing easier.
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:
ATROVENT
Ipratropium bromide, sold under the trade name Atrovent, among others, is a type of anticholinergic medication that opens up the medium and large airways in the lungs. It is used to treat chronic obstructive pulmonary disease and asthma symptoms. It is used as an inhaler or nebulizer.
SIDE EFFECTS:
The most common adverse reactions were bronchitis, COPD exacerbation, dyspnea, headache, throat irritation, cough, dry mouth, gastro-intestinal motility disorders (including constipation, diarrhea and vomiting), nausea, and dizziness
What is a Pulmonary Embolism? What are the signs and symptoms? What is the diagnostic test for determining a possible PE?
PE is a clot (blood, fat) that obstructs the pulmonary artery which prevents blood flow, deadly hypoxemia and possible death.
Priority- Impaired gas exchange related to an imbalance of ventilation and perfusion mismatch
Risk factors- obesity, immobility, heart valve issues or a fibrillation, estrogen birth control.
Signs and symptoms- hypoxemia- restlessness, agitation, mental status changes, chest pain, SOB, dyspnea, tachypnea, tachycardia, and anxiety.
High D-Dimer blood test indicates high risk for blood clotting disorder or blood clots somewhere in the body.
What is the priority nursing action if a patient is suspected of TB?
Airborne precautions; private room
Proper PPE everytime you enter the patient's room.
Key Points
Medication treatment 6-12 months
You must wear an N-95 mask with patient care at all times.
The family must be tested for TB because of exposure.
Sputum samples are collected every 2-4 weeks.
Pt is no longer infected if they have 3 negative cultures on 3 different days.
What are the assessment findings with hyponatremia?
Causes for hyponatremia?
Hyponatremia (below 135)
HYPONATREMIA - DEPRESSED & DEFLATED
NEURO = Seizures & Coma
HEART = Tachycardia, & weak thready pulses RESPIRATORY ARREST
Causes for hyponatremia
Common causes include diuretics, vomiting, diarrhea, congestive heart failure, renal and liver disease.
Syndrome of inappropriate antidiuretic hormone (SIADH)
Ingestion of large amounts of excessive fluids
What is HEMOPHILIA?
What are the nursing interventions for HEMOPHILIA?
a medical condition in which the ability of the blood to clot is severely reduced, causing the sufferer to bleed severely from even a slight injury. The condition is typically caused by a hereditary lack of a coagulation factor, most often factor VIII
NURSING INTERVENTION
Provide emotional support and reassurance when indicated. Encourage the patient to verbalize feelings and concerns. Assist with the use of positive coping strategies.
Encourage the patient's participation in care and decision-making to promote feelings of control over the situation.
Emphasize positive aspects of the patient's status.
Institute safety precautions to reduce the risk of injury.
Provide opportunities for rest; cluster activities to promote rest; institute energy-conservation measures.
Inspect skin and mucous membranes closely for evidence of bruising and hematoma formation.
Assist with measures to promote routine activities within the limits of the disease.
Apply antiembolism or sequential compression stockings to prevent VTE if the patient is hospitalized.
Obtain specimens for laboratory testing, as ordered.
Assess quality-of-life issues.
For immunizations, use a small-gauge needle and apply pressure and ice for 5 minutes. Avoid intramuscular injections.
Institute rest and splinting with joint bleeding followed by active range of motion and strengthening exercises once bleeding is resolved.
Screen for and assess the patient's pain using facility-defined criteria that are consistent with the patient's age, condition, and ability to understand.
Treat the patient's pain, as needed and ordered, using nonpharmacologic, pharmacologic, or a combination of approaches.
Reassess and respond to the patient's pain by evaluating the response to treatment and progress toward pain management goals
bleeding precautions: INJECTIONS, ORAL CARE, BLEEDING.
What are two causes of Metabolic Alkalosis?
What are two signs/symptoms for Metabolic Alkalosis?
Antacids
Hyperaldosteronism; Cushing's disease, steroids'
Acid loss by: vomiting, gastric suctioning, Diuretics-K+/NA+ loss
S/SX
weakness muscle cramps, hyperactive reflexes, tetany, confusion, slow shallow respirations to minimize co2 loss(Body needs this to counter alkalotic state), nausea, seizures
What are the vital patient teachings for patients with COPD?
Promote healthy eating- small frequent meals with rest periods, high calories and high protein.
Avoid- high carbs, and exercise 1 hour before/after meals to conserve energy. Avoid gassy foods.
Increase fluid intake (8 glasses or 2-3L daily) to thin mucous. Avoid drinking fluids with meals.
Report an increase in sputum, fever, or worsening dyspnea.
Prevention- pneumococcal every 5 years, flu vaccine every year.
Meds- good inhaler technique. Always have albuterol to lessen cough and wheezing.
Bronchitis- guaifenesin and cool mist humidifier to mobilize secretions.
Pursed lip breathing- inhale for 2 seconds, exhale for 4 seconds.
Hugg coughing technique- sit upright in a chair, deeply and slowly inhale, hold your breath for 2-3 seconds, and then forcefully exhale.
What are the 4 TB meds and their precautions with administration and monitoring?
RIPE
Rifampin- RED-FAMPIN- normal to see red, and orange in tears urine, and sweat. Pts should not wear contacts due to discoloration of tears; oral contraceptives are NOT effective; use backup birth control, monitor for jaundice; hepatotoxic!
INH Isoniazid- interferes with Vit B6 so monitor for peripheral neuropathy- new numbness, tingling extremities, ataxia. Pts may be on Vit B6 25-50mg daily for supplementation. Hepatotoxic- report jaundice, dark urine, elevated liver enzymes (HOLD MEDS); NO ETOH
Pyrazinamide- 3rd TB drug; hepatotoxic
Ethambutol= EYE; May cause blurred vision and color changes!
What are the signs and symptoms of asthma?
A- accessory muscle use
S- shortness of breath and dyspnea
T- tight chest and tachypnea
H- High-pitched wheezing
M- minimal diminished breath sounds
A- Absent breath sounds (silent chest) PRIORITY, acidosis, air trapping (prolonged expiration)
MAY LEAD TO RESPIRATORY FAILURE= High CO2, hypercapnic; Respiratory acidosis- PaOs< 80 Hypoxic
How is CF Diagnosed?
What are nursing interventions for CF? Name 2
Sweat test, DNA, and stool test.
Normal findings for CF- recurrent lung infections, blood-tinged sputum, weight loss, loss of appetite, loose fatty stool or steatorrhea mucus build up and lack of enzymes to help break down fat.
Nursing care- High-calorie diet, pancreatic enzymes with all meals, increased fluid intake, exercise, chest physiotherapy, postural drainage, financial counseling for expensive treatments