NSG 3800/ NSG3800 Exam 1 – Adult Health II | 2026/2027 Update | Galen | Latest Questions & Verified Answers

NSG 3800/ NSG3800 Exam 1 – Adult Health II | 2026/2027 Update | Galen | Latest Questions & Verified Answers The nurse is providing care for a client with a decreased calcium level. Which of the following foods should the nurse recommend? (Select all that apply). a. Sardines b. Milk c. Cheese The nurse is providing care for a client with a serum sodium level of 130 mEq/L. Which of the following signs and symptoms should the nurse monitor for? (Select all that apply). a. Convulsions b. Decreased LOC What labs help us determine fluid status? (Select all that apply). a. Blood Urea Nitrogen (BUN) b. Serum Sodium (Na+) c. Creatinine d. Serum Potassium (K+) The nurse is providing care for a client who has a serum potassium level of 5.2 mEq/L. Which of the following signs and symptoms should the nurse monitor for? (Select all that apply). a. Irregular pulses b. Hypotension c. Muscle weakness d. Cardiac dysrhythmias While the nurse is washing the face of a patient in renal failure, the patient demonstrates a spasm of the lips and face. The nurse examines the recent electrolyte levels to assess the level of a. calcium Decreased blood pressure is the #1 sign of fluid volume deficit. a. False Explanation: Tachycardia is the #1 sign of fluid volume deficit. Heart rate will increase first to compensate and maintain blood pressure. Blood pressure may drop but it is a later sign. An excess of fluid being pushed into the intravascular space results in? (Select all that apply). a. edema b. sore joints The nurse is caring for a client with hypovolemia The nurse should anticipate that the client may experience a. thirst Which of the following electrolytes reside mostly in extracellular fluid? (Select all that apply). a. Chloride b. Bicarbonate c. Sodium Prior to hanging an IV containing potassium, the nurse will confirm a. urine output of at least 30 mL/hr The nurse is providing care for a client who currently has a serum sodium lab value of 148 mEq/L. Which of the following signs and symptoms should the nurse monitor for? (Select all that apply). a. Seizures b. Headache c. Abdominal cramping Which substance accounts for 90% of plasma? a. water The nurse is providing care for a client with decreased sodium level. Which of the following foods should the nurse recommend? (Select all that apply). a. Pre-made meals such as canned or frozen dinners b. Celery c. Ham The nurse is providing care for a client who has an elevated serum calcium level. Which of the following signs and symptoms should the nurse monitor for? (Select all that apply). a. Bone pain b. Blood clots The nurse is caring for a client who was admitted with the following labs. Which of the following interventions should the nurse perform? (Select all that apply). a. Provide extra blankets for warmth b. Observe and institute seizure precautions A patient is admitted to the hospital with severe dehydration. The nurse would expect to see which of the following serum lab values? a. Na 155 mEq/L A client presents to the Emergency Department (ED) with a diagnosis of Metabolic Acidosis. The nurse understands that which of the following conditions can contribute to this metabolic derangement. (Select all that apply.) a. Excessive ingestion of Aspirin b. Fever c. Severe diarrhea Which organs in the body serve as a compensatory function to maintain acid-base balance? (Select all that apply.) a. Kidneys b. Lungs You are caring for a client with the following ABG results. Which of the following is an appropriate interpretation? pH 7.30 CO2 44 HCO-3 20 a. Metabolic Acidosis You are providing care to a client who has just returned from surgery. As you assess the client, you determine the client is heavily sedated, has shallow respirations, and is having difficulty staying awake. The client has the following vital signs and arterial blood gas lab results: HR: 80 bpm BP: 132/86mmHg RR: 10 bpm Oxygen saturation: 88% on 2 Liters of Nasal Canal pH: 7.33 CO2: 52 HCO3: 26 Which of the following cues should the nurse report to the primary healthcare provider? a. CO2 b. Shallow respirations c. RR d. Sedate e. Oxygen Saturation What is the interpretation of the following arterial blood gas results? pH: 7.35 CO2: 37mmHg HCO3: 24mEq/L Oxygen saturation: 98% on room air a. Normal The nurse is caring for a client who rates their pain at a 10 on a scale of 1-10. The respiratory rate is 32 breaths/min. Which acid-base imbalance does the nurse expect to find with sustained tachypnea? a. Respiratory Alkalosis A nurse is caring for a client who just arrived to the Intensive Care Unit (ICU). The client is mechanically ventilated and the rate of respiration on the ventilator is set at 22. The nurse understands that this client is at risk for which acid-base derangement? a. Respiratory Alkalosis The nurse is caring for an adult client who has an ABG return with the following values. Based on the ABG, which of the following interventions is appropriate? pH 7.30 CO2 49 HCO-3 23 K+ 4.9 a. Encourage the client to use the incentive spirometer. As the nurse, you are providing care to a client who has just returned from surgery. As you assess the client, you are aware that the client is sedate, with shallow respirations and is having difficulty staying awake. The client has the following vital signs and arterial blood gas lab results: HR: 80bpm BP: 132/86mmHg RR: 10bpm Oxygen saturation: 88% on 2LNC pH: 7.33 CO2: 52 HCO3: 26 When calling the primary healthcare provider regarding the assessment findings, which of the following should be anticipated orders by the nurse. a. Apply 2LNC O2 b. Keep HOB at semi to high Fowler's position The nurse is caring for a client with the following ABG result. pH 7.49 PaCO2 41mmHg HCO3 38mEq/L Which of the following is an appropriate interpretation of these results? a. Metabolic alkalosis A nurse is providing care for a client who is somnolent and weak with a respiratory rate of 8 breaths/min. Which acid-base finding does the nurse anticipate when analyzing the client's arterial blood gas result? a. PaCO2 56 mmHg As the nurse, you are providing care to a client who has just returned from surgery. As you assess the client, you are aware that the client is sedate, with shallow respirations and is having difficulty staying awake. The client has the following vital signs and arterial blood gas lab results: HR: 80bpm BP: 132/86mmHg RR: 10bpm Oxygen saturation: 88% on 2LNC pH: 7.33 CO2: 52 HCO3: 26 Using the lab values and vital signs provided, why do you think the client might have an elevated CO2 level? (Select all that apply.) a. The decreased respiratory rate has caused the client to retain CO2. b. The sedation used in surgery could cause the breaths to be more shallow thus causing the client to retain CO2. c. The sedation from surgery has caused the client to have a decreased respiratory rate. A nurse is caring for a client who overdosed on diazepam. The nurse is most concerned with which potential acid-base imbalance? a. Respiratory Acidosis As the nurse you are providing care for a client who had an arterial blood gas analysis return with the following results: pH: 7.33 CO2: 48mmHg HCO3: 24mEq/L Oxygen saturation: 92% on room air As the nurse providing care to this client, the nurse should perform which of the following interventions? (Select all that apply.) a. Call the primary healthcare provider. b. Ask the client to perform deep breathing exercises. c. Raise the head of the bed. The nurse is providing care for a client with prolonged gastric suctioning. Which arterial blood gas result should the nurse anticipate? a. pH: 7.48, PaCO2: 45 mmHg, HCO3: 38 mEq/L The nurse is caring for a client who has an ileostomy. When care planning for this client, the nurse understands that this client is at risk for which acid-base imbalance? a. Metabolic Acidosis As the nurse, you are caring for a client who has been experiencing wasting syndrome as a complication of AIDS. As the nurse, you assess the following: The client is restless, alert, and oriented. The client has excoriation in the perineal area due to experiencing up to 10 episodes of very liquid stools a day for several days. VS: HR: 148 bpm BP: 110/74mmHg RR: 32 bpm on room air Oxygen saturation: 96% ABG results: pH: 7.32 CO2: 42mmHg HCO3: 19mEq/L Using the lab values, assessment data, and vital signs provided, why do you think the client might have an elevated CO2 level? (Select all that apply.) a. The large amount of bowel movements from the client has caused the client to experience metabolic acidosis. You are caring for a patient who has a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH). Your patients plan of care includes assessment of specific gravity every 4 hours. The results of this test will allow the nurse to assess what aspect of the patients health? a. Fluid volume status You are caring for a patient admitted with a diagnosis of acute kidney injury. When you review your patients most recent laboratory reports, you note that the patients magnesium levels are high. You should prioritize assessment for which of the following health problems? a. Diminished deep tendon reflexe You are working on a burns unit and one of your acutely ill patients is exhibiting signs and symptoms of third spacing. Based on this change in status, you should expect the patient to exhibit signs and symptoms of what imbalance? a. Hypovolemia A patient with a longstanding diagnosis of generalized anxiety disorder presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acidbase imbalance? a. Respiratory alkalosis You are an emergency-room nurse caring for a trauma patient. Your patient has the following arterial blood gas results: pH 7.26, PaCO2 28, HCO3 11 mEq/L. How would you interpret these results? a. Metabolic acidosis with a compensatory respiratory alkalosis You are making initial shift assessments on your patients. While assessing one patients peripheral IV site, you note edema around the insertion site. How should you document this complication related to IV therapy? a. Infiltration You are performing an admission assessment on an older adult patient newly admitted for end-stage liver disease. What principle should guide your assessment of the patients skin turgor? a. Inelastic skin turgor is a normal part of aging A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased intracranial pressure. This solution will increase the number of dissolved particles in the patients blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following? a. Osmosis and osmolality You are the surgical nurse caring for a 65-year-old female patient who is postoperative day 1 following a thyroidectomy. During your shift assessment, the patient complains of tingling in her lips and fingers. She tells you that she has an intermittent spasm in her wrist and hand and she exhibits increased muscle tone. What electrolyte imbalance should you first suspect? a. Hypocalcemia A nurse is planning care for a nephrology patient with a new nursing graduate. The nurse states, A patient in renal failure partially loses the ability to regulate changes in pH. What is the cause of this partial inability? a. The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH You are caring for a 65-year-old male patient admitted to your medical unit 72 hours ago with pyloric stenosis. A nasogastric tube placed upon admission has been on low intermittent suction ever since. Upon review of the mornings blood work, you notice that the patients potassium is below reference range. You should recognize that the patient may be at risk for what imbalance? a. Metabolic alkalosis A patient who is being treated for pneumonia starts complaining of sudden shortness of breath. An arterial blood gas (ABG) is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg, HCO3= 24 mm Hg. What does the ABG reflect? a. Respiratory acidosis One day after a patient is admitted to the medical unit, you note that the patient is oliguric. You notify the acute-care nurse practitioner who orders a fluid challenge of 200 mL of normal saline solution over 15 minutes. This intervention will achieve which of the following? a. Help distinguish reduced renal blood flow from decreased renal function The community health nurse is performing a home visit to an 84-year-old woman recovering from hip surgery. The nurse notes that the woman seems uncharacteristically confused and has dry mucous membranes. When asked about her fluid intake, the patient states, I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom. What would be the nurses best response? a. Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids A 73-year-old man comes into the emergency department (ED) by ambulance after slipping on a small carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and oriented; his pupils are equal and reactive to light and accommodation. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed, and 40 mL of urine is present. What is the nurses most likely explanation for the low urine output? a. The man is having a sympathetic reaction, which has stimulated the reninangiotensinaldosterone system that results in diminished urine output. You are the nurse evaluating a newly admitted patients laboratory results, which include several values that are outside of reference ranges. Which of the following would cause the release of antidiuretic hormone (ADH)? a. Increased serum sodium The nurse is providing care for a patient with chronic obstructive pulmonary disease. When describing the process of respiration the nurse explains how oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli. The nurse is describing what process? a. Diffusion When planning the care of a patient with a fluid imbalance, the nurse understands that in the human body, water and electrolytes move from the arterial capillary bed to the interstitial fluid. What causes this to occur? a. Hydrostatic pressure resulting from the pumping action of the hear The nurse caring for a patient post colon resection is assessing the patient on the second postoperative day. The nasogastric tube (NG) remains patent and continues at low intermittent wall suction. The IV is patent and infusing at 125 mL/hr. The patient reports pain at the incision site rated at a 3 on a 0-to-10 rating scale. During your initial shift assessment, the patient complains of cramps in her legs and a tingling sensation in her feet. Your assessment indicates decreased deep tendon reflexes (DTRs) and you suspect the patient has hypokalemia. What other sign or symptom would you expect this patient to exhibit? a. Dilute urine You are caring for a patient who is being treated on the oncology unit with a diagnosis of lung cancer with bone metastases. During your assessment, you note the patient complains of a new onset of weakness with abdominal pain. Further assessment suggests that the patient likely has a fluid volume deficit. You should recognize that this patient may be experiencing what electrolyte imbalance? a. Hypercalcemia A medical nurse educator is reviewing a patients recent episode of metabolic acidosis with members of the nursing staff. What should the educator describe about the role of the kidneys in metabolic acidosis? a. The kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. What factors contribute to this phenomenon? Select all that apply. a. Decreased kidney mass b. Decreased renal blood flow c. Decreased excretion of potassium You are called to your patients room by a family member who voices concern about the patients status. On assessment, you find the patient tachypnic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance is the most plausible cause of this patients signs and symptoms? a. Hyperchloremia You are caring for a patient with a diagnosis of pancreatitis. The patient was admitted from a homeless shelter and is a vague historian. The patient appears malnourished and on day 3 of the patients admission total parenteral nutrition (TPN) has been started. Why would you know to start the infusion of TPN slowly? a. Malnourished patients receiving parenteral nutrition are at risk for hypophosphatemia if calories are started too aggressively. You are doing discharge teaching with a patient who has hypophosphatemia during his time in hospital. The patient has a diet ordered that is high in phosphate. What foods would you teach this patient to include in his diet? Select all that apply. a. Milk b. Poultry c. Liver You are caring for a patient with a secondary diagnosis of hypermagnesemia. What assessment finding would be most consistent with this diagnosis? a. Shallow respirations What solution/fluids should we use for patients in mild Na deficit? Normal saline A patient who has blood loss or diarrhea, can benefit from what type of fluids? Lactated Ringers Approximately 2/3 of body fluid is in the compartment. Approximately 1/3 of body fluid is in the compartment. Intracellular fluid (ICF) Extracellular fluid (ECF) Which compartment contains the intravascular (blood), interstitial, and trans cellular fluid spaces? ECF Total body water makes up approximately how much body weight? 60% What are the 3 divisions of ECF? 1. Intravascular space (plasma) 2. Interstitial space (fluid which surrounds cell i.e. lymph) 3. Transcellular space (CSF, pericardial, synovial, intraocular, pleural fluids, sweat, and digestive secretions) Third-space fluid accumulates within membrane-bound spaces in the body. What are examples of third-spacing fluid? - ascites - pleural effusion - pericardial effusion - angioedema What is serum osmolality? A measure of the solute concentration of the blood (usually sodium, BUN, and glucose) What is urea? Waste! BUN measures urea 1. Protein is digested 2. turned into ammonia 3. liver turns ammonia to urea for excretion Will your HCT be higher or lower of you are dehydrated? Higher *HCT measures percentage of RBCs in whole blood Will your HCT be higher or lower of you are overhydrated? Lower What lab measures muscle breakdown which is excreted by kidneys? Creatinine The body does not retain sodium in fluid volume deficit. T/F? False. It does. Dehydration causes cells to become hypertonic. What study is best to measure fluid status and most indicative of sodium? Urine osmolality What does urine specific gravity measure? Density of urine compared to water. It includes glucose and protein. What is the difference between hypovolemia and dehydration? Hypovolemia indicates equal parts of electrolyte and water loss while dehydration refers to loss of water alone with increased Na levels. ADH and aldosterone tell our kidneys to hold onto water. Can ADH deficiency or resistance cause hyper- or hypovolemia? Hypovolemia * ADH means "anti" + "excessive urine" which means when we have a defect in ADH, we are urinating excessively and losing fluid. What is the #1 sign of hypovolemia? It is also our first intervention. Weight loss * daily weights every 24hrs at the same time of day I have: - high HCT - high BUN - high Na+ - Increased urine specific gravity + osmolality Am I hypovolemic or hypervolemic? Hypovolemic How do we medically manage hypovolemia? - if not severe, oral hydration preferred - isotonic or hypotonic IV (helps excrete metabolic waste) What is nursing management of hypovolemia? 1. I+O q8h or hourly 2. daily weights 3. V/S q4h 4. observe for weak, rapid pulse, and orthostatic hypo 5. skin turgor and mucus membranes 6. id risk factors (treat the cause) An acute loss of 0.5kg (1.1lbs) represents a fluid loss of how many mLs? 500mL How much does 1L of fluid weigh? 1kg What are causes of hypervolemia? - low kidney fx - heart pumping action - hormonal imbalance (ADH, aldosterone) aka retaining too much H20 and Na+ - liver failure - rapid fluid administration - high Na+ intake I have acute weight gain, edema, crackles, distended neck veins, SOA, HTN, bounding pulse, tachypnea, increased CVP (central venous pressure), and increased urine output. What am I? Hypervolemia I have: - low HCT - low BUN - low Na+ - Decreased serum osmolality Am I hypovolemic or hypervolemic? Hypervolemia What is nursing management of hypervolemia? - I+O - id high risk pts - assess edema on legs and sacrum - daily weights - must elevate HOB - educate on dietary restrictions Alka-seltzer contains a lot of sodium. T/F? True What is the medical management of hyponatremia? - water restriction if not severe - sodium replacement - do not increase quickly due to nerve damage - LR or isotonic fluids may be prescribed What is the nursing management of hyponatremia? - foods in high in Na+ - frequent neuro checks - monitor labs - falls and seizure precautions What is diabetes insipidus? a disorder caused by LOW amounts of ADH which causes excessive water loss (flushes out H2O but not Na+) What is the medical management of hypernatremia? - gradual lowering of Na+ through hypotonic soln. infusion - D5W in very high sodium levels What is the nursing management of hypernatremia? - medical hx - ask about meds with high Na+ - thirst? high body temp? - LOC changes - abnormal water loss or lower water intake? What causes hypokalemia? - meds (diuretics, corticosteroids, sodium penicillin) - gastric suctioning + vomit - diarrhea, recent ileostomy - extra insulin release and DKA treatment - poor nutrition - CKD Gastric secretions are high in which electrolyte? K+ Insulin promotes the entry of K+ into cells and from the bloodstream, therefore, pt's with persistent insulin hyper secretion may experience: hypokalemia. Clinical signs of hypokalemia develop when K+ levels reach mEq/L. 3 Digitalis toxicity and metabolic alkalosis is associated with: hypokalemia. How do we diagnose hypokalemia? - serum K+ 3.5 - ECG (flat T waves, high U wave) What is the medical management of hypokalemia? - dietary first - K+ supplements (salt substitutes) - IV route mandatory for severe cases - ALWAYS through a pump What are the causes of hyperkalemia? - renal insufficiency - too rapid K+ admin - crush, burn, severe sepsis, tumor lysis syndrome (K+ moves from cells in excess) What is the medical management of hyperkalemia? - IV Ca gluconate - sodium bicarb - IV insulin and glucose - loop diuretics - sodium polystyrene - dialysis - restriction of dietary K+ What is the nursing management of hyperkalemia? - V/S - apical pulse - serum K+, BUN, creatinine, ABGs - I+O - check soft drink labels (some high in K+) What causes hypocalcemia? - hypoparathyroidism (parathyroids move Ca from bone to blood) - large blood transfusions (due to citrate [anticoagulant] moving Ca from circulation) - pancreatitis - AKI How do we diagnose hypocalcemia? - serum calcium 9.0 - impaired clot time - ECG (prolonged QT interval) How do we medically manage hypocalcemia? - IV calcium salts - watch closely for infiltration - IV calcium gluconate + caution with Dig rx + NO 0.9% sodium chloride + always check med compatibility - PO calcium chloride What is the nursing management of hypocalcemia? - seizure precautions - safety precautions - airway - educate on foods high in Ca - no EtOH, caffeine, smoking - no laxatives and antacids (they contain phosphorous) What products are high in calcium? Milk, green leafy veggies, canned salmon, canned sardines, and fresh oysters Hyposensitive skeletal muscles occurs with: hypercalcemia (i.e. hypoactive DTRs, muscle weakness) What causes hypercalcemia? Hyperparathyroidism or malignancies How do we diagnose hypercalcemia? - serum calcium 10.5 - cardiac changes - bone changes on x-ray - urine calcium What is the medical management of hypercalcemia? - treat underlying cause - avoid calcium sources - normal saline drip - furosemide can increase Ca excretion - IV phosphate - calcitonin injection What causes hypomagnesemia? - lower GI tract losses (suction, vomitting, diarrhea) - fistula - chronic alcohol use or withdrawal - meds (Dig, diuretics, PPIs) - citrated blood - DKA How do we medically manage hypomagnesemia? - Mg replacement - diet - V/S - ONLY infuse Mg via pump, do not exceed 150mg/min What is the nursing management of hypomagnesemia? - V/S - dysphagia present? - increase dietary intake - admin Mg - if severe, seizure precautions - educate on diet What causes hypermagnesemia? *rare - kidney injury most common Mg increases when creatinine clearance decreases What is the medical management of hypermagnesemia? - IV calcium gluconate - loop diuretic, normal saline or LR - hemodialysis with Mg free dialysate What causes hypophosphatemia? - chronic diarrhea, Crohn's, celiac dx - anorexia, bulimia - alcoholism - vit D deficiency - resp alkalosis - malignancies - burns How do we diagnose hypophosphatemia? . - serum phosphate 2.5 - skeletal changes on x-ray How do we medically manage hypophasphatemia? - treat cause - oral supplements - IV phosphorous (SLOWLY) What causes hyperphosphatemia? Renal injury How do we diagnose hyperphosphatemia? - serum phosphate 4.5 - serum Ca - BUN/creatitine - x-ray How do we medically manage hyperphosphatemia? - treat cause - calcitriol - Ca-binding antacids - Amphojel - restriction of dietary phosphate What is the nursing management of hyperphosphatemia? - avoid enemas and laxatives - monitor urinary output - avoid phosphate rich foods What are normal BUN labs and what does it measure? 10-20 Measures urea What are normal creatinine labs for M/F? What does it measure? Male - 0.6-1.2 Female - 0.5-1.1 Measures the muscle breakdown excreted by the kidneys What is normal HCT for M/F? What does it measure? Male - 42-52% Female - 37-47% Measures the % of RBCs in while blood What is normal urine specific gravity and what does it measure? 1.005-1.030 Measures overall concentration including glucose and protein What are causes of hypovolemia? - lack of sufficient fluid intake that does not keep up with normal or abnormal losses - vomiting - diarrhea - 3rd spacing - hemorrhage - ADH deficiency or resistance (leading to diabetes insipidus) What are S/S of hypovolemia (fluid volume deficit)? - weight loss - poor skin turgor - dry mucus membranes and furrowed tongue - oliguria (decreased urine) - urine color changes - decreased b/p, increased pulse - flattened neck veins - muscle cramps - cool, clammy skin - reduced concentration, confusion What are the S/S of hypervolemia? - acute wt gain - edema - distended neck veins - crackles - SOA - HTN - bounding pulse - tachypnea - increased CVP - increased urine output What solutions are reserved for central lines ONLY? Hypertonic What solution can ONLY be delivered through an IV pump? IV potassium (for severe hypokalemia) What are the S/S of hyponatremia? - anorexia - N/V - headache - lethargy - muscle cramps - dizziness, confusion, seizures - papilledema (optical nerve swelling) - increased pulse - decreased b/p What are causes of hyponatremia? - vomiting - diarrhea - GI suctioning - diuretics - Mannitol - excessive water intake Why can a parenteral route be more effective? It bypasses the GI system If hyponatremia is not severe, what can we do to tx? Water restriction What are causes of hypernatremia? - cognitive impairment [they do not respond to thirst] - hyperventilation/burns - diabetes inspidius - hypertonic tube feeding with little water + less common: saltwater near drowning, hypertonic IV, overuse of sodium bicarb [Alka-Seltzer], and bad dialysis What are S/S of hypernatremia? - excessive thirst - sticky or dry mucus membranes - irritability and restlessness - hallucinations - seizures - anorexia, vomiting - elevated temp, BP, HR Why does gastric suctioning and vomiting cause hypokalemia? Because there is a lot of K+ in gastric secretions Why can insulin hypersecretion/DKA treatment cause hypokalemia? Insulin movies K+ back into the cells What are causes of hypokalemia? - K+ lossing meds: thiazide and loop diuretics, corticosteroids, sodium penicillin - gastric suctioning - vomiting - insulin hyper secretions and DKA tx - poor nutrition intake - CKD What are S/S of hypokalemia? *develop when K+ 3 - dampened T-waves, V-fib, asystole - fatigue - muscle weakness - leg cramps - anorexia, N/V, abd distention - polyuria - decreased bowel fx - decreased BP What causes hyperkalemia? - renal insufficiency with low EXCRETION of K+ - too rapid IV K+ admin - potassium moves from cells in excess (crush, burn, severe sepsis, and tumor lysis syndrome) What are S/S of hyperkalemia? - dysrhythmias, tall tented (peaked) T-waves - flaccid paralysis - paresthesia - intestinal colic, abdominal distention, abdominal cramping - irritability and anxiety - hypotension What are causes of hypocalcemia? - hypoparathyroidism (parathyroids move calcium from bone to circulating blood) - large blood transfusions (due to citrate) - pancreatitis - AKI What are S/S of hypocalcemia? - positive Trousseau's and Chvostek's sign - HYPERactive DTRs - decreased BP - paresthesias in extremities - depression, confusion, irritability - capopedal spasms - seizures - bone pain - diarrhea What are S/S of hypercalcemia? - hypoactive DTRs - deep bone pain/patho fractures - lethargy, confusion, coma - muscle weakness - constipation - anorexia - N/V - polyuria/polydipsia - calcium stones - flank pain What causes magnesium imbalances? - lower GI tract losses - vomiting - NG suction - fistula - diarrhea - chronic alcohol use - meds: Dig., diuretics, PPIs, citrated blood - DKA What are S/S of hypomagnesemia? - neuromuscular irritability - positive Trousseau's and Chvostek's sign - mood changes - anorexia, vomiting - insomnia - increased tendon reflexes - increased BP - EKG changes What are S/S of hypermagnasemia? - flushing - hypotension - muscle weakness - decreased reflexes - depressed respirations (if severely low) - cardiac arrest and coma What is the #1 cause of hypermagnasemia? Kidney injury What are S/S of hypophosphatemia? - paresthesia - muscle weakness - bone tenderness - chest pain - cardiomyopathy - confusion - resp failure - seizures - nystagmus The rate of phosphorous administration should not exceed mEq/h and site should be carefully monitored for infiltration. 10 What is hyperphosphatemia most commonly caused by? Renal injury What are S/S of hyperphosphatemia? - tetany - tachy - anorexia, N/V - HYPERactive reflexes - soft tissue calcifications Sodium depleted patients (hyponatremic) will receive what kind of IV solution? hypertonic sodium 3 multiple choice options When is IV mannitol (hypertonic soln) used? Acute cerebral edema What are the requirements for parenteral nutrition? Inability to ingest at least 50% of daily required calories and nutrients within a 7-day timeframe for healthy people. 3-5 days for malnourished people. Do not use parenteral nutrition if the solution is: separated, oily, or if it has precipitate Why is parenteral nutrition discontinued slowly? Allows the pt to adjust to the decreased levels of glucose When do we give parenteral nutrition? any condition where they can't get enough orally - burns - short bowel syndrome - paralytic ileus - obstruction - anorexia - extended NPO pt's Is parenteral nutrition hypertonic or hypotonic? It is hypertonic and must be diluted How do we treat an air embolism from parenteral nutrition error? 1. [if disconnected tubing] replace tubing immediately and notify MD 2. [if its cap missing from port] replace cap and notify MD 3. [if blocked segment] turn pt on left side and notify MD What happens if we infuse TPN rapidly? Too abruptly? 1. fluid overload 2. rebound hypoglycemia How do we place a central line? STERILE PROCEDURE: must be in full-body sterile drapes and gloves, cap, gown, and mask 1. educate pt 2. Trendelenburg 3. clean skin and have pt turn head from site 4. lidocaine injection 5. insert large-bore needle parallel and beneath clavicle 6. Valsalva maneuver can be done to lower risk of air embolism 7. x-ray for placement What is the #1 job of RBCs? To carry oxygen from lungs to tissues How do we classify anemias? 1. decreased production = hypoproliferation 2. increased destruction = hemolytic anemia 3. bleeding Older adults with mild anemia are likely to have Hgb levels of? 11g How do we dx all forms of anemia? + CBC: Hgb, HCT, reticulocyte (immature RBC), MCV (volume) and RDW (width) + Iron studies: iron, ferritin (protein in blood that contains iron), total iron binding cap., percent saturation + vit B12 and folate + Bone marrow aspiration (iron-deficient anemia) Hemolytic anemia is associated with what conditions? - SCD - thalassemia's - G-6-PD deficiency - hereditary spherocytosis What are S/S of iron-deficient anemia? - general anemia S/S - smooth and sore red tongue - brittle and rigid nails - angular cheilosis - pica, multiple pregnancies, GI bleeding What is the medical management of iron deficiency anemia? - oral iron supplements/vitamin - pt will need to take oral supplements for 6-12 months - IV iron (pump or slow push) What is the nursing management of iron deficiency anemia? - take iron on empty stomach - increase fiber intake to avoid constipation - iron rich foods (organ meats, beans, leafy veggies, raisins, fortified cereals) - vitamin C rich foods to increase absorption What are the causes of aplastic anemia? (stem cells in marrow are decreased or destroyed causing a reduction in blood production) - environmental toxins - chemo - autoimmune What is pancytopenia? deficiency of all three cellular components of the blood (red cells, white cells, and platelets). How do we do dx aplastic anemia? - pancytopenia present - bone marrow aspirate reveals hypo plastic marrow - fat in bone marrow What are S/S of aplastic anemia? - weakness, dyspnea, fatigue, pallor - infection - bruising - lymphadenopathy and splenomegaly - retinal hemorrhage What is the medical management of aplastic anemia? - immunosuppressive tx (suppress t-cells) using ATG - hematopoietic stem cell transplant (age 60) - determine cause (meds, T-cell destruction, toxins) - supportive therapy for infection, bleeding, oxygenation risk What is nursing management of aplastic anemia? - educate on drug-drug interactions with ATG - do not stop ATG abruptly What is megaloblastic anemia? Abnormally large erythrocytes are produced called megaloblastic red cells + Caucasians develop a lemon-yellow color and mild jaundice What are causes of pernicious anemia (vit. B12 deficiency)? - Crohn's - post-ileal resection - bariatric sx - chronic use of histamine blockers and antacids What are S/S of pernicious anemia? - beefy red tongue - weakness - listelessness (little interest) - fatigue - pallor - confusion + due to B12s impact on nerve function - parasthesia - no balance - proprioception loss What is the medical management of pernicious anemia? - vit B12 replacement FOR LIFE - oral supp - lack of intrinsic factors pt's = B12 injections - 4-8 wks blood counts should return to normal What is the nursing management of pernicious anemia? - monitor gait and ambulation - if impaired sensation, avoid excessive heat and cold - encourage soft bland foods for mouth soreness What are causes of folic acid deficient anemia? - alcohol abuse - pts with liver dx - pregnancy - celiac disease What are the s/s of folic acid deficiency? same as pernicious anemia sore tongue upper GI symptoms (n/v) abdominal pain main difference: no neuromuscular issues What is the medical management of folic acid deficiency? - increase dietary intake of folic acid (think green veggies and liver) - alcohol? must take folic acid supp - 1mg PO daily - multivitamin What are S/S of sickle cell crisis? - pain! - paresthesia - jaundice - hypoxia/dyspnea - profound fatigue What is the nursing management of sickle cell anemia? - aggressive pain management is priority - O2 - aseptic technique and abx - PRBC infusion - oral or IV hydration - monitor for complications - stem cell transplant What is polycythemia vera? Disorder that results in increased number of erythrocytes, leukocytes and platelets. Result = thick blood What are dx labs for polycythemia vera? Hct 55% = M 50% = F What are S/S of P Vera? - abdominal fullness and pain, early sateity - Neuro: HA, dizzy, blurred vision, TIA - Cardio: erythema, thrombus formation, dyspnea, HTN - fatigue - night sweats - itching What is the management of polycythemia vera? - routine labs: reduce iron stores and keep Hct 45% - meds: aspirin, hydroxyurea, interferon-alpha, other meds as needed - manage fatigue with frequent rest periods - itching? cool baths and soothing products - avoid iron rich foods - follow med/phlebotomy schedule Normal acid-base balance? pH = 7.35-7.45 Bicarb = 22-28 CO2 = 35-45 Kidneys regulate (alkaline) in ECF. Bicarb Lungs control (acid) and thus the carbonic acid of ECF. CO2 What are causes of respiratory acidosis? think conditions which reduce ventilation and gas exchange in lungs - COPD - opioid or sedative - PE - atelectasis - pneumonia What are S/S of respiratory acidosis? LOW pH, HIGH CO2, bicarb variable - dyspnea - ↑ RR and HR - ↓ LOC I am undergoing treatment to improve my ventilatory status. I need to blow off CO2. I am told to TCDB, and have been going to chest physiotherapy. My team is cautious to use mechanical ventilation. I am on bronchodilators, abx, and thrombolytics. What condition do I have? Respiratory acidosis What are causes of respiratory alkalosis? think hyperventilation - severe anxiety - aspirin OD - hypoxemia - Gram-neg sepsis - incorrect vent settings What are S/S of respiratory alkalosis? HIGH pH, LOW CO2, bicarb variable - ringing in ears - lightheaded - can't concentrate - numbness/tingling I am taking anti-anxiety meds and breathing into a paper bag. What am I being treated for? Respiratory alkalosis What are causes of metabolic acidosis? *build-up of acid in the blood direct loss of bicarb or too much acid - severe diarrhea - renal insufficiency - DKA - lactic acidosis (sepsis and aspirin toxicity) Why does severe diarrhea cause metabolic acidosis? Intestinal and pancreatic secretions are rich in bicarb - when you have diarrhea, they don't get reabsorbed causing build-up of acid What are S/S of metabolic acidosis? LOW pH, LOW bicarb, CO2 variable - Kussmaul breathing - drowsiness leading to coma - N/V - ↓ BP and shock I am receiving bicarb slowly to reverse the cause of my condition. My electrolytes are also being monitored. What condition am I being treated for? Metabolic acidosis What are causes of metabolic alkalosis? - severe vomit (losing acid) - NG suction - loss of K+ - excessive antacid ingestion What are the s/s of metabolic alkalosis? HIGH pH, HIGH bicarb, CO2 variable - tetany - parasthesia - hypokalemia ECG changes I am having fluids restored. I am receiving NaCl to reverse fluid and electrolyte loss and carbonic anhydrase inhibitors. What condition am I being treated for? Metabolic alkalosis Does aging alter the older adults response to F/E and acid-base imbalances? Yes Decreased renal function in the older adults can result in slightly elevated . creatinine (kidneys are having a harder time filtering waste from the blood if levels are high) Multiple medications have no affect on older adults renal and cardiac function. T/F? False Older adults with anemia are more likely to have fatigue, dyspnea, and confusion due to reduced cardiac reserve. They also are unable to respond with an in HR and cardiac output. increased, increased