NCLEX-RN Blood Ions QUESTIONS AND ANSWERS ALL CORRECT

NCLEX-RN Blood Ions QUESTIONS AND ANSWERS ALL CORRECT Signs of Hypoxia Correct Answer: Restlessness and Tachycardia Potassium Correct Answer: is excreted by the kidneys. 3.5-5.0 Signs and Symptoms of Hypokalemia Correct Answer: Muscle cramping, weakness, life threatening arrhythmias (U waves, PVC's, Ventricular tachycardia) Signs and Symptoms of Hyperkalemia Correct Answer: Muscle twitching, weakness, flaccid paralysis, arrhythmias (Peak and tall T Waves, conduction block, V fib, prolong PR interval, widen QRS complex, flat or absent P waves, bradycardia) Cause of Hyperkalemia Correct Answer: Kidney trouble, Spironolactone (Aldactone) - Makes you retain K+ Cause of Hypokalemia Correct Answer: Vomiting, NG suction (we have lots of K+ in stomach), diuretics, Not eating ) Tx of Hypokalemia Correct Answer: Give K+, Sprionolactone (Aldactone) makes them retain K+, Eat more K+ Tx of Hyperkalemia Correct Answer: Dialysis - Kidneys aren't working, Ca gluconate decreases arrhythmias, Glucose and insulin -- insulin carries glucose and K+ into the cell. Anytime you give IV insulin worry about hypoglycemia and hypokalemia, Na polystyrene sulfonate (Kayexalate) which exchanges Na for K+ in the GI tract. You want to push IV fluids to prevent dehydration. Important facts on K+ Correct Answer: Major problem with PO K+ is GI upset, Assess UP before and during IV K+ Always put IV K+ on a pump Mix well Never give IV K+ push K+ burns during infusion so monitor IV site Food high in K+ Correct Answer: spinach, fennel, kale, mustard greens, Brussels sprouts, broccoli, eggplant, cantaloupe, tomatoes, parsley, cucumber, bell pepper, apricots, ginger root, strawberries, avocado, banana, tuna, halibut, cauliflower, kiwi, oranges, lima beans, potatoes white and sweet, and cabbage Hypervolemia Correct Answer: to much fluid in the vascular space Causes of hypervolemia Correct Answer: Heart failure (heart is weak, CO down, kidney perfusion decrease, UO decreases Renal Failure (Kidneys aren't working) meds high Na (Alka-Seltzer, fleet enema, IVF with Na) Hormonal Regulation of Fluid Volume Correct Answer: Aldosterone (volume low, aldosterone secretion increases - retain Na/water - blood volume goes up Disease with too much Aldosterone Correct Answer: Cushing; Hyperaldosterone Disease with too little aldosterone Correct Answer: Addison ANP Correct Answer: found in the artrium of the heart, excreted Na and water when with fluid builds up causing the heart to stretch ADH Correct Answer: retains water TOO much ADH Correct Answer: Retain water leading to fluid volume excess SIADH (too many letter, too much water); urine is concentrated while the blood is dilute TOO little ADH Correct Answer: Diuresis leading to fluid volume deficit, DI can lead to shock. Urine is dilute while blood is concentrated Potential ADH problem Correct Answer: Craniotomy, head injury, sinus surgery, transpenoidal hyophysectomy or any condition that can lead to an increase ICP Drugs used for ADH problem Correct Answer: Vasopressin (Pitressin) or desmopressin acetate (DDAVP) used to replace ADH in DI. S/S of Hypervolemia Correct Answer: Distend neck veins/peripheral veins (vessels are full), peripheral edema, 3rd spacing (remember fluid leaking out), CVP goes up (measured in RA), Lungs: bilateral crackles, Polyuria, Pulse up because you want to move fluid to go forward, if it doesn't it will move backwards causing pulmonary edema, BP increase, Wt increase, Tx of Hypervolemia Correct Answer: Low Na diet, restrict fluid, I&O, daily weight, Diuresis (furosemide/Lasix or bumetanide/bumex when Lasix don't work. Hydrolorothiazide, Sparaaldoctone (watch lab work with all diuretics. dehydration and electrolyte problem. Bed rest induces diuresis by releasing ANP and decrease production of ADH. Physical assessment pertinent s/s, Give IVF slowly to the elderly, young, heart and kidney problem Hypovolemia Correct Answer: fluid volume deficit; big time deficit = shock Causes of Hypovolemia Correct Answer: Throacentesis, paracentesis, vomiting, diarrhea, hemorrhage. 3rd spacing: burns and ascites Disease with polyuria: polyuria - oliguria - anuria S/S of Hypovolemia Correct Answer: Wt loss, Decreased skin turgor, dry mucous membranes, decreased UO, BP down, pulse up because heart is trying to pump what little fluid left to the vital organs, respiration up, CVP down, peripheral veins/neck veins very tiny, Cool and clammy extremities, Urine SG up Tx of Hypovolemia Correct Answer: Prevent further losses, replace volume where if the deficit is mild use PO to fix, severe use IV. High risk for falls, monitor for overload Isotonic Solution Correct Answer: goes into the vascular space and stays there. Examples are LR, NS, D5W, D5 1/4NS. Use in clients that has lost fluids through N, V, Burns, sweating, trauma. Don't use in clients with HTN, Cardiac disease or renal disease. These solution can cause FVE or HTN. Hypotonic Solution Correct Answer: go into the vascular space then shift out into the cells to replace cellular fluid. they rehydrate but do not cause HTN. D2.5W, 1/2NS, .45NS, 0.33%NS. Uses for dilution when a client has hypernatremia and for cellular dehydration ppl with N, V, burns hemorrhage, etc. who has HTN, renal and cardiac problems. WATCH for cellular edema because this fluid is moving out the cells which could lead to fluid volume deficit and decrease blood pressure. NOTE: fluid is moving out of the cells Hypertonic Solution Correct Answer: Volume expander that will draw fluid into the vascular space. Examples are D10W, 3%NS, 5%NS, D5LR, D5 1/2 NS, TPN, Albumin. Use with client that has hyponatremia or a clients who has shifted large amounts of vascular volume to a 3rd space or has severe edema, burns or ascites. WATCH for fluid volume excess. Monitor in an ICU setting with frequent monitoring of blood pressure, pulse, and CVP, especially if they are receiving 3%NS or 5%NS. Magnesium Correct Answer: act like a sedatives. Is excreted by the kidney but it can be lost in other ways GI upset. 1.3 - 2.1 Hypermagnesemia Causes Correct Answer: Renal failure, antacid Mg think muscle Hypermagnesemia S/S Correct Answer: flushing, warmth, Mg makes you vasodilated DTR, LOC, Pulse, Respiration decrease, Muscle tone: weak and flaccid Tx of hypermagnesemia Correct Answer: Ventilator, Dialysis bcz of the kidney, Ca gluconate is the antidote for mg toxicity. Ca gluconate is administered IVP very slowly (max rate: 1.5-2ml/min), Safety precaution Hypercalcemia causes Correct Answer: hyperparathyroidism, thiazides retains Ca, Immoblization Hypercalcemia S/s Correct Answer: bones are brittle, kidneys stones, DTR, LOC, Pulse, Respiration decrease, Muscle tone: weak and flaccid Tx hypercalcemia Correct Answer: move/mobility, fluid prevents kidney stones, Na phosphate (phospho soda and fleet) Enema both have phosphorus Ca has inverse relationship whith phosphorus, When you drive Phos up, Ca goes down, steroids decreases Ca, Add phosphorus, safety precaution, Must have Vit D to use Ca, Calcitonin decrease serum Ca Hypomagnesemia causes Correct Answer: Diarrhea - lots of Mg in intestine, ETOH, ETOH suppresses ADH and its hpertonic (not eating or drinking) Hypomagnesemia S/S Correct Answer: muscle tone is tight and rigid Seizures is possible, Stridor/laryngospasm (airway made up of smooth muscle), + Chvostek (tap cheek and it twitches, + trousseaus - pump up BP cuff, Arrhythmias - heart is a muscle, DTR increase, Swallowing problems. Hypomagnesemia Tx Correct Answer: Give Mg, check renal function before/after IV Mg, Seizure precaution, Eat Mg Hypocalcemia Causes Correct Answer: 9.0-10.5 Hypoparathyroidism, Radical neck, Thyroidectomy Hypocalcemia S/s Correct Answer: muscle tone is tight and rigid Seizures is possible, Stridor/laryngospasm (airway made up of smooth muscle), + Chvostek (tap cheek and it twitches, + trousseaus - pump up BP cuff, Arrhythmias - heart is a muscle, DTR increase, Swallowing problems. Hypocalcemia Tx Correct Answer: Vit D, phos binders Sevelamer hydrochloride (Renagel) Ca acetate (phosLo), IV Ca give slowly and always make sure client is on a heart monitor. Sodium Correct Answer: 135-145 your Na level in your blood is totally dependent on how much water you have in your body Hypernatremia = Dehydration Correct Answer: Too much Na, not enough water Causes: Hyperventilation, Heat stroke, DI Hypernatremia S/s Correct Answer: Dry mouth, Thirsty, swollen tongues Hypernatremia tx Correct Answer: Restrict Na, Dilute client with fluids. Diluting makes NA go down. Daily Wt, I&O, Lab work - remember if you have a Na problem you have a fluid problem Hyponatremia = Dilution Correct Answer: Too much water; not enough Na Causes: Drinking H2O for fluid replacement (vomiting, sweating) Psychogenic polydipsia: loves to drink water D5W (sugar and water) SIADH: retaining water Hyponatremia S/s Correct Answer: HA, seizure, Coma Hyponatremia Tx Correct Answer: Clients needs Na, Client doesn't need water, if having neuro problems needs hypertonic saline (packed with particles, 3%NS or 5%NS) Sodium Testing strategy Correct Answer: neuro changes: the brain doesn't like it when Na is messed up. Feeding tube clients tend to get dehydrated Acid-Base Correct Answer: Lungs chemical = CO2 which is an acid Kidney chemical = Bicarb and hydrogen These chemicals can either make you sick or compensated. It depend on the imbalance. If the pH is messed up it can be dangerous because the brain does not like it when the pH is messed up Compensating Organs Correct Answer: Kidney remove acid through urine, Bicarb can hold on to it or excrete. Kidney takes hours to days to do their job. In the lung on way to get rid of CO2 is through exhaling. Hypoventilation retain CO2, Hyperventilation eliminate CO2 and the Lungs respond fast to compensating the imbalance. Respiratory Acidosis Patho Correct Answer: lungs sick, CO2 causing the problem, Bicarb and Hydrogen from the kidney is compensating. The body must excrete the acid and retain the bicarb. The pH is low. Res. Acidosis Causes Correct Answer: Retaining of CO2 through Mild abdominal incision, narcotics, sleeping pills, pneumothorax, collapsed lung, pneumonia Res Acidosis S/s Correct Answer: HA, Confused, sleep. If not corrected, could lead to a coma. Hypoxic another s/s where you can give oxygen. REMEMBER: increase CO2 = decrease LOC; Increase CO2 = decrease O2. CO2 and O2 has an inverse relationship Res Acidosis Tx Correct Answer: Fix the breathing problem. Treat pneumonia, get rid of secretions by postural drainage, percussion (vibration therapy), deep breathing exercises, suctioning, fluids, elevated HOB, and incentive spirometry. Pneumothorax client will have chest tubes. Encourage post-op to turn, cough and deep breath. Teach how splint the incision. Res Alkalosis Path Correct Answer: lung sick, kidney compensate with bicarb and hydrogen. Lost of CO2 taking place - hyperventilation. pH is high. Res Alkalosis Causes Correct Answer: Anxiety, Hysterical and Acute aspirin overdose (the client is breathing too fast and therefore CO2 is being removed) Res Alkalosis S/S Correct Answer: Lightheaded, faint, peri-oral numbness and tingling in fingers and toes Res Alkalosis Tx Correct Answer: Don't wait for kidneys to kick in. Breathe into a paper bag. May sedate client to decrease respiratory rate. Treat the cause. Monitor ABGs Metabolic Acidosis path Correct Answer: Kidney is sick where retaining hydrogen or does not have enough bicarb, lungs compensate with CO2. pH is low and respiration rate will increasae Metabolic Acidosis Causes Correct Answer: DKA and Starvation (Cells are starving for glucose, so the body will breakdown protein and fat, produce ketones, ketones are acid. Renal failure, Severe diarrhea. Metabolic Acidosis S/s Correct Answer: Depend on the cause. Hyperkalemia (muscle twitching, muscle weakness, flaccid paralysis, arrhythmias), increased respiratory rate (pt trying to remove CO2) Metabolic Acidosis Tx Correct Answer: Treat the causes. Drug to help acidosis - IV Na bicarb Metabolic Alkalosis Path Correct Answer: Kidney is sick where too much bicarb is being retained and excreting hydrogen. Lungs compensating with CO2. pH is high Metabolic Alkalosis causes Correct Answer: Loss of upper GI contents such as vomiting, too much antacid (too much base), Too much IV bicarb. Metabolic Alkalosis S/s Correct Answer: Depends on cause, observe LOC, Serum K + will increase in metabolic acidosis and go down in metabolic alkalosis. Monitor for muscle cramps and life threatening arrhythmias. Metabolic Alkalosis Tx Correct Answer: Fix the problem. Replace K+ Burns Correct Answer: Occurs at home in the very young (due to decrease BSA) and elderly (due to less sub q tissue). Burns patho Correct Answer: Increase capillaries permeability -leaks out into the tissues leading to shock. The majority of this occurs in the 24 hours. Pulse increase when in deficit. CO decrease due to less volume to pump out. UO decrease because Kidney are either trying to hold on to fluid or they aren't being perfused adequately. takes 20 mins of poor perfuse to cause permanent kidney damage. Epi is secreted to cause vasoconstriction to shunt blood to vital organs. ADH and aldosertone kicks in increasing blood volume Airway injuries in Burns Correct Answer: Carbon monoxide poision. Oxygen normally bind to hgb, but Carbon monoxide binds to the hgb faster than oxygen. Client is now hypoxic. Give 100% O2 so that O2 can bind faster to the hgb. Its important to determine if the burn occurred in an open or closed space because can increase the airway injury. Burns to the neck/face/chest think what Correct Answer: airway what might the physician do prophylactically Correct Answer: intubate How do you determine burns Correct Answer: Total body surface area, formula known as the rule of nine Rule of nine Correct Answer: Head and neck = 9% Trunk = Front 18%; back 18% Genital = 1% Arm = 9% each Leg = 18% each Is it important to know what time the burn occurred Correct Answer: Yes Calculate what is needed for the first _______ hours and give half of the volume calculating the first 8 hours. This is the _________ formula. Correct Answer: 24, Parkland. Parkland Formula Correct Answer: 4ml of LR x body wt in Kg x % of TBSA burned = total fluid replacement for the 1st 24 hours after the burn 1st 8 hours = 1/2 of the total volume 2nd 8 hrs = 1/4 of the total volume