PN2 Exam 1 SG - PN2 Exam 1 SG.docx PDF

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PN2 Exam 1 SG.docx...

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When It Is

High CO2 – retaining Respira tory Acidosi s

Respira tory Alkalosi s

Metabol ic Acidosi s

Metabol ic Alkalosi s

Definiti on

Exampl e

When to use

When to avoid

Common Causes  LOC

RR:  = hypoventilation =

S/S

COPD CO2

Hypoventilation

retention

Low CO2 – blowing off  O2 RR:  = hyperventilating =

losing

Pregnancy Hyperventilation

CO2

Low HCO3 pH:  Low RR:  to get rid of acid

DKA

High HCO3

Vomiting Overuse of antacids

pH:  High RR: 

Hypotonic Water pulled out of BV’s into cells  vascular vol =  cell ’s water 0.45% NaCl (1/2 NS) 0.225% NaCl (1/4 NS) 0.33% NaCl 2.5 D5W

Isotonic No pressure ê , no shift Replace ECF loss & expand vol fast 0.9% NacL LR D5W (5% dextrose in water)

Cellular hydration

Fluid/electrolyte replacement

ICP Burns

VOL OVERLOAD

Hypertonic Water pulled from cells into BV’s  vascular vol =  cell ’s water D5 ½ NS D5NS D5LR Hypovolemia Vascular expansion urine output (post-op) 3rd spacing DKA RENAL PT (d/t pulm. edema) CARDIAC PT (d/t pulm. edema) DEHYDRATION

Hypovole mia

Hypervol emia

Caused By Insensible h20 loss DI Hemorrhage vomiting Excess hypotonic fluids SIADH Cushing’s Organ Failure

Best Indicator Daily Weight Orthostatic BP, HR

 urine output Edema

S/S Hypotension Wt loss Tented dry skin RR P Hypertensio n Edema Headache JVD Bounding Pulses Crackles Frothy sputum

TX Prevent further fluid loss, fluid vol. back to normal provide safety Mild-Mod deficit: PO Fluids Severe deficit: IVF (monitor HR, output) Ensure safety restore normal fluid balance provide supportive care prevent future overloads Risk for skin breakdown: Turn and Repo Q2H May need O2 Diuretics (If Kidney function is good) Fluid, Na+ restrictions Monitor I & O

Electrolytes (Normal Values, S/S, TX, Teaching Points For ALL)Potassium: Excreted By Kidneys And Has An Inverse Relationship With Sodium HYPOKALEMIA = A SIC WALT HYPERKALEMIA = MURDER K+ hypokalemia hyperkalemia s/s Tx

Alkalosis, Shallow resp, Irritability, Confusion, Weakness, Arrhythmia, Lethargy, Thready P A SIC WALT

Musc. Weak, Urine- lack , Resp distress, Decrsd cardiac contractility, Ecg change Reflexes MURDER

Give K+- NEVER IM SQ IVP, Spironolactone, Cardiac monitor

Patiromer (Valrassa), K restriction, K+ excr diuretics, dialysis, glucose & insulin, heart mon

Sodium: Think Neuro Changes (Where Sodium Goes Water Follows) HYPONATREMIA = DILUTION Na+ hyponatremia s/s

Lethargy, headache, confusion, seizure, coma

HYPERNATREMIA = DEHYDRATION hypernatremia Fever, Restless, Increased retention fluid. Edema, Decreased urine output

Tx

Calcium: has an inverse relationship with phosphorus HYPOCALCEMIA = THINK NOT ENOUGH SEDATIVE LIKE A SEDATIVE Ca+ hypocalcemia

HYPERCALCEMIA= THINK THEY ACT hypercalcemia

s/s

Numb tingling, cramps, spasm, DTR, trosseu’s/Chvostsk’s sign, convulsions, QT, arrhyth

Weakness, DTR,  polyuria, anorexia, arrhyth, N, V, heart block, short QT, hypertension

Tx

Vit D, Phos Binders (oscal), IV Cal- give slow, Heart monitor, decrease stimuli

Get pt moving, IVF 0.9%NS, Na Phos Enema, Calcitonin, Steroids, Cardiac Monitor

Magnesium: Excreted By The Kidneys But Is Also Lost In The Gi Tract HYPOMAGNESEMIA = ANGRY RHINO OUT Mg+ hypomagnesemia

HYPERMAGNESEMIA = CHILLIN hypermagnesemia

s/s

Confusion,  DTR, seizures, cramps, tremor, insomnia, tachy

Flushing  DTR weakness, lethargy,  resp, bradycardia, hypotension

Tx

Give Mg, monitor kidney function, seizure precautions

Calcium gluconate, loop diuretics, vent if RR 7.45, PaHCO3- >26, PaCO2 normal or < 35) Lungs & Kidneys How does lung & kidney function affect acid-base regulation? How do the lungs balance out acid-base issues? Aldosterone vs ADH What affect do they have on electrolytes & fluid balance? What is it, where does it come from? What triggers it? How Does Potassium interact w/ ABGs? Other Things to Know Delegation What tasks can be delegated to Nursing assistant (unlicensed personnel)? What things should the charge nurse consider when making nurse-patient assignments? Prioritization ABCs- airway, breathing, circulation Maslow’s Hierarchy of needs Expected vs unexpected Chronic vs acute Stable vs unstable Therapeutic Communication Read each question and all answers carefully! Study Strategies: https://guides.rasmussen.edu/nursing/studystrategies Testing Strategies: https://guides.rasmussen.edu/nursing/testingstrategies

Lab Values- normal ranges

       

Electrolytes ABGs Albumin Hematocrit Hemoglobin BUN & creatinine CBC Urinalysis (note that pH of urine is NOT the same as arterial pH)

Dosage Calc Make sure you know basic med math! Ex: How to calculate a dose, IV rate, convert g to mg to mcg… There are two dosage calc questions on this exam. I will provide a calculator, but you may use a SIMPLE one as long as you show both sides. No cell phones, no scientific calculators

Uncompensated

Ph abnormal + 1 other abnormal

Partial

All 3 abnormal

full

Ph normal...