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GUIDE/CHAPTER 11: CARE OF PATIENTS WITH FLUID
AND ELECTROLYTE BALANCE,100% CORRECT
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
Chapter 11: Care of Patients with Fluid and Electrolyte Balance Hypervolemia S/S: pitting edema, increased HR/BP/HR, distended neck and hand veins, weight gain, SOB, lung crackles, pale/cool skin, decreased lab values, alter LOC Treatment: patient safety (assess every 2 hours for PE), assess for skin breakdown (skin care), provide supplemental O2 and position patient in semi-fowler’s to improve SOB, furosemide, fluid restriction , monitor daily weight and output, restrict Na/low sodium diet (water follows) Hypovolemia S/S: increased HR, orthostatic hypotension (increased risk for falls), weak/thready pulse, flattened neck/hand veins, increased RR, decreased turgor, warm/dry skin, dry mucous membranes, fever, decreased urine and increased concentration, increased lab values Treatment: fluid replacement (monitor pulse rate/quality and urine output of 30 ml/hr. during rehydration ), antidiarrheals, antiemetics, antipyretics Calcium: Hypercalcemia Causes: hyperparathyroidism /hyperthyroidism, dehydration, use of thiazide diuretics, use of glucocorticoids, kidney failure, malignancy, excessive intake of calcium or vitamin D S/S: (EKG CHANGES FROM CLOT): cyanosis, pallor, EKG changes, increased risk for blood clots, profound muscle weakness , decreased DTR, decreased peristalsis/bowel sounds, constipation, kidney stone formation Calcium: Hypocalcemia Causes: lactose intolerance, Crohn’s disease, celiac disease, acute pancreatitis, ESKD, diarrhea, wound drainage, alkalosis (hyperventilation), hyperproteinemia S/S: (HYPERACTIVE CRAMPS): muscle spasms (“charley horses”), tetany , hyperactive reflexes, + Trousseau’s and Chvostek’s signs, arrythmias, weak/thready pulse, painful abdominal cramping, diarrhea, loss of bone density (osteoporosis), brittle/fragile bones (may break with slight trauma), confusion Normal Calcium (Ca+): 9.0-10.5mg/dL Potassium: Hypokalemia Causes: diuretics, alkalosis (hyperventilation), TPN, NPO, Cushing’s syndrome, vomiting , wound drainage, prolonged NG suctioning, heat-induced/excessive diaphoresis, corticosteroids, increased aldosterone
GUIDE/CHAPTER 11: CARE OF PATIENTS WITH FLUID
AND ELECTROLYTE BALANCE,100% CORRECT
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
S/S: (SLOW, LOW, + LETHAL): low/shallow respirations, muscle weakness , reduced DTR, leg cramps, limp muscles, lethal cardiac changes, low BP and HR, increased urine output, decreased bowel sounds (constipation) Normal Potassium (K+): 3.5-5.0 mEq/L
GUIDE/CHAPTER 11: CARE OF PATIENTS WITH FLUID
AND ELECTROLYTE BALANCE,100% CORRECT
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
Common Causes of Acidosis Metabolic Acidosis Overproduction of hydrogen ions Excessive oxidation of fatty acids: Diabetic ketoacidosis Starvation Hypermetabolism: Heavy exercise Seizure activity Fever Hypoxia, ischemia Excessive ingestion of acids: Ethanol or methanol intoxication Salicylate intoxication Under-elimination of hydrogen ions Kidney failure Underproduction of bicarbonate Kidney failure Pancreatitis Liver failure Dehydration Over-elimination of bicarbonate Diarrhea Respiratory Acidosis Under-elimination of hydrogen ions Respiratory depression: Anesthetics Drugs (especially opioids) Electrolyte imbalance Inadequate chest expansion: Muscle weakness Airway obstruction Alveolar-capillary block Acid-Base Assessment TEST ARTERIAL SIGNIFICANCE OF ABNORMAL FINDINGS
GUIDE/CHAPTER 11: CARE OF PATIENTS WITH FLUID
AND ELECTROLYTE BALANCE,100% CORRECT
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
pH 7.35-7. Increased: Metabolic alkalosis , loss of gastric fluids, decreased potassium intake, diuretic therapy, fever, salicylate toxicity, respiratory alkalosis, hyperventilation Decreased: Metabolic or respiratory acidosis , ketosis, renal failure, starvation, diarrhea, hyperthyroidism
GUIDE/CHAPTER 11: CARE OF PATIENTS WITH FLUID
AND ELECTROLYTE BALANCE,100% CORRECT
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
S/S: temporary or permanent damage to normal tissues, chemo-induced N/V, alopecia, mucositis, stomatitis, cognitive changes, psychosocial issues, chemo-induced peripheral neuropathy, anemia, thrombocytopenia, infection (bone marrow suppression and neutropenia ), bladder toxicity, anxiety, low activity level (tolerable activity)
GUIDE/CHAPTER 11: CARE OF PATIENTS WITH FLUID
AND ELECTROLYTE BALANCE,100% CORRECT
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
Patient Teaching: hand hygiene, stay at home as much as possible, personal hygiene, mouth care, PPE for oral/home chemotherapy (no direct skin contact with agent) Radiation Side Effects: acute or long-term site-specific skin changes (radiation dermatitis: redness and rash), alopecia, altered taste, loss of appetite (eat 1 hour before therapy, liquids between meals, bland carbs like cereal or crackers, avoid high-fat, cold/room temp. foods, sit up for 1 hour following) , fatigue, xerostomia (dry mouth), photosensitivity, bone marrow suppression, tissue fibrosis and scarring Patient Teaching: skin care (pat dry, no washcloths), do not remove temporary ink markings, wash skin with mild soap and water/avoid scrubbing, avoid sun exposure, avoid alcohol-containing/aluminum- containing products, frequent/gentle mouth care, swabs (no toothbrushes), use saliva substitutes, regular dental visits, speech therapy, exercise, ensure good night sleep Surgical Treatment Complications: reduced function with organ loss, depression, altered appearance (scarring, disfigurement), reduced activity level, cancer remains Patient Teaching: encourage TCDB (turn, cough, deep breathing, spirometry), nutritional support (radiation on throat can cause speech/swallowing issues), early mobility, pain management, infection prevention, psychosocial support, rehabilitation (PT, OT) Infection Prevention: Low WBC Count o Avoid crowds and other large gatherings of people who might be ill. o Do not share personal toiletries such as toothbrushes, toothpaste, washcloths, or deodorant sticks with others. o If possible, bathe daily with an antimicrobial soap. If total bathing is not possible, wash the armpits, groin, genitals, and anal area twice a day with an antimicrobial soap. o Keep your toothbrush dry. o Wash your hands thoroughly with an antimicrobial soap before you eat and drink, after touching a pet, after shaking hands with anyone, as soon as you come home from any outing, and after using the toilet. o Follow the cancer center's instructions for eating fresh salads; raw fruits and vegetables; meat, fish and eggs; and pepper and paprika. o Wash dishes between use with hot, sudsy water or use a dishwasher. o Do not drink water, milk, juice, or other cold liquids that have been standing at room temperature for longer than an hour. o Do not reuse cups and glasses without washing. o Do not change pet litter boxes. o Take your temperature at least once a day and whenever you do not feel well. o Report any of these indications of infection to your oncologist immediately:
GUIDE/CHAPTER 11: CARE OF PATIENTS WITH FLUID
AND ELECTROLYTE BALANCE,100% CORRECT
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
o Take all prescribed drugs. o Wear clean disposable gloves underneath gardening gloves when working in the garden or with houseplants. o Wear a condom when having sex. If you are a woman having sex with a male partner, ensure that he wears a condom. Chapter 53: Care of Patients with Stomach Disorders Peritonitis: complication post abdominal surgery (high fever, rigid pain, tachycardia) S/S: abdomen is tender, rigid, and board-like; abdominal pain and distention, N/V, anorexia, diminishing bowel sounds, inability to pass flatus/feces (obstipation), high fever, tachycardia, dehydration, decreased urine output, hiccups, rebound tenderness, possible compromise in respiratory status
GUIDE/CHAPTER 11: CARE OF PATIENTS WITH FLUID
AND ELECTROLYTE BALANCE,100% CORRECT
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
Diagnostics (including labs): high WBC count (20,000 or above) and neutrophil count, blood culture studies, fluid and electrolyte balance, renal status, O2 sat, ABGs, abdominal x-ray, ultrasound PUD (H. pylori and NSAIDs) Diagnostics: epigastric tenderness (between umbilicus and xiphoid process), dyspepsia, abdominal pressure or fullness, urea breath test, stool antigen test, decreased H & H, chest and abdominal x-ray, EGD (major test) endoscopy Patient Teaching: medication adherence (drug regimen consists of a PPI and 2 antibiotics), avoid NSAIDs (use Tylenol/acetaminophen/analgesic) , avoid spicy/acidic foods, sit upright after eating, stress reduction Duodenal Ulcers (type of peptic ulcer) S/S: N/V, dyspepsia (indigestion), abdominal pressure/fullness, abdominal pain (RLQ) exacerbated by food/NSAIDs/corticosteroids, epigastric tenderness (rigid, board-like abdomen with rebound tenderness and pain), pain usually occurs 90 mins.-3hrs. after eating , weight loss Gastritis Causes: H. pylori , long-term NSAID use, alcohol/coffee/caffeine/corticosteroid use, radiation therapy, smoking, autoimmune disorders Dumping Syndrome Patient Teaching: eat high-protein, high-fat, low-to-moderate carbs, low roughage, no milk/sweets/sugars, eliminate liquids with meals , eat small meals Chapter 54: Care of Patients with Esophageal Problems Hiatal Hernia Etiology: protrusion of stomach through esophageal hiatus of the diaphragm into the chest; rolling (obesity; reflux not present but volvulus/obstruction/strangulation high), sliding (structural defect, anemia, most common) Risk Factors: aging (weakening of diaphragm), smoking, obesity/straining S/S: sliding (heartburn, regurgitation/reflux, chest pain, dysphagia, belching: worsens after meal or when patient is supine), rolling (feeling of fullness/breathlessness after eating, feeling of suffocation, chest pain that mimics angina, laying down worsens)
GUIDE/CHAPTER 11: CARE OF PATIENTS WITH FLUID
AND ELECTROLYTE BALANCE,100% CORRECT
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
FEATURE GASTRIC ULCER DUODENAL ULCER
GUIDE/CHAPTER 11: CARE OF PATIENTS WITH FLUID
AND ELECTROLYTE BALANCE,100% CORRECT
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
Early Gastric Cancer
- Indigestion
- Abdominal discomfort initially relieved with antacids
- Feeling of fullness
- Epigastric, back, or retrosternal pain Advanced Gastric Cancer
- Nausea and vomiting
- Obstructive symptoms
- Iron deficiency anemia
- Palpable epigastric mass
- Enlarged lymph nodes
- Weakness and fatigue
- Progressive weight loss Age Usually 50 yrs. or older Usually 50 yrs. or older Gender Male/female ratio of 1.1:1 Male/female ratio of 1: General nourishment May be malnourished Usually well nourished Stomach acid production Normal secretion or hyposecretion Hypersecretion Occurrence Mucosa exposed to acid-pepsin secretion Mucosa exposed to acid-pepsin secretion Clinical course Healing and recurrence Healing and recurrence Pain Occurs 30 - 60 min after a meal; at night: rarely Worsened by ingestion of food Occurs 1.5- 3 hrs. after a meal; at night: often awakens patient between 1 and 2 AM Relieved by ingestion of food Hemorrhage Hematemesis more common than melena Melena more common than hematemesis Recurrence Tends to heal and recurs often in the same location 60% recur within 1 yr.; 90% recur within 2 yrs. Surrounding mucosa Atrophic gastritis No gastritis Early vs. Advanced Gastric Cancer Chapter 56: Care of Patients with Non-inflammatory Intestinal Disorders Colon Cancer: CEA (tumor marker)
GUIDE/CHAPTER 11: CARE OF PATIENTS WITH FLUID
AND ELECTROLYTE BALANCE,100% CORRECT
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
Patient Teaching: recommend annual screening (fecal occult blood test) for patients over 50; post-op: avoid lifting heavy objects or straining on defecation, avoid vigorous activity and driving for 4-6 weeks (open surgical approach), consume foods high in fiber and protein, avoid read meats and eat veggies , avoid foods that cause flatus (beans, eggs, carbonated beverages), odor (eggs, fish, garlic), and obstruction (nuts, raw carrots, popcorn); proper colostomy care (wound care nurse), s/s of complications Bowel Obstruction S/S: obstipation, mid-abdominal pain/cramping, vomiting Assessment: NG tube patency, placement, residual (COCA: color, odor, consistency, amount/volume), output at least every 4 hours, dry mucous membranes (provide oral care), pain and abdominal assessment (hyperactive bowel sounds=early; hypoactive bowel sounds=late) Chapter 57: Care of Patients with Inflammatory Intestinal Disorders Diverticulosis Complications: diverticulitis can result in rupture of the diverticulum with peritonitis, pelvic abscess, bowel obstruction, fistula, persistent fever or pain, or uncontrolled bleeding (bacteria in diverticula) S/S: usually asymptomatic (found incidentally on routine colonoscopy), pain or bleeding may develop , intermittent pain in LLQ, history of constipation, low-grade fever Ulcerative Colitis Complications: toxic megacolon , hemorrhage, dysplastic biopsy results, colon cancer Patient Teaching: report pale blue/dark color of stoma, skin care, support groups, manifestations of GI bleed (black, tarry stool), rest to reduce intestinal activity/provide comfort/promote healing Treatments: amino-salicylates, glucocorticoids, antidiarrheal drugs, immunomodulators; diet modification ( low-fiber/residue , high-protein, high-calorie), avoid dairy/alcohol/caffeine/raw vegetables/carbonated beverages/pepper/nuts/corn/dried fruit/smoking, complementary therapies, surgery, colon removal, ileostomy, NPO with TPN for severe cases, steroids=hyperglycemia Side Effects: report N/V, anorexia, rash, headache with amino-salicylates; higher doses: hemolytic anemia, hepatitis, male infertility, agranulocytosis Crohn’s Disease
GUIDE/CHAPTER 11: CARE OF PATIENTS WITH FLUID
AND ELECTROLYTE BALANCE,100% CORRECT
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
Complications: weight loss, anemia, severe malabsorption issues, fistulas , anal fissures, peritonitis, bowel obstruction, nutrition and fluid imbalances/deficiencies (malabsorption) Appendicitis
GUIDE/CHAPTER 11: CARE OF PATIENTS WITH FLUID
AND ELECTROLYTE BALANCE,100% CORRECT
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
Peritonitis S/S
- Rigid, board-like abdomen (classic)
- Abdominal pain (localized, poorly localized, or referred to the shoulder or chest)
- Distended abdomen
GUIDE/CHAPTER 11: CARE OF PATIENTS WITH FLUID
AND ELECTROLYTE BALANCE,100% CORRECT
NUR 2356/MDC II Final Exam Study Guide/Chapter 11:
Care of Patients with Fluid and Electrolyte Balance,100%
Chapter 58: Care of Patient with Liver Problems Cirrhosis S/S: early: fatigue, significant change in weight, anorexia, vomiting, liver/abdominal tenderness; late: jaundice , dry skin, rashes, petechiae, warm/bright red palms of hands, ecchymoses, spider angiomas, ascites (abdominal fluid), peripheral dependent edema, vitamin deficiency Diagnostics (including labs): bilirubin (itching) , serum protein (decreased albumin), hematocrit, electrolytes, liver enzymes, elevated AST and ALT, LDH, alkaline phosphatase, prolonged PT/INR , elevated serum ammonia, WBCs, x-ray, ultrasound, MRI, biopsies Esophageal Varices Complications: bleeding varices (medical emergency) , can result in shock from hypovolemia, loss of consciousness; hematemesis or melena (black, tarry stool) Hepatitis A Risk Factors: adults over 40 years of age, pre-existing liver disease (hepatitis), recent travel Transmission: fecal-oral route, contaminated food ( shellfish ) or water Hepatitis B Risk Factors: compromised immunity by disease/drug therapy, drug users, hepatitis carriers Transmission: blood-body fluids , unprotected sex with an infected partner, sharing needles/syringes, sharing razors/toothbrushes, accidental needlestick injuries, blood transfusions, hemodialysis, direct contact with blood or open sores, transfer during birth Hepatic Encephalopathy (result of severe liver disease)
- Nausea, anorexia, vomiting
- Diminishing bowel sounds
- Inability to pass flatus or feces
- Rebound tenderness in the abdomen
- High fever
- Tachycardia
- Dehydration from high fever (poor skin turgor)
- Decreased urine output
- Hiccups
- Possible compromise in respiratory status
