Bingo 3

1. State all normal values for electrolytes. a. Na – sodium 135- 145 mEq/L b. K – potassium 3.5-5 mEq/L c. Ca – calcium 8.5 – 10.5 mg/dL d. Mg – magnesium 1.8 – 2.6 mg/dL e. Phos – Phosphorus 2.5 – 4.5 mg/dL f. Cl – chloride 98 – 106 mEq/L 2. Arterial blood gases a. pH= 7.35- 7.45 b. PaCO2 (respiratory) = 35-45mmHg c. HCO3 (metabolic) = 22-26 mEq/L d. Serum osmolality = (<280 = dilute & fluid overload) 280-300 (>300 = dehydration) 3. Discuss electrolyte imbalances with possible symptoms and causes a. Excess = respiratory assessments, check LOC (confusion), edema, cardiovascular check #1, I&O (daily weights), fluid restrictions, BP (higher), HR (higher). b. Deficit = I&O, CBC, electrolytes, LOW BP, WEAK pulse, respiratory, tissue perfusion, check LOC, producing urine (@ least 30mL/h), weight changes, c. Sodium= hyponatremia and hypernatremia i. Hyponatremia= water excess (water intoxication arises from gain of relatively more water than salt or loss of relatively more salt than water) ii. Hypernatremia- dehydration, water loss (low concentration of water and high concentration of solutes) d. Potassium= hyperkalemia and hypokalemia i. Hypokalemia= diarrhea, vomiting and use of potassium wasting diuretics ii. Hyperkalemia= decreased urine output e. Calcium= hypocalcemia and hypercalcemia i. Hypocalcemia= acute pancreatitis, neuromuscular excitability ii. Hypercalcemia= cancer pt f. Magnesium= hypomagnesemia and hypermagnesemia i. Hypomagnesemia= increase neuromuscular excitability ii. Hypermagnesemia= ESRD (end stage renal failure), neuromuscular excitability, with lethargy and decreased deep tendon reflexes 4. Identify symptoms of metabolic acidosis/ alkalosis a. Metabolic acidosis i. Renal failure ii. Severe diarrhea iii. Sepsis iv. Shock v. Metabolic ketoacidosis b. Metabolic alkalosis i. Loss of gastric juices ii. Potassium wasting diuretics iii. Overuse of antacids  have a lot of magnesium 5. Identify symptoms of respiratory acidosis/ alkalosis a. Respiratory acidosis  hypoventilation (not enough) i. Restlessness ii. Lethargy iii. Muscle twitching

iv. Tremors v. Convulsions vi. Coma b. Respiratory alkalosis  hyperventilation (too much) i. Anxiety ii. High altitudes iii. Pregnancy iv. Fever v. Hypoxia vi. Pulmonary disease 6. Discuss complications of IV therapy and treatment for them (infiltration, phlebitis, cellulitis and extravasation) (as found in both meds PP and fluid and electrolyte PP) a. Electrolyte PP i. Too rapid or excessive infusion of any IV fluid has the potential to cause serious problems ii. Infiltration = fluid went into surrounding tissue and not in vein (most common) 1. Warm compress on site once IV is taken out iii. Phlebitis = inflammation in the walls of veins. 1. Thrombophlebitis- blood clot formation at site of inflammation 2. Redness to area iv. Cellulitis = bacterial infection at site and has similar signs and symptoms of phlebitis v. Extravasation = when IV fluid is infusing into tissues outside of the vein 1. Tx- stop IV fluid, remove catheter, elevate extremity, encourage active ROM, apple warm or cold compress depending on type of solution, restart Iv and IV fluid proximal to infusion 7. Recognize if pt are in metabolic respiratory acidosis/ alkalosis by analyzing levels, causes, and symptoms (how to solve an acid base problem a. Metabolic alkalosis and acidosis i. Metabolic acidosis= increase in PH (greater than 7.45) and increase HCO3 (greater than 28) 1. Arises from increase metabolic acid or decrease in base (bicarbonate) 2. Kidneys unable to excrete enough metabolic acids which accumulate in blood 3. Results in decreased level of consciousness ii. Metabolic alkalosis = decrease pH (less than 7.35) and decrease HCO3 (less than 21) 1. Arises from direct increase in base (bicarbonate) or decrease in metabolic acid 2. Results in increased blood bicarbonate 3. Loss of gastric juices potassium wasting 4. Overuse of antacids b. Respiratory acidosis and alkalosis i. Respiratory acidosis 1. Arises from alveolar hypoventilation 2. Lungs unable to excrete enough CO2 3. Excess carbonic acid in blood decreases pH

4. Ventilation is depressed, co2 is retained causing hypercapnia (increase H2CO3) which lowers the PH to below 7.35 ii. Respiratory alkalosis 1. Arises from alveolar hyperventilation 2. Lungs excrete too much CO2 3. Deficit of carbonic acid in the blood increases pH 4. Hypoxia 5. Fever 6. Pregnancy 7. High altitudes 8. Initial stages of pulmonary emboli 8. Discuss nursing assessment related to fluid and electrolyte imbalances a. Nursing history i. Age – very young and old at risk of fluid and electrolyte balances ii. Environment- excessively hot? iii. Dietary intake- fluids, salt, foods rich in potassium, calcium and magnesium iv. Lifestyle- alcohol intake hx v. Medications- include over the counter (OTC) and herbal, in addition to prescription medications b. Medical hx i. Recent surgery (physiological stress) ii. Gastrointestinal output iii. Acute illness or trauma 1. Respiratory disorders 2. Burns 3. Trauma iv. Chronic illness 1. Cancer 2. Heart failure 3. Oliguric renal disease c. Physical assessment i. Daily weight = #1 indicator of fluid status 1. Use same condition- time, place, scale ii. Fluid intake and output 1. 24 hour I&O- compare intake versus output 2. Intake includes all liquids eaten, drank or received through IV 3. Output- urine, diarrhea, vomit, gastric suction, wound drainage 9. What is nursing care while administering a blood transfusion (pt identifiers, frequent vital signs, adverse reaction) a. CHECK CHECK CHECK at least 2 people b. Beware of reactions – itching, fever i. Stop transfusions if reaction occurs c. Have to check vital every 5 minutes during transfusions 10. What are the endocrine functions of the kidney? a. BP control i. Renin causes vasoconstriction when released from juxtaglomerular cells = increased BP ii. RAAS- promotes sodium uptake iii. Prostaglandin E2 and Prostacyclin = vasodilation= decreased BP

b. Erythropoietin= stimulates bone marrow to make RBC i. give blood if hemoglobin less than 7 ii. RBC low  anemia c. Makes Vit D – regulate Ca and phosphorus in body (inverse relationship) i. Vit d syntheses stimulated by parathyroid hormone ii. PTH also helps regulate calcium (low Ca  osteoporosis) and phosphate (in food we eat)  when Ph is up, Ca goes down 11. What problems does poor kidney function cause a. Chronic kidneys disease can lead to anemia , hypertension and electrolyte imbalances b. Glomerulus  filters water, electrolytes, glucose, amino acids, uric acid, creatine 12. Discuss healthy actions to prevent bowel elimination/ urinary problems a. Urinary i. Drink 2-3L daily if no fluid restrictions or contraindications ii. Limit caffeine, alcohol, acidic drinks, artificial sweeteners iii. Limit fluids 2h before bedtime to decrease nocturia iv. Good to know: bladder contracts during urination, urinary sphincters relax during urination. VOID 30mL/day = 1-2L/day 1. Internal sphincter it is at the top of the urethra, smooth muscle = involuntary control by brain 2. external sphincter is commonly seen with toilet training, voluntary control 3. sphincters help hold urine 4. parasympathetic promotes urination 5. Batter holds 600 to 1000 milliliters b. Bowel i. Regular exercise (150mins) ii. Fluids and food- fiber, fruits, veggies iii. Sets regular defecation habits 13. Discuss types of urinary incontinence and the various tx for each a. Stress incontinence- coughing, sneezing, laughing or physical activity causes urine leakage i. Tx- kegel exercises- strengthen pelvic floor b. Urge incontinence- a strong need or urge to urinate causing leakage (common w UTI) i. Tx- kegel exercises c. Reflex incontinence- urine leakage due to nerve damage (paralysis, spinal cord injury, scoliosis) i. Will need catheter most often d. Overflow incontinence- incomplete bladder emptying- bladder overfills, when fill leads to leakage i. Credé method ****** 1. Manual compression to help bladder w emptying e. Function incontinence- physical inability to reach the toilet in time i. Tx- Habit training 14. Review nursing assessment and physical assessment for urinary and bowel elimination including definitions, causes, nursing care and tx a. Kidneys, ureters, bladder, urethra i. Must be intact for effective waste removal

ii. Nerves of spinal cord and brain must intact to sense bladder fullness or innervates voiding (micturition) b. Systolic blood pressure at least 80 or > healthy kidney prefusion c. Urine typically sterile d. Average output is 1-2L/day e. Nurse observes for minimum of 30ml/h f. If urine out is < 30mL/h for more than 2 hours, asses for blood loss and call provider g. Physical assessment of urinary i. Skin and mucus membranes- pink warm, dry smooth intact, look for breakdown suggesting incontinence or poor hygiene, overall good turgor (no tenting) ii. Kidneys- place hand on posterior flank and other hand on abdomen and gently squeeze iii. Bladder- if full, felt above symphysis pubis (bladder scan- ultrasound) iv. Urethral meatus- pink, small slit like opening- observe discharge, redness, lesions 15. Describe UTIs and symptoms a. Symptoms- urge incontinence, cloudy urine (sediment) 16. Discuss prevention of UTIs and CAUTIs a. CAUTI i. Hand hygiene- before and after cath ii. Cath care q8h prn iii. Fluid intake iv. Closed drainage system- free drainage by gravity. Urine flow unobstructed v. Catheter irrigation and instillations- continuous bladder irrigation b. UTI – i. Explain urinary tract infection prevention by stating wear cotton panties, cleanse front to back, no buddle bathes or feminine hygiene sprays or douches =, tight clothing, void after sexual intercourse, drink at least 2-3L of water daily or enough for pale yellow urine, avoid excessive dairy products, and have a glass of cranberry juice each morning 17. Describe catheter care a. Q8h and prn, sterile technique for insertion b. Hand hygiene -before and after touching cath c. Securement device- i. females to inner thigh ii. Males- insert cath at 90 degree angle to straighten urethra and ease insertion, insert until bifurcation to ensure ballon not inflating in prostatic urethra secure to upper thigh or lower abdomen 18. Review peritoneal and hemodialysis, the process for each and nursing concerns a. Peritoneal dialysis i. Surgically inserted abdominal catheter into peritoneal cavity allows sterile electrolyte solution to be instilled and absorb waste products and excess fluid through osmosis, diffusion and ultrafiltration b. Hemodialysis i. Artificial kidney circulates blood as electrolyte fluid bathes it and removes wastes and excess fluid by osmosis, diffusion and ultrafiltration. Blood is