Nursing Care and Medication Management Quiz

Fluid and Electrolytes

• Types of Solutions:
  • Hypotonic: Half normal saline (0.45%).
  • Isotonic: Normal saline and lactated Ringer's.
  • Hypertonic: 3% saline.
• Uses:
  • Hypotonic: Cerebral edema, hyponatremia, hypovolemia.
  • Isotonic: Surgery, burns, blood loss.
  • Hypertonic: DKA, hypernatremia, sick cell.
• Hypovolemia:
  • High blood pressure.
  • Rapid weight gain.
  • Edema.
  • Increased urine output.
  • Bounding pulse.
  • Shortness of breath (SOB).
  • Crackles (abnormal lung sounds).
  • Dedicated level of consciousness (LOC).
• Hypervolemia:
  • Low blood pressure.
  • Dry mouth.
  • Rapid weight loss.
  • Low urine output.
  • Confusion.
  • Lethargy.
• Normal Electrolyte Levels:
  • Potassium: 3.5 - 5.
  • Calcium: 9 - 11.
  • Sodium: 135 - 145.

Potassium

• Potassium Pumps the Heart: Immediately think cardiac monitor for potassium imbalances.

• IV Insulin: Lowers potassium, SQ insulin does not.

• Potassium Burns: A vesicant (causes blistering).

• Foods High in Potassium: Avocados, fish, bananas, orange juice, raisins, dried fruits, meat, milk, fruits, vegetables, salt substitutes.

• Hyperkalemia (High Potassium):

  • Signs/Symptoms: Changes in ECG (wide QRS, prolonged PR, absent P waves), muscle weakness/cramping, leg pain, areflexia, slow pulse, low blood pressure, diarrhea, abdominal cramping, nausea, oliguria.
  • Causes: Kidney failure, salt/potassium supplements, old blood transfusions, cell destruction, acidosis, hypoxia, exercise, catabolic state, potassium-sparing diuretics.
  • Treatment: Cardiac monitor, Kayexalate (oral or enema), calcium gluconate, glucose & insulin IV, restrict potassium-rich foods (meats, dairy, bananas, OJ, avocados, broccoli, potatoes, spinach), stop IV potassium, use diuretics (Lasix) if kidneys are functioning, dialysis may be needed.

• Hypokalemia (Low Potassium):

  • Causes: Excessive vomiting, suctioning, dehydration, diarrhea, medications (diuretics, laxatives, insulin), alkalosis, rapid cell building (B12 or erythropoietin), aldosterone.
  • Signs/Symptoms: Weakness, nausea, vomiting, dysrhythmias (ST depression, changes in T waves, increased U waves), constipation, low blood pressure, increased pulse, increased digoxin toxicity, muscle weakness/paralysis, muscle cramps, rhabdomyolysis, hyperglycemia, diuresis.
  • Treatment: Encourage foods high in potassium (fruit juice, citrus fruits, dried fruits, bananas, nuts, vegetables). Monitor for digitalis toxicity. Stop diuretics (HCTZ, Lasix, cortisone). Ensure adequate urine output (600 mL/day or higher).

Sodium

• Hyponatremia: LOW sodium (less than 135 mEq/L) neuro/LOC concerns.

  • Symptoms: confusion, headaches, seizures (can progress to coma), abdominal cramps, nausea and vomiting.

• Hypernatremia: HIGH sodium. Symptoms include lethargy, headache, confusion, apprehension, seizures, and coma.

ABG's

• Normal pH: 7.35-7.45.

• Normal CO2: 35-45.

• Normal HCO3: 22-26.

• Respiratory Alkalosis: High ph, low CO2. Causes include hyperventilation. Metabolic: caused by vomiting, NG suction, diuretics, hypokalemia.

• Respiratory Acidosis: Low pH, high CO2. Causes include COPD, pneumonia.

• Metabolic Alkalosis: High pH, high HCO3. Causes include vomiting, NG suction, diuretics, hypokalemia.

• Metabolic Acidosis: Low pH, low HCO3. Causes include DKA, diarrhea, renal failure, and starvation

Anemia

• Sickle Cell:
  • Signs/Symptoms: Low oxygen, pain, shortness of breath (SOB), jaundice, vision issues, organ failure, acute chest syndrome.
  • Interventions: Hydration, oxygen, pain management (hydroxyurea).
• B12 Deficiency:
  • Signs/Symptoms: GI tract issues (sore, red, beefy tongue, anorexia, nausea, vomiting), abdominal pain, weakness, paresthesia (feet and hands), ataxia, reduced sensation, muscle weakness, impaired thought process.

Blood Transfusion

• Verification: Verify order, patient identity, blood type, and consent with two licensed personnel at bedside.
• Infusion: Start slowly, monitor patient closely for first 15 minutes, vital signs per protocol; complete transfusion within 4 hours.
• Reactions: STOP transfusion; maintain IV with normal saline; assess patient; notify Blood Bank and healthcare provider; send blood and tubing to lab; obtain labs and urine specimens; document.

Pneumonia

• Signs/Symptoms: Fever, tachypnea (rapid breathing)/dyspnea (shortness of breath), tachycardia, productive cough, chest pain, shaking chills, hypoxemia (low oxygen), Altered LOC, restless, agitation.
• Interventions: Chest x-ray, sputum Gram stain, blood cultures, ABGs, antibiotics, nebulizer treatments, encourage fluids and ambulation, high fowler's position.

Asthma

• Signs/Symptoms: Albuterol, Corticosteroids, nasal polyps, asthma sensitive to NSAIDS, wheezing, dyspnea, prolonged expiration, chest tightness, speaking 1-2 words, tachycardia, anxiety, silent chest.
• Interventions: Never leave pt in distress when having an attack. Albuterol and Corticosteroids to manage. Encourage fluids.

Diabetes

• Type 1 Diabetes: Autoimmune disease, cannot make insulin.
• Type 2 Diabetes: Inadequate insulin secretion and resistance to cellular level.
  • Symptoms: Hyperglycemia (high blood glucose), possibly fruit-smelling breath, kussmal breathing, lethargic, and abdominal pain.
• Treatment: Hydration (normal saline), regular/short-acting insulin, Potassium (10 meq/hr).
• Normal Ranges: A1C ≥ 6.5, fasting blood glucose ≥ 126.
• Types of Insulin: Rapid-acting (Lispro, Aspart, Glulisine, Apidra), short-acting (Regular, Humulin N, Novolin N), intermediate-acting (Humulin R, Novolin R), and long-acting (Glargine, Detemir, Degludec).

Hypertension.

• Causes: Cirrhosis, oral birth control, corticosteroids, SNS stimulants, endocrine disorders, neurological disorders, renal disease, sleep apnea.
• Medications: ARBs, sartans, ACE inhibitors, beta-blockers, calcium channel blockers.
• Management: DASH diet, low sodium, limit alcohol, exercise (30 minutes x 5 days a week), manage weight (BMI 18-25), stop smoking.
• Labs to Monitor: HDL (+50), LDL (<100), triglycerides (<150), total cholesterol (<200).

Stroke

• Ischemic: Blood clot within the brain (cannot be seen in a CT scan). Mini stroke (TIA) puts you at higher risk for ischemic stroke. Watch for sudden numbness, confusion, trouble seeing, trouble walking, severe headaches. Act FAST (Face, Arms, Speech, Time!).
• Hemorrhagic: Major bleed, patient often states "worst headache of my life." Ataxia, loss of muscle coordination, Hemianopsia (blindness in half the field of vision).
• Interventions (Ischemic): CT scan, TPA if applicable (within 3-4.5 hours of onset).
  • Interventions (Hemorrhagic): Antiplatelets, anticoagulants.

Myocardial Infarction (MI)

• Types: ST-elevation MI (STEMI) - complete blockage, and Non-ST-elevation MI (NSTEMI) - partial or incomplete blockage.
• Symptoms: ST elevation in ECG leads facing the infarction (90 min for STEMI); NSTEMI 12-72 hrs.

Acute Otitis Media

• Treatment: Antibiotics are required.

Heart Failure

• Left Side: Think lungs.
• Right Side: Think rest of the body.
• ECG Rhythm: An EKG shows the heart's electrical activity in a rhythmic waveform pattern.

Meningitis

• Causes: Bacterial (bacterial infection) or Viral (HIV, Herpes).
• Bacterial: Streptococcus
• Population at risk: +65, Prisons, People in dorms, Young.
• Viral: HIV, Herpes

Endocarditis

• Definition: Disease of the endocardium and heart valves. Can be subacute (months) or acute (progressive illness).
• Cause: Blood flow allows organisms to enter and infest previously damaged valves.

Failure to Thrive

• Causes: Underlying physical problems (medical issues, chromosomal abnormalities, lung/heart defects). Malnutrition.

Pacemaker

• Follow-up appointments.
• Avoid direct blows.
• No high-output generator (unless approved).
• Microwaves OK.
• Avoid antitheft devices.
• Travel not restricted.
• Monitor pulse, Pacemaker ID card, Medic alert ID card.

Enteral Nutrition

• Definition: Feeding a person with a functional gastrointestinal tract. Administering balanced liquefied food or formula through a stomach/intestinal tube.
• Functioning GI Tract: Tube feeding is indicated if patient is unable or unsafe to take enough oral nutrition.

Parenteral Nutrition

• Definition: Nutrients are delivered directly into the bloodstream when the patient's GI tract is not functional for ingestion, digestion, and absorption.
• Purpose: Meet needs when the GI tract is not functional. Customized to patient’s needs.

Tonsillectomy

• Post-op instructions: No red liquids, No suction.

Vision

• Classifications: Based on visual acuity in the better eye with correction:
  • 20/30-20/60: Mild loss/near normal vision.
  • 20/70-20/160: Moderate visual impairment.
  • 20/200 or worse: Severe visual impairment (legal blindness).
  • 20/500-20/1000 : Profound visual impairment
  • Less than 20/1000 : Near-total visual impairment
  • No light perception: Total visual impairment