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Why are weights valued so much?
- Most reliable indicator of fluid gain or loss
- same time, same scale, same clothes
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BMI Formula?
lbs/in2 x 703
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What is the pathophysiology of malnutrition?
- marasmus: calorie malnutrition - fat and protein wasted
- kwashiorkor: lack of protein quantity and quality in the presence of adequate calories
- marasmus-kwashiorkor: combined protein and energy malnutrition
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Nursing risk assessment for malnutrition
- decreased appetite
- weight loss
- poor-fitting dentures/poor dental health
- poor eyesight
- dry mouth
- limited income
- lack of transportation
- inability
- failure to thrive
- depression
- pain
- meds and OTC meds
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What is a safety priority action alert for malnourished patients?
- encourage to eat
- instruct UAP to keep food at appropriate temps and provide oral care before feeding
- assess for pain, comfort prior to eating
- allow appropriate time to eat - don't rush
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Describe ways to promote nutrition intake
- toilet and oral care
- glasses and hearing aids
- move urinals, emesis basins, bedpans
- give antiemetics, pain meds 1H prior
- SERVE HIGH-CALORIE, HIGH-PROTEIN SNACKS
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Care and maintenance of Total Parenteral Nutrition
- Check TPN bag against order and have a 2nd nurse check
- monitor pump for accuracy of hourly rate
- if TPN unavailable give D10W or D20W
- don't attempt to "catch up" by increasing rate
- daily weight
- monitor electrolytes and glucose levels
- I&O's
- change IV tubing Q24H
- change dressing Q48-72H
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Name some drugs that may cause weight gain
- steroids
- hormones
- NSAID's
- anti-HTN
- antidepressants, psychoactive drugs
- antiepileptics
- oral antidiabetics
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What is the primary role of the nurse during pre-op for bariatric surgery?
reinforce health teaching in preparation for surgery
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Nursing safety action alert regarding bariatric surgery NG tube
- never reposition - it can disrupt the suture line
- closely monitor for patency
- removed 2nd day is passing gas
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What is the most common and serious complication and cause of death after gastric bypass surgery?
- anastomotic leaks
- monitor for: back, shoulder, abd pain, restlessness, tachycardia, oliguria
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Normal Calcium level
9.0-10.5
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Normal chloride level
98-106
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Normal magnesium level
1.3-2.1
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Normal phosphorus level
3.0-4.5
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Normal potassium level
3.5-5.0
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Normal sodium level
136-145
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Normal albumin level
3.5-5.0
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What should we teach patients regarding hydration?
- match intake with output
- more water with heavy or prolonged activity or live in dry climates or high altitude
- caffeine and alcohol increase fluid loss
- offer fluids frequently to elderly
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What are clinical manifestations (systems) that correspond with hydration status
- cardio - HR, BP, orthostatic hypotension
- respiratory - increased rate
- skin
- neurologic - confusion, fever
- kidney
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What interventions (patient safety) in relation to dehydration?
- monitor V/S (HR, BP)
- risk for falls: orthostatic hypotension, dysrhythmia, muscle weakness, confusion
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Indicators of adequate rehydration status?
- pulse quality
- urine output
- pulse pressure
- weight (Q8H)
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Indicators of fluid overload?
- bounding pulse
- difficulty breathing
- neck vein distention in the upright position
- presence of dependent edema
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What are the interventions for fluid overload?
- safety
- restore normal fluid balance (drugs, nutrition, I&O)
- supportive care
- prevent future overload
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Pulmonary edema can occur very quickly and can lead to death. What is priority?
notify provider of any change that indicates fluid overload or not responding to tx
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What is the most obvious problem associated with hyponatremia?
- Cerebral changes
- LOC
- behavior
- mental status
- seizures, coma, death
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What are the priorities for nursing care of the patient with hyponatremia?
- monitoring pt's response to therapy
- preventing hypernatremia
- preventing fluid overload
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Why is hypokalemia so dangerous?
life-threatening because every body system is affected
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What is a result of hypokalemia to all excitable tissues?
nerve and muscles are less responsive to normal stimuli
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What must we assess Q2H in patients with hypokalemia?
- respiratory status
- respiratory insufficiency is a major cause of death for these patients
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What can occur with the GI system of a patient with hypokalemia?
paralytic ileus
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If infiltration of potassium solution occurs what is the priority?
- stop IV
- remove IV
- notify provider or RRT
- Document
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What is the rate of IV potassium NEVER to exceed?
20 mEq/hr
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A patient with hyperkalemia: what do we do if HR falls below 60 or elevated T-waves?
call provider or RRT
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What is the most severe problem and most common cause of death with Hyperkalemia?
- cardio changes
- bradycardia
- hypotension
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What are some manifestations of hyperkalemia?
- palpitations
- muscle twitching
- leg weakness
- tingling or numbness in hands feet or face
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What are some manifestations of hypocalcemia?
- paresthesias of hands and feet
- cramping "charley horse"
- Trousseau's and Chvosteks signs
- ECG: cardio changes (weak, thready pulse)
- hyperactive GI
- osteoporosis
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Interventions for hypocalcemia?
- drug therapy (Ca+ and Vit D)
- nutrition
- environmental mgmt: reduce stimulation
- injury prevention
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What are some manifestations of hypercalcemia?
- cardio: increased HR and BP
- DVT's, clotting
- neuromuscular: severe muscle weakness, DTR's, confusion, lethargic
- decreased peristalsis of GI, constipation, anorexia, N/V
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Interventions for hypercalcemia?
- D/C IV solutions containing Ca+
- D/C Ca+ supplements or Vit D
- Start NS to excrete calcium in urine
- cardiac monitoring
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What are some common causes of Hyperphosphatemia?
- kidney disease
- cancer tx's
- hypoparathyroidism
- increased phosphorus intake
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What other electrolyte is affected with hyperphosphatemia?
Calcium = HYPOcalcemia
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Hypocalcemia results in what to membranes?
increased membrane excitability = life threatening
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What cardiac changes are seen with hypermagnesemia?
- bradycardia to cardiac arrest
- peripheral vasodilation
- hypotension
- prolonged PR interval
- widened QRS complex
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Hypermagnesemia can cause what that is life-threatening?
cardiac arrest
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CNS issues related to hypermagnesemia?
-
Neuromuscular changes seen with hypermagnesemia?
reduced or absent DTR'svoluntary skeletal muscle contractions become weaker and finally stop
-
What happens to the membranes with hypermagnesemia?
Reduced membrane excitability
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