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BMI catagories
- <18.5 = underweight
- 18.5 - 25 = healthy weight
- >25 - 29.9 = overweight
- > 30 = obese
- > 40 = morbidly obese
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BMI calculations
lbs / (in)(in) * 703 = BMI (*100)
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Parenteral nutrition
through IV
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Enteral nutrition
NG tube, G tube, J tube, peg tube
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What to do for hypovolemia:
increase fluid intake to 2,000 ml/day
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How do you assess fluid volume for a pt who has recovered from dehydration
Checking daily weight
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Solution used for a blood transfusion
blood transfulsion cannot be given with anything but normal saline
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System which regluates producion of carbonic acid
Respiratory, (CO2 concidered acid when too much)
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System which regulates bicarbonate, HCO3-
Renal
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High sodium foods
tomato soup, pickles, ham, soda, canned fruit, anything canned or preserved
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High potassium foods
bananas, potatoes
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High calcium foods
dairy products
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IV fluid therapy: solution which provides no fluid shift
Isotonic
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Clear liquid diet
anything that can be seen through (jello, clear juice or soda)
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Full liquid diet
milk, custard/pudding, icecream
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Pureed diet
mashed potatoes, mac and cheese
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Why do you flush an NG tube?
flush with 30ml to prevent clogging
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Applying heat:
improves blood flow, blood carries oxygen to site
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Applying ice:
constricts vessels (stops clotting, inflammation, edema)
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Why must TPN be given continuously, and not stopped abruptly?
Has electrolytes, one of the main electrolytes is sugar, stopping abruptly can cause hypoglycemia, must maintain consistant rate
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How often must bag and tubing be changed for TPN
daily
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If giving lipids via with TPN for calories, what must be monitored?
lipid levels
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What must be monitored with TPN?
glucose levels
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What must be done when D/C TPN?
taper off
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What is the purpose for giving hypotonic solution?
purposely given to shift water to the cell for cellular hydration
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What is the purpose for giving hypertonic solution?
purposely given w/ increased amout of solutes in the solution, which shifts fluid out of cell
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ECF
interstitial fluid and plasma (extracellular fluid)
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Isotonic solution
normal, equal balance, no fluid shift occurs across cellular or vascular membranes
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Types of IV fluids (isotonic)
- normal saline solution (0.9% sodium chloride)
- lactated ringer's (LR) solution
- 5% dextrose in water (D5W)
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Hypertonic solution
high concentration, pulls fluid from low to high concentration, pulls fluid from cells and interstitial spaces into vasculature/blood vessels, causes a shift, pulls fluid from inside of cell to outside causing cell to shrink, for cellular over-hydration
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Types of IV Fluids, hypertonic
above 9%
- 5% dextrose in 0.45% NaCl (D5 1/2 NS)
- 10% dextrose in water (D10W)
- 5% dextrose in 0.9% NaCl (D5NS)
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Hypotonic solution
less concentration, causes fluid to leave vasculature/blood vessels to shift into the cells, causing cellular hydration, give to move water into cell
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Types of IV fluids, hypotonic
Below 0.9%
- 0.33% NaCl (1/3 strength saline)
- 0.45% NaCl (1/2 strength saline)
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Colloids
IV fluids that contain solutes in the form of large proteins or other similarly sized molecules
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Purpose of colloids
remain in blood vessels for long time, increasing volume of blood, pulling water from cells into blood vessels
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Colloids examples of therapy
albumin, dextran, hetastarch
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Crystalloid
contains electrolytes (sodium, potassium, calcium, chloride), but lacks large proteins and molecules found in colloids
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Purpose of giving crystalloid
effect of fluid depends on if it is isotonic, hypotonic, or hypertonic
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Examples of crystalloid therapy
normal saline, dextrose fluid, lactaded ringer
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Normal PH level
7.35 - 7.45
- below 7.35 = acidosis
- above 7.45 = alkalosis
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HCO3- shows
metabolic (kidneys)
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Bicarbonate levels
22 - 26
- below 22 = acidosis
- above 26 = alkalosis
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CO2 shows
Respiratory (lungs)
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Normal CO2 range
35 - 45
- <35 = alkalosis
- >45 = acidosis
(opposite pH, and metabolic)
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ABG
Ph = 7.30
HCO3 = 24
CO2 = 51
Respiratory Acidosis
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ABG
Ph = 7.35
HCO3 = 26
CO2 = 38
Normal
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PH = 7.51
HCO3 = 25
CO2 = 29
Respiratory Alkalosis
(blowing off too much CO2, example: during labor and delivery)
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What event brings on respiratory acidosis?
Cardiopulmonary arrest
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