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NCLEX HURST STUDY GUIDE
o
o Calcium has an inverse relation to phosphorus
• When Calcium goes up, Phosphorus goes down
(Hypophosphatemia) and vice versa
o Sodium has an inverse relation to Potassium
• When sodium goes up, Potassium goes down
and vice versa
⟶ HyperParathyroidsm = HYPERCALCEMIA = HYPOPHOSPATEMIA
Every time you see Hyperparathyroidism that’s the same exact thing as Hypercalcemia
o Epinephrine is secreted – vasoconstrictor
When Hypovolemic (blood volume deficit), ADH and aldosterone will be secreted so keep blood volume up
Weight is the best indicator for fluid status EXCEPT for Burns, Its Urine Output
Also for ventilator alarms
HOLD
High alarm- Obstruction due to incr. secretions, kink, pt. coughs, gag or bites
Low press alarm- Disconnection or leak in ventilator or in pt. airway cuff, pt. stops spontaneous breathing
To remember blood sugar:
hot and dry-sugar high (hyperglycemia)
cold and clammy-need some candy (hypoglycemia)
Eu = Normal for example: Euthyroid is normal thyroid
Increase of LDL, THINK Coronary Artery Disease
Increase secretion of PTH makes serum calcium go up
Decrease secretion of PTH makes serum calcium go down
You dangle artery problems and you elevate vein issue problems
Hypervolemia: Too much fluid in the vascular space (too much water in the hose)
Will Cause: HF Weak Heart low Cardiac output Low Urine Perfusion LowUrine
Output Heart Failure Renal Failure
S/S: Bounding Pulse SOB; Dyspnea Crackles/ wet lung sounds (listen to the low area in the back) Distended Neck (JVD) and Peripheral Veins Peripheral Edema (sacrum area) and Third spacing Rapid Weight gain Low urine output (specific gravity of 1.010 or less)
Central Venous Pressure (CVP): More volume (Hypervolemia) = More Pressure CVP normal is 2-8 Low volume (Hypovolemia) = Low Pressure
Position: Semi Fowler; BED REST FOR THESE PATIENTS (hyper & Hypo)
Diet: Hypertension, heart failure, CAD—low sodium, calorie-restricted, Low fat
Treatment: Hydrochlorothiazide: Will make you lose Potassium
Furosemide: Will make you lose Potassium
Bumetanide: Will make you lose Potassium
• Give SPIRONOLACTONE to retain Potassium but watch for
Hyperkalemia
o KEEP CLIENT ON BED REST (helps reduce sodium and water)
Teaching: Check Daily weights and Input and Output
***clients with History of HF and Kidney, give fluids slow and
watch for Hypervolemia***
HYPOVOLEMIA: Fluid not in the vascular space SHOCK
(COLD AND CLAMMY)
Look for Hypovolemia in (anything that causes losing fluid): Trauma SURGERY patients NG tube Paracentesis you losing fluid Vomiting and diarrhea Ascites: fluid in the abdomen; Edema: Fluid in the wrong spot so check for Hypovolemia Polyuria: Fluid in the wrong spot so check for Hypovolemia
Will Cause: Third spacing: When fluid goes somewhere else other than
Other than the vascular space Ascites: fluid in the abdomen People with liver Disease will have this Edema Polyuria: When you see this, THINK Shock First
** When you go into HYPOVOLEMIC STATE (Hemorrhage, vomiting, or anything that causes you to lose water), the ALDOSTERONE hormone secretion will increase to preserve/retain sodium and water***
S/S: Increased temp
Decreased skin Turgor Low mucous COLD AND CLAMMY Rapid/weak/thready pulse, High pulse (tachycardic) and Tachypnea Increased Respirations Hypotension (Orthostatic/postural mainly) Anxiety, weight loss Decreased Urine output Urine specific gravity >1. Low CVP pressure Vessels are vasoconstricted
Aldosterone = Steroids aka Mineralocorticoids retains sodium and water
Cushing’s Syndrome: Too much Aldosterone (steroids) Hyperaldosteronism (Conn’s Syndrome): Too much Aldosterone (steroids)
S/S: HyperNa: If you are obese, you have to much sodium
HypoK Hyperglycemia, Prone to infection, Muscle wasting; weakness, Edema; Obesity HTN, Hirsutism, Moon face Buffalo hump
Diet: Low sodium, High potassium diet. Increase protein, Increase Calcium
Cushing: Everything is High Except Potassium
CLIENT NEEDS QUITE ROOM
Risk for osteoporosis
Protein means kidney damage
Glucose and ketones are for long term use which will show in urine sample
Uric acid is kidney stones
ADDison disease is ABSENT of steroids. think of a bodybuilder who’s on steroids, he’s very big vs the other guy who isnot taking steroids. He will be SMALL, AND WEAK AND TAN
With Addison disease, they have Absent of steroids meaning LOW so everything will be LOW except 2 things LOW BP (CRITICAL) Shock LOW weight (water loss) LOW sodium (hyponatremia) LOW glucose (Hypoglycemia) LOW or slow periods (amenorrhea) LOW resistance to stress Fractures Alopecia Weight loss GI distress
HIGH Potassium (hyperKalemia) HIGH pigmentation “Bronze Pigment” don’t get this confused with the Acanthosis nigricans
Loss of libido and decreased axillary and pubic hair are common in Addison's disease due to lower levels of androgens.
Diet: Increased sodium, low potassium diet.
Addisonian Crisis: N/V Confusion Abdominal pain Extreme weakness Hypoglycemia Dehydration Decreased BP
- Treatment: Meds: NEVER STOP TAKING MEDS ABRUPTLY ▪ Prednisolone: 2x a day in split days ▪ Fluicosteriods: this is Aldosterone
SIADH: causes include central nervous system disorders (eg, stroke, trauma, neurosurgery) and some commonly used medications (eg, desmopressin, carbamazepine Diabetes insipidus (DI): think D for dehydrated so they are Dry Inside Diabetes Insipidus R N Y S I *****WHEN YOU SEE DI, REMEMBER D FOR DIURESES***** D E
- High Urine Output (because they are peeing everything out, so they are dry inside)
- Low urine gravity which automatically means they’ll have high osmolality
- HyperNatremia this goes with the High Osmolality, if you have high osmolality, you’ll have high sodium and vice versa
- Polydipsia aka DIURESIS (since they are dry inside, they’ll be thirsty
- Dry mucous membranes CUZ they DRY INSIDE DUHH!
- HYPOTENSION REMEMBER CARDIAC, when you have a low fluid inside, you turn HYPOTENSIVE SHOCK
- DESMOPRESSION AKA VASOPRESSIN gets your BP up AND decreases Urine output can cause deadly headaches because it also decreases sodium
BIGGEST COMPLICATION IS SHOCK FOR DI
TREATMENT: Any Med with -RESSIN (desmopressin, Pitressin)
Hyper Magnesium and Hyper Calcium: Think Act like Sedatives
Everything goes Down!!! Magnesium: normal: 1.5-2.5 mEq/L
HYPER magnesium: Excreted through Kidneys and GI
- Causes of Hyper magnesium: ▪ Kidney Failure if you can’t excrete it, then it will cause this ▪ Antacids has too much magnesium
⟶ S/S: (vasodilation) ----- Hyper Magnesia: will make everything go down o Depresses the CNS/ LOC o Hypotension o Facial flushing/warmth vasodilation o Muscle weakness o Absent deep tendon reflexes o Shallow/Decreased respirations o Arrhythmias o Emergency
** Sometimes Magnesium is given to Preeclampsia patients to
prevent seizures because magnesium relaxes everything**
⟶ Treatment:
o Ventilator if O2 is >10 breathe
o Dialysis: kidneys not working
o Calcium Gluconate antidote
o Safety precautions:
HYPERCalcemia:
⟶ Causes of Hypercalcemia:
▪ Too much PTH (parathyroid Hormone)
▪ Thiazides: makes you retain calcium
▪ Immobilization: If you’re immobile, calcium goes into the blood
which makes PTH go up
o Mind changes (wild, see things, depression, etc) o Swallowing problems (dysphagia)
- Treatment:
o Give Magnesium
▪ Check kidney function before giving IV Mg
⟶ Diet: High in Mg (Remember Vegetables , seeds, and peppermint)
o Spinach o Greens o Squash o Broccoli o Halibut o Turnip o Pumpkin seeds o Peppermint o Cucumber o Green beans o Celery o Kale o Sunflower seeds o Sesame seeds o Flax seeds
HYPOCalcemia:
⟶ Causes of Hypocalcemia:
▪ Not enough Parathyroid Hormone (PTH)
Hypoparathyroidism
▪ Radical Neck
▪ Thyroidectomy
⟶ S/S: SAME AS HYPOMAGNESIUM
o Rigid and tight muscles o Possible seizures
o Stridor/ Laryngospasm and Tetany (spasms of the hands and feet, cramps, spasm of the voice box (larynx)) o POSTIVIE CHVOSETK’S (hyper irritability) AND TROUSSEAU o Arrythmias o Increase deep tendon reflex o Mind changes (wild, see things, depression, etc) o Swallowing problems (dysphagia)
⟶ Treatment: o Give Calcium: Make sure client has heart monitor on when giving calcium ▪ Give IV calcium slowly b/c too fast will cause widened QRS aka Arrythmias o Vitamin D: This Utilizes the calcium for better absorption o Phosphate binders to excrete phosphate: Calcium acetate (hydrochloride)
⟶ Diet: o Decrease in Phosphate foods
Sodium: Think Neuro changes!!!
Hypernatremia: Dehydration
⟶ Causes of HyperNatremia: Think what causes Dehydration ▪ Hyperventilation: When you exhale too much, you lose water ▪ Heat stroke ▪ DI ▪ Vomiting ▪ Diarrhea
⟶ S/S: o Thirsty o Dehydration o Swollen Tongue o Neuro Changes (disorientation/delusions) o Increased temp
⟶ Causes of HyperKalemia:
- Kidney Trouble
- Drugs such as Spironolactone
⟶ S/S: Early to Late (severe) sign - Mnemonic is (FMURDER) o Muscle Weakness and twitching o Flaccid Paralysis o Urine (oliguria/anuria) o Respiratory depression o Decreased cardiac contractility o ECG changes o Reflexes
⟶ Treatment: o Dialysis: Kidneys not working o Calcium Gluconate o Glucose and insulin Watch for Hypokalemia and Hypoglycemia o Sodium Polystyrene (kayexalate) used only for clients who are hyperkalemic ONLY ▪ given as enema o Push Fluids
HypoKalemia:
⟶ Causes of HypoKalemia They are all losing potassium ▪ NG Suction ▪ Vomiting ▪ Diuretics ▪ Not eating
⟶ S/S: Early to Severe o Muscle Cramps o Muscle Weakness o Arrhythmias
⟶ Treatment: o Give potassium Spironolactone o Increase K Foods ▪ Raisins ▪ Bananas ▪ Apricots ▪ Oranges ▪ Beans ▪ Potatoes ▪ Carrots ▪ Celery
⟶ Safety Issues with Potassium: o Oral Potassium causes GI upsets – Give with foods o Assess Urinary Output before/during IV Potassium o Always put IV Potassium on a Pump o Mix well o Never give potassium PUSH o Burns during infusion? Yes, very common
Acid/ Base Solution (Listen to MARK!!)
From the a** (diarrhea)= metabolic acidosis From the mouth (vomitus)=metabolic alkalosis
s
o high caloric, o Increase in Vitamin C
⟶ Treatment: o Fluid replacement: 2 large bore IVs Lactated ringers or Albumin (colloids)…. Give half of fluid for the first 8 hrs, The remaining half is given over the next 16 hrs. o Oxygen o Make sure to time what time the burn occurred
⟶ Management: o Wrap client in blanket Helps with hypothermia o Cool Water: No more than 10 min – NO ICE o Remove Jewelry o Remove non-adherent clothing o Do not remove stuck Clothes o Inhalation injury Give 100% oxygen b/c low hemoglobin o Intubate if airway is compromised
Weight is the best indicator for fluid status EXCEPT for Burns, Its Urine Output
⟶ Immunizations: o Tetanus If client doesn’t know he had it, give Immunoglobulin
⟶ Oncology: KNOW ALL THESE!!
⟶ Risk Factors: ▪ Tobacco and alcohol ▪ Obesity ▪ Low fiber diet: you retain more carcinogens ▪ Increased red meat consumption ▪ Increased animal fat ▪ Nitrates: processed sandwich meats. Salt cured or smoke meats ▪ Preservatives and additives ▪ Aging ▪ African Americans ▪ Radiation ▪ Stress ▪ Chronic Irritations GERD ▪ History
⟶ Diet: o High fiber: Increase in fruits o High Calorie o High Protein
⟶ Cancer Primary Prevention: Teaching o No smoking o Exercise o Lose weight o Vaccines – Heb B, and HPV o Wear sunscreen, and avoid sun, and secondhand smoking
⟶ Secondary Prevention Screening
⟶ Tertiary Prevention Treatment (support group and Rehab) o
