Cachexia (syndrome of cachexia) - most severe form of malnutrition
- decrease quality of life
- present in 80% of cancer patients at death
- includes anorexia, early satiety, weight loss, anemia, taste alterations
BMI classifications - underweight = <18.5
- normal weight = 18.5-24.9
- ov...
NUR 334 Exam 1 Questions and 100%
Correct Answers
Cachexia (syndrome of cachexia) ✅- most severe form of malnutrition
- decrease quality of life
- present in 80% of cancer patients at death
- includes anorexia, early satiety, weight loss, anemia, taste alterations
BMI classifications ✅- underweight = <18.5
- normal weight = 18.5-24.9
- overweight = 25-29.9
- obesity = BMI or 30 or greater
Disorders of the wbcs ✅- leukocytes key player in the inflammatory response and
fighting infections
- normal range = 4500 - 11,000 ml (or mm3)
- leukopenia = decreased levels (<4500/ml)
- leukocytosis = increased levels (>11,000/ml)
Lung perfusion ✅- this is the movement of blood through the pulmonary vascular
system
- ph = 7.35 - 7.45
- PCO2 = 35-45 mmhg
- PO2 = 80-100 mmhg
- HCO3 = 22-26 meq/L
- normal sao2 = 95%-100%
- hgb is saturated with O2
- HGB normal male = 13-18g/100ml
- HGB normal female = 12-16 g/100ml
- HCT normal male = 43%-49%
- HCT normal female = 38%-44%
Diffusion ✅- is the net movement of molecules from a region of higher concentration to
a region of lower concentration
Osmosis ✅- controlling the movement of water between compartments
Osmotic pressure ✅- pressure exerted by the solutes in solution
Oncotic pressure ✅- is called colloidal pressure
- refers to the pressure exerted by albumin (keeps fluid in the vasculature)
Hydrostatic pressure ✅- is the push against the capillary walls
- pushed fluid out of the vasculature
Osmolarity ✅- blood osmolarity is between 250-375 mosm/L
- influences how water moves between intracellular and extraceullar compartments
Isotonic solutions ✅- 0.9% sodium chloride
- D5W
- lactated ringers
- same or nearly same osmolarity as plasma
- no movement of fluid into or out of cells)
- fluid deficit, dehydration, fluid challenges (urine output/fluid bolus)
Hypotonic solutions ✅- 0.45% NS
- 2.5% dextrose in water
- 0.33% nacl
- lower solution concentration than plasma
- fluid moves from the intravascular space into both the intracellular interstital spaces
- diabetic ketoacidosis (cells are dehydrated)
- hyperosmolar hyperglycemia (HHS) = high blood sugar, hyperosmolar state without
significant ketoacidosis (blood sugars >600 mg/dl to over 1000 mg/dl)
Hypertonic solutions ✅- 3% nacl
- D5LR
- D20
- D5 1/2 NS
- D5.45
- albumin 25%
- concentration higher than plasma
- fluid moves from the cells into the intravascular space
,- severe dehydration
- severe electrolyte imbalance
Acidic medications ✅- can cause phlebitis
- ex. = amiodarone (cordarone), vancomycin (vaanococin), ciprofloxacin (Cipro) have ph
<5
2 major types of IV solutions ✅- crystalloid solutions
- colloid solutions
Cystalloid solutions ✅- composed of electrolytes dissolved in water
- ex. = dextrose solutions, sodium chloride solutions, lactated ringers solutions
Colloid solutions ✅- protein or starch suspended in fluid and are not a true solution
- plasma volume expanders
- draw fluid into vascular space
- ex = albumin, dextran, mannitol (diuretic)
Peripheral venous access ✅- peripheral vein = catheter, steel wing (butterfly)
- midline catheter = not central line, NOT to be used for vasicants or agents that cause
destruction of the skin (ex. Vanomycin, dopanine, vasopressin, chemotherapy drugs),
central infusion total peripheral nutrition (TPN), or ph less than 5 or greater than 9 (ex.
Phenytonin)
Extravasation ✅- a vesicant that infiltrates
- signs = blanched skin, burning of the site, skin is cool to touch, edema at the site
- stop infusion and disconnect administration port
- aspirate cannula
- leave catheter in place (see hospital policy)
- administer antidote (phentolamine/reginite for norepinephrine)
- cold compress except for vinca alkaloids and epipodphyrlltoxins
- photograph site
- monitor site
- may need surgery
Considerations for central access ✅- patients length of therapy (if the patient is going
to stay for a while)
- acuity of patient
- medications
- patient venous access
Central line for venous access ✅- terminates at the level of SVC or the interfeior vena
cava
- non-tunneled percutaneous central catheters, tunneled catheters, implanted ports,
peripherally inserted central catheters (PICC)
, - possible multiple lumens (separate lines)
- inserted by mds, advances practice RN (ex. CVP)
Central lines (CVP line) ✅- subclavian
- jugular
Insertion of central line catheter ✅- subclavian or jugular approach = directly to
superior vena cava, trendelenburg position (head down), reducing the possibility of air
embolism and increases distention of jugular
- need chest X ray after placement prior to use
- femoral (not desirable site) = emergency site should be removed within 24 hours due
to increased likelihood of infection (central line blood infections)
Tunneled catheters ✅- tunneled through subcutaneous tissue to central vasculature
- non-emergency insertion
- procedure room or operating room
- verification of placement upon insertion
Ports ✅- long term therapy (ex. Cancer)
- non- emergency situation
- upper extremity, back, or upper chest (preferred)
- inserted in procedure room or operating room
- entire device is internal
- catheter is placed in vein and catheter tip is advanced to the center access
vasculature
-reservoir with septum and catheter
- can have one or multiple ports
- patency is critical and maintaining flushing
- special non-coring needle used for access
- RN needs specialdevice training to access the port
- verification of placement upon insertion
- never use force to flush port?
- peripherally inserted central catheter (PICC) ✅- inserted into a peripheral vein and
inserted to central vasculature (SVC)
- bedside insertion using ultrasound
- insertion by trained and certified rns
- moderate to long term placement
- insertion may be done early in hospital stay (if extended stay is anticipated) to
maximize vein availability)
- need chest X ray after placement prior to use
- cost effective
- flushing of catheter is critical, with attention to pressure exerted
- needs care with flushing
- only power pick can withstand high pressure for infusion insertion (contrast infusion)
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