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Older Adults Pt 2 > 2.1 Pathophysiologic Mechanism > Flashcards

2.1 Pathophysiologic Mechanism Flashcards

1
Q

Nursing Process

A 
Assessment
Diagnosis
Planning
Interventions
Evaluation
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2
Q

Hydrostatic Pressure

A
  • Movement of fluid through capillary wall

- Pressure exerted on the walls of blood vessels pushing fluid out

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3
Q

Oncotic Pressure

A

Colloid Oncotic Pressure - Drawing power of protein in plasma
Draws water back into the intravascular spaces

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4
Q

Passive Transport

A
  • Does not require energy to transport
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5
Q

Diffusion

A
  • Movement of molecules/solutes from high concentration to low concentration
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6
Q

Filtration

A
  • Movement of water and dissolved substances across semi-permeable membrane from area of high hydrostatic pressure to low hydrostatic pressure.
  • Example includes blood pressure
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7
Q

Osmosis

A
  • Movement of water across semi-permeable membrane over a solute gradient from low concentration to high concentration
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8
Q

Active Transport

A
  • Example is sodium-potassium pump

- Maintains higher concentration of extracellular sodium and higher concentration of intracellular potassium.

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9
Q

Fluid Gains and Losses

A
  • Intake and output should be basically equal
  • Loss of water is mainly through the kidney which is roughly 1mL/kg/hour.
  • Skin Sensible Loss - Sweating
  • Skin Insensible Loss - Fever, Exercise, Burns
  • Lungs lose about 300mL a day
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10
Q

Fluid Imbalances

A
  • Fluid deficit may cause delirium
  • Dehydration is common in older adults due to reduced renal function, decreased cardiac reserve, age related thinning of skin, loss of skin strength and elasticity, and decreased extracellular fluid.
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11
Q

Pediatric Fluid Imbalances

A
  • Children and infants have higher body water content
  • Children also have higher metabolic rates and increased body surface to mass index
  • Because of this infants and children require more water to maintain equilibrium
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12
Q

Fluid Volume Deficit Interventions

A
  • Measure I&O at least every 8 hours, sometimes hourly
  • Measure daily weight
  • Monitor vital signs (especially BP and HR)
  • Assessment of skin and tongue turgor, mucosa, mental status
  • Measures to minimize fluid loss
  • Oral rehydration (preferred)
  • Parenteral fluids (if unable to tolerate oral fluids or if deficit is severe)
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13
Q

Fluid Volume Excess

A
  • I&O
  • Daily Weights
  • Assess lung sounds, edema, etc
  • Monitor responses to diuretics and parental fluids
  • Promote fluid restriction adherence
  • Teach patient sodium and fluid restrictions
  • Avoid sources of excess sodium including medications
  • Promote rest
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14
Q

Diuretics

A
  • Reduces fluid volume in the body
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15
Q

Diuretic Pharmacotherapeutics

A
  • Hypertension
  • Heart failure
  • Cirrhosis (liver damage from alcohol or hepatitis)
  • Renal disease
  • Increased Intracranial Pressure
  • Increased Intraocular Pressure
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16
Q

Diuretic Mechanism of Action

A
  • Blocks sodium and chloride from being re-absorbed

- This prevents passive re-absorption of water

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17
Q

Sites of Action Diuretic

A
  • Loop diuretics affect Loop of Henley
  • Thiazide diuretics act on early segment of distal convoluted tubule
  • Potassium sparing diuretics act on distal nephron
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18
Q

Examples of Diuretics

A

Furosemide (Lasix) - Loop (High-Ceiling) Diuretic
Hydrochlorothiazide (HCTZ) - Thiazide Diuretic
Spironolactone (Aldactone) - Potassium Sparing (Aldosterone Antagonist)
Triamterene - Potassium Sparing (Non-Aldosterone Antagonist)
Acetazolamide (Diamox) - Carbonic Anhydrase Inhibitor Diuretic
Mannitol (Osmitrol) - Osmotic Diuretic

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19
Q

Diuretic Effect on Electrolytes

A
  • Affects absorption and excretion of electrolytes, mainly potassium.
  • Major adverse effect is electrolyte imbalance
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20
Q

Electrolytes

A 
Sodium - 135-145
Chloride - 98-106
Potassium - 3.5-5.0
Phosphate - 2.5-4.5
Magnesium - 1.8-3.0
Calcium - 8.5-10.5
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21
Q

Urine Specific Gravity

A
  • Normal value is 1.010-1.025
  • Measures kidneys ability to excrete or conserve water
  • Specific gravity is inversely related to urine volume
  • Larger the urine volume, lower the specific gravity is
  • Glucose/protein in urine can falsely elevate urine specific gravity
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22
Q

BUN (Blood Urea Nitrogen)

A

Normal Value 10-20 mg/dL

  • End product of muscle and protein being metabolized in the liver.
  • Breakdown of amino acids produces ammonia which is converted into urea and excreted.
  • BUN is increased by dehydration, diminished renal function, fever, GI Bleeding, increased protein intake and sepsis.
  • BUN is decrease by low-protein diet, starvation, end stage liver disease, pregnancy
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23
Q

Serum Creatinine

A

Normal Level - 0.7-1.4 mg/dL

  • End product of muscle metabolism
  • Does not vary with protein intake and metabolic state
  • Better indicator of renal function than BUN
  • Levels depend on lean body mass which varies between individuals.
  • Serum Creatinine increases when renal function decreases
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24
Q

Hematocrit

A

Normal Level (42-52% For Men) (35-47% For Women)
- Measures volume percent of RBC in whole blood
Increase caused by dehydration or polycythemia (condition of increased RBC’s)
Decreased caused by fluid volume excess and anemia

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25
Q

Major Cations

A
  • Sodium
  • Potassium
  • Calcium
  • Magnesium
  • Hydrogen Ions
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26
Q

Major Anions

A
  • Chloride
  • Bicarbonate
  • Phosphate
  • Sulfate
  • Proteinate Ions
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27
Q

Management of Hyponatremia

A
  • Gradual sodium replacement (IV or oral)
  • Water restriction
  • Assess I&O, daily weight, lab values, CNS changes
  • Monitor fluid intake
  • Consider effects of current medications such as diuretics or lithium
28
Q

Management of Hypernatremia

A
  • Gradually lower serum sodium by infusion of hypotonic electrolyte solutions
  • Diuretics
  • Assessment of abnormal loss of water or low water intake
  • Assess OTC sources of sodium intake
  • Monitor CNS changes
29
Q

Management of Hypokalemia

A
  • Potassium Replacement (Oral and IV for severe deficit)
  • Monitor ECG changes
  • Monitor ABG’s
  • Monitor patients taking digitalis for toxicity
  • IV potassium only after adequate urine output has been established
  • Potassium salts preferred because chloride deficiency co-exists with hypokalemia
30
Q

Management of Hypokalemia

A
  • Oral potassium chloride
    Used for mild deficit and may cause abdominal discomfort, n&v, diarrhea. Sustained release version has less GI effects
  • IV potassium chloride
    Used for severe deficit. Must be diluted and infused slowly
31
Q

Management of Hyperkalemia

A
  • Monitor ECG especially for tall peaked T waves.
  • Assess labs, monitor I&O, obtain apical pulse
  • Limit dietary potassium
    EMERGENT CARE
  • IV Calcium Gluconate, IV Sodium Bicarbonate, IV Regular Insulin, Hypertonic Dextrose IV, Beta-2 Agonists, Dialysis. (Administer slow with IV infusion pump)
32
Q

Kayexalate

A
  • PO, NG tube, or Rectal Edema

- Binds with potassium and allows for elimination via GI Tract

33
Q

Calcium Gluconate

A
  • Given via IV to protect the heart.

- Does not lower potassium levels

34
Q

Insulin and Glucose

A
  • Given to move potassium from blood into cells to lower blood potassium levels
35
Q

Sodium Bicarbonate

A
  • Counteracts acidosis to promote potassium moving back into the cells from extracellular fluid
  • This is because acidosis can cause hyperkalemia
36
Q

Beta-2 Adrenergic Receptor Stimulant

A

Albuterol/Epinephrine

- Have been seen to drive potassium back into cells

37
Q

Foods High in Potassium

A
  • Bananas, oranges, beans/lentils, potatoes, sweet potatoes, parsnips, spinach, chard, tomato sauce, avocados, yogurt, clams, salmon
38
Q

Management of Hypocalcemia

A
  • Oral calcium and vitamin D supplement
  • IV Calcium Gluconate for Emergency
  • Seizure precaution
  • Exercise to decrease bone calcium loss
  • Teachings related to diet and medications
39
Q

Management of Hypercalcemia

A
  • Administer IV fluids, furosemide, phosphate calcitonin, biphosphates.
  • Increase mobility and ensure safety
  • Encourage fluids
  • Dietary teaching such as fiber for constipation
40
Q

Furosemide

A
  • Increases calcium excretion in direct proportion to sodium excretion
41
Q

Calcitonin and Biphosphates

A
  • Inhibits osteoclastic bone resorption (bone degradation)

- Effective in treating hypercalcemia due to bone resorption and malignancy related hypercalcemia.

42
Q

Calcitonin and Biphosphate (cont)

A

Pamidronate and Etidronate
- Given via IV
Risedronate and Alendronate
- Given Orally

  • Often given concurrently
43
Q

Foods High in Calcium

A
  • Diary, sardines, (poppy, chia, sesame, celery) seeds, beans/lentils, almonds, whey protein, dark leafy greens such as kale, spinach, collards, rhubarb, edamame, figs.
44
Q

Management of Hypomagnesemia

A
  • Oral replacement for mild deficit
  • Magnesium sulfate IV with infusion pump
  • Monitor Vitals and Urine Output
  • Monitor for dysphagia, respiratory and neuromuscular status.
  • Seizure precautions
  • Dietary Teachings
45
Q

Management for Hypermagnesemia

A
  • Teachings of magnesium containing OTC medications
  • Limiting intake is usually sufficient
  • IV Calcium Gluconate may be used in severe situations because magnesium effects on neuromuscular and cardiac functions are antagonized by calcium
  • Hemodialysis for emergent situations such as renal dysfunction or severe high levels
  • Loop diuretics, sodium chloride, and lactate ringer IV fluids to help get rid of magnesium
  • Observe Deep Tendon Reflexes (DTR) and change in LOC (Level of Consciousness)
46
Q

Foods High in Mangesium

A
  • Spinach, dark leafy greens, nuts and seeds, fish, beans, lentils, whole grains, avocados, low-fat dairy, bananas, dried fruit, dark chocolate
47
Q

Management of Hypophosphatemia

A
  • Oral and IV replacement
  • Encourage foods high in phosphate
  • Gradually introduce calories for malnourished patients receiving parenteral nutrition
48
Q

Management of Hyperphosphatemia

A
  • Vitamin D preparations
  • Calcium binding antacids
  • Phosphate binding gels/antacids
  • Loop diuretics
  • NS IV
  • Dialysis
49
Q

Management of Hyperphosphatemia

A
  • Avoid high phosphorous foods

- Signs of hypocalcemia

50
Q

Foods High in Phosphate

A
  • Protein rich foods
    (meat, poultry, fish, nuts, beans, dairy)
  • Phosphorous from animals are absorbed more easily than plants.
51
Q

ABG’s

A 
PaCO2 - 35-45 mmHg
HCO3- - 22-26 mmHg
PaO2 - 80-100 mmHg
pH - 7.35-7.45
Oxygen Saturation - >94%
Base excess/deficit - +/- 2mEq/L
52
Q

Management of Acidosis

A
  • Administer Bicarbonate
  • Hyperkalemia may occur
  • Potassium levels decrease when acidosis is corrected because potassium goes back into cells
  • Monitor potassium levels
  • Serum calcium levels may be low with chronic acidosis
    (Must be treated before treating acidosis)
53
Q

Management of Alkalosis

A
  • Supply chloride to excrete excess bicarbonate

- Restore fluid volume with sodium chloride solutions

54
Q

Respiratory Acidosis

A
  • Improve ventilation
55
Q

Respiratory Alkalosis

A
  • Correct cause of hyperventilation
56
Q

Innate Immunity

A

Innate Immunity - Non Specific
Neutrophils - Phagocytosis (1st to inflammation)
NK Cells - Nonspecific Cell Antigen Destruction
Dendritic Cells - Antigen Presentation
Monoctye - Macrophage and Phagocytosis

57
Q

Adaptive Immunity

A

B Lymphocytes
- Memory Cells - Antibody response to antigen recognition
- Plasma Cells - Secrete Antibodies and Immunoglobins
T Lymphocytes
- Cytotoxic T-Cells - Specific Cellular Antigen Destruction
- Helper T-Cells - Activation of antigen-specific T-Cells

58
Q

B Cells

A
  • Humoral Immunity
  • Involves formation of antibodies in response to specific antigens
  • Antibodies known as immunoglobins
  • Antibodies bind to target antigens which target it for phagocytosis by neutrophils and macrophages
59
Q

T Cells

A
  • Cellular Immunity
  • T-Lymphocytes recognize antigens processed by macrophages
  • Killer Cells release cytokines that cause cell lysis
  • CD4 enhance the humoral immunity response by stimulating B-Cells to differentiate and produce antibodies.
60
Q

Innate Immunity

A
  • Nonspecific
  • Natural resistance from birth
  • Rapid general response
  • Each exposure is similar response
  • Recognizes non-self
  • Includes barriers, chemical agents, and inflammatory response
61
Q

Adaptive Immunity

A
  • Targets specific antigens
  • Slower response but more effective
  • Involves T and B Lymphocytes
  • Microbes can develop resistance to immunity systems
  • Specific, Diverse, Memory, Recognition
62
Q

Active Immunity

A
  • Development of antibodies to antigens such as having the disease or a vaccine
63
Q

Passive Immunity

A
  • Immunity transferred from host to recipient
  • Mother-Infant transfer from placenta to breast milk
  • Injection of antibodies (immunoglobins)
64
Q

Fetal and Neonate Immunity

A
  • Capable of IgM responses
  • Unable to produce IgG challenge
  • Immunity provided by maternal antibodies where trophoblastic cells transport maternal IgG across placenta.
  • Newborn IgG levels are near adult levels
65
Q

Aging and Immune Function

A
  • Aging results in lowered T-Cell function
  • Thymus gland is 15% of maximum size
  • Decreased production of specific antibodies
  • Increase circulation of antigen-antibody complexes
  • Increase in circulation of autoantibodies
  • Decrease in circulation of B Cells

Older Adults Pt 2 (17 decks)

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