3 (fluids, electrolytes, acid-base, IV therapy) and 6 (infection prevention) Flashcards
control of fluid balance is managed by the receptors: o__ receptors (located in the h__ and provoke the thirst mechanism), b__ receptors (located in the c__ sinus and the a__ arch detect pressure changes stimulating the sympathetic system)
osmoreceptors, hypothalamus
baroreceptors, carotid, aortic
control of fluid balance managed by the hormones: A__ (released by the p__ pituitary, controls fluid by urine and reabsorption of water from kidneys), a__ (regulates reabsorption of water and sodium from kidney tubules)
ADH, posterior
aldosterone
control of fluid balance managed by the b_ natriuretic peptide (or B-type natriuretic peptide) and a_ natriuretic peptide= both promote loss of water and sodium from kidney tubules and cause vasodilation
brain
atrial
3 examples of extracellular fluid (i_, i_, t_)
intravascular, interstitial, transcellular
what electrolyte maintains the osmolality of the intracellular fluid
K+
what electrolyte controls the osmolality of the extracellular fluid
sodium
Movement of fluid and electrolytes; how is fluid moved- what type of transport
Passive transport: diffusion, osmosis, filtration
Active transport requires ATP (amino acids, glucose, iron, hydrogen, sodium, potassium, and calcium)
any disease that affects circulation will ultimately affect the distribution and composition of b_ f_
body fluids
extra fluid is l_ when the metabolic rate is a_; ex’s
lost
accelerated
ex’s: fever, burns, trauma, states of extreme stress
which pt is in need for TPN
pt’s who will be unable to take in fluids or food on their own for an extended period
(think down) thirst; poor skin turgor; weight loss; weakness; complaints of dizziness; postural hypotension; decreased urine production; dark, concentrated urine; dry, cracked lips and tongue; dry mucous membranes; sunken, soft eyeballs; thick saliva; dry, scaly skin; flat neck veins when lying down; rapid, weak, thready pulse; elevated temp; increased hematocrite; high urine specific gravity with low volume
s/s dehydration
(think up) weight gain; slow, bounding pulse; elevated blood pressure; firm subcutaneous tissues; possible edema; possible crackles in lungs on auscultation; lethargy, possibly seizures; possibly visible neck veins when lying down; decreased serum sodium; decreased hematocrit from hemodilution; low urine specific gravity with high volume
s/s overhydration
hydroxyzine
promethazine
prochlorperazine maleate
ondansetron
metoclopramide
antiemetics
diphenoxylate atropine
loperamide HCI
kaolin-pectin
bismuth subsalicylate
camphorated opium tincture
antidiarrheals
an increase in capillary hydrostatic pressure
loss of plasma proteins
obstruction of lymphatic circulation
increase in capillary permeability
causes of e_
general causes of edema
congestive heart failure, liver disease with ascites, and chronic renal failure result in excessive water retention- putting pt’s at risk for which electrolyte imbalance
hyponatremia
water loss from fever, respiratory infection, or watery diarrhea, impaired thirst, or restricted access to water- can cause
what is restricted intake for these pt’s
hypernatremia
sodium
what type of solution shifts fluid into the cell, rehydrating them
hypotonic
what type of solution causes fluid to shift from the intracellular
hypertonic
which type of fluid is infused to a pt getting blood
0.9% NSS
important to keep the s_ sterile when changing the intravenous tubing
spike
cool, pale, pain, and edema are symptoms of IV i_
infiltration
How does a pt receive TPN: c_ v_ c_
central venous catheter
infusion of medications or chemicals into tissues that can cause injury: e_
extravasation
infusion of IV fluids into tissues
infiltration
inflammation of the vein caused by a clot
thrombophlebitis
caused by too-rapid infusion of medications
speed shock
when is TPN begun; how is TPN delivered
when nutrition cannot be delivered by oral intake and PPN or by enteral feedings
PICC- peripherally inserted central catheter
h_ alters the way digitalis is metabolized in the body and predisposes the pt to d_ t_
hypokalemia
digitalis toxicity
fatigue, anorexia, headache, blurred vision, yellow-green halos around lights, nausea, diarrhea, and cardiac dysrhythmias: signs of d_ t_
digitalis toxicity
Lactated Ringer’s solution is: isotonic, hypotonic or hyptertonic
isotonic
sterile water is: isotonic, hypotonic, hypertonic; can cause what; how is it used
hypotonic
hemolysis
used to reconstitute powdered medications
0.9% saline, lactated Ringer solution, dextrose 5% in water, and dextrose 5% in 0.225% saline- isotonic, hypotonic or hypertonic
isotonic
sodium normal range = think odd numbers
135-145
potassium normal range = think bananas
3.5-5
BUN = bunions
5-20
creatinine = think nine
0.6-1.2
glucose = energy
70-100
calcium = milk
8.5 - 10.5
chloride = chlorine (hot tub)
95-105
bicarbonate = think carbonation/ soda x2
23-29
-approx 1/3 of total body water
-transports water, nutrients, oxygen, waste, and more to and from the cells
-regulated by renal, metabolic, and neurologic factors
-high in sodium content
extracellular fluid includes
-fluid within the blood vessels
-consists of plasma and fluid within blood cells
-contains large amounts of protein and electrolytes
intravascular fluid
-fluid in the spaces surrounding the cells
-high in sodium content
interstitial fluid
includes aqueous humor; saliva; cerebrospinal, pleural, peritoneal, synovial, and pericardial fluids; gastrointestinal secretions; and fluid in the urinary system and lymphatics
transcellular fluid
(because it transports)
-about 2/3 of total body fluid
-fluid contained within the cell walls; most cell walls are permeable to water
-high in potassium content
intracellular fluid
what non-fluid sensation can also cause the pituitary to release ADH: p_, n_, s_
pain, nausea, stress
primary triggers for ADH are:
d_ p_ or i_ c_ of blood
decreased pressure or increased concentration of blood
when ECF volume is low or sodium concentration is decreased the adrenal cortex releases a_, causing r_ of sodium from renal tubules
aldosterone
reabsorption
what system regulates release of aldosterone
renin-angiotensin-aldosterone system
baroreceptors in the atrium of the heart detect fluid o_ and stimulate the myocardium to release A_ , which increases s_ excretion
overload, ANP, sodium
what nonelectrolytes contribute to the osmolality of body fluids: p_, g_, b_, c_, u_
protein, glucose, bilirubin, creatinine, urea
acyclovir is which type of antimicrobial drug
antifungal
along with: amantadine, azidothymidine, oseltamivir phosphate, peramivir, saquinavir, zanamivir
lypressin is which type of medication
vasopressor
removing ppe
gloves, goggles, gown, mask, hand hygeine
pt’s who are more susceptible to infection include: 5
pt’s who:
-are already weakened by illness
-have drainage tubes, intravenous catheters, other invasive devices for monitoring or treatment
-very old or very young
-have had recent surgery
-are immunocompromised
speed of action in innate immunity is r_, and occurs in s_ h_
rapid, several hours
pt’s will be more c_ with therapy if they understand the purpose of the treatment
compliant
latent phase of any communicable disease: pt is a_ to transmit the disease to others, s/s are o_ n_ present, pt may n_ feel ill or have general malaise
able
often not
not
Body’s protective and defensive mechanisms against infection: f_, n_, a_, a_, b_, l_, p_, m_, l_
fever
nutrition
antigens
antibodies
bone marrow
liver cells
leukocytosis
phagocytosis
macrophages
Body’s mechanisms of defense:
Adaptive immunity-
a_-m_ i_ r_ (B lymphocytes)
c_-m_ i_ r_ (T lymphocytes)
Innate immunity-
i_ s_, n_ f_, m_ m_, GI tract, GU tract, i_, phagocytosis by white blood cells, f_
antibody-mediated immune response
cell-mediated immune response
intact skin
normal flora
mucous membranes
inflammation
fever
-decreased: skin turgor and greater skin friability,
elasticity and atherosclerosis of peripheral vessels, GI tract motility as muscles weaken, acid production, immune response because bone marrow does not produce new blood cells as rapidly, ciliary action from smoking or exposure to air pollution
-calcification of heart valves
-stiffness of thorax from arthritis or aging changes
- weakened respiratory muscles
-prostate changes, bladder prolapse, and urethral strictures
changes in natural defense mechanisms that occur with age
Airborne precautions: disease (MTv’s)
measles, tuberculosis, varicella-zoster (chickenpox and shingles, and variola (smallpox), SARS (severe respiratory syndrome)
Contact precautions: ABCDEF
-abscess- large and major drainage
-bronchiolitis- RSV and parainfluenza
-cutaneous- herpes zoster, varicella, herpes simplex, impetigo, lice, major pressure/ decubitus ulcers, —scabies, major staph/strep, skin wounds/burns, —-diphtheria
-diarrhea- c. diff, norovirus, rotavirus, hep a
-eyes- conjunctivitis -acute, viral
-funky/feisty- MDRO’s
droplet precautions- MY PERfect MUM FLU a Dozen STRong MEN on a PLAne to a PARk in GERMANY to ADd a NEW EPIc RHINO
mycoplasma pneumonia (walking pneumonia)
pertussis (whooping cough)
mumps
flu
diptheria (pharyngeal)
streptococcus
meningitis
plague (pneumonic)
parvovirus B 19 (5th disease)
german measles (rubella)
adenovirus
pneumonia
epiglottitis
rhinovirus
Contact:
Mode of transmission
PPE
Room type
prevent transmission of infections spread by direct or indirect contact with the pt or pt’s environment
gown and gloves
single-pt room
Droplet:
Mode of transmission
PPE
Room type
prevent transmission of infections spread via air droplets by coughing, sneezing, talking, or close contact with respiratory secretions/mucous membranes
surgical mask
single-pt room
Airborne:
Mode of transmission
PPE
Room type
prevent transmission of infections that remain infectious over long distances when suspended in the air
N95 or higher level respirators
airborne infection isolation room
negative pressure, special ventilation
What is sepsis
S/S to watch with pt’s at risk for sepsis (systemic inflammatory response syndrome SIRS)
conditions that can lead to sepsis
infection enters bloodstream
change in mental status, tachycardia, tachypnea, changes in bp, decreased urine output, fever, elevated WBC
pneumonia, UTI, and post-surgical wound infections
what is shock, what can it lead to
circulatory failure causing inadequate perfusion of the tissues - there’s an underlying process preventing us from delivering adequate oxygenated blood to tissues and organs- can lead to tissue hypoxia, cell death, organ failure
