Acute Quiz 1 Flashcards
Hypovolemia Definition
Loss of fluids (plasma, blood, water)
Hypovolemia Clinical Manifestations
dehydration, significant blood loss, fatigue, elevated HR (maintain CO)
Hypervolemia Definition
excessive fluid intake or fluid retention
hypervolemia clinical manifestation
fatigue, shortness of breath, usually related to abnormal retention of fluid due to heart failure
Basic Metabolic Panel (BMP)
Sodium (134-142 mEq/L), chloride (98-108 mEq/L), BUN (6-21mg/dL), Potassium (3.7-5.1mEq/L), CO2 (22-29 mol/L), Creatinine (0.8-1.4mg/dL), Glucose (70-100mg/dL)
Hypernatremia Definition
High Levels of Sodium (Na+), usually due to high salt intake and severe dehydration
hypernatremia clinical manifestation
irritability, hypotension, tachycardia, depressed urine output, >150 may need to hold therapy
hyponatremia definition
Low sodium levels, due to anything leading to hypovolemia/hypervolemia
hypoatremia clinical manifestation
headache, lethargy, confusion, seizures, coma, <125 may need to hold therapy
Sodium (Na+)
assists with fluid balance, muscle contraction, regulates neuromuscular activity
Hyperkalemia Definition
High potassium, caused by impaired excretion(renal failure), medication, excess intake
Hyperkalemia Clinical Manifestation
muscle weakness, paralysis, numbness/tingling, bradycardia, ventricular fibrillation, cardiac arrest, deter treatment >5.1
hypokalemia definition
low potassium, caused by excessive loss (diarrhea, vomiting) or inadequate intake
hypokalemia clinical manifestation
extremity weakness, numbness and tingling, leg cramps, cardiac arrhythmias and arrest, deter Rx <3.2
potassium (K+)
involved in neuromuscular functioning of skeletal and cardiac muscle, and in protein synthesis, can be replenished through IV (V small window)
hypercalcemia definition
high levels of calcium, due to excess intake or release from bones, inadequate excretion by kidneys
hypercalcemia clinical manifestations
cardiac arrhythmias ( bradyarehythmias ), asystole, lethargy, weakness. possible poor tolerance to Rx (defer for arrhythmias)
hypocalcemia definition
low calcium levels, caused by inadequate dietary intake, limited absorption in GI, excess loss
hypocalcemia clinical manifestations
anxiety, confusion, irritability, arrhythmias (ventricular tachycardia risk), fatigue, muscle cramps, therapy contraindication <CV 6.0
Calcium (Ca2+)
functions in bone formation, cell growth and division, blood clotting, muscle contraction, and neuromuscular functioning
hyperchloremia definition
low chloride, caused by high salt diet w/o water, IV solutions, kidney failure
hyperchloremia clinical manifestation
lethargy, weakness, tachypnea/dyspnea, tachycardia
hypochloremia definition
low chloride, caused by decrease intake or too much water, excessive loss (vomiting, diarrhea, diuretics)
hypochloremia clinical manifestation
agitation, irritability, cramping, twitching
chloride (Cl-)
normal (98-108mEq/L), major anion in extra cellular fluid. accompanies sodium to maintain osmotic pressure of blood. maintains electrical neutrality
CO2 (BMP) (22-29 mmol/L)
high- respiratory acidosis (lower pH, and lethargy)
low- respiratory alkalosis (elevated pH, dizziness/ confusion)
Creatinine (Cre)- Kidney Panel {norm:0.5-1.2mg/dL)
byproduct of muscle metabolism, if increased: (impaired GFR, muscle injury), pt’s mental status is altered
BUN (blood urea nitrogen) (kidney panel)norm: 6-30mg/dL
urea forms in liver, increased (renal impairment, high levels of protein breakdown), pt’s altered mental state
Hyperglycemia Definition
High Blood Sugar, occurs with diabetes, acute stress, and steroids
hyperglycemia clinical manifestations
deter Rx for BS of >300-500, critical level >450 (life threatening, risk of diabetic ketoacidosis)
hypoglycemia definition
low blood sugar, occurs in presence of too much insulin, inadequate food intake
hypoglycemia clinical manifestations
dizziness, shakiness, CV <50 hold treatment, symptoms can appear <60-70
blood glucose
normal (ages 2 and up)= 70-100mg/dL
Liver Function Tests (LFT)
liver function can really impact mental status, no direct PT regulations
Complete Blood Count (CBC)
WBC, Hgb, Hct, PLT
WBC normal
4,000-11,000
Hgb normal
13-18 gm/dl (male)
12-16 gm/dl (female)
Hct normal
40.7-50.3% -male
36.1-44.3%- female
PLT normal
150,000-350,000
WBC <4000
increased risk for infection hand hygiene (leukopenia)
WBC > 11,000
leukocytosis- dealing with some sort of infection, can be a result of increase stressed, symptoms can include fever, weakness, dizziness
Low Plt
increased risk of bruising, bleeding, need to be mindful of fall risks/bumping into things
High plt
increased risk from thrombosis (clot)
plt <5k
strict bed rest
plt 5k-20k
AROM, walking in room, light ADL
plt 20k-50k
light resistance training, bike, walking as tolerated
plt 50k-150k
mod resistance training, bike, walking as tolerated
plt 150k-450k
activity as tolerated
Low Hgb
symptoms of low oxygenation, decreased tolerance to exercise, fatigue, tachycardia
low Hgb CV
CV<8 (therapy may contraindicate… likely transfusion)
CV<5 (can progress to heart failure or death)
CV>20 (clogging of capillaries, blood thickening)
Hct CV
CV <15-20% (severely reduced tolerance to exercise, SOB) [mostly due to surgery]
CV> 60% (clogged capillaries)
Coagulation Profile Tests
-Prothrombin time (PT)
-International Normalized Ratio (INR)
-Partial Thromboplastin Time (PTT)
-Activated Partial Thromboplastin Time (aPTT)
-D-diner
International Normalized Ratio (INR): normal: 0.8-1.2
used for monitored Coumadin (Warfarin) dosage
-pt at higher riskier for bleeding >3.6
-absolute hood for activity >6.0
Partial Thromboplastin Time (PTT): normal 30-45 seconds
Used to monitor affects of heparin
-therapeutic range (for effective anti coagulation) 2-2.5x normal [60-109s]
> 70s increased risk for spontaneous bleeding
Cardiac Biomarkers
Troponin I/ Troponin T- TnI, TnT
used for diagnosing MI or other inflammatory trauma to heart, if these are increasing heart is still being damaged
norm TnI: <0.04ng/mL
norm TnT: <0.01ng/mL
Vesicular Lung Sounds
most commonly heard lung sound, heard over most lung surfaces
:quiet, mostly heard on inhale, soft low pitched, rustling quality
Bronchovesicular Lung Sounds
heard over 1st and 2nd intercostal spaces b/w scapulae, equal inhale and exhale, mixture of bronchial breath sounds near trachea and vesicular sounds of alveoli
Bronchial Lung Sounds
heard adjacent to manubrium/main stem bronchi, longer expiratory vs inspiration sound, low pitched, hollow sound
Respiratory Rate
Normal: 12-18 breaths per minute, tidal volume 500cc
Physiological Effects of BedRest
-deconditioning: loss of physiologic and performance adaptations
-multi-system involvement
Atrophy: bed rest
predominate response to rest , reduction in muscle bulk and density in bone size, can also see a loss of neuromuscular excitation
muscle length: bed rest
Reduced ROM, loss of muscle fiber length, contracture formation/deformities
(affects blood flow, puts pt at risk for pressure injuries)
cardiovascular adaptations : bed rest
reduction of aerobic power, reduced CO from reduced blood volume, increased HR, increased venous compliance (stretch), orthostatic intolerance (trouble getting blood to head)
orthostatic intolerance : bed rest
postural hypotension
-plasma volume loss and excessive pooling of blood in lower extremities when upright
-decline in cerebral perfusion
vital sign changes: bed rest
-increased HR (trying to maintain CO)
-exaggerated HR response w/ activity
*3 days of BR ^32%
*7 days of BR ^62%
*21 days of BR ^89%
DVT : bed rest
people on airplanes are at risk
-Virchows Triad (venous stasis, hyper coagulability, vessel trauma)
-reduced muscle pump
-manifestations are pain and swelling
risk of PE: bed rest
PE- peripheral clot that travels and lodges in lung
symptoms of PE: dyspnea, tachypnea, chest pain, cough
pulmonary affects: bed rest
-reduced ventilators muscle strength and endurance
-decreased strength of contraction
-increased RR and work of breathing
-contributes to atelectasis (collapse of alveoli) mucus pooling and impaired cilia functioning * PNEUMONIA*
gastrointestinal affects :bed rest
-reduced appetite, fluid intake
-increased risk for reflux
-constipation
genitourinary affects: bed rest
-increased diuresis
(excretion of sodium’s and fluid in urine, reduced blood volume)
-difficulty voiding
-increased risk of UTI
integumentary affects: bed rest
-pressure injuries (bony prominences)
psychological affects: bed rest
-increased number of stressors isolation
-sleep deprivation
-impaired cognition
-dependency
-reduced tolerance to pain
-depression and anxiety
-delirium
Delirium: bed rest
sense of vulnerability, high confusion
movement can clear delirium
VS respiratory rate (normal)
12-18 breaths per minute equal rate and depth
VS Pulse Rate norm
60-100 beats per minute
VS blood pressure norm
120/80
prehypertensive BP
120-129/ <80
stage 1 hypertension BP
130-139 / 80-89
stage 2 hypertension BP
> = 140 or >=90
hypertensive crisis BP
> = 180 and or >120
