Adult health 2 - unit 2 exam Flashcards
Metabolic Alkalosis
what is it and what does it look like
Increased pH and Increased bicarbonate
if it is an increase in base components it requires medical treatment and disease process
it looks like CNS overexcitement/ Muscle cramps and arrhythmias
what causes it metabolic alkalosis
Severe vomiting/ Excessive gi suctioning/ diuretics/ excessive NaHCO3
Metabolic alkalosis
what are you going to do about it?
correct underlying causes, hydration oxygen, electrolyte monitoring Administer medications (Bronchodilators, Antiemetics. Antidiarrheals)
Respiratory Acidosis
what is It? what does it look like?
increased production of hydrogen ions
it looks like hyperventilation, rapid shallow respirations, pale muscous membranes/ headache/ hyperkalemia/ drowsiness/ muscle weakness/ hyperreflexia
Respiratory acidosis
what causes it?
Respiratory depression, inadequate chest expansion, airway obstruction, reduced alveolar-capillary diffusion, improper mechanical ventilation
Respiratory acidosis
what am I going to do about it?
administer Oxygen, Semi-fowlers position, TCDB, Monitor potassiun levels,
Respiratory alkalosis
what is it? what does it look like?
what is it? fluid imbalance caused by excessive loss of carbon dioxide
what does it look like S/S? Tachycardia, Hyperventilation, Tetany, EKG changes, hypotension or normal blood pressure, Deep rapid breathing, Lethargy/ confusio, N/V
Respiratory alkalosis
what causes it?
Hyperventilation/ mechanical ventilation
what are you going to do about respiratory alkalosis
correct underlying causes, hydration, oxygen, electrolyte monitoring, administer the medications
(Bronchodilators, Antiemetics/ Antidiarrheals)
Metabolic acidosis
what is it?
what does it look like?
What is it? a fluid imbalance tha is caused by overproduction of hydrogen Ions
what does it look like? Kussmal Respirations, N/V, Decreased muscle tone and reflexes, Hyperkalemia, Warm, flushed skin/ Muscle twitching
Metabolic acidosis
what causes it?
overproduction of hydrogen ions/ underelimination of hydrogen ions/ underproduction of bicarbonate ions/ over-elimination of bicarbonate ions
what are you going to do about Metabolic acidosis?
what are you going to do about it? Monitor Intake and output, Administer Iv solution of sodium bicarb, initiate seizure precautions, Monitor potassium levels
(dialysis for kidney disease)
(for DKA give insulin and monitor for hypovolemia due to polyuria)
hypernatremia
what is it? high value of sodium electrolyte levels
what is the value of Hypernatremia? >145
what does it look like? (FRIED) fever, restlessness, increased bp, Edema, Decreased Urine, Dehydration
what causes it? Hyperaldosteronism, Kidney failure, Corticosteroids, Cushing syndrome or disease, Excessive Oral Sodium ingestion, Excessive administration of sodium-containing IV fluids
what are you going to do about it? Medications, Monitor I/O’s, Dietary Na restrictions, Iv fluids
Hyponatremia
what is it? a low sodium value
what is the diagnostic value? <136
what causes it? excessive diaphoresis, Diuretics, wound drainage, decrease secretion of aldosterone, Low sodium diet
what does it look like? sudden onset of confusion/ increased confusion, Muscle weakness, GI changes
what are you going to do about it? Fluid restriction, Oral Na supplements, Dietary teaching, Hypertonic solutions
Hypocalcemia
what is it? low calcium level in the blood
what does it look like? Convulsions, Arrhythmias, Tetany, Spasms/ stridor and skeletal changes
what are you going to do about it? Drug therapy Nutrition therapy
what are signs of hypocalcemia? Positive ckvostek sign and Trousseau sign
Hypercalcemia
what is it?high level of calcium
what Is the diagnostic value for the calcium? >10.5 mg/dL
what does it look like? Cardiovascular changes, Neuromuscular changes, Intestinal changes
what causes it? excessive oral intake of calcium, Excessive oral intake of Vitamin D, Kidney failure, Use of thiazides diuretics
what are we going to do about it? Drug therapy, ROM exercises, rehydration, dialysis, Cardiac monitoring
Hypomagnesemia
what is it? low level of magnesium in the body
what is the diagnostic value? <1.3
what does it look like? Neuromuscular changes(Increased nerve impulse transmission), intestinal changes (decreased intestinal smooth muscle)
what causes it? Malnutrition, Starvation, Diarrhea, Steatorrhea, Celiac disease, Crohn’s disease, Medications
what are you going to do about it? Balance and maintain, Drug therapy replace the Magnesium intravenously but always have Calcium gluconate available
Hypermagnesemia
what is it? a high value of Magnesium in the body
what does it look like? cardiac changes, CNS changes, Neuromuscular changes
what causes it? Increased Magnesium intake, decreased kidney excretion
what are you going to do about it? reducing serum magnesium levels, drug therapy, Calcium
Hypokalemia
What is it? low potassium level in the body
what does it look like? toxicity to digoxin, U wave on EKG, Constipation, Irregular/ weak pulses, Numbness, Respiratory changes
what causes it? Diuretics, Poor Diet, Fluids, N/V/D, Prolonged NG suction, Wound drainage
what are you going to do about it? Prevention by increasing K supplements, IV potassium, Nutrition therapy
Hyperkalemia
what is it? too much potassium in the body
what causes it? Ingesting potassium, IV potassium, Adrenal insufficiency, potassium-sparing diuretics, ACE inhibitors
what does it look like? Cardiac changes, Tingling and burning, Hyperactive bowel sounds
what can you do to treat it? Kayexalate, Stop Potassium-containing IV infusion, Stop oral potassium meds, Dietary restrictions
Hypophosphatemia
what is it? low phosphate level in the body
what is the diagnostic value? less than 3.0
what does it look like? anemia, coma, constipation, muscle weakness, Hypoactive bowel sounds
what causes it? Diet, Malabsorption
what are you going to do about it? Drug therapy, oral replacement if stable, iv oral replacement if symptomatic
Hyperphosphatemia
what is it? too much phosphate in the system
what is the diagnostic value? level greater than 4.5
what does it look like? Tetany, Calcification, Convulsions, Cardiac arrest, prolonged QT interval
what causes it? renal failure, excessive intake of phosphorus
what are you going to do about it? Diet Modifications, Dialysis if renal failure is underlying cause, Drug therapy Phosphate binders
Hypochloremia
what is it? low chloride levels
<98
what does it look like? Tetany-like symptoms, diaphoresis, Fever, weakness
what causes it? Diarrhea, Vomiting, Excessive Sweating, Kidney problems
what are we going to do about it? rehydration, treat symptoms
Hyperchloremia
What is it? high levels of chloride in the blood
what does it look like? Dyspnea, Fatigue, Muscle weakness, Tachycardia
what causes it? Excess salt intake, renal failure, metabolic acidosis, Hypertonic fluids
what are you going to do about it? treat dehydration, stop fluids with saline and dietary restrictions
what are examples of Hypotonic fluids
0.45% NACL/ 5% Dextrose
what are examples of isotonic fluids
0.9% NS/ 5% albumin/ Lactated ringers
what are examples of hypertonic fluids
3% Saline/ Mannitol/ 20% Albumin/ D51,2Ns/
Albumin
what is it’s diagnostic lab values? 3.5-5 g/dL
what can low levels indicate? kidney injury/ Malnutrition/ Used to Shift Fluids
Irritable Bowel Disease
what is it? chronic inflammation of the GI tract
what does it look like? it can look like Crohns or Ulcerative Colitis
what causes It? there is no exact cause but can be influenced by a combination of factors, including environmental factors, genetic predisposition, and alteration in the function of the immune system.
what education would you provide for the patient? avoid the long-term use of NSAIDs it can cause excessive gastric secretions,
what are some of the clinical manifestations? Diarrhea, Bloody stools, weight loss, abdominal pain, fever, fatigue, Mild to severe exacerbations
what are some interventions you can implement? implement a Bland diet, Aminosalicylates, Antimicrobials, Corticosteroids, Immunosuppressants, and biologic and targeted therapy, Antidiarheal Medications
Gallbladder disease or cholecystitis
what is it? Inflammation of the Gallbladder it can be classified as chronic or acute stones in the gallbladder
what does it look like? clay colored stools, severe pain that lasts for an hour then usually subsides, the attack of pain occurs 3-6 hours after a high fat meal and the patient lies down , diaphoresis.
what are the risk factors? 4 F’s (fluffy, farty, female, fertile) in females over 40 years old, sedentary lifestyle, familial tendency, and obesity
what are some education you would provide for the patient? don’t eat fatty foods, proper dietary management
what are some interventions you can implement?
NONSURGICAL
- Avoid fatty foods, opiod analgesic, Ketorlac, Urosodiol and Chenodiol, Extracorporeal shock wave lithotripsy
SURGICAL
-laparoscopic cholescystectomy
-traditional cholescystectomy (abdominal Laparotomy) it is used from severe obstruction, Drainage tube JP drain and another drainage tube T tube
Peptic Ulcer Disease
what Is it? Occurs when mucosal defenses become impaired, epithelium not protected from effects of acid and pepsin
what causes it? many of PUD is caused by the infection of H. Pylori and NSAIDs and other substances that increase gastric secretion
what does it look like? Epigastric tenderness and pain/ rigid board-like abdomen with rebound tenderness and pain (peritonitis) and chronic gastritis
what education are you going to tell the patient? Nutrition therapy and complementary and integrative therapies
what are the diagnostic assessments for PUD? testing for H. Pylori/ Hemoglobin and hematocrit/ Occult blood in the stool/ EGD/ Nuclear medicine scan
what are some interventions you will implement?
PPI Triple therapy (Two Antibiotics/ PPI). PPI quadruple therapy (PPI with Bismuth and two antibiotics) / H2 blockers these medications promote healing of the stomach ulcer by decreasing secretion of Gastic acid
what are some complications of Peptic Ulcer disease
Hemorrhage/ Perforation
Hemorrhage is the most severe complication
how Is Crohns disease different from Ulcerative Colitis?
Crohns disease can be anywhere in the GI tract and UC is limited to the large intestine and colon/ pattern of inflammation of Ulcerative colitis us typically found int he lower left abdomen and for Crohns it is also in the lower left abdomen/ Appearance of inflammation and location of the pain for Ulcerative colitis are in the ulcers the inner lining of the abdomen only and Crohn’s disease penetrates the entire thickness/ Bleeding in Ulcerative colitis is common during a bowel movement and for Crohns it is not
Ulcerative colitis
What is It? Widespread chronic inflammation of the rectum and rectosigmoid colon
where does it affect?
what does it look like? periodic remission and exacerbations, stool contains blood and mucus, Low grade fever findings are nonspecific Decreased H/H, increased WBCs, C reactive protein, ESR low sodium, potassium, chloride and hypoalbuminemia
they can have diarrhea, acute or persistent pain and potential for lower GI bleeding
what causes it? Genetic, immunological and environmental factors it is often found in families and twins and cellular changes can increase colon cancer risk
what are some diagnostic assessments? MRE, Upper endoscopy, Colonoscopy
what education would you provide this patient with? how to manage the diarrhea, manage the pain at home, preventing or monitoring for Lower GI bleeding
what are some interventions the nurse will implement for the patient?
NONSURGICAL
-physical and emotional rest/ record weight/ color, volume, frequency & consistency of stools/ Perineal area
DRUG THERAPY
Aminosalicylates/ Glucocorticoids/ Antidiarrheal drugs such as Diphenoxylate hydrochloride, atropine sulfate, loperamide
(too much antidiarrheal drugs lead to toxic megacolon)/
Immunomodulators and nutrition therapy and rest of (NPO, TPN, DIET)
SURGICAL this is only necessary when complications occur such as Toxic megacolon, Hemorrhage, Dysplastic biopsy results, Colon Cancer
-End-to-end anastomosis/ restorative proctocolectomy with ileal pouch-anal anastomosis the procedure of choice
Ileostomy, STOMA
How does Irritable Bowel Disease relate to Crohn’s Disease and Ulcerative Colitis?
Irritable bowel disease is the condition but is qualified in 2 sections that are Crohns and Ulcerative Colitis
Crohns disease
what is it? Chronic inflammatory disease of small intestine, colon or both
what does it look like? unintentional weight loss, stool characteristics, fever, abdominal pain/ Assess for distention, masses, visible persistalsis/ Anemia is common
what are the diagnostic tests for it?
what are some education for the patient?
what are the interventions the nurse will collaborate with the doctor on?
NONSURGICAL
5 ASAs, Azathioprine/ Mercaptopurine/ Methotrexate (moderate to severe), Biologic response modifiers
SURGICAL
resection of diseased area
(this is only performed when improvements has not been made in the patient with the nonsurgical route or they have complication of the Crohns disease
what are the complications of Ulcerative colitis?
Toxic Megacolon, Hemmorhage, Bowel perforation, Dysplastic biopsy results, Colon cancer
what are the complications of Crohns disease
Hemorrhage, Severe Malaborption, Malnourishment, debilitation, Cancer
Nasal Cannula
1-6 lpm
simple face mask
start at 5 LPM
Rebreather mask
6-11 ppm
Non-rebreather mask
10-15 ppm
