CCRN- Endocrine/Hema/Renal/GI Flashcards
SIADH
too much ADH
-kidneys hold on to water leading to hypodilutional vascular volume» hyponatremia and hypo-osmolar
With ↑ADH = ↓ Na ↓ serum Osmo ↓ UOP
Causes:
> oat cell carcinoma- tumor in apical portion of lung makes own ADH
>Viral PNA- hypoxic areas of lungs stimulates posterior pituitary to release ADH
> Head problems
> Incr serum osmo from dehydration, anesthesia, analgesics, stress
Complications:
>w/ vascular volume full of water retention, the water is going to go into brain cells where there is a higher concentration»_space; RISK FOR SEIZURES
Tx:
>fluid restriction, treat cause, Hypertonic solution (NaCl 3%, D5NS, D5 0.45%NS to make vascular volume more concentrated
Hypertonic solutions
NaCl 3% - Osmolarity 1500 (25ml/hr max)
D5NS- Osmolarity 565
D5 0.45%NS - Osmolarity 406
Goes into less concentrated area, vessels
Hypotonic solutions
All hypotonic sol’n goes into the cells
- 45% Saline - Osmolarity 155
- 33% Saline - Osmolarity 100
- 5% Dextrose - Osmolarity 130
Note: D5W is isotonic in the bag, but hypotonic in the body. The body takes up the dextrose then water goes into the cells (b/c water goes where concentration is higher)
Normal values for
- Na,
- Osmolarity,
- Urine specific gravity
Na 135-145
Osmo 275-295 ( range is Na x2)
Urine Specific Gravity 1.005 - 1.030
DI
NO ADH, so the body isn’t holding on to any water
>hypernatremia and hyperosmolar in vascular spaces
With ↓ADH = ↑ Na ↑ serum Osmo ↑ UOP
UOP is 6-24L per day!
Urine specific gravity 1.001 - 1.005 (lower than normal)
Causes:
>Head problems
>Dilantin
Complications:
>severe hypovolemia leading to Shock
Tx: give ADH- Pitressine, vasopressin (also vasoconstrictor so monitor EKG for ischemia)
IVF, monitor urine specific gravity
Hypoglycemia - cardiovascular and CNS s/s
When you’re low on glucose adrenaline is released which goes to liver which converts glycogen to glucose
Cardiovascular s/s:
- tachycardia
- palpitations
- diaphoresis
- irritable
- restless
- *if pt on Beta blockers, all these symptoms are masked!!!
CNS s/s:
- confusion
- lethargy
- slurred speech
- seizure
- coma
DKA
Diabetic Ketoacidosis
BG 400-900
Dehydration 4-6L
Tx: Insulin gtt (ALOT!!) + fluids (NS, 0.45%NS, D5 0.45%NS)
> > When body isn’t making insulin, acidosis occurs and thus K+ is elevated d/t acidosis
Kussmaul breathing- labored, deep, hyperventilation
HHNK
Hyperglycemia Hyperosmolar Non-Ketotic
BG > 1000 SEVERE DEHYDRATION (look like neuro pt)
Who gets it?
- old age
- pt on TPN
- Diet controlled diabetics
- Pancreatitis
- Thiazide (makes kidney hold on to glucose)
- or steroid therapy
Tx: TON OF FLUIDS + a little insulin
»The pt is still making insulin, takes small baby breaths
For every drop in pH by 0.1, how much does K+ increase?
by 0.6
If pH drops from 7.35 to 7.25,
The K increases from 5.1 to 5.7
> > correct the pH with Bicarb to increase pH and K+ will go into the cells
Pancreatitis
-this is autodigestion of the pancreas
Causes:
- *main cause obstruction of pancreatic ducts
- gall stones
- infection
- alcoholism
- drug toxicity (cyclosporins, steroids, thiazides, tetracyclines)
- trauma
> > note pt is hypocalcemic w/ pancreatitis since the needs calcium to break down fat; they also develop HHNK b/c the body isn’t producing enough insulin
**also develop Left side atelectasis (rapid, shallow breathing) and pleural effusion (SOB, sharp pain), bilateral rales
@@@@PT CAN DIE FROM ARDS:
- –the pancreas releases phspholipaise A and kills the alveoli cells and you don’t develop anymore surfactant
- -Cullens sign (belly button black and blue)
- -Gray turners sign (flank/groin black and blue)
- -elevated amylase
Bowel obstruction- small vs large
Small bowel there is small distention:
–b/c the pt is vomiting and having diarrhea. It’s leaving the body
Large bowel there is large distention b/c nothing is leaving the body
With liver disease, which diuretic is appropriate?
Potassium sparing, aldactone. Don’t give lasix.
> with liver dz you don’t want K+ levels to drop b/ the kidneys will hold on to K+ as well as ammonia
What will cause ammonia levels to rise in liver patient?
↓ K+ ↑BUN ↑Proteins ↑Acids ------------------------------- ==hepatic encephalopathy
-AVOID dehydration, this will cause ↑BUN
-AVOID increase in proteins b/c the body will produce ammonia with the breakdown of proteins and cause hepatic encephalopathy
-AVOID increase in acids (metabolic acidosis)
»don’t give LR b/c it’s converted to Bicarb by the liver
How does liver disease cause esophageal varices and spleenomegaly?
The kupper cells of liver detoxifies the blood
The liver rcvs 1500ml/min of blood
–blood drains from esophagus, stomach, spleen, intestines to the liver»_space; so if liver bad then there is backflow of pressure
Neomycin therapy complication
Neomycin is abx given to treat a condition in which the liver doesn’t filter toxins properly
> > abx kills the bacteria in the gut, preventing production of ammonia.
However, bacteria makes vitamins, so when killed the pt is left with vitamin deficiencies
