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
Liver failure vs Gall Bladder problem
Hepatic failure:
If Bilirubin indirect or unconjugated is HIGH
Gall Bladder:
If increase in direct or conjugated bilirubin
classic symptom of a ruptured spleen
Kehr’s sign is the occurrence of acute pain in the tip of the shoulder due to the presence of blood or other irritants in the peritoneal cavity when a person is lying down and the legs are elevated.
Acute renal failure
>Pre-renal
-ACUTE = decreased UOP of <400ml in 24 hrs
Pre-renal: Urine sodium 20-200
↓UOP d/t low blood supply to kidneyes
> CHF or hypotension
>Urine Na 20 w/ pre-renal b/c the kidneys want to hold on to the Na to increase water retention
BUN/Creat 20:1
»lasix or fluid challenge , see ↑UOP
Acute renal failure
>RENAL
Urine sodium 40-100
Renal: Urine sodium 40-100
↓UOP d/t kidney damage to tissues or nephrons >>Acute tubular necrosis (ATN) d/t ---ischemia *hemorrhage *burns, sepsis *HF *Transfusion rxn
- –nephrotoxicity
- eating heavy metals
- medications
- street drugs
- rhabdo
- contrast induced
BUN/Creat 10:1
»lasix or fluid challenge , see ↓UOP
CRRT modes for hemodynamically unstable patients:
- fluid overloaded
- acute or chronic renal failure
- electrolyte imbalances
- drug overdose
***SCUF- slow continuous ultra filtration
»primary goal is fluid removal
CVVF- Con’t Veno-Venous Hemofiltration
»fluid mgmt with some solute removal
Chronic renal failure
-the decline in kidney fxn correlates w/ the degree of nephron loss, which can be linked to serum creatine levels
