Disease States & Conditions Flashcards
Fluid Volume Excess: Hypervolemia
Too much fluid in vascular space
Cause: Heart Failure> decreased CO> decreased kidney perfusion (RF)> decreased Urine Output
Too much Na+ (Alka-Seltzer, Fleet enema, IV fluid with Na+)
S/S: Distended neck veins, peripheral edema, increased CVP, wet lung sounds (base of lung), SOB, polyuria, bounding increase pulse (prevent PE), increased BP, increase weight
Tx: low Na+ diet, I&O, daily weights, diuretics (loop - Lasix, Thiazide, K+ sparing - Aldactone), bed rest (infuse diereses > increase ANP, decrease ADH, watch for DVT and Kidney stone)
Fluid Volume Deficit: Hypovoemia = Shock
Cause: surgery trauma, vomiting, diarrhea, hemorrhage, NG tube suction
Third Spacing (Burns, Ascites - measure abdominal girth)
Polyuria> Oliguria> Anuria (RF)
S/S: weight decrease, decrease skin turgor, dry mucus membranes, decrease UO (Kidney aren’t perfused or compensating to hold on to fluid), decrease BP, increase pulse (heart pumping what little blood is left), increase reap (body things low BV is hypoxia> increase reap), decrease CVP, cool extremities (vaso constriction to shunt blood to vital), increase urine specific gravity
Tx: prevent further losses, replace fluid (PO or IV), safety precaution (fall risk, monitor for fluid overload -in young, old, Hx of Kidney & Heart problems-)
Hyper-Magnesemia
Act like sedative
Mg excreted by Kidneys, Think MUSCLES first
Cause: RF, antacids
S/S: Vasodilatation (flushing, warmth, decreased BP), Relaxed muscles, decrease DTR, decreased muscle tone, possibility of arrhythmias, decreased LOC, decreased pulse, decreased reap
Tx: ventilator, dialysis, Calcium gluconate -max rate: 1.2-2 ml/min- (antidote to mag toxicity and prevent arrhythmia)
Hyper-Calcemia
Act like sedative
Calcium has inverse relationship with Phosphoeous, Think MUSCLES first
PTH makes serum Calcium go up
Causes: Hyper-parathyroidism (pulls Ca+ from bone), Thiazides (retain Ca+ -Fact-), immobilization (weight bearing prevents Ca+ leakage from bones)
S/S: brittle bones, Kidney stones (due to high serum Ca+), decrease DTR, decrease muscle tone, arrhythmias, decrease LOC, decrease pulse, decrease reap
Tx: Move, fluids (prevent kidney stones), Phospho soda & Fleet enema ( both have Phos), steroids, add protein to diet (contains Phos), safety precautions, must have Vit D to use Ca+, Calcitonin decreases serum Ca+ (osteoporosis treatment)
Hypo-Magnesemia
No Sedation
most Mg comes from diet
Causes: Diarrhea, Alcoholism (poor diet, ADH supression & hypertonic cause more urination)
S/S: rigid/tight muscle tone, possibility of seizure, stridor/laryngospasm -airway is smooth muscle, positive Chcostek’s sign, positive Trousseau’s sign, Arrhythmia - heart is muscle (right/tight tone), increase DTR, mind changes, swallowing problems -esophagus is smooth muscle
Tx: give Mg+ (check renal fxn first - STOP if flushing/sweating, if UO drops- sign of Mg+ toxicity), seizure precautions, eat Mg+ (spinach, mustard greens, summer squash, etc.)
Hypo-Calcemia
No Sedation
Think muscles first, Ca+ inverse Phos
Causes: hypoparathroidsm, radical neck, thyroidectomy (not enough PTH)
S/S: rigid/tight muscle tone, possibility of seizure, stridor/laryngospasm -airway is smooth muscle, positive Chcostek’s sign, positive Trousseau’s sign, Arrhythmia - heart is muscle (right/tight tone), increase DTR, mind changes, swallowing problems -esophagus is smooth muscle
Tx: Vitamin D (utilize Ca+), Phosphate binders (renagel, calcium carbonate, Os-Cal), IV Ca+ - GIVE SLOWLY- and make sure Pt is on heart monitor (STOP if IV Ca+ widens QRS complex, & slow HR, give Epi
Hyper-Natremia: Too much Na- not enough H2O
Think Neuro Changes
Causes: vomiting, diarrhea, hyperventilaiton (insensible losses), heat stroke, Diabetes Incipidus, tube feeding can dehydrate client
S/S: dry mouth, thirsty, swollen tounge
Tx: restrict Na+, dilute with fluids, daily weight, I&O, lab work
Hypo-Natremia: Too much water - not enough Na+
Think Neuro Changes
Causes: drinking too much water for fluid replacement (vomiting, sweating), psychogenic polydipsia, D5W, SIADH (retain all water)
S/S: headache (neuro changes), seizure, coma
Tx: if neuro changes give hypertonic saline (packed with particles - 3%, 5% NS) WATCH for OVERLOAD in vascular space, usually only in ICU
Hyper-Kalemia
Excreted by kidneys
Sodium and Potassium have inverse relationship
Causes: kidney trouble, aldactone (K+ sparing)
S/S: muscle twitching> weakenss> flacid paralysis> life threatening arrhythmias (bradycardia, tall tented T waves, prolonged PR interval, flat P waves, widened QRS, conduction block V fib)
Tx: Dialysis, Calcium Gluconate (decreases arrhythmia), Glucose & Insulin (carries K+ into cell -WATCH for hypoglycemia & hypokalemia), Sodium poly styrene Sulfonate -Kayexalate (exchange Na+ with K+ in GI tract)
Hypo-Kalemia
Causes: vomiting, NG suction (loss of K+ in stomach), Diuretics -pee out K+), not eating
S/S: muscle cramps> weakness> life threatening arrhythmias (U waves, PVCs, Ventricular Tachycardia)
Tx: give Potassium, Aldactone (K+ retain), eat more potassium (spinich, fennel, kale, mustard greens, Brussel sprouts, etc.), GI upset with PO K+, IV potassium on pump (if UO drops during infusion> K+ retention> Heart Px> Death -NEVER PUSH-) injusing will burn
Respiratory Acidosis
Lung problem (CO2)
pH below 7.35 - ACID
pCO2 above 45 mmHg
Causes: HYPO-ventilation, CO2 retention (abdominal incision, cacrcotics, sleeping pills, pneumothorax, collapsed lung, pneumonia -not deep breathing> CO2 retention)
S/S: headache, confusion, sleepy, coma (if not corrected) -change in LOC-, hypoxic (RESTLESSNESS & TACHYCARDIA- think hypoxia first)
Tx: Fix breathing Px, treat pneumonia (get rid of secretions by postural dranage, percussion, deep breathing, suctioning, fluids, elevate HOB, incentive spirometry), pneumothorax (chest tubes), encourage post op turn/cough/DB
-RESTLESSNESS = think HYPOXIA first-
Kidney compensates by: excreting H+, retaining HCO3 (Bi-carb),
Respiratory Alkalosis
Lung problem (CO2)
pH above 7.45 - BASE
pCO2 below 35 mmHg
Causes: HYPER-ventilation (loosing CO2 too quickly), hysterical, acute aspirin overdose (stimulate reap center in brain), vasoconstriction of cerebral vessels
S/S: lightheaded, faint, peri oral numbness, numbness & tingling in fingers and toes
Tx: breathe into paper bag -forces re-uptake of CO2, sedate - to decrease resp rate, treat the cause, monitor ABGs
Kidney compensates by: retaining H+, excreting Bi-Carb HCO3
Metabolic Acidosis = hyperkalemia
Kidney problem (HCO2 & H+) - lungs will fix
pH below 7.35
HCO3 below 22 mmHg
Causes: DKA & starvation (cells in need of glucose> breakdown of fat and protein> produce ketones -acids), RF (can’t regulate HCO3 & H+), severe diarrhea (GI has lots of Bi-Carb - diarrhea causes ACIDOSIS> diarrhea comes from your ASS - ACIDOSIS)
S/S: LOOK UP S/S of DKA & STARVATION, hyperkalemia (muscle twitching, muscle weakness, flaccid paralysis, arrhythmias), increases resp rate (get rid of CO2)
Tx: treat the problem of the cause, IV push Bi-Carb (NaCO3> fix pH to help brain, must also fix underlying problem)
Metabolic Alkalosis = hypokalemia
Kidney problem (retaining too much HCO3 & excreting too much H+) - lungs will fix with CO2
Causes: Loss of upper GI content (acid loss), too many antacids, too much IV bicarb
S/S: depends on cause, observe LOC, HYPO-kalemia (muscle cramps> weakness> life threatening arrhythmias -U waves, PVCs, Ventricular Tachycardia-)
Tx: fix underlying problem, replace potassium
