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Med Surg > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Cause of disease (general)

A

When compensatory mechanisms are not adequate.

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2
Q

Body’s goal under stress

A

Adaptation –> Return to equilibrium

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3
Q

Coping with stress depends on (6)

A
  • Level of health and energy before stressor
  • Personal belief system
  • Life goals
  • Self-esteem
  • Experience with problem solving
  • Hardiness
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4
Q

Intended effects of adrenergics: Heart (3)

A

+ Chronotropic (HR)
+ Inotropic (force)
+ Dromotropic (AV Rate)

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5
Q

Intended effects of adrenergics: Blood vessels (2)

A
  • Vasoconstriciton causes increased BP & CO

* Increased blood flow to brain, heart and large skeletal muscles

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6
Q

Intended effects of adrenergics: Bronchi

A

Bronchodilatation

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7
Q

Intended effects of adrenergics: Eyes (2)

A
  • Dilated pupils

* Aids vision

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8
Q

Intended effects of adrenergics: Emotions

A

Subjective feelings of tension

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9
Q

Intended effects of adrenergics: GI

A

• Decreased GI activity (blood shunted away from GI)

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10
Q

Intended effects of adrenergics: Blood sugar

A

Increased blood sugar 2/2 glycogenolysis and gluconeogenesis

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11
Q

Intended effects of adrenergics: Fatty acids

A

Increased fatty acids

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12
Q

Intended effects of adrenergics: Fluids

A

Increased sweating

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13
Q

Intended effects of adrenergics: Blood

A

Increased blood coagulation

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14
Q

Glucogenolysis (def)

A

Breakdown of glycogen to form glucose

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15
Q

Gluconeogenesis (def)

A

Making glucose from non-CHO sources

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16
Q

Adverse effects of adrenergics: Heart (3)

A
  • Tachycardia
  • Arrhythmias
  • Palpations
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17
Q

Adverse Effects of adrenergics: Bood vessels (3)

A
  • Pale
  • Cool
  • Hypertension
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18
Q

Adverse effects of adrenergics: Emotions (3)

A
  • Restlessness
  • Tremors
  • Insomnia
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19
Q

Adverse effects of adrenergics: GI system (5)

A
  • N/V
  • Anorexia
  • Constipation
  • Ulcers
  • GI bleeding
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20
Q

Adverse effect of adrenergics: Blood sugar (2)

A
  • Increased fasting blood sugar –> DM

* Increased insulin needs for diabetic patients

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21
Q

Adverse effects of adrenergics: Fatty acids

A

• Increased lipids (cholesterol) –> ATHERSCLEROSIS

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22
Q

Adverse effects of adrenergics: Fluids

A

• Increased sweating leads to fluid loss, claminess

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23
Q

Adverse effect of adrenergicss: Blood

A

• Increased blood coagulation can lead to increased risk of MI, stroke

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24
Q

Body’s physiologic response to stress

A

ANS is divided into SNS and PSNS

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25
Q

Adrenergic receptors (3)

A
  • Alpha
  • Beta 1
  • Beta 2
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26
Q

Effects of “Alpha” Adrenergic Receptor

A
  • “Arms and Legs”

* Peripheral vasoconstriction in extremities

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27
Q

Effects of “Beta 1” Adrenergic Receptor

A

Cardiac: “1 Heart”
• + Chronotropic (HR)
• + Inotropic (Force)
• + Dromotropic (Rate of AV node)

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28
Q

Effects of “Beta 2” Adrenergic Receptor

A

Lungs “2 Lungs”

• Bronchodilation

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29
Q 
Age and body fluid:
•	Infants %
•	Adults %
•	Geriatric %
•	Obese %

** Who is at highest risk for losing water? **

A
  • Infants: 70-80%
  • Adults: 60%
  • Geriatric: 45-50%
  • Obese: As low as 30%
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30
Q

Early signs of dehydration (3):

A
  • Some thirst
  • Headache
  • Lightheadedness
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31
Q

Late signs of dehydration (3):

A
  • Seizures
  • Coma
  • Death
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32
Q

INTRACELLULAR
• % of body fluid
• Prime cation

A
  • 2/3 of body fluid

* K+ is prime cation

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33
Q

EXTRACELLULAR
• % of body fluid
• Prime cation
• Components (2)

A
  • 1/3 of body fluid
  • Na+ is prime cation

• Components: Intravascular (plasma), interstitial (between the cells)

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34
Q

Fluid balance: Typical input (3)

A

2600 Total
• Fluids: 1300mL
• Food: 1100 mL
• Oxidation: 200mL

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35
Q

Fluid balance: Typical output (3)

A 
2600 Total
•	Urine: 1500 mL
•	Feces: 200 mL
•	Insensible: 900 mL
(300mL lungs, 600 mL skin)
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36
Q

Urine output
• Average
• When to worry

A
  • > 60 mL/hr

* Worry if <30

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37
Q

Forces that move water (3)

A
  • 1) Hydrostatic pressure
  • 2) Osmotic pressure
  • 3) Hormones
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38
Q

Hydrostatic pressure (def)

A

The weight and volume of water

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39
Q

In the capillaries, hydrostatic pressure is also generated by…

A

The pumping action of the heart!

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40
Q

Hydrostatic pressure
• What’s normal
• What happens with increase

A
  • Normal: Pores allow fluid to leak out (blood counts on this)
  • Increase in weight and volume of water: Pores stretch out, water leaks out –> EDEMA
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41
Q

What determines osmotic pressure?

A

The number of particles in each compartment

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42
Q

Function of osmotic pressure

A

To keep water where it is supposed to be

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43
Q

Particles that draw a lot of water (3)

A
  • Sodium
  • Glucose
  • Albumin
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44
Q

Oncotic pressure (def)

A

“Pulling Pressure”

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45
Q

Osmolality (def)

A

Number of particles in a kg of fluid

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46
Q

Osmolality: Norm

A

285-295 mOsm/L

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47
Q

How is osmolality tested?

A

With a blood test

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48
Q

Osmolarity (def)

A

Number of particles in a liter of fluid

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49
Q

Osmolarity versus osmolality

A

Osmolarity: Number of particles per liter of fluid

Osmolality: Number of particles per Kg of a fluid

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50
Q

Increased osmolality indicates…

A

DEHYDRATION! Decreased H20 per particle

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51
Q

Decreased osmolality indicates…

A

FVE! Increased H20 per particle

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52
Q

What happens when BV or BP is low? (3)

A

BARORECEPTORS:
• Renin signals angiotensin to increase pressure and afterload
• Renin signals aldosterone to have kidney retain H20 and increase BV, BP and preload
• ADH signals kidney to retain water and increase BV, BP and preload

53
Q
  • Two components to increase preload

* Mechanism

A
  • Renin production through aldosterone
  • ADH

Mechanism: Kidney retains H20, increasing BV and BP

54
Q

What happens when BV or BP is high? (2)

A
  • ANP secreted by atria

* BNP secreted by ventricles

55
Q

What is the most important player in lowering the Renin system?

A

BNP

56
Q

Diagnosing Respiratory v. Cardiac
• What component
• What three diseases can be diagnosed this way

A
  • BNP

* CHF, PE, Pulm HTN

57
Q

When is ANP released?

A

• Secreted by atria when BV or BP is elevated

58
Q

When is BNP released?

A

• Secreted by ventricles (mostly L) when heart muscle is stretched

59
Q

Action of both ANP and BNP (5)

A
  • Inhibits renin-angiotensin system
  • Decreases ADH
  • Inhibits SNS
  • Decreases vascular resistance
  • Increased loss of water and sodium decreases BP
60
Q

How do ANP and BNP inhibit the renin-angiotensin system? (2)

A
  • Decreased renin –> Vasodilation

* Decreased aldosterone –> Inhibits reabsorption of Na and H20, decreasing fluid volume and BP

61
Q

How is a hypotonic crystalloid solution defined?

A

<250 mOsms / L

62
Q

How is an isotonic crystalloid solution defined?

A

> 250 mOsms / L

63
Q

How is a hypertonic isotonic crystalloid solution defined?

A

> 375 mOsms / L

64
Q

Two examples of Hypotonic Crystalloid solutions

A
  • 0.33%NS (third NS)

* 0.45%NS (half NS)

65
Q

Two examples of Isotonic Crystalloid solutions

A
  • 0.9% NS

* Lactate Ringer

66
Q

Four examples of Hypertonic Crystalloid solutions

A
  • D5 0.45% NS
  • D5 0.9% NS
  • 3% Saline
  • 5% Saline
67
Q

Action / use of hypotonic solutions (2)

A
  • Hydrates cells

* Moves fluid OUT of vascular and into cells.

68
Q

Action / use of isotonic solutions (3)

A
  • NO FLUID SHIFT
  • Vascular expansion
  • Electrolyte replacement
69
Q

Action / use of hypertonic solutions (3)

A
  • Shifts fluid into vascular
  • Vascular expansion
  • Electrolyte replacement
70
Q

Nursing considerations of hypotonic solutions (3)

A
  • May worsen hypotension
  • Can increase edema
  • May increase hyponatremia
71
Q

Nursing considerations of isotonic solutions (3)

A
  • May cause FVE
  • Generalized edema
  • Dilutes hemoglobin
72
Q

Nursing considerations of hypertonic solutions (3)

A
  • May irritate veins
  • May cause FVE
  • May cause hypernatremia
73
Q

How is D5W classified, and why?

A

It is isotonic until the glucose is metabolized, then it is hypotonic.

74
Q

What is the best solution for vascular expansion? Why?

A

Isotonic solution:

• Tends to stay intravascular and doesn’t shift

75
Q

What type of solution is always used for resuscitation and peri-operative?

A

Isotonic

76
Q

How do colloids differ from crystalloids?

A

They are larger particles – meant not to leak out of intravascular areas

77
Q

How do colloids compare to crystalloids clinically?

A

In small quantities of 250 mL, colloid solutions can have the same effect as 4 liters of crystalloid saline.

78
Q

Four types of colloids:

A
  • Albumin
  • Dextran
  • Hetastarch
  • Mannitol
79
Q

Types of albumin (2)

A

5% or 25%

80
Q

Action / use of albumin (3)

A
  • Keeps fluid intravascular
  • Maintains volume
  • Replaces protein and treats shock
81
Q

Nursing considerations for albumin (3)

A
  • May cause anaphylaxis
  • May cause FVE
  • May cause PE
82
Q

Three patients who might receive albumin:

A
  • Malnourished
  • Liver problems
  • Shock
83
Q

Why would albumin cause anaphylaxis?

A

Because it is a natural blood product

84
Q

Why would albumin cause FVE?

A

Because of increased hydrostatic pressure

85
Q

Why would albumin cause PE?

A

If too much was administered too fast

86
Q

Dextran and Hetastarch (def)

A
  • Synthetic

* Pull fluid into vessels

87
Q

Dextran and Hetastarch: Indication

A

Vascular expansion

88
Q

Dextran and Hetastarch: Four nursing considerations

A
  • May cuase FVE
  • May cause hypersensitivity
  • Increased risk for bleeding
  • Can affect blood typing (draw blood for that first)
89
Q

Mannitol: Types (2)

A

5% or 25%

90
Q

Mannitol: Action / use (2)

A
  • Oliguric diuresis

* Eliminates cerebral edema

91
Q

Mannitol: Risks (3)

A
  • May cause FVE
  • May cause electrolyte imbalances
  • May cause cellular dehydration
92
Q

Mannitol: Indication

A

Neurology: To fix cerebral edema by pulling fluid in brain into other vascular areas.

93
Q

Causes of FVE (4)

A
  • Fluid overload
  • Excessive ADH secretion
  • Excessive aldosterone
  • Excessive dietary intake
94
Q

Four causes of increased aldosterone

A
  • Renal malfunction
  • Adrenal malfunction (Cushing’s)
  • CHF
  • Liver failure
95
Q

Why does CHF cause Edema?

A

Increased capillary hydrostatic pressure

96
Q

Why would cirrhosis or malnutrition cause edema?

A

Decrease in plasma proteins. Albumin deficit –> Fluid seeps out of vessels

97
Q

Why would breast cancer surgery cause edema?

A

Lymph node dissection –> Obstructed lymphatics

98
Q

Why would kidney malfunction / renal disease cause edema?

A

Increase in aldosterone, ADH

99
Q

When would edema be due to increased capillary permeability? (3 causes)

A
  • Allergies
  • Toxins
  • Massive infection
100
Q

Define second spacing

A
  • Localized edema

- Anasarca = generalized

101
Q

Define third spacing

A

Fluid moves into spaces that normally only contain minimal fluid

102
Q

What causes second spacing

A

Secondary to cardiac or renal problems

103
Q

What causes third spacing

A

Secondary to infection, blood pooling

104
Q

Four examples of third spacing

A
  • Ascites (stomach)
  • Pulmonary Edema (alveoli)
  • Pleural effusion (2/2 cancers)
  • Pericardial effusion (limits contractions)
105
Q

Intervention for pericardial infusion

A

Pericardiocentesis

106
Q

What three nursing interventions would address FLUID in FVE?

A

1) Low sodium diet, decreased H20 intake
2) Diuretics (Lasix)
3) Hypertonic IV therapy (albumin) – RARE

107
Q

Three nursing interventions that maintain skin integrity with FVE

A
  • Protect skin from injury
  • Keep skin clean and dry
  • High protein diet
108
Q

Bed position with FVE

A

High or Semi-Fowler’s helps patient breathe

109
Q

Clinical manifestations of FVD (2 categories)

A

2% loss: Thirst, light-headedness

4-6%: Convulsions, coma, death

110
Q

Who is at the highest risk for FVD? (3)

A
  • Babies
  • Post-op
  • Elderly
111
Q

Three clinical situations of FVD

A
  • Decreased intake
  • Increased output
  • Decreased fluid absopriton
112
Q

FVD w/ Hypernatremia: vital signs (4)

A
  • Increased Temp
  • Decreased BP / postural hypotension
  • Rapid HR
  • Oliguria
113
Q

What is the most abundant electrolyte in intravascular and interstitial space

A

Sodium

114
Q

What regulates sodium? (3)

A
  • Thirst
  • Hormones
  • Renin - Angiotensin
115
Q

Most common causes of sodium loss (2)

A
  • Diuretics (Lasix)

- Loss of GI fluids (V/D, GI suction)

116
Q

Common pathologies that cause sodium loss (2)

A
  • Decreased ADH (Addison’s)

- Renal disease

117
Q

Other causes of hyponatremia (5)

A
  • Hyperglycemia
  • Sweating
  • Burns
  • High volume ileostomy
  • NPO
118
Q

What is the most common cause of a gain in water (resuling in hyponatremia)

A

Excess electrolyte-poor IV fluids (like D5W)

119
Q

Four other causes of water gain (leading to hyponatremia) - other than excess electrolyte-poor IV fluids

A
  • CHF
  • Polydipsia
  • Liver failure
  • Renal failure
120
Q

4 Symptoms of hyponatremia: <125

A
  • Mental status changes
  • Headache
  • Personality changes
  • Irritability
121
Q

4 Symptoms of hyponatremia: <115

A
  • Muscle twitches
  • Focal weakness
  • Seizures
  • Coma
122
Q

Why does hyponatremia cause mental status changes?

A

CEREBRAL EDEMA

**Na drops intravascularly, but remains the same intracellularly. Body pulls fluid into cells to compensate –> Cerebral edema

123
Q

Nursing interventions for hyponatremia

A

TREAT THE CAUSE

  • If Na loss: Replace Na, administer 3% or 5% NS IV until neuro signs clear
  • For excess H20, restrict fluid
124
Q

Four causes of water loss that would lead to hypernatremia

A
  • Excessive fluid loss
  • Decreased fluid intake
  • Hyperglycemia
  • Renal failure
125
Q

Five causes of Na Excess leading to hypernatremia

A
  • Hypertonic IV fluid
  • Hypertonic NG tube feedings
  • Malfunctions
  • Salt ingestion
  • Partial drowning in salt water
126
Q

Four malfunctions leading to Na excess

A
  • CHF
  • Diabetes insipidus (decrease in ADH)
  • Cushing’s
  • Renal failure
127
Q

What causes mental status changes with hypernatremia?

A

Cellular dehydration in cerebral areas

128
Q

six CNS changes in hypernatremia

A 
Restlessness
Irritability
Delirium
Twitching
Seizures
Coma
129
Q

Nursing interventions for Hypernatremia

A

TREAT THE CAUSE

  • Treat water loss with IV D5W or oral-glucose-electrolyte solutions (with Low Na)
  • Treat excess Na with restricted Na intake

Med Surg (13 decks)

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