Exam 1 Flashcards
Cause of disease (general)
When compensatory mechanisms are not adequate.
Body’s goal under stress
Adaptation –> Return to equilibrium
Coping with stress depends on (6)
- Level of health and energy before stressor
- Personal belief system
- Life goals
- Self-esteem
- Experience with problem solving
- Hardiness
Intended effects of adrenergics: Heart (3)
+ Chronotropic (HR)
+ Inotropic (force)
+ Dromotropic (AV Rate)
Intended effects of adrenergics: Blood vessels (2)
- Vasoconstriciton causes increased BP & CO
* Increased blood flow to brain, heart and large skeletal muscles
Intended effects of adrenergics: Bronchi
Bronchodilatation
Intended effects of adrenergics: Eyes (2)
- Dilated pupils
* Aids vision
Intended effects of adrenergics: Emotions
Subjective feelings of tension
Intended effects of adrenergics: GI
• Decreased GI activity (blood shunted away from GI)
Intended effects of adrenergics: Blood sugar
Increased blood sugar 2/2 glycogenolysis and gluconeogenesis
Intended effects of adrenergics: Fatty acids
Increased fatty acids
Intended effects of adrenergics: Fluids
Increased sweating
Intended effects of adrenergics: Blood
Increased blood coagulation
Glucogenolysis (def)
Breakdown of glycogen to form glucose
Gluconeogenesis (def)
Making glucose from non-CHO sources
Adverse effects of adrenergics: Heart (3)
- Tachycardia
- Arrhythmias
- Palpations
Adverse Effects of adrenergics: Bood vessels (3)
- Pale
- Cool
- Hypertension
Adverse effects of adrenergics: Emotions (3)
- Restlessness
- Tremors
- Insomnia
Adverse effects of adrenergics: GI system (5)
- N/V
- Anorexia
- Constipation
- Ulcers
- GI bleeding
Adverse effect of adrenergics: Blood sugar (2)
- Increased fasting blood sugar –> DM
* Increased insulin needs for diabetic patients
Adverse effects of adrenergics: Fatty acids
• Increased lipids (cholesterol) –> ATHERSCLEROSIS
Adverse effects of adrenergics: Fluids
• Increased sweating leads to fluid loss, claminess
Adverse effect of adrenergicss: Blood
• Increased blood coagulation can lead to increased risk of MI, stroke
Body’s physiologic response to stress
ANS is divided into SNS and PSNS
Adrenergic receptors (3)
- Alpha
- Beta 1
- Beta 2
Effects of “Alpha” Adrenergic Receptor
- “Arms and Legs”
* Peripheral vasoconstriction in extremities
Effects of “Beta 1” Adrenergic Receptor
Cardiac: “1 Heart”
• + Chronotropic (HR)
• + Inotropic (Force)
• + Dromotropic (Rate of AV node)
Effects of “Beta 2” Adrenergic Receptor
Lungs “2 Lungs”
• Bronchodilation
Age and body fluid: • Infants % • Adults % • Geriatric % • Obese %
** Who is at highest risk for losing water? **
- Infants: 70-80%
- Adults: 60%
- Geriatric: 45-50%
- Obese: As low as 30%
Early signs of dehydration (3):
- Some thirst
- Headache
- Lightheadedness
Late signs of dehydration (3):
- Seizures
- Coma
- Death
INTRACELLULAR
• % of body fluid
• Prime cation
- 2/3 of body fluid
* K+ is prime cation
EXTRACELLULAR
• % of body fluid
• Prime cation
• Components (2)
- 1/3 of body fluid
- Na+ is prime cation
• Components: Intravascular (plasma), interstitial (between the cells)
Fluid balance: Typical input (3)
2600 Total
• Fluids: 1300mL
• Food: 1100 mL
• Oxidation: 200mL
Fluid balance: Typical output (3)
2600 Total • Urine: 1500 mL • Feces: 200 mL • Insensible: 900 mL (300mL lungs, 600 mL skin)
Urine output
• Average
• When to worry
- > 60 mL/hr
* Worry if <30
Forces that move water (3)
- 1) Hydrostatic pressure
- 2) Osmotic pressure
- 3) Hormones
Hydrostatic pressure (def)
The weight and volume of water
In the capillaries, hydrostatic pressure is also generated by…
The pumping action of the heart!
Hydrostatic pressure
• What’s normal
• What happens with increase
- 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
What determines osmotic pressure?
The number of particles in each compartment
Function of osmotic pressure
To keep water where it is supposed to be
Particles that draw a lot of water (3)
- Sodium
- Glucose
- Albumin
Oncotic pressure (def)
“Pulling Pressure”
Osmolality (def)
Number of particles in a kg of fluid
Osmolality: Norm
285-295 mOsm/L
How is osmolality tested?
With a blood test
Osmolarity (def)
Number of particles in a liter of fluid
Osmolarity versus osmolality
Osmolarity: Number of particles per liter of fluid
Osmolality: Number of particles per Kg of a fluid
Increased osmolality indicates…
DEHYDRATION! Decreased H20 per particle
Decreased osmolality indicates…
FVE! Increased H20 per particle
What happens when BV or BP is low? (3)
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
- Two components to increase preload
* Mechanism
- Renin production through aldosterone
- ADH
Mechanism: Kidney retains H20, increasing BV and BP
What happens when BV or BP is high? (2)
- ANP secreted by atria
* BNP secreted by ventricles
What is the most important player in lowering the Renin system?
BNP
Diagnosing Respiratory v. Cardiac
• What component
• What three diseases can be diagnosed this way
- BNP
* CHF, PE, Pulm HTN
When is ANP released?
• Secreted by atria when BV or BP is elevated
When is BNP released?
• Secreted by ventricles (mostly L) when heart muscle is stretched
Action of both ANP and BNP (5)
- Inhibits renin-angiotensin system
- Decreases ADH
- Inhibits SNS
- Decreases vascular resistance
- Increased loss of water and sodium decreases BP
How do ANP and BNP inhibit the renin-angiotensin system? (2)
- Decreased renin –> Vasodilation
* Decreased aldosterone –> Inhibits reabsorption of Na and H20, decreasing fluid volume and BP
How is a hypotonic crystalloid solution defined?
<250 mOsms / L
How is an isotonic crystalloid solution defined?
> 250 mOsms / L
How is a hypertonic isotonic crystalloid solution defined?
> 375 mOsms / L
Two examples of Hypotonic Crystalloid solutions
- 0.33%NS (third NS)
* 0.45%NS (half NS)
Two examples of Isotonic Crystalloid solutions
- 0.9% NS
* Lactate Ringer
Four examples of Hypertonic Crystalloid solutions
- D5 0.45% NS
- D5 0.9% NS
- 3% Saline
- 5% Saline
Action / use of hypotonic solutions (2)
- Hydrates cells
* Moves fluid OUT of vascular and into cells.
Action / use of isotonic solutions (3)
- NO FLUID SHIFT
- Vascular expansion
- Electrolyte replacement
Action / use of hypertonic solutions (3)
- Shifts fluid into vascular
- Vascular expansion
- Electrolyte replacement
Nursing considerations of hypotonic solutions (3)
- May worsen hypotension
- Can increase edema
- May increase hyponatremia
Nursing considerations of isotonic solutions (3)
- May cause FVE
- Generalized edema
- Dilutes hemoglobin
Nursing considerations of hypertonic solutions (3)
- May irritate veins
- May cause FVE
- May cause hypernatremia
How is D5W classified, and why?
It is isotonic until the glucose is metabolized, then it is hypotonic.
What is the best solution for vascular expansion? Why?
Isotonic solution:
• Tends to stay intravascular and doesn’t shift
What type of solution is always used for resuscitation and peri-operative?
Isotonic
How do colloids differ from crystalloids?
They are larger particles – meant not to leak out of intravascular areas
How do colloids compare to crystalloids clinically?
In small quantities of 250 mL, colloid solutions can have the same effect as 4 liters of crystalloid saline.
Four types of colloids:
- Albumin
- Dextran
- Hetastarch
- Mannitol
Types of albumin (2)
5% or 25%
Action / use of albumin (3)
- Keeps fluid intravascular
- Maintains volume
- Replaces protein and treats shock
Nursing considerations for albumin (3)
- May cause anaphylaxis
- May cause FVE
- May cause PE
Three patients who might receive albumin:
- Malnourished
- Liver problems
- Shock
Why would albumin cause anaphylaxis?
Because it is a natural blood product
Why would albumin cause FVE?
Because of increased hydrostatic pressure
Why would albumin cause PE?
If too much was administered too fast
Dextran and Hetastarch (def)
- Synthetic
* Pull fluid into vessels
Dextran and Hetastarch: Indication
Vascular expansion
Dextran and Hetastarch: Four nursing considerations
- May cuase FVE
- May cause hypersensitivity
- Increased risk for bleeding
- Can affect blood typing (draw blood for that first)
Mannitol: Types (2)
5% or 25%
Mannitol: Action / use (2)
- Oliguric diuresis
* Eliminates cerebral edema
Mannitol: Risks (3)
- May cause FVE
- May cause electrolyte imbalances
- May cause cellular dehydration
Mannitol: Indication
Neurology: To fix cerebral edema by pulling fluid in brain into other vascular areas.
Causes of FVE (4)
- Fluid overload
- Excessive ADH secretion
- Excessive aldosterone
- Excessive dietary intake
Four causes of increased aldosterone
- Renal malfunction
- Adrenal malfunction (Cushing’s)
- CHF
- Liver failure
Why does CHF cause Edema?
Increased capillary hydrostatic pressure
Why would cirrhosis or malnutrition cause edema?
Decrease in plasma proteins. Albumin deficit –> Fluid seeps out of vessels
Why would breast cancer surgery cause edema?
Lymph node dissection –> Obstructed lymphatics
Why would kidney malfunction / renal disease cause edema?
Increase in aldosterone, ADH
When would edema be due to increased capillary permeability? (3 causes)
- Allergies
- Toxins
- Massive infection
Define second spacing
- Localized edema
- Anasarca = generalized
Define third spacing
Fluid moves into spaces that normally only contain minimal fluid
What causes second spacing
Secondary to cardiac or renal problems
What causes third spacing
Secondary to infection, blood pooling
Four examples of third spacing
- Ascites (stomach)
- Pulmonary Edema (alveoli)
- Pleural effusion (2/2 cancers)
- Pericardial effusion (limits contractions)
Intervention for pericardial infusion
Pericardiocentesis
What three nursing interventions would address FLUID in FVE?
1) Low sodium diet, decreased H20 intake
2) Diuretics (Lasix)
3) Hypertonic IV therapy (albumin) – RARE
Three nursing interventions that maintain skin integrity with FVE
- Protect skin from injury
- Keep skin clean and dry
- High protein diet
Bed position with FVE
High or Semi-Fowler’s helps patient breathe
Clinical manifestations of FVD (2 categories)
2% loss: Thirst, light-headedness
4-6%: Convulsions, coma, death
Who is at the highest risk for FVD? (3)
- Babies
- Post-op
- Elderly
Three clinical situations of FVD
- Decreased intake
- Increased output
- Decreased fluid absopriton
FVD w/ Hypernatremia: vital signs (4)
- Increased Temp
- Decreased BP / postural hypotension
- Rapid HR
- Oliguria
What is the most abundant electrolyte in intravascular and interstitial space
Sodium
What regulates sodium? (3)
- Thirst
- Hormones
- Renin - Angiotensin
Most common causes of sodium loss (2)
- Diuretics (Lasix)
- Loss of GI fluids (V/D, GI suction)
Common pathologies that cause sodium loss (2)
- Decreased ADH (Addison’s)
- Renal disease
Other causes of hyponatremia (5)
- Hyperglycemia
- Sweating
- Burns
- High volume ileostomy
- NPO
What is the most common cause of a gain in water (resuling in hyponatremia)
Excess electrolyte-poor IV fluids (like D5W)
Four other causes of water gain (leading to hyponatremia) - other than excess electrolyte-poor IV fluids
- CHF
- Polydipsia
- Liver failure
- Renal failure
4 Symptoms of hyponatremia: <125
- Mental status changes
- Headache
- Personality changes
- Irritability
4 Symptoms of hyponatremia: <115
- Muscle twitches
- Focal weakness
- Seizures
- Coma
Why does hyponatremia cause mental status changes?
CEREBRAL EDEMA
**Na drops intravascularly, but remains the same intracellularly. Body pulls fluid into cells to compensate –> Cerebral edema
Nursing interventions for hyponatremia
TREAT THE CAUSE
- If Na loss: Replace Na, administer 3% or 5% NS IV until neuro signs clear
- For excess H20, restrict fluid
Four causes of water loss that would lead to hypernatremia
- Excessive fluid loss
- Decreased fluid intake
- Hyperglycemia
- Renal failure
Five causes of Na Excess leading to hypernatremia
- Hypertonic IV fluid
- Hypertonic NG tube feedings
- Malfunctions
- Salt ingestion
- Partial drowning in salt water
Four malfunctions leading to Na excess
- CHF
- Diabetes insipidus (decrease in ADH)
- Cushing’s
- Renal failure
What causes mental status changes with hypernatremia?
Cellular dehydration in cerebral areas
six CNS changes in hypernatremia
Restlessness Irritability Delirium Twitching Seizures Coma
Nursing interventions for Hypernatremia
TREAT THE CAUSE
- Treat water loss with IV D5W or oral-glucose-electrolyte solutions (with Low Na)
- Treat excess Na with restricted Na intake
