exam 3 Flashcards
interstitial fluid
fluid between cells
intravascular fluid
plasma
osmosis
movement of water down a concentration gradient, from region of low to high
diffusion
from high to low
osmotic pressure
amount of pressure needed to prevent movement of water across membrane
colloids
increase osmotic pressure, makes it easier for fluid to move from interstitial to plasma
3 primary colloids
albumin, globulin, fibrinogen
hydrostatic pressure
fluid pushing against cell membrane, generated by blood pressure, push water into interstitial space
oncotic pressure
pulls tissue space to vascular space
intracellular electrolytes
potassium +
magnesium +
phosphorous -e
extracellular electrolytes
sodium +
Chloride -
bicarbonate-
calcium +
sodium lab
136-145p
potassium lab
3.5-5
magnesium lab
1.3-2.1
phosphate
3-4.5
hyponatremia
gi, renal, skin loss
excess hypotonic fluid,
Signs: confusion, weakness, seizures
treatment: replace slowly, PO/IV. normal saline, fluid restriction,
sodium bicarbonate
MOA: provides bicarbonate ion which neutralizes ion concentrations to raise blood and urinary PH, increases sodium in plasma
indication: metabolic acidosis
adverse effects: edema, cerebral hemorrhage,electrolyte abnormalities,
nursing: cardiac, ABG, electrolytes
hypernatremia
over 145
caused by: iv fluid, tube feed, excess intake,
symtoms: LOC, confusion, seizure, coma, thirst, crampst
treatment of hypernatremia
if due to water loss add water, if excess sodium is cause remove sodium
potassium
intracellular cation, regulates electrical status, diet, kidneys source of K loss
hypokalemia
renal or gi loss, acid base disorders
symtoms: cardiac rhythm disturbance, cramps, weakness, decreased bile motility
potassium chloride
indications: prevent or treat K + depletions when diet is insufficient, assess for n/v, may cause gi issues
MUST BE DILUTED/SLOW
contraindications: renal failure, ask about dialysis
hyperkalemia
> 5
decreased output, burn, crush injuries, sepsis, potassium sparing diuretics
sings: cardiac, muscle weakness, cramps
abd pain. d/v
kayexalate/sodium polystyrene sulfonate
class: cation exchange resins
indication: treat hyperkalemia
MOA: binds to potassium in digestive track and replaces it with sodium ions
only for use in people with normal bowel function
adverse reactions: constipation, diarrhea, n/v, hypokalemia
intestinal obstruction
D50 and insulin
shifts potassium to cell temporarily, 10 units insulin, 1 ampule D50
magnesium function/levels
helps stabilize cardiac muscle cells, blocks movement of K out of them
stabilizes smooth muscle
hypomagnesemia = <1.3
hypermagnesemia= >2.1
hypomagnesemia
<1.3
causes: diuresis, renal loss, limited intake, alcohol, pancreatitis, hyperglycemia
signs: hyperative reflexes, confusion, cramps\, tremors
oral or IV
magnesium sulfate and magnesium oxide
MOA: replaces mag
indication: hypomagm prevent/treat pre-eclampsia seizures, treat cardiac rhythm disturbances
adverse rxn: hypermag, confusion, sluggish, slow movement, SOA
hypermagnesemia
> 2.1
causes: increased intake/renal failure
symptoms: lethargy, weakness, decreased reflexes, low pulse and BP
treatment: stop replacing
calcium levels and function
hypocalcemia <9
hypercalcemia>10.5
hormones released by thyroid and parathyroid are controllers of amount of calcium
=99% calcium in bone
role in enzyme reactions, membrane potentials, hormone release, cardiac contractility, blood clotting
hypocalcemia
<9
unable to mobilize from bone, could be caused by increased renal lost
increased neuromuscular excitability, muscle cramps, tetany, hyperactive reflexes, prolonged QT that can lead to fatal arrhythmia
chvosteks sign, trousseaus sign
chvosteks sign
ipsilateral twitching in response to tapping of facial nerve
trousseaus sign
carpal spasm upon inflation of bp cuff to 20 mm above systolic for 3 minutes
hypercalcemia >10.5
caused by hyperparathyroidism, cancer
fatigue, lethargy, confusion, weakness
hypercalcemia treatment
hydration, increase urine output
phosphorous levels and function
role in bone formation, atp formation
hypophosphatemia <3
hyperphosphatemia >4.5
calcium and phosphate work together.. low calcium=high phosphate
hypophosphatemia
decreased absorption, antacid OD, diarrhea
tremor, confusion, seizure, bone pain
hyperphosphatemia
caused by kidney failure, laxatives, trauma
asymtomatic
treat the cause!
types of white blood cells
never let monkeys eat bananas
neutrophils
lymphocytes
monocytes
eosinophils
basophils
granulocytes
neutrophils, eosinophils, basophils (majority neutrophils)
agranulocytes
lymophocytes (majority) monocytes
neutrophil
WBC
first to arrive for inflammation, increase in acute bacterial infections and trauma
lymphocyte
WBC, primary immune response, increase with chronic bacterial infection and acute viral infection
monocytes
WBC, phagocytocis, increase with bacterial infection and cancer
eosinophils
WBC, increase with allergic rxn or parasites
basophils
WBC, increase with allergic rxn
hemoglobin
amount of hemoglobin in blood (oxygen carrying capacity
low: bleeding, cancer, kidney/liver disease, b12 deficiency
high: polycethemia, copd, high altitude, heavy smoking
hematocrit
percent of blood made up of packed red blood cells
low: anemia, bleeding, fluid imbalance
high: copd, dehydration, congenital heart disease, shock
leukocytosis
increased wbc
leukopenia
decreased wbc
neutropenia-decreased neutrophils
filgrastim
hematopoietic agent
leukocyte growth factor
MOA: promotes proliferation and differentiation
indication: leukopenia, neutropenia, bone marrow trasnplants
adverse effect: bone pain, leukocytosis
pegfilgrastim
long acting
MOA: increase neutrophil production
effects: bone pain
mononucleosis
b lymphocyte infection, epstein barr
patho:atypical lymphocytes proliferate
4-8 week incubation
hepatitis, high WBC
myelodysplastic syndrome
disorder characterized by change in quality or quantity of bone marrow elements
clinical: anemia, infection, bleeding, bruising
leukemia
malignant neoplasm of cells
leukemic cells: immature and unregulated, circulate blood, infiltrate spleen and lymph nodes
classified according to cell type
acute leukemia
fast onset chrmost childhood, diagnosed based on blood and bone marrow tissue, immature WBC
chronic leukemia
discovered with routine exam
relatively mature cells are incompetent
fatigue, weight loss, anorexia
leukemia treatment
chemo, stem cell transplant
allogenic-donor
syngenic-identical twin
autologous-pt own
hodgkin disease
rubbery enlargement of single or group of nodes, reed stenberg cell-tumor cell
diagnosis: blood analysis, lymph node biopsy,
treatment: chemo, radiation, stem cell transplant
non hodkin disease
spreads to liver, spleen, bone marrow quickly
lymph node enlargement
multiple myeloma
plasma cell (b cell) cancer
bone pain/fractures, impaired RBC and WBC production
skeletal pain, hypercalcemia
diagnosed: lab tests, bone marrow exam
treatment: corticosteroids, chemo, stem cell, hydration
implantation fungal transmission
tineas
taking antibiotics fungal transmission
candidasis
dermatophytes
fungi that cause superficial skin infections
tinea pedis
dry scaling foot lesions
wear shower shoes
treat with topical antifungals
tinea capitis
scalp/eyebrows/lashes
scaly hair loss, PO antifungals
tinea versicolor
upper chest, back, arms
risk: hot, sweaty
bleached skin from yeast
topical antifungals
thrush/yeast candidiasis
risk is being immunosuppressed, antibiotic use
white lesions in mouth, beefy red on skin
topical anti-fungal
systemic fungal infections
require po/iv antifungals
affect internal organs, lungs, meninges
melasma
dark molecules on face
avoid sun, use bleach creams/tretinoin
vitiligo
abnormal melanin production, no treatment, unknown cause
herpes zoster shingles
lies dormant after chicken pox, reactivated
prodrome:burning, tingling, rash that crusts over
treat with anti virals
impetigo
organisms in nose, staph and strep
acute and contagious
topical antibacterial
furuncle and carbuncle
furuncle:bacterial infection of hair follicle,
carbuncle is painful deep swelling caused by bacteria
treatment: I and D, antibiotics
cellulitis
bacterial skin infection staph or strep, not contagious
red/warm/painful
antibiotics
MRSA
staph bacteria, painful boil
purulent drainage, fever, abcess, can affect bloodstream
antibiotics
actinic keratosis
benign lesions
damage from sun, rough
solar lentigos
age spots, benign lesions
basal cell
most common, least malignant
translucent shiny nodule, ulcer with shiny border
squamous cell
2nd most common, can metastasize
increased with sun exposure
red scaly, irregular border
melanoma
rare, high metastasis rate
dark spot, fam hx, can form in eyes and under nails
ABCDE
eczema
itching, rash, ooze
treatment: lotion/cream
cortisone
psoriasis
over active immune syste, skin cells grow too quick, keep moist, steroid cream
polyenes
nystatin, Amphotericin B
pyrimidine
flucytosine
azoles
fluconazole
misc agent
grisefulvin
nystatin
class: polyene
indication: topical candida, thrush, vag, skin
side effects: skin irritation, n/v/d., poor GI absorption
amphotericin B
polyene
indication: systemic mycoses
moa:binds ergosterol in fungal cell membranes and destroys cell wall
high alert drug, diluted and infused slowly, monitor bun and creatinine, cardiac monitor, every other day for several months
pre treat with diphenhydramine, tylenol, or aspirin
flucytosine
pyrimidine
moa: inhibits fungal dna synthesis
indications: lower dose amphotericin b
azoles
MOA: interrupts cell wall integrity by interfering with synthesis of ergosterol
indications: superficial and non serious systematic
SE: redness, itching, gi upset, liver toxicity
take with food, separate from antacids
fluconazole/diflucan
completely absorbed orally, narrow spectrum, many drug interactions (CYP450 pathway)
do not mix iv with other meds, monitor if on warfarin, monitor for hypoglycemia if on sulfonureas. increases haldol and dilantin levels
grisefulvin
moa: inhibits fungal mitosis, binds to keratin
bone marrow suppression, rash, cns change, anorexia, n/v/d
indications: resistant dermatophyte infection of scalp/skin/nails
