Final Flashcards
What does Hypovolemia mean?
Hypo= low
volemia=volume
(fluid volume deficit)
What are some s/s of Hypovolemia?
skin tenting
dry, scaly skin
dry mucus membranes
altered LOC
oliguria
wt loss
↑ HR
↑RR
↓BP
low grade fever
hypotension
thirst
sluggish
What are some abnormal labs linked to Hypovolemia?
↑BUN/creatinine
↑HCT
↑glucose
↑Protein
↑Osmolarity
What does Hemoconcentration mean?
In the body:
Solutes > fluids = ↑ labs
What does Hypervolemia mean?
Hyper= high
volemia= volume
(Fluid overload)
What are some s/s of Hypervolemia?
↑BP
↑HR
Distended neck veins (JVD)
Crackles
SOB
Wheezing
Edema
↑ urine output
Skin is pale/cool
Altered LOC
↑ motility
Hepatomegaly
Paresthesia
What are some abnormal labs linked to Hypervolemia?
BMP (basic metabolic panel)
What does Hemodilution mean?
In the body:
Solutes < fluids = ↓labs
What is Hypokalemia?
Hypo= low
K= potassium
Emia= blood
(low potassium in blood)
What are the s/s of Hypokalemia?
SUCTION
Skeletal muscle WEAKNESS
U wave ↓
Constipation
Toxicity
Irregular weak pulse
Orthostatic hypotension
Numbness
What is the Tx for Hypokalemia?
1st = oral supplement
2nd = IV potassium (dilute- it burns, and give slowly)
What is Hyperkalemia?
Hyper= high
K= potassium
Emia= blood
(high potassium in blood)
What are the s/s of Hyperkalemia?
(numb/tingling-early sign)
1st tachycardia -> bradycardia
MURDER
Muscle cramps
Urine abnormalities
Respiratory distress
Decreased cardiac function
EKG changes
Reflexes
What is the Tx for Hyperkalemia?
C BIG KD (see big kid)
Calcium glucontae
Bicarbonate
Insulin
Glucose
Kayexalate
Diuretics (last resort-Dialysis)
What is Hyponatremia?
Hypo= low
Na= sodium
Emia= blood
(low sodium in blood)
What are the two types of Hyponatremia?
Hyponatremia Hypovolemia
Hyponatremia Hypervolemia
Where salt goes…
…fluid goes
…water follows
What are the s/s of Hyponatremia?
SALT LOSS
Stupor
Anorexia
Lethargy
Tachycardia
Limp muscle
Orthostatic hypotension
Seizures
Stomach cramping
What is the Tx for Hyponatremia?
IV fluids (hypertonic solution- salt>fluid)
seizure precautions
SIADH = fluid restriction
airway protection (NPO- aspiration)
What is Hypomagnesemia?
Hypo= low
Mag= magnesium
Emia= blood
(low magnesium in blood)
What are the s/s of Hypomagnesemia?
(EVERYTHING IS HIGH)
↑ DTR’s
↑ HR
↑ BP
Shallow respirations
Twitches
Tetany
Irritability
TROUSSEAU’S
CHVOSTEK’S
What is Trousseau’s?
lower arm spasm- bp cuff inflating
What is Chvostek’s?
light touch of face- cheeky smile reaction
What is the Tx for Hypomagnesemia?
Magnesium sulfate IV or PO
Seizure precaution
Increase intake of magnesium rich foods
What assessments should be done for the GI?
Current Problems
Patient hx
Nutrition
Family hx
Abdominal assessment
What should occur during an abdominal assessment?
INSPECTION
-pt empty bladder
-lie supine w/ knees bent
-inspect symmetry, coloration, distention, pressure injuries
-contour, symmetry
-abdominal movements (rise and fall)
AUSCULTATION
-hypo or hyperactive bowel sounds
(PERCUSSION- provider only)
PALPATE
-size and location or organs and masses
What are GI changes related to aging?
GASTRIC MUCOSA ATROPHY
-anemia
-B 12 deficiency
-Gastritis
CALCIFICATION, PANCREATIC VESSELS
-↓ lipase production
-↓ fat absorption
- Steatorrhea
↓ HEPATIC CELLS
-poor filtration
-drug toxicity
What is Crohn’s?
Inflammation of GI tract (anus to mouth)
Transmural
Patches (cobblestone)
Diarrhea (NO BLOOD)
What are the s/s of Crohn’s?
(abscess/fistulas-↑ infection risk/sepsis)
-Diarrhea/steatorrhea
-Abdominal pain
-Wt loss
-Nutritional deficiencies
-Fatigue
What is the Tx for Crohn’s?
NO CURE- drug therapy
-Medication. (azathioprine, mercaptopurine, methotrexate & corticosteroids)
-Daily wt
-3000 calories daily
-No caffeine/alcohol
What are abnormal labs for Crohn’s?
WBC urinalysis infection
↑ C-reactive protien
↑ ESR
↓ albumin
↓ folic acid
↓ vitamin B12
↓ potassium
↓ magnesium
(fluid/electrolyte imbalance)
What is Ulcerative colitis?
Chronic inflammation/ulceration of rectum and large intestine (starts at rectum and works up)
mucosa/submucosa
continuous inflamed areas
BLOODY diarrhea
What are the s/s of Ulcerative colitis?
(toxic megacolon, rupture bowel, dehydration-↑ risk hemorrhage/shock)
-diarrhea BLOODY
-abdominal pain
-wt loss
-deficiencies
-fatigue
What is the Tx for Ulcerative colitis?
NO CURE- drug/nutritional therapy
-physical/emotional rest
-record everything about stool
-daily wt
-medications (amino-salicylates, glucocorticoids, antidiarrheal, immunomodulators)
-no caffeine, carbonated drinks, alcohol
-no lactose, raw veggies, high fiber
-surgery - ostomy
What are abnormal labs for Ulcerative colitis?
↓ H&H
↑ WBC
↑ C-reactive protein
↑ ESR
↓ sodium
↓ potassium
↓ chloride
↓ albumin
What is IBS?
Irritable Bowel Syndrome
-GI disorder
-chronic/recurrent
-diarrhea
-constipation
-abdominal pain/bloating
What are preventions for IBS?
-Increase fiber (30-40g/day)
-8-10 glasses water/day
-Chew slowly
-Bulk-forming laxatives/anti-diarrheal
-Probiotics
-Stress management
-Regular exercise (promotes elimination)
What are the types of Bowel Obstructions?
mechanical and nonmechanical
What are the risks for Bowl obstruction?
-reduced/blocked flow
-abdominal pain/cramping/distention
-vomiting/diarrhea
-dehydration
-obstipation
What are complications of a Bowel Obstruction?
Fluid & electrolyte imbalance
Acid-base imbalance
-Metabolic Alkalosis (SBO- ↓ hydrochloric acid)
-Metabolic Acidosis (LBO- ↓ alkaline fluids)
What is Dumping syndrome?
Rapid emptying of food contents into the small intestine
What are the two types of Dumping syndrome?
Early stage
-30min after eating
Late stage
-90min after eating
-insulin release
What are the s/s of early Dumping syndrome?
-vertigo
-tachycardia
-syncope
-sweating
-pallor
-palpitations
-desire to lie down
What are the s/s of late Dumping syndrome?
-dizziness
-lightheadedness
-palpitations
-diaphoresis
-confusion
What is the Tx for Dumping syndrome?
(nutrition changes, eliminating fluids w/ meals)
-high protein/fat, low carb diet
-several small meals through day
-no milk, sweets, sugar
-liquid between meals only
What is the care for a colostomy/ileostomy?
skin protection
pouch care
nutrition
drug therapy
symptoms to watch for
What is included in skin protection for a colostomy/ileostomy?
-use of a skin barrier (protects from contact with ostomy contents)
-watch skin for irritants or redness
What is included in pouch care for a colostomy/ileostomy?
-empty pouch 1/3 or 1/2 full
-change during inactive times
-change entire system every 3-7 days
-cleanse peri-stoma skin meticulously
-waffler 1/8” larger than the stoma
What is included in nutrition for a colostomy/ileostomy?
-chew food thoroughly
-low fiber, high protein diet
-no high fiber/gassy foods
-no hard to digest foods (seeds/nuts)
-↑ fluid intake (3000mL/day)
What is included in drug therapy for a colostomy/ileostomy?
-NO enteric coated/capsule meds
-NO laxatives/enemas
What symptoms should be watched for for a colostomy/ileostomy?
-↑ or ↓ drainage
-stoma swelling
-abdominal cramping/distention
-ostomy contents stop draining
What assessments of colostomy/ileostomy mean?
Good
-red “beefy” (after surgery)
-pink (long term)
-moist and shiny
Bad
-cold
-discoloration(pale, gray, purple, dusky)
What is a common complication of a colostomy/ileostomy?
-sexual dysfunction
-urinary incontinence
What is HTN?
Hyper= high
Tension= pressure
(chronic high blood pressure)
“silent killer”
What is the Tx for HTN?
THIAZIDE DIURETICS
-↓ lidibo
-hyperglycemia
-no gout
LOOD DIURETIC
-dehydration
-orthostatic hypotension
-↑ potassium intake
POTASSIUM SPARING(spironolactone)
-hyperkalemia
CALCIUM CHANNEL BLOCKER
-effective for African Americans
-for older adults
-NO grapefruit
-hold if BP ↓90
ACE INHIBITOR
-dry cough
-angieoedema
-not as effective in African Americans
ARB’S
-hyperkalemia (no potassium foods)
-not as effective in African Americans
-interaction w/ -zole meds
BETA BLOCKERS
-fatigue
-weakness
-depression
-↓ libido
-orthostatic hypotension
-hyperglycemia
What is PAD?
Peripheral Arterial Disease
(manifestation of atherosclerosis)
What are the s/s of PAD?
Pain: intermittent claudication/rest pain
Pulse: poor/absent
Edema: no (no blood)
Temp: cool (no blood)
Color: pale, hairless, thin, dry, scaly
wounds: red, round, regular,
Gangrene: yes (lack of blood)
Position: dAngle arteries (A)
What is the Tx for PAD?
Exercise
-gradually/slowly (no for rest pain, ulcers, and gangrene
Positioning
-dAngle
-dependent position
Promote vasodilation
-no smoking
-warmth
-avoid cold
-no heat pads
-stay hydrated
-medications(vasodilation/antiplatelets)
What is PVD?
Peripheral Venous Disease
What are the s/s of PVD?
Pain: dull/constant
Pulse: can’t palpate due to edema
Edema: yes (blood is pooling)
Temp: warm (blood is warm)
Color: stasis dermatitis (brown/yellow)
Wounds: venous stasis ulcers, irregular
Gangrene: no (too much blood)
Position: eleVate
What is the Tx of PVD?
-eleVate
-medications (aspirin/statins)
-surgery (angioplasty, bypass, endarterectomy)
-compression/ted hose
What is HF?
heart can’t pump enough blood to meet the needs of the body
(HTN, CAD, valvular disease)
What are the two types of HF?
right sided HF
left sided HF
What is right sided HF?
Right Retains fluid
Right=Rest of body
peripheral edema
What are the s/s of right sided HF?
SWELLING
Swelling of legs, hands
Wt gain
Edema (pitting)
Large neck veins (JVD)
Lethargy
Irregular HR
Nocturne
Girth (ascites)
What is left sided HF?
Left=Lungs
pulmonary fluid congestion
(COPD)
What are the s/s of left sided HF?
DROWNING
Dyspnea
Rales
Orthopnea
Weakness
Nocturnal dyspnea
Increased HR
Nagging cough
Gaining wt
What are the two types of left sided HF?
systolic
diastolic
What is systolic HF?
weak heart (can’t empty)
↓EF
What is diastolic HF?
stiff heart (can’t fill)
normal EF
Normal levels of cholesterol and triglycerides?
Cholesterol <200
Triglycerides <150
What is the Dash diet?
Whole grains (6-8)
fruits/veggies (4-5)
low fat dairy (2-3)
nuts/seeds (4-5)
fats/oils (2-3)
sweets/added sugar (5/wk)
What are the abnormal lung sounds?
Crackles
Wheeze
Rhonchi
Stridor
Pleural Friction Rub
What is Crackles?
Crackles=Crazy fluid
-lower lobes filled w/ fluid
-pulmonary edema
-diuretics
What is Wheeze?
Wheeze=Whistle
-narrow airways “bronchoconstriction”
-asthma/COPD (expiration)
-AIM
What is Rhonchi?
Ronchi=Rumble
-bronchi (bronchitis)
-snoring sound
-↑fluids/percussion
What is Stridor?
Stridor=Squeak
-blockage (emergency
-remove obstruction
What is Plural Friction Rub?
Plural Friction Rub=Fruity Pebbles
-inhalation/exhalation
-pneumonia - antibiotics
Prednisone
anti-inflammatory
-hyperglycemia
-↓ bone density
-immune suppression
-THRUSH
-GI bleeding
-No stop suddenly
-no live vaccine
Ipatropium
anticholinergic DRIES EVERYTHING UP
-no for glaucoma/peanut allergies
-no swallow- crush
What are general respiratory complications?
-high fowlers
-change position for lung expansion
-purse lip breathing
-fan on nose/mouth
-O2
Allopurinol
alloPurinol= Prevents gout
-IV dilute 30-60min
-w/ food ↓ GI upset
-stop if rash
Colchicine
Colchicine= aCute attacks
-w/ food prevent GI upset
-NO grapefruit
-Rnhabdomylosis
-4-7days
6 P’s?
Pain
Pallor
Pulselessness
Paralysis
Parasthesia
Poikilothermia
Hep A
water/fecal
vaccine
hand hygiene
Hep B
bodily fluid
vaccine
hand hygiene
Hep C
bodily fluid
hand hygiene
