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medsurg final > M2 recap > Flashcards

M2 recap Flashcards

1
Q

sodium

what is it for? normal levels

A

Sodium (Na+)
- 136 to 145 mEq/L

Major ECF Cation

Necessary for
- maintain fluid levels
- prevents low blood pressure
- Helps muscles contract
- Sends nerve impulses throughout the body

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2
Q

hypernatremia

causes? manifestations, Tx

A

Hypernatremia: Serum Sodium Levels > 145 mEq/L

Caused
- Excessive Na intake,
- Diabetes insipidus, Renal Failure, Cushing Syndrome
- Causes hyperosmolality leading to cellular dehydration

Manifestations
- Confusion, low urinary output
- HTN, tachycardia
- Hyper-reflexia, muscle twitching
- seizures, coma

Treatment
- Correct fluid deficit (hypo or iso)
- Diuretics
- Monitor fluid balance

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3
Q

HypoNatremia

A

Caused by
-Excessive Na loss by Sweat, emesis, diarrhea,
- Renal dysfunction, Diuretics, GI loss
- H20 gain (dilution effect), Inappropriate use of hypotonic IV fluids

Manifestations
- Hypotension
- confusion, headache, lethargy, seizures
- decreased muscle tone, twitching, tremors

Treatment
- Hypertonic IVF
- Fluid restriction
- Diet

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4
Q

potassium

A

Potassium (3.5 to 5.1 mmol/L)
- Major ICF cation

Necessary for
- Transmission and conduction of nerve and muscle impulses
- Maintenance of cardiac rhythms
- Depolarizes and generates action potentials
- Low K is shown as a flat T wave in cardiac rhythm
- Regulates protein synthesis, and glucose use and storage

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5
Q

hyperkalemia

A

Causes
- Massive cell destruction (burns, tumour, severe infections)
- Shift from ICF to ECF
- Most common cause of renal failure

Manifestations
- Oliguria
- Renal failure
- Addison disease
- Bradycardia, irregular heart rhythm
- Cramping leg pain
- Abdominal cramping

Treatment
- Hold K intake (ie meds)
- Loop diuretics
- Force K from ECF to ICF by IV insulin or sodium bicarbonate, calcium gluconate IV.
- Dialysis

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6
Q

hypokalemia

A

Caused by
- Abnormal losses of K+ via the kidneys or gastrointestinal tract
- Magnesium deficiency
- Metabolic alkalosis

Manifestations
- Oliguria
- cardiac issues
- Weakness of respiratory muscles
- Decreased gastrointestinal motility
- Impaired regulation of arteriolar blood flow

Treatment
- Diet – potassium-rich foods
- KCl supplements orally or IV

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7
Q

calcium

normal levels and functions

A

Calcium (2.10 to 2.75 mmol/L)
- More than 99% combined with phosphorus and concentrated in skeletal system
- Only about 30% of the calcium from foods is absorbed in the GI tract.

Functions:
- Strong bones and teeth
- Blood clotting
- Muscle contraction 
(even keeping a normal heartbeat)
- Nerve function

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8
Q

hypercalcemia

A

Caused by
- Hyperparathyroidism (two-thirds of cases)
- Cancer and malignant bone disease
- Vitamin D overdose

Manifestations
- Muscle weakness, decreased reflexes
- Decreased memory
- Behavioural changes: confusion, disorientation,
- Constipation, nausea and vomiting

Treatment
- Calcitonin
- Excretion of Ca with loop diuretic
- Oral fluids (3-4L per day)
- Hydration with isotonic saline infusion
- Dialysis

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9
Q

hypocalcemia

A

Caused by
- Renal failure
- Hypothyroidism
- Acute pancreatitis
- Alkalosis

Manifestations
- Positive Trousseau’s or Chvostek’s sign
- Laryngeal stridor
- Tingling around the mouth or in the extremities

Treatment
- Oral or IV calcium supplements
- Diet (calcium, vitamin D, protein)
- Anticipate tracheostomy (laryngeal spams)

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10
Q

magnesium

normal level, what is its use

A

Magnesium (serum 0.65 to 1.05 mmol/L)
- 50% to 60% contained in bone.
- Regulated by GI absorption and renal excretion
- Kidneys conserve magnesium in times of need and excrete excess
- metabolism of protein and carbohydrates
- Important for normal cardiac function

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11
Q

hypermagnesemia

A

Hypermagnesemia (>1.05 mmol/L)
Caused by
- Increased intake or ingestion of products containing magnesium when renal insufficiency or failure is present
- Renal failure
- Adrenal insufficiency

Manifestations
- Bradycardia, hypotension
- Respiratory and cardiac arrest

Treatment
- IV CaCl or calcium gluconate
- Fluids to promote urinary excretion

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12
Q

hypomagnesemia

A

Caused by
- alcoholism
- Fluid loss from gastrointestinal tract
- Prolonged parenteral nutrition without supplementation
- Diuretics
- DKA

Manifestations
- Skeletal muscle weakness
- Hyperactive deep tendon reflexes
- Numbness and tingling
- Painful muscle contractions

Treatment
- Diet
- Oral supplements
- Parenteral IV magnesium when severe

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13
Q

phosphorus

A

Phosphorus (serum 1.0 to 1.5 mmol/L)

Activates vitamins and enzymes
Forms ATP for energy supplies
Assists in cell growth and metabolism
Maintains acid-base balance
Maintains calcium homeostasis

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14
Q

hyperphosphetemia

A

Hyperphosphatemia (>1.5 mmol/L)

Caused by
- Renal failure

Manifestations
- Same as hypocalcemia
- Muscle cramps
- Perioral numbness and tingling
- Bone and joint pain

Treatment
- Phosphate binders (e.g. calcium acetate)
- Diet low in phosphorus

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15
Q

hypophosphatemia

A

Caused by
- Alcohol withdrawal
- Recovery from diabetic ketoacidosis
- TPN

Manifestations
- Decreased cardiac output
- Weak peripheral pulses
- Skeletal muscle weakness

Treatment
- Diet high in phosphorus
- Vitamin D Supplements
- Oral or IV calcium (e.g. calcium carbonate)
- Sodium phosphate

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16
Q

labs for fluid and electrolyte imbalances

A
  • Common serum electrolytes Na, K, Cl
  • Extended electrolytes: Ca, Mg, Phosphate
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17
Q

DKA

characteristics

A

Caused by profound deficiency of insulin

Characterized by
Hyperglycemia
Ketosis
Acidosis
Dehydration
Most likely occurs in type 1

s/s
Tachycardia
Orthostatic hypotension
Lethargy/weakness

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18
Q

managment of DKA

A

Emergency Management of DKA
Airway management
Oxygen administration

Correct fluid/electrolyte imbalance
IV infusion 0.45% or 0.9% NaCl
When blood glucose levels approach 14 mmol/L
5% dextrose added to the regiment
Potassium replacement
Sodium bicarbonate

19
Q

hyperparathyroidism

A

hyperparathyroidism happens when the thyroid gland makes too much thyroid hormone.

manifestations
- elevated T3/T4
- bruit over thyroid

medication:
Propylthiouracil (PTU) therapy to block the synthesis of T3 and T4
Iodine (131I) therapy to destroy thyroid cells

Surgery (Thyroidectomy)
Check behind neck for drainage
Position in high- fowlers
Calcium gluconate at bedside

20
Q

addisons disease

A

Adrenal insufficiency occurs when the adrenal glands don’t make enough of the hormone cortisol.

Cause
Sudden withdrawal from corticosteroids
Hypofunction of adrenal cortex
Lack of pituitary ACTH

Signs and Symptoms
- Hypovolemia, hypoglycemia
- Hyponatremia, hyperkalemia
- Postural hypotension
- Hyperpigmentation

treatment
- corticosteroid therapy

21
Q

cushings

cause?manifestations? symtpoms?

A

Cause: Excess adrenal corticoid activity caused by adrenal, pituitary, or hypothalamus tumours (cortisol)

Symptoms
- Edema of lower extremities
- Abdominal striae
- Buffalo hump (fat deposits)

manifests as
- Hyperglycemia
- Hypernatremia
- Hypokalemia
- Increased plasma cortisol levels

22
Q

gastritis

A

inflammatio of the gastric mucisa
- resulting in tissue edema which can cause a gastric hemorage

Clinical manifestations
Anorexia, Epigastric tenderness
Hemorrhage

Risk factors
Drug-related gastritis (ASA, corticosteroids)
Helicobacter pylori
burns , chrons disease, GERD, hernia
Vitamibn b12 deficiency

23
Q

upper Gi bleed

A

80-85% spontaneously resolve

esophageal
- Varices
- Any types of drugs that irritate the esophagus
- Mallory weis tear

Stomach and duodenal origin (50% of all GI bleed)
- Cancer
- ulcers

24
Q

appendicitis

what is it? manifestations? tx?

A

Often caused by an occlusion of the appendicile lumen or accumulation of feces, hypergrowth of lyphoid tissue, infection

Clinical manifestations
- Abdominal pain, the pain will radiate to the RLQ, lying still with right leg flexed

Nursing Management:
- NPO in case of surgery
- Pain control (opiods)
- heat is not advised because it may cause the appendix to rupture.
- The patient should be observed for evidence of peritonitis.
- Surgery

25
Q

peritonitis

what? Manifestations? managment

A

Localized/generalized inflammation of peritoneum
Can be acute or chronic
Ruptured organs can lead to organs into the peritoneal cavity

Clinical manifestations
Pain, rebound tenderness (gently palpate hold it for 10-15 seconds secer paiun upon release), distension, fever

Nursing Management:
Fluid replacement (I/0)
Antibiotics
narcotics
NPO

26
Q

gastroenteritis

A

Inflammation of mucosa of the stomach and small intestine
Often misdiagnosed with appendicitis

Signs and symptoms
Nausea vomiting dirahhrea, fever, ncreased WBC, blood in mucosa

Nursing management
NPO
IV fluids (glucose + electrolytes)

27
Q

UC

A

Inflammation and ulceration of rectum and colon → bleeding, decreased muscosal area → protein loss
Starts in rectum and spread proximally along colon

clinical manifestations
- Bloody diarrhea and abdominal pain with/without systemic response

drug therapy
Antimicrobial
5-ASA
Corticosteroids
Antidiarrheals
Immunosuppressant

surgical therapy

28
Q

chrons disease

A
  • A chronic IBD of unknown origin that can affect any part of the GI tract from the mouth to anus
  • Elevated TNF-alpha levels, low RBC (ESR)
  • Skip lesions, abscesses or fistulas
  • Thick walls with narrowing of lumen

clinical manifestations
- Non-bloody diarrhea
- stiaterria (fat in stool)

complications
- Scar tissue from inflammation narrows lumen
Strictures and obstructions
- Fistulas between segments of bowel, urinary tract, perianal areas
- Intra-abdominal abscesses and peritonitis

drug therapy
- Antimicrobials
- Corticosteroids
- Immunosuppressants
- Immunodilators
- TPN

29
Q

celiac disease

A

Immune mediated response
- Chronic inflammation from the ingestion of gluten because it contains prolamins
- This causes the partial digestion of gluten releasing prolamins which are releases the prolamin peptides into the intestinal mucosa

Clinical manifestations
- Foul smelling diahreea
- Stinerrhea (fat in stool)
- Abdominal distention after gluten consumption
- Malnutrition (may look overweight but will be malnourished)

30
Q

intestinal obstruction

A

Types of intestinal obstruction

Mechanical
- Occlusion of lumen of intestinal tract
- Small intestine: Adhesions, hernias, neoplasms
- Large intestine: cancer, diverticular disease

Nonmechanical
- Neuromuscular or vascular disorder
- Paralytic ileus

Collaborative care
NG tube – decompress bowel
IV fluids
TPN
Surgery – partial or total colectomy, colostomy, ileostomy

31
Q

diverticulitis

clinicalmanifestations

A
  • Due to fibre deficiency
  • Slows passage of stool with narrowed lumen of sigmoid colon causes high intraluminal pressure
  • due to retention of stool and bacteria in diverticulum
  • Increased risk for complete perforation with peritonitis

Clinical manifestations
- Cramping in left lower quadrant relieve with flatus or BM
- Alternating constipation and diarrhea
- Fever, n & v, anorexia, elevate

therapy
- High-fibre diet (during non-symptomatic periods)
- Bulk laxatives
- Stool softeners
- Clear liquid diet
- Oral antibiotics

32
Q

UTI medications

A

care and drug therapy
Medications: Trimethoprim–sulfamethoxazole (TMP–SMX) or nitrofurantoin (older adults);
Cipro or levaquin
Urinary analgesic

33
Q

pyelonephritis

A

Inflammation of renal prigma and colecting system
common cause is bacterial infection, but fungi, protozoa, or viruses can also cause
Acute starts in the renal medulla and spreads to the adjacent cortex

Recurring episodes (esp in the presence of abnormalities) scarring of kidneys → chronic pyeloneprhitis

care and drug therapy
Medications: ampicillin, vancomycin, cipro, septra, NSAIDS, antipyretic

Nursing implementation
Push fluids,
Follow up urine culture

34
Q

AKI

initiation maintenance and recovery phase

A

Initiation Phase
- decrease in UO

Maintenance Phase
- Presence of kidney failure = low serum calcium results → decreased release of phosphate by kidneys
oliguria → 10-14 days, toxins not removed by kidneys
- Urinary output is less than 400 mL in less than 24 hrs

Recovery Phase
- GFR becomes normal, kidneys secrete waste but do not concentrate urine
- Diuretic phase begins w gradual increase of UO 1-3L per day or more
- High urine volume is by osmosis not nephrons as they are still recovering

35
Q

CKD

interventions? what parts of CKD do we want to treat

A

Chronic irreversible loss of kidney function, a GFR of less than 60/min for 3 months or longer

interventions
- monitor I/o
- retrict fluid, sodium, potassium
- monitor protein

if on dyalisis
- monitor complications

Drug therapy to treat
- Hyperkalemia
- Hypertension
- Anemia
- Dyslipidemia

36
Q

peritoneal and hemo dialysis

A

Peritoneal dialysis is a treatment for kidney failure that uses the peritoneum to filter your blood

complications of P dialysis
- hernia
- exit site infection
- peritonitis

hemodyalisis uses machine to clean blood along with:
- Vascular access site
- Arteriovenous fistulas and grafts
- Central venous catheters
- Temporary vascular access

complications
- hypotension
- hepatitis
- disequilibrium syndrome

37
Q

initial treatment of fractures

A
  • Ensure ABCs
  • Check for impaired circulation (colour movement sensation)
  • Control external bleeding with direct pressure or sterile pressure dressings and elevation of extremity.
  • Check neurovascular status distal to injury before and after splinting.
  • Obtain X-rays of the affected area.
  • Administer tetanus and diphtheria prophylaxis.
  • Mark location of pulses to facilitate repeat assessment.
  • CSM!!!!!
38
Q

compartment syndrome

6ps? medication?

A
  • Characterized by excessive 6 P’s - pain, pallor, paresthesia, paralysis, and pulselessness (emergency)
  • Pain unrelieved by medications and out of proportion to the level of injury
  • Ischemia can occur within 4–8 hours after onset.
39
Q

osteoarthritis

tx

A

Slowly progressive noninflammatory disorder
Osteopenia is a decrease in bone density → osteoarthritis is severe
- localized pain and stiffness, crepitation

signs
- Herberden’s nodes
- crepitation

tx:
- hot and cold compress
- pharm is an adjuvant

40
Q

rheumatoid arthritis

manifestations, interventions

A

Chronic, systemic autoimmune disease

menifestations
- Sjögren syndrome –> Decreased fluid like tears/saliva
- Felty syndrome (splenomegaly)
- swan hands and bouteneir hands
- Those affected usually have high levels of biomarkers such as rheumatoid factor (RF).
- muscle fibre degeneration
- Cataracts and loss of vision

interventions
- monitor for sjorgen syndrome
- monitor for splenomegaly
- pharm

41
Q

rheumatoid arthitis medications

A
  • Methotrexate
  • Hydroxychloroquine (Plaquenil)
  • Immunosuppressants
  • Gold preparations
  • Corticosteroid therapy
  • NSAIDs and salicylates – high doses
42
Q

lupus

A

Chronic, multisystem inflammatory, autoimmune disease
Results from interactions among genetic, hormonal, environmental, and immunological factors

manifestations:
- rash on the nose
- pericarditis
- joint pain
- nephritis
- fever

teaching
- Medications –> Pain management
- Conservation of energy
- Avoid exposure to ultraviolet rays.
- Use steroids for joint inflammation.
- Therapeutic exercise and heat therapy

43
Q

osteoperosis

s/s, tx, interventions

A

signs:
- Dowager’s hump (outward curvature of the upper spine)
- Kyphosis of the dorsal spine
- Loss of height
- Pathological fractures

Pharm tx:
Bisphosphonates (—inate)

interventions:
- Encourage diet high in vitamin D, protein, and calcium.
- Encourage 20 minutes of UV exposure a day.
- Routine DEXA screening begins at 60.

medsurg final (7 decks)

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