module 1 Flashcards
FVE hypervolemia
too much fluid in the vascular space causes: HF RF Too much sodium
hormonal regulation of fluid volume aldosterone
made in the adrenal glands and retains sodium and water which increases fluid volume. mineralsteriods
Too much aldosterone
CONN syndrome -hyperaldosteronism
Cushings
Not enough aldosterone
Addisons disease
hormonal regulation of fluid volume ADH
retains water
anti-diuretic hormone
too much ADH
FVE
SIADH
*ADH- think health problems
too little ADH
FVD
DI
*think shock
vasopressin
desmopression
ADH replacement
causes fluid retention
used for DI, enuresis
FVE s/s
distended neck veins edema VS changes: increase CVP, increase BP polyuria lung sounds wet
FVE tx
diuretic- hydrochlorothiasize, K sparing
decrease NA
bed rest
IV slowly to elderly pt
fluid retention
think heart first
FVD = hypovolemia
causes: loss of fluid from anywhere such as vomiting, diarrhea, bleeding
polyuria
third space- burns, ascites
FVD s/s
weight loss, decrease skin turgor, dry membranes
decreased uo
VS: D BP, I PULSE, I RR, D CVP
Urine specific gravity: increase
FVD tx
prevent further loss
replace fluids: mild deficit= oral; severe deficit= IV
monitor for overload
fall precautions
IV fluids isotonic
goes in and stays
D5W, 0.9 NS, LR, 55 1/4 NS
FOR: fluid loss when they dont have HTN, kidney or heart problems
NOT FOR: HTN, cardiac or kidney problems because it can cause hypernatremia, FVE, HTN
IV hypotonic
goes into the vascular space then moves OUT to rehydrate
D2.5W, 1/2 NS, 0.33 NS
FOR: clients with HTN, cardiac or kidney problems but need fluid replacement. immunocompromised patient
Will dilute in hypernatremia; good for dehydrated pt
Watch for cellular edema, FVD, Decrease BP
ph
Normal: 7.35 – 7.45 < 7.35 = Acidosis > 7.45 = Alkalosis Affects the brain Kidneys & Lungs control pH Lungs with CO2 = fast Kidneys with H+, HCO3 =slow
burns home safety
Hot h2o heaters table clothes ovens attached to walls cooking pots electrical socket
burn patho
tissue damage - plasma seeps (3rd spacing) - FVD/shock - increase pulse - decrease UO - epi and aldosterone compensate
too much ADH
retain water FVE SIADH worried about HF UO = concentrated blood= dilute
not enough ADH
losing water - SHOCK FVD DI UO = diluted blood = concentrated
concentrated makes the numbers go
UP
urine specific gravy, sodium, and hematocrit
problems with ADH think
head injury
basic solution given with blood
ns
IV hypertonic
enters the vessels and expands the vascular space
D10W, 3% NS, 5% NS, D5LR, TPN, ALBUMIN
FOR: hyponatremia, severe edema, burns, or ascites
watch: FVE, BP, PULSE
hypermagnesium
causes: renal failure anatacids s/s: warm, flushing tx: calcium gluconate, dialysis
hypercalcemia
causes: too much PTH thiazides (retain ca) immobilizations s/s: brittle bones, kidney stones tx: MOVE, fluids, add phos to diet,
s/s hyper magnesium and calcemia
D DTR weak muscle tone arrhythmia YES D LOC D pulse D RR
hypomagnesium
causes: diarrhea, alcohol
Tx: Mg, check kidney function, seizure precautions
hypocalcemia
caues: not enough PTH; decreases serum Ca
Tx: calcium, vitamin D, phosphate binders, IV Ca give slowly since it slows HR and widen QRS
S/S HYPO mag and cal
rigid/tight muscle tone seizures \+chvosteks or +trousseaus DTR I muscle problems
hypernatremia = dehydration
too much sodium and not enough water
causes: hyperventilation, heat stroke, DI
S/S: dry mouth, thirst, swollen tongue, neuro changes
Tx: no Na, dilute client with fluids, I/O, daily weight, hypotonic solutions
sodium problems think
neuro changes
hyponatremia
too much water not enough sodium
causes: drinking too much water, SIADH
S/S: headache, seizure, coma
Tx: Na, restrict water, hypertonic solution
problems with K
arrhythmias
sodium has an inverse relationship with
potassium
where do you want to give potassium
if possible, in the largest site because it burns and hurts the vessels
respiratory acidosis
too much CO2
hypoventilating; slow breathing so retaining co2
tx: give o2, fix the breathing problem
respiratory alk
too little co2
hyperventilation
tx: possible sedation, monitor abgs
metabolic acidosis = hyperkalemia
RR will increase
causes: DKA, starvation, renal failure
kussmaul rr, hyperkalemia
metabolic alk=hypokalemia
too much base
replace with K
RULE OF 9
head and neck - 9 front trunk- 18 back trunk - 18 each arm - 9 each leg - 18 genitals - 1
carbon monoxide
hemoglobin binds with o2
carbon monoxide is a lot faster than o2 and will bind with hemoglobin first, client is hypoxic and needs o2
pulse ox is not a good indicator
fluid replacement for burns
crystalloids and colloids (LR and albumin) are used for fluid replacement
what does albumin do
holds onto fluid in the vascular space
alert: cause stress the heart too much so we wanna check CVP to ensure the infusion is not overloading the client
what 2 things in diet will help with burns and promote healing
protein and vitamin c
Eschar
is dead tissue that has to be removed so that new tissue can form. if its not no new tissue will form and can put the client at risk for infections
chemical burns
flush w water or sterile saline for 15-30 mins
electrical burns
put them on a cardiac monitor
monitor for v fib
can cause neurological deficits
top 5 high alert meds
insulin opiates and narcotics potassium chloride or phosphate concentrate IV anticoagulants- heparin sodium chloride solutions about 0.9%
FVD
numbers are HIGH
sodium, hematocrit, and urine SG
because you are dehydrated and this concentrates these numbers
FVE and diseases
cushings, CONN, heart failure, renal failure, SIADH
FVD and diseases
DI, diabetes, addisons, burns, ascites, shock
formula for fluid replacement
2-4 mL of LR X body weight in kg X % of TBSA burned= total fluid requirement for the first 24 hours
1st 8 hours= 1/2 total volume
2nd 8=1/4 total volume
3rd 8 = 1/4 total volume
immunizations for burns
tetanus toxoid: active immunity
immune globulin: passive immunity with provides immediate protection
compare and contrast isotonic and hypertonic solutions
iso- increases fluids in vascular space
hyper- pulls fluids from the tissues
BOTH increase BP/CO
COMPLICATIONS of burns
muscle damage
myoglobin clogs renal tubules
renal failure
SO give fluids and diuretic so they get rid of all this, mannitol
loop diuretic
pulls fluid from the blood
osmotic diuretic
pulls fluid from intracellular compartments
hydrotherapy
worried about cross contamination and infection so patient needs pain meds and antibiotics
specific indicator of renal function
creatinine
abdominal surgeries
worry about acidosis
when a patient has reduced blood flow
the body cant get rid of alkaline
diarrhea and vomiting
losing acid in the body so becoming alkalosis
