MT Flashcards
Hypovolemia: M+T
↓ BP, dry muc. memb., ↓ skin turgor, dizziness
IV/PO fluids, treat cause of fluid loss! (high fall risk)
Hypervolemia: M+T
↑ BP/HR/RR, edema, crackles in lung bases → fluid in lungs
daily weights, I&O’s, fluid/sodium restriction, diuretics, dialysis
HypoNa CMT
Fluid Loss or Retention
musc. weakness, cramping, lethargy, confusion
fluid restriction,
increase PO Na+ intake
HyperNa CMT
Hyperaldosteronism, Cushing’s Syndrome
musc. weakness, lethargy, confusion
increase PO fluid intake ,
restrict PO Na+ intake
HypoCa
Hypoparathyroidism, Vitamin D deficiency
musc. spasms, tetany,
+ve Trousseau & Chvostek signs, altered LOC, seizures
PO Ca+ and Vitamin D, IV calcium gluconate
HyperCa
Hyperparathyroidism, Bone Malignancy
++ musc. weakness, cardiac dysrhythmias,
kidney stones
IV Pamidronate, limit PO Ca+ intake,, diuretics, HD
HypoMg
Hypomagnesemia
Starving, n/v, diabetes, prolonged TPN
Resembles hypocalcemia - muscle cramps, tremors, confusion/seizures, cardiac dysrhythmias
Oral supplementation, IV replacement if severe (rapid admin = risk for hypotension)
HyperMg
Hypermagnesemia
Cause: Increased intake, renal failure
SS: Hypotension, lethargy, urinary retention, n/v, facial flushing
→ muscle paralysis/coma
Tx: Avoid antacids/laxatives, limit dietary intake. increase fluids/diuretics? dialysis?
HypoK
N/V/D, GI suctioning, diuretics, insulin, third spacing (ex. ascites)
constipation, fatigue, musc. weakness or spasms
T
PO/IV K+ supplements
NOT IV PUSH
IV irritates veins
HyperK CMT
Causes:
CKD, hyperglycemia,
K+ sparing diuretics
M
cardiac dysrhythmias
T
IV insulin and dextrose, Kayexalate, ?diuretics, ?dialysis
HypoPh
Associted with hyperCa
Hyperparathyroidism, Bone Malignancy
++ musc. weakness, cardiac dysrhythmias,
kidney stones
IV Pamidronate, limit PO Ca+ intake,, diuretics, HD
HyperPh
Associated with HypoCa
Hypoparathyroidism, Vitamin D deficiency
musc. spasms, tetany,
+ve Trousseau & Chvostek signs, altered LOC, seizures
PO Ca+ and Vitamin D, IV calcium gluconate
Indications for isotonic solution
To increase intervasc fluid
NaCl, LR, D5W - don’t use D5W with diabetics or those with increased ICP. Don’t use NaCl if hypernatremic.
Hypertonic solutions
D10W, D5/0.9% NaCl- I have only seen used in kids, not exactly sure why, may give, may give if brain injury, or serious hyponatremia - don’t give if CHF/CKD
Hypotonic solutions
0.45% NaCl, maybe for tx of cellular dehydration, Don’t give if risk for ICP, trauma, burns or hypovolemia
N/V/D causes which electrolyte imbalances?
All of them
CKD causes electorlyte imbalances such as
HyperK
Typically typical manifestations of electorlyte imbalances are
Neuro: Seizures, LOC change
Neuromuscular: Twitching and weakness
DO we replace sodium quickly
No, can affect fluid balance, so must fix slolwy
What manifestations are associated with hypoCa
+ve Trousseau & Chvostek signs, altered LOC, seizures
Cells affected by chemo
Rapidly producing cells
Hair, GI lining, Bone Marrow
TNM charting
TUMOR (T)
T0 – no evidence of primary tumor
Tis – evidence of carcinoma in situ
T1, T2, T3, etc. Progressive increase in tumor size and involvement.
Tx – unable to assess tumor
NODES (N)
N0 – No regional lymph node metastasis
N1, N2, N3 – Increasing involvement of regional nodes.
Nx –Regional lymph nodes cannot be assessed clinically.
METASTASIS (M)
M0 – no evidence of distant metastasis
M1, M2, M3 – Metastatic involvement
Mx- Presence of metastasis cannot be assessed.
common complications for cancer pts
Infection
Febrile Neutropenia
Malnutrtion
Obstructive
Superior Vena Cava
Syndrome
Malignant Spinal Cord Compression
Intestinal
Obstruction
Causes of infection in cancer pts
ulceration/necr osis caused by tumour
* compression of vital organ
* neutropenia d/t disease process or treatment
Causes of Febrile neutropenia in cancer pts
myelosuppression
* loss of 1st line of defense WBC
Causes of malnutrition in cancer pts
associated with treatment (ex. nausea from chemo)
Manifestations of infection and febrile nutropenia in cancer pts
SIRS criteria, but not all may present with fever
Neutrophils = <
0.1 × 10%L
T = 38.0, go to
ER
Interventions for cancer pts with infection or febrile neutropenia
antibiotics (prophylactic),
G-CSF, ?hold
chemotherapy
PREVENT INFECTION
* hand hygiene
* private rooms
Manifestations of malnutrtion in cancer pts
depletion of fat and musc. → anorexia, cachexia,
altered taste and appetite
Intervention for malnutrtion in cancer pts
monitor weight (refer to dietitian if > 5% loss), albumin monitoring, high-calorie/high-prot ein diet
Why might cancer pts not necessarily present with fever
Immunosuppressants reduce ability to produce temp
Intervention for malignant spinal cord compression
emergent glucocorticoids (ex.
Dexamethasone IV)
* decompression of spinal cord via reduction of swelling
urgent radiation therapy
pain management
Intervention for malignant intestinal blockage
NG tube compression
* relieves pressure from stomach surgical removal of tumour
Metabolic emergencies for cancer pts
SIADH
Hypercalcemia
MOST COMMON!
Tumour Lysis
Syndrome
Causes of SIADH
abnormal/sustained prod. of ADH → Small Cell
Lung Ca
SIADH s/s
fluid retention, serum hypo-osmolality, dilutional hyponatremia, decreased urine output
Interventions for hyperCa in cancer pts
monitor Cat + albumin levels
encourage mobility, hydration (IV bolus + maintenance fluids), calcitonin, lasix (fl. overload), bisphosphonates
What is tumor lysis syndrome
destruction of neoplastic/cancer cells
after treatment = high
level of electrolytes to enter bloodstream (t K*,
What is the only hormone produced by the kidneys
Renin
What method is used to deal with third spacing
Centisis
Intervention for hyper Na
Administering fluid SLOWLY (D5W NOT NS)
Daily wt monitoring
Monitor labs
Why might CKD pts require less insulin
Bc it takes more time for them to excrete out insulin
Hypothalamus fluid regulation
Stimulates the hypothalamus to release ADH in response to barrow receptors sensing lowered BP. Stimulates thirst sensation
Pit gland fluid regulation
Releases ADH which reabsorbs water in kidneys and raises BP
Adrenal Cortex
Releasing aldosterone which increases retention of Na and water (decreasing blood osmolarity)
Kidneys fluid reg
Adjust urine volume
Selective reabsorption of water and electrolytes
Renal tubules are sites of action of ADH and aldosterone
Heart role in fluid reg
Atrial natriuretic factor (ANF)
Hormone released by the cardiac atria in response to atrial pressure ( volume)
Primary actions of ANF are vasodilation and urinary excretion of sodium and water, which decrease blood volume
GI system role in fluid regu
Intake PO, Excretion by feces, D/V can account for water loss
7 systems of fluid reg
Hypothalamus
Pit gland
Adrenal Cortex
Kidneys
Heart
GI
Insensible water loss
Tumor classification TNM
T0 – no evidence of primary tumor
Tis – evidence of carcinoma in situ
T1, T2, T3, etc. Progressive increase in tumor size and involvement.
Tx – unable to assess tumor
Node classification TNM
N0 – No regional lymph node metastasis
N1, N2, N3 – Increasing involvement of regional nodes.
Nx –Regional lymph nodes cannot be assessed clinicall
Metastis classification TNM
M0 – no evidence of distant metastasis
M1, M2, M3 – Metastatic involvement
Mx- Presence of metastasis cannot be assessed.
Oncologival emergencies
Superior Vena Cava Syndrome
Malignant SC compression
Bowel Obstruction
SIADH
Oncological HyperCa
Tumor Lysis Syndrome
Hyper viscosity Syndrome
Cardiac Tamponade
Superior vena cava syndrome manifestations + Tx
Facial Edema
Periorbital edema
Distended neck and chest veins
Headache
Seizures
Treat with urgent radiation therapy
Malignant SC Compression ss + Tx
Tingling, loss of sensation, bowel and bladder function impaired/lost, paralysis pain etc.
Steriods to decrease inflammation
Urgent radiation therapy
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
abnormal or sustained production of ADH (occurs most often in Small Cell Lung Ca)
Fluid retention
Serum hypo-osmolality
Dilutional hyponatremia
Early: muscle cramps, weakness
Late: vomiting/ abd cramping/ seizures/ coma
Decreased urine output
Tx cause + FLuid restriction
Oncological Hypercalcemia
Most common condition metabolic oncolgoical emergency
-Has a poor prognosis
Increased breakdown of bone tissue (osteoclastic activity) due to malignancy (multiple myeloma) or bony metastases (from lung, breast, etc). Or release of parathyroid like substance from certain cancers.
Confusion
Apathy/ Depression/ Fatigue
Muscle weakness
ECG changes
Anorexia/ Nausea/ vomiting
Polyuria/ nocturia
severe muscle weakness, decreased deep tendon reflexes, kidney stones, irregular heartbeat even heart attack.
Tx
HYDRATION ***
Mobility
Calcitonin
Tumor Lysis Syndrome
Follows the destruction of a large number of neoplastic / cancer cells due to chemo or radiation, changing electorlyte levels
seen in patients with highly aggressive hematologic cancers
HyperKalemia
Hyperphosphatemia
Hypocalcemia
Hyperuricemia
Tx with LOTS OF FLUIDS***
Alipuronal - reducing buildup of uric acid in the blood - preserves kidneys
Hyperviscosity Syndrome
Classic triad of SS includes mucosal bleeding, visual abnormalities, and neurological abnormalities
tx = Thereapeutic aphresis
Cardiac Tamponade
Fluid accumulation in the pericardial sac, constriction of the pericardium by a tumour, or percarditis secondary to radiation.
Heavy feeling over chest, Tachycardia
SOB, Cough, Distant heart sounds
tx: Reduce the fluid around the heart and mange symptoms
Steps to effective PRN use
Regular assessment and documentation
PRN use and documentation
Evaluation of PRN and documentation
Advocacy for around-the-clock (ATC) management if PRN use becomes frequent (ATC is always preferable for persistent pain management)
Advocacy for different PRNs if initial ones ineffective
Causes of Respiratory acidosis
OD, Acute asthma attack (CO2 retention and O2 depletion)
(Partial/full compensation)
Pneumonia (CO2 retention)
Chronic use of narcotics
Causes of resp alkalosis
Pain and anxiety, acute CNS injury
Compensated
CNS disorder
Causes of Metabolic acidosis
Lots of Diarrhea (Loss of bicarb), AKI
Partial/full compensation
Septic Shock (Shock bc hypoxemic) otherwise sepsis, DKA, CKD, Chronic Diarrhea, starvation
Causes of metabolic alkalosis
Diuretic use, excess antacid ingestion (Bicarb intake)
Partial/full compensation
Chronic Diuretic use, profuse vomiting
Treatment of hyperK
C - Calcium Gluconate (stablize myocardium)
B - Beta2 Adrenergic Agonist (Salbutamol) - bronchodilator
I - Insulin - Moves glucose into cells AND K+ into cells
G - Glucose
K - Kayxalate - Binding Resin working in GI tract, sustain lower level
Drop - Diuretics (Loop or Thirazide)
- Require functional kidneys
- Dialysis
