random 3 (hurst) Flashcards
adosterone found? does what?
in adrenal gland (steroid, mineralcorticoid)
when blood vol gets low, aldosterone is secreted and and kidneys retain Na and water
cushings too much
addisions too little
ANP found? what does it do?
artial natretic peptide
artium of heart
when volume increases, atrium stretches and releases ANP which causes kidneys to excrete Na and water
ADH found? does what?
what causes?
what is the drug name?
Antidiuretic hormone in pituitary
ADH = H2O
makes you retain water
< often cause of head trauma or sinus injury.
< increased ICP can = ADH prob
< vasopressin
ADH problems:
Too much
< causes water retention. FVE
< SIADH–> often caused by lung tumor!
< too many letters = too much water
< urine concentrated bc not peeing. makes Na and USG increase
< blood is dilute bc too much fluid. Hct is decreased
ADH too little
< causes diurese. lose water.
< DI. think shock!!!
< urine is dilute and blood is concentrated.
< Na and urine specifc grav goes down
< Hct goes up
< use vasopressin
normal CVP
2-6 mmHg
5-10 cm H2O
bed rest…
induces diueses by increasing ANP and decreasing production of ADH
renal failure think…
shock first!!!!
isotonic
NS, D5W, RL, D5 1/2NS
do not use on PT HTN or renal failure
can cause HTN, FVE or hyperNa
Hypotonic
D2.5W,
1/2 NS
.33% NS
< rehydrates but doesnt stay in vas space
< use if HTN, renal, or cardic disease
< water moves out of vas space and into cells
hypertonic
all others and TPN
Use for 3rd spacing and hypoNa (edema, burns, ascites)
returns fluid to vascular space.
Mg
< does the opp of prefix.
< sedative
< 1.3- 2.1
PTH pulls Ca from
bones to blood
Calcitonin pulls CA from
blood to bones
sodium polyesterene sulfonate
Kayexalate
for hyperkalemia
give enema or PO. will exchange K+ ions for Na ions in the GI tract. will have Na prob then but you can treat with fluids then.
takes a bit longer than Glucose and insulin. Insulin pushes glucose and K+ back into cells and out of blood
if giving potassium… causes?
must have?
never?
causes GI upset and burns veins
must have good urine output. make sure to watch otherwise they will retain K+
never push IV K+
restless and tachycardia think?
hypoxic first!
systolic < 90 =
inadequate perfusion to vital organs
what do you use to determine PTs fluid vol is adequate?
IV fluids to maintain OP?
urine output
> 0.5mls/kg/hr
what immunizations would you give after a burn?
- tetanus toxoid - active immunity.
> takes 2-4 weeks to develop own immunity - immune globulin- passive immunity.
> immediate protection
> inject antibodies until body has time to make own.
what is released into blood from muscles post burn
myoglobin fro damaged muscles. Makes the urine red/brown and can clog the kidneys.
Call MRP
what might be ordered to flush out the kidneys?
mannitol- flushes out debri
how long after burn will PT start to diurese?
24 hrs when fluid return to vascular space.
need to watch for FVE then
what happens to the K+ in burn victim?
it increased d/t cellular lysis.
burn ppl will get NG tube bc?
they will have decreased motility and could develop paralytic ileus
PTs need more calories and increased protein
what lab would you look at to ensure proper nutrition?
PRE-ALBUMIN, albumin and total protein
what type of isolation for PT with burn?
protective
first thing you do for an electrical burn?
24 heart monitor
PT at risk for V. Fib
what is brachytherapy?
internal radiation. get radiation close to Ca tissue
> PT emits radiation for period of time and is a hazard to others
Sealed- emits radiation but body fluids are safe
> temp or permanent implant
Unsealed- PT and body fluids emit radiation
> IV or PO
Nurse: precautions with radiation
Time, distance, shielding
> wear a film badge
visitors 30 min at a time and stay 6 feet away
External radiation
focused beam of high energy to body
> PT not radioactive
will be noticed on skin. PT will have altered taste
>N: good skin care
FATIGUE
chemotherapy
Ca drug. most IV port. Vesicant drug can cause necrosis
STOP infusion if extravasate
determined by:
> which phase of cell, time, growth fraction, tumor burden
> given Q 3-4 weeks
most common body systems affected by chemo?
- blood
- GI
- Integument (skin.hair)
Precautions for chemo Nurse:
isolation gown
2 pairs chemo gloves
goggle and/or mask if splashing
dispose in yellow bins
types of transplants for Ca
- bone marrow
2. stem cell
number 1 cause of Ca related death
infection
watch Absolute Nutropenia Count (ANC) and slight increase in temp (> 38), can cause sepsis
neutropenia precautions for Ca PT
all general infection precaution plus:
> VS Q4H min > antimicrob soap > private room no visitors > no invasive procedures > to tylenol
thyroid gland produces:
T3
T4
Calcitonin (decreases serium Ca by taking Ca from blood and pushing back to bones)
> needs iodine to make
hyperthyroid T4 and TSH?
increased T4 and decreased TSH
can be confused with mania
best drug for hyperthyroid
- methimazole- stops thyroid from producing hormones
and propylthiouricil
> used pre-op to stun thyroid
- iodine compound- give with straw. stains teeth
- BB- supportive therapy
- radioactive therapy- one dose. destroys cells
> follow radioactive precautions for 1 week after
> watch for thyroid storm!!! increased: HR, BP and TEMP x 100
hypothyroid
T4? TSH?
can be confused with depression
> T4 down
TSH up
Tx: give synthroid on empty stomach
parathyroid probs
> produces PTH which pulls Ca from the bones and puts into the blood = increase Ca in blood
> too much PTH = too much Ca
hyperparathyroid =
hypercalcemia and hyperphosphate = sedated
> might have to have partial parathyroidectomy
watch for decreased Ca = tetany and tight ridged muscles
hypoparathyroid =
hypocalcemia and hypophosphate = not sedated
> give IV Ca
give phosphorus binding drugs
–> Ca acetate or elsalvemere
pheochromocytoma
benign tumor on adrenal medula that secretes epi and norepi in boluses
how to diagnose pheochromocytoma
check catecholimine levels using:
1. Vanillylmandelic test- dont eat anything with vanilla, coffee, banana, Vit B, juice
> 24 hr urine collect. throw out first urine and keep last void.
> avoid anything that can increase epi/norepi (stay calm)
- matanepherine- check epi in blood
adrenal cortex
Glucocorticoids, mineralcorticoids and sex hormones
what do Glucocorticoids do? 4
(cortisol) prednisone
1. change your mood
- alter defense mechanism:
> immunosuppressed = high risk for infections - break down fats, proteins and carbs
- inhibit insulin = hyperglycemic (increase BS)
> N: glucose monitor
ACTH- adrenocorticotropin hormone from pit gland stimulates adrenal cortex to make cortisol
what do mineralcorticoids do?
Aldosterone: make you retain Na and water and lose K+
Too much:
FVE and decrease K+
Too little:
FVD and too much K+
sex hormones
test, estrogen and progesterone
Too much:
> hirsutism, acne, irreg periods
Too little:
> decreased pubic/pit hair and libido
adrenal cortex problems =
- not enough steroids
- shock
- hyperK+
- hypoglycemia
addisons disease
not enough steroids. adrenal cortical insuf.
> less aldosterone = lose Na and water and increase K+
> S and S:
decreased Na, increased K+, hypoglycemia, hypotension
tx: combat shock, increase in diet, I and O’s
Meds: prednisone
» Fludrocortisone is aldosterone
addison crisis
severe hypotension and vascular collapse
cushings
too many steroids
Gluco- cortisol: think of what the man looks like
> hyperglycemia
> depresion
sex: oily skin
mineral: aldosterone
> retaining Na and water
> decreased K+
Diet:
increased K+, decreased Na, increased protein and Ca (steroids decrease Ca)
what does insulin do
carries glucose out of the blood and into the cell.
if no insulin, glucose builds up in the blood and not in the cells. blood becomes hypertonic and pulls fluid into the vascular space.
kidneys filter excess glucose and fluid (polyuria and dipsia).
cells are starving so they start to break down protein and fat = ketones (acids). = Kussmauls
polyuria think?
SHOCK
metformin
> reduces glucose production and enhances hoe glucose enters the cell
> does not stimulate the release of more insulin so do not see hypoglycemia
> any Surgery or Radiologic procedure that involves contrast dye = must discontinue Met and resume 48hrs post procedure when kidney function has returned to normal and creatinine is normal.
Pts should eat when insulin is at its?
PEAK
HbA1c
glycosylated HGb blood test > or = to 6.5% = diagnose for DM
average of what BS has been over the past 3-4 months
DKA can happen?
treat?
T1DM
can happen at first time hyperglycemic or DM PT with any infection or skipping insulin
> IV insulin = decreased blood sugar and K+ by driving back into the cell from vascular space.
watch K+ and monitor ECG. could develop arrhythmias
I and O
ABG- metabolic acidosis
START with isotonic IV fluids first until sugar is down to 13.9-16.7 then switch to D5W
MRP will want to add K+ to IV at some point
HHNK
like DKA but no acidosis
> no fat breakdown = no ketones = no fruity breath = no kussmals
T2DM
Preload
the amount of blood returning to the heart from vena cava
> stretch = release of ANP
stretch = more power
Afterload
pressure (resistance) in aorta and periph arteries the left vent has to pump against
> HTN causes ++ resistance = HF and puml edema
high afterload decreases CO and forward flow
CO
HR x SV
tissue perfusion depends on CO
3 arrhythmias that are always a big deal
- pulseless V.tach
- V. Fib
- Asystole
chronic stable angina
Tx: 4
ischemia that leads to pain most often d/t exertion.
- relieved by rest and/or nitro SL
- BB (prevention)- decreases BP, P and myocardial contractility
- CCB (prevention)- dipine, Verapamil, Diltiazem
> causes vasodilation to arterial system and coronary arteries - ASA (acetylsalicylic acid) antiplatelet-
- Cardiac Catheterization- most invasive
Nitroglycerine
causes venous and atrial vasodilation which will decrease preload and afterload. Also dilates coronary arteries.
> take 1 Q5 min x 3 doses.
dark glass bottle
> PT will get a HA
> manipulating someones BP is considered unstable>
cardiac catheterization
> ask if allergy to shellfish or iodine
check kidney function
PT will feel flushing, warm sensation, maybe palpitations
> assess all P’s 5 after
bed rest flat 5-6 hrs
watch for bleeding
unstable chronic angina
impending MI/ acute coronary syndrome
> can have ischemia and/or necrosis
can come on without cause
nitro will not relieve pain
Women presenting with MI
> less than man
epigas discomfort
jaw pain
pain btwn shoulders
Woman triad
> indigestion
> chronic fatigue
> SOB
Elderly MI
> SOB number 1 > cold/clammy > vomiting > ECG changes > CO decreasing
diagnostics for MI
- CPK-MB (creatine kinase)- cardiac specific iso-enzyme increases with damaged cardiac cells
> elevates in 3-4 hrs and peaks in 10-24hrs - Troponin- increases from myocardial damage
> elevates in 3-4 hrs and remains elevated for up to three weeks
> most sensitive!!! - Myoglobin- increases in 1 hr and peaks in 12 hrs.
Epi
Amioderone
Vassopressor
Anti-arrhthmic
For V.Fib and pulseless V.Tach are resistant to tx. Also for fast arrhythmias
what meds are used for chest pain when in ED?
MONA
- O2
- ASA chewable
- Nitro
- Morphine
thrombolytics
Alteplase- dissolve clot
> give within 6-8 hours of stoke. The sooner the better.
> mjr complication = bleeding. dont give if bleeding
> N: during or after admin we take bleeding precautions
what meds for bleeding precautions?
- anticoagulants/platelets
- antithrombotics- end “aban” “atran” rivaroxiban
- Tylenol
NO ABGs with thrombolytics
PCI
percutanious Coronary Intervention
> major complication is MI
> need anti=platelet meds
> ASA
> clopidogrel (plavix)
Widow maker
Left coronary artery occlusion = sudden death
diagnose HF
med Tx: for HF
- BNP
> secreted by ventricular tissues in heart when vol and pressure are increased
- CXR- heart will be enlarged
- Echocardiogram- looks at pumping action/ ECG (electrocardiogram)
> echo = US/ ECG = 12 lead - know that New York Heart association = number 4 is the worst
Tx: ACE, ARBs, Digoxin, Diuretics
ACE and ARBs
both block aldosterone. Then losing Na and water and increasing K+.
A PT with HF will be sent home on?
An ACE inhib and/or BB
bc these drugs decrease the workload on the heart by vasoconstricting (decrease afterload)
Digoxin
watch for toxic
> norm: 0.5-2.0
> simus rhythm or A.Fib
stronger contraction and decrease HR = slow rate, more time for vents to fill
> needing loading (larger dose/s)
> bfr admin always check APICAL pulse (5th intercoastal space)
> hypokalemia + Dig = toxicity
any electrolyte imbalance can cause Dig toxic
S and S of Dix toxicity
Early:
Late:
Early: anarexia, N/V
Late: arrhythmias, visual changes (halo around lights, yellow/purple)
diuretics
decreases preload and fluid retention
Take daily weights –> report gain of 2-3 lbs /day
If fluid retention think
HF
what else can you do for HF?
> low Na diet
elevate HOB
daily weight
pacemaker (SA node) increased HR with symptomatic bradycardia
most common complcation post-op for pacemaker is
displacement
> perform passive ROM to prevent frozen shoulder
dont raise arm above shoulder height
PT:check HR/pules daily, carry ID card, AVOID electromagnetic feilds and MRIs
loss of capture
no contraction to follow stimulus
firing at inapprop times =
failure to sense
who is at risk for pulm edema?
Young/old
IV fluids fast
HF or RF ppl
pulm edema what do you see?
productive pink froth sputum
cough…
give O2 and keep stats above 90
> give diuretics
pulm edema what do you do
- furosemide- push slow to avoid ototoxic or bumetenide
- nitro- to vasodialte and decrease CO
- Morphine- vasodilate, decrease preload and afterload
- Nesiritide - vasodialtes and has a diuretic effect (counteracts BNP)
» if on this drug–> turn off 2 hrs prior to drawing a BNP»
If in HF, what possition?
> want legs to dangle to pool fluid and upright
Cardiac Tamponade
20-50mls around sac
> CVP will be increased but BP will be decreased d/t CO dropping»_space;> hallmark for CT
> neck vains distended but lung sounds clear
> shocked
narrowed pulse pressure»_space;> = CT
widened pulse pressure»_space;> = increased ICP
(diff between systolic and diastolic) 40-60 normal
< 40 = narrow
60 = wide
Tx: pericardiocentesis/ surgery
intermitt claudication is hallmark sign for what?
Arterial Disease
no blood getting to extreamities d/t atherosclerosis
> numb/pain/cold/no pulse palp…
> atrophy, bruit, nail/skin changes/ ulcerations, no leg hair
we elevate
veins
we dangle
arteries
