SI#2 Flashcards
Without energy, where does fluid go?
Fluid moves wherever it is required to achieve homeostasis
It flows towards concentration
Should know the numbers for individual pressures of hydrostatic and onctic pressure
40mmhg hydrostatic arteriole
10mmhg hydrostatic venous
25mmhg oncotic pressure througout
1mmhg oncotic and hydrostatic in interstitial
Hydrostatic pressure
Pushes
Oncotic pressure
Pulls
Normal oncotic pressure in vasculare system
25mmHg
Normal hydrostatic pressure at arterial end of vessels
40mmHg
Normal hydrostatic pressure at venous end
10mmHg
If albumin is too low it can result in
Edema
Edema caused bh
HTN causing hydrostatic pressure is greater than oncotic pressure
Restrictive clothing
Serum protein is too low
What is the danger of fixing fluid imbalance too fast?
Hypovalemia - resulting in HF
How is 3rd spacing treated
Centesis - aspiration of fluid out of body
Always treat the cause - don’t just treat symptoms
Need to know chart of hyper hypo electrolyte imbalances
Hyponatremia manifestations
Affects nerves, muscles, and fluid balance
Muscle weakness, cramping, lethargy, confusion
hypernatremia symptosm
Musc. weakness or spasms, fatigue, constripations
Treatment of hypernatremia
Increase fluid intake po, restrict po Na intake.N
N/V and Diarrhea almost always causes
Electrolyte imblances
Hypokalemia
DO NOT push Potassium - irritates veins
Often given PO
Hypocalcemia manifestations
Muscle spasms, tetany +ve, Trousseau and Chvostek altered LOC, seizures
Phosphate a Calcium have an ____ relationship
Inverse
Hyperphosphetemia goes with hypocalcemia
Hypophosphetemia goes with hypercalcemia
Examples of Isotonic fluids
NaCl, LR, D5W - DONT use D5W with diabetics or those
Hypertonic
D10W, D5/0.9% NaCl
Why wouldn’t u give IV albumin to CHF pt
Because this increases vascular pressure, increases workload of an already weak heart
Main diagnositc for pneumonia
Chest x ray for consolidation of lung
Lobar pneumonia
One lung with pneumonia
Lobular pneumonia
Patchy consolidations everywhere
3 kinds of pneumonia
Fungal, aquired, aspiration
Pneumonia symptom
Fever, chills, sweats, fatigue, cough, sputum production, dyspnea, confusion in older adults
Collab care for pneumonia
Abx
Supportive care (Incentive spirometry, couging, deep breathing, SPO2 monitoring)
COPD
Chronic inflammation, does not get better inflammation of perncyma in lungs
Chronic productive cough
Decreased surface for gas exchange
Most common broncho dialator
Ventalin or Salbutamol
COPD can cause pts to be
Cachexia, osteoporosis, chronic anemia, weakness
Manifestation of COPD
Cough and sputum production worse in morning, dyspnea, increased WOB, prolonged expiration, wheeze, barrel chest, wt loss and anorexia, fatigue
Care for COPD
Bronchodilators, O2, postural drainage, smoking cessation, get vaccines, generally healthy
Barrel chest due to
Air trapping and accessory muscle use
Do we need an order for Oxygen?
No for NC up to 6L
Normal PaO2 Range
80-100
Resp acidosis manifestations
Neuro changes
Lethargy, dizziness, seizures, BP drops, Vfib, Hypoxia
Resp alkolosis
Tachycardia, neuro symptoms, nausea, vpmitinh, jhyperreflexia, seizures
Metabolic acidosis symptoms
Kussmaul’s, neuro, NVD, decrease BP, dysrhythmia, peripheral vasodilation
Causes if metabolic acidosis
Accumulation of acid (DKA, starvation, septic shock), decrease bicarb (diarrhea/renal failure)
Metabolic alkalosis manifestations
Neuro, tachycardia, dysrhythmias, NV, tremors, muscle cramps
Metabolic alkalosis causes
NG suction, prolonged vomiting (decreased HCl), hypokalemia
BUN and Creatinine basically represent
amount of urea in blood that is not being filtered out
How does CKD affect diabetics
Insulin builds up, and therefore DM pts may require less insulin bc it’s not excreted as fast
Metabolic acidosis includes what two things
Inability to excrete ammonia and defective reabsorption of bicarb
Why does anemia occur in CKD
R/t decreased EPO, increased PTH, and iron/folic acid deficiencies, therefore materials are lacking to create more RBCs
Risk of bleeding r/t defect in platlet function
CVD complications with CKD
HTN,HF, LV Hypertrophy, Periph edema, dysrythmias, uremic pericarditis
To do with uremia build up and fluid retention
Resp system changes with CKD
Kussmaul’s,
dyspnea,
pulmonary edema, uremic pleuritis, pleural effusion
CKD effects on GI system
Ulcers, constipation, diabetic gastroparesis
CKD effects on Musculosk
High PTH = Osteitis Fibrosa
Bone demineralization - weak bones
High phosphte and calcium = vascular and soft tissue calcification
Why does bone demineralization occur in CKD
Kidney failure results in Decreased availability of active Vit D, required to absorb Calcium
This results in serum hypoCa
PTH secreted causing -
Bone demineralization occurs to release more Ca into blood stream
Phosphate is also released from bones, which cannot be excreted fast enough by kidneys
Results in hyperPh
How do we treat CKD MBD
Phosphate restriction (<1g/24h)
Phosphate binders w/ meals (SA: constipation)
Supplement ACTIVE Vitamin D
Control hyperparathyroidism
Treatment of anemia in CKD
Give EPO - SC or
IV
Supplement iron and folic acid (if dialysis)
No blood
transfusions
Why don’t we give blood transfusions to anemic CKD pts?
Bc we treat the underlying cause
They are not bleeding or lacking RBCs but are lacking MATERIALs to make RBCs
Why does drug toxicity occur in CKD
Drugs are excreted as quickly and therefore can buildiup
With digoxin, oral glycemic agents, abx, opioids, and NSAIDs - give tylenol instead
Treatment for High potassium
CBIGKD(rop)
