💉- Stress, Nutrition, Fluid & Electrolyte Test Flashcards
Distress vs eustress
Distress- threatens health
Eustress- ‘good stress’ is protective
External vs internal
External stressor- stressors may be external to the person ex: death of a family member
Internal- ex: disease, anxiety or nervous anticipation of an event
Developmental stressors vs situational stressors
Developmental- those that can be predicted to occur at various stages of a persons life
Situational- unpredictable , ex: you can’t predict if you will experience a car accident
Physiological stressor vs psychosocial stressor
Physiological- those that affect body structure or function
Psychosocial - are external stressors that arose from work, family dynamics, living situation, social relationships and other aspects of our daily lives
Adaptive (effective) coping
Consists of making healthy choices that reduce the negative effects of stress
Ex: exercising to relieve tension , etc
Maladaptive (ineffective) coping
Does not promote adaption
General adaptation syndrome
Selye’s name for the group of nonspecific responses that all people share in the face of stressors
What are the 3 stages of GAS
- Alarm stage
- Resistance (adaptation)
- Final stage either recovery or exhaustion
What are the two phases of the alarm stage
Shock - begins when the cerebral cortex first perceives a stressor and sends out messages to activate the endocrine and sympathetic nervous systems
Countershock - all the changes produced in the shock phase are reversed , person becomes less able to deal with the immediate threat
Resistance stage
The body tries to cope, protect itself against the stressor and maintain homeostasis through the use of physiological and psychological coping mechanisms
Reflex pain response
Protective reflex to pain
Ex: moving hand from a hot stove
Inflammatory response
Local reaction to cell injury
List 4 emotional responses to stress
Anxiety
Fear
Anger
Depression
Conversion
Ego defense mechanism
Emotional conflict is changed into physical symptoms that have no physical basis. The symptoms often disappear after the threat is over
Ex: developing nausea that causes the person to miss a major exam
What 3 types of disorders can develop when adaptation fails
- stress induced organic responses
- somatoform disorders
- stress induced psychological responses
Stress-induced organic responses
Continual stress brings about long-term changes in various body systems
Ex: overeating, substance abuse
Somatoform disorders
Conditions characterized by the presence of physical symptoms with no known organic cause
Ex: hypochondriasis, somatization, pain disorder, malingering
Somatization
Anxiety and emotional turmoil are expressed in physical symptoms, loss of physical function, pain that changes location often and depression
Unable to control the symptoms and behaviors, and complaints are vague or exaggerated
Pain disorder
Emotional pain that manifests physically
Level of pain the person states is inconsistent with the physical condition- the pain doesn’t change location
Malingering
Conscious effort to escape unpleasant situations
Patient pretends to have the symptoms for personal or tangible gain
Ex: calling in sick because the person doesn’t want to go to work
Stress-induced psychological responses
Long-term stress leads to exhaustion and mechanisms begin to fail.
Person may try maladaptive wAys to cope
Ex: crisis, burnout, ptsd
Carbohydrates CHO
The primary energy source for the body
- increase satiety
- spare proteins
- enhance insulin secretion
- improve absorption of Na and excretion of Ca
Nitrogen balance
Occurs when intake and output of nitrogen are equal
Positive - nitrogen intake exceeds output , making a pool of amino acids available for growth , pregnancy , tissue maintenance and repair
Negative- intake lower than loss. Occurs in illness, injury (burns) and malnutrition
Proteins
Secondary energy source
- fluid balance (attract water)
- immune system function
- acid/base balance
Lipids
Supply essential nutrients
- back up energy source
- flavor and satiety
- cholesterol functions
- 3 types: glycerides, sterols and phospholipids
Saturated fats
- raise cholesterol
- animal fats
- solid at room temp
Unsaturated cats
- lower cholesterol
- most vegetable fats
- liquid at room temp
- dietary fats
Trans-fatty acids
- raise cholesterol
- artificially created to extend shelf life
Sterols
- cholesterol is the most critical sterol
- required for cellular membrane structure and sex hormones
- made in the liver and ingested
Phospholipids
Lipoproteins (phospholipid + protein) transport lipid in blood ; soluble in water
ldl- bad cholesterol (brings fat to body cells)
Hdl- good cholesterol (removes fat from blood stream and brings to liver)
Vldl- Carey triglycerides to the cell
Fat soluble vitamins
K - synthesis of proteins for clotting
A- visual acuity
D- calcium and phos metabolism and stimulates Ca absorption
E- antioxidant
How is energy in food measured
Calories
Basal metabolic rate
Determines how much energy is needed to maintain body function
List 6 things that can raise BMR
Muscle mass Growth Elevated body temp Low environmental temp Disease states Prolonged exertion
Underweight BMI
18.4 or below
Overweight BMI
25-29.9
Obese BMI
30 or greater
What is the formula for calculating BMI
Weight in kilograms divided by height in meters squared
Lbs/2.2
1meter = 39.37inches
Normal range of glucose
Hypoglycemia: less than 50 mg/dl
Hyperglycemia: greater than 109 (fasting) ; greater than 127 (random)
Normal range of BUN
8-21 mg/dl
Normal range of hemoglobin in men and women
Men: 13.2-17.3
Women: 11.7-15.4
Normal range of albumin and prealbumin
Albumin: 3.4-4.8 g/dl
Prealbumin: 12-42 mg/dl
List 7 ways to check feeding tube placement
1 radiographic verification - most accurate and must be done b4 feeding takes place
2 measuring ph
3 measuring residual
4 whoosh test
5 measure tube outside the body
6 capnometry - measures CO2 levels , if positive in the wrong place
7 measuring the aspirate
What is required in order to use feeding tubes
A functioning gi tract
Clear liquids diet
Provides fluids to prevent dehydration and supplies simple carbs to help meet energy needs
Ex: water, tea, coffee, broth, clear juice, popsicles
Full liquids diet
Contains all the liquids included in the clear liquid diet plus any food items that are liquid at room temp
Ex: soup, milk, shakes, pudding
Mechanical soft diet
Diet of choice for people with chewing difficulties resulting from missing teeth, jaw problems or extensive fatigue
Ex: full liquid diet plus soft vegetables, shredded meat, eggs etc
Puréed diet
Blended food
What is the order of abdominal assessment
Inspect , auscultation , percuss , palpate
Colonoscopy vs sigmoidoscopy
Colonoscopy- examines the entire length of the colon
Sigmoidoscopy - examines only the lower third
What is the BRAT diet related to diarrhea
Consume Bananas 🍌, rice 🍚, applesauce 🍎 and toast 🍞
Hemorrhoids
- dilated, engorged veins in the lining of the rectum
- caused by straining, pregnancy, chf or chronic liver disease
What are the 3 types of enemas
1 cleansing - promote removal of feces from the colon
2 retention - introduce a solution into the colon that is meant to be retained for a prolonged period
3 return-flow - ‘harris flush’ may be ordered to help a patient expel flatus and relieve abdominal distention
Flatulence
Gas accumulation in the lumen of the intestines
Medications that can slow peristalsis
Antacids , antidiarrheals
Valsalva maneuver
The effort to breathe out forcibly while the mouth and nose are firmly closed or the vocal cords pressed together - ‘bearing down’
Why is pregnancy a factor affecting bowel elimination
Because blood volume doubles during pregnancy and can cause constipation
Anticholinergic medications related to urine elimination
Urinary retention
Ex: antihistamine, anticholinergics/antispasmodics, tricyclic antidepressants
Nephrotoxic
Damaging to the kidneys
Ex: gentamicin, amphotericin b and long term use of aspirin or ibuprofen
Pyridium
Is a bladder analgesic that turns urine orange
Elavil
Can turn pee blue or green
Levodopa
Can turn urine red, brown or black
Anuria
Absence of urine ; urine output less than 100mL in 24hrs
Dysuria
Painful or difficult urination
Enuresis
Involuntary loss of urine
Oliguria
Urine output of less than 400 ml in 24hrs
Polyuria
Excessive urination
Pyuria
Pus in the urine
Urge incontinence
Is the involuntary loss of larger amounts of urine accompanied by a strong urge to void
Stress incontinence
Is an involuntary loss of small amounts of urine with activities that increase intraabdominal pressure
Overflow incontinence
The loss of urine in combination with a distended bladder
Functional incontinence
The untimely loss of urine when no urinary or neurological cause is involved
Reflex incontinence
Is the loss of urine when the person doesn’t realize the bladder is full and has no urger to void
Straight catheter
Is a single lumen tube that is inserted for immediate drainage of the bladder
Indwelling catheter
Aka foley or retention catheter
Used for continuous bladder drainage
Suprapubic catheter
Used for continuous urine drainage when the urethra must be bypassed
Ex: after gynecological surgery or where there is a prostatic obstruction
What are the 3 uses for bladder irrigation
To maintain patency of a urinary catheter, to wash out the bladder (remove blood clots in the bladder after surgery) or to instill medications into the bladder
What is the normal range of specific gravity
1.002 - 1.030
Oxygenation
How well the cells, tissues and organs of the body are supplies with oxygen
Respiration
Gas exchange (co2 and o2) in the lungs or tissues
Ventilation
Movement of air in and out of lungs
Lung elasticity
Refers to the tendency of the elastin fibers to return to their original position away from the chest wall after being stretched
(Think of stretching a rubber band, then letting go of it
Lung compliance
Refers to the ease of killing inflation
Lung compliance is reduced by increased edema, loss of surfactant or conditions that cause elastin fibers to be replaced with scar tissue (collagen)
External respiration
alveolar/capillary membrane
Affected by surface area of alveoli available for gas exchange
Conditions that slow diffusion are: pulmonary effusion (fluid around the lung), pneumothorax, bronchospasms, vascular compromise in lungs and loss of lung tissue
Internal respiration
Occurs in body organs and tissues
Examples of conditions affecting: vascular compromise in tissue , arterial or venous disease, edema, pressure trauma
Affected by integrity of vessels within body tissues
Chemoreceptors
Located in the medulla, aorta, carotids
Detect changes in pH, O2, CO 2
CO2 levels are primary stimulus
High CO2 levels stimulate what
Breathing to eliminate the excess CO2
Low blood O2 levels stimulate what
Breathing to get more oxygen into the lungs
Hypoxemia
Lung receptors
Located in the lung and chest wall
Detect changes in breathing patterns, expansion, compliance, resistance, irritants
Voluntary control
Temporary increase or decrease in ventilation
List 6 purposes of fluids in our bodies
- Maintain old volume
- Regulate body temperature
- Transport material to and from cells
- Serve as a medium for cellular metabolism
- Assist with digestion of food
- Serve as a medium for excreting waste
Interstitial fluid
Fluid in the spaces between the body cells
Excess interstitial fluid is called edema
Intravascular fluid
Plasma within the blood.
Main function is to transport blood cells
Transcellular fluid
Includes specialized fluids that are contained in body spaces (ex: cerebrospinal , pleural , peritoneal and synovial fluid) and digestive juices
Third spacing
Occurs when fluid is trapped in spaces other than ICF or ECF
What are the 3 major ICF Electrolytes
K , mg and phosphate
What are the three major ECF Electrolytes
Na , Ca and bicarbonate
Active transport
Requires energy to move against concentration gradient
Molecules moved from low concentration to high concentration
Ex: sodium-potassium pump
Passive transport
Doesn’t require energy to move molecules or fluid
Ex: osmosis , diffusion , filtration
Hypotonic fluids
Lower osmolality than blood, fluid moves from vessels into cells
Cell SWELLS
Hypertonic fluids
Higher osmolality than blood, fluid moves from cells into ECF
Cells SHRINK
Sensible fluid loss
Measurable and perceived
Ex: urine, diarrhea, ostomy and gastric drainage
Insensible fluid loss
Loss that we don’t perceive , is not easily measured
Ex: sweat, exhalation
Fluid regulation
Kidneys are the principal regulator
Antidiuretic hormone Renin-angiotensin system Aldosterone Thyroid hormones ANP, BNP, CNP
Normal sodium range
135 - 145
Regulates fluid volume, muscle contraction
Normal range of Potassium
3.5 - 5
Regulates cardiac conduction, electrical impulse
Normal range of Calcium
8.5 - 10.5
Muscle contraction, clot formation
Normal range of Magnesium
1.6 - 2.6
Metabolism, cellular DNA synthesis
Normal range of Chloride
95 - 105
Acid base balance
Normal range of Phosphate
1.7 - 2.6
Intracellular catalyst
Normal range of Bicarbonate
22 - 26
Acid base balance , primary buffer
List 6 symptoms of hyponatremia
Anorexia, nausea , vomit
Weakness
Lethargy
Confusion
Muscle cramp or twitching
Seizures
Severe low Na can cause what
Hallucinations, irritability , lethargy and seizure
Hypovolemia
Proportionate loss of fluid and Electrolytes
Caused by trauma , surgery , hemorrhage , sepsis
Dehydration
Loss of water resulting in state of negative fluid balance
Caused by insufficient fluid intake, vomiting, diarrhea, sweating, diuresis, burns, fluid shifts and sepsis
Hypervolemia
Retention of fluid and sodium
Caused by excessive sodium intake, renal disease, hepatic disease and poor cardiac function
Who is at risk for fluid excess
Clients on dialysis
Clients with heart failure
Clients with hepatitis (can cause decreased albumin; acities)
Clients receiving IV fluids
SIADH
Crystalloids
IV fluids - LR, D5W, NS
Colloids
Volume expanders - dextran, amino acids, albumin
Hypertonic crystalloid IV fluid
D5NS, D51/2NS, D50, 3% saline
Hypotonic crystalloid IV fluid
D5W and 1/2 NS
Isotonic crystalloid IV fluid
LR and NS
List the 5 types of Central venous access
Nontunneled CVC
PICC (peripherally inserted central catheter)
Tunneled CVC
Implanted port (ex: port-a-cath)
Intraosseous (quick IV for large volumes of fluid)
Black sputum can signify what
Fire, smoke inhalation
Paroxysmal nocturnal dyspnea
Sudden awakening due to shortness of breath that begins during sleep.
The patient feels panic and extreme dyspnea and must sit upright to ease breathing
Hemoptysis
The coughing up of blood or bloody sputum.
Pink and frothy sputum signifies what
Associated with pulmonary edema / CHF
Peak flow monitoring
Measures the amount of air that can be exhaled with forcible effort
**asthmatics should measure peak flow daily
Normal range for pulse oximetry
95-100%
Which type of client is it best to maintain a pulse oximetry level of 88-92%
COPD
CO2 retainers
List the 5 types of radiography diagnostic tests
X-ray
Angiogram
CT scans
VQ scan (ventilation perfusion)
MRI
Partial pressure of oxygen
Amount of oxygen available to combine with hemoglobin
Normal range: 80-100
Saturation of oxygen
Amount of oxygen actually bound to hemoglobin
Normal range: 95-100
Partial pressure of carbon dioxide
Amount of carbon dioxide in blood
Normal range: 35-45
Fraction of inspired air FIO2
Percentage of oxygen inhaled
‘Room air’ FIO2 is 21%
Spirometry
Measurement of how much air is inhaled
Can be used as a diagnostic tool or as a prevention measure
Nebulizer
A device that turns liquids into an aerosol mist that can be inhaled directly into the lungs
BiPAP
Uses patients spontaneous breathing to trigger rate
CPAP
Regulates rate
What are the 4 types of stressors
- distress/eustress
- external/internal
- developmental/situational
- physiological/psychosocial
