💉- Stress, Nutrition, Fluid & Electrolyte Test Flashcards by Carolyn Cuartero

Distress vs eustress

Distress- threatens health

Eustress- ‘good stress’ is protective

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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

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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

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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

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Adaptive (effective) coping

Consists of making healthy choices that reduce the negative effects of stress

Ex: exercising to relieve tension , etc

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Maladaptive (ineffective) coping

Does not promote adaption

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General adaptation syndrome

Selye’s name for the group of nonspecific responses that all people share in the face of stressors

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What are the 3 stages of GAS

Alarm stage
Resistance (adaptation)
Final stage either recovery or exhaustion

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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

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Resistance stage

The body tries to cope, protect itself against the stressor and maintain homeostasis through the use of physiological and psychological coping mechanisms

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Reflex pain response

Protective reflex to pain

Ex: moving hand from a hot stove

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Inflammatory response

Local reaction to cell injury

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List 4 emotional responses to stress

Anxiety
Fear
Anger
Depression

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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

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What 3 types of disorders can develop when adaptation fails

stress induced organic responses
somatoform disorders
stress induced psychological responses

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Stress-induced organic responses

Continual stress brings about long-term changes in various body systems

Ex: overeating, substance abuse

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Somatoform disorders

Conditions characterized by the presence of physical symptoms with no known organic cause

Ex: hypochondriasis, somatization, pain disorder, malingering

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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

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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

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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

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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

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Carbohydrates CHO

The primary energy source for the body

increase satiety
spare proteins
enhance insulin secretion
improve absorption of Na and excretion of Ca

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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

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Proteins

Secondary energy source

fluid balance (attract water)
immune system function
acid/base balance

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Lipids

Supply essential nutrients

back up energy source
flavor and satiety
cholesterol functions
3 types: glycerides, sterols and phospholipids

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Saturated fats

raise cholesterol
animal fats
solid at room temp

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Unsaturated cats

lower cholesterol
most vegetable fats
liquid at room temp
dietary fats

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Trans-fatty acids

raise cholesterol

- artificially created to extend shelf life

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Sterols

cholesterol is the most critical sterol
required for cellular membrane structure and sex hormones
made in the liver and ingested

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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

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Fat soluble vitamins

K - synthesis of proteins for clotting

A- visual acuity

D- calcium and phos metabolism and stimulates Ca absorption

E- antioxidant

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How is energy in food measured

Calories

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Basal metabolic rate

Determines how much energy is needed to maintain body function

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List 6 things that can raise BMR

Muscle mass 
Growth 
Elevated body temp 
Low environmental temp 
Disease states 
Prolonged exertion

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Underweight BMI

18.4 or below

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Overweight BMI

25-29.9

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Obese BMI

30 or greater

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What is the formula for calculating BMI

Weight in kilograms divided by height in meters squared

Lbs/2.2
1meter = 39.37inches

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Normal range of glucose

Hypoglycemia: less than 50 mg/dl

Hyperglycemia: greater than 109 (fasting) ; greater than 127 (random)

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Normal range of BUN

8-21 mg/dl

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Normal range of hemoglobin in men and women

Men: 13.2-17.3

Women: 11.7-15.4

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Normal range of albumin and prealbumin

Albumin: 3.4-4.8 g/dl

Prealbumin: 12-42 mg/dl

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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

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What is required in order to use feeding tubes

A functioning gi tract

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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

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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

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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

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Puréed diet

Blended food

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What is the order of abdominal assessment

Inspect , auscultation , percuss , palpate

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Colonoscopy vs sigmoidoscopy

Colonoscopy- examines the entire length of the colon

Sigmoidoscopy - examines only the lower third

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What is the BRAT diet related to diarrhea

Consume Bananas 🍌, rice 🍚, applesauce 🍎 and toast 🍞

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Hemorrhoids

dilated, engorged veins in the lining of the rectum

- caused by straining, pregnancy, chf or chronic liver disease

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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

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Flatulence

Gas accumulation in the lumen of the intestines

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Medications that can slow peristalsis

Antacids , antidiarrheals

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Valsalva maneuver

The effort to breathe out forcibly while the mouth and nose are firmly closed or the vocal cords pressed together - ‘bearing down’

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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

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💉- Stress, Nutrition, Fluid & Electrolyte Test Flashcards

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