test 2 Flashcards
sodium plays a major role in
ECF volume and concentration
generating and transmitting nerve impulses
muscle contractility
regulating acid-base balance
what is the brain mostly
water
normal sodium range
135-145
what causes hypernatremia? MODEL mnemonic
M- Medications, meals
O- osmotic diuretics
D- Diabetes insipidus
E- Excessive H20 loss
L- low H2O intake
signs and symptoms of hypernatremia
restlessness, seizures, thirst, weakness, increased pulse, postural hypertension
treatment of hypernatremia
hypotonic fluids slowly, restrict Na
what is hypernatremia
sodium levels >145
hyponatremia causes
excess water or Na loss
what is hyponatremia
Na >135
hyponatremia signs and symptoms, SALTLOSS mnemonic
S- stupor/coma
A- anorexia (nausea and vomiting)
L- legathy
T- tendon reflex decreased
L- limp muscle weakness
O- orthostatic hypotension
S- seizure/headache
S- stomach cramping
hyponatremia treatments
restrict fluids if excess water and look diuretics
in extreme cases give 3% Nacl (hypertonic solution)
for Na loss, replace IV fluids, hold diuretics, encourage PO
normal potassium level
3.5-5
how much of body’s potassium is inside cell
98%
what does Na- K pump do
push Na out of the cell and K inside the cell
hyperkalemia causes
renal failure, acidosis, burns, K- sparing diuretics, ace inhibitors
hyperkalemia symptoms
muscle weakness (first symptom), paralysis, diarrhea, interstitial colic, cardiac arrthymias
hyperkalemia treatments
restrict K, kayexalate (pulls potassium into gut, makes poop), IV admin of insulin and dextrose to shift K into cells, dialysis, diuretics
hypokalemia ECG effects
slightly prolonged PR Interval
slightly peaked P wave
shallow T wave
Prominent U wave
hyperkalemia ECG effects
wide flat P wave
prolonged PR interval
decreased R wave amplitude
widened QRS
depressed ST segment
Tall, peaked T wave
hypokalemia causes. DITCH mnemonic
D- drugs like look diuretics, laxatives, glucocorticosteroids
I- inadequate consumption of K
T- too much water intake
C- Cushing syndrome (causes kidney to excrete K)
H- heavy fluid loss
hypokalemia signs and symptoms. 7 Ls
Lethargic
Low, shallow respirations- failure
Lethal cardiac dysrhythmias
Lots of urine
Leg cramps
Limp muscles
Low blood pressure
hypokalemia treatment
IV supplements, slowly, no more than 20 meq/hr
PO supplements
watch for digoxin toxicity if taking
increase food with K
roles of calcium
clotting, muscle contraction, nerve transmission
major cation in bones and teeth
how does body maintain calcium levels
through bone deposits or moving it back into system through parathyroid levels and calcitonin
what is needed for calcium to be absorbed thru food
vitamin D
normal calcium levels
8.5-10.2
hypercalcemia causes
hyperparathyroidism, malignancy in body, immobilization
hypercalcemia treatment
loop diuretic, isotonic solution, push PO fluids, limit calcium carbonate antacids (tums)
hypercalcemia symptoms
painful bones
renal stones
abdominal groans: nausea, vomiting, constipation, indigestion
psychiatric moans- legarthy, fatigue, depression, memory loss
hypocalcemia causes
parathyroid removal or injury, acute pancreatitis, alkalosis, laxative abuse, renal failure
hypocalcemia treatment
oral calcium chloride, IV calcium admin slowly, oral supplements
hypocalcemia signs and symptoms. CATS mnemoic
C- convulsions
A- arrhythmias
T- tetany
S- stridor and spasms
normal magnesium levels
1.3-2.1
magnesium functions
Bone structure, energy production, DNA/RNA synthesis, blood sugar control, BP regulation, muscle contraction, heart beat, nerve function
hypomagnesemia causes
renal loss, limited magnesium intake, chronic alcohol, high glucose, malabsorption
hypomagnesemia symptoms
neuromuscular and CNS irritability, confusion, muscle cramps, tremors, seizures, dysrhythmias
hypomagnesemia treatment
Oral and IV supplement. give IV slowly to avoid cardiac/resp arrest
hypermagnesemia symptoms
depressed nerve function and skeletal contraction, nausea, vomiting, bradycardia, hypotension, resp depression
hypermagnesemia causes
rare, caused by renal failure or excessive intake
hypermagnesemia treatment
Oral and IV, hemodialysis, ventilation, monitor cardiac rthyms
normal phosphate levels
2.5-4.5. higher in children
hypophosphatemia symptoms
rhabdomyolysis (muscles break down and release harmful protein), muscle weakness, ricketts or bone pain, mental confusion, seizures
hyperphosphatemia symptoms
associated with low calcium, tetany, seizures, muscle cramp
relationship between phosphate, magnesium and calcium
when calcium is low, magnesium and phosphate may be high, and vise versa
why is fluid deficiency more common in elderly
higher fat, less fluid
interstitial fluid
fluid that surrounds cells not in blood
diffusion
high to low
facilitated diffusion
use of protein carrier across membrane flowing low to high
ex- glucose requiring insulin
active transport
molecules move against gradient using energy
ex- Na-K pump
osmosis
water from low to high
ex- IV fluids
second spacing fluid
abnormal accumulation of interstitial fluid (edema)
third spacing fluid
fluid trapped and cant get back into cell or blood vessel
what causes edema
decreased albumin/protein
increased interstitial oncotic pressure to cap walls- burns, inflammation
increased venous hydrostatic pressure inhibits fluid to move back into capillaries (varicose veins)
iv fluids
fluid volume excess symptoms
changes in levels of consciousness, headache, seizures, pulmonary congestion, presence of S3, bounding pulse, high blood pressure, anorexia, nausea, edema
FVD symptoms
Weak pulse, thirst, postural hypotension, confusion, hypovolemia, tachycardia , dry mucous membrane, poor skin turgor
implementations for fluid volume
Daily weight, labs, auscultate heart and lung sounds, patient safety, IV fluids for deficit
isotonic solution
expand ECF and don’t move into cell, no net movement of water occurs.
has same osmotic pressure as plasma so ideal for fluid replacement
ex- 0.9 NS, LR, D5W
hypotonic solution
water moves into cell causing it to swell. not a lot of salt, lowers serum osmolarity.
used for hypernatremia, replacement fluids
ex- 0.45 NaCL, 0.22 NaCl
Hypertonic solution
more salt, less water. draws fluid out of cell and into blood.
used for hypernatremia and cerebral edema
ex- 3% NaCl, 5% NaCl, D10W, 25% albumin
what is important to be monitored in hypertonic fluid or hypotonic fluid
change in neuro status due to pulling or overloading sodium
colloids
large molecules hat pull fluid into blood vessels increasing oncotic pressure. AKA volume expanders
ex- albumin, fresh frozen plasma, blood, dextran
what IV fluid can blood only be given with
NS
important things to remember when doing blood transfusion
infuse packed RBC over 2-3 hours to decrease risk of fluid overload
have 2 verifications before beginning
get consent
monitor for reaction
what can cause low platelets and WBC
chemo
Hormone that regulates RBC
Erythropoietin
why and where is Erythropoietin released
released due to low o2
released from adrenal glands
Diseases that cause chronic hypoxemia
Copd
Emphysema
Chronic bronchitis
CAD
Diseases that can affect production of RBC
- Folic acid, b12, folic acid deficiencies
- Bone marrow cancers
- Chronic kidney disease (erythropoietin cant be released)
- HIV/aids
-inflammation
food high in folic acid
leafy greens, seafood, fortified cereals
foods high in b12
leafy green. Red meat, fortified cereals, legumes,diary
foods high in iron
leafy green, red meat, poultry, seafood, dairy, fortified cereals, dark chocolate
hemoglobin level
11-17
hematocrit level
35-48%
RBC level
4-6
what does bone marrow make
PLT, WBC, RBC
how long does RBC live
120 days
Anemia
deficiency in number of circulating RBC
many causes:
overproduction of normal or defective cells
decreased erythrocyte production
blood loss
increased erythrocyte destruction
Polycythemia
increase in number of RBC
unknown etiology
decreased erythrocyte production anemia
iron deficiency
thalassemia
megaloblastic (folic acid, b12)
increased erythocyte destruction anemia
sickle cell
overproduction of normal or defective cells anemias
polycythemia
blood cancers
common symptoms of anemia
Fatigue, cold, dizziness, orthostatic hypertension, pale, dark urine and little output (kidneys aren’t working as well due to lack of o2), difficulty exercising due to lack of energy and labored breathing, palpitation, weakness, constipation, diaphoresis
what organ diseases can affect RBC
liver, kidney
why is jaundice possible in anemia
liver may not be able to excrete bilirubin so builds up
anemia diagnostics
total erythrocyte count
hgb/hct
iron/b12/folic acid level
elevated pulse
low o2 saturation
iron deficiency anemia diagnosis
low ferritin level
microcytic cell
-decreased RBC prod
thalassemia
insufficient production of hemoglobin
- genetic_ autosomal recessive
only cure is Hemptopatic stem cell trans… lots of risks
decreased RBC production
causes of b12 (pernicious) anemia
decreased intake/decreased absorption
intrinsic factor no longer secreted
autoimmune
crohns, bowel resection, gastrectomy
-decreases RBC prod
causes of folic acid anemia
inadequate intake of folic acid
- decreases RBC prod
interventions for anemia
advice rest periods, assess for falls and safety, prevent skin breakdown (lack of o2), assess dietary needs, monitor labs, oxygen, oral hygeine
adding iron
iv route- preferred
oral (between meds not during)
iron causes constipation
B12 supplements
oral
IM
nasal
folic acid supplement
oral
job of spleen
stores RBC
sickle cell
thick, hard irregular shaped RBC that does not carry oxygen and can occlude blood vessel
inherited autosomal recessive disorder
managing SCD to prevent
good hydration, nutrition, stress prevention, and preventing illness
how to diagnose SCD
peripheral blood smear
complications of SCD
HF (damage)
pulm infarction (blocked artery)
retinal damage (small vessels- eye issues)
stoke
renal damage
leg ulcers
osteoporosis (bone not getting oxygen)
pneumonia (fluid may not be able to move in and out of cell)
shock
interventions for SCD
o2
fluids
blood transfusions
pain management
prevention**
hydroxyurea- drug that helps but suppresses RBC and PLT
UTERINE PROLAPSE
uterus into vaginal canal
symptoms vary, but feeling something is “coming down”, backache, stress incontinence
treated by pelvic muscle strengthening exercises, pessary, surgery
cystocele
protrusion of bladder through vaginal wall
symptoms- issues voiding, stress incontinence, inability to empty bladder, causing UTIs
diagnosed by cystourethrogram- injecting dye, taking x-ray
treated by pelvic floor therapy, surgery
rectocele
protrusion of rectum through vaginal wall
symptoms- rectal pressure, hemorrhoids
diagnosed by pelvic exam
treated by pelvic floor therapy, pessary, surgery
fistula
abnormal connection between organs
most common between rectum and vagina
due to complications from childbirth, or long labor
can close on own or surgery may be needed
menopause
cessation of menses with decline in ovarian function, diagnosed by 12 months no period, or can check estrogen levels
induced menopuase
taking out uterus and ovaries
what does menopause put women at risk for
CAD
osteoporosis
fat redistribution
weight gain
joint and muscle pain
hair thinning
atrophy of genitalia and breast tissue
memory loss
frequent urination
hot flashes, night sweats
management for menopause
prevent further bone loss- vitamin D, calcium (1500 mg/day)
bisphosphonates for bone loss
exercise
diet
HRT therapy
emotional support
what is high BP a sign of
heart and blood vessels are being overworked
if heart builds up to much muscle what can happen
less room to hold blood or heart enlargement
if untreated, hypertension can lead to
atherosclerosis, CHF, blindness, kidney failure, stroke, heart attack, erectile dysfunction, aneurysms, enlarged heart
systolic BP
pressure from contracted beat
diastolic BP
pressure when heart is relaxed
s1 sound
mitral and tricuspid closing
s2
pulmonic and aortic valve closing
preload
amount of blood left in ventricle after diastole (relaxed)… trying to get out
med that decreased preload
diuretic
what causes a increase in preload
Hypervolemia
regurgitation of cardiac valves
heart failure
afterload
resistance left ventricle must overcome to circulate blood
-ventricle is trying to push blood out
the more afterload, the more cardio workload
what causes afterload
hypertension
vasoconstriction
normal BP
<120 over <80
elevated BP
120-129 over <80
keep in mind if diastolic above 80 then its stage 1
stage 1 hypertension
130-139 diastolic
or 80-89 systolic
stage 2 hypertension
> 140 sysolic
or >90 diastolic
patient position for bp
make sure legs aren’t crossed, arms at heart length
race most at risk for htn
blacks
what gender is more likely to get htn at a younger age
men
woman and htn
higher rate after age 64 with poorer control
increased with risk of birth control pills
cardiac output
HR and contractility
renal fluid volume control (renin-angiotensin)
systemic vascular resistance
Sympathetic NS (alpha vasoconstrict, beta vasodilate)
neurohormonal (vasoconstrict- NE, angiotensin)
local regulators
primary htn
no identifiable cause
Risk factors- obesity, family history, lack of exercise, smoking, diabetes, stress, alcohol, ethnicity, socio economic, age
secondary htn
caused by cirrhosis, sleep apnea, renal disease, pregnancy, drugs, neuro causes
diagnostics for htn
history and physical
eye exam
Blood test- cbc, lipid panel, UA
ECG
*bring BP diary to dr
echocardiogram
preventning HTN
DASH diet - low Na, fat, increase veggies and fruits
exercise- aerobic and muscle strength
manage stress
stop smoking
limit alc
how many drinks can genders have a day
men- 1-2
woman- 1 or less
ACE inhibitors for htn
prevent conversion of angiotensin 1 to angiotensin 2: reduces vasoconstriction, salt and water retention
*doesnt effect heart rate
- these drugs end in -pril
side effect- cough
ARBS for htn
angiotensin receptor blocker, prevents angiotensin II from binding to receptor
*does not affect heart rate
ends in -statin
thiazide diuretic for htn
promote Na and water excretion, decrease plasma volume and SVR
- typically first drug given
- ends in -zide
K+ wasting drug
calcium channel blocker (CCB) for htn
increases Na excretion, prevents artery constriction
ends in -pine
peripheral edema common side effect
common side effects for all htn drugs
orthostatic hypotension, hypotension
common OTC drugs that cause htn
sudafed, ibuprofen
talk to pharmacist before buying otc drugs
why do elders get HTN
Loose elasticity in cardiovascular, change in lifestyle, organs wearing out
- at risk for orthostatic hypo— fall risk
bp goal for above 60 is 150/90
