Unit 2 Lav values, Lytes, and Fluids Flashcards
Anemia
Body does not have enough
Red blood cells to carry oxygen through the body
What does Braden scale measure
The risk for pressure ulcers/skin breakdown
What is 23-19 on Braden score
Not at risk
what is 18-15 on Braden score
Mildly at risk
What is 14-13 on Braden scale
Moderate risk
What is 12-10 on Braden scale
High risk
What is the point of packing a wound
cause it to heal from bottom up
Lab tests
Urinalysis, Hematology, Coagulation, Chemistry, Blood gases
How to get a UA
Midstream or from a catheter
Types of UA
-Random (glucose, white count) 24 hour collection, Urinary C and S (what is growing and what antibiotic is needed to kill it)
When to take a Urine sample
In the morning (urine is least diluted)
24 hour Urine sampling
Start 0600-0600 collect every drop of urine to determine kidney failure
What does high Urea in blood and Low urea in Uric tell us?
It shows that they are unable to metabolise it and kidneys are not working
Low creatinine indicates
chronic kidney disease or serious kidney damage
High serum creatinine indicates
Blocked urinary tract. Kidney problems, such as kidney damage or failure, infection, or reduced blood flow. Loss of body fluid (dehydration)
Culture and sensitivity
Culture and sensitivity testing is done to help diagnose an infection. It may also help your health care provider decide which antibiotics to use in treating your infection.
what does it means to be antibiotic sensitive
This means that the antibiotic will work to fight against the bacteria
What does it mean when an antibiotic is intermediate
This means the antibiotic will work but needs an extra dosage
What does it mean if an antibiotic is resistant
the antibiotic will not work against the bacteria (should not take this specific antibiotic)
Gram staining
A Gram stain is a laboratory test that checks for bacteria at the site of a suspected infection or in certain bodily fluids.
What is blood made of?
Plasma, RBC, EBC, Platelets
What does Plasma do
55% of blood
Liquid proton of your blood
What are RBC
The red blood cell’s main function is to carry oxygen from the lungs and deliver it throughout our body.
What are WBC purpose
White blood cells are part of the body’s immune system. They help the body fight infection and other diseases. Types of white blood cells are granulocytes (neutrophils, eosinophils, and basophils), monocytes, and lymphocytes (T cells and B cells) High can show infection
Platelets
Platelets, or thrombocytes, are small, colorless cell fragments in our blood that form clots and stop or prevent bleeding
3 Functions of the blood:
Transport:
-Oxygen, nutrients, hormones, metabolic waste, CO2, Ammonia, Urea
Regulates:
-Fluid balance
-Electrolyte balance
-Body temp
Protection:
-Fight infection
-Prevent recurrent infection
-Coagulation
High WBC count may indicate
infection
Hemoglobin
Iron/has carrying capacity. This is the protein that carries oxygen to organs
Hematocrit
The percentage by volume of red cells in your blood
MCH
The weight of your red blood cells
MCV
The size of your Red blood cells (can help diagnose anemia)
MCHC
RBC saturated with hemoglobin (average concentration of hemoglobin in a group of red blood cells
RDW
Red blood cell distribution (helps diagnose anemia)
MPV
Mean platelet volume based on side
Neutrophils
They travel to the site of infection, where they destroy the microorganisms by ingesting them and releasing enzymes that kill them.
High Neutrophils
They help you fight infection. If there are too many neutrophils in your bloodstream, you may develop leukocytosis, or a high total white blood cell count. Symptoms of fever or infection
Low Neutrophil
Neutropenia is the result of your body destroying neutrophils before your bone marrow can create more. Causes of a low neutrophil count include: Infection (hepatitis, tuberculosis, sepsis, Lyme disease). Chemotherapy.
Coagulation
When to bleed, how much, but not too much… how much time it take
APTT
used to measure and evaluate all the clotting factors of the intrinsic and common pathways of the clotting cascade
APTT is effected by what medication
Heaparin
INR
tells you how long it takes for your blood to clot.
What med is INR effected by
Warfarin
4 stages on Clotting cascade
- Vascular response
- Platelet plug
- FIbrin clot
- Clot dissolution
Clot process
-injury to blood vessel
-Blood vessel around wound constrict reduce blood flow to the damage area
-Activated platelets stick to injury site
-Platelets and damaged toss release clotting factors
-Blood clotting mechanism to form fibrin which acts like mech to stop the bleeding
Normocytic
(not enough)
Caused by…
-Acute blood loss
-Chronic blood loss
-Renal disease
-Anemia of Chronic disease
-Body cannot make enough iron due to chronic demand and inflammation (Females)
Microcytic
Caused by…
Too small. Iron Deficiency, blood loss
Macrocyte
Caused by…
Too large. Megaloblastic, Vitamin B12/Folate deficiency, Alcoholism, Hypothyroidism, Error in bone marrow production, COPD, Erythropoietin administration
Sickle cell disease
genetic defect that happens in chromosomes, it make red cells a different shape causing them to flow differently (Can get stuck together causing a clot)
Symptoms of Anemia
Faitning and fatigue, SOB, Muscle weakness, Changed stool colour, yellowed eyes, chest pain, angina, heart attack, spleen enlargement, yellow skin
Diet changes for people with anemia
iron-is anemia comrich, greens, increased meat, whole grains
why is anemia common in older people
Potential causes of iron deficiency anemia in this age group include blood loss, nutritional deficiencies, medications, underlying conditions, and malabsorption.
Why is a patient with chronic renal failure at risk for anemia?
When your kidneys are damaged, they produce less erythropoietin (EPO), a hormone that signals your bone marrow—the spongy tissue inside most of your bones—to make red blood cells. With less EPO, your body makes fewer red blood cells, and less oxygen is delivered to your organs and tissues.
how are electrolytes measured
mmol/L in serum
What can cause fluid shift (electrolyte imbalance)
Inflammation and illness can alter the pressure
Sodium function in the body
-Maintaining water balance (NA follows water)
-Maintain BP
-Transmission of nerve impulse
-Acid-base balance
-Regulated by the renel system and ADH
HyperNAtremia
(too much sodium)
Symptoms of Hypernatremia
Fatigue, seizure, weakness, edema, agitation, coma, weight gain, hypertension
Symptoms of Hyponatremia
GI loss, Renel loss, Resp complications, Burns, High output wounds, headaches, irritability, confusion, coma
Potassium does
Muscle contraction, conduct nerve impulses, promote cellular growth, maintain normal cardiac rhythm, regulate Renal system
Hyperkalmia effects
Increased intake, impaired renel function, metabolic acidosis
Hyperkalmia Symptoms
Weak skeletal muscle, leg cramping, ECG changes, Irregular pulse
Hypokalemia effects
Lose too much fluid
Loss of NA intake
Hypokalemia Symptoms
Fatigue, muscle weakness, leg cramps, N and V, Slow, weak pulse
Treatment Hyperkalemia
-This is a medical emergency
-Need to move K+ from the serum to the cell (extracellular to intracellular)
-Cardiac monitoring
-Humulin R
-Dexrose
IV furosemide
-PO/PR Kayexulate
-Ventolin Neb
-IV Calcium Glucomnate
Humulin R
insulin is a potent stimulus for hypokalaemia, sparing body potassium from urinary excretion by transporting it into cells.
Foresemide
Inhibits the reabsorption of sodium and chloride from the loop of Henle and distal renal tubule.
Increases renal excretion of water, sodium, chloride, magnesium, potassium, and calcium.
Effectiveness persists in impaired renal function.
Why are people with diabetes who require a lot of insulin at risk for hypokalameia
Exogenous insulin can induce mild hypokalemia because it promotes the entry of K+ into skeletal muscles and hepatic cells by increasing the activity of the Na+-K+-ATPase pump
Chloride
tags along with potassium and maintains the acid base balance
Urea function in the body
-Measures amount of nitrogen in blood
-indicates how well the kidneys filter
-by product of protein metabolism
-formed by the liver
-Helps identify the fluid status
-regulated by renal system
creatinine function in the body
-waste product of the muscle metabolism
-regulated by the kidneys
-muscle contraction
(transported through the bloodstream to the kidneys, filtered out through urine)
High creatinine indicates
severe dehydration, renal failure
low creatinine indicates
decreased muscle mass, inadequate protein intake
Calcium job in the body
-Development of healthy teeth and bones
-Transmission of nerve impulse
-cardiac contraction
-blood clotting
-Large muscle contraction
what is calcium regulated by
parathyroid gland
Calcium needs
Vit D and Calcitonin
When serum levels drop where does the body get calcium from
bones
Is excess calcium stored
no, it is filtered out
Hypercalemia symptoms
-Impaired memory
-Confusion
-faitgue
-muscle weakness
-constipation
-ABN heart rhythm
-Renal calculi
Hypercalemia is caused by
Hyperparathyroidism, cancers, calcium leeches out
Hypocalcemia is caused by
Acute pancreatis
blood transfusion
diet/absorption
Vitamin D deficiency
Foods to treat Hypocalcemia
Raw milk, yogurt kale, cheese, sardines, broccoli, okra, almonds, book chow, watercress
Hypermagnesmia caused by
Renal failure, prenatal treatment of preeclampsia
Symptoms of Hypermagnesmia
Nerves and muscle function, hypotension, fatigue, facial flushing
Hypomagnesemia is caused by
GI loss, renal loss, Chronic alcoholism, prolonged malnutrition, serum glucose over 10 mmol
Symptoms/Assessment for Hypomagnesemia
Can mimic hypocalcemia, cardiac, neuromuscular, confusion, seizure
What happens if magnesium is administered too fast
Hypotension, cardiac and resp arrest
Phosphate function in the body
Helps control function of muscle, RBC and nervous system, deposited with calcium
As phosphate rises what happens to calcium
it decreases
Hyperphsophatemia is caused by
renal failure, chemotherapy, large doses of vitamin D
What to assess when suspecting Hyperphosphatemia
See symptoms of hypocalcemia because Calcium will be low
Hypophosphatemua is caused by
malnourishment, Alchohol withdrawal
Symptoms of Hypophsphatemia
Altered CNS, Muscle weakness, Increased WOB, Cardiac dysrhythmia
Function of glucose
provides energy for the cells
Regulates liver, kidney, pancrease
Causes of Hyperglycemia
too much food, too little insulin, illness, stress, steroid use
Symptoms of hyperglycaemia
Thirst (polydipsia), Frequent urination (Polyuria), loss of appetite (Polyphagia), flushed dry skin, fruit like breath, rapid deep breathing, nausea/vomitting, abdominal cramping, increased temp
Cause of hypoglycaemia
too little food, too much insulin or oral diabetes, extra exercise
Symptoms of hypoglycaemia
shaky light headed, causes, nervous/irritable, confused unable to concentrate, hungry, tachycardia, diaphoretic, headache, weak, drowsy, numb, tingling, chills, cold sweats, low orientation
Hot and dry
sugar high
Cool and clammy
Need some candy
Why does fluid stay where it belongs
Starlings hypothesis States that fluid movement due to filtration across the all of a capillary is dependent between the hydrostatic pressure gradient and the oncotic pressure gradient
what is the hydrostatic pressure gradient
what pushes the water out
what is the osmotic pressure gradient
Pushes the water in
the release of what simulates thirst
ADH
2nd spacing fluid
accumulation of interstitial fluid edema
3rd spacing fluid
accumulation of fluid between serial membranes ascites, effusion, peritoneal fluid
Hypertonic fluids
pulls water from the cell
3% saline
Isotonic fluids
no effects on the cell
Hypotonic fluids
water moves into the cell
Why would a patient get IV fluids
- Maintenance
- Replacement
Colloids IV fluids
(come in a bottle) large molecules (usually protein) do not pass through see permeable membrane remain in intravascular compartment
Crystalloid IV fluid
Small molecules that pass through semi permeable membrane (NA, K) and non electrolyte dextrose
Symptom of dehydration
increased thirst, fatigue, headache, dizziness, trouble concentrating, decreased urine output, nausea, muscle cramps/ABD pain, decreased bowel sounds
Why does dehydration matter
Cells cannot function without water, body response by pulling needed fluid from the periphery
what will doc order when patient is dehydrated
IV bolus, Lab work
Patient teaching for dehydration
what to drink how much to drink
Symptoms of fluid overload
headache. increased uric output, SOB, Palpations, weight gain, edema
What labs will change in Fluid overload
WBC, RBC, Hemoglobin, Hematocrit, MVV, Platelets
Nursing intervention for excess fluid
-Cath, Furosemide, daily weight
How much urine should be in the bladder in an hour
20 mL
