Wk 5: Fluids&electrolytes/skin disorders/ WBC/Anti-fungal Flashcards
what do body fluids do?
transport nutrients & waste from cells
solvent for electrolytes
maintains body temp
role in digestion, elimination, acid-base balance, lubricant of joints
what is body fluid?
It is plasma:
water
glucose
electrolytes
proteins
how much of the adult body is water?
50-60%
intracellular
inside the cells
extracellular
outside the cells
interstitial fluid
between cells
(interstitial and intravascular fluid)
intravascular fluid
plasma
osmosis
-moving water from low to high concentration gradient
-moves across semipermeable membrane
diffusion
movement of molecules from high to low concentration, until equal
what is the difference between osmosis and diffusion?
osmosis is the movement of liquids to even out the concentration gradient, while diffusion is the movement of molecule to even out the concentration gradient.
what is osmotic pressure?
the amount of pressure needed to prevent movement of water across a cell membrane
what are colloids
substances that increase colloid oncotic pressure
-move fluid from interstitial to plasma
what are the three primary colloids ?
albumin *
globulin
fibrinogen
what causes your colloid oncotic pressure to decrease?
age and malnutrition
hydrostatic pressure
push fluid OUT of capillaries
force of FLUID against cell membrane
-generated by BP
-water pushed out of capillaries to interstitial space
-at arterial end of capillaries
-increases filtration
-aids in nutrition supplementation
Oncotic pressure (colloid pressure)
*pulls fluid INTO capillaries *
force d/t ALBUMIN
caused by plasma colloid
moved from vascular place to tissue space
at venular ends of capillaries
removing metabolic waste
what is an electrolyte?
substances that are electrically charged when inside a solution
(+)
T/F: if there is a change in one electrolyte, it can affect the balance of the rest?
true
what influences electrolytes ?
fluid balance
acid base balance
nerve impulses
muscle contraction
heart rhythm
other cell functions
concentrations of electrolytes are dependent on what factors
electrolyte intake, absorption, distribution, excretion
what electrolytes are primarily inside the cell?
potassium (+)
Magnesium (+)
Phosphorous (-)
What electrolytes are primarily outside the cell?
Sodium (+)
Chloride (-)
Bicarbonate (-)
what is the normal lab values for sodium?
136-145
what is the normal lab values for potassium?
3.5-5.0
what is the normal lab values for magnesium?
1.7-2.2
what is the normal lab values for calcium?
9-11
what is the normal lab values for phosphate?
3.2-4.3
what electrolyte is the key factor in influencing water distribution throughout the body?
sodium
causes of hyponatremia
GI loss (D/V/fistulas/NG suctioning)
Renal loss (diuretics, insufficiency)
Skin loss (burns/ wound damage)
fasting diets
polydipsia
excess hypotonic fluid
S/Sx of hyponatremia
confusion/AMS
anorexia, Wk
Sz/coma
Dilutional hyponatremia
HYPERvolemia
increased BP
weight gain
bounding/rapid pulse
increased urine SP gravity
depletional hyponatremia
HYPOvolemia
decreased BP
tachycardia
dry skin
weight loss
low urine Sp gravity
when giving sodium bicarbonate does it increase or decrease the pH levels in your urine and blood?
increases
why would you give someone sodium bicarbonate?
they are experiencing metabolic acidosis
why are there so many drug to drug interactions with sodium bicarbonate?
b/c a lot of drugs are diluted with sodium solutions
what are some causes of HYPERnatremia?
IV fluids, tube feedings
near drowning in salt water
not enough water intake or too much water loss
D, F, heat stroke
cognitively impaired
profound diuresis
S/Sx of hypernatremia
AMS/ALOC/ confusion
Sz/coma
extreme thirst
dry& sticky mucus membranes
muscle cramps
why do you have to gradually achieve a normal sodium level over 48 hours ? (in regards to hypernatremia)
too quick= damage to brain cells
-avoid edema of cerebral cells
what does potassium help regulate?
-cell excitability and electrical status (cardiac)
-controls intracellular osmolality
what is our main source of K+ intake?
what is our main source of K+ loss?
-diet
-kidneys
what are some causes of hypokalemia?
renal or GI loss (diuresis)
acid base disorders
S/Sx of hypokalemia
cardiac rhythm disturbances (lethal)
Wk, leg cramping
decreased bowel motility/constipation/N/ileus
how do you treat hypokalemia?
KCL
PO or IV, IV MUST ALWAYS BE DILUTED
what is a contraindication for KCL?
renal failure
what are some causes of hyperkalemia?
decreased potassium output (renal failure)
burns/crush injury/sepsis (anything with massive cell injury)
K+ sparing diuretics, ACE, ARB’s, NSAIDS
S/Sx of hyperkalemia
cardiac rhythm disturbances
Wk, cramps
Abd cramps, D,V
magnesium
-stabilizes cardiac muscle cells by controlling movement of K+
-stabilizes smooth muscles
causes of hypomagnesemia
diuresis, GI/renal loss, limited intake, alcohol abuse, pancreatitis, hyperglycemia
S/Sx of hypomagnesemia
hyperactive reflexes, confusion, cramps, tremors, seizures
nystagmus
causes of hypermagnesemia
increased intake alongside renal failure.
ex: ESRD pt who takes milk of mag
OB pt
S/Sx of hypermagnesemia
lethargy, floppiness, weakness, decreased reflexes, flushed/warm skin, deceased pulses decreased BP
hormones released from _____ control the amount of calcium that that released and absorbed by the bone
thyroid and parathyroid glands
where is a majority of calcium found?
in the bones (99%)
what are two distinctive signs of hypocalcemia?
- positive Chvostek’s sign (facial twitch)
- positive Trousseau’s sign (BP)
Trx of hypocalcemia
IV calcium
oral calcium
what are two causes of hypercalcemia?
hyperparathyroidism
cancers
S/Sx of hypercalcemia
sedative
fatigue/ lethargy
confusion
weakness
Sz/coma
kidney stones
Trx of hypercalcemia
hydration
increased urine output
diuretics and NaCL
dialysis ( in renal failure)
Phosphorus has a role in forming what?
-bones
-ATP formation
-part of DNA/RNA formation
Hypophosphatemia causes
decreased absorption, antacid OD, severe Diarrhea, increased kidney elimination, malnutrition (EtOH, TPN)
Or Calcium level changes
S/Sx of hypophosphatemia
tremor, paresthesia, confusion/coma, Sz, wk, joint stiffness, bone pain, hemolytic anemia, platelet dysfunction, impaired WBC function
hyperphosphatemia causes
*kidney failure *
laxatives/enemas with phosphorus
massive trauma
heat stroke
hypoparathyroidism
S/Sx of hyperphosphatemia
usually asymptomatic
muscle spasms
paresthesias
tetany
how would you treat a patient with HYPERphosphatemia?
treat the cause
how would you treat a patient with HYPOphosphatemia?
IV/PO replacement
increase oral intake
what patients are more susceptible to a fungal transmission?
elderly
immuno-compromised
vascular indwelling catheters
organ transplant recipients
chemotherapy
how do you treat superficial fungal infections?
topical anti-fungal preparations
tineas corporosis
ringworm
tinea pedia
what is it?
characteristics
risk factors
prevention
treatment
athletes foot
characteristics: dry/scaling pruritic lesions. may only affect webbed part of toes
RF: contact with infection or fungus in environment
prevention: shower shoes, cleaning shower
Trx: topical anti-fungal (OTC) or systemic anti-fungals for resistant cases
tinea versicolor
what is it?
risk factors
characteristics
treatment
skin of the upper chest, back or arms with ringworm, caused by a yeast that is naturally on skin, rash occurs then yeast grows out of control
RF: hot climate, dia, oily skin, wk immune system
**not contagious*
characteristics: acidic bleach causing skin discoloration (white/pink/red/brown)
Trx: topical anti-fungal
tinea capitis
what is it?
characteristics
Treatment
hair/scalp/eyebrow/eyelashes fungal infection
characteristics: scaly erythematous lesions, hair loss, can cause alopecia
common in pediatric dermatophyte
Trx: PO systemic anti-fungals BID for 4-6 wks
*topicals not as effective
tinea cruris
ringworm of the groin
candidiasis
what is it?
risk factors
appearance
Trx
thrush/yeast infection
RF: immunosuppression, Abx use
appearance: white lesions in mouth, beefy red lesions in intertriginous areas
Trx: topical anti-fungal
what affects does a systemic fungal infection have on the body?
-affects internal organs
-affects lungs and meninges
-requires aggressive treatment
how does shingles become reactivated?
by immunosuppression, stress or illness
varicella zoster remains dormant on a _____ segment after an infection with ________
- dermatome
- chickenpox
prodrome
(related to shingles)
burning/tingling along dermatome
rash develops
dry/crusting
herpes zoster
characteristics
Trx:
complications:
characteristics: extreme pain, clears in 2-3 wks, usually in ppl >50y/o, can occur in anyone who has had chickenpox
Trx: anti-virals
complicationL post-herpetic neuralgia persistent pain in the area where the rash was
when is the person with herpes zoster most contagious?
when vesicles are weeping
impetigo appearances
vesicles, pustules, honey colored crust on red base
*they are usually acute and CONTAGIOUS
Abscess characteristics
inflamed skin with pus
-raised/palpable boarder
tender
-main have purulent drainage or be flactuant
how would someone with an abscess be treated?
I&D with Abx
Furuncle
bacterial infection of hair follicle
carbuncle
painful deep swelling caused by bacteria
how do you treat furuncles and carbuncles ?
I&D and Abx
cellulitis
what is it ?
causes ?
Trx?
bacterial infection (usually strep or staph)
d/t injuries, wounds, animal bite, insect bites that get infected
Trx: PO Abx or IV (depending on severity)
*not contagious, can become systemic though
how does cellulitis appear?
red, painful, warm to touch
blisters
Methicillin Resistant Staph Infection (MRSA)
what is it?
it is d/t a type of staph bacteria that is resistant to many Abx
what is hospital acquired MRSA most associated with?
invasive procedures (Surgery, IV tubing, artificial joints)
community acquired MRSA
how does it start?
who is most at risk?
often beings as a painful boil
-person to person
at risk: high school wrestlers, child care workers, people who live in crowded conditions
S/Sx of MRSA
wam to touch, purulent drainage, F, abscess
Trx of MRSA
hospital acquired: IV vancomycin or Zyvox
community acquired: PO bactrim or dicloxacillin
what is the prophylaxis treatment used for MRSA prior to surgeries?
bactroban nasal ointment
Actinic Keratosis
bengin (precancerous) skin lesion
d/t sun UV damage
common w/ fair skinned
rough/scaly/red plaque
solar lentigos
benign skin lesions
“liver/age spots”
Can indicate cancer risk
what are the three major types of skin cancer
- basal cell: most common
- squamous cell: 2nd most common, can metastasize to remote areas
- melanoma: rarer, but high rate of metastasis
ABCDE if skin lesions
Asymmetry
Border
Color
Diameter
Evolution
what are the characteristics of a basal cell carcinoma
small nodular dome that is flesh colored or pink
-eventually will form an ulcer surrounded by a shiny border
what are the characteristics of squamous cell carcinomas?
-curable with early treatment
-red and scaling, keratotic, slight elevation, irregular boarder, usually with shallow chronic ulcer
what are some risk factors for melanoma?
FHx, blond/red hair, freckling upper back, h/o blistering sunburns, h/o >3 yrs of an outdoor job as a teen
-risk increases with sun exposure
-highest in caucasian males
why is melanoma more worrisome than the other skin lesions?
-it can invade the blood and lymphatic vessels then metastasizes to distant sites
melanoma characteristics
vary in shape and size
irregular borders
color varies (shades of tan/brown/black/white/red/blue)
diameter greater than 6mm
it evolves, changes in color/size/shape
characteristics of eczema
pruritus, rash, skin is dry/thickened/scaly, reddish color then turn brown, lesions can ooze and crust over
-can be exacerbated by heat, cold, detergents, URI, stress
what is the most common eczema
atopic
treatment for eczema
relieve itching/ prevent infection
lotions and creams
cold compress
OTC/Rx hydrocortisone
immune modular medications
what is psoriasis
-chronic condition
-begins in young adults
-not contagious
-1-3% of population
-d/t an overactive immune system, may be autoimmune
-skin cells grow to quick
link between psoriasis/obesity/CVD
psoriasis characteristics
thick/white/silvery or red patches of skin and plaque
Trx of psoriasis
keep skin moist, UV light phototherapy, corticosteroid creams/lotions, topical medications, immune modulating medications
what is the most abundant cells of the blood?
erythrocytes
Nml count 4.2-6.2
48% in men
42# in women
what is the primary responsibility of erythrocytes ?
tissue oxygenation
what are the different kinds of leukocytes?
Never Let Monkeys Eat Bananas
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
what are considered granulocytes ?
neutrophils, eosinophils, basophils
what are considered agranulocytes ?
lymphocytes
monocytes/ macrophages
neutrophils
bands and segs
first to arrive at the site of infection
increase with acute bacterial infections and trauma
shift to the left (increase of bands)
60-70&
lymphocytes
primary cells of immune response
increase with chronic bacterial infection and acute viral infection
20-25%
monocytes
phagocytosis
increase with bacterial infections and cancers
3-8%
eosinophils
increase with allergic reactions or parasitic infections
-worms, wheezes and weird diseases
2-4%
basophils
increase with allergic reactions
0.5-1%
what are the normal Hgb ranges for men and women?
men: 13.5-17.5
women: 12-15.5
what are some reasons that a patient may have a low Hgb?
bleeding
folate/B12 deficiency
cancers
kidney & liver Dz
what are some reasons that a patient may have a high Hgb?
polycythemia
COPD
high altitude
heavy smoking
what is the hematocrit (Hct)?
percentage of blood that is made up of paced red blood cells (RBCs)
how would you interpret a hematocrit of 40%?
this means there are 40 mL of packed RBC’s in 100 mL of blood
what are the normal ranges for Hct ? for males and females
males: 41-50%
females: 36-44%
S/Sx of low Hct
anemia, bleeding disorders, fluid imbalance
S/Sx of high Hct
polycythemia, COPD, dehydration, shock, congenital heart Dz
what are some other red cell labs other than Hct and Hgb?
red cell count (# if erythrocytes in blood)
mean corpuscle volume (size of erythrocytes)
mean corpuscle hemoglobin (amt of hgb n erythrocytes by weight)
what is a normal range for WBC count
5,000-10,000
leukopenia
decreased WBC count
leukocytosis
increased WBC count
what are some precautions to be taken when a patient has neutropenia ?
have good hygiene
avoid sick contact
avoid raw fruits, veggies, grains
keep door closed
neutropenia
decreased neutrophils
-most often CA pt (result of Dz or Trx)
-susceptible to bacteria infection
WBC with diff
- total # of WBC’s in mm^3
- determination of the proportion of each of the 5 WBC’s in a sample of 100 WBC’s (% in the sample of 100)
what else should you be looking for with an infection, other than WBC?
increased temperature
-Fever is the body responding to an infection
-can improve immune response
-can decreased the virulence of some bacteria
-can stop growth of some microorganisms
leukopenia pharmacologic treatments
hematopoietic agents (HA)
-G-CSF
- filgrastim
What is a cation?
Positively charged electron
If a patient is confused what electrolyte do they most likely have a deficit in?
Sodium
Causes of hypocalcemia
Hypoparathyroidism, hypomagnesemia, renal failure, decreased vitamin D, thyroid/ parathyroid surgery, increased neuromuscular excitability, cardiac insufficiency
If a patient has low calcium they will have______phosphorus since these electrolytes work together
High
Mononucleosis “mono”
Infectious
Self-limiting lymphoproliferative disorder
Infection of B lymphocytes
Caused by EBV
Mode of transmission: EBV contaminated saliva
Onset of mono
Insidious
Incubation of 4-8 weeks
Clinical manifestations of mono
Lymphadenopathy
Hepatitis
Splenomegaly
95% lymphocytes
Lethargic for 2-3 months
Acute phase can be 2-3 weeks
Trx: symptomatic and supportive
What is mylodysplastic syndrome?
Group of hematologist disorders that has a change in the quality and quantity of bone marrow elements
Cytopenias
Affects elderly
Unknown cause
Trx: depends on severity
Leukemias
Immature and unregulated white blood cells/ undifferentiated that proliferate in bone marrow and circulate in the blood. Can get into spleen and lymph nodes
-WBC’s that are rapidly producing and causing problems
How do you classify different kinds of leukemia ?
Classified according to the predominant cell type and if the condition is acute or chronic
What is the most common childhood leukemia ?
ALL
Acute lymphatic leukemia
What is the most common leukemia in older adults?
CLL
Chronic lymphocytic leukemia
Leukemia that affects the lymphoid stem cells affect what kind of cells?
T cells, B cells, Plasma cells
Leukemia that is related to myeloid stem cells affect what kind of cells?
Granulocyte cells: neutrophils, eosinophils, basophils
Monocytes cells: monocytes and macrophages
Treatment for leukemia
Goal: attain remission
Cytotoxic chemotherapy
Stem cell transplant
Risks of treatment: infection, rejection, relapse
Types of malignant lymphomas
Hodgkin Dz
Non-Hodgkin Dz
Hodgkins Dz
Painless/ progressive/ rubbery enlargement of lymph nodes. Slow onset
Reed-Stenberg Cells (originate from B cells)
Non-hodgkins
Also affects lymphoid tissue
Prognosis less certain
Spreads early to liver, spleen, and bone marrow
Multiple myeloma
Cancer of B cells
Abnormal immunoglobulins, increases osteoclasts and bone breakdown
More likely to get sick when exposed
More common in men and African Americans
