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NUR 325 Intro Pathophysio > Wk 5: Fluids&electrolytes/skin disorders/ WBC/Anti-fungal > Flashcards

Wk 5: Fluids&electrolytes/skin disorders/ WBC/Anti-fungal Flashcards

1
Q

what do body fluids do?

A

transport nutrients & waste from cells
solvent for electrolytes
maintains body temp
role in digestion, elimination, acid-base balance, lubricant of joints

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2
Q

what is body fluid?

A

It is plasma:
water
glucose
electrolytes
proteins

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3
Q

how much of the adult body is water?

A

50-60%

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4
Q

intracellular

A

inside the cells

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5
Q

extracellular

A

outside the cells

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6
Q

interstitial fluid

A

between cells
(interstitial and intravascular fluid)

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7
Q

intravascular fluid

A

plasma

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8
Q

osmosis

A

-moving water from low to high concentration gradient
-moves across semipermeable membrane

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9
Q

diffusion

A

movement of molecules from high to low concentration, until equal

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10
Q

what is the difference between osmosis and diffusion?

A

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.

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11
Q

what is osmotic pressure?

A

the amount of pressure needed to prevent movement of water across a cell membrane

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12
Q

what are colloids

A

substances that increase colloid oncotic pressure
-move fluid from interstitial to plasma

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13
Q

what are the three primary colloids ?

A

albumin *
globulin
fibrinogen

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14
Q

what causes your colloid oncotic pressure to decrease?

A

age and malnutrition

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15
Q

hydrostatic pressure

A

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

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16
Q

Oncotic pressure (colloid pressure)

A

*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

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17
Q

what is an electrolyte?

A

substances that are electrically charged when inside a solution
(+)

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18
Q

T/F: if there is a change in one electrolyte, it can affect the balance of the rest?

A

true

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19
Q

what influences electrolytes ?

A

fluid balance
acid base balance
nerve impulses
muscle contraction
heart rhythm
other cell functions

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20
Q

concentrations of electrolytes are dependent on what factors

A

electrolyte intake, absorption, distribution, excretion

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21
Q

what electrolytes are primarily inside the cell?

A

potassium (+)
Magnesium (+)
Phosphorous (-)

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22
Q

What electrolytes are primarily outside the cell?

A

Sodium (+)
Chloride (-)
Bicarbonate (-)

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23
Q

what is the normal lab values for sodium?

A

136-145

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24
Q

what is the normal lab values for potassium?

A

3.5-5.0

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25
Q

what is the normal lab values for magnesium?

A

1.7-2.2

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26
Q

what is the normal lab values for calcium?

A

9-11

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27
Q

what is the normal lab values for phosphate?

A

3.2-4.3

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28
Q

what electrolyte is the key factor in influencing water distribution throughout the body?

A

sodium

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29
Q

causes of hyponatremia

A

GI loss (D/V/fistulas/NG suctioning)
Renal loss (diuretics, insufficiency)
Skin loss (burns/ wound damage)
fasting diets
polydipsia
excess hypotonic fluid

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30
Q

S/Sx of hyponatremia

A

confusion/AMS
anorexia, Wk
Sz/coma

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31
Q

Dilutional hyponatremia

A

HYPERvolemia
increased BP
weight gain
bounding/rapid pulse
increased urine SP gravity

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32
Q

depletional hyponatremia

A

HYPOvolemia
decreased BP
tachycardia
dry skin
weight loss
low urine Sp gravity

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33
Q

when giving sodium bicarbonate does it increase or decrease the pH levels in your urine and blood?

A

increases

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34
Q

why would you give someone sodium bicarbonate?

A

they are experiencing metabolic acidosis

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35
Q

why are there so many drug to drug interactions with sodium bicarbonate?

A

b/c a lot of drugs are diluted with sodium solutions

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36
Q

what are some causes of HYPERnatremia?

A

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

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37
Q

S/Sx of hypernatremia

A

AMS/ALOC/ confusion
Sz/coma
extreme thirst
dry& sticky mucus membranes
muscle cramps

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38
Q

why do you have to gradually achieve a normal sodium level over 48 hours ? (in regards to hypernatremia)

A

too quick= damage to brain cells
-avoid edema of cerebral cells

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39
Q

what does potassium help regulate?

A

-cell excitability and electrical status (cardiac)
-controls intracellular osmolality

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40
Q

what is our main source of K+ intake?
what is our main source of K+ loss?

A

-diet
-kidneys

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41
Q

what are some causes of hypokalemia?

A

renal or GI loss (diuresis)
acid base disorders

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42
Q

S/Sx of hypokalemia

A

cardiac rhythm disturbances (lethal)
Wk, leg cramping
decreased bowel motility/constipation/N/ileus

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43
Q

how do you treat hypokalemia?

A

KCL
PO or IV, IV MUST ALWAYS BE DILUTED

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44
Q

what is a contraindication for KCL?

A

renal failure

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45
Q

what are some causes of hyperkalemia?

A

decreased potassium output (renal failure)
burns/crush injury/sepsis (anything with massive cell injury)
K+ sparing diuretics, ACE, ARB’s, NSAIDS

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46
Q

S/Sx of hyperkalemia

A

cardiac rhythm disturbances
Wk, cramps
Abd cramps, D,V

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47
Q

magnesium

A

-stabilizes cardiac muscle cells by controlling movement of K+
-stabilizes smooth muscles

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48
Q

causes of hypomagnesemia

A

diuresis, GI/renal loss, limited intake, alcohol abuse, pancreatitis, hyperglycemia

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49
Q

S/Sx of hypomagnesemia

A

hyperactive reflexes, confusion, cramps, tremors, seizures
nystagmus

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50
Q

causes of hypermagnesemia

A

increased intake alongside renal failure.
ex: ESRD pt who takes milk of mag
OB pt

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51
Q

S/Sx of hypermagnesemia

A

lethargy, floppiness, weakness, decreased reflexes, flushed/warm skin, deceased pulses decreased BP

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52
Q

hormones released from _____ control the amount of calcium that that released and absorbed by the bone

A

thyroid and parathyroid glands

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53
Q

where is a majority of calcium found?

A

in the bones (99%)

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54
Q

what are two distinctive signs of hypocalcemia?

A
  1. positive Chvostek’s sign (facial twitch)
  2. positive Trousseau’s sign (BP)
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55
Q

Trx of hypocalcemia

A

IV calcium
oral calcium

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56
Q

what are two causes of hypercalcemia?

A

hyperparathyroidism
cancers

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57
Q

S/Sx of hypercalcemia

A

sedative
fatigue/ lethargy
confusion
weakness
Sz/coma
kidney stones

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58
Q

Trx of hypercalcemia

A

hydration
increased urine output
diuretics and NaCL
dialysis ( in renal failure)

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59
Q

Phosphorus has a role in forming what?

A

-bones
-ATP formation
-part of DNA/RNA formation

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60
Q

Hypophosphatemia causes

A

decreased absorption, antacid OD, severe Diarrhea, increased kidney elimination, malnutrition (EtOH, TPN)

Or Calcium level changes

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61
Q

S/Sx of hypophosphatemia

A

tremor, paresthesia, confusion/coma, Sz, wk, joint stiffness, bone pain, hemolytic anemia, platelet dysfunction, impaired WBC function

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62
Q

hyperphosphatemia causes

A

*kidney failure *
laxatives/enemas with phosphorus
massive trauma
heat stroke
hypoparathyroidism

63
Q

S/Sx of hyperphosphatemia

A

usually asymptomatic
muscle spasms
paresthesias
tetany

64
Q

how would you treat a patient with HYPERphosphatemia?

A

treat the cause

65
Q

how would you treat a patient with HYPOphosphatemia?

A

IV/PO replacement
increase oral intake

66
Q

what patients are more susceptible to a fungal transmission?

A

elderly
immuno-compromised
vascular indwelling catheters
organ transplant recipients
chemotherapy

67
Q

how do you treat superficial fungal infections?

A

topical anti-fungal preparations

68
Q

tineas corporosis

A

ringworm

69
Q

tinea pedia
what is it?
characteristics
risk factors
prevention
treatment

A

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

70
Q

tinea versicolor
what is it?
risk factors
characteristics
treatment

A

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

71
Q

tinea capitis
what is it?
characteristics
Treatment

A

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

72
Q

tinea cruris

A

ringworm of the groin

73
Q

candidiasis
what is it?
risk factors
appearance
Trx

A

thrush/yeast infection
RF: immunosuppression, Abx use
appearance: white lesions in mouth, beefy red lesions in intertriginous areas
Trx: topical anti-fungal

74
Q

what affects does a systemic fungal infection have on the body?

A

-affects internal organs
-affects lungs and meninges
-requires aggressive treatment

75
Q

how does shingles become reactivated?

A

by immunosuppression, stress or illness

76
Q

varicella zoster remains dormant on a _____ segment after an infection with ________

A
  1. dermatome
  2. chickenpox
77
Q

prodrome
(related to shingles)

A

burning/tingling along dermatome
rash develops
dry/crusting

78
Q

herpes zoster
characteristics
Trx:
complications:

A

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

79
Q

when is the person with herpes zoster most contagious?

A

when vesicles are weeping

80
Q

impetigo appearances

A

vesicles, pustules, honey colored crust on red base

*they are usually acute and CONTAGIOUS

81
Q

Abscess characteristics

A

inflamed skin with pus
-raised/palpable boarder
tender
-main have purulent drainage or be flactuant

82
Q

how would someone with an abscess be treated?

A

I&D with Abx

83
Q

Furuncle

A

bacterial infection of hair follicle

84
Q

carbuncle

A

painful deep swelling caused by bacteria

85
Q

how do you treat furuncles and carbuncles ?

A

I&D and Abx

86
Q

cellulitis
what is it ?
causes ?
Trx?

A

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

87
Q

how does cellulitis appear?

A

red, painful, warm to touch
blisters

88
Q

Methicillin Resistant Staph Infection (MRSA)
what is it?

A

it is d/t a type of staph bacteria that is resistant to many Abx

89
Q

what is hospital acquired MRSA most associated with?

A

invasive procedures (Surgery, IV tubing, artificial joints)

90
Q

community acquired MRSA
how does it start?
who is most at risk?

A

often beings as a painful boil
-person to person
at risk: high school wrestlers, child care workers, people who live in crowded conditions

91
Q

S/Sx of MRSA

A

wam to touch, purulent drainage, F, abscess

92
Q

Trx of MRSA

A

hospital acquired: IV vancomycin or Zyvox
community acquired: PO bactrim or dicloxacillin

93
Q

what is the prophylaxis treatment used for MRSA prior to surgeries?

A

bactroban nasal ointment

94
Q

Actinic Keratosis

A

bengin (precancerous) skin lesion
d/t sun UV damage
common w/ fair skinned
rough/scaly/red plaque

95
Q

solar lentigos

A

benign skin lesions
“liver/age spots”
Can indicate cancer risk

96
Q

what are the three major types of skin cancer

A
  1. basal cell: most common
  2. squamous cell: 2nd most common, can metastasize to remote areas
  3. melanoma: rarer, but high rate of metastasis
97
Q

ABCDE if skin lesions

A

Asymmetry
Border
Color
Diameter
Evolution

98
Q

what are the characteristics of a basal cell carcinoma

A

small nodular dome that is flesh colored or pink
-eventually will form an ulcer surrounded by a shiny border

99
Q

what are the characteristics of squamous cell carcinomas?

A

-curable with early treatment
-red and scaling, keratotic, slight elevation, irregular boarder, usually with shallow chronic ulcer

100
Q

what are some risk factors for melanoma?

A

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

101
Q

why is melanoma more worrisome than the other skin lesions?

A

-it can invade the blood and lymphatic vessels then metastasizes to distant sites

102
Q

melanoma characteristics

A

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

103
Q

characteristics of eczema

A

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

104
Q

what is the most common eczema

A

atopic

105
Q

treatment for eczema

A

relieve itching/ prevent infection
lotions and creams
cold compress
OTC/Rx hydrocortisone
immune modular medications

106
Q

what is psoriasis

A

-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

107
Q

psoriasis characteristics

A

thick/white/silvery or red patches of skin and plaque

108
Q

Trx of psoriasis

A

keep skin moist, UV light phototherapy, corticosteroid creams/lotions, topical medications, immune modulating medications

109
Q

what is the most abundant cells of the blood?

A

erythrocytes
Nml count 4.2-6.2
48% in men
42# in women

110
Q

what is the primary responsibility of erythrocytes ?

A

tissue oxygenation

111
Q

what are the different kinds of leukocytes?

A

Never Let Monkeys Eat Bananas
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils

112
Q

what are considered granulocytes ?

A

neutrophils, eosinophils, basophils

113
Q

what are considered agranulocytes ?

A

lymphocytes
monocytes/ macrophages

114
Q

neutrophils

A

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&

115
Q

lymphocytes

A

primary cells of immune response
increase with chronic bacterial infection and acute viral infection
20-25%

116
Q

monocytes

A

phagocytosis
increase with bacterial infections and cancers
3-8%

117
Q

eosinophils

A

increase with allergic reactions or parasitic infections
-worms, wheezes and weird diseases
2-4%

118
Q

basophils

A

increase with allergic reactions
0.5-1%

119
Q

what are the normal Hgb ranges for men and women?

A

men: 13.5-17.5
women: 12-15.5

120
Q

what are some reasons that a patient may have a low Hgb?

A

bleeding
folate/B12 deficiency
cancers
kidney & liver Dz

121
Q

what are some reasons that a patient may have a high Hgb?

A

polycythemia
COPD
high altitude
heavy smoking

122
Q

what is the hematocrit (Hct)?

A

percentage of blood that is made up of paced red blood cells (RBCs)

123
Q

how would you interpret a hematocrit of 40%?

A

this means there are 40 mL of packed RBC’s in 100 mL of blood

124
Q

what are the normal ranges for Hct ? for males and females

A

males: 41-50%
females: 36-44%

125
Q

S/Sx of low Hct

A

anemia, bleeding disorders, fluid imbalance

126
Q

S/Sx of high Hct

A

polycythemia, COPD, dehydration, shock, congenital heart Dz

127
Q

what are some other red cell labs other than Hct and Hgb?

A

red cell count (# if erythrocytes in blood)
mean corpuscle volume (size of erythrocytes)
mean corpuscle hemoglobin (amt of hgb n erythrocytes by weight)

128
Q

what is a normal range for WBC count

A

5,000-10,000

129
Q

leukopenia

A

decreased WBC count

130
Q

leukocytosis

A

increased WBC count

131
Q

what are some precautions to be taken when a patient has neutropenia ?

A

have good hygiene
avoid sick contact
avoid raw fruits, veggies, grains
keep door closed

132
Q

neutropenia

A

decreased neutrophils
-most often CA pt (result of Dz or Trx)
-susceptible to bacteria infection

133
Q

WBC with diff

A
  1. total # of WBC’s in mm^3
  2. determination of the proportion of each of the 5 WBC’s in a sample of 100 WBC’s (% in the sample of 100)
134
Q

what else should you be looking for with an infection, other than WBC?

A

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

135
Q

leukopenia pharmacologic treatments

A

hematopoietic agents (HA)
-G-CSF
- filgrastim

136
Q

What is a cation?

A

Positively charged electron

137
Q

If a patient is confused what electrolyte do they most likely have a deficit in?

A

Sodium

138
Q

Causes of hypocalcemia

A

Hypoparathyroidism, hypomagnesemia, renal failure, decreased vitamin D, thyroid/ parathyroid surgery, increased neuromuscular excitability, cardiac insufficiency

139
Q

If a patient has low calcium they will have______phosphorus since these electrolytes work together

A

High

140
Q

Mononucleosis “mono”

A

Infectious
Self-limiting lymphoproliferative disorder
Infection of B lymphocytes
Caused by EBV
Mode of transmission: EBV contaminated saliva

141
Q

Onset of mono

A

Insidious
Incubation of 4-8 weeks

142
Q

Clinical manifestations of mono

A

Lymphadenopathy
Hepatitis
Splenomegaly
95% lymphocytes
Lethargic for 2-3 months
Acute phase can be 2-3 weeks
Trx: symptomatic and supportive

143
Q

What is mylodysplastic syndrome?

A

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

144
Q

Leukemias

A

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

145
Q

How do you classify different kinds of leukemia ?

A

Classified according to the predominant cell type and if the condition is acute or chronic

146
Q

What is the most common childhood leukemia ?

A

ALL
Acute lymphatic leukemia

147
Q

What is the most common leukemia in older adults?

A

CLL
Chronic lymphocytic leukemia

148
Q

Leukemia that affects the lymphoid stem cells affect what kind of cells?

A

T cells, B cells, Plasma cells

149
Q

Leukemia that is related to myeloid stem cells affect what kind of cells?

A

Granulocyte cells: neutrophils, eosinophils, basophils
Monocytes cells: monocytes and macrophages

150
Q

Treatment for leukemia

A

Goal: attain remission
Cytotoxic chemotherapy
Stem cell transplant
Risks of treatment: infection, rejection, relapse

151
Q

Types of malignant lymphomas

A

Hodgkin Dz
Non-Hodgkin Dz

152
Q

Hodgkins Dz

A

Painless/ progressive/ rubbery enlargement of lymph nodes. Slow onset
Reed-Stenberg Cells (originate from B cells)

153
Q

Non-hodgkins

A

Also affects lymphoid tissue
Prognosis less certain
Spreads early to liver, spleen, and bone marrow

154
Q

Multiple myeloma

A

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

NUR 325 Intro Pathophysio (7 decks)

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