3 (fluids, electrolytes, acid-base, IV therapy) and 6 (infection prevention) Flashcards by Em Fulton

control of fluid balance is managed by the receptors: o__ receptors (located in the h__ and provoke the thirst mechanism), b__ receptors (located in the c__ sinus and the a__ arch detect pressure changes stimulating the sympathetic system)

osmoreceptors, hypothalamus

baroreceptors, carotid, aortic

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control of fluid balance managed by the hormones: A__ (released by the p__ pituitary, controls fluid by urine and reabsorption of water from kidneys), a__ (regulates reabsorption of water and sodium from kidney tubules)

ADH, posterior

aldosterone

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control of fluid balance managed by the b_ natriuretic peptide (or B-type natriuretic peptide) and a_ natriuretic peptide= both promote loss of water and sodium from kidney tubules and cause vasodilation

brain

atrial

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3 examples of extracellular fluid (i_, i_, t_)

intravascular, interstitial, transcellular

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what electrolyte maintains the osmolality of the intracellular fluid

K+

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what electrolyte controls the osmolality of the extracellular fluid

sodium

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Movement of fluid and electrolytes; how is fluid moved- what type of transport

Passive transport: diffusion, osmosis, filtration

Active transport requires ATP (amino acids, glucose, iron, hydrogen, sodium, potassium, and calcium)

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any disease that affects circulation will ultimately affect the distribution and composition of b_ f_

body fluids

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extra fluid is l_ when the metabolic rate is a_; ex’s

lost
accelerated
ex’s: fever, burns, trauma, states of extreme stress

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which pt is in need for TPN

pt’s who will be unable to take in fluids or food on their own for an extended period

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(think down) thirst; poor skin turgor; weight loss; weakness; complaints of dizziness; postural hypotension; decreased urine production; dark, concentrated urine; dry, cracked lips and tongue; dry mucous membranes; sunken, soft eyeballs; thick saliva; dry, scaly skin; flat neck veins when lying down; rapid, weak, thready pulse; elevated temp; increased hematocrite; high urine specific gravity with low volume

s/s dehydration

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(think up) weight gain; slow, bounding pulse; elevated blood pressure; firm subcutaneous tissues; possible edema; possible crackles in lungs on auscultation; lethargy, possibly seizures; possibly visible neck veins when lying down; decreased serum sodium; decreased hematocrit from hemodilution; low urine specific gravity with high volume

s/s overhydration

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hydroxyzine
promethazine
prochlorperazine maleate
ondansetron
metoclopramide

antiemetics

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diphenoxylate atropine
loperamide HCI
kaolin-pectin
bismuth subsalicylate
camphorated opium tincture

antidiarrheals

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an increase in capillary hydrostatic pressure
loss of plasma proteins
obstruction of lymphatic circulation
increase in capillary permeability
causes of e_

general causes of edema

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congestive heart failure, liver disease with ascites, and chronic renal failure result in excessive water retention- putting pt’s at risk for which electrolyte imbalance

hyponatremia

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water loss from fever, respiratory infection, or watery diarrhea, impaired thirst, or restricted access to water- can cause
what is restricted intake for these pt’s

hypernatremia

sodium

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what type of solution shifts fluid into the cell, rehydrating them

hypotonic

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what type of solution causes fluid to shift from the intracellular

hypertonic

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which type of fluid is infused to a pt getting blood

0.9% NSS

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important to keep the s_ sterile when changing the intravenous tubing

spike

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cool, pale, pain, and edema are symptoms of IV i_

infiltration

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How does a pt receive TPN: c_ v_ c_

central venous catheter

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infusion of medications or chemicals into tissues that can cause injury: e_

extravasation

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infusion of IV fluids into tissues

infiltration

inflammation of the vein caused by a clot

thrombophlebitis

caused by too-rapid infusion of medications

speed shock

when is TPN begun; how is TPN delivered

when nutrition cannot be delivered by oral intake and PPN or by enteral feedings PICC- peripherally inserted central catheter

h_ alters the way digitalis is metabolized in the body and predisposes the pt to d_ t_

hypokalemia digitalis toxicity

fatigue, anorexia, headache, blurred vision, yellow-green halos around lights, nausea, diarrhea, and cardiac dysrhythmias: signs of d_ t_

digitalis toxicity

Lactated Ringer's solution is: isotonic, hypotonic or hyptertonic

isotonic

sterile water is: isotonic, hypotonic, hypertonic; can cause what; how is it used

hypotonic hemolysis used to reconstitute powdered medications

0.9% saline, lactated Ringer solution, dextrose 5% in water, and dextrose 5% in 0.225% saline- isotonic, hypotonic or hypertonic

isotonic

sodium normal range = think odd numbers

135-145

potassium normal range = think bananas

3.5-5

BUN = bunions

5-20

creatinine = think nine

0.6-1.2

glucose = energy

70-100

calcium = milk

8.5 - 10.5

chloride = chlorine (hot tub)

95-105

bicarbonate = think carbonation/ soda x2

23-29

-approx 1/3 of total body water -transports water, nutrients, oxygen, waste, and more to and from the cells -regulated by renal, metabolic, and neurologic factors -high in sodium content

extracellular fluid includes

-fluid within the blood vessels -consists of plasma and fluid within blood cells -contains large amounts of protein and electrolytes

intravascular fluid

-fluid in the spaces surrounding the cells -high in sodium content

interstitial fluid

includes aqueous humor; saliva; cerebrospinal, pleural, peritoneal, synovial, and pericardial fluids; gastrointestinal secretions; and fluid in the urinary system and lymphatics

transcellular fluid (because it transports)

-about 2/3 of total body fluid -fluid contained within the cell walls; most cell walls are permeable to water -high in potassium content

intracellular fluid

what non-fluid sensation can also cause the pituitary to release ADH: p_, n_, s_

pain, nausea, stress

primary triggers for ADH are: d_ p_ or i_ c_ of blood

decreased pressure or increased concentration of blood

when ECF volume is low or sodium concentration is decreased the adrenal cortex releases a_, causing r_ of sodium from renal tubules

aldosterone reabsorption

what system regulates release of aldosterone

renin-angiotensin-aldosterone system

baroreceptors in the atrium of the heart detect fluid o_ and stimulate the myocardium to release A_ , which increases s_ excretion

overload, ANP, sodium

what nonelectrolytes contribute to the osmolality of body fluids: p_, g_, b_, c_, u_

protein, glucose, bilirubin, creatinine, urea

acyclovir is which type of antimicrobial drug

antifungal along with: amantadine, azidothymidine, oseltamivir phosphate, peramivir, saquinavir, zanamivir

lypressin is which type of medication

vasopressor

removing ppe

gloves, goggles, gown, mask, hand hygeine

pt's who are more susceptible to infection include: 5

pt's who: -are already weakened by illness -have drainage tubes, intravenous catheters, other invasive devices for monitoring or treatment -very old or very young -have had recent surgery -are immunocompromised

speed of action in innate immunity is r_, and occurs in s_ h_

rapid, several hours

pt's will be more c_ with therapy if they understand the purpose of the treatment

compliant

latent phase of any communicable disease: pt is a_ to transmit the disease to others, s/s are o_ n_ present, pt may n_ feel ill or have general malaise

able often not not

Body's protective and defensive mechanisms against infection: f_, n_, a_, a_, b_, l_, p_, m_, l_

fever nutrition antigens antibodies bone marrow liver cells leukocytosis phagocytosis macrophages

Body's mechanisms of defense: Adaptive immunity- a_-m_ i_ r_ (B lymphocytes) c_-m_ i_ r_ (T lymphocytes) Innate immunity- i_ s_, n_ f_, m_ m_, GI tract, GU tract, i_, phagocytosis by white blood cells, f_

antibody-mediated immune response cell-mediated immune response intact skin normal flora mucous membranes inflammation fever

-decreased: skin turgor and greater skin friability, elasticity and atherosclerosis of peripheral vessels, GI tract motility as muscles weaken, acid production, immune response because bone marrow does not produce new blood cells as rapidly, ciliary action from smoking or exposure to air pollution -calcification of heart valves -stiffness of thorax from arthritis or aging changes - weakened respiratory muscles -prostate changes, bladder prolapse, and urethral strictures

changes in natural defense mechanisms that occur with age

Airborne precautions: disease (MTv's)

measles, tuberculosis, varicella-zoster (chickenpox and shingles, and variola (smallpox), SARS (severe respiratory syndrome)

Contact precautions: ABCDEF

-abscess- large and major drainage -bronchiolitis- RSV and parainfluenza -cutaneous- herpes zoster, varicella, herpes simplex, impetigo, lice, major pressure/ decubitus ulcers, ---scabies, major staph/strep, skin wounds/burns, ----diphtheria -diarrhea- c. diff, norovirus, rotavirus, hep a -eyes- conjunctivitis -acute, viral -funky/feisty- MDRO's

droplet precautions- MY PERfect MUM FLU a Dozen STRong MEN on a PLAne to a PARk in GERMANY to ADd a NEW EPIc RHINO

mycoplasma pneumonia (walking pneumonia) pertussis (whooping cough) mumps flu diptheria (pharyngeal) streptococcus meningitis plague (pneumonic) parvovirus B 19 (5th disease) german measles (rubella) adenovirus pneumonia epiglottitis rhinovirus

Contact: Mode of transmission PPE Room type

prevent transmission of infections spread by direct or indirect contact with the pt or pt's environment gown and gloves single-pt room

Droplet: Mode of transmission PPE Room type

prevent transmission of infections spread via air droplets by coughing, sneezing, talking, or close contact with respiratory secretions/mucous membranes surgical mask single-pt room

Airborne: Mode of transmission PPE Room type

prevent transmission of infections that remain infectious over long distances when suspended in the air N95 or higher level respirators airborne infection isolation room negative pressure, special ventilation

What is sepsis S/S to watch with pt's at risk for sepsis (systemic inflammatory response syndrome SIRS) conditions that can lead to sepsis

infection enters bloodstream change in mental status, tachycardia, tachypnea, changes in bp, decreased urine output, fever, elevated WBC pneumonia, UTI, and post-surgical wound infections

what is shock, what can it lead to

circulatory failure causing inadequate perfusion of the tissues - there's an underlying process preventing us from delivering adequate oxygenated blood to tissues and organs- can lead to tissue hypoxia, cell death, organ failure

3 (fluids, electrolytes, acid-base, IV therapy) and 6 (infection prevention) Flashcards

(70 cards)