Exam 1 Flashcards
(129 cards)
1
Q
Cause of disease (general)
A
When compensatory mechanisms are not adequate.
2
Q
Body’s goal under stress
A
Adaptation –> Return to equilibrium
3
Q
Coping with stress depends on (6)
A
- Level of health and energy before stressor
- Personal belief system
- Life goals
- Self-esteem
- Experience with problem solving
- Hardiness
4
Q
Intended effects of adrenergics: Heart (3)
A
+ Chronotropic (HR)
+ Inotropic (force)
+ Dromotropic (AV Rate)
5
Q
Intended effects of adrenergics: Blood vessels (2)
A
- Vasoconstriciton causes increased BP & CO
* Increased blood flow to brain, heart and large skeletal muscles
6
Q
Intended effects of adrenergics: Bronchi
A
Bronchodilatation
7
Q
Intended effects of adrenergics: Eyes (2)
A
- Dilated pupils
* Aids vision
8
Q
Intended effects of adrenergics: Emotions
A
Subjective feelings of tension
9
Q
Intended effects of adrenergics: GI
A
• Decreased GI activity (blood shunted away from GI)
10
Q
Intended effects of adrenergics: Blood sugar
A
Increased blood sugar 2/2 glycogenolysis and gluconeogenesis
11
Q
Intended effects of adrenergics: Fatty acids
A
Increased fatty acids
12
Q
Intended effects of adrenergics: Fluids
A
Increased sweating
13
Q
Intended effects of adrenergics: Blood
A
Increased blood coagulation
14
Q
Glucogenolysis (def)
A
Breakdown of glycogen to form glucose
15
Q
Gluconeogenesis (def)
A
Making glucose from non-CHO sources
16
Q
Adverse effects of adrenergics: Heart (3)
A
- Tachycardia
- Arrhythmias
- Palpations
17
Q
Adverse Effects of adrenergics: Bood vessels (3)
A
- Pale
- Cool
- Hypertension
18
Q
Adverse effects of adrenergics: Emotions (3)
A
- Restlessness
- Tremors
- Insomnia
19
Q
Adverse effects of adrenergics: GI system (5)
A
- N/V
- Anorexia
- Constipation
- Ulcers
- GI bleeding
20
Q
Adverse effect of adrenergics: Blood sugar (2)
A
- Increased fasting blood sugar –> DM
* Increased insulin needs for diabetic patients
21
Q
Adverse effects of adrenergics: Fatty acids
A
• Increased lipids (cholesterol) –> ATHERSCLEROSIS
22
Q
Adverse effects of adrenergics: Fluids
A
• Increased sweating leads to fluid loss, claminess
23
Q
Adverse effect of adrenergicss: Blood
A
• Increased blood coagulation can lead to increased risk of MI, stroke
24
Q
Body’s physiologic response to stress
A
ANS is divided into SNS and PSNS
25
Adrenergic receptors (3)
* Alpha
* Beta 1
* Beta 2
26
Effects of "Alpha" Adrenergic Receptor
* "Arms and Legs"
| * Peripheral vasoconstriction in extremities
27
Effects of "Beta 1" Adrenergic Receptor
Cardiac: "1 Heart"
• + Chronotropic (HR)
• + Inotropic (Force)
• + Dromotropic (Rate of AV node)
28
Effects of "Beta 2" Adrenergic Receptor
Lungs "2 Lungs"
| • Bronchodilation
29
```
Age and body fluid:
• Infants %
• Adults %
• Geriatric %
• Obese %
```
** Who is at highest risk for losing water? **
* Infants: 70-80%
* Adults: 60%
* Geriatric: 45-50%
* Obese: As low as 30%
30
Early signs of dehydration (3):
* Some thirst
* Headache
* Lightheadedness
31
Late signs of dehydration (3):
* Seizures
* Coma
* Death
32
INTRACELLULAR
• % of body fluid
• Prime cation
* 2/3 of body fluid
| * K+ is prime cation
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EXTRACELLULAR
• % of body fluid
• Prime cation
• Components (2)
* 1/3 of body fluid
* Na+ is prime cation
• Components: Intravascular (plasma), interstitial (between the cells)
34
Fluid balance: Typical input (3)
2600 Total
• Fluids: 1300mL
• Food: 1100 mL
• Oxidation: 200mL
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Fluid balance: Typical output (3)
```
2600 Total
• Urine: 1500 mL
• Feces: 200 mL
• Insensible: 900 mL
(300mL lungs, 600 mL skin)
```
36
Urine output
• Average
• When to worry
* >60 mL/hr
| * Worry if <30
37
Forces that move water (3)
* 1) Hydrostatic pressure
* 2) Osmotic pressure
* 3) Hormones
38
Hydrostatic pressure (def)
The weight and volume of water
39
In the capillaries, hydrostatic pressure is also generated by...
The pumping action of the heart!
40
Hydrostatic pressure
• What's normal
• What happens with increase
* Normal: Pores allow fluid to leak out (blood counts on this)
* Increase in weight and volume of water: Pores stretch out, water leaks out --> EDEMA
41
What determines osmotic pressure?
The number of particles in each compartment
42
Function of osmotic pressure
To keep water where it is supposed to be
43
Particles that draw a lot of water (3)
* Sodium
* Glucose
* Albumin
44
Oncotic pressure (def)
"Pulling Pressure"
45
Osmolality (def)
Number of particles in a kg of fluid
46
Osmolality: Norm
285-295 mOsm/L
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How is osmolality tested?
With a blood test
48
Osmolarity (def)
Number of particles in a liter of fluid
49
Osmolarity versus osmolality
Osmolarity: Number of particles per liter of fluid
Osmolality: Number of particles per Kg of a fluid
50
Increased osmolality indicates...
DEHYDRATION! Decreased H20 per particle
51
Decreased osmolality indicates...
FVE! Increased H20 per particle
52
What happens when BV or BP is low? (3)
BARORECEPTORS:
• Renin signals angiotensin to increase pressure and afterload
• Renin signals aldosterone to have kidney retain H20 and increase BV, BP and preload
• ADH signals kidney to retain water and increase BV, BP and preload
53
* Two components to increase preload
| * Mechanism
* Renin production through aldosterone
* ADH
Mechanism: Kidney retains H20, increasing BV and BP
54
What happens when BV or BP is high? (2)
* ANP secreted by atria
| * BNP secreted by ventricles
55
What is the most important player in lowering the Renin system?
BNP
56
Diagnosing Respiratory v. Cardiac
• What component
• What three diseases can be diagnosed this way
* BNP
| * CHF, PE, Pulm HTN
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When is ANP released?
• Secreted by atria when BV or BP is elevated
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When is BNP released?
• Secreted by ventricles (mostly L) when heart muscle is stretched
59
Action of both ANP and BNP (5)
* Inhibits renin-angiotensin system
* Decreases ADH
* Inhibits SNS
* Decreases vascular resistance
* Increased loss of water and sodium decreases BP
60
How do ANP and BNP inhibit the renin-angiotensin system? (2)
* Decreased renin --> Vasodilation
| * Decreased aldosterone --> Inhibits reabsorption of Na and H20, decreasing fluid volume and BP
61
How is a hypotonic crystalloid solution defined?
<250 mOsms / L
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How is an isotonic crystalloid solution defined?
>250 mOsms / L
63
How is a hypertonic isotonic crystalloid solution defined?
>375 mOsms / L
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Two examples of Hypotonic Crystalloid solutions
* 0.33%NS (third NS)
| * 0.45%NS (half NS)
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Two examples of Isotonic Crystalloid solutions
* 0.9% NS
| * Lactate Ringer
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Four examples of Hypertonic Crystalloid solutions
* D5 0.45% NS
* D5 0.9% NS
* 3% Saline
* 5% Saline
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Action / use of hypotonic solutions (2)
* Hydrates cells
| * Moves fluid OUT of vascular and into cells.
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Action / use of isotonic solutions (3)
* NO FLUID SHIFT
* Vascular expansion
* Electrolyte replacement
69
Action / use of hypertonic solutions (3)
* Shifts fluid into vascular
* Vascular expansion
* Electrolyte replacement
70
Nursing considerations of hypotonic solutions (3)
* May worsen hypotension
* Can increase edema
* May increase hyponatremia
71
Nursing considerations of isotonic solutions (3)
* May cause FVE
* Generalized edema
* Dilutes hemoglobin
72
Nursing considerations of hypertonic solutions (3)
* May irritate veins
* May cause FVE
* May cause hypernatremia
73
How is D5W classified, and why?
It is isotonic until the glucose is metabolized, then it is hypotonic.
74
What is the best solution for vascular expansion? Why?
Isotonic solution:
| • Tends to stay intravascular and doesn't shift
75
What type of solution is always used for resuscitation and peri-operative?
Isotonic
76
How do colloids differ from crystalloids?
They are larger particles -- meant not to leak out of intravascular areas
77
How do colloids compare to crystalloids clinically?
In small quantities of 250 mL, colloid solutions can have the same effect as 4 liters of crystalloid saline.
78
Four types of colloids:
* Albumin
* Dextran
* Hetastarch
* Mannitol
79
Types of albumin (2)
5% or 25%
80
Action / use of albumin (3)
* Keeps fluid intravascular
* Maintains volume
* Replaces protein and treats shock
81
Nursing considerations for albumin (3)
* May cause anaphylaxis
* May cause FVE
* May cause PE
82
Three patients who might receive albumin:
* Malnourished
* Liver problems
* Shock
83
Why would albumin cause anaphylaxis?
Because it is a natural blood product
84
Why would albumin cause FVE?
Because of increased hydrostatic pressure
85
Why would albumin cause PE?
If too much was administered too fast
86
Dextran and Hetastarch (def)
* Synthetic
| * Pull fluid into vessels
87
Dextran and Hetastarch: Indication
Vascular expansion
88
Dextran and Hetastarch: Four nursing considerations
* May cuase FVE
* May cause hypersensitivity
* Increased risk for bleeding
* Can affect blood typing (draw blood for that first)
89
Mannitol: Types (2)
5% or 25%
90
Mannitol: Action / use (2)
* Oliguric diuresis
| * Eliminates cerebral edema
91
Mannitol: Risks (3)
* May cause FVE
* May cause electrolyte imbalances
* May cause cellular dehydration
92
Mannitol: Indication
Neurology: To fix cerebral edema by pulling fluid in brain into other vascular areas.
93
Causes of FVE (4)
- Fluid overload
- Excessive ADH secretion
- Excessive aldosterone
- Excessive dietary intake
94
Four causes of increased aldosterone
- Renal malfunction
- Adrenal malfunction (Cushing's)
- CHF
- Liver failure
95
Why does CHF cause Edema?
Increased capillary hydrostatic pressure
96
Why would cirrhosis or malnutrition cause edema?
Decrease in plasma proteins. Albumin deficit --> Fluid seeps out of vessels
97
Why would breast cancer surgery cause edema?
Lymph node dissection --> Obstructed lymphatics
98
Why would kidney malfunction / renal disease cause edema?
Increase in aldosterone, ADH
99
When would edema be due to increased capillary permeability? (3 causes)
- Allergies
- Toxins
- Massive infection
100
Define second spacing
- Localized edema
| - Anasarca = generalized
101
Define third spacing
Fluid moves into spaces that normally only contain minimal fluid
102
What causes second spacing
Secondary to cardiac or renal problems
103
What causes third spacing
Secondary to infection, blood pooling
104
Four examples of third spacing
- Ascites (stomach)
- Pulmonary Edema (alveoli)
- Pleural effusion (2/2 cancers)
- Pericardial effusion (limits contractions)
105
Intervention for pericardial infusion
Pericardiocentesis
106
What three nursing interventions would address FLUID in FVE?
1) Low sodium diet, decreased H20 intake
2) Diuretics (Lasix)
3) Hypertonic IV therapy (albumin) -- RARE
107
Three nursing interventions that maintain skin integrity with FVE
- Protect skin from injury
- Keep skin clean and dry
- High protein diet
108
Bed position with FVE
High or Semi-Fowler's helps patient breathe
109
Clinical manifestations of FVD (2 categories)
2% loss: Thirst, light-headedness
| 4-6%: Convulsions, coma, death
110
Who is at the highest risk for FVD? (3)
- Babies
- Post-op
- Elderly
111
Three clinical situations of FVD
- Decreased intake
- Increased output
- Decreased fluid absopriton
112
FVD w/ Hypernatremia: vital signs (4)
- Increased Temp
- Decreased BP / postural hypotension
- Rapid HR
- Oliguria
113
What is the most abundant electrolyte in intravascular and interstitial space
Sodium
114
What regulates sodium? (3)
- Thirst
- Hormones
- Renin - Angiotensin
115
Most common causes of sodium loss (2)
- Diuretics (Lasix)
| - Loss of GI fluids (V/D, GI suction)
116
Common pathologies that cause sodium loss (2)
- Decreased ADH (Addison's)
| - Renal disease
117
Other causes of hyponatremia (5)
- Hyperglycemia
- Sweating
- Burns
- High volume ileostomy
- NPO
118
What is the most common cause of a gain in water (resuling in hyponatremia)
Excess electrolyte-poor IV fluids (like D5W)
119
Four other causes of water gain (leading to hyponatremia) - other than excess electrolyte-poor IV fluids
- CHF
- Polydipsia
- Liver failure
- Renal failure
120
4 Symptoms of hyponatremia: <125
- Mental status changes
- Headache
- Personality changes
- Irritability
121
4 Symptoms of hyponatremia: <115
- Muscle twitches
- Focal weakness
- Seizures
- Coma
122
Why does hyponatremia cause mental status changes?
CEREBRAL EDEMA
**Na drops intravascularly, but remains the same intracellularly. Body pulls fluid into cells to compensate --> Cerebral edema
123
Nursing interventions for hyponatremia
TREAT THE CAUSE
- If Na loss: Replace Na, administer 3% or 5% NS IV until neuro signs clear
- For excess H20, restrict fluid
124
Four causes of water loss that would lead to hypernatremia
- Excessive fluid loss
- Decreased fluid intake
- Hyperglycemia
- Renal failure
125
Five causes of Na Excess leading to hypernatremia
- Hypertonic IV fluid
- Hypertonic NG tube feedings
- Malfunctions
- Salt ingestion
- Partial drowning in salt water
126
Four malfunctions leading to Na excess
- CHF
- Diabetes insipidus (decrease in ADH)
- Cushing's
- Renal failure
127
What causes mental status changes with hypernatremia?
Cellular dehydration in cerebral areas
128
six CNS changes in hypernatremia
```
Restlessness
Irritability
Delirium
Twitching
Seizures
Coma
```
129
Nursing interventions for Hypernatremia
TREAT THE CAUSE
- Treat water loss with IV D5W or oral-glucose-electrolyte solutions (with Low Na)
- Treat excess Na with restricted Na intake
