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Flashcards in Exam 1 Deck (129):
1

Cause of disease (general)

When compensatory mechanisms are not adequate.

2

Body's goal under stress

Adaptation --> Return to equilibrium

3

Coping with stress depends on (6)

• Level of health and energy before stressor
• Personal belief system
• Life goals
• Self-esteem
• Experience with problem solving
• Hardiness

4

Intended effects of adrenergics: Heart (3)

+ Chronotropic (HR)
+ Inotropic (force)
+ Dromotropic (AV Rate)

5

Intended effects of adrenergics: Blood vessels (2)

• Vasoconstriciton causes increased BP & CO
• Increased blood flow to brain, heart and large skeletal muscles

6

Intended effects of adrenergics: Bronchi

Bronchodilatation

7

Intended effects of adrenergics: Eyes (2)

• Dilated pupils
• Aids vision

8

Intended effects of adrenergics: Emotions

Subjective feelings of tension

9

Intended effects of adrenergics: GI

• Decreased GI activity (blood shunted away from GI)

10

Intended effects of adrenergics: Blood sugar

Increased blood sugar 2/2 glycogenolysis and gluconeogenesis

11

Intended effects of adrenergics: Fatty acids

Increased fatty acids

12

Intended effects of adrenergics: Fluids

Increased sweating

13

Intended effects of adrenergics: Blood

Increased blood coagulation

14

Glucogenolysis (def)

Breakdown of glycogen to form glucose

15

Gluconeogenesis (def)

Making glucose from non-CHO sources

16

Adverse effects of adrenergics: Heart (3)

• Tachycardia
• Arrhythmias
• Palpations

17

Adverse Effects of adrenergics: Bood vessels (3)

• Pale
• Cool
• Hypertension

18

Adverse effects of adrenergics: Emotions (3)

• Restlessness
• Tremors
• Insomnia

19

Adverse effects of adrenergics: GI system (5)

• N/V
• Anorexia
• Constipation
• Ulcers
• GI bleeding

20

Adverse effect of adrenergics: Blood sugar (2)

• Increased fasting blood sugar --> DM
• Increased insulin needs for diabetic patients

21

Adverse effects of adrenergics: Fatty acids

• Increased lipids (cholesterol) --> ATHERSCLEROSIS

22

Adverse effects of adrenergics: Fluids

• Increased sweating leads to fluid loss, claminess

23

Adverse effect of adrenergicss: Blood

• Increased blood coagulation can lead to increased risk of MI, stroke

24

Body's physiologic response to stress

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

33

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

35

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

47

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

57

When is ANP released?

• Secreted by atria when BV or BP is elevated

58

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

62

How is an isotonic crystalloid solution defined?

>250 mOsms / L

63

How is a hypertonic isotonic crystalloid solution defined?

>375 mOsms / L

64

Two examples of Hypotonic Crystalloid solutions

• 0.33%NS (third NS)
• 0.45%NS (half NS)

65

Two examples of Isotonic Crystalloid solutions

• 0.9% NS
• Lactate Ringer

66

Four examples of Hypertonic Crystalloid solutions

• D5 0.45% NS
• D5 0.9% NS
• 3% Saline
• 5% Saline

67

Action / use of hypotonic solutions (2)

• Hydrates cells
• Moves fluid OUT of vascular and into cells.

68

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