m2 day 2 Flashcards
phosphorus
normal amount, what it does
Phosphorus (serum 1.0 to 1.5 mmol/L)
Activates vitamins and enzymes
Forms ATP for energy supplies
Assists in cell growth and metabolism
Maintains acid-base balance
Maintains calcium homeostasis
Hyperphosphatemia
Hyperphosphatemia (>1.5 mmol/L)
Caused by
- Renal failure
Manifestations
- Same as hypocalcemia
- Muscle cramps
- Tetany
- Perioral numbness and tingling
- Bone and joint pain
Treatment
- Phosphate binders (e.g. calcium acetate)
- Diet low in phosphorus
Hypophosphatemia
causes, manifestations, treatment
Hypophosphatemia (<1.0 mmol/L)
Caused by
- Alcohol withdrawal
- Recovery from diabetic ketoacidosis
- TPN
- Glucose administration
- Malabsorption syndrome
Manifestations
- Decreased cardiac output
- Weak peripheral pulses
- Skeletal muscle weakness
Treatment
- Diet high in phosphorus
- Vitamin D Supplements
- Oral or IV calcium (e.g. calcium carbonate)
- Sodium phosphate
fluid spacing
1st, 2nd, 3rd degree + symptoms of 3rd
First spacing
- Normal distribution of fluid in ICF and ECF
Second spacing
- Abnormal accumulation of interstitial fluid (edema)
Third spacing
- Fluid accumulation in part of body where it is not easily exchanged with ECF
- Transcellular space
- Fluid fills cavity, compresses soft structures
- Ascites, pleural effusions, pericardial effusion or tamponade
Patient Assessment for Fluid and Electrolyte Imbalances
labs
- Common serum electrolytes Na, K, Cl
- Extended electrolytes: Ca, Mg, Phosphate
- Kidney function test (Urea, Creatinine –> better indicator of renal function)
- Serum osmolality (pOSM)
- Concentration of fluid by weight
Urinalysis
- Creatinine clearance: eGFR
treatment of fluid loss
- Isotonic fluids expand the extracellular fluid volume (osmolarity between 250 and 300 mOsm/L): 0.9% normal saline (NS), LR (lactated Ringer’s solution)
- Hypotonic fluids move water into the cell by osmosis, causing them to swell (osmolarity less than 250 mOsm/L): 0.45NS.
- Hypertonic fluids pull fluid from cells, causing them to shrink (osmolarity >300 mOsm/L): D10; 3% Saline, D5 in 0.45NS.
fluid volume excess
causes, symptoms, treatment lab
Causes
- CHF (most common), renal failure, cirrhosis, overhydration
Symptoms
- Peripheral edema, periorbital edema, elevated BP, dyspnea, altered LOC
Lab findings
- ↓ BUN, ↓ Hgb, ↓ Hct, ↓ serum osmolality, ↓ urine specific gravity
Treatment
- Diuretics, fluid restrictions, weigh daily, monitor K+
fluid volume deficit
causes, symptoms, lab, treatment
Causes
- Inadequate fluid intake, hemorrhage, vomiting, diarrhea, massive edema
Symptoms
- Weight loss, oliguria, postural hypotension
Lab findings
- ↑ BUN and ↑ or normal creatinine, ↑ Hgb, ↑ Hct, ↑ urine specific gravity
Treatment
- Strict intake and output (I&O), replace with isotonic fluids, monitor BP
prediabetes
- ↑ Risk for developing diabetes
Assessment
- Fasting blood glucose level of 6.1 to 6.9 mmol/L (100 to 125 mg/dL)
- 2-hour oral glucose tolerance test (OGTT)
diabetes oral pharmacological interventions
Sulfonylureas
- increase insulin production from the pancreas
Glyburide
Biguanides
- reduce glucose production by the liver
- Side effects: bloating, nausea, cramping, and diarrhea
Metformin
DKA
causedby, characterized, s/s
Caused by profound deficiency of insulin
Characterized by
Hyperglycemia
Ketosis
Acidosis
Dehydration
Most likely occurs in type 1
s/s
Tachycardia
Orthostatic hypotension
Lethargy/weakness
managment of DKA
Emergency Management of DKA
Airway management
Oxygen administration
Correct fluid/electrolyte imbalance
IV infusion 0.45% or 0.9% NaCl
When blood glucose levels approach 14 mmol/L
5% dextrose added to the regiment
Potassium replacement
Sodium bicarbonate
hyperparathyroidism
manifestations, medications and surguries
happens when the thyroid gland makes too much thyroid hormone.
manifestations
weight loss
elevated T3,T4
diarrhea
tachycardia
bruit over thyroid
medication:
Propylthiouracil (PTU) therapy to block the synthesis of T3 and T4
Iodine (131I) therapy to destroy thyroid cells
Surgery (Thyroidectomy)
Check behind neck for drainage
Position in high- fowlers
Calcium gluconate at bedside
addison disease
what, s/s, tx
Adrenal insufficiency occurs when the adrenal glands don’t make enough of the hormone cortisol.
Cause
Sudden withdrawal from corticosteroids
Hypofunction of adrenal cortex
Lack of pituitary ACTH
Signs and Symptoms
Weight loss, N/V
Hypovolemia, hypoglycemia
Hyponatremia, hyperkalemia
Postural hypotension
Hyperpigmentation
treatment
- corticosteroid therapt
Cushings syndrome
symptoms and manifestations
Cause: Excess adrenal corticoid activity caused by adrenal, pituitary, or hypothalamus tumours (cortisol)
Symptoms
- Edema of lower extremities
- Abdominal striae
- Buffalo hump (fat deposits)
- Muscle atrophy, weakness
- Hypertension
- Osteoporosis
- Hypervolemia
manifests as
- Hyperglycemia
- Hypernatremia
- Hypokalemia
- Increased plasma cortisol levels
