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MT Flashcards

1
Q

Hypovolemia: M+T

A

↓ BP, dry muc. memb., ↓ skin turgor, dizziness

IV/PO fluids, treat cause of fluid loss! (high fall risk)

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2
Q

Hypervolemia: M+T

A

↑ BP/HR/RR, edema, crackles in lung bases → fluid in lungs

daily weights, I&O’s, fluid/sodium restriction, diuretics, dialysis

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3
Q

HypoNa CMT

A

Fluid Loss or Retention

musc. weakness, cramping, lethargy, confusion
fluid restriction,
increase PO Na+ intake

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4
Q

HyperNa CMT

A

Hyperaldosteronism, Cushing’s Syndrome

musc. weakness, lethargy, confusion

increase PO fluid intake ,
restrict PO Na+ intake

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5
Q

HypoCa

A

Hypoparathyroidism, Vitamin D deficiency
musc. spasms, tetany,

+ve Trousseau & Chvostek signs, altered LOC, seizures

PO Ca+ and Vitamin D, IV calcium gluconate

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6
Q

HyperCa

A

Hyperparathyroidism, Bone Malignancy
++ musc. weakness, cardiac dysrhythmias,

kidney stones

IV Pamidronate, limit PO Ca+ intake,, diuretics, HD

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7
Q

HypoMg

A

Hypomagnesemia
Starving, n/v, diabetes, prolonged TPN

Resembles hypocalcemia - muscle cramps, tremors, confusion/seizures, cardiac dysrhythmias

Oral supplementation, IV replacement if severe (rapid admin = risk for hypotension)

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8
Q

HyperMg

A

Hypermagnesemia
Cause: Increased intake, renal failure

SS: Hypotension, lethargy, urinary retention, n/v, facial flushing
→ muscle paralysis/coma

Tx: Avoid antacids/laxatives, limit dietary intake. increase fluids/diuretics? dialysis?

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9
Q

HypoK

A

N/V/D, GI suctioning, diuretics, insulin, third spacing (ex. ascites)

constipation, fatigue, musc. weakness or spasms

T
PO/IV K+ supplements
NOT IV PUSH
IV irritates veins

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10
Q

HyperK CMT

A

Causes:
CKD, hyperglycemia,
K+ sparing diuretics

M
cardiac dysrhythmias

T
IV insulin and dextrose, Kayexalate, ?diuretics, ?dialysis

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11
Q

HypoPh

A

Associted with hyperCa

Hyperparathyroidism, Bone Malignancy
++ musc. weakness, cardiac dysrhythmias,

kidney stones

IV Pamidronate, limit PO Ca+ intake,, diuretics, HD

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12
Q

HyperPh

A

Associated with HypoCa

Hypoparathyroidism, Vitamin D deficiency
musc. spasms, tetany,

+ve Trousseau & Chvostek signs, altered LOC, seizures

PO Ca+ and Vitamin D, IV calcium gluconate

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13
Q

Indications for isotonic solution

A

To increase intervasc fluid

NaCl, LR, D5W - don’t use D5W with diabetics or those with increased ICP. Don’t use NaCl if hypernatremic.

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14
Q

Hypertonic solutions

A

D10W, D5/0.9% NaCl- I have only seen used in kids, not exactly sure why, may give, may give if brain injury, or serious hyponatremia - don’t give if CHF/CKD

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15
Q

Hypotonic solutions

A

0.45% NaCl, maybe for tx of cellular dehydration, Don’t give if risk for ICP, trauma, burns or hypovolemia

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16
Q

N/V/D causes which electrolyte imbalances?

A

All of them

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17
Q

CKD causes electorlyte imbalances such as

A

HyperK

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18
Q

Typically typical manifestations of electorlyte imbalances are

A

Neuro: Seizures, LOC change

Neuromuscular: Twitching and weakness

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19
Q

DO we replace sodium quickly

A

No, can affect fluid balance, so must fix slolwy

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20
Q

What manifestations are associated with hypoCa

A

+ve Trousseau & Chvostek signs, altered LOC, seizures

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21
Q

Cells affected by chemo

A

Rapidly producing cells

Hair, GI lining, Bone Marrow

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22
Q

TNM charting

A

TUMOR (T)
T0 – no evidence of primary tumor
Tis – evidence of carcinoma in situ
T1, T2, T3, etc. Progressive increase in tumor size and involvement.
Tx – unable to assess tumor
NODES (N)
N0 – No regional lymph node metastasis
N1, N2, N3 – Increasing involvement of regional nodes.
Nx –Regional lymph nodes cannot be assessed clinically.
METASTASIS (M)
M0 – no evidence of distant metastasis
M1, M2, M3 – Metastatic involvement
Mx- Presence of metastasis cannot be assessed.

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23
Q

common complications for cancer pts

A

Infection

Febrile Neutropenia

Malnutrtion

Obstructive
Superior Vena Cava
Syndrome

Malignant Spinal Cord Compression

Intestinal
Obstruction

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24
Q

Causes of infection in cancer pts

A

ulceration/necr osis caused by tumour
* compression of vital organ
* neutropenia d/t disease process or treatment

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25
Causes of Febrile neutropenia in cancer pts
myelosuppression * loss of 1st line of defense WBC
26
Causes of malnutrition in cancer pts
associated with treatment (ex. nausea from chemo)
27
Manifestations of infection and febrile nutropenia in cancer pts
SIRS criteria, but not all may present with fever Neutrophils = < 0.1 × 10%L T = 38.0, go to ER
28
Interventions for cancer pts with infection or febrile neutropenia
antibiotics (prophylactic), G-CSF, ?hold chemotherapy PREVENT INFECTION * hand hygiene * private rooms
29
Manifestations of malnutrtion in cancer pts
depletion of fat and musc. → anorexia, cachexia, altered taste and appetite
30
Intervention for malnutrtion in cancer pts
monitor weight (refer to dietitian if > 5% loss), albumin monitoring, high-calorie/high-prot ein diet
31
Why might cancer pts not necessarily present with fever
Immunosuppressants reduce ability to produce temp
32
Intervention for malignant spinal cord compression
emergent glucocorticoids (ex. Dexamethasone IV) * decompression of spinal cord via reduction of swelling urgent radiation therapy pain management
33
Intervention for malignant intestinal blockage
NG tube compression * relieves pressure from stomach surgical removal of tumour
34
Metabolic emergencies for cancer pts
SIADH Hypercalcemia MOST COMMON! Tumour Lysis Syndrome
35
Causes of SIADH
abnormal/sustained prod. of ADH → Small Cell Lung Ca
36
SIADH s/s
fluid retention, serum hypo-osmolality, dilutional hyponatremia, decreased urine output
37
Interventions for hyperCa in cancer pts
monitor Cat + albumin levels encourage mobility, hydration (IV bolus + maintenance fluids), calcitonin, lasix (fl. overload), bisphosphonates
38
What is tumor lysis syndrome
destruction of neoplastic/cancer cells after treatment = high level of electrolytes to enter bloodstream (t K*,
39
What is the only hormone produced by the kidneys
Renin
40
What method is used to deal with third spacing
Centisis
41
Intervention for hyper Na
Administering fluid SLOWLY (D5W NOT NS) Daily wt monitoring Monitor labs
42
Why might CKD pts require less insulin
Bc it takes more time for them to excrete out insulin
43
Hypothalamus fluid regulation
Stimulates the hypothalamus to release ADH in response to barrow receptors sensing lowered BP. Stimulates thirst sensation
44
Pit gland fluid regulation
Releases ADH which reabsorbs water in kidneys and raises BP
45
Adrenal Cortex
Releasing aldosterone which increases retention of Na and water (decreasing blood osmolarity)
46
Kidneys fluid reg
Adjust urine volume Selective reabsorption of water and electrolytes Renal tubules are sites of action of ADH and aldosterone
47
Heart role in fluid reg
Atrial natriuretic factor (ANF) Hormone released by the cardiac atria in response to  atrial pressure ( volume) Primary actions of ANF are vasodilation and  urinary excretion of sodium and water, which decrease blood volume
48
GI system role in fluid regu
Intake PO, Excretion by feces, D/V can account for water loss
49
7 systems of fluid reg
Hypothalamus Pit gland Adrenal Cortex Kidneys Heart GI Insensible water loss
50
Tumor classification TNM
T0 – no evidence of primary tumor Tis – evidence of carcinoma in situ T1, T2, T3, etc. Progressive increase in tumor size and involvement. Tx – unable to assess tumor
51
Node classification TNM
N0 – No regional lymph node metastasis N1, N2, N3 – Increasing involvement of regional nodes. Nx –Regional lymph nodes cannot be assessed clinicall
52
Metastis classification TNM
M0 – no evidence of distant metastasis M1, M2, M3 – Metastatic involvement Mx- Presence of metastasis cannot be assessed.
53
Oncologival emergencies
Superior Vena Cava Syndrome Malignant SC compression Bowel Obstruction SIADH Oncological HyperCa Tumor Lysis Syndrome Hyper viscosity Syndrome Cardiac Tamponade
54
Superior vena cava syndrome manifestations + Tx
Facial Edema Periorbital edema Distended neck and chest veins Headache Seizures Treat with urgent radiation therapy
55
Malignant SC Compression ss + Tx
Tingling, loss of sensation, bowel and bladder function impaired/lost, paralysis pain etc. Steriods to decrease inflammation Urgent radiation therapy
56
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
abnormal or sustained production of ADH (occurs most often in Small Cell Lung Ca) Fluid retention Serum hypo-osmolality Dilutional hyponatremia Early: muscle cramps, weakness Late: vomiting/ abd cramping/ seizures/ coma Decreased urine output Tx cause + FLuid restriction
57
Oncological Hypercalcemia
Most common condition metabolic oncolgoical emergency -Has a poor prognosis Increased breakdown of bone tissue (osteoclastic activity) due to malignancy (multiple myeloma) or bony metastases (from lung, breast, etc). Or release of parathyroid like substance from certain cancers. Confusion Apathy/ Depression/ Fatigue Muscle weakness ECG changes Anorexia/ Nausea/ vomiting Polyuria/ nocturia severe muscle weakness, decreased deep tendon reflexes, kidney stones, irregular heartbeat even heart attack. Tx HYDRATION *** Mobility Calcitonin
58
Tumor Lysis Syndrome
Follows the destruction of a large number of neoplastic / cancer cells due to chemo or radiation, changing electorlyte levels seen in patients with highly aggressive hematologic cancers HyperKalemia Hyperphosphatemia Hypocalcemia Hyperuricemia Tx with LOTS OF FLUIDS*** Alipuronal - reducing buildup of uric acid in the blood - preserves kidneys
59
Hyperviscosity Syndrome
Classic triad of SS includes mucosal bleeding, visual abnormalities, and neurological abnormalities tx = Thereapeutic aphresis
60
Cardiac Tamponade
Fluid accumulation in the pericardial sac, constriction of the pericardium by a tumour, or percarditis secondary to radiation. Heavy feeling over chest, Tachycardia SOB, Cough, Distant heart sounds tx: Reduce the fluid around the heart and mange symptoms
61
Steps to effective PRN use
Regular assessment and documentation PRN use and documentation Evaluation of PRN and documentation Advocacy for around-the-clock (ATC) management if PRN use becomes frequent (ATC is always preferable for persistent pain management) Advocacy for different PRNs if initial ones ineffective
62
Causes of Respiratory acidosis
OD, Acute asthma attack (CO2 retention and O2 depletion) (Partial/full compensation) Pneumonia (CO2 retention) Chronic use of narcotics
63
Causes of resp alkalosis
Pain and anxiety, acute CNS injury Compensated CNS disorder
64
Causes of Metabolic acidosis
Lots of Diarrhea (Loss of bicarb), AKI Partial/full compensation Septic Shock (Shock bc hypoxemic) otherwise sepsis, DKA, CKD, Chronic Diarrhea, starvation
65
Causes of metabolic alkalosis
Diuretic use, excess antacid ingestion (Bicarb intake) Partial/full compensation Chronic Diuretic use, profuse vomiting
66
Treatment of hyperK
C - Calcium Gluconate (stablize myocardium) B - Beta2 Adrenergic Agonist (Salbutamol) - bronchodilator I - Insulin - Moves glucose into cells AND K+ into cells G - Glucose K - Kayxalate - Binding Resin working in GI tract, sustain lower level Drop - Diuretics (Loop or Thirazide) - Require functional kidneys - Dialysis

NURS232 (27 decks)

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