test 2 Flashcards
(141 cards)
1
Q
sodium plays a major role in
A
ECF volume and concentration
generating and transmitting nerve impulses
muscle contractility
regulating acid-base balance
2
Q
what is the brain mostly
A
water
3
Q
normal sodium range
A
135-145
4
Q
what causes hypernatremia? MODEL mnemonic
A
M- Medications, meals
O- osmotic diuretics
D- Diabetes insipidus
E- Excessive H20 loss
L- low H2O intake
5
Q
signs and symptoms of hypernatremia
A
restlessness, seizures, thirst, weakness, increased pulse, postural hypertension
6
Q
treatment of hypernatremia
A
hypotonic fluids slowly, restrict Na
7
Q
what is hypernatremia
A
sodium levels >145
8
Q
hyponatremia causes
A
excess water or Na loss
9
Q
what is hyponatremia
A
Na >135
10
Q
hyponatremia signs and symptoms, SALTLOSS mnemonic
A
S- stupor/coma
A- anorexia (nausea and vomiting)
L- legathy
T- tendon reflex decreased
L- limp muscle weakness
O- orthostatic hypotension
S- seizure/headache
S- stomach cramping
11
Q
hyponatremia treatments
A
restrict fluids if excess water and look diuretics
in extreme cases give 3% Nacl (hypertonic solution)
for Na loss, replace IV fluids, hold diuretics, encourage PO
12
Q
normal potassium level
A
3.5-5
13
Q
how much of body’s potassium is inside cell
A
98%
14
Q
what does Na- K pump do
A
push Na out of the cell and K inside the cell
15
Q
hyperkalemia causes
A
renal failure, acidosis, burns, K- sparing diuretics, ace inhibitors
16
Q
hyperkalemia symptoms
A
muscle weakness (first symptom), paralysis, diarrhea, interstitial colic, cardiac arrthymias
17
Q
hyperkalemia treatments
A
restrict K, kayexalate (pulls potassium into gut, makes poop), IV admin of insulin and dextrose to shift K into cells, dialysis, diuretics
18
Q
hypokalemia ECG effects
A
slightly prolonged PR Interval
slightly peaked P wave
shallow T wave
Prominent U wave
19
Q
hyperkalemia ECG effects
A
wide flat P wave
prolonged PR interval
decreased R wave amplitude
widened QRS
depressed ST segment
Tall, peaked T wave
20
Q
hypokalemia causes. DITCH mnemonic
A
D- drugs like look diuretics, laxatives, glucocorticosteroids
I- inadequate consumption of K
T- too much water intake
C- Cushing syndrome (causes kidney to excrete K)
H- heavy fluid loss
21
Q
hypokalemia signs and symptoms. 7 Ls
A
Lethargic
Low, shallow respirations- failure
Lethal cardiac dysrhythmias
Lots of urine
Leg cramps
Limp muscles
Low blood pressure
22
Q
hypokalemia treatment
A
IV supplements, slowly, no more than 20 meq/hr
PO supplements
watch for digoxin toxicity if taking
increase food with K
23
Q
roles of calcium
A
clotting, muscle contraction, nerve transmission
major cation in bones and teeth
24
Q
how does body maintain calcium levels
A
through bone deposits or moving it back into system through parathyroid levels and calcitonin
25
what is needed for calcium to be absorbed thru food
vitamin D
26
normal calcium levels
8.5-10.2
27
hypercalcemia causes
hyperparathyroidism, malignancy in body, immobilization
28
hypercalcemia treatment
loop diuretic, isotonic solution, push PO fluids, limit calcium carbonate antacids (tums)
29
hypercalcemia symptoms
painful bones
renal stones
abdominal groans: nausea, vomiting, constipation, indigestion
psychiatric moans- legarthy, fatigue, depression, memory loss
30
hypocalcemia causes
parathyroid removal or injury, acute pancreatitis, alkalosis, laxative abuse, renal failure
31
hypocalcemia treatment
oral calcium chloride, IV calcium admin slowly, oral supplements
32
hypocalcemia signs and symptoms. CATS mnemoic
C- convulsions
A- arrhythmias
T- tetany
S- stridor and spasms
33
normal magnesium levels
1.3-2.1
34
magnesium functions
Bone structure, energy production, DNA/RNA synthesis, blood sugar control, BP regulation, muscle contraction, heart beat, nerve function
35
hypomagnesemia causes
renal loss, limited magnesium intake, chronic alcohol, high glucose, malabsorption
36
hypomagnesemia symptoms
neuromuscular and CNS irritability, confusion, muscle cramps, tremors, seizures, dysrhythmias
37
hypomagnesemia treatment
Oral and IV supplement. give IV slowly to avoid cardiac/resp arrest
38
hypermagnesemia symptoms
depressed nerve function and skeletal contraction, nausea, vomiting, bradycardia, hypotension, resp depression
39
hypermagnesemia causes
rare, caused by renal failure or excessive intake
40
hypermagnesemia treatment
Oral and IV, hemodialysis, ventilation, monitor cardiac rthyms
41
normal phosphate levels
2.5-4.5. higher in children
42
hypophosphatemia symptoms
rhabdomyolysis (muscles break down and release harmful protein), muscle weakness, ricketts or bone pain, mental confusion, seizures
43
hyperphosphatemia symptoms
associated with low calcium, tetany, seizures, muscle cramp
44
relationship between phosphate, magnesium and calcium
when calcium is low, magnesium and phosphate may be high, and vise versa
45
why is fluid deficiency more common in elderly
higher fat, less fluid
46
interstitial fluid
fluid that surrounds cells not in blood
47
diffusion
high to low
48
facilitated diffusion
use of protein carrier across membrane flowing low to high
ex- glucose requiring insulin
49
active transport
molecules move against gradient using energy
ex- Na-K pump
50
osmosis
water from low to high
ex- IV fluids
51
second spacing fluid
abnormal accumulation of interstitial fluid (edema)
52
third spacing fluid
fluid trapped and cant get back into cell or blood vessel
53
what causes edema
decreased albumin/protein
increased interstitial oncotic pressure to cap walls- burns, inflammation
increased venous hydrostatic pressure inhibits fluid to move back into capillaries (varicose veins)
iv fluids
54
fluid volume excess symptoms
changes in levels of consciousness, headache, seizures, pulmonary congestion, presence of S3, bounding pulse, high blood pressure, anorexia, nausea, edema
55
FVD symptoms
Weak pulse, thirst, postural hypotension, confusion, hypovolemia, tachycardia , dry mucous membrane, poor skin turgor
56
implementations for fluid volume
Daily weight, labs, auscultate heart and lung sounds, patient safety, IV fluids for deficit
57
isotonic solution
expand ECF and don't move into cell, no net movement of water occurs.
has same osmotic pressure as plasma so ideal for fluid replacement
ex- 0.9 NS, LR, D5W
58
hypotonic solution
water moves into cell causing it to swell. not a lot of salt, lowers serum osmolarity.
used for hypernatremia, replacement fluids
ex- 0.45 NaCL, 0.22 NaCl
59
Hypertonic solution
more salt, less water. draws fluid out of cell and into blood.
used for hypernatremia and cerebral edema
ex- 3% NaCl, 5% NaCl, D10W, 25% albumin
60
what is important to be monitored in hypertonic fluid or hypotonic fluid
change in neuro status due to pulling or overloading sodium
61
colloids
large molecules hat pull fluid into blood vessels increasing oncotic pressure. AKA volume expanders
ex- albumin, fresh frozen plasma, blood, dextran
62
what IV fluid can blood only be given with
NS
63
important things to remember when doing blood transfusion
infuse packed RBC over 2-3 hours to decrease risk of fluid overload
have 2 verifications before beginning
get consent
monitor for reaction
64
what can cause low platelets and WBC
chemo
65
Hormone that regulates RBC
Erythropoietin
66
why and where is Erythropoietin released
released due to low o2
released from adrenal glands
67
Diseases that cause chronic hypoxemia
Copd
Emphysema
Chronic bronchitis
CAD
68
Diseases that can affect production of RBC
- Folic acid, b12, folic acid deficiencies
- Bone marrow cancers
- Chronic kidney disease (erythropoietin cant be released)
- HIV/aids
-inflammation
69
food high in folic acid
leafy greens, seafood, fortified cereals
70
foods high in b12
leafy green. Red meat, fortified cereals, legumes,diary
71
foods high in iron
leafy green, red meat, poultry, seafood, dairy, fortified cereals, dark chocolate
72
hemoglobin level
11-17
73
hematocrit level
35-48%
74
RBC level
4-6
75
what does bone marrow make
PLT, WBC, RBC
76
how long does RBC live
120 days
77
Anemia
deficiency in number of circulating RBC
many causes:
overproduction of normal or defective cells
decreased erythrocyte production
blood loss
increased erythrocyte destruction
78
Polycythemia
increase in number of RBC
unknown etiology
79
decreased erythrocyte production anemia
iron deficiency
thalassemia
megaloblastic (folic acid, b12)
80
increased erythocyte destruction anemia
sickle cell
81
overproduction of normal or defective cells anemias
polycythemia
blood cancers
82
common symptoms of anemia
Fatigue, cold, dizziness, orthostatic hypertension, pale, dark urine and little output (kidneys aren't working as well due to lack of o2), difficulty exercising due to lack of energy and labored breathing, palpitation, weakness, constipation, diaphoresis
83
what organ diseases can affect RBC
liver, kidney
84
why is jaundice possible in anemia
liver may not be able to excrete bilirubin so builds up
85
anemia diagnostics
total erythrocyte count
hgb/hct
iron/b12/folic acid level
elevated pulse
low o2 saturation
86
iron deficiency anemia diagnosis
low ferritin level
microcytic cell
-decreased RBC prod
87
thalassemia
insufficient production of hemoglobin
- genetic_ autosomal recessive
only cure is Hemptopatic stem cell trans... lots of risks
decreased RBC production
88
causes of b12 (pernicious) anemia
decreased intake/decreased absorption
intrinsic factor no longer secreted
autoimmune
crohns, bowel resection, gastrectomy
-decreases RBC prod
89
causes of folic acid anemia
inadequate intake of folic acid
- decreases RBC prod
90
interventions for anemia
advice rest periods, assess for falls and safety, prevent skin breakdown (lack of o2), assess dietary needs, monitor labs, oxygen, oral hygeine
91
adding iron
iv route- preferred
oral (between meds not during)
iron causes constipation
92
B12 supplements
oral
IM
nasal
93
folic acid supplement
oral
94
job of spleen
stores RBC
95
sickle cell
thick, hard irregular shaped RBC that does not carry oxygen and can occlude blood vessel
inherited autosomal recessive disorder
96
managing SCD to prevent
good hydration, nutrition, stress prevention, and preventing illness
97
how to diagnose SCD
peripheral blood smear
98
complications of SCD
HF (damage)
pulm infarction (blocked artery)
retinal damage (small vessels- eye issues)
stoke
renal damage
leg ulcers
osteoporosis (bone not getting oxygen)
pneumonia (fluid may not be able to move in and out of cell)
shock
99
interventions for SCD
o2
fluids
blood transfusions
pain management
prevention**
hydroxyurea- drug that helps but suppresses RBC and PLT
100
UTERINE PROLAPSE
uterus into vaginal canal
symptoms vary, but feeling something is "coming down", backache, stress incontinence
treated by pelvic muscle strengthening exercises, pessary, surgery
101
cystocele
protrusion of bladder through vaginal wall
symptoms- issues voiding, stress incontinence, inability to empty bladder, causing UTIs
diagnosed by cystourethrogram- injecting dye, taking x-ray
treated by pelvic floor therapy, surgery
102
rectocele
protrusion of rectum through vaginal wall
symptoms- rectal pressure, hemorrhoids
diagnosed by pelvic exam
treated by pelvic floor therapy, pessary, surgery
103
fistula
abnormal connection between organs
most common between rectum and vagina
due to complications from childbirth, or long labor
can close on own or surgery may be needed
104
menopause
cessation of menses with decline in ovarian function, diagnosed by 12 months no period, or can check estrogen levels
105
induced menopuase
taking out uterus and ovaries
106
what does menopause put women at risk for
CAD
osteoporosis
fat redistribution
weight gain
joint and muscle pain
hair thinning
atrophy of genitalia and breast tissue
memory loss
frequent urination
hot flashes, night sweats
107
management for menopause
prevent further bone loss- vitamin D, calcium (1500 mg/day)
bisphosphonates for bone loss
exercise
diet
HRT therapy
emotional support
108
what is high BP a sign of
heart and blood vessels are being overworked
109
if heart builds up to much muscle what can happen
less room to hold blood or heart enlargement
110
if untreated, hypertension can lead to
atherosclerosis, CHF, blindness, kidney failure, stroke, heart attack, erectile dysfunction, aneurysms, enlarged heart
111
systolic BP
pressure from contracted beat
112
diastolic BP
pressure when heart is relaxed
113
s1 sound
mitral and tricuspid closing
114
s2
pulmonic and aortic valve closing
115
preload
amount of blood left in ventricle after diastole (relaxed)... trying to get out
116
med that decreased preload
diuretic
117
what causes a increase in preload
Hypervolemia
regurgitation of cardiac valves
heart failure
118
afterload
resistance left ventricle must overcome to circulate blood
-ventricle is trying to push blood out
the more afterload, the more cardio workload
119
what causes afterload
hypertension
vasoconstriction
120
normal BP
<120 over <80
121
elevated BP
120-129 over <80
keep in mind if diastolic above 80 then its stage 1
122
stage 1 hypertension
130-139 diastolic
or 80-89 systolic
123
stage 2 hypertension
>140 sysolic
or >90 diastolic
124
patient position for bp
make sure legs aren't crossed, arms at heart length
125
race most at risk for htn
blacks
126
what gender is more likely to get htn at a younger age
men
127
woman and htn
higher rate after age 64 with poorer control
increased with risk of birth control pills
128
cardiac output
HR and contractility
renal fluid volume control (renin-angiotensin)
129
systemic vascular resistance
Sympathetic NS (alpha vasoconstrict, beta vasodilate)
neurohormonal (vasoconstrict- NE, angiotensin)
local regulators
130
primary htn
no identifiable cause
Risk factors- obesity, family history, lack of exercise, smoking, diabetes, stress, alcohol, ethnicity, socio economic, age
131
secondary htn
caused by cirrhosis, sleep apnea, renal disease, pregnancy, drugs, neuro causes
132
diagnostics for htn
history and physical
eye exam
Blood test- cbc, lipid panel, UA
ECG
*bring BP diary to dr
echocardiogram
133
preventning HTN
DASH diet - low Na, fat, increase veggies and fruits
exercise- aerobic and muscle strength
manage stress
stop smoking
limit alc
134
how many drinks can genders have a day
men- 1-2
woman- 1 or less
135
ACE inhibitors for htn
prevent conversion of angiotensin 1 to angiotensin 2: reduces vasoconstriction, salt and water retention
*doesnt effect heart rate
- these drugs end in -pril
side effect- cough
136
ARBS for htn
angiotensin receptor blocker, prevents angiotensin II from binding to receptor
*does not affect heart rate
ends in -statin
137
thiazide diuretic for htn
promote Na and water excretion, decrease plasma volume and SVR
- typically first drug given
- ends in -zide
K+ wasting drug
138
calcium channel blocker (CCB) for htn
increases Na excretion, prevents artery constriction
ends in -pine
peripheral edema common side effect
139
common side effects for all htn drugs
orthostatic hypotension, hypotension
140
common OTC drugs that cause htn
sudafed, ibuprofen
talk to pharmacist before buying otc drugs
141
why do elders get HTN
Loose elasticity in cardiovascular, change in lifestyle, organs wearing out
- at risk for orthostatic hypo--- fall risk
bp goal for above 60 is 150/90
