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Med Surg Ex 2
Respiratory Notes
137
Nursing
Undergraduate 2
04/25/2012

Additional Nursing Flashcards

 


 

Cards

Term
Anatomy and physiology of the Respiratory system
Definition

Upper resp. tract

Lower Resp. Tract

Lungs

Assessory muscles of the respiratory tract

Resp. Changes assoc. with age

Term
Patient history for Resp. system
Definition

˜Collect history of patient data on family, personal, smoking, drug use, allergies, travel, place of residence, dietary history, occupational history, and socioeconomic level.
˜Pack-years of smoking—number of packs smoked per day multiplied by the number of years the patient has smoked.
˜Assess current health problems such as cough, sputum production, chest pain, and dyspnea
˜Drug use
˜Allergies
˜Travel and geographic area of residence
˜Nutritional status
˜Cough, sputum production, chest pain, dyspnea, PND, orthopnea

Term
Indications of respiratoy adequacy
Definition

˜Clubbing
˜Weight loss
˜Unevenly developed muscles
˜Skin and mucous membrane changes
˜General appearance
˜Endurance 

Term
Psychosocial assessment of the respiratory tract
Definition

˜Some respiratory problems may be worsened by stress.
˜Chronic respiratory disease may cause changes in family roles, social isolation, and financial problems due to unemployment or disability.
˜Discuss coping mechanisms and offer access to support systems.

Term
Pulmonary Function Testing
Definition

˜These tests evaluate lung volumes and capacities, flow rates, diffusion capacity, gas exchange, airway resistance, and distribution of ventilation.
˜Patient preparation.
˜Procedure for performing tests at the bedside.

Term
Other Invasive Diagnostic Tests
Definition

˜Endoscopic examinations
˜Thoracentesisaspiration of pleural fluid or air from the pleural space:
ØPatient preparation for stinging sensation and feeling of pressure
ØCorrect position
ØMotionless patient
ØFollow-up assessment for complications

Term
Follow up care for a lung biopsy
Definition

˜Follow-up care:
ØAssess vital signs and breath sounds at least every 4 hr for 24 hr.
ØAssess for respiratory distress.
ØReport reduced or absent breath sounds immediately.

Monitor for hemoptysis

Term
Epistaxis   
Definition

Defined as any bleeding from the nostril, nasal cavity, or nasopharynx.

  •   Nosebleeds are very common because the lining of the nose is very vascular.

  •   Tend to occur more in the winter months when viruses are common and heated

    indoor air dries out the nostrils.

  •   Occurs more in children under 10 and adults older than 50 

Term
Etiology/Risk Factors for epistaxis    
Definition
  •   Trauma: primary cause

  •   Systemic problems: coagulation disorders or hypertension (makes it difficult to

    control)

  •   Environmental problems: dry air

  •   Irritation: nose picking

  •   Drug use: non-prescribed or illegal

  •   Medications: nasal sprays(cause), anticoagulants (make it harder to control but

    does not cause)

  •   Surgery: nasal or sinus

  •   Deviated septum may make a person more susceptible to nosebleeds

  •   Age: The elderly are susceptible to nosebleeds due to the skin and the lining of the

    nose becomes more friable (easily torn) and retains less turgor. 

Term
Pathophysiology of epistaxis   
Definition
Tiny distended vessels in the mucous membrane of any area of the nasal passage rupture. 
Term
Two main areas within the nasal passage where bleeding is at the greatest risk include: 
Definition

Anterior

Posterior

Term
Anterior Epistaxis
Definition

Most common. Bleeding erupts when the relatively thin nasal mucosa overlying a dilated septal vessel dries, scabs, and fall (or is picked) off. More in younger children 

 

Term
Posterior Epistaxis
Definition

bleeds are located over the posterior middle turbinate, and are less common. This site of bleeding is higher and deeper within the nose and the blood flows primarily down the back of the throat. Seen more in older people and is more serious. 

  •   Rarely is a nosebleed life threatening or actually fatal.

  •   In most cases of life-threatening nosebleeds, some underlying health

    problem, such as hypertension, a bleeding disorder, or use of anticoagulant medication, is impacting the patient’s ability to clot. 

Term
Nursing Assessment of epistaxis
Definition
  •   Amount and location of the bleeding

  •   Monitor vital signs

  •   Patient’s color

  •   Question nose bleed occurrence

  •   Medications

  •   What attempts have been made 

Term
Clinical Manifestations of epistaxis    
Definition
  •   Bleeding from the nose

  •   Could be slight or profuse depending on the cause

  •   Bleeding following an injury to the head may indicate a skull fracture or

    broken nose and x-rays should be taken no matter how trivial the blow seems. 

Term
Emergency care of Anterior Nosebleed:    
Definition
  •   Position patient upright (high fowlers) and leaning forward if possible: to prevent blood from entering the stomach and possible aspiration.

  •   Reassure the patient and attempt to keep him or her quiet: to reduce anxiety and blood pressure

  •   Apply direct lateral pressure to the nose for 5-10 minutes and apply ice or cool compresses to the nose and face if possible. Pressure helps to clot off the bleeding and cool compresses help with vasoconstriction.

  •   If nasal packing is necessary, loosely pack both nares with gauze or nasal tampons

  •   To prevent rebleeding from dislodging clots, instruct the patient not to blow the nose for several hours after the bleeding stops.

  •   Provide tissues and an emesis basin: for expectoration of blood

  •   Reassure patient in a calm, efficient manner that bleeding can be controlled. 

Term
If First Aid measures are not effective for Anterior nosebleeds    
Definition

Vasoconstrictive medication, cauterization or anterior packing may be implemented.

Packing usually stays in place for 40-72 hours 

Term
Posterior Packing: Patient should be hospitalized for this.    
Definition
  •   Monitor patient closely: Make sure the packing is not blocking the airway.respiratory rate, heart rate, oxygen saturation(pulse ox) and level of consciousness.

  •   Observe for signs of aspiration: coughing, gaging

  •   Have a Yankauer available: If suction is needed

  •   Nasal packing may alter respiratory status (increase co2 and decrease in o2may lead to cardiac dysrhythmias, respiratory arrest)

  •   Nasal Packing: painful, risk for infection, & septal hematoma

  •   Administer Pain medication and antibiotics as ordered

  •   Leave packing in for a minimum 3 days

  •   Remove packing: this can be very painful so provide pain medication, nare care 

Term
Patient Education for epistaxis    
Definition
  •   Self-care: avoid vigorous nose blowing, strenuous activity, lifting, and straining for 4-6 weeks, avoid aspirin use, sneeze with mouth open, humidification.

  •   Instruct patient how to apply direct pressure to nose for 15 minutes if nose bleeds recurs.

  •   Instruct patient to seek medical attention if recurrent bleeding cannot be stopped. 

Term
Acute Viral Rhinitis (common cold)    
Definition
  •   An infectious process of the upper respiratory tract:

  •   Caused by viruses: rhinovirus, adenovirus, respiratory syncytial virus (RSV), influenza

    virus...because of this diversity, development of a vaccine is almost impossible.

  •   Highly contagious: the virus is shed for about 2 days before the symptoms appear

  •   Spread by airborne droplets or direct contact: practice good hand washing

  •   September (just after the opening of school), January, & End of April: most common times 

Term
Pathophysiology of Rhinitis (acute)   
Definition
  •   Mucous Membranes

    Inflammation Congestion Edema

  •   Sinus Openings Blocked

    Rhinorrhea 

Term
Clincial manisfestation of Acute Rhinitis
Definition
  •   Runny Nose

  •   Congestion

  •   Sneezing

  •   Weakened senses of taste and smell

  •   Scratchy throat

  •   Cough/Sneezing

5-14 days    

Term
Influenza   
Definition
Two main groups of influenza viruses: A & B: H1N1 (Swine )virus falls into the A group    
Term
clinical manisfestation with Influenza
Definition
  •   Abrupt onset of fever

  •   Sweating

  •   Headache

  •   Muscular aches and pains

  •   Nonproductive cough

  •   Malaise

  •   Sore throat, laryngitis

Term
Symptom Management: similar for both acute viral rhinitis and influenza virus    
Definition
  •   Decongestants

  •   Expectorants

  •   Antitussives

  •   Analgesics

  •   Rest and Fluids

  •   Annual influenza vaccination

  •   Antiviral: Relenza,Tamiflu, Flumadine 

Term
4 steps to the nursing process for Influenza
Definition

Prevention   

Management

When to contact health care provider

When to obtain immediate health care    

  

Term
Prevention of the flu
Definition
Hand hygiene, use disposable tissue, cover mouth when coughing, avoid crowds during the flu season, avoid people with infections, obtain annual influenza vaccination 
Term
Flu management
Definition
Increase fluid intake (warm fluids such as chicken soup are especially soothing for irritated throats),elevate head of bed, gargle with salt water frequently for sore throat (1/4 teaspoon of salt dissolved in eight ounces warm water), use throat lozenge for sore throat or cough, use saline nose drops/sprays. 
Term
When to contact a health care provider for the flu?
Definition
  1. If symptoms worsen after 3-5 days, new symptoms develop or symptoms do not improve after days. 

Term
When to obtain immediate health care for the flu
Definition
Upper respiratory distress (stridor, drooling, inability to swallow), lower respiratory distress (moderate to severe dyspena), severe headache (“worst ever”, rigid neck, altered mental state, focal neurologic symptoms) 
Term
Target group for influenza?
Definition
  •   Anyone>50 years-old

  •   Chronic cardiac or pulmonary disease

  •   Hospitalized the preceding year

  •   Long-term care facilities

  •   Immunocompromised

  •   Groups who can transmit influenza to high-risk persons

  •   Women in 2nd or 3rd trimester of pregnancy

  •   Children (6 months -5 birthday) 

Term
Complications of influenza   
Definition
  •   Viral or Bacterial pneumonia (most common complication)

  •   Ear infections

  •   Dyhydration

  •   Encephalitis (Brain inflammation)

  •   Acute sinusitis

  •   Exacerbation of pre-existing respiratory problems: asthma, COPD...

 Older adults,pregnant women, immunocompromised, chronic diseases: Increaed risk for developing complications 

Term
Acute Sinusitis    
Definition
  •   Usually results from the common cold

  •   Lingers in about 10% of people.

  •   Other causes:

  •   Upper respiratory tract infection

  •   Allergies

  •   nasal polyps

  •   Bacterial, viral or fungal infection 

Term
Pathophysiology of acute sinusitis   
Definition
  •   Obstruction of sinus openings

  •   Mucous membranes in side the cavity becomes swollen and inflamed

  •   The cavity fills with secretions 

Term
S/sx of acute sinusitis
Definition
  •   Nasal congestion and pressure

  •   Pain over affected sinus

  •   Edematous nasal mucosa and edema of the face and periorbital area

  •   Fever

  •   Nasal discharge

  •   Malaise 

Term
Treatment for Acute Sinusitis   
Definition
  •   Antibiotic

  •   Nasal decongestants

  •   Analgesic

  •   Nasal corticosteroids

  •   Steam inhalation

  •   Warm compresses 

Term
Patient Teaching for acute sinusitis    
Definition
  •   Symptoms of complications

  •   Methods to promote drainage of sinuses

  •   Stop smoking

  •   Avoid swimming, diving & air travel

  •   Side effects of nasal sprays

  •   Complete antibiotics

  •   Preventive measures 

Term
Pneumonia CAP (community aquired) 
Definition
Onset in the community or during the first 2 days of hospitalization Highest in the winter months
Streptoccoccus pneumoina most common 
Term
HAP Pneumonia   
Definition

Occurs 48 hours or longer after hospital admission & not incubating at the time of hospitalization.

Can be VAP or Health care associated

Health care –associated is the 2nd most common nosocomial infection 

Term
Risk factors for Pneumonia
Definition
Altered consciousness
Tracheal intubation
Impaired mucociliary mechanism
Malnutrition
Diseases: leukemia, alcoholism, diabetes mellitus
Altered oropharyngeal flora
Intestinal and gastric feedings via nasogastric or nasointestinal tubes Immunosuppressive drugs/therapy 
Term
Five Cardinal Signs of Early Bacterial Pneumonia    
Definition

Coughing

Sputum production

Pleuritic chest pain

Shaking Chills

Fever 

Sputum production Pleuritic chest pain Shaking Chills Fever

(confusion or stupor in the elderly or dibilitated) 

Term
Diagnostic Studies for Pneumonia
Definition

History & physical exam

Chest x-ray
Gram stain of sputum Sputum C & S
Pulse oximetry or ABGs CBC
Blood cultures 

Term
Therapy for Pneumonia   
Definition

Antibiotic therapy

Increased fluid intake

Limited activity and rest

Antipyretics
Analgesics

Oxygen therapy 

Term
Complications of Pneumonia
Definition

Pleurisy
Pleural effusion

Atelectasis

Bacteremia
Lung abscess
Empyema
Pericarditis, Menigitis, or Endocarditis 

Term
Subjective Assessment for Pneumonia
Definition

Past health history

Medications
Surgery or other treatments Functional Health Patterns:

  • –  Health perception-health management:

  • –  Nutritional-metabolic

  • –  Activity-exercise

  • –  Cognitive 

Term
Planning or goals of Pneumonia
Definition
  1. Improved airway patency

    Rest to conserve energy

Proper fluid volumew

Adequate nutrition

Absence of complications 

Term
Improve airway patency
Definition

Encourage hydration: 3 L/day

Provide humidified air

Encourage cough, CPT, INS

Provide nasotracheal suctioning

Provide & monitor O2 therapy 

Term
Promoting Fluid intake & Nutrition    
Definition

Encourage fluids (3 L/day with electrolytes and calories)

Administer intravenous fluids and/or nutrients 

Term
Promoting Activity Tolerance    
Definition
Counsel patient to rest and to avoid overexertion
Assist patient into a comfortable position that maximizes breathing (semi-Fowler’s) Change position frequently (particularly in elderly) 
Term
Pneumococcal Vaccination
Definition

65 years of age and older

Chronic illness

Environmental settings

Immunocompromised 

Term
Tuberculosis   
Definition

M. tuberculosis, a gram-positive, acid-fast bacillus,is usually spread by airborne droplets via coughs, sneezes, speaks...

 

When the celluar immune system is stimulated by the microorganism, a tissue granuloma is formed from the alveolar macrophages this contains the bacteria and prevents replication.

If the initial immune response is not adequate, control of the organism is not maintained and active primary disease results. 

Term
Classification of TB
Definition

Class 0: No TB exposure: No infection
Class 1: TB exposure, no evidence of infection

Class 2: Latent TB: infection without disease

Class 3: TB infection with clinically active disease

Class 4: No current disease
Class 5: TB suspect 

Term
Risk Factors for TB
Definition

Close contact with TB active person
Injection drug use and alcoholism
Residence in overcrowded, substandard housing, or institutions. Immunocompromise
Preexisting medical conditions, no health care, immigrants

Occupation 

Term
Clinical Manifestations of TB
Definition

Low-grade fever, fatigue, anorexia, weight loss, night sweats, chest pain, and cough

Nonproductive cough, which may progress to mucopurulent sputum with hemoptysis 

Term
Diagnostic Methods of TB    
Definition

TB skin test

Sputum culture *

Chest radiograph

QuantiFERON-TB (QFT) 

Term
Pharmacologic Therapy for TB    
Definition

First-line: isoniazid (INH), rifampin (Rifadin), ethambutol (Myambutol), pyrazinamide (PZA), rifabutin (Mycobunin), and rifapentine (Priftin).

Second-line: cycloserine (Seromycin), ethionamide (Trecator),streptomycin, capereomycin (Capastat), kanamycin, Fluoroquinolones 

Term
Adverse Effects of TB medications INH    
Definition
hepatotoxicity: jaundice, liver function test, peripheral neuritis (numbness and tingling) vitamin B6 (pyridoxine) 
Term
Adverse effects of Rifampin
Definition
monitor CBC, liver function test and renal status, causes orange discoloration of body fluids. 
Term
Pyrazinamide: side effects   
Definition
hepatotoxicity and elevates uric acid levels: monitor for jaundice and joint pain.    
Term
Ethambutol: side effects   
Definition
optic neuritis (baseline vision screening) monitor for loss of visual acuity and red/green color discrimination. 
Term
Streptomycin: side effects   
Definition
ototoxicity & nephrotoxicity. Monitor hearing ability and renal function; fluid intake of 2.5-3 liters of fluid per day. 
Term
Nursing Assessment of TB
Definition

Complete history & physical exam

Respiratory assessment: fever, anorexia, weight loss, night sweats, fatigue, cough, and sputum production

Changes in temperature, respiratory rate, amount & color of secretions, frequency and severity of cough & chest pain

Evaluate breath sounds for consolidation (diminished, bronchial, or bronchovesicular, crackles), fremitus, egophony, and percussion (dullness)

Enlarged =, painful lymph nodes

Patient’s living arrangements

Review results of physical and lab 

Term
Goals of treatment for TB
Definition

Comply with therapeutic regimen

Have no recurrence of disease

Pulmonary function within set limits

Prevent spread of infection 

Term
Acute Interventions for TB
Definition

Instruct about best position to facilitate drainage
Encourage increased fluid intake
Provide high-humidity
Airborne isolation: High-efficiency particulate air (HEPA) mask use

Negative-pressure isolation room 

Term
Advocate Compliance for TB    
Definition

Explain that TB is a communicable disease and that taking medications is the most effective way of preventing transmission.

Instruct hygiene measures: mouth care, covering mouth and nose with paper tissue every time he or she coughs, sneezes,

Instruct about medication, schedule, & side effects. 

Term
Evaluate in TB pts.   
Definition
Maintains patent airway
Demonstrates adequate level of knowledge Adheres to treatment regimen
Maintains activity schedule
Exhibits no complications 
Term
What is homeostasis?
Definition

—  State of equilibrium in body

—  Naturally maintained by adaptive responses

—  Body fluids and electrolytes are maintained within narrow limits.

Term

ž  Water Composition of the Body

Definition

—  50% to 60% of body weight in adult

—  45% to 55% in older adults

—  70% to 80% in infants

—  Varies with gender, body mass, and age

Term

ž  Composition of body fluid compartments

Definition

ž  Intracellular fluid (ICF)

ž  Extracellular fluid (ECF)

Term
What are Electrolytes?
Definition

ž  Substances whose molecules dissociate into ions (charged particles) when placed into water

—  Cations: positively charged

—  Anions: negatively charged

Term

International standard 

Definition

millimoles per liter (mmol/L).ž 

U.S. uses milliequivalent (mEq).  Ions combine mEq for mEq.

Term

ž  Electrolyte Composition of the ICF

Definition

ž  ICF

—  Prevalent cation is K+.

—  Prevalent anion is PO43-.

Term
Composition of the ECF
Definition

—  Prevalent cation is Na+.

—  Prevalent anion is Cl-.

—  Diffusion

Term
What is diffusion?
Definition

ž  Movement of molecules from high to  low concentration

—  Occurs in liquids, solids, and gases

—  Membrane separating two areas must be permeable to diffusing substance.

—  Requires no energy

Term
What is osmosis?
Definition

—  Movement of water between two compartments by a membrane permeable to water but not to solute

—  Moves from low solute to high solute concentration

—  Requires no energy

Term
what is osmotic pressure?
Definition

ž  Amount of pressure required to stop  osmotic flow of water

Determined by concentration of solutes in solution

Term
What is Hydrostatic pressure?
Definition

—  Force within a fluid compartment

—  Major force that pushes water out of  vascular system at capillary level

Term
what is filtration?
Definition

—  The process by which water and dissolved substances (solutes) move from an area of high hydrostatic pressure to an area of low hydrostatic pressure

—  Occurs across capillary membranes

—  Glomerulus<-- where filtration occurs

Term

  Oncotic Pressure?

Definition

ž  Osmotic pressure exerted by colloids in solution

—  Protein is a major colloid.

Term

ž  Fluid and Electrolyte Imbalances

Definition

—  Common in most patients with major illness or injury

      Directly caused by illness or disease (burns or heart failure)

      Result of therapeutic measures
(IV fluid replacement or diuretics)

Term

ž  Gerontologic Considerations for imbalances in fluids and electrolytes

Definition

—  Reduced thirst mechanism results in decreased fluid intake.

—  Nurse must assess for these changes and implement treatment accordingly

—  Structural changes in kidneys decrease ability to conserve water.

—  Hormonal changes lead to decrease in ADH and ANP.

—  Loss of subcutaneous tissue leads to increased loss of moisture.

Term

what is ž  Hypovolemia

 

Definition

ž  ECF volume depletion

—  Occurs with abnormal loss of body fluids

—  Inadequate intake

—  Plasma-to-interstitial fluid shifts

—  Dehydration

—  Refers to loss of pure water alone without corresponding loss of Na+

ž  The tank is empty

Term

Causes of Hypovolemia

(Gi issues)

Definition

—  Vomiting

—  Nasogastric suctioning

—  Diarrhea

—  Intestinal drainage

Term

Hypovolemia causes

(hemorrhage)

Definition

—  Major trauma

—  GI bleeding

Term

Hypovolemia causes

(altered intake)

 

Definition

—  Coma

—  Fluid deprivation

Term

Hypovolemia causes

(abnormal skin losses)

Definition

—  Excessive diaphoresis

      Fever

      Exercise

—  Burns

Term

Hypovolemia causes

(renal losses)

Definition

Diuretic therapy

Term
S/sx of Hypovolemia
Definition

ž  Hypovolemia

ž  Furrowed tongue/dry mucous membranes

ž  Sunken eyeballs

ž  Flat neck veins

ž  Clinical pallor

ž  Dizziness/syncope/weakness/fatigue

ž  Hypovolemia

ž  Anorexia

ž  Nausea/vomiting/constipation

ž  Thirst

ž  Confusion

Term
Hypovolemia labs
Definition

ž  Hematocrit

—  Elevated with dehydration

—  Decreased with bleeding

ž  BUN

—  Elevated; BUN/Creatinine ration greater than 20:1 suggests hypovolemia

ž  Electrolytes

—  Levels will vary depending on the type of fluid lost

Term
Assessment of Hypovolemia
Definition

ž  I & O

ž  Monitor cardiovascular changes.

ž  Assess respiratory changes.

ž  Daily weights

ž  Skin assessment

Term
Goals for Hypovolemia
Definition

ž  Restore normal fluid volume

—  Mixed isotonic saline/electrolyte solution- LR

—  Isotonic (0.9%) NaCl is used when rapid replacement is indicated

—  Blood- when volume loss is due to blood loss


ž  Correct acid-base

ž  Correct electrolyte disturbances

Term
Hypervolemia
Definition

ž  A state of higher-than-normal intravascular volume

—  Excessive retention of Na+ and water

      Chronic renal stimulus to conserve Na+ and water

—  Abnormal renal functioning

      Reduced excretion of Na+ and water

—  Excessive administration of IV fluids

—  Interstitial-to-plasma fluid shifts

Term
Hpervolemia labs
Definition

ž  Hematocrit

—  Decreased due to hemodilation by excess fluids in the vasculature

ž  BUN

—  Decreased in pure hypervolemia

—  Increased with renal failure

Term
S/sx of Hypervolemia
Definition

—  Periorbital edema

—  Warm, moist skin

—  Moist tongue

Pitting edema

—  Excessive, frothy saliva

—  Pulse- rapid

—  Respirations-dyspnea, rales, cough

—  BP- normal to high

—  Weight gain

Term
Hypernatremia
Definition

ž  Serum Na+ greater than 145 mEq/L

—  Elevated serum sodium occurring with water loss or sodium gain

ž  Causes hyperosmolality leading to cellular dehydration

ž  Primary protection is thirst from  hypothalamus. 

Term
Causes of Hypernatremia
Definition

ž  Excessive Na+ intake

—  IV fluids

      Hypertonic NaCl, excessive isotonic NaCl,

      Near-drowning in salt water

ž  Inadequate water intake

—  Unconscious

—  Cognitively impaired

ž  

Term
Clinical Manisfestations of hypernatremia
Definition

—  Intense Thirst, lethargy, agitation, seizures, and coma

—  Impaired LOC

—  Restlessness, agitation, twitching, seizures, coma

—  Dry swollen tongue, sticky mucous membranes

—  Postural hypotension

—  Weight loss

—  Weakness, lethargy

—  Hypernatremia 

Term
What do you treat in Hypernatremia?
Definition

—  Water deficit

      Prevent further water loss with oral fluids

      IV D5W or hypotonic saline

—

  Sodium excess

      Dilute the Na+ concentration

—  IV D5W

—  Diuretics

—  Dietary Na+ restriction

Term
Hyponatremia s/sx
Definition

ž  Serum Na+ less than 135mEq/L

ž  Net gain of water

ž  Loss of Na+ rich fluids that have been replaced by water

GI loses- diarrhea, vomiting, NG suction,

ž  Renal losses- diuretics, adrenal insufficiency

ž  Skin losses- burns, wound drainage, excessive diaphoresis

ž  Irritability

ž  Apprehension

ž  Confusion

ž  Dizziness

ž  Personality changes

ž  Tremors

ž   Seizures

ž  Dry mucous membranes

ž  COMA

Term
Causes of hyponatremia
Definition

  Hyponatremia caused by water excess

  Fluid restriction

  Severe symptoms

 

  Small amounts of IV hypertonic saline (3% NaCl)

 

Abnormal fluid loss

 

  Fluid replacement with Na+ containing solutions

Term
What is potassium necessary for?
Definition

—  Transmission and conduction of nerve and muscle impulses

—  Cellular growth

—  Maintenance of cardiac rhythms

—  Acid-base balance

Term
What are sources of potassium
Definition

—  Fruits and vegetables (bananas and oranges)

—  Salt substitutes

—  Potassium medications (PO, IV)

—  Stored blood

Term
Hyperkalemia
Definition

ž  Serum K+ level greater than 5mEq/L

—  Increased intake of K+

      Excessive or rapid parenteral administration

      K+ containing drugs

      K+ containing salt substitutes

—  Decreased urinary excretion of K+

      Renal disease

      K+ sparing diuretics

      ACE inhibitors

Term
Manisfestations of hyperkalemia
Definition

—  Irritability

—  Anxiety

—  Abdominal cramping/diarrhea

—  Weakness of lower extremities

—  Paresthesias

—  Irregular pulse

—  Cardiac arrest

Term
Hypokalemia
Definition

  K+ loss

—  GI losses- diarrhea, vomiting,  NG suction

—  Renal losses- diuretics,  Mg+ depletion

ž  Shift of K+ into cells

  Increased insulin

—  Alkalosis

ž"  Lack of K+ intake

—  Starvation

—  Diet low in K+

—  Failure to include K+ in parenteral fluids if NPO

Term
Manisfestations of hypokalemia
Definition

—  Fatigue

—  Muscle weakness, leg cramps

—  Nausea, vomiting

—  Soft, flabby muscles

—  Parasthesias, deceased reflexes

—  Weak, irregular pulse

—  Polyuria

—  Hyperglycemia

Term
Calcium
Definition

ž  Bones are readily available store.

ž  Blocks sodium transport and stabilizes cell membrane

ž  Ionized form is biologically active.

Term
Functions of Calcium
Definition

ž  Functions

—  Transmission of nerve impulses

—  Myocardial contractions

—  Blood clotting

—  Formation of teeth and bone

—  Muscle contractions

Term
Hypercalcemia causes
Definition

ž  High serum calcium levels caused by

—  Hyperparathyroidism (two thirds of cases)

—  Malignancy

—  Vitamin D overdose

—  Prolonged immobilization

Term
Manisfestations of Hypercalcemia
Definition

—  Decreased memory

—  Confusion

—  Disorientation

—  Fatigue

—  Constipation 

Term
Treament of hypercalcemia/Goals
Definition

ž  Excretion of Ca with loop diuretic

ž  Hydration with isotonic saline infusion

ž  Synthetic calcitonin

ž  Mobilization

ž  Hypocalcemia

ž  Serum Ca++ less than 8.5 mg/dl

ž  Increased calcium loss

ž  Reduced intake secondary to altered intestinal absorption

ž  Altered regulation

Term
Hypocalcemia manifestations
Definition

—  Positive Trousseau’s or Chvostek’s sign

—  Laryngeal stridor

—  Dysphagia

—  Tingling around the mouth or in the extremities

—  Tetany

—  Seizures

Term
Phosphate
Definition

 Primary anion in ICF

  Essential to function of muscle, red blood cells, and nervous system

  Deposited with calcium for bone and tooth structure

  Involved in acid-base buffering system, ATP production, and cellular uptake of glucose

  Maintenance requires adequate renal functioning.

Term
Hyperphosphatemia
Definition

ž  Serum phosphate greater than 4.5mg/dl or 2.6mEq/L

ž  Common in patients with renal failure

—  Kidneys cannot excrete excess phosphorus

Term
Causes of Hyperphosphatemia
Definition

ž  Causes

—  Renal failure

—  Chemo agents

—  Enemas containing phosphorus (Fleet enema)

—  Excessive ingestion- milk, phosphate-containing laxatives

—  Large vitamin D intake

Term
Manifestations of Hyperphosphatemia
Definition

—  Calcified deposition in soft tissue such as joints, arteries, skin, kidneys, and corneas

—  Neuromuscular irritability and tetany

Term
Pt teaching Hyperphosphatemia
Definition

ž  Identify and treat the underlying cause

ž  Hyperphosphatemia causes Hypocalcemia

ž  Signs and symptoms of acute hyperphosphatemia are due to the effects of hypocalcemia. 

Term
Hypophosphatemia
Definition

ž  Serum PO43-   less than 2.5mg/dl

ž  Low serum PO43- caused by

—  Malnourishment/malabsorption

—  Alcohol withdrawal

—  Use of phosphate-binding antacids

—  During parenteral nutrition with inadequate replacement

Term
Manisfestations of Hypophosphatemia
Definition

—  CNS depression

—  Confusion

—  Muscle weakness and pain

—  Dysrhythmias

—  Cardiomyopathy 

Term
Management of hypophosphatemia
Definition

—  Oral supplementation

—  Ingestion of foods high in phosphorus

—  IV administration of sodium or potassium phosphate 

Term
Magnesium
Definition

ž  50% to 60% contained in bone.

ž  Coenzyme in metabolism of protein and carbohydrates

ž  Factors that regulate calcium balance appear to influence magnesium balance.

ž  Acts directly on myoneural junction

ž  Important for normal cardiac function

Term

Hypermagnesium

(how high?)

Definition

ž  Serum Mg+ greater than 2.5 mEq/L

ž  Occurs almost exclusively in individuals with renal failure who have an increased intake of Mg+

Term
Clinical Manisfestations of Hypermagnesium
Definition

—  Mild levels

      Lethargy, drowsiness

      Nausea, vomiting

—  Increased levels

      DTR’s are lost

      Somnolence

—  If continues

      Respiratory and/or cardiac arrest

Term
Management of hypermagnesium
Definition

—  Prevention

—  Emergency treatment

      IV CaCl or calcium gluconate

—  Fluids to promote urinary excretion

Term
Hypomagnesium and its causes
Definition

ž  Serum Mg less than 1.5

ž  Low serum Mg caused by

—  Prolonged fasting or starvation

—  Chronic alcoholism

—  Fluid loss from gastrointestinal tract

—  Prolonged parenteral nutrition without supplementation

—  Diuretics

Term
Manisfestations of hypomagnesium
Definition

—  Confusion

—  Hyperactive deep tendon reflexes

—  Tremors

—  Seizures

—  Cardiac dysrhythmias 

Term
Management of Hypomagnesium
Definition

—  Oral supplements

—  Increase dietary intake.

—  Parenteral IV or IM magnesium when severe

Term
Acid Base regulation
Definition

  • Normal plasma pH is 7.35 to 7.45: hydrogen ion concentration
  • Major extracellular fluid buffer system; bicarbonate-carbonic acid buffer system
  • Kidneys regulate bicarbonate in ECF
  • Lungs under the control of the medulla regulate CO2 and, therefore, carbonic acid in ECF
  • Other buffer systems

ú  ECF: inorganic phosphates and plasma proteins

ú  ICF: proteins, organic and inorganic phosphates

ú  Hemoglobin

Term
Metabolic Acidosis causes
Definition

—  Renal failure

—  Diabetic acidosis

—  Lactic acidosis

—  Ingestion of paraldehyde, anti-freeze, ASA, methyl ETOH

—  Severe diarrhea

Term
Manisfestations of Metabolic acidosis
Definition

—  Headache, confusion, drowsiness

—  Increased respiratory rate and depth

—  Decreased blood pressure

—  Decreased cardiac output, dysrhythmias

—  Shock

—   If decrease is slow, patient may be asymptomatic until bicarbonate is 15 mEq/L or less

Term

ž  With acidosis, hyperkalemia may occur as potassium shifts out of the cell

ž  As acidosis is corrected, potassium shifts back into the cell and potassium levels decrease

ž  Monitor potassium levels

ž  Serum calcium levels may be low with chronic metabolic acidosis and must be corrected before treating the acidosis

Definition
Term
Metabolic Alkalosis
Definition

  • High pH >7.45
  • High bicarbonate >26 mEq/L
  • Most commonly due to vomiting or gastric suction; may also be caused by medications, especially long-term diuretic use
  • Hypokalemia will produce alkalosis 

Term
Metabolic Alkalosis Manisfestations
Definition

—  Symptoms related to decreased calcium

—  Respiratory depression

—   Tachycardia

—  Symptoms of hypokalemia

Term
Treatment of metabolic alkalosis
Definition

ž  Correct underlying disorder,

—   Supply chloride to allow excretion of excess bicarbonate

—   Restore fluid volume with sodium chloride solutions

ž  IV solutions

ž  Purposes

—  Maintenance

      When oral intake is not adequate

—  Replacement

      When losses have occurred 

Term
Hypotonic
Definition

—  More water than electrolytes

      Pure water lyses RBCs.

—  Water moves from ECF to ICF by osmosis.

—  Usually maintenance fluids

Term
Isotonic solution
Definition

—  Expands only ECF

—  No net loss or gain from ICF

Term
Hypertonic solution
Definition

—  Initially expands and raises the osmolality of ECF

—  Require frequent monitoring of

      Blood pressure

      Lung sounds

      Serum sodium levels

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