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112 Cards in this Set
- Front
- Back
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Causes of fluid & Electrolyte Imbalance
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renal disease, illness, trauma, surgery & medications, confused clients (inadequate fluid intake), Vomiting, diarrhea, nasogastric sunctioning, Tissue trauma from burns cause F&E to be lost, diuretics & corticoseroids can result in abnormal losses of electolytes & in fluid loss retention, Diabetic ketoacidosis, cancer, & head injury lead to electrolyte imbalance
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Fluid volume Deficit Symptoms
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-Thirst (early sign)
-Temperture increases -Rapid weak pulse -Respirations increase -Poor skin turgor- skin cool, moist -Hypotension -Emaciation, weight loss -Dry eye sockets, mouth & mucous membranes -Anxiety, apprehension, exhaustion -Urine specific gravity > 1.030 -Decreased urine output -Increased hemoglobin, hematocrit, Na+ serum osmulality, BUN, headache, confusion, disorientation -Hyperthermia- increased pulse, decreased blood pressure, disorientation, treatment is fluid replacement -Older Adults- orthostatic hypotension, falls, pressure ulcers, constipation, dry oral mucous membranes not reliable , vital signs not reliable in early dehydration |
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Fluid Volume Deficit Causes
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Isotonic loss
-Vomiting -Diarrhea -GI sunction -Sweating & warm weather -Decreased intake; increased caffeine & alcohol intake -Hemorrhage -Third Space shift -Hyperthermia -Diuretics -Elderly- decreased total body water; inability to regulate sodium and water balance; decreased thirst perception |
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Fluid Volume Deficit Treatment
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-Force Fluids
-Provide Isotonic IV fluids: lactated Ringers solution or 0.9% NaCl -I and O, hourly outputs -Daily weights (1 liter fluid = 1kg or 2.2 lb) -Monitor vital signs & pulse quality -Check skin turgor -Assess urine specific gravity (should be >1.020) -Give fluids as appropriate; space fluids over 24hr |
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-No change in temperature
-Pulse increases slightly & is bounding -Respirations increase, shortness of breath, dyspnea, rales (crackles) -Peripheal edema-bloated appearance, weight increase -Hypertension -May have muffled heart sounds -Jugular vein distention -Urine specific gravity < 1.010 -Apprehension -Increased venous pressure -Decreased hematocrit, BUN, hemoglobin, Na+, serum osmolality -Edema -Distended veins -Increased Blood Pressure -Bounding Pulse -Crackles -Decreased hematocrit & BUN-normal: 5-20mg/dL; elderly is slightly higher -Weight gain |
Fluid Volume Overload Signs & symptoms
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-Isotonic gain, increase in the interstitial compartment, intravascular compartment, or both
-CHF -Renal Failure -Cirrhosis of the liver -Excessive ingestion of sodium -Excessive or too rapid IV infusion -Heart failure - |
Fluid Volume Overload Causes
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-Administer diuretics
-Restrict fluids -Sodium-restricted diet (average daily diet -6-15g NA+) -Daily weight -Assess breath sounds -Check feet/ankle/sacral region for edema -Semi-Fowler's position if dyspneic -Sodium restricted diet (500mg to 4g salt diet) -I & O -Skin care |
Fluid Volume Overload Treatment
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-Vomiting
-Gastric Suction -Prolonged diarrhea -Diuretics & steroids -Inadequate intake |
Causes of Hypokalemia
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Signs & Symptoms of Hypokalemia
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-Anorexia, nausea, vomiting
-Weak peripheral pulses -Muscles weakness, paresthesias; decreased deep tendon relexes -Impaired urine concentration -Ventricular dysrhythmias -Potential for digitalis toxicity -Shallow respirations |
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Treatment of Hypokalemia
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-a. Administration of oral potassium supplements- dilute in juice & give with meals to avoid gastric irritation
-b. Increase dietary intake-raisins , bananas, apricots, oranges, beans, potatoes, carrots, celery c. IV supplements- 20-40mEq/L, usual concentration; cannot give concentration greater than 1 mEq/h infusion rate; stop solution immediately if burning occurs d. Assess renal function prior to administration e. Risk for digitalis toxicity |
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Causes of Hyperkalemia
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-Renal Failure
-Use of potassium supplements -Burns -Crushing Injuries -Severe infection -Potassium Sparing Diuretic -ACE inhibitors |
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Signs & symptoms of Hyperkalemia
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-EKG changes- peaked T waves, wide QRS complexes
-Dysrhythmia , ventricular fibrillation, heart block -Cardiac arrest -Muscle twitching & weakness -Numbness in hands & feet & around mouth -Nausea -Diarrhea |
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Treatment of Hyperkalemia
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a. Restrict dietary potassium & potassium- containing medications or IV solutions
b. Sodium polystyrene sulfonate (Kayexalate)- cation- exchange resin (causes diarrhea) 1.Orally- dilute to make more palatable 2. Rectally- give in conjunction with sorbitol to avoid fecal impaction c. In emergency situation 1.Calcium gluconate given IV 2. Sodium bicarbonate given IV d. IV administration of regular insulin & dextrose shifts potassium into the cells e.Peritoneal or hemodialysis f. Diuretics b. |
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Causes of Hyponatremia
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-Vomiting
-Diuretics -Excessive administration of dextrose and water IVs -Burns , wound drainage -Excessive water intake -Syndrome of inappropriate antidiuretic hormone secretion (SIADH) -Elderly- kidneys unable to excrete free water |
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Signs & Symptoms of Hyponatremia
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-Nausea
-Muscle cramps -Confusion -Muscular twitching, coma -Seizures -Headache -Delirium in older adults |
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Treatment of Hyponatremia
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a. Oral administration of sodium rich foods -beef broth, tomato juice
b.IV lactated Ringer's or high concentrations of NaCl(0.9%) c. Water restriction (safer method) d. I & O e. Daily weight |
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Causes of Hypernatremia
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-Hypertonic tube feedings w/o water supplements
-Hyperventilation -Diabetes insipidus -Ingestion of OTC drugs such as Alka-Seltzer -Inhaling large amounts of saltwater (near drowning) -Inadequate water ingestion |
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Signs & Symptoms of Hypernatremia
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-Elevated temperature
-Weakness -Disorientation -Irritability & restlessness -Thirst -Dry, swollen tongue -Sticky mucous membranes -Postural hypotension w/ decreased ECF Hypertension with normal or increased ECF -Tachycardia -Elderly- mental status changes, coma |
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Treatment for Hypernatremia
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-IV administration of hypotonic solution- 0.3% NaCl or 0.45% NaCl; 5% dextrose in water
-Offer fluids at regular intervals -Decrease sodium in diet -Daily weight |
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-Hypoparathyroidism
-Pancreatitis -Renal Failure -Steroids & loop diuretics -Inadequate intake -Post-thyroid surgery |
Causes of Hypocalcemia
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-Nervous system becomes increasingly excitable
-Tetany 1.Trousseu's sign- inflate BP cuff on upper arm to 20mm Hg systolic pressure, carpal spasms w/n 2-5 minutes indicate tetany 2. Chvosteks' sign- tap facial nerve 2 cm anterior to the earlobe just below the zygomatic arch; twitching of facial muscles indicates tetany -Hyperactive reflexes -Confusion -Paresthesias -Irritability -Seizures |
Signs & Symptoms of Hypocalcemia
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-Orally-calcium gluconate or calcium chloride; administer w/ orange juice to maximize absorption
-Parenterally- calcium gluconate 1.Effect is transitory & additional doses may be necessary 2. Caution w/ digitalized patients bc both are cardiac depressants 3. Calcium may cause vessel irritation & should be administered through a long, stable IV line -Avoid infiltration bc tissue can become necrotic & slough -Administer at a slow rate to avoid high serum concentrations & cardiac depression -Seizure procautions -Maintain airway bc laryngeal stridor can occur -Safety needs due to confusion -Increase dietary intake of calcium -Calcium supplements -Regular exercise -Administer phosphate -binding antacids, calcitrol, Vitamin D |
Treatment of Hypocalcemia
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Causes of Hypercalcemia
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-Malignant neoplastic diseases
-Hyperparathyroidism -Prolonged immobilization -Excessive intake -Immobility -Excessive intake of calcium carbonate antacids |
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Signs & Symptoms of Hypercalcemia
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-Lack of coordination
-Anorexia, nausea, & vomiting -Confusion, decrease LOC -Personality Changes -Dysrhythmia. heart block, cardiac arrest |
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Treatment of Hypercalcemia
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-IV administration of 0.45% NaCl or 0.9 NaCl
-Encourage fluids -Lasix -Calcitonin- decrease calcium level -mobilizing the patient -Dietary calcium restriction -Prevent development of renal calculi 1. increase fluid intake 2. Maintain acidic urine 3. Prevent urinary tract infection -Injury prevention -Limit intake of calcium carbonate antacids -Surgical intervention may be indicated in hyperparathyroidism (cause of hypercalcemia) 1.Preoperatively- directed toward preventing dangerously high serum calcium levels 2. Postoperatively a. Observe for signs of hypocalcemia b. Due to calcium drop postop, large quantities of calcium salts may be required c. Encourage early ambulation to aid in recalcification of bones |
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-Alcoholism
-GI sunction -Diarrhea -Intestinal fistulas -Poorly controlled diabetes mellitus -Malabsorption syndrome |
Causes of Hypomagnesium
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-Increased neuromuscular irritability
-Tremors -Tetany -Hyperactive deep tendon reflexes -Seizures -Dysrhythmias especially if hypokalemia present -Disorientation -Confusion |
Signs & symptoms of Hypomagnesemia
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-Increase intake of dietary Mg- green vegges, nuts, bananas, oranges, peanut butter, chocolate
-Parenteral admin. of supplements- Magnesium Sulfate; monitor cardiac rhythms & reflexes to detect depressive effects of magnesium, keep selfinflating breathing bags , airways & oxygen a bedside in case of respiratory emergency; -Oral- longterm maintence w oral magnesium -IV- assess renal function -Monitor for digitalis toxicity -Seizure precautions -Safety measures for confusion -Test ability to swallow before PO fluids/ food bc of dysphagia |
Treatment for Hypomagnesemia
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Causes of Hypermagnesemia
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-Renal Failure
-Excessive magnesium administration (antacids, cathartics) |
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Signs & Symptoms of Hypermagnesemia
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-Depress the CNS
-Depresses cardiac impulse transmission -Cardiac arrest -Facial flushing -Muscle weakness -Absent deep tendon reflexes -Paralysis - Shallow respirations |
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Treatment of Hypermagnesemia
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-Discontinue oral & IV Mg
-Emergency 1. Support ventilation 2. IV Calcium gluconate -Hemodialysis -Monitor reflexes -Teach regarding OTC drugs containing MB -Monitor respiratory status -Monitor cardiac rhythm; have calcium preparations available to antagonize cardiac depressant |
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Causes of Asthma
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-Air pollutants
Tobacco Smoke Ozone Nitrous & sulfur oxides Fumes from cleaning fluids or solvents Burning leaves -Allergens Pollen from trees, grasses & weeds Animal Dander Household dust Mold -Chemicals & Food Drugs including aspirin, Ibuprofen & betablockers Sulfite presservatives Food & condiments inc. nuts, monosodium glutamate (MSG), SHELLFISH, & DAIRY PRODUCTS -Respiratory Infections Bacterial, fungal & viral -Stress Emotional Stress/anxiety Exercise in dry cold climates Nitrous & sulfur oxides Fumes from cleaning fluids or solvents Burning leaves |
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Signs & symptoms of Asthma
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-Coughing, wheezing , shortness of breath, CHEST TIGHTNESS, Tachypnea, TACHYCARDIA, anxiety & apprehension
-Mucosal Edema -Bronchoconstriction -Excessive mucous production |
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Asthma diagnoses are diagnoses based on symptoms & classified into one of the following four categories.
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-Mild intermittent- Symptoms occur less than twice a week.
-Mild persistent- Symptoms arise more than twice a week but not daily -Moderate persistent- Daily symptoms occur in conjunction with exacerbation twice a week -Severe persistent- Symptoms occur continually, along with frequent exacerbation that limit the clients physical activity & quality of life. |
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Drugs that treat Asthma
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-Anti-inflammatory Drugs
-Short Acting & long Acting Bronchodilators Leukotriene modifiers -Short acting adrenergic stimulants ( rapid acting bronchodilators), anticholinergic drugs & methylxanthines -MDI, DPI or Nebulizer-acute attack -Bronvhodilator by Nebulizer relieves bronchoconstrictio -Primary bronchodilators are adrenegic stimulants, methylxanthines & anticholinergic agents; these administered in combination with antiinflammatory agent- Long acting adrenergic stimulants such as inhaled salmetrol & pral albuterol are used in conjuction w antiinflammatory drugs to control the symptoms but are not appropriate to treat acute asthma attack, Inhale SABA, such as albuterol, bitolterol, pirbuterol & terbutaline ,administered by MDI or DPI are treatment of choice for quick relief |
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Causes of the FLU (Influenza)
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Caused by Influenza Virus (A,B,C)
Incubation period-18-72 hours Infects respiratory epithelium Necrosis (death of cell) & shedding of cells Increases risk for secondary bacterial infection Linked to increased risk for pneumonia Young and old Primary viral influenza pneumonia rare Bacterial pneumonia, exacerbations of COPD Reye’s syndrome- rare but potentially fatal complication of flu Neurologic disease Typically following viral infection More likely to affect children Associated with administration of aspirin products Other potential complications- of flu, while uncommon, include myositis (inflammation of skeletal muscles), myocarditis (inflammation of the heart muscle), & central nervous system disorders, such as encephalitis & Guillain- Barre syndrome. Transmitted by airborne droplet and direct contact Three strains: A, B, C New strains of flu virus are named according to the strain, geographic origin, & year the strain was identified (A/Taiwan/89) Type A influenza viruses Bi |
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Signs & symptoms of Flu (influenza)
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-Coryza-inflammation of mucous membranes lining the nose, usually associated w nasal discharge
-Cough, initially dry -Substernal burning -Sore throat -Fever & chills -Muscle aches -Malaise -Fatigue -Uncomplicated nasopharyngeal inflammation -Viral upper respiratory infection followed by bacterial infection -Viral pneumonia -Headache |
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Treatment of FLu
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-Antiviral drugs amantadine (symmetrel) or rimantadine (flumadine) may be used for prophylaxis in people who have not been vaccinated but exposed to the virus; if drug given within 48hours of exposure, it inhibits viral shedding & prevents or decreases the symptoms of influenza.
-Amantadine, rimantadine & the antiviral drugs zanamivir (relenza), oseltamivir (tamiflu) and the ribavirin (virazole) also may be used to reduce the duration & severity of the flu symotims -Aspirin, Tylenol, or NSAIDs are given for symptomatic relief -Dont give aspirin to children |
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What is atelectasis?
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The collapse of lung tissue affecting all or part of the lung, impacting the exchange of oxygen & carbon dioxide
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Causes of Pneumonia
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1-Bacteria, fungi, viruses, parasite, chemical
2-Inflammatory process that results in edema of lung tissues & etravasation of fluid into alveoli, causing hypoxia -3. Risk factors a. Community aquired pneumonia i. Older adults ii.Has not recieved pneumococcal vaccine iii.Has not recieved yearly flu vaccine iv. Chronic illness v. Exposes to viral infection or flu vi. Smokes or drinks alcohol b. Hospital acquired pneumonia i. Older adult ii. Chronic lung disease iii. Aspiration iv. Prescence of endotracheal, tracheoostomy, or nasogastric tube v. Mechanical ventilator vi. Decreased LOC vii. Immunosuppression (disease or pharmacologic etiology) c. Older adults- decreased cough effectiveness; decreased immune response; increased risk w/ decreased mobility & swallowing disorders |
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Signs & symptoms of Pneumonia
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-Fever & chills
-Leukocytosis -Cough productive of rusty colored sputum, green whitish yellow sputum ( depends on organism) -Dyspnea, accessory mucle us, upright position -Pleuritic pain -Tachycardia, crackles, sonorous wheezes, bronchial breath sounds -Elevated WBC count, sputum culture & sensitivity, blood culture & sensitivity Dyspnea -hemoptysis( bloody sputum) -Chest pain -diminished appetitie -cyanosis -Tachypnea (heartrate > 100 beats/min) -Fever over 100F -Shaking chills ( w/ bacterial pneumonia) -Hacking Cough -Anxiety & confusion |
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Medications for Pneumonia
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-Mucolytics
-Expectorants -Bronchodilators (beta 2 agonist) nebulizer or MDI -Antibiotics |
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Treatment of Pneumonia
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-Assess vital signs every 4 hours
-Cough & breathe deepl every 2 hours -Assess breath sounds & oxygen saturation -Incentive spirometer- 5-10 breaths per hour while awake -Encourage fluids to 3000ml/24h -Sunctioning as needed -Oxygen therpay -Semi-fowlers position/ bedrest -Teaching: fluid intake and stop smokong |
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Diagnostic test for Pneumonia
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-ABGs & pulse oximetry to determine need for oxygen
-Chest Xray -Sputum for culture & sensitivity testing -CBC (WBC; depressed in mycoplasmal or viral pneumonia) -Blood culture & sensitivity |
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What is pneumothorax?
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The presence of air or gas in the pleural space that causes air collapse.
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When does tension pneumothorax occur?
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It occurs when air enters the pleural space during inspiration through a one way valve & is not able to exit on expiration. The trapped air causes pressure on the heart and the lung. As a result, the increase in pressure compresses blood vessels and limits venous return, leading to a decrease in cardiac output. Death can be a result if not treated immediately.
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Risk factors of pneumothorax
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-Blunt chest trauma
-Penetrating chest wounds -Closed/ Occluded chest tube -Older Adults clients have decreased pulmonary reserves due to normal lung changes, including decreased lung elasticity and thickening alveoli -Older Adult clients are more susceptible to infection |
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Subjective Data for Pneumothorax
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-Anxiety
-Pleuritic pain |
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Objective data for Pneumothorax
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Physical assessment findings
-signs of respiratory distress (tachypnea, tachycardia, hypoxia, cyanosis, dyspnea, & use of accessory muscles) -Tracheal deviation to the unaffected side (tension pneumothorax) -Reduce or absent breath sounds on the affected side -Asymmetrical chest wall movement -Hyperresonance on percussion due to trapped air (pneumothorax) -Subcutaneous emphysema (air accumulation in subcutaneous tissue) |
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What is appendicitis?
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Inflammation of the appendix
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What causes Appendicitis?
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-Occlusion of lumen of appendix from infection, strictures or fecal masses
-Fecalith- hard mass of feces -Obstruction in the appendiceal lumen -Other obstructive causes are a calculus or stone, a foreign body, inflammation, a tumore , parasites (pinworms), edema of lymphoid tissue |
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Signs & symptoms of Appendicitis
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-Abdominal pain in the right lower quadrant (McBurney's point)
-Anorexia -Nausea & Vomiting -Diarrhea or constipation -Rigid abdomen, muscle guarding -Increased temperature -Leukosytosis (WBC 15,000-20,000 cells/mm3) -Highest incidence 10-30 y of age -Rebound tenderness on palpation -Hiccups -Distended or board like abdomen -Fever -Tachycardia |
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Nursing management of Appendicitis
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-No heating pads, enemas, or laxatives
-Maintain NPO status until blood count reports recieved -No analgesics unti cause of pain determined -Ice bag to abdomen to alleviate pain -Observe for signs and symptoms of peritonitis -Sudden abscence of pain can indicate appendix has ruptured -Surgical removal of appendix (appendectomy) |
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Medications for Appendicitis
(Antibiotics) |
-Antibiotics-
Third generation Cephalosporins -cephoperazon, (Cefobid), -cefotaxime (Claforan), -ceftazidime (Fortaz), -ceftriaxone (Rocephin) |
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For Acute Pain relief of Appendicitis
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Administer analgesics as ordered (morphine sulfate)
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Signs & Symptoms of Iron deficiency Anemia
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-Behavioral disturbances (Pica)
-Brittle, Spoon Shaped nails -Cheilosis (cracks at the corners mouth) -smooth sore tongue -Increased respiratory rate -Tachycardia -Palpitaions -Systolic murmur -Ventricular hypertrophy -Angina -Pallor- skin, mucous membranes, Conjuctiva, Nail beds -Bone pain |
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Signs & Symptoms of B12 Anemia
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-Headache
-Fainting -Forgetfullness -Anorexia -NAusea -Night cramps -Slight Jaundice -Weakness -Increased respiratory rate -Tachycardia -Palpitaions -Systolic murmur -Ventricular hypertrophy -Angina -Pallor- skin, mucous membranes, Conjuctiva, Nail beds -Bone pain |
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Signs & Symptoms of Pernicous Anemia
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-PArathesias
-Proprioception deficits -Sore beefy red tongue (Glossitis) -Diarrhea -Bc Vitamin B12 is important for neurologic function, parathesis (altered sensations, such as numbness & tingling) in the extremities & problems with proprioception (the sense of one's position in space) develop. These manifestations may progress to dificulty maintaining balance as a result in spinal cord damage. -Increased respiratory rate -Tachycardia -Palpitaions -Systolic murmur -Ventricular hypertrophy -Angina -Pallor- skin, mucous membranes, Conjuctiva, Nail beds -Bone pain |
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Signs & Symptoms of Folic Acid Anemia
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-Develops gradually
-Pallor, progressive weakness & fatigue, shortness of breath & heart palpitations -Glossitis -Cheilosis -Diarrhea -NO NEUROLOGICAL SYMPTOMS Occur / Folic acid defienciency anemia, helping differentiate from Vitamin B12 defiency anemia, but can coexist. |
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Signs & Symptoms of Hemolytic Anemia
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-Jaundice
-Splenomegaly -Bone deformity & fractures -Increased respiratory rate -Tachycardia -Palpitaions -Systolic murmur -Ventricular hypertrophy -Angina -Pallor- skin, mucous membranes, Conjuctiva, Nail beds -Bone pain |
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Signs & Symptoms of Thalassemia Anemia (Hemolytic Anemia)
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-mild to moderate anemia
-Splenomegaly -bronze skin coloring -Bone marrow hyperplasia -The major form of the disease cause Heart failure & liver & spleen enlargement, from increased red cell production |
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Signs & Symptoms of Acquired Hemolytic Anemia (Hemolytic Anemia)
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-The manifestations of acquired hemolytic anemia depend on the extent of hemolysis and the body's ability to replace destroyed red blood cells.
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Signs & Symptoms of GLucose 6 Phosphate Dehydroggenase Anemia (G6PD) (Hemolytic Anemia)
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-Hemoglobinuria (kidneys- Hemoglobin in the urine)
-When the client is exposed to a stressor that triggers G6PD anemia, symptoms develop w/in several days . THese may include pallor, jaundice, hemoglobinuria, and elevated reticulocyte count. As new RBC develop, counts return to normal |
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Signs & Symptoms of Aplastic Anemia
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Manifestaions vary w/ severity of the pancytopenia
-Petechiae -Purpura -fatigue -Pallor -progressive weakness -exertional dyspnea -headache -tachycardia -heart failure -Platelet deficienccy lead to bleeding problems, bleeding gums , excessing bruising, and nosebleeds may be initial symptoms. -A deficiency of WBC increases the risk of infecion, causing manifestaions such as sore throat & fever. |
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Causes of Iron deficiency Anemia
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-Dietary deficiencies
a. Vegetarian diet b.Inadequate protein intake -Decreased absorption a.Partial or total gastrectomy b. Chronic diarrhea c.Malabsorption syndrome -Increased metabolic requirements a. Pregnancy b.Lactation -Blood loss a.Gastrointesinal bleeding ( especially caused by ulcers or chronic aspirin use) b. Menstraul Losses -Chronic hemoglobinuria |
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Causes of B12 Anemia (Pernicious Anemia)
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-Pernicous anemia due to deficiency of intrinsic factor produced by gastric mucosa, which is necessary for absorption of B12
-Inadequate amounts of B12 consumed in diet usually vegetarians -resections of stomach or ileum, loss of pancreatic secretions & chronic gastritis |
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Causes of Folic Acid Anemia
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-Inadequate dietary intake
At risk: a. Older Adults b.Clients w. Alcoholism c.Clients recieving total parenteral nutrition -Increased metabolic requirements At risk: a.Pregnant woman b.Infants & teenagers c. Clients undergoing hemodialysis d. Clients w/ forms of hemolytic anemia -Folic acid malabsorption & impaired metabolism a. Celiac Sprue b. Chemotherapeutic agents, folate antoagonist ( methotrexate, pentamidine), or anticonvulsants c. Alcoholism |
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Causes of Hemolytic Anemia
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INTRINSIC
-Red blood cell membrane defects -Hemoglobin structure defects ( sickle cell anemia, thalassemia -Inherited enzyme defects ( glucose 6 phosphate dehydrogenase deficiency EXTRINSIC -Drugs, chemicals -Toxins and venoms -Bacterial & other infections -Trauma, burns -Mechanical damage (prosthetic heart valves) |
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Causes of Aplastic Anemia
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-Bone marrow fails to produce all 3 types of blood cells
-other cases follow stem cell damage caused by radiation, or certain chemical substances, such as benzene, arsenic, nitrogen mustard, certain antibiotics & chemotherapeutic drugs, -Occurs with viral infecions, such as mononucleoisis, hepatitis C, & HIV disease |
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Diagnostic test Anemia
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CBC
Hemoglobin & Hematocrit Hemoglobin Electrophoresis Serum Iron Serum Ferritin Iron Binding capacity Microscopic Analysis Schilling test Bone marrow examination Quantitative assay of G6PD |
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Pharmacological Therapies for Anemia
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Medications to treat anemia depend on the underlying cause. Drugs used to treat anemia
-Ferrous sulfate or other sources of iron -Folic Acid -Vitamin B12 Can be given Oral or Parenterally IV more common w acute anemia, or an anemia associated w/ chronic renal failure & other chronic conditions that increase the need for blood cell production( cancers) Risk for anaphalaxisis a major concer for IV ron dextran -Other parenteral iron solutions, including IV sodium ferric gluconate ( ferlecit) & iron sucrose (venofer) carry a much lower risk of adverse and allergic reactiond -Parenteral B12 given when malabsorption or lack of intrinsic factor leads to vitamin 12 deficiency anemia -Erythropoietin- Epoetin alfa (Epogen, Procrit)- a hemopoetic growth factor used to increase production of RBCs -Blood Transfusion for major blood loss, such as trauma, majo surgery, & sever anemia regardless of cause |
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Complimentary Therapies of Anemia
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-Plant enzymes to treat nutritional anemias
Plant enzymes are believed to aid in digestion of proteins, fats & carbohydrates, facilitating absorption of their nutrients. Therapy should not be used alone to treat anemia, & check for interactions w/ prescribed medications before starting therapy |
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Risk Factors for Cancer
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Infection
Tobacco Use Alcohol Use Recreational Drugs Obesity Sun Exposure Heredity Age Gender Poverty Stress Diet Occupation |
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Manifestations
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Cachexia -wasted appearance, weight loss-
pain, infection, depression, Restlessness, anorexia, excessive bruising, weight loss, unusual bleeding, pallor, and general weakness. Disruption of function Obstruction or pressure Hematologic alterations Impair normal function of blood cells Infection Invade, connect two organs Necrotic tissue Impaired immune response Hemorrhage Erosion through blood vessels Anemia to hypovolemic shock Anorexia-cachexia syndrome Neoplastic cells divert nutrition Pain, infection contribute to anorexia Catabolism of body’s tissues, muscle proteins Paraneoplastic syndromes are symptoms that result from chemicals secreted by tumor & the immune systems response. They may be early warning signs of cancer or indicate complications or return to malignancy. Pain- most serious complaints Acute- primary symptom that led to diagnosis tends to associate pain with introduction to their disease Chronic- Causes- Direct tumor involvement is the primary cause of the pain |
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Test for cancer
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X-ray- least expensive & least invasive( breast, lung & bone)
CT-More expensive that Xray ( renal & GI) MRI- Expensive (cranial & head & neck tumors) Ultrasound- safe & noninvasive; for specific tumors Nuclear imaging- Angiography- expensive invasive- used when location of tumor can’t be identified or needs to be seen before surgery. Direct visualization-invasive but don’t require radiography- Sigmoidoscopy, Cytoscopy, Endoscopy, Bronchoscopy Laboratory tests Pharmacologic therapies Chemotherapy- cancer treatment involving the use of cytotoxic medications to decrease tumor size, adjunctive to surgery or radiation therapy; or to prevent or treat suspected metastases. Chemotherapy has Three general purposes Cure Palliation treating symptoms for someone w/out cure Prophylaxis Pharmacologic therapies, continued Six categories Alkylating agents- Nitrogen mustards, Nitrosoureas Antimetabolites- Folic Acid antagonists, Pyrimidine analogs, Purine analogs Antitumor antibiotics- Natural produc |
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In Cancer:
1.BUN (5-25) 2.Calcitonin (Male: <40; female <20) 3.Bilirubin Total: 0.1-0.2 mg; Direct 0.0-0.3mg |
BUN (5-25) Decreased in ,malnutrition; increased in renal cancer
Calcitonin (Male: <40; female <20) Elevated to > 500 in thyroid medullary cancer, breast cancer and lung cancer Bilirubin Total: 0.1-0.2 mg; Direct 0.0-0.3mg Elevated in liver & gallbladder cancer |
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Common cause for Respiratory Alkalosis?
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Anxiety- based hyperventilation
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Causes of hyperventilation in Respiratory Alkalosis
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Physiological causes of hyperventilation, include high fever, hypoxia, anesthesia and mechanical ventilation
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Hyperventilation of Respiratory Acidosis is due to:
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Extreme Anxiety
Elevated body temperature Overventilation with mechanical ventilator Hypoxia ASPIRIN OVERDOSE Brain stem injury Fever Increased Basal Metabolic Rate |
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If patient has an Aspirin Overdose, it would be
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Metabolic Acidosis
(ealry in Respiratory Alkalosis) |
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Respiratory Alkalosis Signs & symptoms
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Dizziness
Numbness & tingling around the mouth, hands & feet Palpatations Dyspnea Chest tightness Anxiety/panic Tremors Tetany Seizures, loss of consciousness -Chvosteks sign (facial spasm, indicating hypocalcemia) -Trousseau's sign (spasm of hand & arm) |
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Respiratory Alkalosis Therapy
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-Monitor vital signs, LOC, & ABGs
-Encourage the client to breath more slowly using breathing and stress reducing techniques -Administer a sedative or antianxiety agent -Monitor ventilator settings -Administer oxygen as ordered -Maintain fluid status |
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Risk factor for Respiratory Alkalosis
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A person with an anxiety disorder
-A client critically ill on mechanical ventilation if breaths per minute or peak pressures are set too high for clients needs |
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The best treatment for suspected hyperventilation in respiratory alkalosis is to
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teach breathing exercises ,encouraging the client to take slow, regular breaths
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RespirAtory Alkalosis
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Hypocalcemia
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Narcotics overdose
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Respiratory Acidosis
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Aspirin Overdose
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Metabolic Acidosis
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Pneumothorax can cause alveolar
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hypoventilation & increased CO2 levels, resulting in a state of respiratory acidosis
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Causes of Metabolic Acidoses
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Accumulation of metabolic acids
Excess acid production- Lactic acidosis, Ketoacidosis related to diabetes, starvation or alcoholism; salicylate toxicity Loss of bicarbonate Hyperchloremic acidosis Starvation leads to acid buildup -DKA -Lactic Acidosis -Starvation -Heavy exercise -Seizure activity -Fever -Hypoxia -Aspirin OVERDOSE -Renal Failure -Diarrhea -Ileostomy -Liver Failure -Dehydration |
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Cancer
In a hospital setting, cancer is the most common cause of high blood calcium. Symptoms of high calcium can include weakness, apathy, constipation, nausea and other problems. |
High calcium in the blood is also known as hypercalcemia. Calcium is an important electrolyte, or charged mineral, for many processes in the body, especially nerve and muscle tissues function. Albumin is a protein that helps to carry calcium in the blood. Its levels need to be measured along with the calcium level in order to determine how much calcium is available to the rest of the cells. High blood calcium can cause problems for the cells and lead to fatigue, weakness, constipation, nausea, bone pain, depression and confusion.
In a hospital setting, cancer is the most common cause of high blood calcium. Symptoms of high calcium can include weakness, apathy, constipation, nausea and other problems. |
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Causes of Obesity
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Nutrients in food provide energy
Excess calories stored as fat, triglycerides Basal metabolic rate (BMR) Appetite regulated by CNS, emotions Hormones involved in regulating obesity Thyroid hormone- Insulin- body fat distribution Lepton |
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Risk Factors for Obesity
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Genetic
Psychologic Self-esteem Physiologic Physical inactivity Probably most important factor Environmental Food supply Fast food, vending Advertising Sociocultural |
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Clinical Manifestations of Obesity
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Defined by body mass index (BMI)
BMI 25–29.9 kg/m2 overweight BMI ≥ 30 kg/m2 obese Central obesity (Upper Body Obesity) Waist-to-hip ratio > 1 in men > 0.8 in women Peripheral obesity (Lower Body Obesity) Waist-to-hip ratio < 0.8 Many contributing factors Treatment ongoing Classification of overweight (25-29kg) and obesity (>30kg) Associated disease risks Therapies Diet, exercise, behavior modification Pharmacotherapy Surgery- lap band, Roux y gastric bypass, Gastric bypass |
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Risk Factors of Obesity
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Adverse consequences increase
Morbid obesity >200% of ideal body weight Risk of dying 12 times greater Significant risk factor for cardiovascular disease 60% have metabolic syndrome Affects reproductive function Increased weight increases risk for Gallstones Several types of cancer Osteoarthritis Cardiovascular disease Type 2 DM Depression Postoperative complications |
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Collaboration
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Treatment interdisciplinary- Nutritionist, Physical therapist
Focuses on reducing health risks Changing eating and exercise habits Diagnostic tests BMI divide weight (in kg) by height (in m2) Anthropometry- height, weight, bone size & skinfold – to measure Subq fat Underwater weighing- most accurate to determine body fat Bioelectrical impedance Waist circumference Other tests Thyroid profile Serum glucose Serum cholesterol Lipid profile EKG |
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Pharmalogical Therapy Obesity
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Prescription and OTC
Amphetamine (stimulant- ex: aderol), nonamphetamine appetite suppressant Phentermine Sibutramine (Meridia) Orlistat (Xenical) OTC Bulk-forming agents- inhinits fat absorption from GI tract leading to weight loss |
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Collaboration
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Exercise- Aerobic exercise 30–40 minutes 5 days each week; 10 min warm up
-Nutrition- Collaborate with nutritionist Create diet plan to create 500–1000 kcal deficit Low kcal, low fat, high in fiber Very low calorie diet for client BMI > 30 -Behavior modification- Critical component Food records Eliminating cues that precipitate eating Examine factors that affect eating behaviors Social support and group programs successful -Surgery- Bariatric surgery BMI > 40 kg/m2 Malabsorptive procedures- Bypass portion of small intestine Rapid weight loss Restrict stomach capacity limiting food intake, bypass portion of the small intestine to restrict the absorption of calories & nutrients Restrictive procedures Safer Generally less effective in long term Complications High risk of complications |
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Cause of Hyperthyroidism
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Autoimmune stimulation (Graves disease)
Excess secretion of thyroid stimulating hormone (TSH) Thyroiditis , neoplasms ( toxic multinodular goiter) Excessive intake of thyroid medications |
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Risk factors of hyperthyroidism
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Risk factors
Women are at increased risk Genetic- history of Graves disease Age (20–40) Increased iodine intake |
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MAnifestations of Hyperthyroidism
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Clinical manifestations
Increased appetite with weight loss Hypermotile bowels Heat intolerance, insomnia Palpitations Increased sweating Hair changes- becomes fine & hairloss I scalp, eyebrows, axillary & pubic areas Emotional liability |
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Graves Disease - Hyperthyroidism
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Graves’ Disease is a
Autoimmune disorder have an Enlarged thyroid gland (goiter) Manifestations of hyperthyroidism Opthalmopathy (disease of eye) Proptosis (forward displacement of the eye) Exophthalmos (forward protrusion of the eyeballs) Dermopathy of Grave’s disease (disease of the skin)- plaques & nodules develop bilaterally over the shins & dorsal surface of the feet. Other manifestations- fatigue, difficulty sleeping, hand tremors and changes in menstruation ranging from decreased flow to amenorrhea |
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Thyroiditis & Thyroid Storm
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Thyroiditis – inflammation of thyroid gland
Viral infection of the thyroid gland Symptoms: acute inflammation & effects of increased thyroid hormone Acute disorder that may become chronic resulting in a hypothyroid state as repeated infections destroy gland tissue Thyroid storm (thyroid crisis) Extreme state of hyperthyroidism Affected by people w/ Untreated hyperthyroidism or stressor (such as an infection, trauma, untreated DKA or manipulation of Thyroid Gland during surgery) Life-threatening Rapid increase in metabolic rate Rapid treatment essential- treatment includes cooling w/out aspirin (which increases free TH) or inducing shivering ; replacing fluids glucose & electrolytes; relieveing respiratory distress; stabilizing cardiovascular function & reducing TH synthesis & secretion. |
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Diagnostic Test Hyperthyroidism
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Diagnostic tests
Thyroid antibodies test- Serum TA determine thyroid autoimmune disease is causing symptoms (TA are elevated in Graves Disease) TSH test- TSH levels are compared w/ T4 levels to differentiate pituitary from thyroid dysfunction. The best indicator of primary hyperthyroidism (Graves Disease) is suppression of TSH below 0.1 mcg/ml. When the sensitivity TSH is not suppressed , the hyperthyroidism is caused by a TSH secreting pituitary tumor T4, T3- T4 & T3 elevated in hyperthyroidism & thyroiditis. T3 uptake- T3 uptake measured w/ vitro test , clients blood mixed with radioactive T3- elevated results hyperthyroidism. RAI uptake (thyroid scan)- uptake of RAI= Graves disease, & the scan reveals the size and shape of the gland Thyroid suppression test- RAI & T4 levels measured 1st. The client then takes TH for 7-10 days, after which the test are repeated. Failure f hormone therapy to suppress RAI & T4 indicate hyperthyroidism. |
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Lab findings for Hyperthyroidism
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-Serum TA (Negative to 1:20)
Findings Increased -Serum TSH (sensitve assay) (2-10mU.mL) Decreased inprimary hyperthyroidism -Serum T4 (512mcg) Increased -Serum T3 (80-200) Increased -T3 uptake (25-35) relative % Increased |
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Collaboration Hyperthyroidism
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Pharmacologic therapies
Antithyroid medications Reduce TH production Therapeutic effects in several weeks To rapidly decrease the cardiovascular symptoms assoc. w/ hyperthyroidism a beta blocker , such as propranolol (Inderal) is part of initial treatment. Radioactive iodine (RAI) therapy Thyroid gland takes up iodine RAI concentrates in thyroid Destroys thyroid cells 6–8 weeks Surgery Thyroid gland enlarged Pressure on esophagus, trachea Problems with breathing, swallowing Thyroidectomy ( removal of all or part of the gland) Remainder of gland produces adequate TH Total thyroidectomy for cancer requires lifelong hormone replacement |
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Pathophys & Cause of Hypothyroidism
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Pathophysiology and Etiology
TH production decreases Thyroid gland enlarges in attempt to produce more hormone Older clients have decrease in T4 Hypothyroid state in adults myxedema; The face of the client appears puffy , the tongue is enlarged & voice hoarse & husky. Myxedema- accumulation of nonpitting edema in the connective tissues throughout the body |
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Cause of Hypothyroidism
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Hypothyoidism may be Primary or Secondary
Primary (more common) bc Defects in gland, loss of thyroid tissue following treatment of hyperthyroidism w/ surgery & radiation, antithyroid medications, thyroiditis, endemic iodine deficiency Secondary Pituitary TSH deficiency or peripheral resistance to TH Medications can cause- Cardiac drug (amiodarone (Cardaron)), which contains Iodine could cause thyroid problems. Common in women 30–60 years |
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Risk Factors for hypothyroidism
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Women over 50 years
Close relative with autoimmune condition Thyroid surgery, radiation to neck Iodine deficiency- Iodine is necessary for synthesis of thyroid hormone. Iodine deficiency can result from goitrogenic drugs, which block TH synthesis, lithium carbonate- used for bipolar mental disorders & antithyroid drugs. Hashimoto’s thyroiditis- most common cause of goiter & primary hypothyroidism in adults & children. Antibodies destroy thyroid tissue. Compensating TH cause goiter, but as disease progresses the thyroid gland becomes smaller. |
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Manifestations of Hypothyroidism
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Pallor
Hoarseness Muscle stiffness Decreased taste, smell Menstrual disorders Anemias Cardiac enlargement Pallor Hoarseness Muscle stiffness Decreased taste, smell Menstrual disorders Anemias Cardiac enlargement Abnormalities in lipid metabolism Myxedema coma Life-threatening Severe metabolic disorder Precipitated by Trauma Infection CNS depressants Exposure to cold Failure to take medication |
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Collaboration
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Diagnostic tests
Decrease in TH TSH may be increased Pharmacologic therapies Replace TH Levothyroxine (T4)- medicaraion of choice |
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Diabetes Management Monitoring
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Fasting blood glucose (FBG): 70–110 mg/dL
Glycosylated hemoglobin (c) (A1c) Average blood glucose over 2–3 months Normal: 7–9% Urine glucose, ketones not as accurate Urine test for protein Serum cholesterol, triglyceride levels Serum electrolytes |
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S/S of Asthma
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Coughing, wheezing, shortness of breath, chest tightness, tachypnea, tachycardia
Abrupt or insidious Frequency, severity varies Anxiety and apprehension Disease monitoring Peak expiratory flow reading (PEFR) Preventive measures Avoid allergens, environmental triggers |
