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549 Cards in this Set
- Front
- Back
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DETERMINE
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Nutritional assessment:
D: disease E: eating poorly T: tooth, mouth pain E: economic hardship R: reduced social hardship M: meds I: involuntary weight loss/gain N: needs help E: elderly |
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ETOH depletes vit. ____ stores
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B
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Measuring system of the size and make-up of the body:
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athropometry data; BMI; head circumference; skin folds
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carbon, hydrogen, oxygen; least expensive; prevents ketosis
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carbohydrates
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clear fluids at room temp
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clear liquid diet
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Nutrition directly to GI
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enteral nutrition
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Na+, K+, Ca+, Ph+; needs greater than 100mg/day
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essential macrominerals
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Nutrients not made in body
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essential nutrients
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Vit. A, E, D, K
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Fat soluble vitamins
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Most concentrated energy source in the body:
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fats
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Made of carbon, hydrogen, oxygen; insoluble in blood and water, concentrated energy source:
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fats/lipids
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Diet that contains milk; plain frozen desserts, eggs, cream of wheat, creamy soups, ice cream
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full liquid diet
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vitamins, trace minerals
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micronutrients
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Body makes these; includes vitamin D and cholesterol
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non-essential nutrients
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Elements used by body for growth, development, activity, reproduction, maintaince, recovery of health:
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nutrient
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Study of food and health
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nutrition
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TPN; not thru GI tract; into a large vein
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parental nutrition
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Made of carbon, oxygen, hydrogen, nitrogen;amino acids, key of life, repair muscles
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proteins
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suctions out; use saline to flush
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salem sump
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carbs, protein, fats, minerals, vits, H2O
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Six classes of nutrients
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Modified regular diet, eliminates foods hard to digest or chew; eliminates high fiber foods; low in fiber and residue
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soft diet
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Fruit high in vitamin C:
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strawberries
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Used to prevent CHF; avoid foods high in K
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triamterene
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Vitamins that are not stored:
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water-soluble vitamins
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What plant protein contains all essential amino acids necessary to support growth?
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soy
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Deficiency results in negative nitrogen balance in the body:
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protein
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TPN; not thru GI tract; into a large vein
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parental nutrition
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Made of carbon, oxygen, hydrogen, nitrogen;amino acids, key of life, repair muscles
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proteins
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suctions out; use saline to flush
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salem sump
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carbs, protein, fats, minerals, vits, H2O
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Six classes of nutrients
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Modified regular diet, eliminates foods hard to digest or chew; eliniates high fiber foods; low in fiber and residue
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soft diet
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Action of nitrogen is to build up body tissue:
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protein
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Deficiency results in xerophthalmia (night vision):
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vitamin A
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Action of vitamin effects development of teeth and bones:
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vitamin A
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Deficiency can increase hemolysis, or destruction of RBC's, macrocytic anemia in premature infants:
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Vitamin E
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Action is that is synthesizes (heme), or builds up RBC's:
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Vitamin E
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Deficiency contributes to prolonged clotting/bleeding times in adults & hemorrhagic diseaes in newborns:
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Vitamin K
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Action: Forms prothrombin in the blood and aids blood clotting:
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Vit K
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Deficiency leads to bleeding gums, bruising, scurvy & wounds that do not heal. Infant's growth retardation, diarrhea, vmiting, cry when they are picked up:
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Vit C
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Action: Builds strong capillary walls & RBC's and aids in the metabolism of amino acids and wound healing:
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vit C
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Deficiency: Beriberi develops (disease that affects the cardiac and nervous system, especially peripheral nerves. Infants - pallor, facial edema, & irritability. Mental confusion, muscle weakness & tachycardia, enlarged heart & cardiac failure:
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Vit B1 (Thiamine)
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Action: For nerves, muscles and heart:
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Vit B1 (Thiamine)
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Deficiency manifests itself in anemia, cracks at corners of mouth and other skin lesions:
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Vit B6 (pyridoxine)
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Action: Necessary for healthy blood & nerve cells. It stimulates production of heme:
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Vit B6 (pyridoxine)
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Deficiency: Macrocytic anemia (pregnant women). Results in neural tube defects in children, causing spinal deformities:
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Folic acid
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Action: Maturation of RBC's:
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Folic acid
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Deficiency results in Pellagra - anorexia & general weakness if mild; neurological & gastrointesinal disorders & skin eruptions if severe:
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Niacin
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Action: Synthesizes fat and contributes to the utilization of protein:
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Niacin
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Excessive levels lead to abnormal fetal develpment:
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Vit. A
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Excessive levels lead to increased levels of calcium:
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Vit. D
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Action: hyperbilirubinemia - increase Vit. K in infants:
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Vit. D
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Excessive amounts: Hypocalcemia - muscle cramping & spasms of toes or thumb; tetany - involuntary muscle spasms, is a SE. Children - stunt growth. Older person - bone loss:
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Calcium
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Facilitates the body's nerve impulse transmission, cardiac function, muscle contraction & formation of bones. Increases carciac irregularities:
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Calcium
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Excessive amounts leads to confusion, irritability of nervous system when low:
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Magnesium
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Action: Electrical activity in nerves and muscles:
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Magnesium
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Excessive amounts lead to confusion, slow pulse, muscle weakness and low output:
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potassium
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Action: Cardiac impulse transmission and muscle contraction:
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Potassium
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Low amounts leads to low BP, weakness, decrease LOC, muscle twitching, N/V, abd. cramps:
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Sodium
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Excessive amounts leads to swelling, SO , thirst, restlessness:
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Sodium
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Action: Maintenance of acid base and fluid balance:
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Sodium
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Low amounts leads to poor dental health:
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Fluoride
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Excessive amounts leads to discoloration of tooth enamel:
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Fluoride
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Low amounts leads to Cretinism in infants and hypothyroidism in adults:
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iron
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Excessive amounts leads to goiters and is toxic:
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iron
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Low amounts lead to impaired wound healing and skin lesions. Also a decreased sense of smell and taste:
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zinc
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Action: connective tissue, like skin:
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zinc
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Low level indicates:
Iron deficiency anemia or fluid retention: |
Hgb
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High level indicates: dehydration
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Hgb
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Low level indicates increase fluid, anemia, protein-calorie malnutrition:
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Hct
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High level indicates dehydration:
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Hct
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Low level indicates depressed immune system:
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lymphoyte
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Low level indicates protein-calorie malnutrition
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albumin (protein levels)
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Low levels indicate malnutrition
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cholesterol
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Low levels indicate insufficient protein intake:
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BUN
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High levels indicate too much protein:
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BUN
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P=regulate blood pressure
V=regulate blood volue C=controle composition of blood PVC |
3 basic homeostatic mechanisms of the urinary system
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1. routine/random
2. clean catch midstream 3. sterile |
3 types of urine sample
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The amount of urine a body should produce every 24 hours
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30 ml ?
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Hormone secreted by the anterior pituitary gland to tell the kidneys to reabsorb more H2O:
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ADH (anti-diuretic hormone)
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Administer slowly; retain solution for 5-10 minutes for cleansing, 30 minutes for a retention:
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enema
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Age child should have full urinary control of their bladder
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3-4 years
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An adult receiving a cleansing enema should receive how much fluid
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1000 ml
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absence of urine; <100mL/day
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Anuria
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Stop the flow for a few minutes when the client complains of cramping
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Appropriate in the administration of an enema
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Basic unit of the renal system is the
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nephron
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Blood in the urine is called
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hematuria
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Blood tests for renal funcitons are used to evaluate:
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how well the kidneys are working
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Diet high in fiber, fluid intake 2500-3000ml day, increases exercise, provide privacy- management of
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Bowel training program
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Capacity of bladder:
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600ml
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Given to expel flatus:
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Carminative enema
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Drugs that induce defecation
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Cathartics
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Certain types of fluids such as alcohol increase fluid output by inhibiting the production of
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anti-diurietic hormone
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Caffeine products such as coffee, tea & cola drinks also increase
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urine production
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CCMS checks for
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bacteria
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Cleaning around the urethral orifice regularly helps prevent
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infection
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Given primarily to prevent escape of feces during surgery, prepares intesting for diagnostic testing, or to remove fecal impactions:
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cleansing enema
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Will weaken the bowels natural responses, resulting in chronic constipation:
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continual use of laxatives
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Lower UTI; inflammation of bladder; more common in women or ppl with diabetes
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Cystitis
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Inflammation of the urinary bladder
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cystitis
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Endoscopic test; used for biopsy, removal of calculi, measures bladder capacity, stent placement top complications are 1) infection 2) perforation 3) hematuria
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cystoscopy
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Insufficient ADH; a lot of urination
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Diabetes insipidus
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Blood BUN (blood, urea, nitrogen), creatinine level, electrolytes (salt & potassium) and radiologic:
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diagnositc tests for urinary systems
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Encourage fluids, bland foods, increase foods with soluble fiber, oatmeal, skinless fruits, and potatoes:
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diarrhea
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Difficult painful voiding is called
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Dysuria
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Discomfort in the pubic area and either an inability to void or frequent voiding of small volumes are clinical signs of
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retention
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Diseases of the kidney may affect the ability of the nephrons to produce
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urine
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Abnormal amounts of protein or blood cells may be present in the urine or kidneys may stop producing urine altogether, a condition known as
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renal failure
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Producing a lot of fluid
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diuresis
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Increases urine formation by preventing the absorption of water and electrolytes from the tubules of the kidney into the bloodstream. Commonly prescribed for hypertension and cardiac disease:
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Diuretics
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Painful or difficulty voiding
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Dysuria
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Solution introduced into the rectum and large intestine to distend the intestine and irritate the intestinal mucosa:
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Enema
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Involuntary urination in children beyond the age when voluntary control is normal; causes - family hx of , difficult access to toilet facilities or home stresses:
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enuresis
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Secreted by kidneys to stimulate RBC production when hypoxia is sensed:
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Erythropoietin
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Sphincter normally under voluntary control:
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External sphincter
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Disease, age meds, foods, social/cultural factors, surgery, social/cultural issues:
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factors affecting urination
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Fetus begins to excrete urine between __________ weeks of development.
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11th and 12th
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Fluids and foods high in sodium can cause fluid retention as water is _______ to maintain the normal concentration of electrolytes.
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retained
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Voiding at frequent intervals; more often than normal.
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frequency
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These will cause the colonic movement to cease or slow down by blocking parasympathetic stimulation to the muscles of the colon:
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general anesththetics
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Inflammation of kidney; more frequent in children who have had a recent case of strep throat; MOST COMMON KIDNEY DISEASE
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glomerulonephritis
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This is important to maintain the stretch and contractibility of the detrusor muscle so the bladder can fill adeqately and empty completely:
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good muscle tone
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Assists in the bladder emptying
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abdominal muscle contraction
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Greatest hazard when insufficient water is taken with bulk-producing laxatives containing fibers, seeds, granules is that the drug may
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obstruct the esophagus
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During this, the container is held high above the rectum no higher than 18"
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high enema
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How long are the large intestine in an adult?
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125-150cm (50-60 in)
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How much fluid does a normal adult require in 24 hours?
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2600
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H2O accumulates in kidney; urine flow is obstructed and backs up into the kidney; can happen during pregnancy:
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hydronephritis
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Solutions used in disposable enemas are
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Hypertonic
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Fleets enema are what type of solution?
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hypertonic
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Fleets enema adverse effect
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retention of sodium
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Tap water is what type of solution?
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hypotonic
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Tap water enema lowers osmotic pressure could have fluid and electrolyte
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imbalance
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If a client is put onto a cold bedpan, the client will not defecate because the ________ sphincter muscle contracts.
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External
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Involunary, unpredictable passage of urine
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functional incontinence
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Impaired neurologic function can interfere with the normal mechanisms of urine
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neurogenic bladder
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Involuntary loss of urine occurring at somewhat predictable interval when a specific bladder
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reflex incontinence
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One experiences a loss of urine of less than 50 ml occurring with increased abd. pressure ex: sneezing, coughing, laughing, lifing
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stress incontinence
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State of which one experiences a continuous and unpredictable loss of urine
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total incontinence
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Involuntary passage of urine occurring soon after a strong sense of urgency to void
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urge incontinence
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Increase in this means urine is more concentrated which may indicate fluid deficit/dehydration, excess solutes such as glucose in the urine
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increased specific gravity
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Measures accurate urinary output for critically ill patients
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indwelling cath
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Irrigating a Foley with NS helps prevent
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drainage obstruction
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IV radio-opaque dye and series of x-rays
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intravenous pylogram
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Caused by dehydration, infection, diet, urinary stasis
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kidney stones/calculi
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Kidneys double in size between ages
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5 and 10
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Kidneys reach maturity between
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1st and 2nd year of life
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Kidneys, ureters, bladder x-ray
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KUB
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Solution no higher than 12" above the rectum:
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low enema
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Monitor fluid intake, positioning head of bed elevated to Fowlers position:
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measures to promote normal voiding habits
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Anticholinergic, antispasmodics, atropine, belladonna, antidepressants, antipsychotics, antihistamines, antihypertensives:
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Medications that cause urinary retention
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Impared neurologic funciton can interfere with the normal mechanisms of urine elimination
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neurogenic bladder
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Voiding 2 or more times at night
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Nocturia
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Introduces oil into the rectum and sigmoid colon, softens feces and to lubricate the rectum
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Oil retention enema
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Constipation is a big problem and need to increase water and fiber in diet; kidney function diminishes, nephrons decrease impairing filter abilities
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older adults
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Low amount of urine: 100-400ml/day
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oliguria
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Usually lasts 24-48 hours and is caused by direct handling of the intestines which temporarily ceases the intestinal movement:
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Paralytic ileus
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hereditary fluid filled sacs/cysts; treatement includes controlling BP
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Polycystic kidney
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Kidney function reaches maturity between
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1st and 2nd year
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Are able to hold urine beyone the urge to void
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18-24 months
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A = amount
C = clarity C = color C= concentration O= odor P= pH S=STERILE G=glucose K= ketone P=protein |
A= 1 1/2 - 2 l/day
C= clear C= straw, yellow, amber C= 1.005 - 1.030 O= slightly aromatic P= 4.8-8 (6 is normal) S= STERILE G= no K=no P=no |
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Pt.s who have nausea, cramps, colic, vomiting, or undiagnosed abdominal pain are not recommended to use
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cathartics
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Bacterial infection that can either start in the bladder and work up or can enter thru the bloodstream:
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pylonephritis
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Length of the average adult rectum:
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10-15 cm (4-6 in)
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Limit carbonated beverages, chewing gum, drinking with straws, cabbage, beans, and onions:
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reduce flatulence
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Involuntary loss of urine occurring at somewhat predictable intervals when a specific bladder volume is reached:
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Reflex
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Catheter inserted to femoral artery and ran to renal artery; successive x-rays are taken; assess blood flow to distant too insertion site after procedure and apply pressure to site; diagnostic test to measure profusion of kidneys:
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Renal arteriogram
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Used to detect renal disease, malignancy and trasnplant status; percutaneous--aided by US thru skin; incisional--surgical incision
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renal biopsy
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Secreated by kidneys when BP is too low to increase vasoconstriction and reaise BP
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renin
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Uses cystoscopy to complete an IVP; Dr. puts catheters into ureters and injects dye to assess kidney and ureter funciton
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retro-grade pylogram
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Serious consequence for the client whose urinary output falls below _____ ml/hr - damage to kidneys:
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10
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Voiding small amount frequently, bladder retention, restlessness, NOT hematuria:
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signs of urinary retention
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Specific gravity of urine is 1.035 means
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the urine is concentrated
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Spinal cord injuries and head injuries can decrease the sensory stimulation for
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defecation
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The adult urinary bladder holds __________ of urine before the micturation reflex is initiated.
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250-450 ml
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Toddlers have some control of defecation at age
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11.5 -12 months
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Urge to void when bladder has
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150-200 ml
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Urinary output ___________ a day necessary
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1200-1500
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Emptying bladder is impaired the urine accumulates and the bladder becomes distended
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urinary retention
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Respiratory rate by late adolescence:
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12-18
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A decrease in arterial oxygen concetrations stimujlate chemoreceptors. the chemoreceptors stimulate the respiratory dcenter to increase
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ventilation.
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Hydrogen, oxygen and carbon dioxide can trigger the
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chemoreceptors.
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Increase _____ concentration normally stimulates respiratoins most strongly.
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CO2
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A specimen from the oropharynx is used for a
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throat culture
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A blood volume expander which provides plasma protein:
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albumin
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Increased HR, RR and systolic BP
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Early sign of hypoxia
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Acid fast bacillus AFB serial collection 3 days identifying presence of
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TB
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Agents that decrease the intensity and frquency of coughing episodes:
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Antitussives
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Prolonged gasping inspiration followed by a very short usually inefficient expiration:
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Apneustics
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Done to evaluate acid base balance, oxygenation, measure pH, PAO2, HcO3, BE SAO2
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arterial blood sample
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Shallow breaths interrupted by apnea
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Biot's
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Included in this: hemoglobin, hemaocrit, erythrocytes count, leukocyte, and differential white cell count:
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CBC
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Check for return of the ________ when pt. is post bronchoscopy:
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gag reflux
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Very shallow breathing and temporary apnea. Common cause include: CHF, incrase intracranial pressure, or drug OD:
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Cheyne stokes
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Childhood resp
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25 per minute
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Chilling will cause ___ O2 demand
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increased
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S/S
Fatigue, lethargic, clubbed fingers and toes |
chronic hypoxia
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Used for pts with clotting factor deficiencies:
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Clotting factors and cryoprecipitate
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Coughing, sneezing and intrapleural pressure al laid in the patency of the
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respiratory tract
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A canopy placed over the frame of the bed that delivers oxygen with a cooling mechanism:
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croup tent
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Lab test to identify a specific organism and drug sensitivity
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culture and sensitivity
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Lab test to identify origin, structure, function, and pathology of cells; three early morning specimens identify cancer in lungs and specific cell types:
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cytology
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Decrease body temp decreases _________ rate.
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respiratory
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A diet deficient in iron or folic acid causes _______ and ______ that are not formed adequately.
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hemoglobin and RBCs
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Exchange of oxygen and CO2 in the alveoli:
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Diffusion
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Do not smoke when using
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bronchodilators
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Muscular skeletal changes in teh chest wall reduce the size in the chest which makes the elderly inhale smaller volumes of
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air
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This medication causes the heart to contract more forcefully, bronchioles dilate, increase in blood flow and O2 delivery to active muscles:
|
epinephrine
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These increase in the blood when the hematrocrit increases:
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erythrocytes (RBCs)
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Factor that affects the rate of O2 transport from the lungs to the tissues:
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exercise
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This increases metabolism which increases rate and depth of respirations:
|
exercise
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Delivers 40-60% O2 concetration at 5-8L/m
|
face mask
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Delivers 30-50% O2 at 4-8L/m for those who poorly tolerate a mask:
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face tent
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Measure oxygen in the number of liter per minute:
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flow meters
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As fluid filled lungs drain, pco2 incresaes and neonates take
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1st breath
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% of blood that is erythrocytes
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hematrocrit
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Necessary for the transportation of O2 to the cells
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hemoglobin
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O2 carrying red pigment
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hemoglobin
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a. ___________ increase repiratory rate and depth.
b. ____ increases rate and depth of breating. c. ______ reduces need for oxygen |
a. high altitudes
b. heat c. cold |
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CO2 accumulates in the blood as with hyperventilation
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Hypercarbia
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Can cause hypoxia:
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hypoventilation
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Inadequate alveolar ventilatoin CO2 retained in the blood stream, occurs as a result of collapse of the alveoli
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hypoventilation
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Reduced oxygen in the blood and is characterized by low partial pressure of oxygen in arterial blood or a llow hemoglobin saturation
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hypoxemia
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Improves pulmonary ventilation, loosens respiratory secretions, facilitates respiratory gaseous exchange, expands collapsed alveoli, measures flow of air inhaled through mouthpiece, offers an incentive to improve inhalation
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incentive spirometer
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Increased body temp ______ respiratory rate
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increases
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Increasing the intake of ____ and ___ will promote oxygen transport and absorption.
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protein and iron
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In infants, lungs gradually expand with each breath reaching full inflation by ___ weeks, respriatory rate hight __________ per minutes, rates greadually decrease with age.
|
2
40-80 |
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Hyperventilation deep and rapid breathing:
|
Kussmaul's
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Stridor, harsh high pitched sound (may be heart upon inspiration), restlessness, dyspnea, abnormal breath sounds:
|
lower airway
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|
|
The expandability or stretchability of lung tissue, necessary for normal inspiration:
|
lung compliance
|
|
|
Continual tendency of the lungs to collapse
|
lung recoil
|
|
|
Records emissions from radio isotope albumin injected intravenously as it circulates through the lung:
|
lung scan
|
|
|
The control center for rate and depth of respirations:
|
MEDULLA
|
|
|
Type of acidosis that will cause Kussmaul's breathing:
|
Metabolic acidosis
|
|
|
Low concentration 24-45% 2-6L/m
|
NC
|
|
|
Chemical that increases the heart rate, BP, peripheral vascular resistance, increasing the hearts workload, causes vasoconstriction; where vessels already are narrowed by atherosclerosis, tissue oxygenation can be impaired:
|
nicotine
|
|
|
Delivers highest O2 concentration 95-100% 10-15L/m
|
NRB
|
|
|
Catecholamine that increases BP causing vasoconstriction:
|
norepinephrine
|
|
|
Normal hematocrit in
men: women: |
Men: 40-54
Women: 37-47 |
|
|
Oxygen saturation below _____ is life-threatening.
|
70%
|
|
|
Risk factor for impaired blood to the tissues and for impaired oxygenation:
|
obesity
|
|
|
In older adults, the chest wall becomes more ___ and less ______.
|
Rigid and elastic
|
|
|
Delivers 60-90% O2 at 6-10L/m reservoir bag attached allows client to rebreathe about first 3rd of exhaled air
|
partial rebreather mask
|
|
|
Clapping; forceful striking with cupped hands over lung bases. This can mechanically dislodge tenacious secretions;
|
percussion
|
|
|
Type of breathing that creates a resistance to the air flowing out of the lungs, prolonging exhalation and preventing airway collapse by maintaining positive airway pressure:
|
Pursed lip breathing
|
|
|
1 unit RBCs increases hematocrit by ____%
|
4
|
|
|
Surfactant is a
|
lipoprotein
|
|
|
Volume of air inspired and expired is
|
tidal volume
|
|
|
Low pitched snoring sound during inhalation is a sign of
|
uper airway obstruction
|
|
|
Delivers 24-40-50% O2 @ 4-10L/m
|
venturi mask
|
|
|
-relativel high pitched and loud
-equal and a length -the neck over and the trachea |
tracheal breath sound
|
|
|
-major normal breath sound
-heard over most of the lungs -soft and low-pitched -inspiratory longer than expiratory sounds -may b eharsher and slightly longer if there is rapid deep ventilation (eg post-exercise) or in children who have thinner chest walls. As well, vesicular breath sounds may be softer if the patient is frail, elderly, obese, or very muscular |
Vesicular Breath Sounds
|
|
|
-very loud, high-pitched and sound close to the stethoscope
-gap between the inspiratory and expiratory phases of repiration -expiratory sounds arelonger than the inspiratory sounds. If these sounds are heard anywhere other htan over the manubrium, it is usually an indication that an area of consolidation exists (ie space that usually contains air now contains fluid or solid lung tissue). |
Bronchial Breath Sound
|
|
|
-intermediate intensity and pitch
-equal in length -best heard in teh 1st and 2nd ICS (anterior chdest) and between the scapulae (poster chest) - ie over the mainstem bronchi. -As wieh bronchial sounds, when these are heard anywhere other than over the mainstem bronchi, they usually indicate an area of consolidation. |
Bronovesicular Breath Sound
|
|
|
Normal value:
Sodium |
1.35-1.45 mEq
|
|
|
Normal value:
potassium |
3.5-5.0 mEq
|
|
|
Normal value:
calcium |
4.5-5.5 mEq
|
|
|
Normal value:
magnesium |
1.5-2.5 mEq
|
|
|
Normal value:
phosphate |
1.8-2.6 mEq
|
|
|
Normal value:
serum osmolarity |
280-300mosm/kgh2o
|
|
|
Normal value:
urine pH |
4.6-8.0
|
|
|
Normal value:
urine specific gravity |
1.005-1.030
|
|
|
Normal value:
pH |
7.35-7.45
|
|
|
Normal value:
Sodium |
1.35-1.45 mEq
|
|
|
Normal value:
potassium |
3.5-5.0 mEq
|
|
|
Normal value:
calcium |
4.5-5.5 mEq
|
|
|
Normal value:
magnesium |
1.5-2.5 mEq
|
|
|
Normal value:
pao2 |
80-100mmhg
|
|
|
Normal value:
paco2 |
35-45mmhg
|
|
|
Normal value:
hco3 |
22-26meq/l
|
|
|
Normal value:
base excess |
-2 to +2 mEq/l
|
|
|
Normal value:
O2 sat |
95-98%
|
|
|
% of body weight = H2O
full term newborn |
70-80%
|
|
|
% of body weight = H2O
1 year |
52-60%
|
|
|
% of body weight = H20
puberty to 39 |
52-60%
|
|
|
% of body weight = H2O
40-60 years |
47-55%
|
|
|
% of body weight = H2O
over 60 |
46-52%
|
|
|
Average Daily Fluid Requirements:
3 days 3.0kg |
250-300 mL/24hr
|
|
|
Average Daily Fluid Requirements:
1 yr 9.5kg |
1150-1300 mL/24hr
|
|
|
Average Daily Fluid Requirements:
2 yr 11.8kg |
1800-2000 mL/24hr
|
|
|
Average Daily Fluid Requirements:
6 yr 20.0kg |
1800-2000 mL/24hr
|
|
|
Average Daily Fluid Requirements:
10 yrs 28.7kg |
2000-2500 mL/24hr
|
|
|
Average Daily Fluid Requirements:
14 yrs 45.0 kg |
2200 - 2700 mL/24hr
|
|
|
Average Daily Fluid Requirements:
18 yrs 45.o kg |
2200-2700 mL/24hr
|
|
|
Assess skin (color, temp, moisture, turgor, edema), mucous membranes (color, moisture), eyes (firmness), fontanels (firmness), cardiovascular system (HR, peripheral pulses, BP, cap refill), neurologic (LOC, orientation, motor function, reflexes) when monitoring for
|
fluid and electrolyte imbalance
|
|
|
Dehydration in children:
Weight Loss: Mild dehydration: Moderate dehydration: Severe dehydration: |
Mild: 5%
Moderate; 5-9% Severe: 10-15% |
|
|
Skin: grey, cold to touch, poor skin turgor
Mucous membranes: dry oral buccal mucosa, salivation absent Eyes: sunken eyeballs, absence of tearing when crying Anterior fontanel (infant): sunken Shock: increase pulse, increase respirations, decrease BP Urine: oliguria, increase specific gravity, ammonia odor Alterations in consciousness:irritability, lethargy, stupor, coma poss., seizures, metabolic acidosis or alkalosis |
S/S dehydration in children
|
|
|
Extracellular most abundant cation; controls and regulates water balance:
|
sodium Na+
|
|
|
Intracellular major cation in intracelluar fluids; vital electrolyte for skeletal, cardiac and smooth muscle activity, also acid base balance:
|
potassium K+
|
|
|
Cation mostly found in skeletal system:
|
Ca2+
calcium |
|
|
Cation found mostly in skeleton, intracellular fluid, neuromuscular, cardiac function:
|
magnesium
Mg2+ |
|
|
Carried nutrients to and from the the cells; fluid found outside the cells accounts for 1/3 of total body fluid:
|
extracellular fluid
|
|
|
Intravascular extracellular fluid
|
plasma
|
|
|
interstitial extracellular fluid
|
lymph
|
|
|
transcellular fluid
|
cerebrospinal, pleural peritoneal, synovial fluids
|
|
|
Average fluid output:
|
1400-1500ml
|
|
|
Average fluid output/hr
|
30-50ml
|
|
|
The movement of the bone away from the midline of the body:
|
abduction
|
|
|
Evaluates pts. acid-base balance and oxygenation; composed of pH, PaO2, PaCO2, OCO3, base excess, O2 sat:
|
ABGs
|
|
|
Substances combine with a carrier on the outside surface of the cell membrane and they move to the inside surface of the cell membrane:
|
active transport
|
|
|
The movement of bone toward the midline of the body:
|
adduction
|
|
|
Substance produced in the posterior pituitary gland and is a major controller of fluid balance:
|
ADH
|
|
|
System that promotes sodium and water retention in the distal nephron:
|
Aldosterone
|
|
|
Edema that is generalized throughout the body as a result of over loading of vascular fluid compartment; a generalized edema throughout the body:
|
anasarca
|
|
|
Ion that carries a charge; chloride, HCO3 (bicarbonate), HPO4 (phosphate), SO4 (sulfate):
|
anions
|
|
|
These can cause metabolic alkalosis with N/V and convulsions:
|
antacids
|
|
|
Regulates water excretion from the kidney, located in hypothalamus:
|
ADH
anti-diuretic hormone |
|
|
Accumulation of fluid in the abdominal cavity:
|
ascites
|
|
|
Released from cells in the atrium of the heart in response to excess blood volume and stretching of atrial walls; acts as a diuretic; inhibits thirst, reducing fluid intake:
|
Atrial natriuretic factor (ANF)
|
|
|
Forms bones bones and teeth, transmitting nerve impulses, regulating muscle contractions, maintaining cardiac pacemaker, blood clotting activating enzymes:
|
calcium
|
|
|
-hypoparathyoidism
-acute pancreatitis -hyperphosphatemia -thyroid carcinoma -inadequate Vit D intake -malabsorption -alkalosis -sepsis -alcohol abuse |
S/S hypocalcemia
|
|
|
-Paget's disease
-malignancy of bone |
S/S hypercalcemia
|
|
|
Ions that carry equal charges; NA+, K+, Ca2+, Mg2+
|
cations
|
|
|
Inserted for long term IV therapy, parenteral nutrition, for chemical damaging to the veins; assess for SOB, CP, cough, hypotension, tachycardia and anxiety:
|
central lines
|
|
|
Daily weights provide adequate assessment of
|
fluid status
|
|
|
-hyperosmolar imbalance
-water lost from body without significant loss of electrolytes occurs in older patients because of decreased thirst sensation -prolonged fever -diabetic ketoacidosis -those receiving enteral feedings with insufficient water |
S/S dehydration
|
|
|
Continual intermingling of molecules in liquids, gases or solids brought about by the random movement of molecules; movement of particles from an area of greater concentration to an area of lower concentration
|
diffusion
|
|
|
Do not administer hypotonic fluids to pts with _____________ or ____________disease and watch for hypovolemia.
|
kidney
heart disease |
|
|
Fluid volume excess intravascular and interstitial spaces have an increased water and sodium content; when the body starts to utilize the stored protein due to poor nutritional intake:
|
edema
|
|
|
Have an altered thirst response which can alter the fluid and electrolyte balance
|
Elderly
|
|
|
Contain various amounts of cations and anions:
|
electrolyte solutions
|
|
|
Charged particles capable of conducting electricity:
|
electrolytes
|
|
|
Depends on the informational input from the labyrinth (inner ear), vision and from stretch receptors of muscles and tendons:
|
equilibrium
|
|
|
Fluid in the interstitial space; accounts for 1/3 total body fluid:
|
ECF
|
|
|
Process whereby fluid and solutes move together across a membrane from one compartment to another, moves from high pressure to low pressure:
|
filtration
|
|
|
Body retains both water and sodium (hypovolemia) caused by excessive sodium chloride intake, administering infusions too fast, disease process that alters the regulatory mechanisms (eg: CHF, renal failure, cirrhosis of liver, Cushing's syndrome):
|
fluid volume excess
|
|
|
1. body alignment (posture)
2. joint mobility 3. balance (stability) 4. coordinated movement |
four basic elements of normal body movement
|
|
|
Body loses both water and electrolytes from the ECF
|
Fluid Volume Deficit (FVD)
|
|
|
Produced by the body in response to a specific antigen called an antibody:
|
globulin
|
|
|
Measures % of whole blood composed of RBCs; increase with severe dehydration; decrease with severe over hydration; norm in males 40-50% and females 37-47%:
|
hematocrit
|
|
|
Major component of EBCs; increases with dehydration:
|
hemoglobin
|
|
|
Homeostatic mechanisms that regulate the body fluids:
1. 2. 3. 4. 5. 6. |
1. kidneys
2. endocrine system 3. cardiovascular system 4. lungs, 5. GI 6. hormone |
|
|
Body's measurement of acidity and alkalinity:
|
hydrogen ion concentration
|
|
|
The pressure exerted by fluid within a closed system of the walls of a container in which it is contained:
|
hydrostatic pressure
|
|
|
S/S include:
acidosis weakness and lethagry risk for dysrhythmias coma |
hypercholoremia
|
|
|
S/S include:
lethargy weakness anorexia N/V constipation polyuria dysrhythmias |
hypercalcemia
|
|
|
S/S include:
GI hyperactivity diarrhea irritability apathy confusion muscle weakness |
hyperkalemia
|
|
|
S/S include:
N/V muscle weakness paralysis decrease BP bradycardia |
hypermagnesium
|
|
|
S/S include:
thirst tongue red, dry, swollen weakness fatigue decrease in LOC disorientation convulsions |
hypernatremia
|
|
|
S/S include:
tingling around the mouth, fingertips muscle spasms tetany |
hyperphosphatemia
|
|
|
D5NS
D51/2NS D5LR |
hypertonic solutions
|
|
|
Higher osmolarity than bodyfluids eg: 3% sodium chloride
|
Hypertonic solutions
|
|
|
TPN is what type of solution?
|
Hypertonic
|
|
|
Body retains both water and sodium:
|
hypervolemia
|
|
|
S/S include:
numbness and tingling in extremities cramps |
hypocalcemia
|
|
|
S/S include:
Excess loss of Ca2+ through the GI tract, kidneys or sweating |
hypochloremia
|
|
|
S/S include:
muscle weakness leg cramps fatigue lethargy anorexia N/V decreased bowel sounds cardiac dysrhythmia ABs may show alkalosis |
hypokalemia
|
|
|
S/S includes:
chronic alcoholism renal failure adrenal insufficiency neuromuscular irritability positive Chvostek and Trousseau's sign |
hypomagnesium
|
|
|
S/S include:
lethargy confusion apprehension muscle twitching abdominal cramps anorexia vomiting nausea HA |
hyponatremia
|
|
|
S/S include:
muscles weakness pain mental changes possible seizures |
Hypophosphatemia
|
|
|
What type of solutions are
1/2NS 1/3NS |
hypotonic
|
|
|
Lower osmolarity than body fluids eg: 0.45% sodium chloride
|
hypotonic
|
|
|
Fluid lost from the intravascular compartment:
|
hypovolemia
|
|
|
Hypovolemia patients should be on what type of diet:
|
low sodium
|
|
|
Infants and growing children have a greater fluid turnover due to increase __________ rate which can affect fluid and electrolyte balance.
|
metabolic
|
|
|
_____________ is swelling, coolness, pallor and discomfort at the site.
|
infiltration
|
|
|
Perspiration looses 300-400 ml per day
Exhaled air looses 300-400 ml/day Feces looses 100 ml |
insensible losses
|
|
|
Fluid that surrounds cells and includes lymph:
|
interstitial
|
|
|
Fluid within all of body; 2/3 of total body fluid; contains O2, dissolved nutrients, excretory products of metabolism (such as carbon dioxide and charged particles called ions):
|
intracellular fluid
|
|
|
Contains solutes, O2, electrolytes and glucose; provides medium which metabolic process of cells takes place:
|
intracellular fluid
|
|
|
Largest fluid compartment in an adult:
|
Intracellular
|
|
|
Found within vascular system; plasma
|
intravascular
|
|
|
Involves muscle contraction or tension against resistance:
|
isokinetic
|
|
|
Static or setting; there is a change in muscle tension but no change in muscle length and no muscle or joint movement (cast, traction):
|
isometric
|
|
|
Dynamic - muscle shortens to produce muscle contraction and active movement
|
isotonic
|
|
|
Same osmolarity as body fluids eg: NS
|
isotonic
|
|
|
Includes:
NS LR (treats metabolic acidosis) 5% dextrose in water D5W |
isotonic solutions
|
|
|
Excessive loss from GI tract; can be caused from long term diuretic use, chronic alcohol abuse, pancreatitis, burns:
|
hypomagnesium
|
|
|
Can be caused from abnormal retention of, renal failure, adrenal insufficient
|
hypermagnesium
|
|
|
Regulates cardiac functions, transmits nerve impulses, relaxes muscle contractions, intracellular metabolism:
|
magnesium
|
|
|
This acidosis can be caused by severe diarrhea:
|
metabolic
|
|
|
pH less than 7.35, PaCO2 less than 38, Kussmaul's respirations, lethargic, confusion, HA, weakness, N/V, monitor ABGs, I/O, LOC, administer IV sodium bicarb carefully, treat underlying problem:
|
metabolic acidosis
|
|
|
pH greater than 7.45, PACO2 greater than 45mmhg, decreased rate and depth, dizziness, hypertonic muscles, monitor I/O, LOC, V/S, IV fluids:
|
metabolic alkalosis
|
|
|
Water lost through respirations, skin and feces; approximately 1300ml
|
obligatory losses
|
|
|
Pulling force exerted by colloids:
|
oncotic pressure
|
|
|
Loss or gain of water only; osmolarlity of serum is altered:
|
osmolar
|
|
|
Movement of H2O across cell membranes from less concentrated solution to the more concentrated solution; important to maintain homeostasis:
|
osmolarity
|
|
|
The power of a solution to draw water across a semi-permeable membrane
|
osmotic pressure
|
|
|
Hyposmolar imbalance of water intoxication is gained in excess of electrolytes resulting in low serum osmolarity and low serum sodium levels;water drawn in cells makes them swell:
|
over-hydration
|
|
|
Warmth or redness over the vein; inflammation of the vein:
|
phlebitis
|
|
|
Major anion of intracellular fluids, absorbed from intestines; involved in metabolism of fats, proteins, carbs:
|
phosphate
|
|
|
Causes:
- TPN can cause it to shift into the cells from ECF compartment - ETOH withdrawl - acid/base imbalance |
hypophosphatemia
|
|
|
Shifts out of cells
Ex: - tissue trauma - chemo - renal failure - infants fed cow milk |
hyperphosphatemia
|
|
|
Major cation in the intracellular fluid
|
potassium
|
|
|
-Maintains ICF osmolarity
-Transmits nerve and other electrical impulses -Regulates cardiac impulses and muscle contraction -Regulates acid base balance |
Potassium
|
|
|
Causes include:
- Vomiting - Diarrhea - Gastric suctioning -Diarrhea - Heavy perspiration - Diuretics - Hyperaldosteronism - Hyper-renal failure - Hypoaldosterone - Excess or rapid infusions of K+ |
Hypokalemia
|
|
|
This may occur in pts who are newly diagnosed with diabetes or in the individual who either did not administer enough insulin or the body requirements exceeded the supply available:
|
Diabetic ketoacidosis (DKA)
|
|
|
The body will demand more insulin whenever faced with increased physical activity or serious illness. The excessive glucose and ketones within the blood cause the serum osmolarity to rise. Water will begin to exit the cells to dilute the blood and make it less hypertonic. The cells become dehydrated and the patient will develop neurological changes. Glucose and ketones will spill over into the urine causing an osmotic diuresis to occur within the kidneys. This compounds the original problem as now the cells must release more of their water and potassium, phosphate and magnesium. Acidosis promotes potassium moving out of cells to buffer the pH change (hydrogen moves into the cells, potassium moves out).
|
Diabetic Ketoacidosis
|
|
|
S/S include:
-polyuria -hypotension -weight loss -tachycardia -fatigue -irritability, lethargy, coma -N/V -initially signs of hyperkalemia -dry, flushed skin - dry mucus membranes - hypokalemia p insulin administration |
diabetic ketoacidosis
|
|
|
Treatment:
- Rehydration usually with NS then D5W - Rapid-acting insulin - Restoration of electrolyte balance (Na with NS; K+ levels can shift from hyper to hypo p admin of insulin (causes K+ to shift back into the cells) - IV bicarbonate: given if pH <7.1. It's use is controversial as insulin therapy will correct the low bicarbonate levels - Treat Underlying cause: e.g. infection |
Diabetic ketoacidosis
|
|
|
Caused by most often by too little ADH produced by the pituitary gland or occasionally by the inability of the kidneys to respond to ADH. Patients will excrete large amounts (5 to 40 liters per day) of extremely dilute urine. They are at risk of serious complications as vascular volume quickly falls, serum osmolarity rises and hyponatremia results. Also as serum osmolarity rises, patients become prone to thromboemboli.
Most often caused by tumors or injury of the pituitary gland or cerebral death: |
Diabetes Insipidus
|
|
|
S/S include:
- polyuria - signs of dehydration such as dry mucous membranes, poor skin turgor, hypotension, tachycardia - urine osmolarity decreased < 200 - urine specific gravity > 300 - serum sodium > 147 mEq/L Risk Factors: - head injury - pituitary tumors - brain death - increased ICP |
Diabetes Insipidus
|
|
|
Treatment:
- Rapid rehydration with hypotonic saline to correct fluid losses then replacement is tailored to urinary losses - Exogenous vasopressin (DDAVP) - Chlorpropamid (stimulates ADH release) |
Diabetes Insipidus
|
|
|
Stimulated by:
- Increased plasma volume as sensed by stretch recptors located in the left atrium & pulmonary vasculature & decreased BP as sensed by pressure receptors located in the carotid arteries - During these times increased ADH release occurs which causes the kidneys to conserve water. This extra water expands in the serum & decreased serum osmolarity & sodium levels. Decrased serum osmolarity causes water to move into first the extracellular space then the intracellular spaces, causing the brain to swell - causing increased ICP. - The increase in ECF causes an increase in aldosterone secretion which further reduces serum Na levels. Without prompt treatment the pt. will experience increased ICP due to cerebral edema & severe hyponatremia which may be fatal. - common in ICU settings |
SIADH
Syndrome of Inappropriate Secretion of Anti Diuretic Hormone |
|
|
Risk Factors:
- Oat cell carcinoma of the lung; carcinoma of the pancreas, duodenum, prostate, or thymus, and some forms of leukemia - fear, pain or stress - head trauma, brain tumors, intercranial hemorrhage, meningitis - positive pressure ventilation (stimulates pressure receptors in the carotid sinus & aortic arch) - medications such as chlorpropramide, acetaminophen, morphine, amitriptyline, thiazide diuretics, CA, chemotherapy drugs |
SIADH
|
|
|
Causes serum and cellular fluid overload but not interstitial overload. This can be seen by fingerprint edema (when a finger is pressed over the sternum a fingerprint will be left).
|
SIADH
|
|
|
- COPD
- CHF - kidney disease - CA - ileostomy - elderly - young - fever - surgery - homeless |
Pts at risk for electrolyte imbalances
|
|
|
Rate of bone loss is slowed with regular exercise in __________ and _________.
|
________ and _______________
|
|
|
Receptors in juxtaglomerular cells in kidneys causing sodium and water retention:
|
Renin-angiotensin
|
|
|
-pH > 7.45
-PACO2 < 35mmhg -C/O - SOB - CP - chest tightness - difficulty concentrating - blurred vision - Monitor - V/S - ABGs - Assist client to - Breath more slowly - Breath in paper bag - Apply NRB |
Respiratory alkalosis
|
|
|
- pH < 7.35
- PaCO2 > 45mmhg - S/S - increase HR - increase RR - dizziness - confusion - decrease LOC - convulsions - warm flushed skin - Assess - Respiratory status - lung sounds - Monitor - Airway - I/O - V/S - ABGs - Narc antagonists - Maintain - Adequate hydration |
Respiratory acidosis
|
|
|
Major cation in the ECF:
|
Sodium
|
|
|
- Renal absorption or excretion
- aldosterone increase it - re-absorbed in collecting ducts of nephrons - Regulates ECF volume and distribution - Maintains blood volume - Transmits nerve impulses and contracts muscles |
sodium
|
|
|
Causes:
- GI fluid loss - sweating - diuretics - hypotonic tube foods - drinking water - excess IV D5W - head injury - AIDS - Malignant tumors |
Hyponatremia
|
|
|
Causes
- Loss of fluids - hyperventilation - diarrhea - water deprivation - excess salt intake - heat stroke |
hypernatremia
|
|
|
________ increases cellular metabolism blood glucose concentration, catecholaminelevels.
|
Stress
|
|
|
_______ can increase ADH and decrease urine output.
|
Stress
|
|
|
Sudden weight gain, blurred vision, H/A, and decreased fluid output compared to intake is an early sign of
|
water excess
|
|
|
______________ can affect the body's ability to maintain fluid.
|
Surgery
|
|
|
The diameter of the lumen is the _______ of the needle.
|
gauge
|
|
|
The ___________ are the primary regulator of body fluids and electrolytes.
|
kidneys
|
|
|
The ____________ is the organ that assumes the greatest responsibility for the __________________ balance.
|
potassium
|
|
|
The normal fluid intake is _____________ ml. We need _______________ ml. We get an extra _______ ml from the food taken in during metabolic process.
|
1500 ml
2500 ml 1000 ml |
|
|
The fluid shifts from the vascular space into an area where it is not readily accessible as ECF.
|
Third space syndrome
|
|
|
_______________ is the primary regulator of fluid.
|
Thirst mechanism
|
|
|
These are used to increase blood volume following severe loss of blood. Examples are Dextran, plasma and human serum albumin.
|
Volume expanders
|
|
|
You are at risk for dehydration if you have a decrease in
|
Anti-diuretic hormone
|
|
|
Risk factors include:
-alveolar gas exchange impairment (pneumonia, acute pulmonary edema, aspiration, near-drowning) -chronic lung disease (asthma, CF, emphysema -OD narcotics/sedatives that depress respiration -brain injury Manifested by: -PaCO2 above 45 mmHg -pH < 7.35 |
Respiratory acidosis
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Risk Factors:
-Hyperventilation (anxiety, increased body temp, overventilation via mechanical vent, hypoxia, salicylate OD) Manifested by: -light-headedness -pH >7.45 -PaCO2 35 mmHg |
Respiratory alkalosis
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Risk Factors include:
-Increased nonvolatile acids in the blood (renal impairment, diabetes mellitus, starvation) -Decreased bicarbonate (prolonged diarrhea) -Excess IV of NaCl Manifested by: -Kussmaul's respirations -pH <7.35 -serum bicarbonate<22 mEq/L |
Metabolic acidosis
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Risk Factors include:
-Excess acid loss (vomiting, GI sx) -Excess use of potassium-losing diuretic -Excess adrenal corticoid hormones (Cushing's syndrome, hyperaldosteronism) -Excess bicarbonate intake (antacids, parenteral NaHCO3) Manifested by: -tetany -dizziness -dizziness -decreased RR and depth -pH > 7.45 -serum bicarbonate > 26 mEq/L |
Metabolic alkalosis
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-Relationship is critical for homeostasis
-Significant variations from normal pH ranges are notwell tolerated and may be life threatening -Balance is achieved by Respiratory and Renal systems |
Acid base balance
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There are two buffers and they work in pairs:
Associated with the respiratory and renal compensatory system |
H2CO3 Carbonic acid
NaHCO3 Base bicarbonate |
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Approximately 98% normal metabolites are in the form of
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CO2
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Metabolic element of the acid base balance is a function of the
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kidneys
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Process of kidneys excreting ____ into the urine and reabsorbing ____ into the blood from the renal tubules
1) active exchange ______ for H+ between the tubular cells and glomerular filtrate 2) carbonic _________ is an enzyme that accelerates hydration/dehydration CO2 in renal epithelial cells |
H+
Na+ anhydrase |
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Acid Base Relationship
H20+CO2 = ______ = HCO3 + H+ |
H2CO3
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Normal ABGs:
pH: PCO2: PO2: HCO3: BE: SaO2: |
pH: 7.35-7.45
PCO2: 35-45 mmHg PO2: 80-100 mmHg HCO3: 22-26 mmol/L BE:-2 - +2 SaO2:>95% |
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Acidosis:
pH: PCO2: HCO3: |
pH: <7.35
PCO2: >45 HCO3:<22 |
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Alkalosis:
pH: PCO2: HCO3: |
pH: > 7.45
PCO2: < 35 HCO3:> 26 |
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- emphysema
- drug OD - narcosis - respiratory arrest - airway obstruction |
causes of Respiratory acidosis
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- think of CO2as an acid
- failure of the lungs to exhale adequate CO2 - pH <7.35 -PCO2 > 45 - CO2 + H2CO3 - decreased pH |
Respiratory acidosis
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-Failure of kidney function
-Decreased blood HCO3 which results in decreased availability of renal tubular HCO3 for H+ excretion -pH < 7.35 -HCO3 <22 |
Metabolic Acidosis
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-renal failure
-diabetic ketoacidosis -lactic acidosis -excessive diarrhea -cardiac arrest |
Causes of Metabolic Acidosis
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-too much CO2 exhaled (hyperventilation)
-decreased PCO2, H2CO3 insufficiency = increased pH -pH > 7.45 - PCO2 < 35 |
Respiratory Alkalosis
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-hyperventilation
-panic d/o -pain -pregnancy -acute anemia -salicylate OD |
Causes of Respiratory Alkalosis
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-Increased plasma bicarbonate
-pH > 7.45 - HCO3> 35 |
Metabolic Alkalosis
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-increased loss acid from stomach or kidney
-hypokalemia -excessive alkali intake |
Causes of Metabolic Alkalosis
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Analyzing an ABG:
1. PO2: NL = ______ 2. pH NL = ________ 3. PCO2 NL = _________ 4. HCO3 NL = ________ |
PO2 NL = 80-100 mmHg
pH NL = 7.34-7.45 acidotic <7.35 alkalotic>7.45 PCO2 NL = 35-45 mmHg HCO3 NL = 22-26 mmol/L acidotic <22 alkalotic >26 |
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Analyzing an ABG:
Step 1: 1. Determine PaO2 & SaO2 2. Determine oxygen status 3. Low PaO2 (< ____mmHg) means hypoxia 4. NL/elevated oxygen means adequateoxygenation Step 2: pH acidosis < 7.35 alkalosis >7.45 Step 3: Study PaCO2 & CHO3 Respiratory irregularity if PaCO2 _______ & HCO3 _____ Metaboic irregularity if HCO3 ______ & PaCO2 ____ Step 4: Determine if there is a compensatory mechanism working to try to correct the _____. (ie: If have primary respiratory acidosis will have increased PaCO2 and decreased pH. Compensation occurs when the kidneys retain _______. |
step 1: 80
step 3: abnormal & NL abnormal & NL step 4: pH HCO3 |
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Respiratory Acidosis:
pH = PaCO2= HCO3= |
Respiratory Acidosis:
pH = 7.30 PaCO2= 60 HCO3= 26 |
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Respiratory Alkalosis:
pH = PaCO2= HCO3= |
Respiratory Alkalosis:
pH = 7.50 PaCO2= 30 HCO3= 22 |
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Metabolic Acidosis:
pH = PaCO2= HCO3= |
Metabolic Acidosis:
pH = 7.30 PaCO2= 40 HCO3= 15 |
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Metabolic Alkalosis:
pH = PaCO2= HCO3= |
Metabolic Alkalosis:
pH = 7.5 PaCO2= 40 HCO3= 30 |
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Compensations:
Respiratory acidosis and metabolic _______________ |
alkalosis
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Compensations:
Respiratory alkalosis and metabolic _______________ |
acidosis
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In respiratory conditions, the _______ will attempt to compensate and visa versa.
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kidneys
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In chronic respiratory acidosis (COPD), the __________ increase the elimination of H+ and absorb more ________. The ABG will show NL pH, increase CO2 and increase HCO3.
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kidneys
HCO3 |
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Buffers kick in within________. Respiratory compensation is rapid and starts within minutes and complete within _____ hours. Kidney compensation takes hours and up to ______ days.
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minutes
24 hours 5 days |
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Valuable information can be gained froman ABG as to the patients
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physiologic condition
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A diet high in ______, ______ and ______ should be encouraged for an immobile patient.
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protein, calories, fiber
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Activity which the amount of O2 taken into the body is greater than or equal to the amount the body requires, uses large muscle groups.
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aerobic
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Activity in which muscles cannot draw out enough O2 from the bloodstream; endurance training athletes:
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anaerobic
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Bring about movement at a joint by contraction of a prime mover and relaxation of its antagonist; eg: to flex the arm, the prime mover (biceps brachii) contracts while its antagonist (tricpes brachii) relaxes.
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antagonistic muscle groups
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Bring about and maintain an upright or sitting posture by contracting and/or relaxing to oppose the effect of gravity on the body
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antigravity muscle groups
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Instillation of a radiopaque contrast medium into the joint followed by by Plain radiographs to determine gross anatomic features and/or abnormalities of the joint.
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arthrogram
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A complication of immobility; calcium and phosphate levels (serum and urine) may be increased:
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bone demineralization
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When blood levels of Ca decrease, the parathyroid gland senses the decrease and releases parathyroid hormone (PTH) to increase the removal of Ca from the bones. When blood levels of CA increase, the thyroid gland senses the increase and releases Calcitonin to inhibit the removal of Ca from the bones:
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Calcium homeostasis
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Nonvascular, supporting connective tissue, located chiefly in the joints and in the nose, ear, thorax, trachea and larynx, that provides strength and flexibility of the skeleton
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cartilage
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The ability of a skeletal muscle to respond to a stimulus by forcibly shortening:
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contractility
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Permanent shortening of a muscle and eventual shortening of the ligaments and tendons:
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contractures
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The ability of the skeletal muscle to resume its resting length after it has shortened or lengthened:
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elasticity
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The ability of a skeletal muscle to receive and respond to a stimulus:
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Excitability
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The ability of a skeletal muscle to respond to a stimulus by extending and relaxing:
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Extensibility
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Assists in producing coordinated body movements by alerting the brain of the need to stimulate extensor muscles to reestablish an erect posture through stimulation of receptors in antigravity:
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Extensor or antigravity reflex
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The most serious consequences of improper body mechanics:
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falls
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The position of choice for a pt. that has difficulty breathing; the bed is elevated 45 degrees with the knees slightly bent:
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Fowler's position
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Injection of gallim citrate (Ga 67) or thallium (TI 201) into a vein and monitoring its uptake in the bones to provide gross information about the bones:
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Gallum/thallium scan
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Increase in size:
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hypertrophy
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Injection of a client's white blood cells, which have been tagged with indium (In 111), into a vein and monitoring its uptake in the bones to provide gross information about the bones:
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Indium scan
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Results in increase muscle tension and energy expenditure but no muscle shortening or work; eg: having a client press his/her feet against an immovable footboard - no work accomplished; footboard does not move , nervous system control of skeletal muscle contraction:
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Isometric
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Involves no joint movement or change in the length of the muscle but does involve change in the muscle tension;an exercise to help maintain muscle strength, ex: pt. wit cast on leg:
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isometric exercise
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Results in increase muscle tension , energy expenditure, muscle shortening, and work; eg: having a client use a trapeze to move him/er up in bed; work accomplished: lifting:
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isotonic
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Areas where bone surfaces come into close contact with one another (articulate):
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joints
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Assists in producing coordinated body movement by alerting an individual to movement of the head in relation to gravity through stimulation of receptors in the semicircular canals in the inner ear:
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Labyrinthine sense
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White, shiny, flexible bands of fibrous tissue connect bones to bones and provide strength and flexibility of skeleton:
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ligaments
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Most common problem seen in the standing position of an adult; inward curvature of a portion of the lumbar and cervical vertebral column
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Lordosis
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Normal body alignment for a _____ yr old is marked lumbar lordosis and protruding abdomen; this is not a sign of a problem:
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2
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The position that facilitates respiration by maximizing chest expansion; most helpful for pts who have problems with exhalation:
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orthopneic
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A condition in which bones become brittle and fragile due to calcium depletion; common in older women; primarily affects the weight bearing joints of the lower extremity and the back causes compression fractures of the vertebrae and hip function:
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Osteoporosis
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Can cause obesity and can distort movement; affects balance and posture:
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over-nutrition
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Assists in producing coordinated body movement by alerting the brain of the need to stimulate extensor muscle of lower legs through stimulation of receptors in the soles of the feet:
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Plantar reflex
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Assists in producing coordinated body movements by alerting the brain of the location of a limb or body part in space through stimulation of proprioceptive receptors in muscles, tendons and fascia:
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Proprioceptive or kinesthietic sense
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Bring about movement at a joint by strengthening the contraction of a prime move:
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Synergistic
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White, glistening bands of fibrous tissue; connect muscles to bones; provide strength and flexibility of the skeleton:
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tendons
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Urinary stasis, venous pooling, decreased vital capacity and increased HR can occur with
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immobility
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Urine will become alkaline with
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immobility
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Smooth muscle; located in walls of internal organs and blood vessels; function: contraction of viscera and blood vessels; cell shape: cylindrical; number of nuclei: one; striations: absent: type of control: involuntary:
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Visceral muscle
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Assists in producing coordinated body movement by alerting the brain of the spatial relationships within the environment through stimulation of receptors in the visual special sense:
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visual or optic reflex
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-support body tissues and provide the skeletal framework of the body
-protect body organs -provide for movement -act as a storehouse for mineral salts -provide for hematopeoiesis -divisions of the skeleton |
Bones
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Those bones comprising the skull, vertebral column and thorax; number = 60:
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axial skeleton
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Those bones comprising the legs, arms, shoulders and pelvis; number = 126
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appendicle skeleton
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Bone cells that form bone:
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osteoblasts
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Bone cells that reabsorb bone
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osteoclasts
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Dense, heavy, rigid bone arranged in concentric circles known as the Haversian system (or Osteen) which consists of the following:
- A central canal, called a Haversian canal - Concentric layers of bone matrix, called lamellae - Spaces between the lamellae, called lacunae - Bone cells within the lacunae, called osteocytes - Small channels, called canaliculi |
Cortical (compact) bone tissue
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Light, porous, bone arranged in concentric layers known as trabeculae, which branch and join to form meshwork:
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Cancellous (spongy) bone tissue
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Bones that are longer than they are wide consist of the following:
- Cancellous bone at the extremities (epiphyses) - Compact bone in the shaft (diaphysis) - General features of long bones - A diaphysis, or shaft of long bones, Epiphyses, or extremities of long bones - Articular cartilage, or thin layer of hyaline cartilage covering the articulating surface of each epiphysis of long bones - Periosteum, or dense, white fibrous membrane that covers long bones, except at joint surfaces where articular cartilage forms the covering - A medullary )marrow) cavity, or cavity in long bones, that contains yellow or fatty bone marrow - An endosteum, or membrane that lines the medullary cavity and Haversian canals of long bones - Ex: femur, fibula, tibia, humerus, phalanges of the fingers and toes |
Long bones
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Roughly cube-shaped bones consist of the following:
- An inner core of cancellous bone - A thin outer layer of compact bone - ex: Bones of the wrist and ankle |
Short bones
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Thin, flattened and usually curved bones consist of the following:
- An inner core of cancellous bone - Two outer layers of compact bone - eg: ribs, bones of the skull |
Flat bones
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Differing shaped bones consisting of the following:
- An inner core of cancellous bone - A thin outer layer of compact bone - eg: - Vertebrae - bones of the jaw |
Irregular bones
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- Stage One: A stimulus, such as a hormone, drug, or stressor, activates bone cell precursors to become osteoclasts
- Stage Two: Osteoclasts gradually reabsorb bone and leave behind an elongated cavity called a reabsorption cavity. -Stage Three: Osteoblasts follow path of osteoclasts to crease new Haversian systems (orosteons) and trabeculae: |
bone remodeling
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Immovable joints such as skull sutures, epiphyseal plates, joint between first rib and manubrium of sternum:
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Synarthroidal joint
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Slightly moveable joints such as vertebral joints, joint of the symphysis pubis:
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Amphiarthroidal
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Freely movable joint; consistent features includes
- Ability to move freely - A fibrous joint capsule - A joint cavity - A synovial membrane that lines the inner surface of the joint capsule - Lubricating synovial fluid secreted by the synovial membrane - Articular cartilage that covers the bony surfaces |
Diarthroidial
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Includes
- Ball-and-socket - Ball-shaped head fits into concave socket of another bone - hip joint |
types of diarthoidial joints
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Oval-shaped condyle (protuberance at the end of a bone) fits into elliptical cavity of another bone; eg: wrist joint between the radius and carpals
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condyloid joint
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Articular surfaces; usually flat; eg: finger joints between carpal bones:
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Gliding joint
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Spool-like surface fits into concave surface of another bone; eg: elbow joint between the humerus, ulna and radius:
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Hinge joint
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Arch-shaped structure rotates about rounded, or peg-like, pivot; eg: joint between the atlas and axis:
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Pivot joint
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Saddle-shaped bone fits into a socket that is convex on one side and concave on the other; eg: thumb joint between the trapezium and metacarpal:
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Saddle joint
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Areas where bone surfaces come into close contact with one another (articulate):
|
joints
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White, shiny, flexible bands of fibrous tissue connect bones to bones and provide strength and flexibility of the skeleton:
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Ligaments
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White, glistening bands of fibrous tissue connect muscles to bones and provide strength and flexibility of the skeleton:
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Tendons
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Nonvascular, supporting connective tissue, located chiefly in the joints and in the nose, ear, thorax, trachea, and larynx that provides strength and flexibility of the skeleton:
|
cartilage
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- heart
- Function: - Pump blood through the heart and blood vessels - Cell shape: - Cylindrical - Branching - Number of nuclei - One - Striations - Present - Type of control - Involuntary |
Cardiac muscle
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In a muscle cell contraction, nerve impulses travel along to the ________ junction where it stimulates the release of a ____________ which allows the nerve impulse to cross the _______ junction triggering it.
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monaural junction
neurotransmitter myoneural junction |
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- degree of comfort
- anxiety - environment - lifestyle - diet - drugs and other substances - age/aging - physical factor |
factors affecting rest and sleep
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|
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- physical or emotional pain
- loss of familiar surroundings - loss of routine - fear of the unknown - loss of privacy - timing of assessment, procedures and treatments - intrusive lighting or equipment - noise level |
factors affecting sleep
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- trusting nurse-client relationship
- relaxing environment - relaxation techniques -appropriate nutrition - pharmacological interventions -client education |
nursing interventions to promote rest and sleep
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-dark areas under eyes
- puffy eyelids, reddened conjunctiva -glazed or dull appearing eyes -limited facial expression |
symptoms of sleep problems
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Relaxed and drowsy, profound restfulness, usually last only a few minutes, floating sensation, eyes roll side to side:
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Stage I NREM
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Lightly asleep; easily aroused; 40-50% total sleep time:
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Stage II NREM
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Less easily aroused, medium depth sleep, muscles relaxed, BP and temp decrease:
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Stage III NREM
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Deepest sleep stage, rarely moves, muscles completely relaxed, difficult to arouse:
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Stage IV NREM
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Active dreaming occurs, muscle tone depressed brain very active, HR and RR irregular, rapid eye movements; 25% sleep:
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REM
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- Valium
- Dalmane - hypothyroidism - depression - respiratory distress disorders - sleep apnea - age |
Common causes of NREM deprivation
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- withdraw
- apathy - feeling physically uncomfortable - lack of facial expression |
S/S NREM deprivation
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-ETOH
- barbiturates - shiftwork - jet lag - MS and demerol |
common causes of REM deprivation
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- Excitability
- Restlessness - Increase sensitivity to pain - confusion - suspiciousness - emotional ability |
S/S REM deprivation
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Distract pt away from painful sensations:
|
cutaneous stimulation
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The most effective RX in promoting sleep:
|
Dalmane
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An affect of MS:
|
Decreased amount of REM sleep
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An effect of a mother with a newborn who awakens q 3 hrs
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decreased REM sleep
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During 7-8 hrs, a sleeper usually has _____ cycles of sleep:
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4-6
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Elderly adults have a decrased or absent Stage ____
|
IV
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-PNS increases necessary for protein synthesis
-Restores normal level of activities -Normal balance among parts of the nervous system |
Functions of sleep
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Hypnotics affect stages:
|
III & IV
|
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Infradian
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monthly
|
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Secobarbital interferes with
|
III, IV and NREM
suppresses REM sleep |
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Beta blockers known to cause
|
insomnia
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Narcotics suppress
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REM
|
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SE of tranquilizer withdrawal
|
nightmares
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Sleepwalking is a disorder that occurs when people walk or do another activity while they are still asleep:
|
somnambulism
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Decreased judgment, ability to concentrate, inattentiveness, fatigue, blurred vision, difficulty performing ADLs, lack of memory:
|
REM and NREM deprivation
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REM complete the ____ cycle of sleep:
|
1st
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Sedative hypnotics induce
|
sleep
|
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Sequence of a normal sleep cycle stages:
|
I
II III IV III II REM |
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Stage where body rests, restores and relaxes:
|
IV
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Stage where sleeper is difficult to arouse:
|
IV
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Stages when norepi is released in the bloodstream and results in anxiety
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IV and NREM
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