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107 Cards in this Set
- Front
- Back
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Cation?
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Most plentiful in cells.
K, Mg, Ca in blood tissue. Na and Ca in GI tract. Positively charged electrolyte |
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Anion?
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Attached to cations.
Chloride and bicarbonate Negatively charged electrolyte |
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Osmolality?
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Osmotic pull exerted by all particles per unit of water Hyper-hi Na & BUN
*concentration of a solution *measurement of dissolved particles per unit of water in blood or fluids *refers to osmotic pull |
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Tonicity?
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The effect of fluid on cellular volume. Primarily used as a measurement of the concentration of IV solutions.
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Isotonic?
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240-340; solution that has an osmolility about equal to serum.
-D5W, 5% dextrose in water -NaCl, 0.9% sodium chloride -LR, lactated ringers Indications - expand circulating vol, replace fluid loss Assess for IV infiltration, monitor for FVE, no LR for liver DJ |
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Hypotonic?
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<240; solution that has an osmolility lower then that of serum
- NaCl, 0.45% Indications - help hydrate the cells and can lower the amount of fluid in the circulatory system, replace intercellular fluid. Assess for infiltration, stop when patient can drink, not for ICP patient |
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Hypertonic?
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>340; osmolitity higher then serum
-D10W, 10% dextrose -D5NaCl, 5% dextrose on 0.9% NS Indications - reestablish equilibrium in electrolytes and acid base imbalances, help restore circulation blood, high risk FVE Assess infiltration, osmolility >600 should be infused into central line, not give DKA cause cell dehydration |
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What happens to D5W when infused?
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Becomes hypotonic instead of isotonic
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Colloids?
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Volume expanders.
- dextran solutions, not O2 carrying - amino acids - heat starch - plasma note |
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Dextran?
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Not a substitute for whole RBC
Not able to carry oxygen Interferes with platelet function and bleeding time |
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Blood products?
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Packed RBC's = whole blood with no plasma, better then whole blood b/c lowers chance for circulatory overload, low risk of reaction, and low risk for transmitting hepatitis.
Whole blood, plasma, albumin |
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What lab values may be elevated with FVD?
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BUN
Hemocrit Specific Gravity |
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FVD (dehydration)
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Elevated BUN
Elevated hemocrit SG >1.030 = dehydration Low BP = hypovolemia is severe Determine urine output |
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Most significant signs and symptoms of FVD?
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Low urine output
Elevated HR Thirst, poor skin turgor, low BP |
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Signs and symptoms of FVE?
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Cough, dyspnea, neck vein engorgement, rales in lungs
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Potassium value
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3.5 - 5.3
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What is the major effect with too little or too much potassium?
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cardiac arrest
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What is the major function of K?
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transmission and conduction of the nerve impulses
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How can K be administered?
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oral liquid, oral tab or cap, IV
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Which medications promote K loss?
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diuretics
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Why is it so important to assess renal function when a client is on K?
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if kidneys are not functioning hyperkalemia can occur
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What is the onset of action for oral and IV K?
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oral: 30 minutes
IV: immediate |
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Give examples of medication that might be ordered for hyperkalemia?
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sodium bicarb
calcium gluconate insulin kayexalte |
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What drugs can cause hypokalemia?
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laxative
enema corticosteroids |
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What drugs can cause hyperkalemia
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potassium chloride
ACE inhibitors angiotension II receptor agonists beta bloskers heparin |
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Contraindications of potassium?
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renal failure
Addison's disease hyperkalemia |
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What is the therapeutic effect/uses and mode of action of potassium?
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to correct deficits, strengthen cardiac activities
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3 side effects
and 3 adverse effects |
Nausea, vomiting, diarrhea
hyperkalemia, oliguria, cardiac changes |
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assessment for potassium imbalance
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S/S = N/V, polyuria, cardiac dysrhythmias, abd distension
assess K level, vitals, EKG low K enhances action of digitalis |
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normal value for sodium
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135-145
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What is the major function of Na?
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promotes the transmission and conduction of nerve impulses
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What is the treatment for hyponatremia?
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hypertonic 3% saline solution and 0.9% NS
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What medications can cause hyponatremia?
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diuretics; SSRI's
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What is the treatment for hypernatremia?
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avoid foods high in Na; avoid adding salt to meals
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What medications can cause hypernatremis?
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cortisone preparation; cough medication; some antibiotics
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assessment for sodium imbalance
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S/S hypo = weakness, headache, lethargy, N/V, tachy
S/S hyper = flushed, dry skin, N/V, temp, agitation, muscle twitching, hyperreflexia |
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Normal value for calcium?
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4.5 - 5.5
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What is the relationship between protein and calcium?
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50% of Ca in body fluids is bound to protein. Ca unbound is free ionized Ca and can cause a physiologic response. low albumin = free Ca (malnourished)
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If the client is acidotic, what happens to the calcium levels?
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calcium is released from serum protein and increases the serum calcium level
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If the client is alkalotic, what happens to the calcium level?
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calcium is bound to protein and there is less calcium
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What is the major function of calcium?
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promotes normal nerve and muscle activity; increase contraction of myocardium; maintians normal celluallr permeability and promote blood clotting by converting prothrombin into thrombin; formation of bone and teeth
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What is the rationale for administering IV calcium with D5W?
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Cannot mix with NS b/c sodium promote calcium loss. can be given undiluted on ER only.
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What symptoms would occur with rapid infusion of calcium?
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tingling, warm sensations and metallic taste
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How should IV calcium be administered?
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at moderate rate and diluted
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What are the therapeutic uses of calcium?
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tetany (weak/limp muscles)
promoted blood clotting, heart muscle contraction, muscle activity |
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What mediations promote calcium loss?
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loop or high ceiling diuretics, steroids, Mg preparations, phosphate preparations
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What two medications alter the absorption of vitamin D and why is this important?
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aspirin and anticonvulsants
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What diuretic increases the risk of hypercalcemia?
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thiazide diuretics
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Elevated calcium levels can increase the risk of which drug toxicity?
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digitalis
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What drugs will decrease the effects of calcium?
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calcium channel blockers, tetracycline and NaCl
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What is normal magnesium level?
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1.5 - 2.5 mEq/L
or 1.8 - 3.0 mg/L |
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What is the major function of magnesium?
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promotes the transmission of neuronmuscular activity; important mediator of the neural transmission in the CNS; promotes contraction of myocardium
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What is the effect on the neuromuscular system with hypomagnesemia and hypermagnesemia?
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hyper = sedative effect; loss of deep tendon reflexes, hypotension
hypo = cardiac dysrhythmia |
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What are the 2 groups of drugs that can result in hypermagnesemia?
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laxative and antacids
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Decreased serum Mg level can increase the risk of which drug toxity?
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digitalis
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What is the medication and rout for emergency tx of hypermagnesemia?
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IV calcium gluconate
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What is the normal level of chloride?
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95 - 108
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What electrolyte does chloride work with?
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sodium
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What is the normal level of phosphorus?
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1.7 - 2.6
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What electrolyte does phosphorus associate with?
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calcium
inverse relationship |
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Stimulation of what hormone can result in decreased serum phosphorus levels?
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parathyroid hormone
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What is the major function of phosphorus?
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essential in bone and teeth formation; neuromuscular activity
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how is the heart rate controlled?
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sympathetic nervous system = norepinephrine (fight or flight)
parasympathetic nervous system = acetylcholine (rest and digest) |
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alpha receptors
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increase contraction
vasoconstriction |
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beta 1 receptors
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HEART
increase HR, contraction, AV node conduction, BP |
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beta 2 receptors
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LUNGS
brochodialation |
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What is a adrenergic agonist?
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potent inotropic effect; positive chronotropic effect; increase BP vasoconstriction; promotes bronchodilation
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What is an adrenergic blocker (antagonist)?
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block alpha receptor sites directly by occupying receptor and indirectly by inhibiting release of neurotransmitter
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adrenergic blocker cont...
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used for BPH; HTN, adrenal gland tumor; raynauds disease
contraindication: low HR, low BP, heart block side effect: orthostatic hypotension, tachy, vertigo |
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What is a beta blocker?
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antihypertensive
suffix = LOL lowers HR, lowers BP, blocks SNS, suppress production of renin, vasodilation |
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When is a beta blocker given?
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angina or chest pain
HTN; dysrhythmias; MI; HF; migraines ( will lower HR and blood flow, lowers oxygen demand, lowers workload) |
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beta blocker cont...
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contraindication: brady; COPD; heart block; asthma
side effect: brady; brochospasm; N/V; hypotension; impotence |
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beta blocker cont...
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additive affect: digoxin, CCB = heart block; lowers drug effects
lab assessment: BUN & creatine |
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What is a cardiac glycoside?
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heart failure and a. fib
DIGOXIN (Lanoxin) |
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cardiac glycoside cont...
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contraindications: heart blocks, V tach or V fib, MI
side effects: brady, fatigue, anorexia, N/V, blurred vision |
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cardiac glycoside cont...
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lab assessment: K level
herbal interactions antidote for toxicity: digibind |
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What is a antianginal?
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vasodialator
Nitro (short acting) Imdur (long acting) dilate all blood vessels - coronary!!, lowers cardiac oxygen demand |
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antianginal cont...
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contraindications: beta blocker, CCB, erectial dysfunction meds
side effect: HEADACHE, dizziness |
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inotropic
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a drug the influences the force or energy of muscular contractions, particularly by the heart
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chronotropic
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a drug that influences the heart rate
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dromotropic
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a drug that influences to conduction of electrical impulses
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What is calcium channel blocker (CCB)?
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therapeutic effect: HTN, angina, antiarrhythmic
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CCB cont...
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contrindications: heart bock, acute MI
side effect: constipation, dizziness, brady, hypotension |
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CCB cont...
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Educate client: no grapefruit!
check liver and renal function interactions with digoxin |
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What is an antiarrhythmic?
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restores normal rhythm of the heart; blocks adrenergic stimulation of heart; depress myocardial contractibility; repolarize myocardium
can be sodium channel blocker, beta blocker, CCB |
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antiarrhythmic cont...
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contraindications: heart block, bradycardia
side effect: hypotension, brady, fatigue, N/V, dizziness assess: EKG, Vitals, troponin |
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What is a diuretic?
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promotes urine output, lowers HTN, edema, blocks sodium and chloride reabsorption
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diuretic cont...
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thiazide: hydrochlorothiazide
loop (most effective): furosemide (Lasix) and bumetamide (Bumex) potassium sparing: spironolactone (aldactone) |
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diuretics cont...
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contraindications: anuira, olguria, hperkalemia, renal failure, gout
side effect: potassium imbalance interactions: digitalis, lithium, antihypertensives, NSAIDs Assess electrolytes! |
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What is an ACE inhibitor?
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lowers after load and preload
therapeutic: HTN, heart failure suffix: PRIL |
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ACE cont...
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how it works: vasoconstrictor > retains Na > retains water > prevents breakdown of Bradykinin (vasodilator on pulmonary & renal epithelium)
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ACE cont...
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tends to cause K to rise
contraindications: hx of neck swelling, renal stenosis, pregnancy, K imbalance, Potassium sparing diuretic use side effects: low BP, dizziness, headache, cough (Bradykinin) neutropenia, angioedema |
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ACE cont...
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assessments: BP baseline, K, BUN, Creatnine, WBC
interactions: NSAIDs, diuretics, lithium, high K foods |
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What is an angiotensin II receptor blocker (ARB)?
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suffix: SARTAN
therapeutic: HTN, Heart failure, stroke prevention, MI, diabetic neuropathy (slows progression) BLOCKS ANGIO II effect: vasodilatation, lowers after load, lowers aldosterone, workload lowers |
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ARB cont...
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contraindications: angioedema, preg, renal stenosis
side effects: high K, angioedema assessments: Same as ACE interactions: cimetidine, lithium, NSAIDs, beta blockers, CCB |
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What is an anticoagulant?
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reduce formation of fibrin, increases clotting time, decreases clot formation (allows to not get bigger)
therapeutic use: MI, A-fib, indwelling devices, post-op, immobilization tx: DVT, PE |
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anticoagulant cont...
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Heparin, enoxaprin/Lovenox (inhibiting clotting factors)
warfarin/Coumadin, Pradaxa (inhibiting synthesis of clotting factors) warfarin is highly protein bound, metabolized on the liver, can alter other meds easily |
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anticoagulant cont...
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contraindications: bleeding disorders, low platelets, pork allergy, surgical procedures, epidural catheter
side effects: localized bleeding (gums), systematic bleeding ( stool, hematuria, anemia), skin necrosis assessment: stool, urine, local bleeding/brusing labs: coumadin = INR and PT heparin = PTT, HCT, platelets lovenox = CBC, platelet pradaxa = no blood work |
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anticoagulant cont...
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antidote for heparin and lovenox: protamine sulfate
antidote for coumadin: phytomadine/vitmain K |
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What is an antiplatelet drug?
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therapeutic use: primary prevention of forming a clot, lowers platelet aggression, vasodilators
effect: increase clotting time, lowers clot formation chances |
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antiplatelet cont...
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acetylsalicylic/aspirin, clopidogrel/plavox, dipyridamole/persantine, cilotazol/pletal
once a day medication |
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antiplatelet cont...
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contraindications: thrombocytopenia, active bleeding, GI ulcer, vitamin K deficient, recent stroke
side effects: BLEEDING assessments: monitor bleeding, CBC interactions: NSAIDs, antacids, herbal alert |
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What is an antilipidemic?
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lowers cholesterol
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antilipidemic bile-acid sequestrates?
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cholestryamine/Questran
drug and bile acids in the intestines, insoluable compound > GI tract > increases clearance of cholesterol |
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antilipidemic fibrates?
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gemfibrozil/Lopid
decreases early productions of cholesterol, mobilize cholesterol form tissues and increases excretion, lowers synthesis and secretions of lipoprotiens, lowers triglycerides |
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antilpidemic cholesterol absorption inhibitor?
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exetimine/Zetia
no absorption of cholesterol for small intestine, increase eliminations |
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What is a HMG_CoA Reductase Inhibitor?
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suffix: STATIN
no cholesterol, lowers LDL, increases HDL side effects: hepatoxicity (liver function), rhabdomyolysis (break down of muscle) Urine has brown color! need baseline renal function! |
