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112 Cards in this Set
- Front
- Back
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What hormones could be released when someone is dehydrated? |
ADH released - BP increases Aldosterone released - BP increases |
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Sodium Potassium Pump |
-cell controls [Na] and [K] |
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Renal damage can cause |
lyte imbalances! |
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Kayexalate |
-supplement given when [K] is too high -it makes the kidneys excrete K -causes frequent, loose BM |
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Bone tumors and Ca |
-causes bone resorption -increases level of Ca in blood |
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Albumin and oncotic pull |
-always has oncotic pull -fluid always follows -usually in blood stream |
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High albumin could indicate |
dehydration |
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pH/PCO2 |
Hydrogen - Carbon dioxide *acidic More hydrogen = acidic Less hydrogen = alkalinic/basic
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Low pH/paCO2
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Basic |
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Bicarbonate(HCO3) |
-Produced by kidneys More = Basic Less = Acidic |
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ADH action |
-antidiuretic hormone -increased the ECF or lowers the [solute] by reabsorption of H2O in kidneys |
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Calcitonin action
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-released by thyroid -when Ca serum levels are high -lowers levels by: -decreasing loss of Ca from bone -renal excretion of Ca -opposes action of PTH |
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PTH action
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-Parathyroid hormone -When Ca serum levels are low -increased levels by: -increasing absorption in intestines -increases resorption from bone -increases reabsorption in kidneys -decreases excretion in kidneys |
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3 Stress Hormones |
-adrenaline -norepinephrine -cortisol |
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Stress hormones action |
-causes vasoconstriction
-BP, HR increases -increased perfusion to core organs |
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Why does polyuria occur with high blood sugar? |
Water follows glucose as excess is excreted by kidneys *fluid follows solute |
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What causes cortisol to be released? |
-stress -hypoglycemia |
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Action of Cortisol |
-cortisol released -liver converts amino acids to glucose -blood sugar rises *sugar = energy |
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Affect of aldosterone |
-Raises BP and Na serum levels by reabsorption of Na in kidneys and H2O follows Na -K serum levels drop because K is excreted from kidneys |
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3 fluid spaces of the body |
-ICF -ECF -transcellular |
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Hydrostatic Pressure |
-pressure against wall of vessel or organ -if pressure is too high (BP) then fluid gets pushed out of vessel and can cause edema |
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Oncotic Pull |
-the pull of the direction that osmosis flows in More solutes = more oncotic pull |
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What type of solution is appropriate to give a patient for vomiting or diarrhea?
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isotonic -to replace isotonic fluid lost
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What type of solution is appropriate for severe dehydration? |
hypotonic -fluid shifts from ICF to ECF |
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What type of solution is appropriate for cellular edema? |
hypertonic -fluid shifts from ECF to ICF |
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Where is Na primarily found? |
ECF |
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Major functions of Na |
-ECF osmolality -regulates nerve impulses -acid base balances |
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How is Na regulated? |
-GI tract -Renal via: aldosterone, ADH |
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Increased Na intake S/S |
-CNS alterations (due to cell shrinkage)
-increased BP (due to fluid retention) -edema (due to hydrostatic pressure) |
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Increased Na intake Tx |
-restrict Na -IV DSW -PO H2O -diuretics for Na excretion |
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Increased Na serum levels |
-serum becomes hypertonic -fluid drawn into ECF from ICF -fluid retention -cell shrinkage |
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Increased Na from H2O loss |
-shift from ICF to ECF -CNS alteration due to cell shrinkage -decreased BP *replenish fluids |
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Decreased Na due to low intake or renal losses
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-fluid shifts from ECF to ICF causing edema
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Decreased Na due to fluid overload |
-BP increases - increased hydrostatic pressure -fluid leaks into pulmonary vessels -pulmonary edema (crackles and decreased air entry at bases) |
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Primary functions of K |
-nerve impulses -cardiac rhythms -muscle contractions -acid base balance -ICF osmolality |
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Possible causes of increased K serum |
-potassium sparing diuretics -increased intake -renal failure -acidosis -decreased aldosterone production |
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Tx for high K serum |
-decrease intake -use non-K sparing diuretics -dialysis -resolve acidosis (insulin for short term) -calcium gluconate (decreases cardiac cell excitability) |
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Causes for decreased serum K |
-vomiting -diarrhea -NG suction -alkalosis -renal losses -lasix -hyperaldosteronism -starvation(decreased intake) |
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Altered K serum levels can cause
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cardiac arrythmias |
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Where is K found? |
ICF |
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Tx for low K levels |
-PO or IV K -increase K in diet -K sparing diuretic |
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Functions of Ca |
-nerve impulses -muscles contractions -blood clotting -bone and teeth formation |
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Causes of increased levels of Ca |
-increased vitamin D -increased PTH -Bone tumours -decreased mobilization -some diuretics |
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Increased levels of Ca can cause |
-confusion -weakness -dysrhythmias |
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Tx for increased Ca levels |
-pomidronate (decreases bone resorption) -isotonic solution to flush Ca out -lasix -decrease in diet -synthetic calcitonin -increase activity to decrease bone resorption |
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Causes of decreased Ca levels |
-decreased intake -decreased PTH -pancreatitis -lasix |
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Decreased Ca levels can cause
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-muscle rigidity (tetany) -cardiac arrythmias |
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Tx for decreased Ca levels |
-oral or IV Ca -increase vitamin D -diuretic |
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Increased Mg causes |
-CNS/neuromuscular dysfunction -decreased LOC -decreased HR -decreased cardiac function |
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Increased Mg is caused by |
-increased intake -renal failure |
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Tx for increased Mg |
-dialysis -increase fluids -Mg restriction -IV calcium gluconate |
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Decreased Mg causes |
-neuro/muscular dysfunction -cardiac arrythmias |
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Decreased Mg can be caused from |
-diuretics -starvation -alcoholism(decrease Mg intake and increase diuresis) -GI fluid loss = decreased Mg absorption -increased blood sugar = increased diuresis |
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Tx for decreased Mg |
-CIWA and ativan (for alcoholism) PO or IV Mg |
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Decreased albumin caused by |
-liver dysfunction -burns |
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What happens when serum albumin levels are low? |
-fluid shifts from vessels to tissues causing edema and ascites |
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Tx for low serum albumin |
-increase carb/protein intake (except with liver failure) -albumin transfusion |
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Increased serum albumin |
-can indicate dehydration -tx by replacing fluids |
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At what acidity does the cell start losing function?
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7.25 and lower |
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At what acidity does cell death occur? |
6.8 |
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At what alkalinity does cell death occur? |
7.8 |
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At what alkalinity does the cell start to lose function? |
7.55 and higher |
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Resp Acidosis Process |
-decreased ventilation
-increased CO2 buildup -increased H in blood -decreased pH (acidosis) *kidneys start to compensate in 24hrs -conserve bicarbonate -increased H excretion |
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Tx Resp Acidosis
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-restore ventilation -Bicarb IV |
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Resp Alkalosis Process |
-hyperventilation
-excessive CO2 exhaled -increased pH (alkalosis) *eventually kidneys compensate -bicarb excretion -H retention |
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Tx Resp Alkalosis |
-restore ventilation (resolve pain or anxiety?) |
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Causes of Metabolic acidosis |
-Diabetic Ketoacidosis (DKA) - ketones = acidic -Shock - anaerobic metabolism - increased lactic acid -diarrhea - loss of alkaline enzymes -renal disease - bicarb loss and H retention |
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What happens with metabolic acidosis |
-resp compensation -increased RR -excretes CO2 *tires out too quickly |
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Causes of metabolic alkalosis |
-NG suction -vomiting -decreased bicarb excretion |
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What happens in metabolic alkalosis? |
-RR compensation -decreased RR -increase CO2 retention -Renal compensation -renal excretes bicarb |
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ABG |
arterial blood gases -pH -PCO2 -HCO3 -PO2 |
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Na-K pump - Acidosis |
-excess H in ECF -H flows into ICF *to keep electrical charge neutral, K is kicked out of the cell = increased serum K |
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Na-K pump - alkalosis |
-low H in ECF -H flows into ECF from ICF *to keep electrical charge neutral, K moves into ICF = decreased serum K |
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Ulcerative Colitis |
-inflammation of Colon only |
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Crohn's |
inflammation is most often ileum and colon -may occur anywhere in GI tract |
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Inflammation in GI tract |
-tissues thicken and narrow lumen -can cause obstruction |
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Ulcers in GI tract |
Risk for perforation -can lead to sepsis or peritonitis(inflammation of abd cavity lining -can lead to hemorrhage *leads to shock Risk for decreased absorption -dehydration -lyte imbalance |
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Inflammation |
-fibrotic tissue formation (scarring) -tissues thicken -decrease function of cell or tissue -adhesions (things stick together) |
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S/S inflammatory bowel syndrome |
-decreased or absent bowel sounds -hyperactive bowel sounds before area of obstruction -nausea and vomiting -abd distention -malaise -anorexia/weight loss -pain/cramps -diarrhea -lyte imbalance |
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anaerobic metabolism |
-when cells are deprived of oxygen and nutrients -cells function without and produce lactic acid |
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Gastroenteritis S/S |
-abd cramping and distention -diarrhea (bloody mucous in school) -nausea and vomiting -fever (increased WBC) |
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Gastroenteritis causes |
-parasite -virus -bacteria |
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Gastroenteritis Tx |
-treat cause -universal precautions (gown and glove) -antipyretics -imodium (except for cdiff) -antiemetics -lytes-fluid replacement -NPO -monitor ins and outs |
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Irritable bowel syndrome s/s |
pain, cramps, diarrhea, bloating, constipation |
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Inflammatory Bowel Syndrome Causes |
-virus -bacteria -stress -genetics -autoimmune response -allergies -enviorment |
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Tx for inflammatory bowel syndrome |
-surgery (remove colon/SI) -treat symptoms *crohn's can appear anywhere in the GI tract even after surgery |
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Mechanical Obstruction causes |
-neoplasms (tumors) -adhesions(secondary to inflammation) -hernia pressing on lumen -twisting of sigmoid |
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Mechanical obstruction Tx |
-surgery -chemo or radiation (for tumour) Treat s/s -NG tube -analgesics -IV fluids -bowel rest (NPO) -TPN if needed |
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Causes of Non-mechanical Obstruction |
-abdominal surgery -meds (analgesics and anaesthetics) -shock (reduced blood supply) -inflammation (colon, appendix, pancreas) -thoracic and lumber fractures |
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non-mechanical obstruction patho |
-decreased or absent parastalsis |
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Paralytic ileus |
most common type of non-mechanical obstruction |
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Non-mechanical obstruction Tx |
-usually resolves on its own -surgery? |
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Peptic Ulcer Disease Tx |
-histamine-2 receptor blocker -proton pump inhibitor -antacids -anticholinergics -cytoprotective drug |
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Histamine-2 receptor blocker |
-blocks action of histamine-2 -decreases HCl -decreases conversion of pepsinogen to pepsin (digestive enzyme) -increases healing |
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Proton pump inhibitor |
-blocks adenosine triphosphatease enzyme (ATPase) -decrease HCl -decreases conversion of pepsinogen to pepsin (digestive enzyme) -increases healing |
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Antacids |
-decrease HCl secretions -decrease damage -increase healing |
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What is the duration of antacids? |
-20-30 mins when taken without food -3-4 hours when taken with food |
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Cytoprotective drug therapy |
-pretects mucosal cells -most effective in low pH and 30 min AC or PC antacids |
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Appendicitis patho |
-fecalith (accumilation of feces) -edema, venous engorgement, invasion of bacteria -gangrene an perforation -peritonitis -shock |
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Appendicitis Tx |
-removal of appendix or debris in peritoneum |
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Appendicitis S/S |
-increased WBC -acute pain to RLQ -nausea -anorexia -fever? |
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Diagnostics for colorectal cancer |
-pt over 50 years or at risk -fecal occult blood (yearly) - sigmoidoscopy (every 5 years) -colonoscopy for high risk -fecal immunochemical test (every 2 years) |
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Hemicolectomy |
-removal of portion of colon -immediate anastamosis or temp colostomy |
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Anterior resection
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-sigmoid colon and rectum removed -immediate anastomies or temp colostomy |
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Lower anterior resection
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-only rectum removed -immediate anastomies or temp colostomy |
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APR - abdominal perineal resection |
-through abd and perineum -colon, rectum and entire anal sphincter removed -permanent colostomy abd and perineal wounds |
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Total proctolectomy
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-removal of colon and rectum, anus is closed -permanent ileo |
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Total proctolectomy and ileal pouch |
-removal of colon and rectum, distal ends of small intestine made into a pouch and sewn to working anus muscles -reversible ileostomy *ileal pouch will pass 3-6 pasty BMs/day |
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Hartmann's pouch |
-Proximal bowel is a stoma -distal bowel sewn closed for possible future anastomosis |
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True or false: Hypokalemia is one of the most common electrolye inbalances. |
True! |
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Which pt is at most risk of FVDs (fluid volume deficits)? |
Patients who are very young or very old are at greater risk for fluid, electrolyte and acid-base imbalances. |
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What medication CANNOT be given directly IV? |
Potassium Chloride (KCL) |
