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91 Cards in this Set
- Front
- Back
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fluid in the cells 2/3 of total body fluid 40% of body weight |
intracellular space (intracellular fluid)
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Fluid outside of cell space 1/3 of totally body fluid 20% of body weight Intravascular, Intersitial, Trancellular |
Extracellular space (Extracellular fluid) |
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osmosis |
water moves from high water concentration to low water concentration (moves to where there are MORE solutes) |
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diffusion |
movement of solutes from high to low |
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active transport |
solutes moves from lower to higher, against concentration gradient (requires ATP) |
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Routes of Gain |
oral fluids food IV fluids tube feeding |
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Routes of Loss |
urinating sweating breathing GI |
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Intake = 2600ml |
oral liquids = 1300ml water in food = 1000ml water produced by metabolism = 300ml |
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output = 2600ml |
urine = 1500ml stool = 100ml lungs = 400ml skin = 600ml |
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obligatory output to eliminate waste |
400-600 ml/24 hours |
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pituitary gland |
hypothalamus produces ADH posterior pituitary store ADH ADH causes retention of water high osmolality or blood volume triggers thirst center and posterior pituitary to release ADH |
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adrenal glands |
decreased sodium in ECF or increases sodium in urine triggers aldosterone -aldosterone, acts on distal tubules to regulate sodium loss --- water follows sodium |
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RAAS (Renin-Angiotensin-Aldosterone-System) -activated with decreased blood pressure/decreased renal perfusion |
Kidney releases Renin, Liver releases angiotensinogen, act together to form Angiotensin I, moves to lungs where ACE converts to Angiotensin II, stimulates adrenals to release Aldosterone = results in vasoconstriction (increased BP) and sodium and water retention |
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Parathyroid Function |
regulates calcium and phosphorus |
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Atrial Natriuretic Peptide |
stretch of the atria r/t volume expansion stimulates release of ANP which decreases BP and volume |
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Brain Natriuretic Peptide |
stretch of the ventricles r/t volume stimulates release of BNP |
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1 liter of fluid equals |
1 kg of weight (2.2 lbs) |
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tools for assessing fluid balance |
body weight, I & O, BP, edema, lung sounds, JVD, serum osmolality, urine specific gravity BUN (normal 10-20, more fluid = low BUN) Creatinine (indicates renal function) Hematocrit (high hemat = low fluid) urine sodium studies |
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Crystalloids |
think salt crystals (small) Isotonic, hypertonic, hypotonic |
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Colloids |
larger molecules don't shift fluid around volume expanders remain within intravascular space longer Albumin, Dextrans |
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isotonic fluids |
no fluid shift 0.9% NaCl lactated ringer's 5% dextrose in water (D5W) -surgery and burns, blood loss during surgery |
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Hypertonic solutions |
higher solute concentration would cause cell shrinkage, pulls water out -D51/2NS, D5NS -3% or 5% NaCl |
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Hypotonic Fluids |
lower solute concentration would cause cells to swell, water moves in -0.25% NS -0.45% NS -D5W |
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Hypovolemia |
causes = GI suction, vomiting, diarrhea, sweating profusely, hemorrhage, adrenal insufficiency (sodium), SIADH -decreased skin turgor, oliguria, tachycardia, weak HR, hi specific gravity, dry mucous membranes, postural hypoTN, thirst, cool clammy skin, sluggish cap refill -IV fluids (isotonic, hypertonic) -increase salt intake (water follows salt) |
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Hypervolemia |
causes = renal failure, CHF, cirrhosis, excessive salt consump., SIADH -JVD, hi BP, tachycardia, crackles, SOB, wheezing, edema, weight gain, inc. urine output -Diuretics, IV fluids (hypotonic) -avoid salt, more protein -possible dialysis |
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Normal Sodium Values |
135 - 145 |
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Hyponatremia |
<115 (critical) -salt loss greater than water loss, excess of water relative to total body sodium -FVD or FVE -Restlessness, decr. LOC, irritability, confusion, lethargy, seizure, coma ***Incr. GI motility, nausea, cramping, diarrhea -osmotic diuretics -Declomycin (antagonized ADH) -IV saline (0.9%)
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Hypernatremia |
>160 (critical) -gain of salt in excess of water or loss of water -Restlessness, decr. LOC, irritability, confusion, lethargy, seizure, coma **Dry skin/mucous membranes, tongue furrows -loop diuretics, hypotonic IVF (to dilute) -Na restriction, H2O intake |
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Potassium normal values |
3.5 - 5.5 |
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Hypokalemia |
< 2.5 (critical) -muscle weakness, leg cramps, SOB, apnea, decr. peristalsis, N/V, constipation, abdominal distention, paralytic ileus, postural hypotension, v-fib, asystole -potassium supp., IV potassium (5-10mEq/hr), K sparing diuretics (spironolactone) -Fish, whole grains, veggies, fruits, coffee, OJ, TJ ***May be HYPOMAGNESIA if tx does not help! POT-MAG |
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Hyperkalemia |
>6.5 (critical) -increased GI motility, diarrhea, bradycardia, hypotension, tall T waves, muscle twitches, widened QRS -IV calcium gluconate (protects heart), **Kayexelate (poop it out, takes awhile) -Insulin (incr. activity of Na-K pump) -possible dialysis |
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Calcium Normal Values |
8.5 - 10.5 |
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Hypocalcemia |
<6.0 (critical) -prolonged bleeding time ***Trousseau's sign, Chvostek's sign, muscle twitches/spasms, laryngospasms, seizures -IV Calcium (diluted in D5W*), drugs to reduce muscle excit. -calcium replacement, dairy products, vitamin D, dark leafy greens, oatmeal, rhubarb, tofu |
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Hypercalcemia |
> 13.0 (critical) -faster clotting times (blood clots), cardiac arrest, initially hi HR & BP, then cardiac depression, decr. LOC, lo GI motility, constipation -IV saline (dilute), calcitonin/biphosphonates (prevents bones from releasing calcium), Caclium CHELAators (bind in blood to make Ca inactive) -Stop Ca and Vit D -possible dialysis |
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Magnesium normal values |
1.3 - 2.1 (13.21 inch needs mag) |
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Hypomagnesemia |
<1.0 (critical) -hyperreflexia, **Trousseau's sign, Chvostek's sign, tetany, seizures -IV magnesium, oral magnesium -green leafy veggies, nuts, avacados -often occurs with hypocalcemia |
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Hypermagnesia |
>4.7 (critical) **RARE** -hyporeflexia, lo HR, lo BP, cardiac arrest -IVF, loop diuretics, calcium gluconate (protects heart), stop magnesium |
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Phosphorus Normal Values |
2.5-4.5 (Phosphorus has 2 P's) |
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Hypophosphatemia |
< 1 (critical) -lo HR, weak pulses, Rhabdomyolysis (breaking down of muscle), hyporeflexia, decr. bone density -IV replaement (10mEq/hr, irritant) ***Phosphorus and Calcium inversely related! -when trying to incr. phosphorus, monitor for hypocalcemia! (CmPhorus)
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Hyperphosphatemia |
>9 (critical) HYPOCALCEMIA MANIFESTATIONS ***tetany |
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Chloride normal values |
97 - 107 -produced in stomach, acid base balance of plasma, formation of hydrochloric acid, food sources same as Sodium |
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Seizure precautions in |
Hypocalcemia Hyponatremia Hypomagnesia (Hyperphosphatemia)
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Tetany in |
Hypocalcemia Hypomagnesia Hyperphosphatemia
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Cullen's sign |
Ecchymosis (bruising) around belly button *means bleeding |
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Grey Turner's sign |
Ecchymosis on flanks and groin |
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Borborygmus |
High-pitched sounds/severe gastroenteritis |
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Malabsorption will cause |
decreased calcium |
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Vomiting, gastric suctioning, diarrhea, draining from intestinal fistulas will cause |
decreased Potassium (K) |
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Breath Test |
tests for H. Pylori, measures amount of CO2 (no antibiotics for a month) |
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Abdominal Ultrasound |
looks for fluid filled masses, pt. NPO for 6-8 hours prior |
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DNA Testing |
Crohn's Disease |
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Abdominal X-rays, MRI, CT |
can pick up on structural changes, simple tumors, or masses |
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esophageal acidity measurements |
NG tube into esophagus to wear for 24 hours, NG tube is connected to device, measures over 24 hour period. Or capsule is implanted into the esophagus that measures acidity and transmits data to office, passes in stool |
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Gastric Emptying Studies |
pt. has problems with N/V. done to see if patients food is emptying form the stomach into SI like it should. patient eats food with radioactive marker, monitor how it passes into duodenum |
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Esophagogastroduodenoscopy (EGD) |
fiberoptic flexible tube with camera down throat into stomach. view abnormalities, bleeding, inflammation. EGD can stop bleeding during the procedure. NPO prior. Must test gag reflex before allowing them to eat/drink, can have them swallow own saliva |
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barium enema |
use enema to insert barium into colon. looking for masses and tumors. push PO fluid after to flush |
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Lower Endoscopy (colonoscopy) |
must be on clear liquid 24 hours before procedure, and have to be NPO 6-8 hours prior. can remove polyps during procedure. Report s/s of perforation |
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Functions of stomach |
Digestive organ Endocrine Organ Reservoir |
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Causes of Gastritis (acute and chronic) |
H. Pylori, long term NSAID use, alcohol, caffeine, steroids, chocolate, stress, reflux of bile salts |
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Manifestations of Acute Gastritis |
Epigastric pain (rapid onset), N/V, anorexia, cramping, dyspepsia, hematemesis or melena |
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Chronic Gastritis |
persistent inflammation deep into mucous, gastric walls thin and atrophy, N/V, discomfort after eating, abdominal pain |
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Diagnosis of gastritis |
EGD with biopsy (gold standard) or blood samples (when suspected h. pylori) |
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H2 Receptor Antagonist *Treatment of Gastritis |
H2 receptor antagonist = histamine, block production of histamine acid (Zantac)
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Sucralfate (Carafate) *Treatments of gastritis |
prevent ulcer formation, or coat ulcer w/ viscous layer |
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Antacids *Treatments of Gastritis |
alter pH in stomach, decrease acidity. Must be given on an empty stomach. 1 hour before meals or 2 hours after meals. (Mylanta, Maalox) May have magnesium (diarrhea) or aluminum (constipation) |
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Proton-pump Inhibitor *Treatments of gastritis |
trying to privet production of acid (Protonix, Nexium) |
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Antimicrobial *treatments of gastritis |
aimed to treat H. pylori (Flagyl, Biaxin, Amoxicillin) *antibiotics may be coupled with a proton pump inhibitor |
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Surgery in severe cases of gastritis |
vagotomy (decreases acid production) gastrectomy (partial removal of the stomach) |
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Gastric Cancer causes |
-h. pylori infection -chronic gastritis -gastic polyps -diet (nitrosamines-cancer causing agent) pickled foods, low intake of fruits and veggies, highly smoked and salted foods, processed foods -genetic link |
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Gastric Cancer manifestations |
Early -asymptomatic -indegestion -abdominal discomfort
Advanced -N/V, weakness, fatigue, anemia, weight loss, occult blood, Virchow's nodes (distant metastasis, nodes in superclavicular area), Blumer's Shelf (distant metastasis, palpable mass in vagina or rectum), Sister Mary Joseph (distant metastasis, nodes around peri-unbilical area), hepatomegaly |
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Gastric Cancer diagnostic |
EGD with biopsy Endoscopic ultrasound CT abd/chest/pelvis |
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Gastric Cancer Treatment |
Chemotherapy-Cisplatin & Epirubicin Radiation-For palliative management when surgery not an option
Surgery-subtotal or total gastrectomy Gastroenterostomy-if the cancer is more localized to the area of the stomach before emptying into duodenum, remove upper stomach to jejunum |
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Gastrectomy |
primary surgical procedure for gastric cancer partial or total omentum, spleen, and lymph nodes removed |
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Pyloroplasty |
open the pyloric sphincter to allow contents to flow easily into the duodenum from the stomach |
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Gastroenterostomy |
tumors at gastric outlet passage created between body of stomach and small intestine |
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Complications specific to gastric surgery |
Dumping syndrome-concerned about fluid shifts Afferent loop syndrome-refers to issues with a bypassed duodenum, severe abdominal pain, N/V, bloating, requires surgical procedures Delayed gastric emptying-scare tissue preventing movement Stump leakage-bypassed duodenum, issue with contents leaking from closing of duodenum Vitamin B12 and iron deficiency-intrinsic factor Calcium and Vitamin D deficiency |
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Dumping Syndrom |
Rapid stomach emptying dumps food into small intestines and causes distention
Early=30 min (severe abdominal pain, vertigo) Late-1.5-3hrs (insulin release)(high sugar/carb meal.... mimics hypoglycemic state, diaphoretic, confused |
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Afferent loop syndrome |
Duodenal loop becomes partially obstructed, requires surgical correction |
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Irritable Bowel Syndrome |
-impairment in motor function of GI tract without changes in the mucosal lining -abdominal pain assoc. relieved by defecation -abdominal pain assoc. with changed in stool frequency or consistency -abdominal distention -sensation of incomplete evacuation -presence of mucous with stool Contributing factors -diverticular disease, diet (caffeine, fat, lactose allergy), stress/anxiety/depression, smoking Exacerbated by stress, psychological factors and food intolerances
LLQ pain, nausea/pain at mealtime and defecation, cramps abdominal pain with diarrhea/constipation, belching/gas/anorexia/bloating, diffuse tenderness of abdomen, stable weight, no altered labs |
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Medications for IBS |
anticholinergics/antispasmodics--Dicyclomine (Bentyl) slow down peristalsis
Muscarinic receptor antagonist--Darifenacin (Enablex) prevent overaction of the muscle of the GI tract
Anti-Diarrheal--Immodium or Lomotil, also Alosetron (Lotronex)
Constipation--bulk forming laxatives (Metamucil)
Tricyclic Antidepressants--Paroxetine (Paxil) |
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Diverticular Disease |
Diverticula--hypertrophy and thickening of colon; muscle weakness leading to pouch like herniations in the intestinal wall
Diverticulosis--NonInflamed diverticula are present, may not have symptoms
Diverticulitis--inflamed diverticula, something trapped in tiny herniations
-Result of decreased fiber in diet and aging process
Asymptomatic (diverticulosis) Abdominal Pain over involved area (LLQ, descending colon) N/V low grade fever Chills increased heart rate
Diagnostics--elevated WBC, Decreased H/H (bleeding), positive occult stool, CT scan, Colonoscopy |
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Treatments for Diverticulitis |
Rest Drug Therapy--anagesic (pain), Broad spectrum antibiotics, IVD for dehydration (from diarrhea), Anticholinergics (reduce secretions), Avoid enemas and laxatives Nutrition--low fiber or clear liquids, NPO, NGT
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Crohn's Disease |
Chronic, nonspecific inflammation of the colon, small intestine, or both ***Terminal ileum most affected of small intestines ***Multiple regions of intestines involved with normal sections in between (skips) Thickening of bowel wall, strictures, deep fissures, and ulceration--fistulas -Severe malabsorption -Intestinal Obstruction
Diarrhea (non-bloody), steatorrhea (fatty stools), Abdominal pain (crampy, LLQ-terminal ileum) Low grade fever weight loss inspect abdomen for increased distention, masses, or visible peristalsis -Inspect perianal area for ulceration or fissures, fistulas
Labs---folic acid decr., vitamin b12 decr., elevated ESR (erythrocyte sedimentation rate, indicative of inflammation), incr. WBC, Anemia-low H&H due to malnourishment/malabsorption
Colonoscopy--definitive diagnostic |
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Ulcerative Colitis |
Chronic diffuse inflammation of mucosal lining of colon & rectum -Cause unknown: genetic? auto immune? -mild to severe disease ***begins at rectum and spreads up the colon in CONTINUOUS pattern -Chronic UC disease causes cellular changes and incr. risk of colon cancer
-bloody/mucus diarrhea (anemic), Tenesmus (unpleasant feeling of bowel urgency), Low abd. pain (colicky), malaise, anorexia, weight loss
Labs--low H&H (bleeding), incr. WBC, incr. ESR, incr. platelet count (due to inflammatory process), low K, Chloride, and sodium, Hypoalbuminemia (losing protein)
Colonoscopy--definitive diagnostic test |
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Aminosalicylates *treatment for Crohn's and UC |
inhibit prostoglandin synthesis (to decrease inflammation) **Take after meals and with lots of water |
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Glucocorticoids *treatment for Crohn's and UC |
suppresses inflammation **side effects with long term use, hyperglycemia, osteoporosis, PUD and higher risk for infection |
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Immunomodulators *treatment for Crohn's and UC |
immunosuppressive, interferes with DNA synthesis ***side effects |
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Proctocolectomy *treatment for Crohn's and UC |
-colon, rectum, and anus removed with closure of anus -terminal ileum forms the stoma (RLQ) -Ileostomy adaptation occurs over time (loose watery output)=small intestine absorbs Na & Water, stool volume decr., becomes thicker, yellow-brown, little odor (sweet, foul smell=problem)
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Total colectomy with continent ileostomy *treatment for Crohn's and UC |
-surgeon creates an internal pouch from terminal ileum -Kock's ileostomy or ileal resivoir -Teach client to drain with catheter -Client will feel full -Watch skin problems |
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Total colectomy with ileoanal anastomosis (ileoanal reservoir-J pouch) *treatment for Crohn's and UC |
-surgeon sutures ileum into the anal canal -spares the rectal sphincter, no need for ostomy -2 phases = removal with temporary ileostomy to allow healing, 3-4 months loops ileostomy is reversed (closed) -Stool formation similar to traditional ileostomy |
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Colorectal cancer |
-colon and rectum -most are believed to arise from adenomatous polyps -can metastasize by direct extension or spreading through blood or lymph (common sites: liver, lungs, brain, bones, adrenal glands
Risk factors = age (>50), genetic (Familial adenomatous polyposis, hereditary nonpolyposis CRC), dietary factors (hi fat, lo fiber), IBS (UC and Crohn's)
Rectal bleeding (microscopic amounts, dark colored stool, bright red blood "hematochezia") Anemia Change in stool Abdominal fullness, gas, cramping, incomplete evacuation, weight loss
Labs--H&H decr., FOBT+, CEA, direct visualization per colonoscopy |
