Med Surg Test 2

Front 1

1 L =

Back 1

2.2 kg = 1lb

Front 2

normal level of sodium

Back 2

135- 145

Front 3

HYPERnatremia

Back 3

restlessness, agitation, twitchings, seizures, coma, thirst, dry swollen tongue, weakness lethargy, may have edema, bp changes. Caused by insensible H2O loss, diarrhea, DM, cushings, DM, diabetes insipidus, near drouning in salt water. Hypernatremia causes hyperosmolality, which causes a shift of H2O out of cells... dehydration. primary protection is the thirst center.

Front 4

HYPOnatremia

Back 4

irritablity, apprehension, confusion, dizziness, personality changes, tremors, seizures, coma, tachycardia, thready pulse, cold clammy skin, HA, muscle spasms, Caused by diarhea, vomiting, NG suction, diuretics, renal disease, fasting diets, excessive hypotonic IV fluids, heart failure. Causes H2O shift into cells. neurological problems. Possible fluid restrictions. give hypertonic solutions. check for fluid overload and pulmo edema.

Front 5

normal potassium level

Back 5

3.5- 5.0

Front 6

HYPERkalemia

Back 6

98% of body's K+ is in cells. neuromuscular and cardiac functions. diet is primary source of K+. Caused by excessive parenteral admin, excess K+ containing drugs, K+ salt substitute, acidosis, crash injury, fever, sepsis, burns, renal disease, K+ sparing diuretics, ACE inhibitors (prils). S/SX: irritability, anxiety, abd cramping, diarrhea, weak lower extremities, paresthesias, irregular pulse, cardiac arrest if hyper sudden or severe, tall peaked T wave, prolonged PR interval, ST depression, loss of P wave, widening QRS, V-fib, ventricular standstill.

Front 7

HYPOkalemia

Back 7

tx for diabetic ketoacidosis can cause hypoK+, digoxin levels can become toxic(TEST), K+ very caustic to veins- always dilute!, potassium chloride given to death row inmates. caused by diarrhea, vomiting, diuretics, magnesium depletion, diaphoresis, dialysis, increased insulin, alkalosis, tissue repair, epinephrine, starvation, if NPO need to include K+ in parenteral fluids. S/SX: fatigue, muscle weakness, leg cramps, nausea, vomiting, soft flabby muscles, weak irregular pulse, polyuria, hyperglycemia, ST segment changes, flattened T wave, presence of U wave, ventricular dysrhythmias, bradycardia, enhanced Dig effects

Front 8

normal level of calcium

Back 8

8.5-10.5

Front 9

HYPERcalcemia

Back 9

stored in skeletal sys, regulates heart function, muscles, nerves, can be caused by hyperparathyroidism or tumor, controlled by PTH, calcitonin lowers CA levels, give 3-4 L to help excrete, Caused by MS, malignancies with bone metastasis, prolonged immobilization, hyperparathyroidism, vit D overdose, thiazide diuretics, acidosis. S/SX: lethargy, weakness, depressed reflexes, decreased memory, confusion, personality changes, anorexia, bone pain, fractures, polyuria, dehydration, stupor, coma, shortened ST segment, shortened QT interval, ventricular dysrhythmias, increased digitalis effect

Front 10

HYPOcalcemia

Back 10

damaged Parathyroid gland, pancreatitis, tetany can occur,calcium gluconate given,Caused by chronic renal failure, elevated phosphorus, hypoparathyroidism, vit D deficiency, magnesium deficiency, furosemide, chronic alcoholism, diarrhea, decreased serum albumin, alkalosis. S/SX: easy fatigability, depression, anxiety, confusion, numbness and tingling in extremitites and around mouth, hyperreflexia, muscle cramps, chvosteks sign (contraction of face), trousseaus sign(carpal spasm), tetany, seizures, elongationi of ST segment, prolonged QT interval, ventricular tachycardia.

Front 11

normal range for magnesium Mg++

Back 11

1.7-2.2 , proper level is important for cardiac function

Front 12

HYPERmagnesemia

Back 12

causes: renal failure, excess administration of magnesium give for eclampsia, adrenal insufficiency, can be r/t CA and K+ imbalances. Magnesium is in: green veggies, chocolate, PB. increased Mg++ is and emergency treated with calcium chloride. check deep tendon reflexes. s/sx: depression of neuromuscular and CNS function.

Front 13

HYPOmagnesemia

Back 13

Causes: diarrhea, vomiting, chronic ETOH use, impaired GI absorption, malabsorption syndrome, prolonged malnutrition, large urine output, NG suction, poorly controlled DM, hyperaldosteronism. s/sx neuromuscular and CNS hyperirritability

Front 14

normal range of pH

Back 14

7.35-7.45

Front 15

normal range of PaO2

Back 15

80-100

Front 16

normal range of PaCO2

Back 16

32-48

Front 17

normal range of HCO3

Back 17

22-26

Front 18

what is metabolic alkalosis?

Back 18

loss of acid or increase in bicarb. s/sx: dizziness, irritability, confusion, nervousness, tachycardia, dysrhythmias, nausea, vomiting, anorexia, tetany, tremors, tingling of fingers/ toes, muscle cramps, seizures, hypoventilation. R/T: loss of acid (prolonged vomiting or gastric suction) or a gain in bicarb (ingesting baking soda)

Front 19

what is metabolic acidosis?

Back 19

bicarb deficit, accumulation of acid (diabetics: ketones) s/sx: drowsiness, confusion, headache, dysrhythmias, decreased bp, warm flushed skin, nausea, vomiting, kussmaul respirations(deep quick)

Front 20

what is respiratory alkalosis?

Back 20

hyperventilation; CO2 is released- often with anxiety. s/sx: lethargy, light headedness, confusion, tachycardia, dysrhythmias, nausea, vomiting, tetany, numbness, tingling of extremities, hyperreflexia, seizures, hyperventilation.

Front 21

what is respiratory acidosis?

Back 21

hypoventilation CO2 build up; often seen in COPD. s/sx: drowsiness, disorientation, dizziness, headache, decreased BP, warm flushed skin, dysrhythmias, seizures, coma, hypoventilation.

Front 22

ROME

Back 22

respiratory= opposite;
· pH is high, PCO2 is down (Alkalosis).
· pH is low, PCO2 is up (Acidosis).

metabolic= equal;
· pH is high, HCO3 is high (Alkalosis).
· pH is low, HCO3 is low (Acidosis).

Front 23

fluid volume deficit s/sx

Back 23

restlessness, drowsiness, lethargy, confusion, thirst, dry mouth, decreased skin turgor, decreased cap refill, postural hypotension, increased pulse, decreased output, concentrated urine, increased resp rate, weakness, dizziness, wt loss, seizures, coma

Front 24

fluid volume overload s/sx

Back 24

headache, confusion, lethargy, peripheral edema, distended neck veins, bounding pulse, increased BP, polyuria, dyspnea, crackles(rales), pulmo edema, muscle spasms, wt gain, seizures, coma

Front 25

tx for fluid deficit

Back 25

correct underlying cause and replace lost H2O and electrolytes. balanced IV solutions such as LR or isotonic (0.9%) sodium chloride or blood when indicated.

Front 26

tx for fluid excess

Back 26

removal of fluid without affecting electrolyte composition or osmolarity of ECF. primary cause identified and treated, diuretics, fluid restriction, restricted Na+ at times.

Front 27

tx for HYPERnatremia

Back 27

treat underlying cause, iv 0.5% dextrose in H2O or hypotonic saline. rapid correction can cause cerebral edema. diuretics given. Na+ restriction.

Front 28

tx for HYPOnatremia

Back 28

fluid restriction, at times small amts of hypertonic saline given (0.3%). give sodium containing solutions.

Front 29

tx for HYPERkalemia

Back 29

eliminate K+ oral intake, increase elimination of K+ (diuretics, dialysis, kayexalate), force K+ from ECF to ICF by using insulin along with glucose, IV sodium bicarb, give calcium gluconate

Front 30

tx for HYPOkalemia

Back 30

giving K+ chloride supplements, increase K+ dietary intake, KCL supplements may be given orally or IV. KCL is NEVER given unless there is urine output of at least 0.5ml/kg. KCL given slowly to prevent hyperkalemia and cardiac arrest. VERY CAUSTIC TO VEINS

Front 31

tx for HYPERcalemia

Back 31

promotion of excretion by loop diuretic(Lasix) and hydration with isotonic saline. drink 3000-4000ml of fluid a day. synthetic calcitonin may be given.

Front 32

tx for HYPOcalemia

Back 32

primary tx is to treat the cause. tx with oral or IV CA supplements. CA not given IM b/c it may cause severe local reactions such as burning, necrosis, tissue sloughing. calcium carbonate may be used PO when diet isn't high enough in CA.

Front 33

tx for HYPERmagnesemia

Back 33

focus on prevention... persons with kidney diseases shouldn't use magnesium containing drugs such as MOM. emergency tx is IV admin of calcium chloride or calcium gluconate to oppose effects of Mg++. Renal impaired pt. may need dialysis.

Front 34

tx for HYPOmagnesemia

Back 34

oral supplements increased dietary intake of foods high in Mg++ (green veggies, nuts, bananas, oranges, PB, chocolate) . if severe IV or IM mag sulfate may be given SLOWLY r/t chance of cardiac or respiratory arrest.

Front 35

risk factors for laryngeal CA

Back 35

90% in people 50 years or older after prolonged use of tobacco and ETOH. other factors- diet poor in fruits and veggies, and infection by HPV. males are affected 2-5x greater rate than women.

Front 36

s/sx of laryngeal CA

Back 36

vary with location. laryngeal rarely produce early s/sx. usually diagnosed in late stages. pt may complain of persistent unilateral soar throat or otalgia (ear pain). hoarseness may be an early sign. may have lump in throat or change in voice.

Front 37

tx for laryngeal CA

Back 37

radiation with early stages, chemo for later stages, cordectomy(partial removal of cord), hemilaryngectomy(full removal of one cord or part of cord, requires temp trach.), supraglottic laryngectomy (removing structures above the true cords- the false cords and epiglottis, left as high risk for aspiration and requires temp trach), total laryngectomy, radical neck dissection(to decrease chance of lymphatic spread), or modified neck dissection.

Front 38

osteoarthritis risk factors and s/sx

Back 38

old age, female, decreased estrogen, genetics, obesity, ACL injury. s/sx: joint pain that worsens with use, in advanced disease may be present at rest and interfere w/ sleep, crepitation, usually involves DIP and PIP and MCP joints of hands, hips, knees, and MTP joint of foot, cervical and lumbar vertebrae.

Front 39

heberden's and bouchard's nodes

Back 39

heberden's: DIP
bouchard's: PIP

Front 40

diagnostics for osteoarthritis

Back 40

CT, MRI, xray, synovial fluid studies

Front 41

tx for osteoarthritis

Back 41

rest and joint protection, heat and cold application, nutritional therapy and exercise, wt loss, drug therapy- APAP 3000mg/day max, capsaicin, bengay, aspercream, NSAID such as Motrin(IBU), Celebrex, doxycycline(vibramycin). complementary therapies: yoga, massage, glucosamine

Front 42

RA risk factors and s/sx

Back 42

occurs globally, affecting all ethnic groups, incidence increases with age, women 3x more likely. cause is unknown. autoimmune etiology is most widely accepted. genetic predisposition. s/sx: fatigue, anorexia, wt loss, stiffness(general). - bone and cartilege erosion, breakdown of synovial membrane, contractures, subluxation. 4stages. systemic s/sx: 1. rheumatiod nodules-high tiders of RA antibodies can break down et become infected. 2. Sjogren's syndrome: 10-15% of RA pts; diminished salivary et lacrimal secretions. 3. Felty syndrome: Most often with pts with nodules; enlarged spleen, lymphnodes, blood disorders, etc.

Front 43

complications of RA

Back 43

joint destruction, contractures and deformities, decreased grasp strength, nodular myositis and muscle degeneration, pain, cataracts, nodule ulceration

Front 44

diagnostics for RA

Back 44

Rheumatoid factor, ESR et CRP (indicate inflammation), ANA (antinuclear antibody titers)

Front 45

drug therapy for RA

Back 45

methotrexate(rapid antiinflammatory effects), Sulfasalazine, plaquenil

Front 46

normal phosphate level

Back 46

3.0-4.5
opposes calcium!
calcium up: phosphate down
helps with function of RBCs and nervous sys. Source: dairy. renal failure can lead to hyperphosph.

Front 47

HYPERphosphatemia

Back 47

hypocalcemia, tetany, calcium phosphate deposits in tissues. tx: finding underlying cause, restricting dairy, correction of hypocalcemic condition, hydration.

Front 48

HYPOphosphatemia

Back 48

cns dysfunction, muscle weakness, wasting, cardiac problems

Front 49

ankylosing spondylitis

Back 49

HLA- B27 antigen 80-90% of cases. more common in men, milder in women. onset 15-35 y.o. s/sx: low back pain, stiffness, limited motion, uveitis (intraocular inflammation). affects axial skeleton. eventually neck remains fixed with rigid lumbar and thoracic kyphosis

Front 50

psoriatic arthritis

Back 50

arthritis involving small joints of hands and feet, asymmetric arthritis in joints of extremities, symmetric polyarthritis resembling RA, arthritis of sacroiliac joins and spine, or arthritis mutilans(rare but deforming)

Front 51

reactive arthritis

Back 51

(reiter's syndrome) more common in men. associated w/ a symptom complex that includes urethritis, conjunctivitis, and mult mucoutaneous lesions. also cervicitis. can be caused by chlamydia. usually a symmetric. Doxycycline given- ABX for up to 3 months

Front 52

septic arthritis

Back 52

microorganism in joints, staph most common. knee and hip joint most common. treat quickly to avoid damage. culture and treat with ABX. monitor fever, joint pain, inflammation. immobilization helps with pain.

Front 53

Lyme disease

Back 53

spirochetal infection caused by borrelia burgdorferi and transmitted by deer ticks. s/sx: erythema migrans- skin lesion that occurs @ site, starts as red macule and expands to a lg round lesion with bright red border and central clearing. viral like symptoms: swollen nodes, fever, chills, stiffness, HA, joint and muscle pain. diagnosis: EIA positive with western blot confirmation. TX: ABX; doxycyline, amox, seftin, iv rocephin.

Front 54

Gout

Back 54

Uric acid level NOT diagnostic! accumulation of uric acid or under excretion or increased intake of purine rich foods. Primary gout: hereditary or overproduction of uric acid (90% of pts). can occur when taking HCZ lasix. can be transplant reaction. Secondary gout: chemo, meds, diet intake. Risk factors: obesity, HTN, thyozide diuretics, ETOH use, prolonged fasting, impaired kidney function. Purines: fish, seafood, meats, sweetbreads. TX:bed rest, joint immobilization, foot cradle, antiinflammatory drugs, colchicine, corticosterroids, allopurinol.

Front 55

podagra.

Back 55

buildup of uric acid in big toe

Front 56

tophi

Back 56

sodium urate crystal deposits

Front 57

SLE

Back 57

multi sys inflam disease. skin, joints, serous membranes, neuro, hepatic, et renal sys. hormones play lg role. sun exposure and burns: triggers for flare up. overprod of self antibodies.ANA test NOT diagnostic. diagnosed by Anti Smith antibody but it only occurs in 30-50%. attacks RBC and Coag factors, lymphocytes, et platelets. 50% have butterfly rash. excessive fatigue, arithomas, patchy hair loss, polyarthralgia et morning stiffness, diffuse swelling of joints, 50% renal probs. s/sx: cognition change, memory problems, HA, anemia, susseptible to infection, can die from infections, mood disorders. TX: NSAIDS, antimalarial, corticosteroids short term, immunosuppressants, targeted therapy drugs and hormones. should not recieve live vaccinations such as varicella

Front 58

systemic sclerosis

Back 58

2 types: limited cutaneous disease (80%) and diffuse cutaneous disease. overproduction of collagen. connective tissue disorder. risk factors: coal, plastics, cilica dust, african american, women. S/SX: CREST: calcinosis, raynaud's phenomenon(abnormal blood flow in cold), esophageal dysfunction, sclerodactyly, telangiectasia(red spots on body). dry eyes et mouth, dental caries, gingivitis, pulmofibrosis, pleura thickening, dyspnea, kidney disease, pericarditis. DX: SCL-70(scleroderma antibody), distal esophageal hypomotility, bilat pulmo fibrosis. TX: no specific tx. possibly cardizem or ditazelam.

Front 59

sjorgrens syndrome

Back 59

90% women. dry mouth, dry eyes, autoimmune, associated with SLE, RA, thyroid disorders. RISK of developing lymphoma.

Front 60

methotrexate (rheumatrex)

Back 60

can lead to birth defects also can cause bone marrow reduction

Front 61

hydroxycholorquine (plaquenil)

Back 61

can cause vision changes

Front 62

corticosteriods (-sones)

Back 62

cataracts, wt gain, increased risk of infection, high BP and BG, hypokalemia, muscle atrophy, weakness, mood and behavior changes, protein depletion decreases bone formation.