Upgrade to remove ads
Only $35.99/year

IMPORTANT EXAM 3

Terms in this set (29)

Hypovolemia {Dehydration}
Expected Findings for Hypovolemia
↓ in Weight (bc you have less fluids)

THE ❤️
↑HR (weak and thready) ↓BP ↓CVP

KIDNEYS: ↓ urine output

SKIN:
↓ skin turgor
Dry mucous membranes
Thirsty
Flat neck veins

Labs For Hypovolemia { Concentrated numbers go ↑}
↑ Hemoglobin
↑ Hematocrit
↑ Sodium
↑ Urine specific gravity
↑ BUN
↓ Urine

How To Treat Hypovolemia
✩ Isotonic fluid
✩ PO / IV
✩ Daily Weight
✩ Daily I&O
✩ Orthostatic hypotension (↑ FALLS)
✩ MONITOR FOR FLUID VOLUME OVERLOAD
Hypervolemia {Overhydrated}
What can cause Hypervolemia
Heart failure
Kidney Dysfunction
Cirrhosis
↑ Sodium intake

S&S Hypervolemia
↑ Weight

The ❤️:
↑ HR (bounding ) ↑BP ↑CVP

RESPIRATORY: Wet lung sounds (crackles)

KIDNEYS: Polyuria

SKIN:
✩ JVD
✩Edema
✩Distended neck vein

Labs For Hypervolemia {Diluted makes numbers go ↓}
↓ Hematocrit
↓ Urine specific gravity
↓ Sodium
↓ BUN

How To Treat Hypervolemia
✩ Low sodium diet
✩ Daily Weight
✩ Daily I&O
✩ Diuretics
✩ Upright position
IMPORTANT
☆ MORE THAN A 2.2 LB WEIGHT GAIN REPORT

☆ LITER OF FLUID 2.2 LBS


ANYTHING PREPACKAGED
Hypernatremia >145
Big and bloated
S&S
You are 'fried' or S.A.L.T.
F - Fever (low grade), flushed skin
R - Restless (irritable)
I - Increased fluid retention and increased BP
E - Edema (peripheral and pitting)
D - Decreased urinary output, dry mouth
S = Skin flushed
A = Agitation
L = Low-grade fever
T = Thirst

How to fix
☆ Hypotonic solution
☆ Diuretics
Sodium 135-145
Sodium rich foods
🍕 🍞 🍤

SUGGESTED INTAKE FOR SODIUM P/ DAY
{1500 - 2300}
Potassium 3.5-5
Potassium rich foods
🍈 🍊 🍌 🍅
Spinach
Tuna
Beets

MEDS
Potassium sparing: Spironolactone
Hyponatremia <135
S/S
Neuro= headache, restless, confused, seizure

CV= decreased BP because of decreased fluid volume

GI= nausea and vomiting

M/S= ↓ sodium
increased calcium movement into the cells which causes twitching and cramps

How to fix?
Fluid restriction PO bc water is a hypotonic solution
Give hypertonic = 3% or 5%
Hyperkalemia > 5
Think Potassium = ❤️
S&S
"MURDER"
M= muscle weakness,
U= urine (oliguria/anuria),
R= respiratory depression
D= ↓ cardiac contractility
E= ECG changes
R= reflexes

Causes of Hyperkalemia
☆ Excessive potassium intake
☆ Renal failure
☆ Potassium containing drugs
☆ K+ sparing diuretic
☆ Ace inhibitors

How do we fix Hyperkalemia?
Eliminate PO and IV potassium intake
Potassium wasting diuretic Thiazide / Loop - ide
Kayexalate


Potassium > 5.0
Hypokalemia < 3.5
Think Potassium = ❤️
S&S
Neuro= fatigue, ↓ deep tendon reflexes
❤️ = weak or irregular
Resp= weakened diaphragm can lead to apnea
GI= Constipation hold onto K+
Renal= Polyuria=
Flush out sodium and water so that K+ will ↑ in the body

How to fix?
Administer PO and IV intake of K+

Be careful of Digoxin with low K+, then they are more at risk for Dig toxicity
Calcium
9-11 🚔🚨
Food high in calcium


What is calcium important for?
blood clots
Hypercalcemia > 11
S&S
✩ Muscle weakness
✩ Constipation
✩ Anorexia, nausea, and vomiting
✩Polyuria
✩ Kidney stones
✩ Bizarre behavior
✩ Bradycardia

Causes of Hypercalcemia
✩ Hyperparathyroidism
✩ Kidney failure
✩ Prolonged immobility

How to fix?
✩ Administer loop diuretic= pulls out calcium in process
✩ Isotonic fluids to ↑ calcium excretion
✩ ↑ PO fluids to 3-4 L/ day
Hypocalcemia < 9
S&S
C.A.T.S.
C - Convulsions
A- Arrhythmias
T - Tetany
S - Spasms and stridor

Causes of Hypocalcemia
✩ Chronic Kidney disease
✩ Chronic alcohol abuse
✩ Vit D deficiency

How to fix?
✩ Diet high in calcium rich foods
✩ Vit D supplementation
✩ PO calcium supplements/ IV

Calcium < 9
hypotension
Magnesium 1.5-2.5
Foods high in magnesium
🍞 🍚 🍗 🍅
Raisins
Hypermagnesemia > 2.5
S&S
✩ Neuro=Drowsy
✩ CV= Bradycardia Hypotension
✩ Resp = poor effort
✩ Renal= may be impaired

Causes of Hypermagnesemia
✩ Renal failure
✩ Admin of Mg = never give to renal patients
✩ Diabetic ketoacidosis

How to fix Hypermagnesemia?
✩ Diuretics
✩ Avoid laxatives / Antacids
Hypomagnesemia < 1.5
Causes of Hypomagnesemia
Diabetes Mellitus
Chronic alcohol abuse

S&S
Neuro = tremors, seizures, hyperactive reflexes
CV = tachycardia, vasospasm

How to fix Hypomagnesemia?
✩ Oral supplements
✩ ↑ dietary intake
Phosphorus 2.5-4.5
Foods high in Phosphorus
🍗 🌾 🍚 🍫
Need good renal function to excrete phosphorus
Primarily found in bone and teeth
Chloride
95-100
BUN
7 - 20
Creatinine
0.6 - 1.2
Hypertonic Solution
Enters the vessel from the cell

Hypertonic Solutions
Isotonic Solution
...
Hypotonic Solution
...
BOWEL
How many grams of fiber a day?
25-38

How much fluid should you take in a day?
2-3 L

Walking promotes passing gas.

Who is at risk for hemorrhoids?
pregnancy constipation liver disease heart failure

Paralytic ileus: intestinal obstruction the bowel isn't working

vagus nerve stimulation = bradycardia
hypotension/syncope

Enema last resort

soapsuds enema : use cautiously with pregnant and elders

Safest enema normal saline

Oil Retention Enema: lubes the rectum allowing it to pass easier
3-4 inch insertion 7.5 - 10 adult
Max height to hold enema 46 cm 18 inch
PAIN
Acetaminophen Tylenol: (hepatotoxic)
✩ People who have liver problems should use Tylenol very cautiously.

✩ Antipyretic only deals with pain

Nsaids WATCH WITH GI BLEEDING TAKE WITH FOOD TO MINIMIZE GI UPSET caution with kidneys
Aspirin Advil and ibuprofen
✩ Anti Inflammatory Antipyretic
Analgesics (pain)

Opioid Analgesics (everything slows)
✩ ↓ bp HR RR {hypotension}
✩ CAN ONLY GIVE IF THE PT. PAIN SCALE > 7
✩ MONITOR FOR SEDATION
✩ Nausea vomiting constipation
urinary retention: check distended stomach no output
Pain scale > than 3 with limit ADL ability

Narcan given when respirations < 8
Infection
Contact precautions
C-diff mrsa herpes vrsa

Standard precautions used on everyone

Droplet: Covid flu measles mumps pertussis

AIRBORNE: MTV Measles TB Varicella

Physical Assessment
↑ temp pulse RR WBC ↓ bp

✩ CRACKLES
✩ Redness / edema
✩ Enlarged lymph nodes
✩ Dysuria
✩ Dyspnea
✩Cough
✩Sputum
✩ Urinary frequency
Dysphasia

ESR: 15-20 WHEN ↑ YOU HAVE AN INFECTION OR INFLAMMATION

✩✩ADULTS AND ELDERLY AT RISK SHOULD BE GIVEN PNEUMONIA VACCINE✩✩

Gillian- Barre has been associated with some flu vaccines
✰Muscle weakness caused by the immune system damaging the peripheral nervous system(can be debilitating or fatal)
Medications
Acetaminophen/ aspirin
✩Antipyretic
✩Analgesics (pain)
- Helps reduce pain fever and discomfort
✩✩MONITOR ✩✩
-FEVER TO DETERMINE IF THE MED IS WORKING DOCUMENT TEMPS

Vancomycin
USES:
⭒ Enterocolitis due to MRSA and C. Diff, Staph Aureus Septicemia, Serious
skin / joint / bone infections

Ototoxicity: hearing difficult
nephrotoxicity: kidney toxic

Red Man syndrome (RMS)
with rapid infusion

MRSA VANCOMYCIN CAN ONLY BE GIVEN

VRSA IS RESISTANT TO VANCOMYCIN

Flu Antiviral meds such

⭒ Zanamivir (inhaled) DON'T USE IN Patients with COPD (cause Bronchospasm)

⭒ Oseltamivir (oral pill)
can cause delirium, confusion, hallucinations, and suicidal thoughts. Can cause dizziness and vertigo The elderly may fall.

Antipyretic Acetaminophen(Tylenol): Used to treat fevers and generalized discomfort
Antitussives: Used for cough

Antibiotics: are to be used for bacterial infections only, not viral infections.

Antipyretic Acetaminophen (Tylenol): Used to treat fevers and generalized discomfort

Antitussives: Used for cough

Fluoroquinolones
Ends in floxacin
LEVOFLOXACIN USE ONLY IF NECESSARY!

Nitrofurantoin
harmless brown color
UTI
80% of all UTIs are caused by the bacteria E. coli

Candida infection YEAST INFECTION

Catheter Associated UTI (CAUTI)
Risk of infection increases 3 to 10% per day

Risks of CAUTI
𖤐 Any break in the closed urinary system (Changing the bag, irrigating)

Use straight cath If possible less chance of infection

Stop using catheters ASAP. Stopping requires a doctor's order

Clinical manifestations
✰ Burning, urinary frequency, dysuria
✰ Foul smelling urine
✰ Urine that appears cloudy or blood tinged
✰ Suprapubic tenderness and pain
✰ In elderly may become confused

Urosepsis bacteremia:
The spread of bacteria from the urinary tract into the blood

Urine analysis
🚫ANY OF THESE PRESENT IS A UTI 🚫
✰ Presence of white blood cells (Pyuria)

✰ Red blood cells (hematuria)

✰ Casts (clumps of cells)

Physical examination of a patient with a UTI
⭒ Vital signs ( assess for fever tachycardia and Tachypnea)
⭒ Abdominal shape, contour, and tenderness on palpation.
⭒ Distention after voiding indicates an incomplete voiding
C. diff
C. diff
Contact Precaution

Diarrhea with fever and abdominal pain

Treatment:
Metronidazole and Vancomycin.

How to treat C. diff without medication!!!!

FECAL MICROBIOTA TRANSPLANTATION

Sulfonamides can cause c.diff stop immediately if you get a rash
Vitamins
Vitamin D
bones and muscle
Other sets by this creator