1
Q
Hydrostatic Pressure definition
A
- Major force that pushes water and solutes out of vascular system at capillary level
2
Q
What is oncotic pressure?
A
Pressure exerted by colloids in solution like protein
3
Q
What causes movement of water out of the capillaries?
A
- Capillary hydrostatic pressure
- Interstitial oncotic pressure
4
Q
What causes movement of fluid into the capillary?
A
- Plasma oncotic pressure
- Interstitial hydrostatic pressure
5
Q
What causes edema?
A
- Plasma to Interstitial fluid shift
- Due to
- Elevation of hydrostatic pressure
- Decrease plasma oncotic pressure
- Elevation interstitial oncotic pressure
- Compression stockings can decrease peripheral edema
6
Q
How can fluid enter the vascular space?
A
- fluid drawn into plasma space whenever increase in PLASMA OSMOTIC/OSMOTIC pressure
- Ex: administering colloids, dextran, mannitol, hypertonic solutions
- fluid drawn from cells via osmosis
- results in shrinkage of cells
- EX: neurologic symptoms caused by altered CNS from brain cell shrinkage
- Opposite is brain swelling
- EX: neurologic symptoms caused by altered CNS from brain cell shrinkage
7
Q
What effects can old age have on fluid in the body?
A
- decrease
- water conservation
- GFR
- Creatinine clearance
- ability to concentrate urine
- hormone changes: ADH/ANP
- loss of moisture due to loss of SQ tissue
- thirst mechanism
- narrowed limits for excretion of H2O, Na, K, H+
8
Q
What effect can prolonged NG tube suction have?
A
Decrease in Na+, K+, H+, and Cl-
9
Q
Why would you give D5W?
A
- Replace fluid loss/dehydration
- Treat Hypernatremia
10
Q
Why would you give 0.9% NS?
A
- Blood Transfusion
- Fluid challenge
- Fluid replacement w/ DKA
- Treat
- Hypercalcemia
- Hyponatremia
- Metabolic Alkalosis
- Shock
11
Q
Why would you give LR?
A
- Acute blood loss
- Treat burns
- Dehydration
- Third spacing
- Lower GI fluid loss
12
Q
What is the osmolarity formula?
A
2(Na) + (Glucose)/18 + (BUN)/3 = serum osmolarity
Na decreases by 2 for ea 100 increase in glucose
13
Q
How do you calculate MAP?
A
MAP = 1/3 (SBP) + 2/3 (DBP)
14
Q
What are common bronchodilators used to treat respiratory problems?
A
- Beta-agonists: “-iterol”
- Anticholinergics: “-pium”
- Bring down mucous production
- Methloxanthines: “-phylline”
- Raises HR, sympathetic response
15
Q
What are common anti-inflammatory drugs for respiratory diseases?
A
- Steroids: “-sone”
- Leukotriene stablizer: “-lukast” (Singulair)
- Mast Cell stabilizer: “-crome”
16
Q
What is SIRS criteria?
A
- Temp: <36, >38.5
- WBC: <4, >12 (or >10%bands)
- RR: >20
- HR: >90
17
Q
When do you treat a high BP in stroke patients?
A
- Ischemic Stroke: BP >200/100
- TPA candidate: >185/110
- Hemorrhagic: >160/90
18
Q
When does a patient qualify for TPA?
A
- 3 hour treatment window
- no recent major surgery or trauma
- no recent hemmorhage or coagulopathy
- BP <185/110
- No seizure at onset
19
Q
What is the RAAS?
A
- Low BP signals kidneys to secrete renin
- Renin stimulates production of angiotensingen>angiotensin 1
- ACE convernts A1 to A2 in the lungs
- Angio2 induces thirst, vasoconstriction, and production of aldosterone (anti-diuretic) from the adrenal glands
- Aldo. signals kidneys to retain Na
- All these mechanisms increase BP
20
Q
How do you calculate CO?
A
CO = Stroke volume x HR
Normal is 4-8 L
21
Q
What are some drugs used for HTN?
A
- Diuretics (HCTZ)
- ACE inhibitors (-prils)
- ARB’s (-artan)
- Alpha blockers (Clonidine)
- blocks receptors of vasoconstriction
- Calcium Channel Blockers (-pine)
- tells heart to not work so hard
- Beta blockers (-olol)
- Decrease HR, contractility
- Can hide hypoglycemia
22
Q
Normal BNP
A
- BNP: <100 pg/mL
- Possible heart failure 100-300
23
Q
Signs of diastolic failure?
A
- LV: SOB, tachypnea, crackles
- RV:anorexia, hepatomegaly, JVD
- Thick walls of heart muscle
24
Q
What are signs of systolic failure?
A
- Thin walls
- Weakness, fatigue, decreased exercise tolerance
25
Characteristics of arterial vascular disorders
* Intermittent claudication
* Rest pain @ night
* Ischemia to a muscle group
* Pain while walking same distance
* Pain relieved by dangling foot
* Pulse problems
* Skin
* Cool, dusky, hairless, thin, non-edematous
26
Characteristics of Venous disorders
* edema
* redness, dry, flaky skin, itchy
* ulcers in lower 3rd leg
* inactivity major risk factor
* pulse present
27
What are the diagnostic tools for BPH?
* Med hx
* digital rectal exam
* Labs
* UA
* BUN/Creat
* PSA
28
What are the diagnostic tools for prostate cancer?
* Digital rectal exam
* PSA
* Biopsy to fully diagnose
* TR US
* Blood work
* Bone scan/CT/MRI/CXR/IVP
29
What are the diagnostic tests for Testicular Cancer?
* Palpation of scrotum
* US of testes
* Bloodwork
* AFP, LDH, hCG
* CXR
* CT chest/abd
30
What are the diagnostic tests for bladder cancer?
* Cystoscopy
* UA
* IVP/Urogram
* Pelvic Lymphandenectomy during Cystectomy
* CT/MRI/CXR
31
What is the treatment for BPH?
* Alpha Adrenergic Blockers (Relaxs smooth muscles)
* Flowmax (tamsulosin)
* Hytrin (terzosin)
* Cardura (doxazin)
* 5-alpha reductase inhibitors (Blocks DHT - Testosterone conversion preventing progression and reducing size)
* Proscar (finesteride)
* Avodart (dutasteride)
32
Surgical treatment options for BPH?
* TURP
* TUIP
* TULIP
* TUNA
* Greenwave
* Hyperthermia
33
What is the treatment for prostate cancer?
* **Stages T1(hasn’t left prostate)/ T2 (slightly radiated off prostate)**
* Observation/waiting
* Radical Prostatectomy
* Radiation Therapy
* SE: dysuria, frequency, hematuria, stricture
* **T3 (Left margin of prostate/ into seminal vesicle)**
* Experimental treatments only - radiation/hormone therapy
* **T4 (Invaded other structures, retroperineum, bladder)**
* Hormone (including bilateral orchiectomy)
* Injections given q 3-4 months
* decrease level of circulating testicular androgens
* SE: hot flashes, decreased libido, mood swings, gynecomastia
* Chemo
34
Treatment for testicular cancer
* Orchiectomy/radical o
* Retroperitoneal LND
* Post op
* surviellance
* radiation therapy
* chemo
35
Treatment for bladder cancer
* TURBT
* Laser Treatment
* Chemo (Cisplatin, Taxol)
* Intravesical immunotherapy w/ BCG (causes an immune response/inflammation of bladder walls killing cancer cells)
* Radiation (5-8 weeks, **Preferred to preserve bladder)**
* Radical Cystectomy w/ Urinary diversion
36
Uses and precautions for 0.45%NS
* HYPOTONIC
* Treat DKA after NS but **BEFORE** D5W
* replace gastric fluid loss from NG suction or vomiting
* replace Na+ & Cl-
* provide water replacement
* *Precautions*
* *Cardiovascular collapse*
* *Increase ICP*
* ***DONT use in liver, trauma, or burn patients***
37
Uses and precautions for D5W
* ISOTONIC
* Replace fluid loss/dehydration
* Treat hypernatremia
* *Precautions*
* *turns hypotonic*
* *use cautiously w/ **RENAL/CARDIAC** pt*
* ***DON'T use for resuscitation to avoid hyperglycemia***
38
Uses and precautions for NS
* ISOTONIC
* Blood transfusion
* fluid replacement w/ DKA
* Treat: hypercalemia, hyponatremia, metabolic alkalosis, shock
* *Precautions*
* *used as replacement for ECF*
* ***DONT use w/ heart, edema, hypernatremia pts to avoid fluid overloade***
39
Uses and precatuions for LR
* ISO
* Acute blood loss
* treat burns, 3rd spacing, lower GI fluid loss, dehydration
* *Precaution*
* *Similar to plasma in content*
* DON'T USE
* **RENAL** to avoid hyperK
* **LIVER** pts can't metabolize lactate
* **PH \>7.5**
40
Uses and precautions for D5 1/2NS
* HYPER
* Treats DKA AFTER NS& 1/2 NS
* Prevent hypoglycemia
* *Precautions*
* *In DKA patients, use only when BS fall \<250mg/dl*
41
Uses and precautions for D5 NS
* HYPER
* Treat
* Addisonian crisis
* hypotonic dehydration
* Syndrome of Inappropriate Anti Diuretic Hormone
* Temporarily for shock when plasma expanders not available
* *Precautions*
* *Chloride content higher than natural plasma content*
* ***DONT use in cardiac or renal due to r/o fluid overload***
42
Uses and precautions for D10W
* HYPER
* when nutrition w/ glucose required
* provide water replacement
* *Precaution*
* *Monitor glucose levels*
43
EKG pattern during hyper/hypokalemia vs. normal
* Hypo: Prominent U wave, Shallow T wave
* Hyper: Tall T wave
44
Electrolyte disorder of Na
* Hypernatremia
* thirst, **CNS deterioration**, increased ISF
* Hyponatremia
* CNS deterioration
45
Electrolyte disorder of Ca
Inverse relationship to Phosphorus
* Hypercalemia
* thirst, CNS deterioration, increased ISF, slows nervous system
* Hypo
* tetany, Chvostek's/Trousseau's sign, CNS/EKG changes
46
Electrolyte disorder of K
Insulin drives K back into cells
* Hyperkalemia
* V-fib, **HEART** EKG changes, CNS changes
* Hypo
* Bradycardia, ","
47
Electrolyte disorder of Mg
HEART
* Hypermagnesemia
* loss of deep tendon reflexes
* depression of CNS/Neuromuscular fxn
* Hypo
* hyperactive deep tendon reflexes, CNS change
48
What are some medications for Diabetics aside from insulin?
* **Metformin (PO):** Increases insulin sensitivity of cells so useful for TYPE 2 diabetics/insulin resistant diabetics. Only use on patients with good renal fxn. Works in ***liver*** to decrease glucose production
* **-ides (PO):** Stimulates ***pancreas*** to secrete insulin; not effective for type 1; risk for hypoglycemia
* **Arcabose** (PO): Inhibits ***gut*** enzyme responsible for breaking down carbs; take before meals
* **Rosiglitazone (Avandia):** Not recommended for CVD/CHF pts due to risk of edema/increase fluid retention (***muscle***)
* **Incretin Enhancers (GLP-1):** Increases insulin production in pancreas; decreases glucagon; increases satiety; delays gastric emptying
* **Sitagliptin (Januvia)**: Risk of hypoglycemia very low because drug only works w/ high serum glucose; increased fullness feeling;
49
What is onset, peak, duration of rapid insulin?
* Rapid (Humalog, Novalog)
* Onset: 5-10mins
* Peak: 1 hr
* Duration: 2-4hrs
* Inject w/n 15 mins BEFORE meal
50
What is the onset, peak, duration of short/regular insulin?
* Short/regular (Humulin, Novolin)
* Onset: 30mins-2hrs
* Peak: 2-4 hrs
* Duration: 4-6 hrs
* When given in AM, produces rxns before lunch
51
What is the onset, peak, duration of intermediate/NPH insulin?
* Intermediate/NPH (Humulin N/L)
* Onset: 2-4 hrs
* Peak: 4-10 hrs
* Duration: 10-16hrs
* When given in AM, produces rxns 2-3hrs before dinner
* When given in PM, produces rxn 2am & 8am
52
What is the onset, peak, duration of long acting insulin?
* Long acting insulin (Humulin U, Lantus)
* Onset: 1 hr
* Peak: NONE
* Duration: 18-24 hrs
* When given in AM, produces rxns 2am & breakfast
53
What is Osteoarthritis?
* Localized inflammatory response
* RISK FACTOR: **WOMEN, 65+, familial tendency, obesity**
* rest allevieates symptoms
* MANAGEMENT
* improved mobility - low impact aerobics, rest/exercise balance, heat therapy, NSAIDs
* fxnl independence - braces, glucosamine, chondroitin
* *Osteotomy:* resection of bone deformity fragment
* *Arthrodesis:* joint fusion, holding bone ends together
* *Total Arthroplasty:* replacing arthritic bone w/ metal
54
What is rheumatoid arthritis?
* chronic systemic autoimmunde, inflammation
* comes and goes
* RISK FACTOR: FEMALE, 40-60, small joints
* Pain at rest
* Management
* Education: Pain management, Rest/Activity Balance, Nutrition, Weightloss, Self care strategies, Medications
* Work with OT
55
What is the management for hip fractures?
* Impaired mobility: weight bearing? (TTWB, PWB, WBAT)
* Positioning: adductor pillow (not too tightly, watch peroneal nerve), NEVER internally rotate (adduct), no flexion past 90 degrees.
* Mobile ASAP! Active ROM, PT referral, pain management
* Anticoagulants to prevent PE or DVT, monitor for bleeds! FALL- screen for cerebral bleed!
* Circulation, sensation! Check often! (pedal pulses, skin color, temp, dorsiflexion)
* High risk for infection, OR tries to limit that by implementing laminar flow (highly filtered air supply), antibiotics
56
What are the 5 stages of bone healing?
* Bone Healing: ENSURE GOOD CIRCULATION
* Hematoma formation: 1-3 days
* Fibrocartilage formation: 3days to 2 wks
* Callus: 2-6wks
* Ossification: 3wks to 6mths
* Consolidation/remodeling: 6months - 1 yr
57
Management of MS trauma
* Pain management
* Associated with muscle spasms so give central/peripheral muscle relaxants (carisoprodol - Soma; cyclobenzaprine - Flexeril; methocarbamos - Robaxin)
* Antibiotics (cefazolin)
* Nutrition (protein, Vit BCD, calcium/phosphorus, 2k-3kmL fluid)
* To relieve swelling elevate higher than heart for first 24-48 hours of cast
* SPLINT FIRST IN CASE OF COMPARTMENT RISK
58
Characteristics of visceral pain?
* DEEP
* sensitive to tension, ischemia, rapid enlargement of organs
* dull achy
* PNS (Decrease HR/BP)
* steady or intermittent
59
Pain patterns of the abdomen
* Epigastric
* stomach, gall bladder, liver, pancreas. Can be confused w/ cardiac-related pain
* Umbilical
* distal duodenum, jejunum, ileum, appendix, ovary, testes, upper ureter
* Lower abdomen
* colon, bladder, rectum, uterus, ovaries
60
Characteristics of diverticulitis
* inflammation of the small pouches of intestine
* Acute pain LLQ
* Palpable abdominal mass
* systemic infection symptoms
* TX
* fiber/stool softener
* antibiotics
* possible colonostomy
61
Characteristics of pancreatitis
* inflammation caused by gallstone obstruction or chronic etoh intake
* Elevated: lipase, amylase, lft, WBC, glucose
* Steady, intense epigastric pain, radiates to back
* N/V w/ no relief
* Turner/cullen
* R/o pleural effusion
62
Characteristics of Paralytic Ileus
* High pitched bowel sounds
* Upper, mid, abd cramping
* pain in waves
* TX
* decompress
* parenteral fluids/nutrition
* METOCLOPRAMIDE
* stimulates peristalsis
63
Types of GI bleeding
* **Hematemesis** (blood in vomit), indicates bleeding above duodenal/jejunal junction. Coffe ground or red.
* **Melena** (black, tarry feces) indicates bleeding below duodenal/jejunal junction
* **Hematochezia (**fresh blood in feces) indicates bleeding in colon
64
Diagnostic tools for GI bleeding
* Orthostatic BP \>10 drop, Increased pulse by 20
* Labs
* Increased INR/PTT
* Decreased H/H and PLTs
* BUN \>40
* +Guiac stool
* Test w/ endoscopy or barium contrast
65
Management of GI bleed
* IV access
* Check blood is ordered/avail
* Upper GI
* No Alch, ASA, Anticoags
* Tx: pressure, sclerosis, banding, surgery, acid blockers, antibiotics
* Lower GI - Surgery
* Fluid electrolyte replacement
* Skin Care
* Bowel Rest
* Clear fluids 1st 24 hrs post op
* BRAT diet 24 hrs: bananas, rice, applesauce, toast
66
Characteristics of Duodenal Ulcer
* Higher incidence than gastric.
* Risk factors:Protein rich meals, alcohol consumption, and vagal stimulation
* Pain with empty stomach, may be helped w/ food or antacids
67
Characteristics of Gastric Ulcers
* break in mucosal barrier
* incompetent pylorus = decrease in protective mucus
* risk factors: smoking, steroids, NSAIDs, caffeine, alcohol, stress, gastritis
* pain with eating, antacids ineffective
68
Characterisitics of Gastritis
* Epigastric discomfort
* Hyperactive BS
* Management
* Remove cause/offending substance
* Treat symptoms
* Anti-emetics, antacids, Bowel rest w/clear fluids then slowly escalate to reg diet
69
Characteristicis of cholecystitis
* Cholelithiasis: gallstone in cystic duct or common bile duct
* Midline epigastric pain, may radiate to intrasapular
* Risk factors
* Women\>Men
* 40’s-50’s
* High fat diet
* Late phase
* RUQ pain
* Elevated AST and Alk Phos
70
Normal values for Chem panel
* Cl: 95-110
* CO2: 24-32
* Crea: 0.5-1.3
* Phosphorus: 3.0-4.5
* Ca: 8.6-10.5
* Mg: 1.2-2.0
* Triglycerides: 35-160
71
Normal values for liver panel
* Total Proteins: 6.3-8.3
* Amylase: 56-190
* Lipase: 0-110
* Troponin: \<0.3
* Myoglobin: 0-85
* Albumin: 3.5-5.1
* Alk Phos.: 20-180
* T. Bili: 0.3-1.3
* Lactate: 0.3-2.6
* AST: 8-42
* ALT: 10-60
72
Normal values for blood panel
* RBC: 4.5-5.3
* Hgb: 13-16
* Hct: 37-49
* PLTs: 130-400
* PTT: 23-33.5 (Hep)
* PT: 11-12.5 (Coum w/ INR)
73
Normal ABG values
* PO2: 80-100
* PCO2: 35-45
* HCO3: 22-28
74
What are the volumes for each type of O2 therapy?
* Nasal Cannula: **1-6L**
* 24%-44%
* Simple Face mask: **8-12L**
* 35%-60%
* Partial Rebreather: **6-10L**
* 40-60%
* Non Rebreather: **15L**
* 60-100%
* Venturi
* **24-65%**
75
NURS112
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