Pharm unit 2

Shock

What are the 4 types of shock?

inadequate tissue perfusion (O2 to tissues)

-Hypovolemic = low volume of blood

-Cardiogenic = heart can’t pump blood efficiently

-Obstructive = something is blocking the vessels (example: pulm embolism)

-Distributive = fluid collects in between BV, making it hard for O2 to pass thru into the tissues

Thrombocytopenia

Low platelet count → bleeding

Intrinsic factors

Common intrinsic factors of bleeding disorders

Measured by “PTT”

-Von Wilderbrand disease, Bernard Soulier Syndrome, Glansmann Thrombosthania

Extrinsic factors

Common extrinsic factors of bleeding disorders

Measured by “PT”

-Taking warfarin, liver disease, vitamin K deficient, CF7 deficiency or AF inhibitor

K Potassium normal blood level

3.5 - 5

Na sodium normal blood level

135-145

Magnesium normal blood level

1.3-2.1

Calcium normal blood level

9.0-10.5

Phosphate normal blood level

3.0-4.5

Chloride normal blood level

98-106

Normal mOsm in the blood level

275-295 mmol/kg

Potassium food sources

Green leafy veggies, banana, avocado, salt substitues

Sodium food sources

Canned food, fast food, processed meat and cheese

Magnesium food sources

green leafy veggies, spinach, almonds, yogurt

Electrolyte food sources all together

Folic acid sources

FOOL - Fish, organ meats, oranges, leafy green veggies

Iron sources

Meat

How do electrolytes get lost from the body?

VPPS

Vomiting, Peeing, Pooping, Sweating

The role of the liver in managing bleeding disorders is to _________

create clotting factors

Which fluid is the closest in content to blood?

A. plasmalyte

B. normal saline

C. lactated ringers

D. dextrose in water

A. Plasmalyte

Long term use of normal saline can cause…?

A. respiratory acidosis

B. respiratory alkalosis

C. metabolic acidosis

D. metabolic alkalosis

C. metabolic acidosis

Hypernatremia and Hyponatremia

HypER = high Na (sodium) in blood

HypO = low Na

Normal Saline (NS) 0.9%

-Made of Na and Cl (154 of each)

*isotonic —> mOsm is similar to blood

-acidic pH of 5.7

-Resuscitation fluid

Half Normal Saline 0.45% (1/2 NS)

-made of Na and Cl (77 of each)

-NOT isotonic, has higher mOsm

-still acidic at 5.6 pH

-Used for hypernatremia

Hypertonic saline 3%

-made of Na and Cl, has lots of Na

-used for hypOnatremia

D5W

-made of glucose → sugar water. Has no electrolytes

-over mOsm

-acidic pH of 5

-Used for hypernatremia, maintanance fluid

D5/ half Normal Saline (D5 1/2)

-combine HNS and D5 → Na, Cl, glucose

-77 Na & Cl

-VERY high mOsm

-even more acidic pH of 4.4

Lactated Ringers (LR)

-Na, Cl, as well as HCO3, lactate, K, and Ca

-Isotonic

-pH of 6.75 which is close to 7.4 blood pH

-Used in surgery, Resuscitation fluid

Plasmalyte

-closest to real blood composition

Na 140 and Cl 98, as well as some K

-Isotonic

-7.4 pH

What fluid do you give to hypovolemic patient?

NS 0.9%

Eventually switch to LR or plasmacyte to prevent acidosis

What fluid do you give to a pre-procedure or NPO patient?

D5 ½, and possibly maintenance sugar

What fluid do you give for hypOnatremia?

Hypertonic saline 3% NaCl

Normal Saline 0.9%

What fluid do you give for hypERnatremia?

D5W

½ NS

All fluids table comparison

Microcytic anemia

Anemia caused by not enough iron available

→ treat with iron supplements

Megaloblastic anemia

anemia caused by malabsorption of B12 or folic acid

→ treat with B12, folic acid, or both

Pernicious anemia

How do we test for it?

Specifically anemia caused by lack of B12

→ low IF in stomach to absorb B12

→ tested with Shilling test - give radioactive B12 and track elimination 24h later. Less than 10% is normal, but lower = pernicious anemia

How is pernicious anemia tested?

B12 injections

Hemolytic anemia

occurs when RBC are destroyed faster than they can be produced

→ caused by drugs, immune disorders

Sickle cell anemia

How is it treated?

RBC are abnormally shaped and they can’t carry O2 efficiently

→ treated with administering O2 and fluid

Aplastic anemia

considered a type of cancer, the body stops producing RBC

What factors contribute risk to B6 deficiency?

Alcohol use, bleeding, old age, kidney failure, diseases like celiac

Hgb normal lab values

Males 14-18

Females 12-16

Hematocrit

How is it affected by dehydration, anemia, or bleeding?

Vol of RBC compared to total blood volume

→ when you are dehydrated this number goes up as there is less fluid

→ anemic pts have low Hematocrit

→ bleeding will not affect it much

Hematocrit normal lab values

Males 40-54%

Females 36-48%

What instructions to give for administering iron?

Take on empty stomach, can take with orange juice to help absorption, measure Hgb and hematocrit regularly

Are malabsorption or chronic blood loss worse risk factors for anemia?

Chronic blood loss

T or F

People with bleeding disorders are at high risk for hemorrhage or hypovolemic shock

True

DIC

Who is at risk for it? How do we test for it?

a process of abnormal over-coagulation; the pt uses all their clotting factors and then they bleed w/o ability to stop it

-more risk for ppl after trauma/injury or surgery

-risk indicated by low fibrinogen

Hypertension BP values table (must memorize)

Complications of hypertension

it causes cracks in the endothelial cells in the BVs

→ lead to myocardial infarction, aneurysm, or stroke

Primary vs secondary hypertension

Primary = most common (>90%!) where there is no known cause, and BP goes up steadily

Secondary = has another cause → usually caused by altered kidney function causing more renin → more fluid stays in BV

How do kidneys affect hypertension?

Kidneys release renin

Renin converts angiotensin → leads to more fluid retention

If kidneys produce too much renin, then too much fluid retention, and BP will rise

Risk factors for primary hypertension

Old age

obesity

high-salt diet

sedentary lifestyle

Hypertensive crisis

Hypertension symptoms

Hypertension treatment

Diet changes

Lifestyle/exercise changes

Stress mgmt

Antihypertensive drugs

(congestive) Heart failure definition

Prior to administration of digoxin (Lanoxin), the nurse completes which assessment?

Apical pulse

Where each diuretic (loop, thiazide, potassium sparing) acts on the kidney

Preload, afterload

Preload = blood left in ventricles after pumping

Afterload = peripheral resistance

Right vs Left-sided heart failure causes

Right = lung disease, LHR, preload problem

Left = stress of left ventricle, HTN, MI, afterload problem

Warfarin antidote

vitamin K

Heparin antidote

Protamine sulfate

Alteplase antidote

aminocaproic acid

Name the list of drugs that has bleeding as an adverse effect (6 drugs)

aspirin, alteplase, warfarin, heparin, enoxaparen, and dabigatran

What is the mechanism of action for drugs to treat dysrhythmias?

Prolongs cardiac action potential

coronary artery disease (CAD)

clogged BV’s

Atherosclerosis

cholesterol buildup in BVs

-symptom of CAD

Heart attack (MI) vs heart failure

MI = necrosis of part of heart tissue due to blockage

HF = heart can’t pump enough blood effectively

Site of origin for arrythmias for:

Sinus, Atrial, Ventricular,

Sinus = SA node

Atrial = atria

ventricular = ventricles

Major food source that increases triglycerides

Sugar

→ nonpharm low triglyceride diet includes reducing sugar in diet