Acute Exam 3

Sodium normal lab values

Sodium normal lab values

Sodium (NA+): Normal range = 135-145; Elevated = hypernatremia, dehydration, kidney disease, hypercortisolism; Low = hyponatremia, fluid overload, liver disease, adrenal insufficiency

Potassium normal lab values

Potassium (K+): Normal range = 3.5-5; Elevated = hyperkalemia, dehydration, kidney disease, acidosis, adrenal insufficiency, crush injuries; low = hypokalemia, fluid overload, diuretic therapy, alkalosis, insulin administration, hyperaldosteronism

Calcium normal lab values

Calcium (Ca+): Normal range = 9-10.5; Elevated = hyercalcemia, hyperthyroidism, hyperparathyroidism; Low = hypocalcemia, vit D deficiency, hypothyroidism, hypoparathyroidism, kidney disease, excess intake of phosphorus-containing food or drink

Chloride normal lab values

Chloride (Cl-): Normal range = 98-106; elevated = hyperchloremia, metabolic acidosis, respiratory alkalosis, hypercortisolism; Low = hypochloremia, fluid overload, excessive vomiting or diarrhea, adrenal insufficiency, diuretic therapy

Magnesium normal lab values

Magnesium (Mg2+): Normal range = 1.8-2.6; elevated = hypermagnesemia, kidney disease, hypothyroidism, adrenal insufficiency; low = hypomagnesemia, malnutrition, alcoholism, ketoacidosis

osmolarity normal lab value

Osmolarity: Normal range = 270-300; high = dehydration, hypernatremia, hyperglycemia; low = fluid overload, hyponatremia, hypoproteinemia, malnutrition

Review hormonal regulation of fluid and electrolyte balance

Three hormones help control fluid and electrolyte balance: Aldosterone, Antidiuretic hormone (ADH), and Natriuretic peptides (NPs)

Aldosterone

secreted by the adrenal cortex whenever sodium levels in the extracellular fluid (ECF) are low. Prevents both water and sodium loss. When it is secreted it acts on the kidney nephrons, triggering them to reabsorb water and sodium from the urine back into the blood. Increases blood osmolarity and blood volume. Aldosterone promotes kidney potassium excretion

Antidiuretic hormone (ADH)

released from the posterior pituitary gland in response to change in blood osmolarity. The hypothalamus contains osmoreceptors which are sensitive to changes in blood osmolarity. Increased blood osmolarity, especially an increase in the level of plasma sodium results in a slight shrinkage of these cells and triggers ADH release from the p.p gland. Action of ADH is to retain just water it indirectly regulated electrolyte retention or excretion. Acts on kidney nephrons making them more permeable to water, and as a result water is reabsorbed by the tubules and returned to the blood, diluting blood osmolarity. (when there is a low blood osmolarity then prevention of ADH occurs)

Natriuretic peptides (NPs)

hormones secreted by special cells that line the atria of the heart (ANP) and the ventricles of the heart (BNP). These peptides are secreted in response to increased blood volume and blood pressure, which stretch the heart tissue. NP binds to receptors in the nephrons, creating effects that are opposite of aldosterone. Kidney reabsorption of sodium is inhibited and urine output is increased

Make sure to know and understand the vocabulary - chpt 13

Understand the Renin-Angiotensin-Aldosterone system

Most important body fluids to keep in balance for optimal function are the blood volume (plasma volume) and fluid inside the cells (intracellular fluid). Changes in these volumes especially decreases can lead to poor organ perfusion and cellular dysfunction

RAAS is a major regulator of fluid balance. Kidneys monitor blood pressure, blood volume, blood oxygen levels, and blood osmolarity. When kidneys sense that any one of these is low they secrete a substance called renin that sets into motion a group of hormonal and blood vessel response to ensure blood pressure is back up and normal

Renin then activates angiotensinogen activated angiotensinogen is angiotensinogen I which is activated by the enzyme ACE to its most active form angiotensinogen II. angiotensinogen II starts several actions to increase blood volume and blood pressure. First it constricts the size of the arteries and veins increasing peripheral resistance and then it constrict the size of the arterioles going to the kidneys lowering urine output, and it triggers the release of aldosterone

Understand dehydration, signs/symptoms, how treated, which IV solution used, who is most at risk

Dehydration is when fluid intake/retention does not meet the body’s needs, results in fluid volume deficit. Condition rather than a disease caused by many factors. May be an actual decrease in total body water caused by either too little intake of fluid or too great a loss of fluid. Can also occur  without an actual loss of total body water such as when water shifts from the plasma to the interstitial space (vascular dehydration)

Isotonic dehydration is the most common type (with water and electrolyte loss). Fluid is lost only from the ECF space

Mild dehydration is common among healthy adults and can easily be corrected by matching fluid intake with fluid output

Hr elevated, bp decreased, weak thready type plus, rr will increased bc trying to get oxygen

would give the patient isotonic iv solution

Normal pH

7.35 - 7.45; increased = metabolic alkalosis, loss of gastric fluids, decreased potassium intake, diuretic therapy, fever, salicylate toxicity, respiratory alkalosis, hyperventilation; decreased = metabolic or respiratory acidosis, ketosis, renal failure, starvation, diarrhea, hyperthyroidism

Normal Pa02

80-100 increased = increased ventilation, oxygen therapy; decreased = respiratory depression, high altitude, carbon monoxide poisoning, decreased cardiac output

Normal PaC02

35 - 45; increased = respiratory acidosis, emphysema, pneumonia, cardiac failure, respiratory depression; decreased = respiratory alkalosis, hyperventilation, diarrhea

Normal Bicarb

increased = metabolic alkalosis,bicarbonate therapy, metabolic compensation for chronic respiratory acidosis; decreased = metabolic acidosis, diarrhea, pancreatitis

What is acidosis?  What is alkalosis?

Acidosis = below 7.35 (can be respiratory or metabolic)

Alkalosis = above 7.45 (can be respiratory or metabolic)

Understand the different acid-base imbalances, s/s of each imbalance, what would patient be exhibiting

What is compensation?  What systems work to compensate for imbalances?  How?

The body adapts to attempt to correct the change in blood pH and maintain acid-base imbalances. Both kidneys and lungs can compensate but are not equal in their final responses.

Respiratory system much more sensitive to changes and can begin compensation efforts within seconds to minutes after a change in the pH. These efforts are limited and can be overwhelmed easily. (compensates for metabolic problems)

The kidneys compensatory actions are much more powerful and result in rapid change in the ECF composition. However these more powerful actions are not fully triggered unless the acid base imbalance is off for several hours to days (compensates for respiratory problems)

Compensation can be full or partial

Hyperventilation – what is it, what is happening with respect to acid-base balance

Breathing too quickly - can be caused by fear improper vent settings, stimulation of central respiratory center due to fever, CNS lesions, salicylates

Respiratory alkalosis; ABG with show increased PH with low C02 levels, usually oxygen and bicarb levels are normal

Difference between central venous access and peripheral access

Central = A thin flexible tube inserted into a vein and guided into a larger vein to the heart

Peripheral = short infusion catheters are most commonly used for this. inserted further away such as arm or hand

PICC line – what is it, complications of

A peripherally inserted central catheter: a thin flexible tube inserted into a vein in the upper arm and guided into a large vein above the right side of the heart (superior vena cave), x-ray has to be done to confirm the placement

Complications could be - contraindicated in patients with kidney disease and n-stage renal disease, bleeding, nerve injury, irregular heartbeat, INFECTION AND CLOT = most common

IV site care – what is phlebitis, infiltration

Phlebitis = the inflammation of a vein caused by mechanical, chemical, or bacterial irritation

Infiltration = occurs when iv solution leaks into the tissues around a vein

Central line catheters care

IV solutions, isotonic, hypotonic, hypertonic

Isotonic = same osmotic pressure as blood plasma (give to someone who is dehydrated) - lactated ringers, .9 normal saline

Hypotonic = lower concentration of dissolved solute than blood - .45 normal saline (hyponatremia, diarrhea, vomiting)

Hypertonic = higher concentration of dissolved solute than blood - 3% normal saline also hyponatremia

What is arteriosclerosis/atherosclerosis

Arteriosclerosis = thickening or hardening of arterial walls; often associated with aging

Atherosclerosis = type of arteriosclerosis involving formation of plaque within the arterial wall

Review the different types of HTN

Essential (primary) hypertension = most common type; not caused by an existing health problem. There are a number of risk factors that can increase the likelihood of becoming hypertensive.

Secondary hypertension = caused by a specific disease state or a drug ex: caused by kidney disease

Malignant hypertension (hypertensive crisis) = severe type of elevated BP that rapidly progresses and is considered a medical emergency

Review classifications of antihypertensives

Diuretics = first type of drug used to manage hypertension, three basic types of diuretics are used to decrease blood volume and lower blood pressure

Calcium channel blockers = (amlodipine) lower blood pressure by interfering with the transmembrane flux of calcium ions. This results in vasodilation which decreases blood pressure. It also blocks SA and AV node conduction resulting in a decreased hr

Ace inhibitors = (pril drugs) used as a single or combination agent in the treatment of hypertension. Block the action of the angiontensin-converting  enzyme (ace) - powerful vasoconstrictor in the body. It also decreases sodium and water retention and lower peripheral vascular resistance both of which lower blood pressure

ARBs = (-sartan drugs) selectively block the binding of angiotensin II to receptor sites

Beta blockers = (-olol) block beta receptors in the heart and peripheral vessels

What is PAD, signs/symptoms of

Peripheral arterial disease, result of systemic atherosclerosis, chronic condition and decreases perfusion to the extremities. The tissue below the narrowed or obstructed arteries cannot live without an adequate oxygen and nutrient supply. Symptoms = legs tire but improve with rest, coldness in leg, numbness, pulselessness, painful cramping when walking

Inflow/outflow problems

Inflow = obstructions involve the distal end of the aorta and the common, internal, and external iliac arteries. Located above the inguinal ligament

Outflow = obstructions involve the femoral, popliteal, and tibial arteries and are below the superficial femoral arteries.

Review the types of aneurysms

Fusiform = a diffuse dilation affecting the entire circumference of the artery

Saccular = an outpouching affecting only a distinct portion of the artery

Dissecting = the aneurysm enlarges, blood is lost and blood flow to the organ is diminished

Abdominal aorta = account for most of the aneurysms, are commonly asymptomatic and frequently rupture

Thoracic aorta = not as common and frequently misdiagnosed and typically discovered when having advanced imaging for other conditions

Review the slide concerning “Other Arterial Health Problems:

Buerger’s Disease - claudication in the feet and lower extremities worse at night usually

Raynaud’s Phenomenon / Disease - vasospasm especially in fingers

Subclavian Steal - upper extremities due to the subclavian artery, ischemia

Thoracic Outlet Syndrome - compression of subclavian artery

Review DVTs

A blood clot that forms in one or more of the deep veins in the body, usually the legs

Review the different types of anginas

Angina pectoris = chest pain caused by a temporary imbalance between the coronary arteries ability to supply oxygen and the cardiac muscle’s demand for oxygen.

Two main types = stable angina and unstable angina

Stable = “Strangling of the chest”, Ischemia limited in duration and does not cause permanent damage to myocardial tissue. Normally resolves with nitroglycerine

Unstable = chest pain or discomfort that occurs at rest or with exertion and causes severe activity limitations. An increase in the number of attacks and in the intensity of the pressure indicates UA.

MI, different types

Non-ST-segment elevation myocardial infarction (NSTEMI) coronary vasospasm, spontaneous dissection, sluggish blood flow

ST-elevation myocardial infarction (STEMI) caused by rupture of plaque

CAD – treatments, assessments, diagnostic studies, drug therapy

CAD = leading cause of premature, permanent disability in the united states and the world. Symptoms = chest pain, weakness, sob, dizziness etc. Treatments = lifestyle changes and possibly medications. tests to diagnose = ecg, echocardiogram, stress test etc