Module 2: Health Alterations

Serum sodium normal lab value

136 to 145

What happens if sodium if less than 125

cause weakness and dehydration

cause weakness and dehydration

Cause neurologcal symptoms and vascular problems

Electrolyte loss from diarrhea

primarily causes hyponatremia (low sodium below 135) and hypokalemia (low potassium below 3.5)

Who is most at risk for dehydration

infants and toddlers are most at risk for dehyration.

Signs and Symptoms of dehydration

Sunken eyes and fontanels (infants)

Dry mucous membranes

Weight loss= water loss

fatigue, lethargy, decrease tearing

decreased skin turgor

Slow cap refill >2seconds

Which skin assesment indecates adequate hydration and nutrition in children

Skin turgor

When the body is dry

specific gravity is high

Causes of diarrhea

viruses that can cause infection, and bacteria and parasites from undercooked food, causing salmonella, medication, and poor water quality

Most common cause of diarrhea in children under 5

Rotavirus

Hydration tips

ORS↔First line. Oral rehydration solutions. Avoid energy drinks as they have to much sugar

IV Fluids→severe, 20ml/ kg iv normal saline bolus

Diet for diarrhea

Normal diet (solid foods).

Additionally, avoid antidiarrheal meds, such as loperamide

as it can prolongue some bacterial infections and even cause fatal paralytic iliues.

Never give live vaccines to individuals

with low immune system individuals.

example of live vaccine

Varicella-zoster (chickenpox)

Influenza

Measles, mumps, and rubella (MMR)

Rotavirus

Example of low immunity individuals

Leukemia

lymphoma

On chemotherapy & radiation

Immunosuppressants (Methotrexate)

IVIG (Immunoglobulin therapy)

Common reaction after vaccine

MILD fever

Redness and swelling at injection site (apply cold pack)

Severe reaction after vaccine

Fever above 102F (38.9) (administer acetaminophen)

Febrile siezures

allergies associated with not taking Influenza vaccine

Avoid if allergic to eggs

allergies associated with not taking MMR vaccine

Avoid if you have a prior allergic reaction to neomycin.

adverse affect of MMR

arthritis

allergies associated with not taking Hepatitis b vaccine

prior anaphalactic reaction to yeast

allergies associated with not taking IPV vaccine

Prior anaphalctic reaction to neomycin

Prior anaphalctic reaction to neomycin

Yes

Vaccines at birth

Hepatitis B

Vaccines at 2 months

B DR HIP

B= Hepatitis B

D= DTaP (diphtheria, tetanus, pertussis)

R= RV Rotavirus

H= Hib

I= IPV inactivated polio vaccine

P= PCV Pneumococcal vaccine

vaccines 4 months

DR. HIP

D= DTaP (diphtheria, tetanus, pertussis)

R= RV Rotavirus

H= Hib

I= IPV inactivated polio vaccine

P= PCV Pneumococcal vaccine

Vaccines 6 months

B DR. HIP flu

B= Hepatitis B

D= DTaP (diphtheria, tetanus, pertussis)

R= RV Rotavirus

H= Hib

I= IPV inactivated polio vaccine

P= PCV Pneumococcal vaccine

vaccines 12 months

MAD HPV

M= MMR

A= Hepatitis A

D= DTaP

H= Hib

P= PCV

V= Varicella

vaccine 4-6 yrs

Very DIM

VERY= Varicella

D= DTaP

I= Influenza & IPV

M= MMR

11-12 years vaccine

MITH

M=Meningitis

I= Influenca

T= T daP

H= HPV

16-18 Years Vaccine

Men Flu

Meningitis booster

Annual flu shot

Shock

A critical condition where the body doesn't have enough tissue perfusion, which can lead to organ death. A state of inadequate tissue perfusion and oxygenation, marked by hypotension, tachycardia, altered mental status, and poor capillary refill.

4 stages of shock

1. Initial

2. Compensatory

3. Progressive

4. Refractory/ irreversible

initial stage of shock

Too little oxygen in the blood to feed the organs, resulting in anerobic metabolism, which doesn't require oxygen. There are no symptoms at this stage.

Compensatory stage of shock

- Heart pumps faster to compensate, causing tachycardia

- Sympathetic nervous system becomes activated (speeds up vitals)

- Renin and angiotensin activate

Progressive stage of shock

Weak thready pulse

Excessively low BP

Edema

Dysrhythmia

Cold and Clammy

irreversible shock

a condition defined by the inability to successfully achieve resuscitation regardless of the methods employed. death is imminent

Septic shock

Septic shock is a life‑threatening systemic response to blood born infection that causes profound hypotension, widespread vasodilation, capillary leak, and organ dysfunction. A cytokine is released, causing extreme vasodilation and fluid leaking from the capillaries.

Example of infections that can cause septic shock

Pneumonia, UTI or kidney infection.

signs and Symptoms of septic shock

- Low BP (Less than 80/ systolic)

-Cold, clammy skin (pale & cool extremities)

-Delayed capillary refill

-Mental status change (confusion and disorientaation from hypoxia)

-High WBC (over 10,000)

-High temperture in the initial stages and then very low later on

-Tachycardia (increased heart rate)

Neurogenic shock

caused by a spinal cord injury that occurred at T6 or higher. The autonomic system is damaged, blocking the SNS, which is supposed to speed up the heart rate and cause vasoconstriction. Only PNS works, causing widespread vasodilation and hypotension.

Signs and symptoms of neurogenic shock

-Low bp

-Bradycardia

-Skin that is WARM, PINK & DRY mostly from the vasodilation

intervention of neurogenic shock

IV Normal Saline (0.9 % sodium chloride) to increase the blood pressure

Complication of neurogenic shock

Autonomic dysreflexia

Hypovolemic shock (hemorrhagic)

A sudden, severe loss of blood volume that reduces cardiac output, leading to inadequate tissue perfusion and organ dysfunction.

causes of hypovolemic shock

Diarrhea, vomiting, fluid shifts in burn patients or extreme blood loss

Signs and Symptoms of hypovolemic shock

Cold and clammy skin

Hypotension

Tachycardia

Low central venous pressure

Low urine output

Hypovolemic interventions

-LOWER head of bead right away

-IV Normal Saline (0.9% sodium chloride)

-Administer blood products if indicated

-Then give IV norepinephrine/ dopamine

-Maintain MAP over 65

-Maintain CVP as (2-6 mmHg)

Cardiogenic shock

A state of inadequate tissue perfusion caused by severe cardiac dysfunction.

interventions for cardiogenic shock

dopamine and digoxin. Both have inotropic properties making the heart pump more forcefully. Dopmine is a vassopressor, so be careful of tachycardia and arrythmias.

Anaphylactic shock

A sudden, life‑threatening systemic allergic reaction that causes widespread vasodilation, bronchospasm, urticaria, and swelling, leading to hypotension and potential cardiovascular collapse.

treatment for anaphylactic shock

Epinephrine or an EpiPen Auto Injector, then diphenhydramine, then albuterol, steroids

Pathophysiology of seizures

Excessive, synchronous neuronal firing that disrupts normal brain function.

Epilepsy

A neurological disorder marked by recurrent seizures caused by abnormal electrical discharges in the brain.

causes of epilepsy

Overall anything that can cause swelling in the brain, such as infections, trauma, MASS and increase ICP, fever, withdraw from drugs and alcohol.

tonic seizure

Sustained, continuous muscle contraction that maintains posture.Tight & Tense

clonic seizure

Rhythmic jerking movements of muscles. Convulsions, contractions and clonic clicking.

tonic clonic seizure

A generalized seizure that begins with a tonic phase of sustained muscle contraction and is followed by a clonic phase of rhythmic jerking.

Phases of tonic clonic seizures

Loss of consciousness

Pt. falls to ground

Body stiffens for 10-20 seconds

Extremities jerk for 30-40 seconds

Pt. feels tired and sleepy

atonic seizure

Lacking tone or muscle tone; weak or flaccid.

Myoclonic seizure

Brief, involuntary muscle jerks.

absent

brief; lasts seconds; pt may or may not lose consciousness

No loss of change in muscle tone

May occur several times during the day

Appears to be daydreaming

More common in children

partial or focal seizure

when only one part or side of the body is affected

triggers of a seizure

Stress

Sleep deprives, fatigue

Strobe lights or flashing lights

Stimulants

Sugar & sodium that is low

stages of a seizure

prodromal

aura

ictus

post-ictus

prodormal phase

Prodromal phase→The prodromal phase is the period before the seizure, often presenting as warning signs

Aura phase

The initial warning phase, marked by sensory, autonomic, or psychic symptoms that precede the seizure. Unusual sensation prior to the seizure

Ictal phase

The active seizure period during which clinical signs and EEG changes occur.

postictal phase

Recovery period after a seizure, marked by confusion, fatigue, and possible neurological deficits.

Status Epilepticus

A prolonged seizure lasting more than 5 minutes or recurrent seizures without return to baseline consciousness. An emergency as it cuts of oxygen to the brain. Also an emergency is repeated seizure activity within 30 minutes.

Status eplipticus treatment

IV or Rectal benzodiazepine or diazepam!

partial seizure

A seizure that originates in a specific area of the brain and involves only part of the body, often with preserved consciousness. It can occur at any age

Symptoms of a partial seizure

-No loss of consciousness, lasts less than 30 seconds, no post seizure confusion, may occur anytime of day

-NO aura

-May have twitching, loss of muscle tile, paresthesia

Cause of partial seizures

-Focal damage, arising from a lacalized are of one cerbral hemisphere

-Tumor or lesion

-Arteriovenous malformation (tangling of blood vessels in brain

-Brain abscesses

Complex partial seizure

A seizure that originates in a specific region of the brain and may involve both motor and non‑motor symptoms.

Complex partial seizure onset

3 years of age to adolescence

Complex partial seizure cause

-Lesion, cysts, or tumors

-Perinatal trauma

-Focal sclerosis

-Vascular anomolies

-Brain trauma

symptoms of a complex partial seizure

Losing contact with surroundings-a few seconds to 20 minutes

Automatisms

At the end of motor activity, mental confusion or fear

generalized seizure

Seizures that involve both hemispheres of the brain, causing loss of consciousness and generalized convulsive activity.

Generalized seizure onset

any age; rare before 6 months of age

Generalized seizure symptoms

-Abrupt onset, 1- 2 minutes of lost consciousness

-Post seizure confusion

-Eyes roll upward or deviate to one side, pupils dilate

-Drooling or foaming at mouth as secretions are not swallowed

-Abdominal or chest wall ridgity

-Urinary or bowel incontinence

-Cry or grunt as air is forced out when diaphragm and chest muscles contract

Cause of generalized seizure

-Cerebral injury

-Metabolic disturbances

-Infections

-Genetic factors

-Toxic exposure

-Febrile episodes

-Structural brain abnormalities

-Electrolyte imbalances