NUR 219: PATHOPHARM Exam 3

Purdue Nursing 2025 pathopharmacology with Dr. Swartzell and Dr. Renbarger

intracellular fluid

contained within cells

extracellular fluid

fluid outside of cells

interstitial compartment

surrounds the tissue cells

intravascular fluid

contains the plasma and blood vessels

transcellular compartment (third space)

contains plasma and blood vessels as well as other fluids (mucous, GI, CSF, pericardial, synovial, and ocular fluids)

TBW of 154 lb man

60%

TBW neonates

75-80%

TBW older adults

45-55%

hypovolemia factors

prolonged decreased intake, excessive loss d/t bleeding/ trauma, GI losses

hypovolemia signs

excessive thirst, confusion, decreased urine output, vomiting, diarrhea, weakness, decreased BP, dry mucous MB

hypovolemia late signs

clammy skin, thready pulse, confusion, oligura

hypovolemia interventions

isotonic IVF, encourage frequent oral intake, measure I+Os, obtain weight daily

hypervolemia contributing factors

heart failure, liver disease, kidney failure, excessive fluid intake, rapid IV infusion

hypervolemia signs

tachy, bounding pulse, tachypnea, increased BP, altered mental status, generalized edema, cough, dyspnea, orthopnea, crackles, pulmonary congestion, muffled heart sounds, fatigue, jugular distention, increased urine output

hypervolemia interventions

moniter daily weight, administer diuretics, monitor labs, monitor I+O

electrolytes

substances that separate ions, in ECF and ICF

electrolyte importance

carry electrical impulses to other cells in the body

homeostasis principals

1) anions (-) and cations (+) must be balanced within each compartment and remain electrically neutral 2) fluid compartments remain osmotic equilibrium except for transient changes

osmosis

the movement of water across semipermeable MB from low to high concentration

diffusion

the movement of molecules from high or low concentration

hydrostatic pressure

the force within the fluid compartment

osmolality

concentration of fluids

active transport 

requires metabolic activity and expenditure to move a substance across a MB

osmole

the number of solutes in a solution is expressed as a unit of measurement call the osmole

iso-osmolar

fluid has the same weight proportion particles and water

hypo-osmolar

fluid contains fewer particles than water

hyperosmolar

fluid contains more particles than water

recommended water intake

2300 to 2900 mL daily

insensible waiter loss

continuous daily water loss that occurs through skin and lungs, not measurable

sensible water loss

occurs through lungs (respiration), skin (perspiration), and GI tract (feces), not measurable  

types of IV fluids

crystalloids, colloids, blood or blood products

crystalloids

contains fluids and electrolytes that cross capillary walls, does not contain proteins, used as short term

hypotonic (crystalloid)

Allows water to move into the cell (IV solution has less
pressure than the ECF); excessive infusion can result in hemolysis,
decreased blood pressure, and decreased IVF fluid

isotonic (crystalloid)

solutions have the osolarity was ECF or plasma, water does not enter or leave the cell, used for hydration and to increase ECF volume

hypertonic (crystalloid)

solutions have greater osmotic pressure than ECF, need to moniter for signs of circulatory overload

dextrose solutions

can be in different concentrations and in combination with other types of fluids, provides hydration and calories and increases blood glucose levels, affects the tonicity of the solution after it is infused

balanced electrolyte solutions

ringers and lactated ringers used for hydration; contraindicated in pt with liver disease

isotonic IV fluids

Lactated Ringers, 0.9% NaCl, 5% dextrose in water (D5W)

hypotonic IV fluid

0.45% NaCl, 0.33% NaCl, 0.225% NaCl

hypertonic IV fluids

3% NaCl, 5% NaCl, 5% dextrose in .45% NaCl (D51/2NS), 5% dexrose in.9% NaCl (D5NS), 5% dextrose in LR (D5LR), 10% dextrose in water (D10W)

colloids

contains proteins/ large molecular substances that increase osmolarity without dissolving, pull interstitial fluid into plasma; ex. albumin

blood product types

PRBCS, plasma, platelets, and crypoprepriocipiate

blood product infusion max rate

4 units/ hour STRICT

potassium (K+)

primary cation, 98% in cells, acidotic conditions pull K out of cells, needed for nerves, muscle contraction, and kidney function, NEVER GIVE IM OR IV BOLUS/PUSH

hypokalemia causes

trauma, injury, GI loss, diuretics

hypokalemia S/S

muscle weakness, fatigue, anorexia, N/V, paresthesia, leg cramps, decreased bowel motility, dysrhythmias, cardiac arrest

hyperkalemia causes

excessive intake, impaired renal excretion, renal failure, meds that interfere with excretion

hyperkalemia risk factors

premies, geriatric, adrenal insufficiency, cancer, uncontrolled diabetes, polypharm

hyperkamelia S/S

cardiac dysrhythmias, tachy, brady, GI hyperactivity

potassium rich foods

tuna, fruits (mangoes, oranges, tomatoes, avocados, cucumbers, spinach, strawberries, bananas), veggies (potatoes)

sodium (Na)

cation in ECF and body fluids, combines with chloride and bicarb, important in neuromuscular irritability and conduction of nerve impulses

hyponatremia causes

loss of sodium fluids, low intake, water gain; V/D, NG suction, burns, draining wounds, trauma, renal failure, heart failure, third spacing

hyponatremia S/S

muscle weakness, decreased tendon reflexes, headaches, lethargy, confusion, seizures, coma, N/V, hypotension, dry mucouse MB, tachy

sodium admin

PO preferred, IV may be used

hypernatremia causes

excessive intake, low water intake, hypertonic tube feed/ IVF, kidney failure

hypernaturemia S/S

dry mucous MB, dry skin, agitation, elevated body temp, rough tongue, N/V, anorexia, tachy, HTN, muscle twitching, hypereflexia, seizures, coma

sodium rich foods

bacon, lunch meats, corned beef, decaf coffee, ham, tomato juice, pickles, soda crackers, table salt

calcium

most abundant mineral in body, 90% found in bones and teeth, necessary for nerve impulses, muscle contraction, BP reg, hormone secretion, and maintenance of muscle tone

hypocalcemia causes

inadequate intake, hyperphosphatemia, acute pancreatitis, diarrhea, alcoholism, malnutrition, loop diuretics, vit D deficiency, blood transfusions

calcium administration

can be PO or IV

hypocalcemia S/S

anxiety, irritability, tentany, twitching, hyperactive deep tendon reflexes, spasms, seizures

hypercalemia causes

hyperparathydroidism, malignancy, hypophosphatemia, excessive intake, fractures, steroids

hypercalcemia S/S

fatigue, muscle weakness, depressed deep tendon reflexes, confusion, impaired memory, N/V, constipation, kidney stones

calcium rich foods

milk and dairy products, foods rich in protein and vit D enhance absorption

magnesium

plays a role in calcium potassium balance, deficits occur w/ hypokalemia and hypocalcemia, promotes transmission of NM activity and neural transmission in CNS

hypomagnsemia

most undiagnosed electrolyte deficit

hypomagnesemia S/S

increase neuromuscular excitability, muscle cramps, twitching

magnesium rich foods

green veggies, fruits, fish, grains, nuts

low magnesium administration

IV magnesium sulfate is often given

hypermagnesemia causes

magnesium salts, mag sulfate, mag citrate

high magnesium administration

calcium gluconate

hypermagnesemia S/S

loss of deep tendon reflexes, hypotension, heart block, cardiac dysrhythmias 

phosphorus

primary anion, second most abundant in body

hyperphosphatemia causes

malabsorption, alcoholism, V/D, can lead to blood disorders

hyperphosphatemia S/S

muscle weakness, tremors, parasthesia, bone pain, hyporeflexia, seizures, hyperventilation, anorexia, dysphagia

hypophosphatemia

can be related to kidney issues and increased intake in the form of laxatives

hyperphosphatemia S/S

hyperreflexia, tetany, flaccid paralysis, muscular weakness, tachycardia, N/D, abdominal cramos

phosphorus rich foods

whole grain cereal, nuts, milk, meat

urinary tract disorders

can be cause by gram -/+ bacteria, degree of illness depends on microbe and virulence, most are caused by UTIs

upper UTI

pyelonephritis

lower UTI

cystitis, urethritis, protatitis

urinary antiseptics/ antiinfectives

group of drugs which prevent bacterial growth in kidneys and bladder, not effective for systemic infections, low doses are bacteriostatic, high doses are bactericidal

acute cystitis

lower UTI, common in females (especially those sexually active, older females, you females, caused by e. coli, culture needed before diagnosis, in males more likely prostatitis with symptoms like cystitis

acute cystitis symptoms

pain and burning on urination, frequency and urgency

acute pyelonephritis

upper UTI, seen in women, E. coli is most common cause, bacterial count in urine is 100,000 bacteria/mL, may need to be hospitalized for IV antibiotics (aminoglycoside or pieracillin-tazobactam)

acute pyelonephritis S/S

chills, high fever, flank pain, pain during urination, frequency and urgency, pyuria

nitrofurantoin and TMP-SMZ

treatment is 3-7 days; 7-14 days

1-5th generation cephalosporins

treat UTIs

fluoroquinolones (ofloxacin, ciprofloxacin)

for uncomplicated UTIs, levoflaxacin may be used when options are not available

urinary antiseptics/ antiinfectives and antibiotics

limited to treatment of UTIs, drug action occurs in renal tubule and bladder where it reduces growth, UA and C&C performed before starting drugs, drugs are bactericidal and can cause superinfections

TMP-SMX

SMZ combined to prevent resistance to TMP, used to treat acute and chronic UTIs, amount of drug is 2-3x greater in prostatic fluid than the vascular fluid

TMP-SMZ pharmacokinetics

well absorbed in GI tract, may be taken with food, water milk, can cause GI distress and crystalluria

TMP-SMZ pharmacodynamics

ration of TMP to SMZ is 1:5, bactericidal effects against gram +/- bacteria, peak action is at 4 hours

methenamine MOA

bactericidal effect when urine pH is less than 5.5 (urine can be acidified with cran juice, ascorbic acid, or ammonium chloride)

methenamine uses

effective against E. coli, used for UTI prophylaxis

methenamine contraindications

should NOT be taken with sulfonomides d/t crystaluria

methenamine absorption site

GI tract

methenamine side effects

nausea, dysura, rash, elevated hepatic enzymes, hemauria, crystellura

nitrofurantoin

approved in 1954, antacids decrease absorption, short half life, use with food to avoid GI upset

nitrofurantoin MOA

bacteriostatic or bactericidal, low does are preventative,