PathoPharm - Resp & Fluids/Acid-Base

What type of fluid is 0.45%NS

hypotonic crystalloid that will cause shift of fluid from vascular space into clles

What symptoms may indicate a need for antibiotics?

symptoms longer than 7 days and fever

Which med category is used to suppress a cough reflex

antiussives

Which disorder might the use of antibiotics be most beneficial?

pneumonia

A patient taking a nebulizer treatment of albuterol must be assessed for the development of which side effect/adverse effect?

tachycardia

The following are signs of hypokalemia

muscle twitching, depressed T wave, muscle weakness

For FVE what fluid is given?

D5/.9%NS

The RAAS system causes

kidneys to hold sodium and water

Antidiuretic hormone in RAAS causes

kidney to hold in water

Assessment of proper hydration should include

BP, skin turgor, I&O

Late symptoms of hyponatremia

lethargy, seizure, confusion, headache

Diffusion

movement of molecules from higher to lower concentration

Osmosis

diffusion of water

Recommended intake of fluids

Men: 3.7 L, Women: 2.7 L

What to assess for hydration

urine color, dry mouth, skin turgor, cap refill, urine osmolality, blood electrolytes

Things that affect hydration

high tmep, humidity, physical activity, illness, meds, high altitude

S&S of dehydration

increased thirst, dry mouth, dark urine, fatigue, headache, low BP, dizziness, confusion, dry skin, muscle cramps, rapid HR

Osmolality

natural body concentration of solutes

Homeostasis

natural balance

Tonicity

number of solutes in solution

Isotonic

equal to natural osmolality

hypotonic

lower than natural osmolality; moves out vascular into cells

hypertonic

higher than natural osmolality; moves out of cells into vascular

RAAS system function

regulates BP and fluid balance

renin is released by

the kidney when BP drops

Aldosterone tells kidneys to

reabsorb sodium and water

Activation of angiotensin II causes

vasoconstriction

Role of electrolytes in the movement of fluid and osmosis

more concentration causes fluid to move towards the concentration

Primary electrolyes

sodium, potassium, chloride, calcium, magnesium

FVD S&S

tachycardia, hypotension, dizziness, cool, clammy, thready pulse

Treatment for FVD

isotonic for mild, hypotonic given w/ isotonic for more severe

FVE S&S

pulm congestion, hypertension, SOB, JVD, late sign edema, bounding pulse

FVE treatment

hypertonic

Hypotonic example

0.45%NS, 0.25%NS

Hypertonic example

D5/0.45%NS, 3% and 5% saline

Isotonic example

0.9%NS, LR

Isotonic fluids are

first line

We give hypotonic in conjunction with

an isotonic

intersitial fluid (IF)

fluid between cells

Extracellualr fluid (ECF)

fluid outside cells

Intracellular fluid (ICF)

fluid within cells

Intravascular fluid

fluid within blood vessels

Add fluids when

electrolytes are high

Restrict fluids when

electrolytes are low

Sodium concern

nerve conduction, neuro, seizures

When sodium is high,

give fluids (D5W)

When sodium is low,

restrict fluids

Sodium normal levels

135-145

Hyponatremia S&S

seizures

Hypernatremia S&S

thirst, elevated temp, dry tongue

Potassium concern

cardiac dysrhythmias, muscle tone

Potassium nursing action

cardiac monitor

For high potasium give

sodium polystyrene sulfonate, IV sodium gluconate, IV calcium gluconate

For low potassium

replace potassium PO when possible, never IV push, piggyback (10 mEq/hour max)

Potassium normal levels

3.5-5.0

Hypokalemia S&S

muscle cramps, dysrhythmias, depressed T wave

Hyperkalemia S&S

peaked T wave

Calcium normal level

9.0-10.5

Hypocalcemia S&S

parasthesia, trousseau's, chvostek's, seizures

Hypercalcemia S&S

constipation, bone pain, confusion, thirst

Treatment for calcium deficit

give calcium through diet

Treatment for calcium excess

give fluids PO, biphoshponates

Ventilation

movement of air into and out of the lungs

Respiratory diffusion

gas transport

Perfusion

control of pulmonary circulation

3 steps of the pulmonary system

ventilation, diffusion, perfusion

Dyspnea

altered breathing

Dyspnea assessment

nasal flaring, accessory muscle use, retraction

Orthopnea

difficulty breathing when lying down

Transient dyspnea

certain times

Paroxysmal nocturnal dyspnea (PND)

SOB that occurs suddenly during sleep

Dyspnea on exertion (DOE)

SOB with activity

Hyperventilation

hypocapnia, resp alkalosis, anxiety

Hypoventilation

hypercapnia, resp acidosis

Hypercapnia

too much CO2

Hypoxemia

reduced O2 in blood

Hypoxia

reduced O2 in tissue

Acute respiratory failure

combined hypercapnia and hypoxemia

Common cold etiology

rhinovirus

Common cold affects

nasopharyngeal tract

Common cold contagious period

1-4 days before symptoms

Common cold transmission

indirect contact, droplet contact

Acute rhinitis

inflammation of nasal mucous membranes

Sinusitis

inflammation of mucous membranes of sinuses

Acute pharyngitis

inflammation of throat

Symptoms of common cold

nasal congestion, nasal discharge, cough, increased mucosal secretions

Common cold treatments

antihistamines, intranasal glucocorticoids, expectorants, antiussives

Antiussives

agents that relieve or prevent coughs

Antiussive opioids

codeine, hydrocodone

Antiussive non-opioids

dextromethorphan, benxonatate, diphenhydramine

Antiussive side effects

dizziness, drowsiness, resp depression

Benzonatate is good for

COPD

Expectorants

loosens bronchial secretions, allows elimination by coughing

Expectorant example

guaifenesin

Expectorant considerations

take w fluids

Expectorant side effects

drowsiness, dizziness, irritability, nausea, sensitivity

Mucolytics

agents that destroy or dissolve mucus

Mucolytics example

acetylcysteine

Mucolytics side effects

bronchospasms, dizziness, drowsiness, hypotension, tachycardia, hepatotoxicity

Acetylcysteine is the antidote for

acetaminophen poisoning