What three things contain a lot of Na? - ✔✔ 1. Effervescent soluble medications
2. Canned processed foods
3. IVF with Na
What is aldosterone?
... [Show More] Where is it found? - ✔✔ Steroid or mineralocorticoids; adrenal glands
When blood volume is low what happens to aldosterone secretion? - ✔✔ It increases and Na/H2O are retained in order to increase volume
What are two examples of too much aldosterone? Too little? - ✔✔ Cushings & Herpaldosteronism (Conn's syndrome); Addisons
What is ADH also called? - ✔✔ Vasopressin
What does ADH do? - ✔✔ Makes you retain ONLY H20
If you have too much ADH what happens? - ✔✔ Retain H20
FVE
urine is concentrated
blood is dilute
If you have too little ADH what happens? - ✔✔ Lose/diuresis H20
FVD
urine is dilute
blood is concentrated
How does SIADH become FVE? - ✔✔ The kidney can't excrete waste so they retain water because the body is producing too much ADH
Where is ADH found? - ✔✔ Pituitary
What type of surgery is an example that can lead to an ADH problem? - ✔✔ Sinus surgery but really anything that leads to an increased ICP
What is the pt at risk for developing after sinus surgery? How is is prevented? - ✔✔ DI or going into shock; given ADH replacement (vasopressin/desmopressin acetate)
Where is CVP measured? what's normal? - ✔✔ Right atrium; 2-6mmHg
How do you treat FVE? - ✔✔ 1. Diuretics
2. Bedrest
3. Low Na/fluid restrictions
4. Daily weights/I&Os
5. Physical assessment
6. Give IVFs to elderly/young and pts with a hx of heart/kidney disease slowly
How do you treat FVD? - ✔✔ 1. Prevent further losses
2. Replace volume (mild deficit: PO fluids, severe deficit: IVFs)
3. High risk for falls, monitor for overload
what type of pts do you not use isotonic fluids for? - ✔✔ Pts with HTN, cardiac or renal disease because they can cause FVE, HTN or hypernatremia
Do hypotonic solutions cause HTN? - ✔✔ No, because they rehydrate the cell but don't stay in the vascular space
What type of pts do you use hypotonic solutions for? - ✔✔ Pts with HTN, cardiac or renal disease or pts who need fluid replacement because of n/v, burns, hemorrhage or for dilution when a pt has hypernatremia and cellular dehydration
What type of pts do you use hypertonic solutions for? - ✔✔ Pts with HYPOnatremia or pts who have shifted large amounts of vascular volume to a 3rd space or has severe edema, burns or ascites because a hypertonic solution will return the fluid volume to the vascular space
If a pt is receiving 3% NS or 5% NS what do you monitor? - ✔✔ Vitals but especially CVP
Where is magnesium excreted? - ✔✔ Kidneys
What causes hyperMg? How do you treat it? - ✔✔ Renal failure and antacids
Ventilator, dialysis, calcium gluconate
What causes hypoMg? How do you treat it? - ✔✔ Diarrhea, alcoholism, alcohol suppresses ADH and its hypertonic
Give Mg, check kidney function, seizure precautions, eat Mg
What causes hyperCa? How do you treat it? - ✔✔ Too much PTH, thiazides (retain Ca), immobilization
Move, fluids prevent kidney stones, Ca has an inverse relationship with phosphorus, steroids, meds
What meds decrease serum calcium? - ✔✔ Biphosphates and calcitonin
What causes hypoCa? How do you treat it? - ✔✔ Hypoparathroidism, radical neck, thyroidectomy (NOT enough PTH)
PO Ca, IV Ca, Vit D, phosphate binders
What are two phosphate binders? - ✔✔ Sevelamer hydrochloride and calcium acetate
What causes hyperNa? How do you treat it? - ✔✔ Hyperventilation, heat stroke, DI
restrict Na, dilute fluids, DW, I&Os, lab work
What causes hypoNa? How so you treat it? - ✔✔ Drinking H20 for fluid replacement, psychogenic poly dips is loves to drink H20, D5W, SIADH
Need Na, do not need H20, if having neuro problems need hypertonic solution (3%NS or 5%NS)
Where is potassium excreted by? - ✔✔ Kidneys
What happens to the serum K level if the kidneys are not working? - ✔✔ It goes up
What causes hyperK? How do you treat it? - ✔✔ Kidney trouble, spironolactone
dialysis, calcium gluconate decreases arrhythmias, glu and insulin (insulin carries glu and K into the cell), sodium polystyrene sulfonate (kayexalate)
What causes hypoK? How do you treat it? - ✔✔ Vomiting, NG suction, diuretics, not eating
Give K, spironolactone, eat more K
During respiratory acidosis the body must excrete and retain what? - ✔✔ Excrete hydrogen and retain bicarb
What are s/s of respiratory acidosis? - ✔✔ Headache, confusion, sleepy
During respiratory alkalosis the body must excrete and retain what? - ✔✔ Excrete bicarb and retain hydrogen
What causes respiratory alkalosis? - ✔✔ hyperventilation
What are the s/s of respiratory alkalosis? - ✔✔ lightheaded, faint, peri-oral numbness, tingling in the fingers & toes
What organ is the problem with metabolic acidosis? - ✔✔ Kidneys
What causes metabolic acidosis? - ✔✔ DKA/starvation because the cells are starving because glucose is not available. The body will breakdown fat for energy and as a result produce ketones
OR kidney failure, severe diarrhea
What organ is the problem with metabolic alkalosis? - ✔✔ Kidneys
What causes metabolic alkalosis? - ✔✔ Loss of GI contents or too many antacids
Is metabolic acidosis and metabolic alkalosis, hyperK or hypoK? - ✔✔ Metabolic acidosis is HYPER K
Metabolic alkalosis is HYPO K
When does plasma seep out of tissue the most due to a burn? What is it caused by? - ✔✔ 1st 24 hrs; increased capillary permeability
What is secreted in order to vasocontrict so blood is shunted towards the vital organs? What is also secreted? - ✔✔ Epinephrine and noreprinephrine
aldosterone to retain Na & H20
ADH to retain H20
If the systolic BP is less than what, when will the pt not have adequate tissue perfusion? - ✔✔ <90
What is the #1 injury in burns? - ✔✔ Inhalation injury is the #1 cause of death which is caused by inhaling carbon monoxide and hydrogen cyanide
How do you get carbon monoxide poisoning? (In the body) - ✔✔ Oxygen normally binds with Hbg but now CO binds to Hgb leaving the pt hypoxia because O2 can't bind to Hgb anymore
If a pt is cherry red, what is wrong with them? - ✔✔ Hydrogen cyanide poisoning
What type of fluids are used in fluid replacement for a burn pt? - ✔✔ LR (crystalloids) and albumin (colloids) [Show Less]