study guide unit 3 and 4

• Babies and elderly
• pt that cannot get themselves something to drink

• ↑ HR
• ↑ RR and depth
• ↓ BP
• flattened neck and hand veins

water and dissolved electrolytes are lost in equal proportions

Water loss in greater that electrolyte loss

Electrolyte loss is greater than water loss

• Normal Saline same concentration as intravascular (TREATS DEHYDRATION)
• D5W same as intravascular but not volume expander
• Lactated Ringers has many minerals and electrolytes same concentration as intravascular, great for pumping up volume (USED DURING HEMORRHAGE)

• I&O
• daily weights
• ring and shoe size
• urinary output
• hypostatic hypotension, less fluid in vessels when stand up BP will drop

• Heart (PUMP)
• Kidney (FILTER)

they have diminished deep tendon reflexes, they are fatigued and weak, therefore they are at risk for falling

• cardiac dysrhythmia
• cardiac ischemia

• only give PO or IV Infusion
• freq. check IV site for infiltration
• K+ can cause tissue necrosis
• max infusion rate 5-10meq/hr, absolutely no more than 20meq/hr
• ALWAYS QUESTION ORDER TO ADMINISTER K+ TO PT WITH RENAL FAILURE

136-145mEq/L

3.5-5.0mEq/L

9.0-10.5 mEq/L

98-106 mEq/L

1.3-2.1 mmol/L

3.0-4.5

• sodium 136-145
• potassium 3.5-5.0
• calcium 9.0-10.5
• chloride 98-106
• magnesium 1.3-2.1
• phosphorus 3.0-4.5

overadministration

Alcoholics (are at risk for seizure)

• Calcium Gluconate
• give IM or IV

respiratory arrest

• ↑HR & BP
• Muscle & tendon weakness
• ↓GI Motility, constipation
• dehydration, develop renal calculi

• Stop all sources of calcium
• admin saline
• admin LOOP diuretics or calcium clockers
• dialysis if life threatening
• cardiac monitoring watch for dysrhythmias

• paresthesias, twitches, cramps, tetany, hyperactive deep tendon reflexes
• decreased HR and contractability
• increased GI motility, diarrhea, abdominal cramping, hyperactive BS
• Give Ca+ supplements and increase vit d intake (need vit d to metabolize calcium)
• IV CALCIUM DRIPS SHOULD BE A BODY TEMP OR IT WILL NOT ABSORB RIGHT

phosphorus follows calcium

• "if phosphorus is low than calcium is prob high"
• for hypo or hyper phophatemia control the calcium

• variable pulse and rhythm often rapid with weak and thread quality
• lethargy LOC changes
• shallow ineffective resp with diminished breath sounds because resp muscles are weak
• skeletal muscle weak flaccid

brisk reflexes, cramps, possible tetany

• complete: break across the entire width of the bone
• incomplete: the break is through only part of the bone
• Stress Fx: caused by excessive stress or strain on the bone
• Compression Fx: produced by loading force applied to long bones
• open/compound: the skin is open
• closed/simple: does not extend through the skin
• Pathologic (spontaneous): fx occur after minimal trauma, the bone was weakened by disease

• grade I: least severe injury minimal skin damage
• Grade II: accompanied by skin and muscle contusions
• Grade III: damage to skin, muscle, nerve tissue, and blood vessels. the wound is greater than 2.4-3.2 inches in diameter

• check every 8 hours for drainage (if there is a wound) crumbling of the cast, alignment and fit
• explain the purpose of the cast
• educate on care of casts and s/s of compartment syndrome(pain, loss of movement, swelling)
• prevent soiling cast
• ensure cast is not too tight
• teach to monitor neurovascular status

• application of pulling force to the body to provide reduction alignment and rest at the site
• May also prevent muscle spasms

• maintain correct balance between traction pull and countertraction force
• DO NOT REMOVE WEIGHTS without an order let them hang freely
• inspect sin every 8 hours

serious condition in which increased pressure within 1 or more compartments cause massive compromise of circulation to the area

• can be from external source: bulky dressings, cast
• internal source: blood or fluid accumulation in compartment
• Burns
• Snake Bites

• 5 P's
• Pulses
• Pallor
• Pain
• Paresthesia
• Paralysis

Fasiotomy can be preformed to relieve the pressure

• potentially fatal complication of compartment syndrome
• injured muscles release myoglobinuric (muscle protein) into circulation and causes Renal Failure.
• Hyperkalemia develops because the muscle releases potassium which cannot be passed due to renal failure

• dialysis to get rid of extra potassium
• monitor cardiac functions

• Syme- ankle
• Lisfranc- midfoot
• BKA below the Knee
• AKA- above the knee

trapeze placed over their bed for better control over movements and to help them move on their own

• to help them be prepared to return to active lifestyle
• wear a prosthesis is the best way to do that

• the stump has to be wrapped securely to shrink it and prepare the stump to fit inside prosthesis
• also important to prevent contractures at hip or knee by doing ROM exercises with the patient

• Humpback
• curvature of the dorsal spine
• is a classic sign of osteoporosis

• S shaped lumbar curvature
• Beer Belly or Preg Lady
• caused by obesity, pregnancy
• reversible

• most common type is congenital
• less than 50% conservative Tx
• greater than 50* needs repaired Harrington Rods
• Greater than 60* cardiopulmonary compromise, spontaneous spinal fx compressed organs hypoxia

• Bisphosphonates
• Calcitonin
• Estrogen Agonist/Antagonist
• Calcium and Vit D

• most common treatment for osteoporosis
• inhibits resorption of bone by binding with the elements in the bone
• Fosamax, Actenel, Boniva
• Must take with 8oz water in AM or on empty stomach for best absorption
• Pill can cause severe esophagitis, do not crush, take sitting up, on empty stomach

DXA Scan

• Aredia (3-6 months)
• Reclast (once a year)
• small risk of aseptic osteonecrosis jaw bone will dissolve

• mimic estrogen
• do not give to women with H/O DVT
• EVISTA lowers cholesterol

hormone that inhibits osteoclastic activity thus decreases bone loss

treatment for osteoporosis

• stimulates new bone formation and increased BMD
• given SQ injection
• teach pt to give injection
• patient must have physical dexterity and mental capacity to give injections

you have to have vit d to metabolize calcium

• Vertebra
• radius
• upper 1/3 of femur

• decrease in estrogen promotes and increases the rate of bone reabsorption
•  
• Men: decrease in testosterone and altered ability to absorb calcium

• results from an associated medical condition such as hyperparathyroidism (increase in circulating calcium)
• long term drug therapy
• long term immobility
• long term steroid use

occurs when a limb is immobilized

• continued weight bearing
• diet high in calcium and vit d

softening of the bones caused by vit d deficiency

• most often occurs 10-30
• very small % of all cancers, many more are secondary and metastasize to bone
• previous radiation therapy to previous cancer is big risk
• EX: bone cancer in the ribs is not uncommon after having radiation for breast cancer

lungs

proper arch support, rest and ice

• Compression and elevation not effective
• Pain is worse in the morning

• rest
• Ice
• Compression
• Elevation

Compression Fractures

blood loss and hypovolemia

DVT and yellow fat embolism

hypoxia

• changes in LOC
• Brain injury