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what type of patient is most likely to suffer fro dehydration
- Babies and elderly
- pt that cannot get themselves something to drink
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What happens to VS in the presence of dehydration?
- ↑ HR
- ↑ RR and depth
- ↓ BP
- flattened neck and hand veins
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Isotonic Dehydration
water and dissolved electrolytes are lost in equal proportions
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Hypertonic Dehydration
Water loss in greater that electrolyte loss
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Hypotonic Dehydration
Electrolyte loss is greater than water loss
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which IV Fluids are isotonic?
- 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)
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What are important assessments for dehydration
- I&O
- daily weights
- ring and shoe size
- urinary output
- hypostatic hypotension, less fluid in vessels when stand up BP will drop
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what are the body's 2 important regulatory mechanisms that control intravascular fluid volume?
- Heart (PUMP)
- Kidney (FILTER)
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Why is a pt with hypokalemia at risk for falling?
they have diminished deep tendon reflexes, they are fatigued and weak, therefore they are at risk for falling
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what is the most important and dangerous concern with hyperkalemia?
- cardiac dysrhythmia
- cardiac ischemia
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how is supplemental k+ administered?
what routes and what specific nursing implications are important when adminishtering
- 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
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normal sodium value
136-145mEq/L
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normal value Potassium
3.5-5.0mEq/L
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normal value for calcium
9.0-10.5 mEq/L
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normal value for Chloride
98-106 mEq/L
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normal value for Magnesium
1.3-2.1 mmol/L
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Normal Value for Phosphorus
3.0-4.5
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sodium
potassium
calcium
chloride
magnesium
phosphorus
- 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
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if magnesium is high what is the most likely cause
overadministration
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what pt likely to need Magnesium
Alcoholics (are at risk for seizure)
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what is the reversal agent for over administration of Mg+
- Calcium Gluconate
- give IM or IV
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danger with high Mg+ levels
respiratory arrest
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S/S hypercalcemia
interventions
- ↑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
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Hypocalemia
S/S
interventions
- 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
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the relationship between phosphorus and calcium
phosphorus follows calcium
- "if phosphorus is low than calcium is prob high"
- for hypo or hyper phophatemia control the calcium
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hypokalemia
s/s
- 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
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seizure precautions with hypokalemia due to
brisk reflexes, cramps, possible tetany
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types of fractures
- 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
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3 grades of an open Fx
- 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
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cast care and education
- 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
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what is the purpose of skeletal traction
- application of pulling force to the body to provide reduction alignment and rest at the site
- May also prevent muscle spasms
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Skeletal traction care
- 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
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compartment syndrome
serious condition in which increased pressure within 1 or more compartments cause massive compromise of circulation to the area
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causes of compartment syndrome
- can be from external source: bulky dressings, cast
- internal source: blood or fluid accumulation in compartment
- Burns
- Snake Bites
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how to assess for compartment syndrome
- 5 P's
- Pulses
- Pallor
- Pain
- Paresthesia
- Paralysis
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Surgical treatment for compartment syndrome
Fasiotomy can be preformed to relieve the pressure
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what is rhabdomyolosis
- 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
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nurse interventions for rhabdomyolosis
- dialysis to get rid of extra potassium
- monitor cardiac functions
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Amputation: what does following mean
Syme
Lisfranc
BKA
AKA
- Syme- ankle
- Lisfranc- midfoot
- BKA below the Knee
- AKA- above the knee
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New amputees should have _____
trapeze placed over their bed for better control over movements and to help them move on their own
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most important thing nurse can do for new amputee is
- to help them be prepared to return to active lifestyle
- wear a prosthesis is the best way to do that
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what needs to be done for new amputee to be able to wear prosthesis
- 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
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Kyphosis
- Humpback
- curvature of the dorsal spine
- is a classic sign of osteoporosis
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Lordosis
- S shaped lumbar curvature
- Beer Belly or Preg Lady
- caused by obesity, pregnancy
- reversible
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Scoliosis
- 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
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Meds for Osteoporosis
- Bisphosphonates
- Calcitonin
- Estrogen Agonist/Antagonist
- Calcium and Vit D
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Bisphosphonates
- 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
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best screening tool for osteoporosis
DXA Scan
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IV Bisphosphonates
- Aredia (3-6 months)
- Reclast (once a year)
- small risk of aseptic osteonecrosis jaw bone will dissolve
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Estrogen Agonists/Antagonists
- mimic estrogen
- do not give to women with H/O DVT
- EVISTA lowers cholesterol
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Calcitonin
hormone that inhibits osteoclastic activity thus decreases bone loss
treatment for osteoporosis
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Parathyroid Hormone
Forteo
- 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
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what is the relationship with calcium and vit D
you have to have vit d to metabolize calcium
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what bones are most fractured with osteoporosis
- Vertebra
- radius
- upper 1/3 of femur
-
classifications of osteoporosis
Primary
- decrease in estrogen promotes and increases the rate of bone reabsorption
-
- Men: decrease in testosterone and altered ability to absorb calcium
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secondary osteoporosis
- results from an associated medical condition such as hyperparathyroidism (increase in circulating calcium)
- long term drug therapy
- long term immobility
- long term steroid use
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regional osteoporosis
occurs when a limb is immobilized
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best ways to prevent osteoporosis
- continued weight bearing
- diet high in calcium and vit d
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what is osteomalacia?
softening of the bones caused by vit d deficiency
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facts about bone cancer
- 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
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where does primary bone cancer metastasize?
lungs
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best treatment for plantar fasciitis?
proper arch support, rest and ice
- Compression and elevation not effective
- Pain is worse in the morning
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RICE
- rest
- Ice
- Compression
- Elevation
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Fracture caused by loading force?
Compression Fractures
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specific assessment for
pelvic fractures
blood loss and hypovolemia
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specific assessment for big bone fractures
DVT and yellow fat embolism
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specific assessment for rib fractures
hypoxia
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specific assessment for skull fractures
- changes in LOC
- Brain injury
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