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What happens when BV gets low (vomiting, hemorrhage, etc)?
aldosterone secretion increases, which causes body to RETAIN Na+ & H2O in the vascular space, causing BV to increase
Too little aldosterone
Too MUCH aldosterone
What works the opposite of aldosterone?
ANP; it causes EXCRETION of Na+ & H2O
Some causes of FV excess.
- HF (CO & UOP decreases, volume stays in vascular space)
- Alka-seltzer, fleet enema, IVF with Na+
Action of ADH.
Makes you retain water
In SIADH, UOP is _____ and blood is ______.
- decreased (concentrated)
- increased (diluted)
With DI, UOP ______ and blood _______.
- increases (diluted)
- decreases (concentrated)
What is unique about DI?
There is decreased UOP but a high risk of shock.
When fluid is concentrated, what numbers go up (and down when diluted)?
USG, Na+, hct
Key words that would make you think potential ADH problem.
- head injury
- sinus surgery
- transphenoidal hypophysectomy (pit. removal)
- anything that can lead to increased ICP
How does bedrest induce diuresis?
By the release of ANP and decreased production of ADH
Anytime you see assessment or evaluation on the NCLEX, look for what?
Presence or absence of pertinent s/s.
What happens to BV and BP with ascites?
both are decreased because the abdomen pushes on the diaphram making it hard to breathe.
What should you think about with polyuria?
What does it mean to the kidneys when there is decreased UOP?
Either they are not being perfused or they are trying to hold on to fluid to compensate in hypovolemia
What happens to peripheral veins/neck veins in hypovolemia?
vasoconstrict in effort to shunt blood to vital organs (cool extremities)
What is the USP like in hypovolemia?
increased; urine is very concentrated
Normal lab values for Mg & Ca.
S/S of hypermagnesemia and hypercalcemia.
- decreased DTRs
- weak/flaccid muscle tone
- decreased LOC
- decreased pule
- decreased respirations
What does Mg do to BP?
S/S of hypomagnesemia and hypocalcemia.
- Rigid & tight muscle tone
- Could have seizure!
- chvostek's & trousseau's
- increased DTRs
- swallowing probems
What electrolyte imbalance can be caused by SIADH?
Causes of hypokalemia.
- NG suction
- not eating
s/s of hyperkalemia
- begins with muscle twitching
- then weakness
- then flaccid paralysis
Treatment for hyperkalemia.
- dialysis (kidneys aren't working)
- calcium gluconate (decreases arrythmias)
- glucose & insulin
Any time you give IV insulin, what should you worry about?
decreased BGL & K+
Major problem with PO K+?
Can cause GI upset (take w/ food)
What is important to assess before/during IV K+?
What can happen when blood is acidic?
What can happen when blood is alkalotic?
What happens to RR when fat breaks down into ketones?
it increases to blow off the ketones (which are acid)
Causes of respiratory alkalosis.
- hyperventilation (breathing too fast and removing CO2)
- acute aspirin OD
Causes of metabolic acidosis.
- DKA (kussmaul's resp)
- severe diarrhea
How does DKA and starvation cause metabolic acidosis?
Cells are starving for sugar, so the body will break down protein and fat & produce ketones (acid).
Tx for metabolic acidosis.
IV sodium bicarb
Causes of metabolic alkalosis.
- Loss of upper GI contents
- Too many antacids (too much base)
- too much IV bicarb
Serum K+ will go _____ in metabolic acidosis and ____ in metabolic alkalosis.
Tx for metabolic alkalosis.
What hormones are secreted in burn pts?
- ADH (to retain H20) &
- aldosterone (to retain H20 & Na+)
- to increase the BV;
- epinephrine - shunts blood to vital organs by vasoconstricting and increasing BP
What is the Parkland Formula?
- Used to calculate fluids needed for first 24 hrs after a burn (>20-25% TBSA burned)
- 4ml LR x wt in kg x % TBSA burned
How to stop burning process on a body?
- submerse in COOL water to stop the burning
- wrap in blanket to put out flames (also to hold in body heat and keep out bacteria)
What do shallow respirations mean, esp with a burn pt?
They are retaining CO2 and are in respiratory acidosis
What treatment is important for burn pts (other than LR)?
- -holds fluid in vascular space
- -increases vascular volume, kidney perfusion, BP, & CO
What could happen with a (burn) pt who is receiving albumin and rapid fluids? What can you do to prevent it?
- Could stress heart too much (albumin increases CO) and pt could be thrown into FVE, causing CO to decrease and lungs to sound wet.
- Measure CVP to prevent this.
What kind of immunity does the tetanus toxoid provide?
Active (takes 2-4 weeks to develop their own immunity)
What kind of immunity does an immune globulin provide?
passive (immediate protection)
Four things you check for circulation.
- cap refill
- skin color
- skin temp
How often to monitor a Foley for a burn pt?
Why might you not get any urine return when inserting a Foley in a burn pt? What would you worry about?
- kidneys are trying to retain fluid or they are not being perfused adequately
- FV overload
Why would you give a diuretic to a burn pt and what would it be?
- To flush out the kidneys
What happens with fluids after 48 hrs in a burn pt?
they begin to diurese & UOP increases b/c fluid is going back into the vascular space - now we worry about FV overload
How is K+ affected in a burn pt?
Cells begin to lyse, so K+ in vascular space increase, causing hyperkalemia
Why would a pt with burns have an NG tube with suction?
- To prevent a paralytic ileus due to:
- -decreased vascular volume
- -decreased GI motility
- -hyperkalemia (muscle weakness)
With an NG tube, hold feedings if resudual is > _____?
Specific measures for hands of burn patients.
- wrap each finger separately
- use splints to prevent contractures
How is the head positioned for a burn pt?
- hyperextend the neck w/ head back
- no pillows
- (prevent chin-to-chest)
Enzymatic drugs that eat dead tissue (eschar).
- sutilanis (Travase)
- collagenase (Santyl)
- *don't use on face, over lg nerves, if area is opened to a body cavity, or if pregnant
What to worry about with mycin drugs?
- When pt's BUN or Cr increases (nephrotoxicity)
- comp of hearing loss (ototoxicity)
What kind of dressing is applied to the donor site for a graft?
transparent until bleeding stops, then left open to air
If a pt is well nourished, when can the donor site for a graft be reharvested?
How long to flush a chemical burn with water?
What type of arrythmia is an electrical burn pt at rish for?
v-fib (monitor heart for 24 hrs after burn)
What kind of organ damage can occur with electrical burns?
kidney (myoglobin and hemoglobin build up)
Why are amputations common with electrical burns?
Circulatory system gets destroyed
Other than heart and kidney, what other complications can occur from electrical burns?
cataracts, gait probs, any type of neuro deficit
For how long is a pt radioactive with an unsealed isotope for a tumor?
How to prevent dislodgment of radiation implant?
- Keep pt on bed rest
- decrease fiber in diet
- prevent bladder distention
How do you position a pt who just had a pneumonectomy? Will they have a chest tube?
- ON affected side
- NO (so space can fill w/ fluid)
How should you position a pt who just had a lobectomy (partial lung removal)? Will they have a chest tube?
How should you position a pt post-op total laryngectomy?
semi-high Fowlers (30-45)
NPO pts tend to get _________.
Suction no longer than ______.
What should you watch for when suctioning?
arrythmias b/c vagus nerve can be stimulated
What does it mean if alkaline phosphatase or acid phosphatase is increased in a prostate CA pt?
Two major complications from a gastrectomy (removal of stomach).
- dumping syndrome
- pernicious anemia
What is Schilling's test?
measures the urinary excretion of vitamin B-12 for dx of pernicious anemia
How does calcitonin decrease Ca++?
takes it out of blood and puts it back into bone
Who should not take beta blockers?
- diabetics - they hide the symptoms of hypoglycemia
What must you do prior to giving PO radioactive iodine?
Rule out pregnancy
Following a dose of radioactive iodine, what should be avoided and for how long?
babies and kissing anyone for 24 hrs
HOB up to decrease edema
Where should you check for bleeding post-thyroidectomy?
behind the neck
Teach a post-thyroidectomy pt to report what?
any c/o pressure
*What are the FOUR things that glucocorticoids do?
- Change your mood
- Alter defense mechanisms
- Breakdown fats & proteins
- Inhibit insulin
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