Adult Health Exam 1
normal magnesium range
1.3-2.1
how do we treat hyperkalemia?
10% calcium gluconate or calcium chloride, insulin IV kayexalate, albuterol nebulizer
normal Hb range for females
12-16
normal sodium range
135-145
normal Hb range for males
14-18
normal platlet range
150,00-400,000
hemeglobin contains what?
2 alpha chains, 2 beta chains
normal HCO3 level
21-28 mEq/liter
normal osmolality range
280-295
Potassium normal range
3.5-5.0
normal PaCO2 level
35-45 mmHg
normal Hct for females
37-47%
normal Hct for males
42-52%
normal pH level
7.35-7.45
normal PaO2 level
80-100 mmHg
calcium normal range
9.0-10.5
normal oxygen saturation level
95%-100%
patients with type B blood cannot have ____ or _____ blood
A or AB
an A positive patient is anemic and needs a blood transfusion. What blood types can be given to this patient?
A positive and O positive, A negative, O negative
Type A cannot have ___ or ___ blood.
B or AB.
GI surgeries, celiac, Chron's and diverticulita can cause ....
B12 deficit
what are the causes of hypokalemia?
BADDIE Bicarbonate Excess Alkalosis Diuretics' Diarrheas Insulin Eating Disorder
what is the most common chronic lung disease in the world, and what is the most common cause?
COPD, smoking! also causes by tobacco smoke, pollution, dust and chemicals
Hypernatremia clinical manifestations "CHIPS"
Coma, restless, agitation Hypotension, dec. BP, tachycardia Intense thirst, dry swollen tounge Pretty tired (weak + fatigued) Sticky mucous membranes, weight is dec.
s/s of severe iron deficit anemia
Dry brittle nails, ridged nails, angular chelitis
when you give a hypertonic IV fluid (ex: 3% sodium chloride) , the water will go into the...
ECF ( extracellular/vascular space). This shrinks the cells
T of F: always clamp the chest tube.
FALSE!! DO NOT do this unless only for a few seconds. this will increase their chances of pneumothorax which is bad
what is an example of a pulmonary function test?
Forced vital capacity (FVC) this is the amount of air that can be forcibly exhaled after max. inspiration ( how much can they breath out, after breathing in as much as they can?)
how do we diagnose COPD?
H&P, chest radiography, pulmonary (lung) function tests and labs
with dehydration do we typically see high or low lab values?
HIGH! increased serum osmality, RBCs, Hematocrit, Hb, WBC, platlets. Sodium will be up or down
how do we treat hypocalcemia?
High Ca diet or oral Ca salts, 10% calcium chloride or calcium gluconate. Vitamin D
causes of hypercalcemia "HIMTTE"
Hyperparathyroidism Immobilization Malignancy Thiazide diuretics' Thyrotoxosis Excess vitamin D or Ca
When you give a hypotonic IV fluid(ex: 0.45% NS), the water will go to the...
ICF (into the cell)
treatment for folate deficiency
IV banana bag, oral folic acid
how do we treat hypokalemia?
IV potassium replacement ( infuse slowly!) or oral supplements. Check K level before giving! Watch for S/S of infiltration or phlebitis
Clinical manifestations of hypermagnesemia "Lethargy"
Lethargy EKG changes Tendon Reflexes are absent ** Hypotension Arrthymias (bradycardia) Respitory Arrest GI issues (V/D) Impaired breathing
Clinical manifestations of hypokalemia
Lethargy, leg cramps, limp muscles, low, shallow respirations, lethal cardiac rhythms, lots of urine
Causes of hypomagnesemia "low mag"
Limited intake of magnesium Other electrolyte imbalances Wasting of magnesium by the kidneys, V/D Malabsorption Alcohol Glycemic issues
causes of hypermagnesemia "MAG"
Magnesium containing meds (antacids , laxatives) Addison's Disease Glomerular Filtration Issues( renal problems)
hyperkalemia causes "MACHINE"
Meds such ACE inhibitors, NSAIDS Acidosis Cell injury ( burns, trauma) Hyperaldosteronism Increased intake of potassium Nephrons: renal failure Excretion problems
Hyperkalemia clinical manifestations "MURDER"
Muscle weakness Urinary issues like oliguria, anuria (little to no urine) Respitory distress Decreased cardiac ECG/EKG changes Reflexes ( hyperreflexia)
Hyponatremia causes " NO Na+"
Na+ excretion is increased (NG suction, renally, V/D) Overload of fluids Na is low from low salt diet Antidiuretics hormone (SIADH, adrenal dec.)
Type O can only have ____ blood
O universal donor --> O has lots of antibodies, so can only have O
S/S of hemolytic anemia
SOB, fatigue, jaundice
Hyponatremia clinical manifestations "SALT LOSS"
Seizures Apprehension, irritable, confused, dizzy Lethargic Tachycardia, tremors Lots of neuro changes Orthostatic hypotension Such cold, clammy skin Spasms of the muscles
Hypernatremia causes "SIW"
Sodium intake in up Intake of water is low Water is lost
tension pnemothorax
TRAPPED AIR! intrapleural pressure > atmospheric pressure life threatening!
Clinical manifestation's of hypomagnesemia "twitch'n"
Trousseau + Chvostek's sign Weird personality (personality changes) In conjunction with dec. Ca and dec. K+ Tetany (muscle spasms) Cardiac problems (tachy, arrthymias) Hyperactive muscles, HTN Nystagmus
T or F: Negative blood does not have a D antigen ( Rh factor), but positive does. This means if someone has A positive blood, they would be able to receive A negative blood.
True
T or F: We always check a patients sodium level before we decide what kind of IV therapy is best.
True
T or F: patients on a PPI and vegetarians are at an increased risk of B12 deficit
True
patients with type AB can have any type of blood T or F
True no antibodies ---> universal recipient
T or F: you may not see a low Hct until hours or days after acute blood loss.
True!
T or F: anyone who has negative blood cannot receive positive blood.
True! this is because they will then get the D antigen.
Clinical Manifestations of hypercalcemia "WEAK"
Weakness and lethargy EKG: ventricular fibrilation/systole Absent minded (confused), absent DTR Kinda painful bones
What defines chronic bronchitis?
a chronic productive cough that lasts for at least 3 months of the year, for 2 consecutive years
Thrombocytopenia
a decrease in number of circulating platlets to a level of less than 150,000
Anemia
abnormally low numbers of RBCs, low Hb level, or both. This results in a dec. of oxygen carrying capacity. Normally indictive of underlying disease
A client with pernicious anemia is receiving vitamin B12. The nurse should evaluate the client for which expected outcome?
absence of paresthesia's. ** bc vitamin B12 can cause neuro issues!
what do we see with emphysema?
air trapping! prevention of normal expiratory flow
how do we treat COPD?
albuterol ( SABA) AE: tachycardia, angina, tremors Ipratropium Methyl prednisone AE: DONT stop suddenly- can cause HPA suppression
who is at more risk for folate deficiency anemia?
alcoholics, pregnant patients
what should you asses for in a chest tube?
an air leak, and bubbling in H2O seal chamber
TTP patho
an increase in platlet aggregration which leads to the formation of micro thrombi issue with VWF (dec)
DIT is caused by an
antigen antibody response to the drug . Treat by stopping the drug!
nursing interventions for anemia?
asses CBC and iron levels . Asses for risk factors, monitor oxygen levels, prepare for blood replacement, transfusion safety, educate pt and family
CM of thrombocytopenia
asymptomatic, bleeding, gingiva, petechiae, ecchymoses, internal bleeding, dizzy, faint, tachycardia, abdominal pain, hypotn, hemmorage
what is most important to include in a patients plan with aplastic anemia?
avoid exposure to others with acute infection
aplastic anemia is caused by
bone marrow failure
how do we treat aplastic anemia?
bone marrow transplant, steroids
when you give an isotonic solution, this goes to...
both ICF and ECF Ex: 0.9% normal saline, lactated ringer, D5W
what can cause aplastic anemia?
chemo, infections, chemical, cancer drugs
blood loss examples of anemia causes
chronic hemorrhage, liver disease. colorectal cancer, acute trauma, ruptured aortic anyerisum, GI bleed, hemmorids
someone with iron deficit anemia should not have what with their breakfast?
coffee or tea. These increase GI motility, which will get rid of more iron.
dietary sources of iron
dark green leafy veggies, legumes, liver and meats, dried fruit, whole grain breads, beans and peas
Causes of thrombocytopenia
dec platlet production, dec bone marrow function, splenomegaly, mechanical injury
decreased RBC production examples of anemia causes
deficit or nutrients, dec. erythropoiten, dec. iron availability
normocytic normochromic is described as
destruction or depletion of normal erythroblasts or mature RBC ex: acute blood loss, aplastic anemia, sickle cell, hemolytic
S/S of severe dehydration
difficulty arousing, lethargy, coma, decreased BP, tachycardia, poor perfusion, cool fingers and toes, decreased capillary refill, decreased UOP
S/S of fluid volume excess ( hypervolemia)
edema weight gain dyspnea altered mental status distended neck veins
Symptoms of mild dehydration
extreme thirst, restless
how do we treat hypovolemic hypernatremia?
first 0.9% NS if sodium is more than 150, we will give 250-500 , 0.45% NS followed with 0.9% NS
how do we treat hypovolemic hyponatremia?
first, 0.9% normal saline if sodium is less than 120, then we give 3% sodium chloride ( a hypertonic fluid)
what is the primary function of the respiratory system?
gas exchange between atmospheric air in alveoli and blood in pulmonary circulation
what foods are high in folate?
green vegetables, beans, calf liver, orange juice, peanuts, weakness, beefy red tounge NO neuro symptoms
what types of issues can cause hypovolemia?
heart failure, renal failure, liver failure, cirrhosis, cancer, PVD, drug therapy
inc. RBC destrcution examples of anemia causes
hemolysis, sickle cell, trauma, incompatible blood
HIT is caused by
heparin! It is an autoimmune reaction to heparin platelet 4 factor. the formation of antibodies that activate platelets following heparin administration
how do we treat hypermagnesemia?
hold mg- containing supplements. Calcium Chloride IV. Check patellar reflexes. IV Rehydration and diuretics
what are some characteristics of chronic bronchitis?
hypersecretion of mucus, mucus is thicker than normal. This leads to hyperinflation, which leads to that chronic cough of mucus.
causes of hypoxemia
hypoventilation, V/Q mismatch, bad blood circulation
The fundamental pathophysiologic alterations seen in all forms of anemia is ...
hypoxemia leading to tissue hypoxia not enough oxygen in the blood!
causes of TTP
idiopathic, drug toxicity, pregnancy, preeclampsia, infection, autoimmune disorders
treatment of hypocalcemia
increase calcium intake ( diet or supplements) calcium gluconate calcium chloride Fix dec Po and/ or inc mg levels Vitamin D
CM of acute hypoxemia
increased HR, vasoconstriction, diaphoresis, hyperventilation severe: altered mental status, stupor, coma
CM of chronic hypoxemia
increased ventilation, pulmonary vasoconstriction, polycthemia cyanosis (bluish color of skin) clubbing
how to treat severe iron deficit anemia?
iron supplements, blood transfusion
S/S of moderate dehydration
irritable, lethargy, decreased BP, tachycardia, poor skin turgor, decreased UOP
in hemolytic anemia, a symptom you might see will be
jaundice
macrocytic/megalobastic normochritic is described as
large, abnormally shaped RBC. normal Hb concentration. Ex: B12 deficit anemia, folate def. anemia, pernicious anemia
the ___ conjugates bilirubin
liver
how do we treat hyponatremia?
loop diuretic, isotonic sodium solutions, hypertonic 3% in severe cases
emphysema (COPD)
loss of lung elasticity and abnormal enlargement of air spaces with destruction of alveolar walls and capillary beds
Vitamin B12 Anemia RBC indices
macrocytic and normochromic ( large, normal color)
Folate deficiency is characterized by
macrocytic normochromic
heme sources
meat, poultry, eggs, tofu
what is hemolytic anemia characterized by?
medications (methyldopa), transfusions, chemicals, toxins, infections, obstruction in microcirculation, renal and spleen disorders
ventilation
movement of air into the lungs
perfusion
movement of blood through pulmonary circulation
Vitamin B12 is important for the
myelin sheath
blood loss anemia indices
normal size, normal color- just less!
RBC indices of hemolytic anemia?
normocytic normochromic
in hemolytic anemia, the RBCs are destroyed prematurely. What distinguishes it from all types of hemolytic anemia?
normocytic normochromic cells
where does iron come from?
our diet!
Some nonspecific symptoms of anemia are
pallor, dizziness, lack of energy, paresthesia's
iron deficiency anemia s/s
pallor, glossitis, tired, headache, SOB, tachycardia, dizzy. Dry brittle nails, ridged nails, angular chelitis s/s occur when Hb falls to 9
Rh factor (negative)
patients that are negative have no Rh factor no D antigen
Rh factor (positive)
patients that have positive have an Rh factor has the D antigen
hematocrit%
percent of the total RBC count
what is the most common type of B12 anemia?
pernicious anemia this is an absence of the intrinsic factor
Hemoglobin
porteins that binds to oxygen, found in RBC
how do we treat hypercalcemia?
rehydrations, loop diuertetic
how do we treat dehydration?
replace fluids IV or orally treat the underlying cause monitor I+O's monitor weight our young and old are at an inc risk of mortality
how do we treat hypernatremia?
replace fluids! Oral route preferred, or IV. seizure precautions
what are causes of iron deficit anemia ( prolonged/severe)?
slow GI bleeds, hemmoroids, bleeding ulcer, blood thinner
microcytic- hypochromic is described as
small, abnormally shaped. dec production of RBC and dec Hb Ex: iron def anemia, slow GI bleed
what does an iron deficit anemia RBC look like?
small, pale, abnormal shape (microcytic and hypochromic)
causes of emphysema
smoking, a-1 antitrypsin deficit
in hypotonic fluids, there is less ____ and more ____.
sodium; water
in hypertonic fluids, there is more ____ and less ____
sodium; water 3% sodium chloride
non heme sources
spinach, beans, tofu, nuts, grains, seeds
how do we treat hypomagnesemia?
start PO! Inc. dietary intake with grains, nuts, legumes, green veggies, dairy, meat, fish, fruit , Mag salts. MgSO4 for severe cases
DIT caused by
statins, antibiotics, etc.
TTP
syndrome characterized by hemolytic anemia, thrombocytopenia, neuro issues, fever, renal issues
a client with thrombocytopenia has developed a hemogramage. The nurse should asses the client foe which finding?
tachycardia
ITP
this is an autoimmune disease. The body creates antibodies that surround platlets. Platlet function is unaffected by it is destroyed by the spleen who see's the platlets as foreign Treat with corticosteroids, IV immunoglobulin, can take the spleen out.
erythropoiesis
this is the production of RBCs. RBC's are produced in the bone marrow by pluripotent stem cells
signs and symptoms of anemia
tissue hypoxia which leads to fatigue, weakness, dyspena, angina brain hypoxia leads to headache, faintess, dim vision pale skin
causes of hypervolemia
too much IV fluid, abnormal aldosterone levels, eating foods that are high in sodium, drinking too much fluid
what are red blood cells( aka mature erythrocytes) job?
transports oxygen to the tissue! There are a thin, flat flexible cell with no nucleus .
T or F: all blood cells are affected by aplastic anemia
true
how do we treat low magnesium?
usually through the diet! encourage greens, grains, meat, fish, legumes severe cases give MGSO4 IV
patient education of thrombocytopenia
warn about s/s of bleeding, ask about activity restriction, dont bend head bellow waist, try not to get constipated, use an electric razor, avoid aspirin, G herbals, use a soft bristle toothrbrush, count the # of menstrual pads, notify dentist
S/S of aplastic anemia?
weak, pale, fatigue, bruising, petechiae, loss of platlets, RBC are normal color, normal size. Just not enough
vitamin B12 s/s
weakness, fatigue, lethargy, ataxia, paresthesia's **neurologic symptoms