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