Exam 3

A nitrogenous compound, essential to all living organisms

Relates to albumin, globulin, and fibrinogen

Relates to albumin and globulin

A serum protein; constitutes about 50% of the blood protein

A group of simple protein

An indicator of fluid need

Sodium promotes water retention. With a water deficit, less sodium is excreted via kidneys; thus more water is retained.

Produced by the hypothalamus and stored in the posterior pituitary gland (neurohypophysis). ADH is secreted when there is an ECF volume deficit or an increased osmolality (increased solutes). ADH promotes water reabsorption from the distal tubules of the kidneys.

A hormone, secreted from the adrenal cortex. It promotes sodium, chloride, and water reabsorption from the renal tubules.

Decreased renal blood flow increases the release of renin, an enzyme, from the juxtaglomerular cells of the kidneys. Renin promotes peripheral vasoconstriction and the release of aldosterone (sodium and water retention).

Plasma protein that shifts to the tissur spaces cannot be reabsorbed into the blood vessels. Thus, the lymphatic system promotes the return of water and protein from the interstitial spaces to the vascular spaces.

Skin excretes approximately 300-500 ml of water daily through normal perspiration.

Lungs excrete approximately 400-500 ml of water daily through normal breathing.

The kidneys excrete 1000-1500 ml body water daily. The amount of water excretion may vary according to the balance between fluid intake and fluid loss.

• 1. Monitor I & O
• 2. Observe for any edema
• 3. Report any abnormal lab findings

A layer of tissue covering a surface or organ or separating spaces

The capability of a substance, molecule, or ion to diffuse through a membrane

An artificial membrane such as a cellophane membrane

Permeability of the human membranes

A liquid with a substance in solution

A substance dissolved in a solution

The passage of a solvent through a membrane from a solution of lesser solute concentration to one of greater solute concentration

The movement of molecules such as gas from an area oh higher concentration to an area of lesser concentration. Large molecules move less rapidly than small molecules.

A unit of osmotic pressure. The osmotic effects are expressed in terms of osmolality. A milliosmol (mOsm) is 1/1000th of an osmol and determines the osmotic activity.

Difference in pressure between two points in a fluid.

Nondiffusible substance

A decrease in water intake results in an increase in the number of solutes in body fluid. The body fluid becomes hyperosmolar.

An increase in solute intake increases the solute concentration in body fluid; The body fluids can become hyperosmolar with a normal or decreased fluid intake.

Results in a loss of body water greater than the loss of solutes such as electrolytes, resulting in hyperosmolar body fluid.

In increase in glucose and ketone bodies can result in body fluids becoming more hyperosmolar, thus causing diuresis. The resulting fluid loss is greater than the solute loss (sugar and ketones).

Water loss is usually greater than sodium loss.

Usually results in fluid losses that are in proportion to electrolyte (sodium potassium, chloride, bicarbonate) losses.

The G.I. track is rich in electrolytes. With a loss of G.I. secretions, fluid and electrolytes are lost in somewhat equal proportions.

Results in fluid and sodium losses via the skin. With profuse sweating, the sodium is usually lost in proportions equal to water losses. Depending upon the severity of the sweating and fever, symptoms of mild, moderate or marked fluid loss maybe observed.

Excess blood loss is fluid and solute loss from the vascular fluid. If hemorrhage occurs rapidly, fluid shifts to compensate for my blood losses can be inadequate.

Burns cause body fluids with solutes to shift from the vascular fluid to the burn site and surrounding interstitial space (tissues). This may result in an inadequate circulating fluid volume.

Fluid and solutes (protein, electrolytes, etc.) shift to the peritoneal space, causing ascites (third-space fluid). A decrease in circulating fluid volume may result.

Fluid accumulates at the intestinal obstruction site (third-space fluid), thus decreasing the vascular fluid volume.

• Lactated ringers 1500 ml
• Normal saline (0.9%NaCl solution) 500 ml

Five percent dextrose in water (D5W) 4700 ml

Potassium chloride 40-80 mEq, may be divided into 3 liters. Serum potassium levels must be closely monitored

Bicarbonate as needed

Blood

An agent that produces states such as loss of consciousness, analgesia, relaxation, and loss of reflexes.

An incomplete expansion or collapse of a part of the lungs

formation of a blood clot (“thrombus”) in a deep vein

• surgery that is recommended but can be omitted or delayed without catastrophe

blood clot, foreign body, or air in the circulatory system; plural form is emboli

surgery that must be performed immediately to save the person’s life or a body organ

excessive blood loss due to the escape of blood from blood vessels

low body temperature

(conscious or procedural sedation)- used for short term and minimally invasive procedures

one not critical to survival or function

wide variety of nursing activities carried out before, during, and after surgery

three phases of perioperative patient care including the preoperative, intraoperative, and postoperative phases

inflammation or infection of the lungs

body’s reaction to acute peripheral circulatory failure due to an abnormality of circulatory control or to a loss of circulating fluid

inflammation in a vein associated with thrombus formation

surgery that is not an emergency, but must be done within a reasonably short time frame to preserve health

episode of pain that last from seconds to less than six months

a pattern of compulsive use of addictive substances for means other than those prescribed

drugs typically use for other purposes, but also used to enhance effect of opioids by providing additional pain relief

pharmaceutical agent use to relieve pain

temporary flare-up of moderate to severe pain that occurs even when the patient is taking around-the clock medication for persistent pain

episode of pain that last for six months or longer maybe intermittent or continuous

superficial pain usually involving the skin or subcutaneous tissue

the endorphin having the most potent analgesic effects

morphine-like substances released by the body that appear to alter the perception of pain

opioids that are widespread throughout the brain and dorsal horn of the spinal cord and are believed to reduce pain sensations by inhibiting the release of substance P

period in chronic illness when symptoms of the disease reappear

theory that explains that excitatory pain stimuli carried by small-diameter nerve fibers can be blocked by inhibiting signals carried by large-diameter nerve fibers

severe pain that is extremely resistant to relief measures

process by which the sensation of pain is inhibited or modified

endogenous opioid chemical regulators that appear to have analgesic activity and alter pain perception

pain that results from an injury to or abnormal functioning of peripheral nerves or the central nervous system

substances that either excite or inhibit target nerve cells

pain receptors

more correct term for narcotic analgesics since these drugs act by binding to opiate receptor sites in the central nervous system

amount of stimulation required before a person experiences the sensation of pain

amount of stimulation required before a person experiences the sensation of pain

conscious process of organizing and interpreting data from the senses into meaningful information

sensation of pain without demonstrable physiologic or pathologic substance; commonly observed after the amputation of a limb

phenomenon in which the body physiologically becomes accustomed to an opioid and suffers withdrawal symptoms if the opioid is suddenly removed or the dose is rapidly decreased

Latin word meaning, “I shall please”; an inactive substance that gives satisfaction to the person using it

pain for which no physical cause can be identified

pain in an area removed from that in which stimulation has its origins

Any chronic illness when the disease is present but the person does not experience symptoms of the disease

pain originating in structures in the body’s external wall

occurrence of the body’s becoming accustomed to an opioid and needing a larger dose each time for pain relief

activation of pain receptors

conduction of pain sensations from the site of an injury or inflammation along clear and unclear pathways to the spinal cord and then on to higher centers

pain originating any internal organs in the thorax, cranium, or abdomen

hormone-like substances that send additional painful stimuli to the CNS

• powerful vasodilator that increases capillary permeability and constricts smooth muscle
• Triigers release of histamine and in combo produces the redness, swelling, and pain typically observed when an inflammation is present

sensitizes receptors on nerves to feel pain and also increases the rate of firing of nerves

the propensity of a drug to bind or attach itself to a given receptor site

the drugs ability to initiate biologic activity as a result of that binding

combines with receptors and initiates biochemical and physiologic changes

period of time it takes after a drug is administered for it to produce a response

time it takes for a drug to reach its highest effective concentration

Length of time during which the drug is present in a concentration great enough to produce a response

Blood serum concentration is reached and maintained after repeated, fixed doses.

produces the desired effect without toxicity

produces serious adverse effects

• Age
• Body mass
• Environment/activity
• Time of administration
• Pathology
• Psychological state
• Genetics

Drug accumulates in the blood because of impaired metabolism or excretion - get toxic effects and can be lethal.

• Unpredictable response could cause anaphylaxis (antigen - antibody)
• range from minor skin rash, rhinitis, pruritis to fatal symptoms that require immediate action

• Epinephrine
• start an IV
• oxygen
• benadryl
• drugs to support B/P, bronchodilators

• Stimulates alpha and beta-adrenergic receptors causing bronchial dilation
• Relieves congestion in bronchial mucosa and pulmonary vessels

over, under, unexplained or unpredictable response

Drug builds up in the blood stream, can lead to toxicity

Effects of primary drug increased

Combined action is greater than each alone

decrease in response to either drug

• Occurence of withdrawal symptoms when the drug is suddenly stopped.
• Time for physical dependency to develop varies

• Need for increasingly larger amount of a drug to achieve the same physical or psychological effect.
• Occurs quickly with opioids.

• psychological dependence
• pattern of compulsive drug use characterized by continued craving for the drug with the need to use the drug for other than pain relief.

• Dose
• Action (know main classifications)
• Nursing considerations
• contraindications
• Side effects/adverse reactions (iatrogenic -caused by the prescription)

DOSAGE!!!

• Name
• Room
• Drug
• Dose
• Route
• Time/Frequency
• Doctor
• Date
• Special considerations as indicated

• Absorption
• Distribution
• Biotransformation/metabolism
• Excretion

Primun nin nocere

• 1. Drug
• 2. Dose
• 3. Route
• 4. Time
• 5. Patient
• 6. Documentation

Patient has the right to refuse

Identifies accurate and complete reconciliation of medications across the continuum of care

• 1. When reaching for container
• 2. After getting med from drwawer
• 3. When replacing container to drawer or before administering to patient

• United States Pharmacopeia
• National Formulary

• Entry site into body to the bloodstream
• Influenced by 6 things
• --Route of admin
• --Lipid solubility
• --pH
• --blood flow
• --local conditions at site of administration
• --drug dosage

depends on blood flow to the tissues, the drug's ability to leave the bloodstream, and the drug's ability to enter the cells

• biotransformation, is the change of a drug from its original form to a new form
• consider liver functioning

• drug is broken down to its inactive form
• process of removing a drug or its metabolites
• depending on kidney

• oral liquids
• IV
• IVPBs
• Gastric or jejunostomy feedings
• blood

• Urine
• Diarrhea
• Vomitus
• gastric suction
• drainage
• estimation on insensible loss (persperation)

• post-op pts.
• pts. w/ elevated temp
• Pts. on fluid restrictions
• Diuretic or intravenous therapy
• Poor intake
• Pts. w/ medical conditions such as COPD, CHF

• 50 - 60% of body weight
• (40% ICF & 20% ECF)

• third compartment
• include cerebrospinal, pericardial, synovial, intraocular, and pleural fluids
• sweat and digestive secretions

The more obese the smaller the percentage of total body water

• regulated by hypothalamus
• stimulated by intracellular dehydration and decreased blood volume

measurable

can't be measured

• regulate ECF, pH and electrolytes
• excretion

• pumping action of the heart
• reacts to hypovolemia by stimulating fluid retention

• eliminates 13,000 mEq of Hydrogen ions
• hypoventilation increases acidity
• hyperventilation decreases acidity
• 300 mL of water expelled daily through exhalation

regulates blood volume, Na, K by ALDOSTERONE and CORTISOL

• a mineral corticoid secreted by the adrenal cortex
• primary regulator = angiotensin II (RAS)
• Decreases in blood volume=increase in aldosterone =Na retention = K loss
• Increase in blood volume = decrease in aldosterone=Na loss=K retention

stores and releases ADH = retain water

• maintains osmotic pressure
• --> when osmopressure of ECF, greater than ICF=ADH secretion increase = renal water retention
• --> when osmopressure of ECF, less than ICF = ADH secretion decrease = renal water excretion
• Controls blood volume
• --> blood volume decrease = increase ADH = water conservation
• --> blood volume increase = decrease ADH = water loss

• thirst center - hypothalamus
• inhibits and stimulates mechanisms influencing fluid balance

regulates Ca and phosphate by parathyroid hormone (PTH)

• parathyroid hormone
• influences bone reabsorption, Ca absorption=intestines and Ca reabsorption=renal tubules
• increase PTH = elevated serum Ca = low serum Phos
• Decrease PTH = low serum Ca = elevated serum Phos

• 135-145
• Major ECF cation
• accompanied by water
• enter through GI tract
• lost from GI, kidneys and skin
• reabsorb through kidneys
• out of cell by Na-K pump
• regulated by RAS

• <135
• Causes = hypoglycemia, tap water enema, ↑ H2O, ↑ SIADH, ↓ GI fluids
• Symptoms = ↑ pulse, ↓ BP, status epileptics, coma, cerebral edema, muscle twitches, lethargy, headache
• Tx = LR, 0.9% NS, for SIADH also give lasix

• >145
• Causes = salt water drowning, diabetes insipidus, diaphoresis, heatstroke, burns, hypertonic tube feedings
• Symptoms = ↑ pulse, ↑ BP, ↑ temp, thirst, flush skin, seizures, hallucinations
• Tx = 0.3% NaCl, diuretics, D5W

• 3.5-5.0
• Major ICF cation
• cheif regulator of cellular enzyme activity
• role in transmission of electric impulses and cellular building
• Absorbed = from well balanced diet
• Lost = kindeys, stool, sweat (large quantities lost through vomitus)
• regulated = aldosterone and transcellular shifts
• eliminated by kidneys

• < 3.5
• Causes = diarrhea, gastric suction, starvation, vomiting, digoxin toxicity, ↓ MG++
• Symptoms = ↓ BP, ↓ bowel movement, abdominal distention, polyuria, ventricular fib or asystole
• Tx = K+ high diet: fruits, veg, whole grains, milk, meat, eggs, coffee, tea, Ca gluconate (severe cases), insulin, lasix, albuterol

• > 5.0
• Causes = addison's disease, K+ conserving diuretics, burns,oliguric renal failure, (pseudohyperkalemia = tourniquet on while drawing blood, blood drawn where K+ is infusing)
• Symptoms = Tachycardia, bradycardia, dysrhythmias, anxiety
• Tx = kayexalase

• 8.5-10.5
• most abundant in whole body
• role in transmitting nerve impulses, regulates muscle contraction and relaxation, blood coag
• activates enzymes that stimulate essential chemical reactions
• absorbed = foods w/ presence of normal gastric acidity and vit D
• Lost = GI tract -- feces and urine, lesser amount by kidneys
• Regulated = PTH and calcitonin (inverse w/ phosphate)

• < 8.5
• Causes = ↓ vit D, ↑ PO4++, fistulas, burns, malabsorption, hypoparathyroidism, sub q infection
• Symptoms = + Trousseau & chevostek's sign, numbness in extremeties, ↓ clotting time
• Tx = Vit D, Ca diluted in D5W as a bolus

• > 10.5
• Causes = ↑ vit D, hyperparathyroidism, ↑ immobilization
• Symptoms = ↓ neuromuscular, confusion, slurred speech, deep bone pain, polyuria
• Tx = 0.9% NaCl, Lasix, calcitonin, PO4++

• 1.8-2.7
• important for metabolism of carbohydrates and protein
• Role in neuromuscular function and acts on cardiovas system w/ vasodilation
• enters = GI
• Lost = kidneys -- urine -- loop diuretics
• Regulated by PTH

• < 1.8
• Causes = chronic alcoholism, AMI, small bowel resection, ↓ K+ & Ca, hyperparathyroidism, hyperaldosteronism
• Symptoms = ↑ Trousseau & Chevostek's sign, neuromuscular irritability, ↑ BP
• Tx = Diet foods high in Mg

• > 2.7
• Causes = ↑ IV Mg, DKA, hypothyroidism
• Symptoms = ↓ BP & resp, cardiac arrest, coma, flush skin
• Tx = Ca gluconate (severe cases), NaCl, LR, Lasix

• 96-108
• ECF anion
• major component of interstitial and lymph fluid
• acts w/ Na to maintain osmopressure
• role = acid-base balance, combines w/ hydrogen ions to produce hydrochloric acid
• Enter = GI
• Chloride=salt in diet
• Paired w/ sodium
• excreted and conserved w/ sodium by kidneys
• Regulated by aldosterone
• low K = Low Cl

• <96
• Causes = Addison's disease, ↑ sweating, ↓ Na & K, diuretics
• Symptoms = Shallow resp,. seizures, coma, tremors, irritability
• Tx = NS

• >108
• Causes = ↑ Na, head injury, dehydration, diuretics, steroids
• Symptoms = ↓ CO, tachycardia, tachypnea, coma, edema
• Tx = hypotonic IV LR, sodium bicarb, diuretics

• 2.5-4.5
• major ICF anion
• promotes energy storage; carb, protein, and fat metabolism
• bone and teeth formation
• role in muscle and RBC function
• Enter = GI (source = animal products, ect)
• Absorption diminished by concurrent ingestion of Ca, Mg, and aluminum
• Eliminated = kidneys
• Regulated = PTH and activated = Vit D
• Inverse proportion w/ Ca

• < 2.5
• Causes = ↓ K+, Mg++ & vit D, hyperventilation, alcohol
• Symptoms = cardiomyopathy, resp. failure, seizures, confusion, bone pain, ↑ infection
• Tx = sodium phosphase, potassium phosphate

• > 4.5
• Causes = ↑ PO4++ & vit D, renal failure, tissue breakdown
• Symptoms = tachycardia, tetany, hyperactive reflexes
• Tx = Avoid laxatives and enemas, diet

regulate BP in response to changes in pressures (parasympathetic and sympathetic)

• 2 % of body weight loss
• 1-2 liters
• symptoms - thirst

• 5%
• 3-5 liters

• Marked thirst
• dry mucous membranes
• dryness and wrinkling of skin - poor skin turgor
• hand veins: slow filling with hand lowered
• temperature - low-grade elevation, (99.7 degrees)
• tachycardia (>100) as blood volume drops
• respiratory >28
• systolic BP 10-15 mmHg ↓ in standing position
• urine volume <30 ml/hr
• Specific gravity >1.025
• body weight loss
• Hct, Hgb and BUN ↑
• acid-base equilibrium toward greater acidity

• 8%
• 5-10 liters

• same symptoms as marked dehydration, plus:
• flushed skin
• systolic BP <60 mmHg
• behavioral changes, e.g., restlessness, irritability, disorientation, and delirium

• 20-30 total body water loss can prove fatal
• symptoms = anuria, coma leading to death

• constant, irritating, nonproductive cough
• dyspnea
• neck vein engorgement
• sublingual vein engorgement
• moist crackles in lung
• bounding pulse
• cyanosis

• pitting edema in extremities
• tight, smooth, shiny skin over edematous area
• puffy eyelids (periorbital edema)
• weight gain evidenced as generalized edema or anasarca

• decreased serum osmolality
• decreased serum protein and albumin, BUN, Hgb, Hct
• Increased CVP (central venous pressure)

found w/ impaired renal function (such as associated w/ shock, heart failure, salt and water depletion), diabetic ketoacidosis, burns

found with impaired renal function, heart failure, shock, dehydration

• to dilute because of irritation
• no more than 40 mEq/L PERIPHERALLY
• no more than 60 mEq/L CENTRALLY
• DO NOT administer more than 10 mEq/hour peripheraly
• no more than 20 mEq/hour in a central line
• w/ oral replacement = w/ food, know pts GI history, renal function, and last serum K

alternative treatments used with traditional medical interventions

methods not included in the scope of conventional medical care

• (biomedicine)
• the term generally used to describe "traditional" medical care, dominant for about 100 years, which spearheaded remarkable advances in biotechnology, surgical interventions, pharmaceutical approaches and diagnostic tools

• whole
• mind-body
• energy
• manipulative and body-based
• biologically based

• movement based therapies
• nutritional and herbal remedies
• mind-body medicine
• energy healing
• physical manipulation
• lifestyle changes