fluids
name an example of an isotonic iv solution
LR
0.9% NaCl
what happens in hypernatremia (name 2 things)?
Na > 145; excessive Na intake or inadequate water intake or excess water loss
will see change in mental status; or
if accompanying ecf vol deficit is present: postural hypotension, tachycardia, weakness
name 2 causes of respiratory acidosis
chronic respiratory disease (copd)
chest wall abnormality
severe pna
atelectasis
mechanical hypoventilation
pulmonary edema
where are blood cells made?
bone marrow
what are counterregulatory hormones to insulin (name 2)?
glucagon
epinephrine
growth hormone
cortisol
all of the above work to oppose the effects of insulin
define intracellular, intravascular, and interstitial
intracellular- within the cell
intravascular- within the blood vessel
interstitial- outside the blood vessel
extracellular = intravascular + interstitial
what happens in hyperkalemia (name 2 things)?
K > 5.0
will see increased cell excitability
changes in cardiac conduction
tall, peaked T waves
loss of P wave, prolonged PR interval, ST seg depression, and widening QRS complex
fatigue, confusion, tetany, muscle cramps, paresthesias, weakness, abd cramping, vomiting, diarrhea
name 2 causes of respiratory alkalosis.
hyperventilation
stimulated respiratory center
liver failure
mechanical hyperventilation
what is the function of the rbc?
transports gases, maintain acid/base balance
name the 3 p's of dm.
polyuria
polyphagia
polydipsia
what happens to a red blood cell when iv hypertonic solution is infused?
the rbc shrinks; fluid within the cell is being drawn out of cell because of higher ion concentration outside of cell
what happens in hypocalcemia (name 2 things)?
Ca<9.0
seen in primary hypoparathyroidism, renal insuff, acute pancreatitis, high phosphate levels, low Mg levels
weakness, fatigue, depression, irritability, confusion, hyperreflexia, numbness and tingling in extremities and region around mouth, laryngeal/bronchial spasms, tetany/seizures
name 2 causes of metabolic acidosis.
dka
lactic acidosis
starvation
diarrhea
renal tubular acidosis
renal failure
gi fistulas
shock
what is the most common leukocyte (wbc)?
neutrophils
mature= seg
immature= bands
type 2 dm diagnostics: HgbA1C? Fasting Plasma Glucose (FPG)? Oral Glucose Tolerance Test (OGTT), Random Plasma Glucose
HgbA1C 6.5%<
FPG >126 mg/dl
OGTT >200 mg/dl with glucose load of 75g
Random >200 mg/dl in presence of s/sx of hyperglycemia
what do hypotonic iv solutions do?
lower osmolality than body fluids; provides more fluids than electrolytes, administer slowly to prevent cerebral edema, causes fluid movement of water INTO cells
what happens in hypophosphatemia (name 2)?
po4 <3.0
caused from malabsorption syndromes, chronic diarrhea, malnutrition, chronic alcohol, parenteral nutrition, phosphate binding antacids, resp alkalosis
cns depression, muscle weakness, polyneuropathy, seizures, heart problems, osteomalacia, rhabdo
name 2 causes of metabolic alkalosis
vomiting
ng sxn
diuretic therapy
hypokalemia
excessive NaHCO3 intake
mineralocorticoid use
what happens to the hematological system as we age (name 2)?
decrease in hemoglobin
decrease in iron and iron binding capacity
decrease in ability to produce reticulocytes as rapidly as a younger adult
poor response to infection
name a biguanides and describe the moa
metformin
acts on liver to reduce release of glucose from stored glycogen
increase cell sensitivity to insulin
side effects include flatulence, dizziness, ovulation induction
adverse effects lactic acidosis
check renal fxn before and during therapy; DC at least 48 hrs before and after any diagnostic test using contrast media containing iodine
if serum osmolality is >325...
increased water loss
will see hypernatremia
excessive hyperventilation
leads to cellular dehydration
will see more electrolyte gain > vs fluid gain
what happens with hypermagnesemia (name 2 things)?
Mg >2.1
caused by renal failure, tumor lysis syndrome, hypothyroidism, mets bone disease, adrenal insuff
lethargy, muscle weakness, urinary retention, nausea, vomiting, diminished dtr, dec pulse, dec bp
what are the normal values in an abg for pH, pco2, hco3, po2, Sao2?
pH 7.35-7.45
pco2 35-45
hco3 22-26
po2 80-100
Sao2 >95
what will the rn see with a neutropenic pt?
no signs or symptoms of infection
treat low grade fevers 100.4 stat - these pts don't have the ability to fight off infection
ANC<1
WBC count <3.5
blood smear shift to the Left (immature wbcs cant fight off infection)
what iv insulin can never be mixed with any other type of insulin?
lantus/glargine