Anemia, Fluids & Electrolytes

Fluid and Electrolytes

• Intracellular Fluid (ICF) is inside cells, making up ~2/3 of total body water, and contains Potassium (K+) and Magnesium (Mg2+).
• Extracellular Fluid (ECF) is outside cells, making up ~1/3 of total body water.
• ECF includes Interstitial Fluid (surrounding cells), Intravascular Fluid (plasma within blood vessels), and Transcellular Fluid (small amounts in cerebrospinal, pericardial, pleural, and synovial fluids).

Third Spacing

• Fluid moves from intravascular space into interstitial/transcellular spaces, making it unusable.
• Burns, trauma, liver failure, kidney disease, and severe infections can cause third spacing.
• Edema, ascites, hypotension, tachycardia, and decreased urine output are symptoms of third spacing.

Sodium (135-145 mEq/L)

• Hyponatremia (<135 mEq/L) presents as confusion, muscle weakness, seizures, nausea, vomiting, postural hypotension, dizziness, abdominal cramping, tachycardia, convulsions, and coma.
• Hypernatremia (>145 mEq/L) presents as thirst, dry mucosa/skin, irritability, restlessness, fever, agitation, convulsions, and irritability.

Potassium (3.5-5.0 mEq/L)

• Hypokalemia (<3.5 mEq/L) presents as muscle weakness, cardiac arrhythmias, fatigue, hyporeflexia, intestinal distention, decreased bowel sounds, ventricular dysrhythmias, weak/irregular pulse, and paresthesias.
• Hyperkalemia (>5.0 mEq/L) is indicated by ECG changes (peaked T waves), anxiety, dysrhythmias, paresthesias, diarrhea, muscle cramps, and bradycardia.

Calcium (8.5-10.5 mg/dL)

• Hypocalcemia (<9.0 mg/dL) presents as muscle spasms, tetany (Trousseau's & Chvostek's signs), seizures, numbness/tingling of fingers, and hyperactive reflexes.
• Hypercalcemia (>10.5 mg/dL) presents as weakness, kidney stones (low back pain), confusion, nausea, vomiting, lethargy, decreased level of consciousness, cardiac arrest, and EKG changes.

Magnesium (1.5-2.5 mEq/L)

• Hypomagnesemia (<1.5 mEq/L) presents as tremors, seizures, muscle weakness, dysrhythmias, hyperactive DTR, confusion, and disorientation.
• Hypermagnesemia (>2.5 mEq/L) presents as hypotension, respiratory depression, cardiac arrest, hypoactive DTR, decreased respiratory rate/depth, hypotension, and flushing.

Bicarbonate (22-28 mEq/L)

• Bicarbonate regulates acid-base balance.
• Low bicarbonate levels indicate metabolic acidosis while high levels indicate metabolic alkalosis.

Albumin (3.5-5.0 g/dL)

• Albumin maintains oncotic pressure.
• Low albumin can lead to edema and third spacing, and high albumin can lead to dehydration (rare).

Isotonic Solutions (NS 0.9%, LR, D5W)

• Isotonic solutions cause no fluid shift and remain in the intravascular space and are used for dehydration, blood loss, surgery, and fluid resuscitation.

Hypotonic Solutions (0.45% NS, 0.33% NS)

• Hypotonic solutions shift fluid into cells, hydrating them, are used for cellular dehydration (e.g., DKA, hypernatremia).

Hypertonic Solutions (3% NS, D10W, Mannitol)

• Hypertonic solutions pull fluid out of cells into blood vessels and are used for cerebral edema and severe hyponatremia.

Solution Usage

• Hypertonic solutions treat cerebral edema, severe hyponatremia and are for ICU patients.
• Isotonic solutions treat hypovolemia, trauma, and are for surgery and normal hydration.
• Hypotonic solutions treat DKA and hypernatremia, and dehydration inside cells.

Colloids (Albumin, Dextran, Hetastarch)

• Colloids contain large molecules that stay in blood vessels to expand plasma volume.
• Colloids treat hypovolemia, burns, shock, and hypoalbuminemia.

Crystalloids (NS, LR, D5W)

• Crystalloids contain small molecules that freely move and are used for IV hydration, electrolyte replacement, and fluid resuscitation.

Albumin's Effects

• Albumin draws fluid from interstitial spaces into the bloodstream, increasing blood volume and pressure.
• Excess fluid shift due to albumin can cause pulmonary edema (fluid in the lungs, crackles, dyspnea).
• Increased intravascular volume from albumin leads to increased kidney perfusion and urination.

Fluid Volume Deficit Signs and Symptoms

• Symptoms: Tachycardia, hypotension, dry mucosa, decreased urine output, and confusion.
• Common causes include dehydration, hemorrhage, vomiting, diarrhea, and burns.

Fluid Volume Excess Signs and Symptoms

• Symptoms: Edema, crackles in lungs, hypertension, bounding pulse, and JVD (jugular vein distention).
• Common causes: Heart failure, kidney disease, and IV fluid overload.

Edema

• Edema is swelling caused by excess fluid in tissues.
  • Pitting edema leaves an indentation.
  • Non-pitting edema has no indentation and presents as firm swelling.
  • Pulmonary edema is fluid in the lungs, causing dyspnea.
  • Anasarca is generalized severe edema, seen in liver/kidney failure.

Hormonal Regulators

• Antidiuretic Hormone (ADH) is released by the pituitary gland to retain water.
• Aldosterone is released by adrenal glands to retain sodium and water.
• Atrial Natriuretic Peptide (ANP) is released by the heart to decrease blood volume.
• Renin-Angiotensin-Aldosterone System (RAAS) regulates blood pressure and fluid balance.

Diagnostic Tests

• Basic Metabolic Panel (BMP) assesses electrolyte imbalances.
• Complete Blood Count (CBC) checks for fluid overload (low Hct) or dehydration (high Hct).
• Urine Specific Gravity measures hydration status (normal: 1.005 - 1.030).

Medications Causing Electrolyte Issues

• Diuretics (Lasix, Hydrochlorothiazide) cause low potassium and sodium loss.
• Steroids (Prednisone) cause hyperglycemia, sodium retention, and potassium loss.
• Calcium Carbonate (Tums) can cause hypercalcemia.
• Laxatives (Kayexalate) are used for hyperkalemia, but can cause low potassium.

Acidosis Causes

• Acidosis (pH < 7.35) occurs when there is too much acid or too little bicarbonate.
  • Respiratory Acidosis is caused by CO2 retention 2/2 hypoventilation, COPD, pneumonia, and opioid overdose.
  • Metabolic Acidosis is caused by HCO3 loss or acid buildup 2/2 diarrhea, kidney disease, DKA, and lactic acidosis.

Alkalosis Causes

• Alkalosis (pH > 7.45) occurs when there is too little acid or too much bicarbonate.
  • Respiratory Alkalosis is caused by CO2 loss 2/2 hyperventilation, anxiety, pain, and mechanical ventilation.
  • Metabolic Alkalosis can be caused by HCO3 excess 2/2 vomiting, NG suction, excessive antacid use, and diuretics.

Acidosis Signs and Symptoms

• Respiratory Acidosis presents confusion, lethargy, dyspnea, cyanosis, hyperkalemia, hypotension, drowsiness, Respiratory Rate<12, dysrhythmias, and hyperreflexia.
• Metabolic Acidosis presents Kussmaul respirations, confusion, hypotension, warm/flushed skin, fatigue, fruity-smelling breath, tachycardia, headache, weakness, nausea, vomiting, and diarrhea.

Alkalosis Signs and Symptoms

• Respiratory Alkalosis presents lightheadedness, numbness/tingling, hyperventilation, muscle twitching/cramping, hypokalemia, irritability, hyporeflexia, anxiety, tetany, seizures, tachycardia, positive Chvostek's and Trousseau's signs, and paresthesia. -Metabolic Alkalosis presents muscle cramps, tremors, confusion, hypoventilation, hypokalemia, dizziness, irritability, nausea, vomiting, diarrhea, anxiety, seizures, tingling fingers/toes, and confusion.

Arterial Blood Gases (ABGs)

• Uncompensated Acidosis/Alkalosis features an abnormal pH ( <7.35 or >7.45) AND an abnormal PaCO2 or HCO3, while the other is normal.
• Partially Compensated Acidosis/Alkalosis features an abnormal pH BUT also abnormal PaCO2 and HCO3, meaning the body is trying to fix the imbalance.
• Fully Compensated Acidosis/Alkalosis features a normal pH BUT abnormal CO2 and HCO3, meaning the body has compensated.

Example ABG Interpretations

• Low pH (<7.35), High PaCO2 (>45) indicates Respiratory Acidosis.
• Low pH (<7.35), Low HCO3 (<22) indicates Metabolic Acidosis.
• High pH (>7.45), Low PaCO2 (<35) indicates Respiratory Alkalosis.
• High pH (>7.45), High HCO3 (>28) indicates Metabolic Alkalosis.

Fluid/Electrolyte Imbalance Causes

• Vomiting/Diarrhea causes loss of potassium and bicarbonate, leading to Metabolic Acidosis.
• Kidney Disease causes poor fluid/electrolyte regulation, leading to Hyperkalemia and Acidosis.
• Diuretics (Lasix, HCTZ) lead to Hypokalemia and Hyponatremia.
• Heart Failure leads to fluid retention and Hyponatremia.

Assessing Fluid Balance

• Daily Weights provide the most accurate measure.
• Intake and Output (I&O) measures fluid intake (IV/oral) vs. output (urine, stool, vomit).
• Skin Turgor checks for dehydration (poor turgor = dehydration).
• Lung Sounds: Crackles may indicate fluid overload.
• Urine Specific Gravity: Low indicates fluid overload, high indicates dehydration.

Older Adults

• Older adults have decreased thirst perception, increasing dehydration risk.
• Kidneys have reduced urine concentration ability, increasing fluid overload/electrolyte imbalance risk.
• Medications (diuretics, laxatives, antihypertensives) can affect fluid and electrolyte balance.

Compensation Systems

• The respiratory system compensates fastest (minutes to hours) by adjusting CO2.
• The renal system regulation of HCO3 slower (hours to days).

Lung Sounds

• Vesicular sounds are normal, soft breath sounds heard over lung fields.
• Crackles (Rales) are popping sounds caused by fluid in alveoli (seen in pneumonia, CHF).
• Rhonchi presents as coarse, low-pitched wheezing caused by secretions in large airways (seen in COPD, bronchitis).

Chronic Kidney Disease (CKD) Risk Factors

• Diabetes mellitus and Hypertension damages kidney blood vessels and are leading causes.
• Smoking, heart disease, obesity, and hyperlipidemia can affect kidney circulation/perfusion
• Drug Use and Chronic glomerulonephritis can cause kidney damage.
• Polycystic kidney disease (genetic disorder) and Repeated Kidney Infections (Pyelonephritis) can impact kidney funciton.
• Nephrotoxic Drugs e.g. NSAIDs, aminoglycosides can cause kidney damage after long-term use

Dialysis

• Hemodialysis (HD) removes waste and excess fluid via a machine filtering the blood (short outside the body procedure). This requires vascular access (AV fistula/graft), more efficient but needs frequent hospital visits (3x/week).
• Peritoneal Dialysis (PD) uses the peritoneal membrane to filter waste inside the abdomen (continuous inside the body procedure done at home that requires fluid exchanges multiple times daily but has a higher risk of peritonitis).

Hemodialysis Clinical Manifestations

• Hypotension, muscle cramps, fatigue, anemia, infection risk, nausea, vomiting, diarrhea, chest pain, arrhythmias, and bleeding/hematoma are manifestations.

Peritoneal Dialysis Clinical Manifestations

• Cloudy dialysate, abdominal pain (peritonitis), hernias, muscle cramping, weight gain, and malnutrition are manifestations.

Chronic Kidney Disease (CKD) Stages

• Stage 1: GFR > 90 mL/min; has Kidney damage.
• Stage 2: GFR 60-89 mL/min; mild loss of function, and possible Hypertension.
• Stage 3: GFR 30-59 mL/min; moderate loss, increased symptoms (Hypertension, fatigue, anemia, anorexia, malnutrition, bone pain).
• Stage 4: GFR 15-29 mL/min; severe kidney damage, prepare for dialysis symptoms: Hypertension, anemia, malnutrition, altered bone metabolism, edema, metabolic acidosis, hypercalcemia, possible uremia, and azotemia.
• Stage 5 (End-Stage Renal Disease - ESRD): GFR < 15 mL/min; kidney failure with azotemia and overt uremia requires dialysis or kidney transplant.

Impact of Renal Failure

• Renal Failure affects multiple systems, including:
  • Cardiovascular: Hypertension, heart failure, and pericarditis due to fluid overload
  • Respiratory: Pulmonary edema and Kussmaul respirations (metabolic acidosis)
  • Hematologic: Anemia (low erythropoietin production)
  • Neurological: Confusion, neuropathy, seizures (due to uremic toxins)
  • Gastrointestinal: Nausea, vomiting, and metallic taste (uremia)
  • Skeletal: Osteodystrophy (low calcium, high phosphate)
  • Integumentary: Dry, itchy skin; ecchymosis; and impaired wound healing

CKD Symptoms (By Stage)

• Early stages (1-3): Mild proteinuria, but no major Symptoms.
• Moderate stage (3-): Hypertension, fatigue, anemia, anorexia, malnutrition, and bone pain.
• Stage 4: Hypertension, anemia, malnutrition, altered bone metabolism, edema, metabolic acidosis, hypercalcemia, possible uremia, azotemia, hypercalcemia, and urination changes.
• End-stage (5): Severe uremia and azotemia, nausea, vomiting, loss of appetite, fatigue, confusion, edema, shortness of breath, and dysrhythmias.

Electrolyte Imbalance 2/2 Chronic Renal Failure

• Hyperkalemia leads to risk for cardiac arrhythmias and cardiac arrest.
• Hyponatremia leads to fluid retention, confusion/weakness.
• Hypocalcemia & Hyperphosphatemia leads to bone disease. Hypercalcemia causes muscle cramps and seizures.
• Metabolic acidosis causes fatigue, nausea, and breathing difficulties.

Peritoneal Dialysis Solutions

• Dialysate contains Dextrose-based or Icodextrin-based solutions to pull excess fluid out of the blood and should be kept at room temperate or warm..

Medications for Elevated Phosphate

• Phosphate binders are ordered for to prevent elevated phosphate levels in dialysis patients. Examples include Sevelamer, Calcium Acetate, Lanthanum carbonate, Ferric Citrate, and Sucroferric Oxyhydroxide.

Nursing Implications

• Check AV fistula/graft for bruit/thrill, monitor BP (risk of hypotension), and hold on antihypertensive meds before dialysis (risk of hypotension),

Peritoneal Dialysis Nursing Implications

• Monitory for Fever, pain, and peritonitis, as evidenced by cloudy dialysate. Maintain strict aseptic technique, assess for hernias (due to increased intra-abdominal pressure), and monitor Intake and Output.

Hemodialysis Patient Teaching

• You should stay out of water and have you labs values checked, take your vitals before and after treatment, and weigh yourself before the next fill and after "dry weight".

Dialysis Psychological Effects

• Depression & Anxiety (due to lifestyle changes), anger/denial, body image issues, and financial burdens all impact patients.

Asthma

Asthma Signs and Symptoms

• Early signs include wheezing, shortness of breath, chest tightness, and coughing (especially at night).
• Worsening is indicated by increased respiratory rate (tachypnea), use of accessory muscles, and prolonged expiratory phase.

Asthma Nursing Management

1. Assess respiratory status (O2 saturation, lung sounds, peak flow readings)
2. Administer bronchodilators (Albuterol).
3. Administer corticosteroids (Prednisone, Fluticasone) to reduce inflammation.
4. Provide oxygen therapy if needed.
5. Teach avoidance by identifying triggers (allergens, smoke, cold air, stress).
6. Monitor worsening (silent chest = emergency).

Asthma Patient Education

• Avoid triggers (dust, smoke, pets, strong odors, pollen).
• Use inhalers correctly (spacer improves medication delivery).
• Peak Flow Monitoring measures air flow.
  • Green zone = stable
  • Yellow zone = worsening
  • Red zone = emergency
• Always carry a rescue inhaler (Albuterol).

Medications

• Albuterol is a short-acting beta agonist (SABA) that can is used for quick relief asthma attacks.
• Albuterol (SABA) treats emergencies via nebulizer or metered-dose inhaler (MDI).
• Corticosteroids (IV or oral Prednisone) treats emergencies.
• Epinephrine injection treats life-threatening case emergencies.
• Inhaled Corticosteroids (Fluticasone, Budesonide) and Oral Corticosteroids (Prednisone) used for severe cases treats inflammation.

Status Asthmaticus Signs and Symptoms

• Breathlessness at rest, inability to speak, RR > 30 breaths/min, use of accessory muscles/chest retractions, and "silent chest" (no wheezing = no air movement = EMERGENCY) are telltale signs.
• Provide High-dose Albuterol nebulizer, IV corticosteroids, oxygen to support breathing and intubate patient if necessary

Asthma Medications

• Steroids (Fluticasone, Budesonide, Prednisone) reduce inflammation and may cause oral thrush, hyperglycemia, weight gain. Be sure to rinse your mouth after using inhaler.
• Bronchodilators (Albuterol and Salmeterol) relax airways, but can lead to tachycardia, tremors, and palpitations.
• Anticholinergic Drugs (Ipratropium and Tiotropium) prevent bronchoconstriction, but can lead to dry mouth and blurred vision.
• Xanthines (Theophylline) relaxes smoother muscles and ahve side effect such as nausea.

Bronchitis/Emphysema (COPD)

• COPD complicates oxygen due to difficulty exhaling CO2, leading to respiratory acidosis.
• Hypoxia leads to chronic low oxygen levels due to poor gas exchange.
• Excess oxygen administration leads to Oxygen-Induced Hypoventilation, so keep it close to 3L/min.

COPD Devices

• Nasal Cannula (1-3L/min) prevents oxygen toxicity.
• Venturi Mask provides precise O2 delivery and prevents over-oxygenation.
• Non-Rebreather Mask is only for emergencies.

COPD Causes

• #1 cause is Smoking, but also Air pollution/occupational exposure (coal, dust, chemicals), and Genetics (Alpha-1 Antitrypsin Deficiency) can be factors.

COPD Signs and Symptoms

• Chronic cough (productive in bronchitis, dry in emphysema), sputum production (worse in chronic bronchitis), dyspnea, barrel chest, pursed-lip breathing, clubbing, tripod position, and repeated respiratory infections are common signs.

COPD Terms

• Chronic Bronchitis: Excess mucus production, chronic productive cough.
• Emphysema: Alveolar destruction, air trapping, hyperinflation.
• Cor Pulmonale: Right-sided heart failure due to lung disease

Thoracentesis

• Removes excess fluid with use of a needle by going into the pleural space.
• Treats pleural effusion, lung infections, and cancer
• Be careful not to cause Pneumothorax, Bleeding,and Infection in patient

Chronic Bronchitis

• "Blue Bloaters" exhibits chronic productive cough, cyanosis, peripheral edema, wheezing/rhonchi due to mucus buildup, and respiratory acidosis (high CO2).
• "Pink Puffers" exhibits dyspnea on exertion, pursed-lip breathing, barrel chest minimal cough, and hyperresonance on percussion.

Symptoms of Cor Pulmonale

• Peripheral edema, JVD (jugular vein distension), ascites, dyspnea, fatigue and cyanosis all point to lung disease.

Chronic Bronchitis/Emphysema Diagnosis

Lab Findings

• ABGs: Respiratory acidosis (low pH, high CO2)
• Polycythemia: High Hct (body compensates by producing more RBCs).

Diagnostic Tests

• Use Pulmonary Function Tests and FEV1, as well as Chest X-rays.

Medications

• Same as Asthma (Albuterol/Ipratropium, Fluticasone, Prednisone, and Theophylline), but with added Antibiotics (Azithromycin).

Nursing Interventions

• Pursed-lip breathing, tripod position for better breathing, small and frequent meals (high-calorie and high-protein), plus avoided use of respiratory depressants.

Patient Education

• Get flu & pneumonia vaccines, stop smoking, and avoid cold air, dust, or strong smells.

Pneumonia, Bronchitis, Emphysema, and Asthma Similarities

• Pneumonia causes fever, chills, productive cough, and crackles.
• Bronchitis causes a chronic cough, mucus production, and rhonchi.
• Emphysema causes dyspnea, pursed-lip breathing, and barrel chest.
• Asthma causes wheezing, chest tightness, and reversible airway obstruction.

Obstructive sleep apnea (OSA)

• It is caused blockage from the relaxation of throat muscles, a large tongue, or inflamed throat, leading to pauses in breathing. Mixed form has both types.

Causes of obstruction

• Obesity is #1
• Enlarged tonsils/adenoids
• Deviated Septum/ Nasal Congestion
• Excessive Alcohol Consumption

Interventions

• Advise for weight loss
• Elevate HOB
• Avoid alcohol, smoking, and CNS depressants
• Reinforce BiPAP/ CPAP

Signs and Symptoms

• Gasping/ Choking at night
• Loud/Chronic Snorer
• Morning Headaches
• Memory Decline/ Issues with Cognition
• Weight gain

BiPAP vs CPAP

• CPAP constant postive pressure
• BiPAP varies with inhalation and exhalation

How to avoid infecions (pneumonia)

• Clean CPAP
• Hydrate with humidifier

Types of Pneumonia

Different Types

1. Aspiration Pneumonia – Food, liquid, or vomit enters the lungs.
2. Inhalation- Airborne pathogens enter the lungs.
3. Hematogenous spread – Infection spreads from the bloodstream.

Different Catagories

• CAP- Community Acquired Home or other settings
• HAP- Hospital 48 hrs
• Ventilation Machines
• Immunocompromised people

Risk Factors

• Weak immune system
• Preexisiting conditions such as COPD or diabetes
• Smoker

• 65 years age

Complications

• Pleural Effusion- Fluid Buildup in the Pleural Space
• Sepsis
• Abscess
• Respiratory Failure

Identification of symptoms by the elderly

Elderly do not mount a ferver response

• Fatigue/Weak
• Confusion very common

Diagnositics

Chest X-Ray- identify the buildup CBC increases Sample

Treatmens

• O2 supply
• Fluids
• Antipryretics such as Tylenol
• Nebulizers

Nursing Interventions

• Ensure patient keeps up to date
• Encourage patient to sit upright
• and not smoke second hand

Tuberculosis (TB)

Infection due to tuberculosis. The bacteria multiply in the alveoli, triggering an immune response leading to isolation of the infection.

• Mycobacterium spread by airborne transmission via cough

Causes

• Substance Abuse
• Malnutrition
• Close contact with an infected individual
• HIV Transplant. HIV weakens Immune System

Signs and Symptoms

• Cough >21 days
• Night Sweats/ Fevers
• Weight Loss
• Hemopytsis

Nursing Interventions

• airborne percaustions
• Isolation in negative pressure room
• N95/ Papper is needed
• Limited movement

Tests

Blood, Sputum and Skin- PPD positive could indicate TB but will not tell you if it active TB

What drugs are used to treat TB

• RIPE theraphy that consists of 4 drugs and the use of other therapies Ensure you keep an eye on 1 - Rifampin, monitor liver and turns fluid Orange/red 2 - Isoniazid, check liver and look for new problems 3 - Pyrazinamide, watch out for liver issue 4 - Ethambutol, watch out for vision issue

Anemia

• What if the patient has low iron*"

Pathophysiology:

• Patient will experience decreased hemoglobin
• Can happen from heavy menstrual flows, poor diet, or Gl issues

Syptoms

• Brittle nails, Glossitis, Pallow
• TachyCardia, Pica

Interventions

• Iron suppliments
• Blood rich food

Complications

• Increase Heart Rate
• Renal Problems

teaching

• Take iron suppliment with orange juice
• Make sure you have your blood tested

B12 Anemia

Patophysiology

• Decrease abosrbtion of b12 which will lead to low DNA syshthesis This can happen due to autoimmune disorders, surgery, or Celiac's Complication
• Can caused other heart problem
• Neropathy Intervention
• Injections
• Aninmal Food

Sickel Cell

Pathophysiology

• Blockage caused to cells that get turned into sickles. The blocked flow willl lead to pain. This condition inhereated. Syptoms
• Severe pain
• Swelling
• Muscle weakness

Complications

• Blindness
• Stroke
• Muscle Weekend

Intervetions

• Take medication hydra
• Avoid certain areas/ activities
• Stay hydrated

Polycythemia

Patology

• Due to genetic disorders the bone marrow produces too much and makes blood to thick which leads to clotting. Syptoms
• Skin irritation
• Dizziness
• Loss of Appetite Interventions
• Avoid tight areas
• Hydrate to thinout the blood
• If you have to take meds follow doc guidance

Thrombocytopenia

Pathophysiology

• Low plate count will increase bleeding. Could be form cancer/ infection Syptoms
• Easy petechiae
• Blood in pee/stool

Intervenions

• Avoid taking spirl
• Use a soft toohbrush

G6PD

Genetic lack of G6PD will affect the blood production Syptoms

• Dark pee
• Fatigue
• Jaundice Interventions
• Blood Transfusions with severe symptoms
• Use sunsreen

Hypertension

Risk factors

1. Over weight
2. Smoking
3. Age
4. Sedentery

How to measure BP MAP= (2x Diastolic +Systolic)/3

Medications

• Diurectic- will decrease potassium 1 - Spironolactone is a potassium sparing ( monitor K+ levels). Blocks aldosterone. Also removes H20 2 - Lasix: Watch electrolytes potassium as well watch hearing and remove alot of H20 3 - HCTZ thiazide decreases BP and salt/H20 levels. Watch BP and electrolyte

ACE inhibitors (Vasoconstriction)

• Zestril monitor K+ levels

Vasoliadators direct

• Nitrates- for the heart

Causes

• RAAS- increases BP by increase in salt in the blood
• Aldosterone -increases by increasing the volume and retaining salt
• Fight or Flight-

Angina

When the blood heart has more blood that is is getting

Syptoms

• Tight Ness
• Shortness of Breath

Triggers

• Stress
• Extertions
• Cold

Stabale

Chest pain relieved via rest

Unstabale

• Not relieved via test. Needs help quick!
  • Admin o2

Variant

• Reduce blood flow and leads pain

Pre-infraction

• Worsening angina and can't be reliece and needs medical help
• Stress Hormones
• Releases stress homes, epinephrine and norephrine.
  • Increase heart rate/respirations -Increase Body Temp and blood glucose -Dilation

Effects

• Dilation
• Vaso constriction
• Increase BP/ Breath rate
• Increase alertness, pupil dilation, decrease digestion and peristalsis

Medications"

Nitrogylcenrides

• Increase oxygen and reduce blood volume

beta

• Blocks lower BP

Signs of angina unique to ladies

• Fatigue and ab muscles
• High cholestials

Peripheral Ardery Dieases

• High cholesterol and bloodclots and leads to narrowies Arteries

How to test the body

• Ultrasound
• Angiogrpahgy- narrow arteries detection

Signs and Symtoms

• Numbes
• Feet will be cool and very slim

Diagnosis

• Peripheral problems

Nursing Interventions

1 - Encourage walking/ exercise 2 -Keep feet warm and ensure they wear shoes 3 - Elevted 4 - Monitier for signs of ulcers

Medications

• Use of ant hypertension
• If there his pain. Lisinopril and zomcor Anti- Cholesterol medications Anti-Platelets to prevent narrowing of arteries

Teaching

• Monitier the areas
• keep them clean and dry
• Stop Smooking
• Exercsie
• Hydrate

Test your knowledge of anemia types like iron deficiency and sickle cell. Learn about fluid compartments (intracellular, extracellular, transcellular), imbalances, and electrolyte disorders, including hyponatremia. Explore IV fluids and diagnostic tests.