Cell Regulation Notes PDF

**Cellular regulation**- Refers to all functions carried out within a cell to maintain homeostasis. Most things within the cell are protein based. **Homeostasis**- Any self-regulating process by which biological systems tend to maintain stability while adjusting to conditions that are optimal for s...

**Cellular regulation**- Refers to all functions carried out within a cell to maintain homeostasis. Most things within the cell are protein based. **Homeostasis**- Any self-regulating process by which biological systems tend to maintain stability while adjusting to conditions that are optimal for survival. **Apoptosis**- Death of a cell. **Differentiation**- Refers to the acquisition of a specific cell function. A normal process by which a less specialized cell becomes a more specialized cell type. **Proliferation**- The reproduction of new cells through cell growth & division. **Neoplasia-** Abnormal & progressive multiplication of cells, leading to the formation of a neoplasm. **Neoplasm**- New but abnormal tissue growth that is uncontrolled and progressive. **Benign**- Non-cancerous. **Malignant**- Cancerous. **Replication**- Duplicating the parent cells with alike genetic material (DNA). 23 pairs of chromosomes. **Growth**- Cells replicating faster than they can die. **Dysplasia**- Abnormal cells. **Cachexia-** Extreme body wasting & malnutrition. **Adjuvant Therapy-** Chemotherapy that is used along with radiation or surgery. **Desquamation-** "Skin peeling" Shedding of the outermost layer of skin. **Antigen-** Any substance the immune system recognizes as foreign **B-cells-** Memory cells and plasma cells. Plasma cells are immunoglobulins. Prepare cells for destruction **T-cell-** Destroys the foreign invader. Over-active suppression causes tumor growth. **Macrophages-** Cancer killing cells of the cellular immune system. **Myeloid Blasts-** Immature tumor cells in the bone marrow, seen in acute myeloid leukemia. **Cytokines-** Immune system proteins that direct action between humoral immunity and cell mediated immunity and they enhance the immune response. **Capillary Leak Syndrome-** Capillaries unable to retain colloids like albumin and proteins. Fluid retention 20-30 lbs. Complications of fluid overload. **Cell Cycle**- **G1 phase drugs-** Hormonal drugs; Antineoplastic enzymes (asparaginase, pegaspargase) **S phase drugs-** Antimetabolites- Folate Analogs (Methotrexate) Purine Analogs (Cladribine, Fludarabine, Mercaptopurine, Pentostatin, Thioguanine) Prymidine analog (Capecitabine, Cytarabine, Gemcitabine, Floxuridine, Fluorouacil) Miscellaneous (Hydroxurea) Tipoisomerase-1 inhibitors (Topotecan, Irinotecan) **G2 phase drugs-** Epiodophyllotoxin (Etoposide, Teniposide) Miscellaneous Bleomycin Taxanes (Docetaxel, Paclitaxel) **M phase drugs-** Taxanes (Docetaxel, Paclitaxel) Vinca alkaloids (Vinblastine, Vincristine, Vinorelbine) **[Biologic Response Modifiers-]** Enhances and restores immune system defense. Toxic effect on cancer cells causing rupture (lysis). Modifies biology of tumor cells. Inhibits reproduction. 2 classes: Hematopoietic, Immunomodulating. **[Immunomodulating Drugs (Interleukins)]-** Proliferates and enhances T cells and B cells. Aldesleukin (Proleukin). Used for metastatic melanoma, and metastatic renal cancer. **Nursing Actions with Immunomodulating Interleukins-** Caution with BP meds, causes hypotension. Contraindicated for transplant patients. No corticosteroids, reduces antitumor effectiveness. [Adverse effects]- Capillary leak syndrome, massive fluid retention, respiratory distress, heart failure, arrhythmias, MI (reversible with D/C), fever, chills, rash, fatigue, liver toxicity, myalgias, and headaches. **[Immunomodulating Drugs (Monoclonal Antibodies)]-** Antineoplastics: Targets cancer cells with little effect on other cells. Bevacizumab (Avastin) Inhibits development of new blood vessels in tumor. \ Cetuximab (Erbitux), Rituximab (Rituxan) Non-Hodgkins lymphoma **Nursing Actions with Immunomodulating Monoclonal Antibodies-** Contraindicated in TB or other active infections. [Adverse effects-] Immunosuppression, flu-like symptoms, dyspnea, DVT, HTN, hypokalemia, proteinuria **[Rituximab]**- Potentially fatal inflammatory infusion reactions: Severe bronchospasms, ***tumor lysis syndrome***, ARF. Premedicate with acetaminophen and diphenhydramine. Humera for RA is in this drug class. **[Immunomodulating Drugs (Interferon)]-** Prevents cancer cells from dividing. Increases activity of macrophages. Increases cancer cell antigens. Interferon alfa (Roferon-A) Interferon alfa 2b (Intron-A) **Nursing Actions with Immunomodulating Interferon-** Contraindicated in severe liver disease and antiviral drugs [Adverse side effects]- Flu-like symptoms, neutropenia, thrombocytopenia, EKG changes, Orthostatic hypotension, confusion and seizures. [Black Box Warning]- Can cause/aggravate autoimmune disorders and neuropsychiatric symptoms. Some are used for antiviral therapy of Hep C. **[Hematopoietic Drugs]-** (Formation of blood) Decrease the duration of anemia, neutropenia, and thrombocytopenia. Enable higher doses of chemo. Decrease bone marrow recovery time after radiation or transplant. Binds to progenitor cells to stimulate production of RBCs, WBCs, and platelets. [Erythropoietic drugs:] (formation of RBCs) Epoetin alfa, requires adequate iron storages (***Epogen***, Procrit) Darbepoetin alfa (Aranesp) [Colony Stimulating Factors:] (Formation of WBCs) Filgrastim (***Neupogen***) Pegfilgrastim (Neulasta) Sargramostim (Leukine) [Platelet Promoting drugs-] (Formation of platelets) Oprelvekin (Neumega) **Nursing actions with Hematopoietic drugs-** (Colony stimulating factor) Contraindicated in 10% of patients with myeloid blasts because it can stimulate malignant growth. Avoid administering within 24 hours of chemo drugs (may kill the new formations) [Adverse side effects-] Fever, muscle aches, bone pain, flushing, edema, anorexia, nausea, vomiting, diarrhea, alopecia, rash, dyspnea. Establish baseline labs and monitor WBCs, RBCs, Platelets, ANC (Absolute neutrophil count) D/C when ANC is greater than 10,000 **Tumor Markers**- A biomarker found in urine, blood, or tissues that can be elevated by the presence of 1 or more types of cancer. Ex. PSA Prostate-specific antigen, CEA Carcinoembryonic agent. **Angiogenesis**- Formation of new blood vessels to feed the tumor so it can grow. **Free radical**- Breakdown of waste products from the cell. **Mucositis-** Painful inflammation & alteration of the mucous membranes lining the digestive tract. **Stomatitis-** Painful swelling & sores inside the mouth. **Vesicants-** Chemicals that damage tissue on direct contact **Oral cryotherapy-** Ice, Cold water, Vasoconstriction to reduce exposure to chemo drugs. **7 Warning signs of cancer**: C Changes in bowel or bladder habits --- --------------------------------------------------- A **A** sore that does not heal U **U**nusual bleeding or discharge T **T**hickening or lump in the breast or elsewhere I **I**ndigestion or difficulty swallowing O **O**bvious change in a wart or mole N **N**agging cough or hoarseness **Carcinomas & Adenocarcinomas**- Tumors of glandular tissue: Originates in the skin, lungs, breast, pancreas and other organs and glands. Breast, Prostate, Lung, Colon cancers. **Sarcomas**- Tumors of connective tissues: Arise in bone, muscle, fat, blood vessels, and cartilage. Chondrosarcoma, Ewing's sarcoma, Fibrosarcoma, Kaposi sarcoma, Rhabdomyosarcoma, Osteosarcoma. **Blastomas**- Tumors of less differentiated embryonal tissues: **Lymphomas**- Cancer of the lymphocytes. Hodgkin's and Non-Hodgkin's lymphoma. **Leukemia**- Cancer of the blood. Chronic Lymphocytic leukemia (CLL), Chronic Myeloid Leukemia (CML), **[Acute Lymphocytic Leukemia (ALL)]**, Acute Myeloid Leukemia (AML). **Melanomas**- Arise in the cells that make pigment in the skin. **Primary Tumor-** Identified by the parent tissue. **Secondary Tumor-** Metastatic. Cancer cells move from their primary location through the bloodstream or lymphatic system. Additional tumors retain the name of the original site. +-------------+-------------+-------------+-------------+-------------+ | **T** | **TX-** | **T0-** No | **Tis-** | **T1/T2/T3/ | | | Tumor | evidence of | Tumor in | T4-** | | **Primary | cannot be | primary | situ, | Primary | | Tumor** | measured. | tumor. | malignant | tumor based | | | | (Cannot be | cells only | on size and | | **Tumor | | found). | within | invasion | | size and | | | superficial | into nearby | | invasivenes | | | layer of | structures. | | s** | | | tissue. No | The higher | | | | | extension | the T the | | | | | into deeper | larger the | | | | | tissue. | tumor | | | | | | and/or | | | | | | grown into | | | | | | nearby | | | | | | tissues. | +=============+=============+=============+=============+=============+ | **N** | **NX-** | **N0-** No | **N1/N2/N3- | | | | Nearby | evidence of | ** | | | **Regional | lymph nodes | cancer | Size, | | | Lymph | cannot be | cells in | location, | | | Nodes** | evaluated. | regional | and/or | | | | | lymph | number of | | | **Lymph | | nodes. | lymph nodes | | | nodes | | | involved. | | | involved** | | | The higher | | | | | | the N the | | | | | | more | | | | | | extensive | | | | | | lymph node | | | | | | involvement | | | | | |. | | +-------------+-------------+-------------+-------------+-------------+ | **M** | **MX-** | **M0-** No | **M1/M2/M3/ | | | | Metastases | evidence of | M4-** | | | **Metastas | cannot be | metastases | Extent of | | | es** | evaluated. | found. | metastases. | | | | | | The higher | | | **Metastase | | | the M, the | | | s | | | more | | | to distant | | | extensive | | | organs.** | | | the | | | | | | metastases. | | +-------------+-------------+-------------+-------------+-------------+ | | | | | | +-------------+-------------+-------------+-------------+-------------+ | **Grading** | **GX-** | **G2-** | **G3-** | **G4-** | | | Grading | Moderately | Poorly | Undifferent | | | cannot be | differentia | differentia | iated | | | assessed. | ted. | ted | | | | | | | (High | | | **G1-** | (Intermedia | (High | grade) | | | Well | te | grade) | | | | differentia | grade) | | | | | ted | | | | | | | | | | | | (Low grade) | | | | +-------------+-------------+-------------+-------------+-------------+ **Risk Factors-** Socioeconomic status, age, smoking, tobacco use, bacteria & virus, genetics, radiation, carcinogens, nutrition, physical activity, immunity. Risk Factor Associated Cancer ------------------------------------ --------------------------------------------------- Environment Radiation (ionizing) Leukemia, breast, thyroid, lung Radiation (ultraviolet) Skin, melanoma Viruses Leukemia, lymphoma, nasopharyngeal Food Aflatoxin Liver Dietary factors Colon, breast, endometrial, gallbladder Lifestyle Alcohol Esophageal, liver, stomach, laryngeal, breast Tobacco Lung, oral, esophageal, laryngeal, bladder Medical Drugs Diethylstilbestrol (DES) Vaginal in offspring, breast, testicular, ovarian Estrogens Endometrial, breast Alkylating drugs Leukemia, bladder Occupational Asbestos Lung, mesothelioma Aniline dye Bladder Benzene Leukemia Vinyl chloride Liver Reproductive History Late first pregnancy, early menses Breast No children Ovarian Multiple sexual partners Cervical, uterine **Men-** 3 most common new cancer diagnosis are: 1. Lung/Bronchus, 2. Prostate, 3. Colon/Rectum. Most common cause of death in that order. **Women-** 3 most common new cancer diagnosis are: 1. Lung/Bronchus, 2. Breast, 3. Colon/Rectum. Most common cause of death in that order. **Children (ages 0-14)-** Cancer remains the second most common cause of death in this age group, exceeded only by accidents. Leukemia and cancers affecting the brain & CNS are the most common childhood cancers. **Assessment-** Health Hx, Family Hx, smoking Hx, BM, Mole changes, Unintentional weight loss, visible lesions, physical asymmetry, palpable masses, abnormal sounds, presence of blood in stool, or during a pelvic exam. Testing. **Primary Prevention-** Behavior modification, Modification of environment, Vaccinations, Treatment of infections, Smoking cessation, Avoid sun exposure, Participating in regular physical activity, Eating a balanced diet, **Prophylactic surgery.** **Secondary Prevention (Screening)-** **Diagnostics-** Radiographic: X Rays, CT scan, MRI, Radioisotope scan, Ultrasound, Diagnostic mammography, Tomosynthesis, Breast Biopsy. **Extravasation-** The leakage of any intravenously or intra arterially administered medication into the tissue space surrounding the vein or artery; Can cause serious tissue injury. Generally prefer central line administration. Antineoplastic chemo agents are classified by their potential to damage soft tissue if they inadvertently leak from vein. **Tumor lysis syndrome-** A common metabolic complication of chemotherapy for rapidly growing tumors. It is characterized by the presence of excessive cellular waste products & electrolytes, including uric acid, phosphate, and potassium, and by reduced serum calcium levels. **Breast Cancer Risk Factors-** Increased age, family Hx, early menarche nulliparity (Never gave birth), late menopause. Lack of breast feeding, postmenopausal obesity. Use of postmenopausal HRT, Alcohol consumption, mutations in BRCA1/BRCA2. 1 in 8 women will develop by age 70. Second leading cause of death in women. **Breast Cancer Non-invasive or Preinvasive-** Ductal carcinoma in situ (DCIS). Lobular carcinoma in situ (LCIS). **Breast Cancer Invasive-** [Infiltrating ductal carcinoma]. Fibrosis develops around the cancer. Peau d'orange. [Inflammatory breast n cancer]. Diffuse erythema. Peau d'orange. Aggressive, harder to treat. **Breast Cancer in Men-** Family Hx. BRCA ½ mutation. Diabetes, gynecomastia, testicular disorders, obesity. Usually presents as a hard, painless, subareolar mass. ***Common sites of metastases-*** ***Breast Cancer-** Bone, Lung, Liver, Brain. Dense breast tissue make it harder to detect.* ***Lung Cancer-** Brain,, Bone, Liver, Lymph nodes, Pancreas* ***Colorectal Cancer-** Liver, Lymph nodes, Adjacent structures* ***Prostate Cancer-** Bone (Especially spine & legs), Pelvic nodes* ***Melanoma-** GI tract, Lymph nodes, hLung, Brain* ***Primary Brain Cancer-** CNS* **Characteristic** **Normal Cell** **Benign Tumor Cell** **Malignant Cell** ------------------------------ ------------------------------- ------------------------------- --------------------- Cell Division None or sow Continuous or inappropriate Rapid or continuous Appearance Specific morphologic features Specific morphologic features Anaplastic Nuclear to cytoplasmic ratio Smaller Smaller Larger Differential Functions Many Many Some or nome Adherence Tight Tight Loose?\*: Migratory No No Yes Growth Well regulated Expansion Invasion Chromosomes Diploid (Euploid) Diploid (Euploid) Aneuploid Mitotic Index Low Low High **Chemo is systemic / Radiation is local** **Chemo brain-** Decreased concentration, memory loss, cognitive changes cause difficulty learning new things **Radiation therapy-** Can be used as [curative] for certain cancers. To [control] malignant disease when tumors cannot be removed. [Prophylactically] to prevent spread of primary cancer to distant area. [Palliatively] to relieve signs & symptoms of metastatic disease, especially with brain, bone, or soft tissue. **Teletherapy-** Is an external beam radiation. Most commonly used. **Brachytherapy-** Is internal radiation. Delivers a high dose of radiation to a localized area. (Used for prostate cancer) **Systemic-** Is radioisotopes. For implantation, patient must maintain bed rest. **Health Care Provider Safety-** When handling chemo drugs or excreta from patients receiving IV chemo dawn the appropriate PPE: Eye protection, Masks, Chemo gloves, Gown. No crushing, spitting or chewing oral chemo. Excreta is contaminated for 48 hours. **Nursing management in chemotherapy-** Assessing and managing many problems patients experience. Chemo agents affect both normal and malignant cells, meaning, they affect all organ systems. [Assess fluids & electrolytes]- Anorexia, nausea, vomiting, altered taste, mucositis, stomatitis, & diarrhea. [Modify risk factors for infections & bleeding]- Suppression of bone marrow & immune system at risk for anemia, infection, & bleeding. [Administering chemo]- Observe patient carefully especially with vesicants. [Protecting caregivers-] Nurses must have specialized chemo certification to administer. Nurses handling chemo could be exposed to low doses of chemo by direct contact, inhalation, or ingestion. **Nursing care of patients with cancer-** [Fatigue-] Debilitating and can last for months [Breast Cancer & Radiation]- Radiation can cause pulmonary fibrosis (lung scarring) [Maintaining tissue integrity]- Most frequently encountered disturbances of tissue integrity, in addition to stomatitis, include skin and tissue reaction to radiation, alopecia and metastatic skin lesions. [Stomatitis]**-** Mucositis is a common s/e of radiation and some types of chemo. Can lead to the inflammation and ulceration of any portion of the GIT. Can see mild redness and edema or can be severe, painful ulcerations, bleeding, and secondary infection. Best for pts to keep up with oral hygiene for best outcomes. Brushing, flossing, rinsing. [Radiation associated skin impairment]**-**Patients can develop irritation, pruritus, burning, and diminished quality of life. Nursing care is maintain skin integrity, reduce pain, clean skin, promote comfort, preventing trauma and infection. [Alopecia]**-**Temporary or permanent thinning or complete loss of hair is a potential adverse effect of radiation to the brain and various chemo agents. Major issue for some patients, challenges to self-esteem, depression, anxiety, anger, rejection, and isolation. Hair growth begins 1 month after chemo ends; New hair may differ in color, texture, and thickness. [Chemotherapy Induced Peripheral Neuropathy-] Protect feet, proper foot care and shoes, avoid extreme temperatures, test water temperatures with a thermometer. [Malignant skin lesions]**-**Can occur with local extension or mets of the tumor into epithelium and surrounding lymph and blood vessels. Skin can be red, discolored nodules, edema, exudates, and tissue necrosis. Note size, appearance, condition of surrounding skin, odor, bleeding, drainage, and associated pain, infection. Serious complications are hemorrhage, vessel compression, or airway obstruction. Nursing care is clean skin, reduce bacteria, control bleeding, reduce odor, protect skin from further trauma, and relieve pain. **Avoid sun exposure to radiated skin for 1 year.** [Nutrition promotion]**-** [Relieving pain]**-** Frequently is chronic pain. Can influence the person physically, psychosocially, culturally, and spiritually. Some chemo agents can cause tissue necrosis, peripheral neuropathies, and stomatitis. [Decreasing fatigue-] Look for factors such as anemia, electrolyte imbalance, organ dysfunction, pain, nausea, dysp nea, constipation, fear, and anxiety. Exercise can be helpful as well coping mechanisms. **Monitoring and Managing Potential Complication-** [Infection]**-** Nurse monitors labs to detect changes in the WBC counts. Common sites of infection, pharynx, skin, perianal area, urinary tract, and respiratory tract checked regularly. Risk for infection rises as ANC(Absolute Neutrophil Count) decreases (1500 cells) reflects severe risk. [Bleeding and Hemorrhage]**- Bone marrow suppression/Impaired clotting.**Thrombocytopenia is a decreased in circulation platelets, most common cause of bleeding in patients with cancer. Platelet count is less than 100,000). Platelet count decreases to 20,000 - 50,000 the risk of bleeding increases. Use electric razors, soft bristle toothbrushes. Do not take aspirin or ibuprofen. If bumped apply ice for 1 hour. Do not use enemas or suppositories. **Patient Teaching Prevention of Infections-** **[Neutropenic Precautions]-** No fresh flowers due to pesticides \* No potted plants soil may contain mold \* Symptoms of infection can be absent \* Report a temperature of 100 F \* Private room \* Monitor WBC count daily \* Avoid indwelling catheters \* Limit visitors to healthy people \* Ensure good hand washing techniques **Oncologic Emergencies-** [Sepsis]- Presence of bacteria, infection, or toxins, spread throughout the body via the bloodstream. [Disseminated Intravascular Coagulation (DIC)]- Condition affecting the blood's ability to clot and stop bleeding. **[SIADH (Syndrome of inappropriate antidiuretic hormone)]- A condition where high levels of ADH hormone cause the body to retain water.** [Spinal cord compression]- May experience pain, numbness, weakness, or tingling of an extremity. Altered bowel and bladder function. Gait changes. [Hyperkalemia]- High levels of potassium. [Superior Vena Cava Syndrome]- Group of symptoms caused by the obstruction of the superior vena cava. Facial swelling, venous distention, headache, upper limb edema. **[Tumor Lysis Syndrome]-** Large amounts of tumor cells are destroyed, releasing their contents into the bloodstream. **Colorectal Cancer-** Ascending colon and cecum 22% \* Transverse colon 11% \* Descending colon 6% \* Sigmoid colon 25% \* Rectum 30% \* Adenocarcinomas [Risk factors]- Over 50 \* Genetic predisposition \* Personal & family Hx of cancer \* Familial adenomatous polyposis \* Smoking \* Obesity \* Diet \* Alcohol [Physical assessment]- Bleeding/changes in stool (Most common sign) \* **Leukemia**- Cancer of the blood. Chronic Lymphocytic leukemia (CLL), Chronic Myeloid Leukemia (CML), **Acute Lymphocytic Leukemia (ALL)**, Acute Myeloid Leu **Risk Factors:** **GENERAL** **Gender-** Men are more likely to develop CML, CLL and AML than women. **Age-** The risk of most leukemias, with the exception of ALL, typically increases with age. **GENETICS** **Family history-** Most [[leukemias]](https://www.cancercenter.com/leukemia/) have no familial link. However, first degree relatives of CLL patients, or having an identical twin who has or had AML or ALL, may put you at an increased risk for developing the disease. **Genetic diseases-** Certain genetic abnormalities, such as Down syndrome, may play a role in the development of leukemia. **LIFESTYLE** **Smoking**- Although smoking may not be a direct cause of leukemia, smoking cigarettes does increase the risk of developing AML. **EXPOSURES** **Exposure to high levels of radiation-** Exposure to high-energy radiation (e.g., atomic bomb explosions) and intense exposure to low-energy radiation from electromagnetic fields (e.g., power lines). **Chemical exposure-** Long-term exposure to certain pesticides or industrial chemicals like benzene is considered to be a risk for leukemia. **PREVIOUS TREATMENT** **Previous cancer treatment-** Certain types of chemotherapy and radiation therapy for other cancers are considered leukemia risk factors. **Neutropenia-** The presence of abnormally few neutrophils in the blood, leading to increased susceptibility to infection. It is an undesirable side effect of some cancer treatments. **Neutropenic Precautions**- No fresh flowers due to pesticides \* No potted plants soil may contain mold \* Symptoms of infection can be absent \* Report a temperature of 100 F \* Private room \* Monitor WBC count daily \* Avoid indwelling catheters \* Limit visitors to healthy people \* Ensure good hand washing techniques \* No fresh fruit or vegetables **Myelosuppression-** A condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets. **Myelosuppression** is a side effect of some cancer treatments. When **myelosuppression** is severe, it is called myeloablation. **Precautions-** Use electric razors, soft bristle toothbrushes. Do not take aspirin or ibuprofen. If bumped apply ice for 1 hour. Do not use enemas or suppositories. **Targeting the Hallmarks of Cancer and the Enabling Characteristics:** **Cancer Cell Phenotype** **Targeting Agent** Sustaining proliferative growth signalingCyclin-dependent kinase inhibitors Evading growth suppressorsEpidermal growth factor inhibitors Resisting Cell death Programmed death receptor blocking antibodies Avoiding immune destructionImmune activators of cytotoxic T cells Enabling replicative immortality Telomerase inhibitors Inducing angiogenesis Inhibitors of VEGF signaling Activating invasion and metastases Inhibitors of HGF/c Met Deregulating cellular energetics Aerobic glycolysis Genome instability and mutation Poly-ADP-ribose polymerase inhibitors Tumor-promoting inflammation Selective anti-inflammatory drugs **The first eight phenotypes represent acquired functional capabilities of cancer cells that are necessary for tumor growth and progression. The last two phenotypes represent the enabling characteristics that help the cancer cell acquire these functional capabilities.** **Interrelated concepts:** - - - - - - - - +-----------------------+-----------------------+-----------------------+ | Stage 1: | Infancy (0-1 ½) | Hope- The infant | | | | develops a sense of | | Trust vs. Mistrust | | trust when | | | | interactions provide | | | | reliability, care, | | | | and affection. | | | | | | | | A lack of this will | | | | lead to mistrust. | +=======================+=======================+=======================+ | Stage 2: | Early Childhood (1 ½ | Will- The infant | | | - 3) | develops a sense of | | Autonomy vs Shame | | personal control over | | | | physical skills and a | | | | sense of | | | | independence. | | | | | | | | Erikson states it is | | | | critical that parents | | | | allow their children | | | | to explore the limits | | | | of their abilities | | | | within an encouraging | | | | environment which is | | | | tolerant of failure. | | | | | | | | Success leads to | | | | feelings of autonomy, | | | | failure results in | | | | feelings of shame and | | | | doubt. | +-----------------------+-----------------------+-----------------------+ | Stage 3: | Play Age (3-5) | Purpose- The child | | | | begins to assert | | Initiative vs Guilt | | control and power | | | | over their | | | | environment by | | | | planning activities, | | | | accomplishing tasks | | | | and facing | | | | challenges. Success | | | | at this stage leads | | | | to a sense of | | | | purpose. | | | | | | | | If initiative is | | | | dismissed or | | | | discourages, either | | | | through criticism or | | | | control, children | | | | develop a sense of | | | | guilt. | +-----------------------+-----------------------+-----------------------+ | Stage 4: | School Age (5-12) | Competency- It is at | | | | this stage that the | | Industry vs. | | child's peer group | | Inferiority | | will gain greater | | | | significance and will | | | | become a major source | | | | of the child's | | | | self-esteem. The | | | | child is coping with | | | | new learning and | | | | social demands. | | | | | | | | Success leads to a | | | | sense of competence, | | | | while failure results | | | | in feelings of | | | | inferiority. | +-----------------------+-----------------------+-----------------------+ | Stage 5: | Adolescence (12-18) | Fidelity- Teenagers | | | | explore who they are | | Ego Identity vs. Role | | as individuals, and | | Confusion | | seek to establish a | | | | sense of self, and | | | | may experiment with | | | | different roles, | | | | activities, and | | | | behaviors. | | | | | | | | According to Erikson, | | | | this is important to | | | | the process of | | | | forming a strong | | | | identity and | | | | developing a sense of | | | | direction in life. | +-----------------------+-----------------------+-----------------------+ | Stage 6: | Young Adult (18-40) | Love- During this | | | | period, the major | | Intimacy vs. | | conflict centers on | | Isolation | | forming intimate, | | | | loving relationships | | | | with other people. | | | | Success leads to | | | | strong relationships, | | | | while failure results | | | | in loneliness and | | | | isolation. | +-----------------------+-----------------------+-----------------------+ | Stage 7: | Adulthood (40-65) | Care- People | | | | experience a need to | | Generativity vs. | | create or nurture | | Stagnation | | things that will | | | | outlast them, often | | | | having mentees or | | | | creating positive | | | | changes that will | | | | benefit other people. | | | | | | | | Success leads to | | | | feelings of | | | | usefulness and | | | | accomplishment, while | | | | failure results in | | | | shallow involvement | | | | in the world. | +-----------------------+-----------------------+-----------------------+ | Stage 8: | Maturity (65+) | Wisdom- involves | | | | reflecting on one\'s | | Ego Integrity vs. | | life and either | | Despair | | moving into feeling | | | | satisfied and happy | | | | with one\'s life or | | | | feeling a deep sense | | | | of regret. | | | | | | | | Success at this | | | | stages leads to | | | | feelings of wisdom, | | | | while failure results | | | | in regret, | | | | bitterness, and | | | | despair. | +-----------------------+-----------------------+-----------------------+ Let's remember **Van Nortwick's stories**: Her mother: Breast cancer that metastasized to the spine, created a **spinal cord compression** that she could identify because of the change on her mother's **gait**. Can also cause tingling sensation and **numbness in the lower extremities, and continence issues with both bowel and bladder.** Her mother had **chemo and radiation as palliative care**. Remember it is not always used to get better, but to just improve quality of life by reducing pain and discomfort. Her mother's cancer then metastasized to her brain. She had a temporary emergency colostomy bag placed: Remember stoma care and **foods to avoid that can produce gas.** An **Ascending Colostomy** is located in the ascending colon.\ The **stool is liquid to semi-liquid** and contains digestive enzymes that can be irritating to the skin around the stoma. You will probably empty your pouch 4-6 times a day. A **Transverse Colostomy** is located in the transverse colon.\ The **stool is usually liquid to semi-formed (paste-like)** because the colon has absorbed some of the water from the stool as it moved through the ascending colon. You will probably empty your pouch 4-6 times a day.\ \ A **Descending Colostomy** is located in the descending colon.\ The **stool is semi-formed (paste-like)** to formed because much of the water in the waste materials has been absorbed as it moved through the ascending and transverse colon. You will probably empty your pouch 1-3 times a day.\ \ A **Sigmoid Colostomy** is located in the sigmoid colon.\ **Stool from a sigmoid colostomy is usually formed** since most of the water has been absorbed as the waste passed through the ascending, transverse and descending colon. You may empty your pouch 1-2 times a day, or once Lab Normal Increased Decreased Interfering Factors +-------------+-------------+-------------+-------------+-------------+ | BUN | Adults: | \*Impaired | \*Liver | \*A | | | 6-20 mg/dL | Renal | failure: | combination | | | or | function: | from | of a | | | 2.1-7.1mmol | CHF, salt | hepatitis | low-protein | | | /L | and water | drugs, or | and | | | | depletion, | poisoning | high-carboh | | | Geriatrics: | shock, | | ydrate | | | 8-23 mg/dL | stress, | \*Acromegal | diet can | | | or 2.9-8.2 | acute MI | y | cause ↓BUN | | | mmol/L | | | | | | | \*Chronic | \*Malnutrit | \*BUN is | | | Peds: 5-18 | renal | ion, | lower in | | | mg/dL or | disease: | low protein | children | | | 1.8-6.4 | Glomerulone | diets | and women | | | mmol/L | phritis, | | b/c they | | | | pyelonephri | \*Impaired | have less | | | | tis | absorption, | muscle mass | | | | | celiac | than adult | | | | \*Urinary | disease | men | | | | Tract | | | | | | \*Obstructi | \*Nephrotic | \*↓BUN | | | | on | syndrome | normally | | | | | | occur in | | | | \*GI | \*Syndrome | late | | | | hemorrhage | f | pregnancy | | | | | inappropria | b/c of | | | | \*Diabetes | te | increased | | | | w/ | antidiureti | plasma | | | | ketoacidosi | c | volume | | | | s | hormone | | | | | | (SIADH) | \*Geriatric | | | | \*Excessive | | s | | | | protein | | have ↑BUN | | | | intake, | | when their | | | | protein | | kidneys are | | | | catabolism | | not able to | | | | that occurs | | concentrate | | | | in burns or | | urine | | | | cancer | | adequately | | | | | | | | | | \*Anabolic | | \*IV | | | | steroid use | | feedings | | | | | | only may | | | | | | result in | | | | | | overhydrati | | | | | | on | | | | | | and ↓BUN | | | | | | | | | | | | \*Many | | | | | | drugs may | | | | | | cause ↑or↓ | | | | | | BUN | +=============+=============+=============+=============+=============+ | CBC | See WBC, | See WBC, | See WBC, | See WBC, | | | RBC, Hb, | RBC, Hb, | RBC, Hb, | RBC, Hb, | | | Hct | Hct | Hct | Hct | +-------------+-------------+-------------+-------------+-------------+ | WBC | Black | \*Neutrophi | \*Viral | \*Hourly | | | Adults: | lic | infection | rhythm: | | | 3.2-10.0 x | leukocytosi | | There is an | | | 10₃ | s, | \*Hypersple | early-morni | | | cells/mm₃ | neurophilia | nism | ng | | | or x 10₉/L | | | low level | | | or | \*Lymphocyt | \*Barbitura | and | | | 3200-10,000 | ic | tes | late-aftern | | | cells/mm₃ | leukocytosi | | oon | | | | s, | \*Antibioti | high peal. | | | Adults: | lymphocytos | c | Age, sex, | | | 4.5-10.5 x | is | | xercise, | | | 10₃ | | \*Antihista | medications | | | cells/mm₃ | \*Monocytic | mines | , | | | or x 10₉/L | leukocytosi | | pregnancy, | | | or | s, | \*Chemother | pain, temp, | | | 4500-10,500 | monocytosis | apy | altitude, & | | | cells/mm₃ | | | anesthesia | | | | \*Basophili | \*Diuretics | affect | | | Neo: | c | | reults | | | 9.0-30.0 x | leukocytosi | \*Perniciou | | | | 10₃ | s, | s | \*Age: In | | | cells/mm₃ | basophilia | anemia | newborns | | | or 10₉/L or | | | and | | | 9000-30,000 | \*Eosinophi | \*analgesic | infants, | | | cells/mm₃ | lic | s/Anti-nifl | the count | | | | leukocytosi | ammatory | is ↑; the | | | Peds ↑ to | s, | drugs | count | | | 6: 5.0-21.0 | eosinophili | | gradually | | | x 10₃ | a | \*Aplastic | decreases | | | cells/mm₃ | | anemia | in children | | | or x 10₉/L | \*Hemoconce | | until adult | | | or | ntration | \*Immune-as | values are | | | 5000-21,000 | | sociated | reached | | | cells/mm₃ | \*Leukemia | neutropenia | between | | | | | | 18-21 | | | Peds 6-18 | 8Trauma/tis | | | | | yr:4.8-10.8 | sue | | \*Any | | | x 10₃ | injury/tiss | | stressful | | | cells/mm₃ | ue | | situation | | | or x 10₉/L | necrosis | | that leads | | | 4800-10,800 | | | to an | | | cells/mm₃ | \*Hemorrhag | | increase in | | | | e | | endogenous | | | | | | epinephrine | | | | | | production | | | | | | and rapid | | | | | | rise in the | | | | | | leukocyte | | | | | | count. | +-------------+-------------+-------------+-------------+-------------+ | RBC | Men: | \*Polycythe | \*Anemia | \*When | | | 4.2-5.4 x | mia | | blood | | | 10₆/mm₃ or | vera | \*Addison's | sample is | | | x 10₁₂/L | | disease | obtained | | | | \*Erythremi | | from a | | | Women: | c | \*Rheumatic | healthy | | | 3.6-5.0 x | erythrocyto | fever | person in a | | | 10₆/mm₃ or | sis | | recumbent | | | x 10₁₂/L | | \*Subacute | position | | | | \*Renal | endocarditi | the RBC is | | | Neo: | disease | s | 5% lower | | | 4.0-6.1 x | | | | | | 10₆/mm₃ or | \*pulmonary | \*Chronic | \*Hemoconce | | | x 10₁₂/L | disease | infection | ntration | | | | | | is | | | Peds: | \*Cardiovas | \*Lupus | dehydrated | | | 3.8-5.6 x | cular | | adults may | | | 10₆/mm₃ or | disease | \*Leukemia | obscure | | | x 10₁₂/L | | | significant | | | | \*Alveolar | \*Lymphomas | anemia | | | Teens: | hypoventila | | | | | 4.0-5.5 x | tion | | \*Stress | | | 10₆/mm₃ or | | | can cause ↑ | | | x 10₁₂/L | \*Hemoglobi | | RBC | | | | nopathy | | | | | | | | \*The blood | | | | \*Tobacco | | sample must | | | | | | not be | | | | \*Dehydrati | | clotted | | | | on | | | +-------------+-------------+-------------+-------------+-------------+ | ABG | \*Adult: | pH: | pH: | \*Mechanica | | | | Hyperventil | Strenuous | l | | | pH:7.35-7.4 | ation | physical | factors | | | 5 | Anxiety, | exercise, | | | | | pain, | Obesity, | \*Ventilato | | | Paco₂: | Anemia, | Starvation, | ry | | | 35-45 mm Hg | Shock Some | Diarrhea, | efficiency | | | | degrees of | Ventilatory | | | | Pao₂: \>80 | pulmonary | failure, | \*Gas | | | mm Hg | disease, | More severe | exchange | | | | Some | degrees of | factors | | | HCO₃-: | degrees of | pulmonary | | | | 22-26 mEq/L | congestive | disease | \*Cardiac | | | | heart | More severe | status | | | \*Peds: | failure | degrees of | | | | | Myocardial | CHF, | \*Physical | | | pH: | infarction, | Pulmonary | condition | | | 7.32-7.42 | Hypokalemia | edema, | | | | | , | Cardiac | \*Sensitivi | | | Paco₂: | Gastric | arrest, | ty | | | 30-40 mm Hg | suctioning | Renal | or the | | | | or | failure, | respiratory | | | Pao₂: | vomiting, | Lactic | control | | | 80-100mm Hg | Antacid | acidosis, | mechanism | | | | administrat | Ketoacidosi | | | | | ion, | s | \*Obese | | | | Aspirin | in diabetes | people have | | | | intoxicatio | Paco₂: | higher than | | | | n | Hyperventil | normal O2 | | | | Paco₂: | ation, | consumption | | | | Pulmonary | Hypoxia, | at any | | | | edema, | Anxiety, | given work | | | | Obstructive | Pregnancy, | rate | | | | lung | Pulmonary | | | | | disease | embolism  | | | | | Pao₂: | | | | | | Increased | Pao₂: | | | | | oxygen | Decreased | | | | | levels in | oxygen | | | | | the inhaled | levels in | | | | | air, | the inhaled | | | | | Polycythemi | air, | | | | | a | Anemia, | | | | | | Heart | | | | | HCO₃-: | decompensat | | | | | Lactic | ion, | | | | | acidosis, | Chronic | | | | | Ketoacidosi | obstructive | | | | | s, | pulmonary | | | | | Ingestion | disease, | | | | | of acids, | Restrictive | | | | | Cardiopulmo | pulmonary | | | | | nary | disease, | | | | | collapse, | Hypoventila | | | | | Shock | tion | | | | | HCO₃-: Loss | | | | | | of buffer | HCO₃-: | | | | | base, | Lactic | | | | | Hemorrhage, | acidosis, | | | | | Diarrhea, | Ketoacidosi | | | | | Ingestion | s, | | | | | of alkali | Ingestion | | | | | | of acids, | | | | | | Cardiopulmo | | | | | | nary | | | | | | collapse, | | | | | | Shock | | +-------------+-------------+-------------+-------------+-------------+ | Hb | Women: | \*Polycythe | \*Iron | \*People | | | 12.0-16.0 | mia | deficiency | living at | | | g/dL or | | | high | | | 120-160 g/L | \*CHF | \*Anemias | altitudes | | | | | | have ↑Hb | | | Men: | \*COPD | \*Liver | | | | 14.0-17.4 | | disease | \*Excessive | | | g/dL or | | | fluid | | | 140-174 g/L | | \*Hemorrhag | intake | | | | | e | causes ↓Hb | | | Neo: | | | | | |.5-24.5 | | \*Reactions | \*↓ in | | | g/dL or | | to | pregnancy | | | 125-245 g/L | | infectious | due to | | | | | agents | plasma | | | Peds: | | | volume | | | 9.5-17.3 | | \*Leukemia | | | | g/dL or | | | \*Extreme | | | 95-173 g/L | | \*Lymphoma | physical | | | | | | exercise | | | Teens: | | \*Carcinoma | causes ↑Hb | | | 10.3-15.7 | | tosis | | | | g/dL or | | | | | | 103-157 g/L | | \*Sarcoidos | | | | | | is | | | | | | | | | | | | \*Pregnancy | | +-------------+-------------+-------------+-------------+-------------+ | Hct | Women: | \*Erythrocy | \*Leukemia | \*People | | | 36%48% or | tosis | | living at | | | 0.36-0.48 | | \*Lymphoma | high | | | | \*Polycythe | | altitudes | | | Men: | mia | \*Adrenal | have ↑Hct | | | 42%-52% or | | insufficien | | | | 0.42-0.52 | \*Shock | cy | \*↓ in | | | | (when | | pregnancy | | | Neo: | hemoconcent | \*Chronic | | | | 35%-59% or | ration | disease | \*↓ in | | | 0.39-0.59 | rises | | geriatrics\ | | | | considerabl | \*Acute & | *Severe | | | Peds: | y) | chronic | dehydration | | | 29%-43% or | | blood loss | can cause | | | 0.29-0.43 | | | falsely ↑ | | | | | \*Hemolytic | Hct | | | Teens: | | reaction(re | | | | 32%-44% or | | actions) | | | | 0.32-0.44 | | | | | | | | \*Pregnancy | | +-------------+-------------+-------------+-------------+-------------+ | Creatinine: | Men: | \*Impaired | \*Small | \*↑ levels | | | 0.9-1.3 | renal | stature | of ascorbic | | | mg/dL or | function | | acid & | | | 80-115 | | \*Decreased | cephalospor | | | µmol/L | \*Chronic | muscle mass | in | | | | nephritis | | antibiotics | | | Women: | | \*Advanced | cause | | | 0.6-1.1 | \*Obstructi | & severe | falsely ↑ | | | mg/dL or | on | liver | creatinine | | | 53-97 | of urinary | disease | | | | µmol/L | tract | | \*Drugs | | | | | \*Inadequat | that | | | Neo: | \*Muscle | e | influence | | | 0.3-0.7 | disease | dietary | kidney | | | mg/dL or | | protein | function & | | | 27-62 µmolL | \*CHF | | other meds | | | | | \*Pregnancy | can cause a | | | Peds: | \*Shock | | change in | | | 0.5-1.0 | | | blood | | | mg/dL or | \*Dehydrati | | creatinine | | | 44-88 | on | | | | | µmol/L\*BUN | | | \*Diets ↑ | | | to | \*Hyperthyr | | in meat | | | Creatinine | oidism | | cause ↑ | | | ratio: 10:1 | | | creatinine | | | to 20:1 | | | | | | | | | \*Ketoacido | | | | | | sis | | | | | | may ↑ serum | | | | | | creatinine | +-------------+-------------+-------------+-------------+-------------+ | Glucose | Fasting | \*Diabetes | \*Pancreati | \*Steroids | | | plasma | | c | & diuretics | | 60-110 | glucose | \*Cushing's | islet | cause | | | Adults: | disease | carcinoma | changes in | | | ≤100 mg/dL | | | glucose | | | or ≤5.6 | \*Acute | \*Stomach | | | | mmol/L | emotional | tumors | \*Surgical | | | | or physical | | procedures | | | Fasting | stress | \*Addison's | & | | | peds: | | disease | anesthesia | | | 60-100 | \*Gigantism | | | | | mg/dL or | | \*Hypopitui | \*Obesity | | | 3.3-5.6 | \*Pituitary | tarism | or | | | mmol/L | adenoma | | sedentary | | | | | \*Hypothyro | lifestyle | | | Fasting | \*Hemochrom | idism | | | | Neo: 60-110 | atosis | | \*Parentera | | | mg/dL or | | \*Starvatio | l | | | 3.3-6.1 | \*Pancreati | n | glucose | | | mmol/L | tis | | | | | | | \*Liver | \*IV | | | Fasting | \*Clucagono | damage | glucose | | | preme: | ma | | | | | 40-65 mg/dL | | \*Premature | \*Heavy | | | or 2.2-3.6 | \*Advanced | infant | smoking | | | mmol/L | liver | | | | | | disease | \*Insulin | \*DAWN | | | | | overdose | phenomenon | | | | \*Chronic | | | | | | renal | \*Aspirin | \*Hct \>55% | | | | disease | overdose | | | | | | | \*Intense | | | | \*Vit B | | exercise | | | | deficiency | | | | | | | | \*Toxic | | | | \*Pregnancy | | doses of | | | | | | aspirin | +-------------+-------------+-------------+-------------+-------------+ | BMP | See: Cl-, | See: Cl-, | See: Cl-, | See: Cl-, | | | K+, Na+, | K+, Na+, | K+, Na+, | K+, Na+, | | | BUN, | BUN, | BUN, | BUN, | | | Creatinine, | Creatinine, | Creatinine, | Creatinine, | | | CO2, | CO2, | CO2, | CO2, | | | Glucose | Glucose | Glucose | Glucose | +-------------+-------------+-------------+-------------+-------------+ | Cl- | \*Adults: | \*Dehydrati | \*severe | \*Certain | | | 96-106 | on | vomiting | drugs may | | | mEq/L | | | alter Cl- | | | | \*Chushing' | \*Gastric | levels | | | \*Newborns: | s | suction | | | | 96-113 | syndrome | | \*Increases | | | mEq/L | | \*Chronic | are | | | | \*Hypervent | respiratory | associated | | | | ilation | acidosis | with IV | | | | causing | | saline | | | | respiratoru | \*Burns | infusion | | | | alkalosis | | | | | | | \*Metabolic | | | | | \*Metamolic | acidosis | | | | | acidosis w/ | | | | | | prolonged | \*CHF | | | | | diarrhea | | | | | | | \*Addison's | | | | | \*Hyperpara | disease | | | | | thyroidism | | | | | | | \*Salt-losi | | | | | \*Kidney | ng | | | | | disorders | diseases | | | | | | | | | | | \*Head | \*Overhydra | | | | | injury | tion/water | | | | | | intoxicatio | | | | | \*Eclampsia | n | | | | | | | | | | | \*Diabetes | \*Acute | | | | | insipidus | intermitten | | | | | | t | | | | | | porphyria | | | | | | | | | | | | \*Salt-losi | | | | | | ng | | | | | | nephritis | | +-------------+-------------+-------------+-------------+-------------+ | K+ | Adults:3.5- | \*Renal | \*Diarrhea, | \*To draw | | | 5.2 | failure | vomiting, | K+ values | | | mEq/L | | sweating | do not use | | | | \*Dehydrati | | a | | | Peds: | on | \*Starvatio | tourniquet. | | | 3.4-4.7 | | n | May | | | mEq/L | \*Obstructi | | increase | | | | on | \*Draining | the K+ | | | Infants: | | wounds | level by | | | 4.1-5.3 | \*Trauma | | 10% to 20% | | | mEq/L | | \*Cystic | | | | | \*Cell | fibrosis | \*IV | | | Neo: | damage | | administrat | | | 3.7-5.39 | (burns, | \*severe | ion | | | mEq/L | accidents, | burns | of K+ | | | | surgery, | | penicillin | | | | chemo | \*Primary | ay cause | | | | | aldosteroni | hyperkalemi | | | | \*Metabolic | sm | al | | | | acidosis | | penicillin | | | | | \*Alcoholis | Na+ may | | | | \*Pseudohyp | m | cause | | | | oaldosteron | | increased | | | | ism | \*Osmotic | excretion | | | | | hyperglycem | of K+ | | | | \*Uncontrol | ia | | | | | led | | \*Excessive | | | | diabetes | \*Respirato | intake of | | | | | ry | licorice | | | | \*Primary | alkalosis | decrease K+ | | | | acquired | | | | | | hyperkalemi | \*Renal | \*Leukocyto | | | | a | tubular | sis | | | | | acidosis | in leukemia | | | | \*Lupus | | raises K+ | | | | | \*Diuretic, | | | | | \*Sickle | antibiotic, | | | | | cell | mineralocor | | | | | | ticoid | | | | | \*Kidney | administrat | | | | | transplant | ion | | | | | | | | | | | | \*Barium | | | | | | Chloride | | | | | | poisoning | | +-------------+-------------+-------------+-------------+-------------+ | Na+ | \*Adults:13 | \*Dehydrati | \*Severe | \*Anabolic | | | 6-145 | on | burns | steroids↑Na | | | mEq/L | | | + | | | | \*Insuffici | \*CHF | | | | \*Peds:136- | ent | | \*Corticost | | | 145 | water | \*Excessive | eroids↑Na+ | | | mEq/L | intake | fluid loss | | | | | | (diarrhea, | \*Calcium↑N | | | \*Neo:133-1 | \*Conn's | vomiting, | a+ | | | 42 | syndrome | sweating0 | | | | mEq/L | | | \*Fluorides | | | | \*Primary | \*Excessive | ↑Na+ | | | \*Preme:132 | aldosteroni | IV | | | | -140 | sm | induction | \*Iron↑Na+ | | | mEq/L | | of | | | | | \*Coma | nonelectrol | \*Heparin↓N | | | | | yte | a+ | | | | \*Cushing's | fluids | | | | | disease | | \*Laxatives | | | | | \*Addison's | ↓Na+ | | | | \*Diabetes | disease | | | | | insipidus | | \*Sulfates↓ | | | | | \*Severe | Na+ | | | | \*Tracheobr | nephritis | | | | | onchitis | | \*Diuretics | | | | | \*Pyloric | ↓Na+ | | | | | obstruction | | | | | | | \*High | | | | | \*Malabsorp | tryglycerid | | | | | tion | es | | | | | syndrome | false↓Na+ | | | | | | | | | | | \*Diabetic | \*Low | | | | | acidosis | protein | | | | | | false↓Na+ | | | | | \*Diuretic | | | | | | | | | | | | \*Edema | | | | | | | | | | | | \*Water | | | | | | intoxicatio | | | | | | n | | | | | | | | | | | | \*Stomach | | | | | | suction w/ | | | | | | water or | | | | | | ice chips | | | | | | | | | | | | \*Hypothyro | | | | | | idism | | | | | | | | | | | | \*Excessive | | | | | | ADH | | | | | | production | | +-------------+-------------+-------------+-------------+-------------+ | Mg₂+ | \*Adults:1. | \*Renal | \*Hypercalc | \*Prolonged | | | 8-2.6 | failure | emia | salicylate | | | mg/dL or | | | therapy, | | | 0.74-1.07 | \*Reduced | \*Diabetic | false↑Mg₂+ | | | mmp;/L | renal | acidosis | | | | | function | | \*lithium, | | | \*Children: | | \*Hemodialy | false↑Mg₂+ | | | 1.7-2.1 | \*Hypothyro | sis | | | | mg/dL or | idism | | \*Magnesium | | | 0.70-0.86 | | \*Chronic | products, | | | mmol/L | \*Addison's | renal | false ↑Mg₂+ | | | | disease | disease | | | | \*Neo:1.5-2 | | | \*Calcium | | |.2 | \*Adrenalec | \*Chronic | gluconate, | | | mg/dL or | tomy | pancreatiti | false ↓Mg₂+ | | | 0.62-0.91 | | s | | | | mmol/L | \*Diabetic | | \*Hemolysis | | | | acidosis | \*Hyperaldo | will | | | | | steronism | invalidate | | | | \*Use of | | results | | | | antacids | \*Pregnancy | | | | | containing | | | | | | magnesium | \*Hypoparat | | | | | | hyroidism | | | | | \*Administr | | | | | | ation | \*Excessive | | | | | of | loss of | | | | | magnesium | body fluids | | | | | salts | (sweating, | | | | | | lactation, | | | | | \*Oliguria | vomiting, | | | | | | diarrhea, | | | | | | diuretic | | | | | | abuse) | | | | | | | | | | | | \*Malabsorp | | | | | | tion | | | | | | syndromes | | | | | | | | | | | | \*Chronic | | | | | | alcoholism | | | | | | | | | | | | \*Long-term | | | | | | hyperalimen | | | | | | tation | | | | | | | | | | | | \*SIADH | | +-------------+-------------+-------------+-------------+-------------+ | P | \*Adults:2. | \*Renal | \*Hyperpara | \*Hemolysis | | | 7-4.5 | insufficien | thyroidism | false ↑P | | | mg/dL or | cy | | | | | 0.87-1.45 | | \*Rickets | \*Drugs can | | | mmol/L | \*Severe | | cause ↓P | | | | nephritis\* | \*Diabetic | | | | \*Peds:4.5- | Renal | coma | \*Laxatives | | | 5.5 | failure | | w/ large | | | mg/dL or | | \*Hyperinsu | amounts of | | | 1.45-1.78 | \*Hypoparat | linism | sodium | | | mmol/L | hyroidism | | phosphate | | | | | \*Continuou | ↑P | | | \*Neo:4.5-9 | \*Hypocalce | s | | | |.0 | mia | administrat | \*Seasonal | | | mg/dL or | | ion | variations | | | 1.45-2.91 | \*Milk-alka | of IV | exist in P | | | mmol/L | li | glucose in | levels (max | | | | syndrome | nondiabetic | in | | | | | pt | May/June; | | | | \*Excessive | (phosphorus | min in | | | | vit D | fallows | winter) | | | | | glucose) | | | | | \*Fractures | | | | | | in healing | \*Liver | | | | | stage | disease | | | | | | | | | | | \*Bone | \*Acute | | | | | tumors | alcoholism | | | | | | | | | | | \*Addison's | \*Vomiting | | | | | disease | & severe | | | | | | diarrhea | | | | | \*Acromegal | | | | | | y | \*Severe | | | | | | malnutritio | | | | | \*Liver | n | | | | | disease | & | | | | | | malabsorpti | | | | | \*Cirrhosis | on | | | | | | | | | | | \*Cardiac | \*Gram-nega | | | | | resuscitati | tive | | | | | on | septicemia | | | | | | | | | | | | \*Prolonged | | | | | | hypothermia | | | | | | | | | | | | \*Respirato | | | | | | ry | | | | | | alkalosis | | | | | | due to | | | | | | cellular | | | | | | use of P | | | | | | for an | | | | | | accelerated | | | | | | glucose | | | | | | metabolism | | +-------------+-------------+-------------+-------------+-------------+