Exam #2 PDF

Exam #2 - Hold the bones together, allow for Movement, and protects vital organs Chapter 40: assessment of Musculoskeletal Function - The movement also contributes to - Pg 1442-1456...

Exam #2 - Hold the bones together, allow for Movement, and protects vital organs Chapter 40: assessment of Musculoskeletal Function - The movement also contributes to - Pg 1442-1456 maintaining body temperature and the return Structure and function of the skeletal system of deoxygenated blood to the heart Types of bones Structure and function of the skeletal muscle system Long bones: shaped like rods and are for Atrophy weight bearing - decrease in the size of a muscle - Femur - Age and disuse cause loss of muscular Short bones: cancellous bone covered by a function as fibrotic tissue replaces the layer of compact bone contractile muscle tissue. - Metacarpals - Bed rest and immobility cause loss of Flat bones: site of hematopoiesis muscle mass and strength. - Sternum Hypertrophy Irregular bones: unique shapes - Enlargement of muscles - Vertebrae - repeatedly develops maximum or close to Types of bone cells maximum tension over a long time, as in Osteoblasts: secret bone matrix regular exercise with weights, the Osteocyte: mature bone cell that help with cross-sectional area of the muscle bone maintenance increases. Osteoclasts: multicellular cell involved in - results from an increase in the size of dissolving and reabsorbing bone individual muscle fibers without an increase What does bone marrow do? in their number. - Produced RBC, WBC and platelets to the Isometric contraction body - the length of the muscles remains constant Bone Formation but the force generated by the muscles is Osteogenesis: bone formation increased Ossification: how the bone matrix is formed - an example of this is pushing against an - is formed and hard mineral crystals immovable wall composed of calcium and Isotonic contraction phosphorus (e.g., hydroxyapatite) - shortening of the muscle with no increase in are bound to the collagen fibers. tension within the muscle The mineral components of the - An example of this is flexing the forearm. bone give it its characteristic - many muscle movements are a combination of strength, whereas the isometric and isotonic contraction. proteinaceous collagen gives bone Terminology related to muscle tone its resilience. - Flaccid: limp without tone Bone maintenance - Spastic: greater then normal tone Remodeling: maintains bone structure and - Atonic: soft and flabby function Gerontologic considerations - Done through simultaneous Bones reabsorption and osteogenesis Structural changes Reabsorption: removal and destruction of - gradual , progressive loss of bone tissue mass after 30 years of age The process of bone healing - Vertebrae collapse; decreased 1. Hematoma formation osteoblastic activity (reduced 2. Inflammatory phase production of new bone) 3. Reparative phase functional changes 4. Remodeling - Bone fragile and prone to fracture: Structure and function of the articular system vertebrae, hip, wrist What is the function of joint is the articular system History findings  - Loss of height, posture changes, Altered sensation kyphosis, loss of flexibility, flexion - Frequently sensory disturbances of hips and knee, back pain, associated with musculoskeletal osteoporosis, fracture problems Muscles Paresthesias: burning, tingling, and Structural changes numbness - Increase in collagen and resultant - May be caused by pressure on fibrosis nerve or circulatory impairment - Muscles diminish in size (atrophy); - The nurses should ask if the patient wasting is experiencing any altered - Tendons less elastic sensations functional changes Physical assessment - Loss of strength and flexibility Arms - Weakness, fatigue, stumbling, and Hands falls Fingers History findings Posture: normal curvature of the spin is - Loss of strength, diminished agility, convex through the thoracic portion and decreased endurance, prolonged concave through the cervical and lumbar response time (diminished reaction portions time), diminished tone, wide based - Kyphosis: increase forward gait, history of falls curvature of thoracic spine hunched Joints over walk Structural changes - Lordosis: exaggerated curvature of - Cartilage shows progressive the lumbar spine, hunched back deterioration - Scoliosis: lateral curving deviation - Thinning of intervertebral discs of the spine, tilted functional changes Gait: have patient walk away from the - Stiffness, reduced flexibility and examiner for a short distance to makes sure pain interfere with activities of daily its smooth History findings - Assessing the rhythm and - Diminished range of motion, smoothness of ambulation stiffness, and loss of height - Stroke: spastic hemiporesis gait, Ligaments limp Structural changes - Lower motor neuron disease: - Lax ligaments )less than normal steppage gait strength; weakness) - Parkinson's disease: shuffling gait functional changes Bone integrity: compare sides of the body - Postural joint abnormality and - Abnormal angulation of long bone, weakness motion at points other than joints, History findings and crepitus - Joint pain on motions; resolves with Joint function: ROM, deformity, stability and rest, crepitus, joint nodular formation, color changes, skin swelling/enlargements, integrity, and injury osteoarthritis - Contracture, effusion and crepitus Assessment Muscle strength and size: muscular strength, - Maily asses in to make sure they can coordination, size of muscle and ability to perform ADL’s change positions Health history - Assessing muscle strength with Pain and without resistance - Bone: dull, deep ache - Compare both sides, both sides - muscle : soreness and aching should be equal bilaterally - Fracture: sharp and piercing - Clonus and fasciculation  - 0 = no strength, no contraction Diagnostic evaluation - 1 = trace strength, palpable - Because patient often experience a lot of contraction only anxiety before diagnostic test as well as - 2 = poor strength, moves joints after the teat waiting for results it is without gravity important to a nurse to explains what os - 3 = fair strength, moves joints going to be done, why it's being done, and against gravity what the patient can expect to experience in - 4 = good strength, moves against order to help the patient manage their gravity and resistance anxiety - 5 = normal strength XR studies: X Rays look at the bone density, Skin: observe the skin texture, and erosion - Edema, temp, color, cuts, bruises, CT: show in detail a specific plain of involved Neurovascular status: neurovascular bone and can reveal tumors of the soft assessment tissue or injuries to the ligaments or tendons - Checking the nerves (assessing MRI: magnetic resonance imaging (MRI) is a sensation or how something feels), noninvasive imaging technique that uses musculoskeletal assessment magnetic field and radio waves and (assessing motion and look for computers to demonstrate abnormalities of weakness), and blood flow soft tissue (tumors) , muscle, tendon, (vascular, looking for color temp , cartilage, nerve, and fat low blood perfusion, and capillary - Make sure patient doesn't have any refill) metal implants - Tissue and nerve changes Arthrography: a radiopaque contrast agent is Indicators of peripheral neurovascular dysfunction injected into the joint cavity to outline soft Peroneal nerve tissue structures and the contour of the joint. - Stimulate the skin midway between The joint is put through it ROM to distribute the great and second toes to contrast then and MRI is obtained - Ask the patient to dorsiflex the foot - uses contrast to see leaks in joint and extend the toes capsules Tibial nerve Chapter 51: Assessment of integumentary function - - Stimulate the medial and lateral Pg 1442-1456 surface of the sole - Ask the patient to plantar flex toes General anatomy and foot Epidermis Radial nerve - Continuously divides - Stimulate the skin midway between - There's a completely new layer the thumb and second finger every 3-4 weeks - Ask the patient to stretch out the Dermis thumb, then the wrist, and then the - Provides strength and structure fingers at the metacarpals - Eher cellulitis and infection occurs Ulnar nerve Hypodermis - Stimulate the distal fat pad of the - Mostly adipose makes up the small finger cushion between skin and bone - Ask the patient to abduct - Where cellulite occurs Median nerve Function of the skin - Stimulate the top or distal surface Protection of the index finger - against invasion by aqueous, - Ask the patient to touch the little chemical, and mechanical assault; finger. Also observe whether the and bacterial and viral pathogens patient can flex the wrist as well as ultraviolet rays - when caring for a patient with musculoskeletal injury - Protects from microbes and they requires a lot of physical and psychological prep chemicals  - thickened skin of the palms and - Decreased protection and soles protects against the effects cushioning of underlying tissues of the constant trauma that occurs and organs, decreased muscle tone, in these areas. and loss of the insulating properties Sensation of fat. - sense temperature, pain, light touch, Cellular replacement slows as a result of and pressure (or heavy touch).using aging, and there is thinning of the dermal nerve endings layers. Fluid balance - Skin becomes fragile and - has the capacity to absorb water, transparent. thereby preventing an excessive The blood supply to the skin also changes loss of water and electrolytes from with age. Vessels, especially the capillary the internal body and retaining loops, decrease in number and size. moisture in the subcutaneous - Vascular changes are associated tissues with delayed wound healing. - has the capacity to absorb water, Sweat and sebaceous glands decrease in thereby preventing an excessive number and functional capacity. loss of water and electrolytes from - Dry and scaly skin the internal body and retaining Reduced hormonal levels of androgens moisture in the subcutaneous - Associated with declining tissues sebaceous gland function Thermoregulation Hair growth gradually diminishes, especially - Evaporation in the from of sweat over the lower legs and dorsum of the feet. from the skin aids heat loss by Thinning is common in the scalp, axilla, and conduction pubic areas. Vitamin synthesis - Decreased hair growth, hair loss - Skin exposed to ultraviolet light can Photoaging (damage from excessive sun convert substances necessary for exposure) synthesizing vitamin D - Profound wrinkling; increased loss (cholecalciferol) of elasticity; mottled, pigmented Immune response function areas; cutaneous atrophy; and - Recent research has confirmed a benign or malignant lesions definite action of Langerhans cells The beginning changes in elderly skin (specialized cells in the skin) in Cherry angiomas (bright red moles) facilitating the uptake of Diminished hair especially on scalp and IgE-associated allergens. pubic area Gerontologic considerations Dyschromias (color variations) Thinning at the junction of the dermis and - Solar lentigo (liver spots) epidermis result in fewer anchoring sites - Melasma (dark discoloration of the between the two skin layers, which means skin) that even minor injury or stress to the - Lentigines (freckles) epidermis can cause it to shear away from Neurodermatitis (itchy spots) the dermis. Seborrheic keratoses (crusty brown - Increased vulnerability of aged skin “stuck-on” patches) to trauma Spider angiomas (network of dilated The epidermis and dermis are thin and capillaries radiating from a central arteriole) flatten. Telangiectasias (red marks on skin caused - Wrinkles, sags, and overlapping skin by stretching of the superficial blood vessel) folds Wrinkles (a small fold, ridge, or crease in the Loss of the subcutaneous tissue substances skin) of elastin, collagen, and fat Xerosis (dryness)  Xanthelasma (yellowish waxy deposits on - Dusky blue upper and lower eyelids) - Dark but dull, lifeless; only severe Ichthyosis (fish scale appearance of the cyanosis is apparent in skin skin) (observe conjunctivae, oral mucosa, - nurses should stay mindful abbott wearing nail beds) sunscreen, hydration, and overall hygiene Central: chronic heart and lung disease Integumentary assessment cause arterial desaturation Health history questions a nurse should ask - Bluish Discoloration of skin, about the skin mucous membranes and nail beds - Any family and personal history of skin Peripheral: exposure to cold, anxiety allergies; allergic reactions to food, - Nail bed dusky medications, and chemicals; previous skin Ecchymosis problems; and skin cancer. Blood leaking into the skin and appears as - The names of cosmetics, soaps, shampoos, varied discoloration and other personal hygiene products are - Bruise obtained if there have been any recent skin Erythema problems noticed Hyperemia: increased blood flow through - The names of cosmetics, soaps, shampoos, arterial vessels and seen in inflammation and other personal hygiene products are and fever obtained if there have been any recent skin - Red, bright pink problems noticed - May be difficult to see in [patients Gloves should be worn while assessing a with darker skin tone patient's skin if a rash or lesion needs to be - Purplish tinge, but difficult to see palpated because epidermal melanin may Physical assessment alter disease presentation by Skin color (pallor) maskeen erythema (palpate for Anemia: Decreased hematocrit / Shock: increased warmth with Decreased perfusion, vasoconstriction inflammation, taut skin, and - Generalized pallor hardening of deep tissue) - Brow skin appears yellow-brown, Polycythemia: increased red blood cells, dull; black skin appears ashen gray, capillary stasis dull) - Ruddy blue in face, oral mucosa, - Observe area with less conjunctivae, hands and feet pigmentation: conjunctiva, mucosa, - Well concealed by pigment membranes (observe for redness in lips) Local arterial insufficiency Carbon monoxide poisoning - Marked localized pallor (lower - Bright, cherry red in face and upper extremities, especially when torso elevated) - Cherry red nail beds, lips, and oral - Ashen gray, dull; cool to palpation mucosa Albinism: total absence of pigment melanin Stasis dermatitis (venous stasis) is poor - Whitish pink venous return in the lower extremities - Tan, cream, white causing hemosiderin staining and cracking vitiligo :a condition characterized by of the skin (skin breakdown) that causes destruction of the melanocytes in stasis ulcers or venous ulcers. circumscribed areas of the skin (may be - Brown or rusty discoloration of the localized or widespread) skin resulting from a buildup of - Patchy, milky white spots, often hemosiderin (iron-containing symmetric bilaterally pigment derived from the Cyanosis breakdown of hemoglobin) in the Increased amount of unoxygenated interstitial fluid hemoglobin  - More difficult to detect signs of - Macule: less than 1 cm, venous insufficiency such as circumscribed border hemosiderin staining (reddish, - Patch: greater than 1 cm, may have brown color) irregular Venous disease Papule / Plaque: Elevated, palpable, solid - Edema, hyperpigmentation mass with a circumscribed border surrounding the skin (reddish or - Plaque may be coalesced papules brown due to hemosiderin), warmth with flat top at feet with palpable pulses - Papule: less than 0.5 cm (exception if no coexisting arterial - Plaque: greater than 0.5 cm disease) Nodule / Tumor: Elevated, palpable, solid Jaundice mass that extends deeper into the dermis Increased serum bilirubin concentration than a papule (>2.5–3 mg/dL) due to liver dysfunction or - Nodule: 0.5–2 cm; circumscribed hemolysis, as after severe burns or some - Tumor: greater than 1–2 cm; infections tumors do not always have sharp - Yellow first in sclerae, hard palate, borders and mucous membranes; then over Vesicle / Bulla: Circumscribed, elevated, skin palpable mass containing serous fluid - Check sclerae for yellow near - Vesicle: less than 0.5 cm limbus; do not mistake normal - Bulla: greater than 0.5 cm yellowish fatty deposits in the Wheal: Elevated mass with transient borders; periphery under eyelids for often irregular; size and color vary jaundice. (Jaundice is best noted at Pustule: Pus-filled vesicle or bulla junction of hard and soft palate, on Cyst: Encapsulated fluid-filled or semisolid palms) mass in the subcutaneous tissue or dermis - Starts in the whites of the eyes then Ulcer: Skin loss or damage at or extending moves to the trunk then to the past the epidermis. May include necrotic extremities tissue development, bleeding or scarring Carotenemia: Increased level of serum - Skin lesions are described clearly and in detail on the carotene from ingestion of large amounts of patients health record, using precise terminology; carotene-rich foods color of the lesion, any redness/heat/pain/swelling, - Yellow-orange tinge in forehead, size/location of the involved area, patterns of eruption palms and soles, and nasolabial (macular papular, scaling,oozing,discrete,confluent), folds, but no yellowing in sclerae or and distribution of the lesion mucous membranes (bilateral,symmetric,linear, circular) - Yellow-orange tinge in palms and - skin moisture, temperature, and texture are assessed soles primarily by palpation Uremia: Kidney failure causes retained - skin turgor is assessed by palpation, decrease in urochrome pigments in the blood skin turgor is caused by lack of hydration and loss of - Orange-green or gray overlying skin elasticity pallor of anemia; may also have - edema is assessed by palpation, and is caused ecchymoses and purpura venous diseases - Easily masked. (Rely on laboratory - petechiae are small lesions that are red and purple in and clinical findings) color - Pruritus is another way to say itching Nails: observation of configuration, color, and Assessing skin lesions consistency Types of skin lesions - Beau lines: stunted growth of nail Macule / Patch: Flat, non palpable skin color matrix because of illness or trauma change (color may be brown, white, tan, - Paronychia: inflammation of the purple, red) skin around the nail - Clubbing  Hair: inspection and palpation - ⅓ of the body = extracellular space - Hair loss (ECF) - Hirsutism ( excessive hair growth ) - Sodium ions outnumber the other Diagnostic evaluation cations in the ECF, sodium is Skin biopsy: obtaining tissue for microscopic important in regulating the volume examination of body fluids Patch testing: applying suspected allergens - retention of sodium is associated to normal skin to see if allergic reaction with fluid retention (bloating), and develops conversely excessive loss of Skin scraping: tissue sample are scraped sodium is usually associated with from suspected fungal lesions and examined decreased volume of body fluid microscopically - Extracellular fluid divided into Clinical photographs: Photographs are taken - intravascular space = contains to document the nature and extent of the plasma skin condition and are used to determine - interstitial space = fluid between progress or improvement resulting from cells, tissues, and organs ( treatment measuring interstitial electrolytes levels directly is no commonly done Chapter 4: Fluid and Electrolyte - Pg 54-86, 91-95 in clinical practices - transcellular space = cerebrospinal Fluid and electrolyte balance are dependent fluid, pericardial fluid, and pleural on dynamic process that are crucial for life fluid and homeostasis Third Spacing Approximately 60% of a typical adults weight - When we lose ECF and it goes into consist of fluid (water and electrolytes) space that does not contribute to - Age impacts amount of water in the balance or create equilibrium body, as atrophy increases water between the ICF and ECF, this is decreases called third spacing or interstitial - Men have more water in their body fluid shift than women - Fluid moves from the blood to - Fat doesn't hold fluid places where it can easily move Cellular spacing back - Body fluid is in two compartments - this can be due to traumas Intracellular space (ICS) - can result in people looking puffy - Fluid inside the cells or pregnant, decreased blood - ⅔ of the body fluid = intracellular pressure, increased heart rate, fluid (ICF) increase respiration rate, edema, - Mostly in the skeletal muscle mass decreased urine output, increase in - The major electrolytes in the ICF are body weight, and rapid weight gain potassium and phosphate, the ECF - Space that does not contribute to has low concentration of potassium equilibrium between the ICF and and can only tolerant small changes ECF in potassium concentration - Loss of ECF into a space that does - any condition that causes the not contribute to equilibrium release of large stores of between the ICF and the ECF is intracellular potassium is extremely referred to as an interstitial fluid dangerous, thes can be things l9ke shift, or third-spacing. crushing injuries and types of - Results in decreased urine output diuretics and can result in heart - Urine output decreases because arrhythmias fluid shifts out of the IVS; kidneys Extracellular space (ECS) then receive less blood and attempt - Fluid outside the cells  to compensate by decreasing urine - Total anions = 200 output Important electrolyte and imbalances Electrolytes BUN Electrolytes in body fluids are active Normal range: 10-20 mg/dL chemical (cations that carry positive charges Definition: part of basic metabolic panel and anions that carry negative charges) made up of urea - Maintain homeostasis and are Factors that increase levels needed for body functioning - Kidney function Major cations - GI bleeding Sodium (Na+) - Dehydration Potassium (K+) - Increased protein intake Calcium (Ca+2) - Fever Magnesium (Mg+2) - Sepsis Hydrogen (H+) Factors that decrease Major ions - End stage liver disease Chloride (Cl-) - Low protein diet Bicarbonate (HCO-3) - Starvation Phosphate (PO4 3-) - SIADH Sulfate (SO4 2-) - Andy condition that increased fluid Proteinate ions volume - sodium is the primary ion extracellular fluid Creatine - potassium is the primary cation in the intracellular Normal range: ).6 -1.4 mg/dL fluid Definition: increases when kidney function Although all body fluid contains equal decreases amount of cations and anions, the electrolyte Factors that increase levels concentrations in the ICF are markedly - Levels increase when kidney different from those in the ECF function decreased Electrolytes of the extracellular fluid (plasma) Factors that decrease Cations Urine Specific Gravity - Sodium (Na) = 142 mEq/L Normal range: 1.010 -1.025 - Potassium (K) = 5 Definition: measure the kidney ability to - Calcium (Ca +2) = 5 excrete or conserve water - Magnesium (Mg +2) = 2 - Comp to specific gravity of H2) = - Total cations = 154 1.000 Anions Factors that increase levels - Chloride (Cl-) = 103 - Urine levels - Bicarbonate (HCO3-) = 26 Factors that decrease - Phosphate (PO4 3-) = 2 Level Hematocrit - Sulfate (SO4 2-) = 1 Normal range - Organic acids = 5 - W: 36 -48 % - Porteinate = 17 - M: 42 - 52% - Total anions = 154 Definition: measure volume % of RBC in Electrolytes of the Intracellular fluid whole blood Cations Factors that increase levels - Potassium (K+) = 150 - Dehydration - Magnesium (Mg+2) = 40 - Polycythemia - Sodium (Na+) = 10 Factors that decrease - Total cations = 200 - Overhydration Anions - Anemia - Phosphates and sulfate 150 urine sodium - Bicarbonate (HCO3-) = 10 Normal level: 40 -220 mEq every 24 hr - Proteinate = 40  Definition: used to assess volume status and - Occurs when the loss of ECF diagnosis of hyponatremia and acute kidney volume exceeds the intake fluid, failure water and electrolytes are lost in Fluid intake and output the same proportion Fluid intake: drinking, and IV - Loss of water and electrolytes, as in Fluid output: peeping, vomition vomiting, diarrhea, fistulas, fever, Insensible water loss: the amount of water excess sweating, burns, blood loss, lost from the body each day that is not easily gastrointestinal suction, and measured or perceived third-space fluid shifts; and Osmolality decreased intake, as in anorexia, When two different solutions are separated nausea, and inability to gain access by a membrane that is impermeable to the to fluid dissolved substance, fluid shifts through the - Diabetes insipidus and membrane from the region of low uncontrolled diabetes mellitus also concentration to the region of high solute contribute to a depletion of concentration until the solutions are equal extracellular fluid volume. concentrations - Acute weight loss (1 lb = 500 ml of - Osmosis: the movement of water caused by fluid in a short amount of time); a concentration gradient decreased skin turgor; oliguria ( Osmolality and osmolarity describes the decreased urine output, below 400 concentration of solutes or dissolved ml/day); concentrated urine; weak, particles rapid pulse; prolonged capillary - Osmolality: the concentration of fluid that filling time; low CVP; ↓ blood affects the movement of water , expressed pressure (less fluid = less pressure) as milliosmoles per kilogram (mOsm/kg) ; orthostatic hypotension; flattened - Osmolarity: concentration of solution, neck veins; dizziness; weakness; expressed as milliosmoles per L (mOsm/L), thirst and confusion; ↑ pulse; how IV meds are measured muscle cramps; sunken eyes - These impact the movement of particles into - Labs indicate: ↑ Hemoglobin and and out of cells hematocrit, ↑ serum and urine - Tonicity: the ability of the solutes to cause osmolality and specific gravity, ↑ water movement from one compartment to BUN out of proportion to serum another creatinine Sodium potassium pump: is another way of Fluid volume excess (FVE) (hypervolemia) keeping balance - Isotonic expansion of ECF due to - It's located in the cell membrane retention of water and sodium, and actively moves sodium from excess water and electrolytes same the cell into the ECF. The higher proportion in ECF intracellular potassium - Compromised regulatory concentration is maintained by mechanisms, such as kidney failure pumping potassium into the cell. (kidney is supposed to get rid of Active transport is utilized because extra fluid) , heart failure (blood is energy must be expended for the not moving), and cirrhosis; movement to occur against a overzealous administration of concentration gradient sodium-containing fluids; and fluid Gerontologic consideration shifts (i.e., treatment of burns). - Dehydration in the elderly is common as a Prolonged corticosteroid therapy, result of decreased reserve capacity of the severe stress, and kidney from the aging process, disease, and hyperaldosteronism augment fluid use of medications. volume excess. Major Fluid and Electrolyte imbalances - Acute weight gain, peripheral Fluid volume deficit (FVD) (hypovolemia) edema (extra fluid) and ascites (  3rd spacing in abdomen) , - Water deprivation in patients unable distended jugular veins, crackles, to drink at will; hypertonic tube and elevated CVP, shortness of feedings without adequate water breath, ↑ blood pressure, bounding supplements; diabetes insipidus; pulse and cough, ↑ respiratory rate heatstroke; hyperventilation; watery - Labs indicate: ↓ Hemoglobin and diarrhea; burns; and diaphoresis; hematocrit, ↓ serum and urine excess corticosteroid, sodium osmolality, ↓ urine specific gravity, bicarbonate, and sodium chloride decreased BUN (due to plasma administration; and salt water dilution). near-drowning victims. Sodium deficit (hyponatremia) Serum - Thirst, elevated body temperature, sodium potassium >5.0 mEq/L pulls fluid out of the cell - Often caused by iatrogenic ( treatment-induced) causes  - Less common than hypokalemia torsades de pointes (form of but more dangerous ventricular tachycardia) - Cardiac arrest is more frequently - Labs indicate: Serum calcium associated with high serum concentration is low; ionized serum potassium levels calcium concentration is also low; ↓ - Pseudohyperkalemia, oliguric Mg++ (inhibits PTH secretion) kidney failure, use of Calcium excess (hypercalcemia) Serum potassium-conserving diuretics in calcium >10.5 mg/dL patients with renal insufficiency, - Ninety percent of hypercalcemia metabolic acidosis, Addison cases are related to either disease, crush injury, burns, stored malignancy or hyperparathyroidism bank blood transfusions, and rapid - Hyperparathyroidism, malignant IV administration of potassium neoplastic disease, prolonged - Vague muscular weakness, immobilization, overuse of calcium tachycardia → bradycardia, supplements, vitamins A and D arrhythmias, flaccid paralysis, excess, oliguric phase of kidney paresthesias, intestinal colic failure, acidosis, thiazide diuretic - ECG: Tall tented T waves, prolonged use PR interval and QRS duration, - Muscular weakness, confusion, absent P waves, ST depression constipation, anorexia, nausea and Calcium deficit (hypocalcemia) Serum vomiting, polyuria and polydipsia, calcium 1,800/mL Patients with severe neutropenia are at - Hemoglobin: 14-18 for men and significantly increased risk for developing 12-16 g/dL for women opportunistic infections and sepsis which is - Hematocrit: 40-52% for men and an infection of the blood 37-47 % for women The most common sites of infection in - Platelets 150,000 - 400,000/mm3 neutropenic patients includes the respiratory The purpose of bone marrow aspiration and tract, GI and GU tracts, and the skin biopsy is to assess the underlying causes of Unable to manifest the classic signs of abnormal CBC infection due to compromised WBCs - Used in the diagnosis and - Signs of infection may be subtle -> classification of malignancies, presence of fever may be the only benign hematologic disorders, sign that the patient has an infections, storage disorders, and infection and should be addressed response to treatment immediately - Usually aspirated from the posterior - Inflammation and redness iliac crest - Cough, inflammation of nasal The education that should be provided passages, green sputum, and sore - Before: explain what the throat prod\cedure will feel like - Abdominal pain, Decreased bowel - During: talk them through their sounds, nausea, discomfort and work on deep - Confusion, disorientation, breathing headaches, and stiff neck - After: cover expectations and Patients are risk for bleeding results Thorough examination of bleeding history, Peripheral blood smear or PBS family history, laboratory test Drop of blood is spread on a glass slide, - The strongest predictor of bleeding stained, and examined under a microscope. risk is a history of bleeding Visualizes the shape and size of the Comprehensive physical examinations leukocytes, erythrocytes, and platelets