Exam 2 Study Guide PDF

Exam 2 Study Guide Exam 2 will cover the following material: Potter & Perry Chapter 42 (Fluid and Electrolytes), Ignatavicius Chapter 3 (Overview of Health Concepts for Medical-Surgical Nursing), and Lilley Chapters 22 and 54 (Antihypertensive and Anemia Drugs). VALUES TO KNOW! 1. Metabolic aci...

Exam 2 Study Guide Exam 2 will cover the following material: Potter & Perry Chapter 42 (Fluid and Electrolytes), Ignatavicius Chapter 3 (Overview of Health Concepts for Medical-Surgical Nursing), and Lilley Chapters 22 and 54 (Antihypertensive and Anemia Drugs). VALUES TO KNOW! 1. Metabolic acidosis- signs and symptoms a. Signs and symptoms Physical symptoms i. Kussmaul respirations ii. Decreased level of consciousness (fatigue, headache, confusion) iii. Abdominal pain (nausea & vomiting) iv. Abnormal heartbeat (caused by hypokalemia) v. Low BP b. Lab findings i. pH below 7.35 ii. HCO3 below 21 *Remember acidosis leads to a chain reaction: Acidosis stresses the body, dehydration worsens it, and low potassium disrupts the heart. Metabolic acidosis → dehydration (from fluid loss) Dehydration → hypokalemia (from potassium loss) Hypokalemia → arrhythmias (from disrupted heart signals)  a. Hyperchloremic acidosis: loss of HCO3 occurs in the GI i. Diarrhea, laxative abuse b. Renal tubular acidosis: kidneys unable to remove acids through urine acidification. c. Lactic AcidoSiS: sepsis (severe blood infection) & shock (REALLY low BP, resulting in low perfusion aka low oxygenation to the organs), cardiac arrest, trauma, seizures: lack of O2= anaerobic metabolism in cells and lactic acid accumulation. i. Compensation: rapid, deep respirations (Kussmaul respirations) d. Diabetic Acidosis: Type 1DM: glucose is not transported into cells because of the lack of insulin. 2. Be able to identify metabolic acidosis, respiratory acidosis, metabolic acidosis alkalosis and respiratory alkalosis. What are the causes and signs and symptoms of each. Which kind of conditions is each associated with? Conditions that can lead to metabolic acidosis, respiratory acidosis, metabolic acidosis alkalosis and respiratory alkalosis. a. Metabolic Alkalosis It's when the blood doesn't have a lot of acid, but instead there's too much bicarbonate (HCO3). When this happens the body compensates by slowing down breathing (to try to hold on to CO2) but that doesn't ‘fully’ fix it. Treatments include replacing lost fluids and adjusting meds. Imbalance and related causes a. Increase of bicarbonate i. Excessive administration of sodium bicarbonate ii. Massive blood transfusion iii. Mild or moderate ECV deficit b. Loss of metabolic acid i. Excessive vomiting ii. NGT Suction iii. Hypokalemia (k+ below 3.5) iv. Dehydration v. Excess aldosterone Signs & Symptoms a. Physical i. Lightheadedness ii. Numbness & tingling of fingers, toes, and circumoral region (area around your mouth) iii. Muscle cramps iv. Decreased level of consciousness v. Dysrhythmias b. Metabolic Acidosis It happens when the body produces too much acid. When the acid builds up it makes the blood acidic, the body then increases breathing (Kussmaul respirations- to try to get rid of extra CO2).  Imbalance and related causes i. Increase of metabolic acids 1. Ketoacidosis (diabetes, starvation, alcoholism) 2. Hypermetabolic state (burns, severe infection, hyperthyroidism) 3. Oliguric renal disease (acute kidney injury, renal failure) 4. Circulatory shock (lactic acidosis) 5. Ingestion of acid ii. Loss of bicarbonate 1. Diarrhea 2. Pancreatic fistula 3. Renal tubular acidosis Signs & symptoms a. Physical i. Decreased level of consciousness (lethargy, confusion, coma) ii. Abdominal pain iii. Dysrhythmias b. Lab i. pH below 7.35 ii. PaCO2 normal (uncompensated) below 35 (compensated) iii. HCO3 below 21 c. Respiratory Acidosis (low & slow RR) Cause: not breathing out enough CO2 Result: blood becomes acidic Bodies response: kidneys try to fix the balance, but its not instant *in respiratory acidosis decreased cerebral spinal fluid (CSF) pH and intracellular pH of the brain cause decreased level of consciousness Imbalance and related causes a. Impaired gas exchange 1. COPD/ asthma 2. Pneumonia 3. Airway obstruction 4. Atelectasis (collapsed lungs) ii. Impaired neuromuscular function 1. Respiratory muscle weakness 2. Paralysis from hypokalemia 3. Respiratory failure 4. Chest wall injury iii. Drugs: CNS depressants (they make the breathing slow) 1. Opioids 2. Sedatives 3. Anesthetics 4. Alcohol intoxication 5. Benzodiazepines (Diazepam)  Signs and symptoms a. Physical i. Headache ii. Light-headedness iii. Decreased level of consciousness (confusion, lethargy, coma) iv. Dysrhythmias b. Lab i. pH below 7.35 ii. PaCO2 above 45 iii. HCO3 normal (uncompensated) above 28 (compensated) d. Respiratory Alkalosis (fast RR) Cause: breathing out too much CO2 quickly Result: blood becomes too alkaline Body's response: kidneys try to balance it by releasing more bicarbonate BUT it is only effective in long lasting condition *When the pH of blood, CSF, and ICF increase suddenly, cell membrane excitability also increases which sends signals that can cause neurological symptoms such as excitement, confusion, and paresthesia. Imbalance and related causes i. Hypoxemia ii. Acute pain iii. Panic attack/anxiety iv. Nicotine overdose v. Sepsis vi. Meningitis 1. Increased metabolic states (fever, high altitudes) 2. Salicylate overdose (when someone takes too much salicylate- which is most commonly found in aspirin) Signs & symptoms a. Physical i. Light-headedness ii. Numbness and tingling of fingers, toes, circumoral region iii. Increased respirations iv. Dysrhythmias b. Lab i. pH above 7.45 ii. PaCO2 below 35 iii. HCO3 normal (uncompensated) below 21 (compensated) 3. Normal values of arterial blood gas (PH, Partial pressure of oxygen (PaO2) , Partial pressure of carbon dioxide (PaCO2). i. pH 7.35-7.45 ii. PaO2 80-100 mmhg iii. PaCO2 35-45 mmhg iv. HCO3 21-28  v. Respiratory Acidosis: pH< 7.35 + PaCO2 > 45 mmHg (Hyperventilation) vi. Respiratory Alkalosis: pH > 7.35 + PaCO2 < 35 mmHg (Hypoventilation) vii. Metabolic Acidosis: pH < 7.35 + HCO3 < 22 mEq/L (diarrhea) viii. Metabolic Alkalosis: pH > 7.35 + HCO3 > 26 mEq/L (vomiting + NGT suctioning) 1. ROME 4. Phlebitis vs infiltration and treatment for both a. Phlebitis- Inflammation of a vein, often caused by irritation from an intravenous potassium solutions, chemical, transient mechanical, infectious, and postinfusion causes Risk factors i. Acidic or hypertonic IV solutions ii. Rapid IV rates iii. IV drugs (KCl, vancomycin, penicillin) iv. VAD inserted in an are of flexion v. Poorly secured catheter vi. Poor hand hygiene vii. Lack of antiseptic techniques Symptoms 1. Redness 2. Swelling 3. Warmth 4. Pain along the vein. Treatment i. Stop infusion and discontinue IV ii. Start new IV line in other extremity OR proximal to previous IV site iii. Apply warm, moist compress OR contact IV therapy team iv. Elevate affected extremity v. Document phlebitis b. Infiltration- occurs when an IV catheter becomes dislodged or vein ruptures and IV fluids enter subcutaneous tissue around the puncture site (extravasation: technical term used when a tissue damaging drug -vesicant, ex. chemotherapy- enters tissues) Symptoms 1. Swelling 2. Coolness 3. Blanching of the area 4. Edematous (swollen with fluid)  Treatment i. Stop the infusion ii. Discontinue IV if there is no vesicant drug (if there is a vesicant drug then you have to aspirate the drug from the catheter & you may need to deliver antidote through catheter before you remove it) iii. Remove the catheter iv. Elevate affected extremity v. Avoid applying pressure over site vi. Contact DR vii. Apply warm, moist compress viii. Start new IV in other extremity 5. Normal lab value of potassium and treatment for hyperkalemia. Signs and symptoms of hyperkalemia. - Potassium lab value: 3.5-5.0 - Bananas + Potatoes are good sources of potassium - Check urine output before administering IV containing potassium Hyperkalemia interferes with electrical conduction, leading to heart block and ventricular fibrillation. Causes a. Increased potassium intake and absorption b. Excess ingestion of potassium salts c. Insufficient insulin d. Shift of potassium from cells into the ECF (cellular damage) e. Decreased potassium output (people who have oliguria are at high risk for hyperkalemia) f. Use of potassium sparing diuretics g. Adrenal insufficiency (deficit of aldosterone & cortisol) Signs & symptoms a. Muscle weakness b. Life threatening cardiac dysrhythmias c. Cardiac arrest d. Abdominal cramps e. Diarrhea  Treatment a. Administer calcium gluconate or calcium chloride intravenously i. Purpose: protect the heart by stabilizing myocardial cella and preventing arrhythmias b. Give insulin with glucose (IV) i. Purpose: insulin facilitates the movement of potassium from the extracellular space into the cells.Glucose is given to prevent hypoglycemia. c. Give sodium bicarbonate (IV) i. Given to drive potassium into cells d. Diuretics (loop or thiazide diuretics) i. Purpose: promotes potassium excretion through urine, especially in patients with adequate kidney function. e. Sodium polystyrene sulfonate (Kayexalate) i. Purpose: a cation exchange resin that binds potassium in the gastrointestinal tract and promotes its excretion through stool. f. Dialysis i. In cases of renal failure or life threatening hyperkalemia g. Restrict dietary potassium intake 6. Intracellular fluid vs extracellular fluid vs transcellular fluid a. Intracellular fluid: Inside the cells b. Extracellular fluid: Outside the cells Extracellular fluid makes up 1/3rd of total body weight and its divided into 2 major divisions (Intravascular and Interstitial fluid) and 1 minor division (Transcellular fluids) i. Intravascular Fluid: the liquid part of the blood: PLASMA ii. Transcellular fluid: fluid secreted by epithelial cells: cerebrospinal, pleural, peritoneal, and synovial fluids 7. Nursing interventions for blood transfusion reactions a. Febrile non hemolytic reaction Signs and symptoms i. Temperature increases by more than 2% ii. Chills iii. Headache iv. Vomiting Interventions 1. Stop transfusion 2. Administer 0.9sodium chloride through IV 3. Administer antipyretics and antihistamines b. Acute hemolytic transfusion reaction Signs and symptoms i. Fever ii. Chills iii. Tachycardia iv. Hypotension v. Abdominal pain vi. Chest pain vii. Back pain viii. Flank pain ix. Dyspnea x. Shock Interventions i. Stop transfusion ii. Get help immediately iii. Administer 0.9% sodium chloride iv. Notify dr and blood bank v. Treat shock vi. Maintain BP and renal perfusion vii. Insert foley catheter viii. Monitor I&O hourly ix. Obtain blood and urine samples to send to lab immediately c. Allergic reaction Signs and symptoms i. Urticaria ii. Pruritus iii. Facial flushing iv. Mild wheezing Interventions i. Stop transfusion ii. Administer 0.9% sodium chloride iii. Notify dr and blood bank iv. Administer antihistamines v. Monitor vital signs every 15 minutes d. Severe allergic reaction Signs and symptoms i. Hypotension ii. Tachycardia iii. Urticaria iv. Bronchospasm v. Anxiety/Shock vi. Nausea/Vomiting vii. Diarrhea viii. Abdominal pain  Interventions i. Stop transfusion ii. Administer 0.9% sodium chloride iii. Notify dr and blood bank iv. Administer antihistamines, corticosteroids, epinephrine, and antipyretic v. Monitor vital sign vi. Initiate CPR if necessary e. Transfusion related acute lung injury (TRALI) Signs and symptoms a. Fever b. Respiratory failure c. Hypoxemia d. Hypotension e. Pulmonary edema Interventions a. Stop transfusion b. Provide respiratory support (oxygen) c. Administer vasopressor agents (dopamine, norepinephrine, epinephrine, phenylephrine) f. Transfusion associated circulatory overload (TACO) Signs and symptoms a. Dyspnea b. Cyanosis c. Tachycardia d. Orthopnea e. Jugular vein distention f. Hypertension g. Cough Interventions a. Stop transfusion b. Place patient in high fowlers c. Notify dr d. Administer oxygen e. Administer diuretics 8. Conditions associated with chronic diarrhea Diarrhea can result - Malabsorption disorders a. Celiac disease (reaction to gluten) b. Lactose intolerant (inability to digest lactose) - Infections a. C-diff  - Inflammatory bowel disease - Crohn’s disease - Ulcerative colitis - Functional disorders - Irritable bowel syndrome - Medications - Antibiotics - Laxatives - Chemotherapy - Endocrine disorders - Hyperthyroidism (increased metabolism causes diarrhea) - Addison's disease (adrenal insufficiency affects fluid balance) - Dehydration - Fluid/ electrolyte imbalance i. Sodium: vital for maintaining blood pressure, fluid balance, and nerve function ii. Potassium: important for heart function and muscle contractions iii. Chloride: helps maintain fluid balance and acid-base balance iv. Magnesium: supports muscle and nerve function, as well as energy production v. Bicarbonate: helps maintain the body’s pH balance - Leading to hypokalemia, hyponatremia (low sodium), acid-base imbalance (metabolic acidosis), hypomagnesemia, and muscle weakness and fatigue. - Possibly causing cardiac dysrhythmias, organ failure, coma or even death 9. Febrile nonhemolytic reaction, what is it, nursing interventions, and drugs to treat Febrile non hemolytic reaction It's the most common type of transfusion reaction caused by WBC antigen-antibody reaction. It occurs when the recipient's immune system reacts to white blood cells, cytokines or platelet antigens in the transfused blood. It is typically non-life threatening but can cause discomfort and anxiety. It may begin early in the transfusion or hours after the transfusion is completed. Premedicate as ordered with antipyretic if prior history to reaction. Use leukocyte reduced blood blood products. Signs and symptoms v. Temperature increases by more than 2% vi. Chills vii. Headache viii. Vomiting Interventions i. Stop transfusion ii. Administer 0.9sodium chloride through IV iii. Administer medications  Medications a. Antipyretics i. Acetaminophen (to reduce fever) b. Antihistamines (for allergy reaction) 1. Diphenhydramine (for discomfort) 10. Education regarding iron supplements a. Take with vitamin C or citrus juices to enhance absorption b. Avoid taking with milk, caffeine, or antacid (it will interfere with absorption) c. Best absorbed on an empty stomach d. Expect stool to turn dark/green color e. Take stool softeners as needed for constipation f. Symptoms like nausea, vomiting, diarrhea, constipation will be temporary g. Have regular blood test to monitor levels and avoid excessive iron intake h. Stay well hydrated 11. What foods contain folate? a. Dried beans (lentils, beans) b. Nuts and seeds c. Whole grains (bread, cereals) d. Liver & other organ meats e. Peas f. Oranges (citrus fruits/juices) g. Green vegetables (spinach, romaine lettuce) 12. Pernicious anemia vs Sickle cell anemia vs Megaloblastic anemia a. Pernicious anemia: the stomach cannot absorb B-12 i. Glossitis: inflamed red smooth tongue ii. Extreme weakness iii. Jaundice iv. Treatments: B12 injections (IM or IV) not PO! Injections can be lifelong duration b. Sickle cell anemia: INHERITED disorder to have a distorted shape with a lifespan of less than 3 weeks. They clot a lot which leads to ischemia in certain parts of the body that are not receiving adequate oxygen through RBCs. Associated with hypovolemic shock (aka severely low BP) i. Signs/Symptom: 1. One sided arm weakness = aka stroke 2. Swelling of the feet and hands (dactylitis) 3. Most pxs have small spleens so reporting an enlarged SPLEEN and LOW BP is crucial  ii.Treatments: 1. Hydration: IV fluids 2. Bedrest 3. Pain control: 4. PCA: patient control analgesia pump 5. Call HCP for higher doses c. Megaloblastic anemia: abnormally large, immature red blood cells in the bone marrow. i. Caused by deficiency of vitamin B12 or folate, which are essential for DNA synthesis and proper RBC maturation. 1. Folate deficiency is often seen with MALNUTRITION, ALCOHOLISM, or increased demands like pregnancy. ii. Symptoms: fatigue, SOB, pale skin, smooth tongue, numbness/tingling, and diarrhea, iii. Treatment: vitamin replacement is crucial to prevent potentially irreversible neurological damage. Root Causes: Pernicious anemia and megaloblastic anemia share a Vitamin B12 deficiency component, while sickle cell anemia is purely genetic. Symptoms: Sickle cell anemia involves pain crises and organ damage, distinct from the fatigue and neurological symptoms of the other two. Management: Sickle cell anemia often involves more systemic treatment (e.g., hydroxyurea), whereas the others focus on supplementing the missing nutrient. 13. NSAIDS and anemia, side effects of NSAIDS a. NSAIDs can contribute to anemia by causing GI bleeding and iron deficiency. b. NSAIDs increase the risk of peptic ulcers and gastritis, which can lead to chronic blood loss from the GI tract. c. Additionally, they can directly irritate the stomach lining, causing microscopic bleeding and gradual iron loss. d. Side effects: i. Gastric irritation (gastritis + gastric ulcers) ii. Decrease renal blood flow 14. Side effects of anticoagulants a. Bleeding (MOST SIGNIFICANT RISK): anticoagulants increase the chance of bleeding from any site. i. Signs: bruising, nosebleeds, bleeding gums, heavy menstrual flow, and blood in urine or stool b. Hematoma formation: increase the risk of hematoma @ injection sites c. Thrombocytopenia: a drop in platelet count can occur, especially with heparin (HIT- heparin induced thrombocytopenia) d. Hypersensitivity reactions: some patients may experience allergic reactions like RASH, ITCHING OR ANAPHYLAXIS 15. Excessive clotting vs Diminished clotting a. Increased clotting: Venous thrombosis i. Increased risk for clotting ii. Venous thrombosis (redness, pain, swelling, warmth) iii. Arterial thrombosis (not observable, but marked by decreased perfusion to distal extremity or internal organ) iv. Critical rescue b. Decreased clotting: Prolonged internal or external bleeding i. Decreased clotting ii. Bruising iii. Petechiae iv. Occult or frank blood in urine and/or stool v. Frank bleeding from gums/nose 16. Carbonic acid a. CO2 retention: excessive buildup of CO2 combines with water to produce carbonic acid, decrease blood pH and respiratory acidosis 17. What is the nervous system responsible for a. “for post operative pain control, basal continuous dose of patient-controlled analgesia” b. “This means providing a steady, low-level amount of pain medication through a pump (called patient controlled analgesia or PCA) that the patient can use to give themselves extra doses if needed. The “basal continuous dose” is the automatic, constant flow of pain medication to keep pain under control, even when the patient isn’t pressing the button for an extra dose” 18. Side effects of opioids a. CNS: i. Respiratory depression(most concerning) ii. Sedation iii. Dizziness iv. confusion b. GI: i. Constipation(most common) ii. N/V iii. delayed gastric emptying c. Others: i. Pruritus (itching) ii. urinary retention, flushing, hypotension, and addiction 19. Pain control for post op patients a. After surgery or a traumatic event, acute pain must be well controlled to prevent persistent/chronic pain that may last for months or years. - Drug therapy for persistent pain must be taken on a continuous regimen basis for the best control. (PCA pumps) b. Pharmacologic interventions include a variety of analgesics and are determined on the basis of severity, type, and source of pain. - Analgesics may be divided into nonopioid drugs and opioid drugs. OPIOIDS - Opioids do have concerns related to abuse and addiction. - Persistent cancer pain often requires opioids at the end of life to provide comfort and prepare for a “good death.” - Ex: morphine, hydromorphone, fentanyl, local anesthetics - Administered via IV, PO, or PCA pumps NON OPIOIDS - Nonopioid drugs may be used without concern related to abuse or addiction. Still have side effects that require careful monitoring. (Example: Acetaminophen can cause liver damage if taken in large doses for a prolonged period of time.) - NSAIDS - Ex: Tylenol, ibuprofen, ketorolac (toradol) 20. Minerals- calcium, iron, magnesium Calcium - Hypocalcemia is low calcium in the blood - People who have acute pancreatitis frequently develop hypocalcemia because calcium binds to the feces and is excreted - Hypocalcemia can cause muscle cramps, seizures, and arrhythmias. - Hypercalcemia - Hypercalcemia is high calcium in the blood - Patients with cancer usually develop hypercalcemia because cancer cells secrete chemicals in the blood that are related to parathyroid hormone - When the chemicals reach the bones they shift calcium into the ECF - Hypercalcemia decreases neuromuscular excitability (the most common sign: lethargy) - Intake & absorption - Dairy - Broccoli - Oranges - Requires vitamin D for best absorption  - Functions - Critical for bone strength, muscle contractions, blood clotting, and nerve signaling. - Treatment: Oral or IV calcium, with dietary sources like dairy and fortified foods. Iron -Functions - Essential for hemoglobin formation and oxygen transport in red blood cells. - Deficiency - Leads to iron-deficiency anemia, causing fatigue, weakness, and pallor. - Treatment - Oral supplements (take with vitamin C to enhance absorption) or IV/IM iron if severe. - Intake - Red meat, poultry, fish, beans, lentils, tofu, spinach, and fortified cereals. Pair with vitamin C-rich foods (e.g., oranges, tomatoes) to improve absorption. Magnesium - Functions - Supports enzyme activity, nerve conduction, and muscle relaxation. - Deficiency - Hypomagnesemia may cause muscle twitching, arrhythmias, and seizures. - Treatment - Magnesium supplements (oral or IV for acute cases). - Intake - Nuts (almonds, cashews), seeds (pumpkin, sunflower), leafy greens, legumes, and whole grains like brown rice. 21. Gas exchange, elimination, glucose regulation, fluid and electrolyte balance a. Gas exchange i. Process: Oxygen diffuses from alveoli to blood; CO2 diffuses from blood to alveoli. ii. Factors: Ventilation, perfusion, and diffusion efficiency. iii. Disorders: COPD, asthma, and pneumonia can impair gas exchange. Risk factors i. Chronic Respiratory Diseases: COPD, asthma, and pulmonary fibrosis. ii. Acute Respiratory Conditions: Pneumonia, pulmonary edema, or ARDS. iii. Obesity: Increased pressure on the diaphragm, leading to difficulty in ventilation. iv. Smoking: Damages alveolar sacs and decreases oxygen absorption. v. Age: Older adults have reduced lung compliance and weaker respiratory muscles.  Interventions i. Oxygen Therapy: To maintain optimal oxygen saturation. ii. Positioning: High Fowler's or semi-Fowler’s to improve lung expansion. iii. Incentive Spirometry: To encourage deep breathing and prevent atelectasis. iv. Chest Physiotherapy: For patients with thick mucus to improve clearance. v. Medication: Bronchodilators and steroids for conditions like asthma and COPD. b. Elimination a. Elimination is the excretion of waste from the body by the GI tract through feces or urine b. Bowel elimination occurs as a result of food and fluid intake and ends with passage of feces from food into the rectum of the colon. c. Bowel elimination control depends on muscle strength and nerve function d. Urinary elimination occurs as a result of multiple kidney processes and ends with the passage of urine through the urinary tract. e. When the urge to void occurs, urine is passed from the bladder to the urinary sphincter, urethra, and meatus f. Urinary control depends on muscle strength and nerve function Risk factors Incontinence: lack of bladder/bowel control Retention: inability to expel stool or excrete urine i. Incontinence can result as people age when the pelvic floor becomes weaker. ii. May also occur in adults with neurologic disorders such as strokes, dementia, and multiple sclerosis iii. Excessive use of laxatives can cause fecal incontinence Diarrhea can also result from GI infections like gastroenteritis and chronic inflammatory bowel diseases (crohn's disease) iv. Urinary retention is a problem in men who have benign prostatic hyperplasia (this overgrowth blocks the bladder neck and prevents urination) v. Constipation Lack of dietary fiber Use of opioids Use of diuretics Use of psychoactive drugs Interventions i. Adequate nutrition 1. Diet high in fiber, fruit, vegetables, whole grains 2. Drink 8 to 12 glasses of water per day ii. Promptly void when the urge occurs iii. Exercise frequently c. Glucose regulation a. Insulin: Regulates blood glucose by promoting glucose uptake into cells and storage as glycogen. b. Hypoglycemia: Can occur if glucose drops too low; symptoms include shaking, sweating, and confusion. c. Hyperglycemia: High blood sugar, often in diabetes, can lead to complications like kidney damage and poor wound healing. d. Management: Includes monitoring blood sugar levels, insulin administration, and diet control. Risk Factors i. Diabetes (Type 1 and Type 2) ii. Obesity iii. Sedentary lifestyle iv. Poor diet (high in refined sugars) v. Family history of diabetes vi. Stress or illness Interventions i. Monitor blood glucose regularly ii. Administer insulin or oral hypoglycemic agents as prescribed iii. Educate on balanced diet, exercise, and weight management iv. Encourage stress management techniques v. Promote patient adherence to prescribed treatment plans d. Fluid and electrolyte balance i. Homeostasis: The kidneys, heart, and hormones maintain fluid and electrolyte balance. ii. Imbalances: Conditions like dehydration or edema affect electrolyte levels (sodium, potassium, etc.). Risk factors a. Kidney disease b. Heart failure c. Severe dehydration or overhydration d. Vomiting, diarrhea, or excessive sweating e. Medications (diuretics, steroids) Interventions a. Monitor intake and output (I&O) b. Administer IV fluids or electrolytes as prescribed c. Encourage proper hydration d. Monitor lab values (e.g., serum sodium, potassium) e. Educate on recognizing early signs of imbalances (e.g., muscle cramps, dizziness) 22. Interventions to decrease risk for clotting a. Interventions to decrease risk for clotting i. Drink adequate fluids to prevent dehydration ii. Avoid crossing legs iii. Ambulate frequently/avoid prolonged sitting iv. Explore smoking cessation programs as needed v. Call primary provider if redness/hyperpigmentation, pain, swelling, and warmth occur in lower extremities vi. Anticoagulants/antiplatelet drugs “blood thinners” 1. Example: Sodium Heparin/Warfarin ( must do frequent laboratory) 23. Secondary prevention vs primary prevention a. Primary prevention i. Minimizing risk of developing impaired cellular regulation ii. Teach patients to minimize the risk of developing impaired cellular regulation (primary prevention). iii. Protect exposed skin with sunscreen of at least 30 skin protection factor iv. Vaccines b. Secondary prevention i. Proper and regular screenings ii. Screening also enables the primary health care provider to diagnose cancer early iii. Routine physical examinations with primary care iv. Annual skin examinations v. Required annual testing (pap smear, mammogram, colonoscopy) 24. Signs and symptoms of chronic kidney disease As kidney function declines, waste products build up in the blood, disrupting the normal balance of fluids and electrolytes in the body. a. Fatigue, weakness, and general ill feeling b. Nausea, vomiting, and loss of appetite c. Swollen legs, feet or ankles due to fluid retention d. Difficulty concentrating e. Decreased urine output or need to urinate more often f. Muscle cramps or twitches g. Dry, itchy skin h. Shortness of breath due to fluid buildup in the lungs i. High blood pressure j. Anemia k. Bone pain or fractures l. Changes in how foods taste m. Numbness or tingling in hands and feet 25. Confusion Assessment Method (CAM) a. CAM, Mini-Cog: consists of nine open ended question and a diagnostic algorithm for determining delirium b. Diagnostic testing c. Neuropsychological testing 26. Treatment for hyperkalemia and hypokalemia, and foods potassium is found in a. Treatment for Hyperkalemia: Eliminate K+ from the body, Eliminate oral intake, remove K+ from IVs, i. Dialysis, peritoneal, hemodialysis, continuous renal replacement therapy(CRRT) ii. Meds sodium bicarbonate if acidotic, calcium, diuretics, kayexalate, insulin/glucose. iii. Force K+ from ECF to ICF by IV insulin and a B-adrenergic agonist such as albuterol(stimulate the action of sodium-potassium pump) Treatment for hypokalemia : K+ replacement(KCI Supplement orally or IV), Always dilute IV KCI when in liquid form, NEVER GIVEN IN CONCENTRATED AMOUNTS(NEVER GIVE VIA IVP/BOLUS this is what is utilized for “Lethal Injection”. Do not exceed 10 mEd/hr, Use smart IV infusion pump for control of dosage. b. Foods Potassium K+ is found in: Mainly Bananas+Potatoes, Instant Coffee, Lima beans, Molasses, Brazil nuts, fruits 27. Laboratory test for malnutrition a. The most common assessment for generalized malnutrition is Prealbumin and albumin measurement. Albumin is a major serum protein that is below normal in patients who have had inadequate nutrition for weeks. Prealbumin assessment is preferred because it decreases more quickly when nutrition is inadequate. 28. Conditions at risk for decreased perfusion (which patients have higher risk factors) Perfusion is the heart's ability to adequately supply blood to the body. Impaired perfusion is known as ischemia. a. Non-modifiable risk factors i. Age ii. Family history iii. Older adults are at most risk for decreased perfusion w/ non-modifiable risk factors b. Modifiable risk factors i. Smoking ii. Lack of physical activity iii. Obesity  iv. Patients w/ hyperlipidemia, diabetes mellitus, peripheral vascular disease, and atherosclerosis are at most risk for decreased perfusion w/ modifiable risk factors Peripheral perfusion most often occurs in the lower extremities. Legs become pale and cool, and pedal pulses become diminished. If treated inadequately it may result in tissue ulcers or cell death like gangrene. Because decreased perfusion can have life threatening consequences, doctors may prescribe vasodilating drugs. Central perfusion Decreased central perfusion may result in myocardial infarction, stroke, and shock. a. Signs and symptoms i. Dyspnea ii. Dizziness iii. Syncope iv. Chest pain b. Decreased cardiac output i. Hypotension ii. Tachycardia iii. Diaphoresis iv. Anxiety v. Dysrhythmias vi. Decrease in cognitive function Decreased peripheral perfusion a. Signs and symptoms i. Decreased hair distribution ii. Non Localized pain/discomfort iii. Coolness iv. Decreed capillary refill time v. pallor/ash gray appearance vi. Cyanosis of extremities (blue/purple discoloration) CH 22 Antihypertensive Drugs (Pharmacology book) 29. ACE inhibitors (side effects & MOA) a. Mechanism of Action: ACE inhibitors, such as lisinopril and enalapril, inhibit the conversion of angiotensin I to angiotensin II. This results in vasodilation and reduced blood volume, helping to lower blood pressure. They also reduce the secretion of aldosterone, which can further help with fluid retention and blood pressure. b. Side Effects: Common side effects include cough, hyperkalemia, hypotension, dizziness, and rare but serious effects like angioedema. c. Nursing Interventions: Monitor blood pressure, renal function, and electrolyte levels, particularly potassium.  d. Educate patients about the risk of a persistent cough and signs of angioedema. Ensure the patient does not abruptly stop taking the drug to avoid rebound hypertension. 30. Potential complications and associated conditions that can arise from untreated hypertension. Potential Complications from Untreated Hypertension: a. Cardiovascular Disease (CVD): i. Coronary Artery Disease (CAD): High blood pressure causes increased workload on the heart, leading to the narrowing of the coronary arteries (atherosclerosis), which can eventually cause angina, heart attacks, or heart failure. ii. Heart Failure: Persistent high blood pressure can lead to left ventricular hypertrophy, which eventually reduces the heart's ability to pump blood effectively, leading to heart failure. iii. Arrhythmias: Long-term hypertension can lead to structural changes in the heart, which increases the risk of arrhythmias like atrial fibrillation. b. Cerebrovascular Accidents (Stroke): i. Hypertension is the leading cause of stroke, particularly ischemic strokes, due to the damage it causes to the blood vessels in the brain. This can result in clot formation or a rupture of a weakened blood vessel (hemorrhagic stroke). c. Chronic Kidney Disease (CKD): i. Untreated hypertension can damage the renal blood vessels, leading to nephrosclerosis (hardening of the kidneys) and chronic kidney disease (CKD). Over time, this can progress to end-stage renal disease (ESRD), requiring dialysis or kidney transplant. d. Retinopathy: i. Chronic high blood pressure can lead to damage to the blood vessels in the retina, causing retinopathy. This can lead to vision changes and may cause blindness if untreated. e. Aneurysm: i. Persistent hypertension can cause the weakening of blood vessels, increasing the risk of an aneurysm, which may rupture and cause life-threatening internal bleeding, particularly in areas like the aorta. f. Metabolic Syndrome: i. Hypertension is one of the key components of metabolic syndrome, a cluster of conditions including obesity, high blood sugar, abnormal cholesterol levels, and increased waist circumference, which raises the risk for heart disease, stroke, and diabetes. g. Dementia and Cognitive Impairment:  i. Chronic hypertension, particularly in older adults, is associated with vascular dementia and cognitive decline due to reduced blood flow to the brain. Associated Conditions from Untreated Hypertension: a. Hyperlipidemia: High blood pressure can be associated with higher levels of cholesterol, which contributes to atherosclerosis. b. Obesity: Increased body weight, especially abdominal fat, is closely associated with high blood pressure. c. Diabetes Mellitus: Hypertension is common in people with diabetes, and both conditions act synergistically to increase the risk of cardiovascular events and kidney damage. d. Sleep Apnea: Obstructive sleep apnea (OSA) is a common cause of secondary hypertension and exacerbates the risks of cardiovascular diseases. Nursing Considerations: a. Monitoring: Regular blood pressure monitoring is essential to track the effectiveness of interventions and detect early complications. b. Patient Education: Encourage lifestyle modifications (e.g., weight management, exercise, low-sodium diet) and medication adherence to prevent complications. Educate patients about symptoms of stroke, kidney problems, and other complications. 31. Losartan and ibuprofen concern with taking it together a. Concern: When used together, NSAIDs like ibuprofen can reduce the blood pressure-lowering effects of ACE inhibitors and may also cause kidney damage. This is especially concerning in patients with pre-existing kidney issues or those using other blood pressure medications. 32. Side effects of enalapril Enalapril / Vasotec a. Is a pro drug (means it has to be metabolized by the liver for it to work) b. CANNOT be given to someone with liver dysfunction/failure c. The only ACE inhibitor that can be given via IV d. More suitable for chronic management Common side effects: i. Dry cough ii. Fatigue iii. Dizziness iv. Hyperkalemia v. Angioedema vi. Renal impairment Pharmacology: Route: PO Route: IV Onset: 1 hour Onset: 15 min Half life: 2 hours Half life: 11 hours Duration: 12-24 hours. Duration: 4-6 hours 33. Captopril, side effects, and contraindications (what can you not give with it) Captopril / Capoten a. Is an active drug (starts working as soon as it enters the bloodstream) b. Has the shortest half-life (must be given 3-4 times a day) c. More suitable for acute conditions Common side effects: i. Dry cough ii. Fatigue iii. Dizziness iv. Hyperkalemia v. Angioedema vi. Renal impairment Side effects specific to captopril i. Skin rash ii. Loss of taste iii. Higher risk for hypotension Pharmacology: Route: PO Onset: 15 minutes Half life: 2 hours Duration of action: 2-6 hours. 34. Nurse education regarding hypertension a. Patient Education: Patients should be encouraged to follow a low-sodium diet, exercise regularly, avoid excessive alcohol, and quit smoking. It's crucial to monitor blood pressure regularly and adhere to medication regimens. Lifestyle changes often complement medication therapy in managing hypertension effectively. 35. MOA of Calcium Channel Blockers (how do they work and what do they do to the vessels) a. By blocking calcium ions to bind to their receptors b. Calcium channel blockers (CCBs) are discussed in detail in the chapters on antianginal drugs (see Chapter 23) and antidysrhythmic drugs (see Chapter 25). As a class, they are used for several indications and have many beneficial effects and relatively few adverse effects. Their primary use is for the treatment of hypertension and angina. Their effectiveness in treating hypertension is related to their ability to cause smooth muscle relaxation by blocking the binding of calcium to its receptors, which thereby prevents contraction. 36. Nursing interventions and education for ace inhibitors Mechanism of Action (MOA): ACE inhibitors block the angiotensin-converting enzyme, which prevents the conversion of angiotensin I to angiotensin II, a potent vasoconstrictor.  This leads to vasodilation, reduced blood pressure, and decreased sodium and water retention in the kidneys​ Nursing Interventions: a. Monitor vital signs regularly, especially blood pressure. Watch for hypotension, particularly after the first dose​ b. Assess kidney function, including serum creatinine and BUN levels, as ACE inhibitors can cause renal impairment​ c. Monitor potassium levels since ACE inhibitors can lead to hyperkalemia​ d. Educate the patient on potential side effects like persistent cough, dizziness, and risk of angioedema​ e. Teach the patient to rise slowly to prevent orthostatic hypotension​ f. Avoid potassium supplements or salt substitutes, which can increase the risk of hyperkalemia​ 37. Nursing interventions for severe range blood pressure Nursing Interventions: a. Immediate blood pressure reduction is crucial in hypertensive emergencies. Use IV medications like nitroprusside or labetalol to rapidly lower blood pressure​ b. Monitor for end-organ damage (e.g., stroke, heart failure, or renal failure). Check for signs of damage such as changes in mental status, chest pain, or decreased urine output​ c. Continuous monitoring of blood pressure is necessary, using an automatic cuff or arterial line​ d. Positioning the patient in a semi-recumbent position to reduce intracranial pressure and help with blood pressure regulation​ Patient Education: a. Teach the patient to monitor blood pressure at home, follow medication regimens, and maintain lifestyle changes such as dietary adjustments and weight loss​ b. Warn against abrupt discontinuation of ACE inhibitors or blood pressure medications, which could lead to rebound hypertension​ 38. Hydrochlorothiazide- MOA, class, indication, side effects, and nursing education a. Most commonly used Diuretics (potassium wasting aka excretes sodium and potassium) b. Thiazide diuretics, antihypertensives c. Hypertension + edema associated with HF, Renal impairment, cirrhosis, glucocorticoid therapy d. Hypotentension, STEVEN JOHNSON SYNDROME, pancreatitis, hypokalemia e. Take med at the SAME TIME EACH DAY. Take missed doses as soon as you remember but not before the next dose is due. DO NOT DOUBLE DOSE i. Monitor weight (notify doctor of significant changes) ii. Can cause orthostatic hypotension therefore patients should be cautious when changing positions.  iii. Use sunscreen to prevent photosensitivity reactions. iv. Encourage fluids. v. Discuss dietary potassium requirements with health care provider (aka give potassium rich foods) 39. Amlodipine- MOA, class, indication, side effects, and nursing education a. Inhibits the transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction b. Antianginals, antihypertensive, calcium channel blockers c. HTN (alone or with combination with other antihypertensive agents), chronic stable angina d. Peripheral edema, angina, bradycardia, flushing, nausea, dizziness and fatigue e. Instruct patients to take medication as directed, even if feeling well. Take missed doses as soon as possible within 12 hrs. i. Caution patient to change positions slowly to minimize orthostatic hypotension ii. May cause drowsiness or dizziness (avoid driving or other activities) 40. Clonidine- - MOA, class, indication, side effects, and nursing education a. Class: Alpha-2 adrenergic agonist. b. Mechanism of Action: Clonidine works centrally to decrease sympathetic nervous system activity, leading to reduced heart rate and vasodilation, which helps to lower blood pressure. c. Side Effects: These include drowsiness, dry mouth, bradycardia, and rebound hypertension if the medication is abruptly discontinued. d. Nursing Education: Patients should be taught to taper the drug slowly to prevent rebound hypertension. They should also be informed about potential sedation and advised to avoid activities requiring mental alertness (like driving). 41. Diuretics and hypertension; MOA (pharmacology book) a. Mechanism of Action: Diuretics like hydrochlorothiazide and furosemide lower blood pressure by reducing blood volume through increased urinary excretion of sodium and water. b. Side Effects: Hypokalemia (especially with thiazide diuretics), dehydration, dizziness, and hyponatremia. c. Nursing Interventions: Monitor electrolytes, especially potassium, and renal function. Educate patients on the importance of hydration and possible side effects like dizziness when standing up. Mentioned in class! 42. Manifestations of kidney disease? (signs and symptoms)  Signs and symptoms of chronic kidney disease (CKD) can vary depending on the severity and stage of the disease. Early stages may be asymptomatic, but as kidney function declines, the following signs and symptoms may appear: a. Fatigue: Reduced kidney function can lead to anemia, causing tiredness or weakness​ b. Swelling (Edema): Due to fluid retention, swelling in the legs, ankles, or feet may occur​ c. Changes in Urination: This can include frequent urination, especially at night (nocturia), or foamy or bloody urine​ d. Shortness of Breath: Fluid retention in the lungs can lead to difficulty breathing​ e. High Blood Pressure: Kidneys play a key role in regulating blood pressure, so impaired kidney function often leads to hypertension​ f. Nausea and Vomiting: Buildup of waste products in the blood (uremia) can lead to gastrointestinal issues​ g. Back Pain: Pain may be felt in the lower back, especially if there is an underlying infection or kidney stones​ h. Metallic Taste and Loss of Appetite: A buildup of waste can alter taste and cause nausea, leading to reduced appetite​ 43. What does diarrhea cause and what food helps with that? Causes of Diarrhea: a. Infections: Bacterial, viral, or parasitic infections can cause diarrhea​ b. Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can lead to chronic diarrhea​ c. Irritable Bowel Syndrome (IBS): This functional gastrointestinal disorder can result in episodes of diarrhea​ d. Medication side effects: Certain medications, including antibiotics and chemotherapy, can cause diarrhea​ Foods that Help with Diarrhea: a. Bananas: Easy to digest and help replenish potassium lost during diarrhea​ b. Rice and Applesauce: These are part of the BRAT diet (Bananas, Rice, Applesauce, Toast) and can help firm up stool​ c. Toast: Plain, white toast can be easily digested and may help with reducing diarrhea​ d. Boiled Potatoes: Skinless potatoes provide carbohydrates without irritating the stomach​ e. Plain Crackers: Help absorb fluid and soothe the digestive system 44. Interventions for hydrochlorothiazide Hydrochlorothiazide (HCTZ) is a commonly used diuretic for treating hypertension and edema. Nursing interventions include: a. Monitor Electrolytes: HCTZ can cause hypokalemia, so check potassium levels regularly. Potassium-rich foods like bananas or supplements may be needed​  b. Monitor Vital Signs: Monitor blood pressure and heart rate, as HCTZ can lower blood pressure​ c. Assess for Dehydration: Ensure the patient stays hydrated, as diuretics increase urine output​ d. Patient Education: Educate patients about the importance of taking the medication as prescribed, potential side effects (like dizziness), and dietary recommendations (such as increasing potassium intake)​ 45. First line drugs for hypertension (which diuretic is given as drug of choice) First-Line Drugs for Hypertension: a. Thiazide diuretics (e.g., hydrochlorothiazide) are generally the first-line treatment for uncomplicated hypertension​ b. Calcium channel blockers and ACE inhibitors are also commonly used in combination with thiazide diuretics, especially in patients with other conditions like diabetes or heart failure​ 46. What makes up blood pressure? (vascular resistance) a. Cardiac Output (CO): This is the volume of blood the heart pumps per minute. It is determined by both the heart rate and the stroke volume (the amount of blood pumped with each beat). Increased cardiac output can raise blood pressure, as more blood is being pushed through the arteries. b. Vascular Resistance (Peripheral Vascular Resistance, PVR): This refers to the resistance the blood encounters as it flows through the blood vessels, especially the arterioles. It's influenced by the diameter of the blood vessels. Smaller, constricted vessels create more resistance, increasing blood pressure. Conversely, dilated vessels decrease vascular resistance, which can lower blood pressure. Factors that influence vascular resistance include: i. Blood vessel diameter: Constricted vessels (e.g., during sympathetic nervous system activation) increase resistance and thus blood pressure. ii. Blood viscosity: Thicker blood (e.g., in polycythemia) increases resistance, raising blood pressure. iii. Vessel elasticity: Stiff or non-compliant vessels, often seen with aging or atherosclerosis, contribute to increased resistance and higher blood pressure. c. Blood Volume: An increase in blood volume (e.g., due to excessive sodium intake or fluid retention) leads to an increase in blood pressure because there is more fluid in the vascular system to exert pressure on the vessel walls. d. Elasticity of Arteries: The ability of the arteries to stretch and recoil is essential for managing blood pressure. Stiff arteries (due to conditions like arteriosclerosis) do not expand as easily and can contribute to higher blood pressure. e. Renin-Angiotensin-Aldosterone System (RAAS): This system plays a significant role in regulating vascular resistance and blood volume. When blood pressure drops, the kidneys release renin, which activates the angiotensin system. This causes vasoconstriction (narrowing of blood vessels) and stimulates the release  of aldosterone, which causes the kidneys to retain sodium and water, increasing blood volume and pressure. In summary, blood pressure is influenced by cardiac output, vascular resistance, blood volume, and arterial elasticity. Vascular resistance, especially, is affected by factors like vessel diameter, blood viscosity, and arterial stiffness, all of which are key contributors to hypertension when dysregulated 47. Nursing education for hypertension (pharmacology book) Understanding Hypertension: a. Hypertension is often called the "silent killer" because it may not show symptoms until significant damage has occurred. Educating patients about the importance of regular blood pressure monitoring is crucial for early detection​ Lifestyle Modifications: a. Dietary Changes: Encourage a low-sodium diet, as sodium intake can directly affect blood pressure. Advise patients to adopt the DASH diet (Dietary Approaches to Stop Hypertension), which emphasizes fruits, vegetables, whole grains, lean proteins, and low-fat dairy​ b. Weight Management: Obesity contributes significantly to hypertension. Educating patients on the importance of weight reduction can significantly lower blood pressure. Regular exercise, such as 30 minutes of aerobic activity most days of the week, can also help reduce blood pressure​ c. Limiting Alcohol and Tobacco Use: Excessive alcohol consumption and smoking increase blood pressure. Educating patients to limit alcohol to no more than 2 drinks per day for men and 1 for women can help manage hypertension. Smoking cessation programs should be encouraged as smoking constricts blood vessels and raises blood pressure​ Medication Adherence: a. Explaining Medications: Patients should be educated on the purpose and side effects of their prescribed antihypertensive medications, such as ACE inhibitors, beta-blockers, or diuretics. Emphasize the importance of taking medications regularly, even if they feel fine, to prevent complications like stroke, heart attack, or kidney damage​ b. Side Effects Management: Educate patients on the potential side effects of medications, such as dizziness or hypotension with ACE inhibitors or leg cramps with diuretics. Hydration and adequate electrolyte balance are key, particularly with diuretics​ Signs of Hypertensive Crisis: a. Teach patients to recognize symptoms of a hypertensive crisis, such as severe headache, dizziness, blurred vision, or chest pain. Immediate medical attention is needed if these symptoms occur to prevent damage to vital organs like the heart, kidneys, or brain​ Monitoring and Follow-up Care:  a. Encourage regular follow-up visits for blood pressure checks, especially if they are on antihypertensive medications. Blood pressure should be checked at each visit to assess the effectiveness of treatment​ Stress Management: a. Stress reduction techniques such as deep breathing, yoga, or meditation can help lower blood pressure. Educating patients on managing stress is important for overall health and blood pressure control​ Patient Empowerment: a. Empower patients to take an active role in managing their hypertension. Encourage them to track their blood pressure readings at home and keep a journal to share with their healthcare provider​