Module 3: Homeostasis and Regulation PDF

MODULE III: Homeostasis and Regulation 1. Fluid and Electrolyte 2. Thermoregulation 3. Intracranial Regulation 4. Nutrition 5. Elimination - Application of the nursing process to clinical situations - Related practical skills to module +-----------------------------------+----------...

MODULE III: Homeostasis and Regulation 1. Fluid and Electrolyte 2. Thermoregulation 3. Intracranial Regulation 4. Nutrition 5. Elimination - Application of the nursing process to clinical situations - Related practical skills to module +-----------------------------------+-----------------------------------+ | **MODULE III THEME: HOMEOSTASIS | | | AND REGULATION** | | +===================================+===================================+ | **CONCEPTS:** | **EXAMPLARS** | +-----------------------------------+-----------------------------------+ | Fluid and Electrolyte Balance | 1\. Fluid volume deficit | | | (dehydration) | | | | | | 2\. Fluid volume excess | | | (over-hydration) | | | | | | 3\. Electrolytes | | | | | | 4\. Intake and Output | | | calculation  | | | | | | Pharmacy focus: | | | | | | Community focus: | +-----------------------------------+-----------------------------------+ | | | +-----------------------------------+-----------------------------------+ | Thermoregulation | 1\. Afebrile | | | | | | 2\. Febrile | | | | | | 3\. Hypothermia | | | | | | 4\. Heat stroke | | | | | | Pharmacy focus: | | | | | | Nutrition focus: | | | | | | Community focus | +-----------------------------------+-----------------------------------+ | Intracranial Regulation | 1\. Level of Consciousness | | | assessment | | | | | | 2\. Cranial nerve function | | | | | | 3\. Motor functions and | | | reflexes. | | | | | | 4\. Positioning | | | | | | Pharmacy focus: | | | | | | Nutrition focus: | | | | | | Community focus: | +-----------------------------------+-----------------------------------+ | Nutrition | 1\. Body mass index (BMI) | | | | | | 2\. Vitamin and mineral | | | deficiency | | | | | | 3\. Oral feeding (blind, poor | | | appetite, dysphagia) | | | | | | 4\. Nasogastric tube feeding | | | | | | 5\. Gastrostomy tube feeding | | | | | | 6\. Total Parental Nutrition | | | (TPN) | | | | | | 7\. Positioning | | | | | | Pharmacy focus: | | | | | | Nutrition focus: | | | | | | Community focus: | +-----------------------------------+-----------------------------------+ | Elimination | 1\. Normal urine and stool | | | elimination | | | | | | 2\. Diagnostic urine and stool | | | assessment | | | | | | 3\. Indwelling catheter care | | | | | | 4\. Suprapubic catheter care | | | | | | 5\. Ostomy care | | | | | | 6\. Positioning | +-----------------------------------+-----------------------------------+ **[nursing process ]** A close-up of a nursing process Description automatically generated 1. Assessment 2. Diagnosis 3. Planning 4. Implementation 5. Evaluation **[1.Assessment]** -- is gathering of information about a pt. - **subjective data =**Patient describes signs and symptoms they are feeling - **objective data =** Nurse or healthcare provider list patient results or observations of patient's signs. **[2. Diagnosis]** nurse clinical judgment about the client response to actual and potential problems - **[Actual nursing]** [**diagnosis=** has 3-part statements. ] - You have a **problem**; **[related to]** **etiology** as **[evidenced by]** **signs and symptoms**. **Example** The **problem** could be that **gas exchange Related to** **respiratory** complications as **evidence by** (**signs and symptoms)** - patient has **shortness of breath.** - Respiration is 24 more above the normal of 12 to 20%. - Cannot handle activity without having shortness of breath. - The word **related to** and as **evidence by** are **[standard.]** - the **problem,** the **etiology** and the **signs and symptoms** change. - **etiology means the cause of the problem**. So, you have a problem what causes the problem and what signs and symptoms helped you in making the assumption that that is actual problem. - **[Actual diagnosis:]** The patient has clear signs and symptoms of the problem. - **[Potential diagnosis]**: The patient is at risk of developing a problem but has no current signs or symptoms. - **Nursing diagnosis has** - 3 Part Diagnosis - 2 Part Diagnosis [***Potential problems ===*** 2 Part Diagnosis] Risk for **problem related to etiology** and **signs and symptoms.** Example: Risk of fall related to neurological status and GCS score of 8 **For example**, risk for fall patient have neurological **damage**. - **Actual problem** has 3-part statement - **Potential problem** has 2-part statement ***[Actual problem]*** [3 Part Diagnosis] Problem related to etiology as evidence by signs and symptoms ***[Example:]*** Gas exchange related to respiration complication as evidence by shortness of breath and respiration of 8 So, we don\'t have assign and symptoms yet, but there\'s a **risk for a form because of the patient\'s neurological status**. - **an actual problem has a 3-part statements**. - **A potential problem has 2 parts statements**. **[3.Planning ]** **smart** goals Meaning it is. - **Specific=** what do you want to accomplish - **Measurable=ensure you can measure success** - **Attainable= set the goal you know you can achieve** - **realistic = set goal relevant to your career or education** - **timely= set deadline for completion** - **How do you set for patient goals?** You always begin with a **patient will.** - **For example,** Patient will not sustain any falls in my ships. - **I will make patient doesn't fall**\-- \--**That is your intervention** the goal to **begin with patient Will** that guides you\'re writing. Because the focus is who the **patients.** **[4.implementation]** - Then **implementation,** not an **action** it begins with an action word is **what the nurse does.** - For example\-\-- **[I can say if you get patient on risk for fall]** - ***[Educate]*** the patient on fall privation strategy - ***[Administer medication]*** to keep patient calm. - ***[Reinforce]*** the importance of staying in bed. - ***[Give]*** the patient their personal belonging So, they don\'t get out of bed to reach it - ***[Encourage]*** family members to stay with their loved one. - all of these are **interventions words** - How do you see how I use each of those **actual words** to tailor or **fall prevention** the patients on for prevention strategies. - what is **my rationale** for that? Fall **prevention strategies will keep the patient safe.** - Look at your goal - Goal was patient will not fall in my shift. - **Turn your goal to a question!** - if my patient falls in my shift goal not met. - If the goal doesn't met, we make another assessment, diagnosis, goal, internation and evaluation. - That\'s why the nursing process is **cyclical** until the goal is met and then we can make new ones or patient is discharged. You see, so that\'s how the nurse things scientifically. - Types of interventions - **Dependent** **nursing interventions** - **Independent nursing interventions** A. [**Dependen**t] **[nursing internation]** - need a doctor\'s order to do it. - **For example**, I have a patient who\'s getting out of bed cannot stay in bed we need to call a doctor to get an order for restriction. - I need to provide us signature on that if I need to give them medications to calm them down, - ***[for example,]*** benzodiazepines ones that ends in pam - **lorazepam** - **diazepam** - It is beyond nurse **scope of practice** need to **call the doctor** - **need someone\'s signature or approval to do this**. **[B. Independent nursing interventions]** - I don\'t need a doctor order or signature. - **For example** - Put 2 side bed rails up. - Bring their personal belongings to their bedside - Make sure that the whole way to the bathroom is clear. **Fluid and electrolytes** If a student doesn\'t understand fluid and electrolyte, it is hard to understand complex issues like - Diabetes, - Heart failure - Renal disease - Cancer situations - **Chapter 12 of** - **pharmacology** - **fundamental textbooks** - **clinical skills book**. 1. **[Dehydration vs over hydration ]** - **[Dehydration]** - is also called ***[fluid volume deficits]*** that means patients don\'t have enough volume in their body. - ***[Sign and symptoms]*** - Dry mouth and skin\-\-\-- dehydrated - **Hypotension \-\-\-\-- Low blood pressure** - **Tachycardia\-\-- faint** -fast heart rate - Urine concentrated -- dark or dark orange +-----------------------------------------------------------------------+ | Key word | | | | - hypotension | | | | - tachycardia | | | | - Urine concentrated | +=======================================================================+ | - **Hypotension** | | | | also known as **low blood pressure**, | | | |  is a cardiovascular condition characterized by abnormally reduced | | blood pressure. | | | |  Blood pressure is the force of blood pushing against the walls of | | the arteries as the heart pumps out blood and is indicated by two | | numbers, | | | |  the systolic blood pressure (the top number) and | | | |  the diastolic blood pressure (the bottom number), which are the | | maximum and minimum blood pressures within the cardiac cycle. | | | |  A systolic blood pressure of less than 90 millimeters of mercury | | (mmhg) | | | |  diastolic of less than 60 mmhg is generally considered to be | | hypotension. | | | | - **Tachycardia** | | | | | | | | - is the medical term for a heart rate that is faster than 100 | | beats per minute. | | | | - Tachycardia can occur as a normal or an abnormal heart rate | | response. | | | | - When tachycardia occurs as a normal response, it is called sinus | | tachycardia. | | | | - Happen because of the low blood pressure, the body will try to | | pump it faster to accommodate the low blood pressure, but | | there\'s no the volume pump. | | | | | | | | - **Urine concentrated** | | | | | | | | - it means that the urine contains a higher concentration of | | solutes (dissolved particles) and less water compared to diluted | | urine. | +-----------------------------------------------------------------------+ [**B. Over hydration** ] - too much fluid in the body. - It could be from - congestive **heart failure** - **renal disease** - Sign and symptoms - High blood pressure because of too much volume. - **My heart rate** pulse will still be high - **Bracycardia** - Narye edema - lung sound is going to be very crackled - Have edema - shortness of breath\-\-- from fluid overload - urine clear up - Why, because the heart button that is pumping fast well, okay, what kind of going to work harder? So, for a difference, I wanted to pay attention to. physical assessment - Assess pulse force using a four-point scale: - 3+: Full and bounding. - **2[+: Normal or strong.]** - 1+: Weak, diminished, or thready. - 0: Absent or non-palpable (Dead) - Edema scale - 0 means - low - **[Grade +1 (Trace):]** Mild pitting with a 2mm indent and rapid return to normal. - **[Grade +2 (Mild):]** Moderate pitting with a 4mm indent, rebounding in a few seconds. - **[Grade +3 (Moderate):]** Deep pitting with a 6mm indent, lasting for 30 seconds. - **[Grade +4 (Severe):]** Very deep pitting with an 8mm indent, taking more than 30 seconds to return to normal -- **[pit edema]** **signs and symptoms for over hydration -- textbook** +-----------------------------------------------------------------------+ | Key word | +=======================================================================+ | **[Narye edema-]**is a term that does not have a widely | | recognized medical meaning. However, I can provide information | | related to edema, which refers to swelling caused by too much fluid | | trapped in the body's tissues. | | | | **Narye edema** is a term that does not have a widely recognized | | medical meaning. However, I can provide information related | | to **edema**, which refers to **swelling caused by too much fluid | | trapped in the body's tissues**. Here are some key points about | | edema: | | | | 1. **Definition**: | | | | - **Edema** can affect any part of the body but is more likely | | to show up in the **legs and feet**. | | | | - It results from an abnormal accumulation of fluid in the | | tissues. | | | | 2. **Causes**: | | | | - **Medications**: Certain medications can cause edema. | | | | - **Pregnancy**: Edema is common during pregnancy. | | | | - **Diseases**: | | | | - **Congestive heart failure**: The heart's inability to | | pump blood effectively leads to fluid buildup. | | | | - **Kidney disease**: Impaired kidney function affects | | fluid balance. | | | | - **Venous insufficiency**: Damaged veins struggle to | | return blood to the heart. | | | | - **Cirrhosis of the liver**: Liver dysfunction affects | | fluid regulation. | | | | 3. **Symptoms**: | | | | - Swelling in affected areas (legs, ankles, feet). | | | | - Skin may appear stretched, shiny, or puffy. | | | | - Discomfort or pain due to pressure on surrounding tissues. | | | | 4. **Management**: | | | | - Treating the underlying cause (e.g., managing heart failure, | | improving kidney function). | | | | - Elevating the affected limb. | | | | - Using compression stockings. | | | | - Reducing salt intake. | | | | - Diuretics (if prescribed by a doctor). | +-----------------------------------------------------------------------+ **2.Hormones** - Anti- diuretic hormone (ADH) - Aldosterone A. **[ADH]** - ***Diuresis*** means peeing - **Furosemid**e- it makes them pee - **Anti-Diuretic hormone** it regulates **your body and stop you from** Peeing too much. - If you have so much **ADH,** you want to keep all the fluid in your body. - **[Oliguria]**: Low urine output. - **[Anuria]**: No urine output. - **[Polyuria]**: Excessive urine production. B. **[Aldosterone]** - save the **sodium**, pushes away **potassium** +-----------------------------------------------------------------------+ | **Key word** | | | | - ADH | | | | - Aldosterone | +=======================================================================+ | 1. **ADH (Anti-Diuretic Hormone)**: | | | | - **Definition**: ADH is a **peptide hormone** secreted by the | | pituitary gland. Its primary role is to **prevent the | | production of dilute urine**. | | | | - **Function**: ADH helps **maintain fluid balance** in the | | body by controlling the amount of water passed through urine. | | It does this by making the **collecting tubules** of the | | nephron more permeable to water, allowing water to be | | reabsorbed back into the bloodstream. ADH is also known | | as **vasopressin**. | | | | - **Stimuli for Release**: ADH release is stimulated | | by **decreased blood pressure**, **volume**, **nausea**, | | and **vomiting**. | | | | - [**Effect on Blood Pressure**[: ADH acts on arterioles, | | causing ]**vasoconstriction**[ and increasing | | blood | | pressure^1^]](https://pediaa.com/difference-betwe | | en-adh-and-aldosterone/)[^^](https://www.difference101 | |.com/n-adh-vs-aldosterone/). | | | | 2. **Aldosterone**: | | | | - **Definition**: Aldosterone is a **corticosteroid | | hormone** synthesized and secreted by the **adrenal cortex**. | | | | - **Function**: Aldosterone plays a crucial role | | in **regulating blood pressure** by managing the levels | | of **sodium** and **potassium** in the blood. It stimulates | | the **absorption of sodium** by the nephron, which affects | | water and salt balance. By retaining sodium, aldosterone | | indirectly increases blood volume and impacts blood pressure. | | | | - **Control Mechanism**: Aldosterone is part of | | the **renin-angiotensin-aldosterone system**, which responds | | to changes in blood pressure. [[When blood pressure falls, | | the system is activated, leading to aldosterone | | release^3^]](https://my.clevelandclinic.org/healt | | h/articles/24158-aldosterone). | | | | In summary: | | | | - **ADH**: Prevents dilute urine by increasing water reabsorption. | | | | - **Aldosterone**: Regulates sodium absorption and impacts blood | | pressure by maintaining water-salt balance. | +-----------------------------------------------------------------------+ 3. **[Electrolyte values ]** **Urine specific gravity** **-dehydrated** - we don\'t have enough volume in your body, oliguria you don't enough **urine outputs**. - **urine is concentrated** **It is concentrated with salutes a little water**. - If it is concentrated has **high specific Urine gravity.** **-over hydration** - They **pee a lot** and they\'re human is they **looks or dilute** - **If it is Dilute has a low a specific gravity**. - **[Urine Concentration -high urine gravity/ dehydrated]** - **[Urine Dilutes- low urine gravity / over hydrated ]** - **normal urine specific gravity** - **1.010 \-- 1.030** - **concentration urine (oliguria or scanty urine**) - have high urine specific gravity (grater) \>1.030 - **Dilute urine** (fluid **volume access)** - have a low urine specific gravity (less) \< 1.010. +-----------------------------------------------------------------------+ | Key word | | | | -oliguria vs polyuria | +=======================================================================+ | Oliguria: | | | | **[Oliguria]** is a medical term referring to low urine | | output. Specifically, in adults, it means producing less than 400 | | milliliters (mL) to 500 mL (around two cups) of urine within a | | 24-hour period. For infants, the threshold is even lower, with an | | output of less than 1 mL per kilogram (kg) per hour. Oliguria can | | occur due to various factors, including kidney diseases, heart | | conditions, or lung issues. | | | | It's essential to identify the underlying cause of oliguria to | | determine the appropriate treatment1. | | | | Polyuria: | | | | **[Polyuria]**, on the other hand, refers to excessive | | urine production. If you find yourself urinating more frequently than | | usual or passing large volumes of urine (at least 3,000 mL over 24 | | hours), you might be experiencing polyuria. | | | | Several factors can contribute to polyuria, including diabetes, | | certain medications, kidney disorders, and hormonal imbalances. | | | | Monitoring urine output and traits can provide valuable information | | for healthcare providers in assessing overall health2. | +-----------------------------------------------------------------------+ 4. Atomies  +-----------------------+-----------------------+-----------------------+ | 5. **Potassium\-\--3 | **Hypokalemia | **Hyperkalemia** | |.5 - | (digoxin toxicity)** | | | 5 MEq/L** | | | +=======================+=======================+=======================+ | 1. **sodium -- 134- | **Hyponatremia | **hypernatremia** | | 145** | (lithium toxicity)** | | +-----------------------+-----------------------+-----------------------+ | 2. **calcium** | **hypocalcemia** | **hypercalcemia** | +-----------------------+-----------------------+-----------------------+ | 3. **magnesium** | **hypomagnesemia** | **hypermagnesemia** | | | | (**Magnesium | | | | toxicity)** | +-----------------------+-----------------------+-----------------------+ | 4. **phosphates | **Hypophosphatemia** | **Hyperphosphatemia** | | -2.5 - 4.5** | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ **A. potassium** - **[Furosemide]-**-**potassium wasting** diuretics - means you lose too much potassium from your body along with the extra water you pass. - **[Spironolactone]** **potassium sparing** diuretics - means are drugs that cause the excretion of sodium and water while preventing the loss of potassium in the urine and that increase diuresis (urination) - **The king of the electrolyte's potassium** helps - **Affect muscle e.g. heart is controlled by potassium**. - **hypokalemia low potassium** - **hyperkalemia is high potassium** = answer -low potassium can cause patient to have muscle cramps. Which one is more dangerous? **low potassium or high potassium**. - **high potential is more dangerous** **a low potassium**, I might have little populations on my chest. - Low potassium can be corrected by different foods which are rich in potassium - banana - green leafy vegetables - potatoes - potassium supplements - orange juice - Too high in potassium need to contact your doctor. - We can do a blood test called [**basic metabolic panel** (BUM)] - More than 5 or 6 BMP IS dangerous sign. -- heart can stop working **Potassium level** 3.5 - 5 MEq/L - **How do we bring it down**? Drug medication - **sodium polystyrene sulfonate** - calcium gluconate - **insulin** - **glucose** **insulin and glucose** - body we have **intracellular fluids**- Intra is inside of cell - An **extra cellular fluid**- extra is outside of cell Potassium and sodium have this in **a seniority context** that they do all the time. - **potential is more *[inside]* the cell** because it controls your muscles - **sodium is more *[outside]* of cell** - The level of **sodium level is 135 to 145.** - **Potassium level is 3.5 to 5.** - **potassium is more in *[inside]* the cell;** insulin helps the carry glucose. From the extra cellular to the where it is used for energy. **Glucose** is just a vehicle. - Give the patient **insulin, and glucose** so that as the glucose is being carried into the cell. - as **the glucose is carried as insulin is carrying the glucose** - as **insulin** is carrying the glucose into the cell the **extra potassium joins** in the extra cellular, which is causing the **hyperkalemia** can now move into the cell. So, now it moves into the cell, and we can normalize our body. - we **use insulin and glucose** in ***hyperkalemia***. - **low potassium** Causes the **digoxin toxicity**. - What medication the jobs that you\'ve heard before? - Digoxin is all called **[cardiac glucoside]** it helps to control **the movement of heart like helps in contractility of heart** - **We cannot give** digoxin if epical pulse is **less than 60**, and you must hear the **epical pause for 1 for a minute**. - When the patient\'s **potassium level is low, they will have *[digoxin toxicity ]*** - **We cannot give both medications together [digoxin and florisemin]** - [Florisemin potassium wasted, and it can cause the digoxin toxicity.] **[signs and symptoms of hypokalemia and hyperkalemia]** -textbook - The pharmacology book - fundamentals. **2 sodium** - **Normal sodium is high in the extracellular fluid**. - It controls **brain function** - Sodium control \-- ***brain function*** - Low sodium cause - lethargy - **seizures** - **tenderness with stability restlessness** - neurological issues - **low potassium** -- digoxin toxicity - **low sodium -- lithium** toxicity. - Lithium mood stabilizer - Sodium medications that deal with **a brain** Can be affected by medication that look like that affects the muscle. Medication that deals with our hearts will be affected by, by hormones that affect it looked like I pick the hearts similar. - **Digoxin and lithium** have a small or narrow therapeutic window. - **digoxin therapeutic level** -- **0.5 -- 2** - **Lithium therapeutic level** -- **0.6 -- 1.2** - **normal creatinine level** -- 0.6 to 1.2 - **normal BUN level** -- 6 or 8 -- to 24 mg/dL - **Creatinine** is a part of the electrolytes that tells you about your **[kidney]** function. +-----------------------------------+-----------------------------------+ | 1. | **3.5 to 5** | +-----------------------------------+-----------------------------------+ | 2. | **134 to 145** | +-----------------------------------+-----------------------------------+ | 3. | **0.6 to 1.2** | +-----------------------------------+-----------------------------------+ | 4. | **6 to 24** | +-----------------------------------+-----------------------------------+ | 5. | **1.010 to 1.030** | +-----------------------------------+-----------------------------------+ - **low salt** cause **lithium toxicity** - Sign and symptoms are - *Restlessness* - *Trauma* - *Seizure* 5. **[calcium]** - controls your excitability and reflexes - Chvostek and Trousseau signs are typically associated with low calcium levels (hypocalcemia), not low sodium (hyponatremia). - **Chvostek's sign:** This is observed when **[facial muscles]** twitch after tapping the facial nerve near the cheek. It indicates increased neuromuscular excitability due to low calcium. - **Trousseau's sign:** This involves a **[carpopedal spasm]** (involuntary contraction of the muscles in the hand and wrist) when a blood pressure cuff is inflated above systolic pressure for a few minutes. 1. Positive Chvostek's -- face - If you put that a patient\'s face in the facial nerve, the pressure would Twitch the twitching is considered Chvostek's sign. - Also indicated of hypocalcemia 2. Trousseaus -- arm - if you put a BP coughing patients arm and inflated the ankles inward. - That is a sign of low **calcium** hypocalcemia. - Hyperactive defender reflexes **low calcium** - Hypoactive deep tendon reflexes **high calcium** +-----------------------------------------------------------------------+ | - | +-----------------------------------------------------------------------+ | - | +-----------------------------------------------------------------------+ - **Deep tendon reflects**. How do you check the reflex? you use a little **[reflex hammer]** if the pt knee and even the chefs, like about to kick you real hard. - That is hyperactive too active. - That is a sign of **hypocalcemia they just jack** - a **little bit jack +2 = normal deep tendon reflex** - **Reflex. +5** is a bad - don\'t move their knee That is **hypoactive** Not good type. **- hyperactive = knee kick** **- hypoactive = no movement** **- normal deep tendon reflex= little bit jack** - **Calcium and magnesium** are similar. +-----------------------------------------------------------------------+ | - - **symptoms of hypocalcemia** same as **hypo magnesium** | | | | - **symptoms of hypercalcemia** same as **of hypo magnesium**. | | | | - | +-----------------------------------------------------------------------+ **[4. PHOSPHATE]** - phosphates normal is 2.5 - 4.5 - it really comes into play with patients that have **renal failure.** Kidneys are not working anymore, and your protection and phosphate is lost to your kidneys. They keep all the potassium in their body. That means they can become **hypokalemia** easily. They keep all the phosphate in their body. I mean, they can become hyperphosphatemia. - We have a medication called **calcium acetate** now we give these patients with End-stage renal disease (ESRD) every meal to eat food the **calcium acetate** will bind to their phosphate first phase and get rid of it in just stool. - [**calcium and phosphate** are Enemies.] - So that\'s why for end stage disease we give them **calcium acetate** with every meal. - So that when they eat the phosphate in their meal is absorbed by the calcium and excreted. ***[5. Magnesium]*** - **Magnesium mad** is a drag - **High magnesium** \-\-\-\-\-\-\-\-\-\-\-\-\--excited - low magnesium\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- drags - The treatment of **magnesium toxicity** is **Calcium gluconate** Same treatment for hyperkalemia - Magnesium toxicity, also known as hypermagnesemia, occurs when there is an excess of magnesium in the body. This condition is most commonly seen in individuals with impaired kidney function, as the kidneys are responsible for excreting excess magnesium. It can also result from excessive intake of magnesium-containing medications, such as antacids or laxatives, or from high-dose IV magnesium treatments (e.g., for preeclampsia in pregnant women). - [**Tonicity of solution**] psychology textbook as a page 1. ***hypertonic solution*** - less of concentration than the blood causes some kind of swelling of the of the cell. 2. ***isotonic solution*** meaning there are normal. 3. ***hypotonic solution*** is solution high concentrate cause shrinking. - **Isotonic = 0.9**% - **hypotonic =** 0.45% - **hypertonic = 3**% same solution, but different concentrations. how much it takes you the patient have per day? +-----------------------------------------------------------------------+ | Input | +-----------------------------------------------------------------------+ | outputs | | | | - intake and output are similar | +-----------------------------------------------------------------------+ hormones - **ADH- balance the fluid volume** - **aldosterone - save sodium push potassium** - White looking substance - Why do patients need to have TPN? ***For example***: - Patent **abdominal surgery** - We gave them nutrition that avoids the ***internal system***. Meaning they\'re not going to eat, does not go to stomach and intestines. They're not going to pop it out. - If the **system is resting from surgery**, the GI tract (interior system) - we have to use the **[parenteral system]** which is the veins use your vein to give you solution that contains the thing you would have gotten if you are eating. [**Total parental nutrition** ] [[Total parenteral nutrition: MedlinePlus Medical Encyclopedia]](https://medlineplus.gov/ency/patientinstructions/000177.htm) - It contains the right nutrients that your body need to function normal. - this solution is **hypertonic** it has **sodium, sugar, and fat** E.T.C - 1^st^ they will do **a basic metabolic panel** by Draw your blood then Find out what electrolytes blood look like and **a customized bag** of food fill with nutrients and electrolytes minerals for patient. - Then the nurse will come and hang it in an **IV bag,** and body. - And we have to use central line. 1. **a central line-**goes to major vein and doesn't burn s much. - You must have a filter because the fact that you are given to the patient might have emotion. Some particles. You don\'t want that to enter the patient\'s blood. - Because if the patient blood, it can cause a **[fat embolism]** and that can kill the patient. 2. **a peripheral line** -- goes to small vein - **[Complications of TPN ]** **1.hyperglycemia** - TPN is a sugar continuous substance which is hypertonic sugar level can go high 2.They can **have infection**, or sepsis, - If we don\'t follow proper asset, the technique where you\'re giving the patient, the medications IV intravenously. 3.They can get a **fluid overload** - If you give it too fast, but it can become too overloaded. 4.High blood pressure 5\. Shortness of breath 6.edema 7\. Jugline distension (the pain in the neck), because too much fluid in their body. - **What solution to use when runs dry inadvertently?** \-\-\-- **deksol 10%** - It means air has entering the patient\'s body that is as **dangerous because** **[Air embolism] can occur** and can die air heart. - which is - shortness of breath of - feeling of impendent doom - traditional level will go lower -95 - if somebody wants out of **TPN** before the changing of the dose for 24 hours, you need to give them another **hypertonic solution**. - Give them same tonicity as TPN called **deksol 10%** - That has a **high tonicity** That\'s what you\'re going to give to the patient and that will help the patient sustain until this time for the next TPN. - Fat embolism is caused by particles of fat blocking a blood vessel, while **[air embolism]** is caused by a bubble of air. - if your patient has **Air embolism**, or Air goes to central line we need to put patient a particular position is **called left Lateral recumbent position or semi -prone position or Sim recumbent.** - **Left lateral decubitus or left lateral recumbent position** - Putting a patient **left side** you are trapping the air in the atrium, but it doesn\'t have a chance to, in touch with the **heart system** And eventually the air will melt. - **head down** - Leg up - No medications for treating **hyperkalemia** just so you guys never this is the red, so you cannot I didn\'t tell you. - **never administer potassium in IV be pushed never** It will cause heart attack. - Correct, potassium should never be administered via IV push because it can lead to severe, potentially fatal consequences, including a heart attack (cardiac arrest). When potassium is given too quickly, it disrupts the heart's electrical signals, which can cause life-threatening arrhythmias. - Instead, potassium is typically administered slowly via an IV infusion, diluted in a suitable volume of fluid, and under careful monitoring of the patient's cardiac rhythm and serum potassium levels. This ensures the electrolyte is absorbed gradually, reducing the risk of adverse effects. - it has to be given to a piggyback. I run over an 1 hour 10 ML - when prisons have capital punishment, and they are dying by little injection, they give them potential IV push to kill them. - **It has to go slowly because potassium Burns** Cause **a vesicle** you have to go slowly over time. ***[F]****[. Magnesium]*** - **Magnesium mad** is a drag - **High magnesium** \-\-\-\-\-\-\-\-\-\-\-\-\--excited - low magnesium\-\-\-\-\-\-\-\-\-\-\-\-\-\-\-- drags - The treatment of **magnesium toxicity** is **Calcium gluconate** Same treatment for hyperkalemia **[Now, that the nursing process video here for you to look at,]** I can discuss it now, but that\'s something to focus on. Okay back. You see how I\'m coming back to the same information over and over.  - **Hyponatremia** -- cause lithium toxicity. - **Hypokalemia** - cause digoxin toxicity. +-----------------------+-----------------------+-----------------------+ | **1.Potassium\-\--3.5 | **Hypokalemia | **Hyperkalemia** | | - 5 MEq/L** | (digoxin toxicity)** | | | | | | | | **-Treated by** | | | | | | | | **-** **Sodium | | | | polystyrene** | | | | | | | | **-** **insulin and | | | | glucose** | | | | | | | | **-** **calcium | | | | gluconate** | | +=======================+=======================+=======================+ | **2. sodium -- 134- | **Hyponatremia | **hypernatremia** | | 145** | (lithium toxicity)** | | +-----------------------+-----------------------+-----------------------+ | **3. calcium** | **hypocalcemia** | **hypercalcemia** | +-----------------------+-----------------------+-----------------------+ | **4. magnesium** | **hypomagnesemia** | **hypermagnesemia** | | | | (**Magnesium | | | | toxicity)** | +-----------------------+-----------------------+-----------------------+ | 5\. **phosphates | **Hypophosphatemia** | **Hyperphosphatemia** | | -2.5 - 4.5** | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ | | | | +-----------------------+-----------------------+-----------------------+ - **Pregnancy** induce **hypertension**. - **Preterm labor** is treated with **magnesium sulfate.** - Remember if somebody\'s having too many contractions, we want to drop things down give them magnesia to slow things down. If we give them too much magnesium to **slow things down**, - the antidote is **calcium gluconic**, which is also used for **hyperkalemia**. - Patients in **[end stage renal disease]** received ***[calcium acetate]***. +-----------------------------------------------------------------------+ | - Calcium and magnesium are always proposing one another and never | | ever agree **like water and oil**. | | | | - | +-----------------------------------------------------------------------+ - They can never mix. - phosphates number 2.5 -- 5 - **[How do you treat hypokalemia?- ]** - **Sodium polystyrene** generic name. - **insulin** and **glucose** the data - **calcium gluconate** which is also used for **[magnesium overdoes]**. **APA formatting on your tests**. **[Thermoregulation \--]** temperature control. - normal temperature by - **Fahrenheit= 97F to 99F** - **Celsius= 36 C to 37.2C** - Metod of checking temperature? 1. Oral (by mouth)- most common 2. Axillary 3. Rectal -most accurate for child 4. Tympanic (by ear) 5. Temporal (forehead) l -children. - Checking temperature by rectal can cause skin tear if the pro doesn't not lubricate properly it can lead to spray infection specially to patient who are **immunocompromised.** - Immunocompromised low white blood cell. - **normal white blood cell 5000 -- 10,000 thousand** Site Temperature f = 1-p C = 0.5- p ------------------ --------------------- ------------ ***3.Rectal*** 99.6 F 37.5 C ***2.Oral*** 98.6 F 37 C ***1.Axillary*** 97.6 F 36.5 C - **Hypothermia** means **being cold**. - **Hyperthermia** means being **very warm**. The temperature can drop. - In the operating room temperatures, I can very cool because bacteria cannot grow very well in good temperatures. So, the problem is always cold so that bacteria don\'t grow. - Right the same thing for **hyperthermia** temperature levels too high. - It\'s also dangerous for the body, especially for your children was with children, they can end up having **seizures**. - for children, give them a hybrid temperature. Don\'t come down, give them Tylon but keep them in that temperature. Because if you don\'t do that, they can also get into **seizures.** - **malignant hypothermia** caused by **anastatic succinylcholine** - If a patient is getting it in surgery and if they are allergic to this anastatic, and they get it in surgery, guess what the patient\'s temperature go So high I both **104 105, and the body gets too rigid** and sometimes patients die from that. - **[Malignant]** means very **dangerous** Hypothermia. - What is the treatment? **Dantrolene (dantrium)** - And once it happens the family member, there needs to start when a bracelet that says do not give this **anestheti**c to that to that family. **Pharmaceutical management of fever** - A genetic in nature remember that, because anchors asked about it, that\'s why I want to mention it here. How do we treat fever? 1. Aspirin\-- dangers even if its in counter. 2. Tylenol 3. acetaminophen - hepatotoxicity 4. ibuprofen - which is your but Tylenol and acetaminophen a similar thing. I want to say maximum find. Adam is 4000 milligrams or 4 grams. - For your older adults, it is **3 grams**, because as amino acids can cause **hepatotoxicit**y. - It can damage your **liver** and what enzymes have to do with the liver. They call it - alkaline phosphate (ALP) - Alanine Transaminase (ALT) - Aspartate transaminase (AST) - Those liver enzymes can be damaged are really high from **[acetaminophen.]** Liver metabolizes medication. - **non-pharmacologic management fever** - remove extra floating - tepid bath - Hydration - Use fan and cooling blanket - Wet their body - rest - **non-pharmacologic** that is not medication related that can truly help your patients feel better. **12 cranial nerves**  The **12 cranial nerves** are essential for various sensory and motor functions, originating from the brain and passing through different openings in the skull. Here\'s a list of the cranial nerves with their primary functions: **1. Olfactory Nerve (I)** - **Function**: Smell (Sensory) - **Key Role**: Transmits sensory information from the nose to the brain. **2. Optic Nerve (II)** - **Function**: Vision (Sensory) - **Key Role**: Transmits visual information from the eyes to the brain. **3. Oculomotor Nerve (III)** - **Function**: Eye movement, pupil constriction (Motor) - **Key Role**: Controls most of the eye\'s movements, including constriction of the pupil and maintaining an open eyelid. **4. Trochlear Nerve (IV)** - **Function**: Eye movement (Motor) - **Key Role**: Controls the superior oblique muscle, which allows the eye to move downward and laterally. **5. Trigeminal Nerve (V)** - **Function**: Sensation in the face, chewing movements (Both Sensory & Motor) - **Key Role**: Transmits sensory information from the face and controls the muscles used for chewing. **6. Abducens Nerve (VI)** - **Function**: Eye movement (Motor) - **Key Role**: Controls the lateral rectus muscle, responsible for moving the eye outward (lateral movement). **7. Facial Nerve (VII)** - **Function**: Facial expressions, taste (Both Sensory & Motor) - **Key Role**: Controls muscles for facial expressions, transmits taste sensations from the anterior two-thirds of the tongue, and controls tear and salivary glands. **8. Vestibulocochlear Nerve (VIII)** - **Function**: Hearing and balance (Sensory) - **Key Role**: Transmits sound and balance information from the inner ear to the brain. **9. Glossopharyngeal Nerve (IX)** - **Function**: Taste, swallowing, salivation (Both Sensory & Motor) - **Key Role**: Transmits taste from the posterior one-third of the tongue, controls some muscles for swallowing, and stimulates the parotid gland (salivation). **10. Vagus Nerve (X)** - **Function**: Control of PNS (heart, lungs, digestive tract) (Both Sensory & Motor) - **Key Role**: Controls functions of the heart, lungs, and digestive tract, as well as transmitting sensory information from internal organs. **11. Accessory Nerve (XI)** - **Function**: Shoulder and neck movement (Motor) - **Key Role**: Controls the sternocleidomastoid and trapezius muscles, which are responsible for shoulder and neck movements. **12. Hypoglossal Nerve (XII)** - **Function**: Tongue movement (Motor) - **Key Role**: Controls muscles of the tongue, important for speech and swallowing. **Mnemonic to Remember Cranial Nerves:** **O**h- **O**h- **O**h-**T**o-**T**ouch-**A**nd-**F**eel-**V**ery-**G**reen-**V**egetables,-**A**h-**H**eaven! This corresponds to: 1. **O**lfactory (I) 2. **O**ptic (II) 3. **O**culomotor (III) 4. **T**rochlear (IV) 5. **T**rigeminal (V) 6. **A**bducens (VI) 7. **F**acial (VII) 8. **V**estibulocochlear (VIII) 9. **G**lossopharyngeal (IX) 10. **V**agus (X) 11. **A**ccessory (XI) 12. **H**ypoglossal (XII) The **Glasgow Coma Scale (GCS)** is a neurological scale used to assess a person's level of consciousness after a brain injury. It is based on three components: **Eye Opening (E)**, **Verbal Response (V)**, and **Motor Response (M)**. Each component is scored separately, and the total score ranges from **3 to 15**, with 15 being fully alert and 3 indicating deep unconsciousness or coma. **Components of the Glasgow Coma Scale:** **1. Eye Opening (E): Score 1 to 4** - **4** = Spontaneous (opens eyes without prompting) - **3** = To sound (opens eyes in response to a voice) - **2** = To pressure (opens eyes in response to physical stimulation) - **1** = None (does not open eyes at all) **2. Verbal Response (V): Score 1 to 5** - **5** = Oriented (responds coherently, knows who and where they are, and the time) - **4** = Confused (disoriented conversation, but can respond) - **3** = Inappropriate words (random or inappropriate speech) - **2** = Incomprehensible sounds (moaning, but no words) - **1** = None (no verbal response) **3. Motor Response (M): Score 1 to 6** - **6** = Obeys commands (can perform simple actions, such as squeezing a hand when asked) - **5** = Localizes pain (purposeful movement towards painful stimulus) - **4** = Withdraws from pain (pulls away from painful stimulus) - **3** = Abnormal flexion to pain (decorticate posture; flexes arms inward in response to pain) - **2** = Abnormal extension to pain (decerebrate posture; extends arms and legs in response to pain) - **1** = None (no motor response) **Total Glasgow Coma Scale Score:** - **Mild brain injury**: GCS 13-15 - **Moderate brain injury**: GCS 9-12 - **Severe brain injury**: GCS 3-8 A GCS score of **3** is the lowest possible, indicating deep coma or death, while a score of **15** is the highest, indicating full consciousness. The GCS is widely used in emergency settings to assess a patient\'s consciousness level and to track changes over time. - [**Glasgow coma scale** ] - maximum is 15 the - three things and the Glasgow commerce skill is - verbal response -5 - motor- 6 - eye opening -4 You must also know the lowest number you can have in Glasgow coma scale is 3 not 0. - **that less than 3 it means\-\-\-- dead** - **less than 8 means\-\-\-\-\-\-\-- comma** this assessment is very **subjective** because I might ask someone to give them a 14 A better man somebody, I gave them 12 So you have to also use your other assessments to see what\'s going on your patient. - It accesses **Neuro function** like =sodium - Reflexes= calcium and magnesium - if someone has **[hyperactive deep tendon reflex]**- hypocalcemia - if someone is **[hypoactive deep tendon reflex]**- hyper calcium - hypermagnesemia and hypercalcemia Hyperactive reflexes = Hypocalcemia (low calcium levels) ---------------------------------------------------------- Hypoactive reflexes = Hypercalcemia (high calcium levels - **Babinski reflex** - mostly Pediatrics use it. - When you touch the 2 of the of a child their foot - After 2 years, or somewhat more than 1 who did less than 2 but after 2 years old, when you, when you, when you start to swallow a bit of each of the feet. Your point in. - ***positive Babinski*** is a funny for child less than 2. - ***Negative Babinski*** It should go in word so if I\'m adults Something is wrong Neurologically. The **Babinski reflex** is a neurological reflex that is assessed in infants and is used to evaluate the integrity of the central nervous system, particularly the spinal cord and brain. Here's a detailed overview: **Definition** - The Babinski reflex is a response observed when the sole of the foot is stroked. It is characterized by the extension of the big toe and often fanning out of the other toes. **How to Test the Babinski Reflex** 1. **Positioning**: The patient (usually an infant) is laid down comfortably. 2. **Stimulus**: Using a pointed object (like a pen cap or the end of a reflex hammer), the examiner lightly strokes the lateral aspect of the foot from the heel to the toes. 3. **Observation**: - **Positive Babinski Response**: The big toe extends upward (dorsiflexes) and the other toes fan out. - **Negative Babinski Response**: The toes curl downward (plantar flexion). **Age and Normal Responses** - **Infants**: A positive Babinski reflex is normal in infants up to about 12 months of age. This is due to the immaturity of the nervous system. - **Adults**: A positive Babinski reflex in adults is considered abnormal and may indicate neurological damage or dysfunction in the pathways connecting the brain and spinal cord. **Clinical Significance** - **Positive Babinski Reflex in Infants**: Indicates normal neurological development. - **Positive Babinski Reflex in Adults**: May indicate: - Lesions in the corticospinal tract - Conditions such as multiple sclerosis, amyotrophic lateral sclerosis (ALS), or other neurological disorders **Conclusion** The Babinski reflex is an important neurological test that helps assess the functioning of the nervous system. Understanding the normal and abnormal responses is crucial for healthcare providers in diagnosing potential neurological conditions. - **Position** - **decorticate position** - **decerebrate position**. [- Decorticate position- cort] - When patients are in coma status put their arm in cortex the patient is still protecting their code. - is a better position neurologically for someone who is lethargic or not doing well. [- Decerebrate position ] - a person like this extension of the arms. - The **brain stem is damaging** your brainstem controls your breathing center. - That person might be dead already or close to dying. +-----------------------------------------------------------------------+ | - - | +-----------------------------------------------------------------------+ - You understand that on the specific gravity. - understand your solutions like iso, hyper, hyo **Key Differences:** **Feature** **Decorticate Posture** **Decerebrate Posture** ------------------- ------------------------------------- -------------------------------------- **Arm Position** Flexed at elbows, close to body Extended straight out **Leg Position** Extended Extended **Hand Position** Clenched fists Palms facing down **Indication** Damage above brainstem (cortex) Damage at the level of the brainstem **Severity** Less severe neurological impairment More severe neurological impairment **Conclusion** Both decorticate and decerebrate postures are signs of significant neurological impairment and can help clinicians assess the severity and location of brain injury. Prompt evaluation and management are essential for patients exhibiting these postures.