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Fluid overload- too much fluid in the blood.

Sodium is increased and there is a high


volume of extracellular body water. It happens in congestive heart failure, kidney and liver
failure. Also in iv transfusions containing sodium, high intake of sodium or reactions to blood
transfusions, corticosteroid therapy.
Symptoms: peripheral edema, ascites, pulmonary edema, dyspnea.
Treatment: diuretics, fowlers position, limited intake of water, restriction of sodium.

Asthma chronic lung disease where the air ways become swollen, narrow and more mucus
is produce. This drives to wheezing in exhale, shortness of breathe, chest tightness, pain.
It is not known the cause but it is supposed to be genetically determinated or triggered by
allergens (animal dander, dust, gases, perfumes) common cold, emotions, stress, smoke.
Tests: peak flow (how hard you breath out) and spirometry .
Medication: inhaled corticosteroids (rhinocort), beta agonists or anticholinergics ipatropium
(atrovent) oral corticosteroids (prednisone).

COPD obstructive lung disease cause characterized by long term poor airflow. Main
cause- smoke. Others: long exposure to irritants: chemicals, air pollution, dust.
Symptoms: shortness of breath with physical activities , cough sputum, chest tightness,
wheezing.
Tests: spirometry (FVC- forced vital capacity, FEV1 forced expiratory volume in 1 sec; x-
ray.
Treatment: bronchodilators. Anticholinergic- ipratopium, short-acting beta-agonist
salbutamol (ventolin), corticosteroids, pulmonary rehabilitation, stopping smoking.

Pneumonia inflammation of the alveoli, caused specially by bacteria and viruses.


Symptoms: cough, sputum, fast breathing and shortness of breath, low oxygen saturation, fast
heartbeat, fever, chest pain, fatigue, diarrhea, nausea vomiting, delirium, low BP.
Tests: x-ray, FBC, sputum culture.
Treatment: antibiotics/antivirals, fluids.

Myocardial infraction- necrosis of heart muscle secondary to lack of oxygen supply.


Symptoms: crushing chest pain, jaw, arm, neck or back pain > 30 min. nitroglycerine has no
effect
- shortness of breath, sweating, nausea, vomiting, fast heart rate
Treatment- immobilization, oxygen therapy, administration of aspirin, transfer to hospital.
Low-salt, low-fat, low-cholesterol diet.
Angina- pain is bursting, burning, pressing the chest it reduces with nitroglycerin.

Hypovolemic shock- due to loss of blood/body fluids.


Symptoms: low blood pressure, anxiety, tachycardia, weak pulse, cold, clammy skin,
tachypnea, hypothermia, dry mouth, fatigue, altered mental state.
Therapy: blood transfusions, infusion of electrolyte solutions, O2 therapy.

Cardiogenic shock- heart is damaged to sustain blood supply. (AMI, acute mycarditis,
arrhythmias).
Symptoms- the same + distended jugular veins
Therapy: O2, cardiac drugs.
Septic shock: infections leads to low blood pressure and low blood flow.i.e ARDS. Same
symptoms but not in the first stage (fever). O2, restore intravascular fluid via IV, antibiotics.

Anaphylactic shock: reexposure to allergen cause high release of histamine and


vasodilatation. (drug, food allergies, bites)
Symptoms: polyuria, respiratory distress, hypotension, fainting, urticaria, angioedema,
vomiting.
Therapy: removing agent, iv fluids, o2, anti-histamine medications/

Urea- 2.5-7.8 mmol/l


Potassium (K) 133-146 mmol/l
Chloride (Cl) 95 -108 mmol/l
Creatinine (plasma) 64-104 mmol/l

FBC full blood count


Hb w 12-15.5 g/dl, m 13-17.5 g/dl
PCV (hematocrit) 0.370-0540 L/L
RBC 10^12 L = 4.00-6.50
MCV (mean cell volume) 79-96
MCH- mean corpuscular hemoglobin 27-32
RDW (red cell distribution width) = 12-13.50
PLATELETS 140-400/10^9L
WBC- 4.00-11.00
NEUTROPHILIS- 2.00-7.50
LYMPHOCYTE- 1.00-4.00
MONOCYTES- 0.20-1.00
EOSINOPHILIS- 0.04-0.40
BASOPHILIS- 0.01-0.10

Coagulation
PT (prothrombin time) measures the extrinsic clotting of blood (11-13 sec)
APTT (activated partial thromboplastin time) intrinsic pathway -25-38 sec
TT- thrombin time -9-35
Fibrinogen 2-4g/l
INR 0.9-1.3
Bleeding time 3-7 min

Cardiac enzymes checked in MI


Creatine kinase
Gasgow Coma scale is used to assess the grade of consciousness for people who suffered
brain injury/coma stroke, general trauma, poisoning. Consists of 3 elements: eye response,
verbal and motor response. The result 3 means deep coma and 15 fully awake person.
Brain injury:

Severe, with GCS < 89


Moderate, GCS 8 or 912
Minor, GCS 13.
Should be completed on half hourly bases till the score reaches 15. If GCS =15, observe half
hourly for 2 hours, then 1 hourly for 4 hours, then 2 hourly thereafter. If the states deteriorates
between the 2 hours and GCS <15 then again monitoring every 30 min.

Renal impairment (renal failure, renal insufficiency) kidneys fail to filter


metabolic waste from blood. The 2 main forms are acute kidney injury reversible and chronic
kidney disease irreversible.
AKI happens when blood supply to kidney is interrupted > toxins.
Causes : prerenal hypovolemia, low blood pressure, heart failure, liver cirrhosis, renal vein
thrombosis.
Intrinsic- glomerulonephritis, acute tubular necrosis.
Postrenal- urinary tract obstruction benign prostate hyperplasia, kidney stones, bladder
stones.
AKI is also caused by nephrotoxic drugs. Overdose of paracetamol/ ibuprofen.
Symptoms:
- fatigue, loss of appetite, nausea, vomiting, rash, irregulars heart beats
Treatment d/c of antibiotics/ drugs causing impairment, diuretics, removing obstructrion, iv
line, hemodyalisis.
Chronic kidney disease is often caused by diabetes miellitus and uncontrolled hypertension:
polycystic kidney disease.
Symptoms:
-hypertension, uremia, hyperkalemia, anemia, edema, pulmonary edema, hyperphosphatemia,
hypocalcemia, acidosis.
There are 5 stages which evaluates the glomerular filtration rate.
Treatment- transplant, dyalisis, control of hypertension.

Altered urine ouput hypovolemia, bleeding, vomiting, diarrhea, burns, fever< output
-diabetes miellitus, hyperthyroidism, hypercalcemia, diabetes insipidus, hemochromatosis
polyuria
-deacreased muscle tone in obesity, multiple pregnancies, immobility, catheterization
-neurological injuries like stroke or spinal cord injury can cause retention of urine
- diuretics polyuria
- antidepressants, antihistamines, narcotics urinary retention
- kidney obstructions, prostatic hyperplasia oliguria
- sodium levels high oliguria
- heart failure oliguria
- AKI, CKD- oliguria
- UTI - oliguria
- high intake of food and fluids
-dehydration
- catheter blockage

Anuria - <100 ml urine/ day., nausea, weakness, vomiting.


- insertion of catheter, dextrose, dobutamine
Oliguria 100-400 ml/day
Polyuria - >2500 ml/day
Dysuria- painful urination in UTI, STD, kidney stones, vaginitis, benign prostate
hyperplasia.
Urinalysis MSU (midstream specimen of urine) , CSU (catheterized specimen urine),
dipstick urine test, macroscopic ( clear and yellow without any cloudiness), foamy urine-
proteinuria
Result- normal bacteria absent
Leukocyte esterase absent
WBC- < 5; >10 pyuria
Nitrate- absent, present= bacteria
RBC < 5; >5 hematuria
Epithelial cells < 5 = good urine sample
pH 4.5-8

Types of catheters:
Size- range form 8-18 Fr diameter
Types intermittent with one opening, single use
- foley inflatable balloon (5cc-30cc) known as indwelling has 2 openings
- continuous catheter with 3 openings 1 to drain urine, 1 inflate balloon 1 irrigate
bladder
- coude curved tip for men with enlarged prostate or for obstruction
- suprapubic
- condom catheter for those without obstruction or bladder condition. Rather for
dementia
PEG percutaneous endoscopic gastrostomy is a medical procedure in which a tube is
inserted in the stomach by endoscopic guidance. It is recommended in stroke, while
swallowing muscles are weak, and the feeding cannot take place. It is used an anesthetic for
the abdominal wall. The endoscope is inserted and shows the place where to insert the tube. A
canula is then inserted and a wire which is pulled through mouth, than the tube is attached to
the wire and pulled through abdominal wall. The push method is that one in which the tube is
pushed into the stomach.

Nursing care of peg- 360 daily rotation, 2 times/day clean the site with soap and water,
deflate./inflate every week, check the position, the leakage, infection signs, flushes.

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