| what are some symptoms of hypokalemia? | muscle weakness and ileus (lack of peristalsis), serious cardiac arrhythmias such as ventricular tachycardia |
| what is the function of the thyroid gland? | *secrete thyroid hormones - regulate the rate at which calories are burned
*regulates basal metabolic rate - hormones
*secretes calcitonin |
| Risk factors for thyroid function? | *The incidence of thyroid dysfunction increases with age
*Those with other autoimmune disease, e.g. type 1 diabetes, Addison’s disease, coeliac disease
*A family history of thyroid dysfunction
*more common in woman |
| what is hypothyroidism? | deficient levels of thyroid hormones
(low basal metabolic rate) |
| what does primary, secondary and tertiary hypothyroidism indicate? | Primary means the problem is with the thyroid gland itself.
Secondary means it is a result of a disorder of the anterior pituitary gland where TSH is produced.
Tertiary is when the hypothalamus ceases to make enough TRH |
| Common causes of hypothyroidism? | *hashimotos thyroidistis - most common (autoimmune disease of the thyroid)
*Previous treatment for hyperthyroidism ie: Loss of thyroid tissue - thyroidectomy, radioiodine treatment, anti thyroid medication
Iodine deficiency
*Drug induced hypothyroidism such as from Lithium
*Congenital Hypothyroidism (Guthrie Test) can retard growth and mental development |
| symptoms of hypothyroidism? low BMI | *intolerance to cold
*constipation
*weight gain
*fatigue
*muscle weakness |
| what is hashimotos thyroiditis? | Is an Autoimmune Disease and is the most common cause of hypothyroidism
Characterized by the destruction of thyroid cells through auto immune-mediated destruction leading to progressive fibrosis |
| diagnostics tests for hashimotos ? | *Thyroid stimulating hormone (TSH) test: A high TSH level most commonly means the thyroid gland is not producing enough T4 hormone.
*Free T4 test: A low T4 level suggests that the person has hypothyroidism.
*Antithyroid antibody test: Presence of antibodies indicates a higher risk of developing Hashimoto’s hypothyroidism. |
| what is the treatment for hypothyroidism? | levothyroxine - synthetic form of thyroxine (T4) is converted by the liver to the active form of T3 |
| nursing considerations for hypothhyroidism? | *promote activity - give rest periods
*thermal regulation - blankets, heaters etc
*altered body image - think about phycological support
*educate on Decreased metabolism means medications such as opioid and anesthetics will be in the body longer, therefore more chance of increased effects/overdose.
*decreased cardiac output - risk of atherosclerosis |
| what is myxedema coma? | life threatening severe untreated hypothyroidism leading to decreased mental status, hypothermia, and other symptoms related to slowing of function in multiple organs. |
| what is hyperthyroidism? (high basal metabolic rate) | excess thyroid hormones than the body needs |
| risk factors for hyperthyroidism? | * female, aged over 60
*Have been pregnant or had a baby within the past 6 months
*Hx of thyroid surgery or goitre
*Have a family history of thyroid disease
*Have another autoimmune disease such as type 1 diabetes or primary adrenal insufficiency.
*Increased iodine ie ingesting to much iodine from food or using iodine-containing medicines or supplements |
| causes of hyperthyroidism? | *Grave's disease, which is an autoimmune disorder in which the immune system attacks your thyroid which results in the thyroid making too much hormone. This is the most common cause of hyperthyroidism
*Thyroid nodules, which are basically growths (normally benign) on the thyroid. They nodules may become overactive and in turn produce too much thyroid hormone.
*Thyroiditis, is as the name suggests inflammation of the thyroid. It causes stored thyroid hormone to leak out of the thyroid gland.
*Too much iodine. Iodine is found in some medicines, cough syrups, seaweed and seaweed-based supplements.
*Medication induced hyperthyroidism can occur when people who take thyroid hormone medicine for hypothyroidism take too much of it perhaps due to not having the correct blood tests . |
| symptoms of hyperthyroidism? | sensitivity to heat
weight loss
tremors
diarrhea
enlarged thyroid
bulging eyes |
| what is graves disease? | autoimmune disease of the thyroid gland causing thyroid to hypersecrete thyroid hormone - most common cause of hyperthyroidism
Caused by thyroid antibodies that activate the TSH-receptors
Stimulates thyroid hormone synthesis and secretion and thyroid cell growth |
| what are the treatments for hyperthyroidism? | The primary treatment goals are to inhibit production of thyroid hormones and lessen the severity of symptoms
*Medication: Anti-thyroid Drugs (Thionamides)
Carbimazole
Propylthiouracil (PTU)
*Non-selective Beta Blockers as an adjunct
Propanolol
*Radioiodine Therapy:
Involves drinking a solution containing radioactive iodine that over time destroys the thyroid cells
*Surgery: Partial or full thyroidectomy |
| Carbimazole & Propylthiouracil are a class of antithyroid drugs (Thionamides) to treat hyperthyroidism, what is their mode of action? | metabolised to its active metabolite thiamazole (methimazole). It interferes with the synthesis of thyroid hormones by inhibiting thyroid peroxidase. |
| why would a non-selective betablocker (propanolol) be used for hyperthyroidism? | Provides rapid symptomatic relief of adrenergic symptoms:
Tachycardia
Tremor
Heat intolerance
Anxiety |
| why would a thyroidectomy be the first line of treatment for hyperthyroidism? | if there is Allergy to Iodine
Pregnancy
Large Goitre – enlarged thyroid |
| what medications are associated with thyroid dysfunction? | lithium - hypothyroidism - Monitor patients on Lithium, TSH and T4 are tested at baseline, then TSH at three months and annually thereafter.
amiodarone - both hypo and hyper - High iodine content with direct toxic effect on the thyroid gland. TSH at baseline and then six monthly for patients taking amiodarone |
| functions of cortisol in the body? | Regulates protein metabolism
Increases blood glucose
Regulates the action of cellular sodium-potassium pump
Helps regulate pH
Stimulates sympathetic response
Reduces immune response
Cause memory impairment
Chronic levels of high stress disrupt the feedback mechanism |
| what is Addison's disease? | autoimmune disorder (immune system attacks adrenal glands) insufficient levels of cortisol |
| primary adrenal insufficiency is caused by Addison's disease. what is secondary adrenal insufficiency caused by? (involved pituitary gland) | occurs when the pituitary gland doesn't make enough of the hormone ACTH.
Stoppage of Corticosteroid Medication
Surgical Removal of Pituitary Tumours - ACTH-producing tumours of the pituitary gland that cause Cushing’s syndrome
Tumours (most commonly adenoma), infection in the pituitary
Loss of blood flow to the pituitary (eg. post partum haemorrhage |
| what are the symptoms of addisons disease? | lack of energy or motivation (fatigue)
muscle weakness.
low mood.
loss of appetite and unintentional weight loss.
increased thirst. |
| what is adrenal crisis? | acute medical emergency caused by a lack of cortisol during physical stress such as infection, dehydration, trauma, or surgery |
| symptoms of adrenal crisis? | Hypotension
Hyperkalemia
Hyponatremia
Hypoglycaemia
Confusion/Loss of Consciousness |
| treatment of adrenal crisis? | Administration of glucocorticoid - Dexamethasone is the initial drug of choice
Fluid and electrolyte replacement are essential
A short ACTH stimulation test may be performed during resuscitation
Followed by hydrocortisone 100 mg IV every 6 hours is the preferred treatment to provide mineralocorticoid support
Fludrocortisone- a mineralocorticoid |
| what is cushings disease? | Exclusively describes excessive cortisol production arising from a pituitary tumour secreting the hormone ACTH |
| what is cushings syndrome? | Excessive levels of cortisol in the blood
Tumours of the adrenal glands producing cortisol |
| causes of cushings syndrome? | Most common cause - taking medications that have cortisol, including: hydrocortisone, prednisone, topical skin ointments, asthma inhalers and joint steroid injections |
| what is the symptoms of cushings syndrome/disease? | buffalo face/moon face
weight gain
slow healing - reduced immune response
Headaches
Tiredness/fatigue
Depression/irritability/anxiety
stretch marks - striae |
| what are some health impacts of diabetes? | increased risk of heart attacks and strokes
Cardiovascular complications and neuropathy increase incidence of: risk of:
foot ulcers
Infection
limb amputation
kidney disease |
| what is the pathophysiology of diabetes type 1? | autoimmune disease - destruction of insulin-secreting beta cells of the islets of Langerhans in the pancreas - Results in an absolute deficiency of insulin - glucose cannot be moved out of bloodstream and into cells |
| what are some risk factors for developing type 2 diabetes? | HX of cardiovascular disease
BMI more than 30
HX of gestational diabetes
long term steroid use
Lifestyle: obesity, diet ,activity
smoking |
| central obesity - Fat accumulates in the pancreas, and this contribute to the decline in B-cell function, As insulin resistance increases Beta- cells compensate by producing increasing amounts of insulin Resulting in B-cell decompensation
Contributes to eventual B-cell dysfunction. true or false? | true |
| what is metabolic syndrome? | closely linked to obesity
characterized by Central/abdominal obesity - BMI > 30 ; waist circumference 102cm men / 88cm women
Hypertension
Dyslipidaemia – characterised by raised triglycerides and low HDL – increase
Insulin resistance/pre-diabetes
These factors individual;ly or in combination are associated withincreased risk of cardiovascular disease and diabetes (if not already diagnosed) |
| what is the pathophysiology of diabetes type 2? | develops when the receptor sites of cells becomes resistant to the effects of insulin (glucose cant enter cells) and/or when the pancreas stops producing enough insulin |
| what are the four main symptoms of diabetes? | polyuria - frequent urination
polyphagia - excessive hunger
polydipsia - excessive thirst
weight loss - body starts to break down fat |
| what is diabetic ketoacidosis? | acute metabolic complication of diabetes - mostly common with type 1
Insulin deficiency causes the liver to metabolize triglycerides and amino acids (fats) instead of glucose for energy which produces ketones |
| what are the symptoms of DKA? | Fatigue
Thirst, weight loss
Nausea, vomiting
fruity smelling breath
metabolic acidosis |
| what are some causes of DKA? | infection
intoxication
not taking insulin
heart disease |
| what are the diagnostics of DKA? | ABG's
Urinalysis – glucose levels/keytones
Serum ketones |
| treatment of DKA? | IV fluid replacement and insulin – type 1
Bicarbonate may be given if marked acidosis (pH < 7) persists after 1 h of therapy
Insulin may be withheld until serum potassium is ≥ above 3.3 mmol/L |
| what is Hyperosmolar hyperglycaemic state? | more common in type two - characterized by severe hyperglycaemia
extreme dehydration due to osmotic diuresis resulting in tachy and hypotension
absence of significant ketoacidosis – no ketones as beta cells still producing some insulin
altered consciousness |
| what are the causes of hypoglycaemia? | Insulin , sulfonylureas – taking medication and not eating – too much insulin
Lower than normal food intake
Higher than normal energy expenditure
Post partum in type I diabetes – woman has used up all stored glucose during labour |
| what is the compensation for hypoglycemia? | Glucagon stimulates liver to release stored glucose and adrenaline increase in response to acute hypoglycaemia and research shows this is the body’s first line of defence |
| what is the treatment for hypoglycemia? | Eat/drink 15-20 grams of glucose for example- glucose tablets gel tube, 2 tablespoons of raisins, 1/2 cup of juice, tablespoon sugar or honey, 4-6 hard candies, jellybeans
Follow with some complex carbohydrates for example a sandwich or a scone
Recheck blood glucose
Glucagon - to release stored glucose
Injectable glucagon is important if unconscious |
| what are the complications of diabetes? | Retinopathy - retinal ischemia due to blood vessel changes – microvascular – more prone in type 2. ;largest cause of blindness
Nephropathy – most common cause of end stage renal disease -30% type I (onset begins 10yrs post diagnosis) – 40% type II develop this (onset begins 5-8yrs post diagnosis
Neuropathy - may lead to amputation
Cardiovascular Disease:
Coronary Artery Disease (CAD) – linked to duration of disease – most common cause of death type II diabetes
Stroke twice as common in people who have diabetes (ischemic)
Peripheral Artery Disease (PAD) Peripheral vascular disease (PVD) more common in type 2 diabetes leading cause of amputation – neuropathy – where ppl don’t experience pain – non healing wunds |
| what is the pathophys of diabetic retinopathy? | Microaneurysms – occurring in blood vessels, membrane can become damaged
intraretinal haemorrhage
Exudates – vhange in permability - leakage
macular oedema, ischemia – immune process
vitreous haemorrhage – increase pressure |
| what is the treatment for diabetic retinopathy? | Achieving target levels: BGL, HbA1C, BP, lipid levels – managing ranges - below 50
retinal laser photocoagulation - ;Laser of new blood vessels |
| what are the causes of nephropathy? | by the metabolic and hemodynamic changes of diabetes
glomerular sclerosis and fibrosis – capilires changing permeability – loose nephrons
progressive albuminuria
hypertension and renal insufficiency – as kidneys deteriote contribute to hypertension – RAAS system is effected – spiraling downfall – effects oter systems |
| diabetic neuropathy is the result of? | nerve ischemia due to microvascular disease
direct effects of hyperglycaemia on neurons
intracellular metabolic changes that impair nerve function – nerve impulse is lost – sensation is lost . Messages are getting lost |
| what are the complications of peripheral neuropathy? | Paraesthesia - pins and needles
Painless loss of sense of touch, vibration or temperature In the lower extremities
Symptoms can lead to blunted perception of foot trauma e.g. due to ill-fitting shoes and abnormal weight bearing
Foot ulceration and infection
Fractures and dislocation – painless
Destruction of normal foot architecture (Charcot joint)
Necrosis, gangrene
Amputation |
| what are some complications for autonomic neuropathy? | orthostatic hypotension
urinary retention/incontinence
resting tachycardia
Dysphagia |
| what does a limb assessment for diabetics involve? | need to assess for neuropathy
check pulse dorsalis pedis and prosterior tibial artery
monofilament - check sensation |
| how does diabetes exacerbate atherosclerosis? | Hyperglycaemia
Hypertension
Dyslipidemia – lipids, adds to growth of plaques
And in type two diabetes – hyperinsulinemia – high insulin
Damage to endothelial lining causes an inflammatory response - swelling, edema, inflammatory mediators |
| in coronary artery disease, what are the proinflammatory & prothrombotic
effects of hyperglycaemia & hyperinsulinemia? | Cause an inflammatory response
Increase vascular permeability
Cause endothelial dysfunction
Contributes to hypertension
Contributes to dyslipidaemia |
| what does HBA1C refer to? | glycated hemoglobin.
measures the proportion of hemoglobin molecules in the blood that have become chemically bonded with glucose over the last three months |
| The target HbA1c in most patients with diabetes is? | < 53 mmol/mol |
| what does an annual diabetes review involve? | Blood pressure
Examine feet (including skin, nails, deformity) monofliament
Review HbA1c, eGFR, creatanine, BUN, lipid profile, LFTs, TSH(more prone to developing fatty liver disease)
Urinalysis |
| what else would you check? | Retinal photoscreening up to date
CVD risk
Smoking status, alcohol intake and recreational drug use
bgl diary |
| what is the step wise treatment approach for diabetes type 2? | Step 1: Lifestyle interventions
Add metformin - first line treatment
Step 2: Add a second oral hypoglycaemic agent:
empagliflozin, dulaglutide, vildagliptin, a sulfonylurea or pioglitazone (can be taken with metformin) stimulate beta cells to produce more insulin
A third can be added instead of stepping up to insulin
Step 3: Add insulin start on 2 units and gradually build up |
| what are the three ways metformin works to treat hyperglycemia ? | Decreases glucose formation in the liver
Increases peripheral utilisation of glucose by increasing sensitivity to insulin at insulin receptors on cell membranes
Decreases glucose absorption in the intestine |
| what is the major defence against urinary tract infection? | complete emptying of the bladder during urination |
| what is Pyelonephritis? | kidney infection due to a UTI |
| why is UTI more common in females? | bacteria ascend the urethra to the bladder therefore the risk is higher in females |
| risk factors of UTI? | female
Abnormality of the urinary tract that obstructs the flow of urine
Diabetes – glucose in urine promotes bacterial growth
Immunocompromised
sex |
| signs and symptoms of UTI? | Dysuria
Frequency
Urgency
Burning sensation
Pressure in lower pelvic area
Only small amounts of urine passed |
| what is an uncomplicated UTI? | Any UTI occurring in an adult female who is not pregnant and has a normal genitourinary tract and a routine presentation of symptoms |
| what is a complicated UTI? | woman who are pregnant
children
abnormal gentiurinary tract
patients with a catheter
renal impairment |
| People with complicated UTI require urine testing for culture and susceptibility testing. True or false? | true |
| People with symptoms of uncomplicated UTI do not require a urine culture
and can be treated with no follow ups. True or false? | true |
| what is the first line treatment for a UTI? | Nitrofurantoin/macrobid - antibiotic |
| what is the mode of action of nitrofurantoin? | Bactericidal
Inactivates protein synthesis
Inhibits DNA synthesis
Inhibits RNA synthesis
Inhibits cell wall synthesis |
| how to prevent UTI? | Increase fluids-six to eight glasses of water daily, 8-ounce glasses a day- keep hydrated
Urinate regularly and when the urge arises
Urinate shortly after sex
Women should wipe from front to back |
| what is pyelitis? | inflammation of walls of the renal pelvis |
| What is the main complication of an untreated UTI? | Pyelonephritis-bacteria invade renal cortex and medulla |
| what are the symptoms of kidney infection from UTI? | High fever (fever > 38c)
Intense pain
Loin pain in upper abdo or back and sides
Nausea & vomiting - systemic infection |
| what is the treatment of kidney infection in the community with mild symptoms? | Augmentin |
| what is the treatment of a kidney infection for people who are systemically unwell, high fever, dehydrated, nausea & vomiting or during pregnancy ? | IV infusion ciprofloxacin antibiotic |
| what is urgency incontinnence? | overactive neurogenic activity - result from loss of neurological control - stroke, ms, spinal cord injury |
| what are the impacts of incontinence? | Depression
Feelings of shame
Loss of self-confidence
Social isolation
Sexual dysfunction
Financial difficulties (due to the cost of pads, bedding, laundry and reduced ability to work)
Loss of sleep |
| what is overflow incontinence? | obstruction at the bladder neck or an impairment of detrusor contractility - more commonly in males – involuntary release of urine |
| what is Benign Prostatic Hyperplasia ? | Age-associated prostate gland enlargement |
| what are the symptoms of benign prostatic hyperplasia? | Difficulty to start to void
Poor flow of urine
Stopping and starting/stuttering
Need to strain to pass urine
Frequency
Nocturia |
| how is BPH diagnosed? | international prostate symptom score
Urine Dip Test – rule out other complications
Digital rectal examination
A voiding chart/diary For 24 hours
Record frequency; how voiding occurs eg - difficulty starting, stuttering, flow
mild amounts of prostate specific antigen |
| what is a Prostate-specific antigen (PSA) test? | PSA is a protein produced by normal and abnormal cells of the prostate gland - test measures level in blood – may indicate cancer |
| what is the lifestyle treatment of benign prostate hyperplasia? | Lifestyle - Avoid liquids for one to two hours before going to bed
Avoid smoking tobacco, alcohol and caffeine
moderate exercise eg. walking for 30 to 60 minutes a day improve symptoms
kegal exercises to strengthen pelvic floor |
| what is the medication to treat BPH? | Finasteride or dutasteride - shrinks prostate - Blocks action of enzyme 5-alpha reductase – this enzyme usually changes testosterone to another hormone (DHT) that causes the prostate to grow
alpha blockers - relax bladder muscles – blocks alpha receptors |
| what is a eGFR test used for? | estimated glomerular filtration rate - measures level of kidney function and filter blood - based of creatinine |
| what is acute kidney injury AKI? | acute reversible decline in kidney function - can be life threatning |
| what are some pre renal causes of AKI? interference with renal perfusion (hypoperfusion) | - Trauma
-Heart failure
-Medication – NSAIDs, ACE inhibitors, ARBs (dilate arterioles of the efferent arteriole)
-GI bleeding |
| what are some instinct causes of AKI? | Acute tubular necrosis - ischemia to cells due to pre-renal causes or nephrotoxicity
Crush injuries - the release of myoglobin a protein released from muscle when injury occurs and haemoglobin to be released into the circulation causing renal toxicity/ischemia (clog up capilliries in glomerulus)
Acute glomerulonephritis - from infections
transfusion reaction |
| what are some post renal causes of AKI? Interference with the outflow of urine from the kidney | blockage to the flow of urine resulting in a back pressure to the kidney causing damage to nephrons
- obstruction in urinary tract
-prostatic enlargement
- Pelvic malignancy
- kidney stones |
| what are the four phases of AKI? | onset
oliguric
diuretic
recovery |
| The focus of management of acute kidney injury is to? | restore renal blood flow
treat urinary obstruction |
| what is chronic kidney disease? | gradual loss of kidney function leading to kidney failure - from long term damage to disease of the kidney |
| what are the symptoms of AKI? | decreased urinary output, swelling due to fluid retention, nausea, fatigue and shortness of breath |
| what us end staged renal disease characterized by ? | Renal functions are almost totally absent with GFR less than 5% of normal - dialysis or transplant required |
| what are the risk factors of CKD? | hypertension - artery walls that supply kidney become thick and narrow resulting in ischemia
diabetes - over time uncontrolled glucose can cause damage to the kidneys blood vessels - effects afferent arteriole causing pressure within the glorerulus
cardiovascular disease
nephrotoxic medications |
| how is CKD diagnosed? | eGFR); Creatinine; BUN and markers of kidney damage, urinalysis, imaging or biopsy |
| what are the markers of renal damage? | Persistent proteinuria/albuminuria
Persistent haematuria/WBC in urine
Red blood cell casts/dysmorphic cells on urine microscopy
Ultrasound/other radiological abnormalities |
| what are the six key assessments undertaken in CKD? | Annual cardiovascular risk assessment
Blood pressure
Weight
Urinalysis - Proteinuria and haematuria
Serum creatinine/eGFR, BUN
Serum Electrolytes |
| what are the treatment aims of CKD? | Early intervention to reduce progression towards end-stage renal disease
Monitoring and treatment of cardiovascular risk factors
Monitoring and treatment of complications
Maintaining blood pressure below target levels |
| what is the target blood pressure levels in people with CKD? | less than 130/80 mmHg, or less than 125/75 mmHg in people with diabetes |
| what are some systemic effects of end stage kidney disease? | Arrythmias
Edema
Prutitis - from excretion of waste products thru the skin
Bleeding
osteopenia/osteoperosis |
| what are some life style changes to prevent end stage kidney disease? | Control your blood sugar if you have diabetes.
Keep a healthy blood pressure.
Follow a low-salt, low-fat diet.
Exercise at least 30 minutes on most days of the week.
Keep a healthy weight.
Do not smoke or use tobacco.
Limit alcohol. |
| Three to four medications are required in CKD stages 3–5. what is the first line treatment? | ACE inhibitors, ARBS or diuretics - management of hypertension |
| why is osteoporosis a common complication of CKD? | kidneys are unable to convert vitamin D to its active form - due to reduced vitamin D - extra parathyroid hormone is released in the blood to move calcium from inside the bones into the blood
When vitamin D level is low, the absorption of calcium in the intestines becomes less, which then causes the level of calcium in the blood to go down. As a consequence the parathyroid glands become more active and produce more PTH that causes calcium to come out of the bones, therefore weakening the bones. |
| why is anemia a complication of CKD? | kidneys fail to produce erythropoitein which decreases stimulation of red blood cells production in bone marrow |
| what are some nursing education for people with end stage renal disease? | low protein diet
low sodium diet
strict fluid management - to prevent fluid overload
avoid unnecessary medications |
| what are some lifestyle treatments for osteoperosis? | Calcium - most easily absorbed from dairy products = the best source
Vitamin D – sun exposure plus some foods in small amounts such as oily fish e.g. salmon, sardines but adequate amounts are not usually attained through diet alone
Weight bearing exercise increases and maintains bone density
avoid smoking - decreases amount of 02 of bones |
| Alendronate (Fosamax) is a bisphosphonate for the treatment of osteoperosis, what is the mode of action ? | inhibits action of osetoclasts which decreases bone absorption |
| Electrolyte concentrations can be low when? | - electrolytes are normal and fluid volumes are high (dilutes electrolytes)
-Electrolyte amounts are low and fluid volumes normal |
| electrolyte concentrations can be high when? | - Electrolyte amounts are normal and Fluid volumes are low (makes electrolytes concentrated)
-Electrolyte amounts are high and fluid volumes normal |
| what are some sources of fluid loss? | Diarrhoea
Vomiting
Sweating/fever
Diuretics
Excessive urination
hemorrhage |
| what are some sources of fluid gain? | excess sodium intake
Congestive heart failure
Renal failure
cirrhosis of the liver - causes portal hypertension to cause ascites - fluid overload in abdomen |
| what are some factors that can increase the risk of a fluid or electrolyte imbalance? | diabetes
heart failure
eating disorders
dehydration
medications - diuretics
diarrhea/vomitting
infants - due to fast metabolism - vulnerable to dehydration |
| how do diuretics contribute to electrolyte imbalance? | promote fluid excretion by the kidneys and excess loss of sodium and potassium |
| how do OTC vitamins and minerals lead to electrolyte imbalance? | can cause increase in electrolytes |
| what is hyponatremia? | sodium levels in the blood are lower than normal |
| what are some causes of hyponatremia? | fluid retention due to cardiac or renal or hepatic failure |
| what are some symptoms of hyponatremia? | confusion, agitation, nausea and vomiting, muscle weakness, spasms or cramps |
| what cause hypernatremia? | anything that leads to excessive water loss or salt gain such as vomiting or diarrhoea |
| what are some symptoms of hypernatremia? | fever, irritability, drowsiness, lethargy and confusion |
| what are some symptoms of hypokalemia? | muscle weakness and ileus (lack of peristalsis), serious cardiac arrhythmias such as ventricular tachycardia |
| what are some causes of hyperkalemia? | excessive intake, tissue damage for example - burns or crush injury, potassium (necrotic cells release potassium into cirulation) sparing diuretics, renal failure |
| what are some symptoms of hyperkalemia? | muscle weakness, hypotension, bradycardia, cardiac arrest |
| what are some causes of hypocalcemia? | parathyroid disease, vitamin D deficiency (need vitamin D to absorb calcium in the GI tract), malnutrition, medications |
| what are some symptoms of hypocalcemia? | increased neuromuscular excitability - Confusion, memory loss, muscle spasms/cramps, numbness and tingling in the hands/feet/face, depression, hallucinations, decreased cardiac output, seizures |
| what are some causes of hypercalcemia? | parathyroid disease, dehydration, renal disease, OTC vitamin supplements and indigestion medication/antacids, lithium, some cancers |
| what are some symptoms of hypercalcemia? | weak muscles, arrhythmias, fatigue, confusion, headaches |
| what is bicarbonate (HC03) function? | main chemical buffer maintaining acid base balance |
| what are some indications for fluid balance monitoring? | Intravenous infusions
Nasogastric tubes aspiration/drainage
Urinary catheterisation
Vomiting
Diarrhoea
Wound drains
Chest drains
Enteral feeding |
| medical conditions that can affect fluid balance? | heart failure
kidney failure
sepsis
hypovolemic shock
malnutrition |
| what are some things to consider in IV fluid assessment of patients? | Clinical presentation
Underlying health issues
Co-morbidities
Current medications
Physical examination
Observation of vital signs over time (trend)
Fluid balance chart
Weight chart |
| what are the Parameters for fluid resuscitation - the need for rapid fluid resuscitation? | Systolic blood pressure: <100mmHg
Heart rate: >90 beats per minute
Capillary refill: >2 seconds or peripheries cool to touch
Respiratory rate: >20 breaths per minute |
| what are the Five ‘Rs’ of intravenous fluid administration? | Resuscitation
Routine maintenance
Replacement
Redistribution
Reassessment |
| how does the respiratory system regulate acid base imbalances? | Chemoreceptors in the medulla oblongata sense changes in pH and vary the rate and depth of breathing to compensate.
Breathing faster and more deeply eliminates more CO2 from the lungs.
The more CO2 is lost, the less carbonic acid is made, and as a result the pH rises |
| How do the kidneys compensate for acidosis? | Acidosis causes more bicarbonate to be reabsorbed from the tubular fluid, while the collecting ducts secrete more hydrogen to generate more bicarbonate, |
| How do the kidneys compensate for alkalosis? | the renal system retains hydrogen ions and excretes basic substances primarily (bicarbonate) into the urine |
| What is the pathophys of respiratory acidosis? | Impaired respiration (hypoventilation) due to asthma, COPD or other respiratory conditions which causes co2 to retain in the blood causing acidosis |
| what is the pathophys of respiratory alkalosis? | hyperventilation or increase in respiratory rate causes too much co2 to be lost which makes the blood too alkaline |
| what are some factors that cause respiratory alkalosis? | Pain
pregnancy
stress
lung conditions
excercise |
| what are some causes of metabolic alkalosis? (Too much base, to little acid) | *Nasal gastric tube suctioning
*Vomitting
*Use of diuretic medication
*Hypokalemia |
| what are some causes of metabolic acidosis? (Too much hydrogen ions, to little bicarbonate) | Diarrhea
Renal failure
diabetic ketoacidosis
Sepsis - lactic acid build up |
| what is the meaning of stress? | feeling overwhelmed or unable to cope as a result of pressures that are unmanageable. |
| what is the meaning of anxiety? | necessary emotion that functions to protect us by eliciting a number of stress responses in the face of a stressor or threat |
| what is the Sympathomedullary Pathway (SAM) stress response in response to immediate threat of stress? | hypothalamus activates the sympathetic NS to trigger the adrenal medulla to release epinephrine and nor epinephrine into the blood stream (prepares for fight/flight response) |
| Chronic stress leads to a sustained sympathetic nervous system response = adversely affecting immune, cardiovascular, neuroendocrine and central nervous systems. True or false? | true |
| what are some common symptoms of stress? | anger, depression, anxiety,
changes in behavior e.g. frequent crying, social isolation, insomnia, tiredness, difficulty concentrating
changes in appetite |
| how would you explore the symptoms of anxiety that impacts on quality of life? SIT | Severity of symptoms
Impact of symptoms
how much time the symptoms are happening |
| Generalised anxiety disorder (GAD) is the most common of anxiety disorders. What are the key features? | -Excessive anxiety and worry in which a person becomes consumed by everyday situations and issues.
-The anxiety and worry is out of proportion to the event or issue
-Difficulty controlling the worry and find that it disrupts day-to-day functioning |
| what are the key symptoms of GAD? | Restlessness
Fatigue
Concentration difficulty
Irritability |
| what is the GAD-7 assessment tool used for people experiencing anxiety? | scoring system that measures peoples symptoms over the past 2 weeks -Guides patients treatment interventions |
| what are panic disorders? | Characterized by intense recurrent surges of anxiety (panic attacks) |
| what is a panic attack? | unexpected periods of intense fear or discomfort triggered by a perceived threat (absence of real danger) – fight or flight response |
| What are some common symptoms of panic attack? | Palpitations, shortness of breath, feelings of choking, chest pain or discomfort
Sweating, chills or heat sensation
Trembling or shaking
numbness or tingling |
| what are some nursing considerations for panic disorders? | Provide calm reassurance and a quiet low stimulus environment
Breath in and out of a paper bag
Coach client to use breathing techniques |
| what is agoraphobia? | Anxiety in situations where the person perceives their environment to be unsafe.
including being in a crowd
being outside the home
using public transport
going shopping
Social gatherings |
| what are specific phobias? | an intense, persistent fear of a specific object or situation that's out of proportion to the actual risk - spiders, food, heights etc |
| what is social anxiety disorder? | Marked persistent and unreasonable fear of being observed or evaluated negatively by other people in social or performance situations - often associated with embarrassment, judgment or humiliations |
| what is PTSD? | Presents following direct exposure to a traumatic event or multiple traumas, either by first-hand experience or by vicarious traumatisation
Usually occur within 3 months of the trauma but can present years later
Not diagnosed until one month after trauma |
| what are some key symptoms of PTSD? | Intrusive re-experiencing (nightmares, memories)
Hyperarousal
Persistent avoidance of trauma stimuli (avoiding external reminders and internal trauma-related experiences such as memories)
dissociation |
| what is acute stress disorder? | Very similar to PTSD, but usually diagnosed within 1 month of exposure to trauma |
| what is adjustment disorder? | an emotional or behavioral ongoing stress response to a stressful event or change in a persons life |
| what are the key symptoms of adjustment disorder? | Low mood, worry, a sense of inability to cope and withdrawal from activities with accompanying impairment in social or occupational functioning |
| what are some interventions nurses can provide for someone experiencing anxiety or have been diagnosed with anxiety disorders? | Psychoeducation - increases persons health literacy and self awareness, can help the person view anxiety as a normal emotion (websites, handouts, books)
social support - Can provide companionship, a sense of connection, increased access to resources and opportunities for engaging in activities that provide enjoyment |
| what are some therapies that can be used for people experiencing mental health disorders? | Cognitive behavioral therapy (CBT)
acceptance and commitment therapy (ACT)
Dialectical behavioral therapy (DBT) |
| what is mindfulness? | type of meditation that involves being aware of each moment of your day as it happens
It involves becoming aware of your thoughts, feelings and body sensations as you experience them
can assist with stress, anxiety and depression |
| what are the main classes of medications used for anxiety disorders? | Antidepressants
Benzodiazepines
Non-benzodiazepine Anxiolytic
Hypnotics
Beta-blockers |
| Benzodiazepines can be used for short term management of acute anxiety symptoms, what is their mode of action? | CNS depressants - bind to GABA receptors and increase the inhibitory action of GABA |
| What are the common side effects of benzos? | drowsiness, sedation, confusion, disorientation, memory impairment |
| Benzodiazepines have an anxiolytic, hypnotic, anticonvulsant and skeletal muscle effect, true or false? | true |
| how can hypnotics help treat anxiety? (temazepam) | Used to treat short-term or transient insomnia and to re-establish a good sleeping pattern which may alleviate anxiety symptoms |
| what impacts on how someone experiences a traumatic event? | Context
History
Current emotional state
Age
Abilities
Circumstances |
| what are the three E's of trauma? | Events, Experiences and Effects |
| what are some types of trauma? | Acute trauma
Complex trauma
Neglect trauma
Historical trauma/ intergenerational trauma
Sanctuary trauma / harm or betrayal trauma |
| what are some lasting effects of adverse childhood experiences? | heart disease
suicide
depression
life potentials
behaviors - smoking, STDs, pregnancy, drug use |
| what are some examples of ACES? | emotional abuse of child
physical abuse of child
use of illegal street drugs by parent or partner
depression of parent or partner |
| Protective and compensatory experiences (PACEs) are positive experiences that can increase resilience and protect against risk for mental and physical illness. What are some PACEs? | nurturing & attachment in early childhood
intergenerational support - social connections
mastery of skills - resilience and coping skills |
| what is the impact of trauma? | activated fight/flight/freeze response - hyperarousal - impacts on longer term - less rational thoughts - physical and psychological effects |
| how does trauma affect brain structure and function? | prolonged trauma causes neuroendocrine dysregulation, hyperactive HPA axis system and neurodegeneration |
| What other ways can prolonged trauma affect someone? | Cause an individual’s natural alarm system (stress response) to no longer function as it should
Create emotional and physical responses to stress
Result in emotional numbing and psychological avoidance
Affect an individual’s sense of safety
Diminish an individual’s capacity to trust others |
| what are some trauma symptoms? | Emotional and behavioural dysregulation (Physical stress responses)
Hyper-vigilance
Dissociation
Numbing
Amnesia, flashbacks and fragmented memory
Insomnia – either due to the trauma occurring at night, nightmares or via the arousal of sympathetic nervous system |
| what is complex trauma? | Long lasting anxiety response following exposure to extreme prolonged and/or repeated trauma that impacts mental, physical, social, emotional or spiritual wellbeing - usually occurs in childhood |
| what is borderline personality disorder? | mental health disorder of having very unstable relationships, having difficulty controlling emotions, moods and thoughts, and behaving recklessly or impulsively. |
| High numbers of people with a diagnosis of borderline personality disorder (BPD) have a history of repeated emotional, sexual or physical trauma and/or emotional neglect in their childhood. true or false? | true |
| what are some nursing considerations for someone with borderline personality disorder? | Focus on strengths and skills development/ Self responsibility/ Person is expert on self (self management)
create safe environment
validating relationships (recognition and acceptance of persons thoughts, feelings and behaviours)
clear communication |
| Psychological interventions are considered evidence-based and often preferable treatment options for trauma-related disorders. True or false? | true |
| what is trauma awareness? | requires an understanding how trauma impacts all people, everywhere. Trauma has affected most people
Requires a shift in thinking from “what is wrong with you” to “what happened to you and your whānau”. |
| what are the 4 R's of trauma informed care? | realize
recognize
respond
resist re-traumatization |
| what are the 6 guiding principals to a trauma informed approach? | cultural, historical and gender issues
safety
trustworthiness
peer support
collaboration & mutuality
empowerment, voice & choice |
| what is the aim of trauma informed care? | to enable people to develop resiliency - Resiliency is the capability of individuals to cope successfully in the face of significant change, adversity, or risk
people can recover |
| what is a trauma informed approach? | A trauma-informed approach is a strengths-based model of service delivery which focuses individuals strengths and competencies.
recognises and understands trauma can negatively affect wh nau, groups, organisations and communities, as well as individuals. in response to traumatic events (their own or others) can be improved if systematically addressed through prevention,
treatment, and achieving wellbeing. |
| what is Co-existing mental health and substance use problems (CEP), or dual diagnosis? | the co-occurrence of mental health and substance use problems in the same person at the same time |
| what are thr Interactions Between Substance Use and Mental Distress? | people who use substances may cause biochemical changes in the brain which may lead to mental health disorders
or
people who have mental health disorders may use substances to relieve symptoms |
| Underpinning Te Ariari The assessment and management of people with co-existing mental health and substance use problems is a philosophy representing a set of principles and values for working with people who have mental health and or addiction problems. Focusing on? | person centred care
well-being orientated
integrated care |
