PRN 1178 client centered care 2 exam 1 already passed

PRN 1178 client centered care 2 exam 1 already passed 4 main functions of water in the body Act as a vehicle of transportation of substances to and from cells 4 main functions of water in the body Aid heat regulations by providing perspiration which evaporates 4 main functions of water in the body Assist with maintence of hydrogen balance in the body 4 main functions of water in the body To serve as a medium for the enzymatic action for digestion How much of the body is water? More than half - 60% males contain 50% females contain 60% due to fat tissue Lose more fluid through skin than adults Infants - kidneys are not as efficient as adults less fluid absorption Adults - age related decline in total body water Diminished thirst sensations; decrease in urine concentrating abilities of kidneys; decreases the effectiveness of the antidiuretic hormone (ADH) Hypovolemia Abnormal decrease in the volume of blood plasma (occurs with dehydration or bleeding) What is critical in maintaining homeostasis Water Cells can't function without Water - death will occur Electrolytes are Minerals or salt dissolved in body fluid. Major source is from diet Electrolytes are measured MEq/L Electrolytes in A solution breaks into particles known as ions from reactions from hydrogen and electrolyte Ions Develop a positive electrical charge known as citations; for each positive charge in a fluid compartment there must be a negatively charged anion so that the balance is maintained Circulating blood volume 4 to 6 liters Erythrocytes Red cells - carried in plasma Leukocytes White cells - carried in plasma Platelets thrombocytes - carried in plasma Cancer Results from defect in DNA genes; Inherited or caused by mutation; carcinogens is external and internal environment ***men and women who are overweight by 40% or more have a 33%-35% greater risk of developing cancer than persons of normal weight*** Environmental agents Carcinogen exposure ( x-rays, sun, UV light, lifestyle, tobacco use ) viruses are capable of introducing new genetic material into normal cell and transforming it into a malignant one Cancer warning signs Unusual bleeding; sores that don't heal; change in bowel or bladder habits; lump in breast or other part of the body; nagging cough; dysphangia (difficulting swallowing); change in mole cancer prevention Make early detection; nitrite and food additives - cancer stimulators; moderation in drinking alcohol too much can cause liver damage, vitamin c (bacon) Common problems cancer Anorexia; malnutrition; mucositis; weight loss of 2 or more lbs per week; fatigue; hyperuricemia- elevated uric acids; immunosuppression decreases WBC Biopsy Sample of tissues Radiologic X-Ray; CT ; MRI Endoscopy Scope of throat Laboratory Blood + urine Dietary requirements- malignancies ( cancerous tumors) Foods high in protein and calories, bland, lukewarm; carbonated drinks can be tolerated but not taken with meals 1 hr before or after; *** caffeine, rich or fatty foods AVOID*** Mucositis- irritation and inflammation of the mucosa in the mouth Mouth must be moist; swish and spit meds for PAIN RELEIF; maintain oral hygiene Cancer nursing interventions Medications: antiemetic's - monitor for dehydration and electrolyte imbalance Immunosuppression : keep comfortable, encourage oral intake Ineffective coping: be honest, positive approach, psychosocial and spiritual care Palliative care- comfort care : netting the needs of the dying put by providing comfort and maintaining a high quality of life. - allow pain free death - transdermal medications - rectal pain meds End stage symptoms Pain, dyspena, death rattle, delirium Osmolaity Concentration of the solution determined by the # of solutes in it *** normal osmolality of body fluids : 280 to 294 mOsm/kg (millions miles per kilogram) nonelectrolyte solutes Protein, urea, glucose, creatinine, bilirubin Electrolytes contribute to The osmolality of the ICF (intracellular fluid) Potassium maintains The osmolality of the ECF (extracellular fluid) Cations + Anion - For each positively charged cation in a fluid compartment There must be a negatively charge anion so the balance is maintained K+= 3.5-5.0 mEq/L Major intracellular cation NA+= 135-145 mEq/L Major cation of extracellular fluid CA+ = 8.4-10.6 mg/L Calcium - formation of bone and teeth Mg2+=1.3-2.1 mg/dl Magnesium- building bones and teeth PO43-=2.7-4.5 mg/dl Potassium- necessary for formation of ATP CL-=96-106 mEq/L Chlorine - helps maintain acid- base balance HCO3-=22-26 mEq/LA Bicarbonate- buffet that neutralizes excess acids in the body. Helps regulate acid- base balance Diffusion Substances move from an area of HIGH concentration to an area of LOW concentration Ex: capillaries in kings move between alveoli and capillaries Filtration Filtration, water and substances move through a semipermeable due to pushing force- hydrostatic pressure Ex: kidney filter Osmosis Diffusion of liquid across membrane Ex: fluid absorption Active transport requires Cellular energy, uses ATP Potassium/sodium cannot enter. Must be broke from electrolyte. Let's electrolytes move back and forth Hyponatremia Sodium- 135 mEq/L Restrict water intake as ordered for patients with congestive heart failure, kidney failure, and inadequate antidivertic hormone production; liberalize a low sodium diet; closely monitor patient receiving IV solutions to correct hyponatermia; replace water loss with fluids containing sodium Hyperkalemia Potassium- 5.0 mEq/L Decrease intake of foods high in potassium, increase fluid intake, provide adequate carbs to prevent use of body proteins for energy, proper insulin to patients with diabetes, salt substitutes Hypernatremia Sodium - 145 mEq/L Increase fluid intakes, I's and O's, give water between tube feedings, restrict sodium intake, monitor temperature Hypokalemia Potassium - 3.5 mEq/L Cardiac arrest, extra potassium must be given to help correct imbalance Hypocalcemia Calcium- 8.4 mg/dL Blood clotting, nerve condition, muscle contraction, cerpopedal soasm ( trousseau's sign). Hyperactive reflexes (chvostek's sign), laryngospasm may occur if deficit is severe Hypercalcemia Calcium - 10.6 mg/dL Administer diuretics, monitor I's and O's, encourage high fluid intake ( ml/ day) Hypomagnesemia Magnesium- 1.3 mEq/L DNA and protein synthesis, magnesium imbalances and rare Monitor IV infusions Hypermagnesemia Magnesium 2.1 mEq/L Avoid abuse of laxatives and OTC, encourage fluid intake to increase urinary excretion, I's and O's, administer diuretics as ordered Hypophosphatemia Phosphate- 3.0 mg/dL Vitamin D deficiency, overuse of aluminum- containing antacids Hyperphosphatemia Phosphate- 45 mg/dL IV fluid therapy, calculation of IV fluid rates, monitor weight Hypertonic solutions More solute outside the cell than inside the cell. Water molecules leave the cell, this water loss causes the cell to shrink Hypotonic solutions There is more solute inside the cell than outside the cell, causing the cell to expand, as the water volume inside the cell increases Isotonic solutions Same amount of solute of both sides of the cell, it will remain stable, neither shrinking nor swelling Fluid imbalance happens when The body has too much (excess) or too little (deficit) water Fluid imbalances signs and symptoms Dizziness; confusion; cool dry skin; dark concentrated urine; low BP; poor skin turgor; high pulse; flat neck veins when laying down; thirst; weakness fluid overload Cardiac issues; renal shut down; can't move blood through vascular system; edema/pitting; stomach distending too much fluid in the intercellular space fluid volume deficit Dehydration; depleting electrolytes; potassium shift; diabetes