Final Exam Study Guide/Final Exam Study Guide latet, Exams of Health sciences

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Head to Toe Head & Neck ● Lymph nodes (10) Eyes ● Inspect for color, shape, symmetry, position, & alignment of eyes ○ Corneal light reflex: light appears equally in the same spot on both pupils; strabismus (cross eye) ● Conjunctiva & sclera ○ Bulbar conjunctiva: delicate mucous membrane that covers the exposed surface of the sclera (white) ○ Palpebral conjunctiva: membrane that lines the anterior portion of sclera (uniformly pink) ● Lids: Lacrimal apparatus ○ Nasolacrimal sac: upper dilated end of the nasolacrimal duct; is lodged in a deep groove formed by the lacrimal bone & frontal process of the maxilla ● Confrontation ○ Peripheral vision ○ Pt can see fingers enter visual field (180 degrees) ● CN 2 Optic: S (visual acuity) ○ Snellen (far vision): myopia/nearsightedness ○ Rosenbaum (arms length): hyperopia/farsightedness ○ Ishihara (color vision) ■ od/os/ou ● PERRLA ○ Pupils ○ Equal ○ Round ○ Reactive to Light ■ CN 3 Oculomotor: M

■ Pupillary constriction (bringing light in from the side) ○ Accommodation ■ Constrict & converge (focus on something, then refocus on pen) ● Cardinal Positions of gaze (nystagmus or involuntary rapid eye movements, drifting) ○ CN 3 Oculomotor: M ○ CN 4 Trochlear: M ○ CN 6 Abducens: M ● Cataracts: cloudy or opaque areas in the ocular lens, temporary ○ Risk factors: Increasing age, Diabetes, high BP ● Glaucoma: a group of eye conditions that can cause blindness; often caused by an abnormally high pressure in your eye; permanent ○ Risk factors: having high internal eye pressure (intraocular pressure) ● Terms (exam 4) ○ Wk 9 terms: https://quizlet.com/585839860/week-9-terms- flash-cards/ Ears ● Inspect & palpate auricles for redness, swelling, tenderness ● Inspect external canal for redness, swelling, drainage, cerumen, foreign bodies ● Otitis externa: inflammation of external ear; allergic reaction to beauty/personal care products ● Otitis media: inflammation of middle ear; common in pt’s with environmental/seasonal allergies ● Weber (lateralization) ○ Vibration and sound equal bilaterally ● Rinne ( AC>BC 2:1) ○ Pt unable to hear or feel the sensation in one ear during Weber ○ Conduction : air conduction to bone conduction, hear it twice as long as you should be able to feel it ❖ Whisper ➢ Able to identify words Nose ● Inspect nares for symmetry, lesions, tenderness ● Inspect internal nares for inflammation, drainage

○ Make sure septum is midline, not deviated ○ Septal deviation: a condition in which the nasal septum (the bone and cartilage that divide the nasal cavity of the nose in half) is significantly off center, or crooked, making breathing difficult ○ Palpate pt’s nose assessing for pain, tenderness, swelling & deformity? ● CN 1 Olfactory: S ○ Can smell ⅔ odors ○ Patency: air is moving freely within nasal cavity ● Palpate sinuses ○ Frontal: superior orbital rim above eyebrow ○ Maxillary: superior aspect of the cheek bones (around eyes) ● Terms ○ Epistaxis: Nosebleed ○ Nasal flaring: Occurs when the nostrils widen while breathing; often a sign of trouble breathing ○ Nasal discharge: Excess drainage, ranging from a clear fluid to thick mucus, from the nose and nasal passages; rhinorrhea Mouth & Throat ● Inspect ○ Lips: color, moisture, cracking, lesions, ○ Oral mucosa: color, moisture, lesions (moist & pink) ○ Gums: color, swelling, retraction of gingiva, lesions (pink, smooth moist) ○ Teeth: decay, alignment ● Glossopharyngeal 9 & Vagus 10: B ○ Soft palate/uvula movement ■ Smooth, moist, pink, rises w vocalization ■ Uvula is midline ○ Speech quality ○ Swallow ■ Dysphagia: difficulty swallowing ○ Gag reflex ○ Only 9: verbalize taste ● Hypoglossal 12: M ○ Color, saliva, symmetry, open areas ○ Ease & equality of tongue movement

○ Strength of tongue ● Tonsils: color, exudate, lesions ● Thyroid assessment ● Throat pain ● Swollen lymph nodes ● Thrush: An infection in which the fungus Candida albicans accumulates in the mouth Cardiovascular ● Inspect/palpate color, temperature, texture of skin, hair distribution in extremities ● Observe the neck and precordium for visible pulsations ○ Precordium: portion of the body over the heart and lower thorax, APEToMan ● Capillary refill < 3 seconds ● S1: best heard at apex (loudest in mitral); closure of mitral & tricuspid valves; “LUB”; low pitched & dull; beginning of ventricular systole ● S2: best heard in aortic area at base of heart; closure of aortic & pulmonic valves; “DUB”; end of ventricular systole; shorter, higher- pitched, louder sound than S ● S3: ventricular gallop; may be cardinal sign of heart failure in adults; best heard at apex with pt lying on left side; low-pitched; the y sound in “Ken-tuck-y”; follows S2; may also be associated with such conditions as pulmonary edema, atrial-septal defect, acute MI and last trimester of pregnancy ● S4: atrial gallop; heard over tricuspid or mitral areas with pt on left side; heard in elderly, or those with HTN, aortic stenosis, or a history of MI; commonly describe as sounding like; “Ten-nes-see” ○ Murmurs: regurgitation of blood between atrium & ventricles (valve isn't closing all the way) ○ Thrills: palpable vibration: usually valvular dysfunction ○ Heaves: lifting of the chest wall felt during palpation ○ Bruits: abnormal “swooshing or blowing” heard over blood vessel; stenosis or occlusion ■ Feel a thrill, hear a bruit ❖ APETM ➢ Aortic: 2nd^ intercostal space R sternal border ➢ Pulmonic: 2nd^ intercostal space L sternal border ➢ Erb's point: 3rd^ intercostal space L sternal border

➢ Tricuspid: 4th^ intercostal space L sternal border ➢ Mitral: 5th^ intercostal space Midclavicular line ■ Bell & diaphragm ■ S1, S2 present, no murmurs, no abnormal sounds ❖ Aortic impulse ➢ 5th intercostal space, midclavicular line or MITRAL (palpate) ➢ Small pulsation is normal only in this location ❖ Pulses ➢ Radial pulse at the same time ➢ Dorsalis pedis pulse at the same time ➢ Or all of them? ■ +2, regular, equal bilaterally ❖ Edema ➢ If pt has, grading (+1 to +4: pitting, non-pitting, brawny, dependent) ■ 1+: 2mm, slight imprint/trace; pulse weak (0 or absent) ■ 2+: 4mm, moderate; pulse normal ■ 3+: 6mm, deep; pulse increased ■ 4+: 8mm, leaves deep imprint that slowly returns to normal; pulse bounding ➢ No edema bilaterally (wk 1) Respiratory ❖ Inspection ➢ Inspect color (cyanosis) & respiratory effort (inspect for ease, distress, cough) ➢ Shape & configuration, AP diameter 1:2 ratio (½ transverse diameter); barrel chested ➢ Clubbing of nailsBulging of the last part of the finger with curved, convex nails ➢ Related to reduced oxygen in blood ❖ Palpate anterior & posterior for lumps, masses, tenderness ❖ Auscultate, anterior & posterior ➢ Adventitious sounds: not normally heard in the lungs & result from air moving through moisture, mucus, or narrowed airways ➢ Diminished: hear to hear, dim, “quiet”; pneumonia ➢ Crackles: bubbling, crackling, popping; low- to high-pitched,

discontinuous sounds; auscultated during inspiration & expiration; opening of deflated small airways & alveoli; air passing through fluid in the airways (CHF, pulm edema, bronchitis) ➢ Rhonchi: sonorous or coarse; snoring quality, low-pitched, continuous sounds; auscultated during inspiration & expiration; coughing may clear the sound somewhat; air passing through or around secretions (bronchitis, COPD, cystic fibrosis) ➢ Rub: rubbing or grating; loudest over lower lateral anterior surface; auscultated during inspiration & expiration; inflamed pleura rubbing against chest wall ➢ Noting that all lung fields are clear & the pt was breathing regularly w/ no difficulty or use of accessory muscles ❖ Percussion ➢ Anterior and posterior thoracic region (lean forward, round shoulders) ■ Location, shape, size density of tissues ➢ Resonance: the prolongation & intensification of sound produced by transmission of its vibrations to a cavity during percussion; air filled, normal lung tissue ➢ Hyperresonance: greater than normal resonance (the prolongation & intensification of sound produced by transmission of its vibrations to a cavity), often of a lower pitch, elicited during percussion; pneumothorax ➢ Dull: the sound obtained by percussing over a solid body part that does not resonate, usually obtained over a body part or area containing less air than those parts or organs that do resonate; liver, mass, lobar pneumonia ➢ Flat: the sound obtained by percussion over solid areas such as bone; pleural effusion ➢ Noting terms & sounds flat, dull resonance upon percussion; equal ❖ Wheeze: musical or squeaking; high-pitched, musical, continuous sounds; auscultated during inspiration & expiration; air passing through narrowed airways (asthma, COPD) ❖ Stridor: harsh, loud, high-pitched; auscultated on inspiration; narrowing of upper airway (larynx or trachea); presence of foreign

body in airway ❖ Inspect shape & configuration, AP diameter ■ Inspect for cyanosis (blue mucous membranes) ■ Inspect clubbing of nails ■ AP diameter ❖ Lobes ➢ L lung 2 lobes ➢ R lung 3 lobes ➢ Main bronchus branches > secondary bronchi (one to each lobe) > bronchioles ■ Alveoli: small air sacs, site of gas exchange ■ Surfactant: reduces surface tension between moist membranes of alveoli; phospholipid ❖ Terms (wk 4) https://quizlet.com/572069000/week-4-5-terms-flash- cards/ Abdominal ❖ Inspect hair, color, scars, bumps ❖ Inspect contour (flat) ❖ Inspect symmetry ➢ Epigastric: Region of the upper abdomen immediately below the ribs ➢ Umbilical: region that surrounds the area around the umbilicus; contains part of the stomach, the head of the pancreas, the duodenum, a section of the transverse colon & the lower aspects of the left & right kidney ➢ Suprapubic: region of the abdomen located below the umbilical region ❖ Auscultate FIRST: 4 quadrants, clockwise (umbilicus midline) ■ Normoactive bowel sounds in all 4 quadrants ■ Bowel sounds ● Normoactive: High pitched, gurgling noises; Considered normal ● Hypoactive: Heard infrequently ● Hyperactive: loud, high-pitched tinkling sounds occurring frequently; Indicative of diarrhea ● Absent: >2 min, absence of motility,

peritonitis, ileus ❖ Light palpation for guarding, rigidity, masses, tenderness, motility ➢ Identify muscle resistance & tenderness & location of some superficial organs ➢ Palpate liver to check for enlargement & tenderness ➢ Cannot detect spleen; can cause rupture ➢ Location of organs (Quadrants) ■ RUQ ● Liver ● Right kidney ● Head of pancreas ● Duodenum ● Pylorus ■ RLQ ● Cecum ● Appendix ● Right ureter ■ LUQ ● Stomach ● Spleen ● Left kidney ● Body of pancreas ■ LLQ ● Sigmoid colon ❖ Percussion: direct or indirect used to detect; size & location of abdominal organs and/or air or fluid in the abdomen, stomach or bowel ➢ Direct: strike your hand or finger directly on patients abdomen ➢ Indirect: Use middle finger of dominant hand to strike a finger resting on patient’s abdomen: Begin in RLQ and proceed clockwise to all four quadrants ➢ Do not percuss the abdomen of pt. w/ abdominal organ transplant ➢ Two sounds normally heard ■ Tympany: clear hollow sound like drum beating heard over hollow organs ■ Dullness: muffled sound heard over solid organs

(liver) ❖ Bruits/pulsations ❖ Peristalsis: Contractions of the circular and longitudinal muscles of the intestines; Occur every 3 to 12 minutes; Moves waste products along the length of the intestine; Controlled by nervous system ❖ Ascites: Accumulation of fluid in the peritoneal cavity; caused by advanced liver disease, heart failure, pancreatitis or cancer (wk 7) Neuro/Mental Status ●^ Inspect appearance, behavior, cognitive functions, thought processes, & perceptions ● They are dressed appropriately for the weather, they have appropriate cognitive function upon assessment ● Appropriate thought process, pts affect is appropriate for pts age ❖ Inspect position, alignment of eyes (corneal light reflex) ❖ Facial (7): Sensory & Motor ● Symmetry of smile, frown, show teeth, puffed cheeks, raised eyebrows (muscle strength) ● Sense of taste (sweet, sour, salty) ● Corneal reflex (motor response): q tip ● Inspect gait ● Smooth, rhythmic, effortless, coordinated arm swing ● Trigeminal (5): Sensory & Motor ● Symmetry of sharp & dull stimuli of face ● Corneal reflex (sensory stimuli) ● Clench teeth tightly (masseter & temporalis strength) ● Stereognosis ● Pts identification of different items (pen, paperclip, quarter) ● Palpate carotid ● Orientation ● Reflexes ● Tricep reflex ○ C7 to C ○ Elicits involuntary contraction of the triceps brachii muscle ● Patellar reflex ○ L2 to L

○ Knee-jerk reflex ● Babinski’s sign ○ The plantar reflex that is a reflex elicited when the sole of the foot is stimulated with a blunt instrument Musculoskeleta l ●^ Abduction: moving limb away from midline ● Adduction: moving a limb toward body’s midline ● Supination: the assumption of the supine position (laying horizontal) ● Extension: the state of being in a straight line ● Flexion: the state of being bent ● Dorsiflexion: he action of raising the foot upwards towards the shin ● Crepitus: grating sound/sensation produced by friction between bone and cartilage or the fractured parts of a bone ● Contour: outline ● Symmetry: evenness ● Scoliosis: curvature of a portion of the spine to the side, laterally ● Lordosis: curving inward of the lower back ● Kyphosis: forward rounding of the back; hunchback Terms (exam 4) https://quizlet.com/583151111/week-10-terms-flash-cards/ ❖ Cranial Nerves CN S, M, or B? Assessments Description

1. Olfactory S ● Can smell ⅔ odors ● Patency Olfactory bulb located in frontal lobe of brain
2. Optic S Visual Acuity: ● Snellen ● Rosenbaum ● Ishihara Retina (rods & cones) transmit info to optic nerve to process
3. Oculomotor M ● 6 cardinal positions of gaze (nystagmus, ● Muscle function (around eyes)

drifting) ● Pupillary reaction to light (PERRLA) ● Pupil response ○ Controls size of pupil ○ Response to light

4. Trochlear M ● 6 cardinal positions of gaze ● Superior oblique muscle ● Eye movement
5. Trigeminal B ● Symmetry of sharp & dull stimuli ● Corneal (light) reflex: sensory ● Clench teeth tightly: masseter & temporalis strength ● Ophthalmic (forehead/scalp/upper eyelids) ● Maxillary (cheeks/upper lip/nasal cavity) ● Mandibular (ears/lower lip/chin)
6. Abducens M ● 6 cardinal positions of gaze Eye muscle movement: ● Lateral rectus movement ● Pons
7. Facial B ● Symmetry of smile, frown, show teeth, puffed cheeks, raised eyebrows ● Sense of taste (sweet, sour, salty) ● Corneal reflex: motor (Q tip) ● Muscle strength Pons of brainstem is complex ● Facial expressions/jaw muscles ● Sense of taste ● Supplying salivary/tear- producing glands ● Sensations to ear
8. Acoustic (Vestibulocochlear) S Cochlear: ● Weber ● Rinne ● Whisper test Vestibular: ● Romberg test Cochlear: ● Hearing ● Pitch/vibrations Vestibular: ● Balance/equilibrium ● Linear & rotational movements of head

9. Glossopharyngeal B ● Soft palate/uvula movement ● Speech quality ● Swallow (stylopharyngeus) ● Gag reflex ● Verbalize taste: sweet, bitter, salty ● Sinuses ● Sense of taste
10. Vagus B ● Soft palate/uvula movement ● Speech quality ● Swallow ● Gag reflex Sensation from ● Ear canal to throat ● Chest & trunk Motor control of ● Muscles in throat ● Stimulation muscles in chest & trunk
11. Accessory M ● Shoulder shrug ● Strength in turning head side to side: sternocleidomastoi d & trapezius muscle ● Controls muscles in neck (rotate, flex, extend) ● Spinal cord: control ● Cranial: medulla oblongata
12. Hypoglossal M ● Ease & equality of tongue movement ● Strength of tongue ❖ Skin ➢ Melanoma ■ A type of skin cancer that occurs when pigment producing cells called melanocytes mutate and begin to divide uncontrollably ■ ABCDE ● Asymmetry ◆ One side does not match other ● Border ◆ Irregular, ragged

● Color ◆ Not evenly colored ● Diameter ◆ Larger than 6mm across ● Evolving ◆ Changing in size, shape or color ➢ Pressure injuries ■ Ⅰ ● Nonblanchable ● Intact skin ● Erythema (red in color) ● Epidermis ■ Ⅱ ● Partial thickness ● Abrasions ● No adipose tissue ● Dermis ● Skin tear; blister ● No slough ■ Ⅲ ● Full thickness ● Adipose tissue ● Granulation ● Slough/eschar ● Tunneling ■ Ⅳ ● Full thickness ● Muscle & bone ● Undermining ● Epibole ■ DTI ● Deep tissue injury ● Intact skin ● Maroon/purple in color (looks like a bruise) ● Nonblanchable ● Stage 1 & 2 ( red = 1; purple = 2) ■ Unstageable

● Stage 3 & 4 (under slough/eschar) ● Slough/eschar ◆ Causes difficulty in discerning extent of tissue damage ● Full thickness ❖ Arterial insufficiency vs. venous insufficiency ➢ Arterial insufficiency ■ Chronic condition in which partial or total arterial occlusion deprives the lower extremities of oxygen and nutrients ■ Pulses decreased or absent ■ Pain may be present in feet/legs ■ Ulcerations in area of toes, foot usually turns deep red when dependent ■ Nails may be thick and rigid ■ Pale shiny skin ➢ Venous insufficiency ■ Includes disorders that result from increased venous pressure or valve damage of a vein wall ■ Ulcerations usually around the ankle ■ Pulses present but may be difficult to find because of edema ■ Foot may be cyanotic when dependent ■ Skin may have brownish discoloration ■ Edema may be pitting CRITERIA ARTERIAL VENOUS Pain: Intermittent classification, pain at rest Painful Mechanism: Tissue ischemia Venous hypertension Pulses: Decreased or absent Normal, through may be difficult to feel Color: Pale, dusky red Normal or cyanotic on dependency, petechiae, brown pigmentation Temperature: Cool Normal Edema: Absent/mild Present Skin changes: Thin, shiny, atrophic skin, loss of hair over foot and toes, nails thickened Brown pigmentation around the ankle, dermatitis

Ulcerations: If present, toes or trauma on feet Develops at sides of ankle Gangrene: May develop Does not develop Medications ➢ Beta Blockers ■ -olol ■ Decreases blood pressure ■ Side effects ● Fatigue ● Weakness ● Erectile dysfunction ● Bradycardia ● HF ● Pulmonary edema ➢ Benzodiazepines ■ -zepam ■ CNS depressant; controls anxiety; sedative ➢ ACE Inhibitors ■ -pril ■ Decreases blood pressure; treats HF ➢ ARB Blockers ■ -artan ■ Decreases blood pressure ➢ Calcium Channel Blockers ■ -dipine ■ Decreases blood pressure; treats chest pain; treats migraines ➢ Thrombolytics ■ -ase/-plase ■ Dissolves blood clots ➢ Corticosteroids ■ -sone ■ Treats asthma, arthritis, cancer, autoimmune disorders ➢ Bronchodilators (Beta2-agonists) ■ -terol ■ Treats asthma, COPD ➢ DPP4 inhibitors ■ -gliptin

■ Decreases blood sugar ■ Sitagliptin ● Side effects ◆ Pancreatitis ◆ Anaphylaxis ◆ Angioedema ◆ Exfoliative skin conditions (Stevens-johnsons syndrome) ● Interactions ◆ Risk of hypoglycemia when also on insulin, glyburide, glipizide, glimepiride ➢ Incretin mimetics ■ -tide ■ Decreases blood sugar ➢ Leukotriene antagonists ■ -ast ■ Treats asthma & allergies ➢ Proton pump inhibitors (PPI’s) ■ -prazole ■ Treats GERD, peptic ulcers & H. pylori ■ Take 30 minutes before meals ➢ Sulfonylureas ■ -ide ■ Decreases blood sugar; treats type 2 diabetes ➢ Biguanide ■ Metformin ■ Decreases blood sugar ➢ Anticoagulant ■ -arin ■ Prevents blood clots ■ Warfarin ● Side effects ◆ Calciphylaxis ◆ Bleeding ● Avoid foods high in vitamin K ◆ Broccoli ◆ Cauliflower ◆ Cabbage ◆ Brussel sprouts ◆ Kale

◆ Spinach ➢ Statins ■ -statin ■ Lipid-lowering medication; lowers cholesterol ■ Avoid grapefruit when taking ● Atorvastatin ● Lovastatin ● Simvastatin ■ Take at night ➢ Stool Softeners ■ Docusate, Senna ■ Prevents constipation ■ Take at night ➢ NSAIDs ■ Aspirin, ibuprofen, diclofenac ■ Relieve pain, reduce inflammation, brings down temperature ➢ Loop Diuretics ■ Bumetanide, furosemide, torsemide ■ Increases flow of urinal removes sodium & chloride from body in urine ➢ Anticonvulsants ■ -zepine/-in ■ Decreases incidence/severity of seizures ■ Gabapentin ● Side effects ◆ Suicidal thoughts ◆ Confusion ◆ Depression ◆ Dizziness ◆ Drowsiness ◆ Anaphylaxis ◆ Angioedema ◆ Multiorgan hypersensitivity reactions ● Take 2 hours after antacid (if you’re on one) ● Can interact with benzos Labs ➢ Na

■ 135-145 mEq/L ■ Cation in ECF ■ Hyponatremia <135 mEq/L (severe <125) ● Symptoms: No Salt VAN ◆ Vomiting ◆ Anorexia ◆ Nausea ● Causes: 5 D’s ◆ Diuretics ◆ Diarrhea ◆ Dehydration ◆ Drains (NG, Fistulas) ◆ Diet ● Symptoms ◆ Headache/irritability, muscle twitching, tremors ● Assessments: Lab value, VS (BP, HR, Temp, Neuro/Mental Status Assess, I&O ● Interventions ◆ Restricted fluid intake, I&O monitoring, Monitor VS (administer Furosemide) ■ Hypernatremia: >145 mEq/L ● Tachycardia ● Oliguria (dec. urinary output) ● BP (↑ then ↓) ● Seizures ● Symptoms: AFISH ◆ Anorexia ◆ Flush ◆ Irritable ◆ Sleepy ◆ Hot ● Common signs & symptoms: SALT ◆ Skin flushed ◆ Agitation ◆ Low-grade fever ◆ Thirst ● Causes ◆ Elderly with mental/physical impairments ◆ Acute infection

◆ Diuretics ◆ Diabetes ◆ Decreased LOC ● Symptoms ◆ Neurologic impairment, restlessness, weakness, disorientation, delusion, hallucinations ● Assessments ◆ Lab value, VS (BP, HR, Temp), dehydration (skin turgor), I&O ● Interventions IV Fluid replacement (D5W), Monitor VS, I&O, skin breakdown, encourage oral intake ➢ K ■ 3.5-5.1 mEq/L ■ Intracellular ■ Cation ■ Hypokalemia <3. ● K+ deficit in ECF ● Symptoms - 5 L’s ◆ Lethargy ◆ Lethal cardiac arrhythmia ◆ Leg cramps ◆ Limp muscles ◆ Low, shallow respirators ● Symptoms: muscle weakness, fatigue, dysrhythmias ● Causes - GRADE ◆ GI loss ◆ Renal/kidney ◆ Alkalosis ◆ Diuretics ◆ Eat (lack of) ● Assessments ◆ VS, labs, I&O, reflexes ● Interventions ◆ VS monitoring, ECG, K administration, labs (Mag level) ■ Hyperkalemia >5. ● Excess K+ in ECF (you typically die from having high K+) ● Symptoms - MURDER ◆ Muscle weakness ◆ Urine (oliguria/anuria)

◆ Respiratory distress ◆ Decreased cardiac contractility ◆ EKG changes ◆ Reflexes (hyper/hypo) ● Symptoms: nerve conduction changes, paralysis, murder ● Causes - MIKA ◆ Meds ➢ Supplements, ACE inhibitors, Beta blockers, NSAIDs, K+ sparing diuretics ◆ Intake ➢ Excessive intake of bananas, spinach, yogurt, high K+ foods ◆ Kidney ➢ Impaired ability to secrete fluid ◆ Acidosis ➢ Result of an increase in acid components or an excessive loss of bicarbonate ● Assessments ◆ Labs, VS, I&O, reflexes ● Interventions ◆ VS monitoring, ECG, labs, meds ➢ CO ■ 23 -29 mEq/L ■ Symptoms: headache, lightheaded, change in LOC, cyanosis, pain during expiration/inspiration, barrel chested, hyperventilating, clubbing, cap refill > ● Heart: organs unable to perfuse d/t < O2 resp ● Lungs: SOB, hyperventilation, AKI, trauma, infection ■ Labs: Na, CO2, GLU, Hgb, Hct, WBC ■ Diagnosis ● Alterations in Oxygenation; ineffective airway clearance, ineffective breathing pattern, impaired gas exchange ■ Outcome identification & planning ● Oxygenation problem ● The patient will: ◆ Demonstrate improved gas exchange in the lungs by an absence of cyanosis or chest pain ◆ Pulse oximetry <95% ◆ Exercise

◆ Demonstrate self-care behaviors that provide relief from symptoms and prevent further cardiopulmonary problems. ■ Implementing ● Promote/control coughing, suction, med administration, supplemental oxygen, manage chest tubes, artificial airways, CPR, teaching ■ Teach ● Vaccination, smoking cessation/environment, nutrition, reducing anxiety, positioning, fluid intake, incentive spirometry, breathing techniques, coughing meds, chest physiotherapy oxygen, chest tube, CPR ■ Meds ● Bronchodilators ● Liquefy or loosen thick secretions ◆ Reduce inflammation in airways ● Metered dose inhaler ● Nebulizer ● Dry powder inhaler ➢ Cl ■ 95-105 ■ Anion ■ ECF ■ Hyperchloremia ● Major causes ◆ Metabolic acidosis, head trauma, increased perspiration, decreased GFR ● Tachypnea, weakness, lethargy, decreased awareness, hypertension, decreased cardiac output, dysrhythmias, coma ■ Hypochloremia ● Major causes ◆ Vomiting/diarrhea, drainage of GI tube, metabolic alkalosis, diuretics, burns ● Hyperexcitability, tetany, hyperactive DTRs, weakness, muscle cramps ➢ BUN ■ 7-24 mg/dL ■ Backs up Cr findings ■ Formed in liver from ammonia

■ Excreted by kidneys ● Can be used to assess nutritional status ■ Evaluates kidney function & aids in diagnosis of renal or liver disease ■ Assessment of ● Hydration ● Effectiveness of dialysis ■ Symptoms: seizures, altered LOC, swelling, chest pain, tachycardia, BP changes, dyspnea, crackles, oliguria/anuria ● Heart: cardiac enlargement, HF, HTN ● Lungs: COPD, respiratory failure ● Kidneys: AKI, CKD ● GI: meds, obesity ■ Labs: Na, K, BUN, Cr, GLU, WBC, Mg, Phos ■ Cells overfilled ➢ Cr ■ 0.7-1.4 mg/dL ■ Provides a more sensitive measure of renal damage than BUN levels ● Stress on kidneys ■ Waste product from breakdown of tissue ■ Assessment of ● Glomerular filtration ● Renal damage ■ Symptoms: seizures, altered LOC, swelling, chest pain, tachycardia, BP changes, dyspnea, crackles, oliguria/anuria ● Heart: cardiac enlargement, HF, HTN ● Lungs: COPD, respiratory failure ● Kidneys: AKI, CKD ● GI: meds, obesity ■ Labs: Na, K, BUN, Cr, GLU, WBC, Mg, Phos ■ Cell overfilled ➢ GLU ■ 60-110 mg/dL ■ Symptoms ● Retinopathy, changes in LOC, dizziness, sweaty, tremors, HTN, palpitations, infection, renal failure, nephropathy, obesity, hunger, changes in urine, neuropathy ● Heart: blood vessel contraction, risk for CAD, HTN ● Lungs: reduced lung function, infection ● Kidneys: acute renal failure, nephropathy

● GI: meds, diet/obesity ■ Labs: Na, K, BUN, Cr, GLU ■ Affected by different hormones ● Insulin ◆ Lowers glucose level ◆ Secreted by Islet cells of the pancreas ● Glucagon ◆ Increases glucose level by breaking down stored glucose ◆ Secreted by Islet cells of the pancreas ■ Decreased levels of glucose to the brain (neuroglycopenia) ● Confusion ● Inability to concentrate ● Irritability ● Hallucinations ● Focal impairments ● Seizure ● Coma ● Death ■ Causes to low glucose ● Medications ◆ Insulin, antidiabetic medications, beta-blockers ● Alcohol ● Sepsis, acute kidney injury ● Hormone deficiency ● Tumor/mass ● Malnourishment ● Family history ● Strenuous exercise ● Age ■ Hyperglycemia ● ↑ Blood glucose levels ● Symptoms (3 P’s) ◆ Polyuria (frequent urination) ◆ Polydipsia (↑ thirst) ◆ Polyphagia (↑ hunger) ◆ Blurred vision ■ Hypoglycemia ● ↓ Blood glucose levels ● Symptoms

◆ Sweating, chills, clammy ◆ Shakiness ◆ Confusion ➢ Hct ■ 35-45% ■ Measures percentage by volume of RBCs in a whole blood sample ● 40% = 100mL sample of blood contains 40 mL of RBCs ● 5 below and above; 20% is a big deal ■ General ● Solidifies Hgb (can mean more than one thing) ■ Mean volume & hemoglobin concentration ■ Packed-cell volume ● 60%: ¾ full (many RBCs; do not need to carry as much) ◆ Dehydration ◆ CO2 poisoning ◆ Living at high altitude ● 40%: RBC full (normal) ● 20%: RBC very full (half the amount of RBCs; trying to carry as much oxygen as possible); can’t carry enough affecting oxygenation ◆ Tachycardic: not getting enough O2, tries to compensate ◆ Pregnancy ◆ Anemia ◆ Heavy menstrual cycles ■ Measures ● Polycythemia, anemia, dietary deficiencies ◆ Polycythemia (increase in RBC count) → ➢ Aspirin ➢ Bloodletting (Hct <45) ● Hydration status ◆ Hydration, IV fluids lowers RBCs ● Aid in calculation of erythrocytes ● Monitor response to treatments ● Determining need for blood transfusions ● Baseline before surgery/invasive procedures/treatments ➢ Hgb ■ Males: 12-16 g/dL ■ Females: 10-14 g/dL ■ Protein in RBCs that carries oxygen to organs & tissues

■ Transports carbon dioxide from organs back to lungs ● How many RBCs do we have to carry O2 & CO2? ■ Main indicator of general bleeding; specific/localized ● <8 big deal (.1 increments not a big deal) ■ Measures ● Severity of anemia ● Polycythemia (too many RBC) ◆ Causes: ➢ Bone marrow produces too many RBCs → cancer ➢ Autoimmune disorder ● Response to therapy ● Baseline prior to surgery/invasive procedures/treatments ◆ Have we tried some sort of treatment like giving RBCs or iron? ◆ Have we done something to determine the reason why we don't have enough RBCs? ◆ Determine the underlying reason why our RBC is low/low production ➢ GI bleed → colonoscopy to determine where the bleed ➢ Hematoma ➢ Aneurysm ◆ Surgery is invasive (blood loss) ➢ Male patient hemoglobin is 10-11 before surgery and then after surgery it is 6-7 ● Distribution of oxygen to organs & tissues ➢ WBC ■ 5,000 to 10,000/mm3 ■ Respond to infection in the body ■ Symptoms: febrile, change in LOC, confusion, dizziness, swollen lymph nodes, high HB (to compensate), sweaty, pain, BP changes (hypotension), body aches, oliguria/anuria (dehydrated), burning, increase RR, diarrhea ■ Labs: Na (high, dehydrated), K (low, laxatives to get rid of K, 5Ds), BUN, Cr, GLU, WBC ● Heart: tachycardia, HF, MI ● Lungs: pneumonia (tachypnea) ● Kidneys: UTI