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Cystic Fibrosis Chronic multisystem disorder characterized by exocrine gland dysfunction. Progressive and incurable; respiratory failure is a common cause of death. Organ transplant can increase survival rate
CF Mucus Abnormally thick and copious, causing obstruction of small passageways of resp, GI, and reproductive systems
CF Symptoms Associated with pancreatic enzyme deficiency and fibrosis caused by duct blockage, progressive chronic lung disease, and sweat gland dysfunction (^ Na and Cl sweat concentrations)
CF: Respiratory system Stagnation of mucus leads to bacterial colonization and destruction of tissue; emphysema and atelectasis occur; chronic hypoxemia; pulm HTN, cor pulmonale; pneumothorax, hemoptysis. Wheezing, cough, cyanosis, clubbing, barrel chest, bronchitis, pneumonia
CF: GI System Meconium ileus, intestinal obstruction (pain, abd distention, N/V), frothy foul-smelling stools, deficiency of vit A,D,E,K, malnutrition, hypoalbuminemia, rectal prolapse, pancreatic fibrosis
CF: Dx Tests Quantitative sweat chloride test (40-60 mEq/L); newborn screening; CXR; pulmonary function tests; stool, fat, enzyme analysis
CF: Interventions for Resp Antibiotics, chest physiotherapy, suction, flutter mucus clearance device, hand-held percussors, vest, PEEP mask, huffing, brochodilator meds, exercise, O2 during acute episodes, vit k replacement, bedrest, vaccinations
CF: Interventions for GI High-calorie, high-protein, well-balanced diet; multivitamin w/ vit A, D, E, K; monitor weight, stool patterns; replace pancreatic enzymes within 30 mins of eating; monitor for constipation; monitor for GERD; blood glucose level; adequate salt intake
Hirschsprung's disease Congenital; absence of ganglion cells in the rectum and other areas of intestine; mechanical obstruction results because of inadequate motility; most serious complication is enterocolitis
Hirschsprung's disease assessment Newborn: failure to pass meconium, refusal to suck, abd distention, bile-stained vomit. Children: failure to gain weight, abd distention, vomiting, constipation/diarrhea, ribbon-like foul-smelling stool
Hirschsprung's disease interventions Low-fiber, high-calorie, high-protein diet, stool softeners, daily rectal irrigations, measure abd girth, avoid rectal temps, colostomy and excision of portions of bowel
Omphalocele Herniation of abdominal contents through umbilical ring with an intact peritoneal sac; cover sac with sterile wet gauze immediately with plastic wrap; frequent vitals, NPO, IV fluids, surgical repair
Gastroschisis Herniation of the intestine is lateral to the umbilical ring, without membrane. Cover loosely with saline-soaked pads and plastic drape; surgery within several hours
Glomerulonephritis Group of kidney disorders characterized by inflammatory injury in the glomerulus, most of which are caused by an immunological reaction (usually antigen-antibody reaction); results in in proliferative and inflammatory changes in the glomerular structure
Causes of glomerulonephritis Immunological diseases, autoimmune diseases, steptococcal infection, history of pharyngitis or tonsillitis 2-3 wks before symptoms
Complications of glomerulonephritis Renal failure, hypertensive encephalopathy, pulmonary edema, heart failure
Glomerulonephritis assessment Periorbital and facial edema (more prominent in AM), anorexia, decreased urine output, cloudy, foamy, brown urine (hematuria), pallor, irritability, lethargy, HA, abd/flank pain, dysuria, HTN, proteinuria, azotemia, ^ BUN, ^ Cr, ^ antistreptolysin O titer
Gloermerulonephritis interventions Monitor vitals, weight, I&O, characteristics of urine, limit activity; Na, K, protein and fluid restrictions,; diuretics, antihypertensives, antibiotics, anticonvulsants; seizure precautions
Nephrotic syndrome Kidney disorder characterized by massive proteinuria, hypoalbuminemia, and edema. Goals: reduce excretion of urine protein, reduce edema, prevent infection, maintain protein-free urine
Nephrotic syndrome interventions Monitor vitals, I&O, daily weights, urine sp grav and protein, edema; regular diet without added salt (Na and fluid restrictions during edema), corticosteroids, immunosuppressants, diuretics, plasma expanders
Hemolytic-uremic syndrome Acute renal failure in children; sx: Triad of anemia, thrombocytopenia, and renal failure, proteinuria, hematuria, urinary casts, ^BUN&Cr, low Hgb and Hct, vomiting, irritability, lethargy, pallor, bruising/bleeding, oliguria/anuria, seizures, coma
Hemolytic-uremic syndrome interventions Hemodialysis or peritoneal dialysis, fluid restrictions, blood products
Impetigo Contagious bacterial skin infection; associated with poor hygiene; common sites of infection are on the face, around mouth, hands, neck; lesions begin as vesicles w/ edema and redness, become exudative and honey-colored crusts
Impetigo assessment lesions, erythema, pruritis, burning, secondary lymph node involvement
Impetigo interventions Contact isolation, allow lesions to dry by air exposure, antibacterial soap, warm saline compresses, Burrow's solution, antibiotic ointments, antibiotics, emollients, handwashing, use separate towels, linens, etc
S/S of Respiratory Alkalosis Lethargy, lightheadedness, confusion, tachycardia, dysrhythmias r/t hypokalemia, N?V, epigastric pain, and numbness/tingling of the extremeties
Rapid-Acting Insulin End in "log"; Onset: 15-20 mins, Peak: 30 mins-3, Duration: 3-5 hrs
Short-Acting Insulin "Regular" "R" in brand name; Onset: 30 mins, Peak: 2-5 hrs, Duration: 5-7 hrs
Intermediate-Acting Insulin "N" and Levemir (1, 6-8, 5-24); Onset: 1.5 hrs, Peak: 4-12 hrs, Duration: 16-24+ hrs
Long-Acting Insulin Lantus; Onset: 2-4 hrs, no peak, Duration: 24 hrs
Platelets 150,000-400,000
WBCs 4,500-11,000
RBCs Male: 4.5-6.2 million, Female: 4.5-5 million
Sodium 135-145 mEq/L
Potassium 3.5-5.1 mEq/L
Chloride 98-107 mEq/L
Bicarbonate (venous) 22-29 mEq/L
aPTT 20-36 seconds (should be 1.5-2.5xnormal with heparin; >90 seconds=bleeding precautions)
PT 9.6-11.8 seconds (2-3xnormal with coumadin; PT > 30 seconds=bleeding precautions; vitamin K shortens PT)
Erythrocyte sedimentation rate 0-30 mm/hr; For acute and chronic illness, inflammation, advanced neoplasm, and tissue necrosis or infarction
Hemoglobin Male: 14-16.5, Female: 12-15
Hematocrit Male: 42-52%, Female: 35-47%
Serum iron Male: 65-175, Female: 50-170
Creatine kinase (CK) 26-174 units/L; cell trauma, rises within 6 hrs, peaks at 18, returns to normal in 2-3 days
CK-MB Cardiac muscle; 0-5% of total
CK-MM 95-100% of total; skeletal muscle
CK-BB 0% of total; brain tissue
Lactate dehydrogenase (LDH) 140-280; MI; begins to rise after 24 hrs, peaks in 48-72 hrs, returns to normal in 7-14 days. When LDH1 is higher than LDH2, it indicates MI.
Troponins I: <0.6 ng/mL, >1.5 ng/mL indicates MI; T: >0.1-0.2 ng/mL indicates MI; eleaves in 3 hrs, remain elevated 7-10 days
Myoglobin Normal <90 mcg/L; elevation indicates MI, rises in 2 hrs, drops after 7 hrs
BNP Primary marker for CHF; normal <100 pg/mL
Albumin 3.4-5 g/dL
Ammonia Byproduct of protein catabolism; 10-80 mcg/dL
Amylase Enzyme produced by pancreas; in acute pancreatitis level is greatly increased, starts rising in 3-6 hrs after onset of pain, peaks in 24 hrs, returns to normal in 2-3 days; normal: 25-151 units/L
Lipase Elevation 24-36 hrs, remains elevated up to 14 days; normal: 10-140 units/L
Bilirubin Direct (conjugated): 0-0.3 mg/dL, Indirect (unconjugated): 0.1-1 mg/dL, Total: <1.5 mg/dL
Total cholesterol 140-199
LDL <130
HDL 30-70
Triglycerides <200
Uric acid Male: 4.5-8, Female: 2.5-6.2
Creatinine 0.6-1.3; elevation indicates decreased GFR
BUN 8-25; elevation indicates decreased GFR
Calcium 8.6-10
Magnesium 1.6-2.6
Phosphorus 2.7-4.5
CD4+ 500-1600
Normal Urine pH 4.5-7.8
Urine Sp. Gravity 1.016-1.022
Urine glucose <0.5 g/day
Urine ketones none
Urine protein none
Urine bilirubin none
Urinary casts none-few
Urine crystals none
Urine bacteria none or <1000/mL
Urine RBC <3 cells/HPF
Urine WBC <4 cells/HPF
Urine chloride 110-250 mEq/24 hrs
Urine magnesium 7.3-12.2
Urine potassium 25-125
Urine sodium 40-220
Uric acid 250-750
Folic acid sources Green leafy vegetables, liver, beef, fish, legumes, grapefruit, oranges
Niacin sources Meats, poultry, fish, beans, peanuts, grains
Vitamin A sources Liver, egg yolks, whole milk, green or orange vegetables, fruits
Vitamin K sources Green leafy vegetables, cauliflower, cabbage
Calcium sources Broccoli, carros, cheese, collard greens, green beans, milk, spinach, tofu, yogurt
Magnesium sources Avocado, tuna, cauliflower, cooked rolled oats, green leafy vegetables, milk, peanut butter, peas, pork, beef, chicken, potatoes, raisins, yogurt
Potassium sources Avocado, bananas, canteloupe, carrots, fish, oranges, pork, beef, veal, potatoes, raisins, spinach, strawberries, tomatoes
Iron sources Breads, cereals, dark green vegetables, egg yolk, liver, meats
Zinc sources Eggs, leafy vegetables, meats, protein-rich foods
Gas-forming foods Apples, artichokes, barley, beans, bran, broccoli, brussels sprouts, cabbage, celery, cherries, coconut, eggplant, figs, honey, melons, milk, molasses, nuts, onions, radishes, soybeans, wheat, yeast
Fat-restricted diet For malabsorption disorders, pancreatitis, gallbladder disease, GERD
High-calorie, high-protein diet For severe stress, burns, cancer, wound healing, HIV, AIDS, COPD, respiratory failure
Sodium-restricted diet For HTN, heart failure, renal disease, cardiac disease, liver disease
Protein-restricted diet For renal disease and liver disease
Low-purine diet Used for gout, kidney stones, and elevated uric acid levels; restrict anchovies, herring, mackerel, sardines, scallops, glandular meats, gravies, meat extracts, wild game, goose, and sweetbreads
Created by: kahadzima1