Ch. 3: Human Development

fluids and electrolytes

Fluids Part Two

Electrolyte Homeostasis

Here is a long list of NCLEX PN review online test reviews.
EKG

~Remember This

NCLEX Common Lab Values
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The article below is from:

NNii – National Network for Immunization information has published this update about Vaccine Safety

 

Concerns about Vaccine Safety

Updated: 02/12/2009
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“Ketamine”, “Special K,” “cat Valium”) is a dissociative Anesthetic developed in 1963 to replace PCP and currently used in human anesthesia and veterinary medicine. Much of the ketamine sold on the street has been diverted from veterinarians’ offices. Although it is manufactured as an injectable liquid, in illicit use ketamine is generally evaporated to form a powder that is snorted or compressed into pills. Ketamine’s chemical structure and mechanism of action are similar to those of PCP, and its effects are similar, but ketamine is much less potent than PCP with effects of much shorter duration. Users report sensations ranging from a pleasant feeling of floating to being separated from their bodies. Some ketamine experiences involve a terrifying feeling of almost complete sensory detachment that is likened to a near-death experience. These experiences, similar to a “bad trip” on LSD, are called the “K-hole.” Ketamine is odorless and tasteless, so it can be added to beverages without being detected, and it induces amnesia. Because of these properties, the Drug is sometimes given to unsuspecting victims and used in the commission of sexual assaults referred to as “drug rape.” Source: The National Institute on Drug abuse (NIDA) Image Source: Drug Enforcement Agency

 

 

Rohypnol and GHB are predominantly Central nervous system Depressants. Because they are often colorless, tasteless, and odorless, they can be added to beverages and ingested unknowingly. These substances emerged a few years ago as “Drug-assisted assault” drugs.* Because of concern about their abuse, Congress passed the “Drug-Induced Rape Prevention and Punishment Act of 1996″ in October 1996. This legislation increased Federal penalties for use of any controlled substance to aid in sexual assault   Rohypnol Rohypnol, a trade name for flunitrazepam, belongs to a class of drugs known as Benzodiazepines. Rohypnol can incapacitate victims and prevent them from resisting sexual assault. It can produce “anterograde amnesia,” which means individuals may not remember events they experienced while under the effects of the drug. Also, Rohypnol may be lethal when mixed with Alcohol and/or other depressants. Rohypnol is not approved for use in the United States, and its importation is banned. Illicit use of Rohypnol started appearing in the United States in the early 1990s, where it became known as “rophies,” “roofies,” “roach,” and “rope.” Abuse of two other similar drugs appears to have replaced Rohypnol abuse in some regions of the country. These are clonazepam, marketed in the U.S. as Klonopin and in Mexico as Rivotril, and alprazolam, marketed as Xanax. Rohypnol, however, continues to be a problem among treatment admissions in Texas along the Mexican border. GHB Since about 1990, GHB (gamma hydroxybutyrate) has been abused in the U.S. for its euphoric, sedative, and anabolic (body building) effects. It is a central nervous system depressant that was widely available over-the-counter in health food stores during the 1980s and until 1992. It was purchased largely by body builders to aid in fat reduction and muscle building. Street names include “liquid Ecstasy, ” “soap,” “easy lay,” “vita-G,” and “Georgia home boy.” Coma and seizures can occur following abuse of GHB. Combining use with other drugs such as alcohol can result in nausea and breathing difficulties. GHB may also produce Withdrawal effects, including insomnia, anxiety, tremors, and sweating. GHB and two of its precursors, gamma butyrolactone (GBL) and 1,4 butanediol (BD) have been involved in poisonings, overdoses, date rapes, and deaths. Extent of Use According to the 2004 Monitoring the Future** (MTF) survey, NIDA’s annual survey of drug use among the Nation’s high school students, 0.6 percent of 8th-graders, 0.7 percent of 10th-graders, and 1.6 percent of 12th-graders reported annual*** use of Rohypnol. Annual use of GHB among 8th-graders and 12th-graders remained relatively stable from 2003 to 2004, but 10th-graders reported a significant decrease according to MTF findings. In 2004, 0.7 percent of 8th-graders, 0.8 percent of 10th-graders, and 2.0 percent of 12th-graders reported annual use. Hospital emergency department (ED) episodes involving GHB rose from 56 in 1994 to 4,969 in 2000, then declined in 2002 to 3,330. Among ED mentions involving club drugs, however, only MDMA (ecstasy) is cited more frequently than GHB.****  * Also known as “date rape,” “drug rape,” or “acquaintance rape.” ** These data are from the 2004 Monitoring the Future survey, funded by the National Institute on Drug abuse, National Institutes of Health, DHHS, and conducted annually by the University of Michigan’s Institute for Social Research. The survey has tracked 12th-graders’ illicit drug use and related attitudes since 1975; in 1991, 8th- and 10th-graders were added to the study. The latest data are online at www.drugabuse.gov. *** “Lifetime” refers to use at least once during a respondent’s lifetime. “Annual” refers to use at least once during the year preceding an individual’s response to the survey. “30-day” refers to use at least once during the 30 days preceding an individual’s response to the survey. **** Emergency department data are from the annual Drug Abuse Warning Network, funded by the Substance Abuse and Mental Health Services Administration, DHHS. The survey provides information about emergency department visits that are induced by or related to the use of an illicit drug or the nonmedical use of a legal drug. The latest annual data are available at 1-800-729-6686 or online at www.samhsa.gov. Source:  The National Institute on Drug Abuse (NIDA) Image Source:  Drug Enforcement Agency (DEA) (Rohypnol);  Indiana State Police (GHB) Toll Free: 888-9NO-DRUGS or 888-966-3784

Functions of the Gastrointestinal System

• To prepare food for absorption into the body and utilization by the cells
• To excrete any food material of no use to the body

 

Gastrointestinal System composed of:

• Gastrointestinal tract
• Accessory organs and structures

 

Gastrointestinal Tract

• Approx 4.5 meters in length
• Almost doubled when no muscle tone
• A fibromuscular tube

 

Gastrointestinal tract is made up of:

• Mouth
• Pharynx
• Esophagus
• Stomach
• Small intestine
• Large Intestine

 

Accessory organs & structures are:

• Salivary glands
• Teeth
• Tongue
• Liver
• Gall bladder
• Pancreas

 

Digestive Processes – 5 stages:

1.    Ingestion

2.    Movement of food

§  Peristalsis

3.    Digestion

§  Mechanical

§  Chemical

4.    Absorption

5.    Defecation

 

Mucosal layers (3)

• protection
• secretion
• absorption

 

Mouth

• Provides an entrance to the gastrointestinal system
• Initiates digestion by the mechanical breakdown of food material
• Normal swallowing mechanisms move the food bolus to the esophagus
• Mediated by Cranial nerves IX, X, and XII

 

Functions of the Mouth

• Chewing, grinding and mixing of food
• Formation of a bolus
• Initiation of digestive processes
• Swallowing
• Taste
• These functions assisted by teeth, tongue, salivary glands and sensory nerve endings

 

Pharynx

• Food passes through the oropharynx and laryngopharynx to reach the esophagus
• Once a bolus of food reaches the pharynx swallowing is no longer voluntary

 

Swallowing

• swallowing initiates peristalsis

 

Peristalsis

• An involuntary activity of the longitudinal and circular layers of smooth muscle within the wall of the tract
• Rhythmic, pulsatile contractions of these muscle layers move the contents of the tract forward

 

Esophagus

• Hollow tube connecting mouth to stomach
• Runs through mediastinum
• Attaches to the stomach just below the diaphragm
• Mucus membrane lining secreting protective mucoid substance

 

Functions of the esophagus

• Transport of food
• Movement of food by peristalsis
• Mechanical dispersion of food as the first part of digestion

 

Cardiac Sphincter

• A one-way valve preventing reflux of stomach contents into the esophagus
• Relaxes as peristaltic wave approaches so that food can enter the stomach
• Also known as the lower esophageal sphincter

 

Stomach

• A dilation of the intestinal tract between the esophagus and the beginning of small intestine
• Separated form the small intestine by the pyloric sphincter
• Has three regions:
  1. fundus
  2. body
  3. pylorus

 

Stomach

• Food bolus enters the stomach moving slowly towards the pylorus (2 – 6 hours)
• Fluid mass in stomach called chyme
• Chyme pumped through pyloric sphincter into the small intestine
• Rate of movement of stomach contents depends on:
  1. food type and consistency
  2. rate of pancreatic and biliary secretions
• Functions of the Stomach
  1. Temporary storage
  2. Mixing
  3. Exocrine secretions
     • hydrochloric acid
     • intrinsic factor
     • pepsinogen
     • mucus
  4. Outflow regulation of processed food particles to the small intestine
  5. Extraction of iron from food
  6. Limited absorption

 

Control of Gastric Activity

• Gastric secretion is regulated by nervous and hormonal activity
• Gastric emptying is stimulated in response to stretch, stomach gastrin, and certain food types
• Gastric emptying is inhibited by reflex and hormonal activity

 

Small Intestine

• 2.5cms wide and 6m long
• Fills most of the abdomen
• Begins at the pyloric sphincter and ends with its connection to the large intestine at the ileocecal valve
• 3 parts:
  1. Duodenum
     • First 25cms of small intestine
     • Receives chyme from the stomach through the pyloric sphincter
     • Fluids from the pancreas and gall bladder via the common bile duct
     • Manufactures intestinal juice
     • Susceptible to inflammatory processes  
• Function:
  • Neutralizes the acidic chyme from the stomach
  • Mixes chyme with pancreatic, biliary and intestinal secretions

1. Jejunum
   • Jejunum – the largest section of small intestine
   • 8 feet
   • Absorption of Magnesium, Calcium, Iron
2. Ileum
   • last 40cms of small intestine
   • Chyme moves slowly towards the ileocecal valve (3 – 10 hours)

 

• Functions of Small Intestine
  1. Forward propulsion of contents
  2. Major site of digestion
  3. 90% absorption
  4. Protection against infection
  5. Hormone secretion
  6. Intestinal juice secretion

 

Large intestine

• 2.5cms wide 1.5m long
• Stretches from ileocaecal valve to rectum
• Often described in 7 parts
  • cecum
  • ascending colon
  • transverse colon
  • descending colon
  • sigmoid colon
  • rectum
  • anal canal
• Exit tract controlled by anal sphincters
• Functions of the Large Intestine
  • Reabsorption water and electrolytes
  • Microbial activity
  • Mass movement
  • Defecation – reflex action, abdo/diaphragmatic contraction
  • Feces
    • Water
    • Inorganic salts
    • Eplithelial cells
    • Bacteria – E- Coli is the main bacteria present
    • Undigested food

 

Normal enteroclysis- nasojejunal tube inserted to DJ flexure. Contrast outlines the duodenum and the first bit of jejunum. Note the irregular gas bubble in the stomach.

 

 

 

 

 

 

Upper GI Bleed VS Lower GI Bleed

 

ü 

 

 

Melena is described as black tarry in color from an upper GI source, “tarry” feces that are associated with gastrointestinal hemorrhage. The black color is caused by oxidation of the iron in hemoglobin during its passage through the ileum and colon.

ü  Hematochezia – passing a large loose, bright red or maroon colored stool, considered frank bleeding usually from the rectum, considered a lower GI Bleed.

ü  Coffee ground stool is classic of an upper GI bleed as it is old blood that had been decomposed by the stomach acid.

ü  Ischemic bowel disease-  - a blood clot  or other blockage has cut off blood flow to the colon as a result of reduced blood flow Ischemia seen in the elderly, a twisting of the intestine that is not relived, those with hx of atrial fib throw clots.

ü  Mallory –Weiss tear- Repeated or profuse vomiting may cause erosions to the esophagus or small tears in the esophageal mucosa

ü  Diverticula -are found throughout the colon, and sustained dark red lower GI bleeding from the large intestine is characteristic of  a bleeding diverticula

ü  Exanguination ( bleeding out) the fatal process of total hypovolemia ( Blood loss) commonly known as bleeding to death can be from the following caused:

1.      Mallory-Weiss tear

2.      Esophageal varices ( may be torn- ie: Mallory Weiss seen in protracted vomiting, and  by an alcoholic vomiting with end-stage liver disease,

3.      or distended varices due to backed up hepatic/portal circulation with loss of clotting factors in end stage Liver disease – cirrhosis

4.      Slitting the throat in suicide (cutting any of the arteries carotid, radial, brachia, ulnar, and femoral.

Treatment of an Upper GI Bleed

1.       Fluid resuscitation by restoring blood volume with Normal Saline.

2.      Maintain open airway – us of oxygen, and mechanical ventilation if needed.

3.      Coffee ground, melena indicative  of upper GI. Bleeding

4.      If unable to stabilize, usually if flushing NGT does not clear, patient will go stat to GI lab for endoscopy.

 

 

Treatment of Lower GI Bleed

1.       Establish underlying cause, and location of bleed,

2.      Hematochezia

3.      If unstable based on labs and patient VS – IV Fluids and will go to GI Lab for colonoscopy STAT