Preparation Questions 1. Discuss the pathophysiology, signs and symptoms, treatments and complications of heat • exhaustion. HEAT EXHAUSTION: pathophysiology Occurs when there is prolonged body temperature and the body is unable to regulate it’s temperature / cool itself down. There is extreme vasodilation (in attempts to release heat) and profuse sweating (cool the body via sweat evapotation). The excess sweating leadings to dehydtration, which leads to decreased blood plasma volume, which leads to severe hypotension, which leads to decreased cardiac output, and eventually the reflex mechanism of tachycardia (to counter act the decreased cardiac output). Signs and symptoms include an altered mental status, profuse sweating, skin cool & moist to the touch, dilated pupils, thirst, weaknessm, nausea/vomiting, and hyperventilation. Treatments include giving cool beverages (to combat dehydration), cool the patient with cool compresses/ ice packs/ airconditioning (to decrease body temperature), and to loosen the clothing. Some complications of heat exhaustion is a progression to heat stroke which is a medical emergency. This is when the body temperature is 104 degrees Fahrenheit or above and can result in permanent brain and organ damage. 2. What are the clinical findings and complications of dehydration? DEHYDRATION: clinical findings Occurs when there is a water deficit in the patient. Clinical findings include thirst, headache, weight loss, oliguria, concentrated urine, decreased skin turgor, dry mucous membranes, decreased sweating, increased body temperature, prolonged capillary refill time, tachycardia, weak pulses, low blood pressure, confusion and eventually coma. There is also an increased serum sodium concentration due to the water loss from blood plasma. 3. What medical and nursing management may be anticipated for a geriatric patient with heat exhaustion and/or dehydration? Treatments would include getting them into a cool place, cooling them down with compresses or a cold bath, giving them water to replace lost fluids, and give them a place to lay down and rest. 4. Describe how prolonged immobilization results in muscle injury. • When a patient is immobilized for an extended period of time their muscles atrophy. This atrophy occurs because muscle cells are made up of contractile proteins, whose function and accumulation in muscle cells is supported through muscle use. If the muscle is not being used, the body is not making use of the contractile proteins inside muscle cells, and due to the lack of use, their growth and accumulation in muscle cells is not supported. Fewer contractile proteins means smaller muscle cells, and a muscle with smaller muscle cells is small/ or atrophied. 5. Discuss conditions that predispose patients to rhabdomyolysis. • Some conditions can predispose patients to rhabdomyolysis. These people have muscular, metabolic , or metabolic conditions. These include diabetes, muscular dystrophy, and sickle cell disease. 6. What are the clinical findings and signs and symptoms of rhabdomyolysis? • The clinical finding of rhabdomyolysis are a classical triad of muscle pain, weakness, and dark urine. Moreover, there is dehydration (due to fluid shift), weakness, anuria, edema, and malaise. With further testing, the dark urine contains myoglobin (dark urine is therefore myoglobinuria). Moreover, there is an increase in creatinine kinase to 5 to 10 times the normal limit, other serum enzymes, and intracellular elements like potassium, phosphate, nucleotides, and creatine into the blood. Note that normal creatinine kinase levels in the blood plasma are 5 to 25 units/L in women and 5 to 35 units/L in men. Therefore, treatment for rhabdomyolysis is 1000 units/ L. Initially hypocalcemia is experienced, followed by hypercalcemia during recovery. Hyperkalemia should be expected. 7. What is the most common life-threatening complication of rhabdomyolysis? • Renal failure (severely increased creatinine kinase levels and myoglobin levels) and cardiac dysrhythmias (associated with hyperkalemia). 8. What is the medical management of a patient with rhabdomyolysis? • Goals of treatment include maintaining electrolyte balance and fluid management, a urinary flow, and the prevention of kidney failure. This can include hemodialysis where the blood is filtered, so that myoglobin and other excess electrolytes in blood plasma can be removed. This prevents cardiac dysrhythmias by getting rid of all the plasma potassium. Other forms of management include diuretics to restore electrolyte balance. Moreover, IV therapy for electrolyte and fluid promotes normal fluid blood volume and electrolyte balance. 9. Discuss the medical interventions for hyperkalemia. • Medical interventions for hyperkalemia include calcium gluconate, insulin, alkanizing agents, or albuterol. All three support the movement of potassium back into the intracellular space from the extracellular space. Moreover, non- potassium sparing diuretics can be used to release potassium via urine. 10. What are the nursing responsibilities related to the care of the patient with rhabdomyolysis? • The nursing responsibilities related to the care of patients with rhabdomyolysis include fluid management by increasing oral intake of fluids & IV therapy. This includes measuring the weight of the patients consistently to catch any fluctuations that could indicate further dehydration or muscle wasting. They also include hemodialysis to promote normal electrolyte levels in blood plasma and to prevent kidney failure. Nurses must also monitor patient vital signs consistently for effects of hyperkalemia or hypocalcemia & then respond accordingly. 11. Explain the role of nutrition in promoting healing for a geriatric patient with dehydration, rhabdomyolysis Dehydration is a common symptom of rhabdomyolysis. A common symptom of muscle wasting & rhabdomyolysis is edema. A deficiency of protein in plasma can result in fluid shifts that contribute to edema. A deficiency of protein & calorie intake (due to malnutrition) results in muscle wasting. It is your body’s attempt to make up for the lack of glucose in the body that it needs to fuel cellular function. It does so by converting available muscle to glucose to be used as the source of energy. By improving the nutrition of geriatric patients, they will be putting more quality sources of protein and calories into their body. This will prevent muscle breakdown and therefore decrease dehydration.
