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N232 > Case study Cram (-; > Flashcards

Case study Cram (-; Flashcards

1
Q

WBC

A

4-10.5

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2
Q

RBC

A

3.8-5.2

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3
Q

HgB

A

120-150

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4
Q

HCT

A

0.38-0.48

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5
Q

PT-INR

A

0.9-1.1

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6
Q

platelet

A

150-400

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7
Q

Neutrophil

A

2-6

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8
Q

Na

A

135-145

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9
Q

K

A

3.5-5

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10
Q

glucose

A

3.9-11

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11
Q

creatinine

A

50-90

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12
Q

GFR

A

> 60

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13
Q

PTT

A

23-32

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14
Q

what could polycythemia mean

A

increased RBC so hypoxia, tumour, dehydration, kidney tutor

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15
Q

what could anemia mean

A

bleed, renal failure, malnutrition, iron deficiency, over hydration

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16
Q

why do we get HgB

A

CBC (complete blood count) bleeding, surgery, kidney disease, cancer treatment

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17
Q

what would low HgB mean

A

anemia, bleeding, chronic kidney disease, cancer treatment, rheumatoid arthritis

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18
Q

what would hi HgB mean

A

COPD, lung scaring, HF d/t chronic hypoxia

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19
Q

what is HCT

A

%RBC in blood

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20
Q

what is low HCT

A

anemia, nutritional deficiency, CKD, leukaemia

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21
Q

what would hi HCT mean

A

dehydration, lung disease, CAD

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22
Q

what does neutrophilia mean

A

acute bacterial infection, inflammation (RA_, tissue death (sx, MI, Burn) stess

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23
Q

what does neutropenia mean

A

sepsis, reaction to drugs, autoimmune

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24
Q

hat does lymphocytosis mean

A

viral infection, lymphocytic leukaemia

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25
Q

what doe lympopenia mean

A

autoimmune (RA) infection, bone marrow dmg, immune disease

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26
Q

why test NA

A

general malaise, dehydration, vomiting, monitor in (HTN, HF, Chronic liver disease & kidney disease)

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27
Q

what would cause hyponatremia

A

diarrhea, vom, diuretics, increased H2O, chronic kidney disease, malnutrition, heart failure

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28
Q

what would cause hyper natremia

A

usually dehydration

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29
Q

why is K+ tested

A

kidney disease, weak muscles, arrhythmia, diuretics, HTN med

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30
Q

what would cause hyperkelemia

A

kidney disease, tissue dmg, infection, diabetes, dehydration, drugs

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31
Q

what would cause hypokalemia

A

diuretics, diarrhea, vomiting, diabetes

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32
Q

what is creatinine

A

waste product removed by kidneys

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33
Q

what does high creatinine mean

A

kidney disease, UTI, infection, decreased blood flout kidneys

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34
Q

what does thrombocytopenia mean

A

not enough made or there has been distruction
cancer treatment, drugs, autoimmunity
bleeding risk

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35
Q

what does thrombocytosis mean

A

hemolytic anemai, iron deficiency, surgery, trauma, infection, medication, spleen removal, blood clots

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36
Q

what does troponin elevation mean

A

even slight increase means Heart damage

may also be d/t medical procedure, cardiomyopathy of HF

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37
Q

when would you test BNP

A

symptoms of HF (SOB, EDEMA)

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38
Q

what does it mean when BNP is high

A

heart cannot pump the way it should
most likely HF or (KF, PE, Pulm HTN, sepsis, lung problems)
it is a hormone secreted by cardiomyocytes in the ventricles in response to increased streching cause by increased blood volume

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39
Q

what is PTT

A

partial thromboplastin time - measures time it takes for a clot to form - an tell if clotting factors are working

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40
Q

why would you test PTT:

A

unexplained bleeding, bruising, clouting, liver disease, surgery, HEPARIN
LOOKING AT EXTRINTRINSIC & COMMON PATH

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41
Q

why would PTT be longer than normal

A

bleeding disorder, liver disease, lupus, vitamin K deficiency

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42
Q

why is PT INR tested

A

detect blleeed/ clot disorder - INR to determine how well anticoagulant warfarin is working (INTRINSIC PATHAY)

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43
Q

what should you INR be if you’re taking warfarin

A

2-3

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44
Q

what does a prolonged PT mean with normal PTT

A

liver disease, vitamin K insufiecnecy, defective clouting factors or WARFARIN

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45
Q

what does normal pt with prolonged put mean

A

defect clot factors, lupus anticoag, von will, autoimmune

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46
Q

what does prolonged PT & PTT-INR mean

A

defective factors, severe liver disease, warfarin over dose

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47
Q

what does D-Dimer test

A

rule out clotting (thrombotic episodes) (DVT, PE)

D-Dimer is one of the protein fragments produced when a blood clot gets dissolved in the body -> usually undetected

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48
Q

when is D-Dimer ordered

A 
DVT symptoms (leg pain, edema, discolour) 
PE symtoms (SOB, cough, chest pain, rapid HR)
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49
Q

what does a negative D-Dimer test mean

A

person doesn’t have acute clot formation of breakdown

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50
Q

what does a positive D-Dimer mean

A

abnormally high fibrin degradation products, doesn’t tell us location or cause
elevated levels also after Sx, trauma, infection, MI, cancer or liver disease
*used to rule out, not confirm diagnosis

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51
Q

what is you HgB A1C if you don’t have diabetes vs. if you do

A

No diabetes <5.7%

Diabetes 6.5% or higher

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52
Q

what are the signs of hyperglycemia

A

increased thirst, frequent urination, blurry vision, slow healing

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53
Q

what are the signs of hypoglycaemia

A

sweat, hunger, tremble, anxiety, confusion, blurred vision

54
Q

what id normal FBG

A

3.9-5.5

55
Q

what is normal OGTT after 2 hr

A

<7.8 = norm

56
Q

what are normal BG numbers

A

fasting: 4-7
Post-prandial (2 hr after meal): 5-10
random: <7

57
Q

what does the oral glucose tolerance test determine

A

measures bodes ability to use glucose

58
Q

what is the normal results of OGTT

A

fast: <7
1 Hr: <10.2
2 hr <7.7

59
Q

what are the prediabetic response for OGTT

A

2 hr: 7.8-11.0

60
Q

normal vs prediabetic vs diabetic HbA1C

A 
Normal = <6
pre = 6.0-6.4
dia= 6.5+
61
Q

what are the neurogenic/autonomic hypoglycaemia symptoms

A

Tremble, hunger, palpitations, nausea, sweating, tingle, anxiety

62
Q

what are the neurglycopenic symptoms of hypoglycaemia

A

difficulty concentration ,vision changes, difficulty speaking, confusion, headache, weak, dizzy, drowsy, tired

63
Q

what is mild-mod hypoglycemia

A

2.8-3.9mmol/L with autonomic symptoms

64
Q

what do you do with mild-mod hypoglycaemia

A

1) 16g glucose or 4 tabs
2) repeat BG in 15 minutes
3) repeat until BG >4.0
4) give meal or snack
5) inform physician if happens 3+ times
6) document

65
Q

what is severe-conscious hypoglycaemia

A

autonomic & neuroglycopenic symptoms & <2.8mmol

66
Q

what do you do with severe conscious

A

1) 20g carbs
2) bg again 15 mins repeat until >4.0
3) meal or snack
4) physician
5) document

67
Q

what is severe uncontious

A

same as severe continous except they not conscious

68
Q

what do you do in severe uncontious

A

1) IV glucose, 25g as 50ml D50W over 1-3 minutes or 1mg glycogen SC
2) 10 min retest (redo step one title <4)
(max one glycogen shot)
3) ASAP inform doctor
4)Document

69
Q

explain morphine

A

Reduces pain
opiod analgesic
side effects are Resp depress & conspitation
mechanism is it binds to opiod receptors in cans, alters perception & response to painful stimuli with generalized CNS depression
Assess: rr, bp, pain, narcan is less than 8 is less than 12 hold, urinary retention, cranial pressure, tolerance & physical dependence

70
Q

what class of drug is lipitor / atorvastatin

A

lip lowering agent -> HMG-CoA reductase inhibitors

71
Q

what is the indication for a atorvastatin

A

hypercholestemia. Prevent CAD. Lower LDL (2 weeks) must be taken life long
increases HDL & decreases Tg

72
Q

what are the non lipid benefits of atorvastatin/lipitor

A 
stability of atherosclerotic plaques 
decreases inflamation 
slows calcification 
improves abnormal endothelial function 
increases dilation 
decreases AFIB 
suppreses thrombin
73
Q

what are the worst outcome for atorvastatin

A

LIVER DISFUNCTION CAN OCCUR (LFT tests prior & 3 months post) (ALT, AST)
Muscle pain, tenderness or weakness -> CHECK CPK (INDICATES MUSCLE INJURY)
n/v, heart burn, cramping, diarrhea, memory loss
can cause overweight fetus
CANNOT BE GIVEN WITTH LIVER DISEASE

74
Q

what is the mechanism of atorvastatin action

A

increased LDL receptors on hepatocytes

inhibits HMG cos-reductase (rate limiting enzyme in cholesterol biosynthesis) = hepatocytes better able to remove LDLS

75
Q

what is the therapeutic use of atorvastatin

A 
hypercholesterolemia 
prevent CV 
primary prevention with normal LDD 
post MI therapy 
diabetes 
influenza
76
Q

what class is metoprolol

A

beta blockers (Anti-anginas & anti-HTN)

77
Q

what is the mechanism of metoprolol

A

blocks beta 1 receptors ( myocardial) adrenergic receptors (doesn’t usually affect beta 2)

78
Q

what is the indication for metoprolol

A

HTN, angina, prevent MI . decrease mortality, management of HF
Unlabled for: ventricular arrhythmia, tremor, anxiety & migraine

79
Q

what does metoprolol do?

A

blocks action of NE & E so it decreases HR & BP

80
Q

what are the adverse effects of metoprolol

A

low bp, low hr, pulmonary edema, HF

81
Q

when is metoprolol contraindicated

A

decreased hr or bp, pulmonary edema, heart block, cariogenic shock, signs of HF
CANT GIVE WHEN BPM UNDER 50

82
Q

teaching about metoprolol

A

abrupt withdrawal can lead to arrhythmia, HTN, ischemia

may cause drowsiness & orthostatic HTN

83
Q

when is hydrochlorthizide in effective

A

with a low GFR

84
Q

what class is hydrochlorothiazide

A

antiHTN, thiazide diuretics

85
Q

when is hydrochlorothiazide indicated

A

HTN, edema

86
Q

what is hydrochlorothiazide mechanism

A

increased urine production via block or reabsorption of Na+ & chloride in early DCT (smaller amt than loop)
Dependent on kidney function - INEFFECTIVE WITH A LOW GFR 15-20
Diuresis within 2 hours, 4-6 hr peak, duration 10 hour

87
Q

what are the adverse effects of hydrochlorothiazide

A

hyponatremia, hypochloremia, dehydration, hypokalemia
hyper uricemia
increased LDL
increased excreted MG

88
Q

what kind of drug is furosemide

A

loop diuretic

89
Q

what is the mechanism of furosemide

A

acts on henley loop to block reab or Na & CL-
prevent passive reabsorption of H20
oral onset is 60 minutes for 8 hours
IV onset is 5 min for 2 hours

90
Q

what are indications for furosemide

A

pulmonary edema, edema, HTN

91
Q

what are the adverse effects of furosemide

A 
hyponatremia 
hypochloremia 
dehydration 
hypotension 
hypokalemia 
ototoxicity 
hyperglycaemia 
hyperuricemia 
reduces LDL, raises HDL 
NOT SAFE FOR PREG
92
Q

what type of insulin is lispro/humalog

A

RAPID ACTING ANALOG of regular insulin

93
Q

when would lispro/humalog be given

A

food must be in front of them -> immediately b4 meals

94
Q

what is the onset of lispro/humalog

A

10-15 minutes

95
Q

what is the peak of lispro/humalog

A

60-90 minutes

96
Q

what is the duration of lispro/humalog

A

3-5 hr

97
Q

what is the color of lispro/humalog

A

clear

98
Q

can you mix lispro/humalog

A

yes with NPH

99
Q

why does lispro/humalog work faster than regular

A

aggregates less than normal insulin b/c of a changed animo acid so is absorbed pasted
usually SC

100
Q

what type of insulin is glargine/lantus

A

long acting basal insulin analogue

101
Q

what is the onset of glargine/lantus

A

90 mins

102
Q

what is the peak of glargine/lantus

A

non

103
Q

what is the duration of glargine/lantus

A

24 hours

104
Q

what are some special considerations of glargine/lantus

A 
DO NOT GIVE IV 
DO NOT MIX WITH OTHER INSULIN 
DOSING CAN OCCUR AT ANY TIME 
LOW SOLUBILITY SO EXTENDED RELEASE 
is clear
105
Q

what is warfarin

A

vitamin K antagonist

106
Q

what does warfarin do

A

prevents thrombosis
delayed onset -> inappropriate for emergencies
LT prophylaxis
poses a huge hermorage risk

107
Q

what is the mechanism of warfarin

A

decreased clotting factor production (by inhibiting enzyme needed to convert vitamin K to active form)
* no effect on clotting factors already in circulation

108
Q

when does warfarin start to work

A

Onset: 8-12 hours
peak: 72-96 hours
Direction 2-5 days

109
Q

what is the therapeutic use of warfarin

A

prevent VT

prevent PE, thromboembolism with prosthetic valve, thrombosis from AFIB, decreases TIA & MI risk

110
Q

what do u need to monitor for warfarin

A

PT-INR 2-3 for most

daily for first 5 days

111
Q

what are side effects of warfarin

A

hemorrhage, skin necrosis, weak bones, fever, GI disturb

112
Q

when is warfarin contraindicated

A

thrombocytopenia. Lumbar puncture. Recent CNS surgery. Hi risk bleeders (Hemophilia, aneurysm, GI ulcer, HTN, abortion)
vitamin K deficiency, Liver disease, alchoholism
pregnancy & lactation
*KEEP VIT K INTAKE STABLE

113
Q

what kind of drug is ramipril

A

Ace inhibitor

114
Q

what does ramipril do

A

lowers bp b/c not angio 2 which causes there to be vasodilation & decreased heart workload

115
Q

what are the indications for ramipril

A

treats HTN, HF, MI (prevent)

116
Q

what are the side effects of ramipril

A

hypotension, Increasd K, cough, kidneys disease need reduced dosage, fetal death

117
Q

what do assess for ramipril

A

Bp (HR not most important) electrolytes, K+, dry cough

118
Q

what is digoxin

A

Cardiac glycoside - effects both mechanical & electrical

119
Q

what does if the effect of digoxin

A

increases myocardial contractility & effects on neural hormonal
CAN CAUSE DANGEROUS DYSRYTHMIAS EVEN WITHIN THERAPEUTIC DOAGE
DOESNT PROLONG LIFE - SYMPTOM RELIEF ONLY. Increases exercise tolerance & decreases hospital stay

120
Q

what are the indications for digoxin

A

HF, dysrhythmias

121
Q

what is mechanism of digoxin

A

IT IS A POSITIVE INOTROPE -> increases the force of ventricular contraction -> increased CO

  • Inhibits na+/K+ATPASE -> which promotes Calcium accumulation in the myocytes ->augments contractile force
  • K+ IONS COMPETE TO BIND Na+/K+ATPASE so when K+ is low, excessive inhibition occurs -> toxicity
  • K+ MUST BE MONITORED
122
Q

what are the benefits of digoxin

A

increased CO

Decreased sympathetic tone. increased urine, decreased renin, decreased heart size & fatigue reduced.

123
Q

what are the side effects of digoxin

A

Dysrythmias b/c hypokalemia or OD (0.5-0.8 ideal)

anorexia, N/v, fatigue, visual distrubance,

124
Q

when do hold Digoxin

A

if HR <60

125
Q

what class is hydralazine

A

direct action vasodilator

126
Q

what is the effect of hydralazine

A

direct relaxation of arteriolar smooth muscle
(no effect on veins)
(BP falls)
(HR & myocardial contraction increases)

127
Q

what is onset & duration for hydralazine

A

PO 45 minutes for 6 hr

IV: 10 minutes for 2-4 hours

128
Q

what is the therpeatuic use for Hydralazine

A

essential HTN with a beta blocker
HTN crisis ( 220/130)
HF

129
Q

what are the side effects of hydralazine

A

reflex tachycardia, increased blood volume, systemic lupus erythmatosis

130
Q

what should you monitor for HYDRALAZINE

A

BP, ECG, O2, RR.

hold if BP LOW

N232 (10 decks)

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