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ACNP Certification > Common Problems > Flashcards

Common Problems Flashcards

1
Q

Low sodium on renal panel but no sx, order what next?

A
  1. Serum osmo (if normal, pt has no problem) <270 low
  2. Are they wet, dry, or normal by clinical sx
  3. If low, order urine sodium (if >20, kidney problem)
    4.
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2
Q

Serum osmo is 2 x the sodium

Euvolemic think endocrine!!!!

A
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3
Q

Risk factors for fungal infectious fever

A

Chronic illness

immunosupression

chronic ATB use

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4
Q

if sodium is high, where is the water going?

if urine osmo is low, they are not concentrating, think DI

A
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5
Q

non-infectious causes of fever

A

Auto immune disease:

giant cell arteritis, IBS, thyroid issues, UC, RA/Lupus

Post-op- atelectasis, dry

Drug fever >102 - Neuroleptic malignant syndrome,

serotonin syndrome

Dehydration

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6
Q

Anion gap formula

A

(NA+K)- (HCO3+Cl)

Nrml is 7-17

higher the gap, sicker the pt

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7
Q

Most common complication of enteral feeding?

A

Diarrhea

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8
Q

Most common complication of perenteral feeding?

A

Delivery mechanism: IV probs

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9
Q

3.5-5 normal range

A

Albumin, potassium, phosphorus

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10
Q

Ratio of solute to fluid is the same on both sides of the membrane

A

Iso-osmolar

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11
Q

270-290 normal

A

osmolar content

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12
Q

What hormone causes men to have increased H&H?

A

Testosterone

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13
Q

Transfuse at what H&H?

A

8/24

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14
Q

What is the best indicator of protein malnutrition?

A

Pre-albumin

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15
Q

What is the average serum osmolality?

A

280-285

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16
Q

What is the first thing to order in a patient with low sodium?

A

Sodium osmolality

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17
Q

Low sodium, normal osmo (284-295)

A

Isotonic hyponatremia

Lab error

No treatment except to order statin

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18
Q

low sodium, serum osmo <270

What’s next?

A

Check clinical volume?

Wet, dry or normovolemic

19
Q

Low sodium, low serum osmo, wet clinical picture

A

Wet: retaining water, diluting water

liver, heart or kidney failure

Fix underlying problem then:

water restriction

20
Q

Low sodium, low osmo, dry picture

Next step?

A

Sodium loss exceeds water loss

Check urine sodium >20=kidney, <10 other sources

Where is it going?

Kidney, anus (diarrhea), mouth (vomit), pores (sweat)

If kidney, diuretic use-STOP, ACE, mineralocorticoid deficiency

21
Q

Hyponatremia, low osmo, euvolemic

A

Hypothyroidism is most common cause

22
Q

Hyponatremia, hyper osmo >290

A

Some other substance is too high in the blood, body attempts to fix it by getting rid of sodium which is plentiful in the body

Most common cause is hyperglycemia!

FIx the sugar!

23
Q

Hypernatremia

A

Due to loss of free water, where did it go?

Mouth, kidney, anus, pores

If lots of urine, DI

If urine osmo is high, not from the kidney

24
Q

Potassium

A

Ion of diastole- if too high, diastole never ends, permanent rhythm!

25
Q

Broad T waves, decreased amplitude, U waves

A

Hypokalemic

26
Q

Failure to convert with shock?

A

Hypokalemia

27
Q

Ca+

A

Contraction Ion for heart and neuro system

28
Q

Increased DTR’s, Chovestek’s sign, Trousseau’s Sign, prolonged QT

A

Hypocalcemia

Give IV calcium gluconate

29
Q

Calcium is bound to what substance?

A

Albumin

30
Q

Carpopedal spasm with BP cuff around the thigh

A

Trousseau’s sign

31
Q

Normal calcium

A

8.5-10.5

Ionized calcium 4.5-5.5

32
Q

Normal Ca+ in a pt with low albumin?

A

pt is actually hypercalcemic

33
Q

Serum calcium > 12

A

Medical emergency

(muscle weakness, N/V, fatigue),

possibly d/t thiazide diuretics

Give NS with loop diuretic, may need HD

34
Q

Adjuvant therapy for pain

A

Lyrica, antileptic

35
Q

Carb cal/gm

Protein:

Fat:

Alcohol:

A

Carb 4cal gm

Protein: 4cal/gm

Fat: 9 cal/gm

Alcohol: 7 cal/gm

36
Q

Best assessment of TPN efficacy?

A

Nitrogen balance

Neg? not enough protein

Pos? Extra protein

37
Q

Heparin is an aldosterone antagonist

A

Lose sodium, reabsorb potassium, risk for hyperkalemia

38
Q

Hyperventilating- what is the ABG finding?

A

Respiratory alkalosis, stocking glove paresthesias

39
Q

Most common post-op acid/base imbalance?

A

Metabolic alkalosis (they are dry)

Give fluid/ NS

40
Q

Most important thing in I&D?

A

Fluid irrigation

41
Q

What electrolyte abnormality is an absolute contraindication for succinylcholine?

A

Hyperkalemia

42
Q

What med is used for metabolic alkalosis?

A

Diamox/Acetazolamide

also used in closed angle glaucoma

43
Q

If the pH and Bicarb are Both in the same direction, its metaBolic!

A

resp opposite, metabolic =

pH and Co2 oppostie=respiratory

ACNP Certification (17 decks)

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