Fundamentals Flashcards
Hypomagnesia
Opposite of the prefix (high)
Tachycardia, hyperreflexia, etc
Hypocalcemia
Do the opposite of the prefix
Agitation, Irritability, 3+ or 4+ reflexes, spasm, Chvostek sign (tap the cheek) or Trousseau (inflate BP cuff)
Managed with calcitonin
Hypokalemia (+ Txt)
Symptoms go low with hypo except HR /UO
Lethargy, bradypnea, hyporeflexia (+1), tachycardia & polyuria
Txt using K+, NEVER IV PUSH K+
K+ order less than 40 mEq/L of IV fluid, more should be questioned
Hyponatremia
HypOnatremia = Overload
Crackles, distended neck veins
TXT:
Fluid restriction, Lasix
Hyperkalemia (+ Txt)
Symptoms go HIGH with hyper except HR/UO
Seizures, diarrhea, hyperreflexia (+3,+4), bradycardia, oliguria
Fastest way to lower K levels:
Give D5W, Regular Insulin, and Kayexalate
D5W, and Regular insulin draw potassium into cells and out of blood, but only temporary
Kayexalate will treat long term but takes HOURS to kick in, will cause hypernatremia managed by IV fluids
K exits LATE
Hypercalcemia
Opposite of prefix
Sedative with heavy use (hyper-)
Bradycardia, bradypnea, hypoactive reflexes, lethargy, constipation
To txt hypercalcemia, use phosphates to exchange. Calcitonin is typically given as well to compensate for overuse
Hypernatremia
hypErnatremia = dEhydration
Hot, flushed, dry skin, thready pulse, rapid HR
TXT: Give FLUIDS
Hypermagensia
Opposite of the prefix
Acts as a sedative with heavy use (hyper-)
Low symptoms: Bradycardia, bradypnea, hyporeflexia, constipation
Normal pH
7.35 - 7.45
Normal bicarb + symbol
HCO3, 22 - 26
(2 + 2 + 2 = 6)
If _ and _ move both in the same direction, then the acid-base imbalance is _
If pH and bicarb move both in the same direction, then the acid-base imbalance is metabolic
Bicarb Both Bolic
S/Sx of low pH
Acidotic; Everything low -> body shuts down
Hyporeflexia (+1), bradycardia, coma, lethargy,
S/Sx of high pH
Alkalosis; Systems are irritable
hyperreflexia (+3/+4), tachypnea, febrile
As the _ goes, so goes my patient except _
As the (pH) goes, so goes my patient except (K+)
MAC Kussmaul
Metabolic ACidosis is the only metabolic imbalance to lead to kussmaul respirations
If imbalance is LUNG related, it is
Respiratory
OVER-ventilating is low/high pH?
Alkalosis - pH is high
UNDER-ventilating is low/high pH?
Acidotic - pH is low
High Pressure Alarms mean what? Caused by?
Increased Resistance to air flow
Kinks in tubing, buildup of water in the tube, mucus plugs
Steps to fix high pressure alarms
1) Unkink
2) Empty water from tubing
3) Turn pt, ask to cough/deep breathe
4) Suction
Low pressure alarms mean what? Caused by?
Decreased resistance to air flow
1) Main tubing d/c
2) O2 sensor tubing d/c
Solutions for disconnects
Reconnect them unless tubing is on the floor, then bag patient and contact RT
Lithium (Indications, Therapeutic Range, Toxicity)
Used for bipolar disorder
Therapeutic Range = 0.6 to 1.2
Toxic > 2.0
(2s: Low # Lithium & Lanoxin)
Lanoxin (Indications, Therapeutic Range, Toxicity)
Used for A-fib/CHF (Digoxin)
Therapeutic Range = 1 to 2
Toxic > 2.0
(2s: Low # Lithium & Lanoxin)
Aminophylline (Indications, Therapeutic Range, Toxicity)
Muscle spasm relaxer for the airway (paradoxical bronchospasm)
(If bronchodilator do not work -> Aminophylline
Therapeutic = 10 - 20
Toxic >= 20
Non-therapuetic = less than 10
If not therapeutic, increase dose and assess compliance
20s: High # (Aminophylline, Dilantin, Bilirubin)
Dilantin (Indications, Therapeutic Range, Toxicity)
Seizure medication
Therapeutic: 10-20
Toxic >= 20
20s: High # (Aminophylline, Dilantin, Bilirubin)
Bilirubin (Indications, Therapeutic Range, Toxicity)
Breakdown product of RBC’s
Normal levels in adults: 0.2 - 1.2
In newborns, much HIGHER
Elevated level 10-20
Toxicity > 20
Hospitalize around 10-15
20s: High # (Aminophylline, Dilantin, Bilirubin)
Jaundice
Yellowing of the skin from excess bilirubin in blood
Visible at > 20 levels
Pathological Jaundice vs Physiological Jaundice
Pathological - Born yellow
Physiological - Turns yellow after 1-2 days
Dumping syndrome (S/Sx, Txt)
Gastric content dumped too quickly
Right direction - wrong rate
Drunk + Shock + Acute Abdominal Distress = Dumping
Impaired judgement, cold/clammy, tachy, N/V, diarrhea, borborygmi, guarding
Txt:
Lower HOB during meals and turn patient
Decrease fluid content 1/2 hours before/after meals
Decrease amount of carb content
Everything LOW
HIGH Protein diet
Protein in digestion
Opposite of carbs; longer digestion
High protein diet - dumping
Low protein diet - hiatal hernia
Hiatal Hernia (S/Sx, txt)
Regurgitation of gastric acid upward or backward into esophagus
Wrong direction, right rate
S/Sx similar to GERD; heartburn, indigestion on lying down after eating
Txt:
Elevate HOB during + 1 hour after meals
Increase amount of fluids with meals
Increase the amount of carb content
HIGH-anal hernia = Everything HIGH (except protein)
Memorize these 3 sentences:
_ do the same as the prefix (hypo-, hyper-) except _ and _, which go opposite
_ do the opposite as the prefix
_ do the opposite as the prefix
Kalemias do the same as the prefix (hypo-, hyper-) except HR and UO (urine output), which go opposite
Calcemias do the opposite as the prefix
Magnesimia do the opposite as the prefix
What two electrolyte imbalances are possible in DKAs
Hyperkalemia
Hypernatremia
Earliest sign of electrolyte imbalance
Numbness and tingling = paresthesia
Universal sign of electrolyte imbalance
Muscle weakness = Paresis
HELLP Syndrome
Hemolysis, Elevated Liver Enzymes, Low Platelets
Definitive txt is giving birth
Kawasaki Disease
Systemic inflammation of arterial walls
Txt: IV Immunoglobulin & Aspirin (Peds exception)
Tumor Necrosis Factor (meds, considerations)
Immunosupprresing medications
Should not have any active infections, test for TB prior to starting as latent TB can become active TB
Ex: Adalimumab (suffix -mab)
Live Vaccines
Polio, Rotavirus, Measles Mumps & Rubella, Varicella, Yellow Fever
Preconception Counseling
Folic acid supplements (400 mcg/daily)
Rubella immunity
Dentist appt for peridontal disease
Sjoren Syndrome
Chroic autoimmune disorder where moisture-producing exocrine glands are attacked by WBCs
Angiotensin-Converting Enzyme (ACE) inhibitors
“-pril”
Used for treatment of high BP by inhibiting Angiotensin 2 production
May cause hyperkalemia
Used for kidney protection but still can cause harm
Purpura
Small blood vessels under skin (red dots)
Sunburn txt
Fluids, cool compress, no aspirin for peds
Complications with digoxin (other name)
Lanoxin - Digoxin toxicity (greater than 2)
Monitor for hypokalemia
Sulfalazine
Used to treat IBD and rheumatoid arthritis
S;Sx: Crystalluria, photosensitivity, folic acid deficiency, SJ syndrome
Beta-Blockers
“-olol” suffix
Like vallium for your heart, measure BP and HR prior to admin
Used for diabetes w hypertension & proteinuria
Decreased C/O
Negative chronotrope & inotrope (slows HR and strength of HR contraction)
Anti-arrythmic
Serotonin Syndrome
Life-threatening condition caused by excess serotonin in the CNS
S/Sx: Mental status change (anxiety), autonomic dysregulation (tachy, htn, diaphoresis), neuromuscular hyperactivitiy
Txt: D/C sertraline agents -> administer benzodiazepines to prevent seizure onset
Angiotensin Receptor Blockers (ARBs)
(“-sartans”)
Treats high blood pressure and heart failure, can be used for CKD
Considerations: Can cause hyperkalemia
Intussception
Occus when one section of bowel telescopes over another
S/Sx: Inconsolable crying, legs to abdomen, “currant jelly” stools (blood/mucus), palpable sausage-shaped mass in abdomen
Can lead to bowel resection, perforation, decreased blood supply
Impetigo
Rash with red base and honey-colored crusts
Highly infectious bacterial infection in children
Low platelets _ chance of bleedings
Increases (less likely to clot)
Herpes Type 1
Life-long virus, periods of dormancy/flares
Contagious during flares
Tingling sensation
Ereythamous skin lesions -> rupture -> crust
1 mg = _ mcg
1000 mcg
1 kg = _ lbs
2.2 lbs
Rheumatoid arthritis
Autoimmune inflammatory response in synovial joints, symmetric
Systemic Sx: Fever, Fatigue, Weight loss
Small joints of hands/feet first -> wrists/elbows/shoulders/knees
Med: Methotrexate + NSAIDs
Thrombolytics
Used to lyse thrombi (clots) and restore perfusion
tPA is commonly used
Contraindicated if major surgery last 2 weeks, can cause life-threatening bleeds
Methatrexate
Antirheumatic - immunosuppressing
Osteoarthritis
Ages 40+
Asymmetric and non-inflammatory that worsens over time
No systemic Sx
Mainly weight-bearing joints (hips, knees)
Noncomediogenic
Does not clog pores
Narcissistic Personality Disorder (NPD)
Recurrent pattern of grandiosity, need for admiration, and lack of empathy
Fragile self-esteem AND fear of abandonment
Heart Failure Symptoms
Elevated B-type natiuretic peptides
S1/S2/S3 heart sounds
Crackles (PE)
Skin Cancer Examination Rules
ABCDE
Asymmetry
Border Irregularity
Color changes + Variation
Diameter of 6 mm or larger (pencil eraser)
Evolving (changing aspects)
Minimizing GERD in pregnant patients
Small, frequent meals
Eliminating fried/fatty foods
do NOT lie down after meals
Cluster fluid intake between meals
Tricyclic Antidepressant OD Sx
“-tyline” suffix
Tachy, orthostatic hypotension, AMS, hypoactive bowel sounds, pupillary dilation
Causes QRS + QT elongation -> cardiac arrest
Sodium Bicarbonate use via IV
Narrows QT interval
Hyperemesis leads to which electrolyte imbalance?
Hypokalemia
Indication for Activated Charcoal
Needs to be given within 1-2 hours of toxin ingestion to be effective
Nitrazine pH test
Turns blue when exposed to amniotic fluid/alkalytics
Semen and blood can trigger false positives
Vitamin C & Iron Relationship
Vitamin C increased iron absorption
Use of laxatives in pregnancy
Not indicated d/t risk of electrolyte imbalance, stool softener should be used instead
Chest drainage rate concern
Greater than 100 mL/hr
Approximate normal urine output
~ 30 mL/hr
