Klimek Lectures Flashcards
pH
As the pH goes, so goes my patient, except K+
Alkalosis = excited = overventilated
Acidosis = shut down = underventilated
Wernicke-Korsakoff’s
Vitamin B deficiency
Amnesia and confabulation
Any brain damage is permanent
Uppers/Downers
Caffeine, Cocaine, PCP/LSD, Methamphetamine, Adderall
Everything else
Aminoglycosides
A mean old Mycin for a mean old infection
IV or IM, never PO (except with hepatic encephalopathy and pre-op bowel surgery)
Mycin = mice ears = ototoxicity
Ear is shaped like a kidney = also nephrotoxic (monitor creatinine)
Sublingual/IV/IM peak levels
Sub = 5-10 minutes after dissolved
IV = 15-30 minutes after drug is finished
IM = 30-60 minutes after injection
Calcium channel blockers
Same goes for beta blockers
Valium for the heart / depressant
A/AA/AAA
- Antihypertensive
- Anti Angina
- Anti Atrial Arrhythmic (A flutter + A fib)
EKG words
QRS depolarization = ventricular
P wave = atrial
SVT treatment
ABCD
Adenosine
Beta Blocker
Calcium channel blocker
Digoxin
Asystole treatment
Epi then Amiodarone (asystole backwards)
Chest tube bubbles
Water seal continuous = bad
Water seal intermittent = good
Suction chamber continuous = good
Suction chamber intermittent = bad
Congenital heart defects
TRouBLe
R-L shunting
Blue/cyanotic
All CHD start with T
Trouble or not, all patients will have
- Murmurs + echo
Tetralogy of Fallot
VarieD PictureS Of A RancH
Ventricular Defects
Pulmonary Stenosis
Overriding Aorta
Right Hypertrophy
Insulin
R - Onset 1 hr, Peak 2 hr, Duration 4 hr
N - Onset 6 hr, Peak 8-10 hr, Duration 12 hr
Humalog/Lispro - Onset 15 min, Peak 30 min, Duration 3 hr
Low glucose in type 1
Insulin shock
Can cause permanent brain damage
Drunk in shock
Treat w/ sugar/rapidly metabolized carb + protein/starch
DKA
1# cause = acute upper respiratory infection in the last 10 days
S/S = DKA
- Dehydration
- Ketones, Kussmaul, High K+
- Acidosis, Acetone breath, Anorexia
HHNK
High glucose in type 2 = severe dehydration
A1C
Normal = 6 -
Out of control = 8+
Lithium Levels
For mania
Therapeutic = .6 - 1.2
Toxic = 2+
Digoxin
For A fib + CHF
Therapeutic = 1-2
Toxic = 2+
Get apical pulse before giving
Aminophylline
Bronchodilator
Therapeutic = 10-20
Toxic = 20+
Hiatal hernia
Wrong direction, right rate
GERD symptoms when supine after eating
Acute dumping syndrome
Right direction, wrong rate
ADS
- Abdominal distress
- Drunk
- Shock
HH + ADS treatment
HOB = HH/high ADS/low
Fluids w/ meal = HH/high ADS/low
Carbs = HH/high ADS/low
Protein = HH/low ADS/high
Kalemias
Same as prefix, except HR + urine
Calcemias
Opposite of prefix
Hypocalcemia
- Chvosteks sign = cheek tap
- Trousseaus sign = BP cuff
Magnesemias
Opposite of prefix
Natremia
HypO = Overload (crackles, distended neck vein)
HypEr = dEhydration
Electrolyte imbalance signs
Earliest sign = paresthesia
Universal sign = Paresis
Thyroidism
= Metabolism
Hyperthyroidism
Graves disease (run yourself into the grave)
Weight loss, diarrhea, heat intolerance, exophthalmos (bulging eyes), irritable, etc.
Treatment = Radioactive iodine + PTU (puts thyroid under) + surgical removal (most common)
PTU = immunosuppressant
Thyroidectomy
Total = needs lifelong hormone replacement + at risk for hypocalcemia
Subtotal = at risk for thyroid storm
Post op risks (12-48 hrs)
Total = tetany
Subtotal = storm
Thyroid storm
Medical emergency
S/S
- Stroke level high BP
- Severe tachycardia
- Extremely high fever (105+)
- Delirious
Treatment = get temp down and O2 up
Will either come out of it on their own or die
Hypothyroidism
Hashimoto’s disease
S/S
- Hypotension, bradycardia, weight gain, constipation, cold intolerance, dull+slow
Treatment = thyroid replacement
NEVER sedate these patients
Clarify NPO orders (never hold thyroid meds)
Adrenal Cortex diseases
Start with A or C
Addison’s = Under secretion
Cushings = Over secretion
Addison’s
Hyperpigmented + terrible stress response (glucose + BP drop instead of rising)
Treat w/ glucocorticoids (-sones)
Add-A-Sone
Cushing’s
Cushy=more/excess
Moon face, hirsutism, gynecomastia (man boobs), buffalo hump, trunkal obesity + thin extremities, bruise easily, immunosuppressed, increased glucose, water and sodium retention, excrete K+
** Same side effects for steroid use**
Treatment = Cut it out (can lead to Addison’s)
Droplet
Flu, meningitis, diphtheria, pertussis, mumps
Airborne
MMR, TB, Chicken pox (varicella), SARs
0-6 months
Best = musical mobile
Next = large + soft
6-9 months
Best = Cover/uncover toy
Next = Firm but large
9-12 months
Best = verbal toy
1-3 years
Best = push/pull toys
Parallel play
Preschoolers
Cooperative play
Creatinine
Level D
best indicator of kidney function
.6-1.2
INR
Monitors coumadin levels
Normal = 2-3
4+ = level C (bleeding risk)
- Hold coumadin
- Assess for bleeding
- Prepare to give Vit K
- Call dr
K+
Normal = 3.5-5
3.5- = level C
- Assess heart
- Prepare to give K+
- Call dr
5.4-5.9 = level C
- Hold K+
- Assess heart
- Prepare Kayexalate/D5W
- Call dr
6+ = level D
- Do all of the above at once
pH
Normal = 7.35-7.45
In the 6’s = level D
- Check vitals
- Call dr
BUN
Normal = 10-20
Elevated = level B
- Check for dehydration
Hgb
Normal = 12-18
8-11 = level B
- Monitor for anemia or malnutrition
8- = level C
- Assess for bleeding
- Prepare for transfusion
- Call dr
CO2
Normal = 35-45
In the 50’s = level C
- Assess RR
- Do pursed lip breathing
- If not resolved, call dr
In the 60’s = level D
- Assess RR
- pursed lip breathing (for anxiety)
- Prepare to intubate + ventilate
- Call RT then dr
Hct
Level B
Normal = 36-54 (3xhgb)
PO2
Normal = 80-100
70-77 = level C = sign of respiratory insufficiency
- Assess RR
- Prepare O2
- If not resolved, call dr
60- = level D = sign of respiratory failure
- Assess RR
- Give O2
- Prepare to intubate +ventilate
-Call RT then dr
BNP
Best indicator of CHF
Normal = - 100
100+ = level B
Sodium
Normal = 135-145
Abnormal = level B
UNLESS change in LOC, then level C
WBC
Normal = 5k - 11k
- 5k = level C
- Neutropenic precautions
ANC
Normal = 500
- 500 = level C
- Neutropenic precautions
CD4
Normal = 200
-200 = AIDS = level C
- Neutropenic precautions
Platelets
Normal = 150k - 400k
-90k = level C
- Assess for bleeding
- Initiate bleeding precautions
-40k = level D (can spontaneously bleed to death)
- Same as above
RBCs
Normal = 4 - 6
Laminectomy
Removal of vertebral spinous processes
Pre-op laminectomy assessments
Cervical = diaphragm (breathing) + arms
Thoracic = cough (abd muscles) + bowel sounds
Lumbar = Bladder/urine output + legs
Laminectomy post-op
Rules
- Do not dangle/sit on the side of the bed
- Limit sitting to 20-30 minutes
Complications
- Cervical = pneumonia
- Thoracic = pneumonia + paralytic ileus
- Lumbar = urinary retention + problems w/ legs
Laminectomy d/c
Temporary (6 week) restrictions
- Don’t sit longer than 30 minutes
- Lie flat + log roll
- Don’t lift more than 5 lbs
- No driving
Permanent restrictions
- Never lift by bending at the waist
- Never lift things above the head
- No horse riding, off trail bike riding, jerky rollercoasters, etc.
Pregnancy weight gain
Ideal = week # - 9
Total = 25-31 lbs
1st trimester = 1 lb/month (3 lbs total)
2nd/3rd = 1 lb/ week
Pregnancy complications
Morning sickness - 1st trimester
Urinary incontinence - 1st + 3rd trimester
Dyspnea - 2nd + 3rd trimester
Back pain - 2nd + 3rd trimester
Station (labor)
Presenting part to ischial spine (narrowest part baby has to pass through
Negative = above
Positive = below
Engagement = at ischial spine = 0
Lie (labor)
Mom’s spine + baby’s spine
Vertical lie = good l I
Transverse lie = bad l–
Presentation (labor)
The part that enters the birth canal first
- ROA + LOA = most likely answers
Stages of labor
Stage 1 = labor (includes all 3 phases of labor)
Stage 2 = Delivery of baby
Stage 3 = Delivery of placenta
Stage 4 = Recovery (2 hours; to monitor bleeding)
Phases of labor
LATent (LAT = order)
Active
Transitional
Active labor
Dilated 5-7 cm
Contraction frequency = 3-5 min
Contraction duration = 30-60 seconds
Intensity = moderate
(less = latent; more = transition
Postpartum
2 hours after delivery of placenta
Contractions
Should not be longer than 90 seconds or closer than every 2 min
If they are, TROUBLE
Prolapsed cord
Cord is presenting part
High priority
Push head back in off cord
Position knee to chest
Prep for C-section
All labor complications
LION Pit
Left side
Increase IV
Oxygen
Notify provider
Stop pitocin if in crisis
Delivery of placenta
Check umbilical for AVA
2 arteries 1 vein
Tocolytics
Stop contractions
Terbutaline (can’t give w/ cardiac disease)
Nifedipine (can give w/ cardiac disease)
Oxytocics
Stimulate labor
Oxytocin + cervidil (SE = uterine hyperstimulation)
Fetal lung development
Betamethasone
Birth complications for baby
Cephalohematoma = bleeding in the skull; does not cross the suture line
Caput succedaneum = fluid in the skull; can cross the suture line
Rules for priorities
1 - Acute beats chronic
2 - Fresh post-op (<12 hrs) beats medical or other surgical patients
3 - Stable beats unstable
4 - The more vital the organ, the higher the priority
Organ priority
Brain - Lungs - Heart - Liver - Kidney - Pancreas
Black tag patients
Pulseless
Breathless
Fixed and dilated pupils
Psych drug SE’s
ALL psych drugs cause
- Hypotension
- Weight changes
Anticholinergic (dry mouth)
Blurred vision + bladder retention
Constipation
Drowsiness
EPS
“F”otosensitivity
aGranulocytosis
Phenothizines
Typical antipsychotics
All end in -zine
Large doses = antipsychotics Small doses = antiemetics
SE’s = A-G
Tricyclic Antidepressants
NSSRI’s
Mood elevators to treat depression
SE’s = A-E (Euphoria)
Benzodiazepines
Antianxiety meds/minor tranqs
Pam or lam
Cannot take for more than 6 weeks - 3 months
SE’s = A-D
MAOI’s
Antidepressants
SE’s = A-D
Avoid tyramine
- Salad BAR (Banana, avocado, raisins + any dried fruits)
- No organ meats or preserved meats
- No aged cheese
- No alcohol, caffeine, chocolate, licorice, soy sauce
Lithium
Treats mania
SE’s = Peeing (polyuria), Pooping (diarrhea), Paresthesia (tingling/numbness)
Toxicity = Tremors, metallic taste, severe diarrhea, other neuro signs
Only works when sodium is controlled
Prozac
SSRI
SE’s = A-D
Causes insomnia = give before noon
Causes SI when changing dose in adolescent or young adult
Haldol
Typical antipsychotic
Tranq
SE’s = A-G
Elderly patients may develop neuroleptic malignant syndrome
Neuroleptic malignant syndrome
Can look similar to EPS but will have high fever (104+)
Is a medical emergency
Clozapine
Atypical antipsychotic
Treats severe schizophrenia
SE = G
Can only be prescribed for 7 days (then get WBC drawn for 4 weeks, then 1/month for 6 months, then every 6 months
Zoloft
SSRI
Antidepressant
SE’s = SAD Head
Sweating
Apprehensive
Dizzy
Headache
Can interact w/ St. John’s Wort (serotonin syndrome) + warfarin
Before changing an answer
Explain why new answer is superior to first pick. If you can’t do this, don’t change your answer
