Lab Levels Flashcards
Sodium (Na+)
135-145 mEq/L
Magnesium
1.8 - 2.6 mg/dL
Calcium
9-10.5 mg/dL
Phosphorus
2.5-4.5 mg/dL
Potassium
3.5 - 5 mEq/L
Hemoglobin abbreviation and level
Hgb
Female: 12-16 g/100mL
Make: 13-18 g/100mL
Hematocrit abbreviation and level
HCT
female: 37%—47%
Male: 42%—52%
Chloride
95 - 105
WBCs
5,000 — 10,000/mm3
Temperate Fº and C º
F— 97.8 - 99
C — 36.5 - 37.2
BUN
10 — 20 mg/dL
Creatinine
Female: 0.5 — 1.1 mg/dL
Male: 0.6 — 1.2 mg/dL
Glucose
75 - 105 mg/dL
HgbA1c
- < 6.5%
6.5 or less is a good range anything higher NOT good diabetic patient for sure
5 - 6.5 pre-diabetic
RBC
Women: 4.2 — 5.4 million/mm3
Men: 4.7 — 6.1 million/mm3
Platelet
150,000 - 400,000/mm3
pH
7.35 - 7.45
pC02
35 to 45 mm Hg
p02
80 — 100 mmHg
HCO3
22- 26 mmol/L
Normal PT
11- 12.5 sec
Normal INR
0.7 - 1.8
Normal PTT
30-40 sec
Borborygmi (means ?)
Increased bowel sound
If pt’s pH is high what is the nursing intervention?
Suctioning because of seizures
If pt’s pH is low what is the nursing intervention?
Pt needs to ventilated with a Ambu bag due to respiratory distress
What acid-base imbalance does Kussmaul respirations cause?
MAC Kussmaul
Metabolic ACidosis
What #’s are HYPERflexia?
3+ and 4+
What #’s are hypoFlexia?
0 and 1+
What is Paralytic lieus?
Condition where bowels are impaired
(muscles of the intestines do not allow food to pass through, resulting in a blocked intestine)
What does obtunded mean?
Means one step more lethargic then lethargy (Difficult to arouse)
Who needs an Ambu bag at the bedside?
Acidic patients due to respiratory distress/arrest
Which patients need suction at the bedside due to seize?
Alkalosis patients due to seizures (foaming of mouth, at risk for aspirating)
What does paroxysmal mean?
Spasms or seizures
Which type of acid-base balance is Overventilating?
alkalosis which equals Respiratory alkalosis, because it has to due with breathing/Lungs
Which type of acid-bas balance is underventilating?
Acidosis which equals Respiratory acidosis (Respiratory due to respirations/Lung related)
Which type of acid-base disorder would tell you maybe they need to come off the pump, pt is on PCA (patient-controlled anesthesia) pump?
Respiratory acidosis would tell you they may need to be taken off pump
(because ventilation is down, and respirations would be down due to drug, PCA pumps depress respirations)
If patient has prolonged gastric vomiting or suctioning what acid-base balance is it?
Metabolic alkalosis
Because acid is being sucked out causing pH to become alkalosis
Pt had GI surgery, NG tube two low intermittent gonko suctioning for three days. What acid-base disorder will patient most exhibit?
Metabolic Alkalosis
Because acid is being suctioned out
Part 1) If your patient has hyperemesis gravidarum what acid-base disorder are they most likely to exhibit?
Part 2) what if patient now becomes dehydrated what acid-base disorder will they have?
Answer 1) Metabolic Alkalosis
(Due to acid being expelled, causing Alkalosis to rise)
Answer 2) Metabolic acidosis, because it flipped under
What acid-base disorder would a pt with acute renal failure have?
Metabolic acidosis
(Think DKA diabetic keto acidosis)
What acid-base disorder would an infant have who has infantile diarrhea?
Metabolic acidosis
(Because its not Lung or vomiting or suctioning so that by default makes it metabolic acidosis)
What acid-base disorder would a patient with 3rd degree burns over 60% of the body first phase?
Metabolic acidosis
By default not Lungs or vomiting/suctioning
What is the default setting for answering acid-base imbalance disorders? When you don’t know what it is
MAC
Metabolic acidosis
How often do you suction patients?
As necessary
What is the appropriate order to address high pressure alarms in a mechanical ventilator?
1) unkink
2) empty water out of tubing
3) change positions: turn, cough, deep breathe
4) suction
What are ventilators High pressure alarms for?
Solution to problem in order?
To alert of an increase in resistance caused by obstructions.
1) Unkink
2) Empty water from tubing
3) change positions: turn, cough, deep breathe
4) suction
what are ventilators low pressure alarms for?
Solution to problem? And exception
To alert a decrease in resistance, caused by a disconnection
Re-connect unless tubing is on floor, Bag pt and call respiratory therapist
If ventilator pressure is set to high what is pt at risk for?
Respiratory Alkalosis
If ventilator pressure is set to low what is pt at risk for?
Respiratory acidosis
What is the number one psychological problem in abuse?
Denial
(Rule can be used for any abuse situation)
How do you treat Denial in abuse?
By confronting them
Point out the differences b/t what they say and what they do
How do you confront an abuser? Alcohol for examples
“Ok, you say you’re not an alcoholic but it is 10 a.m. and you’ve already had a 6 pack”
(It’s not the same as aggression. Don’t attack the person)
How do you confront a child abuser who is in denial?
Confront
“You say your not a child abuser but child protective services has your children”
What are the stages of grief?
“DABDA”
Denial
Anger
Bargaining
Depression
Acceptance
When abusers Deny what do you do?
Confront
“They deny, You Confront”
When is denial accepted?
When it is a loss or grief
What do you do in denial when it is a loss or grief?
Support
What is the #2 psychological problem in abuse?
Dependency and Co-dependency
Define Dependency in abuse?
When they get the significant other to do things for them
Ex: “Will you call my boss” or “ Will you go do this…”
Who is dependent in abuse?
The abuser is dependent
Define Co-dependency in abuse?
Is when the significant other derives self-esteem for doing things or making decisions for the abuser
Who is Co-dependent in abuse?
The significant other is the co-dependent
How do you treat dependency and co-dependency in abuse?
Answer for each pt
Co-dependent:
You set limits, and enforce them for co-dependents
Work on self-esteem
Teach to say NO and I’m a gd person
Dependent:
Confront the abuser the dependent
What is Manipulation in abuse?
When the abuser gets the significant other to do things/decisions not in the best interest of the significant other
(Nature of the act is dangerous & harmful to the significant other)
What is it called when a significant other is being asked to do something that is not inherently dangerous and harmful?
Dependency/Co-dependcy
What is it called when the significant other is being asked to do something that is inherently dangerous and harmful
Manipulation
How do you treat manipulation? How many pts
Set limits and enforce them, only the manipulated person is being treated as they have the self-esteem issues
How many pts do you treat/have in denial?
One
How many pts do you have in dependency?
Two
-dependent & - co-dependent
What is Wernicke?
A brain disorder caused by lack of Vitamin B1
encephalopathy is?
Any brain disease that alters brain function or structure
What is psychosis?
a disconnection from reality
Or
Loss from reality
What is amnesia?
Memory loss
What is confabulation?
Making up stories
(pt believes their story/lie, pts are psychoatic, The lie is just as real as reality to them)
How do you deal with a pt with Wernicke and Korsafoff who is confabulating about going to a meeting with Barack Obama this morning?
Redirect pt ex: “Can we go watch TV to see what is on the news today, in Washington DC”
Do NOT present reality
Some brain damage is permanent
3 Characteristics of Wernicke and Korsafoff syndrome
1) Preventable…Take B1
2) Arrestable (stop it from getting worse) Take B1
3) Irreversible (70%) will kill brain cells
2 Good news 1 Bad news
What is aversion therapy?
A type of behavior therapy designed to make a pt give up an undesirable habit by causing them to associate it with an unpleasant effect
Used in alcoholism
How long is the onset and duration of effectiveness of Antabuse and Revia (Disulfiram)?
2 weeks for both
2 weeks to start working
And
It Last 2 weeks (need to be off for 2 weeks before you decide to drink again)
What would you teach a pt who is doing aversion therapy for alcohol?
-To avoid ALL forms of Alcohol (Can lead n/v and death)
-AVOID items: Mouth wash, cologne, perfume, aftershave, OTC liquid medicine ending in elixir, insect repellent, alcohol based hand sanitizer, uncooked icing that have vanilla extract
-DO NOT PICK RED WINE VINAIGRETTES (does NOT have alcohol in it)
What is the most overused drug in elderly that is not an Upper or a downer?
Laxatives
Name the 5 uppers?
Caffeine
Cocaine
PCP/LSD (psychedelics/hallucinogen)
Methamphetamine (crystal meth)
Adderall (ADD drug)
S/SX of Uppers
Borborygmi
Diarrhea
Euphoria
HYPERflexia 3+, 4+
Irritability
Restlessness
Seizure
Tachycardia
*Have suction equipment ready foam from seizure
What is the highest priority to anticipate in an Upper?
Suctioning due to seizures
What is the highest priority in a downer?
Intubation/ventilation due respiratory arrest
Squad calls saying they are bringing in a pt who overdosed on cocaine. What do you expect to see? Select all that apply
- Irritability
- 4+ reflexes
- Respirations less than 12
-difficult to arouse
-borborygmi
-increased temp.
Irritability
4+ reflexes
Borborygmi
Increased temp.
Your caring for a pt who is withdrawing from cocaine, what will you do?
Administer Narcan
Drug addiction for newborn at birth what will you assume?
Intoxication
After 24 hours newborn baby is what in drug abuse?
Withdrawal
You are caring for an infant born to a Quaalude addicted mother 24 hrs after birth. Select all that apply s/sx
-difficult to console
-low core temp
-exaggerated startle reflux
-resp. Depression
-seizure risk
-shrill, high-pitched cry
-difficult to console
-seizure risk
- shrill, high-pitched cry
-exaggerated startle reflux
When does an alcoholic go through alcohol withdrawal syndrome?
Approx. 24 hours after they stopped drinking
When does Delirium tremens occur?
72 hours after the person stop drinking
Is Alcohol withdrawal syndrome life threatening?
No
Is delirium tremors life threatening?
Yes
What does pt is “Up ad lib” or “up ad Liberum” mean?
Pt is free to move around as desired
Would you as an LPN take on an assignment of a Delirium Tremons pt?
No pt is unstable
As RN yes but would have to decrease work load
Nursing Care plan for AWS?
-regular diet
-semiprivate room
-up ad lib
-No restraints
Nursing care plan for Delirium Tremons?
-NPO or clear liquid diet (seizure precautions)
-private room
- Bed bound
- Restraints Vest or 2-point lock letters (one arm and 1 leg opposite of each other)
What are the toxic effects of aminoglycosides? What should you monitor when taking
1- Monitor hearing, balance (vertigo, dizziness), tinnitus
1) Ototoxicity
2) Nephrotoxicity
“A mean old mycin” sounds like Mice (think Mickey ears)
Human ears are shaped like kidneys (nephrotoxicity= toxic to the kidneys)
BEST indicator of kidney function
What is better 24-hour creatinine clearance or a serum creatinine test?
24-hour creatinine clearance
What is hepatic encephalopathy (or hepatic coma)?
The loss of brain function when a damaged liver doesn’t remove toxins from the blood
Where Ammonia level gets too high
Ammonia causes confusion, disorientation, and coma
What is the ringing in the ear called?
TinnitUS
how often are aminoglycosides taken?
And
What nerve are they toxic too?
-q8h
-Nerve 8 auditory nerve
How is “Mycin” given?
Except for 2 exceptions what are they?
IM or IV
PO
1- hepatic coma or hepatic encephalopathy
2- pre-op bowel surgery to sterilize the bowels
Who can sterilize the bowels?
Which aminoglycosides
“Neo Kan”
Neomycin and Kanamycin
What is Trough?
When drug is at its Lowest concentration in pt’s blood
Why and When due you draw a Trough? Aka TAP
When there is a narrow therapeutic window
And 30 minutes before next dose no matter the route
What is the peak of a subL route?
5 - 10 min. After drug is dissolved
What is the peak of IV route?
15 - 30 min. After the bag is empty/finished
What is the peak time of IM route?
30 - 60 minutes
When do you want to relax and slow down the heart? Using Calcium Channel Blockers and one exception
A, AA, AAA
Anithypertensive
AntiAnginal drugs
AntiAtrialArrhythmia
Supraventricular= atrial
What are the most common side effects of Calcium Channel blockers?
Headache and hypotension
Calcium Channel Blockers end in “dipine” and also what 2 others?
And which of the two others is given IV?
-Verapimil
-Cardizem (diltiazem)
-Cardiezem (diltiazem) is given continuous IV drip
What are the parameters to assess before giving CCB?
BP
Hold if SBP < 100
A lack of QRS complexes is?
Asystole= A flat line
QRS depolarization=
Ventricular
P wave=
Atrial
P waves in the form of a saw tooth wave=
Atrial flutter
Think of the movie jaws
I saw the teeth of jaws and my heart fluttered
Chaotic P wave patterns=
Afib
Chaotic is word used to describe what in sinus rhythm?
Fibrillation
Chaotic QRS complexes=
V-fib
Bizarre QRS complexes=
V-tach
Periodic wide Bizarre QRS complexes =
Premature Ventricular Contractions (PVC)= short run of v-tach
Low priority
Which arrhythmias are lethal and HIGH priority?
Asystole
V-fib
Both produce a low or NO cardiac output
(Will kill pt in 8 minutes or less)
Which arrhythmia is POTENTIALLLY lethal?
V-tach
Treatment of ventricular arrhythmia use?
Lidocaine or Amiodarone
Supraventricular arrhythmias are?
Atrial arrhythmias
Treatment of Atrial arrhythmias?
ABCD’s
Adenocard (Adenosine)
Beta-blockers
CCBs
Digitalis (Digoxin), Lanoxin
Which cardiac arrhythmia do you Defib?
V-fib
Or
“For V-fib you DeFib”
Treatment of Asystole?
Epinephrine and Atropine in that order
Pneumothorax chest tubes remove?
Air
Hemothorax chest tube removes?
Blood
Hemopneumothorax chest tube removes?
Blood and air
A chest tube is placed in a pt for hemothorax. What would you report to the nurse?
A) Chest tube is not bubbling
B) Chest tube drains 800 mL in the first 10 hours
C) Chest tube is not draining
D) Chest tube is intermittently bubbing
C) Chest tube is not draining
What is the chest tube NOT suppose to in a hemothorax?
Bubble
A chest tube is placed in a pt for a pneumothorax. What would you report to the nurse? Select all that apply
A)Chest tube is not bubbling
B)Chest tube drains 800 mL in the first 10 hours
C)Chest tube is not draining
D) Chest tube is intermittently bubbling
A) Chest tube is not bubbling
B) Chest tube drains 800 mL in the first 10 hours
Chest tube is in the Apical part of lungs, what location is this?
Top of lung
Chest tube is in the basilar part of the lungs what part is it draining?
Bottom part of lungs
Where would you place a chest tube for a postoperative right pnuemoectomy?
NO where there NO lung
When water seal breaks what is the order of operation?
-Submerge
-cut
-clamp
-unclamp
-clamp
-cut
-submerge
-unclamp
When you see First its about?
Order
You get to do multiple things, what you pick is what you do first
When you see BEST it means?
Means what is the priority thing to do
You only get to do one thing
What do you do first if a chest tube gets pulled out?
Cover the opening
What is the best thing to do if a chest tube gets pulled out?
Vaseline gauze w/tape 3 sides
In chest tube pt is intermittent bubbling in water seal chamber good or bad?
Good
In chest tube pt is continuous bubbling in water seal chamber good or bad?
Bad, means a leak in system
What is a Thoracentesis?
A chest tube that goes in and out
What is one things ALL children with congenital heart defects have?
-murmur
What are the defects of Tetralogy of Fallot?
“PROVe”
P
R
O
V
Contact isolation precautions for what diseases?
-Anything enteric (GI or fecal/oral)- C. Diff, Hepatitis A, E. Coli, Cholera, Dysentery, MRSA also airborne **
-Staph
-RSV- even thou transmitted through droplet
-Herpes: shingles
How do you get Hepatitis A ?
A for Anus (bowel or contaminated food)
What is the PPE for contact precaution?
-private room (or same cohort/disease)
-hand washing
-gown
-gloves
-Disposable supplies
-Dedicated equipment
Droplet precautions disease?
-Anything traveling 3 feet:
pertussis,
Influ A & B,
MRSA,
RSV
-ALL meningitis
-H. Influenza B (causes epiglottitis)
What are PPE for droplet precautions?
-private room is preferred or w/others of same cohort/disease
-hand washing
-mask
-Goggles/face shield
-Gloves
-disposable supply’s
-dedicated equipment
Airborne is for? What diseases
“MTV”
-MMR= Measles, Mumps, Rubella
-TB
-Varicella (chickenpox)
What PPE is needed for airborne diseases?
-Negative air pressure/flow room
-private room REQUIRED
-hand washing
-gloves
-goggle/face shield
-mask (N95 for TB)
-Pt must wear mask when leaving room
-Disposable/Dedicated equipment is not essential
Order of PPE putting on?
Gown
Mask
Goggle
Gloves
Order of PPE taking off?
Alphabetical order
Gloves
Goggles
Gown
Mask
How do you measure crutches length? And handgrips
Rule out landmarks on foot or say axila
-2-3 inches width b/t the pad and axilar y
- the tip point of crutch lateral and slightly in front of foot
- Elbow flexed at 30 degrees
- Wrist should be at level of the handgrip
How to walk with a 2-point gait?
Move crutch and opposite food, then the other
2 points always touching ground and 2 points moving together
How to walk with a 3-point gait?
Move 2 crutches and the bad leg TOGETHER= 3 points moving together
How to walk with a 4 point gait?
Move everything separately
Right crutch —> Left foot —>Left crutch —> Right foot
Slow but table
Which crutch gait do you use when non-weight bearing?
Swing-through (amputees or injured leg)
Amputee which crutch gait do you use?
Swing-through
What crutch gait would you use evenly distributed weakness?
Which is mild
Which is severe
2-point gate- mild
4- point gate- severe
What crutch gait would you use for one leg is affected?
Odd 3 point gait
A pt has a left ATK (above the knee) amputation 2 days ago. What gait should the pt use?
Swing-through b/c non-weight bearing
Pt is in advanced stages of ALS. What gait should the pt use?
4-point gait b/c advanced
Pt is first day postop, right knee, partial weight bearing allowed. What gait should the pt use?
3-point gait b/c partial weight bearing allowed
Pt with bilateral total knee replacement first day postop. Weight bearing is allowed. What gait should the pt use?
4-point gait considered severe
Pt with bilateral knee replacement 3 weeks postop. What gait should the pt use?
2-point gait not as severe considered mild
How should you go Up and Down the stairs with crutches?
Up with the GOOD, down with bad
Note: Both crutches move with bad leg
What side does the cane go on?
Strong side/unaffected leg
How to use a Walker?
“Pick them up, Set them down, Walk to them”
If you must tie belonging to the walker where would they tie them?
On side of walker so does not tip over
A false, fixed belief or idea or thought is?
Delusion
What are the 3 types of delusion?
-paranoid - ppl going to kill me
-grandiose - I’m president
-somatic - there are worms inside my body
A psychotic sensory experience is called a?
hallucination
Or Illusion
Depends if there is a referent is something there
What are the types of hallucinations?
There are 5
-Auditory “ppl are out to kill me”
-Visual “I see bugs on the wall”
-Tactile “I feel bugs on my arm”
-Gustatory “Taste”
-Olfactory “smell”
A psychotic symptom of a misinterpretation of reality is?
An illusion
What is the 4 step process for a functioning psychotic pt?
1) Acknowledge feelings
2) Present reality
3) Set limits
4) Enforce these limits
Acronym “Annual passes sell everyday”
What is the 2 step process for psychosis of dementia?
1) Acknowledge their feelings
2) Redirect them- Give them something to do
What is the 2 step process of delirium in psychosis?
1) Acknowledge feeling
2) Reassure safety and temporariness
What is Oliguria?
l-O-w has O like low=
low urine output
Who gains weight DI, DM or SIADH?
SIADH they retain water
Normal specific gravity level
1.005 to 1.030
What are the s/sx of Diabetes?
Know the 3 Ps
Polyuria- excess peeing
Polydipsia- excess thirst
Polyphagia- increased hunger
What is the primary modification made in type II DM diet?
Calorie Restriction
How many meals should a DM II pt have in a day?
6 small frequent meals
Normal Glucose level?
70-110
R-regular insulin onset, peak, duration?
Clear short acting, IV Only insulin type
1
2
4
N-NPH, intermediate insulin onset, peak, duration?
6
8-10
12
Lispro (Humalog) onset, peak, duration?
When do you give it?
15
30
3 hrs
Give it WITH meal
Glargine (Lantus) onset, peak, duration?
Long-acting
0 peak
12-24 hours
What action by the nurse invalidates the manufacturers expiration date on vial of insulin?
Opening the package and new expiration date is 30 days after that
Acute complications of diabetes? 3 things
Low blood glucose
Hypoglycemia
Hypoglycemic shock
What does hypoglycemia look like s/sx?
Think DRUNK pt in Shock
Drunk:
-staggering gait
-slurred speech
-Cerebral impairment (liable means same thing)
-Slow reaction time
-Decrease social inhibition (loud annoying)
Shock:
-tachycardia
-tachypnea
-Low BP
-Cold/clammy
-mottled skin
Treatment of hypoglycemia
Give sugar + starch:
-orange juice
-crackers
-apple juice
-turkey
-Skim milk but 1/2 cup
Unconscious pts: Glucagon IM, or Dextrose IV of D10, D50
High Glucose in a type I causes?
DKA
What causes DKA?
-too much food
-not enough insulin
-not enough exercise
-Viral infection Upper respiratory infection within 2 weeks
What are the s/sx of DKA?
DKA
Dehydration
Ketones in serum, kussmauls, high K+
Acidosis, acetone breath (fruity breath), Anorexia due to nausea
When diabetics are sick what happens? 2 main things
High glucose
Dehydrated s/sx (hot/flushed)
What is the treatment of DKA?
Insulin IV remember R-Regular
IV fluid! 200mL/hr
Who can have HIGH blood sugar in diabetes?
Type 2
S/sx of dehydration:
-skin is dry
-flushed
-decreased turgor
-increased HR
-dry mucous membranes
Which test is the best indicator of long term blood glucose level?
HbA1C
6 or lower good
7 or greater pre-diabetic/have pt come in for eval
8 or greater is out of control
Lithium is used for what?
Therapeutic level:
Toxicity level:
Bipolar (antimania drug) Manic episode only
Thera: 0.6 - 1.2
Tox: 2 or greater
Lanoxin (Digoxin) is used for?
Therapeutic:
Toxicity:
Digitalis: A-fib and CHF
Thera: 1-2
Tox: 2 or greater
Aminophylline is used for what?
Therapeutic
Toxicity
Airway, muscle spasm relaxer
Thera: 10-20
Toxicity: 20 or greater
Dilantin (phenytoin) is used for what?
Therapeutic
Toxicity
for seizures
Thera: 10 - 20
Tox: 20 or greater
Bilirubin elevated level and toxicity in newborns range?
10 - 20 elevated
20 or greater toxic
14-15 physicians want NB in hospital the
Newborn comes out yellow which type of jaundice is this?
Pathological jaundice
What is Kernicterus? When does it occur?
Bilirubin in the brain, when level in blood gets greater or equal to 20
What is Opisthotonos?
A position a NB assumes due to irritation of the meninges from kernicterus
Hyperextended posture MEDICAL EMERGENCY
In what position do you place an opisthotnic newborn?
On side
What is Hiatal Hernia?
Like GERD but WITH lying down
Heartburn and indigestion
Treatment of Hiatal hernia?
-elevate HOB
-increase fluids with meals
-increase carb content helps empty faster
-Decrease protein
Dumping syndrome s/sx:
DRUNK: staggering gate, impaired judgement,
SHOCK: cold/clammy, tachycardia, pale
Acute Abd distress: n/v, diarrhea, cramping, guarding, borgorygmi, bloating, distensión
Treatment of Dumping Syndrome:
-Lower HOB
-Decrease the amount of fluids 1 or 2 hours before or after meals
-Decrease carbs content
-High protein (bulks gastric content)
how do you check Chvostek sign and when do you see it?
Tap the cheek
Hypocalcemia
How do you check trousseau sign? And with which electrolyte imbalance?
Inflate BP cuff
Hypocalcemia
If s/sx are nerve or skeletal involvement which electrolyte should you choose?
Calcium
What is tetany?
Muscle spasm
What is clonus?
Irritable
Choosing answers for potassium and calcium? Pick what for potassium
Heart or blood pressure
Magnesium is a?
Sedative
Paresthesia?
Numbness and tingling
Circumoral paresthesia?
Numbness and tingling around the lips
Paresis?
Muscle weakness
Never push which electrolyte in IV?
Potassium
How do you lower potassium? Temporary
Give D5W and regular insulin TEMPORARY solution
Long term treatment for potassium?
Kayexalate (enema or PO)
What should you know about electrolytes?
Kalemias same as prefix except HR and Urine Output
Calcemias- opposite of prefix
Magnesium- opposite of prefix
Natremia- Dehydration or Over load
Why is HIGH potassium a bad thing?
Stops heart/ Cardiac Arrest
S/sx of thyroid storm?
1) temp of 105 or greater
2)High BP, stroke level 210/180
3)Severe tachycardia 180 or higher
4)Psychotically delirious
Lowering body temp in thyroid storm First step?
Ice pack
Lowering temp in thyroid storm best step?
Cooling blanket
Postop Risk in total thyroidectomy and substotal?
Total= tetany due to Hypocalcemia
Subtotal= Storm
Treatment of hypothyroidism?
Levothyroxine (Synthroid) take on empty stomach w/water 30min - 1 hour before breakfast
Postop risk in first 12 hours of thyroidectomy total and subtotal?
Airway
And
Hemorrhage
Postop risk after 12 - 48 hours for thyroidectomy of total and subtotal?
Total = tetany
Sub = storm
Postop after 48 hrs of thyroidectomy?
Infection
Never pick infection in the first ______ hours?
72 hrs
Tetany is dangerous in thyroidectomy b/c?
Causes spasm of the larynx, or voice box causing breathing problems, asphyxiation=death
S/sx of Addison disease?
Hyperpigmented (Very Tan)
They do NOT adapt to stress which means they will go into Shock (Time Bomb waiting to go off)
Purpose of stress response is to?
Raise BP and glucose
Cushing Syndrome s/sx?
-moon face
-hirsutism (excess hair)
-Truncal or central obesity
-Arms and legs are skinny- muscle atrophy
-gynecomastia (big breast)
-buffalo hump
-retain N+ and Water
-Lose K+ out the back
-striae = stretch marks
-Increase glucose check q6h
-Bruises easily
-Grouchy
-Immunosuppressed
Treatment for cushings?
Adrenalectomy
If bilateral= now Addisons give steroids ending is SONE
S/sx of nerve root compression?
3 Ps
1) Pain
2) Paresthesia (numbness and tingling)
3) Paresis (muscle weakness)
What is the most important pre-op assessment for cervical laminectomy?
First: Assess breathing
Next: functions of arms/hands
What is the most important pre-op assessment for Thoracic laminectomy?
First: Assess Cough
Next: Bowels
What is a post-op complication for Thoracic laminectomy?
Pneumonia and paralytic lieus
What is a post-op complication for cervical laminectomy?
Pneumonia
What is a post-op complication for lumbar laminectomy?
Urinary retention and Leg problems
What do you asses post-op in lumbar laminectomy?
Urinary retention/last void or empty bladder
And
Leg functions
D/C teaching for laminectomy 4 temp 3 permanent?
Temp 6 weeks:
1)No sitting for more then 30 minutes
2)Lie flat, Log roll
3)No driving
4) Don’t lift more then 5 lbs
Permanent:
Never lift by bending at waist (use knees)
Never lift over the head
Never jerky movement. NO rides, horse back riding, trail biking
INR range
2 to 3
Anything 4 and above is critical do something=
HOLD warfarin/Coumadin, Assess for bleeding, prepare to give Vit K, Call physician
