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