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Lab values > Mark K lecture 6 > Flashcards

Mark K lecture 6 Flashcards

1
Q
  1. Lithium Use
A

(antimania drug), used for mania in bipolar

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2
Q

Lithium Therpidic level, toxic level, grey area

A

Therapeutic level: 0.6 to 1.2
* Toxic level: >2.0
* Notice gray area: 1.3 to 2

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3
Q

Lanoxin or Digoxin use

A

Used to treat A-Fib and CHF

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4
Q

Lanoxin or Digoxin Therpidic level, toxic level, grey are

A

Therapeutic level: 1 to 2
* Toxic level: >2

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5
Q

Aminophylline use

A

muscle spasm relaxer for the airway

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6
Q

Aminophylline Therpidic level, toxic level,

A
  • Compound of the bronchodilator theophylline
  • Therapeutic level: 10 to 20
  • Toxic level: >20
  • Non-therapeutic level: <10 … if it is not therapeutic, increase dose of medication, and assess for compliance
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7
Q

Dilantin (phenytoin) use

A
  • Seizure medication
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8
Q

Dilantin (phenytoin) Therpidic level, toxic level,

A
  • Therapeutic level: 10-20
  • Toxic level: >20
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9
Q

Bilirubin

A

*Breakdown product of Red Blood Cells

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10
Q

The normal level for Bili for adults

A

Normal level in adults: 0.2 to 1.2

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11
Q

Bili levels in newborns

A

o Elevated level: 10 to 20
o Toxicity: >20

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12
Q

When do physicians want to hospitalize these newborns?

A

o When bilirubin level is about 14 to 15

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13
Q

Patterns

A
  • 1s and 10s
  • 2s and 20s
    o 2s: Low # (Lithium and Lanoxin)
    o 20s: High # (Aminophylline, Dilantin
    and Bilirubin)
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14
Q

Kernicterus

A

Excess bilirubin in the brain
* Occurs when level in the blood gets >20
* In the brain, it may cause aseptic (sterile) meningitis or encephalopathy (don’t need to know)
* It can be DEADLY

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15
Q

Opisthotonos

A
  • Position the newborn assume due to irritation of the meninges from kernicterus
  • Presentation: hyperextended posture … (Is a medical emergency)
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16
Q

In what position do you place an opisthotonic newborn?

A
  • Put newborn on the side
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17
Q

Pathological vs. Physiological Jaundice

A
  • If the newborn comes out yellow, something is wrong = Pathologic jaundice
  • If the newborn turn yellow 2 to 3 days postpartum, that’s ok = Physiologic jaundice
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18
Q

Hiatal Hernia

A
  • Regurgitation of gastric acid upward or backward into the esophagus. Because the stomach herniates up.
  • “Like a cow with 2 stomachs,” gastric contents go in wrong direction at the correct rate
19
Q

S&S of Hiatal Hernia

A

similar to GERD (Heartburn and indigestion)
* S/Sx of hiatal hernia = S/Sx of GERD when lying down after a meal
o In other words, Heartburn, Indigestion on lying down after eating

20
Q

Treatment for HH

A

o Can do 3 things, as shown below
1.Elevate HOB (head of bed) during and 1 hour after meals
2.Increase the amount of fluids with meals
3.Increase the amount of Carb content
o These cause the stomach to empty quickly so its content doesn’t back up
o High-atal Hernia … Everything high

21
Q

Dumping Syndrome

A
  • Gastric contents are dumped too quickly into duodenum
    o Right direction but at wrong rate
22
Q

S/Sx of dumping syndrome

A

o Drunk: Staggering gate, impaired judgment, labile—all blood gone to gut
o Also get Shock: cold/clammy, tachycardia, pale
o Now add Acute abdominal distress: n/v, diarrhea, cramping, guarding, borborygmi,
bloating, distention
* Dumping syndrome = Drunk, Shock, Acute Abdominal Distress

23
Q

Treatment of Dumping Syndrome

A
  • Can do 3 things, as shown below
    1.Lower HOB (head of bed) during meals and turn pt on the side
    2. Decrease the amount of fluids 1 or 2 hours before or after meals
    3. Decrease the amount of Carb content
    o These 3 things prevent the stomach to empty quickly or dump its content into the
    duodenum
  • Dumping syndrome … Everything low
24
Q

Memorize these 3 sentences

A
  1. Kalemias do the same as the prefix (hypo-, hyper-), except for HR and urine output which
    go opposite
    2.Calcemias do the opposite as the prefix
  2. Magnesemias do the opposite as the prefix
    * Natremias
    o HypoNatremia = Volume overload … HyperNatremia = Dehydration
    Kalemia(s)
25
Q

Kalemia(s) go what directions

A

Go in the same direction as the prefix, except for HR and urine output (UO), which go in
the opposite direction
* Hypo—Symptoms go low with hypo, except HR and UO
* Hyper—Symptoms go high with hyper, except HR and UO

26
Q

S&S of hyperkalemia

A
  • Brain: seizures, agitation, irritability, loud down
  • Heart: tented T waves, ST elevated, tachypnea
  • Bowel: diarrhea, borborygmi
  • Muscle: spasticity, increase tone, hyperreflexia (3+, 4+)
  • Heart rate: down (bradycardia)
  • UO: down (oligouria)
27
Q

Some S/Sx of Hypokalemia

A
  • Lethargy, bradypnea, paralytic ileus, constipation, muscle flaccidity, hyporeflexia (0, 1+)
  • Tachycardia (HR is up)
  • Polyuria (UO is up)
28
Q

Question
Your patient has hyperkalemia, select all that apply
a. Adynamic ileus
b. Obtunded
c. 1+ reflex
d.Clonus (irritable)
e. U wave
f. Depressed ST
g. Polyuria
h.Bradycardia

A

Answer
* Kalemia goes in the same direction, except HR and urine output … therefore,
* Clonus are bradycardia are right

29
Q

Calcemia(s)
* Go in

A

the opposite direction as the prefix
* Hypo—Symptoms go high with hypo
* Hyper—Symptoms go low with hyper

30
Q

Calcemias do the ______ of the prefix—it

A

Opossite —it is a sedative
* So Hypercalcemia is bradycardia, bradypnea, flaccid, hypoactive reflexes, lethargy,
constipation, etc.
* So Hypocalcemia is agitation, irritability, 3+ or 4+ reflexes, spasm, seizure, tachycardia,
Chvostek sign (tap the cheek), Trousseau (inflate BP cuff), etc.

31
Q

Choosing answers for potassium and calcium

A
  • For potassium pick answers related to heart problems
  • For calcium pick answers related to muscle problems
32
Q

Magnesium goes in the _____direction of the prefix—it is also a sedative

A

Opposite —it is also a sedative

33
Q

It is possible that S/Sx are from several electrolytes imbalances. In that case,

A
  • Choose CALCIUM if nerve or skeletal involvement
  • Pick POTASSIUM for any other symptom
    o Generally anything effecting blood pressure
34
Q

Your patient has diarrhea … Which one of the following electrolyte imbalances causes diarrhea?

A

Hyperkalemia, hypokalemia, hypocalcemia, or hypomagnesemia
* Tetany? Hypocalcemia

35
Q

HypErnatrema

A

DEhydration
o Hot, flushed, dry skin, thready pulse, rapid HR … Give fluid
o Associate “E” in hypernatremia with DEhydration

36
Q

HypOnatremia

A

= Overload
o Crackles, distended neck veins … Fluid restriction, Lasix
o Associate “O” in hyponatremia with Overload
o Nursing Dx: Fluid Volume Excess

37
Q

In addition to a high potassium, what other electrolyte abnormality can be seen in DKA?

A
  • Hypernatremia = Dehydration
  • DKA should make you think of DEhydration, which is also associates with hypErnatremia
38
Q

SIADH imbalance

A

Hyponatremia

39
Q

DI

A

Hypernatremia

40
Q

HHNK

A

Hypernatremia

41
Q

How to spot early signs of electrolyte imbalance?

A

The earliest sign of any electrolyte disturbance is
o Numbness and tingling = Paresthesia
o Circumoral paresthesia = Numbness and tingling around the lips

42
Q

The universal sign of all electrolyte imbalances is

A

o Muscle weakness = Paresis

43
Q

Considerations for potassium admiin

A
  • Potassium is the only one Boards will test
  • Never Push Potassium IV
  • Potassium <40 mEq/L of IV fluid
    o If >40 mEq/L, clarify dosage with physician
44
Q

How do you lower potassium?

A
  • Of all electrolyte imbalance, high potassium is the most problematic
  • High potassium can stop the heart
  • The fastest way to lower potassium level is to
    o Give D5W and regular insulin to decrease potassium
    o This will drive the potassium into the cell and out of the blood
    o Temporary solution but quick
  • Kayexalate is long-term solution
    o Through enema or ingestion, Kayexalate exchanges potassium for sodium

o Potassium is eliminated through feces and pt becomes hypernatremic
o Hypernatremia is managed with IV fluid administration
o The downside is it takes hours to work
* To solve this problem
o Give D5W, Regular insulin, and Kayexalate and the same time
D5W and Regular insulin work instantly
Kayexalate works in a few hours—K Exits Late

Lab values (13 decks)

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