Mark K lecture 6 Flashcards
- Lithium Use
(antimania drug), used for mania in bipolar
Lithium Therpidic level, toxic level, grey area
Therapeutic level: 0.6 to 1.2
* Toxic level: >2.0
* Notice gray area: 1.3 to 2
Lanoxin or Digoxin use
Used to treat A-Fib and CHF
Lanoxin or Digoxin Therpidic level, toxic level, grey are
Therapeutic level: 1 to 2
* Toxic level: >2
Aminophylline use
muscle spasm relaxer for the airway
Aminophylline Therpidic level, toxic level,
- 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
Dilantin (phenytoin) use
- Seizure medication
Dilantin (phenytoin) Therpidic level, toxic level,
- Therapeutic level: 10-20
- Toxic level: >20
Bilirubin
*Breakdown product of Red Blood Cells
The normal level for Bili for adults
Normal level in adults: 0.2 to 1.2
Bili levels in newborns
o Elevated level: 10 to 20
o Toxicity: >20
When do physicians want to hospitalize these newborns?
o When bilirubin level is about 14 to 15
Patterns
- 1s and 10s
- 2s and 20s
o 2s: Low # (Lithium and Lanoxin)
o 20s: High # (Aminophylline, Dilantin
and Bilirubin)
Kernicterus
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
Opisthotonos
- Position the newborn assume due to irritation of the meninges from kernicterus
- Presentation: hyperextended posture … (Is a medical emergency)
In what position do you place an opisthotonic newborn?
- Put newborn on the side
Pathological vs. Physiological Jaundice
- 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
Hiatal Hernia
- 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
S&S of Hiatal Hernia
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
Treatment for HH
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
Dumping Syndrome
- Gastric contents are dumped too quickly into duodenum
o Right direction but at wrong rate
S/Sx of dumping syndrome
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
Treatment of Dumping Syndrome
- 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
Memorize these 3 sentences
- 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 - Magnesemias do the opposite as the prefix
* Natremias
o HypoNatremia = Volume overload … HyperNatremia = Dehydration
Kalemia(s)
Kalemia(s) go what directions
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
S&S of hyperkalemia
- 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)
Some S/Sx of Hypokalemia
- Lethargy, bradypnea, paralytic ileus, constipation, muscle flaccidity, hyporeflexia (0, 1+)
- Tachycardia (HR is up)
- Polyuria (UO is up)
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
Answer
* Kalemia goes in the same direction, except HR and urine output … therefore,
* Clonus are bradycardia are right
Calcemia(s)
* Go in
the opposite direction as the prefix
* Hypo—Symptoms go high with hypo
* Hyper—Symptoms go low with hyper
Calcemias do the ______ of the prefix—it
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.
Choosing answers for potassium and calcium
- For potassium pick answers related to heart problems
- For calcium pick answers related to muscle problems
Magnesium goes in the _____direction of the prefix—it is also a sedative
Opposite —it is also a sedative
It is possible that S/Sx are from several electrolytes imbalances. In that case,
- Choose CALCIUM if nerve or skeletal involvement
- Pick POTASSIUM for any other symptom
o Generally anything effecting blood pressure
Your patient has diarrhea … Which one of the following electrolyte imbalances causes diarrhea?
Hyperkalemia, hypokalemia, hypocalcemia, or hypomagnesemia
* Tetany? Hypocalcemia
HypErnatrema
DEhydration
o Hot, flushed, dry skin, thready pulse, rapid HR … Give fluid
o Associate “E” in hypernatremia with DEhydration
HypOnatremia
= Overload
o Crackles, distended neck veins … Fluid restriction, Lasix
o Associate “O” in hyponatremia with Overload
o Nursing Dx: Fluid Volume Excess
In addition to a high potassium, what other electrolyte abnormality can be seen in DKA?
- Hypernatremia = Dehydration
- DKA should make you think of DEhydration, which is also associates with hypErnatremia
SIADH imbalance
Hyponatremia
DI
Hypernatremia
HHNK
Hypernatremia
How to spot early signs of electrolyte imbalance?
The earliest sign of any electrolyte disturbance is
o Numbness and tingling = Paresthesia
o Circumoral paresthesia = Numbness and tingling around the lips
The universal sign of all electrolyte imbalances is
o Muscle weakness = Paresis
Considerations for potassium admiin
- 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
How do you lower potassium?
- 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
