MedSurge Exam2 Flashcards
Reference Ranges
Na, K, Ca, Mg, P, Cl
135 - 145 3.5 - 5 9 - 10.5 1 - 2 3.0 - 4.5 98 - 106
Reference Ranges
BUN, Creatinine, Blood, Urine Specific Gravity
10 - 20
0.5 - 1.5
70 - 120
1.00 - 1.03
Reference Ranges
WBC, RBC, Hgb, Hct
4k - 10k
4.6 - 5.5
13.5 - 15.5
39 - 49
Reference Ranges
T3, T4, HDL, LDL, ADH
70 - 205 4 - 12 > 50 < 190 1 - 5
Cushings @ Plasma Cortisol
suggestive if Ø↑ in mornings and ↓ night
Salivary Cortisol and hypercorticoidism
suggestive if ↑<2.0 @ midnight
Urinary Cortisol and hypercorticoidism
sugg. if ↑10-100
Reference Range
Serum ACTH and direction Addisons/Cushings
25 - 200
↑ Addisons
↓ Cushings
VMA test Range and direction
↑2-7 sugg. pheochromocytoma
Fx on SIADH on Urine [Na, K, Cl, Osma]
75 - 200 26 - 123 110 - 250 200 - 800 Low values is sugg.
Pain med re-assessment interval
30 - 60 minutes
Acute vs Chronic Pain
Temporary FoF S/S
vs
Ongoing >60mo ØFof byt depression, fatigue
Nonopiods
Mild - Moderate
Acetaminophen (toxic if >4 days), NSAIDS, salicylates (tinnitus, vertigo. ↓hearing)
Opiods
Moderate - Severe
Morphine, Fentanyl (Sublimaze)
(constipation, hypoTN, UTR, Resp Depression)
Phantom Pain? Feeling/meds
pins and needles/anti-depressants/spasmodics
Adjuvants
Boost nonopiods
Anti/convulsant (Tegretol), anxiety (Valium, Depressants (Elavil)
4 CAMS
Natural Products - supplements
Mind-body - imagery, meditation
Manipulative - chiropractice
Other - touch, reiki
6 Herbs
Ginkgo Biloba - memory/bleeding
Garlic - Chol and BP - bleeding
Glucosamine - inflammation, ØWarfarin
Ginseng - anti-aging, ØWarfarin
Saw Palmetto - prostatic hyperplasia, Øclotting
Aromatherapy - well-being, nausea and vomitting
Pain Perceptions 4
Addiction - compulsive use despite harm
Psuedoadditcion - anger w/ staff b/c undertx
Tolerance - rq. ↑ drug for fx
Physical Dependence - withdrawal
WHO Pain Relief Ladder
- Nonopiod (g/t adjuvant)
- Weak opiod (g/t nonopiod/adjuvant)
- Strong opiod (g/t nonopiod/adjuvant)
Benzodiazepines
reduce anxiety pre-surgery
Diazepam (Valium and Versed)
Adfx. CR
Antiemetics
Decrease post-anesthetic nausea/vomitting
Ondansetron (Zofran)
Adfx. Dry mouth, dizziness
Sedatives
General anesthesia
Pentobarbital (Nembutal)
Adfx Øgive if w/in 14 days MAOI
Neuromuscular Blocking Agents
Skeletal relaxation/Airway placement
Succinylcholine (Anectine)
Rq. mechanical ventilation b/c blocks all contraction
Phases of General. Anesthesia
Induction
Maintenance
Emergence
Malignant Hyperthermia
Overdose Anesthetic
Unrecognized Hyperventilation
Intubation Problems
Hot contractions, iced NSS and Dantrolene (Dantrium)
Proper screening
Monitor equipment
Proper assistance, r/in sore throat/neck injury
Epidural/Spinal blockade Interventions (3)
lower head
quiet environment
keep hydrated
Types of Surgeries (4)
Emergency
Palliative
Elective
Radical
Renal Failure
Fx on BUN/Creatinine
↑
Type of assessment for BUN, Creatinine, Na, Ca, catecholamines, and proteins
24 hour
Renal GRAM interventions have…?
4 followups
Iodine, so check seafood allergies, meds, history of asthma, and get an enema
Hemodialysis Dos(5) and Don’ts(3)
Elevate, x3week, 3-5 hour sessions, 2 needles, continue held meds afterwards
Take BP, give IV, injection near access site.
Hemodialysis vs. Peritodialysis
Running lines through veins, filling peritoneal cavity with hypertonic glucose solution to even out electrolytes.
B/c loss, gain… watch labs.
Acute (4 phases) vs. Chronic Glomulonephritis (5 stages)
Acute - clogged, recovers
Chronic - progressive destruction
AKI - onset, oliguria, diuresis, recovery
CKD - 1 (90), 2 (60), 3 (30), 4 (15), 5 (<15)
Reasons for pre, intra, post renal injury
pre - fluid leveles
intra - injury
post - obstruction
S/S UTR
Protein, blood, etc. in urine
Low labs, High WBC/leukocyte esterase/nitrates
Lethargy, deep sighing, yawning, anemia, ↓turgor
Renal Calculi Fx, tx, and 4 food groups to avoid
↑ Ca absorption ↓ excretion Treat w/ opiods q4h Calcium phosphate - high animal protein Calicum Oxalate - spinach and K stuff Struvite - dairy, red mean, whole grain P stuff Uric Acid - Poultry, fish, wine
ADH fx if too high/low
high = SIADH, retaining low = polyuria, sugg. DI
Water Deprivaiton Test
Don’t drink H2O
If [urine] ↑ then +
VMA Testing
24 hour collection Vanillymandelic acid w/out K foods
Clonidine Suppression Test
Catecholamines q3h before Clonidine (Catapres)
if BP Ø↓ +
Fx SIADH
↑ urine specific gravity
↓ all labs b/c retention
Phentolamine Blocking test
Phentolamine (Regitene) Ablocker administered
if BP ↑= 25, pheochromocytoma
Cushings Syndrome
Hyperfx Adrenal Cortex r/in ↑ cortisol
Dexamethasone Suppression TEst
Dexa PO. ATCH and Cortisone should drop.
No? + Cushings
Fx DI
Sunken eyes, Tachy, HypoTN
↓ urine labs ↑ serum labs, osmo, and thirst
Fx SIASH
↑ urine labs, ↑ serum labs
RESTRICT FLUIDS TO .5 - 1 L/day
Cushings Fx on Labs
↑ Na
↓ K, Ca, Glucose
Addisons Syndrome
Adrenal Insufficiency
↓ aldosterone and cortisol
Addisons Fx on labs
↓ Na
↑ K, Ca, Glucose
Hyperthyroidism Fx and Tx (3)
Overdrive! Reduce stimulation Thionamides (Methimazole and PTU 1-2 years) Propanolol (Inderal) to relieve S/S Iodine Solutions - after meds
Hypothyroidism Fx and Tx
Cooldown! Levothyroxin (Synthoid) Replacement therapy q2-3wks !!! fiber, calcium, iron, antacides. TAKE ON EMPTY STOMACH
Diabetes S/S (4)
Hyperglycemia Polyuria Polydipsia Polyphagia Acetone/Fruity Breath
Diabetes Expected Labs (4)
Casual > 200
Fasting > 126
2 hour > 200 w/ oral tolerance
Urinanalysis (glucose/ketones in urine)
Type1 v Type 2 Diabetes
1 - genetic, younger, Ø beta cells
2 - behavioral, older, resistance,
Kussmaul Respirations
b/c acid buildup to substitute energy production.
↑ rate and depth of respirations and fruity breath
Glycogenesis
Glycogenolysis
Ketogenesis
Gluconeogenesis
glucose to glycogen
glycogen to glucose
fat to acid
protein to glucose
Diabetic KetoAcidosis vs. Hyperglycemia-hyperosmolar state
DK- ↑ ketosis b/c ↓ insulin PH < 7.4
HHS- ↓ insulin, hydration. PH > 7.4
Fx Hypoglycemia vs. Hyperglycemia
Cool clammy, anxious, Øresp change
Warm moist, stuporous, Kussmaul Resps.
Mild, Moderate, Severe hypoglycemia and tx
hungry, irritable, eat sweet things
cold, clammy, rapid pulse, rapid absorbing carbs
dysphagia, unconscious - IM/SubQ glucagon
Diabetes 2 drug alerts
Metformin r/in lactic acidosis
Actos, anti-diabetic.
NOT Actonel, which prevents calcium loss.
