Misc. Flashcards
most common causes of infectious fever in the acute care setting
bacteria and fungus
neutrophils
fights bacterial infection
60% of differential
lymphocytes
fight viral infections
30% of differential
monocytes
clear cellular debris
eosinophils
worms, wheezes, weird diseases (allergic responses, parasitic infections)
3% of differential
basophils
role undetermined
0-1% of differential
left shift
suggests bacterial infection
neutrophils >70%
Absolue neutrophil count >7000
Bands >4% or 400
risks of fever
double cardiac requirement
uncomfortable and may inhibit mobility
teratogenic
rapid temp rise precipitates seizure
benefits of fever
kills most infectious organisms
augments the inflammatory response; accelerates it
improves survival in animal studies
infectious fever pattern
lowest in the morning, climbs throughout the day, highest in the middle of the night
drug fever pattern
tends to be higher and stay higher, does not exhibit the diurnal pattern
calories needed to maintain body weight
30-35kcal/kg body weight
enteral nutritional support
use nasoenteric tube if support is needed for 6 weeks, use enterostomal tube
parenteral support
2 wks use central vein (TPN - highest glucose D50)
complications of nutritional support
Complications of nutritional support Enteral - diarrhea; usually related to the solution
Parenteral - usually related to delivery; pneumothorax from line placement, line infection, etc.
hyponatremia
most common electrolyte imbalance < 135
Isotonic hyponatremia
Na is low, but osmolality is normal (270-290)
Most common with hyperlipidemia (>1000-1500 mg/dl) and
hyperproteinemia (>12-15 g/dl - seen in multiple myeloma)
Body water is normal, pts. are asymptomatic
hypotonic hyponaremia
Low Na and low osmo (<270)
Need to assess volume status to determine cause
hypervolemic hypotonic hyponatremia
Most common type of hyponatremia
Pt. is fluid overloaded and retaining free water typically caused by cardiac, hepatic or renal failure
Treatment aimed at free H2O restriction and diuresis
hypovolemic hypotonic hyponatremia
Pt. is clinically dry - losing water & sodium
Assess urine sodium for cause:
Urine Na 20 - renal loss; diuretic excess is most common cause
Treatment is replace Na, water, and treat underlying cause
euvolemic hypotonic hyponatremia
most common cause is hypothyroidism
hypertonic hyponatremia
osmo >290, Na <135
Increase in some other solute raises osmolality
Hyperglycemia is most common
assessing hyponatremia
- Serum Sodium
135-145 - Serum Osmolality
270-290 - Clinical Volume
- Urine Sodium
10-20
normal urine osmolality
250-400
hypernatremia
Due to free water loss
Assess urine osmolality
400 (very concentrated urine) - good water conservation, look for extrarenal source of water loss
cardiac effects of hypokalemia
tachycardia, vtach, vfib, dysrhythmias, very excitable heart
cardiac effects of hyperkalemia
bradycardia, systole- heart cannot excite
S/S of hypocalcemia
Carpopedal spasm
Increased DTRs
Chvostek’s sign
S/S hypercalcemia
Symptoms vague
> 12 is medical emergency and produces a progressive decline in neuro status. Can lead to coma.
Step 1 of WHO pain management
Patients with mild to moderate pain
Non-opiod +/- adjuvant
Tylenol, ASA, Ibuprofen
Step 2 of WHO pain management
Patients with moderate-severe pain or who fail to achieve adequate relief after a trial of a nonopioid analgesic
Weaker opioid +/- non-opioid, +/- adjuvant
Oxycodone (Percocet/Percodan), Hydrocodone, Codeine
Step 3 of WHO pain management
Patients who present with severe pain or who fail to achieve adequate relief following appropriate administration of drugs on the second step of the analgesic ladder
Strong opioid +/- non-opioid, +/- adjuvant
Morphine, Dilaudid, OxyContin, Methadone
Most common causes of post-op fever
volume contraction and atelectasis
caloric needs in a hyper metabolic pt.
Figure calories needed to sustain weight -
kg x 35 (kcal/kg)
Multiply that by 2
calories per gram of carbohydrates
4
calories per gram of fat
9
calories per gram of protein
4
best assessment of TPN efficacy
positive nitrogen balance
this fluctuates daily so it is a good assessment of daily efficacy
medications associated with hyperkalemia
ACE inhibitors
Heparin- aldosterone antagonist property excretes
Na so body reabsorbs K
NSAIDS
granulocyte colony stimulating factor (neupogen) stimulates what
WBCs
Redman syndrome
IgE mediated vasodilation secondary to vancomycin administration
most common organism to cause line sepsis
staphylococcus epidermis
management of a tar burn includes
Immersion of the burned area to stop the expansion of the burn
Do NOT remove the tar - it will peel away the skin. The tar will debride itself
