toxic levels/ dumping syndrome/ electrolytes

Question 1

lithium

Answer 1

• used for bi polar manic phase
• TR: 0.6-1.2
• Toxic: >2
• hint: 6-12 shots gets you lit

Question 2

digoxin/lanoxin

Answer 2

• used for a fib and congestive HF
• TR: 1-2
• toxic: >/= 2
• hint: dig 1-2 holes

Question 3

aminophylline

Answer 3

• used to relax a spasm
• can relieve spasm in airway
• TR: 10-20
• toxic: >/= 20
• hint: it has 10-20 letters in the name

Question 4

dilantin

Answer 4

• used for seizures
• TR: 10-20
• toxic: >/= 20
• hint: same as aminophylline

Question 5

bilirubin

Answer 5

• product of RBC breakdown
• TR: <9.9
• elevated level: 10-20
• toxic level: >/=20
• hint: 9 letters in bilirubin

Question 6

when hospitalized for biliruben

Answer 6

• ## when you get halfway in the elevated level (14-15)

Question 7

jaundice

Answer 7

• yellow due to bili in the skin

Question 8

kernicterus

Answer 8

• bilirubin in the brain (crosses BBB an din the menengis and CSF, brain)
• occurs when bili gets around 20 (can die and will be rigid)

Question 9

opisthotonus

Answer 9

• position the baby goes in when they are kernicterus (HYPEREXSTENSION due to irritation of the menengies)
• can be as bad as heels touching ears

Question 10

when baby in opisthotonus, what position do you put them in

Answer 10

• on their side

Question 11

pathologic jaundice

Answer 11

• bili increased at birth

Question 12

physiologic jaundice

Answer 12

• bili increases over 2-3 days
• it was normal at birth

Question 13

hiatal hernia

Answer 13

• high everything
• going the wrong way on a one way street at normal emptying rate
• regurgitation of acid into esophagus because the upper part of the stomach herniates upwards through the diaphragm (2 chambered stomach)
• want to stomach to empty faster so it doesn’t reflux

Question 14

S/S of hiatal hernia

Answer 14

• feel like heartburn
• signs of GERD (heartburn)/ indigestion when you lay down after eating (it has to occur when you lay down after you eat)

Question 15

tx of hiatal hernia

Answer 15

• high HOB after meals
• high fluids with meals
• high carbs with meals
• everything needs to be high except protein (low)

Question 16

Hiatal hernia vs GERD

Answer 16

• gerd: indigestion/ epigastric pain randomly
• Hiatal hernia: indigestion when lay down after eating

Question 17

dumping syndrome

Answer 17

• usually following gastric surgery
• gastric contents dump too quickly into the duodenum
• moving in the right direction at the wrong speed
• that is where is it supposed to go it just goes too fast

Question 18

s/s of dumping syndrome

Answer 18

• drunk and in shock and acute abdominal distress
• drunk: staggering gait, slurred speech, delayed reaction time, emotional labile
• shock: hypotension, pail, cool clammy skin, tachycardia
• acute abdominal distress: pain, guarding, borbyrygmi, diarrhea bloating, distention, tenderness

Question 19

tx of dumping syndrome

Answer 19

• low position (HOB flat)
• turn to the side with head down
• low fluids (1-2 hours after meals not with them)
• low carbs
• everything low but protein (high)

Question 20

earlist sign of electrolyte imbalance

Answer 20

• paresthesia (numbness/tingling)

Question 21

all electrolyte imbalances causes

Answer 21

• paresis (muscle weakness)

Question 22

k +

Answer 22

• does the same as the prefix except for heart and urine output (do the opposite)

Question 23

hypokalemia

Answer 23

• everything low except HR and UO
• obtunded, lethargy, bradypnea, dynamic ileum, constipation, flaccid muscles, hyporeflexia, U wave, depressed ST
• polyuria, tachycardia

Question 24

hyperkalemia

Answer 24

• everything increased but HR and UO
• agitation, irritability, tachypnea, tall p waves, elevated ST waves, diarrhea, borborygmi, spastic muscles, hyperreflexia
• oliguria, bradycardia

Question 25

tx for potassium imbalances - in general

Answer 25

- never push K+ - never give more than 40 of k+ per liter of IV fluid

Question 26

tx of hypekalemia

Answer 26

- D5W with regular insulin (temporary fix but works fast) - drives k+ into cell out of blood (k+ in blood will kill you not k+ in cells but doesn tget rid of the k+) - kayexalate: works late but is permanent - its full of sodium - given enema or orally - trades sodium for k+ so you shit it out. will result in hypernatremia (dehydration) so give them fluids to correct it

Question 27

calcium (and mg)

Answer 27

- calcium calms - does the opposite of the prefix - calcium and mg have the same s/s - in a tie pick calcium > magnesium - always pick muscles and nerves if they are going the right direction and you have to pick

Question 28

hypocalcemia (and mg)

Answer 28

- everything high - tachycardia, agitaiton, irritability, tachypnea, diarrhea, borborygmi, spastic muscles- tetny, hyperreflexia, seizure, chvostek (cheek and face spasm) trousseaus sign (bp hand spams)

Question 29

hypercalcemia (and mg)

Answer 29

- everything low - bradycardia, bradypnea, flaccid muscles, hypoactive, reflexes, lethargy, constipation

Question 30

Na+

Answer 30

- the one with the E is dEhydration and the one with the O is Overload - Hyponatremia: overload - hypernatremia: dehydration

Question 31

hyponatremia

Answer 31

- overload - fluid restriction - lasix - siadh has this

Question 32

hypernatremia

Answer 32

- hot flushed skin - dehydration - give lots of fluids - DKA, DI, AND HHNS has hypernatremia