Toxicities, GI and Electrolytes

Question 1

What is lithium used for? Therapeutic? Toxic?

Answer 1

Used for mania in bipolar disorder

Therapeutic: 0.6 - 1.2
Toxic: >2.0

Question 2

What it Lanoxin/Digoxin used for? Therapeutic? Toxic?

Answer 2

Treat A-fib and CHF

Therapeutic: 1-2
Toxic: 2`

Question 3

What Is Aminophylline used for? Therapeutic? Toxic?

Answer 3

Muscle spasm relaxer for airway
Compound bronchodilator theophylline

Therapeutic: 10-20
Toxic: >20

Question 4

What is Phenytoin used for? Therapeutic? Toxic?

Answer 4

Seizure medication

Therapeutic: 10-20
Toxic: >20

Question 5

What is normal bilirubin in newborns? Elevated? Toxic?

Answer 5

Normal: <10
Elevated: 10-20
Toxic: >20

Question 6

Why is newborns bili higher than adults? When would the doctor want to hospitalize?

Answer 6

Breaking down RBC from mom

Hospital with levels around 14-15

Question 7

Trick to remember toxicities

Answer 7

2s: Low - lithium and lanoxin
20s: High - aminophylline, dilantin, and bilirubin

Question 8

What is Kernicterus?

Answer 8

Excess bili in the brain that occurs when the level is >20 in the blood

DEADLY

Question 9

What is opisthotonos?

Answer 9

Position the newborn will assume d/t irritation of meninges from kernicterus

Hyperextended posture

Should have them lay on their side

Question 10

What is the difference between pathological and physiological jaundice?

Answer 10

If newborn comes out yellow, something is wrong and it is pathological jaundice

If newborn turns yellow in 2-3 days, that’s okay and it is physiological jaundice

Question 11

What occurs in a hiatal hernia? S/S?

Answer 11

Regurgitation of gastric acid upward into esophagus

Correct rate, wrong direction

GERD (heartburn) and indigestion lying down after eating

Question 12

What is the treatment for Hiatal Hernia?

Answer 12

High-atal Hernia.. everything is HIGH

Elevate HOB during and 1 hour after meals
Increase fluids with meals
Increase carbs (low protein)

There help the stomach empty quickly so doesn’t come back up

Question 13

What is dumping syndrome? S/S?

Answer 13

Gastric contents are dumped too quickly into duodenum

Drunk: staggering, impaired judgement, labile
Shock: Tachycardia, low BP, cool/clammy, pale
Acute ABD distress: N/V, diarrhea, cramping, guarding, borborygmi, bloating, distention

Question 14

What is the treatment for dumping syndrome?

Answer 14

When everything is LOW, the stomach goes SLOW

Lower HOC during meals and turn pt on side
Decrease fluids 1-2 before meals and after
Decrease carbs (high protein)

All prevent stomach form emptying quickly

Question 15

What does protein do r/t dumping and hiatal?

Answer 15

Bulks gastric content, takes longer to digest, moves slow through gut

High for dumping
Low for hiatal

Question 16

How do you remember the S/S of hyper/hypo kalemia?

Answer 16

Kalemias do the same as the prefix except HR and UO which go opposite

Question 17

S/S of hyperkalemia

Answer 17

Everything goes up besides HR & UO

Seizures, agitation, irritability, tented T waves, ST elevation, tachypnea, diarrhea, borborygmi, clonus, spasticity, increased tone, hyperreflexia, bradycardia, decreased UO (oliguria)

Question 18

S/S of hypokalemia

Answer 18

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

Question 19

How do you remember the hypo/hyper calcemias?

Answer 19

Go in the opposite direction

Hypo—Symptoms go high with hypo
Hyper—Symptoms go low with hyper

Question 20

S/S of hypocalcemia

Answer 20

agitation, irritability, 3+ or 4+ reflexes, spasm, seizure, tachycardia, Chvostek sign (tap the cheek), Trousseau (inflate BP cuff and hand spasms), tetany

Question 21

S/S of hypercalemia

Answer 21

bradycardia, bradypnea, flaccid, hypoactive reflexes, lethargy, constipation

Question 22

How do you remember the s/s of Megnesemia?

Answer 22

Goes in opposite direction of prefix

Also a sedative

Hypo—Symptoms go high with hypo
Hyper—Symptoms go low with hyper

Question 23

When the S/S could possibly be from several electrolyte imbalances, how do you narrow it down?

Answer 23

First chose which ones make sense based on the symptoms
Eliminate Mg
Choose calcium if nerve, muscle, or skeletal
Choose potassium for anything other symptom especially heart and BP

Question 24

How do you remember hypo/hyper natremia?

Answer 24

HypErnatremia = Dehydration

HypOnatremia = overload

Question 25

S/S of hypernatremia? Treatment?

Answer 25

Hot, flushed, dry skin, thready pulse, rapid HR

Give fluid

Question 26

S/S of hyponatremia? Treatment?

Answer 26

Crackles, distended neck veins

Fluid restriction, Lasix

Question 27

DKA has which types of electrolyte abnormalities?

Answer 27

Hypernatremia = dehydration

Hyperkalemia

Question 28

What is the earliest sign of an electrolyte imbalance?

Answer 28

Paresthesia

Question 29

What is the universal sign of an electrolyte imbalance?

Answer 29

Muscle weakness = paresis

Question 30

How do you treat hypokalemia?

Answer 30

Give potassium

NEVER push potassium

Make sure the order is <40mEq/L IV fluid. If >40mEq IV fluid then clarify dose with physician

Question 31

What is the fastest way to lower potassium? Problem?

Answer 31

D5W and regular insulin to decrease potassium by pushing it into the cell and out of the blood

Temporary solution but it is quick

Question 32

What is the long-term solution to lower potassium? Problem?

Answer 32

Kayexelate

By enema or ingestion, works by exchanging potassium for sodium so when you defecate it is full of potassium. Patient become hypernatremic so administer fluids

Takes hours to work

Question 33

When working with a patient with high potassium what do you do? Why?

Answer 33

Give D5W, Regular insulin, and Kayexalate and the same time

D5W and Regular insulin work instantly
Kayexalate works in a few hours

Question 34

Why is high potassium the most problematic and dangerous electrolyte imbalance?

Answer 34

It can stop the heart