Toxicities, GI and Electrolytes Flashcards
What is lithium used for? Therapeutic? Toxic?
Used for mania in bipolar disorder
Therapeutic: 0.6 - 1.2
Toxic: >2.0
What it Lanoxin/Digoxin used for? Therapeutic? Toxic?
Treat A-fib and CHF
Therapeutic: 1-2
Toxic: 2`
What Is Aminophylline used for? Therapeutic? Toxic?
Muscle spasm relaxer for airway
Compound bronchodilator theophylline
Therapeutic: 10-20
Toxic: >20
What is Phenytoin used for? Therapeutic? Toxic?
Seizure medication
Therapeutic: 10-20
Toxic: >20
What is normal bilirubin in newborns? Elevated? Toxic?
Normal: <10
Elevated: 10-20
Toxic: >20
Why is newborns bili higher than adults? When would the doctor want to hospitalize?
Breaking down RBC from mom
Hospital with levels around 14-15
Trick to remember toxicities
2s: Low - lithium and lanoxin
20s: High - aminophylline, dilantin, and bilirubin
What is Kernicterus?
Excess bili in the brain that occurs when the level is >20 in the blood
DEADLY
What is opisthotonos?
Position the newborn will assume d/t irritation of meninges from kernicterus
Hyperextended posture
Should have them lay on their side
What is the difference between pathological and physiological jaundice?
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
What occurs in a hiatal hernia? S/S?
Regurgitation of gastric acid upward into esophagus
Correct rate, wrong direction
GERD (heartburn) and indigestion lying down after eating
What is the treatment for Hiatal Hernia?
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
What is dumping syndrome? S/S?
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
What is the treatment for dumping syndrome?
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
What does protein do r/t dumping and hiatal?
Bulks gastric content, takes longer to digest, moves slow through gut
High for dumping
Low for hiatal
How do you remember the S/S of hyper/hypo kalemia?
Kalemias do the same as the prefix except HR and UO which go opposite
S/S of hyperkalemia
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)
S/S of hypokalemia
Lethargy, bradypnea, paralytic ileus, constipation, muscle flaccidity, hyporeflexia (0, 1+), Tachycardia (HR is up), Polyuria (UO is up)
How do you remember the hypo/hyper calcemias?
Go in the opposite direction
Hypo—Symptoms go high with hypo
Hyper—Symptoms go low with hyper
S/S of hypocalcemia
agitation, irritability, 3+ or 4+ reflexes, spasm, seizure, tachycardia, Chvostek sign (tap the cheek), Trousseau (inflate BP cuff and hand spasms), tetany
S/S of hypercalemia
bradycardia, bradypnea, flaccid, hypoactive reflexes, lethargy, constipation
How do you remember the s/s of Megnesemia?
Goes in opposite direction of prefix
Also a sedative
Hypo—Symptoms go high with hypo
Hyper—Symptoms go low with hyper
When the S/S could possibly be from several electrolyte imbalances, how do you narrow it down?
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
How do you remember hypo/hyper natremia?
HypErnatremia = Dehydration
HypOnatremia = overload
S/S of hypernatremia? Treatment?
Hot, flushed, dry skin, thready pulse, rapid HR
Give fluid
S/S of hyponatremia? Treatment?
Crackles, distended neck veins
Fluid restriction, Lasix
DKA has which types of electrolyte abnormalities?
Hypernatremia = dehydration
Hyperkalemia
What is the earliest sign of an electrolyte imbalance?
Paresthesia
What is the universal sign of an electrolyte imbalance?
Muscle weakness = paresis
How do you treat hypokalemia?
Give potassium
NEVER push potassium
Make sure the order is <40mEq/L IV fluid. If >40mEq IV fluid then clarify dose with physician
What is the fastest way to lower potassium? Problem?
D5W and regular insulin to decrease potassium by pushing it into the cell and out of the blood
Temporary solution but it is quick
What is the long-term solution to lower potassium? Problem?
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
When working with a patient with high potassium what do you do? Why?
Give D5W, Regular insulin, and Kayexalate and the same time
D5W and Regular insulin work instantly
Kayexalate works in a few hours
Why is high potassium the most problematic and dangerous electrolyte imbalance?
It can stop the heart
