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594 Cards in this Set
- Front
- Back
must discontinue iodine containing med how long before thyroid scan?
|
1 week
|
|
Propylthiouracil (PTU) and Methimazole (Tapazole)
|
- stops thyroid from making hormone
- used preop - goal is euthyroid (normal) - ok in pregnancy - 3x/day PTU - 1x/day Tapazole - agranulocytosis and hypothyroid side effects |
|
Potassium Iodine (SSKI), Strong Iodine Solution (Lugol's Solution)
|
- decrease size and vascularity of gland to decrease risk of bleeding
- give in milk, juice, and use straw to prevent staining teeth - dif from dietary iodine - causes soreness in mouth also |
|
Propanolol (Inderal)
|
- Beta Blocker- don't let you release epi and nor epi
- decreases myocardial contractility - could decrease cardiac output - decreases HR and BP **do not give beta blockers to asthmatics or diabetics **Decreases anxiety |
|
Radioactive Iodine
|
- Given PO, usually 1 dose
- rule out pregnancy first - Destroys thyroid cells - expected to become hypothyroid after about 3 months, then have serial TSH - radioactive precautions * Watch for thyroid storm (thyrotoxicosis or thyrotoxic crisis), could be rebound effect of radioactive iodine |
|
Radioactive precautions for radioactive iodine
|
- stay away from babies for 24 hours
- don't kiss anyone for 24 hours |
|
Thyroid surgery can cause vocal cord ________, which leads to______
|
vocal cord paralysis
airway obstruction--> immediate trach |
|
hypothyroid at birth
|
cretinism--> very dangerous, can lead to slowed mental and physical development if undetected (thyroid profile checked in hospital)
|
|
Hypothyroid pts have a tendency to also have?
|
CAD
|
|
post op thyroid removal
|
- HOB up to decrease edema
- nutrition--> increase calories - assess for hoarsness/weak voice - put personal items close as to not put tension on sutures - teach to report any complaints of pressure - trach at bedside |
|
hypoparathyroid electrolyte levels
|
low serum calcium
high phosphate |
|
hyperparathyroid electrolytes levels
|
high serum calcium
low phosphate |
|
phosphoSoda and Fleet Enema
|
give to increase phosphate and lower calcium
|
|
Meds for hypercalcium
|
- phosphoSoda, Fleet Enema
- steroids - Calcitonin (lowers serum calcium and puts it back in bone) |
|
Meds for hypocalcemia
|
- phosphate binders- Renegel, PhosLo
- IV Calcium--> GIVE SLOW, watch for arrythmias! - Calcium carbonate (Os-Cal) |
|
Pheocromotytoma secretes
|
Epi and nor epi in boluses from adrenal medulla
|
|
VMA (vanillylmandelic acid) test
|
- 24 hour urine test for metnephrines
- no vanilla for about a week - remain calm, no caffeine, no stress, no exercise, etc. |
|
Adrenal medulla hormones
|
Epi and Nor Epi
|
|
Adrenal Cortex Steroids
|
Glucocorticoids
Mineralcorticoids Sex hormones |
|
Glucocorticoids do what
|
- change mood (insomnia, depressed, psychotic, euphoric)
- alter defense mechanisms (immunosuppressed, infection risk) - breakdown of fats and proteins - inhibit insulin (hyperglycemia, do accuchecks-might need insulin) |
|
Mineralcorticoids
|
Aldosterone--> make you retain Na and water and secrete potassium
|
|
Adrenocorticotropin hormones (ACTH)
|
made in pituitary ad stimulate cortisol
cortisol is made in adrenal cortex too many steroid or too much ACTH = hypercortisolism |
|
Addison's Disease
|
- not enough steroids- all three, but main is aldosterone
- shock risk - high potassium |
|
S/S of Addison's
|
- hyperkalemia signs
- Anorexia/Nausea - hyperpigentation (bronzing) and vitiligo (white patchy areas) -hypotension - decreased Na - hypoglycemia (lack of steroids) |
|
Fludrocortisone (Florinef)
|
- weights daily
- frequent changes - for Addison's (low aldosterone) - keep weight within 2-3 lbs (+ or-) of their normal weight |
|
Addisonian Crisis =
|
severe hypotension and vascular collapse
|
|
Cushing's
|
too much steroids (all 3). Think symptoms of increased gluco, increased sex, and fluid volume excess (mineral, aldosterone)
- hypokalemia - increased cortisol levels |
|
Pre treatment diet for Cushings
|
increased K
decreased Na Increased Protein Increased Calcium |
|
What may be in urine of Cushings pt
|
ketones and glucose (NOT protein unless kidney damage)
|
|
why quiet environment for cushings
|
can't handle added stress, need removal of adrenal glands (1 or 2)
|
|
when u see polyuria think...
|
think shock first
|
|
Normal glucose level (fasting)
|
70-110 mg/dL
|
|
Metabolic syndrome
|
Syndrome X
- insulin resistence - obesity - increased triglycerides - decreased HDL - increased BP - CAD |
|
Extreme blood sugar =
|
vascular damage
|
|
Glipizide, Metformin, Actos
|
oral anti-diabetic agents, only give to Type II
|
|
Illness in Diabetics=
|
DKA
|
|
D50W
|
IV push, like syrup, large bore IV
can also give injectable Glucagon if no IV access (IM) |
|
Insulin decreases _____ and _____
|
glucose and potassium
|
|
IV fluids for DKA
|
NS then when glucose around 300 switch to D5W to prevent hypoglycemia
Potassium may be added eventually also |
|
3 products that have a lot of Na
|
Alka Seltzer
Fleet enema IVF with Na |
|
Where is aldosterone found
|
adrenal glands (cortex)
- retain WATER and Na |
|
ADH is found
|
pituitary
- retain only WATER |
|
ANP found where
|
atria
opposite of aldosterone causes secretion of Na and H2O |
|
Normal specific gravity
|
1.016- 1.022 (Concentrated goes up)
|
|
Water deprivation test
|
neuro vs kidney test
hold water, give vasopressin If it works, then neuro |
|
Vasopressin or Desmopressin Acetate (DDAVP)
|
for ADH replacement or DI
|
|
DI
|
not enough ADH--> diuresis
Diluted urine, Concentrated blood Fluid volume deficient --> Shock |
|
SIADH
|
too many letters, too much water
decreased in UOP (urine concentrated) Diluted blood Fluid volume excess |
|
Weighing patient rules
|
- same time
- same scale - same clothes - void before **NOT SAME nurse |
|
Fluid retention think...
|
think heart problems FIRST
|
|
Measure what when have ascites
|
abdominal girth (could have breathing problems from fluids pushing on diaphragm)
|
|
2 reasons for decreased urine output in fluid volume deficit
|
either not being perfussed or trying to conserve fluids
|
|
Pulse in fluid deficit and excess
|
both are up with is bounding in excess and thready and weak in deficit
|
|
Isotonic solutions
|
NS, LR, D5W, D51/4NS
called "crystalloid" |
|
DO not use isotonic solutions in clients with-
|
HTN, cardiac disease, or renal disease
because the solutions can cause HTN and hypernatremia (with NS) |
|
Hypotonic solutions
|
1/2NS, .33% NS, D2.5W
- does not cause HTN but rehydratres- goes into vascular space then goes into cells - HTN, renal, and cardiac pts or replacement for nausea, vomiting, burns, hemorrhage - also used for hypernatremia and cellular dehydration ** watch for cellular edema, fluid deficit, and decreased BP |
|
Hypertonic solutions
|
D10W, 3%NS, 5%NS, D5LR, D51/2 NS, D5NS, TPN, Albumin
- hyponatremia, 3rd spacng, severe edema, burns ascites--> will return it to vascular space Called "Colloid" - watch for volume excess, usually in ICU for monitoring |
|
Hypermagnesemia
|
SEDATIVE
-think muscles first - flushing, warmth (vasodilate) - DTRs down, muscle tone down, arrythmias, LOC down, Pulse down, respirations down - caused by renal failure and antacids |
|
Hypercalcemia
|
SEDATIVE
-think muscles first - brittle bones, kidney stones - DTRs down, muscle tone down, arrythmias, LOC down, Pulse down, respirations down - caused by hyperparathyroidism, thiazides (retain calcium), immobilization |
|
Normal magnesium levels
|
1.8-2.4
|
|
Normal calcium levels
|
8.6 to 10,6
|
|
Hypomagnesemia
|
NOT ENOUGH SEDATIVE
- think muscles first - increased muscle tone, seizure risk, strodor or laryngeospasm, swallowing problems, Chovstek's (cheek), Trousseau's (hand shakes with BP), arrythmias, increased DTRs, Mind changes (psychotic or depressed) - causes: diarrhea (lots of MG in intestines) Alcoholism** (suppresses ADH, and its hypertonic) not eating or drinking |
|
Monitor what when giving Mg
|
KIDNEY FUNCTION!
stop infusion if output drops Seizure precautions (low Mg) |
|
When giving calcium...
|
IV- give SLOWLY and put on cardiac monitor!!
|
|
Hypocalcemia
|
NOT ENOUGH SEDATIVE
- think muscles first - increased muscle tone, seizure risk, strodor or laryngeospasm, swallowing problems, Chovstek's (cheek), Trousseau's (hand shakes with BP), arrythmias, increased DTRs, Mind changes (psychotic or depressed) - causes: hypoparathyroidism, radical neck, thyroidectomy |
|
Foods high in magnesium
|
veggies, seeds, and halibut
|
|
if pt starts flushing and sweating when giving IV mg, do what??
|
STOP infusion, could be normal but could be S/S of something worse
|
|
With sodium, think....
|
think neuro changes
|
|
Hypernatremia causes
|
dehydration
- too much Na, not enough water Causes: - hyperventilation - heat stroke - DI |
|
Hypernatremia s/s
|
dry mouth
swollen tongue thirst neuro changes |
|
Na is the only electrolyte that cares about...
|
water
|
|
Hyponatremia causes
|
Dilution
- drinking only water for replacement from vomiting and sweating - psychogenic polydipsia - D5W (sugar and water) - SIADH |
|
hyponatremis S/S
|
- HA
- Seizure - Coma - neuro changes! |
|
If having hyponatermia with neuro changes then pt needs...
|
hypertonic solution!
- 3% or 5% NS - watch for fluid overload as it will draw water into vascular system as it gives Na |
|
Feeding tube pts tend to become...
|
dehydrated
|
|
Hyperkalemia causes
|
- renal problems (K excreted by kidneys)
- Aldactone diuretic (retain K) - Metabolic acidosis |
|
Hyoerkalemia S/S
|
- begins with muscle twitching
- proceeds to weakness - then flaccid paralysis - life threatening arryhtmias! |
|
Hypokalemia causes
|
- vomiting
- NG suction (lots of K in stomach) - diuretics - not eating |
|
Hypokalemia
|
- muscle cramps
- weakness - life threatening arryhtmias |
|
ECG changes for hyperkalemia
|
bradycardia, tall and peaked T waves
prolonged PR interval, flat or absent P waves, and widened QRS, conduction blocks, V-fib |
|
ECG changes for hypokalemia
|
U waves, PVCs, and ventricular tachycardia
|
|
Tx for hyperkalemia
|
- dialysis (kidneys aren't working)
- calcium gluconate (decreases arrythmias) - glucose and insulin - Kayexalate - removing K puts pts at higher risk for increased Na since they are inverse relationship. so push fluids to prevent dehydration |
|
Kayexalate worry
|
make sure pt has bowel sounds!!
|
|
Any time you give IV insulin worry about...
|
hypoglycemia and hypokalemia
|
|
Tc for hypokalemia
|
Give K
Aldactone (retain K) Eat more Potassium |
|
Major problem with PO Potassium
|
Gi upset, give with food
|
|
Assess what before giving K
|
UOP
|
|
Always give IV K on ...
|
a pump, never hang free. Prefer to put in central line instead of peripheral also
****NEVER GIVE K IV PUSH*** |
|
Foods high in potassium
|
veggies, fruit, tuna, halibut
|
|
Increase in CO2 S/S
|
decreased LOC (confused, sleepy, coma)
increase in CO2= decrease in O2 |
|
If pt restless think...
|
hypoxia first! Give O2 before the Ativan
|
|
Respiratory acidosis
|
O2 does not help!, have to blow of Co2 first! (deep breathing exercises, HOB up, incentive spirometer) or get rid of pneumonia, etc.
|
|
Acute aspiring OD can cause
|
respiratory alkalosis (aspirin stimulates resp center to breath more, like hyperventilation)
|
|
Metabolic acidosis causes and tx
|
DKA, starvation (ketones are acid), renal failure, severe diarrhea (lower Gi loss- bicarb)
tx: treat problem and can give sodium bicarb (1x IV push) for temporary fix **hyperkalemia |
|
Metabolic alkalosis causes and tx
|
- upper Gi loss (stomach)
- too many antacids (too much base) - too much IV bicarn (like in a CODE situation) ***hypokalemia tx:fix problem and replace K |
|
In burns, when is most edema (increased capillary perm)
|
first 24 hours
|
|
Epinephrine with burns
|
Epinephrine is excreted by body in order to vasoconstrict (because of fluid deficit from edema) in order to shunt blood to vital organs and bring BP back up
|
|
burn edema body compensatory thins
|
epinephrine, ADH, and aldosterone secretion in order to increase blood volume
|
|
SBP for adequate perfusion
|
90
|
|
how would carbon monoxide pt appear
|
cherry red but normal O2 sat because all it sees is that SOMETHING is on RBCs
|
|
Rule of Nines
|
head-9
Arm-9 Trunk front-18 Trunk back- 18 Leg- 18 Genital area- 1 |
|
Formula used if pt has more than 20-25% burns
|
Parkland formula
|
|
When start 24 hours after burn
|
first 24 hours is based on when the burn actually occurred NOT when treatment was started
|
|
Parkland Formula
|
4mL LR x kg body weight x % number for first 24 hours
albumin given later too |
|
With burns,you would determine the clients fluid volume is adequate by?
|
Urine output (not daily weight because giving so much fluid, of course weight is gonna go up)
for things other than burns, weight is a good indicator |
|
what type of water and other things can be used on burn pt to stop burning proicess
|
COOL water (not ice water!)
can use blankets to hold in body heat and decrease germs remove jewelry to decrease swelling and metal gets hot remoe non-adherent clothing and cover with clean dry cloth |
|
In a client that is receiving fluids rapidly, what is best measurment to ensure not overloading?
|
CVP
|
|
Immunization after burns
|
Tetanus toxoid (active immunity, takes 2 weeks)
Immune globulin ((immediate protection, passive immunity) |
|
If urine is brown or red after burn?
|
call MD so dr can flush out myoglobin--> Mannitol would do this (monitor closely for fluid deficit, when pee clear call Dr immediately to stop Mannitol)
|
|
about 48 hours after burn pt will...
|
start to diurese as fluid goes back into vascular space, NOW worry about excess
|
|
Curling's ulcer
|
burn related ulcer
|
|
what give to prevent Curlings ulcer
|
Mylanta, Protonix, Pepcid
Amphogel, Milk of Magnesia, Zantac, Pepcid, Axid, Nexium |
|
Gi risk in burns
|
ulcer and paralytic ileus (pt NPO and NG)
NG will be removed when hear bowel sounds |
|
Travase, Santyl
|
enzymatic drugs for burns that eat dead tissue
don't use on: - face, pregnant, over large nerves, open body cavity |
|
Silvadene
|
soothing, apply more if comes off, can lower WBC, can cause rash
|
|
Sulfamylon
|
stings, apply more if rubs off, can cause acid base problems
|
|
Silver nitrate
|
keep dressings wet, can cause electrolyte problems
|
|
Betadine
|
atings, stains, allergies, acid-base problems
|
|
electrical burn
|
- first 24 hours on cardiac monitoring (Vfib risk)
- renal damage from myoglobin and hemoglobin |
|
Chemical burn
|
- flush for 15-20 min or dust off powder then flush
|
|
Female prevention screenings
|
- monthly breast exams over 20 yo (day 7-12)
- Yearly MD breast exam over 40, 20-39 every 3 years - annual pelvic exam - pap smear every 4 yrs if no problem - mammogram yearly starting at 40 (no deo, pwdr, lotion) - colonoscopy at age 50 then every 10 yrs - no sex or douche prior to pap smear |
|
Male prevention screenings
|
- Monthly breast exam
- monthly testicular exam (15-36 esp) - yearly digital rectal and yearly PSA for over 50 - colonoscopy at 50 and every 10 yr |
|
Cachexia
|
extreme wasting and malnutrition
|
|
How to prevent dislodgement of radioactive implants
|
bed rest, decrease fiber, prevent bladder distention (foley)
|
|
is radioactive pt immunocomprimised?
|
YES! private room if possible and non-infectious for sure
|
|
If chemo drug is a vesicant...
|
then have to stay with pt the whole time
extravasation--> STOP infusion, ice packs so it does't spread (THINK vasoconstriction!) |
|
Radioactive and chemotherapy length of "worry"
|
Radioactive- 24-48 h
chemo- 48 hours )waste is hazardous, eash linens x2 and special bag, flush toilet x2) *****Bleeding precautions in cancer pts because of pancytopemia!! |
|
some infection prevnetion for immunocompormised (cancer pt)
|
- change IV tubring q 24h
- no fresh flowers or plants - bath warm, moist areas 2x/day - avoid raw fruits and veg - wash hands after pets - frewsh water only (less than 15 min sitting out) **absolute neutrophil count is most important!! and slight temp increase = sepsis!! |
|
Classic S/S for cervical cx
|
painless vaginal bleeding
- may also have watery, blood tinged discharge, pelvic pain (may occur with intercourse), leg pain alon sciatic nerve, and flank/back pain 100% curable if caught early |
|
if have abnormal pap smear...
|
repeat it!
|
|
Conization?
|
removal of part of cervix
|
|
Uterine cancer risks
|
greater than 50
estrogen without progesterone no pregnancy late menopause |
|
uterine cx s/s
|
after menopausal bleeding (50% chance of cancer if this happens)
|
|
CA-125
|
rules out ovarian cancer involement
|
|
Most difiniative dx of uterine cx
|
D&C
|
|
TAH- total abdominal hysterectomy
|
uterus and cervix only
|
|
Radical hysterectomy
|
ALL pelvic organs
- greatest time for hemorrhage for first 24 hours (pelvic congestion of blood) - Avoid high fowlers (suture tension and makes blood go to pelvis even more) - may have abdominal and perineal dressings |
|
major complication after abdominal hysterectomy
|
hemorrhage (pt can hemorrahge 10-14 days after surgery still!!)
|
|
major complication of vaginal hysterectomy
|
infection
|
|
Adriamycin
|
chemo, cardio toxic
|
|
Plantinol AQ
|
Chemo for uterine cx
|
|
Depro-Provera, Tamoxifen
|
estrogen inhibitors (uterine cx)
|
|
Tail of Spence
|
almost half of breast cancers located here in the upper outer quadrant
|
|
Post op masectomy
|
drains
elevate arm on affected side stay away from affected arm side FOREVER! (no constriction of ANY kind) have pt brush har, squeeze ball, wall climbing, fles and extend elbow of affected side - have pt look at incision, see if they can lymphedema |
|
Taxol, Adriamycin
|
chemo for breast cancer (adriamycin is cardio toxic)
|
|
Tamoxifen, Lupron, Zoladex
|
for breast cancer, estrogen inhibitors or blockers (breast tumors are estrogen dominant)
|
|
lung cancer and TB
|
Tb has night sweats
|
|
after bronchoscopy has respiratory depression...
|
perforated airway? EMERGENCY!! RR may be lower but not under 12 (abnormal)!
|
|
sputum specimen
|
first thing in moring, sterile, rinse pt mouth first to decrease bacteria in mouth
|
|
Lobectomy
|
remove part of lung
Chest tube and surgical side up! |
|
Pneumonectomy
|
remove entire lung
- position ON affected side (good lung up so it doesn't fill with fluids!) - no chest tubes - avoid severe lateral positioning (mediastinal shift) |
|
Total laryngectomy
|
removal of vocal cords, epiglotis, thyroid--> perm trach
- position in highest position but NOT high fowlers (rarely choose high fowlers). semi fowlers is good (30-40) - |
|
complication of total laryngectomy
|
carotid artery rupture (nicked)- watch drains
CALL DR!! |
|
Bloom-Singer device
|
connection is made between trachea and esophagus, keep it clean and mucus free
|
|
Electrolarynx
|
handheld device held up to clients cheek or neck
|
|
if vagus nerve is activated with suctioning, is the pt hypoxic?
|
no, because HR goes bradycardic in vagus and hypoxia causes tachycardia
|
|
Most frequent site of metastasis of colorectal cx
|
liver (same blood supply)
|
|
flexible sigmoidoscopy frequency
|
every 5 yrs after age 50 (or colonoscopy every 10 yrs after age 50)
|
|
Gi onstruction s.s
|
visible peristalsis, high pitched tinkling bowel sounds
|
|
Dont take rectal temp if?
|
thrombocytopenicm abdominoperineal resection, immunocommpromised
|
|
major symptoms of bladder cancer
|
painless intermittent gross/microscopic hematuria
|
|
ileal conduit
|
made from intestines, increase fluids, change appliance in morning before pt starts drinking alot
|
|
#1 place for prostate metastasis
|
bone--> alkaline phosphatase increases if gone to bone (likes to go to spine, sacrum, pelvis)
acid phosphatase also increased with bone metasisis |
|
most common sign of prostate cancer
|
painless hematuria
|
|
PSA normal levels
|
less then 4ng/mL
|
|
frequency of PSA
|
if you have two or more 1st degree relatives with prostate cx, start by age 45
|
|
pudendal nerve damage
|
can cause erectile dysfunction with radical prostectomy (nerve will try to be conserved if there is no lymph involvement, no increase in acid phosphatase, and no metastasis)
|
|
TURP (prostectomy)
|
usually reserved for just benign prostatic hypertrophy, most common complication is bleeding, but some bleeding is normal
-continuous bladder irrigation to maintain patency and flush out clots (can affect kidneys) ***never manually irrigate an catheter with fresh surgery without a specific order - when cath removed watch for urine retention |
|
Belladonna and Opium Suppository (B&O Suppository) and Oxybutynin
|
given for bladder spasms
|
|
If pt has pain would u assess for kinks or bladder distention first?
|
bladder distention-assess actual pt first!
|
|
Lupron
|
decreases testosterone for prostate cx (can also have bilateral orchiectomy-testicle removal)
|
|
high risk for stomach cx
|
hy pylori, pernicious anemia, achlorhydrai (no stomach acid)
- pickled foods, salted meats/fish, nitrates, increased salt -billroth II (partial gastrectomy with an anastomosis) -tobacco and alcohol |
|
Treatment for obstruction
|
NPO, NG tube to suction for abd decompression
|
|
Schillings test
|
measures urinary excretion of Vit B12 for diagnosis of pernicious anemia
|
|
5-FU, Adriamycin, Mitomycin-C, Platinol-AQ
|
chemotherapy
|
|
The 5 P's
|
Pulselessness, Pallor, Pain, Parasthesias, Paralysis
|
|
Are palpitations normal after cardiac cath?
|
yes
|
|
bed rest after cardiac cath
|
bed rest for 4-6 hours
Report pain ASAP! (hematoma, and bleeding) |
|
CPK-MB time frame
|
elevates in 3-12 hours and peaks in 24hrs
cardiac specific |
|
Troponin
|
T and I
Elevates within 3-4hrs and remains elevated for 3 weeks |
|
Normal troponin levels
|
T <.2
I < .03 |
|
Myoglobin
|
increases within an hour and peaks at 12 hours
not cardiac specific, any muscle If negative, then no muscle damage, including heart |
|
Lidocaine toxicity
|
think neuro changes
|
|
Amiodarone
|
used for V fib and fast arrythmias
Lidocaine can also be used to prevent second episode, or amiodarone can cause hypotension which can lead to further arrythmias |
|
why put head up on MI pt?
|
decreased cardiac workload and increased CO
|
|
Streptokinase, t-PA, TNKase, Retavase
|
fibrinolytics
- want within 6-8 hours of MI pain onset - brain is within 3 hours |
|
Absolute contraindications of fibrinolytics
|
intracranial neoplasm, intracranial bleed, suspected aortic disection, internal bleeding of any kind
|
|
Aspirin, Plavix, RReoPro IV
|
anti platelet drugs
|
|
If chest pain after PCI (percutaneous coronary intervention)
|
call Dr immediately! need to go back to OR!
|
|
Pcemakers are used when?
|
symptomatic bradycardia
|
|
Always worry if the rate goes_____ if pt on a pacemaker
|
down, should never decrease!
|
|
loss of capture
|
no mechanical event or contraction
- may not be programmed properly, electrodes and be dislodged, or battery depleted watch for a decrease in Co or decreased rate (most conclusive) |
|
Killer combination of Pulmonary artery placement (swanz ganz)
|
air embolus --> pulmonary infarction
|
|
A line rules
|
never put medicine in it, placed in radial, Allen's test done (want positive), make sure stop cocks are in right position
|
|
Natrecor
|
must be turned off for 2 hours prior to drawing BNP (will cause false high)
|
|
Digitalis
|
used with HF and A-fib
strengethens contraction decreases HR to given ventricles more time to fill leads to increased cardiac output |
|
Digoxin normal values
|
.5-2 ng/mL
|
|
Digoxin toxicity s/s
|
anorexia, N/V
arrythmias and vision changes late ****hypokalemia increases toxicity risk!! |
|
Aldactone
|
K sparing and decreases aldosterone levels too
|
|
Report a weight gain of...
|
2-3 lbs
|
|
Ace inhibitors
|
-prils
used for HTN and HF watch for hyperkalemia, angioedema (laryngeal swelling), non productive cough (reversible after stop med), renal dysfunction |
|
ARB's
|
-sartan
used for HTN and HF -watch for hyperkalemia, hypotension, and renal dysfunction |
|
Beta blockers
|
-lol
used for angina, chest pain, HTN, ventricular dysrhythmias, and thyroid storm - don't given to asthmatics or diabetics |
|
Lasix
|
causes diuresis and vasodilation to decrease preload and afterload
- 40 mg IV push over 1-2 minutes (SLOW) to prevent HTN and ototoxicity |
|
Bumex
|
1-2 mg IV push over 1-2 minutes, diuretic
|
|
Nitrglycerine
|
vasodilation to decrease afterload
|
|
Natrecor
|
short temr therapy, not longer than 48 hours
stop for 3 hours before pulling blood for BNP has a diuretic effect |
|
Primacor
|
continuouse infusion
vasodilates veins and arteries |
|
Dobutrex
|
increass CO
|
|
Cardiac tomponade CVP and BP
|
increased CVP and decreased BP (opposite of what normally happens)
Neck veins distended cause they can't empty into heart |
|
Pulsus Paradoxus
|
BP is greater than 10mm higher on expiration than incpiration
a S/S of cardiac tomponade (increased pressure on heart in inspiration) |
|
Narrowed pulse pressure
|
worry if 30 or below (or 40 or under?)
results from decreased contraction |
|
Acute arterial occlusion (numb, pain, cold, no pulse)
|
A medical emergency!!!
|
|
Intermittent claudication
|
hallmark pain, only have this with ARTERY problems
|
|
Rest pain in arterial obstructions
|
indicates a SEVERE obstruction, medical emergency!!
|
|
Dangle____problems, elevate_____problems
|
artery, venous
|
|
After AAA and decreased in lower pulses
|
call MD!!!
|
|
Buerger's disease
|
inflammation of veins adn arteries, men, heavy smoking, cold, emotions
causes vasoconstriction usually lower extremities and sometimes fingers |
|
Reynaud's disease
|
female, bilaterally in finger tips
white, blue, red can cause gangrene |
|
DVT, give oxygen?
|
no, oxygen does not help!
|
|
aPTT, PT, and INR normal values
|
aPTT- 30-40s
OT- 11-12.5s INR- 1.3-2 |
|
Persantine
|
anticoag med (like warfarin, plavix, etc.)
|
|
limit foods with ? with DVT and o blood thinners
|
Vitamin K, no more than 3x/week
|
|
with known clot, put what on area?
|
warm, moist heat to decrease inflammation
** never cold on a vein and never hot on a vein!! If there is something the nurse can do before calling Dr, do it! |
|
A good nursing dx for schizophrenia
|
alteration in communication
|
|
how to rechannel anger (suicidal)?
|
the most exerting answer there is
|
|
Restraints
|
last resort
check every 15 min hydration, nutrition, elimination observation at 15-30 min intervals or one on one if client cant contract for safety |
|
Meds that can be given for OCD
|
SSRIs or TCAs
|
|
Stages of alcohol withdrawal
|
Stage I- mild trmors, Nausea, nervousness
Stage II- increased tremors, hyperactive, nightmares, disorientation, hallucinations, increased pulse, increased BO Stage III- most dangerous, severe hallucinations (visual and kinesthetic), grand mal seizures II and III are DT's (withdrawal delirium)---keep the light on! they are scared, don't want them to injur themselves stage I and II walk and talk to them **Don't be araid to given an anxiolytic!, they can handle meds every 2 hours |
|
Korsakoff's syndrome
|
chronic problem after detox
disoriented to time, confabulates |
|
Wernicke's syndrome
|
chronic problem after detox
emotions labile, moody, tire easily |
|
S/S of alcoholics also
|
peripheral neuritis (b vitamin deficiencies)
liver and pancreas, impotence, gastritis Mg and K loss many deny and rationalize |
|
Antabuse
|
Deterrent to drinking (bad reaction with alcohol so have to agree to not have ANY of ANY kind)
|
|
panic disorder symptoms will peak when?
|
10 minutes
|
|
ECT (electro-convulsive therapy)
|
- NPO
- void - atropine to dry secretions - signed permit - series of txs Succinylcholine Chloride to relax muscles * postiion pt on side afterwars, stay with client as they are scared and confused, temp memory loss (reorient), make sure family knows they will be confused, involve pt in days activity as soon as possible ** always check for injury after procedure! |
|
TCA
|
Elavil, Pamelor, Tofranil
risk of OD, not first choice anymore, anticholinergic side effects for OCD and depression |
|
SSRI
|
Luvox, Celexa, Prozac, Effexor, Paxil, Lexapro
less S/E HA, increased sweating, blurred vision, weight gain, sexual side efects |
|
MAOI
|
Parnate, Nardil, Marplan
causes HTN crisis with foods with tyramine Avoid: aged cheese, avocados, raisins, beer, red wines, no OTC cough meds contaiin ephedrine or ephedrin-like |
|
Serotonin syndrome
|
tachycardia
HTN fever sweating shivering confusion anxiety restlessness disorientation tremors muscle spasms muscle rigidity St johns wart increases risk as well as more than one med |
|
Anxiolytics
|
valium, ativan, xanax, flurazapam, librium
-sedation, dizziness, constipation, raise seizure threshold, relaxes client non benzo- Buspar |
|
Anticonvulsants
|
Tegretol, Depakote, Neurontin, Lamictal, Trilecliental
good for manic states S/E: drowsiness, vertigo, blurred vision, unsteady gait toxic to liver, MONITOR LIVER FUNCTION |
|
Lithium (anticonvulsant, for mood stabalization)
|
Normal level- .6-1.2
up to 1.5 for acute states >2 = TOXIC S/S: hand tremors, N/V, slurred speech, unsteady gait, life threatening Keep food, fluid, exercise constant. If changes, lithium levels change (salt?) |
|
Glomerulonephritis cause
|
strep or other infections
|
|
Glomerulonephritis S/S
|
fluif volume excess (facial edema, BP up)
urine specific gravity up (concentrated) and decreased UOP flank pain, sediment, protein, blood in urine (rusty, coca cola), BUN and creatinine up, malaise and HA (toxins), sore throat diuresis will begin in 1-3 weeks after onset, could lead to renal failure (s/s are toxins plus fluid) |
|
Fluid replacement for glomerulonephritis
|
24 hour fluid loss plus 500 mL (to account for insensible losses)
|
|
Diet changes for glomerulonephritis
|
decrease protein, decrease Na, increase carbs for energy
|
|
Nephrotic syndrome description
|
glomerulous but with a lot of protien loss leading to major edema and alodosteroine cycle kicking in and making it worse
|
|
Anasarca
|
TOTAL body edema
|
|
Problems associated with high protein loss
|
blood clots (dehydrated and losing proteins/clotting factors)
Cholesterol and triglycerides up as liver tries to produce proteins |
|
tx for nephrotic syndrome
|
diuretics, ace inhibitors to block aldosterone, prednisone to decrease inflammation (shrink protein holes)--> immunosuppression!, lipid lowering meds, lower Na, INCREASE protein, anticoagulants for 6 months, dialysis if needed
|
|
Meds that causes intrarenal failure
|
Aminoglycosides, mycins (nephrotoxic)
|
|
Specific gravity in renal failure
|
intitially concetrated with decreased UOP
but as kidneys lose ability to concentrate and dilute urine it will be fixed no matter hwo much fluids are given (fluid challenge of 250mL) |
|
why anemia in kidney problems?
|
no erythropoetin
|
|
what electrolytes/acid base problems with renal failure
|
hyperkalemia (retain)
metabolic acidosis hyperphosphatemia (retain) hypocalcemia |
|
Oliguric phase
|
1-3 weeks
UOP of 100-400ml/24 hours (would be a good time to do a fluid challenge) fluid volume excess and hyperkalemia |
|
Diuretic phase
|
sudden
increase in UOP fluid volume deficit--> shock hypokalemia |
|
nurseing care if pt has vascular access (dialysis)
|
no BP, no needles sticks, no contriction to arm of ANY kind!
|
|
Tenckhoff catheter
|
for paritoneal dialysis
|
|
Continuous abulatory peritoneal dliaysis (CAPD)
|
manual exchange, 4x/day, 7 days a week, fluid causes pressure on back, can't do if have a colostomy (high risk for infection!)
|
|
Continuous Cycle Peritoneal Dialysis (CCPD)
|
connected at night onle, may have trouble sleeping or may not have insurance to pay for this machine
|
|
complications of peritoneal dialysis
|
#1- cloudy effluent- peritonitis!
constant sweet taste (fluid has glucose in it) hernia altere body image/sex anorexia (constant sweet taste can affect this) low back pain |
|
diet of peritoneal dialysis pt
|
increase fiber (decreased peristalsis because of abd fluid)
increased protein (lose protein through peritoneum with each exchage) |
|
CContinuous renal replacement therapy (CRRT)
|
ICU
24h/day, 7days a week never more than 80mL out of body at one time on pt with fragile cardiovascular system and acute renal failure (very sick pts) |
|
if you suspect a kidney stone...
|
get a urine specimen and have it checked for RBCs
If stone present, immediate pain meds (not imagery, etc.) |
|
Toradol, Zofran, Dilauded
|
meds used for kidney stones
|
|
Pancreatitis pain
|
increased with eating
|
|
Rigid boardline abdomen =
|
think bleeding first, but can also be peritonitis
|
|
Cullen sign
|
bruising around umbilicus (pancreatitis)
|
|
Gray Turner's sign
|
brusiing in flank area (pancreatitis)
|
|
pt with pancreatitis gets hypotension from...
|
asites or bleeding
|
|
Peritoneal lavage results
|
if pink tinged = bleeding
|
|
Normal Amylase levels
|
45-200 U/L
|
|
Normal lipase levels
|
0-110 U/L (more specific)
|
|
Pancreatitis labs
|
- increased lipase and amylase
- increased WBCs - Increased blood sugar (beta cell destruction) - ALT, AST increased (liver involved and bleeding) - Prolonged PT, PTT - Increased bilirubin - Increased or decreaed H and H (dehydration OR bleeding) |
|
With pancreas client keep stomach...
|
dry and empty! (NPO, NG to suction, bed rest to decrease secretions, antocholinergics (cogentin, lonox/atropine), protonix, santac, pepcid, antacids
Also given steroids to decrease inflammation |
|
Why would a pancreatitis pt need insulin?
|
beta cell destruction
steroids TPN |
|
If lier is sick, number one concern is
|
BLEEDING
|
|
Never give _____ to liver pts
|
Tylenol
|
|
When spleen is enlarged...
|
the immune system is involved
|
|
ammonia =
|
sedation
|
|
Position during liver biopsy
|
supine with R arm behind head, exhale an hold to get diaphragm out of way during biopsy (only like 2 sec, not 30s)
|
|
Post liver biopsy position
|
lie on R side, can have pillow under there too, worry about bleeding, check vitals
|
|
Paracentesis
|
have client void to move bladder
position sitting up vitals sign (removing fluids, shock risk) avoid narcotics (liver can't metabolize) |
|
Asterixis
|
flapping of hands from ammonia (hepatic coma)
|
|
Fetor
|
ammonia breath
|
|
What 2 things will also increase ammonia?
|
Protein and blodd (old GI blood)
|
|
any time pt is anemic...
|
give oxygen
|
|
Sengstaken Blakmore tube
|
hold pressure on varices
make sure to tape an dmark may need restraints if confused |
|
Sandostatin
|
lowers BP in liver
|
|
After gastroscopy watch for...
|
pain, bleeding, or trouble swallowing
|
|
Upper Gi series avoid
|
NPO past midnight
smoking also increases moticile and secretions which will alter test--> stop them if you see them smoking, it is an aspiration risk!! |
|
Need to follow peptic ulcer pts for?
|
a year
|
|
S/S of gastric ulcers
|
laboring pt, malnourished, pain half hour to hour after eating, food doesn't help, vomiting does, vomit coffee ground blood
|
|
S/S of duodenal ulcers
|
executives, well nourished, night time pain commona and 2-3 hours after meals, food helps, blood in stools (black, tarry)
|
|
S/S of dumping syndrome
|
fullness, palpitations, faintness, weakness, cramping, diarrhea
|
|
lay on what sude to keep food in stomach?
|
left side
|
|
dumping syndrome tx
|
semi recumbent with meals, lie down after meals (left), no water with meals, decrease carbs
|
|
Rebound tenderness =
|
peritoneal inflammation (ulcerative colitis, Crohns, appendicitis)
|
|
Colonscopy pre care
|
clear liquid for 12-24 h
NPO 6-8h Avoid NSAIDs laxatives and enemas until clear (watch pts, hard to handle) Gl-Lytely 8oz every 10 min, may need to give antiemetic and serve cold, NO straw (air) |
|
post colonoscopy care
|
WATCH for perforation!!
never ignore pt complaint, send for US to chack for free air or perf |
|
Diet for ulcerative/Crohns
|
low fiber to limit motility and conserve fluids
|
|
Kocks ileostomy
|
nipple valve that opens and closes to empty intestines (for ulcerative colitis) (no external pouch)
|
|
J pouch
|
removes colon and attaches the ileum into rectum (no external pouch)
|
|
If giving enema...
|
put ot on left side
stop and check fluid temp if pt complains (same for irrigations) |
|
Best time to irrigate colostomy
|
same time every day, and after a meal
(bowel training) **ONLY irrigate descending and sigmoid colostomies want pt lying flat if possible and stop if complains and check temp of irrigant |
|
Position of pt waiting for appendectomy
|
right side and sitting up just in case it ruptures
|
|
first sigsn of appendicitis
|
first abdominal pain, then N/V
|
|
Enema for appendicitis?
|
do not do, worried about rupture, tell surgeon you are nervous about doing that
|
|
TPN care
|
- keep refrigerated but room temp before use
- central line needed - filter needed - nothing else in that line - dicontinue gradually (to prevent hypoglycemia) - may need to be on insulin - daily weights - accu checks q 6h - check urine for glucose and ketones - can be hung for 24 hours - change tubing with each new bag - on a pump - handwashing if at home (high infection risk!) |
|
#1 TPN complication
|
infection
|
|
If ketones in TPN urine pt
|
needs more lipids in TPN
|
|
Would there be proteins in TPN pt urine?
|
only if there is kidney damage
|
|
Central line plaement pt position
|
trendelenburg
|
|
If air gets in line what position for central line?
|
left side, trendelenburg
|
|
do what before adminstering meds, etc in central line???
|
xray- check for pneumothorac and placement
|
|
Cushing triad
|
(increased ICP)
- HTN, bradycardia, irregular resp, widening PP |
|
Occulocephalic reflex (Doll's eyes)
|
want a positive doll eye reflex (means eyes should move in opposite direction as moing head, only works for unconscious pt)
|
|
Ice cold water calorics (oculovestibular reflex)
|
assesses brain stem
50mL cool water in ear eyes will move to irrigated ear and back (positive) put pt on side and elevate head (unless contraindicated) before leaving, may cause nausea |
|
Babinski or plantar reflex
|
Want positive babinski <1yr (flare toes)
Want negative >1 year old (toes curl) |
|
CT vs MRI
|
can talk in MRI
no pacemakers or jewelry in MRI (magnetic and MRI will make pacemaker stop working right) old tattoes may matter (lead) for MRI no radiation in MRI |
|
bed rest after cerebral angiogram
|
4-6 hours (same femoral area used as in heart cath)
|
|
major complication of cerebral angiogram
|
embolus
can go anywhere! but brain emboli would show change in LOC, weaknes, paralysis, motor/sensory deficits |
|
Can't have what beofre EEG?
|
hold sedatives, no caffein, NOT NPO (this would drop blood sugar)
|
|
Where is lumbar puncture performed?
|
3rd-4th lumbar subarachnoid space
|
|
client position for lumbar puncture
|
head down, propped on table
or lie on side in fetal position |
|
Complication of lumbar puncture
|
meningitis (fever, chills, positive kernig and brudinski, vomiting, nuchal rigidity, photophobia)
- most common is HA (increases with sitting up and decreases with lying down)--> treat with fluid, pain meds,and possible blood patch -brain herniation |
|
positive kernig sign
|
can't fully extend raised knee/leg when pt supine
|
|
positive Brudzenski sign
|
when neck flexed, knees and kips flex
|
|
post lumbar puncture
|
lie flat for 2-3 hours and increase fluids
|
|
Basal skull fractures s/s
|
battles sign (mastoid bruising)
raccoon eyes (periorbital) cerebrospinal rhinorrhea (no blowing nose, no sticking anything up there, let flow freely) |
|
Signs of increased ICP
|
difficult awakening/speaking, confusion, severe HA, vomiting, pulse changes, unequal pupils, one side weakness
|
|
Epidural hemoatoma
|
ARTERY, EMERGENCY!
injury, loss of consciousness, recovery period, can't compensate, neuro changes |
|
Subdural hematoma
|
VEIN, acute, subacute, chronic
slow bleed may be mistake for drunk or DM |
|
spinal cord injury above T6 worry about
|
hyperreflexia, autonomix disreflexia
|
|
autonomic disreflexia
|
HTN and HA, bradycardia, nasal stuffiness, flushing, sweating, blurred vision, anxiety, sudden onset, emergency due to HTN and stroke risk
|
|
causes adn tx of autonomic disreflexia
|
distended bladder, constipation, painful stimuli, cold draft, pressure ulcers, etc.
Tx: sit pt up to lower BP, treat the cause! |
|
Steroid do what to ICP
|
decrease ICP
|
|
why no restraints in pt recovereing from coma
|
restraints increase ICP!
need quiet environment, seizure precautions |
|
Normal ICP
|
< or equal to 15
|
|
Additional signs of increased ICP
|
- earliest sign is change in LOC
- change in speech - resp pattern chances (cheyne stokes, ataxic respirations) - increased drowsy - mood changes subtle - quiet to restless - absent reflexes -flaccid - pupil changes - projectile vomiting |
|
pupils in profound coma
|
fixed and dilated
|
|
Deceberate
|
arched spine, plantar flexion (WORST)
|
|
Decorticate
|
toward "core"
arms flexed inward, legs extended with plantar flexion |
|
Glasgow scale normal
|
want like 13-15, intubate if less then 8
|
|
mannitol
|
for increased ICP
increases circulating blood volume and icnreases work load of heart * watch for crystalizing in tubing and fluid volume excess |
|
Decadron
|
Steroid to decrease cerebral edema
|
|
to decrease ICP, may set respirations to...
|
hyperventilation, to keep CO2 on low side, don't want it tooo low with will cause vasoconstriction in brain
|
|
goal temp for ICP pt
|
less than 100.4 (may need cooling blanket if hupothlamus not working right)
|
|
Phenobarbital
|
barbituate induced coma to decreased cerebral metabolism
|
|
head position for ICP
|
elevated and midlin (JV drainage)
|
|
fluids for ICP
|
restrict to 1200-1500 ml per day
|
|
Vitals to watch for in ICP
|
bradycardia and increased BP (blood not pumping enough volume or increased pressure which will decreased cerebral perfussion)
|
|
If a pt can't sit up for thoracentesis, what position should they be in
|
lie on unaffected side with HOB 45 degrees
|
|
chest tube placement for removal of air
|
2nd intercostal space
|
|
chest tube placement for fluid removal
|
8th or 9th intercostal space
|
|
What type of bubbles in the water seal chamber
|
intermittent and fluctuation/tidaling ok
continuous not ok (possible air leak) If nothing, then expanded or kinked or dependent loop has 2 cm of water If tidaling stops= expanded |
|
Suction control chamber bubbling
|
should have slow, gentle, continuous bubbling
20 cm of water or knob turned to 20 cm if dry system. turn wall suction up till have slow, gentle, continuous bubbling but otherwise wall does not control suction, 20 cm do. |
|
Notify physician if draininage is what?
|
>100 ml of drainage in 1st hour and if there is a change to bright red
|
|
Tension pneumo s/s
|
subcu emphysema, absence of breath sounds on affected side, asymetry of thorax/trachea, respiratory disease
emergency!! cause of decrease in CO |
|
if pt has open pneumo (sucking chest wound)..how positioned?
|
if can, sit up to expand lungs, but if trauma pt they eed to say flat till other injuries evaluated
|
|
If pt has broekn ribs/sternum, what meds?
|
NON narcotic pain meds as to not suppress RR. its hard for them to breath already, don't use chest binders or immobilizers (can lead to pneumo or flail chest)
|
|
BPAP
|
bi level positive airway pressure
used a lot with COPD, HF, sleep apnea exerts dif levels on insp and exp may be used in vent weening |
|
CPAP
|
Continuous Positive Airway pressure
constant pressure for insp and exp used for obstructive sleep apnea |
|
Anytime you see PEEP, CPAP, BiPAP, your priority nursing assessment is?
|
Checking bilateral breath sounds
|
|
Right sided HF can be caused by...
|
pulmonary embolism
|
|
Will O2 help PE?
|
NO, with pulm embolism, O2 can't get to needed area
|
|
D Dimer
|
increased if clot anywhere in body, not just PE...so if pt post op, this will already be up!
|
|
If PE, CXR will show...
|
atelectisis
|
|
Splints help what?
|
fat emboli and muscle spasm
|
|
Most important thing with ortho injuries
|
neurovascular checks (pulse, color, movement, sensation, capillary refill, temp)
|
|
Fat embolism s/s
|
petechia or rash over chest
Conjunctival hemorrhages snow storm on CXR young mails (risk takers) *FIRST 36 HOURS* After this, can get other embolism though!! |
|
Common bones for fat embolism
|
long bones, pelvic frractures, crushing injury
same bones increase risk of hypovolemia |
|
Compartment syndrome
|
fluid accumulation in tissues, muscle swells and hard, pain NOT relieved with pain meds
pain is disproportional to injury if undetected can cause nerve injury |
|
Common compartment syndrome areas
|
forearm and quad
can be from fracture or burns |
|
tx for compartment syndrome
|
elevate
soft cast then rigid loosen cast to restore circulation (better have a horrible neurovasc check to actually remove whole cast) fasciotomy |
|
If pt has pain and in cast what to assess?
|
neurovascular check, 5 P's
If neurovascular check ok, then give pain meds |
|
skin traction
|
short term for immobilization and prevent muscle spasms until surgery
do good skin assessments (its tape like) |
|
pin cleaing for skeletal traction
|
steril, remove crusts, serious drainage is OK
|
|
Any time you have someone with an orthopedic or joint injury they need what?
|
a firm mattress
|
|
post op hip replacement
|
no weight bearing until MD says
avoid crossing legs or bending over (no flexion) dont sleep on operated side till dr says don't given injectable pain meds in operation side prevent external rotation with trochanter roll tense and squeeze muscles want abduction (keep hips apart) neutral toes, to the ceiling no lifting HOB (flexion) *teach pt that stresses to hip need to be minimal in first 3-6 months |
|
dislocation s/s
|
shortening of leg, abnormal rotation, cant move extremity, PAIN
|
|
best exercise for hip replacement pt
|
1- walking
2. swimming rocking chair |
|
where to NOT store CPM (continuous passive motion)
|
on the floor --> infection!
|
|
total knee replacement post op
|
CPM to prevent scar tissue
neer hyperextend or hyperflex knee neuro checks pain relief tell fam not to touch CPM machine |
|
amputation post op
|
want extension to prevent contractions
only elevate for SHORT time if going to as this will cause contractions do not elevte on pillow, elevate whole foot of bed make sure limb lies copleely flat on bed if BKA, prone positiong to extend hip and knee limp sock for edema and hemorrhage reduction first then for shaping |
|
phantom pain tx
|
diversion al activities first, seen more with AKAs
usually subsides in 3 months but not always |
|
is it ok to massage stump?
|
yes, improves circulation and reduce tenderness
soft pillow, firm pillow, bed, chair (sand) |
|
crutches up and down stairs
|
up with the good leg and down with the bad leg
|
|
Goodell's sign
|
softening of cervix, 2nd month (probable sign)
|
|
Chadwick's sign
|
bluish color of vaginal mucosa and cervix, week 4
probable sign |
|
Hegar's sign
|
softening of the lower uterine segment, 2nd-3rd month
|
|
fetal heartbeat/doppler dates
|
10-12 weeks
|
|
Fetoscope dates
|
17-20 weeks
|
|
Gravidity
|
how many times been pregnant
|
|
Parity
|
how many times fetus has reached 20 weeks or more
|
|
Viability
|
How many have reached 24 weeks (ability to live outside of uterus)
|
|
A 20 week baby is NOT considered
|
viable
|
|
TPAL
|
T-term
P-preterm A-abortion/miscarriage L- living children |
|
Negel's rule
|
LMP + 7 days - 3 months and add 1 year
|
|
pregnancy exercise rule
|
don't let HR go above 140 bpm (decreases CO)
|
|
don't rec any meds until...
|
talking to MD
|
|
danger signs in pregnancy
|
sudden gush of vaginal fluid
bleeding persistent vomiting severe HA abdominal pain increased temps edema no fetal movement |
|
date for fetal quickening
|
16-20 weeks
|
|
normal fetal HR
|
120-160
(worried and watching when 110-120) (pain if less than 110!) |
|
If pregnant pt gains more than 1 lb a week in 3rd trimester, what should u worry about?
|
PIH
edema |
|
fetal stations
|
measuring in cm
measures the relationship of the presenting part of fetus ad the ischial spines of the mother |
|
lightening
|
when presenting part of fetus, usually head, descends into the pelvis
usually 2 weeks before term |
|
signs of labor
|
lightening (less congestion and easier to breath, urinating more)
engaement (head we hope) fetal stations more frequent and stronger braxton hicks contractions softening of cervix bloody show (not heavy bleeding, that would be hemorrhage) sudden burst of energy (nesting) diarrhea rupture of membranes |
|
when should client go to hospital
|
when contractions are 5 min apart or when membranes rupture
|
|
#1 worry with rupture of membranes
|
prolapsed cord (fastest problem)
infection is next |
|
Reactive Non stress test
|
want to see two or more accelerations of 15beats/min (more more) WITH fetal movement
over 20 minute period |
|
Acceleration =
|
acceleration= greater than or equal to 15 beats per min above baseline and lasts at least 15 seconds. HR should come back to baseline within 2 minutes
|
|
Biophysical profile test (BPP)
|
done in last trimester,
32-34 weeks in high risk pregnancy (may have it twice a week or every week in 3rd tri) measurements done by US- want 8-10/10, 6 worry, <4 omninous. MD may deliver with 6 or less Measures HR (NST), muscle tone (1 flexion/extension in 30 min), movement (3 times in 30 min), breathing (breathing movement 1/30 min), amniotic fluid (is there enough around baby?) |
|
Contraction stress test (CST)- Oxytocin challenge test
|
if NST non reactive
hifh risk to see if baby can hande uterine contractions looks for late decellerations (placenta wearing out) WANT a NEGATIVE- negative for late decels rarely done before 28 weeks results are good for one week only |
|
what decels are bad?
|
late and variable
late- uteroplacental insufficiency variable- umbilical cord compression |
|
true labor vs false
|
regular, increased, back and radiates to abd, activity increases pain
irregular, abdomen, pain dereases with activity |
|
epidrual position
|
lie on left side, legs flexed, not as arched as lumbar (don't go as deep)
|
|
when is epidural given
|
stage 1- 3-4cm
|
|
HA after epidural?
|
no, that would be lumbar
|
|
If hypotension after epidural
|
put in semi fowlers on side to preent vena cava compression
(1000ml NS or LR given preventively) alternate position hourly side to side |
|
Oxytocin nursing care
|
one-on-one, don't leave pt
watch for hypertonic laor, fetal distress, uterine rupture |
|
s/s complete uterine rupture
|
sudden, sharp, shooting pain (soething gave way), if in labor pain and contractions will stop
pt may also have signs of hypovolemic shock due to hemorrhage If placenta seperates, the fetal heart tones will be absent |
|
s/s of incomplete uterine rupture
|
stop in peritoneal cavity
internal bleeding may not have pain fetus may or may not have late decels client may vomit hypotonic uterine contractions and lack of progress fetal heart tones may be lost |
|
VBAC risk
|
increased risk for uterine rupture, especially with oxytocin and high risk or forceps
|
|
D/C oxytocin if
|
contractions are too often, contractions last too long
fetal distress (late decels) make sure you don't turn off main IV fluid when turning off oxytocin |
|
Best position with oxytocin
|
any position BUT flat (alwyas contra in pregnancy)
left side is best, especially if fetal bradycardia |
|
Post partum normal vitals
|
temp may increase to 100.4
stable BP HR 50-70 common for 6-10 days (diuresis after birth causes this, diuresis begins 24 hrs after birth) |
|
when does engorgement start
|
2-3 days after
|
|
Diastasis recti
|
separation of abd muscles
goes away by its self or with VIGOROUS exercise |
|
fundus immediately after birth
|
2-3 fingerbreadths below umbilicus
a few hours after birth it will rise to umbilicus or one FB above will decrease 1FB/day |
|
If pt has boggy fundus...
|
massage and check for bladder distention (suspected if uterus is above normal area)
|
|
Involusion
|
when fundus descends and uterus returns to its pre pregnancy size
If it doesn't --> hemorrahge risk |
|
afterpain
|
common for first 2-3 days and will continue to be common if mother breastfeeds (increases oxytocin)
|
|
blood color after pregnancy
|
rubra for 3-4 days (red)
serosa for 4-10 days (pink brown) alba for 10-28 days (whitish, yellow) clots ok unless bigger thana nickle (hemorrhage risk) |
|
Peripad rule
|
no more than 1 pad saturation/hr
|
|
In infancy, trust is not only a emotion need but also.....
|
physiological (#1 in Maslow)
|
|
Kangaroo care
|
1 hr at least 4 times a week
|
|
non breast feeding care of breasts
|
ice packs, binders, chilled cabbage leaves (dialtes capillaries, lowers inflammation and engorgment)
|
|
When infection risk post partum
|
10 days (ecoli, beta hemolytic strep)
|
|
post partum hemorrhage definitions
|
early- more than 500 mL blood lost in first 24 hours AND a 10% drop in Hematocrit
late- after 24 hours but up to 6 weeks post partum at risk |
|
Meds to halt excessive post partum hemorrhage
|
oxytocin
Methergine Hemabate |
|
Mastitis
|
within 204 weeks, staph, baby not feeding properly, needs to empty all the way
|
|
treatment of mastitis
|
binding and cabbage leaves if stopping breastfeeding completely
bed rest, supportive bra, frequent feeding and pumping, pcn or erythromycin pain med heat feed baby frfrequently and offer affected breast FIRST, even if it hurts! |
|
Apgar scores
|
done at 1 and 5 min
HR, R, muscle tone, reflex irritability, color want at least an 8 or 10 (most get a 9 cause of feet and hand cyanosis) |
|
eye ointment for newborn
|
erythromycin for neisseria gonococcus, chlamydia, etc.
|
|
Aquamephyton
|
Vit K, IM in vastus lateralis to promote formation of clotting factors
|
|
cord care
|
dries and falls off in 10-14 days
cleanse with each diaper changing with alcohol or NS (up to MD) fold diaper below cord no water immersion till cord falls off, watch for infection |
|
risk for baby hypoglycemia
|
large for gestational age, small for gestational age, perterm, babies of diabetic moms
|
|
pathologic jaundice
|
first 24 hours, usually means Rh/ABo incompatibility
|
|
physiological jaundice
|
after 24h
due to normal hemolysis of excess RBCs releasing bilirubin, or liver immaturity |
|
Erythroblastosis fetalis
|
increase in immature RBCs in fetal circulation, from Rh incompatibility
s/s - hyperbilirubinemia - anemia - hypoxia - HF - neurologic damage - hydrops fetalis (a severe form of erythroblastosis fetalis) at some point baby will stop growing |
|
Indirect Coomb's test
|
on Mother, measure her antibodies in her blood
|
|
Direct Coomb's test
|
on baby, looks to see if any antibodies stuck to RBCs
|
|
RhoGAM
|
given (2nd or more child), withi 72 hours at birth (mother, to protect next baby) and at 28 weeks, any bleeding episode in pregnancy
**once mother has antibpdies she has them for life, has to be given before antibodies are formed **GIVE with ANY bleeding |
|
If client has had one ectopic pregnancy then..
|
she is at risk for another
|
|
Methotrexate
|
given to mother to stop growth of embryo to save tube, in ectopic pregnancy
|
|
Most common cause of bleeding in later months (7th)
|
placenta previa
|
|
problem with placenta previa
|
baby doesn't get enough oxygen during contractions and the placents comes out first instead of baby
|
|
s/s of placenta previa
|
painless bleedig in 2nd half of pregnancy (could be spotting pr perfuse)
|
|
Complete previa requires...
|
hospitalization, from as early as 32 weeks until birth, to prevent blood loss and fetal hypoxia if client goes into labor
if there is not much bleeding- bed rest and watch closely (like with partial, low, etc) |
|
If pt has placenta previa and starts contractions...
|
call MD, not going to be a normal delivery
C- section is delivery of choice |
|
DO NOT_____ with placental previa
|
vaginal exams!, can puncture placenta and cause emergency surgery and hemorrhage
|
|
Abruptio placenta
|
normal placental placement
may be partial or complete concealed means bleeding into uterus caused by MVC, domestic violence, previous C section, rapid decompreesion of utereus with membrane rupture, cocain, PIH, smoking |
|
If there is EVER unexplained bleeding...
|
NEVER EVER do a vaginal exam
|
|
incimpetent cervix
|
4th month, repeated 2nd trimester miscarriages
tx is cerclage at 14-18 weeks |
|
tx for hyperemesis gravidarum
|
NPO 48h
IVF 3000mL for 1st 24h antiemetic IV replace vitamins quiet environment oral hygiene don't talk about food and keep emesis basin out of sight 6-8 small, dry feedings followed by clear liquids make foods and liquids icy cold or steamy hot well ventilated room |
|
Preeclampsia
|
increase BP (if moms prepreg baseline is not known go with 130/90 being mild preecamplsia
proteinuria (losing protein so edema, must increase protein intake) edema after 20th week may also have HA, blurred visions, seeing spots from vasospasms, increased DTR |
|
If pt has increased DTRs or hyperreflexia think...
|
clonus--> seizure!!!!!
|
|
Severe preeclampsia
|
BP elevated above 160/110 documented 6 hours apart
sedate to delay seizures Mag sulfate is drug of choice |
|
Magnesium sulfate
|
anticonvulsant, sedative, vasodilation
vasodilation increases renal perfussion place on side, preferrably left mag sulfate is hypertonic (salt). If kidnye function is impared then fluid shift may be too fast, watch for pulmonary edema |
|
Mag sulfate nursing care
|
watch for pulm edema
check mag toxicity q 1-2 hours (BO, respirations, DTRs, LOC) UOP (excreted through kidneys) mag sulfate will decrease labor, it can be used for preterm labor for this effect |
|
If diastolic is >100 give...
|
Hydralazine with mag sulfate
watch for tachycardia |
|
cure for preeclampsia
|
delivery is only cure, but pt at risk for seizures for 48 hours after delivery
-dingle room, very quiet environment, dim lights, no tv, decrease stimulation |
|
Steroid therapy for preterm
|
Bethamethasone- stimulates surfactant, given between 24 and 34 weeks
|
|
Eclampsia
|
seizures!!
monitor FHT watch for labor, HF, stroke, MI, renal failure, DIC, HELLP, neuro damage, multisystem organ failure |
|
PIH
|
pregnancy induced HTN
after 20 weeks with proteinuria |
|
Gestational HTN
|
after 20 weeks, NO proteinuria
|
|
Preterm labor definition
|
labor between 20 and 37th week
|
|
Tocolytic
|
to stop pre term labor
s/e are increased HR and hyperactivity its actually a bronchodilator |
|
Preterm labor can sometimes be stopped by...
|
hydration and treated vaginal and urinary infections
|
|
If cord ceases to pulsate =
|
fetal death
|
|
if prolapsed cord...
|
lift head off cord untill MD arrives, never release!!
trendelenburg or knee-chest position admin o2 monitor FHT don't push cord back in, hold head off of it!! |
|
Shoulder dystocia
|
delivery prevented by shoulder stuck in maternal pelvis
can lead to cerebral palsy and asphyxia brachail plexus injury (Erbs point) causing drooping or paralysis of arm broken clavicle bell's pasy can be caused by forceps many resolve but can lead to perm damage |
|
At risk for shoulder distocia
|
LGA or macrosomia (>4000 grams)
gestational diabetes previous hx of shoulder dystocia post fate delivery (large fetus) |
|
McRoberts Maneuvers
|
nurse pulls legs to hyperextend
|
|
Mazzanti techniques
|
applies suprapubic pressure to assist shoulder to pass
**never apply fundal pressure- the physician must do this or call another physician to do it!!** |
|
Leading cause of neonatal morbidity
|
Group B streptococcus (GBS), not an STD
risk to fetus is only after ruptre of membranes preterm baby risk, positive cultures in pregnancy, PROM (longer than 18h), past hx, intrapartum maternal fever higher than 100.4 PCN or clindamycin given |
|
Order of vitals in peds
|
respirations
HR *count HR and R for one whol emin because of irregularities BP temp |
|
Rectal temp on peds
|
DO NOT use in children over 3 months old, but it is the most reliable core temp
|
|
Axillary temp on peds
|
all ages when oral can't be done
|
|
Oral temp on peds
|
start at age 5-6
|
|
Tympanic temp on peds
|
all agesw, evidence that less accurate in under 3yo
|
|
pulse ox should correlate with
|
childs radial pulse
|
|
growth charts
|
within 5-95% for H, W, HC is desired
15% is median growth slows between 6-12yo but will have growth spurt after girsl have adolescence 1-2y earlier |
|
pale skin sign of
|
anemia
|
|
CRIES acronym
|
for infants
crying requires increased oxygen increased vitals expression sleepless 0-2 on each higher the worse pain |
|
FLACC scale
|
2 months to 7 yrs
face, legs, activity, crying, consolability each 2 pts, 10 is worst |
|
Wong Baker
|
face pics, if pt not cognitive development use FLACC
usually by 3yo can use Numerical scale if over 5 |
|
Laryngotracheobronchitis
|
Croup, usually under 5
diarrhea, barking or brassy cough, increased temp distress depends on size of airway |
|
mild croup tx
|
home with steam, cool mist humidifier, car rides with windowns down, breath in freezer
if symptoms worsen or don't improve then hospitalization for corticosteroids |
|
Epiglottitis
|
H influenza, most kids are vaccinated now
absence of cough drooling look worse than they sound Emergency!, may require intubation or trach, iv antibiotics, corticosteroids LTB sounds worse than they look |
|
Tonsilitis
|
difficulty swallowing, mouth breather, bad breath, swollen can block ear drainange and cause otitis media
|
|
Tonsillectomy
|
position on side with HOB elevated or prone with no HOB elevation to prevent aspiration
no red or brown fluids watch for frequent swallowing, sign of hemorrhage |
|
how many days post op tonsillectomy is pt at risk for hemorrhage
|
10 days, teach parents
|
|
Otitis media tx
|
heating pads on ear
avoid chewing, provide soft foods lie ON affected side for drainage may not hear you avoid smoke may require pressure equalizing tubes, stay in for 6 months then fall out |
|
prevention of otitis media
|
ear plugs if have tubes
baby sit up during feedings no bottle propping gentle nose blowing (shoot ifection to ear) avoid smoke |
|
RSV- Respiratory syncytial virus
|
leading cause of lower resp tract infections in less than 2 yo
becomes worse 2-3 days after onset s/s URI, nasal discharge, mild fever, dyspnea, nonproductive cough, tachypnea and nasal flaring, retraction or wheezing can range from mild to severe with resp distress |
|
dx RSV
|
nasal or naso pharyngeal swab- to make sure its not asthma
|
|
precautions for RSV
|
contact
treat symptoms |
|
Ribavirn/antiviral
|
mya be given for severe RSV with aerosol or ten
**if tent, shut off for a bit before opening to nurse doesn't inhale it |
|
Down syndrome pts are likely to develop what?
|
respiratory infections because of poor immune system
heart defects |
|
Cystic fibrosis
|
inherited from both parents
thick, sticky, secretions in lungs and GI, exocrine gland dysfunction pancreas enxymes can't get through mucus so get Gi problems and pancreatitis Positive sweat chloride test, taste salty |
|
Electrolyte imbalance of cystic fibrosis pt
|
hyponatremia
|
|
earliest sign in newborn of cystic fibrosis
|
meconium ileus
will also have steatorrhea, fatty, frothy stools |
|
tx for CF
|
pancreatic enzymes, 30 min prior to eating, do not crush or chew
well balanced, low fat diet (increased enzymes with more fat), high protein require 150% of daily allowances need water soluble ADEK since they can't have a lot of fat |
|
Digoxin in peds
|
infants rarely given more than 1mL
give 1 houre before and 2 hours after feeding DO NOT mix with food or fluid ALWAYS check dose with another nurse check apical pulse for 1 min |
|
Ace inhibitors for peds
|
enalapril, captopril
decrease BO, kidney problems, dry cough (can stop med and try a dif one) block aldosterone |
|
nursing care of peds HF pt
|
well rested and may give O2 before eating, decrease crying
small frequent feedings with large opening in nipple may require gavage feedings usually dont require Na and water restrictions because they aren't taking in as much food etc anyways |
|
Rheumatic fever
|
loves hearts and kidneys
PCN-G |
|
Kawasake disease
|
inflammation of small and medium sized vesseld, coronary arteries most susceptible
high does of IV immune-globulin, aspirin therapy, quiet environment |
|
post op position for cleft lip repair
|
back or side lying to protect suture line
do not place prone clean sutures with saline |
|
Post op cleft palate repaire
|
place prone to promote drainage (no sutures to worry about)
avoid putting things in mouth (temp, straws, etc.), soft diet elbow restrains if have to pick one to keep arms straight need speech therapy so best time for surgery is before speech is developed |
|
position for GERD in peds
|
upright for feedings and at night
30 degree prone to decrease reflux and improve stomach emptying small, thickened, frequent feedings (rice cereal mix) |
|
Esophageal Atresia
|
no connection to stomach
no meconium cause never digested amniotic fluid fed with gastrostomy tube |
|
T-E fistula s/s
|
coughing, choking, cyanosis
this is why first feeding needs to be sterile (breast milk or sterile O2) top nursing dx is aspiration! |
|
positiong for TE/atresia surgery
|
infant placed on their back with head and shoulders elevated so secretions pool in lower esophagus
|
|
Pyloric stenosis
|
projectile vomiting after eating
very hungry olive shaped mass in epigastric region, near umbilicus (enlarged pyloris) obvious peristalsis/waves |
|
Intussusception and s/s
|
piece of bowel backward on self
sudden onset, cramping, abd pain-ACUTE!! inconsolability drawing knees up currant jelly stools (maroon colored of blood and mucus) |
|
Dx/tx
|
barium enema, this will sometimes fix problem
teach reoccurance signs in hospt for 10-14 days |
|
Hirschsprung's disease
|
congenital anomaly
also known as aganglionic megacolon obstruction of bowel (usually sigmoid) because of no nerves in area/no peristalsis constipation, distention, ribbon like stools, remove portion of bowel, temp colostomy possible |
|
Imperforate anus
|
no rectal opening, no meconium passed
temporary colostomy |
|
Celiac disease
|
no gluten
can't have BROW barley rye oats wheat CAN have RCS rice corn soy |
|
UTI in <2
|
<2 non specific s/s, might seem like GI, girls more than boys
failure to thrive, feeding problems, vomiting and diarrhea untreated leds to renal failure fishy urine smell risks are: renal anomalies, consitpation (bladder distention), bubble baths, poor hygiene, pin worms, sexual abuse |
|
UTI >2
|
classic
frequency, dysuria, fever, flank pain, hematuria may need cath, but try other methods first |
|
Testicular torsion
|
SURGICAL EMERGENCY!
peak is 13 yrs of age most common cause of testicular loss in adolescent males s/s unilateral pain to affected testicle edema possible n/v discoloration of testicle |
|
when caring for pts with hemotological disorders always include...
|
protective isolation in plan of care
|
|
Sickle cell disease
|
sickled hgb/rbcs
bed rest, HYDRATION!!!! (may stop sickling on its own!), pain meds, antibx, blood transfusions, oxygen |
|
leukemia in child
|
immature WBCs
ALL (acute lymphoid) or AML (acute muelogenous) |
|
s/s of leukemia
|
fever, pallor, anorexia, petechiaw, vague abdominal pain, early acquired infections
|
|
always think what three things with leukemia...
|
immunosupression, thrombocytopenia, anemia
|
|
Wilm's tumor
|
kidney
swelling, non tender mass on one side of abd DON"T PALPATE ABDOMEN! gentle care when caring for pt |
|
Hydrocephalus
|
distubance of ventricular circulation of the CSF in brain --> increased ICP
bulgind of anterior fontanel dilated scalp veins depressed eye (forehead protruding) irritability and changes in LOC high pitched cry (associated with anything that casues increased ICP) |
|
Insertion of a VP shunt
|
measure the frontal occipital circumference
fontanel and cranial suture line assessment monitor temp SUPINE position (if have meningeocele MD may want steril gauze over it and hurry to surgery so it doesn't hurt it) |
|
Seizure disorders
|
a symptom of underlying conditions
first indicator of problem may be school work deterioration |
|
partial seizure
|
particular location in brain
aura simple- loss of consciousness with numbness, tingling, pricking, or pain complex- imparied consciousness and may be confused and unable to response |
|
Generalized seizures
|
loss of consciousness
tonic-clonic- formally known as grand mal myoclonic- sudden, brief contractures or muscles, may look like startle reflex absence- petit mal, brief loss of consciousness |
|
tape test
|
to dx pin worms
do early i morning |
|
pinworm S/S
|
intense rectal itching
irritability restlessness poor sleep bed wetting distractibility short attention span |
|
Vermox
|
Pinworm medication
lots of times only need one dose or maybe one more a week or 2 later |
|
Acyclovir
|
anticiral
if ped has chicken pox and high risk for severe varicella then will given |
|
mono and spleen
|
enlarged spleen, no contact sports
|
|
When delegating you must communicate...
|
- time frame and priority of the task
- provide clear directions and expectations and what you want reported |
|
If floating nurse is from different floor..
|
give them no specialized care, but basic nursing knowledge stuff, pretend they are a brand new nurse
|
|
Never delegate...
|
assessment, evaluation
|
|
LPNs can
|
help with data collection but not assessment, no evaluations
|
|
who must do new admission history?
|
RN only (new unstable pt!)
|
|
Can the LPN do tasks on the plan of care?
|
yes, but RN must do the planning for the care
|
|
LPN and teaching?
|
LPN can not teach a newly diagnosed pt, etc. they can only implement STANDARDIZED techniques (like cough and deep breathing)
|
|
what type of pts can RN delegate to LPN?
|
STABLE!, it can be complex as long as it is stable!!, don't let chronic, complex dx make you not delegate if they are stable (like COPD or something)
|
|
Always consider a new admission...
|
unstable!
|
|
what can an LPn do in an unstable situation? (like a code)
|
specific things, like "go take the blood pressure and tell me"
|
|
what type of tasks can Rn delegate to assistive personnel?
|
routine, non-complex tasks, they can do CPR
NO ONE receiving blood, IV dopamine, or IV nitroglycerine (vitals, etc.) look at each situation. CNA can feed a client with 2 broken arms but not a dysphagia pt or can bathe a stroke pt but not a burned pt, etc. if there is EVER a degree of potential hard, the RN must retain the task no matter how routine it is!! |
|
make sure to also be...
|
cost effective
remember that you are a manager of patient care |
|
5 rights of delegation
|
right task
right circumstances right person right directions (tell staff all rules for daily weights, etc.) right supervision ad evaluation |
|
Sigs of transfusion reaction
|
chest pain, hives or skin rash, HTn or hypoTN, fever, chills, anxiety, wheezing, HA or muscle pain with fever, flushing, back pain, dizziness, itching, urticaria, tachycardia, tachypnea, dyspnea, N/V
|
|
If an adverse reaction occurs during transfusion...
|
stop it immediately
remove blood and blood tubing- may have to be returned to blood bank start NS with new set at KVO check and document vitals, STAY with client notify MD and monitor pt close for anaphylaxis notify blood bank of reaction |
|
type and screen is good for...
|
72 hours
|
|
infusion of blood should be started within..
|
30 min of receiving blood from blood bank
all blood administered within a 4 hour time frame (must be discarded otherwise) afterwards, flush with NS |
|
normal AST/ALT
|
AST- 8-40 U/L
ALT 10-30 U/L |
|
Hemoglobin normal
|
men- 14-18
women- 12-16 |
|
hematocrit normal
|
men- 40-45%
women- 38-47% |
|
WBC
|
5000-10000
|
|
Platelets
|
150,000-400,000
|
|
BUN
|
10-20 mg/dL
|
|
Creatinine normal
|
.8-2
men- .6-1.3 women- .5-1 |
|
RBC normal
|
4.7-6.1 (men)
4.2-5.4 million.mm3 (women) |
|
Digoxin normal
|
.5-2
|
|
CVp normal
|
2-6
|
|
PAOP normal
|
8-12
|
|
Absolute neutrophils cautions
|
<1500- neutropenic
<1000- mind-mod infections risk <500- severe infection risk |
|
Total cholesterol normal
|
122-200
|
|
HDl normal
|
45-50 men, 55-60 women
|
|
LDL normal
|
60-180
|
|
Urine pH normal
|
4.6-8
|
|
urine alb normal
|
0-8
|
|
urine WBC normal
|
0-4
negative for glucose |
|
Albumin normal
|
3.5-5
|
|
Lithium level normal
|
3.5-5
|
|
Bilirubin normal
|
Total: .3-1
|
|
Ammonia normal
|
10-80 mg/dL
|
|
Total protein
|
6.4-8.3
|
|
ESR
|
men 0-10, women 0-20
|
|
PSA normal
|
less then 4ng/mL
|
|
TSh
|
1-3
|