Mark Klimek Test taking strategies: Lecture Notes
Lab Values:
DEADLY DANGEROUS:
• Elevated K+ ( >6)
- Hold K+, Assess heart, Prepare Kayexalate/D5W, Call Dr.
• Elevated pH ( >6)
- Assess Vitals, Call doctor
...
Mark Klimek Test taking strategies: Lecture Notes
Lab Values:
DEADLY DANGEROUS:
• Elevated K+ ( >6)
- Hold K+, Assess heart, Prepare Kayexalate/D5W, Call Dr.
• Elevated pH ( >6)
- Assess Vitals, Call doctor
• CO2 in the 60’s
- Assess Resp., Do purse lip breathing, prepare to intubate and ventilate, Call Resp. Therapy, Call Dr.
• PO2 < 60’s
- Assess Resp., Give O2, Prepare to intubate and ventilate, Call resp. therapy, Call Dr.
• Platelets < 40,000
- Assess for bleeding, Place on Bleeding precautions, prepare for administration on Platelets
CRITICAL:
• INR > 4
• Low K+ ( < 3.5)
• High K+ (5.4 – 5.9)
• Elevated Hgb ( < 8)
• CO2 in the 50’s
- Assess Resp., Do purse lip breathing, DO NOT GIVE O2
• Low PO2 but still in the 70’s
- Assess Resp., Give O2
• O2 < 93%
- Assess Resp., Give O2
• Abnormal Na+ with a change in LOC
• WBC < 5000
• ANC < 500
• CD4 < 200
• Platelets < 90,000
- Assess for bleeding, Place on bleeding precautions
BE CONCERED:
• Elevated BUN
- Check for dehydration
• Elevated Hgb
- Monitor for Bleeding
• Elevated BNP (Best indicator for heart failure)
• Abnormal Na+
- If elevated, assess for dehydration
- If Low, assess for overload
ABNORMAL BUT NOT A CONCERN:
• Elevated Creatinine ( > 1.2, Best indicator for Kidney function)
• HCO3
• Hct
- Assess for bleeding
*** HOLD, ASSESS, PREPARE, CALL DOCTOR***
Creatinine: 0.6-1.2
INR: 2-3
K+: 3.5-5.0
pH: 7.35-7.45
BUN: 8-30
Hgb: 12-18
Acid Base balance:
• Rule of the B’s: If the pH and the Bicarb are Both in the same direction then it is metaBolic
• MacKussmauls: Kussmauls Respirations only occur in Metabolic ACidosis
• As the pH goes, so goes my patient except K+
- If pt has a LOW pH, s/s will be elevated except K+
- If pt has a HIGH pH, s/s will be decreased except for K+
• Causes for acid base imbalances
1. Ask yourself is it a lung problem? Yes, then it is Resp.
2. Then ask yourself are they over ventilating or under ventilating?
- If OVER VENTILATING pick ALKALOSIS
- If UNDER VENTILATING pick ACIDOSIS
If it is not a lung problem then is has to be a metabolic problem
- If the patient has PROLONGED SUCTIONING or VOMITING pick ALKALOSIS
- For EVERYTHING else or when you don’t know what to pick, pick ACIDOSIS
Aminoglycosides = “A MEAN OLD MYCIN”
• Tx serious, life-threatening infections
• All mycin drugs end in “-MYCIN”
• The wannabe mycin’s all end in “-ROmycin”
• Toxic Effects: “Mycin” sounds like “mice” mice have big EARS that are shaped like KIDNEYS with an 8 drawled inside the ear.
- EARS = Ototoxicity –Monitor ringing in ears and balance
- KIDNEY EARS = Nephrotoxicity –Monitor Creatinine lvls
- 8 inside ears= these meds are given every 8 hrs. and affect the cranial 8 nerve
• Who can sterilize my Bowels?........ NEO-KAN
- Mean old mycins are never giving PO, except for hepatic encephalopathy, ammonia, and bowel prep surgery.
- They are only given PO when the bowel are needing cleaned out
KANmycin and NEOmycin are administered
Calcium Channel Blocker:
• They are like VALIUM for the ♥, it allows the heart to relax
- Negative inotropic, chronotropic, and dromotropic
• What do CCB treat?
- A, A-A, and A-A-A, PLUS SVT
- Antihypertensive
- Anti Angina
- Anti Atrial Arrhythmic (A-Fib, A-Flutter)
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