Mark Klimek Test taking strategies.

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 • • • • Platelets 90,000 Place patient in Neutropenic - 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 HCO3: 22-26 BNP 100 Na+: 135-145 WBC: 5000- 10,000 Co2: 35-45 ANC: 500 Hct: 36-54 CD4: 200 PO2: 78-100 Platelets: 150,000-400,000 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