LAB VALUES

LAB VALUES CBC RBC 4.5-5.0 million WBC 5,000-10,000 Hct F: 37-48 M: 45-52 Hgb F: 12-16 M:14-18 Platelet 150,000-400,000 Serum Electrolytes Na 135-145 K 3.5-5 Cl 98-107 Mg 1.3-2.3 Ca 8.5-10.5 PO 2.5-4.5 Anticoagulants INR - COUMADIN 2-3 sec PT - COUMADIN 11-16 sec PTT - HEPARIN 25-35 sec ABGs pH 7.35-7.45 PaCO2 35-45 PO2 80-100% HCO3 22-24 Urinalysis BUN 7-22 Protein 6.2-8.1 Specific Gravity 1.010-1.030 Uric acid 3.5-7.5 Creatinine 0.6-1.35 Chemistry Glucose 70-110 LDH 100-190 Triglyceride 40-50 Total Cholesterol 130-200 Albumin 3.4-5.0 Bilirubin <1.0 PAULA LUZADAS VITAL SIGNS NEWBORN Normal High Low Blood Pressure 80-60/45-40 (at birth) > 100/50 < 100/50 Pulse Rate 100-180 bpm > 100 bpm < 60 bpm Respiratory 30-60 bpm > 65 bpm < 25 bpm Temperature 97.6ºF (36.5ºC) > 101ºF (38.3ºC) < 96.8ºF (36ºC) CHILD Normal High Low Blood Pressure 90-120/60-75 > 130/85 < 100/60 Pulse Rate 60-110 bpm > 110 bpm < 60 bpm Respiratory 14-22 bpm > 22 bpm < 14 bpm Temperature 98.6ºF (37ºC) > 101ºF (38.3ºC) < 96.8ºF (36ºC) ADULT Normal High Low Blood Pressure 110-120/85-90 > 140/95 < 100/60 Pulse Rate 60-100 bpm > 100 bpm < 60 bpm Respiratory 12-18 bpm > 25 bpm < 12 bpm Temperature 98.6ºF (37ºC) > 101ºF (38.3ºC) < 96.8ºF (36ºC) PAULA LUZADAS CRANIAL NERVE ASSESSMENT Cranial Nerve Name & Number Mnemonic Sensory (S) Motor (M) Both (B) Assessment Olfactory (I) Oh S – Some Smell Optic (II) Oh S – Say Visual acuity and visual fields Oculomotor (III) Oh M – Marry Pupil constriction & extraocular movements Trochlear (IV) To M – Money Extraocular movements – inferior addiction Trigeminal (V) Touch B – But Clench teeth and light touch Abducens (VI) And M – My Extraocular movements – lateral abduction Facial (VII) Feel B – Brother Facial movement – close eyes, smile Acoustic (VIII) A S – Said Hearing and Romberg test Glossopharyngeal (IX) Good B – Big Gag reflex Vagus (X) Velvet B – Brains Say ‘ah’ – uvular & palate movement Spinal Accessory (XI) Such M – Matter Turn head & lift shoulders to resistance Hypoglossal (XII) Heaven M – More Stick out tongue PAULA LUZADAS PHARMACOLOGY MNEMONICS DIURETICS: "Leak Over The CAN" Loop diuretics Osmotic Thiazides Carbonic anhydrase inhibitors Aldosterone inhibitors Na channel blockers CARBAMAZEPINE: use CN(V) (trigeminal) neuralgia Bipolar disorder Zeisures MORPHINE: s/e Miosis Out of it (sedation) Respiratory depression Pneumonia (aspiration) Hypotension Infrequency (constipation, urinary retention) Nausea Emesis CORTICOSTEROIDS: s/e Cataracts Up all night (sleep disturbances) Suppression of HPA axis Hypertension/ buffalo Hump Infections Necrosis (avascular) Gain weight Striae Bone loss (osteoporosis) Acne Diabetes Myopathy, moon faces Depression TRICYCLIC ANTIDEPRESSANT: s/e Thrombocytopenia Cardiac (arrhythmia, MI, stroke) Anticholinergic (tachycardia, urinary retention) Seizures SULFONAMIDES: characteristics Steven-Johnson syndrome/ Skin rash / Solubility low Urine precipitation/ Useful for UTI Large spectrum (gram positives and negatives) Folic acids synthesis blocker (as well as synthesis of nucleic acids) Analog of PABA WARFARIN: interactions ACADEMIC QACS: Amiodarone Cimetidine Aspirin Dapsone Erythromycin Metronidazole Indomethacin Clofibrates Quinidine Azapropazone Ciprofloxacin Statins TORSADES DES POINTES: tx drugs drugs causing APACHE: Amiodarone Procainamide Arsenium Cisapride Haloperidol Eritromycin SEROTONIN: s/e components cause HARM: Hyperthermia Autonomic instability (delirium) Rigidity Myoclonus PARKINSONISM: tx drugs SALAD: Selegiline Anticholinenergics (trihexyphenidyl, benzhexol, ophenadrine) L-Dopa + peripheral decarboxylase inhibitor (carbidopa, benserazide) Amantadine Dopamine postsynaptic receptor agonists (bromocriptine, lisuride, pergolide) BENZODIAZEPINES drugs decrease metabolism "I'm Overly Calm" Isoniazid Oral contraceptive pills Cimetidine PAULA LUZADAS POSITIONING TUBE FEEDING WITH DECREASED LOC Position pt on right side with the HOB elevated Rationale: promotes emptying of the stomach & prevent aspiration AIR/PULMONARY EMBOLISM Turn pt to left side and lower head of bed S/S: chest pain, difficulty breathing, tachycardia, pale, impending doom LABOR W/UN-REASSURING FHR Turn on left side, and administer O2, stop Pitocin, increase IV fluids S/S: late decelerations, decreased variability, fetal bradycardia AFTER LUMBAR PUNCTURE Pt placed in the supine position for 4-12hrs as prescribed Rationale: prevent headache and leaking of CSF AFTER MYRINGOTOMY Position on side of affected ear after surgery Rationale: allows drainage of secretions AFTER CATARACT SURGERY Pt will sleep on unaffected side with a night shield for 1-4wks; semi-fowlers Rationale: to prevent edema MENIERE’S DISEASE Change position slowly; bedrest during acute phase Rationale: Provide protection when ambulating AUTOGRAFTING Immobilize site for 3-7 days Rationale: To promote healing and maximal adhesion HEART FAILURE W/PULMONARY EDEMA Sitting up, with legs dangling Rationale: decrease venous return & reduce congestion; promotes vent. PAULA LUZADAS POSITIONING AUTONOMIC DYSREFLEXIA/HYPERREFLEXIA place client in sitting position (elevate HOB) first; legs dangling Rationale: reduce BP below dangerous levels & provide relief SHOCK Bedrest; flat on bed Rationale: To improve or increase circulation HEAD INJURY Elevate HOB 30 degrees, head should be kept in neutral position Rationale: decrease ICP; keep head from rotating; avoid freq. suctioning BUCKS TRACTION Elevate FOB for counter-traction; use trapeze for moving Assess: Ask patient to dorsiflex foot of the affected leg EVISCERATION Place in low-Fowler’s position don’t cough; NPO; keep intestines moist & covered w/sterile saline GERD Reverse trendelenburg (head higher) Pediatric: prone with HOB elevated Rationale: to promote gastric emptying and reduce reflux CEREBRAL ANEURYSM HOB elevated 30-45 degrees; bed rest Rationale: To prevent pressure on aneurysm site SEIZURE Side-lying or recovery position Rationale: To drain secretions and prevent aspiration RETINAL DETACHMENT Bed rest w/minimal activity; affected area on dependent position Rationale: helps detached retina fall into place PAULA LUZADAS ISOLATION PRECAUTIONS AIRBORNE o My – Measles o Chicken – Chickenpox/Varicella o Hez – Herpes Zoster/Shingles o TB – Tuberculosis Airborne precautions may be needed for germs that are so small they can float in the air and travel long distances. o Private room o Negative pressure with 6-12 air exchanges per hour o Mask – N95 for TB DROPLET o S – sepsis o S – scarlet fever o S – streptococcal pharyngitis o P – pneumonia o P – parvovirus B19 o P – pertussis o I – influenza o D – diphtheria (pharyngeal) o E – epiglottis o R – rubella o M – mumps o M – meningitis o M – Meningeal pneumonia o An – Adenovirus Droplet precautions are used to prevent contact with mucus and other secretions from the nose and sinuses, throat, airways, and lungs. o Private room or cohort o Mask CONTACT o M – Multidrug resistant organism o R – respiratory infection o S – skin infections* o W – wound infection o E – enteric infection: o E – eye infection: conjunctivitis Skin Infections: o V – varicella zoster o C – cutaneous diphtheria o H – herpes simplex o I – impetigo o P – pediculosis o S – scabies Contact precautions may be needed for germs that are spread by touching. o Private room or cohort o Gown o Gloves o Hand hygiene w/soap & water PAULA LUZADAS HYPER VS. HYPO ADDISONS DOWN, DOWN, UP, DOWN Hyponatremia, hypotension, hyperkalemia, hypoglycemia CUSHINGS UP, UP, DOWN, UP hypernatremia, hypertension, hypokalemia, hyperglycemia MYXEDEMA/HYPOTHYROIDISM slowed physical and mental function; sensitivity to cold; dry skin; brittle hair GRAVESDISEASE/HYPERTHYROIDISM accelerated physical and mental function; sensitivity to heat; fine/soft hair HYPOPARATHYROIDISM CATSS – convulsions, arrhythmias, tetany, spasms, stridor (decreased calcium); diet – low phosphorus HYPERPARATHYROIDISM fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium) HYPOCALCEMIA CATSS – convulsions, arrhythmias, tetany, spasms and stridor HYPERCALCEMIA: muscle weakness, abdominal pain, confusion, absent tendon reflexes, sedative effect on CNS MYASTHENIA GRAVIS weakness of muscles; worsens w/exercise & improves w/rest MYASTHENIA CRISIS complication of myasthenia gravis; resp. failure; positive reaction to Tensilon will improve symptoms HYPOVOLEMIA High temp, rapid/weak pulse, tachypnea, hypotension, urine specific gravity >1.030 HYPERVOLEMIA bounding pulse, SOB, dyspnea, crackles, edema, HTN, urine specific gravity <1.010 HYPOKALEMIA dysrhythmias, diet – increase K (raisins, bananas, apricots, oranges, potatoes) HYPERKALEMIA: MURDER – muscle weakness, urine (oliguria/anuria), resp. depression, decreased cardiac contractility, ECG changes, reflexes TX: 50%DEXT with regular insulin HYPONATREMIA muscle cramps, increased ICP, muscular twitching, convulsion; TX: osmotic diuretics, fluids HYPERNATREMIA increased temp, weakness, disorientation, hypotension, tachycardia; TX: hypotonic solution HYPOMAGNESIA tremors, tetany, seizures, dysrhythmias, depression, confusion, dysphagia; digoxin toxicity HYPERMAGNESIA depresses the CNS, hypotension, facial flushing, absent deep tendon reflexes, shallow respirations, emergency DIABETES INSIPIDUS (LOW ADH) excessive urine output and thirst, dehydration, weakness Tx: vasopressin SIADH (HIGH ADH) change in LOC, decreased deep tendon reflexes, tachycardia Tx: Declomycin, diuretics CHOLINERGIC CRISIS excess of acetylcholine leads to inactivity or decrease of AChE enzyme, which breaks down acetylcholine; stop med PHEOCHROMOCYTOMA hypersecretion of epi/norepinephrine, HTN, hyperglycemia, avoid stress; avoid cold PAULA LUZADAS TYPES OF FLUIDS HYPERTONIC Ø Under/beneath; cell has a low amount of solute extracellularly and it wants to shift inside the cell to get everything back to normal via osmosis. This will cause CELL SWELLING which can cause the cell to burst or lyses Ø Used: when the cell is dehydrated and fluids need to be put back intracellularly. This happens when patients develop diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemia Ø Fluids: o 0.45%NS (1/2 NS) o 0.225% Saline (1/4 NS) o 0.33% saline (1/3 NS) HYPOTONIC Ø Excessive; cell has an excessive amount of solute extracellularly and osmosis is causing water to rush out of the cell intracellularly to the extracellular area which will cause the CELL TO SHRINK Ø Used: (very cautiously – most likely to be given in the ICU due to quickly arising side effects of pulmonary edema/fluid overload); preferred to give hypertonic solutions via a central line due to the hypertonic solution being vesicant on the veins and the risk of infiltration Ø Fluids: o 3% Saline o 5% Saline o 10% Dextrose in Water (D10W) o 5% Dextrose in 0.9% Saline o 5% Dextrose in 0.45% saline o 5% Dextrose in Lactated Ringer’s ISOTONIC Ø Same/equal; cell has the same concentration on the inside and outside which in normal conditions the cell’s intracellular and extracellular are both isotonic Ø Used: to increase the EXTRACELLULAR fluid volume due to blood loss, surgery, dehydration, fluid loss that has been loss extracellularly; BURNS; emergency Ø Fluids: o 0.9%NS o Lactated Ringer’s o 5% dextrose in water (D5W) o 5% dextrose in 0.225% saline (D5W 1/4NS) o Hydroxyethyl starch o PAULA LUZADAS ABG INTERPRETATION ABNORMALITY pH 7.35-7.45 CO2 45-35 HCO3 22-24 EXAMPLES Respiratory Acidosis Uncompensated ¯ ­ normal SEVERE ASTHMA PNEUMONIA HYPOVENTILATION S/S: WHEEZING, DEPRESSED MENTAL STATUS Partially Compensated ¯ ­ ­ Fully Compensated normal ­ ­ Respiratory Alkalosis Uncompensated ­ ¯ normal HYPERVENTILATION PANIC ATTACK ASPIRIN POISONING S/S: TACHYPNEA, DIZZINESS, CONFUSION, SEIZURES Partially Compensated ­ ¯ ¯ Fully Compensated normal ¯ ¯ Metabolic Acidosis Uncompensated ¯ normal ¯ DIABETIC KETOACIDOSIS LACTIC ACIDOSIS ALCOHOL, SALICYLATE S/S: KUSSMAL’S BREATHING, TACHYPNEA, COMA, HYPOTENSION Partially Compensated ¯ ¯ ¯ Fully Compensated normal ¯ ¯ Metabolic Alkalosis Uncompensated ­ normal ­ LOSS OF ACID: SEVERE VOMITING LOSS OF POTASSIUM S/S: WEAKNESS, NEURALGIA, POLYURIA, ALTERED MENTAL STATUS, HYPERTENSION Partially Compensated ­ ­ ­ Fully Compensated normal ­ ­ PAULA LUZADAS MATERNITY – BELLY MAPPING PAULA LUZADAS CHILD DEVELOPMENTAL STAGES PAULA LUZADAS CHILD DEVELOPMENT PAULA LUZADAS ERIKSON’S DEVELOPMENTAL STAGES PAULA LUZADAS INSULIN ADMINISTRATION PAULA LUZADAS SEPSIS INTERPRETATION PAULA LUZADAS RULES OF NINES PAULA LUZADAS SUCTION CHAMBER PAULA LUZADAS AREAS OF PAIN TO THE ABDOMEN PAULA LUZADAS ACLS PAULA LUZADAS DRUG TERMINOLOGY prefix, root, suffix examples (generic names) drug class or drug category actions/used for -asone betamethasone; dexamethasone; fluticasone corticosteroid anti-inflammatory; useful in treating many conditions – lupus, asthma -bicin doxorubicin; epirubicin; idarubicin; valrubicin antineoplastic; cytotoxic agent cancer chemotherapeutic agents; treat malgnancies -bital butabarbital; phenobarbital barbiturate (sedative) depress the CNS; anxiety -caine bupivacaine; lidocaine; prilocaine; local anesthetic depress the CNS; block nerve transmission to pain centers cef-, cephcefaclor; cefdinir; cefixime; cefprozil; cephalexin cephalosporin antibiotic; treat a wide range of bacterial infections; ear infections -cillin amoxicillin; ampicillin; nafcillin penicillin antibiotic; pneumonia, scarlet fever throat infections; rheumatic fever -cycline doxycycline; tetracycline tetracycline antibiotic -dazole albendazole; metronidazole anthelmintic antibiotic; antibacterial -dipine amlodipine; felodipine; nifedipine; calcium channel blocker lowers BP; relax & widen blood vessels -eprazole esomeprazole; omeprazole; proton pump inhibitor (PPI) antacid; peptic ulcers; GERD -fenac bromfenac; diclofenac; nepafenac NSAID analgesics; arthritis; -floxacin ciprofloxacin; levofloxacin quinolone antibiotic -iramine chlorpheniramine; pheniramine antihistamine allergic reactions -lamide acetazolamide; brinzolamide; dorzolamide; methazolamide carbonic anhydrase inhibitor anticonvulsant; control certain seizures in the treatment of epilepsy -nacin darifenacin; solifenacin muscarinic antagonist anticholinergic; reducing spasms of smooth muscles -nazole fluconazole; ketoconazole; miconazole; terconazole; tioconazole antifungal antimycotic; ringworm, candidiasis (thrush) PAULA LUZADAS -olol atenolol; metoprolol; timolol beta blocker antagonist; lowers BP; angina; overactive thyroid symptoms -parin enoxaparin; heparin antithrombotic blood thinner; DVT -phylline aminophylline; theophylline xanthine derivative bronchodilator; asthma symptoms -pramine clomipramine; imipramine tricyclic antidepressant (TCA) depression pred- prednisolone; prednisone corticosteroid anti-inflammatory; asthma -pril benazepril; captopril; enalapril; lisinopril; moexipril; ramipril ACE inhibitor blood vessels enlarge or dilate; lowers BP; heart failure -sartan candesartan; losartan; valsartan angiotensin II receptor antagonist; ARB lowers BP; heart failure -semide furosemide; torsemide loop diuretic (water pill) used for impaired kidney function -setron ondansetron; palonosetron antiemetic and antinauseant nausea and vomiting -statin atorvastatin; lovastatin; pitavastatin; pravastatin; rosuvastatin; simvastatin HMG-CoA reductase inhibitor; statins lower cholesterol levels; prevent heart attacks and strokes sulfa- sulfadiazine; sulfamethoxazole anti-infective; anti-inflammatory antibiotic -terol albuterol; formoterol; levalbuterol beta agonist bronchodilator; inhaler; asthma -thiazide chlorothiazide; hydrochlorothiazide; methyclothiazide thiazide diuretic (water pill) treat high BP and congestive heart failure; edema -tyline amitriptyline; nortriptyline; protriptyline tricyclic antidepressant (TCA) increase levels of norepinephrine and serotonin; depression -vir acyclovir; famciclovir; penciclovir; antiviral anti-herpes -zepam clonazepam; diazepam; lorazepam; benzodiazepine anxiety-reducing; sedative; anticonvulsant; insomnia -zolam alprazolam; estazolam; midazolam; benzodiazepine anxiety-reducing; sedative; anticonvulsant; insomnia -zosin alfuzosin; doxazosin; prazosin; alpha blocker blood vessels to dilate; lowers BP;