Rapid Prep NCLEX Review Course Archer Review

Rapid Prep NCLEX Review Course Archer Review Welcome! ● Please stay muted so that there is no background noise. ● If you have a question please enter it in the chat, or use the ‘raise hand’ feature, so that I can un-mute you and you can ask your question. ● We will be taking a 5-10 minute breaks throughout the course, and a half hour break for lunch. Introduction ● Morgan Taylor, BSN, RN, CCRN ● Pediatric nurse at heart ● Units I’ve worked on: ○ PICU ○ PCICU ○ NICU ○ Mother-Baby ○ ED ○ Bone Marrow Transplant ● Current position: Children’s Resource Unit… a little bit of everything pediatrics! ● Fun fact: I got married in my backyard this year because….COVID. My niece and nephew totally stole the show! Part I - Fundamentals Archer Review - NCLEX Rapid Prep Lab Values Need to know NCLEX numbers! Complete Blood Count (CBC) ● Hemoglobin (Hgb) ○ Female: 12-16 g/dL ○ Male: 14-18 g/dL ● Hematocrit (Hct) ○ Female: 37-47% ○ Male: 42-52% ● Red Blood Cells (RBCs) ○ 4.5-5.5 million ● White Blood Cells (WBCs) ○ 5,000 - 10,000 ● Platelets ○ 150,000 - 400,000 Metabolic Panel ● Sodium - 135-145 ● Potassium - 3.5 - 5 ● Calcium - 8.5 - -10.5 ● Magnesium - 1.5 - 2.5 ● Chloride - 95 - 105 ● Phosphorus - 2.5 - 4.5 ● Glucose 70-100 ● BUN - 5 - 20 ● Creatinine - 0.6-1.2 ● GFR - >60 ● Total protein - 6.2 - 8.2 ● Albumin - 3.4 - 5.4 ● Bilirubin - <1 ● Ammonia - 15 - 45 ● AST - 10 - 40 ● ALT - 7 - 56 ● ALP - 40 - 120 Coagulation Panel ● Activated partial thromboplastin time (aPTT) ○ Tests the intrinsic coagulation cascade ○ Not on anticoagulants: 30 - 40 seconds ○ On Heparin, ‘therapeutic aPTT’ is 1.5-2.5x normal. ● Prothrombin Time (PT) ○ Tests the extrinsic coagulation cascade ○ 10 - 12 seconds ● International Normalized Ratio (INR) ○ It is calculated from a PT and is used to monitor how well warfarin is working. ○ Not on anticoagulants: <1 ○ Taking warfarin, ‘therapeutic INR’ - 2-3 Cardiac Labs ● Troponin ○ Troponins are a group of proteins found in skeletal and cardiac muscle fibers that regulate muscular contraction. ○ Test measures the level of cardiac-specific troponin in the blood to help detect heart injury. ○ Several types of troponin ○ Normal = 0-0.4 ● BNP ○ When there is fluid retention, the heart senses the need to pump harder to move fluid forward, and releases BNP. ○ Test for CHF ○ Normal <125 Lipid Panel ● Total cholesterol <200 ● HDL > 60 ● LDL < 100 ● Triglycerides <150 ● HbA1C ○ Non-diabetic: 4-5.6% ○ Target level for diabetics - <7% ○ >6.5% - Diabetic Misc. ABG Interpretation Get it right, every time! Normal Values pH 7.35-7.45 Bicarbonate (HCO3) 22-28 CO2 35-45 Bicarb = BASE CO2 = ACID Step 1: Compensated or uncompensated? Uncompensated! NO! Is the pH normal?? 7.35-7.45 YES! Compensated! Normal!! Are the CO2 and HCO3 normal? No Yes Step 2: Acidotic or alkalotic? But… what if it’s compensated?! If the pH is between 7.35 and 7.45, but you have determined that the gas is compensated, it is an acidosis if the pH is <7.4 and an alkalosis if the pH is >7.4…. Essentially whatever side it is closest to! Step 3: Metabolic or Respiratory? > 45 = TOO MUCH acid = acidotic < 35 = NOT ENOUGH acid = alkalotic CO2 > 26= TOO MUCH base = alkalotic < 22 = NOT ENOUGH base = acidotic HCO3 Putting it all together 1. Compensated or uncompensated 2. Alkalosis or acidosis 3. Metabolic or respiratory Let’s practice together! pH 7.58 CO2 41 HCO3 38 Your patient has the following arterial blood gas values: 1. Compensated or uncompensated? ○ The pH is in OUT of normal range- this is UNCOMPENSATED. 2. Alkalosis or acidosis ○ The pH is higher than 7.45 - this is ALKALOSIS. 3. Metabolic or respiratory ○ There is a high amount of HCO3, a base, correlating with our alkalosis - this is METABOLIC. UNCOMPENSATED METABOLIC ALKALOSIS pH 7.36 CO2 69 HCO3 37 pH 7.36 CO2 69 HCO3 37 Your patient has the following arterial blood gas values: 1. Compensated or uncompensated? ○ The pH is in normal range, but the CO2 and HCO3 are not - this is COMPENSATED. 2. Alkalosis or acidosis ○ The pH is normal - but closer to 7.35 - this is ACIDOSIS. 3. Metabolic or respiratory ○ There is a high amount of CO2, an acid, correlating with our acidosis - this is RESPIRATORY. COMPENSATED RESPIRATORY ACIDOSIS pH 7.36 CO2 69 HCO3 37 Break Back at…. Fluids Fluid Volume Excess Causes ● Excessive fluid intake ● PO intake ● IV fluid administration ● Excessive sodium intake ● Kidney failure ● Congestive heart failure ● Liver failure Assessment ● High blood pressure ● Jugular venous distention ● Edema ● Weight gain ● Crackles ● Shortness of breath Complications ● High blood pressure ● Third spacing ● Fluid in the lungs ● Dilutional Hyponatremia ● Dilutional anemia Nursing Interventions ● Monitor I&O’s ● Daily weight ● Diuretics ● Hypotonic IVF ● Dialysis Fluids Fluid Volume Deficit Causes Isotonic ● Water loss = solute loss ● Trauma ● Diarrhea ● Vomiting ● Sweating Hypertonic ● Water loss > solute loss ● There is more solute in the blood and less water ● Cells are “shriveled up” ● Polyuria ● DKA ● ESRF ● Severe fluid restriction Hypotonic ● Water loss < solute loss ● There are less solutes in the blood and more water ● Hyponatremia ● Cells are swollen Assessment ● Low blood pressure ● Tachycardia ● Weak pulses ● Concentrated urine ○ High specific gravity ○ High urine osmolality ● Thirsty Complications ● Decreased perfusion to organs ● Hypovolemic shock ● MODS Nursing Interventions ● Strict I&O’s ● Monitor BP and HR ● Daily weight ● IV fluids ○ Isotonic dehydration - give isotonic IVF ○ Hypotonic dehydration - hive hypertonic IVF ■ Will help pull water out of swollen cells ○ Hypertonic dehydration - give hypotonic IVF ■ Will help move water into shriveled up cells IV Fluids Must know types and uses!