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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 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 Place patient in Neutropenic Precautions
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+
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
-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) SE of CCB (H and H) Headache and Hypotensive
Arrhythmias:
Atrial Flutter = Saw Tooth Fibrillation = “Chaotic” Tachycardia = “Bizarre” Lethal Arrhythmias -Asystole -V-Fib Potentially life threatening -V-Tach -A-fib -A-Flutter
Chest Tube:
Chest tube in Apical (up high) is to remove Air. Aka Apex Chest tube in the Basilar (low) is to remove Blood. Aka Base Intermittently Bubbling is WATER SEAL chamber is GOOD!!!-Document it Continuous Bubbling is the WATER SEAL chamber…… BAD!!!!-There is a leak…. FIND IT Intermittently Bubbling in the SUCTION CONTROL chamber …. BAD!!!-Suction needs to be turned up Continuous Bubbling in the SUCTION CONTROL chamber….. GOOD!!!!Congenital Heart Defect Are either TRouBLe or No TRouBLe
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