blood, tpn, ng tube,

Question 1

lab values (5)

Answer 1

Hgb Men: 14-18 g/dL, Women: 12-16 g/dL
Hct: Men: 38-54%, Women: 36-47%
K: 3.5-5.5 mEg/L
Na: 135-145 mEq/L
Glucose: 70-120 mg/dl

Question 2

Increased K (4)

Answer 2

• Indication: renal failure, metabolic acidosis, tissue breakdown (trauma), massive blood transfusion, hemoconcentration
• S/sx: widened QRS, peaked T wave on EKG
• intervention: dialysis, monitor ekg
• Meds: cation, insulin/glucose, calcium, bicarb, diuretics

Question 3

decreased K (4)

Answer 3

• Indication: result of diuretic rx, steroid rx, GI losses, poor diet, hemodilution
• s/sx: decreased peristalsis, ileus, pvc, u wave on eKG, muscle flaccidity, first degree heart block
• intervention: replace k, increase k in diet, iv k no faster than 10meq/100ml/hr, monitor EKG
• -risk for dig toxicity

Question 4

increased Na (3)

Answer 4

• Indication: dehydration, water loss/npo, cushings disease, diabetes insipidis, osmotic diuresis, hypertonic saline
• s/sx: thirst, oliguria, confusion, lethargy, inc temperature, s of dehydration
• intervention: rehydrate, limit na intake

Question 5

decreased na (3)

Answer 5

• indication: water intoxication, GI loss of NA, diuretics, SIADH, retained irrigation soln
• s/sx: cns dysfunction, r/t neuronal swelling-ha, confusion, lethargy, seizure, n/v, anorexia
• intervention: give na, restrict fluids

Question 6

H & H (2)

Answer 6

hct: % of RBC to plasma and is an indicator of RBC only when hydration status is normal, dehydration causes a false high
hgb: component of all rbc all conditions that dec rbcs also dec hgb, but rbc and hct can be normal yet hgb decreased secondary to iron deficiency anemia

Question 7

increased glucose (3)

Answer 7

• indication: diabetes, stress, cushings, pancreatitis, TPN
• s/sx: dka, coma, n/v, abd pain, dehydration
• intervention: insulin, hydration, k as needed

Question 8

decreased glucose (3)

Answer 8

• indication: insulin reaction, too little cho, addison’s dz, liver dz, pituitary hypo function
• s/sx: cns activation, tachycardia, tremors, seizure, weakness, hungry, diaphoretic, anxiety
• intervention: give cho, juice, candy, glucagon, monitor DM therapies

Question 9

Whole blood (3)

Answer 9

• Indication: symptomatic anemia with large volume deficit, massive hemorrhage, used to increase red cell mass and plasma volume
• amount: 500 ml
• tubing: Y type blood soln set with filter via gravity or pump
• time: 1-4 hrs

Question 10

packed red blood cells whole blood minus the plasma (3)

Answer 10

• indication: severe or symptomatic anemia, suppression of erythropoiesis, used to increase the red cell mass without delivering the plasma component
• amount: 250 ml
• tube: y-type blood soln set with 170-260 micron filter, via gravity or infusion pump
• time: 1-<4 hr

Question 11

platelets

Answer 11

• platelet pheresis used more than pooled platelets
• indication: control bleeding or prevent bleeding on a patient with severe thrombocytopenia (bleeding doesn’t occur until plt drop to <10,000 (start at 150,000)
• amount: up to 200 ml
• tube: straight type blood set with micron filter, no pump, no refrigeration
• time: as fast as tolerated, ave time is 30-60 min

Question 12

fresh frozen plasma (2)

Answer 12

• provide clotting factors to pt with coagulation deficiencies who are bleeding or about to undergo and invasive procedure
• indication: used in massive hemorrhage, multiple clotting deficiencies to replace clotting factors
• amount: up to 200-300 ml
• tube: straight type blood set with micron filter, no pump
• time: as tolerated, ave time 30-60 min

Question 13

cryoprecipitate

Answer 13

: protein particulate that precipates out of FFP when it is thawed at a low temp

• indication: used to control bleeding in patients with fibrinogen deficiency, von woillerands dz, dic, severe liver dz
• amount: 15-30 ml/unit
• tube: y-type blood/soln set with micron filter
• time: ave time 20-30 min/unit

Question 14

PN: high alert medication (3)

Answer 14

• risk for significant harm when used in error
• adverse effects r/t intravenous access (thrombosis, bloodstream infection)
• r/t metabolic homeostasis (hyper, hypoglycemia, fluid and elyte probs)

Question 15

iv lipids (3)

Answer 15

• emulsion of egg phospholipids and soybean oils in water that is commonly used as a source of fat, nutrients, and calories for pt who cannot tolerate oral intake
• available in 10, 20, 30% soln in volumes from 100ml to 1 L
• available as PN

Question 16

iv lipids as antidote (6)

Answer 16

• unlabeled use= antidote (lipid rescue rx) used to treat intentional od of anti-epileptic, cardio and pyschotropic meds unresponsive to usual therapies
• involves fatty acid metabolism
• myocardium uses fatty acids for energy. local anesthetics inhibit fatty acid metabolism in heart
• iv lipids provide exogenous source of energy for myocardium to reverse potentially cardiotoxic effects of local anesthetics on heart
• drugs or chemicals with high degree of lipid solubility are easily absorbed by it before they reach the tissues or pull them from tissue binding sites
• iv lipids may also act as positive inotrope

Question 17

neuro screening components (5)

Answer 17

• mental status
• cranial nerves
• motor system
• sensory system
• reflexes

Question 18

neuro screening: mental status (3)

Answer 18

• level of alertness
• appropriateness of responses
• orientation to date and place

Question 19

neuro screening: cranial nerves (5)

Answer 19

• visual acuity
• pupillary light reflex
• eye movements
• hearing
• facial strength, smile, eye closure

Question 20

neuro screening: motor system (3)

Answer 20

• strength: shoulder abduction, elbow extension, wrist extension, finger abduction, hip flexion, knee flexion, ankle dorsiflexion
• gait: casual, heel to toe
• coordination: fine finger movements, finger to nose

Question 21

neuro screening: sensory system

Answer 21

-one modality at time, light touch, pain/temp, proprioception

Question 22

neuro screening: reflexes (2)

Answer 22

• dtr: biceps, patellar, achilles

- plantar responses

Question 23

cranial nerves (10)

Answer 23

1: smell
2: visual acuity, visual fields and ocular fundi
2, 3: pupillary reactions
2,4,6: extraocular movements
5: corneal reflexes, facial sensation, jaw movements
7: facial movements
8: hearing
9,10: swallowing and rise of palate, gag reflex
5, 7, 10, 12: voice and speech
11: shoulder and neck movements

Question 24

x-ray verification of NG tube (3)

Answer 24

• visualize the entire course of the tube
• read by a radiologist
• mark and document tubes exit side immediately after confirmation of correct placement

Question 25

dec H & H

Answer 25

- indication: dec oxygen carrying capacity, dec 02 to myocardium, and to all cells, possible tissue ischemia and death - interventions: give packed rbc and rest, give 02, check 02 sats, and monitor ekg

Question 26

inc h&h

Answer 26

- Indication: inc viscosity of blood leads to increased tendency to clot leads to painful ischemia to area, dehydration or compensatory response to chronic hypoxemia - intervention: give vol to hemodilute, give 02

Question 27

potassium (6)

Answer 27

- major intracellular ion - contributes to intracellular osmolality - necessary for neuromuscular control - necessary for precise regulation of skeletal, cardiac, and smooth muscle activity - influences acid-base - participates in many enzyme reactions

Question 28

sodium (3)

Answer 28

- major extracellular ion - largely regulated by aldosterone - major role in maintaining osmolality of extracellular fluids