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Nclex Review > Lab Levels > Flashcards

Lab Levels Flashcards

1
Q

Sodium (Na+)

A

135-145 mEq/L

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2
Q

Magnesium

A

1.8 - 2.6 mg/dL

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3
Q

Calcium

A

9-10.5 mg/dL

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4
Q

Phosphorus

A

2.5-4.5 mg/dL

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5
Q

Potassium

A

3.5 - 5 mEq/L

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6
Q

Hemoglobin abbreviation and level

A

Hgb
Female: 12-16 g/100mL
Make: 13-18 g/100mL

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7
Q

Hematocrit abbreviation and level

A

HCT
female: 37%—47%
Male: 42%—52%

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8
Q

Chloride

A

95 - 105

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9
Q

WBCs

A

5,000 — 10,000/mm3

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10
Q

Temperate Fº and C º

A

F— 97.8 - 99

C — 36.5 - 37.2

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11
Q

BUN

A

10 — 20 mg/dL

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12
Q

Creatinine

A

Female: 0.5 — 1.1 mg/dL
Male: 0.6 — 1.2 mg/dL

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13
Q

Glucose

A

75 - 105 mg/dL

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14
Q

HgbA1c

A
  • < 6.5%

6.5 or less is a good range anything higher NOT good diabetic patient for sure
5 - 6.5 pre-diabetic

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15
Q

RBC

A

Women: 4.2 — 5.4 million/mm3

Men: 4.7 — 6.1 million/mm3

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16
Q

Platelet

A

150,000 - 400,000/mm3

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17
Q

pH

A

7.35 - 7.45

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18
Q

pC02

A

35 to 45 mm Hg

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19
Q

p02

A

80 — 100 mmHg

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20
Q

HCO3

A

22- 26 mmol/L

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21
Q

Normal PT

A

11- 12.5 sec

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22
Q

Normal INR

A

0.7 - 1.8

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23
Q

Normal PTT

A

30-40 sec

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24
Q

Borborygmi (means ?)

A

Increased bowel sound

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25
Q

If pt’s pH is high what is the nursing intervention?

A

Suctioning because of seizures

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26
Q

If pt’s pH is low what is the nursing intervention?

A

Pt needs to ventilated with a Ambu bag due to respiratory distress

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27
Q

What acid-base imbalance does Kussmaul respirations cause?

A

MAC Kussmaul

Metabolic ACidosis

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28
Q

What #’s are HYPERflexia?

A

3+ and 4+

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29
Q

What #’s are hypoFlexia?

A

0 and 1+

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30
Q

What is Paralytic lieus?

A

Condition where bowels are impaired
(muscles of the intestines do not allow food to pass through, resulting in a blocked intestine)

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31
Q

What does obtunded mean?

A

Means one step more lethargic then lethargy (Difficult to arouse)

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32
Q

Who needs an Ambu bag at the bedside?

A

Acidic patients due to respiratory distress/arrest

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33
Q

Which patients need suction at the bedside due to seize?

A

Alkalosis patients due to seizures (foaming of mouth, at risk for aspirating)

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34
Q

What does paroxysmal mean?

A

Spasms or seizures

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35
Q

Which type of acid-base balance is Overventilating?

A

alkalosis which equals Respiratory alkalosis, because it has to due with breathing/Lungs

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36
Q

Which type of acid-bas balance is underventilating?

A

Acidosis which equals Respiratory acidosis (Respiratory due to respirations/Lung related)

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37
Q

Which type of acid-base disorder would tell you maybe they need to come off the pump, pt is on PCA (patient-controlled anesthesia) pump?

A

Respiratory acidosis would tell you they may need to be taken off pump

(because ventilation is down, and respirations would be down due to drug, PCA pumps depress respirations)

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38
Q

If patient has prolonged gastric vomiting or suctioning what acid-base balance is it?

A

Metabolic alkalosis

Because acid is being sucked out causing pH to become alkalosis

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39
Q

Pt had GI surgery, NG tube two low intermittent gonko suctioning for three days. What acid-base disorder will patient most exhibit?

A

Metabolic Alkalosis

Because acid is being suctioned out

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40
Q

Part 1) If your patient has hyperemesis gravidarum what acid-base disorder are they most likely to exhibit?

Part 2) what if patient now becomes dehydrated what acid-base disorder will they have?

A

Answer 1) Metabolic Alkalosis

(Due to acid being expelled, causing Alkalosis to rise)

Answer 2) Metabolic acidosis, because it flipped under

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41
Q

What acid-base disorder would a pt with acute renal failure have?

A

Metabolic acidosis

(Think DKA diabetic keto acidosis)

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42
Q

What acid-base disorder would an infant have who has infantile diarrhea?

A

Metabolic acidosis

(Because its not Lung or vomiting or suctioning so that by default makes it metabolic acidosis)

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43
Q

What acid-base disorder would a patient with 3rd degree burns over 60% of the body first phase?

A

Metabolic acidosis

By default not Lungs or vomiting/suctioning

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44
Q

What is the default setting for answering acid-base imbalance disorders? When you don’t know what it is

A

MAC
Metabolic acidosis

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45
Q

How often do you suction patients?

A

As necessary

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46
Q

What is the appropriate order to address high pressure alarms in a mechanical ventilator?

A

1) unkink
2) empty water out of tubing
3) change positions: turn, cough, deep breathe
4) suction

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47
Q

What are ventilators High pressure alarms for?

Solution to problem in order?

A

To alert of an increase in resistance caused by obstructions.

1) Unkink
2) Empty water from tubing
3) change positions: turn, cough, deep breathe
4) suction

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48
Q

what are ventilators low pressure alarms for?

Solution to problem? And exception

A

To alert a decrease in resistance, caused by a disconnection

Re-connect unless tubing is on floor, Bag pt and call respiratory therapist

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49
Q

If ventilator pressure is set to high what is pt at risk for?

A

Respiratory Alkalosis

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50
Q

If ventilator pressure is set to low what is pt at risk for?

A

Respiratory acidosis

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51
Q

What is the number one psychological problem in abuse?

A

Denial

(Rule can be used for any abuse situation)

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52
Q

How do you treat Denial in abuse?

A

By confronting them

Point out the differences b/t what they say and what they do

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53
Q

How do you confront an abuser? Alcohol for examples

A

“Ok, you say you’re not an alcoholic but it is 10 a.m. and you’ve already had a 6 pack”

(It’s not the same as aggression. Don’t attack the person)

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54
Q

How do you confront a child abuser who is in denial?

A

Confront

“You say your not a child abuser but child protective services has your children”

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55
Q

What are the stages of grief?

A

“DABDA”

Denial
Anger
Bargaining
Depression
Acceptance

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56
Q

When abusers Deny what do you do?

A

Confront

“They deny, You Confront”

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57
Q

When is denial accepted?

A

When it is a loss or grief

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58
Q

What do you do in denial when it is a loss or grief?

A

Support

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59
Q

What is the #2 psychological problem in abuse?

A

Dependency and Co-dependency

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60
Q

Define Dependency in abuse?

A

When they get the significant other to do things for them

Ex: “Will you call my boss” or “ Will you go do this…”

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61
Q

Who is dependent in abuse?

A

The abuser is dependent

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62
Q

Define Co-dependency in abuse?

A

Is when the significant other derives self-esteem for doing things or making decisions for the abuser

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63
Q

Who is Co-dependent in abuse?

A

The significant other is the co-dependent

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64
Q

How do you treat dependency and co-dependency in abuse?

Answer for each pt

A

Co-dependent:
You set limits, and enforce them for co-dependents
Work on self-esteem
Teach to say NO and I’m a gd person

Dependent:
Confront the abuser the dependent

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65
Q

What is Manipulation in abuse?

A

When the abuser gets the significant other to do things/decisions not in the best interest of the significant other

(Nature of the act is dangerous & harmful to the significant other)

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66
Q

What is it called when a significant other is being asked to do something that is not inherently dangerous and harmful?

A

Dependency/Co-dependcy

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67
Q

What is it called when the significant other is being asked to do something that is inherently dangerous and harmful

A

Manipulation

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68
Q

How do you treat manipulation? How many pts

A

Set limits and enforce them, only the manipulated person is being treated as they have the self-esteem issues

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69
Q

How many pts do you treat/have in denial?

A

One

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70
Q

How many pts do you have in dependency?

A

Two
-dependent & - co-dependent

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71
Q

What is Wernicke?

A

A brain disorder caused by lack of Vitamin B1

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72
Q

encephalopathy is?

A

Any brain disease that alters brain function or structure

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73
Q

What is psychosis?

A

a disconnection from reality

Or

Loss from reality

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74
Q

What is amnesia?

A

Memory loss

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75
Q

What is confabulation?

A

Making up stories

(pt believes their story/lie, pts are psychoatic, The lie is just as real as reality to them)

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76
Q

How do you deal with a pt with Wernicke and Korsafoff who is confabulating about going to a meeting with Barack Obama this morning?

A

Redirect pt ex: “Can we go watch TV to see what is on the news today, in Washington DC”

Do NOT present reality

Some brain damage is permanent

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77
Q

3 Characteristics of Wernicke and Korsafoff syndrome

A

1) Preventable…Take B1
2) Arrestable (stop it from getting worse) Take B1
3) Irreversible (70%) will kill brain cells

2 Good news 1 Bad news

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78
Q

What is aversion therapy?

A

A type of behavior therapy designed to make a pt give up an undesirable habit by causing them to associate it with an unpleasant effect

Used in alcoholism

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79
Q

How long is the onset and duration of effectiveness of Antabuse and Revia (Disulfiram)?

A

2 weeks for both

2 weeks to start working
And
It Last 2 weeks (need to be off for 2 weeks before you decide to drink again)

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80
Q

What would you teach a pt who is doing aversion therapy for alcohol?

A

-To avoid ALL forms of Alcohol (Can lead n/v and death)
-AVOID items: Mouth wash, cologne, perfume, aftershave, OTC liquid medicine ending in elixir, insect repellent, alcohol based hand sanitizer, uncooked icing that have vanilla extract
-DO NOT PICK RED WINE VINAIGRETTES (does NOT have alcohol in it)

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81
Q

What is the most overused drug in elderly that is not an Upper or a downer?

A

Laxatives

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82
Q

Name the 5 uppers?

A

Caffeine
Cocaine
PCP/LSD (psychedelics/hallucinogen)
Methamphetamine (crystal meth)
Adderall (ADD drug)

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83
Q

S/SX of Uppers

A

Borborygmi
Diarrhea
Euphoria
HYPERflexia 3+, 4+
Irritability
Restlessness
Seizure
Tachycardia

*Have suction equipment ready foam from seizure

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84
Q

What is the highest priority to anticipate in an Upper?

A

Suctioning due to seizures

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85
Q

What is the highest priority in a downer?

A

Intubation/ventilation due respiratory arrest

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86
Q

Squad calls saying they are bringing in a pt who overdosed on cocaine. What do you expect to see? Select all that apply
- Irritability
- 4+ reflexes
- Respirations less than 12
-difficult to arouse
-borborygmi
-increased temp.

A

Irritability
4+ reflexes
Borborygmi
Increased temp.

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87
Q

Your caring for a pt who is withdrawing from cocaine, what will you do?

A

Administer Narcan

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88
Q

Drug addiction for newborn at birth what will you assume?

A

Intoxication

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89
Q

After 24 hours newborn baby is what in drug abuse?

A

Withdrawal

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90
Q

You are caring for an infant born to a Quaalude addicted mother 24 hrs after birth. Select all that apply s/sx
-difficult to console
-low core temp
-exaggerated startle reflux
-resp. Depression
-seizure risk
-shrill, high-pitched cry

A

-difficult to console
-seizure risk
- shrill, high-pitched cry
-exaggerated startle reflux

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91
Q

When does an alcoholic go through alcohol withdrawal syndrome?

A

Approx. 24 hours after they stopped drinking

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92
Q

When does Delirium tremens occur?

A

72 hours after the person stop drinking

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93
Q

Is Alcohol withdrawal syndrome life threatening?

A

No

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94
Q

Is delirium tremors life threatening?

A

Yes

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95
Q

What does pt is “Up ad lib” or “up ad Liberum” mean?

A

Pt is free to move around as desired

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96
Q

Would you as an LPN take on an assignment of a Delirium Tremons pt?

A

No pt is unstable

As RN yes but would have to decrease work load

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97
Q

Nursing Care plan for AWS?

A

-regular diet
-semiprivate room
-up ad lib
-No restraints

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98
Q

Nursing care plan for Delirium Tremons?

A

-NPO or clear liquid diet (seizure precautions)
-private room
- Bed bound
- Restraints Vest or 2-point lock letters (one arm and 1 leg opposite of each other)

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99
Q

What are the toxic effects of aminoglycosides? What should you monitor when taking

A

1- Monitor hearing, balance (vertigo, dizziness), tinnitus

1) Ototoxicity
2) Nephrotoxicity

“A mean old mycin” sounds like Mice (think Mickey ears)

Human ears are shaped like kidneys (nephrotoxicity= toxic to the kidneys)

BEST indicator of kidney function

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100
Q

What is better 24-hour creatinine clearance or a serum creatinine test?

A

24-hour creatinine clearance

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101
Q

What is hepatic encephalopathy (or hepatic coma)?

A

The loss of brain function when a damaged liver doesn’t remove toxins from the blood

Where Ammonia level gets too high
Ammonia causes confusion, disorientation, and coma

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102
Q

What is the ringing in the ear called?

A

TinnitUS

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103
Q

how often are aminoglycosides taken?
And
What nerve are they toxic too?

A

-q8h
-Nerve 8 auditory nerve

104
Q

How is “Mycin” given?

Except for 2 exceptions what are they?

A

IM or IV

PO
1- hepatic coma or hepatic encephalopathy
2- pre-op bowel surgery to sterilize the bowels

105
Q

Who can sterilize the bowels?
Which aminoglycosides

A

“Neo Kan”

Neomycin and Kanamycin

106
Q

What is Trough?

A

When drug is at its Lowest concentration in pt’s blood

107
Q

Why and When due you draw a Trough? Aka TAP

A

When there is a narrow therapeutic window
And 30 minutes before next dose no matter the route

108
Q

What is the peak of a subL route?

A

5 - 10 min. After drug is dissolved

109
Q

What is the peak of IV route?

A

15 - 30 min. After the bag is empty/finished

110
Q

What is the peak time of IM route?

A

30 - 60 minutes

111
Q

When do you want to relax and slow down the heart? Using Calcium Channel Blockers and one exception

A

A, AA, AAA

Anithypertensive
AntiAnginal drugs
AntiAtrialArrhythmia

Supraventricular= atrial

112
Q

What are the most common side effects of Calcium Channel blockers?

A

Headache and hypotension

113
Q

Calcium Channel Blockers end in “dipine” and also what 2 others?

And which of the two others is given IV?

A

-Verapimil
-Cardizem (diltiazem)

-Cardiezem (diltiazem) is given continuous IV drip

114
Q

What are the parameters to assess before giving CCB?

A

BP
Hold if SBP < 100

115
Q

A lack of QRS complexes is?

A

Asystole= A flat line

116
Q

QRS depolarization=

A

Ventricular

117
Q

P wave=

A

Atrial

118
Q

P waves in the form of a saw tooth wave=

A

Atrial flutter

Think of the movie jaws
I saw the teeth of jaws and my heart fluttered

119
Q

Chaotic P wave patterns=

A

Afib

120
Q

Chaotic is word used to describe what in sinus rhythm?

A

Fibrillation

121
Q

Chaotic QRS complexes=

A

V-fib

122
Q

Bizarre QRS complexes=

A

V-tach

123
Q

Periodic wide Bizarre QRS complexes =

A

Premature Ventricular Contractions (PVC)= short run of v-tach

Low priority

124
Q

Which arrhythmias are lethal and HIGH priority?

A

Asystole

V-fib

Both produce a low or NO cardiac output

(Will kill pt in 8 minutes or less)

125
Q

Which arrhythmia is POTENTIALLLY lethal?

A

V-tach

126
Q

Treatment of ventricular arrhythmia use?

A

Lidocaine or Amiodarone

127
Q

Supraventricular arrhythmias are?

A

Atrial arrhythmias

128
Q

Treatment of Atrial arrhythmias?

A

ABCD’s

Adenocard (Adenosine)
Beta-blockers
CCBs
Digitalis (Digoxin), Lanoxin

129
Q

Which cardiac arrhythmia do you Defib?

A

V-fib

Or

“For V-fib you DeFib”

130
Q

Treatment of Asystole?

A

Epinephrine and Atropine in that order

131
Q

Pneumothorax chest tubes remove?

A

Air

132
Q

Hemothorax chest tube removes?

A

Blood

133
Q

Hemopneumothorax chest tube removes?

A

Blood and air

134
Q

A chest tube is placed in a pt for hemothorax. What would you report to the nurse?
A) Chest tube is not bubbling
B) Chest tube drains 800 mL in the first 10 hours
C) Chest tube is not draining
D) Chest tube is intermittently bubbing

A

C) Chest tube is not draining

135
Q

What is the chest tube NOT suppose to in a hemothorax?

A

Bubble

136
Q

A chest tube is placed in a pt for a pneumothorax. What would you report to the nurse? Select all that apply
A)Chest tube is not bubbling
B)Chest tube drains 800 mL in the first 10 hours
C)Chest tube is not draining
D) Chest tube is intermittently bubbling

A

A) Chest tube is not bubbling
B) Chest tube drains 800 mL in the first 10 hours

137
Q

Chest tube is in the Apical part of lungs, what location is this?

A

Top of lung

138
Q

Chest tube is in the basilar part of the lungs what part is it draining?

A

Bottom part of lungs

139
Q

Where would you place a chest tube for a postoperative right pnuemoectomy?

A

NO where there NO lung

140
Q

When water seal breaks what is the order of operation?
-Submerge
-cut
-clamp
-unclamp

A

-clamp
-cut
-submerge
-unclamp

141
Q

When you see First its about?

A

Order

You get to do multiple things, what you pick is what you do first

142
Q

When you see BEST it means?

A

Means what is the priority thing to do

You only get to do one thing

143
Q

What do you do first if a chest tube gets pulled out?

A

Cover the opening

144
Q

What is the best thing to do if a chest tube gets pulled out?

A

Vaseline gauze w/tape 3 sides

145
Q

In chest tube pt is intermittent bubbling in water seal chamber good or bad?

A

Good

146
Q

In chest tube pt is continuous bubbling in water seal chamber good or bad?

A

Bad, means a leak in system

147
Q

What is a Thoracentesis?

A

A chest tube that goes in and out

148
Q

What is one things ALL children with congenital heart defects have?

A

-murmur

149
Q

What are the defects of Tetralogy of Fallot?

A

“PROVe”
P
R
O
V

150
Q

Contact isolation precautions for what diseases?

A

-Anything enteric (GI or fecal/oral)- C. Diff, Hepatitis A, E. Coli, Cholera, Dysentery, MRSA also airborne **

-Staph

-RSV- even thou transmitted through droplet

-Herpes: shingles

151
Q

How do you get Hepatitis A ?

A

A for Anus (bowel or contaminated food)

152
Q

What is the PPE for contact precaution?

A

-private room (or same cohort/disease)
-hand washing
-gown
-gloves
-Disposable supplies
-Dedicated equipment

153
Q

Droplet precautions disease?

A

-Anything traveling 3 feet:
pertussis,
Influ A & B,
MRSA,
RSV

-ALL meningitis

-H. Influenza B (causes epiglottitis)

154
Q

What are PPE for droplet precautions?

A

-private room is preferred or w/others of same cohort/disease
-hand washing
-mask
-Goggles/face shield
-Gloves
-disposable supply’s
-dedicated equipment

155
Q

Airborne is for? What diseases

A

“MTV”

-MMR= Measles, Mumps, Rubella
-TB
-Varicella (chickenpox)

156
Q

What PPE is needed for airborne diseases?

A

-Negative air pressure/flow room
-private room REQUIRED
-hand washing
-gloves
-goggle/face shield
-mask (N95 for TB)
-Pt must wear mask when leaving room
-Disposable/Dedicated equipment is not essential

157
Q

Order of PPE putting on?

A

Gown
Mask
Goggle
Gloves

158
Q

Order of PPE taking off?

A

Alphabetical order

Gloves
Goggles
Gown
Mask

159
Q

How do you measure crutches length? And handgrips

A

Rule out landmarks on foot or say axila

-2-3 inches width b/t the pad and axilar y
- the tip point of crutch lateral and slightly in front of foot

  • Elbow flexed at 30 degrees
  • Wrist should be at level of the handgrip
160
Q

How to walk with a 2-point gait?

A

Move crutch and opposite food, then the other

2 points always touching ground and 2 points moving together

161
Q

How to walk with a 3-point gait?

A

Move 2 crutches and the bad leg TOGETHER= 3 points moving together

162
Q

How to walk with a 4 point gait?

A

Move everything separately

Right crutch —> Left foot —>Left crutch —> Right foot

Slow but table

163
Q

Which crutch gait do you use when non-weight bearing?

A

Swing-through (amputees or injured leg)

164
Q

Amputee which crutch gait do you use?

A

Swing-through

165
Q

What crutch gait would you use evenly distributed weakness?

Which is mild
Which is severe

A

2-point gate- mild
4- point gate- severe

166
Q

What crutch gait would you use for one leg is affected?

A

Odd 3 point gait

167
Q

A pt has a left ATK (above the knee) amputation 2 days ago. What gait should the pt use?

A

Swing-through b/c non-weight bearing

168
Q

Pt is in advanced stages of ALS. What gait should the pt use?

A

4-point gait b/c advanced

169
Q

Pt is first day postop, right knee, partial weight bearing allowed. What gait should the pt use?

A

3-point gait b/c partial weight bearing allowed

170
Q

Pt with bilateral total knee replacement first day postop. Weight bearing is allowed. What gait should the pt use?

A

4-point gait considered severe

171
Q

Pt with bilateral knee replacement 3 weeks postop. What gait should the pt use?

A

2-point gait not as severe considered mild

172
Q

How should you go Up and Down the stairs with crutches?

A

Up with the GOOD, down with bad
Note: Both crutches move with bad leg

173
Q

What side does the cane go on?

A

Strong side/unaffected leg

174
Q

How to use a Walker?

A

“Pick them up, Set them down, Walk to them”

175
Q

If you must tie belonging to the walker where would they tie them?

A

On side of walker so does not tip over

176
Q

A false, fixed belief or idea or thought is?

A

Delusion

177
Q

What are the 3 types of delusion?

A

-paranoid - ppl going to kill me
-grandiose - I’m president
-somatic - there are worms inside my body

178
Q

A psychotic sensory experience is called a?

A

hallucination
Or Illusion

Depends if there is a referent is something there

179
Q

What are the types of hallucinations?

A

There are 5
-Auditory “ppl are out to kill me”
-Visual “I see bugs on the wall”
-Tactile “I feel bugs on my arm”
-Gustatory “Taste”
-Olfactory “smell”

180
Q

A psychotic symptom of a misinterpretation of reality is?

A

An illusion

181
Q

What is the 4 step process for a functioning psychotic pt?

A

1) Acknowledge feelings
2) Present reality
3) Set limits
4) Enforce these limits

Acronym “Annual passes sell everyday”

182
Q

What is the 2 step process for psychosis of dementia?

A

1) Acknowledge their feelings
2) Redirect them- Give them something to do

183
Q

What is the 2 step process of delirium in psychosis?

A

1) Acknowledge feeling
2) Reassure safety and temporariness

184
Q

What is Oliguria?

A

l-O-w has O like low=

low urine output

185
Q

Who gains weight DI, DM or SIADH?

A

SIADH they retain water

186
Q

Normal specific gravity level

A

1.005 to 1.030

187
Q

What are the s/sx of Diabetes?

A

Know the 3 Ps
Polyuria- excess peeing
Polydipsia- excess thirst
Polyphagia- increased hunger

188
Q

What is the primary modification made in type II DM diet?

A

Calorie Restriction

189
Q

How many meals should a DM II pt have in a day?

A

6 small frequent meals

190
Q

Normal Glucose level?

A

70-110

191
Q

R-regular insulin onset, peak, duration?

A

Clear short acting, IV Only insulin type
1
2
4

192
Q

N-NPH, intermediate insulin onset, peak, duration?

A

6
8-10
12

193
Q

Lispro (Humalog) onset, peak, duration?
When do you give it?

A

15
30
3 hrs
Give it WITH meal

194
Q

Glargine (Lantus) onset, peak, duration?

A

Long-acting
0 peak
12-24 hours

195
Q

What action by the nurse invalidates the manufacturers expiration date on vial of insulin?

A

Opening the package and new expiration date is 30 days after that

196
Q

Acute complications of diabetes? 3 things

A

Low blood glucose
Hypoglycemia
Hypoglycemic shock

197
Q

What does hypoglycemia look like s/sx?

A

Think DRUNK pt in Shock
Drunk:
-staggering gait
-slurred speech
-Cerebral impairment (liable means same thing)
-Slow reaction time
-Decrease social inhibition (loud annoying)
Shock:
-tachycardia
-tachypnea
-Low BP
-Cold/clammy
-mottled skin

198
Q

Treatment of hypoglycemia

A

Give sugar + starch:

-orange juice
-crackers
-apple juice
-turkey
-Skim milk but 1/2 cup

Unconscious pts: Glucagon IM, or Dextrose IV of D10, D50

199
Q

High Glucose in a type I causes?

A

DKA

200
Q

What causes DKA?

A

-too much food
-not enough insulin
-not enough exercise
-Viral infection Upper respiratory infection within 2 weeks

201
Q

What are the s/sx of DKA?

A

DKA
Dehydration
Ketones in serum, kussmauls, high K+
Acidosis, acetone breath (fruity breath), Anorexia due to nausea

202
Q

When diabetics are sick what happens? 2 main things

A

High glucose
Dehydrated s/sx (hot/flushed)

203
Q

What is the treatment of DKA?

A

Insulin IV remember R-Regular
IV fluid! 200mL/hr

204
Q

Who can have HIGH blood sugar in diabetes?

A

Type 2

205
Q

S/sx of dehydration:

A

-skin is dry
-flushed
-decreased turgor
-increased HR
-dry mucous membranes

206
Q

Which test is the best indicator of long term blood glucose level?

A

HbA1C
6 or lower good
7 or greater pre-diabetic/have pt come in for eval
8 or greater is out of control

207
Q

Lithium is used for what?
Therapeutic level:
Toxicity level:

A

Bipolar (antimania drug) Manic episode only
Thera: 0.6 - 1.2
Tox: 2 or greater

208
Q

Lanoxin (Digoxin) is used for?
Therapeutic:
Toxicity:

A

Digitalis: A-fib and CHF
Thera: 1-2
Tox: 2 or greater

209
Q

Aminophylline is used for what?
Therapeutic
Toxicity

A

Airway, muscle spasm relaxer
Thera: 10-20
Toxicity: 20 or greater

210
Q

Dilantin (phenytoin) is used for what?
Therapeutic
Toxicity

A

for seizures
Thera: 10 - 20
Tox: 20 or greater

211
Q

Bilirubin elevated level and toxicity in newborns range?

A

10 - 20 elevated
20 or greater toxic
14-15 physicians want NB in hospital the

212
Q

Newborn comes out yellow which type of jaundice is this?

A

Pathological jaundice

213
Q

What is Kernicterus? When does it occur?

A

Bilirubin in the brain, when level in blood gets greater or equal to 20

214
Q

What is Opisthotonos?

A

A position a NB assumes due to irritation of the meninges from kernicterus

Hyperextended posture MEDICAL EMERGENCY

215
Q

In what position do you place an opisthotnic newborn?

A

On side

216
Q

What is Hiatal Hernia?

A

Like GERD but WITH lying down
Heartburn and indigestion

217
Q

Treatment of Hiatal hernia?

A

-elevate HOB
-increase fluids with meals
-increase carb content helps empty faster
-Decrease protein

218
Q

Dumping syndrome s/sx:

A

DRUNK: staggering gate, impaired judgement,
SHOCK: cold/clammy, tachycardia, pale
Acute Abd distress: n/v, diarrhea, cramping, guarding, borgorygmi, bloating, distensión

219
Q

Treatment of Dumping Syndrome:

A

-Lower HOB
-Decrease the amount of fluids 1 or 2 hours before or after meals
-Decrease carbs content
-High protein (bulks gastric content)

220
Q

how do you check Chvostek sign and when do you see it?

A

Tap the cheek
Hypocalcemia

221
Q

How do you check trousseau sign? And with which electrolyte imbalance?

A

Inflate BP cuff
Hypocalcemia

222
Q

If s/sx are nerve or skeletal involvement which electrolyte should you choose?

A

Calcium

223
Q

What is tetany?

A

Muscle spasm

224
Q

What is clonus?

A

Irritable

225
Q

Choosing answers for potassium and calcium? Pick what for potassium

A

Heart or blood pressure

226
Q

Magnesium is a?

A

Sedative

227
Q

Paresthesia?

A

Numbness and tingling

228
Q

Circumoral paresthesia?

A

Numbness and tingling around the lips

229
Q

Paresis?

A

Muscle weakness

230
Q

Never push which electrolyte in IV?

A

Potassium

231
Q

How do you lower potassium? Temporary

A

Give D5W and regular insulin TEMPORARY solution

232
Q

Long term treatment for potassium?

A

Kayexalate (enema or PO)

233
Q

What should you know about electrolytes?

A

Kalemias same as prefix except HR and Urine Output
Calcemias- opposite of prefix
Magnesium- opposite of prefix
Natremia- Dehydration or Over load

234
Q

Why is HIGH potassium a bad thing?

A

Stops heart/ Cardiac Arrest

235
Q

S/sx of thyroid storm?

A

1) temp of 105 or greater
2)High BP, stroke level 210/180
3)Severe tachycardia 180 or higher
4)Psychotically delirious

236
Q

Lowering body temp in thyroid storm First step?

A

Ice pack

237
Q

Lowering temp in thyroid storm best step?

A

Cooling blanket

238
Q

Postop Risk in total thyroidectomy and substotal?

A

Total= tetany due to Hypocalcemia

Subtotal= Storm

239
Q

Treatment of hypothyroidism?

A

Levothyroxine (Synthroid) take on empty stomach w/water 30min - 1 hour before breakfast

240
Q

Postop risk in first 12 hours of thyroidectomy total and subtotal?

A

Airway
And
Hemorrhage

241
Q

Postop risk after 12 - 48 hours for thyroidectomy of total and subtotal?

A

Total = tetany

Sub = storm

242
Q

Postop after 48 hrs of thyroidectomy?

A

Infection

243
Q

Never pick infection in the first ______ hours?

A

72 hrs

244
Q

Tetany is dangerous in thyroidectomy b/c?

A

Causes spasm of the larynx, or voice box causing breathing problems, asphyxiation=death

245
Q

S/sx of Addison disease?

A

Hyperpigmented (Very Tan)
They do NOT adapt to stress which means they will go into Shock (Time Bomb waiting to go off)

246
Q

Purpose of stress response is to?

A

Raise BP and glucose

247
Q

Cushing Syndrome s/sx?

A

-moon face
-hirsutism (excess hair)
-Truncal or central obesity
-Arms and legs are skinny- muscle atrophy
-gynecomastia (big breast)
-buffalo hump
-retain N+ and Water
-Lose K+ out the back
-striae = stretch marks
-Increase glucose check q6h
-Bruises easily
-Grouchy
-Immunosuppressed

248
Q

Treatment for cushings?

A

Adrenalectomy
If bilateral= now Addisons give steroids ending is SONE

249
Q

S/sx of nerve root compression?

A

3 Ps
1) Pain
2) Paresthesia (numbness and tingling)
3) Paresis (muscle weakness)

250
Q

What is the most important pre-op assessment for cervical laminectomy?

A

First: Assess breathing
Next: functions of arms/hands

251
Q

What is the most important pre-op assessment for Thoracic laminectomy?

A

First: Assess Cough
Next: Bowels

252
Q

What is a post-op complication for Thoracic laminectomy?

A

Pneumonia and paralytic lieus

253
Q

What is a post-op complication for cervical laminectomy?

A

Pneumonia

254
Q

What is a post-op complication for lumbar laminectomy?

A

Urinary retention and Leg problems

255
Q

What do you asses post-op in lumbar laminectomy?

A

Urinary retention/last void or empty bladder
And
Leg functions

256
Q

D/C teaching for laminectomy 4 temp 3 permanent?

A

Temp 6 weeks:
1)No sitting for more then 30 minutes
2)Lie flat, Log roll
3)No driving
4) Don’t lift more then 5 lbs

Permanent:
Never lift by bending at waist (use knees)
Never lift over the head
Never jerky movement. NO rides, horse back riding, trail biking

257
Q

INR range

A

2 to 3
Anything 4 and above is critical do something=
HOLD warfarin/Coumadin, Assess for bleeding, prepare to give Vit K, Call physician

Nclex Review (4 decks)

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