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Exam 1: 175

QuestionAnswer
Normal Serum Osmolarity 270-300 mOsm/L
Hemoglobin 12-17g/dL. Increased in COPD, high altitudes and dehydration. Decreased in anemia, hemorrhage and chronic disease (renal disease, cancer). Strains C/V system to maintain O2, increasing the risk of MI and CVA.
Hematocrit 35%-51%. Increased in COPD, high altitudes and dehydration. Decreased in anemia, hemorrhage and chronic disease (renal disease, cancer). Strains C/V system to maintain O2, increasing the risk of MI and CVA.
WBC 5,000-10,000. Increased in inflammation, infection and stress.Decreased in immune disorders and cancers.
"Shift to the left" Baby WBC are released to fight infections or inflammation.
Platlets "Thrombocytes" 150,000-400,000 units/L. Increased in malignancies and acute infections. Decreased in certain types of anemia, cancer chemo, clotting disorders, autoimmune disorders and RA. "Heparin induced thrombocytopenia" = decreased platlets
Potassium 3.5-5.0 Cell and heart contractability. Increased in cardiac arrhythmias and renal disease. Decrease in cardiac arrhythmias and w/ diuretics, NG suctioning and vomiting
Sodium 135-145 mEq/L Decrease due to polyuria, not eating, diuretics, vomiting and NG tubes, cause weakness, confusion, muscle cramps, seizures and coma. Increase due to Na IV solutions, causes dry mucous membranes, thirst and convulsions.
PT/INR Prothrombin time/International normalized ratio. Time it takes to clot. 11-12.5 sec/ 0.9-1.2. PPT (partial PT)30-40 sec. Therapeutic INR is increased 2-3.5x to prolong clot time for surgery and other procedures.
Carboxyhemoglobin Carbon monoxide on oxygen-binding sites of the hemoglobin molecule.
Atelectasis Collapse of the alveoli
Insufflation Injecting gas or air into a surgical cavity to separate organs and improve visualization.
Myoglobinuria Presence of muscle proteins in the urine.
Inhalation Anesthetics desflurane- Suprane enflurane- Ethrane halothane- Fluothane isoflurane- Forane sevoflurane- Ultane nitrous oxide- N2O
IV Anesthetics etomidate- Amidate ketamine- Ketalar midazolam- Versed propofol- Diprivan methohexital sodium- Brevital thiopental sodium- Pentothal
Neuromuscular Blockers succinylcholine- SUX or Anectine atracurium- Tracrium cisatracurium- Nimbex mivacurium- Mivacron vecuronium- Norcuron pancuronium- Pavulon
Opioids alfentanil- Alfenta fentanyl- Sublimaze remifentanil- Ultiva sufentanil- Sufenta
Benzodiazepines Valium, Ativan, Versed Decrease anxiety and memory, increase sedation. SE= dizziness, hypotension, respiratory depression. Monitor respiratory status, level of consciousness and safety considerations.
Opiate analgesics Moderate to severe pain. Morphine, Fentanyl, Oxycodone, Hydrocodone/ASA (Lortab), Demerol, Hydromoephone, Dilaudid, butorphanol tartrate (Stadol), ketorolac tromethamine (Toradol), and combinations such as Hydrocodone/ Tylenol (Vicocin)
Antiemetics Prevent nausea. Zofran/ Ondansetron, Phenergon, Promethazine (not compatible with Lactate Ringers), Compazine Prochlorperazine, Reglan Metoclopramide
Anticholinergic Dries up respiratory secretions, decrease risk of aspiration. Atropine- adverse effects in elderly: restlessness, irritability, delirium, urinary retention, tachycardia and dry mouth.
Basal insulin secretion Insulin secreted at low levels during fasting
Prandial insulin secretion Insulin secreted at increased levels after eating
Glycogenesis Production and storage of glucose
Glycogenolysis Glycogen breakdown into glucose
Ketogenesis Conversion of fats to acids
Gluconeogenesis Conversion of proteins into glucose
Lipolysis Fat breakdown
Proteolysis Protein breakdown
Polydipsia Excessive thirst
Polyphagia Excessive hunger
Syncope Brief loss of consciousness on standing
Gastroparesis Delay in gastric emptying
Azotemia Increased protein or nitrogen waste products in the blood.
Sulfonyureas-secretagogues Stimulates pancreas to secrete more insulin, increases sensitivity of tissues to uptake insulin. SE= hypoglycemia. glipizide- Glucotrol (long half life, weight gain). glimepiride- Amaryl
Meglitinide Increase meal related insulin secretion, short duration of action. SE= hypoglycemia, prevents postmeal blood glucose increase. repaglinide-Prandin, nateglinide-Starlix
Biguanides Lowers both basal & prandial BG by decreasing overproduction of glucose & by making insulting more effective in tissues. Creatinine increase in surgeries causes renal insufficiency. Stopped for procedures and contrast dyes. metformin-Glucophage.
Alpha-glucosidase Slows/delays glucose to prevent postmeal BG elevation. S/S=abd pain, diarrhea & flatulance. acarbose-Precose, miglitol-Glyset
Thiazolidinediones (TZD) In combine w/ other drugs, improves tissue sensitivity to insulting, increases intravascular volume, caution w/ pts w/ CHF or cardiac disease. pioglitazone-Actos, rosiglitazone-Avandia
Type 1 DM S/S= hyperglycemia, polyuria, glucosuria, polyphagia, polydipsia, weight loss, fatigue, blurred vision and dehydration. Abrupt onset, normal/ under weight.
Type 2 DM S/S=polyuria, polydipsia, blurred vision,skin infections slow to heal, obese. Gradual onset. Risk= age > 45, had gestational diabetes, baby >9lbs., excessive weight, inactivity, genetically.
Rapid acting insulin Insulting aspart: Novolog, insulin glulisine: Apidra, human lispro injection: Humalog
Short acting insulin Humulin R, Novolin R, ReliOn R
Intermediate acting insulin Humulin N, Novolin N, ReliOn R, Levemir
Regular acting insulin Treats DKA. Only insulin that may be given IV. Humulin R
Long acting insulin glargine: Lantus
Hypoglycemia Too much insulin, too much physical activity, too little CHO. BS <60mg/dl. Sudden onset. S/S=hunger, nausea, irritability, shakiness, sweating, anxiety, slurred speech, cool skin, difficulty thinking, confusion, tingling of extremities, increased pulse.
How to treat hypoglycemia 15g/15 min rule. 1/2 cup fruit juice or 8oz skim milk. If comatose IV dextrose followed by IV infusion of D5W. Glucogon IM/SQ 1mg
DKA Progresses over 1-2 days. Severe depletion of K, Na, Cl, dehydration. Low K/Na causes heart problems/muscle contraction issues. Ketones present in urine. Cause= surgery, trauma, illness/flu, omitted insulin, stress, neglect, undiagnosed DM.
S/S of DKA fruity, alcohol smelling breath;confusion; Kussmal's breathing; decreased BP; increased P; serum oSmo >340; pH <7.3; abnormal K, Na, Cl; lethargy; coma; thrist; polyuria; dry mucous membranes; weakness; warm/dry skin; N/V/ABD pain; death
Treatment of DKA Assess, vital signs, regular insulin IV, labs, oxygen, cardiac monitor, BS q1hr, change to IV w/ dextrose when BS <250. Fluids given 15-20mL/kg/hr at first. Hypotonic solution. Goal is to perfuse major organs then replace body fluids.
HNKC/HHS Hyperosmolar nonketotic coma.BS>600.Altered mental state, lethary, coma.Life-threatening.24hr-2weeks to manifest.Severe dehydration. S/S= oSmo >340, BS 600-2000, altered consciousness, neuro deficits, seizures, no ketones, normal pH, dehydration, polyuria
Treatment of HNKC/HHS regular insulin, same as DKA, correct underlying cause (acute illness/infection, UTI, flu, certain drugs, diuretics, cardiac drugs, beta blockers)
Hyperdermoclysis Slow infusion of isotonic fluids into the patients subcutaneous tissue.
Intrathecal Meds are infused into the subaracnoid space (spine) closer to the spinal cord, allowing reduced doses.
Crystalloids Isotonic Hypertonic Hypotonic
Colloids Hypertonic
Isotonic 0.9% NS, Lactate Ringers, D5W. Good for fluid replacement, blood loss, blood transfusions, DKA, decreased B/P. Bad for cardiac disease, CHF, HTN.
Hypotonic 0.45% NS. oSmo <275. fluid travels from vascular to cells and interstitial. Good for dehydration, gastric fluid loss, Na/Cl depletion, DKA. Caution: increases intracranial pressure
Hypertonic D5/0.45% NS. oSmo>275-300. Moves from cells and interstitial areas into vascular system. Good for post-op, to increase BP, increase urine output, decrease edema, perfuse kidneys. Bad for HTN
Complications of IV therapy Infiltration Phlebitis/Thrombophlebitis Infection Air embolism Fluid overload
Infiltration S/S= coolness, pain, leaking, edema, tightness. Assess IV site often, if S/S remove IV, apply sterile dressing, elevate extremity, apply warm (increase circulation, speed healing) or cold (decease pain and edema) compress
Phlebitis/Thrombophlebitis S/S= pain redness, edema, red line along vein. From poor insertion technique, not sterile technique, high oSmo of drug. Remove IV, apply sterile dressing, elevate, warm compress, report/document.
Speed shock S/S= lightheadedness, flushing, chest tightness, irregular pulse, SOB. Stop infusion, hang isotonic solution to KVO, notify provider
Circulatory overload S/S= Increased BP, SOB, increased P. More common in elderly or cardiac diesase. elevate head, slow IV rate, admin O2, report, careful I&Os
Biguanides Lowers both basal & postmeal blood glucose levels by decreasing overproduction of glucose & by making insulin more effective in tissues. High creatinine level can increase more in surgery causing renal insufficiency. Stopped for procedure & contrast dyes
Alpha-glucosidase Slows/ delays glucose to prevent postmeal blood glucose elevation. S/S= abd pain, diarrhea, flatulance
Thiazolidinediones (TZD) In combo w/ other drugs, improves tissue sensitivity to insulin, increases intravascular volume so caution w/ pts w/ CHF or cardiac disease
Biguanides metformin- Glucophage
Alpha-glucosidase acarbose- Precose miglitol- Glyset
Thiazolidinediones (TZD) pioglitazone- Actos rosiglitazone- Avandia
Created by: cmpenney88