Exam 1: 175
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| Normal Serum Osmolarity | 270-300 mOsm/L
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| 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.
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| 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.
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| WBC | 5,000-10,000. Increased in inflammation, infection and stress.Decreased in immune disorders and cancers.
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| "Shift to the left" | Baby WBC are released to fight infections or inflammation.
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| 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
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| 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
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| 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.
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| 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.
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| Carboxyhemoglobin | Carbon monoxide on oxygen-binding sites of the hemoglobin molecule.
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| Atelectasis | Collapse of the alveoli
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| Insufflation | Injecting gas or air into a surgical cavity to separate organs and improve visualization.
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| Myoglobinuria | Presence of muscle proteins in the urine.
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| Inhalation Anesthetics | desflurane- Suprane
enflurane- Ethrane
halothane- Fluothane
isoflurane- Forane
sevoflurane- Ultane
nitrous oxide- N2O
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| IV Anesthetics | etomidate- Amidate
ketamine- Ketalar
midazolam- Versed
propofol- Diprivan
methohexital sodium- Brevital
thiopental sodium- Pentothal
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| Neuromuscular Blockers | succinylcholine- SUX or Anectine
atracurium- Tracrium
cisatracurium- Nimbex
mivacurium- Mivacron
vecuronium- Norcuron
pancuronium- Pavulon
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| Opioids | alfentanil- Alfenta
fentanyl- Sublimaze
remifentanil- Ultiva
sufentanil- Sufenta
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| Benzodiazepines | Valium, Ativan, Versed
Decrease anxiety and memory, increase sedation.
SE= dizziness, hypotension, respiratory depression.
Monitor respiratory status, level of consciousness and safety considerations.
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| 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)
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| Antiemetics | Prevent nausea. Zofran/ Ondansetron, Phenergon, Promethazine (not compatible with Lactate Ringers), Compazine Prochlorperazine, Reglan Metoclopramide
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| Anticholinergic | Dries up respiratory secretions, decrease risk of aspiration. Atropine- adverse effects in elderly: restlessness, irritability, delirium, urinary retention, tachycardia and dry mouth.
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| Basal insulin secretion | Insulin secreted at low levels during fasting
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| Prandial insulin secretion | Insulin secreted at increased levels after eating
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| Glycogenesis | Production and storage of glucose
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| Glycogenolysis | Glycogen breakdown into glucose
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| Ketogenesis | Conversion of fats to acids
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| Gluconeogenesis | Conversion of proteins into glucose
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| Lipolysis | Fat breakdown
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| Proteolysis | Protein breakdown
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| Polydipsia | Excessive thirst
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| Polyphagia | Excessive hunger
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| Syncope | Brief loss of consciousness on standing
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| Gastroparesis | Delay in gastric emptying
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| Azotemia | Increased protein or nitrogen waste products in the blood.
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| 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
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| Meglitinide | Increase meal related insulin secretion, short duration of action. SE= hypoglycemia, prevents postmeal blood glucose increase. repaglinide-Prandin, nateglinide-Starlix
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| 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.
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| Alpha-glucosidase | Slows/delays glucose to prevent postmeal BG elevation. S/S=abd pain, diarrhea & flatulance. acarbose-Precose, miglitol-Glyset
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| 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
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| Type 1 DM | S/S= hyperglycemia, polyuria, glucosuria, polyphagia, polydipsia, weight loss, fatigue, blurred vision and dehydration. Abrupt onset, normal/ under weight.
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| 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.
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| Rapid acting insulin | Insulting aspart: Novolog, insulin glulisine: Apidra, human lispro injection: Humalog
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| Short acting insulin | Humulin R, Novolin R, ReliOn R
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| Intermediate acting insulin | Humulin N, Novolin N, ReliOn R, Levemir
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| Regular acting insulin | Treats DKA. Only insulin that may be given IV. Humulin R
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| Long acting insulin | glargine: Lantus
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| 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.
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| 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
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| 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.
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| 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
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| 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.
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| 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
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| Treatment of HNKC/HHS | regular insulin, same as DKA, correct underlying cause (acute illness/infection, UTI, flu, certain drugs, diuretics, cardiac drugs, beta blockers)
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| Hyperdermoclysis | Slow infusion of isotonic fluids into the patients subcutaneous tissue.
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| Intrathecal | Meds are infused into the subaracnoid space (spine) closer to the spinal cord, allowing reduced doses.
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| Crystalloids | Isotonic
Hypertonic
Hypotonic
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| Colloids | Hypertonic
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| 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.
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| 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
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| 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
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| Complications of IV therapy | Infiltration
Phlebitis/Thrombophlebitis
Infection
Air embolism
Fluid overload
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| 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
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| 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.
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| Speed shock | S/S= lightheadedness, flushing, chest tightness, irregular pulse, SOB. Stop infusion, hang isotonic solution to KVO, notify provider
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| 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
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| 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
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| Alpha-glucosidase | Slows/ delays glucose to prevent postmeal blood glucose elevation. S/S= abd pain, diarrhea, flatulance
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| Thiazolidinediones (TZD) | In combo w/ other drugs, improves tissue sensitivity to insulin, increases intravascular volume so caution w/ pts w/ CHF or cardiac disease
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| Biguanides | metformin- Glucophage
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| Alpha-glucosidase | acarbose- Precose
miglitol- Glyset
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| Thiazolidinediones (TZD) | pioglitazone- Actos
rosiglitazone- Avandia
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