68WM6 NCLEX Review Lectures
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| WBC | 5,000 - 10,000
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| HCT | 41-49
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| Hgb | 12-16(Female) 14-18(Male)
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| PLT | 200-400 thousand
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| Na | 135-145
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| K | 3.5 - 5.5
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| Cl | 98-107
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| Glucose | 70 - 110
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| Co2 | 35 - 45
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| Kidneys release _____renin in response to low ____ concentration. | Renin , Na
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| Renin stimulates conversion of angiotensinogen to _____ which converts to _____ in the lungs. | angiotensin I , angiotensin II
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| ACE inhibitors do what? | blocks the conversion of angiotensin I to angiotensin II..blocks the constriction affect and prevents HTN.
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| What does angiotensin II do? | Major vasoconstrictor, stimulates Aldosterone release, causes Na retention, increases water reabsorbtion, releases K+ and H+
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| Mag | 1.5 - 2.5
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| Ca | 8.5 - 10.9
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| Phos | 2.5 - 4.5
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| BUN | 7 - 22
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| Creat | 0.6 - 1.35
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| PT | 10 - 12
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| PTT | 30 - 45
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| INR | 2-3
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| Billi | < 1.0
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| Alb | 3.4 - 5.0
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| Alk | 20-125
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| PreRenal Failure causes | Fluid Volume Loss Hemorrhage GI Losses (vomiting, diarrhea) Renal Losses Burns Inadequate Volume Replacement
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| PreRenal Failure causes r/t Inadequate Cardiac Output | CHF MI cardiogenic shock dysrhythmias cardiac tamponade, PE
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| Vasoconstriction/Occlusion of Renal Blood Vessels r/t AFR | catecholamines hypertension vasopressors renal vessel embolism
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| RAAS System | retain volume increase sodium and water reabsorption
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| ARF Diagnostics | Decreased Urine Sodium , Urine Osmolality Increased (decreased free water excretion), Urine Specific Gravity Increased(> 1.020), oliguria/anuria, BUN:Cr ratio is increased >20
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| ARF Treatment | Volume Replacement Extracellular Volume Sequestration, Inadequate Cardiac Output , Renal Artery Occlusion
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| Postrenal failure includes | Obstruction kidney, ureter, bladder, urethra Increased Intra-tubular Pressure abnormal nephron function reverses rapidly once obstruction is removed
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| Diagnosis of Renal Failure | KUB, ultrasound, IVP, retrograde pyelography, CT
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| Causes of Intrarenal Failure | Glomerulus or Renal Tubule Damage, glomerular, vascular or hematologic problem glomerulonephritis systemic lupus erythematosus (SLE) DIC endocarditis pre-eclampsia
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| decrease in the blood supply to a bodily organ, tissue, or part caused by constriction or obstruction of the blood vessels | ischemia
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| Acute Tubular Necrosis (ATN) | perfusion to the kidney is severely reduced Vasoconstriction & Ischemia damage the glomerular basement membrane and tubular epithelium
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| Na+/K+ Pump Fails | sodium remains in cell potassium remains outside cell causes additional cellular dysfunction and cellular edema
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| Uric Acid | 3.5 - 7.5
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| Triglyceride | 40 - 50
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| Total Cholesterol | 130 - 200
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| Protein | 6.2 - 8.1
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| HCO3 | 24 - 26
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| Protein | 6.2 - 8.1
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| LDH | 100 - 190
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| CPK | 21 - 232
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| HR | 80 - 100
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| RR | 12 - 20
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| BP | 110 - 120 (Sys) / 60 - 90 (Dia)
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| Digoxin | 0.5 - 2.0 mg
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| Lithium | 0.8 - 1.5 mEq
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| Dilantin | 10 - 20 mcg
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| Theophylline | 10 - 20 mcg
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| Spec Gravity | 1.010 - 1.030
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| Therapeutic level of PT/ PTT | 1.5 - 2 times base
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| 3 segments of small intestine | Duodenum - 1st segment Jejunum - 2nd segment Ileum - 3rd segment
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| funciton of liver | Plays Major Role in Bile Secretion Iron Metabolism Plasma-Protein Production Detoxification of Drugs & Other Substances
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| where is the gallbladder? | Depression on Posterior Surface of Liver hangs from anterior/inferior margin of the liver
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| Function of the gallbladder | Secretes/Stores Bile Produced by Liver
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| where is the pancreas? | Posterior to Greater Curvature of Stomach
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| Arterial Bleed from Acute Longitudinal Tear in the Gastroesophageal Mucosa | Mallory-Weiss Tear
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| Associated with Chronic Cirrhosis causes the liver to become less compliant Pressure Increases in the Portal Circulation Blood in the Splanchnic System collateral circulation | Esophageal Varicies
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| bright red blood or "coffee-ground" emesis | Hematemesis
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| shiny, black, foul-smelling stool from UGI bleeding | Melena
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| bright red blood from the rectum indicates a lower GI bleed may also come from hemorrhoids or fissures | Hematochezia
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| test for occult blood in the stool | Guaiac
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| Signs of Shock | Hypotension (advanced shock) Tachycardia, Dyspnea Decreased Peripheral Pulses Cool, Clammy Skin Increased Capillary Refill Decreased LOC Decreased Urinary Output Assess for Cardiac Ischemia (EKG)
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| describe the action of Crystalloid Solutions | source for electrolytes and a temporary source of fluid volume. They flow out of the vascular system rather quickly...fluid expanders
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| example of Crystalloid solution | Lactaced Ringers and Normal Saline
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| describe the action of Colliod Solutions | colloidal solutions are needed when a solution is required to remain in the vascular system and contain a protein
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| examples of Colloids | Whole human blood U.S.P. and Hetastarch are examples of colloid solutions.
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| action of antacids | control the pH of the gastric mucosa side effects diarrhea, electrolyte disturbances, metabolic alkalosis
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| action of histamine blockers | block stimulation of acid secretion from parietal cells Cimetidine Ranitidine Famotidine
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| side effects of histamine blockers | mucosa due to decreased pH increased risk of nosocomial pneumonia can cause thrombocytopenia
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| action of proton pump inhibitors | work within parietal cells, decrease acidity of acid pump Pantoprazole Omeprazole Side effects GI distress, headache, dizziness
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| action of Mucosal Enhancers | reduce effects of acid secretion by improving the mucosal barrier sucralfate
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| injection of a necrotizing agent into bleeding vessel | Sclerotherapy
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| use of a heater probe, laser photocoagulation and electrocoagulation | Thermal Tamponade
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| results in thrombosis, sloughing, fibrosis of varix | Endoscopic Band Ligation
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| removal of lower portion of stomach | Antrectomy
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| removal of the stomach | Gastrectomy
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| surgical connection of the stomach to the jejunum | Gastroenterostomy
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| Vagotomy | severing of the vagus nerve to the stomach
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| Billroth I | vagotomy and antrectomy with anastomosis of the stomach to the duodenum
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| Billroth II | vagotomy and antrectomy with anastomosis of the stomach to the jejunum
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| action of Vasopressin (ADH) | lowers portal pressure constricts splanchnic arterial bed decreases pressure and flow in liver collateral circulation channels to decrease bleeding
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