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Labs: Normal iValues: HgB: - Males:
- 14 - 18
- Female:
- 12 - 16 Hct: - Males:
- 42 - 52
- Female:
- 37 - 47 RBC’s: - Males:
- 4.7-6.1 imillion
- Female:
- 4.2-5.4 imillion WBC’s: - 4.5-11k Platelets: - 150 - 400k PT: INR:
- 11 - 12.5 iseconds
- 1.5-2.5 itimes inormal APTT: - 60 - 70 iseconds BUN: - 10 - 20 Creatinine: - 0.5-1. Glucose: - 70 - 110 Cholesterol: - < Bilirubin iNewborn: - 1 - 12 Phenylalanine: - Newborn: i<
- Adult: i< Na: - 135 - 145 K: - 3.5-5.
- Hypokalemia:
- Prominent iU iwaves
- Depressed iST isegment
- Flat iT iwaves
- Hyperkalemia:
- Tall iT-Waves
- Prolonged iPR iinterval
- Wide iQRS
Ca: - 9 - 10.
- Hypocalcemia:
- Muscle ispasms
- Convulsions
- Cramps/tetany
- Trousseau’s
- Prolonged iST iinterval
- Prolonged iQT isegment Mg: - 1.5-2. Cl: - 96 - 106 Phosphate: - 3 - 4. Albumin: - 3.5- 5 Specific iGravity: - 1.003-1. A1c: - 4 - 6% iis iideal
- <7.5= iOK
- This itells iyou iaverage iblood iglucose iover i 120 idays Dilantin: - 10 - 20 Lithium: - 0.5-1. ABGs: - Used iin iacidosis iv ialkalosis
- PH:
- 7.35-7.
- CO2:
- 35 - 45 i iRespiratory iDriver
- HCO3:
- 21 - 28 i iMetabolic iDriver
- O2:
- 80 - 100
- O2 iSTAT:
- 95 - 100%
Precautions i& iRoom iAssignments Precautions i& iRoom Assignments: Universal iStandard iPrecautions:
- Wash iHands
- Wear iGloves
- Gowns ifor isplashes
- Masks iand iEye iprotection ifor isplashes iand idroplets
- Don’t irecap ineedles
- Mouthpiece ior iambu ibag ifor iresuscitation
- Refrain ifrom igiving icare iif iyou ihave iskin ilesion Droplet iPrecaution: - Respiratory iPrecaution
- Wear ia imask
- Used ifor:
- Sepsis
- Scarlet iFever
- Strep
- Fifth iDisease i(Parvo iB19)
- Pertussis
- Pneumonia
- Influenza
- Diphtheria
- Epiglottitis
- Rubella
- Rubeola
- Meningitis
- Mycoplasma
- Adenovirus
- Rhinovirus
- RSV ineeds icontact iprecaution itoo
- TB i iRespiratory iisolation Contact iprecaution: - Universal i+ iGoggles, iMask, iGown No iInfection iPatient: - No iinfection ipatients iwith iimmunosuppressed ipatients
Weird iMiscellaneous iStuff: Miscellaneous iStuff: Rifampin: - iBody ifluids iwill iturn irust/orange/red Pyridium: - Used ifor iUTI
- Will iturn iurine iorange/ ired/pink GGCS: - <8 i= iComa Myasthenia iGravis: - Myasthenic iCrisis: i Weakness iwith ichange iin ivitals i(give imore imeds)
- Cholinergic iCrisis: iWeakness iwith ino ichange iin ivital signs i(Reduce imeds) Diabetic iComa ivs. iInsulin iShock
- Give iglucose ifirst
- If ino ihelp, igive iinsulin
- Fruity ibreath= idiabetic iketoacidosis Acid-Base iBalance: - If iit icomes iout iof iyour iass iits iacidosis
- Vomiting iis ialkalosis Cystic iFibrosis: - Skin iTaste iSalty Stroke: - Tongue ipoints itoward ilesion i(paralysis)
- Ulva ideviates iaway ifrom ithe iside ilesion iparalysis Drugs: - Hold idigoxin iif iHR iis i<
- Stay iin ibed ifor i 3 ihours iafter ifirst iACE iinhibitor idose
- Avoid igrapefruit ijuice iwith iCa++ ichannel iblockers
- Anthrax= imulti-vector ibiohazard PE: - Trendelenburg i iHOB idown
- Place ion ileft iside iThis iwill itrap iair iin iright iside iof ithe iheart Head itrauma/ iSeizure: - Maintain iairway= iprimary iconcern Peptic iUlcers: - Feed ia iduodenal iulcer i(relieved iwith ifood)
- Starve ia igastric iulcer i(worse iwith ifood) Acute iPancreatitis: - Fetal iposition
- Bluish idiscoloration iof iflanks i(tuner’s isign)
- Bluish idiscoloration iof iperiumbilical iregion i(Cullen’s iSign)
- Board ilike iabdomen iwith iguarding
- Self idigestion iof ipancreas iby itrypsin Tube iFeeding: - Hold itube ifeeding iif iresidual i> i100mL During ia ifire: - RACE
- PASS Gullain iBarre Syndrome:
- Weakness iprogresses ifrom ilegs iupward
- #1 iComplication= iRESPIRATORY iARREST Trough iDraw: - ~30 iminutes ibefore ischeduled iadministration
- Peak iDraw= i 30 iminutes iafter idrug iadministration
Opiate: What iare iyour itypical opiates?
- Heroine
- Morphine Withdrawal: (^) - Withdrawal isigns:
- Watery ieyes
- Runny inose
- Dilated ipupils
- Nausea
- Vomiting
- Diarrhea Overdose: - Pinpoint ipupils Stimulants Withdrawal: What iwill iyou isee? - Depression
- Fatigue
- Anxiety
- Disturbed isleep
Medical-Surgical Medical iSurgical: Hypoventilation: - Acidosis
- Too imuch iCO Hyperventilation: - Alkalosis
- Low iCO Lesions ion iMidbrain: - With imidbrain ilesions, iyou iwill isee ithat ipatient iin decerebrate iposturing
- Decerebrate:
- Extended ielbows
- Head iarched iback Lesions ion icortex: - With icortex ilesions, iyou iwill isee ithe ipatient iin ia decorticate iposturing:
- Flexion iof ielbows, iwrists, ifingers, istraight ilegs
- Mummy iposition Urinary iSystem: Urinary ioutput: - 30 iml/hr iis ithe iminimal icompetency iof iheart iand ikidney ifunction
Kidney iStones: - Kidney istones= iCholelithiasis
- Flank ipain= istone iin ikidney ior iupper iureter
- Abdominal iscrotal ipain= istone iin imid/lower iureter ior bladder Renal iFailure: - Restrict iprotein iintake Fluid iand iElectrolyte: - Watch ifor iHyperkalemia
- Dizzy
- Weak
- Nausea
- Cramps
- Arrhythmias Pre-Renal iProblems: - Interference iwith irenal iperfusion Intra-renal iperfusion: - Damage ito irenal iparenchyma Post-Renal iProblem: - Obstruction iin iUT ianywhere ifrom itubules ito iurethral meatus Phases: - Oliguric
- Diuretic
- Recovery What iwe ineed ito monitor?
- Body iweight
- I&O’s
BPH:
Treatment: - TURP
- Transurethral iresection iof iprostate What ito iexpect ipost- TURP:
- Some iblood ifor i 4 idays
- Burning ifor i 7 idays Irrigation: - Only iisotonic isterile isaline ifor ibladder iirrigation Thyroidectomy: What ishould iyou ido? - Keep itracheostomy iset iby ibed iwith:
- O2 isuction
- Calcium iGluconate Post- iStrep iURI: What ican ihappen iafter? - Acute iglomerulonephritis
- Rheumatic iFever…Valve idisease
- Scarlet ifever Chest itubes: Disconnection: - If ia ichest itube ibecomes idisconnected…DO iNOT iCLAMP iIT!
- What ido iyou ido?
- Put ithe iend iin isterile iwater
- Chest itube idrainage isystem iSHOULD ishow ibubbling iand iwater ilevel ifluctuations i(tidaling iwith ibreathing) Tuberculosis: Treatment: (^) - Multidrug iregimen ifor i 9 imonths
- Rifampin ireduces ieffectiveness iof iOC’s iand iturns ipee iorange
- Isoniazid i(INH) iincreases iDilantin iblood ilevels Asthma: What iyou iteach ithe ipatient
- Use ibronchodilators iBEFORE isteroids ifor iasthma
- Exhale icompletely, iinhale ideeply, ihold ibreath ifor i 10 seconds Ventilators: What iyou ineed ito ido - Make isure ialarm iis ion
- NEVER isilence ialarms
- Check ion ipatient ievery i 4 ihours iMINIMUM
Suctioning: What ito ido - Pre iand ipost ioxygenation iwith i100% iO
- No imore ithan i 3 ipasses
- No ilonger ithan i 15 iseconds
- Suction ion iwithdrawal iwith irotation COPD: Two iparts: (^) - Emphysema:
- Pink iPuffer
- Chronic iBronchitis
- Blue ibloater o Cyanosis o Right isided iHF= ibloating/edema Treatment: - O2 iadministration
- Never imore ithan i6L/min iby icannula
- Must ihumidify iwith imore ithan i4L/hr
- No imore ithan i2L iwith iCOPD i(CO2 iNarcosis) Ascending iorder iof idelivery ipotency:
- Nasal icannula
- Simple iFace iMask
- Non-re-breather iMask
- Partial iRe-breather imask
- Venturi iMask Signs ito ilook ifor: - Restless i& iIrritability iare iearly isigns iof icerebral hypoxia
Diabetes iand iInsulin: When iin idoubt: - iTreat ifor ihypoglycemia iFIRST Hypoglycemia: - Confusion
- HA
- Confusion
- Irritable
- Nausea
- Sweating
- Tremors
- Hunger
- Slurring Hyperglycemia: - Weakness
- Syncope
- Polydipsia
- Polyuria
- Blurred ivision
- Fruity ibreath i iDKA iacidosis Insulin: - May ibe ikept iat iroom itemp ifor i 28 idays
- Draw iclear i(regular) ifirst iwhen imixing iinsulin
- Rotate iinjection isites i(rotate iin ione iregion ithen move ito ianother iregion) Rapid iActing iInsulin: - Names: iLispro i(Humalog)
- Onset: i 5 - 15 iminutes
- Peak: i 45 - 1.5 ihours Short iActing: - Regular
- Onset: i 30 - 60 iminutes
- Peak: i 2 - 3 ihours
- ONLY iONE iGIVEN iIV Intermediate iacting: - Isophane i(NPH)
- Onset: i 1 - 2 ihours
- Peak: i 6 - 12 ihours Long iActing: - Glargine i(Lantus)
- Onset: i 1 ihours
- Peak: i 14 - 20 ihours
- DO iNOT iMIX
Oral iHypoglycemic: - Decrease iglucose ilevels iby istimulating iinsulin iproduction iby ibeta icells iof ipancreas, iincreasing iinsulin isensitivity iand idecreasing ihepatic iglucose iproduction
Type: - Glyburide
- Metformin
- Avandia
- Actos
- Acrabose i iblunts isugar ilevels iafter ia imeal Oncology: Leukemia: - Anemia ireduced iRBC iproduction
- Immunosuppression
- Neutropenia iand iimmune iWBC
- Hemorrhage iand ibleeding itendencies (thrombocytopenia) Acute iLymphocytic: - Most icommon itype
- Kids
- Best iprognosis Testicular iCancer: - Painless ilump ior iswelling itesticles
- STE iin ishower i> i 14 iyears
- STE ishould ibegin iaround i 15 - 35 Prostate iCancer: - >40= iage
- PSA ievaluation
- DRE
- Elevated iPAP
- TRUS= itransurethral iUS
- Metastasis ito:
- Spine
- Hips
- Legs Post-OP iTRUS: - Monitor ifor ihemorrhage iand iCVD icomplication Cervical iUterine iCancer: - Treatments:
- Laser
- Cryotherapy iradiation
- Conization
- Hysterectomy
- Exenteration
- Chemo= idoesn’t ihelp
- PAP ismears ishould istart iwithin i 3 iyears iof iintercourse
Sexually iTransmitted iDisease: STDs: Syphilis: - Primary istage: i 90 idays
- Chancre i+ ired ipainless ilesions
- Secondary istage: iup ito i 6 imonths
- Rash ion ipalms iand isoles i+ iflu ilike isymptoms
- Tertiary iStage: i 10 - 30 iyears
- Neurologic iand iCardiac iDestruction
- Treated iw/ iPenicillin iG i iIM Gonorrhea: - Yellow igreen iurethral idischarge i(the iclap)
Chlamydia: - Mild ivaginal idischarge ior iurethritis
- Treated iwith idoxycycline ior itetracycline Trichomoniasis - Frothy- ifoul ismelling ivaginal idischarge Candidiasis: - Yellow, icheesy idischarge iwith iitching
- Treated iwith:
- Miconazole
- Nystatin
- Clotrimazole
- Gyne-Lotrimin Herpes iSimplex i 2 - Treated iwith iAcyclovir HPV: - Acid
- Laser
- Cryotherapy HIV - Cocktails
General iPost-Op iCare: - Watch ifor istridor iw/ iany ineck ior ithroat isurgeries ikeep ia itrach ikit iat ibed iside
- Staples iand isuture istay iin iplace ifor i 7 - 14 idays i(tell ipatient ito itry iand ikeep ithem idry itill ithen)
- No ilifting iover i 10 ilbs
- If ichest itube ibecomes idisconnected iplace ifree iside iin isterile iwater
- If ichest itube icomes idisconnected, iput ifree iend iin icontainer iof isterile iwater
- Removing iChest iTube i… iValsalva’s, ior iDeep ibreath iand ihold
- If ichest itube idrain istops ifluctuating, ithe ilung ihas ire- iinflated i(or ithere iis ia iproblem)
- Keep iscissors iby ibed iif ipt ihas iS. iBlakemore iTube i(for iesophageal ivarices)…
- Sudden irespiratory idistress i– iCut iinflation itubes iand iremove
- Tracheostomy ipatients i… iKeep iKelly iclamp iand iObturator i(used ito iinsert iinto itrachea ithen iremoved ileaving icannula) iat ibed iside
- Turn ioff iNG isuction ifor i 30 imin iafter iPO imeds
- NG iTube iRemoval i… iTake ia ideep ibreath iand ihold iit
- Stomach icontents ipH i= i< i 4 i(gastric ijuices iaspirated)
- NG iTube iInsertion i… iIf icough iand igag, iback ioff ia ilittle, ilet icalm, iadvance iagain iwith ipt isipping iwater ifrom istraw
- NG iTube iLength i… iEnd iof inose, ito iear ilobe, ito xyphoid i(~22- 26 iinches)
Positioning: - Total ihip ireplacement:
- No iadduction ipast imidline
- No ihip iflexion ipast i 90 idegrees
- Supratentorial:
- HOB i 30 - 45 idegrees i(Semi-Fowlers)
- Infratentorial
- Flat
- Phlebitis:
- Supine
- Elevate iinvolved ileg
- Thoracentesis:
- Unaffected iside
- HOB: i 30 - 45 idegrees
- Enema:
- Left iSIMS i(flow iinto isigmoid icolon)
- Liver iBiopsy:
- Right iside iw/ ipillow/towel iagainst ipuncture isite
- Cataract:
- Opposite iside
- Semi ifowler
- Cardiac iCath
- Flat
- HOB ino imore ithan i 30 idegrees
- Leg istraight i 4 - 6 ihours
- Bed irest i 6 - 12 ihours
- Burn iAutograph
- Elevated iand iimmobile i 3 - 7 idays
- Amputation:
- Supine
- Elevate istump ifor i 48 ihours
- Large iBrain iTumor:
- On inon-operative iside
