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What type of IV solution should you avoid in neurological patients?
Hypotonic- cellular overexplansion can cuase increased ICP and mental status disorientation
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What fluid would you use for the treatment of SIADH or water intoxication and how would you need to administer it?
3 % NS hypertonic solution through a central line and monitor neuros
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Third spacing of fluid would be moved into where???
lungs, brain, etc. a special cavity where it should not be
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With fluid volume excess CVP would be increased or decreased?
Increased
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With fluid volume deficit CVP would be increased or decreased?
decreased
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What type of fluid would you use for shock and dehydration?
isotonic
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What type of fluid would you use for water intoxication, hyponatremia, SIADH, or high solution osmolarity?
hypertonic
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what type of fluid would you use for low solution osmolarity, or intracellular dehydration?
hypotonic
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Dominant ECF electrolyte:
Sodium
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Dominant ICF cation electrolyte:
potassium
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What electrolte imbalance??
confusion, thirst, twitching, coma
hypernatremia
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Treatment for hypernatremia:
- hypotonic solution
- diuretics
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Which electrolyte imbalance can the thirsty person who can access water not get?
hypernatremia
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Treatment of hyponatremia:
NS or hypertonic if severe, retrict fluids, increase sodium
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If calcium is low what happens in the body?
parathyroid hormone stimulates clacitrol to increase intestinal absorption and release of calcium from bone
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If calcium is high what happens in the body?
thyroid hormone secretes calcoitonin to inhibit realease from the bone
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What type of electrolyte imbalance does prolonged immonblization cause?
hypercalcemia
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What other two electrolyte imbalances are associated with hypocalcemia?
hyperphosphatemia and hypomagnesium
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What type of electrolyte imbalance is secondary to removal of parathyrod?
hypocalcemia
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Chvostek's sign (cheek) and trousseus sign (bicep) are manifestations of what electrolyte imbalance?
hypocalcemia
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Tx of hypocalcemia:
oral supplements and camlcium chloride or gluconate (adminster slow due to change of infiltration and irritation to veins)
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If you have acidosis what type of electrolyte imbalance would you suspect?
high potassium
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What ECG change will you see with hyperkalemia?
peaked or tall T waves
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What ECG change will you see with hypokalemia?
U waves
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Food high in potassium:
bananas, pears, dried apricots, fruit juices, team cola beverages, milk, meat, fish, baked potato, dried beans
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normal range for magnesium:
1.3-2.5
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What type of electrolyte imbalance would use of antacids and laxatives cause?
- hypermagnesium
- (milk of magnesium)
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What does calcium gluconate treat?
decrease cardiac effects in electrolyte imbalances
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What type of electrolyte imbalance would you expect with tetany, trousseus and chovetsks signs?
hypocalcemia and hypomagnesium
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Example of Prerenal, intrinsic or post renal injury:
Excessive fluid loss: hemorrhage, burn, vomiting, diarrhea, polyuraia, diabetes insipidus
pre renal injury
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Example of Prerenal, intrinsic or post renal injury:
decreased renal perfusion from decreased cardiac output such as heart failure, MI or third spacing of fluids
pre renal injury
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Example of Prerenal, intrinsic or post renal injury:
increased vascular capacity SHOCK
pre renal
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Example of Prerenal, intrinsic or post renal injury:
vascular obstructin such embolus, dissecting aortic aneurysm, or tumor
pre renal
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Example of Prerenal, intrinsic or post renal injury:
Drugs that alter renal hemodynamics
Angiotensin, cocain, cyclosporine, NSAIDS
pre renal injury
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Example of Prerenal, intrinsic or post renal injury:
ischemia
intrinsic
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Example of Prerenal, intrinsic or post renal injury:
nephrotoxicity
intrinsic
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Example of Prerenal, intrinsic or post renal injury:
rhabdomyolysis
(crush injuries, severe burns, compartmetn syndrome, severe exertion, seizure,
intrinsic
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Example of Prerenal, intrinsic or post renal injury:
intratubular obstruction
uric acid crystals
intrinsic
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Example of Prerenal, intrinsic or post renal injury:
mechanical causes (blood clots, calculi, tumors, prostatic hypertrophy, prostate cancer, uretheral strictures)
post renal
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Example of Prerenal, intrinsic or post renal injury:
funcgtional causes (diabetic neuropathy, neurogenic bladder)
post renal
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What do you give with aminoglycoside antibiotics to prevent intrinsic inury to the kidneys?
mucomyst
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Criteria for acute kidney injury:
Creatinine 0.3 increae or >50% increase or decrease in urine output <0.5 ml/kg/hr (after adequate fluid resuscitation within 48 hr period)
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Diarrhea, vomiting, bleeding, hypotension, low CO suspect which type of kidney injury?
pre renal
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fluid overload, hypertension, nephrotoxic agents, multisystem involvment (DM), hematuria, prtoeinuria suspect which type of kidney injury?
intrarenal
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hx of UTI, hx of calculi, poor urinary stream, full bladder suspec which type of kidney injury?
post renal
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Laborartory findings with Acute Kidney Injury:
- Elevated BUN >25
- Elevated Cr >1.5
- Elevated K >5.3
- Decreased Ca <9
- Elevated Phosphorus >4.5
- Decreased Albumin
- Metabolic Acidosis
- Reduced RBCS
- Decreased H & H
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How to calculate creatnine clearanace?
urine creatinine X urine volume / serum creatinine
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What type of diet would you need for a person with AKI?
restrict protein, sodium, potassium and fluids
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What is the quickest way to treat severe hyperkalemia with ECG manifestations?
calcium gluconate (reduces excitability of cardiac muscle and stabilizes the membrane to resting potential)
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If a patient presented with headache, n & v, altered LOC, and hypertension after dialysis what would you expect?
dialysis disequilibrium syndrome: cerebral edema r/t rapid changes
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-
-
-
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Magnesium ranges:
1.3-2.1
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Phosphorus ranges:
3.5-4.5
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serum osmolality range:
270-300
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-
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Depolarization=
contracting or stimulation (Sodium moves in)
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Repolarization=
resting (potassium moves out)
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Phases of action potential of cardiac cells:
phase 0
stimulus: rapid depolarization Na moves into cell
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Phases of action potential of cardiac cells:
Phase 1
partial repolarization K moves out of cell
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Phases of action potential of cardiac cells:
Phase 2
- plateau slow ca into cell (calcium channels open)
- calcium channel blockers prevent this from happening
- cause vasodilation and decreased spasms of ventricles
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Phases of action potential of cardiac cells:
Phase 3
repolarization K into cell
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Phases of action potential of cardiac cells:
Phase 4
- resting state
- if a pacemaker is in place there is constant Na flow into cell:automaticity
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Absolute refractory period:
onset of QRS to peak of t wave abosoluely no impulse no matter how strong the stimulus
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Relative refractory period:
- downslope of the t wave
- cardiac cells can be stimulated if stimulus is strong enough
- this may be a vulnerable period for the patient
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Supernormal refractory period:
- corresponds with end of the t wave
- a weaker than normal stimulus can cause depolariztion of cardiac cells
- R-on-T may occur here
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The postive lead is placed in what area of the body?
left leg
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Tx for brady rhythms:
atropine, pacemaker
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Tx for tachy rhythms:
vagal, adenosine, digoxin, beta blockers, calcium channel blockers, cardioversion
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PVCs tx:
amiodarone, lidocaine, magnesium, procainamide
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Pulseless rhythms tx:
- CPR, ETT, IV acess, epi
- vfib/vtach: defibrillate
- asystole: atropine
- PEA: etiology
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If a patient has a pacemaker and has a spike before the p wave is it ventricular pacing or atrial?
atiral
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If a patient has a pacemaker and has a spike before the ORS is it ventricular pacing or atrial?
ventricular
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cardiac index:
- best indicator for CO= CO/BSA
- 2.4-4.0 L/min/m2
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failure to capture
firing but atria isnt responding no p wave after
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failure to sense
firing like crazy
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