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Hyperkalemia EKG
increased QRS complex, elevated/peaked T wave, shallow U wave
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hypokalemia EKG
smaller QRS complex, flattened or inverted T waves, prominent U wave
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PT and APTT lab values
- prothrombin time: 11-15 seconds
- Activated partial thromboplastin time: 60-70 seconds
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Hb/Hct levels
- Hemoglobin: 12-16
- Hematocrit: 35-47
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BUN
blood urea nitrogen: 5-25
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unapproved abbreviations
- U for unit and IU for international unit
- q.d and q.od for daily and every other day
- magnesium sulfate and morphine sulfate
- anything for left/right or both eyes or ears
- micrograms has to be written out
- no 0 after a decimal point, always a 0 before the decimal point
- H.S for bedtime
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Potassium deficit cause
- GI losses
- medications
- acid-base balance alterations
- hypoaldosterism
- poor dietary intake
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Hypokalemia signs
- fatigue, anorexia, n/v dysrhythmias, muscle weakness
- paresthesis, glucose intolerance
- * need to look our for digitalis toxicity in older adults- increased sensitivity of myocardium to digitalis induced dysrhythmias
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high potassium foods
fish ( not shellfish), whole grains, nuts, broccoli, collards, potatoes with skin, cantaloupe and other melons, brewed coffee, tomato juice
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low potassium foods
corn, sweet potatoes, lima beans, apples, blueberries, cranberries, instant coffee, soda, ginger ale
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kayexalate use
- to reduce hyperkalemia- removes excess Potassium from the system
- must give diluted with IV fluids- not dextrose
- 10-20 mEq/l per hour can be given
- if this doesnt work, assess for hypomagnesemia- once you administer magnesium the potassium levels will also increase
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fluid deficit signs
- thirst
- restless or irritable behavior
- dry mucus membranes ,warm skin
- decreased BP but increased HR ( due to decreased CO)
- concentrated urine, dark in color
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fluid overload signs
- peripheral edema
- electrolyte imbalance
- bounding pulse, increased BP
- headache, confusion
- diarrhea
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SIADH expected lab findings
- syndrome of inappropriate ADH secretion
- causes hypervolemia and affects the Na ratio in our bodies
- increases water in the body and it looks like we dont have enough Na, so more ADH is secreted
- causes dilutional hyponatremia
- can be caused by CNS injury
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hyperphosphatemia
- causes: renal failure, excess vitamin D, hypoparathyroidism, chemo
- patient teaching related to diet
- manifestations: few symptoms, soft tissue calcifications, symptoms may be related to hypocalcemia
- usually need to treat underlying disorder first
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hypophosphatemia
- causes: alcoholism, refeeding patients after starvation, heat, stroke, major burns
- manifestations: neuro symptoms, confusion, tissue hypoxia, muscle and bone pain, increased susceptibility to infection
- management: oral or IV phosphorus replacement, foods high in phosphorus
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5 rights of delegation
- person
- task
- supervision
- communication/direction
- circumstance
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infiltration
- fluid is no longer going into the vein
- skin is cool to touch, pale, may be swollen, will meet resistance when you try and inject something through that IV
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phlebitis
- can develop from infiltraion
- skin will be red, tender, swollen- infection is beginning
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