1. Serum Albumin?
    3.5-5 g/dl-half life is 18-20 days poor indicator.
  2. Thyroxine-binding pre-albumin?
    normal 17-36 mg/dl Half life is 2 days
  3. Hemoglobin & hematocrit?
    • Hct should be 3 times Hgb
    • Male hemoglobin: 14-18 g/dl Hct: 42-54%
    • Female hemoglobin: 12-16 g/dl Hct: 36-48%
  4. Total Cholesterol?
    should be under 200
  5. BUN?
    • 10-20
    • High level: dehydration, prerenal failure or renal failure, GI bleeding. They will usually check a serum creatinine level to determine if the high BUN is renal or due to dehydration. Also indicative of BPH
    • Low level: overhydration (hypervolemia), severe liver damage, low protein diet, malnutrition
  6. TPN?
    Other components?
    Other components: electrolytes, vitamins, minerals-micronutrients, regular insulin and Famotidine (antiacid) Use a 1.2 micron filter for lipids & TNA w/lipids. And 0.22 micron filter for TPN
  7. Starting rate of TPN? and UNSPOKEN RULES!? :)
    TPN: initial starting rate is 1.6ml/kg/hr or go slow. Never speed up or slow down rate without MD order Never piggyback medication, iv solutions, blood into PN.
  8. TPN Safety checks?
    • Safety checks: double check with RN, check concentration for peripheral or central line use. Assess PN solution for color, precipitates, cracking, aggregation, ingredients are specifically formulated for patient.
    • Be concerned with rebound hypoglycemia Discontinue gradually over 4-6 hours to discontinue PN decrease by half every 1-2 hours. PN CANNOT BE ABRUPTLY STOPPED OR SEVERE HYPOGLYCEMIA CAN OCCUR AND FLUID IMBALANCES.!!
    • Monitor for spikes in CBG which is the FIRST SIGN OF SEPSIS! Send cultures to lab from IV site. refeeding syndrome is where there are excess calories required for patient needs can cause abnormal fluid shifts and arrhythmias
  9. Indication for Packed Red Blood Cells (PRBC)?
    • Anemia (Hgb ≤ 7g/dl, also based on clinical presentation), excessive blood loss as in trauma (>30% of blood volume)
    • Will need filter to prevent WBC
  10. Indication for Fresh Frozen Plasma (FFP)?
    Deficiency in clotting factors, emergent reversal of anticoagulation therapy
  11. Indication for Platelets?
    Thrombocytopenia with symptoms or platelet function deficit
  12. Indication for Cryoprecipitate (Factor VII or IX)
    Hypofibrinogenemia (fibrinogen < 100mg/dl)
  13. Indication for Washed or Leukoreduced PRBCs
    Removes the WBC, indicated for transplant recipients and patient’s with a history of febrile, non-hemolytic transfusion reactions, CMV infections, and immunosuppressed patients.
  14. Irradiated blood?
    Prevention of Transfusion Associated Graft vs Host Disease
  15. Indication for Albumin
    Expand plasma volume, temporary replacement of albumin from kidney &/or liver disease
  16. Blood typing RH?
    • RH- is given to Rh- patients
    • Rh+ or Rh- may be given to Rh+ patients
  17. Allogentic-transfusion of blood from a compatible donor
    • not 100% safe
    • risk of transfusion reaction or disease transmission
  18. Autologous-transfusion of your own blood
    • transfusion reaction unlikely
    • watch for circulatory overload and bacteriemia
  19. RN role in blood product transfusion?
    • 2 RN check of the unit of blood AT THE PATIENTS BEDSIDE
    • Order
    • Signed consent
    • Blood Unit ID
    • ABO & Rh Compatibility
    • Expiration Date of donor unit
  20. RN responsibilities during blood transfusion?
    • Set up with Normal Saline (0.9%NS) ONLY
    • Stay with patient for the 1st 15 minutes of the transfusion!!
    • Start at a slow rate, 50ml/hr, then can increase if patient tolerates.
    • Transfusion must be completed within 4 hrs after initiation.
    • Instruct patient to notify RN/Staff immediately for any s/s of: Chills, Nausea/vomiting, Rash, Itching, Back/flank pain, Dyspnea, Stop transfusion immediately for any signs/symptoms of transfusion reaction.
    • Then ABC's
  21. Multiple blood transfusions risks?
    • Iron overload
    • Hyperkalemia
    • hypocalcemia
  22. Autonomic Dysreflexia
    • Leads to exaggerated sympathetic response below injury. This leads to severe HTN (massive vasoconstriction),  vagus nerve stimulation causing bradycardia, vasodilation above level of injury.
    • S&S: Sweating, headaches, blurred vision, anxiety, HTN, bradycardia, flushing of skin above injury and pallor below injury. If untreated leads to stroke, MI, pulmonary edema, seizures and death.
  23. Receptive-wernicke's (temporoparietal lobe)
    sensory aphasia, difficulty understanding written word or verbal word, speech often meaningless, made-up words.
  24. Expressive broca's (frontal lobe area)
    motor aphasia, difficulty speaking, difficulty writing.
  25. Normal ICP-RN responsibilities
    • 10-20mm hg.
    • Pt. increased risk for ICP 24-48 after stroke*provide O2 if <92% or decreased LOC, avoid pt. activities that increase ICP, quit environment, monitor vitals every 1-2 hours, increased temp can increase ICP, cardiac monitoring possibly. Surgery may be necessary.
  26. Parkinson’s disease
    decreased Dopamine and increased Acetyholine causing loss of control of voluntary muscles. PD also reduces sympathetic response to heart and blood vessels leading to orthostatic hypotension.
  27. IUGR
    • Intrauterine growth restriction-fetal growth retardation or growth restriction
    • Asymmetric: 70-80% incidence, brain sparring, associated with alter insult.
    • Symmetric: 20-30% fetal head and abdomen are decreased, associated with earlier insult.
  28. Maternal Diabetes complications?
    • Increased organ growth, body fat, and insulin production which leads to hypoglycemia after birth.
    • BG < 40 mg/dl
    • symptoms: jitteriness, cyanosis, apnea, temperature instability, hypotonia, poor feeding effort and seizures.
  29. RDS in the newborn?
    • caused by surfactant deficiency making alveoli more likely to collapse.
    • S&S: cyanosis, tachypnea, labored respirations, retractions, nasal flaring, grunting.
    • Treatment: prenatal administration of glucocorticoids. Surfactant administration after birth, ventilator support. Pharm: Poractant alfa (Curosurf), Calfactant (Infasurf), Beractant (Survanta), or Lucinactant (Surfaxin)-administered via ET tube
  30. Meconium aspiration syndrome in the newborn?
    • S&S: pallor, cyanosis, apnea, bradycardia, apgar score of 6 or less, respiration depression, resuscitation needed to initiate respirations. Management: HR< 100, grunting, floppy tone
    • Management: Suction airway/ trachea and provide Positive pressure ventilation (PPV). HR> 100, adequate ventilation, good muscle tone.
  31. Hyperbilirubinemia in the newborn some causes and treatments? Normal lab value for bilirubin adults and newborn?
    • Adult: Less than 1Normal bilirubin levels should be under 5mg in the newborn.
    • Hemolytic  disease of the newborn: caused by RH or ABO incompatibility increased risk of hyperbilirubinemia
    • Treatments: phototherapy, frequent feedings, exchange transfusion.
    • RISK for: Kernicterus occurs when bilirubin levels are high and cross BBB leading to deposits in the brain causing damage-Cerebral Palsy
  32. Prematurity in the newborn? how many weeks?
    • Borderline: 30-37 weeks
    • Moderate: 26-30 weeks
    • Extreme: 23-26 weeks
    • Low birth weight <2500g or very low birth weight < 1500G. *LBW linked to smoking
  33. Prematurity and the respiratory system?
    Lung volume is at 34% maturity at 30 weeks gestation.  Alveoli develop  from 28-36 weeks.
  34. Nutrition in the premature neonate?
    in adequate suctions and swallowing due to CNS immaturity. Immature bowel function. Peristalsis not established until 29-30 weeks. Breast feeding preferred small amounts of 2ml/kg.
  35. Cold stress and temperature regulation-Pediatrics
    • Hypothermia leads to hypoxia, hypoglycemia, metabolic acidosis, death.
    • Prevention: immediately dry neonate, use radiant warmer that has been prewarmed, maintain skin temp at 36.5, skin to skin contact with mother.
    • *hesi hint: assess for hypoglycemia by checking for a CBG-hypothermia and hypoglycemia similar in presentation.
  36. Anemia of prematurity
    • Erythropoietin is not released until 34-36 weeks gestation and there is a 1 week delay on reticulocytes 2-6% in infants.
    • S&S: fatigue, SOB, pallor.
    • Treatment: recombinant  human erythropoietin SQ, blood transfusions.
  37. Hemolytic disease of the newborn
    • IGG molecules cross the placenta from an Rh negative mom carrying an Rh positive fetus. Molecules attack the RBCs circulating leading to anemia and HF in severe cases. Hydrops can develop which is third spacing in the fetus.
    • Treatment: Rho (D) immune globulin administered at 28 weeks gestation & post delivery prophylaxis, also given anytime there is a risk of mixing. Intrauterine blood transfusions, exchange transfusion.
    • unexpected death before 1 year, usually occurs 2-4 months, higher incidence  in winter months, preterm=higher incidence.
    • Prevention: Back to sleep, use crib, avoid soft bedding/ stuffed toys, avoid overheating room, use a pacifier when putting infant to bed, provide smoke free environment, breastfeed to boost immunity to infections, no honey before 1 year of age to avoid botulism.
  39. Gestational Diabetes RN management?Fasting glucose test?
    • Labs for diagnosis: fasting glucose of > or equal to 140
    • Treatment: glyburide is being used due to it enhancing insulin secretion and not crossing the placenta.Management: medical nutrition therapy, exercise, monitoring, medications, problem solving, healthy coping and  reducing risks.
  40. Poorly managed diabetes during gestation; risks to the fetus?
    Fetal risks: severe maternal ketoacidosis: 50% mortality of fetus Infants of diabetic mothers have an increase of 2.5 in fetal death LGA,IUGR, RDS, polycythemia, hyperbilirubinemia, hypocalcemia
  41. Hydatidiform mole?
    • Diagnosis: Elevated hCG levels human chorionic gonadotropin, hyperemesis gravidarum, no fetal heart tones. 
    • Treatment: Suction D&C, hysterectomy if childbearing completed, methotrexate is the primary chemo agent used. 
    • Follow-up: Monitor hCG levels over the next year, regular pelvic exams, continued evaluation for cancer-increased risk of choriocarcinoma.
  42. PROM? risks to fetus?
    Infection, Cord Prolapse, hypoglycemia, hypoxia
  43. S&S of pre-eclampsia?
    • Classic Triad of Pre-eclampsia: sudden weight gain, HTN, proteinuria.
    • Hesi hint* Heart burn, pain under ribs, and headache also S&S for pre-eclampsia. Hyperreflexia may indicate on-coming seizure have Mag ready.
  44. Treatment for Pre-eclampsia?
    • Only cure is delivery, Seizure prophylaxis Magnesium sulfate: loading dose of 4-6 grams in 100ml of fluid bolus over 20 mins, monitor for muscle weakness, flushing of skin, n/v, dizziness, dry mouth, slurred speech, double vision.
    • *Treat magnesium toxicity with calcium gluconate 1gm or 10 ml of a 10% solution
  45. Antihypertensives during pregnancy?
    • Nifedipine 10mg PO TID, maximum of 120mg a day. May repeat in 30 mins.
    • Hydralazine apresoline: used for DBP > 110. 5-10g IV every 15 mins up to 30 mg.-monitor for  tachycardia, palpitations, placental abruptions,  headache epigastric pain.
    • Labetalol 10-20mg IV then 40-80 mg after 10 min up to 300 mg contraindicated for women with asthma or CHF.
  46. Fetal fibronectin ?
    is a protein found in the cervicovaginal fluid that is normally found in fetal membranes and decidua. Not usually present during 20-37 weeks gestation. Positive results indicate increased risk of PTL-99% accurate.
  47. Fetal surveillance
    • Fetal kick counting starts at 12 weeks
    • Fetal auscultation with a Doppler by 10 weeks
    • If there are fewer than 10 movements in a 3 hour period notify healthcare provider.
  48. AVA cord pressure?
    Doppler ultrasound of blood flow for the fetus systolic peak divided by end diastolic peak. S/D ratio Normal (2.8-2.2) Values greater than 3= decreased uteroplacental perfusion.
  49. FHR:early decelerations
    • Head compression
    • symmetrical gradual decrease in FHR, associated with uterine contractions, onset to nadir is > 30 sec-this indicated fetal head compression is ok normal progression of labor.
  50. FHR: variable decelerations
    • Cord compression.
    • Makes a V on the rhythm
    • abrupt drop in FHR below the baseline may or may not be associated with uterine contractions. Onset to nadir > 30 sec. decrease in 15 bpm lasting at least 15 sec, but not more than 2 mins  indicated cord compression.
    • Interventions:  Reposition L to R to hands and knees, O2, decrease Pitocin.
  51. FHR: late decelerations
    • Poor oxygenation during contractions.
    • Associated with poor oxygenation, symmetrical decrease in FHR takes about 30 sec to get to lowest point that gradually increases. Lowest point of deceleration is Nadir. Occurs at the peak of the contraction.
    • Interventions: Give O2, BP give fluid bolus if to low, decrease Pitocin.
  52. FHR: Prolonged deceleration
    • Indicated hypoxemia
    • Decrease of at least 15 bpm for 2 mins, but no more than 10 mins. Can be caused by magnesium sulfate or narcotics or cord compression (90%) of the time. Changing intervention
  53. FHR: accelerations
    • Fetal movement
    • abrupt increase of at least 15 BPM from the baseline. Onset to peak < 30 sec and lasting at least 15 sec but no more than 2 mins. Associated with fetal movement. HR <110 is bradycardia, 110-160 is normal range, >160 is tachycardia.
  54. FHR: variability
    fluctuations in fetal heart rate baseline that are irregular in amplitude and frequency.
  55. Uterine activity? normal?
    Uterine activity Normal=5< in 10 mins averaged over 30 mins.
  56. Review of FHR monitoring during labor
    No complications 1st stage of labor or during passive decent every 30 mins. 2nd stage every 15 mins. With complications or induced labor 1st stage every 15 mins, 2nd stage every 5 mins.
  57. Sinusoidal pattern?
    Sinusoidal pattern indicates fetal anemia or narcotic administration, smooth cycle frequency of 3-5 bpm lasting at least 20 mins.
  58. RN responsibility after placement of epidural? labor?
    After placement: monitor the patient as ordered or every 1-3 mins for 10 mins then every 5-15 mins for hypotensive episodes. Do not leave the patient for 20 mins after procedure.
  59. Anaphylaxis of pregnancy
    • Presence of amniotic fluid in maternal circulation causing a reaction.
    • 3 phases: Respiratory distress & cyanosis, Hemodynamic: pulmonary edema, hemorrhagic shock, neurologic: confusion and coma.Obstetrical  emergency:  resuscitation, delivery, supportive care for left heart failure and corticosteroid administration.
  60. Eclampsia
    • Mag sulfate
    • manage airway and give O2 pevent aspiration.
    • HELLP Syndrome: Hemolysis- RBC breakdown, Elevated Liver enzymes due to decreased blood flow, Low Platelet count <100,000.
    • Women will typically present with viral like symptoms N/V, malaise.
    • Treat: same as pre-eclampsia, activity restriction, lab work, antihypertensives, mag sulfate, platelet transfusion.
  61. Prolapse cord
    • Requires immediate C-section.
    • Management is to keep head off cord, Knee/chest position + or manually.
    • Risk factors: polyhydramnios, multiple gestation, PROM,  malpresentation, long umbilical cord, pre-maturity.
  62. Uterine atony
    • affects 1 in 20 postpartum women.
    • Leading cause of maternal mortality worldwide.
    • Uterus fails to contract due to: overdistension-polyhydramnios, multiple gestations, grand multipara. Dysfunctional uterine activity, effects of drugs anesthetic agents, magnesium sulfate, tocolytics, pre-eclampsia, operative birth-c-section, forceps, vacuum extraction.
    • S&S: signs of shock, vaginal bleeding, large boggy uterus, clots in lochia.Assess: H/HWeighing pads 1gm=1ml.
    • Interventions: Uterine massage assist the uterus to contract.
    • Medications: Oxytocin, methergine, carboprost, misoprostol, prostin E2.Surgical: uterine suturing, hysterectomy
  63. Retained placental fragments
    • most LATE PP hemorrhage is caused by this.
    • S&S: placenta does not appear intact at birth, uterus is atonic, remains larger than normal. Fragments may be visible on ultrasound.
    • Interventions: call provider for possible D&C. Monitor for bleeding, volume maintenance, signs of shock, administer O2 as needed.
  64. Uterine inversion
    • uterus delivers after the baby or placenta
    • S&S: appearance of the uterus on the perineum, unusual crate like fundal exam, sudden severe bleeding.
    • Interventions: uterus must be replaced quickly, call for OB and anesthesia, start a second IV, have terbutaline(relaxes uterus and aids in reinsertion) and nitro ready, possible surgery.
  65. Pregnancy is a hypercoagulable state: DIC?
    • Higher levels of clotting factors in order to help maintain pregnancy and reduce blood loss at delivery.
    • DIC is failure of the normal coagulation system: massive consumption of clotting factors leading to depletion. Lysis of current clots occur and massive hemorrhage and shock follow.
    • Risk is increased in preeclampsia, placental abruption, amniotic fluid embolism S&S: petechiae, ecchymosis, purpura, bleeding from gums, nose, puncture sites, episiotomy, continuous ooze without clots, signs of shock. Abnormal clotting studies. 
    • Interventions: early recognition, monitor labs, manage systemic manifestations, volume replacement, blood component, cardio and respiratory support.
  66. ALT (alanine aminotransferase)
    Liver specific:  4-36 IU/ml
  67. Prothrombin time
  68. Diagnosis for Acute pancreatitis?
    Blood work and noninvasive imaging. CBC, blood glucose level, BUN, serum calcium, lactic dehydrogenase, amylase and lipase. Abdominal endoscopic ultrasound, CT scans and MRCP Elevated serum lipase level is key sign of acute pancreatitis.
  69. RN responsibilities for Acute/Chronic pancreatitis
    • The main treatment goal for acute pancreatitis is to provide supportive care and minimize pancreatic stimulation. Fluid resuscitation, maintenance of optimal fluid balance, close monitoring for signs of systemic complications.
    • May need to monitor CBG
    • Chronic: Synthetic pancreatic enzymes may be prescribed if the pancreas does not secrete enough of its own.  Goal would be to have the patient regain some weight. Diet low in fat pt. may need 4k-6k and includes small frequent meals. Limiting caffeinated beverages is also important
    • Side lying position
    • frequent oral hygiene
    • Assess respirtory status: risk for complications of ARDS, fluid overload, pleural effusions
    • Assess for hypocalcemia: Chvosteks (possible perioral paresthesia) 
    • Assess vitals: looking for tachycardia, hypotension and fever
    • Assess glucose: may lead to hyperglycemia
  70. Cerebral palsy-spastic S&S
    • Characterized by hypertonic muscle stiffness & permanent contractions 70-80% of patients;
    • May follow a period of hypotonia in the young infant
    • Subtypes: Hemiplegia –upper & lower on 1 side, Para-lower half both legs; Triplegia-3 limbs or 2 & face; Tetra-all limbs but 3 >;  Diplegia-all, lower >upper;  Quadriplegia-all limbsAssociated with contractures, & limb deformity, pain, scoliosis
  71. Down syndrome complications?
    • heart defects 50%+, Upper/Lower Respiratory infections, leukemia, hypothyroidism, obesity, early menopause, seizures, hearing loss, premature aging, skeletal problems.
    • Treatments: PT, OT, ST, medications as needed for comorbidities-risk for injury, altered nutrition, potential for infections, activity intolerance,
  72. RBC?
    • Male: 4.7-6.1
    • Female: 4.2-5.4
  73. WBC?
    • 5-10
    • 1000/mm^3
  74. Platelet count?
    • 150-400
    • 1000/mm^3
  75. VEAL CHOP? stands for?
    • V: Variability decels / C: cord compression
    • E: early decels / H: head compression
    • A: accelerations/ O: OK-maybe O2
    • L: late decels / P: placental insufficency
  76. INR?
    • <1
    • Therapeutic value: 2-3 for coumadin
  77. PTT? and aPTT?
    • Partial thromboplastin time: 60-70 sec
    • Activated (faster) partial thromboplastin time: 30-40 sec
  78. ALP (Alkaline phosphatase)?
    • 30-120
    • High level indicated issue with liver/ gallbladder
  79. ALT (alanine aminotransferase)?
    AST (aspartate aminotransferase)?
    • ALT: 4-36 IU/ml
    • High level indicates issue with Liver

    AST: 0-35
  80. TIBC?
  81. Potassium?
    • Most abundant intracellular fluids, Narrow range (2.5 mEq/L-7.0 mEq/L)-can lead to cardiac arrest. 90% of potassium excreted by kidneys. *Rhabdomyolysis can lead to hyperkalemia.
    • 3.5-5.3 mEq/L
  82. Protein total?
    • Composed mostly of albumin and globulins-important in fluid and electrolyte balance.
    • 6.4-8.4 g/dl
  83. Sodium?
    • 135-145 mEq/L
    • Major cation in extracellular fluid, retains water,Maintains body fluids, neuromuscular impulses via sodium pump (Na+ shifts into cells as K+ shifts out for cellular activity) Enzyme activity, regulates PH balance by combining with chloride or bicarbonate ions. Panic: < 115 mEq/L
  84. Triglycerides?
    • Male: 40-160
    • Female: 35-135
  85. TSH?
    • TSH: 2-10
    • T3: 70-200 ng/dl
    • T4: 4-12 mcg/dl
  86. ABG
    • PH: 7.35-7.45
    • <7.35 acidic >7.45 basic/ alkaline 
    • PCO2: 35-45
    • CO2+H2O=Acid
    • <35 is alkalosis >45 acidosis
    • HCO3: 22-26
    • Kidney regulation of PH indicated by Bicarbonate.
    • HCO3- main base for regulation of PH
    • <22 acidosis >26 alkalosis
  87. Respiratory conditions that effect PH
    • Acidosis: hypoventilation, asthma, copd, embolism, CABG surgery, hypoxia, ventilatory management
    • Alkalosis: hyperventilating, panic attacks, head injury possible, fever
  88. Metabolic conditions that effect PH
    • acidosis: ethylene glycol, uncontrolled DM, Starvation, Shock, Renal disease, salicylate(ASA) poisoning impairs cellular respiration.
    • alkalosis: protracted vomiting, excessive antacids, excessive bicarb admin.
  89. Nursing Process? ADPIE
    • assessing: systemic collection of data
    • diagnosis: data analysis, bases on present illness, problem identification, formulate nursing diagnosis
    • planning: holistic plan of care-to achieve outcomes. 
    • implementation: execute nursing care plan
    • evaluation: Pt level of outcome achievement
  90. Maslow's Hierarchy RN priorities
    • Priority 1: physiological needs- food, shelter, water, sleep, oxygen, sexual expression 
    • Priority 2: Safety and Security Needs-avoiding harm, attaining security, order, physical safety. (safe environment)
    • Priority 3: Love and belonging-giving and receiving affection, companionship
    • Priority 4: esteem and recognition- self-esteem and respect of others, success in work, prestige
    • priority 5: self-actualization-fulfillment of unique  potential, search for beauty and spiritual goals.
  91. Arteriole ulcers
    Deep, usually between toes, blackish intermittent claudication ulcers created due to a lack of 02 and nutriets. Atherosclerosis predisposes pt. to this.
  92. Venous ulcers aka stasis leg ulcer
    Shallow-weeping wounds that are poor to heal-poor venous return of blood flow.
  93. Reyes syndrome
    hydrocephalus, liver damage, renal damageUnknown, but higher incidence due to ASA use in pediatrics. Pediatrics should not receive ASA along with teenagers.
  94. ESR (erythrocyte sedimentation rate)
    • Male up to 15 
    • Women up to 20
    • Early indicator of widespread inflammatory reaction due to infection or autoimmune disorders­
    • Usually normal in OA
  95. Total calcium?
    • Necessary for transmission of nerve impulses, blood clotting, strengthens capillary membranes.
    • 9-11mg/dl
  96. HDL?
    • HDL: >50
    • LDL: < 130
  97. Lab values for Muscle
    • CK-Creatine Kinase for skeletal and cardiac muscle
    • CPK-MM-Creatine phosphokinase for skeletal muscle. Male: 50-170 Female: 30-135
  98. Risks associated with osteoporsis
    • excessive caffeine-calcium loss in  urine
    • lack of vitamin D for calcium uptake
    • high phosphorus intake-low calcium levels
    • protein intake too high or too low
    • excessive alcohol and tobacco use
    • eating disorders and female athletes-triad.
  99. rheumatoid arthritis labs
    • rheumatoid factor RF
    • antinuclear titer ANA
    • Erythrocyte sedimentation rate ESR
    • High sensitivity C-reactive protein hsCRP
  100. Vitamin D importance
    • synonym=cholecalciferol=vitamin D3 sunlight
    • VIT D +Parathyroid Hormone+Calcitonin regulate calcium metabolism and osteoblasts.
    • Ergocalciferol=Vitamin D2 absorbed from plants
    • deficiency Leads to increase risk of heart attack, fractures, hypertension and autoimmune diseases.
  101. Anterioposterior (AP) diameter?
    AP diameter of the chest should be half the distance of the transverse diameter.
  102. Gluconeogenosis
    convert protein and lipid to glucose
  103. incretin hormones
    *from stomach*
    • released by stomach which increases insulin production from pancreas.(Beta Cells from islets of langerhans)
    • Also can inhibit glucagon secreation (alpha cells from islets of langerhans)
  104. Hemoglobin A1c
    Glycoslyated hemoglobin
    • bond between RBC and hemoglobin for lifespan of RBC (120Days)
    • (normal 4-6%)
    • uncontrolled diabetic >8%
  105. DKA-Acute hyperglycemia
    • CBG>300Leads to ketogenesis
    • ketones on the breath (alcohol/fruity smell).As acidosis develops excess K+ levels may develop due to body trying to buffer. H+ ions move into cells forcing K+ out into ECF.
    • Also Kussmauls respirations.
    • Common causes: Missed insulin, undiagnosed type 1 diabetic, infection, high levels of stress(cortisol).
    • Treatments: Fluids and insulin drip.
  106. HHS in Type 2
    • #1 cause of HHS in diabetic pt. is INFECTION. 
    • Other causes similar to DKA.
    • Higher mortality rate than DKA.
    • CBG>600 Normally higher than DKA
    • Similar to DKA, but unlikely to have ketones on breath.
  107. somogyi effect
    CBG less than 70 followed by an episode of hyperglycemia
  108. Dawn phenomenon
    CBG spikes in the morning due to hormones being released while they sleep.
  109. Hyperglycemia S&S
    • irritable
    • polyphagia
    • polyuria
    • tachycardia
    • weakness
    • confusion
    • altered LOC
    • hypotension
    • osmotic diuresis
    • SOB
    • fatigue
    • headache
  110. Hypoglycemia S&S
    • Heart palpitations
    • Fatigue
    • Pale skin
    • Shakiness
    • Anxiety
    • Sweating
    • Hunger
    • Irritability
    • Tingling sensation around the mouth
    • leads to confusion, seizures, coma
  111. ADH
    • Saves water-Makes the kidney tubules more permeable.
    • synthesized by hypothalamus
    • secreted by posterior pituitary
    • Controlled by osmoreceptors in hypothalamus
    • Other factors which stimulate ADH- hypovolemia, stress, nausea, nicotine and morphine.
  112. Distribution of water-spacing
    • First spacing: Normal distribution
    • Second spacing: increased fluid in interstitial compartment: (EDEMA)
    • Third spacing: Abnormal fluid distribution in areas where there is minimal to no fluids. (Ascites)/(Pulmonary edema).
  113. Renin
    • Released by kidneys due to decrease in pressure or sodium. 
    • Converts angiotensinogen to angiotensin 1 which then gets converted by ACE(lungs) to angiotensin 2 which has vasoconstrictive effects and increases blood flow to kidneys.
    • Angiotensin 2 simultaneously releases (aldosterone from adrenals, ADH from posterior pituitary, sodium, chloride and water retention in kidneys and excretion of potassium)
  114. Aldosterone
    angiotensin 2 stimulates release of aldosterone form adrenal glands which act on the kidneys to reabsorb conserve sodium and also increasing water reabsorption. Aldosterone also stimulates ADH.
  115. Impending renal failure and Urine specific gravity?
    • urine output less than 30 cc /hr indicates potential renal failure
    • <1.010 indicates dilute urine. too much water
  116. Fluid gain or loss calculations
    • 1 liter=1kg
    • 1kg=2.2 pounds
    • 1 pound=454ml
  117. Chloride (serum)
    • maintaining homeostasis, osmolality of body fluids, Ph balance
    • Adult: 95-105 mEq/L
  118. Magnesium (Mg) (Serum)
    • Neuromuscular activity, influences use of potassium, calcium and protein. responsible for transport of sodium and potassium across cell membrane.
    • Adult: 1.5-2.5 mEq/L, 1.8-3.0mg/dL
    • Child: 1.6-2.6 mEq/L
  119. Osmolality (serum)
    • Indicator of hydration status, helpful in diagnosing fluid and electrolyte imbalances. Sodium contributes 85-90% of serum osmolality.
    • Adult: 280-300 mOsm/kg
    • Child: 270-290 mOsm/kg
    • Panic values: <240 or >300 mOsm/kg
    • High value indicates: hemoconcentration due to dehydration
    • Low value indicates: hemodilution due to overhydration.
  120. Phosphorus (serum)
    • Principal intracellular anion; exists in blood as phosphate. functions include metabolism of carbohydrates, fats, ph balance, use of B vitamins, promotion of nerve transmission. Requires vitamin D for absorption from gastrointestinal tract-stored with calcium in bones/teeth.
    • Adult: 1.7-2.6 mEq/L or 2.5-4.5mg/dL
    • Child: 4.5-5.5 mg/dL
  121. Electrolyte distribution Sodium
    • Extracellular: 142 mEq/L
    • Intracellular: 10 mEq/L
  122. Electrolyte distribution Potassium
    • Extracellular: 4.2 mEq/L
    • Intracellular: 150 mEq/L
  123. Electrolyte loss from Gastric*Sodium and potassium
    • Sodium: 60 mEq/L
    • Potassium: 9 mEq/L
    • Chloride: 84 mEq/L
    • Bicarb: 0
  124. Electrolyte loss from diarrhea
    • mainly from Lg bowel, but can also come from Sm bowel dependent on severity of diarrhea.
    • Mainly going to lose Sodium, Potassium and Bicarb.In mEq/L
    • Sm bowel 
    • Sodium: 129
    • Potassium: 11
    • Bicarb: 29
    • Lg bowel:
    • Sodium: 80
    • Potassium: 21
    • Bicarb: 22
  125. Hypo or Hyper-natremia
    Panic values: <115 mEq/L and >150 mEqL
    CNS most easily affected by this. <115 mEq/L leads to cerebral edema. Water/fluids from ECF goes into the ICF causing swelling. Opposite is said for >150 mEq/L-Crenation takes place or shrinkage.
  126. Hypo or hyper-kalemia
    Panic value: <2.5 mEq/L and >7.0 mEq/L
    • Mainly found in ICF, with hypo there is an increase in ICF distribution leading to abnormal amounts. Leads to Cardiac arrest and respiratory insufficiency. Respiratory failure #1 cause of death in Hypokalemia.
    • Never give potassium supplement if urine output less than 0.5ml/kg/hr. Kidneys main regulator for K+.
    • Most common cause of Hyperkalemia is Renal failure
    • Maximum infusion rate: never exceed 20 mEq an hour.
  127. list a few S&S of Hyponatremia? What is a low value?
    <135 mEq/L is considered Hypo anything below 120 is severe.Profound thirst, headache, malaise, tremors, decreased LOC, tachycardia, nausea.
  128. List a few S&S of Hyperkalemia, what is a high value?
    • anything  >5.3 mEq/L. Panic value > 6.0 -7.0 mEq/L.ECG changes, tremors, twitching, anuria, acidotic, malaise, irritable.
    • Similar S&S to hypo, however increased risk of respiratory failure with hypo.
  129. list a few S&S of Hypocalcemia
    Panic value?
    • Panic value: <7mg/dL causes tetany any lower leads to arrhythmias or
    • death. 
    • S&S: arrhythmia's, twitchy, prolonged QT interval, hypo-tension, weak pulse, confusion,
    • Common cause: is renal failure, hypomagnesemia, hypoparathryoidism, diuretics, malabsorption, hypoalbuminemia, hyperphophatemia (reciprocal relationship).hyperexcitability of cells, (think twitchy) cells are easily depolarized due to increased permeability of membranes.
  130. S&S of Hypercalcemia?
    • Panic value: >13 mg/dL
    • Causes: Renal failure, hyperparathyroidism, vitamin D intoxication,(Think floppy), decreased neuromuscular excitability, bradyarrhythmias, decreased LOC, confusion, hypophophatemia.
  131. Magnesemia is compared to what other electrolytes in terms of S&S?
    • Calcium and potassium-similar S&S to hyper and hypo
    • Hyper: floppy-decreased muscle tone,  bradyarrhythmias, decreased LOC, confusion
    • Hypo: arrhythmias, twitchy, prolonged QT interval, hypotension, weak pulse, confusion
  132. Relationship between calcium and phosphate?
    • there is a reciprocal change
    • Hypercalcemia=Hypophosphatemia
  133. Hypertonic solutions
    • fluids are pulled from the cells and interstitial spaces and into the intravascular space
    • Rarely used, very dangerous.water pulled from cells causing crenation 3-5% saline bags for dangerously low sodium levels.
  134. Hypotonic solution
    • fluids are forced into cells and interstitial spaces.
    • Dilutes ECF, restores ICF balance-flushes kidneys and excretes electrolytes.0.45% NaClD5-10W-2/3 enters cells, 1/3 stays in ECF
  135. Isotonic solutions
    used to replace ECF due to illness. expands circulating volume. has same osmolality as plasma
  136. Chemical Buffers
    • Bicarb-carbonic acid buffer
    • Protein buffer: hemoglobin
    • phosphate buffer
    • ammonia
    • Resp rate will compensate sooner (12min or less) than metabolic (48-72h).
  137. RR for pediatrics?
    • Newborn to 6 months: 30-60
    • 6 months to 1 year: 24-30
    • 1-5 years: 20-30
    • 6-12 years: 12-20
  138. PH: 7.47
    PaCO2: 30
    HCO3: 20
    Partially compensated respiratory alkalosis
  139. PH: 7.33
    PaC02: 50
    HCO3: 22
    Uncompensated Respiratory acidosis
  140. Serum Iron?
    What makes up 95% of a RBC?
    • Normal 50-150 mcg/dl
    • Hemoglobin Which is predominately made of iron which carries O2.
    • Globin=protein carries the CO2
  141. Dietary source of Folic acid?
    Green leafy vegetables, legumes, beets, citrus fruits, fortified grains, sweet potatoes.
  142. Dietary sources of Iron?
    Leafy greens/Meat, OJ can double the absorption from the meal.
  143. Dietary source of B12?
    synthesized by GI bacteria, obtained from milk, meat, eggs, and yeast.
  144. Neutrophils? Range?
    • Associated with bacterial infections
    • 50-70%
    • 2,500-7,000 uL (mm^3)
  145. Eosinophils? range?
    • act against infestation of parasitic larvae and increased in allergic reactions, think: Drug allergies
    • 1-3%
    • 100-300 uL (mm^3)
  146. Lymphocytes? range?
    • Increased number associated with viral infections and  lymphoid leukemia. 
    • 25-35%
    • 1,700-3,500 uL (mm^3)
  147. Reticulocyte range?
    • 0.5-1.5% of all RBCs
    • 25,000-75,000 uL
    • Indicator for bone marrow activity
  148. Creatinine (serum)? range?
    • Adult: Male: 0.6-1.2, Female: 0.5-1.1  mg/dL, 45-132.3 umol/L.
    • Creatinine value of 10mg/dl: 90% of kidney function has been lost
    • Females may have a slightly lower value due to less muscle mass. Creatinine, a by product of muscle catabolism (creatine phosphate). Considered a more sensitive test for renal failure. It's not as easily influenced by diet or fluid intake. 
    • High value: acute and chronic renal failure, shock, systemic lupus erythematosus, cancers, HF.
    • Drug influence: amphotericin (antifungal), cephalosporins(cefazolin), aminoglycosides (gentamicin), lithium, ketone bodies. 
    • Low value: pregnancy, eclampsia.
  149. Creatinine clearance (urine)? range?
    • 85-135 mL/min. females may have somewhat lower values.Urine creatinine: 1-2g/24h Considered reliable test for estimating GFR. 
    • High value: hypothyroidism, hypertension, exercise. Drug influence: ascorbic acid, steroids, levodopa.
    • Low value: mild to severe renal impairment, hyperthyroidism, progressive muscular dystrophy, amylotrophic lateral sclerosis. Drug influence:phenacetin steroids (anabolid), thiazides.
  150. GFR
  151. Urine cultures?
    • —Normal = less than 1000 colonies/mL
    • Clean catch for specimen. Nitrites found in urine may indicate need for a culture due to nitrite forming bacteria.Antibiotics and sulfonamides may cause false negative results.
  152. TSH levels are high but T3 & T4 levels are low?
  153. TSH levels are low and T3 and T3 levels are High?
  154. Adrenal Hypofunction S&S? Addisons? 
    Adrenal crisis?
    • Loss of Aldosterone leading to K, Na, water imbalance
    • hypovolemia: decrease in BP
    • Hyponatremia: AMS
    • Hypoglycemia
    • Hyperkalemia: Metabolic acidosis and dysrhythmias
    • Adrenal crisis: Leads to hypovolemic shock due to excess excretion of fluids.
  155. Parathyroid controls calcium and phosphate. What does an increase or decrease of PTH cause?
    • PTH causes calcium and phosphorous to be resorbed from the bones and increases serum concentration in the blood. Also responsible for calcium absorption through the intestines.
    • High amounts of PTH: Hypercalcemia and hypophophatemia
    • Low amounts of PTH: Hypocalcemia and hyperphosphatemia
  156. ACTH?
    • Adrenocorticotropic hormone released by the anterior pituitary gland that causes the adrenal glands to secrete cortisol.
    • Cortisol is needed to manage fight/flight response, blood sugar levels, gluconeogenesis= fat, protein, carb metabolism to manage BG, immune response, BP, Heart and blood vessel tone and contractions, and CNS activation.
  157. Stimulated by the hypothalamus=Anterior pituitary vs posterior pituitary hormones.
    • Anterior: Adrenocorticotrophic hormone (ACTH) Thyroid-stimulating hormone (TSH) Luteinising hormone (LH) Follicle-stimulating hormone (FSH) Prolactin (PRL) Growth hormone (GH) Melanocyte-stimulating hormone (MSH)
    • Posterior: Anti-diuretic hormone (ADH) Oxytocin
  158. Diabetes insipidus due to too little ADH?
    • Excessive thirst
    • dilute urine <1.005
    • dry mucous membranes
    • rapid heart rate
    • electrolyte imbalance
    • unintended weight loss
    • fever
    • fatigue
  159. Cushings syndrome for andrenal hyperfunction?
    • increase in cortisol, aldosterone, androgens.
    • Moon face
    • buffalo hump
    • weight gain
    • muscle wasting

    • Decrease in sleep and more fatigue
    • increased glucose
    • mood swings
    • bone density loss-osteoporosis
    • decreased immune system
    • masking signs of infection
  160. Adrenal hyperfunction S&S?
    • Hypernatremia
    • Hyperglycemia
    • Hypervolemia
    • Hypokalemia
  161. SIADH? Syndrome of inappropriate secretion of antiduretic hormone (ADH)
    S&S of SIADH?
    • Low blood sodium caused by excess production of ADH leading to water retention leading to dilutional hyponatremia
    • Dilute blood.
    • water retention-fluid overload
    • Low sodium levelsl
    • Low serum osmolality
    • High urine osmolality-high specific gravity
    • decreased LOC
  162. ADH puts water into urine which effects?
    • Urine osmolality or specific gravity. 
    • Too little ADH: Urine is dilute
    • Too much ADH: Urine is concentrated.
  163. Hypothalamus and it's role with TSH?
    Hypothalamus secretes releasing hormones such as TRH and this stimulates the release of TSH in the anterior pituitary gland causing the thyroid to release TH
  164. Acute Pancreatic disorders?
    • Pancreatitis-which causes premature activation of excess pancreatic enzymes-pancreatic and ductal tissue may be destroyed (Pancrease starts to digest itself)-can be acute or chronic. Also may causes pancreatic scarring and obstruction of the ducts.
    • Endocrine function: Management of insulin
    • Exocrine function: management of digestive enzymes
    • Etiology: Alcohol use, biliary tract disease, trauma (blunt), gastric ulcers, peritonitis, infections, thiazide diuretics.
  165. Cerebral palsy-Ataxic-wide gait, poor coordination
    Characterized by poor coordination, balance & depth perception, rare- 5-10%Poor coordination, unsteady- wide-based gait, have difficulty performing quick or precise movements, depth perception impairedIntentional tremors- beginning with a voluntary movement like reaching for something, causes trembling at first & worsens the nearer to the desired object
  166. Cerebral palsy -Dyskinetic-athetoid, dystonic
    Characterized by uncontrolled, slow, writhing movements.10-20% of patientsAbnormal movements involve h&s, feet, arms or legs, & can involve muscles of the face & tongue causing grimacing, drooling & difficulty with speech (dysarthria).Symptoms increase under stress, & may disappear during sleepSubtypes:Athetoid -  involuntary jerky movement, especially in the arms, legs, h&s & face. Dystonic  - slow twisting movements; affect the trunk muscles more than the limbs & results in fixed, twisted postureBoth affect pharyngeal, laryngeal, & oral muscles causing drooling & dysarthria(imperfect speech)
  167. Cerebral palsy-spastic S&S
    Characterized by hypertonic muscle stiffness & permanent contractions70-80% of patients; May follow a period of hypotonia in the young infantSubtypes: Hemiplegia –upper & lower on 1 side, Para-lower half both legs; Triplegia-3 limbs or 2 & face; Tetra-all limbs but 3 >;  Diplegia-all, lower >upper;  Quadriplegia-all limbsAssociated with contractures, & limb deformity, pain, scoliosis
  168. Treatment for Malaria
    Chloroquine main medication used to treat protozoa infection. Sulfadoxine, plus pyrimethamine or quinine plus tetracycline. Mefloquine is prophylactic medication that is recommended for those who travel to areas where malaria remains transmissible.
  169. Complications of acute pancreatitis?
    infected pancreatic necrosis, fever, leukocytosis, sepsis, renal failure.
  170. Complications of chronic pancreatitis?
    Treatment-IV hydration, nutritional support, nasogastric feedings may be necessary for several weeks. Synthetic pancreatic enzymes may be prescribed if the pancreas does not secrete enough of its own.  Goal would be to have the patient regain some weight.Diet low in fat and includes small frequent meals. Limiting caffeinated beverages is also important May need to monitor CBG.
  171. RN responsibilities for Acute pancreatitis
    The main treatment goal for acute pancreatitis is to provide supportive care and minimize pancreatic stimulation. Fluid resuscitation, maintenance of optimal fluid balance, close monitoring for signs of systemic complications.May need to monitor CBG
  172. Diagnosis for Acute pancreatitis?
    Blood work and noninvasive imaging. CBC, blood glucose level, BUN, serum calcium, lactic dehydrogenase, amylase and lipase. Abdominal endoscopic ultrasound, CT scans and MRCP Elevated serum lipase level is key sign of acute pancreatitis.
  173. Normal ICP-RN responsibilities
    10-20mm hg.Pt. increased risk for ICP 24-48 after stroke*provide O2 if <92% or decreased LOC, avoid pt. activities that increase ICP, quit environment, monitor vitals every 1-2 hours, increased temp can increase ICP, cardiac monitoring possibly. Surgery may be necessary.
  174. Expressive broca's (frontal lobe area)
    motor aphasia, difficulty speaking, difficulty writing.
  175. Receptive-wernicke's (temporoparietal lobe)
    sensory aphasia, difficulty understanding written word or verbal word, speech often meaningless, made-up words.
  176. Dysarthria
    slurred speech- loss of motor functions of tongue.
  177. Autonomic Dysreflexia
    Leads to exaggerated sympathetic response below injury. This leads to severe HTN (massive vasoconstriction),  vagus nerve stimulation causing bradycardia, vasodilation above level of injury.S&S: Sweating, headaches, blurred vision, anxiety, HTN, bradycardia, flushing of skin above injury and pallor below injury. If untreated leads to stroke, MI, pulmonary edema, seizures and death.
  178. MCV? 
    Mean Corpuscular Volume=RBC size
    Most useful lab for diagnosing anemias.
    • Measures average volume of RBC
    • (80-98 um^3) 
    • Low value indicates iron deficiency anemia. (chronic blood loss, cancers of GI)
    • High value indicates B12 deficiency anemia ( pernicious/ folic acid)
  179. MCH?
    Mean Corpuscular Hemoglobin
    Weight of Hgb in RBC regardless of size.
    • 27-31 pg-picogram
    • Macrocytic cells have increase in MCH
    • Microcytic cells have decrease in MCH

    • Bigger is Better?
    • MCH: Hgb x10/ RBC count
  180. MCHC?
    Mean Corpuscular Hemoglobin Concentration
    Hgb concentration
    • 32-36%% (0.32-0.36 g/dL)
    • High value: indicates higher concentration of Hgb in RBC.
    • Low value: low concentration of hgb in rbc(hypochromic-anemias where the RBC is more pale than normal)
  181. Anemia is a?
    Symptom caused by a loss of blood, decrease in production of RBC or increase in destruction of RBC.
  182. What causes a decrease in RBC production?
    • Lack of Fe-Iron, B12=cyanocobalamins, Folic acid-B vitamin.
    • Bone marrow damage-chemotherapy, aplastic anemia.
    • Decreased erythropoietin production
    • Hypothyroidism
    • defective Hgh synthesis-thalassemia, SCA-sickle cell anemia.
  183. Hematuria?
    Low platelet count can cause bleeding into the tubules of kidneys
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