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What are the antidotes for the .......?
Coumadin
Heparin
- Vitamin K
- Protamine Sulfate
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What position is the patient for lumber puncture?
side lying, cannonball position
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What disease processes need airborne precautions?
- Chicken pox
- TB
- Influenza
- measles
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What is a concern with long term NSAIDS?
What are a few names of NSAIDS?
Take with food or not?
bleeding
- aspirin
- (Celebrex)
- diclofenac
- Voltaren-XR, Zipsor
- ibuprofen (Motrin, Advil)
- (Indocin)
yes, WITH food to prevent gastric upset
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ELECTROLYTE NORMAL RANGES
calcium?
magnesium?
phosphorus
calcium 9-10.5
mag 1.2-2.1
phos 3-4.5
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HYPOMAGNESEMIA
range?
How is mag good?
Problems associated with low mag?(VERY similar to s/s of hypocalcemia)
Can be used as a laxative, irregular heartbeats.
- PROBLEMS
- High blood pressure
- constipation
- paralytic ileus
- abdominal distension
- positve chvosteks and Trousseau's signs
- hyperactive DTR's
- muscle tetany
- seizures
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Whats the connection with diabetes and low mag levels?
People with diabetes are more likely than those without to be low in magnesium. “Elevated blood glucose levels increase the loss of magnesium in the urine, which in turn lowers blood levels of magnesium.” So getting enough magnesium is especially important in diabetes.
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Meningitis s/s?
- rigid neck
- fever/chills
- n/v
- BAD headache
- decreased LOC (confusion, lethargy, disorientation)
- positive kernig and budzinskis
- hyperactive DTR's
- restlessness
- tachycardia
- seizures
- difficult to arouse
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MENINGITIS
What are some considerations?
AND whats the best way to diagnose it?
- isolate pt
- droplet precautions
- cooling blanket
- lower light and noise
- give electrolytes needed per lab results
- HOB 30 degrees
- test CSF fluid
- IF bacterial-will be cloudy and decreased glucose
- IF viral-CSF will be clear
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Chronic kidney disease
findings....
*think fluid overload
- decreased H&H
- decreased specific gravity
- can see a creatinine 10-20 times the normal range.
- anemia, bruising
- HTN, HF
- SOB, crackles, frothy pink sputum
- kussmaul respiations,
- tachypnea....etc
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CKD
what do urinalysis labs look like?
hematuria and protenuria, gradual increase in BUN and creatinine and decrease in specific gravity
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How do we care for a patient with CKD?
- No nsaids, Ace inhibitors, arbs cuz nephrotoxic
- monitor intake output of urine )amount, color, consistancy, odor?)
- Restrict sodium, potassium, phos and mag
- monitor BP, could be up or down
- daily weights
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SPECIFIC GRAVITY
range?
When conditions would you see in high or low specific gravity?
- range 1.003-1.03
- The higher the number, >1.03, the more concentrated urine is.....Like with SIADH, retaining fluid.
The lower the number <1.003, the more dilute, like seen in Diabetes Insipidus.
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In a normal urinalysis and interpretations.
WBC and glucose, should it be neg in urine?why?
- yes want to see it negative. An increase could indicate UTI, pneumonia or Sepsis with elevated WBC.
- Increase of glucose in urine could mean DM.
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Do you want to have protein or RBC's in urine?
why or why not?
- No
- increase in protein=could be possible infection
- increase in RBC's= indicate internal bleeding
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