Mark Klimek Test taking strategies

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Mark Klimek Test taking strategies Lab Values: DEADLY DANGEROUS:  Elevated K+ ( >6) - Hold K+, Assess heart, Prepare Kayexalate/D5W, Call Dr.  Elevated pH ( >6) - Assess Vitals, Call docto... r  CO2 in the 60’s - Assess Resp., Do purse lip breathing, prepare to intubate and ventilate, Call Resp. Therapy, Call Dr.  PO2 < 60’s - Assess Resp., Give O2, Prepare to intubate and ventilate, Call resp. therapy, Call Dr.  Platelets < 40,000 - Assess for bleeding, Place on Bleeding precautions, prepare for administration on Platelets CRITICAL:  INR > 4  Low K+ ( < 3.5)  High K+ (5.4 – 5.9)  Elevated Hgb ( < 8)  CO2 in the 50’s - Assess Resp., Do purse lip breathing, DO NOT GIVE O2  Low PO2 but still in the 70’s - Assess Resp., Give O2  O2 < 93% - Assess Resp., Give O2  Abnormal Na+ with a change in LOC  WBC < 5000  ANC < 500  CD4 < 200  Platelets < 90,000 - Assess for bleeding, Place on bleeding precautions BE CONCERED:  Elevated BUN - Check for dehydration  Elevated Hgb - Monitor for Bleeding Place patient in Neutropenic Precautions Elevated BNP (Best indicator for heart failure)  Abnormal Na+ - If elevated, assess for dehydration - If Low, assess for overload ABNORMAL BUT NOT A CONCERN:  Elevated Creatinine ( > 1.2, Best indicator for Kidney function)  HCO3  Hct - Assess for bleeding *** HOLD, ASSESS, PREPARE, CALL DOCTOR*** Creatinine: 0.6-1.2 INR: 2-3 K+: 3.5-5.0 pH: 7.35-7.45 BUN: 8-30 Hgb: 12-18 Acid Base balance:  Rule of the B’s: If the pH and the Bicarb are Both in the same direction then it is metaBolic  MacKussmauls: Kussmauls Respirations only occur in Metabolic ACidosis  As the pH goes, so goes my patient except K+ - If pt has a LOW pH, s/s will be elevated except K+ HCO3: 22-26 BNP <100 Na+: 135-145 WBC: 5000- 10,000 Co2: 35-45 ANC: 500 Hct: 36-54 CD4: >200 PO2: 78-100 Platelets: 150,000-400,000- If pt has a HIGH pH, s/s will be decreased except for K+  Causes for acid base imbalances 1. Ask yourself is it a lung problem? Yes, then it is Resp. 2. Then ask yourself are they over ventilating or under ventilating? - If OVER VENTILATING pick ALKALOSIS - If UNDER VENTILATING pick ACIDOSIS If it is not a lung problem then is has to be a metabolic problem - If the patient has PROLONGED SUCTIONING or VOMITING pick ALKALOSIS - For EVERYTHING else or when you don’t know what to pick, pick ACIDOSIS Aminoglycosides = “A MEAN OLD MYCIN”  Tx serious, life-threatening infections  All mycin drugs end in “-MYCIN”  The wannabe mycin’s all end in “-ROmycin”  Toxic Effects: “Mycin” sounds like “mice” mice have big EARS that are shaped like KIDNEYS with an 8 drawled inside the ear. - EARS = Ototoxicity –Monitor ringing in ears and balance - KIDNEY EARS = Nephrotoxicity –Monitor Creatinine lvls - 8 inside ears= these meds are given every 8 hrs. and affect the cranial 8 nerve  Who can sterilize my Bowels?........ NEO-KAN - Mean old mycins are never giving PO, except for hepatic encephalopathy, ammonia, and bowel prep surgery. - They are only given PO when the bowel are needing cleaned out [Show More]

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