Lecture 6 Drug toxicity’s, Dumping Syndrome vs. Hiatal Hernia, Electrolytes Drug Toxicity’s Mark Klimek Audio Lectures

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Lecture 6 Drug toxicity’s, Dumping Syndrome vs. Hiatal Hernia, Electrolytes Drug Toxicity’s Mark Klimek Audio Lectures Lecture 6 Drug toxicity’s, Dumping Syndrome vs. Hiatal Hernia, Electrolyt... es Drug Toxicity’s - Drug toxicity’s is one of the biggest areas that can cause patient harm. Medication Use Therapeutic Levels Toxic Levels Lithium Used in anti-mania, Medication used in bipolarism. 0.6 -1.2 Greater than or equal to 2 Lanoxin (Digoxin) Used to treat A-fib, and congestive heart failure. 1 - 2 Greater than or equal to 2 Aminophylline Used to treat airway spasms that cause airway constriction. Given first, then a bronchodilator. 10 – 20 Greater than or equal to 20 Dilantin (Phenytoin) Used to treat seizures. 10 - 20 Greater than or equal to 20 Bilirubin (waste product of RBC breakdown) Waste product of red blood cell breakdown. In adults it is abnormal to have a high bilirubin. In newborns the bilirubin is elevated because they are breaking down RBC’s from the mother blood stream. Adult: 1-2 Newborn: less than 10 Adult: elevated levels Newborn: The toxic level is 20, however a newborn with 14 and above is cause for concern -Kernicterus: - Bilirubin in the brain. - Jaundice is caused by Bilirubin in the skin and is a sign of elevated Bilirubin levels. - When Bilirubin levels in a newborn reach around 20, the bilirubin enters the brain and spinal cord and irritates the brain. - The bilirubin causes aseptic meningitis and aseptic encephalitis. - Opisthotonos: - This is a position the newborn assumes due to the irritation of the bilirubin on the brain and meninges. - The newborn hyperextends. - The neck will begin to extend backwards and the heels will arch towards their head - The newborn should be placed on its side. Pathological Jaundice vs. Physiological Jaundice: - Pathological Jaundice: the bilirubin is high and jaundice at birth. (Bad) - Physiological Jaundice: the bilirubin is normal at birth and goes high 2 – 3 days after birth causing jaundice. (typical) Dumping Syndrome vs. Hiatal Hernia - Hiatal Hernia: - The upper part of the stomach has herniated through the diaphragm. - The stomach then has two chambers, one inside the abdominal cavity and the other in the thoracic cavity. - This causes gastric acid to be regurgitated back up into the esophagus. - The gastric contents move in the wrong direction at the right rate. - Signs and symptoms of Hiatal hernia: - GERD: Gastric esophageal reflux disease. - Heartburn - Indigestion - Hiatal hernia is GERD if you lay down after you eat. - Example: Eating a pizza then lay down and get GERD. - Dependent on position and time of last meal. - Treatment of Hiatal hernia: - Goal is to empty the stomach faster by: - Bed in high position - Increase fluids with meal - Increase carbohydrates, decrease protein - Dumping Syndrome: - The gastric contents dump too quickly into the duodenum - Usually happens after gastric surgery. - The gastric contents move in the right direction at the wrong rate. - Signs and symptoms of dumping syndrome: - Appearance of being drunk: Since all the stomach contents emptied at once blood rushes to the abdomen to compensate for the added stress. - Slurred speech - Poor gait - Impaired judgment - Labile - Appearance of shock: - Hypotension - Tachycardia/tachypnea - Pale - Cold/clammy - Acute abdominal distress: - Cramping - Abdominal protecting - Borborygmi - Treatment of Dumping syndrome: - Goal is to slow down gastric emptying: - Bed in flat position, turn to side to eat - Liquids 1-2 hours after meal [Show More]

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