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55 Cards in this Set
- Front
- Back
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Sodium (Na)
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135-145
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Potassium (K+)
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3.5-5.0
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Calcium (Ca+)
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9-10.5
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Magnesium (Mg)
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1.8-3.0
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BUN
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5-25
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Specific Gravity
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1.010-1.025
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Creatine
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0.5-1.5
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PT & Therapeutic Level
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10-13 sec
TL=1.5-2x |
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PTT & TL
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60-70 sec
TL 1.5-2.5x |
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aPTT & TL
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20-35 sec
TL 1.5-2.5x |
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INR
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2.0-3.0
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Hemoglobin
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12-15
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Hematocrit
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36-45
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WBC
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5-10K
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RBC
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4.5-5.0
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Platelet
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150-400
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Albumin
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3.5-5.0
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protein
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6.4-8.3
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Glucose (fasting)
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70-110
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Iron
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M=80-180
F=60-160 |
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Osmolality
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280-300
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Bilirubin
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0.3-1.2
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Amylase
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30-110
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Lipase
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40-375
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ALT
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10-40 u/L
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AST
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15-40 U/L
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Pancreatitis
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Grey Turner-Spots
Cullen's sign-bluish periumbil Watch for Chvostek's & Trousseaus sign. No Alcohol, Demerol, Hyperglycemia, worse w/lying down |
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GERD
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Antacids-Take 1 hr ac (Mylanta, Riopan)
H2Receptor-Take w/meals and HS, Proton Pump "zole" |
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Liver Biopsy
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Check PT(INR)/PTT and Vitamin K
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Gastroscopy
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Consent Needed
NPO Check Gag reflex |
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Colonoscopy
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Consent needed
Bowel prep (Go-Lytely) Risk for perforation |
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Celiac
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NO BROW-Barley, Rye, Oats, Wheat
YES-corn, rice, soybeans, potatoes |
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Lactase
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Lactose free diet. May need Ca supplement
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Sedation
Narcotics-Demerol, Morphine=pain relief. Reversal=naloxone (Narcan) |
Sedation: diminish anxiety, amnesia
benzodiazepines. (Versed, Ativan, Valium) Reversal=flumazenil (Romazicon) |
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General Anesthesia
propofol (Diprivan), etomidate, Ketamine. Short duration does not relieve pain |
Evaluate pt q5min
Think oxygenation before drugs Snoring=think airway |
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Cholethiasis (stones in GB)
5 F's Labs (I) WBC, bilirubin |
Treatment: Dissolve it (UDCA)
Endoscopic-remove it Extracorporeal shock wave=Lithotripsy |
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T-Tube
-drainage 500ml/day bright yellow-dark green. |
Care of T-Tube"
Check daily keep tube below suture prevent kinks |
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Cushing syndrome
Corticosteroids "Some People Get Cold" Wean slowly Poor wound healing |
decreased immunity
weight gain, moon face, buffalo hump |
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Cholecystitis (inflammation of GB)
S/S-irriated by fatty food Acute onset, colicky Severe RUQ pain-R subscapular area |
N/V
+Murphy sign steatorrhea |
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Hepatits A-oral/fecal
Hep B-IV, Sex Vaccine Hep C-no vaccine, no symptoms until damage severe Treatment: Interferon (INF-alpha) horrible flu like symptoms s/e |
Hep D-must have Hep B
sudden onset/death Hep E=transmission through contaminated water supply |
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Hep Disease Course
Pre-Icteric=1-21 days (flu like symptoms, smoker loses taste for cig) Icteric-2-4wks Bilirubin 3x normal=jaundice Dark Urine Clay colored stool Pruritus from bile salts in skin Hepatomegaly Lymphadenopathy |
Post Icteric-2-4 months
Malaise, easy fatigability Dissappearance of jaundice does not mean liver is healed Stay away from acetaminophen and alcohol for 1 yr! Diet (I) calorie, protein, carb, (D) fat |
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Irritable Bowel Syndrome (IBS)
Symptoms: Intermittent, Alternating diarrhea & constipation w/o pain, relieved by passing stool, Abd distention, increase flatulence, Feel urge to defcate/sensation of incomplete evacuation |
Treatment:
Diet modifications Increase fiber, low fat Drugs: Anticholinergic (dicyclomine, Betyl) Antidiarrheal (Lomotol) (Imodium) Laxatives Antiflatulent (simethicone (Mylicon) |
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Inflammatory Bowel Disease
Ulcerative Colitis: S/S bloody diarrhea, abd pain Toxic megacolon, risk for perf malabs, risk for cancer TX: Bowel rest Diet: NPO, (I) calorie, (I) protein, low residue |
Drugs: Sulfasalazine (Azulfidine)=urine orange-red
allergy risk, increase fluids sulfa crystalizes in kidneys Corticosteroids 15-20% surgery |
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Chron's Disease-ulcerations deep "cobblestone" Abscesses/fistulas, scarring causes stricture formation & intestinal obstruction.
S/S-diarrhea-non-bloody, abd pain, weight loss DX: colonoscopy shows inflammation, granulomas (little tumors) |
TX: Bowel Res, (I)protein, (I) calorie, (D) fat, low residue, NO MILK
Drugs: Sulfasalazine, corticosteroids, Metronidazole (Flagyl) Infliximab (Remicade) Nutrient supplement (Iron, Ca) B12 injection Surgery-results in short bowel syndrome |
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Peritonitis (Inflammation of Peritoneum)
S/S= Abd pain, Ab tenderness (Rovsing's sign)(McBarney point) Kehr's sign=left shoulder tip pain, free air from perforation Ab muscular rigidity, board like position fetal |
These people are very sick contact MD!
NPO-prep for surgery |
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Digoxin: (decreases HR)
Therapeutic dose= 0.5-2 Toxic over 2 Apical pulse 1 min hold if <60 (D) K+, (D) Mg, (I) Ca+=toxicity monitor values |
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Heparin: anticoagulant
(I) effect w/aspirin, alcohol, antibiotics, (I) risk of bleeding, garlic, ginger, ginko, ginseng, chamile (D) effect w/ digoxin, antihistamine, nitro-glycerin |
Monitor Therapeutic Range=
PTT 1.5-2.5x control Antidote=Protamine Sulfate |
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Corticosteroids "one"
Take early in AM w/food Never STOP abruptly Monitor glucose |
S Na (I)
P K (D) G Glucose (I) C Ca+ (D) "Some people get cold" |
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Glascow Coma Scale
Best =15 Worse=3 Less than 8=coma |
LOC
Presence Voice Touch Pain-minimum of 15 seconds (Alert and Oriented x4) Name, Location, Time, Month, Season, year, Event |
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Pupils
PERL-pupils equal, reactive to light PERLA-Pupils equal, reactive to light and accomodation PERRLA-Pupils Equal, Round and reactive to light |
Motor Assessment:
0=no contraction/no response 1=slight contraction/flicker trace 2=Full ROM/w/gravity (Sideways) 3=Full ROM/move against gravity 4-Full ROM/against some resistance 5-Full ROM/against resistance Best=5 |
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Decorticate (Flexion)=damage to corticispinal tract
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Decerebrate (extension)=brain stem damage
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Proprioception/Cellular Function:
Grasp finger/toe move and ask direction Vibration-tuning fork to distal toe/finger |
Cortical Sensation
Stereognosis=recognize feeling of familiar object in hand (pen) Graphesthesia-trace symbol in hand Two point discrimination |
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Cerebellar Function-balance coordination
-Walk heal to toe -Ataxia-unsteady gait -Foot drop-high knee slap foot down Parkisonian shuffle-stooped posture Spastic paralysis-pt throws leg forward |
Romberg Test=feet together, eyes closed for 20sec loss of balance =+
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Rapid Alternating Movement (RAM)
-Pat hand to knee and flip over -Fine motore -Gross motor |
Negative dolls eye=brain stem damage
decorticate=flexion (corticospinal tract) Decerebrate-brain stem damage |
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Tonic-Clonic Seizure
Tonic-stiffening 20 sec Clonic=subsequent jerking Typical Absence -glassy stare usually children, can happen 100x per day |
Myoclonic
-sudden excessive jerk of body, thrown to ground Simple, partial (Jacksonian) -NO LOC -slow, repetitive jerking of a body party 5-15 sec, increases in strength Psychomotor seizure -most common -lip smaking |
