Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key


Play button


Play button




Click to flip

57 Cards in this Set

  • Front
  • Back
Assessment (go beyond the admitting diagnosis)
Criteria for writing patient goals?
1. Is the goal a client goal or yours?
2. Is the goal realistic or attainable?
3. Is the goal measurable? (Can you validate it by seeing or hearing? OBJECTIVE vs. SUBJECTIVE)
4. Is the verb measurable (states, demonstrates) or not measurable (knows, understands)?
5. Is the time frame realistic?
6. Does the patient agree with the goals? (is the patient coherent enough to agree?)
Maslow's Hierarchy of Needs
5.SELF-ACTUALIZATION (personal growth and fulfillment)
4.ESTEEM NEEDS (achievement, status, responsibility,reputation)
3.BELONGINGNESS AND LOVE NEEDS (family, affection, relationship, work groups, etc.)
2. SAFETY NEEDS (protection, security, order, law, limits,stability etc.)
1.BIOLOGICAL AND PHYSIOLOGICAL (basic life needs: air, food, water, shelter, warmth, sex, sleep, etc.)

1990's listing with transcendence:
1. Biological and Physiological needs - air, food, drink, shelter, warmth, sex, sleep, etc.

2. Safety needs - protection from elements, security, order, law, limits, stability, etc.

3. Belongingness and Love needs - work group, family, affection, relationships, etc.

4. Esteem needs - self-esteem, achievement, mastery, independence, status, dominance, prestige, managerial responsibility, etc.

5. Cognitive needs - knowledge, meaning, etc.

6. Aesthetic needs - appreciation and search for beauty, balance, form, etc.

7. Self-Actualisation needs - realising personal potential, self-fulfillment, seeking personal growth and peak experiences.

8. Transcendence needs - helping others to achieve self actualisation.

Maslow said that needs must be satisfied in the given order. Aims and drive always shift to next higher order needs. Levels 1 to 4 are deficiency motivators; level 5, and by implication 6 to 8, are growth motivators and relatively rarely found. The thwarting of needs is usually a cause of stress, and is particularly so at level 4.
7 dimensions of the Clinical Problem
"When Dogs See Quiet Quails Resume Assing" (thanks v!)
1. When?
2. Duration?
3. Setting?
4. Quality?
5. Quantity?
6. Relieving? (or Accentuating. What makes it better or worse?)
7. Associated Symptoms?

1. Palliates/Precipitating
2. Quality/Quantity
3. Radiates/Region
4. Severity
5. Symptoms asso w/ CC
6. Timing
7. Type
Rule of 9s for BURNS
- is a quick way of estimating tbe surface area that is affected by a burn.

In children the head is more than 9% and a good way of estimating burns is to say the child's palm is 1% of its surface area.

* Face & Scalp 9%
* Back 18%
* Perineum 1%
* Arm each 9%
* Front 18%
* Upper arm each 9%
* Lower leg each 9%
Evaluation of the ABCs
Parkland Formula for Burn Patients
-used to establish the correct rate and timing of fluid replacement

How much and what type of fluid, work out the requirement from the following formula:

Volume = weight (kg) x percent burn (% total body surface area using rule of 9s) x 4ml (of RINGER's LACTATE)

V = 70 x 30 x 4

This volume is then given at different rates

First 8 hrs - give half of total

Next 16 hrs - give half of total

Next 24 hrs - give half of total

The greatest loss of fluids occurs in first 48 hrs.

Type of fluid is Hartmann's solution OR LINDA TELLS US: RINGER'S LACTATE.

Adjust volume for each patient according to urine output ( 30-35ml per hour minimum), hematocrit (40-45).

Must provide the daily maintenance requirement of 2-3 litres on top of the calculated amount.

Insert urinary catheter.

Pathology tests: full blood count, urea, electrolytes, proteins.

Analgesia, preferably IV.

Routine medication: tetanus toxoid, Cimetidine.
Ringer's Lactate (for Burn Therapy)
Lactated Ringer's solution is a solution that is isotonic with blood and intended for intravenous administration.

Lactated Ringer's solution is abbreviated as "LR" or "RL". It is also known as Ringer's lactate solution (although Ringer's solution technically refers only to the saline component, without lactate). It is very similar--though not identical to--Hartmann's (Compound Sodium Lactate) Solution, the ionic concentrations of which differ.

One liter of Lactated Ringer's Solution contains:

* 130 mEq of sodium ion = 130 mmol/L.
* 109 mEq of chloride ion = 109 mmol/L.
* 28 mEq of lactate = 28 mmol/L.
* 4 mEq of potassium ion = 4 mmol/L.
* 3 mEq of calcium ion = 1.5 mmol/L .

Generally, the sodium, chloride, potassium and lactate come from NaCl (sodium chloride), NaC3H5O3 (sodium lactate), CaCl2 (calcium chloride), and KCl (potassium chloride). GIVE KCL WITH RINGER'S LACTATE!!

There are slight variations for the composition for Ringer's as supplied by different manufacturers. As such, the term Ringer's Lactate should not be equated with one precise formulation.[1]
What must you always check before you give Digoxin for Afib and Aflutter?
Digoxin is given to make the heart muscle beat stronger and slower SO you must always always check the K+ levels because a lower than normal K+ level (less than 3.5) is an indication of HYPOKALEMIA which already causes the heart to beat slower so giving Digoxin at a HYPOK+ state can cause TOXICITY.
Troponin I levels
NORMAL= less than or = to .5

.5-.8 = possible Mycardial Injury/Infarction


Troponin I levels appear 4-6 hours after onset and PEAK at 10-12 hours and can stay in teh system for 7 days
Normal= 0-5%

>6% = MI

-appears 4-6 hours after MI and PEAKS at 12-24 hours
-back to normal 48-72 hours
Total Lipids
NORMAL Cholesterol= 115-200 or <200
>20O Risk of CVD

Total Lipids: 400-1,000
LDH: (an enzyme secreted after MI) 45-90u/L
LDL: 80-190 (Least Desirable)
HDL: 30-60 or >40 (Highly Desirable)
LDL:HDL = 3:1
PR interval
.12 - .2
QRS interval
.04 - .1
Prominent U Wave
ST interval relationship to ischemia?
Angina Pectoris = ischemia = causes ST segment elevation or depression
PVCs (premature ventricular contractions) happen with what electrolyte imbalance?
HYPOKALEMIA bc this elec imbalance inc the electrical instability of the heart.
EF= Ejection Fraction Normal?
<40% is SUPER BAD!! = HF
CO = Cardiac Output
CO = SV * HR
Cardiac Output = Stroke Volume * Heart Rate
CO= 4-6 L
% of blood that Atrial Kick adds?
30% and this happens right before the tricuspid valve closes

(70% flows in on its own)
-think of the toilet analogy
CVP (Central Venous Pressure)
-Pulmonary Arterial Wedge Pressure
-Pulmonary Capillary Wedge Pressure

-Mean Arterial Pressure
Sys + Dias(3)/2

NORMAL= 60-100
Normal Urine Output

SO healthy avg = 60-70cc/hr
BUT in hospital = 30cc/hr
AND Daily urine output should be about 1500cc!!!
Normal Daily Insensible Fluid Loss
-cant be measured: loss from skin and breathing (lungs)
Replace Fluids
at a rate of 25-30cc/kg/day
30*70kg = 2100cc of fluid a day
Blood Glucose
NORMAL: 70-110
After Fasting: 60-100
After eating: 100-160
5-10,000 so if inc = infection

"Nature Lets Monkeys Eat Bananas"

140-400 (an inc = FVD)
(temp is OVER 101 or 100.2??)
Orthostatic Hypotension
Change in 20/change in 10

lie, sit, stand

watch for dizziness!
O2 stat

below 993-90= KNICKERS IN A TWIST

<2.5 = 6x greater morbidity rate
96-106 mEq/L
23-30 mEq/L
10-20 mg/dL

High values

* A high BUN value can mean kidney injury or disease is present. Kidney damage can be caused by diabetes or high blood pressure that directly affect the kidneys. High BUN levels can also be caused by blockage of the urinary tract (by a kidney stone or tumor) or low blood flow to the kidneys caused by dehydration or heart failure.
* Many medicines may cause a high BUN. Be sure to tell your doctor about all the nonprescription and prescription medicines you take.
* A high BUN value may be caused by a high-protein diet, Addison's disease, tissue damage (such as from severe burns), or from bleeding in the gastrointestinal tract.
* High BUN-to-creatinine ratios occur with sudden (acute) kidney failure, which may be caused by shock or severe dehydration. A blockage in the urinary tract (such as a kidney stone) can cause a high BUN-to-creatinine ratio. A very high BUN-to-creatinine ratio may be caused by bleeding in the digestive tract or respiratory tract.

Low values

* A low BUN value may be caused by a diet very low in protein, malnutrition, or severe liver damage.
* Drinking excessive amounts of liquid may cause overhydration and cause a low BUN value.
* Women and children may have lower BUN levels than men because of how their bodies break down protein.
* A low BUN-to-creatinine ratio may be caused by a diet low in protein, a severe muscle injury called rhabdomyolysis, pregnancy, cirrhosis, or syndrome of inappropriate antidiuretic hormone secretion (SIADH). SIADH sometimes occurs with lung disease, cancer, diseases of the central nervous system, and the use of certain medicines.
Cr (creatinine)
Women: .5-1.1

(can only be too high not too low!!)

Blood creatinine level

The blood creatinine level shows how well your kidneys are working. A high creatinine level may mean your kidneys are not working properly. The amount of creatinine in the blood depends partly on the amount of muscle tissue you have; men generally have higher creatinine levels than women.

A blood creatinine level or a creatinine clearance test is done to:

* See if your kidneys are working normally.
* See if your kidney disease is changing.
* See how well the kidneys work in people who take medicines that can cause kidney damage.
* See if severe dehydration is present. Dehydration generally causes BUN levels to rise more than creatinine levels. This causes a high BUN-to-creatinine ratio. Kidney disease or blockage of the flow of urine from your kidney causes both BUN and creatinine levels to rise.
Hematocrit (Hct)
Men: 42-52%
Women: 37-48%

The ratio of the volume of red cells to the volume of whole blood.
Hemaglobin (Hb)
Men= 13-18
Women= 12 -16

The amount of hemoglobin in a volume of blood. Hemoglobin is the protein molecule within red blood cells that carries oxygen and gives blood its red color.
Urine Specific Gravity
specific gravity is 1.001-1.035 (m&m's in your pee) <1.010 is dilute,
>1.025 is concentrated.....false highs from: glucose, mannitol, x-ray
dyes, protein

1.001-1.035 (AROUND 1)

-measures the amount of M&Ms in urine
Acceptable Wt Change
1/2 pd gain or loss/day
How much waste must the kidneys excrete per day?
600cc of solutes (waste per day) and it needs to excrete at least 500cc of urine in order to do this!

If the kidneys only excrete 400 or less = VERY BAD!!
less than 500cc output of urine a day
Adults are x% water?
neonatals = more (83%)
elderly = less (about 50%)
women and obese = less bc more fat and fat cells have less H2O
Daily K+ intake?
20 - 60 or an avg of 40
Daily Na+ intake?
americans= 5g
HTN restricted diet=2g
the extra Na+ in our bodies is flushed out and we need at least 50-150 mEq of Na+ for homeostasis and normal body function
Most Common IV fluid used?
D5.45NaCl ALWAYS GIVEN with KCL bc of the risk of HYPOK+ w/ addition of Na+ and HPO

-Glucose for the brain
Bed Positions?
-Trendelenberg (head lower for shock, charging, and inserting central lines)
-Semi-Folwers SF 30 to 60 (for feeding tubes)
-Fowlers (60-90)
-reverse Trendelenberg
Pulse Pressure?

IF <30 = FVD
Most common IV used post surgery?
Ringer's Lactate + KCL (Ringer's has the same molality as blood so dont give to Liver surgery patients bc they cant metabolize the lactate. GiVE THEM D5.45NaCl)
Cardiac Index?
2.2 - 4.44