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20 Cards in this Set

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Rules for Blood Product Adminstration
Whole blood is rarely used. It is used to resolve hypovolemic shock.
Fresh Frozen Plasma may be used to provide clotting factors or volume expansion.
Autologus donation is NOT an option for a client with leukemia or bacteremia.
Blood Adminstration Rules
A large volume of refridgerated blood infused rapidly through a central catheter into the ventricles of the heart can cause cardia dysrhythmias.
Blood Adminstration Rules
No solution other than NS should be added to blood components.
BUN
indicated how well glomerular filtration rate is; normal value is 8 to 25 mg/dL
Platlet Count
150,000 to 400,000
Serum Protein Level
6.0 to 8.0
Allen's Test
you may do this by applying direct pressure over ulnar and radial arteries simultaneously. The hand should blanch when the patient opens and closes their hand repeatedly.
Respiratory Acidosis
When CO2 levels go higher than 45.
Caused by hypoventilation, emphysema, asthma, pulmonary edema, and meds such as sedatives, and narcotics

Clinical Manifestations include respiratory rate increases, mental status change, hyperkalemia, leads to ventricular fibrillation.
PTT
measures how well the coagulation sequence works.
Normal Value; 20 to 30 seconds (1.5-2.5 times the norm)
Creatinine
a special indicator of renal function.
Normal Value= 0.6 to 1.3
Rules for Hanging Blood
The RN should measure vital signs and assess lung sounds before the transfusion and again after the first 15 minutes and every hour until one hour after completion
Signs of Immediate Transfusion Reaction
Chills and diaphoresis, muscle aches, back pain, or chest pain. Rashes, hives, itching, and swelling. Rapid thready pulse.
Early Symptoms of Alcohol Withdrawal
Increased pulse, hyper-alert, startles easily, anorexia, tremors, anxiety, insomnia, hallucinations.
Somagyi Phenomenon
hyperglycemia normal or elevated blood glucose are present at bedtime. Hypoglycemia occurs at 2 to 3 AM which caused an increase in production of counter regulatory hormones.
Left Sided Heart Failure
This is much more serious than Right Sided Failure. It manifests in pulmonary edema. Client will complain of having to sleep while sitting up (orthopnea).
How Lung Cancer Spreads
Lung Cancer metasizes to the spine, in 70 to 80% of the cases you will find the client suddenly becomes incontinent or cannot ambulate
Amputation of the Lower Extremity
During the first 24 hours after amputation support the stump with pillows but Do Not elevate because of the risk of flexion contractures.
Lumbar Puncture
During the procedure patient is in lateral (side lying) position after the procedure place client in the supine position for 4 to 12 hours as prescribed.
Total Hip Replacement
Post Op care includes no extreme external/internal rotation. Aviod adduction. Place a pillow between the clients legs to maintain abdomen. Instruct the client NOT to cross their legs.
Post Liver Biopsy
A right side lying position with a small pillow of folded towel under the puncture site is preferred.