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72 Cards in this Set

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Fluids that are Isotonic
ECF, ICF, LR, NS
Fluids that are hypotonic
D5W
1/2 NS
D51/2
Hypertonic IV fluids
Na Lactate
3%
Causes of Isotonic dehydration
vomiting, diarrhea, polyuria, gastric suction, hemmorrhage, fever
third-space shifting(burns, BO, peritonitis)
A BUN >30 suggest?
Isotonic Dehydration
Normal BUN levels
8-20
Which IV fluid should not be used with patients that have electrolyte imbalance
LR
IV fluid most similar to ECF?
LR
safest IV fluid to give to a pt.
1/2 NS
BUN between 20-30 suggest?
true renal complications
In which types of patients would you see Isotonic overhydration
Renal failure
CHF
Liver cirrhosis

Excess Na intake
S/Sx of isotonic overhydration
Peripheral edema
Wt gain
JVD
pleural effusion
>BP
ascites
<HCT
Tx for Iso Overhydration
restrict fluids
diuretics
Monitor: VS,CXR, BUN,HCT
Normal K levels
3.5-5 meq/L
what shift takes place in Hypokalemia
transcellular shift ECF to ICF
S/Sx of Hypokalemia
anorexia, Drowsiness, Coma, N/V, arrythmia, hypotension
Tx of Hypokalemia
Correct underlying cause
K-sparing diuretics
correct hypomagnesemia
severe hyperkalemia level
>7
drug given to pt's experiencing stinging pain due to rapid K infusion
Neut
A BUN/Cr ratio >30 suggest
dehydration
Burn pts tend to be Hypo or Hyperkalemic?
Hyper bcz the cells burst and the K goes into the extracellular fluid; so use NS bcz LR has K in it
what do you monitor in isotonic overhydration
I/O, VS,CXR,BUN,HCT
Important lab to get with hypokalemic patients
Magnesium level
amphotericin B causes hypokalemia by what mechanism?
It decreases magnesium levels therefore it indirectly decreases K
explain how lithium can cause hypo or hyperkalemia
lithium is a salt that competes with K; so >k=<Li or >Li=<K; therefore must monitor K, Li, and Na
drug that reverses digoxin toxicity
Digibind
normal digoxin levels
.8-1.2
if your pt tells you he sees halos, what's happening
He has digoxin toxicity; he may also have ALOC
what method is used to give K
Infused 10meg/L over 30 min; if given too fast it can cause an arrythmia
what is Neut?
Sodium Bicarb, used to decrease stinging effect of fast K infusion
causes of Hyperkalemia
Acute renal failure
chronic renal failure
Burns
metabolic acidosis
Tumor lysis syndrome
Drug induce:
K-sparing diuretics, ACE-I, NSAIDS(arthritis, Gout),Heparin,Bactrim
what causes latic acidosis
glucophage
Pt presentation in pt with Hyperkalemia
confusion, arrythmias, N/V/D
Tx for Hyperkalemia
Acute: cardiac monitor, Calcium gluconate 10%(cardioprotective)
HCO3(for acidosis)
Insulin/dextrose(brings K into cell)
Kayexelate-30 gm PO

Never give Calcium who is Dig Toxic
what happens if you give calcium to pt who is Dig toxic?
you get a stone heart
In Hyperkalemia, if pt is acidotic, how do you treat?
give HCO3
Kayexelate(Sodium Polyestherine)
sugar-bases product given orally or enema, binds to K;
usually given to moderate pts.
Tx for severe hyperkalemia
Dialysis
What is Hyponatremia
sodium levels less than 135 meq/l
what shift takes place in Hyponatremia?
ECF to ICF-results in cell swelling
Pt presentation with hyponatremia
<skin turgor
malaise/headache/confusion
cerebral edema
seizures (below 118)
resp arrest
Types of Hyponatremia
Hypovolimic (<Na, <TBW)
Euvolemic (Normal Na, >TBW)
Hypervolemic (>Na, >TBW)
Drugs that can cause Hyponatremia
NSAIDS, SSRIs, Clonidine, Tricyclic antidepressants, vasopressin
Tx of hypovolemic and Euvolemic hyponatremia
iso saline 1.5-2 mEq/L/hr until symptoms resolve

Goal is 120
when can you give 3% hypertonic solution
if pt <118 Na; infuse slowly bcz can induce paralysis
what is Hpernatremia
Serum >145 mEq/L
fluid shift from ICF to ECF
Cell shrinks
Tx for hypernatremia
Extrerenal: NS, once stable switch to 1/2 NS
Renal: hypotonic saline, monitor until Na<148
NSAIDS decrease Na (true or false)
True
what is the strongest diuretic
loop diuretics
serum level of Hypocalcemia
<8 mEq/L
Diuretics, insulin/glucose therapy, alcohol, <magnesium can all cause this condition
hypokalemia
which pts would use osmotic diuretics
pt's with renal losses- ICP, hyponatremia(cell swelling,cerebral edema) because they reduce
if you have renal losses with a hypertopnic pt, which fluid do you give
hypotonic saline
Tx for extrarenal hypernatremia
start with NS then switch to 1/2 NS
serun level of hypomagnesemia
< 1.5
causes of Hypomagnesemia
excessive GI loss, laxative use, hypercacemia, pancreatitis
serum level of hypermagnesemia
> 3 mEq/L
S/Sx of hypermagnesemia
lethargy, depressed respirations, wide QRS, prolonged PR, elevated T waves
S/Sx of hypophosphatemia; serum level <3
anorexia, bone pain, arrhythmias, seizures,
which cells secrete HCL
parietal cells of the stomach
what do prostaglandin do to protect the stomach lining?
Mucus secretions
bicarbonate secretion
name 3 things that cause GI mucosal injury
aspirin
alcohol
K supplements
drugs to use for mild to moderate GERD
H2 antagonist:
Cimetidine (tagamet) Famotidine (Pepcid) Nizatidine (Axid)
Ranitidine (Zantac)
drugs to use for moderate to severe GERD
PPIs
Lansoprazole (Prevacid)
Pantoprazole (Protonix)
How do you Dx H.Pylori
Biopsy
breath ureases test
Culture
Tx for H. Pylori
Omoxicilin, H2 Blockers, Tetracyclin
some risk factors for stress ulcers
Hepatic Failure
Mechanical Ventilation
Major surgery
Severe Burns
Organ failures

Place these pts on prophylaxis
Best treatment regimen for H.Pylori
Contains 2 antibiotics and PPI:
1 g Amoxicilin
500 mg clarithromycin
PPI

x 7 days
prolonged use of PPI causes?
Gastric CA
Tx for NSAID ulcers
DC NSAIDs except with post MI pts
Prophylaxis dose stress ulcers
IV:
Pepsid 20 mg q12
Zantac 50 mg

or PO:

20 mg Pepsid BID
150 mg Zantac BID
Normal Chem levels
BUN 8-20 mg/dL
Creatinine .6-1.2 mg/dL
Sodium 135-145 mEq/L
Chloride 98-106 mEq/L
Potassium 3.5-5 mEq/L
CO2 24-29 mEq/L
Calcium 8.8-10.5 mg/dL
Phosphate 2.5-4.5 mg/dL