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72 Cards in this Set
- Front
- Back
Fluids that are Isotonic
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ECF, ICF, LR, NS
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Fluids that are hypotonic
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D5W
1/2 NS D51/2 |
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Hypertonic IV fluids
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Na Lactate
3% |
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Causes of Isotonic dehydration
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vomiting, diarrhea, polyuria, gastric suction, hemmorrhage, fever
third-space shifting(burns, BO, peritonitis) |
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A BUN >30 suggest?
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Isotonic Dehydration
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Normal BUN levels
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8-20
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Which IV fluid should not be used with patients that have electrolyte imbalance
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LR
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IV fluid most similar to ECF?
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LR
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safest IV fluid to give to a pt.
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1/2 NS
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BUN between 20-30 suggest?
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true renal complications
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In which types of patients would you see Isotonic overhydration
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Renal failure
CHF Liver cirrhosis Excess Na intake |
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S/Sx of isotonic overhydration
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Peripheral edema
Wt gain JVD pleural effusion >BP ascites <HCT |
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Tx for Iso Overhydration
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restrict fluids
diuretics Monitor: VS,CXR, BUN,HCT |
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Normal K levels
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3.5-5 meq/L
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what shift takes place in Hypokalemia
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transcellular shift ECF to ICF
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S/Sx of Hypokalemia
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anorexia, Drowsiness, Coma, N/V, arrythmia, hypotension
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Tx of Hypokalemia
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Correct underlying cause
K-sparing diuretics correct hypomagnesemia |
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severe hyperkalemia level
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>7
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drug given to pt's experiencing stinging pain due to rapid K infusion
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Neut
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A BUN/Cr ratio >30 suggest
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dehydration
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Burn pts tend to be Hypo or Hyperkalemic?
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Hyper bcz the cells burst and the K goes into the extracellular fluid; so use NS bcz LR has K in it
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what do you monitor in isotonic overhydration
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I/O, VS,CXR,BUN,HCT
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Important lab to get with hypokalemic patients
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Magnesium level
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amphotericin B causes hypokalemia by what mechanism?
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It decreases magnesium levels therefore it indirectly decreases K
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explain how lithium can cause hypo or hyperkalemia
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lithium is a salt that competes with K; so >k=<Li or >Li=<K; therefore must monitor K, Li, and Na
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drug that reverses digoxin toxicity
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Digibind
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normal digoxin levels
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.8-1.2
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if your pt tells you he sees halos, what's happening
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He has digoxin toxicity; he may also have ALOC
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what method is used to give K
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Infused 10meg/L over 30 min; if given too fast it can cause an arrythmia
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what is Neut?
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Sodium Bicarb, used to decrease stinging effect of fast K infusion
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causes of Hyperkalemia
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Acute renal failure
chronic renal failure Burns metabolic acidosis Tumor lysis syndrome Drug induce: K-sparing diuretics, ACE-I, NSAIDS(arthritis, Gout),Heparin,Bactrim |
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what causes latic acidosis
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glucophage
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Pt presentation in pt with Hyperkalemia
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confusion, arrythmias, N/V/D
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Tx for Hyperkalemia
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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 |
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what happens if you give calcium to pt who is Dig toxic?
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you get a stone heart
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In Hyperkalemia, if pt is acidotic, how do you treat?
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give HCO3
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Kayexelate(Sodium Polyestherine)
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sugar-bases product given orally or enema, binds to K;
usually given to moderate pts. |
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Tx for severe hyperkalemia
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Dialysis
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What is Hyponatremia
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sodium levels less than 135 meq/l
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what shift takes place in Hyponatremia?
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ECF to ICF-results in cell swelling
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Pt presentation with hyponatremia
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<skin turgor
malaise/headache/confusion cerebral edema seizures (below 118) resp arrest |
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Types of Hyponatremia
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Hypovolimic (<Na, <TBW)
Euvolemic (Normal Na, >TBW) Hypervolemic (>Na, >TBW) |
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Drugs that can cause Hyponatremia
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NSAIDS, SSRIs, Clonidine, Tricyclic antidepressants, vasopressin
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Tx of hypovolemic and Euvolemic hyponatremia
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iso saline 1.5-2 mEq/L/hr until symptoms resolve
Goal is 120 |
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when can you give 3% hypertonic solution
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if pt <118 Na; infuse slowly bcz can induce paralysis
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what is Hpernatremia
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Serum >145 mEq/L
fluid shift from ICF to ECF Cell shrinks |
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Tx for hypernatremia
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Extrerenal: NS, once stable switch to 1/2 NS
Renal: hypotonic saline, monitor until Na<148 |
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NSAIDS decrease Na (true or false)
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True
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what is the strongest diuretic
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loop diuretics
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serum level of Hypocalcemia
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<8 mEq/L
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Diuretics, insulin/glucose therapy, alcohol, <magnesium can all cause this condition
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hypokalemia
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which pts would use osmotic diuretics
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pt's with renal losses- ICP, hyponatremia(cell swelling,cerebral edema) because they reduce
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if you have renal losses with a hypertopnic pt, which fluid do you give
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hypotonic saline
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Tx for extrarenal hypernatremia
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start with NS then switch to 1/2 NS
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serun level of hypomagnesemia
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< 1.5
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causes of Hypomagnesemia
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excessive GI loss, laxative use, hypercacemia, pancreatitis
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serum level of hypermagnesemia
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> 3 mEq/L
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S/Sx of hypermagnesemia
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lethargy, depressed respirations, wide QRS, prolonged PR, elevated T waves
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S/Sx of hypophosphatemia; serum level <3
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anorexia, bone pain, arrhythmias, seizures,
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which cells secrete HCL
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parietal cells of the stomach
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what do prostaglandin do to protect the stomach lining?
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Mucus secretions
bicarbonate secretion |
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name 3 things that cause GI mucosal injury
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aspirin
alcohol K supplements |
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drugs to use for mild to moderate GERD
|
H2 antagonist:
Cimetidine (tagamet) Famotidine (Pepcid) Nizatidine (Axid) Ranitidine (Zantac) |
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drugs to use for moderate to severe GERD
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PPIs
Lansoprazole (Prevacid) Pantoprazole (Protonix) |
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How do you Dx H.Pylori
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Biopsy
breath ureases test Culture |
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Tx for H. Pylori
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Omoxicilin, H2 Blockers, Tetracyclin
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some risk factors for stress ulcers
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Hepatic Failure
Mechanical Ventilation Major surgery Severe Burns Organ failures Place these pts on prophylaxis |
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Best treatment regimen for H.Pylori
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Contains 2 antibiotics and PPI:
1 g Amoxicilin 500 mg clarithromycin PPI x 7 days |
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prolonged use of PPI causes?
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Gastric CA
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Tx for NSAID ulcers
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DC NSAIDs except with post MI pts
|
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Prophylaxis dose stress ulcers
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IV:
Pepsid 20 mg q12 Zantac 50 mg or PO: 20 mg Pepsid BID 150 mg Zantac BID |
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Normal Chem levels
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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 |