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89 Cards in this Set
- Front
- Back
Hyponatremia
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below 135 mEq/L
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Hypernatremia
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above 145 mEq/L
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Hypokalemia
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below 3.5 mEq/L
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Hyperkalemia
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above 5 mEq/L
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Hypocalcemia
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below 8.9 mg/dl
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Hypercalcemia
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above 10.1 mg/dl
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Hypomagnesemia
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below 1.5 mEq/L
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Hypermagnesemia
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above 2.5 mEq/L
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Signs and Symptoms: Dehydration
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DRY MUCOUS MEMBRANES
poor skin tugor, weight los, fever, increased RR, BP low |
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Dehydration
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Hypotonic Solutions- D5W- SLOWLY--> Cerebral edema if given too fast
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Hypovolemia
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loss of fluid AND solutes ( hemorrhage)
Tachycardic- compensate for lack of circulating volume BP drops, less than 30 ml/hr of urine restless, shock |
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SHOCK
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Bp down, Urine Down, HR INCREASE
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Hypovolemia Treatment
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ISOTONIC= same level of each lost
NS or LR Dopamine ( raise BP) = vasopressors LOWER HOB |
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Hypervolemia
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excess water and Na in extracellular space
rapid pulse, increased BP, distended veins, edema ( dependent areas), weight gain, crackles in the lungs--> Pulmonary Edema |
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Hypervolemia Tx
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restrict Na and fluid
STOP IV diuretics MOrphine ( air hunger is present-lowers RR) RAISE HOB |
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Hyponatremia
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excess h20, increased Na loss or deficient Na intake
headache nausea lethargy |
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Hyponatremia Tx
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Hypovolemic- IV NS and high sodium foods
Hypervolemic- restrict fluids, replace NA |
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Tx of Hyponatremia
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GIVE IV SLOWWWLY!!! Can cause fluid overload--> irreversible brain damage
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Hypernatremia ( rare)
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>145--thirst prevents this from happening
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Causes of Hypernatremia?
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MODEL ( Medications, osmotic diuretics, diabestes inspipidus, excessive fluid loss, low water intake)
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Signs and Hymptoms of Hypernatremia
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SALT
skin flushed agitation low grade fever thirst |
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Na
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big time responsibility for fluid balance and nerve impulse control
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Potassium
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3.5-5 mEq/L
within the cell neuromuscular transmission skeletal and cardiac muscle contraction and conductivity |
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Hypokalemia Causes
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< 3.5
diuresis vomiting, diarrhea poor intake low Mg levels--renin--aldosterone = K secretion |
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S&S Hypokalemia
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muscle paralysis ( repiratory/cardiac)
decreased DTR decreased pulse polyuria- dumping K |
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Tx of Hypokalemia
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IV potassium replacement if severe:
GIVE THROUGH CENTRAL LINE--SLOWLY--CARDIAC ARREST IF TOO FAST!!!!! NEVER GIVE POTASSIUM IV PUSH!!! |
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Hyperkalemia
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>5mEq
-use of salt substitutes -Beta-blockers, chemotherpay, K-sparring ( destroy cells--leak) |
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Hyperkalemia S&S
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muscle weakness
crampls decreaed pulse and BP ( iregular and slow) decreased CO ( cardiac arrest) |
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TX of Hyperkalemia
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hemodyalysis
Kayexelate/Sorbitol EMERGENCY= 1-% ca gluconate ( treats cardiac changes) Insuilin with hypertonic dextrose |
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Infilltration
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leak into extravacular tissue
edema, tight skin , coolness, tender STOP infusion, remove, cold compress, elevate |
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Phlebitits
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red, painful, vein is hard/cordlike
inflammation of the vein remove catheter, warm compress, start new cath in opp extremity |
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Echymosis/Hematoma
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bruise
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small intestine
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absorption( carbs protein)
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Large intestine
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primary organ of elimination
strongest peristalsis defacation begins with desending colon |
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straining bad for
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cardiac problems
glaucome increased intercranial pressure and increased BP) |
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Constipation
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symptom, not a disease
<3 bm/week hard feces= more water absorbed |
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Diarrhea
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loose, unformed stool
causes: antibiotics, NG tube feedings, foodborne pathogens, C-dipth |
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Flatulence
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inability to control feces and gas to the anus
abdominal surgery, opiates, general anesthesia |
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Ileostomy
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bypasses the large intestine- waterry/frequent stool
ascending- watery transverse- little more formed desending- normal looking |
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Clay or white bowel
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no bile
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Tarry black bowel
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BLOOD- Upper Gi bleed
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Red bowel
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lower gi bleed OR hemorroids
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Mucosy bowel
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infection or collitis
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Strong odor in bowel
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blood or infection
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Acute Pain
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trauma, inflammation, ischemia, surgery
localized subsides without treatment acts as a warning signal |
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Chronic Pain
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LONG term > 3 months
healed injury but healed poorly emotional response/behavioral |
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Non-Opiod Tx
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first line for mild-moderate pain
aspirine, tylenol, NSAIDS |
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NSAID ( ibuprofen)
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GI Upset, bleeding, nephrotoxicity, CHF, drug interactions with antihypertensives
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Opiods
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block release of neurotransmitters
Codeine, Hydrocodone, Morphoine, Hydromorhopne, fentanyl, methadone, tramdol, meperidine |
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Codeine
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short acting weak
can cause constipation in older adults need enzyme to break down... |
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Opiod Side Effects
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NV- antiemetic
COnstipation Sedation respiratory depression |
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Normal Flora
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competes with microorganisms to prevent infections
do NOT cause disease- prevent them! |
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Droplet transmission
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Flu
droplets don't stay susended in air |
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Airborne transmission
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TB
leaves host and enters host BUT these are suspended in air for longer periods of time |
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standard precautions
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gloves, masks, gown, goggles
( splash) |
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Airborne
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negative pressure rooms
(air from hallway in) high filtration masks |
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Droplet
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private or co-hort room
weak mask if close contact |
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COntact
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private or co-hort
gloves, gown, specific equipment |
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Infection : Physical infection
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pain, swelling, heat, redness, puss, lymphadenopathy, GI upset, sore throat, photophobia, fever > 100.5
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Hyperthermia interventions
FEVER |
antimicrobial, antipyretic therapy
External cooling, fluid administration and NO FANS! sponge with tepid water, hyperthermia blanket |
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Fever
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fluid loss ( sweating)-- increased thirst, decreased skin tugor, dry mucous membrane---disorientation
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Shivering
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cooled too quickly using energy to create heat--fever will spike again
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Calcium
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bone strength, bone density, cardiac muscle contraction, transmit nerve impulses, clotting
8.9-10.1 mg |
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Ca and PTH
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serum Ca is low--pth released--draw CA into plasma from bones increasing serum level
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CAlcitonin
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increases and lowers by inhibiting Vtamin D activation
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Hypocalcemia S&S
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anxiety/confusion/irritability
muscle twitching ( initial painful muscle spasms) trousseau and chvostek sign |
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Trousseu
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inflate bp cuff for 1-4 minutes...will have a palmar flexion
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Chvosteks
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tap below and front of ear...will cause facial twitching for patient...side of mouth by nose
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Hypocalcemia Tx
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Acute: calcium gluconate or chloride IV
Chronic: oral replacement with vitamin D |
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Ca Seizures
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risk of seizures...
take precaution |
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Hypercalcemia causes
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>10.1
loss of calcium INTO bone plasma prolonged immobility osteoporosis excess intake ( antacids) bone tumors |
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Hyperparathyroidism
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pulls more Ca from bone ( excess in ECF) kidneys holding onto it
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Hypercalcemia SS
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personality change
fractures ( serum level is high) excessive clotting |
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Hypercalcemia Management
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weight bearing exercise
IV NS loop diuretics ambulate |
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Magnesium
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1.5-2.5
tied in function to Ca low mg= low pth= decreased Ca |
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MEagnesium Functions
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carb metabolism
produce ATP moves Na and K across cell membrane influences vasodilation cardiac and muscle contractility cofator in clotting cascade |
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Hypomagenesemia CAuses
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<1.5
alcoholism uncontrolled diabetes mellitis malabsorption, starvation renal disease ( dumping) |
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Hypomagenesia Symptoms
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tetany, irritability
Chvostek's sign dysrhtymias, HTN NVAC |
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Hypomag Management
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slow infusion of MgSo4 NO IM
dietary intake reduce environmental stimuli avoiding laxatives |
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Hypermag Causes
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>2.5
Chronic renal failure ( not dumping) excessive intake-- ABUSE ANTACIDS--takes lots of laxatives |
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Hypermag Symptoms
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>2.5
BP drops bradycardia, weak pulse respiratory weakness CARDIAC DYSRHTYMIA AND MUSCLE TETANY |
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Hypermagnesium Management
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dialysis if renal failure
IV fluids loop diuretics Ca ( reverse cardiac affects) Diet therapy: limit nuts, beans, fish, whole grains |
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SYmptoms if DIstress at End of LIfe
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pain, dyspnea, cheyne-stokes, lethary, restlessness
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Kubler-Ros Theory of DEath and Dying
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Depression
Anger Bargaining Denial Acceptance |
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Blood transfusion needle gage
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18,19 or 20
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Autologous Transfusion
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collects their own blood for 5 weeks before surgery
1-5 units |
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Starting transfusion
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remain with client for 15 minutes
slowly finished infusing within 4 hours tell client to tell you if they feel ANYTHING |
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Transfusion Reaction
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flush with saline
notify MD remain with patient save the blood product, tubing |
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Documentation of Restraints
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1 hour- Doc to give order
24 hours- order is good for 2 hour- assessment results 15 minutes- eyes on them 30- circulation and neurovascular |