10 - 20  RATIO 1:20 

BLOOD UREA NITROGEN

FORMED IN THE LIVER AS AN END PRODUCT OF PROTEIN METABOLISM

DIRECTLY RELATED TO METABOLIC FUNCTION OF LIVER AND EXCRETORY FUNCTION OF KIDNEYS

#2 CHOICE FOR DETERMINING KIDNEY FUNCTION

.6 - .12 

BREAK DOWN OF CREATINE PHOSPHATE IN MUSCLE THAT HAPPENS CONTINUOUSLY THROUGHOUT THE DAY - IF THE GFR IS INADEQUATE AND RENAL CLEARANCE IN INTERRUPTED CREATINE BLOOD LEVELS INCREASE.

#1 INDICATOR FOR RENAL FUNCTION

BUN/CREATININE RATIO 1:20

NOT AFFECTED BY DEHYDRATION, MALNUTRITION OR HEPATIC FUNCTION

REFLECTS THE KIDNEYS ABILITY TO DILUTE OR CONCENTRATE URINE.

INCREASES WITH DEHYDRATION

DECREASES WITH FLUID OVERLOAD (RENAL INSUFFICIENCY)

CAUSES OF HYPERCALCEMIA

HYPERPARATHYROIDISM

BONE DISEASE

PROLONGED IMMOBILIZATION

EXCESS CALICIUM SUPPLEMENTS

S/S OF HYPERCALCEMIA

MUSCLE WEAKNESS (PROLONGED EXCITATION)

CONSTIPATION

ANOREXIA

N/V

POLYURIA (TO EXCRETE EXCESS CA+)

POLYDIPSIA (FROM LOSS OF FLUIDS FROM INCREASED URINARY CLEARANCE)

NEUROSIS (MENTAL IMBALANCE THAT CAUSES DISEASE - DOESNT AFFECT RATIONAL THOUGHT)

SHORT QT INTERVAL

WIDENED T WAVE

NORMAL VALUE 9 - 11

BONE FORMATION - MUSCLE CONTRACTION - NERVE AND BRAIN FUNCTION - RELEASE OF HORMONES

PTH & VIT D REGULATE CA+ IN BODY

HYPERCA+ = THYROID PRODUCES CALCITONIN

HYPOCA+ = PARATHYROID PRODUCES PTH

S/S OF HYPOCALCEMIA

DIARRHEA

NUMBNESS

TINGLING OF EXTREMITIES (EARLIEST S/S)

CONVULSIONS

POSSITIVE TROUSSEAUS SIGN (CARPAL SPASM FROM BP CUFF)

CHVOSTEKS SIGN (FACIAL SPASM FROM TAPPING THE ZYGOMA)

HYPERREFLEXIA

TATANY

PROLONGED ST INTERVAL

CAUSES OF HYPOCALCEMIA

HYPOPARATHYROIDISM

RENAL FAILURE (PHOSPHATE RETENTION CAUSES CA+ EXCRETION)

PANCREATITIS

ALKALOSIS

MALNUTRITION - HYPOMAGNESIA

CAUSES OF HYPONATREMIA

DIURETICS

DIAPHORESIS

GI FLUID LOSS

CAUSES OF HYPERNATREMIA

DIABETES INSIPIDUS

HYPERVENTIALTION

WATERY HIARRHEA

RENAL FAILURE

CUSHINGS SYNDROME

S/S OF HYPONATREMIA

ANORIEXA, N/V

WEAKNESS, LETHARGY

CONFUSION - SEIZURES

MUSCLE CRAMPS, TWITCHING

S/S OF HYPERNATREMIA

THIRST

HALLUCINATIONS - SEIZURES

IRRITABILITY

CAUSES OF HYPOKALEMIA

DIURETICS

DIARRHEA

 VOMITING

GASTRIC SUCTION

HYPERALDOSTERONISM

AMPHOTERICIN B

BULIMIA

CUSHINGS

S/S OF HYPOKALEMIA

ANOREXIA, N/V

MUSCLE WEAKNESS

DECREASED GI MOTILITY

FLAT T WAVES

DYSRHYTHMIAS

S/S OF HYPERKALEMIA

DIZZINESS 

MUSCLE WEAKNESS/CRAMPS

BRADYCARDIA

FLASSID PARALYSIS

TALL TENTED T WAVES

CAUSES OF HYPERKALEMIA

OLIGUIRA

ACIDOSIS

RENAL FAILURE

ADDISONS

MULTIPLE BLOOD TRANSFUSIONS

TREATMENT FOR HYPERKALEMIA

50% GLUCOSE WITH REGULAR INSULIN

CALCIUM GLUCONATE (PROTECT THE HEART)

KAYEXELATE (FLUSH OUT THE K+)

LOOP DIURETICS

NORMAL VALUES 1.5 - 2.5

HYPERMAGNESEMIA = DECREASED DEEP TENDON REFLEXES

HYPOMAGNESEMIA = NEUROMUSCULAR IRRITABILITY

NORMAL VALUES 2 -4

INVERSE RELATIONSHIP WITH CALCIUM

- INFLAMMATION OF THE LOWER RES TRACT

- BACTERIAL = FEVER

- CAUSE LIKELY FROM ASPIRATION

- BRONCHIAL BREATH SOUNDS HEARD OVER CONSOLIDATION

- ELDERLY = CONFUSED, ANOREXIA

"CILLIN"

- ANAPHYLAXIS 

- SUPERINFECTION

- DECREASED BCP'S

- GRAM POSITIVE

- PENICILLIN G ON EMPTY STOMACH

ZOSYN

TIMENTIN

URASYN

"CYCLINE"

- PHOTOSENSITIVITY

- NO ANTACIDS OR MILK

- CAUSES DISCOLORATION OF TEETH AND BONES

"SULFATE"

VANCOMYCIN

FLAGYL

- NEPHRO TOXICITY

- OTTO TOXICITY

"CEF" OR "CEPH"

- THROMBOPHLEBITIS

- GI DISTRESS

- SUPER INFECTIONS

- SAME REACTIONS AS PCN

AZACTAM

- MOST EFFECTIVE ON GRAM NEGATIVE

- SERIOUS SIDE EFFECTS (NEURO, RENAL AND HEPATIC)

"THROMYCIN"

- VESICANT

- CLARITHORMYCIN (BIAXIN) = TX H.PYLORI - GIVE WITH FOOD

- AZITHROMYCIN (ZITHORMAX) = EMPTY STOMACH

- S/E = PSUDOMEMBRANOUS COLITIS, PHLEBITIS, SUPERINFECTION, DYSPNEA

- INCLUDES EMPHYSEMA, CHRONIC BRONCHITIS AND ASTHMA

- HYPOXIC DRIVE BREATHING - TOO MUCH 02 CAN KILL THEM

- STEROIDS, BRONCHODILATORS, HUMIDIFIED AIR

- CHRONIC SIGN OF INADEQUATE O2 = CLUGBBING OF FINGERNAILS - LATE SIGN CLUBBING OF FINGERS

- GIVE MECHANICALLY SOFT DIET = DECREASES O2 DEMAND

35 - 45

HCO3

- EARLY SIGNS HOARSNESS

- TONGUE AND MOUTH WHITE, GRAY, DARK BROWN OR BLACK AND PATCHY

- MEDICAL ALERT BRACELET IF LARYNGECTOMY

- KEEP LARYNGEAL AIRWAY HUMIDIFIED AT ALL TIMES OR SECRETIONS BECOME THICK & CRUSTY

- SPEECH REHAB - ESOPHAGEAL SPEECH

- #1 POST OP RISK = BLEEDING AND OCCLUSION

- PT MAY HAVE FEAR OF CHOCKING - CANNOT COUGH - TEACH GLOTTAL STOP (TAKE DEEP BREATH, OCCLUDE TRACH TUBE, COUGH AND REMOVE FINGER FROM TUBE AT THE SAME TIME)

- GHONS LESIONS

- POSITIVE 10MM +

- CLIENT CAN RETURN TO WORK AFTER 3 NEGATIVE SPUTUM CULTURES

- INH - GIVE VIT B6 (PYRIDOXINE) TO COUNTERACT NERUPATHIES

- RIFAMPIN - ORANGE BODY FLUIDS

- ETHAMBUTOL = VISON PROGLEMS

- TEBRAZID

- DRY HACKING COUGH INITIALLY

- PNEUMONECTOMY - NO CHEST TUBE

- LOBECTOMY - POSITION ON BACK OR NOT OPERATIVE SIDE

- REPORT > 100ML OF DRAINAGE/HR

- CHEST TUBE D/C'D PUT TUBE IN CONTAINER WITH STERILE SALINE OR WATER

- RADIATION - WEAR SOFT COTTON GARMENTS

- USE BRONCHODILATORS BEFORE STEROID INHAILERS

TROUGH DRAWN IMMEDIATELY BEFORE THE NEXT DOSE

PEAK DRAWN 30 MIN AFTER THAT DOSE

"OLOL"

DECREASE HEART RATE

DECREASE CONTRACTILITY

DONT USE WITH COPD, ASTHMA OR RENAL FAILURE

"IL"

CATOPRIL

DONT USE WITH CHF PATIENTS - BRONCHIAL CONSTRICTION

NO PROTEIN (GLUTEN)

FOUDN IN WHEAT, RYE, BARLEY

HYPOKALEMIA

HYPOMAGNESEMIA

HYPERCALCEMIA

BACTERIAL INFECTION IN THE BONE

ONSET = 2 - 4 HRS

PEAK = 12 - 20 HRS

DURATION = 2 - 3 DAYS

ONSET = 1 HR

PEAK = 10 - 24 HRS

DURATION = 5 - 14 DAYS

ONSET = 1 - 4 HRS

PEAK = 4 - 8 HRS

DURATION = 24 HRS

EXCRETE 1ML/KG = 1 - 2 L/DAY

FILTER 1 L OF BLOOD / MIN

ADDISONS = DECREASED = HYPOTENSIVE

CUSHINGS = INCREASED = HYPERTENSIVE

MONITOR GLUCOSE LEVELS

PREVENT AIR EMBOLISM BY PUTTING HEAD DOWN - DO VALSALVA MANEUVER WHEN CHANGING TUBING OR CAP

> 20% GLUCOSE GIVE IN CENTRAL LINE

TPN & PPN MUST HAVE INLINE FILTER TO REMOVE CRYSTALS

TPN WITH LIPIDS USE 1.2" FILTER

WITHOUT LIPIDS USE .22" FILTER

TPN RUNS OUT GIVE 10% GLUCOSE

COLLAGEN LESIONS IN SKIN AND ORGANS

FATAL

KEEP PATIENT WORM

NEUROLOGICAL DEGENERATIVE DIEASE

INHERITED PROGRESSIVE

NO TREATEMENT

NEED 2 -3 X NORMAL CALORIES

SUDDEN PIERCING UNILATERAL PAIN IN MAXILLARY AND MANDIBLE

TX = TEGREATOL (SODIUM CHANNEL BLOCKER)

PAIN WITH EXERTION

RELEIVED WITH REST AND ELEVATION

EARLY SIGN IS NOCTURIA

PRERENAL - HYPOVOLEMIA (DECREASED PEFUSION)

INTRARENAL = RENAL INJURY

POST RENAL - OBSTRUCTION (TUMOR)

NEPHROTOXIC DRUGS = SALICYLATES, ANTIBIOTICS & NSAIDS

OLIGURIC PHASE = WATER RETENTION (INCREASED BUN, CREATININE, K+ & SPEC GRAV / DECREASED NA+ & PH)

DIURETIC PHASE = HYPOVOLEMIA (>10L/DAY OUTPUT) DECREASED K+, NA+, & SPEC GRAV

RECOVERY PHASE - LAB VALUES NORMAL

DIET = DECREASED PROTEIN, NA+,K+ & PH+ - HIGH CARB/CAL - MOD FAT

NA+ & CHL- = EXTRACELLULAR

K+ & PH+ = INTRACELLULAR

INDICATOR FOR PROTEIN NEEDS

LOSS OF TOO MUCH PROTEIN = NEGATIVE NITROGEN BALANCE = MUSCLE WASTING

S/S = AMMONIA BREATH, METTALIC TASTE, PROTEINURIA, HEMATURIA, DISURIA

GIVE CALCIUM OR ALUMINUM ANTACIDS TO GET RID OF ACCUMULATING PH

DO NOT GIVE MAGNESIUM BASED ANTACIDS

COMLICATIONS: ANEMIA, RENAL OSTEODYSTROPHY, METABOLIC ACIDOSIS, HTN, INFECTION

CAN RESULT IN BLOOD LOSS

POSSIBLE ______ IMBALANCE

LESS GLUCOSE THAN PERITONEAL

POSSIBLE PROTEIN LOSS

INCREASED GLUCOSE - RISK FOR HYPERGLYCEMIA

"WET" SOUNDS IN LUNGS = INFECTION

SPLINT TO COUGH

UTI

MOST COMMON CAUSE = E. COLI

DX: CLEAN CATCH, INTRAVENOUS PYLEOGRAM, CYSTOGRAM, CYSTOSCOPY

VOID Q 2-4 HRS

SITZ OR WARM BATH FOR COMFORT

MOIST HEAT FOR PAIN

ATC PAIN MEDS

FLANK PAIN = KIDNEYS OR UPPER URETER

PAIN RADIATING TO ABDOMEN OR SCROTOM = URETER OR BLADDER

EXCRUTIATING, SPASTIC PAIN = COLIC

INJECTION OF SUBSTANCE TO BREAK UP STONE

LITHOTRISPY = ULTRASOUND WAVES TO BREAK UP CLOTS

HYPOXEMIA/HYPERCAPNIA =

PA02 = <55

PCO2 =  >45

36% - 51%

HBG:HCT RATIO = 1:2

RIGHT SIDE = COLICY PAIN

LEFT SIDE = PENCIL LIKE STOOLS

POST OP = CONTANT BLADDER IRRIGATION

INCREASE THE RATE OF IRRIGATION IF BRIGHT RED BLOOD

SHOULD RETURN TO NORMAL COLOR IN 4 DAYS

PAIN WITH URINATION AND SPASM FOR 1 WK

TX BLADDER SPASMS WITH B&O SUPPOSITORIES, DITROPAN

NO SX TX: COUDE TOP CATHETER

SX TX: TURP

REED STERNBERG CELLS

AFFECTS LYMPH NODES, SPLEEN & LIVER

OCCURS IN YOUNG PEOPLE

BOWEL OBSTRUCTION

BOWEL OBSTRUCTION - MECHANICAL = DISORDERS OF THE BOWEL (HERNIA, TUMOR, GALLSTONES - BLOCKAGE) - NONMECHANICAL = PARALYTIC ILIEUS - BOWEL SOUNDS HIGH PITCHED EARLY ON - BLOOD GASE IS ALKALOTIC IF HIGH IN SMALL INTESTINES - BLOOOD GAS AS ACIDIC IF IN LOWER BOWEL- NG TUBE - LOW SUCTION  (80MMHG) DOCUMENT OUTPUT Q 8 HRS - ADVANCE TUBE EVERY 2-4 HRS - REPOSITION Q 2 HRS - IRRIGATE WITH AIR ONLY  - S/S CONSTIPATION - THREADY STOOLS , RECTAL BLEEDING