Mark Klimek Test taking strategies
Lab Values:
DEADLY DANGEROUS:
Elevated K+ ( >6)
- Hold K+, Assess heart, Prepare Kayexalate/D5W, Call Dr.
Elevated pH ( >6)
- Assess Vitals, Call doctor
CO2 in the 60’s
-
...
Mark Klimek Test taking strategies
Lab Values:
DEADLY DANGEROUS:
Elevated K+ ( >6)
- Hold K+, Assess heart, Prepare Kayexalate/D5W, Call Dr.
Elevated pH ( >6)
- Assess Vitals, Call doctor
CO2 in the 60’s
- Assess Resp., Do purse lip breathing, prepare to intubate and
ventilate, Call Resp. Therapy, Call Dr.
PO2 < 60’s
- Assess Resp., Give O2, Prepare to intubate and ventilate, Call
resp. therapy, Call Dr.
Platelets < 40,000
- Assess for bleeding, Place on Bleeding precautions, prepare for
administration on Platelets
CRITICAL:
INR > 4
Low K+ ( < 3.5)
High K+ (5.4 – 5.9)
Elevated Hgb ( < 8)
CO2 in the 50’s
- Assess Resp., Do purse lip breathing, DO NOT GIVE O2
Low PO2 but still in the 70’s
- Assess Resp., Give O2
O2 < 93%
- Assess Resp., Give O2
Abnormal Na+ with a change in LOC
WBC < 5000
ANC < 500
CD4 < 200
Platelets < 90,000
- Assess for bleeding, Place on bleeding precautions
BE CONCERED:
Elevated BUN
- Check for dehydration
Elevated Hgb
- Monitor for Bleeding
Place patient in
Neutropenic
Precautions Elevated BNP (Best indicator for heart failure)
Abnormal Na+
- If elevated, assess for dehydration
- If Low, assess for overload
ABNORMAL BUT NOT A CONCERN:
Elevated Creatinine ( > 1.2, Best indicator for Kidney function)
HCO3
Hct
- Assess for bleeding
*** HOLD, ASSESS, PREPARE, CALL DOCTOR***
Creatinine: 0.6-1.2
INR: 2-3
K+: 3.5-5.0
pH: 7.35-7.45
BUN: 8-30
Hgb: 12-18
Acid Base balance:
Rule of the B’s: If the pH and the Bicarb are Both in the same direction
then it is metaBolic
MacKussmauls: Kussmauls Respirations only occur in Metabolic ACidosis
As the pH goes, so goes my patient except K+
- If pt has a LOW pH, s/s will be elevated except K+
HCO3: 22-26 BNP <100
Na+: 135-145 WBC: 5000-
10,000
Co2: 35-45 ANC: 500
Hct: 36-54 CD4: >200
PO2: 78-100 Platelets:
150,000-400,000- If pt has a HIGH pH, s/s will be decreased except for K+
Causes for acid base imbalances
1. Ask yourself is it a lung problem? Yes, then it is Resp.
2. Then ask yourself are they over ventilating or under ventilating?
- If OVER VENTILATING pick ALKALOSIS
- If UNDER VENTILATING pick ACIDOSIS
If it is not a lung problem then is has to be a metabolic problem
- If the patient has PROLONGED SUCTIONING or VOMITING pick
ALKALOSIS
- For EVERYTHING else or when you don’t know what to pick, pick
ACIDOSIS
Aminoglycosides = “A MEAN OLD MYCIN”
Tx serious, life-threatening infections
All mycin drugs end in “-MYCIN”
The wannabe mycin’s all end in “-ROmycin”
Toxic Effects: “Mycin” sounds like “mice” mice have big EARS that are shaped
like KIDNEYS with an 8 drawled inside the ear.
- EARS = Ototoxicity –Monitor ringing in ears and balance
- KIDNEY EARS = Nephrotoxicity –Monitor Creatinine lvls
- 8 inside ears= these meds are given every 8 hrs. and affect the
cranial 8 nerve
Who can sterilize my Bowels?........ NEO-KAN
- Mean old mycins are never giving PO, except for hepatic
encephalopathy, ammonia, and bowel prep surgery.
- They are only given PO when the bowel are needing cleaned out
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