Normal Values Electrolytes Potassium: Sodium Calcium: Magnesium Chloride Bicarbonate Serum Osmolality Phosphate Phosporus

3.5 - 5.5 mEq/L 135 -145 mEq/L 4.5 - 5.2 mEq/L or 8.6 - 10 mg/dL 1.6 - 2.6 mEq/L 98 -107 mEq/L 22 – 26 mEq/L 285-290 mOsm/kg H2O 1.7-2.6 mEq/L 2.5 - 4.5 mg/dL

(NPH, Humulin N) Long Acting Ultralente, Humulin U) Combination Humulin 70/30




½ hr



Gastro-Intestinal Serum Studies Albumin 3.4 - 5 g/dL Protein 6.0 - 8.0 g/dL Alkaline 4.5 - 13 u/dL Phosphatase ALT AST 7-40 mu/ml Ammonia 15 - 45 ug/dL Amylase 25 - 151 IV/L Lipase 10 - 140 U/L BUA M 4.5 to 8 mg/dL F 2.5 to 6.3 mg/dL Total Bilirubin < 1.5 mg/dL Direct Bilirubin 0 - 0.3 mg/dL Indirect Bilirubin 0.1 – 1 mg/dL

Lipids Cholesterol LDL HDL Triglycerides

140 – 200 mg/dL < 130 mg/dL 30 to 70 mg/dL < 200 mg/dL

Glucose FBS CBG (monitoring) OGTT Baseline 30 mins 60 mins 90 mins 120 mins Glucose 2 hr post-prandial HbA1c (Glycosylated) Good Control Fair Poor

Coagulation Studies PT M: 9.6-11.8 s F: 9.5 - 11.3 s PT - 10-13sec x 2 2-3 INR Clotting Time 8 - 15 mins Bleeding Time 1-9 mins Platelet Count 150,000 - 450,00 u/L aPTT APTT - 25-35sec x 3 1.5 - 2.5 x (therapeutic) Fibrinogen M: 180 - 340 mg/dL F: 190 - 420 mg/dL ESR 30-40 mm/hr Mild inflammation 40-70 mm/hr Moderate inflammation 70-150 mm/hr Severe inflammation Hemoglobin Hematocrit M- 42-52% F - 37-47%

70 -110 mg/dL 60 - 110 mg/dL 70 - 110 mg/dL 110 - 170 mg/dL 120 - 170 mg/dL 100 -140 mg/dL 70 -120 mg/dL < 140mg/dL < 7.5% 7.6 - 8.9% 9% and up

Blood Gases pH pCO pO HCO3 O2 Sat %
2 2

7.35 - 7.45 35 - 45 80 - 100 22-26 95-98%

Pressures Tonometry (IOP) ICP CVP Stomach Capacity Newborn 1-week-old 2-3-week-old 1-month-old

10-21mm Hg 0-15mmHg 4-11cm H2O or 3-7 mmHg

Insulin Type of Insulin Regular (Humulin R) Intermediate Acting

Onset ½ -1 hr 2hr

Peak 2-4 hr 6-12hr

Duration 6-8 hr 18-26hr

10 to 20 mL 30 to 60 mL 75 to 100 mL 90 to 150 mL

Obstructive VS Restrictive


Obstructive Inc Inc Inc Dec Inc Dec

Restrictive Dec Dec Dec Dec Dec Normal

Intelligence Quotient: <70 <50 <35 <20

Mild mental retardation Moderate mental retardation Severe mental retardation Imbecile/Idiot

Immunizations 2 DTP OPV Hepa B HiB MMR Varicella Td x x x x

4 x x x x

6 x x x


15 x x

4-6 y/o x


Low Pressure Alarm Patient disconnection, Circuit leaks, Airway leaks, Chest tube leaks

High Pressure Alarm Patient coughing, Secretions or mucus in the airway, Patient biting tube, Airway problems, Reduced lung compliance, Increased airway resistance, Patient fighting the ventilator, Accumulation of water in the circuit, Kinking in the circuit, Problems with inspiratory or expiratory valves

x or x or

x x

x x x


Diabetic, Arterial, Venous Diabetic Pain None Location Plantar Aspect, Heel, Metatarsals Inc Red

Newborn Arterial Painful, Inc w/ Elevation Distal Lateral Leg, Toes, Phalanges Venous Dec

RR 30-60 20-40 15-25 12-20

HR 120-160 80-140 70-115 60-100


1-4 y/o 5-12 y/o Adult

BP 60systolic or 80/40 90/60-99/65 100/56 - 110/60 90/60 - 140/90

Temp Color

Dec Pale Base

Medial aspect of Lower Leg and Ankle, Malleolus area Inc Red/Purple

Glasgow Coma Scale I. EYE MOVEMENT (4) 4 Spontaneous 3 To speech 2 To pain 1 No response

Newborn Measurements HC 30-35cm CC 31-33cm AC 50-55cm HC=CC - 2y/o AC=CC Barrel Chest


II. MOTOR RESPONSE (6) 6 Obeys Commands 5 Localizes pain 4 Withdraws to pain 3 Flexing (Decorticate) 2 Extension (Decebrate) 1 No response

III. VERBAL RESPONSE (5) 5 Oriented 4 Confused 3 Inappropriate words 2 1 RULE OF NINES Head Arms Torso Legs & Thighs Perineum Incomprehensible sounds No response

9 18 36 36 1

Therapeutic Levels Medication Acetaminophen (Tylenol) Acetylcysteine Carbamazepine (Tegretol) Cycloserine Digoxin (Lanoxin) Digitoxin (Crystodigin) Gentamycin (Garamycin) Lidocaine (Xylocaine) Lithium (Lithobid) Magnesium So4 Phenytoin (Dilantin) Phenobarbital (Luminal) Procainamide (Pronestyl) Propranolol (Inderal) Salicylate (Aspirin) Theophylline (Aminophylline) Vancomycin Things to prepare : Hemodialysis Sengstaken-Blakemore Tube CTT Acetylcysteine overdose Laryngospasm Tracheostomy Skeletal pinning Sterile water /NSS bottle tongue depressor and flashlight Bence Jones Protein Auer Rods Reed Sternberg cells EBV ANA test Rheumathoid factor (RF) Bone Scan/Gallium Scan Bone Densitometry Diskogram

Levels 5 to 20 ug/mL 5 to 20 ug/mL 3 to 14 ug/mL 25 to 35g/mL 0.5 to 2 ng/mL 15 to 25 ng/mL 5 to 10 ug/mL 1.5 to 5 ug/mL 0.5 to 1.3 mEq/L 4 to 8 mg/dL 10 to 20 ug/mL 10 to 30 ug/mL 4 to 10 ug/mL 50 to 100 ng/mL 100 to 250 ug/mL 10 to 20 ug/mL 30 to 40 ug/mL

Parkland-Baxter = 4mL x kg x %TBSA 1/2 = given 1st 8 hrs Renal Function GFR SG Crea BUN BUN:Crea Ratio albumin Urine Culture Urine Output Oliguria Anuria

Bulldog clips Scissors Rubber-tipped hemostat Suction Apparatus Tracheotomy Set Obturator Wire cutter if the chest tube bottle breaks tonsillectomy Multiple Myeloma AML Hodgkin's lymphoma infectious mononucleosis SLE Rheumatoid Arthritis Bone Cancer osteoporosis HNP

125mL/min 1.010 - 1.030 0.6-1.3 mg/dL 10-20mg/dL 15 : 1 3.2 - 4.5 g/dL >/= 100,000 (Positive Culture) 30-50mL/hr < 400cc in 24 hr <100 in 24hr

URINE Clear cloudy smokey foamy Pain Ladder (0-10) 1-3 Mild 4-7 8-10 Moderate Severe

normal UTI AGN nephrotic syndrome

Paget's dse Rheumatoid Arthritis Osteoarthritis STANDARD AIRBORNE

bowing of legs wrist drop or foot drop bouchard's & heberden's nodule Gloves, Goggles, Gown, Mask HEPA filter mask, N45 Negative pressure room 6-12 exchanges/ hr, Private Door Closed GGG(gown, goggles, gloves) 3 feet away

Universal Prec PTB, Varicella Measles

Non-narcotic (Acetaminophen)PNS Narcotic (Morphine)- CNS Non-narcotic + Narcotic CONTACT

MRSA (vancomycin), CDAD (vancomycin), RSV(Ribavirin)


Herpes simplex Impetigo Respiratory infections, Meningitis, Pneumonia, Legionnella, Scarlet Fever Pertussis Strep. Pharyngitis GIT , Hepa A, Salmonella, Typhoid, Cholera

MOBILITY 3 feet away, Private room Mask ELIMINATION

(all musculoskeletal cases) Arthritis Autonomic dysreflexia, BPH, UTI

PHOTOSENSITIVITY DRUGS Antipsychotic Oral-fecal route Gloves and gown Leukemia, Organ transplant, Sickle cell dse, HIV, AIDS Immunocompromised, undergoing chemotherapy, Radiation therapy, Steroid therapy, Burns No fresh fruits, fish, meat, stagnant water, no yoghurt, buttermilk, Strict handwashing, private room, no dental boxes, no populated area No immunization with Attenuated vaccines Antihyperlipidemic agents/ Sulfa Drugs Quinolones Tetracyclines Herbal PHENOTHIAZINE derivatives (Haldol, Thorazine, Stelazine, Risperdal) Simvastatin/Atorvastatin Trimethoprim-Bactrim, Sulfa Levofloxacin, Ciprofloxacin (Doxycycline) St. John's Wort




Rifampicin, Azulfidine, Pyridium

Causes Hyper K Cellular Shift, Trauma, Burns, Sepsis Metabolic Acidosis, Respiratory Acidosis, renal Insufficiency, Potassium sparers Cushing's Syndrome , Colitis, Laxative Abuse, Anorexia, Alcoholism, NGT, GI surgery, Vomiting, Diarrhea, Thiazide Diuretics, stress, Alkalotic states

Prioritization AIRWAY



Bronchiolitis, Apnea, Burns, Chest Croup, Cystic fibrosis, DM, DKA Asthma, Seizure, Multiple sclerosis Myasthenia gravis Flail chest CHF, Edema,Thromboplebitis Angina, Shock Abortion, Addison’s disease, Norwalk virus, Clostridium defficile Anemia, Sickle cell, DI, Giardiasis Hemorrhage, Renal colic Salmonellosis, SIADH Anorexia,Bulimia, Cancer, esophagus Cleft palate, Diverticulitis, TB Agoraphobia, ADHD, Autism, Battered wife, Meniere’s disease Cataract, Cerebral palsy, CVA, Depression, Seizure, Hemophilia, Hepatic coma, Fracture, Hypertension, Hypothyroidism, Hyperthryroidism, Increase ICP, Leukemia, Mania, Meningitis, Osteoporosis, Parkinson’s disease, Poisoining, PIH, Suicide, Spinal cord injury, Wilm’s tumor,

ECG Findings BradycardiaBr Tall Peaked adypnea;N & T waves V; diarrhea; Flat P waves Intestinal Colic, Widened Irritability; QRS Muscle Prolonged weakness, PR lntervals Numbness, Flaccid Paralysis Thready, rapid, weak pulse; faint heart sounds; Hypotension, skeletal muscle weakness; shallow respirations; malaise; apathy; lethargy; loss of orientation; dec reflexes anorexia, vomiting, weight loss, Ileus Dry, Flaky skin & mucous Inverted T waves ST seg Depression U waves Heart block

S & Sx

Hypo K

Hyper Na

Steroid intake Renal failure

Hyperaldostero nism Hypo Na Diaphoresis or GI suctioning, Adrenal insufficiency

Hyper Ca

HyperparaThyroidism, Excess Vit. D osteoporosis and osteomalacia

mem, thirst edema Low UO High SG N & V, abdominal cramps; weight loss; cold, clammy skin; decreased skin turgor; fingerprinting over the sternum; shrunken tongue; apprehension; headache; convulsions; confusion; weakness; fatigue; Postural hypotension; rapid, thready pulse Hypoactive Bowel sounds N & V, anorexia, constipation, headache, confusion, lethargy, stupor, decreased muscle tone, deep bone and/or flank pain Painful tonic muscle spasms, fatigue, laryngospasm, Trousseau's Chvostek's signs, convulsions, dyspnea Drowsiness,Se dation, Lethargy, Somnolence Muscle Weakness N&V paresthesias Dec RR, DTRS Paresthesias, confusion, hallucinations, convulsions, ataxia, tremors,

Hyper P04

Renal insufficiency Tumor Lysis Syndrome Hypoparathoroi dism Malnutrition, Starvation Alcoholism, AlMg (antacids)

Hypo PO4

Shortened ST segment Widened T wave

Fluid Volume Deficit

Cause Vomitting, Diarrhea, Hemorrhage, Tachypnea Inc UO, Kidney dse. Insufficient IVF replacement Diuretics Draining Fistulas, Peritonitis, Edema Ileostomy, Colostomy NGT CHF Dec Kidney Fxn. Liver Dse.

S & Sx Increased = RR, HR, Hct, SG Decreased = CVP, Wt., UO, BP Anorexia, Wt. loss

Hypo Ca

Prolonged Bed Rest, Vit D Deficiency Hypoparathyroidism Acute Pancreatitis, Diarrhea, steroid therapy Renal insufficiency, dehydration,

Prolonged QT interval Prolonged ST interval

Fluid Volume Overload

Altered LOC Vein Distention Cough, Dyspnea, Rales Inc RR, HR, CVP

Hyper Mg

Isotonic LR D5W NS D5 0.5 NaCl D5 1/4 NS

Hypotonic 0.45 NS 1/2 NS

Hypertonic D10W D5 NS D5 1/2 NS

Respiratory Acidosis

Hypo Mg

Low intake of magnesium in diet, prolonged diarrhea, massive diuresis,

Cause COPD, Barbiturate or Sedative Overdose, Acute Airway Obstruction, Weakness of Respiratory muscles

S & Sx Headache, weakness, visual disturbances, , confusion, drowsiness, coma Inc. RR & HR

Respiratory Alkalosis

Hyperventilation, mechanical overventilation, encephalitis

Metabolic Acidosis

Ileostomy, Hyperpnea w/ Kussmaul's DKA, Uremia, starvation, Diarrhea, Severe infections, Renal Tubular Acidosis

Inc RR & Depth Headache, Lightheadedness, Vertigo Mental Status Changes Paresthesias Dry Mouth Low K, Low Ca Tetany, Convulsions Headache, N&V Fruity Breath CNS depression Drowsiness, Convulsions, Tremors ↑ K, Ca N &V, diarrhea, Paresthesia, Tetany, ↓ RR & HR

transfusion LPN Technical Doer, Stable, medications, wound dressing Routine Care, Urine Dip Stix, Reporting to RN, Routine VS turning q2H, conducting group activities, ambulation


Metabolic Alkalosis

Severe Vomiting, NGT suctioning Excessive Antacids, NaHCO3, Diuretics, Biliary Drainage

Dietary Restrictions KOSHER Jewish, no mixture of meat and dairy HALAL Islam, No pork VEGAN vegetable diet - Buddhism R. CATHOLIC No Meat on Good Fri & Ash Wed JEHOVAH’S No Blood or Blood Products WITNESS Herbal Medications St. John's Antidepressant, photosensitive (C/I in Wort SULFA drugs) Garlic Antihypertensive, (avoid Aspirin) Ginseng Anti stress, (C/I in Coumadin) Green tea Echinacea Licorice Ginger root Ginkgo Antioxidant, (C/I risk for calculi-oxalates) immune stimulant (6-8 weeks only) (C/I in SANDIMMUNE) cough and cold antinausea, (C/I in Coumadin) Improves Circulation; (C/I in anticoagulant, headache side effect check PT) Bronchodilator, Stimulant (Ephedra) For Insomnia For Menopause For stress and anxiety relief

Ma Huang Valerian Black Cohosh Kava kava


Least stable, unstable, central catheters (hickman, broviac), admission, discharge, health teachings, patient for transfer, blood

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