FAT SOLUBLE VITAMINS VITAMIN A Epithelial tissues, skin, eyes, hair, bone growth RDA of 5000IU Stored in liver

for 2 years Aids in formation of visual pigment needed for night vision  Promotes integrity of mucosal and epithelial tissues
VITAMIN B COMPLEX

WATER SOLUBLE VITAMINS B1 THIAMINE

  
VITAMIN D

For peripheral neuritis (alcoholism/ beriberi)

VITAMIN E

Regulating calcium and phosphate metabolism needed for calcium absorption from the intestines which requires bile salts for absorption. ○ Vitamin D2: Ergocalciferol (synthetic fortified) ○ Vitamin D3: Cholecalciferol (natural form)  RDA of 40-80µ/ 200-400IU  Vitamin DCalcifediol (liver)calcitriol (kidneys)  Calcitriol+ PTH+ Calcitonin  Regulates calcium and phosphorus metabolism  Stimulates bone reabsorption of calcium and phosphorus  Protect cellular components from being oxidized and Red Blood cells from hemolysis  Protects heart and arteries because of antioxidant effects  Prolongs Prothrombin time  DO NOT MIX IRON: can interfere with absorption  RDA OF 15IU

B2 RIBOFLAVIN

Manage dermatologic problems (scaly dermatitis, wind burns)

B3 NICOTINIC ACID/ NIACIN

For pellagra and hyperlipidemia

B6 PYRIDOXINE VITAMIN K

     

For B6 deficiency, alleviate neuritis related to isoniazid Essential for DNA synthesis Aids Folic acid conversion to its active

Synthesis of prothrombin and clotting factors VII, IX and X. ○ K1 Phytonadione- most active form

B12 COBALAMIN

○ ○ ○

form Promotes cellular division Needed for normal hematopoiesis Maintain nervous system integrity  Requires intrinsic factor in Gastric parietal cells for absorption (Pernicious Anemia) VITAMIN C  Aids in absorption of iron and conversion of folic acid  Average Dose: 50-100mg  Needed for Carbohydrate metabolism, protein and lipid synthesis  Collagen formation, capillary endothelium, connective tissue repair, osteiod tissue of the bone

K2 Menaquinone- synthesized in Intestinal flora K3 Menadione K4 Menadiol- Synthetic forms

HIGHT ALERT DRUGS FORMULATION A) DOPAMINE- ↑ CO and SBP Low Dose (renal Dose) ↓ renal vascular resistance ↑ GFR and UO B) DOBUTAMINE- ↑ myocardial contractility Vasodilator ↑ CO thru β receptor stimulation gtt factor = (dose in mg) (1000) / (IV diluent) (60ml) mcg/kg/min = [drop factor / (ml/hr)]÷weight (kg)
ml

/hr = [(mcg/kg/min) (weight)] / drop factor

C) HEPARIN- inhibits conversion of PT to thrombin and aggregation of Plt. Antidote: Protamine Sulfate Monitor: PTT (NV: 25-35seconds)
units ml

 Essential for body growth, needed for DNA synthesis SCALE FOR GRADING REFLEX RESPONSE 0 No reflex response FOLIC ACID +1 +2 +3 +4 Minimal activity (hypoactive) Normal response More active than normal DROP FACTORS Maximal Activity (hyperactive) 1000
hours ml

/h = units of Heparin ÷ No. of hours to infuse

/hr = [(units/ h) (IV diluent ml)] ÷ total units of Heparin units /ml = total units of Heparin ÷ IV diluent ml
GLASGOW COMA SCALE Eye 4 SPONTANEOUS Opening 3 TO SPEECH 2 TO PAIN Verbal Response 1 NO RESPONSE 5 ORIENTED 4 CONFUSED 3 INAPPROPRIATE WORDS 2 INCOMPREHENSIBLE 1 NO RESPONSE 6 OBEYS COMMANDS 5 LOCALIZES PAIN 4 WITHDRAWS FROM PAIN

500 80ml 20gtts 60ml 15gtts 50ml 12gtts 40ml 10gtts 30ml 7gtts 20ml 5gtts

250 40ml 10gtts 30ml 7gtts 25ml 6gtts 20ml 5gtts 15ml 3gtts 10ml 2gtts

LEVEL OF CONSCIOUSNESS Alert Responds fully to voice appropriate spontaneously Lethargic Responds to voice (drowsy) slowly but with appropriate purposeful movements Obtunded Responds to touch than voice, confused Stuporous Arouses from sleep only after a painful stimuli Semi-Coma Coma Responds inconsistently to painful stimuli

6 8 10 12 16 24

160ml 40gtts 120ml 30gtts 100ml 25gtts 80ml 20gtts 60ml 15gtts 40ml 10gtts

Motor Response

3 DECORTICATE 2 DECEREBRATE 1 FLACCID ELECTROLYTES Potassium  Important cellular cation  (3.5-5.5mEq/L) Sources:  Bananas and dried fruits  Oranges and fruit juices Function:  transmission and conduction of nerve impulses  contraction of skeletal, cardiac, and smooth muscles  Also needed for enzyme action.  Carbohydrate to energy  Amino acids to protein Sodium  Major cation in ECF  (135-145mEq/L)  regulates body fluids  transmission and conduction of nerve impulses Hypokalemia  Damage from trauma, injury, surgery, shock Signs: Nausea and vomiting Dysrhythmias Abdominal distention Soft flabby muscles Hyperkalemia  Results from renal insufficiency  Administration of large doses of Potassium overtime Signs: Nausea Abdominal cramps Oliguria  Tachycardia to bradycardia  Weakness, numbness, tingling of extremities    Hypernatremia Signs:  Flushed skin  Elevated body temperature and blood pressure  Rough, and dry skin Hypercalcemia  Results from hyperthyroidism, hypophosphatemia, tumor of the bone, multiple fraction    Signs: Flabby muscles Pain over bony areas Kidney stones of calcium deposition Hypermagnesia

   

Calcium  Approximately equal proportion in ICF and ECF  (4.5-5.5mEq/L)  Half of Calcium is bound to protein  Promotes Normal nerve/ muscle activity  Increases contraction of heart muscle  Maintains normal cellular permeability and promotes blood clotting thru PT to Thrombin  Formation of bone and teeth Magnesium  Most plentiful in ICF  Loss of potassium is loss of magnesium  (1.5-2.5mEq/L)  promotes transmission of neuromuscular activity  important mediator of neural transmission in CNS also promotes contraction of myocardium  activates enzymes for metabolism of Carbohydrates and protein  responsible for transportation of sodium and potassium across cell membranes

Hyponatremia  Results from diarrhea vomiting, surgery, potent diuretics Signs:  Muscular weakness  Headaches  Abdominal cramps  Nausea and vomiting Hypocalcemia Signs:  Anxiety  Irritability  Tetany  (twitching around mouth)  tingling and numbness of fingers  carpopedal spasm  spasmodic contraction  laryngeal spasm  convulsion Hypomagnesia  Results with calcium and or potassium deficit  Increase in Acetylcholine Signs:  Increased neuromuscular excitability  Cardiac (ventricular) dysrhythmias  Hyperexitability  Tremors  Ventricular tachycardia  Hypertension  Trousseau’s (arm twitching)  Chvostek’s (facial twitching)


      

Signs: Sedative effect on neuromuscular system Loss of deep tendon reflex Hypotension Heart block Lethargy Drowsiness Weakness paralysis

NORMAL BREATH SOUNDS Type Vesicular  


Description Soft-intensity low-pitched, “gentle sighing” sounds (bronchioles and alveoli)

Location Over peripheral lung; best heard at the base of the lungs

Characteristics Best heard on inspiration 2.5 times longer than expiratory phase (5:2)


Broncho-vesicular   

Moderate-intensity and moderatepitched “blowing” sounds  (bronchi) High-pitched Loud, Harsh sounds (trachea)

Between the scapula and lateral to the sternum at the first and second intercostals spaces Anteriorly over the trachea, not normally heard over lung tissue

Equal inspiratory and expiratory phases (1:1) Louder than vesicular sounds; have a short inspiratory phase and long expiratory phase (1:2)

Bronchial (tubular)

ADVENTITIOUS BREATH SOUNDS Name

Crackles (rales)

Description Fine, short, interrupted crackling sounds; alveolar rales are high pitched  Best heard on inspiration but can be heard on both inspiration and expiration  May not be cleared by coughing

Cause Air passing through fluid or mucus in any air passage

Location Bases of the lower lung lobes


Ronchi

Continuous, low-pitched, coarse, gurgling, harsh, louder sounds with a moaning or snoring quality  Best heard on expiration but can be heard on both inspiration and expiration  May be altered by coughing

Air passing through narrowed air passages as a result of secretions, swelling, tumors

Loud sounds can be heard over most lung areas but predominate over the trachea and bronchi

Friction Rub

Superficial grating or creaking sounds heard during inspiration and expiration.

Rubbing together of inflamed pleural surfaces

Heard most often in areas of greatest thoracic expansion (e.g., lower anterior and lateral chest)

 
Wheeze

Not relieved by coughing Air passing through a constricted bronchus as a result of secretions, swelling, or tumors Heard over all lung fields.

Continuous, high-pitched, squeaky musical sounds.  Best heard on expiration  Not usually altered by coughing

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