CCRN Pediatric Everything to work on

Increased magnesium symptoms

flaccidity, decreased reflexes, shallow RR

Cause of increased magnesium

renal failure

causes of decreased magnesium

Gastric bypass or fistulas

HCO3- breakdown

binds with free H to form carbonic acid which breaks down to water and CO2

Respiratory imbalances are measured by

PCO2

Metabolic imbalances are measured by

HOC3

Renal Acidosis and calcium levels

increase in the level of free iCal

Renal Alkalosis and H

Increase in the secretion of H in distal tubules

Cocaine ingestion can cause renal?

Infarction

Immunoadsorption

Paraneoplastic Neurologic Syndrome

Plasmalymphocyte

MS

Photopheresis and Leukopheresis

Cutaneous T-Cell

Photopheresis and Plasmapheresis

Heart Trabsplant

Plasamapheresis Replacement Ratio

1:1, 1.5:1

Addisons Disease aldosterone / potassium

Decreased aldosterone, increased potassium

Decreased [K] EKG changes

(flattened T waves, U wave, prolonged PR and QT intervals)

Arrhythmias

May progress to ventricular fibrillation

increased K in the ECG

Peaked T wave, Short QT, no P wave

Increased K can cause

Oliguria

Causes of increased K

glucose, insuline, Ca gluconate, BiCarb

Decreased K can cause

Res and Met alkalosis

Causes of decreased K

lasix, renal disease, increased adrenal cortical hormones

Parathyroid Levels

Ca levels and Mag influences secretion rate (small intestine absorbs mag and ca). If Ca increased, parathyroid decreases secretions

How much of calcium is stored in bones?

99%

How much mag is found in the bones and intracellular spaces?

50% in bones, 49% in the intracellular spaces

Trousseau's sign

A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes.

Chvostek's sign

spasm of the facial muscles produced by sharply tapping over the facial nerve in front of the parotid gland and anterior to the ear; suggestive of latent tetany in patients with hypocalcemia

Decreased BUN causes

chloramphenicol, streptomycin

Increased BUN causes

steroids, GI or Mucosal bleeding, increased protein intake

What does the kidney secrete?

Renin and prostaglandin

Bumetanide (Bumex) can cause

hypochloremia acidosis, low Na, low K

Diuril (chlorothiazide) suppresses?

The pancrease

Decreased Na side effects

twitching, seizures, apnea, irritability, muscle weakness

Increased NA side effects

Lethargy

Where is large amount of NA found?

peritoneal cavity

CRRT

- Min Map: 60

- Thrill and Bruit

- Urea clearance is the best indicator for effectiveness

peritoneal dialysis

- 2-3 L of Dialysate

- uses diffusion and Osmosis

GFR Rates

* Newborn: 35-40 ml/min

* 6 mo: 60 ml/ min

* 1 yo: 80-120 ml/min

* peaks in 20's: 120-130s

ADH - Antidiuretic hormone (vassopressin)

increased urine concentration. does not affect NA retention

low calcium can cause

Long QT and torsades

When is aldosterone released?

HYPOvolemia

HIGH K+ (max reabsorb pulls na into cell and kicks K out)

Alcohol and K

K comes out of circulation and into cells

How do you determine what type of renal failure is occurring?

fluid boluses of 10-10 mls

Prerenal

respond with rapid and sustained diuresis within 1-2 hours after bolus

Intra or post renal failure

UO < 2ml/hr after lasix

Intrinsic renal failure

casts, tubular failure, proteinuria caused by congenital, thromboembolic disease, infection, inflammatory disease, acute tubular necrosis

Magnesium levels

1.8-2.3

Potassium levels

3.5-5.5

Neonate (4.5-6.8)

Sodium levels

*2.5-4.5

*3.5 - 6.5 <5 year olds

Calcium Levels

9-11

iCal Levels

4.8-5.2

BUN levels

10-20

creatine levels

.8-1.4

Proximal Tubules

Secretion of H

Loop of Henle

section of the nephron tubule that conserves water and minimizes the volume of urine (reabsorbs water and Na)

distal tubule and collecting duct

secretion of potassium, ammonia, and H+; site of action of aldosterone and ADH

Amides

Carbonic anhydrase inhibitor

UO

< 60 kg: .5- 1 ml/kg/ hr

> 60 kg: 30 ml/hr

sympathetic stimulation in the kidney

restriction of efferent and afferent arterioles

Parasympathetic stimulation of the kidney

vasodilation of the arterioles

sickle cell anemia

*High blood viscosity and low oxygen tension

*RF- dehydration, vomiting, diarrhea, high altitude, excessive exercise, stress

Non granular Leukocytes

monocytes (mature to macrophages which destroy bacteria) and lymphocytes

Adverse effect of erythropoietin

Epogen and Procrit

* clotting, depletion of iron, increase in K creatinine, and BUN

What mediates cellular humoral immunity?

B Lymphocytes

* from the bone marrow

* form antibodies

All factors except which are synthesized in the liver?

VIII and XII

Where is hemoglobin phagocytized?

The liver

What type of bili is found in cord blood?

Unconjugated

What happens when the levels of free bili rise in a newborn?

Kernicterus- lethargy, irritability, hypotonia, high pitched cry, poor eating. Can try bili light or exchange transfusion if severe

Carbonic Acid dissoiation

function of the red blood cells (RBS transport hemoglobin and CO2)

What does MCH test for?

The average amount (weight) of hemoglobin in each RBC

Coombs test

a test for the presence of anti-Rh factor antibodies in the blood (this is often given to pregnant women that are Rh- to see if they will mount an immune response against the blood of their fetus)

- a positive test indicates antibodies against the infants red cells are present in the mothers serum

Amicar

treats excessive bleeding from DIC

How long does HITT start after heparin therapy

5-7 days, pt could have pulmonary emboli, dyspnea, pain and pallor

ITP

Diagnosis: Platelet antibody screen

Test: Decreases platelets, normal PT and PTT

Side effects of exchange transfusions

Necrotizing enterocolitis, air embolism, volume and pressure changes, thromboembolism, bradycardia, and bacterial contamination

Kleihauer-Betke test

Determined amount of fetal blood in maternal circulation if large fetomaternal transfusion is suspected (helpful for determining the amount of ThoGam needed)

IgA

present in BM, prevents infection

IgG

crosses placenta, found in serum and interstitial fluid

Cytokines

proteins secreted by cytotoxic T cells to aid in antigen destruction. High concentration in BM.

The extrinsic system of the coagulation cascade is initiated by

the exposure of the cell membrane tissue to an injury

The intrinsic system of the coagulation cascade is initiated by

vascular endothelial injury

Antagonist of Vitamin K

Phenobarb, hydantoin, heparin, and warfarin

Adverse effects of cyclosporine

nephrotoxicity, hypertension, hyperkalemia, leg cramps, HA, seizures, neoplasms

What anti-rejection drugs is an antimetabolites?

Imuran

What can presensitize you to organ rejection?

Hx of multiple pregnancies , transfusions, previous organ transplants, blood type incompatibilities

Factor 8 deficiency

Von Willebrands disease

Factor 9 deficiency

Hemophilia A and B

Dextran

decreased platelet aggregation and may cause allergic rxn. may cause acute tubular necrosis.

Quinidine, procainamide, acetaminophen

may cause hemolytic anemia

What type of anemia does phenobarb cause?

aplastic

What type of anemia does furosemide cause?

generalized anemia

What type of anemia does capyopril cause?

pancytopenia

Cryoprecipitate

fibrinogen and factor VIII, XIII

Thrombocytopenia causes

portal HTN, sepsis, viral infection, burns, radiation therapy. Meds: thiazides, furosemide, penicillins, sulfonamides, ranitidine, heparin, chemo

Patients with HIT are at high risks for developing?

Pericarditis

PRBS do not contain?

platelets

A snake bite activates which system?

The extrinsic cascade. Thromboplastin and factor 7 are released and are activated because of calcium.

Renal transplant rejection S/S

Pelvic pain

Type of rejection 3-5 days s/p transplants with fever and oliguria

Accelerated acute rejection

Why does organ rejection usually occur?

d/t cellular immunity.

Polyclonal Antibodies

Anti-rejection agents which lower the level of T cells and help with acute rejections