NCLEX: Mark Klimek - Lecture 6 (Drug Toxicities, Hiatal Hernia, Dumping Syndrome, & Electrolytes)

What is Lithium used for?

Anti-mania

Mood stabilizer for bipolar disorder

What is the therapeutic level of Lithium?

0.6-1.2

What is the toxic level of Lithium?

>2.0

(L = lower #)

What is Lanoxin/Digoxin used for?

Controls heart rate and blood pressure

Used to treat A-fib and CHF

What is the therapeutic level of Lanoxin/Digoxin?

1-2

What is the toxic level of Lanoxin/Digoxin?

>2.0

(L = lower #)

What is Aminophylline (Theophylline) used for?

Muscle spasm relaxer for the airway, anti-spasmodic

What is the therapeutic level of Aminophylline (Theophylline)?

10-20

What is the toxic level of Aminophylline (Theophylline)?

>20

What is the non-therapeutic level of Aminophylline (Theophylline)?

<10, increase dose of medication and assess for compliance

What is Dilantin (Phenytoin) used for?

Seizures

What is the therapeutic level of Dilantin (Phenytoin)?

10-20

What is the toxic level of Dilantin (Phenytoin)?

>20

What is bilirubin?

a orange-yellow pigment formed in the liver by the breakdown of hemoglobin and excreted in bile. waste product from breakdown of RBCs from mom

What are the normal levels of bilirubin in adults?

0.2-1.2

What are the normal levels of bilirubin in newborns?

9.9<

What is the toxic level of bilirubin in newborns?

>20

What level of bilirubin do physicians want to hospitalize newborns?

14-15

Between the drug toxicity levels >2 and >20, the lows are...

Lithium and Lanoxin

Between the drug toxicity levels >2 and >20, the highs are...

Aminophylline, Dilantin, Bilirubin

What is jaundice?

Yellowing of the skin/sclera from excess bilirubin in the blood

Physiological: yellow on day 2

Pathologic: yellow at birth

What is kernicterus?

When bilirubin is >20 and in brain

What is opisthotonus?

Position of hyperextension seen with kernicterus due to irritation in the meninges. Medical emergency!

What position do you place a baby with opisthotonus?

Place them on the side!

If the newborn comes out yellow, it is a ________ jaundice.

Pathologic (bad)

If the newborn turn yellow in 2 to 3 days postpartum, it is a ________ jaundice.

Physiological (okay)

What is a hiatal hernia?

"A cow with two stomachs." Regurgitation of gastric into esophagus in WRONG direction at the CORRECT rate.

What are s/s of a hiatal hernia?

Heartburn and indigestion (GERD) + it happens when lying down after eating

What is the treatment for a hiatal hernia?

Elevate HOB during and 1hr after meal

Increase amount of fluids with meals

Increase amount of carb content

Low protein

These cause the stomach to empty faster so its content doesn't back up.

What is Dumping Syndrome?

Gastric contents are dumping in the RIGHT direction into duodenum at the WRONG rate.

What are s/s of Dumping Syndrome?

Drunk: Staggering gait, impaired judgement, labile -- all the blood gone to the gut

Shock: Cold/clammy skin, tachycardia, low bp, pale

Acute abdominal distress: N/V, diarrhea, cramping, guarding, borborygmic, bloating, distention, tenderness

DRUNK + SHOCK = HYPOGLYCEMIA

What is the treatment for Dumping Syndrome?

Lower HOB and turn to side

Decrease amount of fluids

Decrease amount of carbs

Give high protein

These causes the stomach to empty slower.

For Kalemia, go in the _______ direction as the prefix, except for _______ and ________.

SAME, except for HR and UO.

(for heart and everything else)

In HYPOkalemia, symptoms go _______, except for....

LOW symptoms

HIGH HR and UO.

In HYPERkalemia, symptoms go _______, except for....

HIGH symptoms

LOW HR and UO.

What are symptoms of hyperkalemia?

- Brain: seizures, agitation, irritability, loud

- Lung: tachypnea

- Heart: tented T waves, ST elevated

- Bowel: diarrhea, borborygmi

- Muscle: spasticity, increase tone, hyperreflexia (3+, 4+)

- Heart rate: down (bradycardia)

- UO: down (oligouria)

What are symptoms of hypokalemia?

- Brain: lethargy

- Lung: bradypnea

- Heart: tachycardia

- Bowel: constipation, absent bowel sounds

- Muscle: flaccid, hyporeflexia (0, 1+)

- Heart rate: UP (tachycardia)

- UO: UP (polyuria)

Your patient has hyperkalemia, select all that apply

a. Adynamic ileus

b. Obtunded

c. 1+ reflex

d. Clonus (irritable)

e. U wave

f. Depressed ST

g. Polyuria

h. Bradycardia

d. Clonus (irritable)

h. Bradycardia

For Calemias, go in the _______ direction as the prefix.

OPPOSITE.

(if it is skeleton, muscle, or nerve, blame it on calcium)

In HYPERcalcemia, symptoms go _______.

Low

In HYPOcalcemia, symptoms go _______.

High

What are symptoms of hypercalcemia?

Bradycardia

Bradypnea

Flaccid

Hypoactive reflexes

Lethargy

Constipation

Etc.

What are symptoms of hypocalcemia?

Tachycardia

Tachypnea

Irritable

Hyperactive reflexes

Spasm

Seizure

Chvostek sign (Cheek spasm)

Trousseau sign (Inflate BP cuff, hand spasm)

For potassium, pick answers related to which body problem?

HEART or anything affecting BP.

For calcium, pick answers related to which body problem?

MUSCLE, skeletal, or nerve involvement

For Magnesemia, go in the _______ direction as the prefix.

OPPOSITE

(in a tie, don't pick magnesium)

Your patient has diarrhea. Which one of the following electrolyte imbalances causes diarrhea?

a. Hyperkalemia

b. Hypokalemia

c. Hypocalcemia

d. Hypomagnesemia

a. Hyperkalemia

Hypocalcemia is the opposite prefix, which is right... but calcium is involved in skeletal and nerve. Blame it on potassium.

Your patient has tetany. Which one of the following electrolyte imbalances causes tetany?

c. Hypocalcemia

Hyperkalemia is the same prefix, which is right... but tetany is skeletal, so blame calcium.

What are the s/s of hypErnatremia?

dEhydration

Hot, flushed, dry skin

Thready pulse

Rapid HR

What is the treatment for hypernatremia?

Give fluids!

What are the s/s of hypOnatremia?

Overload

Crackles, distended neck veins

What is the treatment for hypernatremia?

Lasix. Fluid restriction.

In addition to a high potassium, what other electrolyte abnormality can be seen in DKA?

Hypernatremia (dehydration)

How to spot early signs of any electrolyte imbalance?

Paresthesia (Numbness and tingling)

Circumoral paresthesia (around the lips)

The universal sign of all electrolyte imbalances is....

Paresis (Muscle weakness)

When giving potassium IV, NEVER...

push.

If potassium dosage is >40 mEq/L, what should you do?

Clarify order with physician. Never give more than 40.

What is the fastest way to lower potassium level?

Give D5W and regular insulin

Drives potassium into the cell and out of the blood. High K+ in blood is what can kill you.

What is the temporary solution to lower potassium level?

Give D5W and regular insulin

Drives potassium into the cell and out of the blood. High K+ in blood is what can kill you.

What is the long-term solution to lower potassium level?

Kayexalate - enema or ingestion

K Exits Late - exchanges potassium for sodium but takes hours to work.

When potassium is eliminated through feces, the patient can become...

hypernatremic - give IV fluids, hydrate

Heparin is to Digoxin as D5W and insulin is to.......

Kayexalate