Comp 1

RBC

females 4.2-5.4 million males 4.7-6.1 million

decrease RBC

anemia

WBC

5,000-10,000

elevated WBC

infection.

decreased WBC

immunosuppression

Iron

females 60-160 mcg males 80-180

elevated iron

hemochromatosis, iron excess liver disorder, magaloblastic anemia

decreased iron

anemia or hemorrhage

platelets

150,000-4000,000

increased platelets

malignancy or polycythemia vera

decreased platelets

autoimmune disease bone marrow suppression or enlarged spleen

Hbg

females 12-16 males 14-18

decrease Hgb and Hct

anemia

Hct

females 37%-47% males 42-52%

anemia in children

pallor, brittle spoon shaped nails

S & SX:

irritability, muscle weakness systolic heart murmur, enlarged heart, HF

iron supplements

give 1 hr before or 2 hr after antacid to prevent malabsorpt N/D and constipation common at start of therapy use straw for liquid iron to prevent staining of teeth

aPTT

1.5-2X control range of 30-40 seconds test clotting factors and monitor heparin therapy

increased aPTT

hemophilia

disseminated intravascular coagulation DIC

liver disease

PT

11-12.5 seconds, 85-100%

increased PT time

evidence of deficiency or clotting

decreaed PT time

evidence of vit K excess= bleed out

acute hemolytic blood transfusion reactions

**low back pain, TACHYcardia, HYPOtension

febrile reactions

30 min-6 hr after transfusion -chills, fever, flushing, headache use WBC filter, administer antipyretics

mild allergic reactions

during or up to 24hr after transfusion itching, urticarial, flushing administer benadryl

anaphylactic shock

wheezing, dyspnea, cyanosis, hypotension maintain airway, admin O2, IV fluids, antihistamines, corticosteroids and vasopressor

fluid overload

HYPERtension, jugular vein distention, peripheral edema orthopnea, crackles at base of lungs sudden anxiety

sepsis and septic shock

-fever, N/V, abdominal pain, chills HYPOtension administer antibiotics, blood cultures, vasopressor (dopamine)

if disseminated intravascular coagulation (DIC)

admin heparin in early stage -blood products and clotting factors in late stage

PICA

eating things like soil, chalk, for at least 1 month

parenteral iron

given Z track

erythropoietin epoetin alfa (epogen, Procrit)

used to increased production of RBC monitor increase in BP, Hgb, Hct

folic acid

turn urine dark yellow necessary for new RBC

hypovolemia causes

peritonitis, ascites, burns, NPO

causes of dehydration

hyperventilation DKA tube feeding without sufficient water intake

subjective and objective HYPOvolemia

Hyperthermia, Tachycardia, HYPOtension decreased central venous pressure hypoxia thirst, dizziness, N/V, -poor skin turgor, tentin

lab test hypovolemia

increased: HCT, specific gravity, NA, protein, BUN, glucose

Hypervolemia causes

HF, cirrhosis, increased gluccorticosteroids hypertonic fluids

S & SX HYPERvolemia

bounding pulse, increased CVP, HYPERtension, confusion, muscle weakness, ascites, diminished breath sounds, distended neck veins

lab test HYPERvolemia

Decreased: HCT, BUN, electro respiratory alkalosis PaCO2 less than 35, increased PH

notify doctor if

weight gain 1-2(b/24 or 3 lb in a wk

foods high in potassium

avocados, broccoili, dairy products, dried fruit, cantaloupe, bananas

HYPOcalcemia

positive chvosteks (facial twitching) positive trousseau (hand/finger spasm with blood pressure cuff inflation

excess caffeine causes excretion

calcium in urine

secondary osteoporosis results from

hyperparathyroidism, long term corticosteroid long term anticonvulsant (Dilantin) manifestations: kyphosis

stages of grief

1. denial 4. depression 2. anger 5. acceptance 3. bargaining

theophylline

relaxation of bronchioles causing bronchodilator oral used to control asthma or COPD therapeutic range 5-15 avoid in HTN, liver and kidney dysfunction

theophylline interactions

caffeine

glucocorticoids: beclomethasone- inhalation prednisone- PO

prevent inflammation, suppress airway mucus production

leukotriene (monelukast)

suppressing inflammation, bronchoconstriction's, airway edema, mucus production

digoxin

makes the heart beat stronger and regular rhythm therapeutic 0.5-2.0

S & SX of dig tox

fatigue, weakness, vision changes, Gl effects infuse over 5 min

hemophilia

difficulty controlling bleeding X linked recessive disorder joint pain and stiffness, impaired mobility, easy bruising slurred speech

lab test indication of hemophilia

prolonged aPTT avoid unnecessary needle sticks, apply pressure for 5 mins after needle sticks monitor for occult blood

DDAVP

synthetic form of vasopressin increases plasma factor VIII not for hemophilia B

acute hemolytic blood transfusion reactions

**low back pain, TACHYcardia, HYPOtension, hemoglobinuria,

ICP

10-15 mm Hg

mannitol

osmotic diuretic treat cerebral edema

phenytoin (Dilantin)

prophylactically to prevent or treat seizures

crainiotomy

removal of nonviable brain tissue that allows for expansion or removal of epidural or subdural hematomas

KUB (kidneys, urter, bladder

determines size shape and position of structures

cystoscopy

use a scope to visualize the bladder and urthera

reflex incontinence

Reflex - The involuntary loss of a moderate amount of urine usually without warning due to hyperreflexia of the detrusor muscle, usually from altered spinal cord activity,

treatment for urinary infections

gentamycin and Keflex take with food may change urine odor and report loose stools

TCA (nortriptyline (pamelor)

helps relieve urinary incontinence -cause dizziness monitor BP, don't take with MAOI

phenazopyridine (pyridium)

treats urinary spasms, analgesic wont treat infection only bladder discomfort liver and renal contraindication take with food and change urine organge

interventions for reflex incontinence

Bladder compression techniques (Credé, Valsalva, double- voiding, splinting) to help clients manage.

ORCHIECTOMY

removal of testes

BPH

impaired outflow, fam Hx, -urine hesitancy and retention, plainless hematuria

TRUS

diagnosis and R/o BPH

ways to reducuse prostatic fluids

frequent ejaculation

TURP

using a scope inserted though urethra and trims away excess prostatic tissue, enlarging passage through prostate

CBI

irrigation to keep clots from forming, if bright red blood or clots increase rate

intervention for CBI obstruction

1. turn off CBI 2. irrigate with 50 mL of irrigant sol with lg piston syringe 3. contact doc if cant dislodge clot

expectations of D/c of CBI

red in color, expect 150-200 output every 3-4 hrs contact doc if cant void

discharge instructions after TURP

avoid sex 2-6 wks, 12+ glasses of water of day, avoid caffeine, expect pink urine

abnormal PSA

less than 4

DRE signs of prostate CA

hard palpable irregular

fluoxetine (prozac

monitor tremors, AE: headache, urinary freq, hypotension -agitation, confusion, anxiety, hallucination (Serotonin syndrome

tonsilectomy

milk products coat throat causing coughing; coughing should be avoided admin pain on a reg sched or 1st 24 hrs to prevent breakthrough pain

hypovolemic shock

cool clammy skin

mannitol

direurtic

anaphylactic reaction

wheezing, rah

ataxia

involuntary movement

digoxin

monitor HR

digoxin tox

nausea, muscle weakness, diarrhea

IVP

admin lasix

estrogen

helps prevent osteroposis

estradiol SE

headaches and HTN

epi

teaching: report chest pain, increases work load and 02 demand can result in angina

NPO

can cause dehydration and low grade fever

hemolytic blood reaction

**low back pain, tachycardia, hypotensiokn

structure audit

eval of avail resources

precess audit

examine how nursing care is provided

prospective audit

performance on a new

valporic acid

monitor LFT

chlorpromazine (haloperidol)

decrease hallucinations teach: sips fluids freq, minimize sun exposure

cyclophosphamide

maintain hydration with liberal intake doesn't affect glucose

dehiscence

stay with client, 2. place saline over organs, 3. put in supine 4. take vitals