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19 Cards in this Set
- Front
- Back
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Prophylaxis
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Lovenox for DVT
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FENGI
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Fluids, diet, bowel movements
1) no IV fluids 2) electrolytes are normal 3) medium consistency carb diet and tolerating it well |
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Disposition
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Code status and discharge plan
1) Full code 2) Just here for observation if she improves we can taper steroid and send home 3) PT, OT |
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General assessment
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awake, alert, comfortable, no acute distress
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Cardiovascular
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1) Normal S1and S2
2) No murmurs, rubs or gallops 3) regular rate and rhythm and capillary refill |
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Extremities
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1) no pitting edema (+1,+2)
2) normal strength and pulses (5/5, 3/5, 1/5) |
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Abdomen
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1) active bowel sounds
2) soft and nontender 3) no distension |
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Respiratory
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1) thorax symmetric w/ good expansion
2) no rales, wheezes, or ronchi 3) clear to anterior auslatation bilaterally |
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HEENT
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1) No pain on palpation
2) No thyromegaly, lymphadenopathy or JVD 3) tongue deviation, slurred speech 4) normal extraocular muscles |
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Neuro
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1) tongue deviation
2) pupils are reactive 3) sensation on Left is decreased |
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HEENT exam
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1) I need to examine your sinuses, so I am going to press on your forehead and cheeks. Please tell me if you feel pain anywhere
2) I would like to examine your eyes now 3) I am going to shine this light in your eyes. Can you please look straight ahead at the wall 4) I need to examine your ears now 5) can you please open your mouth? I need to check the inside of your mouth and your throat |
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What to perform during the HEENT exam
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Head
1) Inspect the head for signs of trauma and scars 2) palpate the head for tenderness or abnormalities Eyes 1) Inspect the sclerae and conjunctivae for color and irritation 2) Check the pupils for symmetry and reactivity to light 3) Check the extraocular movements of the eyes 4) Check visual acuity with the Snellen eye chart 5) Perform a funduscopic exam |
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Normal potassium level
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3.5-5
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Causes of hypokalemia
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1. GI loss
2. renal loss 3. Other |
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causes of hyperkalemia
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1. increased total body potassium 2. redistrubution (translocation of potassium from intracellular to extracellular space
3. Pseudohhyperkalemia |
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EKG changes with hyperkalemia
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prominent when potassium >6
1. Peaked T waves 2. prolonged PR interval 3. widening of QRS 4. ventricular fibrillation and cardiac arrest |
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Treatment of hyperkalemia
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1. Give IV calcium- calcium stabilizes the resting membrane potential of myocardial membrane (decreases membrane excitability)
2. Shift potassium into the intracellular compartment (glucose and insulin- glucose alone will stimulate insulin from beta cells, but exogenous insulin is more rapid. Give both to prevent hypoglycemia; sodium bicarb- increases pH level, which shifts K+ into the cells ) 3. Remove potassium from the body- Kayexalate, hemodialysis, diuretics (furosmide) |
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what is the potential problem with rapid sodium correction
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Central pontine myelinolysis or osmotic demyelination syndrome is a demyelinating lesion in the brain that occurs with rapid correction of hyponatremia (low sodium levels in the blood). It is characterized by acute paralysis, dysphagia (difficulty swallowing), and dysarthria (diffuculty speaking), and other neurological symptoms.
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Amiodarone side effects
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1. Lung- pulmonary fibrosis
2. Thyroid- hypo/hyperthyroidism 3. Eye- corneal deposits 4. Skin deposits- blue/gray 5. Liver- abnormal liver enzymes |
