Potasium

 3.5-5

Essential for montaining cardiac rythm, used for nevere impulses, used for smooth muscel contration (Sketal Muscle and Heart), needed for Cardiac and Respirtory fucntion

Osmolarity

270-300

Creatine

0.6-1.2

Sodium

135-140

Maintains ECF fluid volume, nerve impulses, and sketal and Cardiac muscle contration.

Calcium

 9-10.5

Calms nevers and muscles. Helps with blood clotting and formation of bone an teeth. Controled by the parathyriod hormone.

Magnesium

 1.3-2.1

Calms the nerves and muscles. Used for blood clotting

BUN

10-20

WBC

5,000-10,000

Hemoglobin

12-16

Hematocrit

45%-50%

Platelet

150,000-400,000

Hypokalemia

Happens becuase of diuretic use, peeing to much, vommiting, diarrhea, not eating, and GI suctioning

Will see muscle weakness, Weak irregular pulse, Bradycardia, dysrhythmias, orthostatic hypotension, decrease GI mobility (n/v,consitpation,abdominal distension), tachopiena

Treatment is Supplement replacement through IV or Oral

As a nurse you need to monitor I's and O's, monitor for muscle weakness and respirations, Monitor lab values, Give oral meds with water and with meals to prevent GI Irrataion, encourage banna's/oranges/rasins/prunes/potatoes/cantaloupes, can cause digoxin toxicity, NEVER ADMINISTER IV PUSH, Always dilute at 5-10 meq/hour, USE Seperate IV, Never give it IM or SUBCUT, Monitor for IV Infiltration and phlebitis (can cause tissue damage), may need cardiac monitor, Asses renal function, Urine output must be a least 30ml/hour, Monitor HR and BP. Notify is patient isn't responding to treatment. 

Hyperkalemia

When potasium level is to high is going to cause increase muscle, cardiac, and respiratory function

Caused by Overtreatment, impaired renal function (The kidney is unable to left it go), Using potassium sparing diuretics, the body is holding on to the electrolyte instead of letting it go, and over use of salt subsitutes.

Will see irregular pulse, Bradycardia, Dysrythmias, hypotension, numbness/tingling, mucle twitch that leads to muscle weakness, Diarrhea, and Hyperactive Bowel Sounds

Treatment is to administer Kayexalate where Potasium is excreated in the stool. Can be given orally or through an enema. Medication can cause diarrhea so monitor for dehydation, potassium level (don't want it to go into hypo state), and skin breakdown. Can also be put on a low potassium diet

As a nurse DC potassium containing IV  solutions, Potassium supplements, and potassium sparing diuretic. Monitor VS closely, and aviod salt subsitutes.

Hyponatremia

To much water and not enough sallt in the cell. Water goes where sodium is, so if sodium leaves water leaves. Not enough sodium to excort water out so water stay right where it is at in the cell. With no salt cardiac and sketal muscles move.

This is caused by diuretics getting rid of to much sodium, diarrhea,vomitting, gastric suctioning, excess water intake, excessive use of hypotonic IV solutions.

Will see hypoosmolarity levels (not enough solutes to pull the water and waste back in to the vein, so it stays in the cells). Cell Swelling. First thing you will see is headache, confussion, irriatable, tremors and seziures (if level is below 120). Muscle weakness, Tachycardia, nausea, diarrhea, and abdominal cramping.

Treatment you need to put on fluid restriction to get rid of water, Iostonic IV solution for replacement (Solution is 0.95% sodium chloride), if level is below 115 they will administer 3% hypertonice sodium chloride which is more solutes than water (small amount, slowly over a long period of time it can cause overload quickly), Discontinue diuretics.

As a Nurse you need to monitor vs, safety meassures for the seizures and weakness, monitor I's and O's, daily weights, and instruct patient to eat foods high in Sodium.

Hypernatremia

There is to much salt and not enough water. So the water moves from the cell into the vien to try to dilute the soluntion. Muscle are over excited so they cause weakness because they become woren out

Caused by to much salt intake, to much IV fluids, not enough water intake, increase water loss.

Will see the same sighns as dehydration. Confussion, restless, thirsty, dry mucous membranes, weakness, ortheostatic hypotension, Increase heaert rate, Decrease urinary outpput.

Treatment includes sodium restriction, hypotonic IV soultion done slowly to prevent edema.

As a nurse you should monitor sodium levels, monitor for skin breakdown and I's&O's, weight, and safety messures (weak).

Hypocalcemia

Not enough calcium the muscles can't calm down.

Caused by not enough calcium or Vitamin D intake, hypoparathyriodism, reneal failure (gets rid of to much calcium)

Can have numbness and tingling in fingers and around the mouth, muscle twitching/ cramps, teteny (continous muscle contraction), chvstek's and trousseau's sign, laryngeal spasms, and sezuires

Treatment is to give oral supplements, Vitamin D, and Calcium enriched diet.

As a nure you need to implement sezuire precautions, safety meassures, position patient carefully, and educate on calcium rich foods

Hypercalcemia

When you have to much calcium the muscles are to relaxed so it cause them to be weak and the calcium has left the bones so they bones can break easier.

Caused by hyperparathyroidism, prolonged immoblization, to much calcium intake, renal failure, and dieases that caue bone destruction.

Signs are lethargic, weakness, depressed refluxes, confusion, bone pain, fractures, kidney stones.

Treatment is IV of NS and diuretics to increase urination

Nurses should increase fluid intake to at least 3 litters a day, encourage ambulation, and position patient carefuly

Hypomagnesemia

Caused by malnutrient, starvation, chronic alcoholism, diarrhea, and diuretics.

Causes numbness, tingling, tremmors,twitching,hyperactive deep tendon reflexes, dysrhythmias, tachycardia

Treated by IVPB and oral supplement. Oral can cause diarrhea which leads to lower levels.

Nurse should monitor fot hypotension (vasodilation and cardiac arrest), have Calcium Gluconate IV ready (Reverse OD), Monitor VS, and implement safety meassures

Hypermagnesemia

Caused by taking to many laxatives and antacids, and renal insufficiency.

Causes deep tendon refluxes, muscle weakness, lethargic, Bradycardia, hypotension (Vasodilation), and respiratory depression.

Treated by DC oral and IV supplement, and diuretics to secreate it out.

Nurse should monitor VS and muscle strength, aviod using magnesium containing laxatives, and imply safety meassures

Antidiurect Hormone (ADH)

A way the body caompisates for dehydration. When osomoreceptors in the hypothalmus detect an increase in blood solutes (Increase in Osmolarity) or the blood volume is low. The hypothalmus tells the posterior putitary gland to release ADH. Which cause the kidney's to reasorb water. Which dilutes the serium and increasesthe volume. Urine out put is decreased.

When there is to much water or decrease in blood solute. The hypothelmus inhibits the secreation of ADH. The kidney doesn't reabsorb the water (lets it go). Increasing blood solutes and decreases the ammount of water. Causes frequent urination and urine is less consitrated.

Renin-Angiotensin-Aldosterone

When you are dehydrated the kidney's don't perfuse as well, this change triggers the adreneal glands to release Renin. The renin travels to the liver and the liver then knows it needs to covert angiotension to angiiotension I, the angiotension I tavels to the lungs and is converted to angiotension II (a vasoconstrictor). To raise the BP. The release of the agiotension II and the increase BP signals to the adrenal glands to reabsorb salt and water. Which increases the fluid volume. 

Gantamicin Sulfate (Gardmycin)

Classification: Aminoglcosides

MOA: Ihibits protien making in Bacteria

Indications: Used to treat  bacterial infections that couldn't be treated with another drug.

What you need to Know: Very toxic, mostly given IV or IM, need to collect peaks and trough levels.

causes photosenistivity/hearingloss/damage to the kidney's, monitor renal function in elderly, monitor for dehydration and electrolyte imbalance. Dilute before administering, drink a lot of fluids

G=Grand=Use to treat Grand infection and has Grand Side Effects

Cefazolin (Ancef)

Clasification: Cephalosporins

MOA: Binds to the cell well and causes cell death

Indications: Kills bateria on skin, lung, and urinary, Broad spectrum usage.

Nursing: do not use if allegric to penicillin, do not drink during thearppy, take oral form with food, monitor bowel cuncition can cause collitis, flush tubing afterward, if can keep them seperate, can cause increase BUN and Creatine level.

 I'm a posser you Ce I want to be just like Pinicillin so don't drink with me

Flagyl (Metrogel)

Classification: Metronidazole

Indications: Used to treat GI and Peri areas

MOA: Disrupts Protien Synthesis can kills

Nursing: Gives a metalic taste in mouth, monitor for neurological changes, monitor I's and O's, use condom or refrain from intercourse, aviod Alchol, caution when driving b/c of dizziness, have good oral hygiene, causes Redish brown colored urine, do not take if pregnant

If you take the Metro and drink your pee might be discolored

Amoxicillin (Amoxil)

Classification: Penicillin

Indications: Broad spectrum

Nursing: Hypersenistivity (highly allergic), causes diarrhea, can cause hyperkalemia, can take without regards to food, weakens oral conderceptions, use alternative, Use Bactrium if senistive to it

Ill because it weakens the Pill

Levoflozacin (Levaquin)

Classification: Fluoroquinolones

Indications: Bone, Skin, Urinary, Respiratory, GI, broad spectrum

Nursing: Photosenistivity, Stay well hydrated to aviod crystilization,can cause glucose level changes, medications with calcium, iron, or zinc prevent absorbtion, aviod driving, DC other medication before giving IV

Fl=Fluids need to stay hydrated

Inflamation

Local: swelling, pain, redness, impaired function, heat, pain in exact location.

Systemic: Low grade fever, increase WBC count, chills, sweating, loss of appietite, weight loss, malaise

Apendicitis

Risk Factors: Happens in young adult

Caused: Obstruction, tumor, lympth nodes thickening, and fesis bloackage

Symptoms: RLQ pain, N/V, gaurding, rebound pain, poor appiatite, low grade fever, and Increased WBC count

Treatment is Surgery

Before Surgery monitor pain and VS, NPO, IV fluids for replacement r/t N/V, antibiotics if rupture has occured, NEVER give LAXATIVES and HEAT application. apply ice.

After Surgery Monitor VS, pain mangement, ambulation, splint when coughing, and discharge teaching

Cholecystitis

Risk Factors: Female, over 40, fatty diet, ferital, native american, Hispanic, obiest, family history, immobile, have diabetes, on birth control

Causes: Obstruction by; Calculous inflamation with gallstones. Acalculous inflammation with out gallstones (tummor). Chronic cholecytsis is reacurring episodes cause scar tissue, and unable to store bile, which decreases bile movement, and can't be absorbed

Symptoms: Increase WBC, Billirubin, AST (liver enzyme), LDH (Liver enzyme), and amylase and lipase (shows blockage in pancreatic duct). Pain in URQ, that radiates to right shoulder, N/V, upset stomach, burping, farting, abdominal fullness, rebound tenderness, low grade temp, Increase HR, Fatty stool, clay colored stool, dark urine, and juandise 

Treatment is surgery. Nonsurgica intterventions can be used for comfort but not cure. Include low fat diet, opioids, medication to relax gallbladeer to decrease pain, antibiotics for infaction. ESWL breaks up the stone to be able to pass. Insert  T-tube to reroute bille to give time for the gallblader to heal.

T-Tube needs to be below the level of the gallblader, Asses the amount, consisty, and ordor of drainage. Should be 400ml a day, Clamp tube for 1-2 hours before and after meals. Check skin around the tube.

Imflamatory Bowel Disease

Risk Factors: Teenage to young adult, reappears in 60's, White, jewish, family history,

Causes: Unknown, autoimmune, chronic, out of control, enviromental

Signs is diarrhea 6 to 7 times a day, blood in stool, weight loss, abdominal pain, fever, and fatigue, increase WBC and ESR (shows inflamatory process is occuring), decrease hemoglobin, hematocrit, sodium, potassim, clhoride, magnessium, albumin. Stool positive for blood, puss, and mucus

Complications: bleeding in GI tract, stictures, tears in GI tract, fistulas, megacolon, arthytsis, eye inflamation, skin lessions, and kidney stones, diarrhea, anoxiea, anemic, decrease B12 absorbtin, fat malabsorbtion.

Treatment anti-inflamatory medications for pain, diet high in calories and protien, sstay away from fiber, stay away from diary products, IV fluids, oral supplements, external feedings, no specific triggers, fatty food cause diarrhea, cold food cause diarrhea and so does smoking.

Nursing prevent skin breakdown, use of witch hazel or ointments for comfort, increase fluids to stay hydrated, prevent having drinks with meals, when to call the doctor.

Ostomy

Not a cure, is done when medication failled, tear in tract, bleeding, obstruction, or for comfort.

Total colestomy removal of some intestant, intestant made into ostomy or is reconected to another part of the intestant.

Proctocolectomy they remove everything including anus and Illiostomy is placed.

Stoma should be red, moist, edema for 2-3 weeks, stitches intact and dry, skin should be try intact. Blue stoma mean not geting blood flow and black mean the intestiant is dead.

After surgery Illeostomy has high output of 1500-2000ml a day. Cholostomy can take up to 24 hours for bowel sounds to return, fallowed by gas, then stool should come.

Nutriention: Drink fluids, chew food well, low fiber, high in calorie and protien, Stay away from food that cause odor (eggs,aspargius,onion), gas forming (beans,soda, cabbage, drinking through a straw, chewing gum), Diarrhea causing (smoking, coffee, spicy foods, caffine), and obstruction (nuts, popcorn, and raw veggies)