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LAB TESTS Arterial Blood Gases (ABG) pH PaO2 SaO2

Normal Levels 7.35 -- 7.45 80 -- 100 mm Hg 95% -- 100%

Description

Below normal range

Above normal range

Arterial partial pressure of oxygen.

Acidosis Alkalosis Hypoxemia; possible hypoventilation --> results in decreaed myocardial Hyperventilation oxygen supply

Hypocapnia = more CO2 is being exhaled than normal If pH >7.45 then Respiratory Alkalosis (low CO2 levels and decreased H+ concentration) Kidneys excrete bicarbonate and conserve H+ to restore carbonic acid : bicarbonate ratio Summary Respiratory Alkalosis: >pH, <PaCO2 <HCO3 (compensation to lower pH) PaCO2 35 -- 45 mm Hg

Hypercapnia = CO2 is being retained If pH <7.35 then Respiratory Acidosis (retained CO2 causing increased H+ concentration) Kidneys conserve bicarbonate to restore carbonic acide : bicarbonate ratio of 1:20. Summary Respiratory Acidosis: <pH, >PaCO2 >HCO3 (compensation to raise pH)

Common Etiologies: Common Etiologies: Hyperventilation caused by hypoxia, fear, fever, pain, exercise, anxiety, COPD, sedative or barbiturate overdose, chest wall abnormalities, pulmonary embolus; Mechanical overventilation; Septicemia (resp. pneumonia, atelectasis, respiratory muscle weakness, hypoventilation center stimulation), brain injury, encephalitis, salicylate poisoning. Manifests as (ACUTE): Resp. rate incr and shallow to blow off CO2; Manifests as: Incr. myocardial irritability, Incr. HR, Incr. sensitivity to Hypotension; Heart block; Peaked T waves; Prolonged PR interval; digitalis preparations; Dyspneal; dizziness, light-headedness, feeling of Weak and thready pulse; Tachycardia; Headache, warm/flushed skin, panic, difficulty concentrating, curcumoral and distal extremity blurred vision, irritability, altered mental status, decreasing LOC, parathesias, tremors, positive Chvostek's and Trousseau's signs, cardiac arrest; Papilledema. tinnitus, chest tightness, palpitations (cardiac dysrhythmias), seizures, Manifests as (CHRONIC): Weakness, dull headache, sleep disturbances loss of consciousness. with daytime sleepiness, impared memory, personality changes. If pH > 7.45 (alkalosis) = Metabolic Alkalosis (high bicarbonate level and low H+ concentration) If pH <7.35 (acidosis) = Metabolic Acidosis (low bicarbonate level and Rate and depth of respirations decrease, retaining CO2, and PaCO2 high H+ concentration). increases (>45mmHg). Respiratory system attempts to return pH to normal by increasing rate and depth of respirations (CO2 elimination increases, and PaCO2 falls Summary Metabolic Alkalosis: <35mmHg) >pH, >HCO3, Summary Metabolic Acidosis: Is a weak base; when an acid is added to the sytem, the H ion in the >PaCO2 (compensation to lower pH) <pH, acid combines with bicarbonate, and the pH changes slightly. When < HCO3, depleted (by adding a strong acid to extracellular fluid), results in Common Etiologies: <PaCO2 (compensation to raise pH) acidosis (i.e. ratio of bicarbonate to carbonic acid decreases from 20:1). Severe vomiting, excessive NG suctioning, diuretic therapy, This is the Metabolic Componennt of ABG. hypokalemia, excess licorice intake, excessive NaHCO3 use, excessive Common Etiologies: mineralcorticoids. Diabetic ketoacidosis (DKA), lactic acidosis, starvation, severe diarrhea, Bases can be lost in stool (diarrhea); acids lost in stomach contents (NG renal tubule acidosis, renal failure, GI fistulas, shock. suctioning) Manifests as: Incr. HR, dysrhythmias secondary to hypokalemia, hypotension, PVCs, atrial tachycardia, hypoventilation, respiratory Manifests as: Hypotension, dysrhythmias, peripheral vasodilation, failure; decreased calcium ionization (hypocalcemia), including cold/clammy skin, weakness, confusion, fatigue, headache, general numbness and tingling/paresthesia around mouth, fingers, and toes; malaise, anorexia, nausea, diarrhea, vomiting, abdominal pain, dizziness; irritability; nervousness, tremors, Trousseau's sign; muscle consciousness declines, cardiac arrest may occur, skin is warm and spasm; respirations are depressed and respiratory failure with flushed, respirations are labored, deep and rapid (Kussmaul's hypoxemia and respiratory acidosis may develop. Confusion, decreasing respirations), SOB or dyspnea. LOC, hyperreflexia, tetany, dysrhythmias, hypotension, seizures, respiratory failure.

HCO3

22 -- 26 mEq/L

Mixed Venous Gases SvO2 Serum Levels

60% -- 75%

Glucose

70 -- 110 mg/dL (fasting) 100 -- 140 mg/dL (non-fasting

Monosaccharide found in fruits and formed from digestion of carbohydrates and conversion of glycogen by the liver. Glucose is the main source of cellular energy for the body and is essential for brain and erythrocyte function. Levels are used to diagnose diabetes mellitus and hypoglycemia.

Hypoglycemia: Cold, clammy skin Trembling or feelings of nervousness Lack of motor coordination and fatigue Irritability or confusion Blurred vision, headache or dizziness Nausea or stomach pain Faining or unconsciousness

Hyperglycemia: Increased thirst and urination (polydipsia and polyuria) Sweet odor to the breath Fatigue Agitation and confusion High levels of ketones in the urine Weight loss

Diabetes mellitus: chronic hyperglycemia due to: 1. Inadequate insulin secretion by pancreas (Type 1) 2. Effectiveness of endogenous insulin (insulin resistance) (Type 2) Type1: Body makes too little or no insulin. Beta cells in pancreas are being attacked by body's own cells and therefore can't produce insulin to take sugar out of the blood stream. Insulin is not produced. Type2: Body can't use insulin it makes. Body has taken in so much sugar that insulin has become desensitized to sugar and does not take it out fo the bloodstream. Insulin is not funcational (insulin resistance) Elevations in blood glucose level will cause elevations in glycosylation. The test is useful in identifying clients with periods of hyperglycemia that are undetected in other ways. BUN level is elevated in heart disorders that adversely affect renal circulation, such as HF and cardiogenic shock. Elevated levels indicate slowing of glomerular filtration rate (but not necessarily renal disease). Eleveated by dehydration, poor renal perfusion, intake of high-protein diet, infection, stress, corticosteroid use, GI bleeding, and factors that cuase muscle breakdown.

Glycosylated Hemoglobin A (Hemoglobin A1c)

good control < 7% fair control 7% - 8% poor control >8%

Measures amount of glucose that has become permanently bound to RBCs from circulating glucose over 3 months / 120 days. Measures amount of nitrogenous urea, a byproduct of protein metabolism in the liver. BUN levels indicate the extent of renal clearance of urea nitrogenous waste products. Nitrogen portion of urea, a substance formed in the liver through enzymatic protein breakdown process. Urea is normally filtered through renal glomeruli, with amounts reabsorbed in tubules and remainder excreted in urine. An end product of protein and muscle metabolism. Creatinine level reflects glomerular filtration rate. Renal disease (when 50% of renal function is lost) is the only patholigical condition that increases the serum creatinine level. Specific indicator of renal function. Hyponatremia: net gain of H2O or loss of Na-rich fluids. Delays and slows depolarization of membranes. Water moves from ECF into ICF causing cells to swell (cerebral edema) Risk factors: 1) Deficient ECF volume (abnormal GI losses: vomitting, NG suctioning, diarrhea; Renal losses: diuretics, kidney disease; Skin losses: sweating, burns, wound drainage) 2) Increased or normal ECF volume (excessive water intake) 3) Edematous states (heart failure, cirrhosis, nephrotic syndrome) 4) Excessive hypotonic IV fluids 5) Inadequate Na intake (NPO) Subjective/Objective Data: Hypothermia, tachycardia, rapid thready pulse, hypotension; headache, confusion, lethargy, muscle weakness, fatigue; increased motility, hyperactive bowel sounds, abdominal cramping, nausea

Blood Urea Nitrogen (BUN)

5 -- 25 mg/dL

Creatinine

0.5 -- 1.5 mg/dL

Increased levels indicate slowing of glomerular filtration rate.

Sodium

135 -- 145 mEq/L

Major extracellular cation Maintains osmotic pressure and acid-base balance, and assists in transmission of nerve impulses. Absorbed in small intestine, excreted in urine Minimum daily requirement is 15 mEq

Hypernatremia: increased Na causes hypertonicity of serum. This causes shift of H2O out of cells (causing dehydrated cells). Causes significant neurological, endocrine, and/or cardiac disturbances. Risk factors: 1) Water deprivation (NPO), 2) Excessive Na intake (dietary, hypertonic IV), 3) Excessive Na retention (renal failure, Cushing's syndrome), 4) Fluid loss (diaphoresis, burns, DI, hyperglycemia, watery diarrhea), 5) old age (decreased total body water) Subjectove/Objective Data: 1) Hyperthermia, tachycardia, orthostatic hypotension, 2) restlessness, irritability, decreased deep tendon reflex (DTR), 3) thirst, dry mucous membranes, hyperactive bowel sounds, abdominal cramping, nausea, 4) edema, warm flushed skin, oliguria

Chloride

98 -- 107 mEq/L

Most abundant extracellular anion Counterbalances cations (e.g. Sodium) and acts as buffer during O2 and CO2 exchange in RBCs Aids in digestion and maintaining osmotic pressure and water balance Altered by conditions accompanied by prolonged vomiting and/or diarrhea

Potassium

3.5 -- 5.3 mEq/L

Major intracellular cation Regulates cellular water balance, electrical conduction in muscle cells, and acid-base balance. Obtained through dietary ingestion and preserved or excreted by the kidneys depending on cellular need. Potassium levels used to evaluate cardiac function, renal function, gastrointestinal function, and need for IV replacement therapy. Elevated WBC and platelet counts may give falsely elevated potassium levels.

Hypokalemia: increased loss of K from body or movement of K into cells. Risk Factors: Decreased total body K (Abnormal GI losses: vomitting, NG suctionioning, diarrhea; Renal losses: excessive diuretics; Skin losses: diaphoresis, wound losses); Insufficient K (dietary intake, prolong admin of non-electrolyte containing IV (D5W)); Intracellular shift (metabolic alkalosis, after correction of acidosis, during periods of tissue repair, total parenteral nutrition) Subjective/Objective Data: Causes increased cardiac electrical instability, ventricular dysrhythmias, and increase risk of digoxin toxicity; inverted T waves, ST depression, and appears of U wave. Can cause PREMATURE VENTRICULAR CONTRACTIONS (PVCs). Weak, irregular pulse, hypotension, respiratory distress; weakness up to respiratory collaps and paralysis, muscle cramping, decreased muscle tone and hypoactive reflexes, mental confusion; bradycardia, blocks, ventricular tachycardia; decreased motility, abdominal distention, constipation, ileus, nausea, vomitting, anorexia; polyuria (dilute urine)

Hyperkalemia: increased intake of K, movement of K out of cells, inadequate renal excretion Risk Factors: IV K admin, salt substitute; Extracellular shift: decreased insulin, acidosis (DKA), tissue catabolism (sebsis, trama, surgery, fever, myocardial infarction); Hypertonic states (uncontrolled DM); decreased excretion of K: renal failure, dehydration, K-sparring diuretics, NSAIDs, angiotensin-converting enzyme inhibitors. Subjective/Objective Data: Causes asystole and ventricular dysrhytmias; peaked T waves, widened QRS, prolonged PR intervals, or flat P waves. Slow, irregular pulse, hypotension; restlessness, irritability, weakness to point of ascending flaccid paralysis, paresthesias; ECG: premature ventricular contractions, ventricular fibrillation; nausea, vomitting, diarrhea, hyperactive bowel wounds

Bicarbonate

22 -- 29 mEq/L 65 -- 175 mcg/dL (M) 50 -- 170 mcg/dL (F)

Iron

Part of bicarbonate-carbonic acid buffering system and mainly responsible for regulating pH of body fluids. Found in HGB. Acts as carrier of O2 from lungs to tissues and indirectly aids in return of CO2 to lungs. Aids in diagnosing anemias and hemolytic disorders. Hypermagnesemia: Results from decreased renal excretion of magnesium. Monitor for cardiac manifestations (bradycardia, peripheral vasodilation, hypotension) Monitor CNS manifestations (decreased nerve impulse transmission, such as drowsiness or lethargy) Monitor neuromuscular manifestions (reduced/absent deep tendon reflexes or weak or absent voluntary skeletal muscle contractions). Administer loop diuretics (Lasix) Administer calcium (for resulting cardiac problems)

Magnesium

1.6 -- 2.6 mg/dL

Used as an index to determine metabolic activity and renal function. Needed in blood-clotting mechanism, regulates neuromuscular activity, acts as cofactor that modifies activity of many enzymes, and has effect on calcium metabolism. Long-term parenteral nutrition therapy or excessive fluid loss may decrease calcium levels.

Hypomagnesemia: Risk factors: Malnutrition, Alcohol ingestion (Mg excretion) Subjective/Objective Data: Increased nerve impulse transmission (hyperactive deep tendon reflexes, parasthesias, muscle tetany), positive Chvostek's and Trousseau's signs; Hypoactive bowel sounds, constipation, abdominal distension, paralytic ileus.

or

1.8 -- 3.0 mg/dL Hypocalcemia Risk factors: Malabroption syndromes (Crohn's disease), Hypoalbuminemia, End-stage kidney disease, Post thyroidectomy, Hypoparathyroidism, Inadequate intake, Vitamin D deficiency, Pancreatitis, Hyperphosphatemia, Meds that block parathyroid Cation absorbed into bloodstream from dietary sources and functions function, cause hyperphosphatemia, chelate calcium, or prevent Ca in bone formation, nerve impulse transmission, and contraction of absorption; Sepsis myocardial and skeletal muscles. Subjective/Objective Data: Paresthesia of fingers/lips, Muscle Aids in blood clotting by converting prothrombin to thrombin. twitches/tetany, Frequent, painful muscle spasms at rest, Hyperactive deep tendon reflexes, Positive Chvostek's sign, Positive Trousseau's sign, Decreased myocardial contractility (decrease HR and hypotension), Hyperactive bowel sounds, diarrhea, adbdominal cramping Hypophosphatemia: Accompanied by increase in serum calcium level (see hypercalcemia) Causes: Insufficient phosphorus intake, Increased excretion (Hyperparathyroidism, Malignancy, Use of magnesium-based or Important in bone formation, energy storage and release, urinary acidaluminum hydroxide-based antacids), Intracellular shift base buffering, and carbohydrate metabolism. (Hyperglycemia, Respiratory Alkalosis) Absorbed from food and excreted in kidneys. Assessment: Decreased contractility and cardiac output, Slowed High concentrations are stored in bone and skeletal muscle. peripheral pulses, Shallow respirations, Weakness, Decreased deep tendon reflexes, Decreased bone density, Rhabdomyolysis, Irritability, Confusion, Seizures, Decreased platelet aggregation and increased bleeding, Immunosuppression.

Total Calcium

8.6 -- 10 mg/dL

Phosphorus/phosphate

2.7 -- 4.5 mg/dL

Hyperphosphatemia: Most systems tolerate elevated levels well. Accompanied by a decrease in serum calcium level (see hypocalcemia) Causes: decreased renal excretion resulting from renal insufficiency, Tumor lysis syndrome, Increased intake of phosphorus, Hypoparathyroidism Assessment: see Hypocalcemia

or Lactate - Arterial Blood Lactate - Venous Blood

2.5 -- 4.5 mg/dL 0.5 -- 2.0 mmol/L .5 -- 1.5 mmol/L Cholesterol present in all body tissues. Increased cholesterol levels, LDL levels, and triglyceride levels place client at risk for coronary artery disease. Major component of LDLs, brain and nerve cells, cell membranes, and gallbladder stones.

Cholesterol TOTAL

desired less than 200 mg/dL

Cholesterol - LDL (low-density lipoprotein) Cholesterol - HDL (high-density lipoprotein) Triglycerides

60 -- 160 mg/dL 29 -- 77mg/dL Protects against risk of coronary artery disease Constitute major part of very low-density lipoproteins and small part of LDLs. Synthesized in liver from fatty acids, protein, and glucose, and are obtained from diet. Main plasma protein of blood. Maintains oncotic pressure and transports bilirubin, fatty acids, medications, hormones, and water-insoluble substances. Decreased in acute infection, ascites, and alcoholism. Increased in dehydration, diarrhea, and metastic carcinoma. Presence in urine indicative of abnormal renal function. Reflects total amount of albumin and globulins in the plasma. Regulates osmotic pressure and is necessary for formation of many hormones, enzymes, and antibodies. Major source of building material for blood, skin, hair, nails, and internal organs. Increased --> conditions like Addison's disease, autoimmune collagen disorders, chronic infection, and Crohn's disease. Decrease --> conditions such as burns, cirrhosis, edema, and severe hepatic/liver disease. Used to identify hepatocellular disease of liver and monitor improvement or worsening of disease. Used to evaluate client with suspected hepatocellular disease Byproduct of protein catabolism. Mostly created by bacteria acting on proteins present in gut. Metabolized by the liver and excreted by the kidneys as urea Elevated levels from hepatic dysfunction my lead to encephalopathy. Produced in liver, spleen, and bone marrow. Byproduct of hemoglobin breakdown. Direct --> excreted via intestinal tract. Indirect --> circulates primarily in bloodstream. Time required for blood to stop flowing from small puncture wound. Evaluates how well coagulation sequence is functioning by measuring amount of time it takes for recalcified citrated plasma to clot after partial thromboplastin is added to it. Used to monitor HEPARIN therapy with HEPARIN DRIP and screen for coagulation disorders. NC: if receiving intermittent HEPARIN therapy, draw blood sample 1hr before next dose. The aPTT should be 1.5 to 2.5 times normal when receiving heparin therapy; if value is prolonged (>90sec), client is at risk for bleeding. Initiate bleeding precautions. Prothrombin is necessary for fibrin clot formation. Prothrombin = protein for blood clotting dependent on intake & absorption of vitamin K. PT measures amount of time it takes for clot formation (clotting factors II, V, VII, X and fibrinogen) and time it takes these factors to clot blood. Used to monitor response to WARFARIN SODIUM (COUMADIN) therapy or to screen for dysfunction of extrinsic clotting system from liver disease, vitamin K deficiency, or disseminated intravascular coagulation.

Lower than 200 mg/dL

Albumin

3.5 -- 5.0 g/dL

Total Protein

6.0 -- 8.0 g/dL

Alanine Aminotransferase ALT (SGPT) Aspartate Aminotransferase AST (SGOT)

10 -- 35 units/L 8 -- 38 units/L

Ammonia

5 -- 45 mcg/dL

Bilirubin - Indirect (unconjugated) Bilirubin - Direct (conjugated) Bleeding Time

0.1 -- 1.0 mg/dL 0.1 -- 1.2 mg/dL 3.0 -- 9.5 minutes

Activated Partial Thromboplastin Time (aPTT)

24 -- 36 seconds

Prothrombin Time (PT)

10 -- 14 seconds

International Normalized Ratio (INR)

0.9 -- 11 sec 2.0 -- 3.5 x the control

Red Blood Cells (RBC)

4.5 mil -- 6.2 mil cells/uL (M) 4.2 mil -- 5.4 mil cells/uL (F)

Hematocrit (HCT)

42% -- 52% (M) 35% -- 47% (F) 13.5 -- 18 g/dL (M) 12 -- 16 g/dL (F)

Hemoglobin - (HGB)

Platelet Count

150,000 -- 400,000 ul

More accurate determination of PT. A ratio of PT to Thromboplastin activity. INR is used to measure effects of oral ANTICOAGULANTS. NC: baseline PT should be drawn before anticoagulation therapy is started. A PT >30sec places client at risk for bleeding. Initiate bleeding precautions. Function in HGB transport, which results in delivery of O2 to body tissues. Formed in red bone marrow, removed from blood via liver, spleen, and bone marrow. RBC count aids in diagnosing anemias and blood dyscrasias. Represents RBC mass and is an important measure in identifying anemia or plycythemia. % of packed RBCs in whole blood. Main component of erythrocytes and serves as vehicle for transporting O2 and CO2. Important in identifying anemia. Function in hemostatic plug formation, clot retraction, and coagulation factor activation. Produced by the bone marrow to function in hemostasis. NC: Monitor venipuncture site for bleeding in clients with thrombocytopenia (i.e. receiving chemotherapy). Institute bleeding precautions for clients with low platelet count. Functions in immune defense system. Count assesses leukocyte distribution. "Shift to the Left" --> increased number of immature neutrophils is present in blood. Low WBC count with left shift indicates recovery from bone marrow depression or infection (demand for neutrophils in tissue is higher than capacity of bone marrow to release them into circulation) High WBC count with left shift indicates release of neutrophils by bone marrow in response to overwhelming infection or inflammation. "Shift to the Right" --> cells have more than usual number of nuclear segments; found in liver disease, Down syndrome, and megaloblastic and pernicious anemia. Enzyme produced by pancreas and salivary glands. Aids in digesting complex carbohydrates and excreted by kidneys. In Acute Pancreatitis, level may exceed 5x's normal value. Chronic Pancreatitis, rise does not usually exceed 3x's normal value.

RBC count decreases in rheumatic heart disease and infective endocarditis.

RBC count increases in conditions characterized by inadequate tissue oxygenation.

Decreases in HGB and HCT can indicate anemia

Elevated hematocrit level can result from vascular volume depletion.

Decreases in HGB and HCT can indicate anemia

White Blood Cell Count

4,000 -- 11,000 cells/ul (mm3)

WBC count increases in infectious and inflammatory disease of the heart and after MI because large numbers of WBCs are needed to dispose of necrotic tissue resulting from infarction

Neutrophils Amylase

1800 -- 7800 ul (mm3) 25 -- 151 units/L Troponin I lower than 0.6 ng/mL > 1.5 ng/mL = myocardial infarction Troponin T higher than .1 to .2 ng/mL = myocardial infarction

Troponins

Regulatory protein found in striated muscle (skeletal and myocardial) Increased levels released into bloodstream when infarction causes damage to myocardium.

Urine (see also Creatinine and BUN serum above) Formed as purines adenine and guanine are metabolized continuously during formation and degradation of DNA and RNA. Also formed from metabolism of dietary purines. Elevated amounts deposit in joints and soft tissue and cause gout. Slowed renal excretion of uric acid may cause hyperuricemia Elevated levels precipitate into urate stones in kidneys. Decrease (less concentrated urine) occurs with fluid intake or DIABETES Increase (more concentrated urine) occurs with insufficient fluid intake, INSIPIDUS; it may also indicate renal disease or kidneys inability to decreased renal perfusion, or increased ADH. concentrate urine.

pH (uric acid)

4.5 -- 8 (average 6)

Specific Gravity

1.005 -- 1.030 1.015 -- 1.024 with normal fluid intake Measures ability of kidneys to concentrate urine. Elevation in value indicates myocardial damage. Occurs within hours and peaks at 18 hours following acute ischemic attack Elevations in LDH occur 24 hours following MI and peak in 48 to 72 hours. When LDH1 > LDH2 = "flipped" / myocardial necrosis Troponin I has high affinity for mycoardial injury; it rises within 3 hours and persists for up to 7 to 10 days Any rise can indicate myocardialcell damage Oxygen-binding protein found in cardiac and skeletal muscle. Level rises within 2 hours after cel death, with rapid decline after 7 hours 3 -- 4 2 -- 8 mg/dL

CK-MB (Creatine kinase, mycardial 0% -- 5% of total; total CK is 26 -muscle) 174 units/L LDH1 < LDH2 Lactate dehydrogenase (LDH) Normal value of LDH: 140 -- 280 international units/L Troponin -Troponin C Troponin I: <0.6 ng/mL -Cardiac troponin I Troponin T: 0 -- 0.2 ng/mL -Cardiac troponin T Myoglobin

White Blood Cell Count Protein

See Albumin When intracellular glucose is inadequate due to starvation or lack of insulin to move it into cells (i.e. type 1 diabetes mellitus), the body breaks down fatty tissue to meet metabolic needs. In this process, fatty acids are released, which are converted to ketones; ketoacidosis develops (see Metabolic Acidosis above) Phases of ACUTE RENAL FAILURE: 1. Onset: begins with precipitating event 2. Oliguria Phase (8-15 days): sudden decrease in output (<400mL/day) -Signs of excess fluid volume: hypertension, edema, pleural and pericardial effusions, dysrhythmias, congestive heart failure (CHF), pulmonary edema. -Signs of EUREMIA: anorexia, nausea, vomitting, pruiritus -Signs of metabolic acidosis: Kussmaul's respirations -Signs of neurological changes: tingling of extremities, drowsiness progressing to disorientation, and then coma -Signs of pericarditis: friction rub, chest pain with inspiration, low-grade fever

Ketones

CHRONIC RENAL FAILURE: -Slow, progressive, irreversible loss in kidney function, with a GFR <= 60mL/min for 3 months or longer. Hypervolemia can occur because kidney's inability to excrete sodium and water; Hypovolemia can occur because kidney's inability to conserve sodium and water.

Urine Output

400 -- 1500 mL/day

Interventions: a) restrict fluid intake, b) administer medications such as Primary causes: -Diabetes Mellitus diuretics (Lasix) to increase renal blood flow and diuresis -Hypertension 3. Diuretic Phase: Excessive urine output indicates damaged nephrons -Chronic urinary obstruction -Recurrent infections are recovering their ability to excrete wastes. -Renal artery occlusion -Signs: dehydration, hypovolemia, hypotension, and tachycardia can -Autoimmune disorders occur, LOC improves Interventions: Administer IV fluids, which may contain electrolytes to replace loses 4. Recovery phase (convalescent): Urine volume returns to normal, HORMONES Produced by Responsible for reabsorption of water by the kidneys. Stimulated by dehydration or high sodium intake, and by decrease in blood volume. Makes Distal Convoluted Tubule (DCT) and collecting duct permeable to water Water is drawn out of tubles by osmosis and returns to blood; concentrated urine remains in tuble to be excreted

ADH - Antidiuretic Hormone

Hypothalamus and secreted from posterior lobe of pituitary gland

If ADH is lacking, person develop Diabetes Insipidus (DI), producing large amounts of dilute urine.

Renin

Kidney

Analgesics: Mainstay for relieving pain 3 classes: 1. Nonopioids 2. Opioids 3. Adjuvants

Nonopioids Acetaminophen Ibuprofen Aspirin

Opioid analgesics

Morphine sulfate Fentanyl [Sublimaze] Codeine

Adjuvant analgesics Anticonvulsants --> carbamazepine (Tegretol) Antianxiety agents --> diazepam (Valium) Tricyclic antidepressants --> amitriptyline (Elavil) Antihistamine --> hydroxyzine (Vistaril) Glucocorticoids --> dexamethasone (Decadron) Antiemetics --> ondansetron hydrochloride (Zofran)

Description Appropriate for mild to moderate pain Has analgesic (reduce pain) and antipyretic (reduce fever) effects NSAIDs (non-steroidal, anti-inflammatory drugs) have analgesic, antiinflammatory, antiplatelet (blood thinner), and antipyretic effects

Normal Range

Appropriate for moderate to severe pain (postoperative pain, MI pain, cancer pain)

Enhance the effects of nonopiods, help alleviate other symptoms that aggravate pain (depression, seizures, inflammation), and are useful for treatment of neuropathic pain

Risks Liver toxicity

Constipation Orthostatic hypotension Urinary retention Nausea/vomiting Sedation Respiration depression

Classification Acetominophen Therapuetic: antipyretics, nonopioid analgestics

Route (Onset, Peak, Duration) Range (adult only) Oral (0.5-1hr, 1-3hr, 3-8hr) Rect (0.5-1hr, 1-3hr, 3-4hr) IV (<30min, 30min, 4-6hr) PO: 325-650mg q4-6hr, or 1g 3-4 times daily, or 1300mg q8hr (not to exceed 4g or 2.5g/24hr in patients with hepatic/renal impairment.

Alendronate (Fosamax)

Therapeutic: bone resorption PO (1mo, 3-6mo, 3wk-7mo) inhibitors Pharmacologic: PO: 10mg once daily or 70mg once biphosphonates weekly (Treatment of Osteoporosis) PO: 5mg once daily or 35mg once weekly (Prevention of Osteoporosis)

Aspirin (see Salicylates) Bisacodyl

Therapeutic: laxative Pharmacologic: Stimulant laxatives

PO (6-12hr, unknown, unknown) Rectal (15-60min, unknown, unknown) PO: 5-15mg/day (up to 30mg/day) as single dose Rect: 10mg/day single dose

Celecoxib (CeleBREX) Therapeutic: antirheumatics, nonsteroidal antiinflammatory agents Pharmacologic: COX-2 inhibitors

PO (24-48hr, unknown, 12-24hr) PO: 200mg once daily or 100mg twice daily (Osteoarthritis) PO: 100-200mg twice daily (Rheumatoid arthritis)

Diltiazem

Therapeutic: antianginals, antiarrhythmics (class IV), antihypertensives Pharmacologic: calcium channel blockers

PO (30min, 2-3hr, 6-8hr) IV (2-5min, 2-4hr, unknown) PO: 30-200mg 3-4 times daily (should not exceed 240mg/day)

Docusate sodium

Therapeutic: laxatives PO (12-72hr, unknown, unknown) Pharmacologic: stool softener Rect (2-15min, unknown, unknown) PO: 50-400mg in 1-4 divided doses Rect: 50-100mg or 1 unit containing 283mg docusate sodium, soft soap, and glycerin

Fluoxetine

Therapeutic: antidepressants PO (1-4wk, unknown, 2wk) Pharmacologic: selective serotonin reuptake inhibitors PO: 20mg/day in morning (Depression) (SSRIs) 10mg/day (Panic disorder) 60mg/day (Bulimia nervosa) 20mg/day (PMDD)

Furosemide (Lasix)

Therapeutic: diuretics Pharmacologic: loop diuretic

PO (30-60min, 1-2hr, 6-8hr) IM (10-30min, uknown, 4-8hr) IV (5min, 30min, 2hr) PO: 20-80mg/day single dose initially, may repeat 6-8hr; may incr. dose 2040mg q6-8hr until desired response. Maint. Doses may be given once or twice daily 40mg twice daily (Hypertension), decr dose of other hypertensives by 50% when added to regimen. 120mg/day in 1-3 doses (Hypercalcemia) IM, IV: 20-40mg, may repeat in 1-2hr and incr. by 20mg every 1-2hr until desired response. Maint. dose may be given q6-12hr

Gabapentin

Therapeutic: analgesic adjuncts, therapeutic, anticonvulsants, mood stabilizers

PO-IR (rapid, 2-4hr, 8hr) PO-SR (unknown, 5-8hr, 24hr) See Drug guide for dosages specific to: Renal Impairment Epilepsy Post-Herpetic Neuralgia Restless Legs Syndrome

Heparin (Low Therapeutic: anticoagulants Molecular Weight) Pharmacologic: Enoxaparin/Lovenox) antithrombotics

SQ (unknown, 3-5hr, 12hr) SQ: 30-40mg q12hr starting 12-24hr postop for 7-10days 1mg/kg q12hr (treatment of DVT/PEoutpatient)

HMG-CoA Reductase Theraptuetic: lipid-lowering Inhibitors (statins) agents Simvastatin Pharmacologic: HMG-CoA reductase inhibitors

PO (several days, 2-4wks, unknown) PO: 5-40mg once daily in evening: if LDL goal cannot be achieved with 40mg/day dose, add another lipid-lowering therapy

Hydralazine

Therapeutic: antihypertensives Pharmacologic: vasodilators

PO (45min, 2hr, 2-4hr) IM (10-30min, 1hr, 3-8hr) IV (5-20min, 15-30min, 2-6hr) PO: 10mg 4 times daily (2-4 days), then up to 25mg 4 times daily (1st week), then up to 50mg 4 times daily (up to 300mg/day) IM: 5-40mg repeated as needed

Hydrochlorothiazide

Therapeutic: antihypertensives, diuretics Pharmacologic: thiazide diuretics

PO (2hr, 3-6hr, 6-12hr) PO: 12.5-100mg/day in 1-2 divided doses (up to 200mg/day); not to exceed 50mg/day for hypertension; daily doses >25mg associated with greater likelihood of electrolyte abnormalities

Hydrocodone

Therapeutic: allergy, cold, and cough remedies (antitussive), opioid analgesics Pharmacologic: opioid agonists/nonopioid analgesic combinations

PO (10-30min, 30-60min, 4-6hr) PO: 2.5-10mg q3-6hr as needed (Analgesic) 5mg q4-6hr as needed (Antitussive)

Isosorbide mononitrate

Therapeutic: antianginals Pharmacologic: nitrates

PO (30-60min, unknown, 7hr) ER (unknown, unknown, 12hr) PO: 5-20mg 2 times daily, 7hr apart

Levothyroxine

Therapeutic: hormones Pharmacologic: thyroid preparations

PO (unknown, 1-3wk, 1-3wk) IV (6-8hr, 24hr, unknown) PO: 50mcg single dose (hypothyroidism) IV: 50-100mcg/day single dose

Magnesium hydroxide Therapeutic: mineral and (Dulcolax magnesia electrolyte tablets) replacements/supplements, laxatives Pharmacologic: salines

PO (3-6hr, unknown, unknown) 30-60mL single or divided dose or 1020mL as concentrate

Mesalamine (Asacol) Therapeutic: gastrointestinal anti-inflammatories

PO (unknown, unknown, 6-8hr) ER (2hr, 9-12hr, 24hr) Rectal (3-21days, unknown, 24hr) PO: 800mg 3 times daily for 6wk; 1.6g 3 times daily for 6wk

Metoprolol

Therapeutic: antianginals, PO (15min, unknown, 6-12hr) antihypertensives IV (immediate, 20min, 5-8hr) Pharmacologic: beta blockers PO: 25-100mg/day as single dose (antihypertensive/antianginal) 25-50mg q6hr for 48hr, then 100mg twice daily (MI) 12.5-25mg/daily (heart failure) 50-100mg 2-4 times daily (migraine prevention IV: 5mg q2min for 3 doses (MI), followed by oral dosing

Nitroglycerin

Therapeutic: antianginals Pharmacologic: nitrates

Patch/transdermal (40-60min, unknown, 8-24hr) Patch/transdermal: 0.2-0.4mg/hr initially; patch should be worn 1214hr/day then taken off for 1012hr/day

Omeprazole (Prilosec) Therapeutic: antiulcer agents PO-delayed release (within 1hr, within Pharmacologic: proton-pump 2hr, 72-96hr) inhibitors PO: 20mg once daily (GERD/erosive esophagitis) 40mg once daily for 4-6wk (Gastric ulcer) 20mg once daily for up to 14 days (OTC)

Pantaoprazole

Therapeutic: antiulcer agents PO (2.5hr, unknown, 1wk) Pharmacologic: proton-pup IV (15-30min, 2hr, unknown) inhibitors

Potassium chloride

Therapeutic: mineral and electrolyte replacements/supplements

See Drug Guide

Propranolol (Inderal) Therapeutic: antianginals, PO (30min, 60-90min, 6-12hr) antiarrhythmics (Class II), IV (immediate, 1min, 4-6hr) antihypertensives, vascular headache suppressants Pharmacologic: beta blockers

Salicylates (Aspirin)

Therapeutic: antipyretics, nonopioid analgesics Pharmacologic: salicylates

Vancomycin

Therapeutic: anti-infectives

IV (rapid, end of infusion, 12-24hr)

Zolpidem (Ambien)

Therapeutic: sedative/hypnotics

See Drug Guide

Indication & Action PO & Rect: Treatment of mild pain & fever IV: Treatment of mild to moderate pain, Moderate to severe pain with opioid analgesics, Fever

Contraindications/Precautions Previous hypersensitivity; Products containing alcohol, aspartame, saccharin, sugar, or tartrazine (yellow dye) should be avoided in patients who have hypersensitivity; Severe hepatic impairment/active liver disease.

Inhibits synthesis of prostaglandins that may serve as mediators of pain and fever, primarily in CNS. No significant anti-inflammatory props. or GI toxicity. Treatment & prevention of postmenopausal Abnormalities of esophagus with delay osteoporosis. esophagel emptying; Inability to stand/sit upright for 30min; Renal insufficiency Inhibits resorption of bone by inhibiting (CCr<35mL/min). osteoclast activity Use cautiously in history of upper GI disorders; Pre-existing hypocalcemia or vitamin D deficiency; Cancer, receiving chemotherapy or corticosteroids, dental disease.

Treatment of constipation. Evacuation of bowel before radiologic studies or surgery. Part of bowel regimen in spinal cord injury patients Stimulates peristalsis. Alters fluid and electrolyte transport, producing fluid accumulation in the colon.

Hypersensitivity, Abdominal pain; Obstruction; nausea or vomiting. Use cautiously in severe cardiovascular disease; Anal or rectal fissures; Excess or prolonged use

Relief of S&S of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and juvenile rheumatoid arthritis. Mgmt. of acute pain including parimary dysmenorrhea.

Inhibits enzyme COX-2, the enzyme required for synthesis of prostaglandins. Has analgesic, anti0inflammatory, and antipyretic properties. Use cautiously in CV disease or risk factors for CV disease; Pre-existing renal disease, heart Decreased pain and inflammation caused by failure, liver dysfunction; Hypertension or arthritis or spondylitis. Decrease pain. fluid retention; Renal insufficiency; Serious dehydration (correct before administering); Hypertension, Angina pectoris and vasopastic angina. Supraventricular tachyarrhythmias and rapid ventricular rates in atrial flutter or fibrillation. Inhibits transport of calcium into myocardial and vascular smooth muscle cells, resulting in inhibition of excitation-contraction coupling and subsequent contraction. Therapeutic effect: Systemic vasodilation resulting in decreased BP. Coronary vasodilation resulting in decreased frequency and severity of attacks of angina. Reduction of ventricular rate in atrial fibrilation or flutter. Hypersensitivity; Sick sinus syndrome; 2nd or 3rd degree AV block (unless artificial pacemaker is inplace); SBP <90 mmHg; Recent MI or pulmonary congestion; Concurrent use of rifampin. Use cautiously in severe hepatic impairrment; incr. risk of hypotension; consider age-related decrease in body mass, decr. hepatic/renal/cardiac function; Severe renal impairment; Serious ventricular arrhythmias or HF

Hypersensitivity; Cross-sensitivity may exist with other NSAIDs (e.g. aspirin); Allergies to sulfonamides; History of asthma, urticaria, or allergice-type reactions to aspirin or other NSAIDs; Advanced renal disease; Severe hepatic dysfunction.

Prevention of constipation (in patients who should avoid straining, such as after Mi or rectal surgery. Used as enema to soften fecal impaction. Promotes incorporation of water into stool, resulting in softer fecal mass. May also promote electrolyte and water secretion into colon. Softening and passage of stool.

Hypersensitivity; Abdominal pain, nausea, or vomiting, especially when associated with fever or other signs of acute abdomen. Use cautiously in excessive or prolonged use leading to dependence; Should not be used if prompt results are desired

Major depressive disorder. OCD. Bulimia nervosa. Panic disorder. Depressive episodes associated with bipolar I disorder. Selectively inhibits reuptake of serotonin in CNS. Therapeutic effects: antidepressant action. Decreased behaviors associated with panic disorder, bulimia. Decreased mood alterations associated with PMDD (premenstrual dysphoric disorder) Edema due to heart failure, hepatic impairment or renal disease. Hypertension. Inhibits reabsorption of Na and Cl from loop of Henle and distal renal tubule. Incr. renal excretion of H2O, NA, Cl, Mg, K, and Ca. Effectiveness persists in impaired renal function. Diuresis and subsequent mobilization of excess fluid (edema, pleural effusions). Decreased BP.

Hypersensitivity; Concurrent use or use within 14 days of discontinuing MAO inhibitors; Concurrent use of pimozide; Concurrent use of thioridazine. Use cautiously in history of seizures; Debilitated patients (incr. risk of seizures); DM; Concurrent chronic illness of multiple drug therapy; May incr. risk of suicide attempt/ideation; Pt. with incr. intraocular pressure or at risk of acute narrow-angle glaucoma. Hypersensitivity; Cross-sensitivity with thiazides and sulfonamides may occur; Hepatic coma or anuria; Some liquid products may contain alcohol, avoid in patients with alcohol intolerance. Use cautiously in severe liver disease (may precipitate hepatic coma; concurrent use with K-sparing diuretics may be necessary); Electrolyte depletion; DM; Hypoproteinemia (incr. risk of ototoxicity; Severe renal impairment (incr. risk of ototoxicity).

Partial seizures (adjunct treatment) (immediate-release only). Post-herpetic neuralgia (immediate-release and Gralise only). Restless legs syndrome (Horizant only) Mechanism of action is not known. May affect transport of amino acids across and stabilize neuronal membranes. Therapeutic effects: Decreased incidence of seizures. Decreased post-herpetic pain. Decreased leg restlessness. Prevention of venous thromboembolism (VTE), deep vein thrombosis (DVT) and/or pulmonary embolism (PE) in surgical or medical patients. Treatment of DVT with or without PE (warfarin). Prevention of ischemic complications (with aspirin) from unstable angina and non-ST-segment-elevation MI. Treatment of acute-ST-segment-elevation MI (with thrombolytics or percutaneous coronary intervention). Adjunctive management of primary hypercholesterolemia and mixed dyslipidemias. Secondary prevention of cardiovascular events (ecr. Risk of MI, coronary revascularization, stroke, and CV mortality) in patients with clinically evident CHD or those at high-risk for HCD (e.g. history of diabetes, peripheral arterial disease, or stroke) Moderate to severe hypertension (with diuretic).

Hypersensitivity Use cautiously in all patients (may incr. risk of suicidal thoughts/behaviors); Renal insufficiency.

Hypersensitivity to specific agents or pork products; cross-sensitivity may occur; Some products contain sulfites or benzyl alcohol and should be avoided; Active major bleeding; History of heparin-induced thrombocytopenia. Use cautiously in severe hepatic or renal disease. Hypersensitivity; Active liver disease or unexplained persistent incr. in AST or ALT; Concurrent use of gemfibrozil or azole antifungals; Concurrent use of nelfinavir or ritonavir. Use cautiously in hisotry of liver disease; Alcoholis Hypersensitivity; Some products contain tartrazine and should be avoided in patients with intolerance.

Direct-acting peripheral arteriolar vasodilator. Therapeutic effects: lowering of BP in Use cautiously in cardiovascular or hypertensive patients and decreased cerebrovascular disease; Severe renal and afterload in patients with HF. hepatic disease

Mgmt. of mild to moderate hypertension. Trmt. Of edema associated with: HF, Renal dysfunction, Cirrhosis, Glucocorticoid therapy, Estrogen therapy. Increases excretion of NA and H2O by inhibiting NA reabsorption in distal tubule. Promotes excretion of Cl, K, Mg, and HCO3. May produce arteriolar dilation. Lowering of BP in hypertensive patients and diuresis with mobilization of edema.

Hypersensitivity (cross-sensitivity with other thiazides or sulfonamides may exist); Some products contain tartrazine and should be avoided in patients with intolerance; Anuria; Lactation. Use cautiously in renal or hepatic impairment.

Used mainly in combination with nonopioid analgesics (acetaminophen/ibuprofen) in mgmt of moderate to severe pain. Antitussive (usually in combination with decongestants)

Hypersensitivity to hydrocodone. Hypersensitivity to acetaminophen/ibuprofen; Ibuprofen-containing products should be avoided in patients with bleeding disorders or thrombocytopenia; AcetaminophenBind to opiate receptors in CNS. Alter containing products should be avoided in perception of and response to painful stimuli patients with severe hepatic or renal disease; while producing generalized CNS depression; Ibuprofen-containing products should be Suppress the cough reflex via a direct central avoided in patients undergoing coronary action. Therapeutic effects: decrease in artery bypass graft surgery. severeity of moderate pain. Suppression of cough reflex. Use cautiously in incr. intracranial pressure; Severe renal, hepatic, or pulmonary disease; CV disease (ibuprofen-containing products only); History of peptic ulcer disease (ibuprofen-containing products only); Alcoholism

Acute treatment of anginal attacks (SL only). Prophylactic mgmt of angina pectoris. Produce vasodilation (venous greater than arterial). Decrease left ventricular enddiastolic pressure and left ventricular enddiastolic volume (preload). Net effect is reduced myocardial oxygen consumption. Increase coronary blood flow by dilating coronary arteries and improving collateral flow to ischemic regions. Therapeutic effects: relief and prevention of anginal attacks.

Hypersensitivity; Concurrent use of sildenafil, vardenafil, or tadalafil. Use cautiously in volume depleted patients; Right ventricular infarction; Hypertrophic cardiomyopathy

Thyroid supplementation in hypothyroidism. Hypersensitivity; Recent MI; Hyperthyroidism Treatment or suppression of euthyroid goiters. Adjunctive treatment for thyrotropin- Use cautiously in CV disease; Severe renal dependent thyroid cancer. insufficiency; Uncorrected adrenocortical disorders Replacement of or supplementation to endogenous thyroid hormones. Principal effect is increasing metabolic rate of body tissues: promote gluconeogenesis, Increase utilization and mobilization of glycogen stores, Stimulate protein synthesis. Promote cell growth and differentiation, Aid in development of brain and CNS. Therapeutic effects: Replacement in hypothyroidism to restore normal hormonal balance. Suppression of thyroid cancer. Treatment/prevention of hypomagnesemia. Hypermagnesemia; Hypocalcemia; Anuria; As a: laxative, Bowel evacuant in prep for Heart block. surgical radiographic procedures. Use cautiously in any degree of renal insufficiency. Essential for activity of many enzymes. Play an important role in neurotransmission and muscular excitability. Are osmotically active in GI tract, drawing water into lumen and causing peristalsis. Therapeutic effects: replacemnent in deficiency states. Evacuation of colon.

Treatment and maintenance of remission of mildly-to-moderately active ulcerative colitis

Hypersensitivity reactions to sulfonamides, salicylates, mesalamine, or sulfasalazine; Cross-sensitivity with furosemide, sulfonylurea hypoglycemic agents, or carbonic anhydrase inhibitors may exist; Hypersensitivity to bisulfites; Urinary tract or intestinal obstruction; Porphyria.

Use cautiously in severe hepatic or renal impairment Hypertension, Angina pectoris, Prevention of Uncompensated HF; Pulmonary edema; MI and decreased mortality in patients with Cardiogenic shock; Bradycardia, heart block, recent MI. Mgmt of stable, symptomatic (class or sick sinus syndrome (in absence of II or III) heart failure due to ischemic, pacemaker). hypertensive or cardiomyopathic origin (may be used with ACE inhibitors, diuretics and/or Use cautiously in renal impairment; Hepatic digoxin; Toprol XL only) impairment. Blocks stimulation of beta1 (myocardial)adrenergic receptors. Does not usually affect beta2 (pulmonary,vascular, uterine)adrenergic receptor sites. Therapeutic effects: decreased BP and heart rate. Decreased frequency of attacks of angina pectoris. Decreased rate of cardiovascular mortality and hospitalization in patients with heart failure. Acute and long-term prophylatic management Hypersensitivity; Severe anemia; Pericardial of angina pectoris. tamponade; Constrictive pericarditis; Alcohol intolerance. Increases coronary blood flow by dilating coronary arteries and improving collateral Use cautiously in head trauma or cerebral flow to ischemic regions. Produces hemorrhage; Glaucoma; Hypertrophic vasodilation (venous greater than arterial). cardiomyopathy; Severe liver impairment Decreases left ventricular end-diastolic pressure and left ventricular end-diastolic volume (preload). Reduces mycardial oxygen consumption. Therapeutic effects: Relief or prevention of anginal attacks. Increased cardiac output. Reduction of BP.

GERD/maintenance of healing in erosive Hypersensitivity. esophagitis. Duodenal ulcers (with or without Use cautiously in liver disease. anti-infectives for Helicobacter pylori). Shortterm treatment of active benign gastric ulcer. Pathologic hypersecretory conditions, including Zollinger-Ellison syndrome. Reduction of risk of GI bleeding in critically ill patients Binds to an enzyme on gastric parietal cells in the presence of acidic pH, preventing the final transport of hydrogen ions into the gastric lumen. Therapeutic effects: diminished accumulation of acid in the gastric lumen with lessened gastroesophagel reflux. Healing of duodenal ulcers. Erosive esophagitis associated with GERD. Hypersensitivity. Decrease relapse rates of daytime and Use cautiously in patients using high-doses for nighttime heartburn symptoms on patients >1yr (incr. risk of hip, wrist, or spine fractures) with GERD. Pathologic gastric hypersecretory conditions. Binds to an enzyme in the presence of acidic gastric pH, preventing the final transport of hydrogen ions into the gastric lumen. Therapeutic effects: diminished accumulation of acid in the gastric lumen, with lessened acid reflux. Healing of duodenal ulcers and esophagitis. Decreased acid secretion in hypersecretory conditions.

Treatment/prevention of potassium Hyperkalemia; Severe renal impairment; depletion. Arrhythmias due to digoxin toxicity Severe tissue trauma Maintain acid-base balance, isotonicity, and electrophysiologic balance of the cell. Activator in many enzymatic reactions; essential to transmission of nerve impulses; contraction of cardiac, skeletal, and smooth muscle; gastric secretion; renal function; tissue synthesis; and carbohydrate metabolism. Therapeutic effects: replacement. Prevention of deficiency. Management of hypertension, angina, arrhythmias, hypertrophic cardiomyopathy, thyrotoxicosis, essential tremors, pheochromocytoma. Also used in prevention and mgmt of MI, and prevention of vascular headaches. Blocks stimulation of beta1 (myocardial) and beta2 (pulmonary, vascular, and uterine)adrenergic receptor sites. Therapeutic effects: decreased heart rate and BP. Suppression of arrhythmias. Prevention of MI. Inflammatory disorder including: Rheumatoid arthritis, Osteoarthritis. Mild to moderate pain. Fever Prophylaxis of transient ischemic attacks and MI Produce analgesia and reduce inflammation and fever by inhibiting the production of prostaglandins. Decreases platelet aggregation Therapeutic effects: analgesia. Reduction of inflammation. Reduction of fever. Decreased incidence of transient ischemic attacks and MI. Use cautiously in cardiac disease, Renal impairment; Diabetes mellitus; Hypomagnesemia; GI hypomotility including dysphagia or esophageal compression; patients receiving potassium-sparring drugs

Uncompensated HF; Pulmonary edema; Cardiogenic shocks; Bradycardia, sick sinus syndrome, or heart block (unless pacemaker present) Use cautiously in renal or hepatic impairment; Pulmonary disease (including asthma); Diabetes mellitus (may mask signs of hypoglycemia)

Hypersensitivity to aspirin or other salicylates. Cross-sensitivity with other NSAIDs may exist; Bleeding disorders or thrombocytopenia Use cautiously in hisotry of GI bleeding or ulcer disease; Chronic alcohol use/abuse; Severe renal disease; Severe hepatic disease; CV disease or risk factors for cardiovascular disease

Treatment of potentially life-threatening infections when less toxic anti-infectives are contraindicated. Particularly useful in staphylococcal infection, including: Endocarditis, Meningitis, Osteomyelitis, Pneumonia, Septicemia, Soft-tissue infection in patients who have allergies to penicillin or its derivatives or when sensitivity testing demonstrates resistance to methicillin

Hypersensitivity Use cautiously in renal impairment; Hearing impairment; Intestinal obstruction or inflammation

Binds to bacterial cell wall, resulting in cell death. Therapeutic effects: Bactericidal action against susceptible organisms. Spectrum: Active against gram-positive pathogens, including Staphylococci, Group A betahemolytic streptococci, Streptococcus pneumooniae, Corynebacterium, Clostridium difficle, Enterococcus faecalis, Enterococcus faecium Insomnia Hypersensitivity; Sleep apnea Use cautiously in history of previous Produces CNS depression by binding to GABA psychiatric illness, suicide attempt, drug or receptors. Has no analgesic properties. alcohol abuse; Hepatic impairment Therapeutic effects: sedation and induction of sleep.

Adverse React. Hepatotoxicity (liver damage), renal failure

CNS: Headache EENT: Blurred vision, conjunctivities, eye pain/inflammation. CV: Atrial fibrillation GI: Abdominal distention, abdominal pain, acid regurgitation, constipation, diarrhea, dyspepsia, dysphagia, esophagel cancer, esophagel ulcer, esophagitis, flatulence, gastritis, nausea, taste perversion, vomiting Derm: Erythema, photosensitivity, rash MS: Musculoskeletal pain, femur fractures

GI: Abdominal cramps, nausea, diarrhea, rectal burning F&E: Hypokalemia (chronic use) MS: Muscle weakness (chronic use)

CNS: dizziness, headache, insomnia CV: Myocardial infarction, stroke, thrombosis, edema GI: GI bleeding, abdominal pain, diarrhea, dyspepsia, flatulence, nausea

CNS: anxiety, confusion, dizziness, drowsiness, headache, nervousness, psychiatric disturbances, weakness. EENT: blurred vision, disturbed equilibrium, epistaxis, tinnitus. Resp: cough, dyspnea CV: arrhythmias, HF, peripheral edema, bradycardia, chest pain, hypotension, palpitations, syncope, tachycardia GI: incr. liver enzymes, anorexia, constipation, diarrhea, dry mouth, dysgeusia, dyspepsia, nausea, vomiting. Hemat: anemia, leukopenia, thrombocytopenia Metab: weight gain. MS: joint stiffness, muscle cramps EENT: throat irritation GI: mild cramps, diarrhea Derm: rashes

CNS: Neuroleptic malignant syndrome, seizures, suicidal thoughts, anxiety, drowsiness, headache, insomnia, nervousness. GI: diarrhea GU: sexual dysfunction Derm: incr sweating, pruritus Neuro: tremor Misc.: Serotonin Syndrome

CNS: blurred vision, dizziness, headache, vertigo. EENT: hearing loss, tinnitus CV: hypotension GI: anorexia, constipation, diarrhea, dry mouth, dyspepsia, incr. liver enzymes, nausea, pancreatitis, vomiting GU: incr. BUN, excessive urination, nephrocalcinosis Derm: toxic epidermal necrolysis, photosensitivity, pruritis, rash Endo: hypercholesterolemia, hyperglycemia, hypertriglyceridemia, hyperuricemia F&E: dehydration, hypocalcemia, hypochloremia, hypokalemia, hypomagnesemia, hyponatremia, hypovolemia, metabolic alkalosis Hemat: Aplastic anemia, Agranulocytosis

CNS: Suicidal thoughts, confusion, depression, drowsiness Neuro: ataxia Misc.: multi-organ hypersensitivity reactions

Hemat: Bleeding, anemia

GI: abdominal cramps, constipation, diarrhea, flatus, heartburn Derm: rashes MS: Rhabdomyolysis

CV: tachycardia F&E: sodium retention Misc.: drug-induced lupus syndrome

CNS: dizziness, drowsiness, weakness CV: hypotension EENT: acute angle-closure glaucoma, acute myopia GI: anorexia, cramping, hepatitis, nausea, pancreatitis, vomiting Endo: hyperglycemia F&E: hypokalemia, dehydration, hypercalcemia, hypochloremic alkalosis, hypomagnesemia, hyponatremia, hypophosphatemia, hypovolemia Hamat: thrombocytopenia Metab: hypercholesterolemia, hyperuricemia MS: Muscle cramps CNS: convusion, dizziness, sedation CV: hypotension GI: constipation, dyspepsia, nausea

CNS: dizziness, headache CV: hypotension, tachycardia

Usually only seen when excessive doses cause iatrogenic hyperthyroidism.

GI: diarrhea

CNS: headache Misc.: Anaphylaxis

CNS: fatigue, weakness CV: Bradycardia, HF, Pulmonary edema GU: erectile dysfunction

CNS: dizziness, headache CV: hypotension, tachycardia

GI: abdominal pain

CV: arrhythmias GI: abdominal pain, diarrhea, flatulence, nausea, vomiting

CNS: fatigue, weakness CF: arrrhythmias, bradycardia, HF, pulmonary edema GU: eretile dysfunction Derm.: Erythema multiforme, exfoliative dermatitis, toxic epidermal necrolysis Misc.: Anaphylaxis

GI: GI Bleeding, dyspepsia, epigastric distress, nausea Derm: Exfoliative dermatitis, Toxic epidermal necrolysis Misc.: Anaphylaxis and laryngeal edema

GU: nephrotoxicity Local: phlebitis Misc.: Anaphylaxis

CNS: daytime drowsiness, dizziness Misc.: Anaphylactic reactions

Room

Time

Name

LOC

Temp 96.8 - 99.5 F 36 - 37.5 C

Temp Method

Pulse 60 - 100

BP 120/80 mmHg Pulse Press. 40

Pulse Ox 95 - 100%

Air

Respiration 20-Dec

Pain

Pain Notes

Sodium 135 - 145 mEq/L

Potassium 3.5 - 5.3 mEq/L

Calcium 8.6 - 10 mg/dL

SERUM LEVELS Magnesium Chloride 1.6 - 2.6 mEq/L 98 - 107 mEq/L

Phosphate 2.7 - 4.5 mg/dL

Bicarbonate 22 - 29 mEq/L

BUN 10 - 20 mg/dL

Arterial Glucose 70 - 110 mg/dL (fasting) 100 - 140 mg/dL (non-fasting) pH 7.35 - 7.45

Arterial Blood Gases PaO2 SaO2 PaCO2 80 - 100 mm Hg 93 - 96% 35 - 45 mm Hg

HCO3 22 - 26 mEq/L