Clinical Helper Sheet

8/14/2019 Clinical Helper Sheet

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Pulse (beats/

min)

RR (breaths/

min)

Systolic blood

pressure

Adult > 18 yrs 60-100 12-20 100-140

Adolescent

12-18 yrs

60-100 12-16 90-110

Children

5-12 yrs

70-120 18-30 80-110

Preschool

4-5 yrs

80-140 22-34 80-100

Toddler1-3 yrs

90-150 24-40 80-100

Infants

1 month to 1 yr

100-160 30-60 70-95

Newborn to 1

month

120-160 40-60 50-70

Pulse (beats/

min)

RR (breaths/

min)

Systolic b

pressu

Adult > 18 yrs 60-100 12-20 10

Adolescent

12-18 yrs

60-100 12-16 9

Children

5-12 yrs

70-120 18-30 8

Preschool

4-5 yrs

80-140 22-34 8

Toddler1-3 yrs

90-150 24-40 8

Infants

1 month to 1 yr

100-160 30-60

Newborn to 1

month

120-160 40-60


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Ventrogluteal landmarks Ventrogluteal landmarks


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Note: no dorsogluteal injections!!! Site no longer

Recommended. Preferred infant site: vastus lateralis

Note: no dorsogluteal injections!!! Site no longer

Recommended. Preferred infant site: vastus lateralis


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Subcutaneous shots can be given straight in at a 90 degree angle, or at a 45

degree angle. Give the shot straight in at a 90 degree angle if 2 inches of skin

can be grasped between your thumb and first (index) finger. If only 1 inch of

skin can be grasped, give the shot at a 45 degree angle.

Subcutaneous shots can be given straight in at a 90 degree angle, or at a 45

degree angle. Give the shot straight in at a 90 degree angle if 2 inches of skin

can be grasped between your thumb and first (index) finger. If only 1 inch of

skin can be grasped, give the shot at a 45 degree angle.


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Mixing insulins. Ensure the insulins can be mixed! Most facilities dont

mix anymore

1. Air to cloudy (dont draw up yet!)2. Air to clear, draw up clear.

3. Draw up cloudy.

4. Inject

Mixing insulins. Ensure the insulins can be mixed! Most facilities dont

mix anymore

1. Air to cloudy (dont draw up yet!)2. Air to clear, draw up clear.

3. Draw up cloudy.

4. Inject


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Code Bluecardiopulmonary arrest

Code Blackweather related emergency

Code pinkinfant abduction or pediatric code

Code redfire

Code whitedisruptive physician

These codes will vary by hospital.

Important phone numbers:

Instructor

Unit:

Unit:

Unit:

Unit:

Unit:

Dietary:

Linen:

Transportation:

Lab:

Pharmacy:

Operator:

Door codes:

Code Bluecardiopulmonary arrest

Code Blackweather related emergency

Code pinkinfant abduction or pediatric code

Code redfire

Code whitedisruptive physician

These codes will vary by hospital.

Important phone numbers:

Instructor

Unit:

Unit:

Unit:

Unit:

Unit:

Dietary:

Linen:

Transportation:

Lab:

Pharmacy:

Operator:

Door codes:


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Rotation objectives:

Skills you may perform:

Rotation objectives:

Skills you may perform:


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ommon diagnoses on this floor:

ommon medications on this floor:

Common diagnoses on this floor:

Common medications on this floor:


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. (Acid) The Respiratory System

CO2 is a volatile acid.

If you increase your respiratory rate (hyperventilation) you "blow off" CO2

cid) therefore decreasing your CO2 (acid)--giving you Alkalosis.

If you decrease your respiratory rate (hypoventilation) you retain CO2

cid) therefore increasing your CO2 (acid)--giving you Acidosis.

B. (Base) The Renal System

The Kidneys rid the body of nonvolatile acids (H+=Hydrogen ions) and

aintain a constant HCO3 (bicarbonate = base).

You have Acidosis when you have excess H+ and decreased HCO3 (base)

using a decrease in pH.The Kidneys try to adjust for this by excreting H+ and retaining HCO3

ase).The Respiratory System will try to compensate by increasing ventila-

on to blow off CO2 (acid) and therefore decrease the Acidosis.

You have Alkalosis when H+ decreases and you have excess (or increased)

CO3 (base).The Kidneys excrete HCO3 (base) and retain H+ to compensate.The Respiratory System tries to compensate with hypoventilation to

tain

CO2 (acid) to decrease the Alkalosis.

There are other "buffers" involved here--like Carbonic Acid, Ammonia,

nd Protein. (Hgb)

Compensation

The Respiratory System can effect a change in 15-30 minutes.The Renal System takes several hours to days to have an effect.

A. (Acid) The Respiratory System

CO2 is a volatile acid.

1. If you increase your respiratory rate (hyperventilation) you "blow off

(acid) therefore decreasing your CO2 (acid)--giving you Alkalosis.

2. If you decrease your respiratory rate (hypoventilation) you retain CO2

(acid) therefore increasing your CO2 (acid)--giving you Acidosis.

B. (Base) The Renal System

The Kidneys rid the body of nonvolatile acids (H+=Hydrogen ions)

maintain a constant HCO3 (bicarbonate = base).

1. You have Acidosis when you have excess H+ and decreased HCO3 (b

causing a decrease in pH.The Kidneys try to adjust for this by excreting H+ and retaining H

(base).The Respiratory System will try to compensate by increasing vent

tion to blow off CO2 (acid) and therefore decrease the Acidosis.

3. You have Alkalosis when H+ decreases and you have excess (or incre

HCO3 (base).The Kidneys excrete HCO3 (base) and retain H+ to compensate.The Respiratory System tries to compensate with hypoventilation

retain

CO2 (acid) to decrease the Alkalosis.

4. There are other "buffers" involved here--like Carbonic Acid, Ammon

and Protein. (Hgb)

C. Compensation

The Respiratory System can effect a change in 15-30 minutes.The Renal System takes several hours to days to have an effect.


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A. Respiratory Acidosis pH < 7.35 (Normal = 7.35-7.45)

CO2 > 45 (Normal = 35-45)

1. Causes:

--Hypoventilation

a. Depression of the Respiratory Center (sedatives, narcotics,

drug overdose, CVA, cardiac arrest, MI)

b. Respiratory muscle paralysis (spinal cord injury, Guillian-

Barre, paralytics)

c. Chest wall disorders (flail chest, pneumothorax)

d. Disorders of the lung parenchyma (CHF, COPD, pneumonia,

aspiration, ARDS)

e. Alteration in the function of the abdominal system (distention)

2. Signs and Symptoms:

a. CNS depression (decreased LOC)

b. Muscle twitching which can progress to convulsions

c. Dysrhythmias, tachycardia, diaphoresis (related to hypoxia

econdary to hypoventilation)

d. Palpitationse. Flushed skin

f. Serum electrolyte abnormalities including elevated K+ (K+

eaves the cell to replace the H+ buffers leaving the cell)

3. Treatment:

a. Physically stimulate the pt to improve ventilation

b.Vigorous pulmonary toilet (chest PT, coughing and deep

breathing, inspirometer, respiratory treatments with Bronchodilators)

c. Mechanical Ventilation (to increase the respiratory rate and

idal volume

A. Respiratory Acidosis pH < 7.35 (Normal = 7.35-7.45)

CO2 > 45 (Normal = 35-45)

1. Causes:

--Hypoventilation

a. Depression of the Respiratory Center (sedatives, narcotics

drug overdose, CVA, cardiac arrest, MI)

b. Respiratory muscle paralysis (spinal cord injury, Guillian

Barre, paralytics)

c. Chest wall disorders (flail chest, pneumothorax)

d. Disorders of the lung parenchyma (CHF, COPD, pneumo

aspiration, ARDS)

e. Alteration in the function of the abdominal system (disten

2. Signs and Symptoms:

a. CNS depression (decreased LOC)

b. Muscle twitching which can progress to convulsions

c. Dysrhythmias, tachycardia, diaphoresis (related to hypoxia

secondary to hypoventilation)

d. Palpitationse. Flushed skin

f. Serum electrolyte abnormalities including elevated K+ (K+

leaves the cell to replace the H+ buffers leaving the cell)

3. Treatment:

a. Physically stimulate the pt to improve ventilation

b.Vigorous pulmonary toilet (chest PT, coughing and deep

breathing, inspirometer, respiratory treatments with Bronchodil

c. Mechanical Ventilation (to increase the respiratory rate an

tidal volume


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C. Metabolic Acidosis pH < 7.35

HCO3 < 22 (normal = 2226)

1. Causes:

--Increased H+, excess loss of HCO3

a. Overproduction of organic acids (starvation, ketoacidosis,

ncreased catabolism)

b. Impaired renal excretion of acid (Renal Failure)c. Abnormal loss of HCO3 (diarrhea, biliary fistula, Diamox)

d. Ingestion of acid (salicylate overdose, oral anti-freeze)

2. Signs and Sypmtoms:

a. CNS depression (confusion to coma)

b. Cardiac Dysrhythmias (elevated T wave, wide QRS to Ven-

ricular Standstill)

c. Electrolyte abnormalities (elevated K+, Cl-, Ca+)

d. Flushed skin (arteriolar dilitation)

e. Nausea

3. Treatment: (treat the underlying cause)

a. NAHCO3 (Sodium Bicarbonate) based on ABGs only and

with caution

b. IV fluids and Insulin for DKA

c. Dialysis for Renal Failure

d. Antibiotics, increased nutrition for tissue catabolism

e. Increase cardiac output and tissue perfusion for low C.O.

tates

f. Rehydrate, monitor I & O

g. Treat Dysrhythmias, support hemodynamic and respiratory

tatus

C. Metabolic Acidosis pH < 7.35

HCO3 < 22 (normal = 2226)

1. Causes:

--Increased H+, excess loss of HCO3

a. Overproduction of organic acids (starvation, ketoacidosis,

increased catabolism)

b. Impaired renal excretion of acid (Renal Failure)c. Abnormal loss of HCO3 (diarrhea, biliary fistula, Diamox

d. Ingestion of acid (salicylate overdose, oral anti-freeze)

2. Signs and Sypmtoms:

a. CNS depression (confusion to coma)

b. Cardiac Dysrhythmias (elevated T wave, wide QRS to Ven

tricular Standstill)

c. Electrolyte abnormalities (elevated K+, Cl-, Ca+)

d. Flushed skin (arteriolar dilitation)

e. Nausea


a. NAHCO3 (Sodium Bicarbonate) based on ABGs only and

with caution

b. IV fluids and Insulin for DKA

c. Dialysis for Renal Failure

d. Antibiotics, increased nutrition for tissue catabolism

e. Increase cardiac output and tissue perfusion for low C.O.

states

f. Rehydrate, monitor I & O

g. Treat Dysrhythmias, support hemodynamic and respiratory

status


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D. Metabolic Alkalosis pH > 7.45

HCO3 > 26

. Causes:

--Loss of H+ or increased HCO3

a. Large losses of gastric contents (vomiting, NG suction)b. Loss of K+ (diarreah, vomiting)

c. Ingestion of large amounts of bicarbonate (antacids, resuscitation)

d. Prolonged use of diuretics (distal tubule lose ability to reabsorb Na+and Cl- therefore Na+, Cl-, K+,

Ammonia are lost in the urine and these bind with H+)

(Note: al-K+-low-sis means K+ value is low when pt is alkalotic)

2. Signs and Symptoms: (similar to the associated disease process)

a. Diaphoresis

b. Nausea and Vomitingc. Increase neuromuscular excitability (Ca+ binds with protein)d. Shallow breathing (Respiratory Compensation)e. EKG changes (increased QT, Sinus Tachycardia)

f. May also see confusion progressing to lethargy to comag. Electrolyte abnormality (decreased Ca+, normal or decreased K+, in-

reased Base Excess on the ABG)


a. Replace KCL losses in 0.9% NaCl (rehydrates and increases HCO3

xcretion)b. Diamox (Acetazolamide) (increases HCO3 excretion)

c. Monitor neuro status, re-orient, seizure precautions, monitor I & O

D. Metabolic Alkalosis pH > 7.45

HCO3 > 26

1. Causes:

--Loss of H+ or increased HCO3

a. Large losses of gastric contents (vomiting, NG suction)b. Loss of K+ (diarreah, vomiting)

c. Ingestion of large amounts of bicarbonate (antacids, resuscitation

d. Prolonged use of diuretics (distal tubule lose ability to reabsorb Nand Cl- therefore Na+, Cl-, K+,

Ammonia are lost in the urine and these bind with H+)

(Note: al-K+-low-sis means K+ value is low when pt is alkalotic)

2. Signs and Symptoms: (similar to the associated disease process)

a. Diaphoresis

b. Nausea and Vomitingc. Increase neuromuscular excitability (Ca+ binds with protein)d. Shallow breathing (Respiratory Compensation)e. EKG changes (increased QT, Sinus Tachycardia)

f. May also see confusion progressing to lethargy to comag. Electrolyte abnormality (decreased Ca+, normal or decreased K+

creased Base Excess on the ABG)


a. Replace KCL losses in 0.9% NaCl (rehydrates and increases HCO

excretion)b. Diamox (Acetazolamide) (increases HCO3 excretion)

c. Monitor neuro status, re-orient, seizure precautions, monitor I &


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BC components norms Facility norms significance

Wbc 5000-10000/mm3 See varying componentcells. Measure infection.

Also called leukocytes

bc M: 4.5-6 million/mL

F: 4-5.5 million/mL

# of RBC in a volume of

blood

ct M: 40-50%F: 35-45%

Ratio of volume of redcells to volume of whole

blood

gb M: 14-18 g/dLF: 12-16 g/dL

Amount ofhemoglobin in a volume

of blood

CV 80-95 cubicmicrometers

Average volume of anRBC

CH 27-31 pg Average amt of Hgb inaverage RBC

CHC 32-36 g/dL Avg concentration of Hgbin given volume of RBC

DW 11-15% Measuresvariability of RBC size

and shape

Neutrophils 2500-8000 /mm3 Most common type ofWBC. Part of immunesystem. Go to sites of

trauma and inflammation

osinophils 50-500/mm3 Combat parasites, asthma,allergies, part of immune

system

asophils 25-100/mm3 Inflammation. Containhistamine and heparin.

ymphocytes 1000-4000 /mm3 T cells, B cells and NKcells. Immune defense.

onocytes 100-700/mm3 Immune response.Phagocytosis

platelets 140000-400000/

mm3

Number of platelets in a

given volume of blood

CBC components norms Facility norms significan

Wbc 5000-10000/mm3 See varying cocells. Measure

Also called le

Rbc M: 4.5-6 million/mL

F: 4-5.5 million/mL

# of RBC in a v

Hct M: 40-50%F: 35-45%

Ratio of volumcells to volume

Hgb M: 14-18 g/dLF: 12-16 g/dL

Ahemoglobin in

MCV 80-95 cubicmicrometers

Average volu

MCH 27-31 pg Average amt aver

MCHC 32-36 g/dL Avg concentratioin given volum

RDW 11-15%variability of

a

Neutrophils 2500-8000 /mm3 Most commoWBC. Part osystem. Go

trauma and infla

Eosinophils 50-500/mm3 Combat parasitesallergies, part o

Basophils 25-100/mm3 Inflammationhistamine and

Lymphocytes 1000-4000 /mm3 T cells, B cellcells. Immune

Monocytes 100-700/mm3 Immune Pha

platelets 140000-400000/

mm3

Number of pla

given volume


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