Download - 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
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.
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)
3. Treatment: (treat the underlying cause)
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)
3. Treatment: (treat the underlying cause)
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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