FAT SOLUBLE VITAMINS WATER SOLUBLE VITAMINS

VITAMIN A VITAMIN B COMPLEX

 Epithelial tissues, skin, eyes, hair, bone growth
 RDA of 5000IU B1 THIAMINE  For peripheral neuritis
 Stored in liver for 2 years (alcoholism/ beriberi)
 Aids in formation of visual pigment needed for night
vision
 Promotes integrity of mucosal and epithelial tissues
VITAMIN D  Regulating calcium and phosphate metabolism  Manage dermatologic problems (scaly
B2 RIBOFLAVIN
needed for calcium absorption from the intestines which dermatitis, wind burns)
requires bile salts for absorption.
o Vitamin D2: Ergocalciferol (synthetic
fortified)
o Vitamin D3: Cholecalciferol (natural
form)
 RDA of 40-80µ/ 200-400IU
 Vitamin DCalcifediol (liver)calcitriol (kidneys)
 Calcitriol+ PTH+ Calcitonin
 Regulates calcium and phosphorus metabolism
 Stimulates bone reabsorption of calcium and
phosphorus
VITAMIN E  Protect cellular components from being oxidized
and Red Blood cells from hemolysis B3 NICOTINIC ACID/  For pellagra and hyperlipidemia
 Protects heart and arteries because of antioxidant NIACIN
effects
 Prolongs Prothrombin time
 DO NOT MIX IRON: can interfere with absorption
 RDA OF 15IU

B6 PYRIDOXINE  For B6 deficiency, alleviate neuritis

related to isoniazid
VITAMIN K  Synthesis of prothrombin and clotting factors VII, IX  Essential for DNA synthesis
and X. B12 COBALAMIN  Aids Folic acid conversion to its active
o K1 Phytonadione- most active form form
o K2 Menaquinone- synthesized in  Promotes cellular division
Intestinal flora  Needed for normal hematopoiesis
o K3 Menadione  Maintain nervous system integrity
o K4 Menadiol- Synthetic forms  Requires intrinsic factor in Gastric
parietal cells for absorption (Pernicious
Anemia)
HIGHT ALERT DRUGS FORMULATION  Aids in absorption of iron and conversion
A) DOPAMINE- ↑ CO and SBP VITAMIN C of folic acid
Low Dose (renal Dose) ↓ renal vascular resistance  Average Dose: 50-100mg
↑ GFR and UO  Needed for Carbohydrate metabolism,
B) DOBUTAMINE- ↑ myocardial contractility protein and lipid synthesis
Vasodilator ↑ CO thru β receptor stimulation  Collagen formation, capillary
endothelium, connective tissue repair, osteiod
gtt factor = (dose in mg) (1000) / (IV diluent) (60ml) tissue of the bone
mcg/kg/min = [drop factor / (ml/hr)]÷weight (kg)
FOLIC ACID  Essential for body growth, needed for
ml
/hr = [(mcg/kg/min) (weight)] / drop factor DNA synthesis
SCALE FOR GRADING REFLEX RESPONSE
C) HEPARIN- inhibits conversion of PT to thrombin and aggregation of Plt. 0 No reflex response
Antidote: Protamine Sulfate
Monitor: PTT (NV: 25-35seconds) +1 Minimal activity (hypoactive)
units
/h = units of Heparin ÷ No. of hours to infuse +2 Normal response
ml
/hr = [(units/ h) (IV diluent ml)] ÷ total units of Heparin +3 More active than normal
units
/ml = total units of Heparin ÷ IV diluent ml +4 Maximal Activity (hyperactive)

GLASGOW COMA SCALE LEVEL OF CONSCIOUSNESS DROP FACTORS

Eye 4 SPONTANEOUS Alert Responds fully to voice appropriate ml
Opening 3 TO SPEECH spontaneously 1000 500 250
hours
2 TO PAIN Lethargic Responds to voice (drowsy) slowly
160ml 80ml 40ml
but with appropriate purposeful 6 40gtts 20gtts 10gtts
1 NO RESPONSE movements
Verbal 5 ORIENTED Obtunded Responds to touch than voice, 120ml 60ml 30ml
8 30gtts 15gtts 7gtts
Response 4 CONFUSED confused
3 INAPPROPRIATE Stuporous Arouses from sleep only after a 100ml 50ml 25ml
WORDS painful stimuli 10 25gtts 12gtts 6gtts
2 INCOMPREHENSIBLE
80ml 40ml 20ml
1 NO RESPONSE Semi-Coma Responds inconsistently to painful 12 20gtts 10gtts 5gtts
Motor 6 OBEYS COMMANDS stimuli
Response 5 LOCALIZES PAIN Coma 60ml 30ml 15ml
16 15gtts 7gtts 3gtts
4 WITHDRAWS FROM PAIN
3 DECORTICATE 40ml 20ml 10ml
2 DECEREBRATE 24 10gtts 5gtts 2gtts
1 FLACCID
ELECTROLYTES
Potassium Hypokalemia Hyperkalemia
 Important cellular cation  Damage from trauma, injury, surgery,  Results from renal insufficiency
 (3.5-5.5mEq/L) shock  Administration of large doses of
Sources: Potassium overtime
 Bananas and dried fruits
 Oranges and fruit juices Signs: Signs:
Function:  Nausea and vomiting  Nausea
 transmission and conduction of nerve impulses  Dysrhythmias  Abdominal cramps
 contraction of skeletal, cardiac, and smooth muscles  Abdominal distention  Oliguria
 Also needed for enzyme action.  Soft flabby muscles  Tachycardia to bradycardia
 Carbohydrate to energy  Weakness, numbness, tingling of
 Amino acids to protein extremities
Sodium Hyponatremia Hypernatremia
 Major cation in ECF  Results from diarrhea vomiting,
 (135-145mEq/L) surgery, potent diuretics
 regulates body fluids Signs: Signs:
 transmission and conduction of nerve impulses  Muscular weakness  Flushed skin
 Headaches  Elevated body temperature and blood
 Abdominal cramps pressure
 Nausea and vomiting  Rough, and dry skin
Calcium Hypocalcemia Hypercalcemia
 Approximately equal proportion in ICF and ECF Signs:  Results from hyperthyroidism,
 (4.5-5.5mEq/L)  Anxiety hypophosphatemia, tumor of the bone,
 Half of Calcium is bound to protein  Irritability multiple fraction
 Promotes Normal nerve/ muscle activity  Tetany
 Increases contraction of heart muscle  (twitching around mouth) Signs:
 Maintains normal cellular permeability and promotes blood  tingling and numbness of fingers  Flabby muscles
clotting thru PT to Thrombin  carpopedal spasm  Pain over bony areas
 Formation of bone and teeth  spasmodic contraction  Kidney stones of calcium deposition
 laryngeal spasm
 convulsion
Magnesium Hypomagnesia Hypermagnesia
 Most plentiful in ICF  Results with calcium and or potassium
 Loss of potassium is loss of magnesium deficit Signs:
 (1.5-2.5mEq/L)  Increase in Acetylcholine  Sedative effect on neuromuscular system
 promotes transmission of neuromuscular activity Signs:  Loss of deep tendon reflex
 important mediator of neural transmission in CNS  Increased neuromuscular excitability  Hypotension
also promotes contraction of myocardium  Cardiac (ventricular) dysrhythmias  Heart block
 activates enzymes for metabolism of Carbohydrates and  Hyperexitability  Lethargy
protein  Tremors  Drowsiness
 responsible for transportation of sodium and potassium  Ventricular tachycardia  Weakness
across cell membranes  Hypertension  paralysis
 Trousseau’s (arm twitching)
 Chvostek’s (facial twitching)

NORMAL BREATH SOUNDS

Type Description Location Characteristics
 Soft-intensity Over peripheral lung; Best heard on inspiration 2.5 times
 low-pitched, best heard at the base of the lungs longer than expiratory phase (5:2)
Vesicular  “gentle sighing” sounds
 (bronchioles and alveoli)

 Moderate-intensity and moderate- Between the scapula and lateral to Equal inspiratory and expiratory
Broncho-vesicular pitched “blowing” sounds the sternum at the first and second phases (1:1)
 (bronchi) intercostals spaces

 High-pitched Anteriorly over the trachea, not Louder than vesicular sounds; have a
Bronchial (tubular)  Loud, Harsh sounds normally heard over lung tissue short inspiratory phase and long
 (trachea) expiratory phase (1:2)

ADVENTITIOUS BREATH SOUNDS

Name Description
 Fine, short, interrupted crackling sounds;
alveolar rales are high pitched
Crackles (rales)  Best heard on inspiration but can be
heard on both inspiration and expiration
 May not be cleared by coughing
 Continuous, low-pitched, coarse,
gurgling, harsh, louder sounds with a
moaning or snoring quality
Ronchi
 Best heard on expiration but can be
heard on both inspiration and expiration
 May be altered by coughing
 Superficial grating or creaking sounds
Friction Rub heard during inspiration and expiration.
 Not relieved by coughing
 Continuous, high-pitched, squeaky
musical sounds.
Wheeze
 Best heard on expiration
 Not usually altered by coughing
Cause
Air passing through fluid or
mucus in any air passage
Air passing through narrowed air
passages as a result of
secretions, swelling, tumors
Rubbing together of inflamed
pleural surfaces
Air passing through a
constricted bronchus as a result
of secretions, swelling, or
tumors
Location
Bases of the lower lung lobes
Loud sounds can be heard over most
lung areas but predominate over the
trachea and bronchi
Heard most often in areas of greatest
thoracic expansion (e.g., lower anterior
and lateral chest)
Heard over all lung fields.