Normal Values (NPH,

Humulin N)
Electrolytes Long Acting 4hr 8-20hr 24-36hr
Potassium: 3.5 - 5.5 mEq/L Ultralente,
Sodium 135 -145 mEq/L Humulin U)
Calcium: 4.5 - 5.2 mEq/L or Combination ½ hr 2-12hr 24hr
8.6 - 10 mg/dL Humulin
Magnesium 1.6 - 2.6 mEq/L 70/30
Chloride 98 -107 mEq/L
Bicarbonate 22 – 26 mEq/L
Serum Osmolality 285-290 mOsm/kg H2O

Phosphate 1.7-2.6 mEq/L

Phosporus 2.5 - 4.5 mg/dL

Lipids
Cholesterol 140 – 200 mg/dL
LDL < 130 mg/dL
Gastro-Intestinal Serum Studies HDL 30 to 70 mg/dL
Albumin 3.4 - 5 g/dL Triglycerides < 200 mg/dL
Protein 6.0 - 8.0 g/dL
Alkaline 4.5 - 13 u/dL
Phosphatase Coagulation Studies
ALT PT M: 9.6-11.8 s
AST 7-40 mu/ml F: 9.5 - 11.3 s
Ammonia 15 - 45 ug/dL PT - 10-13sec x 2
Amylase 25 - 151 IV/L INR 2-3
Lipase 10 - 140 U/L Clotting Time 8 - 15 mins
BUA M 4.5 to 8 mg/dL Bleeding Time 1-9 mins
F 2.5 to 6.3 mg/dL Platelet Count 150,000 - 450,00 u/L
Total Bilirubin < 1.5 mg/dL aPTT APTT - 25-35sec x 3
Direct Bilirubin 0 - 0.3 mg/dL 1.5 - 2.5 x (therapeutic)
Indirect Bilirubin 0.1 – 1 mg/dL Fibrinogen M: 180 - 340 mg/dL
F: 190 - 420 mg/dL
ESR
30-40 mm/hr Mild inflammation
40-70 mm/hr Moderate inflammation
70-150 mm/hr Severe inflammation
Glucose Hemoglobin
FBS 70 -110 mg/dL
CBG (monitoring) 60 - 110 mg/dL Hematocrit M- 42-52%
OGTT F - 37-47%
Baseline 70 - 110 mg/dL
30 mins 110 - 170 mg/dL
60 mins 120 - 170 mg/dL Blood Gases
90 mins 100 -140 mg/dL pH 7.35 - 7.45
120 mins 70 -120 mg/dL pCO 2 35 - 45
Glucose 2 hr post-prandial < 140mg/dL pO 2 80 - 100
HbA1c (Glycosylated) HCO3 22-26
Good Control < 7.5% O2 Sat % 95-98%
Fair 7.6 - 8.9%
Poor 9% and up Pressures
Tonometry (IOP) 10-21mm Hg
ICP 0-15mmHg
CVP 4-11cm H2O or
3-7 mmHg

Insulin Stomach Capacity

Type of Onset Peak Duration Newborn 10 to 20 mL
Insulin 1-week-old 30 to 60 mL
Regular ½ -1 hr 2-4 hr 6-8 hr 2-3-week-old 75 to 100 mL
(Humulin R) 1-month-old 90 to 150 mL
Intermediate 2hr 6-12hr 18-26hr
Acting Obstructive VS Restrictive
 Obstructive Restrictive
TLC Inc Dec Intelligence Quotient:
FRC Inc Dec <70 Mild mental retardation
RV Inc Dec <50 Moderate mental retardation
VLC Dec Dec <35 Severe mental retardation
PaCO2 Inc Dec <20 Imbecile/Idiot
FEV1 Dec Normal

Immunizations
2 4 6 12 15 4-6 10y
y/o
DTP x x x x
OPV x x x x
Hepa B x x x
HiB x x x
MMR x or x x
Low Pressure Alarm High Pressure Alarm Varicella x or x x
Patient disconnection, Patient coughing, Td x
Circuit leaks, Airway leaks, Secretions or mucus in the
Chest tube leaks airway, Patient biting tube,
Airway problems, Reduced Allergy Vaccine Contraindications
lung compliance, Increased EGGS INFLUENZA , MMR
airway resistance, Patient NEOMYCIN VARICELLA,IPV,MMR
fighting the ventilator, YEAST HEPA-B
Accumulation of water in the
circuit, Kinking in the circuit, GELATIN VARICELLA
Problems with inspiratory or
expiratory valves

RR HR BP
Newborn 30-60 120-160 60systolic or
Diabetic, Arterial, Venous
80/40
Diabetic Arterial Venous
1-4 y/o 20-40 80-140 90/60-99/65
Pain None Painful, Inc w/ Dec w/
Elevation Elevation
5-12 y/o 15-25 70-115 100/56 - 110/60
Location Plantar Distal Lateral Medial
Aspect, Leg, Toes, aspect of Adult 12-20 60-100 90/60 - 140/90
Heel, Phalanges Lower Leg
Metatarsals and Ankle,
Malleolus Glasgow Coma Scale
area
I. EYE MOVEMENT (4)
Temp Inc Dec Inc
4 Spontaneous
Color Red Pale Base Red/Purple
3 To speech
2 To pain
1 No response

Newborn Measurements
HC 30-35cm
CC 31-33cm
II. MOTOR RESPONSE (6)
AC 50-55cm
6 Obeys Commands
HC=CC - 2y/o
5 Localizes pain
AC=CC Barrel Chest
4 Withdraws to pain
3 Flexing (Decorticate)
PROPERTY OF www.aaroncyuntalan.com 2 Extension (Decebrate)
1 No response
 Therapeutic Levels
III. VERBAL RESPONSE (5) Medication Levels
5 Oriented Acetaminophen (Tylenol) 5 to 20 ug/mL
4 Confused Acetylcysteine 5 to 20 ug/mL
3 Inappropriate words Carbamazepine (Tegretol) 3 to 14 ug/mL
Cycloserine 25 to 35g/mL
2 Incomprehensible sounds Digoxin (Lanoxin) 0.5 to 2 ng/mL
1 No response Digitoxin (Crystodigin) 15 to 25 ng/mL
Gentamycin (Garamycin) 5 to 10 ug/mL
Lidocaine (Xylocaine) 1.5 to 5 ug/mL
RULE OF NINES Lithium (Lithobid) 0.5 to 1.3 mEq/L
Head 9 Magnesium So4 4 to 8 mg/dL
Arms 18 Phenytoin (Dilantin) 10 to 20 ug/mL
Torso 36 Phenobarbital (Luminal) 10 to 30 ug/mL
Legs & Thighs 36 Procainamide (Pronestyl) 4 to 10 ug/mL
Perineum 1 Propranolol (Inderal) 50 to 100 ng/mL
Salicylate (Aspirin) 100 to 250 ug/mL
Theophylline (Aminophylline) 10 to 20 ug/mL
Vancomycin 30 to 40 ug/mL

Things to prepare :
Hemodialysis Bulldog clips
Parkland-Baxter
Sengstaken-Blakemore Scissors
= 4mL x kg x %TBSA Tube
1/2 = given 1st 8 hrs
CTT Rubber-tipped hemostat
Acetylcysteine overdose Suction Apparatus
Renal Function Laryngospasm Tracheotomy Set
125mL/min Tracheostomy Obturator
GFR
Skeletal pinning Wire cutter
SG 1.010 - 1.030
Sterile water /NSS bottle if the chest tube bottle
Crea 0.6-1.3 mg/dL
breaks
BUN 10-20mg/dL
BUN:Crea Ratio 15 : 1 tongue depressor and tonsillectomy
flashlight
albumin 3.2 - 4.5 g/dL
Urine Culture >/= 100,000 (Positive Culture)
Bence Jones Protein Multiple Myeloma
Urine Output 30-50mL/hr
Auer Rods AML
Oliguria < 400cc in 24 hr
Reed Sternberg cells Hodgkin's lymphoma
Anuria <100 in 24hr
EBV infectious mononucleosis

ANA test SLE

Rheumathoid factor (RF) Rheumatoid Arthritis
Bone Scan/Gallium Scan Bone Cancer
Bone Densitometry osteoporosis
Diskogram HNP

URINE Paget's dse bowing of legs

Clear normal Rheumatoid Arthritis wrist drop or foot drop
cloudy UTI Osteoarthritis bouchard's & heberden's
smokey AGN nodule
foamy nephrotic syndrome
STANDARD Universal Prec Gloves, Goggles,
Gown, Mask
Pain Ladder (0-10) AIRBORNE PTB, HEPA filter mask, N-
1-3 Mild Non-narcotic (Acetaminophen)- Varicella 45
PNS Measles Negative pressure
4-7 Moderate Narcotic (Morphine)- CNS room
8-10 Severe Non-narcotic + Narcotic 6-12 exchanges/ hr,
Private Door Closed
CONTACT MRSA GGG(gown, goggles,
(vancomycin), gloves)
CDAD 3 feet away
(vancomycin),
RSV(Ribavirin)
Herpes
simplex MOBILITY (all musculoskeletal cases)
Impetigo Arthritis
DROPLET Respiratory 3 feet away, ELIMINATION Autonomic dysreflexia, BPH, UTI
infections, Private room
Meningitis, Mask
Pneumonia,
Legionnella,
Scarlet Fever
Pertussis
PHOTOSENSITIVITY DRUGS
Strep.
Pharyngitis Antipsychotic
PHENOTHIAZINE derivatives
ENTERIC GIT , Hepa A, Oral-fecal route (Haldol, Thorazine, Stelazine,
Salmonella, Gloves and gown Risperdal)
Typhoid, Antihyperlipidemic Simvastatin/Atorvastatin
Cholera agents/
NEUTROPENIC Leukemia, Organ
transplant, Sickle cell Sulfa Drugs Trimethoprim-Bactrim, Sulfa
dse, HIV, AIDS Quinolones Levofloxacin, Ciprofloxacin
Immunocompromised, Tetracyclines (Doxycycline)
undergoing Herbal St. John's Wort
chemotherapy,
Radiation therapy,
Steroid therapy, Burns
No fresh fruits, fish,
meat, stagnant water,
no yoghurt, buttermilk,
Strict handwashing, RED-ORANGE URINE Rifampicin, Azulfidine, Pyridium
private room, no
dental boxes,
no populated area
No immunization with Causes S & Sx ECG
Attenuated vaccines Findings
Hyper Cellular Shift, BradycardiaBr Tall Peaked
K Trauma, adypnea;N & T waves
Burns, Sepsis V; diarrhea; Flat P waves
Metabolic Intestinal Colic, Widened
Acidosis, Irritability; QRS
Respiratory Muscle Prolonged
Acidosis, renal weakness, PR lntervals
Prioritization Insufficiency, Numbness,
AIRWAY Bronchiolitis, Apnea, Burns, Chest Potassium Flaccid
Croup, Cystic fibrosis, DM, DKA sparers Paralysis
Asthma, Seizure, Multiple sclerosis
Hypo Cushing's Thready, rapid, Inverted
Myasthenia gravis
BREATHING Flail chest K Syndrome , weak pulse; T waves
CIRCULATION CHF, Edema,Thromboplebitis Colitis, Laxative faint heart ST seg
Abuse, sounds; Depression
OXYGEN Angina, Shock
Anorexia, Hypotension, U waves
FLUIDS Abortion, Addison’s disease,
Alcoholism, skeletal Heart block
Norwalk virus, Clostridium defficile
NGT, GI muscle
Anemia, Sickle cell, DI, Giardiasis
surgery, weakness;
Hemorrhage, Renal colic Salmonellosis,
Vomiting, shallow
SIADH
Diarrhea, respirations;
NUTRITION Anorexia,Bulimia, Cancer, esophagus
Thiazide malaise;
Cleft palate, Diverticulitis, TB
Diuretics, apathy;
SAFETY Agoraphobia, ADHD, Autism, stress, lethargy; loss
Battered wife, Meniere’s disease Alkalotic states of orientation;
Cataract, Cerebral palsy, CVA, dec reflexes
Depression, Seizure, Hemophilia, anorexia,
Hepatic coma, Fracture, Hypertension, vomiting,
Hypothyroidism, Hyperthryroidism, weight loss,
Increase ICP, Leukemia, Mania, Ileus
Meningitis, Osteoporosis, Parkinson’s Hyper Steroid intake Dry, Flaky skin
disease, Poisoining, PIH, Suicide,
Na Renal failure & mucous
Spinal cord injury, Wilm’s tumor,
 Hyperaldostero mem, thirst
nism edema
Low UO
High SG
Hypo Diaphoresis or N & V,
Na GI suctioning, abdominal
Adrenal cramps; weight Hyper Renal
insufficiency loss; cold, P04 insufficiency
clammy skin; Tumor Lysis
decreased skin Syndrome
turgor; Hypoparathoroi
fingerprinting dism
over the
sternum; Hypo Malnutrition,
shrunken PO4 Starvation
tongue; Alcoholism, Al-
apprehension; Mg (antacids)
headache;
convulsions;
confusion;
 weakness;
fatigue;
Postural
hypotension;
rapid, thready Cause S & Sx
pulse Fluid Vomitting, Diarrhea, Increased = RR,
Hyper Hyperpara- Hypoactive Shortened Volume Hemorrhage, HR, Hct, SG
Ca Thyroidism, Bowel sounds ST segment Deficit Tachypnea
Excess Vit. D N & V, Widened T Inc UO, Kidney dse.
osteoporosis anorexia, wave Insufficient IVF Decreased = CVP,
and constipation, replacement Wt., UO, BP
osteomalacia headache, Diuretics
confusion, Draining Fistulas, Anorexia, Wt. loss
lethargy, Peritonitis, Edema
stupor, Ileostomy, Colostomy
decreased NGT
muscle tone,
deep bone
and/or flank Fluid CHF Altered LOC
pain Volume Dec Kidney Fxn. Vein Distention
Overload Liver Dse. Cough, Dyspnea,
Hypo Prolonged Bed Painful tonic Prolonged Rales
Ca Rest, Vit D muscle QT interval Inc RR, HR, CVP
Deficiency spasms, Prolonged
Hypopara- fatigue, ST interval
thyroidism laryngospasm,
Acute Trousseau's
Pancreatitis, Chvostek's
Diarrhea, signs,
steroid therapy convulsions, Isotonic Hypotonic Hypertonic
dyspnea LR 0.45 NS D10W
Hyper Renal Drowsiness,Se D5W 1/2 NS D5 NS
Mg insufficiency, dation, NS D5 1/2 NS
dehydration, Lethargy, D5 0.5 NaCl
Somnolence D5 1/4 NS
Muscle
Weakness Cause S & Sx
N&V
Respiratory COPD, Barbiturate or Headache,
paresthesias
Acidosis Sedative Overdose, weakness, visual
Dec RR, DTRS
Acute Airway disturbances, ,
Hypo Low intake of Paresthesias,
Obstruction, Weakness confusion,
Mg magnesium in confusion, of Respiratory muscles drowsiness,
diet, prolonged hallucinations,
coma
diarrhea, convulsions, Inc. RR & HR
massive ataxia,
diuresis, tremors,
Respiratory Hyperventilation, Inc RR & Depth transfusion
Alkalosis mechanical Headache,
overventilation, Lightheadedness, LPN Technical Doer, Stable, medications, wound
encephalitis Vertigo dressing
Mental Status
 Changes CAN/UAP Routine Care, Urine Dip Stix, Reporting to RN,
Paresthesias Routine VS
Dry Mouth turning q2H, conducting group activities,
Low K, Low Ca ambulation
Tetany,
Convulsions
Metabolic Ileostomy, Hyperpnea Headache, N&V
Acidosis w/ Kussmaul's Fruity Breath
DKA, Uremia, CNS depression
starvation, Diarrhea, Drowsiness,
Severe infections, Convulsions,
Renal Tubular Acidosis Tremors
↑ K, Ca

Metabolic Severe Vomiting, NGT N &V, diarrhea,

Alkalosis suctioning Paresthesia,
Excessive Antacids, Tetany,
NaHCO3, ↓ RR & HR
Diuretics,
Biliary Drainage

Dietary Restrictions
KOSHER Jewish, no mixture of meat and dairy
HALAL Islam, No pork
VEGAN vegetable diet - Buddhism
R. CATHOLIC No Meat on Good Fri & Ash Wed
JEHOVAH’S No Blood or Blood Products
WITNESS

Herbal Medications
St. John's Antidepressant, photosensitive (C/I in
Wort SULFA drugs)
Garlic Antihypertensive, (avoid Aspirin)
Ginseng Anti stress, (C/I in Coumadin)

Green tea Antioxidant, (C/I risk for calculi-oxalates)

Echinacea immune stimulant (6-8 weeks only) (C/I in
SANDIMMUNE)
Licorice cough and cold
Ginger root antinausea, (C/I in Coumadin)
Ginkgo Improves Circulation; (C/I in
anticoagulant, headache side effect -
check PT)
Ma Huang Bronchodilator, Stimulant (Ephedra)
Valerian For Insomnia
Black Cohosh For Menopause
Kava kava For stress and anxiety relief

RN Least stable, unstable, central catheters

(hickman, broviac), admission, discharge,
health teachings, patient for transfer, blood