Airbags, Catalytic Converters and Cars: What Thieves Targeted Across Montgomery County

0:01 Digoxin.

0:02 Watch the heart and the potassium. Digoxin increases cardiac contractility, meaning the strength of the heart's contraction while slowing electrical conduction through AV or atrioventricular node. Digoxin has a narrow therapeutic index, meaning the difference between a therapeutic dose and a toxic dose can be relatively small. Before administering digoxin, assess the apical pulse for one full minute. For adults, it commonly tests the nursing rules to hold digoxin and notify the provider if the pulse is below 60 beats per minute, although the patient's prescribed parameters always take priority.

0:39 Important lab values include the serum, digoxin level, potassium, magnesium, and renal function. Classic signs of digoxin toxicity include nausea, vomiting, loss of appetite, fatigue, confusion, and bradycardia. Those arrhythmias include and visual disturbances such as blurred or yellow-green vision.

0:57 Here's an important exam connection.

0:58 Hypokalemia, meaning low potassium, can increase the risk of digoxin toxicity. Severe, life-threatening toxicity may be treated with digoxin immune fab, an antibody fragment that binds circulating digoxin. An exam trap that you may encounter is digoxin plus nausea plus an unusually slow pulse should make you think toxicity is not simply an upset stomach.

1:25 Lithium, sodium and water matter.

1:27 Lithium is commonly used to treat bipolar disorder 1 and also has a narrow therapeutic index. Monitor the serum lithium concentration, kidney function, thyroid function, sodium and hydration. Lithium blood levels are generally measured as a trough, commonly about 12 hours after the previous dose. Early toxicity may produce nausea, vomiting, diarrhea, increasing or coarse tremor, Weakness, drowsiness, report coordination. More severe toxicity can cause confusion, significant neurologic impairment, seizures, coma.

2:00 Remember this relationship.

2:01 Low sodium or dehydration can increase lithium concentrations. Heavy sweating, vomiting, diarrhea, severe fluid restriction, or major changes in sodium intake can therefore increase the risk of toxicity.

2:16 There is no specific antidote for lithium.

2:19 Treatment involves stopping lithium and providing appropriate fluid and electrolyte management. Severe poisoning may require hemodialysis, which removes lithium from the bloodstream. How about warfarin and heparin? Warfarin interferes with the production of vitamin K, dependent clotting factors. Monitor the patient's INR, or international normalized ratio, according to the indication and prescribed therapeutic range. The classic reversal agent is vitamin K. Serious or life-threatening warfarin-associated bleeding may require rapid clotting factor replacement with four-factor prothrombin complex concentrate or PCC in addition to vitamin K. Compare that with heparin. Unfractionated heparin commonly requires

3:09 lab monitoring for its anticoagulant effect. Nurses should also monitor for bleeding and heparin-induced thrombocytopenia. commonly abbreviated as HIT, heparin-induced thrombocytopenia. Thrombocytopenia means an abnormally low platelet count. The reversal agent for unfractionated heparin is protamine sulfate. For the exam, I would memorize warfarin to INR to vitamin K, heparin to APTT or anti-XA to protamine sulfate.

3:40 Insulin, check the glucose.

3:42 Before administering insulin, know the patient's blood glucose, the type of insulin ordered, meal timing, and relevant medication parameters. The major acute danger is hypoglycemia, again, meaning low blood glucose. Watch for sweating, trembling, rapid heartbeat, confusion, and severe cases, seizures.

4:01 If the patient is conscious and can safely swallow, hypoglycemia is generally treated with a rapid-acting oral.

4:06 Carbohydrate, followed by reassessment.

4:09 Severe hypoglycemia may require intravenous dextrose or glucagon, depending on the situation.

4:14 And available IV access.

4:16 Another high-yield nursing fact is regular insulin is the insulin classically given intravenously, such as during treatment of diabetic ketoacidosis. Look at these associations, lock these associations into memory. Digoxin is apical pulse plus potassium plus renal function, digoxin immune fab. lithium to lithium level plus sodium plus renal function, supportive care, hemodialysis if severe, warfarin to PTINR to vitamin K, PCC for serious bleeding, heparin APTT to platelets plus protamine sulfate, insulin, blood glucose plus amino timing, oral carbohydrate, Medical administration is never just about giving the drug. Before administering a high-alert medication, connect the medication to the patient's vital signs, lab results, symptoms,

5:07 and conditions.

5:09 That's it for now.