HURST REVIEW BOOK (HYPOVOLEMIA, INTRAVENOUS THERAPY, ACID BASED HOMEOSTASIS, HURST REVIEW SERVICES)

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HURST REVIEW BOOK (HYPOVOLEMIA, INTRAVENOUS THERAPY, ACID BASED HOMEOSTASIS, HURST REVIEW SERVICES) Instructions IF you have pre-registered for this review prior to the first day of class via the in... ternet or by mail or if you have attended a live review in the past AND you have paid for the class in full or you have attended Hurst Review before, please turn in the following information to your instructor before the end of the first day of class: 1. Please print on the outside of the envelope (that will be provided to you by your Hurst Review instructor) the following information: 1. Name 2. Address 3. Phone number 4. Name of Nursing School 5. Graduation Date 6. Print: “Paid in Full” on the outside of your envelope—ONLY if you are paid in full PRIOR to the first day of class. IF you have pre-registered for this review prior to the first day of class via the internet or by mail AND you have a remaining balance, please turn in the following information to your instructor before the end of the first day of class: You must be paid in full the first day of the review. 1. Please print on the outside of the envelope (that will be provided to you by your Hurst Review instructor) the following information: 1. Name 2. Address 3. Phone number 4. Name of Nursing School 5. Graduation Date 6. Print the method of payment on the outside of your envelope— (Do not put “paid in full” on the outside of your envelope if you are paying off your balance. Put the form of payment).  If you are paying by credit card print “credit card” on the outside of your envelope.  If you are paying by check (s) please print “check” on the outside of your envelope.  If you are paying by cash, please print “cash” on the outside of your envelope. 2. Complete the form marked: Payment Information a. If you are writing a check(s), checks are to be made payable to Hurst Review Services. Hurst Review Services i Instructions3. Once you have completed the Payment Information form, place the form and the method of payment (cash, check(s) or credit card information) in the envelope and return it to your instructor. IF you have NOT pre-registered for this review prior to the first day of class via the internet please turn in the following information to your instructor before the end of the first day of class: You must be paid in full the first day of the review. 1. Please print on the outside of the envelope (that will be provided to you by your Hurst Review instructor) the following information: 1. Name 2. Address 3. Phone number 4. Name of Nursing School 5. Graduation Date 6. Print the method of payment on the outside of your envelope  If you are paying by credit card print “credit card” on the outside of your envelope.  If you are paying by check(s) please print “check” on the outside of your envelope.  If you are paying by cash, please print “cash” on the outside of your envelope. 2. Complete the forms marked: General Student Information AND Payment Information AND Notice for the Student. 3. Once you have completed all 3 forms, place all forms and the method of payment (cash, check(s) or credit card information) in the envelope and return it to your instructor. ii Hurst Review Services InstructionsGeneral Student Information ***ONLY COMPLETE THIS FORM IF YOU HAVE NOT PRE-REGISTERED FOR THIS REVIEW*** Name:_____________________________________________________________ Gender: ________ Address:______________________________________________________________________ _____________________________________________________________________________ Phone Number(s): (Home) ______________________________________ (Cell)______________________________________________________ E-mail Address: _____________________________________________________ Are you currently enrolled in a nursing program? Yes or No School of Nursing: ___________________________________________________ Graduation Date: _____________________________________________________ Place of Employment (if known):_________________________________________ Is this your first time to take the boards? Yes or No (please circle one answer) If not, how many times have you taken the boards? Have you taken a NCLEX® Review class prior to attending Hurst Review? Yes or No (please circle one answer) If yes, which NCLEX® Review class did you attend? Hurst Review Services iii Instructions***ONLY COMPLETE THIS FORM IF YOU HAVE NOT PRE-REGISTERED FOR THIS REVIEW*** NOTICE FOR THE STUDENT I, the undersigned ____________________________, do hereby agree not to reproduce or transmit in any form or by any means (electronic, mechanical, photocopying, or otherwise) any part or parts of the course or course materials offered by Hurst Review Services. I understand this course is designed and presented to assist in my passing of the NCLEX® and agree not to divulge any teaching techniques, topics, sources, or any other data used within this class to anyone. I do hereby further understand that any infraction of this notice will result in prompt litigation. SIGNED: _________________________________ PARTICIPANT WITNESS: ____________________________ NOTICE You must select one of the following by putting your initials in the blank: 1. _____ If I am unsuccessful on the boards, I would like to end my relationship with Hurst Review Services and receive my money back for having taken the class. I understand that I will be refunded all of my money except for a $75 administrative fee. I further understand that it is my responsibility to notify Hurst Review Services within 2 weeks of receiving my board scores and that I must send the following information to Hurst Review Services’ office in order to receive my refund. You will not receive a refund until all items listed below have been received by Hurst Review Services. a. The postmarked envelope that my results were sent in b. My candidate report c. All material received from Hurst Review Services (student book, CD, and DVD). 2. _____ If I am unsuccessful on the boards, I would like to continue my relationship with Hurst Review Services as a remedial student and receive help in passing my boards. I understand Hurst Review will be committed to my passing and will assist me until I am successful. I must agree to make the initial contact with Hurst Review and stay in touch on a regular basis (every 45 days) until I pass boards. After 12 months (starting from the date the student takes the class) the remedial student will be charged $50.00 every 90 days if they are still participating in the remedial process. Signed: __________________________________ PARTICIPANT iv Hurst Review Services InstructionsPayment Information I am paying by: (please select the method of payment) Cash__________ Check (see page vi) ___________ Credit Card (complete bottom of page) _________ *If you are paying with cash you will receive a receipt by the end of the review from your instructor. *If you are paying with a check or credit card, your bank statement or credit card statement will serve as your receipt. My hospital is reimbursing me for this class or is paying for this NCLEX® review class. Yes or No (please circle one answer) If yes, please provide the following information: Hospital_____________________________________ Contact person________________________________ If documentation is required for reimbursement or proof of attendance, please have your Hurst Review instructor complete the proof of attendance letter on page vii. Notice I, _____________________________, do hereby agree to pay Hurst Review Services in full for the NCLEX® review course which I participated on ___________________ (please put the date of attendance). The terms we agreed upon are outlined above, I understand that if I do not pay according to the plan agreed upon, my wages will be garnished if necessary and any and all legal measures will be taken within a court of law. Signed :__________________________________( Participant) Credit Card Information *Fill out the following section ONLY if you are paying by Credit Card Card Holder Name (please print clearly):________________________________________________________ Billing Address:________________________________________________________________ Phone Number: ________________________________________________________________ Type of credit card (please circle one): Visa MasterCard Discover Card Number:_________________________________ Expiration Date:___________________ Total amount to be charged: _________________________________________________________ Signature: _______________________________________________________________________ Hurst Review Services v InstructionsCheck Information *Fill out the following section ONLY if you are paying by Check Checks may be made payable to: Hurst Review Services ** Please be sure your name is printed in the “memo” blank on the bottom of the check** You can write one check for your balance dated the first day of the class. OR If you are participating in our payment plan, you will enclose 2 checks in your envelope. This is the only form of payment plan that we offer… so if you wish to participate in the payment plan you will need to write two separate checks. -The first check will be in the amount of half of your balance dated the first day of the class and a second check for the amount of the other half of the balance dated ONE month later. (Example: If the first day of class is on January 3, 2009 AND you have a remaining balance of $300.00, you will write ONE check for $150.00 dated January 3, 2009 and then a SECOND check for $150.00 dated February 3, 2009.) All checks must be turned in the first day of class. Checks will not be cashed until the date printed on the check. If you are writing a check(s), you must complete the following section: This is your authority to obtain a Credit Bureau on me in the event circumstances should arise (i.e. stopping payments; Non-sufficient Funds checks, closed accounts, skip tracing, and etc.) Signed this day, ___________________________ (today’s date) Signature: __________________________________ Social Security Number: ______________________ Witness: ___________________________________ Anyone who is writing a check(s) has to read the following statement, understand it, and remember it!! If you write a check and then close the account or the check is returned due to insufficient funds or other reasons… it is considered to be “issuing a false instrument.” In other words, it is illegal! Any and all measures will be taken to collect on the check. If a criminal affidavit needs to be issued, it will. The District Attorney in your area will be notified for collection and prosecution. Your District Attorney will be given the legal document (the bad check). The Board of Nursing and your employer will be alerted to the fact that you are participating in illegal activity. Hurst Review Services has authorized the District Attorney’s Office to institute collection proceedings and then further authorized to sign a criminal affidavit on our behalf. vi Hurst Review Services InstructionsThis is written to confirm that ______________________________ (print student’s name) attended the NCLEX® review class, Course in Critical Thinking and Application, conducted by Hurst Review Services. This 4-day review was held in _______________________________________ (location) on __________________________________________________________ (insert dates). The cost of this course, including all materials, was $350.00. If you need any further information or have any questions, please contact our office. Date Time of class Hurst Review Instructor/Representative ___________________________________________________ (Initials_____________) Hurst Review Services Instructor/Representative Hurst Review Services 111 South Railroad Avenue Brookhaven, Mississippi 39601 Office: (601) 833-1961 Fax: (601) 833-1142 Hurst Review Services vii Letter of AttendanceAdditional Services Provided by Hurst Review Services Online Supplement Review On the website (www.hurstreview.com) you are able to review all materials presented in our review. You will find all lectures, notes and test questions for practice. This site is EXCELLENT for students to re-listen to all lectures again and again. It is perfect for students who are waiting to take their boards, have been out of school for a while, or for those students who have been unsuccessful on the boards. The online supplement review subscription will allow you to have unlimited access to all lectures presented in the live, DVD, or online review for 30 days for only $50.00. The online review is usually retailed for $300.00, but because you have already attended or signed up for one of our reviews (Live, Online, or DVD); we are giving it to you at a discounted price. If you would like to subscribe to the Online Supplement Review you must meet the following conditions (A-C) A. You must have already created an account on our website B. You have attended and completed a live, DVD review, or you have previously completed an online review. C. Your account is paid in full. You may register for the online supplemental review by following the following steps: 1. Please go to our website (www.hurstreview.com). 2. Log into your account using the username and password you were given when you originally created your personal account. - PLEASE DO NOT CREATE ANOTHER ACCOUNT if you do not remember your username and password, please contact our office at 601-833-1961. 3. Go to the tab labeled “My Account” and you will see a link that says “Supplemental Review… Click here to sign up for the supplemental review.” 4. You will click the link and follow the directions. viii Hurst Review Services Additional ServicesComputer Lab Our office, located in Brookhaven, Mississippi, is equipped with a complete computer lab in which students can come and practice questions. If you are interested in practicing test questions at our office, you must schedule (in advance) an appointment by calling our office at 1-601-833-1961. There is a $25.00 fee (per day) to reserve your computer. You are able to come and go as you please throughout the day. This service is an excellent opportunity for students who wish to practice test questions in a quiet environment prior to taking the boards, or for those students who are retaking the NCLEX®. **Please note: The services provided above are not required to pass the NCLEX®. You are given all material needed to pass the boards during the class. These services are for students who wish to have concepts reiterated or review additional test questions. You can pass the NCLEX® the first time with the material provided to you in class, IF you study properly. To register for a second live review If you would like to register for a second LIVE review you MUST meet all of the following conditions (A-C) A. You must have already created an account on our website B. You have attended and completed a Hurst LIVE review. C. Your account is paid in full. You may register for a second LIVE review by following the following steps: 1. Please go to our website (www.hurstreview.com). 2. Log into your account using the username and password you were given when you originally created your personal account. - PLEASE DO NOT CREATE ANOTHER ACCOUNT if you do not remember your username and password, please contact our office. 3. Go to the tab labeled “My Account” and you will see a link that says “Live Lectures… Click here to find a live review in your area.” 4. You will click the link, select the live review you would like to attend and click “sign up” link. -If your account is NOT paid in full, it will not allow you to complete this action. Please contact our office (601-833-1961) with any questions. Hurst Review Services ix Additional Servicesx Additional ServicesTABLE OF CONTENTS Fluids and Electrolytes…………………………………………………………… 4 Acid-Base Balance……………………………………………………………….. 14 Burns………………………………………………………………….………….. 18 Oncology………………………………………………………………..………… 25 Endocrine…………………………………………………………………..…….. 41 Cardiac…………………………………………………………………..……….. 56 Psychiatric Nursing…………………………………………………………….. 78 Making Room Assignments……………………………………………………. 99 Priority Questions……………………………………………………………….. 100 Gastrointestinal………………………………………………………………….. 101 Neuro……………………………………………………………………………... 115 Maternity Nursing………………………………………………………………. 125 Complications of Maternity…………………………………………………....... 143 Respiratory………………………………………………………………..……… 153 Orthopedics………………………………………………………………………. 160 Renal……………………………………………………………………………… 167 Questions…………………………………………………………………………. 175 Final Thoughts…………………………………………………………………… 196 Evaluations………………………………………………………………………… 203 Table of Contents for the 5th Day CD…………………….………………………..205 Pediatrics……………………………………………………………………………206 Testing Strategies…………………………………………………………………...240 Management and Delegation………………………………………………………243 Hurst Review Services 1 Table of ContentsHurst Review does not condone the discussion of the NCLEX® post-test. Thank you. Hurst Review has been helping nursing students pass the NCLEX® since 1988. Our approach has proven to be very successful. We believe that learning should not be stressful… it should be fun and in a relaxed atmosphere. This is why we use conversational language during our lectures. We also have made an effort to present the content that focuses on what is MOST LIKELY to happen in a particular situation or with a specific disease, but you all know that ANYTHING can happen in the REAL world. We have all had patients before that did not look anything like our textbook had described. We have seen things ordered by physicians that may have been contraindicated according to our textbooks. We have all had a teacher that taught something one way and then another who taught it differently. The Hurst Review tries to teach content in a way that is acceptable and safe to all (especially the NCLEX®). Our goal is to de-confuse you, not confuse you! We also want to emphasize we are trying to help you pass a particular test and our lectures are specifically geared toward this goal, but at the same time we want to provide quality, safe information that you can use as you begin to practice nursing. It is not Hurst Review’s goal to re-teach nursing school (This is only a review ), but our goal is to ensure that each student understands the core content that will be covered on the NCLEX®. This class is offered and available to ALL students. You do not have to have completed nursing school to attend our review. Many students find that taking the class throughout nursing school is VERY helpful. So remember, you may hear some wild answers in class due to different student levels! That’s okay (it’s even kind of funny sometime!) The Hurst faculty will always clarify and correct content as needed. This is a learning process and we are all in it together! NOTICE TO FACULTY All materials used during any Hurst Review Services seminar are copyrighted and are not for use without the sole permission of Marlene Hurst in any form or fashion. This material is not intended for lecture use by any School of Nursing without permission. NOTICE TO STUDENTS If you are a student who has obtained this book from a past participant of this workshop . . . . .SHAME, SHAME, SHAME!!! Please understand that this book is written to accompany the live, online, or DVD lectures presented in our review. This book is only an outline of what is needed to pass NCLEX®. We hope you will join Hurst Review in a live, online, or a DVD lecture to reap the full benefits of the core content and other material presented. 2 Hurst Review Services General InformationGeneral Class Information - Please turn off ALL cell phones and pagers. -If you are text messaging in class, you are missing valuable content! -This class MAY NOT be recorded in any manner. (This includes tape recording or videoing.) -Class Time: 8AM-4PM (READ BELOW) Class will start each day at 8:00am unless otherwise specified. The latest class will last will be 4:00pm. There may be days when you will complete the material earlier than 4:00pm and this is perfectly okay! Smaller classes tend to finish earlier than 4:00pm as breaks tend to be shorter. Larger classes tend to finish closer to 4pm as breaks take longer. With either situation, all material will be completed prior to the end of class. If your class does let out earlier than 4pm your faculty person will be happy to stay and answer individual questions at your request. There is a designated amount of material that is to be covered each day. Many times, the time class is dismissed is totally dependent on the class itself (some classes ask lots of questions and take long bathroom breaks and some do not). The bottom line is this….you will get all of your material needed to pass the NCLEX® the first time and we will be FLEXIBLE with the time class ends!!!!! -We have given you LOTS of practice questions (both knowledge based and NCLEX® style) located on the 5th day CD. Hurst Review Services 3 General Information** Please note that all normal ranges for blood test will depend on the lab performing the test. The normal values listed in this book are to be used as references only** FLUID VOLUME EXCESS: HYPERVOLEMIA Define: too much volume in the ___________________________________ A. Causes: a. CHF: heart is__________, CO__________, decreased__________ perfusion, UO__________ *the volume stays in the ________________________________ b. RF: Kidneys aren't____________________ c. Alkaseltzer Fleets enemas IVF with Na d. Aldosterone (steroid, mineralocorticoid) -Where does aldosterone live? All 3 have a lot of _________ A patient feels the “urge” to void when the bladder has approximately 250-300 ml of urine in it -Normal action: when blood volume gets low (vomiting, blood loss, etc.) aldosterone secretion increases retain Na/water blood volume ___________ ** Diseases with too much aldosterone: -also seen with liver disease and heart disease 1._________________________________________ 2._________________________________________ **Disease with too little aldosterone: 1._________________________________________ Normal Urinary Output: 1ml/kg/hr Good Rule: Call the MD if the UO is < 30ml/hr 4 Hurst Review Services Fluid and Electrolytese. ADH (Anti-diuretic Hormone) -Normally makes you retain or diurese? -Retain? _________________________ 2 ADH Problems Too Much Retain Fluid Volume _________ SIADH Syndrome of Inappropriate ADH Secretion (TOO MANY _________ TOO MUCH ______) Urine Blood *Concentrated makes #’s go up *Dilute makes #’s go down Urine Blood specific gravity, sodium, and hematocrit ADH lives in pituitary; key words to make you think potential ADH problem: craniotomy, head injury, sinus surgery, transphenoidal hypophysectomy or any condition that could lead to an increased ICP… there is a risk of an ADH problem. Trans-______________, sphenoid______________, hypophysis__________ ,ectomy____________ *Another name for anti-diuretic hormone (ADH) is vasopressin. The drug vasopressin (Pitressin®) or DDAVP® (desmopressin acetate) may be utilized as an ADH replacement in diabetes insipidus. Not enough Lose (diurese) Fluid Volume __________ DI Diabetes Insipidus Hurst Review Services 5 Fluid and ElecttolytesB. S/S: -Distended neck veins/peripheral veins: vessels are_______________ -Peripheral edema, third spacing: vessels can't hold anymore so they start to ________ -CVP: measured where? _________________; number goes________ More____________________....More____________________ The ideal location of the catheter tip is within the superior vena cava (SVC), so that it is close, but not inside, the right atrium. It reflects pressures readings in the right atrium. -Lung sounds: -Polyuria: kidneys trying to help you_________________________ -Pulse: _______________; your heart only wants fluid to go__________________ -If the fluid doesn't go forward it's going to go____________into the_____________ -BP: _______________ move volume.....more_______________ -Weight: _______________ any acute gain or loss isn't fat-it’s fluid C. Tx : -Low Na diet -Diuretics: Fluid Retention… Think heart problems FIRST CVP: Central Venous Pressure Normal: 2-6 mmHg *CVP checked per MD orders… usually every 4 hours -Loop: Example: __________________________ *Bumex® (bumetanide) may be given when Lasix® (furosemide) doesn’t work. -Thiazide (hydrochlorothiazide) * Watch lab work with all diuretics * Dehydration and electrolyte problems -K+ sparing: Example: __________________________ -Bed rest induces_______________________________________ *in general, when you are supine you perfuse your kidneys more because you have more cardiac output D. Interventions: -Physical Assessment -Give IVF’s slowly to elderly 6 Testing Strategy Anytime you see assessment or evaluation on the NCLEX, you should be looking for the presence or absence of the pertinent signs and symptoms Hurst Review Services Fluid and ElectrolytesFLUID VOLUME DEFICIT: HYPOVOLEMIA Big Time Deficit=Shock A. Causes: -Loss offluids from anywhere Examples: Thoracentesis, paracentesis, vomiting, diarrhea, hemorrhage -Third spacing (Definition: When fluid is in a place that does you no good) *burns *ascites Polyuria -Diseases with polyuria B. S/S: -Weight -Decreased skin turgor -Dry mucous membranes -Decreased Urine Output *kidneys either aren't being__________________ or they are trying to ____________ -BP? ___________ (less_____________________, less______________________) -Pulse? __________, heart is trying to pump what little is left around -CVP? __________ (less volume, less __________) -Peripheral Veins/Neck veins -Cool Extremities (peripheral ______________in an effort to shunt blood to ____________ __________________) -Urine Specific Gravity __________, if putting out any urine at all it will be ____________ C. Tx: -Mild Deficit: -Severe Deficit: Hurst Review Services 7 Oliguria Anuria Polyuria-usually the patient will have a total urinary output of over 2000ml in 24 hours Oliguria-total urinary output between 100 ml and 400ml in 24 hours Anuria-Total urinary output of less than 100 ml in 24 hours Fluid and ElecttolytesQuickie IV Fluid Lecture -Isotonic: Go in the vascular space and stays there! -Examples of isotonic solutions: _____________, ________________, ________________ Although D5W is considered an isotonic solution due to the osmolarity… it is not used often for patients that need a large amount of vascular volume replaced. This is because when D5W is initially administered it is isotonic; however, it does metabolize into free water and is no longer isotonic. An example of when this solution is used is when a patient has hypernatremia. -Hypotonic Solution: Go in the vascular space, hang out a little while and rehydrate, but they do not stay in the vascular space.....If they stayed in the vascular space they wouldn't be hypotonic.....they would be ___________________. These solutions go in and hang out and rehydrate, then they move into the cell and the cell burns the remainder up in cellular metabolism. They are hydrating solutions, but they won't drive your pressure up because they do not stay in the vascular space. -Hypotonic Solution: - Causes a fluid shift from the vascular space into the cells. A solution that will cause water to enter the cell, which could induce swelling or lysis of the cell. - Examples: D2.5 W, ½ NaCl, 0.33% NaCl, tap water -Hypertonic Solution: - Volume expander and solution that draws fluids into the vascular space. Draws water out of the cell. - Examples: D10W, 3% NaCl, 5% NaCl, D5 LR, D5 ½ NaCl, D5 NaCl, TPN Quick Tips for IV Solutions Isotonic Solutions “Stay where I put it!” Hypotonic Solutions “Go Out of the vessel” Hypertonic Solutions “Enter the Vessel” 8 Hurst Review Services Fluid and ElectrolytesNormal Lab Values Mg: 1.2-2.1 mEq/L Calcium: 9.0-10.5 mg/dl MAGNESIUM AND CALCIUM Fact: Magnesium is excreted by kidneys and it can be lost other ways, too (GI tract) Hypermagnesemia Hypercalcemia Causes: Renal Failure Antacids *S/S* DTR's Muscle Tone Arrhythmias LOC Pulse Respirations Flushing Warmth Mg makes you _________ Tx: Ventilator Dialysis Calcium gluconate *Calcium gluconate in the presence of magnesium- they inactivate each other **Calcium gluconate is administered IVP very slowly (Max rate: 1.5-2 ml/min) *Ca has inverse relationship with _______________. When your serum calcium gets low parathormone (PTH) kicks in and pulls Ca from the ______________ and puts in the blood....therefore, the serum calcium goes ___. *When you drive Phos up, Ca goes ______________. Steroids Add what to diet? Safety Precautions? *Must have Vitamin _____ to use Ca. *Calcitonin __________ serum Ca HINT: If you want to get Mg & Ca questions right, think muscles 1st. * the signs and symptoms listed above in the box are common in a patient with hypermagnesemia and hypercalcemia* Tx: Move! Fluids! Phospho Soda® & Fleets® Enema -both have phosphorous bones kidney stones *majority made of calcium Causes: Hyperparathyroidism: too much Thiazides (retain __________) Immobilization (you have to bear weight to keep Ca in the ___________________) Hurst Review Services 9 Fluid and ElecttolytesNormal Lab Values Mg: 1.2-2.1 mEq/L Calcium: 9.0-10.5 mg/dl HYPOMAGNESEMIA Causes: Diarrhea - lots of Mg in intestines Alcoholism -alcohol suppresses ADH & it’s hypertonic -not eating -drinking HINT: If you want to get Mg & Ca questions right, think muscles 1st. S/S Muscle Tone Could my patient have a seizure? __________ Stridor/laryngospasm - airway is a ____________________________ +Chvostek's - tap cheek (“C” is for Cheek) +Trousseau's - pump up BP cuff Arrhythmias - heart is a ______________ DTR's Mind Changes Swallowing Probs - esophagus is a _______________________ *these signs and symptoms are common in a patient with hypomagnesium or hypocalcemia* Tx: Give some Mg Check _________function (before and during IV Mg) NCLEX® scenario answers: A. call the doctor B. decrease the infusion C. Stop the infusion D. Reassess in 15 min. Seizure Precautions Eat Magnesium Foods high in magnesium: spinach, mustard greens, summer squash, broccoli, halibut, turnip greens, pumpkin seeds, peppermint, cucumber, green beans, celery, kale, sunflower seeds, sesame seeds, and flax seeds What do you do if your patient begins to c/o flushing and sweating when you start IV Mg? Hurst Review Services 10 Tx: Vit D Renagel® (sevelamer hydrochloride) PhosLo ® (calcium acetate) Os-Cal ® (calcium carbonate) Amphojel ® (aluminum hydroxide gel) is another phosphorus binding drug that is used however; don’t give it to renal patients because they can’t get rid of the aluminum and will get TOXIC! IV Ca (GIVE SLOWLY) Always make sure pt. is on a ________________ HYPOCALCEMIA Causes: Hypoparathyroidism Radical Neck Thyroidectomy Not Enough __________. [Show More]

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