Helenz

Platybasia is a spinal disease of a malformed relationship between the occipital bone and cervical spine. It may be caused by Paget's disease.

thank you for all you help, the right answer is #4. answer key from book: Goal in pain management for the client with an acute MI is to completely eliminate the pain.Even pain rated at a level of 1 out of 10,should be treated with additional morphine(possibly lower dose).the other date indicate a need for ongoing assessment for the possible adverse effects of hypertension respiratory depression, and tachycardia but do not require further action at this time.

Q: you have give Morphine sulfate 4mg IV to a client who has an acute MI. when you evaluate the client's response 5 mins after giving the medication, which of these indicates a need for immediate further actions? A: 1. the blood pressure decreases from 114/65 to 106/58 mm Hg. 2. the respiratory rate drop from 18 to 12 breaths/min. 3. the cardiac monitor indicates sinus rhythm at a rate of 96 beats/min. 4. the client still has chest pain at level of 1(on a scale of 0 to 10) anyone who can help me find the right answer? :)and why ?

HEMATOLOGY VALUES Red Blood Cell Values RBC (Male) 4.2 - 5.6 M/μL RBC (Female) 3.8 - 5.1 M/μL RBC (Child) 3.5 - 5.0 M/μL White Blood Cell Values WBC (Male) 3.8 - 11.0 K / mm cubed WBC (Female) 3.8 - 11.0 K / mm cubed WBC (Child) 5.0 - 10.0 K / mm cubed Hemoglobin Values Hgb (Male) 14 - 18 g/dL Hgb (Female) 11 - 16 g/dL Hgb (child) 10 - 14 g/dL Hgb (Newborn) 15 - 25 g/dL Hematocrit Values Hct (Male) 39 - 54% Hct (Female) 34 - 47% Hct (Child) 30 - 42% MCV 78 - 98 fL MCH 27 - 35 pg MCHC 31 - 37% Neutrophils 50 - 81% Bands 1 - 5% Lymphocytes 14 - 44% Monocytes 2 - 6% Eosinophils 1 - 5% Basophils 0 - 1% Hematology Values CD4+ (normal % value) 31 - 63% CD4+ (absolute count) 416 - 1751/μL Red Cell Distribution Width (RDW) Coefficient of variation: 11.5 - 14.5%, Standard deviation: 35 - 47 fL Reticulocyte (adult) 0.5% - 1.5% Reticulocyte (infant) 0.5% - 3.1% Reticulocyte (newborn) 1.1% - 4.5% Polymorphonuclear WBC's (PMN) 35 - 80% CARDIAC MARKERS Troponin I 0 - 0.1 ng/ml (onset: 4-6 hrs, peak: 12-24 hrs, return to normal: 4-7 days) Troponin T 0 - 0.2 ng/ml (onset: 3-4 hrs, peak: 10-24 hrs, return to normal: 10-14 days) Myoglobin (Male) 10 - 95 ng/ml (onset: 1-3 hrs, peak: 6-10 hrs, return to normal: 12-24 hrs) Myoglobin (Female) 10 - 65 ng/ml (onset: 1-3 hrs, peak: 6-10 hrs, return to normal: 12-24 hrs) Troponin I 0 - 0.1 ng/ml (onset: 4-6 hrs, peak: 12-24 hrs, return to normal: 4-7 days) Creatinine Kinase Index (CKIndex) 0 - 3 Creatinine Kinase-MB (CK-MB) 0 - 3 ng/ml Total Creatinine Kinase 38 - 120 ng/ml GENERAL CHEMISTRY Acetone 0.3 - 2.0 mg% Alanine Aminotransferase (ALT) 7 - 56 U/L Albumin 3.5 - 5.0 gm/dL Albumin (newborn) 2.9 - 5.5 gm/dL Albumin (child) 3.8 - 5.4 gm/dL Alkaline Phosphatase 32 - 110 U/L Anion gap 5 - 16 mEq/L Ammonia 11 - 35 μmol/L Amylase 50 - 150 U/dL Anti-streptolysin O Titer (ASO) (adult) Anti-streptolysin O Titer (ASO) (child) AST, SGOT (Male) 7 - 21 U/L AST, SGOT (Female) 6 - 18 U/L Bilirubin, Direct 0.0 - 0.4 mg/dL Bilirubin, Indirect total minus direct Bilirubin, Total 0.2 - 1.4 mg/dL BUN 6 - 23 mg/dL Calcium (total) 8 - 11 mg/dL Carbon dioxide 21 - 34 mEq/L Carbon monoxide symptoms at greater than or equal to 10% saturation Chloride 96 - 112 mEq/L CK-MM 96 - 100% CK-BB 0% Cortisol (8 AM) 5 - 25 gm/dL Cortisol (8 PM) 2 - 9 gm/dL Creatine (Male) 0.2 - 0.6 mg/dL Creatine (Female) 0.6 - 1.0 mg/dL Creatinine 0.6 - 1.5 mg/dL Creatinine (newborn) 0.3 - 0.7mg/dL Creatinine (child) 0.3 - 1.0 mg/dL Creatinine Kinase Isoenzyme, MB 0 - 121 U/L Creatinine Phosphokinase (CPK) 24 - 195 U/L Ethanol 0 mg%; Coma: greater than or equal to 400 - 500 mg% Ferritin (male) 18 - 250 ng/mL Ferritin (female) 12 - 160 ng/mL Folate 3.6 - 20 ng/mL Folic acid 2.0 - 21 ng/mL Gamma GT 8 - 78 U/L Gamma-glutamyl transferase (GGT) (male) 1 - 94 U/L Gamma-glutamyl transferase (GGT) (female) 1 - 70 U/L Glucose 70 - 110 mg/dL (diuresis greater than or equal to 180 mg/dL) Growth Hormone (male) 0 - 4 ng/mL Growth Hormone (female) 0 - 18 ng/mL IGF-1 (male) 54 - 329 ng/mL IGF-1 (female) 142 - 329 ng/mL HDL (Male) 25 - 65 mg/dL HDL (Female) 38 - 94 mg/dL Insulin 0 - 180 pmol/L Iron 52 - 169 μg/dL Iron binding capacity 246 - 455 μg/dL Lactic acid 0.4 - 2.3 mEq/L Lactic Dehydrogenase (LDH) 56-194 IU/L Lactate 0.3 - 2.3 mEq/L Lipase 10 - 140 U/L Luteinizing Hormone (LH) (female) follicular: 3-14 IU/L, luteal: 2-14 IU/L Magnesium 1.5 - 2.5 mg/dL Osmolarity 276 - 295 mOsm/kg Parathyroid hormone 12 - 68 pg/mL Phosphorus 2.2 - 4.8 mg/dL Potasssium 3.5 - 5.5 mEq/L Protein (total) 6.0 - 9.0 gm/dL Rheumatoid Factor (RF) SGPT 8 - 32 U/L Sodium 135 - 148 mEq/L T3 0.8 - 1.1 μg/dL Thyroid Stimulating Hormone (TSH) 2-11 microU/L Thyroglobulin Less than 55 ng/mL Thyroxine (T4) total 5 - 13 μg/dL Thyroxine-binding Globulin (TBG) 12 - 30 mg/L Free Thyroxine (T4 Free) 0.8 - 1.5 ng/dL Total protein 5 - 9 gm/dL Total serum iron (male) 76 - 198 μg/dL Total serum iron (female) 26 - 170 μg/dL Transferrin 204 - 360 mg/dL TSH Less than 9 μU/mL Urea nitrogen (BUN) 7 - 25 mg/dL Uric acid (Male) 3.5 - 7.7 mg/dL Uric acid (Female) 2.5 - 6.6 mg/dL Vitamin B12 (cobalamin) 200-800 pg/ml LIPID PANEL (ADULT) Cholesterol (total) Less than 200 mg/dL desirable Cholesterol (HDL) 30 - 75 mg/dL Cholesterol (LDL) Less than 130 mg/dL desirable Triglycerides (Male) Greater than 40 - 170 mg/dL Triglycerides (Female) Greater than 35 - 135 mg/dL URINE VALUES Color Straw Specific Gravity 1.003 - 1.040 pH 4.6 - 8.0 Na 10 - 40 mEq/L K Less than 8 mEq/L Cl Less than 8 mEq/L Protein 1 - 15 mg/dL Osmolality 80 - 1300 mOsm/L Urine Bilirubin Negative Urine Blood Negative Urine Ketone Negative Urine Leukocytes Negative Urine Nitrite Negative RBC's 0-2/HPF WBC's 0-2/HPF RBC Casts 0/HPF Urobilogen 0.2-1.0 Ehr U/dl 24 HOUR URINE VALUES Amylase 250 - 1100 IU / 24 hr Calcium 100 - 250 mg / 24 hr Chloride 110 - 250 mEq / 24 hr Creatinine 1 - 2 g / 24 hr Creatine Clearance (Male) 100 - 140 mL / min Creatine Clearance (Male) 16 - 26 mg / kg / 24 hr Creatine Clearance (Female) 80 - 130 mL / min Creatine Clearance (Female) 10 - 20 mg / kg / 24 hr Magnesium 6 - 9 mEq / 24 hr Osmolality 450 - 900 mOsm / kg Phosphorus 0.9 - 1.3 g / 24 hr Potassium 35 - 85 mEq / 24 hr Protein 0 - 150 mg / 24 hr Sodium 30 - 280 mEq / 24 hr Urea nitrogen 10 - 22 gm / 24 hr Uric acid 240 - 755 mg / 24 hr COAGULATION ACT 90 - 130 seconds APTT 21 - 35 seconds Platelets 140,000 - 450,000 / ml Plasminogen 62 - 130% PT 10 - 14 seconds PTT 32 - 45 seconds FSP Less than 10 μg/dL Fibrinogen 160 - 450 mg/dL Bleeding time 3 - 7 minutes Thrombin time 11 - 15 seconds CEREBRAL SPINAL FLUID Appearance clear Glucose 40 - 85 mg/dL Osmolality 290 - 298 mOsm/L Pressure 70 - 180 mm/H2O Protein 15 - 45 mg/dL Total cell count 0 - 5 cells WBC's 0 - 6 / μL HEMODYNAMIC PARAMETERS Cardiac Index 2.5 - 4.2 L / min / m squared Cardiac Output 4 - 8 LPM Left Ventricular Stroke Work Index 40 - 70 g / m squared / beat Mean Arterial Pressure 70 - 105 mm Hg Pulmonary Vascular Resistance 155 - 255 dynes / sec / cm to the negative 5 Pulmonary Vaslular Resistance Index 255 - 285 dynes / sec / cm to the negative 5 Right Ventricular Stroke Work Index 7 - 12 g / m squared / beat Stroke Volume 60 - 100 mL / beat Stroke Volume Index 40 - 85 mL / m squared / beat Systemic Vascular Resistance 900 - 1600 dynes / sec / cm to the negative 5 Systemic Vascular Resistance Index 1970 - 2390 dynes / sec / cm to the negative 5 Systolic Arterial Pressure 90 - 140 mm Hg Diastolic Arterial Pressure 60 - 90 mm Hg Central Venous Pressure 2 - 6 mm Hg; 2.5 - 12 cm H2O Ejection Fraction 60 - 75% Left Arterial Pressure 4 - 12 mm Hg Pulmonary Artery Systolic 15 - 30 mm Hg Pulmonary Artery Diastolic 5 - 15 mm Hg Pulmonary Artery Pressure 10 - 20 mm Hg Pulmonary Artery Wedge Pressure 4 - 12 mm Hg Pulmonary Artery End Diastolic Pressure 8 - 10 mm Hg Right Atrial Pressure 4 - 6 mm Hg Right Ventricular End Diastolic Pressure 0 - 8 mm Hg NEUROLOGICAL VALUES Cerebral Perfusion Pressure 70 - 90 mm Hg Intracranial Pressure 5 - 15 mm Hg or 5 - 10 cm H2O ARTERIAL VALUES pH 7.35 - 7.45 PaCO2 35 - 45 mm Hg HCO3 22 - 26 mEq/L O2 sat 96 - 100% PaO2 85 - 100 mm Hg BE -2 to +2 mmol/L VENOUS VALUES pH 7.31 - 7.41 PaCO2 41 - 51 mm Hg HCO3 22 - 29 mEq/L O2 sat 60 - 85% PaO2 30 - 40 mm Hg BE 0 to +4 mmol/L ENDOCRINE VALUES 17-Hydroxycorticosteroid (17- OHCS) >4 mg/day Adrenocorticotrophic Hormone (ACTH) 20-100 pg/ml Prolactin (PRL) 0-14 ng/ml Serum Alpha-Fetoprotein (AFP) 0-44 ng/ml

suggests three levels of priority setting: 1. the first ABC plus V ( airway,breathing,cardiac&circulation,vital signs) 2. concerns mental status changes,untreated medical issues,acute pain,acute elimination problems,abnormal laboratory results,and risks. 3. more long-term issues in health education,rest,coping,and so on.