NR GI PART 1&2 STUDY GUIDE EXAM 4 –ADULT HEALTH, Exams of Nursing

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4 –ADULT HEALTH

GI Part 1

GERD: reflux of stomach contents into the esophagus

*Caused by relaxation / opening of lower esophageal sphincter

**- pH of stomach 1.5 - 2

• pH of Esophagus 6- 7**
• Risk factors: o Obesity o Older age (delayed gastric emptying & weakened LES tone) o Sleep apnea o NG tube o Theophylline, nitrates, calcium channel blockers, anticholinergics & diazepam
• Symptoms:
• Dyspepsia (indigestion)
• Regurgitation (may lead to aspiration or bronchitis)
• Water brash (hypersalivation)
• Dental caries (severe cases)
• Dysphagia
• Odynophagia (painful swallowing)
• Globus (feeling of something in back of throat)
• Pharyngitis
• Coughing, hoarseness or wheezing at night (sleep apnea)
• Chest pain
• Pyrosis (heartburn)
• Epigastric pain
• Generalized abd. pain, Belching / Nausea
• Flatulence ATI Expected findings:
• Dyspepsia (indigestion) after eating & regurgitation
• Radiating pain (neck jaw back)
• Feeling of a heart attack
• Pyrosis (burning)
• Odynophagia (pain on swallowing)
• Dysphagia, throat irritation
• Increased eructation (burping)
• 4-5 x/wk
• Diagnosis: o Symptoms & history!! o EGD ▪ Check gag reflex before taking off NPO, monitor for perforation – fever, pain, dyspnea, bleeding

4 –ADULT HEALTH

o Chp 48 SCOPE procedure ▪ Through mouth, down the throat into esophagus to the stomach and upper portion of the duodenum (lower intestine)

• Anesthesia: moderate conscious sedation, Lidocaine (local anesthetic)
• Consent
• NPO
• Aspiration / perforation (PAIN, bacteria leaking out/ sepsis, tachypnea, infection, severe abd. pain)
• Vocal cords
• Low risk of infection
• Risk of bleeding (anticoags, preop blood labs) (coughing/ vomiting blood, hypotension & tachycardia, dark stools)
• Semi fowlers

o Post care

o ABC’s / VS

o Gag reflex

o LOC (due to sedation)

o pH monitoring (diary)

• Treatment : o Diet (avoidance of citrus, alcohol, coffee, smoking) o Lifestyle (smaller more frequent meals  less pressure on sphincter) ▪ Remain upright after eating, not right before bed ▪ Sleep sitting up (severe)

Barrett’s Epithelium: result of CHRONIC GERD

• Acid erodes esophagus
• Cell structure changes from squamous epithelium to columnar epithelium (more resistant to acid BUT it is premalignant  cancer)

Hiatal Hernia : stomach protrudes through diaphragmatic opening  Stomach ends up on top of

diaphragm 2 types:

1. Sliding : everything slides straight up (esophagus and stomach) - GERD SYMPTOMS: heartburn, reflux, chest pain, dysphagia, belching
2. Rolling : esophagus stays in place & stomach rolls on top of diaphragm - SOB, Fullness (feeling fuller quicker), chest pain, worsening of manifestations when reclining, volvulus (twisting of GI structure)  necrosis

• Diagnosis: o Barium swallow ▪ Xray of drinking barium
• NPO & Increase fluids post procedure

4 –ADULT HEALTH

• Chalky white stools (may give them a laxative) o EGD - Treatment: o Treat GERD o Nissen Fundoplication (surgery, laparoscopic or open) ▪ Take upper portion of stomach  wrap around lower portion of esophagus and stitch it together)  holds stomach below diaphragm & applies a little pressure to the lower esophageal sphincter ▪ HUG SURGERY ▪ Complications: temporary dysphagia, gas bloat syndrome (difficulty burping & distention), atelectasis/ pneumonia
• RISKS: Bleeding & infection, perforation, diaphragm damage
• Pre-Op: general anesthesia, consent, NPO,
• Pos-Op: ABC’s, LOC, bleeding!!
• Pain meds, abd. binder, pillow (support)
• Ambulate asap but avoid heavy lifting
• Incentive spirometer
• Cough and deep breathe
• NG TUBES  decompress the stomach while sutures heal  vomiting o Nasogastric Decompression: suction applied to NG tube to relieve abd. distention
• do not mess with an NG tube without an ORDER!!!!!!!

Esophageal Tumors

**- Caused by GERD, obesity, alcohol, eating high amts of smoked & pickled foods, MEN

• Cancer: develops rapidly and metastasizes easily, prognosis is usually poor, spreads easily,** **MEN (higher intake of tobacco & alcohol, abd. obesity) !!!! Can grow in weeks
• Symptoms:** - Persistent & progressive dysphagia (most common feature)
  • Feeling of food sticking in the throat
  • Odynophagia (painful swallowing)
  • Halitosis (bad breath) - Chronic hiccups
  • Chronic cough with increasing secretions
  • Hoarseness
  • Severe, persistent chest or abd. Pain / discomfort
  • Anorexia
  • Regurgitation
  • N/V
  • Weight loss (often more than 20 lb.)
  • Changes in bowel habits (diarrhea, constipation, bleeding)
• Diagnosis: o Barium swallow

4 –ADULT HEALTH

o Needle aspiration of tissue o PET scan (to see if cancer is anywhere else in the body)

• Treatment: o Nutrition (can’t eat) – nutritionist & speech pathologist o Chemo & radiation (localized) / surgery ▪ Pre-Op: general an., GOOD ORAL CARE (bacteria) ▪ Post-Op: ICU, intubation, cardiac complications  hypertension, decreased OP, a. fib. Risk, fluid overload risk (lymphatic removal)  crackles, edema, swelling, ▪ infection risk, NG tube, J-tubes, eat very small amts.,

Gastritis: inflammation of the stomach

Acute *more common Chronic

Long term NSAIDS, alcohol, coffee, caffeine, stress, smoking Autoimmune, pernicious anemia, H. Pylori Sudden onset, short duration Long term, increased risk for gastric cancer Local irritation Patchy, diffuse Severe symptoms- pain, dyspepsia, hematemesis, melena Few symptoms unless ulceration, then N/V, pain EGD EGD (PPI) OMEPRAZOLE: TAKE 30 MIN BEFORE MEAL Expected findings:

• Dyspepsia
• HA
• Indigestion, abd. discomfort
• Hiccupping
• Upper abd. pain or burning
• N/V
• Reduced appetite and weight loss
• Abd. bloating / distention
• Hematemesis (positive occult blood stool test)
• Gastric hemorrhage
• Anorexia
• Pernicious anemia
• Intolerance of spicy & fatty foods Labs & Diagnostics:
  • CBC to check for anemia (Females Hgb <12g/dL, Males Hgb < 14 g/dL)
  • Endoscopy: maintain NPO 6-8 hr prior, throat may be sore, monitor for perforation
    • Remove causative agent
    • Treat underlying disease
    • Medications: Mucosal barrier agents, antacids, PPI’s & H2 Blockers

4 –ADULT HEALTH

Peptic Ulcer Disease (PUD): chronic gastritis, HCl and enzymes ate through multiple layers of the

stomach (gastric and duodenal) – A peptic ulcer is an erosion of the mucosal lining of the stomach, esophagus, or duodenum o HYPOTENSION o Dyspepsia (heartburn, bloating, N/V, fullness, or hunger) o Dull, gnawing pain or burning sensation at the midepigastrium or the back

• Risk Factors: o Stress o H. Pylori o NSAID and Corticosteroid use o Severe stress o Familial tendencies o Hypersecretory states o Gastrin-secreting benign or malignant tumors of the pancreas o Type O blood o Excess alcohol consumption o Chronic pulmonary / kidney disease o Zollinger-Ellison syndrome (combination of peptic ulcers, hypersecretion of gastric acid & gastrin- secreting tumors o Pernicious anemia

Gastric Ulcer Duodenal Ulcer

Pain 30-60 min after eating Pain 1.5-3 hours after meal Less often pain at night Awakening with pain during the night Pain exacerbated by ingestion of food Pain relieved by indigestion of food or antacid Malnourishment Well-nourished Hematemesis Melena Sensation of bloating & pain upon palpitation of the epigastric region Esomeprazole: take 1 hr before meal & limit NSAID’s when taking this med

• Diagnosis: o H. Pylori bacteria (LEADING CAUSE OF GASTRIC CANCER) o Labs, blood, breath or stool o EGD
• Treatment: PPI’s, H2 blockers, Antacids, Antibiotics for H. Pylori o Bland diet o Surgery ▪ Gastrectomy (surgery to remove some or all of the stomach w/ ulcer) - Complications: delayed gastric emptying (delay mvmt in GI tract after surgery) & malabsorption (supplements & vitamins / minerals) ▪ Pyloroplasty (the opening between the stomach & small intestine is enlarged to increase the rate of gastric emptying) ▪ Vagotomy (cutting of vagus nerve in stomach)

4 –ADULT HEALTH

• Complications: o Bleeding: N/V, pain, duodenal (blood in stool), hypervolemia, hypertension, decrease in hematocrit o Pyloric Obstruction: vomiting, give it a “rest” (NG tube), reduce swelling, scar tissue (pyloroplasty) o Perforation: Stomach & GI contents leak (peritonitis- shock, hypotension, tachycardia, dizziness / confusion & decreased hemoglobin) o Pernicious anemia: lifelong B12 injections will be necessary Vomiting profusely at home before coming to ED, which acid-base imbalance will the nurse expect? A: Metabolic Alkalosis Diarrhea = Acidosis *Suspected peptic ulcer: rigid abd., tachycardia, rebound tenderness

Gastric Cancer

• Causes: H. Pylori, chronic gastritis, pernicious anemia, pickled foods / nitrates Symptoms:

Early Advanced

Abd. discomfort IDA Feeling of fullness Palpable mass Weakness/ fatigue Weight loss Enlarged lymph nodes Treatment: o Chemotherapy o Radiation o Surgery (total / subtotal gastrectomy) ▪ Implications Post-Op:

• NG tube… do not touch w/o orders!!!!!!!!!!! (prevent N/V)
• Cough and deep breathe (support abd. w/ pillow)
• Ambulate ASAP

Dumping Syndrome: rapid passage of food into the jejunum and drawing of fluid into the jejunum

causing abd. distention Early symptoms occur within 30 minutes of eating o Vertigo, tachycardia, syncope, pallor, diaphoresis, desire to lay down Late symptoms occur within 90 minutes to 3 hours after food

4 –ADULT HEALTH

o Similar Sx o Rapid entry of high- CHO food into jejunum, rise in blood glucose, then excessive insulin release o Risk for hypoglycemia, dizziness, diaphoresis, confusion & palpitations Manage w/ dietary change o Avoid fluid w/ meals o Avoid high carb / sugar intake and DAIRY / ICE CREAM o Fat high protein, high fat -- *Eat chicken & white rice (avoid high fiber, chicken salad, ranch dressing) o *GASTRIC ULCER: HEMMORHAGE GI Part 2

Intestinal Obstruction:

Two types: Mechanical: physical (tumor, scarring, surgical adhesions, volvulus, hernia, intussusception (bowel telescopes on itself, more common in kids), Chron’s disease, carcinomas Non-Mechanical (Paralytic Ileus): functional, lack of peristalsis (post GI surgeries), diffuse constant pain, N/V SEMI FOWLERS

- Symptoms: Hypovolemia, hypotension - Complications: - Acid base imbalance (metabolic alkalosis) - Hypovolemia - Sepsis

Small Bowel Obstruction Large Bowel Obstruction

Severe fluid and electrolyte imbalance Minor fluid / electrolyte imbalances Metabolic ALKALosis (SM. INTESTINAL OBSTRUCTION, hypoventilation, confusion, hypercarbia) Metabolic ACIDosis (LRG. BOWEL OBSTRUCTION, deep, rapid respirations, confusion, hypotension, flushed skin Visible peristaltic waves (possible) Significant lower abd. distention Epigastric / upper abd. distention Intermittent abd. cramping Abd. pain / discomfort Infrequent vomiting Profuse, sudden projectile vomiting w/ fecal odor Diarrhea / ribbon-like stools around an impaction

- Diagnosis: CT / X-ray scan, abd. ultrasound, endoscopy, & labs: WBC and amylase increased, hemoglobin & hematocrit increased, BUN & creatinine increased (BUN first), loss of sodium, chloride & potassium - Non-surgical mgmt: monitor O2, HR, fluid & electrolyte status, NPO, hard stool? Laxative, enema – NG tube: get all air out to keep from vomiting, leave NPO until peristalsis returns, time…  Med that helps wake up the bowel: ALVIMOPAN - Surgical mgmt: depends on the underlying cause…, EXP lap, exploratory surgery (pull out intestines and look for issue )

4 –ADULT HEALTH

Colorectal Cancer: cancer of the rectum or anywhere in the large intestine or colon – 3 rd^ leading

cancer in the U.S.—Most are adenocarcinoma (develops from polyps)

• Risk Factors: o >50 y/o o Genetics / Family Hx o FAP (familial adenomas polyposis- born w/ it, develop thousands of polyps by age 20, almost 100% develop CRC) o Chron’s & Ulcerative Colitis o Smoking, alcohol, diets low in fiber high in fat, obesity - Symptoms: o Rectal bleeding, anemia o Change in stool consistency - CRC Screening: everyone at age 45 o *Colonoscopy – every 10 years (once a polyp develops, typically takes 7-10 years for it to turn into a malignancy) ▪ Moderate/ conscious sedation ▪ NPO, bowel prep (day before, clear liquids, liquid pt drinks, causes diarrhea) ▪ OP, driver - Risk Factors: o Bowel perforation o bleeding o FOBT (fecal occult blood test, every year) o Sigmoidoscopy - Prevention: o Exercise, healthy diet- lean meats, veggies, high fiber intake o Avoid smoking & alcohol o Men have higher risk - Treatment: depends on type o Chemo / radiation o Surgery

Ostomies: surgical opening from the inside of the body to the outside and can be located in various

areas of the body, can be permanent or temporary

• A stoma is the artificial opening created during the ostomy surgery
• Ileostomy: ileum, large intestine is passed (entire colon is removed, Chron’s disease, ulcerative colitis)
• Ostomy: opening into the large intestine (cancer, ischemic injury, diverticulitis, trauma, rest…) o Avoid high fiber foods o Chew food well

4 –ADULT HEALTH

o Increase fluids

Irritable Bowel Syndrome: diarrhea, constipation, abd. pain / bloating

IBC / IBD

• Caffeinated & carbonated beverages, hormonal component (women), stress / anX
• Symptoms: cramping, pain, N/V, anorexia, abd. bleeding, bloating, diarrhea / constipation, hyperactive / hypoactive BS, incomplete defecation sensation, mucous in stools
• Diagnostics: bacterial overgrowth in intestine (Hydrogen Breath Test)—NPO, excess hydrogen = overgrowth
• Treatment: Diet 30-40 g of fiber/ day, Education, Stress reduction,
• Meds: probiotics, Metamucil (plant, treats constipation & diarrhea), anti-diarrheal loperamide, alosetron, psyllium o IBD (Loperamide – can cause drowsiness, Psyllium – monitor for electrolyte imbalances, Alosetron – last resort only, C/I: Chron’s, ulcerative colitis, report constipation, fever, increasing abd. pain) o IBS (Lubiprostone – take w/ food & water, Linaclotide – take 30 min. before breakfast)

Hernias: bowel coming through abd. wall

• bowel herniation: displacement of the bowel through a weakness of the abd. muscle into other areas of the abd. cavity
  • Risk factors: o Men / genetics o Advanced age o Increased abd. pressure – obesity, pregnancy
  • Types: o Incisional (inadequate healing of incisional site from malnutrition, infection, or obesity) o Umbilical (children, obese & pregnant women) o Femoral (pregnant women & obese pts) o Direct inguinal (most common in men, bowel comes through the inguinal ring) (ICE TO REDUCE SWELLING) / Indirect inguinal o Epigastric
  • Symptoms: o Lump, pain
  • Classifications: o Reducible o Irreducible o strangulated (surgical EMERGENCY): tachycardia, abd. distention & pain, N/V & fever
  • Treatment: TRUSS belt, Herniorrhaphy and Hernioplasty surgeries

4 –ADULT HEALTH

• Nursing Implications: Outpt, Post op most go home, driver, DON’T COUGH OR LIFT ANYTHING HEAVY

Hemorrhoids : SWOLLEN VEINS IN AND AROUND THE RECTUM

• Pain, burning sensation
• Ice packs, baths, lidocaine, reverse complication

Drug therapy (Chp 50- table 50.1)

▪ PPI’s (-zole drugs)

- Pantoprazole, omeprazole, esomeprazole, rabeprazole & lansoprazole

o Reduce gastric acid by inhibiting the cellular pump of the gastric parietal

cells necessary for gastric acid secretion

▪ Nursing Actions:

• Monitor for electrolyte imbalances & hypoglycemia in

clients who have diabetes mellitus

• Monitor for abd. cramping, fever & diarrhea (CDAD-Cdiff)

o Long term use fractures (older adults)

▪ Antacids

- Aluminum hydroxide, magnesium hydroxide, calcium carbonate &

sodium bicarbonate (neutralize excess acid & increase LES pressure)

o Nursing actions:

▪ Ensure there are NO C/I’s w/ other prescribed meds (levothyroxine)

• evaluate kidney function when taking MG Hyd.

▪ Take 1-3 hr after eating & at bedtime)—take separate from

other meds by at least one hour

▪ Histamine Receptor Agonists (H2 blockers) (-dine drugs)

- Ranitidine, famotidine, cimetidine & nizatidine (reduce the secretion of acid)

• !! Use cautiously in clients who have kidney disease

o Client Ed:

▪ Take w/ meals & @bedtime

▪ Separate dosages from antacids (1 hr before / after)

4 –ADULT HEALTH

1. GI assessment & history – questions to ask, prioritization for abnormal findings. - Patient’s age, gender, culture - Typical diet, appetite, and any changes in these - Medications, vitamins, minerals, herbal supplements - Weight loss or gain - Difficulty chewing or swallowing - Dentures - Indigestion or heartburn – how often and what helps? - Tobacco or alcohol use - Typical bowel habits, stool consistency, pain or bleeding associated with BM - Physical Assessment: o Inspect ▪ Symmetry of abdomen ▪ Discoloration or scarring ▪ Distention ▪ Bulging flanks ▪ Skin folds ▪ Subcutaneous fat ▪ Pressure injuries o Auscultate o Percuss o Palpate- tender areas last 2. Know age related GI changes and interventions/prevention - Peristalsis slows with age o Constipation o Bowel incontinence - Weakening of the colonic muscular wall produces diverticula o Sac-like out-pouching of the colon lining that balloon through the outer colon wall o Diverticulitis and diverticulosis - Risk of colon cancer increases with age - Older adults should get adequate fiber and fluid intake to prevent constipation, diarrhea, or diverticular disease - Vitamin B12, Vitamin D, calcium and iron supplements may be needed 3. Know indications for different lab tests, how to perform, patient education, and what abnormal findings indicate. - Carcinoembryonic Antigen (CEA) – colorectal, stomach, pancreatic cancer, UC, Chron’s disease, hepatitis, cirrhosis

4 –ADULT HEALTH

- Hypokalemia – vomiting, gastric suctioning, diarrhea, drainage from intestinal fistulas - Xylose absorption (decreased) – malabsorption in the small intestine - CBC – looks for anemia and infection (GI bleed is the most common cause of anemia) - Stool Samples o Colorectal cancer – annual guaiac-based FOBT annually o Tests for ova and parasites o Fecal fats – steatorrhea (fatty stools) or malabsorption o C-diff 4. Know patient prep, patient education, indications, nursing implications and post- **procedure care for the following:

• X-rays** - Patient Prep: o Hospital gown o Removal all metal - Patient Education: o Supine o Plain film of abdomen o Reveals masses, tumors, strictures, and obstructions - Upper GI Series (Barium Swallow) - Patient drinks barium and stands in front of X-ray plate and pictures are taken during swallowing - Barium glows white on the X-ray - Patient NPO - Encourage fluids after testing to flush barium out of body - Stool can turn a chalky white color - Indications: o Diagnose problems in the upper digestive system (esophagus, stomach, duodenum, or hiatal hernias) - MRI - Patient Prep: o Hospital gown o Remove all metal - Patient Education: o Not exposed to radiation o Takes longer than CT - CT (w/wo contrast)

4 –ADULT HEALTH

- Patient Prep: o May require sedation if patient is claustrophobic o NPO for at least 4 hours o IV access (contrast) ▪ One injection ▪ Patient may feel warm and flushed ▪ Metallic taste o Stop Metformin if patient is taking it - Patient Education: o Noninvasive cross-sectional X-ray view that can detect tissue densities and abnormalities in the abdomen o Lie still and hold breath when asked o Takes about 10 minutes - Post-Procedure Care: o ABCs/VS o Sufficient oral or IV fluid intake - Abdominal Ultrasound - High-frequency, inaudible vibratory sound waves are passed through the body via a transducer - Used to view soft tissues such as liver, spleen, pancreas, and biliary system - Painless and noninvasive - Must lay still - May need to be NPO beforehand, depending on organ being examined - Patient supine - Takes 15 – 30 minutes - Endoscopic Ultrasound - Provides images of the GI wall and high-resolution images of the digestive organs - Useful in diagnosing the presence of lymph node tumors, mucosal tumors, and tumors of the pancreas, stomach, and rectum - Esophagogastroduodenoscopy (EGD; P 1082) - Visual examination via scope of the esophagus, stomach, and duodenum - Patient Prep: o Informed consent o Lidocaine to numb the throat o Sedated to depress the rate and depth of respirations

4 –ADULT HEALTH

o Atropine to dry secretions o Moderate conscious sedation o Performed in semi-fowler’s position o NPO 6 – 8 hours before o Elevate HOB o Bite block inserted to prevent biting down on the scope and to protect teeth

- Patient Education: o Scope advanced down the throat to show the esophagus and any other abnormalities o Allows the view of esophagus and gastric lining o Need someone to drive them home o Takes about 20 -30 minutes o A hoarse voice or sore throat may persist for several days ▪ Throat lozenges can be used to relieve discomfort - Indications: o GERD along with other complications o Patient usually has dysphagia or painful swallowing - Nursing Implications o Monitor RR and depth, O2 sat o Use sternal rub to encourage deeper and faster respirations if RR is below 10/min or exhaled CO2 level falls below 20% - Post-Procedure Care: o ABCs/VS o Monitor LOC due to the use of moderate conscious sedation o Ensure the return of the gag reflex/swallowing - Complications: o Puncture/Perforation (ABD pain, increased BP/HR, peritonitis/rigid abdomen) o Aspiration o Bleeding (coughing up blood, melena, hematemesis) o Infection (fever, sore throat, tachycardia) o Advancing into the trachea instead of the esophagus (noticed quickly) o Other respiratory issues

4 –ADULT HEALTH

- Endoscopic Retrograde Cholangiopancreatography (ERCP) - Visual and radiographic examination of the liver, gallbladder, bile ducts, and pancreas to identify the cause and location of obstruction. - Patient Prep: o Avoid anticoagulants, antiplatelets, anti-hyperglycemic agents, aspirin, or other NSAIDs for several days before o NPO 6 – 8 hours before o Remove dentures o Ask about prior exposure to X-ray contrast media, sensitivities, allergies, and implanted medical devices o IV access o Left lateral position ▪ Put patient in prone once cannula is placed ▪ Contrast media usually injected, and X-rays are taken once the cannula is in the common duct - Patient Education: o Provider may perform a papillotomy to remove gallstones o If biliary duct stricture is found, plastic or metal stents may be inserted to keep ducts open o Biopsy samples often taken o Lasts 30 minutes – 2 hours - Indications: o Pancreatitis of unknown cause o Obstructive jaundice o Suspicion of pancreatic cancer - Post-Procedure Care: o ABCs/VS o NPO until gag reflex/swallowing returns o Colicky abdominal pain and flatulence can result from air instilled during the procedure ▪ Instruct patient to report abdominal pain, fever, N/V that fails to resolve (indicative of pancreatitis)

4 –ADULT HEALTH

- pH Monitoring (P 1082) - Patient Prep: o Informed consent - Patient Education: o A trans nasally placed catheter or wireless, capsule-like device is affixed to the distal esophageal mucosa o Keep a diary of activities, food intake, time of eating, symptoms, body position, etc. over the next 24 – 48 hours. o pH is continuously monitored and recorded - Indications: o GERD Liver Function Albumin: 3.5 - 5 g/dL Ammonia: 10 - 80 mcg/dL Amylase: 30 -220 u/L Lipase: 0 - 160 u/L AST: 0 - 35 u/L ALT: 4 - 36 u/L Complete Blood Count (CBC) RBC: 4.2 - 6.1 million/uL Hgb: 12 - 18 g/dL Hct: 37% - 52% WBCs: 5,000 - 10,000 mm Platelets :150,000 - 400,000 mm ESR: less than 20 mm/hr Arterial blood gases pH: 7.35 - 7.45 Kidney Function PaO2: 80 - 100 mm Hg Specific gravity: 1.010 - 1.

4 –ADULT HEALTH

PaCO2: 35 - 45 mm Hg Serum creatinine: 0.5 - 1.2 mg/dL HCO3: 22 - 26 mm Hg BUN: 10 - 20 mg/dL Electrolytes Sodium: 136 - 145 mEq/L Potassium: 3.5 - 5 mEq/L Calcium: 9 - 10.5 mEq/L Magnesium: 1.3 - 2.1 mEq/L Phosphorus: 3 - 4.5 mEq/L Chloride : 98 - 106 mEq/L