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INTRAVENOUS THERAPY By: Michael Norbert L. De Guzman  IV THERAPY IV medications and fluids enter the bloodstream directly through the vein. They act rapidly to restore fluid volume and deliver medications. Thus, the action cannot be terminated once in the vein. The nur...

INTRAVENOUS THERAPY By: Michael Norbert L. De Guzman  IV THERAPY IV medications and fluids enter the bloodstream directly through the vein. They act rapidly to restore fluid volume and deliver medications. Thus, the action cannot be terminated once in the vein. The nurse is responsible for administering and maintaining IVT, including client teaching. It is essential when clients are unable to take sufficient food and fluids orally  PURPOSES To supply fluid when clients are unable to take in an adequate volume of fluids by mouth To provide electrolytes to prevent imbalances To provide glucose for body metabolism To provide water-soluble vitamins and medications To establish a lifeline for rapidly needed medications  IV FLUID SOLUTIONS CRYSTALLOIDS COLLOIDS SMALL molecules LARGE molecules, stays in the Hypertonic, Isotonic, & intravascular spaces longer Hypotonic solutions than crystalloids Uses depend on type GELATINOUS LARGE amounts can cause Fresh frozen plasma, PRBC, peripheral edema & pulmonary Albumin, Dextran edema LARGE amounts can cause CHF  CRYSTALLOID: HYPERTONIC Has HIGHER numbers, except D5W (which starts as isotonic then changes to hypotonic when metabolized) Eg.: 5% saline, 3% saline, 5% dextrose in 0.9% saline (D5NS), 5% dextrose in LR (D5LR), 10% dextrose in water (D10W) HIGH SALT, LOW WATER Dehydrates cells, therefore, cells SHRINK MONITOR: Fluid volume overload  CRYSTALLOID: HYPOTONIC Has LOWER numbers Eg.: 0.45% SALINE (1/2 NS), 0.33% saline (1/3 NS), 0.225 saline (1/4 NS), D5W LOW SALT, HIGH WATER Hydrates cells, therefore, cells SWELL MONITOR: BP (may decrease)  CRYSTALLOID: ISOTONIC SAME CONCENTRATION as intracellular fluid & stays in intravascular compartment (NO FLUID SHIFTS) Eg.: 0.9% sodium chloride = normal saline(only sol. compatible with blood or blood products), D5W, Lactated Ringer’s Cells STAY THE SAME Used for: blood loss, dehydration, fluid maintenance, DKA (high glucose in cells)  IV CANNULA 14 G Orange Small, color-coded plastic tubes of different SIZES / 16 G Grey GAUGES ORANGE – Rapid blood transfusion, Trauma, Surgery 18 G Green GREY – Rapid fluid replacement, Trauma, Surgery 20 G Pink GREEN – Blood transfusion, large volume transfusions PINK – MULTIPURPOSE; Medications, Hydration, & Routine 22 G Blue therapies BLUE – Pt with Small Veins, Elderly / Pediatric patients 24 G Yellow YELLOW – Very Fragile Veins, Elderly / Pediatric patients 26 G Violet  INFUSION ADMINISTRATION SETS – consists of an insertion spike (trocar), a drip chamber, a roller flow valve/controller, tubing with a secondary port (Y-type), and a protective cap over the connector to the IV catheter (Luer Lock)  OTHER EQUIPMENT Intravenous poles – rods used to hang the IV fluid solution container. The height of most poles is adjustable. Tourniquet – a device used to apply pressure to a part of a limb or extremity in order to limit the flow of blood; tourniquet application should be 6-8inches above the venipuncture site (Berman, Snyder, Frandsen, 2020) Clean gloves and alcohol swabs Dressing and stabilization supplies (micropore or Tegaderm, IV splint)  IV COMPUTATION FORMULAS # of volume in cc df (gtts/ml) ----------------- x ---------------- = gtts/min # of hours 60 mins  COMMON COMPLIC ATIONS PATHOLOGY SYMPTOMS TREATMENT AIR EMBOLISM AIR in vein through IV Tachycardia Clamp tubing tubing Chest pain Turn pt onto their left & Hypotension place in Trendelenburg Decreased LOC position Cyanosis Notify HCP Dyspnea / cough INFILTRATION LEAKING of IV fluid into Pain, swelling, cooling, & Remove IV surrounding tissue numbness at the site Elevate extremity No blood return Apply warm or cool compress DO NOT RUB area  COMMON COMPLIC ATIONS PATHOLOGY SYMPTOMS TREATMENT INFECTION An infectious Tachycardia Remove IV microorganism in vein Redness Obtain cultures through IV tubing Swelling Administer antibiotics as Chills & fever needed Malaise Nausea & vomiting CIRCULATORY Rapid administration of High BP Decrease flow rate OVERLOAD fluids Distended neck veins (KVO rate) Dyspnea Elevate head of the bed Wet cough & crackles Keep pt warm Notify HCP  PATHOLOGY SYMPTOMS TREATMENT PHLEBITIS Inflammation of the vein: Heat, redness, & Remove IV may lead to tenderness at the site Notify HCP thrombophlebitis (clot) Decreased flow of IV Restart the IV on OPPOSITE side HEMATOMA Collection of blood in the Blood, hard & painful Elevate the extremity tissues lump at the site Apply pressure & ice Ecchymosis EXTRAVASATION Unintended administration Burning, stinging pain STOP the infusion of vesicant drugs / fluids in Redness followed by immediately E = EMERGENCY SC tissue blistering, tissue necrosis Leave catheter in place & ulceration & aspirate remaining drug Notify HCP  TAKE NOTE! The patient’s CONSENT is NEEDED. A nurse should make NO MORE THAN 2 attempts in initiating an IV access  QUESTION A client had a 1000 mL bag of 5% dextrose in 0.9% sodium chloride hung at 3 pm. The nurse making rounds at 3:45 pm finds that the client is complaining of a pounding headache and dyspneic, experiencing chills, and is apprehensive, with an increased pulse rate. The IV bag has 400 mL remaining. The nurse should take which action first? A. Call the physician B. Slow the IV infusion C. Sit the client up in bed D. Remove the IV catheter  ANSWER B. Slow the IV infusion  QUESTION The nurse is inserting an IV line into a client's vein. After the initial stick, the nurse continues to advance the catheter if: A.The catheter advances easily B.The vein is distended under the needle C.The client does not complain of discomfort D. Blood return shows in the backflush chamber of the catheter.  ANSWER D. Blood return shows in the backflush chamber of the catheter.  QUESTION The nurse has been caring for a client with nausea, vomiting, and diarrhea for 3 days. The nurse would anticipate which of the following fluid choices is best for this client? A. D5 ½ NS B. D5W C. LR D. D5LR BLOOD THERAPY By: Michael Norbert L. De Guzman  BLOOD THERAPY Blood transfusion or blood component therapy is the IV administration of blood components such as RBCs, platelets, or plasma. In certain conditions or diseases, it may be required to replace the blood components to restore the oxygen levels in the blood. An adult human has about 4–6L of blood circulating in the body.  PURPOSES Quickly restores blood volume (hemorrhage, burns, injury) Combat shock Treat severe anemia  When typing someone’s blood , two antigens are looked at: AL L B L OOD H AS T H E SAME PART S, B UT NOT AL L B L OOD I S T H E SAME T Y P E. ABO antigen type - Everyone has either type A, B, AB, or O People have different blood blood. This means that their blood types based on antigens. cells have either antigen A (type A), Antigens are substances that antigen B (type B), both antigens trigger the body’s immune (type AB), or neither antigen (type response. O). Rh factor - Everyone is either Rh- positive or Rh-negative (you either have Rh or you don’t).  BLOOD GROUPS W/ THEIR ANTIGEN & ANTIBODY COMPONENTS BLOOD ANTIGENS ANTIBODIES CAN GIVE CAN GROUP PRESENT PRESENT BLOOD TO: RECEIVE BLOOD FROM? AB A&B None AB AB, A, B, O A A B A & AB A&O B B A B & AB B&O O None A&B AB, A, B, O O People with blood type O are universal donors and people with blood group AB are called universal receivers.  BLOOD TYPING & CROSS-MATCHING Blood typing - determine the blood group and Rh factor Cross matching - identify possible interactions of the antigens with their corresponding antibodies. Screening - rigorously done to protect both the donor and the recipient from exposure to blood-borne diseases. Potential donors are screened for: ✓ history of hepatitis, ✓ HIV infection, ✓ heart disease, TAKE NOTE! ✓ most cancers, Blood donation is voluntary. ✓ severe asthma, ✓ bleeding disorders  BLOOD PRODUCTS TYPE USES Whole blood (FWB = fresh whole blood) Acute hemorrhage *can be stored, normally and conventionally, for Blood volume replacement 5 weeks Replacement of ALL blood components Packed red blood cells Increase blood oxygen levels in anemia & surgeries Platelets Bleeding disorders *fresh platelets are most effective; can be Platelet deficiencies stored at the blood center for up to 5 days Fresh frozen plasma (FFP) Provides clotting factors *no need for blood typing & cross-matching; can be stored for up to 5 days Albumin Plasma expanders; provide plasma proteins  TRANSFUSION REACTIONS REACTION Cause / Signs & Symptoms HEMOLYSIS - an incompatible blood type; watch out for fever, flank pain, reddish or brown urine, tachycardia, hypotension FEBRILE REACTION - sensitivity of client’s blood to blood products; watch out for fever, warm flushed skin, nausea, anxiety ALLERGIC - sensitivity to infused plasma (mild); watch out for flushing, urticaria REACTION without itching CIRCULATORY - fast blood administration than the client’s circulation can accommodate; OVERLOAD watch out for dyspnea, hypotension, crackles, orthopnea SEPSIS - contaminated blood was administered; watch out for high fever and chills, hypotension, oliguria URINARY CATHETERIZATION By: Michael Norbert L. De Guzman  WHAT IS C ATHETERIZATION? Involves the insertion of a thin, flexible tube into the bladder through the urethra or a surgical opening in the abdomen 2 Main Types: Indwelling & Non-Indwelling  PURPOSES Relieve urinary retention Obtain sterile urine specimen Monitor urine output Measure residual urine Empty the bladder before, during, and after surgery Bladder irrigation (Cystoclysis) Administration of medication  2 TYPES INDWELLING CATHETER NON-INDWELLING CATHETER AKA Foley Catheter AKA Intermittent catheter a thin, sterile tube inserted into the bladder that is a simillar type of catheter will be inserted but will left in place to drain urine not be left in place. held in place with a balloon at the end, which is used for a one-time evacuation of urine filled with sterile water to prevent the catheter usually goes in through your urethra and drains from being removed from the bladder your bladder the urine drains through the catheter tube into a the doctor or nurse may teach a patient how to bag, which is emptied when full put it in and take it out needs to be replaced every 3 months or so by a doctor or nurse  1. SINGLE LUMEN – used for one-time catheterization TYPES OF C ATHETERS 2. TWO- LUMEN – also called an indwelling folley or retention catheter 3. TRIPLE – LUMEN – used for bladder irrigation or Cystoclysis SIZE OF CATHETERS  PROPER POSITIONING Female - Place the patient in dorsal recumbent or lithotomy positions (hips and knees slightly flexed, heels on the bed, hips comfortably abducted) to expose the vulva. Male - Place the patient in the supine position with legs extended and flat on the bed.  QUESTION Which action would the nurse take to reduce the risk for a catheter-associated urinary tract infection (CAUTI) in a patient with an indwelling urinary catheter? A. Wear clean gloves when inserting the catheter. B. Inflate the balloon on the catheter before using it. C. Use the smallest-size catheter possible. D. Empty the urine by disconnecting the catheter from the collection bag.  ANSWER C. Use the smallest-size catheter possible. To reduce the risk of CAUTI in a patient with an indwelling urinary catheter, the nurse would use the smallest-size catheter possible  QUESTION What is the best reason for the nurse to instruct a male patient to take slow, deep breaths during insertion of an indwelling urinary catheter? A. To increase oxygenation B. To reduce blood pressure C. To distract him D. To promote relaxation  ANSWER D.To promote relaxation The nurse would instruct a male patient to take slow, deep breaths during catheter insertion if the nurse felt resistance to the advancing catheter or if the patient reported pain. Deep breathing promotes relaxation, which might help to pass the catheter through the urinary sphincter.  QUESTION Which action(s) would minimize the patient's risk for injury during insertion of an indwelling urinary catheter? A. Assessing the patient for allergies related to latex, antiseptic, tape, and/or iodine-based substances B. Thoroughly cleansing the patient's perineal area with povidone-iodine solution before inserting the catheter C. Performing proper hand hygiene and applying gloves before inserting the catheter D. Terminating the insertion if the patient reports pain at any time during the procedure  ANSWER A. Assessing the patient for allergies related to latex, antiseptic, tape, and/or iodine-based substances Serious allergic reactions may occur if the patient has an allergy to latex, antiseptic, tape, or iodine- based cleanser. ENEMA ADMINISTRATION By: Michael Norbert L. De Guzman  ENEMA A technique used to STIMULATE STOOL EVACUATION. A liquid treatment MOST COMMONLY USED to relieve SEVERE CONSTIPATION. Requires a doctor’s order.  PURPOSES Mainly to treat constipation. Prevent involuntary escape or fecal material during surgical procedures and childbirth. Promote visualization of the bowel when an x-ray or medical exam is to be performed Also used to give meds and fluids  CLEANSING - Water-based, meant to be held in the rectum for a short time to flush the colon. - Prevent the escape of feces during surgery. SOLUTIONS 1. HYPERtonic - 90-120 ml of sol, eg. Sodium phosphate TYPES OF ENEMA - Draws water INTO the colon - Time of effect: 5-10 mins - Adverse Effect/s: Sodium retention CLEANSING 2. HYPOtonic - 500-1000 ml of tap water - Distends colon, stimulates peristalsis, & softens feces - Time of effect: 15-20 mins - Adverse Effect/s: Fluid & electrolyte imbalance, water intoxication  CLEANSING - Water-based, meant to be held in the rectum for a short time to flush the colon. SOLUTIONS 3. ISOtonic TYPES OF ENEMA - 500-1000 ml of normal saline (9-1000 ml water) - Distends colon, stimulates peristalsis, & softens feces - Time of effect: 15-20 mins CLEANSING - Adverse Effect/s: Possible sodium retention 4. Soapsuds - 500-1000 ml (3 -5 ml soap to 1000 ml water) - Irritates mucosa, distends colon - Time of effect: 10-15 mins - Adverse Effect/s: Irritated & may damage mucosa  CLEANSING - Water-based, meant to be held in the rectum for a short time to flush the colon. SOLUTIONS TYPES OF ENEMA 5. Oil (Mineral, olive, cottonseed) - 90-120 ml CLEANSING - Lubricates the feces & the colonic mucosa - Time to effect: 0.5 – 3hours  CARMINATIVE - A small volume enema to release FLATUS and provide relief from gaseous distention. TYPES OF ENEMA - The solution (60-80 ml) instilled into the rectum releases gas, distending the rectum and the colon, thus, stimulating peristalsis. CARMINATIVE - May be antihelminthic which destroys parasites  RETENTION - Introduces oil or medication into the rectum & sigmoid colon. - Retained in the bowel for a TYPES OF ENEMA prolonged time. It is held in the body for 15 mins or more. - To soften the feces and lubricate RETENTION the rectum & anal canal, which helps in the passage of feces. - Provide laxative benefits when oral laxatives are not allowed.  RETURN-FLOW - AKA Harris flush - To expel FLATUS & stimulate peristalsis TYPES OF ENEMA - A large volume fluid is used but is instilled in 100-200 ml increments. - Then, the fluid is drawn out by RETURN-FLOW lowering the container below the level of the bowel. This brings the flatus out with the fluid.  GUIDELINES ADULT CHILDREN INFANT SIZE OF RECTAL Fr. 22 - 30 Fr. 14 - 18 Fr. 12 TUBE AMOUNT OF 500 – 1000 ml 250 – 500 ml 250 ml or less SOLUTION DISTANCE OF 7.5 – 10 cm 5 – 7.5 cm 2.5 – 3.75 cm TUBE INSERTION (3 – 4 in) (2 – 3 in) (1 – 1.5 in) SOLUTION 40.5 – 43 C 37.7 C TEMPERATURE  PROPER POSITIONING Left SIM’s position, bring pt’s hip toward the edge of the bed Rationale: The colon descends on the left side, therefore the flow of the solution is better.  QUESTION The nurse is preparing to administer an enema to a patient. Which type of enema is most likely to lead to circulatory overload? a. Hypertonic solution b. Soapsuds c. Tap water d. Harris flush  ANSWER c. Tap water A tap-water (hypotonic) enema should not be repeated after the first instillation because water toxicity or circulatory overload can develop.  QUESTION When preparing an infant for an enema, the nurse understands that which solution is the safest? a. Tap-water enema solution b. Hypertonic enema solution c. Oil retention d. Physiological normal saline  ANSWER d. Physiological normal saline Physiological normal saline is the safest solution. Infants and children can only tolerate this type of solution because of their predisposition to fluid imbalance. OXYGENATION By: Michael Norbert L. De Guzman  OXYGEN THERAPY Treats or prevents the symptoms & manifestations of hypoxia Reduces the workload of the respiratory system Decreases the heart’s effort in pumping blood  OXYGEN DELIVERY SYSTEM LOW-FLOW HIGH-FLOW Deliver oxygen via Deliver all the oxygen small-bore tubing required during ventilation in precise amounts, Includes nasal cannulas, regardless of the client’s face masks, oxygen respirations tents, & transtracheal Includes Venturi mask with catheters large-bore tubing  LOW-FLOW: NASAL CANNULA - - Most common and inexpensive - - Simple and comfortable - - Used for precise oxygen delivery - - Flow rate: 2 – 6L/min (24 – 45% FiO2)  LOW-FLOW: SIMPLE FACE MASK - - Used for short-term oxygen therapy - - Flow rate: 8 - 12L/min (35 – 65% FiO2)  LOW-FLOW: PARTIAL REBREATHER MASK - - Simple mask with a reservoir bag - - Flow rate: 6 – 10 L/min (40 – 60 % FiO2) - *Partial rebreather bag should not totally deflate during inspiration to avoid CO2 buildup.  LOW-FLOW: NON-REBREATHER MASK - - Delivers the highest oxygen concentration - - has one-way valves that - prevent exhaled air from - returning to the reservoir - bag - - Flow rate: 6 – 15 L/min (60 – 100 % FiO2)  HIGH-FLOW: VENTURI MASK - - Has wide-bore tubing & color-coded jet adapters that correspond to a precise oxygen concentration & liter flow - - Flow rate: 4 - 10 L/min (24 – 40% or 50 % FiO2) VENTURI MASK COLOR CODING TRACHEOSTOMY By: Michael Norbert L. De Guzman  TRACHEOSTOMY a surgical incision in the trachea just below the larynx. for clients who need long-term airway support. a curved tracheostomy tube is inserted to extend through the stoma into the trachea TRACHEOSTOMY  OUTER CANNULA Inserted into the trachea and a flange that rests against the neck, allowing the tube to be secured with tape or ties. OBTURATOR Used to insert the outer cannula and then removed. It is kept at the bedside if the tube becomes dislodged and needs to be reinserted.  CUFFED TRACHEOSTOMY TUBES Surrounded by an inflatable cuff that produces an airtight seal between the tube and the trachea. This seal prevents aspiration of oropharyngeal secretions and air leakage between the tube and trachea.  TRACHEOSTOMY CARE Assist pt in SEMI-FOWLER’S POSITION. May use HYDROGEN PEROXIDE & NORMAL SALINE. Suction when necessary.  OSTOMY By: Michael Norbert L. De Guzman  INDICATIONS Inflammatory Bowel Disease – Primarily Ulcerative Colitis Cancers, Tumors – Colon or Rectum – Pelvis – Rectovaginal Fistula Trauma Birth Defects  QUESTION Does the patient always require the creation of an ostomy if a section of the bowel has been removed?  ANSWER NO. The surgeon can remove a part of the colon and re-connect without Creating an Ostomy. This is called a Primary END to END Anastomosis  HARTMAN’S POUCH ONLY ONE STOMA The non-functional end of the bowel stitched or staples shut and left inside GOAL: usually to reconnect  DOUBLE-BARREL OSTOMY the surgeon cuts out a section of the diseased colon There are TWO STOMAS: - One discharges effluent - The 2nd secretes mucus (mucus fistula)  SITES OF OSTOMY The location of ostomy influences the character and management of the fecal drainage. 1. An ileostomy produces liquid fecal drainage. It contains digestive enzymes, which are damaging to the skin. Odor is minimal because fewer bacteria are present. 2. Transverse colostomy – produces a mal-odorous, mushy drainage 3. Descending colostomy produces increasingly solid fecal drainage. STOMA – an end or terminal colostomy COLOSTOMY By: Michael Norbert L. De Guzman  COLOSTOMY First few days: beefy red and swollen Gradually swelling recedes and the color is pink or red Notify the physician immediately if the stoma is dark blue, “blackish,” or purple- indicates insufficient blood supply BEGINS TO FUNCTION 3-6 DAYS POSTOPERATIVELY  COLOSTOMY CARE & IRRIGATION Colostomy is irrigated to empty the feces, gas, or mucus Suitable time selected: preferably after a meal and same time each day Irrigating reservoir: 500-1500 ml of lukewarm tap water, hung 45 to 50 cm (18 to 20 in) Pouches need to be emptied when they are one-third to one-half full. Empty the contents of the pouch through the bottom opening into a bedpan (prevents spillage of effluent onto the client’s skin) Use warm water, and mild soap to clean the stoma and skin. In applying appliance, about 0.3 cm (1/8 in) larger than the stoma. (to prevent rubbing, cutting, or trauma to the stoma)  COLOSTOMY CARE & IRRIGATION Patients should avoid foods that cause excessive odor and gas such as cabbage family, eggs, fish, beans, and high-cellulose products such as peanuts.  BRYANT’S TRACTION To reduce femoral fracture in children. The buttocks are slightly elevated and clear off the bed. Position is on flat.  BUCK’S TRACTION To reduce femoral fracture in children. Nurse should periodically assess skin status. Skin should be clean and dry. Position is on flat or trendelenburg.  DUNLOP’S TRACTION Includes horizontal & vertical tractions Horizontal traction is used to align the fracture of the humerus. Vertical traction is used to maintain proper alignment of the forearm. Assess for skin breakdown and signs of circulatory impairment and nerve damage, and make sure that the weight is hung freely.  PELVIC TRACTION To relieve back pain. The client is positioned in which the head of the bed is slightly elevated.  RUSSELL’S TRACTION To immobilize the hip or knees or to reduce fracture. The heel of the client should be off the bed.  HALO VEST It is used to immobilize the cervical spine. When caring client with halo vest the nurse should: - avoid putting powder inside the vest - turn the client as a unit (do not use the halo vest to lift the client) - assess for signs of shoulder stress or pressure ulcer NASOGASTRIC TUBE By: Michael Norbert L. De Guzman  PURPOSES Feedings & medications for pts unable to eat by mouth or swallow Suctioning stomach contents to prevent gastric distention, nausea, & vomiting Remove stomach contents for lab analysis Lavage the stomach (poisoning/overdose of medications)  NGT Determine how far to insert the tube. - Tip of the nose -> tip of the earlobe and from the tip of the earlobe -> tip of the xiphoid. Insert the tube into the selected nostril with its natural curve downward. Ask pt to hyperextend the neck.  NGT Slight pressure and a twisting motion are sometimes required to pass the tube into the nasopharynx. If the tube meets resistance, WITHDRAW, RELUBRICATE, & INSERT it in the other nostril. - Tube should never be forced against resistance; risk for injury  NGT Once the tube reaches the throat, the pt will feel the tube and may gag and retch. Ask the pt to tilt the head FORWARD, and encourage him/her to drink and swallow. If the pt continues to gag and the tube doesn’t advance with each swallow, withdraw it slightly, and inspect the throat by looking through the mouth.  NGT: INFANTS & YOUNG CHILDREN Measure from the nose -> tip of the earlobe -> point midway between the umbilicus and the xiphoid process. If an orogastric tube is used, measure from the tip of the earlobe ->corner of the mouth ->xiphoid process  GASTRONOMY & JEJUNOSTOMY Used for long-term nutritional support More than 6 – 8 weeks Tubes are placed surgically or by laparoscopy through the abdominal wall into the stomach (gastronomy) or into the jejunum (jejunostomy)  EXAMPLES OF FOOD FOR CLEAR LIQUID, FULL LIQUID AND SOFT DIETS CLEAR LIQUID FULL LIQUID SOFT Coffee All foods on clear liquid diet All foods on clear & full liquid diets Tea Milk , yoghurt, eggs (in custard Meat & pudding) Carbonated beverages Ice cream, sherbet Meat alternatives; scrambled eggs, omelet, poached eggs; cottage cheese & other mild cheese Clear fruit juices (apple, Vegetable juices Vegetables; mashed potatoes, cranberry, grape) sweet potatoes, squash Popsicles, gelatin Strained cereals Fruits Hard candy, sugar Cream, butter, margarine Bread, cereals Desserts: soft cake, bread pudding  NORMAL LAB VALUES: ELECTROLYTES ELECTROLYTE NORMAL VALUE Ammonia 40–70 μg/dL Chloride 95-105 mmol/L Creatinine 0.8-1.3 mg/dL BUN 8–20 mg/dL Glucose 70–99 mg/dL Magnesium 1.6–2.6 mg/dL Potassium 3.5–5.0 mEq/L  NORMAL LAB VALUES: ELECTROLYTES ELECTROLYTE NORMAL VALUE Sodium 136–145 mEq/L Total Calcium 2-2.6 mmol/L (9-10.5 mg/dL) Total iron-binding capacity 250–310 μg/dL Total serum iron 50–150 μg/dL Urea 1.2-3 mmol/L Uric acid 0.18-0.48 mmol/L Zinc 75–140 μg/dL  NORMAL LAB VALUES: HEMATOLOGY HEMATOLOGY NORMAL VALUE Hemoglobin Female: 12–16 g/dL; male: 14–18 g/dL Hematocrit Female: 37%–47%; male: 42%– 50% WBC 5000—10,000/mm3 Platelets 150,000-350,000/µL (150-350 x 109/L) PTT 11–13 seconds APTT 25–35 seconds Bleeding time < 8 minutes  NORMAL LAB VALUES: LIPIDS LIPIDS NORMAL VALUE Triglycerides ˂150 mg/dL Total cholesterol ˂200 mg/dL HDL Female: ˂50 mg/dL; male: ˂40 mg/dL LDL ˂100 mg/dL