LPN Mark Klimek
For blood types:
"O" is the universal donor (remember "O" in donor) "AB" is the universal recipient
C to F
(C x 1.8) + 32
*Never get pregnant with a German
(German measles/rubella is the dangerous one for pregnant women)
Air embolism positioning
(S/S: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of impending doom) ● Turn patient to LEFT side and LOWER head of bed
Aluminum Hydroxide (Amphojel)
(antacid) treatment of GERD and kidney stones- watch for constipation *Take after meals
Hypovolemia:
(dehydration) increased temperature, rapid/weak pulse (tachycardia), increased respirations, hypotension, anxiety, urine SG > 1.030 (dark urine), confusion (early sign) ● Increased sodium with dehydration ● Increased BUN with dehydration ● Increased hematocrit with dehydration
*All psych meds
(except Lithium) have the same side effects- SNS (exception is hypotension)
Hypervolemia:
(fluid volume excess/overload) bounding pulse, SOB, dyspnea, crackles, peripheral edema, HTN, urine SG <1.010 (dilute urine); Semi-Fowler's *D5W-body rapidly metabolizes the dextrose and the solution becomes hypotonic Low phosphorous—patient will exhibit generalized muscle weakness→ may lead to acute muscle breakdown (rhabdomyolysis) ● Phosphate is necessary for energy production in the form of ATP—when not produced, leads to generalized weakness
S3
(heart sound) is normal in CHF, not normal in MI *May also hear S3 in fluid volume overload
Isoniazid
(medication for TB) causes peripheral neuropathy -patients may be instructed to take Vitamin B6 to counter; hepatotoxicity (monitor LFTs); should not be taken with Phenytoin (Dilantin) as it can lead to toxicity; hypotension may occur initially but should resolve
To prevent dumping syndrome
(post operative ulcer/stomach surgeries) eat in reclining position. Lie down after meals for 20-30 min. also restrict fluids during meals, low carb and fiber diet. small, frequent meals. high fat and protein
Rifampin
(treatment of TB)- watch for red/orange tears, urine *Decreases effectiveness of contraceptives
Aminoglycosides
(vancomycin and gentamicin) can cause nephrotoxicity and ototoxcity if given too quickly - monitor BUN and creatinine "Red Man" syndrome occurs when vancomycin is infused too quickly—because the client needs the medication to treat infection, the vancomycin should not be discontinued—antihistamines my help decrease the flushing, but vancomycin should be administered over at least 60 min!
Bipolar Disorder
*Avoid competitive games when in manic phase (leads to increase in agitation)
Rheumatic fever can lead to cardiac valve malfunctions/disease
*Group-A strep precedes rheumatic fever ● Patients experience chorea (grimacing, sudden jerky body movements) ● Joint pain is common ● Penicillin is usually given ● Watch for antistreptolysin O to be elevated
MAOIs
*Pirates say "arrrr"—when pirates are depressed they take MAOIs -MAOIs used for depression have an "ar" sound in the middle (parnate, marplan, nardil) ..or.. PANAMA PArnate- tranylcypromine NArdil- phenelzine MArplan- isocarboxazid *Avoid tyramine when taking MAOIs—aged cheese, chicken liver, avocados, bananas, meat tenderizer, salami, bologna, wine, beer—may cause HTN crisis
Cimetidine- H2
*Take with meals and at bedtime S/E: constipation
Tetralogy of Fallot
*Think DROP (child drops to floor or squats) D- defect, septal R- right ventricular hypertrophy O- overriding aorta P- pulmonary stenosis For neonates with Tetralogy of Fallot- prostaglandin E1 infusion *Give O2 and morphine, IVF for volume expansion
Post Total Hip Replacement
- Don't sleep on operated side - Don't flex hip more than 45-60 degrees - Don't elevate HOB more than 45 degrees - Maintain hip abduction by separating thighs with pillows. -no adduction or internal rotation
Morphine is contraindicated in what?
- Pancreatitis - It causes spasms of the sphincter of Oddi, therefore Demerol should be given
Post cataract surgery position
- Patient will sleep on UNAFFECTED side with a night shield for 1-4 weeks Pain not relieved by pain meds-hemorrhage, infx, high intraocular pressure
Sulfamethaxozole/Trimethoprim (Bactrim)
- antibiotic- do not take if allergic to sulfa- diarrhea is a common side effect, drink plenty of fluids
Hyperthyroidism
- excess secretion of thyroid hormone (TH) from thyroid gland resulting in increased metabolic rate (accelerated physical and mental function) ● Causes o Graves disease (autoimmune reaction) o Excess secretion of TSH, tumor, medication reaction ● Thyroid Storm (Thyroid Crisis) o Extreme hyperthyroidism (life threatening) due to infection, stress, trauma ▪ Febrile state, tachycardia, HTN, tremors, seizures
Carbidopa/Levodopa (Sinemet)
- sweat, saliva, urine may turn reddish brown, causes drowsiness; patients should not take with MAOIs ● Levodopa- contraindicated for patients with glaucoma, avoid Vitamin B6, avoid high protein diet (interferes with the body's response to medication)
Trimethobenzamide HCl (Tigan)
- tx of post-op N/V and for nausea associated with gastroenteritis
GLASGOW COMA SCALE
-Eyes, verbal, motor *It is similar to measuring dating skills- max 15 points, one can do it! If below 8, you are in a coma -To start dating, you have to open your EYES first- if you are able to do that spontaneously and use them correctly to SEE whom you are dating, you earn 4 points—but if she has to scream at you to make you open them it is only 3 points. If you dare not to open your eyes, even if she kicks you, you only get 1 point! -If you get good EYE contact (4 points) then move on to VERBAL—talk to her/him, if you can do that you are oriented (4 points)—if you like her try not to be CONFUSED (3 points), and of course do not use INAPPROPRIATE WORDS (3 points) because she won't like it—try not to respond with INCOMPREHENSIBLE SOUNDS (2 points)—but if you just don't like her—do not respond at all- NO VERBAL RESPONSE (1 point)
Heroin withdrawal for a neonate
-Irritable -Poor sucking -High pitched cry *Withdrawal seen 12-24 hours later
Contact Mrs. Wee
-MRSA -VRSA -RSV -Skin infections (herpes zoster, cutaneous diphtheria, impetigo, pediculosis, scabies, and staphylococcus) -Wound infections -Enteric infections (Clostridium difficile) -Eye infections (conjunctivitis) Management: gown, gloves, goggles, private room Nurse with localized herpes zoster can care for patients who are not immunocompromised and lesions are covered.
Priority situation Neuroleptic Malignant Syndrome (NMS)
-You get hot (increased temp/hyperpyrexia) -Stiff (increased muscle tone) -Sweaty (diaphoresis) -BP, pulse, and respirations go up -You start to drool *Flu like symptoms
Hepatitis
-ends in a VOWEL and comes from the BOWEL (Hep A) -Hepatitis B- Blood and Bodily fluids -Hepatitis C is just like B
Post bronchoscopy
-semi-fowler's position -check VS every 15 minutes until stable -assess for respiratory difficulty (stridor and dyspnea resulting from laryngeal edema or laryngospasm
FIVE INTERVENTIONS FOR PSYCH PATIENTS
1. Safety 2. Setting limits 3. Establish trusting relationship 4. Medications 5. Least restrictive methods/environments to most restrictive
low glucose
15g carbs 5 lifesavers 6 oz juice recheck in 15 mins
1lb
16oz
IV push to be given over
2 minutes
Developmental
2-3 months- demonstrates head lag, able to turn head up (can lift off mattress), tummy time, can turn side to side, cooing or gurgling noises and can turn head to sound, palmar grasp 4-5 months- rolls from back to side (4), places objects in mouth, rolls from front to back (5) 6-7 months- rolls from back to front, holds bottle/sippy cup, sits at 6 and waves bye/bye; can recognize familiar faces and knows if someone is a stranger, moves objects from hand to hand 8-9 months- stands straight at 8; sits unsupported, begins using pincer grasp, has favorite toy, plays peek-a-boo 10-11 months- crawling, changes from a prone to a sitting position (belly to butt), grasps rattles by its handles, finger foods 12-13 months- sits down from a standing position without assistance, starts walking (uses furniture to cruise), tries to build a two-block tower without success; cries when parents leave *Twelve and up, drink from a cup
Epiglottitis
3 D'S --Drooling, Dysphonia, Dysphagia
1 ounce
30 mL
Pregnant women should increase calories by
300 for fetal growth, maternal tissues and placenta
transesophageal fistula
4 C's: Coughing Choking Cyanosis Continuous drooling
1 cup
8 oz
After removal of pituitary gland
After removal watch for hypocortisolism and temporary Diabetes Insipidus
Anterior and posterial fontanels closure
Anterior fontanel closes by 18 months Posterior fontanel closes by 6-8 weeks *Posterior closes before anterior
Biperiden
Anti-Parkinson's used to counteract EPS (acute attack)—encourage partial weight bearing
Dangle
Arteries
*Cultures are always taken
BEFORE starting IV antibiotics
Phenobarbital
CAN be taken during pregnancy- phenytoin is contraindicated
Verapamil
CCB- tx of HTN, angina, and dysrhythmias- assess for constipation
Chlohexadine used to prevent
CLABSI-central line associated bloodstream infections
Laparoscopy
CO2 used to enhance visual general anesthesia foley catheter Post op EARLY AMBULATION to mobilize CO2
Hot & Cold
COLD for acute pain (sprain, fracture), HOT for chronic pain (rheumatoid arthritis)
CBT
Can Block Tremors (meds for Parkinson's)
Multiple sclerosis
Charcot's Triad: nystagmus, intention tremor, and dysarthria-scanning speech
pancreatitis
Cullen's sign (ecchymosis of umbilicus); (+) Grey turners spots
Heart defects-
Cyanotic = 3 T's (Tetrology of Fallot, Truncus arteriosus, transposition of the great vessels)—blood does not adequately return to the heart→ if problem does not fix itself, or cannot be corrected surgically, CHF will occur→ followed by death With right-sided cardiac catheterization- look for valve problems With left-sided cardiac catheterization- look for coronary complications
DKA
Diabetic ketoacidosis: Occurs when the body cannot use sugar (glucose) as a fuel source because there is no insulin or not enough insulin. Fat is used for fuel instead and produces ketones
Myasthenia Gravis- Worsens with exercise and improves with rest
Diagnosis made Tensilon test- improvement muscle weakness indicates positive reaction Avoid alcohol crowded places try reduce stress avoid heat sauna hot tub sunbathing spread activities throughout the day thicken liquids
No pee, no k
Do not give potassium without adequate urine output
Compartment Syndrome
EMERGENCY SITUATION ● Paresthesia-earliest sign and increased pain are classic symptoms—neuromuscular damage is irreversible 4-6 hours after onset
Dawn phenomenon
Early morning glucose elevation produced by the release of growth hormone, which decreases peripheral uptake of glucose resulting in elevated morning glucose levels. Admin of insulin at a later time in day will coordinate insulin peak with the hormone release.
duchenne's muscular dystrophy
Gowers' sign (use of hands to push one's self from the floor
Best time to take medications:
Growth Hormone (PM) Steroids (AM) Diuretics (AM) - prevent nocturia Donepezil (Aricept) (AM)- Alzheimer's medication Cholesterol medications (PM) Sulcrafate (before meals)- acts as a mucosal barrier—S/E: constipation Cimetidine (with meals and/or at bedtime)- many interactions Antacids (1 hour after eating or when experiencing heartburn)- large amounts of antacid consumption can lead to osteoporosis
Endocrine System
Growth Hormone GH Anterior Pituitary ADH Posterior Pituitary T3 T4 Thyroid PTH Parathyroid Glucocorticoids cortisol Adrenal gland Insulin Pancreas
NG tube
HOB 30 degrees to prevent aspiration maintain elevation for continuous feeding for 1hr after intermittent feedings
Ventilator bundle
HOB 30-45 daily assessment for extubation daily oral care with chlorhexadine solution
After Supratentorial Surgery (incision behind hairline)
HOB 30-45 degrees
Hemorrhagic stroke
HOB elevated 30 degrees to reduce ICP and facilitate venous drainage
Ischemic stroke
HOB flat supine
VENTILATOR ALARMS
HOLD High pressure alarm- Obstruction due to increased secretions (mucus plug), kink in tubing, patient coughs, gags or bites Low pressure alarm- Disconnection or leak in ventilator or patient airway cuff, patient stops spontaneously breathing
To Remember Blood Sugar
Hot and dry sugar high hyperglycemia Cold and clammy need some candy hypoglycemia
Insulin lispro
Humalog Rapid-Acting Insulin 15 minute onset 1/2-1/12hr peak 2-5hr duration
NPH insulin
Humulin N, Novolin N intermediate acting cloudy 60-90 minute onset 4-12 hour peak 24 hour duration
regular insulin
Humulin R, Novolin R 30-60 mins peak 2-3hrs duration 6-12 hours
Asked about the FIRST option, think
If i can only do one action and then I have to go home, what would the outcome be?
Increased ICP and Shock- OPPOSITE V/S
Increased ICP (Cushing's Triad)- increased BP, decreased pulse (bradycardia), decreased respirations Shock- decreased BP, increased pulse, increased respirations
Prolapsed Cord
Knee to chest or Trendelenburg
measles
Koplik's spots (clustered white lesions on buccal mucosa)
systemic before local
Life before limb
Fiber
Low residue means low fiber Fiber adds bulk- patients who are constipated should add fiber to their diet High fiber- oatmeal, celery, green beans
Postural drainage positions
Lung segment to be drained should be in the uppermost position to allow gravity to work.
Airborne MTV
M - Measles T - TB V - Varicella private room, negative pressure with 6-12 pressure air exchanges/hr, mask, N95 for TB
Pregnancy antibiotics that are contraindicated
MCAT Metronidazole Chloramphenicol Aminoglycoside Tetracycline
Head injury Medication
Manntiol osmotic diuretic -crystallizes at room temperature so ALWAYS use a filter needle
HYPONATREMIA (less than 135)
Muscle twitching Convulsions Diarrhea Headache Apprehension Lethargy
ASA
NO ASPIRIN TO CHILDREN- can cause Reye's Syndrome (encephalopathy) ● S/S of Reye's: vomiting, lethargy, unusual sleepiness, increased RR, diarrhea, confusion, loss of consciousness ASPIRIN OVERDOSE SIGNS ● Tinnitus ● Gastric distress
Indomethacin (Indocin)
NSAID- tx of arthritis (osteo, rheumatoid, gout), bursitis, tendonitis *Ototoxic
Medications to be given with food:
NSAIDs, corticosteroids, medications for Bipolar Disorder, cephalosporins, and sulfonamides When using a bronchodilator in conjunction with a glucocorticoid inhaler, administer the bronchodilator first!
JEWISH
No meat and milk together
insulin aspart
Novolog Rapid-Acting Insulin
Most antidepressants take 3 weeks to take effect
Obsession = thought Compulsion = action Hallucinations- redirect patient Delusions- distract patient
During internal radiation
On bedrest while implant in place
Meds of choice
Oral anticoagulant therapy should be instituted 4-5 days before discontinuing heparin therapy Cardiac output decreases with dysrhythmias- dopamine increases blood pressure Med of choice for v-tach and PVCs is lidocaine Med of choice for SVT and paroxysmal atrial tachycardia is adenosine Med of choice for asystole is atropine Med of choice for CHF is ACE-Inhibitor Med of choice for burn pain management is morphine sulfate Med of choice for candidiasis is ketoconazole Med of choice for anaphylaxis is epinephrine Med of choice for Status Epilepticus is benzodiazepine (valium, lorazepam) Med of choice for bipolar is lithium ● Increase fluid intake with lithium (2500-3000 mL/day) ● Maintain adequate salt intake (2-3 grams per day) ● S/E: increased U/O and dry mouth ● No ETOH with lithium ● Therapeutic level- 0.4 to 1.4 ● Toxic level - 2 to 3: N/V/D, tremors (give mannitol and acetazolamide if signs of toxicity are present)
Asthma position
Orthopneic position where patient is sitting up and bent forward with arms supported on a table or chair arms "tripod"
PT, PTT, INR
PT- 10- 14 seconds - therapeutic is 1.5 to 2 times INR- 0.8 to 1.2- therapeutic is 2 to 3 times PTT - 20-45 seconds- therapeutic is 1.5 to 2.5 times
Jaundice
Pathological jaundice- occurs before 24 hours and lasts 7 days Physiological jaundice- occurs after 24 hours ● Phototherapy considered for infant with total serum bilirubin >15 mg/dL at 72 hours of age
OB info
Placenta previa- bright red bleeding, no pain- NO VAGINAL EXAMS Placental abruption- pain, no bleeding, rigid/board-like abdomen (monitor fluid volume stauts/I&O) Betamethasone = surfactant- given to mothers in pre-term labor to help baby's lungs mature before delivery - given in 2 doses (12-24 hours apart) Magnesium sulfate- anticonvulsant for pregnant women with risk of seizures due to HTN *Also used as a tocolytic to halt pre-term labor - contraindicated for women with myasthenia gravis, also with absent deep tendon reflexes ● Magnesium sulfate- (CNS depressant) can cause slowing of respirations and hyporeflexia; oliguria is another S/E Oral (PO) medications are not recommended in labor—decreased GI motility When breastfeeding- only wash breasts with water→ soap should be avoided as it causes dryness Fundal height should correlate with weeks of pregnancy *26 weeks = 26cm Epigastric pain in pregnancy→ usually a sign of impending convulsion Crisis intervention = short term
Below knee amputation
Position: The client should be placed in the prone position several times a day to prevent hip flexion contractions. Don't elevate more than 24 hours-causes hip flexion and contractures
Gout
Probenecid (Benemid)- increases uric acid secretion in urine Colchicine- prevention of gout Allopurinol- acute
Tube feeding with decreased LOC
Right lateral + elevated HOB
Sulindac (NSAID)
S/E are typically GI distress (GI bleeding, ulcers, perforation of the stomach and/or intestines)
Sertraline (Zoloft)
SSRI, depression; S/E: agitation, disruption in sleep, dry mouth
Fluoxetine (Prozac)
SSRI; doses that are greater than 20mg should be given in divided doses
intussusception
Sausage shaped mass , Dance sign (empty portion of RLQ) red currant jelly stools
Post-thyroidectomy
Semi-Fowler's; prevent head/neck flexion/hyperextension; have trach ready at the bedside monitor respiratory status every hour
During epidural/lumbar puncture
Side lying ( c curved spine) lateral recumbent/ fetal position
HYPERNATREMIA (greater than 145)
Skin flushed Agitation Low grade fever Thirst
Phobic disorders
Systematic desensitization- relaxation and gradual exposure to anxiety producing stimulus
Answer SATA as
T or F for each one
Epinephrine is always given in
TB syringe
AVA:
The umbilical cord has two arteries and one vein
TB
Tuberculosis (TB)- medications must be taken for 6 to 9 months Endemic to Asia, Middle East, Africa, Latin America, Caribbean A positive PPD confirms infection, not just exposure—a sputum test confirms active disease PPD is (+) if induration is: ● >5mm for immunocompromised patients ● >10mm for high risk populations (IV drug users, recent immigrants, lab personnel, children <4 years) ● >15mm positive in any person (patients with no risk factors) If a TB patient is unable/unwilling to adhere with treatment—may need supervision (direct observation) → TB is a public health risk TB medications are toxic to the liver Adverse reaction is peripheral neuropathy
Women in labor with un-reassuring FHR (late decels, decreased variability, fetal bradycardia). What to do? 3 things
Turn mother on L side, give 8-10L mask o2, stop pitocin, increase IV fluids-bolus
Hydralazine
Tx of HTN or CHF, report flu-like symptoms, rise slowly from sitting/lying positions to prevent orthostatic hypotension, take with meals
Dicycloverine
Tx of irritable bowel- assess for anticholinergic side effects
Lindane (Kwell)
Tx of scabies (lotion) and lice (shampoo) Scabies- apply lotion once and leave on for 8-12 hours Lice- wash hair with shampoo and leave on for 4 minutes with hair uncovered, then rinse with warm water and comb with a fine tooth comb
Skin Infections VCHIPS
V - varicella zoster C - cutaneous diphtheria H - herpez simplex I - impetigo P - pediculosis S - scabies
Fetal Heart Rate Patterns
VEAL CHOP V= variable decels, Cord compression E = early decels, Head compression A = accelerations, OK L = late decels, Placental insufficiency (baby is not receiving enough oxygen and nutrients)
chicken pox
Vesicular Rash (central to distal) dew drop on rose petal
Parathyroid gland relies on the presence of
Vitamin D to work
REVERSAL AGENTS/ANTIDOTES
a. Heparin = protamine sulfate b. Coumadin = vitamin K c. Ammonia = lactulose d. Acetaminophen = n-Acetylcysteine e. Magnesium sulfate= Calcium gluconate f. Iron = deferoxamine g. Digoxin = digibind h. TPA = aminocaproic acid (amicar) i. Methotrexate toxicity = leucovorin j. Alcohol withdrawal = Librium (Chlordiazepoxide) k. Opioids/Narcotics = Naloxone (Narcan) l. Methadone is an opioid analgesic used to detox patients addicted to narcotics
If the question is about endorsement
always report anything new or different to the next shift
Avoid absolutes
always, never, must
Preload affects
amount of blood that goes to the right ventricle, afterload is the resistance the blood has to overcome to leave the heart
Promethazine (Phenergan):
anti-histamine; can be given as an antiemetic for nausea—crosses BBB—sedative effect - monitor fluid status (anticholinergic effects- anorexia, dry mouth and eyes, constipation, orthostatic hypotension)
Doxycyline
antibiotic; dairy products inhibit the absorption of this medication
Warfarin (Coumadin)
anticoagulant therapy; watch for signs of bleeding, diarrhea, fever or rash; stress the importance of complying with prescribed dosage and follow-up appointments ● Patients taking warfarin should not make sudden dietary changes, because changing the oral intake of foods high in Vitamin K (green leafy vegetables, some fruits) will impact the effectiveness of the medication
Dabigatran
anticoagulant with NO antidote- do not take with other anticoagulants
Doxepin HCl
antidepressant *Signs of overdose: excitability and tremors
N-Acetylcysteine
antidote for Tylenol and is administered orally
Risperidone (Risperdal)
antipsychotic (schizophrenia)—doses over 6mg can cause tardive dyskinesia—first line antipsychotic in children ● Causes weight gain, impairs temperature regulation, photosensitivity, orthostatic hypotension
Protease Inhibitors
antiviral drugs used to treat HIV/AIDs and hepatitis C *Decrease the metabolism of many drugs—including midazolam Serious toxicity can occur when protease inhibitors are given with other medications
ARDS (fluid in alveoli), DIC (disseminated intravascular coagulation)
are always secondary to something else (another disease process) ● Cardinal sign of ARDS is hypoxemia (low oxygen level in tissues) o First sign is usually increased respirations → later comes dyspnea, retractions, air hunger, cyanosis
Koplik's spots
are red spots (commonly found in mouth) with a bluish/whitish center—characteristic of PRODROMAL phase of MEASLES
Albumin levels
are the best indicator of long-term nutritional status (normal 3.5-5.0) ● (Same range as potassium) One of the goals for a client with anorexia is to achieve a sense of self-worth and self-acceptance that is not based on appearance → encourage activities that will promote socialization and increase self-esteem Physical S/S of anorexia ● Amenorrhea ● Constipation ● Hypotension ● Cold intolerance ● Bradycardia ● Fatigue ● Muscle weakness ● Osteoporosis
Detached retina
area of detachment should be in the dependent (lower) position
Test child for lead poisoning
around 12 months of age
*Most common complication following MI
arrhythmias (ventricular being the most serious)
guillian barre
ascending muscle weakness
Digoxin
assess pulse for a full minute, hold if HR less than 60, check digoxin levels and potassium and magnesium levels (low K and Mg can lead to digoxin toxicity) S/S of toxicity- yellow halo, N/V *Digoxin is given with loading doses (normally 2- 0.5mg or higher)—maintenance dose is typically 0.25mg **Increases ventricular irritability—can convert a rhythm to V-Fib following cardioversion
Assess first before implementing
assess unless in distress
Huntington's Chorea
autosomal dominant disorder (50% chance of inheriting) S/S: chorea (jerky, involuntary movement effecting shoulders, hips, and face); gait deteriorates with no ambulation, no cure, palliative
Thrombolytic therapy
avoid injury→ avoid activities that could cause bleeding (NO IM injections) *The Institute for Safe Medication Practices guidelines indicate that the use of a trailing zero is not appropriate when writing medication orders—because it is easily mistaken for a larger dose! First action after medication administration error is to assess the client for adverse outcomes
Fruits high in potassium
bananas, potatoes, citrus fruits
Hyperemesis gravidarum
bed rest, NPO to rest GI tract, anti-emetics, IVF
Shock
bedrest with extremities elevated 20 degrees. knees straight, head slightly elevated (modified Trendelenberg)
Give sucralfate (anti-ulcer)
before meals to coat stomach Pantoprazole (Protonix) is given prophylactically to prevent stress ulcers (PPI)
Peptic Ulcer
bland diet
For CPR of an infant
brachial pulse
If you don't know a word,
break it down in medical terms
always look for the umbrella option
broad universal statement
addison's
bronze like skin pigmentation
Obesity, overweight
calorie-restricted, high-fiber
Projectile vomiting
can be a signal of obstruction in the GI tract
Benztropine (Cogentin)
can be used for Parkinson's, as well as to treat EPS - may lead to the inability to move specific muscle groups or weakness (too much of an effect)—anticholinergic (may lead to blurred vision, dry mouth) *Increase fluid intake
Palpate thyroid gently
can cause thyroid storm with hyperthyroidism
Terbutaline
can lead to maternal tachycardia- withhold if HR is elevated prior to administration
retinoblastoma
cat's eye reflex grayish discoloration of pupils seen in photos
Never increase patients to
catch up
During continuous bladder irrigation CBI
catheter is taped to thigh so leg should be kept straight. No other positioning restrictions.
Peptic ulcers
caused by H. pylori are treated with Metronidazole (Flagyl), Omeprazole (Prilosec), and Clarithromycin (Biaxin)—this treatment kills bacteria and stops production of stomach acid- it does not heal the ulcer!
Cholinergic Crisis
caused by excessive medication stop med- Tensilon will make it worse
Impetigo
caused by staph or strep untreated can cause acute glomerulonephritis Periorbital edema indicates poststreptococcal glomerulonephritis
before liver biopsy
check PT time
glucose and exercise
check before, during, and after to make sure its safe
Four options for cancer management:
chemo, radiation, surgery, palliative/hospice (treatment/management can be a combination of these four)
5-Fluorouracil (5-FU)
chemotherapy agent
bulimia
chipmunk facies (parotid gland swelling) poor dental status
Make an educated guess
choose answer with most information
acute before
chronic
Put patients with the same or similar diagnosis in the same room
clean vs dirty
Drawing up regular and NPH insulin g
cloudy-air into NPH clear-air into regular clear-draw up regular cloudy draw up NPH
acromegaly
coarse facial hair
myocardial infarction
crushing stabbing pain radiates to left shoulder, neck, arms, unrelieved by NTG
*BEST WAY TO EVALUATE FLUID STATUS (fluid volume deficit)
daily weight
Dietary calcium-
dairy products, seafood, nuts, broccoli, spinach Non-dairy sources of calcium- RHUBARB, SARDINES, COLLARD GREENS ● Daily calcium intake- 1000 to 1500mg
Myasthenia Gravis-
decrease in receptor sites for acetylcholine- because the smallest concentration of ACTH receptors are cranial nerves expect fatigue and weakness in eye mastication chewing and pharyngeal muscles Sometimes first sign patient can't brush hair * Not enough receptor sites for Acetylcholine to bind to for activation leading to muscle weakness
Hypo-parathyroid:
decreased calcium (implement high calcium, low phosphorous diet; provide Vitamin D which aids in calcium absorption) *Trousseau's and Chvostek's signs CATS (S/S): C- convulsions A- arrhythmias T- tetany S- spasms S- stridor
Propranolol (Beta Blocker)
decreases effectiveness of atorvastatin
Hypermagnesemia (high Mg):
depresses the CNS, hypotension, facial flushing, muscle weakness, absent deep tendon reflexes, shallow respirations *Emergency
Myasthenis Gravis
descending muscle weakness, ptosis
Recognizes trends of
deterioration
Management of DM
diet and exercise insulin protective foot wear prevent infections and wounds feet should be kept dry watch high insulin when sick
Caput succedaneum
diffuse edema of the fetal scalp that crosses the suture lines- swelling reabsorbs within 1-3 days
Birth weight
doubles by 6 months and triples by 1 year of age
Glipizide
effective for client diagnosed with Type 2 DM, who produces minimal amounts of insulin (oral hypoglycemic agent)
Head injury
elevate HOB 30 degrees to decrease ICP
Buck's traction
elevate foot of bed for counter traction
above knee amputation
elevate for first 24 hours on pillow, position prone daily to provide for hip extension. Do not elevate more than 24 hours causes hip flexion and contractures rewrap 3x a day in elastic bandages
Priority goes to assessment on patient nad not with
equipment auscultate FHR before checking monitor
Syndrome of Inappropriate Antidiuretic Hormone (SIADH):
excessive secretion of ADH (from posterior pituitary) leading to hyponatremia and water intoxication (excessive water retention) ● Caused by trauma, tumors, infection, medications ● NCLEX Points o Assessment (S/S) ▪ Fluid volume excess (HTN, crackles, JVD) ▪ Altered LOC ▪ Seizures ▪ Coma ▪ Urine specific gravity > 1.032 ▪ Decreased BUN, hematocrit, Na (hyponatremia) o Therapeutic Management ▪ Cardiac monitoring ▪ Frequent neuro exams ▪ Monitor I&O ▪ Fluid restriction ▪ Sodium supplement ▪ Daily weight (loss of 2.2 lbs or 1 kg = 1 L) ▪ Medication ● Hypertonic saline (D5 w/ NS) ● Diuretics (furosemide) ● Electrolyte replacement *Water intoxication - drowsiness and altered mental status
grave's/hypothyroidism
exopthalmos bulging of the eyes
Timolol (Beta Blocker)
eye drops, used for treatment of glaucoma
If a patient is an adult
family options can be ruled out unless patient is incompetent
Hyperlipidemias
fat-controlled, calorie-restricted
Lipoatrophy
fatty mass at injection site
Pancreatitis position
fetal NPO to rest gut PICC line for TPN/fluids
After intratentorial surgery (incision at nape of neck)
flat and lateral on either side
Post Lumbar Puncture and oil based myelogram
flat supine to prevent CSF and HA for 2-3 hours Sterile dressing Neuro checks
Agranulocytosis
flu-like symptoms (fever, sore throat, lethargy)
vomiting
fluid and electrolyte replacement
Always check following endoscopy
gag reflex
chronic pancreatitis
give pancreatic enzymes with meals
Midazolam (Versed)
given for conscious sedation- watch for respiratory depression and hypotension (benzodiazepine) ● Contraindicated in patients taking protease inhibitors
Procainamide HCl-
given to treat PVCs- withhold if severe hypotension—adverse signs are bradycardia and hypotension
Order of PPE doffing
gloves, goggles, gown, mask
celiac disease
gluten-free diet (no BROW: barley, rye, oat, and wheat).
Order of PPE donning
gown, mask, goggles, gloves
Milk products and carbonated beverages
have sodium
Post liver biopsy
have the patient lie on the right side over a pillow to prevent bleeding and maintain for several hours applying pressure on the liver. watch for bleeding at the puncture site. No heavy bleeding for 1 week
Postural drainage
head in dependent position
catheters the most common
health care acquired infection remove asap
Interventions for wellness
healthy nutrition, regular exercise, proper weight, rest, avoiding harmful chemicals such as nicotine and risk taking behaviors-no seatbelt
Pentamidine
helps treat and prevent pneumocystis pneumonia ● Can cause fatal hypoglycemia—monitor blood glucose (low BG may indicate need to change treatment)
Try to focus on the
here and now as much as possible
cancer
high calorie, high protein
underweight
high calorie, high protein
spinal cord injury
high fiber, low fat-prevent constipation and straining
Burns
high protein, high caloric, increase in Vitamin C.
ADHD and bipolar
high-calorie and provide finger foods.
constipation
high-fiber, increased fluids
DVT
homan's sign
Hypoglycemia requires urgent treatment
hunger, irritability, weakness, HA, BG <60 15 rule
Cushing's Disease
hypersecretion of glucocorticoids leading to elevated cortisol levels; greater incidence in women; life threatening if untreated ● NCLEX Points o Assessment ▪ Hypernatremia (up) ▪ Hypokalemia (down) ▪ Hyperglycemia (up) ▪ Increased blood volume (up) ▪ Hypertension (up) ▪ Prone to infection ▪ Moon face ▪ Buffalo hump ▪ Muscle wasting ▪ Edema (signs of CHF) ▪ Risk to bruising ● Therapeutic Management - you have excess "cushion" of hormones o Monitor electrolytes and cardiovascular status ▪ Prevent fluid overload - respirations are the first priority ▪ Cardiovascular feature- capillary fragility→ results in bruising and petechiae o Provide skin care and meticulous wound care (paper thin skin that is easily injured) o Provide for client safety o Adrenalectomy (surgical removal of adrenal gland) o Protect client from infection o Often caused by tumor on adrenal or pituitary gland
Addison's Disease
hyposecretion of adrenal cortex hormones; decreased levels of glucocorticoids and mineralcorticoids leads to hyponatreamia, hyperkalemia, hypoglycemia, decreased vascular volume—fatal if not treated ● NCLEX Points o Assessment ▪ Hyponatremia (down) ▪ Hyperkalemia (up) ▪ Hypoglycemia (down) ▪ Decreased blood volume (down)- anemia ▪ Hypotension (down) - most important assessment parameter ▪ Weight loss ▪ Hyperpigmentation (tanned skin) ▪ Decreased resistance to stress o Therapeutic Management - with Addison's you must add hormone (teaching about steroid replacement is important) ▪ Monitor vital signs ▪ Monitor electrolytes ▪ Monitor glucose ● Treat low blood sugar ▪ Administer replacement adrenal hormones as needed ▪ Lifelong medication therapy needed ▪ Managing stress in a patient with adrenal insufficiency is important—if the adrenal glands are stressed further it can result in Addisonian Crisis
Myxedema Hypothyroidism
hyposecretion of thyroid hormone resulting in decreased metabolic rate
Diabetes Insipidus (DI):
hyposecretion or failure to respond to ADH from posterior pituitary—leading to excess water loss
Spinal Cord Injury
immobilize on spine board, with head in neutral position. Immobilize head with padded C-collar, maintain traction and alignment of head manually. Log roll client and do not allow client to twist or bend.
Nurse working with infants but be
immunized against pertussis
Schizophrenia
inappropriate affect
*If mixing antipsychotic medications (Haloperidol, Fluphenazine, Chlorpromazine) with fluids,
incompatible with caffeine and apple juice
Pernicious anemia B12
increase B12, found in high amounts in shellfish, beef, liver, and fish
SNS
increase BP, HR, and RR, dilated pupils (blurred vision), urinary retention, constipation (decreased GI motility), constricted blood vessels, and dry mouth
sickle cell anemia
increase fluids to maintain hydration since sickling increases when patients become dehydrated.
Cystic Fibrosis
increase in fluids, high sodium
Hyper-parathyroid:
increased calcium (implement low calcium, highphosphorous diet) S/S: Fatigue, polyuria, muscle weakness, renal calculi (55% have urinary tract calculi), back and joint pain, monitor for bone deformities Pre-parathyroidectomy- low calcium, high phosphorous diet *For patients who are not candidates for para-thyroidectomy, diuretics (furosemide) and hydration (IV NS) in combo help reduce serum calcium → furosemide increases kidney excretion of calcium when combined with IV saline in large volumes
Kidney Stones
increased fluid intake, calcium-controlled, low-oxalate
addisons
increased sodium, low potassium
Theophylline
increases the risk of digoxin toxicity and decreases the effects of lithium and phenytoin
● Exposure to rubella for a pregnant woman
incubation is 14 to 21 days (communicable 7 days before)
Chest pain in a client undergoing a stress test
indicates myocardial ischemia and is an indication to stop testing to avoid ongoing ischemia, injury, or infarction
Alcohol and insulin
ingest a meal before drinking
Cystic Fibrosis
inherited by autosomal recessive trait First sign of cystic fibrosis may be meconium ileus (bowel obstruction) at birth—baby is inconsolable, does not eat, does not pass meconium ● Respiratory problems are the chief concern o Airway clearance techniques are critical (postural drainage/chest physiotherapy) ● Give aerosol bronchodilators, mucolytics and pancreatic enzymes ● Cystic Fibrosis- diet o Low fat o High sodium o Fat soluble vitamins- ADEK
laryngotrachebronchitis
inspiratory stridor
DM1
insulin dependent-body attacks insulin producing beta cells
DM2
insulin resistant-body doesn't produce enough insulin or becomes resistant
Glaucoma-
intraocular pressure is greater than normal—give miotics to constrict (pilocarpine) - NO ATROPINE ● Tonometer is used to measure IOP and diagnose glaucoma o Normal- 10 to 21 mmHg (according to Kaplan)
Rhogam
is a blood product—as such, for NCLEX purposes, ONLY RN's can administer Rhogam IM to client (do not delegate to LPN/LVN) Indirect Coomb's Test- Negative (normal) result means no antibodies are found; positive (abnormal) result means antibodies were found—DO NOT ADMINISTER RHOGAM TO A WOMAN WHO IS POSITIVE!
Angiotensin II
is a potent vasodilator (from lungs)
Nitroglycerine
is administered up to 3 times (every 5 minutes)—if chest pain does not stop- GO TO HOSPITAL or call 911—do not give if blood pressure is <90/60
Oxybutynin
is an anticholinergic agent—can lead to extremely dry mouth; max dose is 20 mg/day; should be taken between meals as food interferes with absorption
COPD
is chronic, pneumonia is acute—emphysema and bronchitis are both COPD ● In COPD patients, baroreceptors that detect the CO2 level are destroyed—therefore, O2 level must be low because high O2 concentration blows the patient's stimulus for breathing o Ex: Patient is on O2 at 6L/min- this is too high→ causing high serum oxygen levels, which results in decreased respiratory rate ● Encourage pursed-lip breathing (promotes CO2 elimination) ● Encourage fluids ● High Fowler's and leaning forward (tripod position)
Amiodarone (anti-arrhythmic)
is effective in both ventricular and atrial complications
Edema
is in the interstitial space NOT in the cardiovascular space
Pain
is usually the highest priority for rheumatoid arthritis
*Sometimes it is hard to determine who to check on first, mom or baby—
it is usually easy to tell the right answer if the mother or baby involves a machine—if you are not sure who to check on first, and one of the choices is a machine, that's the wrong answer- eliminate
Cardiac catheterization
keep site extended-usually involves femoral artery
Meningtitis
kernig's sign knee flex and pain on extension brudzinski's neck flex=lower leg flex/bend nuchal rigidity photosensitivity
Rectal exam
knee-chest position, Sim's, or dorsal recumbent
DKA
kussmal's breathing (deep rapid), acetone breath
pneumonia
lay on affected side to splint and reduce pain try to reduce congestion-sick lung goes up
GERD
lay on left side HOB 30 increases sphincter pressure
least invasive to most invasive
least restrictive to most restrictive-restraints rarely a good option
leprosy
leonine facies (thickened folded facial skin)
Patient with heat stroke
lie flat with legs elevated
Myxedema coma
life threatening state of decreased thyroid production coma result of acute illness rapid cessation of medication hypothermia
Diarrhea
liquid, low-fiber, regular, fluid and electrolyte replacement
Pelvic exam
lithotomy
Furosemide (Lasix)
loop diuretic ● Ototoxic especially when given with other ototoxic drugs ● Monitor BP ● Monitor U/O ● Monitor K+ ● Can lead to anorexia due to reduced potassium
Pulmonary TB
low grade fever in afternoon
bowel surgery
low residue
Gallbladder disease
low-fat, calorie-restricted, regular
Pancreatitis
low-fat, regular, small frequent feedings; tube feeding or total parenteral nutrition.
Gastritis
low-fiber, bland diet
HTN, HF, CAD
low-sodium, calorie-restricted, fat-controlled
Cholestyramine
lower cholesterol ● S/E: constipation ● Should not take with spironolactone- increases blood chloride levels ● Many interactions- anticoagulants, beta blockers, diuretics, penicillins, hormonal contraceptives, phenobarbital
Gemfibrozil
lowers high cholesterol and triglycerides; monitor liver functions - increased risk of gallstones - rhabdomyolysis
A patient with leukemia
may have epistaxis due to low platelets
stroke
mechanical soft, regular, or tube-feeding.
cushing's
moon face, buffalo hump
Blood tests for MI:
myoglobin, CK and Troponin ● Troponin levels are elevated 3 hours after onset of MI- most specific to cardiac muscle injury or infarction MONA- FIRST GIVE OXYGEN
Ethambutol (TB)
negative effect on eyes (blurred vision, eye pain, red-green color blindness, any loss of vision—more common with high doses); liver problems may occur
Do not read into the question
never assume anything that has not been specifically mentioned and do not add extra meaning or history to the question
Somogyi effect
nocturnal hypoglycemia followed by rebound hyperglycemia
If two or three answers are similar
none are correct
cirrhosis
normal protein
Meningitis-
nuchal rigidity, headache, photosensitivity, fever- Kernig's and Brudzinski's sign *CSF in meningitis- high protein, low glucose
First time doing something for patient
nurse does it-including VS
When patient comes to hospital in active labor
nurse's first action is to listen to fetal heart rate
Assessment of Hyperthyroidism
o Assessment ▪ Elevated T3, T4, free T4, decreased TSH, positive radioactive uptake scan ▪ Goiter ▪ Bulging eyes ▪ Cardiac- tachycardia, HTN (increased systolic, decreased diastolic), palpitations ▪ Neurological- hyperactive reflexes, emotional instability, agitation, hand tremor ▪ Sensory- exophthalmos (Graves disease), blurred vision, heat intolerance ▪ Integumentary- fine, thin hair ▪ Reproductive- amenorrhea, decreased libido ▪ Metabolic- increased metabolic rate, weight loss
GERD Risk Factors
o Female o Smoking o >45 years old o Obesity o Caucasian ● Limit spicy foods, caffeine, lie with 2 pillows
Myasthenic Crisis
often follows some type of infection client is at risk for inaquate respiratoryfunction
pyloric stenosis
olive like mass projectile vomiting
If two answers are the exact opposite,
one is usually the answer
Cytomegalovirus
owl's eyes appearance of cells (huge nucleus in cells)
Diverticulitis (inflammation of the diverticulum in the colon)
pain in LLQ ● Can cause chronic or severe bleeding, if no obvious blood in the stool, the stool may be tested for occult blood
More often than not,
pain will not be your answer except with compartment syndrome
glaucoma
painful vision loss, tunnel, gun barrel, halo vision, change in color
bladder cancer
painless hematuria
cataract
painless vision loss, opacity of the lens, blurring of the vision, change in color
Hodgkin's lymphoma
painless, progressive enlargement of spleen & lymph tissues, Reedstenberg Cells
diabetes mellitus
pancreatic disorder resulting in insufficient or lack of insulin producing beta cells with resulting ketosis
activity helps with
phantom pain
parkinson's
pill rolling tremors
*For cord compression,
place the mother in TRENDELENBURG position- this removes the pressure of the presenting part from the cord (baby is no longer being pulled out of the body by gravity) ● If the cord is prolapsed- cover it with sterile saline gauze to prevent drying of the cord and to minimize infection *For late decels, turn the mother on the left side to allow more blood to flow to the placenta- give mother O2 via face mask, stop Pitocin, open IV fluids (increase)
Cord Compression
place the mother in the TRENDELENBERG position because this removes pressure of the presenting part off the cord. (If her head is down, the baby is no longer being pulled out of hte body by gravity) If the cord is prolapsed, cover it with sterile saline gauze to prevent drying of the cord and to minimize infection.
Diabetes mellitus
polyuria, polydipsia, polyphagia
Assessment of DM
polyuria, polydipsia, polyphagia high glucose blurred vision elevated hg a1c poor wound healing neuropathy inadequate circulation end organ damage CAD retinopathy
Cerebral palsy
poor muscle control due to birth injuries and/or decreased oxygen to brain tissues
Infant with Cleft Lip
position on back or in infant seat to prevent trauma to the suture line. while feeding hold in upright position.
post appendectomy
position on the RIGHT side with legs flexed
post myringotomy
position on the side of affected ear after surgery (allows drainage of secretion). surgical incision in eardrum to relieve pressure and drain fluids
Thoracentesis
position patient with arms on pillow over bed able or lying on side No more than 1000cc at a time post-check BP, auscultate, check for leakage, sterile dressing
Infant with spina bifida
position prone (on abdomen) so that sac does not rupture
Vena Cava syndrome
position woman on her left side knees flexed for blood return-mother may have low BP
enema position
positions the patient left side-lying (Sim's) with knee flexed. -tube inserted no more that 4 inches
Actual problems before
potential
actual before
potential
Autonomic Dysreflexia definition
potentially life threatening emergency (seen with patients with spinal cord injuries) ● Elevate HOB to 90 degrees - FIRST ● Usually T6 or above spinal cord injury ● Vasoconstriction below ● Vasodilation above ● Sudden, acute onset of HTN ● Loosen constrictive clothing ● Assess for bladder distention and bowel impaction (can trigger AD)-SECOND ● Administer anti-HTN medications (may cause stroke, MI, seizure ● Metallic bitter taste
Low potassium
potentiates digoxin toxicity (low Mg too)
Haloperidol (Haldol)
preferred antipsychotic for elderly patients—high risk of EPS (dystonia, tardive dyskinesia, tightening of jaw, stiff neck, swollen tongue, swollen airway)—monitor early for signs of reaction (IM Diphenhydramine can be given) ● Side Effects- galactorrhea (excessive or spontaneous flow of milk), lactation, gynecomastia, drowsiness, insomnia, weakness, headache ● When given IM- should be given deep into large muscle mass—is very irritating to subcutaneous tissue
Propylthiouracil (PTU) and methimazole (tapazole)
prevention of thyroid storm *Tx: hyperthyroidisim
Heparin
prevents platelet aggregation
Liver biopsy
prior administration of vit k, NPO at midnight, teach pt that he will be asked to hold breath for 5-20 secs, supine position with upper arms elevated
Systemic Lupus Erythematous
progressive systemic inflammatory disease resulting in major organ system failure; immune system "hyperactive" attacks healthy tissue; no known cure ● NCLEX Points o Assessment ▪ Assess for precipitating factors ● UV light ● Infection ● Stress ▪ Arthritis ▪ Weakness ▪ Photosensitivity ▪ Butterfly rash ▪ Elevated ESR and C Reactive Protein o Therapeutic Management ▪ Assess respiratory status ▪ Assess end organ function ▪ Plan rest periods ▪ Identify triggers ▪ Refer to dietitian for dietary assistance ▪ Medications ● Glucocorticoids ● NSAIDs ● Cyclophosamide (immunosuppressive agent) **Should be in remission (SLE) at least 5 months prior to conceiving *A high number of patients with SLE develop nephropathy, so an increase in blood urea may indicate a need for a change in therapy or for further diagnostic testing (such as creatinine clearance)
Infant with cleft palate
prone
acute renal disease
protein-restricted, high-calorie, fluid-controlled, sodium and potassium controlled.
chronic renal disease
protein-restricted, low-sodium, fluid-restricted, potassium-restricted, phosphorus-restricted.
pregnancy induced hypertension
proteinuria, hypertension, edema
down syndrome
protruding tongue
diptheria
pseudo membrane formation
Maslow's-physiological before
psychological
If you cannot determine the topic of the question,
read all the answer choices to help you understand the problem look for patterns
Try not to determine the answer before
reading the answer NCLEX uses answers that scream pick me but are wrong
An answer that delays care is usually wrong
reassess in 15 mins, monitor for symptoms continuing
Appendicitis
rebound tenderness psoas sign rovsing's sign
pernicious anemia
red beefy tongue pallor tachycardia
benign prostatic hyperplasia
reduced size and force of urine
Therapeutic communication
reflect feelings and provide correct information
Hepatitis
regular, high-calorie, high-protein
Placenta previa
requires c-section
Cirrhosis with hepatic insufficiency
restrict protein, fluids, and sodium.
cholera
rice watery stool
tetanus
risus sardonicus
typhoid
rose spots on the abdomen
Pneumonia
rusty sputum
Pulmonary Embolism position
s/s: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of impending doom Elevate HOB
Autonomic Dysreflexia
s/s: pounding HA, profuse sweating, nasal congestion, goose flesh, bradycardia, HTN FIRST ACTION: HOB HIGH FOWLERS decrease venous return check for kinks in foley catheter tubing
When in doubt, think
safety
Cystic Fibrosis
salty skin, intussusception
Clozapine
schizophrenia; S/E: agranulocytosis (low WBC count), tachycardia, seizures *Significant toxic risk associated with clozapine is blood dyscrasia
Trihexyphenidyl HCl (Artane)
sedative effect
paracentesis
semi fowler's or upright on edge of bed. Empty bladder. post VS--report elevated temp. watch for hypovolemia
Prochlorperazine maleate (Compazine)-
should be considered incompatible with all other medications in syringes
Anti-cholesterol medications
should be given with evening meal (at night)
Prenatal vitamins
should be taken with something acidic (orange juice) at bedtime (Vitamin C increases absorption)
Best way to warm a newborn:
skin to skin contact on mother's chest with a blanket *Below 97.7 is a CONCERN
Nephrotic Syndrome
sodium-restricted, high-calorie, high-protein, potassium-restricted.
COPD
soft, high-calorie, low-carbohydrate, high-fat, small frequent feedings
Infectious mono
sore throat, cervical lymph adenopathy, fever, fatigue
liver cirrhosis
spider like varices
Avian influenza
start O2 therapy-initial action SOB, diarrhea, abdominal pain, epistaxis Institute airborne and contact precautions
malaria
stepladder like fever--with chills
kawasaki syndrome
strawberry tongue, peeling skin on fingers and toes
TPN is given via
subclavian line (requires central line)
One select document if
the assessment is normal
DROPLET: "SPIDERMAn"
think of SPIDERMAN! S - sepsis S - scarlet fever S - streptococcal pharyngitis P - parvovirus B19 P - pneumonia P - pertussis I - influenza D - diptheria (pharyngeal) E - epiglottitis R - rubella M - mumps M - meningitis M - mycoplasma or meningeal pneumonia An - Adenovirus Private Room or cohort Mask (door open, 3ft distance)
DO NOT LEAVE THE PATIENT
think safety
Questions that say ESSENTIAL
think safety
Methylphenidate (Ritalin)
treatment of ADHD; assess for heart related side-effects and report immediately; child may need drug holiday because the drug stunts growth; poor appetite- parents should watch for weight loss
Dopamine
treatment of hypotension, shock, low cardiac output, poor perfusion to vital organs (ex: kidneys)- monitor EKG for arrhythmias, monitor BP
Neostigmine
treats Myasthenia Gravis—administer to clients 45 min before eating—helps with swallowing and chewing *Also reverses the effects of anesthesia
Amiodarone
treats life-threatening heart rhythm problems; watch out for diaphoresis, dyspnea, lethargy—take missed dose any time in the day or skip it entirely—DO NOT take double dose
Dantrolene (Dantrium)
treats muscle spasms caused by MS—may take a week or more to be effective
Hypomagnesemia (low Mg):
tremors, tetany, seizures, dysrhythmias (life threatening ventricular arrhythmias), depression, confusion, dysphagia *Low Mg may lead to digoxin toxicity
Peritoneal Dialysis (when outflow is inadequate)
turn pt from side to side BEFORE checking for kinks in tubing
Amniotic fluid is alkaline-
turns nitrazine paper blue Urine and normal vaginal discharge are acidic and turn the nitrazine paper yellow/orange (some color charts vary) If a woman's water breaks and she is at a (-) station, you should be concerned about a potential prolapsed cord
Premarin (conjugated estrogen tablets)
tx after menopause- estrogen replacement *Estrogen can cause dry eyes
Chlordiazepoxide (Librium)
tx of alcohol withdrawal- do not take alcohol with this (including mouth wash that contains alcohol), very bad nausea and vomiting can occur
Hydroxyzine (Vistaril)
tx of anxiety (can also be used to help with itching)-watch for dry mouth- commonly given pre-operatively
Sucralfate
tx of duodenal ulcers (coats ulcer)- take before meals (1 hour)- best on empty stomach *Protects from acid
Acetazolamide (Diamox)
tx of glaucoma, high altitude sickness, increased ICP- DO NOT take if allergic to sulfa *Can cause hypokalemia
Simvastatin
tx of hyperlipidemia, take on empty stomach to enhance absorption at night, report any unexplained muscle pain (could indicate rhabdomyolysis)—especially if fever is present
Levothyroxine (synthroid)
tx of hypothyroidism- may take several weeks to take effect, notify doctor if chest pain—take in AM on empty stomach, can lead to hyperthyroidism
Vincristine (oncovin)
tx of leukemia (anti-leukemic)- IV only
Thiothixene (Navane)
tx of schizophrenia- assess for EPS
Phenytoin (Dilantin)
tx of seizures *Therapeutic drug level = 10-20 S/E: rash (stop med), gingival hyperplasia (practice good dental hygiene) Toxicity- poor gait + coordination, slurred speech, nausea, lethargy, diplopia Can cause leukopenia (low WBC)- stop medication
Do not say why or that you
understand
Rephrase the question in your own words
understand what it is asking
Epixtasis
upright and lean forward-prevent blood from entering the stomach and avoid aspiration
Dextroamphetamine (Dexedrine)-
used for ADHD, may alter insulin needs, avoid taking with MAOI's, take in morning after breakfast (insomnia is a possible side effect)
Theophylline
used for COPD and asthma (bronchodilator) ● Causes GI upset, take with food ● Avoid use of alcohol and caffeine while taking this medication ● Watch for toxicity (10 to 20 is therapeutic range)- >20 is considered toxic (persistent nausea and vomiting are signs) ● Many drug interactions tx of asthma and COPD *Therapeutic drug level: 10-20 (12 letters in theophylline—12 is in between 10 and 20, also the "1" in 10 and "2" in 20 = 12)
Ganciclovir (Cytovene)
used for retinitis caused by cytomegalovirus- patient will need regular eye exams, report dizziness, confusion, or seizures immediately
Alendronate
used for treatment and prevention of osteoporosis ● Photosensitivity- wear sunscreen and protective clothing when outdoors ● Take in the morning ● If missed dose, wait until next day to take
Hydroxyurea
used to help treat sickle cell, can help reduce the number of acute chest syndrome episodes, pain crises, and need for blood transfusions—report GI symptoms immediately—could be sign of toxicity
Naproxen (NSAID)
used to mild to moderate pain ● Can cause gastrointestinal bleeding- monitor stools for blood
Bromocriptine
used to treat menstrual problems *Take with meals to avoid GI upset
Wilm's tumor
usually encapsulated above the kidneys- causing flank pain- DO NOT PALPATE THE ABDOMEN
Pheochromocytoma
vascular tumor of adrenal medulla (adrenal glands) leading to a hypersecretion of epinephrine/norepinephrine ● S/S: persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding headache ● Management: avoid stress and frequent bathing, and take rest breaks (limit activity), avoid stimulating foods, avoid foods high in tyramine ● Avoid palpating the abdomen as it can cause a sudden release of catelcholamines and severe HTN ● Tx: surgery to remove tumor
Elevate
veins
retinal detachment
visual floaters, flashes of light, curtain like shadow vision-emergency
patent ductus arteriosus
washing machine-like murmur
Wherever there is sugar (glucose),
water follows
Asthma
wheezing on inspiration
For a CABG,
when the great saphenous vein is taken, it is turned inside out due to the valves that are inside
A board-like abdomen
with shoulder pain is a symptom of a perforation, which is the most lethal complication of peptic ulcer disease
If you have never heard of an answer, do not eliminate it
work around it if you can safely eliminate all the other answers, that is the answer. If you are down to two answers and you know the other answer is right, do that one.
DO NOT do something
you always have to do something
Positioning questions
you are trying to prevent or promote-think of the outcome
NCLEX land is set at Utopian General Hospital
you have all the time, resources, and staff you need
Hyperosmolar Hyperglycemic Nonketotic Syndrome HHNS
• Potassium is low due to diuresis • No acidosis and no ketosis ● Fluids are the most important intervention • Weight loss is a symptom . Often occurs in older adults with T2 Diabetes ● Risk Factors o Diuretics o Inadequate fluid intake dehydration HbA1c assesses how well blood sugar has been managed over 3 month period- 4 to % is good 8 % or greater indicates poor control .7 % is ideal for a diabetic Usually hold insulin prior to surgery and monitor blood glucose
Prednisone toxicity
→ Cushing's syndrome - buffalo hump, moon face, hyperglycemia, HTN (too much steroid)
Water seal chamber
▪ 2 cm of water ▪ Creates a one way valve that allows air to come out but nothing to go in ▪ Continuous bubbling is a bad sign→ air leak ▪ Should see gentle tidals (fluctuates with respirations)
Addisonian Crisis
▪ Caused by acute exacerbation of Addison's Disease ▪ Causes severe electrolyte disturbances ▪ Monitor electrolytes and cardiovascular status closely ▪ Administer adrenal hormones as needed ▪ S/S: N/V, confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased blood pressure ▪ During times of stress- increase sodium intake → a decrease in aldosterone leads to increase in excretion of sodium)
Assessment (S/S) of diabetes insipidus
▪ Excessive urine output ● Dilute urine (USG <1.006) ▪ Hypotension leading to cardiovascular collapse ▪ Tachycardia ▪ Polydipsia (extreme thirst) ▪ Hypernatremia ▪ Neurological changes o Therapeutic Management ▪ Water replacement ● D5W if IV replacement is required ▪ Hormone replacement ● Desmopressin ● Vasopressin ▪ Monitor urine output hourly and urine SG ● Report urine output > 200mL/hour ▪ Daily weight monitoring
Therapeutic Management of hyperthyroidism
▪ Provide rest in a cool quiet environment ▪ Anti-thyroid medications (PTU, propylthiouracil) ▪ Cardiac monitoring ▪ Maintain patent airway ▪ Avoid drinks that are stimulants (increases metabolic rate) ● Caffeine- coffee, tea, soda ▪ Provide eye protection ● Regular eye exams ● Moisturize eyes ▪ Radioactive Iodine 131 ● Taken up by thyroid gland and destroys some thyroid cells over 6-8 weeks o Avoid with pregnancy o Monitor lab values for hypothyroidism ▪ Surgical removal ● Monitor airway ● Maintain in semi-Fowlers position ● Assess surgical site for bleeding ● Monitor for hypocalcemia o Have calcium gluconate available ● Minimal talking during immediate post-op period ● (Partial-thyroidectomy) Monitor temperature post-op→ elevated temp by even 1 degree may indicate impending thyroid crisis→ report to MD immediately *Think of MICHAEL JACKSON IN THRILLER -Skinny, nervous, bulging eyes, up all night, heart beating fast (Insomnia is aside effect of excess thyroid hormones—due to increased metabolic rate—body is "too busy to sleep")
Suction control chamber
▪ Tells you how much suction is applied to the client ▪ MD sets the suction parameters ▪ Should see bubbling in suction chamber—means it is functioning properly
ASSESSMENT OF MYXEDEMA COMA
▪ Think HYPOmetabolic state ▪ Cardiovascular- bradycardia, anemia, hypotension ▪ Gastrointestinal- constipation (GI motility slows) ▪ Neurological- lethargy, fatigue (due to decreased metabolic rate—"body is slow and sleepy"), weakness, muscle aches, paresthesias ▪ Integumentary- goiter, dry skin, dry hair, loss of body hair 18 Downloaded by Milly Allred ([email protected]) lOMoARcPSD|21586514 ▪ Metabolic- cold intolerance, anorexia, weight gain (due to decreased metabolic state), edema, hypoglycemia o Therapeutic Management ▪ Cardiac monitoring ▪ Maintain open airway ▪ Monitor medication therapy (overdose with thyroid medications possible) ▪ Medication therapy- levothyroxine (Synthroid) ● Take in morning before breakfast to prevent insomnia (on empty stomach) ▪ Assess thyroid hormone levels ▪ IV fluids ▪ Monitor and administer glucose as needed *Myxedema is COLD (hypothermia)
Specific Gravity
● 1.010-1.030 ● High- (concentrated/dark urine) o Dehydration o SIADH o Heart failure ● Low- (dilute/water-like urine) o CKD o Diabetes Insipidus o Fluid volume overload
Blood Transfusions
● ALWAYS ALWAYS ALWAYS NORMAL SALINE ● Use Y-connector ● Large-bore needle should be used (usually 20 gauge) ● Should be infused as soon as possible after they are obtained ● If patient presents with S/S of reaction- STOP the INFUSION!
Blood Transfusion Reactions
● Allergic- Mild facial flushing, hives/rash, increased anxiety, wheezing, dyspnea, hypotension ● Febrile- Fever, chills, anxiety, headache, tachycardia, tachypnea ● Hemolytic- N/V, pain in lower back, hypotension, tachycardia, decreased urinary output, hematuria, fever, chest pain *FOR ALL REACTIONS- Stop infusion and maintain line with NS Also supportive care (oxygen, Benadryl, airway), obtain urine specimen, blood product goes back to lab
Skeletal Traction
● Applied directly to a bone to reduce a fracture or maintain a surgically manipulated bone alignment o Pins or wires inserted through skin and soft tissue into the bone o Balanced suspension using splints, slings, weights
Skin Traction
● Buck's Traction- used to maintain proper alignment- hip fractures- want to maintain skin integrity and circulation ● Bryant's ● Cervical halter ● Pelvic
Normal Contraction Pattern
● Contractions every 2-5 minutes for 60 seconds (<90 seconds) o Longer lasting and shorter intervals is NOT normal (could be a complication of Pitocin)
Calcium channel blockers affect afterload
● DO NOT DRINK GRAPEFRUIT JUICE WITH CCB DO NOT GIVE BLOCKERS (BETA BLOCKERS, CALCIUM CHANNEL BLOCKERS) to PATIENTS WITH HEART BLOCKS
Maternity Normal Values
● Fetal Heart Rate- 120 to 160 bpm ● Amniotic fluid- 500- 1200 mL ● APGAR- 7 and above = normal; 4 to 6 fairly low; 3 and below are critically low o Done at 1 and 5 minutes
Pulmonary Embolism
● First sign- sudden chest pain, followed by dyspnea and tachypnea ● O2 deprived—first intervention is usually oxygen (check ABGs) o Patient may be hyperventilating as a compensatory mechanism Risk Factors ● Obesity ● Immobility ● Pooling of blood in extremities ● Trauma (MVA)
Symptoms of onset of labor
● Gush of fluid down legs ● Some blood in vaginal discharge ● Low back pain
*Atropine Overdose
● Hot as a Hare - elevated temperature ● Mad as a Hatter- change in LOC ● Red as a Beet- flushed face ● Dry as a Bone- thirsty
ETOH Dependence
● Indication of need for more sedation- steadily increasing vital signs—client is approaching DTs
Hypovolemic Shock
● Isotonic fluids - increase intravascular volume (NS or LR) ● Albumin can be given too (expander)
What NOT to do with Chest Tubes:
● Milk the catheter ● Never try to reinsert the tube if it is pulled out
Heroin Withdrawal (Adult)
● Mimics S/S of fu- runny nose, yawning, fever, muscle and joint pain, diarrhea
Prednisone Adverse Effects
● Osteoporosis ● Hyperglycemia (patient may require more insulin) ● Hypokalemia ● Hypernatremia ● Fluid retention and edema ● Decreased immune response (greater risk of infection—BUT do not see changes in bone marrow) ● Gastrointestinal bleeding—monitor stool for bleeding *Rapid weight gain and edema are signs of excessive drug therapy and the dosage of the drug needs to be adjusted (contact physician to report)
Post-delivery
● Pitocin should only be administered after the placenta separates from the uterine wall o Signs: gush of blood, umbilical cord out of vagina, uterus contracting Umbilical cord care: clean cord several times a day and expose to air frequently (to encourage drying and prevent infection) Oxytocin should always be a secondary infusion controlled by IV pump
Chest tubes are placed in the pleural space
● Placed to remove air/fluid from pleural cavity ● Creates a vacuum- NEGATIVE PRESSURE ● Air in the pleural space - pneumothorax ● Blood in the pleural space - hemothorax ● Should be below chest level ● Cough and deep breathing is encouraged ● 3 chambers o Collection chamber ▪ Collects drainage- should be serosanguinous ● Assess drainage q4h (if new chest tube, assess more frequently) ● Notify MD if drainage is bright red (could indicate possible hemorrhage) ● Should not be more than 100mL/hour
Post radical mastectomy
● Position in Semi-Fowler's with arm (affected side) elevated - if left mastectomy, elevate left arm, if right mastectomy, elevate right arm! o This facilitates removal of fluid through gravity and enhances circulation
Serotonin Syndrome
● Rare, life threatening ● S/S: abdominal pain, fever, sweating, tachycardia, HTN, delirium, myoclonus (jerky movements), irritability, mood changes
External Fixation Devices
● Rigid metal frames with attached percutaneous pins or wires used to align and immobilize o Halo Traction- THINK SAFETY FIRST—always have a screwdriver nearby *Place apparatus first, then place the weights when putting a patient in traction
Drug Schedules
● Schedule I- no currently accepted medical use, research only (heroin, LSD, MDMA) ● Schedule II- drugs with high potential for abuse and requires written prescription (Ritalin, hydromorphone/Dilaudid, meperidine/Demerol, and fentanyl) ● Schedule III- requires new prescription after 6 months or five refills (codeine, testosterone, ketamine) ● Schedule IV- requires new prescription after 6 months (benzodiazepines) ● Schedule V- dispensed as any other prescription or without prescription (cough preparations, laxatives)
Nursing Considerations for Traction
● Teach about movement ● DO NOT ADJUST WEIGHTS (they should NEVER be on the floor—not exerting pulling force) ● Report pain (look for signs of compartment syndrome) ● Maintain skin integrity and circulation
Epidural
● When doing epidural anesthesia, hydration beforehand is a priority ● Hypotension, bradypnea and bradycardia are major risks and emergencies ● Patients will have a foley catheter due to the inability to void
Continuous bubbling indicates air leak that must be identified:
● With the physician's order, you can apply a padded clamp to the drainage tubing close to the occlusive dressing—if the bubbling stops, the air leak may be at the chest tube insertion, which will require you notifying the MD ● If the air leak does not stop when you apply the padded clamp, the air leak is between the clamp and the drainage system—you must now assess the system to carefully locate the leak
