nclex

Dilantin phenytoin

Anti-seizure 10-20 20 is toxic

prozac ssri

Anticholinergic Blurred vision Constipation Drowsy and euphoria and insomnia do not give at bed time when changing dosage watch for suicidal ideation

first stage Low baseline variability

BAD when the fetal heart rate stays the same and does not change whether high low or in the middle it just stays the same do lion STOP THE PITOCIN THEN DO LION L left side first I increase iv lpn cant do this O oxygenate them N notify physician

suction control chamber INTERMITTENT

BAD suction is not high enough. suction is too low. have to go to dial on the wall and turn it up. till it starts to bubble CONTINUOUS is GOOD

water seal CONTINUOUS

BAD there is a leak. find the leak and put tape over it till it stops leaking just like a water bottle bubbling continuously the water seal is broken

first stage Late decelerations

Bad placenta you LION STOP THE PITOCIN THEN DO LION L left side first I increase iv lpn cant do this O oxygenate them N notify physician

Hypocalcemia

CATS Convulsions, Arrythmias, Tetany, spasms and stridor aggitation irritability clonus +4reflexes sz tachycardia EVERYTHING GOES UP WHEN CA GOES DOWN

CHEST TUBES

CHEST TUBES

A client is admitted following a severe burn. What changes related to fluid status would the nurse anticipate?

Causes of fluid volume deficit (hypovolemia) include loss of fluid from anywhere as well as third spacing of fluid that occurs with such things as burns. Burns can result in fluid loss from the burn area as well as the third spacing, which increases the risk for hypovolemia and shock. As the fluid volume decreases, the BP and CVP both decrease. Remember, less volume, less pressure. Also, when the fluid volume becomes depleted, the urine output will decrease in an effort to hold on to the fluid (compensate) or the kidneys are not being perfused. You will see the urine specific gravity increase because the small amount of urine being produced will be very concentrated.

only high blood glucose type 1 get this: dka ketosis come

# 1 cause of dka is Acute Viral Upper Respiratory Infection within the last 2 weeks

Lithium interventions

#1 ni is INCREASE FLUIDS watch for dehydration and sodium sweating - dont give free water, give GATORADE low na= makes lithium more toxic high na= makes lithium ineffective only works if na is normal

your pt has respiratory acidosis sata

*1 reflexes diarrhea adynamic ileus spasm urinary retention paroxysmal atrial tachycardia 2nd degree mobits type 2 heart block hypokalemia *in a acidotic environment everything seize so everything goes down

*1st thing to pay attention to in a drug overdose question, is it an upper or a downer*

*2nd thing is it an overdose or withdrawal* overdose and intoxication TOO MUCH. Put the answers to the 2 questions together and you will get the answer the question. if they say overdose on an upper, you have too much upper and it makes everything go up, so I pick all up things BUT... what if they say downer intoxication that case you have too much downer which makes everything go down & it goes the opposite the other did HOWEVER... what if they talk about withdrawal then you don't have enough you have too little, lets put it together, *too little upper makes everything go down not enough downer makes everything go up*

*A*pical removes

*A*ir

high blood glucose in the type 2 is

*Acute Complications* HHNK- dehydration -skin: hot, dry flushed - # 1 nursing dx: fluid volume deficit -# 1 intervention: give fluids -Outcomes: increased output, moist mucus membranes -hhnk is dka without the k or a -RE HYDRATE THESE PPL -more ppl die from hhnk than dka HH& C HHS HHNS DKA -use of insulin most essential to treating -higher priority than hhnk , but will die faster than hhnk THEY GET THIS BC THEY'RE non ketotic any prefix with non you know its a type 2 wherever you see the phrase hyperosmolar, hyper glycemia, non ketotic coma, ***you can pull this out and use what word DEHYDRATION

*B*asilar removes

*B*lood

Stages of Death and Dying

*D*enial *A*nger *B*argaining *D*epression *A*cceptance

signs of pregnancy

*Presumptive*/ *Probable* 1. all urine and blood test= maybe not + sign of pregnancy 2. a positive pregnancy test is NOT a positive sign of pregnancy 3. Chadwick: cervical color change to cyanosis goodell: cervical softening hegar: uterine softening *Positive* 1. fetal skeleton on xray 2. fetal presence on ultrasound 3. auscultation of fetal hr occurs in 8-12wks 4. examiner palpates fetal movement/outline

ideal weight gain week-9

*TAKE THE WEEK OF GESTATION AND SUBTRACT 9* GOOD: if she's with a pound or 2 extra BAD: if she 3lbs off assess TROUBLE: 4lbs off

Asytole

*a* lack of QRS depolarizations

DM hypoglycemia treatment

*administer rapidly metabolize carbohydrates AKA SUGAR* IE sugars any juice or SKIM MILK -apple -grape -pineapple -guava -pomegranate -pop -honey -icing -jam -jelly candy -let them chew it up IDEAL COMBINATION OF FOODS sugar + starch + protein 1 sugar 1 starch/ 1 sugar 1 protein -crackers (starch) REALLY GOOD COMBO - Oj (sugar) OR -apple juice (sugar) -slice of turkey (protein) 1/2 CUP SKIM MILK IS FANTASTIC. GETTING SUGAR + PROTEIN BAD COMBOS!!!!! candy + pop bc 1 sugar is good. 2 sugars are bad 5 packs of sugar emptied into a glass of oj UNCONSCIOUS give glucagon IM dextrose per IV D10 D50 (powerful) NOT...d5= 1L 300 cal and wont do it what will determine which one to give glucagon IM or dextrose per IV D10 D50 --- the setting, if you are talking to the mom and dad over the phone and they're asking what to do with their unconscious hypoglycemic diabetic kid. what do you tell them to give? IM glucagon that should be in the refrigerator DO NOT TELL THEM to start an IV of d50 BUT IF THEY SAY ITS IN THE ED, and you got a severely unconscious hypoglycemic client with a glucose of 7 what do you give them to start an IV of d50

what do you have to know for pH

*if the pH and the bicarb go in the same direction it is metabolic * as the pH go so goes my pt...except for K* *K+ goes up *vomiting/suctioning = metabolic alkalosis* *everything else metabolic acidosis *if I dont know what to pick= metabolic acidosis overventalate= resp alkolosis underventalate= resp acidosis translate

opisthotonic /kernicterus

*kernicterus= bilirubin in the brain*. when the bilirubin crosses the blood brain barrier and its in your cerebral spinal fluid, its in your brain and menegis you have kernicterus and it causes aseptic meningitis/encephalitis opisthotonic = position baby assumes when bilirubin is on the brain -what babies do is hyper-extend. due to the irritation of the meninges with the bilirubin - if you see a kid who bilirubin is 15 and he starts extending his neck MEDICAL EMERGENCY bc he is opisthotonic /kernicterus juandice= yellow color due to bilirubin in the skin

prolonged gastric vomiting or suctioning pick

*meta-alk* metabolic alkalosis Bc ur losing acid & becoming basic

Hyp*o*natremia causes

*o*verload

Sesame Street guess

*only use if you have too* all wrong answers are similar right answer is different dont answer question based on your ignorance instead of knowledge *if you dont know something, pull it out of the question re read and see what happens*

complications of labor

*painful back labor* low priority -position then push in what position would you place her?' -knee chest -goes on hands and knees with butt up and head down then take ur fist and push in her sacrum= counterpressure *prolapse cord* high priority cord is the presenting part means it comes out first -push then position -DONT touch the cord, you push the head back up -aka push the head off the cord -put in knee chest position -c section *interventions for all complications in labor & birth* treated with lion STOP THE PITOCIN THEN DO LION L left side first I increase iv lpn cant do this O oxygenate them N notify physician for: maternal htn ecclampsia hypoxemia uterine rupture AS LONG AS ITS NOT PAINFUL BACK, OR PROLAPSE CORD USE LION

5 uppers

*pam cc* pcp/lsd -psychadelic hallucinogens ADDERAL- add drug 1st 3 letters of adderal methamphetamine's -crystal meth -pseudoephed(decongestant) cooked down to meth caffeine cocaine

aci*d*osis ph down

*resp arrest ambu bag*

12 -48 for *s*ubtotal hyperthyroidism

*s*torm

12 - 48 hrs post *t*otal thyroidectomy hyperthyroidism

*t*etany bc low ca

ob meds

*tocolytics* -stop labor -terbutaline causes maternal tachycardia -mag sulfate decease hr,bp, reflexes, loc, resp if resp are < 12 slow infusion, reflexes we want +2, if its +1 we slow down. +3 speed it up -we dont want to see 11 and 1 - for premature labor *oxytoxics* -stimulate and strengthen labor - pitocin: causes uterine hyperstimulation aka longer than 90s and closer than 2min- if you see this stop the pit *methergine* -causes high bp *fetal lung maturing meds* betamethasone -given to the mother -given IM -given before the baby is born cervonta=surfactant -given to neonate - trans-tracheal- blown into the trachea -giving after the baby is born

labs: high priority wbc

*total wbc* 5,000-11,000 *anc*absolute neutrophil count ABOVE 500 *cd4 count* ABOVE 200 INTERVENTION -assess for signs of infection -place on neutropenic precautions -dont drink water thats been standing longer than 15min- no water picture, open water bottles only fresh water

Treatment of hyperthyroidism

- Radioactive iodine (I131) works by destroying the thyroid gland -ptu- puts thyroid under - Surgery to remove all or part of the thyroid gland - Lifelong thyroid hormone replacement will be needed

ABG Rules (Respiratory or Metabolic)

- Respiratory = <> or >< (opposite) - Metabolic = >> or << (same) - Acidosis = pH < 7.35 - Alkalosis = pH > 7.35

crutch gate pt teaching: 4 point

- move everything separatly -how many things do you have? you have 2 legs and 2 crutches 2+2=4 - *move any crutch, once u move that crutch you are locked in. your sequence is now locked in* - must move the opposite foot followed by the opposite crutch, followed by the other foot -slow and stable

crutch gate pt teaching: 3 point

- moving 2 crutches and the bad leg together - how many things is that? 3 -3,1,3,1

crutch gate pt teaching: 2 point

- pretend my arms are crutches - move a crutch and opposite foot together -followed by the other crutch and they other foot together - 2 things, 2 things -ALWAYS CRUTCH AND OPPOSITE

aws delirium tremens treatment

-*Anti-hypertensive* med blood pressure pill everything is going up bc they're in withdrawal -*tranquilizer* bc they're up why are they up? bc they're withdrawing from a downer -*multivitamin* containing b1 bc wernicke's and korsakoff

crutch gate pt teaching: swing through

-amputations for ppl who cannot bear weight on the stoma -for *non weight bearing* -cant bear weight, so you plant the crutches and then you swing through - you never put the leg down. the leg never touches down -fast

Cirrhosis signs and symptoms

-applicable to any liver problem o Firm, nodular liver is palpable—not usually palpable o Abdominal pain b/c the liver capsule has stretched With a PIH pregnant woman who complains about epigastric pain think SEIZURE b/c pressure is increasing due to liver swelling o Chronic dyspepsia/GI upset or a change in bowel habits o Ascites o Splenomegaly—enlarged spleen due to immune response o Decrease serum albumin levels Get albumin from protein in the diet or the liver b/c the liver synthesizes albumin • Albumin holds fluid in vascular space so when albumin is decreased, fluid is going to leak out and cause ascites in any area so need to check albumin levels o Increase SGOT/AST and SGPT/ALT levels o Anemia b/c liver is sick so increased risk for hemorrhage b/c a healthy liver helps clot blood o Can progress to hepatic encephalopathy/coma b/c ammonia builds up and acts like a sedative also called Reyes syndrome • Protein breaks down to ammonia which the liver converts to urea and the kidneys secrete urea

rn always gives report and always says exeration instead of exerbation when referring to copd

-approach later on and talk to them

sx cataminates the pinky of left hand

-confront imme.

uap given perineal care without gloves

-confront imme. and take over bc it causes harm to pt

PVC ventricular TREATMENT : vfib/vtac

-lidocaine -amirodorone

Airbourne Precautions

-measeals - mumps -ruebella -tuberculosis -varicella chicken pox -private room unless corhoting - *mask and gloves* -handwashing -N95 for tb aka special filter mask -should leave the room, if they do mask -negative airflow **tb is spread by droplet, but it is on airborne precautions

creatine - best indicator of kidney function

0.6 - 1.2 abnormal do nothing

Creatinine

0.6-1.2

low priority abnormal labs: no concern will never be your highest priority serum creatine

0.6-1.2 do have kidney dz but will not die in the next 4hrs only time you will call doctor for creatine is if they were going for a test that had a dye in it, this will need to be reported(higher than normal)

math use leading zeros as long as it maintains place iv replacement question

000.00300 4 is not needed 3 is needed DO NOT USE TRAILING 0'S DONT HAVE TO WRITE THE UNIT AT THE END mini/micro= 60dttps/ml macro=10

4 stages

1 labor: latent active transient 2 deliver baby: 3 deliver placenta 4 recovery

what do you do if the chest tube gets pulled out

1. FIRST take a gloved hand and cover the hole 2. BEST thing is to cover it with a vasoline gauze

have pay attention to the location of the chest tubes

1. apical - means the chest tube is way up high - if you put a chest tube way up high what are you going to remove air bc air rises - apical removes air - apical chest tube draining 300ml per hour BAD - apical tube is not bubbling BAD -apical tube is bubbling GOOD 2. basilar -bottom of the lungs -they remove blood bc blood is subject to gravity - basilar is draining 200ml per hour GOOD - basilar tube is not bubbling GOOD -basilar tube is bubbling BAD

Antibuse revia disulfiram

1. aversion therapy 2. the world aversion means a strong hatred for something- gut hatred for something 3. what we want is for alcoholics to develop a gut hatred for alcohol 4. what we do is give them this drug 5. makes alcoholics very sick- work in theory, not reality when you take this drug and its gets into a bld level in alcohol it will interact with that chemical in your blood and make you super sick to your stomach- super sick, horribly ill

you have a patient with a pneumo with chest tubes in for a hemothorax what would you report to the doctors

1. chest tube is not bubbling 2. the chest tube drained 800ml in first 10 hours 3. the chest tube is not draining and is intermittenly bubbling -report this to physician ***you have to say what do i expect from a hemo? ***what is it suppose to do? DRAIN BLOOD ***which of these is saying it is not doing what it is supposed to do? # 3

a pneumothorax, what will you report from the physician

1. chest tube is not bubbling - it needs to bubble, its not boiling and doing whats its suppose to do 2. the chest tube drained 800ml in first 10 hours -its doing something its not suppose to do 3. the chest tube is not draining and is intermittently bubbling - not this one bc its been changed from a hemo to a pneumo so its no longer an option

prioritization

1. decide which patient is the sickest or the healthiest 2. the answers will always have 4 parts -age -gender -diagnoses -modifying phrase age and gender doesnt matter if the patient had angina pectarus vs. myocardial infarction. MI is higher priority if the patient had angina pectarus, with unstable bp, with stable v/s vs. myocardial infarction. angina is higher priority

second stage delivery of the baby

1. first you deliver the head 2. suction the mouth/ nose 3. nuchal cord -nuchal means neck---cord around the neck 4. deliver the shoulders then the body 5. baby must have id band on b4 it leaves the delivery area

4 things that are always unstable regardless if its expected or not

1. hemorrhage 2. high fevers over 105 bc of sz 3. hypoglycemia 4. pulselessness & breathlessness -at the scene of unwitness accident this is low priority bc there dead. MUST BE WITNESSED

inappropriate behavior of staff

1. is what there doing illegal -tell supervisor 2.is pt or staff member in imme. danger of physical or psychological harm -confront imme. and take over 3. is this behavior legal, not harmful but simply innap. -approach later on and talk to them

PRIORITY *moderate pvc*

1. more than 6 pvcs in a minute 2. more than 6 pvcs in a row 3. pvc falls on the t wave of the previous beats (r on t phenomenon ) if they are having a MI and theyre having pvc that is good it means theyre reperfusing and it doesnt raise there piority it actually lowers it pvcs never reach high in priority

Aminoglycosides Abx toxic effects

1. mycin-mice-ears-*ototoxic* MONITOR ***hearing -tinnitus -vertigo/dizziness 2. nephrotoxicity (kidney) MONITOR *creatine* best indicator of kidney/renal function if they told you serum creatine vs. 24 hour creatinine clearance -24 hour creatinine clearance would be better than the serum creatinine -but the serum creatinine would be 2nd best and beat everything else 3. toxic to cranial nerve #8 (ear) 4. administer every 8 hours

5 d's HIGH PRIORITY PATIENTS

1. ph in the 6's 2. k+ in the 6's 3. co2 in the 60's 4. o2 in the 60's 5. platelet count of less than 40,000

Closed chest drainage devices

1. pluruvac thoravac puemovac immerson these are the plastic containers the tube is connected too what do you do if you knock that over, didnt break just knocked over, what do u do? - set them back up and have them take deep breaths - NOT a medical emergency just have them take deep breaths - dont worry if this device is knocked over 2. what do you do if the water seal breaks -now positive pressure can get into the pleural space - 1st thing you do is clamp the tube, so nothing gets in -2nd is cut it away from the broken device -3rd the end of the tube under sterile water -4th unclamp it bc reestablished the water seal - doesnt need clamp as long as its under water IT IS BETTER TO BE UNDER WATER THAN TO BE CLAMPED bc air cant go in and stuff cant come out. - if its clamped nothing can come in or out -you want stuff to go out you dont want stuff to go in -clamping is only a stop gatch measure - sticking the tube under water solves the problem

click and drag high pressure alarm goes off. what do you do 1st

1. unkink- check for kinks 2. empty water out of tubing 3.turn cough deep breathe 4. suction

1st/2nd question you ask yourself

1. upper or downer 2. overdose or withdrawal too much or not enough, just put it together and pick the obvious one and that's the answer

vanco trough

10-20mg/l

1st age a child can manage their own care

12

low priority abnormal labs: no concern will never be your highest priority hemoglobin

12-18 if the hemoglobin is 8-11 assess for low hgb -anemia or malnutrition if the hemoglobin falls below an 8= high priority 1. assess for bleeding 2. prepare blood transfusion 3. call dr

labs: high priority sodium

135-145 if the na is high = dehydration if the na is low= overload if the question says the na is abnormal and there is a change in loc it then becomes critical

IV

15 - 30 minutes after drug is finished

iv peak

15-30 min after the drug is finished NOT when u hang it you dont start ur clock when its finished when your bag is empty then you go 15-30min after that

quikening

16 - 20

quickening when the baby kicks

16-20wks first 16 most likely 18 should you by 20

first stage high fetal heart rate

160 This is ok- no big deal document and *take moms temp* bc mom probably has a fever nothing is wrong with baby

bmi

19 - 25

organ vitality

1st vital organ: brain 2nd vital organ: lung 3rd vital organ: heart 4th vital organ: liver 5th vital organ: kidney 6th vital organ: pancreas

how many chest tubes and where would you place them for post op chest sx

2 chest tubes apical and basilar on the side of the sx bc you are to assume that chest sx or trauma is unilateral never assume bilateral -only time u take care of bilaterial is if they say bilateral

how many chest tubes and where would you place them for a unilateral puemo/hemothorax

2 chest tubes puemo- apical hemo-basilar

where would you place the chest tubes for a bilateral pneumo?

2 chest tubes apical on the right and apical on the left

when does post partum begin

2 hours after delivery of the placenta

Bilateral total knee replacement 3 weeks post op

2 point

early stages of rheumatoid arthritis

2 point * did not say how many legs were affected, but it was a systemic disease * if its a systemic disease you should assume both legs

INR-monitor warfarin levels

2-3 administer vit k

how do you measure the length of the crutch?

2-3 finger widths BELOW the anterior axillary fold to a point lateral to and slightly in front of the foot EX) you see the rn, lpn, aid measuring a person for crutches. you notice they are doing all of the following, what would you correct? have to pick something that theyre doing wrong/right they write sets of instructions when youre measuring from the wrong point to the wrong point ex they'll say to get the length in the crutch you measure from the axilla. YOU DONT MEASURE FROM THE AXILLA!!!!! YOU *MEASURE 2-3 FINGER WIDTH BELOW THE ANTERIOR AXILLA FOLD*. so they will give you the wrong upper point or they will say... you measured to the heal. YOU DONT MEASURE TO THE HEAL. you measured it to the lil toe/ you DONT MEASURE to the LITTLE TOE NOT MEASURED BY HEEL OR LIL TOE Dont measure to any landmark on the foot you measure to a point lateral to and slightly in front of the foot If any of the answers say -axilla INCORRECT ANSWERS -any landmark of the foot -rule these answers out

you start getting kernicterus bilirubin in the brain when bilirubin gets

20 dangerous and newborn can die

2nd trimester when is the fundus at the umbilicus at or below

20 weeks to 22 weeks gestation bc this deals with the date of viability -22-24 weeks END OF 2ND TRIMESTER

which needle to use for IM injection

21 gauge 1 inch look at the abbr. and find the number that matches 1st letter

when is the fundus at the belly button

22 wks

date of viability

22-24 weeks end of 2ND trimester

low priority abnormal labs: no concern will never be your highest priority Bicarb

22-26 abnormal bicarb is no concern

how old does the baby have to be to withdrawal

24 hours

which needle to use for SQ injection

25 gauge 5-8 in look at the abbr. and find the number that matches 1st letter pick the answer that has a 5 in both parts

difficulty breathing

2nd and 3rd trimester teach them tripod position feet lat arms on table leaning forward

-zapine

2nd generation atypical newer tranquilizers

pulmonic

2nd intercostal space at the left sternal border

aortic

2nd intercostal space at the right sternal border

high pressure alarm causes

3 obstructions 1. kinks in the tubing, increases resistance tx: un kink 2. water condensing within the tube- water condensing in the dependent loops tx: empty it 3. mucus secretions in the airway, they got goop/gunk there tx: change positions, turn, cough, deep breathe....if this doesnt work then suction

1st day post op right total knee replacement partial weight bearing allowed

3 point

kids toys

3 things to consider 1. is it safe - no small toys for kids under 4= aspiration - no metal toys if o2 is in use= sparks -beware of phomites- non living object that harbors microorganisms. stuffed animals 2. is it age appropriate 3. is it feasible -could you play it - is swimming ok for a 13yr? yes -is swimming ok for a 13yr in a body cast? no hard plastic toys are the BEST bc u can sanitize it

potassium

3.5 - 5.3

highest priority potassium

3.5-5.3 low k+ lower than 3.5 is a high priority *hypokalemia* if your k+ is low is there anything you have to hold? no 1. assess the heart 2. prepare to administer potassium 3. call doctor *hyperkalemia* what if its b/t 5.4 and 5.9 this is high priority 1. hold the k+ 2. assess the heart 3. give kaexitlate and d5w regular insulin 4. call dr IF THE K+ IS > OR EQUAL TO 6 IT IS VERY CRITICAL DO ALL OF THE HYPERKALEMIA STEPS AND STAY WITH PT

im

30 - 60 minutes

im peak

30-60 mins after you give it

women 31 week trimester and she has gained 15 pounds. what is your impression

31-9=22 lbs -suppose to gain 22lb if said she gained 15lb get a biophysical on the baby bc the baby could have died last month

low priority abnormal labs: no concern will never be your highest priority co2

35-45 a co2 that is high but in the 50's is CRITICAL dyspnic -51 -57 -56 -59 1. assess respiratory status 2. purse lip breathing now if they're in the 60's and above that means they have respiratory failure HIGH PRIORITY 1. assess respiratory status 2. prepare to intubate and ventilate 3. call respiratory FIRST then hcp click and drags o2 assess them prepare to intubate and ventilate call respiratory FIRST then hcp

low priority abnormal labs: no concern will never be your highest priority hematocrit

36-54 an elevated hematocrit assess for dehydration

Erb's point

3rd intercostal space, left sternal border

fundus above the umbilicus

3rd trimester baby will then be the priority

crutch gate pt teaching

4 crutch gates 2 point - pretend my arms are crutches - move a crutch and opposite foot together -followed by the other crutch and they other foot together - 2 things, 2 things -ALWAYS CRUTCH AND OPPOSITE 3 point - moving 2 crutches and the bad leg together - how many things is that? 3 -3,1,3,1 4 point - move everything separatly -how many things do you have? you have 2 legs and 2 crutches 2+2=4 - *move any crutch, once u move that crutch you are locked in. your sequence is now locked in* - must move the opposite foot followed by the opposite crutch, followed by the other foot -slow and stable swing through -amputations for ppl who cannot bear weight on the stoma -for *non weight bearing* -cant bear weight, so you plant the crutches and then you swing through - you never put the leg down. the leg never touches down -fast ***amputation with prosthetic device u can bear weight

Bilateral total knee replacement 1st day post op weight bearing allowed

4 point

advanced stages of amyotropic lateral scelorosis als

4 point

4th stage of labor: recovery

4 things you do 4 times an hour 15min 4 stage of labor 1. take v/s & assess for s/s of shock shock -pressures go down -rate goes up -pale cold clammy 2. check the fundus -boggy= massage -displaced= catheterize 3 . check the perineal pads - if she is bleeding excessively she will saturate a pad in 15min or less - you go back and its 98% saturated GOOD bc it has to be saturated 100% 4. roll her over= check for bleeding underneath her DO THIS EVERY 15MIN

labs: low priority rbc's

4-6 million

tricuspid

4th intercostal space at left sternal border

sublingual peak

5-10 min after the drug is dissolved

mitral valve

5th inter costal space at mid clavicular line apical pulse

6 rhythms most tested on nclex

6 rhythms most tested on nclex

highest priority pH

7.35-7.45 pH in the 6's is a high priority 6.4 is bad = death 1. assess v/s to make sure they still alive 2. to correct this acidosis is to treat the underlying cause - nothing the nurse can do the physician has to do this with a low pH nurse has to call the hcp ASAP faster than any other dz process ASSESS VITALS- STAY WITH PT CALL DR

Never pick infection within

72 hours after surgery/ labor only AFTER only after 42h

you go into delirium tremens

72 hours after you stop drinking

priority labs: po2

78-100 if it is low but still in the 70's like 77 this is CRITICAL 1. ASSESS respiratory 2. lpn/rn can give o2 if its low in the 60's -68 -69 -64 -63 1. assess respiratory status 2. prepare to intubate and ventilate 3. call respiratory FIRST then hcp click and drag o2 assess them prepare to intubate and ventilate call respiratory FIRST then hcp

low priority abnormal labs: no concern will never be your highest priority BUN

8-25 if bun is elevated assess them for DEHYDRATION

bun

8-25mg/dl

labs: high priority o2sat

93-100 anything less 93 is high priority 1. assess them 2. give o2 peds is really bad if they're BELOW 95 INVALIDATES IT ***anemia falsely elevates sao2 - if someone is anemic they are going to look alot better than they actually are *** dye procedure in last 48hrs BC it colors the blood reading color causinf falsey elevated sao2

bnp

<100 >100 pg/mL indicates heart failure

ccb treat

A A A s/s dizziness flushing headache peripheral edema o htn constipation

what do ccb treat & when do we want to that

AAA Anti-hypertensives - they relax your heart and blood vessels -if you relax your heart & relax your bp, what does your bp do? -your pressure goes down Anti-anginals -relax the heart and uses less oxygen - so the angina goes away -it treats angina by decreasing o2 demand - bc it relaxes the heart - whats the worst thing that can happen in the heart for a person w/ angina? SPEED UP -so we want to do what to the heart? slow it down Anti-atrial arrhythmia -will not treat ventricular tachycardia, bc it only tx atrial -will it treat atrial flutter? yes -will it treat atrial fibrillation? yes -will it treat premature ventricular contractions? no -will it treat premature atrial contractions? yes -paroxosmal atrial tachycardia? yes -atrial bygemini? yes -ventricular bygemini? no -SUPRA-VENTRICULAR TACHYCARDIA (SVT)? YES -SUPRA means above uworld -ventricular bygemini following MI is BAD -Causes vtac & vfib (dangerous)

3 mycin that are not Aminoglycosides not mean old mycin

ACE 1. azi*thro*mycin 2. clari*thro*mycin 3. ery*thro*mycin

clozapine zap

Agranulocytosis used for severe schizophrenia advantage -does not have s/e abcdef disadvantage - trashes bone marrow low wbc -infections 2nd generation atypical antipsychotic

uppers s/s things go up

DRESS RIBS IT *D*iarrhea *R*eflexes 3/4 *E*uphoria *S*pastic *S*eize *R*estlessness *I*rritability *B*ORBORGYMI high bowel sounds *S*uction *I*ncreased temp *T*achycardia

psychological problem:

Dependency/coDependency

Benzodiazepines prototype

Dia*zep*am Valium lora*zep*am flua*zep*am clora*zep*am chlor*zep*oxide they always have zep in them

what 2 situations will resp arrest and depression be your highest 2 priorities

Downer Overdose & upper withdrawal

calculate due date

FIRST DAY of the last menses add 7 days subtract 3 mts

hiatal hernia sign and symptom

GERD if you *lie down* after you *eat* heart burn and indigestion dependent on position n mealtime

water seal INTERMITTENT

GOOD document it

s/e of ccb

H & H headache -bc you get vasodialation in the brain and that gives you a migraine -n- hypotension -bc it relaxes the heart and the blood vessles

first stage High baseline variability

HR changing a lot. This is ok. document v/s all over the place- baseline always changing

first stage Variable decelerations

HR up or down, cord compression = VERY BAD treated with push position prolapse cord high priority cord is the presenting part means it comes out first -push then position -DONT touch the cord, you push the head back up -aka push the head off the cord -put in knee chest position -c section

what pt is giving lots of fluids

Hyp*e*rnatremia

which pt is put on fluid restriction and laxis

Hyp*o*natremia d*e*hydration

a student nurse runs to you the rn and says i just ran an iv a whole liter of iv fluid into the patient in 10mins. i forgot to close the clamp. what electrolyte imbalance would you expect to see?

Hyp*o*natremia *o*verload NURSING DIAGNOSIS fluid volume excess

prozac s/e

INSOMNIA -give it before noon -not a bedtime when *changing doses* for *adolescents/young adults* watch for suicide risk if an adolescent is on prozac not risk for suicide only when you CHANGE THE DOSE anticholinergic = dry mouth blurred vision constipation drowsiness euphoria

Rule of the B's

If the *pH & Bicarb* are both in the same direction then its *metabolic*, doesn't matter if its up or down who cares what direction, you must use metabolic b's is 4 bicarb both bolic Bicarb has the b in it. *respiratory does not have b in it. * if its going in different directions then its respiratory

sodium level of 149 is too high? The normal sodium level is 135-145 mEq/L (135-145 mmol/L)

Look for neuro changes when the sodium level is not within normal limits. The brain does not like it when the sodium level is messed up. So, performing a neurological assessment on this client would be important

Cushing's disease s/s

MS. BIG RATS LIBBIE HHH moon face striae buffalo hump infection gynecomastia retains na and water atrophy of arms and legs trunkal/central obesity skinny limbs lose potassium irritability big body bruising immunosupressed excess hair on body *high glucose* hyperglycemic hirsutism same symptoms as side effects of steroids:

Flexeril

Muscle Relaxant

Baclofen

Muscle Relaxant s/e fatigue/ drowsiness muscle weakness patient teaching dont drink dont drive dont operate heavy machinery

Chvostek's sign Trousseau's sign

NEUROMUSCULAR IRRITABILITY from low calcium

Haldol docunate

NMS neuroleptic malignant syndrome -anxiety and tremors -fatal hypopyrexia >102- 108=eps BAD -elderly pts, young white schizophrenics may develop nms from an overdose. -elderly dose is half the adult dose EX -pt on major tranquilizers and he is having tremors and anxiety and confusion, what would be the first action you will take? take the temp long acting IM same as thorazine s/e abcdefg typical first generation antipsychotic

1st thing you have to decide is my patient

Non-psychotic or psychotic

pancytopenia

Pancytopenia is a condition in which there is a concurrent leukopenia (a reduction in white blood cells), thrombocytopenia (a reduction in platelets), and anemia (reduction in red blood cells).

diabetes insipidus

Polyuria polydipsia high urine output leading to dehydration due to low adh fluid part of diabetes mellitus lose water lose weight

presentation

ROA or LOA

first stage if you get a feta heart tracing that begins with the letter L do

STOP THE PITOCIN THEN DO LION L left side first I increase iv lpn cant do this O oxygenate them N notify physician

Wolf-Parkinson-White Syndrome

Short PR interval (< 0.12), delta wave, procainamide

K+ sparing diuretics

Spironolactone eplerenone Triametereme Amiloride

sublingual TAP

T : 30 minutes prior to administration Administer P: 5 - 10 minutes after dissolved

Laminectomy discharge teaching

TEMP 1. do not sit longer than 30min for 6wks 2. lie flat and log roll for 6 wks 3. no driving for 6 wks 4. do not lift more than 5 lbs for 6wks -gallon of milk is 5 lbs PERMANENT 1. will never be able to lift objects by bending at the waist - they need to lift with the knees 2. cervical Laminectomy are not allowed to lift anything over their head forever 3.no off trail biking, amusement jerky rides, horseback riding

treatment for thyroid storm - hyperthyroidism

Treatment a. Give O2 MASK 10 ML and lower body temp b. Tx focuses on saving the brain until they come out of it c. Lowering body temp: i. FIRSTIce packs: on axilla, axilla, groin, groin, back, neck ii. Cooling blanket BEST WAY come out or die 2 staff for 1 pt

Troubleshoot

Troubleshoot

Downer withdrawal

UP DOESN'T HAVE ENOUGH DOWNER SO EVERYTHING GOES UP

Stairs with crutches patient teaching

UP with the GOOD and DOWN with the BAD lead with the good FOOT then crutches go 2nd. *the crutches always move with the bad leg*

Compensation levels

Uncompensated- Abnormal Ph, 1 abnormal value, and 1 normal value. Partially compensated- Abnormal Ph, 2 abnormal values Fully compensated- Normal Ph plus 2 abnormal values. Corrected- All WNL (Within normal limits).

first stage veal chop

Variable - Cord compression Early - Head Compression Acceleration - Okay Late - Placental insufficiency

Potentially life-threatening arrhythmias

Ventricular tachycardia, All atrials b/c of clots, PVCs has a cardiac output

psychotic Wernicke-Korsakoff syndrome

Wernicke encephalopathy Korsakoff- psychosis they tend to go together and you find them in the same pt #1 psychosis induced by vitamin b1 or thiamine deficiency - this is a scenario where you loose touch with reality - YOU GO INSANE BC YOU DON'T HAVE B1

saw tooth

a flutter treat with ccb

Aminoglycosides abx think the following

a mean old mysin Abx used to treat mean infections if they are mean old drugs what kind on infection would they treat? -serious -life treating -*Resistant* -*gram negative* resistant, serious, life threatening, gram-negative infections are treated by mean old mysin

diabetes mellitus type 2 has 1600cal what is the best dietary action

a) restrict calories to appropriate level b) divide food into 6 feedings a day ANS A

dr says ween off ventalator in am...he's writing it today for tomorrow, the 6 am abg's show resp acidosis. what would you do

a. follow the order b. call resp therapy c. hold order call dr d. begin to decrease the setting b. never pick an answer where you have to do it and someone else has to do it -same as picking call chaplin *he needs the ventilator. How do u know he is on the vent? he has resp acidosis. He needs this vent? Yes, bc he is being underventalated on the vent, he's on the vent he needs to be on the vent... if i take him off its going to be worse...you really want to see respiratory alkalosis at 6a, which means hes being overventalated and means he probably doesn't need the vent

you notice a person has vfib(bad, no cardiac output) on the monitor, you run to the room they are nonresponsive and they dont have a pulse what is the FIRST thing your going to do needs to be done in less than 8min

a. place a back board b. begin chest compressions if you choose place backboard what do you say? - im going to place the backboard first then im going to start chest compressions if you choose place chest compressions what do you say? - im going to start chest compressions then im going to place the backboard what will be better to do 1st? - place the backboard, its s perfect world so the black board is there BUT... the person has vfib and they are unresponsive, no pulse whats the BEST thing to do - start chest compressions w/out the backboard

calculating weight gain A women is in her 28th week. she has gained 22 pounds. what is your impression?

a. she just fine b. underweight c. overweight d. she could either way do assessment *TAKE THE WEEK OF GESTATION AND SUBTRACT 9* D -something can be wrong lets assess -if she's with a pound or 2 she's GOOD -if she 3lbs off BAD assess -4lbs off TROUBLE

atrial flutter & atrial fib

abcd

Supraventricular Tachycardia (SVT): atrial treatment

abcd's for atrial treatment: ADENA, BETA,CA, DIG Adenocard/ Adenosine - push in less than 8 seconds, another nurse pushes 20ml of flush after - fast IV push super fast...slam it - use big vein - when u slam it fast they go into asystole for 30 sec, but they will come out of it beta blockers -lol -negative dic (dromotropic, inotropic,chromotropic) - like ccb, valium for your heart -tx a,aa, aaa, anti-atrial arrhythmia -s/e headache and hypotension ccb -ccb & beta blockers are like valium for your heart - negative, chromo, dromo, ino - treats a,aa, aaa - have the s/e of H & H digitalis/ lanoxin/ digoxin 0.5-2.0 *************Digoxin Toxicity**************** -fatigue -weakness -projectile vomiting in infants -GI effects: anorexia, n/v, ab pain -vision changes: diplopia, blurred vision, yellow green white halos -HYPOKALEMIA= MUSCLE WEAKNESS -dysrhythmias- cardiotoxicity -tx dysrthymias with lidocaine/phenytoin -take apical pulse for 1 min, hold id <60 or >100 -know each of the dig name- nclex is not going to give both

exophthalmos-hyperthyroidism

abnormal protrusion of the eyeball

Ammenorhea

absent period

manipulation

abuser gets significant other to do things for her w/o the best interest of the significant other nature of the act is dangerous and harmful/interest no positive self esteem like dependent/codependency

Dependency

abuser gets significant other to do things for them or make decisions for them abuser says... - call my boss. can u go do this\that...and they do it dependent is the abuser

empathy ignores what is said and goes with what is felt

accepts patients feelings as being valid real and worthy of action all about feeling 1. recognize its an empathy question - they always have a quote in the question and each of the answers is a quote 2. put yourself in the clients shoes 3. if i said those words and meant them, how would i be feeling rn 4. go and choose the answer that reflects the feeling or anything close DO NOT CHOOSE THE ANSWERS THAT REFLECT THEIR WORDS bc it ignores what they pt felt BAD ANSWERS dont worry dont feel you shouldnt feel i would feel anybody will feel nobody will feel most people feel

ph low

acidosis

underventilating

acidosis

ph down

acidosis -paralytic ileus -hyporeflexia -bradycardia -lethargy -obtunded -coma -*resp arrest ambu bag*

you have a pt with Alzheimer disease who during ur conversation points to 2 people sitting in a table and says you see those people they are plotting to kill me

acknowledge feeling - I see you're frighten or scared redirect: going with what ur talking about but getting it achieved in the right way - lets go somewhere where you can feel safe will it be alright to say i see you're frightened and that will go away when you feel better - no bc they didn't learn anything and this is PERMANENT

patient with scizoaffective d/o who points to 2 people talking across the room and they say those people are plotting to kill me what would you say

acknowledge feeling - I see youre frighten or scared present reality - those people are not plotting to kill you were all safe set limits -we are not going to discuss this anymore enforce limit - i see your to ill to have a conversation so we will end the discussion and in 30min we will have a reality based conversation will it be alright to say i see you're frightened and that will go away when you feel better - no bc they didn't learn anything

a client with delirium tremens says to you, you see those 2 people over there, they are plotting to kill me

acknowledge feelings - i see ur scared. youre safe and that feeling will go away when you feel better redirect

when on any steroid

acucheck q 6

4 rules of prioritization

acute beats chronic fresh post op 12hrs beats med surg unstable beats stable tie breaker is which organ - the more vital the organ, the higher priority -organ of modifying phrase is used 1st vital organ: brain 2nd vital organ: lung 3rd vital organ: heart 4th vital organ: liver 5th vital organ: kidney 6th vital organ: pancreas

4 rules of priority

acute beats chronic fresh post op beats medical or other surgical unstable vs stable

Cushing's treatment

adrenalectomy bilateradrenalectomy= addisone

your pt has hyperkalemia sata

adynamic ileus obtundant +1 reflex clonus-irritability u wave - goes down depressed st oliguria bradycardia 4,8

pc

after meals

Phenothiazines docunate

after the name of a drug it means it is a long acting -sometimes it works for 2weeks or a month 1 shot for a month- court ordered long acting IM form giving to non compliant clients

confrontation is not the same as

aggression - you too are an alcoholic, you jerk you just have to admit it -you attacked the person.."you", "jerk","admit it"

post op risk with thyroidectomy first 12 hrs hyperthyroidism

airway and hemmorage -edema in airway doesnt matter if its a total or sub total

every alcoholic goes through

alcohol withdrawal 24 hours after they stop drinking

what always comes 1st?

alcohol withdrawal within 24 hours then 72 hrs after that you go into dt

so if you had dt, you had

alcohol withdrawal, but just bc you had alcohol withdrawal doesn't mean you're going to get dts

overventilating

alkalosis

ph high

alkalosis

ph up

alkalosis -irritability -hypereflexia= 3 & 4... 2 is normal...1 is 0=hypo -tachypnea -tachycardia *borborygmi* increased bowel sounds -seizures *suction

amino tells you what it treats

all Aminoglycosides end in mycin but not all drugs that end in mycin are Aminoglycosides for the most part -most drugs that end in mycin are Aminoglycosides

congenital heart defect/ parent teaching

all bad or all good TRouBLe - trouble you need surgery now in order to live - no trouble defect you do not need sx u can have it years later if it causes a trouble TRouBLe defect growth and development -slow, delayed bc u have a trouble defect -exercise intolerance - short life expectancy bc its trouble -parents experience, stress, grief, financial,caregiver issues -APNEA monitor - hospital stay long (weeks) -pediatric cardiologist no trouble growth and development - no trouble - life expectancy is normal -parents have normal problems like the average person on the street -hospital stay 24-36 hours then ur gone -pediatrician/ nurse practitioner

Alcohol withdrawal syndrome

always precedes delirium tremens, however delirium tremens does not always follow Alcohol withdrawal syndrome

PPE (personal protective equipment)

always take it OFFin alphabetical order 1. gloves 2. goggles 3. gown 4. mask ON is reverse alphabectical for the g's but mask comes 2nd gmgg 1. gown 2.mask 3. goggles 4. gloves

psychotic Wernicke-Korsakoff symptoms

amnesia & confabulation amnesia: memory loss -lose entire decades of their memory confabulation: making up stories. they make up stories bc they forgot but they BELIEVE IT

a baby is in the womb for 9mts

another 9 mts until they do anything purposeful

Lithium toxicity

anti mania drug- used for bipolar the mania part not depression 0.6-1.2 6-12 toxic level > 2 1.2-2= grey area you do * boards will never give you a lithium of 1.3,4,5,6,7,8,9 why? bc its in the gray area where books dont agree. and item writers have to get to where all books agree. mark teaches 2 and greater bc all books agree that is toxic

Benzodiazepines

anti-anxiety drugs minor tranquilizers always have zep in the name work quickly dont take for more than 2-4 weeks

Benzodiazepines s/e

anticholinergic = dry mouth blurred vision constipation drowsiness

tricyclic antidepressants sle

anticholinergic= dry mouth blurred vision constipation drowsiness *euphoria* take for 2-4 weeks for full effect

Phenothiazines s/e

anticholinergic= dry mouth blurred vision constipation drowsiness eps -pill rolling, rigidity, shuffling gate fotosensitivity -skin burns to light agranulocytosis/ immunosupressed - low wbc DO NOT HAVE TO HOLD DRUG OR CALL DR THESE ARE JUST S/E NOT TOXIC EFFECTS toxic effects you WILL hold med/ call dr

MAOIs

antidepressants, happy pills spot these drugs from the beginning of the name not the ending mar plan nar dil trade name par nate

LOCATION what would they put in for a pneumo

apical

LOCATION what would they put in for a pneumo/ hemo

apical/basilar one of each

Calcium Channel Blockers

are like Valium to your heart what does Valium do for your body= calms you down ccb has nothing to do with Valium, its like Valium for your heart *ccb -*calms the heart down* if your heart is tachycardic, it can use a little relaxant you could use a -ccb if your heart was having tacharrythmias would you give a ccb -yes If you had a heart attack and you wanted to rest your heart, what would you give? -ccb does your heart need to relax while in shock -no, it needs to go up. get cooking if your heart is in heart block, would you give a ccb -no

how often do you suction patients

as necessary when they cannot mobilize after they have turned, coughed and deep breathe 1st and if they cant do that then suction

kernicterus= bilirubin in the brain causes

aseptic meningitis/ aseptic encephalitis

after you know if the drug is an upper or a downer

ask if they are taking about overdose or withdraw bc they're opposite and you have to know which one your talking about overdose= too much withdraw= not enough IMPORTANT!!!!

postpartum assessment

assess every 4-8 hours bubble head breast *uterine fundus* -want it firm, *midline* -boggy=massage -if it is not midline cath them just like in the recovery -HEIGHT OF THE FUNDUS IN RELATION TO THE BELLY BUTTON, *FUNDUL HEIGHT=DAY POSTPARTUM* bladder bowel *lochia* -rubra: red -serosa: pink -alba: white check the perineal pads - if she is bleeding excessively she will saturate a pad in 15min or less - you go back and its 98% saturated GOOD bc it has to be saturated 100% episeotomy hemoglobin and hemacrit *extremity check* homan sign is not the answer -*thrombophlebitis* bilateral calf circumference measure BEST WAY measure their calfs affect -means emotional discomfort

can hear heart beat

at 8 to 12 wks

o on abgar means

baby is still born

LOCATION what would they put in for a hemo

basilar

ac

before meals

labs: low priority bnp

best indicator for congestive heart failure should be under 100 watch for chf

Pathologic juandice

bilirubin high kid is yellow at birth if they come out yellow SOMETHING IS WRONG

ventricular qrs= ventricular tachycardia

bizarre always applies to tachycardia if you put bizarre/chaos together you get ventricular tachycardia

Aminoglycosides abx not used for

bladder infection sinusitis otitis media-middle ear infection viral pharyngitis- strep throat treatment 1. ery*thro*mycin 2. azi*thro*mycin 3. clari*thro*mycin

hemophillia

bleeding disorder in which clotting does not occur or occurs insufficiently OCCURS IN THE JOINTS OF THE KNEE ESP THE JOINTS

what vital sign do you need to measure before you give a ccb

blood pressure bc hypotension is the side effect bp parameters -hold the ccb, if the systolic (top) is under 100 * what do you have to monitor continuously, fairly,quickly, intermittently while they are on a cardizem drip -bp 98/52 - slow it down and measure it again - titrate: change the iv rate to keep the bp systolic over 100

bob is in denial how many pts do u have...1 bob is a manipulator. how many pts do u have...1

bob is in denial and is dependent. how may pts do you have...2 bc u have to get codepent

3 types of psychosis: 2 type of psychosis: psychosis of dementia

brain damage Alzheimers stroke/ post stroke organic brain syndrome senile *a problem these people tend to have is where they are, where there room is, what day it is THIS IS NOT PSYCHOSIS this is just forgetting. if they're have illusions, delusions and hallucinations then they are psychotic. presenting reality is Not appropriate for psychotic patients DO NOT confuse with reality orientation* reality orientation= person, place, and time *this person has a structural brain problem and cannot learn reality.* INTERVENTION 1. acknowledge their feelings 2. redirect them - channel them from something they cannot do, to something they can do you dont set limits on their bizarre communication bc its mean DONT..present reality bc they cant learn

Droplet precautions

bugs that travel 3 ft on large particles -meningitis gets lumbar puncture -h flu b= epiglottis (dont stick nothing in their throat) -private room is preffered -*mask and gloves* - handwashing - pt wears mask when leaving room -disposable supplies and dedicated equipment

never pick answers with purpose words in it when the child is under 9mts

build sort stack make construct these are purpose words and kids under 9mts and kids do nothing purposeful b4 9mts

radioactive iodine-hyperthyroidism

by themself for 24 hr - private room -NO VISITORS for 24 hrs excreted through urine- NURSE has to be careful w urine careful with urine -flush 3 times -if they spill urine call hasmat team -CANT CALL HASMAT GOTTA CALL HASMAT

if skeletal muscle or nerve blame on

calcium

rn passing narcotics to a bunch of pts and u notice rn is incoherant

call supervisor

diabetes mellitus type 2 diets

calorie restriction BEST 6 small feedings a day

12-15y formal operations

can abstract think cause and effect can be taught like an adult manage

how do you measure the hand grip of the crutch?

can be adjusted up and down *when the hand grip is properly placed, the angle of elbow flexion would be 30 degrees*

haldol

can be given to pregnant women

aws semi- private anywhere

can be in a semiprivate room anywhere on the unit

delerium tremens

can kill you Are dangerous to self and others unstable cannot give to a uap

canes

canes

LPN/UAP

cannot except delirium tremens client bc they're unstable rns except the assignment- decrease workload, if dt is excepted

Zoloft sertraline ssri

cause insomnia but can give at bedtime increase toxicity because not broken down -causing other drugs not to get metabolized -lower the dose of the other drugs weight gain -*interaction with st johns wort=serotonin syndrome* *sad head* sweat sexual dysfunction apprehensive -impending sense of doom dizzy headache NO warfarin/coumadin= bleed out st johns wart= serotonin syndrome

when your heart needs stimulating do not use a

ccb

post op laminectomy and spinal cord complications

cervival laminectomy complication -trouble breathing deeply -PNEUMONIA thoracic laminectomy complication -ileus -trouble coughing lumbar laminectomy complication -urine retention -leg problems trick question a person underwent a lumbar laminectomy 10hrs ago, whats they #1 problem a.airway b.breathing c. circulation d. urine retention d you are caring for a pt with a lumbar oligodendroglio sytoma. what is thr #1 problem a.airway b.ileus c. cardiac arrthymias d. urine retention d

ventricular fibrillation

chaos= fibrillation

atrial p wave

chaotic the word always used to describe fibrillation

uap cannot do

charting -can chart what they did, but not about pt give meds no assessments/ treatments cath ???

first stage ace of spades what answer always wins in a tie

check fetal heart rate - pick on nclex, good answer

#1 priority in the 3rd phase of labor

checking for dilation helping with pain help with breathing

anterior thoracic laminectomy

chest tubes anterior front though the thoracic chest you go to the spine bc of a pneumo/hemo thorax so u need chest tube

chest tube 3 dimensional demonstration

chest wall -inside of the chest wall is a lining called the perarital plural lines the inside of the chest wall -on the outside is the visceral plural and it lines the outside of the lung b/t the perarital plural and visceral plural is the plural space - negative pressure should be in the plural space -negative makes things stick together -this works by breathing in/out = good air exchange - if they get shot, air & blood pools in the plural space creating positive pressure which pulls things apart -so were no longer stuck together negative -has muscles- does the work of breathing -now that there is positive pressure breathe in/out -no air exange bc positive pressure in the pleural space -chest tube is now in with suction - with the chest tube we reestablished negative pressure in the plural space -now you could breath in/out -we heal, and the tube can come out lung -plural space -alveoli - no muscles does not do work of breathing

what is the first thing your going to do if the water seal breaks

clamp the tube temp fix -its the first but its not the best

click and drag when the water seal breaks

clamp the tube cut it submerge under sterile water unclamp

#1 priority in the 2nd stage of labor

clearing the babies airway

Aminoglycosides Abx examples

clindamycin cleomycin bleomycin dactinmycin adrianmycin Streptomycin cannomycin

never put anything

cloudy in an iv bag

opiod analgesics

cns depressants--sedative -lethargy -flaccidity -reflexes of +1 -hyporeflexia -obtunded

total thyroidectomy hyperthyroidism

complete removal of thyroid Need lifelong T3, T4 hormone replacement. At risk for hypocalcemia bc at risk for loosing parathyroid gland S/S hypocalcemia: everything go up tetany spasm sz clonus irritability htn tachycardia tremors TROVESTEK/CHOSSEUS a. Earliest sign: parasthesia

deny

confront

denial treatment

confront it point out the difference b/t what they say and what they do they deny, but you confront by what they say and what they do EX. you say you're not a alcoholic, but it's 10am and you already have a 10pack you pointed out, the difference b/t what she said which was "im not an alcoholic", what she did, drink 6pack of beer before 10a you say you're not a spouse abuser, but she has a restraining order against you you say you're not a child abuser, but cps has your children you say you're not a food abuser, but you're 400lbs and you're 5'1

ccb cardizem

continuous IV drip

school age 6-12

creative -let them make it, dont u make it collective -always collecting something -pokemon -digimon competitive -like to play games where there is a winner/loser LEGOS -transformers tea party -make cookies/tea/lemonade/muffins no color book crayons - yes blank paper color pencils

dka s/s

d dehydration -they look dehydrated -dry mucus membranes -weak thready pulse -dry skin -poor elasticity -headache -overheat skin hot, dry and flushed k K+, ketones, kussmaul(deep rapid hyperventilate) -will have ketones in the blood, but not urine a acidotic (metabolic), acetone breath fruity, anorexia due to nausea (loss of appetite)

Hyp*e*rnatremia causes

d*e*hydration hot,flushed,dry skin

delirium tremens is private near nurses station

dangerous and unstable

low pressure alarm 2 disconnections you need to know about

decreased resistance 1. disconnection of the main tubing tx: reconnect 2. o2 sensor tubing, senses the fio2 in the airway/trach area -comes from the ventalator machine, it is a black coated wire, very small ( half the diameter of pencil, pen) goes right along the tubing, piggy back along the tubing, comes right to the trach or where the endo tube is hooks in hole in tubing (right angle) and it measures the fio2, the oxygen delivers, but if that pops off the air comes in it causes less resistance tx: take sensor and plug it back in *reconnect the main tubing and reconnect the o2 sensor*

lithium

decreases mania toxic above 2 tremors, metalic taste and severe diarrhea pee, poop, and parastesia increase fluids and watch sodium low sodium makes more toxic if high sodium lithium wont work

what do you use for vfib

defib defib means shock them

high blood glucose type 2

dehydration

only the minority gets

delirium tremens

psychotic symptoms

delusions: false fixed(not changing) idea or belief there is no sensory component - you're not hearing feeling tasting smelling anything your just thinking it, its not a thought 1. *paranoid delusion*= false fixed belief that people want to harm you ex -the police are out to kill me - my wife is having me committed so she can run off with the psychiatrist - the kids are lying on me so they can get my house -neighbors are shining lasers on me to hurt me 2. *grandiose delusion*: false fixed delusion that you are superior ex -think they are Christ -think they are the worlds smartest person - think they are mohammad -think they are gangus khan - greatest person, the future of the universe hinges on u 3. *somatic delusions*: false fixed belief about a body part ex - i have xray vision i can melt stones with my eyes -my brain is a martian super conduction protonics accelerator -there are worms inside my arm -my body hollow - your pregnant 83 and male hallucinations: purely sensory, false fixed sensory experience - 5 hallucinations 1 for each sense -hear, taste, smell, see touch - most common hallucination is letter a for auditory where you hear things. voices telling you to hurt yourself -next most common is visual seeing things that are not there -3rd most common is tactile: feeling things that are not there -gustatory: tasting things that are not there (rare) -olfactory: smelling things that are not real (rare) -if a client says " i hear demen voices hallucination bc it was sensory and nothing is there - during a interview a client stands at the wall and says look i see a bomb illusions : misinterpretation of reality - it is a sensory experience -with a illusions there are a referent in reality -referent: something to which a person refers when they say something - a client overhears nurses and doctors laughing and talking at the nurses station and says "listen i hear demen voices" illusion bc there was actual people talking making real sounds that they misinterpreted - during the interview the client looks at the fire extinguisher in the wall and says look i see a bomb illusion bc there was something in reality to which they referred yes..the fire extinguisher IT HAS TO BE SOMETHING THERE

number 1 problem with alcohol & abuse child/spouse/elder, gambling, cocaine,

denial bc they dont admit to having a problem

p wave

depolarization of the atrial NOT VENTRICULAR

135 Downers relaxed state of mind make you go down

depressants, such as barbiturates Phenobarbital penni barbital Secobarbital Ativan/Lorazepam Xanax/Alprazolam valium/Diazepam librium/Chlordiazepoxide dilauted/Hydromorphone ms contin morphine sulfate codeine demmerol Fentanyl globain Nubain/Nalbuphine Thorazine/Chlorpromazine stolzeine fluphenazine pherzene Chlorpromazine/antipsychotic med Piperazine prolixin/Fluphenazine chromozene crilicsin heroin marijuana alcohol hashish

siadh, di, dm who would have who would have fluid volume deficit

di dm

who will urine out of 200ml/hr for 3hrs straight with a normal blood glucose

diabetes insipidus

who will have 200ml/hr of 3 hrs in a row with a glucose of 280

diabetes mellitus

metabolic acidosis

diarrhea causes paralytic ileus

Calcium Channel Blockers are

dic negative *D*romotropic negative *I*notropic negative *C*hronotropic THESE ALL RELAX YOUR HEART they calm it down all its saying is its like Valium for your heart *cardiac depressant* weaken,slow down & depress the heart important

metal

die'cast die'cast car is a no no if o2 is in use

when would you FIRST = first range when would you *MOST LIKELY = middle range* when SHOULD YOU BY= end of range

different questions for the same fact ex Q. when would you 1st auscultate a fetal hr A. 8wks Q. when would you MOST LIKELY auscultate a fetal hr A. 10wks Q. when should you auscultate by a fetal hr by A. 12wks

you're caring for an infant that is being cared for a qualood mom, 24 hrs after birth sata

difficult to consul low,poor body temp exaggerated startle reflex resp depression sz risk shrill high pitch cry ANS 1,3,5,6 DOESN'T HAVE ENOUGH DOWNER SO EVERYTHING GOES UP *24 hrs after birth makes the baby go the opposite way

whats the purpose of uterine contractions in the first stage

dilate and efface the cervix

ccb endings

dipine - your dipping in the ca channel verapamil cardizem iv drip -monitor blood pressure!!!

pain meds in labor

do not give a pain med to a woman in labor if the baby is likely to be born when the med peaks ex you have a primagravida aka 1st timer, at 5cm who wants her IV push pain med. will you give it to her or not? iv peaks 15-30min... - so she can have the med you have a multip at 8, who wants her IM pain med, is it likely that a multip at 8cm could deliver 30-60 min? -no meds for her

aws no restraints

do not restrain these people bc they are not a danger to themselves or others

calcemias

do the opposite of the prefix muscle n nerves are more important

Magnesemias

do the opposite prefix

in a code situation, and theyre given drugs and the rhythm changes. whats the first question the dr. will always ask

do you get a pulse with that they are asking if theyre is a cardiac output with that even if the rhythm changes to something that looks good, if theyre no pulse there is not cardiac output, it is just as bad as it was before

physicians

dont say... - you wrote the order in incorrectly say... I am having a hard time interpreting what you want

concrete

dont use slang

Upper overdose looks like what other situation

downer withdrawal

you're caring for a client who is withdrawing from cocaine. what are you going to answer

downers resp <12 difficult to arose TX: narcan

drug addiction in the newborn

drug addiction in the newborn

peak

drug is at its highest depends on the route sublingual peak -5-10 min after the drug is dissolved iv peak -15-30 min after the drug is finished NOT when u hang it - you dont start ur clock when its finished -when your bag is empty then you go 15-30min after that im peak -30-60 mins after you give it subq -see diabetes lecture po peak - NCLEX does not test your going to give 100ml of a drug at 200ml/hr(30min) you hang it a 10am. when do you draw the peak? -11 when ever you get 2 within the same correct range, go with the highest without going over ---- you gave an im demoral for pain, when would you check them for relief, 30 min or an hour -60

trough

drug is at its lowest when do u draw a trough b4 u get a sublingual med? -30 minutes b4 the next dose if a med is given at 10. when do u draw ur trough -930 ---------------------- *IV/IM/subq/po 30 MIN BEFORE NEXT DOSE* when do u draw a trough on an IV/IM/subq/po med -30 minutes b4 the next dose

drug toxicity

drug toxicity

drugs

drugs

drugs that have to do with alcohol

drugs that have to do with alcohol

S/S acute complications of diabetes mellitus

drunk in shock *drunk/ HYPOGLYCEMIA= cerebral corticoid compromise* staggering gate slurred speech poor judgement delayed reaction time emotions LABILE - emotions all over the place -laugh cry laugh cry obnoxious and belligerent -loud decrease social inhibition mild shakiness confusion sweating palpitation headache lack of coordination blurred vision sz coma THESE ARE ALL SIGNS OF HYPOGLYCEMIA *shock vasomotor part of the syndrome* low bp tachycardia tachypnea cold, pale, clammy mottled patchy

Dumping syndrome s/s

drunk, shock, abdominal distress symptoms looks drunk: staggering gate, slurred speech , impaired judgement, delayed rx time, labile emotions, cerebral impairment bc bld going to gut shock signs; hypotension, tachcardia, tacypnea, pale cold clammy acute abdominal distress; cramping pain, guarding, bobirigimi, diarrhea, bloating distension,tenderness

parasthesia

early sign numbness and tingling in extremities

diets

emphasize what they can have instead of what they cant have

*A*systol*E* treatment

epinephrine (first) if that doesnt work then atropine

diabetes mellitus

error of glucose metabolism. you dont metabolize your glucose well causing diabetics not to use fuel source and without that cells die -sometimes its a lack of insulin -sometimes the cells become resistant to insulin Polyuria polydipsia high urine output lose water lose weight

variations in the newborn normal

erythema toxicum neonatorum= rash *Caput succedaneum* *cephly hematoma* look at the initials -Caput succedaneum starts with CS= crosses sutures and symmetrical -cephly hematoma starts with CH= does not cross sutures

when do you use crutches

even for even -use the even numbered gates which are 2 and 4 when weakness is evenly distributed -use a even number of gates when you have even numbers messed up - use 2 point for a mild bilateral weaknesses -4 point for a severe bilateral weaknesses odd for odd -use odd numbered gate when 1 leg is odd -if you say 1 leg is affected. this is odd -pick the odd number gate which is 3

overdoses and withdrawls

every abused drug is either a upper or a downer why are drugs that's not uppers/downers abused bc they dont do anything nexium is not a upper nor downer most abused class drug that is not a upper or downer LAXATIVES IN THE ELDERLY the elderly abuse laxative and that is not a upper or downer

your patient is on dilaudid an opiod analgesic, what things would you expect to see if they were getting too much, or got a lil 2 much sata

everything goes down lethargy flaccidity reflexes of +1 hyporeflexia obtunded

delirium tremens dt

everything goes up downer

subtotal thyroidectomy -partial- hyperthyroidism

excision of part of the thyroid gland At risk for thyroid storm 2. S/S thyroid storm: a. Very high fever >105 F b. Very high V/S BP in stroke category 210/180 c. Psychotic Delirium *life threatening priority* d.severe tachycardia in 180, 200s fries brain to death bc of hypoxia permanent other names for thyroid storm -thyroid toxicosis -thyroid crisis

psychotic symptoms: somatic delusions

false fixed belief about a body part ex - i have xray vision i can melt stones with my eyes -my brain is a martian super conduction protonics accelerator -there are worms inside my arm -my body hollow - your pregnant 83 and male

psychotic symptoms: paranoid delusion

false fixed belief that people want to harm you ex -the police are out to kill me - my wife is having me committed so she can run off with the psychiatrist - the kids are lying on me so they can get my house -neighbors are shining lasers on me to hurt me

psychotic symptoms: grandiose delusion

false fixed delusion that you are superior ex -think they are Christ -think they are the worlds smartest person - think they are mohammad -think they are gangus khan - greatest person, the future of the universe hinges on u

psychotic symptoms: delusions

false fixed(not changing) idea or belief there is no sensory component - you're not hearing feeling tasting smelling anything your just thinking it, its not a thought 1. *paranoid delusion*= false fixed belief that people want to harm you ex -the police are out to kill me - my wife is having me committed so she can run off with the psychiatrist - the kids are lying on me so they can get my house -neighbors are shining lasers on me to hurt me 2. *grandiose delusion*: false fixed delusion that you are superior ex -think they are Christ -think they are the worlds smartest person - think they are mohammad -think they are gangus khan - greatest person, the future of the universe hinges on u 3. *somatic delusions*: false fixed belief about a body part ex - i have xray vision i can melt stones with my eyes -my brain is a martian super conduction protonics accelerator -there are worms inside my arm -my body hollow - your pregnant 83 and male

3-6y pre operational

fantasy/ imaginative illogical understands future/past PICK AN ANSWER THAT SAYS -the morning of -the day of -2 hours before teach them what ur going to do=future learn through play -story -book -equipment -dolls

hyperthyroidism - metabolim

fast metabolism/*graves disease* weight loss high pulse high bp irritable, obnoxious HATES the heat intolerant bc dey hot LOVE the cold tolerant tachycardia

video 11

fetal monitoring patterns

chaos

fibrillation

preschool 3-6 role play

fine motor color pencils crayons safety scissos balance tricycle tumbling/dance ice skate cooperative play -play with each other in groups pretend play

frequent urination

first and third trimester void every 2 hours

Discomforts of pregnancy

first trimester: -morning sickness-dry carbs b4 you get out of bed -urinary incontinence void q 2hrs 2nd trimester: -difficult breathing- tripod position -back pain-pelvic tilt exercises tilt pelvis forward 3rd trimester: -urinary incontinence void q 2hrs -difficult breathing- tripod position -back pain-pelvic tilt exercises tilt pelvis forward

Hemoglobin will decease in pregnancy

first trimester: 11 is normal 2nd trimester: 10.5 normal 3rd trimester: 10 normal NOT GOOD 9

black tag

fixed and dilated pupils pulselessness breathlessness

loosening of associations

flow of thoughts that is vague, unfocused, and illogical

diabetic get sick for other reasons besides their diabetes they get the

flu diarrhea otitus media *take their insulin even when they're not eating*

atrial bc it said p wave

flutter is always saw tooth

contact isolation

for anything enteric enteric -HERPES/ shingles -caught from intestine, fecal or oral -CDIFF -HEP A anus -COLLAIR/disinteri/bugs in shit, touch something and u eat shit too -STAPH INFECTIONS -RSV ***RSV transmitted through droplet but on contact precautions -private room - kids can be in the same room as long as they're cohort (same disease) can play with same toys -rsv kid with suspected rsv kid NO they have to be cultured/positive 1st -* gloves and gown* -handwashing - disposable supplies ( plastic utensil, paper plate) -dedicated equipment (stethoscope, bp cuff stays in the room) - dedicated toys only they play with them cohort is done by -culturing

Timing contractions

frequency- beginning of 1 contraction to the beginning of the next /a-c including contraction\ a-c is the beginning duration- beginning to end of one contraction. /a-b or c-d\ intensity- strength of the contraction this is subjective *palpate with 1 hand over the fundus with the pads of the finger* aka finger tips

you get alkalosis and acidosis

from pH

schizophrenic pt says to you, imma kill you all and be dead by morning. imma slit ur throats and im starting with you. whats the first thing you say to him?

functional category 1) i understand youre upset or i can see that youre angry DONT SAY how do you feel rn....the data tells u how they feel 2) say a positive answer like..."were all going to be kept safe" DONT SAY youre on a fluid. your only allowed to have 10cc at bfast time 3)were not going to talk about that kind of stuff, although they are real to you, they are off limits in our conversation BUT he keeps talking about it, imma kill you imma slit your throat, ive got this knife imma shank ya NURSE SAYS: i see your too ill to have a reality based conversation, so our conversation is over

heparin

give iv or sq not to exceed 3wks antidote is protamine sulfate`

uap can

give topical otc barrier creams v/s acucheck enemas adl bedbath

Heparin

given IV n SQ works asap cannot be giving more than 3 weeks -except for lovenox antidote -protamine sulfate lab test is PTT can be given to pregnant women

Non-psychotic treatment

good therapeutic communication "tell me more about what you're experiencing right now" "that must be very difficult" "all of this has been fairly overwhelming for you" "how are you feeling right now" " what do you mean by" "can you explain to me more fully about" Alice is depressed and she says " i hate this depression its ruining my life, i have no energy to do any thing" Alice is Non-psychotic bc she recognized her problem and had insight, but she is depressed/emotional so you would say "how are you feeling right now","what is currently causing distress for you"? --- Alice is depressed she says "I cant stand this depression, its ruining my life" what symptoms would you expect sata deceased energy level psychomotor retardation - everything slows down delusions of persecution 1,2

immunosuppression child which toy is good for them

hard plastic action figure

psychotic

has NO insight and is NOT REALITY BASED they dont know theyre sick they think everyone else has the problem if they do know they are sick, but they say all the martians are causing all there problems then thats not insight bc insight means you know your sick and you know its messing up your life they may be able to state the disease but that doesnt means they have insight

when someone is hypoxic, which rate increases first the respiratory rate or the heart rate

heart rate when the heart can no longer compensate for it your rr goes up

first stage Early decelerations

heart slows before a contraction or at the beginning of a contraction normal

which lab test is the best indicator of blood glucose control

hemoglobin A1C 6 and below GOOD aka glycocated hemoglobin aka glycosolated hemoglobin OUT OF CONTROL A1C 8 and above BAD 7 a1c MAYBE on the border they need a workup/evaluation brought to hospital find out whats going on infection somewhere

teach pregnant

hemoglobin will fall first trimester 11 second 10.5 third 10

2 cases where we want to give Aminoglycosides Abx orally

hepatic encepholopathy : hepatic/liver coma -ammonia level gets too high -ammonia too high=coma treatment goal -reduce ammonia level

67y male with ibs who spiked a temp of 100.3 this afternoon

high priority

Lethal arrhythmias

high priority can kill you in 8mins or less 1. asystole 2. vfib both of these have no cardiac output in common if you do not have cardiac output you do not have brain perfusion= death in 8 mins

if they give u 4 patients and one of the patients has asystole, vfib

high priority patients

what type of specific gravaties will siadh have

high specific gravity

hypothyroid

high tsh low t4 TREATMENT synthroid- levothyroxine do not sedate these people-AMBIEN SLEEPING PILL -bc low pulse low bp if u sedate they go into a coma

dumping syndrome treatment

hob flat on side to eat decrease fluids low carbs when everything is low the stomach empties slow high protein

cane

hold the cane on the strong side *if i had a weak right leg, hold the crutch in the left hand, but I advance it with the bad leg when u put ur crutch down, u have a wide base of support...which keeps u upright

wrong cane

holding cane on the bad side causing weight to be shifted over base of support; causing them to rock back

Antibuse revia disulfiram onset & duration

how long does it take to get into their system and how long does it take to get out of their system how long do they have to be on the drug before it starts to work? how long do they have to be on the drug to safety drink again 2 weeks Dr prescribes antibuse in transition home when in two weeks you take the pill and then your let out of the community and it will work every time you drink you get dearly ill

crutch gate question. ask

how many legs are affected if its an even number of legs 2 -pick 2 or 4

add i sone

hyper pigmented, any stress can cause shock, glucose goes down and bp goes up

when sick diabetes has 2 problems

hyperglycemia and dehydration

your patient has diarrhea what caused it?

hyperkalemia hypokelemia hypocalcemia hypomagesemia 1

your patient has tetany what caused it?

hyperkalemia hypokelemia hypocalcemia hypomagesemia 3

diabetes insipidus would have

hypernatremia

in addition to a high potassium which electrolyte is possible with dka/hhnk

hypernatremia dehydration

Addison's disease s/s

hyperpigmented -very tan do not adapt to stress STRESS CAN TRIGGER!!! stress happens to perfuse the brain RAISE BP and give the brain glucose BUT... if they do not have the adrenal cortex to carry out the stress response when they undergo stress YOUR GLUCOSE WILL GO DOWN AND BP GOES DOWN= SHOCK!!!!

your going to run your self into the grave

hyperthyroid

siadh

hyponatremia

beta blockers and ca channel blockers are like the samething

hypotension headache ccb is better for ppl with asthma, copd betablocker is not for asthma/copd bc they bronchoconstrict

delirium tremens should be in

icu they get stuck on step down units dangerous and unstable

All congenital heart defects that start with t are trouble

if it does not start with the letter t it is not trouble not trouble: shunts blood from left to right, acyonitic pink -ventricular septal defect-harsh systolic murmur -patent ducus arterious: loud machine like murmur -patent ora pervalley -atrial septic defect -pulmonic stenosis- systolic ejection murmur trouble: shunts blood right to left kid is cyonotic -tetrallogy of fallot -trunkus arteriosis -transposition of the great vessels -tricusid atresia - tapv ***exception to rule LEFT VENTRICULAR HYPOPLASTIC SYNDROME

Walkers

if they must tie their belongings to the walker have them tie it to the SIDE and NOT the FRONT bc it can tip over -no wheels on walker -no tennis balls on walker

iv push

if you dont know, you go slow when ur pushing except for Adenocard/ Adenosine which is FAST - push less than 8 secs

Aminoglycosides Abx route

im, iv do not give po because they're not absorbed if u give a oral mycin what will happened? -just goes through gut and have no systemic effect

high pressure alarm

increased resistance to airflow machine pushes to hard to get the air into the lung when this happens the machine would set off a high pressure alarm when you set up a vent you set up two alarms, you say i dont want you to use less than this pressure, to get that area and i dont want you to use anymore than that pressure and when it exceeds that the high pressure alarm goes off * ex you set the high pressure at 40ml of mercury .you say i dont want you to push no more than 40 ml of mercury to get that air in & if the machine has to it will set off the high pressure alarm bc its telling you im having to work too hard bc its high pressure

psychosis

insanity lose of touch with reality

Non-psychotic

insight and reality based - yes they are emotionally ill/distress -yes they have mental and behavior d/o BUT.... they are not psychotic they have insight meaning they know whats wrong with them, they know they have a problem, they know what the problem is. they know how its messing up their life they are reality based. what they are hearing seeing, smelling feeling, tasting is what U believe hear and see feel and taste

diabetes mellitus type 1

insulin dependent juvenile onset ketosis prone tx tx or they will die diet insulin exercise diet is not restricted anymore ,,,least important

NPH insulin

intermediate acting insulin onset: 6 hours *peak/hypoglycemia: 8-10 hrs* duration: 12 hrs cloudy= suspension NOT iv drip bc it separates to the bottom over dose=brain death "N" -not so fast= intermediate -not in the bag

you have a baby at birth or the 1st 24 hrs. what would you assume the baby is in?

intoxication

always assume

intoxication NOT withdrawal at birth

amount of urine & specific gravity relationship b/t the 2

inverse relationship less the urine out the higher the specific gravity the more urine out lower the specific gravity

squad calls and says they are bringing in a pt and they are 10 mins out and he has overdose on cocaine what will you expect to see sata

irritability +4 reflexes resp <12 difficult to arose borborgymi increased temp ans 1,2,5,6

Lithium

is an electrolyte stabilizes nerve cell membranes used for treat bipolar bc it decreases mania it does not tx depressions it only decreases the mania

lie

is spine of mom and spine of baby vertical is good

presentation

is the part of the baby that enters the birth canal first roa loa pick roa before loa anything with op at the end think oh pain

goal of hepatic encepholopathy

is too get the ammonia down treatment - oral mycins-sterilizes bowles *all mycins will desolve in ur gut and kill gram negative bacteria in ur gut -kills ecoli reducing ammonia since these people have liver damage we dont want this to ever get to their liver - it will never go into their liver taking orally it will go in one end and sterilize the bowel and go out the other end ----------------------------- ORAL MYCINS ARE ALSO GIVEN PREOP bowel SX - to sterilize the bowel

manipulation is like dependency

is what the significant other being asked what to do is neutral no harm done. Then is *dependent/codependency* is what the significant other being asked what to do is inherently harmful or dangerous to the sign. other. That person is being *manipulated* ex. -manipulation 49y alcoholic gets her 17y daughter to go to the store and buy alcohol for her....(harm)illegal -dependent/codependency 49y alcoholic gets her 50y old husband to go to the store and buy alcohol from her... -(sis in-law dependent) (you- codependent, arent I a good aunt) last friday evening, your sister in law calls and says would you pick up lil bill from basketball practice at school. so he can spend the night at your house bc of the snow. you have a big 4 wheel drive for the snow and you live 3 blocks from the school and you say ok sis in-law ill do that -(manipulation bc its dangerous for you to get in car especially when she could do it herself) your sis inlaw calls you and she has the 4wheel drive alternate vehicle. she lives 3 blocks from the school. she ask you to pick up her son and take him to your house, you have a kia serento with bald tires, it leaks oil, got no heat, and you live 20 miles from the school manipulation: doing something bad for you -tx: set limits and inforce them dependent/codependency: neutral

diabetics have to stay as active as possible bc

it helps lower the glucose

how do you measure crutches?

its for risk reduction so you dont cause nerve damage

kalemias

kalemias do the same as the prefix except for heart rate and urine output does opposite of prefix s/s hyperkalemia -brain: agitation, restlessness, aggression, irritable, obnoxious, decreased inhibition, loud -lungs: tachypnea, -heart: low heart rate, T WAVE PEAK, ST ELEVATED, ****everything in the heart goes with prefix except for heart rate* -bowles: dirrhea, borborgymi, -muscles: spasticity, increased tone -reflexes: +3 +4 ---s/s hypokemia -brain: lethargy -heart: tachycardia bc it can go both ways -polyuria bc it can go both ways bowles: slow down, ileus , constipation muscles: flaccidity reflexes: +1 0

in psy

keep the patient talking "lets talk about this right here, right now" never wrong to get your pt to talk

Asystole Flat Line

lack of qrs no qrs 0 none Treatments: Check leads, check your patient! CAB, Start CPR ICEM Epinephrine 1 mg every 3-5 minutes Vasopressin has been removed

congenital heart defect which way is non trouble defects shunting blood

left to right left to right sx not bad NORMAL Acyonatic

Vtach & PVCs treatment

lidocaine

chest tubes are used for

lobectomy wedge resections

post op laminectomy and spinal cord

log roll do not dangle these ppl -laying down to imm. walking around no sitting for 30min walk stand lie down with no restriction only a restriction on sitting

Lantus Glargine

long acting insulin no peak low risk for hypoglycemia given at bedtime duration: 12-24 hours

when you get a chest tube question

look at the reason for which it was placed PUEMOTHORAX the chest tube removes air -pueumo= air - what created the positive pressure? air - so i gotta put a chest tube in to remove the air so i can reestablish the negative pressure in the plural space HEMOTHORAX chest tube removes blood -blood is causing the positive pressure - i have to remove it to restablish the negative pressure PUEMO/HEMO THORAX -whats in the pleural space: blood/air -so we must remove both air and blood to reestablish the negative pressure in the pleural space

pay attention to denial in a question to know if its

loss & grief -support or abuse -confront

denial is operative in

loss and grief **denial is acceptable, healthy, normal first reaction to grief and loss

All psych drugs cause

low BP and weight change usually gain but in prozac it can go both ways

3 acute complications of diabetes mellitus VERY IMPORTANT 1)

low blood glucose in type 1 & 2 aka insulin shock insulin reaction hypoglycemic shock hypoglycemia THIS MEANS THEIR GLUCOSE IS LOW what can cause a diabetic blood sugar to go low? -bc when a diabetic isn't sick but does have diabetes what does their sugar run high or low -HIGH and when they get sick it runs even higher -how can it ever go low? CAUSES OF LOW BLOOD SUGAR not enough food too much insulin or medication too much exercise the primary cause is *too much medication* OVER MEDICATION # 1 CAUSE OF HYPOGLYCEMIA IN DIABETICS BC OF *BRAIN DAMAGE* BRAIN DAMAGE IS PERMANENT DON'T MAKE NO MISTAKES WITH INSULIN!!!

hypothyroid s/s

low metabolic rate obese flat personality cold intolerant HEAT TOLERANT always cold so they love heat low pulse low bp MIXEDEMA -do not sedate these people--AMBIEN SLEEPING PILL -bc low pulse low bp if u sedate they go into a coma

16y female with mengicoccus meningitis who has had a temp of 100.38 since admission 3 days ago

low priority bc unchanging

headache

low sodium high sodium high glucose low glucose high blood pressure low blood pressure headache is good to choose for a sata

what type of specific gravaties will diabetes insipidus have

low specific gravity

SIADH

low urine output- oliguria not thirsty bc theyre retaining water gains weight suddenly

insulin

lowers blood glucose levels check the expiration date-only good if its still closed the min you open a vial of insulin it expires 30 days after that on bottle write date and exp, or opened and date refrigeration is optional in the institutions if they are the are the unopened vials, but they need to refrigerate at home once a nurse opens a vial man exp date is no good and now does not have to be refrigerated in hospital BEST dealing w/ insulin in the hospital check exp date exercise potentiates insulin= does the samething as think of exercise as another shot of insulin -playing soccer -gym class this morning more exercise= less insulin less exercise= more insulin EX if a diabetic is going to play soccer in the afternoon, what should the school nurse do? so he betta what?? TAKE RAPIDLY METABOLIZABLE CARBOHYDRATES as a snack before the game and during the game

kusmal breathing only seen with

mac kusmal - *metabolic acidosis* *K*etones diabetic ketoacidosis *U*remia *S*epsis *S*ilicyates *M*ethanol *A*ldehyde U *L*actic acid

in a tie never pick

magnesium if skeletal muscle or nerve blame on calcium everything else kalemia

magnesium sulfate IV to an alcoholic client with hypomagnesemia. Prior to the initiation of IV magnesium, which assessment data would be important for the nurse to document?

magnesium acts like a sedative. Since we know that magnesium can cause respiratory depression, the nurse should always have a baseline respiratory assessment prior to initiating an infusion of magnesium. Muscle tone and DTRs can also become depressed, so a baseline assessment of DTRs would be very important. The nurse should always assess kidney function and urinary output prior to and during IV magnesium administration because of the risk of magnesium toxicity if it is being retained.

lpn can

maintain iv and document flow reinforce teaching implement care plan tube feeds post op dressings feed stroke pts ambulate post op cts

#1 priority in the 3rd stage of labor

make sure 3 vessels in the cord delivery of the placenta

Third Stage: Delivery of Placenta

make sure it is all there check for 3 vessel cords -2 arteries, 1 vein -think of the women's name Ava

loosening of associations: neologisms

making up imaginary new words youre a brinklbic youre shobosniac

find due date her last menses was june 10 - june 15

march 17 gotta start with june 10 bc thats the 1st day of the last menstrual period add 7, thats 17 subtract 3 from 6 thats march

video 10

maternal newborn

Everything not lung its

metabolic acidosis

if you dont know what it is... idiopathic bolus pegasus choose

metabolic acidosis

infantile diarrhea

metabolic acidosis bc its not lung or vomiting

3rd degree burn 60% of body 1st phase

metabolic acidosis bc ur not vomiting or suctioning

zep/ zine

minor tranquilizers major tranquilizers zine

Benzodiazepines indicators

minor tranquilizers pre op to induce anesthesia muscle relaxant good for etoh withdrawl good for sz help ppl who fight the ventilator -it helps them to relax and calm down

psychotic symptoms: illusions

misinterpretation of reality - it is a sensory experience -with a illusions there are a referent in reality -referent: something to which a person refers when they say something - a client overhears nurses and doctors laughing and talking at the nurses station and says "listen i hear demen voices" illusion bc there was actual people talking making real sounds that they misinterpreted - during the interview the client looks at the fire extinguisher in the wall and says look i see a bomb illusion bc there was something in reality to which they referred yes..the fire extinguisher IT HAS TO BE SOMETHING THERE

what is humalin 70/30

mix of regular and nph 70= nph 30= regular ex if you give a 100 units of 70/30 how many units of n would there be? 70 and how many units of r? 30 if you gave 50 units of 70/30. how many units of n would it be? 35. how many r would that be? 15 multiply .7 for 70 and .3 for 30 n is in the numerator

bun 8 -25

monitor for dehydration below 8

highest priority INR

monitors coumadin/warfarin pt normal range -2-3 -2.1 or 3.8 thats what you want ANYTHING 4 AND ABOVE IS HIGH PRIORITY INTERVENTION 1. Always hold the coumadin 2. Assess bleeding/ focused of assessment on area lab value is telling there is a problem 3.prepare to give vit k 4.call hcp or respiratory/whoever hold assess prepare

Dumping syndrome

move in the right direction at the wrong rate

All congenital heart defects will have 2 things whether trouble or not

murmur - bc the shunting of the blood from the right to left, or left to right echocardiogram done

myasthenia gravis

muscle grave

Hypercalcemia

muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, shallow respirations, emergency! bradycardia bradypnea flaccid muscles hypoactive reflexes lethargy constipation EVERYTHING GOES DOWN WHEN CA GOES UP

universal sign of electrolyte imbalance

muscle weakness= paresis they all have this the "electrolytes"

infant toys sensory motored 0-6mts

musical mobile soft & large toys

station

negative is above the tight squeeze engagement is station zero

who can sterilize my bowels

neo can neomycin & cannomycin

rules for clamping tube

never clamp a tube for longer than 15 secs without a doctors order so if you break the water seal what is the 1st thing you do -clamp the tube -have 15 secs to get it cut and under water - use rubber tipped double clamps

Potassium

never push it iv

kalemias treatment

never push k+ iv no more than 40 k+ of iv fluid if more than 60 in a liter= call physician k+ can stop your heart: tx fastest way- d5w with regular insulin - does not get rid of excess k+...it drives it into the cell - temp fix bc hrs later k+ is back in the bld -kacelyte: mouth or rectum -full of sodium -trades na for k+ -causes hypErnatremia= dehydration -give fluids -GOOD gets rid of k+ never to come back -BAD it takes a long time...takes hrs and person might die K EXITS LATE= kacelyte

tricyclic antidepressantss

nnsri mood elevators used to treat depression Desyrell avatil Tofranil elavil

diabetes mellitus type 2

non-insulin dependent non-ketosis prone adult onset tx doa diet oral hypoglycemia activity diet IS more important for type 2 dm physicians will like dm to be treated with diet alone

trick question how many chest tubes will you need and where would you place them for a post op right pueumonectomy

none pueumonectomy - removal of the whole lung - if there is no lung there is no pleural space; there is nothing -if there is no pleural space you cannot reestablish pressure in something that doesnt exist

physiologic juandice

normal at birth over the next 2-3 days he goes high on bilirubin If they turn yellow over the next few days. this is normal

growth development test

normal, older, easier

Alcohol withdrawal syndrome AWS

not life threatening not a danger to self or others wont hurt you you are stable you are fine they are not going to hurt anybody, yea they're loud and obnoxious bc they are withdrawing from a downer which makes up, so they are going to be loud and obnoxious, bur they are not going to hurt anybody

fundus of uterus

not palpable til wk 12

ALCOHOL WITHDRAWL VS. DELEIRUM TREMONS

not the same

delirium tremens

npo clear liquids sz risk bc they are withdrawing from a downer and everything is going to go up SEIZURE= ASPIRATION keep npo or clear liquids

delirium tremens diet

npo/clear liquids is the same thing

delirium tremens is

on restricted bed rest no bathroom privileges if they have to use the facilities BED PANS & URINALS

opisthotonic child place in what position

on side

Pattern of Office Visits for prenatal care

once a month til wk 28 once every 2 wks until wk 36 every wk until delivery

pregnancy patient teaching pattern of office visits

once a month until week 28 -first & 2nd even into 3 trimester come in 1 a month week 28 she should come in once every 2 weeks until week 36 come in every week until delivery or week 42 42 weeks= c section/induction

Coumadin warfarin

only given po takes a few days to a week to work lifelong antidote -vit k lab test is PT which is inr CANNOT be given to pregnant women

coumadin

only po antidote vitamin k

high blood glucose in a type 1 dka ketosis coma 2)

only type 1 get this goes high bc too much food not enough medication not enough exercise # 1 cause of dka is Acute Viral Upper Respiratory Infection within the last 2 weeks type 1 gets viral pharyngitis and recover from it like everyone else, but after they recover initially they start going down hill they get more and more lethargic when they come in the er and you check their blood glucose and its 850 and they have the signs of dka what do you ask mom and dad? if they had a Acute Viral Upper Respiratory Infection within the last 2 weeks the stress of that illness causes the blood glucose to go high, they started to burn fats for food and they got into a negative situation

Regular insulin

onset : 1 hr *peak/hypoglycemia: 2 hr* duration: 4 hrs clear bottle= solution iv drip rapid short acting "R" -means rapid -run means run it iv

true valid sign of labor

onset of regular progressive contractions

valid sign in labor

onset of regular progrssive contrations

Dilation

opening of the cervix 0-10cm 0- closed 10-fully dilated

few days before sx, what might a pt take?

oral aminoglycocide will not cause ototoxicity or nephrotoxicity bc its not absorbed

Cushing's disease

over secretion of the adrenal cortex will be retaining sodium and water due the increased amount of aldosterone hypokalemia immunosupred private room

#1 priority in the 2nd phase of labor

pain management

Earliest sign of electrolyte d/o

parasthesia cirum parasthesia= numbness and tingling in lips

muscle weakness

paresis

Lithium s/e

pee poop parasthesia - early sign of electrolyte imbalance TOXIC EFFECTS tremors metallic taste severe diarrhea

adolescence

peer group association friends gang of teens hanging out in 1 teens room what do u do? let them hang unless -fresh post op less than 12h out of sx -immunocomprimised -contagious dz

psychotic Wernicke-Korsakoff treatment

permanent *redirect them*: take what he's all about that he cant do and re-channel it into something he can do...dont fight with them can he go to pres cabinent meeting? no what you could say is... how about we get a shower and when were done we could watch it on cnn DONT PRESENT REALITY BC THEY CANT LEARN THAT..THEY HAVE BRAIN DAMAGE

agression attack the

person

test taking rule...pay attention to the modifying phrase than the original noun modifying phrase triumphs original noun

person w ocd is now psychotic.. which one is more important psychotic ---- a pt who is vomiting who is now dehydrated...which is more important dehydrated

walkers are slow

pick them up set them down walk to them

hypocalcemia. Which treatment would the nurse anticipate for this client?

po calcium, vitamin d, sevelamer hydrochloride

diabetes mellitus type 2 symptoms

polyuria polypasgia -increased swallowing polydipsia -thirsty

long term complications of diabetes

poor tissue perfusion -renal failure -dont heal well peripheral nephropathy -loss control of bladder= incontinent -cant feel when they injure themselves -

critical labs stay with patient

potassium greater than six hold med access patient prepare kexelate ph belox 6 co2 below 60 platelet less than 40

A client was admitted with reports of prolonged diarrhea. The client's admission potassium level was 3.3 mEq/L (3.3 mmol/L) and is receiving an IV of D5 ½ NS with 20 mEq KCL at 125 mL/hr. The UAP reports an 8 hour urinary output of 200 mL. The previous 8 hour urinary output was 250 ml. What should be the nurse's priority action?

potassium is excreted by the kidneys. If the kidneys are not working well, the serum potassium will go up! You always monitor the urinary output before and during IV potassium administration. Since the urine output has decreased below 30 mL/hr, we know that the urinary output is not adequate. Therefore, the client could start retaining too much potassium. The priority action would be to stop the infusion and then follow this action by notifying the healthcare provider.

Spironolactone

potassium sparing diuretic

Aminoglycosides abx

powerful class of abx used to tx mean infections used when nothing else works dangerous

0-2 ys Sensorimotor

present oriented they dont think about the past/future teach them WHILE you do it- cant learn future/past teach them what you're doing they dont understand play- tell them VERBALLY

psychotic Wernicke-Korsakoff characterics

preventable/ arrestabile means stopping it from getting worse by taking b1/irreversible- 2 good news 1 bad news take vitamin b1 they can still drink, they dont have to stop drinking

video 12

prioritization, delegation and staff management

confrontation attacks the

problem

what hormone causes ammenorhea

progesterone

geodon ziprasidone

prolong qt interval and can cause sudden cardiac arrest not used for ppl with heart problems tordes de pointes

ptu- puts thyroid under

propylthiouracil hyperthyroidism immunosuppressant watch wbc

dont give advice in

psy

how to guess BEST ANSWERS

psy - the nurse will examine their own feelings about - establish a trust relationship nutrition -pick bake chicken not fried or fish not shellfish -never pick casserole for kids -never mix meds in kids food -finger foods for toddlers -leave preschoolers alone 1 meal a day is ok pharm s/e -pick a s/e in the same body system where the drug is working -if you dont know what the drug is, look to see if its po PICK A GI S/E -never tell a kid a med is candy OB -check for FETAL HEART RATE med surg -assess loc -1st thing u do airway ped growth and development -always give the kid more time -dont rush growth a dev -when in doubt call it normal -when in doubt pick the older age -when in doubt pick the easier task

video 9

psy drugs

chest tubes are not used for

pueumonectomy

psychotic symptoms: hallucinations

purely sensory, false fixed sensory experience - 5 hallucinations 1 for each sense -hear, taste, smell, see touch - most common hallucination is letter a for auditory where you hear things. voices telling you to hurt yourself -next most common is visual seeing things that are not there -3rd most common is tactile: feeling things that are not there -gustatory: tasting things that are not there (rare) -olfactory: smelling things that are not real (rare) -if a client says " i hear demen voices hallucination bc it was sensory and nothing is there - during a interview a client stands at the wall and says look i see a bomb

toddler 1-3 y

push pull toy finger/hand painting lawn mower wagon strollers WORK ON GROSS MOTOR SKILLS RUNNING jumping no finger dextrety no color pencils scissors crayons

whats the purpose of uterine contractions in the 2nd stage

push the baby out

whats the purpose of uterine contractions in the 3rd stage

push the placenta out

psychosis of dementia

reality orientation- loss of memory person place time NOTTTT presenting reality IS NOT appropriate for psychosis pts ex you have a patient with Alzheimers. she is in the lobby of the nursing home. she is all dressed up and its sunday. you day to her ms smith ur all dressed up. she says my husband is picking me up and were going to go to church, but the husband has been dead for 10 years she has a false fixed belief, so she is delusional now she is psychotic first thing you do 1. acknowledge feeling - that sounds like an exciting thing to do/fun/interesting -dont always answe on nclex "are you" "what are you" -just say i see youre happy/sad 2. why dont we sit down here and talk about whats going to happen at church today WRONG ANSWERS that sounds exciting, but ur husband is dead -it presents reality - good for a scizo scizo major manic, but not dementia

farmer comes in and his hand get's amputated, and its wrapped in a bandage. The next morning you're taking care of him and he says... I cant wait to go home and play piano.. problem, he only has 1 hand..what is he refusing to accept?

reality- he is in denial dont say.. - you say you're going to play piano, but you only have 1 hand - this is confrontation denial is ok for abuse NOT ok for loss and this guy is loss you say, "how long you been playing, did you take lessons" -you support it

chest tube

reestablishes negative pressure in the plural space plural space is a place where negative pressure is good negative makes things stick together

your patient is high on cocaine. what is critically important to assess

reflexes not going to be resp arrest bc they're on an upper which makes everything go up

denial

refusing to except the reality of a problem ex. "Im not an alcoholic I can quit anytime I want" "im not a spouse abuser we just have a really physical relationship" "im not a child abuser, im just a very strict parent and my kids are not spoiled" "im not a gambler, I like giving games a chance" "im not a food abuser, im a gomar" *they have all these denials about there problem

rn do it that way

regular before

aws

regular diets

hiatal hernia

regurgitation of acid. acid come back up into esophagus, upper part of the stomach herniates upward through the diaphragm 2 stomachs gastric content move in wrong direction at normal rate

lie

relationship of spine of fetus to spine of mother compatible with a vaginal birth-uncomplicated PARALLEL

downers s/s

resp depression leading to arrest lethargic

Ventalation

respiratory *gas exchange sao2*

when you get a scenario first question you ask is... is it lung and it is going to be

respiratory it can be 50/50 either resp alk, or resp acid you can tell bc the ct will be overventilating/ underventilating

myasthenis and cholinergic crisis is

respiratory arrest

ccb is givem when you want to

rest the heart

purpose of a chest tube

restablish negative pressure in the plural space, so that the lung expands when the chest wall moves thats why you need the tube in there ***positive pressure makes things come apart/ push it away

delirium tremens must be

restrained because they're dangerous APPROPRIATE RESTRAINTS -*vest* -*2 point locked leathers* -2 points mean 2 extremities (opposite arms & legs) -always lock down 1 arm and opposite legs in 2pts -rotate q 2hrs -2 hours later you switch it -what would you do 1st? -there right arm is locked down and their left leg is locked down, what would you do 1st? -lock the left arm, then the right leg then release the opposite -all extremities should be on lock b4 u release -don't release (them) arm 1st INAPPROPRIATE RESTRAINTS -soft wrist- can easily get out -4 point sofs

rhythm strips

rhythm strips

congenital heart defect does the trouble defect shunt blood right to left or left to right

right to left t*R*oub*L*e right to left sx its bad

Phenothiazines nursing diagnosis

risk for injury safety issues bc they are on a major tranquilizer

7-11 concrete operations

rule oriented live and die by the rules cannot abstract if you tell them, this is the way its going to be, that the way it has to be only 1 way to do something *teach them days ahead* -1 or 2 days ahead can teach them *skills* -insulin use age app. reading a demonstration

general guessing

rule out absolutes if 2 answers say the same-thing, neither is right if two answers are opposite 1 of them are probably right umbrella strategy -covers all the others without saying it does -broad answer if the question gives you 4 right answers and ask you to pick the one with the highest priority if they give you a pt and ask which of the following needs are highest priority, -take each option, and ask urself if i did not do this whats the worst that could happen -then the best answer is the one that has the worst outcome if you dont do it ex which is highest priority when caring for a suicidal pt. -theres only 1 pt - if you do not give him a tranq whats the worst that could happen, hell be agitated -if you dont orient him to the unit whats the worst that can happen, hell get lost and disoriented - if you dont put him on suicide precautions whats the worst that can happen, hell die-------------- -if you dont introduce to staff whats the worst that could happen, wouldnt know anyone when your stuck b/t 2 answers read the question again

Haldol safety concerns r/t

s/e abcdefg

Benzodiazepines nursing diagnosis

safety and injury risk

delirium tremens causes

seizures

prozac

selective serotonin reuptake inhibitor similar to elavil

Dependency/coDependency treatment

set limits and enforce it teach the significant other to say NO!! and they have to keep doing it *work on self-esteem* ex. "will you call my boss?"...NO "will you go buy me some?"...NO "will you drop me off at the trap"...NO ham sandwich is ok as long as ur not feeding into it

manipulation tx

set limits and inforce them start saying NO

exercise is like a

shot of insulin exercise potentiates insulin= does the samething as think of exercise as another shot of insulin -playing soccer -gym class this morning more exercise= less insulin less exercise= more insulin EX if a diabetic is going to play soccer in the afternoon, what should the school nurse do? so he betta what?? TAKE RAPIDLY METABOLIZABLE CARBOHYDRATES as a snack before the game and during the game

siadh, di, dm who would have who would have fluid volume excess

siadh

who has 10cc of urine out in 3hrs and a normal blood glucose

siadh

loosening of associations: word salad

sick and cant make a phrase thats coherent they just babble random words

haldol long acting im

side effects A B C D E F G medical emergency NMS from overdose neuroleptic malig syndrom which is high temp, tremors and anxiety elderly half adult dose

narrow therapeutic window for trough and peak

small difference b/t what works and what kills -so we draw taps on them smallest dose of laxis ever saw given -10-120 -wide range so we would not draw trough and peak dig whats the lowest given of dig -.125- .25 -this is a narrow level so we do trough and peak

ischial spine

smallest diameter through which the baby has to fit to be born vaginally "tight squeeze" narrow part of pelvis if the baby cant fit through there it cannot be born vaginally

as the pH goes

so goes my pt if my pH goes up, my pt goes up: i get more irritable, hyperexcited if my pH goes down, my pt goes down: my body shuts down *exception is potassium, potassium always goes up

addi son

sone steroid

Amonophylline/Theophylline tx

spasms in airway *if a bronchodialator doesnt work in an acute airway problem give Amonophylline/Theophylline* therapuetic level 10-20 20 is toxic

Laminectomy aka

spinal cord

4 stages of labor and delivery

stage 1: *labor* latent: -dilate from 0-4cm -contractions are 5-30min apart -contraction duration 15-30 seconds -intensity is mild active -dilate 5-7cm -frequency 3-5min -last 30-60 seconds -intensity is moderate transition -dilate 8-10cm -frequency 2-3 mins -duration 60-90 secs - intensity is strong ex a women comes into the l&d suite she is 5cm, her contractions are q 5mins apart and they last for 45 sec. what phase is she in? active CONTRACTIONS SHOULD NOT BE LONGER THAN 90 SEC OR CLOSER TO EVERY 2 MIN AKA -uterine tetany -uterine hyper stimulation stage 2: delivery of the baby stage 3: delivery of the of the placenta stage 4: recovery - recovery last 2 hrs

delegation lpn cannot do

starting an iv hanging or mixing iv meds iv push meds administer blood mess with central lines -flushing -dressings plan care perform or develop teaching unstable pts 1st of anything -tube feedings -post op dressings -feed stroke pts -ambulate post op cts -get pts out of bed 1st time -no v/s out of sx admissions discharge transfer first assessment after theres been a change

#1 action an oral mycin will have

sterilize the bowel BOWEL STERILIZERS neomycin & cannomycin

Addison's disease treatment

steroids glucocorticoids sone's -betamethasone -prednisone -beclamethasone -dexamexasone -mometasone -hydrocortisone

what does positive dromo's, ino's, and chrono's do?

strengthen, speed up are called cardiac stimulants

what is the best thing your going to do if the water seal breaks

submerge under sterile water its the best bc it solves the problem of reestablishing the water seal

what do you do with the denial for loss and grief

support it

tetany (tetanus)

sustained APs > continuous calcium release prevents relaxation

left above the knee amputation

swing through

left hip replacement 2nd day post op, non weight bearing

swing through

bizzare

tachycardia

Laminectomy with fusion

take a bone graft from the iliac crest if they take the disc out you cannot have bone on bone so they have to take some bone from ur hip and fuse it only done when they remove the disc and have to get bone from hip 2 incisions hip/spine hip more painful, bleeding and drainage is hip=hemovac, both equal for infection, spine highest risk for rejection SX ARE USING CADAVERS/SYNTHETIC BONDING SYNTHESIS FROM BONE BANKS AND LABS

diabetics get dehydrated when not eating so

take sips of water

9-12 vocalization learning to speak

talking toys talking books speaking/verbal toys woody the cowboy teddy rubskin tickle me elmo pull string and it says something see and say barnyard friends - cow says moo

trough and peak

tap levels t b4 p

Antibuse revia disulfiram pt teaching

teach these pts to avoid all forms of alcohol -MOUTHWASH even if they swish and spit they are going to get sick -AFTERSHAVES even if they put it on topically they are still going to get nauseated - UNCOOKED ICINGS NO BAKE ICING vanilla extract, can't have cupcake with the unbake icing on it -INSECT REPELLANTS -*OTC ENDING WORD -ELIXIR* have alcohol - dimatap -Robitussin -dayquil -nyquil -tyelonol pm -benadryl - ETOH hand sanitizes -PERFUMES & COLOGNES do not pick the red wine venigarate, this is ok to avoid nausea vomiting and possibly death(not what were going for)

infants 6-9 mts

teaching object prominence large/ hard -wood -metal -hard plastic blocks cover/uncover toy window books jack in the box books with windows -wheres the birdies peek a boo putting blanket on head then uncover head WORST TOY musical mobile bc strangulation purposeful activities -7 mts play with 3 wooden blocks -7mts cannot build with 3 wooden blocks

rn going home with bulging pockets

tell supervisor could be stealing

you suspect an rn is selling drugs

tell supervisor bc its illegal

3 types of psychosis: 3 type of psychosis: psychotic delirium

temporary sudden dramatic episodic secondary loss of reality due to chemical imbalance in the body different from functional bc its temp and sudden different from dementia bc its temp and sudden and seconday who are these people? crazy -for the short term bc there is something that is causing them to become crazy - meds= tagaman -people high on uppers/intoxicated -withdrawing from downers -delirium tremens -cocaine overdose -meth overdose -*POST OP PSYCHOSIS elderly* -UTI -thyroid storm THIS IS TEMP INTERVENTION remove the underlying cause and keep them safe 1. acknowledge feeling 2. reassure -its temp -they will be kept safe DONT PRESENT REALITY, REDIRECT, ALWAYS REASSURE

tocolytic - ob medication

terabutaline, magsulfate - stop labor terabultaline increase heart rate mag sulfate - everything goes low

transverse lie

the baby lies crosswise in the uterus-shoulder tries to come out first baby is perpendicular BAD T

to get chest tube questions correct pay attention to

the disease for in which it was placed and this will tell you what you should expect

pressurize the vial which vial will you inject the air into first

the nph then inject air into the regular then draw up the regular then draw up the nph NR RN

station

the relationship b/t the fetal presenting part to moms ischial spine negative stations - presenting part is above the tight squeeze -presenting part is below and already made it through the tight squeeze station 0 -engagement -presenting part AT the ischial spine

Codependency

the significant other derives *positive self esteem* for making decisions for or doing things for the abuser - the abuser says call my boss and tell them im sick .dependency. - the spouse calls the boss and says he's sick, he cant come to work. hangs up and says aint I a wonderful spouse cuz i did that, nobody else will do it for that jerk .Codependency. bc they got positive self esteem "aren't I a good spouse bc i did that" what does the dependent/abuser person get out of the relationship? -gets a life w/out reponsibilities what does the Codependent person get out of the relationship? -positive self esteem but Codependent ppl cant leave bc their self esteem is tied into the whole thing

Amonophylline/Theophylline

therapuetic level 10-20 any Amonophylline/Theophylline under 10 - if you get an Amonophylline/Theophylline under 8 they need to take more Amonophylline/Theophylline of 20 is toxic airway anti-spasmodic it relieves spasms in your airway not a bronchodialator-doesnt stimulate beta 2 agonist cell to bronchodilate- it just relaxes a spasm -bronchodialators -epinephrine -iprotropium -alupent -albuterol -terbutaline -bronchodialator sometimes dont work bc there in a spasm, so you have to give them Amonophylline to relax the spasm then you can give a bronchodialator when your in a spasm your airway is =narrow when you relax the spasm youre airway= wider *muscle spasm relaxer* *if a bronchodialator doesnt work in an acute airway problem give Amonophylline/Theophylline*

normal sinus rhythm

there is a p wave before every qrs and every qrs is followed by a twave what else tells u its normal sinus rhythm? -peaks of p wave, how equally distant they're from one another qrs complexes are evenly spaced doesnt matter if they are going up or down, you can have a pwave going up, qrs going down thats ok, its still normal sinus

arenal cortex

these diseases start with the letter A & C EX cushings addisons cortico insufficiency adrenal insufficiency

3 types of psychosis: 1 type of psychosis: functional psychosis

they can function in everyday life life can have a family/marriage/ relationship/job live alone and take care of themselves pay there bills/taxes *4 fx psychotic schizo,schizo,major, manics* schizo: schizophrenia schizo: schizoeffective d/o MAJOR depression manic: acutely manic *bipolar are functional and not always psychotic, they are only psychotic in the manic phase 1. person has the potential to learn reality bc they DONT have brain damage they may need some medicine to balance some chemicals then you may need to set some structure but they can learn and improve NURSES ROLE: teach reality use the 4 step process to teach reality to a functional 1. acknowledge feeling - usually the word feel is in the answer -can specify feel, if they dont use feel there is a specification of the word feel - ex) " I see your angry" " you seem upset" "that must be distressing" " thats so sad" "all that has happened has been so devastating" "tell me more about how your feeling rn" 2. present reality - I know that blank is real to you, but i do not blank -i know that you see a demon, but i do not see a demon -i understand those voices are real to you, but i do not hear any voices. -i understand that you think the mafia is out to kill you but in reality no one is going to harm you ANOTHER FORMAT IS PRESENTING WHAT IS REAL -i am a nurse this is a hospital, and this is your bfast YOU CAN TELL THEM WHAT REALITY IS, OR SAY I KNOW THATS REAL TO YOU BUT I DO NOT(acceptable for presenting reality either one is good but its not the first thing u do, its the 2nd thing u do) 3. set a limit - the answer will sound like "that topic is off limits in our conversation" -"when we talk together, we are not going to address that problem" -" we are not going to talk about that" -sometimes it can be extreme and say "STOP TALKING ABOUT" those aliens/voices or were not going to talk about those voices 4. enforce limit - "I see you're too ill, to stay reality based, so our conversation is over" -enforcing the limit is ending the conversation -it is NOT taking away a privilege= punishing -difference b/t forcing and punishing them -you told them to stop talking about the voices and they continue to talk about the voices, violating the limit a bad way of enforcing is "since you cant follow the rules you can loose your phone/fridge/ privileges or youre going to be restricted to your room" - these are ex of punishing not enforcing THE ONLY ENFORCEMENT IS ENDING THE CONVERSATION when they're not reality based and wont stay reality based

aws up. ad. lid

they can go anywhere they want to go

DKA treatment

theyre dehydrated and their sugars high -FAST IV FLUIDS 200/hr - regular insulin to lower the sugar 200/hr -d5 will not create a hyperglycemia rx bc its so small, D10 D50 will, but not d5 DKA -use of insulin most essential to treating --higher priority than hhnk

ideas of reference

think everyone is talking about you psychotic patient

ENFACEMENT

thinning

effacement

thinning of the cervix

effacement

thinning of the cervix thick-100%

causes of acid base imbalance

this is what is happening to your pt what acid/base disorder will result from this theyre flipping it around, instead of saying what sign and symptom will the acid/base balance cause one thing ppl do when answering causation is they will get s/s mixed up * diarrhea will cause a metabolic acidosis- once you get acidotic it will shut your bowels down and you will get paralytic ileus - diarrhea caused it, paralytic ileus resoloved it

straight catheter is to a foley cathetar as

thorencentisis is to a chest tube straight cath- in/out foley-in/secure continious drainage -higher chance for infection chest tube- stick it in/ secure it and leave it -higher risk for infection thorencentisis-in/out to reestablish negative pressure **thorencentisis in/out chest tube

loosening of associations: flight of ideas

thought to thought they say phrases that are coherent, but the phrases are not tightly connected each phrase by itself is coherent but the phrases together are not coherent

what do all the mycin that is not Aminoglycosides have in them

thro "throw it off the list"

whats the purpose of uterine contractions in the 4th stage

to contract the uterus to stop bleeding

MAOIs Patient Teaching

to prevent severe, acute, sometimes fatal hypertensive crisis patient must avoid ALL foods containing tyramine *CAN HAVE* -fruits -veges -grains -pies -cookies -cakes -breads -cottage -mozzarella *CANNOT HAVE* BAR 1. *bananas* 2. avacados/guacomole 3. raisins NO DRIED FRUIT NO ORGAN MEATS -liver -brain -KIDNEY -triphin -intestine -heart -lung -tongue NO PRESERVED MEATS -smoked -dried -cured -pickled -hot dogs DIARY -no cheese except cottage/mozzarella -*NO YOGURT* -aged cheese no etoh/chocolate -no elixers -no tinctures -NO CAFFEINE -no licorice -no soy sauce NO OTC MEDS

overdose and intoxication

too much

pregnancy weight gain

total weight gain is +28lbs plus or minus 3 first trimester: gain 1 pound a month -1st T is 3mts so she gains 3lbs -alot of weight gain in the 1st trimester is BAD 2nd/3rd: gain 1 pound a week *TAKE THE WEEK OF GESTATION AND SUBTRACT 9* week 12 End of first trimester weight gain 3lbs week 13 she gained another lb total of 4lbs week 14 another lb for a total of 5 week 15 another lb total of 6 week 16 another lb total of 7 week 17 another lb total of 8 week 18 another lb total of 9 week 19 another lb total of 10 week 20 another lb total of 11 week 21 another lb total of 12 week 22 another lb total of 13 week 23 another lb total of 14 B/T WEEKS & POUND DIFFERENCE OF 9 *TAKE THE WEEK OF GESTATION AND SUBTRACT 9*

labs: high priority platelets

trigger values for thrombocytopenic bleeding precautions below 90,000 is high priority below 40,000 high priority

congenital heart defect Cyonatic

trouBle b means blue what types of shunts are blue? right to left means blue

Aminoglycosides abx all have

trough and peak drawn on them because they have narrow therapeutic windows

Streptomycin

tuberculosis

Aminoglycosides abx are used for

tuberculosis foamating pyelonephritis septic peritonitis septic shock infected 3rd degree burns over 80% of body

lanoxin digoxin

tx afib, chf 1-2 toxic level > 2

low blood glucose

type 1 is the same as type 2

Phenothiazines

typical first generation antipsychotics they do not cure, they just reduce the symptoms small doses=antiemetic high doses= antipsychotics *considered major tranquilizers*

downer endings Barbital Fentanyl Hashish

um ol in ine ed ax pam lam ne zene Exception *pam cc*

first stage low fetal heart rate

under 110 when you see it you do lion STOP THE PITOCIN THEN DO LION L left side first I increase iv lpn cant do this O oxygenate them N notify physician

Addison's disease

undersecretion of adrenal cortex, not enough hormone, BRONZE/tan, go into shock very easily. STRESS can trigger.

chest trauma or chest surgery is always

unilateral

assess before you do

unless delaying doing in order to assess puts the pt at risk ex a patient pulls out their arterial line they are bleeding in bright red spurts from their radial artery what do you do first a. assess v/s b. apply pressure do precedes assess

when diabetic is sick the glucose goes

up even if npo it will never go down it always goes up *take their insulin even when they're not eating/npo*

Ascending stairs with Cane

up with the good down with the bad the cane always moves with the weaker leg

Descending stairs with Cane

up with the good down with the bad the cane always moves with the weaker leg

tween effect

upper & downer

which 2 will seizure be your biggest risk

upper overdose and downer withdrawal

Downer Overdose

upper withdrawal

stable

use of the word stable chronic illness post op greater than 12 hours local or regional anesthesia lab abnormalities of an a or b level ready for discharge to be discharged admitted longer than 24 hours ago unchanged assessments experiencing the typical expected s/s of the dz with which they were dx

unsable

use of the word unstable acute illness post op less than 12 hours general anesthesia in the first 12 hours lab abnormalities of c or d not ready for discharge newly admitted newly diagnosed admitted less than 24 hours ago changing assessments -something new something different experiencing unexpected s/s mild pain with chest xray

clozaril / clozapene

used to treat severe schitzo side effect a granulocytosis lower wbc

4 defects of tetralogy of fallot

valentines day pick someone out a red heart 1. ventricular septal defect 2. pulmonic stenosis 3. overriding aorta 4. right ventricular hypertrophy very pictures of ranch important!!!

diabetes mellitus management recognizing: shock

vasomotor part of the syndrome low bp tachycardia tachypnea cold, pale, clammy mottled patchy

nurse given too much insulin causes

vegetative state and brain damage in an a/o client

respiratory alkalosis

ventilator setting too high=overventalating

respiratory acidosis

ventilator setting too low= underventalating tx reconnect, plug sensor back in?

qrs depolirazation

ventricular NOT ATRIA

what do you use for ventricular/ arias

ventricular= lidocaine atrias= abcds

variable

very . bad

Humalog insulin lispro

very fast onset: 15min peak/hypoglycemia: 30 min duration: 3 hrs give it when they eat...give *with* meals

laminectomy

vetebra spinal processes = lamina removes posterior processes done to relieve nerve root compression s/s pain paresthesia paresis= muscle weakness LOCATION *cervical*- neck for diaphram arms/hand fx *thoracic*-upper back/spinal-cough/bowels *lumbar*- lower back- innervates the bladder/legs most important pre op assessment for a cervical laminectomy. most important thing to check b4 sx - breathing - *fx of arms and hands* most important pre op assessment for a thoracic laminectomy. most important thing to check b4 sx -cough most important to check is how well they cough b4 sx -bowels most important pre op assessment for a lumbar laminectomy. most important thing to check b4 sx -innervates bladder -innervates legs -ask when the the voided, if bladder is distended or empty

chaotic sguilly line

vfib treat with dfib no pattern chaotic=fibrillation

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labs

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pregant women

void q 2 hrs even 6wks after delivery postpartum

shap peaks and jags

vtach use amiodarone has a pattern

hiatal hernial treatment

want to empty faster place hob in high position increase fluids high carbs protein low

any diurectic ending in x plus durel

waste k+ lasix

bilirubin

waste product of rbcs bilirubin 9.9 or less is normal for newborn elevated level in newborn 10-20 -halfway through the elevated range they start to hospitalize toxic level is 20 a child with what bilirubin and above needs to come into the hospital? *14-15 causes for hospitalization* tx sunlight fluids

if some thing is sealed which chamber is it? should you have a continuous bubble

water seal no, continuous bubble that means its leaking

fundus top of uterus is not palpable until

week 12 NOT PALPABLE DURING THE FIRST TRIMESTER

in general

what ae high pressure alarms due to= obstructions what are low pressure alarms due to= disconnection

narrow self concept

when a *psychotic* refuses to leave their room or change their clothes functional psychotic - doing it bc they wont know who they are unless they are wearing those clothes in that room & wont change bc it terrifies them to change and leave room NURSE dont make them leave the room or change clothes bc they will not know who they were and will have a panic escalation and someone will get hurt RIGHT ANSWER -what do you tell a fx psychotic who refuses to change clothes and leave room ****i see youre uncomfortable and upset you do not have to change your clothes or leave the room untill you feel ready (psychotic) its a perfect world so they can stay for 30 years if thats the case OTHER CHOICE ms jones been depressed since her last child went to college 3 mts ago. she has no energy to do the house work and she lost her job bc she didnt have the energy to get up and work. she says she hates the way she feels. i am going to kill myself if things dont get better bc the depression is ruining my life. please help me. she is refusing to leave her room or eat her bfast and do her daily hygiene care. what do you do. she is a ((non psychotic)) she just has depression. she has insight - use good therapeutic communication skills but u you say, i see youre depressed and feeling down, tell them...say its time for a shower just like you would a post op who wont get out of bed be directive ((non psychotic)) depression, psychomotorally if they dont make choices you make choices for them force them

you have a staff nurse who has more seniority than you on your job, and they find fault with everything you do.

when dealing with psychodynamic problems with staff use *I/i'm* not you *good pronoun* -*I* *good- "I seem to be having a problem, thats frustrating". "we are seeming to not get along well" *bad pronoun* - *you* *bad- "why don't you like me?" "why are you so mean?"

Bubbling on Chest Tube questions ask 2 questions

when is it bubbling where is it bubbling -water seal INTERMITTENT GOOD document it -water seal CONTINUOUS BAD there is a leak. find the leak and put tape over it till it stops leaking - lpn scope of practice - suction control chamber INTERMITTENT BAD suction is not high enough. suction is too low. have to go to dial on the wall and turn it up. till it starts to bubble CONTINUOUS is GOOD the chambers are opposite, whats good in one is bad in the other

when you get an overdose question you have to ask is this an upper or a downer

when you get an overdose question you have to ask is this an upper or a downer

pvc- periodic wide and bizzare qrs

why is it ventricular? qrs why is it wide an bizzare (snap shot of tachycardia) can you call a salvo of pvcs (group of them in a row) aka short run of vtach *physicians do not care about ppl having pvcs- it is only periodic not a continuous phenomenon

after 24 hrs after birth you will assume

withdrawal

can you put a alcohol withdrawal pt on pediatric overflow unit

yes

can you mix insulin's in the same syringe

yes draw up the regular first then NPH RN

we use zines for the

zanies

Hypothyroidism (Hypo-Metabolism)Signs & Symptoms

↑ weight♦ cold♦ sluggish♦slow♦ decreased BP♦bradycardia♦ hair and nails brittle♦decreased E