Remember This
When does a baby recognize faces?
4 months
When does a baby roll over?
4 months
Stages of Labor Active
4-7cm dilated contractions every 3-5 minutes - pain meds now
RBC
4.5-5.0 million
When do you need to induce pregnancy?
42 weeks
WBCs
5,000-10,000
IV onset
5-15 min
When do you give first influenza vaccine?
6 month
When can baby sit up with support?
6 months
When can you start implementing solid foods
6 months
When does baby recognize and respond to name?
6 months
When does baby see self in mirror?
6 months
When does stranger anxiety begin?
6 months
Glucose
70-110
When can baby stand while holding onto things?
8 months
When does baby develop object permanence?
8 months
When does baby develop pincer grasp?
8 months
When does baby move things from hand to hand?
8 months
When does baby sit without support?
8 months
When does crawling begin?
8 months
Stages of Labor Transition
8-10cm dilated contractions every 2-3 minutes
Calcium
8.5-10.5 Symptoms: Do the opposite of the prefix Hypo - Chvosteks (cheek), Trousseaus (inflated BP cuff = hand spasm) - phenytoin - aminoglycocides (-mycin)
Chloride
95-105 - loss of sodium associated with loss of chloride
LDL
< 100
Triglycerides
< 150
Cholesterol
< 200
Pain Scale Peds
< 3 = FLACC > 3 = Faces
What is considered infection fever?
> 104
Mantoux Skin Test
> 15mm = POSITIVE > 10mm = positive in immigrant, IV drug user, homeless, child < 4 > 5mm = positive in HIV/immunosuppressed
Gestational Hypertension - when is it diagnosed? - meds?
> 20 weeks Hypertensive Mothers Loves Nifedipine Hydrolatine Methyldopa Labetalol Nifedipine
HDL
> 60
Universal Recipinent
AB+
ACE/ARBs - what do they end in? - SE - pregnancy?
ACE - pril A:ngioedema C:ough E:xcess potassium I:nstead use ARBS - teratogen ARBs - sartan - hyperkalemia - teratogen
Which BP meds CANNOT be used in pregnancy?
ACEs and PRILs
-sartan
ARBs - decrease BP workload
Acetaminophen antidote
Acetylcystine
What are migranes treated with?
Acute: NSAID, Sumatriptan (Imitrex) Prevention: Propranolol
What type of bacteria is tuberculosis?
Aerobic acid-fast bacilli
TB precautions
Airborn - N95/negative pressure room
Psych Meds
Anticholinergic effects (dry eyes) Blurred vision Constipation Drowsiness Euphoria Fotosensitivity Granulocytosis (LOW WBC) MAOIs: ABCD Benzos: ABCD SSRIs (prozac, Zoloft): ABCDE Tricyclics (-il): ABCDE Phenothiazines (-zine): ABCDEFG
When is Hepatitis B vaccine administered?
Birth and 2 months
Infant Developmental Milestones
Birth-1 year Body changes (Anterior close 18mo, posterior 2mo) (weight 6 months, double, 12 months, triple) (length 1/2 to 1 inch every month) (teeth erupt 10 months) Achieving Milestones: (2 months, move head side to side, smile, verbal (coo), track with eyes, lift head while on stomach) (4 months: babble, hold and reach for toys, remember faces, roll over) (6 months: sit up with support, stranger anxiety, responds to name, when does baby see self in mirror) (8 months: sits without support, crawling, stands while holding onto things, pincher grasp, move object hand to hand, object permanence)(10-12 months: walking, put items in container, say mama, separation anxiety) B Infants (trust vs. mistrust) Eating (breastfeeding until 6mo exclusively, no cows milk or honey for first year) Social stimulation: independent play
3 Types of Headache location? duration? description? treatment?
Cluster - unilateral - 15min-3 hours, repeat, same time - sharp shooting periorbital pain, sinus drainage - O2, triptan Tension - bilateral - > 30 minutes, 4-6 hours - tight, squeezing pressure - NSAID, acetaminophen Migrane - unilateral - 4-72 hours - nausea/vomiting - phono/photophobia Acute: NSAID, -triptan Prevention: beta blockers, propanolol
Dumping Syndrome vs Hiatal Hernia - symptoms? - position? - diet? - fluids?
Dumping syndrome - gastric contents dump too quickly - move in right direction at wrong rate - cramping, stomach pain, diarrhea - treatment: want stomach to empty slower: head of bed flat, low fluids or fluids BEFORE or AFTER meals, low carbs Hiatal Hernia - regurgitation of acid - moving at wrong direction at the correct rate - same symptoms as GERD when they eat and lie down - treatment: want stomach to empty faster, raise head of bed, increase liquids, high carbs
Cranial Nerve VII
Facial - unilateral facial drooping
Cranial Nerve IX - nursing considerations
Glossopharyngeal - AIRWAY ISSUE
What position for paracentesis
High fowlers - pee before
Erikson's Stages
Infant (birth-1): trust vs mistrust Toddler (1-3): autonomy vs shame and doubt Preschool (3-6): initiative vs guilt Schoolage (6-12): industry vs inferiority Adolescene (13-20): identity vs role confusion Young adulthood (20-40): intimacy vs isolation Middle adulthood (40-60): generativity vs stagnation Older adulthood (60-death): integrity vs despair
budesonide
Inhaled Corticosteroids
What stage (Erikson's) are preschoolers in?
Initiative vs guilt
What do you give for ammonia buildup?
Lactulose
Long Acting Insulin
Lantus (glargine) - no peak - duration 12-24hrs
Rapid Insulin
Lispro O: 15min P: 30min D:3hr
Intermediate Acting Insulin
NPH (Humulin N, Novolin N) O: 6hr P: 8hr D: 12hr - cloudy
What are tension headaches treated with?
NSAID/Acetaminophen
Opioid antidote
Naloxone (Narcan)
Tetrology of Fallout
Not enough oxygen V - Ventricular septal defect O - Overriding aorta R - Right ventricular hypertrophy P - Pulmonary outflow tract obstruction any other defects that start with T = trouble
Universal Donor
O-
1-3 Cranial Nerves
Olfactory Optic Oculomotor
peripheral vascular disease (PVD) - two diseases? - risk factors?
Peripheral Artery Disease - atherosclerotic plaque - DONT elevate..they already aren't getting enough bloodflow, use gravity - pale skin, cool to touch Venous Insufficiency - obesity, standing too long, sitting - peripheral edema - dark, hot to touch
What Stage (Piagets) are preschoolers in?
Preoperational
Heparin antidote
Protamine sulfate
Fetal Positions
ROA and LOA Okay - If in OP, make mom do knee chest position
Short Acting Insulin
Regular (Humulin R, Novolin R) O: 1hr P: 2hr D: 4hrs - only IV insulin
TB MEDS
Remember PERI Pyrazinamide: (can increase uric acid, take with food) Ethambutol: (peripheral neuropathy, vision changes) Rifampin: (body fluids turn orange, birth control less effective) Isonized: (decrease vitamin B12, peripheral neuropathy, hepatotoxic)
Aspirin antidote
Sodium bicarbonate
Stages of Labor
Stage 1 - Latent - Active - Transitional Stage 2 - baby Stage 3 - placenta Stage 4 - postpartum
Airborne precautions
Standard + N95 & Negative pressire - measles - TB - varicella
Droplet Precautions
Standard + surgical mask - pertussis - pneumonia - flue - rubella - mumps
opisthotonus
The back is rigid and arching, and the head is thrown backward. - happens with hyperbilirubia - put them on their side
Lithium
Therapeutic levels 0.6-1.2 >2 = toxic - 3 Ts Tremors Taste that's metalic Too much diarrhea - may need supplemental sodium, lithium causes hyponatremia
Cranial nerve V - what region? - sensitive to? - what drug is used to treat this?
Trigeminal - Temporal region..goes to eye cheek and jawline - Sensitive to touch and temperature - carbamazepine
Ionized - What is it used for and what are it's side effects? - what do we give with it?
Tuberculosis - decrease vitamin B12, peripheral neuropathy - hepatotoixic - vitamin B6 or pyridoxine
Rifampin - What is it used for and what are it's side effects?
Tuberculosis - orange urine - birth control less effective
Ethambutol - What is it used for and what are it's side effects?
Tuberculosis - peripheral neuropathy - vision changes E = Eye
VEAL CHOP
Variable - Cord Compression Early - Head Compression Acceleration - Okay - Placental insufficiency
Which arrhythmia do you use amiodarone?
Ventricular arrhythmias
Warfarin antidote
Vitamin K
PT (prothrombin time)
WARFARIN 9.5-12.0 seconds
INR
Warfarin 2-3
-pril
ace inhibitor
Asterixis
aka Liver Flap, a flapping tremor of the hands. When the client extends the arms & hands in front of the body, the hands rapidly flex & extend.
When is DTaP vaccine administered?
always
-olol
beta blocker - lower HR and BP
Which of eriksons stage are infants in?
birth-1 trust vs. mistrust
-pine
calcium channel blocker
Magnesium sulfate antidote
calcium gluconate
-mide, -nide
diuretics
-cytosis
elevated
Sympathetic nervous system
fight or flight
When are contractions bad
if they are longer than 90 seconds and less than 2 minutes apart - fetal hypoxia
A1C
levels for 3 months - < 6% - < 8% if they have diabetes
furmoterol
long acting bronchial relaxers..like albuterol but not rescue
salmeterol
long acting bronchial relaxers..like albuterol but not rescue
What is the treatment for preeclampsia?
magnesium sulfate & delivery of fetus
Delivery Date
minus 3 months + 7 days
Quickening - when does it occur
movements felt at 16-20 weeks
aPTT
normal 30-60 seconds Heparin: 1.5x2.5 times normal range..60-80 seconds
Metformin - what is it used for - what can it cause
oral hypoglycemic - can cause lactic acidosis
Parasympathetic nervous system
rest and digest
Four point gait
right crutch then left foot
What vaccines are given at 6 months?
same as 2, also influenza
cardiac catheterization - what is it? - what is it called when you open the vessels? - where would you place a stent? - post-op?
thin, flexible tube is guided into the heart via a vein or an artery - angioplasty - groin area, femoral artery - bedrest until proper clotting - stool softer (no straining) - antiplatelet (clopidogrel + aspirin)
QRS wave
ventricle depolarization/contraction
ST wave
ventricular repolarization/relaxation
what is pyridoxine
vitamin B6
Hypotonic solution
- 0.45% saline - Rehydrate
Isotonic fluids
- 0.9 NS, LR - burns, shock
When should the posterior fontanel close?
- 2 months
Hypertonic
- 3% saline - fluid overload
When does baby change from coo -> babble
- 4 months
Restraints - how long do you need to reevaluate use in each age group
- < 9 yrs old: 1 hr - 9-17yrs old: 2hrs - 18+: 4 hours - need MD order within 1 hour of applying
Carbamazepine (Tegretol) - What is it? - Side effects
- Anticonvulsant - Steven Johnson Syndrome - Agranulocytosis
Which arrhythmia do you use atropine? (2)
- Asystole - Sinus bradycardia
HHNK
- BG > 600 - Hot, dry skin - Water, IV fluids, insulin
What drugs treat sinus tachycardia?
- Betablockers
Sumatriptan (Imitrex) - what is this given for?
- Cluster headache - Migranes
What vaccines are given at 12-18 months?
- DTaP - Hib - Polio - MMR - Varicella - Hepatitis A - Influenza
What vaccines are given at 4-6 years old?
- DTaP - Polio - MMR - Varicella - Influenza
PPE TAKING OFF
- Gloves - Goggles - Gown - Mask
PPE PUTTING ON
- Gown - Mask - Goggles - Gloves
Rules of 9's
- Groin 1% - Head 9% - Arms 9% each - Legs 18% each - Abdomen 18% for front 18% for back
what vaccines are given at 2 months (6)
- Hep B - RV - DTaP - Hib - PCV - IPV
What vaccines are given at 4 months? (5)
- RV - DTaP - Hib - PCV, - IPV
Hypoglycemia - what do you give
- Rapid carbs, juice - Glucagon
Folic Acid Deficienies - 3 types - Nursing considerations - What drug should you not take?
- Spina bifida - tuft of hair - Myelomeningocele - meninges & neural tissue protruding - Meningocele - meninges protruding - must go to surgery - cover with sterile dressing, keep moist - PHENYTOIN (cannot get pregnant)
Nitrates what are they given for? ways to take it? do not take with?
- Stable angina - Sublingual -> 3 times q 5 minutes - Pills: need to be kept in cool dark setting - Patches: need to remove when defib, use for 12-14 hours - nafils AKA viagra
Which arrhythmia do you use adenosine?
- Supraventricular tachycardia
Pyrazinamide (PZA) what is it used for and what are it's side effects?
- Tuberculosis - Raises Uric Acid - Take with food
Which arrhythmia do you use lidocaine?
- V tach - V fib
Ethosuximide (Zarontin) - When is this given? - Side effect
- absence seizures Ethosuximide Fatigue GI distress Headache Itching Steven Johnson Syndrome
Crutches
- always move weak side first - 2 fingers below axilla
Treat ventricular arrhythmias
- amiodarone - lidocaine
Atropine - which two dysrhythmias give with - what condition can you not give with
- asystole, sinus bradycardia - glaucoma
P wave
- atrial depolarization, atrium contracts
Sinus bradycardia
- atropine - pacemaker
Treat atrial flutter
- beta blockers - calcium channel blockers - digoxin
Kernicterus
- bilirubin in the brain
Tachycardia - what word used to describe it - meds used to treat sinus tachycardia - meds used to treat ventricular tachycardia
- bizarre - Sinus tachycardia = Beta blockers, calcium channel blockers, cardioversion - Ventricular tachycardia = defib, amiodarone, lidocane
Three point gait
- both crutches forward with weak leg
Contact Precautions
- c-diff - MRSA - Herpes - RSV
Complication of heart attack - which cardiac arrhythmia
- cardiac myocytes start releasing K+ - K+ = ventricular arrythmias - V-fib - DEFIB
Fibrilation
- chaotic - ventricular fibrillation = defibrillation
How to count HR
- count QRS complexes x 10
How to count HR on EKG
- count boxes between R peak, then do 300/that number
Pregnancy nausea
- crackers before getting out of bed
Apruptio placentae
- dark bleeding - painful - give O2, bedrest vasoconstrictors such as cocaine or smoking can cause it, also trauma, & history
-statins What do they do? What time do you take them? Prior to taking med what do you check?
- decrease cholesterol (< 200) - decrease triglycerides (< 150) - decrease LDL (< 100) - increase HDL (> 50) - take at bedtime because you are going into a fasting state, when you are fasting you release cholesterol (perfect time to attack them) - check ALT, AST before administer because of myopathy (myopathy, something wrong with muscles) and or rhabdomyolysis -> rhabdomyolysis = excretion of more protein = acute kidney injury -> HYDRATE - symptoms of rhabdomyolysis = muscle tenderness, pain - how to check for rhabdomyolysis BUN & creatinine
DKA
- dehydration - ketones, kussmaul, elevated K+ Treatment: IV fluid/Insulin
Cephalosporin - when cant you give
- do not give if they have a penicillin allergy
Burn Treatment (4 things)
- fluids - pain meds - topical antibiotics - high calorie
Inhaled Corticosteroids - 3 - how to administer - what med would you give if they got complications?
- fluticasone - beclamethasone - budesonide - use a spacer - rinse after every use - nystatin (NOT a statin..a fungal medication) - used if oral flush develops - swish and swallow
1 month milestone
- grasp reflex
Standard Precautions
- hand hygiene - gloves - gown - mask
Preeclampsia
- hypertension - edema - protein in urine - eclampsia = seizures
Blood Transfusion
- infusion must be started within 30 minutes of getting it from bloodbank - needs to be infused within 4 hours
Coronary Artery Bypass - normal postop findings
- itching, fever
Signs Symptoms of Hepatotoxicity
- jaundice - yellow skin - fatigue - hepatomegaly - scleral icterus
24 months milestone
- kickball - stairs - anal and urethral spinsters controlled by about 18-24 months Weight/Height - gain 4-6lbs per year, 4x their birth weight - increase 2-3 inches/year (2 year olds are about half of their adult height) - head circumference and head size same by 2-3
-mycin
- kidney/ear damage
ipratropium
- long term asthma drug - prevents constriction
tiopropium
- long term asthma drug - prevents constriction
Antacids - medication interactions
- must wait 2 hours between taking with other drugs
Asystole
- no QRS waves - Atropine - Epinephrine
Latent TB
- non infectious, no symptoms, regular chest x-ray, negative sputum - positive for blood test
Placenta Previa
- painless bleeding - give fluids and blood, magnesium, steroids, bedrest
Fundus
- palpate at 12 weeks - 22 weeks palpate at umbilicus - after 24 weeks its at same level as weeks pregnant - 24 hours after birth fundus should be back at level of umbilicus
What to give if mom is past due date
- pitocin/oxytocin - also given for postpartum hemorrhage - remember..it can have an antidiuretic effect because it stops bleeding
PPIs - what do they end in - what do they treat - adverse side effects
- prazole - GERD - increased pH may cause cdiff..watch out for nausea/diarrhea - can cause hypocalcemia, supplement with calcium and vitamin D, weight bearing exercises and bone density scan
What meds do you treat GERD with? - side effect
- prazole's
What type of play do preschoolers use?
- pretend play - animistic
Superficial 1st Degree
- redness - heat - pain - blanching - dry
Two point gait
- right crutch & left foot forward together
6 month milestone
- roll back to front - first sounds - teeth erupt
4 month milestone
- roll front to back - smile
3 years milestone
- run - draw circle
Atrial Flutter
- sawtooth appearance - vagal maneuver, cardioversion - adenosine
When would someone get an EEG?
- seizures
8 months milestone
- sits unsupported
9-12 months milestone
- start to walk
What to give if mom is giving birth preterm
- terbutaline - also can be given for variable decelerations
long acting muscarinic antagonist - 2 - what are they used for? - what are they used along with?
- tiopropium - ipratropium - prevention of constriction for long term asthma - salmeterol - furmoterol (long acting bronchial relaxers..like albuterol but not rescue) - also used with inhaled corticosteroids
Phlebitis
- treat with heat
Infiltration
- treat with ice
4 years milestone
- use scissors - pour drinks
Nitroglycerin
- vasodilator - for stable angina - x3 5 minutes apart - NO VIAGRA
Full Thickness 3rd Degree
- waxy - charred - pale - white - NO PAIN
Partial Thickness 2nd Degree
- wet - blisters - pale - pink - pain
Subarachnoid Hemmorhage - how is it described
- worst headache of my life
What is Piaget's sensorimotor stage?
0-2 years
Piaget's Stages
0-2: sensorimotor 2-6: preoperational 7-11: concrete operational 12-adulthood: formal operational
Digoxin
0.5-2 Toxic > 2 - HF - Atrial fibrillation
Creatinine
0.6-1.2
Erikson's Autonomy vs. Shame and Doubt/Guilt Ages
1-3
What age are toddlers?
1-3 years Developmental Milestones Temper Tantrums (developing autonomy, easily stressed) On the move (safety) Diaper to potty transition (most trained by 3 years) Developmental theories (Piaget birth-2yr = Sensory-motor, 2-7yr = Preoperational - egocentric, symbolic play..stick is sword, parallel play, push and pull toys) (Eriksons = Autonomy vs. Shame/Guilt Love to say no (negativism) Eating plan (small nutritious snacks) Ritualism, Rivalry, Regression
Stages of Labor: Latent
1-3cm dilated contractions 5-30min apart
Specific Gravity
1.010-1.030 - Low is caused by dilution - diabetes insipidus - High is caused by dehydration - SIADH
Magnesium - symptoms of high and low?
1.5-2.5 Symptoms: Opposite of prefix
When should first teeth show up by
10 months
When can babies put items in container?
10-12
When do babies get separation anxiety?
10-12 months
When do babies say mama/dada?
10-12 months
When should baby start walking?
10-12 months
BUN
10-20
DIlantin/Phenytoin - side effect
10-20 Toxic over 20 - DO NOT GET PREGNANT - Steven Johnson Syndrome
Theophylline
10-20 Toxic over 20 - respiratory drug, relaxes spasm
Bilirubin
10-20 elevated in newborn > 20 = elevated
Fetal HR
110-160 - if < 100 stop Pitocin and do LION Lie on side Increase IV fluids Oxygen Notify provider
Hemoglobin
12-18
When is Hepatitis A vaccine given (once)
12-18 months
When is MMR vaccine given? (2)
12-18 months 4-6 yo
When is varicella vaccine given?
12-18 months 4-6 yo
Sodium - Hyponatremia causes? - Hypernatremia cause?
135-145 Hyponatremia Causes - diuretics (thiazides) Hypernatremia - Cushings
Platelets
150,000-400,000
When should the anterior fontanel close?
18 months
When should a baby hold head up when on stomach?
2 months
When should a baby make verbal noises?
2 months
When should a baby track with eyes?
2 months
When should a. baby smile?
2 months
When would an infant move their head side to side?
2 months
When is RV vaccine administered? (three)
2, 4 & 6
When is IPV vaccine administered?
2, 4, 6
When is PCV vaccine administered? (3)
2, 4, 6
When is HiB vaccine administered? (4)
2, 4, 6, 12-18
Phosphorus
2.5-4.5 - When calcium goes up, phosphate goes down
Ear medication
3+ = up & back
Preschoolers - age - height
3-5 years - grow 3 inches/year
Albumin
3.5-5
Potassium
3.5-5.0 Symptoms: Do the same as the prefix except HR and urine output Hypokalemia - look diuretics - too much insulin - Cushing syndrome
When does insulin go bad
30 days after opening
SubQ/IM Onset
35-45 min
Hematocrit
37-52%
When does a baby grasp and reach for things?
4 months