exit
MI
crushing stabbing chest pain unrelieved by nitro
angina
crushing, stabbing chest pain relieved by nitro
when on nitroprusside monitor:
cyanide. normal value should be 1.
wilm's tumor
encapsulated above kidneys...causes flank pain
nursing intervention for preventing delays in healing
encourage fluid intake of 2-3L; increase protein, keep serum albumin levels above 3.5
54. Below the knee amputation?
foot of bed elevated for first 24 hours, position prone daily to provide for hip extension.
BKA (below knee amputation)
foot of bed elevated for first 24 hours. position prone to provide hip extension.
406. Signs to look for in meningitis?
for Meningitis check for Kernig's/ Brudzinski's signs.
72. CABG?
for a CABG operation when the great saphenous vein is taken it is turned inside out due to the valves that are inside.
289. Knee replacement?
for knee replacement use continuous passive motion machine.
unconcious patient unable to give consent in ER?
health care personnel may proceed with necessary life-saving care because the law considers this implied consent
230. Heart Defects?
heart defects. Remember for cyanotic -3T's( Tof, Truncys arteriosus, Transposition of the great vessels). Prevent blood from going to heart. If problem does not fix or cannot be corrected surgically, CHF will occur following by death. 94. with R side cardiac
If JP drainage has doubled in last two hours, possible cause?
hemorrhage. Access, stat CBC, notify physician
DVT (MEDS)
heparin (monitor aPTT, platelet count because of hep induced thrombocytopenia, complication is bleeding. Protamine sulfate is the antidote for excessive bleeding), Warfarin (antidote is vitamin K for excessive bleeding; monitor via INR), thrombolytic therapy, Analgesics, tissue plasminogen activator (t-PA), a thrombolytic agent, and platelet inhibitors such as abciximab (REoPRo), tirofiban (Aggrastat) and sptifibatide (Integrilin) may be effective in dissolving a clot or preventing new clots during the first 24 hr.
TB drugs are
hepatotoxic!
iron deficiency anemia lab results
hgb <12, hct <33
After a blood transfusion, will you look at hub, hct, BP or HR for changes?
hgb!!! 1-2 pt increase per unit of blood
What do bananas, avocado and spinach have in common? If patient on what med, these are good foods?
high K+, so good for hypokalemic patients; if patients on thiazide diuretics (Diuril, enduron), may be HYPOKalemic, so give these!
clyclosporin
immunosuppressant, clcineurin inhibitor. contraindicated in recent contact or active infection of chicken pox or herpes zoster
388. Rule of thumb for assisting pysch patients?
if patients have hallucinations redirect them. In delusions distract them.
DKA is rare
in DM II (there is enough insulin to prevent fat breakdown)
Edema is located
in the interstitial space, not the cardiovascular space (outside of the circulatory system)
Chest tubes are placed
in the pleural space
UTERINE ATONY
inability for the uterine muscles to contract due to lack of muscle tone --> exccessive bleeding because muscle fibers cannot contract firmly around blood vessels when the placenta separates.
Common Prostaglandin Analogs:
latanoprost (Xal atan ) (see the suffix atan in this drug and the drug below, they are the same) Travoprost (trav atan ) (see the suffix atan in this drug and the drug above; they are the same)
positioning for pneumonia
lay on affected side, this will splint and reduce pain. However, if you are trying to reduce congestion, the sick lung goes up! (like when you have a stuffy nose and you lay with that side up, it clears!)
advocacy
leadership role that helps others to grow personally through self actualization
409. STD= gonnorrhea?
Gonorrhea is a reportable disease
224. Guillian Barre?
Guillain-Barre syndrome= ascending paralysis. Keep eye on respiratory system.
225. Guthrie test?
Guthrie Test - Tests for PKU, baby should have eaten source of protein first
IMPORTANT LAB VALUES (HEMATOLOGY)
HEMATOCRIT (HCT) - Adult Female- 37 - 47% - Adult Male 40 - 54% Newborn Range: 50 - 62% •HEMOGLOBIN (HGB) Adult Female - 12 - 16 g/dl Adult Male 14 - 18 g/dl Newborn Range: 14 - 20 g/dl oR.B.C. (Red Blood Cell Count) Adult Female:3.9 - 5.2 mill/mcl Adult Male: 4.2 - 5.6 mill/mcl •W.B.C. (White Blood Cell Count) Adult Range: 4,000 - 12,000 /mcl Higher ranges are found in children, newborns and infants. •PLATELET COUNT Adult Range: 130,000 - 400,000/mcl NEUTROPHILS - High levels may indicate an active infection. Adult Range: 48 - 73 % Children's Range: 30 - 60 %
what test for breast cancer vs ovarian cancer?
HER2 (her 2 boobs) gene = breast AFTER biopsy but BRCA1 (bra) is for detecting breast cancer w/o biopsy.. ca-125 (clit area) for ovarian cancer
CSF meningitis
HIGH protein LOW glucose
POSTOP CARE AFTER JOINT REPLACEMENT (HIP, KNEE, ETC)- PT TEACHING
HIP REPLACEMENT use of assistive devices (for example, walker)- DO's- use elevated seating/raisedtoilet seat avoid flexion of hip > 90 degrees, use straight chairs with arms, avoid low chairs, use and abduction between legs while in bed (and with turning); do not cross legs; externally rotate toes don not internally rotate toes. CLIENT POSITION- supine with head slightly elevated with affected leg n neutral position, pillow or abduction device between legs to prevent abduction (movement toward midline) which could cause hip dislocation arrange for raised toilet seats, extended handle items (shoehorn, dressing sticks) KNEE REPLACEMENT - Positions of flexion of the knee are limited to avoid flexion contractures; Avoid knee gatch and pillows placed behind the knee, knee immobilizer may be used while in bed
Atorvastatin (Lipitor) Simvastatin (Zocor) Lovastatin (Mevacor) Pravastatin (Pravachol) Rosuvastatin (Crestor) Fluvastatin (Lescol)
HMG CoA Reductase Inhibitors also known as 'statins' are some of the most prescribed medications in this country. Statins are used to treat primary hypercholesterolemia, for prevention of coronary events (primary and secondary), for protection against MI and stroke for clients with diabetes, and to help increase HDL levels in clients with primary hypercholesterolemia. Remember LDL is the 'bad' cholesterol and HDL is the 'good' cholesterol (HDL helps keep the 'bad' cholesterol from building up in artery walls). You want your LOW (LDL)LOW and your HIGH (HDL) HIGH. While statins are a wonderful addition to our pharmaceutical arsenal, they are not without risk. When you think 'statins' think that we need to protect the liver and muscles stat: There is a risk of hepatotoxicity. It is important to obtain a baseline liver function and to monitor liver function tests after12 weeks and then every 6 months and to avoid alcohol. There is also a risk of myopathy and peripheral neuropathy. Clients should be told to report muscle weakness and/or aches, pain, tingling and tenderness. CK levels will be monitored periodically during treatment as well.
Ventilatory alarms
HOLD High alarm--Obstruction due to secretions, kink, pt cough etc Low alarm--Disconnection, leak, etc
441. Ventilator Alarms?
HOLD High alarm- Obstruction due to incr. secretions, kink, pt. coughs, gag or bites Low press alarm- Disconnection or leak in ventilatior or in pt. airway cuff, pt. stops spontaneous breathing
ACID BASE IMBALANCES
HOMEOSTASIS - PH (7.35-7.45)/ PaCO2 (35-45); HCO3 (22-26) - RESPIRATORY ACIDOSIS- PH (<7.35); PaCO2 (>45); HCO3 (22-26) - METABOLIC ACIDOSIS- pH (<7.35); PaCO2 (35-45); HCO3 (<22) - RESPIRATORY ALKALOSIS- pH (>7.45); paCO2 (<35); HCO3 (22-26) - METABOLIC ALKALOSIS- pH (>7.45); paCO2 (35-45); HCO3 (>26)
Thyroid storm
HOT (hyperthermia)
Apgar measures
HR RR Muscle tone, reflexes, skin color. Each 0-2 points. 8-10 ok, 0-3 resuscitate
120. Common S/S of Increased ICP?
HYPERTENSION, BRADYpnea, BRADYcardia (cushings triad)!
143. Common S/S of Shock?
HYPERtension TACHYpnea and TACHYcardia
262. Hyperthyroidism?
HYPERthyroidism think of MICHAEL JACKSON in THRILLER! SKINNY, NERVOUS, BULDGING EYES, Up all night, heart beating fast
253. Huntington's Chorea?
Huntington's Chorea: 50% genetic, autosomal dominant disorder S/S: chorea --> writhing, twisting, movements of face, limbs and body -gait deteriorates to no ambulation -no cure, just palliative care
51. Before Epidural?
Hydration is a big priority!
192. Emphysema?
In emphysema the stimulus to breathe is low PO2, not increased PCO2 like the rest of us, so don't slam them with oxygen. Encourage pursed-lip breathing which promotes CO2 elimination, encourage up to 3000mL/day fluids, high-fowlers and leaning forward.
257. HyperKalemia?
MURDER - muscle weakness, urine (oliguria/anuria), respiratory depression, decreased cardiac contractility, ECG changes, reflexes
Hyperkalemia
MURDER Muscle weakness, Urine (olig, anuria) Resp depression, decreased cardiac contractility, ECG changes, reflexes
136. Common s/s of PDA
Machine like murmur
Spinal shock occurs
immediately after injury
infant has scaly spots, erythemic papillae, and something on lips. Report which to physician/
lips
valproic acid
liver failure, jaundice
149. Common sites for metastatsis?
liver, brain, lung, bone, and lymph
pain with diverticulitis
located in LLQ
appendicitis pain
located in RLQ
prednisone 10 months ok? watch for what?
long term not recommended, never change dosage, watch for osteoporosis, avoid large crowds due to increased risk for infection;
long term effect of corticosteroids
losing hair on legs
dehydration = what v/s
low bp, high hr, metabolic acidosis (low ph, high bicarb), postural hypotension, h&h, BUN, elevated
PTB
low grade afternoon fever
30. After Thyroidectomy?
low or semi-Fowler's, support head, neck and shoulders.
after Thyroidectomy
low or semi-fowler's position, support head, neck and shoulders.
299. Low Residue diet?
low residue diet means low fiver
diet for glomerulonephritis?
low sodium, water restriction
Adult axillary & tympanic temps are usually _____ than oral temps.
lower (0.5° C / 0.9° F)
neuroblastoma
maintain hydration with liberal fl intake
Creatinine
males 0.6 - 1.2 mg/dL; female 0.5-1.1
Arterial Blood Gases (ABG)
pH 7.35 -7.45 Pa02 80-100 mm Hg PaC02 35-45 mm Hg HCO3 21 - 28 mEq/L Sa O2 95-100% Cl 98-106
329. Myasthenia gravis?
myasthenia gravis= decrease in receptor sites for acetylcholine. Since smallest concentration of ACTH receptors are in cranial nerves, expect fatigue and weakness in eye, mastication, pharyngeal muscles.
multiple sclerosis
myelin sheath destruction. disruptions in nerve impulse conduction
glaucoma
painful vision loss. tunnel vision. halo
Bladder CA
painless hematuria
99. Common S/S of Bladder Cancer?
painless hematuria... CA=Cancer ! Duhh
what can grant informed consent?
parent of minor, spouse or closest relative granted power of attorney, court-ordered rep, legal guardian
354. Parkisons?
parkinson's = RAT: rigidity, akinesia (loss of muscle mvt), tremors. Treat with levodopa.
stage 2 pressure ulcer
partial-thickness skin loss
hemophilia is x linked
passed from mother to son
357. PDA?
patent ductuous arteriousus in infants! Valve doesn't close!
355. Pathological jaundice?
pathological jaundice= occurs before 24hrs and last7 days. Physiological jaundice occurs after 24 hours.
singulair
prevent exercise-induced bronchospasm, and for long-term use; take ONCE DAILY AT BED TIME
pancreatitis pts
put them in fetal position, NPO, gut rest, Prepare anticubital site for PICC, they are probably going to get TPN/Lipids
Cushing's triad
r/t ICP (HTN, bradycardia, irritability, sleep, widening pulse pressure)
Cushings ulcers
r/t brain injury
active labor and monitored variability with accelerations
reassuring FHR patterns indicating intact fetal CNS and a healthy placental/fetak exchange of O2. document and continue to monitor
96. Common S/S of appendicitis
rebound tenderness
138. Common S/S of pernicious anemia
red beefy tongue
pernicious anemia
red beefy tongue
patients with hallucinations patients with delusions
redirect them distract them
100. Common S/S of BPH?
reduced size and force of urine
BPH
reduced size and force of urine
Client's family asks you to pray with them. Response?
refer to spiritual services
s/s hyperkalemia
slow/irregular pulse, hypotn, restlessness, irritability, weakness with ascending flaccid paralysis, n/v/d, hyperactive bowel sounds
331. Myxedema/ hypothroidism?
slowed physical and mental function, sensitivity to cold, dry skin and hair
Myxedema/ hypothyroidism
slowed physical and mental function, sensitivity to cold, dry skin and hair.
dantrolene (dantrium)
slows metabolism -definitive treatment for malignant hyperthermia which is often triggered by succinylcholine (anectine)
s/s of early lithium toxicity
slurred speech, nvd, thirst, polyuria, muscle weakness
signs of abuse in elderly
unexplained bruises or welts, multiple bruises, unex[lained fractures, abrasions, lacerations, mulitplie injuries, withdrawal or passivity or fear, depression, and hopelessness
home safety for older adult group
unplug appliances by grasping the plug set their water heater temp at 49 C ( 120 F) avoid using throw rugs install bars in shower and around the toliet
Hyper reflexes absent reflexes
upper motor neuron issue (your reflexes are over the top) Lower motor neuron issue
urolithiasis
uric acid crystals found in urine
s/s of magnesium toxicity? 2 main interventions
urine output <30, rr <12, no deep patellar tendon reflexes, decreased LOC, cardiac dysrhythmia, immmmmmediately d/c, give calcium glucanate
SIGS OF RENAL FAILURE
urine output less than 30mL/hr, increased serum creatinine [greater than 1.2 mg/ dL] and BUN [greater than 20 mg/dL
indication of dehydration
urine specific gravity elevated
Communication: If the client is suicidal
use direct, yes or no questions to assess suicide risk
Communication: If the client is panicked
use gentle guidance and direction
effectiveness of blood transfusion
use hemoglobin or hematocrit levels to determine effectiveness
dumping syndrome?
use low fowler's to avoid. limit fluids
Communication: If the client is anxious or depressed
use open-ended, supportive statements
prevent heat loss by conduction
use protective cover on the scale when weighing infant
for phobias
use systematic desensitization
Urine specific gravity
1.015-1.030
specific gravity
1.015-1.030
133. Common S/S of orbital fracture?
Battles Sign and Racoon's eyes
Stage 1 hypertension
Systolic 140 to 159 Diastolic 90 to 99
Normal BP
Systolic <120 Diastolic <80
Stage 2 hypertension
Systolic >= 160 Diastolic >= 100
428. TIA?
TIA (transient ischemic attack) mini stroke with no dead brain tissue
433. TPN is given in ?
TPN(total parenteral nutrition) given in subclavian line.
Hypoglycemia Signs: TIRED
Tachycardia Irritability Restlessness Excessive hunger Depression and diaphoresis (Cold n clammy, give em candy)
88. Cold stress in a newborn?
The biggest concern with cold stress and the newborn is respiratory distress.
what to tell woman if trying to get pregnant
after stops, may take awhile
complications of chest tube insertion
air leaks - monitor the water seal chamber for continuous bubbling (air leak); tension pneumothorax - sucking chest wounds, prolonged clamping of the tubing, kinks in the tubing, or obstructing can cause this
varicella zoster or measles precation
airborne precaution
Shortness of Breath (SOB) Causes: AAAPPP
Airway obstruction Angina Anxiety Asthma Pneumonia Pneumothorax Pulmonary Edema Pulmonary Embolus
3. 1 gr= how many mg?
1 gr (grain)= 60 mg-
457. What to do if your patients chest tube accidently getes removed?
An occulsive dressing is used
430. To prevent dumping syndrome?
(post-operative ulcer/stomach surgeries) --> eat in reclining position, lie down after meals for 20-30 minutes (also restrict fluids during meals, low CHO and fiber diet, small frequent meals)
Autonomic Dysreflexia
(potentially life threatening emergency!) HOB elevate 90 degrees, loosen constrictive clothing, assess for full bladder or bowel impaction, (trigger) administer antihypertensives (may cause stroke, MI, seizure)
JOINT COMMISSION (JCAHO)
- sets standards in relation to policies, procedures, and the competency of health care team members. -- annually publishes the national patient safety goals wich specify the standard of care that clients should receive.
Airborne precautions
MTV or My chicken hez tb measles, chickenpox (varicella) Herpes zoster/shingles TB
Kawasaki disease
(inflammation of blood vessles, hence the strawberry tongue) causes coronary artery aneurysms.
Addison's disease: Cushing's syndrome:
"add" hormone have extra "cushion" of hormone
The generic names of ACE inhibitors end in...
"pril": · Capto pril (Capoten) · Enala pril (Vasotec) · Fosino pril (Monopril) · Lisino pril (Prinivil) · Rami pril (Altace)
460. What to do in the case of- A woman in labor with Un-Reassuring FHR?
(late decels, decreased variability, fetal bradycardia, etc) --> turn on left side (and give O2, stop Pitocin, increase IV fluids)
Woman in labor (un-reassuring FHR)
(late decels, decreased variability, fetal bradycardia, etc) Turn pt on Left side, give O2, stop pitocin, Increase IV fluids!
To prevent dumping syndrome
(post operative ulcer/stomach surgeries) eat in reclining position. Lie down after meals for 20-30 min. also restrict fluids during meals, low CHO and fiber diet. small, frequent meals.
expect what during latent phase of labor?
(0-3, 5-30, 30-45) 0-3 cm, contractions mild and moderate, 5-30 min apart/30-45 seconds
186. During CBI (continuous bladder irrigation)
(CBI) --> catheter is taped to thigh so leg should be kept straight. No other positioning restrictions.
461. What to do in the case of- an Air/Pulmonary Embolism?
(S&S: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of impending doom) --> turn pt to left side and lower the head of the bed.
47. Autonomic Dysreflexia/ Hyperreflexia?
(S&S: pounding headache, profuse sweating, nasal congestion, goose flesh, bradycardia, hypertension) --> place client in sitting position (elevate HOB) first before any other implementation.
ALS
(amyotrophic lateral sclerosis) degeneration of motor neurons in both upper and lower motor neuron systems
HYPONATREMIA ASSESSMENT FINDINGS
(below range of f135-145mEq/L) - delays and slow the deplarization of membranes - serum osmalarity <270mOsM/L - VS: hypothermia, tachycardia, thready pulse, hypotension, orthstatic hyptension - NUERO: Headache, confusion, lethargy -MS: muscle weakness to the point of possible respiratory compromise, fatigue, decreased deep tendon reflexes - GI: Increased motility, hyperactive bowel sounds, abdominal cramping - Complications: Seizures
176. Diabetes Insipidus?
(decreased ADH): excessive urine output and thirst, dehydration, weakness, administer Pitressin
TCA'SNURSING INTERVENTION FOR ANTICHOLINERGIC EFFECTS
(dry mouth, blurred vision, photobia, acute urinary reention, constipation, tachycardia) chew sugarless um, eat foods high in fiber, increase water intake, monitor HR, notify provider if sx are intolerable
25. After Infratentorial Surgery?
(incision at nape of neck)--> position pt flat and lateral on either side.
After infratentorial surgery
(incision at the nape of neck) position pt flat and lateral on either side.
After supratentorial surgery
(incision behind hairline on forhead) elevate HOB 30-40 degrees
29. After Supratentorial Surgery?
(incision behind hairline) --> elevate HOB 30-45 degrees
400. SIADH?
(increased ADH): change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a, HA; administer Declomycin, diuretics
68. Buck's Traction?
(skin traction) --> elevate foot of bed for counter-traction
290. Koplick's spots?
* Koplick's spots are red spots with blue center characteristic of PRODROMAL stage of Measles. Usually in mouth.
352. Pancreatitis pts>?
* Pancreatitis patients but them in fetal position, NPO, gut rest, prepare antecubital site for PICC cuz they'll probably be getting TPN/Lipids
416. Temp conversion?
* To convert Centigrade to F. F= C+40, multiply 9/5 and substract 40 * To convert Fahrenheit to C. C= F+40, multiply 5/9 and substract 40.
52. Before giving MMR>?
** Ask for anaphylactic rxn to eggs or neomycin before MMR
64. Botox?
** BOTOX for strabismus. Patch the GOOD eye so that the weaker eye can get stronger. Found a cool link about its use in peds pt with strabismus. I had to look it up cuz I heard it was important ah hem ah hem
155. COPD patients?
** COPD patients REMEMBER: 2LNC or less (hypoxic NOT hypercapnic drive), Pa02 of 60ish and Sa02 90% is normal for them b/c they are chronic CO2 retainers. ...
180. Disease precautions?
** Hepatitis A is contact precautions ** Tetanus, Hepatitis B, HIV are STANDARD precautions
281. IVP requires?
** IVP requires bowel prep so they can visualize the bladder better
429. Tidal volume?
** TIDAL VOLUME is 7 - 10ml / kg
478. Willam's position?
** William's position - Semi Fowlers with knees flexed (inc. knee gatch) to relieve lower back pain.
272. If kid has a cold?
**If kid has cold, can still give immunizations
394. SARS?
**SARS (severe acute resp syndrome) airborne + contact (just like varicella)
can you give an antibiotic in a TPN infusion line? what can you add to a TPN infusion line?
NO! Nothing!
211. Gastric ulcer pain
*Gastric Ulcer pain occurs 30 minutes to 90 minutes after eating, not at night, and doesn't go away with food
325. MRSA and VRSA precautions?
*MRSA - Contact precaution ONLY *VRSA - Contact AND airborne precaution (Private room, door closed, negative pressure)
309. Menieres's disease?
*Meniere's Disease - Admin diuretics to decrease endolymph in the cochlea, restrict Na, lay on affected ear when in bed. Triad: 1)Vertigo 2)Tinnitus 3)N/V
336. NMS?
-NMS is like S&M; -you get hot (hyperpyrexia) -stiff (increased muscle tone) -sweaty (diaphoresis) -BP, pulse, and respirations go up & -you start to drool
Cholecystitis: Dietary Restrictions
Low in fat, and sometimes a wt reduction diet is also recommended (4-6 weeks take fat soluble vit supplements
425. Thrombocyopenia- bleeding precautions
*Thrombocytopenia -Bleeding precautions! 1)Soft bristled toothbrush 2)No insertion of anything! (c/i suppositories, douche)
305. Maslow for a guy who lost his house in a fire?
- A guy loses his house in a fire. Priority is using community resources to find shelter, before assisting with feelings about the tremendous loss. (Maslow).
Psychopharmacological Therapies- Fluoxetine (Prozac)
- Advise the client to take med with meals/food and to take the med on a daily basis to establish therapeutic plasma levels - therapeutic effects may not be experienced for 1-3 weeks and that it might take 2-3 months for full benefits to be achieved. - continue therapy after improvement in sx. sudden d/c of med can result in relapse - therapy usually continues for 6 months after resolution of sx and may continue for 1 yr or longer - older adults clients taking diuretics should be monitored for sodium levels. Obtain baseline sodium levels and monitor periodically.
IV THERAPY PROBLEM AND INTERVENTION ( fluid volume excess)
- As evidenced by crackles in lungs, shortness of breath, edema - inteventions- reduce flow rate, notivuy MD
IV THERAPY PROBLEM AND INTERVENTION (electrolyte imbalances)
- As evidenced by- abnormal serum electrolyte levels, changes in mental status, and alterations in nueromuscular function, changes in VS -interventions- notify MD, additives in IV or type of IV fluid may be adjusted
characteristics of contractions during TRUE LABOR
- CONTRACTIONS- regular frequency, stronger last longer and are mnore frequent, felt in lower back radiating to abdomen, walking can increase intesntiy, continues despite comfort measures
RISK FACTORS FOR GLOMERULUAR DISEASES
- Primary infection with group A beta-hemolytic streptococcal infection (most common)- Systemic Lupus Erythematosus -Vascular injury (HTN) -Metabolic disease (DM) - Nephrotoxic drugs -Excessively high protein and high sodium diets
Psychopharmacological Therapies- LITHIUM CLT TEACHINGS
- Clients must maintain adequate sodium and fluid intake ,. lithium takes the place of sodium in body - effects of lithium begin within 5-7 days and that it may take 2-3 weeks to achieve full benefits - monitor thyroid and renal function
EXPECTED LAB FINDINGS OF DIABETES INSIPIDUS
- DILUTE URINE CHEMISTRY: decreased urine specific gravity ( < 1.005); decreased urine osmolality (50-200 mOsm/kg); decreased urine pH; decreased urine Na; decreased urine K - SERUM CHEMISTRY: increased serum osmolality ( > 295 mOsm/kg); increased serum Na; increased serum K+- As serum volume decreases, the serum osmolality increases
MEDS FOR CARDIAC HEART FAILURE
- DIURETICS- todecrease preload loop diuretics (furosemide (Lasix), bumetanine (Bumex) ) thiazide diuretics: HCTZ (ingest foods and drinks that are high in K+ to counter hypokalemia effect. )Administer IV furosemide no fast than 20mg/min AFTERLOAD REDUCING AGENTS- - ACE inhibitors (enalapril, captopril, monitor for initial dose hypotension) beta blockers (Coreg, metoprolol) Angiotensin II blockers such as losartan Inotropic agents n(increase contractility)- digoxin; dopamine; dobutamine; milrinone Vasodilators-nitrates hBNP-nesiritide (Natrecor)- causes natriuresis ANTICOAGULANTS- warfarin (Coumadin), heparin, clopidrogrel
S/E and interventions of ESTROGEN
- Endometrial and ovarian cancer- give progestins with estrogen, report persistent bleeding, endmotrial biopsy q2yrs - Estrogen dependent breast cancer- rule out prior to starting therapy, enourage mammograms and breast exams - embolic events- discourage smoking, monitor pain, swelling, warmth, anr erythema in lower legs. - feminization (gynemostia, testicular atrophy), impotence, decreased libido- avoid use of estrogen vaginal creams during intercourse. should go awyay when med is d/cd
CHEMICAL BURNS INTERVENTIONS
- Ensure patent airway - assess airway, breathing, circulation before decontamination procedures - Brush dry chemical from skin before irrigation flush chemical from wound and surrounding area with saline or water -remove clothing, including shoes, watches, jewelry and contact lenses if face exposed establish IV access with large-bore catheter needle if greater than 15% TBSA burn - begin fluid replacement b- lot skin dry with clean towels. Do not rub dry cover burned areas with dry, sterile dressing or clean, dry sheet - anticipate intubation if significant inhalation injury present - contact poison control center for assistance
EXPECTED FINDINGS OF FLUID VOLUME EXCESS
- Hemodilution: decreased Hgb and Hct; decreased serum osmolarity (<270 mOsm/L) ; decreased portein and electrolytes; decreased serum sodium, increased electlouytes BUN creatinine. - client findings- tachycardia, bounding pulse, HTN, tachpnea, increased ICP, confusion, muscle weakness, wt gain, ascities, dyspnea, orthopnea, crackles, edema, distendded neck veins
332. Nephrotic syndrome?
Nephrotic syndrome s/s edema + hypotension. Turn and reposition (risk for impaired skin integrity)
VENITLATOR ALAMRS
- If the nurse cannot determine the cause of a ventilator dysfx, the client is disconnected from the ventilator and manually ventilated with an Ambu bag - Ventilator alarms should never be turned off There are three types of ventilator alarms: therefore based on the alarm, know what to assess for. 1)volume(low pressure) alarms indicate low exhaled volume due to disconnection, cuff leak and tube displacement 2) pressure (high pressure) alarms indicate excess secretions, client biting the tubing, kinks in the tubing, client coughing, pulmonary edema, bronchospasm, and pneumothrorax. 3) apnea alarms indicate does not detect spontaneous respiration in a present time period.
GI FEEDINGS PROPER CARE
- Monitoring for tube placement initial placement is confirmed with xray - monitor gastric contents for pH. A good indication of appropriate placement is obtaining gastric contents with a pH between 0-4 - Injecting air into the tube and listening over the abdomen is not an acceptable practice - Aspirate for residual volume---note: intestinal residual < 10 mL, gastric residual < 100mL - return aspirated contents or follow protocol
POSSIBLE RESULTS FOR A NONSTRESS TEST DURING ANTEPARTUM PERIOD
- NST- tests fetal heart rate in response to fetal mvement. - Reactive NST- 15 beats/min increase in FHR for 15 seconds and 2 in 20 minutes Non reactive NST- inadequate FHR acceleration in response to movement . no fetal movement for 40 minutes
MEDS FOR MYOCARDIAL INFARCTION
- Nitroglycerin- vasodilator- reduce preload and afterload decreaseing myocardial oxygen demand (heart works less) -MORPHINE- analgesics reduce pain, which decrease sympathetic stress leading to preload reduction. -BETA BLOCKERS- antidysrthmic and antihypertensive properties. decrease imbalance between myocardial oxygen supply and demand by reducing afterloadde , decease infarct size -THROMBOLYTIC AGENTS- effective if given within the first 6 hrs forllowing an MI, . contraindications include recent surgery , recent head trauma, and any other situation that poses an additive risk for bleeding internally. -ASPIRIN- antiplatlet agents inhibit cyclooxygenase , which produces thromboxane A2 , a potent platelet activato. -ANTICOAGULANTS- (heparin)- used to prevent reoccurence of clot after fibrinolysis.
CLIENT EDUCATION REGARDING EEG
- No caffeine - Wash hair before the procedure (no oils, sprays) and after the procedure (remove electrode glue) - May be asked to take deep breaths and/or be exposed to flashes of a strobe light duringthe test -Sleep may be withheld prior to test and possible induced during test
TRANSFUSION RXNS ACUTE HEMOLYTIC
- ONSET- IMMEDIATE - findings- chills, fever, low back pain, tachycardia, flushing, hypotension, chest tightening or pain, tachypnea, nausea, anxiety, and hemoglobinuria - medical emergency as it results from rapid destruction of the donor red blood cells by host antibodies (IgG, IgM). It is usually related to ABO blood group incompatibility -INTERVENTIONS- treat shock, draw blood samples, mainain BP with IV colloid solutin, give diuretics to miantin urine flow, insert indwelling catheter or measure amouns of hourly UOP, do not transfuse additional RBC
TRANSFUSION RXNS Febrile
- Onset: 30min to 6 hr -FINDINGS- chills, fever, flushing, HA, anxiety - give anitpyretics - do not restart transfusion
INTERVENTIONS FOR ELECTRICAL BURNS
- Removal of current source must be done by trained personnel with special equipment to prevent injury to rescuer - Assess and tx pt after removal from source of current -ensure patent airway -stabilize cervical spine -administer hi flow 02 by non rebreather mask -establish IV access with large-bore catheter needle -begin fluid replacement -remove ptʼs clothing - check pulses distal to burns - cover burn sites with dry dressing assess for any other injuries (fractures, head injury) Ongoing Monitoring -monitor cardiac rhythm, VS, LOC, 02 sat, neurovascular status in injured limbs -monitor UOP to ensure adequate volume replacement -monitor urine for development of myoglobinuria secondary to muscle breakdown - anticipate admin of mannitol and NaHCO3 for myoglobinuria and hemoglobinuria.
HYPONATREMIA NURSING INTERVENTIONS
- Report abnormal findings to PCP - Fluid Overload: restrict water intake as ordered -acute hyponatremia: admin hypertonic oral and IV fluids as ordered; encourage foods and fluids high in sodium (cheese, milk, condiments) - restoration of normal ECF: administer isotonic IV therapy (0.9% NS, LR) -monitor I/O and daily wt - monitor VS and LOC--report abnormal findings.
Low molecular wt Heparin (LMWH)
- SQ,.Enoxaparin (Lovenox), dalteparin (Fragmin) and ardeparin (Normiflo) - client must be willing to learn self injection; - aPTT is not checked on an ongoing basis bec the doses of LMWH are
uncompensated and compensated acid-base imbalances
- Uncompensated: The pH will be abnormal and either the HCO3 or the PaCO2 will be abnormal - Partially compensated: The pH, HCO3, and PaCO2 will be abnormal - Fully Compensated: The pH will be normal, but the PaCO2 and HCO3 will both be abnormal
S/S OF newborn HYPOGLYCEMIA
- s/s: poor feeding, jitterness/tremors, hypothermia, diaphoresis, weak shrill cry, lethargy, flaccid muscle tone, seizures/coma
NURSING INTERVENTIONS FOR MYOCARDIAL INFARCTION
- administer O2 4-6L as prescribed - obtain and maintain IV access - administer meds as prescribed
IV THERAPY PROBLEM AND INTERVENTION ( fluid volume deficit)
- as evidenced by decreased UOP, dry mucous membranes, hypotension, tachycardia - interventions: notify MD, may require adjustment of infusion rate
IV THERAPY PROBLEM AND INTERVENTION (infiltration)
- as evidenced by swelling and possible pitting edema, pallor, coolness, pain at insertion site, and possible decrease in flow rate - intervention- stop infision and D.C iv- elevate affected extremity, restart new IV if continued therapy is necessary
NURSING ROLE SOCIAL ISOLATION IN OLDER ADULTS
- assist in rebuilding social networs and revers patterns of isolation (in response to conditions, changing appearance, or by choice) via outreach programs, meals on wheels, socialization needs, daily telephone call by volunteers, need for activities such as outings.
ORAL hypoglycemics (sulfonureas)
- avoid use in pregancy and lactation 0 rrisk for fetal infant hypoglycemia and causes birth defects
HYPOKALEMIA
- below 3.5 MeQ/L - most common causes- abnormal lossess via the kidneys or GI tract, metabolic alkalosis, sometimes associated with treatment of diabetic ketoacidosis because of increased urinary K loss and shift of K into cells with admini of insulin and correction of acidosis - EKG- PVCs, bradycardia, blocks, Vtach, inverted T waves, ST depression. - metabolic alkalosis- pH >7.45 - skeletal muscle weakness and paralysis (most observed in legs) ; respriatory muscls and those innervated by cranial nerves not involved. - rhabdomyolysis- muscle cramps and muscle cell breakdown , - leads to myogloblin in the plasma and urine which can lead to renal failure
albuterol (proventil, ventolin)
- beta2 adrenergic agonist- activates beta 2 in bronchial smooth muscles resulting in bronchodilation, inhibiting histamine release and increasing ciliarily motility Indications- longterm control of asthma. ongoing asthma attack effectiveness- long term control of asthma attack, prevention of excercise induced asthma attack, resolution of asthma attack as evidenced by absence of SOB, clear breath souds, absence of whessing,
PT teaching for CYSTIC FIBROSIS
- child stand on his head for chest physiotherapy - encourage our child to use Flutter mucus clearance device -use a metered dose inhaler to administer a bronchodilator - 6 month influenza vaccine and yearly booster - regular physical activity - administer abx through a venous access port. Parents/caregivers need instruction in admin techniques, SE to observe for, and how to manage difficulties with the venous access port
Prolapsed umbilical cord assessment findings
- client states she can feel something coming through the vagina - visiualization or palpation of the umbilical cord protruding from the inroitus - FHR- variable decelerations - extreme increase in fetal activity that occur and the ceases- suggestive of severe fetal hypoxia
TASKS THAT CAN BE DELEGATED TO both LPN & AP
- collecting VS q30min 1 hr post cardiac cath - calculating client I&O - providing oral and bathing hygiene to immobilized client- -assisting client with toileting assisting with ambulation - turining client q2 hrs
DANGER SIGNS OF HEMORRAGE FROM UTERINE ATONY
- constant steady trickle of blood - saturation of peripad in 15 minutes --> excessive blood loss - saturation of peripad in 1 hour = large amount of blood loss
AMNESTIC DISORDER FINDINGSGS
- decreased awareness of surroundings - inability to learn new info despite normal attention -inability to recall previously learned info -possible disorientation to place and time -typically there is no personality change or impairment in abstract thinking.
NEWBORN HYPOGLYCEMIA
- different for preterm and term infants - Term (first 3 days)- blood glucose levels of less than 40mg/dL - preterm - less than 25mg/dl
MAJOR SIGNS OF UTERINE ATONY
- difficult to locate fundus - soft or boggy fundus - firm fundus when massaged but soft when stopped - fundus above where it should be (at or near the umbilicus) - excessive lochia (bright red) - excessive clots expelled.
signs of exploitation of elderly
- disappearance of possessions, forced to sell possiessions or change will, overcharged for home repairs, inadequate living environment, inability to afford social activities, being forced to signg over cotron of finances, no money for food or clothes
pain management
- do not wait till severe - if if analgesis is not working well- add relaxation excercise, guided imagery, consult with physician to try new med, reduce interval between dosage, or increase dosage. - client is the best judge if treatment is working. - nurse must evaluae tolerance, side effects of meds, and clients reported pain reliev.
CLIENT EDUCATION FOR CAST CARE
- dont let it get wet, dont bear wt for 48 hrs - apply ice directly over fracture site for first 24 hr (avoid getting wet); dry cast thoroughly after exposure to water ; elevate extremity above level of heart for first 48hrs ; move joints above and below cast regularly; report signs of possible problems to HCP (increasing pain, swelling associated with pain and dicoloration of toes or finger, pain during movement, burning or tingling under the cast, sores, or foul odor under the cast); keep appt to have fracture and cast check
NURSING ROLES DURING TAKING IN PHASE (POST PARTUM)
- facilitate bonding- skin to skin immediatley after birth in the enface position, encourage feeding cuddling, diapering;
CLIENT EDUCATION (ADOLESCNET
- formal and concrete operations - peer teaching and group discussions are very effective
NURSING INTERVENTIONS FOR HYPOKALEMIA
- giving potassium chloride supplements (PO or IV) and increasing dietary intake of potassium - KCL is never given unless there is UOP of at least 0.5ml/kg of body wt per hour. -KCL supplements added to IV should never ecxeed 60meq/L . preferred level s 40meq/L -Rate should not exceed 10-20 meQ per hour to prevent hyperkalemia and cardiac arrest. - encourage foods high in potassium- avocados, brocolli, dairy products, dried fruit, cantaloupe, bananas - IV potassium- never IV push (risk of cardiac arrest); macimum recommended rate is (5-10mEq/hr) ; monitor for phlebitis, monitor and maintain UOP
EXPECTED CHANGES FOR TODDLER
- growth slows - head circumference approximately the same as chest . chest progressively grows larger than head - average wt @ 2 years 12kg - 2 years- longer leaner appearance as chest exceeds abdo
IV THERAPY PROBLEM AND INTERVENTION (bleeding)
- guaze dressing applieed, eventually IV may be D/C and restarted. .
Psychopharmacological Therapies- Disulfiram (antabuse)
- helps with alcoholism - works by blocking the processing of alcohol in the body. This causes you to have a bad reaction when you drink alcohol -Inform the client of the potentials dangers of drinking any alcohol - advise the client to avoid any products that contain alcohol (eg cough syrups, aftershave lotion) - encourage the client to wear medic alert bracelet
EPOETIN
- hematopoetic growth factor used to stimulate bone marrow to in increase production of RBCs - indicated for - anemia of chronic renal failure, HIV clients taking retrovir, anemia from chemo, anemia for clients undergoing surgery
correct use of CONDOMS
- hold rim when withdrawing -leave empty space at the tip for sperm reservoir - may be used with spermicidal gel or cream to increase effectveness - only water soluble lubricants should be used with latex condoms
TAKING IN PHASE (POST PARTUM)
- immediatly after birth (hours- couple days)- Passive dependent behavior- relies on others for comfort, rest , and care. concerned for her own needs and overall health of newborn, talkative and excited reviewing birth experience.
LAB VALUES FOR DEHYDRATION
- increased normal Hgb = above 13.5-18 g/dL (males) & 12-16 g/dL (females) - increased Normal HCT = above 40-54% (males) & 38-47% (females) = -INCREASED Serum osmolarity = (> 300mOsm/L) - -INCREASED protein, BUN, electrolytes and glucose- BUN = > 10-30 mg/dL; above Potassium = 3.5-5.5 mEq/L; -INCREASED Urine Specific Gravity and osmolarity = Specific Gravity = above 1.005-1.030 -INCREASED Serum Sodium = above Normal 135-145 mEq/L
TO ENSURE CONTINUITY OF CARE VIA REFERRALS
- initaite the discharge upon the client's admission - evaluate the client/family competencies in relation to home care prior to discharge 0 invovlve the client and family in care planning - collaborate with other health care professionals to ensure all health care needs are met - complete referral forms to ensure proper reimbursement of services offered.
HERPES ZOSTER INTERVENTIONS
- isolate them until sores have crusted -Administer meds as prescribed: Analgesics (NSAIDS, narcotics); Antiviral agens such as acyclovir, valacyclovir, favicilovir moisten - dressings with cool tap water or 5% aluminum acetate (Burowʼs solution) and apply to the affected skin for 30-60 min 4-6x/day as prescribed - Lotions (for example, Calamine) may help relieve discomfort.
INTERVENTION WHEN UTERUS IS NOT FIRMLY CONTRACTED
- massage and expel clots (one had is placed above the symphis pubis to support lower uterine segment and other hand firmly but gently massages the fundus in circular motion) - PRECAUTION- make sure uterus is contracted before attempting to apply pressure to expel clots to because pushing on an uncontracted uters could invert the uterus causing hemoorage and shock
TASKS THAT CAN BE DELEGATED TO LPN not AP
- monitoring clients condition during blood transfusions and IV administration - dressing change of an uncomplicated wound, routine nasotracheal suctioning - SQ insulin administration - assessing and documenting a clients decubitus ulcer - providing written info regarding advance directives - administerin oral meds - administer IM pain med - checking a clients feeding tube placement and patency
COMPLICATIONS OF IMMUNIZATION (thrombocytopenia)
- mostly associated with with measles vaccination -teach parents to observe for bleeding - call provider if bleeding, bruising, dot like rash.
BLOOD PRODUCTS
- no dextrose or lactalted ringers NS OK - 1st 15 minuts or 50ml nurse should stay with pt - no other additives should be given via same tubing. - rate should be nor more than 2 ml/min - should not take over 4 hrs to administer
AGE APPROPRIATE ACTIVITIES (adolescents)
- nonviolent video games nonviolent music - sports - caring for a pet - career training programs - reading -social events.
INTERVENTIONS OF NEWBORN HYPOGLYCEMIA
- obtain blood per heel stick for glucose monitoring. - treat via frequent oral, gavage, or parentral nutrition feeding.
s/s of HYPOVOLEMIC SHOCK
- one of the first signs of shock is hypovolemia - Decreased LOC; Restlessness; Anxiety;l Weaknessl Rapid, weak, thready pulses; Arrhythmias; Hypotension; Narrowed pulse pressure; cool clammy skin; tachypnea, dyspnea, shallow irregular respirations; decreased 02 saturation; extreme thirst ; chills; feeling of impending doom; pallor; cyanosis obvious hemorrhage; temperature dysregulation
opoids
- pain management all produce dose related respiratory depression - requires continous monitoring and pusle ox monitoring - respiratory depression is revereed with NARCAN( naloxone) but this also reverses analgesic effects.
CHARACTERISTICS OF CONTRACTION DURING FALSE LABOR
- painless , irregular frequency, and intermittent - decrease in frequency, duration, and intensity with walking or position changes, -felt in lower back or abdomen above umbilicus - often stop with comfort measurs such as oral hydration
PEOPLE ALLOWED TO GRANT INFORMED CONSENT FOR ANOTHER
- parent of minor - legal guardian - spouse - dual power of attorny court specificed representative.
INTERVENTION FOR NON REACTIVE NON STRESS TEST
- problem- might be false nonreactive because of fetal sleep cycle , meds, fetal immaturity or smoking- use a vibroacoustic stimulation to wake them up (applied for 3 seconds) - further assessment such as contraction stress test or biophysical profile.
Protonix (pantoprazole); omeprazole (prilosec)
- proton pump inhibitors used to reduce astric acid secretion by irreveribly inhibitin the enzyme that produces gastric acid. presribed for gatric and peptic ulcers, GERD, and hypersecretarory conditions,. (Zollinger- Ellison syndrome) - allow at least 2 hrs between med and these (because it delays absorption of these meds- digoxin, iron, ketoconazole, ampicillin - INTERVENTIONS & TEACHING - take once a day prior to eating, do not chew sustained release, avoid taking irritating meds (ibuprofen and ETOH), acitive ulcers should be txed for 4-6 wks, notify PCP for any signs of obvious or occult GI bleeding
Nursing Responsbilities regarding advance directives
- provide written information regarding advance directives - document the cleints advance directive status - ensure that the advance directive is current and reflective of the clients current decisions. - inform all members of the health care team of the clients advance directive
PROLAPSED UMBILICAL CORD INTERVENTIONS
- relieve cord compression immediately and increase fetal oxygenation 1) call for assistance immediately notifiy the primary care provider of the prolapsed cord 2) relieve pressure- position the clients hips higher than her head, reposition in the client in knee-chest postion . trendlenberg or a side-lying position with a rolled towel under the clients right or left hip to relieve pressure on the cord, use sterile gove insert two fingers into the vagina and apply finer pressure to elevate it off cord, apply sterile saline soaked towel to the cord to prevent drying and to maintain blood flow - closely monitor the FHR for variable decelerations indicative of fetal asphyxia and hypoxia from cord compression - amnioinfusion of NS or LR as prescribed if compression caused by oligohydramnios. ) increase oxyenation - administer 8-10L via face mas
C6 spinal cord injury movement remaining
- shoulder and upper back abduction and rotation at shoulder, fulll biceps, wrist extension, weak grasp of tongue, decreased respiratory reserve - rehab potential- abiity to assist with transfer and perform some self carel feed self with hand devices , attendant 6 hrs a day
MAGNESIUM SULFATE THERAPY TOXICITY and INTERVENTIONS
- signs of MG toxicity- absence of patellar deep tendon reflexes. urinary output of <30 cc/hr decreased LOC, resp <12 min. -interventions- immediate discontinue infusion. administer calcium gluconate (IV admin of 1g (10 ml or 10% solution) @ 1ml/1min) - should always be available - UOP falls below 20: notify MD to adjust med.
CLIENT EDUCATION REARDING RESPONSE TO CHEST PAIN FROM MI
- stop activity and rest, -place nitro under tongue to dissolve (quick absorption) - repeat every 5 min if the pain is not relieved - call 911 if pain is not relieved in 15 minutes
COPD fatigue interventions
- structure activity to include periods of rest - provide adequate nutrition- increased work of breathing increases caliric demands. - energy conservation techniques: tripod position, pursing lips , sit while performing activities. -exhale during exertion, inhale during rest - use O2 during hygiene activitities. walking is the best excercise for COPD
AGE APPROPRIATE HEALTH PROMOTION ADOLESCENTS (12-20)
- substance abuse- programs that assist with preventing (ie_ drug abuse resistance education (DARE)- - sexual experimentation- abstinence is highly recommended. or birth control -STDs- encourage gentalia exams, cervical or urethral cultures. counseling about risk taking behaviors . condoms. -PREGNANCY- education to prevent, identify to ensure adequate prenatal healthcare
NAGELE"S RULE FOR CALCULATING EDD
- take first day of last menstrual period - subtract 3 months, add one year, add 7 days
NURSING ROLE DURING TAKING HOLD PHASE (POST PARTUM)
- taking hold- mother moves towards independence in care of the newborn and adjusts to the maternal role. - provide frequent praise, reassurance, and support to mother - encourage parents to disucss feelings, fears, and anxieties about caring for their newborn.
FIVE RIGHTS OF DELEGATION (RIGHT TASK)
- the right task is based on specific client and appropriate for team member- one that requires little supervision, repeititve , and relatively noninvasive -EX: Right task- LPN to do dressing change on cellulitis WRONG - LPN to do care plan -EX- Right task- AP to assist with bedpan WRONG- AP to administer neubulizer treatment to client with pneumonia.
NARCAN (NALOXONE)
- used post op to reverse respiratory depression thay may occur due to anesthetics and opoid use. also reverses analgesic effects - if the clientʼs respirations are less than 8/min and shallow and the client is difficult to arouse. Naloxone must be diluted in NS (0.4mg/10mL) and given by IV slowly. After admin of naloxone, the client should be reassessed.
MAGNESIUM SULFATE THERAPY
- used to treat gestational hypertension that occus after 20th week of pregnancy (BP 140/90 or greater systolic increase of 30mmhg diastolic increas of 15 mmhg, NO PROTEINURIA OR EDEMA)
TRIAGE LAST PRIORTY
- victims with local injuries without immediate complications and who can wait several hour. or minimial probability of surviving.
naegeles rule
-3+7
COMPLICATIONS OF IMMUNIZATIONS (anaphylaxis)
-ANAPHYLAXIS- (prodromal sx)- uneasiness, impending doom, restlessness, irritability, severe anxiety, headache, dizziness, paresthesia, disorientation, CUTANEOUS SIGNS are the most common intial sign (child may complain of feeling warm, angioedeme (most notciable in the eyelids, lips, tongue, hands, feet, genitalia) - cutaneous signs often follwed by bronchiolar constriction. - BRONCHIOLAR CONTRICTION- narrowing of the airway, dilated pulmonary circulation causis pulmonary edema and hemorrhages, and there is often life threatenin larygeal edema. -INTERVENTION- call 911 keep child quiet until help arrives
Emergency Management: Decontamination Following Exposure to Bioterrorism
-ANTHRAX: remove contaminated clothing and store in labeled plastic bags. Handle clothing minimally to avoid agitation. shower throroughly with soap and water. Recommended postexposureprophylaxis includes the admin of oral fluorquinolones (cipro, levofloxacin, and ofloxacin) -BOTULISM - decontamination is not required -PLAGUE- Risk for reaerosolization form contaminated clothing of exposed persons is low same as anthrax The antimicrobial agentof choice is doxycycline or cipro. -SMALL POX- Client decontamination after exposure is not indicated.
EXPECTED LAB FINDINGS OF RHEUMATIC FEVER
-Antistreptolysin O titer - > 250 IU/ml - Erythrocyte sedimentation rate- > 15 mm/hr in men, > 20 mm/hr in women -C-reactive protein- Positive -Throat culture- Positive for streptococci (usually negative) -WBC count- Elevated -Red blood cell parameters- Mild to mod degress of normocytic, normo- (HCT, Hgb, RBC)- chromic anemia
INTERVENTIONS FOR THERMBAL BURNS
-Ensure patent airway -Stop the burning process -inspect face and neck for singed nasal hair, hoarseness of voice, stridor, soot in the sputum -administer high flow 02 by non rebreather mask anticipate intubation with significant inhalation injury -establish IV access with large bore catheter begin fluid replacement -remove clothing and jewelry -identify and tx associated injuries (fractured ribs, pneumothorax) -determine depth, extent, and severity of burn -administer IV analgesia -cover large burns with dry dressing -apply cool compresses or immerse in cool water for minor injuries only (less than 10% TBSA burn) -insert urinary catheter for severe burns prevent loss of body heat -transport asap to burn center -do not debride burns or apply topical agents before transfer to a burn center -administer tetanus prophylaxis as appropriate
INTERVENTIONS TO INHALATION BURNS
-Ensure patent airway -administer high flow 02 by non rebreather mask remove ptʼs clothing -establish IV access with large bore catheter needle -begin fluid replacement -place in high fowlerʼs position unless spinal cord injury suspected -assess for facial/neck burns or other trauma -obtain arterial blood gas carboxyhemoglobin levels and chest xray -anticipate need for fiberoptic bronchoscopy or intubation
USES FOR COLD THERAPY
-Good to reduce inflammion (ie sprained ankle, knee arthroplasty, toothache,) - reduces fever diminishes muscle spasms -Reduce bleeding (ie nose bleed) -CONtraindicated with pts with vascular disease, rynauds phenomemenon- it can trigger it.
242. Hirschsprungs?
-Hirschsprung's --> bile is lower obstruction, no bile is upper obstruction; ribbon like stools.
Psychopharmacological Therapies- Methylphenidate (Ritalin)- clitent teaching
-Instructing the client to be alert for signs of mild overdose such as restlessness,insomnia and nervousness. Signs of severe overdose include panic, hallucinations, circulatory collapse and seizures. -Suggesting to parents to initiate a periodic pill count if they doubt the clientʼs med compliance -avoid other CNS stimulants such as coffee, cola, tea, and chocolate -instructing the client to avoid alcohol or OTC meds unless approved by the PcP. Many OTC meds contain CNS stimulant properties -SE of abruptly stopping the med (potential for abstinence syndrome) -Instructing the client to take the morning (or daily) dose after breakfast and the last dose in the early afternoon to minimize wt loss and insomnia. -should be taken at least 6 hr before bedtime - minimize dry mouth- candy, water
discharge critera after Conscious sedation
-LOC as on admission -VS stable for 30-90 min -Ability to cough and deep breathe -ability to take oral fluids -No N/V, SOB, or dizziness
326. MS?
-Multiple Sclerosis is a chronic, progressive disease with demyelinating lesions in the CNS which affect the white matter of the brain and spinal cord. Motor S/S: limb weakness, paralysis, slow speech Sensory S/S: numbness, tingling, tinnitus Cerebral S/S: nystagmus, ataxia, dysphagia, dysarthria
327. Munchhausen Syndrome?
-Munchausen Syndrome is a psychiatric disorder that causes an individual to self-inflict injury or illness or to fabricate symptoms of physical or mental illness, in order to receive medical care or hospitalization. In a variation of the disorder, Munchausen by proxy (MSBP), an individual, typically a mother, intentionally causes or fabricates illness in a child or other person under her care.
SAFE USE OF ARTIFICIAL AIRWAY EQUIPMENT
-Provide trach care q 8 hrs- if necessary using sterile suctioning supplies. remove old dressing and excess secretions -apply the oxygen source loosely if the client desaturates during the procedure use cotton-tipped applicators and gauze pads to clean exposed outer cannula surfaces. -Begin with H20 followed by normal saline. Clean in circular motion from stoma site outward. -using surgical aseptic technique, remove and clean the inner cannula (use H202to clean the cannula and sterile saline to rinse it. -Clean the stoma site and the trach plate with H202 followed by sterile saline. -Place split 4x4 dressing around trach. -Change trach ties if they are soiled. (Secure new ties in place first) -One or two finger should be able to be placed between the tie tape and the neck. -document the type and amt of secretions, the general condition of the stoma and surrounding skin, the clientʼs response to the procedure, and any teaching that occurred. -Provide adequate humidification and hydration to thin secretions - Suction PRN (not routinely) when assessment findings indicate (eg audible/noisy secretions, crackles, restlessness, tachypnea, tachycardia, presence of mucus in the airway.
CLIENT P
-Semi-Fowler's position • frequently used to prevent regurgitation of tube feedings and aspiration in clients with difficulty swallowing. -FOWLERS- frequently used during procedures such as nasogastric tube insertion and suctioning. It also allows for better chest expansion and ventilation, as well as better dependent drainage, after abdominal surgeries.ergonomic principles -HIGH FOWLERS- promotes lung expansion by lowering the diaphragm and is used for clients experiencing severe dyspnea. -PRONE- promotes drainage from the mouth for clients following throat or oral surgery, but inhibits chest expansion. -LATERAL OR SIDE LYING- • This is a good sleeping position, but the client must be turned regularly to prevent development of pressure ulcers on the dependent areas. A 30° lateral position is recommended for -ORTHOPNEIC POSITION The client sits in the bed or at the bedside. rests his arms on the over-bed table. allows for chest expansion and is especially beneficial to clients with COPD. -TRENDELENBURG POSITION- entire bed is tilted with the head of the bed lower than thefoot of the bed.is used during postural drainage, and it facilitates venous return.
COMMON ABNORMAL ECG CHARACTERISTICS
-VTACH- Wide QRS, no P wave -SUPRAVTACH- narrow QRS -VENTIRCULAR FIB- NO waves, No pattern -R VENTRICULAR HYEPRTROPHY- negative or tall QRS -ATRIAL FIB- No P waves, irregular baseline -ATRIAL FLUTTER- T/P waves indistinguishable, saw tooth P waves , more P waves that QRS
UNFRACTIONATED HEPARIN IV
-anticoagulant preventing and reducing clot formation. - Followed by anticoagulant (warfarin), based on body weight ,- monitor aPTT to allow for adjustments of heparin dosage, - monitor platelet counts for heparin-induced thrombocytopenia, - protamine sulfate is the antidote for heparin if needed for excessive bleeding)
IV THERAPY PROBLEM AND INTERVENTION (phlebitis)
-as evidenced by pain, increasd skin temp, erythema along vein, throbbing, burning, slow ed infusion. - intervention- stop infusion, and D/C iv. restart new if coninued therapy is needed, place moist warm compress over area
SEICURE PRECAUTIONS
-assess the client with a hx of seizures for: freq; type and date of last seizure; meds; triggers or trends of the seizures -Ensure rescue equipment is at the bedside to include oxygen, an oral airway, andsuction equipment. A saline lock may be put in for IV access -Inspect the clientʼs environment for items that may cause injury -Assist the client at risk for a seizure in ambulation and transfer to reduce the risk of injury -DO NOT put anything in the clientʼs mouth (except in status epilepticus, where an airway is needed) -DURING SEIZURE- do not restrain the client in the event of a seizure, lowerhim to the floor or bed, protect his head, remove nearby furniture, provide privacy, put the client on his side, if possible and loosen clothing -After a seizure, explain what happened to the client, provide comfort and understanding and a quiet environment for the client to recover. -Document and report it to the PCP.
CARE THAT CANNOT BE DELEGATED
-assessment -diagnosis - planning - evaluation - administering blood to a client - initiating client referrals. - recieving report -iniating conitnous IV - evaluating a clients advance directive status - inital feeding of client with risk of aspiration - calculating and monitoring TPN flow rate
TPN
-clients who are unable to digest or absorb eneral nutrition benefir from PN. TPN is a nutritionaloy adequate hypertonic solution of glucose and other nuttrients and electrolytes iven trhouh indwelling or central IV catheter -lipid emulsions provide supplemental kilocaleries and prevent essential fatty acid deficinceis- can be admninistered through sep peripheral line or as a mixture, if adding to PN solution (3 in 1 mixture)- givenover 24 hour period. should not be given mixture if oil droplets or layer observed to prevent fat emboli.
CYSTIC FIBROSIS
-hereditary and is transmitted as an autosomal recessive trait, both parents must be carriers. -dysfunction of the exocrine glands, causing the glands to produce thick, tenacious mucus.--> over inflation of lungs, obstruction in small pathways in various organs, (pancreas, liver, reproductive organs) - Major organs affected are the lungs, pancreas and liver - Chronic, recurrent respiratory infections are a classic sign of the disease process. Atelectasis and small lung abscess are common early complications. Bronchiectasis and emphysema may develop with pulmonary fibrosis
dehydration
-hypovolemia - elevated urine specific gravity
PROPER CARE OF COLOSTOMY
-intact skin barriers with no evidence of leakage do not need to be changed daily andcan remain in place for 3-5 days. -skin should be washed with mild soap, warm water and dried thoroughly beforebarrier applied -pouch must fit snugly to prevent leakage around stoma. The opening around the appliance should be no more than 1/16 inch larger than the stoma. Stoma shrinks and -does not reach usual size for 6-8 weeks -empty pouch before it is 1/3 full to prevent leakage -cleanse skin and use skin barriers and deodorizers to prevent skin breakdown and malodor -apply skin barrier and pouch. if creases next to stoma occur, use barrier paste to fill in; let dry 1-2 min -apply non-allergic paper tape around the pectin skin barrier in a picture frame method.
DIET MODIFICATIONS FOR DUMPING SYNDROME
-meal size must be reduced accordingly (6 small feedings) -no drinking fluids with meals (30-45 min before or after meals) helps prevent distention or a feeling of fullness -dry foods with low-carb content and moderate protein and fat content -proteins and fats are increased -no concentrated sweets (honey, sugar, jelly, jam)- cause dizziness, diarrhea, a sense of fullness -short rest period after each meal
CLINICAL MANIFESTATIONS OF DIABETIC KETOACIDOSIS
-severe hyperglycemia >300 mg/dl , accumulation of ketons in blood and urine, rapid onset; -polyuria, polydypsia, polypahgia (early signs) , change in mental status, signs of dehydration (dry mucous membranes, wt loss, sunken eyeballs, resulting from fluid loss such as polyuria - Kussmaul respiration pattern, rapid and deep respirations, "fruity" breath N/V, abdominal pain
Peds Labs: Conjugated direct Bilirubin
0.0-0.2 mg/dl
lithium levels
0.4-1
Digoxin
0.5-2 ng/mL
Adult temporal temps are nearly _____ higher than oral temps.
0.5° C / 1° F
Normal INR Therapeutic INR
0.7-1.8 2-3
creatinine
0.7-14
Lithium
0.8-1.4 mEq/L
INR
0.9 - 1.2 but 2 to 3 on Coumadin therapy (therapeutic)
8. 1 tablespoon = how many ml?
1 T(tablespoon)= 3 t = 15 ml
Peds Labs: Hematocrit
1 day: 48-69% 2 day: 48-75% 3 day: 44-72% 2 month: 28-42% 6-12 year: 37-49% 12-18 year Male: 37-49% 12-18 year Female: 36-46%
when should a trough level be scheduled for a once daily dosing of gentamycin?
1 hr prior to next dose
6. 1 pint = how many cups?
1 pint= 2 cups-
7. 1 quart = how many pints?
1 quart = 2 pints
9. 1 tsp= how many ml ?
1 t (teaspoon)= 5 ml
NURSING POLICIES PROCEDURES AND STANDARDS ARE DEFINED & DOCUMENTED,
1) standard is developed and approved by facility committee 2) provide and document care according to standard. an AUDIT is performed to determine if the standard is being met - retrospective audit- happens after the client receives care -concurrrent audit- occurs while the client is recieving care. -prospective audit- predicts how future client will be affected by current level of services. 3) educational or corrective actin is provided if standard not met
INTERVENTIONS FOR ACUTE BLOOD RXN DURING BLOOD TRANSFUSION
1) stop transfusion 2) maintain a patent IV line with saline soln 3) notify the blood bank and HCP immediately 4) recheck ID tags and numbers 5) monitor V.S and Urinary output 6) treat symptoms per MD order 7 save blood bag and tubing and send to bllod bank 8) complete transfusion reaction reports 9) collect required blood and urine specimens at intervals stipulated by hosptal policy 10) document on transfusion reaction
CYSTIC FIBROSIS INTERVENTIONS
1)Resp interventions- tx resp infx with abx therapy; provide pulmonary hygiene with CPT a minimum of twice a day; Flutter mucus clearing device; Administer bronchodilators through MDIs or hand held neb - Administer dornase alfa (Pulmozyme) through a nebulizer to decrease viscosity of mucus. - Promote physical activity GI interventions- Administer pancreatic enzymes with meals and snacks( capsules can be swallowed whole or opened
Peds Labs: Hemoglobin
1-3 day: 14.5-22.5 g/dl 2 month: 9.0-14.0 g/dl 6-12 years Male: 13.0-16.0 g/dl 6-12 years Female: 12.0-16.0 g/dl
When prioritizing, remember the four orders:
1. Any immediate threats to safety (ABCs, Maslow) 2. Actual problems for which the client is requesting help 3. Actual or potential problems of which the client may not be aware 4. Actual or potential future problems
73. Cane walking?
1. COAL (cane walking): C - cane O - opposite A - affected L - leg
Orders of prioritization:
1. Treat first any immediate threats to a patient's survival or safety. Ex. obstructed airway, loss of consciousness, psychological episode or anxiety attack. ABC's. 2. Next, treat actual problems. Ex. nausea, full bowel or bladder, comfort measures. 3. Then, treat relatively urgent actual or potential problems that the patient or family does not recognize. Ex. Monitoring for post-op complications, anticipating teaching needs of a patient that may be unaware of side effects of meds. 4. Lastly, treat actual or potential problems where help may be needed in the future. Ex Teaching for self-care in the home. Here are some great principles to help you as you prioritize: Systemic before local Acute before chronic Actual before potential Listen don't assume Recognize first then apply clinical knowledge Maslow's Hierarchy of Needs: Prioritize according to Maslow with physiological and safety issues before psychological esteem issues.
Magnesium
1.3- 2.1 mEq/L
Magnesium
1.3- 2.1 mg/dL
Stomach pH
1.5-2.5
In bilateral arm BP measurements, if the difference is more than _____ mm Hg, use the arm with the higher reading for subsequent measurements.
10
flush a central line with how many mL?
10! 3 if peripheral
Theophylline
10-20 mcg/mL
therapeutic drug level of Dialantin
10-20 mcg/mL
BUN
10-20 mg/ dL
BUN
10-20 mg/dL
Average Resting Heart Rates: Birth to 1 week 1 week to 3 months 3 months to 2 years 2 to 12 years 12 years and older
100-160/min with brief fluctuations above & below this range, depending on activity level (crying, sleeping). 100 to 220/min 80 to 150/min 70 to 110/min 70 to 110/min
1 g (gram)
1000 mg
Expected Blood Pressure Ranges for Girls 16 yrs
108-138/ 64-93
Normal PT
11-12.5 sec
Prothrombin Time (PT) (Coumadin)
11-14 seconds: therapeutic range 1.5-2x normal or control value
Expected Blood Pressure Ranges for Boys 16 yrs
111-145/ 63-94
Normal Adult Respiration Range
12 to 20/min
hgb
12-18
BUN
12-20
Normal Infant Pulse Rate
120 to 160/min
na
135-145
Sodium
136-145 mEq/L
Sodium (Na)
136-145 mEq/L
Ammonia
15-110 mg/dL
PLTs
150,000- 400,000/ mm3
Platelets
150,000-450,000
platelets normal
150-400
I lb
16 oz
Partial thromboplastin Time (aPTT) (Heparin)
16-40 range; therapeutic range 1.5-2x normal or control value
Fibrinogen levels
170 - 340mg/dL
anterior fontanelle closes by...posterior by..
18 months, 6-8 weeks
Kidney glucose threshold
180
1. 1cup=howmanyoz?
1cup=8oz-
2. 1g=howmanymg?
1gram=1000mg-
70. Burn Degrees?
1st Degree - Red and Painful 2nd Degree - Blisters 3rd Degree - No Pain because of blocked and burned nerves
Adult temporal temps are nearly _____ higher than axillary temps.
1° C / 2° F
1 pint
2 cups
1 quart
2 pints
advance directives
2 types: living will (directions in case of terminal illness) or durable power of attorny (cant make decisions byself - needs to be signed by 2 witnesses not a relative or physician - to be enforcable client needs to be incompetent (determined by judge) or lack decisional capacity (determined by physician & family)
postoperative are for a client following a colon resection for colorectal cancer includes which of the following? SATA; 1: report to the provider that the stoma is red in color and has serosanguineous discharge 2: monitor and treat pain & evaluate pain-relief measures 3: start a full liquid diet upon return to medical unit 4: provide wound care using surgical aseptic technique 5: advise the client to use stool softners to prevent straining
2, 4, 5
Developmental
2-3 months: turns head side to side 4-5 months: grasps, switch and roll 6-7 months: sit at 6 and waves bye bye 8-9 months: stands straight at 8 10-11 months: belly to butt 12-13 months: 12 and up, drink from a cup
3 years of age normals; immunization?
2-3kg/yr, 2.5-3 in/yr, picky eaters, initiative vs guilt, imaginary friends, ride tricycle, jump off bottom step, stand on one foot for a few seconds, DTaP, IPV, MMR, varicella, influenza
1 kg
2.2 lbs
4. 1 kg= how many pounds?
2.2-
School-age Children Respiratory Rate Range
20 to 30/min
HCO3
21-26mmol/L
Bicarb HCO
21-28 mEq/L
With hyperthermia, maintain environmental temp between _____ & _____.
21° C / 27° C (70° F / 80° F)
aPTT normal level
25-35
TIBC
250-460 mcg/dL
MCH
27 -31 pg/cell
COPD patients and O2
2LNC or less. They are chronic CO2 retainers expect sats to be 90% or less
113. Common S/S of epiglottitis?
3 D'S --Drooling, Dysphonia, Dysphagia
What walking gate for stairs? (crutches)
3 point
159. Cranial nerves for Assessing extraocular eye movements?
3,4,6
Phosphorus
3.0- 4.5 mg/dL
Phosphorus PO4
3.0-4.5 mg/dL
potassium
3.5-5
Potassium
3.5-5.0 mEg/L
Potassium
3.5-5.0 mg/L
uric acid
3.5-7.5
Arms at what degrees when hands on crutch rails while standing?
30 degrees
when should a peak level be drawn for divided doses of gentamycin?
30 m after admin of med or infusion has finished
1 oz
30 mL
take peak gentamicin (amino glycoside) when? trough?
30 min after giving IM, or 30 min after IV has finished; trough immediately before giving next dose
New Born Respiratory Rate Range
30 to 60/min
Average Resting Respiratory Rates: Newborn Newborn to 1 year 1 to 2 years 2 to 6 years 6 to 12 years 12 years and older
30 to 60/min with short periods of apnea (less than 15 seconds) 30/min 25 to 30/min 21 to 24/min 19 to 21/min 16 to 18/min
Normal PTT Therapeutic PTT
30-40 sec 1.5-2 x normal control values
247. Howmanyozinaml?
30ml=1oz
pCO2
35-45 mmHg
Hypothermia, a body temp below _____ is an abnormally low body temp.
35° C / 95° F
Average Temperature Ranges: Birth to 1 year (Axillary) 1 to 12 years (Oral) 12 years and older (Oral)
36.5 to 37.2 C (97.7 to 98.9 F) 36.7 to 37.7 C (98.1 to 99.9 F) 36.6 to 36.7 C (97.8 t 98.0 F)
Newborn's temps should be maintained between _____ & _____.
36.5° C / 37.5° C (97.7° F / 99.5° F)
Older adult average body temps is _____.
36° C / 96.8° F
Adult Oral Temperature Range
36° to 38° C / 96.8° to 100.4° F
Normal Adult Temp - Oral
37° C / 98.6° F
Fever is usually not harmful unless it exceeds _____.
39° C / 102.2° F
145. Common S/S of TEF?
4 C'S- Coughing, Choking, Cyanosis and continuous droolings
tx for hypoglycemia
4 oz or 2 oz grape juice or 8 oz milk, recheck bg in 15 min if still low (<70) give 15 g more carbs, recheck in 15 min, if w/n normal limits eat 1g protein (peanut butter, cheese)
11. 4 year olds?
4 year old kids cannot interpret TIME. Need to explain time in relationship to a known COMMON EVENT (eg: "Mom will be back after supper").
increase PAWP means what? reference?
4-12, increased means left sided heart failure
rbc
4-6
incubation period for infectious mono
4-6 weeks
hct
40
Sphygmomanometer cuff width should be _____ of the arm circumference.
40%
With menopause, intermittent body temp may increase by up to _____.
4°C / 7.2° F
1 tsp
5 mL
Give what for hypovolemic shock ?
5% dextrose in LR
a client involved in a motor vehicle crash presents to the emergency department with severe internal bleeding. The client is severely hypotensive & unresponsive. The nurse anticipates that which IV solution will most likely be prescribed to increase intravascular volume, replace immediate blood loss volume & increase BP? (5% dextrose in LR, 0.33 NaCl, 0.225% NaCl, 0.45 NaCl)
5% dextrose in LR
Dolasetron (Anzemet) Granisetron (Kytril , Sancuso) Ondansetron (Zofran) Tropisetron (Navoban) It's 'Tron' to the rescue!
5-HT3 receptor antagonists (serotonin antagonists)
hungtington's
50% genetic autosomal dominanat disorder.. s/s uncontrolled muscle movements of face, limbs and body. no cure
nurse is educating on losing one pound a week; how many calories?
500 calories/day
WBC
5000 -10,000
WBCs
5000- 10,000/ mm3
wbc
5000-10000
Normal Adult Pulse Rate
60 to 100/min
Alzheimer's
60% of all dementias, chronic, progressive degenerative cognitive disorder.
Tidal volume is
7-10 ml/kg
Stranger anxiety is greatest at what age?
7-9 months..separation anxiety peaks in toddlerhood
pH
7.35-7.45
Glucose
70-105 mg/dL
glucose
70-110
fentanyl patch changing time
72 hours, 48 if intolerant
Average pulse range for a 12 to 14 year old child is
80 to 90/min
The bladder of a blood pressure cuff should surround _____ of the arm circumfrence of an adult and the whole arm of a child.
80%
pO2
80-100 mmHg
Expected Blood Pressure Ranges for Boys 1 yr
80-114/ 34-66
1 cup
8 oz
calcium
8.5-10
Expected Blood Pressure Ranges for Boys 6 yrs
91-125/ 53-84
MCV
80-90mm3
Expected Blood Pressure Ranges for Girls 1 yr
83-114/ 38-67
A pulse ox less than _____ is considered abnormal.
85%
Some illness states may allow for a pulse ox of _____ to _____.
85% to 89%
Expected Blood Pressure Ranges for Girls 3 yrs
86-117/ 47-76
Expected Blood Pressure Ranges for Boys 3 yrs
86-120/ 44-75
Calcium
9.0-10 mg/dL
Total Calcium
9.0-10.5 mg/dL
Glomerular filtration rate (GFR)
90-120 ml/min
Acceptable pulse ox range for some clients range from_____ to _____.
91% to 100%
Expected Blood Pressure Ranges for Girls 6 yrs
91-122/ 54-83
Normal Adult Pulse Ox
95% to 100%
chloride
95-105
Expected Blood Pressure Ranges for Boys 10 yrs
97-130/ 58-90
Chloride
98-106 mEq/L
Expected Blood Pressure Ranges for Girls 10 yrs
98-129/ 59-88
Fibrin degradation products
< then 10 mcg/mL
HgbA1c
<6.5%
Foster Family
A child or children who have been placed in an approved living environment away from the family of origin-usually one or two parents
12. A child with a ventriculoperitoneal shunt
A child with a ventriculoperitoneal shunt will have a small upper-abdominal incision. This is where the shunt is guided into the abdominal cavity, and tunneled under the skin up to the ventricles. You should watch for abdominal distention, since fluid from the ventricles will be redirected to the peritoneum. You should also watch for signs of increasing intracranial pressure, such as irritability, bulging fontanels, and high-pitched cry in an infant. In a toddler watch lack of appetite and headache. Careful on a bed position question! Bed-position after shunt placement is flat, so fluid doesn't reduce too rapidly. If you see s/s of increasing icp, then raise the hob to 15-30 degrees.
Diverticulosis and Diverticulitis:
A high-fiber diet may prevent diverticulosis and diverticulitis by producing stools that are easily passed and thus decreasing pressure within the colon. During acute diverticulitis, a low-fiber diet is prescribed in order to reduce bowel stimulation. Avoid foods with seeds or husks. Clients require instruction regarding diet adjustment based on the need for an acute intervention or preventive approach.
321. More IVP info?
A laxative is given the night before an IVP in order to better visualize the organs.
371. Potassium and acid base balance?
A little trick regarding potassium: ALKALOSIS: K is LOW Acidosis is just the opposite: K is High The vital sign you should check first with high potassium is pulse (due to dysrhythmias).
274. If you THINK a patient has new HTN?
A newly diagnosed hypertension patient should have BP assessed in both arms
Anti-Parkinsonian Drugs include: A Cat Does Like Milk!
A nticholinergic Agents C OMT Inhibitors (catechol-O-methyltransferase); An enzyme involved in degrading neurotransmitters. D opamine Agonists L evodopa M AO-B Inhibitors
Tips on Delegation
A nursing assistant can perform tasks such as taking vital signs, range of motion exercises, bathing, bed making, obtaining urine specimens, enemas and blood glucose monitoring. Nursing assistants cannot interpret results or perform any task beyond the skill level of the certification they received. The PN is managed under the supervision of the RN. Certain higher level skills can be delegated after competency has been established by the RN (e.g., dressing changes or suctioning).
298. Low crit/hemoglobin?
A patient with a low hemoglobin and/or hematocrit should be evaluated for signs of bleeding, such as dark stools.
379. Pt with edema and walking?
A patient with liver cirrhosis and edema may ambulate, then sit with legs elevated to try to mobilize the edema.
TB
A positive Mantoux test indicates pt developed an immune response to TB. Acid-fast bacilli smear and culture:(+suggests an active infection) the diagnosis is CONFIRM by a positive culture for M TB A chest x-ray may be ordered to detect active lesions in the lungs QuantiFERON-TB Gold: DIAGNOSTIC for infection, whether it is active or latent
445. Western blot test?
A positive Western blot in a child <18 months (presence of HIV antibodies) indicates only that the mother is infected. Two or more positive p24 antigen tests will confirm HIV in kids <18 months. The p24 can be used at any age.
414. TB test confirmation?
A positive ppd confirms infection, not just exposure. A sputum test will confirm active disease.
Oral contraceptives: Signs of potential problems—"ACHES"
Abdominal pain (possible liver or gallbladder problem) Chest pain or shortness of breath (possible pulmonary embolus) Headache (possible hypertension, brain attack) Eye problems (possible hypertension or vascular accident) Severe leg pain (possible thromboembolic process)
83. Charcots sign?
A. Charcot's triad for multiple sclerosis 1. Nystagmus 2. Intention tremor 3. Scanning or staccato speech
MEDS FOR COMPLICATIONS OF CHEMO AND RADIATION THERAPY
A. Oprelvekin (Interleukin-11)- for decreased platelet count B. Epoetin alfa (Epogen)- used in the treatment of anemia C. Filgrastim (Neupogen)- stimulates WBC production D. Megestrol (Megace)- used toincrease appetite.
41. Apgar Scoring?
A= appearance (color all pink, pink and blue, blue [pale]) P= pulse (>100, < 100, absent) G= grimace (cough, grimace, no response) A= activity (flexed, flaccid, limp) R= respirations (strong cry, weak cry, absent)
ACE Inhibitors
ACE inhibitors block the production ofangiotensin II which results in vasodilation, sodium and water excretion, and potassium retention. Drugs in this class are used for treating heart failure, hypertension, myocardial infarction, and diabetic or nondiabetic nephropathy. Clients taking captopril (Capoten) should be instructed to take med at least 1 hour before meals; all other ACE inhibitors are not affected by food.
300. Lumbar Puncture?
AFTER the procedure, the client should be placed in the supine position for 4 to 12 hrs as prescribed. (Saunders 3rd ed p. 229)
Alkalosis/ Acidosis and K+
ALKalosis=al K= low sis. Acidosis (K+ high)
BP MEDS Parzosin (minipress); Doxazosin mesylate (cardura)
ALPHA ADRENERGIC BLOCKERS (SYPATHOLYTIC)-->dilation of vessels for HTN SE -Orthostatic hyptension(monitor BP for 2 hrs) INTERACTIONS -Antihypertenisves, NSAIDS
Serotonin Norepinephrine Reuptake Inhibitors.
Common SNRIs include Venlafaxine (Effexor) and Duloxetine (Cymbalta). Adverse effects may include nausea, weight gain, and sexual dysfunction.
140. Common S/S of PTB?
Common Signs and Symptoms 01. PTB - low-grade afternoon fever.
Asthma Management: ASTHMA
Adrenergics: Albuterol and other bronchodilators Steroids Theophylline Hydration: intravenous fluids Mask: oxygen therapy Antibiotics (for associated respiratory infections)
BATTERY & ASSAULT
Assault- any intetnial threat to bring about harmul or offensive contact. it is an assualt for a nurse to trhreaten to give a client an injection or to trheaten to restrain a client whhen the client has refused consent - BATTERY- any intential toughing without consent
PREVENTING COMPLICATIONS OF (CERBROVASCULAR DISEASE(STROKE)
ASPIRATION--Maintain a patent airway; assess swallowing reflexes: swallowing, gag, and cough before feeding; liquids may need to be thickened to avoid aspiration, place food in the back of the mouth on the unaffected side; suction on standby INCREASED ICP--monitor for changes in clientʼs LOC; Elevate clientʼs; . Avoid extreme flexion or extension, maintain head in midline neutral position and elevate to 30 degrees; seizure precautions - maintain a non-stimulating environment SPEECH IMPAIRMENT - assist with communication
Acute Renal Failure (ARF):
ARF is an abrupt, rapid decline in renal function. It is usually caused by trauma, sepsis, poor perfusion, or medications. ARF can cause hyponatremia, hyperkalemia, hypocalcemia, and hyperphosphatemia. Diet therapy for ARF is dependent upon the phase of ARF and its underlying cause.
39. Anorexia sucks because?
Absence of menstruation leads to osteoporosis in the anorexic.
Acetylcysteine (Mucomyst) is the antidote for...
Acetaminophen (Tylenol)
254. Hydrocele?
After a hydrocele repair provide ice bags and scrotal support.
17. ACID ash diet?
Acid Ash diet - cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread
Clients Who Require Dialysis: AEIOU (The Vowels)
Acid base imbalance Electrolyte imbalances Intoxication Overload of fluids Uremic symptoms`
What Can you delegate to Assistive Personnel?
Activities of daily living (ADLs) Bathing, Grooming, Dressing, Toileting, Ambulating, Feeding (without swallowing concerns), Positioning, Bed making Specimen Collection Intake and output Vital signs (stable clients)
Addison's & Cushings
Addison's = down down down up down Cushings= up up up down up hypo/hypernatremia, hypo/hypertension, blood volume, hypo/hyperkalemia, hypo/hyperglycemia
456. What to do for addisons/cushings?
Addison's disease (need to "add" hormone) Cushing's syndrome (have extra "cushion" of hormones)
24. After Gtube placement?
After g-tube placement the stomach contents are drained by gravity for 24 hours before it can be used for feedings.
351. Pancreatitis prioritys?
After pain relief, cough and deep breathe is important in pancreatitis, because of fluid pushing up in the diaphragm.
28. After removal of the pituitary gland what should you watch for?
After removal of the pituitary gland you must watch for hypocortisolism and temporary diabetes insipidus.
Lumbar Puncture
After the procedure, the pt should be supine for 4-12 hours as prescribed.
32. Age 4=5 year shots?
Age 4 to 5 yrs child needs DPT/MMR/OPV
draw up regular and NHP?
Air into NHP, air into Regular. Draw regular, then NHP
34. Alkaline Ash diet?
Alk Ash diet- milk, veggies, rhubarb, salmon
35. Allen's test?
Allen's test - occlude both ulnar and radial artery until hand blanches then release ulnar. If the hand pinks up, ulnar artery is good and you can carry on with ABG/radial stick as planned. ABGS must be put on ice and whisked to the lab.
BP MEDCLONODINE (CATAPRES)
Alpha 2 agonist --> bradycardia, decreased cardiac output, vasodilation, for HTN and severe cancer pain SE -Drowsiness, sedation, dry mouth, rebound HTN (consult HCP prior to D.C) INTERACTIONS- -CNS depressants, anithypertensives, Minipress, MAIOS, TCAs
153. Coomb's test?
Also if indirect Coomb's test is positive, don't need to give Rhogam cuz she has antibody only give if negative coombs
37. Alzheimers?
Alzheimer's disease is a chronic, progressive, degenerative cognitive disorder that accounts for more than 60% of all dementias
386. Room air is?
Ambient air (room air) contains 21 % o2
TCAs: Tricyclic Antidepressants.
Amitriptyline (Elavil) is an example. Anticholinergic effects and orthostatic hypotension may occur.
335. Nitrazine paper?
Amniotic fluid is alkaline, and turns nitrazine paper blue. Urine and normal vaginal discharge are acidic, and turn it pink.
36. ALS?
Amyotrophic lateral sclerosis ( ALS ) is a condition in which there is a degeneration of motor neurons in both the upper & lower motor neuron systems.
334. NG tube rules?
An NG tube can be irrigated with cola, and should be taught to family when a client is going home with an NG tube.
Antiemetics
An antiemetic is a medication used in the treatment and/or prevention of nausea and vomiting. Remember generic names are our friend because meds in the same classification often have similar generic names but brand names can come and go.
Antiparkinsonian
An antiparkinson, or antiparkinsonian medications are used for clients diagnosed with Parkinson's Disease. These medications increase dopamine activity or reduce acetylcholine activity in the brain. They do not halt the progression of the disease. These medications offer symptomatic relief
234. Hep B vaccine always ask?
Anaphylactic reaction to baker's yeast is contraindication for Hep B vaccine.
Leukemia Signs and Symptoms: ANT
Anemia and decreased hemoglobin Neutropenia and increased risk of infection Thrombocytopenia and increased risk of bleeding
40. Apgar scores/scoring?
Apgar measures HR,RR,Muscle tone, Reflexes,Skin color each 0-2 point. 8-10 OK. 0-3 RESUSCITATE.
Phyosostigmine (Antilirium) is the antidote for...
Anticholinergic drugs · Atropine
Anticoagulants: HEPARIN & COUMADIN
Anticoagulants prevent the formation of blood clots by interfering with the clotting cascade, thereby preventing coagulation. The use of this class of medications is contraindicated with active bleeding, such as with bleeding disorders, ulcers, or hemorrhagic brain injuries. HEPARIN and COUMADIN are the two main anticoagulant medications. See the acrostics below for helpful hints and important facts about these drugs. HEPARIN H eparin sodium prevents thrombin from converting fibrinogen to fibrin. It is administered IV or SQ. E noxaparin (Lovenox) is a low-molecular weight heparin. It has the same action as heparin, but has a longer half-life. It is administered via subcutaneous injection. P rotamine sulfate is the antidote for heparin. A dminister heparin when there is the likelihood of clot formation, such as with myocardial infarction or deep-vein thrombosis. R isk for bleeding is the major side effect that clients should be educated about. Clients should be educated to monitor for bleeding, including bleeding gums, bruises, hematuria, and petechiae. I nstruct clients to avoid corticosteroid use, oral hypoglycemic agents, salicylates, NSAIDs, green leafy vegetables, and foods high in Vitamin K. N ormal activated partial thromboplastin time (aPTT) is 20 to 36 seconds, but to maintain a therapeutic level of anticoagulation while on heparin, the aPTT should be 1.5 to 2 times the normal value (60 to 80 seconds). COUMADIN C oumadin (generic name Warfarin sodium) interferes with coagulation factors by antagonizing vitamin K. O ral administration is typically used. Clients may need continued heparin infusion via IV until therapeutic effect of Coumadin is experienced (may take3-5 days). U se is contraindicated in clients with low platelet counts or uncontrolled bleeding. M ephyton (trade name vitamin K) is the antidote for Coumadin. A dvise clients to avoid foods that are high in vitamin K, and avoid the use of acetaminophen, glucocorticoids, and aspirin. Clients should wear a medical alert bracelet indicating warfarin use. D oses are typically taken once daily. I NR and PT are monitored for clients who are taking Coumadin. Depending on intent of therapy, PT should be 1.5 to 2 times control and INR should be 2-3. Target INR is 3 to 4.5 for clients with a mechanical heart valve. N o Coumadin for pregnant women! Oral anticoagulants fall into Pregnancy Risk Category X. Heparin maybe safely used in pregnancy.
Antidotes
Antidotes are agents given to counteract the effects of poisoning related to toxicity of certain drugs or substances. Antidotes are extremely valuable, however most drugs do not have a specific antidote.
Diphenhydramine (Benadryl) Dimenhydrinate (Gravol, Dramamine) Meclozine (Bonine, Antivert)
Antihistamines (H1 histamine receptor antagonists) - also can be used as antiemetics
Antineoplastics
Antineoplastics are used combat cancerous cells. There are many kinds of anti-cancer drugs with a variety of actions. But in simple terms this category of drugs attack cells that multiply and divide. This very action which can kill cancer cells can also do the same to healthy dividing cells. This is especially true of cells that need a steady supply of new cells such as skin, hair and nails. There are over 90 different kinds of chemotherapy agents and different drugs cause different side effects
Aspirin (Ecotrin) Clopidogrel (Plavix) Pentoxifylline (Trental)
Antiplatelets PRIORITY POINT: Recall that this class of medications increases a client's risk for bleeding because of their prevention of platelet aggregation. Nursing interventions and client education focus on the client's increased risk for bleeding. How they work: Antiplatelets prevent platelets from clumping together by inhibiting enzymes and factors that normally cause arterial clotting. What they are used for: These medications are used to prevent myocardial infarction and stroke. Low dose therapy (81 mg) is effective for prevention of strokes and MI. How are they given: These medications are most commonly taken orally. They may also be administered IV.
Antithyroid Medications (hyperthyroidism)
Antithyroid medications are used to block (anti) the thyroid hormones. Antithyroid medications block (anti) the conversion of T4 into T3. Used to treat clients with Graves Disease, thyro toxicosis. Antithryoid medications are prescribed for clients who have an overactive thyroid or hyperthyroidism. In hyperthyroidism....everything is HIGHHHHHHH(HYPERRRRRRRRR) Clients that are prescribed this medication need to take radioactivity precautions. Common Antithyroid Medications: Propylthiouracil (PTU) Thyroid-Radioactive Iodine (hyperthyroidism) At high doses, thyroid radioactive iodine destroys thyroid cells. This drug is used for clients who have thyroid cancer and an over active thyroid (hyperthyroidism). Thyroid-NonRadioactive Iodine (hyperthyroidism) This medication creates a high level of iodine that will reduce iodine uptake by the thyroid gland. It inhibits the thyroid hormone production and blocks the release of thyroid hormones into the bloodstream. This medication tastes nasty; has a metallic taste! Clients are to drink this medication through a straw to prevent tooth discoloration. Radioactivity precautions are not necessary due to this drug is nonradioactive.
Heart Sounds: All People Enjoy the Movies
Aortic: 2nd right intercostal space Pulmonic: 2nd left intercostal space Erb's Point: 3rd left intercostal space Tricuspid: 4th left intercostal space Mitral or Apex: 5th left intercostal space
Newborn assessment components—"APGAR"
Appearance Pulse Grimace Activity Respiratory effort
APGAR
Appearance (all pink, pink and blue, blue (pale) Pulse (>100, <100, absent) Grimace (cough, grimace, no response) Activity (flexed, flaccid, limp) Respirations (strong cry, weak cry, absent)
42. Appendicitis
Appendicitis (inflammation of the appendix) pain is in RL quadrant with rebound tenderness.
116. Common S/S of guillian Barre Syndrome
Ascending muscle paralysis.. dont confuse with MG
HEAD INJURY: ASSESSING S/S of impaired NUERO STATUS
Assess/Monitor: RESPIRATORY STATUS(priority assessment); Changes in LOC ( EARLIEST indication of neurological deterioration); CUSHING REFLEX (severe HTN with a widened pulse pressure and bradycardia- late sign of ICP) , POSTURING (decorticate, decerebrate, flaccid), PUPILLARY CHANGES (PERRLA, pinpoint, fixed/nonresponsive, dilated); SIGNS OF INFECTION (nuchal rigidity with meningitis), CSF LEAKAGE FROM NOSE AND EAR (halo sign yellow stain surrounded by by blood, test positive for glucose), GCS rating (15 normal; 3=deep coma) CRANIAL NERVE FUNCTION (I - Olfactory nerve; II - Optic nerve; III - Oculomotor nerve; IV - Trochlear nerve (motor of eye) V - Trigeminal nerve (sensations of face) VI - Abducens nerve (motor nerve of eye), VII - Facial nerve (facial expression & taste) ; VIII - Vestibulocochlear nerve/Auditory nerve; IX - Glossopharyngeal nerve; X - Vagus nerve; XI - Accessory nerve/Spinal accessory nerve; XII - Hypoglossal nerve)
Extended Family
At least one parent, one child, and other individuals either related or not
Blended (also called Reconstituted) Family
At least one stepparent, stepsibling, or half-sibling
46. Autonomic Dysreflexia?
Autonomic dysreflexia: potentially life threatening emergency - elevate head of bed to 90 degree - loosen constrictive clothing - assess for bladder distention and bowel impaction (triger) - Administer antihypertensive meds (may cause stroke, MI, seisure )
Rifampin, isoniazid, phenytoin, what's up?
INH/Isoniazid increases phenytoin toxicity, meaning ataxia and hallucinations may present; decrease phenytoin dosage; hepatotoxicity possible with rifampin
Remember BAD POCC for key points or side effects of Opthalmic Medications:
B -Blurred vision A -Angle closure glaucoma (medications are used for this kind of glaucoma) D -Dry eyes P -Photophobia O -Ocular pressure (used to treat OP from glaucoma) C -Can Cause systemic effects C -Ciliary muscle constriction
Remember BAD POCC: Ophthalmic Medication Classes for treatment of Glaucoma
B -beta adrenergic blocking agents A -Alpha-Adrenergic Agonists D -Direct Acting Cholinergic Agonists P -Prostaglandin Analogs O -Osmotic Agents C -Carbonic Anhydrase Inhibitors C -Cholinesterase Inhibitor; An indirect acting Cholinergic Agonist
late s/s of cold stress in infants
apneic episodes, bradycardia, acrocyanosis, decreased activity
Nine-point Postpartum Assessment...BUBBLEHER
B- Breasts U- Uterus B- Bladder B- Bowel function L- Lochia E- Episiotomy H- Homan's sign E- Emotional Status R- Respiratory System
Hepatitis b
B= blood and body fluids (hep c is the same)
BP MEDS Metaprolol (lopressor -selective B1); propanaolol (inderal- nonselective B1 and B
BETA ADGRENERGIC BLOCKERS- decrease heart rate and myocardial contractility for HTN angina, tachydys SE- -BRADYCARDIA- hold med if HR below 60 , can mask early sign of low BS use cautiously with diabetic pts -DECREASED CO- monitor for worsening gisngs of heart failure (shortness of breah, edema, fatigue) -ORTHOSTATIC HYPOTENSION - BRONCHOCONSTRICTION (with nonselevtive ie propanolol only)- dontuse with asthma pts. INTERACTIONS- Calcium channel blockers, antihypertensives, insulin
LAB FINDINGS OF HEART FAILURE
BNP (Human B type Natriuretic Peptide)= used to differentiate dyspnea r/t CHF vs respiratory problem and to monitor the need for and effectiveness of aggressive CHF intervention -BNP levels < 100 pg/mL = no CHF -BNP levels 100-300 pg/mL suggest CHF is present -BNP levels >300 pg/mL = mild CHF -BNP levels > 600 pg.mL = moderate CHF -BNP levels > 900 pg/mL = severe CHF Hemodynamic Monitoring -increased CVP (central venous pressure) -increased right arterial pressure -increased PCWP (pulmonary capillary wedge pressure) -increased pulmonary artery pressure (PAP) -decreased CO
S/S of Hypoglycemia
BS: < 50 mg/dL cool, clammy skin diaphoresis anxiety, irritability, confusion, blurred vision hunger general weakness, seizures, (severe hypoglycemia)
323. Most accurate way to test kids for medication accuracy?
BSA is considered the most accurate method for medication dosing with kids. (I though it was weight, but apparently not)
408. Sources of potassium?
Bananas, potatoes, citrus fruits
112. Common S/S of emphysema?
Barrel chest
114. Common S/S of GERD?
Barrets Esophagus (erosion of the lower portion of the esophageal mucosa)
Antineoplastics Nursing Hints:
Be aware of the importance of leucovorin rescue with fluorouracil therapy, if prescribed. · The best treatment for extravasation is prevention. · Extravasation can cause pain, reddening, or irritation on the arm with the infusion needle. In severe cases in can lead to tissue necrosis and even loss of an extremity. · Check infusion site frequently · Stop infusion immediately if suspected · Slowly aspirate back blood back from the arm · Elevate arm and rest in elevated position · Check institution policies on how to remove catheter
50. Before a pft?
Before going for Pulmonary Fuction Tests (PFT's), a pt's bronchodilators will be with-held and they are not allowed to smoke for 4 hrs prior
53. Behavior/Developmental-Peds
Behavior motivated by need to avoid anxiety and satisfy needs 1. Infancy 0-18 months others will satisy needs 2. childhood >6yrs learn to delay need gratification 3. juvenile 6-9 years learn to relate to peers 4. preadolescence 9-12 yrs learns to relate to friends of of opposite sex 5. early adolescence12-14yrs:learn independence and how to relate to opposite sex 6. late adolecence 14-21yrs: develop intimate relationship with person of opposite sex is this not about communication?....
359. Peds weight ?
Birth weight doubles by 6 month and triple by 1 year of age.
Peds Labs: Leukocyte count (WBC count)
Birth: 9.0-30.0 24 hour: 9.4-34.0 1 month: 5.0-19.5 1-3 years: 6.0-17.5 4-7 years: 5.5-15.5 8-13 years: 4.5-13.5
Anti-reabsorptives: Medications
Bisphosphonates prevent the loss of bone mass Alendronate (Fosamax) Monthly used to treat and prevent osteoporosis in menopausal women. Facts: The benefits of Fosamax can even be seen in elderly women over 75 years of age. Hint: Fosamax has been associated with severe esophagitis and ulcers of the esophagus. Should be avoided in clients with history of gastric ulcers. Risedronate (Actonel): This is a newer drug and less likely to cause esophageal irritation Hint: Teach clients taking either drug to take on an empty stomach with at least 8 ounces (240 ml) of water, while sitting or standing. This minimizes the chances of the pill being lodged in the esophagus. Clients should also remain upright for at least 30 minutes after taking these pills to avoid reflux in to the esophagus. For those clients who cannot tolerate the esophagus side effects of Fosamax, estrogen, etidronate (Didronel), and calcitonin are possible alternatives. Teriparatide (Forteo): It acts like parathyroid hormone and stimulates osteoblasts, thus increasing their activity. Promotes bone formation. Facts: This drug is associated with a risk of bone tumors so is only used when the benefits outweigh the risks.
453. What is bleeding considered in ADPIE?
Bleeding is part of the 'circulation' assessment of the ABCD's in an emergent situation. Therefore, if airway and breathing are accounted for, a compound fracture requires assessment before Glasgow coma scale and a neuro check (D=disability, or neuro check)
Anti-reabsorptives: What is an anti-reabsorptive?
Bone is a living organ which is continually being removed (resorbed) and rebuilt. Osteoporosis develops when there is more resorption than rebuilding. Antiresorptive medications are designed to slow bone removal and or improve bone mass. Treating and preventing osteoporosis can involve lifestyle changes and sometimes medication. Lifestyle change includes diet and exercise, and fall prevention. Prevention and treatment of osteoporosis involve medications that work by preventing bone breakdown or promote new bone formation.
118. Common S/S of Hydrocephalosis?
Bossing Sign (prominent forehead)
Common Alpha2-Adrenergic Agonists:
Brimon idine (Alphagan) (see the similarities with idine in the name of the drug) Apraclon idine (Iop idine ) (see the similarities with idine in both of the names of the drug)
Bronchodilators
Bronchodilators are used to treat the symptoms of asthma that result from inflammation of the bronchial passages, but they do not treat the inflammation. Therefore, most clients with asthma take an inhaled glucocorticoid concurrently to provide the best outcomes. The two most common classes of bronchodilators are beta2-adrenergicagonists and methylxanthines
127. Common S/S of Lyme's disease
Bull's eye rash
Atypical antidepressants.
Bupropion (Wellbutrin) is the most common example. Appetite suppression is a common side-effect. Headache and dry mouth may be severe and client should notify the provider if this occurs. Atypical antidepressants should not be used with clients with seizure disorders.
107. Common S/S of Cystitis?
Burning on urination
144. Common S/S of SLE?
Butterfly rashes
Cane Walking (COAL)
Cane Opposite Affected Leg
Communication: If the client has obsessive / compulsive behavior
communicate AFTER the compulsive behavior
481. Yeast infection in a babys mouth?
If you can remove the white patches from the mouth of a baby it is just formula. If you can't, its candidiasis.
S/S of COMPLICATIONS OF ANGIOGRAPHY
CARDIAC TAMPONADE (results from fluid accumulation in the pericardial sac)- s/s- hypotension; muffled heart sound; paradoxical pulse (variation of 10 mmHg or more in systolic blood pressure between expiration and inspiration); intracardiac and pulmonary artery pressures similar and elevated (plateau pressures); HEMATOMA (assess groin), RESTENOSIS (assess ECG pattern), RETROPERTONIAL BLEEDING- flank pain and hypotension
INTERVENTIONS FOR COMPLICATIONS OF ANGIOGRAPHY
CARDIAC TAMPONADE—notify the PCP immediately; admin IV fluids to combat hypotension; obtain a chest xray or echocardiogram to confirm dx; prepare the client for pericardiocentesis (informed consent, gather materials,admin meds as appropriate); monitor hemodynamic pressures as they normalize; monitor heart rhythm; changes indicate improper positioning of the needle. HEMATOMA- assess the groin at, hold pressure for uncontrolled oozing/bleeding, monitor peripheral circulation, notify PCP, RESTENOSIS assess ECG patterns and for occurrence of CP, notify PCP immediately, prepare the client for return to the cardiac cath lab RETROPERTONIAL BLEEDING- assess for flank pain and hypotension; notify the PCP; admin IV fluids and blood products as ordered.
265. Hypocalemia?
CATS - convulsions, arrhythmias, tetany, spasms and stridor
264. Hypo-parathyroid?
CATS - convulsions, arrhythmias, tetany, spasms, stridor (decreased calcium), high Ca, low phosphorus diet
Hypocalcemia
CATS Convulsions, Arrythmias, Tetany, spasms and stridor
Hypo-parathyroid
CATS---Convulsions, Arrhythmias, Tetany, Spasms, Stridor. (decreased calcium) give high calcium, low phosphorus diet
CHARACTERISTICS OF CERVIX & FETUS DURING FALSE LABOR
CERVIX (assessed by vaginal exam)- no significant changes in effacement and dilation; often remains in posterior position, no significant bloody show FETUS- presenting part not engaged.
223. Guided imagery is great for?
CHRONIC pain
AMYTRIPTYLINE (ELAVIL)
CLASS- TCA PREDOMINANT SE- sedation, dry mouth, blurred vision, urinary retention, delatued mictruition, dizziness, fainting
BP = _____ x _____
CO x SVR (Cardiac Output / Systemic Vascular Resistance)
laparoscopy
CO2 used to enhance visual. general anesthesia. foley. post--ambulate to decrease CO2 buildup
Myxedema coma
COLD (hypothermia)
152. Contact transmission precautions
CONTACT PRECAUTION MRS.WEE M - multidrug resistant organism R - respiratory infection S - skin infections * W - wound infxn E - enteric infxn - clostridium difficile E - eye infxn - conjunctivitis
154. COPD and Pneumonia?
COPD is chronic, pneumonia is acute. Emphysema and bronchitis are both COPD. in COPD patients the baroreceptors that detect the CO2 level are destroyed. Therefore, O2 level must be low because high O2 concentration blows the patient's stimulus for breathing.
477. Why would somone who is allergic to latex be allergic to food too?
CROSS REACTION! People who have a latex allergy may be allergic to some foods, as well. This is called a cross reaction. When this happens, your body responds with the same allergic symptoms that you would have if you were exposed to latex. Cross reactions differ from one person to another. Someone may have a reaction to all the foods noted to cause cross reaction while another may have no reaction at all. Likewise, if you are allergic to any of these foods, you may also be allergic to latex: •apples, bananas, kiwi, peaches, plums, figs, grapes, melons, papaya, passion fruit, cherries, nectarines, pears, pineapple and strawberries; •carrots, celery, raw potatoes, avocados and tomatoes; •chestnuts and hazelnuts; •wheat and rye.
252. How will CSF look in meningitis?
CSF in meningitis will have high protein, and low glucose.
166. CVA?
CVA (cerebrovascular accident) is with dead brain tissue.
BP MEDS NIFEDIPINE (ADALAT) ; VARAPRAMIL (CALAN )
Calcium Channel Blockers: Angina pectoris, HTN, S/E- PERIPHERAL EDEMA - may prescribe diuretic REFLEX TACHYCARDIA (use lopressor to counteract tachy); ACUTE TOXICITY (hypotension, tachydys)- monitor ECG, gastric lavage may be initiated , CONSITPATION INTERACTIONS- -Grapefruit juice --> toxicity -Verapramil with digoxin --> digoxin tox -Beta blockers -->heart failure and bradycardia
calcium (Ca2+) · Essential for normal musculoskeletal, neurological, and cardiovascular function · Normal range: 9.0-10.5 mEq/L
Calcium citrate (Citrical) · Calcium carbonate or calcium acetate · Oral or IV administration · Implement seizure precautions during administration and have emergency equipment on hand
INSTRUCTIONS FOR CRUTCHES & CANE
Cane instructions • Maintain two points of support on the ground at all times. • Keep the cane on the stronger side of the body. • Support body weight on both legs, move the cane forward 6 to 10 inches, then move the weaker leg forward toward the cane. • Next, advance the stronger leg. Crutch instructions • Do not alter crutches after proper fit has been determined. • Follow the prescribed crutch gait. • Support body weight at the hand grips with the elbows flexed at 30°. • Position the crutches on the unaffected side when sitting or rising from a chair.
Cannabis - Medical marijuana, in the U.S., it is a Schedule I drug. Dronabinol (Marinol) - a Schedule III drug in the U.S.
Cannabinoids
77. Cath lab?
Cardiac cath- npo 8-12hr, empty bladder, pulses, tell pt may feel heat palpitations or desire to cough with dye injection. Post- Vital signs keep leg straight bedrest 6-8hr.
76. Cardinal signs of ARDS?
Cardinal sign of ARDS is hypoxemia (low oxygen level in tissues).
90. Common S.S of Retino Blastoma?
Cat's eye reflex (grayish discoloration of the pupil)
Cholinergic Crisis
Caused by excessive medication ---stop giving Tensilon...will make it worse.
Dealing with Dysphagia:
Causes include: Obstruction Inflammation Edema Certain neurological disorders Modifying the texture of foods and the consistency of liquids may enable the client to achieve proper nutrition. Clients with dysphagia are at an increased risk of aspiration. Place the client in an upright or high-Fowler's position to facilitate swallowing. Provide oral care prior to eating to enhance the client's sense of taste. Allow adequate time for eating, utilize adaptive eating devices, and encourage small bites and thorough chewing. Avoid thin liquids and sticky foods.
79. Cephalhematoma (caput succinidanium)?
Cephalhematoma (caput succinidanium) resolves on its own in a few days. This is the type of edema that crosses the suture lines.
67. Bryant's traction=
Children <3yoa, <35 lbs with femur fx
Cancer Early Warning Signs: CAUTION UP
Change in bowel or bladder A lesion that does not heal Unusual bleeding or discharge Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing Obvious changes in wart or mole Nagging cough or persistent hoarseness Unexplained weight loss Pernicious Anemia
132. Common S/S of MS>?
Charcot's Triad (IAN)
MAOI's/Nardil, avoid what?
Cheese!
419. Tet spells?
Children with tetralogy of Fallot may develop "tet spells". The precise mechanism of these episodes is in doubt, but presumably results from a transient increase in resistance to blood flow to the lungs with increased preferential flow of desaturated blood to the body. Tet spells are characterized by a sudden, marked increase in cyanosis followed by syncope, and may result in hypoxic brain injury and death. Older children will often squat during a tet spell, which increases systemic vascular resistance and allows for a temporary reversal of the shunt.
Cholecystitis:
Cholecystitis is characterized by inflammation of the gallbladder. The gallbladder stores and releases bile that aids in the digestion of fats. Fat intake should be limited to reduce stimulation of the gallbladder. Other foods that may cause problems include coffee, broccoli, cauliflower, Brussels sprouts, cabbage, onions, legumes, and highly seasoned foods. Otherwise, the diet is individualized to the client's needs and tolerance.
119. Common S/S of hypocalcemia?
Chvostek and Trosseaus sign! Also hypomag!
85. Chvostek and Trosseaus sign
Chvostek= Tapping on the face above the cheek bone will cause spams! Trosseaus= using a BP cuff and inflating it, and it will cause spasms of the wrist
181. Diverticulitis?
diverticulitis (inflammation of the diverticulum in the colon) pain is around LL quadrant.
71. c02 builds up and causes?
Co2 causes vasoconstriction.
87. coarctation of the aaorta causes?
Coarctation of the aorta causes increased blood flow and bounding pulses in the arms
91. Common S/S Acromegaly?
Coarse facial features
Shock Signs and Symptoms: CHORD ITEM
Cold, clammy skin Hypotension Oliguria Rapid, shallow breathing Drowsiness, confusion Irritability Tachycardia Elevated or reduced central venous pressure Multi-organ damage
Intussusception
Common in kids with CF. Obstruction may cause fecal emesis, current jelly stools. enema---resolution=bowel movements
For Insulin Overdose
Common medication for insulin overdose: Gluc agon (see the form of glucose in the drug name?) Glucagon (or glucose) is needed to increase blood glucose or blood sugar.
151. Complications of mechanical ventilation?
Complications of Mechanical Ventilation: Pneumothorax, Ulcers
Medication/food interactions:
Concurrent use with diuretics can lead to first-dose orthostatic hypotension · Concurrent use with other antihypertensives can lead to increase effect resulting in hypotension · Concurrent use with potassium supplements or potassium-sparing diuretics increases the risk of hyperkalemia · Concurrent use with lithium can increase serum lithium levels, leading to lithium toxicity · Concurrent use with NSAIDs can decrease the therapeutic effects of the ACE inhibitor
TREATMENT FOR PULMONARY EMBOLISM
Conservative Therapy: 02 by mask or cannula given in a concentration determined ABG analysis - endotrach intubation and mechanical vent may be needed to maintain adequate 02 - turning, coughing and deep breathing to prevent or tx atelectasis - TREAT SHOCK- vasopressor agents -TREAT heart failure- digitalis, diuretics - TREAT PAIN with narcotics, usually morphine Drug Therapy: anticoags- Heparin and warfarin drugs of choice - heparin should be started immediately and is continued while oral anticoags are initiated. dosage adjusted according to PTT and warfarin dose is determined by INR - thrombolytic agents- -if degree of pulmonary arterial obstruction is severe (greater than 50%) and the pt does not respond to conservative therapy, an immediate embolectomy may be indicated.
Dealing with Constipation:
Constipation is difficult or infrequent passage of stools, which may be hard and dry. Causes include: irregular bowel habits, psychogenic factors, inactivity, chronic laxative use or abuse, obstruction, medications, and inadequate consumption of fiber and fluid. Encouraging exercise and a diet high in fiber and promoting adequate fluid intake may help alleviate symptoms.
Hypocalcaemia Signs and Symptoms: CATS
Convulsions Arrhythmias Tetany Stridor and spasms
Peds Labs: Creatinine
Cord: 0.6-1.2 mg/dl Newborn: 0.3-1.0 mg/dl Infant: 0.2-0.4 mg/dl Child: 0.3-0.7 mg/dl Adolescent: 0.5-1.0 mg/dl
Peds Labs: Carbon Dioxide
Cord: 14-22 mEq/l Premature 1 week: 14-27 mEq/l Newborn: 13-22 mEq/l Infant, child: 20-28 mEq/l
Peds Labs: Chloride
Cord: 96-104 mEq/l Newborn: 97-110 mEq/l Child: 98-106 mEq/l
Hypertension Complications: The 4 C's
Coronary artery disease (CAD) Congestive heart failure (CHF) Chronic renal failure (CRF) Cardiovascular accident (CVA): Brain attack or stroke
158. Crackles most likely are?
Crackles suggest pneumonia, which is likely to be accompanied by hypoxia, which would manifest itself as mental confusion, etc.
Cleft lip: nursing care plan (postoperative)—"CLEFT LIP"
Crying, minimize Logan bow Elbow restraints Feed with Brecht feeder Teach feeding techniques; two months of age (average age at repair) Liquid (sterile water), rinse after feeding Impaired feeding (no sucking) Position—never on abdomen
44. Asthmas and wheezers?
Coughing w/o other s/s is suggestive of asthma. Speaking of asthma, watch out if your wheezer stops wheezing. It could mean he is worsening.
48. Awesome remembering for cranial nerves?
Cranial Nerves: *I am sorry if this vulgar for some, but hey, it sticks Sensory=S Motor=M Both=B Oh (Olfactory I) Some Oh (Optic II) Say Oh (Oculomotor III) Marry To (Trochlear IV) Money Touch (Trigeminal V) But And (Abducens VI) My Feel (Facial VII) Brother A (Auditory VIII) Says Girls (Glossopharyngeal IX) Big Vagina (Vagus X) Bras And (Accessory XI) Matter Hymen (Hypoglassal XII) More
162. Cullens sign?
Cullen's sign - ecchymosis in umbilical area, seen with pancreatitis
134. Common S/S of pancreatitis?
Cullens sign ( ecchymosis of umbilicus) (+) Grey Turner spots
454. What is obtained before starting any iv antibiotic?
Cultures
Prednisone toxicity
Cushings (buffalo hump, moon face, high blood sugar, HTN)
163. Cushing ulcers and cushings triad?
Cushings ulcers r/t BRAIN injury *Cushings triad r/t ICP in BRAIN (htn, bradycard, irr. resp)
Key points of ophthalmic medications:
Cylo plegics are drugs that cause paralysis of the ciliary muscle...plegic-like paraplegic, paralysis · Mydriatics are drugs that dilate the pupil. · Drug therapy for glaucoma is directed at reducing elevated IOP, by increasing aqueous humor outflow or decreasing aqueous humor production. · Oculus Dexter: OD (right eye) · Oculus Sinister: OS (left eye) · Oculus Uterque: OU (both eyes)
167. Cystic fibrosis?
Cystic Fibrosis give diet low fat, high sodium, fat soluble vitamins ADEK. Aerosal bronchodilators, mucolytics and pancreatic enzymes.
All anti-epileptic drugs can be remembered by this mnemonic: Dr.BHAISAB's New PC.
D ...Deoxy barbiturates B ...Barbiturates H ....Hydantoin A ....Aliphatic carb acids I ....Iminostilbenes S ....Succinimides B ....Benzodiazepines (BZD's) N ....Newer drugs P ....Phenyltriazines C ...Cyclic gaba analogue
205. For a lung biopsy?
For a lung biopsy, position pt lying on side of bed or with arms raised up on pillows over bedside table, have pt hold breath in midexpiration, chest x-ray done immediately afterwards to check for complication of pneumothorax, sterile dressing applied
best to orient what? what not?
follow nurse, not skills checklist
Hypertension Care: DIURETIC
Daily weight Intake and Output Urine output Response of blood pressure Electrolytes Take pulse Ischemic episodes or TIAs Complications: CVA, CAD, CHR, CRF
best pain management for 8-10 post open cholecystectomy; demerol, hydromorphine, fentanyl, morphine
DEMEROL NOT morphine or others; morphine can cause biliary spasms
Antirheumatics Hints:
DMARDs slow joint degeneration and progression of rheumatoid arthritis. Glucocorticoids and NSAIDs provide symptom relief from inflammation and pain. Rheumatrex ( methotrexate ) is the most commonly used DMARD. This is because it has been shown to work as well or better than any other single medicine. It is also relatively inexpensive and generally safe. Methotrexate has many food and drug interactions especially affect digoxin and phenytoin. Very difficult to absorb and should be taken on an empty stomach. Taking folic acid helps reduce some of the side effects. Methotrexate's biggest advantage could be that it has been shown to be safe to take for long periods of time and can even be used in children
171. Delegation Rule of Thumb?
DO NOT delegate what you can EAT! E - evaluate A - assess T - teach
Tetrology of Fallot
DROP (Defect, septal, Right ventricular hypertrophy, Overriding aortas, Pulmonary stenosis)
183. Droplet Precautions Transmission?
DROPLET think of SPIDERMAN! S - sepsis S - scarlet fever S - streptococcal pharyngitis P - parvovirus B19 P - pneumonia P - pertussis I - influenza D - diptheria (pharyngeal) E - epiglottitis R - rubella M - mumps M - meningitis M - mycoplasma or meningeal pneumonia An - Adenovirus
first thing to do with a newborn; take temperature, weight, dry...
DRY
168. Dance Sign?
Dance's sign: RUQ mass (intussusception) with RLQ empty space (movement of cecum out of normal position).
170. Decorticate and Decerebrate?
Decorticate positioning in response to pain = Cortex involvement. Decerebrate in response to pain = Cerebellar, brain stem involvement
248. How to Dx a AAA?
Definitive diagnosis for abd. aortic aneurysm (AAA) --> CT scan
Transient Incontinence Causes: DIAPERS
Delirium Infection Atrophic urethra Pharmaceuticals and psychological Excess urine output Restricted mobility Stool impaction
173. Depression manifests itself?
Depression often manifests itself in somatic ways, such as psychomotor retardation, gi complaints, and pain.
131. Common S/S of MG?
Descending muscle weakness
175. Developmental milestones?
Developmental 2-3 months: turns head side to side 4-5 months: grasps, switch & roll 6-7 months: sit at 6 and waves bye-bye 8-9 months: stands straight at eight 10-11 months: belly to butt (phrase has 10 letters) 12-13 months: twelve and up, drink from a cup
Oral hypoglycemics: What is diabetes?
Diabetes is a disorder that affects glucose metabolism. Type 1 diabetes: The client either makes no insulin or not enough insulin. Type 2 diabetes: The client makes enough insulin at least early in the disease but is unable to transport glucose from the blood into the cells. In both cases, the individual is unable to metabolize glucose. The purpose of oral hypoglycemics is to assist with glucose metabolism.
LLQ
Diverticulitis
182. DKA?
Diabetic ketoacidosis (DKA)= when body is breaking down fat instead of sugar for energy. Fats leave ketones (acids) that cause pH to decrease. 71. DKA is rare in diabetes mellitus type II because there is enough insulin to prevent breakdown of fats.
62. Birth control- Diaphram?
Diaphragm must stay in place 6 hours after intercourse. They are also fitted so must be refitted if you lose or gain a significant amount of weight.
285. Kidneys and ears?
Did you know there is an association between low-set ears and renal anomalies? Now you know what to look for if down's isn't there to choose. (just to expand on it a little, the kidneys and ears develop around the same time in utero. Hence, they're shaped similarly. Which is why when doing an assessment of a neonate, if the nurse notices low set or asymmetrical ears, there is good reason to investigate renal functioning. Knowing that the kidneys and ears are similar shapes helped me remember this).
Digoxin immune Fab (Digibind) is the antidote for...
Digoxin, digitoxin
Alpha Adrenergic Blockers (Sympatholytics) · Pra zosin (Minipress) · Doxa zosin (Cardura)
Dilate veins and arteries · Potential for 1st dose orthostatic hypotension · Concurrent use of prazosin & NSAIDs or clonidine can interfere with reduction of BP
Organic Nitrates · Nitr oglycerine (Nitrol, Nitrostat) · Isosorbide di nitr ate (Imdur)
Dilates veins and prevents spasms of coronary arteries · Headache is common so client should use with acetaminophen or aspirin · Tolerance can occur with prolonged use · Concurrent use with sildenafil (Viagra) can lead to life-threatening hypotension · Use with alcohol can cause increased hypotension · Sublingual tablets, translingual spray, or transmucosal preparations should be used at the first sign of angina · Sustained-release capsules, transdermal patches, or topical ointment provide long-term prophylaxis
378. Psuedomembrane in DIptheria?
Diptheria is an upper respiratory tract infection. It is characterized by sore throat, low fever and the psuedomembrane! Which is just a capsule around the tonsils that you can see with your penlight... It just looks like a whiteish yellow capsule around the tonisils
Antirheumatics Medications
Disease-modifying Antirheumatic drugs (DMARDs), glucocorticoids, and non-steroidal anti-inflammatory drugs (NSAIDs) may be used individually or in combination to manage this chronic disorder. The major categories of antirhematics are: DMARDs I - Major Nonbiologic DMARDs · Cytotoxic medications: Methotrexate (Rheumatrex), leflunomide (Arava) · Antimalarial agents: Hydroxychloroquine (Plaquenil) · Anti-inflammatory medication: Sulfasalazine (Azulfidine) · Tetracycline antibiotic: Minocycline (Minocin) DMARDs II - Major Biologic DMARDs · Etanercept (Enbrel) · Infliximab (Remicade) · Adalimumab (Humira) · Rituximab (Rituxan) · Abatacept (Orencia) DMARDs III - Minor nonbiologic and biologic DMARDs · Gold salts: Aurothioglucose (Solganal) · Penicillamine (Cuprimine, Depen) · Cytotoxic medications: Azathioprine (Imuran), cyclosporine (Sandimmune, Gengraf, Neoral) · Glucocorticoids: · Prednisone (Deltasone), prednisolone (Prelone) ● NSAIDs
220. Gross things to remember about nurses with herpes!!!!
Disseminated Herpes Zoster is AIRBORNE PRECAUTIONS, as to Localized Herpes Zoster is CONTACT PRECAUTIONS. A nurse with a localized herpes zoster CAN care for patients as long as the patients are NOT immunosuppressed and the lesions must be covered!
Disseminated herpes zoster localized herpes zoster
Disseminated herpes=airborne precautions Localized herpes= contact precautions. A nurse with localized may take care of patients as long as pts are not immunosuppressed and the lesions must be covered!
246. How do you treat a small bowel obstruction?
Don't fall for 'reestablishing a normal bowel pattern' as a priority with small bowel obstruction. Because the patient can't take in oral fluids 'maintaining fluid balance' comes first.
Electrolyte Replacements
Electrolytes refer to salts that carry either positive or negative charges to carry electrical impulses in the form of muscle contractions and nerve impulses. Electrolyte balance must be maintained in the body to protect cardiac and nerve function. Therefore, replacement is critical when electrolytes are lost due to sweating, vomiting, diarrhea, or gastric suctioning.
Promethazine (Phenergan) Prochlorperazine (Compazine) Metoclopramide (Reglan)
Dopamine antagonists
316. More info on droplet precautions?
Droplet Precautions:sepsis, scarlet fever, streptococcal pharyngitis, parovirus B19, pnuemonia, pertusis, influenza, diptheria, epiglottis, rubella, mumps, meningitis, mycoplasma and adenovirus. Door open, 3 ft distance, private room or cohort, mask
Dumping Syndrome:
Dumping Syndrome occurs as a complication of gastric surgeries that inhibit the ability of the pyloric sphincter to control the movement of food into the small intestine. This "dumping" results in nausea, distention, cramping pains, and diarrhea within 15 min after eating. Weakness, dizziness, a rapid heartbeat, and hypoglycemia may occur. Small, frequent meals are indicated. Consumption of protein and fat at each meal is indicated. Avoid concentrated sugars. Restrict lactose intake. Consume liquids 1 hr before or after eating instead of with meals (a dry diet).
184. Dumping syndrome?
Dumping syndrome: increase fat and protein, small frequent meals, lie down after meal to decrease peristalsis, wait 1 hr after meals to drink.
401. Sickle cell crisis?
During sickle cell crisis there are two interventions to prioritize: fluids and pain relief.
233. Hep A precautions?
During the acute stage of Hep-A gown and gloves are required. In the convalescent stage it is no longer contagious.
206. For an EEG test?
EEG, hold meds for 24-48 hrs prior, no caffine or cigarettes for 24 hrs prior, pt can eat, pt must stay awake night before exam, pt may be asked to hyperventilate and watch a bright flashing light, after EEG, assess pt for seizures, pt's will be at increased risk
317. More info on EEG?
EEG- no sleep the night before, meals not withheld, no stimulants for 24hr before, tranquilizer/stimulant meds held 24-48hr before, may be asked to hyperventilate 3-4min and watch a bright flashing light.
End Stage Renal Disease (ESRD):
ESRD, or chronic renal failure, occurs when the glomerular filtration rate (GFR) is less than 25 mL/min, the serum creatinine level steadily rises, or dialysis or transplantation is required. The goal of nutritional therapy is to maintain appropriate fluid status, blood pressure, and blood chemistries. A high-protein, low-phosphorus, low-potassium, low-sodium, fluid restricted diet is recommended. Calcium and vitamin D are nutrients of concern. Protein needs increase once dialysis is begun because protein and amino acids are lost in the dialysate. Fifty percent of protein intake should come from biologic sources (eggs, milk, meat, fish, poultry, soy). Adequate calories (35 cal/kg of body weight) should be consumed to maintain body protein stores. Phosphorus must be restricted. The high protein requirement leads to an increase in phosphorus intake. Phosphate binders must be taken with all meals and snacks. Vitamin D deficiency occurs because the kidneys are unable to convert it to its active form. This alters the metabolism of calcium, phosphorus, and magnesium and leads to hyperphosphatemia, hypocalcemia, and hypermagnesemia. Calcium supplements will likely be required because foods high in phosphorus (which are restricted) are also high in calcium. Potassium intake is dependent upon the client's laboratory values, which should be closely monitored. Sodium and fluid allowances are determined by blood pressure, weight, serum electrolyte levels, and urine output. Achieving a well-balanced diet based on the above guidelines is a difficult task. The National Renal Diet provides clients with a list of appropriate food choices.
Better peripheral perfusion?
EleVate Veins, DAngle Arteries
444. VV and AA?
EleVate Veins; dAngle Arteries for better perfusion
DVT INTERVENTIONS
Encourage REST, elevate the extremities above the level of the heart (DO NOT PUT THINGS UNDER KNEES)- Moist compress to prevent embolus from dislodging- (DO NOT MASSAGE EXTREMITY) - Use SCD's and antiembolism stalking- promote blood flow - Administer Meds (comp-bleeding) - LOW MOLECULAR WT HEPARIN, WARFARIN, ANALGESICS -Thrombolytic therepy- must be initiated within 5 days
Hepatitis A
Ends in a vowel, comes from the bowel
Sildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis)
Erectile Dysfunction Agents Erectile dysfunction (ED) meds act by increasing nitric oxide which opens and relaxes the blood vessels of the penis causing increased blood flow (helping lead to getting and keeping an erection). Notice these end in 'fil'. 'Fil' helps the nitric oxide to 'fil' the penis. While 'Fil' is a great guy (well-tolerated by most clients) he does have a few side effects - headache, flushing, back pain and muscle aches (with Levitra), temporary vision changes, including "blue vision" (with Viagra) and not all men can spend time with 'Fil'. Men who have heart problems, uncontrolled blood pressure problems, history of stroke, or a health problem at can cause priapism can't hang out with 'Fil.'
Stages of Development: Toddler (12 months to 3 years):
Erikson: Psychosocial: Autonomy vs shame Freud: Psychosocial: Anal Piaget: Cognitive: Sensorimotor transition to preoperational
Stages of Development: Adolescents (12 to 18 years):
Erikson: Psychosocial: Identify vs role confusion Freud: Psychosocial: Genital Piaget: Cognitive: Formal operations
Stages of Development: School-Aged (5 to 12 years):
Erikson: Psychosocial: Industry vs inferiority Freud: Psychosocial: Latency Piaget: Cognitive: Concrete operations
Stages of Development: Pre-schooler (3 to 5 years):
Erikson: Psychosocial: Initiative vs guilt Freud: Psychosocial: Phallic Piaget: Cognitive: preoperational
Stages of Development: Infant (Birth to 1 year):
Erikson: Psychosocial: Trust vs. mistrust Freud: Psychosocial: Oral Piaget: Cognitive: Sensorimotor
Evaluation of care plan:
Evaluate the care plan for multiple clients and revise care as need.
Angina Precipitating Factors: 4 E's
Exertion: physical activity and exercise Eating Emotional distress Extreme temperatures: hot or cold weather
86. Cmmon S/S Fibrin Hyalin?
Expiratory grunt-- Causes Infant respiratory distress!
S/S of hip fx
External rotation, shortening adduction
centigrade to Fahrenheit conversion
F= C+40 multiply 5/9 and subtract 40 C=F+40 multiply 9/5 and subtract 40
Pain Assessment by Age: 2 months - 7 years 3 years and older 3 years to 13 years 5 years and older 3 to 18 years
FLACC Faces Oucher Numeric Scale Non-communicating Children's Pain Checklist
Stroke Signs: FAST
Face Arms Speech Time
204. For a lumbar puncture?
For a lumbar puncture, pt is positioned in lateral recumbent fetal position, keep pt flat for 2-3 hrs afterwards, sterile dressing, frequent neuro assessments
391. S/S of a fat embolism?
Fat Embolism: Blood tinged sputum (r/t inflammation), inc ESR, respiratory alkalosis (not acidosis r/t tachypnea), hypocalcemia,increased serum lipids, "snow storm" effect on CXR.
197. Fetal alcohol sydrome?
Fetal alcohol syndrome -upturned nose -flat nasal bridge -thin upper lip -SGA
Antigout Medications
First Line: NSAIDs and prednisone (Deltasone) Purpose: Used as a first line defense to treat the pain and inflammation of gout attacks. Colchicine (Colgout): Purpose: Treat the inflammation and pain associated with gout. Just like NSAIDs, these meds can lead to GI distress and should be taken with foods. HINT: The word gout is right in the name Colgout. Allopurinol (Zyloprim): Purpose: This is the only medical preventative treatment for gout. Allopurinal prevents uric acid production. This can be an effective means of preventing gout attacks when diet alone is not effective. HINT: Examine the name allopurinol and you can see the word PURINE in the middle of the name. Note: There are many drug and food interactions associated with allopurinol: Potential serious interactions with the use of saliscylates, loop diuretics, phenylbutazamines and alcohol and potential for drug interactions with Warfarin (Coumadin).
Prostaglandin Analogs
First line treatment for glaucoma. Fewer side effects and just as effective as the beta-adrenergic Ophthalmic blocking agents. These drugs lower IOP by facilitating aqueous humor outflow by relaxing the ciliary muscle.
200. First sign of pe?
First sign of PE is sudden chest pain, followed by dyspnea and tachypnea.
Turner's sign
Flank--greyish blue. (turn around to see your flanks) Seen with pancreatitis
93. Common S/S Hepatic Encephalopathy ?
Flapping tremors
446. What can also cause an s3 heart sound?
Fluid volume overload caused by IVC fluids infusing too quickly (or whatever reason) and CHF can cause an S3
Antineoplastics Medications
Fluorouracil (5-fluorouracil, 5-FU) Warning - Hazardous drug! 5-FUis one of the oldest chemotherapy drugs and is used against a variety of cancers Following are some of the most common and important ill effects: · Soreness of the mouth, difficulty swallowing · Diarrhea · Stomach pain · Low platelets · Anemia · Sensitive skin (to sun exposure) · Excessive tear formation from the eyes
287. Kids with HIV?
For HIV kids avoid OPV and Varicella vaccinations (live), but give Pneumococcal and influenza. MMR is avoided only if the kid is severely immunocompromised. Parents should wear gloves for care, not kiss kids on the mouth, and not share eating utensils.
208. For PVD remember?
For PVD remember DAVE (Legs are Dependent forArterial & for Venous Elevated)
Valporic Acid
For Seizures may cause jaundice should report to dr to assess for liver damage
63. Blood typing?
For blood types: "O" is the universal donor (remember "o" in donor) "AB" is the universal receipient
207. For cord compression in OB?
For cord compression, place the mother in the TRENDELENBERG position because this removes pressure of the presenting part off the cord. (If her head is down, the baby is no longer being pulled out of hte body by gravity) If the cord is prolapsed, cover it with sterile saline gauze to prevent drying of the cord and to minimize infection.
294. Late Decels?
For late decels, turn the mother to her left side, to allow more blood flow to the placenta.
403. Side rail rules?
Four side-rails up can be considered a form of restraint. Even in LTC facility when a client is a fall risk, keep lower rails down, and one side of bed against the wall, lowest position, wheels locked.
209. From the ass? From the Mouth?
From the a** (diarrhea)= metabolic acidosis From the mouth (vomitus)=metabolic alkalosis
Gastroesophageal Reflux Disease (GERD)
GERD leads to indigestion and heartburn from the backflow of acidic gastric juices onto the mucosa of the lower esophagus. Encourage weight loss for overweight clients. Avoid large meals and bedtime snacks. Avoid trigger foods such as citrus fruits and juices, spicy foods, and carbonated beverages. Avoid items that reduce lower esophageal sphincter (LES) pressure, such as alcohol, caffeine, chocolate, fatty foods, peppermint and spearmint flavors and cigarette smoking.
165. Cute way to remember glascow coma?
GLASGOW COMA SCALE. EYES, VERBAL,MOTOR! It is similar to measuring dating skills...max 15 points -one can do it if below 8 you are in Coma.cSo, to start dating you gotta open your EYES first, if you able to do that spontaneously and use them correctly to SEE whom you dating you earn 4. But if she has to scream on you to make you open them it is only 3....and 1 you don't care to open even if she tries to hurt you. if you get good EYE contact (4 points) then move to VERBAL. talk to her/ him! if you can do that You are really ORIENTED in situation she/he uncontiously gives you 4 points! if you like her try not to be CONFUSED (3), and of cause do not use INAPPROPRIATE WORDS (3), she will not like it)), try not to RESPOND WITH INCOMPREHENSIBLE SOUNDS (2), if you do not like her just show no VERBAL RESPONSE(1)cSince you've got EYE and VERBAL contact you can MOVE now using your Motor Response Points. This is VERY important since Good moves give you 6!
Anxiety disorders are common mental health disorders.
Generalized Anxiety Disorder, Panic Disorder, Phobias, Obsessive Compulsive Disorder, and Posttraumatic stress disorder (PTSD) are all considered types of anxiety disorders. Assess the client for risk factors, triggers and responses.
215. Glomerulonephritis?
Glomerulonephritis: take vs q 4 hrs + daily weights
57. Besides sodium, water also follows?
Glucose
222. GTT for preggos?
Glucose Tolerance Test for preggies result of 140 or highter needs further evaluation.
Antigout Medications - What is gout?
Gout is a type of arthritis. In healthy people the body breaks down dietary purines and produces uric acid. The uric acid dissolves and is excreted via the kidneys. In individuals affected with gout the body either produces too much uric acid or is unable to excrete enough uric acid and it builds up. High uric acid levels results in urate crystals which can now collect in joints or tissues. This causes severe pain, inflammation and swelling. Treatment is both lifestyle adjustment and medication.
92. Common S/S Duchennes Muscular Dystrophy?
Gower's sign (use of the hands to push ones self from the floor_) Looks EXACTLY like the Pilates Downward dog!!!!!!!
Some final test taking tips for you too: Pay attention to Communication Skills
Graduate Nurses have a tendency to use the same communication skills regardless of whether the client has anxiety, depression, schizophrenia, bipolar disorder or obsessive-compulsive disorder. Everyone wants to use empathetic listening and everyone wants to be caring. Unfortunately these are not therapeutic responses for all disorders and every situation. Keep it very simple and apply it correctly. Use what you know. · Responses that are open-ended acknowledge the client's feelings and seek more information. This approach is appropriate for the client with anxiety, a knowledge deficit or depression. · Reality orientation is important for the client with paranoia and delusions. · Distraction is more appropriate for the client with obsessive-compulsive disorder.
Obstetric (maternity) history—"GTPAL"
Gravida Term Preterm Abortions (SAB, TAB) Living children
CABG
Great Saphenous vein in leg is taken and turned inside out (because of valves inside) . Used for bypass surgery of the heart.
217. Greeks?
Greek heritage - they put an amulet or any other use of protective charms around their baby's neck to avoid "evil eye" or envy of others
218. Greenstick fracture?
Greenstick fractures, usually seen in kids bone breaks on one side and bends on the other
221. Group-A strep?
Group-a strep precedes rheumatic fever. Chorea is part of this sickness (grimacing, sudden body movements, etc.) and it embarrasses kids. They have joint pain. Watch for elevated antistreptolysin O to be elevated. Penicillin!
121. Common S/S of Infectious Mononucleosis?
Hallmark= Sore throat, cervical lymph adenopathy, fever
301. LVN/LPN cant?
Handle any blood
198. FHR patterns in ob?
Have trouble remembering fhr patterns in OB? Think VEAL CHOP VC EH AO LP V = variable decels; C = cord compression caused E = early decels; H = head compression caused A = accels; O = okay, not a problem! L = late decels = placental insufficiency, can't fill
227. Hba1c?
HbA1c - test to assess how well blood sugars have been controlled over the past 90-120 days. 4- 6 corresponds to a blood sugar of 70-110; 7 is ideal for a diabetic and corresponds to a blood sugar of 130.
340. Normal Hemoglobin?
Hemoglobin Neonates 18-27 3 mos 10.6-16.5 3 yrs 9.4-15.5 10 yrs 10.7-15.5
Complication of severe preeclampsia—"HELLP" syndrome
Hemolysis Elevated Liver enzymes Low Platelet count
232. Hemovac?
Hemovac- used after mastectomy, empty when full or q8hr, remove plug, empty contents, place on flat surface, cleanse opening and plug with alcohol sponge, compress evacuator completely to remove air, release plug, check system for operation.
Protamine sulfate is the antidote for...
Heparin
HEPATITIS TRANSMISSION ROUTES & RISK FACTORS
Hepatitis A (HAV) Oral-fecal route • Ingestion of contaminated food/water; Daycares and communalliving facilities Hepatitis B (HBV) Blood • Drug abuse; sexual contact; Health care work Hepatitis C (HCV) Blood • Drug abus; Sexual contact Hepatitis D (HDV) Co-infection with HBV • Drug abuse Hepatitis E (HEV) Oral-fecal route • Ingestion of contaminated
235. Hepatitis?
Hepatitis Hepatitis: -ends in a VOWEL, comes from the BOWEL (Hep A) Hepatitis B=Blood and Bodily fluids Hepatitis C is just like B
Herb/ Botanical Therapy
Herbal supplements are widely used and have much less precise dosages than more regulated medications. Clients may not mention herbal supplements as a part of their medication history, so it is important to ask clients specifically if they are taking any supplements in addition to prescription or over the counter medications THE BOTTOM LINE: Clients who are taking herbal supplements should be advised to speak to their provider about possible interactions or adverse reactions that may occur.
172. Dengue hemorrhagic fever?
Hermans sign= flushes and redness of skin with lighter color at the center of the rash.... It is a disease that comes from tropical and subtropical areas that are spread by misquotos
75. Carbon dioxide narcosis?
High potassium is expected with carbon dioxide narcosis (hydrogen floods the cell forcing potassium out). Carbon dioxide narcosis causes increased intracranial pressure.
241. Hirschsprungs is dx how?
Hirschsprung's diagnosed with rectal biopsy looking for absence of ganglionic cells. Cardinal sign in infants is failure to pass meconium, and later the classic ribbon-like and foul smelling stools.
243. Hodgkins disease?
Hodgkin's disease= cancer of lymph is very curable in early stage.
if HR is <100 (children)
Hold Dig
244. How do children less than one breathe?
It is essential to maintain nasal patency with children < 1 yr. because they are obligatory nasal breathers.
Cushings
Hyper Na, Hypo K, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN, hirsutism, moonface/buffalo hump
260. Hypernatremia? SALT?
Hyper natremia (greater than 145) SALT! Skin flushed Agitation Low grade fever Thirst
348. Other S/S of MS?
Hyperactive deep tendon reflexes, vision changes, fatigue and spasticity are all symptoms of MS
Addison's
Hypo Na, Hyper K, Hypoglycemia, dark pigmentation, decreased resistance to stress fx, alopecia, weight loss. GI stress.
Trousseau and Chvostek's signs observed in
Hypocalcemia
360. Penis Problems?
Hypospadias: abnormality in which urethral meatus is located on the ventral (back) surface of the penis anywhere from the corona to the perineum (remember hypo, low (for lower side or under side) Epispadias: opening of the urethra on the dorsal (front) surface of the penis Priapism: painful erection lasting longer than 6 hrs.
304. Major risks of epidural?
Hypotension and bradypnea / bradycardia are major risks and emergencies.
464. What will alter the accuracy of o2 sats?
Hypotension and vasoconstricting meds
shock
Hypotension, tachypnea, tachycardia
SaO2 below 90% is called
Hypoxemia
169. Dangerous thing to get during pregnancy?
I kept forgetting which was dangerous when you're pregnant; regular measles (rubeola), or German measles (rubella), so remember: -never get pregnant with a German (rubella)
memory loss
ICP
271. ICP?
ICP (intracranial pressure) should be <2. measure head circonference.
270. ICP and Shock have?
ICP AND SHOCK HAVE OPPOSITE V/S ICP-increased BP, decreased pulse, decreased resp. shock- decreased BP, increased pulse, increased resp.
ICP and Shock
ICP- Increased BP, decreased pulse, decreased resp Shock--Decreased BP, increased pulse, increased resp
S/S of appendicitis
INITIAL- mild or cramping, epigastric or periumbilical pain LATE- constant, intense RLQ pain - anorexia; Rebound tenderness; Pain that decrease with a decrease in right hip flexion or increases with coughing and movement may indicate perforation with peritonitis; muscle rigidity, tense positioning, guarding may indicate perforation with peritonitis normal to low grade temp (higher suggests peritonitis)
PICC LINE- insertion, indication, care
INSERTION- basilic or cephalic vein at least 1 fingerbreaths below or above the anticubital fossa. tip is positioned in the lower 1/3 of supeiro vena cava INDICATIONS- administration of blood, long term chemo, antibiotics, TPN CARE- assess q8hrs note redness, swelling, drainage, tenderness , and condition of dressing ; change tube and postive presure cap per protocol (usually q 3days) ; 10ml syringe to flush line , intermittend med (perform flush with 10ml NS before and after); use transparent dressing, usually changed once a week.
Tunneled Cath (HICKMAN)- insertion, indication, care
INSERTION- subq tunnel seperating point where the cath enters the vein from wher it enters the skin with a cuff indication- need for vascular access for long term (longer than 1 year) , commnoly for chemo CARE- to access apply local anesthetic palpate to locate the pot, clean with alcohol for 3 sec, acess with noncoring needle, flush after every use and at least once a month
never give K+ in
IV push
413. TB health risk?
If a TB patient is unable/unwilling to comply with tx they may need supervision (direct observation). TB is a public health risk.
273. If you see a nurse make a mistake? Chain of command?
If one nurse discovers another nurse has made a mistake it is always appropriate to speak to her before going to management. If the situation persists, then take it higher.
229. Hearing the baby in OB?
If the baby is a posterior presentation, the sounds are heard at the sides. If the baby is anterior, the sounds are heard closer to midline, between teh umbilicus and where you would listen to a posterior presentation. If the baby is breech, the sounds are high up in the fundus near the umbilicus. If the baby is vertex, they are a little bit above the symphysis pubis.
Having trouble focusing?
If you find it hard to focus while reading all answer options, try reading the options backwards (start with "D" and work up to "A"). Read rationales for questions carefully as you are studying. Many students remark that they can get the answer choices narrowed down to 2 and then can't seem to pick the right one. A good tip for improving your ability to pick the BEST answer is to read rationales for correct answers and begin to understand WHY the correct answer is correct. This will help you gain information that you can carry into future tests.
451. What if a toddler says no to medication?
If you gave a toddler a choice about taking medicine and he says no, you should leave the room and come back in five minutes, because to a toddler it is another episode. Next time, don't ask.
14. A preggo in a minus station?
If your laboring mom's water breaks and she is any minus station you better know there is a risk of prolapsed cord.
275. If your patient starts seeing bugs?
If your normally lucid patient starts seeing bugs you better check his respiratory status first. The first sign of hypoxia is restlessness, followed by agitation, and things go downhill from there all the way to delirium, hallucinations, and coma. So check the o2 stat, and get abg's if possible.
157. CPR in a five year old?
In a five-year old breathe once for every 5 compressions doing cpr.
TCA'SNURSING INTERVENTION FOR CARDIAC TOXICITY
obtaine client baseline ECG and monitor during treatment
Antagonists
In order to understand how antagonist drugs work, you need to understand how agonist drugs produce therapeutic effects. Agonists are simply drugs that allow the body's neurotransmitters, hormones, and other regulators to perform the jobs they are supposed to perform. Morphine sulfate, codeine, and meperidine (Demerol) are opioids agonists that act on the mu receptors to produce analgesia, respiratory depression, euphoria, and sedation. These drugs also work on kappa receptors, resulting in pain control, sedation and decreased GI motility. Antagonists, on the other hand, are drugs that prevent the body from performing a function that it would normally perform. To quote William Shakespeare & the US Army, these drug classes allow the body's functions "to be or not to be...all that they can be".
Some final test taking tips for you too: Rule out an Answer Associated with Something Else
In some instances, rule out an option if you know it is associated with something else. For example, you may not know about the labs for Coumadin therapy, but you do know the labs for heparin and aspirin. Those labs can be eliminated because you are "using what you know."
Angiotenson II
In the lungs...potent vasodialator, aldosterone attracts sodium.
278. Incentive Spirometry steps?
Incentive Spirometry steps:1) Sit upright 2) Exhale 3) Insert mouthpiece 4) Inhale for 3 seconds, and then HOLD for 10 seconds
fluid volume deficit indicators
orthostatic hypotension poor skin turgor tachycardia increased BUN levels
Nephrolithiasis (Kidney Stones)
Increasing fluid consumption is the primary intervention for the treatment and prevention of the formation of renal calculi. Excessive intake of protein, sodium, calcium, and oxalates (rhubarb, spinach, beets) may increase the risk of stone formation.
Communal Family
Individuals who share common ownership of property and goods and exchange services without monetary considerations.
402. Side effects of thyroid hormones?
Insomnia is a side effect of thyroid hormones. Saunders confirms it. Makes sense though!Increased met. rate, your body is "too busy to sleep" as opposed to the folks with hypothyroidism who may report somnolence (dec. met rate, body is slow and sleepy).
Order of Abdominal Assessment
Inspection, Auscultation, Percussion, Palpation.
Order of Assessment (excluding abdominal assessment)
Inspection, Palpation, Percussion, Auscultation
Glucagon is the antidote for...
Insulin-induced hypoglycemia
Insulins
Insulins are used to manage diabetes mellitus, a chronic illness that results from an absolute or relative deficiency of insulin. There are various insulins that are available to manage diabetes. For each type of insulin, you will need to know the onset, peak, and duration.
318. More info on intussception?
Intussusception common in kids with CF. Obstruction may cause fecal emesis, currant jellylike stools (blood and mucus). A barium enema may be used to hydrostatically reduce the telescoping. Resolution is obvious, with onset of bowel movements.
236. Heroin withdrawl in a neonate?
Irritable, and poor sucking
196. Facts about hemophilia?
It is X-linked. Mother passes the disease to her son
363. Phenalalanine?
It is an amino acid that is BAD for people with PKU. It is found in food only and is also found in aspartame
Some final test taking tips for you too: Look for Layers
It would seem that life and death issues would be very easy to recognize in the text of a question. Unfortunately, they are usually not obvious. Instead they are buried beneath words that, at first glance, seem to bear no clinical significance. To prevent glancing over these words and missing the most critical or impending symptom, you will need to ask yourself "What could be the possible clinical significance of each answer choice?"
249. How to itch under a cast?
Itching under cast area- cool air via blow dryer, ice pack for 10- 15 minutes. NEVER use qtip or anything to scratch area
374. Prior to liver biopsy?
Its important to be aware of the lab result for prothrombin time
Peritoneal dialysis
Its ok to have abd cramps, blood tinged outflow and leaking around site if the cath (tenkoff) was placed in the last 1-2 weeks. Cloudy outflow is never ok
313. MMR and Varicella?
Just know the MMR and Varicella immunizations come later (15 months).
189. Dystocia?
Just means a difficult or abnormal delivery or birth... example.. shoulder dystocia
Meningitis--check for
Kernig's/ brudinski's signs
130. Common S/S of Meningitis?
Kernigs Sign (leg flex then leg pain on extension) Brudinzski sign (neck flex= lower leg flex)
297. Liver biopsy?
Liver biopsy- Adm vit k , npo morning of exam 6hr, give sedative, Teach pt that he will be asked to hold breath for 5-10sec, supine postion, lateral with upper arms elevated. Post- postion on right side, frequent v.s., report severe ab pain stat, no heavy lifting 1wk.
288. Kids with RSV?>
Kids with RSV; no contact lenses or pregnant nurses in rooms where ribavirin is being administered by hoot, tent, etc.
Prolapsed cord
Knee to chest or Trendelenburg oxygen 8 to 10 L
129. Common S/S of measles?
Kopliks spots
110. Common S/S of DKA
Kussmauls breathing (deep rapid RR)
350. Pain in the LLQ indicative of?
LLQ - diverticulitis , low residue, no seeds, nuts, peas
Lactose Intolerance:
Lactose intolerance results from an inadequate supply of lactase, the enzyme that digests lactose. Symptoms include distention, cramps, flatus, and diarrhea. Clients should be encouraged to avoid or limit their intake of foods high in lactose such as: milk, sour cream, cheese, cream soups, coffee creamer, chocolate, ice cream, and puddings.
293. Laparoscopy?
Laparoscopy- CO2 used to enhances visual, general anesthesia, foley. Post- walk patient to decrease CO2 build up used for procedure.
295. Latex allergies?
Latex allergies => Assess for allergies to bananas, apricots, cherries, grapes, kiwis, passion fruit, avocados, chestnuts, tomatoes, peaches
372. Potassium lab importance?
Let's say every answer in front of you is an abnormal value. If potassium is there you can bet it is a problem they want you to identify, because values outside of normal can be life threatening. Normal potassium is 3.5-5.0. Even a bun of 50 doesn't override a potassium of 3.0 in a renal patient in priority.
Hypokalemia Signs and Symptoms: 6 L's
Lethargy Leg cramps Limp muscles Low, shallow respirations Lethal cardiac dysrhythmias Lots of urine (polyuria)
239. Highest priortiy in status elipticus?
Level of consciousness is the most important assessment parameter with status epilepticus.
462. What to in the case of- Pt with heat stroke?
Lie flat with legs elevated
124. Common S/S of leprosy?
Lioning face
322. More labs suggestive of renal failure?
Low magnesium and high creatinine signal renal failure.
319. More info on lumbar puncture?
Lumbar puncture- fetal postion. post- nuero assess q15-30 until stable, flat2-3hr, encourage fluids, oral anlgesics for headache, observe dressing
Contact Precautions: MRS WEE
MRSA RSV Skin Infections (herpes zoster, cutaneous diphtheria, impetigo, pediculosis, scabies, and staph) Wound Infections Enteric Infections (C-diff) Eye Infections
302. Lymes mostly found in
Lymes is found mostly in Conneticuts
BP MEDS- NITROPRUSSIDE
MEDS FOR ANTIHYPERTENSIVE CRISIS- rapid reduction of B/P SE- escesive hyptension (admit slowly) , CYANIDE POISONING manifested by drwosiness and head ache)= (give thiosulfate concurrently)
324. MRI?
MRI- claustrophobia, no metal, assess pacemaker
Contact precaution
MRS WHISE protect visitors & caregivers when 3 ft of the pt. Multidrug-resistant organisms RSV, Shigella, Wound infections, Herpes simplex, Impetigo, Scabies, Enteric diseases caused by micro-organisms (C diff), Gloves and gowns worn by the caregivers and visitors Disposal of infectious dressing material into a single, nonporous bag without touching the outside of the bag PMGG= Private room/ share same illness, mask, gown and gloves
magnesium (Mg2+) · Regulates skeletal muscle contraction and blood coagulation · Normal range: 1.3-2.1 mEq/L
Magnesium sulfate · Magnesium gluconate or magnesium hydroxide · Monitor BP, pulse and respirations with IV administration · Decreased/absent deep tendon reflexes indicates toxicity · Have injectable calcium gluconate on hand to counteract toxicity when giving magnesium sulfate via IV
HOW TO USE A CANE
Maintain two points of support on the ground at all times Keep the cane on the stronger side of the body Support body wt on both legs, move cane forward 6-10 inches, then move the weaker leg forward toward the cane. Next, advance the stronger leg
Organizational skills:
Make effective and efficient use of time by combining nursing activities like physical assessment and bath.
Creatinine
Males: 0.6- 1.2mg/dL Females: 0.5- 1.1 mg/dL
238. High priority in Addisons?
Managing stress in a patient with adrenal insufficiency (Addison's) is paramount, because if the adrenal glands are stressed further it could result in Addisonian crisis. While we're on Addison's, remember blood pressure is the most important assessment parameter, as it causes severe hypotension.
Traditional Nuclear Family
Married couple and their biological children (full brothers and full sisters).
306. Mcburney's point?
McBurney's Point - pain in RLQ indicative of appendicitis--RLQ - appendicitis, watch for peritonitis
Airborne Precautions: "My Chicken Hez TB"
Measles Chicken pox Herpes Zoster TB
469. When patient is in distress?
Med administration is rarely a good choice
MEDICATIONS AFFECTING URINE OUTPUT- FUROSEMIDE (LASIX)
Medication Classification: High Ceiling Loop Diuretics- Cause extensive diuresis even with severe renal impairment Uses- edema COMPLICATIONS- Dehydration, hyponatremia,hypochloremia- Assess/monitor clients for signs of dehydration: dry mouth, increased thirst, minimal urine output, and weight loss. Report urine output less than 30 mL/hr. Stop medication and notify the provider. If signs of headache and/or chest, calf, or pelvic pain occur, notify the provider. This may be an indication of thrombosis or embolism. HYPOTENSION- OTOTOXICITYY- Advise clients to notify the provider of tinnitus, Avoid use with other ototoxic medications, such as gentamicin. HYPOKALENMIA- consume high-potassium foods such as bananas, potatoes.; Teach clients signs of hypokalemia such as nausea/vomiting,general weakness. INTERACTIONS - Digoxin (Lanoxin) toxicity can occur in the presence of hypokalemia; antihypertensives can have additive hypotensive effects IMPORTANT NURSE IMPLICATIONS-●● Avoid administering the medication late in the day to prevent nocturia.
MEDS AFFECTING URINE OUTPUT- SPIRONOLACTONE (MANNITOL (OSMITROL))
Medication Classification: Osmotic Diuretics- reduce intracranial pressure and intraocular S/E= HEART FAILURE AND PULMONARY EDEMA (If signs of heart failure develop (dyspnea, weakness, fatigue, distended neck veins, and/or weight gain), stop the medication immediately and notify the provider. RENAL FAILURE If signs of renal failure develop (urine output less than 30mL/hr, increased serum creatinine [greater than 1.2 mg/ dL] and BUN [greater than 20 mg/dL]), stop the medication FLUID AND ELECTROLYTE IMBALANCES CONTRAINDICATIONS/INTERACTIONS Use extreme caution in clients with heart failure.
MEDS AFFECTING URINE OUTPUT- SPIRONOLACTONE (ALDACTONE)
Medication Classification: Potassium-Sparing Diuretics- combined with other diuretics for potassium-sparing effects. for heart failure. S/E- HYPERKALEMIA- (Initiate cardiac monitoring for serum potassium greater than 5 mEq/L. Treat hyperkalemia by discontinuing medication, restricting potassium in the diet, and insulin injections to drive potassium back into the cell. INTERACTION- ACE inhibitors increases the risk of hyperkalemia.
MEDICATIONS AFFECTING URINE OUTPUT HYDROCHLOROTHIAZIDE (HYDRODIURIL)
Medication Classification: Thiazide Diuretics- Promote diuresis when renal function is not impaired- (HTN, EDEMA OF HF ) S/E-DEHYDRATION- (Report urine output less than 30 mL/hr. Stop medication and notify the provider); HYPOKALEMIA (Teach clients to consume foods high in potassium, such as spinach and tomatoes.recognize signs and symptoms of hypokalemia (nausea/vomiting, general weakness).HYPERGLYCEMIA- INTERACTIONS- Digoxin (Lanoxin) toxicity can occur in the presence of hypokalemia., ANTIHYPERTENSIVES • Monitor the client's blood pressure.HYPONATREMIA can lead to decrease in lithium carbonate (Eskalith) excretion, which may lead to toxicity. NSAIDs reduce diuretic effect. • Watch for a decrease in the effectiveness of the diuretic, such as reduced urine output. Nursing AdministratioN- Instruct clients to take the medication first thing in the morning; if twice-a-day dosing is prescribed, be sure the second dose is taken by 1400 to prevent nocturia.
Hgb
Men: 14-18g/100ml Women: 12-16g/100ml
RBCs
Men: 4.7- 6.1 mil/mm3 Women: 4.2- 5.4 mil/mm3
Hct
Men: 42%- 52% Women: 37%- 37%
310. Meningeal irriatation>?
Meningeal irritation S/s nuchal rigidity, positive Brudzinski + Kernig signs and PHOTOPHOBIA too!
POST OP NURSING- MAINTAINING FUNCTION OF JACKSON PRATT DRAIN
Monitor incisions and drain sites for bleeding and/or infection; monitor drainage (should progress from sanguineous to serosanguineous to serous); monitor the incision site (should be pink wound edges, slight swelling, under sutures/staples, slight crusting of drainage). Report signs of infection ( redness, excessive tenderness and purulent drainage) ; monitor wound drains (with each VS assessment). Empty as often as needed to maintain compression. Report increases in drainage (possible hemorrhage); Change wound dressing as required using surgical aseptic technique; use an abdominal binder for obese or debilitated clients, encourage splinting with position changes, administer prophylactic abx as prescribed, look for drainage flow through the tubing ( sudden decrease in drainage may indicate a blocked drain, and the PcP should be notified), asses the suction system to be sure the pressure ordered is being exerted
Hyperkalemia can be life-threatening
Monitor potassium levels to maintain normal range of 3.5-5.0 mEq/L
Methylxanthines Nursing interventions:
Monitor serum levels for toxicity at levels >20 mcg/mL · Mild toxicity can cause GI distress and restlessness · Moderate to severe toxicity can cause dysrhythmias and seizures · Educated client regarding potential medication and food interactions that can affect serum theophylline levels · Caffeine, cimetidine (Tagamet), and ciprofloxacin (Cipro) can increase levels · Phenobarbital and phenytoin can decrease levels
105. Common S/S of Cushings syndrome?
Moon face appearance and buffalo hump
Congestive Heart Failure Treatment: MADD DOG
Morphine Aminophylline Digoxin Dopamine Diuretics Oxygen Gasses: Monitor arterial blood gasses
sings of urinary elimination
Most adults produce between 1,500 and 2,000 mL of urine per day. Urine should be ~30cc/hr MEDS AFFECTINE URINE - Diuretics preventing reabsorption of water; Antihistamines and anticholinergics causing urinary retention ◯◯ Medications that change urine color: Pyridium - orange; Amitriptyline - green/blue; ■■ Levodopa (Dopar) - brown/black
Cardiac cath
NPO 8-12 hours. empty bladder, pulses, tell pt may feel heat, palpitations or desire to cough with injection of dye. Post: V.S.--keep leg straight. bedrest for 6-8 hr
Myelogram
NPO for 4-6 hours. allergy hx phenothiazines, cns depressants and stimulants withheld 48 hours prior. Table moved to various positions during test. Post--neuro assessment q2-4 hours, water soluble HOB UP. oil soluble HOB down. oralanalgesics for HA. No po fluids. assess for distended bladder. Inspect site
Munchausen syndrome vs munchausen by proxy
Munchausen will self inflict injury or illness to fabricate symptoms of physical or mental illness to receive medical care or hospitalization. by proxy mother or other care taker fabricates illness in child
328. Murphy's sign?
Murphy's sign - pain with palpation of gall bladder area seen with cholecystitis
Atropine is the antidote for...
Muscarinic agonists, cholinesterase inhibitors · Bethanechol (Urecholine) · Neostigmine (Prostigmin)
Weighted NI (naso intestinal tubes)
Must float from stomach to intestine. Don't tape right away after placement. May leave coiled next to pt on HOB. Position pt on RIGHT to facilitate movement through pyloris
MAOI
Must restrict intake of foods that contain tyramine due to adverse effect HTN
33. Airborne Transmission?
My - Measles Chicken - Chicken Pox/Varicella Hez - Herpez Zoster/Shingles TB
421. The difference between Myasthenia Gravis, Myastenia Crisis, and Cholinergic Crisis?
Myasthenia Gravis: worsens with exercise and improves with rest. Myasthenia Crisis: a positive reaction to Tensilon--will improve symptoms Cholinergic Crisis: caused by excessive medication-stop med-giving Tensilon will make it worse
330. Myelogram?
Myelogram- Npo 4-6hr, allergy hx, phenothiazines, cns depressants, and stimulants withheld 48hr prior, table will be moved to various postions during test. Post- neuro q2-4, water soluble HOB up, oil soluble HOB down, oral analgesics for h/a, encourage po fluids, assess for distended bladder, inspect site.
Addesonian crisis
N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP
Assessment following insulin administration
NCLEX questions may focus on when clients need to be assessed after insulin administration. Assessment should occur frequently, but especially during the PEAK of insulin action, as this is when hypoglycemia is most likely to occur. Signs and symptoms ofabrupt-onset hypoglycemia include tachycardia, palpations, diaphoresis, and shakiness. Gradual onset hypoglycemia may manifest with headache, tremors, or weakness. We'll CLIMB TO THE PEAK...starting FAST and ending SLOW.
342. OB secret?
NEVER check the monitor or a machine as a first action. Always assess the patient first; for exmaple listen to the fetal heart tones with a stethoscope in NCLEX land. Sometimes it's hard to tell who to check on first, the mother or the baby; it's usually easy to tell the right answer if the mother or baby involves a machine. If you're not sure who to check first, and one of the choices involves the machine, that's the wrong answer.
3-4 cups of milk a day for a child?
NO too much milk can reduce the intake of other nutrients especially iron. Watch for ANEMIA
PE
Needs O2!
Airborne Management
Neg. pressure room, private room mask, N-95 mask for TB
Urinalysis
Negative for glucose, RBC, WBC, Albumin, bacteria: <1000 colonies/ml
333. Nepphrotic syndrome?
Nephrotic syndrome is characterized by massive proteinuria (looks dark and frothy) caused by glomerular damage. Corticosteroids are the mainstay. Generalized edema common.
Nephrotic Syndrome:
Nephrotic syndrome results in serum proteins leaking into the urine. The goals of nutritional therapy are to minimize edema, replace lost nutrients, and minimize permanent renal damage. Dietary recommendations indicate sufficient protein and low-sodium intake.
what to check with pregnancy
Never check the monitor or machine as a first action. Always assess the patient first. Ex.. listen to fetal heart tones with stethoscope.
435. Traction rule?
Never release traction unless you have an order from an MD to do so
Peds Labs: Platelets
Newborn (after 1 wk, same as adults) 84-478 x 10 3/mm3 (ul)
Peds Labs: Glucose (Serum)
Newborn, 1 day: 40 to 60 mg/dl Newborn, > 1 day: 50 to 90 mg/dl Child: 60 to 100 mg/dl
Peds Labs: Iron Serum
Newborn: 100-250 mcg/dl Infant: 40-100 mcg/dl Child: 50-120 mcg/dl Fatally poisoned child: >1800 mcg/dl
Peds Labs: Sodium
Newborn: 134-146 mEq/l Infant: 139-146 mEq/l Child: 136-145 mEq/l
Peds Labs: Potassium
Newborn: 3.0-6.0 mEq/l Child: 3.5-5.0 mEq/l
137. Common S/S of Pemphigus Vulgaris?
Nilosky's sign (seperation of epidermis caused by rubbibng of the skin)
286. Kids pain relief in NCLEX land?
No aspirin with kids b/c it is associated with Reye's Syndrome, and also no nsaids such as ibuprofen. Give Tylenol.
Glaucoma
No atropine
Oral hypoglycemics: Hints:
No matter which class the client will be taking there is always the risk of hypoglycemia Be sure to teach client how to recognize early signs and symptoms of hypoglycemia as well as appropriate interventions.
282. Jews?
No meat and milk together
412. Suctioning is good--except
No nasotracheal suctioning with head injury or skull fracture.
365. PKU ?
No phenylalanine with a kid positive for PKU (no meat no dairy no aspartme
Palpate fontanels by 2-3 years?
No! bulging fontanels could mean increased ICP, meiningitis
338. Nondairy sources of calcium?
Non dairy sources of calcium include RHUBARB, SARDINES, COLLARD GREENS
339. Nonfat milk?
Nonfat milk reduces reflux by increasing lower esophageal sphincter pressure
356. PCWP
Normal PCWP (pulm capillary wedge pressure) is 8-13. Readings of 18-20 are considered high.
393. s3 heart sound is normal? not?
Normal in CHF from the squishin'.. NOT normal in an MI patient
Note that clients allergic to _____(10 items) may also be allergic to latex.
Note that clients allergic to bananas, apricots, cherries, grapes, kiwis, passion fruit, avocados, chestnuts, tomatoes, and/or peaches may experience latex allergies as well.
NURSING ACTIONS FOR CLIENT RECEIVING CHEMOTHERAPY - MOUTH SORES
Nursing Actions- Examine the client's mouth several times a day and inquire about the presence of oral lesions; Avoid using glycerin-based mouthwashes or mouth swabs.; Administer a topical anesthetic prior to meals.Client Education- Encourage the client to rinse her mouth with a solution of half 0.9% NaCl and half peroxide at least twice a day, and to brush her teeth using a softbristled toothbrush.Encourage the client to eat soft foods and supplements that are high in calories such
SLOWEST: Long-acting insulins: Insulin glargine (Lantus).
ONSET: 1 hour PEAK: None DURATION: 10 to 24 hours.
SLOW: Intermediate-acting insulins: NPH insulin (Humulin N).
ONSET: 1 to 2 hours. PEAK: 4 to 12 hours. DURATION: 18 to 24 hours.
FAST: Short acting insulins: Regular (Humulin R).
ONSET: 30 minutes to 1 hour. PEAK: 2 to 3 hours. DURATION: 5 to 7 hours.
FASTEST: Rapid acting insulins:Lispro (Humalog).
ONSET: Less than 15 minutes. PEAK: 30 minutes to 1 hour. DURATION: 3 to 4 hours.
TRANSFUSION RXNS anyphylactic and severe allergic
ONSET= Immediate FINDINGS- wheezing, dyspnea, chest tightness, cyanosis, hypotension - intiate CPR if idicated - have Epi ready for injection 0.4ml of 1:1000 solution SQ or 0.1 ml 1L1000 soln diluted to 10 ml with saline for IV use. - do not restart transfusion Maintain airway, administer 02, IV fluids, antihistamines, corticosteroids, vasopressors Stop the transfusion immediately if a reaction is suspected Initiate a saline infusion. The saline infusion should be initiated with a separate line so as not to give more blood from the transfusion tubing Save the blood ag with the remaining blood and the blood tubing for testing
195. Eyes?
OU- both eyes OS- left eye OD- right eye ( dominent Right eye- just a tip to remember)
362. Peritoneal dialysis?
On the other hand, peritoneal dialysis does not require that the patient's blood be pumped outside of his body. Instead, the blood is cleaned while still inside the body. The organs in the abdomen are surrounded by the peritoneum, which is a membrane that allows waste products to pass through it. Peritoneal dialysis uses a Tenckhoff catheter to run the dialysis fluid, a sugar solution with some salts, into the abdominal, or peritoneal, cavity. This allows the patient's blood to be filtered without pumping it through a dialysis machine. A Tenkhoff catheter is usually used in peritoneal dialysis
308. Med that can't be infused Intra osseously?
One medication that cannot be administered by intraosseous infusion is isoproterenol, a beta agonist.
344. Orange tag in pysch
Orange tag in triage is non emergent Psych
66. Brudzinski's sign?
One of the physically demonstrable symptoms of meningitis is Brudzinski's sign. Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed ( The kid knees will fly up and he lift his bum off the table cause it hurts his neck)
284. Kernigs sign?
One of the physically demonstrable symptoms of meningitis is Kernig's sign. Severe stiffness of the hamstrings causes an inability to straighten the leg when the hip is flexed to 90 degrees.
Single-parent Family
One parent and one or more children
TRANSFUSION RXNS mild allergic
Onset: During or up to 24 hr after transfusion -FINDINGS- itching, urticaria, flushing - give antihistamine, - if symptoms are mild and transiet, transfusion may be restarted
Ophthalmic
Ophthalmic medications are drugs used for the eye. These medications are typically prescribed for clients who have Glaucoma, Macular Degeneration. Other ophthalmic medications are used to treat allergic conjunctivitis, inflammatory disorders, dyes to visualize the eye, and to treat infections or viruses.
311. MG and Guillian Barre?
Opposites! Nursing connection! Think about it!
345. Order of assessment?
Order of assessment: Inspection, Palpation, Percussion and Ausculation. EXCEPT with abdomen cuz you don't wanna mess with the bowels and their sounds so you Inspect, Auscultate, Percuss then Palpate (same with kids, I suppose since you wanna go from least invasive to most invasive sine they will cry BLOOD MURDER ! Gotta love them kids !)
389. Rule of thumb for obsessions/distractions?
Osession is to thought. Compulsion is to action
347. Osteomyeltitis?
Osteomyletitis is an infectious bone dz. Give blood cultures and antibiotics, then if necessary surgery to drain abscess.
210. G tube and J tubes are usually?
Other than initially to test tolerance, G-tube and J-tube feedings are usually given as continuous feedings.
98. Common S/S of Basilar Fracture?
Ottorhea
Phenytoin: adverse effects
P - interactions H irsutism E nlarged gums N ystagmus Y ellow-browning of skin T eratogenicity O steomalacia I nterference with B metabolism (hence anemia) N europathies: vertigo, ataxia, headache
patient up & walking, pain 8, need what type of pain management?
PCA pump, prn morphine
GI FEEDINGS- INTERVENTIONS
PREVENT ASPIRATION- Assess for gag reflex, ability to swallow , Clients with impaired LOC may have increased risk of aspiration, Assist client to High Fowlerʼs position unless contraindicated PREVENT ASIRATION INTO RESPIRATORY TRACT (Complication)- evidenced by coughing, dyspnea, cyanosis, auscultation of crackles and wheezes- position client on side; suction nasotracheally and oral tracheally; consult PCP to order chest x-ray exam, prepare for possible initiation of abx
assess lab value for warfarin
PT, INR
Peptic Ulcer Disease (PUD):
PUD is characterized by an erosion of the mucosal layer of the stomach or duodenum. This may be caused by a bacterial infection with Helicobacter pylori or the chronic use of non-steroidal anti-inflammatory drugs (NSAIDs), such as aspirin and ibuprofen. Avoid eating frequent meals and snacks, as they promote increased gastric acid secretion. Avoid alcohol, cigarette smoking, aspirin and other NSAIDs, coffee, black pepper, spicy foods, and caffeine.
349. Paget's disease?
Paget's Disease - tinnitus, bone pain, enlargement of bone, thick bones.
Compartment Syndrome Signs and Symptoms: 5 P's
Pain Pallor Pulse declined or absent Pressure increased Paresthesia
Arterial Occlusion: 4 P's
Pain Pulselessness or absent pulse Pallor Paresthesia
McBurney's point
Pain in RLQ with appendicitis
240. Hightest priority for RA?
Pain is usually the highest priority with RA
Murphy's sign
Pain with palplation of gall bladder (seen with cholecystitis)
102. Common S/S of Cataract?
PainLESS vision loss, opacity of lens, blurring of the vision
115. Common S/S of glaucoma?
Painful vision loss, tunnel/gun barrel/ halo vision (peripheral vision loss)
117. Common S/S of Hodgkins Disease/Lymphoma?
Painless, progressive englargement of spleen and lymph tissues, and Reedstenberg cells!
353. Paracentesis?
Paracentesis- semi fowlers or upright on edge of bed, empty bladder. Post- v.s., report elevated temp, observe for signs of hypovolemia.
Binuclear Family
Parents who have terminated spousal roles but continue their parenting roles
27. After Myringotomy?
Position on the side of the AFFECTED EAR after surgery to allow drainage of secretions
212. Gerd again?
Patients with GERD should lay on their left side with the HOB elevated 30 degrees.
471. When you see coffee brown emesis think?>
Peptic ulcer
358. Peds positioning for GERD?
Position prone w hob elevated with gerd. In almost every other case, though, you better lay that kid on his back (Back To Sleep - SIDS).
IUD: potential problems with use—"PAINS"
Period (menstrual: late, spotting, bleeding) Abdominal pain, dyspareunia Infection (abnormal vaginal discharge) Not feeling well, fever or chills String missing
135. Common S/S of parkinsons?
Pilling rolling tremors
Common Direct Acting Cholinergic Agonist Agents:
Pilocarpine
366. Placement of a wheelchair?
Place a wheelchair parallel to the bed on the side of weakness
250. How to put on traction?
Place the apparatus first then place the weight (der)
Pneumothorax Signs: P-THORAX
Pleuretic pain Trachea deviation Hyperresonance Onset sudden Reduced breath sounds (& dyspnea) Absent fremitus X-ray shows collapsed lung
complications of TPN
Pneumothorax(sudden sharp chest pain, dyspnea, coughing, ), air embolus (can occur during indertion of catheter or when changing the tubing (have pt perform valsava maneuver while assuming a left lateral decubitus position can prevent air embolus) - vitamin K should be given as ordered throughout therapy because PN circumvents GI use and naturally made vitamin K - hypoglycemia- to prevent do not abrduptly dc TPN but taper rate down to within 10% of infusion rate 1-2 hours before stopping - hyperglycemia- monitor BG levels. TPN initiated sloly, , additional insulin may be necessay if problem persisits - catheter occlusion- temporarily stop infusion, flush with NS or heparin, if effort to flush is unsuccessful , attempt to aspirate a clot , if still then follow protocol for use of thromoblyitc agent (urokinase) -refeeding syndrome- movements of K, Mg, Ph intracellularly from hypertonic glucose, causes low serum electrolyte levels-- causing cardiac dysrthmias, CHF , respiratory distress, covulsions, coma.
369. Post spleenectomy?
Pneumovax 23 gets administered post splenectomy to prevent pneumococcal sepsis.
368. Positioning with pneaumonia?
Positioning with pneumonia - lay on the affected side to splint and reduce pain. But if you are trying to reduce congestion the sick lung goes up. (Ever had a stuffy nose, and you lay with the stuff side up and it clears?)
Position of the baby by fetal heart sounds
Posterior --heard at sides Anterior---midline by unbilicus and side Breech- high up in the fundus near umbilicus Vertex- by the symphysis pubis.
Pre-End Stage Renal Disease (pre-ESRD):
Pre-ESRD, or diminished renal reserve/renal insufficiency, is a predialysis condition characterized by an increase in serum creatinine. Goals of nutritional therapy for pre-ESRD are to: Help preserve remaining renal function by limiting the intake of protein and phosphorus. Control blood glucose levels and hypertension, which are both risk factors. Protein restriction is key for clients with pre-ESRD. Slows the progression of renal disease. Too little protein results in breakdown of body protein, so protein intake must be carefully determined. Restricting phosphorus intake slows the progression of renal disease. High levels of phosphorus contribute to calcium and phosphorus deposits in the kidneys. Dietary recommendations for pre-ESRD: Limit meat intake. Limit dairy products to ½ cup per day. Limit high-phosphorus foods (peanut butter, dried peas and beans, bran, cola, chocolate, beer, some whole grains). Restrict sodium intake to maintain blood pressure. Caution clients to use vitamin and mineral supplements ONLY when recommended by their provider.
373. Preload and Afterload?
Preload affects amount of blood that goes to the R ventricle. Afterload is the resistance the blood has to overcome when leaving the heart.
Preload/Afterload
Preload affects the amount of blood going into Right ventricle. Afterload is the systemic resistance after leaving the heart.
Ophthalmic Beta-Adrenergic Blocking Agents
Prescribed for clients who have open-angle glaucoma. These agents decrease the production of aqueous humor. Block beta 1and beta 2 receptors.
POST OP- Preventing Circulatory Complications
Prevent and Monitor for thromboembolism (esp following abdominal and pelvic surgeries)—apply SCDs—reposition every 2 hr and ambulate early and regularly—adminsiter anticoag as prescribed--monitor extremities for calf pain, warmth, erythema, and edema. CLIENT POSITIONING--position the client supine with head flat (prevent hypotension); do not elevate the legs higher than placement on a pillow if the client has eceived spinal anesthesia; do not put pillows under knees or use a knee gatch (decreases venous return)
POST OP- Preventing Circulatory Complications
Prevent and Monitor for thromboembolism (esp following abdominal and pelvic surgeries)—apply SCDs—reposition every 2 hr and ambulate early and regularly—adminsiter anticoag as prescribed--monitor extremities for calf pain, warmth, erythema, and edema. CLIENT POSITIONING--position the client supine with head flat (prevent hypotension); do not elevate the legs higher than placement on a pillow if the client has received spinal anesthesia; do not put pillows under knees or use a knee gatch (decreases venous return)
Prioritization
Prioritization includes clinical care coordination such as clinical decision making, priority setting, organizational skills, use of resources, time management, and evaluation of care. Clinical decisions are made by completing a thorough assessment which will help you make good judgments later when you see a changing clinical condition. A poor initial assessment can lead to missed findings later on. Priority setting refers to addressing problems and prioritizing care. It is critical for efficient care. The RN uses his/her knowledge of pathophysiology when prioritizing interventions with multiple clients.
376. Protocol for Airborne Transmission?
Private Room - negative pressure with 6-12 air exchanges/hr Mask, N95 for TB
377. Protocol for Droplet Precautions?
Private Room or cohort mask
Droplet Management
Private room, mask
Placenta Previa versus Placenta Abruptio
Problem: Placenta Previa- Low implantation of the placenta Abrunptio Plancenta- Premature separation of the placenta Incidence: PP- It occurs in approximately 5 in every 1000 pregnancies AP- It occurs in about 10% of pregnancies and is the most common cause of perinatal death. Risk Factors: PP- Increased parity Advanced maternal age Past cesarean births Past uterine curettage Multiple gestation AP- High parity Advanced maternal age A short umbilical cord Chronic hypertensive disease Pregnancy-induced hypertension Direct trauma Vasoconstriction from cigarette use Thrombic conditions that lead to thrombosis such as autoimmune antibodies Bleeding: PP- Always Present, Bright Red AP- May or may not be present, Dark Red Pain: PP- Painless AP- Sharp and stabbing pain Management: PP- Place the woman immediately on bed rest in a side-lying position. Weight perineal pads. NEVER attempt a pelvic or rectal examination because it may initiate massive blood loss. AP- Fluid replacement Oxygen by mask Monitor FHR Keep the woman in a lateral position DO NOT perform any vaginal or pelvic examinations or give enema Pregnancy must be terminated because the fetus cannot obtain adequate oxygen and nutrients. If birth does not seem imminent, cesarean birth is method of choice for delivery.
ACE Inhibitors · Capto pril (Capoten) · Enala pril (Vasotec) · Fosino pril (Monopril) · Lisino pril (Prinivil) · Rami pril (Altace)
Produce vasodilation by blocking production of angiotensin II · Should be stopped if client experiences cough, rash, altered taste, angioedema, or signs of infections · Can cause hyperkalemia so must monitor serum potassium levels · Concurrent use with potassium supplements or potassium-sparing diuretics can cause hyperkalemia · Concurrent use with lithium can lead to lithium toxicity
Angiotensin II Receptor Blockers Lo sartan (Cozaar) · Val sartan (Diovan) · Irbe sartan (Avapro) · Cande sartan (Atacand) · Olme sartan (Benicar)
Produce vasodilation by blocking the action of angiotensin II · Can cause angioedema · Fetal injury can result if used by pregnant women during 2nd and 3rd trimester
296. Likely cause of cardiac arrest in child?
Prolonged hypoxemia is a likely cause of cardiac arrest in a child.
Infant with Spina Bifida
Prone so that sac does not rupture
Omeprazole (brand names: Prilosec, Zegerid, Omepral, Omez) Lansoprazole (brand names: Prevacid, Zoton, Inhibitol) Dexlansoprazole (brand name: Kapidex, Dexilant) Esomeprazole (brand names: Nexium, Esotrex) Pantoprazole (brand names: Protonix, Somac, Pantozol, Zentro)
Proton Pump Inhibitors (PPIs) PPIs decrease stomach acid by inhibiting those gastric proton pumps that make the acid - they stop the acid at the pump! Think of a pump in your stomach just churning out the acid - 'Zole' is the nice guy who shuts off the pump. 'Zole' is very friendly (well-tolerated by most clients) but can cause vitamin B-12 deficiency if he stays around too long (with long-term use).
Medication for Hypertensive Crisis · Sodium nitroprusside · Labetalol (Trandate) · Diazoxide (Hyperstat) · Fenoldopam (Corlopam) · Trimethaphan (Arfonad)
Provide direct vasodilation of veins and arteries & rapid reduction of BP · Cyanide poisoning can occur and lead to cardiac arrest · Thiocyanate poisoning can lead to altered mental status and psychotic behavior · Nitroprusside may be slightly brown, however solutions that are dark blue, red, or green should be discarded · Continuous BP & ECG monitoring should be performed during administration of these drugs
109. Common S/S of Diptheria?
Psuedo membrane formation
Dystocia: general aspects (maternal)—"3P's"
Psych Placenta Position
Tube feeding with decreased LOC
Pt on Right side (promotes emptying of the stomach) Head of bed elevated (prevent aspiration)
467. When instilling eardrops?
Pull pinna down and back for kids < 3 yrs. when instilling eardrops.
381. Pulmonary sarcoidosis?
Pulmonary sarcoidosis leads to right sided heart failure..Sarcidosis is basically scar tissue build up
65. Brachial Pulse?
Pulse area cpr on infant
380. PTB means?
Pumonary tuberculosis
219. Grey Turners sign?
Purple bruises around the belly button... Pancreatitis!
226. Halo?
Questions about a halo? Remember safety first, have a screwdriver nearby.
chronic emphysema ABG?
RESP, acid (low ph, low co2)
Sprain or Strain
RICE Rest Ice Compress Elevate
382. Radioactive iodine?
Radioactive iodine - The key word here is flush. Flush substance out of body w/3-4 liters/day for 2 days, and flush the toilet twice after using for 2 days. Limit contact w/patient to 30 minutes/day. No pregnant visitors/nurses, and no kids.
Look for those key words:
Read the question and all answer options carefully. Make sure you pay attention to words in the question stem such as "most important", "first", "initial", or "last". Use these cues to help you select your answer, and make sure that the answer you select is answering the question. Is the question asking for an intervention, an assessment, or an evaluation? Choose your answer accordingly.
Words of Magnitude
Read the question and options closely for words asking about direction or magnitude. For instance, stop and concentrate on the terms intra- versus inter- ; hyper- versus hypo - ; increase versus decrease; lesser versus greater; and gain versus lose. It is common to misread these terms by simply skimming over them too quickly.
387. Rule of nines?
Rule of NINES for burns Head and Neck= 9% Each upper ext= 9% Each lower ext= 18% Front trunk=18% Back trunk= 18% Genitalia= 1%
148. Common S/S of Ulcerative Colitis?
Recurrent bloody diarrhea
Orthostatic hypotension values
SBP decreases more than 20 mm Hg and/or DBP decreases more than 10 mm Hg with a 10 to 20% increase in the HR.
277. In depth- Color codes??
Red- Immediate: Injuries are life threatening but survivable with minimal intervention. Ex: hemothrax, tension pneumothorax, unstable chest and abdominal wounds, INCOMPLETE amputations, OPEN fx's of long bones, and 2nd/3rd degree burn with 15%-40% of total body surface, etc. Yellow- Delayed: Injuries are significant and require medical care, but can wait hrs without threat to life or limb. Ex: Stable abd wounds without evidence of hemorrhage, fx requiring open reduction, debridement, external fixation, most eye and CNS injuries, etc. Green- Minimal: Injuries are minor and tx can be delayed to hrs or days . Individuals in this group should be moved away from the main triage area. Ex: upper extremity fx, minor burns, sprains, sm. lacerations, behavior disorders. Black- Expectant: Injuries are extensive and chances of survival are unlikely. Seperate but dont abandoned, comfort measures if possible. Ex: Unresponsive, spinal cord injuries, woulds with anatomical organs, 2nd/3rd degree burn with 60% of body surface area , seizures, profound shock with multipe injuries, no pulse, b.p, pupils fixed or dilated.
codes for pt care
Red- unstable, ie.. occluded airway, actively bleeding...see first Yellow--stable, can wait up to an hour for treatment Green--stable can wait even longer to be seen---walking wounded Black--unstable, probably will not make it, need comfort care DOA--dead on arrival
89. Color codes?
Red--unstable, ie, occluded airway, actively bleeding, see first Yellow---stable, can wait up to an hour for treatment, ie burns, see second Green---stable, can wait even longer to be seen, "walking wounded" Black--unstable clients that will probably not make it, need comfort measures DOA---dead on arrival
What can you delegate to an LPN/LVN?
Reinforcement of client teaching Monitoring client clinical manifestations after the initial RN assessment and evaluation Tracheostomy Care Suctioning Reviewing patency and placement of a nasogastric tube Enteral feeding administration Urinary Catheter insertion Medication administration (excluding intravenous medications - state specific)
150. Compartment syndrome?
Remember compartment syndrome is an emergency situation. Paresthesias and increased pain are classic symptoms. Neuromuscular damage is irreversible 4-6 hours after onset.
Crutch Walking
Remember the phase "step up" when picturing a person going up stairs with crutches. The good leg goes up first followed by the crutches and the bad leg. The opposite happens going down the stairs....OR "up to heaven...down to hell"
160. Crutch use?
Remember the phrase "step up" when picturing a person going up stairs with crutches. The good leg goes up first, followed by the crutches and the bad leg. The opposite happens going down. The crutches go first, followed by the good leg.
291. Labs for congenital heart disease?
Remember yesterday when I mentioned how congenital cardiac defects result in hypoxia which the body attempts to compensate for (influx of immature rbc's)? Labs supporting this would show increased hematocrit, hemoglobin, and rbc count.
383. Renal impairment labs?
Renal impairment: serum creatinine elevated and urine clearance decreased
CF chief concern?
Respiratory problems
84. Chief concern in CF
Respiratory problems!
Hypoxia: RAT (signs of early) BED (signs of late)
Restlessness Anxiety Tachycardia and tachypnea Bradycardia Extreme restlessness Dyspnea
449. What disease leads to cardiac valve malfunctions?
Rhematic fever
Antirheumatics : What is rheumatoid arthritis?
Rheumatoid arthritis (RA) is a chronic disease that results in inflammation of the joints and surrounding tissues. RA affects the lining of the joints and the painful swelling can result in bone erosion and joint deformities. It is the small joints in hands and feet are most often affected. Treatment is designed to provide symptom relief and some delay in progression of the disorder but not a cure.
Non Dairy calcium
Rhubarb sardines collard greens
104. Common S/S of Cholera?
Rice watery stool
Cor pumonae
Right sided heart failure caused by left ventricular failure (edema, jugular vein distention)
146. Common S/S of Tetany?
Risus Sardonicus
385. Risus Sardonicus?
Risus sardonicus is a highly characteristic, abnormal, sustained spasm of the facial muscles that appears to produce grinning--- From Tetany! Sad and scary looking! Never Google image it again, Megan! Nightmares!
147. Common S/S of Thypohiod
Rose spots on abdomen
139. Common S/S of pneumonia?
Rusty sputum
Hypernatremia
S (Skin flushed) A (agitation) L (low grade fever ) T (thirst)
EPOETIN S/E & nursing Interventions
S/E- hypertension due to increase HCT, increased risk for CV event Nursing intervention- monitor iron level, monitor Hgb, Hct, twice a week until targer tange is reached obtain baseline BP, in chronic renal failur control HTN prior to treatment, do not combine with other meds, evalaute med effectiveness- Hgb (10-12) Hct (40%) ; increased reticulocyte count.
Air or Pulmonary Embolism
S/S chest pain, dyspnea, tachycardia, pale/cyanotic, sense of impending doom. (turn pt to LEFT side and LOWER the head of bed.)
Autonomic Dysreflexia/Hyperreflexia
S/S pounding headache, profuse sweating, nasal congestion, chills, bradycardia, hypertension. Place client in sitting position (elevate HOB) FIRST!
RENAL CALCULI S/S INTERVENTIONS
S/S- Nausea, flank pain that radiates to the abdomen, and sweating DIET RESTRICTIONS FOR PT WITH CALCIUM PHOSPHATE STONE - avoid cheese,, soy sauce, red meat all contain calcium phosphate PREVENTING REOCCURENCE OF CALCIUM PHOSPHATE STONE- Limit the intake of foods high in animal protein. ; Reduce sodium intake in diet. Report burning or dysuria to the provider., Increase fluid intake to 3 L/day. Strain all urine. TYPES OF MEDICATIONS FOR RENAL STONES C Calcium phosphate stone- . Allopurinol (Zyloprim) A,Calcium oxalate stone- Captopril (Capoten) A Uric acid (urate) stone - Thiazide diuretic B Cystine stone- Vitamin B6 (pyridoxine)
Cranial nerves
S=sensory M=motor B=both Oh (Olfactory I) Some Oh (Optic II ) Say Oh (Oculomotor III) Marry To (trochlear IV) Money Touch (trigeminal V) But And (Abducens VI ) My Feel (facial VII) Brother A (auditory VIII) Says Girl's (glossopharyngeal IX) Big Vagina (vagus X) Bras And (accessory XI) Matter Hymen (Hypoglossal XII) More
405. Signs of a hip fracture?
SIGNS of a Fractured hip: EXTERNAL ROTATION, SHORTENING, ADDUCTION
(PRESSURE ULCER STAGES
STAGE 1- Nonblanchable erythema of intact skin, the heralding lesion of skin ulceration, alteration of intact skin- STAGE 2 Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater. STAGE 3 Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue. STAGE 4 Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint capsule).
Cancer: Preventing Complications of Radiation Treatments
STOMATITIS: use artificial saliva; assess oral mucosa daily; discourage use of irritant (tobacco and alcohol); apply topical anesthetics such as viscous Lidocaine; NAUSEA/VOMITTING- eat and drink when not nauseated; admin antiemetics use ANOREXIA- monitor wt; small freq meals of high protein, high calorie foods DIARRHEA- antidiarrheal agents CONSTIPATION- stool softener, high fiber foods HEPATOXICITY- monitor liver function tests ANEMIA- Monitor Hgb and Hct levels; encourage Iron intake LEUKOPENIA- monitor WBC count, especially neutrophils; teach to : report temp elevation and any other manifestations of infection, avoid large crowds and people with infections, hand washing techniques THROMBOCYTOPENIA- observe for signs of bleeding; monitor hgb and hct and platelet counts; teach to use soft bristle toothbrush and use electric razor ALOPECIA- discuss impact of hair loss on self image; cut long hair before therapy; avoid excessive shampooing, brushing, and combing of hair; avoid use of electric hair dryers curler and curling irons SKIN RXNS- protect skin from trauma; lubricate dry skin with nonirritating creams avoid the use of harsh soaps CYSTITIS- monitor manifestations such as urgency, freq, and hematuria NEPHROTOXICITY- monitor BUN and serum creatinine levels INCREASED ICP- may be controlled with steroids and pain meds PNEUMONITIS-monitor for dry, hacking cough, fever and exertional dyspnea HYPERURICEMIA- monitor uric acid levels; allopurinol (zyloprim) may be given as a prophylactic measure, encourage high fluid intake
106. Common S/S of cystic fibrosis?
Salty skin
122. Common S/S of Intusseption?
Sausage shaped mass , Dance sign (empty portion of RLQ)
Scenario #1 You receive report in the morning and are assigned the following clients. Prioritize the order in which you will assess these clients: A client needing assistance with feeding due to hemiparesis. A client on a ventilator with a PRN order for tracheal suctioning. A client going to OR for an appendectomy at 0900. A client needing reinforcement of teaching regarding self-administration of insulin.
Scenario #1 Key The order of care should be as follows: 1. A client on a ventilator with a PRN order for tracheal suctioning should be seen 1st—ABCs and Safety! 2. A client going to OR for an appendectomy at 0900 should be seen 2nd to ensure that the procedure is started on time. 3. A client needing assistance with feeding due to hemiparesis can be seen 3rd as hunger and thirst come before teaching according to Maslow's Hierarchy of Needs. 4. A client needing reinforcement of teaching regarding self-administration of insulin can be seen last.
Scenario #2 You receive report in the morning and are assigned the following clients. Prioritize the order in which you will assess these clients: A client requesting discharge instructions because his ride home is waiting. A client requesting pain medication. A client who had an episode of urinary incontinence, resulting in urine on the floor next to the bed. A client needing a dressing change for an infected wound.
Scenario #2 Key The order of care should be as follows: 1. A client who had an episode of urinary incontinence, resulting in urine on the floor next to the bed. 2. A client requesting pain medication. 3. A client needing a dressing change for an infected wound. 4. A client requesting discharge instructions because his ride home is waiting. Think Safety first!! The urine spill needs to be cleaned first to prevent an injury from someone slipping and falling. The pain medication should be given before completing the dressing change because the pain is acute, but the wound is already established. Once client care needs are addressed, then teaching can take place.
RLQ
appendicitis watch for peritonitis
ARDS and DIC
are always secondary to another disease or trauma
Scenario #3 You are the nurse on the day shift and the following events are occurring. Prioritize the order in which you would address these issues: The Emergency Department is full and wants to give you a report on a patient being transferred to you unit. A client is experiencing pallor, a heart rate of 42, and has a change in level of consciousness. Lunch trays need to be passed out to your clients. A family member of one of your client's has a question to ask you.
Scenario #3 Key The client experiencing pallor, a heart rate of 42, and changes in the level of consciousness needs to be seen 1st as these symptoms indicate an emergency situation! Remember—ABCs and Safety 1st!! The remaining tasks can be managed by collaboration and delegation: Ask another nurse to take report on the client being transferred from the Emergency Department. This nurse can also speak with the family that has the question to see if she can be of assistance while you deal with an emergency situation. Delegated the passing of the lunch trays to an Assistive Personnel.
Scenario #4 A trash can in a client's bathroom is smoldering from a lit cigarette being thrown away. Prioritize the following nursing Actions: Pull the fire alarm. Get the fire extinguisher, pull the pin, aim at the base of the fire and spray in a sweeping motion at the base of the fire. Remove the client and any visitors from the room. Close the door to the client's room.
Scenario #4 Key 1. Remove the client and any visitors from the room. 2. Pull the fire alarm. 3. Close the door to the client's room. 4. Get the fire extinguisher, pull the pin, aim at the base of the fire and spray in a sweeping motion at the base of the fire. Remember RACE! Rescue the client and any visitors Activate alarm Confine the fire Extinguish the fire
Scenario #5 The following clients arrive at the Emergency Department at the same time. Which order should be used when attending to these clients? An elderly client who fell at home and is reporting hip pain. An elderly client requesting a flu shot. A middle-aged client who is unable to stop the bleeding after cutting her finger while cleaning up broken glass. A young adult who was splashed in the face and chest with a chemical agent.
Scenario #5 Key The clients should be attending to in the following order: 1. The young adult who was splashed in the face and chest with a chemical agent should be seen 1st due to the risk for serious injury related to the chemical agent. 2. The elderly client who fell at home and is reporting hip pain should be seen 2nd because of the potential for severe internal bleeding if the femur is fractured. 3. The middle-aged client with the bleeding finger should be seen 3rd because the severity of bleeding is not as serious as the potential bleeding secondary to a fractured hip. 4. The elderly client requesting a flu shot should be seen last.
395. School aged kids and five year olds?
School-age kids (5 and up) are old enough, and should have an explanation of what will happen a week before surgery such as tonsillectomy.
470. When to test urine for ketones and glucose?
Second voided urine most accurate when testing for ketones and glucose.
Some final test taking tips for you too: Use Your Presence
Seldom will a correct answer have the nurse physically leave the client. Choose an answer that keeps the nurse with the client.
396. Sengstaken blakemore tube ?
Sengstaken blakemore tube used for tx of esophageal varices, keep scissors at bedside.
Droplet Precautions: SPIDERMAn
Sepsis Scarlet Fever Strep Pertussis Pneumonia Parvovirus Influenza Diphtheria Epiglottitis Rubella Mumps Adenovirus
56. Besides meds and congenital problems .. what can lead to decreased preload ?
Sepsis and anaphylaxis (along with the obvious hemorrhaging) reduce circulating volume by way of increased capillary permeability, which leads to reduced preload (volume in the left ventricle at the end of diastole). This is a toughie...think about it.
292. Labs in DKA>?
Serum acetone and serum ketones rise in DKA. As you treat the acidosis and dehydration expect the potassium to drop rapidly, so be ready, with potassium replacement. Fluids are the most important intervention with HHNS as well as DKA, so get fluids going first. With HHNS there is no ketosis, and no acidosis. Potassium is low in HHNS (d/t diuresis).
187. During epidural puncture?
Side lying
398. Shilling test?
Shilling Test - test for pernicious anemia/ how well one absorbs Vit b12
185. Dunlap traction=
Skeletal or skin
bicarbonate (HCO3-) · Maintains blood pH to prevent metabolic acidosis · Normal pH range: 7.35-7.45
Sodium bicarbonate · Given orally as an antacid or via IV · Numerous incompatibilities with IV form
125. Common S/S of Liver cirrhoisis?
Spider like varices- Varices can be in stomach, esophagus or the skin! They are just spider/varicose veins! Ithcy on the skin
443. VRSA?
Staph infection that is resistant to Vancomycin treatement! Worse than MRSA
Heart Murmur Causes: SPASM
Stenosis of a valve Partial obstruction Aneurysms Septal defect Mitral regurgitation
128. Common S/S of Malaria?
Stepladder like fever with chills
337. No Cantalope?
Thank you, I finally realize why a person shouldn't have cantaloupe before a occult stool test, because cantaloupe is high in vit c and vit c causes a false + for occult blood. Now I just need to figure out why they can't have fish.
ASSESSMENT FINDINGS IN COLOSTOMY CARE
Stoma s/b pink.; Dusky blue stoma---ischemia; Brown-black stoma---necrosis; mild to moderate swelling for 1st 2-3 weeks after surgery;
410. Stomas?
Stomas dusky stoma means poor blood supply, protruding means prolapsed, sharp pain + rigidity means peritonitis, mucus in ileal conduit is expected.
411. Stranger Danger>?!?
Stranger anxiety is greatest 7 - 9 months, Separation anxiety peaks in toddlerhood
123. Common S/S of Kawasaki syndrome?
Strawberry tongue
Stressors in Hospitalized Children: Infant
Stressors: Interrupted routines Parental separation Lack of stimulation Behaviors: Poor feedings Irritability Crying Altered sleep patterns
Stressors in Hospitalized Children: Pre-Schoolers
Stressors: Pain/bodily injury Separation from parents Loss of control Behaviors: Passiveness Withdrawal Poor appetite Sleep disturbances Magical thinking Bed wetting
Stressors in Hospitalized Children: School Age Children
Stressors: Guilty feelings Fear of pain Loss of control Body image changes Falling behind in school Missing school friends Behaviors: Decreased self esteem Anxiety Fearfulness, stalling, bargaining Stoicism, boredom, withdrawal, sleep disturbances Acting out, anger, crying
Stressors in Hospitalized Children: Toddler
Stressors: Interrupted routines Separation from parents Loss of control Fear of being hurt Behaviors: Protest stage (Crying, fighting, tantrums) Despair stage Developmental regression Refusal to eat, sleep pattern disturbance
Stressors in Hospitalized Children: Adolescents
Stressors: Body image changes Self-concept disturbances Social isolation Personal identity issues Behaviors: Anger Aggression Demanding Frustration Withdrawal
Use What You Know
Students have a tendency to focus on what they don't know rather than on what they do know. The ramifications of this mental approach are devastating. When you focus on your lack of knowledge about a particular topic, you are likely to become anxious and start guessing or changing answers. There is also a carry-over effect that can reduce your ability to answer the items that follow the item causing you distress. You might start losing confidence. When that happens, suddenly the test begins controlling you. You should pause, take a deep breath, try to relax and move on. Stay focused.
potassium (K+) · Essential for maintaining electrical excitability of muscle, conduction of nerve impulses, and regulation of acid/base balance · Normal range 3.5-5.0 mEq/L
Suplement: Potassium chloride (K-Dur) · Oral or IV administration · NEVER give IV push to avoid fatal hyperkalemia · Dilute potassium and give no more than 40 mEq/L per IV to prevent irritation of vein · Administer no faster than 10 mEq/L per IV · Concurrent use with potassium-sparing diuretics or ACE inhibitors can cause hyperkalemia · Administer Kayexalate for hyperkalemia with serum potassium > 5.0 mEq/L
sodium (Na+) · Major electrolyte in extracellular fluid · Normal range 135-145 mEq/L
Supplement: Administer isotonic IV therapy of 0.9% normal saline or Ringer's lactate
TRANSFUSION RXNS circulatory overload
Sx include: dyspnea, chest tightness, tachycardia, tachypnea, HA, HTN, JVD,peripheral edema, orthopnea, sudden anxiety and crackles in the base of the lungs - Admin 02, monitor VS, slow the infusion rate and admin diuretics as ordered - Notify PCP immediately - place pt upright with feet in dependent position - administer prescribed diruetics, 02 morphine, - phlebotomy may be indicated
407. SLE?
Systemic Lupus Ethramoutus.... (Lupus)
Prehypertension BP
Systolic 120 to 139 Diastolic 80 to 89
INH can cause peripheral neuritis
Take vitamin B6 to prevent. Hepatotoxic
Imprisonment
Telling the client you cannot leave the hospital
Traction Patient Care: TRACTION
Temperature of extremity is assessed for signs of infection Ropes hang freely Alignment of body and injured area Circulation check (5 P's) Type and location of fracture Increase fluid intake Overhead trapeze No weights on bed or floor
Preterm infant: Anticipated problems—"TRIES"
Temperature regulation (poor) Resistance to infections (poor) Immature liver Elimination problems (necrotizing enterocolitis [NEC]) Sensory-perceptual functions (retinopathy of prematurity [ROP])
shilling test
Test for pernicious anemia
Guthrie test
Tests for PKU. Baby should have eaten protein first
463. What treats tet spells?
Tet spells treated with morphine.
420. Tetraology of Fallot?
Tetralogy of fallot; remember HOPS Think DROP(child drops to floor or squats) or POSH Defect, septal Right Ventricular hypertrophy Overriding aorts Pulmonary stenosis
314. MMR SHot?
The MMR vaccine is given SQ not IM.
18. Acid/ ASH diet?
The acid ash diet has nothing to do with weight loss. It is a diet intended for health and may be prescribed by your physician to control illness or disease. Once your liver has metabolized the food you ingest, it leaves a mineral deposit, known as ash, which can be acidic or alkaline depending on its effect on the pH of your urine. Eating foods that create an acid ash may help to balance your system or create a hostile environment to inhibit bacterial growth. .... Acid/ ash diet is used to BALANCE the acid/alkaline ash in the body... Ash wiill affect the urinary system and even the nervous system. Imbalance will be diet modified
Anticonvulsants
The anticonvulsants are medications used for the treatment of epileptic seizures. These meds suppress the rapid and firing of neurons in the brain that start a seizure. Drugs for all types of seizures, except petit mal: CaPhe like cafe in French CA rbamazepine PHE nytoin/Phenobarbital Drugs for petit mal seizures: ValEt Val proic Acid Et hosuximide
detached retina
area of detachment should be in the dependent position
422. The first s/s of ards?
The first sign of ARDS is increased respirations. Later comes dyspnea, retractions, air hunger, cyanosis.
201. First sign of pyloric stenosis in a baby?
The first sign of pyloric stenosis in a baby is mild vomiting that progresses to projectile vomiting. Later you may be able to palpate a mass, the baby will seem hungry often, and may spit up after feedings.
161. Cryptoorchidism?
Undescended testis or cryptorchidism is a known risk factor for testicular cancer later in life. Start teaching boys testicular self exam around 12, because most cases occur during adolescence.
458. What to do in a sucking stab wound?
The immediate intervention after a sucking stab wound is to dress the wound and tape it on three sides which allows air to escape. Do not use an occlusive dressing, which could convert the wound from open pneumo to closed one, and a tension pneumothorax is worse situation. After that get your chest tube tray, labs, iv.
Vasodilators
The term "vasodilators" refers to drugs that improve oxygenation of tissues by dilating or opening up the body's vascular system. While several classes of drugs dilate vessels through different mechanisms, the goal is the same—to provide improved circulation of oxygen to the body's tissues. It should be noted that concurrent use of any of these drugs with other antihypertensive drugs can lead to severe hypotension.
Oral hypoglycemics: Medications
There are four classes of hypoglycemic drugs: · Sulfonylureas Tolbutamide (Orin ase); glyburide; Micron ase Stimulates insulin production Associated with weight gain · Biguanide: Metformin o First line drug in type 2 diabetes o Reduces the production of glucose within the liver o Associated with modest weight loss o Less likely to cause hypoglycemia. o Significant lipid-lowering activity. · Thiazolidinediones o Reverses insulin resistance o Increases glucose uptake and decreased glucose production o Associated with severe liver damage · Alpha-glucosidaseinhibitors. o Acarbose (Precose) o Reduces the absorption of dietary glucose o Associated with flatulence and diarrhea
174. Detached Retina?
area of detachment should be in the dependent position-- dependent meaning supported by something
Peds Labs: Salicylates
Therapeutic: 15-30 mg/dl
Admittance of a postpartum client to a medical-surgical unit
There are times when a woman may be hospitalized during the postpartum period for a medical condition. When this occurs, she'll most likely be placed on a general medical-surgical unit. Her admission will cause you to ask: "What's normal during the weeks following the birth of a baby?" * Breasts. Within the first 24 hours postpartum, colostrum appears and is followed by breast milk within the first 72 hours. Breast engorgement is most likely to occur around day 4 postpartum. The engorged breast will appear full, taut, and even shiny. Although this is normal, it may be very uncomfortable for your client. In contrast, a woman with mastitis will usually run a fever higher than 100° F, report feeling "ill," and have one breast that's affected (firm, inflamed, swollen, and exquisitely tender to touch). If your client is breastfeeding her newborn, she'll require a breast pump. Depending on the medications ordered, the milk may need to be disposed of and not used for the baby. * Lochia. Sometimes women will experience lochia (vaginal discharge) until the time of their 6-week postpartum visit. Immediately after delivery, the lochia is red and heavy enough to require a pad change every 1 to 2 hours. By 7 days postpartum, the lochia should be lighter in color (pink to red) and amount, requiring a pad change every 4 hours. Lochia that becomes heavier, has a foul odor, and is accompanied by pelvic pain isn't a normal finding and requires immediate intervention. * Perineal care. For the first 2 weeks following delivery, clients will need to perform perineal hygiene as taught during the immediate postpartum period. This may include perineal water rinses following elimination using warm water or medicinal rinses, use of sitz baths, and comfort medications to the perineal and anal area. * Cesarean section. If your client delivered her baby via cesarean section, continued assessment of the surgical incision is warranted for the first 2 to 3 weeks postpartum. Redness and warmth around the incision, excessive bruising around the incision, or incisional drainage requires immediate intervention. If the surgeon used staples to close the incision, they're usually removed approximately 5 days post-delivery. Remember, the hospitalized postpartum client is likely to be very emotional. Not only will she be experiencing the normal hormonal fluctuations of the postpartum period, she'll also likely be distraught at leaving her newborn at home and feeling that she's missing bonding time with her child. Visitation between the mother and her infant may be very limited to minimize the infant's risk of infection, but visits should be arranged if at all possible.
Dealing with the dreaded 'Select All That Apply' question
These are tough. Try to make them true false questions so that you don't miss any correct choices. Read the question, read the first choice - ask yourself is it true or false (is it correct or not). If so check it. Read the question again and the next choice - ask yourself is it true or false. Is that true for all of the choices? Don't allow the info from one answer choice influence you. Only the info in the stem of the question should be considered when picking your answers.
Alpha2-Adrenergic Agonists
These drugs lower IOP by reducing aqueous humor production and by increasing outflow. Also delays optic nerve degeneration and protects retinal neurons from death.
Direct Acting Cholinergic Agonist/Muscarinic Agonist (parasympathomimetic agent)
These drugs stimulate the cholinergic receptors in the eye, constricts the pupil (miosis), and contraction of the ciliary muscle. IOP is reduced by the tension generated by contracting the ciliary muscle and promotes widening of the spaces within the trabecular meshwork, thereby facilitating outflow of aqueous humor.
SSRIs: Selective Serotonin Reuptake Inhibitors.
These medications include Citalopram (Celexa), Fluoxetine (Prozac), or Sertraline (Zoloft). The client should avoid using St. John's Wort with these medications, and should eat a healthy diet while on these medications.
Oral Hypoglycemic Agents
These medications promote insulin release from the pancreas. Clients who are prescribed oral hypoglycemic agents do not produce enough insulin to lower their blood glucose (blood sugar) levels. Prescribed for clients with type 2 Diabetes Mellitus.
Anterior Pituitary Hormones/Growth Hormones
These medications stimulate growth. Are used to treat growth hormone deficiencies. Use cautiously in clients who have Diabetes Mellitus since these medications cause hyperglycemia because of the decreased use of glucose. Common Anterior Pituitary Hormones/Growth Hormone Agents: somatropin somatrem(Protropin)
a patient is experiencing umbilical cord prolapse - intervention?
put hand up vagina and hold it there
FHR patterns for OB
Think VEAL CHOP! V-variable decels; C- cord compression caused E-early decels; H- head compression caused A-accels; O-okay, no problem L- late decels; P- placental insufficiency, can't fill
Posterior Pituitary Hormones/Antidiuretic Hormone
This medication promotes the reabsorption of water within the kidneys; causes vaso constriction due to the contraction of vascular smooth muscle. Common Posterior Pituitary Hormones/Antidiruetic Hormones: desmopressin (DDAVP, stimate) vaso pressin (Pitressin synthetic) (See the form of vaso in the drug name, for vaso constriction)
Assault
Threatening to give pt. medication putting another person in fear of a harmful or an offensive contact.
424. Thoracentesis?
Thoracentesis prep- Take v.s., shave area around needle insertion, position patient with arms on pillow on over bed table or lying on side, no more than 1000cc at a one time. Post- listen for bilateral breath sounds, v.s., check leakage, sterile dressing.
Thyroid Hormones (hypothyroidism)
Thyroid Hormones are a synthetic form of thyro xine (T4) (see the form of thyroid in this hormone). These hormones increase metabolic rate, body temperature, oxygen use, renal perfusion, blood volume, and growth processes. These medications are prescribed for clients who have low thyroid hormone production (hypothyroidism). In hypothyroidism...everything is LOOOOOWWWWWW(HYPOOOOOOOOO) Common Thyroid Medications: Levo thyro xine (Syn thro id,Levo thro id) Lio thyro nien (Cytomel) Liotrix ( Thyro lar) Thyroid ( Thryoid USP)
426. Thyroid storm and myxedema?
Thyroid storm is HOT (hyperthermia) *Myxedema coma is COLD (hypothermia)
Prioritization Tip
To avoid some common pitfalls when answering priority questions, be aware of the following: Never perform ABC checks blindly without considering whether airway, breathing or circulation issues are acute versus chronic or stable versus unstable. For example, a client who is quadriplegic and on a ventilator has chronic airway/breathing problems. However, if there is not an acute consideration such as pneumonia, the client should be considered chronic and stable. This client would not be the nurse's first priority.
Infections during pregnancy—"TORCH"
Toxoplasmosis Other (hepatitis B, syphilis, group B beta strep) Rubella Cytomegalovirus Herpes simplex virus
418. Tension Pneumothorax?
Trachea shifts to the opposite side
Peds Labs: Acetaminophen
Toxic concentration >200 mcg/ml
Peds Labs: Digoxin
Toxic concentration: >2.5 ng/ml
415. TEF?
Transesophageal Fistula (TEF) - esophagus doesn't fully develop (this is a surgical emergency) The 3 C's of TEF in the newborn: 1) Choking 2) Coughing 3) Cyanosis
442. Vertical C section?
Used in plus sized women or risky or emergency c sections. less chance of harm for the baby
Hypo Mg
Tremors, tetany, seizures, dysthythmias, depression, confusion, dysphagia, (dig toxicity)
436. Trendelenberg's test?
Trendelenburg test - for varicose veins. If they fill proximally = varicosity.
404. Signs observed in hypocalemia?
Trousseau and Tchovoski signs observed in hypocalcemia
437. Turner's sign?
Turner's sign - flank grayish blue (turn around to see your flanks) pancreatitis
Gay/Lesbian Family
Two members of the same sex who have children and a legal or common-law tie
Nuclear Family
Two parents and their children (biologic, adoptive, step, foster.
438. Tylenol poisioining ?
Tylenol poisoning - liver failure possible for about 4 days. Close observation required during this time-frame, as well as tx with Mucomyst.
when drawing an ABG
put in heparinized tube. Ice immediately, be sure there are no bubbles and label if pt was on O2
Captopril (Capoten) Lisinopril (prinivil)
USE- ACE INHIBITORS- vasodilation & retain H20 , retains Potassium S/E ORTHOSTATIC HYPOTENSION - monitor B/p for initial 2 hrs, change position slowly, lie down if dizzy DRY COUGH- D/C med HYPERKALEMIA ANGIOEDEMA (manifested in tongue)- D/C med, Sq epi INTERACTIONS -Diuretics- additive -hypotensive Pottassium - -Hyperkalemia NSAIDS
431. To prevent dumping syndrome?
Unusual positional tip - Low-fowlers recommended during meals to prevent dumping syndrome. Limit fluids while eating.
474. Where should placenta be?
Upper part of the uterus
439. Uremic Fetor?
Uremic fetor --> smell urine on the breath
440. Use of cold and hot?
Use cold for acute pain (sprained ankle) and heat for chronic pain (arthritis)
Some final test taking tips for you too: Use the Nursing Process
Use of the nursing process can be helpful. Always remember to "assess" first. Even if your knowledge of the topic is gray, you can still recognize that an answer choice is an "assessment" rather than an "intervention."
Use of resources:
Use other members of the healthcare team to help you when necessary when turning and repositioning, lifting or inserting a catheter. Seeking help can make things safer and easier for you and client.
Skin infection
VCHIPS Varicella zoster Cutaneous diptheria Herpes simplez Impetigo Peduculosis Scabies
C1-C4 SPINAL CORD INJURY
Vagus nerve domination of heart, respirations and all vessels and organs below injury - movement remaining- movement in neck and above C1-C3 (absence of independent respiratory tx) C4 (may be able to breathe without a ventilator) - rehab potentential- able to drive electric wheelchairequipped with portable ventilator , 24 hour attendant
VEAL CHOP-which relates to fetal heart rate.
Variable decels => Cord compression (usually a change in mother's position helps) Early decels => Head compression (decels mirror the contractions; this is not a sign of fetal problems) Accelerations => O2 (baby is well oxygenated-this is good) Late decels => Placental utero insufficiency (this is bad and means there is decreased perfusion of blood/oxygen/nutrients to the baby).
Centrally Acting Alpha2 Agonists · Clonid ine (Catapres) · Guanfac ine HCl (Tenex) · Methyldopa (Aldomet)
Vasodilation is result of CNS involvement · CNS involvement can cause sedation or drowsiness that should diminish with time · Concurrent use of clonidine and prazosin, MAOIs or tricyclic antidepressants can interfere with reduction of BP · Concurrent use with other CNS depressants can increase CNS depression
infants IM site
Vastus lateralis
wound has dehisced, do what?
put saline soaked sterile gauze over
Toddler 18 months+ IM site
Ventrogluteal
94. Common S/S Meniere's Disease?
Vertigo, Tinnitus
103. Common S/S of chicken pox?
Vesicular rash (central to distal) dew drop on rose petal
142. Common S/S of retinal detachment?
Visual floaters, flashes of light, curtain vision
283. Kawasaki disease causes?
We know Kawasaki disease causes a heart problem, but what specifically? Coronary artery aneurysms d/t the inflammation of blood vessels.
There are two types of mental health hospitalizations:
Voluntary commitment and involuntary or civil commitment. Involuntary commitment is against the client's will. Despite that, unless proven otherwise, clients are still considered competent and have the right to refuse treatment
Antiplatelet Nursing Interventions
WATCH FOR BLEEDING. · These medications should be taken with food. · These medications should be used cautiously in clients with peptic ulcer disease and in clients with severe renal/hepatic disorders.
397. Shift to the left means?
WBC shift to the left in a patient with pyelonephritis (neutrophils kick in to fight infection)
UTI/ pyelonephritis
WBCs found in urine
Vitamin K is the antidote fore...
Warfarin (Coumadin)
312. Milk for kids?
Watch out for questions suggesting a child drinks more than 3-4 cups of milk each day. (Milks good, right?) Too much milk reduces intake of other essential nutrients, especially iron. Watch for anemia with milk-aholics. And don't let that mother put anything but water in that kid's bottle during naps/over-night. Juice or milk will rott that kids teeth right out of his head.
Risk assessment questions:
What are the populations at risk within the community? ¨ Have there been previous disasters, natural or man-made? ¨ What size of an area or population is likely to be affected in a worst-case scenario? ¨ What is the community disaster plan? ¨ What kind of warning systems is in place? ¨ What types of disaster response teams are in place? ¨ What kinds of resource facilities are available in the event of a disaster? ¨ What type of evacuation measures will be needed? ¨ What type of environmental dangers may be involved?
448. What could cause bronchopulmonary dysplasia?
What could cause bronchopulmonary dysplasia? Dysplasia means abnormality or alteration. Mechanical ventilation can cause it. Premature newborns with immature lungs are ventilated and over time it damages the lungs. Other causes could be infection, pneumonia, or other conditions that cause inflammation or scarring.
434. Traction in kids?
What traction is used in a school-age kid with a femur or tibial fracture with extensive skin damage? Ninety, ninety. Huh? I never heard of it either. The name refers to the angles of the joints. A pin is placed in the distal part of the broken bone, and the lower extremity is in a boot cast. The rest is the normal pulleys and ropes you're used to visualizing with balanced suspension. While we're talking about traction, a kid's hinder should clear the bed when in Bryant's traction (also used for femurs and congenial hip for young kids).
Do not delegate
What you can EAT E-evaluate A-assess T-teach
97. Common S/S of asthma
Wheezing on EXPIRATION
Some final test taking tips for you too: Go with your First Instinct
Your first response to a question is usually correct. DO NOT change your answers unless you have a compelling reason for doing so.
15. ABG drawin?
When drawing an ABG, you need to put the blood in a heparinized tube, make sure there are no bubbles, put on ice immediately after drawing, with a lable indicating if the pt was on room air or how many liters of O2. Remember to preform the Allen's Test prior to doing an ABG to check for sufficient blood flow
Some final test taking tips for you too: Cause no Harm
When in doubt, always choose a nursing action that could result in harm to the client if not recognized. Even if you don't know whether it is related to the stem, it is still a life-saving maneuver that, in all likelihood, is correct.
315. MORE info on DKA? ugh!
While treating DKA, bringing the glucose down too far and too fast can result in increased intracranial pressure d/t water being pulled into the CSF. Polyuria is common with the hypercalcemia caused by hyperparathyroidism.
479. Wilms tumor?
Wilm's tumor is usually encapsulated above the kidneys causing flank pain.
214. Glomerulonephritis considerations
With glomerulonephritis you should consider blood pressure to be your most important assessment parameter. Dietary restrictions you can expect include fluids, protein, sodium, and potassium.
Antianemics
With iron deficiency anemia, iron supplements are commonly prescribed. Beware though - Iron is 'heavy' stuff and shouldn't be taken 'lightly'! · Iron can cause teeth staining (liquid form). Teach clients to dilute liquid iron with water or juice, drink with a straw, and rinse mouth after swallowing. · Iron can cause staining of skin and other tissues with IM injections. If IM route must be used, give IM doses deep IM using Z track technique. · Iron also has several drug administration interactions- of antacids or tetracycline's reduces absorption of iron. Separate use by at least 2 hr. · Vitamin C increases absorption, but also increases incidence of GI complications. Avoid vitamin C intake when taking medication. · Instruct clients to take iron on an empty stomach such as 1 hr before meals to maximize absorption. Stomach acid increases absorption. However, iron can cause GI distress(nausea, constipation, heartburn) If intolerable, iron can be administered with food to increase compliance with therapy but this does reduce absorption. · Instruct clients to space doses at approximately equal intervals throughout day to most efficiently increase red blood cell production. · Inform clients to anticipate a harmless dark green or black color of stool. · Instruct clients to increase water and fiber intake (unless contraindicated), and to maintain an exercise program to counter the constipation effects. · Encourage concurrent intake of appropriate quantities of foods high in iron (liver, egg yolks, muscle meats, yeast).
245. How do you teach someone to reduce back aches?
With low back aches, bend knees to relieve
343. Omphalocele?
With omphalocele and gastroschisis (herniation of abdominal contents) dress with loose saline dressing covered with plastic wrap, and keep eye on temp. Kid can lose heat quickly.
447. What can't you give to immunosupressed pts?
Yogurt has live cultures- dont give to immunosuppressed pt
465. Whats petaling?
You can petal the rough edges of a plaster cast with tape to avoid skin irritation.
Considerations for the pregnant client
You may have a pregnant client admitted with a diagnosis unrelated to her pregnancy and, therefore, she may be admitted to a general medical-surgical floor. A mnemonic to assist you in performing important assessment elements for these clients is FETUS. * F: Document fetal heart tones every shift. To assess fetal heart tones, use a handheld Doppler ultrasound and place it in an area corresponding to uterine height. For example, for a client who's less than 20 weeks' pregnant, the most likely area to find fetal heart tones is at the pubic hairline or the symphysis pubis. For a client whose pregnancy is more advanced, such as at 24 weeks, the fetal heart rate can most probably be heard midline between the symphysis pubis and the umbilicus. As the pregnancy advances in weeks, fetal heart tones can be heard closer to and possibly above the umbilicus. * E: Provide emotional support. Pregnant women who are experiencing unexpected medical conditions are at a high level of anxiety worrying how the current medical problem may affect the fetus. You should take extra care to alleviate and reduce your client's anxiety by explaining all medications and treatments. Additionally, be prepared to listen for fetal heart tones anytime the client requests it to further reduce her worry and reassure her that the fetus is doing well. * T: Measure maternal temperature. Because your client's core body temperature is higher than you can detect through oral or tympanic thermometers, be alert to the presence of a fever. A high maternal temperature can lead to fetal tachycardia and distress. An order for antipyretics on admission to ensure their quick availability will be a prudent request you should make to the admitting physician. * U: Ask about uterine activity or contractions. Make it a normal part of your routine to ask about any type of uterine pain, tightening, or discomfort throughout your shift. Be aware that early contractions often present as lower back pain. Don't attribute complaints of lower back pain to the hospital bed. If your client reports any unusual activity, take care to softly palpate the lower abdomen for periods of greater than 2 minutes while conversing with her. Watch for subtle changes of facial expression while simultaneously detecting a change in uterine tone. If contractions are suspected, your client will need to be monitored with continuous fetal monitoring in the labor and delivery unit. * S: Assess for the presence of and changes in sensations of fetal movement. After 20 weeks' gestation, all women should be able to report feeling the fetus move. This is an important assessment to perform and document at least every shift, easily accomplished by asking "How often are you feeling the baby move?" By asking this as an open-ended question, you'll receive more information about the quantity of fetal movement such as, "I haven't felt the baby move as much as usual today." If you had asked the question "Have you felt the baby move?" your client may have responded with a simple "yes" rather than providing you with the information that prompts you to perform further assessment.
194. Every new admission needs?
You will ask every new admission if he has an advance directive, and if not you will explain it, and he will have the option to sign or not.
Which of the following is the initial nursing action for the nurse to take when late decelerations appear on the fetal monitor? a - reposition the client in to left-lateral position b - apply a fetal scalp electrode c - increase the iv fluid rate d - perform a vaginal exam to assess dilation
a - reposition the client in to left-lateral positioning
82. Change in color is ?
a LATE sign! Always~!
basal body temperature method of birth control
a drop in body temp of approximately 0.25 C commonly occurs immediately prior to ovulation remains elevated for 2 to 4 days measure upon waking up
346. Orthostatis is verfied by?
a drop in presssure with increasing heart rate... Orthostatis= orthostatic hypotension
Myesthenia Gravis
a positive reaction to Tensilon---will improve symptoms
post op appendix
a rigid board like abd absent bowel sounds temp increased wbc count increase
eclampsia is
a seizure
hypotonic dehydration
a serum sodium level below 130
MMR and varicella immunizaions
after 15 months!
start/adjusting heparin
aPTT expected range is 40 secs client with continuous heparin should have aPTT of 60 to 80
Grave's Disease/ hyperthyroidism
accelerated physical and mental function. Sensitivity to heat. Fine/soft hair.
216. Graves disease/ Hyperthyroidism?
accelerated physical and mental function; sensitivity to heat, fine/soft hair
DKA
acetone and keytones increase! once treated expect postassium to drop! have K+ ready
Communication: If the client has delusions / hallucinations / paranoia
acknowledge these, but don't reinforce
Beta2-adrenergic agonists
act upon the beta2-receptors in the bronchial smooth muscle to provide bronchodilation and relieve spasm of the bronchial tubes, inhibit release of histamines and increase motility of bronchial cilia. These short-acting preparations provide short-term relief during an asthma exacerbation, while the long-acting preparations provide long-term control of asthma symptoms.
contractions 3 minutes apart = what phase of labor?
active
Sargramostim (leukine)
acts on the bone marrow to increase prodution of WBC ( nuetrophils, monocytes, , macrophages, , eosinophils - indications- facilitates recovery of bone marrow after bone marrow transmpalnt, used in the treatment of failed bone marrow transplant SE- diarrhea, weakneess, rash, bone pain. leukocytosis, thrombocytosis. INTERVENTION- reduce treatment if WBC>50,000 l Nuetrophil >20000 or platelts > 500,000 - contraindicated in clients allergic to yeast products. used cautionsly in clients with heart diseae , hypoxia, peirpheral edema, plueral and pericardialeddustion. evaluate effectiveness- WBC in normal ranges
PRIORITIZATION PRINCIPLES
acute before chronic, systemic before local, actual before future problems . always think of ABCs,( open airway, breathing, circulatory), Also consider maslows hierarchy of needs (physiological needs met first), Priority for whatever poses the greates risk, ASSESSMENT FIRST prior to calling primary care provider, , select interventions that are the least restrictive ,consider timing of meds such as antidiabetics and analgesics which is more important than other meds.
TCA'SNURSING INTERVENTION FOR TOXCITIY- (evidenced by dysrthmias, mental confusion, and agitation followed by seizures, and coma)
acutely ill client- give only 1 week supply, monitor for signs of toxicity, notify PCP if signs of toxicity
Liver biopsy
administer Vitamin K, NPO morning of exam 6 hrs. Give sedative. Teach pt to expect to be asked to hold breath for 5-10 sec. supide position, lateral with upper arms elevated. Post--position on RIGHT side. frequent VS. report severe ab pain STAT. no heavy lifting 1 wk
23. After Endoscopy?
after endoscopy check gag reflex.
C7-C8 spinal cord injury movement remaining
all triceps to elbow extension, finger extension , good grasp with some decreased strength, decreased respriatory reserve - rehab potential- ability to transfer self to wheelchair, roll over and sit in bed, push self on most surfaces, perform most self care, independent use of wheelchair, attendend 0-6 hrs a day
202. Flu shot always ask?
allergic to eggs??? (Tristan D. ) !
before an IV urography procedure the nurse should check if patient is
allergic to iodine & check creatinine levels b/c dye can cause renal failure
what to ask before flu shot
allergy to eggs
what to ask before MMR
allergy to eggs or neomycin
455. What to check children for at age 12 months?
always check lead posioning levels
meds for sinus tachy
amiodarone, adenosine, verapamil, synchronized cardioversion
Contraindication for Hep B vaccine
anaphylactic reaction to baker's yeast
177. Diff between angina and MI?
angina (low oxygen to heart tissues) = no dead heart tissues. MI= dead heart tissue present.
theophylline toxicity
anorexia
COPD
anorexia and weight loss barrel chest elevated HCO3 resp acidosis
13. A patient with vertical c- section will likely have?
another c section with any more kids
203. Fontanelles?
anterior fontanelle closes by 18 months. Posterior 6 to 8 weeks.
benztropine
anticholinergic agent can develop tachycardia
terminally ill patient only wants family, not friends with them. Type of grief?
anticipatory, not dysfunctional, normal or disenfranchised
Glucagon increases the effects of?
anticoagulants
NURSING ACTIONS FOR CLIENT RECEIVING CHEMOTHERAPY -NAUSEA & VOMITTING-
antiemetic medications, Perform calorie counts to determine intake. Provide liquid supplements as needed. Add protein powders to food or tube feedings; Administer megestrol (Megace) to increase the client's appetite if prescribed; Perform mouth care prior to serving meals to enhance the client's appetite.; eat several small meals a day if better tolerated, suggest cold foods that don't omit odor , encourage nutrient dense foods
clozapine, Clozaril
antipsychotic anticholinergic
chlorpromazine
antipsychotic med administered to decrease hallucinations adverse effects orthostatic hypertension
s/s pulmonary edema
anxiety, tachycardia, acute respiratory distress, increased vein distention, dyspnea at rest, change in level of consciousness, and ascending crackles (fluid level within lungs) and cough, productive of frothy pink-tinged sputum. INTERVENTIONS: - Position the client in high-Fowler's position to maximize ventilation. ■■ Administer oxygen, positive airway pressure, and/or possible intubation and mechanical ventilation. ■■ Administer morphine and diuretic as prescribed.
report what after a craniotomy?
aphasia, because this means increased ICP r/t increased bleeding, which is the highest risk. keep HOB at 30
gullian-barre syndrome
ascending muscle weakness
Gullian -Barre syndrome
ascending paralysis. watch for respiratory problems.
gastric lavage
ask client to lie on the left side
evaluating proper placement of NG tube
aspirate to collect gastric contents & test pH (4 or less), x-ray, injecting air into tube to listen over abdomen is NOT an acceptable practice
Latex allergies
assess for allergies to bananas, apricots, cherries, grapes, kiwis, passion fruit, avocados, chestnuts, tomatoes and peaches
high pressure alarm, do what?
assess for kinkds, client bitingg, excess secretions (suction), pulmonary edema, etc. Notify provider
Low pressure alarm do what?
assess for leaks, displacement, if can't find anything wrong, MANUALLY ventilate & call respiratory stat, do NOT leave alone
IV pyleogram
assess if allergic to shellfish, milk, eggs, or chocolate encourage to increase fls administer laxative NPO or clear liqs after midnight
FIVE RIGHTS OF DELEGATION (RIGHT CIRCUMSTANCE)
assess the situation- if its too complicated or its an acute care setting where client condition changes quickly then dont delegate EX- RIGHT- AP to record check in vital signs WRONG- AP to take vital signs on clien tundergoing hypovolemic shock .or during depreseed respiration postop taking narcan (used to reverse respriatory depression)
early deceleration
associated with the progression of labor and are benign continue to monitor fetal HR
indications for use of cardioversion
atrial dysrhythmia, SVT, ventricular tachycardia w/ pulse, tx of choice for pt who are symptomatic
GERD s/s
atypical chest pain, SOB
45. autonomic dysreflexia
autonomic dysreflexia ( life threatening inhibited sympathetic response of nervous system to a noxious stimulus- patients with spinal cord injuries at T-7 or above) is usually caused by a full bladder.
Urine pH
average 6.0; range 4.6-8.0
thrombocytopenia teaching
avoid blowing the nose because it increases the risk for bleeding or hemorrhage
early s/s of cold stress in infants
axillary temp <97.7, increase rr, increased hr, mottled skin
TPN given in
subclavian line
Fat embolism
blood tinged sputum r/t inflammations. Increase ESR, respiratory alkalosis. Hypocalcemia, increased serum lipids.
lithium toxicity
blurred vision increased thirst
amitriptyline ( depressive disorders) adverse effects
blurred vision dry mouth urinary retension constipation
476. Why would a pt with leukemia have epistaxis?
b/c of low platelets
emphysema
barrel chest
Communication: If the client has a personality or cognitive disorder
be calm and matter-of-fact
399. Shock?
bedrest with extremities elevated 20 degrees, knees straight, head slightly elevated (modified Trendelenburg)
Shock
bedrest with extremities elevated 20 degrees. knees straight, head slightly elevated (modified Trendelenberg)
perform amniocentesis
before 20 weeks to check for cardiac and pulmonary abnormalities
pathological jaundice occurs: physiological jaundice occurs:
before 24 hours (lasts 7 days) after 24 hours
Empty JP drain when? clean how?
before half full, or every 8-12 hrs, NOT 24 hours. Clean with soap and water, NOT antimicrobials or Dakin's etc.
vertebrae related to paralysis
below or above l1-l2 = paralysis
hydatidiform mole
benign overgrowth of the chroionic vili that develops into cystic, grape like clusters.abnormal fertilization no variable fetus. hemorrhage precaution
flumazenil, Romazicon
benzo overdose
glycosylate hemoglobin
best indicator for average blood glucose level for the past 120d, normal range is 4-6%, diabetic range is 6.5-8%
475. Who produces insulin?
beta cells of pancreas produce insulin
CEPHALOSPORINS
beta lactams antibiotics destroy cell walls of bacteria . effective against gram negative organisms and anaerobes. - more able to reach cerebrospinal fluids. indications- UTIs, post op infections, pelvic incections, and meningitis. -evaluation of effectiveness- improvement of infection ( reduction of fever, pain, and inflammation, clear breat sounds, reduced UTI symptoms , negative urine CX)
Common Beta-Adrenergic Ophthalmic Blocking Agents:
beta xolos ( Bet optic ) (see the form of beta in the drug names?) See optic in Betoptic? Opthalmic medication. levo beta xolol ( Beta xon) (see the form of beta in the drug names?) levobunolol ( Beta gan) (see the form of beta in the drug name?) timolol ( Bet imol) (see the form of beta in the drug name?)
61. Bethamethasone?
bethamethasone (celestone)=surfactant. Med for lung expansion.
s/s hyperglycemia
bg >250; thirst, frequency in urination, hunger, warm/dry/flushed skin, weakness, malaise, rapid/weak pulse, hypotension, deep rapid respirations
Cold stress and the newborn
biggest concern resp. distress
viterous hemorrhaging
bleeding following damage of the retinal blood vessels which can occur due to increased bp or uncontrolled diabetes
INTERVENTIONS FOR CARDIAC HEART FAILURE (decreased Cardiac output)
body will start to compensate by ventricular dilation, hypertrophy, increased SNS stimulation and neurohormonal responses. - If client is experiencing respiratory distress, place the client in high Fowlerʼs position and admin 02 as prescribed - encourage bedrest until the client is stable encourage energy conservation by assisting with care and ADLs - maintain dietary restrictions as prescribed (restricted fluid intake, restricted sodium intake) -administer meds as prescribed
postpartum, immediate action?
boggy uterus, massage fundus
Hypervolemia
bounding pulse, SOB, dyspnea, rales/crackles, peripheral edema, HTN, urine specific gravity <1.010. semi fowler's
263. Hypervolemia?
bounding pulse, SOB, dyspnea, rares/crackles, peripheral edema, HTN, urine specific gravity <1.010; Semi-Fowler's
IVP requires
bowel prep so bladder can be visualized
CPR on infant pulse check is performed on
brachial
450. What happens when phenylalanine increases?
brain problems occur
when phenylaline increases
brain problems occur
antiplatelet drug hypersensitivity
bronchospasm
303. Main hypersensitivity for antiplatelet drugs?
broncospasm (anaphylaxis)
95. Common S/S of addisions?
bronze like skin pigmentation
Addison's
bronze like skin pigmentation
Lymes disease
bullseye rash
sle (systemic lupus)
butterfly rash
Thorazine and Haldol
can cause EPS
fluoentine adverse effects
can cause serontonin syndrome with 2 to 72 he after treatment can experience tremors, agitation, confusion, anxiety, and hallucinations report to provider
UNTREATED NEWBORN HYPOGLYCEMIA
can lead to mental retardation, seizures, brain damage, and death.
PVC's
can turn into V fib.
Hodgkin's disease
cancer of the lymph. very curable in early stages
74. caput succedaneum=
caput succedaneum= diffuse edema of the fetal scalp that crosses the suture lines. Swelling reabsorbs within 1 to 3 days.
complications of pericarditis
cardiac tamponade (hypotension, muffled heart sounds, JVD, pardoxical pulse)
retino blastoma
cat's eye reflex
during Continuous Bladder Irrigation (CBI)
catheter is taped to the thigh. leg must be kept straight.
Methylxanthines
cause bronchial smooth muscle relaxation resulting in bronchodilation. Theophylline (Theolair) is the prototype medication and is used for long-term control of chronic asthma
macular degeneration
caused by deterioration of the macula resulting in decreased central vision
Isoniazid
causes peripheral neuritis
Addison's
causes sever hypotension!
80. Cerebral angio prep?
cerebral angio prep- well hydrated, lie flat, sire shaved, pulses marked post- keep flat 12-14hr, check site, pulses,force fluids.
CVA
cerebriovascular accident. brain tissue dies.
what does abnormal pap smear indicate?
cervical cancer
SIADH (increased ADH)
change in LOC, decreased deep tendon reflexes, tachycardia. N/V HA administer Declomycin, diuretics
A classic symptom of depression is ...
change in sleep patterns, indecisiveness, decreased concentration, or change in body weight. Any client who shows these signs or symptoms should be asked if they have suicidal ideation. Teach clients to never discontinue anti-depressants suddenly.
sublimation
channeling neg feelings over the loss her new job into new hobby
TIA
transient ischemic attack....mini stroke, no dead tissue.
nephrotic syndrome
characterized by massive proteinuria caused by glomerular damage. corticosteroids are the mainstay
before IV antibiotics?
check allergies (esp. penicillin) make sure cultures and sensitivity has been done before first dose.
After endoscopy
check gag reflex
acid ash diet
cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread
10. 4 options for cancer?
chemo, radiation, surgery, allow to die with dignity.
s/s of pericarditis
chest pressure/pain, FRICTION RUB, SOB, pain relieved when sitting and leaning forward
472. Where are chest tubes placed?
chest tubes are placed in the pleural space.
bryant's traction
children <3 y <35 lbs with femur fx
101. Common S/S of Bulimia?
chipmunk face
NCLEX answer tips
choose assessment first! (assess, collect, auscultate, monitor, palpate) only choose intervention in an emergency or stress situation. If the answer has an absolute, discard it. Give priority to the answers that deal with the patient's body, not machines, or equipment.
colostomy care
clean stoma site using a patting motion before applying the skin barrie dry the skin around the stoma using a patting motion before applying the skin barrier activate the adhesive in the skin barrier by holding it in place over the stoma for 30 secs wear clean gloves
assess WBC count
client has fever, infection, or before starting antibiotics
fetal monitoring
client with premature rupture of membranes decreased fetal movement gestational hypertension
Adult temporal temps are _____ to rectal temps.
close
55. Bence Jones protein in urine?
confirms multiple myeloma
clonidine adverse effects
constipation dry mouth can cause alteration in taste, rashes, pruritits, edema
REFERRALS & CONSULTATIONS
consultations provide expertise based on sepcific needs of a client. should be used when nursing practice cant solve problem or more info is needed. provide consulant with all pertinant info. incorporate consultants recommendations into clients plan of care - Referrals. ensure continuity of care . initiate dischare plan upon admission, collaborate with other cealth care professionals to ensure all health care need are met.
VRSA Precautions and Management
contact and airborne precautions (private room, door closed, negative pressure)
post esophagogastroduodenoscopy EGD
cool clammy skin can be indication of hypovolemic shock
post EGD, what to watch for?
cool/clammy skin, sign of perforation
variable decelerations = what? intervention?
cord compression! prep for emergency c-section or inducing labor. also can change position, d/c oxytocin, o2 8-10L/min per mask, perform/assist with vaginal exam, assist with amnioinfusion if ordered
Aspiration into respiratory tract
coughing, dyspnea, cyanosis, auscultation of crackles and wheezes. Late onset- include fever
cognitive therapy
counseling
Sucking stab wound
cover wound and tape on 3 sides to allow air to escape. If you cover and occlude it--it could turn into a closed pneumo or tension pneumo!
IM site for children
deltoid and gluteus maximus
Myasthenia gravis
decrease in receptor sites for acetylcholine. weakness observed in muscles, eyes mastication and pharyngeal musles. watch for aspiration.
if anemic, increase or decrease milk and give iron or no?
decrease milk as it interferes with iron absorption, and they need iron; give iron!
thrombocytopenia
decreased platelet count to prevent risk of bleeding avoid venipuncture when possible
Respiratory rate _____ with age.
decreases
Iron toxicity reversal
deferoxamine
signs of neglect in elderly
dehydration, malnourishment, soiled or inappropriate clothing, overmedication, undermeidcation, abandomment, lack of glasses, dentures, or other aids if usually worn , left unattended
FIVE RIGHTS OF DELEGATION (RIGHT PERSON)
delegate to team member based on scope of practice. ex: RIGHT- LPN to andmister enteral feedings to client with head injury or trach care WRONG- AP to administer enteral feedings to client with head injury or trach care
258. HyperMg?
depresses the CNS, hypotension, facial flushing, muscle ewakness, absent deep tendon reflexes, shallow respirations, emergency
Hyper Mg
depresses the CNS. Hypotension, facial flushing, muscle weakness, absent deep tendon reflexes, shallow respirations. EMERGENCY
Bipolar disorders are mood disorders with periods of...
depression and mania. Clients have a high risk for injury during the manic phase related to decreased sleep, feelings of grandiosity and impulsivity. Hospitalization is often required and nurses should provide for client safety.
myasthenia gravis
descending musle weakness
failure to thrive
developed a structured routine
glucose reaches 250 on insulin, give what? isotonic, hypotonic, hypertonic, dextrose?
dextrose to prevent hypoglycemia
Hirschprung's
diagnosed with rectal biopsy. S/S infant-failure to pass meconium and later the classic ribbon-like/foul smelling stools
digoxin toxicity
diarrhea nausea anaphylaxisis muscle weakness
caput succedaneum
diffuse edema of the fetal scalp that crosses the suture lines. reabsorbes within 1 to 3 days
bad sign with a mother with newborn?
disapproval
short cord
discontinue pictocin
insulin, rotate sites or no?
do not rotate site
NURSING ROLE IN INFORMED CONSENT
does not obtain conset for the PCP under any circumstances, Nurse can clarify information that remins unclear after PCP explains, witness the clients signing after client acknowledges information.
asthma & beta blockers
don't give lol's/beta blockers to asthma patient's
31. After Total Hip Replacement?
don't sleep on operated side, don't flex hip more than 45- 60 degrees, don't elevate HOB more than 45 degrees. Maintain hip abduction by separating thighs with pillows.
After total hip replacement
don't sleep on side of surgery, don't flex hip more than 45-60 degress, don't elevate Head Of Bed more than 45 degrees. Maintain hip abduction by separating thighs with pillows.
whats up with central lines and pushing meds with resistance ?
dont do it! may be dislodging a thrombosis
ateriovenous fistula fact
dont measure bp on this side
mom engorged, don't do what?
dont self express milk; ice packs, support bra all ok
birth weight
doubles by 6 months triples by 1 year
is drainage at pin sites ok with bucks traction?
drainage ok, note the type/color/odor/amount; leave crust as a barrier, pin care 3x/day
isolation precaution for child with pneumonia
droplet precaution place in private room and nurse should wear mask when caring for patient
ace-inhibitors?
dry cough
Basophils reliease histamine
during an allergic response
190. Dystocia?
dystocia= baby cannot make it down to canal
26. After lumbar puncture?
e (and also oil-based Myelogram)--> pt lies in flat supine (to prevent headache and leaking of CSF)
Cullen's sign
ecchymosis in umbilical area, seen with pancreatitis
The most common type of brain stimulation therapy is
electronconvulsive therapy or ECT. ECT is generally performed for major depressive disorders, schizophrenia or acute manic disorders. Most clients receive therapy three times a week for two to three weeks. Prior to ECT, carefully screen the client for any home medication use. Lithium, MAOIs and all seizure threshold medications should be discontinued two weeks prior to ECT. After therapy, reorient the client as short term memory loss is commo
Head Injury
elevate HOB 30 degrees to decrease ICP
228. Head Injury?
elevate HOB 30 degrees to decrease intracranial pressure
Buck's Traction (skin)
elevate foot of bed for counter traction
16. Above the knee amputation?
elevate for first 24 hours on pillow, position prone daily to provide for hip extension.
AKA (above knee amputation)
elevate for first 24 hours on pillow. position prone daily to maintain hip extension.
pt with leukemia may have
epistaxis due to low platelets
Transesophageal fistula
esophagus doesn't fully develop. This is a surgical emergency (3 signs in newborn: choking, coughing, cyanosis)
first priority for DKA patients?
establish venous access, before anything
Cushing's disease
excessive level of cortisol which redistributes fat moon face retain water causing hypertension
Diabetes insipidus (decreased ADH)
excessive urine output and thirst, dehydration, weakness, administer Pitressin
hyperthyroidism/ grave's disease
exophthalmos
reglan
extrapyramidal side effects (twitching, facial spasms, give anthihistamine to help)
Glasgow coma scale
eyes, verbal, motor Max- 15 pts, below 8= coma
oral glucose tolerance test
fasting blood glucose level drawn at start then pt consumes a specified amount of glucose; blood glucose levels drawn every 30 m for 2 hrs, instruct client to consume balanced diet for 3d prior then fast 10-12 hr
Hyper-parathyroid
fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium) give a low calcium high phosphorous diet
261. Hyperparathyroid?
fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium), low Ca, high phosphorus diet
otitis media
feed upright to avoid otitis media!
russell traction
femur or lower leg
390. Russel Traction =
femur or lower leg instability
lumbar puncture
fetal position. post-neuro assess q15-30 until stable. flat 2-3 hour. encourage fluids, oral analgesics for headache.
pneumonia
fever and chills are usually present. For the elderly confusion is often present.
s/s of infections mono
fever, sore throat, swollen lymph glands, increased WBC, atypical lymphocytes, splenomegaly, enlarged liver
priority infection for amniotomy
fever/infection
when a pt comes in and is in active labor
first action of nurse is to listen to fetal heart tones/rate
pancreatitis
first pain relief, second cough and deep breathe
199. First sign of cystic fibrosis?
first sign of cystic fibrosis may be meconium ileus at birth. Baby is inconsolable, do not eat, not passing meconium.
laboring mom's water breaks?
first thing--worry about prolapsed cord!
Pt with heat stroke
flat with legs elevated
bend at waist to pick up, or tuck pelvis and flex abs?
flex & tuck, never bend at waist!
what is histrionic personality disorder?
flirty & seductive
retinal detachment
floaters and flashes of light. curtain vision
client with delirium
fluctuating level of conciousness aware of cognitive changes acute memory deficit level agitation is pronounced at night
C5 spinal cord injury movement remaining
full neck, partial sholder, back biceps, groww elbow, inability to roll over or use hands, decreased respiratory reserve. - Rehab potential- able to feed self with setu and adaptive equipment , attenden 10hrs per day
ASSESSMENT FOR UTERINE ATONY
fundal height, consistency and location , lochia quantity, color, and consisitency
pt teaching for external radiation therapy
gently wash skin over the irradiated area w/ mild soap/water, DONT remove radiation tattoos, DONT apply powders or lotions, wear soft clothing over irradiated area, avoid tight clothing, DON'T expose area to sun or heat
no consent from ed to do surgery, do what?
get official interpreter
heavy lochia, boggy fundus, do what
give oxytocin
213. Glaucoma patients loose?
glaucoma patients lose peripheral vision. Treated with meds
Common Oral Hypoglycemic Agents:
glipizide( Gluco trol, Gluco trolXL). See the form of glucose in the drug name? chlorpropamide ( Diab ines).See the form of Diabetes in the drug name? glyburide ( Diab inese,Micronase). See the form of Diabetes in the drug name? metforminHC1 ( Gluco phage). See the form of glucose in the drug name?
Prednisone
glucororticoid- immunosuppresant, containdicated in recurring live virus vaccines ( increases risk of infection) and sstemic fungal infections
up stairs with crutches? down stairs with crutches?
good leg first followed by crutches(good girls go to heaven) crutches with the injured leg followed by the good leg.
Management
gown, gloves, goggles, private room
what can a 3 month old eat? carrots, grapes, graham crackers or popcorn
graham crackers
assessing newborn and need immediate intervention
grunting tachpnea nasal flarin apnea more than 20 secs
if you run out of TPN, do what?
hang dextrose
burns rule of Nines
head and neck 9% each upper ext 9% each lower ext 9% front trunk 18% back trunk 18% genitalia 1%
tuna good for what? bad for what?
high in protein and potassium; so watch out
Adult rectal are temps usually ______ than oral temps.
higher (0.5° C / 0.9° F)
explain irrigating with solution
hold 1 inch above
thorazine
hold if shuffling
432. To remember blood sugar?
hot and dry-sugar high (hyperglycemia) cold and clammy-need some candy (hypoglycemia)
heat/cold
hot for chronic pain; cold for accute pain (sprain etc)
cytoxan for neuroblastomas in toddlers
hydrate liberally
164. Cushings?
hyperNa, hypoK, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN, hirsutism, moonface/buffalo hump
364. Pheochromocytoma?
hypersecretion of epi/norepi, persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA; avoid stress, frequent bating and rest breaks, avoid cold and stimulating foods, surgery to remove tumor
Pheochromocytoma
hypersecretion of epi/norepi. persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA; avoid stress, frequent bathing and rest breaks, avoid cold and stimulating foods (surgery to remove tumor)
increased ICP
hypertension, bradypnea,, bradycarday (cushing's triad)
s/s hypernatremia
hyperthermia, tachycardia, rapid thready pulse, ortho hypo, restlessness, irritability, muscle twitching, reduced to absent DTR's, hyperactive bowel sounds
s/s dehydration
hyperthermia, tachycardia, thready pulse, hypoTN, orthostatic hypotension, decreased CVP, tachypnea, dizziness, cool/clammy skin, diaphoresis, sunken eyeballs
s/s hypokalemia
hyperthermia, weak irregular pulse, hypotn, resp distress, muscle cramping, pvc's, bradycardia, decreased mobility
20. Addisons?
hypoNa, hyperK, hypoglycemia, dark pigmentation, decreased resistance to stress, fractures, alopecia, weight loss, GI distress
s/s hyponatremia
hypothermia, tachycardia, rapid thready pulse, hypoTN, ortho hypo, headache, confusion, decreased DTR's, hyperactive bowel sounds
with oxygen toxicity, will you see hypo or hyperventilation?
hypoventilation and bradypnea
Cardinal sign of ARDS
hypoxemia
179. Dig rule for kids?
if HR is <100 do not give dig to children.
a woman comes in to you and says she is on contraception and wants to get pregnant. waht is she at risk for?
if IUD, then ectopic pregnancy.
Mental Status Exam
includes: Level of consciousness Physical appearance Behavior Cognitive and intellectual abilities The nurse conducts the MSE as part of his or her routine and ongoing assessment of the client. Changes in Mental Status should be investigated further and the provider notified.
269. Hypovolemia?
incrased temp, rapid/weak pulse, increase respiration, hypotension, anxiety, urine specific gravity >1.030
Dumping syndrome
increase fat and protein, small frequent meals, lie down after meal to decrease peristalsis. Wait 1 hr after meals to drink
glaucoma
increase in the intraocular pressure causing mild headaches and foggy vision
acute glomerulonephritis
increased glomerular permeability allows protein to filter into the urine.
burn injury manifestations
increased hematocrit due to loss of fl volume hyperkalemia due to release of potassium from cells at burn site hyponatremia decrease in sodium is drawn to the edematous burn area and lost thru plasma leakage decreased albumin due to loss of protein form increase permeability
cataract
increased opacity of the lens of the eye that inhibits light penetration
the first sign of ARDS
increased respirations! followed by dyspnea and tachypnea
427. Thyroid storm?
increased temp, pulse and HTN
Thyroid storm
increased temp, pulse and HTN
Hypovolemia
increased temp, rapid/weak pulse, increase respiration, hypotension, anxiety. Urine specific gravity >1.030
Hypernatremia
increased temp, weakness, disorientation, dilusions, hypotension, tachycardia. give hypotonic solution.
259. Hypernatremia?
increased temp, weakness, disorientation/delusions, hypotension, tachycardia; hypotonic solution
IMMUNOSUPPRESSANTS
increases risk of infection such as fever and sore throat, adivist client to notify PCP if sx occur Calcineruin inhibitors : cyclosporins (sandimmune, gengraf, neoral) Glucocorticoids - prednisone Cytotoxics- asathiprine (imuran) tacrolimus (prograf), Methotrextrate (rheumatrex, texal)
Digitalis
increases ventricular irritability ----could convert a rhythm to v-fib following cardioversion
how does dopamine work, by vasodilating or increasing cardiac output?
increasing cardiac output
Toddlers need to express
independence!
variable decelerations
indicates the fetus is at risk for utero placental insufficency first turn on left side to relieve cord compression
DOCUMENTING PT TEACHING
info provided, teaching method, client response, questions and evidence that it was understood (ie demo back) - purpose of recording to provide continuity of care when mulitple care providers are collaborating.
sickle cell anemia with vaso-occlusive crisis ( clumping of the RBCS)
infuse IV fluids to promote hydration and circulation first to increase fl reduces the tissue and organ ischemia
severe gestational hypertension
initiate seizure precautions because high bp can trigger seizure activity.
thyroid med side effects
insomnia. body metabolism increases
abdominal assessment
inspect auscultate percuss palpate ( incase pain do last)
126. Common S/S of LTB?
inspiratory stridor.. LTB = croup!!!!
TCA'SNURSING INTERVENTION FOR ORTHOSTATIC HYPOTENSION
instruct client abouts signs of postural hypotension (lightheadedness, dizziness) advise client to sit or lie down. minimized by getting up slowly
paracentesis
instruct client to void to avoid hitting the bladder
COMPLICATIONS OF IMMUNIZATION *encephalitis, seizures, and or nueritis)
instruct parentes when to seek medical care, teach parents to prevent injury during seizure.
452. What is a bad sign in asthma?
intercostal retractions=bad!
first thing for implementing staff changes?
investigate staffing issues with task force
SPINAL CORD INJURY CLASSIFICATIONS
involve loss of motor, sensory function, reflexes , and control of elimination. C1-C8- tetraplegia - 4 extremities T1-L4- paraplegia - 2 lower extremities C3-C5- high risk for impaired spontenous ventilation because of proximity of the phrenic nerve.
Heroin withdrawal neonate
irritable, poor sucking
normal PCWC (pulmonary capillary wedge pressure)
is 8-13 readings 18-20 are considered high
Defamation
is a false communication or careless disregard for the truth that causes damage to someone's reputation. in writing(Libel) or Verbally(Slander)
orange tag in psych
is emergent psych
MMR
is given SQ not IM
When pt is in distress....medication administration
is rarely a good choice
MEDS used to treat TB
isoniazid (INH)- indicated for active and latent TB Active- use with combination meds- INH, rifampin, pyrazinamide, and or pyridoxine - everyday for 6 months Latent- only INH daily for 6 months. - med interaction with phenytoin- INH interferes with metabolism leading to accumulation of phenytoin causing ataxia and incoordination . monitor phenytoin levels and make adjustments .
woman is post pelvic surgery and asks why she has a foley catheter inserted, what is your response?
it avoids stress on the incision site/bladder
INFORMED CONSENT
it is the responsbility of the PCP to obtain consent after discussing risks and benefits of the procedure. the nurse is not to obtain consent for the PCP in any circumstance. - Nurse can clarify any information AFTER PCP explanantion of procedure. -consent is required for all tx that is given to a client in a healthcare facility - nurse is responsbile of knowing the laws in the state of practice. - NURSE ROLE IS TO WITNESS CONSENT- ensure client understood.
nursing interventions for increased ICP
keep HOB at 30, avoid extreme flextion, extension or rotation of the head & maintain in midline neutral position; keep body aligned to avoid hip flextion/extentio, minimize endotracheal suctioning; instruct pt to avoid coughing or blowing nose
69. Bucks traction =
knee immobility
buck's traction
knee immobility
375. Prolapsed Cord?
knee-chest position or Trendelenburg
measles
koplick's spots
DKA
kussmal's breathing (deep rapid)
autism ati
lack of responsiveness
autism
lack of responsiveness has impairment in social interactions and can show a lack of responsiveness and interest in others
do you report chlamydia, do you need consent, etc?
mandated reporting to CDC, without verbal or written consent
boggy uterus, do what?
massage the fundus
nursing interventions for boggy uterus
massage the fundus then administer oxytocin
Tinnitus
may indicate aspirin toxicity with hold med
Iatragenic
means it was caused by treatment, procedure or medication
McDONALDS RULE FOR CALCULATING EDD
measure fundus height in cm from the symphis pubis to the top of the uterine fundus, between 18-30weeks the gestational age is equivalent to fundal height.
DKA patient drops glucose from 450-250; do what? measure glucose, temp, what and how often?
measure glucose & potassium hourly, provide IV glucose at 250 to prevent hypoglycemia
early sign of cystic fibrosis
meconium in ileus at birth
Treatment for mental health illnesses and disorders can include...
medications, talk and behavior therapy, and / or brain stimulation. Clients undergoing care for mental health disorders may feel pressure to deny behavior or issues to appear 'normal'. The nurse should always carefully assess each individual to ensure optimal response to therapies.
expected findings of schizo?
memory deficit, difficulty concentrating, disordered thinking, poor problem solving and decision-making
SUMATRIPTAN (imitrax)
migraine medication. seratonin receptor agonist. prevents inflammation and dilation of incranial blood vessels. - contraindicated in clients with ischemicheart disease , history of MI, uncontrolled htn and other heart diseases. - do not give with erotamine (ergostat)- leads to speastic reaction of blood vessels - do not give within 2 wks of stopping MAOIs - can lead to MAOI toxicity
423. Therapies?
milieu therapy= taking care of patient/environment cognitive therapy= counseling crisis intervention=short term.
alk ash diet
milk, veggies, rhubarb, salmon
Normal stoma findings
moist shiny/pink; mild soap and water, then dry gently and completely, apply paste if used, apply barrier pastes to creases
256. Hypercalemia?
muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, sedative effect on CNS
Hypercalcemia
muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, shallow respirations, emergency!
Liver biopsy (prior)
must have lab results for prothrombin time
nursing interventions for patient who has HSV-2
monitor fetal well being, fetal consequences include miscarriage, preterm labor, and intrauterine growth restriction, obtain cultures, possible c-section of lesions present during labor
complications following hypophysectomy (removal of pituitary gland)
monitor for bleeding and nasal drainage for possible csf leak, assess neurological condition every hour for first 24 h and every 4h after;
risk for diabetes inspidus
monitor for polyuria
cushings disease, 2 things
moon face and increased cortisol
Cushing's
moon face, buffalo hump
bowel obstruction
more important to maintain fluid balance than to establish a normal bowel pattern (they cant take in oral fluids)
473. Where are most spinal cord injuries?
most spinal cord injuries are at the cervical or lumbar regions
384. Rh?
mothers receive rhogam to protect next baby.
multiple sclerosis
motor s/s limb weakness, paralysis, slow speech. sensory s/s numbness, tingling, tinnitis cerebral s/s nystagmus, atazia, dysphagia, dysarthia
stage 4 pressure ulcer
muscle damage and tendon exposure
266. HypoKalemia?
muscle ewakness, dysrhythmias, increase K (raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery)
Succinylcholine (anectine)
muscle relaxant often used to facilitate intubation - in conjunction iwht volatinle inhalationagents is the primary trigger for malignant hyperthermia (hyperthermia, hypermetabolism, rigidity of muscles, hypoxemia, lactic acidossis, and hemodynamic alterations) -hyperthermia is not an early sign - definitive treatment is dantolene (danttrium) - slows metabolism
hypokalemia
muscle weakness, dysrhythmias, increase K (rasins bananas apricots, oranges, beans, potatoes, carrots, celery)
Thrombolytic Agents
n order to truly appreciate this drug tip, you need to familiarize yourself with the Ghostbusters. If you haven't heard the theme song, cue it up before reading further. We promise it will be worth it. PRIORITY POINT: If the Ghostbusters had a medication class of choice, this would be it! Thrombolytic Agents are CLOT BUSTERS. They work QUICKLY to restore circulation. As such, they increase a client's risk for bleeding. Who you gonna call? Streptokinase (Streptase). Call right away! These medications must be administered within 4 to 6 hours of onset of symptoms. If there's something strange in your neighborhood: Thrombolytic agents dissolve clots that have already been formed. These medications convert plasminogen to plasmin, which destroy fibrinogen and other clotting factors. What's the goal? Restoration of circulation, as evidenced by relief of chest pain, and reduction of initial ST segment injury pattern as shown on ECG. What's the risk? Increased bleeding. These medications should only be given while the client is closely monitored. Baseline platelet and blood counts (including aPTT, PT, and INR) shouldbe carefully assessed. Venipunctures and SQ and IM injections should be limited. After the clot has left the building: Administer beta blockers to decrease myocardial oxygen consumption and reduce the incidence and severity of reperfusion arrhythmias.
19. Addisonian Crisis?
n/v, confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP
Cheese is not good with what? Cheese is good for what and why?
nardil/maoi! good for hyponatremia because high in sodium, high in protein
268. Hyponatremia?
nausea, muscle cramps, increased ICP, muscular twitching, convulsion; osmotic diuretics, fluids
Hyponatremia
nausea, muscle cramps, increased ICP, muscular twitching, convulsions. give osmotic diuretics (Mannitol) and fluids
ABGs of Emphysema
near normal ABGs, decreased PaO2, normal or decreased PaCO2
3 hr glucose test
need to fast the night before the test/ blood sample will be collected every hr
patient has l1-l2 paralysis, lives with spouse, bathroom & bedroom on 2nd floor. Needs PT, respite, speech therapy and what?
needs occupational and physical therapy, but social services is number one for help with home adapation
effective breastfeeding
newborn has six to eight wet diapers per day
teaching for child with asthma
no aspirin record highest of three peak expiratory readings no carpet get flu shot
Cholecystitis diet
no cheese! low fat, low cholesterol (<200), if AST & lipase, any type of bilirubin, WBC, amylase, LDH, are elevate = bad
for neutropenic pts
no fresh flowers, fresh fruits or veggies and no milk
Neutropenic pts
no fresh fruits or flowers
PAD
no heat cut nails across apply lotion to prevent cracked feet elevate feet at heart level
341. Nuetropenic patients?
no live vaccines, no fresh fruits, no flowers should be used for neutropenic patients.
Head injury or skull fx
no nasotracheal suctioning
What is a kosher diet?
no shellfish but yes fish with fins and scales; no pork; no mixing meat with milk, ever
ECG
no sleep the night before, meals allowed, no stimulants/tranquilizers for 24-48 hours before. may be asked to hyperventilate 3-4 min and watch a bright flashing light. watch for seizures after the procedure.
with allopurinol
no vitamin C or warfarin!
TPN, slow down infusion before endingg, d/c until new bag ready?
no, dont d/c or change rate, don't change flow rate!
can clients family change dressing daily? tie tubing to neck?
no, every 8 hours? yes, square knot with 1-2 finger width
pediatric patient dehydrated, after initial oral rehydration, give water, juice or ginger ale?
none!
Creatinine phosphokinase MB (CK-MB)
normal 30-170 units/L *increase 4-6 hrs after MI and remains elevated 24-72hrs
troponin
normal <0.2 ng/dL *gold standard for MI
S3 sound
normal in CHF. Not normal in MI
Unstable Angina
not relieved by nitro
aPTT 30 and platelets 200, what's wrong?
nothing
AV fistula
nurse should ausculate every four hours for bruit to assess patency
466. When a pt comes in and she is in active labor?
nurses FIRST action is to listen to fetal rate/tone
infant has substernal heaves, expect what?
o2, suction, survanta for surfactant, vent support
307. Meconium stained protocol?
oAmniotic fluid yellow with particles = meconium stained`
255. Hyper reflexive? Absent reflexsive?
oHyper reflexes (upper motor neuron issue "your reflexes are over the top") oAbsent reflexes (lower motor neuron issue)
417. Tenkhoff cath?
oIt's ok to have abdominal craps, blood tinged outflow and leaking around site if the Peritoneal Dialysis cath (tenkhoff) was placed in the last 1-2 wks. Cloudy outflow NEVER NORMAL.
468. When is Rhogam given and how?
oRhogam : given at 28 weeks, 72 hours post partum, IM. Only given to Rh NEGATIVE mother.
Before starting IV antibiotics
obtain cultures!
chest tube pulled out?
occlusive dressing
compensation
offsets his percieved deficiencies by the placing emphasis on his strengths ( short client is verbally assertive with co workers
intraosseous infusion
often used in peds when venous access can't be obtained. hand drilled through tibia where cryatalloids, colloids, blood products and meds are administered into the marrow. one med that CANNOT be administered IO is isoproterenol, a beta agonist.
141. Common S/S of pyloric stenosis?
olive like mass
pyloric stenosis
olive like mass
During internal radiation
on bed rest while implant in place
188. During internal radiation?
on bedrest while implant in place
5. 1 lb = how many ozs?
one pound equals 16 0z-
In an emergency
patients with a greater chance to live are treated first
Autonomic dysreflexia
patients with spinal cord injuries are at risk for developing autonomic dyreflexia (T-7 or above)
38. Amniocentesis is performed? and why?
perform amniocentesis before 20 weeks gestation to check for cardiac and pulmonary abnormalities.
Battery
performing procedure without consent
hip arthroplasty, what to watch out for?
peripheral pulses! cool & weak, 1+ peripheral pulses, sign to call provider
Glaucoma patients lose
peripheral vision.
FIVE RIGHTS OF DELEGATION (RIGHT SUPERVISION)
person you are delegating to must feel comfortable to ask questions or seek assistance. approtpriate monitoring , evalulaiton, intervention as needed. - EX: RIGHT- delegating eneteral feeding to LPN after RN checks pts ability to tolerate RIGHT- delegate to APN to ambulate client only after admission assessment has been done by RN
108. Common S/S of Dengue
petechiae or + Herman's sign
392. s/s of a fat embolism?
petechiae. Treated with heparin.
fasting blood glucose
post pone admin of antidiabetic med until after levels are drawns, ensure patient has fasted for 8 hours prior to blood drawn
fontanels close when?
posterior 2-3 months; anterior 12-18 months
phenytoin, SMZ-TMP, command hallucinations = what?
phenytoin toxicity!
There are several different types of abuse, including...
physical, sexual, or emotional. Abuse tends to be cyclic, following a pattern on tension building, battering and honeymoon phase. When test questions appear related to abuse, look for the phase to determine the correct response.
Pulmonary edema
pink, frothy sputum tachycardia clammy cyanotic skin crackles
480. With lower amputations?
place in prone position
178. Diff between placenta previa and placenta abrupto?
placenta previa = there is no pain, there is bleeding. Placenta abruption = pain, but no bleeding.
use cane to assist with walking
places the cane on affected side of the body
367. Pneumonia?
pneumonia, fever and chills are usually present. For the elderly confusion is often present.
complications of mechanical ventilation
pneumothorax, ulcers
post spelectomy
pneumovax 23 is administered to prevent pneumococcal sepsis
DM
polyuria, polydipsia,polyphagia
81. Cerebral palsy?
poor muscle control due to birth injuries and/or decrease oxygen to brain tissues
78. Cause of Ascites?
portal hypotension + albuminemia= Ascites.
279. Infant with Cleft lip?
position on back or in infant seat to prevent trauma to suture line. While feeding, hold in upright position.
Cleft Lip
position on back or in infant seat to prevent trauma to the suture line. while feeding hold in upright position.
21. After appendectomy?
position on the RIGHT side with legs flexed
After Myringotomy
position on the side of AFFECTED ear, allows drainage.
280. Infant with Spina Bifida?
position prone (on abdomen) so that sac does not rupture
193. Enema positioning?
position pt in left side-lying (Sim's) with knee flexed
459. What to do in the case of tube feeding with decreased LOC?
position pt on right side (promotes emptying of the stomach) with the HOB elevated (to prevent aspiration)
Thoracentesis:
position pt on side or over bed table. no more than 1000 cc removed at a time. Listen for bilateral breath sounds, V.S, check leakage, sterile dressing
Airborne precautions protective equip
private room, neg pressure with 6-12 air exchanges/hr mask & respirator N95 for TB
Koplick's spots
prodomal stage of measles. Red spots with blue center, in the mouth--think kopLICK in the mouth
CHARACTERISTICS OF CERVIX & FETUS DURING TRUE LABOR
progressive change in dilation and effacement - moves to anterior portion, -bloody show - FETUS- presenting part engages in pelvis
111. Common S/S of down syndrome
protruding tongue
downs syndrome
protruding tongue
Communication: If the client is confused
provide reality orientation
diptheria
pseudo membrane formation
After lumbar puncture and oil based myelogram
pt is flat SUPINE (prevent headache and leaking of CSF)
administration of enema
pt should be left side lying (Sim's) with knee flexed.
After Cateract surgery
pt sleep on UNAFFECTED side with a night shield for 1-4 weeks
22. After Cataract surgery?
pt will sleep on unaffected side with a night shield for 1-4 weeks.
WBC left shift
pt with pyelo. neutrophils kick in to fight infections
brachial pulse
pulse area on an infant
NURSING INTERVENTIONS FOR EXCESS FLUID VOLUME
report abnormal signs to PCP, assess breath sounds, montor ABGs for hypoxemia and respiratory alkalosis, position, the client in semi fowlers position, administer O2, reduce IV flow rates, administer diruetics , moniotr I/O and wt, limit fluid and sodium as ordered. COMPLICATIONS- edema- montior for circulation to extremities, trun and position q2hr, support arms and legs to decrease dependent edema as appropriate, monitor for treat skin breakdown - pulmonary edema: (s/s- ascenign crackles, dyspnea at rest, and confusion) - position in high folwers , administer IV morphine, , admin IV diruetic, prepare for possible intubation and mechanical ventilation
mild preeclampsia teaching
report swelling of the hands and face rest in side lying position notify dr if UO decreases perform daily count of fetal kicks drink 2 to 3 L of fl per day
impaired nurse, do what?
report to charge nurse
umbilical cord compression
reposition side to side or knee-chest
Furosemide
require a diet high of potassium-rich foods to counter act the potassium loss
what acid base imalance w/ a pt with chronic emphysema most likely have
respiratory acidosis; compensatory metaboli alkalosis
pericarditis commoly follows a
respiratory infection
highest risk to patient is bed tray left in room, tray table at end of bed, restraints tied to bed rails?
restraints tied to bed rails, this is inappropriate
client with neutropenia
restrict visitors to family members only prohibit fresh flowers in clients room
CAUSE OF UTERINE ATONY
retention of large segment of the placenta which does not allow the uterus to contract firmly around the blood vesse.s to stop the flow of blood .
cholera
rice watery stool
when should a trough level be drawn for divided doses of gentamycin?
right before next dose
156. Cor Pulmonae?
right sided heart failure caused by left ventricular failure (so pick edema, jvd, if it is a choice.)
typhoid
rose spots on the abdomen
2 years of age, presentation of arms longer than torso, or round & soft abdomen
round & soft abdomen, NOT arms longer than torso
complications of infections mono
ruptured spleen
pneumonia
rusty sputum
S/S of OXYGEN TOXICITY & INTERVENTIONS
s/s- substernal pain; nasal stiffness; N/V; fatigue; HA; ST; hypoventilation INTERVENTIONS- use the lowest level of 02 to maintain adequate Sa02; Monitor ABGs and notify PCP if Sa02 levels rise above expected parameters use of 02 mask with CPAP continuous positive airway pressure, bilevel positive airway pressure, or positive end-expiratory pressure while a client is on a mechanical ventilator may decrease the amt of need 02 the oxygen amt should be decreased as soon as the client conditions permits.
five interventions for psych patients
safety setting limits establish trusting relationship meds least restrictive methods/environment
how infectious mono is spread
saliva
cystic fibrosis
salty skin
equation for calculating a pulse pressure
sbp - dbp = pp
risk factor for Osteoporosis
sedentary lifestyle
191. Eclampsia is a ?
seizure>
William's position
semi Fowler's with knees flexed to reduce low back pain
Paracentesis
semi fowler's or upright on edge of bed. Empty bladder. post VS--report elevated temp. watch for hypovolemia
370. Post Thyroidectomy?
semi-Fowler's, prevent ncek flexion/hyperextension, trach at bedside
Post-Thyroidectomy
semi-fowler's. Prevent neck flexion/hyperextension. Trach at bedside
dissociation
separating painful events from his conscious mind and is describing the events as if they happened to another person ( person abused describes the abuse as it happened to someone else)
For the aggressive or violent client...
setting boundaries and limits on behavior are important. The nurse should maintain a calm approach and use short, simple sentences.
130/86 BP, severe headache, what would you report in preterm labor to provider?
severe headache; hypertensive crisis
s/s of hypoglycemia
shakiness, diaphoresis, anxiety, nervousness, chills, nausea, headache, weakness, confusion
give patient cooling blanket when febrile, what is sign of adverse reaction?
shivering
initiating PN
short term nutritional needs- less than 10% dextrose via peripheral vein in como with amino acids and lipids. not as colaric dense as TPN - parenteral nutrition greater than 10% dextrose requires a CVC that is placed into a high flow central vein such as superior vena cava by MD under sterile conditions. . after placement the cath is flushed with saline or haparin until position confimed. - before infusion, verify MD order, insepct soltion for break in lipid emulsion, infusion pump ALWAYS used. , inital rate of 40-60ml/hr recommended. . - tubing should be changed q 24 hrs with lipids and q 48 hrs without lipids . -during change use sterile mask and loves.
children 5 and up
should have an explanation of what will happen a week before surgery
chlorpromazine teaching
sip floss frequently through out the day may experience dry mouth
dunlap traction
skeletal or skin
60. Best way to warm a newborn?
skin to skin contact on mom with a blanket
59. Best way to tube feed or feed kids?
small frequent is better than large
risk factors for OA
small thin framed body acromegaly estrogen deficencey
decontamination for radiation?
soap and water & disposable towels
320. More info on TB testing a positive result?
speaking of TB... PPD is positive if area of induration is: >5 mm in an immunocompromised patient >10 mm in a normal patient >15 mm in a patient who lives in an area where TB is very rare.
patient has stairs, has had a stroke, and has trouble communicating - priority therapy?
speech / ABCs
Droplet precautions
spiderman! sepsis, scarlet fever, streptococcal pharyngitis, parvovirus, pneumonia, pertussis, influenza, diptheria, epiglottitis, rubella, mumps, meningitis, mycoplasma or meningeal pneumonia, adeNovirus (Private room and mask)
transmission precautions for infectious mono
standard contact
protrusion of the bowels
stay with client and call for help place saline soaked gauze on internal organs place in supine pos with hips and knees bent to relieve pressure from the open wound check vs
malaria
stepladder like fever--with chills
Filgrastin (nuepogen), pegfilgrastin (Nuelasta)
stimulate the bone marrow to increase production of nuetrophils. decreases the risk of infection in clients with nuetropenia. S/E- bone pain, leukocytosis- decrease dose or stop treatment if WBC > 50000 or platelts >500,000 Contraindicated in cients sensitive to E.Coli. - should not be combined withother meds. evaluate effectiveness- absesne of infection, in chemo an absolute nuetrophil count increase to greather than 10,000 after chemio induced nadir
kawasaki syndrome
strawberry tongue
have client do what with anthrax?
strip down
first sign of PE
sudden chest pain followed by dyspnea and tachypnea
APPROPRIATE CLIENT POSITIONING FOR C-SECTION
supine with wedge under one hip- prevents pressure on aorta and vena cava to ensure adequate perfusion of oxygenated blood to the fetus during procedure.
bethamethasone (celestone)
surfactant. premature babies
43. Asthma and arthritis best excercise?
swimming
TRANSFUSION RXNS SEPSIS
sx include: fever, N/V, abdominal pain, chills, hypotension - maintain patent airway and admin 02; admin abx therapy as ordered obtain samples for blood cultures admin vasopressors such as dopamine, to combat vasodilation in the late phase elevate the clientʼs feet - obtain culture of pts blood and send bag with remianin blood and tubing to blood bank for further study - treat septicemia as directe- antibiotics, IV fluids
T1-T6 spinal chord injury
sympathetic innervation to heart, vagus nerve domination of all vessels and organs below injury - movement remainin- full innervation of upper extremitites, full strength of grasp, decreased trunk stability, decreased respeiratory reserve, rehab potential- full independent use of wheelchair and self care, , standing in frame
251. How to treat phobic disorders?
systematic desensitization
s/s overhydration
tachycardia, bounding pulse, HTN, tachypnea, increased CVP, confusion, muscle weakness, wt gain, ascites, dyspnea, crackles
SSRI's
take about 3 weeks to work
a nurse makes a mistake?
take it to him/her first then take up the chain
ferrous sulfate
take tab on empty stomach
milieu therapy
taking care of pt and environmental therapy
adverse effect of PEEP
tension pneumothorax monitor clients lungs sounds hourly look for tracheal deviation, absent breathe sounds, distended neck veins
lead poisoning
test at 12 months of age
glomuloneprhitis
the most important assessment is blood pressure
placenta previa s/s placental abrution s/s
there is no pain, but there is bleeding there is pain, but no bleeding (board like abd)
urokinase
thrombolytic agent. used for catheter occlusion if flush, and heparin does not work
Paget's disease
tinnitus, bone pain, elnargement of bone, thick bones
No phenylalanine
to a kid with PKU. No meat, dairy or aspartame
never give potassium
to a pt who has low urine output!
Romberg test
to assess balance and motor function inform client will be performed with eyes open and again with eyes closed standing with his feet together hands at his side nurse should stand close to client incase they lose balance
rationalization
to justify an unreasonable idea through developing an explanation that appeases both the talker and the listener (did not get job promotion because boss does not like her )
Rh mothers receive Rhogam
to protect next baby
Chvostek's sign
to test for hypocalcemia tapping the client's facial nerve about an inch infront of the triages of the ear. facial twitching indicates hypocalcemia
49. Babinski sign?
toes curl= GREAT Toes fan = BAD
methergine risk? what does it do?
treats postpartum hemorrhage by inducing uterine contractions; reducing hemorrhage; HYPERTENSION is a risk, so check bp prior to administration, watch for n/v, headache
hyperthyroidism
tremors, tachycardia, diaphoresis,weight loss, insomnia exophthalmia
267. HypoMg?
tremors, tetany, seizures, dyrshythmias, depression, confusion, dysphagia; dig toxicity
TRIAGE HIGHEST PRIORTY
triage- process of separating casualties and allocating treatment based on potential for survival - highest priority - life threatening injuries but who have high probability of survival once stabilized ex: Cardiopulmonary arrest, any upper airway obstruction secondary to trauma, potential for airway compromise (ie, facial injuryor burn), respiratory difficulty Shock as evidenced by: significant hemorrhage, tachycardia, decreased pulses or perfusion, hypotension, need for more than one 20cc/kg fluid bolus prior to arrival, significant neurologic impairment, GCS =9, deteriorating mental status,
CPM continous passive motion machine for total knee arthroplasty
turn off during meal maintain affected extremity in neutral alignment do not adjust settings do not store on floor increase risk for infection
frequent variable decels
turn on left side first
Peritoneal Dialysis (when outflow is inadequate)
turn pt from side to side BEFORE checking for kinks in tubing
361. Peritoneal Dialysis when outflow is inadequate?
turn pt from side to side BEFORE checking for kinks in tubing (according to Kaplan)
nitrazine paper
turns blue with alkaline amniotic fluid. turns pink with other fluids
sickle cell crisis
two interventions to prioritize: fluids and pain relief.
neostigmine
tx: myasthenia gravis se: bradycardia nausea
crutches up stairs
unaffected leg first
crutches on what side when rising? when walking?
unaffected side when rising; affected side when walking;
repression
unconcious omission of unpleasant emotions or experiences from conscious awareness ( forgets partners bday gift after argument
cryptorchidism
undescended testicles! risk factor for testicular cancer later in life. Teach self exam for boys around age 12--most cases occur in adolescence
crutches
use three-point gait rubber sole shoes
Tensilon
used in myesthenia gravis to confirm diagnosis
IV urography
used to detect obstruction; assess for a parenchymall mass, and assess size of kidney
PEEP
used to improve oxygentation and treat hypoxemia used to prevent atelectasis
TCA'SNURSING INTERVENTION FOR SEDATION
usually diminishes over time, avoid hazardous acitivities, take meds at bedtime
s/s of bacterial vaginosis
vaginal odor, discharge, dysuria
L1-L2 spinal cord injury
vagus nerve domination of leg vessels. movement remainin- varying control of legs and pelvis, instabiity of lower back. ambulation with long leg braces
T6-T12
vagus nerve domination only of leg vessels, GI and genitourinary organs, Movement remaining- full stbale thracic muscle and upper back; functional intercostals--> increased respiratory reserve inability to climb stairs
276. Immunizations rules?
vastus lateralis is IM administration site for 6month infants For toddlers above 18 months ventrogluteal The deltoid and gluteus maximus are appropriate sites for children`
med error is what trait? (fidelity, veracity, beneficence?)
veracity
TRIAGE SECOND PRIORTY
victims with injuries hat have systemic complications that are not yet life threatening and could wait 45-60 minutes for treatment
stage 3 pressure ulcer
visible subcu tissure
Parathyroid relies on
vitamin D to work
appropriate post-op care for diabetes/
vitamin c
ventriculoperitoneal shunt
watch for abdominal distention. watch for s/s of ICP such as high pitch cry, irritability and bulging fontanels. In a toddler watch for loss of appetite and headache. After shunt is placed bed position is FLAT so fluid doesn't reduce too rapidly. If presenting s/s of ICP then raise the HOB 15-30 degrees
Metoclopramide (Reglan) SE's
watch for extra-pyramidal side effects
Tamoxifen
watch for visual changes--indicates toxicity
58. Best indicator of dehydration?
weight
clozapine s/e
weight gain, hypotension, hyperglycemia, agranulocytosis
the best indicator of dehydration?
weight---and skin turgor
Cerebral angio prep
well hydrated, lie flat, site shaved, pulses marked. Post--keep flat for 12-14 hr. check site, pulses, force fluids.
Delegation: RNs do not delegate...
what they can EAT- Evaluate, Assess, Teach
asthma
wheezing on expiration
ventricular tachycardia/vtach=what ECG
widened QRS
COPD and O2
with COPD baroreceptors that detect CO2 level are destroyed, therefore, O2 must be low because high O2 concentration takes away the pt's stimulation to breathe.
231. Heart problems?
with R side cardiac cath=look for valve problems with L side in adults look for coronary complications
pancreatic enzymes are taken
with each meal!
Myesthenia Gravis
worsens with exercise and improves with rest
FIVE RIGHTS OF DELEGATION (RIGHT DIRECTION or COMMUNICATION )
written or oral instructions: which patient, what time, method, description of task, limits, expectations, data that needs to be collected, client specific instrctions, expected outcomes. provide feedback (in private) NEVER GIVE TASK THROUGH ANOTHER TASK MEMBER
can digoxin toxicity occur with 3.2 potassium?
yes
If patient has command hallucinations, withold med?
yes!
change a TPN infusion line every 24 hours or how often?
yes! every 24 hours
can you delegate an LPN to check NG tube placement? can they provide first feeding after CVA?
yes, according to book; not clear; but assume no beause high risk scenario
treatment for chlamydia, both mom & baby? timing for baby?
zithromax, amoxicillin and erthromycin for both mom & baby; immmmmmmediately following delivery
Chemotherapy is associated with a variety of side effects:
§ Nausea and vomiting § Diarrhea and or constipation § Alopecia § Anorexia § Fatigue and exhaustion § Mouth sores § Easy bruising
Black cohosh
· Acts on the female reproductive system as an estrogen substitute. · May be used instead of estrogen therapy during menopause. · Increases the effects of antihypertensive medications and may increase effect of estrogen medications. · Increases hypoglycemia in clients who are taking insulin or other medications for diabetes.
The generic names for the inhaled form of these drugs end in"terol" = " T aking E ases R espiratory distress o r L abored breathing"
· Albu terol (Proventil, Ventolin) · Formo terol (Foradil Aerolizer) · Salme terol (Serevent) The brand names of some drugs in this class provide a hint as well because they contain the words "vent " or " breth " referring to ventilation or breathing: · Albuterol (Pro vent il, Vent olin) · Salmeterol (Sere vent ) · Terbutaline ( Breth ine)
Teach client with gout to avoid the following:
· Anchovies, sardine in oil, fish roe, herring · Yeast · Organ meat (liver, kidneys, sweetbreads) · Legumes (dried beans and peas) · Meathextracts (gravies and consommé) · Mushrooms, spinach, asparagus, cauliflower
Antiplatelets: What interactions may occur?
· Avoid concurrent use of mediations that enhance bleeding, including NSAIDs, heparin,and warfarin. · Corticosteroids should be avoided as they may increase aspirin effects. · Concurrent use of aspirin may reduce hypertensive action of beta blockers.
237. HHNS Vs DKA
· Diabetic ketoacidosis (DKA) is a condition of DKA=insulin deficiency resulting in acidemia due to altered metabolism. · Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is primarily a disorder of dehydration due to hyperglycemia
Valerian
· Increases GABA to prevent insomnia. · Promotes sleep with increased effect over time. There is a risk of dependence. · May cause drowsiness and depression. · Should be used cautiously in clients with mental health disorders. · Avoid use in pregnancy or while breastfeeding.
Nursing Interventions for antagonists:
· Monitor for side/adverse effects · Tachycardia and tachypnea · Abstinence syndrome in clients who are physically dependent on opioids agonists · Monitor for symptoms to include cramping, hypertension, and vomiting · Administer naloxone by IV, IM or subcutaneous routes, not orally · Be prepared to address client's pain because naloxone will immediately stop the analgesia effect of the opioid the client had taken · When used for respiratory depression, monitor for return to normal respiratory rate (16-20/min for adults; 40-60/min for newborns)
Antiplatlets: What do clients who are taking these medications need to know?
· Observe for signs of weakness, dizziness, and headache and report them if they occur. These may be signs of hemorrhagic stroke. · Bleeding time should be assessed carefully. Coffee ground emesis or bloody, tarry stools should be reported. Watch for bruising, petechiae, and bleeding gums.
Side/adverse effects of ACEs include:
· Orthostatic hypotension with first dose · Instruct client to monitor BP for at least 2 hours after first dose · Cough, rash or altered or distorted taste (dysgeusia) · Instruct client to notify health care provider · Angioedema · Treated with epinephrine and symptoms will resolve once medication is stopped · Neutropenia is rare but serious with captopril (Capoten) · Instruct client to report signs of infection
Ginkgo biloba
· Promotes vasodilation and may be used to increase recall ability and mental processes. · Used commonly with dementia and Alzheimer's Disease. · May also be used for erectile dysfunction in clients who take SSRIs and experience impotence as a side effect. · May interact with medications that lower the seizure threshold, such as antihistamines, antidepressants, and antipsychotics. · May interfere with coagulation.
Beta2-adrenergic agonists Nursing interventions and client education:
· Short-acting inhaled preparations of albuterol (Proventil, Ventolin) can cause systemic effects of tachycardia, angina, and tremors. · Monitor client's pulse rate before, during, and after nebulizer or inhaler treatments · Long-acting inhaled preparations can increase the risk of severe asthma or asthma-related death if used incorrectly—mainly if used without concurrent inhaled glucocorticoid use · Oral preparations can cause angina pectoris or tachydysrhythmias with excessive use · Instruct clients to report chest pain or changes in heart rate/rhythm to primary care provider · Client should be taught proper procedure when using metered dose inhaler (MDI) and spacer · If taking beta2-agonist and inhaled glucocorticoid concurrently, take the beta2-agonist first to promote bronchodilation which will enhance absorption of the glucocorticoid · Advise client not to exceed prescribed doses · Advise client to observe for signs of impending asthma attacks and keep log of frequency and intensity of attacks · Instruct to notify primary care provider if there is an increase in frequency or intensity of asthma attacks
Common uses of antagonists:
· Treatment of opioids overdose, reversal of effects of opioids, or reversal of respiratory depression in an infant · Example: a post-operative client receiving morphine sulfate for pain control experiences respiratory depression and is treated with naloxone (Narcan)
Ginger root
· Used to decrease nausea of morning sickness, motion sickness, and nausea induced by surgery. · May also decrease the pain and stiffness of rheumatoid arthritis. · These medications suppress platelet aggregation. · Should be used cautiously in pregnancy.
Echinacea
· Used to treat the common cold. · With chronic use, echinacea can decrease positive effects of medications for TB, HIV, or cancer.
Calcium Channel Blockers · Nife dipine (Adalat, Procardia) · Amlo dipine (Norvasc) · Felo dipine (Plendil) · Nicar dipine (Cardene) · Verapamil (Calan) · Diltiazem (Cardizem)
· Vasodilation is result of blocking of calcium channels in blood vessels · Risk of reflex tachycardia, peripheral edema, and acute toxicity with nifedipine · Risk of orthostatic hypotension, peripheral edema, constipation, bradycardia, dysrhythmias, and acute toxicity with verapamil and diltiazem · Drinking grapefruit juice can lead to toxicity · Concurrent use of digoxin with verapamil can lead to digoxin toxicity
D-dimer
• 0.43 - 2.33 mcg/mL • 0 to 250 ng/mL
Liver enzymes
• ALT/SGPT 8-20 units/L • AST/SGOT 5-40 units/L • ALP 42-128 units/L • Total protein 6-8 gm/dL
Pancreatic enzymes
• Amylase 56-90 IU/L • Lipase 0-110 units/L • Prothrombin time 0.8-1.2
Hemoglobin (Hgb)
• Females 12-16 g/dL • Males 14-18 g/dL
Hematocrit (Hct)
• Females 37-47% • Males 42-52%
RBC
• Females 4.2-5.4 million/uL • Males 4.7-6.1 million /uL
Iron
• Females 60-160 mcg/dL • Males 80-180 mcg/dL
NURSING ACTIONS FOR CLIENT RECEIVING CHEMOTHERAPY - IMMUNOSUPPRESSION
• Immunosuppression due to bone marrow suppression by cytotoxic medications is the most significant adverse effect of chemotherapy.- If the client's WBC drops below 1,000/mm3, place the client in a private room and initiate neutropenic precautions. Only leaves room for diagnostic procedure. place a mask on him during transport. Protect the client from possible sources of infection (plants, change water in equipment daily, restrict client to room) Avoid invasive procedures that could cause a break in tissue Keep designated equipment in the client's room (blood pressure, machine, thermometer). •CLT EDUCATION- NUETROPENIA- avoid crowds while undergoing chemotherapy; Avoid eating fresh fruits and vegetables that could contain bacteria. Avoid fluids that have been sitting at room temperature for greater than 1 hr.; Monitor for s/s of infection
USE FOR HEAT THERAPY
• Increases blood flow • Increases tissue metabolism • Relaxes muscles • Eases joint stiffness and pain
Glucose
• Preprandial (fasting) 70-110 mg/dL • Postprandial 70-140 mg/dL • HbA1c (glycosylated hemoglobin) <6%
Bilirubin
• Total 0-1.0 • Unconjugated (indirect) 0.2 -0.8mg/dL • Conjugated (direct) 0.1 1.0 mg/dL
Cholesterol
• Total <200mg/dL • LDL ("bad") <100 • HDL ("good) >40 • Triglycerides <150mg/dL
IMPORTANT RENAL VALUES
•OSMOLALITY (278-300) increased- hyepernatramia, hyperglycemia, water loss (diuretics,) , mannitol, Decreased - hypnatremia, diuretics, addisons disease. •B.U.N. (Blood Urea Nitrogen) - Increases can be caused by excessive protein intake, kidney damage, certain drugs, low fluid intake, intestinal bleeding, exercise or heart failure. Decreased levels may be due to a poor diet, malabsorption, liver damage or low nitrogen intake. •Normal Adult Range: 7 - 25 mg/dl •URINE SPECIFIC GRAVITY - 1.01- 1.03 . higher suggests dehydration oCREATININE - Low levels are sometimes seen in kidney damage, protein starvation, liver disease or pregnancy. Elevated levels are sometimes seen in kidney disease muscle degeneration 0 .7 - 1.4 mg/dl •URIC ACID - High levels are noted in gout, infections, kidney disease, alcoholism, high protein diets, Low levels may be indicative of kidney disease, malabsorption, poor diet, liver damage or an overly acid kidney. Female Range: 2.5 - 7.5 mg/dl Male Range: 3.5 - 7.5 mg/dl BUN/CREATININE - Adult Range: 6 -25 (calculated)
IMPORTANT LAB VALUES (ELECTROLYTES)
•SODIUM - Very Low value: seizure and Neurologic Sx. •Normal Adult Range: 135-146 mEq/L •POTASSIUM -. Very low value: Cardiac arythemia. oNormal Range: 3.5 - 5.5 mEq/L •CHLORIDE - Elevated levels are related to acidosis. Decreased levels may indicate water deficiency crossing the cell membrane (edema). 95-112 mEq/L oCO2 (Carbon Dioxide) - Adult Range: 22-32 mEq/L Childrens Range - 20 - 28 mEq/L oCALCIUM - Adult Range: 8.5-10.3 mEq/dl Magnesium (1.6-2.6mg/dl) Increased- renal failure, severe dehydration, lithium intoxication, hypothyroidism Decreased- hyerpthyroidism, nasogastric suctioning, renal tubular acidosis.
NURSING ACTIONS FOR CLIENT RECEIVING CHEMOTHERAPY - Anemia and thrombocytopenia
■■ Nursing Actions for Anemia- Monitor the client for fatigue, pallor, dizziness, and shortness of breath, Monitor the client's Hgb ■■ Nursing Actions for Thrombocytopenia- Monitor the client for petechiae, ecchymosis, bleeding of the gums, nosebleeds, occult or frank blood in stools, urine, and/or vomitus. Institute bleeding precautions (avoid IVs and injections, apply pressure for approximately 10 min after blood draws, avoid trauma) ; Monitor platelet count, and be prepared to administer platelets if the count falls below 30,000/mm3.■■ Client Education- XX Use an electric razor instead of a razor blade when shaving.XX Use a soft-bristled toothbrush.XX Blow his nose only when necessary.XX Wear shoes when ambulating.XX Avoid the use of NSAIDs.
ASEPTIC TECHNIQUE
◯◯ Medical asepsis (Clean technique)- The use of precise practices to reduce the number, growth, and spread of micro-organisms from an object, person, or area. used for administering oral medication, managing nasogastric tubes, providing personal hygiene ◯◯ Surgical asepsis (sterile technique) - The use of precise practices to eliminate all micro-organisms from an object or area. used for parenteralmedication administration, insertion of urinary catheters, surgical procedures, sterile dressing changes, and many other common nursing procedures. Practices that Maintain a Sterile Field ● Prolonged exposure to airborne micro-organisms can make sterile items nonsterile. ◯ Avoid coughing, sneezing, and talking directly over a sterile field. ● Only sterile items may be in a sterile field. ◯ The outer wrappings and 1-inch edges of packaging that contains sterile items are not sterile. ◯ Any object held below the waist or above the chest is considered contaminated. Do not reach across or above a sterile field. ◯◯ Do not turn your back on a sterile field. ◯◯ Hold items to be added to a sterile field at a minimum of 6 inches above the field. ◯◯ Keep all surfaces dry. ◯◯ Discard any sterile packages that become wet.
Radiation Therapy ACTIONS AND EDUCATOIN
◯◯ Nursing Actions- client should be placed in a private room.; sign on door, wear a dosimeter film badge that records theamount of radiation exposure., 30 minute visitor and maintain 6 ft distance ; lead container should be kept in the client's room if the delivery method could allow spontaneous loss of radioactive material ◯◯ Client Education- remain in a position necessary to prevent dislodgement the of radiation implant.; call the nurse for assistance with elimination.; eat a diet that does not contain red meat.Gently wash the skin over the irradiated area with mild soap and water. ; Do not remove radiation "tattoos" that are used to guide therapy.; Do not apply powders, ointments, lotions, or perfumes to the irradiated skin.; avoid tight or constricting clothes.; Do not expose the irradiated skin to sun or a heat source.