LPN - NCLEX - LPN

Pataasin ang iyong marka sa homework at exams ngayon gamit ang Quizwiz!

Respondeat Superior Doctrine

the employer is responsible for the actions of the employee

petechia, petechiae

a small red or purple spot on the skin caused by the release into the skin of a very small quantity of blood from a capillary

Hematoma

a solid swelling of clotted blood within the tissues.

Guaiac test (Hemoccult, Fecult)

a special chemical test to identify blood in the stool

menarche

the first menstrual period

myxedexa coma

a state of severe hypothyroidism causing decreased LOC that may progress to a coma state ***give respiratory support***

Methylphenidate (Ritalin)

a stimulant used in treating ADHD increases the levels of neurotransmitters in your child's brain increases level of dopamine SE - anorexia, wt loss, nausea, lack of appetite

curretage

a surgical scraping or cleaning by means of currette

Febrile seizures in a child:

high spike in temp when temp goes too high too fast (it's not the rising temp it's the swiftness that it rises)

proper swaddling technique

hips flexed and abducted to allow for movement hips should be flexed out and up to allow for movement (think like a Pavlik's harness)

Urticaria

hives with localized swelling and itching

walk upstairs with a cane

hold cane on stronger side place cane on step move weaker leg

"Palm the label"

holding bottle of liquid med with palm over the label which avoids having medicine drip down side and damaging the label

4 months old motor skills

holds head unsupported rolls back to side, puts objects in mouth reaches for toy

endometriosis treatment

hormone therapy to suppress menstrual cycle, surgery for lesions or hysterectomy

parts of a needle

hub shaft bevel lumen (opening)

nasal canula at certain levels can cause dryness - prevention?

humidify the oxygen

Hyperthyroidism

low TSH

extrapyramidal symptoms

side effects such as restlessness, involuntary movements, and muscular tension produced by antipsychotic medications

purulent drainage

sign of infection

children with nephrotic syndrome

significant edema of scrotum or labia high risk for infection

Extravasation Treatment

stop infusion discontinue administration set aspirate drug if possible apply COLD compress document condition of site

phlebitis treatment

stop infusion remove peripheral IV catheter Elevation apply warm compress NSAIDS

When is Impetigo no longer contagious?

stops being contagious: 48 hours after you start using the medicine prescribed by your GP (antibiotics) when the patches dry out and crust over (if you do not get treatment)

Nitrolycerin

store in a dry, dark place replace every 6 months taking sitting down and stop all activity SE = HA/Hypotension

stridor

strained, high-pitched sound heard on inspiration caused by OBSTRUCTION in the pharynx or larynx

Chronic hyperglycemia causes

structural abnormalities in many organs is most common cause of diabetic retinopathy the leading cause of blindness in adults

what causes complicated grief

sudden death of a loved one/friend

Cushings Syndrome treatment?

surgery to remove tumor, drug or radiation therapy, total adrenalectomy

Inserting urinary catheter

surgical asepsis used

Dehiscence

surgical complication where there is separation or bursting open of a surgical wound

-centisis

surgical puncture to remove fluid

thoracentesis

surgical puncture to remove fluid from the pleural space sitting up, leaning forward

lordosis

swayback, increased lumbar curvature

SIADH

syndrome of inappropriate antidiuretic hormone complication of head injury urine output is decreased and water is retained resulting in high specific gravity of urine

SAIDH

syndrome of inappropriate antidiuretic hormone secretion A condition in which high levels of a hormone cause the body to retain water. In this condition, the body retains water instead of excreting it normally in urine. This process upsets the body's balance of minerals called electrolytes, especially sodium.

hypotension

systole lower than 90

anaphylaxis (anaphylactic shock) signs and symptoms

tachycardia hypotension nausea hives stridor

Food poising symptoms

tachycardia lethargy delirium

S/S of hypovolemic shock

tachycardia low BP, hypotension pallor clammy skin reduced LOC Position pt in modified Trendelenburg.

iron deficiency anemia expected signs

tachycardia & tachypnea (because body tries hard to compensate for lack of O2) **difficulty with concentration**

hypovolemic shock signs & symptoms

tachycardia, pale, and have FLAT neck veins

Early signs of shock

tachypnea tachycardia agitation

when removing a central line, have pt

take a deep breath and hold it

Warfarin (Coumadin) key points

take at same time every day antibiotics can affect INR level DO NOT DOUBLE DOSE IF DOSE MISSED - CALL HCP

DM pt teaching when sick

take blood glucose every 2-4 hours when sick

Potassium Chloride (oral) - how to take!

take with plenty of water (at least 4 oz) sit upright for a period of time afterwards

pt with dysphagia should be given

tart or sour foods first to stimulate salivation

intussusception

telescoping of a segment of the intestine most common abdominal surgical condition in newborns and infants intussusception is the most frequent problem in children between the ages of 6 months and 2 years.

if you suspect a colleague of pocketing pain meds

tell nurse supervisor DO NOT CONFRONT THE PERSON

heparin

test PTT

first sign of puberty in boys

testicular enlargement

safe vaccines during pregnancy

tetanus, diphtheria, (Tdap) influenza

ascites

the accumulation of fluid in the peritoneal cavity, causing abdominal swelling. indicative of cirrhosis

dorsal recombent position

the back-lying or supine position

pubic symphysis

the cartilaginous joint that allows some movement to facilitate childbirth

Elevate 1 or more extremities indications

thrombophlebitis application of a cast edema post-op following procedure on extremity

Levothyroxine (Synthroid)

thyroid hormone take on an empty stomach take in morning used for hypothyroidism

Eye Drops Administration Technique

tilt head back into conjunctival sac

How to measure NG tube length

tip of nose to earlobe to xiphoid process measure from tip of nose to earlobe then down to xiphoid process mark with tape

justice

to be fair to all

fidelity

to be faithful to keep promises

administer eye drops

to the conjunctival sac inner to outer canthus

nurses role in informed consent

to witness the client's signature on the informed consent form & to ensure that consent has been appropriately obtained.

parallel play

toddlers

pedal (dorsalis pedis) pulse

top of foot lateral to the tendon on the top of the foot

TPN

total parenteral nutrition (IV feeding)

LPN tasks

tracheostomy care suctioning inserting urinary catheter checking NG tube patency med admin sterile specimen collection reinforce client teaching colostomy care

Transphenoidal Hyphophysectomy

transphenoidal surgical removal of the pituitary gland

TURP

transurethral resection of the prostate gland

beta-blocker drugs

treat hypertension and angina pectoris by lowering the heart rate

head lice (pediculosis capitus) treatment

treat siblings, parents PETS DO NOT NEED TO BE TREATED! soak child's combs & hair accessories for 10 min in boiling water use a nit comb for 2 weeks post treatment vacuum furniture, rugs, drapes every couple of days

1st sign of Parkinson's

tremors

veracity

truthfulness, honesty

manifestations of spina bifida

tuft of hair at base of spine hemangioma nevus or dimple at base of spine

sickle cell crisis

two interventions to prioritize: fluids and pain relief. abdominal pain!!! elevated bilirubin!!!

buck's traction

type of skin traction that is widely used for femoral, hip, and acetabular fractures, which are fractures in the socket portion of the "ball-and-socket" hip joint.

after arm catheterization

typically can sit up and you MAY be able to get up and walk around soon after

first trimester of pregnancy & insulin dependent diabetics

typically need less insulin

duodenal ulcer

ulcer in the duodenum **coffee ground emesis**

Physiologic Jaundice of the Newborn

unconjugated hyperbilirubinemia; begins on day three due to immature liver

how to insert a J-tube

under general anesthesia, a surgeon surgically places the J-tube. This involves making an incision on the belly area and small intestine. The surgeon then places the tube into the openings and stitches the tube into place

Aniscoria

unequal diameter of pupils

sentinel event

unexpected occurrence involving death or serious injury

Hashimoto's disease hallmark signs

unexplained wt gain lethargy **CAN BE FATAL IF LEFT UNTREATED**

1st sign of pancreatic cancer

unintended weight loss

how long does vaginal discharge last postpartum?

until placental site heals

how long after surgery would bowel sounds resume

up to 24-48 hours post surgery

Most common quadrant for breast cancer

upper outer quadrant

How to insert an oropharyngeal airway.

upside down, then rotate 180 degrees

best indicator that bladder irrigation is running at an adequate rate after TURP

urine output is light pink if output is > 500 ml than intervention is needed (i.e. 3000 input and only 2500 or less output - INTERVENE)

Topical Nitroglycerin Ointment

use measured dose applicator/Apply with "appli-ruler" Wear gloves Avoid "hair" Rotate sites Wash previous application site Remove for hypotension

hydronephrosis

the dilation (swelling) of one or both kidneys

When to do breast self exam

1 week after period when breasts are not tender or swollen After menopause, check first day of every month

When does the Babinski reflex disappear?

1 year

Specific gravity of urine

1.001-1.035

CPR infant

1.5 inch compressions; 30 compressions to 2 breaths; one rescuer is 30 to 2 2 rescuers is 15 to 2 (do compressions with thumbs)

where to place hands for cpr compressions

1.5 inches above tip of xiphoid process

Cirrhosis: Diet therapy

high protein, high carbohydrate , moderate-fat

Pancreatitis (chronic)

EtOH (adults), cystic fibrosis (kids)

formula feeding

Every 3-4 hours feed 1-2 ounces - 6-8 wet diapers a day and 2 stools a day

Ectopic Pregnancy Risk Factors

Pregnant female (HCG positive), STD (PID) ' USING AN IUD IS A BIG RISK FACTOR FOR ECTOPIC PREGNANCY

cotton ball rubbed on cheek test

CN 5 parietal lobe - sensory input

language in toddlers

1 yr - one word sentences 300 words by 2 years 2 yr: 2-3 word sentences 3 yr: simple sentences of several words, grammatical rules

open post-op abdominal wound

1) put moist, sterile cloth over wound 2) flex knees toward chest gently

most concerning/important LT complication of opiods

CONSTIPATION!

BECLAMETHASONE (BECLOVENT OR VANCERIL)

Class: Corticosteroids For: Anti-inflammatory of airways **have pt gently blow nose prior to admin**

nitroglycerin patch

Clients should remove the patch each evening for a medication free time of 12-14 hours before applying a new one

Venous Thrombosis (DVT)

Clot formation in the deep, larger veins of the legs Heparin - monitor PTT Warfarin - monitor INR

cataracts

Clouding of the lens of the eye or its surrounding transparent membranes. results in blurry vision

hyperextend the neck

First step in NG tube insertion is to instruct the client to?

epidymitis treatment

Sitz bath elevate scrotum ice packs bed rest

Atrial Fibrillation (A-Fib)

irregular heartbeat that is too fast and increase in duration

Melanomas

irregularly shaped multi color

Bumetanide (Bumex)

loop diuretic

aphasia

loss of speech **Marilyn's mother**

Small head circumference in newborns could indicate?

Premature suture close Chromosome abnormality Congenital infections Neuro insult

cachexia

loss of weight and generalized wasting that occurs during a chronic disease such as cancer or AIDS

Moro reflex (startle reflex)

loud/clapping sound babies arm abduct birth-4mo **after 4 months - neuro issue**

BPP (biophysical profile)

measures - fetal breathing fetal tone amniotic fluid

calcium oxalate

most common type of kidney stone limit sodium to <2,300 mg

iatrogenic

produced by a physician in the form of a treatment prescribed by a physician

ADLs

"Bathing, showering, Toileting and toilet hygiene, Dressing, Swallowing/eating, Feeding, Functional mobility, Personal device care, Personal hygiene and grooming, Sexual activity"

Hypocalemia S/S

"CATS go numb"- Convulsions, Arrhythmias, Tetany and numbness/paresthesia in hands, feet, around mouth and lips. Also: Trousseau's (hand claws during BP), Chvostek's sign (tap on face and they twitch), hyper-reflexive

endogenous infection

produced or arising from within a cell or organism

Bladder cancer risk factors

#1 = SMOKING/TOBACCO (think of Jean/Ronnie) #2 = Working in dye & chemical plants Chronic UTI Recurrent nephrolithiasis **family hx increases risk**

suspected retinal detachment: mgmt

#1 action - cover both eyes with patch

ages 12-19 - adolescents

#1 issue - maintaining contact with peers encourage visits, friends, peer contact

Extracorporeal lithotripsy

(ESWL) uses shock waves to break a kidney stone into small pieces that can more easily travel through the urinary tract

Green tag

(Minor) "walking wounded"

Right sided heart failure s/s

* Dependent edema (legs & sacrum). * JVD * Abdominal distention * Hepatomegaly * Splenomegaly * Anorexia & nausea * Weight gain * Nocturnal diuresis * Swelling of the fingers & hands. * Increased BP (from fluid volume excess) or decreased BP (from pump failure). SYMPTOMS THAT BLOOD CANNOT MAKE IT BACK TO THE HEART

Cushing's disease s/s

* Generalized muscle wasting & weakness. * Moon face, buffalo hump. * Truncal obesity with thin extremities, supraclavicular fat pads; * Weight gain * Hirsutism (masculine characteristics in female).

telltale symptom of bladder cancer

***painless hematuria***

Hypokalemia S/S

**MUSCLE CRAMPS/WEAKNESS** Cramping Hypoventilation Hypotension

priority of patients to be seen

**acute** takes precedence over chronic

Cushing's disease

**elevated cortisol** INcreased sugar, steriods, sodium SKIN = thin, fragile, striae (Remember: *UP, UP, UP, DOWN, UP*) - HYPERnatremia, HYPERtension, INCREASED blood volume, HYPOkalemia, HYPERglycemia

best way to prevent epiglottitis

**standard childhood immunizations ensure children do not get this illness** **Immunization with the Hib vaccine is an effective way to prevent epiglottitis caused by Hib . In the United States, children usually receive the vaccine in three or four doses: At 2 months.

Meningitis symptoms

- classic triad of headache, neck stiffness and fever - head & neck bend backward & body arches forward -flexion of hip & knee - photophobia

Sjorgen's disease

- destruction of salivary glands as an autoimmune response - inhibit salivation & pt will have a dry mouth

Diabetic Ketoacidosis (DKA) signs and symptoms

-Flushed dry skin -Dry mucous membranes -Decrease skin turgor -Tachycardia -Hypotension -Kussmaul's respirations -Acetone breath/fruity breath -Altered LOC -Visual disturbance -Polydipsia -Nausea and vomiting -Anorexia -Abdominal pain

Hirschsprung disease s/s

*Ribbon-like stool* Failure to pass meconium stool in first 24-48 hours Vomiting bile Swollen belly/distended abdomen Diarrhea Constipation/gas Refuses to feed

*Yang* foods (Chinese)

*bright, hot* foods ex. hot soup from chicken

Circumcision care

- *washing hands* before providing care - *applying petroleum jelly* to glans penis at *diaper changes* (unless plastic ring was used) for *3-7 days* to prevent adhering to diaper - site typically *heals within 7-10 days* - expect *yellow exudate* on penis after the first day, a *normal part of healing* - use *warm water (without soap)* to remove urine/feces during diaper changes or at least twice daily

Kick counts (fetal movement counting)

- 2 hours after eating, same time daily - report less then 10 movements in 3 hours -before bedtime best

Erickson's theory

- 8 stages of psychosocial development unfold throughout the human lifespan -each stage consists of a unique developmental task that confronts individuals with a crisis that must be faced

Abdominal Aortic Aneurysm signs and symptoms

- Abdominal pain radiating to the back - if AAA is large enough, it can be felt pulsating. - absent pulse in extremities

hydatidiform mole signs and symptoms

- Bleeding which mag range from spotting to profuse hemorrhage; cramping may be present - RAPID uterine growth and uterine size that is larger than expected for the gestation - Failure to detect fetal heart activity - Signs of HYPEREMESIS gravidarum - Very EARLY development of gestational HTN - HIGHER than expected hCG level - "SNOWSTORM" pattern on ultrasound w/no fetus

Addison's disease treatment

- High protein, high carb diet - Glucocorticoids - Weigh daily - Injectable IV fast acting steroid may be ordered or indicated for a pt experiencing an Addisonian crisis until the pt is no longer at risk for dehydration, hypotension and shock.

Hemolytic transfusion reaction

- LOW BACK PAIN! Back pain is an adverse reaction, hypotension, tachycardia

Ergotamine

- Medication that should be taken on onset of a migraine - It should be taken upon aura of headache and a max of 3 tablets should be taken in a 24 hour period. -can cause a dependence on med **not safe during pregnancy**

Fat embolism signs and symptoms

- Petechiae on upper body - Altered mental status - low arterial O2 - Tachycardia - Tachypnea - Fever - Elevated BP - SOB

Voiding in newborn

- Should void within the first 24 hours - Urine specimens are obtained with a U-bag (non-invasive)

bethamethasone (celestone)

- Surfactant. -Med for lung expansion especially used for premature infants

Alendronate (Fosamax)

- This medication is used to prevent and treat postmenopausal osteoporosis and Paget's Disease - TAKE 1ST THING IN THE MORNING ON AN EMPTY STOMACH - SIT UP & WAIT 30 MINUTES PRIOR TO EATING, DRINKING OR TAKING ANY OTHER MEDS

Alendronate (Fosamax)

- This medication is used to prevent and treat postmenopausal osteoporosis and Paget's Disease. - Alendronate must be taken first thing in the morning on an empty stomach. -take with a full glass of water! - The pt must be instructed to wait at least 30 minutes after taking Alendronate before eating, drinking, or taking other medications.

Chronic Stable Angina Pectoris

- Typically elicited by physical or emotional stress - Subsides with rest or 1 nitro medication

Plantar creases

- Useful tool in assessing gestational age of the infant - Before 28 weeks, it'll be smooth

water seal chamber

- chest tube chamber that provides a one-way valve so that air leaves and cannot reenter chest - bubbling is normal initial 48 to 72 hours - tidaling (fluid in the water seal chamber is expected to rise with inspiration, fall with exhalation)

Diabetic ketoacidosis (treatment)

- give hypotonic fluid (0.45% saline) -give 10x faster than normal (1000mL/hr) -need large bore needle and good vein -giving glucose before fluids will put the patient into hypovolemic shock 2. normalize glucose levels...regular insulin given IV with fluids to avoid hypovolemia -then switch to D5W when glucose levels around 250 (to avoid hypoglycemia) follow MD orders to rehydrate/restore circulating volume 3. monitor BP, P, R q15h until stable, BP needs to come up 4. I&O very careful...want to get it back up 5. Record F&E balance: -IV electrolytes given after insulin; hypokalemia is significant cause of death in the treatment of DKA -K+ can be high or normal but K+ is not going into the cell without insulin so K+ build in the blood; when insulin is given it drives K+ into the cell, this can lead to life threatening hypokalemia if not treated 6. Cardiac: (reflects K+ levels and cardiac response) -hypovolemic shock; check skin -tachycardia -assess blood (glucose) and urine tests (ketones) -risk of thrombosis due to severe hyperosmolarity; subq heparin prophylactically Note: there will be a slight temperature elevation in the beginning and the skin will feel hot and dry want the pt more alert/oriented After DKA is corrected: determine the cause; most common is infection

dilated pupils indicate

- head injury - ICP - shock - heat stroke -hemorrhage -ingested a stimulant drug

causes of child maltreatment

- parent alc abuse, low self esteem - child low birth weight, phys/cog challenges - low family income -few social supporters

hypovolemic shock signs and symptoms

- rapid, weak pulse (tachycardia) - low bp - change in mental status - cyanosis - cool, clammy skin - increased respiratory rate

older adults & nutrition

- require increased amounts of calcium, Vit D, B12, A -may require increased amts of protein -fewer calories are needed because of slower metabolic rate and decrease physical activity -need more carbs for fiber -decreased saliva and gastric juice secretion may also affect a person's nutrition

Varenicline (Chantix)

- start 1 week before quit date BW -TAKE AFTER A MEAL > Take w/ food to reduce nausea - Serious neuropsychiatric events including depression, etc. Warning - Angioedema, hypersensitivity rxns, seizures, increase intoxicating effect of alcohol, and serious skin reactions have occurred. - use caution in patients with underlying psychiatric disorders and while driving or operating machinery, traffic accidents have occurred. Avoid use in pilot, etc. SE - Nausea , constipation, etc

Decerebrate posturing

-"extensor posturing"; -abduction of arms, elbow and wrist extension damage to the nervous system; upper brain stem

TURP post op care

-3 way bladder catheter irrigated for first 24 hrs to prevent mucous and blood clots -traction used and pulled down into prostatic fossa (cath taped tightly)

CNS depressant drugs

-Benzodiazepines -Non-benzodiazepines -Miscellaneous drugs -Muscle relaxants -Barbiturates psychoactive drugs that inhibit the functioning of the central nervous system

Moderate Alzheimer's Disease

-Confusion -Agnosia -Agitation -Violence -Wandering -Paranoia **RISK FOR WANDERING - LOCKS ON DOORS**

Closed angle glaucoma symptoms

-EXTREME eye pain, blurry vision, HA, N/V -severe HA -HARD, RED eye -pupil dilated, nonreactive to light

Graves disease signs and symptoms

-Enlarged thyroid -Acceleration of body process: weight loss, increased appetite, SOB, diarrhea, heat intolerance, tachycardia, palpitations, increased BP, diaphoresis, nervousness, insomnia -Exophthalmos -Increased T3 and T4 levels -Low TSH levels

Side effects of chemotherapy

-Hair loss -redness at site of radiation -Dry mouth/mouth sores -Difficulty swallowing -alopecia -N/V -Diarrhea *[GI tract replicate often] -Fatigue -Bleeding -Susceptibility to infection -Foggy brain aka "chemo brain"

CPR children 1 + years old

-Hand Position: 2 or 3 fingers on center of chest (below nipple line); 1 hand on head opening airway -Compression Depth: About 2 inches -Cycles: 30 Chest Compressions; 2 Ventilations -Rate: 100-120 Compressions per minute

septic arthritis tx

-Hospitalization (ASAP) -Ceftriaxone 1 gm daily IM -Joint drainage via arthroscopy -Immobilize and elevate limb

cervical cancer risk factors

-Human papilloma virus (HPV) infection -Smoking -Early age at first sexual intercourse. -Multiple sexual partners and/or partners who have multiple partners. -Multiple pregnancies

BSE (breast self examination)

-Is recommend on a monthly schedule. -do this 4-7 days after start of menstrual cycle

Post cardiac cath:

-KEY POINT- BACK OR FLANK PAIN IS CONCERN - COULD BE RETROPERITONEAL BLEEDING - INVESTIGATE - Monitor vital signs, pulses distal to site - Apply pressure to cath site for at least 15 minutes - Keep leg straight, bedrest for 6-8 hrs.

Pavlik harness teaching

-NO LOTIONS OR POWDERS -lightly massage skin under straps daily to ensure skin integrity -shirt under straps -check for red areas under strap several times a day -diaper should be placed UNDER the straps, wear 3-5 months readjust every 1-2 weeks because of infant growth, done by HCP wear knee socks to prevent skin breakdown **regularly assess skin for breakdown/skin integrity**

Autonomic Dysreflexia S/S

-Severe Pounding Headache -Hypertension -Profuse Sweating (especially forehead) -Bradycardia -Nasal Congestion -piloerection -goose flesh

admin insulin

-Subcutaneous injection: syringe/needle, pen and jet injectors abdomen for rapid absorption

intussusception s/s

-Sudden onset of severe, intermittent abdominal pain -screaming and drawing up legs with periods of calm in between episodes -pain relieved once abdomen relaxes -currant jelly stools (blood and mucus) -SAUSAGE SHAPED MASS IN RUQ

Immediate recall memory

-Temporal lobe -Give client three words or numbers and have client repeat them in a few minutes

Probable signs of pregnancy (objective)

-Uterine enlargement -Hegar's Sign -Chadwick's Sign -Goodell's Sign -Ballottement -Braxton Hick's Contractions -Positive Pregnancy Test

examples of sentinel events

-Wrong patient -Wrong site -Wrong procedure -Delay in treatment -Suicide -Operative or post-op complications -Retention of foreign body -Medication error -Perinatal death or injury -Criminal events

paracentesis

-a procedure that removes fluid (peritoneal fluid) from the abdomen through a slender needle. The collected fluid is then sent to a lab for analysis to determine what is causing the excess fluid. The most common reasons to perform paracentesis is to: Diagnose an infection.

Autonomic dysreflexia

-a syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above T-6 -bladder distention most common cause! - Caused by - something as simple as a full bladder or an ingrown toenail can be enough to send your nerve responses into overdrive. Others are - constipation or kidney stones

Mandatory Reporting

-abuse: child or elder abuse, domestic violence -communicable diseases (according to CDC) such as hepatitis and TB

Alcohol withdrawal symptoms

-appear within 4-12 hrs -abd cramping -vomiting -tremors -restlessness -inability to sleep -TACHYCARDIA -HTN -transient hallucinations or illusions -anxiety -increased RR, temp -tonic clonic seizures -diaphoresis

late manifestations of hypoxia & hypoxemia

-bradypnea -bradycardia -confusion and stupor -cyanotic skin and mucous membranes -hypotension -cardiac dysrhythmias

how to collect a specimen from urinary catheter

-clean collection port with an alcohol swab -aspirate urine with a sterile syringe -use aseptic technique to transfer the specimen to a sterile specimen cup **URINE SAMPLE SHOULD BE TAKEN FROM PORT ON CURRENT CATHETER**

Parkinson's risk for

-constipation -aspiration -drooling -dysphagia

Signs of true labor

-contractions are regular with increasing frequency (shortened intervals), duration, and intensity -discomfort radiates from back to abdomen -contractions do not decrease with rest -cervix progressively effaces and dilates

components of med prescription

-date & time written -med name -med dosage -route of administration -frequency of administration -primary HCP signature

assessments that indicate suctioning

-decreased O2 sat -altered mental status -increase HR -increased RR -difficulty breathing (use of accessory muscles, grunting, flaring) -adventitious breath sounds -pallor, mottled or cyanotic skin

end-stage renal disease (ESRD) treatment

-dietary restriction of protein, sodium and potassium intake -antiemetics for nausea -control of HTN example of a meal with these restrictions - chicken sandwich, applesauce

Epistaxis treatment

-direct pressure x 15 minutes with ice or cold cloth -lean forward -if still bleeding, afrin -lidocaine then silver nitrate if you can see bleeding area -nasal packing for anterior bleed -refer to ENT or ED if still bleeding -CBC and clotting times if no obvious reason -saline for dried nasal tissue

phagocytic cell disorder - pts susceptible

-eczema -recurrent abscesses -pneumonia

1 month milestones

-elevates head momentarily from prone position -tight fist grasp -responds to sounds -prefers the human face

Reverse Trendelenburg

-entire bed is tilted with the foot of the bed lower than the head -position promotes gastric emptying and prevents esophageal reflux

functions of the placenta include

-exchange of nutrients & waste between fetus & mother -Nutrient and gas exchange between the mother and fetus -Removal of waste products from the fetus -protection against bacteria

angina pectoris causes

-extreme temps (cold or hot) -tobacco use -physical exertion (training, sex, exercise) -stimulants/amphetamines/ED meds -Coronary artery narrowing (CAD, arteriosclerosis)

Bacterial meningitis (newborns and kids) s/s

-fever or possible hypothermia -irritability, frequent seizures -high-pitched cry -poor feeding & vomiting -nuchal rigidity -bulging fontanelle possible but not always present

dystocia birth (shoulder first)

-flex mother's legs to abdomen -suprapubic pressure

2-3 month milestone

-gains head control -holds rattle when placed in hand -makes cooing sounds -smiles in response to talking or smiling -recognizes familiar faces

testicular cancer signs & symptoms

-hard, painless, usually unilateral masses -testes/scrotum may be enlarged or feel heavy -dull, aching pain in lower abdomen -hydrocele or epididymitis can occur -gynecomastia may develop due to hormone secretion

restraints - pt car

-hourly NV checks -release restraints every 2 hours -offer fluids, nutrition, toileting every 2 hours

Suctioning

-hyperoxygenate client prior to suctioning -suction 10-15 seconds (rotating motion); limit 2-3 attempts -Allow 20-30 sec recovery between attempts -Document amount , color, and consistency of secretions as well as client's response

3 year old milestones

-jumps in place; balances on 1 foot -sentences of 3 - 4 words -feeds self -draws circle -feeds self -asks "why" -states own name -mostly toilet trained -draws circle -rides tricycle

Holter monitor instructions

-keep a diary of activities and symptoms while wearing for comparison later -do not bathe or shower during testing period -engage in normal activities and routine

Tracheostomy care -

-keep two extra tracheostomy tubes (one the client's size and one a smaller size) at the bedside in the event of accidental decannulation -Only suction client as clinically indicated -humidification of oxygen source is required at all times to mucosa stays moist -Tracheostomy care every 8 hours or as needed **SURGICAL ASEPSIS**

normal uterine contractions during the first stage of labor

-lasts 40-80 seconds -should not exceed 90 seconds! -resting tone should not exceed 20 mmHg -strength of contraction at height = 25-50mmHg; should not exceed 80 mmHg -2-5 contractions every 10 minutes -no more than every 2 minutes

10-12 month milestones

-may walk with help or take independent steps -crawls up stairs -uses 2 finger pincer grasp -hits 2 objects together -says 3-5 words -uses nonverbal gestures (waving bye-bye) -separation anxiety -searches for hidden objects

to administer several meds via pt feeding tube

-meds should be crushed -meds should be crushed separately and administered separately -inquire if a liquid form of the med is available and use that -flush line prior to and after admin of each med

guidelines for safe IV administration

-never admin meds through tubing being used for blood admin -implement standard precautions & follow policies -fluids should be infused within 24 hours or disgarded to prevent infection

Contraction Stress Test (CST)

-nipple stimulation or oxytocin stimulation evaluates fetal response to stress -no deceleration with a min of 3 contractions lasting 40-60 seconds in 10 min -done at 28 wks

MRSA - pts at greatest risk

-older pts -suppressed immunity -long hix of antibiotic use -invasive tubes or lines

pyloric stenosis s/s

-olive size mass in RUQ (moveable/firm) -peristaltic waves during and after feedings -projectile vomiting!** -hungry and irritable after vomiting -dehydration & metabolic acidosis

LDL cholesterol levels

-optimal: less than 100mg/dl

4-5 month milestones

-palmar grasp -rolls front to back/back to front -puts objects in mouth -begins to laugh -makes consonant sounds -sits with support -becomes calmed with parents voice

SIADH risk factors/causes

-pneumonia -malignancies -CNS illnesses (stroke, infection, trauma) -water retention -total body water increases -decreased sodium **not associated with DM** could be associated with cancer

Allen's Test (wrist)

-purpose: to ID vascular compromise -to determine ulnar patency -tests radial & ulnar arteries by compressing them -pt opens hand while pressure is maintained over the arteries -one artery is tested by releasing pressure over that artery to see if hand flushes

Right sided heart failure symptoms

-related to systemic congestion -fatigue -increased peripheral venous pressure -ascites -enlarged liver and spleen -may be secondary to chronic pulmonary problems -distended jugular veins -anorexia and complaints of GI distress -weight gain -dependent edema

bat bite/rabies

-scrub & clean bite vigorously -admin tetanus toxoid vaccine -human rabies immunoglobulin -rabies vaccine

6-9 month milestones

-sits without help -begins to crawl -may pull to a stand -moves objects between hands -uses crude pincer grasp -babbles -may say mama -may have stranger anxiety

Diet for Phenylketonuria (PKU)

-special formula and diet *low in phenylalanine* -phenylalanine free medical formula -elemental medical foods (modified protein hydrolysates where phenylalanine has been removed) -avoid high protein foods (milk, dairy, meat, fish, chicken, eggs, beans, nuts)

Naegele's Rule

-subtract 3 months from the LMP then add 7 days and 1 year

early manifestations of hypoxia & hypoxemia

-tachypnea -tachycardia -restlessness -pale skin and mucous membranes -elevated blood pressure -use of accessory muscles, nasal flaring, adventitious lung sounds

guidelines during illness for diabetic

-take usual dose of insulin -test BG every 3-4 hours -report elevated BG or ketones to HCP -consume sugar free beverages every 30 minutes -small frequent meals

taking in, taking hold, letting go

-taking-in (12 hours after birth) - dependent on others, talk about birth, literally taking in her new role as a mom, hesitant to make decisions, perceive as passive, sleep, pain reduction & food are major needs -taking-hold - takes control of self and newborn, becomes less reliant on other people but needs reassurance that she's doing okay -letting go - ready to leave hospital, start new life

TB test administration involves:

-use a 27 gauge, 1/4" needle, clean gloves -10 degree angle with bevel up -make a wheal (bleb) -must go through epidermis into dermal layer of skin -DO NOT RUB SITE AFTER INJECTION -mark circle with red pen -left forearm above wrist (hands-width above wrist)

Cushing's syndrome urine collection

-use a dark jug -24 hour span of time (toss 1st void of the morning) -keep urine collected in a refrigerator or in a cool ice chest by the bed

TPN Care and Maintenance

-verify prescription and solution with another nurse -administer via infusion pump -monitor daily weights -monitor & record I&Os, noting fluid balance -monitor serum glucose levels every 4-6 hours -monitor for signs of infection -change dressing every 48-72 hours per facility protocol -change IV tubing & fluid every 24 hours -if TPN solution is unavailable; administer dextrose 10% in water to prevent hypoglycemia

Folic acid prior to pregnancy

.4 mg daily

deep tendon reflex grading

0 = no response; always abnormal 1+ = a slight but definitely present response; may or may not be normal 2+ = a brisk response; normal 3+ = a very brisk response; may or may not be normal 4+ = a tap elicits a repeating reflex (clonus); always abnormal

Direct (conjugated) bilirubin

0 to 0.3 mg/dL Elevations indicate altered liver functioning, bile duct obstruction, or other hepatobiliary disorder

Lithium levels range

0.5-1.4

Digoxin (Lanoxin)

0.8-2 ng/mL reduces cardiac workload Apical pulse should be taken for a full minute before administration of this medication. If the apical pulse < 60, the dose should be withheld and the prescribing provider notified if child then if AP <90 should be held

6 rights of medication admin

1 right medication 2 right dose 3 right patient 4 right route 5 right time 6 right documentation

walking down stairs using cane

1 - cane first 2 - injured leg 3 - uninjured leg

lifting and transfer of clients - nursing interventions

1 - collect data about mobility & strength 2 - tell clients to assist when possible 3 - use mechanical lift & assistive devices 4 - avoid twisting the thoracic spine or bending at waist 5 - use major muscle groups & tighten abdominal muscles

If the umbilical cord prolapses into the vagina

1 - place client in Trendelenberg position 2 - immediately notify physician

2 drains after thoracic lobectomy

1 drain to remove excess air 1 drain to remove excess blood

Infants urinary output

1-2ml/kg/hr

when to take antacids

1-3 hours after meals

warm milk or small amount of carbs at bedtime

promotes sleep milk contains tryptophan

atrial septal defect

results in heart murmur flaw in the septum that divides the two atria of the heart

types of colostomy

1. Ascending 2. Transverse 3. Descending 3. Sigmoid

Stages of Grief (Kubler-Ross)

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

Cushing's triad consists of:

1. Elevated systolic BP 2. Bradycardia 3. Irregular respirations

Prevention of DVT in bedridden patients

1. Elevation of the foot of the bed 2. Leg exercises 3. Compression hose 4. Intermittent compression devices 5. Anti-coagulation in high risk patients may be necessary

The BPP measures 5 things:

1. HR 2. Breathing 3. Body movements 4. Fetal muscle tone 5. Amniotic fluid volume

How to use an incentive spirometer

1. Hold in upright position 2. Exhale normally 3. Seal lips tightly around mouthpiece 4. Take in slow deep breaths to elevate the balls or cylinder for 2-6 seconds (start low) 5. Avoid brisk low-volume breaths 6. Remove mouth piece and exhale normally 7. Cough after the incentive effort 8. Relax and take several breaths before using again 9. Repeat the procedure several times and four to five times per hour 10. Clean mouth piece and shake it dry.

secondary hypothyroidism

results when the pituitary gland is dysfunctional and does not secrete TSH decreased T3

layer of fat in IV bag

return to pharmacy this is not normal

PRIORITIZATION PRINCIPLES

1. LIFE BEFORE LIMB EX: Shock over pt w limb inj 2. ACUTE BEFORE CHRONIC 3. ACTUAL BEFORE POTENTIAL 4. MASLOWS: SELSP 5. EMERGENCIES VS. EXPECTED FINDINGS

risk factors for DVT

1. Major surgical procedures (especially total hip replacement) 2. Prolonged bed rest 3. Lower extremity trauma 4. Use of OCP and HRT 5. Inherited (Factor V Leiden, Protein C, Protein S, or anti-thrombin deficiencies) 6. Cancer-associated hypercoagulable states 7. Advanced age 8. Obesity 9. Long-distance air travel 10. Multiparity 11. IBD 12. Lupus erythematosus

Hepatitis C signs and symptoms

1. Pre-icteric: Fatigue malaise, anorexia, n/v, headache, aversion to smoking and alcohol 2. Icteric: Weight loss, jaundice, pruritus, RUQ pain, clay colored stool, dark urine - Low grade fever may be present - Hepatosplenomegaly may be present

5 Rights of delegation

1. Right person 2. Right task 3. Right circumstance 4. Right direction/communication 5. Right supervision/evaluation

Hirschsprung disease treatment

1. The majority of children with HD require 1 of 3 operations - *child is stabilized with fluid and electrolyte replacement and colonic cleansing with enemas* and if needed, surgery is performed 2. Surgical management consists primarily of the *removal of the aganglionic portion of the bowel* to relieve obstruction, restore normal motility, and preserve the function of the external anal sphincter

Erikson's stages of psychosocial development

1. trust vs. mistrust (0-2) 2. autonomy vs. shame and doubt (2-4) 3. initiative vs. guilt - preschool 4. industry vs. inferiority - school age 5. identity vs. role confusion - teen 6. intimacy vs. isolation - early adult 7. generativity vs. stagnation - 30s-40s 8. integrity vs. despair - 55+

Tidaling

rhythmic rise and fall of water in a chest tube drainage system

Care after cardiac catheterization

1. bedrest 2. keep insertion site straight/MIDLINE 3. head of bed down or 30 degrees, depending on cardiologist 4. stay in bed for 2-6 hours 5. vital signs 6. assess insertion site for bloody drainage or hematoma 7. assess peripheral pulses, skin temp, and color in affected extremity with every vitals 8. monitor urine output, give oral and IV fluids to flush

NG tube insertion steps

1. check order 2. gather equipment, 3. introduce yourself, identify Pt., provide privacy, explain procedure, hand hygiene, gloves 4. place in high fowler's position 5. determine length of tube measure from the tip of the nose to the top of the ear to the xiphoid process & mark appropriately (add 20-30cm for duodenal and Jujenum) 6. apply lubricant to the tip of the tube 7. insert tube into nose with neck hyperextended & advance straight, if resistance is met increase pressure slightly continue until mark is reached 8. use a syringe to aspirate a small amount of gastric content, test the PH of the contents using using the litmus paper 9. whoosh test, 30 cc bolus of air 10. abd xray for placement check 11. secure the tube with tape or other product to hold the tube in place

NG tube insertion

1. check order, gather equipment, introduce yourself, identify Pt., provide privacy, explain procedure, hand hygiene, gloves. 2. solicit help & consider restraints prn 3. position child in fowler's position 4. (nasogastric)determine length of tube measure from the tip of the nose to the tragus of the ear to the xiphoid process & mark appropriately 5.(orogastric)determine length of tube measure from the mouth to the tragus of the ear to the xiphoid process & mark appropriately 6. apply lubricant to the tip of the tube 7. for orogastric tube insert tube into mouth with neck hyperextended & advance it toward the back of the throat, continue until mark is reached 8. nasogastric tube insert tube into nose with neck hyperextended & advance straight, if resistance is met increase pressure slightly or rotate tube, continue until mark is reached 9. use a syringe to aspirate a small amount of gastric content, test the PH of the contents using using the litmus paper ( a PH of 3 or less indicates gastric contents) 10. secure the tube with tape or other product to hold the tube in place **If cough and gag, back off a little, let calm & then advance again with pt sipping water from straw cough and gag, back off a little, let calm advance again with pt sipping water from straw**

infant formula teaching

1. keep parts of bottles as clean as possible (boil or wash in dishwasher) 2. *wash the top* of can before opening 3. keep *unused prepared formula or cans in refrigerator* after opening but *discard after 48 hours* -but throw away formula that infant left in bottle 4. *never microwave* but instead can be placed in pan of hot water to warm it, then test temp on inner wrist. should be lukewarm 5. *Never dilute or concentrate* formula

LPN scope of practice

1. monitoring RN findings 2. reinforcing education 3. routine procedures (catheterization) 4. most med administrations 5. ostomy care 6. tube patency and enteral feeding 7. specific assessments (like lung, bowel, neurovascular checks)

Piaget's Stages of Development

1. sensorimotor 2. preoperational 3. concrete operational 4. formal operational

Piaget's stages of cognitive development

1. sensorimotor 2. preoperational 3. concrete operational 4. formal operational

Braden scale categories

1. sensory perception 2. moisture 3. activity 4. mobility 5. nutrition 6. friction/shear

How to use a metered-dose inhaler:

1. shake inhaler well before use (three or four shakes) 2. remove the cap 3. exhale completely, away from inhaler 4. bring inhaler to your mouth. place it in your mouth between your teeth and close mouth around it 5. start to breathe in slowly. press top of your inhaler once and keep breathing in slowly until you have taken a full breath (three to five seconds) 6. Remove the inhaler from your mouth and hold your breath for about 10 seconds, then breathe out *wait only one minute between each puff

when does baby's cord fall off

10-14 days

Phenytoin level

10-20

Normal intraocular pressure (IOP)

10-21 mm Hg

Infant chest compressions

100 per minute

Newborn HR and RR & BP

100-180 40-60 60-80/40-50

FHR normal range

110-160 bpm

Avg newborn head circumference

13-14" 33-35 cm

Epiglotitis

3Ds' Drooling, Dysphonia, Dysphagia **inability to swallow - take child to ER immediately because crying may increase inability to breath/swallow**

how long should nurse wait after starting a tranfusion

15 minutes

when to apply sunscreen regarding time to sun exposure?

15-30 minutes prior to going outside

Nagele's Rule

1st day of last period + 7 days - 3 months

Hep B vaccine schedule

1st dose - newborn 2nd dose @ 1-2 months 3rd dose @ 4-6 months

pinworm tape test

1st thing in the morning when a child wakes

fetal heartbeat

1st trimester = 160 - 170 bpm from 2nd trimester until term = 110 - 160 **FHR is approximately 2x mother's heart rate**

stages of labor

1st: dilating stage 3 phases: Latent (0-3cm) Active (4-7cm) Traditional (8-10cm w/ urge to push) 2nd stage: delivery 3rd: placental delivery 4th: recovery- primary goal to prevent hemorrhage from uterine atony, 1st void within 1 hour and then q2-3 hrs, Rhogam

Hep A vaccine schedule

2 doses 12-24 months

DTaP vaccine schedule

2 months, 4 months, 6 months, 15-18 months, 4-6 years

Hib vaccine schedule

2, 4, 6, 12-15 months

colostrum turns into milk @

2-3 days

Regular insulin peak?

2-4 hours

Which STDs can be cured?

Chlamydia, Trichomoniasis, Gonorrhea, and Syphylis basically the bacterial ones - give antibiotics and they are gone the viral ones are not curable

Griseofulvin

>Give with meals-- especially high fat meals (anti-fungal) >taken for several weeks or months - take the full prescription >photosensitivity is a concern

low vs. high phenytoin levels

>if levels are too low = seizures >too high = the person may experience symptoms associated with phenytoin toxicity - Lethargy, confusion, hyperactivity. greater than 50 = seizures or coma

to test for dehydration

Skin turgor (grasp skin on clavicle to see if it springs back) mucous membranes capillary refill

prenatal glucose tolerance test

DO NOT HAVE TO FAST PRIOR TO TEST; can be performed at any time of day @ 24-28 weeks gestation Diagnose for Gestational Diabetes drink 50 g of glucose blood draw 1 hour after ingestion if serum Blood Glucose level is >140 then 2, 3 or hourly exam is given

Nitroglycerin storage

DO NOT STORE IN CAR!!! store in dark, cool place

child with leukemia & taking temp

DO NOT TAKE RECTALLY

Colace (docusate sodium)

stool softener allows fat & water to enter feces to pass the stool more readily

how long to wash hands for

20 seconds

safety razor

DO NOT USE FOR PTS WITH LOW PLATELETS OR ANTI-CLOTTING THIS CAN STILL CUT - PTS WITH CONCERN OF BLEEDING SHOULD USE ELECTRIC RAZOR

assault

threat of unlawful touching or harm

MCH (mean corpuscular hemoglobin)

25.4-34.6 pg/cell* - is the average mass of hemoglobin per red blood cell in a sample of blood. It is reported as part of a standard complete blood count. MCH value is diminished in hypochromic anemias.

how often to change ostomy appliance

2x per week

pulse strength

3+ is full, bounding 2+ is normal 1+ is weak 0 is absent

how far up to insert enema tip

3-4"

how many inches up should enema tip be inserted?

3 - 4"

Glasgow Coma Scale (GCS)

3 = least responsive 15 = most responsive 8 or less = comatose a scoring system used to describe the level of consciousness in a person following a traumatic brain injury

HPV vaccine schedule

3 dose series. Given 0,1-2, and 6 months apart. Females can receive any of the available vaccines start at 11-12 years old. Males receive Gardasil or Gardasil 9 only, usually between 13-21 years old. Duration of protection and need for booster are unknown.

3 point crutch gait

3 point: this gait pattern is used when one side lower extremity (LE) is unable to bear weight (due to fracture, amputation, joint replacement etc).

FACES pain scale

3 years and older good for ppl who do not speak the language

durable power of attorney for health care

A type of advance directive executed by a competent adult that appoints another individual to make medical treatment decisions on his or her behalf in the event that the person making the appointment loses decision-making capacity. a power of attorney names the person who can make financial or health care decisions for you if you are incapacitated.

Albumin

3.5 - 5 protein in blood; maintains the proper amount of water in the blood

Adult CPR

30:2 compression rate of 100-120 2" deep compression

CPR adult repititions

30:2 After every 30 chest compressions, give 2 rescue breaths. Tilt the casualty's head gently and lift the chin up with 2 fingers. Pinch the person's nose. Seal your mouth over their mouth, and blow steadily and firmly into their mouth for about 1 second. Check that their chest rises. Give 2 rescue breaths.

retinal detachment s/s

Flashes of light SHADE DRAWN - a shadow with curtain across the vision

Plagiocephaly

Flattening or asymmetry of the head baby wears helmet

McRoberts maneuver

Flexing the woman's knees toward her shoulders. Assists with shoulder dystocia

Bowlby's theory of grief

4 stages 1. Numbing-being in a state of shock, lasts 1-2 weeks 2. Yearning and searching-phy and psy distress, seeking the lost person/object, lasts 2 wks-3 months 3. Disorganization and despair-manifestation of depression and social withdrawal, anger, retells story over and over, lasts 3-6 months 4. Reorganization-person gradually increases their level of functioning, accepts change, acquires new skills, builds new relationships, lasts 6 months-1 year

Acetaminophen (Tylenol) 24 hour limit

4,000 gram

SIADH treatment

Fluid restriction Oral salt tablets hypertonic saline IV (3%) vasopressin receptor antagonists strict I&Os daily weights

cohort study

Following a subset of a population over a lifetime

Long acting insulin

Glargine (Lantus)

U waves represent

HYPOKALEMIA repolarization of the purkinje fibers

spinal anesthesia side effects

HYPOTENSION HA bradycardia/asystole high spinal, nausea, urinary retention, backache, hypoventilation/dyspnea (loss of proprioception), transient neurologic syndromes, cauda equinal, epidural hematoma

DM 2 amt of carbs should be?

45-60% of daily calories

Kohlberg's stages of moral development

6 identifiable developmental stages of moral reasoning which form the basis of ethical behavior, the pre-conventional (level 1) contains the first stage (obedience and punishment orientation and 2nd stage (self-interest orientation), the conventional (level 2) contains the 3rd stage (interpersonal accord and conformity) and 4th stage (authority and social-order maintaining orientation) the post-conventional (level 3) contains the 5th stage (social contract orientation) and 6th stage (universal ethical principles)

Place cane about ____ inches in front of the foot and slightly to the outside

6-10" in front of and to the side of the foot

serum proteins

6-8 proteins present in serum that are indicators of the body's visceral protein status (e.g., albumin, prealbumin, transferrin)

Adolescent normal heart rate

60-100

When does the umbilical cord fall off?

7-14 days after birth

preschooler normal pulse

80-110

toddler normal pulse

80-130

Amount of amniotic fluid

800-1200ml

pincer grasp age

9 months

BNP (brain natriuretic peptide)

<100 pg/mL or ng/L desired >100 positive >400 severe HF -BNP is ordered to help determine HEART FAILURE & is a more sensitive test than ANP. It is a neurohormone secreted primarily by cardiac ventricles and increases in response to volume expansion and pressure overload.

Triglycerides

<150 mg/dL

infants apnea - normal level

<20 seconds

hip dysplasia treatment

<6 months = *Pavlik harness* provides for longer term positioning​ spica cast - for a toddler, reduction of hip Surgical intervention may be needed

lithium toxicity s/s

>1.5 vomiting, diarrhea, drowsiness, muscular weakness, ataxia Side FX: dizziness, HA, impaired vision, fine had tremor, reversible leukocytosis

HDL cholesterol

>40 mg/dL

5 year old gross motor skills

>>Jumps rope ››Walks backward with heel to toe ›› Throws and catches a ball with ease

rheumatic fever

A bacterial infection that can be carried in the blood to the joints streptococcal throat infection previously

greater trochanter

A bony prominence on the proximal lateral side of the thigh, just below the hip joint.

Tetrology of Fallot (TOF)

A cardiac anomaly that consists of four defects; 1. ventricular septal defect 2. pulmonary stenosis 3. right ventricular hypertrophy 4. overriding aorta.

peripheral artery disease

A circulatory condition in which narrowed blood vessels reduce blood flow to the limbs. skin on legs is shiny, hairless (due to lack of bloodflow), thickened toenails cool extremities, poor pulses intermittent claudication - resolves when walking

Vaginal hematoma

A client that just delivered a term infant reports persistent, severe vaginal pain & a feeling of fullness. What does the nurse suspect?

NG tube - when to call your doctor

A tube that is dislodged from the nose Coughing or trouble breathing Clogged tube Dizziness or lightheadedness Vomiting Fever above 101.5°F (38.5°C) Diarrhea that lasts more than 2 days

Lugol's solution (iodine)

A common test to detect the presence of starch. It turns blue-black in the presence of starch take with OJ/citrus juice to reduce bitter taste

Kwashiorkor

A disease of chronic malnutrition during childhood, in which a protein deficiency makes the child more vulnerable to other diseases, such as measles, diarrhea, and influenza.

functional disorder

A disorder in which there is no known physiologic reason for the abnormal functioning of an organ or organ system. IT DOESN'T MEAN THE PERSON IS CRAZY - JUST THAT THEY CANNOT DETERMINE THE CAUSE - LIKE MIGRAINES and EPILEPSY

living will

A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes. (pt has determined these desires ahead of time and medical staff carries them out)

nasogastric tube

A feeding tube that is inserted into the nose and goes to the stomach.

Crepitus

A grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sound or crinkly feeling. could hear from pneumothorax

Malignant hyperthermia

A hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs. *watch pt for high fever & muscle stiffness*

Hemophilia

A hereditary disease where blood does not coagulate to stop bleeding

placenta abruptio

A life-threatening emergency placenta peels away from the wall of the uterus CAUSES MASSIVE BLEEDING - DARK RED PAIN!

What is sickle cell anemia?

A mutation in a gene causes a problem making the hemoglobin of the red blood cells., A genetic disorder causing red blood cells to be rod/sickle shaped. This causes them to get stuck in capillaries and the bodies cells become deprived of oxygen pain results from decreased hemoglobin which occludes blood flow and hence causes tissue ischemia and pain

heel to shin test

A neurologic test assessing lower limb coordination and position sense.

ECT therapy

A patient gets anesthetic and electrodes put on their head. They produce a fit for one minute, and remember nothing of the procedure.

temporal lobe

A region of the cerebral cortex responsible for hearing and language.

Stevens-Johnson Syndrome

A severe, possibly fatal reaction that mimics a burn; may be due to a medication.

Chlamydia

A sexually transmitted disease, the most common in developed countries, caused by the bacterium Chlamydia trachomatis. Often producing no symptoms, it can cause infertility, chronic pain, or a tubal pregnancy if left untreated.

Bile

A substance produced by the liver that breaks up fat particles.

thrombus vs embolus

A thrombus is a blood clot that forms in a vein. An embolus is anything that moves through the blood vessels until it reaches a vessel that is too small to let it pass (think embolus - energy, travels)

clinical manifestations of pulmonary embolism

Sudden onset of pleuritic chest pain, dyspnea, tachypnea, tachycardia, and unexplained anxiety

risk factors for esophageal cancer

ABCDEF: Alcohol, Achalasia Barrett's esophagus Cigarettes Diverticula Esophageal webs, Esophagitis Familial nitro-containing foods (hotdogs, smoked meats( Obesity

jaundice in a newborn in the first 24 hours

ABNORMAL

Meds that are contraindicated in OB

ACE/ARBs (for HTN) docycline isotretinoin statins! warfarin **thyroid meds and insulin are okay**

Tasks for a UAP

ADLs Ambulating Feeding Positioning VS on stable clients I&O

UAP can do what?

ADLs, hygiene, routine vitals, documenting I&Os, positioning, perineal cleaning with catheter

Nursing Process

ADPIE Assessment Diagnosis Planning Implementation Evaluation

Budesonide for Crohn's

Entocort EC decreases inflammation

Yellow tag

Major injury & should be given attention within 30 minutes to 2 hours.

cervical cancer

Malignant cell growth in the cervix; can be caused by HPV virus

epoetin alfa

Epogen, Procrit helps your body make more red blood cells. Used to treat anemia caused by chronic kidney disease, cancer chemotherapy, or HIV-therapy. It may also be used before surgery if you have anemia.

Pericarditis treatment

Analgesics, antibiotics if bacterial, steroids, high fowler's leaning forward or tripod position monitor for signs of cardiac tamponade

Heparin monitor

PTT remember Heparin+PTT = HARRY POTTER

NSAIDS can exacerbate

ASTHMA symptoms. Tylenol is better

Endometrial cancer signs and symptoms

Abnormal, but painless bleeding between cycles Bleeding in post-menopause HIGH RISK - family hx, polycystic ovary syndrome, infertility, late menopause, early menarche, obesity, use of Tamoxifen use

Leukocytosis

Abnormally high WBC count

Respiratory Therapist (RT)

Administers "breathing treatments" and assists with managing a patient's airway swallowing

Fluticasone/Salmeterol

Advair used for prevention and long term control of asthma after inhalation rinse mouth with water and spit out avoid smoking/tobacco products receive flu vaccine & pneumococcal vaccine usually used 2x daily **is not a rescue inhaler & does not treat exacerbations of asthma**

Left hemisphere stroke

Affects LANGUAGE, mathematic skills, & analytic thinking --Anxiety concerning the future --Feelings of guilt --Expressive aphasia --Agnosia, Alexia (reading difficulty), agraphia (writing difficulty) --depression, anger, & quickly frustrated

RIGHT hemisphere stroke

Affects visual and spatial awareness and proprioception (sense of our body's position) --Impulsive behavior --one-sided neglect syndrome --loss of depth perception --poor judgement --left hemiplegia or hemiparesis --visual changes

BPH (benign prostatic hyperplasia)

Age-associated prostate gland enlargement that can cause urination difficulty.

BPH treatment

Alpha-adrenergic antagonists: terazosin, doxazosin 5-alpha reductase inhibitors: finasteride, dutasteride Transurethral prostatectomy Open prostatectomy

Donezepil (Aricept)

Alzheimer's admin at nightime SEs - n/v/d weight loss frequent urination muscle cramps difficulty controlling urination

Residual Volume (RV)

Amount of air remaining in the lungs after a forced exhalation

Certified Nurse-Midwife (CNM)

An APRN who is also educated in midwifery and is certified by the American College of Nurse-Midwifes highest level of midwife

arteriovenous fistula

An abnormal communication between an artery and a vein. It can also be created surgically to provide access for hemodialysis. problem - skin pallor, skin hardens, ischemia, numbness, tingling

Peptic Ulcer Disease

An abrasion or erosion of the stomach or small intestine.

EEG (electroencephalogram)

An amplified recording of the waves of electrical activity that sweep across the brain's surface. These waves are measured by electrodes placed on the scalp.

Rh immune globulin (RhoGAM)

An anti-Rh (D) gamma globulin given after delivery to an Rh-negative mother of an Rh-positive fetus or child. Prevents the development of permanent active immunity to the Rh antigen.

paradoxical blood pressure

An exaggerated decrease in systolic pressure by more than 10 mm Hg during the inspiratory phase of the respiratory cycle. Normal value is 3 - 10 mm Hg

Hypoglycemia S/S

An irregular or fast heartbeat. Fatigue. Pale skin. Shakiness. Anxiety. Sweating. Hunger. Irritability.

Amiodarone (Cordarone)

Antidysrhythmic agent. Prolongs repolarization, relaxes smooth muscles, decreases vascular resistance. Incompatible with heparin monitor for respiratory complications. no grapefruit juice!

Gemfibrozil (Lopid)

Antihyperlipidemic monitor liver function of pt

Sumatriptan (Imitrex)

Antimigraine **do not take if hx of HTN**

Clopidogrel (Plavix)

Antiplatelet

Sucralfate

Antiulcer Agent forms a gel-like substance that coats ulcers and protects

RN CANNOT Delegate the Following Tasks:

Any part of the NURSING PROCESS: -Assessments that identify needs and problems which diagnose human responses. -Any provision of teaching, health counseling, or referrals to other healthcare providers. -tasks that require nursing judgment **LPN can REINFORCE teaching but the RN does the initial teaching**

NSAIDs contraindications and cautions

Asthma Cardiovascular disease Renal disease Coagulopathies Peptic ulcer Ulcerative colitis Hypovolemic + ACE inhibitors, angiotensin receptor blockers Cardiovascular thrombotic events Myocardial infarction Stroke GI events

ovarian cancer symptoms

Asymptomatic until advanced Abdominal swelling and discomfort (abdominal girth due to bloating) Pelvic pain and possible leg pain Urinary frequency Vague pain, bloating, nausea, anorexia, heartburn

Hydroxyzine

Atarax, Vistaril is used in adults and children to relieve itching caused by allergic skin reactions. also used alone or with other medications in adults and children to relieve anxiety and tension, sedative before surgery AE - dry mouth IT'S AN ANTICHOLINERGIC

Pneumothorax manifestations

Atelectasis, ipsilateral chest pain, dyspnea, tachypnea, tachycardia, hypoxemia. Mediastinal off center

Anticholinergics

Atropine GI - Slows motility, spasm Eyes - Dilates pupils *DO NOT GIVE TO GLAUCOMA PTS* Heart - Increase HR Resp - bronchodilator (Atrovent)

normal weights for toddlers

Average weight for a 30-month-old is 28 - 30 lbs

Hepatitis A in children

Avoid aspirin & ibuprofen meds (avoid meds that inhibit platelet aggregation) no IM injections, SC only avoid contact sports dental hygiene Regular diet is fine!! Dehydration is not an issue!

Allopurinol (Zyloprim)

Anti-gout med Inhibits uric acid production Can cause hypersensitivity reaction, renal injury, hepatitis, N/V Slows metabolism of warfarin **take with a full glass of water** ADVERSE EFFECTS - Numbness/tingling of arms/legs, easy bleeding/bruising, unusual tiredness, signs of kidney problems (such as change in the amount of urine, painful/bloody urination), yellowing eyes/skin, severe stomach/abdominal pain, persistent nausea/vomiting, dark urine, unusual weight loss, eye pain, vision changes.

Cromolyn sodium (Intal)

Anti-inflammatory (mast cell stabilizer) Inhibits release of histamine Used for chronic asthma, allergic rhinitis Safest of all asthma meds **it is given prophylactically to prevent asthma attacks not stop them***

Lorazepam (Ativan)

Antianxiety agent. Increase the efficacy of GABA to reduce anxiety. Used for generalized anxiety disorder and panic disorder, insomnia, ALCOHOL WITHDRAWAL induction of anesthesia. Side effects: CNS depression, paradoxical response (insomnia, excitation, euphoria), withdrawal symptoms, risk of abuse and potential for overdose.

Atropine

Anticholinergic

Metformin (Glucophage)

Antidiabetic - Biguanide

cultures that do not like eye contact

Arabic Native American Indian Asian

cultures who do not like eye contact

Arabs Asians Native Americans

Assault vs. Battery

Assault = placing a person in fear or immediate bodily harm Battery = unlawfully touching a person

paternalism

Assuming the right to make decisions for another

5th disease (erythema infectiosum)

Erythrovirus (parvovirus) 19 - slapped cheek disease viral disease children typically recover in 7-10 days communicable only until onset of rash appears

Saw Palmetto uses

BPH - urinary symptoms promoted as a dietary supplement for urinary symptoms associated with an enlarged prostate gland as well as for chronic pelvic pain, migraine, hair loss, and other conditions.

Late decelerations

Bad (placental insufficiency) If a fetal heart rate is showing late decelerations do LION. - L: Lay the mother on her Left side - I: Increase IV fluids - O: Apply oxygen - N: Notify physician

The Romberg test is used to assess:

Balance and coordination **drunk driving test**

lumbar puncture post care

Bed rest - supine position minimum of 2 hrs. pain meds admin Encourage fluids. Observe site. Assess VS. report parenthesis

iron supplement for children

BETWEEN meals (not with food) with Vitamin C - OJ take on an empty stomach DO NOT TAKE WITH MILK antacids - do not take for 2 hours post-iron supplement

TPN concerns

BG level monitor for hypoglycemia!!!!! esp if client mentions nauseau, thirst, discomfort

key point about ibuprofen!

BLOOD CLOTTING

early signs of glaucoma

BLURRED VISION increased IOP

Lithium toxicity symptoms

BLURRED VISION A PRIORITY! drowsiness, slurred speech, coarse tremors, muscle spasms, blurred vision, diarrhea, stupor, coma, convulsions, death

Complete Metabolic Panel (CMP)

BMP + Proteins (Albumin and total protein) Liver tests (ALP, ALT, AST, Bilirubin)

Furosemide (Lasix) assessments prior to admin

BP BUN potassium level

Older Adults-- BP changes?

BP increases

Culture

Beliefs, customs, and traditions of a specific group of people.

retroperitoneal bleeding

Bleeding into the abdominal cavity behind the peritoneum can occur due to femoral artery puncture (after an angiography)

Universal Precautions (UP)

Blood and certain body fluids of ALL individuals were considered potentially infectious. Required part of infection control plan

Mongolian spots

Blue-ish black macules appearing over the buttocks and/or thighs of darker skinned neonates

macular degeneration s/s

Blurry vision Loss of central vision Blindness

carbidopa levadopa

Brand Name: Sinemet* Use: Movement disorders; Parkinsons decreases muscle rigidity

BUBBLEHE assessment

Breast Uterus Bladder Bowel Lochia Episiotomy Homan's sign/Hemorrhoids Emotion

pursed lip breathing

Breathe in for 2 seconds through your nose, keeping your mouth closed. Breathe out for 4 seconds through pursed lips. relax neck & shoulder muscles

Terbutaline

Brethine Terbutaline is in a class of drugs called betamimetics. They help prevent and slow contractions of the uterus. It may help delay birth for several hours or days.

Albuterol

Bronchodilator temp relief of asthma

Warning signs of cancer (CAUTION)

C- change in bowel habits A- A sore that does not heal U- unusual bleeding or discharge T- thickening or lump in breast or elsewhere I- indigestion or difficulty swallowing O- obvious change in wart or mole N-nagging cough or hoarseness

Oxytocin infusion can lead to

C-section fetal distress

Cocaine intoxication

Impaired judgment, increased mental alertness, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death. Treatment: α-blockers, benzodiazepines. β-blockers not recommended.

cervical vertebrae

C1-C7; first set of seven bones, forming the neck cervical injuries- place in supine position - NO PILLOW

cold cap

Cap that causes vasoconstriction worn to minimize hair loss in a client undergoing chemotherapy

bioterrorism agents

Category A = highest priority; threat to national security - easily transmittable; smallpox, anthrax, viral fevers (ebola) Category B = 2nd highest priority; moderately easy to disseminate; include typhus fever, ricin, diarrheagenic E coli, West Nile Category C = 3rd highest; emerging pathogens

Chvostek's sign

Cheek, facial spasm when Cheek is tapped associates with hypocalcemia

Pneumothorax (PTX)

Collapsed lung due to trauma or a spontaneous small rupture of the lung

sputum sample

Collect sputum before breakfast --Have been laying down all night Patient should take a deep breath and expel air with a deep cough Expectorate into a sterile container

enzymes AST/ALT

Common causes of elevated ALT and AST are viral liver infections, alcohol abuse, cirrhosis (from any chronic causes) hepatotoxicity

purulent

Containing pus or an infection that is producing pus

CLAS standards

Culturally and Linguistically Appropriate Services

Hyperkalemia causes

M.A.C.H.I.N.E. M - Medications - ACE inhibitors, NSAIDS A - Acidosis - Metabolic and respiratory C - Cellular destruction - Burns, traumatic injury H - Hypoaldosteronism, hemolysis I - Intake - Excesssive N - Nephrons, renal failure E - Excretion - Impaired

Hydrocortisone

Corticosteroid used to treat inflammatory bowel disease, enemas, foam, or suppositories Take in the morning, around half an hour before breakfast Hydrocortisone replacement therapy is usually taken twice or three times a day. It can be taken on an empty stomach or with food.

Hyperkalemia S/S

M.U.R.D.E.R. M - Muscle weakness U - Urine, oliguria, anuria R- Respiratory distress D - Decreased cardiac contractility E - ECG changes R - Reflexes, hyperreflexia, or areflexia (flaccid)

Morphine side effects: MORPHINES

M: myosis (contraction of the pupil) O: orthostatic hypotension R: respiratory depression P: pneumonia (aspiration) H: hypotension I: infrequent waste release (constipation URINARY RETENTION) N: nausea E: emesis S: sedation

Live vaccines

MMR and varicella

Vancomycin

MRSA infection antibiotic

Staphylococcus aureus

MRSA, Toxic Shock Syndrome, Food poisoning

Flat Neck Veins: What can it mean?

DEHYDRATION! or Hemothorax, shock

sepsis

Dangerous infection of the blood a bloodstream infection

malignant hyperthermia treatment

Dantrolene *TAKE ACTION IMMEDIATELY*

oliguria

Decreased urine output

Hydrocortizone

Decreases inflammation by suppressing the immune systems response; binds with intracellular corticosteroid receptors *notify provider of any illness or stress *do not discontinue abruptly *report weakness or dizziness

Kussmaul respirations

Deep, rapid breathing; usually the result of an accumulation of certain acids when insulin is not available in the body.

Pulse Pressure (PP)

Difference between Systolic and diastolic pressure PP = SP - DP

Wheezing

Difficult breathing with a high-pitched whistling or sighing sound during expiration

Hepatitis A (acute)

Direct contact or by fecal-contaminated food or water

Schizophrenia (negative symptoms)

Disturbance of affect: expression of emotion Blunting: severe reduction in the intensity of affect expression Flat affect: no signs of emotional expression Inappropriate affect: (ex. schizophrenic starts laughing when talking about someone's death) Avolition: decreased engagement in purposeful, goal-directed actions

beneficience

Doing good or causing good to be done; kindly action

Lambskin condoms

Don't protect against STDs do not protect against HIV infection

respiratory acidosis s/s

Drowsiness Disorientation Dizziness Headache Coma ↓BP V-Fib Hyperkalemia Rapid/Irregular HR Warm, flushed skin Seizures Hypoventilation Hypoxia Cyanosis

Respiratory Alkalosis S/S

EXCITED -vasoconstriction -HA -vertigo -Carpal pedal spasm -Tetany -Parasthesias, tingling -Tinnitus

Kawasaki disease

Early stages include a rash and fever. Symptoms include high fever and peeling skin. In late stages, there may be inflammation of medium size blood vessels (vasculitis). It also affects lymph nodes, skin, and mucous membranes, such as inside the mouth. People may experience: Pain areas: in the abdomen or joints Gastrointestinal: diarrhea or vomiting Whole body: fever or high fever Skin: peeling or red rashes Also common: pink eye, enlarged neck lymph nodes, fast heart rate, irritability, red palms, swollen and bumpy tongue that's red, or swollen feet

Opioid withdrawal symptoms

Excessive sweating, restlessness, and dilated pupils Agitation, goose bumps, tremor, and violent yawning Increased heart rate and blood pressure Nausea/vomiting and abdominal cramps and pain Muscle spasms and weight loss

Guaifenesin

Expectorant—thins respiratory secretions; does not suppress cough reflex.

Piaget's sensorimotor stage

Experiencing the world through sensrors and actions (looking touching mouthing and grasping) Age 0 - 2

Secondary intention healing

Extensive tissue loss Edges cannot be approximated Repair time is longer Scarring is greater Susceptibility to infection is greater

teletherapy radiation

External Beam RT Most common form of radiation. There is a defined outlined precise target area. They make a mold to shield and protect the surrounding areas. *protect skin from sun exposure during & after therapy *wear loose clothing *cleanse skin daily with warm water and mild soap *avoid cold packs and heating pads (heat extremes) *use only creams/lotions approved by HCP

what happens during a thyroid storm?

FEVER! a rapid heartbeat. a high temperature. diarrhea and being sick. yellowing of the skin and eyes (jaundice) severe agitation and confusion. loss of consciousness.

FAST

Face drooping Arm weakness Speech difficulty Time to call 911

Malpractice

Failure by a health professional to meet accepted standards

Piagets pre-operational stage is characterized by?

Fantasy oriented Illogical No rules

Vaginal hematomas are associated with what?

Forceps assisted birth, episiotomy, primigravidity.

S/S BPH (Benign Prostatic Hyperplasia)

Frequency, decreased force of urinary stream, trouble starting to void, dribbling after urination, feeling like bladder not empty, decreased or interrupted urinary stream classic sign - long, thin stream of urine

Hyperglycemia S/S

Fruity-smelling breath. Nausea and vomiting. Shortness of breath. Dry mouth. Weakness. Confusion. Coma. Abdominal pain.

varicella vaccine contraindication - if you're allergic to

GELATIN!

Pancreatitis (acute)

Gallstones, EtOH

Clear liquid diet includes

Gelatin, popsicles, tea, ginger ale, fruit juice without pulp, bouillon, chicken broth, apple juice, water juice with pulp are prohibited.

how far up to insert an enema tip

Gently insert the tip of the nozzle into the anus, and continue inserting it 10 centimeters (3-4 inches) into the rectum. Slowly squeeze the liquid from the container until it is empty, then gently remove the nozzle from the rectum.

herbal supplements that increase bleeding

Gingko Biloba Garlic Ginseng Ginger Feverfew

15/15 rule of hypoglycemia

Give 15 grams of CHO q 15 mins until BG increases

Prednisone (Deltasone)

Glucocorticoid. Decrease inflammation by suppressing leukocytes and fibroblasts, and reversing capillary permeability. Provide symptomatic relief of inflammation and pain. Precautions/interactions: contraindicated in systemic fungal infection, do not administer live virus vaccines during therapy, should only be used for a short duration. Side effects: risk of infection, osteoporosis, adrenal suppression, fluid retention, GI discomfort, hyperglycemia, hypokalemia. **expect insulin dosage to increase**jaim

Vancomycin used for

Gram Positive, MSRA, C- diff

Exopthalmos (proptosis) nursing care

Graves disease tape eyelids shut if needed artificial tears raise HOB 90 degrees to decrease pressure

Gravida/Para/Abortion

Gravida = The total number of times the patient has been pregnant Para = The number of live births (VIABLE) the patient has had (past 20 weeks gestation) Abortion= The total number of miscarriages or elective abortions

endometriosis

Growth of endometrial tissue outside of uterus

HELLP syndrome stands for

H- hemolysis EL- elevated liver enzymes LP- low platelets **RUQ PAIN ALSO** IT IS A SEVERE FORM OF PRE-ECLAMPSIA EMERGENCY

Cystic Fibrosis diet

HIGH calorie, HIGH protein ,HIGH fat + fat vitamin - need higher abx dose - regular exercise - give 3 meals + snacks, pancreatic enzymes given within 30 min, increase dose if high calorie, watch 1-2 stools/day for effectiveness, can sprinkle on food - tend to have pulm infection

bacterial meningitis nursing care

HOB 30 degrees isolation for 1st 24 hours implement seizure precautions maintain hydration & airway

High Fowler's Position

HOB 90 degrees

Fowler's position

HOB raised between 45 and 60 degrees

Semi-Fowler's Position

HOB raised to 30 degrees or HOB raised 30 degrees and the knee portion is raised 15 degrees

Variable decelerations

HR up or down, cord compression = VERY BAD Prolapsed cord= push head up, change mom position

Before Dialysis what meds to hold

HTN and water soluble vitamins like B's and folic acid. Remember they become hypotension that's why no HTN (lowpressor,beta blockers) drugs before..

Graves disease

HYPERTHYROIDISM autoimmune disorder characterized by goiter and/or exophthalmos (bulging eyes)

Propranolol Side effects/adverse reactions

Hallucinations. Cold hands or feet. Muscle weakness. Muscle cramps. Shortness of breath. Memory loss. Fluid retention. Blood sugar changes.

Rule of 9's for burns

Head = 9% 2 Arms = 18% 1 arm = 9% Back = 18%, Front/chest 18% Legs 36% (18% each) Genitalia = 1

dilated pupils

Head injury, shock, heat stroke, hemorrhage, and/or intake of a stimulant drug

INR

Healthy people INR < 1.1 or below is considered normal. On warfarin - INR range of 2.0 to 3.0 is generally an effective therapeutic range for people taking warfarin for disorders such as atrial fibrillation or a blood clot in the leg or lung.

S3 (ventricular gallop)

Heart sound: Early diastolic sound from vibrations produced when ventricles fill rapidly; comes shortly after S2; best heard at apex with pt in left lateral position; indicates heart failure from volume overload or high CO; can be from anemia, hyperthyroidism, and pregnancy; sounds like "Kentucky"

PPI (proton pump inhibitor)

Help to prevent production of acid in the stomach *omeprazole (Prilosec) *pentoprazole (Protonix) *lansoprazole (Prevacid) *esomeprazol (Nexium) take prior to meals sit upright for 30 minutes post taking the med GET BONE DENSITY TEST REGULARLY higher risk of C-diff

TPN (total parenteral nutrition)

Highly concentrated, hypertonic solution provides calories, electrolytes, fluids & nutrients Central venous access device required you have to have a central line not a peripheral line it would burn the tissue* also you will use a filter insulin also given typically because serum glucose of this solution can be high monitor electrolytes daily weights FSBS should be assessed in 1st hour after infusion then 4-6 hours thereafter @ least 4x daily **MEDS MAY BE INFUSED INTO THE SOLUTION or given via IV**

needle lumen

Hollow tube of needle which has a hollow lumen through which medication passes

Hypermagnesemia S/S

Hypotension Bradycardia *Weak pulse* *Sweating* and flushing *Respiratory depression* Loss of deep tension reflexes Prolonged PR interval and widened QRS complex

NSAIDs meds

IBUPROFEN NAPROXEN Indomethacin Celecoxib Ketorolac

lumbar puncture contraindicated with

ICP

Newborn vitamin K injection

IM injection in thigh I mg

Widened pulse pressure is associated with

INCREASED INTRACRANIAL PRESSURE (ICP) or aortic insufficiency, fever, anemia, or complete heart block.

Coumadin (warfarin) - monitor?

INR international normalized ratio

pregnant women should increase

IRON

Kawasaki disease treatment

IV ImmunoGlobulin therapy high-dose aspirin **WATCH FOR FEVER** SKIN WILL PEEL - THAT IS NORMAL IT IS NOT SJ

infiltration

IV fluid leaks into surrounding tissue it is a fluid that does NOTirritate the tissue

respondent superior doctrine

If an agent hurts someone in the course and scope of doing their job, both the principal and agent have liability for it

Left lateral trendelenburg

If you suspect your patient has an air embolus, how do you position them?

innate immunity

Immunity that is present before exposure and effective from birth. Responds to a broad range of pathogens.

POAG (primary open-angle glaucoma)

Increased IOP with optic disc/vision changes OR optic disc/vision changes gradual loss of peripheral vision

Babinski reflex

Infant reflex where if its foot is stroked, the baby's toes fan out

phlebitis

Inflammation of a vein as a result of repeated venipuncture on that vein

Insulin Aspart (Novolog)

Insulin - Rapid Acting make sure meal tray is there right away

Tracheostomy care procedure

Involves cleaning the inner cannula, suctioning, and applying clean dressings

1st degree burn (superficial)

Involves outer layer of skin and produces redness, increased warmth, tenderness, and mild pain -immerse in cool water until pain is relieved -flush chemical burns for at least 20 min - cover with clean or sterile dressing

metacarpophalangeal joint

Is the KNUCKLE between the hand and the finger

In vaso-occlusive crisis

Ischemia and pain caused by sickle-shaped red blood cells that obstruct blood flow to a portion of the body. visual disturbance, hematuria, painful swelling extremities, fever, tachy, PAIN

Tension pneumothorax S/S

JVD diminished/ABSENT lung sounds tracheal deviation towards unaffected side poor BVM compliance

Cardiac Tamponade s/s

JVD, narrow pulse pressure, hypotension ( Becks Triad)

storing insulin

Keep opened vials at room temp Discard opened vials after 1 month Refrigerate UNOPENED vials not in use between 34-36F Expiration date applies to unopened, refrigerated insulin Durable pens and dosing devices should not be refrigerated once in use Do not shake insulin; roll gently in palm of hand to warm and resuspend

ectopic pregnancy rupture

L shoulder (Kehr's sign)

Left sided heart failure symptoms

L= LUNGS - SYMPTOMS EFFECTING LUNGS pulmonary edema, coughing, shortness of breath, and dyspnea

basilic vein

LARGE VEIN ON THE INNER SIDE OF THE UPPER ARM (SMALL FINGER SIDE)

key difference between RN & LPN

LPN can care for clients whose condition is considered to be stable or chronic with an expected outcome

FTT Signs and Symptoms

Lack of appropriate weight gain. Irritability. Easily fatigued. Excessive sleepiness. Lack of age-appropriate social response (i.e., smile) Does not make vocal sounds. Delayed motor development. lack of eye contact Learning and behavior difficulties later in childhood.

1st stage of labor

Last 12.5 hours Latent phase:0-3cm active phase:4-7cm transition:8-10cm

4 point crutch gait

Left crutch followed by right foot, right crutch followed by left foot. Everything moves separate NOT TOGETHER!

PPN (peripheral parenteral nutrition)

Less concentrated Short term Given in a PERIPHERAL IV nothing can be mixed with it, it has its own port and controlled with a pump tubing and bag is discarded every 24 hours

lithium & NSAIDS

Li level will increase with inhibition of prostaglandins (ie. aspirin, tylenol) DO NOT TAKE IBUPROFEN OR NSAIDS WITH LITHIUM

RED tag

Life-threatening & requires immediate attention

Hepatitis B Virus (HBV)

Liver infection caused by the hepatitis B virus that is transmitted by blood, semen, or another body fluid from an infected person

CKD diet

Low protein Low sodium Low Potassium Low phosphate

Hypomagnesemia causes

Malnutrition Diarrhea *Celiac's disease* Crohn's disease *Alcoholism* Prolonged gastric suctioning *Ileostomy, colostomy, or intestinal fistulas* Acute pancreatitis Diabetic ketoacidosis (metabolic acidosis) *Eclampsia* Chemotherapy *Sepsis*

rheumatoid arthritis interventions

Medications: leflunomide (Arava) etanercept (Enbrel) Prednisone NSAIDs Rest during acute attacks, warm, moist packs, warm baths/whirlpools, paraffin baths, physical therapy, teach - more susceptible to false cures -can use ice at times

amnion

Membrane that encloses the embryo in protective amniotic fluid

cold application

Minimizes swelling and reduces bleeding by constricting the blood vessels. Should never be done directly to the skin as it will cause cell damage. Should never be done for more than 20 minutes as damage may occur. NOT ON OPEN WOUNDS - TISSUE DAMAGE

PPIs (proton pump inhibitors)

Most effective class of drugs in inhibiting acid secretion ie omeprazole, meds ending in "prazole" or zole

4th stage of labor

Mother's recovery after birth of baby and placenta

rooting reflex response

Movement of the tongue, mouth and/or head toward the stimulus

Baclofen

Muscle Relaxant can use in children

Vercuronium (Norcuron)

Muscle relaxation during intubation and general anesthesia used to improve client/ventilator synchronization & to increase oxygenation

Hypercalcemia S/S

Muscle weakness Constipation Anorexia N/V Polyuria Polydipsia Neurosis Dysrhythmias

how to draw up NPH and Regular insulin

N R R N clean both vial tops inject air into NPH insulin inject air into Regular insulin draw up Regular insulin draw up NPH insulin cloudy, clear, clear, cloudy

placenta previa s/s

NO PAIN but BLEEDING! - BRIGHT RED BLEEDING

tonsillectomy post care

NO STRAWS!!!!

pregnant women & alcohol

NO amount of alcohol has been determined safe Potential adverse consequences of alcohol use to fetus are well known

Home oxygen therapy guidelines

NO wool! no Vaseline (water based lubricant only) no cooking with gas stove or open flame DO NOT POLISH NAILS

DONUTS

NOT OKAY FOR SKIN INTEGRITY

naproxen

NSAID can reduce clotting like aspirin

asthma patients should not take

NSAIDS! take Tylenol

Concussion Signs and Symptoms

Nausea (feeling that you might vomit) Amnesia of the event HA Brief LOC Balance problems or dizziness Double or fuzzy vision Sensitivity to light or noise Nystagmus Headache Feeling sluggish Feeling foggy or groggy Concentration or memory problems (forgetting game plays) Confusion

Hyperthyroidism symptoms

Nervousness, weight loss despite increased appetite, excessive sweating and heat intolerance, palpitations, frequent bowel movements, muscular weakness of the proximal type and tremor

Normal RR in children

Newborn: 30-60 breaths per minute Infant (1 to 12 months): 30-60 breaths per minute Toddler (1-2 years): 24-40 breaths per minute Preschooler (3-5 years): 22-34 breaths per minute School-age child (6-12 years): 18-30 breaths per minute Adolescent (13-17 years): 12-20 breaths per minute

Normal HR

Newborns 0 to 1 month old: 70 to 180 beats per minute Infants 1 to 11 months old: 80 to 160 beats per minute Children 1 to 2 years old: 80 to 130 beats per minute Children 3 to 4 years old: 80 to 120 beats per minute Children 5 to 6 years old: 75 to 115 beats per minute Children 7 to 9 years old: 70 to 110 beats per minute Children 10 years and older, and adults (including seniors): 60 to 100 beats per minute Well-trained athletes: 40 to 60 beats per minute

Newborn bathing - general

Newborns should only be bathed 1-2x/week. Bathing your baby more than this can dry out his or her skin Do not place in water for a bath until the umbilical cord has fallen off. Give your baby a sponge bath using a soft wash cloth and gentle soap until the umbilical cord has fallen off

Jehovah's Witness

No blood products should be used including FFP, platelet transfusion

The RN CANNOT DELEGATE

Nursing Process Client teaching (LPN can REINFORCE pt teaching only) Tasks that require nursing judgment (including care of unstable client)

without time for crossmatch-what type of blood for transfusion?

O negative think O no!

Cushing's syndrome symptoms

Obesity, wasted extremities, buffalo hump, acne, hirsutism, amenorrhea, proximal muscle weakness, striae, HTN

sickle cell anemia nursing interventions

Observe for pallor, fatigue, lethargy, irritability Encourage diet high in calories, protein, fluids Prevent infection, hand washing, avoid infected people Administer immunizations, prophylactic antibiotics Administer blood products, watch for reaction Administer pharmacologic and nonpharmacologic pain relief Ensure compliance with preventative measures Help child family with coping measures Refer to support groups

Sepsis Checklist

Obtain Cultures Initiate broad spectrum Ab Lactate level Place central line Fluids: Albumin & NS Vasopressors Inotropes

Occupational Therapist (OT)

Occupational therapy helps people with an injury, illness, or disability learn or re-learn to do everyday activities. For adults, this could include activities like getting dressed, cooking, and driving. For children, this could include activities like learning or playing.

Absence seizures (petit mal)

Occurs during childhood, stares off with little to no tonic-clonic movement

Necrotizing Enterocolitis (NEC)

Occurs in premature and newborn infants. Thought to be infection and or ischemia of the gut. Findings: Dilated bowel loops.

Urge incontinence (overactive bladder)

Occurs when the bladder contracts randomly, causing a strong, sudden urge to urinate that is followed by urine leakage.

primary intention healing

Occurs where the tissue surfaces have been approximated, and there is minimal or no tissue loss **me - after surgery**

growth hormone replacement therapy

Option for children who are not growing according to accepted standards ∙ Start as soon as delays are noted and continue until bone growth stops, around age 14 in girls and 16 in boys ∙ Despite replacement therapy, child may still be shorter than their peers ∙ SubQ injections

how to use a fire extingusher

P - pull A - aim S - squeeze S - sweep

atrial contraction and ventricular filling

P-waves

placental abruption s/s

PAIN! NO Bleeding board-like/rigid abdomen Placental abruption is often painful. If you have placental abruption, you may need to deliver your baby early and may need a cesarean delivery.

where do we take the apical pulse

PMI It is located on the left side of the chest at the 5th intercostal space (ICS) at the midclavicular line.

how to measure warfarin

PT/INR

PTT

PTT measures how long the blood takes to clot (increased #=increase bleeding time) In PTT the TT looks like a H--so we use PTT as our test when using Heparin. Think Harry Potter - Heparin Protamine (sulfate) to remember the antidote. PTT normally ranges from 30-40 seconds Proper Teaching Time is 30 to 40 years old--this is how old your teachers are.

thyroid storm tx

PTU preferred 500-1,000 mg loading dose, then 250 mg PO Q4H --> ≥1 hr before iodide to block synthesis of thyroid hormone inorganic iodide therapy + BB (propranolol 40-80 mg PO Q6H + systemic Steroid (dexamethasone 2-4 mg PO Q6H + aggressive cooling w/ acetaminophen and cooling blankets and supportive treatments

Atrial paced rhythm

Pacer spike before P wave

PEG tube complications

Pain at the site Leakage of stomach contents around the tube site Dislodgement or malfunction of the tube Infection at the PEG site Aspiration ( Inhalation of gastric contents into the lungs) Bleeding and perforation ( An unwanted hole in the bowel wall)

McBurney's point

Pain in RLQ with appendicitis

breakthrough pain

Pain that occurs between doses of pain medication

Serosanguineous

Pale, red, watery: mixture of clear and red fluid

panic attack symptoms

Palpitations, perspiration tachycardia HBP chest pain, muscle tension urinary frequency hyperventilation/dyspnea nausea, feelings of choking, chills, hot flashes, and GI symptoms

Ropinirole (Requip)

Parkinson's disease SEs - dizziness, dry mouth, sweating

Psoriasis treatment

Phototherapy laser therapy topical meds

Prothrombin Time (PT)

Pills TakIN Regularly -PT and INR go together INR--I=normal is 1, but therapeutic ranges from 2 (NR, 2 letters after the I) to 3 (INR, 3 letters in total) Usually measured when on Coumadin / Warfarin Think Wiz Khalifa--Warfarin (vitamin) K to remember the antidote. test of ability of blood to clot normal PT time = 11-12.5 seconds

catheter embolus treatment

Place a tourniquet high on the extremity to limit venous flow. Prepare for removal under x-ray or via surgery. Save the catheter after removal to determine the cause.

walking down stairs with crutches

Place the AFFECTED leg and the crutches down on the step below. Support weight by leaning on the crutches and the stair rail. Bring the unaffected leg down. REMEMBER AFFECTED LEG GOES DOWN FIRST and the crutches move with the affected leg

18 month old milestones

Plays simple pretend Points to show others something interesting Says several single words Scribbles on his own Walks alone Drinks from a cup Eats with a spoon temper tantrums understands ownership ("mine") imitates others

Opportunistic infection in AIDS

Pneumocystis carinii pneumonia (PCP) Renamed: Pneumocystis jiroveci (Fungus)

respiratory acidosis causes

Primary Cause: Hypoventilation (causes hypercapnia); Contributing Causes: COPD, Pulmonary dz, Drugs, Obesity, Mechanical asphyxia, Sleep Apnea

respiratory alkalosis causes

Primary cause: Hyperventilation (causes hypocapnia); Contributing Causes: Overventilation on a ventilator, Response to acidosis, Bacteremia, Thyrotoxicosis, Fever, Hepatic failure, Response to hypoxia, Hysteria

Licorice root; primary use + potential interaction

Primary use: ulcers Potential interaction: avoid combinations with diuretics

droplet precautions require (2)

Private room, mask if needed for irrigation, etc. - gloves, gown, shield

chronic pancreatitis

Process of progressive fibrotic destruction of the pancreas RELATED TO CHRONIC ALCOHOL USE Risk factor for pancreatic cancer

Decannulation

Process of removing tracheostomy tube

hormone that PREVENTS miscarriage

Progesterone (think P - prevent, progesterone)

Fluoxetine

Prozac Common side effects include feeling sick (nausea), HA and trouble sleeping AE - blurred vision, HA, confusion, high fever, sweating

Mass casualty/disaster triage priority

RED YELLOW GREEN BLACK

acute cholecystitis pain location

RUQ pain radiates to right shoulder

Insulin Aspart (Novolog)

Rapid acting insulin Onset: 15-30 minutes Peak: 1-3 hours Duration: 3-5 hours

reaction to contrast media

Rapid blood loss Sudden change in body temp Intense pain Stress/anxiety Shock of seeing other trauma to family members or others PE or cardiac-related reason Sepsis (septic shock) Fluid loss related to burns, vomiting/diarrhea, or trauma

Frostbite treatment

Rapid rewarming with warm water (do NOT wait, or use too hot or dry heat) Do not massage area Elevate extremities after rewarming to promote blood flow Provide continuous warm water soaks Provide analgesia Keep wounds open - do not apply dressing!

A peak flow meter measures:

Rate of airflow during forced expiration used to help monitor asthma and adjust medication accordingly

Rhonchi

Rattling noise of mucous in the lungs. Heard on auscultation of lungs.

2nd degree burn

Red, shiny skin, blisters, severe pain

REEDA assessment for episiotomy

Redness Edema Ecchymosis Discharge Approximation

Hematoma treatment

Remove IV device and apply light pressure if bleeding monitor for signs of phlebitis and treat

ARDS treatment

Remove causative factors Administration of 100% oxygen Mechanical ventilation

Rh shot

Rh- negative mother who gives birth to an Rh+ child

SAD PERSONS

Risk factors for Suicide Sex (more male than female) Age (teens & age >45 yo) Depression Previous attempts Ethanol loss of Rational thinking Sickness Organized plan No social support Stated future intent

LPN scope of practice includes:

Routine patient care under the supervision of a RN or a physician. Assess/collect data monitoring client status Admin meds Evaluate pt response to interventions

Status epilepticus treatment

SE is a life threatening emergency in which a client has been seizing for 5+ minutes grunting & dazed appearance are 2 common signs MUST STOP SEIZURE ACTIVITY! admin a benzo via IV or rectally if needed

paracentesis (abdominocentesis) position

SEMI OR HIGH FOWLER'S OR UPRIGHT ON EDGE OF BED Empty bladder. post VS--report elevated temp. watch for hypovolemia

signs and symptoms of major depression

SIGECAPS for at least 2 weeks sleep - increase or decrease interest deficit guilt energy deficit concentration deficit appetite change (over or under eating) psychomotor agitation suicidal ideology

client with Graves # 1 concern is

SOB

Pt not breathing, pulseless, etc. - first action

START CHEST COMPRESSIONS!

nasogastric tubes

Salem-sump Levin

Hepatitis B signs and symptoms

Same as Hep A but more severe - Fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, jaundice

Where are scabies found?

Scabies can spread rapidly under crowded conditions where close body and skin contact is frequent. Institutions such as nursing homes, extended-care facilities, and prisons are often sites of scabies outbreaks.

Bishop score

Score for induction of labor Score of 6 to 8 = induction of labor will be successful the higher the score, the more successful labor induction will be

congenital hypothyroidism (cretinism)

Severe fetal hypothyroidism due to maternal hypothyroidism, thyroid agenesis baby will be - lethargic/difficult to waken dry skin hoarse cry bradycardia constipation

Brudzinski's sign

Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.

Diabetic Ketoacidosis (DKA)

Shortage of insulin resulting in hyperglycemia and production of ketones KUSSMAUL'S RESPIRATIONS 3 Ps blurred vision fruity breath odor decreased LOC orthostatic HTN 1. Assess for dehydration FIRST!!!

Effacement is?

Shortening and thinning of the cervix (0-100%)

2 year old milestones

Shows defiant behavior Says sentences with 2-4 words 300 word vocabulary Follows two step instructions Stands on tiptoes kicks a ball climbs up and down from furniture Throws ball overhand runs without falling begins parallel play walks up/down steps one at a time

Tetrology of Fallot (TOF) clinical manifestations

Signs and symptoms may include: -A bluish coloration of the skin caused by low blood oxygen levels (cyanosis) -SOB, rapid breathing, especially during feeding or exercise -Poor weight gain -Tiring easily during play or exercise -Irritability -Prolonged crying -Heart murmur -Sometimes, babies who have tetralogy of Fallot will suddenly develop deep blue skin, nails and lips after crying or feeding, or when agitated. These episodes are called tet spells. Tet spells are caused by a rapid drop in the amount of oxygen in the blood. Tet spells are most common in young infants, around 2 to 4 months old. Toddlers or older children might instinctively squat when they're short of breath.

Getting up from a chair with crutches

Slide forward to the edge of the chair. Hold both crutches on the injured side. Lean forward. Hold the armrest with the other hand. Push up on the handgrip of the crutch and the armrest of the chair. Stand up putting weight onto the good leg. Put crutches under the arms to start walking.

What does pursed lip breathing do?

Slows expiration keeps airways open on exhalation!!! prevents collapse of small airways controls the rate and depth of respiration

Rhonchi (sonorous wheeze)

Sonorous or coarse; snoring quality Low-pitched, continuous sounds Auscultated during inspiration and expiration Coughing may clear the sound somewhat Air passing through or around secretions

Varicella vaccine side effects

Soreness at injection site Fever Rash (rare) a couple of vesicles at the injection site - cover with a bandage or cloth to ensure they do not spread and should go away in a few days

Hepatitis C (HCV)

Spread by contaminated blood or body fluids. affects the liver

phases of labor

Stage 1 = cervical dilation A. Latent B. Active C. Transition Stage 2 = expulsion of fetus Stage 3 = expulsion of placenta stage 4 = maternal homeostatic stabilization

How to Perform the Heimlich Maneuver

Stand the patient up. Stand with your chest to their back. Place your arms under theirs. Make a fist with you dominant hand and place in the upper mid portion of the abdomen. Thrust upward and inward until the object is expelled.

pulmonary embolism (PE) s/s

Sudden onset, sharp localized pain in the chest, respiratory distress (maybe talking in 2-3 word bursts), cough, sputum coming up with cough, shock vitals

Washing a newborn baby

Start by washing the face with plain warm water. Clean eyes using plain water and wiping from the corner near the nose to the outer corner. Use a washcloth (use a clean part for each eye) or two cotton balls (one for each eye) When cleaning the ears and nose, clean only the surface of the ears and nose. Do not put a cotton swab in the ears or nose to clean Wash the rest of the baby with mild soap. Do not use a perfumed soap. Rinse with warm water Leaving the diaper area for last, make sure to wash all the creases and folds Do not be hesitant about cleaning a baby girl's genitals Use a soft cloth and warm water, and wipe gently between the folds After rinsing, pat the baby dry with a clean towel Shampoo the hair while you hold the baby in the crook of your arm. Put mild soap on the hair, gently scrub and rinse out all of the soap. Don't be afraid to gently shampoo the soft spots to prevent -yellow, oily, scaly flakes from building up. This condition is known as cradle cap Towel the hair dry and then brush it with a soft baby brush Do not use any oil or lotions on your baby because they may cause a rash. Most oils and lotions are too harsh for your baby's delicate skin

infiltration treatment

Stop infusion remove peripheral catheters apply cold compress elevate extremity insert new catheter in opposite extremity

Crohn's Disease Treatment

Stress reduction Avoidance of foods that worsen diarrhea such as raw fruits and vegetables. Adequate caloric, protein, and vitamin intake, parenteral nutrition, if necessary Reduced activity

Tracheal stenosis and atresia

Structural abnormalities such as pectus excavatum or abnormalities involving the great vessels

Subcutaneous injection sites

Subcutaneous tissue is all over your body, but the most common areas for subcutaneous injections are: -the upper outer area of the arm. -the front and outer sides of the thighs. -the abdomen, except for a 2" area around the navel. -the upper outer area of the buttocks. -the upper hip.

acute angle closure glaucoma

Sudden onset of PAIN Dilated pupil Reduced central vision Ocular redness Shallow anterior chamber Halos around lights Most common in adults >50

paracentesis (abdominocentesis)

Surgical puncture to remove fluid from the abdomen. This procedure is necessary to drain fluid (accumulated in ascites) from the peritoneal (abdominal) cavity. can be done in dr's office empty bladder sitting up/Fowler's position

hemorrhoids

Swollen, painful rectal veins; often a result of constipation **witch hazel**

Sickle Cell Anemia Treatment

Symptomatic treatment includes administration of analgesics, fluids, and oxygen. Treat underlying condition Increase fluid intake > Orally > Intravenously Frequently evaluate respiratory and circulatory status > Chest pain, back pain > Fever Cough, dyspnea > Administer supplemental oxygen POX 92% or less > Immediately report changes

Digoxin (Lanoxin) toxicity signs and symptoms

Symptoms - Confusion. Irregular pulse. Loss of appetite. Nausea, vomiting, diarrhea. Fast heartbeat. Vision changes (unusual), including blind spots, blurred vision, changes in how colors look, or seeing spots.

Hashimoto's disease signs and symptoms

Symptoms include fatigue and unexplained weight gain also - Skin: dryness or roughness Hair: hair loss or dryness Also common: constipation, depression, enlarged thyroid, fatigue, joint stiffness, muscle weakness, puffy eyes, sensitivity to cold, slow heart rate, swelling in extremities, or weight gain

Hydrocortisone contraindications

Systemic fungal infections Caution in patients with CHF, MI, immunocompromise

Phalen's maneuver (or Phalen's wrist test)

Test to determine the presence of carpal tunnel syndrome (CTS); a positive test for CTS cause paresthesia in the medial nerve distribution of the palm of the hand in 60 seconds.

Allen's sign

Test used to determine potency of the radial and ulnar arteries

When is varicella-zoster the most contagious?

The day before the rash appears

Extravasation

The leakage of blood, lymph, or other fluid, such as an anticancer drug, from a blood vessel or tube into the tissue around it A FLUID THAT IRRITATES THE TISSUE!

trough level

The lowest concentration of drug reached in the body after it falls from its peak level, usually measured in a blood sample for therapeutic drug monitoring.

carotid artery

The major artery that supplies blood to the head and brain.

peak level

The maximum concentration of a drug in the body after administration

Rotavirus

The most important global cause of infantile gastroenteritis. ROTA = R ight O ut T he A nus diaper cream to stem skin irritation

how to measure heparin

The most widely used laboratory assay for monitoring unfractionated heparin therapy is the activated partial thromboplastin time (aPTT). **THINK HARRY POTTER**

10 day rule

The practice of waiting 10 days after a woman's menstrual flow to conduct a radiographic examination or study.

where to assess for a pulse when doing CPR

The rescuer would place their index and middle finger over the carotid or femoral artery during a pause in Cardiopulmonary Resuscitation (CPR) to see if they could palpate a pulse.

PQRST waves

The standard waveforms found on the EKG tracing. Each wave corresponds to a specific event within the heart's electrical cycle.

Antagonists (drugs)

These drugs block the actions of neurotransmitters. Meds like - haloperidol, a drug that blocks dopamine.

Early decels mean:

This is VERY BAD, this means prolapsed cord. - Stick hand in mother's vagina and push the baby's head up. - Position her knee chest (on hands and knees), with hand still on baby's head - Rush to the operating room in this position for an emergency cesarean section

Distended neck veins

This is a sign of a circulatory overload r/t blood transfusion indicates fluid overload or cardiac tamponade

Pasero Opioid-Induced Sedation Scale (POSS)

This is valid and reliable. Sedation precedes respiratory depression. S = sleep, easy to arouse. 1 = awake and alert. 2 = slightly drowsy, easily aroused. S, 1 & 2 ARE ACCEPTABLE - NO ACTION NEEDED. 3 = frequently drowsy, arousable, drifts off to sleep during conversation. UNACCEPTABLE, monitor respiratory status and sedation level until stable; decrease dose 25-50% or notify prescriber/anesthesiologist for orders. Consider administering non-sedating opioid-sparing nonopioid if not contraindicated. 4 = Somnolent, minimal or no response to verbal or physical stimulation. UNACCEPTABLE; stop opioid, consider admin Naloxone; notify HCP; monitor respiratory status and sedation level.

TORCH infections

Toxoplasmosis (litter box & pregnant women) Other Rubella Cytomegalovirus Herpes

treatment for autonomic dysreflexia

Treat the cause: Catheter, remove impaction, look for skin pressure, painful stimuli, a cold draft breeze. most commonly used agents are nifedipine and nitrates (eg, nitroglycerine paste or sublingual nitroglycerine).

Lithium toxicity

Tremors, Metallic taste, neuro symptoms besides paresthesia

albuterol (side effects/adverse reactions)

Tremors, nervousness, restlessness Dizziness, tachycardia Palpitations, cardiac dysrhythmias

dizygotic (DZ) twins

Twins who are formed when 2 separate ova are fertilized by 2 separate sperm at roughly the same time. Also called fraternal twins.

monozygotic (MZ) twins

Twins who originate from one zygote that splits apart very early in development. (Also called identical twins.) Other monozygotic multiple births (such as triplets and quadruplets) can occur as well.

Hypomagnesemia S/S

Twitching Paresthesias Hyperactive reflexes *Irritability* Confusion Positive Chvostek's or Trousseau's sign Shallow respirations Tetany Seizures Tachycardia *Tall T waves* and depressed ST segment

Adult chest compressions

Two hands in the center of the chest, keep fingers off chest, shoulders above wrists, elbows locked, compress chest at least 2 inches at a rate of 100 compressions per minute.

nosocomial infections routes in order

UTI wounds respiratory tract blood

pancreatitis pain

Upper abdomen (both quadrants); back

Filgrastim (Neupogen)

Used for neutropenia (cancer) Can cause bone pain, leukocytosis (WBC > 100,000) increases neutrophil count

Romberg test

Used to evaluate cerebellar function and balance. Tell the client to close eyes and stand upright with feet together --see if they sway

Terbutaline (Brethine)

Used to relax uterine smooth muscle to inhibit uterine activity STOPS CONTRACTIONS

Detached retina S/S

Usually acute onset like a curtain coming down on part of their visual field Flashing lights & visual fields defects Floaters "web" "tentacles" "black spots" Dilated exam excludes vitreous detachment

Fat embolism syndrome

Usually occurs 1-3 days after fractures of long bones or pelvis. More frequent in closed rather than open fractures. Can occur 3-10 days after surgery. Observe for dyspnea and neurologic decline. symptoms - neuro changes, petechial rash, hypoxemia

VEAL CHOP

V: variable decels C: cord compression Reposition, O2, notify dr E: early decels H: head compression Normal A: accels O: okay L: late decels P: placental deficiency Turn, O2, d/c Pitocin, notify dr

C. diff treatment

Vancomycin

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).

Hindu Dietary Restrictions

Vegetarianism encouraged, the cow is sacred beans, fish okay

pts at greatest risk for PE

Venous injury stasis of blood/hypercoagulability stasis of venous blood C-section pt is at greatest risk

pernicious anemia

Vitamin B12 deficiency red beefy tongue paresthesia in hands/feet

Nutrition needed for wound healing

Vitamin C protein!

Ketoacidosis symptoms

Weakness, drowsiness, HA, blurred vision. Sweet odor to breath Warm, dry skin (flushed) extreme thirst.

Pre-eclampsia

When a pregnant woman develops high blood pressure and protein in the urine after the 20th week (late 2nd or 3rd trimester) of pregnancy. BP of 140/90 or an increase of 30 mmHg systole or 15 mmHg diastole

Abdominal Aortic Aneurysm

When the large blood vessel (aorta) that supplies blood to the abdomen, pelvis, and legs becomes abnormally large or balloons outward.

abstinence syndrome

a characteristic cluster of symptoms that results from a sudden decrease in the level of usage of a substance

informed consent nurse's role

Witness the client's signature on the informed consent form ensure HCP gave necessary information client understands (HCP would answer questions) ensure client is competent to sign

KUB x-ray

X-ray study of the kidneys, ureters, and bladder check for kidney stones

varicella treatment

You'll need to stay away from school, nursery or work until all the spots have crusted over. This is usually 5 days after the spots appeared. drink plenty of fluid (try ice lollies if your child is not drinking) to avoid dehydration take paracetamol to help with pain and discomfort put socks on your child's hands at night to stop scratching cut your child's nails use cooling creams or gels from a pharmacy speak to a pharmacist about using antihistamine medicine to help itching bathe in cool water and pat the skin dry (do not rub) dress in loose clothes check with your airline if you're going on holiday - many airlines will not allow you to fly with chickenpox

C. difficile

a bacterium that is spread by spores in feces that are difficult to kill; it causes symptoms such as diarrhea and nausea and can lead to serious inflammation of the colon

hydatidiform mole

a benign tumor of the placenta consisting of multiple cystic and resembling a bunch of grapes **do not get pregnant for 1 year after removal of hydatidiform mole b/c there is an increased risk of a specific cancer**

Crohn's disease

a chronic autoimmune disorder that can occur anywhere in the digestive tract; however, it is most often found in the ileum and in the colon

ulcerative colitis (UC) stool

a chronic inflammatory bowel disease (IBD) primarily located in the colon and rectum watery stool with blood and mucus

Hyperglycemia Hyperosmolar State

a complication of diabetes... is an insulin deficiency and profound dehydration

Neonatal Abstinence Syndrome (NAS)

a condition in which a child, at birth, goes through withdrawal as a consequence of maternal drug use

kyphotic curve

a curvature of the spine backward, concave curve, normal in thoracic and sacral regions could be indicative of osteoporosis

medical assault

a deliberate threat with the power to carry out the threat

IV cannula

a device inserted into the body, often for the delivery or removal of fluid; provides venous access; most common access is top of hand

cardioverter defibrillator

a device placed in the chest or abdomen that attempts to correct abnormal heart rhythms pt should not lift arms above shoulders for a few weeks if pt can drive again that's up to HCP

cardiac catheterization via femoral artery - post surgery position

a diagnostic procedure in which a catheter is passed into femoral vein or artery and then guided into the heart post surgery client should be low Fowlers or flat (supine)

vegan diet

a diet that excludes foods of animal origin

Internal disaster

a disaster in which a healthcare facility itself is in danger or damaged and its function is impaired

Failure to Thrive (FTT)

a disorder of infancy and early childhood characterized by variable eating and inadequate gains in weight; poor nutrition; could be caused by neglect and poor parental education on feeding

fever can be indicative of

a hypersensitivity reaction to a med!

quickening of the fetus

a legal term for the 1st visual movement of the fetus weeks 16-20 (around the 4th month of pregnancy)

IV Catheter

a medical device inserted into a vein to deliver fluids

Hirschsprung disease - main symptom

a newborn's failure to have a bowel movement within 48 hours after birth. Other symptoms include a swollen belly and vomiting. Surgery is needed to bypass the affected part of the colon or remove it entirely.

Toxoplasmosis

a parasite that is most commonly transmitted from pets to humans by contact with contaminated animal feces **why pregnant women shouldn't empty cat litter**

complicated grief

a person has a prolonged or significantly difficult time moving forward after a loss

catheter embolus

a piece of catheter breaks off & travels in the vein until it lodges.

Peau d'orange

a pitted or dimpled appearance of the skin, retracted nipple enlarged lymph nodes **symptom of inflammatory breast cancer**

Holter monitor

a portable device that is used to record the electrical activity of the heart over extended periods

Neuroleptic Malignant Syndrome (NMS)

a potentially fatal, idiosyncratic reaction to an antipsychotic (or neuroleptic) drug

ADHD (Attention-Deficit Hyperactivity Disorder)

a psychological disorder marked by the appearance by age 7 of one or more of three key symptoms: extreme inattention, hyperactivity, and impulsivity also marked by low self esteem & impaired social skills

case controlled study

a retrospective observational study that compares exposure in two groups of subjects. Subjects in one group have the disease (cases), whereas those in the other group are free of the disease (controls)

cervical cap

a rubber cap that fits over the cervix, used with spermicide to prevent conception. used with spermicide do not use during period - could cause TSS insert several hours prior to intercourse keep in place >6 hours post intercourse but not more than 48 hours after intercourse

myexedema

a skin and tissue disorder caused by hypothyroidism, difficult to treat

Autonomic Dysreflexia/Hyperreflexia

a syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above (T6 or above). S/S pounding headache, high Fowler's profuse sweating, nasal congestion, chills, bradycardia, hypertension. Place client in sitting position (elevate HOB) FIRST!

validation therapy

a type of therapy that lets people with Alzheimer's disease believe they are living in the past or in imaginary circumstances

fight or flight response

activates SNS which is core so dilates - eyes, bronchioles, increases HR, BP constricts - peripheral blood flow (legs/arms) hypoglycemic

cardiac tamponade

acute compression of the heart due to the accumulation of fluid within the pericardial cavity

What are extrapyramidal side effects?

acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome.

tonsillectomy

anticipate ear pain (and admin acetaminophen PRN) pt will have bad breath post-op

Heparin

anticoagulant **it does not thin the blood & does not dissolve the clot** it deters the clot from growing

Ketoconazole (Nizoral) - things to avoid

avoid alcohol avoid antacids avoid sun exposure

bowel obstruction

abdominal rigidity & rigidity often has abdominal distention anorexia, nausea and or vomiting fever lowered BP

orthopnea

ability to breathe only in an upright position patient should stand or sit in a chair straight back

pleural effusion

abnormal accumulation of fluid in the pleural space

pneumoconiosis

abnormal condition caused by dust in the lungs, with chronic inflammation, infection, and bronchitis (like inhalation of asbestos)

meconium aspiration syndrome

abnormal inhalation of meconium (first stool) produced by a fetus or newborn newborn will have have rapid respirations

fistula

abnormal passageway between two organs or between an internal organ and the body surface

exopthalmosis

abnormal protrusion of the eyeball

Primary hypothyroidism

abnormality in the thyroid gland itself

res ipsa loquitur (the thing speaks for itself)

accident occurs due to negligence

during pregnancy - do not take - can cause teratogenic effects

ace inhibitors (prils) for HTN angiotensin II receptor blockers (statins)

aPTT

activated partial thromboplastin time 30-40 seconds It measures how long it takes your blood to form a clot.

mononucleosis (mono)

acute, infectious illness, usually caused by the Epstein-Barr virus, and marked by an increased number of atypical lymphocytes and monocytes

baby with heart failure

add corn oil to baby's bottle

Transdermal Estradiol patch

adhere to abdomen used to treat moderate to severe hot flashes and other symptoms of menopause or low amounts of estrogen.

multiple meds in NG tube

admin each med separately flush the tube before and after each med with water helps to clear the tube of any residual med before the next one is instilled

Erythromycin ointment in newborn

admin within 1-2 hours of birth bilaterally (both eyes) starting at inner canthus going to outer canthus **okay for newborn to have initial breastfeed first**

Glucagon

administer IM or subQ repeat in 10 minutes if client doesn't respond

Open endotracheal suction

administers 100% oxygen prior to suctioning client APPLIES SUCTIONING WHILE WITHDRAWING CATHETER FROM AIRWAY USES STERILE GLOVES & TECHNIQUE THROUGHOUT THE PROCEDURE

Types of consent

admissions agreement, blood transfusion, research, surgical, special consents

Addison's disease symptoms

adrenal glands produce inadequate amounts of steroid hormones characterized by - hypoglycemia wt loss chronic fatigue hyperpigmented skin hypotension hyperkalemia (b/c sodium is not lost from urine)

hospital acquired pressure injuries - risk factors

advanced age impaired sensation nutritional deficits (anemia, low wt, decreased albumin) perfusion/oxygenation deficits skin moisture (dry skin or excess moisture, edema, incontinence, fever/infection)

newborn's first bath

after temperature stabilizes \ avoid submerging in water until cord falls off

Car seat rear facing until

age 2

Separation or stranger anxiety

age 6 months to 3 years **peaks at ages 10-18 mos**

Snellen Eye Chart Test

age 6+ pediatrics - child stands 10' away from chart ***if child wears glasses, he keeps them on for Snellen test** adults - performed (at 20ft) by covering one eye, and reading aloud the letters of each row, beginning at the top. The smallest row that can be read accurately indicates the visual acuity in that eye. The symbols on an acuity chart are known as "optotypes".

pneumothorax

air in the pleural cavity caused by a puncture of the lung or chest wall collapsed lung

continuous bubbling in water seal means

air leak, find and tape

Measles precautions

airborne place client in negative pressure isolation room N95 mask

A-B-Cs

airway, breathing, circulation

PPD skin test

aka Manntoux TB skin test read in 48-72 hrs 25g -27g needle 5-15 degree angle

transcutaneous pacing

aka external pacing. Temporary means of pacing a patient's heart during a medical emergency, accomplished by delivering pulses of electric current through the patient's chest, which stimulates the heart to contract. The most common indication for transcutaneous pacing is an abnormally slow heart rate.

lab values to determine nutritional status

albumin total serum protein

ETOH

alcohol

Pancreatitis common causes

alcoholism cholelithiasis - the formation of gallstones.

possible latex allergy

allergy to avocados & bananas

Flu vaccine contraindications

allergy to eggs infants under 6 years old

function of amniotic fluid

allows growth and movement of fetus protects the fetus from injury maintains body temp of the fetus helps measure kidney function

latex allergy risk factors

also have cross-allergies to bananas, avocado, chestnut, tomatoes, papaya, peaches & grapes health care workers, hairdressers,cleaning staff H/O of multiple surgeries clients with spinal cord injuries clients with urgogenital abnormalities children with neural tube defects

Central vein catheter

also known as a central line, is a tube that doctors place in a large vein in the neck, chest, groin, or arm to give fluids, blood, or medications or to do medical tests quickly.

3 year old

alternate feet to ascend and descend stairs, ride tricycle, emerging of hopping Feeds self well holds glass with 1 hand pulls on pants, socks, and shoes

criteria to leave PACU

ambulate independently stable BP adequate SaO2

Presumptive signs of pregnancy

amenorrhea, nausea, breast tenderness, deepening pigmentation, urinary frequency, quickening

Vital Capacity (VC)

amount of air exhaled after a maximal inspiration

microcephaly

an abnormally small head and underdeveloped brain

Vector

an animal that carries and transmits a disease (flies, bees, rabbit, racoon)

phenytoin/dilantin

an anticonvulsant used to treat & prevent seizures

epileptic client reports aura

an aura is a sensory perception indicating a complex or grand mal seizure

Hashimoto's thyroiditis

an autoimmune disorder that attacks the thyroid gland causing hypothyroidism

DM type 1 key points

an autoimmune response can trigger DM 1 usually develops before age 20 regular exercise can reduce insulin amt needed

cochlear implant

an electronic device that bypasses the damaged portions of the ear and directly stimulates the auditory nerve

PEG tube (percutaneous endoscopic gastrostomy)

an endoscopic procedure in which a tube is passed into a patient's stomach through the abdominal wall and mostly provides a means of feeding or oral intake

Protein-calorie malnutrition (PCM)

an imbalance between nutritional intake and the body's protein requirements dry, brittle hair edema poor wound healing

negative TB test

an induration (hardness) absent or less than 5 mm in diameter

Positive TB test

an induration 10 mm or greater in diameter erythema

nosocomial infection

an infection acquired during hospitalization

Phenylketonuria (PKU)

an inherited disorder of protein metabolism in which the absence of an enzyme leads to a toxic buildup of certain compounds, causing intellectual disability

venturi mask

an oxygen-delivery apparatus high flow oxygen guaranteed oxygen concentration regardless of the client's RR, depth or tidal volume

pinworms

anal itching worse at night **remember your friend had this as a child**

B6 deficiency

anemia peripheral neuropathy (tingling in feet/hands)

Pap Smears given?

annually at age 21 unless otherwise indicated

cephalic vein

anterolateral aspect of the forearm near the antecubital fossa

isosorbide mononitrate

anti-anginal med produces vasodilation change positions slowly when getting up

preterm labor prescribe

antibiotics to prevent Strep B infection if preterm infection occurs

Encephalopathy is defined as

any dysfunction of the brain

pt with arthritis who has pain - do this prior to exercise

apply heat to joints!

PICC line - phlebitis complication

apply low-degree heat discontinue if not resolved

wrist restraints

apply pads to ensure skin integrity remove every 2 hours can fit 2 fingers between skin & restraint tie with quick release buckle or knot that doesn't tighten secure to bed frame

Trousseau's sign

arm/carpal spasm associated with hypocalcemia

Decorticate posturing

arms flexed inward and bent in toward the body and the legs are extended **indicates damage to the pathway between the brain & the spinal cord

leading cause of adult disability

arthritis

Xerostomia (dry mouth) - interventions

artificial saliva oral hygiene multiple times/day sipping water throughout the day

parenteral nutrition administration

aseptic technique bag must be changed every 24 hours

Urine Specimen Collection from catheterized pt

aseptically from the port located on the tubing on the indwelling urinary catheter **NOT from the cath bag - it's been sitting there and subject to bacteria**

Arab men

ask client if his wife would like to give the bath do not look in eyes when communicating

to determine proper placement of NG tube

aspirate stomach contents pH must be 6 or less

to promote interdisciplinary collaboration

assertiveness good communication skills conflict negotiation skills decision making and critical thinking skills

frontal lobe

associated with reasoning, planning, parts of speech, movement, emotions, and problem solving

NSAIDS can cause problems for

asthmatics!

Cows milk introduced

at least 12 months

subtotal thyroidectomy

at risk for thyroid storm/crisis/thyroidtoxicosis stay with pt S&S of thyroid storm: 1-hyperpyrexia (high fever 104+) 2-really high VS (HR 200, BP 210/190) 3-psychotic delirium treatment: high flow rate O2, decrease temp with ice packs (5), spare the brain

Positive signs of pregnancy

audible fetal heartbeat fetal movement felt by examiner ultrasound visualization of fetus

Guillain-Barre syndrome

autoimmune condition that causes acute inflammation of the peripheral nerves in which myelin sheaths on the axons are destroyed, resulting in decreased nerve impulses, loss of reflex response, and sudden muscle weakness **respiratory failure most life-threatening complication**

Nephrotic syndrome (kids)

autoimmune disease that affects children age 2-7 RISK FOR INFECTION MONITOR FLUIDS CORTICOSTEROIDS Sodium restrictions illness can go into remission

myasthenia gravis

autoimmune neuromuscular disorder characterized by weakness of voluntary muscles risk for aspiration

Sim's position used for

exam and treatment of the rectal areas and for enemas, rectal temperature, and rectal meds (one knee up)

some of the discomforts of pregnancy

excess salivation epistaxis breast tenderness tingling in fingers/toes

kyphosis

excessive outward curvature of the spine, causing hunching of the back.

Hyperkalemia

excessive potassium in the blood

ketoacidosis

excessive production of ketones, making the blood acidic

polyuria

excessive urination

High WBC counts may indicate

bacterial infections, autoimmune diseases, or side effects of medications

Impetigo

bacterial skin infection characterized by isolated pustules that become crusted and rupture

foods high in potassium include

baked chicken, potato, bananas, oranges, dates, apricots, raisins, broccoli, green beans, meats, fish, and legumes

High potassium foods

bananas, orange juice, cantaloupe, strawberries, avocados, spinach, fish and salt substitutes

prior to transfer to mortuary - nurse should do what?

bathe the body

to insert urinary catheter - ask client to

bear down gently as if to void

Ventral

belly side front

Propranolol

beta blocker decreases HR and BP **DO NOT GIVE TO ASTHMA PTS**

Bethamethasone

bethamethasone (celestone)=surfactant. Med for lung expansion given when woman goes into premature labor

Therapeutic INR range

between 2 and 3 **for some heart conditions can be 3.5**

uterine cancer

bimanual pelvic exam

Scotomas

blind or partially blind areas in the visual field

peripheral arterial disease (PAD)

blockage of arteries carrying blood to the legs, arms, kidneys and other organs pt will have dry, scaly, cool, hairless skin - due to lack of circulation, brittle, thick nails, possible gangrene due to lack of circulation

If a transfusion reaction occurs what should the nurse do with bag of blood?

blood bank

left to right shunting

blood from systemic redirected into pulmonary manifestations - tachypnea diaphoresis during feeding or exertion heart murmur signs of heart failure poor wt gain

Warfarin (Coumadin)

blood thinner monitor INR **CONTRAINDICATED IN PREGNANCY**

Hep B transmission

blood/body-fluids/sexual fluids (semen, vaginal secretions)

sanguinous drainage

bloody drainage

colorectal cancer

bloody stool change in bowel habits unexplained weight loss abdominal pain low hemoglobin level/anemia (due to blood in stools)

comminuted fracture

bone breaks into many fragments

compression fracture

bone is crushed

BNP

brain natriuretic peptide, elevated in CHF patients elevated would be >100 >100 indicates heart failure BNP aids in the assessment of severity of heart failure and helps distinguish cardiac from respiratory causes of dyspnea

CT scan (computed tomography)

brain-imaging method using computer-controlled X-rays of the brain **watch for shellfish allergy**

low potassium foods

breads, cereals, asparagus, cabbage, cherries, blackberries and blueberries

extracorporeal shock wave lithotripsy (ESWL)

breakdown of kidney stones using sound waves generated outside the body

macular degeneration (MD)

breakdown of the tissues in the macula resulting in loss of central vision ** a blurry spot in the center of vision***

first sign of puberty in girls

breast buds

lightening

breathing is easier for the mother more urination the sensation of the fetus moving from high in the abdomen to low in the birth canal

Theophylline

bronchodilator Therapeutic Level: 10-20 mcg/mL Toxic Level: >20 mcg/mL

theopylline

bronchodilator/anti-asthma - toxicity: anorexia, tachy, albuminuria, hypoTN

exophthalmos

bulging eyes

Milk vitamins and minerals

calcium vitamin D ***not a significant source of iron***

mag sulfate antidote

calcium gluconate 10%

aspirin overuse

can cause hearing loss

Osteosarcoma

cancer of the bone

Opportunistic infection in HIV pts

candidiasis or thrush

3 year old child

cannot hop but can stand on 1 foot for a few seconds

what would indicate sepsis

cap refill >5 seconds oliguria (excess urination) any blood discrepancy

Negative Homan's sign

cardiovascular a "negative" Homan's sign doesn't necessarily rule out a DVT

Clubfoot in infants

casting weekly recasting over 5-8 weeks

aspiration pneumonia

caused by material (food or vomitus) lodging in bronchi or lungs ***place client in side-lying (or lateral) position***

Cushing's syndrome

caused by prolonged exposure to high levels of cortisol

isoniazid

causes peripheral neuritis AE = pains/tingling in legs

Diagnostic test for pneumonia

cbc, chest x-ray blood culture if fever >101.5 sputum gram stain

Brachytherapy used in the treatment of

cervical and endometrial cancer

Reverse Trendelenburg's position used for

cervical traction feeding clients restricted to supine position (after cardiac catheterization)

opiods key points

change positions slowly (hypotension) take with food wear sunscreen

what can precipitate a sickle cell crisis

cold weather dehydration smoking fever

yin foods

cold; eaten with a hot illness

disequilibrium syndrome

characterized by headache, mental confusion, decreasing level of consciousness, nausea and vomiting, twitching, and possible seizure activity. It is caused by rapid removal of solutes from the body during hemodialysis. It most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.

prosthesis care

check for loose or worn parts daily

newborn's ears

check for low-set ears Low-set ears are a clinical feature in which the ears are positioned lower on the head than usual. They are present in many congenital conditions.

before giving atorvastatin, check levels of what?

check liver function lvels

PEG tube care

check tube placement and residual volume Q4h

Unstable Angina (UA)

chest pain that is new in onset, occurs at rest increases in occurrence, severity or duration

Stable angina (aka exertional)

chest pain that occurs when a person is active or under severe stress

unstable angina

chest pain that occurs while a person is at rest and not exerting himself not relieved by nitro

Pericarditis S/S

chest pain worse when lying down, cough, fever, anxiety, FRICTION RUB

school phobia

child won't go to school treatment - insist child attend, starting with a few hours a day

A mild reaction to iodinated contrast medium would be:

chills sweats

2 STDs that cause PID & infertility

chlamydia and gonorrhea

bronchitis symptoms

chronic cough wheezing cyanosis productive cough

How to remove sutures/staples:

clean site first, grasp the knot cut the suture close to the skin and pull out the suture in one piece clip as close to the site as possible

reduce infection for cancer patients

clean toothbrush with hydrogen peroxide solution, bleach or through the dishwasher **antimicrobial soap INCREASES the risk for infection**

clean a hearing aid

clean with a soft cloth do not immerse or use water store in a safe, dry place turn off before inserting then turn up to a comfortable level

Signs of skull fracture

clear fluid coming from nares of nose Severe headache and nausea Palpation may reveal defect in skull May be blood in the middle ear, ear canal, nose, ecchymosis around the eyes (raccoon eyes) or behind the ear (Battle's sign) Cerebrospinal fluid may also appear in ear and nose

serous

clear, watery plasma

restraints & position

clients in any restraint should not be placed supine b/c this could cause aspiration

embolus (emboli)

clot or other substance that travels to a distant location and suddenly blocks a BLOOD VESSEL

dehiscence treatment

collect a full set of VS cover with sterile dressings place client in low Fowler's with knees slightly flexed notify HCP immediately NPO for pt - may have to go back into surgery

Volkmann contracture occurs as a result of

compartment syndrome restriction of arterial blood flow MEDICAL EMERGENCY!!

2nd stage of labor

complete cervix dilation to birth **have pt move positions frequently to move baby down birth canal**

Live vaccines are contraindicated in a patient who:

compromised immune system pregnant

polycythemia vera

condition characterized by too many erythrocytes; blood becomes too thick to flow easily through blood vessels

Hypothyroidism

condition of hyposecretion of the thyroid gland causing low thyroid levels in the blood that result in sluggishness, slow pulse, and often obesity

hypospadias; hypospadia

congenital opening of the male urethra upon the undersurface/VENTRAL of the penis. Also a urethral opening into the vagina.

ductus venosus

connects the umbilical vein to the inferior vena cava, bypassing the liver closes at birth

4 side rails of bed raised

considered a form of restraint!!! can raise 2-3 siderails only

lacto-ovo-vegetarian

consumes all vegan items plus dairy products and eggs.

C diff precautions

contact gown and gloves **mask not required** private room

Scabies

contagious skin disease transmitted by the itch mite Between the fingers. The folds of the wrist, elbow, or knee. Around the waistline and navel.

Post TURP care

continuous bladder irrigation pale pink urine outflow painful bladder spasms are expected input and output should be equal the spasms are treated with antispasmodics normal VS

magnesium body functions

contraction and relaxation of muscles, enzyme function, energy production, and DNA and protein synthesis

Volkmann's contracture

contracture and damage to the muscles of the forearm because of injury to their blood supply **sign of compartment syndrome**

45% Sodium Chloride (NaCl)

contraindicated in burn pt.

Signs of hypocalcemia CATS

convulsions, arrhythmias, tetany, stridor+ spasms Chovstek's (facial twitching) Trousseau's (carpal spasm)

hemoptysis

coughing up blood

acetaminophen

could cause liver damage

formula for newborns

cow's milk based formula best for newborns

ileostomy

creation of an artificial opening into the ileum (small intestine)

BLACK tag

expected and allowed to die prepare for morgue

Meniere's disease

disorder of inner ear causing vertigo, tinnitus, and hearing loss **LOW SODIUM DIET (and therefore lowered potassium)** avoiding nicotine & caffeine & alcohol avoid sudden changes

Ruptured ectopic pregnancy

dizziness low BP tachycardia (high heart rate) shoulder pain

Sputum collection

do at morning rinse mouth with water sit on side of bed or Fowler inhale deeply several times cough deeply and expectorate into sterile container

Ileostomy Care

do not add aspirin - irritates tissue empty bag when it is 1/3 full clean around stoma with warm water & soap change stoma appliance every 5-10 days assess for fluid and electrolyte imbalances

pacemaker pt - check heart rate

daily

best indication of fluid retention & restoration

daily weights

autonomic neuropathy

damage to nerves supplying the internal body structures that regulate functions such as blood pressure, heart rate, bowel and bladder emptying, and digestion **intervention - take BP sitting & standing**

Foods high in folic acid include

dark green leafy vegetables, strawberries, beans, seeds, orange juice, fortified bread and cereals.

decreased renal function

dark, strong smelling urine elevated serum creatinine level elevated BUN decreased hemoglobin level decreased RBC

child with appendicitis

decreased bowel sounds

acute pancreatitis causes

decreased calcium

client deference

deference is submission so client deference is submission to client's wishes - can be a form of advocacy

Nurse Practice Act (NPA)

defines the scope and limitations of professional nursing practice varies from state to state

manifestation of diabetic ketoacidosis

dehydration

dehydration and sodium level

dehydration can increase sodium level

high specific gravity indicates

dehydration, concentrated urine

Delegating vs. Assigning

delegating- requires follow-through of task (evaluation that done properly; you still have the responsibility) assigning- requires no follow up; transfers the authority, accountability & responsibility to another

3rd stage of labor

delivery of placenta

febrile seizure treatment

depends on etiology and antipyretics. Antiepileptics are not indicated. Benzo (Ativan) may be used to break the seizure.

POA (power of attorney)

designates a person to act on the patient's behalf in case that person becomes incapacitated there are various types of POAs - medical, financial, etc.

Liver cirrhosis is characterized by

destruction of liver cells replaced by scar tissue decreased synthesis of proteins made in the liver, abnormal retention of fluid in the abdomen, and poor nutritional status

active acquired immunity aka artificial active immunity,

develops following direct exposure to the pathogenic agent vaccination

ACE inhibitors - "prils" are the drug of choice for

diabetics

Brat diets are contraindicated for

diarrhea

DASH (Dietary Approaches to Stop Hypertension)

diet that is - low sodium high in fruit & vegetables high fiber low to moderate fat rich in potassium, calcium & magnesium

dysphagia

difficulty in swallowing or inability to swallow

caput succedaneum

diffuse edema of the fetal scalp that crosses the suture lines. reabsorbs within 1 to 3 days

Sign of traumatic brain injury

dilated pupils

Low specific gravity of urine

dilute urine diabetes insipidus, chronic nephritis Very low specific gravity means dilute urine, which may be caused by drinking too much fluid, severe kidney disease, or the use of diuretics.

arterial insufficiency symptoms

diminished pulses cool, shiny skin absence of hair on toes pallor of lower extremities on elevation red color of lower extremities when dependent pale in color with well-defined edges and no bleeding

serum prealbumin level

directly related to patient's nutritional status normal = 23-43

external disaster

disasters outside the medical facility can be man-made or natural made

osteomalacia

disease marked by softening of the bone caused by calcium and vitamin D deficiency

Reynaud's Disease

disorder of blood vessels supplying the skin avoid excess caffeine yoga/tai chi (stress relief) refrain from tobacco products wear gloves when handling cold objects

Joint pain in hemophilia patient

eventually can cause hemophilia arthropathy

blood draw

do not attempt more than 2x if unsuccessful (someone else can try but you cannot if no success after 2x) insert needle bevel up at a 15degree angle from skin if must use arm with IV, go several cm below the IV and place tourniquet in between the IV and new site

if the chest tube becomes disconnected...

do not clamp Put distal end in saline or sterile water

Tetracycline key points

do not take with dairy products use add'l contraception! use sunblock take on an empty stomach take with a full glass of water avoid antacids

varicella DON'TS

do not use ibuprofen unless advised to do so by a doctor, as it may cause serious skin infections do not give aspirin to children under 16 do not be around pregnant women, newborn babies and people with a weakened immune system, as chickenpox can be dangerous for them **MANY AIRLINES WILL NOT ALLOW YOU TO FLY WITH CHICKENPOX**

Failure to Thrive (FTT) risk factors

domestic violence in home parent with eating/food disorders poverty/food insecurity

Halo device care

don't grab device to turn pt pin care every shift!!!! clean and dry thoroughly under jacket without removing it - use side entry of jacket only 1 finger should slide between skin and jacket

Pertussis (whooping cough)

droplet precautions

Bacterial Meningitis precautions

droplet precautions, HIGHLY CONTAGIOUS, medical emergency, high mortality

Agonists

drugs which mimic the activity of neurotransmitters binds to receptors and mimics regulatory muscles hormones are agonists

Anticholinergic effects

dry mouth==can't spit urinary retention=can't pee constipated =can't **** blurred vision=can't see

xerosis

dry skin

Variant angina (Prinzmetal's angina)

due to a coronary artery spasm, often occurring during periods of rest

Hepatitis A signs and symptoms

dull RUQ pain, range from mild to severe and can include fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-colored urine and jaundice (a yellowing of the eyes and skin).

Nonmaleficence

duty to do no harm

sign of cranial nerve dysfunction

dysphagia

cerumen

ear wax

Somogyi effect

early-morning hyperglycemia that occurs as a result of nighttime hypoglycemic episodes **monitor nightime glucose levels**

foods with vitamin B

eggs, meat, milk, dark green leafy vegetables, legumes

after mastectomy

elevate affected arm to heart level to reduce fluid retention and prevent lymphedema semi-Fowler's position arm resting on several pillows to prevent lymphedema, blood or fluid pooling

rheumatoid arthritis (RA)

elevated rheumatoid factor & erythrocyte sedimentation rate arthritis with swelling, stiffness, pain, and degeneration of cartilage in joints caused by chronic soft tissue inflammation; may result in crippling deformities; an autoimmune disease

plantar reflex

elicited touching the soles of the feet. toes curl downward. (birth to 8 months) Babinski

cachectic

emaciated, malnourished

best time for postural drainage

empty stomach if done after pt has eaten, could cause N/V

Wilms tumor (nephroblastoma)

encapsulated above kidneys...causes flank pain... DO NOT PALPATE

peripheral artery disease nursing interventions

encourage exercise! meds encourage smoking cessation

priority for pt with PTSD

encourage pt to talk about the trauma!

priority action after birth

establish airway - bulb syringe

after 1st TB injection - return when?

evaluate site 48-72 hours later!

vastus lateralis

extends knee and stabilizes

FLACC scale

face, legs, activity, cry, consolability children ages 2 mos to 7 years

aplastic anemia

failure of blood cell production in the bone marrow causes a deficiency of WBCs, platelets or RBCs can be due to medicines, viruses, toxins or radiation exposure hypoxia, fatigue, pallor increased susceptibility of infection

BP cuff too small

false high reading

restraining a client without a doctor's order

false imprisonment

BP cuff too large

false low reading

skin cancer risk factors

family hx high # of moles immunosuppressant medication use fair skin frequent sun exposure 5 major sunburns will double risk blonde hair blue eyes freckles green eyes red hair occupational (farmers, roofers) genetics

agoraphobia

fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control and panic

Zygote

fertilized egg

perineum after childbirth

first 24 hours - ice pack after 24 hours - warm sitz bath

AFTER cardiac LEG catheterization

flat and keep extremity straight keep leg straight med to relax you prior to procedure supine for 2-6 hours until doctor is sure bleeding has stopped

Macule

flat, colored spot on the skin (freckle)

raised neck veins

fluid volume excess

Obstructed Feeding Tube

flush & aspirate with warm water

How to flush a central line?

flush before and after administering med do not apply force if resistance use a syringe 10 ml or larger

contact of chemical with skin

flush with cool water first

Piaget's formal operational stage

focuses on abstract thought and problem solving

Rifampin

for TB Give on empty stomach (anti-tuberculosis) remember Rifampin causes red urine

Heimlich for infants

for child <1 back blows and chest thrusts

Valsalva maneuver

forceful exhalation against a closed glottis, which increases intrathoracic pressure and thus interferes with venous blood return to the heart STRAINING!

Maslow's Hierarchy of Needs

foundation = physiological (air, food, shelter) safety love/belonging esteem self-actualization

PICC line (peripherally inserted central catheter)

frequently used for a patient who will need IV therapy for more than 7 days

ventral

front

antecutibal

front of elbow

4th degree burn

full-thickness burn extending to muscle or bone

balance and coordination

function of cerebellum

Ketozonazole is used to treat _____.

fungi and protozoa

9th cranial nerve and function

gag reflex ability to swallow pts taught the supraglottic swallow

cancer that metastasizes to brain - changes in body

gait disturbances HA personality changes seizures

cholelithiasis

gallstones in the gallbladder

Semi-Fowler's used for

gastric feedings head injury ICP respiratory illness post-op following cranial surgery or cataract removal

GERD

gastroesophageal reflux disease

2nd trimester teaching

gestational diabetes test gain 1 lb per week abdominal U/S for fetal anatomy analysis/visualization increase consumption of iron-rich foods like dried fruit & meat anticipate light, fetal movements.

Phenytoin (Dilantin) adverse effects

gingival hyperplasia; CNS depression; skin rash; cardiac dysrhythmias; hypotension; narrow therapeutic index

Prior to suctioning what should the nurse do?

give 100% O2

Non-stress test interventions (pregnancy)

give pt glass of OJ prior seat client in a reclining chair or place in semi-fowler's or left lateral position; monitor response of fetal HR to fetal movement

glucose tolerance test (GCT) for gestation

given at 24-28 weeks pt given Glucola pt tested at 1, 2 & 3 hours if under <140 then okay >140 then dx of GD **fast 8 hours prior to test**

chlordiazexpoxide

given for pts in alcohol withdrawal to ensure no seizures & decrease anxiety

Vercuronium

given to decrease resistance to ventilator in pt with ARDS

Atropine Contraindications

glaucoma

B12 pernicious anemia signs and symptoms

glossy tongue numbness & tingling in fingers/toes hypoxemia pallor jaundice poor balance

Tier 1 infection prevention

gloves bagging laundry washing hands

Admin of a rectal suppository >3 yo

gloves place child supine with knees & feet raised against rectal wall use INDEX finger past internal and external sphincter hold buttocks together after insertion **should have result in 10-30 minutes**

Admin of a rectal suppository in child <3

gloves place child supine with knees & feet raised against rectal wall use PINKIE/5TH FINGER finger past internal and external sphincter hold buttocks together after insertion **should have result in 10-30 minutes**

HbA1c

glycosylated hemoglobin

PPE sequence putting on

gown mask goggles gloves

cane length is equal to the distance between the:

greater trochanter and the floor

inguinal area

groin. juncture of the lower abdominal wall and the thigh

Schizophrenia (positive symptoms)

hallucinations, delusions, disorganized speech, disorganized behavior

insert indwelling catheter in female

hand hygiene apply sterile gloves place sterile equipment between legs with nondominant hand spread labial folds with nondominant hand clean labial folds with nondominant hand cleanse urethral meatus dominant lubricate catheter tube dominant insert tube

Heberden's nodes

hard bony lumps in the joints of your fingers SYMPTOM OF OSTEOARTHRITIS Lumps grow on the joint closest to the tip of your finger, called the distal interphalangeal, or DIP joint

breast engorgement while breastfeeding

have baby feed 10-15 minutes on each breast apply warm compresses take warm showers use NSAIDS for pain do not express milk at other times!

lumbar puncture nursing interventions

have client empty bladder place client in lateral recumbent position with chin to chest and knees to abdomen encourage fluids post-procedure

3 months old motor skills

head and shoulders lift with no more grasp reflex and hands held open

2 months old motor skills

head lift 45 degree when prone with hands held open follows object past midline coos, gurgles smiles in response to other

McRoberts maneuver for shoulder dystocia

head of bed flat, exaggerated flexion of maternal legs

hip dysplasia

head of femur slips out of acetabulum **EXTRA GLUTEAL FOLDS**

Preclampsia S/S

headache, dizziness, epigastric pain, visual changes, edema, rise in BP, protein in urine, increase in weight.

APGAR

heart rate respiratory effort muscle tone reflex irritability color

Von Wilebrand Factor

helps platelets to aggregate & attach to the blood vessel wall, which is necessary for normal blood clotting

Dietary fiber good for?

helps prevent colon/colorectal cancer improves glycemic control promotes weight loss reduces risk of vascular disease regulates bowels

which STDs are incurable

hepatitis B. herpes. HIV. HPV.

Hirschsprung disease

hereditary defect causing absence of enteric nervous system HD involves missing nerve cells in the muscles of part or all of the large intestine (colon). Present at birth, it causes difficulty passing stool.

Herpes (genital herpes)

herpes simplex virus no cure c-section indicated if active lesions are present before giving birth **acylovir started at 36 weeks gestation to prevent outbreak before delivery**

Cytomegalovirus

herpes-type virus that usually causes disease when the immune system is compromised

major complication of TPN

hyperglycemia!

CKD - pt at risk for

hyperkalemia (high potassium) & hyperphosphatemia (high phosphate)

Trousseau and Chvostek's signs observed in

hypocalcemia

rapid infusion of TPN can cause

hypoglycemia or hyperglycemia

Flattening of T waves, U wave

hypokalemia low potassium

reasons to fill out an incident report

identify the circumstances for the error and prevent it from happening again

do not take digoxin

if HR <60

Heimlich for children >1 yo

if pt can speak, ask them to cough first then abdominal thrusts - same as adult

Colostomy Types

ileum, transverse, descending, sigmoid

ultrasonography

imaging of urinary tract structures using high-frequency sound waves **full bladder to do this test**

Snakebite Interventions

immobilize limb at level of heart

Apraxia

impaired ability to carry out motor activities despite intact motor function **put coat on upside down**

Hepatic encephalopathy

impaired ammonia metabolism causes cerebral edema. s/s: change in LOC, memory loss, asterixis (flapping tremor) impaired handwriting, hyperventilation w/ resp alkalosis. Rx: lactulose, low protein, safety, rest

ectopic pregnancy

implantation of the fertilized egg in any site other than the normal uterine location

placenta previa

implantation of the placenta over the cervical opening or in the lower region of the uterus

palmar grasp reflex

in response to stroking a baby's palm, the baby's hand will grasp. This reflex lasts a few months

Anhedonia

inability to experience pleasure

aphagia

inability to swallow

amniotomy

incision into the amnion (rupture of the fetal membrane to induce labor; a special hook is generally used to make the incision)

what can cause constipation in pregnant women?

increase in the hormone progesterone

Glaucoma

increased intraocular pressure halos loss of peripheral vision

CKD signs and symptoms

increased potassium & magnesium Increased creatinine, BUN, blood pressure Proteinuria

Thyroid storm

increased temp, pulse and HTN life threatening do not palpate!

head circumference in children

increases by 1" in year 2 then .5" every year after until age 5

Shower chair

increases client safety reduce pt fatigue minimizes pt physical exertion

autonomy

independence

bluish gray stoma color

indicates impaired perfusion/oxygenation **not an infection** this indicates it's dying due to lack of O2

FFP (fresh frozen plasma)

indications: pts who need coagulation factors - liver failure, DIC, massive RBC transfusion indicated for the deficiency of coagulation factors with abnormal coagulation tests in the presence of active **assess PROTHROMBIN TIME after giving** NURSE SHOULD ASSESS PT AFTER ADMIN OF FFP - THE DESIRED EFFECT IS LESSENED PT**

tracheostomy tube

indwelling tube inserted directly into the trachea to assist with ventilation

itis

infection

exogenous infection

infection originating outside an organ or part

Osteomyelitis

inflammation of bone and bone marrow

chronic bronchitis

inflammation of the bronchi persisting over a long time

acute glomerulonephritis

inflammation of the capillary loops of the renal glomeruli MONITOR BP CONTINUOUSLY!

epididymitis

inflammation of the epididymis that is frequently caused by the spread of infection from the urethra or the bladder

Cholecystitis

inflammation of the gallbladder; usually associated with gallstones

endocarditis

inflammation of the inner lining of the heart notify provider of dental procedures to ensure no re-infection

pericarditis

inflammation of the sac surrounding the heart

Statins MOA

inhibit HMG-CoA reductase lipid effects: Greatly lowers *LDL* and lowers triglycerides & total cholesterol SE: hepatoxicity, muscle toxicity (rhabdomyolysis)

intrathecal

injection into the meningeal space surrounding the brain and spinal cord for spinal infusion/injecting dye

Vitamin K injection for newborns

injection to prevent clotting disorders given to all infants but increased risk for preemies or birth injury given IM into into the thigh muscle in the first day of life as this effectively prevents VKDB in virtually all babies. Vitamin K should be given to all newborn infants as a single, intramuscular dose of 0.5 to 1 mg. Given on the vastus lateralis

Inner canthus of the eye

inner corner of eye

central vein catheter - air embolism complication

intervention - place client in LL trendelenberg administer oxygen

Central vein catheter - lumen occlusion complication

intervention - use 10 ml syringe with a pulsing motion

PICC line - infection complication

intervention - use aseptic technique keep dressing clean & dry intervene immediately for any signs of infection

Central vein catheter - pneumothorax complication

intervention - admin Oxygen assist provider with chest tube insertion

central vein catheter - bloodstream infection complication

intervention - change entire infusion notify provider obtain culture administer antibiotics

IUD

intrauterine device; contraceptive replaced every 3-5 years if pt cannot feel string - call doctor

reasons for a contraction stress test - CST

intrauterine growth restriction post-maturity decreased fetal movement

MRSA

invasion of body tissue by methicillin-resistant staphylococcus aureus Staph skin infections, including MRSA, generally start as swollen, painful red bumps that might look like pimples or spider bites. The affected area might be: Warm to the touch Full of pus or other drainage Accompanied by a fever These red bumps can quickly turn into deep, painful boils (abscesses) that require surgical draining. Sometimes the bacteria remain confined to the skin. But they can also burrow deep into the body, causing potentially life-threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs.

Encopresis

involuntary defecation not attributable to physical defects or illness

clonus reflex

involuntary muscle spasms

toddler assessment

involve the parent continue to use comfort objects let child touch equipment use play and toys growing independence-only give choices that are truly options go from least invasive to most invasive areas

Oral Candidiasis (Thrush)

involves white curd-like growth on the mucous membranes of the mouth immunocompromised pts would get this (pt on iv antibiotics or AB therapy, AIDS pt

1st food to introduce

iron-fortified cereal such as cream of rice

NAS symptoms

irritability tremors high pitched/excessive crying hyperactive vomiting diarrhea lacrimation excessive sneezing/yawning poor suck & feeding disturbed sleep difficult to console seizures

B12 deficiency anemia

is an anemia in which low red blood cell count is due to a lack of vitamin B12 aka pernicious anemia. LACK OF INTRINSIC FACTOR TO ABSORB B12!!!

Lithium

is used for mental illnesses, including bipolar disorder, depression, and schizophrenia They are primarily used to treat bipolar disorder and treat major depressive disorder that does not improve following the use of antidepressants. In these disorders, it reduces the risk of suicide lithium is taken orally.

culture and sensitivity (C&S)

laboratory test that grows a colony of bacteria removed from infected area in order to identify the specific type of bacteria and then determine its sensitivity to a variety of antibiotics UAP CAN COLLECT THIS!!

ataxia

lack of muscle coordination **MS patients**

lacto-vegetarian diet

lacto-vegetarians eat milk, cheese, and dairy foods, but avoid meat, fish, poultry, and eggs

IV device for blood transfusion

large bore catheter

position to put unconscious pt in for suctioning

lateral position so tongue won't obstruct

PMI (point of maximal impulse)

left ventricle makes this midclavicular line at 5th intercostal space

prioritization of pts

life before limb acute before chronic actual before potential Maslow's Hierarchy trends vs. transient findings (i.e. temp increasing over hours vs. a sporadic increase) emergencies and complications over expected findings determine priority action based on EBP

pt with DVT

limit sitting time

acetaminophen effects

liver

statins - test for?

liver fx

DM 2 food plan - "clean my plate"

low fat low glycemic index high fiber foods (30-35 g/day) monitor carbs reduce sodium reduce intake of sucrose limit intake of alcoholic beverages

Dumping syndrome diet

low fiber, HIGH FAT, HIGH PROTEIN small frequent meals WAIT 1 hour after meals to drink fluids LIE DOWN immediately after eating to slow down peristalsis PB okay avoid sugary desserts, empty calories

Enoxaparin (Lovenox)

low molecular weight heparin **Good for post surgery to prevent DVT**

Thrombocytopenia

low platelet count

kidney disease diet

low protein limit salt limit potassium (no carrots, tomatoes, potatoes, bananas) limit phosphorous (turkey, chicken, dairy) fluid intake must be monitored low protein

Meniere's disease diet

low sodium

LDL

low-density lipoprotein normal range <100

radium implant

low-residue diet to decrease bowel movements & prevent dislodging of implant nurse should spend no more than 30 minutes in room

Where to tape catheter for men

lower abdomen

abdominal cramping during enema

lower ht of enema container this would reduce flow & thus relieve pressure

recumbent position

lying down in any position

prone position

lying on abdomen, facing downward (head may be turned to one side) legs extended

Trendelenburg position

lying on back with body tilted so that the head is lower than the feet

lithotomy position

lying on back with legs raised and feet in stirrups

dorsal recumbent position

lying on the back with the knees flexed and separated

After a Mastectomy surgery elevate the affected arm to prevent?

lymphedema

Atelactasis

major concern after surgery CADB incentive spirometer

Wilms tumor

malignant tumor of the kidney occurring in childhood DO NOT PALPATE ABDOMEN

Crede's maneuver

manual pressure on the bladder to promote bladder emptying

food blockage ileostomy

massage around the ileostomy

clang association

meaningless rhyming of words

Measles virus

measles incubation period = 7-21 days if child is not vaccinated and exposed; you can give child MMR vaccine within 3-6 days of exposure it could also prevent it from infecting child/person

Thrombocytopenia nursing intervention

measure abdominal girth daily to monitor for internal bleeding

creatinine clearance

measure of the efficiency of the kidneys in removing creatinine from the blood normal range = 85-135

how to time the frequency contractions

measure the time from the beginning of one contraction to the beginning of the next

continuous pulse oximeter monitor for an infant

measures oxygen levels in the blood cover with clothing to prevent light or heat affecting reading place on wrist or foot no gel needed

serum albumin level

measures the main protein in the blood and is used to determine protein status 3.5-5 good for measuring nutritional status

incident report required for

med error procedure/treatment error equipment related injury/error needlestick injuries client fall/injury visitor/volunteer injuries threat made to client or staff loss or property (dentures, jewelry, personal wheelchair)

newborn vomiting green

medical emergency!!! this is bile made by the liver and means an obstruction call for HCP immediately - emergency

herbal supplement for sleep/circadian rhythm

melatonin

remote memory

memory for experiences in the distant past

potential allergic reaction is

mild rash

Full liquid diet includes

milk, yogurt, custard, ice cream, pureed vegetables vegetable juice, cooked refined cereals, pudding, protein drinks/shakes

Fludrocortisone (Florinef)

mineralocorticoid check serum electrolyte levels of pt

In the chain of infection, hand washing breaks is the

mode of transmission

most effective method of sterilization

moist heat (steam)

PAD interventions

moisturize skin daily keep legs below heart level when sitting regular exercise/ROM **blood cannot move away from the heart to periphery so you want to make it easier for blood to go down**

priority during vaso occlusive crisis

monitor O2 sat secondary - antibiotics increase fluids warm compresses

PICC line - catheter dislodges complications

monitor blood return and monitor for discomfort in jaw, chest, ear contact provider

after any procedure using barium

monitor pt for constipation

IADLs (instrumental activities of daily living)

more complex activities. Laundry, shopping for groceries, using a telephone, cooking, shopping, housekeeping, finances, taking medications, preparing meals, fixing things around the house, lawn care,

sigmoid colostomy

more formed stool - left lower quadrant

stool produced in ascending & transverse colon

more liquidy/semi liquid DOES NOT NEED IRRIGATION empty pouch when 1/3 full

4 pt gait pattern

most closely resembles normal walking - for full weight baring

gynecoid pelvis

most favorable pelvis for successful labor considered a typical female pelvis (although only 50% of women have it) round shape blunted ischial spines wide pelvic arch

child abusers

most grow up as been abused or witnessed abuse men & women equally abuse children teens hx of drug abuse

number of teeth at age 1

most kids have between 2-4 teeth

Hep A contracted by

mostly via fecal-oral route poor hand hygiene and improper food handling seen in developing countries **best prevention is hand hygiene before and after meals**

Pelvic tilt (inclination)

movement of the pelvis so the anterior superior iliac spine moves anteriorly or posteriorly to produce an anterior or a posterior tilt or inclination of the pelvis

Clonus

muscle spasm or twitching

Addison's disease hallmark symptom

muscle weakness Nausea / vomiting Weight loss Weakness / fatigue / lethargy craves salt! Hyperpigmentation ***CAUSES SEVERE HYPOTENSION*** -

Dilantatin (phenytoin) side effects

n/v drowsiness head spinning trouble sleeping nervousness AE = swelling & bleeding gums

pyloric stenosis

narrowing of the pyloric sphincter that blocks the passage of food from the stomach into the duodenum pyloric stenosis (HPS) is the most common abdominal surgical condition in newborns and infants **projectile vomiting**

TB precautions

negative pressure room N95 respirator mask AIRBORNE precautions

acute manic epidosde SS

neglected hygiene inadequate nutritional intake wearing bizarre clothing, jewelry insomnia flight of ideas distractibility euphoric mood private room poor impulse control delusions insomnia neglect hygiene

fixed and dilated pupil represents a

neurological emergency BLACK TAG - most likely not make it

priority for warm, tender calf

neurovascular assessment

foods for infants

no citrus fruits, eggs or meat until after 6 months no honey until after 12 months after 8 months - cheese & raw fruits

Colonoscopy prep

no food or drink 8-12 hours prior to the test smoking okay antibiotics not prescribed for most healthy pts day before test - clear liquids 1-2 days prior drinking polyethyline glycol as directed the day prior NPO midnight before day of surgery enemas, laxatives til clear (neomycin/antibiotics if pre surgery)

calcium supplements

no more than 600 mg of calcium can be absorbed at one time so it should be taken 3x daily no more than 2,500 mg daily

long acting insulin peak

no peak

Wilms' Tumor (Nephroblastoma) S/S

non-painful abdominal mass found by parents, also may present with bowel obstruction. Do Not Palpate abdomen!

Prealbumin

normal = 15-35 mg/dl A level < 10.7 mg/dL indicates severe nutritional deficiency. protein measured to evaluate the nutrition status of critically ill patients who are at high risk for malnutrition

prealbumin levels

normal = 15-36 mg/dL

sinus rhythm

normal heart rhythm

Epitaxis

nosebleed **apply direct pressure**

American Red Cross

not a government agency but authorized by the government to assist in natural disasters

molar pregnancy

not a viable pregnancy -dark brown discharge -cannot become pregnant within one year and have frequent checks for cancer

adventitious events

not an everyday occurrence ie workplace violence, bomb scare, etc. everyday events - job loss, divorce

Prevent impetigo by

not sharing towels excellent hand washing avoid close contact with others keep infected area covered with gauze lesions should be soaked with warm water, saline or Burrow's solution and antibacterial soap before adding topical ointment

if you suspect a fellow colleague of alcohol on breath

notify nursing supervisor

hemophilia pt complains of joint pain

notify physician immediately cause of concern b/c can lead to deformities

Bowlby's attachment theory

numbing yearning and seeking disorganization and despair reorganization

B12 deficiency

numbness and tingling of the hands & feet neurologic manifestations

Colostomy irrigation

obtain colostomy irrigation set (cone tip) expel air from tubing position client near toilet instil 500-1,000 mL luke warm water hold irrigation bag 18 - 24 inches above the stoma (shoulder height) lubricate cone and insert into stoma 5 - 10 min in 35 -45 min out stop irrigation if severe cramping

colostomy irrigation

obtain colostomy irrigation set (cone tip) expel air from tubing position client near toilet instill 500-1,000 mL luke warm water hold irrigation bag 18 - 24 inches above the stoma (shoulder height) lubricate cone and insert into stoma 5 - 10 min in 35 -45 min out stop irrigation if sever cramping

Quickening

occurs week 12-14

thrombosis

occurs when blood clots block your blood vessels. 2 main types of thrombosis: Venous thrombosis is when the blood clot blocks a vein. Veins carry blood from the body back into the heart. Arterial thrombosis is when the blood clot blocks an artery.

Addison's disease

occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone

vaso-occlusive crisis

occurs when the microcirculation is obstructed by sickled RBCs, causing ischemic injury to the organ supplied and resultant pain.

newborn feeding

offer breast immediately after birth & feed every 2-3 hours thereafter

kidney transplant rejection - 1st sign

oliguria no or low urine output

Negligence

omission of that which ought to be done

ovo-vegetarian diet

omits all meats, fish, poultry and dairy products but allows eggs

defibrillator - adult equip to use on child

one pad on front of chest one pad on back

Preeclampsia (S/S & Complications)

onset after 20 wks gestation Swelling of the face and hands PROTEINURIA 300 mg in 24 hours protein to creatinine ratio 0.3 urine dipstick 1+ HA or vision changes BP 140/90+ 4 hours apart or 2 separate occasions BP 160/110 confirmed

shingles precaution

open lesions transmit by both AIR AND CONTACT need contact precaution, airborne precaution, negative airflow

Beers Criteria

originally developed by a group headed by Dr. Mark H. Beers, listing of drugs that carry high risks for older adults and criteria for potentially inappropriate medication use in older adults

manifestations of acute otitis media

otalgia (ear pain), fever, and hearing loss, pulling on the affected ear, inability to eat tympanic membrane will be very red typically occurs in children <2 yo

chorion

outermost layer of the fetal membrane

Homan's sign

pain in *calf upon dorsiflexion* of foot and may indicated thrombophlebitis A positive Homans's sign (calf pain at dorsiflexion of the foot) is thought to be associated with the presence of thrombosis.

Ciprofloxacin (Cipro) - key point

pain in Achilles tendon area is of concern!

arthralgia

pain in a joint

hemophilia concern

pain in joints - could be bleeding in joints

infiltration of IV

pallor coolness swelling at IV site

cystic fibrosis & salt

parents should increase child's salt intake in summer/hot weather

subtotal thyroidectomy removes

part of thyroid

cardiac catheterization (CC)

passage of thin tube (catheter) through veins or arteries leading into heart; used to detect heart abnormalities, to collect cardiac blood samples, and to determine pressure within heart

patent ductus arteriosus (PDA)

passageway (ductus arteriosus) between the aorta and the pulmonary artery remains open (patent) after birth loud, machine like murmur

chain of infection model

pathogen, reservoir, method of transmission, susceptible host

Deep breathing exercises

patient concentrates on breathing and muscle movement; oxygenates blood stream and brain oxygen supply **breathe in the through the nose - hold for 3 seconds - breathe out through the mouth** repeat for 2-5 minutes

post lumbar puncture

patient should lie flat in supine to prevent headache and leaking of CSF.

constricted pupils indicate

patient using a CNS depressant drug eye drops

Autonomic Dysreflexia

patients with spinal cord injuries are at risk for developing autonomic dysreflexia (T-7 or above) raise HOB; could be caused by full bladder, fecal impaction or tight clothing

Cheyne-Stokes respiration

pattern of breathing characterized by a gradual increase of depth and sometimes rate to a maximum level, followed by a decrease, resulting in apnea

The dorsal recumbent position is used for what?

pelvic exams in hospital beds and foley insertions abdominal data or wound evisceration

obese pt with low O2

perform head tilt & chin lift to open airway

Dorsal

pertaining to the back

epistaxis interventions

pinch sides of nose keep client seated keep pt calm

during epistaxis with pt with thrombocytopenia

pinch soft portion of nose

removing NG tube

pinch tube while removing tube this decreases the risk of aspiration

to assess for complications of parathyroidectomy

place BP cuff on arm and inflate pressure to > systole BP and hole in place for 3 minutes to assess for Trousseau's sign

post mastectomy care

place client in semi-Fowler's affected side's arm on several pillows (to drain)

to take a BP

place cuff 1" above antecubital space make sure cuff encircles 80% of pt's upper arm cuff too loose - BP will read too high cuff too tight - BP will read too low

after cleft palate surgery

place infant in side-lying position

how to obtain urine specimen from child in diapers - non-sterile

place urine balls into diaper, when wet, squeeze urine from cotton ball into dipstick

post-mastectomy client's affected arm should be

placed on pillow to enhance drainage

Gout - tell pt

plenty of fluids achieve & maintain a healthy weight restrict alcohol consumption avoid red meat and seafoods to reduce purines!

Platelets (thrombocytes)

plug breaks in blood vessels a formed elements in the blood that is responsible for aiding in the clotting process

S/S of diabetes

polyuria >200 mL/hr polydipsia (thirst) polyphagia- increased appetite (usually means frequent swallowing) fatigue/weakness slow wound healing recurrent infections type 1 - sudden wt loss; N/V, abdom pain

crackles (rales)

popping sounds heard on auscultation of the lung when air enters diseased airways and alveoli; occurs in disorders such as bronchiectasis or atelectasis

How to perform a Heimlich thrust on an obese or pregnant person?

position your hands a little higher than with the Heimlich continue with thrusts as in Heimlich

lateral position used for

post-op following abdominal surgery tonsillectomy adenoidectomy client who is unconscious pt during a seizure post-op pyloric stenosis of the lower scapula post-op following liver biopsy rectal irrigations

continuous passive motion device

post-operative, promote recovery after joint surgery (12-14 hrs a day) line up the frame joints with the client's knee INITIATE CLIENT IN SUPINE POSITION then at 20 degrees if client can tolerate

severe hyperkalemia treatment

potassium (K)+ > 7 -IV admin 50 mL 50% dextrose with 10 units regular insulin -if ECG changes present calcium gluconate should be given before insulin/dextrose to stabilize heart muscle

Spironolactone (Aldactone)

potassium sparing diuretic

calcium carbonate

preferred supplement for pts with osteoporosis take in multiple doses with food

congenital

present at birth but not necessarily hereditary

PICC line - catheter occlusion complication

prevent kinks reposition arm flush catheter between meds administer approved anti-thrombolitic

placental abruption risk factors

prior abruption, CHTN, PIH, cocaine, alcohol, tobacco, DM, SLE

eating with a tracheostomy

prior to deflating the cuff, have pt cough to remove any secretions have client sit upright and tuck chin monitor for s/s of infection/fever

Infant with Diarrhea - what type of room?

private room until source of diarrhea is determined

endotrachael intubation

procedure in which a plastic tube is inserted into the trachea to maintain an open airway done when pts are unable to maintain adequate oxygen

Phases of a seizure

prodromal - before seizure, pt may see an aura aural phase - early part of seizure ictal phase - The middle (ictal) stage of a seizure is called the ictal phase. It's the time from the first symptom to the end of the seizure activity. It is during this time that intense electrical activity is occurring in the brain postictal - The final post-ictal stage occurs after the active (ictal) part of the seizure. This is the recovery stage and during this phase any physical after effects of the seizure are felt. The type of seizure and the part of the brain involved will determine how long it takes for a person to return to their usual self.

reverse isolation

protects a patient who is highly susceptible to infection you are trying to protect the pt from everyone else on the floor/unit

Patient Self-Determination Act of 1990

protects patient rights including the right to agree to or refuse medical treatment

foods to promote wound healing

protein vitamin C (collagen)

Tetralogy of Fallot interventions

provide calm environment upon waking sooth infant when crying offer pacifier swaddle infant provide small, frequent feedings do not interrupt sleep

school age children in hospital

provide homework!!!

Physical Therapist (PT)

provides therapy in the form of heat, cold, massage, ultrasound, electricity and exercise to residents with muscle, bone and joint problems. A PT may help a person to safely use a walker, cane or wheelchair.

PQRST Pain Assessment Method

provocation/palliation quality/quantity region/radiation severity scale timing

Lateral (side-lying) position

pt on side with pillow under leg, back and head

How to use a cane

pt should hold cane on the stronger side of the body place it forward 6-10 inches and move his weaker leg forward to the cane

PPSV vaccine is for

pts who are immuno compromised

if client gags while inserting NG tube

pull tube back a little bit

skin traction

pulling effect on the skeletal system by applying devices to the skin

Swann-Ganz catheter

pulmonary artery catheter Tip in proximal right or left pulmonary artery

PERRLA

pupils equal, round, reactive to light and accommodation

How to prevent SIDS (sudden infant death syndrome)?

put baby to sleep on back give infant a pacifier at bedtime smoke-free home breastfeeding

After cleft palate repair

put child in side lying position **first 24 hours clear liquids only**

if trach comes out

put in obturator then insert new trach

after tonic clonic seizure

put pt in side-lying position b/c will have excess saliva the patient will be tired and want to sleep

brachytherapy

radiation therapy in which the source of radiation is implanted in the tissue to be treated -restrict time to 30 minutes per shift -visitors distance of 6' -assign client to private room w/ private bath -all staff must wear a lead apron b/c if they will be providing direct care/closer than 6' to pt -pt must remain on bedrest while on radiation therapy

with pacemaker do not

raise both arms above head use cell phone on opposite ear avoid contact sports unless you wear padding avoid heating pads and electric blankets

randomized clinical trial

randomly chosen subjects used in control and experimental groups to test an independent variable

Humalog (insulin lispro) meal time?

rapid acting insulin meal should be on tray in front of pt to eat immediately post injection

red man syndrome

rash on the upper body caused by certain anti-infectives Vancomycin comes from infusing too fast!

chest compressions for adults

rate of 100 to 120/min compress at least 2 inches (5 cm) allow the chest to recoil completely minimize interruptions

parietal lobe

receives sensory input for touch and body position

peak flow meter (PFM) recording

record highest measured reading

EMG (electromyography)

records the electrical activity of a muscle or group of muscles muscle activity

rifampin (anti-TB med)

red colored urine normal

lactulose (Cephulac)

reduce blood ammonia by excreation of ammonia by stools 2 -3 soft stools per day **IMPROVES MENTAL STATUS**

gauge

refers to the diameter of its lumen the larger the gauge, the smaller the needle

Kidneys function

regulate acid/base balance filter blood waste, excess H2O, impurities controls pH, sodium levels, and K levels in the body Produces hormones that manage RBC production & regulates BP

GERD treatment

relief from lifestyle changes (e.g. avoid problematic food, elevate head during sleep) and over-the-counter medications (e.g. antacids) is usually temporary. eat small meals with sips of water to help food passage Long-term medication may be needed such as PPI low fat small, frequent meals avoid spicy avoid tobacco, alcohol, chocolate & peppermint

polycythemia vera treatment

relies primarily on phlebotomy to reduce hematocrit - bleed them/ drain them (usually 1 or so a week or monthly)

frostbite care

remove clothing place in warm water for 20 minutes and then loosely bandage

care of minor burns

remove clothing and debris cool & cleanse wound antibacterial topical application pain management

Hypermagnesemia causes

renal failure antacids

Steps in inserting a urinary catheter

rep: - consent - allergies - wash hands (medical scrub) Sterile field by opening Foley kit using *sterile technique* Sterile gloves using clinic gloving Drape patient --> using sterile technique Women -- spread labia with non dominant hand and do not remove -- it is now contaminated Prepare genitalia - soaked cotton balls (soak before starting) - Minimum of 3 cotton balls - DO NOT PASS OVER STERILE FIELD WHEN DISCARDING *Do NOT inflate balloon until urine return* want to make sure you are in the right spot balloon inflated

RACE

rescue alarm contain extinguish

High Fowler's position used for

resp illness with dyspnea emphysema dcardiac problems with dyspnea feeding hiatal hernia during & after meals insertion of NG tube

Infant with cardiac dysfunction

respond to his cries immediately - crying uses up Oxygen which strains his heart

signs of hypoxia

restlessness cyanosis tachypnea

Rights of Delegation

right task right circumstance right person right direction/communication right supervision

permanent tooth traumatically comes out (like in sports)

rinse & reinsert it if this doesn't work, place in MILK or saline and then rush to emergency dept.

Fluticasone (Flonase) inhaler

rinse mouth after inhalation

6 months old motor skills

rolls back to front, can hold a bottle

frothy, pink-tinged sputum

s/s of pulmonary edema

PICC line - catheter embolism complication

secure catheter avoid pulling follow safe practices for catheter removal

if a blood transfusion reaction occurs - what to do with blood?

send to BLOOD BANK so they can determine if the blood is contaminated, etc.

GH deficiency in children - how to check

serum insulin growth factor 1 (GF-1)

placenta abruption s/s

severe abdominal and back pain uterine rigidity bright red or dark vaginal bleeding maternal hypovolemia

metabolic alkalosis causes

severe vomiting, excessive GI suctioning, diuretics, excessive NaHCO3

growth hormone deficiency

short stature, delayed growth, delayed puberty (sexual development)

Contractures

shortening and stiffening of muscles **Kathleen's fingers/hands**

space between axilla & pad of crutches

should be 1-2" (2.5-5 cm) 30 degree elbow flexion

cane length

should be equal to the distance between the greater trochanter and the floor; HAVE CLIENT WEAR SHOES WHEN MEASURING

Chest compressions during CPR

should not be interrupted for more than 10 seconds when assessing for pulse or chest rise/fall

Acetaminophen (Tylenol)

should not be used in liver dysfunction

manifestation of ectopic pregnancy

shoulder pain

side effect vs adverse reaction

side effect is benign adverse reaction - possibly cause death or serious health issue

Ebola precautions

single client airborne precautions DOOR CLOSED AT ALL TIMES workers should wear impermeable gown/overalls N95 mask full face mask double gloves single use boot covers single use apron maintain a log of all visitors/workers in and out

Down's syndrome symptoms

single crease across palm of hand

child with NG tube susceptible to

sinus infection

after taking nitroglycerin tablets

sit down when taking this med

Thoracentesis position

sitting position, arms raised and resting overbed table.

to relieve epididymitis

sitz bath ice packs best rest elevate scrotum

Buck's Traction (skin traction)

skin traction applied to both legs client's backside off bed about 15 degrees

4 years old gross motor skills

skips and hops on one foot, throws a ball overhead

benzos and alcohol

sleep walking! driving! cooking! pts can perform complex behaviours when combining alcohol & benzos

Vesicle

small fluid filled sac; blister varicella/chicken pox herpes

wheal

small, round, raised area on the skin that may be accompanied by itching; usually seen in allergic reactions **hives**

abruptio placenta risk factors

smoker cocaine/drug use advanced maternal age maternal HTN

Cranial Nerve 10: Vagus

somatic motor impulses to larynx and pharynx (when you go to vagus you want to hear someone sing with their larynx ie. voice box) say "ah"

Trendelenburg position used for

some surgeries during labor if umbilical cord pressure needs to be relieved if prolapsed umbilical cord

Tracheostomy cuff

some trach tubes have an inflatable cuff near the outer end to keep them from coming out and produces a seal between trachea and the cuff - *preventing air from leaking out. prevent aspiration when eating If your tracheostomy tube has a cuff, the speech therapist or provider will ensure the cuff is deflated during meal times. This will make it easier to swallow. If you have a speaking valve, you may use it while you eat. It will make it easier to swallow.

allergies babies tend to outgrow

soy cow's milk eggs

babies outgrow allergies to

soy cow's milk eggs

Ventricular paced rhythm

spike before QRS

Supine used for

spinal cord injury (NO PILLOW)

Prone (used for)

spine and structures of the back client following lumbar puncture for 6-12 hours post-myelogram post-op following tonsillectomy & adenoidectomy

best position for babies with TOF

squatting! knee to chest when being hel

LPN should be assigned

stable clients who are unlikely to experience changes in status

vaso occlusive crisis in sickle cell

start iv fluids 1st to promote hydration and circulation

varicella/chickenpox in children

starts with red spots. They can appear anywhere on the body and might spread or stay in a small area. The spots fill with fluid and become blisters. The blisters may burst. ... The spots scab over. New spots might appear while others are becoming blisters or forming a scab.

circumcision techniques

sterile technique pacifier dipped in sucrose formula (no analgesia or bottle due to aspiration) during circumcision baby is wrapped in a special board or blanket

peritoneal dialysate

sterile technique when spiking and attaching bag of dilysate

bumethasone

steroid therapy. It stimulates surfactant production in the alveolar spaces and causes less tension when the infant breaths

if neonate after delivery does not breathe spontaneously

stimulate newborn to cry suction newborn assess heart rate cut umbilical cord

ways to stimulate voiding

stimulate spontaneous voiding - take pt to sit on toilet put hands in warm water use bottle to spray warm water over perineum

purpose of estrogen

stimulates uterine development & prepares uterus for pregnancy esp day 15-24

femoral artery

the major artery supplying the leg (groin)

open angle glaucoma

the most common form of glaucoma, where the trabecular meshwork gradually becomes blocked, causing a buildup of pressure HALOS loss of peripheral function

closed angle glaucoma

the opening between the cornea and iris narrows so that fluid cannot reach the trabecular meshwork EMERGENCY

Sims position

the patient is lying on the left side with the right knee and thigh drawn up with the left arm placed along the back

Piaget's Concrete Operational Stage

the period of cognitive development between 7 and 12 years of age, which is characterized by the active, and appropriate, use of logic

embryonic stage

the period of prenatal development that lasts from the 2nd week until about the 8th week

Point of maximal impulse (PMI)

the point where the apex of the heart touches the anterior chest wall and heart movements are most easily observed and palpated below the 5th intercostal space mid-clavicular

conjunctival sac

the potential space between the eyelids and the eyeball, lined by the conjunctiva, the delicate membrane that lines the eyelids and covers the exposed surface of the sclera

conjuntival sac

the potential space between the eyelids and the eyeball, lined by the conjunctiva, the delicate membrane that lines the eyelids and covers the exposed surface of the sclera

ventricular fibrillation

the rapid, irregular, and useless contractions of the ventricles

biopsy

the removal of living tissue from the body for diagnostic examination NPO for 4 hours prior

parathyroidectomy

the surgical removal of one or more of the parathyroid glands

bronchoscopy

the visual examination of the bronchi using a bronchoscope tissue sample may be obtained

pincer grasp/Cheerio's grasp

the well-coordinated grasp that emerges at the end of the first year, involving thumb and index finger opposition

placenta previa s/s placental abruption s/s

there is NO PAIN, but there is bleeding there IS pain, but NO BLEEDING (board like abd)

3rd degree burn

thermal damage to all three layers of the skin, also cooks blood vessels, so it appears to be dry and leathery- color depends on agent

foam padded cushion

these are okay to protect skin integrity

The vitamins a CF patient must have supplemented are:

they have trouble absorbing vitamins that need fat to be absorbed -- A, D, E, and K. People with CF also need to get water-soluble vitamins, which include vitamin C and the B-complex vitamins, folic acid, biotin, and pantothenic acid. They are called water-soluble because they are easily absorbed with water in the body.

Finasteride (Proscar)

used for BPH

Rectal Diazepam (Diastat)

used for client in status elipticus which is a life threatening emergency

Pavlik Harness

used for hip dysplasia in infants used for babies <6 months old diaper underneath socks T-shirt underneath to protect skin integrity do not double diaper **when changing diaper, keep baby's knees apart at all times**

Trach tube with cuff

used in clients with risk for aspiration when pt is awake, difficult to swallow & talk when eating, fully or totally deflate cuff

Troponin

used to diagnose MI value of 0.7 indicates cardiac muscle damage normal values = troponin I <0.5 troponin T = <0.1

Hydrocortisone topical

used to treat a variety of conditions it is used to treat redness, swelling, itching, and discomfort of various skin conditions. Hydrocortisone is in a class of medications ...

Black cohosh

used to treat hot flashes, palpitations, and irritability menopausal symptoms

Alendronate sodium (Fosamax)

used to treat or prevent osteoporosis take with full glass of water on an empty stomach

Biophysical Profile (BPP)

uses a real-time ultrasound for visualization of physical and physiological characteristics of a fetus. score of <6 send client to delivery score of 4 could be possibly asphyxia

NPH and regular insulin

usually administered 2x day lasts 12-18 hours

Dumping syndrome

usually happens after bariatric surgery food moves too quickly from your stomach into your intestine.

non-rebreather mask

usually short term can deliver 60-95% oxygen

Warfarin (Coumadin) taken how long?

usually taken 3-6 months

Tier 2 infection prevention

utilize transmission based precautions by hand hygiene, PPE, and environmental controls (private room/isolation), etc.

THE LITHOTOMY POSITION IS USED FOR PATIENTS IN WHICH CIRCUMSTANCE

vaginal, pelvic, and rectal examinations

chronic venous insufficiency

venous circulation is inadequate due to partial vein blockage or leakage of venous valves brownish, hardened skin on lower extremities leathery skin is highly prone to skin breakdown, ulcers

Virchow Triad of DVT

venous stasis (bed rest, varicose veins, dehydration, heart failure) endothelial damage (direct trauma, central lines repetitive motion injury) altered coagulation (pregnancy, cancer, birth control pills, post menopause, hypothermia and septicemia)

If a tracheostomy tube is dislodged, what should you do?

vent the client using a resuscitation bag & facemask

post - MI - what to watch for

ventricular dysrhythmias

herpes zoster (shingles) contagion

viral infection affecting peripheral nerves You can spread the varicella zoster virus to people who've never had chickenpox and haven't been vaccinated. You're contagious until all of the sores have crusted over.

Low WBC counts may indicate

viral infections, pneumonia, autoimmune diseases, or cancer

occipital lobe functionterm-1015

vision

total lung capacity

vital capacity + residual volume

postpartum breastfeeding mother should increase which vitamins?

vitamin C

when taking Warfarin, avoid

vitamin K spinach, broccoli, kale, other green leafy GF or GF juice

Supraglottic swallow technique

voluntarily close/protect the airway during food intake

phlebitis, infection & thrombosis characteristics

warmth redness swelling

snake bite in a child

wash bite area with soap and water cover with a clean, dry dressing immobilize the area calm the child place child in reclined position remove restrictive clothing

EEG prep

wash hair prior

hypothalamus function

water balance/bp/temp regulation/hunger/thirst/sex.

dumping syndrome manifestations

weakness sweating palpitations dizziness borborygmic urge to defecate diaphoresis pallor and light-headedness

to suppress lactation post-partum

wear support bra

when to resume sexual intercourse after childbirth

when bleeding stops could be 2-4 weeks

Fowler's position used for

white pt is eating thyroidectomy cataract removal resp illness cardiac problems with dyspnea during procedures such as NG tube insertion and suctioning -allows for better chest expansion & ventilation as well as better dependent drainage, after abdominal surgeries. bleeding/esophageal varices

Pertusisis

whooping cough

Grave's Disease/ hyperthyroidism symptoms

wide ranging, anxiety, irritability, fatigue, rapid or irregular heartbeat, fine tremor, sensitivity to heat, enlargement of thyroid, weight loss, change in menstrual cycle, ED, reduced libido, frequent BM, bulging eyes, and thick red skins on shins or tops of feet.

Dilation

widening, stretching, expanding

signs of hearing deficit in toddler

withdrawn monotone speech speaks in a loud voice difficult to understand appears inattentive when given directions or appears "dreamy" and "far off"

newborn should pass meconium

within first 24 hours

Alkaline phosphatase

would be elevated in pts with metastatic bone disease

Primary intention healing

wounds that heal under conditions of minimal tissue loss low risk for infection

pyelogram

x-ray of the renal pelvis dye injected into kidneys, ureter & bladder to determine issues

myelogram

x-ray of the spinal cord

breastfeeding stools

yellow 6-10 per day loose seedy (remember clinical at school)

can i get pregnant when breastfeeding?

yes! mother still ovulates while breastfeeding!

Serotonin syndrome symptoms

• Hyperactivity or restlessness • Tachycardia → cardiovascular shock • Fever → hyperpyrexia • Elevated blood pressure • Altered mental status (e.g., delirium) • Irrationality, mood swings, hostility • Seizures → status epilepticus • Myoclonus, incoordination, tonic rigidity • Abdominal pain, diarrhea, bloating • Apnea → death

metabolic acidosis causes

• Incomplete oxidation of fatty acids. May be due to (1) diabetic ketoacidosis, (2) starvation, or (3) shock, resulting in lactic acidosis. • Abnormal loss of alkaline substances. This may be caused by deep, prolonged vomiting (leading to excessive loss of base products) or severe diarrhea and loss of pancreatic secretions. • Renal insufficiency and failure: kidneys lose ability to compensate for acid overload; thus, H⁺ ions are not excreted, nor is HCO₃⁻ retained in normal amounts. • Salicylate poisoning due to accumulation of ketone bodies produced as a result of the increased metabolic rate.

splenic sequestration sickle cell crisis

• Life threatening—death can occur within hours • Blood pools in the spleen • Signs • Profound anemia, hypovolemia , and shock, enlarged spleen on palpation

Passive immunity: Natural

• Mother to baby (placenta, colostrum and breast milk)

pertussis treatment and prevention

•Antibiotics effective during catarrhal stage; ineffective in stage 2 •Prevented with vaccine (DTaP): Booster recommended every 10 years

Signs of cataracts

•HALOS! =*Clouded, blurred* or dim vision •Difficult with vision at *night* •*Sensitivity* to light and glare •Seeing *"halos"* around lights •Frequent *changes in eyeglasses* or contact prescriptions •Fading or *yellowing* of colors •*Double vision* in a single eye


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