NCLEX

auscultating heart sounds

" All People Enjoy Time Magazines" • Mitral valve = PMI (point of maximum impulse) & Apex found • Erbs point → ascultate murmurs • loud blowing sound @ 2nd intercostal space (ICS), right sternal border = murmur @ aortic area • s3 (ventricular gallop) → may be normal in young adults especially active ones *new s3 in older adults → volume overload or HF • phlebostatic axis → 4th intercostal space, mid-axillary line = used to measure bp or CVP (hemodynamic monitoring)

DI (diabetes insipidus)

" Dry Inside " • too little ADH produced in pituitary • LOW ADH = HIGH UO, HIGH Na in the body, freq uo dilutes urine = LOW specific gravity 7 D's • D: diurese " drained fluid " (high UO) • D: diluted urine (LOW specific gravity) • D: dry inside " high & dry " labs (HIGH serum osmolarity / hyperosmolarity, HYPERnatremia) • D: drinking a lot, thirsty (polydipsia) • D: dehydrated (dry mucosa, skin) • D: decrease bp • D: DDAVP Risk factors: damage to brain (eg. tumors, trauma, surgery) Interventions: daily weights, desmopressin, vasopressin NCLEX TIP: desmopressin decreases UO "pressin" the bp up = monitor for headaches, confusion, agitation *priority ( → low na resulting in sz ), effectiveness of desmopressin = decreased UO

hyperthyroidism / Grave's disease

" Graves' disease → Gains disease " = " HIGH energy HIGH metabolism " • thyroid creates energy, metabolism, & calcitonin to put calcium in the bone • HIGH T3 & T4, low TSH • grape eyes (exopthalamus) • golf balls in throat (goiter) • HTN • tachycardia (heart palpitations, afib) • high weight loss • high TEMP/ heat intolerance (hot & sweaty skin; diaphoresis) • high gi (diarrhea) • tremors Risk factors: graves disease, excess iodine & levothyroxine (from hypo) Interventions: frequent meals & snacks; High cal, protein, & carb diet 4,000 - 5,000 calls/day), NO high fiber, caffeine, or spicy foods, use eyepatch or tape down eyelids, meds: stops thyroid from making T3 & T4 • methimazole (no preggers) • PTU (propylthiouracil) (safe for preggers) → report fever / sore throat • SSKI (potassium iodide) → S: Shrinks thyroid before removal to reduce bleeding → S: Stains teeth (drink w/ straw & juice) → K: Keep 1 hr apart from other meds • Beta blockers " -lol " → for htn & tachycardia • RAIU (radioactive iodine uptake): radioactive pill that destroys thyroid → give preg test (must be neg) → remove jewelry & dentures → 5 - 7 days before hold antithyroid meds → awake no anesthesia; conscious sedation → NPO: 2 - 4 hr before, 1 - 2 hrs after → AVOID everyone for up to 2 - 3 days (no sharing restroom → flush 3xs, utensils, laundry, no crowds / preggers) • Thyroidectomy: post-procedure → monitor for thyroid storm* → airway: laryngeal stridor, noisy breathing, hoarseness or weak voice **priority → monitor voice strength & quality → monitor for bleeding around pillow & insertion site → HOB @ 30 - 45°, neutral head & neck alignment, NO flexing or extending neck → monitor for hypocalcemia "remove the T, check the C" NCLEX TIP: TSH will always be the OPPOSITE so look @ t3 & t4 to determine if hyper or hypo Thyroid Storm (Thyrotoxicosis) *priority • extremely highhhhh • agitation, restlessness, & confusion + HTN crisis *early s/s → htn crisis 180/100 + = MI, CVA, aneurysms • hypocalcemia: tingling circumoral & fingers, muscle twitch, trousseau, chvostek • rapid onset elevated bp, hr, & temp (fever) • trach setup must be at bedside

Airborne precautions

" MTV " • M: Measles • T: Tb • V: Varicella (chickenpox); Herpes zoster/shingles → active shingles lesion is open to contact & airborne precautions → once crusted no longer need isolation precautions N95, neg pressure room, pt wear mask outside room

Droplet precautions

" SPIDERMan " • S: Sepsis, scarlet fever, Strep • P: Pertussis, Parvovirus, Pneumonia • I: Influenza • D: Diphtheria • E: Epiglottitis • R: Rubella, RSV • M: Mumps, Meningitis, mycoplasma • AN: Adenovirus • Adenovirus + contant & droplet • Influenza + contact • parvovirus + contact → parvovirus that infects puppies " You pet on or touch puppies so contact precaution is also needed with droplet precautions " • transmitted thru cough, sneeze, talking Standard face mask & goggles; single room

FHR Accelerations

" VEAL CHOP " • Variable deceleration → Cord compression • Early deceleration → Head compression • Acceleration → Okay • Late acceleration → Placental insufficiency Interventions: intrauterine resuscitation • discontinuing uterotonics • change maternal position • admin o2 at 8 - 10 L/min • IV bolus of LR or NS • notify HCP *Variable decels show a " V " in FHR monitor → fetal bradycardia → may occur after SROM / AROM → Amnioinfusion for variable - complication for amnioinfusion → uterine overdistension (uterine resting tone elevates & minimal-absent fluids return) - pause infusion & notify HCP

Hypo VS hyperglycemia

" cold & clammy, need some candy " " hot & dry, sugars high " Hypoglycemia: bg < 70 • more severe ** • clammy, cool, pallor • trembling, nervous • HIWASH: headache, irritatible, weakness, anxious, sweaty, shaky, hungry Risk factors: exercise, alcohol, insulin peak times Interventions: awake? Ask to eat: juice, sodas, crackers, low-fat milk, NO high-fat milk or peanut butter sleep? Stab w/ D50 IV/IO Hyperglycemia: bg > 115 • 3 P's: • Polyuria, Polydipsia, Polyphagia Risk factors: sepsis, stress, skip insulin, steroids Interventions: insulin NCLEX TIPS: report to HCP if LFT (eg. creatinine) elevated = diabetic nephropathy, acanthosis nigricans = sign of insulin resistance *glucagon use to tx SEVERE hypoglycemia

hypothyroidism

" lOw & slOw energy " • complete opposite of hyper! • LOW t3 & T4, high TSH • Iow energy: fatigue, weakness, muscle pain, aches, lethargic • low metabolism: weight gain / water gain (eg. edema eyes), fat • low digestion: constipation • low hair loss: alopecia • low mental status: forgetfulness, ALOC (altered) • low mood: super depressed, apathy (lack of interest / motivation), confusion • low libido: low sex drive, infertile • low & slow irregular menstruation: amenorrhea, hypermenorrhea (slow heavy bleeding) • slow dry skin turgor Risk factors: iodine deficiency (iodine is needed to create t3 & t4) Intervention: low cal, fat, cholesterol diet, high fiber diet, freq rest periods, no electric blankets, daily weights, increase fluids, avoid narcotics & sedatives meds: levothyroxine - L.E.V.O. - L: life long w/ sloooow onset (3 - 4 weeks till relief) - E: early morning w/ empty stomach - V: very hyper → high hr, bp, temp; report agitation & confusion (thyroid storm); need to lower dose - O: oh baby's fine (preg safe) no doubling doses → take asap, no cure, no abrupt stop NCLEX TIP: priority is to avoid HashimOtos (myxedema coma) • extreme low & slow • Low RR, BP, HR, Temp → Resp Failure, hypotension, bradycardia, cold intolerance • priority placement: tracheostomy kit / endotracheal intubation setup by bedside, calcium gluconate • risk factors: post thyroidectomy, abrupt stop of levothyroxine

SIADH (syndrome of inappropriate antidiuretic hormone)

"Soaked Inside" • too much ADH produced in pituitary • HIGH ADH = LOW UO = LOW SERUM os = LOW Na 7 S's • S: stops urination (low UO) • S: sticky & thick urine (HIGH specific gravity) • S: soaked inside " low & liquidy " labs (LOW serum osmolarity / hypo-osmolality) • S: sodium LOW (hyponatremia) • S: seizures • S: severe high bp • S: stop all fluids, give salt Risk factors: small cell lung cancer, severe brain trauma, sepsis (eg. meningitis) Interventions: daily weights, sz precautions, • meds: vasopressin (conivaptan) • loop diuretics (eg. furosemide) but na has to be at least 125 • no IV or drinking unless IV 3% Saline (hypertonic sol) & eat salt NCLEX TIP: desmopressin decreases UO "pressin" the bp up = monitor for headaches, confusion, agitation *priority → low na resulting in sz

ET tube (suction)

1. hand hygiene & don clean gloves 2. suction oropharynx (back of mouth) & perform oral care 3. hyperoxygenate 4. advance cath into trachea 5. gently rotate cath while suctioning 6. evaulate pt tolerace & document do not suction for more than 10 secs coughing ok cus it releases secretions repeat if needed & allow 20-30 secs of rest semi / high fowlers

Hyper VS hypomagnesmia

1.2 - 2.1 " Law & Order of muscles " * required for calcium & vit D absorption HYPERmagnesemia " calm & quiet " • heartblock, prolonged PR intervals, cardiac arrest • bradycardia, hypotension • hyporeflexia (decreased DTR) • depressed shallow resp, bradypnea • hypoactive bowel sounds Risk factors: lithium toxicity, RF, adrenal insufficiency Interventions: IV calcium gluconate, IV fluids: LR, NS, loop diuretic *Mag should NOT be administered to pt in renal failure HYPOmagnesemia " buck wild " no sheriff in town! • T wave inversion, st depression, Torsades de Pointes (prolonged QT interval), severe vfib, • tachycardia • hyperreflex (increased DTR) • nystagmus (abnormal eye mvmt) • diarrhea Risk factors: hyperparathyroidism, hypocalemia, hypokalemia, DKA, alcoholism, TPN Interventions: sz precautions, monitor swallowing, uo, & RR, IV mag sulfate *Monitor for mag toxicity w/ IV replacement & treat w/ calcium gluconate NCLEX TIPS: Torsades de Pointes → lethal cardiac arrhythmias (eg. Vfib)

Mg+ (magnesium) lvls

1.2 - 2.1 " law & order in the muscles " *does whatever Ca+ does *mag needed for Ca and vit D absorption

Na+ (sodium) lvls

135 - 145 " blood pressure, blood vol, pH balance " *usually inverse w/ K+ *low Cl copies sympts of high Na

Hyper VS hyponatremia

135 - 145 Maintains BP, BV, pH balance HYPERnatremic: (Big & bloated) like Santa clause • skin: flushed " red & rosy ", edema, low grade fever • polydipsia "too much Na in body makes me thirsty" • hallucinations, lethargy, restlessness, irritability, hyperreflexia (increases muscle tone), twitching NCLEX TIP: late & serious signs: swollen / red beefy dry tongue, n&v, increased muscle tone Risk factors: DI, corticosteroids, KF, burns, dehydration Intervention: daily weight, IV infusion, diuretics, I&O HYPOnatremia: (depressed & deflated) • ALOC • tachycardia, weak thready pulse • resp arrest, seizure, coma Risk factors: siadh, anticonvulsants, SSRIs, lithium, demeclocycline Intervention: NA+ replacement, sz precautions, daily weight, I&O, restrict oral fluids Risk w/ hypertonic sol = cerebral edema Chloride copies Na+ only difference hypochloridema gets fever & excessive diarrhea

Burns & rule of nines

1st degree: superficial (redness) 2nd degree: partial-thickness, epidermis & dermis (painful, red, mottled, white, blisters, appear moist / weeping wound) 3rd degree: full-thickness (brown, white, charred, leathery, nerve damage) 4th degree: full-thickness + muscle & bone (brown, white, charred, leathery, nerve damage) Rule of 9's • head & neck: 4.5% • front or back torso: 18% • front or back arms: 4.5% • genital / perineum: 1% • legs: 9% MAJOR burns → hyperkalemia: tall, peaked T waves* → hyponatremia → elevated H&H • tx: IV LR & NS • assess fluid resuscitation = increased UO & BP, decreased HR

Inhaler use instructions

1st shake 2nd breath out 3rd breath in and hold 5-10 secs 4th exhale repeat 5th wait 5 mins & then use steroid if necessary NCLEX TIP: clean mouth piece 1-2 times per week w/ warm water, does not have to be washed after every use. Only steroids are washed after every use.

stages of pregnancy

1st trimester • 1.1 - 4.4 lbs / wk BMI gain • FHR detection 10 - 12 wks • physical changes: → " morning " sickness → tx: high-protein snack on awakening & bedtime, several small meals of high protein, carbs, vit B, & low fat, between meals drink clear, cold, carbonated bevs, ginger 2nd trimester 14 - 27 wks • 1 lb / wk BMI gain (same in 3rd) • overweight 0.5 lb / wk (same in 3rd) • ultrasound; fetal sex & placenta placement 18 - 20 wks • GDM screening 24 - 28 wks • increased iron intake • physical changes: → quickening 16 - 20 wks → 3rd trimester • 25 - 35 lbs BMI gain total • lowest point of decreased BP → 24 - 32 wks • Tdap → 27 - 38 wks • rhoGAM → 28 wks • group B strep → 35 - 37 wks • avoid NSAIDs • leg cramps especially at night *common sympt • increasing mucoid & pink-brownish blood-tinged vaginal discharge twd end of preg *inactivated flu vaccine (injection) OK *acetaminophen OK to take; do not exceed 4g / day postpartum pregnancy • vitals slightly elevated • nonimmune mothers → MMR live vaccine • OK to use NSAIDs & acetaminophen • sexual activity resumed > 2 wks • ovulation may occur as early as 4wks & before resumption of menses • contraceptives 4 - 6 wks after birth

PO4 (phosphorus) lvls

3 - 4.5 " bone & teeth formation, regulates calcium " *inverse relationship w/ Ca+

rubin's theory

3 phases of postpartum • taking-in: 24 - 48 hrs more dependent health care team to help w/ baby bc of physical recovery • taking-hold: 2 - 10 days mother still learning technical skills but may feel inadequate • letting-go: after 10 days mother becomes comfortable w/ new role

PPD (postpartum depression)

3 types of disorders: • Postpartum blues • temp depression for 2 - 3 days; resolves within 2 wks • s/s: emotional lability, mild sadness, irritability, anxiety, insomnia → tx: supportive care, education, assess for worsening sympts • Postpartum depression • mild - moderate depression for 4 - 6 wks; up to 12 mons, gradual improvement over 1st 6 mons • s/s: extreme sadness, crying, irritability, emotional outbursts, severe mood swings, anxiety, feelings of guilt, hopelessness • high risk pts: no support system → tx: supportive care + pharmacologic / psychotherapy intervention • Postpartum psychosis • most severe form, beginning at 2 wks • s/s: hallucinations, delusions, impulsivity, hyperactivity, confusion, delirium (often associated w/ bipolar disorder) → tx: emergency psych hospitalization, pharm intervention

K+ (potassium) lvls

3.5 - 5 " heart & muscle contraction " *usually inverse w/ Na+

hyper VS hypokalemia

3.5 - 5.0 Maintains Heart & Muscle contraction HYPERkalemia: (tight & contracted) like cramping " HYPERheart " • St elevation & peaked T waves, wide QRS • severe v-fib / cardiac standstill • hypotension & bradycardia • diarrhea & hyperactive bowel sounds • paralysis in extremities • increased DTR • profound muscle weakness Risk factors: renal failure, adrenal insufficiency, ACE-inhibitors, burns, acidosis Interventions: Kayexalate (monitor bowel sounds), 50% glucose w/ insulin, calcium gluconate HYPOkalemia: (low & slow) • flat T waves, St depression, & U waves • decreased DTR • muscle cramping • flaccid paralysis • decreased motility = Hypoactive - absent bowel sounds • constipation • abd distention • paralytic ileus = SBO (small bowel obstruction) * priority * - basically intestines can explode! Risk factors: body fluid loss, vomiting,diarrhea, ng suction,kidney disease, alkalosis Interventions: monitor RR, fall precaution, give K+ No P = No K. If pt is not peeing, do NOT admin K+ (causes kidney damage!) Never give K+ IV bolus; MUST dilute NCLEX TIPS: • severe & profound are late & serious signs = priority pt • Always monitor heart • Never push K+ • Only 10-20mg IV per hour MAX • Slow down infusion if arm starts to burn • Calcium gluconate will immediately protect pt from hyperkalemia dysthrmias (stabilizes the myocardium so other methods maybe used) • IV reg insulin w/ dextrose will temporarily decrease hyperkalemia & prevents hypoglycemia

Hyper vs hypocalcemia

9 - 11 Bones, blood (clotting factors), beats (heart beats) *Inverted relationship w/ phosphorus* HYPERcalcemia: " swollen & slow " " stones, moans, & groans " • shortened QT interval • constipation • deep bone pain • renal calculi (kidney Stones) • decreased DTR & severe muscle weakness • flank pain • decreased bs, hr, rr, & increased bp: htn Risk factors: digoxin toxicity, hyperthyroidism, hyperparathyroidism, lithium Interventions: glucocorticoids, cardiac monitoring, dialysis, calcitonin " calciTONIN = TONIN the cal DOWN " → calcitonin given for paget's disease tooo HYPOcalcemia • trousseau's sign (arm twerk w/bp cuff on) • chrostek's sign (face twitch) • circumoral tingling • tetany, cramps • sz • hyperreflexia (increased DTR), diarrhea • impaired clotting time Risk factors: KF, vit D deficiency, hypomag, hypoparathyroid, celiac disease, lactose intolerances, crohn's disease, alcohol use disorder Interventions: sz precautions, IV calcium replacement: cal gluconate, vit D therapy, monitor for orthostatic hypotension * IV cal must be admin slowly, dilute w/ D5W never NS "think about it's job: bones? Risk for fracture, weak. blood? Abnormal clotting. beats? Heart dysrhythmias"

Ca+ (calcium) lvls

9-11 " bones, blood (clotting factors) and beats (heartbeats) " *inverse w/ PO4 *best friends w/ Mg+ (wherever ca goes up so does mag vise versa)

Cl (chloride) lvls

99 - 106 " blood pressure, blood vol, pH balance " *same s/s of Na+ *only difference is low Cl has fever

food for infants

< 12 mons • no honey for ages (toxin of c. botulinum) → may lead to resp failure 4 - 6 mons • introduce allergenic foods (eg. eggs, fish, peanut products) + other foods > 6 mons • iron-fortified cereals (eg. oatmeal) mixed w/ formula or breastmilk OK • small portions of solid foods ok (< 1 tbsp) 8 - 10 mons • finger foods introduced 12 mons (1 yr) • whole milk transitioned **excess iron ingestion = vit toxicity in children NCLEX TIPS: overfeeding infants whom act disinterested (eg. turning away) may lead to future obesity

Emergency / Trauma Assessment (ABCDEFGHI)

A: Airway (eg. stablize spine) B: Breathing (eg. o2, intubation) C: Circulation (eg. control bleeding, pulse, hr) D: Disability (eg. GCS, LOC) E: Exposure (eg. remove clothing) F: Full set of Vitals / Focused interventions G: Give Comfort (eg. assess & tx pain) H: Head to Toe Assessment (use SAMPLE) I: Inspect posterior (eg. logroll & palpate)

ABGs

ACID-PH-BASE pH: 7.35 - 7.45 PaCO2: 35 - 45 • > 45 = hyperCapnia → high CO2 → priority BiPap** for hyperCapnia • < 35 = hypocapnia → hyperventilation PaO2: 80 - 100 HCO3: 21 - 28 • partially compensated: all three abnormal • fully compensated: pH is normal, but other two are not • uncompensated: pH and another val are abnormal, while co2 or co3 is normal

Antidysrhythmic Agents

Adenosine • slows conduction thru AV node • used to tx: SVT • side effects: flushing, nausea, bronchi spasm, prolonged systole • stops the heart to restart it Interventions: rapid IV 1 - 2 secs push, immediately flush w/ NS AFTER Lidocaine & Amiodarone " Calms the Ventricles " • prolongs depolarization, relaxes smooth muscles, decreases vascular resistance • used to tx: VT, unstable VT, Vfib • Lidocane → s/s: HYPOtension → lidocaine toxicity: NEURO checks **priority • Amiodarone → black box warning! → side effects: bradycardia, cardiogenic shock, pulmonary toxic** Interventions: no heparin, monitor resp complication, PO maintenance dose NCLEX TIPS: pulmonary toxicity: dry cough, pleuritic chest pain, dyspnea** Atropine • increases hr by counteracting acetylcholine • used to tx: bradycardia Interventions: monitor for anticolinergic effects, photophobia

Anxiety disorders

Agoraphobia • extreme fear / anxiety of certain places & situations that might cause panic, helplessness, or embarrassment → outside the home alone → in a crowd or standing in line → traveling in a bus, train, car, ship, or airplane → open spaces (eg. parking lots, marketplaces, bridges) → enclosed spaces (eg. theaters, concert halls, stores, tunnels) *in severe → may be homebound

LFTs (liver function tests)

Albumin: 3.5 - 5 g/dL • Ammonia: 10 - 80 mcg/dL • Total bilirubin: 0.1 - 1.0 mg/dL • Total protein: 6 - 8 g/dL • hepatic enzymes • AST (aspartate transaminase) 0-35 U/L • ALT (alanine aminotransferase) 4-36 U/L • ALP (alkaline phosphatase): 30-120 U/L *elevated AST / ALT = hepatic damage *may also elevate w/ gallstones & pancreatitis bc it can cause blocking of bile duct & backup to the liver

Dx test for musculoskeletal disorders

Arthroscopy • visual internal structure of shoulder or knee joints • cannot be done if infection is present, pt must be able to bend joint @ least 40° Interventions: apply ice & elevate 24 hr post-procedure, collabe w/ pt therapist Bone scan • radio active medium • detects tumors, arthritis, osteomyelitis, osteoporosis, vertebral compression fx, unexplained bone pain Interventions: tech / hcp admin isotope 4 - 6 hr prior to test, pt must lie still 30 - 60 min for imaging, increase fluids post-procedure DEXA (dual-energy xray absorptiometry) • most common bone mineral density for osteopenia & osteoporosis interventions: baseline for women in 40's, loose clothing w/o zippers or metal, remove jewelry, pt stop vit D & calcium supplements 48 hr prior to scan EMG (electromyography & nerve conduction) • evaluates muscle weakness by low-freq electrical stimulation • ALS, carpal tunnel, MG, Gullain-Barre Interventions: pt perform activities for measurement of muscle activity, observe needle insertion site for hematoma, support pt anxiety MRI • dx muscle, tissue, & bone disorders • contraindicated for pt w/ pacemakers, stent, surgical clip Interventions: remove all metal, lie still in supine for 45 - 60 mins

Lower respiratory drugs (asthma meds)

BAM / SLM " bam and slmmmmmm " BRONCHODILATORS Dilate bronchi in lungs B: beta 2 agonist (eg. alBUTEROL) "Brutal asthma attacks" • 1st drug used for severe asthma attacks • activates beta 1 = tachycardia, palpitations • hand tremors, insomnia/ difficulty sleeping • increased productive cough Interventions: do not take at night, 2-4 puffs q20 mins for 3 rounds, if med not effective after = notify HCP, monitor RR, o2 sat NCLEX TIP: the only rescue inhaler & used BEFORE steroid inhale! AVOID beta blockers (eg. Atenolol) = Broncospasms AVOID NSAIDs (eg. Naproxen, ibuprofen) A: anticholinergics (eg. ipraTROPIUM) • mod-severe asthma/COPD, decreases secretions • anticholinergic effect (drys body out): urinary retention, blurry vision, constipation, dry mouth/hoarsenesss • bitter taste Interventions: use gym/candy, drink fluids, do NOT swallow capsule (put in inhaler), NCLEX TIP: anticholergic meds are contraindicated to DRY pts (eg. glaucoma, urinary retention, BPH, bowel obstruction (can't poop or pee) M: methylxanthines (eg. theoPHYLLINE) • high toxicity! (therapeutic range 10-20) - tonic-clonic sz (1st sign of severe toxicity) - anorexia, n/v, restlessness, insomnia - tachycardia, dysrhythmias Interventions: take in AM, avoid caffeine or any stimulants, STOP before cardiac stress test, Tx for toxicity: charcoal, lidocaine (for dysrhythmias), diazepam (for sz) NCLEX TIP: toxic OVER 20 mcg/mL = frequent blood draws. tachycardia & dysrhythmias = pt must AVOID BB (decreases HR). Alert HCP of tachycardia BEFORE giving next dose. 2 drugs that INCREASE toxicity risk: cimetidine (h2 blocker) & ciprofloxacin (abx - antibiotics) A.I.M. for acute asthma attacks ANTI-INFLAMMATORY AGENTS Soothe the inflammation S: steroids (eg. beclomethaSONE) • " - sone, - asone " • betamethasone: decreases swelling in bronchi • prednisone: decreases swelling on Person (body) Interventions: slow onset (do NOT use 1st for acute asthma attack), increases glucose, increased risk of infection (sores in mouth, slow wound healing), use spacers to avoid oral thrush (candida), rinse mouth after each use, do NOT swallow water, rinse daily L: leukotriene inhibitor (eg. monteLUKAST: singulair) • prevention • opens airways, long term mgmt, long onset Interventions: teach pt it takes 1-2 week for therapeutic effect NCLEX TIP: given for Prevention!! M: mast cell stabilizer (eg. cromolyn) • prevention • used before sports or exercise! Interventions: use 10-15 mins before physical activity

parkland burn formula

BSA burned (%) x 4 mL x (kg) body weight = total fluid requirement in mL for 24 hours → to calculate what the IV will run at NOW, take that # and divide it by 2, now divide it by (8-however long it took to get to the ER) to get your hourly IV flow rate → 1st half given in 1st 8 hrs w/ remaining amount given over remaining 16 hours → 1/4 in second 8 hours and 1/4 in last 8 hours...starting at the time of the burn, not arrival to ER **fluid resuscitation NEEDS to be used by 18 - 24 hrs after injury

DKA (diabetic ketoacidosis)

Blood glucose 250-500+ • occurs in type 1 dm • fast onset • causes: #1 cause of DKA: sepsis (infection), sickness, stress (eg. surgery), skipping insulin • dry & high sugar • ketones in blood • Kussmals respirations (deep rapid, fruity breath) • abdominal pain • Metabolic acidosis Interventions: dehydration 1st: 0.9% NS, hourly bs checks, over 250 bs = IV reg insulin, below 200 bs or ketones resolve = SQ insulin + D50 IV NCLEX TIP: add K+ during IV insulin *nursing diagnosis: fluid vol deficit

HHS (hyperglycemic hyperosmolar syndrome)

Blood glucose OVER 600+ • Usually occurs in type 2 dm • high bg • extreme dehydration • neurological manifestations: confusion • slower onset w/ stable K+ Interventions: hydration 1st: 0.9% NS, insulin IV (ONLY reg insulin can go in IV) NCLEX TIP: reassess bs & hydration status: bp, skin color & temp, uo, urine spec gravity

hemodynamic parameters

Cardiac output: 4 - 8 L/min • indicates cardiac function Cardiac Index: 2.2 - 4.0 L/min/m2 CVP: 2 - 8 mm Hg • Central Venous Pressure • indicates fluid vol status • elevated = overhydration → increases Venus return • s/s: fluid vol overload MAP: 70 - 105 mm Hg • Mean Arterial Pressure • indicates perfusion of organs & tissues • MAP = SBP + [2 x DBP] / 3 PAWP: 6 - 12 mm Hg • Pulmonary Capillary Wedge Pressure • indicates left-sided heart function SVR: 800 - 1200 dynes/sec/cm • Systemic Vascular Resistance • measures vascular resistance • vessel dilation or constriction

Cardioversion VS Defibrillation

Cardioversion → C - Count a pulse → C - Controlled Rhythms → synchronized button & sedation Defibrillation → Dfib if you → Do NOT have a pulse → Deadly rhythms (vfib & vtach no pulse) → Do NOT synch; shock away**

FHR tracings

Category I • normal • norm FHR, mod variability, no late or variable • early decel & acceleration: present or absent • 2 acc & mod var • expectant; no intervention required Category II • indeterminate • abnormal FHR, minimal variability, or periodic decels • intrauterine resuscitative measures, discontinue uterotonics, continued FHR monitoring Category III • abnormal • absent variability w/ fetal bradycardia, or prolonged, recurrent variable, or late decels • sinusoidal fetal hr pattern Sinusoidal FHR • immediate intervention needed* • pattern characterized by repetitive, wave-like fluctuations w/ absent var and no response to contractions • expedited birth

Respiratory alkalosis

Caused by hyperventilation, respiratory alkalosis develops when the lungs eliminate too much CO2. The most common cause of hyperventilation is anxiety. ** OVERSTIMULATION OF THE RESPIRATORY SYSTEM • Hypoxia Anxiety/Stress/Fear Tachypnea • Fever • Restrictive lung disease • Pulmonary Embolism • S/S: Hypocalcemia ** THINK OF SYMPTOMS YOU GET BEFORE TAKING A MED SURG EXAM!!! OR BEING SUFFOCATED "Brown paper bag"

prevention of preterm delivery

Cervical cerclage • placement 12 - 14 wks up to 23 wks • tx: cervical insufficiency → miscarriage, preterm, premature cervical dilation, short cervix Interventions: teach pt activity restriction & recognize s/s of preterm labor

Dehiscence vs Evisceration

Dehiscence • closed wounds / sutures open • vomiting, dry heaving = increased mechanical stress on wound • obese pts who undergone extensive abd surgery are especially vulnerable* Interventions: teach pt to split w/ pillow if needed to cough or sneeze Evisceration • protruding organs from open wound / suture Risk factors: obesity, DM Interventions: remain calm & stay w/ pt, low-fowlers w/ knees slightly flexed (relieves pressure on abd incision), assess vitals & repeat Q15 mins, cover w/ sterile dressing saturated in NS, NPO (for preparation of emergency surgery), document

Allen's test procedure

Determines patency of ulnar artery Depress radial and ulnar arteries together and have person open and close fist. blood should return via ulnar artery for normal circulation. No return for occluded ulnar artery Interventions: hold firm pressure at sight bc increased bleeding

Insulin

Determir, Glargine • long-acting • no peak, no mix • duration: 24 hrs+ NPH • intermediate • mix clear to cloudy • given 2x a day • duration: 12 - 18 hrs • peak: 4 - 12 hr; most dangerous @ 5 - 6 hr Regular • only IV insulin • duration: 5 - 8 hrs • peak: 2 - 5 hrs Aspart, Lispro, Glulisine • rapid • 15 min onset • duration: 3 - 5 hrs • peak 30 min - 3 hrs Insulin infusion pump • no more blood sugar swings; even basil rate (won't swing too high or too low) • push button during meals • machine malfunction → assess pt 1st Interventions: monitor sugar below > 70, give food during peak times, check bg before using sliding scale, pt should eat bedtime snack with evening dose of NPH (eg. cereal & milk) NCLEX TIP: greatest risk for hypoglycemia is during peaks → peaks = plates • hypoglycemia > 70 (eg. shakey, pale, cool, sweaty, clammy) → awake = ask them to eat, only arousable by painful stimuli = stab them w/ IV D50 • No peak No mix (long acting) • ONLY reg insulin for IV • clear before cloudy "you want clear days before cloudy ones) • rotate locations (best on abd near umbilicus, naval, bellybutton) • DKA = still give insulin on sick days or if they don't want to eat • increase insulin during sickness, surgery, stress, infections **hypoglycemia more serious than hyper

GTPAL

G = gravidity (# of times pregnant) T = term (38-42 wks) P = preterm birth (20-37 weeks) A = abortion (< 20 weeks) L = living children *eg. woman who is pregnant now, has 2 children, one born @ 38 weeks, one @ 42 weeks = 32002 *GP → gravida (# of previous preg) & para (# of births AFTER 20 wks)

Crutches

Good go to heaven (up the stairs) Bad go to hell (down the stairs) • 3-point gait: non-weight bearing • 2-point gait: partial-weight bearing • 4-point gait: partial / full-weight bearing on both legs (closest to normal walking) • 1 - 2 in space between axilla & crutch pad • 6 in apart • support weight on hands & arms • complications: crutch paralysis (muscle weakness or sensory sympts, eg. tingling / numbness, of forearm, wrist & hands)

Contact precautions

Gown & gloves " MRS WEE " • M: Multidrug restant organism; MRSA, VRE SCABIES • R: Resp Infection; RSV • S: Skin infection • W: Wounds open • E: Enteric (intestinal) infections; Rotavirus, CDIFF (wash hands w. SOAP & Water), single-room unless some1 with same infection • E: Eye infections; Conjunctivitis

Cholesterol lvls

HDL: 40 or more LDL: 100 or less Triglycerides: 150 or less Total cholesterol: 200 or less Female waist line: 35 & under Male waist line: 45 & under

Herpes Simplex Virus

HSV 1: oral (sores around mouth & lips) HSV 2: genital or rectum • report to cdc Interventions: dormant: use condoms active lesion: abstinence from sex, keep clean & dry, gloves when applying analgesic or antiviral (acyclovir - zovirax), contact precautions until lesions crust over

Cranial nerves

I. Olfactory • smell test II. Optic • visual acuity & fields III. Oculomotor • pupil constriction & extraocular mvmts IV. Trochlear • extraocular mvmts; inferior adduction V. Trigeminal • clench teeth & light touch • trigeminal neuralgia VI. Abducens • extraocular mvmts; lateral abduction VII. Facial • facial mvmt; close eyes, smile VIII. Vestibulocochlear • hearing & romberg test (balance) • fall risk, vertigo, motion sickness IX. Glossopharyngeal • gag reflex. ability to swallow, taste X. Vagus • say "ahhh" - uvular and palate mvmt, voice quality XI. Accessory • turn head & lift shoulders to resistance XII. Hypoglossal • stick out tongue *moves finger left-to-right → testing II, III, IV, VI *deficits in III, IV, VI → disconjugated gaze (eyes do not move together), nystagmus (rapid eye jerking mvmt), ptosis (drooping of eyelid)

Contraceptives

IUD (intrauterine device) • long-term contraceptive • Copper: ParaGard → 10 yrs • Levonorgestrel-releasing: Skyla, Mirena → 3 & 5 yrs • adverse affects: PID • s/s: PAINS → Period abnormalities → Abd pain, pain during intercourse → Infection → Not feeling well (eg. fever, chills) → Strings longer, shorter, or missing • offers EC up to 5 days Cervical cap / Diaphragm • barrier contraceptive • use w/ spermicide • remain in place for > 6 hrs or more after intercourse • no more than 48 hrs • do not use on menses → toxic shock syndrome ACHES for Hormone Contraceptives POPs (progestin-only pills) • oral contraceptive • complications: thrombotic (eg. DVT) Interventions: take same time every day, > 3 or more hrs late → condom until pill is taken correctly for 2 days, d/v occur within 3hrs → take another Vaginal ring • etonogestrel & ethinyl estradiol • hormonal contraceptive • 3 wk use; new ring after 7 hormone-free days • condom during 1st 7 days • displaced; rinsed & placed back within 3 hrs Transdermal patch • ethinyl estradiol & norelgestromin • hormonal contraceptive • 3 wks; removed for 1 hormone-free wk EC (emergency contraceptives) • high-dose Levonorgestrel • OTC EC should be taken within 3 days /72hrs

positive symptoms of schizophrenia

Impaired thought processes • neologisms: bizzare made-up words or phrases → eg. " i would like to have a phjinox " • concerete thinking: literal interpretation of idea, difficulty w/ abstract thinking → eg. " the grass is always greener on the other side " would interpret that as the grass somewhere else is LITERALLY greener • loose associations: rapid shifting from one idea to another, w/ little or no connection to logic or rationality → eg. " the world turns as the world turns on a ball at the beach " • echolalia: repetition of words, usually uttered by someone else → eg. parrot • tangentiality: going from one topic to the next w/o getting to the point of the original idea or topic → eg. " where are you from? pt: my dog is from england. they have good fish an chips there. fish breathe thru gills " • word salad: mix of words or phrases having no meaning except to pt → eg. " here what comes table, sky, apple " • clang associations: rhyming words in a meaningless, illogical manner → eg. " the pike likes to hike and mike fed he bike near the tyke " • perseveration: repeating the same words or phrases in response to different questions → eg. " asked to draw cat and several other objects but just continues to draw cat " delusions: • reference: believe songs, newspaper articles, & other events are personal & sig to them → eg. " that song is a message sent to me in secret " • persecutory (paranoid): believe that they are being threatened or treated unfairly in some way → eg. " those martians are trying to poison me w/ the tap water " • grandeur: belief of being powerful & important like a god → eg. " i need to get to washington for my meeting w/ the president " • control: belief that force outside body is controlling him → eg. " don't drink the tap water. that's how the gov't controls us " • nihilistic: belief → eg. " it doesnt matter if i take my medicine. im already dead " • somatic: belief body is changing in unusual way. → eg. " the doctor said im fine, but really i have lung cancer; growing 3rd arm " Hallucinations: • tactile: gives pt the sensation of being touched → eg. " i need you to get rid of these bug that are crawling under my skin " • auditory: hearing noises w/o external stimulus → eg. " i have very loud thoughts; the voices in my head are loud " • command auditory: perceives spoken orders or message to do something from an 'entity' → eg. " hear that? they told me i need to kill my father " • visual: sees people, colors, shapes, or items that are not really there eg. command hallucinations *priority to intervene → pt alone are homicidal or suicidal, or if they ask to hurt another person

Castings

Interventions: after a new cast placement; elevated for 1st 48hrs, avoid getting cast wet, report foul odors or hot spots, perform regular isometric & ROM exercises, use dryer on cold-setting for itching large body casts • risk for bowel obstruction* caused by decreased peristalsis or cast syndrome (rare complication) • s/s: bloating, n/v & abd pain = bowel obstruction = bowel ischemia *immediately report to HCP

Types of bone Fx

Interventions: asses 6 P's (compartment syndrome) - monitor skin temp - fat embolism (most common w/ long bone): confusion, anxiety, tachycardia, chest pain, tachypnea, hemoptysis (coughing up blood), late sign → petechiae over neck, upper arms, chest, abd - maintain correct body alignment - cast, traction NCLEX TIP: fat embolism → late sign: petechiae over neck, upper arms, chest, abd for long bone fx *petechiae → small pinpoint red / purple spots on mucus membrane or skin = may indicate current bleeding or blood dyscrasia *purpura → irregular purplish blotches, spots, and patches = may indicate signs of blood dyscrasia (disease or disorder of the blood) *sanguineous (red) wound drainage at = 25mL/hr is expected 1 day postop *excessive drainage > 1500 mL / 24 hrs knee replacement

Violence prevention

Interventions: clear, thorough communication, encourage participation, low-stimuli environment, provding comfort, undivided attention to pt

Injection angles

Intradermal: 15° or less - eg tb maoux test: placed on 1st layer of skin Subq: 45° or 90* - eg. Diabetes IM: 90° - eg. Deltoid, vastus lateralis, & ventrogluteal Filter is needed for glass Ampule (want to avoid shards in pt)

Isotonic, Hypotonic, and Hypertonic Solutions

Isotonic: has no effect on cell " I-so-Perfect " (equal) → eg. Surgery, dehydration, blood loss •0.9 NS •5% dextrose in 0.225% saline •5% dextrose in h2o (D5W) •LR (preferred for preggers, gives some sugar) Hypotonic: causes cell to take in water " Hippo -tonic = cell swells like a big Hippo " → eg. hyperglycemia •0.45% NS (1/2 NS) •0.225% NS (1/4 NS) •0.33% NS (1/3 NS) Do NOT give to pt w/ ICP, burns, trauma Hypertonic: causes cell to lose water " Hyper person = very Skinny cells like hyper person is Skinny " (cell shrinks) Tx: cerebral edema, hyponatremia May cause fluid overload & pulmonary edema *LR for hypovolemic shock

Different diet types

Kosher diet • usually jewish • no pork → gelatin

stages of labor & stations

Latent • 0-5 cm; 0% effaced; - 3-5 station • contractions: 5 - 10 mins apart; 30 - 45 secs; mild intensity • pt is happy, talking Active • 6-7 cm; • contractions: 2 - 3 mins apart; 60 - 90 secs; stronger • increased pain, fear, anxiety " oh shit its real " Transition • 8-10 cm; 80-100% effaced; + 3-5 station • bloody show • pt feels " urge to push " • report sensations of having bowel mvmts • placenta expulsion Recovery • high risk for hemorrhage during 1st 2 - 4 hrs postpartum • assess lochia: dark red & small - mod amt • saturated 1 perineal pad / hr = palpate & massage fundus • slightly elevated vitals, mild dehydration • void within 6 hrs of delivery Stations • -1: above the ischial spines • 0: fetal head at ischial spines • +1: n/v, trembling or shivers experienced *active labor can get opioids 7cm

anesthesia

Lidocaine • pudendal nerve block • relieves perineal pressure not contractions • tx: late 2nd stage of labor; imminent (fully dilated & effaced), laceration repair Epidural • tx: 1st or early 2nd stage of labor • effects: 20 - 30 mins • s/s: hypotension • contraindicated: uncontrolled hypotension, coagulopathies, infection Interventions: assess bp, if hypotension: admin IV fluid bolus & left lateral position **complications: MH (malignant HYPERthermia) → s/s: hypercapnia, muscle rigidity, hyperthermia *late sign

Spine immobilization

NSAIDS • N: Neurological examination (eg. numbness) • S: Significant traumatic mechanism of injury • A: Alertness (eg. disoriented, altered LOC) • I: Intoxication • D: Distracting injury • S: Spinal examination (point tenderness over spin or neck pain on mvmt)

Diagnostic lab tests for DM

Normal glucose: 70 - 115 Fasting glucose: < 100 HgBA1C: 5.7 (over 6.5 = DM) *3 month sugar checkto see if pt is compliant. - under 6: pt is doing good - over 6.5: pt needs to revise

Fire abb

P - pull the pin A - aim the spray @ base S -squeeze the handle S - sweep the spray (side to side)

diff types of catheters & tubing

PICC (peripherally inserted central cath) • inserted thru large peripheral vein in body • tx: long-term fluids & med therapy → assess bp in unaffected arm → clean port w/ chlorhexidine 15 - 30 secs → flush ports routinely → dressing change or soiled = use clear occlusive dressing continuous iv peripheral tubing admin • changed no earlier than every 72 hrs

Mechanical ventilation: PEEP

Positive end-expiratory pressure • prevents alveolar collapse (atelectasis) & improves oxygenation • O2 toxicity: n/v, tinnitus, irritability, anxious, tunnel vision

postpartum complications

Postpartum hemorrhage • defined as maternal blood loss of > 500 mL after vaginal birth or > 1000 mL after csection • perineal pad saturated (means heavy) < 1 hr or more Risk factors: uterine distention: → grand multiparty > 5 births, polyhydramnios, macrosomic infant → hx of PPH → uterine fatigue (atony); prolonged labor >24hrs → prolonged oxytocin use during labor, mag sulfate, general anesthesia → coagulopathy → intrauterine infection Interventions: 1st: immediately assess funal tone, lochia amt, vitals → fundal massage, uterotonics Vaginal hematoma • s/s: feeling of fullness, severe persistent vaginal pain (if pt did not have epidural) Urinary retention (bladder distention) • s/s: displaced / boggy fundus, palpable bladder distention above umbilicus & deviated to right side Interventions: ask pt to void, if limited mobility, not voided within 6 - 8 hrs after delivery or removal of cath after csection, or difficulty empty bladder completely (voiding < 100 mL freq) → In-and-out cath

Preeclampsia/Eclampsia

Preclampsia • screening > 20 wks • s/s: htn w/ proteinuria, severe / persistent headache, visual disturbances, facial swelling (edema), hyperreflexia, RUQ or epigastric pain • complications: eclampsia, HELLP syndrome, placenta abruption Eclampsia • severe: 160/110 mmHg 6 hrs apart = sz prec • severe preeclampsia + sz Interventions: IV mag sulfate (to stop sz), sz precautions, limit environmental stimuli, admin mag sulfate, assess DTRs hourly, cal gluconate & o2 at bedside, labor will halt: oxytocin ready if indicated NCLEX TIPS: bp that exceeds 140/90 mmHg or greater, documented on 2 occasions @ least 4 hrs apart = abnormal****

Health promotion & disease prevention

Primary prevention: promotes health & preventing disease (eg. Immunisations, education, nutrition & fitness activities, health education) Secondary prevention: early ID of illness (eg. disease screening), providing tax, conducting activities to prevent worsening of health status (eg. Exercise program for frail older adults) Tertiary prevention: preventing long-term consequences of chronic illness

CBC (complete blood count)

RBC lvls • 4.5 - 500,000 WBC lvls • 4,000 - 10,000 Platelet lvls • 150,000 - 450,000 • LOW > 150 = blood clot • HIGH < 450 = bleeding risk Hgb (hemoglobin) lvls • Men: 14 - 18 • Women: 12 - 16 Hct lvls • Men: 42 - 52% • Women: 37 - 47% • LOW > 37% = anemia • HIGH < 52% = dehydration aPTT (activated partial thromboplastin time) • 30 - 40 secs • therapeutic range (heparin): 1.5 - 2.5 times norm; 45 - 70 • > 70 secs = critical val; bleeding risk* Interventions: monitored val for Heparin • hemophilia pt = high aPTT (less than 30 secs) • BLEEDING OUT = high aPTT (more than 30 secs) PTT (partial thromboplastin time) • 60 - 70 secs • therapeutic range (heparin): 1.5 - 2 times normal or controlled val PT (prothrombin) • 11 - 14 secs • therapeutic range (warfarin): 1.5 - 2 times the normal or controlled value. Critical val > 20 secs INR • 0.8 - 1.1 secs • therapeutic range (warfarin:) 2 - 3 • Critical val > 5 • decrease effectiveness of drug: foods rich in Vit K • LOW INR = blood clots Serum osmolarity • 270 - 300 mOsm/L • shows concentration of electrolytes WITHIN the body • HIGH os = " high & dry inside " High electrolytes in body; eg. hypernatremia • LOW os = " low & liquidy labs " diluted inside the body (eg. fluid overload), Less concentrated amt of electrolytes; eg. HYPOnatremia

Abd quadrant diseases

RLQ • Appendicitis (referred from periumbilical area) RUQ • Cholecystitis (w/ referred pain to RIGHT shoulder; kehr's sign) • Hepatitis / Cirrhosis LUQ • Pancreatitis (severe epigastric pain referred / radiating to back or flank), cullens & turners signs • Spleen Rupture (w/ referred pain to LEFT shoulder) LLQ • Diverticulitis • diffuse pain & rigid abd → peritonitis (eg. from ruptured appendicitis or perforated bowel) • pulsatile mass in periumbilicus area slightly to the left of midline & abd/back pain → AAA takes priority over all of these *immediately life-threatening emergency

glutamate antagonist

Riluzole • only med approved for ALS tx • slows down progression & prolongs survival by 3 - 6 mons

Metabolic acidosis

Risk factors: ingestion of an acidic substance or substance that can be metabolized to an acid • Production of excess acid • An inability of the kidneys to excrete normal amounts of acid • Loss of base • DKA, Renal failure, Rhabdomyolysis, DIARRHEA, Seizures, Methanol or salicylate overdose Medications (metformin), lactic acidosis • S/S: Kussmaul Respirations Deep and labored breathing pattern Interventions: Treat underlying cause. Diabetic patient - control blood glucose and insulin levels. Poisoning - eliminating the toxin from the blood. Sepsis - may include antibiotic therapy, fluid administration, and surgery, IV fluids

STD/STI

STIs Gonorrhea, Chlamydia • " silent infections " show no sympts • leading cause of PID & infertility in women • screening: < 25 • tx: single dose- azithromycin, doxycycline, abstain from intercourse 7 days after tx, sexual partners should also be tx, annual screening Trichomoniasis • leads to: vaginitis • tx: metronidazole (dark, brownish color urine) Interventions: abstain from intercourse, avoid drinking alc for 3 days after completion, partner should be tx Candidiasis (yeast infection) • leads to: vaginitis • tx: miconazole, fluconazole Interventions: applied at bedtime, 3 - 7 days, loose cotton underwear Oral Candidiasis (thrush) • nonremovable white patches on oral mucosa, palate, & tongue • tend to bleed when touched • infants may have difficulty sucking or feeding • tx: nystatin *antibiotics can cause candida infections HPV • genital & anal warts • leading cause of cervical cancer • dx: PAP smear > 21 every 3 yrs, vaccine • positive HIV preg → take ART (antiretroviral) during preggers, no breastfeeding, & newborn need to take ART for 4 - 6 wks after birth Syphilis • painless genital ulcers • tx: IM penicillin, partner should be tx STDs • Herpes • genital: no sex during outbreak, clean & dry, sitz baths • tx: acyclovir *************** Zika virus • transmitted thru mosquitoes, sexual contact, bodily fluids • complications: microcephaly • tx: avoid travel to zika-area until after birth

RFTs (renal function tests)

Serum creatinine: 0.5 - 1.2 mg • males: 0.6 - 1.2 mg • females: 0.5 - 1.1 mg • HIGH > 1.2 = renal injury, dehydration • LOW < 0.5 = malnutrition (low protein), liver / renal injury BUN: 10 - 20 mg • HIGH > 20 = renal injury, dehydration • LOW < 10 = malnutrition, liver injury GFR: 90 - 120 mL/min • aka creatinine clearance test • HIGH > 120 = absorb capacity of na & o2 overwhelmed (building up fluid) • LOW < 90 = renal injury • men 90 - 139; female 80 - 125

UA (urinalysis)

Specific gravity: 1.005 - 1.030 • LOW > 1.005 = diluted urine (eg. RF, DI) • HIGH > 1.030 = concentrated urine; all electrolytes in urine (eg. dehydration) Protein: 0 - 8 mg • should be none • > 0 = indication of disease Glucose: < 0.5 g • HIGH = underlying disease (eg. preeclampsia, DKA) pH: 4.6 - 8 Ketones: none WBC: 0 - 5 *dx for UTI: urinalysis & urine culture

Signs of preg

Subjective (presumptive) • signs self-reported by pt • urinary freq • amenorrhea • n / v • breast tenderness • quickening • excessive fatigue *ask about last menstrual hx Objective (probable) • uterine & cervical change → goodell sign → chadwick sign → hegar sign → uterine enlargement • uterine & funic souffle • braxton hicks contractions • ballottement • fetal outline palpation • skin pigmentation changes → chloasma → lina nigra → areola darkening → striae gravidarum • positive preg test Positive (diagnostic) • fetal heartbeat w/ doppler • fetal mvmt palpated or observed by HCP • visualization of fetus w/ ultrasound *fetal mvmts or kicks → 4 mvmts / hr *expected findings during preg → chloasma, PUPPP, pyrosis *pyrosis (heartburn) → HOB elevated, sit upright after meals, small freq meals, avoid tight clothes, eliminate dietary triggers

Lithium

Therapeutic range: 0.6 - 1.2 meq/L → > 1.5 = TOXIC* • antimanic (mood stabilizer) • used to tx: bipolar disorder (long-term) • s/s: dry mouth, thirst, decreased renal function Lithium Toxicity • toxicity > 2.0 meq/L • adverse effects: → acute: gi - n/v, diarrhea → chronic: neuro - ataxia, sluggishness, confusion, agitation, coarse tremors* → severe: DI sympts (eg. polyuria, polydipsia) sz, encephalopathy Interventions: before admin monitor labs: renal, thyroid, preg test → RFT: BUN & creatinine → Thyroid: T3, T4, TSH (can cause hypothyroidism) → HCG (contraindicated for preg) • avoid na depletion (low na intake increases lithium toxicity) • reg diet & fluids (2 - 3L to avoid reabsorption) • avoid NSAIDs & thiazide diuretics or diuretic effects (eg. coffee, cola, tea)

Digoxin

Theraputic range: 0.8 - 2.0 ng/mL • antiarrythmic med → INOtropic = INcreases forceful Contractions & Cardiac Contractility" • used to tx: heart failure, Afib, cardiogenic shock • increased toxicity risk: loop & thiazides diuretics = hypokalemia, ace & arbs, verapamil Digoxin toxicity • toxicity > 2.0 ng/mL • antidote: digoxin immune FAB • bradycardia, heart block → dizziness, lightheaded • visual sympts → alt in color (yellow-green tint / halo to vision), scotomas (aura or blind spot), diplopia, blindness • gi sympts → anorexia, n/v, abd pain • neurologic sympts → lethargy, fatigue, weakness, confusion • labs: hypokalemia, hypomagnesiema Interventions: teach pt to take pulse for 1 min → hold if < 60 bpm or skipped beats, if dose missed stay on same schedule & do not admin another, do not admin more if pt throws up, do not mix, NCLEX TIPS: gi sympts are earliest signs of toxicity • Monitor K+ wasting meds, does not need to increase K+ consumption • Tx dysrhythmias w/ phenytoin or lidocaine

Diagnostic test for MI

Troponin • protein BEST for detecting MI • indicates cardiac muscle damage • norm vals: < 0.5 ng / mL; 0.7 ng / mL or above indicates cardiac muscle damage • Increases 4 - 6 hrs after onsets of MI • Returns to baseline after 10 - 14 days (elevated 2 - 3 wks following mi) CK-MB • isoenzyme increased within 4 - 6 hr following mi • stays elevated from 24 - 72 hr after Myoglobin • early response to tissue injury, 1st 2 hrs • quickly declines within 7 hrs of injury (used in skeletal & cardiac; LEAST useful)

Peak Expiratory Flow Rate (PEFR)

Used for asthma • green zone: 80-100% • yellow zone: mellow yellow (need to control asthma) rescue drug Q4 hrs 1-2 days, call HCP for additional meds or change in tx • red zone: (below < 25%) emergency tx needed if pt is not back to yellow zone, rescue inhaler has no effect • stand / sit upright • flow meter scale @ 0 or lowest val • inhale deeply • mouthpiece in mouth & create seal w/ lips • exhale as quickly & forcefully as possible & record reading • repeat 2xs w/ break of 5-10 secs between • record highest score of all 3 attempts • personal best score is obtained over 2 week period when asthma is controlled*

physical changes thru infancy

Weight • birth weight DOUBLES @ 6 mons → (5 - 7 oz) 140 - 196 g / wk • 6 - 12 mons → (3 - 5 oz / wk) 84 - 140 g/wk • 12 mons = TRIPLES → grows 1 in during each of the 1st 6 mons and then 1/2 in each month until 12 mons Head & chest • NO head lag at 4 mons • fontanelles temporarily bulged when infant cries, coughs, or lies down • posterior fontanelle fused by 12 mons • anterior fontanelle fused by 18 mons • equalized head & chest circumference by 12 mons Vision • Teeth • 1st dental visit within 6 mons of 1st tooth eruption or 1st birthday • stop thumb sucking before permanent teeth begin to erupt

Blood & blood products

Whole blood • up to 4 hrs • used to tx: hemorrhage, Burns, shock, trauma, surgery Packed RBCs • up to 4 hrs • 1 go to; cheaper than whole blood • used to tx: increase RBCs, hemolytic / severe anemia Platelets • for 30 - 60 mins • used to tx: increase platelets, active bleeding, aplastic anemia, thrombocytopenia, bone marrow suppression FFP • up to 30 - 60 mins • used to tx: hemorrhage, Burns, shock, TTP (thrombotic thrombocytopenia purpura), reverse effects of warfarin Albumin • up to 5% (1 to 10 ml/min), 25% (4 ml/min) • used to tx: expand vol thru oncotic changes, hypovolemia, hypoalbuminemia, hemolytic disease of the newborn, burns, severe rephrosis

Disorders of the Anterior Pituitary Gland

acromegaly • hypersecretion of GH AFTER puberty • enlargement of skeletal extremities (eg. weight, shoe size) • enlarged organs • headache, vision probs, blindness • muscle weakness gigantism • hypersecretion of GH BEFORE puberty • proportional overgrowth in all body tissue dwarfism • hyposecretion of GH during fetal development • tx: somatropin

Guillian-barre syndrome

acute immune-mediated polyneuropathy • ascending muscle weakness (hypotonia) • absent DTRs • biggest complication: respiratory failure (eg. inability to cough / lift head or eyebrows, shallow resp) Interventions: asses pulmonary function w/ spirometry, slow position changes

pneumothorax

air in the pleural cavity caused by a puncture of the lung or chest wall causing lung to collapse • C: chest pain (sudden, sharp), cyanosis • O: overt tachycardia, tachyphea • L: low bp • L: low spO2 • A: absent breath sound on affected side • P: pushing trachea to unaffected side • S: subq emphysema "crunchy feel" • E: expansion of chest unequal • D: dyspnea Closed pneumothorax • air leaks into intrapleural space w/o an outside wound (eg. rib fx) Open pneumothorax • opening in chest "sucking chest wound" (eg. stab would) • sucking sound Interventions: place a sterile occlusive dressing, tape 3 sides & leave 1 side open, do not remove the object Tension pneumothorax • medical emergency • tachycardia, tachypnea, hypotension, JVD, tracheal deviation to the unaffected side (late sign) Interventions: needle decompression

neonate physical findings

all neonates *common findings • milia (white papules) on nose & chin; resolve naturally • esptein's pearls (white, pearl-like epithelial cysts) on gum margins & palate; disappear within a few wks • physiologic heart murmur expected in 1st 48hrs w/o other sympts • acrocyanosis or peripheral cyanosis blue discoloration of the skin around the mouth or hands & feet → 1st 24 hrs of life or 1st wk if newborn is cold → tx: skin-to-skin • posterior fontanel (triangular & smaller) located at intersection of sagittal & lambdoid sutures • anterior fontanel (diamond-shaped & bigger) located at intersection of frontal & parietal sutures • Caput Succedaneum = Crosses Suture → edema / hematoma of soft tissue on scalp → due to prolonged labor • eyelids should sit above pupils symmetrically w/ irises showing → ptosis (drooping of eyelids) = paralysis of oculomotor nerve • plantar creases; more creases → more mature • cord stump begins to shrivel & turn black in 2 - 3 days • males: → hydrocele (fluid-filled testicular mass) painless, new-onset, bilateral testicular swelling; resolves by 1st bday • females: → mammary gland enlargement, pseudomenstruation (mild uterine withdrawal bleeding), swollen labia, & leukorrhea (non-purulent thin white vaginal discharge) in 1st few wks of life term neonate *common findings • deep plantar creases on entire sole • vernix caseosa (white cheesy/waxy protective substance) found covering axillary & genital areas • palpable, raised breast buds, measuring 5 - 10 mm preterm neonate *common findings • slick heel, fine wrinkles, few plantar creases • lanugo (fine, downy hair) found on back & shoulders → disappears at 36 wks • smooth pink skin w/ visible veins; skin is thin & transparent • flat areolae w/o palpable breast buds • bilirubin elevated 10 • high risk for cold stress • males: • undescended testes palpated in inguinal canal & found in abd • females: post-term neonate *common findings • desquamation " peeling skin "

NSAIDS

anti-inflammatory, antiplatelet, analgesic, antipyretic Use abbr N S A I K • Naproxen NCLEX TIP: #1 NSAID given • Salicylate acid (aspirin) • Acetyisalicylic acid (aspirin) Interventions: monitor toxicity (eg. Tinnitus), tachycardia & hypotension = possible bleeding, use ibuprofen or Tylenol NCLEX TIP: contraindicated w/ children w. Viral infection = Reye's syndrome. NO pepto-bismol • Ibuprofen & Indomethacin • Ketorolac (brand: toradol) Nclex tip: only one we can use thru IV (ketorolac) Risk factors: increases risk for bleeding, DVT, Interventions: monitor for bleeding (eg. black tarry stools, bruising (ecchymosis), blood in urine) • never take 2 NSAIDs simultaneously • contraindicated for asthma • monitor for GI bleed (eg. peptic ulcer) • take w/ food, avoid EGGO: E: vit e, G: ginkgo, G: garlic, O: omega 3 oils NCLEX TIP: ok to use w/ PPI (eg. ranitidine) • nephrotoxicity w/ long term • use to tx: MI, stroke pts • use acetaminophen for fever w/ renal disease pt • avoid HTN / CHF pt = increases htn, swelling, HF

Acetaminophen (Tylenol)

antipyretic (reduces fever), analgesic • used instead of NSAIDs to decrease risk of bleeding • can be used interchangeably w/ NSAIDs • ok for child w/ flu • antidote = acetyleysteine (rotten smell) • can cause Reye syndrome (encephalopathy, acute fatty liver) Risk factors: RF, Interventions: avoid alcoholics ETOH (hepatotoxic), NCLEX TIP: monitor AST & ALT for acetaminophen overdose

pulmonary embolism (PE)

blockage of pulmonary arteries by thrombus, fat or air embolus, tumor tissue → leads to resp arrest • medical emergency* • " FAT, BAT " emboli sources • Fat, Air, Thrombus, Bacteria, Amniotic fluid & Tumor → oral contraceptives = ESTROGEN birth control **most tested • pleuritic chest pain / tightness • petechiae over chest & axilla w/ fat embolism present • anxiety, restlessness, agitation, ALOC *1st signs (hypoxemia) • tachycardia, SOB • dyspnea, tachypnea, coughing, hemoptysis, crackles, wheezing, retractions • syncope (fainting / passing out) • Resp Acidosis • dx: chest CT, pulmonary angiogram (best method), ABGs, troponin lvls, High (positive) d-dimer (norm: 0.4 mcg/mL) - check for allergy to shellfish, if allergic = VQ scan risk factors: immobility, smoking, long-bone fx, *DVT, obesity, CVC, hf, contraceptives, surgery, sickle cell Interventions: semi-fowlers, IV access, O2, assess RR Q30 mins • " PASA " • firbinolytic agent aka thrombolytics: → tPA, Alteplase, Steptokinase • anticoagulants: → warfarin, heparin • wear med alert bracelet, limit alcohol intake • after discharge: warfarin used for 3 - 6 mons to prevent further thrombus formation

Cholelithiasis (gallstones) / cholysistitis

cholelithiasis • solid, round stones in the gallbladder Risk factors: 4 F's fat, fourth, female, fertile (contraceptives) cholysistitis • inflammation of the gallbladder or cystic duct (eg. gallstones) • pain w/ deep inspiration during right subcostal palpation (murphy's sign) • epigastric pain (retrosternal; radiates to back) • sharp pain in RUQ, can radiate to RIGHT shoulder (kehr sign) • intense pain w/ n/v after eating a high fat food caused by biliary colic • abd distention, guarding, rebound tenderness (blumberg sign) • low grade Fever w/ chills • fat intolerance, anorexia, feeling of being full • dyspepsia, eruction (burbing), and gas • jaundice • Clay colored stools, fatty stools (steatorrhea) • Dark urine; uremic frost • Pruritus (itching) (in chronic) • complications: pancreatitis • dx: cholecystectomy, electrotripsy Interventions: continuous IV fluids, electrolyte replacement, pain mgmt, NG tube (gastric decompression) → NPO 24 - 72 hrs → strict I&O → clear liquid diet, LOW cholesterol & fat diet, 6 small meals / day, avoid fats, spicy foods → will develop hives from uremic frost = hypoallergenic, no perfume or cologne, wear light clothes (silk, cotton, linen), frequent skin care → LEFT lateral sims position • Postop: cholecystectomy (replace fat soluble vitamins; ADEK) → EARLY ambulation & prevent infect → no baths NCLEX TIPS: pancreatitis may cause resp failure = monitor rr *priority • if pt has tan / grey stools = biliary obstruction • drains (eg. jackson-pratt) <100cc / hr → notify HCP immediately • older pts w/ diabetes may not have fever or pain

atelectasis

collapsed lung; incomplete expansion of alveoli • fine crackles, discontinuous high-pitched snapping • leads to pneumonia Interventions: ambulation, deep breathing, incentive spirometry

ALS (Lou Gehrig's Disease)

degeneration of motor neurons • ages 40-70 • 3x more man then woman

cystic fibrosis (CF)

genetic disorder that causes exocrine glands to create more mucus secretions (& tears, sweat, & enzymes) • usually detected during 1st year of life • infants develop meconium ileus & resp issues • diagnostic test: sweat test (measures salt in test > 60 mmol/L = positive) • Cillia motility decreased → thick mucus → air trapping →hyperinflated lungs • rhonchi • thick white / green sputum, restlessness, runny nose, cyanosis, digital clubbing, salty skin, diminished breath sounds, tachycardia, ABD distention, foul fatty stools • complications: gallstones (bile duct blocked w/ mucous), diabetes (damages pancreas) Interventions: chest pt, high carb, protein, & fat diet, give supplemental enzymes w/ meal, increase Na during not weather, aerobic exercise

physical assessment process of children

infants • 1st 6 - 8 hrs after birth → critical transition → heart & rr Q30 mins during 1st 2 hrs → axillary temp Q30 mins • least to most invasive • observes • auscultate when infant is quiet • palpate & percuss • traumatic procedures (eg. eye, ears, and mouth exam) • elicitation of moro reflex (startle)

CPR / BLS

infants CPR • assess BRACHIAL pulse for 10 secs or less • call for help • 2 mins of CPR 100 - 120 compressions / min • single rescuer 30:2 • two rescuers 15:2 • place roll under shoulders, slightly extended neck • AED 1 chest & 1 back Asystole / PEA • CPR • EPInephrine Q3 - 5 mins • intubate & ventilate • tx causes • NO shocking **Comatose pts not following commands → Cold fluids (therapeutic hypothermia)

infiltration vs phlebitis

infiltration • fluid around IV site, cool, pallor extravasation • if infiltration has an irritating med admined phlebitis • inflammation of vein can lead to thrombophlebitis and emboli or bloodstream infection • causes: irritating drugs (eg. antibiotics; vancomycin), catheter mvmt, bacteria (eg. poor aseptic techniquw) • s/s: discomfort / burning at IV site, pain, redness, swelling, warmth at site Interventions: stop infusion immediately, admin phentalamine thru present iv site, & notify HCP

puberty

males • testicular enlargement (including scrotal changes ) *1st sign • pubic, axillary, facial, & body hair at 9 1/2 - 14 years old females •

Diabetes mellitus 1 & 2

metabolic disorder of pancreas Diabetes type 1 • unable to produce sufficient insulin • born w/ • sudden weight loss, young, ketones in urine Interventions: teach pt diet, exercise, & insulin for life NCLEX TIP: still give insulin on sick days Diabetes type 2 • inadequate insulin production / insulin resistance • insulin resistance leads to increased insulin production = metabolic syndrome • complications: nephropathy, retinopathy, atherosclerosis, htn, cva, neuropathy Risk factors: diet, sedentary lifestyle, african-americans Interventions: low-carb, fat, high-fiber diet, reduced sodium intake, daily inspection, use cotton, avoid flip flops, corn removal, hot bath / pads NCLEX TIP: metabolic syndrome may occur (3 or more criteria): Use acronym B. B. O. L. B: bp meds / HIGH bp B: blood sugar meds / HIGH glucose lvl (over 100 fasting) O: obese waist size (35+ Female, 45+ male) L: lipids (HIGH cholesterol) • exercise lowers glucose (eg. cyclist doing 10k) = @ risk for hypoglycemia

Opioids (narcotics)

opioid analgesic • Morphine, Hydromorphone, Hydrocodone, Oxycodone, Codeine, Fentanyl, Meperidine Hydrochloride • antidote: naloxone (narcan) • hypotension, n/v (these usually relieve themselves) • pruritus, nausea, resp depression, constipation (common side effects) *anticholinergic *hydrocodone & codeine (antitussives) → cough suppressor Fentanyl • transdermal patch (mod - severe pain) • 72 hrs; slow absorption 17 hrs until full effect *contraindicated w/ head injury *preggers: admin slowly during peak of contractions *follow-up 30 mins to assess effectiveness

PPE placement and removal

placement: -hand hygiene -gown -mask -goggles (eye protection) -gloves removal: -gloves -goggles (eye protection) -gown -mask

Healthcare-associated infection (UTIs)

wash hands pergorm routine perinal hygiene with soap and water each shift and after bowel mvmt keep drainage system off floor or contaminated surfaces keep cath bag Below lvl of bladder ensure pt has a separate clean container to empty collection and measure urine sterile technique (when collecting urine specimen) keep free of kinks

Sexual dysfunction meds

• " - afil " • Sildenafil, Tadalafil, Vardenafil • enhances nitric oxide effect to increase blood flow to penis • do not take w/ nitrate drugs, alpha blockers for BPH, antinypertensives • No stroke, htn / hypotension, or HF pts • side effects: hypotension, vision impairment, hearing loss, headache, flushing, priapism (erection lasting > 2 hrs) Interventions: admin 1 hr before once daily

Steroid drugs (glucocorticoids)

• " - asone, - sone " • anti-inflammatory, pain relief • used to tx: resp issues (eg. asthma), musculoskeletal issues (eg. arthritis, broken bones), organ transplants, addison's disease • oral: Predisone, Prednisolone, Betamethasone • inhalation: Beclomethasone, Budensonide, Triamcinolone acetonide • IV: Hydrocortisone sodium succinate, Methylprednisolone, Betamethasone sodium phosphate 7 S's precautions • S: swollen • S: sepsis • S: sugar increased • S: skinny • S: sight • S: slowly taper off (never abrupt → adrenal dysfunction) • S: stress or surgery (increase dose) Interventions: teach pt to report sudden, excessive, rapid weight gain (1 lb in 1 day, 2 - 3 lbs in a few days), monitor hyperglycemia, monitor muscles & bones for osteoporosis, refer to optometrist → cataract risk, monitory for hypokalemia NCLEX TIP: *priority report low WBC fever, if pt has dm & taking steroids → pt must increase insulin doses • tx pt to take cal supps & vit D for bones *(neonatal) abstinence syndrome = withdrawal sympts from opioids during preggers

Antiemetic

• " - azine " • " anti-vomit / nausea " med Promethazine • side effects: anticholinergic effects (dryyyyyy af), drowsiness, EPS, sever resp depress in child < 2 years, potentates effects when given w/ narcotics • precautions: cardiovascular & hepatic disease Interventions: IM (large muscle), monitor vitals, safety precautions Metoclopramide • side effects: EPS, tardive dyskinesia: mvmt disorder characterized by uncontrollable mvmts (eg. sucking / smaking lips), drowsiness, diarrhea, restlessness • precautions: sz, cardiovascular disease, pheochromocytoma (PCC) → tumor that develops on top of kidney (adrenal gland) Interventions: teach pt about rapid GI emptying, discontinue w/ signs of EPS Ondansetron • side effects: EPS, headache • precautions: risk for dysrhythmias, do not admin to pt w/ prolonged QT interval Interventions: admin tab 30 mins prior to chemo & 1 - 2 hr before radiation Scopolamine • side effects: anticholinergic effects, blurry vision, sedation • precautions: increased mydriatic effect → increased ocular pressure, (eg. glaucoma) Interventions: apply transdermal patch behind ear, use eye drops NCLEX TIPS: if pt is experiencing sympts of TD in metoclopramide → nurse should question or notify HCP for admin of drug

Antibiotics

• " - cillin, - cycline, - mycin, - floxacin " • penicillin, antibiotic, aminoglycoside, antibiotics • " - cillin " • amoxicillin, ceftriaxone • common s/s: diarrhea " - floxacin " • ciprofloxacin • adverse effect: tendon rupture* " - cycline " • doxycycline • adverse effect: tooth discoloration* " - mycin " • tobramycin, gentamicin, amikacin • adverse effect: ototoxicity* NCLEX TIPS: antibiotics have a high risk of being ototoxic, nephrotoxic → monitor for tinnitus, kidney tests: bun & creatinine • pts on antibiotics & warfarin → antibiotics can affect INR by producing vit k+ **creatinine lvl > 1.3

Diuretics

• " - ide " • furosemide, hydrochtorothiazide, chlorthalidone LOOP: Furosemide, Bumetanide • side effects: ototoxicity & everything from thiazides • eat food w/ high K+ THIAZIDES: HCTZ, Chlorothiazide • side effects: hypovolemia, hypokalemia, hyponatremia, hyperglycemia, digoxin & lithium toxicity • eat food w/ high K+ POTASSIUM SPARING: Spironolactone, Triamterene, Amiloride, Eplerenone • " S.E.A.T. " k+ inside • side effects: hyperkalemia, endocrine effects (eg. impotence, menstrual irregularities) • avoid foods w/ K+ (eg. salt substitutes) OSMOTIC: Mannitol • pulls fluid back into vascular & extravascular spare by increasing serum osmolality • used to tx: cerebral edema (reduces icp), RF (prevents hypovolemia), decrease intraocular pressure • side effects: pulmonary edema, F & E imbalances, thirst, dry mouth Interventions: monitor daily weight, I & O, BP, electrolytes, monitor hypovolemia & neurological status, admin early to avoid nocturia, renal function & K+ lvls • caution use of Licorice Root (used for GI disorders; stomach ulcers) w/ diuretics → hypokalemia

Beta-blockers

• " - lol " • Lower the 2 L's → Low hr & Low bp • Metroprolol, Atenolol, Propranolol, Nadolol, Labetalol • used to tx: htn, angina, hr, mi, tachydysrhythmias • orthostatic hypotension *common side effect • major side effects 4 B's: Bradycardia, Bronchospasms, Blood glucose low, Bad for endstage HF NCLEX TIPS: causes bronchiospasms in asthma pts; contraindication (bronchiospasms; wheezing) • propranolol may mask effects of hypoglycemia in pts w/ dm • do not admin labetalol in same IV line w/ furosemide

ARBs

• " - sartan " • Losartan, Valsartan, Irbesartan • block binding of angiotensin II to AT1 receptors in tissue • adverse affects: hyperkalemia** (will increase it) NCLEX TIPS: BLACK BOX WARNING → contraindicated w/ preggers

Sumatriptan

• " - triptan " • Sumatriptan, Almotriptan, Eletriptan, Frovatriptan, Rizatriptan • serotonin agonist • constricts dilated cranial blood vessels • tx: migraine headaches • contraindicated: CAD, uncontrolled htn • risk factors: htn urgency, angina, decreased CO perfusion, acute mi

Antiviral meds

• " - vir" • valacyclovir • adverse effects: thrombotic thrombocytopenic purpura*

Anticoagulant meds

• " -arin " • Heparin, Warfarin, Apixaban, Rivaroxaban, Dabigatran NCLEX TIPS: do not administer w/ NSAIDs = increased risk of bleeding • Apixaban maintenance therapy after PE

PPI (proton pump inhibitor)

• " -azole" • omeprazole, lansoprazole, rabeprazole sodium, esomeprazole • causes rebound GERD when coming off

Bisphosphonate meds

• " -dronate " Alendronate, Risedronate, Ibandronate • treats osteoporosis • long term therapy = @ risk for jaw necrosis Intervention: drink w/ full glass of water in AM on empty stomach 30 mins before other drugs & upright for 30 mins, monitor bone density, esophagitis = sit up NCLEX TIP: after taking med sit up right for @ least 30 mins

Aminoglycoside (antibiotic) med

• " -mycin " • gentamycin, erythromycin, clarithromycin, vancomycin, azethromycin • nephrotoxic, ototoxic • used to tx: e. coli, pneumoniae - prolonged QT intervals (eg. torsades de pointes) = life-threatening arrhythmias → notify provider immediately

Benzodiazepines

• " -pam, -lam " • Midazolam, Alprazolam, Lorazepam, Clonazepam, Diazepam • used to tx: acute antianxiety, pain mgmt • adverse affects: sedative; decreases RR (eg. apnea) & BP (eg. hypotension), slurred speech • antidote: flumazenil Interventions: admin at bedtime, never stop abruptly; gradually tapered off (to prevent withdrawal sympts & rebound anxiety)

Thrombolytic meds

• " -plase " • dissolves clots that have already formed Alteplase, Tenecteplase, Reteplase • used to tx: acute mi, DVT, PE, ischemic stroke (alteplase) • risk for intracranial hemorrhage, active internal bleeding • must be taken within 4 - 6 hrs of sympts onset • contraindicated: active bleeding, prior intracranial hemorrhage, aneurysm, ischemic stroke within 3 mons, head trauma, uncontrolled htn = can cause hemorrhage

ACE inhibitors

• " -pril " • Antihypertensive • Captopril, Enalapril, Afosiopril • Blocks ACE in lungs from converting angiotensin I to angiotensin II • vasoconstrictor • Decreases BP, dry cough, angioedema (allergic reaction) • Decreased Aldosterone secretions, na and fluid loss • adverse affects: hyperkalemia** Interventions: Check BP before giving (hypotension), get out of bed slowly (orthostatic hypotension), monitor aldosterone lvls (hyperkalemia) NCLEX TIPS: BLACK BOX WARNING → contraindicated w/ preggers • Orthostatic Hypotension * main side effect • adverse reaction to watch out for → angioedema • "Aldosterone Saves Sodium & Pushes Potassium out of body" • If pt cannot tolerate ace → give arb • Doesn't slow hr → ok for bradycardia

Anti-lipemic meds

• " -statin " • Atorvastatin, Simvastatin, Lovastatin, Pravastatin sodium, Rosuvastatin, Fluvastatin • lowers LDLs & increases HDLs • used to tx: hypercholesterolemia, prevent coronary issues, & protects against mi & stroke for dm pts • muscle aches • hepatotoxic • rhabdomyolysis • peripheral neuropathy Interventions: no preggers • take in evening or bedtime with a meal (increases chol synthesis) • monitor liver & renal functions; hepatotoxic • low fat & high fiber diet • prolonged bleeding in pts taking warfarin • no grapefruit juice • med interactions with pretty much everything

Calcium Channel Blockers

• " A Very Nice Drug " • Amlodipine, Verapamil, Nifedipine, Diltiazem, • slows mvmts of ca into smooth muscle cells; arterial dilation & decreases bp • peripheral edema, dizziness, flushing, headache, constipation • orthostatic hypotension * • used to prevent / tx: angina pectoris, some arrhythmias (eg. Afib), and htn Interventions: do NOT consume grapefruit juice (results in myopathy) NCLEX TIPS: verapamil w/ digoxin increases risk for dioxin toxicity

Tricyclic Antidepressants (TCAs)

• " ACID DNA " • Amitriptyline • Clomipramine • Imipramine • Desipramine • Doxepine • Nortriptyline • Amoxapine • antidepressants • s/s: orthostatic hypotension, anticholinergic, sedation, drowsiness, confusion, photosensitivity Interventions: change positions slowly, avoid alcohol, sedatives, monitor bp, increase fluids, high fiber, chew sugarless gum, caution when driving, wear sunglasses, protective clothing, give at bedtime • do not admin w/ st. johns wort *contraindicated w/ cardiac probs -> leathal in overdose = cardiotoxic *can trigger suicidal thoughts in early use & young adults **overdoses w/ tricyclics espeically w/ alcohol = 70 - 80% chance of death

MAOIs (monoamine oxidase inhibitors)

• " PITS " • Phenelzine, Isocarboxazid, Tranylcypromine, Selegiline, • first-gen antidepressants • increases amt of dopamine, norepinephrine, & serotonin • tx: 1st line for atypical & tx of non-endogenous depressions • s/s: anticholinergic, insomnia, agitation, confusion, and weight gain Interventions: med change to / from MAOI tapered and discontinued followed by a 2 wk "washout" period w/o either meds • MAOIs & SSRIs should not be given within 2 wks of each other → adverse affects: serotonin syn, neuroleptic malignant syn, htn crisis • NO tyramine foods (eg. bananas, chocolate, coffee, soy) → adverse affects: htn crisis • ok to eat cottage cheese, cream cheese, bagel, tomatoes *do not combine w/ any other drugs

HE (hypertensive encephalopathy)

• *med emergency caused by a sudden elevation in bp (eg. hypertensive crisis) • s/s: severe headache *early sign, visual impairment, anxiety, confusion, epistaxis, sz, coma • complications: MI, hemorrhagic stroke, AKI Risk factors / triggers: acute exacerbation of pre-existing htn, drug use, MAI-tyramine interactions, head injury, pheochromocytoma

developmental milestones of infants

• 1 Month → attempts to hold head up when prone. Maintains fisted hands → cries when upset → gazes at parents face when parent speaks • 2 - 3 Months → gains head control when held → reflectively holds / clasps rattle when placed in hand w/ their palm → makes cooing sounds → smiles in response to smiling and talking → recognizes familiar faces • 4 - 5 Months → rolls front to back then back to front → holds head up independently (>6 mons = abnormal) → sits with support → VOLUNTARILY grasp / hold objects with palmar grasp → puts things in mouth → begins to laugh → makes some consonant sounds → becomes calmed by parents voice • 6 - 9 Months → sits without help → begins to crawl → may pull to a stand → moves objects between hands → uses crude pincer grasp → babbles & imitates sounds → may say " mama " → recognizes familiar faces → stranger anxiety • 10 - 12 Months → may walk with help or takes 1st step independent steps → crawls upstairs → sitting down from a standing position w/o assistance → uses NEAT pincer grasp; self-feeding → hits 2 objects together → says 3-5 words → uses non verbal gestures → may have separation anxiety → searches for hidden objects * 1st 3 - 4 mons not unusual for infant to cry 1-3 hrs / day

Theophylline

• 10 - 20 mcg/mL • methylxanthines • bronchodilator • TOXICITY RISK* • tachycardia • can cause sz & dysrhythmias • contraindications: cimetidine & ciprofloxacin (increases theophylline lvls) • dose adjusted by peak lvls 30 min after given • given for resp pts (eg. asthma pts / copd) Interventions: avoid stimulants (eg. coffee, chocolate), constant blood checks

measuring fundal height

• 12 wks gestation → fundus just ABOVE symphysis pubis • 16 wks gestation → fundus HALFWAY BETWEEN symphysis pubis & umbilicus • 20 - 22 wks → umbilicus • 34 wks / 20 cm → umbilicus • 36 wks / 34 cm → xiphoid process • 38 - 40 wks / 30 cm → fundal height drops • immediately after birth → fundus at midline approximately 1 fingerbreadth below umbilicus • after 1 hr after birth → fundus drops 1 cm / hr *after 20 wks gestation → fundal height measurements in cms (eg. 24 cm = 24 wks)

toilet training

• 18 - 24 months • signs to start toilet training: → able to communicate & follow two step command / directions → ambulate to & sit on toilet → remain dry for several hrs thru a nap → pulls clothes up & down (not selves dress completely) → expresses need to use toilet (urge to defecate or urinate) → imitates toilet habits of adults or siblings → expresses interest in training • may regress if hospitalized → 1st step reassure pt → limit fluids at nighttime → void before bedtime → involve child in planning (eg. changing wet linens)

developmental milestones of toddlers

• 18 months (1 yr & 1/2) • gross motor (physical): → walks up/down stairs with help → throws a ball overhand → jumps in place • fine motor (muscle mvmt; hands & fingers): → builds 3 - 4 block tower → scribbles → turns multiple pages in a book at a time → uses cup and spoon to eat • language: → 10+ word vocabulary → identifies common objects • social / cognitive: → has temper tantrums → understands ownership → imitates others • 2 years (24 mons) " terrible twos " • gross motor (physical): → walks alone → walk up / down stairs alone 1 step at a time → runs without falling → kicks balls • fine motor (muscle mvmt; hands & fingers): → builds 6 - 7 block tower → turns 1 book page → uses or twists doorknob to open → draws line • language: → 300+ word vocab → 2 - 3 word phrases → calls self by name • social / cognitive: → begins to parallel play "alongside but not w" → begins to gain independence from parents PRESCHOOLERS • 3 years (36 mons) " curiosity stage " • gross motor (physical): → walks UP stairs w/ alternating feet → pedals a tricycle → jumps fwd • fine motor (muscle mvmt; hands & fingers): → draws a circle → feeds self w/o help → grips a crayon with fingers instead of fists • language: → 3 - 4 word sentences → asks " WHY " questions → states own age • social / cognitive: → begins associative play / group play → toilet trained except wiping • 4 years • gross motor (physical): → walks DOWN stairs w/ alternating feet → hops & (balances) stand on 1 foot for 5 - 10 secs → catches ball 50 % of time • fine motor (muscle mvmt; hands & fingers): → copy or draws square → cuts w/ scissors → ties simple knot • language: → names > 2 or more colors → likes telling stores • social / cognitive: → begins " magical thinking " imaginative play → recognizes analogies → often focuses on self • 5 years " mostly independent " • gross motor (physical): → skips → walks bckwrd → uses jump rope • fine motor (muscle mvmt; hands & fingers): → copies shapes other than circle; draws a triangle → ties shoelaces → prints letters, numbers, or words • language: → counts to 10 → speaks full sentences → names coins & days of the week • social / cognitive: → independently dresses & bathes → IDs real from pretend

SIRS (systemic inflammatory response syndrome) criteria

• 2/4 of the criteria : • Temp > 38.5 (101.4F) or < 35 (95 F) • Pulse > 90 • Resp > 20 (often associated w/ low paCO2) • WBC > 12,000, < 4000, > 10% bands • triggers: trauma, tissue ischemia, infection: sepsis • complications: hemodynamic instability, resp failure, & multiorgan dysfunction Interventions: aggressive fluid resuscitation & tx of possible causes (eg. antibiotics for infection) *if infectious source Id-ed = sepsis *if not = SIRS *BOTH have hypotension despite adequate fluids *shock + 2 organ system damage = multiorgan dysfunction syndrome

PTL (preterm labor)

• 20 - 37 wks • s/s: ROM, low back aches, contractions, pelvic pressure Risk factors: UTIs, periodontal disease, hx of spontaneous preterm birth, cervical surgery, maternal age of < 17 & > 35, maternal undernutrition, tobacco / illicit drugs Interventions: • IM antenatal gluocorticoids for fetal lung maturity 2:1 (eg. betamethasone, dexamethasone) • antibiotics to prevent group B strep if preterm occurs (eg. penicillin) • IV mag sulfate for fetal neuroprotection < 32 wks • tocolytics (eg. nifedipine, indomethacin, terbutaline)

SVT (superventricular tachycardia)

• 200 - 300 bpm • QRS complex: narrow. P waves usually hidden if not abnormal shape • hypotension Interventions: 1st tx: valsalva maneuver, coughing, carotid massage (vagaries stimulation), placing ice on bridge of nose → adenosine → synchronized cardioversion (sync should be used on dfib), O2 should be turned off and moved away before dfib use)

Breast cancer

• 2nd most common cause of cancer death among women • dx: mammography • s/s: hard irregularly shaped, non-mobile, nontender • tx: Tamoxifen *increased risk of thrombolytic events & endometrial cancer Risk factors: female > 50, fam hx, BRCA1/BRCA2 genetic mutations, personal hx of endometrial / ovarian cancer, menses < 12 or menopause > 55, hormone therapy, postmenopausal weight gain / obesity, hx smoking & alc, dietary fat intake, sedentary lifestyle

CBT (cognitive behavioral therapy)

• 5 basic components of CBT: → education about pts specific disorder → self-observation & monitoring (learns how to monitor anxiety, id triggers, & assess severity) → physical control strategies (deep breathing & muscle relaxation exercises) → cognitive restructuring (learning new ways to reframe thinking patterns, challenging neg thoughts) → behavioral strategies (focusing on sit that cause anxiety & practicing new coping behaviors, desensitization to anxiety-provoking sits, stimulus, or events) • used to tx: anxiety, eating, depressive, med conditions (eg. insomnia, smoking) → maladaptive reactions to stress, anxiety, & conflict

BNP (brain natriuretic peptide)

• < 100 pg/mL or ng/L desired • > 100 positive for HF • > 400 (severe HF) • BNP is ordered to help determine HF and is a more sensitive test than ANP • increases in response to volume expansion & pressure overload

Mucolytic meds

• Acetylcysteine • also hypertonic sol can help excrete secretions Interventions: promote fluid intake

Addison's disease (adrenal insufficiency)

• Addisons → Absents of steroids • "small, weak, tanned" • CRH → ACTH → adrenal cortex produces steroids = aldosterone & cortisol • steroids control SSS: sugar (cortisol), salt (aldosterone), sex & hair (androgens) → aldosterone = increases NA Retention & increases Secretion of K+ → cortisol = increases glucose • 4 S's → surgery, stress, sepsis, strenuous activities • addisonian "adrenal" crisis: characterized by signs of hypotensive shock → hypotension, tachycardia, tachypnea, pallor • occurs secondary to 4 S's, abrupt stop, drop in bp Interventions: add cortisone steroids IV push, dehydration (IV NS), dextrose (D50 IV fluids) A.D.D.S.S. • ADDED pigmentation & K+ • DECREASED weight • DECREASED bp, temp, hair, sugar, energy, mood • SODIUM loss • SALT craving • low Na • low glucose • low bp • low weight (water loss = weight loss) • low temp (cold intolerance) • low hair (alopecia) • low mood (depression) • low energy (fatigue) • slow or absent periods: amenorrhea • HIGH: pigmentation "bronze, hyperpigmentation" & K+ (potassium pumps → muscle spasms, peaked T waves, ST elevation), hypercalcemia • dx: ACTH stimulation test, (decreased) 24 hour urine free cortisol Interventions: add some steroids (eg. hydrocortisol), high protein & carb diet, avoid caffeine & alcohol, med band Risk factors: A.D.D. → Autoimmune, Diseases & infections (eg. HIV/TB, cancer), Damage (eg. adrenal hemorrhage) NCLEX TIPS: monitor for addisonian crisis *priority

Lab tests (renal & hepatic)

• Albumin: 3.5 - 5 • Ammonia: 10 - 80 • Bilirubin: 0.3-1 mg/dL • Total bilirubin: 0.1 - 1.0 • Total protein: 6 - 8 signs *low albumin = cirrhosis, kidney issues *elevated bilirubin = jaundice *elevated ammonia in liver = hepatic encephalopathy *elevated protein in urine = renal probs

Reportable diseases

• Anthrax • Botulism • Cholera • Congenital rubella syndrome (CRS) • Diphtheria • Giardiasis • Gonorrhea • Hepatitis A, B, C • HIV infection • Influenza‐associated pediatric mortality • Legionellosis/Legionnaires' disease • Lyme disease • Malaria • Meningococcal disease • Mumps • Pertussis (whooping cough) • Poliomyelitis, paralytic • Poliovirus infection, nonparalytic • Rabies (human or animal) • Rubella (German measles) • Salmonellosis • Severe acute respiratory syndrome‐associated coronavirus disease (SARS‐CoV) • Shigellosis • Smallpox • Syphilis • Tetanus/C. tetani • Toxic shock syndrome (TSS) (other than Streptococcal) • Tuberculosis (TB) • Typhoid fever • Vancomycin‐intermediate and vancomycin‐resistant Staphylococcus aureus (VISA/VRSA)

Heparin

• Anticoagulant • TOXICITY RISK* • parenteral (subg or IV) • inhibits clotting or prevents clot formation • low molecular heparin → enoxaparin • monitor aPTT Q4-6 hrs for IV, norm: 30 - 40 secs, critical val > 70 secs • aPTT therapeutic effects: 1.5 - 2 xs norm or controlled val (60 - 100 secs) • antidote: protamine sulfate • no bicarb meds, NSAIDs, aspirin, or salicylate Interventions: admin subQ to abd 2in from umbilicus; do not aspirate or massage, rotate injection site, monitor for bleeding or hematoma, complete CBC before admin Hgb, Hct, platelet → can cause thrombocytopenia NCLEX TIPS: doesn't slow hr → ok to admin for pts w/ bradycardia • enoxaparin may cause mild bruising or redness at injection site, pinch and inject at 90 degree angle, do not rub, monitor pt / inr • enoxaparin used to tx DVT / VTE

meds not good for preggers

• BLACK-BOX WARNING • Phenytoin • Lithium • Valproate • Isotretinoin • Methotrexate • ACE inhibitors • Warfarin • Doxycycline (tertracycline antibiotic): impairs bone mineralization & discolor permanent teeth in fetus

Anxiolytic meds

• Buspirone • used to tx: anxiety • minor sympt relief 1 wk after full therapy; full effects 2 - 4 wks • low abuse potential; lacks CNS depressant effects • no withdrawal sympts, dependance, or pyschomotor impairment

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 • " recently i have notice my bowel mvmts appear black "

atypical antipsychotic

• Clozapine, Ziprasidone, Olanzapine, Bupropion Clozapine • tx: schizo that has not responded to traditional tx • adverse effects: agranulocytosis Interventions: baseline CBC & absolute neutrophil count, monitored cbc regularly (once a week), report to HCP → fever or sore throat Ziprasidone hydrochloride • tx: acute bipolar mania, psychosis, and agitation • adverse risk increased w/ alcohol: arrthymias = prolonged QT intervals (leading to torsades de pointes), hypotension, sz Interventions: baseline ECG & K+, EKG weekly & assess pulse for palpitations, admin w/ at least 350-500 cals NCLEX TIPS: pt experiencing NMS life-threatening adverse reaction to antipsychotic meds *priority pt → assess for muscle rigidity Bupropion hydrochloride • tx: depressive disorders (eg. MDD, seasonal, persistent dysthymia), smoking cessation • adverse reactions: weight loss, sz Interventions: no doubling dose, take at same time each day, several weeks for effect

Cushing's Disease/Syndrome

• Cushings → Cushion of steroids • "big, round, hairy" • complete opposite of Addison's! C.U.S.H • Cushion • Unusual hair growth • Skin • High sugar, bp, weight • big glucose & Na+ • big bp • big belly (truncal obesity) • big face (moon face) • big buffalo hump (fat pad) • big hair (hirsutism) • big stretch marks (purple striae) • big red face (rosy cheeks; butterfly mark) • big infections (slow wound healing) • big risk for fx (brittle bones) Interventions: control causes → cut out tumor; slowly decrease steroids, meds: adrenal enzyme inhibitors, postassium sparing diuretics (eg. spironolactone) Risk factors: steroids " -sone ", tumor (eg. pituitary, adrenal), small cell lung cancer NCLEX TIPS: small cell lung cancer is a specific risk factor, adrenalectomy can lead to addisonian crisis → must replace hormones

Vasopressors meds

• Epinephrine, norepinephrine, vasopressin, dobutamine, dopamine • antidote: phentolamine • used to tx: low bp, cardiac arrest, shock • increases hr & bp, muscle strength (cardiac output), & sugar metabolism (increased bg) * " 3 D's for DEEP contraction " → INOtropic = INcreases forceful contractions & cardiac contractility" → Dopamine, Dobutamine, Digoxin → assess IV site hourly for infiltration, hourly bp checks → too much dopamine = s/s: tachycardia * " -nephrine drugs " ADDS " adrenaline " → EPInephrine = initiates heart contraction during cardiac arrest → asystole, PEA (pulseless electrical activity) * " vasoPRESSors → PRESSES BP up " → vasoPRESSIN = PRESSES up ADH

TNF (tumor necrosis factor) inhibitor drugs

• Etanercept, Infliximab, Adalimumab • blocks action of TNF (mediator that triggers a inflammatory response) • used to tx: RA • major adverse effects: infection, bone marrow suppression Interventions: baseline TST before therapy, yearly skin tests (TB) NCLEX TIPS: TB will be reactivated if used *major concern

Serial neurological assessments

• GCS (Glasgow Coma Scale) • PERRLA • Motor strength & mvmt in all 4 extremities • Vitals • GCS of 13 - 15 = mild head injury • < 8 or below = severe • pt must be awakened for prescribed neurologic assessment (eg. blunt head injury)

Expectorant meds

• Guaifenesin • loosens mucus secretions • used to tx: COPD, emphysema, bronchitis, CF Interventions: use huff coughing technique to remove secretions, increase fluid intake, humidified air, take med w/ full glass of water

hypovolemic shock

• HYPO-Vol = LOW blood Vol • s/s: cold, clammy skin **priority (pt is getting WORSE) → hypotension, tachycardia, LOW CVP, " put the Head LOW in HYPOvolemic " • tx: 1st LOWER HOB ASAP, IV NS fluids, norepinepherine or dopamine, spO2 (pulse ox) placed on forehead **do NOT delay new bag of meds

HELLP syndrome

• Hemolysis, Elevated Liver enzymes, Low Platelets • severe form of preeclampsia • s/s: RUQ or epigastric pain *severe, n/v, malaise, increased bp of > 30 / > 15 • complications: bleeding Risk factors: gestational thrombocytopenia, preeclampsia

Fifth disease (erythema infectiosum)

• Human parvovirus B19 • childhood disease • usually harmless • s/s: bright red "slapped-cheek" facial rash, mild flu-like sympts (eg. fever) *preg women should avoid contacted w/ infected person = anemia in fetus *prioritized before pt with vaginal infection

TPN (total parenteral nutrition)

• IV nutrition sol containing carbs, amino acids, vits, minerals, electrolytes, & lipids • specifically made for each pt • before admin verify prescription & sol w/ another nurse • monitor glucose lvls Q 4 - 6 hrs • check residuals Q 4 hrs < 250 mL • > 250 mL = delayed stomach emptying & requires adjustment • mouth care Q 4 hrs • new tpn bag Q 8 hrs • change IV tubing & fluid Q 24 hrs • semi-fowlers Interventions: if TPN is finished / unavailable & waiting for new bag = admin 10% dextrose in water @ same infusion rate until new bag arrives, monitor glucose → hourly glucose checks NCLEX TIPS: TPN abruptly stopped → may cause hypoglycemia = check pt 1st • recommended BG for pts receiving parenteral & enteral nutritional support = 140 - 180 mg/dL • hyperglycemia in TPN pts > 180 mg / dL

Allergies

• IgE (Eosinophils) • vaccine components: neomycin, gelatin, yeast • latex: bananas, kiwis, tomatoes, strawberries, • tx: vasopressors: epinephrine, noepinephrine

RF (rheumatic fever)

• Inflammatory disease of the heart that occurs after group A β-hemolytic streptococcal pharyngitis • J: joints (migratory arthritis) • : carditis • N: nodules (subq) • E: erythema marginatum • S: Sydenham chorea • ffever, arthralgias, elevated ESR & C-reactive protein, prolonged PR interval

Central venous catheter (cvc)

• Inserted by HCP • "central vein" (eg. Subdavian, internal jugular, femoral) • non sterile gloves • scrub port w/ chlorhexidine 10-15 secs • used for admin of incompatible drugs simultaneously, blood draws, parenteral nutrition & hemodynamic monitoring • complications: pul embolism Interventions: use mask to clean port to avoid infection, have pt face away from port, valsalva maneuver NCLEX TIPS: pt experiencing air embolism = clamp the cap, trendelenburg on Left side, admin O2 if needed, notify HCP

anticonvulsant / antiepileptic meds

• Levetiracetam • depresses CNS • drowsiness, somnolence, fatigue improves within 4 - 6 wks • adverse effects: depression Interventions: report increased agitation, anxiety, depression ≈ suicidal ideation • report rash → SJS (steven-johnson syndrome)

TB

• Mantoux test or PPD test (purified protein derivative) 48-72 hrs to read • collecting 3 early morning specimen on 3 consecutive days for AFB smear & culture test • positive tb test > 15mm • active or inactive: chest X-ray & presence of sympts • tx up to 6 months • 3 sputum samples are taken & if all neg & chest xray = pt cleared • low-grade fever, night sweats, anorexia / weight loss, fatigue, malaise (discomfort), cough, purulent / blood-tinged sputum, SOB • late sympts: dyspnea, hemoptysis Interventions: positive = airborne precautions, neg = standard precautions

Stimulant meds

• Methylphenidate, Dextroamphetamine, Lisdexamfetamine • CNS stimulant • affects dopamine & norepinephrine that contribute to hyperactivity & lack of impulse control • used to tx: ADHD, narcolepsy (methyl) • s/s: htn, tachycardia, delayed growth & development, weight loss, loss of appetite*most common • anorexia, restlessness, insomnia, vocal or motor tics • improves attention, decreases distractibility, helps maintain focus, improves listening skills Interventions: monitor weight, bp, hr before & after tx, last dose before 4pm *abuse potential

Childhood immunizations

• NO live vaccines for preg

Antispasmodic meds

• Oxybutynin • anticholinergic • used for overactive bladder • s/s: everything's dry (eg. constipation, dry mouth, flushing / heat intolerance, drowsiness / sedation, blurred vision) Interventions: pt should be cautious in hot weather & physical activities (eg. swimming at beach) → hyperthermia, increase fluids & fiber diet

ECG, EKG

• P wave: atrial depolarization; contraction • QRS complex: ventricular depolarization; contraction < 0.12 secs • T wave: ventricular depolarization; relaxation • PR interval: SA node to AV node between 0.12 - 0.20 secs • T wave inversion: ischemia • Q wave enlargement: injury • ST segment: elevated = MI injury NCLEX TIPS: life-threatening dysrhythmias: VT, VF, SVT

3rd Gen

• Positive + Neg Sympts • improves cognitive functions • Aripiprazole • low riskL weight gain, ACH, EPS • adverse drug effects: insomnia, akathisia (restlessness)

2nd Gen / Atypical *med of choice

• Positive + Neg Sympts (things that are missing- the "A's") • major s/s: weight gain • Risperidone → Blood glucose lvl (weight gain!) → Cardiac issues → w/ food 300-500 cals → May take anytime • Olanzapine • smoking decreased efficacy by 50% • s&s: ?? • (last resort) • Quetiapine → Fall precautions (eg. declutter room) → Used to calm dementia pt* • Clozapine → Blood tests: 6 months after start → Monitor agranulocytosis: ANC under 1,000, WBC under 3,000 STOP med → CANNOT give immunosuppressed / bone marrow suppressed pt → S&S: weight gain, hypersalivation, seizures, SJS, smoking decreases efficacy by 50% → adverse drug effects: agitation, dizziness, sedation (HS), sleep disturbance, fever, sore throat, mouth lesions → (last resort) Interventions: low cal diet, exercise, monitor weight, weekly blood count for 6 mons

VT (ventricular tachycardia)

• QRS wave is wide and bizarre • hr of 150 - 250 bpm • unresponsive, pulseless, apneic Interventions: assess carotid pulse → pulse unstable = cardioversion → pulse stable = drug therapy → pulseless = CPR, dfib, drug therapy (eg. epinephrine, vasopressin, amiodarone)

Meds for tb

• R: Rifampin / rifapentine (priftin) tx for latent tb. - discolors body fluids to red-orange - take w/ meals - reduces effectiveness of oral contraceptives (use nonhormonal contraceptives instead) - hepatotoxicity → LFT every month • I: INH (isoniazid) tx for latent tb. - adverse effects → hepatotoxicity (eg. sclera, jaundice, vomiting, dark urine, fatigue) & peripheral neuropathy (eg. numbness, tingling) - avoid alcohol & acetaminophen - avoid aluminum-containing antacid (eg. aluminum hydroxide) within 1 hour of taking INH - avoid tyramine foods - take pyridoxine (VIT B) to avoid neuropaths - may be taken w/ food • P: Pyrazinamide - increases risk for GOUT (check uric acid lvls before admin) - take w/ 8 oz of water - photosensitivity (use sunscreen, cotton clothing) • E: Ethambutol - neuropathy (check vision before) Interventions: hepatotoxic & nephrotoxic w/ TB meds = monitor kidney & liver function,

Fetal presentations

• ROA → optimal birth position • ROP → lower back pain "back labor" w/ contractions • Brow → head tilted back; nose & mouth 1st • Transverse → shoulder presenting 1st • Breech → feet or buttocks presenting 1st *ROP " sunny side up " baby → position pt on hands & knees to relieve back pain, counterpressure on pt sacrum *breech → may have scrotal edema from birthing; resolves naturally *cephalic head down presentation = diamond-shapped anterior fontanelle

Rh immune globulin (RhoGAM)

• Rh alloimuization • admin at 28 wks / amniocentesis • Mother Rh-negative & Fetus is Rh-positive = admin RhoGAM → ONLY effective if pt has never developed antibodies to RH antigen / Rh sensitization → check for antibody screen (indirect Coombs test) → neg screen = admin

Syphilis

• STD • can be transferred across placenta in pregnancy

nephrotic syndrome

• Set of symptoms due to damage to filtering structure of kidney • non-infectious condition of glomeruli • can go into remission but can relapse • ages 2 - 7 yrs • proteinuria (loss of >3 per day, orange frothy looking urine) • hypoalbuminemia • hyperlipidemia (high cholesterol lvls) • peripheral edema, ascities • htn • fatigue, loss of appetite • frosty urine Risk factors: lupus, dm, hepatitis, hf, HIV, NSAIDs (secondary diseases that cause damage to kidney) Nursing intervention: monitor I&O, daily weight, fluid restrictions, K+ sparing diuretics, assess swelling = measure abd girth, monitor for blood clots, small frequent low Na+ & low fat diet, monitor urine protein, loss of immunoglobulins → increase risk of infection (eg. restrict visitors)

Selective Estrogen Receptor Modulators (SERMs)

• Tamoxifen • used to tx: breast cancer *increased risk of thrombolytic events & endometrial cancer • Clomiphene • 1st line tx for infertility • taken on day 3 - 5 of menses for 5 days • ovulation 5 - 9 days after completion • s/s: mood swings, nausea, hot flashes, headaches • adverse effects: multiple gestation

newborn vitals, labs & assessments

• Temp axillary: 96.8-99 F (36-37.2 C) • > 100.4 F or < 96.8 F "red flag" in neonates <30 days old • fever can be the only sympt** • HR: 120-160 bpm • crying / activity: 100 - 180 bpm • during sleep: may decrease to 100 bpm • Resp: 30-60 breaths / min w/ periodic pauses lasting < 20 secs • may be slightly irregular, diaphragmatic, & shallow immediately after birth → rales (crackles) → wheezes, stridor, or persistence of crackles after 1st few hrs of birth = abnormal; notify HCP • BP: 80-90 / 40-50 mm Hg • glucose: 40 - 60; optimal 70 - 100 • < 40 - 45 = hypoglycemia → fed immediately then notify HCP → asymptomatic: < 25 bg lvl w/ 24 hrs of life = supp feedings (sugar bottle) & breast milk when possible → symptomatic, no toleration to oral feedings, or bg doesn't increase w/ feeding: IV glucose • bilirubin: > 4 - 6 mg/dL → jaundice in 1st 24 hrs of life = pathologic → jaundice after 24 hrs < 5 = physiologic; resolves spontaneously but still monitor & report • vit K lvls: very low during 1st wk of life but may occur up to 6 mons → may result in VKDB = vit k (Aquamephyton) IM at birth • head circumference: 33 - 35 cm • chest circumference: 30 - 33 cm • length: 18 - 22 in • weight: 8 oz → first 3 - 4 days of life weight loss of 5 - 6% is expected → returns to birth weight by 7 - 14 days → weight loss of > 7% = report to HCP → gain about 1oz (30g) / day or 0.5 lbs / wk for 1st 3 mons • 1st void & stool within 24 hrs → meconium • wet diapers: 1st 48 hrs of life = 2 - 6 diapers every 24 hrs → 3 - 4 days = 6 - 8 diapers / 24 hrs • babinski reflex: present birth - 1 yr • absent or weak → neurological defect • moro (startle) reflect: present 3 - 6 mons • absent → underdeveloped or damaged brain or spinal cord

Serotonin Modulators

• Trazodone, Nefazodone, Vilazodone, Vortioxetine • blocks alpha & histamine (H1) receptors • blocking H1 leads to sedation • tx: MDD, insomnia w/ depression • adverse affects: ortho hypotension *Trazodone severe s/s: pirapism (erection wont go away)

True vs. False Labor

• True Labor → progressive dilatation & effacement → regular contractions increasing in frequency, duration, & intensity → cervix opens & thins → pain in lower back & radiates to the abd → pain is not relieved by ambulation or resting • False Labor → no cervical change (eg. effacement & term-275dilatation) → Braxton-Hicks (irregular contractions that taper off) → contractions felt in front term-287 → pain relieved by ambulation, changes of position, resting, or a hot bath or shower *SEDATION helps (key to distinguish)! Can reassure and d/c home

admin of meds to children < 7

• Vastus lateralis newborns: • vit k (Aquamephyton) IM → prevents hemorrhage → if parents refuse; additional paperwork must be signed • hepB vaccine → do not give if baby + • erthromycin, erythrocin

hydrocephalus

• abnormal accumulation of fluid (CSF) in the brain • adverse effects: increased ICP infants • s/s of increased ICP: wide, bulging fontanelle • prominent scalp veins • increased head circumference • sunset eyes (sclera visible above iris) Interventions: tx: VP (ventriculoperitoneal) shunt placed at age 3 - 4 mons, measure head circumference routinely NCLEX TIPS: if pt has clear colorless fluids leaking from nose or ears → glucose (dextrose) test *positive glucose (halo) test → CSF *spontaneous CSF leaks can cause meningitis *if ICP is increased = shunt malfunction

placcenta accreta

• abnormal placental adherence • complications: life-threatening hemorrhage Interventions: c-section, two large-bore IVs, blood type & crossmatch in case blood transfusions are necessary

Bradycardia

• abnormally slow hr < 60 bpm Interventions: tx → atropine

Residual limb care for aka or bka

• above-knee / below-knee amputation • hip flection contractions (common) Interventions: skin integrity, pain mgmt, infection prevention, restoring ROM mobility, clean limb w/ soup & water, lie prone 3 - 4xs for 30 mins/day, avoid sitting in chair > 1 hr, figure 8 compression bandage • may experience phantom limb pain: tingling / pain in missing portion of limb = opioids

anaphylactic shock

• acute ALLERGIC reaction w/ quick onset (20-30 mins) • rash, hypotension, throat tightness, difficulty breathing Interventions: ensure patent airway, admin O2, remove stinger, IM epi (if not working repeat every 5-15 mins), recumbent position & elevate legs, IV fluids, bronchodilator, antihistamine, corticosteroids → 1st: epinephrine then diphenhydramine

Cardiac tamponade

• acute compression of the heart caused by fluid accumulation in the pericardial cavity • muffled (distant) heart tones • JVD • narrow pulse pressure (pulsus paradoxus); hypotension • chest pain • dyspnea tachypnea, tachycardia Interventions: emergency pericardiocentesis NCLEX TIPS: medical emergency*******

Epstein-Barr virus (EBV)

• acute infection which causes sore throat, fever, fatigue, and enlarged lymph nodes; also called infectious mononucleosis • causes: splenomegaly, hepatomegaly, pharyngitis • serious complication: spleen rupture** = hemorrhagic shock → sudden onset of abd LUQ pain • monitor hgb lvls

Asthma

• acute inflammation of bronchi • ASTHMA (attacks) • A: Accessory muscle use (paradoxical breathing = flail chest) **resp failure indication • S: SOB & dyspnea • T: Tight chest & tachypnea • H: High-pitched wheezing • M: Minimal diminished breath sounds • A: Absent breath sounds (silent chest)**priority, Acidosis, Air trapping (prolonged EXhale) • PFT (pulmonary function test): determines reversibility of bronchoconstriction → withhold bronchodilator med 6 - 12 hrs before exam Interventions: teach pt peak flow meter, acute attack: admin magnesium (to relax muscles), suction, use BAM / SLM meds NCLEX TIP: paradoxical breathing / use of accessory muscles (most deadly sign), pt suddenly stops wheezing = pt not breathing • triggers: Eosinophils & IgE = allergies, smoking, stress, severe weathers (cold) • NSAIDS (eg. naproxen, ketorolac), beta blockers (eg. -lol) cause asthma attacks • latex or antibiotics do NOT cause asthma attacks • Status asthmatics: severe inflammation; rapid deterioration of resp status & resp failure • o2 = < 95% or more • key s/s: pulsus paradoxus** (drop in systolic bp > 10 mmHg) • tx: ET tube admin *priority *pt w/ pneumonia & asthma after med & not responding to bed admin → sudden decrease in wheezing = " silent chest " = airflow rapidly reduced due to increased bronchial contriction → status asthmaticus

Osteomyelitis

• acute or chronic bone infection • bone pain, fever, general discomfort, uneasiness or malaise • local swelling, redness, warmth • chills, excessive sweating, low back pain, swelling of ankles, feet, & legs • dx: bone biopsy (which is then cultured), bone scan, CRP, ESR, MRI, needle aspiration of area around affected bone Risk factors: diabetes, hemodialysis, injection drug use, poor blood supply, recent trauma Interventions: IV antibiotics, wound drainage → contact precautions

Preg w/ Hep B

• admin of hep b vaccine & hep b immune globulin within 12 hrs of birth • breastfeeding ok as long as nipples are intact

KD (Kawasaki Disease)

• affects children • causes inflammation of arterial walls (vasculitis) • sudden fever (doesn't respond to antibiotics, antipyretics) • irritable, swollen red feet & hands • swollen, cracked lips & strawberry tongue • skin peeling from hands to feet Interventions: IVIG & aspirin, • IVIG used to prevent heart disease

BPH (benign prostatic hyperplasia)

• age-associated (male pt > 50) prostate gland enlargement that can cause urination difficulty • urinary urgency, frequency, hesitation, dribbling, nocturia, urinary retention Interventions: voiding schedule, avoid caffeine, antihistamines NCLEX TIPS: burning in urination could indicate UTI, herbal supps (eg. saw palmetto) may be used to tx bph

Varicella Zoster Virus (chickenpox)

• airborne precautions until lesions crust over • report to CDC • avoid aspirin (can cause Reyes syndrome) • varicella immunization (can cause discomfort, redness, & vesicles at injection site) Interventions: teach pt to cover vesicles w/ clothing or small bandage to reduce transmission

ICP (intracranial pressure)

• aka cerebral edema • pupil size < 3 or > 5 = ICP (norm: 3 - 5 mm) → ipsilateral pupil dilation (slow reaction to light) • unexpected projectile vomiting • headache worsens w/ lowering head • flat affect, drowsiness • ALOC • Cushing's Triad → 1. hypertension (increased systolic bp; widened pulse pressure) → 2. bradycardia → 3. irregular respirations (bradypnea, cheyne-stokes) Interventions: • improve jugular venous return to heart: maintain head in midline position, elevated HOB • reduce stimuli: quiet, dim lit environment, limiting visitors • reduce straining: stool softeners, strict bed rest, keeping items in reach, assistance w/ ADLs, avoid coughing • sz precautions • frequent neuro checks • NPO • NO lumbar puncture = increases ICP • tx: mannitol (excreted thru kidneys) → monitor serum os, I&O, electrolytes (dilutional hyponatremia), renal function → adverse effects: pulmonary edema (eg. crackles)

ALOC

• altered mental status Risk factors: eg. ALOC who is not following commands & vomiting = increased risk for aspiration & airway compromise *priority pt

Pertussis (whooping cough)

• an airborne bacterial infection that affects mostly children younger than 6 years • droplet precautions • cough lasting > 2 weeks or more • thick mucus plug • high pitched inspiratory "whooping" sound • pottussive emesis Interventions: humidified O2, small amts of fluids, monitor signs of airway obstruction, droplet precaution, no cough suppressant

Myoglobin

• an oxygen-storing, pigmented protein in muscle cells • elevated after MI & w/ skeletal injury

Vancomycin

• antibiotic med • nephrotoxic, ototoxic • can cause thrombophlebitis → verify IV line Interventions: monitor renal functions (eg. BUN, creatinine), admin a minimum of 60 mins (too fast = red man syndrome; slow infusion), measure trough lvl 15-30 min before admin of next dose

Warfarin

• anticoagulant • used to prolong clotting • TOXICITY RISK* • antidote: vit k (phytonadione) • blocks vit K for synthesis of coagulation • INR / PT monitored regularly (norm: 0.8 - 1.1, norm: 11 - 12.5 secs) • on warfarin INR desired val: 2 - 3; critical val > 5 • increase in vit K foods decreases therapeutic use of warfarin • not safe for preggers, decreases efficiency of oral contraceptives Interventions: eat normal amounts of vit k (do not have to restrict) Interventions: admin once / day, bleeding risk remains up to 5 days after discontinuation, wear med alert bracelet • avoid alcohol • avoid NSAIDs & aspirin • avoid G.G.G.G - garlic, ginger, ginkgo (increases bleeding risk) - ginseng (decreases effectiveness) NCLEX TIPS: FFP (blood product) reverses effect of warfarin • sometimes HCP will prescribe heparin (short-term) & warfarin takes (48 - 72hrs) • heparin will be continued during this week warfarin has not taken its full effect & then heparin will be discontinued once it has • k+ rich foods: green veggies (eg. broccoli, spinach), liver **if pt misses a dose of warfarin & has DVT = therapeutic INR continues for 1 - 2 days

Valoproate (Valproic Acid)

• anticonvulsant, antisz, mood stabilizer • tx: bipolar, antipsychotic, cluster headache / migraine (prophylaxis) • s/s: abd pain, n/v, diarrhea, drowsiness, tremors, alopecia, weight gain, liver toxicity Interventions: give w/ food, give at bedtime, propranolol for tremors, monitor LFT (ast/alt & LDH) for 6mons *migraine = unilateral pulsing headache, sensitivity to light

Metformin (Glucophage)

• antidiabetic drug • stomach upset *common side effect NCLEX TIP: discontinue metformin 24 - 48 hrs before IV contrast (eg. CT scan w/ iodine) & restart med 48 hrs after stable renal functionis confirmed

PTSD (Post Traumatic Stress Disorder)

• anxiety disorder that is characterized by pts who have seen or experienced a traumatic event 3 categories of PTSD sympts: 1. re-experiencing traumatic event • haunting memories • recurring nightmares • distress/loss of control of strong physical reactions to event reminders (eg.diaphoresis, gi distress, rapid pounding heart) 2. avoiding reminders of trauma • avoidance of activities, places, thoughts, or other triggers that could serve as a reminder • feeling detached & emotionally numb • loss of interest in life, inability to set goals • amnesia about important details of event, social withdrawal 3. increased anxiety & emotional arousal • irritability, outbursts of rage, persistent anger or fear • difficulty concentrating • jumpy anxiety • hypervigilance • insomnia that lingers for 4 weeks or more after experience * 1st step twd resolution → pt readiness (eg. talking about trauma w/o experiencing high lvls of trauma)

Emphysema

• apart of COPD • damage to alveoli = air trapping • pink skin, pursed-lipped breathing • barrel chest • tripod position • hyperrenosance during percussion (over inflated lungs) • clubbing fingers NCLEX QUEST: Emphysema pt w/ prolonged mobility. Nurse should expect? a. increased calcium excretion (breakdown of bone tissue)

Chronic Bronchitis

• apart of COPD • inflammation of bronchi = not enough air to lungs • usually caused by RSV • droplet precaution*** (no preg nurses) • dx: cultures, ELISA test, IFA test • chronic productive cough for 3 mons for 2 consecutive years • chronic cough & sputum • cyanosis (hypoxia) • rhonchi (continuous low pitched adventitious sounds), resembles snoring / moaning • crackles & wheezing • edema, JVD, weight gain • increased RBCs lvls • respiratory alkalosis Interventions: mobilize secretions before bed (eg. guaifenesin), cool mist humidifier, teach pt pursed-lip breathing, huff coughing technique (aids to release mucus) NCLEX TIP: • pursed-lip breathing: inhale 2 secs w/ mouth closed, exhale 4 secs with pursed lips (prevents air trapping & airway collapse) • Huff coughing: sit upright, deep slow inhalation thru mouth, hold breath for 2-3 secs & forcefully exhale, repeat huff 1 - 2xs & avoid norm cough, rest for 5 - 10 normal breaths • causes prematurity in infants

Aortic dissection

• artery wall splits apart • life-threatening condition* • s/s: chest pain that can radiate to back, abrupt, tearing, moving upper-to-lower back pain & epigastric (abd) pain • abrupt in onset & described as " worst ever " " tearing " or " ripping " pain Risk factors: uncontrolled HTN = aortic dissection = cardiac tamponade or arterial rupture

Amniotomy (AROM)

• artificial rupture of membranes Interventions: assess FHR before & after, check pt temp Q2 hrs, check amniotic fluid color, amt, & odor → clear, colorless w/o foul odor → yellowish-green fluid = meconium → foul odor = infection • assist pt upright after procedure

NRP (neonatal resuscitation program)

• assessment & decision-making at 30 sec intervals • poor APGAR; gestation (eg. preterm), bad tone (eg. limp), no crying / breathing • < 100 bmp → clears airway, dries, stimulates for 30 secs & placed neutral " sniffing " position • remains < 100 bmp → PPV (positive pressure ventilation) • < 60 bmp after 30 secs of PPV → chest compressions, intubate, PPV w/ 100% o2, cardiac monitor • remains < 60 bmp after chest compressions → epinephrine

ITP (immune thrombocytopenic purpura)

• autoimmune condition that destroys platelets • increased risk for bleeding Interventions: avoid razors & NSAIDs, use soft-bristle toothbrush, nonalcoholic mouth wash, stool softeners to avoid straining *petechiae are expected findings

sjogren's syndrome

• autoimmune destruction of minor salivary glands and lacrimal glands • secondary to: rheumatoid arthritis, lupus, sclerosis, MG, cirrhosis, hepatitis • s/s: dry eyes (xerophthalmia) & mouth (xerostomia) • dry skin, dry vagina, dry cough Interventions: eat sugarless gum or candy, artificial salsa, lubricants, lukewarm water & mild soap, low-humidity environment, frequent dental exams, avoid decongestants, eye drops

MG (myasthenia gravis)

• autoimmune disease that has decreased acetylcholine receptors at NMJ (neuromuscular junction) • skeletal muscle weakness • muscles are stronger in the am & weaker w/ day's activities • ptosis / diplopia, bulbar sign (difficulty speaking / swallowing), difficulty breathing Interventions: tx: anticholinesterase meds (eg. pyridostigmine; 1st line of tx); admin before meals, semi-solid foods, annual flu vaccine

Celiac disease (celiac sprue)

• autoimmune disorder caused by sensitivity to gluten • steatorrhea, foul smelling stools • cannot eat B.R.O.W. (barely, rye, oats, wheat) Interventions: rice, corn, potatoes ok to eat NCLEX TIPS: appropriate for pt to eat corn tortillas, baked potato, & rice noodles

GERD (gastroesophageal reflux disease)

• backflow of contents of the stomach into the esophagus, often resulting from abnormal function of the lower esophageal sphincter, causing burning pain in the esophagus Interventions: limit /avoid caffeine, chocolate, fried fatty foods, alcohol, carbonated beverages, spicy and acidic foods, 4-6 small meals per day, don't eat 3 hrs before bed, elevate bed, sleep on right side, loose clothes meds: histamine blockers (famotidine, ranitidine), antacids, PPI (omeprazole)

carbon monoxide (carboxyhemoglobin) poisoning

• binds more readily to Hgb than o2 • pulse ox readings usually appear norm • norm vals < 5% • smokers: < 10 % • dx: carboxyhemoglobin test • s/s: nonspecific (eg. headache, dizziness, fatigue, SOB, nausea) Interventions: 100% o2 to prevent tissue hypoxia & severe hypoxemia → NRB mask: do not open flutter valves, do not tighten face mask straps 1st if reservoir bad is fully deflated

PAD (peripheral arterial disease)

• blocking of arteries carrying blood to body • PAD "dAngle the legs / Arteries = hAng " " ARTS " • A: Absent pulses; cool, dry, shiny, hairless • R: Round, red sores; arterial ulcers @ distal part of body • T: Toes & feet pale or eschar; gangrene on lower extremities • S: Sharp, cramping calf pain • burning pain worsened w/ elevation Risk factors: smoking, dm, htn, hyperlipidemia Interventions: moisturize skin of feet with lotion, do not use heating pads (do not put directly onto feet), trim toenails ONLY by HCP, keep legs down, mod-exercise (eg. walking) to promote circulation, rest for cramping, low-na diet

DVT (deep vein thrombosis)

• blood clot in the lower extremities (eg. legs) • can result into pulmonary embolism if clot is dislodged • *medical emergency should be tx 1st • unilateral leg pain & edema, warm, erythema, low-grade fever, cramping after surgery, tenderness on palpation Risk factors: trauma, major surgery, immobilization, preggers, oral contraceptives, underlying malignancy, smoking, old age, obesity & varicose veins, htn Interventions: ambulate, compression stockings, adequate fluid intake, adequate pain control, limit caffeine & alc (dehydrates body), elevate & dorsiflex feet, exercise program, stop smoking, avoid restrictive clothing **no ambulation if SEVERE edema or leg pain

PE (pulmonary embolism)

• blood clot in the lung • turns into pulmonary edema • hx of orthopnea, nocturnal dyspnea • anxiety, restlessness • tachypnea, dyspnea, use of accessory muscles • productive cough of pink, frothy, blood-tinged sputum • crackles Interventions: diuretics (eg. furosemide) Life-threatening emergency* NCLEX TIPS: acute onset of dyspnea, productive cough with pink, frothy sputum = severe PE (pulmonary edema)

OI (osteogenesis imperfecta)

• brittle bone disease • rare genetic condition, found during infancy, that impairs synthesis of collagen Interventions: lift infant by slipping hand under broadest areas of body (eg. back, buttock), check bp manually, repositioning infant frequently w/ support devices & gel padding

IE (infective endocarditis)

• can be insidious or rapid onset • low-grade fever • malaise (generealized fatigue, pain, lack of interest in activities) • sore muscles/joints • diaphoresis • murmur r/t stenotic turbulence created by bacterial plaques on valve leaflets • splenomegaly • *splinter hemorrhages* • oral petechiae • neonates = dif. feeding, resp distress, tachycardia, CHF, s/s septicemia Risk factors: prosthetic valve replacement, repaired valves, hx of IE Interventions: aggressive abx therapy, pfx abx for invasive procedures, pt needs prophylactic antibiotics prior to dental procedures

TSL (tumor lysis syndrome)

• cancer chemotherapy causes cell lysis • adverse effects: hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia → AKI Interventions: aggressive hydration, electrolytes, and hupouricemic agents (eg. allopurinol) NCLEX TIPS: oncologic emergency*

ASD (autism spectrum disorder)

• cause unknown • abnormal functioning before age 3 • 2 core sympt abnormalities are social interactions & communication (verbal & nonverbal) • s/s: delayed social skills → patterns of behavior, interests, or activities that can be restricted & repetitive → sensory: hyper / hypo sensitive to sounds, lights, mvmts, touch, taste, smell Risk factors: another sibling who has it Interventions: • reduced stimuli: calming environment → private room away from nursing station → quiet, monotone voice → using eye contact & careful gestures → moving slowly → limit visual clutter → minimal lighting → provide single object to focus on

Neurogenic shock

• caused by SCI (spinal cord injury) → T6 & above → complications: autonomic dysreflexia *life-threatening emergency • s/s: → bradycardia *common sign → hypotension, bradycardia, difficulty breathing, hypothermia, dyspnea, cyanosis, weak pulses, chest pain, warm, pink/dry skin → tx: IV NS

aspiration pneumonia

• caused by foreign material (eg. food, vomit) lodging in bronchi or lungs • increased risk: elderly, neurological dysfunction, decreased cough or gag reflexes, decreased immunity, chronic disease • swallowing 2xs before taking another bite • thickening liquids to assist swallowing • avoid OTC cold meds • sitting upright for 30 - 40 mins after meal • brushing teeth & using antiseptic mouthwash before and after meals • smoking cessation

Respiratory acidosis

• caused by hypoventilation, respiratory acidosis develops when the lungs don't adequately eliminate CO2. ** ANYTHING THAT CAUSES AN OBSTRUCTION OF THE AIRWAY OR DEPRESSES THE RESPIRATORY SYSTEM • COPD, Pneumonia, Emphysema, Astma, Atelectasis, Bronchitis, Neuromuscular disease, Head trauma, Drug overdose (drugs that slow a patient's respirations) • S/S: Change in LOC Interventions: tx goal is to improve ventilation. Administer drugs such as bronchodilators to improve breathing and, in severe cases, to use mechanical ventilation. Maintain good pulmonary hygiene. WHY BRONCHODILATORS? 1. Relax airways 2. Mobilize secretions 3. Reduce mucosal edema

MI (myocardial infarction)

• causes irreversible damage to a segment of heart muscle due to prolonged ischemia. • STEMI / NON-STEMI MI → stemi = ST elevation; new angina → nonstemi = no ST elevation; old angina • ischemic chest pain - epigastric burning pain - dull chest pain radiating to neck, jaw, left shoulder, down left arm, abd - not improved w/ rest or position change - worsens w/ exertion - lasts > 30 mins • sob • n/v, belching, indigestion • dizziness, fatigue, generalized weakness, anxiety • sweating, cold, clammy skin (diaphoresis) Risk factors: narrowing of coronary arteries due to atherosclerotic occlusion, poor coronary perfusion secondary to hemorrhage or occlusion or one of the major coronary arteries Interventions: assess first → 12-lead ECG "walk 1 block or 2 flights of stairs w/o symptoms" = pt can have sex, 7-10 days NCLEX TIPS: ST elevated MI *life-threatening emergency

Uterotonic drugs

• cervical ripening / inducing labor by increasing uterine contractions • Oxytocin, Carboprost, Misoprostol, Dinoprostone, Methylergonovine *higher Bishop score = increased likelihood of successful induction; 6 - 8 Oxytocin • high-alert med* • tx: pp bleeding (after bathroom & fundal massage don't work), goal: contractions freq Q2 - 3 mins • adverse affects: uterine tachysystole, abnormal / indeterminate fhr, maternal hypotension, hyponatremia, prolonged use: PPH & water intoxication Interventions: admin thru secondary IV line & infusion pump, continuous FHR monitoring, I&O, decreasing or stopping infusion, if needed admin IV fluid bolus or tocolytic drugs (eg. terbutaline) Misoprostol • prevent ulcers caused by NSAID by reducing stomach acid, contracts uterine muscles • tx: uterine atony w/ htn pts • contraindicated: hx uterine surgery (eg. csection), abnormal fhr Methylergonovine • vasoconstrictor • tx: severe bleeding postpartum • NO htn patient • contraindications: mothers: complete placenta previa, hx of vertical uterine incision, structural abnormalities of pelvis, cervical cancer, active STIs • infants: hydrocephalus, fetal malpresentations, fetal comprise → normal pelvis: gyencoid**

EPS (extrapyramidal symptoms)

• characteristic motor side effects of antipsychotic drugs • s/s: → pseudoparkinsonism: pill rolling; finger mvmt back & forth with thumbs " show me the money mvmt " → akathisia: restlessness of lower extremities (eg. foot pacing, stomping) → tardive dyskinesia: involuntary mvmts of tongue & face (eg. excessive eye blinking, tongue protruding) → acute dystonia: severe spasm of the tongue, neck, face and back → oculogyric crisis: upward deviation of eyes → opisthotonus: muscle spasms; head & heels are bent bkwd & body bows fwd NCLEX TIPS: emergency " COCKTAIL " → TBDs for EPS • Trihexyphenidyl (tx: park) • Benzatropine (antihistamine) • Diphenhydramine *TD is not reversible *if TD sympts seen in metoclopramide (antiemetic for gerd) = notify HCP *acute dystonia → closed throat *priority pt

Serotonin Syndrome

• chemical produced by body needed for nerve cells & brain to function • caused by toooooo much serotonin • must have 3 of the following s/s: • mild → mental changes: anxiety, restlessness, agitation, disorientation, confusion • autonomic dysregulation: hyperthermia, diaphoresis, sinus tachycardia, htn, shivering, diarrhea, abd pain • severe → neuromuscular HYPERactivity: *muscle rigidity, tremor, hyperreflexia, ataxia, fever, sz • tx: cyproheptadine NCLEX TIPS: *life-threatening condition • do NOT mix antidepressants together: TCAs, MAOIs, SSRIs, SNRIs, St. John's Wort, dextromethorphan, ondansetron, tramadol

VSD (ventricular septal defect)

• children • left-to-right shunt • pulmonary congestion • acyanotic defects: - tachypnea - tachycardia even @ rest - diaphoresis during feeding or exertion - harsh systolic murmur or extra heart sounds - congestive heart failure signs - increased metabolic rate w/ poor weight gain NCLEX TIPS: grunting = increase respiratory exertion *must check pt 1st (sign of Resp failure)

PDA (patent duct arteriosclerosis)

• children • left-to-right shunt • pulmonary congestionterm-246 • acyanotic defects: - tachypnea - tachycardia even @ rest - diaphoresis during feeding or exertion - loud continuous machine-like murmurs - congestive heart failure signs - increased metabolic rate w/ poor weight gain → tx: prostaglandin E1

ASD (atrial septal defect)

• children • left-to-right shunt causing right heart enlargement • pulmonary congestion • acyanotic defects: - tachypnea - tachycardia even @ rest - diaphoresis during feeding or exertion - systolic murmur w/ fixed split second heart sound - congestive heart failure signs - increased metabolic rate w/ poor weight gain

triage

• children age < 10 automatically upgraded to 1 lvl higher than the triaged urgency of their medical issue *combo of status asthmaticus + o2 sat at <92% or less = highest priority lvl of triage at any age *chest pain in adult regardless of age or race is a priority *full-thickness burns > 60% or more of total body surface area= lowest priority = least chance of survival

UC (ulcerative colitis)

• chronic condition; unknown cause; repeated episodes of inflammation in the rectum and large intestine • abd pain, bloody diarrhea • anorexia • anemia • complications: ulcers Interventions: high cal / protein, multivitamins containing calcium, oral hydration, dietary triggers (eg. dairy, nuts/legumes, cereal, alcohol, caffeine, fatty / processed foods, tobacco), teach pt to keep a diet journal to assist w/ id of triggers

Osteoporosis

• chronic disease bone loss causes decreased density = possible fx • shortened height, hx of fx, thoracic kyphosis (curvature of thoracic spine; rounded upper back), decreased bone mass Risk factors: females > 65 or older, men > 75 or older, asian or caucasian, fam hx, estrogen or androgen deficiency,protein deficiency, sedentary lifestyle, smoking & alc intake - secondary: bone cancer, cushings, dm, meds: corticosteroids, phenytoin, cytotoxic agents, immunosuppressants, loop diuretics, paget disease, prolonged immobilization, RA Interventions: encourage safe weight-baring exercises, strengthen training, walking, increase vit D & calcium foods, stop smoking, fall precautions meds: biophosphonates, calcium & vit D supps, estrogen, calcitonin, parathyroid hormone (teriparatid → Forteo; subQ daily)

RA (rheumatoid arthritis)

• chronic progressive autoimmune connective tissue disorder (primarily affecting synovial joints) • Seven S's • S: Sunrise stiffness (morning stiffness; pain @ rest or after immobility) • S: Soft, tender & redness, warm joint • S: Swelling in joint (edema) • S: Symmetrical (bilateral joint inflammation w/ decreased rom) • S: Synovium inflamed • S: Systemic (numbness, tingling, or burning in hands & feet) • S: Stages: synovitis, pannus, anklyosis (bone infusion) • Sjögren's syndrome (dry eyes & mouth → leads to pannus) • late stages: joint deformity • dx: positive rheumatoid factor, synovial fluid analysis, antinuclear antibody test, ESR, CRP Risk factors: physical / emotional stress, female, young-middle aged, fam history Interventions: use ice or heat for comfort, encourage physical activity, monitor for fatigue, pt sleep flat neutral position, warm shower / bath or heat app in AM to decrease stiffness meds: NSAIDs, corticosteroids, DMARDs (eg. methotrexate, lefunomide, hydroxychoroquine) should still be taken even when joint doesn't hurt, ot / pt / rt, support groups NCLEX TIP: late stage of RA → joint deformity (eg. anklyosis)

PVD (peripheral vascular disease)

• chronic venous insufficiency • PVD "eleVate the legs" " VEINY " • V: Volumptuous pulses; warm, thick, legs & indurated skin • E: Edema** • I: Irregular shape sores / ulcers • N: No sharp; pain (dull) • Y: Yellow & brown ankles; bronze-brownish pigmentation & hardened skin on lower extremities • varicose veins • warm, thick, indurated skin Interventions: compression bandaging to reduce pressure, elevate legs on pillows, limit standing, antiplatelet, monitor cholesterol

testicular cancer

• common form in men 15 to 35 yrs • high risk: hx undescended testis • s/s: painless, hard lumps on testes, scrotal swelling or heaviness, dull ache in pelvis or scrotum • TSE monthly on same day • TSE while taking warm shower or bath • use both hands to feel each testis separately • palpate each testicle gently using thumb & 1st 2 fingers • check testicle is norm egg-shaped, moveable w/ a smooth surface

newborn loses heat in 4 ways

• conduction: body heat transfers to cold object (eg. infant placed in cold scale) • convection: air currents blow over infant's body (eg. draft) • evaporation: wet skin dries & evaporates • radiation: cold object close but not touching (eg. infant close to cold windowpane causing heat to radiate to window) **vulnerable to cold stress

uterine tachysystole

• contractions occur too freq • more than > 5 contractions in 10 mins • life-threatening complications: inadequate fetal oxygenation, placental abruption, uterine rupture *priority pt Interventions: discontinuation of meds, tocolytics, side-lying position, o2 face mask, IV fluid bolus, notify HCP

trigeminal neuralgia

• cranial nerve V • sudden unilateral electric shock-like pain in lips & gums & severe pain along cheek bone • tx: pain control → carbamazepine (sz med but effective for neuropathic pain) & limiting pain triggers: • triggers: washing face, chewing food, brushing teeth, yawning, talking • oral care: small, soft-bristle tooth brush, warm mouth wash • luke-warm beverages • moderate / even room temp • avoid rubbing / facial massages, use cotton pads to wash face • soft diet w/ high cal, avoid foods that are difficult to chew, chew on unaffected side *carbamazepine risk factors: agranulocytosis (leukopenia) & infection → report any fever or sore throat

post-menopausal women

• decreased estrogen lvls • occurs 50 - 52 yrs • complications: osteoporosis, CAD • s/s: weight gain, hot flashes, sleep disturbances, fat redistribution, vaginal atrophy Interventions: diet: low-cal, increase C+ (eg. green leafy veggies, dairy products) & Vit D, meds: bisphosphonates (w/ full glass of water in AM on empty stomach 30 mins before other drugs & upright for 30 mins), monitor cholesterol lvls, weight-baring exercises, seek support for emotional sympts NCLEX TIPS: if pt is lactose intolerant: other sources of Calcium & Vit D: sardines, salmon, trout, tofu, almonds, green veggies (eg. spinach, kale, broccoli). Vit D (eg. egg yolks, oily fish) • HRT (hormone replacement therapy) only for pts w/ disabling hot flashes = increases risk of thrombotic comp (eg. dvt, mi, stroke) & cancers (eg. breast, uterine)

Antidiarrheals

• decreases intestinal mobility & increases absorption of fluid & na in intestines • precautions: increased risk of megacolon for IBS pts • side effects: constipation, drowsiness, dry mouth, burry vision • meds: diphenoxylate plus atropine, loperamide, paregoric Interventions: monitor fluids & electrolytes, avoid caffeine

Anemia

• deficiency of red blood cells • fatigue, weakness, dizziness, headache • pallor, tachycardia, murmurs & gallops, orthostatic hypotension • decreased activity intolerance, SOB, dyspnea, decreased o2 • labs: decreased Hgb, HCT, & RBCs Risk factors: acute / chronic blood loss (eg. gi bleed), destruction of RBCs (eg. spleen disease), chemotherapy, RF, nutritional deficiencies (eg. Iron, b12, folic acid, intrinsic factor)

amyotrophic lateral sclerosis (ALS)

• degenerative progressive disease of motor neurons in the spinal cord and brainstem • no cure • fatigue, muscle weakness • progresses to paralysis, dysphagia, difficulty speaking (dysarthria), resp failure • tx: riluzole

child abuse

• deliberate action that is harmful to a child's physical, emotional, or sexual well-being guidelines for interview: • speak w/ child in private • be honest about reporting requirements • use language appropriate to child age • avoid making assumptions or communicating anger, shock, or disapproval • reassure child about not being at fault or in trouble

MS (multiple sclerosis)

• demyelinating disease of the CNS • immune system attacks protective myelin sheath that covers nerve fibers causing interruption of nerve impulses • s/s: fatigue, muscle weakness, spasticity, incoordination, loss of balance, bladder or bowel incontinence / retention • dehydration & extreme temps can cause exacerbation Interventions: fall & injury risk, use assistive devices, gait training sclerosis = hardening

Pacemaker

• device that delivers electrical impulses to the heart to regulate the heartbeat Post-Procedure • 1st attach cardiac monitor • assess electrical capture → pacer spikes should be prior to P waves & QRS complexes • assess mechanical capture → palpate pts pulse rate & compare to electrical rate displayed on cardiac monitor • check pt vitals for stability following procedure • if pacemaker not working → failure to capture / sense = notify HCP immediately

GDM (Gestational Diabetes Mellitus)

• diabetes that occurs during preg • complications: macrosomia (fetal weight > 8 lb 13 oz) may lead to shoulder dystocia during birth, increased risk for hypoglycemia in newborn GDM Screening • 24 - 28 wks • 1 hr glucose test → abnormal 130 - 140 → performed any time of day → no fasting required → 50 g glucose sol ingested & take blood sample 1 hr after • if BG > 140 or more → 2 or 3 hr glucose tolerance test (GTT) needed → fasting & hourly samples needed Risk factors: gestational htn: > 140 / > 90 occurring after > 20 wks • Oral hypoglycemics are NOT in 1st Trimester of pregnancy (bcuz it can cross the placenta barrier and cause probs) • Insulin used= DOES NOT CROSS placenta • Regular Insulin used (short acting) • NPH (long acting)

DMARDs

• disease-modifying antiRheumatic drugs • slowly reduce joint destruction and disease progression • interferes w/ folic acid metabolism which inhibits DNA synthesis & cell reproduction • adverse effects: bone marrow suppression (leads to anemia, leukopenia, thrombocytopenia), hepatotoxicity, gi irritation (eg. n/v, diarrhea) • thrombocytopenia: petechiae, purpura, & other signs of bleeding (eg. melena, hematemesis, bleeding gums) • n/v (common signs) • more toxic than NSAIDS Methotrexate Sulfasalazine • tx for bowel inflamm, diarrhea, rectal bleeding, UC for abd pain Hydroxychloroquine Leflunomide Interventions: antiemetics, effective contraceptives (teratogenicin preg),

Generalized Anxiety Disorder (GAD)

• disorder characterized by chronic excessive worry accompanied by three or more of the following sympts: • restlessness, fatigue, concentration problems, irritability, muscle tension, and sleep disturbance Interventions: CBT

Rhabdomylosis

• dissolution of striated causing myoglobin (protein found in muscle tissue) to released into body • complications: AKI / renal failure *severe • s/s: cola-brown urine, muscle aches, weakness • labs: elevated creatine kinase > 15,000, myoglobinemia, myoglobinuria Risk factors: trauma, extreme exertion, or drug toxicity Interventions: IV fluids

influenza (flu)

• droplet precaution (surgical mask, private room) • fever, chills, severe muscleaches, headache, cough, sore throat, nasal congestion, malaise • incubation period: 1-4 days • 'sympts lasts about 5-7 days Interventions: rest, hydration, humidified air, antipyretics/analgesics, & antiviral meds (eg. zanamivir, oseltamivir) given to pt within the last 48-72 hrs, mask while transported, cover mouth & nose when sneezing, hand hygiene

UTI (urinary tract infection)

• e. coli most common cause upper urinary tract infection • eg. pyelonephritis • fever • chills • flank & lower back pain • suprapubic pain • irritable • anorexia lower urinary tract infection • bladder & urethra (eg. cystitis) • hesitancy / delay in voiding • intermittency (interruption while voiding) • post void dribbling • urinary retention / incomplete emptying • dysuria • hematuria cloudy & foul smell • oliguria • anuria • storage sympts: urinary frequency (>8x/24hr, <200 mL/void), polyuria, urgency, incontinence, nocturia, nocturnal enuresis • dx: urinalysis, culture & sensitivity test (clean catch) Interventions: antibiotics, wipe from front to back after urinating, cleanse with warm soapy water after each bowel mvmt, empty bladder before & after intercourse • drink 8 oz of 8 glasses/day, urinate reg (3 - 4 hr/day), avoid alcohol, coffee, citrus, juices, chocolate and spicy foods, cranberry juice or cranberry extract tabs • heat to lower back or suprapubic area to releave pain • avoid vaginal douches and harsh soaps, bubble baths, powders, and sprays • strict I&O, daily weight, assist with ADLs, IV NS maintains fluid balance and helps kidney to flush blood • notify HCP if sympts / signs of recurrent UTI (e.g., fever, cloudy urine, pain on urination, urgency, frequency, flank pain) • pt with foley- check policy for foley cath care- clean with iodine, betadine, or chlorhexidine, strict hand washing & gloves

Colorectal cancer

• early signs: (nonspecific) fatigue, weight loss, anemia, occult gi bleeding • dx: fecal occult test, fecal immunochemical test annually • screening should start regularly @ age 50

BN (bulimia nervosa)

• eating disorder characterized by episodes of uncontrollable binge-eating follows by inappropriate compensatory behaviors to prevent weight gain • weight within or above norm range • compensatory behaviors: laxatives, diuretic use, self-induced vomiting, excessive exercise 1 - 2 hrs after binging • adverse affects: erosion of tooth enamel, dental caries, enlarged parotid glands, scars or calluses on hand Interventions: monitor ot around meal times 1 - 2 hrs after eating, monitor electrolytes, monitor for evidence (eg. hidden food wrappers)

Hip fx injury

• ecchymosis & tenderness over thigh & hip • groin & hip pain w/ weight-bearing • muscle spasms in injured area • shortening of affected extremity • affected extremity usually externally rotated & abducted • do not force hip into > 90° of flexion • do not bend fwd when sitting into chair Interventions: 2 - 3xs/day of leg exercises (eg. isometric quads, gluteal setting, leg raises, & abduction), use assistive devices (eg. reacher / grabber, sock puller, long-handled shoehorn), toilet riser or bedside commode, turning pt put → abd pillow between legs

Third degree AV block (complete heart block)

• electrical conduction from atrial to ventricles are blocked decreasing CO • s/s: dizziness, syncope, mental status changes, HF, hypotension, bradycardia • ventricular rate: 40 - 60 bpm (AV node origin) & relation between P waves & QRS • < 40 bpm (Purkinje system origin) Interventions: atropine & temporary pacing (eg. transcutaneous) until permanent pacemaker placed *priority over AFIB bc pt may decompensate to cardiogenic shock

Cirrhosis

• end stage hepatic disease • r/t: Hep C & ETOH • RUQ, dull abd, joint pain • fever • n/v • fatigue, decreased appetite, weight loss • palmar erytherma, spider angiomas • fetor hepatics (fruity liver breath) • asterixis (liver flapping tumor; flapping by extension & flexion of wrist & fingers) • dark / clay color urine (excess bilirubin & bile salts) • jaundice (excess bilirubin) • pruritus (itchiness; from jaundice) • ascites • esophageal varices & portal htn • splenomegaly • encephalopathy; mental changes (eg. confusion, sleepiness) from excess ammonium • labs: elevated bilirubin, ammonia, pt, inr, aptt, ast / alt Interventions: → small frequent meals of high carb / cal, low fat, na, protein → HOB 30 degrees w/ feet elevated or sit in chair → monitor for skin break down (eg. wash w/ cold water, lotion) → paracentesis to reduce pressure on lungs (monitor RR & abd girth) → IV albumin to relieve ascites *assess vitals → Latulose to decrease ammonium lvls *monitor for HYPOkalemia → Beta blockers to prevent varices bleeding → avoid OTC, Herbal supplements, Aspirin, NSAIDs, Alcohol → avoid intraabdominal pressured activities: Straining, coughing, sneezing, vomiting, heavy lifting, tight clothes → may cause rupture of varices → balloon tamponade or TIPs to put pressure on varices → vasopressin to constrict bleeding veins → limit physical activity, adequate rest NCLEX TIPS: esophageal varices *most life-threatening complication **if pt has esophageal varices = NO new NG tube

Hepatomegaly

• enlargement of the liver due to cirrhosis, hepatitis, or cancer • boggy liver edge below rib cage

Nagele's Rule

• estimates date of birth • EDB = (LMP - 3 mons) + 7 days → 1st day of LMP: month & date → subtract 3 mons → add 7 days → + 1 year

Febril sz

• etiology unknown • children between ages 6 mons - 6 yrs Interventions: safety precautions, antipyretics (eg. acetaminophen, ibuprofen in children > 6 mons), avoidance of shivering -> cooling methods (eg. cool damn compresses to forehead, increasing air circulation in room, wearing loose / minimal clothing) • call 911 if sz last > 5 mins

Anticholinergic (ACh) meds

• everythings dryyyyyyyy inside • dry mouth, urinary retention, constipation, blurry vision, drowsiness meds containing effect & what they're used for: - atropine sulfate (bradycardia) - albuterol, iprotroprium, tiotropium, tiotropium (asthma; bronchospasms) - benzatropine, trihexyphenydil (antiparkinson & EPS sympts) - scopolamine (motion sickness; antiemetic) - promethazine (allergies; antihistamine & antiemetic) - antihistamines (eg. diphenhydramine); (schizo & EPS sympts - relaxes muscles) - opioids (eg. morphine); (anti-inflammatory) - antipsychotic meds (eg. haloperidol; 1st gen, risperidone 2nd gen, trycyclic, MAOIs, SSRIs/SNRIs) - Oxybutynin (antispasmodic) *contraindicated w/ elderly, glaucoma, bowel obstruction, urinary retention (eg. BPH) pts

Meniere disease (endolymphatic hydrops)

• excess fluid accumulation inside inner ear • s/s: vertigo w/ n/v if severe, tinnitus, hearing loss, aural fullness Interventions: fall precautions, quiet dark room, salt restricted diet, sedatives (eg. benzos), antihistamines, anticholinergics, antiemetics

Stool softeners / laxatives

• facilitates peristalsis & bowel mvmts • side effects: F&E imbalances, gi irritation, toxic lvls of mag, fluid retention • precautions: contraindicated in pts w/ fecal impaction, bowel obstruction, acute surgical abd. most contraindicated for pts w/ uc & diverticulitis (psyllium may be used) Psyllium • decreases diarrhea (bulk-forming) Docusate sodium • relieves constipation (surfactant) Bisacodyl • preprocedure colon evacuation (stimulant) Milk of mag (mag hydroxide) • prevent painful elimination (low dose osmotic) • promotes rapid evacuation (high dose osmotic) • also antacid (neutralizes gastric acid & inactivates pepsin) • precautions: diarrhea, renal impairment, hypermag Interventions: reg exercise & promote reg bowel elimination, monitor for chronic lax use / abuse, adequate fluid & fiber to avoid obstruction

Iron meds

• ferrous sulfate, ferrous gluconate, ferrous fumarate • antidote: deferoxamine • PO • dilute w/ orange juice or water & admin w/ plastic straw (discolors teeth); between meals • avoid reclining 30 mins after taking • avoid cal supplements & antacids, dairy products, eggs, chocolate, caffeine, whole grain breads up or after 1 hr after • turns stools black / dark green • monitor for constipation & GI upset • Iron Dextran • IM: using z-track, do not massage, never in deltoid, 19 - 20 gauge • IV: preferred, small test dose 1st & observe for 15 mins • watch for toxicity: N/V/D, fever, cyanotic lips/nailbeds

Ectopic pregnancy

• fertilized ovum implants outside uterine cavity, usually, in fallopian tube • *med emergency • s/s: unilateral lower quadrant abd pain, referred shoulder pain, hypotension • complications: hypovolemic (hemorrhagic) shock, peritoneal signs (eg. tenderness, rigidity, low-grade fever)

Operative vaginal birth

• forceps or vacuum extractor used during vaginal birth • HCP applies traction to forceps during contractions • complications: vaginal hematoma • never apply fundal pressure, ensure empty bladder

endometrial cancer

• forms endometrial overgrowth (hyperplasia) • s/s: abnormal uterine bleeding • major risk factors: prolonged extrogen exposure w/o adquate progesterone *biggest risk factor, fam hx, obesity, anovulatory menstrual cycles (eg. infertility), tamoxifen

FES (fat embolism syndrome)

• from lower extremity fx (eg. femur fx) • s/s: petechiae appearing across chest, axillae, & soft palate, aloc, resp distress *life-threatening emergency *anything w/ embolism

brain lobes & functions

• frontal lobe: behavioral changes; control mvmts of voluntary skeletal muscles, behavioral changes (personality & function) • broca (expressive) aphasia - impaired speech & writing, difficulty w/ word choices, short phrases that require effort • parietal lobe: sensory & somatic (eg. temperature, touch, pressure, and pain involving the skin) • temporal lobe: auditory input; sensory (eg. hearing, visual, past experiences) • wernicke (receptive) aphasia - impaired comprehension of speech and writing → short, simple yes or no quest, gestures, pics, remain patient & allow time for pt to understand • occipital lobe: vision • cerebellum: coordination & mvmt r/t motor skills (eg. posture, balance, equilibrium) → assess w/ heel-to-toe, finger tapping, rapid alt mvmts, finger-to-nose, heel-to-shin • medulla oblongata (at base of brainstem): regulates rate & depth of resp *oculocephalic (dolls eye) reflex: assess brain stem for comatose / unconscious pts → eyes move = good → eyes remain stationary = absent reflect (brainstem dysfunction)

Von Willebrand Disease

• genetic bleeding disorder • deficiency of von Willebrand factor (lines blood vessels and reacts with platelets to form a plug that leads to clot formation) Interventions: desmopression or topical therapies (eg. thrombin) for minor bleeds, vWF replacement for major bleeds, use humidifier to keep mucosa moist, avoid aspirin & NSAIDs, avoid activities w/ high risk for injury, soft-bristle tooth brush, report heavy bleeding, notify HCP if signs of bleeding

AKI (acute kidney injury)

• genitourinary disorder manifests as an oliguric phase followed by diuresis • decreased/absent UO (oliguric at first) • fluid retention • SOB, fatigue, confusion, N&V and seizures/coma in severe cases • labs: decreased GFR

Botulism

• gi absorption of c. botulinum • found in soil & grows in any foods w/ spores • main source is improperly canned / stored foods • descending flaccid paralysis, muscle paralysis (eg. constipation), dysphagia *avoid metal cans that are swollen or bulging *honey for children > 1 yr

Measuring orthostatic bp

• have pt lie for 5 mins • measure bp & hr • have pt stand • repeat bp & hr after standing @ 1 & 3 min intervals A drop in systolic bp of ≥ 20 mm Hg or diastolic bp of ≥ 10 mm Hg = abnormal or lightheadedness, dizziness

coup-contrecoup head injury

• head strikes an object & brain receives injury under the area of impact, rebounds to opposite side of the skull & sustains injury on that side as well • common in motor vehicle accidents & shaken baby syndrome Coup • injury to brain at site of impact Contrecoup • injury to brain at opposite site of impact Coup-contracoup • injury at both sites of impact • causes contusion (bruising), hemorrhage, edema of brain

Upper GI bleeding

• hematemesis (bright red blood- arterial source, coffee ground blood- bleed starting in stomach); old blood • melena (tarry / black stools) • hematochezia (fresh bright red blood in stool) • occult bleeding (small amount of blood in gastric secretions, vomit, or stool) • weakness, fatigue, nervousness, restlessness, agitation, decreased LOC • skin pale, clammy, pale mucous, nail beds and conjunctiva, spider angiomas, jaundice, peripheral edema • severe diaphoretic, low BP & increased HR • n/v • abd pain • dx: Guaiac test used for occult bleeding in stools Risk factors: ulcers, esophageal varices, esophagitis, NSAIDS, aspirin, corticosteroids, anticoagulants, stress related mucosal disease (SRMD): (occurs in patients who have had severe burns or trauma or major surgery), RF Interventions: 1st tx blood transfusion, clear foods diet, avoid Valsalva maneuver, blow nose w/ mouth open, prevent sneezing by trying to yawn, NPO for 24-72 hrs, strict I&O, low stimulate, cool, calm environment, avoid alcohol, smoking, drugs, avoid anticoagulants, NSAIDs, & OTC meds: vasopressin (for esophageal varices), sandostatin, somatostatin (for upper GI bleeding, esophageal varices), epinephrine (bleeding from ulcers), PPI, H2 blockers, beta blockers (decrease risk for bleeding from esophageal varices), sedative, antacids NCLEX TIPS: severe signs are priority (eg. diaphoresis, low bp, hr) = hypovolemic shock

TTP (thrombotic thrombocytopenic purpura)

• hemolytic anemia that causes small blood clots to flow thru body • intravascular hemolysis, thrombocytopenia, decreased renal function, fever NCLEX TIPS: changes in LOC = internal bleeding *med emergency

Cane

• hold can on stronger side • keep elbow slightly flexed (20 - 30°) • cane should equal distance from pt greater trochanter (it's below the waist; hip) to floor • place cane 6" - 10" in front of & to side of foot • max support: move weaker leg fwd to lvl of cane • min support: cane & weaker leg are advanced fwd @ same time • always keep 2 points of support on floor @ all times

Placenta previa

• implantation of placenta over or partially on cervical opening • dx: ultrasound at 1st & 36 wks to assess placental location • s/s: painless vaginal bleeding Interventions: pelvic rest during preg (eg. nothing in vagina), c-section before labor unless increased risk, blood type and screen (Rh), continuous FHR monitor, large-bore IV, LR or NS, monitor bleed → pad counts

Hemophilia

• improper clotting • increased risk of hemathrosis (bleeding in joints) • labs: elevated aPTT & HCT • increased risk for bleeding out (aPTT), dehydration (Hct) Interventions: supplement IV clotting factors, RICE for hemarthrosis & joint should remain extended to prevent contractures, med alert bracelet • long-term complication: joint destruction

CHF (congestive heart failure)

• inability of the heart to pump enough blood through the body to supply the tissues and organs with nutrients and oxygen • s/s: R + L sided HF (1st right then left) • jvd, decreased UO, fluid vol overload • labs: elevated BNP, decreased Na *dyspnea & pink frothy sputum → acute exacerbation w/ PE (pulmonary embolism) = priority pt

uterine atony

• inability of the uterus to contract effectively • s/s: enlarged, soft, boggy uterus, tachycardia, hypotension, skin is pale, cool, clammy, loss of turgor, may result in hysterectomy *most common cause of PPH Risk factors: uterine fatigue, uterine overdistension, retained placenta, grand multiparity, intraamniotic infection Interventions: 1st action: fundal massage if becomes firm → monitor tone, position, lochia Q15 mins, correction of bladder distention, high-dose oxytocin, intrauterine balloon tamponade,

Infertility

• inability to conceive > 12 mons • risk factors: > 35, very low or high bmi, gonorrhea, chlamydia, pid, endometrial cancer, hormonal dysfunction (eg. ovarian cysts)

Cardiogenic shock

• inability to pump blood efficiently • reduced CO bc of CARDIAC PROBs → MI • s/s: hypotension, narrow pulse pressure *BP is priority • pulmonary edema (eg. tachypnea, crackles, decreased o2 sat) Risk factors: cardiomyopathy Interventions: o2 admin, ECG, cardiac enzyme testing, reduce cardiac workload • dopamine (improves heart contractility) → adverse affects: tachycardia • digoxin " digs " for deeper contraction

Hypovolemia shock

• inadequate tissue perfusion • change in mental status (eg. confusion) • tachycardia w/ weak thready pulse • cool, clammy skin • oliguria • tachypnea Interventions: assess perfusion → LOC status, UO, cap refill, peripheral sensation & pulses, skin color & temp

Pulmonic stenosis

• increased pressure in right side of heart bc of narrowed pulmonary ventricle • systolic ejection murmur • cyanotic

prostate cancer

• increased risk for prostate cancer: african americans, family hx, obesity, older age > 50, consuming large amts of red meat, animal fat, high-fat dairy, refined carbs, low fiber intake

Iron decifiency anemia

• increased risk: malabsorption syndrome, gi surgery, blood loss • foods rich in iron: meats, shellfish, eggs, green leafy veggies, broccoli, dried fruits, dried beans, brown rice, oatmeal • eat foods rich with Vit C (eg. citrus fruits, potatoes, tomatoes, green veggies) to enhance iron • no coffee, tea *malabsorption syndrome = 10% dextrose in water

HD (huntington's disease)

• incurable autosomal dominant hereditary disease that causes progressive nerve degeneration • onset age 30 - 50 • impairs mvmt, swallowing, speech, & cognition • chorea (involuntary tic-like mvmt) *hallmark sign

decorticate vs decerebrate posturing

• indicates deep extensive brain lesion DeCortiCate: " C " moves twd " Cord " → probs w/ cervical spinal tract or cerebral hemisphere → internal rotation of lower legs, plantar flexion, flexion of upper extremities → traumatic brain injury, bleeding in brain, tumor, stroke DEcErEbratE: arms are like " E " → probs w/ midbrain or pons → extension & outward rotation of upper extremities, plantar flexion of the feet → severe brain damage (eg. near-drowning pts)

Erikson's stages of psychosocial development

• infancy → trust vs mistrust • birth to 12 - 18 mons • feeding; relationship w/ caregiver • solitary play • toddler → autonomy vs shame/doubt • 18 mons - 36 mons (3 yrs) • toilet training; development of physical skills • learns control but may develop shame/doubt if not handled well • parallel play • preschool → initiative vs guilt • 3 - 6 yrs • independence; more assertive & initiative • may be too forceful leading to guilty • associative / group play • magical thinking • elementary school → industry vs inferiority • 6 - 12 yrs • school; must learn to deal w/ demands to learn new skills • if not a sense of inferiority, failure, & incompetence • cooperative play w/ goal & rules • adolescence → identity vs role confusion • 6 - 12 yrs • peer relationships; must achieve sense of ID → engage in risk-taking behaviors → sense of invincibility, need for independence, strong connection to peers • young adulthood → intimacy vs isolation • 12 - 18 yrs • love relationships; must develop intimate relations • if not, suffers a feeling of isolation • middle adult → generativity vs stagnation • 19 - 40 yrs • parenting; must find some way to satisfy & support next generation or have sense of purpose • late adulthood → integrity vs dispair • 65 - death • reflection & acceptance of ones life; feeling fulfilled & sense of oneself

Tetralogy of Fallot (TOF)

• infants • right-to-left shunt • cyanotic (hypoxia) defects → pulmonary blood flow, mixing of oxygenated & unoxygenated blood • complications: polycythemia → Elevated Hgb > 22 & Hct > 65% → increases risk for blood clots* • s/s: loud, systolic ejection murmur, frustration or fatigue, poor weight gain, • "tet spell" (hypercyanotic episodes): unoxygenated blood enters systemic circulation → occurs during stressful or painful procedures, walking, hunger, crying, feeding → cyanosis w/ crying, hypoxemia, clubbing of fingers Interventions: calm environment, squats down knee-chest position to promote circulation, soothe & quieting child when distressed, offer pacifier, swaddling / holding infant during stress or procedure, frequent small feedings

HD (hirschsprung disease)

• infants • section of large intestine missing nerve cells → internal anal sphincter cannot relax s/s: • distended abd • vomiting green bile • meconium does not pass within the expected 24 - 48 hrs • difficulty feeding, excessive crying • complications: hirschsprung enterocolitis (eg. fever, lethargy, explosive & foul-smelling diarrhea, rapidly worsening abd distention) NCLEX TIPS: hirschsprung enterocolitis is a med emergency* leads to fetal sepsis & death

child's perception on death

• infants birth - 2 yrs → no understanding of death → sensitivity to loss & separation by changes in environment, caregiver, & reg routines • toddlers (preschool) 3 - 5 yrs → believe death is reversible → magical thinking & fantasy (eg. they wished a person would die) → feeling of guilty & responsiblity → avoid discussion of loved ones death & focus on helping child process loss *acknowledge childs fears (eg. look under bed with them if they think they see monsters) • 6 - 9 yrs → understands concrete finality of death → difficult in perceiving their own death → may be preoccupied w/ medical or physical aspect of dying • 10 - 12 yrs → understand death is final & eventually affects everyone → thinks about how death would affect them personally → curiosity & fear about implications of death (eg. process of dying, funeral services) → parents need to be honest discussing about death & providing anticipatory guidance • adolescents → views death on adult lvl → most likely think about religious & spiritual aspects of death

Glomerulonephritis

• inflamed glomeruli within kidney • in children; often caused by a streptococcal infection elsewhere in the body (eg. tonsillitis, pharyngitis) • ascites & peripheral edema • htn w/ headache • oliguria • proteinuria, hematuria (cola or tea-color urine, smoky / rusty urine) • abd / flank pain • azotemia • anemia • depending on severity of glomerulonephropathy = indicates bleeding in upper urinary tract Interventions: maintain bed rest for kidney, restrict fluids, increase cal, reduce k+ & na diet, daily weight, antibiotics

Diverticulitis

• inflammation of diverticulum • s/s: acute onset of LLQ abd pain, n/v, fever, chills, tachycardia • labs: decreased Hct & Hgb, increased ESR • dx: occult blood test • complications: perforation (eg. increased abd pain & peritoneal signs) Interventions: antibiotics, avoid seeds, alcohol, & limit fat intake, clear-liquid diet to low fiber & adequate fluids

Mastitis

• inflammation of mammary gland in breast • s/s: dry cracked nipples, warm, red, painful, & edematous breasts Interventions: freq breast feeding Q2 - 3 hrs, proper breastfeeding technique (eg. alternating, proper latch, positions), warm compresses & massage, adequate rest, nutrition, & hydration, analgesics, wash hands before & after feeding

appendicitis

• inflammation of the appendix • s/s in children: inconsolable crying, drawing up legs twd abd • s/s: RLQ pain referred from periumbilical area

Hepatitis

• inflammation of the liver Hep A: fecal-oral route → shellfish high risk* Hep B: blood (eg. unprotected sex, mother-to-fetal, contaminated needle / blood) Hep C: blood (eg. contaminated needles, blood products, blood transfusions before 1992, organ transplants, most common cause for liver disease/failure) → meds: combo therapy w/ peginterferon alfa-2a and ribavirin Hep D: contaminated needles, unprotected sex Hep E: contaminated food or water • RUQ pain w/ dull abd & joint pain • anemia • asterixis • hepatomegaly • fatigue, malaise • decreased appetite • fever, n/v • jaundice (dark skin observe palate of mouth & eyes) • dark & clay colored urine (bc of excess bilirubin & bile salts) • hepatic encephalopathy → confusion, difficulty concentrating, easy agitation • labs: elevated alt / ast Interventions: high carb / cal, low fat & protein, small frequent meals, paracentesis, monitor rr

bacterial vs viral meningitis

• inflammation of the meninges that cover the brain & spinal cord • incubation period 1 wk; < 1 wk = sympts • droplet precautions for suspected meningitis • before / prior to lumbar puncture; obtain head ct scan (increased ICP = NO LP due to risk of brain herniation) • LP for CSF if bacterial = purulent, turbid, cloud fluids, if viral = clear • dx: Kernig's (leg extension at 90 degrees) & Brudzinki's (neck & knee / hip flexion) signs Bacterial • group b strept • droplet precautions • can be fatal • more virulent infants • high fever, possible hypothermia • irritablility frequent sz • high pitched cry • poor feeding, vomiting • nuchal rigidity • possible bulging fontanelles adults • high fever • nuchal rigidity • severe headache • LOC change, photophobia, n/v • increased risk for sz • complications: hydrocephalus (increased ICP) • spinal tap: cloudy Interventions: sz precautions, reduce environmental stimuli (eg. quiet, dim lighting, cool temp), bed rest w/ HOB elevated to semi-fowlers, admin vasopressors • blood cultures drawn for antibiotics • CT scan to rule out increased ICP *for bacterial meningitis w/ sepsis -> fluid resuscitation is PRIORITY! Viral • rarely fatal • less virulent • low-grade fever • no LOC change • nuchal rigidity • hospitalized to R/O

Pancreatitis

• inflammation of the pancreas • complications: ARDS, Peritonitis** • LUQ / epigastric abd knifelike pain radiating to back or flank unrelieved by n/v • pain while lying down or eating • sinus tachycardia • hypotension • ascites • Turners & Cullens signs (blue discoloration on side; blue discoloration on periumbilicus) • jaundice • steatorrhea (foul-smelling, fatty stools) • absent / decreased bowel sounds • hyperglycemia • tetany • labs: ELEVATED Amylase, Lipase, Glucose, WBC, PT & aPTT, Bilirubin, & HYPOcalcemia & mag Interventions: NPO, IV fluids, pain meds (no morphine), NG tube for decompression • if eating pancreatic enzyme (amylase, lipase, protease) supp prior or w/ each meal; BLAND LOW fat & sugar no stimulants, small freq meal • insuline, antacids, PPI, famotidine

Acute pericarditis

• inflammation of the pericardium • pain worsens w/ deep breathing, supine • Interventions: Fowler's position, monitor signs for cardiac tamponade (eg. sudden decrease in bp)

Peritonitis

• inflammation of the peritoneum (membrane lining the abdominal cavity and surrounding the organs within it) • fever, boardlike (rigidity) abd pain, guarding, rebound tenderness • pts lie still w/ shallow breaths • risk factors: appendicitis Interventions: paracentesis (removal of no more than 4 L / day), NCLEX TIPS: med emergency!

Sickle Cell Anemia (SCA)

• inherited disease in the hgb results in abnormal structure of rbcs • swelling of hands & feet; dactylitis (1st sign in neonates) • complications: priapism, anemia, stroke, splenomegaly Interventions: 1st pain mgmt if o2 not needed, fluids, rest NCLEX TIPS: splenic sequestration crisis (rapid enlargement of spleen w/ hypotension) causing splenomegaly *med emergency

Brachytherapy

• internal radiation therapy in which the source of radiation is implanted in the tissue to be tx • usually 24 - 72 hrs • Time: 30 mins per shift - cluster nursing care - staff must wear dosimeter film badge - no individuals who are preg or under 18 • Distance of at least 6 ft - assign pt to private room w/ private bath - keep door closed - caution sign - instruct pt to remain on bedrest • Shielding w/ lead apron • if implant becomes dislodged → remove pt → pick it up w/ forceps and disburse of it → notify HCP & radiation safety officer → incident report

Intussusception

• intestinal obstruction; one part of intestine prolapses into another part • common in infants (3 mons - 3 years) • medical emergency* • s/s: sudden episodic abd pain • screaming drawing knees to chest w/ pain • mass (sausage shaped), stools mixed w/ blood & mucus (red currant jelly) • vomiting, fever, dehydration • dx: contrast enema (can reduce intussusceptions too), ultrasound Risk factors: cystic fibrosis • complications: intestinal perforation *emergency Interventions: air enema, hydrostatic enema, IV, ng tube for decompression, surgery if reoccurring NCLEX TIPS: priority assessment finding that requires intervention → abd rigidity w/ guarding (peritonitis is developing)

Compartment syndrome

• involves the compression of nerves and blood vessels due to swelling within the enclosed space created by the fascia that separates groups of muscles 5'Ps: • pain unresponsive / unreleased by analgesics • paralysis: immobility of digits • paresthesia: changes in sensation (eg. tingling / numbness) *early sign • pulselessness • pallor: (eg. cool, cyanosis) NCLEX TIP: paralysis is a late sign (should be addressed immediately), pain & numbness are early signs

Creatin-kinase MB

• isoenzymes specific to the myocardium • elevates after MI

post term labor

• labor > 42 wks • tx: AROM, amniotomy (augments labor) • complications: hypoglycemia in infants

end-stage renal disease (ESRD)

• labs: elevated creatinine & BUN Interventions: dialysis: check pt med records to determine last post dialysis weight, obtain vitals & current weight, palpate fistula for latency (eg. bruit, thrill should be heard), do not give anticoagulants (might cause hypotension in pt) Fistula should not be slept on or take bp on

Errors in Sampling

• large changes noted in lab vals - must redraw sample - ex. platelet count decreased from 230,000 to 80,000 two days ago

Genu varum (bowlegs)

• lateral bowing of legs • norm up to 3 yrs old (18 - 24 mons) • 4 yrs can occur again; by age 7 everything should be norm

Duchenne Muscular Dystrophy (DMD)

• lateral curvature of the spine; S-shaped curvature • noticed during rapid periods of growth • early adolescence in girls → screening @ age 10 - 12; boys 13 - 14 • tx: boston, wilmington, tlso & milwaukee brace (used to prevent worsening of spinal deformity; does not cure existing spinaldeformity) Interventions: teach pt to wear cotton t-shirt underneath brace, monitor psychosocial issues, support groups, no lotion or powder under brace, worn for 18 - 23 hrs (removed for bathing & exercises),

Scoliosis

• lateral curvature of the spine; S-shaped curvature • noticed during rapid periods of growth • early adolescence in girls → screening @ age 10 - 12; boys 13 - 14 • tx: boston, wilmington, tlso & milwaukee brace (used to prevent worsening of spinal deformity; does not cure existing spinaldeformity) Interventions: teach pt to wear cotton t-shirt underneath brace, monitor psychosocial issues, support groups, no lotion or powder under brace, worn for 18 - 23 hrs (removed for bathing & exercises),

antiparkinsonian meds

• levodopa and dopamine agonists Carbidopa-Levodopa • increases dopamine & reduces physical sympts Interventions: fall precautions, takes several wks to reach max effects, discoloration of secretions (eg. red, brown, black) • avoid high-protein meals (interferes w/ absorption) • never abruptly stop med • overdose: dyskinesia (eg. facial, eyelid twitching)

Transplant organ pts

• life-long immunosuppressants (eg. cyclosporine, mycophenolate) to prevent rejection Interventions: 1st priority → infection control (eg. strict hand washing, aseptic technique), monitor for infection (eg. fever, productive or dry cough, changes in secretion)

DIC (disseminated intravascular coagulation)

• life-threatening external & internal bleeding • s/s: external bleeding (eg. ventipuncture site bleeding), internal bleeding (eg. petechie, ecchymosis), organ damage from blood clotting (eg. resp distress, RF), hematuria & bloody stools *late signs Risk factors: placental abruption, intrauterine fetal demise, sepsis Interventions: baseline lab tests (eg. CBC, fibrinogen), physical assessment of bleeding • eg. thromboplastin from dead fetus activates clotting followed by consumption of clotting factors & platelets

NMS (neuroleptic malignant syndrome)

• life-threatening reaction to an antipsychotic (or neuroleptic) drug • s/s: fever, autonomic dysfunction, muscle rigidity* • sweating, htn, tachycardia (autonomic dysfunction), sz, change in LOC • tx: stop drug immediately, rehydration, cooling body temp

AFIB (atrial fibrillation)

• loss of effective atrial contraction • P nares not present • risk emoblic stroke • hr: 350 - 600/min • decreased CO; hypotension • complications: atrial clots Interventions: calcium channel blocker (eg. Diltiazem), beta blocker (eg. Metroprolol), cardiac glycoside (eg. Digoxin), or warfarin NCLEX TIPS: 1st priority control ventricular rate, CPR, defib

Metabolic alkalosis

• loss of stomach acid • an excess loss of sodium or potassium • a renal loss of H+ • a gain of base • VOMITING, Steroid therapy, GI suctioning, NG suctioning, Diuretics, Hypokalemia, Hyperaldosteronism, Sodium Bicarb intake (TUMS !!!) • S/S: Hypoventilation Interventions: Focus on the underlying cause. Frequently, an electrolyte imbalance causes this disorder, so treatment consists of replacing fluid, sodium, and potassium

Hypoxia/Hypoxemia

• low o2 in blood • paO2 < 80 mmHg → eg. COPD • s/s: irritability, restlessness, confusion *early signs → bradypnea, bradycardia, hypotension, cyanosis, dysrhythmias *late signs Interventions: suctioning, o2, hydration

Cystitis

• lower UTI inflammation of bladder • burning on urination (dysuria) • frequent & urgent urination • suprapubic discomfort • hematuria

abnormal normal findings in neonates

• magnolian spots (congenital dermal melanocytosis) flat, bluish, discolored area on lower back or buttoks • erythema toxicum neonatarum (firm white or yellow papules or pustules surrounded by erythema) closely resembles flea bites; appears 1st few days after birth 7 & resolves by 5 - 7 days • nevus simplex " angel kiss " is a salmon-colored patch / red mark on nape of neck or eyelid, upper lip, or between eyes; vascular abnormality that disappears within 1 yr

Cervical cancer

• malignant tumor of the cervix • risk factors for cancer: HPV (*most important), multiple sex partners, sex before 18, oral contraceptives, other STIs / STDs, smoking, immunosuppresstion

GBS (group B streptococcus)

• may be present as normal part of vaginal flora transmitted to newborn during labor & delivery • screening: 35 - 37 wks • complications: neonatal GBS sepsis, pneumonia • positive: penicillin G given at 37 wks • GBS status unknown: antibiotics given when PROM / ROM occurs > 18 hrs or more during labor or maternal temp of > 100.4

AAA (abdominal aortic aneurysm)

• medical emergency* • blood-filled bulge in abd aorta caused by weakening in vessel wall due to increased pressure • if ruptured or teared = massive hemorrhage* • s/s: bruit may be asucultated over site, acute onset of abd / periumbilical pain radiating to back, unequal pulses of lower extremities, hemorrhagic shock sympts Risk factors: male, > 65 years, coronary artery & PVD, htn, fam & smoking hx

sepsis neonatorum

• medical emergency** • s/s: elevated temp or hypothermic, subtle changes: irritability, increased sleepiness, poor feeding

Refeeding syndrome

• metabolic alterations that may occur during nutritional repletion of starved patients • rapid decrease in (PPM) phosphorous, potassium, mag • fluid overload, na retention, hyperglycemia, thiamine deficiency Interventions: baseline vitals, nutrition → increase cals gradually, monitor electrolytes

Concussion (head injury)

• minor trauma to brain • brief disruption of LOC • amnesia (retrograde) • headache Interventions: no strenuous activities for 1 - 2 days More severe brain injury • worsening headache & projectile vomiting* • sleepiness or confusion • visual changes (eg. unilateral pupil dilation) • weakness or numbness of part of body *head hematoma can show sympts after 24 - 72 hrs after injury Discharge instructions from hospital • monitor for s/s of increased icp: LOC, projectile vomiting, ataxia, ipsilateral pupil dilation, sz *avoid alc, other cns depressants, driving, extrenuos exercise, hot baths 1 -2 days

Liver biopsy

• most definitive diagnostic → can identify intensity of hep infection → can identify the degree of liver damage intraprocedure • assist pt into supine position w/ the RUQ of abdomen exposed • assist pt w/ relaxation techniques • instruct pt to hold exhale and hold it while needle is inserted • can resume breathing once needle is out • apply pressure to puncture site postprocedure • assist to pt to a RIGHT side lying position and have them maintain for several hours • monitor vitals • assess for abd pain • assess for bleeding from puncture site • assess for s/s of pneumothorax (can be caused by accidental puncture of the pleura or lung) →dyspnea, cyanosis, restlessness *liver is HIGHLY vascular organ = bleeding major complication *tachycardia = early sign of hemorrhage

Magnesium Sulfate

• muscle relaxation • therapeutic lvls: 4 - 7 • tx: asthma attacks, pregnancy issues, hypomagnesimas • adverse effects: decreases RR Interventions: loading dose of 4 - 6 g, maintenance dose of 1 - 2 g / hr Mag Toxicity • Toxicity > 7 • earliest s/s: absent or decreased DTRs, mod/severe: areflexia, hypocalcemia, resp depression, decreased UO, cardiac arrest → antidote: calcium gluconate 10% (kalcinate)

Angina Pectoris (ischemic chest pain)

• myocardial ischemia caused by arterial stenosis or blockage, uncontrolled bp, cardiomyopathy • maybe caused by physical exertion, intense emotion, extreme temps, tobacco, amphetamines, coronary artery harrowing (eg. atherosclerosis) • s/s: crushing, substernal chest pain • complications: MI Stable angina • safer angina; stops w/ rest Unstable angina • Atypical angina • s/s: atypical pain (eg. jaw or radiating down arm), SOB, indigestion, nausea, dizziness, cold sweats Interventions: nitroglycerin (SL): 3 x 5 mins apart, does not relieve after 1st → 911 & take 2nd, no light or heat, replace Q6 mons → adverse effect: hypotension

Mitral stenosis

• narrowing of the mitral valve • diastolic murmur (also heard in aortic regurgitation)

NTD (neural tube defect)

• neural tube doesn't form properly in utero • dx: prenatal screening: 2nd tri ultrasound, maternal serum alpha-fetoprotein • prevention: 400 - 800 mcg of Folic Acid / day (eg. cereals, bread, pasta, green leafy veggies) Risk factors: low folic acid intake, methotrexate, antiepileptics Spina bifida occulta • NTD • outpouching of spinal fluid, spinal cord, & nerves covered by thin membrane • s/s: tuft of hair at baseline of spine, hemangloma, nevus, dimple along base of spine *increased risk for infection, hydrocephalus Interventions: cover area w/ sterile moist dressing, prone position w/ face turned to side, Myelomeningocele • Encephalocele • Anencephaly • little to no brain tissue or skull • stillborn

Babinski sign (plantar reflex)

• neurological reflex: the sole of the foot is stimulated with a blunt instrument • normal adults the plantar reflex causes foot downward flexion • upward response/extension is positive Babinski response • infants = normal reflex <12 to 24 months • Adults = upper motor neuron lesion from damage to corticospinal tract

Mucosal protectants

• neutralize the acids & inactivates pepsin in the stomach • used for gerd & peptic ulcers • use no longer than 2 weeks • other meds taken 1 hr before (can decrease absorption of other meds) Risk factors: hypophosphatemia for older adults w/ poor nutrition

Antacids

• neutralize the acids & inactivates pepsin in the stomach • used for gerd & peptic ulcers • use no longer than 2 weeks • other meds taken 1 hr before (can decrease absorption of other meds) Risk factors: hypophosphatemia for older adults w/ poor nutrition Aluminum hydroxide • side effects: constipation, hypophosphatemia • used for renal impaired pts Milk of mag (mag hydroxide) • side effects: diarrhea, renal impairment, hypermagnesemia Sodium bicarbonate • side effects: constipation

Antianginal meds

• nitrates, beta blockers, calcium channel blockers • nitrates primarily used for mi • common s/s: HA (headache) Nitrates • Nitrostat, Nitrolingual • dilates arteries & veins; reduces preload & decrease O2 demand on heart • increases myocardial o2 by dilating coronary arteries & redistributes blood flow • contraindicated: head injury, NO erectile dysfunction meds (" -afil "), hypotension risk w/ antihypertensives • headache • orthostatic hypotension • reflex tachycardia • tolerance Interventions: SL (sublingual) nitrostat, nitrolingual: rest 5 mins after 1st admin, if pain not relieved call 911 & admin second, can take up to 3 tabs 5 mins apart, keep in dark container, may be used 5 - 10 mins before exercise • topical ointment (nitro-bid) must wear gloves, do not massage or rub, apply to area w/o hair (eg. chest, arm), cover area w/ plastic wrap & tape, gradually reduce dose & freq over 4 - 6 wks • transderm patch (nitro-dur) place upper chest or side, pelvis, inner upper arm, clean, dry, shaven area & wash hands after app, rotate skin site daily, 1 x daily, worn up to 12 - 14 hr then remove, shower ok NCLEX TIPS: nitroprusside metabolizes cyanide • cyanide toxicity →bitter almond smell on breath → lightheaded, cold clammy skin • antidote for cyanide toxicity: methylene blue **patch fall off over 1 hr ago → take nitro pill or spray → patch takes 40 - 60 mins

preconception counseling

• norm BMI 18.5 - 24.9 • abstinence from alc & smoking cessation • folic acid supplementation of 400 mcg / day • check rubella immunity (preg should be avoided for 4 wks after vaccine) • regular dental visits (poor preg outcomes; preterm, low birth weight)

Alcohol abuse disorder

• norm blood alc content for driving under the influence: 80 mg/dL (0.08%) • poor nutrition r/t improper diet • s/s: hypoglycemia, decreased thiamine (B1), nystagmus, confusion, ataxia, drowsiness, slurred speech, mood swings alcohol withdrawal • starts within 8 hrs after last drink; peaks 24 - 72 hrs • hand tremors, abd cramping, hallucinations, anxiety, sz Interventions: 1st give thiamine w/ or before glucose, meds: thiamine used to prevent wernicke encephalopathy (caused from alc suppression of B1) • benzos (eg. long-acting: Diazepam, Chlordiazepoxide, fast-acting: Lorazepam) for gross tremors & sz • beta blockers (eg. Propranolol, Atenolol) decrease cravings, bp, hr • anticonvulsants (eg. Carbamazepine) • Topiramate for decreasing alc craving recovery goals • expressing accountability • using insight • coping skills • setting goals • maintaining abstinence Interventions: meds: • Disulfiram for abstinence & maintenance (does not cure alcoholism) • avoid alcohol products (eg. paint remover, mouthwash, cold / flu meds) • Naltrexone blocks alc & opiates *disulfiram s/s: headache, n/v, sweating, dyspnea, confusion, tachycardia, hypotension

HIT (heparin-induced thrombocytopenia)

• norm platelet count: 150 - 450,000 > 50% reduction in platelet count within 7-10 days of exposure of heparin • 50,000 *extremely dangerous notify HCP • increases risk for DVT, PE, & stroke Interventions: stop heparin infusion immediately & notify HCP

VAP (ventilator associated pneumonia)

• occurs 48hr or more after intubation Interventions: HOB elevation, suction, hand hygiene, drain water from tubing, no routine changes of ventilator circuit tubing

DDH (developmental dysplasia of hip)

• occurs in infants; usually in 6 mons of life • < 3 mons • presence of extra gluteal fold on affected side • laxity / instability of hip joint on affected side • dx: ortolani maneuver (abd w/ anterior lift of hip), barlow maneuver (add w/ posterior pressure on hip) performed by HCP • > 3 mons • limited hip abduction & shortened affected extremity • tx: pavlik harness (leaves hips slightly flexed & abducted position; worn nonstop for 3-5 mons) Interventions: leave harness on during diaper changes, inspect skin 2 - 3 times daily, shirt & knee socks, lightly massage skin under straps, 1 diaper @ a time, diaper under straps, avoid lotion & powder

Pneumonia

• occurs when atelectasis (alveolar collapse) • droplet precaution (surgical mask, private room) • cough w/ or w/o sputum, tachypnea, sob • crackles, dyspnea, pleuritic chest pain • tactile fremitus (palpable vibrations) • high pitched harsh sounds • unequal chest expansion • dullness • fever, chills, productive cough • complications: pleurisy (pleural friction rub): stabbing pleuritic chest pain that increases w/ inspiration. most important to report to provider* Interventions: incentive spirometry, ambulation, cough / deep breathing exercises

prenatal diet

• omega-3 fatty acids → fetal neurologic function & lowers risk of preterm labor • 400 - 800 mcg of Folic Acid / Day → prevention of NTD • increase Iron intake → 20 wks → Hgb < 11 = iron deficiency anemia → may cause constipation → tx: bulk forming fiber supps & high fiber & fluid intake, mod-reg exercising • caffeine limited to 200 - 300 mg / day • avoid intake of high mercury fish → shark, swordfish, mackerel, tilefish • toxoplasmosis → cat feces, undercooked meats, deli meats, hot dogs, raw fish, unpasteurized milk products, unwashed & soil-contaminated fruits, veggies → can eat deli meats, hot dogs if COOKED • pica (may occur during preg): constant craving for & consumption of nonfood / nonnutritive food substances → iron deficiency anemia = check hct & hgb • folic acid (folate) best sources: green leafy veggies, asparagus, turnip / mustard greens, fortified cereal, cooked dried beans, liver → good: broccoli spinach, green peas, fresh-cooked beets, pasta, rice → other: tomato juice, orange juice, sunflower seeds, peanut butter, enriched bread

CABG (Coronary Artery Bypass Graft)

• open heart surgery involving arterial bypass using a transplanted vein to create new blood supply to an area of the heart w/ clotted or blocked artery • complications: atelectasis *common

Opioid withdrawal

• opioid dependence (eg. heroin, oxycodone) • used to tx emergency overdose: antidote: nalaxone • acute withdrawal if abruptly stopped Interventions: meds: • Methadone (opioid replacement) • Naltrexone (blocks alc & opiates) prevents cravings • Clonidine used for physical effects • Buprenorphine (can become addicting), Suboxone Overdose of PCP • admin: Ammonium Chloride & monitor for htn

antidiabetic drugs

• oral hypoglycemics • Glyburide, Glipizide, Glimepiride *eg. takes usual dose of insulin & throws up = pt may need a higher dose if sick or stressed or if oral intake is too low = bg may be decreased - check bg lvl, repeat Q4 hrs, & report to HCP

CTS (carpel tunnel syndrome)

• pain & paresthesia of hand due to median nerve compression Interventions: wrist immobilization splints, no repetitive hand exercises

Raynaud's phenomenon

• peripheral arterial occlusive disease in which intermittent attacks are triggered by cold or stress Interventions: stress mvmt (eg. yoga, tai chi), avoid (vasoconstrictors) tobacco, cocaine, caffeine, extreme temp changes, gloves when handling cold objects, dress in warm layers, maybe admin val channel blockers if other mgmts unaffected

Fluid volume Overload

• peripheral edema • bounding peripheral pulses • increased UO; diluted • acute, rapid weight gain • JVD • S3 heart sounds in adults • tachypnea, dyspnea, crackles Interventions: best position for measuring JVD → HOB 30 - 45% (semi-fowlers),

COPD (chronic obstructive pulmonary disease)

• permanent, progressive, irreversible damage to lungs • norm pulse oz for pt: 88 - 93% • hyperCApnic: high CO2 lvls (makes body more acidic) • respiratory acidosis • complications: respiratory failure, Right-sided HF (cor pulmonale), hepatomegaly • 7 warning signs of COPD: frequent coughing, thickness & color of mucus, SOB, headache / dizziness, trouble falling asleep, excessive tiredness, weight loss • 6 min walk test: SOB after 6 min • expected lab result findings: polycythemia (high RBC count) to compensate for low blood perfusion Risk factors: smoking, wildland fire fighter, car mechanics Interventions: BiPap (priority) for worsening COPD, albuterol if SOB, • monitor LOC (eg. restlessness, decreased loc, confusion) • avoid opioids, avoid benzos (eg. -lam, -pam) • oral hygiene Before meals • small freq meals of high cal / protein, low Na & carb, no gassy / high fiber foods (eg. carbonated drinks, broccoli, beans) • avoid exercise before / after meals (increases exacerbation) • fluids Between meals, increase fluid intake 2-3L/day or 8 glasses • report infection: increased sputum, fever, dyspnea • vaccines: pneumococcal admin every 5 years, yearly flu vaccine • if SOB: give abuterol NCLEX TIP: 1st sign - changes in LOC 1st Tx - BiPap

OCD (Obsessive Compulsive Disorder)

• persistent, intrusive thoughts, impulses, images & ritualistic, repetitive behaviors performed to reduce anxiety or prevent an adverse effect Interventions: • assisting ID of circumstances that increase anxiety • initially allowing time for ritualistic behavior & remaining nonjudgemental • positive feedback when pt engages in nonritualistic behavior (eg. group activities, board games) • CBT (eg. thought stopping)

elderly abuse

• physical or sexual abuse, emotional confinement, passive neglect, willful deprivation, and financial exploitation

Abruptio placenta

• placenta separates from the uterine wall • s/s: rigid board-like & tender abd, sudden-onset of dark red vaginal bleeding, abd pain / back pain, uterine rigidity, tachysystole • complications: hypotensive shock & impaired fetal o2 Risk factors: abd trauma, htn, cocaine, hx of prevous abruption & PROM Interventions: continuous FHR monitoring, draw blood for type & cross match, large-bore cath *med emergency → hemorrhage = csection

meds not good for elderly

• polypharmacy • antipsychotics, anticholinergics, antihistamines, antihypertensives, benzos, diuretics, opioids, sliding insulin scales

PVC (Premature Ventricular Contraction)

• premature (early) conduction of QRS complex; wide & distorted shape • associated w/ stimulants (eg. caffeine, red bull), meds (eg. digoxin), heart diseases, electrolyte imbalances, hypoxia, emotional stress • usually NOT harmful in pt w/ healthy heart • in pt w/ MI, ischemia can deteriorate into life-threatening dysrhythmias Interventions: o2 (hypoxia), reduce caffeine intake, electrolyte replacement

Antisecretory / blocking agents

• prevents or block selected receptors within the stomach • used for gastric and peptic ulcers, GERD, and Zollinger-Ellison syndrome • contraindicated during lactation, caution w/ COPD pt PPI (proton pump inhibitor) • " -prazole " • omeprazole, lansoprazole, rabeprazole sodium, esomeprazole H2 blockers (histamine 2 receptor antagonists) • " - tidine " • ranitidine hydrochloride, cimetidine, nizatidine, famotidine Risk factors: increases risk for osteoporosis w/ long term use (eg. COPD & acid rebound (PPI) • H2 blockers: decreased libido / impotence, lethargy, depression, confusion Interventions: do not crush, chew, break tabs, notify HCP signs of GI bleed

Antiplatelet meds

• prevents platelets from aggregating (forming) • Aspirin, Abciximab, Clopidogrel, Ticlopidine, Pentoxifylline, Dipyridamole • use to tx: prevent MI or acute coronary syndrome, stroke • adverse effects: prolonged bleeding, gastric bleeding, thrombocytopenia Interventions: pt must report signs of uncontrolled bleeding → black tarry stools & stroke → headache, slurred speech

ECT (electroconvulsive shock therapy)

• procedure induces brief, controlled sz (15 - 20 secs) that affects neurons & chemicals in the brain where electric currents are passed thru brain under general anesthesia • used to tx: severe (major) depression, bipolar disorder resistant to meds, & schizophrenia • NPO 6 -8 hrs prior to tx, sips of water w/ meds ok • anesthesia (eg. methohexital, propofol), & muscle relaxant (eg. succinylcholine) admined • pt unconscious & feel no pain during tx • no driving • temp memory loss & confusion *common side effects • therapy is 6 - 12 tx; performed 2 - 3xs a week

OA (osteoarthritis)

• progressive degenerative deterioration & loss of cartilage in 1 or more joints "wear & tear" • O.S.T.E.O. • O: Outgrowths bony → bouchard nodes (middle joints of fingers & toes; b comes before h), heberden nodes (closest to the end of fingers & toes) • S: Sunrise stiffness less 30 mins → worsens @ end of day • T: Tenderness on joint site (no warmth or redness) • E: Experience "crepitus" grating (grating sound produced by friction between bone & cartilage) • O: Only the joints (not systemic; no fever, anemia) • pain diminished after rest & worsens after activities • chronic joint pain & stiffness, limited mvmt, excessive joint fluid, skeletal muscle atrophy from disuse • dx: ESR & CRP elevation, xray Risk factors: aging, female, metabolic disease, obesity, repetitive use of joints, smoking Interventions: asses manage pain, ice or heat for comfort, encourage. ROM & isometric exercises, encourage rest & sleep, PT / RT (rehabilitation therapy for surgery), assisted devices to increase independence & complete activities of daily living • meds: NSAIDs, corticosteroids, topical analgesics, supplements (eg. glucosamine, chondroitin sulfate)

AD (alzheimer's disease) vs Delirium

• progressive disease VS new sudden onset; reversible Alzheimers • risk factors: genetic, lifestyle, environmental, trauma to brain, advancing age > 65 Interventions: healthy lifestyle choices (eg. smoking cessation, avoid excess alc, exercise, participating in mentally challenging activities), Memantine (mod-to-severe) • strategies for caregivers: - use distraction & redirection to manage agitation - speak slowly, use simple words, yes-or-no quest - visual cues for directions - interact w/ pt as adult, respect pt dignity - break down complex activities into steps w/ simple instructions - limit number of choices to decrease pt anxiety Delirium • acute fluctuating change and inattenton in mental status r/t underlying medical condition • risk factors: - advanced age - neurodegenerative disesase (eg. stroke) - polypharmacy - coexisting medical condition (eg. infection) - acid-base/arterial blood gas imbalance (eg. acidosis, hypoxemia) - metabolic & electrolyte disturbances - impaired mobility - postop surgery - untreated pain & inadequate analgesia Interventions: tx underlying cause, safety precautions, reorienting pt freq, promoting reg sleep cycle, providing familiar items from home, encourage fam to stay w/ pt

PD (Parkinson's Disease)

• progressive neurological disorder • decreased dopamine lvls, uncontrolled acetylcholine, formation of abnormal protein clusters • 4 cardinal signs: → bradykinesia (slowness of mvmts) → postural instability → rigidity of skeletal muscles → resting tremors • other s/s: drooling, affected balance, gait-shuffling, increased speed, trouble stopping and starting, bowel/bladder, cognition (eg. dementia) NCLEX TIPS: anticholinergic meds for these pt but contraindicated in pts w/ BPH (benign prostatic hyperplasia) = urinary retention and glaucoma = acute episode

Teletherapy (external beam radiation)

• protect the skin from infection by not rubbing, scratching, or scrubbing • cleanse skin daily by taking a lukewarm shower - use mild soap w/o fragrance or deodorant - do not wash off any radiation ink markings • use only creams or lotions approved by HCP • shield skin from effects of sun during and after tx • avoid extremes in skin temp -avoid heading pads and ice packs - maintain cool humid environment - luke warm water ok

C-reactive protein (CRP)

• protein made by liver indicating inflammation in the body

umbilical cord prolapse

• protrusion of umbilical cord alongside or ahead of the presenting part of the fetus causing cord compression & impaired fetal oxygenation • may occur after SROM, AROM, mutlipregnancy, oligohydramnios, breech delivery Interventions: 1st: elevate protruding part, assist pt to knee-chest position or Trendelenburg, o2 & fluids NCLEX TIPS: if cord stops pulsating = fetal death occurred**

Bipolar disorder

• psychiatric disorder characterized by cycling periods of depression & mania acute mania • s/s: elevated moods, elation, extreme hyperactivity, easily distractible • impulsivity, pressure of speech, flight of ideas • aggressiveness, hostility • delusions • hallucinations • poor judgement, altered decision-making (eg. hypersexuality, excessive spending) • insomnia Risk for: malnutrition, dehydration Interventions w/ mania: high energy & protein dense foods that are easily carried & consumed (eg. on-the-go; sandwiches, shakes, burgers, pizza slice, burritos, fruit juices, granola bars), reduction of stimuli, structured schedule of activities, physical activities, setting limits on behavior

MDD (major depressive disorder)

• psychological disorder involving a significant depressive episode & depressed characteristics for at least 2 weeks • s/s: psychomotor retardation (eg. slowed speech, decreased mvmts, down cast gaze, impaired cog function, severe: catatonia) *contraindicated w/ (tx depression, insomnia) St. John's worts = drug interactions (antidepressants -> serotonin syn)

ADHD (Attention-Deficit Hyperactivity Disorder)

• psychological disorder marked appearance by age 7 of one or more three key symptoms: extreme inattention, hyperactivity, & impulsivity • neg consequences: poor self-esteem, increased risk for substance abuse, depression, & anxiety, academic or work failure (eg. learning disabilities), trouble interacting w/ others, difficulty controlling anger • tx: methylphenidate (stimulant) Interventions: do not take past 6 pm

Schizophrenia

• psychotic disorder involving distortions in thoughts, perceptions, and/or emotions NEGATIVE sympts: • impaired social interactions • 7 A's: • Anhedonia: lack of pleasure / joy, indifferent to things that make others happy • Ambivalence: (emotional) two affects attitudes or two opposite ideas coexisting at same time • Avolition: lack of motivation in activities or hygiene (eg. disheveled appearance) • Anergia: lack of energy • Alogia: poor thought / speech, vaguely respond, mumble • Affect: inappropriate, flat, bizarre, or bland • Apathy: lack of interest, enthusiasm, or concern eg. → inability to establish & move twd goal accomplishment → lack of energy, pacing & rocking, odd posturing → regressive behavior, inability to experience pleasure → seeming lack of interest in world & people POSITIVE sympts: → hallucinations → delusions → thought impairment (disorganized or diminished speech) Interventions: psychotropic meds • psychosocial & supportive tx: psychotherapy, education, behavioral training, cog therapy, social skills therapy eg. " pt spends time in dayroom watching tv in the corner but doesnt initiate convo or interactions w/ others " → practice basic social skills in a safe & non-threatening manner; one-on-one activity w/ nurse to help pt be comfortable in social interactions w/ others

left sided heart failure

• pulmonary edema • s/s: coughing, SOB, dyspnea, crackles

IPV (intimate partner abuse)

• r/t: abusive pt exhibits jealousy & possessiveness • victim chooses to say in relationship for variety of reasons (eg. fear for life, financial or custody concerns, religious beliefs) • abuse intensifies during preggers • IPV occurs in all religious, socioeconomic, racial, education groups, both heterosexual and same-sex

PKU (phenylketonuria)

• rare inherited disorder • deficiency or absence of enzyme required to metabolize phenylalanine (found in proteins) • high lvls = intellectual disability • teratogenic effects* Interventions: low-phenylalanine diet before & during preggers, avoid high protein foods (eg. meat, dairy, dry beans, nuts, eggs)

Uterine inversion

• rare, obstetrical emergency • post-birth; fundus collapses into uterine cavity • adverse affects: hemorrhage, sudden pelvic pain, hypovolemic shock Interventions: requires soft uncontracted uterus (eg. tocolytics; terbutaline) • discontinue uterotonic meds (eg. oxytocin, carboprost) until HCP corrects inversion • after replacement; admin uterotonics

VH (vaginal hysterectomy)

• removal thru vagina • complications: excessive bleeding, urinary retention, backache, decreased UO, DVT s/s • saturated > 1 perineal pad / hr → report HCP

Apgar scale

• repeated Q5 mins for up to 20 mins if 5-min apgar score is < 7 • scores of < 7 indicate transition difficulty & may require further interventions → o2, suctioning, stimulating, drying, warming

acute respiratory distress syndrome (ARDS)

• respiratory failure as a result of disease or injury (eg. sepsis, embolism) • hypoxemia, chest retractions, atelectasis, inspiratory crackles, cyanosis, decreased loc, tachycardia Interventions: PEEP

Osteomalacia

• reversible bone disorder that softens the bone from deficiency of calcium and vitamin D • weak, soft, painful bones Interventions: fall risk precautions, light to mod activity, increase Ca, P, vit D consumption,

CKD chronic kidney disease

• risk for fluid overload • hypocalcemia due to hyperphosphatemia, hyperkalemic & hypernatremic Interventions: avoid salt substitutes, na & k restriction, low protein & phosphorus diet, monitor fluid intake, high phosphorus foods = chicken, turkey, dairy

tonsillectomy and adenoidectomy

• risk for hemorrhage for up to 14 days after surgery • s/s: restlessness, frequent swallowing, clearing throat, vomiting of blood, pallor • to reduce risk teach pt to limit coughing, gargling, & clearing throat,

Muscle relaxers

• sedation, drowsiness, dizziness (common side effect) • do not abruptly stop med • no alcohol (worsens sedation) • liver toxic Dantrolene, cyclobenzaprine, carisoprodpol, baclofen, succinylcholine → adverse affects of succinylcholine = hyperthermia → tx: admin dantrolene Interventions: increase fluids & fibers, change positions slowly

status epilepticus

• seizing for 5 min or longer • aura prior to sz • grunting, dazed appearance • pts @ higher risk: VP shunt, hydrocephalus 4 phases of sz • prodromal: warning signs • aural: visual or other sensory changes before sz • ictal: period of active sz • postictal: confusion, headache; recovering from sz Interventions: diazepam / lorazepam to control sz

ICD (implantable cardioverter defibrillator)

• senses & defibrillates life-threatening dysrhythmias • post-op: refrain from lifting affected arm above shoulder until approved by HCP

Air embolism

• serious complication of CVC • o2 of 100% non rebreather mask • occlusive dressing on CVC • left lateral trendelenburg • monitor vitals & rr • notify HCP

AN (anorexia nervosa)

• severe disturbed body image & morbid fear of obesity • bradycardia, hypotension, electrolyte imbalance, cold intolerance, dry skin amenorrhea, extreme weight loss (< 85% below norm weight) • severe s/s: hypokalemia, lanugo *life-threatening comp: arrhythmias

HG (hyperemesis gravidarum)

• severe persistent n/v during preg • labs: elevated urine specific gravity (concentrated urine), ketonuria, hypokalemia / hyponatremia, metabolic alkalosis

epiglottitis

• severe, life-threatening upper airway obstruction • inflammation of the epiglottis • occurs 2 & 12 yrs of age • common cause Hib (haemophilus influenzae type b) • s/s: abrupt onset of high-grade fever, severe sore throat *1st signs • followed by 4 Ds: drooling, dysphonia, dysphagia, distressed airway • toxic-appearing & tripoding w/ inspiratory stridor Interventions: emergent endotracheal intubation

septic shock

• shock caused by severe infection in the blood stream (sepsis), usually a bacterial infection • causes uncontrolled persistent hypotension & multiorgan dysfunction syndrome • increases risk for DVT → tx: rapid replacement of clotting factors; fresh frozen plasma, platelets, & blood s/s: low bp (cold clammy skin), delayed cap refill, ALOC (confusion, disorientation)** **HIGH WBC over > 10,000 = immediate intervention **temp HIGH or VERY LOW (< 96 F) **early admin of antibiotics reduces mortality *older adults atypical sympts w/ sepsis = ALOC, hypothermia, leukopenia **septic arthritis (joint) = pain, limited ROM, & systemic infection (eg. fever) = surgical emergency

Immunocompromised patients

• should not receive live vaccines (eg. Varicella-zoster, MMR, rotavirus, yellow fever) *cyclophosphamide (immunosuppressant & chemotherapy agent) →hemorrhagic cystitis!! *common complication = drink plenty of fluids!

Antigout meds

• side effects: gi distress, rash & fever, decreases metabolism of warfarin • avoid pt w/ renal, cardiac, or gi dysfunction Allopurinol • inhibits uric acid production • used for GA (chronic) Colchicine • inhibits processes to prevent leukocytes from invading joints • used for GA (acute) • adverse affects: gi (eg. abd pain, diarrhea) *common Interventions: avoid foods high in purine, monitor CBC & ua lvls, avoid aspirin, NSAIDs for pain, admin w/ meals & drink w/ water, increase fluids, do not combine w/ theophylline, store in cool dark place NCLEX TIP: rash or fever occur → discontinue immediately

screening adolescent depression

• signs of depression: • vague somatic sympts: headache, stomachache, irritable, cranky mood • hypersomnolence or insomia; napping during daily activities • low self-esteem; withdrawal from previously enjoyable activities • outbursts of angry, aggressive, or delinquent behavior (eg. vandalism, absenteeism); inappropriate sexual behavior • precipitous weight changes

tractions

• skin traction: - bucks: immobilizes hip fx in straight neutral position (reduce pain & spasm) - Bryant's - cervical halter - pelvic • skeletal traction: - applied directly to bone

Dementia

• slowly progressive decline in mental abilities, including memory, thinking, and judgment, personality changes • s/s: sundowning Interventions: reality reorientation, advanced dementia: validation therapy • meds: Rivastigmine, Donepezil (also tx alzhem) • sudden onset of new behavior = delirium cause by infection

Meds for hematopoietic growth factors

• stimulates bone marrow to synthesize specific blood cells • r/t: aplastic anemia, hemolytic anemia, anemia from ckd, chemotherapy, neutropenia from cancer, thrombocytopenia Epoetin Alfa • stimulates RBC production • subQ or IV, do not agitate vial • side effect: htn • monitor Hct & Hgb Figrastim, injection peyfilgrastim • stimulates (bone marrow) WBC production • IV 2 - 4 hrs, do not agitate vial • side effect: booooone pain, leukocytosis • monitor CBC • tx: given prophylactically or pt has infection Oprelvekin • stimulates platelet production • subQ; within 6 - 24 hrs after chemotherapy • side effect: fluid retention, blurred vision, cardiac dysrhythmias

Sprain

• stretching or tearing of ligaments • s/s: brusing, edema, pain, popping sound (eg. ankle) • R.I.C.E. for the 1st 24 - 48 hrs • R: rest for 24 - 48 hrs • I: ice (eg. cold, ice pack, cryotherapy) applied for 10 - 15 mins/hr for 1st 24 - 48 hrs; ice should not be placed directly to skin (vasoconstriction helps reduce pain, inflamm, swelling) • C: compression (eg. ace wrap, splint) pressure/compression helps prevent edema & promotes fluid return • E: elevate extremity above heart for 24 - 48 hrs (reduces swelling & promotes fluid return) • other interventions: analgesics, exercise rehabilitation • after the 1st 24 - 48 hrs heat can be applied for 20 - 30 mins w/ a cool down between applications to reduce swelling

Cerebral aneurysm (subarachnoid intercerebral bleed)

• subarachnoid hemorrhage • " silent killers " • widening or abnormal dilation of a blood vessel in the brain • asymptomatic unless ruptured; " worst headache of my life* " • evaluating a possible rupture -> severe headache w/ changes, loss of consciousness, neurologic deficits, diplopia, sz, vomiting, stiff neck NCLEX TIPS: *surgical emergency

Stroke

• sudden attack of weakness or paralysis that occurs when blood flow to an area of the brain is interrupted • increases risk: htn, tobacco, heart disease, diabetes • FAST • F: Facial drooping • A: Arm weakness • S: Speech difficulties • T: Time Ischemic stroke • blockage of artery • contraindicated to tPA - hemorrhage (eg. abd surgery within last 2 wks), stroke or head trauma within last 3 mons • tx: tPA must be admined within 3 - 4 1/2 hr from onset of sympts, HOB flat maintaining head in midline position Hemorrhagic stroke • caused by blood vessel bleeding in brain Interventions: freq neuro assessments, sz precautions, NPO, & prevention of increased ICP / BP -> reduce stimuli, stool softeners to avoid straining, reduce exertion, semi fowlers maintaining head in midline position risk factors after stroke: hononymous hemianopsia (lose half of visual field on same side in both eyes)

Risk factors for suicide

• suicide screening considers demographics, mental & physical health hx, support system, coping strategies, fam hx of suicide, previous attempts, & behavioral patters SAD PERSONS • Sex (Male) • Age (Teenager or Elderly) • Depression • Previous Attempt • Ethanol or Drug Use • Rational loss of thinking • Sickness (medical illness) • Organized plan • No spouse (divorced, widowed, or single especially if childless) • Social support lacking • 3 or more prescription meds • women TRY more often, men SUCCEED more often

Aortocaval compression syndrome

• supine hypotensive syndrome • compression of the aorta & inferior vena cava (IVC) by gravid uterus • may mimic other traumas (eg. placental abruption) • s/s: nausea, hypotension, pallor, lightheadedness, syncope Risk factors: trauma (eg. mv collision, fall) Interventions: 1st address supine hypotension → tilted laterally while strapped on backboard, monitor & reassess bp

tocolytic meds

• suppresses uterine contractions • Terbutaline sulfate, Magnesium sulfate, Nifedipine, Indomethacin

Paracentesis

• surgical puncture to remove excess fluid from the peritoneal cavity (ascites) • dyspnea, discomfort • hypovolemia (eg. orthostatic hypotension, tachycardia, decrease pulse & UO) Interventions: validate 1st signs of hypovolemia (eg. light-headedness, unsteady gait, vitals), no more than < 5L maybe removed, albumin NCLEX TIPS: albumin use → vital signs remained within pts norm parameters (no hypovolemia)

Breast engorgement

• swelling of breast tissue Interventions: cold cabbage leaves, ice packs to both breasts for 15 - 20 mins Q3 - 4 hrs, NSAIDs, snug support bra, warm showers, empty breast, manual expressing / massage breasts

right sided heart failure (cor pulmonale)

• systemic edema s/s: JVD, hepatosplenomegaly, ascites, edema, pulmonary hypertension

Gouty arthritis

• systemic inflammation caused by probs w/ purine metabolism (gout) • excruciating pain & inflammation in 1 or more small joints (great toe most common; appears red & warm) • appearance of tophi (deposits of na urate crystals; appears after years of GA) • progressive joint damage & deformity • increases UA renal stones • dx: uric acid > 7, ESR, synovial fluid analysis (will show uric acid crystals) Risk factors: fam hx, excessive alcohol intake, high intake of purine foods (eg. organ meats, yeast, sardines, spinach) Interventions: maintain best rest during attacks, elevated affected joint, promote fluid intake 3L/day, limit purine foods, keep diary of trigger factors, avoid alcohol, lose weight slowly (fast → cause flare up or renal stones) meds: acute phase → colchicine, chronic tx → allopurinol, NSAIDs, corticosteroids

Down Syndrome (Trisomy 21)

• systolic heart murmur • 50% have heart defects • flat nasal bridge • short stocky stature

Uterine rupture

• tear in the wall of the uterus • s/s: sudden-onset vaginal bleeding, abnormal FHR, constant abd pain, loss of fetal station, maternal tachycardia, sudden stop of uterine contractions, reports of " pooping " sensation in abd, • complications: hemorrhage, hypovolemic shock, tachysystole Risk factors: VBAC Interventions: IV fluids & oxytocin, laparotomy to repair rupture, csection or tubal ligation

Hypothermia/Frostbite

• temp < 95 • s/s: " everything super cold; nearly frozen " → pulses weak & thready, wheezing, crackles intervention: 1st cardiac monitor & anticipate dfib NCLEX TIPS: anticipate mechanical VENTILATION! cardiac monitor, rewarming: passive methods, warmed IV fluids, warm blankets Frostbite • popsicle " cells like snowball " • vasoconstriction → vascular stasis • s/s: superficial: blue, mottled, waxy yellow skin • deep: white hard skin; gangrene Interventions: 1st rewarming: warm water soaks (whirlpool), elevate affected extremity after rewarming, & analgesic → no heavy clothing, blankets → no massage, rubbing → no occlusive dressing on wound NCLEX TIPS: priortity is to REWARM & NO occlusive dressings**

Vitals Signs

• temp: 97.8 - 99.1 (100.4 low grade fever) • > 95 F = hypothermia --> cardiac & resp failure • RR: 12 - 20 /min • hr: 60 - 100 bpm • bp: 120/80 Newborns • temp: 97.7 - 98.9 • RR: 30 - 60 bpm • hr: 100 - 160 bpm • bp: 60 - 80 / 40 - 50

Bell's Palsy

• temporary unilateral facial paralysis of cranial nerve VII • s/s: inability to completely close eye on affected side • alt in tear production • flattening of nasolabial fold on affected side • inability to smile or frown symmetrically Interventions: vitals, eye care → use glasses during day, wear patch or tape eyelids at night, use artificial tears • oral care → chew on unaffected side, soft diet, maintain good oral hygiene

lead poisoning

• test at 12 months of age • BLL screening • > 5 or more • s/s: mild: hyperactivity, impulsiveness • complications: neurocognitive impairment, severe kidney injury (*most threatening is neuro & kidney injury), delay in physical growth, gi bleeding

Thoracentesis

• the surgical puncture of the chest wall with a needle to obtain fluid from the pleural cavity Interventions: max amount of fluid removed is only 1L

Phenytoin

• therapeutic range: 10 - 20 mcg/mL • anticonvulsant, antiepileptic • TOXICITY RISK* Phenytoin Toxicity • early signs: horizontal nystagmus, unsteady gait (ataxia), slurred speech • decreased alertness • fever, skin rash, lymphadenopathy • severe adverse effects: bradyarrhythmias & hypotension, osteoporsis Interventions: stop feeding 1 - 2 hrs before & after admin of med, wear med alert bracelet, do not stop abruptly, folic acid supp (to reduce gingival hyperplasia) NCLEX TIPS: gingival hyperplasia *common s/s *decreases effectiveness of oral contraceptives *no preggers *avoid alc

Phenobarbital

• therapeutic range: 10 - 40 mcg/mL • anticonvulsants, hypnotic, sedation • TOXICITY RISK* • used to tx: alcohol withdrawal

Pyloric stenosis

• thickened pylorus; usually in the 1st 5 weeks of life • palpable epigastic olive-shaped mass in RUQ, projectile vomiting, constant hunger, failure to gain weight, dehydration

epistaxis (nosebleed)

• tilt head fwd • direct continuous pressure by pinching nostrils together for 5 - 15 mins • cold cloth or ice pack to bridge of nose • tilt head fwd • calming pt

physical changes of children

• toddlers • slooooow weight gain → " picky eaters " → average yearly weight gain 4 - 6 lbs → approximately 4xs greater than birth weight → offer 2 - 3 options → keep food portions small → expose to new foods repeatedly → avoid distractions during meal / snack times → 15 min period wait after physical activities → do not force or pressure toddler to eat more teeth • most children have all their primary teeth by age 2 - 3

hospitalization for children

• toddlers 12 - 36 mons • rituals & routines • separation anxiety → stability & reassurance (eg. maintain home routines, stay w/ child as much as possible, give snacks at preferred time) to help cope → provide opportunities to play; playroom → stacking blocks → give favorite items → facilitate phone calls → providing support when child is upset → provide pictures of child's family • preschool 3 - 5 yrs • sense of initiative & preoperational thinking • egocentric & magical thinking → believe that they caused their illness → reassure preschooler its not their fault → encourage child to ask questions, voice concerns, & participate → use toys to communicate about procedure (eg. puppets, medical kits) → crayons & drawing → dress-up clothing • school-aged 6 - 12 yrs • concrete thinking → establish trust & show respect → open ended questions, eye contact → posting daily schedule by child → puzzles • adolescents 12 - 19 yrs • peer interactions; independence → visit from friends → discuss body changes → involving pt in care planning

Oligohydramnios

• too little amniotic fluid • complications: umbilical cord prolapse Risk factors: preg > 41 wks, undiagnosed ROM

circulatory overload transfusion reaction

• transfusion of too large a volume → s/s: coughing, cyanosis, SOB, dyspnea, restlessness, lung crackles, dark urine, JVD • complications: HF interventions: slowing infusion to run over 4 hours max; raise HOB semi fowlers, o2, discontinue any other IV infusions hanging w/ blood (eg. NS)

Cardiac catheterization (coronary angiography)

• tube or catheter interested into a vein & guided twd heart to reveal blood vessel blockages • complications: retroperitoneal (hemorrhage) bleeding *med emergency • involves iodine contrast = shellfish allergy • NPO 6 - 12 hrs prior • may feel warm or flushed w/ contrast dye injected • post-procedure: pressure dressing & place pt supine w/ affected extremity flat for 2 - 6 hrs Interventions: 1st hour after cath: assess Q15 mins → report of back or flank pain *1st sign, tachycardia, hypotension = retroperitoneal bleeding → may take up to 12 hrs before sig drop in hct can be measured • if site is bleeding or cooling of extremity on side of cath → 1st apply direct manual pressure about 1 in (2.5 cm) above skin puncture site & notify HCP • lactic acidosis (if metform is administered); should be stopped 24 - 48 hrs before • nephrotoxic (make sure BUN & creatinine are not elevated)

antihistamine meds

• tx for decreasing allergy response • Diphenhydramine, Loratadine, Cetirizine, Fexofenadine, Desloratadine, Chlorpheniramine, Hydroxyzine • s/s: anticholinergic effects, drowsiness Interventions: take at night *reduces twitches & muscle tightness in schizo

Radiation contamination from a disaster

• tx the pts farthest from the source 1st → most severe sympts = least (salvageable) likely to live • early signs: low blood cell counts, oral mucosal ulceration, v/d • 1st step is to decontaminate • bathing & removing any residual hazardous materials & debris from pt • nursing assessment

lamical

• tx: antisz, anticonvulsant, antiepiletic, depression (not mania) • " Steve has a LAMb with a rash " • adverse effects: sjs (steven johnson syndrome; rash)

Open fx (compound fx)

• tx: preventing infections, pain mgmt, muscle spasms • meds prescribed for open fx: antibiotics (eg. cefazolin), muscle relaxant (eg. cyclobenzaprine), tetanus & diphtheria toxoid (if immunizations are not up to date > 10 yrs), ketorolac (eg. NSAIDs), opioids (eg. morphine)

Absence sz

• typically occurs in children 4 - 12 years; usually disappears at puberty • < 10 secs • may have multiple a day • s/s: daydreaming, sparing spells < 10 secs • absence of other forms of epileptic activity • unresponsive during sz • no memory of sz

Autonomic Dysreflexia/Hyperreflexia

• uncompensated sympathetic nervous system stimulation in a spinal injury at T6 or higher • most common cause of autonomic dysreflexia: bladder irritation due to distention • s/s: htn, pounding / throbbing headache, diaphoresis, piloerection "goose bumps", flushing, nausea • nasal congestion, chills, bradycardia • htn Interventions: • place client in sitting position (elevate HOB) FIRST! • palpate the bladder • bowel impaction can also be a cause → digital rectal examination should be performed • check bp with report of headache • pt needs to be cath-ed • meds: alpha-adrenergic blocker or arteriolar vasodilator (eg. nifedipine) NCLEX TIPS: *life-threatening condition → hypertensive stroke, sz, neurogenic shock *emergency tx: correcting cause (bowel or bladder distention), removing tight clothing & raising HOB

herpes zoster (shingles)

• unilateral linear pattern of fluid filled blisters • pain, itching • if pt had varicella (chickenpox) = herpes zoster can appear later on in life Interventions: airborne precautions

Spontaneous abortion (miscarriage)

• unintentional preg loss • < 20 wks Interventions: avoid intercourse & tampons for 2 wks, report foul-smelling discharge, heavy vag bleeding, & severe pain, continue prenatal vits w/ iron to prevent anemia & ibuprofen for cramping, admin RhoGAM if pt is Rh-neg

Pyelonephritis

• upper UTI inflammation of renal pelvis & kidney • positive CVA tenderness & pain in back / flank extending twd umbilicus

renal calculi (kidney stones)

• urine becomes concentrated resulting in crystals • severe / sudden-onset abd or right sided flank pain, n/v Interventions: analgesics, rehydration (3 L/day), ambulation, strain urine for stones • laser lithotripsy → edema, bruising, hematuria, burning on urination

FLACC Scale

• used to assess pain in child who is NONVERBAL • face, legs, activity, cry, consolability

Nitrazine test

• used to detect leaking amniotic fluid in vaginal secretions for PROM Interventions: • Place pt in dorsal lithotomy position • Touch test tape to fluid • Asses test tape for a blue-green, blue-gray, or deep blue color indicating ruptured membranes = positive • semen can create FALSE positives

External fixator device

• used to keep fx bones stabilized and in alignment; device adjusted externally to ensure the bones remain in an optimal position during the healing process • complications: osteomyelitis (bone infection): low-grade fever, drainage, pain, redness, swelling Interventions: assess pin drainage, asses for compartment syn, pin care w/ sterile sol, monitor for loose pin & notify HCP, promote early ambulation Halo • stabilizes cervical or higher thoracic fx Interventions: keep vest liner clean & dry (eg. changing weekly or when soiled, using a cook blow-dryer to dry), pin care w/ sterile sol, place foam inserts under pressure points, small pillow, avoid grabbing device, monitor for loose pin & notify HCP, keep wrench in case of emergency

lumbar puncture (spinal tap)

• used to test CSF • void before procedure • lateral recumbent / fetal position, sitting upright • sterile needle inserted between 3rd & 4th lumbar vertebrae • may feel shair pain shooting to leg; temporary • post-procedure: lie flat w/ no pillow for @ least 4 hrs to reduce change of spinal fluid leak, increase fluid intake for 24 hrs to prevent dehydration *saturated leaking of clear fluid at insertion site dressing = site not sealed off & blood patch required *spinal fluid leak causes headache *clear fluids coming out of nose = CSF = increased ICP *persistent back pain & fever = postop infection = osteomyelitis

1st Gen / Conventional meds

• used to tx schizo Positive Symptoms (things that should not be there) LOW POTENCY: (Typical) • Chlorpromazine • Thoridazine • Mesoridazine → High Sedation, High ACH → Low EPS → HYPOtension → major s/s: photosensitivity (eg. wear sunblock, sunglasses, sunscreen) HIGH POTENCY: (Atypical) • Haloperidol • Fluphenazine • Thiothixene • Trifluoperazine → Low Sedation, Low ACH → High EPSterm-342 → Weight gain ACH Effects Teachings: • Chew sugarless gum • High-fiber foods • 2 - 3L fluids • Offer ice chips • Eye drops for dry eyes • Postural hypotension → get up slowly • Perform AIMS test before ADMIN • Monitor EPS (TD) signs NCLEX TIPS: Higher potency, Higher EPS* • always check for cheeking = OD • best route = liquid

antipsychotic meds

• used to tx: acute psychosis • Risperidone 2nd-gen antipsychotic • s/s: photosensitivity Interventions: do not use w/ dementia pt, no alcohol Haloperidol 1st-gen antipsychotic • s/s: HIGH eps, low sedation, low anticholinergic effects, weight gain

Blood products administration

• verified by 2 nurses: pt ID, name, blood type • prior to admin: baseline vitals • IV 18 - 20 gauge cath • primed tube of NS • 1st 15 mins: monitor for reaction • if reaction occurs: 1st stop blood immediately & take vitals • flush w/ NS bag • complete infusion within 4 hrs • ask pt to void before procedure in the even of a transfusion reaction to occur (need fresh urine specimen to check for hemolyzed RBCs)

Croup (laryngotracheobronchitis)

• viral infection causing swelling of the larynx & epiglottis; acute respiratory syndrome • swelling of the larynx and epiglottis • occurs in children & infants s/s: brassy " barking" cough, mild retractions • presence of stridor or severe retractions *priority

Nutrition therapy

• weight gain is best indicator for pt response to medical nutritional therapy • albumin (3.5 - 5) is a poor indicator of nutritional status in acute & chronic disease (eg. pneumonia); lab lvls may not indicate change for over 2 wks • prealbumin more reliable indicator of acute change (it has a 2 day half-life) NCLEX TIPS: pt has a "weight gain of 2 lb in 2 weeks"

Malnutrition

• weight gain is best indicator for pt response to medical nutritional therapy • albumin (3.5 - 5) is a poor indicator of nutritional status in acute & chronic disease (eg. pneumonia); lab lvls may not indicate change for over 2 wks • prealbumin more reliable indicator of acute change (it has a 2 day half-life) NCLEX TIPS: pt has a "weight gain of 2 lb in 2 weeks" Best indicator for amid loss or gains → daily weight

NAS (neonatal abstinence syndrome)

• withdrawal syndrome • manifests 24 - 48 hrs after birth • yawning, sneezing, high-pitched cry, jitteriness, irritability, diarrhea, vomiting, poor feeding • tx: opioid therapy, swaddle newborn, minimize stimulation; if signs of overstimulation (eg. sneezing, arching) → gentle rhythmic rocking fetal alcohol syndrome • flat midface, smooth philtrum, thin upper lip, epicanthal folds, short palpebral fissures, microcephaly

SSRIs / SNRIs (selective serotonin reuptake inhibitors)

•" Effective For Sadness, Panic, & Compulsion " • Escitalopram, Fluoxetine, Setraline, Paroxetine, Citalopram • second-gen antidepressant • tx: depression, anxiety, ocd • 1st line of therapy used • • s/s: loss of appetite, weight loss or gain, n/v, diarrhea, headaches, dizziness, drowsiness, sexual dysfunction, insomnia Interventions: therapeutic effects 1 - 4 wks, sympts should gradually diminish over 3 mons, SSRIs may increase risk of suicide in young adults (18 - 24), give in AM, take w/ food, no NSAIDs, taper down NCLEX TIPS: sexual dysfunction & insomnia is a common** side effect --> notify HCP if present after 2 - 4wks • fluoxetine = preggers risk • discontinuation sympts: pins & needles, insomnia, dizziness, headaches, tremors " eg. pt who reports increased energy w/o change in depression = suicidal " *priority SNRIs (serotonin-norepinephrine reuptake) inhibitors • Venlafaxine, Duloxetine • tx: depression • s/s: htn, anticholinergic, sexual dysfunction, akathisia Interventions: tapered down if not can cause discontinuation or serotonin syn, monitor bp