NCLEX Readiness exam -- missed topics

SIRS = presence of >/=2 criteria

- HR ?90 - temp ?101 (38.3) or <96.8 (36) - RR >20 or PaCO2< 32 - wbc >12,000 or <4,000 - septic shock is defined as sepsis + systolic BP <90 or drop in sys BP ?40

insulin pen

- a click sounds can aid a visually impaired client w knowing the correct dose - has # on the barrel that correspond w the number of units of insulin to be given pre dose

Neutropenic precautions

- all visitors must wear a surgical mask: droplet spread of bacteria is possible - no visitors who have been recently vaccinated with a live attenuated vaccine should visit the client - no food/drink except what the hospital provides for the client should be brought into the room - avoiding rectal procedures (including temp) a normal neutrophils: 2,500 - 7,500 neutropenia: <2,000

circumcision

- call the HCP if there is no UO in 6-8 jr

L&D onset

- cervix changes (effacement and dilation) - rupture of membranes: check fetal heart tone to assess for fetal distress; monitor for prolapsed cord

polycystic ovary syndrome (PCOS)

- condition where both ovaries have many cysts due to a hormone imbalance; manifested as oligo/amenorrhea, the evidence of polycystic ovaries on u/s, and hyperandrogenism - an endocrine disorder so food intake and environmental influences do not have a major impact on PCOS symptoms - onset during adolescence - atypical appearance of a young woman - emotional comps - mood instability, stubborn weight gain (very common), hair growth on the face, acne - other hormonal effects: insulin resistance - give metformin (also for hyperandrogenism and restore ovulation) - most commonly occurs in women under 30 yr and may c/s infertility - etiology unknown

9 yr

- conflicts btw adult authority and peer group - conflicts btw independence and dependence

basilar skull fracture

- drainage may appear to be a yellowish ring CSF around the blood when wiped with a gauze (halo sign) - clients may describe a sweet (CSF contains glucose; can test this) or salty taste in their mouth if there is drainage of the CSF into the pharynx - racoon eyes (late) - battle sign: bruising behind the ear

lipase

- dx acute and chronic pancreatitis, biliary obstruction, hepatitis, cirrhosis - normal less than 200 U/mL - npo 8 -12 hr before test - avoid opiates 24 hr before test

long acting insulin

- glargine - onset: 3-4 hr - no peak - duration: 24 hr - detemir

episiotomy repair

- immediately: ice pack - 12-24 hr: warm sitz baths

muscular dystrophy

- muscle weakness, lordosis, falls - braces to help ambulation

Fluphenazine decanoate

- oil prep IM/SQ q 1-6wk, onset 24-96d

tracheostomy (fenestrated)

- permits air to flow around and through tube to upper airway - care should be performed q 8 hr and PRN - can be removed if client can swallow, move jaw, and clench teeth

stage 2 labor

- phase 1: 0-+2 station, contractions 2-3 min apart - phase 2: +2 - +4 station, contractions 2-2.5 min apart; increase in dark red, bloody show, increased urgency to bear down - phase 3: +4 to birth, contractions 1-2 min apart; fetal head visible; increased urgency to bear down, delivery of fetus

chemotherapy precautions

- place for clients have chemotherapy in the past 48 hr - wear chemo-approved gloves; double gloves; chemo gown' goggles and face mask as needed - ensure the toilet is flushed x2 - the chemotherapeutic agent usually remains in the client's body for up to 3-7 d but outside 48 hr: The nurse use standard precautions

newborn bathing steps

- place in a warmed surface to prevent heat loss through conduction - eyes (washcloth or cotton ball w warm water only) then faces (warm water only) - body - wrap in a prewarmed blanket/towel - shampoo hair/head: because the newborn will lose most of its heat from the head - wash last

diaphragmatic or abdominal breathing

- position on back w knees bent or sit up right - hands on abd, along the interior border of their rib cage - breathe through the nose, hold the breath, and exhale slowly through the mouth

abruptio placentae

- premature separation of the placenta from the uterine wall - increases w maternal HTN and cocaine use - painful vaginal bleeding, abd tender, painful, tense, possible fetal distress, client may experiences contractions -nx: monitor for maternal and fetal distress; prepare for immediate delivery; monitor for comps -- DIC, infection, and renal failure - goal for this client is the safe delivery of the infant and prevention of comps

Osteomyelitis

- support the extremity w pillows and splints - needs high protein diet to promote healing

nebulizer

- the inhaled mist deposits extra fluid - hypervolemia

infant formula

- to prevent diarrhea, increase the calories by 2kcal/oz/d - regular formula - 20 kcal/oz - a thicker formula would require the infant to expend more sucking energy to eat - offer small, freq feedings q 3 hr and enlarge the holes in the nipple or use a preemie nipple - secure the diaper loosely to promote maximum chest expansion

inguinal hernia

- trendelenbur - reduce pressure on the groin - discourage coughing and bearing down until healing is complete - assist w application of a truss, jockstrap, or suspensory bandage after repair

transformational model

- workers and leaders try to encourage each other to achieve the desired goals - responds to worker needs, empowers individuals to make decisions, and seeks input institutional goals, and objectives - reduces negativity and inspires commitment

cystourethrogram

- x-ray study of bladder and urethra - catheter inserted into urethra, radiopaque dye injected, client voids, x-ray taken during voiding

belt restraint

-At waist level & NOT over chest or abdomen -Ask patient to take deep breath to make sure there is no restriction to his breathing

stages of play

0-1: hold toys 1-7: imitation 8-12: games and hobbies infancy: solitary play toddler (1-3): parallel play preschool(3-6): associate play, f/u a leader school: cooperative play, organized in team verbal children and adolescents benefit from psychodrama - acts out emotional problems and examines subjective experiences to develop new perspectives

normal lactic acid

0.5-2.2

meningococcal

1 dose depending on lifestyle

serious reportable events (SREs)

1. SURGICAL OR INVASIVE PROCEDURE EVENTS 1A. Surgery or other invasive procedure performed on the wrong site (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 1B. Surgery or other invasive procedure performed on the wrong patient (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 1C. Wrong surgical or other invasive procedure performed on a patient (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 1D. Unintended retention of a foreign object in a patient after surgery or other invasive procedure (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 1E. Intraoperative or immediately postoperative/postprocedure death in an ASA Class 1 patient (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices 2. PRODUCT OR DEVICE EVENTS 2A. Patient death or serious injury associated with the use of contaminated drugs, devices, or biologics provided by the healthcare setting (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 2B. Patient death or serious injury associated with the use or function of a device in patient care, in which the device is used or functions other than as intended (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 2C. Patient death or serious injury associated with intravascular air embolism that occurs while being cared for in a healthcare setting (updated)Applicable in: hospitals, outpatient/office-based surgery centers, long-term care/skilled nursing facilities 3. PATIENT PROTECTION EVENTS 3A. Discharge or release of a patient/resident of any age, who is unable to make decisions, to other than an authorized person (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 3B. Patient death or serious injury associated with patient elopement (disappearance) (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 3C. Patient suicide, attempted suicide, or self-harm that results in serious injury, while being cared for in a healthcare setting (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 4. CARE MANAGEMENT EVENTS 4A. Patient death or serious injury associated with a medication error (e.g., errors involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation, or wrong route of administration) (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 4B. Patient death or serious injury associated with unsafe administration of blood products (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 4C. Maternal death or serious injury associated with labor or delivery in a low-risk pregnancy while being cared for in a healthcare setting (updated)Applicable in: hospitals, outpatient/office-based surgery centers 4D. Death or serious injury of a neonate associated with labor or delivery in a low-risk pregnancy (new)Applicable in: hospitals, outpatient/office-based surgery centers 4E. Patient death or serious injury associated with a fall while being cared for in a healthcare setting (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 4F. Any Stage 3, Stage 4, and unstageable pressure ulcers acquired after admission/presentation to a healthcare setting (updated)Applicable in: hospitals, outpatient/office-based surgery centers, long-term care/skilled nursing facilities 4G. Artificial insemination with the wrong donor sperm or wrong egg (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices 4H. Patient death or serious injury resulting from the irretrievable loss of an irreplaceable biological specimen (new)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 4I. Patient death or serious injury resulting from failure to follow up or communicate laboratory, pathology, or radiology test results (new)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 5. ENVIRONMENTAL EVENTS 5A. Patient or staff death or serious injury associated with an electric shock in the course of a patient care process in a healthcare setting (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 5B. Any incident in which systems designated for oxygen or other gas to be delivered to a patient contains no gas, the wrong gas, or are contaminated by toxic substances (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 5C. Patient or staff death or serious injury associated with a burn incurred from any source in the course of a patient care process in a healthcare setting (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 5D. Patient death or serious injury associated with the use of physical restraints or bedrails while being cared for in a healthcare setting (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 6. RADIOLOGIC EVENTS 6A. Death or serious injury of a patient or staff associated with the introduction of a metallic object into the MRI area (new)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices 7. POTENTIAL CRIMINAL EVENTS 7A. Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 7B. Abduction of a patient/resident of any age (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 7C. Sexual abuse/assault on a patient or staff member within or on the grounds of a healthcare setting (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities 7D. Death or serious injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of a healthcare setting (updated)Applicable in: hospitals, outpatient/office-based surgery centers, ambulatory practice settings/office-based practices, long-term care/skilled nursing facilities

intraocular pressure limits

10 to 21 mm Hg

triglycerides

100-200 mg/dL triglyceride: 160

Platelet count (thrombocyte count)

150,000-450,000/mm3 transfuse w platelets when levels are <20,000

Total Cholesterol

150-200 DM: should consume <300/d

Normal L/S ratio

2.0 to 2.5 and is significant for appropriate fetal lung development

Phosphorus level

2.5-4.5 food: greens, broccoli, mushrooms, brussels sprouts, bran, wheat cereals, oatmeal, cola, peanut butter cheese-low-in-P CKD should have low P diet ECF to ICF shift d/t hypomg; renal loss d/t hypomg muscle weakness, confusion, HF, RF

HPV

3 doses before age 26

Fluid resuscitation formula

4 mL LR per kg of body weight per TBSA= total fluid requirements for the 1st 24hours. Give 1/2 -1st 8 hrs, 1/4 total in second 8 hrs, 1/4 total in 3rd 8hrs

Neuroleptic Malignant Syndrome

4-14 d after the start of therapy Adverse reaction to antipsychotics with severe "lead pipe" rigidity, sudden high FEVER, tachycardia, HTN, myoglobinemia, and mental status changes

Normal urine pH

4.6 - 8 (average = 6)

face mask

40-60% 6-8L/min (min 5L) remove mask q 1-2 hr wash, dry, apply lotion to skin claustrophobia

Folic acid during pregnancy

400-800 mcg

partial rebreather mask

50-75% at 8-11 L/min adjust o2 flow to keep reservoir bag 2/3 full during inspiration

normal coagulation time

8-15min

nonrebreather mask

80-100% at 12 L/min adjust o2 flow to keep bag 2/3 full

cystic fibrosis

A genetic disorder (autosomal recessive) that is present at birth and affects both the respiratory and digestive systems, and sweat gland sweat Cl analysis test: elevated Na and Cl infection and lung disease lead to increase needs of calories and proteins absence of pancreatic enzymes leads to malabsorption of fats; weight loss

biophysical profile

A test that assess five variables: fetal breathing, fetal movement, fetal tone, amniotic fluid volume, and fetal reaction (nonstress test). scoring 0-2 for each variable; normal is 8-10 use in the late 2nd and 3rd trimester

Renal toxic drugs

Aminoglycosides(gentamycin: peak-45-60minafter;trough: beforenextdose), vancomycin, 1st gen cephalosporins (cef), sulfonamides, antidepressants, antihistamines, antiretrovirals, benzo, chemo agents, diuretics PPI

electric larynx

Battery powered device that is held against the side of the neck to speak

foods high in fiber

Beans, wheat flour whole grain, lentils, peas, lima beans, dates, berries, corns, dried fruits, avo, potatoes, nuts not unpeeled cucumber

a dg workup to a/s immunity

CBC w diff, ig levels in blood, specific antibody production, oxidative burst, nitroblue tetrazolium test, dihydrorhodamine 123 test, total hemolytic completment assay, chemistry panel, toxoplasma IgG

low fat food

Canadian bacon, baked tortilla chips

caput succedaneum vs cephalohematoma

Caput Succedaneum- soft tissue swelling, that can cross suture lines Cephalohematoma- subperiosteal hemorrhag that does NOT cross suture lines.

acne vulgaris

Comedones (whiteheads and blackheads), pustules (pimples) and nodules on face, neck, shoulders, and back; extremely common, especially in adolescents good hygiene and nutrition po tetracycline (sunscreen with spf of 15: watch out; avoid sun exposure) antibacterial meds: azelaic acid, clindamycin, erythromycin isotretinoin: risk of elevated LFTs, dry skin, and fetal damage drying preparations: benoxyl/vit a may cause redness and peeling early in tx and photosensitivity u/v light and surgery monitor for 2nd infection emotional support

10 mo old

Cranial suture lines are closed - no further head extension Gross motor: Crawls well; pulls self to standing if support Fine motor: can bring hands & fingers together pick up food in the mouth Verbal: say 1 or 2 words Uses "mama" and "dada" - may be out of reference. Psychosocial: has individual sense of identity Social/major events : stranger anxiety (begin in 7mo, abrupt mood shift; 8mo: separation anxiety) Sleep: 11 hr/d Prevent: motor vehicle; choking

9 mo old

Creeps from prone position. Sits steadily - elevates self to sitting position (7mo: sits for short periods) Can lean forward but not sideways. Regains balance. Stands holding onto table. May pull up to standing position. Likes toys that go inside each other - pots, pans. Very aware of the changes in voice tone of others.Crude pincer grasp present by 9 months. Able to pick up raisins and other finger foods at 10 months. Responds to parental anger Toys: books with large pic, push pull toys, teddy bears

need a medical bracelet

DM, allergies, epilepsy/seizure, asthma, HTN, stroke, kidney disease, anemia, visual/hearing impairment, AD, chronic illness, transplant, cancer, pacemaker, blood thinners

tocolytic therapy (terbutaline, Mg sulfate)

Drugs used to relax the uterus. also used with fetal distress noted by abnormal fetal heartrate patterns, improves blood flow through placenta to fetus. Slow down labor Mg sulfate: accelerate development of the premature baby's lungs

Curling's ulcer

Duodenal ulcer that develops 8 to 14 days after severe burns on the surface of the body; the first sign is usually vomiting of bright red blood. gastric pH <5

Dawn phenomenon

Early morning glucose elevation produced by the release of growth hormone, which decreases peripheral uptake of glucose resulting in elevated morning glucose levels. not associated with nocturnal hypoglycemia Admin of insulin at a later time in day will coordinate insulin peak with the hormone release.

acute dystonic reaction

Early signs: tightening of jaw, stiff neck, swollen tongue - recog early! Akathisia (inability to sit or stand still, foot tap, pace) tx by diphenhydramine HCl

reactive nonstress test

FHR accelerates to 15/min for at least 15 seconds, occurs 2 or more times during 20 min period

fetal a/s

FHR: 120-160 bpm - predictor of fetal well-being fetal movement: regular pattern of 10 movements in 20 min to 2 hr twice a day; report <3 movements in 1 hr

ZIDOVUDINE

Fever, headache, malaise Nausea, vomiting, diarrhea Dizziness Insomnia Dyspepsia Rash Hepatomegaly GI upset and insomnia resolve after 3-4 weeks PO: peak 30-90 minutes Check with provider before taking aspirin, acetaminophen, or indomethacin Rx; Preg Cat C

epigastric pain can be seen in

GERD, abd aortic aneurysm (AAA) - when unruptured, can give BB, MI, and preeclampsia

new born v/s

HR: 100 (sleep), 120-160 (awake), up to 180 (crying) RR: 30 -60. <20 sec periods of apnea

Acute Epiglottitis

Inflammation of the epiglottitis that may lead to blockage of the resp sys and death if not treated. Often caused by numerous bacteria. Intubation may be required and speed is critical in Tx. IV antibiotics will help reverse this condition in most cases. Common symptoms are high fever and sore throat; drooling The child should be transported to hospital sitting in an upright position to aid in breathing

Class IB

Lidocaine, Mexiletine, Tocainide CNS: slurred speech, confusion, drowsiness, confusion, seizures; hypotension and bradycardia

3 mo old

Localization of sound by turning head. Vocalization Raises head and shoulders from prone position. bring objects to mouth head erect, smiles at mother, laughs Nursing considerations: parental safety counseling for supine position for sleeping.

Intermediate acting insulin

NPH (cloudy), isophane onset: 1-2 hr peak: 4-12hr duration: 16hr timing of SE: early evening can be given after meals; administered once a day SE include lipodystrophies insulin determir (intermediate/long - clear) onset: 3-4 hr peak: 12-24 hr duration: 18-24 hr

Cr

NPO 8 hr list meds client is taking on lab slip adult: 0.7-1.4 kid: 0.3-0.6 infant: 0.3-0.6

CLINDAMYCIN PHOSPHATE

Nausea, vomiting, diarrhea Abdominal pain Vaginitis Rash Jaundice Do not break, crush, or chew capsules treatment of infections caused by Staphylococcus, Streptococcus, and other bacteria

abx safe during pregnancy

PCN, cephalosporins, erythromycin, clindamycin

Good Samaritan Law

Provides limited protection to someone who voluntarily chooses to provide first aid

Transfusion Related Acute Lung Injury (TRALI)

Resp distress and signs of noncardiogenic pulmonary edema (coarse rales ) Within 6 hours of transfusion Caused by donor anti-leukocyte antibodies - use leukocyte-reduced rbcs - diphenhydramine is indicated for a mild allergic reaction and not for TRALI

oxygen toxicity

SOB, pain behind the sternum; early: cough, nasal congestion, sore throat, reduced vital capacity, substernal discomfort n, tinnitus, anxiety, confusion, twitching

TeamSTEPPS

Team Strategies and Tools to Enhance Performance and Patient Safety

warfarin vs heparin

Warfarin: long-term anticoagulation; takes 3-5 d to reach peak levels use Prothrombin time (PT)/INR - 2-3x must be instituted 4-5 d before d/c heparin Heparin: acute anticoagulation use partial thromboplastin time (PTT) - 1.5-2x

Serotonin Syndrome

With any drug that increases 5-HT (e.g., MAO inhibitors, SNRIs, TCAs) hyperthermia, confusion, myoclonus, cardiovascular instability, flushing, diarrhea, seizures. -Treatment: cyproheptadine (5-HT2 receptor antagonist).

Tarasoff Ruling

a California Supreme Court decision that obligates mental health professionals to break confidentiality when their clients pose a clear and imminent danger to another person

Schilling test

a diagnostic test for vitamin B12 deficiency

hepatoxic drugs

allopurinol, amiodarone, abx, atorvastartin, immunosuppressive drugs, antiepileptic (carbamazepine), antipsychotic, birth control, muscle relaxant, NSAID, antimicrobial, substance abuse agent, antineoplastic, anesthetic, hydralazine (vasodilator), abx, PTU, antidysrhthymias, anti-TB, platelet inhibitors

auditory impairment

aminoglycosides -- end in myocin; chemotherapy agents

photosensitive drugs

amiodarone, NSAIDs, tetracycline family, abx (ciprofloxacin family, trimethoprim), antidepressants, antifungals, antihistamine, CCP med, diuretics, cholesterol drugs, chemo drug, hypoglycemics, sulfonamides

Class iii Potassium channel blockers

amiodarone, bretylium, lbutilide fumarate hypotension, bradycardia and AV block; muscle weakness, tremors; photosensitivity and photophobia; liver toxicity monitor QT interval

Homocysteine

an amino acid normally found in the blood and used by the body to build and maintain tissues high: low vit b12 and folic

diskogram

an x-ray of an intervertebral disk after injection of a contrast medium

18 mo

anterior fontanelle closed walks backward, climbs stairs, scribbles, 10 word vocab, understand "no", comprehend up to 200 words, thumb sucking, build 3-4 blocks

latex allergy should avoid food list

apple, banana, avocado, carrot, celery, chestnut, kiwi, melon, papaya, potato, tomato, apricot, pear, cherry, fig, grape, pineapple, plum, nectarine/peach, passion fruit hypersensitivity response: rhinitis, flushing, conjunctivitis, angioedema, laryngeal edema, bronchospasm, anaphylaxis leading to shock and death

take care of a dead body

ask the family first if they would like to assist for some cultures, it is important that a member of the family prepare the body in a ritualistic way

emancipated minor

assumes most adult responsibilities before reaching the age of majority (usually 18). The law doesn't consider emancipated minors to be under the care and control of parents. Instead, they take responsibility for their own care. Although the conditions vary, emancipated minors generally involve minors who are married, living away from their parents and family and responsible for their own support.

hs

at bed time

diarrhea

avoid food contains diary should have banana (potassium)

cataract

avoid getting water in the eye (shower or washing face; no swimming) client should avoid sneeze, cough, or blow the nose (increase IOP) - influenza can increase these above - a flu shots help prevent the flu; no heavy stuff >15 lb client should report comps: infection (yellow/green/ brown discharge), detached retina, increased IOP, bleeding, lens displacement surgery usually performed on an outpatient basis, w discharge usually 2 hr or less after surgery macular degeneration: postop face down

if the previous nurse forget to complete documentation and sign

begin documenting on the line below the last entry, leaving no spaces the missing entry can be added later as a "late entry"

duration of contraction

beginning to end of one contraction

referential delusions

belief that certain gestures, comments, environmental cues, and so forth are directed at oneself

Denver Developmental Screening Test (DDST)

birth to 6 yr: personal-social, fine motor, language, gross motor age adjusted for prematurity by subtracting the # of mo preterm

genus varum

bow legged usually by 2 yr

rotavirus

contact

Uterine Hyperstimulation

contractions longer than 90 seconds or closer than 2 minutes or 5 or more contrax occur in 10 min may c/s fetal distress or uterine rupture stop the oxytocin ( work by increasing Ca inside the muscle cell)

premature ROM and preterm premature ROM

corticosteroids if pregnancy btw 23-34 wk gestation and viable; fetal lung maturity a/s if pregnancy btw 32-36 wk

blood glucose and HbgA1c

fasting: <120 (normal: 60-100) - dx: >126, btw meals ~180 - dx: >200 during a 2hr tolerance test , HbgA1c <6.5% DM BG target: <126

positive signs of pregnancy (definite)

fetal heartbeat: 12 wk by ultrasonic detector; 18-20 wk by auscultation palpation of fetal movement visualization of fetus by u/s

DTap

fever over 103 (39.4) is contra in pertussis

spintling the incision

helps expand the lungs

ART AE

hyperlipidemia, hypertriglyceridemia, insulin resistance

fetal heart rate acceleration

increased of fetal heart rate above baseline by 15 or more beats for 15 or more seconds for 2min or less with return to baseline

dislocation of the prosthesis

increased pain, shortening of the affected leg, leg externally rotated, and a soft popping sound heard when the affected leg is moved

celiac disease

intestinal malabsorption caused by sensitivity to gluten diarrhea failure to thrive do not give pudding (has gluten in it)

HDL

male 35-70 female 35-85 remember 40

non-pharmacologic pain interventions during cancer

mind-body: guided imagery, meditation, diaphragmatic breathing therapeutic touch needs more investigation application of heat/cold is for acute pain transcutaneous electrical stimulator (TENS)

dispose medications

mix them w coffee ground or kitty litter throwing them in the garbage w/o rendering them inedible is not a safe practice - these items can be turned in at a local take-back program or during National Drug take back events

clonidine

non-opioid analgesic, sedative, antihypertensive (alpha adrenergic) AE include hyperglycemia

genital herpes

painful vesicular genital lesions difficulty voiding reoccurs w stress, infection, menses spread via mucous membranes, congenitally; virus can survive on towels for quite some time tx w acyclovir, sitz bath, topical med monitor pap smears regularly - increased risk for cervical cancer precautions about vaginal delivery- make sure does not have an outbreak at pregnancy - can c/s blindness in the newborn

diplegia

paralysis affecting like parts on both sides of the body

paraplegia

paralysis of both legs and the lower part of the body

monoplegia

paralysis of one limb

hemiplegia

paralysis of one side of the body

cycloplegia

paralysis of the ciliary muscle of the eye

erb palsy

paralysis of the upper brachial plexus; loss of movement is the result of a lesion of the C5 and C6 nerve roots; commonly results from birth injury.

pao2

partial pressure of oxygen measuring the amount of oxygen in the blood (80-100 mmHg)

pectus carinatum

pigeon chest

crackles (fine)

pneumonia, HF, bronchitis, asthma, emphysema

clear or loader voice sounds may indicate areas of consolidation

pneumonia, atelectasis, tumor

crackles (coarse)

pneumonita, pul. edema, fibrosis, COPD

pyuria

presence of white cells in the urine, usually indicating infection

child sexual abuse

refer to child protective services and sexual assault nurse examiner (SANE)

detached retina

repair: scleral buckling; gas or air bubble used to apply pressure to retina n/v increase intraocular pressure and could cause damage to the repaired area -- administer antiemetics and sedatives for restlessness the client should avoid sneezing, coughing, and straining at stool (give stool softeners) -- pain meds can c/s constipation no drainage from the eye after the procedure the client should wear the protective eyewear area of detachment should be in the dependent position the eye should not be irrigated no hair-washing for a wk

terminal agitation/ delirium

restlessness, agitation, and calling out hr to d antipsych and benzo are helpful

chorionic villi sampling

sampling of fetal section of placenta early antepartal test to dx fetal karyotype,sickle-cell anemia, PKU, down syndrome, duchenne muscular dystrophy done btw 8-12 wk common SE: mild abd cramping, vaginal spotting, complications: bleeding, spontaneous abortion, ROM Rh-negative mom should receive Rho u/s used to guide; sample of fetal placental tissue full bladder required

levin tube

single-lumen, used for decompression or tube feeding

mitral area

site of apical impulse and point of maximum impulse (PMI); left 5th intercostal space midclavicular line, apex of heart; S1 - created by the closure of the mitral and tricuspid valves (AV); S2 - created by the closure of the a. & pul. valves at aortic area (2nd intercostal space right sternal)

keofeed/dobhoff

soft silicone, used for LT feedings

assess dark skinned client for cyanosis

soles/palms; oral cavity

stertor

sonorous snoring sound, mid-pitched, may transmit throughout airways nasopharyngeal obstruction: nasal or airway secretions, congestion

2-month-old milestones

stepping reflex disappears by 4 wk 1 lbs/mo, 1 in (2.5cm)/mo, head 4cm bigger, 2 cm/mo closing of posterior fontanelle Lifts head off bed when prone. - 1 mo head sags Improve head leg Visually searches to locate sounds. Gross motor: Turn from side to side Fine motor: grasp Verbal: cry for a reason Social: first social smile; recognize maternal voice Major events: trust to be cared for Nursing considerations: Nutrition: breast milk/formula -- use exclusively until 6 mo Sleep: 14 hr/d Parental safety counseling to prevent: Falls. Suffocation. Drowning. SIDs Car seat Supine position for sleeping. Immunizations. Toys: mobiles

Kegel exercises

strengthen muscles of pelvic floor; tighten pelvic muscles for count of 3, then relax for 3 (hold for 6-10 sec); perform lying down; sitting and standing for total of 45; repeat 8-12x; peat in a series of 3 sets avoid flexing or contracting the abd, thigh, or buttock muscles avoid bearing down - keep mouth open

triggering techniques

stroking medial aspect of thigh, pinching area above groin, pulling pubic hair, providing digital anal stimulation (used with upper motor neuron problem)

Air embolism S/S

sudden onset of pallor cyanosis weak, rapid pulse dyspnea cont coughing hemoptysis crackles wheezing chest pain hypotension syncope generalized seizures may occur coma cardiac arrest

vagus (x)

swallowing and speaking: instruct to say "ah"; observe uvula for midline position; rate quality of voice

whiplash

symptoms caused by sudden, uncontrolled extension and flexion of the neck, often in an automobile accident

prenatal vitamins

take w acidic increases the absorption of iron take w food at bedtime decreases n

after PTCA

telemetry monitoring should last for more than just 1 hour after the procedure

moist-to-dry

the exposed skin around the wound is cleaned and dried before putting dressing

labor fourth stage

the first 2 hr after birth

capture failure

the generated pacing stimulus does not initiate myocardial depolarization dislodged lead, low output, lead maturation, and lead or pacer failure (fibrosis, frax, low pacing voltage) pacing spikes are present, but they are not followed by a QRS complex (ventricular non-capture) or by P wave (atrial non-capture)

cane

the tip is positioned 6 in lateral of the foot on the stronger side;cane,good,bad

hypoglossal (xii)

tongue movements

restlessness and stridor

tracheal collapse, laryngeal edema, resp obstruction tracheo tray, HCP, cool mist vaporizer

scopolamine

transdermal patch motion sickness

graft vs host

transfused wbc attack recipient's bone marrow rejection does not occur imme but will become a priority after the dressing is removed in 3-5d

psedoparkinsonism

tremors, rigidity, and shuffling gait - tx by anticholinergics

sengstaken-blakemore

triple lumen, used for bleeding esophageal varices scissors always secured at the bedside; remove tube if observing signs of resp distress or airway obstruction c/s by upward displacement of esophageal balloon

back blows

try on infants who have obstruction

presenting fetal part station

up negative; down positive

lack vit b 12

use of PPI, metformin, antihistamin, Crohnf

15 mo

walks alone( baby begins walking from 12-15 mo), throws objects, holds spoon, names common places and objects

pt

warfarin: 1.3-2.5x 9.5-12 sec onset 36-72hr, peak 5-7d, duration 2-5d after discontinuation antidotes: vit k, whole blood, plasma avoid venous stasis vit k food: green vege, pork, yogurt, cheeses, fish, rice, milk

IV contrast feeling

warmth, flushed face, salty taste, headache, n, want to pee --typically last 15 sec

30 mo

weight x 4 walks on tiptoe, stands on one foot, jump with both feet, has sphincter control for toilet training

blood products

whole blood and prbc refrigerated and stored for a month; platelets stored at room temp for 5d; plama frozen for up to a year warm blood to 98.6 (37) before transfusion

libel

written defamation

rupture of membranes

yellow tinged: bilirubin; green tinged: meconium

exercise stress test

- BB held 24-48 hr - client should be NPO at least 4 hr - a 12 lead ECG should be completed immediately prior to the test, during the test at each stage, and immediately following the test until the ECG and VS return to baseline

BP during pregnancy

- BP remains at the pre-pregnancy level during the 1st trimester - progesterone c/s peripheral vasodilation - slight decrease in BP (esp diastolic) - lowest point reached at 20 wk and then increases to pre-pregnancy levels until term

Discomforts of pregnancy

- N&V/morning sickness -- may occur any time of day - dry crackers on arising may be helpful along with small, frequent meals - constipation, hemorrhoids -- bulk foods, fiber, stool softeners + increase fluid intake - leg cramps -- increase Ca intake, dorsiflex feet, apply local heat - breast tenderness -- well-fitting bra; wear at night; use cool compresses (warm compress would increase circulation and increase discomfort) - backache-- good posture and body mechanics; good shoes, pelvic tilt exercises - heartburn -- antacids: avoid phosphorus; decreased fatty food - dizziness -- support stockings; slow, deliberate movements - vertigo -- vena cava syndrome (supine, uterus compresses the vena cava, impairs circulation) - turn on left side - urinary frequency/urgency -- kegel exercises; monitor for infection syncope, increased vaginal discharge, nasal stuffiness, fatigue, varicose vein, headaches

tuberculosis

- S/S: low-grade fever-last over a period of time, night sweats, persistent cough, blood-tinged sputum, chest pain or SOB, fatigue; dark green or yellow sputum is expected finding (usually may indicate an infection) - acid-fast bacillus, gram + - PPD: >10 mm is positive for recent immigrants and drug users, health care workers, kids <5yr, malnutrition, medical hx (>5 for AIDS, has fibrotic changes on chest xray that consistent w prior TB) --TST (tuberculin skin test): false positive: BCG hx, infection w a different mycobacterial type; false negative: weakened immune system, old TB infection recent live-virus vaccination (should perform on the same day or wait 4-6 wk after the virus vaccines) - interferon-gamma release assays (IGRAs) are preferred for those who have been vaccinated against TB (BCG) - quantiFERON - TB gold -results within 24 hr - isolation 2-4 wk (until 3 negative sputum cultures) - can go home after drug therapy initiated b/c family already exposed - endemic to Asia, Middle East, Africa, Latin America, and Caribbean ethambutol - used first, isoniazid, rifampin, pyrazinamide, streptomycin 2-3 meds administered together for 6-9 mo (take all three daily for the first 8wk; take isoniazid and rifampin for 4-8 mo) AE: liver failure - early s - n, anorexia for hepatitis need to a/s liver dysfunction, including jaundice; peripheral neuritis; hepatic elevation; hepatitis -- ethambutol: optic neuritis, skin rash --rifampin: hepatitis, febrile, n/v --avoid tuna, aged cheese, red wine, yeast extracts: can c/s flushing, hypotension, palpitations, and diaphoresis the purpose of the gastric analysis: (obtained after fast for 8-10 hr) the gastric secretions contain TB that was swallowed during the night cultures of the sputum or gastric contents determine TB the demonstration of TB bacillus is essential for establishing a dx; collect 3 specimen on 3 different days ; the client should be advised to first breathe deeply and then cough up sputum to provide the sample for analysis

CVC

- a gauze sponge impregnated with anti-microbial substance is used to help prevent infection of the site and subsequent infection - the disc should be changed q 3-7 d

status asthmaticus

- a severe, life-threatening asthma attack that is refractory to usual treatment and places the patient at risk for developing respiratory failure. - symptoms persist despite typical tx - sudden: sob, wheezing, cough, chest tightening, prolonged exhalation; severe bronchospasm; increased mucus secretion - thick, clear, or yellow; tachypnea, absence of air movement - impending RF - cromolyn and nedocromnil, inhaled, for LT control with no role in an acute episode

malignant melanoma

- a/s: most lethal of all skin cancers; variegated color (goes from brown to black to grey), circular lesions w irregular borders; can appear anywhere on the body; freq metastasizes - dx: skin lesion biopsy

Capsicum/Cayenne Pepper

- action: analgesia, improves circulation, alleviate nerve pain, PAD, personal self-defense spray - se: gi discomfort, pain/burning in eye, skin, cough, bronchospasm for spray - nx: may decrease effectiveness of antihypertensives, increase risk of cough w ACE inhibitors, potentiate antiplatelet meds, hypertensive crisis w MAOIs, increase theophylline absorption

non-stress test (NST)

- after 28 wk, records fetal movements and FHR - client should eat a healthy snack before the test to make sure the fetus being active - favorable result is 2+ FHR accelerations of 15 bpm lasting 15 sec over 20 min period

infant apnea monitor

- alarm: 20 sec apnea; HR <80sec - RR: 25-55 bpm; spO2 -90%; HR: 80-150 - white lead on the upper R chest, black on upper L chest (2 fb below the nipple at the midaxillary line), green on the abd - if a belf is used: the electrode should be placed on the belt; electrodes are located at the midaxillary line about 1-2 in below the armpit or halfway btw the armpit and the bottom of the rib cage

maltreatment of children

- alert signs in: symptoms of head injury in an infant 2-8 mo; spanking/paddling is usually not a abuse - the majority of confirmed cases involve physical or emotional neglect, not physical abuse. Emotional abuse is the most common form of abuse. - abusive head trauma (shaken baby syndrome) is not an isolated event: depending on the severity of the shaking, the child may present other S/S -- v, poor feeding, listlessness, seizures, changes in ms

ultrasound

- as early as 5 wk to confirm pregnancy - determines position, # of fetuses, structures - full bladder assists clarity of image - may be possible to detect the sex

abd adhesion

- bands of fibrous scar tissue that can form btw abd tissues and organs - when adhesions shorten and tighten, they are pulling the structures that are connected by this scar -- c/s pain - comps: intestinal obstruction and female fertility

testicular self-examination

- best performed once a mo when cremaster muscles are relaxed and testes are pendulous during warm shower - use thumb and index finger - testicular cancer: most common cancer in males btw 15-44 -- risk: undescended testis (cryptorchidism), orchitis, HIV , maternal exposure to exogenous estrogen in pregnancy, white -- painless lump, scrotal swelling, dull ache or feeling of heaviness in the lower abd/perianal area/scrotum, scrotal mass is nontender and firm

thyroidectomy

- check the back of blood seeping under the dressing and polling behind the neck - thyroid storm: O2, BB, D5W, hypothermia blankets

variable decelerations

- decrease usually more than 15 bpm, lasting 15 sec. -returns to baseline in less than 2 min from onset -indicates cord compression; cord prolapse - ominous if: repetitive, prolonged, severe, slow return to baseline

anticonvulsants

- do not cure seizures, control or decrease seizures - depress hyperactive area of brain - benzodiazepines: rapid onset, tx status epilepticus - Na channel blockers: phenytoin(increasev-vitD&folate), fosphenytoin (can be used for status epilepticus; short-term use only), carbamazepine, oxcarbazine -- precaution and contraindications: hypersensitivity, renal or liver dysfunction, cardiac conduction defects, bone marrow depression, pregnancy and lactation, multiple drug interactions (oral contraceptives, warfarin, diazepam and valproic acid) - AE: bone marrow depression, CNS depression (confusion, sleepiness), nystagmus (initial s of toxicity), blurred vision, double vision, ataxia, hypotension, bradycardia (esp fosphenytoin), long-term effect- gingival hyperplasia (phenytoin), GI upset, changes in urine color - monitor serum levels (narrow therapeutic range) - 10-20 & ped: 8-15; administer w food; do not crush/chew extended-release form; administer IV fosphenytoin slowly (<150 phenytoin equivalent units/min), withhold enteral feedings 1 hr before and after phenytoin suspension (protein binding; shake before use); oral hygiene; no grapefruit juice, antacid, fluconazole, folic acid, and warfarin - CCB: pregabalin, ethosuxamide - precautions and contra: HF, elderly, renal impairment, pregnancy and lactation, use of CNS meds - AE: drowsiness, blurred vision, edema, swelling of neck and face - report to HCP immediately - risk for resp arrest, GI upsest - priority action: monitor weight and edema - Na & CCB: lamotrigene, topiramate, zonisamide, valproic acid (tremor, prolonged bleeding time, sedation) - precautions and contra: liver dysfunction, pregnancy and lactation, elderly, multiple drug interactions - AE: dizziness, double vision, blurred vision, headache, n/v, rash - priority actions: monitor liver function tests, do not crush or chew; take w food or milk - neurotransmitter inhibitors: gabapentin, primidone, phenobarbital - precautions and contra: pregnancy and lactation, med interactions (oral contraceptives, warfarin), elderly (may have agitation and confusion) - AE: drowsiness, sedation, ataxia, dizziness, dependence, confusion in elderly, hypersensitivity in children - closely monitor liver function tests and Cr - interactions: cimetidine, anticoagulants - Mg sulfate - precautions and contraindications: cardiac conduction disturbances and renal insufficiency - AE: muscle weakness and fatigue, n, flushing, depressed deep tendon reflexes, cardiac dysrhythmias and heart block, respiratory depression, hypotension - nx action: baseline V/S and O2 saturation - monitor q 5-15 min during loading dose phase, q 30-60 min during maintenance phase; a/s DTR q 2hr; I&O; maintain seizure precautions; Mg toxicity (depressed tendon reflexes, resp < 14/min, UO <30 ml/hr), have Calcium gluconate 1 g IV available; rescue equipment - levitiracetam - precautions & contra: pregnancy and lactation, elderly, renal dysfunction, interactions w meds (phenytoin and tegretol) - AE: drowsiness and muscle weakness - nx actions: not chew or crush

how to don PPE

- gown first - N95 - face shield or goggles - gloves

case management

- hospital readmissions, chronic disease, and med noncompliance are risk factors for ineffective transitions of care and potential discharge needs - clients with a company is not at greatest risk

promote sleep in elderly

- limit nap <20 min - limit alcohol <4 hr before bed - limit caffeine <6 hr before bed - diminish fluid volume 2 hr before bed

schilling test

- radioactive vit b12 is administered to the client - low value excreted in urine indicates pernicious anemia (normal is greater than 10% o dose excreted in 24 hr) - vit B12 (cyancobalamin injection for life)

8 yr

- seek out friends - writing replaces painting

defribrillator

- should be checked q 8 hr - equipment should remain plugged in at all times - do not place the paddles over the electrodes

colostomy care

- when changing the pouch, a/s: color, moistness, edema, tenderness, skin irritation - remove the pouch by pushing the skin away from the barrier -- prevent peristomal skin trauma - clean around stoma with water and soap, dry well, apply skin barrier - check stoma q 4hr: inspect, palpate, listen, smell; edematous for 6-8 wk; superficial bleeding from the stoma during routine cleaning is also normal -- limp, loose, floppy: poor blood flow, lack of blood flow -- excessive or prolonged bleeding: portal hypertension, use of blood thinners, chemo; bleeding from lumen of the stoma: often associated w underlying disease - empty the pouch or swap pouches when 1/3 full; empty >=6 x/d - if there is leakage around the seal, remove the wafer (skin barrier) and clean the contents from the skin imme - diet: immediately postop: low-residue for several wk for healing, add foods as tolerated, avoid gas-forming foods -- eat yogurt, spinach, parsley, buttermilk to reduce odor; avoid odor-forming foods: asparagus, cabbage, onions, fish, alcohol, broccoli, dried beans, eggs, garlic, and peas (产气/味食物） - do not use straw when drinking - can increase intestinal gas, c/s the pouch to expand and leak - worry about metabolic acidosis: loss of bicarb from the GI tract (diarrhea) - hyperkalemia, kussmaul resp, tachy - sexual function will not need meds to help - usually begin 5-7 d postop; and change appliance q 3-7 d to prevent leakage - if no output for 6 hr, massage around the stoma stimulate peristalsis/take warm bath/drink warm water relax abd muscles ; use a larger opening pouch - foods high in potassium/solution high in Na would be recommended if the client has dehydration d/t reabsorption of fluid and electro in the large intestine - if distal loop of transverse is irrigated; mucus (varies in consistency from clear egg white to opaque, thick, and sticky - normal) may be seen; ileostomies and ascending colostomies are not irrigated - drainage of stool occurs until peristalsis returns to the colon (up to a few d) - no voluntary control of gas or stool expelled through the stoma; no sensation in the stoma (no sensory n) - irrigation: use special sleeve or cone, sit on toilet, use 500-1000 mL tepid water for irrigation solution, insert catheter tip 8 cm (3-4 in), hang irrigation solution about shoulder height, use all of irrigation solution, return flow takes 15-45 min, stop if cramping occurs and restart at lower pace/stop if fluid flows out forcefully around cone or catheter and readjust catheter - - not necessary more than 1 a day and sometimes every 2 or 3 d -- some clients w sigmoid colostomies are able to go w/o a collection bag by performing routine irrigation

pulse quality

-0: absent pulse, not palpable - +1: difficult to palpate, weal, or thready - +2: normal - +3: full to increase - +4: bounding

NaHCO3

-only give if pH < 7

serum albumin

3.5-5.5 g/dL

tracheostomy collar on T-piece

30-100% at 8-10 L/min a/s for fine mist empty condensation from tubing keep water container full

CT

3d a/s; dye

lactate dehydrogenase (LDH) test

90-176 units/L

chloride level

96-107

mummy restraint

A blanket wrapped in a special way to enclose a child's body to prevent movement during a procedure.

DTP

Diphtheria, tetanus, pertussis if child had seizure within 3 days of DTP, evaluate whether risks of giving immunization outweigh the benefits

Glascow Coma Scale

EYE OPENING 4 - spontaneous 3 - open to speech 2 - open to pain 1 - no response VERBAL 5 - alert and oriented 4 - disoriented conversation 3 - inappropriate words 2 - nonsensical sounds 1 - no response MOTOR 6 - spontaneous 5 - localizes pain 4 - withdraws to pain 3 - decorticate posturing 2 - decerebrate posturing 1 - no movement unequal and dilated pupils - brainstem damage

11 mo old

Erect standing posture w support Walks holding furniture. Sequential play. Imitates definite speech sounds. Hold the cup alone. Nursing considerations: parental counseling regarding: Limit setting for beginning tantrums. Safety considerations.

why ac/s MI before open frax and chest contusion?

MI: time is muscle! Can c/s sudden death

Craniotomy Post-Op care

Monitor VS and neuro assessments, cardiac rhythm, perform passive ROM, turn, cough and deep breathe every 2 hours, use cold for edema, prevent DVT with stocking, Supratentorial Surgery (HOB 30 degrees), Intratentorial Surgery (Flat on either side for 2 days), avoid hip or neck flexion, wound suction drainage assessment.

Chronic Kidney Disease (CKD) stages

Normal (GFR >90 mL/min) Mild (GFR 60-89 mL/min) Moderate (GFR 30-59 mL/min) Severe (GFR 15-29 mL/min) End stage (GFR less than 15) Stage 1: diminished kidney reserve (polyuria and nocturia); kidney function is reduced, but the healthier kidney is able to compensate. stage 2: oliguria, swelling stage 5: no longer function older adult clients and CKD clients are most susceptible to CNS AE (confusion, dizziness, memory loss) of the med kidney disease: symptoms (subjective): fatigue, weakness, sob, chest pain, n, confusion signs: (objective) reduced UO, altered electrolytes, lower extremity and periorbital edema, granular casts in the UA, decreased or absent bowel sounds, disorientation, seizures, coma

COPD home care needs

O2, nebulizer for placing meds, medical alert bracelet no need IS, which is used to increase inspirator lung volume after surgery (sustained maximal inspiration used to prevent or to tx atelectasis and increase inspired air) and pneumonia

Erythromycin

PO: give 1 hour before or 2 hours after meals PO: give with full glass of water; avoid citrus juice Can be used in patients with compromised renal function

Class ii (BB)

PROPRANOLOL, ESMOLOL, ACEBUTOLOL bradycardia and hypotension, bronchospasm, increase in HF, fatigue and sleep disturbances

mitten restraint

Restraint client's hand. Prevents clients from dislodging invasive equipment, removing dressings, or scratching, yet allows greater movement than a wrist restraint

Heberden's nodes

Swelling of distal interphalangeal finger joints, characteristic of osteoarthritis maintaining a functional position of the joints to maintain mobility of the joints only use a small pillow under the head or neck; do not use large pillows under the knees; to reduce back discomfort, elevate the legs 8-10 in application of heat 2/3 d - promotes circulation; helpful for pain and stiffness r/t inactivity

CLARITHROMYCIN

Taste abnormalities Ventricular dysrhythmias Vaginitis treatment of respiratory, skin, and sinus infections

lyme disease

Tick-borne disease caused by the spirochete Borrelia burgdorferi. - it takes 4-6 wk for the client's immune system to develop the antibodies - check lab at that time - positive EIA and confirmed by western blot or IFA (also a dx test for AIDS)

Class iv CCB

Verapamil (negative inotrope) Diltiazem bradycardia, hypotension; dizziness and orthostatic hypotension; HF report signs of HF

wheezes (sibilant)

acute asthma (if wheeze is absent - indicates significantly airways constriction impeding exchange of O2 and CO2) , chronic emphysema

s4

atrial contraction pulmonic stenosis, htn, cad, aortic stenosis, acute mi

maniac phase activities

avoid competitive games b/c they increase agitation should be assigned to a private room away from activity

client care assignments

based on the knowledge and abilities of staff members, not based on appearances charge nurse is the best person to a/s clients' needs and make assignments cannot change according to HCP's requests VIP are tx the same as other clients

food low in potassium

berries, watermelon, cauliflower, carrots, green beans, apples, cabbage, white bread, pasta, noodles, grits, wheat cereals, pineapple, grapefruit, cranberries, white rice, eggs, chicken, cheese

hyperglycemia hyperosmolar nonketotic syndrome

bg > 800. occurs in >50 yr. no ketosis or acidosis. K+ when UO is fine thiazides and dialysis can cause

cisplatin

can be given if BUN<25

extravasation

certain medications (tissue-damaging) leak into adjoining tissue - report immediately to HCP similar s/s as infiltration -monitor iv q 1 hr

labor first stage phase one (latent)

cervix dilated 0-3 cm contractions: 10-30 s, 5 - 30 min apart, mild to moderate last for 6 hr in 1st birth, 4.5 in after

Parental nutrition

check bg q 6hr

prep bowl dx testing

clear liquid or low-residue for 2 d; NPO after midnight

cvp and swan

cvp: right a swan: left v, pulmonary artery pressure, CO

pain tolerance

decrease in elderly b/c diminished adaptive capacity

hct

determines % of rbc per fluid volume of blood male: 42-52% female: 35-47% kid (3-12 yr): 35-45%

hemoglobin

determines the amount of hg/100 mL of blood adult: 13-18 g/dL female: 12-16 kid (3-12 yr): 11-12.5 - if a client is taking epoetin alfa for CKD and receiving dialysis, >12 increases the risk for MI and stroke; dosage should be reduced or interrupted once exceed 10-12

bulge test

differentiates soft tissue swelling from accumulation of excess fluid behind the patella client lie down and extend the legs

dystocia

difficult labor d/t fetal or pelvic size and disproportion.

mydriasis

dilation of the pupil

ballottement

during the 4th to 5th mo, the fetus should rise and then rebound to the original position when the nurse taps sharply on the abd

Tarasoff Act

duty to warn of threatened suicide or harm to others

milrinone

dysrhythmias, thrombocytopenia, jaundice, hypokalemia, hypomagnesemia positive inotropic; smooth muscle relaxant to tx HF

ergocalciferl (vit D2)

early signs of od: metallic taste in mouth

s3

early ventricular filling decreased cardiac contractility, myocardial failure, HF, volume overload - a new murmur may indicate papillary muscle rupture w severe mitral regurgitation

hypercalcemia

early: muscle weakness, headache, irritability, depression, bone pain, a/n/v/c, increased urination, sedative effect on central and peripheral nervous systems late: bradycardia or arrhythmias, heart block, hallucinations, seizures, coma

feeling of fullness and tightness around the dressing difficulty swallowing gagging

edema or hematoma compression of the trachea elevate hob to high-fowler

patient self-determination act

ensure a client's right in advance directive

Barrette esophagus

esophageal metaplasia, can be reversible

vagotomy and pyloroplasty or gastroenterostomy

establishes gastric drainage, involves severing of vagus nerves

Guthrie test

evaluates PKU

Tracheoesophageal fistula (TEF)

excessive cuff pressure causes erosion of the posterior wall of the trachea. A hole is created between the trachea and the anterior esophagus. the client at highest risk also has a nasogastric tube present

FLACC scale for pain (though observation)

face, legs, activity cry, and consolability 2-7 yr

glucose tolerance test

fasting: 70-99 1h: 190 2h: 140 3h: 125

structural scoliosis

fixed; curvature shows both on standing and on bending forward; note rib hump with forward flexion; when person is standing, note unequal shoulder elevation, unequal scapulae, obvious curvature, and unequal hip level. greatest risk are females 10 years of age through adolescence at the peak of growth spurt

safety in psych bathroom

fixtures such as towel bars, shower bars, and safety rails should be breakaway from the weight of client attempting self-harm; shower nozzels should be breakaway or recessed; and toilets should be low flush pressure

Valsalva maneuver

forcible exhalation against a closed glottis, resulting in increased intrathoracic pressure you breathe out strongly through your mouth while holding your nose tightly closed. This creates a forceful strain that can trigger your heart to react and go back into normal rhythm

asepsis

free from disease-causing microorganisms is not sterile nurse must prepare the sterile field before cleaning wound IV dressing: old dressing should be removed in the direction toward the catheter insertion site to prevent accidental displacement of the catheter medical asepsis is diff from surgical one (e.g, use povidone-iodine prior circumcision)

pectus excavatum

funnel chest

omission of documentation

goal is to obtain the missing data

conductive hearing loss

hearing impairment caused by interference with sound or vibratory energy in the external canal, middle ear, or ossicles

sensorineural hearing loss

hearing loss caused by damage to the cochlea's receptor cells or to the auditory nerves; also called nerve deafness

palpate uterus to a/s contraction

help client into side-lying position and drape with sheet true labor contrations begin in back and radiate to abd

lead poisoning

high risk: 6-72mo, toys made before 1975

complete breech

hips and knees flexed. feet, legs, and buttocks will be born first

frank breech

hips flexed, knees extended

function of NG tube

hissing sound indicates that air is freely exiting the airway; purpose is to provide cont steady suction w/o pulling gastric mucosa

after administering atropine sulfate eyedrops

hold pressure on the inner canthus decreases the amount of med absorbed systemically

the nurse finds a tach tub is dislodged

immediately replace the tube

Adrenoleukodystrophy (ALD)

impaired addition of CoA to long chain FA; FA accumulates damaging adrenal gland & white matter give Lorenzo's oil tx

choking, freq swallowing ; >50 mL bloody drainage in 24 hr

incisional bleeding, hemorrhage teach client to support head when turning a/s the client's dressing and palpate the back of the neck

chloasma

increased pigmentation on face

apical pulse

it is normal that difficult to palpate in elderly

hemolytic disease of the newborn

jaundice appears first on the head and progress to toe during the first 24 hr during exchange transfusions, the infant's blood is removed in small amounts (5-10 at a time) and replaced w compatible blood (Rh negative blood - should repeat test in 28 wk)

MI S/S in femal

jaw/neck pain, fatigue, and n/v sob, sharp chest pain, abd pain

cord care

keep open to air until cord falls off, usually 1-2wk. no tub baths until healed. once cord falls off, remaining stump needs another 3-5 d of care. observe color change from yellow - brown - black. clean with mild soap and warm water two arteries - deoxygenated blood, one vein - oxygenated blood

renal scan

kidneys radioactive isotope injected IV radioactivity measured by radioactivity counter fluids forced before procedure

esr

male < 50 yr: < 15 mm/h male > 50 yr: <20 mm/h female < 50yr: <25 mm/h female >50 yr: < 30 mm/h

RBC count (erythrocytes)

male adult: 4.6-6.2 million/mm3 (x 10^12/L) female adult: 4.2-5.4 million/mm3 (x 10^12/L) kid: 3.2 - 5.2 mi/mm3 (x 10^12/L)

quickening

maternal perception of fetal movement occurring btw 16-20 wk gestation no fetal movement by 20wk requires HCP intervention

vasopressin

monitor for water intoxication; may have diarrhea

crown-rump length (CRL)

most accurate sonographic measurement for determining gestational age; made in the first trimester (up to 13+6 wk)

Poststreptococcal glomerulonephritis (PSGN)

most common form of acute glomerulonephritis in school age children 8-14d after GAS infection (21-28d after impetigo) hematuria, proteinuria, HTN, periorbital edema/fluid retention (edema on face, lower extremeties, and abd) low serum complement present and transient normalizes within 6-8wks dx: detect prior strep infection w/ ASO titer or ADB titer after respiratory/skin infection (e.g., impetigo) biopsy only if significant impairment: mesangial cell proliferation, increased mesangial matrix supportive care, good prognosis risk not reduced with abx care of GAS infection

Glossopharyngeal (IX)

motor: pharyngeal movement and swallowing sensory: taste on posterior 1/3 of tongue (bitter and sour)

problems in toddler

negativism: say no to parents; temple tantrum expecting toddlers to obey verbal commands consistently is unrealistic. Therefore, it is better to childproof the home and take measures to prevent injury.

muscle flaccidity

neurological condition characterized by weakness or paralysis and reduced muscle tone most indicative of serious, irreversible brain impairment

leg message

not for pt risk for DVT can dislodge a thrombus and cause it to become pul. embolus

lipid-lowering med

oat bran contains a significant amount of soluble fiber, can reduce the effectiveness

infection reactions

occur within a few hr or d mild: low grade fever, local pain, irritability (fussiness) more severe: constant screaming, convulsions, high fever, loss of consciousness

engorgement

occurs on the 3rd - 5th postpartum day both breast: hard, shiny and painful, but not red nurse freq (q 30min to 3hr) completely empty breasts w feeding use warm shower or compresses alternate which breast is offered first mild analgesics (otc ibuprofen) 1 hr before breastfed ice pack 20 min x4/d for bottle-fed clients

sq emphysema

occurs with the rupture of alveoli and is seen w or before the development of a pneumothorax

chaplain

often involved w ethical dilemmas and have specialized training to deal w difficult, emotional situations regarding life and death

breast self-examination

perform 1 wk after onset of menstrual period or on designated day (1st of month) examine w arms at sides, w arms above head, w hands on hips use finger pads of 3 middle fingers

herpes simplex type 1

pruritic vesicular groupings on nose, lips, and oral mucous membranes chronically recurrent Spread by direct contact Administer antivirals (acyclovir, famciclovir, and valacyclovir) bland, soft foods mouth rinses with tetracycline- based preparations

toddler toys

push-pull toys, stuffed animals, dolls, low rocking horse no small pieces fine motor: wood puzzles (4-12 pieces), blocks, objects to sort, cars, pounding board imagination: crayons, large paintbrushes, and finger paints, kitchen sets, dolls, cloth pic books language: parents reading pit books gross motor: balls, drums, low rocking horses toddler use 2-3 word phrases any toy that can fit through a cardboard toilet tissue roll is too small

Class IA

quinidine procainamide disopyramide block the sodium channels delay repolarization increase action potential duration AE: hypotension, HF - toxic AE Nx: monitor for widening of the PR, QRS, or QT intervals

delayed allergic reaction

rash (usually begin on the trunk), hives, swollen joints topical antihistamines, corticosteroids, make sure client not breaking or abrating their skin if they are itching

vagotomy and antrectomy

removal of gastrin-secreting portion of the stomach and severing of vagus nerves

priority decision

review the client's primary s/s, acuity level, risk for being in a life-threatening situation

PIH Pregnancy Induced Hypertension

risk factors: large fetus, older than 35 yr, younger than 17 yr, primigravida, multiple fetuses, poor nutrition, hx of diabetes, renal or vascular disease, family hx of HTN

5 yr

runs well jumps rope dresses w/o help 2100 word vocab tolerates increasing periods of separation from parents beginnings of cooperative play ties shoes

normal skin lesions d/t aging

seborrheic keratosis, cherry angiomas, age spots, skin tags

paracentesis

semi fowler's or upright on edge of bed. Empty bladder. post VS--report elevated temp. watch for hypovolemia, abd pain, and hematuria

shingles (herpes zoster)

shingrix, age >50, 2 doses 2-6 mo apart can return to work to care for non-high risk pt if lesions are crusted and covered

slander

spoken defamation

syphilis

stage 1 - painless chancre fades after 6 wk stage 2 - copper-colored rash on palms and soles stage 3 - cardiac and CNS dysfunc spread via mucous membranes, skin, congenitally tx w IM PCN G

levels of pressure injury

stage 1: nonblanchable erythema 2: blister or a wound pink 3:visible sq fat unstageable (overlying slough and eschar) True depth cannot be determined until the slough or eschar is removed (can either 3/4) Eschar that is "stable" （adherent, dry, intact w/o redness) should not be soften or removed 4: bone, tendon, muscle

transactional model

the leader focuses on the institution's goal and tries to motivate staff w extrinsic or intrinsic rewards

Splenoportogram (splenic portal venography)

to determine adequacy of portal blood flow

external rotation deformity

to prevent this... use a wedge/trochanter roll to keep a proper alignment

valsava and crede maneuvers

used with lower motor neuron problem

ECG paper

- 1 large sq = 0.2 s - 5 large sq = 1 s - 30 large sq = 6 s - 1min = 10*6 - sometimes a 10-sec strip is requested (50 sq) - 10s * 6 = 1 min

dumping syndrome

- 10-30 min after eating; client should lie down after meals - dizziness, weakness; n/v; blushing; diaphoresis, vertigo, pallor, tachycardia (early: 5-30min); epigastric fullness; late: abd cramping and pain (in 1 hr); audible bowel sound, bloating; blushing

acceleration

- 15 bpm rise above baseline f/u by a return - indicates fetal well-being - c/s by fetal movement or contraction

vatus lateralis muscle

- IM site for baby; 22-25 gauge, 5/8-1 in needle - if aspiration is performed, the needle should be withdrawn and a new site selected if blood is aspirated - DTap, DT, Td, Hib, hep A/B, influenza, PCV7 - no dorsogluteal site - high risk for sciatic n. injury

bronchoscopy

- allow visualization of larynx, trachea, and mainstem bronchi - possible to obtain tissue biopsy, apply medication, aspirate secretions for lab exam, aspirate a mucus plug causing airway obstruction, or remove aspirated foreign objects - explain procedure, maintain npo for 6 hr before test, inspect mouth for infection, administer premedication -- diazepam, midazolam, meperidine, atropine - remove dentures - sit or lie on side, remain npo until gag reflex

terazosin, tamsulosin

- alpha 1 blocker - tx for prostatic hyperplasia - decrease urinary urgency, hesitancy and nocturia - se: headache, dizziness, orthostatic hypotension, nasal congestion - nx: avoid alcohol, CNS depressants, hot showers; administer at bedtime, effects may take up to 4 wks

head injuries

- avoid use of sedatives, sleeping pills, alcohol - no strenuous activity for 2d

pulmonary embolism

-s/s: hemoptysis, fever, chest and/or back pain, coughing, dyspnea, cyanosis, tachy - dx: CTA (spiral CT scan), V/Q scan, chest xray, abg, d-dimer, troponin and BNP

ARBs

-sartan Side effects - angiodemia, orthostatic hypotension, hyperkalemia (use Na polystyrene sulfonate enemas to tx) - dilation of blood vessels - initially low dose then increase - can be taken w or w/o food - contra in pregnancy more renal friendly

Alpha 1 Adrenergic Blockers

-zosin

3 generations of antipsychotics

1 st: chlorpromazine, fluphenazine, perphenazine, haloperidol 2nd: clozapine, lurasidone, olanzapine, quetiapine, risperidone, ziprasidone 3rd: aripiprazole, brexpiprazole, cariprazine

lochia

1-3: rubra (bloody), 4-9: serosa (pink/brown), 10+: alba (yellow white)

food and levels of dysphagia

1: pureed food diet (smooth, no lumps or varying consistencies) 2: meats are ground and gravies or sauces used to soften food (mechanical altered food diet) 3: intermediate option before returning to a general diet (no dry, hard, crunchy, sticky food) 4. general diet (dry, hard, crunchy, sticky)

Refeeding syndrome

24-48hrs of therapy d/t fluid shifts: bradypnea, lethargy, confusion, weakness, paresthesias, seizures metabolic disturbances and decreased phosphate, k, mg occurs as a result of reinstitution of nutrition to clients who are starve, severely malnourished, or metabolically stressed d/t severe illness

late effects of chemotherapy and radiation tx

2nd malignancies (leukemia, angiosarcoma - inner lining of blood vessels and lymph vessels, and skin cancer) LT chemo effects: cardiac toxicity, cataracts, arthralgias, endocrine alterations, renal insufficiency, hepatitis, osteoporosis, neuro dysfunc ileus is not an effect

6 mo old

340 g/doubled birth weight, 1 in (2.5cm)/mo, 1 head cm/mo (weight gain 4oz per wk in 2nd 6 mo) Closed posterior fontanel Good head control able to lift head and chest off floor when prone Teething. Gross motor: Rolls from back to abdomen. Fine motor: Manipulates small objects. Begin pinch verbal : babbling Holds arms out to be picked up. Social: engage social smiling & movement Major events: recognizing primary care providers Nursing considerations: Weekly introduction of pureed solid food in cup Sleep: 15 hr /d, 9 hr/night Immunizations (DTaP, Hib). Parental safety counseling regarding: Aspiration. Poisoning. Suffocation. Falls. Burns. Motor vehicle Toys: large toys with bright colors, movable parts, noise makers

pku

A human metabolic disease caused by a mutation in a gene coding for a phenylalanine processing enzyme (phenylalanine hydroxylase), which leads to accumulation of phenylalanine and mental retardation if not treated; inherited as an autosomal recessive phenotype. Lofenalac formula - low in phenylalanine but contains minerals and vitamins - begin in the 2 mo - reduce intellectual disability in most cases low protein diet - no meat, eggs, diary, Nutra sweet

probiotic therapy

A method of treating infections by introducing benign bacteria in numbers large enough to overwhelm harmful bacteria in the body also benefit lactose intolerance

Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease)

A/S: - progressive, degenerative disease of motor neurons - usually begins in the upper extremities - progressive muscle weakness - atrophy with fasciculations - muscle wasting - dysphagia - resp insufficiency - airway!

bioterrorism agents

A: bacteria or viruses that pose a high level of risk to the public (anthrax [bacillus anthracis], botulism [clostridium botulinum toxin], smallpox [variola major]0 B: require CDC dx and disease surveillance (brucellosis [brucella], food safety threats [ salmonella, E.coli, hep A], water safety threats] C: TB, influenza, rabies virus, resp coronaviruses

thrombolytic contraindications

Absolute Contraindications Recent intracranial hemorrhage (ICH) Structural cerebral vascular lesion Intracranial neoplasm Ischemic stroke within three months Possible aortic dissection Active bleeding or bleeding diathesis (excluding menses) Significant head injury or facial trauma within three months Recent Intracranial or spinal surgery Severe uncontrolled hypertension For streptokinase, previous treatment within six months[17] Relative Contraindications History of severe and poorly controlled hypertension Severe hypertension at presentation (systolic blood pressure >180 mmHg or diastolic blood pressure >110mmHg) Prolonged (>10 minutes) cardiopulmonary resuscitation (CPR) or major surgery within three weeks. History of ischemic stroke. Dementia Internal bleeding within 2 to 4 weeks Noncompressible vascular punctures Pregnancy Active peptic ulcer Current therapy of anticoagulant associated with an elevated international normalized ratio (INR) higher than 1.7 or a prothrombin time (PT) longer than 15 seconds[17]

AZITHROMYCIN

Angioedema Anemia Photosensitivity Hearing loss PO: don't take with antacids; can take with or without food superinfection (sore throat, fever, fatigue) If treated for nongonococcal urethritis or cervicitis, sexual partners also need treatment Increases effects of oral anticoagulants Rx; Preg Cat B treatment of mild to moderate infections of the respiratory tract and skin and of nongonococcal urethritis, cervicitis, acute pharyngitis/tonsillitis, and community-acquired pneumonia

Parkinsonian crisis

Caused by emotional trauma/sudden withdrawal of meds Sudden severe exacerbation of symptoms: tremor, rigidity, bradykinesthia With: anxiety, sweating, tachycardia, tachypnea Intervention: Medicate and place client in quiet room with low lights

3 yr

Copies A Circle; Pedals A Tricycle; 3 Cubes; 3 Numbers; 3 Colors; Plays In a Group, f/u 3 step command walks downstairs w/o assistance undresses w/o help less negative than the toddler, decrease tantrums 900 word vocab knows their first and last names may invent an imaginary friend

CEPHALEXIN

Diarrhea Anaphylaxis Nausea Rash Headache Nephrotoxicity Dyspnea Thrombocytopenia Elevated liver function tests Peak 1 hour, duration usually 6 hours, but may be up to 12 hours with decreased renal function Take for 10-14 days to prevent superinfection encourage food that maintain normal intestinal flora (e.g., yogurt, acidophilus milk) Possible cross allergy to penicillin May cause false positive of urine glucose Rx; Preg Cat B treatment of upper and lower respiratory tract, urinary tract, skin, bone, and otitis media infections

4 mo old

Erikson's stage: trust vs mistrust. Begins drooling. disappear of extrusion reflex (吐舌头) Rolls from back to side. Tonic neck, moro reflex absent. Able to oppose thumb. Shows pleasure in social contact. Balances head when sitting. Sits if propped or assisted. Begins eye-hand coordination. Inspects hands. Pulls clothes and blanket over head. Grasps object with both hands. Puts everything into mouth. Laughs. Shows excitement. Enjoys attention. Vocalization of consonants. Age-appropriate toys: rattles, cradle gym. Problem area: injury. Introduce only one food at a time for each two week period - first is rice cereal (fed by spoon), banana. - vegetables/fruits (non-citrus) - potatoes - after 6mo: meats (10-12 mo) - eggs - orange juice Least allergenic foods given 1st 1/2 of first year; more allergenic foods offered last 1/2 of first year should not have no-spill cup toys: brightly colored toys to grasp

Continuous Passive Motion (CPM)

Exercises that are performed by motorized exercise machinery that keeps a joint in constant slow motion - Place the CPM machine against the footboard or a heavy object - plug in the CPM machine - carefully remove the knee immobilizer - place the affected leg in the CPM machine so that the middle of the knee rests where the CPM machine bends - place the affected leg's foot against the footpad - attach the affected leg to the CPM machine by securing the machine's straps around the thigh, shin, and foot

LEVOFLOXACIN

Headache, nausea, vomiting, diarrhea Stomach pain Dizziness Vaginal itching and/or discharge Tendon rupture or tendinitis Insomnia Photosensitivity, rash Hallucination, paranoia Hepatotoxicity Suicidal thoughts Encephalopathy Chest pain, palpitations Infused injection over 60-90 minutes, once every 24 hours Monitor blood sugar; may cause hypoglycemia or hyperglycemia Rx; Preg Cat C treatment of infections such as acute sinusitis, acute chronic bronchitis, pneumonia, and anthrax and of infections of the urinary tract, kidney, prostate, and skin

HIPAA

Health Information Portability and Accountability Act protect health info; applies to organizations that are subject to this privacy rule -- known as "covered entities" privacy right: ensure clients understand and control how their health info is used

Vancomycin

Nephrotoxicity Headache Ototoxicity Dyspnea PO: poor absorption IV: peak 5 minutes, duration 12-24 hours Give at least 60 minutes (IV); do not infuse with other drugs Give antihistamine if "red man syndrome": decreased blood pressure, flushing of face and neck Contact provider if signs of superinfection (sore throat, fever, fatigue) Check peak: 1 hour after infusion Check trough before next dose Encourage fluids to 2 L/day Rx; Preg Cat C treatment of C. difficile, resistant staph infections, colitis, and staph enterocolitis; prophylaxis for endocarditis and dental procedures

nalbuphine

Opioid: mixed agonist−antagonist analgesic that activates kappa and weakly blocks mu receptors. Effective analgesic, but with lower abuse liability and less respiratory depressant effects than most strong opioid analgesics Cross the placenta, which can influence the fetal HR and cause resp depression

Opisthotonic positioning

Opisthotonus Arching of the back Brain injury, cerebral palsy, tetanus

MI nx

PQRST precipitate events, quality of pain, region and radiation of pain, severity of pain, timing and duration indigestion, n, general anxiety, diaphoretic (sweating in nx is never common) (skin may be pale, cool, and moise) could indicate a MI -- look at the Q -- does the pt comes the ED? 12 lead ECG (initial findings may be normal), cardiac markers, v/s, lab (BMP, CBC) , screen for possible fibrinolytic therapy, possible chest xray

postherpetic neuralgia

Pain that lasts longer than a month after a shingles infection and is caused by damage to the nerve; the pain may last for months or years.

phases of crisis

Phase 1: Person confronted by conflict that threatens self-concept responds with increased anxiety. Phase 2: If the usual defensive response fails and if threat persists, then anxiety escalates. Trial-and-error begins. (coping mechanisms) Phase 3: If the trial-and-error attempts fail, then anxiety can escalate to severe and panic levels. sympathetic nervous system is profoundly activated Phase 4: If the problem is not solved and new coping skills are ineffective, then anxiety can overwhelm the person and lead to serious illness; assess for suicidal thoughts. in a crisis, it is more important to determine coping methods that were effective in the past autocratic/directive leadership during a crisis

metabolic alkalosis

Primary Cause: Retention of base or removal of acid from body fluids; Contributing Causes: Excessive gastric drainage, Vomiting, Potassium depletion (diuretic therapy), Burns, Excessive Sodium Bicarb admin seizures, n/v/a, confusion, dizziness, irritability, compensatory hypoventilation, low Ca (tremors, muscle cramps, tingling), low K (dysrhythmias)

stimulants (uppers, pep pills, speed, crystal meth) cocaine amphetamine benzedrine dexedrine

S of abuse: cocaine - nasal septum perforation, rhinorrhea and facial pain (use by inhalation), weight loss, impaired judgement, fatigue, disturbed sleep cycle and patterns, irritability, restlessness, tachy, increased BP, tachypnea, anxiety, seizure, coma, hyperpyrexia, euphoria, n/v, rapid speech, hallucinations withdrawal: apathy, disorientation, HTN, n/v, dysphoria, agitation, SI, fatigue, vivid/unpleasant dreams, extreme depression, insomnia or hypersomnia, and increased appetite involve in physical activity and social activities may reduce withdrawal s/s and associated cravings cravings are intense during the 1st to d of drug cessation and may cont for weeks meds decrease the cravings: lorcaserin, disulfiram, modafinil, buprenorphine give activated charcoal, use gastric lavage

Cannabis Derivatives; marijunan; hashish

S of abuse: fatigue, paranoia, psychosis, euphoria, relaxed inhibitions, increased appetite, disoriented behavior S of withdrawal: insomnia, hyperactivity, decreased appetite Nx: most effects disappear 5-8 hr

narcotics; morphine; heroin (horse, junk, smack); codeine; dilaudid; methadone - for detox and maintenance

S of abuse: marked resp depression, hyperpyrexia, seizures, v dysrhythmias, euphoria then anxiety, sadness, insomnia, sexual difference Od - severe resp depression, pinpoint pupils, coma; stupor leading to coma S of withdrawal: watery eyes, runny nose, loss of appetite, irritability, tremors, panic, cramps, n, chills and sweating elevated BP, hallucinations/delusions; decreased DTR Ns: may give bolus of glucose; have lidocaine and defibrillator available; tx fever; naloxone

hallucinogens; LSD(acid), PCP, mescaline

S of abuse: nystagmus, marked confusion, hyperactivity, incoherence, hallucinations, distorted body image, delirium, mania, self-injury, HTN, hyperthermia, flashbacks, convulsions, coma S of withdrawal: None Nx: control seizures, reduce sensory stimuli, small dose of diazepam

Barbiturates (downers, barbs, pink ladies, rainbows, yellow jackets); phenobarbital, nembutal

S of abuse: resp depression, decreased BP/pulse, coma, ataxia, seizures, increasing nystagmus, poor muscle coordination, decreased mental alertness S or withdrawal: anxiety, insomnia, tremors, delirium, convulsions Nx: give NaHCO3 to promote secretion; give activated charcoal, use gastric lavage

Viral laryngotracheobroncitis (croup)

Westley score (stridor, retractions, air entry, cyanosis, loc)- each score from 0-2 mild (2): child is alert, with a barking cough, stridor when crying or agitated, and no evidence of cyanosis tx: dexamethasone moderate (3-5)/severe (6-11): likely still alert, but stridor may occur at rest. There may be cyanosis when the child is crying or agitated. Retractions and nasal flaring may be present. The client is tachypneic and tachycardic and the client's O2 level may fall tx: dexamethasone, nebulized racemic epi (the client should remain for observation for at least 4 hr) , possibly supplemental O2 by blow-by (hold the mask 2 in away while waving it from side-by-side) - applying a mask or nasal cannula can c/s an infant or small kid to become upset and cry severe/impending resp failure(>12): may be awake and increasingly restless or may have become disoriented, lethargic, difficult to rouse. Cyanosis is present, stridor at rest, retractions and nasal flaring may occur, and air movement is severely restricted tx: corticosteroids, nebulized racemic epi, O2; tracheal intubation Avoid hot steam vaporizes. Use a cool mist humidifier to help loosen secretions. No cough syrups or suppressants - no evidence to improve. Offer cool liquids. No ASA for fever. Use acetaminophen If the kid has drooling or dysphagia, go to HCP

PTSD

a client dx w PTSD is at risk for self-harm or other violence - a/s anxiety triggers, SI - dx requires these S for at least 1 mo: re-experiencing event, avoidance event, 2 arousal and reactive events, 2 cog and mood symptoms

linea nigra

a dark line appearing on the abdomen and extending from the pubis toward the umbilicus

Kernig's sign

a diagnostic sign for meningitis marked by the person's inability to extend the leg completely when the thigh is flexed upon the abdomen and the person is sitting or lying down

Erotomania

a disorder involving the fixed (but incorrect) belief that one is loved by another, which persists in the face of strong evidence to the contrary

emergency medical treatment and active labor act (EMTALA)

a federal law that requires anyone coming to medicare-participating hospitals ED, to be stabilized and tx, regardless of insurance status or ability to pay

esophageal speech

a method of swallowing air, trapping it in the esophagus, and releasing it to create sound.

Wilms tumor

a rare type of malignant tumor of the kidney that occurs in young children

Hypochondriasis

a somatoform disorder in which a person interprets normal physical sensations as symptoms of a disease

contraction ring

a spasmodic contraction of the lower portion of the uterus usually occur in the first phase but persists to 2nd stage

leukocoria

a whitish glow to the pupil - indicate retinoblastoma, congenital, highly malignant

cancer

a/s: change in bowel/bladder habits, a sore that does not heal, unusual bleeding/discharge, thickening or lump, indigestion or difficulty swallowing, obvious change in wart or mole, nagging cough or hoarseness high risk group for lung cancer: African Americans -- early: cough and dyspnea, freq and unresolved resp infections; late: chest pain, wheesing, hemoptysis, fever, and general weakness

Anaphylaxis

a/s: hives, rash (diffuse rash is not the sign?), difficulty breathing, diaphoresis, become hypotensive, dilated pupils, very anxious, panic, swelling in the throat (coughing, clearing the throat), angioedema nx: epi 0.3 mL of 1:1000 solution IM; massage site to speed the med absorption, may repeat q 15-20 min

carbonic anhydrase inhibitors

acetazolamide Treat open-angle glaucoma Decreases aqueous humor production, leading to increased intraocular pressure, can lead to blindness se: pul. edema, decreased K level, blurred vision, lethargy, depression Nx: a/s client's ms before repeating dose other meds: - cholinergics: cause miosis (constriction of the pupil) and promote aqueous fluid outflow - BB and alpha adrenergic agonists: decrease aqueous humor production - prostaglandin analogs: increase fluid outflow

Time limits for restraints

adult: 4 hr - can be ordered for 24 hr, q 4 hr, 6x 9-17: 2 hr <9: 1 hr check clients q hr; check if need restraints again q 4 hr offer food and liquid, help toilet q 2 hr once restrains are dc and left off the client for > 15min, a new prescription needed. while waiting for the order, the nurse should remain w the client and attempt to distract the client bedside rails that are fully raised are also restraints

WBC count (leukocytes)

adult: 4500-11000/mm3 (4.5 - 11 x 10^9/L) kid: 5000 - 13000/mm3 (5 - 13 x 10^9/L)

Laissez-faire

advice and give support team morale high w low productivity (delay) team disagreements result in lower morale

administering two insulin

after injecting air the client should withdraw the syringe to inject air into the other vial before withdrawing any insulin - inject the air in the intermittent insulin vial first

Insertion of intestinal tubes (Cantor, Miller-Abbott- Harris)

after tube is in stomach, have client lie on right side then on back (in fowler position) then on left side to use gravity to position tube

Ophthalmic ointment after birth

against ophthalmia neonatorum - inflammation of the eyes resulting from gonorrheal or chlamydial infection contracted by the newborn during passage through the mother's birth canal

therapeutic conversation

always encourage discussion; use open ended Q tell me about your other experiences with procedures vs tell me what you are afraid of with procedures: the second one is somewhat judgmental and nontherapeutic - assumes the nurse knows best and only focuses on fear

presumptive signs of pregnancy (felt by the client)

amenorrhea morning sickness (n/v) - nausea usually appears 4-6 wk, peaks btw 9-13wk, ends by 14-16 wk -- eat a bedtime snack (e.g., crackers w peanut butter or cheese, small sandwich, or yogurt); do not delay meals b/c excessive hunger can c/s n; eat salty or tart (sour) foods (e.g, potato chips or lemonade) during n, ginger-containing foods or herbal teas, no teeth brush right after meals, eat a dry carb upon waking up in the am; vit B6 and doxylamine (antihistamine) breast sensitivity fatigue quickening (18-20 wk) urinary freq

ocular impairment

anticholinergics -- contraindicated in hx of glaucoma

INR

anticoagulation therapy normal 2-3 2-3 sec for therapy in afib, dvt, and pe 2.5-3.5 sec for therapy in prosthetic heart values

parachute reflex

appears by 7 to 9 months; a protective arm extension that occurs when an infant is suddenly thrust downward when prone

oculogyric crisis

are defined as spasmodic movements of the eyeballs into a fixed position, usually upwards. These episodes generally last minutes, but can range from seconds to hours. 1. At the same time there is often increased blinking of the eyes and these episodes are frequently accompanied by pain.

24 mo

average weight 26.4 lb, 24 in brain growth 75% complete - 90% 300 word vocabulary, obey easy command, 2-word sentences, enjoy jumping, no more thumb sucking - malocclusion occurs if thumb sucking persists past 4 yr old or when permanent teeth erupt visual 20/40 in toddler is acceptable

frequency of contraction

beginning of one contraction to the beginning of the next

Antilipemic Drugs

bile acid sequestrant: - AE: constipation (report imme), rash, abd pain and bloating - depletes fat-soluble vit (ADEK). Milk contains vit A & D, green leafy veg contain E and K - take other med 1 hr before or 4-6 hr after taking cholestyramine - sprinkle powder on non-CO2 liquid, stand for 2 min, and stir thoroughly statins: - AE: myopathy (report if muscle pain, esp with fever or malaise), increased liver enzyme levels (be careful of liver function) - effects: increased LDL, peripheral vasodilation - take with food and at night; absorption is reduced by 30% if taken on empty stomach; no grapefruit juice niacin: - AE: gout, flushing (occur several hr after administration, then subside in 2 wk), hyperglycemia, upper GI distress, liver damage - effects: decrease all fats folic acid derivatives (fenofibrate, gemifibrozil) - AE: abd pain, myalgia and swollen joints (report muscle pain), increased gall bladder risk - effects: decrease all fats - eat before meals lipids should be monitor q 6wk until normal, then q 4-6 mo

infant stools

breast milk — soft and small w even consistency& orange- yellow-brown - expect 3-6 -- 2-5 stools/d formula — past & brown and more firmed --1/d greenish stools commonly in the first wk (frequent loose is abnormal); usually turn to brown by 3rd d

adolescent (male)

breast swelling

kid sleep requirement

breastfed baby usually sleep for shorter periods and wake up more freq during the night most toddlers sleep 11-14 hr a night (infants sleep 13 hr), with a nap during the day most preschoolers (more susceptible to sleep disturbances than infants and toddlers) need 10-12 hr/night + a nap. Many give up napping by 5 yr old

wheeze (sonorous)

bronchitis

Bouchard's nodes

bumps on the middle joint of the finger

digoxin

call HCP if infant/young kid HR <90-110; older kid <70 digoxin immune fab(digiband) - reversal rapid digitalization: 0.5-0.75; gradual: 0.25-0.5; maintenance: 0.125-0.5 long 1/2 life: 36-48 hr IV push is fine AE: abd pain/anorexia/n, visual disturbance, brady, confusion toxicity: tach/brady/heart block, halos, anorexia/n/v

ACE i

can c/s injury and death to a developing fetus

diuretics

can c/s losses of Na, hydrogen (decreased ph), and increases in serum Ca (hypercalcemia can lead to diuresis) - ethacrynic acid bumetanide: K depletion, ototoxicity - chlorthalidone: dizziness, aplastic anemia; monitor BG take w food or milk ginko may increase BP w thiazide; aloe can decrease K

dehydration

can have peripheral vasoconstriction - feel cold

licorice

can lead to hypokalemia avoid taking it when take KCl, furosemide, and prednisone, digoxin

Care of levin/salem pump

check residual before intermittent feeding and q 4 hr with cont feeding; hold feeding if more than 100ml instill 15-30 ml saline or water according to agency policy: before and after each dose of meds and each tube feeding, after checking residuals and pH, every 46 hr with cont feedings, when feeding is discont change bag q 24-72 hr check patency q 4 hr hang the amount of fluid that will be infused in 4 hr

Phenothiazines - antipsychotics

chlorpromazine (brand name: Thorazine), fluphenazine (Duraclon) - sedation is a common AE during the first few wks, mesoridazine (Serentil), perphenazine (Etrafon and Trilafon), prochlorperazine (Compazine), promazine (Robinul and Anectine), thioridazine (Mellaril), trifluoperazine (Stelazine) and triflupromazine (Robinul). chlorpromazine: - SE: skin rash, n, anticholinergics, photosensitivity, orthostatic hypotension, hormonal effects (decreased libido, amenorrhea, weight gain), ECG changes (QT prolongation), leukopenia, agranulocytosis, motor movement changes, NMS, hypoglycemia - monitor BG, CBC, cholesterol, liver function - may take 4-6 wk to work

4 yr

climbs and jumps well laces shoes brushes teeth 1500 word vocab secondary stuttering is a normal phase of language development, it is best to ignore it at this stage - asking about life events implies that something is wrong and has caused the stuttering skips and hops on one foot throws overhead

health exams recommended for adults/elderly

colonoscopy, fecal occult blood > 50 yr mammogram, digital rectal exam >40 yr pelvic exam, Pap test for 21-65 yr BP > 18 yr

ADHD

common to see finger-flapping stereotypical and repetitive motor mannerisms

mastoiditis

commonly c/s by chronic otitis media may c/s vertigo (a spinning sensation); loss of balance, increasing the client's risk for falling, vertigo, tinnitus, hearing loss, n/v/d, headache, nystagmus

food obstruction (choking)

complete: no verbal response - begin abd-thrust maneuver incomplete: gives verbal response "Can you speak?" , encourage person to cough to eject object

nicotine patch

consult if client has hx of HTN, heart disease, MI the patch can be used up to 8 wk AE: transient itching, burning, redness at patch site, insomnia, headache, n

fluids for UTI

cranberries can help - acid-producing drink and reduces the recurrence - alkaline fluids promotes bacterial growth, should avoid: tomato juice, milkshake, carbonated soft drink

classic s/s of MI

crushing, burning, constricting/excruciating angina (stabbing pain) more common in AM (heart pumps more slowly and more relaxed), chest tightness , pressure, or discomfort may also include fever and cool, clammy skin clients dx w DM may be asymptomatic when experiencing an MI

contraindications for organ donation

current IV drug use, septicemia, HIV infection, active TB, and any malignancy other than brain tumors

sulcrafate

cytoprotective SE: constipation, vertigo nx: give 2 hr before or after most meds minimal SE: not systemically absorbed; just absorbed in the GI tract

dentures

do not apply toothpaste for cleansing -- mildly abrasive and may create micro-scratches on the surface of the dentures over time; use a gentle cleanser solution designed for dentures

daily dose

do not use qd;SC/SL;HS

radiation burn

does not pose risk for radiation exposure COLDSPA character onset location duration severity pattern associated factors

palpation of fundus

done with fingertips

salem sump

double lumen, used for decompression or tube feeding one decompression, one air vent never clamp the air vent or connect to suction

a/s thyroid gland

drinking water facilitates swallowing during examination

macrolide abx

ex: erythromycin (verapamil and fluconazole can increase this med - can lead to cardiac death), azithromycin - binds to cell membrane and changes protein function - can use if allergic to PCN - SE: n/v/d, abd cramping, confusion, hepatotoxicity, superinfections - take 1 hr ac or 2-3 hr pc - increase levels of warfarin, theophylline, carbamazapine

facial dropping in infant

facial paralysis - damage to CN VII - usually resolves within a few d to 3 wk, though it can be permanent

Semi-Fowler's Position after surgery

facilitate removal of fluid from venous pathways and lymphatic system through gravity

LDL

fast for 12-14 hr < 160 if no CAD and less than 2 risk factors < 130 if no CAD and 2 or more risk factors < 100 if CAD present < 70 for very high-risk clients

bone marrow depression

fever, chills, sore throat, back pain, dark urine, anemia, thrombocytopenia, leukopenia

superinfection

fever, diarrhea, black hairy tongue, glossitis, vaginal itching & discharge, c.diff

liver impairment

fever, malaise, n/v, jaundice, light stools &dark urine, abd pain, elevated AST & ALT, altered PTT

amputation ROM exercises

firm mattress; prone q 3-4 hr for 20-30min; gently push residual limb down toward bed; progress from using a soft pillow, to a frim pillow and then to the actual bed

doppler

firm pressure of the probe will diminish or occlude blood flow angle 45 degree direction of movement should be distal to proximal

pain a/s

first a/s intensity and location

grade of hepatic encephalopathy

grade 0: insomnia, sleep disturbances, writing changes, hand tremors, change in behavior, mild confusion, slurred speech 1: time disorientation, hypoactive DTRs; impaired ability to write and draw line figures, normal ECG 2: impaired thought processes, increased drowsiness, disorientation, mood swings, agitation, inappropriate behavior; asterixis, fetor hepaticus (smells like a combination of rotten eggs and garlic), abnormal ECG 3: stuporous, marked confusion, incoherent speech, lethargy, extended sleep patterns; flapping of the hands after extension (asterixis), increased DTR, rigidity of extremities, ECG very abnormal 4: coma; absence of asterixis and DTR give lactulose and rifaximin to reduce the GI flora responsible for ammonia production auto low-protein, high carb diet

Foods high in potassium

green leafy vegetables, raisins, bananas, oranges, lentils, cantoloupe, honeydew, beets, spinach, tomatoes, avocados, milk, peanut butter, nuts, yogurt, clams, tuna, salmons, potatoes & sweat potatoes, winter squash, brown/wild rice, whole wheat bread and pasta S of hypokalemia: weakness, hyporeflexia, change in ms, tiredness, shallow respiration, muscular cramping in the arms or legs, abd cramping, paresthesias, palpitations, hypotension, dysrhythmias, n/v, tingling or numbness, bloating and constipation, possibly ileus causes: wound drainage, prolonged npo, v/d, excessive diaphoresis, corticosteroids, loop and thiazide diuretics, cushing syndrome,amphotericinB can c/s major changes in cell membrane excitability even when minor changes in extracellular K occur Administer K: never IM/SQ/IV push Maximum infusion rate 5-10 mEq/hr never exceed 20 mEq/hr monitor cardiac and IV site for phlebitis

Danger signs of pregnancy

gush of fluid or bleeding from vagina, irregular uterine contractions, severe headache, visual disturbances, abdominal pain, persistent vomiting, fever, chills, swelling face and fingers, decrease in fetal movement

apgar

heart rate, respiratory effort (slow weak vs strong cry), muscle tone (some flexion of extremities [sluggish] vs actively moving [flexed, strong]), reflex irritability (grimace = 1, crying = 2), color 1 and 5 min; baby < 7 at 5 min reassess at 10 min 4-6: stimulate the baby. Rub back. A/s if mother had narcotics

viral conjunctivitis

highly contagious restricted from school until symptoms have resolved in 3-7d

constipation diet

highly seasoned foods and fats have no effect

Graves disease

hyperthyroidism use ultrasonography to determine the size and composition of the thyroid gland to rule out Graves, nodular goiter, or other thyroid dysfunct if abnormalities are found w the u/s, may use MRI or biopsy radioactive I-123 is used to destroy overactive thyroid cells, which are present in thyroid cancer

EKG K and Ca

hypokalemia: prominent U waves hyperkalemia: flattening P wave; widening QRS; peaking of the T Insulin and 50% dextrose; Ca gluconate; Na bicarb can tx hyperkalemia hypocalcemia: prolonged QT and ST; torsade de pointes hypercalcemia: shortening of the QT and ST

NSAIDs

ibuprofen: JSJ, fluid retention, dizziness, headache indomethacin: bone marrow depression; use cautiously in ASA allergy, asthma or nasal polyps can use for kids > 6mo ketorolac: renal impairment - use <5 d in elderly sulindac; HTN meloxicam naproxen: MI; use cautiously in ASA allergy, asthma or nasal polyps celecoxinb: fatigue, anxiety, depression, nervousness, n/v/a/c, drymouth; no if allergic to sulfonamides, ASA, or NSAIDs Nx: eye changes (have eye exam), liver and renal function, avoid OTC ibuprofen toxicity: vertigo and drowsiness

ice or heat

ice for acute injuries w inflammation (sprains, strains, bruises, tendinitis); heat for chronic, non-inflammatory pain or stiffness (arthritis, fibromyalgia, back or neck pain)

pyloromyotomy

incision of the longitudinal and circular muscles of the pylorus, which is used to treat hypertrophic pyloric stenosis (infant) infants usually don't show symptoms until the 2nd to 4th wk after birth; then regurgitation develops into projectile vomiting; most freq in male, white, full-term baby

encopresis

incontinent of stool, cause of constipation

valerian

increase the effect of CNS depressants and antihistamines

absent red reflex

indicates an ophthalmic emergency cataracts, retinal detachment, retinoblastoma light is not being transmitted to the retina, and the early suppression of optic nerve function, which results in the obstruction of the light, can c/s blindness kid should be also seen for a markedly diminished reflex, asymmetry of the reflexed (Bruckner reflex), or dark spots in the red reflex, or if a white reflex is present

pelvic inflammatory disease (PID)

inflammation and infection of organs in the pelvic region; salpingitis, oophoritis, endometritis, endocervicitis risk factors: </= 20, multiple sex partners, IUD, vaginal douching, smoking, hx of STD/PID Pain areas: in the pelvis, abdomen, lower back, or vagina Pain circumstances: can occur during sexual intercourse or during urination (refrain sexual intercourse for a wk after starting tx) Whole body: chills, fatigue, or fever, malaise Groin: cervical motion tenderness, vaginal discharge, or vaginal odor Gastrointestinal: nausea or vomiting Also common: cramping or painful menstruation leukocytosis give abx, F&E, warm douches, rest no need to wash w soup for several times/d - increase dryness and itching severe infections are associated w adhesions and infertility

Phlebitis/thrombophlebitis

inflammation of vein - report immediately swelling, tendered; redness, warmth around the site (along the path) d/c; warm compress thrombophlebitis - blood clot; fever; leukocytosis elevate extremity if just clotting: backflow of blood into the iv tubing, decreased iv rate - just d/c iv D50 should be given through a large-bore needle, as extravasation of the solution can c/s tissue sloughing and necrosis & phlebitis

osteogenesis imperfecta

inherited condition when bone formation is incomplete, leading to fragile, easily broken bones

malignant hyperthermia

inherited muscle disorder chemically induced by anesthesia; stop surgery, tx with 100% o2, skeletal muscle relaxant, NaHCO3

malpractice/negligence

injury, causation, duty, and breach of duty

do not shave the client's hair at the operative site

instead, clip the client's hair

battery

intentional touching w/o consent

Braxton Hicks contractions

intermittent painless uterine contractions that occur with increasing frequency as the pregnancy progresses; no cervical changes; false labor

tardive dyskinesia

involuntary movements of the facial muscles, tongue, and limbs; a possible neurotoxic side effect of long-term use of antipsychotic drugs that target certain dopamine receptors tx by decreasing or discont the antipsychotic med

anthetosis

involuntary writhing movements of the limbs accompanied by hypotonia of the trunk intermittent tension though the trunk and limbs basal ganglia involvement usually quadriplegia

crutches

keep 8-10 in out to side place the top of the crutches about 2 in (5cm) below the armpits lean both shoulders slightly forward move the crutches forward about one foot when the client is seated, lean the crutches in a nearby spot upside down when the client is ready to stand up, inch forward to the front of the chair, hold both crutches in the hand on the injured side, then push up and stand on the good leg 4 point: alternate advancing crutch then opposite foot; maximal support; require constant shift of weight 2 pt: crutch and opposite foot at the same time; faster than 4 pt 3 pt: crutches and injured foot, swing good leg forward and plant; requires good balance and upper arm strength; can use a walker swing to: crutches forward and swing BOTH feet to crutches; requires arm strength; can use a walker swing through: crutches forward and swing BOTH feet in front of crutches; requires arm strength, coordination, and balance; most advanced gait

eczema (atropic dermatitis)

kid: rough, dry, erythematous skin lesions that progress to weeping and crusting; distributed on the cheeks, scalp, and extensor surfaces in infants and on flexor surfaces in kid adults: hard, dry, flaking, scaling on face, upper chest, and antecubital and popliteal fossa onset usually in infancy around 2-3mo; often outgrown by 2-3 yr may be precursor of adult asthma or hay fever elimination from diet of common offenders, especially milk, eggs, wheat, citrus fruits, and tomatoes eliminating clothing (rough/wool) or that promotes sweating; cotton is best avoid soap and prolonged or hot baths/showers, which tend to be drying; may use warm colloid baths lotions to affected areas keep fingernails short and clean; arm restraints/mittens may be necessary topical steroids antihistamines

genus valgum

knock-knee normal in 2-7 yr

phlebography

lack of filling of a vein is indicative of venous occlusion d/t a thrombus thrombi are id as radiolucent areas in opaque-filled veins

IICP

late signs: bradycardia, neuro func cushing's triad: bradycardia, HTN with widened pulse pressure, irregular breathing normal pressure: 5-15 hob: 30 infants: tense, bulging fontanelle, separated cranial sutures, irritability, high-pitched cry, poor feeding children: headache, n, forceful vomiting, irritability and restlessness, drowsiness, lethargy

precipitous delivery outside hospital setting

lateral sim's - the fetal head is large w/o causing laceration; this position c/s less stress on perineum

Omnibus Budget Reconciliation Act (OBRA)

law passed by the federal government that includes minimum standards for nursing assistant training, staffing requirements, resident assessment instructions, and information on rights for residents clients have the right to be free from physical and chemical restrains imposed for the purpose of discipline or convenience

output failure: HR falls below lowest programmed rate

lead failure (frax, displacement), generator failure, battery failure no pacer electrical output is noted on the ECG (no spikes)

indwelling catheter insertion

male: - 16-18 Fr size - should not retract foreskin (can c/s paraphimosis), should replace the foreskin - insert 6-7 in female: - 14-16 Fr - insert 2-3 in

neuroblastoma

malignant tumor composed mainly of cells resembling neuroblasts that occurs most commonly in infants and children found in the small glands on top of the kidneys (adrenal glands). It can develop in the belly, chest, neck, pelvis, and bones. Symptoms may include fatigue, loss of appetite, and fever. There may be a lump or compression of tissues in the affected area.

contact precautions

masks not needed and doors do not need to be closed varicella, impetigo, pediculosis (lice), meningitis, rotavirus, scabies, wound drainage, RSV

fainting

may be the result of an irregular cardiac rhythm

chamomile

may increase the effects of sedatives, risk of bleeding if taken w anticoagulant

fluorescein

measures circulation in the retina c/s temp yellow-orange staining of the skin and darker-colored urine

bleeding time

measures duration of bleeding after standardized skin incision used for preop screening 1.5 - 9.5 min

chlamydia

men - urethritis, dysuria, watery discharge women - may be asymptomatic; symptoms - thick vaginal discharge w acrid odor, pelvic pain, sometimes painful menses spread via mucous membranes/sexual contact tx w tetracycline or doxycycline PO comps: sterility

detoxify substances gradually

methadone, naltrexone for LT maintenance and acute withdrawal (narcotic)

intensity (strength at the peak) of contraction a/s

mild - slightly tense but easy to indent (tip of nose) moderate - firm and difficult to indent (like chin) strong - rigid and board-like (like forehead)

Prostaglandin analogs

misoprostol • Synthetic analogue of PGE1. • Can reduce 80% - 90% of basal or food-induced acid production. • Short-acting (3 hr) • Generally only used to prevent NSAID-induced injury (but PPIs and H2-antagonists more commonly used for this purpose) • Adverse Effects: diarrhea (30%), exacerbates inflammatory bowel disease, increases uterine contractions (contraindicated during pregnancy)

ulcer meds nx considerations

monitor for dysrhythmias, take at bedtime, be aware of the time of administration of antacids

trigeminal (v)

motor: jaw movement - able to clench and relax jaw sensory: sensation on the face and neck test w pin and wisp of cotton over all three branches (forehead, cheek, jaw) ask to open jaw, bite down, move jaw laterally against pressure stroke cornea w wisp of cotton

overdose nicotine

n/v, dizziness, weakness, rapid HR

Hirschsprung disease

nb: failure to pass meconium, refusal to suck, abd distention kid: failure to gain weight, delayed growth, constipation alternating w d, foul-smelling stools, abd distension, visible peristalsis

weight gain during breastfeeding

need an additional 400-500 calories each day before breastfeeding alcohol level in the milk peaks at 30-60 min after drinking if it is taken alone, and 60-90 min if taken with food if mothers drink alcohol, they should not breastfeed for at least 2 hr

watch for post op drainage

notify HCP if >200 mL drainage in the 1st hr and more than 100 in subsequent hr monitor during the first 24 hr

Alkaline Phosphatase (ALP)

npo 8-12 hr list meds client is taking on lab slip adult: 50-120 units/L infant and adolescent up to 104 FU/L

esophagus endoscopy

npo at least 8 hr

client under legal guardianship refuse a procedure

nurse should discuss the procedure and options with the guardian

septic shock

once the fluid volume is replaced, you can proceed w implementing the insulin drip to lower bg once the fluid balance is achieved, NE or other vasopressors may not be required bedrest w extremities elevated 20 degrees, head slightly elevated

incomplete (footling) breech

one or both feet are born first

osteoporosis risk factors

over 60 yr old, postmenopausal, use of alcohol, smoking, sedentary, prolonged use of steroids low back pain, kyphosis

sao2

oxygen saturation of hemoglobin in arterial blood (>90%)

Brudzinski's sign

pain with resistance and involuntary flex of hip/knee when neck is flexed to chest when lying supine

Odynophagia

painful swallowing

ADLs (activities of daily living)

personal daily care tasks, including bathing, skin, nail, and hair care, walking, eating and drinking, mouth care, dressing, transferring, and toileting

Striae gravidarum

pink or reddish streaks during pregnancy

Donning the prosthesis

place bottom of liner directly against the end of the residual limb and roll it up completely ensure there are no wrinkles or folds inside the liner and place limb into the socket roll the suspension sleeve to create a seal

preschooler toys

playground materials, housekeeping toys, coloring books, tricycle w helmet

CAP (community acquired pneumonia)

pleuritic pain, diffuse and fine crackles occurs within the past 14 d of the onset of s (not hospitalized or in a LT care facility)

pleural friction rub

pleuritis (worsening dyspnea and chest pain w inspiration)

infant/toddler nutrition

premature: 100-200 cal/kg/d, high Na, Ca, protein, soft preemie nipples full term: 6-8 wet diapers and 1 stool qd. 120 cal/kg/d, breastfeeding 6-12 mo (feed q 1.5-3 hr; if infant sucks s/o swallowing - move to another breast or stop breastfeedindg), formula 12 mo. stomach capacity is only 0.5-1 oz baby will obtain colostrum before the breast milk comes in do not need extra water Do not give liquid med through the feeding tube b/c liquid med may have sorbitol, which can c/s diarrhea Enteral feeding takes 20-30 min 1-4 mo: liquid vit A, D, C; 4-5 mo: rice cereal, strained fruit, 5-6 - veg and meat; 7-9 mo: chopped meat, finger foods toddler: 6-8 teeth (solid food) 12-36 mo. More protein and Ca, balanced diet.

stroke

prevent flexion of the affected extremities to prevent deformities, the nurse needs to prevent adduction of the affected shoulder, external rotation of the hip joint, foot drop (plantar flexion), and place the hand in slight supination so the fingers are barely flexed risk factors also include: males, oral contraceptive use, migraine w aura

braden scale

sensory perception, moisture, activity, mobility, nutrition, friction and shear 1 = least, 4 = best (friction and shear only has 3) high risk: 0-12 moderate: 13-14 mild: 15-18 no risk: 19-23

therapeutic patch

should be cautious around microwave because leaking radiation can heat the patch's metallic backing and result in burn also be cautious of heated blanket - may at risk of orthostatic hypotension d/t increase absorption (vasodilation) remove and replace the patch q 7 d do not cut the patch; should fold the used patch and either flush it down the toilet or place it in a sharps container for return to hcp

chief complain

should be recorded using the client's own words

insulin injection site

should be rotate otherwise fatty deposits may develop (lipodystrophy) (lumpy)or loss of fatty tissue (lipoatrophy) (dimpled/indented), which affects the absorption of insulin, leading to rise of BG can result in decreased discomfort the abd absorbs insulin the fastest, f/u by the arms, thighs, and buttocks keep a record of which injection sites are used (with each 0.5 to 1 in [1.27 - 2.5 cm] square representing an injection site) rotating within one anatomic site is preferred insert the needle at a 45-90 degrees

uterine resting tone

should never be above 20 mm Hg

mature minor

someone over age 15 who can show a health care provider that he or she has enough maturity and understanding to make medical care and treatment decisions without parental consent. Such a minor may seek medical care for treatment of drug or alcohol abuse, contraception, venereal disease and pregnancy.

weber test

sounds are heard louder (lateralized) in the normal unaffected ear if the client has sensorineural hearing loss (inner ear or cochlear n. damage impairs transmission to affected ear) heard louder in the affected ear if the client has conductive hearing loss in one ear - bone (dense objects) are better conductors than air

left brain injury effects

speech/language problems; aphasias (expressive: cannot speak; receptive: cannot comprehend speech) slow, cautious behavior problem-solving difficulties memory loss

miscarriage

spontaneous abortion occur before 20 wk

spinal shock

sudden depression of reflex activity below level of injury; loss of sensation, paralysis, and flaccid in innervated muscles below the level of lesion; impairment of bladder and bowel reflexes

confidentiality

the nurse is obligated to share client info w personnel directly involved w the client's care

mini pill

the only oral contraceptive that can be used for breastfeeding clients since it contains progesterone and not estrogen estrogen contains in other oral contraceptives - affect breast milk production and increase risk of DVT

undersensing

the pacemaker is unable to detect any electrical activity (spontaneous myocardial depolarization) and never turns off pacemaker programming problems, insufficient myocardial voltage signal, lead or pacer failure (fibrosis, frax, etc) a. or v. pacing spikes arise regardless of P waves or QRS complexes wearing pacemaker should avoid large magnets, electromag field, metal detectors; wear bracelet

oversensing

the pacemaker senses electrical signals that it should not normally encounter, causing inappropriate inhibition of the pacing stimulus physiologic signals like T waves or skeletal muscle activity, myopotential signals like MRI or a lead failure a. or v pacing spike is absent, causing an asystolic pause in the client until the next pacing spike

carotid sinus massage

the physician massages over one carotid artery for a few seconds, observing for a change in cardiac rhythm.

epilepsy and seizures

two unprovoked seizures occurring more than 24 hr apart seizures may occur in cerebral palsy, autism, mental retardation fever/meds induced seizures do not lead to epilepsy life-threatening: status-epilepticus - last >5 min or >2 seizures in 5 min w/o returning to normal

methylphenidate

tx ADHD patch on the hip - press firmly for 30 sec

cullen's sign

umbilical bruising/ecchymosis

GI obstruction

upper: onset rapid, vomit freq and copious, pain colicky, cramping, intermittent, bm feces initially, abd distention absent/minimal (upper) then increased (lower) lower: gradual onset, n/v, pain minimal and cramping, absolute constipation, increased distention; initially hyperactive (to eliminate the obstruction) then hypoactive sound lower GI tx: NPO, NG TUBE, NS/LR, analgesic

skin temperature studies

use direct-reading skin temp thermometer immerse one extremity in warm water, and observe for rise in skin temp in the other extremity, which should normally f/u because of reflex vasodilation place a hot water bottle on the client's abdomen and observe extremities for reflex rise in skin temp

crede maneuver

used to initiate urination when there is retention or lack of bladder sensation a cupped hand is placed over the bladder and pushed inward and downward other interventions for retention: catheterization; valsalva maneuver methods for incontinence: toilets the client upon awakening in the morning and before and after emeals; 2 hr interval between voidings)

probably signs of pregnancy (observed by the nurse)

uterine enlargement positive urine pregnancy test (hCG) hegar's sign: softening of isthmus of uterus chadwisk's sign: bluish discoloration of cervix

nitrazine test

vaginal fluid obtained by sterile cotton-tipped swab; color of paper compared to determine ph - blue-green indicate amniotic fluid

vegan may lack

vit B2 (riboflavin), zinc

Wong-Baker FACES Pain Rating Scale

The scale shows a series of faces ranging from a happy face at 0, or "no hurt", to a crying face at 10, which represents "hurts like the worst pain imaginable".

intestinal tubes

Cantor: single-lumen w mercury-filled balloon and suction port Miller-Abbott: double-lumen w mercury-filled balloon and suction Harris: single-lumen w mercury-filled balloon and suction port - after tube is in stomach, have pt lie on R, then back in Fowler's position, then on L; gravity helps to position tube; coil excess tube loosely on bed, do not tape; this process can take several hours. After verification of placement - tape it - measure drainage q shift - watch for peristalsis removal: - deflate balloon or aspirate contents - pt hold breath - remove 6'' q 10 min until reaches the stomach; then remove completely w smooth, cont pull

regional lumbar epidural block, may be PCA

anesthetic most popular injected into epidural space between L4 and L5 - administer 500-1000 mL of IV at rapid rate prior to insertion to prevent maternal hypotension - if mild/moderate hypotension, place in left lateral position, increase IV flow rate, give O2 - if severe hypotension, trendelenburg for 2-3 min

apnea monitor

can be removed during bath

ready for solid food

gain weight, increase the length of time btw feedings, demonstrate good head control, the tongue extrusion reflex is no longer present

toilet training

never begin before 18 months ______ 2-3 y/o: bladder reflex control achieved 2.5 y/o: has sphincter control 3 y/o: reg. voiding habits established 4 y/o: independent bathroom activity 4(g)/5(b) y/o: nighttime control expected bowel control before bladder control Ready to be toilet trained: demonstrates bladder sphincter control able to adjust or remove own clothing able to sit and wait for a period of time (5-10 min) parents are available for when child expresses need for elimination having dry diapers after a nap; staying dry for >2 hr when the child shows interest in a potty-chair or toilet and in wearing underwear when able to f/u basic directions when able to communicate through words, facial expression, or posture the need to eliminate

therapeutic relationship

preorientation: This phase is when the nurse plans for the first session with the patient by gathering information and reviewing records. orientation: This phase can last for a few meetings or extend over a longer period of time. The initial interview includes the following aspects:1. An atmosphere is established in which rapport can grow.2. The nurse's role is clarified and the responsibilities of both the patient and the nurse are defined.3. The contract containing the time, place, date and duration of the meetings is discussed.4. Confidentiality is discussed and assumed.5. The terms of termination are introduced (these are also discussed throughout the orientation phase and beyond).6. The nurse becomes aware of transference and counter-transference issues.7. Patient problems are articulated and mutually agreed upon goals are established. working: During the working phase, the nurse and patient together identify and explore areas that are causing problems in the patient's life. 1. Maintain the relationship.2. Gather further data.3. Promote the patient's problem solving skills, self esteem and use of language.4. Facilitate behavioral change.5. Overcome resistance behaviors. 6. Evaluate problems and goals, and redefine them as necessary.7. Promote practice and expression of alternative adaptive behaviors. termination: 1. Summarizing the goals and objectives achieved in the relationship.2. Discussing ways for the patient to incorporate into daily life any new coping strategies learned.3. Reviewing situations that occurred during the nurse-patient relationship.4. Exchanging memories, which can help validate the experience for both nurse and patient and facilitate closure of that relationship.

proper positioning to prevent joint damage

side-lying: upper leg flexed, hip supported, pillow under neck; prevent hip joints internally rotated/adducted high-fowler: pillow under knees to prevent sliding prone: pillow under legs to keep toes off of bed and allow for dorsiflexion of the ankles

Myasthenic Crisis vs. Cholinergic Crisis

similar S/S but cholinergic crisis also have smooth muscle effects: mtosis, salivation, vertigo, n/v/d, seating, lacrimation iv anticholinesterase (e.g., edrophonium chloride) will improve MC (a dramatic increase in muscle strength) but worsen CC

BUN

values affected by protein intake, tissue breakdown, fluid volume changes 10-20 mg/dL associated w uremic encephalopathy, seizures, coma, and death earlier s: n/v/a, fatigue, muscle cramps

normal breath sounds

vesicular (soft, low pitched breezy), bronchovesicular (medium pitched, moderately loud), bronchial (loud, coarse, blowing)

saving evidence

victim's evidence should be paced in paper bags instead of plastic bags (plastic bag may preserve moisture that will interact w clothing and damage any evidence)

ferning test

viewed under microscope; fern-like; indicates high estrogen content of amniotic fluid

right brain injury effects

vision problems quick, inquisitive behavior disorientation to time/place/people memory loss

venturi mask

24-40% at 4-8 L/min provides high humidity and fixed concentrations keep tubing free of kinks

para

# of pregnancies beyond period of viability (20 wk or 500 g)

MAP

(2x diastolic + systolic)/3

Alanine aminotransferase (ALT), aspartate aminotransferase

*Increase liver disease, hepatitis *10-40 units (males) Hemolysis, elevated liver enzymes, low platelet count (HELLP)

immediate signal

- "crushing" chest pain, arm or should pain (MI) - a sudden loss of motor function of an extremity (stroke) - coughing blood, frothy sputum (PE) - a client report "the worst headache of my life" (subarachnoid hemorrhage)

rule of 15

- 15 g quick-acting carb (4 oz orange juice, 4-6 oz regular soda, 5-8 hard candies, 1 tbsp honey/syrup, 4 tsp jelly) - wait 15 min, check BG -if BG >70, next meal is more than 1 hr away, give additional carb + protein/fat (also for clients who was exercising) - check BG before exercising and if the reading is <100, eat 15-30g carb

chest tube

- 2 cm water seal - acts as an one-way valve & suction control 20cm: in the chest drainage unit (CDU): water can evaporate so you may need to periodically replace sterile water - a/s insertion site for sq emphysema (feel like "crackling" sensation and tube migration): should not pinched btw bed rails; tape all connections - if see clots: squeeze hand-over-hand along the tubbing and release the tubing btw squeezes - avoid clamping the tube: prevents the escape of air or fluid - risk of tension pneumothorax - water level increases during spont inspiration and decreases w expiration - air leak: intermittent bubbling occurs w exhalation, coughing, sneezing as long as air in pleural space - pt in UPRIGHT or the amount of drainage recorded will not be accurate

Chickenpox (Varicella)

- 2 doses if not had as kid - can occur at any age - prodromal indications: slight fever, malaise, anorexia (occur during 1st day; tx w acetaminophen), rash (pruritic, begins as macule on face/scalp/trunk, becomes papule, then vesicle, successive crops of all three stages present at any one time; lymphadenopathy; elevated temp, headache, sore throat, decreased appetite - comps: pneumonia, encephalitis, toxic shock syndrome, dehydration, meningoencephalitis; birth defects and serious infection in nb - spread by direct, contact, droplet, contaminated object - incubation: 13- 17 d (lesions may take up to 10 d after exposure to develop) - nx: airborne isolation until vesicles crusted; communicable from 2 d before appearance of rash; avoid use of aspirin - reye syndrome (confusion, swelling in the brain, and liver damage) - use tylenol; topical calamine lotion; teach not to remove scabs prematurely: scarring will not occur if scabs are allowed to fall off naturally and scars will appear as round, white indentations - use airborne and contact precautions in addition to standard precaution until all lesions are crusted - VZIG provides fast protection for potential exposures: exclude the staff from client care from the 10th day after first exposure through the 21st day (28th day if VZIG given - oral acyclovir or valacyclovir given in first 24 hr after the varicella rash starts

postprandial hypoglycemia

- 2 hr after meals - hypoglycemic s/s

burn care

- 2% loss of body weight - mild caloric deficit - 10% or more requires evaluation - escharotomy - alleviate the compartment syndrome that occurs when edema forms under non-distensible eschar; promote perfusion - skin graft, debridement and wound care promote granulation tissue to grow

MMR

- 2-3 doses before age 55 - AE: fever, allergic reaction, arthritis, arthralgia, encephalitis, burning/stinging pain at injection site - nx: administer sq, do not receive if pregnant or immunosuppressed, may receive as separate injections if unusual reaction occurs

cr clearance

- 24 hr urine collection - blood drawn for cr level at end of urine collection - normal: 1.42-2.08 mL/min

baby bilirubin levels

- 25-48 hr: >/= 15 mg/dL - 49-72 hr: >/= 18 mg/dL - >72 hr: >/= 20 mg/dL

Droplet precautions

- 3 ft apart - spread by coughing, sneezing, talking, procedures - suctioning or bronchoscopy - streptococcal pharyngitis (group A), pertussis, diphtheria, pneumonia meningitis c/s by haumophilus inluenzae type B, mumps (fever, headache, malaise, anorexia, ear pain, swollen parotid glands -- most communicable immediately before and for 9 d after parotid swelling begins), rubella (German measles) - vaccine at least one month prior to becoming pregnant or after the child's birth (even during breastfeeding) - client wear mask during transport - should remain on droplet precautions for 7 d after illness onset or until the fever and resp symtoms have been resolved for 24 hr - should remain on isolation until 24 hr after C/S abx are started; ending isolation will not depend on waiting for negative culture results - eye protection or face shield if risk of splash or spray - neuro check q 4 hr

prepare an IV oxytocin solution

- 3 mL syringe - filter needle (19 gauge 1.5'') - only use to withdraw med - 20 gauge 1'' needle to inject the med into the bag - do not need gloves

Finasteride, Dutasteride

- 5-Alpha reductase inhibitors (for BPH), can decrease PSA level - se: decreased libido, impotence - nx: may c/s harm to male fetus, monitor liver function tests

PTT and heparin infusion dip protocol

- 50-59 sec: PRN re-bolus only if prescribed, no infusion hold time, increase 1 unit/kg/hr, next PTT in 6 hr - 60-80: no PRN or hold time, no change, next PTT in 6 hr; once two in a row, draw q am - 81-100: no PRN or hold time, decrease 1/unit/kg/hr, next PTT 6hr

HF ejection fraction

- 55-70: may be normal or client may have HF with preserved EF - 40-54: may be asymptomatic - 35-39: mild HF; may be dyspnea w exertion, increased BP/HR; some H20 and Na retention - <35: progressively severe

arcus senilis

- A white, gray or blue opaque ring in the corneal margin (peripheral corneal opacity). Also characterized with white ring in front of the periphery of the iris. - common finding in elderly

elderly changes

- ADH increases and ANP decreases decreased Na reabsorption and increased water retention by the kidneys - hyponatremia - increased insensible fluid loss (changes of skin)

atomoxetine

- ADHD med - other meds: amphetamine, methylphenidate, dextroamphetamine , pemoline - increase level of catecholamines (NE, DO) - use: ADHD (dx at 7); narcolepsy - low risk for dependence - may take with or without food - monitor weight b/c possible anorexic effects - constipation and SI can occur - other SE: restlessness, insomnia, tachycardia, tremors, dry mouth (anticholinergic effects) - nx: monitor growth rate (plot on chart); give in am; 2nd dose at least 6 hr before bed time - contraindicated in seizure - can decrease the effects of decongestants; alter effects of insulin; not with MAOIs (c/s hypertensive crisis)

HIV

- AIDS - most serious stage (takes about 10 yr)-- cripple normal immune system can destroy the client - purple patches - CD4 T cells (<200) -- within a few wks, the body adjusts to the virus and the CD4 level rebounds - can be sustained by tx ** T cells count are generally 500-1000 (immunocompromised if below 400) - develop opportunistic infection -- p. carinii pneumonia: chest tightness, sob, nonproductive cough, dyspnea, tach, fever, hypoxemia, cyanosis. Restlessness, agitation, confusion: early signs -- c. albicans stomatitis/esophagitis: changes in taste, dysphagia, retrosternal pain, white exudate and inflammation of the mouth and throat -- c neoformans: severe debilitating meningitis. fever, headache, blurred vision, n/v, stiffness, changes in ms, possible seizures --CMV (cytomegalovirus): significant factor in morbidity and mortality -- fever, malaise, weight loss, lymphadenopathy, visual disturbances, hepatitis -- also fetotoxic -- kaposi's sarcoma: most common malignancy - small, non-painful purple brown palpable lesion (cancer and blood cells)on any part of the body, most common on the skin or in the mouth -- burkitt lymphoma: a form of non-Hodgkin's lymphoma in which cancer starts in immune cells called B-cells - s/s: acute phase: (2-4 wk after infected and last for 1-2 wk) temp decrease in CD4 T-cells, fever, headache, fatigue, swollen lymph glands, blotches on skin, eyelids, inside mouth or nose, memory loss, depression, weight loss, dry cough other comps: encephalopathy, cervical cancers, tb - standard/contact - HIV not transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or casual encounters - western blot confirms the presence of HIV antibodies - p24 is only positive for a number of wk to mo after infection

how to give IV k

- ALWAYS dilute KCl - invert IV bags several times to ensure distribution in the bag - 10/hr peripheral; 20/hr central line - NEVER inject KCl into an infusing container hanging on an IV pole - maintenance fluids: 60/L; supplemental peripheral 20/100 or 40/250; supplemental central 40/100; daily dose: 20-60/24hr and should not exceed 200/24hr - if discomfort: elevate the extremity; apply ice pack or warm compress

Meniere's disease

- Abnormal condition within the labyrinth of the inner ear that can lead to a progressive loss of hearing. The symptoms are dizziness or vertigo, hearing loss, and tinnitus (ringing in the ears). - excessive lymph fluid in the inner ear that obstructs the inner ear and causes swelling within the labyrinth - tx by antihistamines, anticholinergics, benzo, antivertigo - low Na diet, diuretics

when to give oxytocin

- must after the placenta separates from the uterine wall - a gush of blood, the cord extending from the vagina, and the uterus contracting

antianxiety meds

- Benzodiazepines: chlordiazepoxide, meprobamate --shorter acting: alprazolam, lorazepam -- more addictive potential --longer acting: clonazepam, diazepam --use for panic, GAD, phobias, PTSD, not for OCD -- precaution and contraindications: other CNS depressants - additive depressant - decreased cognition and impaired coordination; currently taking MAOIs; pregnancy/lactation; hepatic or renal dysfunction (toxicity); hx of abuse/addiction; depression - increased depression --AE: drowsiness to sedation, hypotension, resp depression, impaired memory & confusion, tolerance & addiction, SI -- implementation: have antidote - flumazenil (reverse in 30 -60 sec but may not reverse resp function); increase water &fiber intake; have client get up slowly - nonbenzodiazepines： --buspirone, hydroxyzine (antihistamines)-- GAD -- AE: dizziness, headache, n, blurred vision -- nx: restrict grapefruit juice (may increase level of med), not a prn - should take 2-3x/d, onset 10-14 d - antidepressants: longer onset; minimal 4 wk --SSRIs: paroxetine, escitalopram, sertraline (higher risk for suicide in 10-14 d after starting the med) --SNRIs: duloxetine, venlafaxine SR --tricyclics: clomipramine AE: sore throat, fever, fatigue, v/d - require change of med/dosage; dry mouth, nasal stuffiness, weight gain - do not require change of dosage/med other AE: sedation, orthostatic hypotension, dizziness, headache, difficulty breathing, increases in SI, tremors, drooling, hyperreflexia, ataxia, EPS. serious comps: cardiac rhythm disturbances, urinary retention, confusion, agitation, seizures - beta-blockers (blocking NE & E) -- propranolol, atenolol

MI lab

- CK: increases in 3-6 hr, peaks 24- 36 hr, returns to normal by d 3 - CK-MB: increase in 4-8 hr, peaks 12-24 hr, returns to normal in 3-4 d - myoglobin: increases in 1-3 hr, peaks in 4-12 hr, returns to normal 12 hr after MI - troponin t & i: increases in 3-4 hr , peaks in 4-24hr, returns to normal in 1-3wk

Trigeminal neuralgia (tic douloureux)

- Carbamazepine, alcohol injection, gaba, tri depressants - no message - no exercise -

religions

- Christian: water - Jewish: medication for pain is fine - Islam: dying to face east - Catholic: sacrament to the sick

African Americans

- DM is more common/more likely to result in comps like amputation or kidney failure - Heart disease and stroke are more likely to develop at a young age - breast cancer occurs at an earlier age - mortality linked to DM, heart disease, stroke, and breast cancer is higher

cold stress

- Excessive loss of heat that results in increased respirations and nonshivering thermogenesis to maintain core body temperature - infant will use metabolic processes to generate heat - increased respirations, mottling of skin, cyanosis, metabolic acidosis c/s: hypoxemia, intracranial hemorrhage or any CNS abnormality, hypoglycemia place in heated environment - 22 C/71 F neutral thermal environment: double walled, servo-control incubator (a radiant warming panel), an open bassinet w cotton blankets should have a fabric insulated cap to conserve the heat

steps for any procedure

- FIRST: verify consent - when administering blood, check patent IV line first then check the blood product - ID the pt

diabetic ketoacidosis

- Fluids (add dextrose to the IV fluid when BG approach 250 to prevent hypoglycemia and cerebral edema), insulin, K+. Blood sugar 300-800 - dropping a client's blood glucose too quickly can result in cerebral edema - use low sorbing pump to ensure the desired amount of insulin is infusing - hourly check bg, breath sounds (low-pitched, rustling breath sounds - vesicular) , abg, and ms - freq v/s, ECG for dysrhythmias

types of dressing

- Gauze: maintains moist wound surface; cleans, packs and covers wound - Nonadherent dressing: saturated w saline, petrolatum or antimicrobials; used for minor wounds or as a 2nd dressing - Transparent films: used w dry, uninfected wounds or wounds w minimal drainage (Bioclusive, Tegaderm) - Hydrocolloids: promote debridement and creation of granular tissue; adherent and non-permeable to water vapor and O2; used on wounds w moderate heavy drainage; can get wet w showering/bathing; can stay for a wk (Aquacel, DuoDerm) - Foams: have a water-absorbing surface which makes contact w the wound and a water-resistant backing to prevent leakage; used on wounds w large amounts of exudate; requires a 2nd dressing (Hydrasorb, Lyofoam) - Hydrogels: used on superficial wounds w mild to moderate drainage such as abrasions, skin grafting and draining venous ulcers; provide autolytic debridement; semi-transparent; requires 2nd dressing to keep in pace (Aquaform, Nu-Gel) - Alginates: as exudate is absorbed, fiber turns into a viscous hydrogel; useful w macerated or irritated tissue; ideal for a deep cavity, wound or sinus tract; requires 2nd dressing; freq change - Antimicrobials: delivers silver, iodine and polyhexamethylene; used w partial and full thickness wounds and over surgical incision - negative pressure wound therapy improve blood flow

eclampsia

- HTN, proteinuria, tonic-clonic seizures, coma - obstetrical emergency - IV with large-bore needle, minimize stimuli, maintain airway, provide O2 - Mg sulfate, hydralazine HCl, diazepam, nifedipine - prepare for delivery; monitor fetal status - monitor for seizures

cranial nerves

- III oculomotor - pupil constriction, raising eyelids; have look up, down, open eyes; shine penlight into eyes -- PERRLA - IV trochlear - downward and inward movement of eyes; have look down, watch finger go toward face - V trigeminal - jaw movement, sensation on face and neck; touch w pin and cotton; have open jaw, bite down; corneal reflex - VI abducens - lateral movement of eyes; have look down, watch finger go toward face - VII face - facial movement, taste on anterior 2/3 of tongue; have frown, smile, raise eyebrows; place sweet, sour, bitter, salty substances on tongue - VIII acoustic- sense of hearing and balance; have listen to ticking watch, caloric test - delivering cold/warm water into the ear canal - the inner ear will change temp and nystagmus (constant rapid involuntary eye movements will occur, seen commonly after birth) - IX glossopharyngeal - swallowing, taste on posterior of tongue; place sweet, sour, bitter, salty substance on tongue; check swallowing, elicit gag reflex - X vagus swallowing and speaking; have say "ah" and speak - XII hypoglossal - tongue movements; have stick out tongue and move side to side

Ultrasonic flow detection - Doppler studies

- Indicates obstruction in blood flow in extremities - electronic stethoscope that detects sound of blood flow

surgery drains w suction

- JP tube, hemovac - exert constant, low pressure suction - JP: notify HCP if drainage increases or becomes bright red; to remove fluid in the bulb, remove the plug and turn it upside down - hemovac: remove the plug, place on flat surface, compress completely to remove air, replace plug, empty q 8 hr or when full

antidepressants

- MAOIs: isocarboxazid, tranylcypromine, phenelzine increase NE,DO, E, Serotonin SE: hypertensive crisis (headache, sweating, palpitations, stiff neck, seizures) - foods containing tyramine and OTC meds w/ ephedrine, peudoephedrine; photosensitivity - avoid fava beans, soybeans, overripe fruits, fish sauce, pickled foods (sauerkraut), snow peas, chicken or beef liver pate and caviar, smoked or pickled meats/fish/poultry Do not give amphetamines, methyldopa (antihypertensive -decrease stimulation of the adrenergic receptors - alpha and beta), levodopa, dopamine, E, NE, imipramine, or vasoconstrictors, opioid analgesics (hypo/hypertension, coma, convulsions, death), hypoglycemia w insulins and oral glycemics; no CNS depressants Needs to be d/c 10 before a procedure involved anesthesia. MAIOs can lower seizure threshold -SSRIs fluoxetine, paroxetine, sertraline, citalopram SE: anxiety, GI upset, change in appetite and bowel function (d/constipation), taste changes, urinary retention, dry mouth, sexual dysfunction, insomnia nx: SI precautions d/t increased motivation; take in the am; not with MAOIs (serotonin syndrome) -SNRIs: venlafaxine, duloxetine (no interaction w nicotine) - tricyclics amitriptyline, imipramine (used in kid who had enuresis [ bed wet]) AE: anticholinergic effects in the CNS and PNS; sedation, blurred vision, confusion, postural hypotension, photosensitivity, bone marrow depression Can also be used as a sleep aid (sedative effect) - take at bed time Monitor V/S (can prevent therapeutic response of some antihypertensives) and lab work (bone marrow depression). Can decrease seizure threshold If stop abruptly: headache, vertigo, nightmares, malaise, weight change - heterocyclics (atypical) bupropion (smoking cessation), trazodone (also tx insomnia) alters effects serotonin on CNS, can also affect NE and DO SE: dry mouth, n, insomnia & agitation (bupropion) , sedation & orthostatic hypotension (trazodone), tremors Wean off slowly (esp bupropion) bupropion can lower seizure threshold

OA/RA/gout

- OA is a chronic joint disease involving progressive degenerative changes in articular cartilage covering joint surfaces and proliferation of bone and cartilage in joints - local and no remission - spur formation; closure of joint spaces - x-ray show narrowing of joint spaces - risk factors: increased age, obesity, trauma to joints d/t repetitive use (carpet installer, construction worker, farmer, sports injuries, coal miner), accident to foot, other inflammatory process - RA: systemic - high fever (esp in JRA) and remission/exacerbation, salmon-pink macular rash on chest, thighs, and upper arms - C-reactive protein, rheumatoid factor (may be negative), ESR, ANA, aspiration of synovial fluid - Risk factors: positive family hx - bone ankylosis - Gout - tophi: deposits of urates in joints - synovial aspiration; WBC, ESR, uric acid level - ASA - risk factors: obesity, diuretics, family hx - arthrocentesis: needle puncture of a joint space to remove accumulated fluid - elastic bandage wrap and joint test for 24 hr to prevent hemorrhage - arthroscopy: local anesthesia, breathing exercise, post-test bulky pressure dressing

methimazole

- take w meals to minimize adverse GI effects - can c/s cellular damage, including carcinogenesis and mutagenesis - not use in liver disease, bleeding disorders, or during the first trimester of pregnancy

isoproterenol

- SE: headache, palpitations, tach, changes in bp, angina, bronchial asthma, pulmonary edema - stimulates beta 1 &2 adrenergic receptors - used for heart block, v. arrhythmias, and bradycardia - bronchodilator used for asthma and bronchospasms - don't give at bedtime - monitor bp and pulse

7 yr

- team games/sports - develops concept of time - prefer playing with same sex - average weight-39-66.5 lb (17.7-30 kg); height - 44-51 in (111.8 -129.7 cm)

cholecystectomy

- T tube inserted into the common bile duct to ensure drainage of bile from common bile duct until edema in area diminishes: nx- 500-1000/d, use zinc oxide or water-soluble lubricant, clamp 1 hr pre and post meals, removed 1-2 wk after surgery, maintain semi-fowl after removed for right shoulder pain d/t co2 during laparoscopic

V/S in elderly

- temp: usually lower; fever if > 100 (37.8); high risk for hyperthermia & heatstroke - pulse: decreased resting HR; HR takes longer to rise; can be harder to auscultate - respiration: increased reliance on abd muscles

pursed lip

- This type of breathing involves deep inspiration and prolonged expiration through pursed lips to prevent alveolar collapse - COPD (SpO2 > 88% implies adequate oxygenation; normal is >92%) - during transition phase active labor: allows client to control pain and urge to push and promotes adequate oxygenation of fetus - as if blowing air through straw - holding breath is contra during active labor as it interferes w oxygen and CO2 exchange

Phenazopyridine

- Urinary Tract Analgesic; reduce spasms in urinary tract - SE: headache, vertigo - nx: urine will be bright orange (also possible to stain clothing); take w meals

postural drainage

- Uses gravity to facilitate removal of bronchial secretions - client placed in variety of positions (head down, prone, place on R. lateral then L. lateral, then upright; the client stays in the position for 10-15 min) to facilitate drainage into larger airways, basically from lungs and bronchi into trachea; secretions may be removed by coughing or suctioning (normal pressure 80-120) - place a pillows under the knees to elevate the thighs - place pressure on the diaphragm and helps move secretions - upright position does not help move secretions - prevents complication of stasis of respiratory secretions - performs 2-4 x/daily; usually before meals and at bedtime

culdoscopy

- Visualization of the ovaries, fallopian tubes, uterus via lighted tube inserted into vagina and through cul-de-sac. - Local anesthetic, light sedation - Knee to chest position. - Post procedure position on abdomen with pillow under. Observe for vaginal bleeding, avoid douching and sex for 2 weeks.

intussusception

- a proximal segment of the bowel telescopes into a more distal segment, c/s obstruction (leading c/s of intestinal obstruction in kids btw 5 mo and 3 yr); usually occurs at the ileocecal valve - sudden, intermittent, acute abd pain, screaming and drawing knees up toward the chest, current jelly stool (the trapped section may have its blood supply cut off - c/s ischemia and mucosal sloughing off into the gut), vomiting/anorexia/d, tender, distended abd - affects males more; hx of viral infection - a barium or air enema for dx and tx - demonstrate model of the condition by pushing the end of a finger of an exam glove back into itself - maintain npo, routine lab, NG tube, IV, abx, a/s stool - if the kid pass a normal brown stool - the condition is spontaneously reduced itself

BP cuff deflation

- a rate of about 2-3 mm Hg/sec - systolic: the blood's force against the artery walls in order to pump blood to peripheral organs - 1st sound means the systolic pressure is now greater than the pressure exerted on the artery by the inflated bp cuff - diastolic: reflective of the pressure on the artery walls as the heart relaxes btw forceful beats - client should avoids caffeinated products, smoking, or exercise for at least half an hour before bp measurement - avoid measure bp in the arm where lymph node dissection for tx of breast cancer - inflate the cuff to a pressure of 30 above the level at which the radial pulse is no longer palpable - the nurse should release the bp cuff about 30-45 sec for a range of 90 mm Hg (e.g. if the radial pulse is about 60) - BP measure above heart: too low; below heart: too high

IV infusion

- a time tape should be placed along the mL marking of the solution bag - do not use marking pens because chemicals within the ink can be absorbed by the plastic and inadvertently contaminate the solution

paroxysmal atrial tachycardia

- a vagal maneuver can be used to increase intrathoracic pressure to stimulate the vagus nerve - cough, forcefully blow through a straw, bear down

thyroid storm

- a/s: abrupt onset of CHF, delirium, altered clotting, fever, increased HR/BP/RR - nx: hypothermia blanket, O2, potassium iodine, PTU (anti-thyroid hormone), propranolol (BB), hydrocortisone (replace cortisol)

leukemia

- a/s: altered leukocyte count - 15, 000 - 500, 000 x 10^3, ulceration of mouth, anemia, fatigue, bone/joint pain, pallor/weight loss, bleeding (ecchymosis, petechiae, retinal hemorrhaging), headache/disorientation/convulsions, hepatomegaly & splenomegaly

alzheimer's disease

- a/s: forgetfulness, changes in motor activity such as cont pacing/wandering/restlessness (early), paranoia, short attention span, agitation, night wandering (secure doors leading from house; nx gently distract and redirect wandering behavior), incontinence, depression - nx: avoid restraints - cholinesterase inhibitors (galantamine, rivastigmine, donepezil) for mild to moderate disease - reduce some symptoms and help control some behavioral symptoms - N-methyl D-aspartate (NMDA) antagonist (memantine - regulate glutamate - excessive glutamate can lead to brain cell death) - moderate to severe - decrease symptoms - maintain certain daily functions a little longer

cholelithiasis, cholecystitis (gallstones)

- a/s: intolerance to fatty foods, indigestion, n/v, flatulence, belching (eructation), severe pain in URQ radiating to back and R shoulder (biliary colic), elevated temp, leukocytosis, diaphoresis, dark urine, clary stools - risk factors: obesity, sedentary lifestyle, women esp multiparous, >40yr, pregnancy, hypothyroidism, increased cholesterol, fasting, Native/Mexican American - surgery: four small punctures made; resume normal activity in a wk, low-fat diet for several wks - removal of gallbladder (may need glucose and protein hydrolysates to aid in wound healing and prevent liver damage)

squamous cell carcinoma

- a/s: red, rough, thick, scaly tumor on arms or face; firm, nodular lesion covered by a crust; most commonly seen on the lip, ears, head, neck, and back of hand; may metastasize (most often to the blood or lymph nodes)

basal cell carcinoma

- a/s: small, waxy nodule on sun-exposed skin, nodule on sun-exposed skin, nodule crusts and ulcerates, most common skin cancer, rarely metastasizes but freq reoccurs

pancreatic tumors

- a/s: weight loss (early), anorexia, d/constipation maybe, vague upper or mid-abd discomfort (radiate to the back; early sign), intolerance to fatty foods or even all foods and freq belching (late stage), hyperglycemia/abnormal glucose tolerance test, jaundice (early), clay-colored stools, dark urine - postop care-Whipple procedure: monitor for intestinal obstruction/peritonitis, monitor for v/s - hypotension, monitor stools for steatorrhea

neurogenic shock

- above T6 - loss or disruption of sympathetic tone - peripheral vasodilation and subsequent reduced tissue perfusion - warm, dry, flushed skin; a drop in BP; decreased CVP - in severe case: the client may experience difficulty breathing, slow faint pulse and bradycardia, chest pain, central or peripheral cyanosis, hypothermia, weakness from irregular blood circulation - need vasopressor

safe IV therapy

- access ports should be cleansed w alcohol, tincture of iodine, or CHG for 30-60 sec - when preparing a cont insulin infusion, the first 50 mL of fluid should be discarded - when injecting a med bolus, the IV tubing above (proximal to) the injection port should be occluded to prevent backward flow of the med into the IV tubing and primary IV solution - time the med administration w a watch

postpartum hemorrhage

- accurate measurement of blood loss is accomplished by weighing peri pads - risk factors: multiparity, retained placental fragments, over distended uterus, prolong labor, delivery of a large infant (>9 lb), cervical or vaginal lacerations, coagulopathy - a/s: boggy uterus; large: blood loss greater than 6 in to saturated on a peri pad in 1 hr; moderate: >4 in but < 6in; lochia regresses to the previous stage - nx: massage uterus until film, administer synthetic oxytocin (also misoprostol, prostaglandin, ergonovine, or methylergonovine maleate)- produces contractions, controls hemorrhage; SE: HTN, n/v; monitor for shock

St. John's Wort

- action: antidepressant, sedative, antiviral, antimicrobial - se: photosensitivity, fatigue, restlessness - nx: decreases effectiveness of digoxin, antineoplastics, antivirals, AIDS meds, antirejection meds, theophylline, coumadin, oral contraceptives, statins, warfarin, hormonal contraceptives contra: SSRIs, MAOIs, major depression, anticonvulsants 5HT, preg&lac, <2 yr

garlic

- action: antimicrobial, antilipidemic, antithrombotic, antitumor, anti-inflammatory - se: flatulence, heartburn, irritation of mouth/esophagus/stomach nx: may potentiate anticoagulants, antiplatelets, antidiabetics, antihyperlipidemics, antihypertensives; avoid if allergic to lily family, may decrease effectiveness of oral contraceptives

chondroitin/glocosamine

- action: collagen synthesis - used for arthritis - se: dyspepsia, n - nx: chondroitin may potentiate anticoagulants; glucosamine may impede insulin secretion or increase resistance

Antiplatelets

- adenosine diphosphate receptor antogonists: ticlopidine (high risk of hemorrhage; greater risk of toxicity w elderly), clopidrogrel: prevent platelet aggregation(not-decrease-platelets) - dipyridamole (+ ASA): administer 1 h ac or w meals, monitor BP; AE: headache, dizziness, HTN/hypotension, EKG changes - dipyridamole, adenosine, and dobutamine are given to a client who cannot perform physical excise for stress test - glycoprotein IIb and IIIa receptor antagonists: epitifibatide, abciximab: does not increase risk of fatal hemorrhage or hemorrhagic shock - ASA: prolonged use- metabolic acidosis, resp alkalosis (later acidosis), dehydration - give w milk, water, or food, or use enteric-coated tablets

anaphylaxis - implementation

- administer 0.3-0.5 mL epi 1:1000 sq/im - decrease epiglottal edema and bronchoconstriction - if iv epi: 1: 10,000 - iv fluids - antihistamines, corticosteroids, inhaled bronchodilators may also use - vasopressor may be needed for continued hypotension

liver biposy

- administer vit K IM to decrease chance of hemorrhage - npo morning of exam (6hr) - sedative administration just before exam - teach client that he will be asked to hold his breath for 5-10 sec - performed at bedside, supine position, lateral with upper arms elevated -post test: position on right side for 2-3 hr with pillow under costal margin - expect mild local pain and mild pain radiating to right shoulder - if client report severe abd pain immediately - may indicate perforation of bile duct and peritonitis

pneumococcal

- administered to immunize against strep. pneumoniae - first dose recommended: < 65 of chronic lung disease, liver disease, cv disease, DM, spleen disorders, immunocompromised; residents of nx homes; client > 65; cigarette smokers - re-vaccination recommended: clients over 65 yr if vaccinated more than 5 yr previously; less than 65 years with initial vaccination; client 19 to 64 if: chronic kidney problems; immunocompromised - administer q 5 yr

polio

- adults traveling to certain parts of the world, lab workers & HCP possible expose to polio - contraindications: anaphylaxis to neomycin, streptomycin, or polymyxin B

RA

- affects lining of the small joints - a/s: pain, joint and muscle stiffness (wakes up in the morning and pursue for an hour; and after periods of activity or sitting); contracture deformities; nodules; fever low grade - remission and exacerbation; systemic and progressive

OA

- affects the cartilage inside the joint (any joints) - pain and stiffness in the joints; Heberden's (closer to finger nails) and Bouchard's (middle) nodules of fingers - nonsystemic, degenerative, no remissions

strep throat

- after 24 hr of abx therapy, it is no longer contagious - fever is the body's reaction to disease as a defense mechanism; being afebrile is often a condition for being able to work

herpes zoster

- airborne and contact for disseminated herpes zoster - vesicular eruption along nerve distribution. pain, tenderness, and pruritus over affected region. primarily seen on face, thorax, trunk -- post-herpetic neuralgia is common in clients after the acute outbreak of shingles has been resolved - shingle rash - usually appears in a band, a strip, or a small area on one side of the face or body - headache and sensitivity to light - flu-like symptoms, but no fever - change in vision; rash or blisters on the face, esp near an eye or on the tip of the nose, can be a warning or eye problems - c/s by reactivation of chickenpox (varicella) - analgesics; compresses, antivirals (famciclovir, and valacyclovir) - systemic corticosteroids to diminish severity - contagious to anyone who has not had chickenpox or immunosuppressed or varicella zoster vaccine - positive titer: immune to the virus - adequate immunity - shingles cannot be transmitted to others.

Home Mechanical Ventilators

- alert the power company, fire and police departments, and 911 that there will be an individual at home w a ventilator - this should be done before discharge - place the ventilator on a sturdy utility cart so that it can be stable and easily maneuvered - people required: ALS, COPD, SCI, muscular dystrophy

antineoplastic

- alkylating agents: cisplatin, cyclophosphamide - interferes with rapidly reproducing DNA - uses in metastatic testicular cancer, ovarian &cervical cancer, head/neck, advanced bladder cancer (smoking is a high risk factor) - AE: hepatotoxicity, bone marrow suppression, n/v (cisplatin can produce severe, protruding v), stomatitis, alopecia, ototoxicity, gonadal suppression, neuropathy -nx: check hematopoietic function, antiemetic prophylactically and symptomatically, good mouth care, IV site - infiltration, extravasation - women's ovarian function may resume after therapy but not guarantee - may need to refer to reproductive service prior to therapy - antimetabolites: 5-FU (fluorouracil), methotrexate - inhibits DNA polymerase - cell division halted - use in acute lymphatic leukemia, RA (methotrexate, also psoriasis and lupus), trophoblastic neoplasms, cancer - breast, head/neck, lung - SE: n/v/d, stomatitis, bone marrow suppression, alopecia, photosensitivity - nx: similar above; methotrexate: monitor abd pain; get baseline of level of pain, range of motion - antitumor antibiotics: doxorubicin, bleomycin, actinomycin - interferes w DNA and RNA synthesis - uses in hodgkin's/non-hodgkin's lymphoma, leukemias, breast/ovarian/bladder/bronchogenic cancers - SE: bone marrow suppression, alopecia, stomatitis, n/v, cardiac toxicity, red colored urine one or two days after receiving a cycle of doxorubicin - nx: monitor hematopoietic function, v/s, teach the client about risk of HF (SOB, edema), antiemetic, moth care - vinca alkaloids: vinblastine, vincristine - interferes w cell division - use in hodgkin's, leukemias, neuroblastoma, rhabdomysarcoma, wilm's tumor - SE: stomatitis, alopecia, neuropathy, bone marrow suppression, loss of DTRs - nx: monitor numbness, tingling, pain, have trouble or difficulty walking or gait disturbances, wrist or foot drop - give w allopurinol, NSAIDs, corticosteroids for gout (painful & inflamed joints, particular great toe) - hormonal agents: tamoxifen (pre and postmenopausal women; prostate), anastrozole/lectrozole/exemestane (postmenopausal), fulvestrant, leuprolide (suppresses ovarian function - put you into menopause) - changes hormone input into sensitive cells - use in breast and prostate cancer - SE: hot flashes, arthralgias, bone pain, hypercalcemia (tamoxifen), thrombotic event (tamoxifen and fulvestrant), vaginal dryness (anastrozole), osteoporosis (anastrozole) - nx: monitor Ca, bone density scan, report abnormal vaginal bleeding, DVT/PE symptoms (SOB, weakness, chest pain, confusion), id triggers for hot flashes, sleep under fan, no caffeine/spicy food/red wine, dress in layers, lubricant for vaginal dryness

fontanels

- anterior: diamond shape 2.5-4 cm, close by 18 mo - posterior: triangle shape 0.5 - 1 cm, close between 8-12 wk - hc: measured until 36 mo

antiparkinsons

- anticholinergics: benztropine, trihexyphenidyl - dopaminergic agonists: bromocriptine and levodopa - SE: dizziness, ataxia, atropine-like (anticholinergic) effects - AE: confusion, psychosis, hemolytic anemia - nx: assess extrapyramidal symptoms - akinesia (loss of ability to voluntarily move), rigidity, tremors, pill-rolling motions, mask facies, shuffling gait, muscle spasms, oculogyric crises and drooling; monitor for urinary retention; early signs: tightening of jaw, stiff neck, swollen tongue -- avoid Vit B6 - reverse the med's effects; avoid use of CNS depressants; potential for orthostatic hypotension; avoid overheat in hot weather - parkinson syndrome (shuffling gait, rigid muscles, excessive salivation, tremors, mask-like face, motor retardation) - contraindications: glaucoma

stomatitis

- antineoplastic med, anticholinergics - swollen gums and tongue, difficulty swallowing, bad breath (halitosis), mouth pain

handling medical wastes

- as long as the bag is sturdy and the waste can be discarded w/o contaminating the bag's exterior, a single-leak resistant biohazrd bag is fine - discard any secretions that risk of escaping: urine, blood soaked dressing, canister of gastric secretions - blood tinged bandage is fine

auditory hallucinations

- ask the nature of command hallucinations: the voices may be telling the client to harm self or others

thoracentesis

- aspiration of fluid or air from the pleural space - to obtain specimen for analysis, relieve lung compression, obtain lung tissue for biopsy, or instill meds into pleural space - informed consent - v/s - monitor color and o2 saturation - position client sitting with arms on pillows on over-bed table or lying onside in bed - expect stinging sensation with injection of local anesthetic and feeling of pressure when needle inserted - check for leakage of fluid, sterile dressing - chest x-ray to ensure absence of pneumothorax

PET Scan

- avoid fluids and food 4 hr before the test - remove any metal objects in the hair -after radioisotope administration, the client wait 30-45min on a stretcher/table so the substance can circulate to the brain - takes 2 hr; void before

wearing pacemakers

- avoid prolonged exposure to electrical devices that may interfere w the functions - keep all electrical devices, including cell phones and hearing aids, at least 6 in away - not linger in or near anti-theft devices -- walk through theses devices at a normal pace

Phenazopyridine

- azo dye excreted in the urine that produces a topical analgesic effect on the urinary tract mucosa - helpful for pt w UTI - can cause orange/red color urine - report if have yellow eye or skin

tracheostomy (cuffed)

- balloon encircles trachea tube to form seal btw outer cannula and trachea. used to permit mechanical vent and protect lower airways - should be inflated: during and after eating, 1 hr after tube feeding, when client unable to handle oral secretions, during mechanical ventilation and resp treatments. - cuff pressure should not exceed 20 cm of h20 - when the trach tube displaced out of stoma, use a hemostat to dilate the opening of the stoma - a newly placed trach will not stay open w/o the tube - because the trach is so new, there is an increased risk that the opening will close or collapse - a hemostat should be at the bedside

ergonomic practices to prevent staff injury

- bariatric client: use a bariatric hoyer lift; lift team; 1 person/100 lb - non- weight bearing pt: use a Hoyer lift; at least 2 pt - pulling multiple clients up:if client can assist, utilize a trapeze bar - stand close to the object being moved; or place the weight of the object being moved close to your center of gravity - avoid lifting - easy to push than pull

alzheimer/Dementia drugs

- check any drugs that affect CNS: antidepressants, antipsychotics, anticonvulsants, antiemetics, antiparkinsons, and muscle relaxants -- divalproex Na (mood stabilizer; traditionally for seizures): AE - sedation, pancreatitis, indigestion, thrombocytopenia, toxic hepatitis. Monitor blood levels; take w food or milk. - anticipate cholinesterase inhibitors and/or memantine, (NMDA receptor antagonist antidepressants), ginkgo biloba, fish oil, vit E

dupuytren's contracture

- contracture of 4th and 5th fingers; associated w several diseases, e.g., DM, gout, arthritis, and alcoholism - dg when a contraction of the palmar fascia c/s the ring and little finger to bend into the palm of the hand, making extension impossible - can be slowly progressive and eventually debilitating if not tx - genetic link - risk factors: male, middle-age, Scandinavian

hyperbaric oxygen therapy

- barotrauma (ear discomfort/trauma d/t pressure changes): swallow or shew gum - nearsigntedness (may last for d-wk after therapy): discuss w HCP (may need to decrease time in chamber) - hypoglycemia (d/t increased tissue insulin secretion, increased insulin sensitivity, increased uptake by the brain): ensure BG 100-150 before tx - oxygen toxicity w seizures: 5 min air break q 30 min - tension pneumothorax: insert a 14/16 G needle into the 2nd intercostal space in the midclavicular line -- needle decompression converts a tension pneumothorax into a simple pneumothorax (does not affect mediastinal), the HCP needs to inserts a chest tube into the pleural cavity to drain the air immediately - HTN d/t vasoconstrictive effects of hyperoxygenation: hold CCB and BB benefits: severe anemia, decompression sickness, CO poisoning, radiation injuries, burns, skin grafts, gangrene, crush injuries, diabetes-related wounds - promote collagen deposits and epithelialization; decrease vasoconstriction, kill anaerobic bacteria, increasing leukocyte activity, enhance growth of new blood cells - multiplace chamber: wear a hood or a mask; mono - nothing; tx last 90-120 min

colonoscopy

- begin low-residue diet several days before procedure and clear liquid diet evening before procedure - clear liquids restricted evening before procedure; avoid liquids w red, blue, purple dye - npo 2-4 hr before - observe for passage of blood and abd pain, signs of perforation, hemorrhage, or resp. distress - resume diet

antidiarrheal

- bismuth subsalicylate -- darkening of stools and tongue -- absorb irritants and soothes intestinal muscle -- give 2 hr before or 3 hr after other meds to prevent impaired absorption; drink more water; take after each loose stool until diarrhea controlled; notify hcp if not controlled in 2d; do not give more than 2 d during fever or for <3 yr old; monitor salicylate toxicity; be cautious if use w ASA; no use before x-rays (is radiopaque) - diphenoxylate HCL and atropine sulfate: -- sedation, dizziness, tachy, dry mouth, paralytic ileus -- onset 40-60 min, increase intestinal tone and decreases peristalsis, may potentiate action of barbiturates, depressants - loperamide -- drowsiness (monitor CNS effects) - opium alkaloids -- narcotic dependence, n -- acts on smooth muscle to increase tone, give w water; dist quickly when stools are controlled

Osteomalacia/rickets

- bone pain and tenderness, muscle weakness, bowed legs, kyphosis, porous bones - decalcification of bones d/t inadequate intake of vit D, absence to sunilght, or intestinal malabsorption, CKD - give vit D, Ca

personality disorders

- borderline: instability, intense emotions, poor self-image, impulsivity. Person may go to great lengths to avoid being abandoned, may have repeated suicide attempts (watch SI all the time), display inappropriate intense anger, or report ongoing feelings of emptiness - obsessive compulsive: not the same as ocd - schizoid: detached from social relationships and expressing little emotion. Not care about praise or criticisms from others.

myelomeningocele

- bulging, sac-like lesion at lumbosacral spine filled with spinal fluid, meninges, portion of spinal cord and nerves; hydrocephalus; paralysis of lower extremities; club feet, kyphosis, scoliosis; neurogenic bladder & bowel - surgical repair - preferably 12 -72 hr after birth - nx: place on abd or semi prone; sterile moist dressing to sac; good skin care, exp in perineal area; maintain warmth, nutrition, hydration, elect balance; gentle range of motion to feet, ankles, knees; use splints to maintain proper body alignment; diet high in Ca and vit D; bowel regimen

seasonal affective disorder (SAD)

- c/s by reduction in natural sunlight during winter months; sadness that cannot be contributed to other cause - phototherapy (max 2500 lux of light 30 min/d) -- should begin in the morning after awakening and repeat exposure to the light after sundown for a cumulative 2-6 hr/d -- sit within 3 ft

intellectual delay

- c/s: heredity, infection, fetal anoxia, cranial or chromosomal abnormalities, intracranial hemorrhage - mild (55-70): slow to walk, feed self, and talk; may be able to learn reading and math for 3rd - 6th grade level - moderate (40-55): delay in motor movement, able to perform some self-help activities, will respond to training, will not progress with reading or math skills, communication poor - severe (24-40): marked delay in development, may not be able to perform self-care activities, will profit from habit training, have some understanding of speech - profound (<25): significant delay, minimal capacity to function, may respond to skill training, show basic emotions

ECT

- candidates: SI or catatonic schizophrenia(sudden onset mutism, bizarre mannerisms, remains in stereotyped position with waxy flexibility; may have dangerous periods of agitation and explosive behavior), mania; pregnant and cannot receive psychotropic meds; unresponsive to multiple trials of meds - contra: cardiac problems, bone weakness or osteoporosis (cue: who takes alendronate), severe pulmonary disease, loose teeth (aspiration risk) - c/s chemical changes in the brain, though the exact mechanism is still unknown; changes mlcl and cells to help relive depression - dose not help: anxiety, phobias, behavior or personality - 2-3 tx/wk (may feel better after but need to take the full), total of 6-12 sessions - npo 8-10 hr d/t anesthesia - administer atropine before the procedure to decrease secretion

induction of labor

- cannot perform if there is cephalopelvic disproportion (CPD) - indicated: mature vertex presentation, engaged head, a ripened cervix; diabetes, postmaturity, PIH, fetal jeopardy, logistical factors (rate of rapid birth, distance from hospital) - nx: fetal monitoring, monitor v/s of mother, monitor progress of labor, prepare for amniotomy, begin synthetic oxytocin administration per pump, contractions q 2-3 min, lasting 90 sec or less - nurse should stop the induction if fetal distress occurs or if hypertonic contractions begin (lasting longer and more freq)

NG tube implementation

- check residual q 4 hr with cont feeding and reinsert those gastric contents - hold feeding if >100 mL - delayed gastric emptying - call HCP - instill 15-30 mL water before and after each dose of med and each tube feeding, after checking residual, q 4-6 hr w cont feeding - change bag q 24-72 hr - HOB at least 30 - irrigation: verify placement; insert 30-50 mL of NS, withdraw solution, if aspirated amount > instilled - record as output/ if no aspirated - record as input - after surgery, a bright red color at first w a gradual darkening and decreases in amount within 36-48 hr

PCN

- cillin - inhibits synthesis of cell wall - stomatitis (can eat w food), diarrhea, allergic reactions, renal and hepatic changes - IM injection: observe for 20 min - take 1-2 ac or 2-3 pc - cross allergy w cephalosporins - IV push okay

v/s during pregnancy

- circulating blood volume increases 40-50% - BP changes little: resistance to blood flow through the vessels decreases - HR increase by accommodate the additional blood volume (increased CO) - RR deeper but only increases slightly - rbc, wbc, and fibrinogen levels increase - increase blood flow to the kidneys and in GFR - mild glycosuria and proteinuria may be present - secretion of relaxin loossens the joints

AV fistula assessment

- circulation check: pulses, sensation, coolness, pallor, cap refill - dialysis access-associated steal syndrome (DASS)/arterial steal syndrome - decreased perfusion of the extremity distal to the AVF - palpate for a thrill(absence means clots or thrombosis) and bruit/swishing sound - a steady, cont thrumming - tenderness is associated w s/s of infection, along w redness, swelling, or purulent drainage

self-cathetherization

- clean perineum with soap and water - location insertion point (female - see and palpation; male - see) - should be done q 4-6 hr, remove 350-400 mL each time - should drink 250 ml at 2 hr intervals or up to 2 L at regular intervals

urine c/s

- cleanse external meatus with povidone-iodine or soap and water before test - normal: less than 100,000 colonies/ml

dementia pt

- client soon forgets orientation - should be encouraged to talk about past life and important things in the past b/c the client has recent memory loss (reminiscing therapy) - no flexible schedule - should have a consistent, repetitive, and reinforced routine - mini cog: repeat back three items the HCP lists; then draw a clock; then repeat back the same items

psych therapeis

- cognitive: assess language use (both in thought and speech) - speech and writing are used to express thoughts - indicators of the client's automatic thoughts schemata, or cognitive structure about themselves, the world, and cognitive distortions - psychoanalytic and dynamic: focus on client's insight

screening tests for colorectal cancer

- colonoscopy q 10 yr - fecal occult blood q year - barium enema q year - screening begins at 50 risk factors include: AA, Jewish persons of Eastern European descent, Type 2 DM (high risk >45), IBD, males

T-tube

- common bile duct - initially 500-1000 mL/d, bloody first 2 hr - then can change to bright yellow/dark green - keep bag below waist - may not be removed in 1-2 wk - can clamp the tube one hr before up to 1 hr after each meal

vertical evacuation

- complete evacuation of a specific floor in a building - clients and staff evacuate vertically towards ground level whenever possible (at least 2 floors from the incident), helps prepare for total or full evacuation of the facility should situation worsen - during vertical evacuation of one floor, other floors may be ordered to shelter in place or prepare for their own evacuation

Total or full evacuation

- complete evacuation of everyone - usually last resort

hypophysectomy

- comps: hematoma, CSF leak (halo, double ring on gauze), epistaxis, DI, SIADH -postop care: maintaining gauze that is covered in petroleum jelly or a balloon-tipped catheter placed in the sphenoid sinus to prevent bleeding or CSF leak, check any protein or glucose, elevate hob, neuro check, abnormalities in ADH secretion)

preop routine

- consent - V/S - IV fluid - void BEFORE anesthetics - lie down - surgeon come - meds Time out: awake pt should confirm right side of the surgery meds for cardiac can be taken 2 hr before surgeries transplant: - a/s support system and grasp of required lifestyle changes - client will need to avoid contact sports - monitor daily weight w I&O, resp status, labs, well-balanced meals, standard precaution, immunosuppressive meds and possible SE

transurethral resection of the prostate (TURP)

- cont bladder irrigation (CBI): prevent blood clots and light pink color; use of glycine to irrigate the bladder can c/s transurethral resection syndrome - lead to hyponatremia (n/v, confusion, bradycardia, hypotension); use NaCl instead; monitor inflow and outflow q hr: outflow should ALWAYS be greater than inflow unless the catheter is no longer patent; if less than inflow, manually irrigate w NS and notify HCP if patency cannot be reestablished - ideal height of the irrigation bag should be 60 cm (23.6 in) and above to achieve adequate flow of fluid - monitor for bladder spasms and leaking around the catheter: medicate w antispasmodics - bladder spasms may occur d/t irritation of blood , presence of the catheter or clots - monitor urethral opening - traction can result in local necrosis - stay 2-4 d - will also have a PCA - monitor hemorrhage - prevent obstruction of the urinary catheter - occasional small clots and pink urinary drainage are expected shortly after the procedure - voiding trial; kegel exercise: tighten the pelvic muscles for 5 sec; then relax and repeat; try to abstain from voiding for at least 4 hr to help increase bladder tone - report: increased hematuria, fever, inability to pass urine, agitation or ms changes, blurred vision, n/v

statin

- contra in pregnancy - blood test at least once a year - familial hypercholesterolemia (FH) is a group of autosomal dominant condition w elevated LDL

insert VAD

- contra in the extremity that has mastectomy -- after mastectomy: the limb should not flex or in dependent position - impede lymphatic drainage and compromise circulation -- removal of lymph tissues increases the client's risk of developing lymphedema - increase pain - limb should elevate on a pillow; pt in semi-fowler - stroking the vein from distal to proximal to dilate the blood vessel - inflates a BP cuff to dilate and reduce the risk of hematoma and infiltraiton

flecainide

- contraindicated in clients w CAD or HF b/s it weakens the force of muscular contractions of the heart

afib

- controlled v. response: v rate 60-100 - rapid v response (RVR): v rate >100 (this client should be seen first) - paroxysmal (begin and end suddenly) or last > 7 d (persistent afib) decrease v response: CBC, BB, digoxin prevent stroke: anticoagulation convert to sinus rhythm: amiodarone, adenosine, cardioversion, radiofrequency catheter ablation

a. flutter

- convert back to sinus: adenosine 6 mg iv f/u by rapid 20 mL NS flush and elevate the arm. In 2-3 min, if no change in the rhythm, repeat 12 mg adenosine; sedate the client and provide synchronized cardioversion; perform radiofrequency catheter ablation to destroy foci of re-entry impulse (rate can be 250-400) - reduce the ventricular rate (if too fast): vagal maneuvers if v. rate elevates, valsalva, BB or CCB - prevent thrombus formation and cerebral emboli: give anticoagulation therapy

umbilical cord prolapse

- cord below the presenting part of the fetus; compresses the cord - c/s fetal hypoxia resulting in cns damage and fetal death - c/s: gravity pushing cord in front of presenting part after rupture of membranes, long cord, malpresentation including presenting part not engaged, placenta previa - tx: puts direct finger pressure on presenting part; relieves pressure on cord; place client on Trendelenburg or knee-chest position; prepare emergency c/s if the cervix not fully dilated

tonsillectomy

- corticosteroids to reduce edema - intake of apple/grape juice is okay - take pain med an hr before meals

safety precautions for ears

- cotton-tipped applicators are only safe for outer ear - blowing with one nostril closed can push foreign material into eustachian tube

tetracyclines

- cyclines - inhibits protein synthesis - SE: discoloration of primary teeth if taken during pregnancy, glossitis, rash, photosensitivity (severe) - take 1-2 ac or 2-3 pc - not w antacids, milk, iron - renal function - not for kids <8 (discoloration and inadequate calcification of teeth)

postpartum depression

- decrease in estrogen may precipitate post partum depression - a/s: sadness, crying, fatigue, appetite and sleep disturbances, "roller-coaster" emotions, "letdown" feeling - screening at 1, 2, 4 mo - underactive thyroid gland can contribute to the S - risk for suicide increases when the client is coming out of a depression

antacids

- decrease stomach acidity, increase gastric pH, decrease pepsin levels, decrease prostaglandin formation - dyspepsia, GERD, PUD, stress ulcers (antacids do not promote healing of ulcers), hyperphosphatemia (in CKD) - Ca carbonate, NaHCO3, Mg hydroxide, Al hydroxide - precautions and contraindications: --Ca: kidney stone, renal disease, parathyroid disease --Na: HTN, HF, kidney disease --Mg: renal disease --Al: bone disease (osteomalacia - softening of the bone) - reactions --Ca: acid rebound, n/v, constipation -combine with other antacids to reduce constipation --Na: increased thirst, Na retention --Mg: diarrhea --Al: constipation, hyperphosphatemia A/S: bowel, renal function; abd pain (peritonitis, risk for perforation), fluid balance implementation: administer after meals, chew tablets and swallow w water, shake liquid prep, avoid taking antacid with any meds (absorption may reduce)

modified risk factors for HTN

- decreased dietary intake of K, Mg, or Ca: a combination of hypercalcemia and hypomagnesemia may c/s muscle spasm w cardiovascular consequences; adequate K reduces the risk of CHD - coffee use is not a risk factor - before 55: mem has higher risk; after 55, women

lumbar sympathetic block

- decreased limb pain and increased temp indicate sympathectomy could improve circulation to the extremities - local anesthetic is injected into sympathetic ganglia, temporarily blocking the sympathetic vasomotor nerve fibers supplying an ischemic limb - shock d/t movement of blood from vital organs to peripheral vessels

myasthenia gravis

- deficiency of acetylcholine - it is not hereditary; no muscular dystrophy or loss of sensation - neither CNS or PNS dysfunction - muscular weakness produced by repeated movement (when the client rest these muscles, they will regain their strength), dysphagia, respiratory distress, diplopia, ptosis (good eye care); soft, weak voice when speaking - muscle weakness worsens after periods of activities and improves after reset; strongest in the morning and weaker as the day goes - give meds before eating: anticholinesterase (pyridostigmine), corticosteroids (blood sugar), immunosuppressants (ivig)- wear medic alert, plasmapheresis - avoid factors that precipitate myasthenia crisis: surgery, infections, use of streptomycin, neomycin (muscle weakness) - myasthenia crisis: aspiration (assist w eating!), resp infection/failure

Parkinson's disease

- deficiency of dopamine - tremors, muscle rigidity, propulsive gait, monotonous speech, dysphagia, drooling, no facial expressions - does not lead to paralysis - sight and hearing are intact - airway! - med: trihexyphenidyl, benzatropine, levodopa, bromocriptine mesylate (antipsychotic, counteract neuroleptic malignant syndrome), carbidopa/levodopa, amantadine HCl - deep brain stimulation may reduce S/S

multiple sclerosis

- demyelination of white matter in brain and spinal canal - changes in vision, sensation, motor function, bowel and bladder function; brain interruptions; speech problems; emotional changes; difficulty swallowing, breathing difficulties; weakened immune system; increased CV risk; upset stomach; heightened pain; sexual dysfunction

durable power of attorney

- different from a living will in that the client does not have to be terminally ill or in a persistent vegetative state for durable healthcare power of attorney to take effect - only become effective when client no longer capable - nx: determine on admission whether advance directive exists according to patient self-determination act

dysphagia

- difficulty swallowing - avoid milk-based products; instruct client to use tongue actively

urinary incontinence

- kegel exercises: pubococcygeal muscle stops the flow of urine; tighten muscle, hold for count of 3, relax, practice 10x TID - avoid caffeine

cystoscopy

- direct visualization of the urethra and urinary bladder with an endoscope - bowel prep - teach client to deep-breathe to decrease discomfort - npo if general anesthesia used - check for abd distention, urinary frequency, fever - urine usually pink-tinged - abd or pelvic pain indicates trauma - provide antimicrobial prophylaxis

ego defense mechanisms

- displacement: yell at the dog when angry w the boss - projection: I am angry w you because you dislike me - undoing: I am sososo sorry - compensation: a small person excels in sports - substitution: marry someone likes ex - introjection: blame self when angry w others - repression: cannot remember sth involuntarily - suppression: consciously putting sth away - sublimation: substituting constructive activity for strong impulses that are not acceptable; change sth negative for sth positive - intellectualization: excessive use of reasoning or logic to prevent a person from feeling - rationalization: justify an unreasonable act or idea - identification: modeling self after a "hero"

picc line

- distal end in the SVC - a catheter tip embolus may be the actual tip or a portion of the catheter - the original length of the picc should be noted - apply a tourniquet to the upper arm to prevent the catheter advance into RA if the full picc is not removed - check radial pulse to ensure the tourniquet is not too tight - push-pause technique c/s turbulence in the lumen, removing any debris and decreases the chance of the line clotting

epidural med

- do not affect uterine contraction, not increase the freq of urinary elimination - can c/s vasodilation - hypotension

a client's cervix is 5 cm dilated and 100% effaced, and the fetal head is at -1 station. The membranes rupture, and the fluid is clear.

- do not ambulate the client bc the head is too high at -1. The cord may prolapse - it is too early to set up for delivery as the client has approx 2-3 hr or more hr of labor remaining. Sterile equipment should be opened for no more than 1 hr - voiding facilitates descent of the fetal presenting part - taking temp b/c of ruptured membranes

limit setting

- do not argue w the psych/substance abuse clients - e.g. tell them to speak quieter - ensure pt safety - needs a consistent, undivided staff approach w clearly defined expectations, e.g., calmly but firmly escort the client from the room

Cohorting

- do not place client with infectious process with client who has open sounds; anticipated prolonged hospitalizations - first level: standard precautions; 2nd: transmission-based precautions

breastfeeding practice

- do not wash w soap btw feedings - c/s dryness; apply breastmilk after feedings b/c breast milk has healing properties; lanolin for dry or cracked nipples -- while the iron breastmilk <iron-fortified formula, it is more easily absorbed by the infant -- breastmilk can be stored in the freezer for 6mo - massage the breast to enhances milk flow and helps w engorgement - begin feeding w less sore breast - a hungry infant nurses more vigorously at first so may be painful - use warm compress before feeding to help milk to flow more quickly - contra: HIV or varicella; untreated active TB; herpes to the breast; chemo or radiation; illicit drug use or smoking; baby w galactosemia

concussion

- does not appear on a head CT scan; dx based upon symptoms - may have a persistent headache for 2wk - 2 mo; can be managed by mild analgesics - can ca/s personality and intellectual disturbances; affect concentration - repetitive concussions can lead to chronic traumatic encephalopathy

bone marrow aspiration

- done at the iliac crest or the sternum under local anesthesia

amylase

- dx pancreatitis and acute cholecystitis - normal: 60-160 somogyi U/dL - restrict food 1-2 hr before test, avoid opiates 2 hr before test

otitis media

- ear pain, feeling fullness, hearing loss, fever, drainage - comps: mastoiditis, perforation of tympanic membrane, meningitis - risk factors: congestion from allergies, colds nd siuns infections, smoking

Somogyi effect

- early-morning hyperglycemia that occurs as a result of nighttime hypoglycemic episodes d/t increased insulin levels, lack of carbohydrates, change in exercise regimen - if morning readings are high and previous evenings low- suspect somogyi effect - prevention: eating bedtime snack; long-acting insulin

intracranial tumors

- elevate head 30-45 degrees after supratentorial surgery - position flat and lateral after infratentorial surgery - no narcotics analgesics - mask the signs of IICP

infant has upper airway congestion and slightly labored respiration

- elevate hob will not promote adequate drainage from the upper airways, poor head control makes this position unstable - should position the infant on one side - facilitate drainage and will promote adjustment to breathing through the nose

cast care

- elevate the cast above heart level for the 1st 24-72 hr; the kid will need to recline if the cast is on a leg - loosely wrap an ice pack covered in a thin towel around the cast - keep the cast dry. Ice that's packed in a rigid container and touches the cast at only one point will not be as effective - sensation of warmth is normal and expected for a plaster cast in the initial stages of drying - encourage the client to freq move the fingers or toes of the injured limb - during bath: use a plastic boot/wrap - low heat dryer to dry a wet cast is safe

oral contraceptives

- ethinyl: prevent pregnancy and hormone control - levonorgestrel: contraceptive implant or an emergency contraceptive in oral form to be given in 72 hr for unprotected intercourse SE: headache, dizziness, n, breakthrough bleeding/spotting - nx: no smoking; if dose missed, take ASAP and use protection, take same time every day - estrogens: estradiol(may need to take for at least 7-10 yr), estrogens conjugated - used for menopausal symptoms, some cancers, prevention of osteoporosis - SE: n, gynecomastia, contact lens difficulty - nx: contact HCP if lumps in breast, vaginal bleeding, jaundice/dark urine/clay colored stools (liver problem), dyspnea, blurred vision, chest pain, numbness/stiffness in legs risk for stroke

48-60yr

- evaluate past - sets new goals - defines values of life - finds serenity and fulfillment - accepts the changes of aging

nurse manager

- evaluate staff, advocate for staff - ensure safe staffing levels - be a mentor or find mentors - keep staff education up to date - maintain department budget - monitor client safety issues; conduct rounds and help to solve concerns - collaborate w upper management

echoencephalography

- evaluates brain structure through sound waves - explain procedure: hand-held transducer used to record sound waves

radiotherapy

- external: avoid use of creams/lotions - internal sealed source: lead container and long-handled forceps; save all dressings, bed linen until radiation source removed; urine and feces not radioactive; don't stand close or in line w source; pt on bedrest; lead apron is to be used when the nurse has to spend any length of time at a close distance, but not for routine care; and lead apron does not protect the head and extremities --client: bed rest (prevent dislodge of the radium implant) w hob < 20; log rolling to prevent displacement of applicator; air mattress to prevent skin breakdown; enema to prevent dislodging the implant by straining; low-residue diet & anti-diarrheal (decrease # of stools)+ fluids; indwelling cath or fracture pan may be used; prevent DVT - internal unsealed source: orally/instilled in body cavity; all body fluids contaminated; greatest danger 1st 24-96 hr nx: internal: time and distance important - close contact w client - limit to 30 min/8 hr shift; no pregnant staff

amputation

- f/v surgery: splint and support the affected area, elevating to reduce edema - prevent hip fx by doing ROM q 2-4 hr, place the client prone for 20-30 min q 3-4 hr to prevent hip flexion contrax - don't elevate residual limb on a pillow after the immediate postop period; after 24 hr, the residual limb should remain flat or extended to prevent hip flexion contractures - air exposure 4x/d - inspect the wound for inflammation after the pressure dressing and drains are removed. Change dressing daily until the sutures are removed - wrap residual limb with a elastic bandage to shape the residual limb and keep the dressing in place - maintain the compression dressing - minimizes edema, prevents infection, and provides for initial shaping needed for future prosthesis - observe for s/s of inadequate tissue perfusion - client rubs the residual limb with alcohol daily to toughen the skin, watching for irritated skin reactions - after 3wk: client massages the residual limb toward the suture line to mobilize the scar and prevent its adherence to bone - client avoids exposing the skin around the residual limb to excessive perspiration, and is aware of the possible need to change bandages or residual limb socks during the day to avoid this - prosthesis may be fitted immediately or delayed until the site is completely healed

Deceleration

- fall in the FHR below the baseline lasting 15 sec or more f/u by a return - early: inversely mirror the contraction, associated w head compression and pushing in 2nd stage of labor (benign) - late: after contraction, usually begins at the peak of contraction, with slow return to baseline after the contraction is complete; fetal hypoxia b/c of deficient placental perfusion - nx interventions for late: position client left side (if no change, move to other side or to knee-chest position); administer O2 by mask; start IV or increase flow rate; dis cont oxytocin - variable: transient decrease in FHR occurring anytime during uterine contraction phase; cord compression - relived by change in maternal position; if prolonged - administer O2 and discont oxytocin

tubal ligation

- fallopian tubes are tied and/or cauterized through an abd incision, laparoscopy, or minilaparotomy - intercourse resume after bleeding ceases - success of reversal by vasovasostomy varies from 40 -75% - does not affect menses

general human trafficking

- fearful behavior; avoid eye contact - no knowledge of addresses or other important demographic information - no ID doc or valid reason for not having them

cluster headache

- feeling of pain that occurs generally on one side of the head; typically localized around the eyes and often radiates to different areas of the head - nasal congestion, lacrimation, swelling around the eyes - short lasting (30-90 min) and occur every day for weeks or months - abortive therapy: sq/sl/intranasal sumatriptan; high flow O2 therapy

testosterone inhibitors

- finasteride - for BPH, male hair loss - se: decreased libido, impotence, breast tenderness - nx: pregnant women avoid contact with crushed drug or client's semen - can affect the male fetus

hodgkin lymphoma

- firm, painless, enlarged, and freely movable lymph nodes around neck - fever, night sweats, weight loss, fatigue, dyspnea, pruritus, ingestion of alcohol may result in pain at the lymph node

Acetaminophen poisoning

- first 2 hr: n/v, sweating, pallor, hypothermia, weak pulse - latent (1-1.5d) when symptoms abate - if no tx, hepatic involvement occurs (may last up to 1 wk): RUQ pain, jaundice, confusion, stupor, coagulation abnormalities - dx: serum acetaminophen levels at least 4hr after ingestion; liver function tests AST, ALT, Cr, BUN - toxicity begins at 150 mg/kg - induce vomiting - N-Acetylcysteine-specific antidote; most effective in 8-10 hr; must be given within 1 d; given PO q 4hr x 72 hr or IV x 3 doses

a client with DNR has deteriorating condition

- first evaluate advance directive (include CPR, mechanical ventilation, tube feed, dialysis, abx/antiviral, comfort are, organ donations) to determine which additional tx will be prescribed and to validate DNR - contact family - place the client in 15-30 hob (also for stroke)

transferring client

- first step is to a/s each situation: determine the weight to be transferred and if help (other staff members, mechanical devices) is required and available - if client has a weaker side, the transfer will be toward the stronger side - a/s if a transfer belt is required and place the chair at a 45 angle to the bed

ostosclerosis

- fixation of the footplate of the stapes, one of the 3 small bone or ossicles in the middle ears - stapes cannot vibrate and carry the sounds transmitted by the other 2 ossicles to the inner ear - tx: do nothing, have a hearing test repeated q year; amplification - hearing aids; NaF - not totally effective; surgery- stapedectomy with prosthetic device; laser dissection - comps from surgery: funny taste in the mouth, loss of taste (temp or perm), infection, dizziness, pain, blood clot, nerve damage

TD/TDap

- for > 7yr - protect for 10yr; give every 10 yr - tetanus toxoid: a booster dose of the toxoid given in case of a dirty wound - tetanus immune globulin used for st passive immunity - pertussis can be given during pregnancy to protect infant from whooping cough

nitrofurantoin

- for UTI - se: asthma attacks, d/n/v - nx: give w food or milk; monitor pul. status; check I&O; check CBC; avoid acidic foods (cranberry, prune, plum) (increase the drug action)

phototherapy

- for client with total serum bilirubin between 12-15 mg/dL - the bilirubin levels peak btw 3 and 5 d of age - place the newborn 30-40 cm (12-16 in) below - AE: greenish loose stools; hyper/hypothermia, increased metabolic rate, priapism, dehydration, electrolyte imbalances (hypocalcemia) - full/later-preterm baby may require additional fluid or feedings to compensate for insensible and intestinal fluid loss

Cholecystogram & Cholangiography

- for gallbladder and bile duct visualization, radiopaque material injected directly into biliary tree - Test: fat free dinner evening before test, Check hx of allergies to iodine, ingestion of dye in tablet form evening before, NPO after dye ingestion, xrays followed by ingestion of high fat meal followed by further xrays

dehydration: infant

- for v/d: withhold food and fluid for approx 3 hr for v or 1 hr for mild d; introduce clear fluids (or Pedialyte) slowly; 1 tsp 1 q 15min for 2 hr, then 1 oz q 2 hr for 12-18 hr; then progress to breast milk or formula; for prolonged v/severe d or kid who will not drink, IV therapy is needed -- avoid water - replace the deficit: lost <5% of body weight - 50ml/kg defict; 10% - 100; 12-15% - 125 - fluid will be given rapidly for 3 - 6 hr, then slowed to a maintenance rate

newborn care

- freq bathing and use of soap can dry out the sensitive skin by removing natural skin oils. bathing is sufficient if it is done every other day or twice a week for the first 2 wk - check temp w elbow rather than hands: <120 (49) - the right-side position after eating assists w digestion by allowing the feeding to flow to the lower end of the stomach by gravity b/c the pyloric sphincter is located at the right side; also facilitates expelling of gas bubbles from the stomach by allowing any swallowed air to rise above the fluid the through the esophagus - the infant should have 8-10 wet diapers/d; if voiding less, then this indicates need for more fluids - no pillow, no blankets; should sleep in pajamas/sleepers/sleep sack - a moist and red umbilical cord stump indicates an infection or other problem; should be dry and no redness; usually dry and drops off in 7-10d

contractions

- frequency of less than q 2 min should be reported - duration greater than 90 sec should be reported - risk of uterine rupture or fetal distress -true labor: regular, increasing in freq, duration, intensity; discomfort radiates from back (low bag pain is the first sign of labor) and radiates to abd ; intensity usually increases with walking; changes of effacement and dilation; fetal movement decreases; bloody show - false labor: irregular, no change in freq, duration, intensity; discomfort is abd; decrease with rest or activity; no cervical changes

anxiety

- goal: cope w what the causes - seeking new experiences may overwhelm the client - it is normal to feel anxiety before new experience

graft

- graft adherence takes 7-10 d for fibrin network development - once donor and recipient sites have healed, direct sunlight must be completely avoided for 1 yr

adolescent (12-20 yr)

- growth spurt in females peak about 12; male 14 - rapid alterations in height and weight - may c/s easy fatigue - id peer group influences

bomb threat

- key info: caller ID, exact wording of threat, type of voice, accent or behavior, background noise = name, where, why placed the bomb, where is the bomb, what kind, when will go off, what will make it explode - callers call during business hours, provides a longer detonation time, and states specific locations, give reasons for placing are more valid - do not use cell phone (signals could detonate a bomb)

mastitis

- hard, red, inflamed breast; exudate from nipple; fever; leukocytosis - systemic antibiotics; warm packs to promote drainage; breast support risk factors: poor hygiene, ductal abnormalities, nipple cracks and fissures, lowered maternal defense, tight clothing, poor support of pendulous breast, failure to empty the breast properly while breastfeeding, missing a breastfeeding, wrong positioning/latching/attachment techniques pain is expected during breastfeeding d/t release of oxytocin - c/s discomfort

signs of SI

- have more energy than they did previously, as they have made a decision and are working on f/u with that decision - "Why do you bother w me" - hopelessness and despair - isolation from friends

obtain sputum sample

- have the client rinse the mouth w water and spit it out before obtain the sample - take deep breaths and then cough deeply from the diaphragm

isotope studies

- helpful in diagnosing early formation of thrombi - fibrinogen labeled with radioactive iodine molecules make up a clot along with naturally occurring fibrinogen - radioactivity counts are increased over thrombi

incentive spirometry

- helps the client maximally inflate their lungs - semi-fowler's or high - inhale deeply and hold breath for 3-5 sec; slowly exhale - form seal around mouthpiece - mobilizes secretions

PTCA

- hematoma: -- groin hematoma: clotting at the femoral artery puncture site dose not occur; or results in a dislodged clot and arterial bleeding creates a hematoma -- prevent: maintain pressure at the site w applied pressure dressing and a sandbag -- keep the leg straight --a/s color, temp, pulses -- tx: apply direct manual pressure; notify HCP - same day procedure; discharged home about 6-12 hr after - drink plenty of water to flush out the dye - report if the site looks increasingly bruised; swells or develops drainage; leg becomes numb or tingles or foot turn blue - high risk for comps: female, >65

PEP

- hep B: if have no hep b series, receive HBIG + HBV series - hep C: avoid behaviors that spread hcv; F/U HCV testing in 4-6 mo to detect early chronic disease - HIV: begin at least in 72 hr; anti-retroviral drug (>/=3 drugs) for 4 wks

mechanical ventilator

- high pressure alarm: look for obstruction or kink (check tubing lengths; sedate client or insert a bite block) - low pressure: disconnection or leak; re-inflate cuff PRN (if ruptured, should be replaced) - low O2 pressure: disconnect pt from ventilator; bag-valve-mask O2 - if pxO2 dose not return to baseline after suctioning, the nurse may consider increasing the sedation to help promote oxygenation

Addison's disease

- high-protein, high carb, high Na, low K diet - life-long hormone replacement - gastric production and glomerular filtration decrease - leads to excessive BUN, can c/s anorexia, n, and weight loss - hyponatremia, hyperkalemia, hypercalcemia

dermatological reactions

- hives, exfoliative dermatitis, erythema multiform excudativum (redness and peeling of the skin over large areas of the body) (SJS) - medical emergency - fever, large lymph nodes, hepatomegaly - nx: good skin care, antihistamines, topical corticosteroids

tx the client, not the monitor

- how your clients clinically presents in conjunction w affirmed monitor readings - FIRST to affirm all the monitors are positioned/functioned well before trusting the readings

transfusion reaction - allergic

- hypersensitivity to donor antibodies - imme to 24 hr - mild: urticaria, pruritus, fever; severe: anaphylactic shock (hypotension, dyspnea, decreased SpO2 - obtain PxO2, wheezing progressing to cyanosis premedicate w antihistamine stop restart NS, O2, diphenhydramine, corticosteroids

labs in malnutrition/starvation

- hypokalemia, hypoglycemia, hypomagnesemia, hypophosphatemia (give P supplement for anorexia nervosa) - decreased vascular volume c/s increased BUN and abnormal renal func - irregular heart rhythm, HF, decreased CO - for anorexia nervosa: avoid discussing food, esp while eating; require consumption of food within a limited amount of time - both anorexia and bulimia has abnormal parotid gland ;bulimia also has inflamed lymph nodes in the neck - bulimia nervosa: monitor for at least 1 hr; ID anxiety triggers and provide a quiet environment - establish a client contract: encourages the client to assume responsibility for actions, should include an agreement about binge eating, purging or vomiting, and hoarding of food

Addisonian crisis

- hypotension (can lead to shock), n/v, extreme weakness, abd pain, severe and rapid hypoglycemia, hyperkalemia, and dehydration - administer and monitor IV infusion of ns, d5w ns - administer vasopressors, hydrocortisone therapy - absolute bedrest - administer K binding and excreting med

retroperitoneal bleeding

- hypotension, tachycardia, widening pulse pressure - decreased peripheral pulses - abd, groin, back pain

cerebral angiography

- id aneurysms, vascular malformations, narrowed vessels - informed consent - explain procedure: lie flat, dye injection into femoral artery by needle/catheter; fluoroscopy and radiologic films taken after injection - well hydrated - preprocedure sedation - skin prep, chosen site shaved - mark peripheral pulses - may experience feeling of warmth and metallic taste when dye injected - neuro a/s q 15-30 min until v/s are stable - keep flat in bed 12-14 hr - check puncture site q hr - forced fluids, accurate intake and output

sputum analysis

- id cause of pul infection and abnormal lung cells - encourage fluid intake night before test - instruct client to rinse mouth with water - do not brush teeth, eat, or use mouthwash before test - use sterile container - ultrasonic/heated nebulizer tx 10-15 min prior aids in collection - teach client how to expectorate - collect early in the am if possible

a client in hemorrhagic shock from injuries sustained in a fall

- id the source of bleeding: then apply direct pressure to the wound and elevate the affected area if possible

compartment syndrome

- more common in younger client w frax of the leg - typically occurs in the first 6-8 hr after injury but may take up to 48 hr - deep, throbbing, severe pain/increased pain w passive ROM (hallmark); paresthesia, loss of movement; pallor and cyanosis of the extremity - pain at pin insertion sites is not an indication -- very painful hot spot under the cast - pressure necrosis

fall safety

- if a client starts to fall and you are close by, move behind the client and take one step back - stand w feed apart - broad-based - support the client around the waist or hip area, or grab the gait belt - bend your leg and place it in between the client's leg. Slowly slide the client down your leg, lowering yourself at the same time - prevents back injury and protect the client's head from hitting the floor - once the client on the floor - a/s injuries - if the client is confused/shaking, has obvious injury or shows signs of weakness, pain, or dizziness, the client should not be moved until full medical transport is available - the nurse should request another staff to help the client into wheelchair/bed - use backboard or lift

insulin injection guideline

- if client miss a dose longer than 2 hr, check bg and contact hcp to determine whether a dose of a short-acting or rapid-acting is needed. - If the missed dose is caught within 2 hr, the client should take the dose. There is an increased chance for hypoglycemia after the next scheduled dose

MRI

- if use gadolinium contrast - ensure good renal and liver function - remove cosmetics and nail polish - things that cannot be removed but may alter the image: metallic spinal rods, plates, pins, screws, or metal mesh, joint prostheses, tattoos, dental fillings or braces - an aneurysm clip cannot be removed, and can heat up, become dislodged, and possibly result in hemorrhage and/or death

ostomies

- ileostomy: UC, Crohn disease, injury, trauma caner -- liquid stool w no ability to regulate output; requires constant pouch and skin barriers - ascending/transverse: perforating diverticulum, trauma, inoperable tumors of colon, rectum, pelvis -- semi-liquid/formed stool w no ability to control output; constant pouch and skin barriers - sigmoid: cancer of rectum or rectosigmoid area, trauma, perforating diverticulum --formed stool, may be able to regulate output w irrigation and a bowel regimen; may not require skin barrier/pouch

Sick day rules

- illness elevates bg level - check bg q 3-4 hr; increase insulin as needed; test urine for ketone - follow soft diet if no n/v; if v/d or fever persists, take liquids (1/2 cup regular cola or orange juice, 1/2 cup of broth, 1 cup of sports drink) q 30min to 1 hr to prevent dehydration - eat several small meals

vasovagal response

- immediately after removal of the arterial catheter (percutaneous transluminal coronary angioplasty) can c/s this - bradycardia, hypotension, n

ectopic pregnancy

- implantation of the fertilized egg in any site other than the normal uterine location - can be d/t PID, tubal surgery, and anomalies of the fallopian tubes - shock is a real possibility d/t blood loss - a/s: unilateral lower quadrant dull pain; rigid, tender abd; referred shoulder pain (results from blood irritating the subdiaphragmatic phrenic nerve) - this pain can progress to colicky, sharp severe pain if rupture occurs and the pain may become generalized throughout the lower abd; low hct and low hCG levels in blood and urine; bleeding - gradual oozing to frank bleeding - nx: monitor for shock; administer RhoD -- at 8 wk: loss of a pregnancy cannot be stopped - prevent rupture and internal hemorrhage

placenta previa

- implantation of the placenta over the cervical opening or in the lower region of the uterus - 1st and 2nd trimester -- spotting; 3 rd - painless, profuse bleeding - nx: bed rest side lying or trendelenburg position; u/s to locate placenta; no vaginal or rectal exams ; amniocentesis for lung maturity; daily Hgb and Hct; monitor bleeding -home care: limit activity; no douching, enemas, coitus; monitor fetal movement; NST perform q 1-2 wk - if active labor starts and bleeding does not subside or the fetus is mature enough for delivery - client will undergo C/S

transfusion reaction - hemolytic

- incompatibility - min to 24 hr - n/v, pain in lower back, hypotension, hematuria, increased HR, decreased UO, SOB - obtain PxO2 before giving O2 - stop the blood and a NS should be restarted - provide supportive care: O2, diphenhydramine, airway management - obtain blood specimens - obtain a urine specimen for Hg determination

meds affect bleeding and heparin

- increase risk of bleeding: ASA, NSAIDs, clopidogrel, some PCN, dextran quinidine, cefotetan, valproic acid, licorice - decrease effectiveness of heparin (may be used safely in pregnant clients): digoxin, tetracyclines, nicotine, antihistamines

pancreatitis

- increased pancreatic enzyme secretion c/s pain d/t pancreatic autodigestion and inflammation - risk of shock (fluid shift) - NPO, abx, I&O - encourage deep breathing to prevent atelectasis - maintain bed rest to reduce metabolic rate and production of pancreatic secretions - monitor resp distress, kidney failure, paralytic ileus, changes in loc - prepare to administer antacids and H2 blockers - increase intake of nutrient-rich foods and carbohydrates - avoid high-fat food; whole milk - acute S/S: severe epigastric of abd pain, n/v, jaundice, decreased or absent bowel sounds; shock r/t hemorrhage; basilar crackles, - chronic: weight loss, constipation, DM - comps: pulmonary effusion, hypotension, hypocalcemia - can lead to DM, resp and renal failure - risk factors: chronic alcohol, middle-age, smoking, pregnancy, infection, hyperlipidemia, meds (diuretics, estrogen, NSAIDs)

33-40yr

- increased sense of urgency; life more serious - major goals to accomplish - plateaus at work and marriage - sense of satisfaction

diabetes during pregnancy

- increases risk of maternal infection, pregnancy induced hypertension (PIH), hydramnios (> 2000 ml), macrosomia (large for gestational age but may have immature organ systems), congenital anomalies, prematurity, resp distress syndrome, ketoacidosis (can c/s coma and death of the mother and fetus if left untreated) - secretion of placental hormones c/s insulin resistance - a/s: hyperglycemia after 20 wk - insulin needs after 20 wk; controlled by diet; oral hypoglycemic med contraindicated (teratogenic) and may lower fetal blood glucose to dangerous levels; test on all women with average risk for diabetes at 24-28 wk - risk factors: obesity, family hx of diabetes, history of gestational diabetes, HTN, PIH, UTI, monilial vaginitis (Candida albicans), polyhydramnios, previous birth to large infant (>9 lbs), unexplained stillbirths and anomalies, glycosuria, proteinuria

50-65yr

- increasing physical decline, forgetfulness - modification of lifestyle - retirement - decreased cognitive and physical functioning - altered family relationships (may d/t chronic illness) - altered body image, self-care deficit

Horizontal evacuation

- moves clients in immediate danger away from the threat or actual event - staff move clients to area of refuge in adjacent smoke/fire zone or, in some cases, at opposite side of the building

angiography

- indicates abnormalities of blood flow d/t arterial obstruction or narrowing - contrast dye is injected into the arteries and x-ray films are taken of the vascular tree -disad include potential allergic reactions to radiopaque dye, potential irritation, or thrombosis of the injection site - client may have n, flushing, warmth, salty taste with injection of dye - a/s hematoma (ecchymosis, immediate swelling, leakage of blood) - cool compress intermittently for 24 hr then warm compress; restart iv at opposite extremity, distal pulses

exercise test for intermittent claudication

- indicates inability of damaged arteries to increase the blood flow needed for increased tissue oxygenation - exercise until pain occurs; record the length of time

cesarean section

- indications: dystocia, repeat cesarean section, breech presentation, fetal distress, fetal anomalies, active gonorrhea or herpes infection, prolapsed umbilical cord, pregnancy induced HTN, placenta previa or abruptio placentae - provide routine preop care, indwelling bladder catheter, administer lower dose preop med - monitor for hemorrhage, massage the uterus for boggy, a/s the incision site for signs of bleeding - medicate for pain

bursitis

- inflammation of the fluid filled sac between the muscles, tendons, and bones - affects larger joints, such as the knees, elbows, and shoulders - nx: immobilize the joints with pillows and splints; apply heat (promote movement)/cold (reduce swelling); cortisone injection

bell palsy (CN VII disorder)

- inflammation of the n on one side of he face in the absence of stroke or another paralyzing disease - rapid onset S and cont to worsen over 48-72 hr: pain in and around the ear; numbness of the face/tongue/ear, flaccid paralysis of the face, drooping on one side, tinnitus, loss of taste, cannot close eye - temporary, recover in 3 wk to 9mo - prevent dysarthria (slurred speech) and use exercise: puffing out the cheeks, wrinkling the forehead, puckering the lips - corticosteroids within 72 hr (antivirals have not been shown to be effective)

lumbar puncture

- insertion of a needle into the subarachnoid space between the third and fourth or fourth and fifth lumbar vertebrae to withdraw fluid for diagnosis - informed consent - procedure done at bedside or in tx room - positioned in lateral recumbent fetal position at edge of bed - neuro a/s q 15 -30 min until stable - fluid 3 L PO - lie flat for 4-6 hr (supine, semi-Fowler, side-lying) - oral analgesics for headache (may begin several hr to 2 days) - contra: IICP - increased risk of developing headache if dehydrated; increase risk of brainstem herniation if IICP; potential comp is meningitis (fever, nuchal rigidity) - report if a headache is not relived by OTC analgesics, fluids, and rest - correct postlumbar puncture headache: epidural patch -- client may feel back pain radiating into the leg -- position supine 4-6 hr post procedure; 15-30 min neuro check

enteral tube feedings

- intermittent feedings should be given slowly over 15-30 min - 30 mL water before and after each intermittent and bolus feeding

multiple myeloma

- involves over production of plasma cells, destructing bone and bone marrow products - leads to bone pain, thinning bones, and broken bones - care includes safety (prevent frax) & maintain renal function & prevent dehydration, infection

DDH

- involves the acetabulum and the head of the femur; the acetabulum is unable to hold the head of the femur in - ortolani's sign - seen in infants < 4 wk old - a clip sound heard when the affected leg move to abduction nx: newborn to 6 mo: reduced by manipulation; pavlik harness for 3-6 mo 6-18 mo: bilateral bryant's traction; hip spica cast older: open reduction then hip spica cast

variability

- irregular fluctuations in the baseline of the FHR - absent (0-2) or decreased (3-5) associated w fetal sleep, prematurity, drugs, hypoxia, acidosis - moderate (6-25) deviations from the baseline may be significant - fetal well-being

Lead Toxicity (Plumbism)

- irritability, sleepiness, n/v, abd pain, poor appetite, constipation, decreased activity, IICP - public health action should occur for blood lead levels >/= 5 mcg/dL (0.24 mcmol/L) - erythrocyte protoporphyrin (EP) level; CBC - anemia (blocks formation of Hg, leading to microcytic anemia - initial sign) - X-rays (long bone/GI): may show radiopaque material, "lead lines" (lead stored in inert form in long bones) - renal: abnormal excretion of protein, glucose, amino acids, phosphates - chelating agent: promotes excretion (dimercaprol, Ca disodium, EDTA); succimer, deferoxamine

home O2

- keep all O2 delivery at least 15 ft (457 cm) away from matches, candles, heaters, a gas stove, or other sources of flames - 5 ft (152 cm) from TV, radio, and other appliances; microwave oven is fine - do not use O2 while cooking w gas - do not use electrical appliances (hair dryers, electric razors, or heating pads) while on O2 - during sleep, wear 100% cotton and use 100% cotton bedding; nylon and synthetic materials can develop static and c/s a spark - do not use aerosols (hair spray, air freshener, deodorant) near the O2 unit - avoid oil-petroleum-based makeup and personal care products - do not use alcohol-based hand sanitizers unless hands dry - store O2 tank UPRIGHT in well-ventilated area - O2 concentrator plugged directly into a grounded outlet - O2 tubing never > 50 ft; place bright-colored tape at 12-intervals along the tubing - clean equipment weekly or indicated by durable medical equipment (DME) comp

car seat

- kids can d/c using it or booster seats once they are 57 in tall - the safest seat in the back is the middle seat, away from doors - install before bb is born - always depends on weight and height - small infant to toddler: convertible seat - can change to forward-facing with a harness and tether based on weight (> 9 kg) & height. Buckle harness then place coat or blanket over to keep warm - preschooler to schooler: forward-facing; use booster seat w high back for head and neck support in car w/o headrests. Switch from car seat to booster seat when the kid has topped the highest weight or height - schooler: advance to seatbelt - use lap and shoulder restraints w booster or alone. Kid <13 should sit in the back. 5 pt or 3 pt harness set the car seat at 45 angle make sure head is secure; use rolled-up blankets if baby slouches strap in toys - attach toys to the car seat w plastic links or very short cords, or get an activity center specifically designed

herniated Intervertebral Disk

- knife-like low back pain nx: - preop: moist heat to relieve pain; fowler's with hip/knee flexion; firm mattress for adequate back support; abd muscle strengthening; TENS - postop: make sure the client has sensation in lower extremities; log roll w knee support q 2 hr; maintain erect posture; avoid the prone position - log roll: each of two person at either head/feet; pt should not help

Sigmoidoscopy/Proctoscopy

- laxative night before - npo at midnight

45-55 yr

- leadership roles at work - alteration in body image - menopause - muscle aches and pains - reassessment of life - decreased sensory acuity

fetal alcohol syndrome (FAS)

- leading c/s of mental deficiencies in kid - 100% preventable - avoid alcohol 3 mo before conception - no safe level of alcohol consumption during pregnancy - intellectual & motor deficiencies, microcephaly, hearing disorders, thin upper lip, epicanthal folds, maxillary hypoplasia (underdevelopment of the maxillary bone) - swaddling the infant, decrease stimuli, administer sedatives, monitor weight gain, promote nutrition

Hib

- leading cause of bacterial meningitis in kid < 5 yr - can also c/s pneumonia, sepsis, and death - infant, older adults, and debilitated persons are most at risk for meningitis - individuals who have not been immunized for mumps, haemophilus influenza, and streptococcus pneumoniae are also at a greater risk

incident report

- legal/ethical: client or family refusing tx as prescribed and refuses to sign consent; client or family voices dissatisfaction and the situation cannot be or has not been resolved - all med errors + near missed (don't notify HCP) --- NEED TO TELL PT - comps from dx or tx procedure (including extravasation and infiltration) - falls of everyone even w/o injury - break in aseptic technique - use direct quote - only one copy for those who need to know (risk management)

bradycardia (fetal)

- less than 110-120 - c/s: fetal asphyxia, maternal hypotension, prolonged umbilical cord compression, fetal dysrhythmia

bronchodilators

- leukotriene-receptor blockers: aminophylline, terbutaline, ipratropium, albuterol, epinephrine - action: blocks inflammatory response - xanthines -resp: acetylcysteine, cromolyn Na, montelukast Na - action: bronchodilation - SE: tachycardia, dysrhythmias, palpitations, n, anticholinergic effects, tremors, headaches, seizures - nx: monitor BP and HR, may aggravate diabetes; when used w steroid inhaler, use bronchodilator first - decrease intake of coffee, cola, chocolate

position for lower back pain

- lie on the side w a pillow btw the knees - alleviate compression of the sciatic n - sleep on the back w a pillow under the knees and a small pillow under the lumbar region - do not sleep on the stomach - elevated 45 and hips and knees moderately flexed - knees should be higher than the hips for comfort

toxic shock syndrome (TSS)

- life-threatening bacterial infection - results from toxins produced by staphylococcus aureus or group A streptococcus bacteria - associated w high absorbency tampons - risk factors: postpartum infection, miscarriage or abortion, use of contraceptives that are inserted vaginally (diaphragm, sponge), skin infection, packing in the body cavities (nose bleeds), osteomyelitis, use of vaginal products that contain deodorants (iiritate the vulvar-vaginal lining) a/s: sudden-onset fever, v/d, drop in systolic BP, erythematous rash on palms and soles on feet, swelling or erythema abx; f&e, educate use of tampons

retinal detachment

- light flashes, floaters, a "cobweb", "hairnet", or ring in the field of vision - keep the client lying on the affected side prevents further detachment - first dx procedure: visual acuity measurement by ophthalmoscopy/slit lamp microscopy; may also use U/S - should be NPO to anticipate surgery (e.g., laser photocoagulation and cryopexy, scleral buckling, and vitrectomy) - no hair wash for a wk

L&D characteristics

- lightening (descending into pelvis): primipara - up to 2 wk before delivery; multipara: when labor begins - softening of cervix - expulsion of mucus plug (bloody show) - uterine contractions that are progressive and regular

telephone and verbal orders

- limit to urgent situations in which immediate electronic is not feasible - transcribe the order into the client's medical record ASAP - requiring recipients (the nurse) of verbal orders to sign, date, time, and note the verbal prescription according to prescribed procedures - these orders will be indicated as VO/TO - record the names of both the nurse and the prescriber and designate the verbal communication as "RBVO" (read back verbal order) or "RBTO" (read back telephone order) - in a non-urgent face2face situation, HCP is expected place the order

fast acting insulin

- lispro, aspart, glulisine - rapid acting - onset: 15-30min - peak: 1-3hr (lispro:30-90 min) - duration: 3-5 hr; shorter with glulisine - time of AE: mid morning - client needs to eat within 5-15 min of injection time - regular insulin - short acting - onset: 30-60min; IV - 10-30min (only regular can administer IV) - peak: 1-5 hr - duration: 6-10 hr - client needs to eat within 20-30 min of injection time

fat embolism syndrome (FTS)

- more common following frax of long bones - typically occurs in the first 12-72 hr after injury - tachypnea, dyspnea, hypoxemia; rapid neurologic deterioration; petechial rash (esp chest and mucous membranes, face, axillary folds, and conjunctiva ) - O2 therapy and cont PEEP used to provide resp support - if cerebral edema is present, corticosteroids may be beneficial - prevention of frax: early stabilization & mobilization, aggressive fluid management; use of steroids

medications for bipolar disorder

- lithium (mood stabilizer), carbamazepine, valproic acid - action: reduces catecholamine release, increase reuptake of NE and serotonin - SE: headache, dizziness, sedation, fatigue, GI upsets (give w meals), fine hand tremors (a coarse hand tremor is an AE and should be reported), polydipsia, polyuria, orthostatic hypotension, metabolic taste, muscle weakness, weight gain, edema, reversible leukocytosis - with LT lithium use - develop a resistance to ADH - nephrogenic DI - nx: a/s ms; PO fluids at least 2 L; adequate Na; no caffeine; do not change Na intake or engage in activities that cause a great deal of sweating - onset of effects take 5-7d, with a peak of 10 d, and not clear the body for 21 d (may take to 4 wk) - if a dose is missed by more than 2 hr, wait until the next scheduled time to take a dose - dangerous level > 1.5; monitor 2-3 mo to start over (initial level 1-1.5) and monthly for maintenance - maintenance level 0.8 -1.2 - initial toxicity (>2): persisting n/v/d, blurred vision/slurred speech; later: tinnitus, worsening tremors, ataxia, uncoordinated, more clonic movements, mental confusion, and stupor; severe: seizure, coma, cardiac dysrhythmias, circulatory collapse - if thrombocytopenia occurs: report

blood ammonia

- liver converts ammonia to urea - with liver disease, ammonia levels rise - normal: 15-45 mcg/dL

Fowler's position

- low: 15-30 - semi: 30-45 - fowl: 45-60 - high: 60-90

neurotoxicity

- manifested by ototoxicity, both vestibular and auditory, can occur in the client w pre-existing renal damage - can occur in clients w normal renal function and who are receiving tx w higher dosages or for longer than recommended periods

cervical biopsy

- may have cramping sensation - restrictions on intercourse, douching, and swimming for 3 d

squatting by a child after small exercise

- may indicate undx cardiac detect - most likely tetralogy of fallot - squatting can temporarily improves O2 by changing pressures in the heart and pul artery to the lungs F

airborne precaution

- measles (rubeola), M.Tuberculosis, varicella (chickenpox), disseminated zoster (shingles) -negative air pressure with 6-12 air changes /hr - N95 can be worn more than once - transport: place a surgical mask - latent TB: - no S/S and do not spread - normal chest xray and a negative sputum smear - expose to bacillus but has walled off the bacillus into Ghon complexes or granulomas and has made antibodies that cause a positive skin reaction

contraceptives

- meds that decrease the effectives of combined hormone contraception: carbamazepine, phenytoin, -cillin, doxycycline/tetracycline, metronidazole, benzodiazepines - meds that increase action: tylenol, ascorbic acid (vit C), fluconazole - risk for hormonal contraceptives include increased risk of heart attack and stroke, migraines, HTN, gallbladder disease, infertility, benign liver tumors - comps: blood clots, breast tenderness, headaches, intermenstrual spotting, missed periods, mood changes, n, weight gain - insert diaphragm up to 2 hr before sex - non-hormonal IUDs use copper ions that are toxic to sperm and induce a thickening of cervical mucus - cervical cap may last up to 2 yr and can still be used if it becomes discolored - the sponge covers the cervix and blocks sperm from entering the uterus and cont release a spermicide

preeclampsia

- mild: begins past 20th wk, BP > 140/90, 2+ to 3+ proteinuria, slight generalized edema - tx at home; bed rest, left-lateral; diet; daily weight - severe: bp>160/110, 4+ proteinuria, oliguria, headache, epigastric pain. pul. edema may develop, hyperreflexia, elevated ALT (normal 10-40) in Hemolysis, elevated liver enzymes, low platelet count (HELLP) - bed rest; tx at hospital; monitor v/s, FHT, I&O; take seizure precautions; Mg sulfate, hydralazine HCl, diazepam, nifedipine - determine freq of uterine contrax when client is in labor risk factors: AA, >35 yr, multiple pregnancies, molar pregnancy

transfusion reaction - febrile

- min to 24 hr - antibodies to donor platelets or leukocytes - fever, chills, n, headache, flushing, tachycardia - stop; supportive care ( O2, diphenhydramine, airway management?); tx fever (avoid ASA in thrombocytopenic pt); seen w client after multiple transfusions

transfusion reaction - circulatory overload

- min to hr: dyspnea, crackles, increased RR, tachy - just decrease rate or dc; give diuretics, elevate hob - be careful high risk group: kids, elderly, HF pt - this pt should be seen after hemolytic

transfusion reaction - bacterial (sepsis)

- min to less than 24 hr - contaminated blood products - tachy, hypotension, fever, chills, shock - stop - get culture - abx, IV fluids, vasopressor, steroids

scabies

- minute, reddened, itchy lesions. linear burrowing of a mite at finger webs, wrists, elbows, ankles, penis -- wavy rash beneath the skin c/s by the female mite trying to bury eggs in the soft tissues - reduce itching: topical antipruritic (calamine lotion/topical steroids), permethrin 5% cream or crotamiton 10% cream; institute skin precautions to prevent spread (contact); cool compress - crusted scabies - shoe covers - 2 tx a week apart - scabicide: lindane or crotamiton lotion; apply lotion (not on face) to cool, dry skin (not after hot shower b/c of potential for increased absorption); leave lindane on for 8-12 hr, then shower off; crotamiton may be applied at bedtime for 2 or more consecutive nights; tx all family members - repeat in 10 d for eggs - launder all clothing and linen after above tx using hot water or high heat - the rash and itching may last for 2-3 wk even though the mite has been destroyed; usually heals in 4 wk

DVT

- more common in pelvic fractures and lower extremity frax - occurs several days to wks - throbbing or cramping pain; swelling and warmth of area; redness and tenderness of extremity

SLE

- need >30 SPF sunscreen - the rash is permanent - s/s: painful joints, fevers, hair loss, loss of circulation in toes/fingers, swelling in legs, ulcer in mouth, swollen glands, extreme tiredness - may also affect heart, lungs, kidneys, nervous system - meds: anti-inflammatory, anti-malarial, corticosteroids, immunosuppressives, anticoagulants, monoclonal antibodies

amniocentesis

- needle puncture of the amniotic sac to withdraw amniotic fluid for analysis - 16 wk, detects genetic disorder - 30 wk, determines lung maturity (L/S ratio) - have client void before procedure - u/s used to determine position of placenta and fetus - comps: premature labor, infection, abruptio placentae, leakage of amniotic fluid, Rh isoimmunization - monitor fetal heart rate and uterine activity before and after the test - have clients report decreased fetal movement, contraction, abd discomfort, fluid loss, or fever after the procedure

Conversion Disorder (Functional Neurological Symptom Disorder)

- neurologic symptom w/o identifiable reasons - conversion S/S affect voluntary motor or sensory functioning suggestive of neurological disease (i.e., paralysis, seizure, coordination disturbance, blindness, deafness) - a client w blindness will have intact optical cranial n function - most resolve within a few weeks - find out precipitating factors, freq, and in which situations the S/S occurs - if the S/S is life-threatening - any non-medical impacts - if intrapsychic factors may influence the undesirable behavior, along w feeling/thoughts (anxiety, depression) that may be occurring

hep b

- newborns, adults at risk for exposure to blood or blood-containing body fluids, hemodialysis, household contacts, sex partners have HBV, some international travelers, injecting drug users, men-who-have-sex-with-men, heterosexuals with multiple sex partners, recent STDs, HIV, all unvaccinated adolescents (under 19) - given in 3 doses, with 2nd dose 1-2 mo after the 1st, and 3 rd dose 4-6 mo after the 1st (3rd is important in producint prolonged immunity) - protect >90% in healthy people - used rarely in: immunodeficient; allergic to recombinant yeast-derived vaccines - nx: thrombocytopenia or coagulopathy - IM injection may cause bleeding; implementation: give after consent - local reactions at injection site: redness, tenderness; other reactions: joint pain, arthralgia, fatigue, headache, anaphylaxis HBV can stay active for up to 7 d

pharm nuclear stress test

- no caffeine-containing meds, foods, or beverages for at least 1 d (including decaf) - methlyxanthines such as theophylline can reduce the coronary vasodilation effects - stop these meds the day of the test/48 hr before: theophylline BB, nitrates - no smoking the day of the test - remain NPO for 3 hr before the test - the test will take 3-4 hr - may have some nausea during the test and headache after the test - vasodilators: dipyridamole, adenosine, regadenoson - can produce bronchospasm and AV block - positive inotrope/chronotrope: dobutamine

prevent pressure injuries

- no donut devices - no side-lying

prevent pressure injuries

- no firm massage red or discolored areas - risk for skin breakdown - inspect bony prominences - a 30 degree lateral turn is recommended - observe and palpate all areas of skin discoloration - a/s discolored skin for blanching

kidney biopsy

- npo 6-8 hr - no anticoagulatns/plates 2-3 d before - x-ray taken prior to procedure - skin is marked to indicate lower pole of kidney (fewer blood vessels) - client instructed to hold breath during needle insertion - apply pressure dressing on affected side for 30-60 min - bedrest for 6-8 hr, up to 24 hr ; supine w back roll for the first 2-6 hr - intake 3000/d - comp: bleeding/hematoma - achy pain begins at the site and radiates to the back (flank), and cont to the abd - hematuria may be present but usually resides in 48-72 hr; should not have blood clots - uremia increases bleeding risk - may need dialysis - avoid heave lifting for 1-2 wk; no driving maybe

Electroencephalogram (EEG)

- observe for seizure activity in seizure-prone clients - painless; will not feel any sensations - require consent - tranquilizer and stimulant meds withheld for 24-48 hr pre-EEG - stimulants such as caffeine, cola, tea, cigarettes withheld for 24 hr - may be asked to hyperventilate 3-4 min and watch bright, flashing light - meals not withheld - kept awake night before test; wash hair the night before and avoid putting any sprays or gels

anorexia nervosa

- obsessive about what they eat, how much they eat, and when they eat - also obsessive about exercise - reports of binging may occur - indications for meeting metabolic demands: return of menses and regular (sufficient intake of fat to maintain FSH and LH) - steady weight gain of no more than 2 kg per wk - an initial target weight is 85% of ideal weight

Autonomic Dysreflexia

- occurs at or above level of T6 - noxious stimulus below SCI sets off cascade of uncoordinated responses - stimulation of sympathetic nerve fibers below the injured area: vasoconstriction and HTN; beta: slows HR, vasodilation above injured area; sever headache, diaphoresis (above injured area), piloerection, n, nasal congestion, flushing - risk factors: skin breakdown, bladder infection, menstrual cramping, irritated or distended bladder or bowel, fecal impaction, sexual activity, sunburn, clothing that compromises circulation or c/s overheating, wound care - hydralazine: rapid-acting antihypertensive -- AE headache and low bp (expected), angina, tachy/palpitation, Na retention (peripheral edema), anorexia/n/v/d (expected), lupus-like syndrome of sore throat, fever, muscle-joint aches, numbness/tingling, anxiety/depression, and rash -- give w food to increase bioavailability

preterm labor

- occurs btw 20 and 37 wk gestation - experience uterine contractions and cervical changes - risk factors: AA, older than 35 yr, younger than 17 yr, problem with pregnancy, smoking and substance abuse; previous preterm labor or birth - implementation: bed rest, side-lying; uterine monitor; daily weight; good nutrition; relaxation techniques; administer terbutaline

"picky" toddler (ritualistic eaters, select a limited number of food, prefer eating familiar foods)

- offer finger foods: preferred style for toddlers; enhance autonomy and independence - they may be testing and exerting independence by refusing to eat certain foods - no need to reduce snacks - they eat small meals freq

home health safety considerations

- older adults - olfactory impairment: check expiration dates on food freq - a client not meeting G & D milestones is more prone to safety issues in the home - clients w impaired mobility, high fall risk, limited ability to perform ADL (including eating), and a lack of ability to provide or seek cont needed medical care - impaired cog (dementia, head injury, substance use) - home health care requires a prescription

therapy for anorexia nervosa

- one of the goals is to achieve a sense of self-worth and self-acceptance that is not based on appearance - do activities to promote socialization and increase self-esteem - another goal is to achieve 85-95% of ideal body weigh: the client may be able to exercise after ST goals are met

facility policies on floating

- only among certain similar units - only to one lower level of care - have certain qualifications - received orientation and cross-training - employed for a period of time

65-80yr

- onset of chronic diseases - change in social roles - caregiver strain - decrease independence

insulin combination (short & intermediate acting)

- onset: 0.5 hr - peak: 2-12 hr - duration: 24 hr

contraception

- oral: inhibits release of follicle-stimulating hormone SE: n, vaginal infections contra: HTN, thromboembolic disease, DM take same time each day miss one pill: take when you remember miss 2: use alternative form of birth control - IUD: cause degeneration of fertilized egg or prevent implantation; inserted by physician during menstrual period SE: cramping, excessive menstrual flow, infection (including STD) report unusual cramping, late period, spotting - condom: prevents sperm from entering vagina; helps prevent venereal disease (STD) - diaphragm: prevents sperm from entering cervix; fitted by health care provider; risk of UTI and TSS; do not insert >6 hr prior to coitus; best when used with spermicidal gel; remove at least q 24 hr - levonorgestrel implant: requires surgical insertion and removal; effective for 5 yr SE: irregular bleeding, n, skin changes - rhythm: periodic absence of intercourse during fertile period, which is determined by drop in basal body temp before and slight rise after ovulation cervical mucus changes from thick, cloudy, to abundant, sticky, clear, thin, and slippery w ovulation - tubal ligation: fallopian tubes are tied/cauterized; intercourse may be resumed when bleeding ceases

neurogenic bladder

- overflow incontinence - teach the client about cont or intermittent self-cath (usually required) (also use in MS and spinal cord/brain injury - low-Ca diet to prevent caculi - bladder retraining and schedule toileting

urinalysis

- overnight urine specimen is more concentrated pH 4.5 (normal pH 4.5 - 8) -specific gravity 1.010 -1.030 -- obtaining urine specimen: clean perineal area first then collect the specimen

genitourinary med - anticholinergics

- oxybutynin, darifenacin - reduce bladder spasms and treat urinary incontinence - se: blurred vision (contra in glaucoma); dry mouth, constipation, urinary retention

paget disease

- pain (long bone, spin, and rib pain), bowed legs & decreased height & shortened trunk w long-appearing arms, enlarged skull, deafness, labored & waddling gait, kyphosis, pathologic fractures - elevated ALP in advanced forms - excessive bone resorption (loss), more in adults - calcitonin, biphosphonates, pamidronate - Calcitonin: n/v, flushing of face, increased urinary freq; use to decrease release of Ca from bone and retard bone resorption, decrease pain, give at bed time - Etidronate disodium: diarrhea; use to prevent rapid bone turnover, don't give w food, milk, or antacids, monitor urinary func - alendraote: esophagitis; use to suppress bone reabsorption, give am w water, upright 30min

post op

- pain after v/s, check for bleeding and changes in v/s, and change of dressing (prescribed by hcp) - evaluate early changes in fluid volume: LOC, RR, lung sounds, UO (normal if oliguria in first 24 hr)

sickle cell disease

- pain, swelling of the joints during the crisis, fever, sclera jaundice, tachycardia (perhaps murmur) - when a/s joints, no palpation - c/s more pain - limit or restrict activity - use opioid and non-opioid meds for pain - monitor for serious comps: acute chest syndrome, ischemic stroke, splenic sequestration (sudden and severe anemia, sudden weakness, pale lips, rapid breathing, excessive thirst, belly pain, rapid HR) - tx w hydroxyurea increase % of hg F and decreases the frequency of vaso-occlusive crises in vasooccusive crisis: hydration - intake should be at least 200 mL/hr; then start O2

women health exam

- pap: q 3 yr btw 21 and 29yr; pap and HPV can be tested together q 5 yr btw 30 and 65 yr - breast exam q 3 yr btw 20 and 40 yr; q yr after 40

pigment studies

- parameters of hepatic ability to conjugate and excrete bilirubin - direct bilirubin increases in obstruction - fast 4 hr - serum bilirubin, direct 0.1-0.4 mg/d; total 0.3 -1 mg/dL - urine bilirubin, total 0 - total 70% of the parenchyma of the liver may be damaged before liver function tests become abnormal

presentation

- part of fetus that enters maternal pelvic inlet - cephalic/vertex - head (95%) - breech - buttocks (3-4%): frank - hip flexed/knee extended; complete (both hip and knee flexed); incomplete(footing) - extension of hip and one of the knees - transverse lie - shoulder (rare)

therapeutic exercises

- passive range of motion: retention of joint, maintain circulation - active assistive rom: increases motion in the joint - active rom: maintains mobility of joints and increase muscle strength - active resistive rom: against manual or mechanical resistance - provision of resistance to increase muscle strength; 5 lb bgs/weights used - isometric: maintain muscle strength when joint immobilized -- non-weight bearing (e.g., quad sets), the muscles are made taut and then relaxed in a repetitive manner, performed at least 3x/d for those who are immobile or on bed rest active exercises promote muscle strength isometric exercises contra in HTN d/t a potential vasovagal response (sudden drop in BP & HR) during intense isometric muscle contraction high-intensity resistance training can improve muscle strength in the elderly - bone health: 1k-1.2k Ca + vit D(fortified cereals, egg yolks, saltwater fish, liver) - nx should a/s current activity levels, exercise hx, limitations, pain, muscle strength and weakness of extremities - inspect joints to determine appearance and ROM - observe gait

tinea

- pedis (athlete's foot): vesicular eruptions in interdigital webs - capitis (ringworm): breakage and loss of hair; scaly circumscribed red patches on scalp that spread in circular pattern; fluoresces green with wood's lamp - corporis (ringworm of body): rings of red scaly areas that spread with central clearing - topical administration of coal-tar preparations: protect from direct sunlight for 24 hr, may stain skin - steroids followed by warm, moist dressings with occlusive outer wrapping (enhances penetration) - antimetabolites (e.g., methotrexate): check liver function studies - u/v light: wear goggles to protect eyes

physical effects of alcohol on the body

- peripheral neuropathy: pain, burning, tingling, prickly sensation - lack of vit B - alcoholic myopathy: muscle pain, swelling, weakness accompanied by increase in myoglobin in the bloodstream that turns the urine a reddish orange color - lack of vit B - wernicke's encephalopathy: thiamine deficiency results in paralysis of ocular muscles, diplopia, ataxia, somnolence, stupor - korsakoff's psychosis: confusion, loss of recent memory, confabulation (distorted memory or confusion of fact and fantasy) - alcoholic cardiomyopathy - esophagitis - portal HTN - esophageal varices - tx by senstaken-blakemore tube - gastritis: can lead to hemorrhage; vasopressin controls bleeding - pancreatitis: constant, severe epigastric pain, n/v, abd distension; can result in steatorrhea, malnutrition, weight loss, diabetes - alcoholic hepatitis; cirrhosis (watch for ascites, esp in abd and lower extremities; and changes in ms) - restrict Na, diuretics, blood products and vit K, lactulose - leukopenia, thrombocytopenia - sexual dysfunction cirrhosis: fluid volume excess d/t plasma dilution: BUN may decrease (normal is 10-20) - gynecomastia and impotence in mem; menstrual irregularities in women b/c liver cannot process estrogen - decreased absorption of iron and vit B12 - anemia - 3,000 cal diet

Ped Cardiac Arrest

- place the head of one hand over the lower 1/2 of the sternum, btw the nipples - begin CPR at a rate of at least 100-120, at least 1/3 the depth of the chest (adult: at least 2 in) - 30:2 at least 2 min. If EMS has not been activated, and you are still alone, leave the child and activate EMS - AED: shock will be delivered in vfib (coarse) and pulseless ventricular tach

AKI

- prenatal: lack of blood flow to the kidneys - dehydration, cardiogenic shock, MI, septic shock, and embolism - intrarenal: direct tissue damage in the kidneys - acute tubular necrosis is the most common c/s - postrenal: mechanical obstruction of urine flow: BPH, renal calculi, sever back, pelvis or perineum trauma; bladder/prostate cancer

air embolism

- prevention: place client supine/trendelenburg when changing tubing; client perform valsalva maneuver - if suspects air embolism: clamp catheter, place in left lateral Trendelenburg position to prevent it from traveling to the lungs/brain and to trap it in the RV, notify hcp, give o2 - resolve when the air is absorbed by tissue

tracheostomy tube cuff

- prevents aspiration of fluids - check the pressure q 8 hr, <25 mm water/ 20 mm mercury - inflate during cont mechanical ventilation, during and after meals, during and 1 hr after tube feeding, when pt cannot handle oral secretions

health prevention

- primary: immunizations (prevent happening) - secondary: health screenings (id issues at earlier stages) - tertiary: rehab services; bereavement group (restoring functions, prevent consequences)

urine specimen collection from indwelling urinary catheter

- prior to obtaining the sample, one of the best nx practices should be to drain the tubing of any urine to ensure the sample is fresh from the bladder - withdraw a urine sample w a sterile needle or needleless system - clean the port with CHG - sterile technique

migraine

- prodromal: depression, irritability, feeling cold, food cravings, anorexia, change in activity level, increased urination - aura: light flashes and bright spots, numbness and tingling (lips, face, hands), mild confusion, drowsiness, dizziness, diplopia - headache: throbbing (often one side), photophobia, n/v, 4 -72 hr - recovery: pain gradually subsides, muscle aches in neck and scalp, sleep for extended period - fluctuating estrogen levels can contribute to it - precipitating factors: changes in BG, stress, chills, bright lights, menstrual cycles, depression, sleep deprivation, fatigue, foods containing tyramine/nitrates/diary, nuts, citrus fruits, chocolate, tomatoes, oranges, onions, aspartame (artificial sweetener), monosodium glutamate (味精） meds: BB (titrate up to a period of wk), triptan (activate serotonin receptors) - take it only when the client has a headache or an aura but not to prevent migraines, tylenol, NSAIDS, topiramate (anticonvulsant) - titrate up to 4 wk to tx migraine, ergotamines (alpha-1 selective adrenergic agonist vasoconstrictor) - take at beginning of headache - elevate HOB 30 - riboflavin (vit B2) 400 mg reduce the # and duration but not the severity of the headaches

during pregnancy

- progesterone levels can result in nasal stuffiness or epistaxis -leukocytosis, increase in erythrocyte production - enlarging uterus c/s pressure on veins - varicosities in the vulva, rectum, and legs - leg cramps: client should elevate the legs and extend the affected leg and keep straight; ask someone to assist bending the food toward the body; if alone, stand and apply pressure on the affected leg w the knee straight

IV peylogram

- provides x-ray visualization of kidneys, ureters, and bladder - bowel prep - npo after midnight - check allergies to shellfish or iodine, chocolate, eggs, milk - burning or reports of salty taste may occur during injection of radiopauqe dye into vein - x-rays are taken at intervals after dye injection and done after procedure - client should be alert to signs of dye reaction: edema, itching, wheezing, dyspnea

breast cancer

- risk factors: menses before age 12; no children; 1st pregnancy after 30; menopause after age 55 - small, fixed, painless lump; puckering or dimpling of the skin; nipple retraction; discharge - mammography performed when a lump is physically felt in the breast; surgery; radiation and or chemo -- breast examination is ideally done about 1 wk after the onset of menses, when hormonal influences on the breasts are at a low level -- examine first w arms at sides, then above head, than w hands on hips -- use finger pads of 3 middle fingers to palpate to detect unusual growths when lying down; or firmly touch the breast in a circular motion -- repeat in standing/sitting

Laxatives/Stool Softeners

- psyllium hydrophilic mucilloid: a bulk-forming laxative; safest even taking on a routine basis. Psyllium is a fiber and works by increasing water absorption or retention within the stool - docusate Na: an emollient laxative of the fecal-softener type; problems include laxative dependency and impaired absorption of fat-soluble vit - Mg(OH)2: hypertonic and works osmotically by drawing water into the intestine from surrounding tissues. Chronic use can alter elec balance, c/s dehydration, and leads to dependency - bisacodyl: a stimulant laxative that achieves its effects by causing an irritation via nerve stimulation directly on the wall of the intestine, thus stimulating peristalsis and evacuation. Chronic use leads to dependence and possible bowel damage

MDD

- pt w depression may have difficulty making choices: nurse should offer the client 1 or 2 choices

walker

- push the walker a few in in front of you - keep straight, lean on the walker so it supports your weight - step into the center w the weak leg, then the strong leg -Moving the walker and one leg together when taking a step is the technique used if a client is experiencing weakness to one leg rather than both. sit down: slide the weak leg forward, reach back w each arm at a time, lower self with arms and strong leg get up: keep the weak leg front, push up using strong leg and arms, do not pull up using the walker, reach out and take hold of your walker, make sure balance first.

postpartum s/s

- rapid pulse rate is not normal - hypovolemia r/t hemorrhage - elevated WBC up to 30,000 - low grade fever concerned if: - elevated temp >24 hr - temp >100.4 (38) - other s/s of infection: chills, tachy, foul-smelling lochia, n/v, fatigue

impetigo

- reddish macule becomes honey-colored crusted vesicle, then crust; pruritus - caused by staphylococcus, streptococcus - Nx: skin isolation - careful handwashing, cover draining lesions, discourage touching lesions; abx - topical or po; loosen scabs w burrow's solution compresses - remove gently; restraints if necessary - mitts for infants to prevent 2nd infection; monitor for acute glomerulonephritis (comp of untreated impetigo)

lie

- relationship of spine of fetus to spine of mother - longitudinal = parallel (nearly all fetuses in longitudinal) - transvers = right angle - oblique = slight angle off true angle

10-12yr

- remainder of teeth (except wisdom) erupt - use phone - loves conversation - increasingly responsible - more selective when choosing friends - begins to develop interest in opposite sex - explain procedures in simple terms with pictures

lung biopsy

- removal of lung tissue for culture or cytology - administer premedication - sedatives or analgesics - have client hold breath in midexpiration - performed with fluoroscopic monitoring - monitor v/s and breath sounds q 4hr for 24 hr

SCDs

- remove at least q 8 hr - encourage the client to ambulate or shower during this time r

how to doff PPE

- remove gloves - remove gown - hand hygiene - remove face shield/goggles - remove mask - hand hygiene

risk factors for latex allergies

- repeated exposure (surgeries, catheterizations, condom, HCW or rubber factory workers) - asthma, eczema, BMD, deformed bladder or urinary tract - latex also found in syringes, vial stoppers, stethoscopes, IV tubing, tape

gestational trophoblastic disease (hydatidiform mole)

- results from over-production of tissue that is supposed to develop into placenta; the tissue develops into an abnormal growth - partial: abnormal placenta and some fetal development; complete: abnormal placenta but no fetus - majority are not cancerous; cancerous ones are called choriocarinomas - a/s: elevated hCG, uterine size larger than expected for dates; no FHT; minimal dark red/brown vaginal bleeding with grape-like clusters; n/v; associated w PIH - implementation: curettage to remove tissue; pregnancy discouraged for 1 yr; do not use IUD; contraceptives are recommended; hCG levels monitored for 1 yr; administer Rho D

pheochromocytoma

- results in the release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism (hyperglycemia, glucosuria, polyuria), and blood pressure d/t secreting tumors of the adrenal medulla (tumor can also occur anywhere, from neck to pelvis, along course of sympathetic n chain) - other S/S: n/v; dyspnea; during hypertensive episodes: pounding headache, weakness, dizziness, visual disturbances, diaphoresis, pallor, tremor, nervousness; weight loss; pain - urinary vanillylmandelic acid (VMA) test: 24 hr urine for VMA - breakdown product of catecholamine metabolism - normal results: 1-5 mg, positive for tumor if significantly higher - foods affecting VMA excretion excluded 3 d prior test: coffee, tea, bananas, vanilla, chocolate - all drugs d/c during test - clonidine suppression test: clonidine levels not decreased - freq bathing but avoid chilling - increase caloric, vit, mineral intake - no foods that contain tyramine, no cola - limit activity - give hydralazine (apresoline) for hypertensive crisis

inserting an IV

- return a flash of blood in the chamber: withdraw the stylet slightly - drop of blood: part of the needle bevel may still be outside the vein; should advance further by 1-2 mmm until flash of blood is observed

collecting a wound drainage specimen culture

- rinsing a wound w sterile water will remove any contaminants that fall into the wound w/o damaging tissue or any bacteria in the wound - culture taken from the cleaned area of the wound - don gloves to remove old dressings; perform hand hygiene; wound irrigation; obtain culture; sterile gloves; apply new dressings

macrosomia

- risk factors: DM, obesity, excessive weight gain, previous pregnancy -- baby with a DM mummy may have resp distress syndrome d/t reduced fetal surfactant in the lungs; prone to hyperbilirubinemia, hypomagnesemia and hypocalemia - S/S: a round, flushed face, chubby body, enlarged internal organs, increased body fat, esp around the shoulders - brain is the only organ that is not enlarged - during pregnancy, excess nutrients cross the placenta and the fetal pancreas produces insulin to match the energy supply - after delivery, the infant is at risk for hypoglycemia

ovarian cancer

- risk factors: nulliparity, infertility, heavy menses - dx: palpation of abd mass (late sign), U/S, CT scan, X-ray, IVP - surgical removal, chemo - paclitaxel

Down Syndrome (Trisomy 21)

- risk: maternal age > 35, heredity - developmental delay (altered cog function, mental retardation) - decreased muscle tone - increased risk of injury - floppy baby syndrome (no muscle tone); increased flexibility - increased predisposition to obesity - congenital heart defects, e.g. ventricular septal defect - leukemia (anemia, fatigue, lethargy, bone and joint pain, hypoxia, bleeding gums, ecchymosis, petechiae, retinal hemorrhages, weakness, pallor, weight loss, hepatomegaly, splenomegaly) - obstructive sleep apnea - intestinal obstruction - low nasal bridge, flat forehead, epicanthal fold, protruding tongue, low-set ears - short statue, cog function impaired, late developmental milestones - report AE: signs of HF, GI destruction, leukemia - dx: chromosome analysis, echo, eye exams, hearing tests, dental tests

traction care

- russell traction: do not turn from waist - buck: provide partial or temp immobilization of lower leg prior to surgical fixation of fractures to the prox femur - to keep client from sliding down - tilting the mattress and raising hob to keep leg straight - apply foam boot or traction tape: elevate and support extremity under heel and knee, have assistant place foam boot under leg and situate heel into boot, apply velcro tape around, grasp rope from spreader or footplate and connect to pulley system, attach prescribed weight to rope

glucagon

- se: n/v, hypotension, bronchospasm - nx: administer IM/SQ/IV - onset of action 8-10min - may repeat the dose in 15 min - give carb PO to prevent 2nd hypoglycemic reactions

care for brachytherapy

- sealed radiation - wear gloves, shoe covers, and gowns - standard precaution - <18 should not enter the room - after 24 hr: visitors are permitted but limit 30 min - wear the badge at waistline -2-3 d hospital -

gun safety

- secure ammunition (bullets) in a separate location from the gun - use trigger locks and locked gun boxes - ensure that visitors abide by the same safety measures - tell the kid: if you see a gun, RUN and tell an adult - adolescents are also high risk group

6 yr

- self-centered, show off(stormy-behavior-at-11yr) - sensitive to criticism - begins loosing temporary teeth - btw ages 6-12, children grow about 2 in (5 cm)/year and gain 4.5-6.5 lb (2-3 kg)/yr

35 -45 yr

- self-questioning - fear of middle age and aging; increased sense of mortality - discards unrealistic goals - "sandwich" generation

dehiscence

- semi-fowler w knees bent to prevent further strain on the incision - ID drainages when it first begins to occur - no deep breathing - can increase strain on abd muscles - usually occurs 5-12 d postop

positions

- semiprone (sims recumbent position): place on left with legs flexed to the abd; hip flexion increases intra-thoracic pressure - lateral w hob 30-45: helps with drainage of respiratory secretions

Piaget's Theory of Cognitive Development

- sensorimotor (0-2yr): using senses and developing motor skills, infants create a schema (e.g., hitting, looking, kicking, grasping) for dealing w environment - preoperational (2-7yr): learn to think w the use of symbols and mental images (many imaginations) - concrete operational (7-11 yr): able to perform mental operations - formal operational (>11): mature in thinking; move to abstract and theoretical subjects

lithium

- should check weight daily - have lithium levels checked 8-12 hr after 1st dose, 2-3x a week the first mo, then weekly to monthly while on maintenance - takes 1-2 wks before client will see results

negative pressure wound therapy

- should not keep the dressing on w/o suction for more than 2 hr - cause infection - notify HCP - remove the entire dressing and place a damp-to-dry dressing (change q 6 hr) over the wound until the NPWT can be applied; only temporary; should not be used on a clean granulating pressure injury b/c it can disrupt the newly epithelialized tissue when remove - do not use hydrogen peroxide and povidone iodine (damage to fibroblasts)

venous pressure measurements

- significant only in early stages of thrombophlebitis before collateral veins develop - venous occlusion in one leg causes venous pressure to be higher in other leg

an infant who is very sleepy and has refused to nurse for 8 hr

- significant risk for dehydration and acidosis - an infant's rate of fluid exchange is significantly higher than an adult's and the infant's metabolism rate is nearly twice that an adult's - acid forms more rapidly infants - acidosis - kidneys are not mature and cannot adequately concentrate urine to conserve water

anti-impotence

- sildenafil, vardenafil, tadalafil - SE: headache, hypotension, priapism, flushing, dyspepsia - nx contraindicated: nitrates (can have fatal hypotension )& alpha blockers (can have severe HTN); no grapefruit juice; call HCP if erection lasts longer than 4 hrs; take no more than 1x/d

colposcopy

- similar to pelvic exam - performed btw menstrual periods - takes 20 min - lithotomy position - cervix is washed with dilute acetic acid

fundal height

- slightly above symphysis: 12-14 wk - halfway btw the symphysis pubis and the umbilicus: 16 wk - at umbilicus or 20 cm: 20 - 22 wk - 3 fb above the umbilicus: 28 wk - rises 1 cm/wk just below the sternum cartilage until 36 wk after birth: - 6-12 hr: at the umbilicus - descend 1 cm/d

eye exams

- snellen letters or numbers are for kids >6; tumbling E or HOTV are for 3-5 yr - >65, eye exams q year - 40-60: test glaucoma q 2yr - type 1 DM should have a dilated eye exam q year - macular (allows sharply focused vision) degeneration - a medical condition responsible for loss of vision (central vision loss) in >60 --dry: yellow spots accumulate around macula; more gradual and less sever vision loss than wet, --wet: retina can become detached, blood vessels may form behind the retina

penrose

- soft, collapsible latex rubber drain used in bowel resection to drain serosanguinous fluid from surgical site - insert into an area near a surgical incision - prevent blood and serous fluids from building up near the incision by creating an outlet into a dressing that is placed over the tube - a pen is used to outline blood drainage on the dressing; date/time - note location, not sutured, have a pin - expect drainage on dressing

Pavlik Harness

- sponge bath; parent should not remove the harness - lotion can irritate the infant's skin - check q 1-2 wk - infant should be encouraged to move around

angina

- squeezing or vise-like pain - relived w rest; pericarditis relived by sitting upright

Lyme disease

- stage one: 1 to several months: rash-erythematous papule develops into lesion w clear center (bull's eye rash); regional lymphadenopathy; flu-like symptoms (fever, malaise, headache); stiff neck; migratory joint and muscle pain; last 7-10 d and reoccur (later signs: facial palsy, severe headaches and neckstiness, erythema migrans rashes other areas of the body, shooting pain, numbness or tingling in the hands and feet) - stage two: 1-6 mo: cardiac conduction defects, neurological disorders (persistent paralysis but not permanent) -- inflammation of the spinal cord and the brain - stage three: several years: arthralgias, enlarged inflamed joints, arthritis care: cover exposed areas when in wooded areas; use repellants; wear light color clothing; watch pets if the tick is found, remove it w tweezers (pulling upward), wash the area w soap and water, and apply an antiseptic; submerge the tick in rubbing alcohol and send to lab for testing if indicated tx may begin prophylactically w one dose of abx given in 72 hr of the bite abx 3-4 wks: doxycycline, ceftriaxone, azithromycin later: IV PCN G tetracycline not for kid <8 d/t staining of the teeth. Used for chlamydia, malaria, acne, rickets, and gonorrhea. SE: glossitis, dysphasia (do not take within 1 hr of bedtime), GI upset, d, phototoxicity, super infection, hyper sensitivity reactions, discoloration and inadequate calcification of teeth

abd thrusts (heimlich maneuver)

- stand behind and place one foot slightly in front of the other foot for balance - tip the client slightly forward - as if trying to lift the person up - perform 6-10x - use >12 mo

transplant rejection

- starts w an itchy or a painful rash on the palms and soles of the feet oliguria, other mild GvHD (liver inflammation, n/v/d); edema, fever, HTN, weight gain, pain and tenderness over kidney/graft site, indigestion (a symptom of a peptic ulcer - common when corticosteroids are used for immunosuppression) - obesity, DM, HTN, advanced age, smoking, substance use, and infectious status may limit a candidate's ability to be placed on a transplant list - cyclosporine is commonly prescribed for immunosuppression -- hepatoxic

weight gain during pregnancy

- steady, consistent is ideal - total: 25-35 lbs for normal bmi - the majority of weight gain should occur in the 2nd and 3rd trimesters, 1lb/wk --1st trimester: 2-4 lbs --2nd: 12-14 lbs --3rd: 8-12 lbs -- an increase of 300 cal/d in 2nd and 3rd -- 2000 cal/d diet: 200-700 cal/d (50-175 g) from protein, carb 45%-65% (225-325 g ) (?6 servings of whole grains) -- eight 8 oz water -- protein:2-3 additional servings of milk and 1 serving of meat in 2nd and 3rd -- 3-5 servings of vege - excessive weight gain >6.6 lbs/mo - inadequate <2.2/mo

PSVT

- sudden onset of a. tachy (150-220 bpm) - s/s: palpitations, sob, dizziness, tachypnea, numbness of fingers and hands, ongoing chest pain, loc - vagal maneuver: stimulates the vagus nerve and result in slowed conduction - cough, blow throw a straw, valsalve maneuver - stable: client is conscious, no chest pain monitor for increasing hypotension, chest pain, decreasing loc; attempt vagal maneuvers; administer adenosine 6 mg rapidly IV push; if not convert, give adenosine 12, may repeat 12 dose of adenosine once - unstable: unconscious: severe decrease in CO and poor cerebral perfusion chest pain: poor perfusion of the coronary arteries and myocardial ischemia synchronized cardioversion: 50-100J

oral antidiabetics

- sulfonylureas: glyburide, glipizide, glimepiride - action: increase insulin secretion/increase sensitivity to insulin - baglinide: metformin-lack-vitb12 - action: decrease hepatic production of glucose/decrease intestinal glucose absorption - nx: contrast media can induce lactic acidosis - let HCP before any tests/surgeries, if client have dehydration, severe or persisting diarrhea - need to stop the med - not with alpha-glucosidase i - alpha-glucosidase inhibitors: acarbose, miglitol - action: prevent absorption of carbs - take imme before meals; can take w other meds or alone - thiazolidinediones: pioglitazone, rosiglitazone - action: delays insulin resistance and inhibits glucogenesis - regular liver functions tests - can c/s resumption of ovulation - meglitinides: repaglinide - action: increase pancreatic insulin increase - gliptins: sitagliptin - action: enhance actions of incretin release - incretin mimetics: exenatide - action: increase insulin secretion and decreasing glucagon secretion - administer 1 hr before meals SE: GI upset, skin reactions (sulfonylureas) nx: take before breakfast, may need to take w food contradicted w iodine

conflict resolution

- summarizing and restating the other person's position, feelings, and concerns allow for validation and insight by all concerned - one principle is to discuss all of the issues and concerns - cannot be done w/o discussing negative thoughts or comments - frequent exchange or feedback

nx intervention for acute URI

- supine or side-lying w HOB elevated: allow increased chest expansion; maximize ventilation, allow for drainage of secretion - provide o2 to maintain spo2 >93 - infants are nasal breathers: suctioning may be considered after HOB elevation - npo, initiate iv fluids: prevent aspiration, promote hydration

prolapsed umbilical cord

- symptoms: presenting part not engaged, fetal distress protruding cord - nx care: call for help, push against presenting part, elevate presenting part off cord, place in trendelenburg or knee-chest position; successful if fetal heart tone remains unchanged;O2(8-10)non-rebreather - early sign of fetal hypoxia: HF>160 - late sign: <110 - use nitrazine test for pH to differentiate amniotic fluid from other fluids

fetal monitoring

- tachycardia > 160 bpm lasting longer than 10 min: early sign of fetal hypoxia, maternal fever, fetal anemia, fetal or maternal infection; non-reassuring sign when associated w late decelerations, severe variable decelerations, or absence of variability - bradycardia <110 bpm lasting longer 10min: late sign of fetal hypoxia, maternal drugs (anesthetics), prolong cord compression, maternal hypotensive syndrome, non-reassuring sign when associated w loss of variability and late decelerations

vasectomy

- terminates passage of sperm through vas deferens - permanent and 100% effective - done under local anesthesia in HCP's office; 30min, low comps; easiest sterilization - vas defrence are cut, clipped, or sealed; sperm stored in the epididymis and reabsorbed by the body - postop discomfort and swelling may be relieved by mild analgesic, ice packs, scrotal support; wear snug underwear/jock strap - avoid sexual intercourse or heavy lifting for a week - sterility not complete until the proximal vas deferens is free of sperm ~ 3 mo - another method of birth control mush be used until two sperm-free semen analyses are performed - success of reversal by vasovasostomy varies from 30 -85% - does not affect hormone production, ability to ejaculate, erection

nutrition needs

- the J club requires nutritional screening within 24 hr of admission - client should have 1.5 -2g/kg protein

peak expiratory flow rate (PEFR)

- the amount of air a person can forcefully exhale in 1 sec - 80-100%: remove the trigger and rest - 50-79%: administer a rescue inhaler - <50%: ED

upper GI fluoroscopy

- the barium interferes w direct visualization and mutes sound waves - should perform after U/S and colonscopy

pyelonephritis

- the client's urine may not have an odor - usually c/s by E.coli - it is okay to OTC antipyretic for a fever - IV abx are reserved for a severe infection; oral abx are indicated for those who are allergic to sulfa meds

peritoneal dialysis

- the difference between inflow (infused) and outflow (returned) is intake - change positions or walking may help with outflow problems - a full colon can create outflow problems: be sure to ask about bowel movement and then help the client make sure this has occurred - it is normal to have discomfort during the first few dialysis exchanges b/c of peritoneal irritation; usually disappear in 1-2 wk - referred shoulder pain may be caused by rapid infusion of dialysate - instruct the client to decrease the infusion rate - increase fluid intake will not affect the outflow dialysate - childbearing age female: because of the tonicity of dialysate, endometrial lining may be pulled through the fallopian tubes and into the dialysate solution during the menstrual cycle

milieu therapy

- the goal is to provide an environment with new patterns of behavior can be developed; prevent self-destructive behavior - structure, support, repetition, consistent expectations - every client should have a plan for activities/responsibilities to address the behavioral disorder - reminders or symbols from home can be negative and interfere w tx - unexpected incidences of behavior or reactions will occur in the milieu therapy setting and may provide necessary insight and personal growth for the client

disaster plan

- the nurse must notify the nurse supervisor, who will notify other departments as appropriate, reroute clients, and determine if the disaster plan will be activated

ischemic stroke

- the proliferative phase occurs 4-21 d after injury - pulmonary edema resolves leaving behind a fibrin matrix that results in progressive hypoxemia - during the fibrotic phase, 2-3 wks after the initial injury, fibrosis can injure the alveoli, bronchioles, and interstitium, decreasing functional residual capacity - may need a lumbar puncture to detect blood in CSF - need a slow rate IV fluid to adminsiter meds - administer thrombolytics in 3-4.5hr (IV) or 6 hr (IA) - risk for aspiration pneumonia (check temp - low grade fever; diffuse crackles) - instruct the client to tuck the chin toward the chest when swallowing to help prevent aspiration - nurse should first complete the national institutes of health (NIH) stroke scale then notify the HCP

position

- the relation of the presenting part of the fetus to the maternal pelvis - fetal reference point: most common : occiput(O), sacrum(S) - maternal pelvis is designated r/l, a/p - most common: loa - FHR best heard below umbilicus on mother's left side

TPN

- the solution, bag, and tubing should be change q 24 hr - provided through a central venous access device (CVAD), because TPN solutions are very concentrated and can injure the lining of peripheral veins (chemical phlebitis) - obtain bg before TPN and q 6 hr - meds are never given through a TPN catheter because of potential incompatibility - it is not flushed w water prior to starting the infusion; a gastric tube is flushed w water prior to starting nutritional support - ideal BG: 110-150

laminectomy

- the surgical removal of a lamina, portion of vertebral body btw spinous process and facet pedicle; allow hcp to inspect spinal canal, locate and remove herniated nucleus pulposus impinging on spinal cord and nerves - pre op: nx a/s sore throat, dysphagia, neurovascular function, gcs, resp - have trach and suction ready, hematoma/edema, dressing for serosanguineous drainage (SF leak), inability cough (lead to atelectasis and pneumonia) - client wear collar; avoid sitting or standing >30min - post op: check fever and hypotension, wear antiembolic stockings, log roll q 2hr by 2 people, back should be straight when out of bed, keep hob flat for 24 hr. Side lying: flex knee, back straight, pillow btw knee. uo and bowel sounds q 2 hr - notify if not void 8-12 hr

TENS

- the transmitter can be adjusted by the client (quality of skin stimulation and intensity)

insulin nx consideration

- thiazide diuretics, glucocorticoids, cortisone, thyroid meds, estrogen - can all elevate yr client's glucose levels -- insulin needs will be greater - tricyclic antidepressants, MAOIs, aspirin, and oral anticoagulants will decrease insulin needs

psoriasis

- thickening of the epidermis and dermis - surface skin cell consolidation w while, silvery patches - patches in various places but are most commonly on the elbows, knees, and along the scalp ridge - patches may also occur on the scrotum - more likely to occur in lighter-skinned (European descent); has periods of latency and exacerbation that have been linked to stress and hormone imbalances; genetic predisposition is also a risk factor

spontaneous abortion

- threatened: cervix is closed, uterus is soft, and the client has vaginal bleeding and cramping - inevitable: cervical dilation (cannot be prevented) and effacement; hemorrhage and moderate to severe cramping - incomplete: vagina bleeding and cramping; expulsion of a part of the products of conception - complete: the symptoms are the same as incomplete; but the client does not have retained tissue in the uterus - missed: the fetus dies in utero, but is not expelled; the client may have some vaginal bleeding and cramping; the cervix is closed -- if there is no symptom, and the client retains the fetus longer than 6 wks, it increases the risk of infection, DIC, and emotional stress - habitual: client has three or more; may result from an incompetent cervix or infertility; - septic: associated with a serious uterine infection; may result from an abortion performed by an untrained practitioner using non-sterile technique - therapeutic: deliberate interruption of a pre-viable pregnancy a/s: persistent bleeding (vaginal bleeding including tissue or clots) with cramp-like pain, back pain level, negative or weakly positive pregnancy test, gestational age and date of last menstrual period, nx: monitor v/s, bleeding, pain; establish IV; pelvic exam; administer Rho D immune globulin; save all tissue; provide emotional support The client needs to decrease activity in threatened or spontaneous abortion and count the # of pads that are saturated. Pelvic rest.

therapeutic communication

- three types of communications: social, collegial, and therapeutic - occurs btw the nurse and the client - the purpose is to promote growth and change in clients

contra in IV contrast

- thyroid disease tx w radioactive iodine - pregnancy/breastfeeding- risk of hypothyroidism in the newborn - risk in multiple myeloma - metformin held 2 d before and after having contrast

ASA poisoning

- tinnitus, n, sweating, dizziness, headache, change in ms - increased temp - hyperventilation (resp alkalosis) - later, metabolic acidosis, resp acidosis, bleeding, and hypovolemia - toxicity begins at 150-200 mg/kg; 4 g may be fatal to child - induce vomiting: initiate gastric lavage with activated charcoal - reduce temp: tepid water baths or hypothermia blankets - prone to seizures - vit k for bleeding disorder; guaiac of vomitus/stools - IV NaHCO3 enhances excretion charcoal lavage within 2 hr is most effective

prepare for procedures (toddler and preschooler)

- toddler: fear separation from parents, strangers, changes in environment; tell parents to expect regression - preschooler: fears mutilation, allow play with models of equipment

age appropriate discipline

- toddler: need independence, beginning id separation, curious and inquisitive, unable to control emotions, has difficulty clearly expressing needs - set clear limits; offer choices, simple instructions, no explanations, warnings, immediate feedback - pre-schooler: improved memory and comm skills, learning social skills, may whine to try to manipulate, have difficulty separating fantasy from reality, may become engrossed and tune-out parents to cont enjoyable activity - use time-outs: one min per age; clear limits and instructions; no begging, repeat requests numerous times or threaten; apply negative consequences immediately, reinforce and reward good behavior; delay the time-out until the kids are quite - school age: able to express feelings, improved language skills, able to exert control, peers importance, may test boundaries and authority w lying/cheating - set boundaries and mimic desired behaviors, refrain from physical punishment use logical consequences for behaviors, give advance notice of when behavior is expected, do not argue, f/u through on limits or consequences immediately after behavior occurs, rec and reward, allow responsibility and opportunity to correct behavior; once punishment is over, the parent should not revisit the offending behavior later

amyotrophic lateral sclerosis

- tongue fatigue, atrophy with fasciculations (brief muscle twitching); nasal quality to speech, dysarthria; dysphagia, aspiration; progressive muscular weakness, muscular wasting, atrophy, spasticity (usually begins in upper extremities; distal portion affected first); emotional lability, cognitive dysfunc; resp insufficiency (usually cause of death) - no alteration in autonomic, sensory, or mental function

mononucleosis 4-6 wk (kissing disease)

- transmitted by direct w oral secretions -- avoid contact w saliva for 3 mo - malaise, fever, enlarged lymph nodes, sore throat, flulike aches, low fever - more in 15-30 yr - rest and nutrition; no strenuous exercise to prevent spleen rupture - comp include encephalitis

postmortem care

- turn off IV - leave the PEG tube d/t possible leakage of gastric contents - dentures remain to keep the natural appearance of the face

steroids

- ulcerogenic: eat w food in the am - can reduce cerebral edema - can cause decreased sq fat in the extremities (DM can c/s this, and can c/s erythematous plaques on the lower extremities) - does not cause changes in skin pigmentation - other dermatological findings: allergic dermatitis, hirsutism (abnormal growth of hair in women), hypertrichosis (abnormal growth of hair above the normal for the age, sex, and race) - other AE: hunger, insomnia, hypo K, hypo Ca

UTI

- urgency, dysuria, hematuria - fever, back pain, abd discomfort - may be asymptomatic - should not tx - tx w sulfa drugs or ampicillin

CVAD

- use a 10 mL NS flush to avoid excess pressure on the catheter - non tunneled CVC: SCV, bedside, days to wks - tunneled: SCV, exits at upper abd, surgically, mon to yr - PICC: AC/upper arm; basilic or cephalic vein; bedside or as outpt, 1 wk to 6 mo - implanted port: upper chest, inner aspect of upper arm; surgically; mo to yr; do not need daily flushing

enemas

- use tepid solution - hold irrigation set no more than 12(regular)-18 in (30-45cm) above rectum (high); 3 in (7.5 cm) (low) - insert tube no more than 4 in - administer slowly to prevent cramping -- if client complains of cramping or if you see fluid escaping around the rectal tube, lower the container or clamp the tubing. - client expect abd distention - the client should hold the enema for 10 min, or as long as possible, before attempting to defecate (oil retention: retain for several hours) - contra: client has abd pain, n/v, appendicitis

PET (positron emission tomography) scan

- used to assess metabolic and physiological function of brain; dx stroke, brain tumor, epilepsy, PD, head injury - client inhales or is injected with radioactive substance, then is scanned - may experience dizziness, headache - relaxation exercises

Anti-streptolysin O

- used to evaluate the amount of inflammation in kidney glomeruli - elevation indicates glomerulonephritis - should tx STAT abx; if left untx, client can have renal failure - s/s: body edema, oliguria, HTN, hematuria, proteinuria, abd or flank pain - urinalysis, bun, creatinine, and electrolyte also dx - estimated GFR is calculated using the following indicators of renal func: serum creatinine, age, gender, and race

alpha-fetoprotein test (AFT)

- used to predict neural tube defects (spina bifida) - decreased levels may predict down syndrome - done at 16-18wk - high incidence of false positives

esophagogastic tube

- used to tx bleeding esophageal varices - balloon tamponade

spinal anesthesia (saddle block)

- usually in c/s - injected into subarachnoid space at L3-L5 - may c/s maternal hypotension and resp depression - may c/s fetal distress - possible post-dural lumbar headache - keep hydrated with IV fluids

cardiac catheterization

- usually used with angiography - introduction of catheter into chambers of heart to evaluate ventricular function and obtain chamber pressures - NPO for 2-6 hr before the procedure, empty bladder - may have feeling of heat, palpitations, desire to cough when dye injected - monitor v/s q 15 min for 2 hr, then q 30 min for 1 hr, then q 1 hr for 3 hr - check pulses, sensation, bleeding at insertion site q 30 min for 3 hr, then 1 hr for 3 hr - bluish around the insertion site resolve in 2 wk - bedrest 6-8 hr with insertion site extremity straight - a/s meds, esp metformin (nephrotoxic) - hold the med 2 days before or after to prevent kidney damage

hemophilia A

- vaccine against hep A and B - check regularly for bloodborne infections - X-linked

laparoscopy

- visualization of pelvic cavity through an incision beneath the umbilicus to view structures - CO2 introduced to enhance visualization - general anesthesia - indwelling catheter inserted for bladder decompression - routine perineal care including cleaning of the catheter - out of bed after procedure - regular diet

myelogram

- visualizes spinal column and subarachnoid space - detect infection, tumor, herniated disc, lesions - informed consent - npo for 4-6 hr before test - phenothiazines, CNS depressants, and stimulants withheld for 48 hr prior to test - empty bladder; remove metal objects - test: 45-60min - table will be moved to various positions during test - assist w positioning - typically in prone and w head support - neurologic a/s q 2-4 hr - bedrest with HOB elevated 30-45 d (recline) for first 24 hr post test to reduce risk of seizures - oral analgesics for headache - encourage po fluids - a/s for distended bladder, n/v, headache may occur

cerebral palsy

- voluntary muscles poorly controlled d/t brain damage - spasticity, rigidity, ataxia, repetitive involuntary gross motor movements

endometrial cancer

- watery discharge, irregular menstrual bleeding, menorrhagia (heavy periods) - internal radiation implant, hysterectomy - postop: a/s for hemorrhage, infection, and thrombophlebitis

normal findings in the newborn

- weight 6-9 lbs (2700 to 4000 g) - length 19-21 in (48-53 cm) - 97.7 to 99.7 F (36.5 to 37.6 C) - RR 30-60 (irregular, w pauses <15 s) - hr 100-180 - BP 65/40 mm Hg in the arm and calf - normal head c 13-14 in (33-35 cm) - normal chest c 12-13 in (30.5-33 cm) - edema of the scalp - normal finding d/t delivery - positive red light reflex (negative indicates ocular pathology, along with any dulling, dark spots, white areas) - milia: distended white sebaceous glands - cord falls off in 1-2 wk; dry and hard to touch; no tub baths - vernix caseosa: protect from amniotic fluid and moisturize the skin; helps maintain heat and against bacteria - IgG is the only Ig transported across the placenta (early as 14 wk) and passed from mother during breastfeeding - passive immunity

a/s hallucinations

- what does the client see/hear? when did that begin? How does the client feel? Does the client believe that is real? (a/s perception - reality orientation) - "I don't see that, but it sounds very frightening." - ensure the client is safe - cenesthetic: occur when the client reporting the sensation of bodily func that are usually undetectable, e.g., urine formation or nerve synapsing

asthma points

- wheezing is usually best heard on exhalation but may be heard on inhalation if severe airway narrowing is present - a pleural friction rub sound are not medical emergency

nx response to anxious pt

- when clients appears anxious and is having difficulty focusing, they freq changes the topics -- a behavior that relieves discomfort - share observation w/o judgement - allow the clients to discuss feelings - discuss w the client the ways they would like to address anxiety

disulfiram

- when taking with alcohol: flushing, increased pulse, difficulty swallowing, headache, n/v, palpitations, hyperventilation, hypotension, syncope, confusion, resp. depression, dysrhythmias, motor seizures - s/s start within 5-15 min and last 30min - several hours - ae: fatigue, drowsiness, headache, hepatotoxicity, psychosis, peripheral neuritis, polyneuritis, erectile dysfunc, optic neuritis, acne, allergic dermatitis, metallic or garlic like taste

Guaiac Test (Fecal Occult Blood Test)

- whether the diet has been free of red meat for 24-48 hr- red meats can produce false positive - vit C can cause false negative - blue color change indicate a positive result - a/s two different areas of the stool - reagent is placed on the specimen after it is applied to the testing card - indication: anemic w no probable cause; screen for colon cancer; freq abd pain; changes in BM; unexpected weight loss

S/S of EOL

- wk before death: increased sleeping, decreased interest in solid food, withdrawal and decreased communication, increased infections - days before death: changes in breathing pattern, increased lung congestion, coughing (elevate HOB to 30-45, turning, opioids), hallucinations, drop in BP, incontinence, decreased urination, require total care, not want food or liquids, severe agitation - one day before: sleep cont (more difficult to rouse), increased lung congestion (periods of apnea), mottling (esp extremities), may have sudden burst of energy/lucidity/talkativeness, high fever (do not try to aggressively lower temp) - hr before: unresponsive or agitated w hallucinations, may toss head or moan, gasping, rattling breaths (periods of apnea) - use oral anticholinergics, deep mottling of extremities, cyanosis or pallor of lips, gums

iron

- women: require 15-18 mg daily, men 10mg, pregnant - 27, average diet supplies 12-15. - better absorbed in empty stomach and with vit c - anemia in kids: excessive intake of cow's milk - rbc are formed in the bone marrow in response the secretion of erythropoietin, a hormone produced in the kidneys - smoking is a risk factor of anemia - do not take w tetracyclines (should not take w Ca supplement; safe to administer during breastfeeding; not for multiple sclerosis), antacids, milk, caffeine, eggs (bind to iron), vit E - iron deficiency anemia may occur w removal of duodenum - iron deficiency anemia associated w slow chronic blood loss (gastric ulcer, gastritis, IBD or colon cancer) - iron deficiency anemia S/S: poor appetite, brittle or spoon-shaped nails, chest pain, cracks in the corner of the mouth (cheilosis), pica - if kid does not absorb 0.8 -1.5 mg of iron per day during the first year of life, anemia results -- newborn at term have iron stored that last for 4mo - food high in iron: liver, poultry giblets, oysters/clams/scallops, egg yolks, mollusks, red meat, dark green leafy vege, lentils, soybeans, white beans

Fluoroquinolones

-Ciprofloxacin, norfloxacin, levofloxacin, ofloxacin, moxifloxacin, gemifloxacin, enoxacin. -Inhibit prokaryotic enzymes topoisomerase II (DNA gyrase) and topoisomerase IV. Bactericidal. Must not be taken with antacids. -Gram-negative rods of urinary and GI tracts (including Pseudomonas), Neisseria, some gram-positive organisms. Toxicity: GI upset, superinfections, skin rashes, headache, dizziness. Less commonly, can cause leg cramps and myalgias. - other SE: diarrhea, decreased WBC & HCT, elevated liver enzymes, elevated ALP, achilles tendon rupture with levofloxacin, seizures, photosensitivity -Contraindicated in pregnant women, nursing mothers, and children < 18 years old due to possible damage to cartilage. Some may prolong QT interval. - May cause tendonitis or tendon rupture in people > 60 years old and in patients taking prednisone. -Resistance: chromosome-encoded mutation in DNA gyrase, plasmid-mediated resistance, efflux pumps. - take 1 hr ac or 2 hr pc as well as iron/antacids/multivitamins (take 2 hr ac or 6 hr pc Ca alter absorption); take w full glass of water - monitor level of theophylline - fluo can increase its level - monitor glucose - watch hypoglycemia; can lead to hypoglycemic coma and acute psychosis

8 mo old

-Continues to increase in height/length by ½ inch per month. Head circumference increases about 0.2 inches monthly. Milestones: Parachute reflex. Sits unsupported. (7mo: sits for short periods) Crawls. Throws objects. (7mo: grasps toys w one hand) Stands holding furniture. Apprehensive around strangers peaks -- reassure the child by offering a favorite blanket or toy; talk to the infant when leaving the room, allow the infant to hear the parent's voice and see the parent in a video Plays peek-a-boo. Vocalizes to toys. babbles. Turns head to own name. Object permanence appears. Looks for dropped toys. Nursing considerations: Protect from stairs. Home free of: Small parts. Plastic bags. Balloons. Avoid baby walkers with wheels, especially near stairs. Keep dangerous products out of reach in locked overhead cabinets. Post Poison Control numbers near phone. Protect from direct sunlight - use sunscreen. Avoid insect repellents with DEET. Nutrition: avoid foods prone to choking: Small candy. Hot dogs. Popcorn. Peanuts. Habits: establish consistent bedtime routine.

elbow restraint

-Rigid, padded, fabric splint -Minimizes movement of elbow joint -Helps with patients who pick on IV lines

echinacea

-action: immunostimulant - prevents and tx colds/flu/UTI and promtoes wound healing - se: n/v, unpleasant taste and tingling on tongue - nx: decreases effectiveness of immunosuppressants, not in autoimmune diseases, avoid if allergic to ragweed or daisies (any plants in the daisies families)

labor first stage phase three (transition)

-cervix dilated 8-10 -contractions: 45-90 s, 2-3 min apart, strong - impending delivery marked by: increased in dark bloody show, increased urgency to bear down, client may become: anxious, apprehensive, irritable - fetal descent is 1 cm/hr - last 1 hr first birth (2cm/hr, 15-30min after first birth) - 1-3 hr in first, 30-60 min in after - n/v, trembling extremities - should not have analgesics!

lung scan, ventilation-perfusion (V/Q) scan

-evaluates pul. perfusion when pul infarction or space-occupying disorders are suspected - perfusion scan- IV injection of iodinated radioactive dye - significance - high level of radioactivity in areas of good perfusion; low levels of radioactivity in obstructed areas -ventilation scan- radioactive gas inhaled, should be equal distribution of gas

Influenza

-given yearly, preferably oct to may -recommended for >6mo - contraindicated: anaphylactic to vaccine or eggs, have had previous guillain-barre syndrome, currently have a moderate or sever illness, corticosteroids (decreased ability to mount an inflammatory response) recommend if pregnant during influenza season - people with flu are most contagious in the 1st 3-4 d - may infect others beginning 1 d before symptoms develop and up to 6-7 d after becoming sick; younger kids may infect longer time - the time for a person is exposed and infected w flu to when s/s begin is about 2 d, but can range from about 1-4 d - quadrivalent inactivated : 2 influenza A + 2 influenza B for >6 mo and chronic diseases - vaccination should not be postponed d/t low-grade fever or minor resp illness or ear infection, diarrhea ; vaccine will not make clients more ill -- abx does not contra; but antiviral dose

Contraction Stress Test (CST)

-nipple stimulation or oxytocin stimulation evaluates fetal response to stress -done at 28 wks - position in semi-Fowler's or side-lying - positive: late decelerations w at least 50% of contractions; potential risk to fetus; c/s may be necessary -negative: no deceleration with a min of 3 contractions lasting 40-60 seconds in 10 min - this test may send a mom to premature labor; nurse should monitor for post-test labor onset

ARB

-sartan headache, tickling in the throat, fatigue, angioedema, GI upset

coughing techniques

-three slow deep breaths through the nose slowly exhaling through the mouth -take another deep breath (1,2,3) and cough several times during expiration -cough from deep within chest

Stages of Parkinson's

1) Unilateral shaking or tremor of one limb 2) Bilateral limb involvement, makes walking and balance difficult 3) Physical movements slow down significantly, affects walking more 4) Tremors decrease but akinesia and rigidity make ADLs difficult 5) Ct unable to stand or walk, dependent for all cares, may have dementia

fundus

1-2hr after birth: btw umbilicus and symphysis; 6-12 hr at umbilicus by 10th d: the fundus has normally descended into the pelvic cavity and cannot be palpated subinvolution can lead to hemorrhage

mg level

1.3-2.1 dietary: green vege, nuts, bananas, oranges, peanut butter, chocolate alcohol induced renal tubular dysfunc cause excess urinary mg excretion; low Mg c/s increased excretion of K in the urine and feces hypo mg: PPI decrease intestinal absorption -- chvostek (tap over the facial nerve about 2cm anterior to the external auditory meatus; first twitching at the angle of the mouth, then the nose, the eye, and all the facial muscles)and trousseau (inflate BP cuff 20mm Hg over SBP for 3 min); torsades de pointes high mg: Things slow down!!! decreased BP and bradycardia, muscle weakness, urinary retention, n/v, choreiform movements (repetitive, jerky, involuntary movements) and seizures -- if Ca is also slow

hep a

2 dose depending on lifestyle begin at 1yr of age; 2nd dose 6 mo apart self-limiting incubation period of 15-50 d most contagious just prior to onset of S communicable for 2-3 wks before onset of jaundice and about 1 wk after onset of jaundice (not frequent in peds) Peds S/S: flu-like. Among <6 yr, up to 70% of kids will be asymptomatic other liver s/s: anorexia, dark urine, gi upset, clary-colored stool, fatigue, pruritus hep a: itching - c/s by accumulation of bile salts under the skin; tx w calamine lotion and antihistamines IG is effective against hepatitis if administered within 2 wks of exposure No specific meds exist to tx hep a

nasal cannula or prongs

23-42% at 1-6L/m a/s patency of nostril apply water-soluble jelly to nostrils every 3-4 hr perform good mouth care

o2 hood

30-100% at 8-10 L/min used for neonates provides cooled humid air check O2 concentraion with O2 analyzer every 4 hr refill humidity jar with sterile distilled water clean humidity jar daily cover client with light blanket and towel or cap for head change lien freqently monitor client's temperature freq

vest restraint

A type of restraint that consists of a sleeveless jacket with tails; the tails are tied to the bed frame under the mattress or to the back of a chair

levels of PPE for bio/chem contamination

A(highest): when highest level of resp, skin, eye, and mucous membrane protection is needed; require self-contained breathing apparatus (SCBA), fully encapsulating, vapor tight chemical protective suit B: lesser level of skin and eye protection; SCBA, chemical resistant clothing (does not need to be vapor tight) C: when type of airborne substance is known, concentration measured, criteria for using air-purifying respirators met, and skin and eye exposure is unlikely; full-face or half-mask, air-purifying respirator, chemical resistant coveralls w splash, blood, hood, chemical resistant gloves and boots D: nuisance contamination only; a work uniform w coveralls and safety shoes/boots as needed

ACEi

AE: HTN, gastric irritation (but should not take with food, give 1 hr ac or 2 hr pc; eat small freq meals), peptic ulcer, MI, proteinuria, rash, pruritis, peripheral edema freq mouth care

AE and severe AE of anesthesia

AE: sore throat; confusion and memory loss (esp elderly), shivering and feeling cold, n/v, dizziness, difficulty passing urine severe: stridor (load, high-pitched, crowing breath sound), RR <12, DM, obesity, core temp <95.8, seizures, malignant hyperthermia, coma

agoraphobia

An abnormal fear of open or public places

anticholinergic effects

Blurred vision Urinary retention Dry mouth (xerostomia) dysphagia Constipation Anhidrosis -- inability to sweat normally Tachycardia impotence nasal congestion bowel obstruction examples: antihistamines(e.g., hydroxyzine) - also contraindicated in peptic ulcer (increased risk for bleeding), use of MAOI, and acute asthmatic attack - cause an expected effect of drowsiness - beneficial to insomnia; help tx diarrhea

H2 antagonists

Cimetidine, Ranitidine, Famotidine, Nizatidine " tidine' they help you TO DINE" -inhibit gastic acid secretion -Peptic Ulcers, Stress Ulcers, GERD -very SAFE (sometimes headache, dizziness, diarrhea, constipation, wheeze w heartburn) - nephrotoxic (prefer UO 50-60 mL/hr) - risk for confusion (in elderly) - take w meals and at bedtime - help w appetite and weight gain

Infectious disease

Disclosure to individuals who have had contact w the source is conducted by the health department unit nurse maintain confidentiality

5 mo old

Doubled birth weight. Rests weight on forearms when prone. Straightens head or back when propped or held in sitting position. Sustains a portion of own weight when in standing position. Grasps objects with a whole hand. - takes objects presented to him/her Has some simple vowel sounds. Plays with a variety of objects. Locates sound downward and to the side by turning their heads and looking down. Displeased when an object is taken away. Working on trust versus mistrust.

GERD

Elevate head of bed and sit up after eating. Decrease high fat foods. Drink fluids BETWEEN meals not with meals. Avoid: milk at bedtime & late night snacking/meals, chocolate, peppermint, caffiene, tomato & orange juice. risk factors: being female, over the age of 45, obese, Caucasians, NG tube (compromises the esophageal sphincter function and permits acidic contents to enter the esophagus)

renal impairment

Elevated BUN & creatinine, Decreased Hct, Altered K & Na, Edema, fatigue, altered UO (oliguric) Fluid and diet restrictions, dialysis, electrolyte replacement

Class IC

Flecainide Propafenone can exacerbate dysrhythmias only used when no response to safer drugs

infiltration

Flow of water from the land surface into the subsurface. edema, pain, coolness, significant decrease in rate; apply tourniquet above the site, if infusion cont to drips, it is infiltration dc iv, apply warm compress, sterile dressing; if the same extremity, proximal to the site monitor iv q 2 hr

Herbals that increase bleeding risk

Ginkgo biloba, dong quai, vitamin e, high dose fish oil, garlic, ginseng, glucosamine, grapefruit, willow bark, licorice, red clover, turmeric, green tea, horseradish, evening primrose, anise, bilberry, cat's claw, fenugreek, chamomile

iv solutions

Hypertonic: D5 NaCl. D5 in Lactated ringers. D5 0.45% NaCl. Isotonic: 0.9% NaCl (Normal Saline) Lactated Ringers (most common to blood; cautious in clients who have liver disease because the liver converts LR to bicarb); given to clients in third-space fluid shifts. D5W (In the bag)- have calories but no electrolytes; not for fluid resuscitation and early postoperative period Hypotonic: D5W (in the body) 0.25% NaCl. 0.45% NaCl (half normal saline) 2.5% Dextrose. IV dextrose - administer slowly to avoid hyperglycemia; reassess the client's serum glucose 15 min and monitor periodically

myxedema coma

Hypothyroidism subnormal temp hypoglycemia and lactic acidosis hypoventilation and hypotension thin lateral eyebrows; dull, puffy face w dry skin

ototoxic drugs

NSAIDs (including ASA, naproxen, indomethacin), diuretics, certain abx (including aminoglycosides - also neurotoxic), certain anticonvulsants, certain chemo drugs (including cisplatin), anti-anxiety meds, tricyclic antidepressants, antimalarial meds, BP controlling meds, allergy meds s/s: unilateral/bilateral hearing loss, dizziness, lack of coordination in movement, unsteady gait, oscillating or bouncing vision, n/v it is important to get blood levels of the abx w peaks and troughs; also monitor creatinine

CEFDINIR

Nausea, vomiting, diarrhea Anorexia Rash Elevated liver function tests Headache Oral and vaginal candidiasis Dizziness Neurotoxicity - tingling, numbness, burning type pain Thrombocytopenia Take for 10-14 days to prevent superinfection Do not give antacids or iron supplements within 2 hours Do not take w milk to maximize absorption If take w iron, will have red stool (normal) May cause false positive for urine glucose Possible cross allergy to penicillin Rx; Preg Cat B treatment of acute exacerbations of chronic bronchitis, sinusitis, pharyngitis, otitis media, tonsillitis, and skin infections

CEFUROXIME

Nausea, vomiting, diarrhea Headache Rash Elevated liver function tests Nephrotoxicity Thrombocytopenia Take for 10-14 days to prevent superinfection May cause increased BUN and serum creatine May cause false positive urine glucose Possible cross allergy to penicillin Rx; Preg Cat B treatment of lower respiratory tract, urinary tract, skin, bone, joint, and gonococcal infections and of septicemia and meningitis

CEFEPIME

Nausea, vomiting, diarrhea,GIupset(eatwfood) Anorexia Elevated liver function tests Rash Headache Dyspnea Nephrotoxicity IV: peak 30 minutes IM: peak 2 hours May cause false positive for urine glucose Possible cross allergy to penicillin Rx; Preg Cat B treatment of respiratory tract, urinary tract, skin, and bone infections

fire in hospital

RACE: rescue, alarm, contain, extinguish - order of evacuation (maximize the # of clients evacuated in the least amount of time --evacuate ambulatory clients FIRST -- clients in general care units who require some transport assistance -- clients who require extensive resources and equipment for transfer -- critically ill clients who require access to intensive monitoring equipment and who require extensive resources to evacuate (also ensure they have access to medical gases, suction, and monitoring for as long as possible) -- - pt in isolation should be evacuated later - risk for the other pt (esp airborne) -- evacuation of the entire unit is the last resort - first thing should contain and extinguish the fire - critical clients require more manpower and resources; close the doors to a critically ill clients' room to prevent fire spread, then return w needed assistance to evacuate the client - must facilitate saving the MOST lives

SIADH and DI

S/S: high specific gravity, decreased serum osmolality, n/v/abd cramps, headache progressing to lethargy and confusion, decreased serum osmolality <280 most common c/s is cancer - maintain fluid restriction 500-1500/24hr; also be aware of hidden fluid (e.g., ice, ice cream) - if Na < 120: client can develop cerebral edema w seizures and coma - place on seizure precaution - do not administer loop diuretics if Na <125 - may promote further Na loss and worsen the symptoms - med: demeclocycline. lithium carbonate most common type of DI - central (neurogenic) - associated w head trauma, cranial surgery, and CNS tumors and infections increased serum osmolality >295

pediculosis (lice)

Scalp: white eggs (nits) on hair shaft with itchy scalp Body : macules and papules Pubis: red macules OCT pyrethrin - leave on 10 min, can stop itching, permethrin 1%, lindane apply shampoo to dry hair and work into lather for 4-5min kills both lice and nits with one application may suggest to repeat in 7 d - depends on severity use hot water for linens

CIPROFLOXACIN

Seizures restlessness Contraindicated in children less than 18 years of age Take 2 hours before or 6 hours after antacid or iron preparation Avoid caffeine Encourage fluids to 2-3 L/day May cause false positive in opiate screening tests Do not infuse with other medications Rx; Preg Cat C treatment of infections caused by E. coli and other bacteria and of chronic bacterial prostatitis, acute sinusitis, and postexposure inhalation anthrax

acrocyanosis

Temporary cyanotic condition up to 24 hr, usually in newborns resulting in a bluish color hands and fingernails, feet and toenails. May last for a few hours and disappear with warming. poor perfusion to the periphery newborn has elevated hg level: 14.5 - 22.5 central cyanosis: blue lips and mucous membranes - late sign of hypoxemia

12 mo old

Tripled birth weight. 50 percent birth length increase. Anterior fontanel closed Cruises well. -- needs help while walking Sits from standing position Says 3 to 5 words. Comprehends the meaning of several words. Has 6-8 teeth. Eats with fingers Eats some table foods; may stop formula or breast; can move to milk and juices (*skin milk is not appropriate until 2; the fat in whole milk is needed to brain development in young toddlers) Nursing considerations: Immunizations. Parental safety counseling. Disappearance of Babinski reflex.

Superior vena cava syndrome

Tumor can compress SVC and cause swelling of face, JVD, and visible chest veins - can cause BC issues

Celiac axis arteriography

Visualizes liver and pancreas anaphylaxis common

substance abuse: alcohol

You should consider the possibility of withdrawal anytime a client dx w alcoholism is admitted to acute care. When did the client has his/her last drink? How long has been drinking and how much daily? A/s elect, CBC coagulation; blood alcohol levels; consciousness and orientation; pain; alcohol consumption's impacts - intoxication: drowsiness, slurred speech (monitor airway), tremors, ataxia (injuries), impaired thinking, memory loss, belligerence, grandiosity, nystagmus - withdrawal: occurs 4-6 hr after last drink. Tremors, agitation, easily started, hyperalertness, anxiety, insomnia, mild tachy, HTN; anorexia; delirium tremors (30-120 hr) (tremors, anxiety, panic, disorientation, hallucination - no psychotic behavior, v, tonic-clonic seizures - 1st 48 hr after withdrawal - lay the head flat) 6-12 hr: agitation, axiety, headaches, shaking, n/v 12-24: disorientation, hard tremors, seizures 48: seizures (up to 72 hr); insomnia; high BP; tactile, visual, auditory hallucinations (2-3d); high fever (3-4d); diaphoresis; delirium tremors - a/s need for iv glucose, use disulfiram. --For withdrawal: administer sedation, v/s and UO (acute phase), ensure seizure precautions, provide well-lighted place to decrease hallucinations. Assist with placement in 12-step program. Use restraints only if suspected client might harm self or others. - chronic alcoholism may lead to: liver disease, pancreatitis, GI bleeding, nutritional deficiencies anemia, thiamine deficiency. - risk: males- more than 4 drinks on one day or more than 14 drinks/wk females: more than 3 drinks on one day or more than 7/wk one drink: 12 oz beer, 8-9 oz malt liqor, 5 oz unfortifiied wine, 1.5 oz hard liquor

oscillometry

abnormal findings help pinpoint the level of arterial occlusion alterations in pulse volume are measured by placing a pneumatic cuff around the extremity at different levels, attached to a monitor

fistula

abnormal passageway between two organs or between an internal organ and the body surface fever and pain may be the initial s unanticipated drainage is noted in an area that does not ordinarily drain body fluids

presybcusis

age-related hearing loss c/s by inner ear changes decreased ability to hear high pitched sounds

Opioid withdrawal symptoms

agitation, insomnia, flu-like symptoms, yawning, sweating, v/diarrhea, abd pain, muscle and bone pain

PVD

arterial: dependent rubor (bright red), cool shiny skin, ulcers/gangrene, intermittent claudication, impaired sensation, decreased peripheral pulses, pallor when elevate extremities - exercise increase collateral circulation; stopping and resting will usually relieve the pain venous: cool, brown skin, edema, ulcers/pain, normal or decreased pulses care: warm, moist packs, bed rest 4-7 d, no extreme temp

Erikson's Developmental Tasks

birth-1yr(infancy): trust vs mistrust - basic need met, mother/consistent caregiver 1-3yr(toddler): autonomy vs shame and doubt - master toilet training, walking, and muscle coordination, self-control - positive: exercise self-control; negative: defiant and negative 3-6yr(preschool): initiative vs guilt - explore the world, begin to understand right/wrong, pursue their initiative w/o trampling on the rights of others - positive: learn limits; negative: fearful, pessimistic 6-12yr (school): industry vs inferiority - achievement/accomplishment are important - positive: sense of confidence; negative: self-doubt, inadequacy 12-20yr(adolescence): identity vs role diffusion - physical & emotional changes - fit in with peers, figure out careers 20-35yr (young adulthood): intimacy vs isolation - positive: intimate relationships; negative: avoid intimacy 35-65yr (middle adulthood): generativity vs stagnation - providing for others and for themselves - making contribution and giving back is important - positive: creative & productive; negative: self-centered 65+yr (late adulthood): integrity vs. despair - positive: see life as meaningful; negative: fear of death, life lack meaning the sequence of development is orderly and predictable, but the rate is variable developmental milestones: standard of reference to compare child's behavior

bone reabsorption inhibitors

bisphosphonates: alendronate, risedronate, ibandronate SE: esophagitis, arthralgia nx: - administer on empty stomach w full glass of water & remain in upright position for at least 30 min before meals; take first thing in the morning. If client is being prescribed monthly, they would need to remain upright for at least 60 min. - stress importance of dosing med correctly to avoid GI SE - teach client to report GI upset ASAP (heartburn, stomach pain, n/v, worsening reflux) - avoid ASA/NSAIDs - regular weight-bearing exercises - risk for hypocalcemia - photosensitivity - if miss a dose: skip it and resume the next morning - very rare adverse event: osteonecrosis of the jaw - contraindications/precautions: renal disease, periodontal disease (A serious gum infection that damages gums and can destroy the jawbone) - report to HCP if the client has very poor dental hygiene

food promotes growth of goiter

cabbage, turnips, spinach, and seafood

agranulocytosis

can happen w antipsychotics (e.g., clozapine), anti-inflammatory drugs, antithyroid medications (such as sulfasalazine (Azulfidine), dipyrone (Metamizole), and nonsteroidal anti-inflammatory drugs (NSAIDs), such as carbimazole and methimazole (Tapazole) (tx hyperthyroidism), PTU (AE: SJS, hepatoxicity) not enough WBCs, neutrophil (<100; normal is 1500) sudden fever, chills, sore throat, and weakness; symptoms of UTI or pneumonia. Other signs of agranulocytosis may include: Rapid heart rate. Rapid breathing.

low residue food

canned, cooked, and skin/seedless vege and fruits no raw vege meat, dairy

UAP

cannot change peripheral IV dressing cannot take any actions for IV fluid/meds - these are for nurses or LPN can be a chaperone --merely presence of another person can measure body limbs can cleanse superficial wounds can measure rectal temp&vs(pacu) can perform hourly rounding gathering supplies for the nurse NO:-suctioning **standard procedures

pregnant minor

cannot give own consent unless fits into one of other exemptions

high K foods

celery, banana, raisin, apricots, oranges, beans, carrots, potatoes

food high in vitamin B12

cereal, milk, peanuts lack of vit B12: neurological S/S, d/c

labor first stage phase two (active)

cervix dilated 4-7 contractions: 30-60 s, 3-5 min apart, moderate to strong 3 hr in first , 2 hr in after

parenteral nutrition

check V/S q 4 hr change tubing q 24 hr client receiving PN w insulin may develop osmotic diuresis if the BG gets too high: monitor daily weight for fluid balance

severe abd pain in diverticulitis

could indicate perforation, peritonitis, hemorrhage, obstruction

compression stockings

ensure the toe hole is under the toes, the heel patch is over the heel, the thigh gusset is on the inner thigh should be placed before getting up

a/s, procedure, client

for any procedure, exam, or a/s, the client's comfort (both phy and psy)should be prioritized strategies: provide pain management when the client is comfortable, you obtain the best subjective and objective a/s

calorie restriction

for wheelchair-bound clients

milk the finger

forces interstitial fluid to mix w capillary blood and dilutes the blood

gonorrhea

freq asymptomatic in females symptoms in females: purulent vaginal discharge, dysuria, dyspareunia (painful intercourse) symptoms in males: painful urination, yellow-green discharge spread via mucous membranes, congenitally, sexual activity tx w IM ceftriaxone w PO doxycycline/aqueous PCN w PO probenecid complication: pelvic inflammatory disease

ptt

heparin - always deep SQ, never IM (danger of hematoma; onset 20-60min, duration 8-12 hr IV: peak 5 min, duration 2-6 hr lower limit of normal: 20-25 sec upper limit of normal: 32 -39 sec 1.5 -2.5 x APTT-23.3-32s if cont infusion dosage are based on the result, obtain q 4-6 hr until a therapeutic range heparin antagonist: protamine sulfate - do not expel air bubble; do not aspirate the plunger after injection (prevent tissue damage, bruising, and hematoma) - use a tuberculin syringe for multi-dose vials - 25-27 G 3/8-5/8 in needles - commonly contain 1 mL solution - alternate sites q 12 hr low-mlcl weight heparin: enxoparin fixed dose (1 ml syringe) must deep SQ, never IV/IM no need lab

types of wound healing

https://woundeducators.com/three-types-of-wound-closure/

discoloration of urine

https://www.goodrx.com/blog/medications-that-can-change-the-color-of-your-urine/

non-pharmacologic pain interventions during labor

hydrotherapy: sitting or standing in the shower or submerging in a bathtub allows warm water to relieve muscle tension - wait until 5 cm dilated swaying, rocking, walking, and lunging have been shown to promote comfort, positions should change q 30 min, choose the breathing techniques that work best

living will

if (e.g., vegetative) then (No ...) statement

oculomotor (III), trochlear (IV), abducens (VI)

iii: pupil constriction, raising of eyelids - pupils equal in size and equally reactive to light iv: downward and inward movement vi: lateral movement test iii/iv/vi: move eye balls; shine penlight normal pupil size: 2-5 mm. Pain c/s increased pupillary diameter, which leads to increased eye accommodation to light

open-angle glaucoma

increased intraocular pressure damages optic nerve, resulting in gradual loss of sight; usually affects both eyes at the same time closed-angle: only one eye, can happen suddenly, may be a medical emergency; risk factors: being highly farsighted - five danger signs: brow arching, halos around lights, blurry vision, diminished peripheral vision, headache/eye pain 6x more common in blacks primary risk fact: >60 some meds (e.g., corticosteroids) can cause Other risks: DM Dx: with tonometer - emphasize to have it done 1/2x a year; indicated for >40yr (the client may not be aware of a worsening eye condition, as the sensory nervous system can compensate for gradual changes in peripheral vision) client w a family hx should also test 1/2x a year t - can be done in three ways: direct pressure from a probe (most common: slit lamp), touching a probe to the eye to gain an electronic reading, puffing air toward the eye to flatten the cornea - normal intraocular pressure is 10-21 s/s: cloudy, blurry vision or loss of vision, artificial lights (halo), decreased peripheral vision, pain, headache, n/v mydriatic drips (pupil-dilating) are contraindicated in all glaucoma

glossitis

inflammation of the tongue

Norepinephrine

infuse with dextrose

appenditis

lower right Q pain with knee flexed make sure the appendix is not rupture

facial (vii)

motor: observe facial symmetry (frown, smile, raise eyebrows, close eyelids, whistle, blow) sensory: taste on the anterior 2/3 of the tongue (sweet and salty)

initial hoarseness after a thyroidectomy

often occurs as a result of edema or use of an endotracheal tube

Antisecretory agents

omeprazole, lansoprozole

intermittent catheterization

perform if the client does not void in 8 hr self: - wash hands before and after gathering equipment - q 4-6 hr to maintain bladder V at a predetermined amount (approx 400-500 mL) - cleanse the catheter w antibacterial soap or povidone, rinse w water, dry w a clean cloth - female length: 2-4 in; male : 6-8 in - if client feel resistance when inserting (sphincter contraction) - try to relax w the catheter in the meatus, then hold firm, stead pressure and attempt to slide the catheter forward as the urethral sphincter relaxes - cloudy is expected; only use abx if clients has UTI symptoms

storage of blood products

rbcs and whole blood: a mo platelets at room temp: 5 d plasma frozen up to a yr

safe shoes

rubber/non-skid soles leather are soft-soled - increase risk of fall

renal calculi

three factors: supersaturation (dehydration and pH changes), nucleation (crystals in urine collect together), loss of inhibitory substances (mg and citrate) types of stones: - ca oxalate and ca phosphate - do not decrease ca b/c it can increase the formation of calculus d/t bone loss; low Na, and lower protein diet for Ca phosphate - Ca oxalate: reduce oxalate-rich food - chocolate and caffeine stuff, nuts, green beans, tea, tomatoes, beet, parsley, spinach, dark roughage, rhubarb, cabbage asparagus - cystine stones: reduce Na; rare - autosomal recessive defect that affects the metabolism of amino acids - uric acid: reduce purines (red meats, organ meats, anchovy, sardines, and most other meats; alcohol and beer - high fructose corn syrup) - struvite: infection; form in urine that is alkaline and rich in ammonia; seen in UTI - obesity, IBD, an excessive vit C can contribute

antiemetics

trimethobenzamide (Tigan), procorperazine (Compazine), metoclopramide (Reglan), meclizine (Antivert), ondansetron (serotonin receptor antagonist), promethazine, prochlorperazine (in the class of phenothiazines) - also antipsychotics block dopamine, increase GI motility (effective gastric emptying) , droperidol (often IV/IM in ambulatory care settings) ae: anticholinergic, sedation, orthostatic hypotension, prophylaxis for chemotherapy as well may cause Reye's (if <21) used during viral infx a/s n/v, bowel sounds, abd before antiemetics (baseline) contraindicated in epilepsy, tardive dyskinesia (imme report if uncontrolled movements or tremors occur), adrenal tumor administer 30 min before meals metoclopramide: - restlessness, anxiety, drowsiness, EPS, tardive dyskinesia (involuntary/repetitive movement of fingers, hands, feet; impaired finger movement; grimacing; lip smacking/puckering pursing, rapid eye movements, tongue protrusion) - TD occurs 6 mo after anti-psychotic meds; do not occur during sleep; irreversible if not caught in time - monitor BP, use w tube feeding to decrease residual and risk of aspiration, 30 min before chemo

sulfonamides

trimethoprim/sulfamethoxazole, sulfasalazine - antagonize essential component of folic acid synthesis - SE: cyrstalluria, photosensitivity, GI upset, stomatitis (mouth care), hypersensitivity (rash - erythema multiforme - can lead to SJS), bone marrow depression - take 1-2 ac or 2-3 pc - sulfonamide interacts w sulfonylurea (hypoglycemia), warfarin (bleeding)

CK (Creatinine Kinase) Normal Range

used to dx acute MI detected in blood in 3-5 hr MM bands present = skeletal muscle damage MB bands present = heart muscle damage 24 hr creatinine (normal: 0.7-1.4) clearance test to measure GFR: - avoid strenuous physical activity b/c it will increase excretion - some collections will require preservatives in the container - diet: may limit beef and other protein - the amount of fluid does not affect the test; limit coffee and tea - void and discard the urine before the test begins - the container should contain a preservative and be kept refrigerated until the specimen is taken to the lab - other factors can affect: dehydration, contrast dye, stress, UTI - normal: 107-139 in men; 87-107 in women