NCLEX + 35 Page study guide, NCLEX UWorld

Risk factors for colorectal cancer

Chronic inflammatory bowel disease [I.B.D] Over 50 years of age FIRST RELATIVE with polyps or colorectal cancer Diet HIGH in fat and LOW in fiber

What to do if an air embolus is expected?

Clamp the tubing Turn the patient on the left side Put them in trendelenburg to [slanted with head downward] trap air in the right atrium

Continuous ambulatory peritoneal dialysis

Client performs self-dialysis 7 days a week 24 hours a day Dialysis is warmed (using heat pad), then infused and then dwell time is 4-8 hours Tubing and bag is disconnected or rolled up and worn under the clothing After the dwell time, the fluid is drained back into the bag and then the process is repeated

Client self determination act

Clients must be given info about their rights to identify written directions about the care that they wish to get in the event they become incapacitated and are unabe to make healthcare decisions Asked about advance directive on admission

Muslim culture

Cover up womans body when in the presence of a man not in her family Arrange for women staff for her care At least female nurse

Tartarazine and aspirin

Cross sensitivity, do not give together [CROSS ALLERGY]

Do not take NSAIDs while on lithium or with heart failure because NSAIDs do what?

DECREASE renal blood flow [worsen heart failure]

Long term use of PPIs can cause what?

DECREASED bone density which INCREASES the risk for fractures and can also cause c. diff

Most important way to see if diuretic therapy is working

Daily weights + decreased edema K+ and Na are not the best way

What is Menieres disease

Dilation of the membrane of the labyrinth There is recurrent attacks or vertigo and sensorineural hearing loss that can occur multiple times a week and go into remission for years at a time

What is conductive hearing loss

Disorder in the auditory canal, ear drum, or ossicles from infection, inflammation, foreign body, trauma or ear wax

Peripheral artery disease [PAD] position

Do NOT elevate [only for venous disease you will elevate legs not for arterial disease] legs above heart level Patients with peripheral artery disease [PAD] must dAngle legs below heart level

What do we do if we note bleeding after an ear procedure

Do not put pressure!! Call the HCP immediately

Screening for latex question

Do your lips swell when blowing up balloons? OR Do your hands get itchy when you put on rubber gloves?

So a patient with SIADH

Does NOT need extra fluid Needs salt [sodium] seizure precautions strict I/Os

What is sensorineural hearing loss (perceptive)

Due to a disorder of the organ of Corti or the auditory nerve caused by congenital things (mother being exposed to a communicable disease), infection, drug toxicity, trauma, Ménière's disease

Barium enema

During the test, patient is instructed to take slow deep breaths so they can retain the enema without blowing it all out Table will tilt in various positions, and the stool might be a different color for 2-3 days following, but this is not the most important information

Pulmonary embolus symptoms

Dyspnea Shortness of breath [SOB] Tachycardia Pleuritic chest pain Severe anxiety Impending doom

Cuput succedaneum

EXPECTED FINDING remember C and S for CROSSES SUTURE LINE -Edema + hematoma above periosteum that crosses suture lines -Resolves within the first week of life

Early stage of dementia vs late stage dementia

Early: impaired concentration and memory loss Late: Disorientation to person, place and time

Elevates INR/ prolonged PT

Easy bruising + increases bleeding risk because blood takes longer to clot

Position for a patient with a head injury

Elevate the head of the bed (HOB) 30 degrees to decrease ICP

What do we do as the nurse for autonomic dysreflexia

Elevate the head of the bed to 90 degree Loosen constrictive clothing Assess for bladder distention and bowel impaction (trigger!) Administer antihypertensive meds

What is expected with a lupus patient?

Elevated ESR [due to systemic inflammation] Positive anti-nuclear analysis [ANA positive if autoimmune disorder is present] Anemia Mild leukopenia Thrombocytopenia

What drugs do we give for SIADH [Syndrome of Inappropriate Anti-Diuretic Hormone]

Declomycin or diuretics

Common expected findings in peripheral arterial disease

Decrease blood supply from plaque buildup [watch for lipid levels] Lack of hair Decrease peripheral pulses Thick brittle nails Cool, dry, shiny skin Skin atrophy Toe ulcers, gangrene [necrosis]

What does the nurse do if fluid over load occurs?

Decrease the rate to a min or at KVO rate Elevate head of bed [HOB] Assess lung sounds + dependent edema of legs

When does lithium toxicity usuallly occur?

Dehydration Decreased renal function (elderly) Diet low in sodium Drug to drug interactions [NSAIDs and thiazides diuretics]

Circulatory (or fluid) overload signs

Increased blood pressure Distended jugular veins Rapid breathing Dyspnea Moist cough + crackles

Diet for a patient with abdominal aortic aneurysm [AAA]

Increased fiber and increased fluid intake so you don't have to strain when you are having a bowel movement which can increase pressure and lead to rupture of the aneurysm

Trachea deviation [mediasternal shift] signifies what

Increased pressure on one side of the lungs aka pneumothorax

Hypernatremia

Increased temp Weakness Disorientation/delusions Hypertension Tachycardia

Why do we do active assistive range of motion

Increases motion of the joint Performed by the client with the assistance of then nurse

What do we do for non-penetrating abrasions

Eye patch for 24 hours

When I see pericardial effusion and/or cardiac tamponade, I think of what?

FLUID BUILD-UP in the pericardium

14 gauge catheter

FLUIDS and DRUGS in pre hospital or emergency setting or hypovolemic shock

Any kind of shock, what do you do

FLUIDS! [0.9 sodium chloride]

How to get a client from sitting to standing

Face client and firmly grasp rib cage Push nurses knees against one of clients knees Rock client forward until they come to a standing position Pivot client to position him/her into chair (chair should be on clients strong side)

Risks for colon cancer?

Family history If you have inflammatory bowel disease [IBD], Crohns, or Ulcerative colitits Diet high in red meat Obesity Alcohol Smoking

Correct positioning for a trochanter roll

From the lateral aspect of the hip to the mid-thigh Trochanter roll is a positioning device that is placed under the greater trochanter to prevent external rotation of the hip joint and prevents the femur from rolling

Fruits and veggies that are high in potassium

Fruits: Bananas, cantelopes, oranges Veggies: Broccoli, spinach, potatoes

GTPAL system

G gravida number of times pregnant T Term babies carried to term 37 weeks or later P Preterm babies delivered from 20 weeks to 36 weeks A Abortions- pregnancy terminates before 20 weeks L Living children or babies currently living children

Botulism is what and caused from?

G.I absorption of toxin produced by clostridium botulinum from improperly canned or stored food •Found in soil and can grow in food •Look out for swollen/bulging cans [discard]

Remember for lung positioning:

GOOD LUNG UP [affected is put down for easy drainage + unaffected lung is up to facilitate breathing]

What do theh traffic signal colors mean in a peak flow meter?

GREEN [asthma is under control] there are no worsening of cough, wheezing, or trouble breathing YELLOW [means caution] symptoms are getting worse -Even after return to the green zone after use of medication, further med or change in treatment is needed -Still take meds if you return to green zone after taking rescue meds RED [needs emrgency treatment] if the level does not immediately return to yellow after taking resue meds

The delivery is oxytocin

Given through an infusion pump into a proximal port (not distal) Monitor FHR and uterine contraction pattern at least every 15 mins Monitor intake and output Continuous FHR monitoring

What does enteral mean?

Given through the G.I tract [orally or feeding tube]

Important education for celiac disease

Gluten-free diet for the rest of their lives. WHY? •Gluten damages intestines [small intestines] which are needed to function properly for nutrient absorption [increased risk for malabsorption] •These are ok to consume by a celiac patient -Rice -Corn -Potatoes •Read food labels of all processed foods because some may contain hidden gluten

Physical assessment on a child

Go from least invasive to most invasive because once the child becomes upset its hard to finish the assessment so FIRST interact with parents, then with the kid and play with them get history and weight Then auscultate [listen to heart, lungs, abdomen] Then get vitals [blood pressure, heart rate]

Hip dysplasia in 16-18 months

Gradual reduction by traction [using bilateral Bryants traction] Cast for immobilization

Diet for toddler through adolescent should be

HIGH protein and HIGH calcium Allow the toddler to pick foods to avoid an argument (we just want them to eat! Anything!)

Mnemonic to remember ventilator alarms

HOLD High alarm? Obstruction in the tube [increased secretions, kink, patient coughs/gags/bites] Low alarm? Disconnection or leak in the ventilator or patient airway cuff + Patient spontaneously stops breathing

How to remember the four defects in tetralogy of fallot

HOPS •Hypertrophy of right ventricle •Overriding aorta •Pulmonary stenosis •Septal defect

Symptoms of addisons disease?

HYPERPIGMENTATION Weight loss Muscle weakness Low blood pressure [HYPOtension] HYPOglycemia

POSITIVE Trousseua + Chvosteks signs are of what electrolyte imbalance?

HYPOcalcemia

Necrotizing enterocolitis

Happens mostly to preterm infants from underdeveloped intestines or gut Bacteria is introduced into bowel and get worse fast because compromised immunity Inflammation + ischemic necrosis of the intestine progresses and causes bowel congestion and gangrenous intestines with gas forming inside bowel wall

What is battery

Harmful or offensive touching of another person Clients can refuse medication, do not force them, even if they are psychotic

How do we prevent retinopathy of prematurity

Have experts look at the eyes in all premature babies [less than 36 weeks or weighing less than 2000g] Use minimal O2 Keep sats 95-100

Nursing interventions that decrease ICP?

Head of the bed [HOB] at 30 degrees Keep head and body midline Give stool softeners [prevent straining, which increases ICP] Suction only when necessary Provide a calm environment with dimmed lights [high risk for seizure, decrease environmental stimuli] Treat fever

Rule of nines

Head: 4.5 front 4.5 back Torso: 18 front 18 back Each arm: 4.5 front & 4.5 back (each arm is 9 total) Each leg: 9 front & 9 back (each is 18 total) genitals: 1

S&S of meningitis

Headache, fever, photophobia Nuchal rigidity Positive [Kernigs sign + Brudinskis sign] Change in LOC Seizures In infants with meningitis: -Refuses feedings -Vomiting/diarrhea -Bulging fontanelles -Vacant stare -High pitched cry

Durable power of attorney

Health care proxy chosen by client to make health care decision on clients behalf id client can no longer make decisons

Directly observed therapy

Health care worker or caregiver watches patient take every medication.This: Helps prevent infection spread Helps patient adhere to drug therapy Helps controls spread worldwide

What is a Holter monitor?

Heart monitors that we have at work Keep a diary of activities and any symptoms experienced by the patient Patient cannot bathe or shower

What suggest a client has a hiatal [diaphragmatic] hernia

Heartburn because of reflux

For adults and children over 1 year of age, how do you help someone that is choking

Heimlich maneuver [abdominal thrusts]

Gemfibrozil

Helps reduce cholesterol and triglyceride levels Must monitor liver function! AST and ALT Take 30 mins before breakfast/dinner

What is HELLP related to pregnancy?

Hemolysis Elevated Liver enzymes Low Platelet It is a severe sign of preeclampsia Symptoms may be -Right upper quadrant [RUQ] pain -N/V -Malaise

What med is given right away for malignant hyperthermia?

I.V dantrolene because it reverses the process by slowing metabolism

SIADH [Syndrome of Inappropriate Anti-Diuretic Hormone]

INCREASED antidiuretic hormone [ADH] [excessive retention of fluid] •Change in LOC •Decreased deep tendon reflexes (DTRs) •Tachycardia •Nausea, diarrhea, Vomiting •Headache

Digoxin function

INCREASES cardiac contractility but SLOWS heart rate EXCRETED BY THE KIDNEY

Increased c-reactive protein is a sign of what?

INFECTION

What lab is monitored when receiving warfarin?

INR/PT

What is expected during I.V infusion of KCL?

IRRITATION and discomfort at the site because KCL irritates the vein

What do we do as the nurse for meningitis

IV antibiotic therapy Monitor ABGs, arterial pressures, body weight, serum electrolytes, urine volume, specific gravity, osmolality Droplet precautions Prevent it! Give vaccines for those 65+ and revaccinate every 5 years Hib vaccine for infants

What do we do as the nurse for trigeminal neuralgia?

Identify and avoid what causes this Avoid rubbing of the eye Chew on the unaffected side Treatment: -Carbamazepine -Alcohol injection to the nerve -Resection of the nerve -Microvascular decompression

Korsakoff syndrome

Korsakoff syndrome CAUSES problems learning new information, inability to remember recent events and long-term memory gaps. Memory problems may be strikingly severe while other thinking and social skills are relatively unaffected. For example, individuals may seem able to carry on a coherent conversation, but moments later be unable to recall that the conversation took place or to whom they spoke Those with Korsakoff syndrome may "confabulate," or make up, information they can't remember They are not "lying" but may actually believe their invented explanations.

What is one golden sign of diabetic ketoacidosis related to breath?

Kussmaul respirations [especially that fruity smell]

What number is consididered a hypoglycemic neonate?

Less than 40 mg per deciliter Feed them right away

What is the care for acute diverticulitis?

Let the BOWEL REST and let the inflammation go DOWN [low residue, HIGH protein + calories] I.V antibiotics since bacteria may contribute to a flare up NPO I.V fluids to prevent dehydration Bed rest Posible N.G suction any procedure that increases abdominal pressure or that increases peristalsis could perforate or rupture the diverticula and should be avoided

Signs of severe dehydration in infants

Lethargy Sunken fontanel Poor feeding Tachycardia Increased Respiratory rate

Med of choice for ventricular tachycardia [V tach]

Lidocaine

What drug do we give for premature ventricular contractions PVCs

Lidocaine [premature ventricular contractions eventually turn into V tach; so this makes sense]

What do we do as the nurse during the oliguric stage

Limit fluids Diet adjustment [RESTRICT protein, sodium, and potassium] Meds as needed (Kayexalate for high K) Dialysis (hemodialysis or peritoneal)

Nystatin given for oral candidiasis is given in

Liquid suspension form Not cream because it goes inside the mouth swish it around in mouth and then swallow it

Introducing a child to table foods: 1-4 months they can have

Liquid vitamins only (A, C, D, and fluoride if indicated)

How do we know that our suctioning of an ETT was effective?

Listen to breath sounds when you are done and make sure it is clear and that there are no more adventitious breath sounds

When a mom comes in active labor, what is the first thing we do for them?

Listen to fetal heart sounds or the FHR

Instructional directive

Lists of medical treatment the client wants to omit or refuse if they become unable to make decision

Diet for prevention of stones

Low calcium Low sodium Low in oxylates [spinach, cola, tea, chocolate] No vitamin D [increases calcium absorption] Low organ meats

Signs of hypoglycemic reaction

Low glucose Shaking Sweating Pale

Juvenile idiopathic arthritis (JIA) - physical activity recommendations

Low impact weight bearing and non weight bearing exercises that involve range of motion & stretching [for example swimming, stationary bike, throwing/kicking ball, low-impact dancing, walking, yoga]

What lab values to we expect to see with adrenocortical insuffiency [Addison's disease]

Low sodium Low glucose Low fluid [dehydration] High potassium

Diet for a patient with Menieres disease

Low sodium [2000mg/day] Avoid caffeine, nicotine, and alcohol

Heatstroke

MEDICAL EMERGENCY S&S: 1. Temperature greater than or equal to 104 F (40 C) 2. Hot, dry skin 3. Hemodynamic instability [tachycardia, hypotension] 4.Altered mental status/neurologic symptoms [confusion, lethargy, coma] Treatment 1. Stabilization of ABCs 2. Rapid cooling interventions [cool water immersion, cool IV fluid infusion] Note: antipyretics are ineffective

Examples of contact precautions

MRSA +VRE + C diff + scabies

Hyperkalemia

MURDER Muscle weakness Urine [oliguria/anuria; common with kidney failure] Respiratory depression Decreased cardiac contractility ECG changes Reflexes depressed (DECREASE deep tendon reflexes)

If we suspect digoxin toxicity, what lab value should we check as a hidden sign

Magnesium could be low causing this!

Why do we do isometric exercises

Maintenance of muscle strength when the joint is immobilized Performed by the client. Alternate contraction and relaxation of the muscle without moving the joint

What is the priority when a client returns from a scleral bucking procedure?

Make sure the client is not nauseated or vomiting as this can increase intraocular pressure and mess up the surgery Scleral buckling surgery is a common way to treat retinal detachment. It is a method of closing breaks and flattening the retina

When someone has a head injury, what medication are we likely to give

Mannitol •An osmotic diuretic that decreases ICP and increase urine output •This crystallizes at room temperature so ALWAYS use a FILTER NEEDLE

Nursing interventions for necrotizing enterocolitis

Measure abdominal girth daily NPO [nothing by mouth] NG suction to DECOMPRESS stomach/intestines Parenteral hydration [I.V fluids] I.V antibiotics Place supine to avoid pressure on the abdomen Avoid rectal temperature in case perforation

Rules for crutches

Measure two fingers below axilla Client should support weight on handpick not axilla Crutches are kept 8-10 inches out to the side Elbows are flexed at 20-30 degrees Stop and rest if diaphoretic and short of breath

Symptoms of acute appendicitis

RLQ pain continuous Anorexia Nausea/Vomiting Rebound tenderness + guarding Prevent increase in intra-abdominal pressure by NOT coughing sneezing or breathing deep

When drawing up regular insulin with NPH, which order do you draw them up?

RN!! Regular before NPH

Dumping syndrome

Rapid emptying of gastric contents into small intestines Client experience: -Abdominal cramping -Nausea, vomiting -Diarrhea -Dizziness -Generalized sweating -Tachycardia

Hip dysplasia in newborn to 6 months

Reduction by manipulation •Pavlik harness: worn from 3-6 months FULL TIME •Do not remove! •Sponge bath is recommended •Check skin 2-3 times a day •Avoid lotions and powders •Gently massage under skin to stimulate circulation •Place diapers under straps •Place shirt under chest straps and knee sox under foot and leg pieces •Move child from room to room for environmental change

What is the only insulin that can be given I.V

Regular. All others must be given sub Q

Treatment of frostbite

Remove clothing/jewelry to prevent vasoconstriction Do not massage rub or squeeze affected area Immerse affected areas in warm water Provide analgesia [rewarming is painful] Elevate affected areas Let areas become dry then put loose nonadherent dressings

RSV/bronchiolitis causes what

Respiratory secretions •Use saline nose drops abd then suction the nares to remove secretions •Give fluids

Who is at risk for circulatory overload?

Respiratory, cardiac, renal or liver disease patients Older clients Very young clients

When giving a client Lithium, what do we need to remember about their diet

Restrict their sodium

3rd degree AV heart block

Results in DISASSOCIATION of atrial & ventricular contraction due to blocked electrical activity LEADS TO decreased cardiac output which is manifested with Dizziness Syncope Mental status changes HF Hypotension Bradycardia

Why do we do passive range of motion

Retention of joint range of motion and maintenance of circulation Performed by the nurse without assistance from the client

Giving aspirin to children can cuase what

Reyes syndrome

Drug of choice for treatment of TB

Rifampin

When we have appendicitis, where is the pain

Right lower quadrant or [RLQ] + Rebound tenderness

What is the only med approved for ALS?

Riluzule (Rilotek)

Signs of complications post tonsillectomy & adenoidectomy

Risk for hemorrhage up to 14 days after surgery and life-threatening airway compromise Signs of Hemorrhage: 1. Restlessness 2. Frequent swallowing or clearing of throat 3. Vomiting of blood 4. Pallor May require surgery to cauterize bleeding vessels

S&S when a client is withdrawing from heroin

Runny nose Yawning Fever Muscle and joint pain Diarrhea (A lot like S&S of the flu)

Classic symptoms of a rotator cuff injury

S &S: •shoulder pain + weakness •Severe pain on arm abduction

Parvo causes fifth disease

S&S: Slapped cheek Bright red facial rash Flu like symptoms

Preeclampsia can lead to what severe thing?

SEIZURES [eclampsia]

What can hyponatremia cause?

SEIZURES, confusion, neurologic complications institute seizure precautions

Parietal lobe [brain]

SENSATION somatic and sensory INPUT Injury of this lobe causes deficits with sensation

Order of progression from SIRS to MODS

SIRS--> sepsis --> septic shock --> MODS

In an MI,

ST elevation is seen in localized leads

Symptoms of Addisonian crisis

SUDDEN drop in blood pressure, tachycardia, hypoglycemia, abdominal pain, and weakness Treat with I.V hydrocortisone

What is a detached retina

Separation of the retina from the choroid caused by trauma, gain, diabetes or tumors Patient will see -Flashes of light, floaters -Curtain coming down Patient may be experience confusion/apprehension

How long is the GBS recovery period?

Several months to a year, normal loss of function is 10% at the end of recovery

Ipratropium

Short acting inhaled anticholinergic to promote bronchodilator

Continuous Ambulatory Peritoneal Dialysis [CAPD]

Should check weight daily Do not milk catheter, drain by gravity Eat a high protein diet as CAPD has taken out protein while flushing out the cells Use strict aseptic technique

What position is someone in for an epidural puncture

Side-lying

Process for breathing from an incentive spirometer

Sit in high fowlers or sitting Seal lips tightly to prevent air leakage inhale deeply Hold breath for 2-3 seconds Exhale slowly Breathe normal for several breaths before repeating the process Cough at the end of the session

Where should the nurse be positioned when helping a client learn to walk with a cane

Slightly behind the client on the good leg side

Test visual acuity in children

Snellen chart 10 feet away for children and 20 feet away for adults

Rhonchi

Snorous wheeze continuous, low-pitched adventitious breath sounds Similar to moaning or snoring that occur when thick secretions or foreign bodies [such as tumors] obstruct airflow in upper airways

When taking lithium, what lab value do we need to monitor

Sodium The excretion of lithium is dependent upon normal sodium levels in the body •If there is too low sodium [HYPOnatremia] that means that lithium will not be excreted and we can get lithium toxicity!

What to do FIRST with an unrestrained patient invovled in a sudden deceleration accident during emergency trauma care?

Spinal precautions are first!! [IMMOBILIZE the spine] before checking pulse AND opening their airway place cervical collar

As the nurse, what do we do for GBS patients

Steroids in acute phase Mechanical ventilation, elevate head of the bed (HOB) Suctioning Plasmapheresis treatment! High dose I.V immunoglobiluns Physical therapy and ROM Pain reducing measures Eye care Prevent complications [URI, aspiration, constipation, urinary retention]

What about if a chest tube separates from the drainage tube and becomes contaminated?

Submerge the distal end 1-2 cm below the surface of sterile water to create a water seal so that air does not get in •Keep bottle of sterile water, clamps, and antiseptic wipes at the bedside

Ovarian cancer

Subtle symptoms at first which contribute to more deaths than any other gynecologic cancer Lack of screening and vague symptoms May not be diagnosed until advanced stage

What S&S will show if it proceeds to a Myasthenia crisis

Sudden inability to swallow, speak, or maintain a patent airway

What do you need to caution a client about when taking tetracycline

Sun is HOT and skin is sensitive [photosensitivity] so wear hats and sunscreen

Position for a patient during the acute phase of a stroke

Supine with the head elevated 15-30 degrees [semi-Fowler's] Facilitates venous drainage from the brain and decreases ICP [with a stroke ICP INCREASES so patient should be placed in a semi Fowler]

How to reduce portal pressure in liver failure and esophageal varices

TIPS [trans-jugular intra-hepatic portosystemic shunt] procedure* and beta blockers [propanolol]

Instructions for taking levothyroxine

Take on EMPTY STOMACH in the morning separate from other meds Blood tests are done to determine accurate dose usually is lifelong therapy Do not take with antacid, iron, or calcium

What does a patient with Marfan syndrome look like

Tall and Thin They often have heart abnormalities so contact sports are discouraged

What do we do for a patient with glaucoma

Meds! [Prostaglandin agonists, adrenergic agonists, beta-adrenergic blockers, cholinergic agonists, carbonic anhydrase inhibitors] Surgery [laser trabeculoplasty] Avoid tight clothing Avoid use of mydriatics [Atropine]

Droplet precautions

Meningitis Haemophilius influenza type b Diphtheria Mumps Rubella Pertussis Strep group A Viral influenza wat do you need? surgical mask + private room as needed for procedures that can splash gloves, gown, goggles/shield

contact precautions

Methods of infection control that must be used for patients known or suspected to be infected with epidemiological microorganisms that can be transmitted by either direct or indirect contact.

Position for a patient in shock

Modified trendelenberg [extremities elevated 20 degrees] with the knees straight and head slightly elevated [slanted with head lower than legs]

Care of the patient with Peripheral Artery disease

Monitor peripheral pulses Good foot care Do NOT cross legs •Stop smoking •Regular exercise

Care of the patient with peripheral venous disease (varicose veins or thrombophlebitis)

Monitor peripheral pulses Thrombectomy Avoid extreme temps SCDs/tedhose/elastic stockings Bedrest 4-7 days Elevate legs Warm moist packs Anticoagulants

No weight bearing

Motorized assist device if cooperative and they have upper body strength 2 person assist with full body sling if uncooperative and/or has no upper body strength

Myopia Hyperopia Presbyopia Astigmatism

Myopia: nearsightedness [can see near things well] Hyperopia: far-sightedness [can see things far well] Presbyopia: blurry vision of near things due to age Astigmatism: Blurry vision from an uneven curving of the cornea

S&S of Menieres disease

N&V Intolerable vertigo and tinnitus Pressure / fullness in the ear Fluctuating/progressive decreased hearing on the involved side Nystagmus/headache

S&S of opioid withdrawal

N&V Restlesness Abdominal cramping

Vancomycin can cause

NEPHROTOXICIY check vancomycin -Trough levels -BUN -Creatinine

After abdominal surgery, do you expect to hear bowel sounds?

NO because postop paralytic ileus

After an amputation, should the residual limb be elevated?

NO, to prevent hip flexion contractures

Cheyne strokes breathing

NOT a good sign concerning in a TBI Tachypnea breathing followed by a gradual decrease that eventually results in apnea This breathing cycle repeats Often seen in a patient that is dying

Chest pain that occurs at rest

NOT considered stable [it is unstable angina] like for example waking up at night with chest pain

During the first 24 hours after amputation, the residual limb is

NOT elevated but can be supported by pillows elevate foot of bed Patient can be put in prone twice day for 20-30 mins

Bipolar patient comes in and is experiencing acute mania.What is the priority?

NOT risk prone behavior because physiological needs like food take priority (remember maslows) So imbalanced nutrition would be the priority

If there is a puncture wound to a person by an object, the nurse should

NOT try to remove the object Instead, the nurse should stabilize it with dressings because removal causes further trauma and bleeding

Nursing care for acute pancreatitis

NPO I.V opioids I.V fluids NG tube for suction

Salicylate

NSAID Therapeutic Level: 100-250 mcg/mL Toxic Level: >300 mcg/mL

What is Toradol?

NSAID used for inflammation and pain

How to assess for clonus?

NURSE dorsiflexes the foot with one hand and supports the leg/ankle with the other When POSITIVE clonus is shown, rhythmic jerking beats of the foot are present as the foot is released

Things to remember about Native American culture

Native americans do not rely on the clock, they used to complete their days by the sun, so they may be late to an appointment

Hyponatremia

Nausea Muscle cramps Increased intracranial pressure [ICP] Muscle twitching Convulsions •Causes CNS irritability due to swollen nerve cells

Transport techs need to know/don't need to know which info

Need to know:pertinent info to transport pt Don't need to know: exact diagnosis

Elevated bun and creatinine may indicate what?

Nephrotoxicity

Toilet training time schedule

Never begin before 18th month 2-3 years: bladder control reflex achieved 3 years: regular voiding habits established 4 years: independent bathroom activity 5 years: night time control expected

Preeclampsia

New elevated blood pressure 20 or more weeks gestation and proteinuria •HA •Visual disturbances •Facial swelling

Sleep apnea features

Nighttime: - Periods of apnea - Loud snoring - Interrupted sleep Daytime - Morning headaches - Irritability - Excessive sleepiness Other - Difficulty concentrating - Forgetfulness - Mood changes - Depression

When a woman is pregnant and having breast discomfort, do we recommend that the massage them?

No

Rate for potassium infusion

No faster than 10 MEQ per hour

For Jewish people, what do we have to remember about their diets

No meat and milk together [must be 6 hours apart, but they have two meals with dairy and one meal with meat] Meat must be Kosher [drained of blood]

When you have a colostomy, what are the restrictions of your new activities

No restrictions You can return to all normal activities after the stoma/incision is healed

Can we ever remove bucks traction weights?

No! Not without a doctors order We must reposition the client in bed with the weights still on If we take them off we are inturrupting the line of pull

Extracorporeal Shock wave therapy

Non-invasive treatment of the kidney using an acoustic pulse Teach patient to report fever, DECREASED urinary output and pain Hematuria is expected but should clear within 24 hours

Late or variable deceleration indicate what in pregnancy?

Not good and need further teaching [VEAL CHOP MINE]

Effective handoff communication components

Nurse should: 1. Provide identifying information [for example: client's name and room number] 2. Note care priorities and upcoming or outstanding tasks [for example time to replace medication infusion bag, need to perform delayed wound care and cause of delay] 3. Provide exact, pertinent information [for example medication dose, time, measurable outcomes] 4. Include multidisciplinary plans [radiology examinations, family meetings, physical therapy] 5. Relay significant client changes in a clear manner

Hep B vaccine series

One shot, then additional shots at 1 and 6 months

Describe the RH incombatibility

Only RH negative mothers have a problem if their baby is positive but they are negative

What are cataracts

Partial or total opacity of the normally transparent lens [Caused by: congenital, trauma, again, diabetes, drugs like steroid therapy, exposure to radioactivity]

Nurse finds a client slumped over in respiratory distress with low O2 Sat and visible food in throat, steps on what to do?

Position to high fowlers Oral suction Oxygenate Lung sounds Notify HCP [usually always last]

What is happening in ventricular trigeminy?

Premature ventricular contractions [PVCs] are occuring every third heartbeat

What things confirm an active TB infection?

Presence of symptoms POSITIVE sputum culture POSITIVE chest xray

What is guillen barre syndrome [GBS]?

Progressive inflammatory autoimmune response resulting in a loss of motor function symmetrically, starting from the lower extremities and working its way up. Also paresthesias and too much or too little autonomic dysfunction [hypotension, tachycardia, flushing, sweating]

What is Alzheimers disease

Progressive, irreversible, degenerative neurological disease characterized by loss of cognitive function and disturbed behavior Forgetfulness progressing to inability to recognize familiar faces, places and objects

What do we do as the nurse for bells palsy

Protect the head from cold or drafts Administer analgesics Teach isometric exercises for the facial muscles Emotional support for body image disturbance Full recovery takes 3-5 weeks

What test do we use to diagnose people with Myasthenia Gravis

Tensilon test. •Where we inject tensilon and ask you to do activities like stand up and sit down and stand up and sit down •If you get tired we inject another dose •If you can stand up again, you probably have MG •MG is susceptible to the Tensilon test

Codeine is used for

acute pain or as a cough suppressant Do NOT give to a COPD [emphysema + chronic bronchitis] patient because it causes accumilation of secretions In general, SEDATIVES like narcotics and benzodiazepines should NOT be given to COPD patients because SEDATIVES can depress the respiratory center in someone with respiratory problems and at high risk due to disease process for respiratory depression

When is the rapid response team notified?

acute significant changes in heart rate, systolic BP, RR, o2 sat, LOC, and urine output

Lithium toxicity symptoms

acute: GI disturbances: nausea, vomiting, diarrhea CNS finding can occur LATER Chronic: CNS effects: neurologic ataxia, confusion, tremors

Naegele's rule

add 9 months and 7 days to LMP [or substract 3 months and add 7 days to last menstrual period date]

What is the priority intervention for pain with sickle cell crisis and why?

administer IV fluids to reduce blood viscosity and restore perfusion to areas affected by vasoocclusion

Addisons disease-what is it?

adrenal glands NOT producing enough steroids

What is the strongest risk factor for late onset Alzeimers?

advancing age

UPPER UTI would be

affecting kidneys

Quick formula to calculate number of teeth in the first 2 years of life?

age of child in months minus 6 EQUALS expected number of teeth

What is peak expiratpry flow?

airflow out of the lungs

What does a peak flow meter measure in a person with asthma?

airflow through the lungs

Cystic fibrosis (CF) nursing priorities

airway & oxygen saturation [pneumothorax can be a complication]

Near-dorwning victim management

airway management [mechanical ventilation] warm blankets warm I.V fluids Do not necessarily need to give blood; only if blood loss has occured but not just cause of drowning

What lab levels will be seen in abnormal liver function?

albumin, ammonia, platelets, INR, and bilirubin

Treat asthma with

albuterol •SE: -N/V -Insomnia -Palpitations -Tremor

Routine contamination when hands are not visibility soiled its safe to use

alcohol sanitizer

Always remember inspection is

always done FIRST, then listening [auscultation] then palpating

If a child has an asthma exacerbation and there is no wheezing/breath sounds heard, this is

an EMERGENCY priorty because it could indicate what? lack of airflow; so this is an airway obstruction This is called "silent chest"

With a delegtaing quesiton, never pick an LPN to do something that

an UAP can do such as taking vital signs It is not an efficient use of resources

Following hip repacement, place

an abducter pillow between the patient's legs to maintain hip in straight and neutral position also do NOT bend at the hip for more than 90 deg or cross the legs or ankles

Continuous bubbling in a chest tube inicates what

an air leak in the chest tube system

Quantiferon-TB [QFT] blood test is what?

an alternative to the Mantoux test It only indicates tht the individual has been infected with TB [cannot distinguish between latent or active TB] The test is more EXPENSIVE but it ONLY requires a single visit rather than having the person coming back in 48-72 hours to have their TBT test read

If patient comes into ER and says they have the worst HeadAche of their life what could it be

an aneurysm

Metronidazole (Flagyl)

an antibiotic

Pinworm infection

anal itching thats worse at night

Chronic kidney disease can cause

anemia becase the kidneys are unable to produce erythropoietin to stimulate the production of RBCs

Bone marrow suppression can lead to what?

anemia, thrombocytopenia, and leukopenia

What meds can precipitate malignant hyperthermia?

anesthesia

What are the sartan drugs like losartan, valsartan, and candesartan

angiotension II receptor blockers used for pateitns that cannot take ACE inhibitors [reason can be the persistent cough]

"sartans"

angiotension receptor blockers like valsartan

If a sibling has autism, there is a high chance

another sibling will have it too, think of closeness of family

Nitroglycerin is what type of drug?

antianginal vasodilator that may cause a headache

Quinidine

antiarrhythmic/anti-parasite Therapeutic Level: 2-5 mcg/mL Toxic Level: >10 mcg/mL

Levofloxacin (Levaquin)

antibiotic

Gentamicin

antibiotic [renal/oto toxic] Therapeutic Level: 0.5-0.8 mcg/mL Toxic Level: >12mcg/mL

What can treat death rattle?

anticholinergic meds because they will DRY the secretions and atropine will decrease saliva production

Magnesium Sulfate

anticonvulsant Therapeutic Level: 4-8 mg/dL Toxic Level: >9mg/dL Antidote/Reversal: calcium gluconate 10% (Kalcinate)

Carbamazepine

anticonvulsant Therapeutic Level: 5-12 mcg/mL

Phenytoin

anticonvulsant used for seizures

MAOIs interact with many meds including

antidepressants SSRIs SNRIs MAOIs should not be given within 2 weeks of taking other antidepressants, SSRI, SNRI

Loperamide (Imodium)

antidiarrheal

Loratidine (claritin)

antihistamine

Orthostatic hypotension is a common side effect of most of what type of meds?

antihypertensives

Chlorhexidine gives

antimicrobial effect really quick [like 30 seconds]

Ondesetron (zofran)

antinausea

Aripiprazole (abillify)

antipsychotic for dementia

Phenytoin (Dilantin)

antiseizure

If a client complains about a staff member mistreating them ,what is the first thing the nurse does?

ask patient to describe what happened so the nurse can assess then choose a course of action

The RN can ask the UAP to apply the restraints but the RN cannot

ask the UAP to verify if they are on correctly That is the RNs job

Children should not take

aspirin as it can cause Reye syndrome especially in children with a recent viral illness It causes acute encepalopathy and hepatic dysfunction Children must instead take acetaminophen or ibuprofen

Suicidal ideations

assess if they had thoughts of self harm. find out if they have a plan and if they have one then ask about the details

After a med error happens, what should you always do first?

assess the patient

FIRST thing to do if a patient is in ventricular tachycardia?

assess them for a pulse [because they can either have a pulse or not]

If an older client is expericing acute delrium, the priority nursing action is to

assess what is causing it and then to intervene

What is the Bishop score?

assesses and rates cervical favorability and readiness for induction of labor •A score above 8 is good

Listening to lungs is part of

assessing the airway because the nurse can determine if it is open or not

Shortness of breath and high pitched expiratory wheezing are expected side effects of what

asthma

Latent vs active TB

asymptomatic/cannot spread versus symptomatic and can spread through air

At what age can infants roll

at 4 to 5 months

Borderline personality disorder

at a very high risk for suicide often make suicide threats if they feel abandonment

Placenta previa is when placenta is

at bottom touching the cervix

Phenytoin toxicity

ataxia [gait disturbance]

Incentive spirometry is important post surgery to prevent

atelectasis and expand lungs

Assessing a sleeping infant

auscultate first the palpate/percuss from head to toe then traumatic procedures like eyes, ears, mouth then moro reflex [this is the last step]

Lupus erythematous is

autoimmune disorder It is mild to severe chronic inflammation of different parts of the body like face, mucosal ulcers, pericarditis, peluritis, nephritis, arthritis, DVT

Ways to reduce dumping syndrome symptoms

avoid fluids with meals and lie down after eating

Things to note about using a walker

The nurse should be behind the client with hold of their gait belt The client should sit down by grasping the armrest on the affected side and then shift weight to the good leg and hand and then lower themselves into the chair

Hypomagnesemia

Tremors Tetany Seizures Dysrhythmias Depression Confusion Dysphagia

What are Eriksons developmental stages and the ages for each

Trust/mistrust=birth to 1 year Autonomy/Shame and doubt = 1 yr to 3 yrs Initiative/Guilt = 3 to 6 yrs Industry/Inferiority = 6 to 12 yrs Identity/ Role confusion = 12 to 20 yrs Intimacy/Isolation = 20 to 45 yrs Generativity/Stagnation = 45 to 65 yrs Integrity/Despair = 65+ yrs

If an infant if allergic to cow milk, what do we do

Try soy milk formula FIRST Then [SECOND] try a predigested formula

If someone was hurt and now is returning to the job but they are impaired forever [walk with a limp, hurt back can't lift] what do we do for them

Try to reassign them a job that is more feasible and fitting for them

What do we do as the nurse for air/pulmonary embolism

Turn patient to the LEFT side and LOWER the head of the bed

How often do we provide oral hygeine for someone with an ETT

Twice a shift

A peak flow meter

USES traffic control signals to recognize degree of asthma symptoms An asthma action plan is individulaized and developed between patient and HCP

Automated peritoneal dialysis

Uses a machine with a warming chamber for the dialysate infusion, dwell and outflow The times and volumes are preset (10 mins infusion, 10 mins dwell, 10 min outflow) and they do this for 8-10 hours

Following total hip replacement, how is hip dislocation prevented?

Using an abductor pillow to maintain hip in a straight position Don't bend hip more than 90 degree Avoid extreme internal and external rotation, tell them not to cross legs AVOID ADDUCTION and hip flexion Client supine with head of the bed elevated less than or equal to 45 degree

Med of choice for status epilepticus

Valium

vagal maneuvers examples

Valsalva Coughing Carotid massage

What is ebola

Viral hemorrhagic fever Extremely contagious High mortality rate Standard, contact, AIRBORNE, and DROPLET precautions SO for people entering an Ebola room: impermeable gown/coveralls, N95 respirator, full face shield, doubled gloves, boot covers, apron No current meds or vaccines to prevent Prevention is key! There is a strict glove removal process when developing -Client should have AIRBORNE ISOLATION room, strict PPE use, restrict visitors, and log of people who entered the room

Croup

Viral inflammation and edema of epiglottis and larynx S&S: -Runny nose -Tachypnea -Inspiratory stridor -Barking cough

Dealing with a patient with hearing loss or deaf

Visibly gain their attention before speaking Directly face the client Put up hearing impairment sign on head of bed [HOB] or door Keep room well lighted so speakers face is well lit Direct speak to least affected ear if partial hearing loss [or speak into the ear the hears best] Speak at a NORMAL volume

S/S of digoxin toxicity

Visual changes N/V Confusion Lethargy Weakness Cardiac arrythmias

When we have a bunch of clients getting blood transfusions, all with reactions who is the most crucial to see first

Vomiting is FIRST Jugular vein distention (JVD) SECOND Itching THIRD Headache FOURTH

What is the best indicator of treatment effectiveness of antibiotics?

WBC count [DECREASES]

Prior to an EEG which diagnoses seizures:

We have these restrictions: -caffeine beverages -Stimulants or depressants •Patient must wash hair [remove oils]

What to remember when someone is in a crisis psychologically

We have to ask them what they have done in the past to cope, since this is a crisis. If it is just a normal situation, we do not focus on what has worked in the past because the past is the past

What do we need to remember about Prochlorperazine

We must draw it up in a separate syringe than all other medications It is an anti-psychotic and treats schizophrenia and anxiety as well as N&V

If we have a client who is withdrawing from alcohol, and their vital signs continue to creep up, what do we do

We need more sedation, these patients are approaching delirium tremors

Diet for a patient after an appendectomy

We need wound healing so we need high protein and high vitamin C and high calories

Osteoporosis and the elderly

We want to prevent fractures especially hip fractures Bisphosphate [example alendronate] Calcium Vitamin D supplement Encourage patients to STOP smoking and consuming alcohol Encourage patients to do weight bearing exercises to increase bone density

After having an M.I, when can sexual activity be resumed

When the client can walk up two flights of stairs or one city block with no shortness of breath [SOB] or chest pain

Glucose levels should be watched when receiving

a steroid [glucocorticoid because it causes HYPERGLUCEMIA]

What does torsades de pointes look like

a strand of DNA

Position of a patient after a laminectomy

a surgical operation to remove the back of one or more vertebrae, usually to give access to the spinal cord or to relieve pressure on nerves. Keep the body straight Pillow should be placed longitudinally between the legs to prevent adduction and spinal torque

What is an amnioinfusion?

a transvaginal infusion of a crystallid fluid to compensate for the loss of amniotic fluid [oligohydramnios or very little amniotic fluid]

What are mongolian spots?

benign discoloration bluish gray but usually fades

Gross tremors and seizures from acute alcohol withdrawal are treated with what?

benzodiazepines like lorazepam and diazepam

What are some meds that treat EPS?

benzos like "pam" drugs and benadryl

Rotate staff members with

bipolar disorder patient

Glucose levels are decreased 1 hour after

birth but gradually increases to normal 2 to 3 hrs after birth optimal is 70 to 100 but 40 or over is normal

What are common triggers of this?

bladder or rectum distention. treat the trigger

PTSD patients tend to

blame themselves Make sure to tell them it wasn't their fault

Cephalohematoma

bleed that does NOT cross suture lines

When do you not give a vaginal exam for a pregnant woman?

bleeding with unknown origin

In cystic fibrosis, pancreatic ducts are

blocked in the GI tract due to thick secretions that clog the ducts Therefore there is a deficiency in what type of enxymes? pancreatic enzymes which are given with meals

Warfarin

blocks the availibility of vitamin k and reduces risk of stroke venous thrombosis or PE; •Check PT/INR levels

How is hep B transmitted?

blood + semen + vaginal secretions "B" for body fluids

D-dimer

blood clot test [test to see if clot is present]

Before starting broad spectrum antibiotics, what must be done?

blood culture and sensitivity

What should be checked before giving erythropoietin?

blood pressure [because it causes HYPERtension]

When a patient is on methylphenidate, what do you measure

blood pressure and weight/height because it can cause Lack of appetitie leading to weight loss HYPERtension Tachycardia

For a blood transfusion, UAP can obtain

blood pressure before the transfusion begins and any time after the first 15 mins of infusion uap can also pick up blood from the blood bank

What is the trousseau sign

blood pressure cuff is inflated and the wrist spasms

UAP can carry

blood products to and from the blood bank

Wear gloves when in contact with

blood, bodily fluids, secretions, excretions, nonintact skin and mucous membranes and Wash hands in between patients and after removing gloves

Infants have a higher

body water precentage than adults so they can become dehydrated quickly with vomiting and diarrhea Severe dehydration occurs more rapidly in infants and young children

High reticulocytes inicate what

bone marrow is producing RBCs fast

Just like chemotherapy, methotrexate causes

bone marrow suppression which places patients at risk for what? infection

What kind of precautions do you need for open lesions from shingles?

both contact and airborne precautions and a negative airflow room

If children eat honey less than 1 years old this can cause

botulism

What is the battle sign?

bruising behind the ear indicates skull fracture that could cause brain injury if not treated

what is the grey-turner sign and what is it a sign of?

bruising of the flanks and retroperitoneal hemorrhage and is a bluish color

Pericardial effusion

build up of fluid between the layers of the pericaridum

What is pericardial effusion?

build-up of fluid in the pericardium

Lactated ringers [LR] is often used for

burns

Mitral valve regurgitation does what?

causes a backflow of blood from the left ventricle through the mitral valve and into the left atrium The back flow can lead to dilation of left atrium and pulmonary edema -Make sure to report any signs of heart failure

What is Sjogren's syndrome?

chronic autoimmune disorder that damages moisture producing glands Causes -Dry eyes -Dry mouth -Dry skin -Dry vagina

vitamin K is and what is it used for?

clotting factors

What does normal CSF look like/contain?

colorless and odorless a little protein, glucose, minimal wbcs, no RBCs, and no microorganisms

Diabetic ketoacidosis [DKA]

common for type 1 diabetes cardinal signs are fruity breath rapid deep respirations [Kussmaul respirations] hyperglycemia Ketosis or metabolic acidosis [caused by an intense deficit of insulin] Treatment: I.V normal saline FIRST, then I.V regular insulin, check finger-stick glucose

Clients with a cast are at risk for

compartment syndrome so they should always have neurovascular checks

What is asystole?

complete absence of ventricular electrical activity in the heart No ventricular contraction occurs client is -pulseless -apneic -unresponsive

Hepatic encephalopathy symptoms

compliction of end stage renal disease [ESRD] Build up ammonia in the blood CNS effects: lethary, confusion, slurred speech, can lead to coma watch for asterixis- flapping hand tremors

How to close a hemovac

compress to create negative suction pressure and APPLY PLUG BEFORE RELEASING THE PRESSURE

UTI and the elderly

confusion may be a sign of a UTI, but still be addressed to R/O other possible causes

What is an arteriovenous malformation [AVM]?

congenital deformity of tangled blood vessels occurring in brain USUALLY found in the brain and can cause Headaches Seizures Neurological deficits -BLOOD PRESSURE CONTROL IS CRUCUIAL -High RISK for having an intracranical bleed due to the weak vessels -ANY neurological changes like sudden severe HA, nausea, vomiting should be assessed immediately as these are symptoms of a hemorrhage -Do not perform heavy exercising as this can INCREASE blood pressure

What happens to the body in botulism?

constipation, respiratory failure and neurologic decline [muscle paralysis which is irreversible] infants usually have -Constipation -Generalized weakness -Diminished deep tendon reflexes I.V human derived botulism immuno-globulin is given ASAP to reduce severity

Shellfish allergy may carry a concurrent risk for allergic reaction to

contrast dye [iodide]

What do yo do if there is itching under a cast?

cool air from an air dryer

Practice resilience by coming up with

coping skills like deep breathing exercises

Chemical burn to the eye is an emergency- priority is what?

copious eye irrigation [water at home and NS or LR at hospital] eye must remain open

Remember when measuring fundal height, that after 20 weeks it

correlates with number of weeks pregnant. •So if you are 24 weeks pregnant, the fundal height should be 24cm above the pubis sympysis

What is the nurses priority action when she hears a sucking chest wound?

cover with petroleum gauze and tape on 3 sides

If a chest tube gets dislodged, immediately

cover with something sterile or clean if you don't have sterile What are we trying to prevent here? air from getting into the pleural cavity

What is strabismus?

cross eyes eyes don't look in the same directon at once closing one eye when viewing objects is a sign

If a patients is receiving palliative care, they can still receive

curative care too

Morphine can do what to the urine output?

decreases urine output

If a patient does have orthostatic hypotension and vitals are changing when sitting and standing, then they could be

dehydrated •Give fluids

Causes of hypernatremia in infants

dehydration [decreased oral intake, vomiting, diarrhea]

Blunt force trauma can have

delayed symptoms from a slow subdural bleed after 24 to 48 hrs it may show signs of increased ICP like LOC [which is usually the fist sign] Projectile vomiting Ataxia [loss in body movement] Unilateral pupil dilation Seizures

St Johns Wort used to treat what?

depression but interacts with many prescription meds

Radioactive iodine

destroys the thyroid gland [treats hyperthyroidism]

if a patient is on digoxin, monitor

digoxin levels as well as potassium levels [because HYPOkalemia causes digoxin toxicity]

ACE inhibitors do what main thing?

dilate blood vessels

When giving morphine or hydromorphine I.V push,

dilute slowly so it does not cause opioid induced adverse reactions like -Nausea -Itching -Flushing

Hydromoprhine IV push can be given

diluted with 5 mL NS or undiluted should be given slowly over 2 to 3 mins

Tracheostomy allow for 1 finger to fit under the ties in order to prevent

dislodgement

What is osteoarthritis?

disorder of the synovial joints [knee, hip, fingers] that causes erosion of joint cartilage and bone beneath cartilage

When starting an IV, start

distally so you can move your way up the arm if infiltration occurs or the vein blows

UAP soft wrist restraints can:

do ROM exercises reapply wrist restraints report changes in skin to nurse turn/reposition client in bed

What to do for a client with positive orthstatic vitals?`

do not complete vitals if patient feels dizzy/weak Give fluids

Important teaching for tiotropium

do not take the capsule orally even though it comes in a capsule and look slike you do. the buttom must also be pushed on the inhaler for the med to be dispersed

Drug of choice for symptomatic hypotension?

dopamine

At 6 months what should baby weigh?

double birth weight

If a patient questions a med they are gettting, just

double check yourself and go through the 6 right again

Do you tilit your head up or down during a nosebleed?

down

Which way to pull pinna for a child?

down and back

While taking lithium clients should:

drink 1-2 L of fluid daily maintain normal sodium levels have their blood drawn regularly for therapeutic levels

Influenza is transmitted how?

droplet

Pertussis and influenze precaution

droplet

Third-degree [full-thickness] burns

dry & inelastic with waxy white, leathery, or charred black color Destroy the dermis and may involve subcutaneous tissue

Peripheral Arterial Disease [PAD] Assessment Findings

due to decreased blood flow to lower extremities -Hair loss -Decreased peripheral pulses -Intermittent claudication [ischemic muscle pain] -Cool, dry, shiny skin -Thick, brittle nails -Toe ulcers + gangrene

Jaundice in a newborn

during FIRST 24 hours: jaundice is pathological related to liver problems AFTER 24 hours: physiological jaundice is related to increase amount of unconjugated bilirubin in system

UAPs CAN perform oral suction for patient

during oral care

Lumbar puncture [LP] positioning

during procedure side lying fetal knees up after procedure supine

Acute lithium toxicity presents early with what and later with what

early/acute: GI disturbances later/chronic: neurologic like ataxia, confusion, tremor, or diabetes insipidus manifestations like polyuria, polydipsia

Who to watch for while taking digoxin?

elderly and those with kidney injury because they have decreased kidney function and digoxin can build up so they must be monitored frequently

Ways to reduce ICP

elevate HOB maintain head/neck in neutral midline position give stool softener manage pain/fever cal dark quiet environment give oxygen hyperventilate before suctioning Do not suction too much [also no longer than 10 seconds]as this increases ICP

Hypothyroidism is said to cause lethargy and depression.So synthroid, the hormone replacement, is supposed to cause

elevated mood and more energy report symptoms like -High heart rate -Chest pain -Tremors as these could mean that patient is getting too much hormone repacement and it is causing symptoms of hyperthyroidism

What is the treatment for tension pneumothorax?

emergency large bore needle decompression chest tube

What are the most important adverse effects of calcium channel blockers?

end in -pine S&S: -Dizziness -Flushing -HA -Peripheral edema -Constipation

Grave's Disease/ hyperthyroidism

enlarged thyroid gland & excessive thyroid hormone secretion -Bounding rapid pulse is expected

Stress ulcers can develop in critically ill patients so what helps with this?

enterel feedings

Where should the nurse listen for a bruit in abdominal aneyurism

epigastric/periumbilical area

How often do we assess for suctioning with a vent

every 2 hours

How often do we move the ETT from one side of the mouth to the other

every 24 hrs to prevent ulcers

Emtpy a JP drain

every 4 to 12 hours or when it is 1/2 to 2/3 full, same thing as an ostomy compress the empty bulb side to side

How often should ostomy bags be changed?

every 5 to 10 days

Changing peripheral I.V tubing should occur no sooner than

every 72 hours [every 3 days]

Opiate withdrawal

everything is increased [INCREASE blood pressure, heart rate, breathing, seizures]

Symptoms of hyperthyroidism

everything is increased! like if someone is moving around a lot they would get all sweating and tired and lose weight •Anxiety/insomnia •Palpitations •Heat intolerance •Sweating •Weight loss w/out decreased appetite •Goiter •Hypertension •Hand/finger tremors •Eyeball protrusion

Narcotics like morphine can do what with obstructive sleep apnea symptoms

exacerbate them

Tetraology of fallot

exacerbation can happen when infant or child cries, becomes upset, or is feeding you immediately place them in KNEE CHEST position

Isotonic solutions [examples are 0.9% sodium chloride and lactated ringers] are given to

expand intravascular fluid volume and have the same osmolality as plasma These solutions replace fluid volume that was loss with -Vomiting and diarrhea -Burns -Traumatic injury -SHOCK

What is Guaifenesin (Mucinex)?

expectorant to facilitate mobilization of mucus

How is toxoplasmosis acquired?

exposure to infected cat feces or ingestion of undercooked meat or soil contaminated fruits/vegetables

How is hep A transmitted?

fecal-oral route

Where is amniotic fluid produced?

fetal kidney

Asterixis

flapping tremors of the hands To assess, have patient extend the arms and dorsiflex the wrist

AFTER cardiac catheterization position

flat and keep extremity straight

Delirium signs and symptoms

fluctuating acute mental status changes inattention with disorganized thinking like hallucinations altered level of consciousness and the presence of infection can cause delirium

Bounding pulses may be present in patients with

fluid overload related to hypertension

Treatment of SIADH

fluid restriction less than 1000 ml per day oral salt tablets to increase serum sodium •Hypertonic saline (3%) •Normal saline [0.9 % sodium chloride] I.V •Vasopressin receptor antagonists to decrease renal response to ADH

A patient with SIADH is going to need

fluid restrictions

Sodium intake leads to

fluid retention if you restrict sodium this leads to a decrease in water retention

While talking with a delusional patient

focus on the patient feelings and reinforce reality

Tuberculosis is curable but the medication regimen must be

followed and it takes about 6 months with unpleasant side effects

When do we give glucagon

for SEVERE hypoglycemia or if the client cannot take oral fluids

Signs of disseminated intravascular coagulation [DIC]

frank external bleeding like venipuncture site bleeding and internal bleeding like petechiae, ecchymosis, hematuria, and bloody stools, also respiratory distress from bleeding into the lungs what to do? REPLACE clotting factors + fresh frozen plasma and platelets

DASH diet

fruite/veggies/fat free/low fat dairy whole grains, fish, poltry, beans, seeds, nuts limit intake of sodium, sweets, sugary beverages, and red meats low in saturated and trans fats and rich in potassium, calcium, magnesium, fiber, and protein

SIRS

generalized inflammatory response to an infectious or noninfectious insult to the body [causes: fever, tachycardia, tachypnea]

Milking chest tubes

generally contraindicated because it messes with the pressure changes in the pleural space

copd teaching

get pneumonococcal and flu vaccine report any signs of infection

Sepsis should be treated immediately by

getting blood cultures then ANTIBIOTIC because it can lead to septic shock then multi organ dysfunction [MOD]

Phenytoin side effect

gingival hyperplasia

How to administer oral liquid med to a child?

give small amounts into the back of the cheek

If a diabetic patient shows symptoms of hypoglycemia, what does the nurse do after checking the blood glucose?

give them a carbohydrate snack!

If someone is having hypoglycemic reaction and glucose is below 70, what is the first thing to do?

give them simple carbs like orange juice or low fat milk

Which long acting insulins can you NOT mix?

glargine and detemir

Babinski sign for a child less than 1 year

great toe bends upward and smaller toes fan out. this is NORMAL

When are lithium levels considred toxic?

greater than 1.5

What is hirsutism?

happens in women where they develop male pattens of hair on the face, abdomen, chest and back CUSHING DISEASE can cause this

What is an aura?

happens right before a seizure [a warning the seizure will take place]

if injury to the spinal cord, what important precaution to take?

hard cervical collar + backboard

Cardiac catheterization

helps assess/diagnose coronary artery disease [CAD] catheter is placed in vein in leg up to heart After, a pressure dressing is applied and client is places supine with affected extremity flat for 2-3 hours If bleeding occurs, direct manual pressure is put above the puncture site peripheral pulses and pulses distal to site should be checked routinely after to make sure adequate blood flow is going to the extremities [cardiovascular check]

After a thyroidectomy, there shouldn't be swelling of the neck or increased pain. What could this indicate?

hematoma formation or increased tissue inflammation which AFFECT airway patency •This patient should be seen first

What is important after an abdominal aortic aneurysm repair?

hemodynamic stability because of graft leakage [Risk for hemorrhage is PRIORITY]

What are preventatives given before and after surgery to prevent venous thromboembolism?

heparin, enoxaparin, lovenox

Hepatic encephalopathy is caused from

high ammonia levels and elevated ammonia levels which are reflected on the patient as? Mental confusion

what is SIADH?

high antidiuretic hormone production leads to Water retention INCREASED total body water DILUTIONAL HYPONATREMIA -Signs of fluid volume overload, changes in loc, weight gain with edema, hypertension, tachycardia -SEIZURE PRECAUTIONS

HYPERcalcemia

high blood calcium level (>10.5)

Cystic fibrosis diet

high calorie, high fat, high protein

Hypovolemic patient should never be places in

high fowlers [these patients are HYPOtensive, patient should be place with head lower than upper body]

How to improve oxygenation flow?

high fowlers and take slow deep breaths

Respiratory alkalosis

high pH, LOW PaCO2

what will excess salt in diet do to BP?

higher BP

Early signs of phenytoin toxicity

horizontal nystagmus and gait unsteadiness

ACE inhibitors and angiotensin receptor blockers [ARBs] can cause

hyperkalemia

I.V iron can cause

hypersensitivity reactions

Decreased sweat production can lead to what?

hyperthermia because you are not sweating which naturally cools your body off

In dehydration the patient can.get

hypotensive and tachycardic

What does frostbite a actually mean

ice crystals form and the intracellular spaces causing peripheral vasoconstriction and reduced blood flow superficial frostbite looks: mottled, blue, or waxy yellow deeper frostibite looks: white heard and unable to sense touch and leads to gangrene

Intussusception [causes intestinal obstruction]

ileum telescopes into cecum, pain obstruction, edema, bowel ischemia, rectal bleeding [CURRANT JELLY stools]

In bacterial meningitis, what is the priority of care?

immediate antibiotics LP with csf is done to find causative organism

What does tamponade require?

immediate pericardiocentesis [to drain the fluid out of the pericardium]

What does a STAT order mean?

immediately and only once

Accidental exubation [dislodgment of Trach or ETT] is a medical emergency. if it happens, what does the nurse do?

immediately deliver rescue breaths using a bag valve mask and 100% oxygen until they can be reintubated

When is the best time to give a pregnant client that is nonimmune to MMR the vaccine?

immediately postpartum [after giving birth]

Buck's traction

immobilizes a fractured hip and reduce pain/swelling Skin/neurovascular assessments every 2-4 hrs Weights should not touch the ground Patient is supine

Buck traction

immobilizes hip and femur fractures •The weight pulls the limb into traction •The foot of the bed is elevated

Notify HCP if child temp is over 100.4 after

immunizations

Vastus lateralis for children less than 7 month is used for

immunizations

People taking corticosteroids are

immunocompromised and are prone to getting infections

Azathioprine

immunosuppressant drug causing bone marrow suppression and increases risk for infection

Hepatic encephalopathy

impaired ammonia metabolism causes cerebral edema s/s: -Change in LOC -Memory loss -Asterixis [flapping tremor] -Impaired handwriting -Hyperventilation w/ resp alkalosis Treatment: LACTULOSE traps ammnia and lowers pH, low protein, safety, rest

Where should there NOT be continuous bubbling in the chest tube drainage system?

in the air leak monitor

Inferior vena cava filter is placed where and does what?

in the femoral vein and catches blood clots from the legs from going to the lungs

Infertility

inability to conceive after unprotected intercourse for more than 12 months

Aphasia

inability to express thoughts and comprehend language

What is presbyopia?

inability to see things close up

What is hyperthyroidism?

increased T3 and T4 hormones which increases the metabolic rate

Lupus nephritis characteristics

increased creatinine and BUN abnormal urinalysis [protein, RBCs]can lead to irreversible kidney damage if not recognized early Elevated kidney tests tells us which organ is being attacked by inflammation

Glaucoma

increased intraocular pressure that can lead to Severe eye pain Reduced central vision Blurred vision Ocular redness

Dopamine

increases heart rate and increases blood pressure

Full weight bearing

independent; no assistance needed unless they are uncooperative or they are a fall risk, which is 1 person standby

What do when late decelerations is indicated in pregnancy and are they ever good>

indicate utero-placental insufficiency and URGENT

Oxytocin

induction or augmentation of labor •Should be given by an electronic infusion pump •Requires frequent mother/fetal assessment Adverse affects: maternal hypotension and water intoxication

What does a positive tuberculin skin test show?

induration [basically a white patch] surrounded by redness

Normal age for head lag

infants display head lag from birth through age 4-6 months

Once a woman's water breaks, this leaves her susceptible to what?

infection

What is a major adverse effect of TNF inhibitors like infliximab or adalimumab?

infection because they cause immunsuppression

What puts a patient at risk for preterm labor?

infection like periodontal disease

A positive reaction to a tuberculosis skin test TST indicated

infection only further testing is needed to see if TB is active therefore contagious [sputum culture required]

18 gauge catheter

infusing blood or large amounts of fluids in adults

What is the specific action of atropine?

inhibits the action of the vagus nerve [the vagus nerve slows the heart rate] This is why you do vagal nerve stimulation in hypertensive crisis ATROPINE increases heart rate

Signs of intussusception [Infants]

initial periodic pain with legs drawn up to abdomen, pain is severe and progressive though, inconsolable crying, blood/mucousy stools "currant jelly"

Lyme disease

initial symptoms: •Flu like headache •Fever •Myalgia •Fatigue •Bulls eye rash •Give ANTIBIOTICS to prevent it from spreading to heart brain or joints

Cauda equina is a medical emergency. WHY?

injury to L4 to L5 causing motor/sensory deficits from pressure on spinal nerves Acute spinal/lower back pain and bowel/bladder incontinence It's a medical emergency to prevent permanent damage

Stroke patients are at a high risk for

injury/falls because of one sided paralysis and confusion [hemiplagia]

What is Meniere disease

inner ear disorder S&S: •Vertigo •Tinnitus •Muffled hearing

Do not suction when

inserting a catheter

Metabolic syndrome- what s it?

insulin resistance syndrome

Stage 1 ulcer

intact skin non-blanchable with localized redness

Fetal alcohol syndrome causes what?

intellectual disability + developmental delay

What are some physical signs of peripheral arterial disease?

intermittent calf muscle pain rest pain hair loss decreased peripheral pulses cool dry shiny skin thick brittle nails gangrene ulcers [all of these signs + symptoms are in the extremities]

What should always be at beside for a gastric lavage?

intubation and suction supplies; it removes toxins and irrigates stomach within one hour after overdose

Symptoms of cold stress in a newborn

irritability, lethargy, decreased temp, hypoxia, bradycardia, weak suck and cry, emesis, hypoglycemia

Ipratropium

is the short acting anticholinergic used as a rescue med for COPD and asthma

When you have a cast, which type of exercises should be performed

isometric exercises Contraction of the affected muscle without movement of the joint

A patient with diabetes does not get dextrose solutions why?

it can increase blood glucose levels

A pregnant client in supine position is never really good because

it compresse the aorta and vena cava

After being found TB positive, more tests are needed to see if

it is latent TB where its noncontagious, or active TB where it is contagious through the air [AIRBORNE PRECAUTIONS]

What is the purpose of continuous bladder irrigation?

it is prescribed after TURP to prevent obstruction of urine outflow by removing clotted blood from the bladder

what does an elevated PTT mean?

it is taking your blood way too long to clot therefore this is a problem because you could bleed out; there may be a coagulation factor deficiency

What is nitroglycerin used for?

its a vasodilator that restores myocardial perfusion

Position after a vascular graft of extremity

keep extremity straight and bed rest for 24 hours

Where should NTG tabs be stores?

keep in original container stored away from light and heat sources but easily accessible

Lithium and sodium are closely related in the body so

keep their levels normal

Wilms tumor is on the

kidney presents as abnormal bulging on one side of child's abdomen DO NOT PALPATE ABDOMEN fatigue in children - kidney tumor usually occurs in children age <5 - usually discovered when caregivers note an unusual bulging/swelling on one side of abdomen

I.V iodinated contrast used for CT scan can cause

kidney injury; metformin is discontinued on the day of I.V iodine contrast exposure

Best fluid solution to give after a burn

lactated ringers [LR] because it most closely resembles blood than all of the others

What drug is going to decrease ammonia levels?

lactulose

When is stridor heard?

laryngospasm or edema of upper airway

What is "sunset eyes" in an infant a sign of?

late sign of increased intracranial pressure [ICP]/hydrocephalus

What position to place a pregnant woman in for seizure precautions?

left side

Recal irrigation and enema position

left side lying for gravity flow natural direction of the colon [SIMS]

Avoid sex with active herpes lesions and disease can still be contracted if

lesions are not present so always use a condom

What number is considered severe neutropenia?

less than 500

In postmortem care, it is ok to

let family members assist with care

Location of the phlebostatic axis [for measuring continuous arterial BP readings]

level of atria at 4th ICS 1/2 anterior/posterior diameter

Body positioning after cardiac catherterization

lie flat

After a [LP] teaching

lie flat with no pillow for at least 4 hours to increase fluid intake

Trisomy 18 and Trisomy 13

life expectancy is a few weeks after birth Discuss palliative/end of life care

When prioritizing care especially in a disaster, remember

life over limb [cut the limb to save the life]

Hemolytic uremic syndrome

life threatening complication of E. coli diarrhea

After a splenectomy, patients are subject to what?

lifelong infections MINOR infection can quickly become life threatening Report any signs of infection ASAP

How do stools look with a biliary obstruction

light gray clay colored

In continuous bladder irrigation, what should the urine look like?

light pink with no clots bladder spasms are expected

Lithium is cleared by the kidneys so a minor change in kidney function could cause

lithium toxicity

Do not take NSAIDs while on

lithium, instead use acetaminophen for pain relief

What must be checked before starting statin drugs

liver function tests because they can cause hepatotoxicity can cause muscle aches and weakness take with evening meal or at bedtime

What is trismus

locked jaw

What to wear to protect yourself from mosquitoes

long sleeve, long pants, and light colors

A porlonged QT interval is usually the result of electrolyte imbalances so what is usually the treatment?

look for electrolyte in the answer

Homonymous hemianopsia

loss in half of the visual field on the same side

symptom of macular degeneration

loss of central field of vision

What is the death rattle?

loud rattling sound when breathing in a person that is actively dying caused by increased secretions

Thrombocytopenia

low platelet count; so this increases risk for bleeding;<100,000 platelet count

Liver cirrhosis patients will have

low platelets

Ulcerative colitis diet

low residue, high protein high calorie

Heart failure patients should be on a what type of diet?

low salt, low fluid intake

heart failure, ascites, hypertension diet

low sodium (fluid overload states)

Heart failure patients must take which very important 2 actions?

low sodium diet and take medications

Magensium toxicity also causes

low urine output like urinary output less than 30 mL per hr

What is a barium enema

lower G.I series used to visualize the colon outlined by contrast to detect polyps, ulcers, tumors, etc

Hydralazine is a vasodilator usually given to what?

lower blood pressure

The elderly tend to have

lower body temps 100.2 is febrile in an elderly patient

Radon [element] can cause

lung cancer

What is given for preeclampsia?

magnesium sulfate [anti-convulsant] to prevent seizures

Most important thing to do to prevent stroke in a patient with a ton of risk factors and hypertension

make sure they take antihypertensives

Second degree [partial thickness] burns

moist or weeping wounds with blisters and shiny, fluid-filled vesicles and moderate to severe pain

What is in the LPN scope of practice?

monitor RN findings reinforce education routine procedures like catheterization most medication administrations ostomy care tube patency and enteral feeding specific assessments

What is a major complication of RA?

morning stiffness. how to fix? take a warm shower or bath

What are some early signs of rhabdomyolysis?

muscle aches or weakness- immediately report to hcp!

Use of dantrolene

muscles spasms & malignant hyperthermia!!!

What does botulism cause?

muslce paralysis [IRREVERSIBLE]

How should I.V potassium be administered?

must be given in an infusion pump so the rate can be regulated •NOT by gravity infusion •It should also always be diluted

Ptosis [eye drooping] is common with

myesthenia gravis

Post surgical patients are usually prescrbed which prn med to help from the opioid drugs they were on

naloxone (Narcan) but it wears off in 1-2 hours so be prepared to give more than once monitor respiratory rate and give oxygen

Aortic stenosis

narrowing of orifice between left ventricle and aorta blood is NOT properly pumped to body Patients may experience passing out and shortness of breath [SOB] and sudden death That is why they should rest and not exericse before surgery

Early signs of digoxin toxicity

nausea and vomiting

What are signs of a bowel obstruction?

nausea, vomiting, abdominal distention, and dec stool production

what is myopia?

nearsightedness, have trouble seeing objects at a distance

What can a baby born to an opioid dependent mom have?

neonatal abstinence syndrome the baby experiences opiod withdrawal 24-48 hrs after birth

Vancomycin can case what 2 things

nephrotoxicity and ototoxicity

Taking folic acid during pregnancy prevents what?

neural tube defects and spina bifida

Parasthesia is an early sign of what?

neurovascular impairment

is supine positioning good for pregnant lady

no because it decreases uteroplacental blood flow and fetal oxygen

In parallel play, there is

no group involvement [child plays individually next to other children]

Can UAP tell familes and alert other departments why patient is on precautions?

no this is for RN to do

Do we massage the site after I.M shots

no!

Stridor is

noisy breathing [upper airway obstruction or laryngeal edema]

What is a magnetic resonance cholangiopancreatography

noninvasive diagnostic test to see biliary, hepatic, and pancreativ ducts via MRI •Contrast (IV gadolinium) given before contraindications of the procedure that should be assessed by nurse beforehand: -Any metal/electrical implants -Any allergic reaction to contrast -Pregnancy the contrast crosses the placenta

Early symptoms of hepatitis B?

nonspecific like -Malaise -N/V -Abdominal pain

Given what meds in hypovolemic shock [besides fluids] ?

norepinephrine + dopamine

Blood transfusions can only be run with what other fluid?

normal saline [0.9% sodium chloride]

A patient with renal or heart failure are usually not given

normal saline because this promotes fluid retention [the kidney is not function therefore extra fluid will just accumulate in the body worsening both conditions]

Local reactions like swelling and erythma, minor illness, exposure of an infectious source, and allergies to non-vaccine components are

not contraindications to immunization

Always try least restrictive before using restraint. NCLEX wants you to know this so most likely the answer is

not going to be apply restraint

If infants have cold stress, they are

not going to shiver

Addison's disease

occurs when the adrenal glands do NOT produce enough of the hormones cortisol or aldosterone; hyperpigmentation of the skin Remember this about Addison's disease, it causes: -HYPOnatremia -HYPOtension -HYPERkalemia -HYPOglycemia

Somatic delusion

of having some physical defect or disease

Pyloric stenosis is the one with

olive shaped mass on the abdomen and causes projectile vomiting

A sucking chest wound indicates what and is caused from what?

open pneumothorax, -Air is rushing in with each inspiration and fills the pleural space

Constricted pupils seen with

opioid use

Nausea and pruritis are common effects of

opioids

Basically, LPNs can give any medication that doesn't invovlve the veins right? So, what can they give?

oral, sub q, IM

Swimming pool water does not cause

otitis media It actually causes otitis externa (swimmers ear)

Gentamycin

ototoxicity

Advere reaction to gentamicin

ototoxicity and nephrotoxicity

Meds should be stored specifically how when hiding from children?

out of sight up in a cabinet and locked

A high troponin value like anything

over 0.5 for troponin I and 0.1 for troponin T indicates cardiac muscle damage

Vancomycin should be given slowly

over 60 mintes to prevent red man syndrome

Conception occurs around the time of

ovulation and is about 14 days from the beginning of the last menstrual period [LMP]

What is failure to capture on a heart rhythm?

pacemaker spikes that are not followed by QRS complexes the pacemaker may be malfunctioning related to the machine like battery or something Patient will be bradycardic and hypotensive The nurse should put on transcutaneous pacemaker pads to regulate the heart beat until the problem with the pacemaker is fixed Transcutaneous pacemaker [TP] is uncomfortable for the patient so give analgesia [painkiller]

What are some symtpoms fo osteoarthritis?

pain exacerabetd by weight bearing crepitus morning stiffness 10-15 mins decrease joint mobility and ROM

LPN can monitor

pain level

Nursing management for hemroidectomy mainly provide

pain relief and prevent constipation NSAIDs Warm sitz baths High fiber diet Lots of fluids Stool softener

A normal kidney is usually not

palpable, if it is it could indicate disease

Proton pump inhibitors examples

pantoprazole and omeprazole given for GERD, ulcer treatment and prophylaxis

Flail chest what happens?

paradoxical breathing from multiple RIB FRACTURES INSPIRATION chest moves inward and EXPIRATION chest moves outwards [it is the opposite of what should be occurring during ventilation] FRICTION RUB can puncture lung or vessels this can likely lead to hemothorax or pneumothorax

Remember with bulemia, which gland is swollen?

parotid gland

What is scanning speech?

pasues between syllables and is expected with multiple sclerosis [MS]

Jaundice in a newborn in the FIRST 24 hours is considered

pathological [ABNORMAL!]

Delusions of reference

patient believe songs newspaper articles the radio and other things are personal and significant to them

LPNs can measure

peak expiratory flow

Best indicator of moving air in an asthma patient is wha?

peak flow

Gingival hyperplasia is en expected side effect of

phenytoin Good oral hygiene can limit symptoms

Target therapy for polycythemia

phlebotomy to remove some of those RBCs

Jaundice that develops after 24 hrs is

physiologic NORMAL because their liver is still maturing but it should disappear in about a week Jaundice before or after 24 hours should still be reported to the HCP

What is suspected in a pregnant woman having painless vaginal bleeding after 20 weeks gestation?

placenta previa

Projection

placing ones own thoughts, feelings, or impulses onto someone else

what is parallel play that toddlers do?

play alongside rather than with other children

Some children may be in pain but may not show it when

playing

Chronic alcohol abusers suffer from

poor nutrition from improper diet and altered nutrient absorption Which vitamin are they specifically at RISK for deficiency in? thiamine

What does a CPAP machine do

positive pressure opens the airway that was previously cut off

If a newborn's heart rate is below 100 bpm, what does the nurse immediately do?

positive pressure ventilation

What is spironolactone and what is it used in?

potassium sparing diuretic used in liver failure, ascites, and edema to promote diuresis

Stridor is NOT good at all as it indicates

potential UPPER airway obstruction

Disaster hits and home care nurse needs to prioritize care, defintely one that needs

pre-filled insulin syringes because they could become hyperglycemic without insulin and lead to life threatening diabetic ketoacidosis

Swelling of the hands + feet + face are expected findings of what pregnant condition?

preeclampsia

How much weight you should gain during pregnancy is determined by

pregnancy BMI If you are obese, you should gain less weight during pregnancy

Warfarin should not be given during

pregnancy because it crosses the placenta and can cause fetal bleeding

If a female patient is getting radioactive iodine to treat hyperthyroidism, what should you get for her?

pregnancy test PRIOR After radioactive iodine treatment [RAI], clients will take supplemental iodine for life

Do not take ACE inhibitors if

pregnant or planning to become pregnant

whos at a high risk fr cold stress and why?

premature babies due to decreased brown adipose tissue

3rd degree AV heart block ECG changes

presents as a regular rate & rhythm with disassociated P waves and QRS complexes

Braden scale ASSESS for what?

pressure ulcer

Priority intervention for eczema

prevent scratching

When are rhonchi primarily heard?

primarily during expiration but also may be present during inspiration

Bronchioltiis

priority as it requires frequent suctioning

In priority questions, chest pain is

priority regrdless of age

When is I.V epinephrine indicated?

profound hypotension or when a patient does not repsond to I.M epinephrine and fluid resuscitation

What rises heartburn in pregnancy?

progesterone

Beneficience

promote good and do whats best for client

After feeding an infant, what does placing the infant in the side lying position do

promotes gastric emptying and reduces the risk of vomiting

If Group b streptococcus [GBS] status is unknown in a pregnant woman, always give what?

prophylactic antibiotics [35 to 37 weeks]

You should not be symptomatic of anything after a

prostatectomy

Bladder spasms are expected after a

prostatectomy with a catheter

Diverticular disease causes what?

protrusions form off the large intestine- they can become inflamed and infected causing acute diverticulitis

All chest pain is considered cardiac until

proven otherwise Need to go in to ER right away fror chest pain to get an ECG

Left-to-right cardiac shunts results

pulmonary congestion [increases pulmonary pressure, which increases risk for heart failure] Compensatory mechanisms [examples are tachycardia, diaphoresis] result from sympathetic stimulation

Acute onset dyspnea and cough with pink frothy sputum [hemotypsis] indicates what?

pulmonary edema [PE]

What to do to if pregnant client has prolapsed cord?

put client on their hands and knees in the knee-chest position

What is a central venous catheter [CVC]?

put in a "central" vein [examples of veins used subclavian, internal jugular, femoral]

What is the first thing you do with autonomic dysreflexia?

raise the head of bed [HOB] then treat the cause

How to treat acute urinary retention?

rapid comeplete bladder decompression

What is red man syndrome and why does it happen

rapid infusion of vancomycin •flushing •erythema •pruritis on face neck and chest

Acute asthma exacerbation

rapid labored respirations using accessory mmuscles

Radiation and chemo affect what type of cells first?

rapidly dividing cells like -Oral mucosa -G.I tract -Bone marrow This causes -Oral ulcerations -Nausea and vomiting Llow blood counts of RBCs, WBCs, platelets

A newly admitted client with Gillian Barr Syndrome GBS is not stable. it is unclear with the analysis when it will stop aka it could

reach the respiratory system

Reactive non-stress test versus non-reactive nonstress test

reactive nonstress test you have a baseline of 110-160/min, moderate variability and 2 or more accelerations in 20 mins and nonreactive does not meet criteria for reactivity

If asked to float to an unfamiliar unit, you can not

refuse but you can clarify the skills that you are unable to perform

Nursing interventions for pin care

regular assessment to make sure pins are not loose or showing signs of infection, notify HCP if signs of infection are present or pins are loose Neuro checks are performed at the affected extremity Clean with -hydrogen peroxide -saline -chlorhexidine

Superventricular tacycardia SVT

regular, narrow QRS complex tachycardia with heart rate at 150 to 220 per minute Stimulants like cocaine, caffeine, nicotine can cause SVT Client may experience Palpitations Dyspnea Angina I.V adenosine is treatment of choice [Mnemonic adenosine for SVT] Vagal stimulation the lines up are very narrow

So what to do with dehydrated infant?

rehydrate is PRIORITY- bolus normal saline for an infant

LOWER UTI

remember FUB Frequency, Urgency, Burning

Incentive spirometry

remember I for INHALE

If infiltration or phlebitis occur, what should the nurse do with either of these situations immediately?

remove the I.V device

If signs of phlebitis are present immediately

removel of the catheter because phlebitis can lead to clot formation [thrombophlebitis] or serious bloodstream infection [sepsis] S&S: pain, swelling, warmth at site and redness

Billroth II surgery [Gastrojejunostomy]

removes part of the stomach and shortens upper GI tract dumping syndrome is possible post-op

Additional heart sounds like S3 and S4 require

reporting to HCP to look for cardiac problems

If a central vein catheter [CVC] is occluded while trying to flush with 10 mL of NS, the first thing to do is

reposition the patient's arm and then check for tubing kinks

Treatment/Interventions - 3rd degree AV heart block

requires temporary or permanent pacing to stabilize patient [pacemaker]

With a chest tube, intermittent bubbling in the water seal chamber consistent with

respirations and it is normal

Hypoventilating can cause a buildup of carbon dioxide in the blood and can lead to

respiratory acidosis

Any condition that causes a decrease in respiratory rate is at risk for developing

respiratory acidosis [less CO2 is being blown off]

If mg toxicity is not reconized early by the DTRs, what can it lead to ?

respiratory depression + cardiac arrest

After Botox, watch for

respiratory problems like dysphagia [difficulty swallowing] and respiratory paralysis

What can cause atelectasis after surgery?

retained secretions

seeing small flashes of light is a sign of

retinal detachment

Regression

returning to a previous level of development

What is a serious complication of statin meds?

rhabdomyolysis

Rheumatoid factor [RF] is POSITIVE in clients with

rhematoid arhtiritis

When doing compressions on an infant, where do you place your fingers?

right below imaginary horizontal line between the nipples

Body positioning after liver biopsy

right side [to put pressure on the liver]

What causes pink frothy sputum in PE?

ruptured bronchial veins from the mix of blood and airway fluids

Meniere disease key to remember

safety falls -Salt restricted diet to prevent further fluid build up

Fourth-degree [full-thickness] burns

same as third-degree [dry & inelastic with waxy white, leathery, or charred black color] plus involvement of fascia, muscle, and/or bone tissue Pain is NOT major feature due to nerve damage

What type of drainage is expected after a surgical procedure?

serosanguinous [pink]

Diabetic ketoacidosis

severe form of hyperglycemia, greater than 250 mg per deciliter. Glucose can not be taken out of the bloodstream without insulin which the pancreas cannot produce The body begins to break down fat stores into ketones [this increases the acidity of the blood]

Epiglottis- what is it?

severe inflammatory obstruction caused by H. influenzae MEDICAL EMERGENCY!! Symptoms progress fast from being asymptomatic to an occluded airway Have emergency intubation available

What are the steps to deliver a dose via a metered dose inhaler MDI?

shake MDI and attach to spacer exhale completely place lips tightly around mouthpiece deliver one puff of med into spacer take a slow deep breath and hold it for 10 scds rinse mouth with water

If a pregnant women is positive for GBS, what happens?

she gets prophylactic antibiotics so that she does not pass it to her baby during labor because it can cause harmful things like pneumonia or neonatal GBS sepsis

Albuterol

short term rescue inhaler that treats reversible airway obstruction with asthma If not effective, use an inhaled corticosteroid

Remember that kids under 2 have

shorter Eustachian tubes therefore they are more prone to respiratory infections that may cause otitis media exposure to smoke, pacifiers, and drinking from a bottle when lying down are all causes of otitis media

PTT should be 1.5 to 2.0 times the control value

should not be equal to the control value

Acute cholecystitis may present with

shoulder pain

Body positioning for enema administration

sims

Enema administration position

sims

C diff room needs

single

How to relieve pain in acute pericarditis?

sit up & lean forward [orthopnea]

What is acanthosis nigricans?

skin condition patches of darkened thick skin

Cardinal physical sign of Parvo A.K.A fifth disease is what?

slapped cheek rash •Spread person to person especially with respiratory secretions

dementia characteristic

slow onset family members usually notice first gradual progressive inability to remember recent events

If there is discomfort when infusing KCL, what should the nurse do?

slow the rate don't stop it because the patient needs the potassium replacement

Undiluted morphine I.V push should be given

slowly over 4 to 5 mins

Metoprolol

slows the HR and lowers the BP

Fever and raised pustules=

smallpox

Why should a patient take diuretic in the morning and not at bedtime

so they won't have to pee a lot at night

In fibromyalgia patients feel "point tenderness" which is where

specific points on their body hurt

Transporters never need to know an exact diagnosis, but rather just

specific things like is the patient fragile

what does DOPAMINE do?

speeds up the heart rate increases cardiac contractility

A tuft of hair at base of spine in a newborn indicates what?

spina bifida

Birth defect associated with depakote during pregnancy

spina bifida

What is spina bifida

spinal cord contents protrude through vertebrae an there is a tuft of hair

How to asisst a falling client?

stand behind and let out leg for supporting them to ground

Excessive hair may be clipped but not shaved when trying to

start an I.V Shaving can cause abrasions which can introduce pathogens

What to do if evisceration happens?

stay calm and remain with patient Notify HCP Make them NPO Cover wound with saturated dressings to not dry out place in low fowlers [FLAT] with knees flexed Assess vitals every 15 minutes

Surgical wounds are re-dressed using

sterile technique remove old dressing with clean gloves and apply new dressing with sterile gloves

Epoetin is what?

stiumlates production of erthropoeitin [makes RBCs) that treats anemia in chronic kidney disease because the kdineys have a big role in blood cell production [kidney disease causes anemia because erythropoietin is not produced by the damaged kidney]

What is Docusate

stool softener

What is docusate?

stool softener

If mg toxicity occurs, what should be done?

stop infusion and give its antidote

How to measure urinary output in diapers?

subtract the weight of the diaper when dry from its weight when wet

What to do when the high pressure alarm on he MV sounds?

suction

Where in the chest tube drainage system is gentle, continuous bubbling normal?

suction control chamber •If more water is needed, add sterile water

hyperventilate [pre-oxygenate] before

suctioning

20-22 guage

sufficient for giving general I.V fluids an meds to adults [Non-urgent, general sizes]

Trimethoprim-sulfamethoxazole [Bactrim]

sulfa antibiotic

How are orthostatic vitals taken?

supine, sitting, then standing with 2 minutes between each position change

Do not stick anthing into vagina with

suspected placenta previa

When is atropine given?

symptomatic bradycardia [Increases heart rate]

Rheumatoid arthritis

systemic inflammation of the synovial joints are swollen and painful joints Usually it starts in smaller joints and affects clients ability to button clothing and difficulty completing ADLs what should you do? -Moist heat for stiffness -Range of motion [ROM] exercises -ICE on painful joints as needed -Allow periods of rest in the afternoon

Orthostatic vitals are present when what happens to systolic/diastolic BP?

systolic drops at least 20 diastolic drops at least 10 pulse usually rises about 20

Transplanted hearts are expected to be

tachycardic like 90-110

Warfrain teaching

take at same time each day Don't have a diet high in vitamin k

UAPS can assist with passive and active ROM exercises that were

taught by the nurse or PT

What is the first sign of puberty change in boys?

testicular enlargement

Knee-chest position is used for a hypoxic/cyanotic infant with

tetralogy of fallot

What does it mean when an induration is shown?

that the person has been exposed to TB Patient has developed antibodies Patient is infected with TB bacteria However, this does not tell if the infection is active or latent so further testing is required [sputum is needed to know it is active or not]

ASSESS implanted pacemakers for electrical capture of the heart rhythm but also mechanical capture of the heart rate by getting a central pulse like

the APICAL pulse this is to make sure that the pacemaker that is producing a rhythm actually corresponds with the body and giving a pulse therefore pumping blood through the body

Before ABGs are taken, what test must be performed?

the Allen's test

What is phenylketonuria PKU?

the amino acid phenylaline is unconverted causing neurological damage

What is quickening?

the awareness of fetal movement [around 16 weeks]

What are symptoms of withdrawal from opioid in infants?

the baby is HYPERSENSITIVE •Irritability •High pitched cry •Jitteriness •Sneezing •Diarrhea •Vomiting •Poor feeding •Treatment: opioid therapy like methadone or morphine

ASSESS for drugs that a pregnant client has had in the last 4 hours if they are in labor because

the baby might be born with respiratory depression [if the mom took opioids in the last 4 hours]

What does fasting do to the body?

the body goes into starvation mode Metabolism slows down and cortisol (stress hormone) increases Body breaks down muscle and converts amino acids to glucose -Fluid loss -Depletion of essential nutrients -Fatigue -HA -Dehydration -Dizziness -Muscle weakness

What is rhabdomyolysis?

the breakdown of muscle tissue releases muscle fiber contents into the blood •These substances can cause kidney damage

What is a saline lock?

the cap that goes onto an IV insertion catheter •It allows you the ability to stop giving I.V fluids and then start again at a later time without having to do another venipuncture

Orthodox jews cannot take capsules why?

the gelatin is NOT kosher (fit to be consumed)

If spine injury is suspected, do NOT use

the head tilt chin lift method as this could damage the spine further What do you use instead? Jaw thrust maneuver

Most frequet sites of bleeding in a hemophiliac are where?

the joints

What is wazy flexibility?

the patients limbs stay in the same position in which they are placed by another person

Placental abruption

the placenta prematurely detaches from the uterine wall

What does an anti-nuclear body tell us?

the presense of ANA means the body produces antibodies against its own DNA and material So this should be positive in autoimmune disorders

What is the moro reflex?

the startle reflex where the nurse holds the baby and lets it "drop" in her hands and the baby's legs and arms move up in a startle motion/crying

If the patient's INR is 2 times the control value then this is

the therapeutic effect [normal finding]

Nurses should ask clients what they think caused illness as a way to assess

their understandings and beliefs of lliness

If a 2 year old is exhibiting symptoms or other abnormal behaviors + communication then assess

their vocabulary because at age 2 kids should have a vocab of about 300 words

antisocial personality disorder

they disregard rules, hx of irresponsible behavior, and blame others for their actions. SET LIMITS with them make them aware of the rules and acceptable behaviors

Clients with alcoholism are commonly deficient in which vitamin?

thiamine

Cystic fibrosis [CF] kids have

thick secretions and lifelong respiratory infections

What is Kawasaki disease and what are he symptoms?

think of it as one big body rash •Systemic vasculitis in children presenting with more than 5 day of a fever •Conjuntivitis •Lymphadenopathy •Mucositis •Hand and foot swelling •A rash •Can cause coronary artery aneurisms •Some skin peeling •Joint pain •Irritability

Having chest pain typical of acute MI for 6 hours or less and no absolute contraindications you can then be given what

thrombolytic therapy

What is hypothyroidism?

thyroid horome deficiency, low T3 and T4 levels which decreases the metabolic rate

How to stop epistaxis

tilt the head forward and apply direct continuous pressure on the alaes (sides) for about 5-20 mins hold a cold washcloth to the bridge of nose for vasoconstriction keep child calm and quiet

What is the purpose of the water seal chamber in a chest tube>

to prevent air from flowing to the client •Up and down movement here with inspiration and expiration is normal •As lung re-expands this will decrease

During pregnancy, why are women in a hypercoaguble state?

to protect them from hemorrhage but there is a risk for DVT ambulate the patient soon after childbirth

What is the purpose of unfractioned heparin?

to slow the time it takes the blood to clot thereby keeping the current clot from getting bigger and preventing new ones from forming

What is magnesium sulfate used for?

to stop seizures during pregnancy therapeutic level is 4 to 7

while giving an enema if the patients reposrts cramping or pain, it is most likely being given

too fast What should the nurse do? stop for 30 seconds and then start at a slower rate

polycythemia

too many RBCs, WBCs, and PLATELETS leading to increased hematocrit and blood volume, thicker blood, and abnormal clotting Hematocrit is 66 is an abnormal finding

Metronidazole (Flagyl)

treatmemt for trichomoniasis Do NOT take with ALCOHOL for for 24 after completing treatment Can cause a metallic taste Cause urine to change a deep red-brown color

Carbidopa-levodopa

treats parkinson's; improves spontaneous activity seen with this disease

What is Levetiracetam (Keppra) used for?

treats seizures the preferred antiepileptic med

Oligohydramnios increases the risk for what?

umbilical cord compression and pulmonary hypoplasia [lung underdevelopment] so needs additional personnel and continuous fetal monitoring [FHR]

Sodium nitroprusside

vasodilator used in hypertensive emergencies can produce a sudden and drastic drop in blood pressure causing symptomatic hypotension monitor blood pressure closely every 5 to 10 mins

What is NTG?

vasodilator used to treat stable angina Sublingual tablet or spray Relives pain in about 3 minutes and lasts 30-40 mins RECOMMENDED dose: 1 tab or 1 spray every 5 minutes for a max of 3 doses If chest pain continues after 5 mins after first dose, call 911

Norepinephrine (Levophed)

vasopresser [increases blood pressure] used to increase -Stroke volume [SV] -Cardiac output [CO] -MAP

Kids with autism spectrum disorders are usually

visual. Do not touch them or make eye contact

Oral isoniazid [INH] interferes with what vitamin?

vitamin B6 [depletes this vitamin in the body] resulting in peripheral neuropathy If taking isoniazid you should take a vitamin B supplement

What can determine if a person with heart problems can resume sexual activity?

walking 1 block or climbing 2 flights of stairs without symptoms

Don't take aspirin/alcohol when on

warfarin

The liver is highly vascular; after a biopsy always

watch out for bleeding

Where should there be intermittent bubbling on a chest tube?

water-seal chamber

What are some reasons for venipuncture to be contraindicted in upper extremities?

weakness paralysis infection AV fistula or graft mastectomy

What is the most accurate indicator of fluid loss or gain?

weight measurements

Refeeding syndrome

what happens after a starved and severely malnourished person finally gets fed via any of the routes electrolytes distubrnaces happen and declines in phosphorus, potassium, and magnesium happen

If schizophrenia is hearing voices, alwasy assess

what those voices are saying to the patient [even if it's a delusion assess how the patient perceives the voices]

When should an ostomy bag be emptied? (when it is how full?)

when it is 1/3 full

When do *advanced directives* go into effect?

when person is unable to speak for him/herself due to either: 1. Mental Incapacity or coma [GCS score less than or equal to 7] 2. Aphasia (as soon as signed; directives can always be changed later by patient)

What are epsteins pearls?

white pearl like cysts on gum and palate that are benign and usually go away within a few weeks

What should the nurse do if the chest tube becomes separated from drainage tubing and is not contaminated?

wipe the end with antiseptic immediately reconnect it, and secure with tape

When walking upstairs use the mnemonic [up with the good and down with the bad]

with injuries and a cane and going upstairs, always hold cane on the STRONG side and move cane before moving weak leg

When does the umbilical cord detach from body?

within 2 weeks

If patients are having an ischemic stroke, they are given tissue plasminogen activator tPA to dissolve the clot. How soon must tPA be given?

within 3 to 4.5 hours of onset of symptoms

What happens in diabetic ketoacidosis?

without insulin, the body breaks down fat for fuel, resulting in ketones, polyuria, rapid respirations (kussmauls sign) DKA is serious and can lead to death

Presence of neurological change in pregnant women may indicate what?

worsening preeclampsia

If a patient has phantom limb pain after an amputation, what can the nurse do for comfort?

wrap and apply ice/heat

What are some non pharmacologic interventions that help with phantom limb pain?

wrapping the extremity or applying ice

At 12 months can in infant go fom standing to siting

yes

HIV precautions- blood borne so STANDARD PRECAUTIONS are good unless

you anticipate splashing body fluids in that case wear a gown + gloves

When giving an IM injection use which method?

z-track

Intermittent peritoneal dialysis

•4 days a week for 10 hours a day •Can be automated or manual

Ovarian cancer symptoms

•ABDOMINAL BLOATING •PELVIC PAIN OR PRESSURE •Early satiety •Abdominal, back, or leg pain •Urinary urgency/frequency G.I disturbances

What are signs of perforation?

•Abdominal pain [with shoulder tip pain] •Positive rebound tenderness •Gaurding •Abdominal distension •Boardlike/rigid abdomen

What do we do as the nurse for BPH

•Administer meds [5-alpha reductive inhibitor and alpha-blocking agents] •Suprapubic cystostomy (mini urostomy to drain bladder) •Prostatectomy [TURP, suprapubic resection through bladder, retropubic resection through abdomen] •Assess for shock and hemorrhage •Avoid long periods of sitting and strenous activity

What are some early symptoms of Increased Cranial Pressure?

•Altered LOC •Headache •Abnormal breathing •Increased blood pressure •Slow pulse [decreased heart rate] •Vomiting

Treatment for premature ventricular contraction [PVC]

•Amiodarione [potassium antidysrhythmic] •Betablockers •Procainamide [sodium antidysrhythmic]

What are the signs of Hemolytic uremic syndrome?

•Anemia [pallor] •Low platelets [petechiae and purpura] •Acute kidney injury [low urine output]

What is methotrexate?

•Antineoplastic [treat malignancies] •Immunosuppressant [lowers immunity] Uses: -Chemotherapy -Rheumatoid arthritis -Psoriasis -Abortions

Nurse actions during a seizure

•Assist them to lie down is standing/sitting, •Put them on side for patent airway •Loosen tight clothing •Give oxygen as needed •Remove objects from immediate area •Document time and duration of seizure (for tests are done later to see which type of seizure and maybe what exacerates it) •Never put anything in mouth or restrain them since muscle contractions can occur during a seizure

Signs of phenytoin toxicity

•Ataxia •Nystagmus •Slurred speech •Decreased mentation

What to check labs while giving ace inhibitors?

•BUN/creatinine •Potassium •Blood pressure

What do we do for a patient with a detached retina

•Bedrest [don't bend forward, no excessive movements] •Area of detachment needs to be in dependent position •Surgery to reattach the retina to the choroid (gas or air bubble used to apply pressure the the retina) •No hair washing for 1 week •Avoid strenuous activity for 3 months

What are the major side effects with methotrexate?

•Bone marrow suppression •Hepatotoxicity •Fetal death

What are adverse affects of methotrexate?

•Bone marrow suppression •Hepatotoxicity •G.I irritation

Cushing's triad

•Bradycardia •Slowed respiratory rate •Widened pulse pressure

What are the 5 dangers we need to educate the public on for S&S of glaucoma

•Brow arching •Halos around lights •Blurry vision •Diminished peripheral vision •Headache or eye pain

Treatment for A Fib

•Calcium channel blockers •Digoxin •Beta blockers •CARDIOVERSON •Warfarin [anticoagulant because A.fib forms clots]

Nursing interventions for a child with ADHD in hospital

•Calm •Structured •Organized •Consistent environment •Written chart or list of daily activities

When is epinephrine given?

•Cardiac arrest •Anaphylactic reactions •Severe asthma attack

Thyroid storm

•Caused by untreated HYPERthyroidism •INCREASED temp, pulses and BP •Give hypothermia blanket, O2, PTU, potassium iodine

Signs and symptoms of air/pulmonary embolism

•Chest pain •Difficulty breathing •Tachycardia •Pale/Cyanotic •Sense of impending doom

Symptoms of active tuberculosis

•Cough •Fever/chills •Malaise •Weight loss •Night sweats •Anorexia •Fatigue •Positive T skin test •Abnormal chest xray •Transmissible [airborne]

What are normal expected findings after a colonoscopy?

•Cramping •Gas •Watery stools

Diabetes insipidus [DI]

•DECREASED antidiuretic hormone [ADH] [excessive urination] •Excessive urine output and thirst •Dehydration •Weakness We always get a urine specific gravity to tell the doctor how aggressively to treat it

Glomerulonephritis

•Damage to the glomerulus caused by an immunological action that results in proliferative and inflammatory changes within the glomeruli •Acute glomerulonephritis = Group A beta hemolytic strep infection that is somewhere else in the body (like a skin or throat strep infection) •Usually happens 10 days after the skin or throat infection

Signs of cold stress

•Decreased temp •Altered mental status •Bradycardia •Hypoxia •Weak cry

What can cause lithium toxicity in a patient taking lithium?

•Dehydration •Decreased renal function •Diet low in sodium •Drug-drug interactions like NSAIDs

Classic heart attack symptoms

•Dizziness •Sweating •Cold clammy skin •shortness of breath [SOB] •n/v •Ischemic chest pain •Pain radiating to neck, jaw, left shoulder, arms, epigastrum

How to help improve sleep

•Dont nap during day •Avoid physical activity at least 5 hours before bed 20 mins of natural sunlight •Avoid caffeine after noon •Avoid alcohol or smoking at bedtime •Relaxing activity before bed •Decrease environmental stimuli •Avoid heavy meals or large amounts of fluid at bedtime •Warm milk or small carbs before bed

Symptoms of a pleural effusion

•Dyspnea on exertion •Non-productive cough •Diminshed breath sounds •Dullness to percussion •Dec tactile fremitus

Complications of preeclampsia?

•Eclampsia [seizure] •Placental abruption [detachment of the placental from uterine wall] •HELLP [hemolysis, elevated liver enzymes, low platelet] syndrome [leads to anemia, dyspnea, jaundice, petechia, clotting disorder, thrombocytopenia]

What does the FLACC scale stand for?

•Facial grimace •Leg movement •Activity •Crying •Consolibility

Possible complications from ear surgery

•Facial nerve damage •Infection •Vertigo, tinnitus

symptoms of mononucleosis

•Fatigue •Fever •Sore throat •Splenomegaly •Hepatomegaly •Swollen lymoh nodes •Contact sports should be avoided •Caused by the epstein barr virus

Hyperparathyroidism [HIGH calcium in the blood]

•Fatigue •Muscle weakness •Renal calculi •Back/joint pain and pathological fractures Too much calcium [HIGH calcium makes you go slow]

What is placenta previa

•First and second trimester bleeding •Third trimester bleeding that is sudden, bright red, profuse and PAINLESS •This is where the placenta is implanted in the lower uterine segment usually near or over the cervical opening •No vaginal or rectal exams

Hypervolemia

•Fluid overload •Bounding pulse •Shortness of breath •Dyspnea •Rales/crackles [pulmonary edema] •Peripheral edema [dependent edema] •High blood pressure •Urine specific gravity less than 1.010 [diluted due to fluid overload]

What are some symptoms of placental abruption?

•Frequent contractions •Abdominal pain •Dark red vaginal bleeding

RSV interventions

•Give oxygen •Elevate head of the bed [HOB] •Airway suction [decrease mucus] •Give antipyretics [treat fever] •I.V fluids [to treat dehydration caused by dyspnea] CONTACT & DROPLET isolation

Signs of bulimia someone may notice

•Going to bathroom after meals •Large amonts of food disappearing •Hidden wrappers/empty food containers like sweets •Intense physical exercise •Parotid gland enlargement •Calluses on hands •Preoccupation with weight food and dieting

A child is having separation anxiety in the hospital, what are some things nurses can do to reduce the anxiety

•Have parent leave familiar objects in room •Don't leave them alone when upset •Establish daily schedule like one at home •Give child time to play

Acceptable methods of blood collection in *neonate*

•Heel stick •Venipuncture [drawing blood from vein] considered less painful and often requires fewer punctures to obtain sample, especially if larger volume is needed

high ammonia can cause what

•Hepatic encephalopathy •Confusion •Lethargy •Asterixis [hand flapping] •Coma

What do we usually see with BPH S&S

•Hesitancy [dribbling, weak urinary system] •Frequency, dysuria, urgency, nocturia •Hematuria before or after voiding •Urinary retention

Preeclampsia 2 main things:

•High blood pressure •Protein in urine •Edema [expected but not part of the criteria]

Scarlet fever symptoms

•High fever •Bright red "sandpaper" rash that begins on chest, •Strawberry tongue •Treat with penicillin

Bacterial meningitis

•High fever •Change in LOC •Nuchal rigidity •Meningeal signs [POSITIVE kernig and brudzinski signs] treat with antibiotics

Malignant hyperthermia symptoms

•High fever •Rigid jaw •Tachypnea •Tachycardia

Proper nasal spray administration

•High fowlers •Head bowed slightly forward •Occlude one nostril and put it in open one •Point tip toward side and away from center •Spray while inhaling deeply

Mnemonic to remember high vs low blood sugar

•Hot and dry? Sugar is high •Cold and clammy? Need some candy

What are early signs of bleeding into the retroperitoneal space?

•Hypotension •Back pain •Flank ecchymosis [grey turner sign] •Hematoma formation •Diminshed distal pulses

ICP vs Shock vital signs

•ICP: High BP, low pulse, low respirations •Shock: Low BP, high pulse, high respirations

After calcium gluconate, what 3 things are given to actually decrease the potassium in a hyperkalemic patient?

•IV regular insulin with dextrose [Increases in these two decreases potassium in the blood] •Sodium polystyrene sulfonate •Hemodialiysis

Hypovolemia

•Increased temp •Rapid/weak pulse •Increased respirations •Decrease blood pressure •Anxiety •Urine specific gravity greater than 1.030 [concentrated due to dehydration caused by decreased intravascular volume]

What are foods high in vitamin k?

•Leafy green veggies •Asparagus •Brocoli •Kale •Brussel sprout •Spinach

Acute hemolytic transfusion reaction

•Life threatening reaction •Develops within the first 15 mins S & S are: -Chills -Fever -Lower back pain -Tachycardia -Tachypnea -HYPOtension

Amyotrophic lateral sclerosis (ALS) typical symptoms

•Limb weakness •Dysarthria [difficulty speaking] •Dysphagia

Septic arthritis symptoms

•Localized pain •Limited ROM •Systemic infection symptoms like fever

What is tiotropium (Spiriva) and what/how is it used for?

•Long acting, 24 hour, anticholinergic inhaled med used to control COPD •Given using capsule-inhaler system where the capsule is placed in the device and a buttom is pressed to put a hole in the capsule and the powder is dispered thru the inhaler •It should NOT be used as a rescue med for example if someone has trouble breathing, that's when you would use the short acting like albuterol

Liver dysfunction abnormalities

•Low albumin •High ammonia •Elevated INR/PT •Increased bilirubin •Low platelets

If it is normal for some children to have a reaction to MMR or V vaccine 5 to 12 days after getting it symptoms like

•Low grade fever •Mild rash •Swelling/redness at injection site •Irritable, restless •Watch that their temp does not get too high because this could lead to febrile seizures •Tell them to give acetaminophen if temperature goes over 102

PKU

•Low phenylalanine diet •Specal infant formula •No meat eggs or dairy

Examples of live vaccines are:

•MMR [measles, mumps and rubella] •Varicella

Characteristics of fetal alcohol syndrome

•Microcephaly •Short eyelids [palpebral fissure] •Flat midface [cheekbones] •Smooth philtrum [between nose and upper lip] •Thin upper lip

Infant formula key points

•Never dilute or concentrate formula •Wash tops of forumla cans before opening •Unused prepare formula can be used for up to 48 hours and then discarded after •To warm prepared bottle, place in pan of hot water •Never microwave formula •Any forumula left over should be thrown out immediately when done

Myasthenia gravis clinical manifestations

•Ocular [ptosis: drooling eyelid] •Facial muscle weakness [difficulty speaking, swallowing, chewing] •Can progress to *respiratory muscles* and affect *breathing*

Noninvasive positive airway pressure ventilation [NIPPV]

•Often prescribed short-term to support gas exchange in patient with -Moderate to severe COPD exacerbations and -Acidosis [pH <7.3] -Hypercapnia [PaCO2 >45 mmHg] -Can prevent the need for tracheal intubation -Administered until underlying cause of ventilatory failure is reversed with parmacologic therapy

Symptoms of anaphylaxis

•Oral/airway swelling •Dizziness •Tachycardic •Stridor/hoarseness •Wheezing •Rash •Pruritis •Flushing •N/V Abdominal pain •Treat with IM epinephrine

Liver biopsy during and after

•Patient supine with right arm above head during after •Right side lying and pillow under puncture site This reduces risk for hemorrhage by adding pressure on the puncture site [this is why the patient lies on the right side because the liver is on the right side]

Cigarettes and pregnant can cause what things

•Perinatal loss •SIDS •Low birth weight •Premature baby

Characteristics of a basilar skull fracture

•Periorbital hematomas [raccoon eyes] •Csf fluid •Rhinorrhea •Battle sign [behind the ear bruising]

S&S of right sided heart failure

•Peripheral edema and anorexia •Distended neck veins •Polycythemia

What is abnormal after a cystoscopy

•Pink tinged urine •Frequency •Dysuria •Abdominal discomfort •Bladder spasms

Incentive spirometer use

•Piston rises with each deep inhalation •Prevents atelectasis & pneumonia in post op patients •5-10 breaths per session every hour patient is awake

Neonatal CPR positioning

•Placed on back with neck slightly extended as if sniffing a flower •A blanket or towel roll can be placed under shoulders elevating them 0.75 to 1.0 inches off mattress

In all of these conditions, breath sounds are either decreased or absent

•Pleural effusion •Pneumothorax •Emphysema •Atelectasis

Latent TB infection

•Positive TST •Negative chest xray •Asymptomatic •Non-transmissible •Steroids can convert latent to active TB

MMR is a live vaccine and live vaccines are contraindicated during what?

•Pregnant •Immunocompromised

Hip dysplasia in an older child

•Preliminary traction •Open reduction •Hip spica cast

Primary use of radioactive iodine?

•Primary treatment for nonpregnant adults with hyperthyroid disorders [Graves disease] -Radioactive iodine [RAI] damages or destroys thyroid tissue and can result in hypothyroidism •Clients need to take thyroid supplementation [levothyroxine] for life

High in sodium foods examples

•Processed meat •Cheese •Brea •Canned soup/veggies •Frozen dinners

Examples of extrapyramidal symptoms

•Pseudoparkinsonism •Dystonia

Left side heart failure symptoms

•Pulmonary edema •Dyspnea •Orthopnea •Crackles

Nursing care for patients in acute mania

•Quiet structured non stimulating environment •One on one activities instead of group •Limiting contact with other people •High protein High calories [finger foods easy to eat]

What are some symptoms that a pregnant woman has HELLP?

•RUQ pain •Nausea + vomiting •Malaise

What do we do for penetrating eye injuries (pointed or sharp objects)

•Refer to a surgeon •Cover the eye with a patch

Classic presentation of a fractured hip

•Shortened •Abducted •Externally rotated leg

Incentive spirometry steps

•Sit upright •Exhale and seal lips tight on mouthpiece •Inhale •Hold breath, then exhale

What will a child with epiglottitis present like?

•Sitting in tripod position •Be drooling •Restless •Anxious

What are some common findings 5 to 10 days after a tonsillectomy?

•Slight ear pain •Low grade fever •Bad breath

Process for a burn at home

•Soak in cool water to stop buring process •Remove clothing around burn •Cover with a clean dry cloth •Don't put any meds or anything on the wound

Signs of Epiglottitis

•Sore throat •Dysphagia [difficulty swallowing] •Drooling •Respiratory distress •Sitting up/leaning forward •An EMERGENCY- PREPARE FOR EMERGENCY AIRWAY [INTUBATION/TRACHEOSTOMY]

Interventions to prevent abdominal wound dehiscence

•Stool softeners •Antiemetics •Use abdominal binder •Monitor blood sugar to maintain tight glucose control to decrease infection risk and promote wound healing Splint the abdomen with pillow when coughing or moving

Introducing a child to table foods: 5-6 months

•Strained veggies •Strained meat

Placental abruption symptoms

•Sudden onset of dark red vaginal bleeding •Abdominal pain •Frequent uterine contractions

Symptoms of hypoglycemia

•Sweating and pallor •Irritable •Tremors/weakness •Tachycardic •Drowsiness •Hunger -If the brain becomes glucose depleted, this could cause seizures and coma

Symptoms of malignant hyperthermia

•Tachycardia •Tachypnea •Rigid jaw •High fever •It is triggered by drugs used for anesthesia Give them I.V DANTROLENE

When a patient is taking lithium, be careful when taking which medications in addition because they can increase lithium levels and lead to toxicity?

•Thiazide diuretics •NSAIDs •Antidepressants

Treatment for sinus tachycardia

•Treat underlying problem •Beta blockers •Calcium channel blockers or Cardioversion

Hypoglycemia symptoms

•Tremors •Palpitations •Anxiety •Restlessness •Sweating •Pallor

What do we do for a woman in labor who has an unreassuring FHR

•Turn to the LEFT side •Give O2 [8 to 10 L per min] •Stop the Pitocin •Increase I.V fluids (LR and NS) •Give tocolytics

What are some classic signs of DVT?

•Unilateral leg edema •Local warmth •Erythema •Low grade fever (PS a negative homan is normal)

Herpes Zoster [Shingles] characteristics

•Unilateral, linear [dermatomal distribution] •Vesicular rash [fluid filled blisters]

Signs of croup

•Upper respiratory tract symptoms •Hoarseness •Barking cough •Stridor •Respiratory distress

Oliguric [little urine] phase of acute renal failure

•Urinary output of less than 0.5 ml/kg/hr •N & V •INCREASED Serum potassium, BUN, and creatinine Increased calcium and sodium Decreased p.H [increased acidity of blood] Anemia Pulmonary edema + congestive heart failure Hypertension Albuminuria [which causes low albumin in the blood and thus leads to ascites]

Imbalances caused by vomiting or diarrhea

•Vomiting (LOSS of acid): metabolic alkalosis •Diarrhea (LOSS of base): metabolic acidosis •We use Narcan to treat (respiratory depression caused by opioid: respiratory acidosis -LOW breathing, LOW blowing off of CO2: respiratory acidosis

What do we do for conjunctivitis

•Warm, moist compress •Topical antibiotics •Hydrocortisone ophthalmic ointment Caused by virus, bacteria, and allergies

Physical findings of peripheral arterial disease

•Weak/absent peripheral pulses •Poor wound healing •Cool pallid skin •Shiny skin •Missing hair

What are symptoms of an asthma exacerbation?

•Wheezing •Coughing •Chest tightness •Dyspnea •Retractions •Cough may be the earliest sign

Characteristics of neuroleptic malignant syndrome

•fever •muscle rigidity •altered mental status •sweating •hypertension •tachycardia

Hypopokalemia can cause

•heart arrythmias •muscle cramps •weakness

What are some expected symptoms in a TBI?

•low grade constant HA •slowness in thinking •memory problems •loss of balance •poor coordination •constant exhaustion •increased sensitivity to light •heightened irritability •ALL symptoms that can last up to 6 weeks

Near drowning hypothermia

•warm I.V fluids •blankets •oxygen •weak and thready pulse

Infants that do not have a complete closure of the esophageal sphincter are therefore prone to

gastroesophageal reflux This is why they spit up after feeds How can this be reduced? Burp during and after FEEDS to get air out HOLD baby upright for 20 to 30 after feeding Feed the baby smaller and more frequent meals

What do advanced care documents include?

healthy care proxy and living will

Should bulemic patients be allowed to keep a daily diary in the hospotal?

yes, to keep track of the amount and type of food the client has eaten

Delirium

•Acute •Consciousness impaired •Fluctuating consciousness •Reversible

Chronic phase of acute renal failure

•Anemia Azotemia [uric acid in the blood] Acidosis Fluid retention Urinary output alterations

Delirium signs

•Sudden onset of fluctuating mental status changes and inattention with disorganized thinking and/or altered level of consciousness •Think of the patient that I had that was lying in bed and reaching up grabbing something in the air with her hand that was not there

Treatment for Premature atrial contraction

•Treat the underlying cause [alcohol, tobacco, caffeine]

what are common SE of immunizations?

•mild fever •soreness and redness at injection site •anorexia/fussiness in the first 24 hours

What is the normal pulse rate for a 1 year old

100-160

Hgb [Hemoglobin]

12 to 18

Fundal height [just need to memorzie this]

12 weeks: just above pubic symphysis 16 weeks: halfway between public symbiosis and umbilicus 20-22 weeks: reaches umbilicus 36 weeks: xiphoid process

Identity vs. Role Confusion

12-20 yrs Provide same age support group

What does the anterior fontanel close?

18 mon

Voluntary control over urethral and anal sphincters occurs about

18 to 24 months of age

When should quickening happen?

18-20 weeks in first time baby havers and sooner for previous moms

When do we assume a baby has developmental hip dysplasia

When the head of the femur does not fit in the acetabulum Uneven gluteal folds and uneven thigh creases Infant lays on back with legs flexed Click sound when legs are moved to abduction Delays in walking/limping with older children

Placenta previa

When the placenta covers the opening of the mothers uterus It usually presents with painless vaginal bleeding

Amlodipine + Nifedipine

calcium chennal blcokers

What is the antidote for magnesium toxicity?

calcium gluconate 10%

Calcium carbonate drug is what?

calcium supplement

Nutrients in cows milk

calcum and vitamin D NOT vitamin k, iron, or fiber

Metoclopramide

can cause tardive dyskinesia

What does magnesium toxicty cause?

central nervous system depression

What type of device would be placed in a client with sudden kidney failure requiring immediate dialysis?

central venous catheter

What is Ancef?

cephalosporin antibiotic thats active against skin flora like staff, given before and after surgery

low platelets= ICP bleeding

change in LOC

indicatrs of increased ICP

change in LOC (often the first sign), cushings triad, and pupillary changes)

Basically what 2 things do you do before and after each feeding or medication given through an NG tube?

check placement and flush tube with sterile water

RN can still delegate a task that is less than LPN for example

checking a pulse oximeter

What is the priority when giving 2 meds at the same time?

checking for drug compatibility

Acute pericarditis

chest pain worse on inspiration pericardial friction rub

The varicella zoster virus can cause what 2 things?

chicken pox and shingles

24 gauge [smallest bore or hole of needle]

children and elderly with frail veins

Peripheral Arterial Disease (PAD)

chronic, atherosclerotic disease caused by buildup of plaque in arteries

Intractible diarrhea

chronic, diarrhea that is hard to control

The trauma room after a patient should be

cleaned this is part of postmortem care aka cleaning blood from floor

Negativism

client resists instructions or attempts to be moved

General rule of thumb for engaging in sexual activity in cardiac clients

climb 2 flights of stairs without symptoms then you're good to resume sexual activities

stage 4

full thickness skin loss exposed muscle tendon or bone

Unstageable pressure ulcer

full thickness skin loss ulcer base covered by slough [yellow] and eschar [black] that needs to be removed to stage

Stage 3

full thickness skin loss with visible sub q fat

A patient with a total knee arthroplasty should be what by discharge?

fully weight bearing

I.V proton pump inhibitors are given for

gastric ulcer bleeding

Pulse assessment post abdominal aortic aneurysm [AAA] repair

-Pulses can be absent for 4-12 hours after surgery due to vasospasm -Pedal pulse decreased from baseline or absent pulse with a painful, cool, or mottled extremity can indicate presence of arterial or graft occlusion [life-threatening] [This why neuro-vascular checks are important to do]

Peripheral arterial pulses

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

Hyperkalemia priority interventions

1. Administer I.V 50% dextrose + I.V regular insulin rapidly 2. If ECG changes are present, give calcium gluconate FIRST •HIGH insulin causes LOW potassium [or decreases high potassium] •LOW insulin causes HIGH potassium •HYPERkalemia=HYPOglycemia

Subjective [presumptive] signs of pregnancy

1. Amenorrhea 2. Nausea and vomiting 3. Excessive fatigue 4. urinary frequency 5. Breast tenderness 6. Quickening

Pulmonary embolism (PE) signs & symptoms

1. Anxiety/restlessness 2. Pleuritic chest pain/tightness 3. Shortness of breath 4. Tachycardia 5. Hypoxemia 6. Hemoptysis [blood in sputum]

Appropriate order of actions when client found on floor

1. Assessment of [physiological stability] ABCs 2. Assessment of injuries 3. Moving client 4. Notifications [REPORT] 5. Documentation

Disorders associated with manipulative behaviors

1. Borderline & antisocial personality disorders 2. Substance abuse problems 3. Somatic symptom disorder 4. Bipolar disorder [during manic phase]

Cognitive behavioral therapy [CBT] 5 basic components

•Education about pts disorder •Self observing and monitoring •Relaxation techniques •Cognitive restructuring •Behavioral strategies

What are some things that put patients at risk for respiratory depression?

•Elderly age •Underlying pulmonary condition •History [hx] of snoring •Obesity •Cigarette smokers •Opiate naive •Post surgery within 24 hours

Before a lumbar puncture teaching

•Empty bladder •Lateral recumbent (fetal position) or sitting •Pain may be felt radiating down the leg but should be temporary

Position for a BELOW the knee amputation

•Foot of bed elevated for the FIRST 24 hours •Position prone daily to help with hip extension

Causes of meningitis

•Infection [virus, bacterial, fungal] •Neurosurgical procedures •Basilar skull fractures •Otitis media •Mastoiditis

What sign and symptom will we see in an infant that has a mom on heroin

•Irritable •Poor sucking

Later signs of hep B?

•Jaundice •Weight loss •Clay colored stools •Thrombocytopenia [low clotting due to liver dysfunction/destruction]

Right side heart failure

•Jugular vein distention [JVD] •Hepatomegaly [enlarged liver] •Splenomegaly [enlarged spleen] •Ascites [enlarged abdomen] •Edema

Hypercalcemia

•Muscle weakness •Lack of coordination •Abdominal pain •Constipation •Pathological fractures •Confusion •Absent/DECREASED DTRs [DECREASED deep tendon reflexes] •Sedative effect on CNS •Body runs SLOW with High calcium

What are some signs of a bowel obstruction?

•Nausea, vomiting •Abdominal distention •Dec stool

For Muslim people, what do we have to remember about their diets

•No Pork •No Alcohol •No fermented fruits/veggies •Meat must be Halal [drained of blood] •Foods with special value: Figs, olives, dates, honey, milk and buttermilk

When would we hold off on a polio vaccine (IPV)

If the client is allergic to -Neomycin -Streptomycin -Polymyxin B Also remember this: "Neo Is Marrying Valery" [this mnemonic tells you what immunizations are NOT given if allergic to neomycin + streptomycin + polymyxin B] •I: IPV (inactivated polio vaccine) •M: MMR •V: varicella

Someone suffering from PTSD

has flashbakcs/nightmares of the event and their body responds with rapid heart rate and sweating They avoid reminders of the trauma like places or activities They feel detached and numb They are hyper-vigilant Cannot sleep Cannot concentrate

If the child swallowed something and is conscious and about to cough or make sounds, what should the nurse do first

have them try to cough it up, but signs of respiraotory distress require immediate intervention

Rule of thumb position for respirator and cardiac patients is with

head of the bed [HOB] elevated

Crackles - when are they heard?

heard typically only during inspiration

Cardiac tamponade

heart cannot squeeze effectively Muffled heart tones Cardiac output [CO] drops Blood pressure [HYPOtension] drops Tachycardic Jugular vein distention [JVD] Distant heart sounds Requires pericardiocentesis (draining of fluid in pericardial sac)

An S3 heart sound is a sign of what?

heart failure

Bumetanide (Bumex)

heart failure to diurese

Do not take licorice root with that medications?

heart meds

If a patient gets a transplant, they are then given immunosuppressants to

help prevent organ rejection HOWEVER, what does this make them susceptible to? infections

Droplet precautions

spiderman! -Sepsis -Scarlet fever -Streptococcal pharyngitis -Parvovirus -Pneumonia -Pertussis -Influenza -Diptheria -Epiglottitis -Rubella -Mumps -Meningitis -Mycoplasma or meningeal pneumonia -AdeNovirus [Private room and mask]

Immediately report any signs of infection after having a

splenectomy because the spleen is part of the immune system and filters the blood

New graduate RNs can be assigned

stable clients who do not require specialized skill or knowledge and can discharge them if they are stable or ones that require new teaching

Asthma

frequent cough at night

Erythropoeitin [Epogen]

stimulates bone marrow to make RBCs and combats the effects of chemo and used for kidney disease

Filgrastinm (Neupogen)

stimulates neutrophil production

If you are having a patient do orthostatic vitals and they become symptomatic like dizzy, you need to

stop the measurement and have them lie in bed

Coarction of the aorta

strong upper pulses and weak lower pulses

Ovarian cancer symptoms

subtle S&S: •Abdominal pain •Pelvic pain or pressure •Abdominal girth [circumference] increases •Urinary urgency/frequency •G.I disturbances

Body positioning after a lumbar puncture

supine

A UTI bacteria can ascend from the bladdder and go to

the kidney where you get pyelonephritis and have Nausea /Vomiting Fever Chills Flank pain Costovertebral angle tenderness Need prompt treatment because this could lead to sepsis

The lower the I.V catheter guage number,

the larger the bore or hole of the needle

What are vegans at risk for since they dont eat animal products?

tingling and numbness from vitamin B 12 deficiency affects the entire nervous system from peripheral nerves to spinal cord and brain

What is atropine used for?

to decrease saliva production before surgery

What is the purpose of hemoglobin?

to pick up oxygen in the lungs and carry it to the tissues

2 major purposes of amniotic fluid

to prevent cord compression and promote lung development

SIADH

too much ADH is produced causing -Water retention -Increased total body water -Dilutional HYPOnatremia -Can be caused by some central nerve disorders -ADH can sometimes be secreted by lung cancer cells

What do you do if a tooth falls

tooth death can occur in one hour so put the tooth in milk and get help

Why should you not give a baby a bottle of milk or other sugary substance to go to bed?

tooth decay

Clozapine

tretment of schizophrenia AGRANULOCYTOSIS MUST CHECK complete blood count [CBC]

At 1 year of age, what should an infant weigh?

triple their birth weight

At 12 months, an infants weight should be

tripled the birth weight

There is no cure or treatment for

trisomy 18

True or fale: antiiotics can affect INR value?

true

Glaucoma eye sees

tunnel vision

Airborne precautions

"MTV" [mnemonic to remember airborne disease] Measles Tuberculosis Varicella •Wear N95 respirator •Neg pressure room and HEPA •Clients suspected are to wear a surgical mask after triage

Late stage Alzheimer's disease - eating problems

-Inability to feed oneself -Dysphagia [difficulty swallowing]

Chronic bronchitis interventions

-Increase fluids to 2 to 3 L which helps thin secretions -Humidifier -Guaifenesin an expectorant -Abdominal breahting using huff method [sit in chair, lean forward and expel it out] -Chest physiotherapy [to break off mucus plugs to be expectorated]

Pre-blood transfusion nursing interventions

-Instruct client to void prior to starting transfusion

Symptoms of hyponatremia in infants

-Irritability + lethargy -In severe cases, hypothermia [cold intolerance] and seizure activity

Chest physiotherapy

-Parents are taught -BEFORE meals -Give supplemental pancreatic enzymes -Hungry but underweight -High protein high calorie

Correct CPR

-Place heel of hand in center of chest between nipples -Compress 2 to 2.4 inches deep -Compress at a rate of 100 to 120 compressions -30 compressions per 2 breaths

Containdications to thrombolytic [for example: Alteplase]

-Previous brain bleed -Ischemic stroke or head trauma within 3 months -Active bleeding -Cerebral aneurysm •All thrombolytics lyse the pathologic clot [a clot that causes an MI] and may lyse other clots so bleeding is a complication

What to do if patient is on oxytocin and late decels, fetal bradycardia, tachycardia, and decreased variability happen, what does the nurse do in order?

-Stop the oxcytocin right away -Put patient in side lying position -Give oxygen [8 to 10 liters via face mask] -I.V fluid bolus -Maybe give terbutaline -Notify HCP -Document

Suspected child abuse [injury patterns in nonaccidental trauma]

-Subdural & epidural hematomas -Retinal hemorrhage on fundoscopic examination* -Frenulum tears & gingival lesions -Linear type immersion burns -Long bone fractures in humerus or femur

Pre-procedure instructions for barium enema

-Take a cathartic (magnesium citrate, polythylene glycol) to empty stool from the colon -CLD day before procedure for bowel prep and to avoid dehydration [avoid red/purple liquids] -NPO 8 hours before test -Abdominal cramping may be felt during procedure

Barium enema teaching pre op

-Take a cathartic to empty stool from colon -CLD the day before for bowel prep and prevent dehydration -Avoid red or purple foo -Do not eat or drink 8 hours before test -May feel abdominal cramping during test

Teaching for PEDICULOSIS=LICE "Pediculosis capitis"

-Treatment with pediculicide [usually permethrin 1% cream] -Soak childs comb and hair accessories in boiling water for 10 minutes -May need to treat child's sibling if they share things -Use a nit comb daily for 2 weeks after treatment -Vaccum furniture, carpet, etc -Wash linens/beding in hot and dry on hot -Pets do not need to be treated as human lice does not get on animals

Abnormal findings post circumcision

-Unusual swelling with increasing redness -Odor, abnormal discharge -Excessive bleeding -Absent/decreased urine output [notify HCP if no voiding happens within 6 to 8 hours]

Teaching for an electroencephalogram [EEG]

-Wash hair before to remove oils from scalp -Avoid caffeine, stimlants, and CNS depressants before the test -Test is not painful, electrodes are just placed on the head

Circumcision care

-Washing hands before providing care -Applying petroleum jelly to glans penis at diaper changes [unless plastic ring was used] for 3 to 7 days to prevent adhering to diaper -Site typically heals within 7 to 10 days -Expect yellow exudate on penis after the first day, a normal part of healing -Use warm water [without soap] to remove urine/feces during diaper changes or at least twice daily

electroconvulsive therapy ECT

-a treatment for major depression disorder [MDD] with psychotic features or when patients are highly suicidal and are not responsing to meds and need immediate treatment to keep them safe where they can not wait for meds -ELECTRODES applied to scalp causing a brief convulsion -General anesthesia and muscle relaxant given -Common side effects after? confusion and memory loss

Conditions when rhonchi are heard

1. Bronchitis 2. Cystic fibrosis 3. Some types of pneumonia may clear with coughing or suctioning

HYPOcalcemia can result in

1. Tetany 2. Laryngeal stridor 3. Seizures 4. Cardiac dysthymia

PT

11-15 Warfarin Therapeutic Range: 1.5-2 times normal value [which ranges from 16.5 to 30]

S&S of syphillis

A papule - like lesion in the vaginal area

Anuria vs oliguria vs polyuria vs dysuria vs enuresis

Anuria = <100 ml in 24 hours (basically nothing) Oliguria = 100-400 ml in 24 hours Polyuria = >2000 ml in 24 hours (too much!) Dysuria = painful or difficult voiding Enuresis = bed wetting in a child over 5 (usually have small bladder and more common in males)

How to safely transfer a patient for the first time

Assess if they can bear weight Assess whether they are cooperative

What is Dexamethasone?

corticosteroid that reduced inflammation and cerebral edema with brain injury and tumors

What is the primary drugs to treat Addison's disease

corticosteroids

If myopathy is present, what will be very elevated?

creatinine kinase

Venturi mask

delivers a guaranteed oxygen concentration to patients with unstable COPD

Bile

made in liver and helps aid in digestion

Low platelets

petechiae + spontaneous bleeding

Which lab results are expected for a patient with severe COPD: anemia, neutropenia, polycythemia, or thrombocytopenia?

polycythemia [excessive RBC] because patient is in hypoxemic state so the body makes more RBCs to compensate

Desmopressin

treat bedwetting

Low albumin can cause what

•Fluid overload •Edema •Weight gain •ASCITES

Placenta previa symptoms

•Painless vaginal bleeding •Ultrasound shows placenta covering cervical os

Remember the 5Ps to compartment syndrome

•Paresthesia •Pain •Pressure •Palor •Pulselessness

What is the kernig sign?

•Patient lies supine •thigh is flexed at right angle •If POSITIVE, the thigh will hurts to extend

Compartment syndrome

"7 P's" 1. Parasthesia 2. Pain 3. Pressure 4. Pallor 5. Pulselessness 6. Poikilothermia (cool skin temp) 7. Paralysis never elevated if these develop

Care after an open radical prostatectomy

-Avoid anything that causes strain on the rectal area so no suppositories or enemas to NOT mess with healing of surgical area -Ways to prevent constipation [fiber, lots of water, exercise] -Do not strain with a BM

Before/after a kidney biopsy

-Discontinue ALL anti-platelet and blood thinners one week before -Type and cross match in case blood is needed -Place in prone position -Monitor vitals every 15 minutes [q15] for FIRST hour -Place patient on procedure side to put pressure -Bed rest for 24 hrs

Care of Alzheimer's patient at home

-Keyed deadbolts -Med bracelet -Remove clutter and throw rugs -Grab bars in showers/bathrooms -Household hazards removed

Teaching for ace inhibitors

-Kidney levels in the first week -CONTRAINDICATED in pregnancy -Watch foods high in potassium since can cause a mild hyperkalemia -Get out of bed slowly -Possible allergic reaction like rash or angioedema

What is homonymous hemianopsia [loss of vision on one eye]?

-Loss of one half of the field of vision on the same side in both eyes -So like a patient can only see one side of their plate -Teach them to scan with their good eye by turning their head -They are at RISK for neglecting that affected eye or not eating food placed on the side of the affected eye [the side they cannot see] -They are also at RISK for safety related injuried because they simply can not see well

A post term baby findings

-deep creases and peeling on soles of feet

Creatinine

0.6 to 1.2

Lithium therpeutic range

0.6 to 1.2

What is the fluid of choice for the rapid correction of hypotension?

0.9 sodium chloride

When calculating GTPAL, twins count as

1 in the preterm and term categories

Hemophilia Patient Education

1. Avoid medications that inhibit platelet aggregation (for example ibuprofen & aspirin) 2. Avoid IM injections [SubQ is preferred] 3. Avoid contact sports & safety hazards (non-contact activities - swimming, jogging, tennis - and use of protective equipment are preferred) 4. Dental hygiene is necesssary [soft toothbrushes should be used] 5. MedicAlert bracelets should be worn at all times

Pneumonia assessment findings

1. Crackles 2. Fever, chills, productive cough, dysnpea, and pleuritic chest pain 3. Increased vocal/tactile fremitus 4. Bronchial breath sounds in peripheral lung fields can be an early sign 5. Unequal chest expansion 6. Dullness on percussion

Testicular self-examination (TSE) instructions

1. Perform monthly on same day 2. Perform while taking a warm shower 3. Use both hands to feel each testis separately 4. Palpate each testicle gently, using the thumb and first 2 fingers 5. Check that the testicle is normally egg-shaped and moveable with a smooth surface

Nursing interventions for manipulative behaviors

1. Setting limits that are realistic, nonpunitive, and enforceable 2. Using a nonthreatening, matter-of-fact tone when discussing limits and consequences of unacceptable behaviors 3. ENFORCING all unit, hospital, or center rules 4. Ensuring CONSISTENCY from all staff members in enforcing set limits

What are normal fetal heart tones?

110-160

What is a normal newborn heart rate

110-160

Diet of a full term infant

120 cal/kg/day Human milk is ideal for FIRST 0-12 months If using formula, should be for 12 months, before going to regular cows milk

Therapeutic INR is what

2-3

Abdominal surgery and other procedures with bowel manipulation cause what for the bowels for the first 24-48 hours?

ABSENT bowel sounds!

What is Cor Pulmonale

Abnormal enlargement of the right side [right sided heart failure] of the heart as a result of disease of the lungs or the pulmonary blood vessels Choose EDEMA or jugular vein distention (JVD) if its a choice

Care of infant wearing pavlik harness

Assess skin 2-3 times daily Put shirt and socks under harness Put diapers underneath straps Leave pavlik harness on at all times Adjusting of straps should only be done by HCP, not nurse or parent

Side effects of Haldol

Galactorrhea Lactation Gynecomastia

What medical / surgical procedure can often lead to dumping syndrome

Gastrojejunostomy Have the patient lay down after eating!

Which disease should you avoid when you are pregnant?

German measles! AKA Rubella

Weight bearing and increasing mechanical stress on the bones actually

INCREASES bone density [treats osteoporosis]

When a patient has a thyroidectomy, what is MOST important to assess

If the parathyroid accidentally gets nicked during thyroidectomy surgery, there can be a DECREASE in serum calcium Must look for tingling around the mouth, toes, fingers, and also for muscular twitching

What is an external fixation

Metal device with metal scerws placed into a bone to stabilize it There is an adjustable external rod Infection with pins is a complication Antibiotics must be started right away to prevent osteomyelitis -Nurse gives sterile pin care with 1/2 strength hydrogen peroxide and normal saline OR chlorhexidine -Neurovascular assessment afterwards -With an external fixator early ambulation is key with device in place

Orienting client to the bedside unit is the job of RN or UAP?

RN

Relation of varicella/chicken pox/herpes zoster

Varicella causes [chickenpox in childhood] and then the virus goes dormant •Reactivation occurs with compromised immune system [for example aging or immunosuppression) •Can get a vaccination to prevent SHINGLES

Atrial fibrillation priority

Ventricular rate control by giving -Diltiazem -metorpolol -Digoxin These meds decrease ventricular response rate to less than 100 beats per min

Chemotherapy results in bone marrow suppression

Which means low RBCS, wbcs, and platelets

What helps minimize vertigo?

a quiet dark environment

guidelines for the pneumococcal vaccination

all adults 65 or above should get 2 pneumonococcal vaccines

Who should get the flu vaccine?

all patients 6 months old or greater unless pt has life threatening allergy to the vaccine or one of its ingredients

What to remember when introducing new foods to a baby?

allow 5 to 7 days between introduction of new food to assess for allergies

Clear and simple sentences when speaking with

an alzheimers patient

Ventricular septal defect is the same thing as atrial but the hole is

between the ventricles instead and can lead to CHF [this a-cyanotic heart defect increases pulmonary pressure or congestion and leads to heart failure] so wacth for signs of CHF like dyspnea and tachypnea

Stage 2 ulcer

blister, abrasion, shallow open ulcer red pink wound with no sloughing

Infants should not be throwing up green vomit, this could indicate what?

bowel obstruction

Laser lithotripsy

breaks down kidney stones S&S: -Burning on urination -Hematuria

Burning at the I.V site can indicate and lead to what?

can indicate phlebitis which can lead to thrombophlebitis [blood clot]

Mastitis

caused by staph [S.aureus] Frequent feeding + Appropriate latching onto breast [these two will prevent it]

Strabismus [crossed eye]

cross eyes misalignment of the eyes eyes looking in dfferent directions

Lithium toxicity occurs with

dehydration and hyponatreima SO what should you do if taking? drink lots of fluid [about 2 L per day] and get adequate salt Do not take NSAIDs or thiazide [diuretics]

Drug for fibromyalgia

duluxetene (cymbalta) It has both antidepressant and pain relieving affects its also prescribed for MDD [major depressive disorder]

Atopic dermatitis is as known as what?

eczema

A cast is place, you should instruct patient to

elevate limb above heart for the FIRST 48 hrs

When can fetal sex be determined?

end of 12 weeks

Behaviors of bulimic person

episodes of binge eating followed by self induced vomiting using enemas/laxatives intense frequent exercise

At 12 months, heat and chest circumference are

equal

In regards to delegation, the RN should

escort a disgruntled family member off the unit and not delegate this to UAP

TIPS procedure is used for what?

esophageal varices

Baseline data before an open abdominal aneuryism surg is

essential ESPECIALLY character and quality of peripheral pulses

Sickle cell crisis cause

excrutiating pain and these patients will need large dose of narcotics PCA pump is th best method with morphine or dilaudid meperedine (Demerol) is contraindicated

how to use the peak flow meter for asthma

exhale quickly and forcibly through the mouthpiece

Guaifenesin [Mucinex]

expectorant med that thins secretions to facilitate expectoration

Pressure ulcer develop how?

external pressure compressing capillaries and underlying soft tissue; occurs mainly over bony prominences

What do rales (crackles) indicate?

fluid in the lungs

Lumbar puncutre purpose is to

get a sample of CSF like for MENINGITIS You as a nurse will need an informed consent Always remember to have the patient empty the bladder PRIOR to procedure

What should nurse do before giving vancomycin?

get trough levels

When a patient is on prednisone, check

glucose levels [causes HYPERGLYCEMIA]

What is a primary component in TPN?

glucose, so the nurse should be monitoring blood glucose and be assessing for signs of hyperglycemia

Rice, corn, and potatoes are

gluten free and are allowed in what type of diet? gluten free diet = celiac disease patient BROW diet [Mnemonic to remember Barley, Rye, Oats, Wheat]

What will chronic pancreatitis show in stool

greasy, foamy, foul-smelling, fatty

Disaster triage

greatest good for the greatest number People with alterations in airway breathing and circulation [ABC!] who are likely to survive with timely [treat within 30 minutes] interventions are given FIRST priority [RED TAG]

If a patient being discarged is a DNR, make sure they

have a bracelet!

what are some hings that happen with myopia?

headache, dizziness, poor school performac,e eye rubbing, frequent blinking.squinting when viewing bjects from afar

What is pyrosis?

heartburn

Anaphlactic shock

hives, itching, skin rash, rapid swelling of the mouth and throat [ANGIOEDEMA] give EPINEPHRINE quick in the thigh BENADRYL can be given for hives or rash Epinephrine is the only thing that can treat anaphylaxis If you have any kind of history of severe allergic reaction then you should always carry an EPI pen.

Chronic kidney disease patients are at risk for

hyperkalemia

Cold clammy skin is a sigh of

hypoperfusion in shock

What can happen as a result of emergent catheterization from acute urinary retention?

hypotension and bradycardia

What is the desired effect of lactulose?

improve mental status [treats mental alterations caused by hepatic encephalopathy] lactulose reduces ammonia by trapping it in the gut then expelling it with a laxative

Intermediate acting [NPH]

in 4 hours

When is digoxin used?

in heart failure to increase cardiac output and in afib to reduce the heart rate

Opioid agonist-atagonist meds can be used when during labor?

in the active phase of stage 1 labor when labor contractions are well established and the cervix is dilated to at least 4 cm

What type of fluids would someone need while in hypovolemic shock?

isotonic like normal saline [0.9% sodium chloride] and lactated ringers [LR]

What type of fluids do patients in hypovolemic shock need?

isotonic solutions like NS, LR

What is the kernig sign?

leg extension on 90 degrees flexing hip causes pain and resistance

Once a nurse provides care to someone this establishes a

legal caregiver obligation + relationship with the nurse and the patient The nurse could be held negligent if the nurse does not continue the care until someone else takes over or unless they are stable

When is the only time that procedures can be performed without getting informed consent first?

lifesaving procedures

Most patients with heart failure take what kind of med

loop diuretic that ends in "ide" like furosemide, torsemide, or bumetanide

What is palliative care?

manages symptoms, provide psychosial support, coordinate care to relieve suffering and improve quality of life for patients with serious illnesses

When I see chronic kidney disease, I think of the kidneys

not producing RBCs because they cannot produce erythropoietin = ANEMIA = epoetin therapy Excessive potassium [hyperkalemia] because normal kidney function is required to rid the body of potassium

Early indicator of hypocalcemia is

numbness and tingling of the lips

How are bowel sounds determined absent

nurse listens for 2-5 mins in each quadrant

A DNR does not provide direction for

nutrition supplementation

Quality improvements should be

objective and measurable

Calf pain that relieves while at rest is what

peripheral arterial disease [intermittent claudication]

what does failing the pinprick test indicate?

peripheral neuropathy

Diffused abdominal pain and rigid abdomen could indicate what?

peritonitis

What does thromboycytopenia [low platelets] present as?

petechiae, purpura, or bleeding

Dental hygiene is required with

phenytoin

After a burn, do NOT

place ice, ointment, creams or butter just run under hot water remove clothing around burn if not stuck to skin cover with a clean dry cloth

To prevent hip fractures after leg amputation

place patient prone with hip extension for 30 mins 3 to 4 times a day

When is digoxin held in kids?

pulse less than 90

How should a person with COPD breathe?

pursed lip breathing

Back pain after catheterization could be what?

retroperitoneal bleeding [Grey Tunner sign]

Risk associated with stent placement using the femoral approach

retroperitoneal hemorrhage

Nasal cannula

short term, allows to eat and drink Delivers oxygen up to 44%

How do 8 month olds play?

solitary play by maneuvering & teething soft toys

18 guage

somewhat stable adults needing large amounts of fluid or blood [blood transfusion]

Rememebr that when delegating, the nurse can only ask for

specific assessments; something like if there are blood clot in the urine or how much urine is there, they can NOT ask the UAP to describe what the urine looks like because this involves assessment

Steps after newborn is born

stimulate •If after 30 seconds the heart rate remains less than 100 then start positive pressure ventilation [PPV] •If after 30 seconds the heart rate still reminds less than 60 after quality positive pressure ventilation [PPV] then do chest compressions and if still less 60 then give epinephrine

RN performs initial client and caregiver

teaching LPN reinforces teaching RN will also do dischagre instructions

Never clamp a chest tube during transport of a patient; what may it cause?

tension pneumothorax cuz the air has no way to escape

Persecutory [paranoid]delusion

the belief of being treated in a malicious way

What is veracity?

the duty to tell the truth

During dressing changes of a PICC line, what should a nurse check?

the external length of the PICC

Manage edema on the residual limb by using

the figure eight compression bandage

What is partial thromboplastin time (PTT)?

the time it takes your blod to clot

If there is a radiation contamination, see

the victims farthest away from the source first

Is it dangerous when someone is throwing PVCs and why?

they could go into a lethal dsrythmia

Why do opioids cause hypotension?

they dilate peripheral blood vessels. if the pt stands it can cause orthostatic hypotension

Children 3 to 6 put inappropriate causes to things that happen for example

they were bad so their knee was scraped

What is wound evisceration?

total seperation of wound layers with internal organs protruding through the wall of an incision Place them in low fowlers [FLAT] with the knees bent helps reduce the tension on the wound

Dispacement

transferring thought feelings toward one person to another Man is mad at his boss and comes home to yell at his wife

Dopamine function

treat distributive shock and maintain cardiac output

Dopamine does what?

treats hypotension caused by bradycardia [Increases cardiac output + heart rate]

What does this cause them to do?

try to regulate their self esteem

Retinoblastoma

tumor of eye usually diagnoses in children under 2 months The pupil will reflect a white color and the child will NOT have the normal RED eye reflex Radiation therapy or removal of the eye

Some symptoms of tardive dyskinesia

unusualy movements of arms, legs, face, body

Which way to pull pinna in an adult?

up and back

Black stools [melena] indicate what?

upper G.I bleeding

It is possible to have a pulse in

v-tach

Best type of oxygen delivery for a COPD patient

venturi mask

Occipital lobe [brain]

vision

What will damage to the occipital lobe cause?

visual disturbances

When are pancreative supplements taken?

with or just before every meal

What is dysarthria?

worsening ability to speak which can lead to respiratory distress

Can UAPs transfer a dead client to the morgue?

yes

Is the babinski sign present at birth?

yes but it disappears at 1 year

What are some seizure triggers?

•Excess caffeine •Alcohol •Sleep deprivation •Stress

Symptoms of RSV in infants

•Excessive mucous production •Rhinorrhea •Fever •Cough •Lethargy •Irritability •Poor feeding

Causes of kidney/ureter stones

•Obstruction and urinary stasis •Hypercalcemia •Dehydration •Immobility •Gout

Dementia

•Onset is gradual (months to years) •Consciousness intact •Progressive •Irreversible

Childhood of someone with NPD

•Sense of inferiority •Poor self esteem •Self criticism

After a cystoscopy notify HCP if there is:

•Urinary retention •Hemorrhage •Infection •Bright red blood when urinating •Blood clots •Inability to urinate [dysuria] •Fever

What do we do for styes

•Warm compresses Antibiotics I&D Caused by a staphylococcal organism

What is the brand name for valproic acid?

Depakote [anticonvulsant]

When should a baby umbilical cord fall off

1-2 weeks after birth No tub baths until them Should be drying up and getting more hard to the touch

Contraindication meds for heart failure

NSAIDS [like ibuprofen, aspirin]

Autonomy vs. Shame and Doubt

1-3 yrs Provide child with acceptable options. Let them CHOOSE [not too many option; like 2 or 3]

What is the chvostek sign

facial twitch after tapping nerve on side of head

In up to 18 months, the toes of an infant should

fan upward + out [babinki sign] and this is a normal response; after 18 months is babinki sign is abnormal, indicates neurological damage

Patients with long bone or pelvic fractures are at risk for developing what?

fat embolism

Acute pancreatitis stool

fatty and foul smelling

what ABG values indicate acute renal failure [ARF]?

low PaO2 and high PaCo2

What causes oligohydramnios?

low amniotic fluid volume caused by fetal kidney anomalies or leaking fluid through the vagina

HYPOcalcemia

low blood calcium level (<8.5)

What is osteoporosis

low bone density

kidney disorders diet

low phosphate

Ethambutol

eye exams are needed

What is polycythemia?

too many RBCs

Initiative vs. Guilt

3-6 yrs Assist parents to identify age/disease appropriate activities

Infants should be breastfed until

6 months then at 6 months infants can introduced to pureed foods [Cereal FIRST] At age 1 year or later they can have cows milk

Separation anxiety in babies

6 months to about 3 years •This is a normal reaction

What is the normal range for wet infant diapers per day?

6 to 10 great way to measure hydration status in infants

When does teeth eruption happen in infants?

6 to 10 months

When does tooth eruption occur in infants?

6 to 10 months

Normal range for wet diapers by 3-4 days of life

6 to 8 wet diapers every 24 hours

Duration of Regular

6-10 hr

Idustry vs. Inferiority

6-12 yrs Encourage child's participation in their care

WATCH our for what organ when taking acetaminophen?

LIVER

What is trismus?

LOCKJAW inablity to open the mouth due to a tonic contraction of the chewing muscles

Respiratory acidosis

LOW pH, HIGH PaCO2, normal HCO3

Metabolic acidosis

LOW pH, LOW HCO3

Obstructive sleep apnea

Lack of airflow due to the occlusion of pharynx

Symptoms of hypothyroidism "everything is slow"

Lackluster mood Bradycardia Weight gain Constipation Cold intolerance Dry/thick skin Cool, pale Brittle nails/hair Hair loss Generalized edema Fatigue Anemia Muscle/joint pain Lethargy Forgetfulness Depression Decreased libido None or little or a lot of menstrual bleeding

What med is given for encephalopathy?

Lactulose which decreases intestinal ammonia absorption [gets rid of the excessive ammonia built up in the body]

What type of syringe to we use to aspirate an NG tube

Large Barrel syringe

Signs and symptoms of a woman in labor with a baby who has an unreassuring FHR

Late decels [VEAL CHOP MINE] Fetal bradycardia Decreased variability

Where do we hear S3 , on the left side or right side of the heart in heart failure?

Left

Which 2 groups of drugs can cause problems for those with asthma?

NSAIDS and beta blockers because they can cause bronchospasm

Acute pericarditis treatment

NSAIDs and colchicine [anti-inflammatory meds]

Dysrhythmias are common after an

myocardial infarction [MI]

What does an ST elevation indicate?

myocardial infarction because one or more of the coronary arteries that supply blood to the myocardium are occluded

What is the extreme thing that happens as a result of hypothyroidism?

myxedema coma like LETHARGY mental SLUGGLISHNESS COLD INTOLERANCE coma

What should someone take with methotrexate to help with adverse affects?

folic acid supplement

What is the classic sign of a tension pneumothorax?

mediastinal shift + tracheal deviation

there are different types of POAs, like

medical and financial

Schizophrenia: Assessment

-Delusions -Tangentiality [deviating from original topic of conversation] -Waxy flexibility [tendency to remain in immobile posture]

14 guage [large bore]

for giving fluids/drugs in pre-hospital emergecy setting or for hypovolemic shock

What is the ABG most consistent with diabetic ketoacidosis?

metabolic acidosis!

Common side effects of immunizations

mild fever, redness and soreness at the injection site Apply a warm compress to the site

Autistic kids

minimal stimulation + calming environment

Hydrocdone/aceteminophen oral tablet is typically used for what type of pain?

moderate

For tuberculosis, an induration of greater than 1 indicates you have

a TB infection

Patients with A fib are usually given

a anticoagulant due to increased risk for blood clots

What is Midalozam [Versed]?

a benzodiazepine used for conscious sedation Commonly given with an opioid

Trisomy 21 [down syndrome] is normally associated with

a cardiac murmur (AV canal defect) If vital signs are stable it requires no action They may have surgery later on

Ulcerative colitis

inflammation/ulcerations in the large intestines causing urgent, frequent, bloody diarrhea, abdominal pain, anorexia, and anemia-lower GI-rectum

Meds common for an open fracture?

•Cefazolin (Ancef) •Tetanus toxoid •Toradol •Opioids

Introducing a child to table foods: 4-5 months they can have

•Cereal (usually rice cereal first) •Strained fruits next

s/s of myocardial infarction [MI]

•Chest pain •Diaphoresis •Dyspnea •Anxiety

What meds do we give for Alzheimers

•Cholinesterase inhibitors •NMDA receptor antagonists antidepressants

Introducing a child to table foods: 7-9 months:

•Chopped meat, hard breads and "finger foods", baked potato and mashed potato

What type of meds should be stopped 7 days before surgery?

•Clopidogrel •Antiplatelet •NSAIDS

What do we do for non-penetrating contusions

•Cold compresses •Analgesics

2 major clinical features of major depressive disorder

1. Depressed mood 2. Loss of interest or pleasure One of these two symptoms must be present DAILY for 2 weeks for the diagnosis to be made

Kegel exercises

Used to strengthen muscles of pelvic floor Tighten pelvic muscles for a count of 3, then relax for a count of 3. Do this lying down, sitting, and standing for a total of 45

Sucralfate

Used to treat duodenal ulcers Best results if taken on an empty stomach!

Contact Precautions

Used when germs are spread by touching Examples: C. difficile + Norovirus Minimal PPE: Gloves and Gown

Atrial septal defect (ASD)

abnormal opening between the left and right atria that causes a murmur from blood flowing in between back to the right side of the heart [increasing pulmonary pressure or congestion]

What are the 2 core symptoms of ASD? autism?

abnormalities in social interaction and communication and patterns of behavior interests and activities

HYPERnatremia

abnormally high sodium level (>145) in the blood, which helps regulate the amount of H2O in and around the cells.

HYPOnatremia

abnormally low sodium level (<135) in the blood, which helps regulate the amount of H2O in and around the cells

For all pregnant clients, weight gain in the first trimester shold be what?

about 1.1 to 4 pounds

Diuretic phase [a lot of urine output]of Acute kidney injury

urinary output of 4000-5000 ml per day Increased BUN Loss of sodium and potassium in urine Increased mental and physical activity

Gabapentin (Neurontin)

used for neuropathic pain

What are some ways iron deficiency can happen?

Diets low in iron like vegetarian Iron not being absorebd like after abdomal surgery or malabsorption syndrome Increased iron requirement Blood loss

What is transferrence?

a client unconscioulsy transfers feelings and behaviors related to a person in the clients past onto the nurse For examples: a client states that the nurse reminds them of their sister

Penicillins and cephalosporins can have

a cross sensitivity response

C section patients have

a longer recovery than vaginal birth and are in the hospital longer watch out for VBAC vaginal birth after c section because previous scaring may easily tear

If a sickle cell patient has an enlarged spleen this is

an emergency SPLENOMEGALY can lead to hypovolemic shock WHY because Most RBCs in a child with sickle cell are defective and will be destroyed

Desquamination is skin peeling and is a normal finding in

an infant, esecially those born late [post-term babies past 42 weeks]

Risperidone-what class and what is it used to treat?

antipsychotic used to treat schizophrenia and bipolar

Why is putting an I.V in the arm of a mastectomy contraindicated?

any trauma to the arm on the operative side can cause lymphedema with painful and lengthy swelling

Avoid what after open radical prostatectomy

anything that could CAUSE strain on the rectal area [give laxatives]

Postpartum psychosis-signs

appear within 2 weeks after birth include: -Hallucinations -Delusions -Paranoia -Severe mood changes -Delirium -Feelings that someone will harm baby

Potassium (K)

3.5-5

Head injury

fowlers or elevate head of bed to reduce ICP

Major depressive disorder demonstrates

•loss of appetite •weight loss •insomnia •hypersomnia •sleep disturbances

Memantine treats what?

Alzheimer's

When you think hyperkalemia, think what?

CARDIAC PROBLEMS

Parent teaching for Kawasaki disease

CHECK FOR FEVER

Metabolic alkalosis

HIGH pH and LOW HCO3

Expect heavy bleeding with

IUD

Audiogram vs tuning fork

Audiogram: quantitates the degree of hearing loss Turning fork: qualitates : the type of loss

Increased bilirubin

Jaundice Scleral icterus Itching

C. diff and scabies sanitizer is

NOT sufficient, you are going to need soap and water

What is a complication from conductive hearing loss

Meningitis

What do you NOT take tetracycline with

Milk or antacids It inhibits the med from working!

Continuous peritoneal dialysis

Automated machine used at night Final exchange is left in place for the next day and then drained at night

Frontal lobe [brain]

PERSONALITY/BEHAVIOR

Position for administration of an enema

Patient should be LEFT side laying with the knee flexed [Sims position]

Methotraxate treats what?

Rheumatoid arthritis

S&S of phlebitis

Redness in the area and red streaks

MODS

Septic shock plus multiple organ system damage (2 or more organs)

When a patient has a phobic disorder, what is the best thing to do for them

Systematic desensitization

Where is insulin produced

The beta cells of the pancreas

What med is Riluzole?

Treats for Lou Gehrig's disease also called Amyotrophic Lateral Sclerosis ALS [SLOWS progression of the disease]

Treatment for Atrial Flutter

Vagal maneuvers Adenosine [antidysrhythmic] CARDIOVERSION Ablation therapy

When is hyper-resonance percussed?

With an over inflated lung [for example asthma, emphysema] With air in pleural space [for example pneumothorax]

What does atrial flutter look like

saw tooth

Decreased hemoglobin/hematocrit levels are

normal in chronic kidney patient

Cataracts have

opaque color to the eye

SSRIs

sexual dysfunction [common side effect]

Remember NOT to choose answers with words like

"never" and "always"

Female prescribed isotretinoin (accutane) acne medication must have what

-2 negative pregnancy tests before starting [causes serious birth defects-category X] -Must use 2 forms of contraception -Enroll in a risk management program to make sure these are both being followed through

Teaching for a phenylketonuria baby

-A low phenylaline diet -Lifetime dietary restrictions -Monitor serum levels of its amino acid and is necessary but just in moderation -Infants on special formulas -Eliminate high phenylaline foods like MEAT, EGGS and MILK

Macrolide antibiotics like azithromycin, erythromycin, and clarithromycin can cause what?

-A prolonged QT interval which can lead to torsades de pointes and sudden death -Also hepatotoxicity

Normal findings after the birth of a preterm baby

-Abundant lanugo [should disappear around 36 weeks] -Smooth pink skin with visible veins [due to lack of adipose fat] -Flat areolae without palpable breast buds (areolae is palpable and raised in newborns closer to term)

How to deliver a dose via a metered dose inhaler?

-Shake MDI and attach to spacer -Exhale completely -Place lips tightly around the mouthpiece -Deliver a single puff of med into spacer -Take a slow deep breath and hold for 10 seconds -Rinse mouth with water after dose

Partial weight bearing

1 person assist stand & pivot transfer with gait belt or motorized assist device if cooperative 2 person assist with full body sling if uncooperative

BMI pregnant client should gain how much per week in the 2nd and 3rd trimestes

1 pound per week

When giving a needle IM, the needle length should be what?

1 to 1 & 1/2 inch

At what age does an infant have equal head and chest circumference?

1 year

Positive [diagnostic] signs of pregnancy

1. Fetal Heartbeat heard with doppler 2. Fetal Movement [felt by an examiner or visible] 3. Visualization of Fetus [ultrasound]

What are the 3 signs of positive [diagnostic] pregnancy?

1. Fetal heartbeat w/ doppler 2. Visualization of fetus with ultrasound 3. Fetal movement felt by the HCP

Posttransplant infections symptoms

1. Fever greater than 100.4 F (38 C) 2. Productive or dry cough 3. Changes in secretions

What modifications to take when giving CPR to a pregnant patient?

1. Perform chest compressions slightly higher on sternum 2. Displace uterus to left side

Pulmonary embolism - Nursing Priorities

1. Rapid symptom identification 2. Assessment of oxygenation [check O2 sat, sit patient up FIRST] 3. Notification of HCP

3 main categories a person with PTSD has

1. Re-experiencing the traumatic event 2. Avoiding reminders of the trauma 3. Hyper-arousal

MMR and Varicella are first given at what age?

12 to 15 mo Use this Mnemonic [MAD HPV]

Second trimester in weeks

13-26 weeks

Sodium (Na)

135-145

How soon after a blood transfusion does an acute hemolytic reaction occur?

15 mins

Ammonia level

15 to 45

Onset of Aspart

15-30 mins

Onset of Lispro

15-30 mins

Platelets

150,000-400,000 Less than 20,000 be very concerned!

Duration of Isophane (NPH)

16 hours

Phosphorus (PO4)

2.5-4.5

Intimacy vs. Isolation

20-35 yrs Provide private time with partner/family

HCO3 [bicarbonate]

22-26

Duration of Glargine [Lantus]

24 hours

Newborns should void and pass meconium within

24 hours

When will thumb sucking go away

24 months [2 years of age]

PTT

25-35 Heparin Therapeutic Range: 1.5-2 times normal value. [which ranges from 37.5 to 70]

Third trimester in weeks

27 weeks to end of pregnancy

Max time for the grieving process is

3 years

Do we aspirate the syringe when administering Heparin?

No, it can cause bruising

Normal urine output in mg/hr and mg/kg/hr

30 ml/hr 0.5-1 ml/kg/hr

What are pregnant clients tested for Group b streptococcus [GBS] ?

35-37 weeks

PaCO2

35-45

Generativity vs. Stagnation

35-65 yrs assist client with illness adaptation and home/work demands

RBC

4 million to 6 million

Age for imaginary play

4-6 [preschoolers] ❤️

Long acting [detemir & glargine]

4-9 hrs

How long does a diaphragm need to be left in the vagina after intercourse

6 hours

How much after TB injection should arm be checked?

48 to 72 hours [after 2 to 3 days]

[Parkland formula] What is the formula and actually how much is given?

4mL of lactated ringers (LR) x weight of patient in kg x % of body burned Half of the calculated parkland volume must be given in the FIRST 8 hours and the other half of parkland volume must be given in the last 16 hours

Oral warfarin is started about

5 days before a continuous heparin infusion is discontinued WHY? because this is the time it takes warfarin to reach therapeutic level

Normal weight gain in first 6 months in infants

5 to 7 oz a week

If you are doing an autologous blood donation, when can you donate to yourself

5 weeks away from your surgery up to three days before

WBC

5,000-10,000

What should the pH be when you aspirate for NG tube?

5.5 or below

Yellow ashtma

50 to 79

When inserting a catheter into a male, put it in about

7 to 9 inches Once you start to see urine drops, then advance about 1 to 2 inches more to make sure you're in bladder then inflate balloon Do NOT inflate balloon too early because it could cause urethral trauma urine could be in urethra So basically just because you are getting drops of urine into the bag does not mean you are in bladder

pH

7.35-7.45

Levothyroxine takes about

8 weeks for patient to see full therapeutic effect

Calcium (Ca)

8.5-10.5

Asthma green

80 or above of personal best

PaO2

80-100

Elbow sling placement

90 deg hand above elbow joint bottom of sling ends in middle of palm with fingers visible

Butorphanol Tartate

A narcotic pain reliever similar to morphine Monitor rate and depth of respirations

What is Bell's palsy?

A 7th cranial nerve disorder where there is an inability to close the eye, decreased corneal reflex, increased lacrimation, speech difficulty, loss of taste, distortion of one side of the face

What is acoustic neuroma

A benign tumor of the 8th cranial nerve that causes deafness (partially initially) and dizziness

What suggests that a client has an inguinal hernia

A bulge in the lower right quadrant

Glipizide is given to what type of client

A client with Type 1 diabetes where they produce none of their own insulin

What is trigeminal neuralgia?

A cranial nerve disorder where there is stabbing/burning facial pain that is excruciating and unpredictable Often will be twitching and grimacing of the facial muscles

What are some risk factors for postpartum hemorrhage?

A history of postpartum hemorrhage [PPH] Uterine distention Uterine fatigue/boggy High parity [given birth to multiple children] Certain meds

Symptoms of an aortic dissection

abrupt worst ever tearing, ripping, moving from upper to lower back epigastric pain and abdominal pain Life threatening Treatment: surgery and lowering the blood pressure which is a contributing factor

LEFT-to-RIGHT congenital heart defects

A-CYANOTIC defects 1. Patent ductus arteriosus [PDA] 2. Atrial septal defect [ASD] 3. Ventricular septal defect [VSD] Oxygenated blood from the LEFT side of the heart moves to the RIGHT side of the heart with deoxygenated blood Oxygenated blood travels systemically and does not cause cyanosis

What combination durgs are normally used to treat heart failure?

ACE inhibitor + lasix

Hyperkalemia is a side effect of

ACE inhibitors

Treatement for aspiriin poisoning

ACTIVATED CHARCOAL, and then I.V sodium bicarbonate

In terms of fetal heart rate, the only normal accelerations are

acceleration [normal-GOOD] What are the abnornal ones? variable, early, and late decelerations [VEAL CHOP MINE]

During a thyroidectomy, the parathyroid glands may be

accidentally removed because they are very small in size

Treatment for ventricular tachycardia [V-tach]

If monomorphic: give -Procainamide -Sotalol -Amiodarone If polymorphic: give -Magnesium sulfate -Isoproterenol If PULSELESS: give -CPR -Defibrillation [AED] -Epinephrine -Amiodarone

Peritoneal dialysis

for someone with insufficient renal function A catheter goes into peritoneal cavity and dialysate is infused then clamped for 30 mins then it is unclamped for the dialysate to drain via gravity

If a child is suddenly in distress and can not speak what should you suspect

foreign body aspiraion

What are the priorities of care for suspected placenta abrupto?

monitor mom for fluid status and fetal heart tones [FHR] because it can cause maternal hemorrhage and/or fetal oxygen supply interruption

Oligohydramnios [very little amniotic fluid] requires

more personnel in the room for delivery

Major complication of rheumatoid arthritis is

morning stiffness take a warm shower or bath upon wakening

Dilaudid is 5 to 10 times the strength of

morphine

What does lead poisoning cause?

neurological and motor impairment

Gestational diabetes

new onset of elevated blood pressure at 20 or more weeks without proteinuria

What is preeclampsia?

new onset of hypertension PLUS proteinuria after 20 weeks gestation

When a patient says something like "Someone is trying to kill me tonight" what do you do

Don't go along with their delusion like you support it [persecutory hallucinations] Just acknowledge how they are feeling and move on. Say something like "It must be frightening to think someone is trying to kill you"

When a mom chooses to bottle feed, what do we need to recommend for her

Don't use a breast pump because your body will think that you need to continue to produce milk The milk will subside on its own in 5-7 days

Cardiac cath

Done via artery Arterial bleed can lead to shock and death if not treated quick Knee are kept flat after procedure to not dislodge clot should not be bleeding at puncture site -This means no clot formed then

Advanced age and pregnant increases risk of what?

Down syndrome baby

Teaching when on lithium

Drink 1 to 2 L of fluid daily Blood levels checked periodically Get adequate sodium

Patient with the Flu precautions

Droplet 3 ft away when coughing or sneezing Place mask on patient when transporting

Once we start mag on a pregnant client with hypertension, what do we do

Assess for their deep tendon reflexes [DTR]

APETOMAN

APETM aortic, pulmonary, erbs point, tricuspid valve, mitral valve

Med of choice for CHF

Ace inhibitor "pril"

What will increase the absorption of iron

Acidic foods! Take with orange juice

As the nurse, what do we do for myasthenia gravis

Administer meds before eating [anti cholinesterase, corticosteroids, immunosuppressants] Optimal eye care [to prevent and help diplopia] Maintain optimal mobility Avoid things that precipitate myasthenia crisis [infections, stress, neomycin/streptomycin, surgery]

Where do we get pulses for CPR in an adult and infant

Adult: Neck [sternoceidomastoid] or carotid Infant: Arm [Brachial]

When does "stormy" behavior onset?

Age 11

Bladder scanner residual urine volume to report

Amount that is less than 100 mL; this indicates urinary retention

Two types of glaucoma

Angle closure: sudden onset, emergency from allergy, vasomotor problems, and emotional disturbances Open angle: blockage of aqueous humor flow from trauma, tumors, hemorrhage, aging

Skin cancer mnemonic ABCDE what does it stand for?

Asymmetrical Border irregularity Color changes Diameter more than the size of a pencil eraser Evolving or changing in any way

Med of choice for Asystole

Atropine

What do we give for bradycardia

Atropine

Treatment for sinus bradycardia

Atropine or possible pacemaker

Clozapine

Atypical antipsychotic used to treat schizophrenia

How to prevent hemorrhage after a tonsillectomy

Avoid clearing the throat •Blowing the nose •Coughing

Albumin is the same normal value as

potassium [3.5 to 5]

What drug is given with furosemide to prevent electrolyte imbalances?

potassium chloride

Spironolactone

potassium sparing diuretic

Bronchiolitis [caused by RSV]

Droplet isolation S&S: -Low grade fever -Tachypnea -Wheezing [lower respiratory obstruction] -Poor feeding

Expected side effects of lithium

Drowsiness Weight gain Dry mouth GI upset

ace inhibitors side effects

Dry cough Orthostatic hypotension Hyperkalemia Angioedema

Anticholinergic effects

Dry mouth and constipation

First degree [superficial] burns

Dry with blanchable redness Usually only epidermis is damaged

Clients with ESRD are unable to excrete which electrolyte?

potassium; so they should eat a diet low in potassium

Corticosteroids and surgery

During the few weeks leading up to surgery, we need to increase the dose of corticosteroids because surgery requires more Nurse must monitor for side effects of too much corticosteroids

What 2 races have a high incidence of getting a cough from ace inhibitors?

BLACKS + asians

KIDNEY and LIVER biopsy [both organs are highly vascularized] what to watch out for

BLEEDING!

Beta blockers major side effects

Bradycardia Bronchospasm [watch out for asthma + COPD patients; make sure cardio-selective] Hypotension Depression Impotence

Signs of heart failure

Dyspnea Orthopnea Weight gain Cough Fatigue

Proton pump inhibitors can increase the risk of

C-diff

Soap and water hand hygiene is used for

C. diff + scabies

What is acute otitis media

Ear infection in the middle of the ear from a pathogenic organism [bacteria or virus]

Amoxicillan can cause what super infection?

C.diff watch out for a fever and abdominal pain that develops with diarrhea

Hypocalcemia

CATS Convulsions Arrythmias Tetany Spasms Stridor

Hypoparathyrodism (LOW calcium in the blood)

CATS: -Convulsions -Arrythmias -Tetany -Spasms -Stridor Too little calcium [the body goes out of control]

What is the standard treatment for overdose?

CHARCOAL [but it is ineffective for lithium, iron, and alcohol]

Diet for adolescent

Caloric, protein and calcium is HIGH! For adolescent girls that are menstruating, we need to increase their iron Must have high minerals and high vitamins

When walking with a cane, what is the sequence of steps

Cane first Then weak foot then good foot

Muffled heart tones are heard in?

Cardiac tamponade

Theophylline toxicity presents as what symptoms?

Central nervous stuff- HA Insomnia Seizures GI disturbances Cardiac toxicity

what is CVP and what does it monitor?

Central venous pressure measuring right ventricular preload and reflects fluid volume status •Connect it to the proximal port to pressure monitoring system Normal range 2-8

Central sleep apnea

Cessation of airflow and respiratory movements

Post-procedure instructions for barium enema

Chalky white stool until barium passes Take a laxative like milk of magnesia to help expel barium Drink plenty of fluids to promote hydration and eat a high fiber diet

What must we do after an endoscopy

Check the gag reflex

When someone has a permanent pacemaker, what is something that we have to be sure they do

Check their pulse for a full one minute every day at the same time of day

Methotrexate

Chemotherapy/Immunosuppressant Toxic Level: >10 mcmol over 24 hours

Myocardial infarction symptoms

Chest pain Dizziness Sweating Shortness of breath [SOB] N/V Pain radiation to neck, jaw, left shoulder, arms and epigastrium

What is a positive sweat test significant for

Child has cystitis fibrosis [CF] Child will need replacement of enzymes, high calorie, high protein diet

What is Duchenne muscular dystrophy?

Childhood form of MD X linked recessive Lack protein called dystrophin for proper muscle stabliizing Muscle of proximal lower extremities are affected first They do the gower sign to help them stand Remove clutter to prevent falls

What is Raynauds phenomenon

Chronic connective tissue disease that causes inflammation, fibroids, and sclerosis of the skin and vital organs Pain and color changes of the extremities when exposed to the cold Arterial peripheral vascular disease

RN scope of practice

Clinical assessment Initial client education Discharge education Clinical judgement Initiating blood transfusion

What do we do for people with strabismus

Close good eye to strengthen bad eye Eye exercises Surgery on rectus muscle of eye

ARBs and ACE inhibitors are contraindicated in

pregnancy

What are some common side effects of anticholinergics?

Constipation Urinary retention Flushing Dry mouth Heat intolerance

What could be causing insufficient outflow in peritoneum dialysis [PD] and what to do?

Constipation could be the cause Assess bowel pattern and give stool softener Assess for abdominal distention and constipation Check tubing for kinks Reposition client to side lying or walk with them Keep drainage bag below abdomen

Rubella titer is contraindicated in

pregnancy

Pertussis [whooping cough] symptoms

Cough lasting 2 weeks or more with one or more of the following: -Violent, spasmodic cough/paroxysms of cough -Inspiratory whooping sound -Coughing up thick mucus plug sometimes followed by vomiting [post-tussive emesis]

Client identifiers

First and last name Medical record number DOB

What do we do as nurses for cystitis

Get a clean catch for testing Encourage 3000ml of fluid a day Give cranberry juice / urinary acidifiers Void every 2-3 hours Teach females to void after intercourse and to wipe from front to back

Rationalization

I did poorly on the test because the questions were hard

Simple face mask

delivers higher concentration than cannula about 40 to 60% Can be used if hypoxemia does not resolve

What is the first line treatet for kawasaki disease?

I.V immunoglobulin and aspirin to prevent the aneurism

What is the FIRST line of treatment for torsades de pointes?

I.V magnesium

Never give potassium via which routes?

I.V push Intramuscular [IM] Subcut

Parenteral?

I.V route

What should all intoxicated patients be given?

I.V thiamine before or with I.V glucose

Delirium vs Dementia

dementia has a slow onset usually with normal attention

What is the pavlik harness used to treat

DDH in kids •It keeps kids legs bent and spread apart

Raising the head of bed [HOB] causes BP to do what?

DECREASE

Beta blockers like the lols do what

DECREASE heart rate [cause bradycardia] and decrease cardiac workload

In some patients with COPD, a too high level of inspired oxygen can

DEPRESS the respiratory drive to breathe causing alveolar hypoventilation Removing supplemental oxygen like a cannula may actually increase the reading

If a patient cannot ingest a simple oral carb during a HYPOglycemic reaction, they are given

DEXTROSE [D50] or glucagon [IM injection] but these can cause rebound hypoglycemia by stimulating more insulin release from the body in response to increased glucose levels

What happens in peritoneal dialysis?

DIALYSATE is infused into the abdominal cavity and the tubing is clapmed to allow the dialysate to dwell [the dialysate stays in the abdomen for several hours] after the dwell time, tubing is unclamped and the fluid drains out

Lmbar puncture positioning

DURING: side lying AFTER: supine

What best detects fluid gain/retention in an infant

Daily weights

Thyroid replacement can give symptoms of hyperthyroidism like

Diarrhea Weight loss Palpitations Tachycardia Sweating Heat intolerance

If a patient is in a hypertensive crisis, give them

I.V vasodilators but remember to lower BP slowly to prevent it from dropping too rapidly and causing organ damage from decreased perfusion

What is the most important med to give for anaphylactic shock?

IM epinephrine

When do we hold potassium

Do NOT give potassium without adequate urine output "No Pee, No K"

Heart failure patient have trouble breathing, what to do first?

Elevate HOB

Position of a patient with Bucks traction

Elevate the foot of the bed for counter traction

What are lab results that support a vaso-occlusive crisis [pain crisis] in sickle cell patients?

Elevated reticulocytes Elevated bilirubin Anemia [Hgb <10 g/dL]

Normal amount of drainage in first 24 hours following surgery

depends on type of procedure performed, but about 80-120 mL/hour of serosanguineous or sanguineous drainge* can be expected

Symptoms of acromegaly [overproduction of growth hormone]

Enlarged face Enlarged hands + feet Enlarged organs like tongue, spleen, kidney, thyroid Hypertension •Heart failure •Joint pain •Skin changes •HYPERglycemia

What is benign prostatic hypertrophy

Enlargement of the prostate gland that causes urinary flow obstruction, incontinence, and possible infection [caused by urinary stasis]

In delegation, nurses must take patients where there is...

Evaluation Assessment Teaching Do not delegate what you can EAT

Additional calories needed for a pregnant woman, and then for a lactating woman

Extra 300/day for a pregnant woman Extra 500/day for a lactating woman

What do we do for a patient with cataracts

Extracapsular extraction [cutting through anterior capsule /more superficial/exposes opaque lens] Intracapsular extraction [removal of entire lens/more radical/easier for us, more harmful to client] Then implant a new lens

What do we do as a nurse for glomerulonephritis

Give meds to treat the infection Treat volume overload and hypertension Give: -Antibiotics [if bacterial infection] -Corticosteroids [to treat inflammation] -Antihypertensives [to treat HYPERtension] -Immunosuppresives [to lower body immunity from attacking glomeruli] -Diuretics [to decrease fluid overload] •Restrict sodium intake •Daily weights •Assess I&O and serum potassium •Bed rest

What do we do if the parenteral nutrition needs to be stopped immediately or the new feeding bag is not ready on the unit

Hang D10% so we can keep the patients sugars in check and they don't suddenly go hypoglycemic

What is the causitive agent of fifth disease?

Human parvovirus

What drug is used to treat skin and athritic manisfestaions of Lupus

Hydroxychloroquine When taking this med, make sure to have an eye appointment every 6 to 12 months Take with food

When administering anti-psychotics, what do we need to monitor for?

Hypotension Ask them to sit and stand while you take their BP two times to make sure they aren't hypotensive before you give the med

Classic symptoms of neurogenic shock

Hypotension Bradycardia Pink + dry skin

Hypermagnesemia

Hypotension Facial Flushing Muscle weakness Absent/DECREASED DTRs [DECREASED deep tendon reflexes] Shallow respirations Emergency •Sedative effects on the CNS Too much magnesium, SLOWS you down!

Signs/symptoms of cardiac tamponade

Hypotension [heart is not contracting effectively, SO cardiac output drops] Muffled or distant heart tones Jugular vein distention [JVD] Dyspnea Tachypnea Tachycardia Weak thready pulses

What route is the best way to give burn victim meds?

I.V

What do we do as the nurse for neuroleptic malignant syndrome

Immediately withdraw [stop] anti-psychotic meds [like Haldol] Control hyperthermia [cooling measures, antipyretic] Hydration Give Dantroline and Bromocriptine

What is an EARLY symptom of hepatic encephalopathy

Impaired thought process and forgetfulness

When is S3 a normal sound

In C.H.F it is normal, but NOT in M.I

When does a depressed client have the highest level of functioning and activity

In the morning hours right after they wake up [sunlight has a positive effect on depressed people]

What to remember about feeding an infant with Tetralogy of Fallot

Increase the size of the hole in the bottle so the infant can get as much nutrition as possible. Do feedings every 3 hours Feed the infant soon after awakening so the infant doesn't cry [prevent crying because it tires them more due to disease process]

What is the FIRST thing we do when a patient has constipation

Increase their fresh fruits, veggies, and cereal Asking for a stool softener or laxative is a last resort

Meningitis causes

Infections (viral, bacteria, fungal) Neurosurgical procedure, basilar-skull fracture Otitis media, mastoiditis

Cystitis

Inflammation of the bladder S&S -Urinary frequency -Burning on urination -Cloudy/foul smelling odor

What is keratitis and what do we do for it

Inflammation of the cornea Antibiotics Warm compresses Steroids, except with Herpes Simplex

What is uveitis and what do we do for it

Inflammation of the iris, ciliary body, and choroid Warm compresses Dark glasses Antibiotics, analgesis, sedatives

Pyelonephritis

Inflammation of the kidney caused by a bacteria S&S -Chills -Fever -Malaise -Flank pain -Urinary frequency -Dysuria -CVA -Tenderness

What is a chalazion and what do we do for it?

Inflammatory cyst leading to a duct obstruction Must I&D

What contains live vaccines?

Influenza nasal spray [ONLY the intra-nasal form] MMR Varicella

What is the main cause of asthma

Inhaled allergens like animal dander, mold, pollen, and dust

How do 10-12 month olds play?

Interactive games [like peek-a-boo, pat-a-cake]

3 classic symptoms of intusseception

Intermittent severe abdominal cramp pain Sausage shaped mass Currant jelly stools •The baby will experience these: Inconsolable crying Drawing up knees to chest Vomiting

Why is tea a problem in graves disease

It is a stimulant and in graves disease your body is already in hyperactive hyper metabolism mode

For what diseases do we use droplet precautions

Think SPIDERMAN S:sepsis S:scarlet fever S: streptococcal pharyngitis P:Parvovirus B19 P:Pneumonia P:Pertussis I:Influenza Type B D: Diptheria (pharyngeal) E: Epiglottitis R: Rubella M:mumps M:Meningitis M:Mycoplasm or meningeal pneumonia An: Adenovirus

What meds are used in black people with heart failure

Isosorbide (nitrate) and hydralazine

Hantavirus

It is a disease from rodents/rodent droppings that can cause -Hematuria -Hematemesis -Bleeding gums

Sepsis

presence of infection along with systemic manifestations of infection

Liver is very vascular- after a biopsy

It is priority to assess for bleeding

When someone has a spinal cord injury, what is very important

Keeping the spine in alignment. •Prevent flexion or hyperextension!

Drug of choice for treatment of candidasis

Ketoconazole [antifungal]

Position for a mom with a prolapsed cord

Knee-chest position or trendelenburg

What do we do as the nurse to prevent thrombus formation

Leg exercises: flexion, extension of toes for 5 mins every hour

S&S of a hemolytic reaction [blood transfusion reaction]

Low back pain Fever Bach ache Hypotension Chills

Why do we do active range of motion

Maintains mobility of joint and increases muscle strength Performed by client without assistance

Drug of choice for trichromonias, I.B.D, and intestinal amebiasis

Metronidazole

Pleurisy

Manifests with pleural friction rub which is loud, rough rubbing or grating sound heard throughout •Inspiration & expiration cause the pleural surfaces to rub against together

What is Ketarolac?

NSAID analgesic used for short term pain relief- usage should not exceed 5 days due to -Kidney injury -GI ulcers -Bleeding

Symptoms of serotonin syndrome

Mild [shivering and diarrhea] Sever [muscle rigidity, fever, seizures] Also tachycardia and hypertension Also agitation/restlessness

What do we do as the nurse for kidney stones

Monitor I&O and temp Avoid over hydration and under hydration Strain the urine and check the PH Give analgesics

Hypokalemia

Muscle weakness Dysrhythmias Increase K intake [INCREASE raisins, bananas, apricots, oranges, beans, potatos, carrots, celery]

What is Myasthenia Gravis

Muscular weakness produced by repeated movements •Disappears when the patient rests •No problems with CNS or PNS just random •We see -Diplopia [double vision] -Ptosis [drooping of eyelid] -Impaired speech -Dysphagia [difficulty swallowing] -Respiratory distress

What is the brudzinski sign?

Neck flexion and exhibits pain and hip/knee flexion

Examples of isotonic solutions?

Normal saline Lactated ringers

Main two signs of meningitis

Nuchal ridigity Photophobia

What patient needs Fluvoxamine

OCD Side effect dry mouth

Itching and nausea are adverse effects of giving

OPIOID benadryl and zofran can provide antihistamine and antiemetic relief respectively

Phases of acute kidney injury

Oliguric Diuretic Chronic

Position during internal radiation

On bedrest while the implant is in place

Position for an infant with a cleft lip

On their back or in an infant seat to prevent trauma to the suture line. If feeding, hold in an upright position

How are late decelerations corrected?

Oxygen by face mask [8 to 10 liters per minute] Reposition left side Stop oxytocin if on it I.V fluid bolus [to increase perfusion to placenta + fetus] Give tocolytic like terbutaline or magnesium sulfate

How do toddlers play?

PARALLEL PLAY right alongside eachother but not with each other

Position of a patient after cataract surgery

Patient should sleep on the UNAFFECTED side and have a night shield for 1 to 4 weeks

testicular self examination

Perform monthly and on same day Perform while after taking warm shower because temp will relax scrotal tissue and make testis hang lower in scrotum Use both hands to feel each testis separately Palpate gently using thumb and first 2 fingers

What do we do if a patient has decreased LOC during tube feeding

Position the patient on the RIGHT side [this increases gastric emptying] and RAISE the head of the bed to at least 30 degrees [this prevents aspiration]

What drug do we use for Diabetes insipidus [DI]

Pitressin

Expected term newborn findings

Plantar creases up entire sole Presence of babinski Epstein's pearls

Babinski sign for child more than 1 year and an adult

Plantar flexion Normal toe flexion [no babinski]

DECREASED breath sounds on left side or right side of the lung could indicate what

Pleural effusion Pneumothorax Atelectasis If these occur and breath sounds decrease is because that side of the lung is collapsing due to disruption of the pleural space or alveoli

S&S dehydration

Poor skin turgor Dry mucous membranes Tachycardia Orthostatic hypotension Weakness Lethargy

Common proton pump inhibitors PPIs

Prazoles: omeprazole, lansoprazole, etc

What do we do as the nurse for acoustic neuroma

Pre and post op care for posterior fossa craniotomy Assist with turning of the neck for comfort measures Treatment: surgical removal of tumor

How long to GBS symptoms last for?

Progresses for 10 days and then last for 10 days

Why do we do active resistive range of motion

Provision of resistance to increase muscle strength 5 lb weights or bags may be used Performed by the client against manual or mechanical resistance

1st line treatment for Myasthenia Gravis

Pyridostigmine

Renal arteriogram

Radiologic test performed to visualize renal blood vessels to detect abnormalities [renal artery stenosis or aneurysm] Contrast medium is injected into femoral artery [check for iodide or shellfish allergy] Client should increase fluid intake after procedure to flush dye out of body Increased urinary output is an expected finding

Goals for IBS

Reduce diarrhea or constipation Abdominal pain Stress Manage with diet Meds Exercise Stress reduction

What is the nursing care focus opioid dependent newborns?

Reduce stimulation Promote nutrition and comfort

What do we do when a baby has club foot

Reposition the foot to normal position every 4 hour Casts and splints correct the deformity if placed early (change casts every few days for the first 1-2 weeks and then every 1-2 weeks after that) Surgery is usually required for older children

What usually causes delayed postpartum hemorrhage?

Retained placental fragments

Decerebrate posturing (toes point down and amrs/legs straight out) is a sign of

Severe brain damages

Protective factors for SIDS

Sleep supine [infants must sleep on their backs] Breastfeeding Pacifier during sleep Up to date vaccines Appropriate clothing like sleep sack Firm mattress Remove loose items from bed like pillows toys blankets [choke hazards] Do not let them sleep in parent room

Remember the SIRS continuum

Starts with inflammatory response [this includes fever, tachycardia, tachypnea] Then when an infectious source is identified, this is considered SEPSIS When the patient remains hypotensive despite 2 liters of fluids being given, this is called septic shock SHOCK + 2 or more organ systems damaged is called multi organ damage syndrome [MODS]

When you have medication-induced Cushing syndrome, what is causing this

Steroids! they need to be tapered off! Never stop them automatically even when you are having a bad reaction because you can die from acute adrenal insufficiency

Positive orthostatic vital signs are present when

Systolic BP DROPS by at least 20 OR Diastolic BP DROPS by at least 10 Pulses usually RISES about 20

what does TORCH stand for?

T: toxoplasmosis O: other like parvo- b 19 + varicella zoster R: rubella C: cytomeglovirus H: herpes

Cystic fibrosis

THICK MUCUS, lungs become clogged with mucus The mucus eventually harbors bacteria and they have recurrent respiratory infections Chest physiotherapy is used

Hypocalcemia is a potential complication of

THYROIDECTOMY The parathyroid glands that regulate calcium are sometimes removed accidentally during thyroidectomy because they are so small WATCH patient for signs of hypocalcemia like POSITIVE trousseau and Chvostek signs Give calcium gluconate to increase serum calcium

Correct way to cough and deep breathe

Take 3 deep breaths, hold your incision, and cough

Position for a patient with a continuous bladder irrigation [CBI]

The catheter is taped to the patients leg so the leg should be kept straight, but there are no other positioning limitations

Sleep apnea syndrome

The client snores loudly, stops breathing for 10 seconds or more and then awakens abruptly with a loud snort (multiple times throughout the night) Often in older, overweight men, elderly, and people with thick necks, smokers

Encourage patients with PTSD to talk about

The experience and discuss the trauma at their own pace The point is to be able to talk about it without experiencing high levels of anxiety Help them decide what causes triggers and identify how they cope

What is strabismus

The eyes do not function as a unit because there is an imbalance of extra ocular muscles

How do we diagnose Menieres disease

Weber and Rinne test C.T scan

Poor thiamine consumption can lead to

Wernicke encepalopathy

Insulin with a fetus right after birth

The fetus produces insulin to match the mother during pregnancy (which is high). When the baby comes out, it is still producing a lot of insulin which can cause HYPOglycemia Must MONITOR for hypoglycemia

What can thiamine deficiency lead to?

Wernicke encephalopathy

What can inadequate thiamine lead to?

Wernicke encephalopathy S&S: Altered mental status Oculomotor dysfunction Ataxia [loss of coordination] Seizures

When are we going to administer an anti anxiety

When a client is restless and has an increased heart rate

What is abruptio placentae

The premature separation of the placenta which leads to hemorrhage. •Biggest concern is fluid volume deficit related to bleeding

What is the Somogyi effect?

When blood glucose levels drop too low in the middle of the night, the body tries to compensate by rebounding into hyperglycemia, so you think you are high blood sugars in the morning when it is all just a FACADE!

Tobramycin

Therapeutic Level: 5-10 mcg/mL Toxic Level: >12 mcg/mL

What are mongolian spots and are they normal?

They are bluish discoloration of the skin on newborns seen on darker skinned newborns on the back or butt They usually fade over 1-2 yrs of life Nurse should measure and document because they look like bruises They are normal

When undergoing a transplant, what do we need to remind visitors of

They cannot be in the room for the first 72 hours

What is the primary problem for a client diagnosed with schizophrenia

They have difficulty forming relationships

What do we need to remember about potassium and people on "-pril" meds

They want low potassium! No bananas, no salt substitutes, etc ACE inhibitors + ARBs INCREASE POTASSIUM levels when combined with other meds that do the same. Risk for HYPERkalemia

Signs of developmental dysplasia of the hip?

Thigh folds Laxity of the hip joint

Autonomic dysrefexia [hyperreflexia]

Throbbing headache from uncontrolled hypertension Nausea Blurred vision Sweating and skin flushing above level of injury

What are the contraindications for giving tPA?

Thrombocytopenia Coagulation disorders Major surgery within the last 14 days

S&S of a preschooler who overdosed on aspirin

Tinnitus and gastric distress

What do we need to teach the client about Menineres disease

To slow down their body movements as jerking or sudden movements can cause an attack Need to lie down when an attack occurs If driving, pull over and stop the car

Side effects of albuterol and other beta 2 agonists

Tremor Tachycardia Palpitations Restlessness Hypokalemia

How can pregnant women avoid heartburn?

Upright position after meals Small frequent meals Keep HOB elevated Drink smaller amounts of fluid while eating Eliminate dietary trigger like cffeien, chocolate, fried/fatty foods, spciy foods , peppermint Do not take Alka seltzer while pregnant

IVPB Potassium Chloride [KCl] route & method

Use: treatment of hypokalemia Infusion rate: should not exceed 10 mEq/hr Give via infusion pump

Positive Pressure Ventilation (PPV)

Used most commonly in acute respiratory failure causes increased intrathoracic pressure: leads to reduced venous return, ventricular preload and cardiac output, which results in hypotension-effect is greater in presence of hypovolemia [such as hemorrhage, hypovolemic shock] and decreased venous tone [such as septic shock, neurogenic shock]

Stress incontinence teaching

Void every 2 hours while awake Void every 4 hours at night Perform kegel exercise to strengthen pelvic floor muscles

When can we give TPA [Thrombolytics] in an M.I

Within 6 hours

What must be done after ng tube placement?

X-ray to confirm location

If you are having a bad reaction to a DtAP vaccine, when will you see the side effects

You will see a low-grade fever and it will be about 48 hours after the injection

Clamping a chest tube should NOT happen for longer than

a minute and only if perscribed by the HCP

Always suction pharynx [throat] first in

a newborn

Goal to reduce ICP is to

reduce metabolic demands

What is sodium polystyrene sulfonate?

reduces potassium levels

Gallstone surgery may have

referred pain

After thyroidectomy watch out for what

respirtory distress from neck compressing [due to swelling from edema at the surgical site]

What is akathisia?

restlessness with inability to sit still

Diet for chronic kidney disease

restrict fluids, sodium, potassium, and phosphorus

Low residue diet may be used for

acute diverticulitis but high fiber for future episodes

Wheezing indicates what in a respiratory issue?

an obstructive process like -Asthma -COPD [emphysema + chronic bronchitis]

Late signs of digoxin toxicity

arrhythmias

What is significant about Guillain Barr Syndrome GBS?

ascending symmetricl paralysis

Reaction formation

behaving in a manner or expressing a feeling opposite of ones true feelings

With a balloon tamponade tube, what should always be kept at the bedside?

scissors

Ultra sound is done around 36 weeks to

see location of placenta

In acute pericarditis, an ST elevtion is

seen in almost all leads

People with narcissistic personality disorder try to maintain what?

self esteem

Septic shock

sepsis induced HYPOtension despite adequate fluid resuscitation

Patient with chronic venous insufficiency should not

clip their own toenails

What are wheezes?

continuous, high pitched musical adventitious sounds caused by air movement through narrow bronchi and bronchioles

What is the Allen's test?

determines patency of the ulnar artery •Patient makes a fist and radial and ulnar arteries are occluded •Patient opens fist and pallor is shown on hand from non-blood flow •Nurse releases pressure on arteries and blood flow is returned to hand •Allens test should be positive and if negative, another artery should be used

Antihypertensives are held the morning before

dialysis [this is because dialysis causes HYPOtension]

Take pulse and withold which med if less than 60?

digoxin

How to give morphine I.V push

dilute and give slowly over 3-5 mins

What does nonmaleficience mean?

do no harm

What can cause pseudohyperkalemia?

hemolysis or clotting during the blood draw

Acute angle closure glaucoma requires

immediate medical intervention!

Ptosis means injury to what nerve

oculomotor nerve [cranial nerve III]

What is fremitus?

palpable vibration on the chest wall when talking

Tochanter rolls

prevent legs from turing outwards

what does excess salt cause?

retention of water

Morphine is typically used for what type of pain?

severe

Delirium tremors

severe alcohol withdrawal symptoms like -Shaking -Confusion -Hallucinations

When is atropine given?

severe bradycardia it will speed up heart rate!

Albuterol

short acting and immediate bronchodilation

Vitamin K would lower INR why

the more clotting factors, the faster it would take the blood to clot so the lower the INR

What is countertransferrence?

the nurse unknowingly displaces feelings and behaviors in the nurses past onto the client

PCA pumps have a running I.V line attached to deliver a flush each time a dose of the pca is delivered, this is to make sure

the patient gets all of the pain med and thus has adequate pain control

Position for a detatched retina

•Area of detachment should be in the dependent position

Trust vs. Mistrust

0-1 yr Teach parents to meet infant's physical and social needs

Dystonia

*abnormal muscle movements* of the *face, neck, and trunk* caused by *sustained muscular contractions* (eg *torticollis, oculogyric crisis, opisthotonos*)

Why is a post op C section patient at high risk for pulmonary embolism?

-Abdominal C section -Engorged BVS from hypercoagubility of blood and venous stasis from being in the operating table -Immobility due to surgery [C-section is a major surgery] -Postpartum hypercoagubility state because the body makes a lot more blood to prepare for blood loss during birth

What is an amniotomy?

-Artificial rupture of the membranes (AROM) -Induces labor -Watch for cord prolapse -Assess fetal heart rate -Assess characteristics of amniotic fluid -Once membranes ruptured this increases the risk for infection -Check patients temp every 2 hours after rupturing -Assist client to an upright position after the procedure

If patient has a chest tube and all of the sudden the dainage stops, what are some interventions?

-Assess lung sounds [because it could be that the lungs have re-expanded which is amazing news and there is no more drainage) -Reposition patient [could be occluded from draining by patient/remember good lung UP and bad lung DOWN to drain OUT] -Get them to cough and deep breathe

Causes of hyponatremia in infants

-Can result from *water intoxication* when formula is diluted to "stretch feeding" -Can also result from *ingestion of plain water*

Immediate client care for basilar skull fracture

-Cervical spine immobilization -Close neurologic monitoring -Support of ABCs

What are some indicators that a child is ready for toilet training?

-Child can express the need to pee or poo -Can understand commands, communicate, and follow directions -Can pull up and down clothing [but not necessarily dressed and undressed themselves] -Walk to and sit on toilet for about 5 to 8 mins without crying or gettting up -Remain dry for several hours through a nap

Examples of cost-effective care

-Considering inside of sterile glove wrapper as a small sterile field -Donning clean, rather than sterile gloves to remove client's dressing

Sleep apnea interventions

-Continuous positive airway pressure [CPAP] device at night -Limiting alcohol intake at bedtime -Weight loss and exercise -Avoiding sedating medications [examples: benzodiazepines, sedating antidepressants, antihistamines, opiates]

Care of anorexic patient

-Determine pt daily calorie requirement -Monitor weight at same time every day with same scale, same amount of clothes on -Limit exercise initially bc they are obsessed -Reflecting with the patient on triggers -Do not encourage a log of food because this contributes to patient's obsession with food

Sjogren's Syndrome symptoms

-Dry eyes [xerophthalmia] can lead to corneal ulcerations -Dry mouth [xerostomia] can lead to dental caries and oral thrush -Dry skin & rashes -Chronic dry cough -Vaginal dryness & painful intercourse

Nursing care for NG tube feeding

-Elevate head of bed [HOB] during and after -Check gastric residual every 4 hours with continuous feeding or BEFORE each intermittent feeding/medication giving -Flush tube before and after bolus feedings -Aspirate but return contents to stomach -Check for excessive residual volume [if more than 100 mL notify doctor, hold feeding] -Start feeding after getting residual volume less than 100 ml -Gastric ph should be acidic or less than 5

Barium enema post op teaching

-Expect chalky white stool (this is the contrast) -Take a laxative MIlk of Magnesia to expel stool -Drink plenty of fluids and eat high fiber foods

Sjogren's syndrome Treatment & Patient Education

-Eye drops -Wearing goggles -Sugar free gum and/or artificial saliva -Regular dental appointments for dental caries -lubricants [such as KY Jelly] -Sip of water frequently -Use lukewarm water and mild soap when showering -Humidifiers to maintain adequate humidity [mainly at night]

Earlier stage Alzheimer's disease eating problems

-Forgetting that meal was consumed due to short-term memory loss -Anorexia & weight loss secondary to depression &/or recognition of disease

Middle stage Alzheimer's disease - eating problems

-Forgetting to eat at all -Not recognizing sensations* of hunger or thirst -Forgetting how to use utensils -Consuming nonfood items -Refusing to eat -Restlessness: inability to sit long enough to consume a meal

How does the nurse prevent refeeding syndrome?

-Get baseline electrolytes -By Initiating nutrition support cautiously with hypo caloric feedings -Closely monitor electrolytes -By increasing caloric intake gradually

Postpartum psychosis - risk factors

-History bipolar disorder -Previous discontinuation of mood-stabilizing medications [such as lithium]

Umbilical cord care after birth

-Keep it clean and let it dry to open air [do not put dipare over it] -Do not put alcohol on it, just soap + water to clean -Report signs of infection such as REDNESS SWELLING PUS coming from the umbilical cord [but remember the normal yellow crust that should form] The cord is cut after birth and a little remains there The cord will shrivel and turn black in a few days and will fall off by itself in a 1 to 2 weeks Teach parents and caregivers to NOT mess with it or pull it off

Strategies to prevent accidental drug overdoses in children

-Keep medications out of sight in a locked drawer or cabinet -Put them away after each use

Peripheral Arterial Disease [PAD] Home Management Instructions

-Lower extremities below heart when sitting and lying down [DANGLE for Peripheral Arterial disease] -Engage in moderate exercise [for example 30 to 45 minute walk, twice daily) -Perform daily skin care, including application of lotion to prevents skin breakdown from dry skin -Maintain mild warmth [lightweight blankets, socks) but never use heating pads -STOP SMOKING! -AVOID tight clothes and stress - Take prescribed medications [such vasodilators + antiplatelets]

Steps for putting in an NG tube

-Measure, mark, and lube -Tell client to extend neck back -Insert tube just passed nasopharynx -Tell client to flex neck forward and swallow -Advance tube to the marked point -Verify placement of tube [X-ray] and anchor to nose

COPD exacerbation nursing monitoring

-Most important for nurse to monitor mental status frequently and report changes [like restlessness, decreased LOC, somnolence, difficult arousal, confusion] to HCP because this may indicate increased CO2 retention & worsening hypercapnia -Altered mental status poses greatest threat to survival of a COPD patient because it can lead to •Decreased protective reflexes [like gag, swallow, cough reflexes] •Periods of apnea •Airway compromise

Hypercalcemia [Low calcium causes everything to run slow] signs and symptoms

-Muscular weakness -CONSTIPATION -DEPRESSED deep tendon reflexes [DTR] -Anorexia -Nausea/vomiting -Polyuria [excessive urination] + Polydipsia [extreme thirst] -Dehydration -Flank pain [kidney involvement due to stone] -Calcium stones -Deep bone pain [pathological fractures] -Hypertension When you think hypercalcemia, think hyper-parathyroidism

ECT patient teaching

-NPO for 6 to 8 hrs before procedure -Anesthesia and muscle relaxant given before; patient will be unconscious during procedure -No driving after procedure -There will be temporary memory loss and confusion in immediate recovery period -Discontinue anticonvulsants because the treatment induces a seizure

Airborne precautions diseases & equipment

-Negative pressure isolation room Disease acronym [airing MTV]: - Measels - TB - Varicella zoster (chicken pox) infections

Signs & Symptoms of hypernatremia in infants

-Neurological symptoms [restlessness, seizures] -On history indicates adequate oral intake & signs of fluid overload [facial edema] not dehydration

Long term corticosteroid treatment

-Never abruptly discontinue; this could lead to addisonian crisis -Report any signs of infection immediately because this usually can cause immunosuppression and can even mask signs of infection -Watch for signs of HYPERglycemia -Cataracts is a SIDE EFFECT [eye checkups every year are recommended] -Never take on an empty stomach

Patient teaching for IBS

-No gas producing foods [such as bananas cabbage onions] caffeine, alcohol, honey, high fructose corn syrup, and other G.I disturbing foods like spices, hot food/drink, dairy, fatty foods -Gradually increase fiber intake -Generally tolerated well are protein, bread, and bland food

Pertussis management & treatment

-Oral antibiotics -Droplet precautions -Supportive measures [humidified oxygenation and oral fluids]

Patient care for acute manic episode

-Reduce environment stimuli -Calm quiet low lit -Limiting person contact -ONE on ONE- not group activities -Structured scheudle of activities to keep focus -Physical activities one on one to relieve energy -High protein high calorie finger foods -SET LIMITS

Pursed lip breathing instruction

-Regular practice [for example 5-10 min 4 times a day] 1. Relax neck & shoulders 2. Inhale 2 seconds through nose while mouth closed 3. Exhale 4 seconds [or twice as long as inhalation] through pursed lips

diverticular disease dviverticulitis

-Sac like protrusions off the large intestine [colon] asymptomatic usually and patient is not aware until this pouch becomes infected or inflammed which is then called diverticulitis -What can the patient do? Prevent constipation which may cause diverticula to become inflamed -High fiber diet -Daily intake 8 glasses water -Daily exercise -DECREASE red meats and foods high in fat BEFORE diverticulitis INCREASE FIBER + fluids but once diverticulitis is present patient needs to be on a low residue diet

Acute pericarditis assessment

-Sharp pleuritic chest pain -Aggravated on inspiration and coughing -Assessment shows pericardial friction rub

What can lead to recurrent otitis media?

-Smoking around child -Regular pacifier use -Drinking from a bottle while lying down -Lack of immunizations

Some facts about cystic fibrosis

-Sticky thick respiratory secretions -Chronic cough -At risk for recurrent lung infections -Reduced pulse ox but 90% requires immediate intervention -Can cough up blood sputum [hemoptysis] -Lose weight -Fecal retention/impaction

When is using an indwelling catheter appropriate?

-Urinary obstruction or retention -The need of strict I/Os in crtically ill patients -Peri op [during surgery] like urologic procedures, prolonged surgeries, or when I.V fluids or diuertics are given during surgery -Prolonged immobilization when bed rest is necessary -To improve end of life comfort -To promote healing of an open perineal or sacral wound in incontinent patients

Bilevel positive airway pressure [BIPAP] device

-Used in conscious client who is breathing spontaneously -Delivers oxygen to lungs and removes CO2

Criteria for diagnosis of IBS

-recurrent abdominal pain + discomfort 3 or more days a month for 3 months At least 2 of these -improvement with bowel movement, change in frequency of stool, or change in form of stool

Neonatal heel stick

-used to collect a blood sample to assess capillary glucose and perform newborn screening for inherited disorders [for example: congenital hypothyroidism + phenylketonuria]

Children under what age should not be given honey?

1 year

When does the Babinski reflex disappear

1 year

Clinical Manifestations of Right-to-Left congenital heart defects

1. Clubbing of fingertips associated with chronic hypoxia 2. Cyanosis evident shortly after birth and during periods of physical exertion [bluish skin color]

Expected number of stools per day in patient on lactulose

2-3 soft stools per day

Hepatitis is diagnosed when liver enzymes are

2-3 times the normal value [elevated ALT + AST]

Short acting [regular] insulin peak

2-5 hrs

Aortic

2nd ICS

Pulmonic

2nd ICS

How to calculate MAP?

2x diastolic + systolic all divided by 3

What number of weeks is considered term?

37 weeks of gestation

Erbs point

3rd ICS

Tricuspid

5th ICS

Mitral AKA apex

5th ICS at midclavicular line

How many diapers for a full term infant

6-8 wet diapers and one stool daily

What is normal MAP

60 or more

Pneumonia vaccine

65 and older need 2 vaccines

How long does an M.R.I ususally last for

90 minutes

Normal O2 Sat for test purposes is

95% to 100% and if under 95% this is hypoxemia

in pregnancy, pts are considered anemic when hemoglobin drops below what?

<11

Mastitis

= postpartum breast infection from clogged milk ducts [poor latch] NOT draining properly -Symptoms: Fever Breast pain Breast inflammation + redness - Treatment: 1. antistaphylococcal antibiotics [dicloxacillin or cephalexin] and analgesics like ibuprofen] 2. Frequent continued breastfeeding [every 2-3 hours] 3. Increase oral fluid intake 4. Wear soft cup bras to encourage milk flow

Refractory hypoxemia

=inability to improve oxygenation with increases in oxygen concentration hallmark of acute respiratory distress syndrome [ARDS]-progressive form of acute respiratory failure that has high mortality rate

What is the blood loss amount to be considered postpartum hemorrhage (PPH)?

>500 ml after vaginal birth >1000 ml after c-section

What is retinopathy of prematurity

A cause of blindness in premature infants because when they are premature, we slam them with O2, but this is much of the cause as to why the retinal vessels constrict; this leads to blindness

Avoid I.M or venipncture when the platelet count is below what?

50,000 cells

Platelets [at least afte chemo] are not considered urgent until below what?

50,000 platelets

What is acute RLQ pain, N/V, and a high WBC count most likely?

APPENDICITIS It's an EMERGENCY surgery because the appendix could rupture If the appendix ruptures, the pain will subside temporarily [until peritonitis + sepsis develops]

Which heart meds cannot be given during pregnancy?

ARBs and ACE inhibitors

Since a client post op is coming off anesthesia, they are at risk for

ASPIRATION due to their altered level of consciousness [LOC] Nausea post op should be a priority

Temporal lobe

AUDITORY input cannot understand visual or written language

What to avoid with Sjögren's syndrome

AVOID -Decongestants can cause further dryness -Oral irritants* (eg coffee, alcohol, nicotine found in cigarettes) -Acidic drinks -Low-humidity environments [such as centrally heated houses, airplanes]

What is glaucoma

Abnormal INCREASE in intraocular pressure leading to visual disabilities and blindness •Cloudy, blurry vision or loss of vision •Artificial lights have rainbows or halos around them •DECREASE in peripheral vision

What scale do we use to detect the presence of tradeoff dyskinesia

Abnormal Involuntary Movement Scale (AIMS)

If someone has a gastric ulcer, when are they going to experience the most pain

About 30 mins to one hours after eating

If you have a cervical cancer radium implant in, how long do you need to abstain from sex and tampons for?

About 6 weeks, whenever your followup with your primary care physician is

Fall risk factors

Above age 60 Previous fall Bowel/bladder incontinence or urinary frequency Sedatives, diuretics, ntihypertensives, CNS drugs unsteady gait Weakness, limited mobility HYPOtension Visual/auditory impairments Dementia Tubes Med equipment SCDs Restraints

What is typically seen in a retinoblastoma?

Absence of red reflex •The pupil reflects a white color

When does a child have an actual concept of death

Age 9

how to calculate the # of teeth a child should have in the first 24 months?

Age of child in months minus 6

Patient with measles precautions

Airborne and negative pressure room N95 respirators

First level priority problems

Airway Breathing Circulation & cardiac [become first priority in cardiac arrest] Vital signs

What is the best lab value to look at for long term nutritional status

Albumin

Contraindication to administering the flu vaccine

Allergy to eggs An allergy to eggs should also be reported before receiving "eggs Make Me Rise Very happy INside" •M,M,R: MMR •V: varicella •IN: influenza

Second level priority problems

Altered mental status Acute pain Untreated medical problems (like hyperglycemia in client with diabetes) Chronic pain Acute elimination problems Abnormal lab results Risk for infection Safety

Aluminum hydrozide

Antacid Take it one hour after meals

What is Amphotericin B?

Anti-fungal med used to treat systemic fungal infections severe adverse reactions like HYPOtension, fever, chills, and nephrotoxicity

What do we do as the nurse for otitis media

Antibiotics (organism specific) Antihistamines for allergies Nasal decongestants Ventilatory tubes [inserted in the eustachian tube for continuous ventilation] Tympanoplasty [reconstruction of the ossicles and tympanic membrane] Myringotomy [incision to tympanic membrane to relieve pressure and release purulent drainage;no water allowed in ear]

What is imipramine

Antidepressant and nerve pain medication Side effects include: -Fever -Dry mouth -Vomiting/diarrhea -Fatigue -Sore throat

Acetaminophen (Tylenol)

Antidote/Reversal: acetylcysteine (Muscomyst) Toxic Level: >250mcg/mL

What meds are we giving to someone with Menieres disease

Antihistamines Anti emetics Antivertigo Diruetics

What volume of chest tube drainage should be reported to HCP

Any thing greater than 100 mL/hr

What do we do for patients with rheumatoid arthritis

Apply heat and do ROM exercises This REDUCES swelling, INCREASES circulation and DECREASES stiffness while preserving joint mobility

Use of aspirin during pregnancy

Aspiring can cause fetal hemorrhage, do not use this during pregnancy [it is contraindicated]

What do we do as the nurse for sleep apnea syndrome

Avoid alcohol and meds that depress the upper airway Talk about weight loss and diet CPAP or BiPAP Surgery Low flow O2 Position [fixing devices are used to prevent subluxation of the neck and tongue obstruction]

In leukemia, bone marrow activity is depressed and so what does this result in

BLOOD CANCER Infection [low WBC] Low RBC production= anemia Decreased making of platelets= bleeding [thrombocytopenia]

Signs of preeclampsia

BP greater than 140/90 Proteinuria greater than 300 mg of protein in urine in 24 hours Headache Visual changes 2+ pitting edema

Beta blockers, calcium channel blockers, and digoxin can all cause

BRADYCARIA [Mnemonic Be a Cautious Detective] WITHHOLD beta blockers, calcium channel blockers or digoxin if heart rate is below -60 for adults -70 for children -90 for infants This is a general rule but check your hospital/nursing policy + procedures

Remember BETA blocker cause

BRADYcardia

Where is gluten found?

BROW [Do not give to celiac patients/gluten free ONLY] •Barley •Rye •Oats •Wheat

How do we diagnose benign prostatic hypertrophy?

BUN and creatinine PSA [Prostate specific antigen][should be less than 4mg per mL] Transabdominal/transrectal ultrasound Prostate biopsy

What labs to check before giving digoxin?

BUN and creatinine because this drug is mostly excreted by the kidney

Which foods may cause a latex-food syndrome in patients with a latex allergy?

Bananas Avocados Tomatoes Kiwi Potatoes Peaches Grapes Apricots

If there is a low potassium level, why do we need to hold the digoxin

Because hypokalemia can lead to dig toxicity •We have to call the HCP and ask for a potassium supplement before giving the dig

Glucose levels during and after pregnancy

Because of hormone levels and a baby in you, glucose rises during pregnancy Glucose will drop after delivery

What do we as nurses do for Pyelonephritis

Bedrest during the acute phase Antibiotic therapy, antiseptics, analgesics Encourage fluid intake of 3000ml per day

Red asthma

Below 500 [medical alert]

pH of gastric contents should be:

Between 1 and 4

When we are admitting a psych patient, what type of admission history do we need to get

Biopsychosocial so we are encompassing all of them, not just a psych approach

When a client with parkinsons is experiencing extrapyramidal side effects, which med should we administer

Biperiden

Signs of complications after a prostatectomy

Bleeding Passing blood clots A decrease in urinary stream Urinary retention Symptoms of a UTI ALL these should al be reported

What do you closely monitor when giving furosemide?

Blood pressure Potassium BUN Creatinine

What is an advantage of having an insulin pump?

Blood sugar does not go way up and way down Sugar level will stay at a more steady rate You still have to test your blood sugar when you have this

Symptoms of hypothyroidism

Bradycardia Dry skin Weight gain

Drugs for stones

Broad spectrum antibiotics Thiazide diuretics Allopurinol Vitamin B6 (pyridoxine)

Aminophylline

Bronchodilator

Terbutaline

Bronchodilator and anti-contraction [tocolytic] Used to stop contractions in preterm labor and delay the process Side effects are •Maternal and fetal tachycardia •Tremors •Nervousness •Headache •Pulmonary edema

What are the 2 signs the nurse does to check for meningitis?

Brudzinski + Kernig

Post extracorpeal shock wave lithotripsy for kidney stones instructions

Bruising on back or abdomen is normal Increase fluid to flush out fragments Ambulate to remove fragments Blood in urine is normal

Examples of proton pump inhibitors (PPIs)

"prazoles" omeprazole, lansoprazole, pantoprazole

Fifth disease

"slapped face" Distinct red rash on cheeks It's on communicable before the onset of symptoms Spreads via respiratory

Parkland formula for burns

% BSA x weight (kg) x 4 Give half calculated volume of fluid in FIRST 8 hours Give the remaining half of the volume calculated the LAST 16 hours

Factors contributing to female infertility

1. Hormonal dysfunction [PCOS] with anovulatory cycles 2. High or low BMI [normal: 18.5-24.9 kg/m2] 3. Maternal age >35 4. Endometriosis 5. Recurrent infections [chlamydia + PID]

Signs of depression in adolescents

1. Hypersomnolence [always sleeping] or insomnia; napping during daily activities 2. Low self-esteem; withdrawal from previously enjoyable activities 3. Outbursts or angry, aggressive, or delinquent behavior (eg vandalism, absenteeism) inappropriate sexual behavior 4. Weight gain or loss; increased food intake or lack of interest in eating

First trimester in weeks

1-12 weeks

Onset of Isophane [NPH]

1-2 hr

Drugs contraindicated in patients with HYPERkalemia

1. ACE inhibitors [-prils] 2. Angiotension 2 (ARBs)[-sartan] 3. Potassium-sparing diuretics

UAP scope of practice

1. ADLs 2. Hygiene 3. Linen change 4. Routine, stable vital signs 5. Documenting input/output 6. Positioning

Diet of a premature infant

100-200 kcal/kg/day Need more sodium, calcium, and protein than full term infants Supplements: Vitamin A, C, D, and iron. Sometimes Vitamin E Vitamin K to prevent clotting problems

Risk factors for cervical cancer

1. Infection with high-risk HPV strains 2. History of sexually transmitted diseases 3. Early onset of sexual activity 4. Multiple or high-risk sexual partners 5. Immunosuppression 6. Oral contraceptive use 7. Low SES 8. Tobacco use

Steps for suctioning an endotracheal tube (ETT)

1. Perform hand hygiene and don clean gloves 2. Suction oropharynx and perform oral care 3. Ensure that the system is connected to appropriate wall suction [less than 120 mm Hg] 4. Hyperoxygenate the lungs [100% FiO2] 5. Advance catheter into trachea until resistance is met. Do not suction while advancing the catheter 6. Gently remove catheter while suctioning and rotating it. Do not suction for more than 10 seconds 7. Evaluate client tolerance; if further secretions remain, suctioning can be repeated 1 or 2 times Document procedure when complete 8. Resume oxygenation and ventilation settings as prescribed

Infant formula teaching

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

Safety promotion for client with moderate Alzheimer's disease

1. Keyed deadbolts and close supervision 2. Medical identification/location devices 3. Decreased water heater temperature and "hot" and "cold" labels on faucets to prevent burns 4. Household hazards [gas applicanes, rugs, toxic chemicals] are removed to prevent injury 5. Grab bars installed in showers and tubs

LPN scope of practice

1. Monitoring RN findings 2. Reinforcing education 3. Routine procedures [like catheterization, med administration expect med that goes through vein] 4. Most med administration 5. Ostomy care 6. Tube patency and enteral feeding [NG, GT] 7. Specific assessments [like lung, bowel, neuro-vascular checks]

What is monitored carefully after an abdominal aortic aneurysm (AAA) repair?

1. PULSES [examples: femoral, posterior tibial, dorsalis pedis] SKIN COLOR and TEMPERATURE of lower extremities 2. Renal status so things like BUN, CREATININE,* and urinary output [any less than 30 mL per hour is bad] reason for checking kidney is that blood is temporarily cut off the kidney to repair the AAA. So monitoring the kidney is essential

Things that UAP are allowed to do

1. Passive/active ROM exercises 2. Transport body to the morgue 3. Pick up something from pharmacy 4. Measurement of vital signs 5. Fingerstick glucose testing 6. Personal hygiene & skin care 7. Oral care 8. Measurement of urine output

Steps for preparing sterile field for a wet-to-damp dressing change

1. Perform hand hygiene 2. Open a sterile gauze package that has a partially sealed edge with ungloved hands by grasping both sides of the edge, one with each hand, and pull them apart while being careful not to contaminate the gauze 3. Hold the inverted opened gauze package 6 inches (15cm) above waterproof sterile field so it does not touch the field, and then drop the gauze dressing onto sterile field 4.Place the sterile dressings on the sterile field 2 inches (5 cm) from the edge*; the 1 inch (1.25cm) margin at each edge is considered unsterile because it is in contact with unsterile surfaces 5. Use sterile normal saline from a recapped bottle that was opened less than 24 hours ago

SBAR Communication Framekwork Components

1. S = Situation - what prompted the communication [what changes occurred] 2. B = Background - pertinent information, relevant history, vital signs 3. A = Assessment - nurse's assessment of the situation [when* & *what changes occurred] 4. R = Recommendation - request for prescription or action from HCP

Neonatal heel stick proper technique

1. Select location on the medial or lateral side of the outer aspect of the heel 2. Warm the heel for several minutes with warm towel compress or approved single-use instant heat pack 3. cleanse intended puncture site with alcohol 4. Sucrose + nonnutritive sucking on a pacifier may reduce pain 5. Use an automatic lancet

Acute hemolytic transfusion reaction - Nursing Interventions

1. Stop transfusion immediately and disconnect tubing at catheter hub 2. Maintain IV access with normal saline using new tubing to prevent HYPOtension & vascular collapse 3. Notify HCP & blood bank 4. Monitor vital signs 5. Recheck labels, numbers and client's blood type 6. Treat symptoms according to HCP's prescription 7. Collect blood and urine samples to evaluate for hemolysis 8. Return blood & tubing set to blood bank for additional testing 9. Complete necessary facility paperwork to document reaction

Situations that nurses must legally report

1. Suspected abuse 2.Suspicious deaths - medical examiners has legal authority & obligation to perform an autopsy independent of family wishes when deaths are suspected to be result of crime, trauma, or suicide 3. Impaired or intoxicated health care professionals regardless of their position

Clinical Manifestations of left-to-right cardiac shunts

1. Tachypnea [hyperventilation] 2. Tachycardia, even at rest [fast heart rate] 3. Diaphoresis [sweating] during feeding or exertion 4. Heart murmur or extra heart sounds [S3] 5. Signs of congestive heart failure 6. Increased metabolic rate with poor weight gain

Objective [probable] signs of pregnancy

1. Uterine/cervical changes -Goodell sign -Chadwick sign -Hegar sign -Uterine enlargement 2. Braxton hicks contractions 3. Ballottement 4. Fetal outline palpation 5. Uterine & funic souffle 6. Skin pigmentation changes -Chloasma -Linea nigra -Areola darkening 7. Striae gravidarum 8. Positive pregnancy tests

Written consents - Nurse's Role

1. Witness that consent was signed voluntarily 2. That patient was competent at time of signing 3. Documenting in medical records after signature obtained with date/time of signature

What medications interact with grapefruit?

1. calcium channel blockers [diltiazem, nifedipine, verapamil] 2. statins [anti-cholesterol meds] 3. SSRIs [antidepressants]

Conditions of being ineligible to leave AMA

1. danger to self or others 2. lack of consciousness 3. Altered consciousness 4. Mental illness 5. Being under chemical influence 6. Court decision

With CO poisoning, what should be the nurses primary action?

100% oxygen at 15ml via non-rebreather mask

Therapeutic PTT

1.5-2 times normal reference of 25-35 seconds so if on heparin expected normal is about 37 to 70 seconds

How many cm is the complete dilation to birth?

10 cm

Normal vancomycin level

10 to 20

Onset of Glulisine

10-15 mins

Dumping syndrome

10-30 mins after eating you get diarrhea and rapid gastric emptying Patient should lay down after eating to delay gastric emptying time, Patient should NOT drink 1 hour before, during, or 2 hours after meals [similar to the antacid rule do not drink fluids 1 hour before or 2 hours after meals] Patient should eat smaller meals more frequently

Med of choice for supraventricular tachycardia [SVT]

Adenosine

What is the priority for a patient with sickle cell crisis

Adequate hydration

A chest tube and catheter should both be placed

below chest and bladder

What does the posterior fontanel close?

2 months

Heparin and warfarin are given simultaneously until the INR reaches

2 to 3, and then the heparin can be discontinued and warfarin continued

Heparin has a short duration like

2 to 6 hours so if it is not being infused, the aPTT level will go back to the control value So check for infiltration [med going into tissue instead of into vein] if the lab studies show aPTT at the control value despite heparin administration

Normal range for wet diapers first 48 hours of life

2 to 6 wet diapers every 24 hours

What is the normal force of the pulse on the scale

2+

What number is the normal, expected deep tendon reflex?

2+

When does the grasp reflex disappear

3 months for palmar 8 months for plantar

What are the criteria for Metabolic syndrome?

3 or more of the following: Increased waist circumference High blood pressure 130/85 Triglyceride level over 150 HDL below 40 or 50 Fasting glucose levels above 100 mnemonic: We Better Think High Glucose

Normal weight gain in an infant from age 6 to 12 months

3 to 5 oz a week

Glasgow coma scale ranges from

3-15; 3 being worst 15 being best condition [8 or below in a coma]

Onset of Glargine [Lantus]

3-4 hr

When does the Moro reflex disappear

3-4 months

When does the Tonic Neck reflex disappear

3-4 months

Duration of Aspart

3-5 hours

Duration of Glulisine

3-5 hours

Duration of Lispro

3-6 hours

Measure NG tube

From nose tip, to earlobe, down to the xiphoid process

Normal albumin level

3.5 to 5.0;function of albumin keeps fluid from leaking out of vessels; low albumin causes pitting edema + ascites

Normal respiratory rate for a neonate?

30 to 60 breaths per minute

Normal newborn respiratory rate

30-60 glucose levels are normally decreased 1 hour after birth

Onset of Regular

30-60 min

Rapid acting insulin peak [aspart, lispro, glulisine]

30mins-3 hours

Normal newborn head circumference

32 to 37 cm

Average head circumference of a newborn

32-36 cm

Tetraology of fallot is the one with

4 issues It is cyanotic There is tet spell where kids will squat down to breathe better Clubbing of fingers + irritabilty expected

How to calculate the parkland formula

4 mL lactated ringers x surface areas that was burned % x weight in kg then divide by 2 because patient should receive the FIRST half of fluid volume in the FIRST 8 hours the other half of the volume calculated is given in the LAST 16 hours [making a total of a 24 hour of fluid resuscitation in a burned patient]

Introduction of solid food usually happens at how many months?

4 to 6 months of age

What are the key signs of refeeding syndrome?

PPM rapid decline in phosphorus, potasium, magnesium Fluid overload

Gout

A high level of uric acid that leads to joint deterioration Put on a low purine diet [no fish or organ meats] You do not need rest and activity and exercise like you do in RA and osteoarthritis, you just need to manage the pain

What is an ewald tube

A large orogastric tube that is designed for rapid lavage and often causes gagging and vomiting Always have suction equpiment at the bedside

What is aluminum hydroxide gel

A medication to prevent epigastric pain. Take it one hour after a meal to neutralize stomach acids Contains sodium so check if the patient is on a restricted sodium diet!

Pseudoparkinsonism

A medication-induced temporary constellation of symptoms associated with Parkinson's disease, signs of -Masklike face -Shuffling gait -Rigidity -Resting tremor -Psychomotor retardation [bradykinesia]

Describe an electromyography

A noninvasive procedure that takes about 30 minutes. Electrodes are attached to the legs and impulse transmission is measured

What is a flourescin angiography

A series of photographs taken that show details of the circulation of the eye The clients eyes are dilated with mydriatic eyedrops [dilatory drops] before the exam and patient has to protect their eyes from the sun AFTER the exam

If an african american needs a blood pressure med, which are we likely to prescribe

A thiazide diuretic NOT a beta blocker or an ACE inhibitor (pril)

Anti diuretic hormone

ADH is a hormone made by the hypothalamus in the brain and stored in the posterior pituitary gland. It tells your kidneys how much water to conserve. ADH constantly regulates and balances the amount of water in your blood.

offer 2 choices with

ADHD

if patient is in respiratory distress what do you assess first?

AIRWAY

Heparin is measured thru what levels?

PTT

Warning signs of cancer

CAUTION

Cystic fibrosis

CF is genetic bronchodilators before chest physiotherapy- to remove secretions that cause ineffective airway clearance Diet high in fat calories, proteins + high fluids Pancreatic enzyme supplements with all meals and snacks Recurrent respiratory infections

About eczema

CHRONIC skin disroder with Prurititis Erythema Skin dryness -Goal: DO NOT SCRATCH [this leads to more infections] -Alleviate the itching and keep skin hydrated -Moisturize, Keep nails short Patient with eczema should NOT wear wool or rough fabrics, gloves or cotton stockings over the hands

First test to show evidence of an MI

CK MB (appears in 3-6 hours) Then Troponin (appears in 4-12 hours)

What happens when carbon monoxide enters the body relating to hemoglobin?

CO displaces oxygen from HGB causing hypoxia that is NOT REFLECTED BY A PULSE OXIMETER the pulse oximeter can not differentiate between carbo-hemoglobin and oxy-hemoglobin SO, their pulse oximeter may relfect normal findings, yet severe hypoxia may be present

Autonomic dysreflexia

COMMON in people wwith spinal injuries T6 or higher It causes: -Severe hypertension -Throbbing headache -Sweating above level of injury -Bradycardia -Goose bumps -Flushing

What is exopthalmos?

COMPLICATION of hyperthyroidism from Graves disease Keep eyes moist and protected

Treatment for ventricular fibrillation [V fib]

CPR

how to treat asystole?

CPR Initiate advanced cardiac life support Give epinephrine and/or vasopressin Place an airway

What does a DNR exactly mean to withhold?

CPR + other lifesaving measures

If 20 to 40 of KCL are needed to be given, use a

CVAD rather than a peripheral vein

RIGHT-to-LEFT congenital heart defects

CYANOTIC defects or decreased pulmonary circulation 1. Tetralogy of Fallot 2. Transposition of the Great Vessels

Difference between Enteral nutrition and Parenteral nutrition

Enteral goes to the stomach via G-tube or something Parenteral goes through the vein straight into the cells

How often do we need to rinse and change a bag of continuous tube feeding

Every 4 hours to minimize the growth of organisms

Cardiac cath position

Femoral approach Bed rest 4 to 6 hrs Client can turn from side to side Keep extremity straight Head of bed is no higher than 30 degree

PTSD characteristics in people

Flashbacks of the traumatic event Persistent angry, fearful mood Difficulty concentrating Feeling detached from others

What do we do as the nurse during the diuretic phase

Fluids need to be replaced Diet adjustment [high carb, restrict protein, potassium and sodium] Replace potassium Dialysis (hemodialysis or peritoneal)

What is the antidote used for benzodiazepams?

Flumazenil (Romazicon)

What is a tilt table and what is it used for

For weight bearing on long bones to prevent de-calcification and bone weakess Use elastic stockings to prevent postural hypotension Board can gradually be tilted in 5-10 degree increments BP needs to be checked during procedure

Majority of cases of Epiglottitis are caused by what?

HiB [Haemophilus inflanzae type B] •most cases are prevented by standard vaccinations

Diet for someone with glomerulonephritis

High calorie, low Protein

How to fix acute renal failure [ARF] immediately?

High concentrations of O2

Body positioning for paracentesis

High fowlers

When a baby has increased ICP, what S&S will they display?

High pitched cry

How to use a cane

Hold cane in the OPPOSITE hand of the affected extremity Advance the cane with the affected/hurt extremity Lean on the cane when advancing the good leg

What is the brudzinski sign?

bending of neck causes flexion of knee and hip

What are the 4 categories for triaging?

Immediate [red tag] life threatening injuries with good prognosis once treated [patients have 30 minutes] Delayed [yellow] injuries requiring treatment within hours [patients have 30 minutes to 2 hours] Minimal [green tag] injuries requiring treatment within a few days [walking wounded] Expectant [black tag] extensive injuries, poor prognosis regardless of treatment

What lab value do we need to be aware of prior to a liver biopsy

PTT [prothrombin time/RISK for bleeding]

Time frame for checking pedal pulses when coming back from a cardiac catheterization

PULSES need to be checked immediately •And then every 15 minutes for the FIRST few hours

Hypercapnia

PaCO2 >45 mmHg

Manifestations of OsteoArthritis

Pain exacerbated by weight bearing Crepitus Morning stiffness Decreased joint mobility and range of motion Atrophy of the muscles

Cystoscope

Inserted through urethra to directly visualize bladder wall and urethra. May cause slight burning sensation with voiding for a day or two

Side effects of albuterol

Insomnia N/V Palpitations (from tachycardia) Tremor

Symptomatic bradycardia will present like what?

Pale Cool skin Hypotension [drop in cardiac output due to drop in heart rate] Weakness Confusion Dyspnea Chest pain Syncope

Autonomic dysreflexia can happen in someone with

a spinal cord injury [SCI] at or above T6

What can long term steroid therapy cause

OSTEOPOROSIS + PATHOLOGICAL FRACTURES + muscle wasting

What is topical capsaicin cream (Zostrix)?

OTC analgesic that relived minor pain like osteoarthritis special instrution: wait 30 mins after massaging cream into hands before washing

What to know about an electrical encephalogram [EEG]

Painless test that records electrical activity of the brain Wash hair before test to remove oils RESTRICT tranquilizer meds and stimulants 24-48 hours befit [example of stimulants include coffee, tea, smoking, soda] Instructed to stay awake late the night before so they can sleep through the test Maybe hyperventilate 3-4 times before the exam

gastric lavage "stomach pumped"

Orogastric tube removes toxins and irrigates stomach Rarely performed unless overdose could be lethal and if it can be done within ONE HOUR of the overdose NOT done a lot because of high RISK for aspiration or esophageal/gastric perforation Intubation/suction should always be at bedside elevate HOB or put patient on side Use large bore

Is reactive nonstress test positive or negative?

POSITIVE

Lactated ringers contains what electrolyte?

POTASSIUM

What patients are considered immunosuppressed?

Patient on -Steroids/chemo -HIV positive -New post op -Multiple chronic co morbidities -Splenectomy -Diabetes -Very young/elderly

Catatonic schizophrenia

Patient remians in a fixed stupor and refuses to move about or do adls, remaining mute, bizarre postures -Patient is unable to meet thier basic needs for adequate fluid and food intake and are at risk for dehydration and malnutrition

Which MAOIs are used to treat depression

Pirates who say "arrrrr" take MAOIs when they are depressed Parnate [Tranylcypromine] Nardil [Phenylzine] Marplan [Isocarboxazid] and then Selegeline (Emsam) Or the Depressed pirates too a ship to PANAMA Parnate Nardil Marplan

How to get a client to sit on the side of the bed

Place hands under knees and shoulders of client Have client push elbow into bed, while at the same time the nurse lifts the clients shoulders with one arm and swings the legs around with the other arm

Patients with Alzheimer's (and other forms of dementia) may wander or get lost so its important to take precautions in the home like

Place locks above or below eye level because they lose their peripheral vision Put alarms on doors Disguise the doors Childproof doorknobs You want to take precautions to PREVENT them actually leaving

What to do if you need to use an aed on a child but there are only adult pads available not kids

Place one on front and one on back to "sandwhich" the heart Just make sure they don't touch

How do we properly instill eardrops

Put the affected ear up Pull the ear up and back for an adult [older than 3] Pull the ear down and back for children under 3

If you have carpal tunnel, what exercise do we recommend for you

Put the back of your hands together and bend both wrists at the same time

RACE for FIRES in a hospital

R: rescue any patient in immediate danger and move them to safety A: alarm [sound the alarm] C: confine fire by closing all doors to all rooms E: extinguish fire with extinguisher

During disaster triage, what do red, yellow, green and black mean ?

RED [life threatening] significant impairment to the ABC and patient will likely survive if treated within 30 minutes YELLOW can wait 30 minimum to 2 hours [examples bone piercing through skin] GREEN [walking wounded] can wait more than 2 hours to receive care BLACK [expected to die, do nothing] TRAFFIC LIGHT Mnemonic [Red FIRST, YELLOW second, GREEN third can GO, BLACK broken traffic light say GOOD BYE]

During instillation and dwell time of peritoneal dialysis, what are clients closely monitored [PRIORITY] for?

RESPIRATORY DISTRESS from -infusing too quickly -overfilling the abdomen -fluid entering the thoracic cavity

With injury to T1-T6 what do we most need to worry about

RESPIRATORY function!

AFTER a liver biopsy positioning

RIGHT SIDE [on affected side] lying to put pressure on liver to stop bleeding

S&S of Neuroleptic Malignant Syndrome

Think of S&S You get HOT [hyper-pyrexia] You get STIFF [increased muscle tone] You get sweaty [diaphoresis] BP, Pulse and Resp INCREASE Patient starts to drool!

Why is throwing up green vomit an emergency?

This is indicitaive of bile ad could mean its a bowel obstruction

HYPOmagnesia causes

a prolonged QT interval which leads to torsades de pointes [lethal + shockable AED]

What is the Simian crease and what is it seen in?

a single transverse crease across the entire palm of the hand; seen in down syndrome

What is uterine atony?

a soft boggy poorly contracted uterus and most commonly causes early PPH

Orders and re-evaluation for wrist restraints

Wrist restraints need to be re-evaluated every 4 hours and a new order for a wrist restraint needs to be obtained every 4 hours

Even after the diagnosis of a DVT, is walking suggested?

YES [AMBULATION]

Is aspirin contraindicated in children and why?

YES bc they can get Reye syndrome

Is it okay to instill 30 ml of air into the stomach before aspirating fluid out of an NG tube?

Yes

What is important to tell the patient before a PET scan

You must empty your bladder before this test

What is creatinine clearance

a measure of glomerular function and an indicator for renal disease progression it is a 24 HOUR URINE COLLECTION. •The test must be started again if all urine in the 24 hours period is not collected when the test begins, the first urine is taken and thrown away

What does an absent babinski or weak reflex indicate?

a neurological deficit

Sinus tachycardia has

a normal looking rhythm with a P wave and QRS complex, but it is just really fast

No lasix to what kind of patient

a pneumonia patient with fine crackles because the patient crackles are not from heart failure or edema

The use of radioactive iodine is contraindicated in

a pregnant client ALL females should be tested before

What kind of environment do autistic kids need?

a private calming one with minimal stimulation

Amoxicillan is the standard treatment for

acute otitis media •If symptoms don't mprove within 48-72 hours, the client should return for further assessment basically if antibiotics are not treating the infection, this may mean your body is resistant to the antibiotic and you need a different one in order to treat the infection

What lab is monitored when receiving unfractioned heparin?

aPTT

What does a pulsating mass in peri umbilical area with back pain indicate?

abdominal aneuryism

What is a pleural effusion?

abnomral collection of fluid greater than 15 to 20 mL in the pleural space between parietal and visceral This prevents the lung ffrom expanding fully Results in: -Decreased lung volume -Atelectasis -Ineffective gas exchange

Age when head lag is abnormal finding

abnormal = remaining after age 6 months often associated with cerebral palsy or autism

A client with a normal pre-pregnancy weight should gain a total of

about 25 to 35 during the whole pregnancy

what is the earliest sign of magnesium toxicty

absent or decreased deep tendon reflexes [DTR] (normal 2+) DTR should be assessed during magnesium infusion

Patients with chlamydia should

abstain from sex for one week after starting treatment and partners must be treated

Which patients should Lactated Ringers not be given to?

acute kidney injury [AKI] or chronic kidney disease [Why? because potassium must be excreted properly from the body in order to give LR]

LDL (bad) cholesterol level is ok if

below 100

What foods to think when you see latex allergy

bananas, avocados, tomatoes [BAT]

What are some foods that are high in potassium?

bananas, strawberries, legumes, green leafy veggies, potatoes, carrots, tomatoes, melons, avocados, whole grains, most fish, beef, pork

here is a PICC line inserted into?

basilic or cephalic veins which go into the superior vena cava

In Arab culture, a man is not allowed to

be alone with a woman other than his wife

After an ABK amputation, the residual limb really should not

be elevated but maybe only in the FIRST 24 hrS definitely NOT after 24 hours

If patient has pertussiss infection, family members should

be treated

normal triglycerides

below 150 mg/dL

Why does tension pneumothorax cause hypotension?

because the HEART and GREAT VESSELS are compressed/shifted and cardiac output is reduced it is LIFE THREATENING

Why is V-fib more lethal than V-tach?

becuase there is no pulse with V-fib No pulse calls for immediate CPR and defibrillation [shockable by AED]

Atrial pacemaker spikes before P waves and ventricular pacemaker spikes

before QRS complexes

An atrial pacemaker shows a spike when?

before the P wave

Bronchiolitits

begins with upper respiratory symptoms like rhinorrhea/congestion and then goes to lower respiratory symptoms like tachypnea, cough and weezing

Delirium in older adults causes

behavior changes and confusion that require assessment by the nurse They have acute onset and are usually REVERSIBLE often caused by -Meds -Infection -Hypoxia

Tet spell where they become cyanotic

baby will SQUAT! knee to chest

If a child under 1 years of age is choking, what do you do

back blows and chest thrusts

What temp means hypothermia?

below 95

In a hypothermic patient, make sure to put them on

cardiac monitor and anticipate defibrillation [AED/shocking] because they can easily go into V fib The myocardim becomes cold and PRONE to dysrhythmias

Pericarditis can lead to

cardiac tamponade

X linked recessive

carried by females and affects males

Take slow deep breaths during

catheter insertion, do not hold breath tell patient to hold breath when changing caps or tubing during a CL dressing change to prevent air embolus

what are TORCH infections

cause fetal abnormalities in pregnant women

What is clonus?

cause is neurological; it is rhythmic muscle spasms

Clients with hypertension should NOT take decongestants why?

decongestants can contain a vasoconstrictor and exacerbate hypertension

Be careful giving too much oxytocin why

can lead to -Uterine tachysystole -Decreased placental perfusion -Fetal distress •This is why it is given via an infusion pump so there are no med errors

Why do we monitor intake and output during oxytocin infusion?

can lead to water intoxication

What is troponin

cardiac marker used to detect an MI

Nifedipine (Procardia) is what?

calcium channel blocker antihypertensive don't give if hypotensive

What is nifedipine?

calcium channel blocker antihypertensive. do not give if bp on the lower end range

What drugs is kept at bedside when getting magnesium sulfate to reverse the event of megnesium toxicity?

calcium gluconate 10%

What is given to hyperkalemia patients to stabilize the myocardium?

calcium gluconate 10%

EpiPen delivery

can be delivered through clothing in the out thigh hold for 10 scds so all med goes in then massage the thigh for 10 more scds

What does atropine treat?

can decrease saliva and also used for bradycardia [to increase heart rate]

How often and where is growth hormone replacement given to a child?

daily sub q injections tretment is most successful when it begins early in a child's life, as soon as growth delays are noted; it stops when bone growth finishes or when parents decide

What is the most accurate indicator of fluid loss or gain?

daily weight

Ventricular bigemy must be assessed rapidly because it can lead to what?

deadly arrythmias like v-tach or v-fib

What is presbyopia?

decrease in ability to see objects close up

Autopsies are typically required when?

death by suicide, homicide, accident, or within 24 hours of admission to facility In these cases consent from family is not required when required dont remove any tubes or lines from deceased patient

What are some iron rich foods?

meats- beef, lamb, liver chicken, pork shellfish- oysters, clams, shrimp eggs, green leafy veggies, broccoli, dried fruits, dried beans, brown rice, oatmeal eating foods rich in vitamin c like citrus fruits potatoes and tomatoes and also orange juice can enhance the absorption of iron

Isotretinoin

med for severe acne a HUGE teratogenic!! Derived from vitamin A Do not take extra vitamin A as this could cause TOXICITY -Required to enter risk management plan and also use 2 forms of birth control -Can not give blood while on it because some could still be in blood

Bulging fontanel signifies

meningitis

The herb black cohosh is used for

menopausal hot flashes

The positive babinski is normal in children

under 1 [positive means big toe moves up and other toes fan out]

Characteristics of herpes zoster

unilateral linear pattern of fluid filled blisters patients report pain and itching

How to go up and down stairs with a cane

up with the good, down with the bad Going up: Step up on the good extremity, then place the cane and affected extremity on the step Going down: Step down on the bad extremity with the cane, and follow with the good leg

What does coffee ground emesis indicate?

upper G.I bleeding

Positioning for paracentesis

upright semi or high fowler

Position during a thoracentesis

upright sitting position on side of bed, leaning forward over bedside table, arms on pillows

Nursing precautions when administering peritoneal dialysis

use sterile technique when spiking and attaching bags of dialysate to the PD catheter

Non rebreather

used in EMERGENCIES Delivers high concentrations of oxygen up to 90% to 95%

What is a barium enema aka lower GI series?

uses fluroscopy to visualize the colon outlined by contrast to detect abnormalities like polyps, ulcers, tumors, and diverticula

What is the gower sign?

uses ones hands to rise from sqaut to a chair

As far as for ostomies, any gray or paleness to the area of the stoma is

usually priority because this indicates lack tissue perfusion which can to necrosis of stoma

What antibiotic is used for c.diff?

vancomycin

What is the purpose of norepinephrine?

vasoconstriction and improved contractility/output

I.V hydralazine for hypertensive emergency

vasodilator goal is to slowly drop blood pressure but not too fast

Five Rights of Medication Administration

1. Right Client 2. Right Drug 3. Right Dose 4. Right Route 5. Right Time

Five Rights of Delegation

1. Right Person 2. Right Task 3. Right Circumstance 4. Right Direction and Communication 5. Right Supervision and Evaluation

Urine Specific Gravity

1.01-1.025 High gravity means urine is concentrated Low gravity means urine is dilute

Magnesium (Mg)

1.5-2.5

BUN

10 to 20

Hct [hematocrit]

36% to 50%

Integrity vs. Despair

65+ yrs Encourage use of personal items when not at home

Addison disease vs Cushings disease

Addison's disease: down down down up down [Low Aldosterone] •HYPOnatremia •HYPOtension •Low blood volume •HYPERkalemia •HYPOglycemia Cushing disease: up up up down up [High Aldosterone] •HYPERnatremia •HYPERtension •HIGH blood volume •HYPOkalemia •HYPERglycemia

Iron

Antidote/Reversal: deferoxamine (Desferal)

Curare

Antidote/Reversal: edrophonium (Tensilon)

Ethylene Poisoning

Antidote/Reversal: fomepizole (Antizol)

Cyanide poisoning treatment

Antidote/Reversal: methylene blue

Lead

Antidote/Reversal: succimer (Chemet)

APGAR

Appearance [color all pink =2, pink and blue=1 blue/pale=0] Pulse [>100=2, <100=1] Grimace [cough=2 grimace=1] Activity [flexed=2 flaccid=1 limp=0] Respirations [strong cry=2 weak cry=1 No cry=0]

What position is the patient in AFTER a lumbar puncture (and also oil-based myelogram)

Have the patient flat on his or her back to prevent CSF from leaking out and prevent a headache

TPN Total Parenteral Nutrition

Hypertonic Solution Given via PICC line, tunneled catheter Prepared daily by pharmacy Use Sterile Asepsis for dressing change Check blood glucose every 4-6 hours Change bag every 24 hours

INR

Less than 2 Warfarin Therapeutic Range: 2-3

Cholesterol

Less than 200

Position of a patient after a thyroidectomy

Low or semi-fowlers •Support the head, neck, and shoulders •Have a tracheostomy at the bedside [in case of an emergency]

For what diseases do we use contact precautions

MRS.WEE M:multi drug resistant organism R: Respiratory infection [such as RSV] S: Skin infections [such as varicella, zoster, cutaneous diptheria, herpes simplex, impetigo, pediculosis, scabies] W:wound infection E: Enteric infection [C.diff] E: eye infection [pink eye or conjunctivitis]

For what diseases do we use airborne precautions

My [Measles] Chicken [chicken pox or varicella] Hez [herpes zoster or shingles] TB [TB]

Airborne Precautions

Needed to prevent transmission from particles so small the can float in the air and travel long distances. Examples: chickenpox, measles, Tuberculosis, SARS Minimal PPE: Well fitting mask [N95]!!!! *Use respirator mask for TB and SARS **Negative Pressure room

Position of a patient after a myringotomy

Position the patient on the side of the AFFECTED ear after surgery to allow for drainage of secretions This procedure is surgical incision into the eardrum [tympanic membrane] to relieve pressure or drain fluid

When implementing droplet precautions, what do we have to do

Private room or cohort them with a client with the same infection Wear a mask Door may remain open

When implementing airborne precautions, what do we have to do

Private, negative pressure room Must wear mask Can cohort with patient who has same organism, but not if they have different organisms Place mask on client when they are being transported

Position for a patient with peritoneal dialysis when the outflow is inadequate

Turn the patient from side to side BEFORE checking the tube for kinking

Droplet Precautions

Used to prevent contact with mucus and other secretions from nose, sinuses, throat, airway, and lungs. Use when contact will be within 3 ft or less Examples: infulenza, mumps, pertussis Minimal PPE: Mask

Standard Precautions

When handling blood, bodily fluid, bodily tissue, mucous membranes, open skin PPE: depends on type of exposure (minimal is nothing)

Amitriptyline

antidepressant + nerve pain med Toxic Level: >500 ng/ML

Position of a patient after total hip replacement

•Do not sleep on the operated side •No flexing the hip more than 45-60 degrees •Don't elevate the head of bed (HOB) more than 45 degrees •Keep the hip abducted by separating legs with a pillow or abductor

Position for an ABOVE the knee amputation

•Elevate for the first 24 hours on a pillow •Position prone daily to help with hip extension

Position if the patient has autonomic dysreflexia/hyperreflexia

•Place the client in a sitting position (elevate the HOB to 90) -FIRST before any other implementation Signs &Symptoms include: •Extreme hypertension •Pounding headache •Profuse sweating •Nasal congestion •Goose flesh •Bradycardia

Position of an infant with spina bifida

•Prone [on their belly] •So their sac does NOT rupture