NCLEX Peter Bailey

Paternalism

(n.) the policy or practice of treating or governing people in the manner of a father dealing with his children assuming the right to make decisions for another

RN cannot delegate

(nursing process), teaching, or nursing judgment

Non stress test variable deceleration

cause is umbilical cord compression, and can be relieved by changing position with late decelerations caused by hypotension: elevating a clients legs is acceptable

Hospital acquired pneumonia

caused mainly by pseudomonas aeruginosa, staph aureus, and escherichia coli.

For cold stress/newborn

cold can lead to hypoxia, acidosis, and hypoglycemia: cold dress manifestations include (skin pallor, mottling, cyanotic trunk, and tachypnea) nurse should warm slowly over period of 2-4 hours. Givene o2 for hypoxia,

Newborn hearing screening

completed early after birth required in most states

simple partial seizure

consciousness maintained throughout

When giving alteplase

hold pressure for up to 30 minutes after puncture made.

Hypercortisolism (Cushing's syndrome)

- excess glucocorticoid hormones (cortisol) due to: 1. Exogenous steroids: taken for rheumatoid arthritis, systemic lupus erythematosus, other autoimmune diseases 2. Adrenal hyperplasia or neoplasia 3. Hypersecretion of ACTH by pituitary adenoma i.e. Cushing's Disease 4. Ectopic ACTH: paraneoplastic syndrome due to e.g. small-cell carcinoma of lung Make sure to weigh daily, look for pathological fractures, and delayed wound healing. Excessive secretion of cortisol causes obesity, central, easy bruising, fluid retention, impaired protein metabolism, inhibition of fibroblasts, and impaired glucose tolerance. Increased risk of fractures due to bone demineralization caused by high calcium reabsorption.

Role of the Nurse in Disaster Preparedness

-Help initiate or update the agency's disaster plan -Provide educational programs and materials regarding disasters specific to the area -Organize disaster drills -Provide an updated record of vulnerable populations within the community -Review individual strategies include an emergency operation plan disaster drills should be conducted twice anually

Mandatory Reporting

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

Steps in performance improvement process

1. a standard is developed and approved by facility 2. standards are made available to employees by policies and procedures. 3. Quality issues are identified by staff, management 4. an interproffessional team is developed to review the issue 5. current state of structure and process related to the issue is analyzed. 6. data collection methods are determined. 7. data are collected, analyzed, and compared with the established benchmark. 7. if not met, RCA. 8. potentialsolutions analyzed, one implemented educational or corrective action taken issue is reevaluated, at a preesablished time to determine the efficacy of the solution or corrective action

HIPAA (Health Insurance Portability and Accountability Act)

1996: federal act providing privacy protection for health care consumers Information can be disclosed without consent in these circumstances: suspicion of abuse, criminal activity required by law, incidences of reportable communicable diseases.

beneficience and nonmaleficence

2 ethical principles that connect with medical indications obligation to do good obligation to not do harm

living will

A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes.

Buddhism

A religion based on the teachings of the Buddha. reincarnation, contraception ok, death calm and peaceful chanting common creamation organ donation encouraged monk delivers last rights dietary: vegetarian, avoid alcohol may refused care holy days like peaceful environment

metabolic syndrome

A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes.

Types of patients that a first trimester pregnant nurse can and can't have

Can't have TORCH INFECTIONS TOXOPLASMOSIS: FROM HIV AIDS OTHER: syphillis, varicella zoster, parvovirus B19 RUBELLA CYTOMEGALOVIRUS HERPES INFECTIONS These infections can pass the placental barrier and cause congenital abnormalities

Type II diabetic education

Carbs should be 45-60% of daily calories, alcohol should be taken with food, space meals throughout the day.

Ectopic pregnancy and other manifestations

Abrupt, sharp, lower abdominal pain, and bright red vaginal bleeding. IUD's increase the risk for ectopic pregnancy: Missed abortions show brownish discharge and no pain Placenta previa will show painless, bright red bleeding during the second or third trimester Client with hydatidioform mole usually has dark brown vaginal bleeding during the second trimester not accompanied by abdominal pain

Patient Bill of Rights

Access to closest ER, choice of doctor, pediatrician, etc: right to human care and treatment

Side effects and adverse effects

Ace inhibitors: angioedema Benzodiazepines: Antergrograde amnesia Beta blockers: Bronchospasm Ciprofloxacin: Tendon rupture Digoxin: Yellow tinge to vision Doxycycline: Tooth discoloration Furosemide: Hypokalemia Lithium: Tremors Tobramycin: Ototoxicity Valacyclovir: Thrombytic thrombocytopenia purpura Antifungals: azole ARB's: sartan CCB's: dipine Histamine receptor antagonists: dine

disaster prevention

Activities to prevent natural and man-made disasters, increase surveillance, improve inspections and airport security, strengthening public health processes such as immunizations, isolation, and quarantine. Strengthen barriers to prevent flooding and teaching methods of preventing communicable disease transmission. ID and assess population populations at risk.

Magnesium Sulfate

Adverse effects are oliguria, and decreased respiratory rate: expected effects are nausea and feeling of flush and warmth during continuous infusion: Check BP q 15-30 min hourly intake shouldn't exceed more than 125, due to kidney problem possibility, administer calcium gluconate for problems

HAZMAT

An abbreviation for hazardous material that would be a danger to life or to the environment if released without precautions hazardous materials response team

Leucovorin

Antidote for methotrexate toxicity give with methotrexate to prevent healthy cells from being destroyed by toxic effects of metho

Portruding umbilical cord

Apply oxygen at 8-10 L/min via nonrebreather, nurse should apply gloves and insert wo fingers into vagina toward the cervix, exerting upward pressure to relieve umbilical cord compression and increase oxygen to the fetus.

Important things needed for TPN

Assess skin turgor daily, monitor blood glucose, and assess insertions site and condition of dressing

Infant assessment

Assessment of auscultation over all areas first, including heart and lungs, then palpation and percussion, then pupillary response, eyes, ears and mouth are performed. Than the moro reflex is assessed last.

Urinary retention in men

Attempt to void again after urine flow stops to prevent urine retentjion. Stand when voiding, contract pelvic muscles, to do kale exercises.

Risk factors for preeclampsia

BMI greater than 30 older than 40, younger than 19, hypertension, renal disease, SLE, rheumatoid arthritis, multiple gestation

Newborn care

Baby Friendly Guidelines Many maternal care facilities today adhere to the World Health Organization's Baby Friendly Hospital Initiative guidelines first published in 1991 and updated occasionally. These guidelines advocate: Uninterrupted and continuous skin-to-skin contact right after birth through the first feeding. Continued skin-to-skin contact while staff are conducting routine procedures, such as assessments and scoring, and throughout the mother and baby's stay when possible. Delaying any separation of mother and baby until after the initial period of contact. Conducting care at the mother's bedside. These procedures should be followed unless there are justifiable medical reasons not to do so. Facility practices may be informed by these guidelines, but be sure to check your facility's policies and procedures for newborn care. Discharge When a patient and her newborn are ready to leave the facility varies with their physiologic status, type of delivery, feeding success, safety, and various other factors. Early discharge is common, with some women and newborns at low risk for complications leaving the hospital within 24 to 36 hours after an uncomplicated delivery. However, federal legislation ensures that all health plans allow for a minimum of 48 hours of hospitalization after a vaginal birth and 96 hours after a cesarean birth. Regardless of the length of stay, parents must learn the skills of feeding, clothing, bathing, and protecting their infant before they leave. You'll ensure that they learn these skills with instruction, demonstration, and observation, along with encouragement and support to help them develop confidence in their ability to care for their newborn. Umbilical cord care Teach parents to keep the newborn's umbilical cord clean and dry. Remove the cord clamp when the cord is dry, usually at about 24 hours of age, then assure them that they may clean the stump with water as long as they allow it to dry afterward. Some providers and facilities recommend soap and water. Parents should watch for swelling, redness at the base of the stump, purulent drainage, and a foul odor from the stump at each diaper change. Show them how to fold the upper edge of the front of the diaper down below the umbilicus so the stump remains exposed and dry. Let them know that the stump will probably fall off somewhere between 10 and 14 days after birth. Circumcision care For newborns who have had a circumcision, apply petroleum jelly to the penis for the first 24 hours to keep the diaper from adhering to the circumcision site. With the Plastibell method, petroleum jelly is unnecessary. Administer acetaminophen (Tylenol) as needed for pain. Observe the penis for bleeding and adequate urination. Cleanse the penis with warm water and apply the diaper loosely. Demonstrate this for the parents, and make sure that understand that they should not use soap or commercial cleansing wipes until the circumcision has healed (about 5 or 6 days later). Caution them about the yellow exudate they may see on the glans after 24 hours and for the next 2 to 3 days. They should not remove it, as it is part of the healing process. Tell them they may control minor bleeding with gentle pressure from a sterile gauze pad. If bleeding continues or if they notice redness, swelling, pus, or a foul odor, they should notify the provider. Bathing Bathing is an opportunity for interaction and bonding. Have parents start with a simple sponge bath, a practice they should continue periodically until the umbilical cord stump falls off. Then they may progress to tub baths. Daily bathing is unnecessary; in fact, it can disrupt skin integrity and the acid mantle, which comprises the uppermost layer of the skin plus amniotic fluid, superficial fat, micro-organisms, sweat, and other metabolic products. A good time for a bath is when the newborn awakes and before a feeding. Emphasize that parents must never leave an infant alone during bathing, not even for a second or two. Go over the following instructions with them, first with a demonstration and then with a return demonstration. To prevent heat loss, perform the bath quickly in a warm room, exposing only a portion of the body at one time. Suggest they use a bath thermometer to ensure that the water temperature is in the appropriate range: about 36.6° C to 37.2° C (98° F to 99° F). Use soft, clean washcloths, not cotton balls or swabs. Begin by washing the face with plain water. Cleanse the eyes from the inner to the outer canthus, using separate parts of the washcloth for each eye. Wrap the infant in a blanket when washing the hair and scalp. Use one hand or a soft brush to wash the scalp with water and a mild, unscented, pH-neutral soap. This and regular hair brushing prevent scalp desquamation, or cradle cap. Wash the creases in the neck and under the arms and legs and in the groin as well as the rest of the body with soap and water. Use corners of a washcloth to clean the ears and nose. Be sure to wash between the fingers and toes. Dry the newborn thoroughly to prevent heat loss. Clean the diaper area with each change. For girls, gently separate the labia and carefully wash from the pubic area toward the anus. In male newborns, cleanse the uncircumcised penis by washing with soap and water and then rinse the penis. The foreskin should not be forced back or constriction can result. The circumcised penis, once healed, requires no special care, just gentle washing of the genital area. Do not use creams, lotions, powders, or ointments routinely. For excessive dryness, apply a non-alcohol-based, unscented lotion. Newborn skin is fragile; excessive scrubbing can injure it. Always rub gently and pat the skin dry. If stool has dried on the skin, soak the area to make it easier to remove. Do not rub it off. And do not expose the skin to direct sunlight. Diaper rash Bacteria that cause diaper dermatitis thrive in moist dark areas. To treat diaper rash, clean the area after each urination and bowel movement. Exposing the buttocks to air helps prevent bacterial growth. For infants prone to diaper rash or to help heal a rash, apply zinc oxide ointment to protect the skin. A fungal rash from Candida albicans requires treatment with an antifungal ointment and possibly oral medication. Signs of this type of diaper rash include severe erythema in the perianal area, inguinal folds, and lower abdomen. Nail care It is not necessary to trim a newborn's nails until they have grown long enough to extend beyond the skin of the tip of the fingers and toes. Then, parents should use manicure scissors or clippers to trim them straight across or use an emery board to file them and keep them short. The best time to trim the nails is while the infant is sleeping. Clothing Parents should dress the infant for comfort and security. A cap can help minimize heat loss and protect the infant from the sun. Swaddling in a blanket provides a secure feeling and helps maintain body temperature. Avoid overdressing the newborn. A general guideline is to dress the newborn as warmly as the parents would dress themselves. Make sure all clothing is flame-retardant. Safety Parents may not be aware of many potential dangers for their newborn. Provide instructions such as these to promote safety. Do not leave an infant alone on a bed, table, or other furniture. Place infant carriers on the floor, never on high places such as counters and beds. Set the water heater to 49° C (120° F) or less. Test bath water temperature with a bath thermometer. Pick an infant up gently and never swing, throw, or shake him. To prevent respiratory illnesses, never expose an infant to tobacco smoke. Make sure crib slats are no more than 6 cm (2.375 inches) apart and the mattress fits snugly against the sides. A mattress is too small if two adult fingers fit between it and the sides of the crib. Position the crib on interior walls to prevent drafts. Keep window cords out of reach. Keep the crib away from heaters to prevent fire. To prevent suffocation, do not place pillows, stuffed animals, or loose bedding in the crib with an infant. Use a sleep sack to keep the infant warm instead of loose bedding or comforters. Do not leave a bib or a pacifier with a string around an infant's neck during sleep. Use a firm mattress covered with a sheet. Position the infant supine to reduce the risk of sudden infant death syndrome. Do not put an infant to sleep on a waterbed or in the same bed with sleeping adults. Install smoke detectors and replace their batteries regularly. Learn infant cardiopulmonary resuscitation. Never leave an infant in a parked car. Car seats Use only a federally approved, rear-facing car seat and secure it in the rear seat of the vehicle. Make sure the harness is snug and the clip is at axillary level and not across the infant's neck or abdomen. Follow federal and state regulations for age and weight parameters for car seat types and positions. Many local agencies offer car seat information and actual installation and verification of adherence to safety regulations. Comforting techniques Newborns use nonnutritive sucking to self-soothe. They suck on their own fingers and some use a pacifier. Instruct parents who give their newborn a pacifier to clean it and replace it regularly and not to coat it with sweet solutions. Advise women who breastfeed to delay the use of a pacifier until breastfeeding is well established (generally about 1 month). Caution parents to use only safety-tested commercial pacifiers. Infants cry to communicate hunger, discomfort, illness, and boredom. They may cry only a few minutes or for 2 hours or more. Encourage parents to interpret what a cry means and respond accordingly. A fussy period each day, usually in the late afternoon or evening, is quite common. During these times comforting measures may not help. It is likely that the infant will fuss until he releases enough energy to fall asleep. Provide parents with education about techniques to quiet their infant. These include swaddling, soothing noise, skin-to-skin contact, patting, back rubbing, or other mild rhythmic movement such as with a cradle or a rocking chair. Outings in a stroller or a motor-vehicle often help. Sensory stimulation Sensory stimulation promotes development. Encourage parents to hold their infant close while face to face, to provide toys and mobiles with black and white contrasting designs, and to incorporate singing, playing music, massaging, and walking using a stroller into their daily routines. Signs of illness Make sure parents know when to contact their provider, for example, for significantly high or low axillary temperatures, frequent vomiting, poor feeding, diarrhea, decreased urination or bowel movements, cyanosis, breathing difficulties, lethargy, inconsolable crying, eye drainage, or bleeding from the umbilical cord or circumcision.

Abnormal findings after birth

Breech birth can cause bruising over buttocks or swollen genitalia Bilateral periauricular papillomas are being and are expected

Types of heat Loss

Conduction: loss of body heat from direct contact with cooler surface Convection: flow of heat from body surface to cooler environmental air Evaporation: loss of heat surface as liquid converts to vapor Radiation: loss of heat from body surface to cooler solid surface that is close to but not in direct contact

Healthy People 2020 goals for preschool age children

Decrease acute middle ear infections, increase rate of correct use of car seats, reduce number of children exposed to secondhand smoke.

Discharge education PEG tube

Do not use scissors to cut away dressing.

silver sulfadiazine

Doesnt penetrate eschar and can cause leukopenia, it also forms sulfa crystals in urine. Sulfonamide used as bactericidal agent, can increase SG, important to keep patient well hydrated. Used to treat and applied topically to patients with 2nd and third degreeewound burns.

Postpartum assessment

During postpartum, the time between delivery and the return of the reproductive system to its pre-pregnancy state, you'll assess your patient's vital signs, breasts, fundus, bladder, lochia, perineum, legs, and any incisions. Measure vital signs with the frequency your facility's policies specify or according to the provider's prescription. Include temperature, heart rate, respiration, blood pressure, and pain level. Temperature may rise due to the dehydration that can accompany labor and sometimes as a result of epidural anesthesia. After the first 24 hours, however, elevations in temperature warrant further investigation as they suggest infection. Pulse rates may be somewhat elevated but should return to their pre-pregnant status gradually. A sustained rapid pulse can indicate hemorrhage. Respiratory rates may be low after epidural anesthesia and after a cesarean birth but should gradually return to the expected range. Orthostatic hypotension is common after delivery. Hypotension can indicate hemorrhage, and hypertension may persist in women who have had pre-eclampsia. Assess your patient's pain, including location, type, quality, and severity. Administer pain medication to keep the patient's pain at a manageable level. For perineal pain, apply cold during the first 24 hours, including cool sitz baths. This helps reduce swelling and irritation. After the first 24 hours, warmth is helpful for promoting circulation and healing. To help reduce pain from sitting down, suggest that your patient compress or tighten her buttocks just before sitting. This reduces pressure on healing perineal tissues. Encourage your patient to urinate prior to assessing her fundus. Assist her to a supine position. First, inspect and gently palpate her breasts for redness, pain, and engorgement. Inspect the nipples for redness, cracks, and bleeding. If she is breastfeeding and her breasts are engorged, suggest warm compresses or a warm shower before breastfeeding to stimulate milk flow. Or, if her newborn isn't emptying both breasts, suggest she pump her breasts to relieve discomfort. If she is not breastfeeding, suggest ice packs to help suppress milk production and reduce discomfort. Next, check your patient's fundus. Assess uterine height, location, and consistency. Determine the fundal height by placing one hand at the base of the uterus and the other at the umbilicus. Measure how many fingerbreadths, which are roughly equivalent to centimeters, you can place between the fundus and the umbilicus above or below it. If none, then the fundus is at the umbilical level. At 12 hours after delivery, the fundus is typically 1 cm above the umbilicus, but this does vary. The uterus descends into the pelvis approximately 1 to 2 cm per day. About a week after delivery, the fundus should be halfway between the umbilicus and the symphysis pubis. Also, assess whether the fundus is boggy or firm. If the fundus is boggy, gently massage the uterus with a rotating motion while supporting the lower uterine segment until it feels firm. Without stabilization of the lower segment, the uterus could invert, and severe hemorrhaging could result. Assess and palpate the bladder at this time as well. Determine whether the fundus is at midline in the pelvis or displaced laterally due to a full bladder. If the bladder is full, encourage the patient to urinate and monitor her fluid intake and output. For some patients, insertion of a straight urinary catheter may become necessary. Examine the patient's perineal pad for bleeding, noting the character, quantity, presence of clots, and odor. Lochia rubra is typical 1 to 3 days following delivery, and small clots are common. Determine the amount of saturation as scant, light, moderate, heavy, or excessive. Be sure to check under the patient's buttocks to be sure blood is not pooling beneath her. Lochia typically increases with breastfeeding and ambulation. If bleeding is excessive, the patient will soak an entire perineal pad within 15 minutes or so. For that finding as well as for numerous large clots or a foul odor, notify the provider immediately. If the patient has had a cesarean delivery, examine the incision for redness, edema, ecchymosis, drainage, and approximation of its edges. If the patient has had an episiotomy, have her lie on her side and assess the episiotomy incision for approximation, edema, and ecchymosis. Also check her rectum for hemorrhoids and assess bowel function by auscultating bowel sounds. Assess for thrombophlebitis by checking the patient's calves for pain, tenderness, or redness. Notify the provider immediately if you find any of these. Check for edema of the hands, the face, and the lower extremities. Finally, assess your patient's comfort level and emotional status. Make selection below: Auscultating fetal heart rate Gestational age assessment Leopold maneuvers Measuring fundal height Newborn care Nonpharmacological pain management Nutritional needs of newborns Postpartum assessment Pregnancy Apgar scoring Make a SelectionAuscultating fetal heart rateGestational age assessmentLeopold maneuversMeasuring fundal heightNewborn careNonpharmacological pain managementNutritional needs of newbornsPostpartum assessmentPregnancyApgar scoring

Medication

Erythromycin: prophylactic eye care is mandatory instillation of abx ointment into eyes to prevent ophthalmia neonatorum: which is caused by neisseria gonorrhea or chylamydia trachoma's and cause blidness Vitamin K: given to prevent bleeding, because it isn't produced in GI tract until day 7 administer 0.5-1mg IM into vests laterals soon after birth Hep B immunization: given to all newborns, with informed consent, given at birth, 1 month, and 6 months For parents infected with hep B, hep b immunoglobulin and hep b vaccine is given within 12 hours of birth, and hep b vaccine given 1 month, 2 months, and 12 months. Don't give HEP b and vitamin K injections in same thigh.

New Ballard Score

Estimates gestational age in very low birth weight infants younger the gestational age, the less flexion newborn demonstrates, term babies have creases, preterm don't, postterm newborns have leathery cracked, and wrinkled skin, while preterm have translucent and friable And flat areola's will be present in preterm with minimal to no breast buds.

purpose of alpha-fetoprotein screening

Excluding the presence of fetal neural tube defects at 20 weeks

PROM risk factors

Gonorrhea, and if they have G, they are at risk for preterm birth, neonatal sepsis, and inautrerine growth restriction: not at risk for excessive bleeding

Vaccination schedule

https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html Child schedule https://www.cdc.gov/vaccines/schedules/hcp/imz/adult.html adult schedule

If not breastfeeding and engorged

ice for 15, leave for 45

Malpractice

Failure by a health professional to meet accepted standards

FEMA

Federal Emergency Management Agency manages federal response and recovery effort

Calcium postpartum

If hypocalcemia is present, the mother should drink milk, and symptoms can include muscle cramps. Intestinal calcium absorption doubles during pregnancy, drive by calcitrol. Average loss of calcium in breastfeeding is 210 mg high, instead of increased absorption, during postpartum, demineralization of bones occurs to keep calcium levels normal.

Hispanic culture newborn

protect clients head and feet from cold air delay bathing for 14 days following birth make sure bedrest is adhered for 3 days following birth Mother should drink only warm beverages following birth

Appropriate procedure for infant heel stick

Heel stick blood samples with clean gloves, warm heel to improve circulation, cleans with antiseptic Outer aspect of the heel will be used, goes no deeper than 2.4 mm dry with gauze, encourage cuddling afterwards

molar pregnancy

Hydatidiform mole These clients have dark red or brown vaginal bleeding because there is no placenta to receive the maternal blood, higher fundal height than normal will be seen.

Contraindications to circumcision

Hypospadias: abnormal positioning of urethra on ventral under surface of penis history of family bleeding disorders newborns not receiving vitamin K

STOP METHOD

Identify the issue and client in question This: about the type of stem and key words Options: consider potential options/responses Pick: the correct answer Always consider if ABC are acute vs chronic or stable vs unstable. Consider options that are least restrictive, assessment takes priority in nursing process. Acute take priority over chronic. Early signs are general and non specific, late signs are serious and specific.

Triage

red Class I: immediate threat to life yellow Class II urgent: major injuries that require treatment, can delay 30 min-2 hr Nonurgent: Class III green: minor injuries, ca delay 2-4 hours Expectant: Black prepare for morgue

S3 heart sound

Increased ventricular filling pressure (e.g., mitral regurgitation, HF), common in dilated ventricles caused by heart failure.

Phototherapy

remove all but diaper, do not apply lotion

When performing and applying an external transducer for fetal monitoring, what should be performed?

Leopold maneuver: assess for position of fetus to determine optimal placement With an internal monitor, determine progression of dilatation and effacement is important A sterile speculum examination is always performed by a provider and isn't required for external transducer fetal monitoring, A nitrazine paper test is performed to assess the components pH level of vaginal fluid to determine if membranes have ruptured, but isn't required for this procedure

Selegiline (Eldepryl)

MAOI it causes dizziness, it affects sleep patterns. Giving to patients who have parkinson's. Inhibits MOA that inactivates dopamine in the brain. Can be given with levodopa. Common side effects are dizziness, dry mouth, insomnia, muscle pain, rashes, nausea, and constipation. Adverse effects are arrhythmias, dyspnea, chorea, and hallucinations. Don't give with MAOI's or fluoxteine.

Staphylococcus aureus

MSSA: nafcillin, oxacillin, dicloxacillin (antistaphylococcal penicillins); MRSA: vancomycin, daptomycin, linezolid, ceftaroline Mastitis: most common organism that does this is Staph A. Failure to treat can lead to an abscess in the breast. Mastitis symptoms include: occurring in 2nd to fourth week postpartum and include local breast tenderness, fever, chill, and malaise. Swelling pain, redness, and axillary aden-patchy can occur. Treatments include abx. Clients empty breasts every 2-4 hours.

Safety

Make sure to verify parent's id band with newborn ID band

non pharm management pregnancy

Many patients base their perception of the birth experience not so much on the amount of pain they feel but on how well they achieve their goals for managing it. Most expect some pain and will count on you to help minimize it. Nonpharmacologic methods of pain management are ideal for this purpose. They are simple, safe, and easy for you to teach to your patients and their support people. For those who have learned and practiced these strategies prior to labor, you can remind them to use them. Breathing techniques Breathing techniques promote relaxation, provide distraction, and improve coping during uterine contractions. They begin and end with a cleansing or focused breath - a slow, relaxing breath in through the nose and gently out through the mouth. Slow-paced breathing is exactly that - the patient inhales slowly through the nose and exhales slowly through the mouth - usually six to nine times per minute and no fewer than three to four. With modified-paced breathing, the patient breathes slowly in and out through her mouth, and, as each contraction reaches its peak, she breathes faster - usually 32 to 40 breaths per minute. As the contraction subsides, the patient returns to slow breathing. Pattern-paced breathing requires more concentration as the patient sets up a pattern of breathing to help her through the final centimeters of cervical dilation. Breathing in and out of her mouth, she takes quick panting breaths and then exhales or blows forcefully. One method is to make a "hee" or "hoo" sound in a pattern. The pattern may vary, but typically after the cleansing breath, the patient breathes in a 3-to-1 pattern - "pant-pant-pant-blow" or "hee-hee-hee-hoo" throughout the entire contraction and ends with a cleansing or focused breath. The rate is usually the same as with modified-paced breathing. The nurse and the support person can coach her by breathing with her, counting the breaths, reminding her to use the cleansing breaths, and making sure she takes even breaths to avoid hyperventilation. Touch Massage is an effective technique for enhancing relaxation and comfort. Massaging the patient's head, hands, feet, and back provides comfort and communicates caring. Counterpressure is steady pressure a support person applies to the sacral area of the patient's back. This is especially helpful for patients who have pain and internal pressure in the lower back because the fetal head is in a posterior position. The coach or the nurse uses the heel of the hand or a fist to achieve adequate counterpressure. Effleurage is light massage or stroking, usually on the patient's abdomen in rhythm with breathing during contractions. The support person uses the fingertips with enough pressure to avoid tickling sensations. For patients who have a monitoring belt across the abdomen, the chest and the thigh are appropriate alternatives. Energy work, such as healing or therapeutic touch, involves manipulating energy fields to help reduce anxiety and pain during labor. Certified practitioners perform these techniques. Positioning Frequent position changes enhance comfort and relaxation and promote more effective contractions. Upright positions such as walking, sitting, or squatting take advantage of gravity to encourage fetal descent. Combining positions and activities like rocking and slow dancing with relaxation can help reduce pain perception. Water therapy Showering, bathing, and sitting in a whirlpool bath can improve comfort, provide a relaxing atmosphere, improve circulation and oxygenation, soften perineal tissues, and make it easier for women in labor to cope with pain. Facility policies vary, but as long as a patient in active labor has no contraindications for these techniques, she can generally stay in the bath for as long as she wishes. Recommendations for jet hydrotherapy are usually for 30 to 60 minutes. Warm water can cause dizziness, however, so it is important to assist patients in and out of the shower or tub. Also be sure to provide a shower stool, so they can sit down easily during showering. Other therapies vary with the practice setting, the provider, and the patient's preferences. Some, such as biofeedback, hypnosis, acupressure, acupuncture, and transcutaneous electrical nerve stimulation, require trained practitioners and sometimes specialized equipment. Others such as aromatherapy, imagery, heat and cold applications, and music therapy are easy to implement, require no special certification, and can provide some unique benefits for patients in labor.

Asthma management children

Mild intermittent - Symptoms occur less than twice a week • Mild persistent - Symptoms occur more than twice a week, but not daily • Moderate persistent - Daily symptoms occur in conjunction with exacerbations twice a week • Severe persistent - Symptoms occur continually, along with frequent exacerbation that limit the child's physical activity and quality of life Risk factors: young and exposed to smoke Meds: bronchodilators: short acting beta 2 agonist: albuterol, terbutaline, provide rapid relief for asthma Cholinergic antagonist: such as ipatropium: block the parasympathetic nervous system, providing relief from bronchospasm Anti-inflammatory agents: decrease airway inflammation long-term management. - Corticosteroids (fluticasone, prednisone) - Leukotriene modifiers (montelukast) mast cell stabilizers (cromolyn sodium) and monoclonal antibodies (omalizumab) nursing consid Instruct/reinforce the child and family in the proper use of MDI, DPI, or nebulizer • Watch the child for tremors and tachycardia when taking albuterol • Observe the child for dry mouth when taking ipratropium • Anti-inflammatory actions and adverse effects considerations - Watch for decreased immunity function - Monitor for hyperglycemia - Advise to report black, tarry stools - Observe for fluid retention and weight gain - Observe throat and mouth for aphthous (cold sores) lesions

Water just broke, what do you do?

Monitor fetal heart rate first, assess cervical dilation, assess fluid, do Nitrazine testing to see if alkaline pH is present, which indicates rupture of membranes.

NCLEX Review Information

NCLEX review Notes Day 1: Min 60-max 130, max four hours, will go on until July 4th Valid Photo ID, renew if necessary Changing address, address is Arrive at least 30 minutes early, and relax Don't bring any material to the center Don't study the day before the exam Don't part after or before the exam LPN: Can care for stable clients, routine, predictable outcomes. Go over education that has already been provided Default strategies: Time elapsed Pre, intra, post, Early vs. late S&S Fat embolism with muscle skeletal fractures, if long bones aren't put into alignment quickly enough. Disorientation is a sign of hypoxia.- trigger alert!!!! Signs and symptoms of fat embolism: shortness of breath, petechaiel rash on the chest, X-ray is like whited out snowstorm, 24 hours out Patient gets an ECT to get schizophrenia, severe depression, bipolar disorder. We induce little seizures in the brain, hold the phenytoin, will prevent the seizures from occurring. Why give atropine? To prevent secretions. Methohexital, is a sedative to be given. Succinylcholine is a paralytic to be given. Stay with the partner/client if it asks. If someone dies, the family becomes the patient. Stay until dismissed. Methotrexate adverse effects: Rheumatoid arthritis is an autoimmune disease, methotrexate is an DMARD immunosuppressant. Try to find the answers, adverse effects are low platelets and low WBC. The most we care about weight gain is heart and kidney failure. When get one that don't know, make best guess, and start as if the test has just restarted. Crutch walking, page 68, 69. Three point crutch walking Sign of tet spell, child squatting after a game of ball, tetralogy of fallot. Review TET spells. Look at page 240 in review book, 241 congenital heart anomalies. Meds: Hydromorphone, opioid agonist, give naloxone to treat Insulin detenir for type 1 and 2, Peak time is 6-8 hours, not given before meals, SE: nausea, vomiting, hypoglycemia, covers basil insulin. Pain control-non-opioid given for pain control not given with alcohol, sedation, dizziness, dry mouth, and constipation, tramadol-central acting non-opioid, don't give to patient with seizures Ergot alkaloid: postpartum bleeding-, SE: nausea, headache, hypertension Methylergonovine What casues hemorrhage? Uterine atony, laceration, impaired clotting, reduced placenta fragments Antineoplastic, immunospurresnt: indicated for RA, cancer, psoriasis, crohn's: NE:m nausea, elevated LFT's, fatigue Improves symptoms of RA due to immunosuppression effects Gabapentin: anticonvulsant, partial seizures, enuropathetic pain, SE: drowsiness, dizziness, fatigue Effective three times a day because does peaks in 2-3 hours, short half life Nitroglycerin: organic nitrate, indicated for angina, don't take with ED such as tadalafil SE: headache, hypotension, tachycardia Safety: worry about falls (vasodilation and dizziness) Oxytocin: uses induce labor, postpartum hemmorahge-uterine stimulant SE: tachysytole, uterine rupture, elevated BP, and fetal hypoxia, Tocolytic: given to reduce effects of oxytocin, terbutaline 1stgen NSAID: analgesia, RA or OA-Meloxicam SE: gi dyspepsia, nausea, bdominal pain, take with milk food, can given with PPI or H2 receptor, can cause Gi bleeding Risperidone: atypical antipsychotic: indicated for shizo, acute bipolar, and autism SE: weight gain, gyslipidemia, diabetes Needs routine blood tests for cholesterol elevation and hypgerglycemia, and agranulocytosis Methylpredinsolone: glucocorticoid: used for inflammation, SE: euphoria, infection, cusions Symptoms of cushings: Buffalo hump, moon face, weakness, hypokalemia, hypgerlgycemia, hypernatremia. Budesonide/formoterol: glucorticoid bronchodilator: used for prophylaxis in COPD SE: Gi upset, and infection At increased risk for infection because of immunosuppressant activity Allopurinol: decreased use of purines, Uricosuric: indicated for chronic gout, SE: nausea, fever, rash Vancomycin: can cause red man syndrome indicated for c diff, assess labs for nephrotoxicity, check BUN and creatinine0.6-1.2 BUN 10-20 Antibiotic: piperacillin/tazobactam=zosyn ABX, SE: gi upset, leukopenia Allergy to penicillin contraindicated Select all that apply rules: STOP TECHNIQUE, more than 4, true false Correct advance directives: are written for the patient, not the family!!!! Advance directives: What it all includes: Living will, use of abx, diagnostics, durable poa, DNR Who should be consulted: Dietician, Speech therapist, physical therapist for CVA. Rapid response is only for coding For trach set up, have: oxygen, suction, manual bag vale mask ventilation, two tracheostomy tubes Traches: one trach that is the same as the one placed, have one that is also a size smaller. Give oxygen through a trach mask. Suction for ten seconds, trach ties, Client Needs: Strong in Management of Care safe and effective care environment Advance directives Advocacy Case management Client rights Concepts of management Consultation Continuity of care Ethics Informed consent Informed technology Legal rights and responsibilities Quality improvement Referrals Supervision Consult the case manager, helps to manage sending patients to different places, what can we do to get patient out of the hospital. Gonnorhea, chlamydia, Herpes, HIV are all reportable diseases, salmonella is reported as well Ebola has incubation period of 2-21 days. Blood draw is used with ebola. Foodborne illnesses, botulism, e-coli, research reportable diseases Anyone discharged is last priority Five rights of delegation Task, person, communication, supervision, circumstance LPN's can administer piggybacks When do we care about performance improvement: falls, near misses, JACHO evals, CAUTI's: collect data, find possible causes variants/deficiencies, not good catheter care, leaving them in too long, educational corrective action is implemented, 21 days is how long foley can stay in, reevaluate if improvement occurred. First infraction, informal reprimand, second-formal, third-suspend with or without pay, fourth, involuntary termination. ADL's: should be completed by the OT. Ethical priniciples Autonomy: right to make ones own decisions Beneficence: obligation to do good for others Justice: obligation to be fair to all people when allocating limited resources Nonmalefiicne: obligation not to harm others Veracity: obligation to tell the truth to patients Fidelity: obligation to be faithful to keep promises to the patient. Legal: Nurse Practice Act is a state law, each state has their own. Criminal laws are felony and misdemeanor. Negligence or malpractice Civil laws: page 17: torts Is it negligence: what was the duty? Breach of duty? Foreseeability of harm? Potential for harm due to breach? Was their actual injury? All 5 have to be true for it to be negligence. Example of negligence is if wrong IV solution is implemented, and if they are hurt, Giving wrong blood and nurse can be sued for malpractice. Injury-not permanent, injury is transitory. If injury doesn't persist, not negligence. Medical errors: Avoid distractions, six to ten rights and three checks, use two client identifiers, clarify orders. Right client education, 8, right to refuse, 9 right assessment, 10 right evaluation Check before removing, when removing, before administering. Incident reports after client is stable, give to nurse manager, never placed in medical record. Medicaions prescriptions: Full name, date and time, medication name, dosage, route, time and frequency, signature of health care provider Nurse responsibility: ensure all components are included, ensure provider signs within allotted time. Difference between negligence and malpractice, there must be permanent injury. Day 2: AMedical avidce: don't need to get discharge order immdediately Zika Virus: Flu like symptoms report Virus is spread through sexual intercourse Infection in pregnancy can cause fetal defects Mosquito repellant should be applied when going outdoors Case management: During discharge, how do we we get them back home? Resolve plan of care, arrang home health, Facilitate referrals for community services, schedule followups West Africa symptoms to report: West Africa Ebola virus: Fever, epistaxis, diarrhea, and vomiting. Physiological integrity: Basic Care and Comfort Dietary modifications During pregnancy, Alternative and complementary therapies: Imagery, meditation, acupuncture, biofeedback Guided imagery: Thinking of something to distract, Use with children, calm soothing voice, self directed Biofeedback: Mind body technique, self regulation, voluntary control over specific Body responses, autonomic nervous system Combines relaxation, consciously regulating body functions ot reduce pain Acupuncture, vital energy, and meridians Review hot and cold therapy Preventing falls in older adults: Install grab bars in shower, wear shoes inside the house, mark stair step edges wihth colorded tape, keep items in reach DIET ACTIVITY: Pancreatitis: NPO, TPN, helps to rest the pancreas Diabetic patient, ETOH, alcoholism Clear liquids, with high fiber: diverticulitis, first have diverticulosis Outpouching inflammation, foods get stuck, seeds Nuts get stuck, starts to form an abscess Concern is growth of rupture Risk for peritonitis Bulking agents gets all food, gets rid of all stool Low fat for: Cholysistitis Low protein: for liver disease Celiac avoid glutens Gout: avoid purines Small frequent meals: nausea vomiting Hepatic encephalopathy: assess LOC prior to giving fluids Heart failure: sodium and fluid restrict GERD: is reflux, remain upright for two hours after eating, no caffeine, COPD: monitor for weight loss, find finger foods, high calorie, Lactose intolerance: no milk PUD: probiotics, ulcerations in stomach or intestine lining Cirrhosis: vitamin supplements Enteral nutrition: G tubes, PEG tube, OG tube Using GI system Need tube for dysphagia, gastric lavage, decompression, Bad PO intake Unconscious, failure to thrive Bowel obstruction Tube feeding Vomitting, abdominal pain, can be signs of intolerance Start full strength at slow rate, increase every 8 to 12 hours Keep bed higher than 30 degrees Sings of intolerance: NVD high gastric residuals Residual too much is 100- to over 250 X ray is the most accurate method for checking placement of NG or PEG, and then pH is the second most reliable method In stomach, should be 5 or less, if in lungs, will above 7-8 Patients should be getting low intermittent suction Don't do da continuous Never leave them on continuous Make sure to flush NG tube, can't crush extended release, ask for different form of the medication Can't dissolve enteric coated medication Don't guess, Tap water is used in the stomach for enteral nutrition Parenteral: goes into the IV: TPN Bowel obstructions I/O: BP, kidneys, heart I/O: solids that liqufy at room temo Pg 28 Bladder irrigation have to subtract from output Dehydration Toddler: Absence of tears, 6% loss of body weight Body percent weight loss Less than 5 mild, 5-10 moderate 10 or more severe review ped vitals Review Maternal newborn Assist woman to bathroom How to communicate with hearing impaired: Communication board Clear low pitched Interpreter for sign language Hearing aids: batteries, how often do I change them? Speak slowly and clearly, brief sentences, normal value Write down important info? Replace batteries in hearing aids, 3 to 22 days PACO2: 63- normal is 35-45 High value is COPD Sodum is 135-145 Review: Hyponatremia: includes symptoms of Hypernatremia: Platelets: 150-450 Fasting glucose: Normal is 70-105 Hypoglycemia signs and symptoms 6oz of orange juice/15 grams of fast acting glucose Stay with client for 15 minutes and retest Give more, if greater than 70, give source of protein If doesn't respond do IV or IM glucose WBC: 5-10 Digoxin: patient taking digoxin 0.8-2.0 become toxic at greater than 2.4 if not taking, would be 0. Signs and symptoms of digitalis toxicity: GI symptoms, CNS changes, yellow and green halos around lights, Dysrthymias, Take digoxin for heart failure patients To lower heart rate, increase cardiac output INR: of 3.4 Normal is 0.8-1.1 if not taking If taking warfarin, 2 and 3. The higher above 3, More at risk for bleeding all over the body Because it becomes more thin Vitamin K: is the reversal agent Hemogloin: 13.5-17.5 Women: 12.0-15.5 Signs and symptoms of hypokalemia and hyperkalemia Calcium: Hypocalcemia signs and symptoms Normal is 9-10.5 Bicarbonate level: Electrolyte section in the book HCO3: 22-26 Phenytoin level of 14: Normal is 10-20, if taking the medication Toxic Is greater than 40 Serum creatine of 2.2 Elevated renal issue, dehydrated Normal is 0.6-1.2 Hgb1ac: 4-6: indicates last three months Goal for diabetes is less than 7 Over 7 or 8 will have complications Magnesium Normal is 1.3-2.1 Signs of hypo and hyper review PAO2: 80-100 is normal can be over 100, which is bad urine SG: 1.005=1.030 higher, more dehydrated lower, hydrated HCT: 30% Remember 45% BUN: 25 Normal is 10-20 Ph: 7.35-7.45 Know acidosis vs alkalosis Lithium level: Normal 0.4-1.4 greater than 2 severe nausea and vomiting, CNS changes, blurred vision, slurred speech, irregular heartbeat consistent fluid intake and sodium or risk of toxicity will occur. Pg 81 is on this one, electrolytes, for hypo and hyper -pg 169-need to know lab values Doing more of interventions than just remembering what the lab values RBCS: 5 WBCS: 5-10 HGB: 15 HCT: multiply by 3, is 45 Growth and Development Milestones: What are the safety issues that we are worried about: Look at page 226 0-1 Year Trust vs Mistrust Erikson stage: success, trust with caregiver Crisis: infant with drawn and unresponsive Posterior fontantel: closes at 2-3 months Remember the immunizations for all age ranges: Feeding: Go to CDC website for immunization timeline CDC has a big chart for lifespan to review Exclusively breastfeed for 4-6 months Or formula in 4-6 months Safe storage of breastmilk: Formula safe storage: Prevention of SIDS Safe sleep Start feeding at 4-6 months Feed them all the things Puree them, make sure, slowly introduce Don't give honey before 1 year, at risk before one year for rsik of botulism Don't give cow's milk prior to one year Don't leave them unattended Rear facing for the first two years, ideally 0-2 1-3 Autonomy vs. shame Success: shows toilet control Crisis: unable to do toilet training Toddler Independence start Review fine and gross motor Discourage candy Healthy well rounded diet Choking hazards Five point harness, two finger breaths under straps More ambulatory, think about drowning, never left alone around water, Keep stuff out of reach Burns, watch out for the stove Cook on back burners Toilet training begin at how ambitious parent is Having accidents up through twelve, still ok, between 2 and 3 is good to start Keeping medications out of reach Medications never as candy Keeping suffocation out of reach, can do pillows at three Evaluate ability to move Physiologial and reduction of risk is largestportion of test Med Surg: Preschooler: 3-6 years Initiative vs guilt: Helping mother to do things Crisis: starting to steal things and doing things knowing it is wrong-guit Bicycles, Use helmets Drowning concerns More able to get to things and be naughty Car seats: still use, can face forward Review nutritional requirements for children School age: 6-12 years: Industry vs inferiority: Im getting good at stuff Crisis: im dumb cause I can't read as fast as others 6-9: play simply, booster seat 9-12: build models, collect things, mental health, Idiopathic scoliosis: unknow etiology: expected finding: Bending at the waist, physical exam palpation, spine alignment Walking, hip alignment is off Start doing checks for it during growth spurts, Ill fitting clothes, asymmetry in scapula, ribs, flanks, shoulder and hips One leg shorter than other And head hips not aligned, (uncompensated) Head aligns with gluteal cleft (compensated) Steady gait And bend at the waist Harringotn Rods steel rods are placed on either side of spine to help it stay n place If less severe, can do braces Screen later on in school age Goes by ten to the degree Adolescence Identify role vs confusion: I am fine with who I am Crisis: I belong to a gang I am nothing without them Less parental interaction Sexual maturation STI's Unplanned pregnancy Suicides Drug use Anorexia/bulimia Puberty Keep safe during driver STI's keep safe Young adult: Intimacy vs. isolation 20-35 marriage, no one is worth being in a relationship Done growing taller, may grow wider, optimal child, career Physical concerns for STI's Unplanned pregnancy, substance abuse become worse Illness due to signs and symptoms being ignored Higher risk of cervical and testicular and skin cancer Self monthly breast exams Blood pressure, cholesterol HPV start at 11-12, three doses for females, and meningococcal Can have oral contraceptive is women with Rheumatoid arthritis: If you smoke, can't have over 35, if don't smoke, can have over 35. Breast cancer is contraindicated because of estrogen Liver enzymes elevated Vein thrombosis is contraindicated Review oral contraceptives Middle Adult: Generativity vs stagnation: I will be taking care of my mom who is terminally ill Crisis: just want to be by myself Has to balance professional life: aging paretns, adult children, grandchildren, career retirements Menopause in women Osteperosis Vision and hearing changes Obesity risk for high bp, heart disease, ype II, UTI Depression and anxiety Start down for crossword Older adult Had a happy and productive life My life has been a waste Decreased skin elasticity Decreased in bladder capacity Low cardiac output Older adults don't need more sleep Infants adolescents: Accidents Nutrition Visions hearing and scoliosis Adults: mammograms, PSA, prostate exams Heart disease, High BP Older adults; herpes zoter 60 years Pneumonia vaccine65 years Breast engorgement: Short comes in swollen, fullness, 2 to three days 3 to five days lasts 24 hours, firm tender ret and hot nipples are flat, full of milk What do we do? Feed baby every two hours, pumping every two hours, drain them out so doesn't become mastitis Cool compress, between feeds cabbage, support bra, warm shower before feeding Review dietary changes pregnancy Pg 210 horomones, oxytocin nursing clamps the uterus after birth to prevent bleeding Horomones needed for lactation, prolactin promote milk synthesis Oxytocin casues milk to be ejected Proper denture Glasgo coma scale: reposition client every 2 hours, provide a high intake of protein and vitamin C because of skin breakdown, CAUTI Unless septic, watching closely. Watch out because it can be bad. Clozapine: Should stand up slowly, if flu symptoms occur, call th provider immediately, at risk for angrulocytosis, is atypical antipsychotic, Pharm: Clopidogrel first: Aspirin platelet aggregation inhibitor: Prevent stenosis, SE: abdominal pain, ceck hand h, epistaxis, bruising and bleeding Mood stabilizer: For bipolar SE: anorexia, confusion, thirst, cns changes, this is lithium Signs of toxicity: slurredspeech, NDV, confusion Antipsychotic: Indicated for acute psychosis, touretts SE: mild leukopenia, EPS< TD, laryngospasms, respo depression, NMS This is haloperidol Symptokms of neuroleptic syndrome: rigifity, sudden high fever, blood pressure instability hypertension Sedative hypnotic For insomnia SE: daytime dizziness, drowsiness fatigue Zopidem: changes in mental health include sleep complex behaviors and depression PPI Indicated for GERD, gastric ulcers SE: nausea, vomiting, abdominal pain Esmopreazole: taken 1 hour prior to eating Antidysrthymic: uses are vib-afib SE: lung damage, liver injury, heart block Amiodarone: what findings indicate respiratory failure: dyspnea, rales, friction rub, diminished breath sounds Atypical antipsychotic: Indicated for shio/bipolar/mDD, autism, bipolar SE: anxiety, insomnia, agitation, EPS Aripiprazole: we are concerned for increased depression and suicidal ideation Grwoth factor med Indicated for anemia, SE: HTN, clotting What labs: CBC< BUN potassium, iron This is epoitein Biphosphonate for oestoperosis SE: bone pain, leg cramps, coitis Risendronate Is to be taken with full glass of water, after taking, need to sit or stand and remain NPO for 30 minutes for 30 minutes to one hour, can cause esopahgela issues if we don't do that Anticonvulsant: indicated for neuralgia, partial seizures, fibrolmyalgia SE: dizziness, ataxia, confusion, weight gain Thi is pregablain Observe for pain fro grimacing, guarding, restlessness Insulin rapid Indicared Type I and type II SE: hypoglycemia Guiven Aspart given 5-10 minutesprior to eating Calcium channel blocker Indicated: HTN, angina,a fib, aflutter, svt SE: heart failure, peripher edema Signs and symptoms of heart failure is Right backs to body, Left to the lungs Smoking cessation: Indicated for stop smoking SE: nausea, anorexa, unusal dreams, modd changes, sucide EVareniciline Take for 12 weeks Loop diuretic Indicated for heart failure SE: hypokalemia, otoxicity if given too fast Assess for hearing loss, Furosemide Antibiotic: For pneumonia, sinusitis, skin infections SE: tendonitis photosensitivity Levofloxacin If pain, place cleitn on bedrest and notify provider abput tendon rupture Statin: Lower cholesterol and LDL levels, raise HDL levels SE: rhabdomylosis, hepatoxicity Which labs should be assess related to side effects? LFT: AST/ALT: rhabdomylososi: myoglobin, CK At Fetanyl: can be worn for 72 hours For chronic pain, remove old, then put on new Can cause resp depression GLucorticid: Indicated for asthma, SE: oropharlgen candidis, Fluticasone: How often should client use this medication Taken Daily Beta blocker: Antihypertension Indicated: lots SE: bradycardia Propanolol Exaccerbation of MI angina if abruptly discontinued Cholinsterase inhibitor: Indicated for severe alzheimers SE: nausea, gi bleed, dizziness, bronchochonrsitrciton Donepezil Take medication at bedtime, may cause vidid dreams, implement safety precautions ACE inhibitor For hypertension, and heart failure SE: persistent dry cough, hyperkalemia, Angioedemea Women should be taking good birth control, bad for pregnancy Abx For TB SE: hepatotoxicity Causes body secretions to turn orange Rifampin Assess liver toxicity: high LFTS, jaundice, dark urine light stools, RUQ pain Anticoagulant: for DVT prevention, ischemia, p Enoxaparin SE: bleeding, Antidote: protamine sulfate Med Surg: P 268 hemophillia and 267 Sickle Cell Anemia Hemophillia: monitor for episatis, teach self care, causes and prevention, assess for joint bleeding Genetic disease We need to give them clotting factors Recessive trait Prophylaxis factor a couple times a week If they fall, give them extra factor Sickle cell: Avoid injections and NSAIDS, manage pain, assess for S/S of infection. The RBC becomes sickled. RBC's carry oxygen, nice smooth surface, oxygen sticks to it When it goes through the body, it goes through very easily Ischemia of tissue, snd RBC's get stuck in the vasculature, deal with a lot of pain Morph T to manage sickle cell Oxygen R rest P pain H hydration T transfuse-temperature control RBC's, hemoglobin can be in 6-or 7 before they begin transfusions. Goal with management is to keep patients from going into a crisis H hydration O oxygen P pain management Culutre group-african American Planning activities that encourage energy conservation, tissue hypoxia, is prevented ny Instead of giving IV fluids, make sure they are actually in crisis before doing a therapy, goal is to encourage rest to make sure they are ok Injury hemophilia: place ice over injury, apply pressure if bleeding, keep above the heart, administer the clotting factors Blood Transfusion: 1 Unit of PRBC's 2 Before starting the blood, 3 Check with two nurses 4 Double check blood type 5 Specific blood consent form, Blood is a medication 6 Patient, unit of blood, blood bracelet, MRN, DOB,name 7 Run blood with normal saline ONLY 8 Use special blood tubing 9 Either y attachment or completely special tubing 10 20 Gauge or larger for administration 11 Informed consent 12 Baseline vitals by the nurse 13 Stay with patient 15 minutes beforehand 14 First 15 minutes Start rate a little slower, when 15 minutes over, increase the rate Vitals again, After 15minutes, check vitals every hour after this Nurse will do that, can delegate to an LPN Must be administered within 4 hours Stop if reaction occurs P 42 for more reading on blood Fureosemide: given Cholesterol should be less than 200 PT: 11-12.5 not on warfarin Aptt: 30-40 with treatment is 1.5-2x that level HCT: F 37-47 HCT M 42-52 HG 12-16 Angina/MI P 130 Review questions: Risks obesity, smoking, sedentary, CAD Family history Diabetes s/s: diaphoretic/chest pain, jaw pain, pale, grey, crushing Women and diabetes: Nausea, malaise, palpitations, Stable angina: relieved by rest and nitro Unstable angina is preinfaraction Prinzmetal's is caused by coronary artery spasm: In coronary artery is what causes the heart attacks, blood flow to that part of heart stops, ischemic tissue is very very painful In major coronary artery, this is when patiens die If lingering problems, if they hve stable angina, not best perfusion, may have ischemia at times, and that is why they have pain MONA Morphine treats pain, decreased preload and afterload Oxygen, need it even if they have 99%, always O2 given Nitroglycerin: improves coronary perfusion becauses dilates those coronary arteries, dilate those arteries to increase blood flow, headache can occurcan get general hypotension Aspirin: decreased clot formation, EKG: ST elevation Troponin, higher than 2, elevation Creatine Kinase Cath Lab, endarcectomy, radiographic dye, view the block, if can be removed, if caused by plaque, put in stent, do CABBAGE, coronary artery bypass if very occluded Misoprostol need to know Cytotek Given to patients who take NSAIDS and who have gastric ulcers Diarrhea is commob while taking this med Take the medication with food to min side effects Don't take antacids because they have magnesium which can make it worse Won't effect uterine bleeding Neg pregnancy test must be confirmed because it can cause contractions and pregnancy loss, If miscarriage, cytotek would be given in hopes to not have to do surgery. Don't ask about other medications, we aren't supposed to ask why,is threatening Estradiol: Monitor BP, mammograms should be taken every year Call provider if they experience bleeding Take this medication with food to reduce nausea Do not need to know first or second degree blocks Nurse won't ask you to identify the strip, will ask what caused it or what will you do EKG 129- and 138 Electrical system SA, AV, Bundle of His, Bundle Branches, Perkinje fibers Contraction of the QRS is the ventricles contracting/depolarization Look at 6-second strip P wave, QRS, and then the T Sinus rhythm Causes of sinus tach: Low blood volume Drugs, exercise, low BP, Fix these by improving cardiac output Treat the cause Sinus Bradycardia Causes-Vagus nerve stimulation, Beta blockers, Neurogenic shock Fix this with pacemaker, atropine-anticholinergic Too much beta-blockers Sinus syndrome Atrial fibrillation: Lots of unknown causes Risk factor of no treatment: blood clots, blood pools in atria, then is launched into vaculature Can try cardioversion Can try diltiazem Fluid Amiodarone On anticoagulants Sinus with PVC's Can be caused by random firing of the heart, anxiety, nicotine, premature ventricular contraction, not perfusing, feel skipped beat When they are too many Complete Heart Block Third Degree Fix this with a pacemaker Ventricular Tachycardia: Stable or unstable? Non symptomatic, awake, talking Unstable: decreased level of consciousness Cardioversion if they are awake, stable Use the synchronize button to make sure it shocks If unstable, defibrillate them V-Fib: d-fib as the treatment, not stable, pulseless Asystole: CPR, do not shock, 100 BPM Starting ACLS protocol If alert and oriented, cardiovert, don't defibrillate Exposure to a metal detector will not activate a Pacemaker Sets a rhythm for the heart to beat Stand against medical detector not as close, not longer than necessary Can go through medical detector, than can get out Talk on the opposite ear, present very small risk to the pacemaker Torsade's des points: give magnesium sulfate Signs of Right HF: JVD, elevated CVP (lots of fluid), edema, ascites, weight gain LSHF: dyspnea, fatigue, frothy sputum, bislarily crackles, elevated pressure of Pulmonary Aertery, S3 Gallop Respiratory interventions: Oxygen, fowlers, lung sounds, fluid management, I/O Medications, CVP: 2-10/12 is too high Cultural Jeapordy: Last test, wanted more cultural stuff in here ODDS are good we won't know NCLEX Jeopordy and pages provided Take for Enlarged prostate, pregnant women shouldn't take, : Saw Palmetto Take for prevention insomnia and anxiety/restlessness, Has an additive effect with and barbituates benzos, is valerian root Believes reincarnation: budhism Islam: practices Ramadan in 9thlunar month, Haram foods prohibited Manages jet lag and insomnia: may experience vivid dreams: melatonin Blocks ldld, raises hdl, lowers tryglycerides: garlic, increases risk of bleeding if taking NSAIDS Chinese: pregnant labor in silence, yin and yang Catholicisim: holy days fast Improves brain flow and improve memory, may decrease pain with walking Ginko biloba Treat mild depression, can cause serotonin syndrome with antidepressant: st johns wort Shaman, native amaerican culture. Jewish, yom kapur Acts as estrogen subsititue, treatsmenopause, don't take for more than 6 months: black cohosh G, interfere with anticogaulants: clients should consult if taking with NSAIDS: ginger, garlic, ginko, and ginseng Hot cold theory, first two days of postpartum strict diet, latino/Hispanic Vegetarian, fasting is common: Hinduism Final Jeopordy: Relieves anxiety promote sleep, can cause severe liver injury: Kava P 62, herbal supplements, use practice A to u Clonidine: Change positions slowly, postural hypotension can result, chewing sugarless gum can help dry mouth, Double check to see if medication should be stopped, medication should be taken at bedtime Risk for falls: Vision deficient, over 60 years of age, chest tube in place, weakness from a stroke Select all that apply: sinus rhythm with runs of v-tach Obtain vitals, assess electrolytes, administer Amiodarone Don't give bolus if no dehydration Hysterectomy surgery: Don't be concerned about urinary incontinence, not uncommon in surgery Over 101 we are concerned Endocrine: Diabetes (needs some review): Hypoglycemia symptoms: cold clammy, anxious confused, palpitations, hunger, blurred vision, weakness: treat with 6 oz orange juice, 15 g carbs Iv glucose/IM glucagon Hyperglycemia: Polydipsia, polyphagia, polyuria, fruity breath, kussmaul respirations, tachycardia Treat with Insulin DKA is caused by lack of insulin: TYPE 1 PROBLEM Acidosis, we try to breathe it out to get pH down, Ketones causes the fruity breath Dehydration from polyuria Regular insulin drip Replace electrolytes Can lose consciousness DKA: dehydration, hyperglycemia, and acidosis: will see this in UA HHS" Hyperglycemic hyperosmolar state (HHS) occurs due to insulin deficiency and profound dehydration. Fix this with lots of fluid, no ketones seen Priorities are airway, fluid volume, electrolytes, IV insulin P122. Review sick day plan, and foot care for Diabetes Chronic problems with type II diabetes: Nephropathy Neuropathy Retinopathy p. 124 Cushing's disease: pg. 116 Everything is opposite: Goal is to get to Euthyroidism Hyperthyroidism: Tigger, expathalamos, increased metabolism, methemsol, helps to calm the thyroid, or thyroidectomy Severe thyrotoxicosis, graves disease, and thyroid storm Euthyroidism: titrate to get to here Hypothyroidism: lethargic, cold intolerance, depression, everything slows down Iore: Needs doses of levothyroxine Myexedema coma: need IV levothyroxine Thyroid pg. 120 Pg. 119 Cushing's syndrome: caused by corticosteroids, Cushing's disease is too much steroids Addison's syndrome: deficit of these steroids: from adrenal gland Big S's: Cushing's Disease: Steroid, Sugar, sodium, and Skin Too much, too much, too much, potassium down, THIN SKIN Patients look like Central obesity, trunchal, moon face, swelling, hypernatremia, enhanced mood (overproduction of steroids), immunosuppression Little S's: Addison's disease Steroid-low, Low sugar, sodium low, hyperkalemia, Bronze tone to skin They need steroids: Kennedy had Addison's Cushings syndrome: taking corticosteroids Addison's crisis: prevent Addison's crisis: taper off the steroids to prevent addison's crisis Diabetes Insipidous, SIADH Review Too much or too little ADH hormone P. 117 SIADH is swollen like a tick: Syndrome of inappropriate antiduretic horomone Diabetes Insipidus, dry like a chip and salty What's that Med: Fill in the blank SVT antidysrthic: Adenosine, SE: bradycardia, dyspnea, hypotension, flushing Should expect that they convert to normal sinus rythym. Urinary retention nd dysuria to treat BPH: SE: decrease ejaculation and libido dutasteride Should not doate blood because it is tertagoenic a\wear gloves Atrial fibrillation to prevent coagulation: Warfarin: SE: bleeding Consistent intake of Vitamin K is ok For epilepsy, therapeutic: Phenytoin: 10-20 therapeutic Can cause steven Johnson syndrome For trichimonos infection Antiprotozoal: SE: nausea, dark urine, metallic taste, headache Metronidazole Don't take any alcohol with it, or mouthwash: Will have disulfiram like reaction, will cause vomiting, stomach cramping Muscle spams, central acting muscle relaxant: Cyclobenzraprine: don't take with MAOI's may cause hypertensive crisis, and seizures Heart failure med Digoxin Blood levels of Monitor for digitalis toxicity: Dig level and potassium level, monitor apical pulse cause it can cause bradycardia For antidepressant induced insomnia Trazadone Should be combined with other antidepressants and for insomnia Prescribed oral opioid analgesia Hydrocodone/acetaminophen Teach them to be careful about Tylenol, avoid driving, increase fluid fiber intake, avoid alcohol Asthma is instructed to take Leukotriene modifier Montelukast: prevent asthma SE: dizziness, gi disturbance, mood changes, suicidal ideation Make Medication med cards for these drugs Why taking Adverse effects Dietary modifications Important patient teaching Cirrhosis: Pg. 106 Liver problem Alcohol use, hepatitis, Medication overdose (rifampin, statins) Comorbidities: Portal hypertension, esophageal varicies, encephaltopahy, Clotting factor production impaired, it stores vitamins and nutrients, not stored well Ascites happens Altered nutrient and vitamin metabolism For these patients, watch LFT ALT/AST, vitamin supplementation Paracentis, lactulose to reduce ammonia, bleeding risk Spironolactone drug of choice, diuretic Assess fluid balance Measure girth: Diet, high calorie, low in fat, protein, and sodium, fluid restrictions To prevent hepatic portal hypertension, administer stool softeners daily to a patient This helps to prevent complications, not giving them a good diet Blood backs up into GI system, straining with bowel movements could cause esophageal varices to rupture, patient will bleed Can't clot very well (NSAIDS usually effect the kidney) Burn Care: p.163 Rescusitation Secure airway Fluid replacement Maintain comfort Maintain Body temperature Acute: Prevent infection High Calorie Diet Maintain Mobility Rule of 9's: Head 9 Back 18 Chest 18: abdomen 9/chest 9 R arm 9 L arm 9 R leg 18 L leg 18 Children Rule of 9 head and neck 18 Back 18 Chest 18 Arms 9 each Perineum 1 Leg 13.5 each Parkland Formula: For first 24 hours: from the start of the burn Lactated Ringer's 4 ml x kg x % of burn TBSA, give the solution warmed up ½ in first 8 hours ½ in remaining 16 hr. Need large bore IV's, ideally put a central line Urine output to monitor enough fluid 30ml/hr. is good Deduct any fluids given pre-hospital Make up for the lost time if not given since burn to hospital Have to get in 4 hours of 8 hours worth of fluid Fracture Complications: Fat embolus: onset usually wthin 12-48 hpurs, tachypnea, tachycardia, hypotension, hoxpia, crackles, thick white sputum, CXR, and infiltrate and Petechiae Interventions: Should be immobilized, cardiopulmonary assessment, respiratory support, pharmacological therapy, intubatiom, monitor and maintain fluid volume, emotional support, Give steroids Give oxygen and treat ABC's, then get Pulse OX, then give the methylprednisolone IV Compartment syndrome: S/S: 6 P's: Pulseless, pain with passive motion, paresthesia, pallor, pressure Unrelieved pain, paralysis, need to get oxygen to the tissue If no cast, relieve the pressure by cutting it open with a Faciotomy Make sure to assess the opposite extremity, Pulse should return If they have a cast, spaces need to be cut into the cast to allow the limb to breathe Leaves a scar Giant open wound Position extremity at the heart level Open or bivalve cast Pg. 112 NEVER LOOSEN AN EXTERNAL FIXATOR 414-3855817 PREVENTING AUTONOMIC DYSREFLEXIA: Encourage a high fiber diet and administer stool softeners, keep foley freek of tubing kinks Peritoneal Dialysis: Turn the patient side to side if there is bad return The dialysate solution should be returned that went in or close Don't advance the catheter into the abdomen Don't milk the catheter IF return is cloudy this might be an infection OB procedures: p 192-194 Relieves umbilical cord compression that results in variable decelerations: Amnioinufsion:infusion of warm isotonic solution when there is low amniotic fluid Determines if fetus is getting enough oxygen during labor: Fetal Scalp Sampling:assess pH pC02, obtained through dilated cervix, after membranes have ruptured The client is instructed to fill bladder prior to procedure: used to detect chromosomal abnormalities in the fetus, performed in first trimester 10-12 weeks, trans-cervically/abdominally, want the client to fill bladder to assist in assisted the catheter insertion, concern could cause spontaneous abortion, fetal limb loss, and rupture of membranes. Chorionic Villus Sampling Assist in determining fetal lung maturity and chromosomal disorders: Amniocentesis: assess for neural tube defects, or ultrasound and blood draw: Need to empty the bladder, lots of fluids given. Complications: maternal and fetal infection hemorrhage, PROM, Non-stress test: Performed in 3rdtrimester to evaluate fetal well being Go to hospital: fetal monitor, press baby every time baby moves, noninvasive procedure, fetal heart rate to movement Reactive is moderate variability No accelerations-non reactive-needs further assessment Decelerations pg 203: top line is fetal heart hate/100-160 Bottom line is mom: and contractions When baby heart rate dips, and moms contractions increase, this is good Early: mirror image, head compression, variation of baseline Late decelerations: Begin at or after the peak of contraction, inadequate fetal oxygenation, Turn on there side, need oxygen give a lot, contact provider IV fluid O2 Discontinue oxytocin, prepare for delivery if none of this works Variable contractions: Indicates fetal hypoxia and cord compression VEAL CHOP MINE pg 202 Preeclampsia: (gestationl hypertension) Hypertension after 20 weeks in pregnant woman Preeclampsia after 20 weeks, recognized by proteinuria, hypertension Intervene: BP and daily weight, urine protein, BUN, assess for edema, given antihypertensives but not lisinopril Eclampsia: includes the onset of seizure activity: Delivering the baby is the only cure Magnesium sulfate can be given to help control or prevent/treat hypertension Will be in hospital Intervene: patent airway, pad side rails, complete bed rest, decreased stimuli, mag sulfate ABG'S: 3 rules of compensation pg. 84 goal is to get pH back to normal Opposite compensation: If kidneys bad, lung compensate If lungs bad, kidneys compensate Uncompensated: ph and 1 other not within expected range Partially compensated: all 3 values are not within expected value range Fully Compensated: pH is normal, and the other are not ROME Resp ACID: Hypoventilation Dizziness, palpiations Metabolic Alkalosis: problems from belly button and out: vomitting Respiratory alkalosis: Hyperventilation Metabolic Acidosis: Below the waist, and out my acidosis: Diarrhea MANAGING THE UNDERLYING CAUSE: Rebreathe Bag: to treat Respiratory alkalosis when they are hypervnetiating Diphenoxylate atropine: antidarrheal: treat metabolic acidosis Nalaxone: given for respiratory acidosis Odansetron: Metabolic alkalosis Regular insulin: metabolic acidosis Hydromorphone: respiratory alkalosis, or respiratory acidosis Chest tubes: p. 90-91 Fixing fluid or air outside of the lungs in pleural lungs, for pneumothorax, tension pneumothorax, pushes structures to one side, problem in the lung table Gunshot, hemothorax, put chest tube into the pleural space Drain out blood, or release air if pneumo-tension pneumo Air got into the lungs from an air leak in the lungs Someone popped some of the alveoli, air would build up and push on the lungs, Chest tube releases all the air until it heals, to keep air and pressure out of the pleural cavity. May have low fluid if pneumo, lots of fluid if hemo, chamber 1 collects the draining from the client, counts in I's/O's Shouldn't see more than 70/hour Chamber 2, this is the water seal and prevents air from re-entering the pleural space If air leak, bubbles will be coming out, water seal doesn't allow any air back in If stops bubbling, healing may have occurred, and may be able to take out chest tube Chamber 3: suction control: like a vacuum, gentle bubbling is seen, pulls open the lung: if chest tube falls out and there is an air leak, while bubble get out, air can get back in, need to cover the hole with a dressing until new tube in Only cover the hole on three sides to let air out Intervene: monitor resp and O2 sat, monitor tubing for kinks Monitor characteristics of drainage Maintain occlusive dressing Assess for bubbling and tidaling Do not strip the tube Assess for trachea and alignment TIdaling: is just breathing in and out, the water rises and falls At bedside: gauze, bottle of sterile water, padded clamps if the drainage system becomes interrupted If bubbling in air chamber, monitor, nothing and update the provider Bubbling occurs in the middle chamber, check all secure connections Constant a lot of bubbling PE'S: p. 89-90 Dyspnea, restlessness, chest pain, diaphoresis, hemoptysis, Interventions: monitor for complications, may need to do interventional radiology,resp assessment, pain management, anticoag, thrombyltic, monitor Risk: oral contracpetives, smoking, pregnancy increases risk Receiving mechanical ventilation, high pressure alarm sounds, which acyion to take? High pressure alarm means that there is a need for suctioning tdue to resistance, is there a secretion in the way? Leak or break gives a low pressure Air escaping around the cuff would also be a high pressure alarm Bronchosopy: Actions to be done during assistance of a bronchoscopy with the provider. Monitor pulse ox, administer sedatives, label container for specimen collection Up in high fowlers Give sedatives Don't check gag reflux IS: High fowlers, inhale slowly, seal lips tightly around mouthpiece, use IS Q hour while awake Hold breath 3-5 second after inhalation Arterial Lines: Obtain manual blood pressure, recalibrate, observe arterial waveform pattern, put in radial artery, monitor arterial blood pressure, assess for occlusion at the catheter site. Don't flush with heparin. Waveform will be same as pulse/means good reading. Pharm: 12-18% of the NCLEX CHART 31-32 Ace Inhibitors: sfx pril: lisinopril, captopril, enalapril: SE: dry cough, angioedema Antivirals: sfx: vir: acyclovir, valacylovir, minimize outbreaks: Antifungals: azole - fluconazole, vorizonazole Antilipidemics: statin Atorvastatin, simvastatin ARB's: sartans can't take ACE inhibitors valsartan and losartan Beta blockers: olol metropolol, nadolol : heart rate and BP Calcium channel Blockers: dipine/diltiazem/: amlodipine, Nifedipine: control A-fib, if heart failure, can't use calcium channel blockers ED: afil, sildenafil, and tadalafil Histamine blockers: dine: ranitidine, famotidine, allergic response or Proton pump inhibits: prazole, pantoprazole, esomeprazole TPN: Is hypertonic solution Given if avoiding GI system PICC line, CVC, tunneled catheter (balloon inflates) TPN dressing change is done with Prepared daily: formula is changed a lot, draw labs everyday based on labs TPN is very expensive: one bag is 1,100 dollars. TPN: surgical asepsis dressing changes TPN blood glucose taken Q 4-6 hours New bag hung every 24 hours, set to run out at that time Hang a new filter with each bag, change the lines, the cap tubing, and bag Monitor: Digoxin monitor: potassium Acetaminophen: temperature Glipizide: blood glucose, type II only take it, type I only take insulin Morphine: respiratory rate, give naloxone for low RR Prednisone: Delayed wound healing Warafrin: INR Zolpidem: sleep patterns Olanzapine: Mood Levofloxacin: culture and sensitivity Digitalis Toxicity/furosemide: Hold furosemide if you feel week, speak to doctor right away Take these medications in the morning Notify your provider if you notice yellow or green halos around objects Dig tox: Take Digoxin as soon as remmebr if forgot Eat higher foods in potassium Review digoxin, make drug card Blurred vision, muscle weakness, NV, and irregular heart rhythm dig tox Diabetes Medications: Pg. 40 NPH: when mixed with regular insulin, draw this medication up last Eat as soon as it is given: Lispro, rapid acting insulin Hold med 48 before and after use of contrast dye: metformin Glargine insulin: subq and has no peak Medication used to lower K+ levels: Insulin regular via IV Onset peak and duration on pg 40 chart Magnesium Sulfate P. 61: Used for preeclampsia and eclampsia: Causes smooth muscle relaxation Monitor Deep tendon reflexes, measure Blood pressure, monitor respirations Closely monitored, ready with antidote to give: Calcium gluconate OXYTOCIN: Used for induction of labor, controlling bleeding after delivery Interventions: monitor FHR Monitor contractions Monitor BP, HR, RR Most a risk for late decels Which Medication can be given Prevent heart disease: atorvastatin Prevent MI or stroke: clopidogrel Slow progession of arthritis: etanercept Prevent urinary incontinence: oxybutynin Prevent rubella: MMR vaccine Lower blood pressure: valsartan Treat neuropathy: pregabalin Treat GERD: esomeprazole Treat Bipolar disorder: quetiapine Treat COPD: tiotropium Treat depression: duloxetine Decreases symptoms of herpes zoster: valacycolir Prevent bronchsoapsm: montelukast Sertraline: If patient is taking phenelzine, because it is a MAOI, contraindicated, can cause serotonin syndrome Weight gain and decline in sexual libidio is a common side effect Review antipsychotic medications Psychosis and Anti-Psychotics: Medications for CNS Pg. 54 Typical: haloperidol 1stgeneration Thiothiexene hydrochloride worst side effects Typical Antipsychotc SE: Sedation EPS Anticholingergic effects TD Agranulocytosis Neuroleptic malignant syndrome seizures Atypicals: olanzapine and aripiprazole SE: Lower risk of EPS and TD Added risk of weight gain, diabetes, dyslipidemia Agranulocytosis, seizure, orthostatic hypotension Nurse Review dietary journal Foods of concern: Phenelzine: avoid tyramine, cheeses, milk, aged meats, wine Beef Jerky should be of concern because it is aged cheese Antidotes matching: Naloxone: opioids Vitamin K: Warfarin Protamine Sulfate: Heparin Acetlcystine: acetaminophen Flumazenil: benzos Dixoin: digitalis Succimer: lead Calcium gluconate: magnesium In ATI, a mild nitrate is antidote for cyanide poisoning Mental Health: Toddler Fracture FACES Play a game to encourage wiggling of fingers Demonstrate wrapping the arm of a stuffed animal with a bndage Toddler communication: Self Management: Walk at least a minimum of 3 times a week is good information At routine 18 month old examination: discuss temperament, document hegith and weight, measure head circumference Mcburney Rinne and Weber test: can't be performed on toddlers Mental Health: Psychosocial integrity Showing signs of aggression and agitation: Eurnesis: is bed wetting, don't assess in toddler age child Major Depressive Disorder: Persistent: Lasts more than two weeks, causes significant change in functioning Priority Assessment: Suicidial ideation: Symptoms and interventions Symptom: flat affect-Observe, rather than ask Self-Neglect: Assist with ADL's Sleep Disturbances: implement bedtime routine Anorexia: frequently offer fluids and small snacks Allowed in a room Suicide: Yes-books Plastic bag- No shoelaces Assess: risk factors history of suicide in the family History of suicide attempts Changes from depressed to happy? Lack of hope or future Feelings of worthlessness One on one supervision Screen all gifts Clients hands always in view No glass or metal meal tray Schizophrenia: p. 178 Delusions Illusions Cycle: spectrum of disorders characterized by psychosis, Perceptions of reality wrong Usually onset in late teens or early 20's Prodrome: months or years before onset Acute: delusions, hallucinations, altered speech Stabilization: medications control symptoms, improved coping Maintenance: symptoms controls, baseline, adheres to medications better quality of life Shiczophrenia: Positive: delusions, derealization, echopraxia, hallucinations, catatonia Negative: anhedonia, anergia, avolition, alogia, flat affect Interventions: Ensure safety Establish trust, provide structured milieu Administer meds monitor SE Assist client to manage anxiety Don't argue about hallucinations, ask Don't argue about delusions Focus on reality Cogentin or diphenhydramine or benzotropine Can help with EPS Stress Management: Physical stressors Substance Use Disorder: Opposite effect of medication is the withdrawal effects Opioids: withdrawal, pg 182 Naloxone if overdose, methadone, naltrexone, or LAAM for withdrawal Stimulants: meth or cocaine Euphoria, anger, tachycardia, chest pain, seizures Withdrawal: depression, anxiety, irritability, hypoinesis, paranoia Interventions: Antipsychotics for buproprian for depression, and diazepam Alcohol: .8 or higher, intoxication, blackouts Withdrawal: cramping, vomiting, delirium tremens can occur in first 72 hours. Interventions: disulfiram, benzodiazepines, If plan to withdrawal, make sure that it is done over time If patient taking antipsychotics, Symptoms will stop when the medication is stopped Treated with benzotropamine, or diphenhydramine Theory of hot and cold pregnancy: When in hot state, want to eat cold foods, so eat cereal and milk, yogurt, and fruit Decreased academic performance Safety and Infection Control: FIRE: RACE: resuce, protected and evaluate client in immediate danger, Alarm activate and report C: contain the fire, close windows and doors Extinguish, use approved extinguishers A client reports smoke: Smoke coming from wall; Remove client, emergency response, close all doors, point extinguisher, squeesze the trigger Use PASS: point base, pull aim, squeeze and sweep Medication Errors: Prevention of med errors Six rights Three checks Clarify Identify the client Understand the medication Follow correct procedures for all administration routes If unclear? Call the provider? Repeat back the order Scan the wristband on the patient Scan the drug Incident reports: pg 12 An auditing mechanism that allows for the process improvement within the organization Documentt factual event in record Don't place in EMR Date of indcietn Objective details CDC recommendations Don't need to wear anything to pick up phone CDIFF: gloves and gown contact Droplet: Mask Doing to do a dressing change or go to bathroom, put on more things Airborn: n95 for TB and SARS Order of putting on stuff: gown, mask, goggles, gloves, enter room Meningitis: p.258 Lumbar puncture and blood cultures to diagnose: Prevention includes? Hand hygiene, immunizations, avoid contacnt and resp secretions Check brudzinski's sign Kernig sign Headache, stiff neck, and photophobia Do give abx Seizure preca Private room Living in dormitory increases risk of getting the disease: meningitis Adults don't typically have a lot of complications PROM: p. 208 ROM one hour before onset of labor is PROM Confirm it is amniotic fluid Vs q4 Nonstress test PPROM: rupture anytime before 37 weeks gestation Manage care: ABX, maintain bed rest, address psychosocial, biophysical profile, avoid vaginal exams Review biophysical profile Worried about infection, notify the provider with any sign of infection Cloudy amniotic fluid indicates infection in PROM Spesis septic shock pg. 135 Vascular changes, renal changes, CNS alterations Give Broad spectrum ABX, progress O2-intubation, fluids, inotropic medicatioms Monitor GFR, BUN and creatinine Prevent ventilator infection: tq2, frequent chand hygiene., clean oral suction Oral care with disinfectant Neonatal sepsis: S/S: temperature instability, lethargy, Intervention: cultures, ABX therapy, maintain hydration, ventilator support

Hypoglycemia: occurs in first few hours of life secondly to energy use

Newborns of clients who have diabetes are small or large for Ga, less than 34 weeks, or late preterm are at risk for hypoglycemia. monitor for jitteriness, twitching, weak cry, cyanosis, lethargy, eye rolling, seizures, and blood glucose lower than 40 by heel stick Have mother breastfeed immediately Brain damage can result if not corrected

Jehovah's Witness

No blood products should be used

Newborn findings

One umbilical vein, and two umbilical arteries, anterior fontanel should be larger than posterior and anterior is diamond shaped while posterior is small triangular shape Babinski reflex is present only till one year of age yellow sclera should not be seen acryanocanysosis is expected for 24-48 hours.

Nutritional needs of newborns

Optimal nutrition during the neonatal period supports newborn growth and development. Feeding also provides an opportunity for parents to bond with their newborn. Current recommendations are for exclusive breastfeeding for the first 6 months of life, followed by a combination of solid foods and human milk until 12 months of age. Parents may also choose to feed their newborn commercially prepared formula. To help parents make an informed decision, offer them evidence-based information about the nutritional needs of newborns, the benefits of breast milk, and the potential risks of formula feeding. Fluid and calories For their first 2 days, newborns need 60 to 80 mL of fluid per kilogram (kg) of body weight per day. For the next 4 days, they need 100 to 150 mL/kg/day. For the remainder of their first month, they need 120 to 180 mL/kg/day. They lose fluid through urination and respiration. It is essential to monitor their intake and output carefully, as they have little tolerance for fluctuations in fluid balance. Caloric intake, measured in kilocalories (kcal), provides energy for growth, physical activity, and metabolic function. For the first 3 months of life, infants require 110 kcal/kg/day. Each ounce of breast milk and of formula contains about 20 kcal. Increases in a newborn's appetite generally correlate with growth spurts. Parents usually notice these changes at 10 days, 3 weeks, 6 weeks, 3 months, and 6 months of age. During these times, they should increase the frequency or duration of feedings to accommodate their infant's nutritional needs. Breastfeeding Human milk offers many health benefits for newborns, including enhanced immunity, maturation of the gastrointestinal tract, and reduced risks of diabetes mellitus and childhood obesity. Advantages for the mother include reduced risks of ovarian and breast cancer, promotion of postpartum weight loss, convenience, and minimal cost. When helping a patient get started with breastfeeding, assess the newborn for feeding-readiness cues, including rooting, sucking motions, and hand-to-hand or hand-to-mouth movements. It is important to initiate breastfeeding when the newborn demonstrates these cues rather than waiting until he is sleeping or crying. The optimal time for initiating breastfeeding is immediately after an uncomplicated birth. Putting the newborn and the mother in direct skin-to-skin contact (kangaroo care) facilitates the first breastfeeding experience for the mother-infant pair. Common positions for breastfeeding are the cradle, the modified cradle or across-the-lap, the football or clutch hold, and the side lying position. Encourage your patient to use a position she finds comfortable and easily achieves latch, that is, a seal between the newborn's mouth over the nipple, areola, and breast that creates enough suction to remove breast milk. Encourage the patient to express colostrum to spread over her nipple. Then, have her support the breast with one hand while bringing the newborn's mouth to it with the other hand. Suggest that she gently stimulate the newborn's lower lip with her nipple to prompt him to open his mouth. As he does this and his tongue moves down, have her position him on her breast. Be sure his mouth covers the nipple and an area about 2 to 3 cm (1 inch) around the nipple. When the newborn has latched on and is sucking effectively, his chin, cheeks, and tip of the nose all touch the breast; his cheeks are rounded and not dimpled; and you can hear him swallow. His mother should feel a tugging sensation, not pain. The newborn's jaw should also move smoothly when he sucks. Breastfeeding patterns vary among newborns, but in general, they should breastfeed eight to 12 times in each 24-hour period, and they should not be restricted in the frequency or length of feedings. Although newborns are often sleepy during the first few days, parents should attempt feedings every 2 to 3 hours. After this initial period, when their newborn is feeding regularly and gaining weight, it is appropriate for them to shift to on-demand feedings. The duration of feedings also varies. Also, some newborns feed from one breast per feeding, while others switch easily during a feeding. For those who do not resume sucking when moved to the other breast, make sure your patient alternates breasts from feeding to feeding. Teach parents how to determine when the newborn is finished feeding. The breast(s) will feel softer, the newborn will suck slowly or release the breast, and he will appear content or will fall asleep. These cues help parents determine the appropriate duration of feedings. For parents who need to wake their newborn for feedings or during feedings, suggest these strategies. Unwrap the newborn's blanket. Massage his chest or back. Stroke the soles of his feet and the palms of his hands. Change his diaper. Sit him upright. Speak to him. Parents are often concerned that their infant isn't receiving enough nourishment from breastfeeding. Tell them to look for the following signs of adequate nutrition. Periods of contentment after feedings alternate with periods of wakefulness. The newborn feeds eight to 12 times in 24 hours. The newborn latches on easily and swallows audibly. The newborn has at least one wet diaper and one stool per day of life for the first 6 days of life; then six or more wet and dirty diapers every 24 hours after day of life 6. The milk supply is developing and filling the breast by the newborn's third or fourth day. Breasts are full before feedings, and the mother feels the let-down, or milk ejection, sensation during feedings. The newborn has returned to his birth weight by 10 to 14 days. Tell the parents not to feed their newborn formula or water unless there is some medical indication for it and it has been prescribed by the health care provider. They should also avoid the use of pacifiers for at least 1 month, when breastfeeding is well established. Expressing and storing breast milk Some patients wish to pump and store breast milk because of engorgement, to prepare feedings for others to give the newborn, or because they will be away from the newborn. This is also appropriate when the infant is premature or unstable and must remain in a neonatal intensive or special care unit after the mother goes home. Mothers can express breast milk by hand, with a manual pump, or with an electric pump. Instruct these patients to store their breast milk in glass containers or plastic containers or bags free of bisphenol A (a chemical that hardens plastics) with the collection date on the label. To prevent waste, they should store only 60 to 120 mL (2 to 4 oz) in each container and should use the oldest milk first. They may keep freshly expressed breast milk at room temperature for up to 8 hours and in a refrigerator up to 8 days. They may store breast milk in the freezer of a two-door refrigerator for up to 6 months and in a separate freezer up to 12 months. Tell them to place breast milk containers in the middle or the rear of the refrigerator or freezer, and to thaw frozen breast milk in running water or in their refrigerator, never in a microwave oven. Bottle feeding Parents of formula-fed newborns also need education and support for their choice and about the feeding process. They should use commercially prepared formula, either the powder, concentrate, or ready-to-feed type, for all feedings. Although manufacturers of infant formula provide detailed instructions for using these products, it is important to make sure parents understand how to use them. Bottle feedings should never be heated in a microwave. Have them hold their newborn in a semi-reclining position for all feedings. Propping of bottles during feedings can result in choking, tooth decay, and loss of interaction opportunities. Have them hold the bottle so that the nipple is filled with fluid, not air. Cues that the newborn is satisfied after feeding include turning his head away, stopping sucking, or falling asleep. Teach parents to recognize these cues to help prevent overfeeding and obesity. During and after each feeding, parents should facilitate burping because newborns swallow air during bottle feeding. Make sure they understand that they must discard any formula that remains in the bottle after a feeding. During the first 24 hours of life, newborns usually drink 15 to 30 mL of formula at each feeding. The amount gradually increases during the first week. Parents should feed them every 3 to 4 hours, with six to eight feedings in each 24-hour period. Instruct parents to wash bottles in warm soapy water using a bottle and nipple brush and then to rinse them thoroughly. They do not need to boil them unless there are environmental risks, such as an issue with safety of the water supply.

Steps of Leopold Maneuver

Palpate client's fundus, determine location of fetal back, palpate fetal part presenting at the inlet, and palpate the cephalic prominence to identify the attitude of the head

Americans with Disabilities Act

Passed by Congress in 1991, this act banned discrimination against the disabled in employment and mandated easy access to all public and commerical buildings.

Vaginal hematoma

Persistent vaginal pain, pressure

Testing for PKU

required testing, phenylketonuria. accumulation of phenylalanine can result in mental retardation Treatment in first two months can prevent mental retardation. Serum bilirubin should be collected upon discharge on all children

Good Samaritan Law

Provides limited protection to someone who voluntarily chooses to provide first aid, as long as not grossly negligent

Reportable diseases

Report HIV to local health department

carboprost for postpartum hemorrhage: is a vasoconstrictor

SE: hypertension, fever, diarreaha,

Questions to Ask Our doctor

Save maybe add later

CDC reportable diseases

STDs--i.e. syphilis, hepatitis, HIV cancer biological agents--i.e. anthrax, botulism food-borne and water-borne agents Anthrax Arboviral diseases (diseases caused by viruses spread by mosquitoes, sandflies, ticks, etc.) such as West Nile virus, eastern and western equine encephalitis Babesiosis Botulism Brucellosis Campylobacteriosis Chancroid Chickenpox Chlamydia Cholera Coccidioidomycosis Cryptosporidiosis Cyclosporiasis Dengue virus infections Diphtheria Ehrlichiosis Foodborne disease outbreak Giardiasis Gonorrhea Haemophilus influenza, invasive disease Hantavirus pulmonary syndrome Hemolytic uremic syndrome, post-diarrheal Hepatitis A Hepatitis B Hepatitis C HIV infection Influenza-related infant deaths Invasive pneumococcal disease Lead, elevated blood level Legionnaire disease (legionellosis) Leprosy Leptospirosis Listeriosis Lyme disease Malaria Measles Meningitis (meningococcal disease) Mumps Novel influenza A virus infections Pertussis Pesticide-related illnesses and injuries Plague Poliomyelitis Poliovirus infection, nonparalytic Psittacosis Q-fever Rabies (human and animal cases) Rubella (including congenital syndrome) Salmonella paratyphi and typhi infections Salmonellosis Severe acute respiratory syndrome-associated coronavirus disease Shiga toxin-producing Escherichia coli (STEC) Shigellosis Smallpox Syphilis, including congenital syphilis Tetanus Toxic shock syndrome (other than streptococcal) Trichinellosis Tuberculosis Tularemia Typhoid fever Vancomycin intermediate Staphylococcus aureus (VISA) Vancomycin resistant Staphylococcus aureus (VRSA) Vibriosis Viral hemorrhagic fever (including Ebola virus, Lassa virus, among others) Waterborne disease outbreak Yellow fever Zika virus disease and infection (including congenital) The county or state health department will try to find the source of many of these illnesses, such as food poisoning. In the case of sexually-transmitted diseases (STDs), the county or state will try to locate sexual contacts of infected people to make sure they are disease-free or are treated if they are already infected. The information gained from reporting allows the county or state to make informed decisions and laws about activities and the environment, such as: Animal control Food handling Immunization programs Insect control STD tracking Water purification

Newborn with plagiocephaly

Should wear customized prescribed 23 hr per day, this helmet decreased the pressure on the affected side of the skull They should sleep supine, and intermittently turn the head during sleep, every 2 hours. Don't place them in a swing, this can place pressure on the skull. Plagiocephaly: is normal asymmetrical shape of an infant's head caused by molding of skull shape due to positioning acquired during birth. At this time, the infants cranial sutures are not closed, which allows for molding of the cranium. Place the infant in prone position often.wear helmet 23 hours a day for three months.

five rights of delegation: transferring authority to perform a task while maintaining accountability.

right person, task, circumstances, direction and communication, and supervision and evaluation

Ineffective breastfeeding

Teach patient how to hand express breast milk and how to use an electric pump to increase production of milk Assess mothers technique Consultant referral if no improvement till after 24 hours

Nonstress test

Test to identify fetal compromise in conditions with poor placenta function Doesn't have to NPO, reclining chair or semi fowlers position is preferred, and it will take 20-30 minutes to administer the test

newborn bathing

The nurse should demonstrate how to bathe a newborn by using a head to toe, clean to dirty, approach. Therefore, the nurse should first wipe the newborn's eyes from the inner canthus outward using plain water. The nurse should then wash the newborn's neck by lifting the newborn's chin. Next, the nurse should cleanse the skin around the umbilical cord stump followed by washing the newborn's legs and feet. The last step of the bath should be to clean the newborn's diaper area. with newborn, daily bathing is not needed, and make sure to give sponge bath until umbilical cord comes off.

Epistotomy care after c section

Use a clean squeeze bottle with warm water to keep the site clean blot dry is best

Ultrasound prior to amniocentesis

Used to determine pocket of amniotic fluid and placenta to decrease risk of injury to the fetus

Moromons

church of latter day saints infant not baptised contraception at discretion of family abortion opposed in most cases accept in maternal circumstances death practice: od permit autopsyt good life continues after death dietary: alcohol coffee and tea prohibit fasting required once a month may use herbal remedies blessing the sick anoint them with oil by two elders

First trimester

Your patient's first question is likely to be about when her newborn will arrive. To calculate this, use Nӓgele's rule. Take the first day of the woman's last menstrual cycle, subtract 3 months, and then add 7 days and adjust the year as needed to make it a future date. So, if the first day of her last menstruation was November 20 of the current year, subtracting 3 months takes you to August, and adding 7 days and one year makes her "due date" August 27 of the following year. Many women develop "morning sickness" during early pregnancy; indeed, your patient might tell you that she does feel nauseated from time to time. Make sure she knows to report severe vomiting, as it could be hyperemesis gravidarum, a serious complication that involves weight loss, fluid and electrolyte imbalances, and nutritional deficits. Tell your patient to report abdominal cramping and any vaginal bleeding at all. In the first trimester, these could indicate miscarriage or ectopic pregnancy. Another major consideration during the first trimester is infection. Burning with urination could mean a urinary tract infection. Diarrhea could mean a gastrointestinal infection. And fever and chills could indicate a systemic infection. All require prompt reporting and intervention. Also instruct your patient to avoid taking any prescription or over-the-counter medications or supplements without first checking with her provider. Be sure she is aware of the dangers to her fetus from her ingestion of alcohol or other dangerous substances.

curare

a drug that blocks nicotinic acetylcholine receptors antidote is edrophonium

7th Day Adventists

abortion acceptable in some circumstances apposed to infant baptised death autopsy acceptable od good vegetarian encouraged alcohol coffee tea prohbit healing medical/and prayer prayer anointing with oil

christian science

abortion no good birth at home death: organ donation no good unlikely to get medical help to prolong life dietary: no alcohol medications and blood avoided healing ministers practice spiritual healing

complex partial seizure

amnesia may occur immediately prior to and after

Advoacy

caring, respect, empowerment, and autonomy.

Absence Partial Seizures

blank staring is associated with it

Defusing

discussion of feelings shortly after disaster Formal debriefing: discussion some hours or days after

Catholicism

don't do contraception, or sterilization no abortion require baptism death: priest administers last rights organ donation good may prevent burial in suicide dietary: ash wednesday don't eat meet during lent, fridays eat fish confession

Hemmorage newborn

ensure clamp is tight, second clamp should be applied if seepage of blood is noted

Internal disasters

events within the hospital that interrupt services and produce victims (e.g. utility interruption or chemical spill)

Breastfeeding

exclusively for first 6 months enhanced cog develop reduces risk of diabetes releases maternal oxytocin promotes partial weight loss promotes bone density Positions: use pilot: face belly to belly cover nipple 2-3 cm Chin nose should both be connecting firm pulling sensation eat 8-12 times in 24 hours C section: trans-abdominal disection Breech complication is most common reason Frank breach: knees extended and hips flexed Complete: hips and knees flexed footling: one or both feet presenting before buttocks risks of c hem aspir wound comp anesthesia c section: patient awake: spinal epidural gen anesthesia exceptional

Clonic

fatigue doesn't follow the seizure

organ donation

federal law specifies that a specially trained professional make the request and provide information regarding consent., provide emotional support and answer questions. Organ donation regulated by state and federal law.

Criminal Law

felony: serious crime Misdemeanor: less serious Civil law: Tort law: Unintential torts: negligence, malpractice Qausi intention torts: breach of confidentiality, defamation of character Intential torts: assault, battery, false imprisonment

Severe side effects of epogen

headache, report to provider, which could progress to a seizure

Nurse Practice Act

law established to regulate nursing practice varies state to state

Tonic seizure

loss of consciousness does not occur

autonomy

make one decisions

NG tube assessment

make sure to disconnect and listen for suction noises

Tonic clonic

may begin with aura

vulnerable populations

migrant workers, poor or homeless, victims of abuse, substance abusers, severe mentally ill, older adult, pregnant adolescents, people with communicable diseases

sponge contraception

non-hormonal should be moistened with tap water until foamy prior to use, it is impregnated with N-( spermicide. Fits over the cervix, one size fits all. Remain i place for six hours after sex, can keep in for 24 hours, wearing for 23-30 hours increases risk of toxic shock syndrome.

Justice

obligation to be fair to all people

Negligence

omission to do something that a reasonable person would do, or would not do

health care provider

only attending has admitting prividlidges

roles of nurse manager

planning, organizing, directing, controlling, staffing

Nursing care of children test

nephrotic syndrome: restrict sodium intake provide quiet activites Baclofen given to patient CP and in need of muscle spams relaxation Hemophillia: obtain blood through a venipuncture because it causes less bleeding than a finger puncture pull down and out and massage anterior part of ear following infant otic administration Lethargic mood is seen in hyperglycemia in children If hypoglycemia, will be irritable Children who have cystic fibrosis should receive stool softeners breath forcefully exhale through PEFM for one second, measure highest attempt of three attempts, wait 30 seconds between attemtps Children with JIA should use warm compresses, and should wear splints in the night to help prevent deformities. Brain tumors are associated with irritalibility, presistant headaches, vomitting, and clumsiness. Children with ADHD should have a consistent school schedule, and have verbal instructions with visual references to keep them interested. Important things to tell provider about severe asthma attacks are profuse sweating, because of status asthmatics, nasal flaring, distended neck veins, and tachypnea. MRI has no radiation, parent may remain in room with child when receiving an MRI. Severe dehydration in infants is absence of tears, sunken eyeballs, parched mucuous membranes, oliguria, and sunken fontanels, and hyperpnea. Add rice cereal to feedings to decrease episodes of infant vomitting. Your child will lose movement in their legs as they near closer to death. Universal consent form does not cover surgeries, must get informed consent Infant normal potassium level is 4.1-5.3, if low check an infant's creatinine Tachypnea in children is a moderate dehydration symptom Pertussis should be droplet precautions Elevate a child's limb for 24 hours following below the knee surgery, elevating for longer can cause hip contractures. Make sure to perform active and isotonic range of motion exercises. After percutaneous biposies, use pressure dressings. Use thermometer for rectal temp, points toward the umbilicus for infants, make sure they are placed side lying, supine, or prone , don't put it in more than 2.5 cm in the child to prevent injury. Phenytoin: observe for constipation, encourage them to brush teeth after each meal, give with meals. Cerebral swelling: complications include respiratory compromise and cerebral edema in the first 24 hours. a child of two years old should get 1 cup or 8 oz of vegetables everyday.

Seizure management children

risk factors: Genetic predisposition • Acute febrile state, especially among infants and children under the age of 2. • Head trauma • Cerebral Edema • Abrupt cessation of antiepileptic medications (AEDs) • Infection • Metabolic disorders • Exposure to toxin, such as lead and insecticides • Brain tumor • Hypoxia • Acute drug and alcohol withdrawal • Fluid and electrolytes imbalances • Triggering factors - Increased physical activity - Excessive stress - Overwhelming fatigue - Acute alcohol ingestion - Exposure to flashing lights - Specific substances (alcohol, caffeine, cocaine, aerosols, and glue products)\ Use of EEG: keep airway, administer sedative prior to procedure: wash hair before and after, if prescribed, hold sleep prior to test, abstain from coffee several hours before, will not be painful Diagnostic: EEG MRI

Umbilical cord postpartum

should blacken by third day, harden by third day, wharton's belly at the tip of umbilical cord is present at day 2 before hardening, if if red at base, purulent drainage, and foul order, this could be an infection, notify the provider.

Talking bad about someone is a tort

slander

LPN

supervised by provider or RN

Confidentiality

the act of holding information in confidence, not to be released to unauthorized individuals

fidelity

to keep promises, be faithful to agreements

Assigning

transferring authority, accountability, and responsibility of a client care to another member of health care team

veracity

truthfulness

Hypokalemia signs and symptoms

weakness and fatigue muscle weakness nausea and vomiting intestinal distention decreased bowel sounds decreased deep tendon reflexes ventricular dysrhythmias paresthesias weak, irregular pulse

Newborn specimen collection

ensure newborn has regular feedings for at least 24 hours prior to testing use capillary blood from heel stick, not urine universal screening is mandated by law Premature newborns have delayed development of liver enzymes and can cause false positive results

Vital signs should be assessed

every 30 minutes x 2, every 1 hr x 2, and then every 8 hour HR will stabilize 30 minutes after birth at 100-120

decreased fetal movement indicates

fetal distress

Betamethasone is a

glucocorticoid given to stimulate fetal lung maturity and prevent respiratory distress

Newborn temperature

greater than 37.5 or 99.5 can indicate sepsis meconium can be passed between 24-48 hours pink tinged urine indicates uric acid crystals and is expected during first week following birth Erythema toxic is rash anywhere on newborn expected between 24-72 hours after birth and lasts 3 weeks, this has no needed treatment

Symptoms of gestational hyperglycemia

increased urinary output, NV, reports of thirst, abdominal pain, constipation, drowsiness, and headaches: weak rapid pulse, fruity breath, urine with sugar and acetones, and BG of greater than 200

Cocaine use

increases the risk for vasoconstriction and possible abruption placenta-but not preeclampsia, maternal bradycardia, and placenta previa

Abdominal cramping at 11 weeks gestation can

indicate ectopic pregnancy or spontaneous abortion

Positive contraction stress test

is a bad finding, conduct a biophysical profile to further evaluate. A Kleinbauer Bete test assesses for fetal blood amount in maternal circulation where there is risk of Rh-isoimmunization Cordocentesis: used to identify fetal blood type of RBC and when there is risk of isoimmune hemolytic anemia.

Maternal Alpha Fetoprotein AFP

lab test to assess for neural tube defects or chromosome disorders

Client on heparin with thrombophlebitis

maintain on bedrest and give warm compress

cyanide posining antidote Digitalis ethylene poisoning Heparin and enoxaparin iron Lead poisoning magnesium sulfate Narcotics Warfarin

methylene blue Digoxin immune FAB fomepizole protamine sulfate deferoxamine succmyer calcium gluconate Naloxone Vitamin K (Phytonadione)

Resp distress newborn

nasal flaring, retractions, grunting, gasping, labored

During non stress test

place mother in lateral position

Circumcision in newborn

should not be done right after birth, because they have low vitamin K which can cause bleeding, usually performed in first few days of life

Assessment on neonate

stroke the spine and neonate moves pelvis toward stimulated side: Galant reflex is this ability, develops at 20 weeks gestational, and stays for 9 months.

Progesterone serum level

taken to determine if client is pregnant or if ectopic pregnancy is present

sacral dimple

-an opening in the skin over the distal spine May be caused by spina bifida occult, a common neural tube defect in which bones around the meninges and spinal cord failure to close during gestation. M

At 26 weeks gestation

1 hr glucose tolerance test should be below 130, abnormal is 130-140 or above, and is a positive test. Hematocrit during pregnancy of 33 or above is expected

Accelerations during a vaginal exam can be

10-15, normal, and in some cases, up to BPM

Aminophylline therapeutic level?

10-20 mcg/mL

Normal range of head circumference newborn

13.75 inch is idl, 35 cm is average half Body length in cm plus 10cm

School Aged child accepting a newborn

Giving a gift to school aged child from the newborn is appropriate

When using oxytocin to stimulate uterine contractions

use an infusion pump, monitor BP and HR, and monitor the FHR continuously, do not interrupt oxytocin unless contractions persist for more than 1 min, or occur more often than 2-3 minutes, only ever increase gradually, oxytocin is produced by the posterior pituitary gland used for postpartum hem, incomplete abortion, indcution Implications include: look for signs of water intoxication which include drowsiness, confusion, headache, and anuria monitor for hyponatremia, and hypochloremia in mother

Late decelerations

uteroplacental insufficiency

VBAC (vaginal birth after cesarean)

vaginal birth of an infant to a woman who has had at least one previous cesarean delivery. increases risk of uterine rupture, they shouldn't undergo induction, Uterine rupture is characterized: constant abdominal pain, abnormal fetal heart rate rate patterns most commonly bradycardia, loss of fetal station, and cessation of uterine contractions.

Heartburn in pregnancy

very common, and causes by back flow of stomach contents into esophagus, pregnant patient should avoid spicy foods, eat smaller portions, and more frequent meals.

Orange juice has

vitamin C, Potassium, and Folate, can have vitamin D which can help absorb Iron

an Indirect Coombs test determines

whether the client has antibodies to the rh antigen. determines Rh incompatibility.

Normal Newborn Vitals/weight and height

45-55 cm in lengt-17.7-21.7 inches 5.5 lb to 8.8 lb or 2500 4000grams 30-60rr 97.7 -99.5 f 37 c-36.5 37.5 HR: 110-160 protein should be less than +1 From gestational weeks 18-32= to cm or plus minus 2 cm. DTR should be +2 Hgb in pregnant client should be greater than 11 g/dl: get order for ferrous iron if below 11, because of anemia.

Nutrition changes pregnacy

600 mcg folic acid to prevent neural tube defects daily should increase by 340 cal during second trimester, and 452 calories during third trimester consume 3 Liters a day Increase protein to 71 gras each day during 2nd and third trimester

Expected findings in newborn

Acryoncanyosis: normal 24-48 hours after birth Transient Strabismus: normal variation that can persist until three to four months of age Jaundice in first 24 hours is associated with ABO incompatability, hemolysis, or Rh- immunization. Nurse should report to provider. Caput succedaneum is benign, edematous area of scalp commonly found on occiput.

Apgar scale

Apgar scores between 0 and 3 reflect severe distress. Scores of 4 to 6 indicate moderate difficulty with extrauterine life adjustment. Scores of 7 to 10 indicate that the newborn is adapting adequately to extrauterine life. If a newborn needs resuscitation immediately at delivery, initiate it before 1-minute Apgar scoring. Be certain to check all resuscitative equipment prior to the delivery to make sure it is functioning properly, and to document your findings and interventions in the newborn's medical record. Apgar Scores012Heart rateAbsent< 100> 100Respiratory effortAbsentSlow, weak cryGood cryMuscle toneFlaccidSome flexionWell-flexedReflex irritabilityNoneGrimaceCryColorBlue, palePink body, cyanotic hands and feet (acrocyanosis)Completely pink Make selection below: Auscultating fetal heart rate Gestational age assessment Leopold maneuvers Measuring fundal height Newborn care Nonpharmacological pain management Nutritional needs of newborns Postpartum assessment Pregnancy Apgar scoring

OTA combined contraceptives SE

Depression is a side effect: amenorrhea, weight gain, headaches, nausea, breakthrough bleeding, and breast tenderness

Circumcision actions

Have newborn on radiating heat bed, use anesthesia, assess for bleeding post procedure: q15-30 for first hour, hourly next 4-6 hr remove from restraining board, apply gauze to penis liquid acetaminophen 15mg/kg PO 14-6 don't allow bottle feed 2-3 hours prior, can breastfeed prior to procedure apply potrelum jelly to penis 24 hour with clamp procedres change diaper every 4 hours clean penis with warm water circumcision should heal within a couple of weeks

Proper bathing of newborn

Head to toe approach: clean to dirty newborn eyes, neck, umbilical cord, legs and feet, and then most dirty, perineal area

leopold maneuver explained

For your patients who are pregnant, Leopold maneuvers comprise a stepwise method of abdominal palpation you can use to determine the number of fetuses, the presenting part, the fetal lie, the fetal attitude, the fetal position, the degree of the descent into the pelvis, and the best location for auscultating fetal heart tones. That location is the point of maximal intensity (PMI) of the fetal heart rate on the patient's abdomen. The four Leopold maneuvers are: Identifying the fetal part in the uterine fundus to determine fetal lie and the presenting part Palpating the fetal back to identify fetal presentation Determining which fetal part lies over the pelvic inlet to identify fetal attitude Locating the fetal cephalic prominence to identify the attitude of the head Begin the procedure by asking your patient to empty her bladder so that she won't feel any discomfort during palpation. Position a small rolled towel under one hip to shift her uterus away from large blood vessels and thus prevent supine hypotensive syndrome. If you are right-handed, stand on the patient's right side facing her. Use the flat palmar surfaces of your fingers to perform Leopold maneuvers. For the first maneuver, face your patient and place both hands on her abdomen, cupping your hands around the fundus or the top of the uterus. Palpate for the fetal part that occupies the fundus to help identify fetal lie and presentation. Feel for shape, consistency, and mobility. The fetal head will feel firm and round. The breech, that is, the buttocks and legs, will feel softer and less defined. For the second maneuver, position the palms of your hands on the side of the patient's abdomen. Use the palmar surface of one hand to locate the fetal back and the various irregularities to identify hands, feet, and elbows. The fetal back will feel smooth and hard. The smaller fetal parts, such as the hands, feet, and elbows, will feel like irregular nodules when you palpate them. This also helps you identify the fetal presentation. For the third maneuver, use your dominant hand to grasp the lower section of the patient's abdomen between your index finger and thumb and press inward over the inlet to the true pelvis. Note any movement and determine whether the presenting part is soft or firm. If there is movement, the presenting part is not engaged. If the head is the presenting part, determine fetal attitude, that is, whether the head is flexed or extended. For the fourth maneuver, face the patient's feet and place both hands on both sides of her uterus. Outline the fetal head with your fingertips. Palpate both sides of her abdomen to determine the cephalic prominence, or brow. Note that this maneuver applies only to cephalic presentations. If you find the cephalic prominence on the same side as the feet, hands, and elbows, the head is flexed and the vertex is presenting. If you find the cephalic prominence on the same side as the back, then the head is extended and the face is presenting. After the procedure, assess the patient's response and then assess fetal well-being. Do this by checking the fetal heart tones and by noticing any changes in fetal position. Document the procedure and discuss the results with your patient's provider.

Review questions Maternal Newborn ATI ​Infant safety is a priority concern for the nurse. What measures can the nurse implement to prevent infant abduction? ​What are indications for amniotomy? Identify one (1) post-procedure intervention. The nurse is assessing a client at 20 weeks gestation for risk factors for preeclampsia. Provide three (3) risk factors that increase the risk for preeclampsia.Suggested learning activity: Gestational Hypertension A nurse is caring for the family of a newborn. What are some interventions the nurse can use to facilitate sibling acceptance of the newborn?Suggested Maternal Newborn Learning Activity: Restorative Stages of the Postpartum Period / Bonding What is one nonpharmacological measures that the nurse should implement to manage pain for labor clients during the latent phase of labor? A nurse is caring for a client who has tested positive for Group B Streptococci. What medication should the nurse anticipate administering to this client?Suggested Maternal Newborn Learning Activity: TORCH Screen The nurse reviews the following in the medical record of a 2 day post cesarean delivery postpartum client. Temperature of 101° F, heart rate of 110, complaints of chills, incision with erythema in the center, and WBC count of 25,000 mm3. What are three (3) priority actions that should be implemented?Suggested Maternal Newborn Learning Activity: Postpartum Infection A 6-week gestation client enters the emergency department with complaints for unilateral stabbing pain and tenderness on the lower right abdominal quadrant and red vaginal bleeding. The provider suspects an ectopic pregnancy. The provider orders methotrexate. What teaching should the nurse perform related to the administration of methotrexate? A nurse is completing an Apgar score on a newborn. What is assessed when obtaining an Apgar score? What does a score of 5 indicate? The nurse is reviewing the postpartum mother's complete blood count (CBC) at 24 hours after delivery and notes a white blood cell (WBC) count of 15,000 mm3. What action should the nurse take? A nurse is providing client education regarding the advantages and disadvantages of intrauterine devices. What information should the nurse include?Suggested Maternal Newborn Learning Activity: Contraceptives​ A nurse is caring for a client undergoing a contraction stress test. What is a negative (normal) finding? What is a positive (abnormal) finding? The nurse is monitoring newborns in the nursery. What two (2) priority complications and the associated findings would the nurse report to the provider upon admission to the nursery?Suggested Maternal Newborn Learning Activity: Normal Newborn Physical Assessment Identify three (3) adverse effects of terbutaline that can be a complication to the laboring client.Suggested Maternal Newborn Learning Activity: Uterine Stimulants A client is in her third trimester is bleeding and placenta previa is suspected. What are two (2) expected findings with this condition?Suggested Maternal Newborn Learning Activity: Placenta Previa and Placenta Abruptio

Prevention of abduction includes using two identifiers, using ID bands on the wrist and ankle, have all employees use ID photo badges who handle care (instruct patient to ask to see them), check the ID band with the mother, electronic record, and baby to make sure they match. Don't leave the baby unattended. Amniotomy can be used for Dystocia, or dysfunctional labor, which is labor that is affected by a deficit in the passenger, passageway, powers, position, and psychologic response. It is used to augment labor, often with oxytocin. It is also used to help provide internal fetal scalp monitoring. One of the most common complications is prolapse of the umbilical cord after an amniotomy. Make sure to have the patient void regularly to empty the bladder afterwards. Three risk factors that increase chance for preeclampsia: maternal age younger than 19, older than 40, extreme obesity, chronic hypertension, rheumatoid arthritis, chronic renal disease. Faciliating acceptance of the newborn: take the sibling on a tour of the OB unit, let sibling be one of the first to see the infant, provide a gift from the sibling to the infant, arrange for parents to spend time with the other, allow other children to help provide care, provide preschool aged children with a doll to care for. Non pharm methods during latent phase of labor: First stage of labor (latent phase): visceral: dilation, effacement, stretching of cervix, contractions of uterus with uterine ischemia interventions include gate control theory methods, that only a certain amount of pain signals can be sent at a time, so filling up those signals with other stimuli will help reduce pain: Therapeutic touch, doula training, and breathing techniques can help. Second stage: somatic, based on fetal descent and expulsion: lacerations of soft tissues, pressure on pelvic structures, burning and tearing, Third Stage: pain from expulsion of placenta is similar to the first stage, uterine contractions, pressure on pelvis, Fourth stage: distension of vagina and perineum from second stage Group B streptococcus medication management: administer abs prophylaxis to a patient who has GBS positive screening, client with unknown GBS who is delivering less than 37 weeks, client who has fever of 38C (100.4) or greater, and a client who has rupture of membranes for 18 hrs or longer Penicillin G or ampicillin are used. Penicillin 5 million units IV bolus, followed by 2.5 million units intermittent IV bolus q4 during intrapartum period. Ampicillin can be 2 g iv, followed by 1 g q4. Postpartum infection 3 interventions: Wound care, IV antibiotics, provide sits baths, perineal care, warm or cold compressed. Change pads from front to back, perform hand hygiene prior and after perineal care. When giving methotrexate, make sure to avoid giving it with folic acid in order to prevent a toxic response to the med, and use protection against the sun. APGAR SCORE: COLOR CRY/RR MUSCLE TONE HEART RATE REFLEX IRRITABILITY and a 5 would indicate moderate distress, meaning there should be intervention to make sure the baby is adjusting appropriately. If the WBC IS 15,000 after delivery, I would look for signs of infection and where it is coming from, whether the breasts, wound, perineum, or other location. advantages and disadvanatages to IUD's: 3-10 5-10 year effectiveness, can be placed while breastfeeding, can be reversed with immediate return to fertility, doesn't interfere with spontaneity, hormonal IUD's decrease menstrual pain and heavy bleeding, copper IUD has no hormones, so its safe for clients who shouldn't use hormonal birth control methods. Disadvantages: can increase risk of PID, or ectopic pregnancy and can be expelled, doesn't protect from STI's, hormonal IUD cause spotting, headaches, irregular bleeding, depression, and breast tenderness. Contraction stress test positive and negative: The test must be delivered by nipple stimulation or oxytocin, and a pattern of at least three contractions within a 10 minute time periodd with a duration of 40-60 second each must be obtainied for assessment. Negative means that within 10 minutes, with three uterine contractions, there are no late decelerations which indicate uteroplacental insufficiency, so this is a positive finding. With a positive test, this is indicated by persistent and consistent late decelerations with 50% or more of the contractions suggesting uteroplacental insufficiency, variable indicate cord compression, and early is head compression. Based on findings, the provider would either induce labor or perform a cesarean birth. Upon admission to nursery two primary complication priorities to look out for: Respiratory distress syndrome, asphyxia, and meconium aspiration, as well as hypoglycemia are things to watch for. Surfactant deficiency and atelectasis can occur in RSD, and can result in severe complications such as infection, pneumothorax, etc. Expected findings to report would be nasal flaring, expiratory grunting, retractions, fine crackles, cyanosis, and decreased responiveness and poor biophysical profile. Hypoglycemia findings include bg outside of 30-60 in first three days, so below 30, so poor feeding could be present, jitteriness, hypothermia, weak cry, flaccid muscle tone, seizures, cyanosis, apnea. Terbutaline: beta adrenergic agonist used as tocolytic that relaxes smooth muscles and inhibits uterine activity. Monitor for adverse effects of palpitations, chest pain, hypotension, pulmonary edema, tachycardia, dysthymia, discontinue if these effects are unmanageable. Placenta previa expected findings: Painless bright red vaginal bleeding in second or third trimester, uterus soft, relaxed, contender, fundal height greater than expected, fetus in breach or traverse position, vitals normal, decreased urinary output.

C section guidelines

ab exercise 4-6 weeks after c section Can have sex (2-6) weeks once the incision has healed and bleeding has stopped encourage waiting till after 6 week follow up before resuming sexual activity

Newborns should void once in first 24 hours

and 6-8 times per 24 hours after day 4 meconium should be passed within 24 hr-48 hours after birth, then will pass 3-4 times a day should have three stools a day for first month ammonia in urine can cause diaper rash Diaper wipes with alcohol avoid

Monitoring temperature in the newborn

axillary less than 36.5 or 97.7 F Hypo should be between 36.5 and 37 97.7 and 98.6

Mongolian spots

bluish purple spots of pigmentation

4 concepts from focused review: preventing abduction Postpartum infection: Presumptive signs/expected changes in pregnancy: Contraceptive devices:

Two identifiers must be used, on wrist and ankle with ID band right after birth, and it should include the name, sex, date, and time of birth, and MRN. Footprint and thumbprint should be taken. Always check the baby's wristband with the mothers and the clients medical record, always have photo ID badges. Postpartum (28 days after birth) infection should be suspected when there is a fever of 38 C (100.4 F) or higher in the first 24 hours, or for two days during the first 10 days pp period. Mastitis is one of these infections: which is milk stasis, caused by a blocked duct, engorgement, or a bra with an underwire, as well as cracked nipples, and other causes: Expected findings (enlarged axillary aden-patchy in the affected side) are painful or tender localized hard mass, influenza manifestations, fatigue, Interventions for this patient include: proper hand washing prior to feeding, frequent change of breast pads, allows nipples to air dry, proper infant positioning, completely empty each breast with each feeding, use ice or warm packs on affected breasts for comfort, manually express milk if too painful, rest and have a fluid intake of 3000 ml per day, complete entire course of prescribed antibiotics. Staph aureus causes the infection. Presumptive signs are signs that a patient feels that may make her think that she is pregnant, but could be signs of other physiological responses. These can be objective or subjective. Amenorrhea, fatigue, nausea and vomitting, urinary frequency, breast changes, quickening (which usually occurs at 16-18 weeks_, and uterine enlargement. Probable signs: sings made by an examiner that make them suspect that a client is pregnant: abdominal enlargement, Hegar's sign: softening and compressibility of lower uterus, chadwick's sign: deepened bluish color of the cervix and vaginal mucosa, goodell's sign: softening of the cervical tip Ballottment: rebound of unengaged fetus Braxton Hick's contractions: false contractions that are painless, irregular, and relieved by walking Positive pregnancy test: fetal outline, determined leopold maneuver Positive signs: fetal heart sounds, visualization through ultrasound, and fetal movement experienced by professional examiner. HCG can be expected 7-8 days before expected menses. HCG peak at 60-70 days, declines around 100-130 days, and then remain at lower level for remained of the pregnancy. ovum can be fertilized 24 hours after ovulation, and sperm can fertilize ovum over a period of 48-72 hours. Calendar method: count first day of menses for a period of at least six menstrual cycles: start of fertile period is determined by subtracting 18 days from the number of days in the shortest menstrual cycle, end is determined by subtracting 11 days from number of days in the longest cycle. Diaphragm: properly fitted by a provider, replace every 2 years and refit for 20% weight fluctutation, and after every pregnancy, must be inserted 6 hours prior to intercourse and kept in 6 hours after intercourse, do not leave in for more than 24 hours, applied with spermicide or cream around the cervix. IUD: chemically activee T shaped device that is inserted through the cervix and placed in the uterus by a provider. It release substance that damages sperm in transit to the uterine tubes and prevents fertilization. It is a Long acting reversible contraceptive. Can be used by nulliparous and multifarious women. Signed consent is needed for the procedure, device must be monitored monthly by clients after menstruation to ensure presence of small string that hangs from device in the upper part of the vagina to rule out migration or expulsion. Pregnancy, pap, and cervical cultures should be negative prior to insertion. if pregnancy is suspected after IUD placement, sonogram may be needed to rule out ectopic pregnancy.

Failure to Thrive infants will exhibit

poor eye contact, uncoordinated movements, decreased muscle tone, decreased tear production poor nurturing or imbalanced nutrition

Fundal Height measurement

During the second trimester, the uterus becomes part of the abdomen, a development that makes it easy to assess fundal height. The duration of pregnancy at this time generally correlates with the height of the fundus above the symphysis pubis. From weeks 20 to 32, the number of centimeters of fundal height is just about equivalent to the weeks of gestation. Thus this measurement can help you assess fetal growth and estimate gestational age. After 32 weeks, it may no longer as accurately reflect the gestational age as the fetus is growing more in weight than in length. Make sure the patient has emptied her bladder because a full bladder can change the measurement by as much as 3 cm. Have her lie supine with her head slightly elevated on a pillow, or her knees in a flexed position, or both. Be sure the patient's position is the same for each fundal height measurement, and ideally the same clinician should measure the fundus each time. Using a disposable metric tape measure, note the distance from the symphysis pubis to the top of the fundus. The result in centimeters is a rough estimate of gestational age. Fundal height measurements below the estimated gestational age might suggest a miscalculation in due dates, intrauterine growth restriction, or a fetal anomaly. Measurements above the patient's gestational age might indicate hydramnios, a large-for-gestational-age fetus, a miscalculation in due dates, or a multiple pregnancy.

Proper bulb use

compress bubble before putting it in one side of mouth avoid center mouth first, then one nostril then second nostril

auscultating FHR

Toward the end of the first trimester, usually around the 10th or 11th week of gestation, it is possible to hear fetal heart rate with an ultrasound fetoscope or stethoscope. A regular stethoscope or fetoscope can detect and transmit fetal heart sounds at 18 to 20 weeks and beyond. To auscultate fetal heart rate, apply conductive gel to the patient's skin, then position the device at midline just above the symphysis pubis and apply firm pressure. If you do not detect heart rate right away, move the device around the abdomen slowly until you hear them. Count the fetal heart rate for 1 full minute, listening to its quality and rhythm as well. Inform the provider immediately if you cannot hear the fetal heart. Fetal heart rate are difficult to hear when a patient has an excessive amount of amniotic fluid (hydramnios) or excessive subcutaneous fat in the abdomen. For optimal hearing later in the pregnancy, use abdominal palpation (Leopold maneuvers) to determine the position of the fetus. Placing the ultrasound device over the fetal back often improves the ability to hear the heart rate.

Misoprostol

can administer oxytocin no sooner than 4 hours after last dose of M, oxytocin can be given to clients who have ervical ripening and have not begun labor, patient should void prior to receiving, remain in side lying position for 30-40 minutes after it is given, avoid giving with antacids. Given for viable or for termination if not viable in second trimester.

Lecithin/Sphingomyelin (L/S) ratio

done with amniocentesis to determine fetal lung maturity

Amniocentesis

if at 15 weeks gestation, and is Rh negative, they should receive a Rh immune globulin, but FHR should be checked immediately after the procedure

Suspected placental abruption

nurse should expect a prescribed Kleihauber Betke test to determine if fetal blood is in maternal circulation. Determines if Rh- immune globulin therapy should be administered to a client who is Rh-negative.

third trimester

During the third trimester, when women are preparing for the birth of their baby, they will want to know how they can tell the difference between "true" and "false" labor. During true labor, your patient will have regular contractions that gradually become stronger and closer together. She will feel the pain of true labor in her lower back, and it will move forward across her lower abdomen. Her cervix will dilate and efface, and as the cervix dilates, she will pass what is called a bloody show vaginally and feel the baby moving down into the birth canal. With false labor, contractions are usually irregular, although they can be regular for short periods. Walking and other activities will stop false labor, as will comfort measures and hydration. (These do not stop true labor.) And of course, with false labor, the cervix does not dilate and it does not efface. The previous danger signs still apply, although after 37 weeks, ruptured membranes are likely to signal an imminent onset of term labor and not a danger sign of preterm labor. Make selection below: Auscultating fetal heart rate Gestational age assessment Leopold maneuvers Measuring fundal height Newborn care Nonpharmacological pain management Nutritional needs of newborns Postpartum assessment Pregnancy Apgar scoring Make a SelectionAuscultating fetal heart rateGestational age assessmentLeopold maneuversMeasuring fundal heightNewborn careNonpharmacological pain managementNutritional needs of newbornsPostpartum assessmentPregnancyApgar scoring

Capillary refill stick

heel stick that occurs within 24 hours of birth, to be accurate, baby must have must have received breast milk or formula for 24 hours after birth

Cold cabbage leaves

help with reducing pain in patient who is breastfeeding: 15-20 minutes, repeat 2-3 times as needed in a day.

Carbamazepine

5-12 digoxin: .8-2.0 gentamicin:5-10 Lidocaine: 1.5-5.0 meq lithium: 0.4-1.4 mag sulfate: 4-8 phenobarbital: 10-40 mcg salicylate: 100-250 mcg theophylline: 10-20 mcg tobramycin: 5-10 mcg Trough drug levels: Gentamacin 1-2 mcg Tobramycin: 1-2 mcg Vancomycin: 15-20 mpg/ml Toxic drug levels: Acetaminophen: >250mcg aminophylline: greater than 20 mcg Amitryptline: greater than 20 mcg digoxin: greater than 2.4 Lidocaine: greater than 5mcg Lithium: greater than 2.0 mag sulfate: greater than 9 Phenobarbital: greater than 40mcg Phenytoin: greater than 30mcg Salicylate: greater than 300mcg Theophylline: greater than 20mcg

second trimester

During the second trimester, many women undergo an ultrasound examination and find out their baby's gender. It can be an exciting time, particularly as women feel their baby's movement, or quickening, for the first time. Your patient may also look to you for help with some of the common discomforts of pregnancy that develop from her ever-expanding uterus. The danger signs from the first trimester still apply; however, in this trimester, vaginal bleeding can also indicate placental problems such as placenta previa and abruptio placentae. Abdominal pain or cramping can mean preterm labor, and a sudden gush of clear fluid from the vagina indicates a rupture of the amniotic membranes - a serious complication this early in pregnancy. Once a woman is accustomed to the pattern and frequency of fetal movement, she must report any significant increase or decrease. Either could be a fetal response to inadequate oxygenation. At this time, be sure to instruct your patient to report any indications that her blood pressure has risen and she has developed pre-eclampsia. Classic manifestations include headache, vision changes, epigastric or abdominal pain, and edema, especially of the face and hands. Gestational diabetes is another complication of pregnancy that manifests with specific warning signs. Instruct your patient to report the concurrent occurrence of flushed dry skin, fruity breath, rapid breathing, increased thirst and urination, and headache. These are manifestations of hyperglycemia. Clammy pale skin, weakness, tremors, irritability, and lightheadedness are manifestations of hypoglycemia. It is also important at this time to teach your patient about the benefits of breastfeeding and of taking childbirth preparation classes.

Client who has parvovirus B 19 (fifth disease)

cannot give antiviral, nurse should schedule an ultrasound examination in prenatal client, to detect for development of fetal hydrops, this virus can cause miscarriage, intrauterine growth restriction, fetal anemia, and stillbirth

Oligohydramnios:

decrease in amniotic fluid associated with congenital anomalies such as renal genesis and intrauterine growth restriction

Signs and symptoms seen in preeclampsia

decreased urine output of 20ml/hr or less oliguria, blurred vision, proteinuria of 500mg in 24 hours, and DTR's of +3+4

durable power of attorney

a legal agreement that allows an agent or representative of the patient to act on behalf of the patient Clients must be provided written information outlining rights related to health care decisions.

agents of bioterrorism

Cat A: easily transmissible high mortality: small pox, botulism, anthrax, tularemia, hemorrhagic viral fevers Cat B: typhus fever, ricin toxin, e coli, west nile virus Cat C: hantavirus, influenzavirus, tb, and rabies virus

APGAR

HR RR auscultation at the apex: 0 absent 1 below 100 2 above 120 0 rr absent 1 slow weak cry 2= good cry muscle tone 0=flaccid 1; some flexion 2= extremities are flexed reflex; 0 no response 1 grimace 2= cry color 0 color blue or pale 1 body pink hands acroncyanois 2 pink Apgar ; 0-3 sever distress 4-6 moderate 7-10 no difficulty

Types of conflict:

Intrapersonal. individual Interpersonal. between two or more people Intergroup. department, organization Causes of conflict are ineffective communication, unmet/unclear expectations, change, and difference in values/beliefs.

Heart sounds

Mechanical heart vale problems low frequency opening and closing. Aortic stenosis sounds soft or normal S1, diminished A2, paradox splitting of S2, prominent S4, and accentuated P2.

Burn Management Children

Moderate burns and major burn treatment: Pre-medicate with an analgesic as prescribed 2. Remove previous dressing 3. Assess/monitor for odors, drainage and discharge 4. Cleanse the wound as prescribed 5. Remove all previous ointments. 6. Assist with debridemen Debridement: 1. Administer hydroxyzine or diphenhydramine for pruritus 2. Provide hydrotherapy (place the client in a warm bath of water, or use warm running water, as if to shower) to cleanse the wound 3. Enzymatic: • Apply a topical enzyme to break down and remove dead tissue • Apply a thin layer of topical antibiotic ointment as prescribed and cover with a dressing using surgical aseptic technique Skin Coverings: Maintain immobilization of the graft site 2. Elevate the extremity 3. Provide wound care to donor site 4. Administer pain med 5. Monitor for signs of infection before and after skin coverings of grafts are applied • Discoloration of unburned skin surrounding burn wound • Green color to subcutaneous fat • Degeneration of granulation tissue • Development of subeschar hemorrhage • Hyperventilation indicating systemic involvement of infection • Unstable body temperature

Sickle Cell anemia management child

Subjective and objective data: • Family history of sickle cell anemia or sickle cell trait • Reports of pain, crisis, and management • Tachycardia • Systolic heart murmur and heart failure • Shortness of breath/fatigue • Nail bed deformities • Lethargy, irritability, and muscle weakness • Abdominal pain, nausea, vomiting, and loss of appetite • Pallor or jaundice • I impaired healing, thinning of hair, low grade fever Vaso-occlusive crisis: acute: Severe pain, usually in bones, joints, and abdomen • Anorexia, vomiting, and fever swollen joints, hands and feet hematuria, obstructive jaundice, visual disturbances Chronic : increased risk of respiratory infections retinal detachment and blindness, systolic murmurs and renal failure, liver failure, seizures, and deformities of skeleton Pain management: treat mild to mod pain with tylenol or ibuprofen, manage severe pain with opioid analgesic, apply warm packs to painful joints Lab tests: CBC for anemia HgB electrophoresis: se[erates various forms of Hgb and is definitive diagnosis for sicker cell Sickledex: a screening tool to detect the presence of HbS but will not differentiate the trait Nursing Care: Promote rest to decrease oxygen consumption of the tissue • Administer oxygen as prescribed if hypoxia is present • Maintain fluid and electrolyte balance • Administer/monitor blood products (RBCs) • Observe for signs of hypervolemia and transfusion reaction • Treat and prevent infection • Monitor and report laboratory results • Encourage passive range -of - motion exercises to prevent venous stasis Client education: discharge: Provide emotional support, and refer to social services if appropriate. • Instruct in signs and symptoms of crisis and infection. • Advise the family of the importance of promoting rest and adequate nutrition for the child. • Encourage the child and family to maintain good hand hygiene and avoid individuals with colds/infection/viruses. • Give specific directions regarding fluid intake requirements, such as how many bottles or glasses of fluid should be consumed daily. • Provide information about genetic counseling. • Encourage maintenance of up-to-date immunizations. • Advise the child to wear a medical identification wristband or medical identification tags.

impaired coworkers

a nurse who suspects a coworker of any behavior that jeopardizes client care or could indicate substance use disorder has a duty to report the coworker to the appropriate manger. each state has laws and regulations that govern the disposition of nurses who have substance use disorders. criminal charges could apply.

Judaism

abortion permitted ritual circumcision : bris performed on 8th day pf life orthodox jews not allowed in delivery room death practice autopsy discouraged organ donation permitted stay with body at all times ritual burial and bath within 24 hours cremation prohibited kosher: milk and meat cannot be saved in same meal or same dishes pork and shellfish prohibit fasting on yan kapour lactose intolerance common in european jews saving a life goes over all obligations prayers for well being of sick during sabbath, refrain from using electricity anything can be done to ease suffering is encouraged

Informed consent

an ethical principle that research participants be told enough to enable them to choose whether they wish to participate have to know benefits and risks. Consent must be given by DPOA, emancipated or married minors, parent of minor, or court order. Nursing role: witness the client signature, notify provider if clarification is needed.

With circumcision care

apply potroleum jelly to penis for first 24 hours, have loose diaper, don't wash with soap for first 5-6 days, leave yellow exudate for 2-3 days as it is part of healing, and apply pressure with a sterile gauze pad to control slight bleeding, notify provider if bleeding continues.

case management

client care coordination, advocate for the family

hindus

contraception good males not circumcized abortion may be prohibited child not named till 10 day of life believe in reincar prefer to allow nat death life on floor while die thread placed on neck/wrist dead organ donate acceptable prefer cremation vegetarian encouraged most abstain from beef and pork cows are scared right hand for eating left hand for toiling hygiene days for fasting during year personal hygiene important future lives influences by how they face death and illness

islam

contraception ok abortion permitted in certain circumstances crimcusision good prayer is said in infant ear in birth death client confess sins prior to death dying placed facing mecca east organ donation and autopsy acceptable by some, devout may refuse both rituals include traditional bathing, burial within 24 hours cremation prohibited dietary: food halal lawful: pork alcohol and shellfish prohibited month of ramadan fast during the day, only eat at night halal animals slaughtered during prayer ritual no eat hospital meat haram foods: prohibit pork geleatin animals with fangs alcohol pray 5 times a day face mecca with rug privacy during prayr woman modest cover whole body may refuse male health care workers

Common suffixes meds

dipine: CA channel blocker fail: ED caine: anesthetic pril: Ace inhibitor pam, lam: benzodiazepine statin: antihyperlipidemic asone/salone: corticosteroid olol: beta blocker cilia: penicillin ide: oral hypoglycemic prazole: ppi vir: antiviral ase: thrombolytic azine: antiemetic phyllite: bronchodilator arin: anticoagulant cycling: anitbioitc mycin: aminoglycoside floxacin: antibiotic tyline: tricylic antidepressant pram/ one: SSRI's

Disease study in form of

identify early and late manifestations identify most important or threatening identify priority actions related to interventions

Meningitis Management nursing care of children

nursing interventions: The presence of petechia or purpuric-type rash requires immediate medication attention. • Isolate the client as soon as meningitis is suspected • Continue frequent vital signs, urine output, fluid status, pain level, neuro status, and head circumference (for infants) • Initiate IV fluids • Maintain NPO status, then clear liquids, and then a diet the client can tolerate • Decrease environment stimuli • Provide for comfort • Maintain safety (keep bed in low position, take seizure precautions) • Keep family informed Labs: CBC blood culture CSF: appears cloudy bacteria, clear viral elevated WBC elevated protein decreased glucose (bacterial) elevated CSF pressure infectious precautions: private room, wearing surgical mask within 3 feet droplet, use of designated equipment, continue for 24 hour after the first abx has been given meds: abs IV corticosteroids: dexamethasone: administer to prevent inflammation anticonvsulatsn: phenytoin-prophylactically. analgesic: non opioids should be given

Caring for a patient with C diff

wear a gown, disinfect all surfaces with bleach, use soap and water, usually occurs 4 to 9 days after start of abx

Advanced directives include

• living will • durable power of attorney for health care decisions • DNR order: Do Not Resuscitate includes if they want extraordinary lifesaving measures: resuscitation, intubation, and articial hydration and nutrition, or assigns another person to make decisions when the client becomes physically or mentally unable to do so. Patient self determination act requires all clients admitted to one asked if they have advance directives.