LPN - NCLEX - LPN
Hypocalemia S/S
"CATS go numb"- Convulsions, Arrhythmias, Tetany and numbness/paresthesia in hands, feet, around mouth and lips. Also: Trousseau's (hand claws during BP), Chvostek's sign (tap on face and they twitch), hyper-reflexive
Bladder cancer risk factors
#1 = SMOKING/TOBACCO (think of Jean/Ronnie) #2 = Working in dye & chemical plants Chronic UTI Recurrent nephrolithiasis **family hx increases risk**
suspected retinal detachment: mgmt
#1 action - cover both eyes with patch
ages 12-19 - adolescents
#1 issue - maintaining contact with peers encourage visits, friends, peer contact
Extracorporeal lithotripsy
(ESWL) uses shock waves to break a kidney stone into small pieces that can more easily travel through the urinary tract
Green tag
(Minor) "walking wounded"
Right sided heart failure s/s
* Dependent edema (legs & sacrum). * JVD * Abdominal distention * Hepatomegaly * Splenomegaly * Anorexia & nausea * Weight gain * Nocturnal diuresis * Swelling of the fingers & hands. * Increased BP (from fluid volume excess) or decreased BP (from pump failure). SYMPTOMS THAT BLOOD CANNOT MAKE IT BACK TO THE HEART
Cushing's disease s/s
* Generalized muscle wasting & weakness. * Moon face, buffalo hump. * Truncal obesity with thin extremities, supraclavicular fat pads; * Weight gain * Hirsutism (masculine characteristics in female).
telltale symptom of bladder cancer
***painless hematuria***
Hypokalemia S/S
**MUSCLE CRAMPS/WEAKNESS** Cramping Hypoventilation Hypotension
priority of patients to be seen
**acute** takes precedence over chronic
Cushing's disease
**elevated cortisol** INcreased sugar, steriods, sodium SKIN = thin, fragile, striae (Remember: *UP, UP, UP, DOWN, UP*) - HYPERnatremia, HYPERtension, INCREASED blood volume, HYPOkalemia, HYPERglycemia
best way to prevent epiglottitis
**standard childhood immunizations ensure children do not get this illness** **Immunization with the Hib vaccine is an effective way to prevent epiglottitis caused by Hib . In the United States, children usually receive the vaccine in three or four doses: At 2 months.
Bacterial meningitis (newborns and kids) s/s
-fever or possible hypothermia -irritability, frequent seizures -high-pitched cry -poor feeding & vomiting -nuchal rigidity -bulging fontanelle possible but not always present
dystocia birth (shoulder first)
-flex mother's legs to abdomen -suprapubic pressure
Status epilepticus treatment
SE is a life threatening emergency in which a client has been seizing for 5+ minutes grunting & dazed appearance are 2 common signs MUST STOP SEIZURE ACTIVITY! admin a benzo via IV or rectally if needed
paracentesis (abdominocentesis) position
SEMI OR HIGH FOWLER'S OR UPRIGHT ON EDGE OF BED Empty bladder. post VS--report elevated temp. watch for hypovolemia
signs and symptoms of major depression
SIGECAPS for at least 2 weeks sleep - increase or decrease interest deficit guilt energy deficit concentration deficit appetite change (over or under eating) psychomotor agitation suicidal ideology
client with Graves # 1 concern is
SOB
Pt not breathing, pulseless, etc. - first action
START CHEST COMPRESSIONS!
nasogastric tubes
Salem-sump Levin
Hepatitis B signs and symptoms
Same as Hep A but more severe - Fatigue, abdominal pain, loss of appetite, nausea, vomiting, joint pain, jaundice
cardiac catheterization via femoral artery - post surgery position
a diagnostic procedure in which a catheter is passed into femoral vein or artery and then guided into the heart post surgery client should be low Fowlers or flat (supine)
vegan diet
a diet that excludes foods of animal origin
Internal disaster
a disaster in which a healthcare facility itself is in danger or damaged and its function is impaired
Failure to Thrive (FTT)
a disorder of infancy and early childhood characterized by variable eating and inadequate gains in weight; poor nutrition; could be caused by neglect and poor parental education on feeding
fever can be indicative of
a hypersensitivity reaction to a med!
quickening of the fetus
a legal term for the 1st visual movement of the fetus weeks 16-20 (around the 4th month of pregnancy)
IV Catheter
a medical device inserted into a vein to deliver fluids
Hirschsprung disease - main symptom
a newborn's failure to have a bowel movement within 48 hours after birth. Other symptoms include a swollen belly and vomiting. Surgery is needed to bypass the affected part of the colon or remove it entirely.
Toxoplasmosis
a parasite that is most commonly transmitted from pets to humans by contact with contaminated animal feces **why pregnant women shouldn't empty cat litter**
complicated grief
a person has a prolonged or significantly difficult time moving forward after a loss
catheter embolus
a piece of catheter breaks off & travels in the vein until it lodges.
Peau d'orange
a pitted or dimpled appearance of the skin, retracted nipple enlarged lymph nodes **symptom of inflammatory breast cancer**
Holter monitor
a portable device that is used to record the electrical activity of the heart over extended periods
Neuroleptic Malignant Syndrome (NMS)
a potentially fatal, idiosyncratic reaction to an antipsychotic (or neuroleptic) drug
ADHD (Attention-Deficit Hyperactivity Disorder)
a psychological disorder marked by the appearance by age 7 of one or more of three key symptoms: extreme inattention, hyperactivity, and impulsivity also marked by low self esteem & impaired social skills
case controlled study
a retrospective observational study that compares exposure in two groups of subjects. Subjects in one group have the disease (cases), whereas those in the other group are free of the disease (controls)
cervical cap
a rubber cap that fits over the cervix, used with spermicide to prevent conception. used with spermicide do not use during period - could cause TSS insert several hours prior to intercourse keep in place >6 hours post intercourse but not more than 48 hours after intercourse
myexedema
a skin and tissue disorder caused by hypothyroidism, difficult to treat
petechia, petechiae
a small red or purple spot on the skin caused by the release into the skin of a very small quantity of blood from a capillary
Hematoma
a solid swelling of clotted blood within the tissues.
Guaiac test (Hemoccult, Fecult)
a special chemical test to identify blood in the stool
myxedexa coma
a state of severe hypothyroidism causing decreased LOC that may progress to a coma state ***give respiratory support***
Methylphenidate (Ritalin)
a stimulant used in treating ADHD increases the levels of neurotransmitters in your child's brain increases level of dopamine SE - anorexia, wt loss, nausea, lack of appetite
curretage
a surgical scraping or cleaning by means of currette
Autonomic Dysreflexia/Hyperreflexia
a syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above (T6 or above). S/S pounding headache, high Fowler's profuse sweating, nasal congestion, chills, bradycardia, hypertension. Place client in sitting position (elevate HOB) FIRST!
validation therapy
a type of therapy that lets people with Alzheimer's disease believe they are living in the past or in imaginary circumstances
bowel obstruction
abdominal rigidity & rigidity often has abdominal distention anorexia, nausea and or vomiting fever lowered BP
orthopnea
ability to breathe only in an upright position patient should stand or sit in a chair straight back
pleural effusion
abnormal accumulation of fluid in the pleural space
pneumoconiosis
abnormal condition caused by dust in the lungs, with chronic inflammation, infection, and bronchitis (like inhalation of asbestos)
meconium aspiration syndrome
abnormal inhalation of meconium (first stool) produced by a fetus or newborn newborn will have have rapid respirations
fistula
abnormal passageway between two organs or between an internal organ and the body surface
exopthalmosis
abnormal protrusion of the eyeball
Primary hypothyroidism
abnormality in the thyroid gland itself
Reverse Trendelenburg's position used for
cervical traction feeding clients restricted to supine position (after cardiac catheterization)
opiods key points
change positions slowly (hypotension) take with food wear sunscreen
disequilibrium syndrome
characterized by headache, mental confusion, decreasing level of consciousness, nausea and vomiting, twitching, and possible seizure activity. It is caused by rapid removal of solutes from the body during hemodialysis. It most often occurs in clients who are new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow rates.
prosthesis care
check for loose or worn parts daily
trough level
The lowest concentration of drug reached in the body after it falls from its peak level, usually measured in a blood sample for therapeutic drug monitoring.
carotid artery
The major artery that supplies blood to the head and brain.
peak level
The maximum concentration of a drug in the body after administration
Rotavirus
The most important global cause of infantile gastroenteritis. ROTA = R ight O ut T he A nus diaper cream to stem skin irritation
how to measure heparin
The most widely used laboratory assay for monitoring unfractionated heparin therapy is the activated partial thromboplastin time (aPTT). **THINK HARRY POTTER**
water seal chamber
- chest tube chamber that provides a one-way valve so that air leaves and cannot reenter chest - bubbling is normal initial 48 to 72 hours - tidaling (fluid in the water seal chamber is expected to rise with inspiration, fall with exhalation)
Meningitis symptoms
- classic triad of headache, neck stiffness and fever - head & neck bend backward & body arches forward -flexion of hip & knee - photophobia
Sjorgen's disease
- destruction of salivary glands as an autoimmune response - inhibit salivation & pt will have a dry mouth
Diabetic ketoacidosis (treatment)
- give hypotonic fluid (0.45% saline) -give 10x faster than normal (1000mL/hr) -need large bore needle and good vein -giving glucose before fluids will put the patient into hypovolemic shock 2. normalize glucose levels...regular insulin given IV with fluids to avoid hypovolemia -then switch to D5W when glucose levels around 250 (to avoid hypoglycemia) follow MD orders to rehydrate/restore circulating volume 3. monitor BP, P, R q15h until stable, BP needs to come up 4. I&O very careful...want to get it back up 5. Record F&E balance: -IV electrolytes given after insulin; hypokalemia is significant cause of death in the treatment of DKA -K+ can be high or normal but K+ is not going into the cell without insulin so K+ build in the blood; when insulin is given it drives K+ into the cell, this can lead to life threatening hypokalemia if not treated 6. Cardiac: (reflects K+ levels and cardiac response) -hypovolemic shock; check skin -tachycardia -assess blood (glucose) and urine tests (ketones) -risk of thrombosis due to severe hyperosmolarity; subq heparin prophylactically Note: there will be a slight temperature elevation in the beginning and the skin will feel hot and dry want the pt more alert/oriented After DKA is corrected: determine the cause; most common is infection
dilated pupils indicate
- head injury - ICP - shock - heat stroke -hemorrhage -ingested a stimulant drug
causes of child maltreatment
- parent alc abuse, low self esteem - child low birth weight, phys/cog challenges - low family income -few social supporters
hypovolemic shock signs and symptoms
- rapid, weak pulse (tachycardia) - low bp - change in mental status - cyanosis - cool, clammy skin - increased respiratory rate
older adults & nutrition
- require increased amounts of calcium, Vit D, B12, A -may require increased amts of protein -fewer calories are needed because of slower metabolic rate and decrease physical activity -need more carbs for fiber -decreased saliva and gastric juice secretion may also affect a person's nutrition
Varenicline (Chantix)
- start 1 week before quit date BW -TAKE AFTER A MEAL > Take w/ food to reduce nausea - Serious neuropsychiatric events including depression, etc. Warning - Angioedema, hypersensitivity rxns, seizures, increase intoxicating effect of alcohol, and serious skin reactions have occurred. - use caution in patients with underlying psychiatric disorders and while driving or operating machinery, traffic accidents have occurred. Avoid use in pilot, etc. SE - Nausea , constipation, etc
Decerebrate posturing
-"extensor posturing"; -abduction of arms, elbow and wrist extension damage to the nervous system; upper brain stem
TURP post op care
-3 way bladder catheter irrigated for first 24 hrs to prevent mucous and blood clots -traction used and pulled down into prostatic fossa (cath taped tightly)
CNS depressant drugs
-Benzodiazepines -Non-benzodiazepines -Miscellaneous drugs -Muscle relaxants -Barbiturates psychoactive drugs that inhibit the functioning of the central nervous system
Moderate Alzheimer's Disease
-Confusion -Agnosia -Agitation -Violence -Wandering -Paranoia **RISK FOR WANDERING - LOCKS ON DOORS**
Closed angle glaucoma symptoms
-EXTREME eye pain, blurry vision, HA, N/V -severe HA -HARD, RED eye -pupil dilated, nonreactive to light
Graves disease signs and symptoms
-Enlarged thyroid -Acceleration of body process: weight loss, increased appetite, SOB, diarrhea, heat intolerance, tachycardia, palpitations, increased BP, diaphoresis, nervousness, insomnia -Exophthalmos -Increased T3 and T4 levels -Low TSH levels
Diabetic Ketoacidosis (DKA) signs and symptoms
-Flushed dry skin -Dry mucous membranes -Decrease skin turgor -Tachycardia -Hypotension -Kussmaul's respirations -Acetone breath/fruity breath -Altered LOC -Visual disturbance -Polydipsia -Nausea and vomiting -Anorexia -Abdominal pain
Side effects of chemotherapy
-Hair loss -redness at site of radiation -Dry mouth/mouth sores -Difficulty swallowing -alopecia -N/V -Diarrhea *[GI tract replicate often] -Fatigue -Bleeding -Susceptibility to infection -Foggy brain aka "chemo brain"
CPR children 1 + years old
-Hand Position: 2 or 3 fingers on center of chest (below nipple line); 1 hand on head opening airway -Compression Depth: About 2 inches -Cycles: 30 Chest Compressions; 2 Ventilations -Rate: 100-120 Compressions per minute
septic arthritis tx
-Hospitalization (ASAP) -Ceftriaxone 1 gm daily IM -Joint drainage via arthroscopy -Immobilize and elevate limb
cervical cancer risk factors
-Human papilloma virus (HPV) infection -Smoking -Early age at first sexual intercourse. -Multiple sexual partners and/or partners who have multiple partners. -Multiple pregnancies
BSE (breast self examination)
-Is recommend on a monthly schedule. -do this 4-7 days after start of menstrual cycle
early manifestations of hypoxia & hypoxemia
-tachypnea -tachycardia -restlessness -pale skin and mucous membranes -elevated blood pressure -use of accessory muscles, nasal flaring, adventitious lung sounds
guidelines during illness for diabetic
-take usual dose of insulin -test BG every 3-4 hours -report elevated BG or ketones to HCP -consume sugar free beverages every 30 minutes -small frequent meals
taking in, taking hold, letting go
-taking-in (12 hours after birth) - dependent on others, talk about birth, literally taking in her new role as a mom, hesitant to make decisions, perceive as passive, sleep, pain reduction & food are major needs -taking-hold - takes control of self and newborn, becomes less reliant on other people but needs reassurance that she's doing okay -letting go - ready to leave hospital, start new life
TB test administration involves:
-use a 27 gauge, 1/4" needle, clean gloves -10 degree angle with bevel up -make a wheal (bleb) -must go through epidermis into dermal layer of skin -DO NOT RUB SITE AFTER INJECTION -mark circle with red pen -left forearm above wrist (hands-width above wrist)
Cushing's syndrome urine collection
-use a dark jug -24 hour span of time (toss 1st void of the morning) -keep urine collected in a refrigerator or in a cool ice chest by the bed
TPN Care and Maintenance
-verify prescription and solution with another nurse -administer via infusion pump -monitor daily weights -monitor & record I&Os, noting fluid balance -monitor serum glucose levels every 4-6 hours -monitor for signs of infection -change dressing every 48-72 hours per facility protocol -change IV tubing & fluid every 24 hours -if TPN solution is unavailable; administer dextrose 10% in water to prevent hypoglycemia
Folic acid prior to pregnancy
.4 mg daily
deep tendon reflex grading
0 = no response; always abnormal 1+ = a slight but definitely present response; may or may not be normal 2+ = a brisk response; normal 3+ = a very brisk response; may or may not be normal 4+ = a tap elicits a repeating reflex (clonus); always abnormal
Direct (conjugated) bilirubin
0 to 0.3 mg/dL Elevations indicate altered liver functioning, bile duct obstruction, or other hepatobiliary disorder
Lithium levels range
0.5-1.4
Digoxin (Lanoxin)
0.8-2 ng/mL reduces cardiac workload Apical pulse should be taken for a full minute before administration of this medication. If the apical pulse < 60, the dose should be withheld and the prescribing provider notified if child then if AP <90 should be held
wrist restraints
apply pads to ensure skin integrity remove every 2 hours can fit 2 fingers between skin & restraint tie with quick release buckle or knot that doesn't tighten secure to bed frame
Trousseau's sign
arm/carpal spasm associated with hypocalcemia
Decorticate posturing
arms flexed inward and bent in toward the body and the legs are extended **indicates damage to the pathway between the brain & the spinal cord
leading cause of adult disability
arthritis
Xerostomia (dry mouth) - interventions
artificial saliva oral hygiene multiple times/day sipping water throughout the day
parenteral nutrition administration
aseptic technique bag must be changed every 24 hours
Urine Specimen Collection from catheterized pt
aseptically from the port located on the tubing on the indwelling urinary catheter **NOT from the cath bag - it's been sitting there and subject to bacteria**
Arab men
ask client if his wife would like to give the bath do not look in eyes when communicating
to determine proper placement of NG tube
aspirate stomach contents pH must be 6 or less
to promote interdisciplinary collaboration
assertiveness good communication skills conflict negotiation skills decision making and critical thinking skills
frontal lobe
associated with reasoning, planning, parts of speech, movement, emotions, and problem solving
NSAIDS can cause problems for
asthmatics!
Cows milk introduced
at least 12 months
subtotal thyroidectomy
at risk for thyroid storm/crisis/thyroidtoxicosis stay with pt S&S of thyroid storm: 1-hyperpyrexia (high fever 104+) 2-really high VS (HR 200, BP 210/190) 3-psychotic delirium treatment: high flow rate O2, decrease temp with ice packs (5), spare the brain
Positive signs of pregnancy
audible fetal heartbeat fetal movement felt by examiner ultrasound visualization of fetus
Guillain-Barre syndrome
autoimmune condition that causes acute inflammation of the peripheral nerves in which myelin sheaths on the axons are destroyed, resulting in decreased nerve impulses, loss of reflex response, and sudden muscle weakness **respiratory failure most life-threatening complication**
Nephrotic syndrome (kids)
autoimmune disease that affects children age 2-7 RISK FOR INFECTION MONITOR FLUIDS CORTICOSTEROIDS Sodium restrictions illness can go into remission
myasthenia gravis
autoimmune neuromuscular disorder characterized by weakness of voluntary muscles risk for aspiration
Ketoconazole (Nizoral) - things to avoid
avoid alcohol avoid antacids avoid sun exposure
High WBC counts may indicate
bacterial infections, autoimmune diseases, or side effects of medications
Impetigo
bacterial skin infection characterized by isolated pustules that become crusted and rupture
foods high in potassium include
baked chicken, potato, bananas, oranges, dates, apricots, raisins, broccoli, green beans, meats, fish, and legumes
High potassium foods
bananas, orange juice, cantaloupe, strawberries, avocados, spinach, fish and salt substitutes
prior to transfer to mortuary - nurse should do what?
bathe the body
newborn's ears
check for low-set ears Low-set ears are a clinical feature in which the ears are positioned lower on the head than usual. They are present in many congenital conditions.
before giving atorvastatin, check levels of what?
check liver function lvels
PEG tube care
check tube placement and residual volume Q4h
Unstable Angina (UA)
chest pain that is new in onset, occurs at rest increases in occurrence, severity or duration
Stable angina (aka exertional)
chest pain that occurs when a person is active or under severe stress
unstable angina
chest pain that occurs while a person is at rest and not exerting himself not relieved by nitro
Pericarditis S/S
chest pain worse when lying down, cough, fever, anxiety, FRICTION RUB
school phobia
child won't go to school treatment - insist child attend, starting with a few hours a day
A mild reaction to iodinated contrast medium would be:
chills sweats
2 STDs that cause PID & infertility
chlamydia and gonorrhea
bronchitis symptoms
chronic cough wheezing cyanosis productive cough
How to remove sutures/staples:
clean site first, grasp the knot cut the suture close to the skin and pull out the suture in one piece clip as close to the site as possible
reduce infection for cancer patients
clean toothbrush with hydrogen peroxide solution, bleach or through the dishwasher **antimicrobial soap INCREASES the risk for infection**
clean a hearing aid
clean with a soft cloth do not immerse or use water store in a safe, dry place turn off before inserting then turn up to a comfortable level
Signs of skull fracture
clear fluid coming from nares of nose Severe headache and nausea Palpation may reveal defect in skull May be blood in the middle ear, ear canal, nose, ecchymosis around the eyes (raccoon eyes) or behind the ear (Battle's sign) Cerebrospinal fluid may also appear in ear and nose
serous
clear, watery plasma
restraints & position
clients in any restraint should not be placed supine b/c this could cause aspiration
embolus (emboli)
clot or other substance that travels to a distant location and suddenly blocks a BLOOD VESSEL
what can precipitate a sickle cell crisis
cold weather dehydration smoking fever
yin foods
cold; eaten with a hot illness
dehiscence treatment
collect a full set of VS cover with sterile dressings place client in low Fowler's with knees slightly flexed notify HCP immediately NPO for pt - may have to go back into surgery
Volkmann contracture occurs as a result of
compartment syndrome restriction of arterial blood flow MEDICAL EMERGENCY!!
2nd stage of labor
complete cervix dilation to birth **have pt move positions frequently to move baby down birth canal**
Live vaccines are contraindicated in a patient who:
compromised immune system pregnant
polycythemia vera
condition characterized by too many erythrocytes; blood becomes too thick to flow easily through blood vessels
Hypothyroidism
condition of hyposecretion of the thyroid gland causing low thyroid levels in the blood that result in sluggishness, slow pulse, and often obesity
hypospadias; hypospadia
congenital opening of the male urethra upon the undersurface/VENTRAL of the penis. Also a urethral opening into the vagina.
ductus venosus
connects the umbilical vein to the inferior vena cava, bypassing the liver closes at birth
4 side rails of bed raised
considered a form of restraint!!! can raise 2-3 siderails only
lacto-ovo-vegetarian
consumes all vegan items plus dairy products and eggs.
C diff precautions
contact gown and gloves **mask not required** private room
Scabies
contagious skin disease transmitted by the itch mite Between the fingers. The folds of the wrist, elbow, or knee. Around the waistline and navel.
Post TURP care
continuous bladder irrigation pale pink urine outflow painful bladder spasms are expected input and output should be equal the spasms are treated with antispasmodics normal VS
magnesium body functions
contraction and relaxation of muscles, enzyme function, energy production, and DNA and protein synthesis
Volkmann's contracture
contracture and damage to the muscles of the forearm because of injury to their blood supply **sign of compartment syndrome**
45% Sodium Chloride (NaCl)
contraindicated in burn pt.
Signs of hypocalcemia CATS
convulsions, arrhythmias, tetany, stridor+ spasms Chovstek's (facial twitching) Trousseau's (carpal spasm)
hemoptysis
coughing up blood
acetaminophen
could cause liver damage
formula for newborns
cow's milk based formula best for newborns
ileostomy
creation of an artificial opening into the ileum (small intestine)
pacemaker pt - check heart rate
daily
best indication of fluid retention & restoration
daily weights
Post cardiac cath:
-KEY POINT- BACK OR FLANK PAIN IS CONCERN - COULD BE RETROPERITONEAL BLEEDING - INVESTIGATE - Monitor vital signs, pulses distal to site - Apply pressure to cath site for at least 15 minutes - Keep leg straight, bedrest for 6-8 hrs.
ADLs
"Bathing, showering, Toileting and toilet hygiene, Dressing, Swallowing/eating, Feeding, Functional mobility, Personal device care, Personal hygiene and grooming, Sexual activity"
Hepatic encephalopathy
impaired ammonia metabolism causes cerebral edema. s/s: change in LOC, memory loss, asterixis (flapping tremor) impaired handwriting, hyperventilation w/ resp alkalosis. Rx: lactulose, low protein, safety, rest
ectopic pregnancy
implantation of the fertilized egg in any site other than the normal uterine location
placenta previa
implantation of the placenta over the cervical opening or in the lower region of the uterus
palmar grasp reflex
in response to stroking a baby's palm, the baby's hand will grasp. This reflex lasts a few months
Anhedonia
inability to experience pleasure
aphagia
inability to swallow
amniotomy
incision into the amnion (rupture of the fetal membrane to induce labor; a special hook is generally used to make the incision)
what can cause constipation in pregnant women?
increase in the hormone progesterone
Glaucoma
increased intraocular pressure halos loss of peripheral vision
CKD signs and symptoms
increased potassium & magnesium Increased creatinine, BUN, blood pressure Proteinuria
Thyroid storm
increased temp, pulse and HTN life threatening do not palpate!
head circumference in children
increases by 1" in year 2 then .5" every year after until age 5
Shower chair
increases client safety reduce pt fatigue minimizes pt physical exertion
autonomy
independence
bluish gray stoma color
indicates impaired perfusion/oxygenation **not an infection** this indicates it's dying due to lack of O2
FFP (fresh frozen plasma)
indications: pts who need coagulation factors - liver failure, DIC, massive RBC transfusion indicated for the deficiency of coagulation factors with abnormal coagulation tests in the presence of active **assess PROTHROMBIN TIME after giving** NURSE SHOULD ASSESS PT AFTER ADMIN OF FFP - THE DESIRED EFFECT IS LESSENED PT**
tracheostomy tube
indwelling tube inserted directly into the trachea to assist with ventilation
itis
infection
exogenous infection
infection originating outside an organ or part
Osteomyelitis
inflammation of bone and bone marrow
chronic bronchitis
inflammation of the bronchi persisting over a long time
acute glomerulonephritis
inflammation of the capillary loops of the renal glomeruli MONITOR BP CONTINUOUSLY!
epididymitis
inflammation of the epididymis that is frequently caused by the spread of infection from the urethra or the bladder
Cholecystitis
inflammation of the gallbladder; usually associated with gallstones
endocarditis
inflammation of the inner lining of the heart notify provider of dental procedures to ensure no re-infection
pericarditis
inflammation of the sac surrounding the heart
Statins MOA
inhibit HMG-CoA reductase lipid effects: Greatly lowers *LDL* and lowers triglycerides & total cholesterol SE: hepatoxicity, muscle toxicity (rhabdomyolysis)
intrathecal
injection into the meningeal space surrounding the brain and spinal cord for spinal infusion/injecting dye
Enoxaparin (Lovenox)
low molecular weight heparin **Good for post surgery to prevent DVT**
Thrombocytopenia
low platelet count
kidney disease diet
low protein limit salt limit potassium (no carrots, tomatoes, potatoes, bananas) limit phosphorous (turkey, chicken, dairy) fluid intake must be monitored low protein
Meniere's disease diet
low sodium
LDL
low-density lipoprotein normal range <100
radium implant
low-residue diet to decrease bowel movements & prevent dislodging of implant nurse should spend no more than 30 minutes in room
Where to tape catheter for men
lower abdomen
abdominal cramping during enema
lower ht of enema container this would reduce flow & thus relieve pressure
recumbent position
lying down in any position
prone position
lying on abdomen, facing downward (head may be turned to one side) legs extended
Trendelenburg position
lying on back with body tilted so that the head is lower than the feet
lithotomy position
lying on back with legs raised and feet in stirrups
dorsal recumbent position
lying on the back with the knees flexed and separated
After a Mastectomy surgery elevate the affected arm to prevent?
lymphedema
Atelactasis
major concern after surgery CADB incentive spirometer
Wilms tumor
malignant tumor of the kidney occurring in childhood DO NOT PALPATE ABDOMEN
Crede's maneuver
manual pressure on the bladder to promote bladder emptying
food blockage ileostomy
massage around the ileostomy
clang association
meaningless rhyming of words
Measles virus
measles incubation period = 7-21 days if child is not vaccinated and exposed; you can give child MMR vaccine within 3-6 days of exposure it could also prevent it from infecting child/person
Thrombocytopenia nursing intervention
measure abdominal girth daily to monitor for internal bleeding
creatinine clearance
measure of the efficiency of the kidneys in removing creatinine from the blood normal range = 85-135
how to time the frequency contractions
measure the time from the beginning of one contraction to the beginning of the next
BPP (biophysical profile)
measures - fetal breathing fetal tone amniotic fluid
continuous pulse oximeter monitor for an infant
measures oxygen levels in the blood cover with clothing to prevent light or heat affecting reading place on wrist or foot no gel needed
serum albumin level
measures the main protein in the blood and is used to determine protein status 3.5-5 good for measuring nutritional status
calcium supplements
no more than 600 mg of calcium can be absorbed at one time so it should be taken 3x daily no more than 2,500 mg daily
long acting insulin peak
no peak
Wilms' Tumor (Nephroblastoma) S/S
non-painful abdominal mass found by parents, also may present with bowel obstruction. Do Not Palpate abdomen!
Prealbumin
normal = 15-35 mg/dl A level < 10.7 mg/dL indicates severe nutritional deficiency. protein measured to evaluate the nutrition status of critically ill patients who are at high risk for malnutrition
prealbumin levels
normal = 15-36 mg/dL
sinus rhythm
normal heart rhythm
Epitaxis
nosebleed **apply direct pressure**
American Red Cross
not a government agency but authorized by the government to assist in natural disasters
molar pregnancy
not a viable pregnancy -dark brown discharge -cannot become pregnant within one year and have frequent checks for cancer
adventitious events
not an everyday occurrence ie workplace violence, bomb scare, etc. everyday events - job loss, divorce
Prevent impetigo by
not sharing towels excellent hand washing avoid close contact with others keep infected area covered with gauze lesions should be soaked with warm water, saline or Burrow's solution and antibacterial soap before adding topical ointment
if you suspect a fellow colleague of alcohol on breath
notify nursing supervisor
hemophilia pt complains of joint pain
notify physician immediately cause of concern b/c can lead to deformities
Bowlby's attachment theory
numbing yearning and seeking disorganization and despair reorganization
B12 deficiency
numbness and tingling of the hands & feet neurologic manifestations
Steps in inserting a urinary catheter
rep: - consent - allergies - wash hands (medical scrub) Sterile field by opening Foley kit using *sterile technique* Sterile gloves using clinic gloving Drape patient --> using sterile technique Women -- spread labia with non dominant hand and do not remove -- it is now contaminated Prepare genitalia - soaked cotton balls (soak before starting) - Minimum of 3 cotton balls - DO NOT PASS OVER STERILE FIELD WHEN DISCARDING *Do NOT inflate balloon until urine return* want to make sure you are in the right spot balloon inflated
RACE
rescue alarm contain extinguish
High Fowler's position used for
resp illness with dyspnea emphysema dcardiac problems with dyspnea feeding hiatal hernia during & after meals insertion of NG tube
Infant with cardiac dysfunction
respond to his cries immediately - crying uses up Oxygen which strains his heart
signs of hypoxia
restlessness cyanosis tachypnea
atrial septal defect
results in heart murmur flaw in the septum that divides the two atria of the heart
secondary hypothyroidism
results when the pituitary gland is dysfunctional and does not secrete TSH decreased T3
layer of fat in IV bag
return to pharmacy this is not normal
Tidaling
rhythmic rise and fall of water in a chest tube drainage system
Rights of Delegation
right task right circumstance right person right direction/communication right supervision
permanent tooth traumatically comes out (like in sports)
rinse & reinsert it if this doesn't work, place in MILK or saline and then rush to emergency dept.
Fluticasone (Flonase) inhaler
rinse mouth after inhalation
6 months old motor skills
rolls back to front, can hold a bottle
frothy, pink-tinged sputum
s/s of pulmonary edema
PICC line - catheter embolism complication
secure catheter avoid pulling follow safe practices for catheter removal
if a blood transfusion reaction occurs - what to do with blood?
send to BLOOD BANK so they can determine if the blood is contaminated, etc.
GH deficiency in children - how to check
serum insulin growth factor 1 (GF-1)
placenta abruption s/s
severe abdominal and back pain uterine rigidity bright red or dark vaginal bleeding maternal hypovolemia
metabolic alkalosis causes
severe vomiting, excessive GI suctioning, diuretics, excessive NaHCO3
growth hormone deficiency
short stature, delayed growth, delayed puberty (sexual development)
Contractures
shortening and stiffening of muscles **Kathleen's fingers/hands**
space between axilla & pad of crutches
should be 1-2" (2.5-5 cm) 30 degree elbow flexion
cane length
should be equal to the distance between the greater trochanter and the floor; HAVE CLIENT WEAR SHOES WHEN MEASURING
Chest compressions during CPR
should not be interrupted for more than 10 seconds when assessing for pulse or chest rise/fall
Acetaminophen (Tylenol)
should not be used in liver dysfunction
manifestation of ectopic pregnancy
shoulder pain
side effect vs adverse reaction
side effect is benign adverse reaction - possibly cause death or serious health issue
extrapyramidal symptoms
side effects such as restlessness, involuntary movements, and muscular tension produced by antipsychotic medications
purulent drainage
sign of infection
children with nephrotic syndrome
significant edema of scrotum or labia high risk for infection
Ebola precautions
single client airborne precautions DOOR CLOSED AT ALL TIMES workers should wear impermeable gown/overalls N95 mask full face mask double gloves single use boot covers single use apron maintain a log of all visitors/workers in and out
Down's syndrome symptoms
single crease across palm of hand
child with NG tube susceptible to
sinus infection
after taking nitroglycerin tablets
sit down when taking this med
Thoracentesis position
sitting position, arms raised and resting overbed table.
to relieve epididymitis
sitz bath ice packs best rest elevate scrotum
Buck's Traction (skin traction)
skin traction applied to both legs client's backside off bed about 15 degrees
4 years old gross motor skills
skips and hops on one foot, throws a ball overhead
benzos and alcohol
sleep walking! driving! cooking! pts can perform complex behaviours when combining alcohol & benzos
Vesicle
small fluid filled sac; blister varicella/chicken pox herpes
wheal
small, round, raised area on the skin that may be accompanied by itching; usually seen in allergic reactions **hives**
abruptio placenta risk factors
smoker cocaine/drug use advanced maternal age maternal HTN
Cranial Nerve 10: Vagus
somatic motor impulses to larynx and pharynx (when you go to vagus you want to hear someone sing with their larynx ie. voice box) say "ah"
Trendelenburg position used for
some surgeries during labor if umbilical cord pressure needs to be relieved if prolapsed umbilical cord
Tracheostomy cuff
some trach tubes have an inflatable cuff near the outer end to keep them from coming out and produces a seal between trachea and the cuff - *preventing air from leaking out. prevent aspiration when eating If your tracheostomy tube has a cuff, the speech therapist or provider will ensure the cuff is deflated during meal times. This will make it easier to swallow. If you have a speaking valve, you may use it while you eat. It will make it easier to swallow.
allergies babies tend to outgrow
soy cow's milk eggs
babies outgrow allergies to
soy cow's milk eggs
Ventricular paced rhythm
spike before QRS
Supine used for
spinal cord injury (NO PILLOW)
Prone (used for)
spine and structures of the back client following lumbar puncture for 6-12 hours post-myelogram post-op following tonsillectomy & adenoidectomy
best position for babies with TOF
squatting! knee to chest when being hel
LPN should be assigned
stable clients who are unlikely to experience changes in status
vaso occlusive crisis in sickle cell
start iv fluids 1st to promote hydration and circulation
varicella/chickenpox in children
starts with red spots. They can appear anywhere on the body and might spread or stay in a small area. The spots fill with fluid and become blisters. The blisters may burst. ... The spots scab over. New spots might appear while others are becoming blisters or forming a scab.
circumcision techniques
sterile technique pacifier dipped in sucrose formula (no analgesia or bottle due to aspiration) during circumcision baby is wrapped in a special board or blanket
peritoneal dialysate
sterile technique when spiking and attaching bag of dilysate
bumethasone
steroid therapy. It stimulates surfactant production in the alveolar spaces and causes less tension when the infant breaths
if neonate after delivery does not breathe spontaneously
stimulate newborn to cry suction newborn assess heart rate cut umbilical cord
ways to stimulate voiding
stimulate spontaneous voiding - take pt to sit on toilet put hands in warm water use bottle to spray warm water over perineum
purpose of estrogen
stimulates uterine development & prepares uterus for pregnancy esp day 15-24
Colace (docusate sodium)
stool softener allows fat & water to enter feces to pass the stool more readily
Extravasation Treatment
stop infusion discontinue administration set aspirate drug if possible apply COLD compress document condition of site
phlebitis treatment
stop infusion remove peripheral IV catheter Elevation apply warm compress NSAIDS
When is Impetigo no longer contagious?
stops being contagious: 48 hours after you start using the medicine prescribed by your GP (antibiotics) when the patches dry out and crust over (if you do not get treatment)
Nitrolycerin
store in a dry, dark place replace every 6 months taking sitting down and stop all activity SE = HA/Hypotension
stridor
strained, high-pitched sound heard on inspiration caused by OBSTRUCTION in the pharynx or larynx
Chronic hyperglycemia causes
structural abnormalities in many organs is most common cause of diabetic retinopathy the leading cause of blindness in adults
what causes complicated grief
sudden death of a loved one/friend
Cushings Syndrome treatment?
surgery to remove tumor, drug or radiation therapy, total adrenalectomy
Inserting urinary catheter
surgical asepsis used
Dehiscence
surgical complication where there is separation or bursting open of a surgical wound
-centisis
surgical puncture to remove fluid
thoracentesis
surgical puncture to remove fluid from the pleural space sitting up, leaning forward
lordosis
swayback, increased lumbar curvature
SIADH
syndrome of inappropriate antidiuretic hormone complication of head injury urine output is decreased and water is retained resulting in high specific gravity of urine
SAIDH
syndrome of inappropriate antidiuretic hormone secretion A condition in which high levels of a hormone cause the body to retain water. In this condition, the body retains water instead of excreting it normally in urine. This process upsets the body's balance of minerals called electrolytes, especially sodium.
hypotension
systole lower than 90
anaphylaxis (anaphylactic shock) signs and symptoms
tachycardia hypotension nausea hives stridor
Food poising symptoms
tachycardia lethargy delirium
S/S of hypovolemic shock
tachycardia low BP, hypotension pallor clammy skin reduced LOC Position pt in modified Trendelenburg.
iron deficiency anemia expected signs
tachycardia & tachypnea (because body tries hard to compensate for lack of O2) **difficulty with concentration**
hypovolemic shock signs & symptoms
tachycardia, pale, and have FLAT neck veins
Early signs of shock
tachypnea tachycardia agitation
when removing a central line, have pt
take a deep breath and hold it
Warfarin (Coumadin) key points
take at same time every day antibiotics can affect INR level DO NOT DOUBLE DOSE IF DOSE MISSED - CALL HCP
DM pt teaching when sick
take blood glucose every 2-4 hours when sick
Potassium Chloride (oral) - how to take!
take with plenty of water (at least 4 oz) sit upright for a period of time afterwards
pt with dysphagia should be given
tart or sour foods first to stimulate salivation
intussusception
telescoping of a segment of the intestine most common abdominal surgical condition in newborns and infants intussusception is the most frequent problem in children between the ages of 6 months and 2 years.
if you suspect a colleague of pocketing pain meds
tell nurse supervisor DO NOT CONFRONT THE PERSON
heparin
test PTT
first sign of puberty in boys
testicular enlargement
safe vaccines during pregnancy
tetanus, diphtheria, (Tdap) influenza
ascites
the accumulation of fluid in the peritoneal cavity, causing abdominal swelling. indicative of cirrhosis
dorsal recombent position
the back-lying or supine position
pubic symphysis
the cartilaginous joint that allows some movement to facilitate childbirth
hydronephrosis
the dilation (swelling) of one or both kidneys
Respondeat Superior Doctrine
the employer is responsible for the actions of the employee
menarche
the first menstrual period
femoral artery
the major artery supplying the leg (groin)
open angle glaucoma
the most common form of glaucoma, where the trabecular meshwork gradually becomes blocked, causing a buildup of pressure HALOS loss of peripheral function
closed angle glaucoma
the opening between the cornea and iris narrows so that fluid cannot reach the trabecular meshwork EMERGENCY
Sims position
the patient is lying on the left side with the right knee and thigh drawn up with the left arm placed along the back
Piaget's Concrete Operational Stage
the period of cognitive development between 7 and 12 years of age, which is characterized by the active, and appropriate, use of logic
embryonic stage
the period of prenatal development that lasts from the 2nd week until about the 8th week
Point of maximal impulse (PMI)
the point where the apex of the heart touches the anterior chest wall and heart movements are most easily observed and palpated below the 5th intercostal space mid-clavicular
conjunctival sac
the potential space between the eyelids and the eyeball, lined by the conjunctiva, the delicate membrane that lines the eyelids and covers the exposed surface of the sclera
conjuntival sac
the potential space between the eyelids and the eyeball, lined by the conjunctiva, the delicate membrane that lines the eyelids and covers the exposed surface of the sclera
ventricular fibrillation
the rapid, irregular, and useless contractions of the ventricles
biopsy
the removal of living tissue from the body for diagnostic examination NPO for 4 hours prior
parathyroidectomy
the surgical removal of one or more of the parathyroid glands
bronchoscopy
the visual examination of the bronchi using a bronchoscope tissue sample may be obtained
pincer grasp/Cheerio's grasp
the well-coordinated grasp that emerges at the end of the first year, involving thumb and index finger opposition
placenta previa s/s placental abruption s/s
there is NO PAIN, but there is bleeding there IS pain, but NO BLEEDING (board like abd)
3rd degree burn
thermal damage to all three layers of the skin, also cooks blood vessels, so it appears to be dry and leathery- color depends on agent
foam padded cushion
these are okay to protect skin integrity
The vitamins a CF patient must have supplemented are:
they have trouble absorbing vitamins that need fat to be absorbed -- A, D, E, and K. People with CF also need to get water-soluble vitamins, which include vitamin C and the B-complex vitamins, folic acid, biotin, and pantothenic acid. They are called water-soluble because they are easily absorbed with water in the body.
assault
threat of unlawful touching or harm
Elevate 1 or more extremities indications
thrombophlebitis application of a cast edema post-op following procedure on extremity
Levothyroxine (Synthroid)
thyroid hormone take on an empty stomach take in morning used for hypothyroidism
Eye Drops Administration Technique
tilt head back into conjunctival sac
How to measure NG tube length
tip of nose to earlobe to xiphoid process measure from tip of nose to earlobe then down to xiphoid process mark with tape
justice
to be fair to all
fidelity
to be faithful to keep promises
administer eye drops
to the conjunctival sac inner to outer canthus
nurses role in informed consent
to witness the client's signature on the informed consent form & to ensure that consent has been appropriately obtained.
parallel play
toddlers
pedal (dorsalis pedis) pulse
top of foot lateral to the tendon on the top of the foot
TPN
total parenteral nutrition (IV feeding)
LPN tasks
tracheostomy care suctioning inserting urinary catheter checking NG tube patency med admin sterile specimen collection reinforce client teaching colostomy care
Transphenoidal Hyphophysectomy
transphenoidal surgical removal of the pituitary gland
TURP
transurethral resection of the prostate gland
beta-blocker drugs
treat hypertension and angina pectoris by lowering the heart rate
head lice (pediculosis capitus) treatment
treat siblings, parents PETS DO NOT NEED TO BE TREATED! soak child's combs & hair accessories for 10 min in boiling water use a nit comb for 2 weeks post treatment vacuum furniture, rugs, drapes every couple of days
1st sign of Parkinson's
tremors
veracity
truthfulness, honesty
manifestations of spina bifida
tuft of hair at base of spine hemangioma nevus or dimple at base of spine
sickle cell crisis
two interventions to prioritize: fluids and pain relief. abdominal pain!!! elevated bilirubin!!!
buck's traction
type of skin traction that is widely used for femoral, hip, and acetabular fractures, which are fractures in the socket portion of the "ball-and-socket" hip joint.
after arm catheterization
typically can sit up and you MAY be able to get up and walk around soon after
first trimester of pregnancy & insulin dependent diabetics
typically need less insulin
duodenal ulcer
ulcer in the duodenum **coffee ground emesis**
Physiologic Jaundice of the Newborn
unconjugated hyperbilirubinemia; begins on day three due to immature liver
how to insert a J-tube
under general anesthesia, a surgeon surgically places the J-tube. This involves making an incision on the belly area and small intestine. The surgeon then places the tube into the openings and stitches the tube into place
Aniscoria
unequal diameter of pupils
sentinel event
unexpected occurrence involving death or serious injury
Hashimoto's disease hallmark signs
unexplained wt gain lethargy **CAN BE FATAL IF LEFT UNTREATED**
1st sign of pancreatic cancer
unintended weight loss
how long does vaginal discharge last postpartum?
until placental site heals
how long after surgery would bowel sounds resume
up to 24-48 hours post surgery
Most common quadrant for breast cancer
upper outer quadrant
How to insert an oropharyngeal airway.
upside down, then rotate 180 degrees
best indicator that bladder irrigation is running at an adequate rate after TURP
urine output is light pink if output is > 500 ml than intervention is needed (i.e. 3000 input and only 2500 or less output - INTERVENE)
Topical Nitroglycerin Ointment
use measured dose applicator/Apply with "appli-ruler" Wear gloves Avoid "hair" Rotate sites Wash previous application site Remove for hypotension
Finasteride (Proscar)
used for BPH
Rectal Diazepam (Diastat)
used for client in status elipticus which is a life threatening emergency
Pavlik Harness
used for hip dysplasia in infants used for babies <6 months old diaper underneath socks T-shirt underneath to protect skin integrity do not double diaper **when changing diaper, keep baby's knees apart at all times**
Trach tube with cuff
used in clients with risk for aspiration when pt is awake, difficult to swallow & talk when eating, fully or totally deflate cuff
Troponin
used to diagnose MI value of 0.7 indicates cardiac muscle damage normal values = troponin I <0.5 troponin T = <0.1
Hydrocortisone topical
used to treat a variety of conditions it is used to treat redness, swelling, itching, and discomfort of various skin conditions. Hydrocortisone is in a class of medications ...
Black cohosh
used to treat hot flashes, palpitations, and irritability menopausal symptoms
Alendronate sodium (Fosamax)
used to treat or prevent osteoporosis take with full glass of water on an empty stomach
Biophysical Profile (BPP)
uses a real-time ultrasound for visualization of physical and physiological characteristics of a fetus. score of <6 send client to delivery score of 4 could be possibly asphyxia
NPH and regular insulin
usually administered 2x day lasts 12-18 hours
Dumping syndrome
usually happens after bariatric surgery food moves too quickly from your stomach into your intestine.
non-rebreather mask
usually short term can deliver 60-95% oxygen
Warfarin (Coumadin) taken how long?
usually taken 3-6 months
Tier 2 infection prevention
utilize transmission based precautions by hand hygiene, PPE, and environmental controls (private room/isolation), etc.
THE LITHOTOMY POSITION IS USED FOR PATIENTS IN WHICH CIRCUMSTANCE
vaginal, pelvic, and rectal examinations
chronic venous insufficiency
venous circulation is inadequate due to partial vein blockage or leakage of venous valves brownish, hardened skin on lower extremities leathery skin is highly prone to skin breakdown, ulcers
Virchow Triad of DVT
venous stasis (bed rest, varicose veins, dehydration, heart failure) endothelial damage (direct trauma, central lines repetitive motion injury) altered coagulation (pregnancy, cancer, birth control pills, post menopause, hypothermia and septicemia)
If a tracheostomy tube is dislodged, what should you do?
vent the client using a resuscitation bag & facemask
post - MI - what to watch for
ventricular dysrhythmias
herpes zoster (shingles) contagion
viral infection affecting peripheral nerves You can spread the varicella zoster virus to people who've never had chickenpox and haven't been vaccinated. You're contagious until all of the sores have crusted over.
Low WBC counts may indicate
viral infections, pneumonia, autoimmune diseases, or cancer
occipital lobe functionterm-1015
vision
total lung capacity
vital capacity + residual volume
postpartum breastfeeding mother should increase which vitamins?
vitamin C
when taking Warfarin, avoid
vitamin K spinach, broccoli, kale, other green leafy GF or GF juice
Supraglottic swallow technique
voluntarily close/protect the airway during food intake
phlebitis, infection & thrombosis characteristics
warmth redness swelling
snake bite in a child
wash bite area with soap and water cover with a clean, dry dressing immobilize the area calm the child place child in reclined position remove restrictive clothing
EEG prep
wash hair prior
hypothalamus function
water balance/bp/temp regulation/hunger/thirst/sex.
dumping syndrome manifestations
weakness sweating palpitations dizziness borborygmic urge to defecate diaphoresis pallor and light-headedness
to suppress lactation post-partum
wear support bra
when to resume sexual intercourse after childbirth
when bleeding stops could be 2-4 weeks
Fowler's position used for
white pt is eating thyroidectomy cataract removal resp illness cardiac problems with dyspnea during procedures such as NG tube insertion and suctioning -allows for better chest expansion & ventilation as well as better dependent drainage, after abdominal surgeries. bleeding/esophageal varices
Pertusisis
whooping cough
Grave's Disease/ hyperthyroidism symptoms
wide ranging, anxiety, irritability, fatigue, rapid or irregular heartbeat, fine tremor, sensitivity to heat, enlargement of thyroid, weight loss, change in menstrual cycle, ED, reduced libido, frequent BM, bulging eyes, and thick red skins on shins or tops of feet.
Dilation
widening, stretching, expanding
signs of hearing deficit in toddler
withdrawn monotone speech speaks in a loud voice difficult to understand appears inattentive when given directions or appears "dreamy" and "far off"
newborn should pass meconium
within first 24 hours
Alkaline phosphatase
would be elevated in pts with metastatic bone disease
Primary intention healing
wounds that heal under conditions of minimal tissue loss low risk for infection
pyelogram
x-ray of the renal pelvis dye injected into kidneys, ureter & bladder to determine issues
myelogram
x-ray of the spinal cord
breastfeeding stools
yellow 6-10 per day loose seedy (remember clinical at school)
can i get pregnant when breastfeeding?
yes! mother still ovulates while breastfeeding!
cardiac catheterization (CC)
passage of thin tube (catheter) through veins or arteries leading into heart; used to detect heart abnormalities, to collect cardiac blood samples, and to determine pressure within heart
patent ductus arteriosus (PDA)
passageway (ductus arteriosus) between the aorta and the pulmonary artery remains open (patent) after birth loud, machine like murmur
chain of infection model
pathogen, reservoir, method of transmission, susceptible host
Deep breathing exercises
patient concentrates on breathing and muscle movement; oxygenates blood stream and brain oxygen supply **breathe in the through the nose - hold for 3 seconds - breathe out through the mouth** repeat for 2-5 minutes
post lumbar puncture
patient should lie flat in supine to prevent headache and leaking of CSF.
constricted pupils indicate
patient using a CNS depressant drug eye drops
Autonomic Dysreflexia
patients with spinal cord injuries are at risk for developing autonomic dysreflexia (T-7 or above) raise HOB; could be caused by full bladder, fecal impaction or tight clothing
Cheyne-Stokes respiration
pattern of breathing characterized by a gradual increase of depth and sometimes rate to a maximum level, followed by a decrease, resulting in apnea
The dorsal recumbent position is used for what?
pelvic exams in hospital beds and foley insertions abdominal data or wound evisceration
obese pt with low O2
perform head tilt & chin lift to open airway
Dorsal
pertaining to the back
epistaxis interventions
pinch sides of nose keep client seated keep pt calm
during epistaxis with pt with thrombocytopenia
pinch soft portion of nose
removing NG tube
pinch tube while removing tube this decreases the risk of aspiration
to assess for complications of parathyroidectomy
place BP cuff on arm and inflate pressure to > systole BP and hole in place for 3 minutes to assess for Trousseau's sign
post mastectomy care
place client in semi-Fowler's affected side's arm on several pillows (to drain)
to take a BP
place cuff 1" above antecubital space make sure cuff encircles 80% of pt's upper arm cuff too loose - BP will read too high cuff too tight - BP will read too low
after cleft palate surgery
place infant in side-lying position
how to obtain urine specimen from child in diapers - non-sterile
place urine balls into diaper, when wet, squeeze urine from cotton ball into dipstick
post-mastectomy client's affected arm should be
placed on pillow to enhance drainage
Gout - tell pt
plenty of fluids achieve & maintain a healthy weight restrict alcohol consumption avoid red meat and seafoods to reduce purines!
Platelets (thrombocytes)
plug breaks in blood vessels a formed elements in the blood that is responsible for aiding in the clotting process
S/S of diabetes
polyuria >200 mL/hr polydipsia (thirst) polyphagia- increased appetite (usually means frequent swallowing) fatigue/weakness slow wound healing recurrent infections type 1 - sudden wt loss; N/V, abdom pain
crackles (rales)
popping sounds heard on auscultation of the lung when air enters diseased airways and alveoli; occurs in disorders such as bronchiectasis or atelectasis
How to perform a Heimlich thrust on an obese or pregnant person?
position your hands a little higher than with the Heimlich continue with thrusts as in Heimlich
lateral position used for
post-op following abdominal surgery tonsillectomy adenoidectomy client who is unconscious pt during a seizure post-op pyloric stenosis of the lower scapula post-op following liver biopsy rectal irrigations
continuous passive motion device
post-operative, promote recovery after joint surgery (12-14 hrs a day) line up the frame joints with the client's knee INITIATE CLIENT IN SUPINE POSITION then at 20 degrees if client can tolerate
severe hyperkalemia treatment
potassium (K)+ > 7 -IV admin 50 mL 50% dextrose with 10 units regular insulin -if ECG changes present calcium gluconate should be given before insulin/dextrose to stabilize heart muscle
Spironolactone (Aldactone)
potassium sparing diuretic
calcium carbonate
preferred supplement for pts with osteoporosis take in multiple doses with food
congenital
present at birth but not necessarily hereditary
PICC line - catheter occlusion complication
prevent kinks reposition arm flush catheter between meds administer approved anti-thrombolitic
placental abruption risk factors
prior abruption, CHTN, PIH, cocaine, alcohol, tobacco, DM, SLE
eating with a tracheostomy
prior to deflating the cuff, have pt cough to remove any secretions have client sit upright and tuck chin monitor for s/s of infection/fever
Infant with Diarrhea - what type of room?
private room until source of diarrhea is determined
endotrachael intubation
procedure in which a plastic tube is inserted into the trachea to maintain an open airway done when pts are unable to maintain adequate oxygen
Phases of a seizure
prodromal - before seizure, pt may see an aura aural phase - early part of seizure ictal phase - The middle (ictal) stage of a seizure is called the ictal phase. It's the time from the first symptom to the end of the seizure activity. It is during this time that intense electrical activity is occurring in the brain postictal - The final post-ictal stage occurs after the active (ictal) part of the seizure. This is the recovery stage and during this phase any physical after effects of the seizure are felt. The type of seizure and the part of the brain involved will determine how long it takes for a person to return to their usual self.
iatrogenic
produced by a physician in the form of a treatment prescribed by a physician
endogenous infection
produced or arising from within a cell or organism
warm milk or small amount of carbs at bedtime
promotes sleep milk contains tryptophan
reverse isolation
protects a patient who is highly susceptible to infection you are trying to protect the pt from everyone else on the floor/unit
Patient Self-Determination Act of 1990
protects patient rights including the right to agree to or refuse medical treatment
foods to promote wound healing
protein vitamin C (collagen)
Tetralogy of Fallot interventions
provide calm environment upon waking sooth infant when crying offer pacifier swaddle infant provide small, frequent feedings do not interrupt sleep
school age children in hospital
provide homework!!!
Physical Therapist (PT)
provides therapy in the form of heat, cold, massage, ultrasound, electricity and exercise to residents with muscle, bone and joint problems. A PT may help a person to safely use a walker, cane or wheelchair.
PQRST Pain Assessment Method
provocation/palliation quality/quantity region/radiation severity scale timing
Lateral (side-lying) position
pt on side with pillow under leg, back and head
How to use a cane
pt should hold cane on the stronger side of the body place it forward 6-10 inches and move his weaker leg forward to the cane
PPSV vaccine is for
pts who are immuno compromised
if client gags while inserting NG tube
pull tube back a little bit
skin traction
pulling effect on the skeletal system by applying devices to the skin
Swann-Ganz catheter
pulmonary artery catheter Tip in proximal right or left pulmonary artery
PERRLA
pupils equal, round, reactive to light and accommodation
How to prevent SIDS (sudden infant death syndrome)?
put baby to sleep on back give infant a pacifier at bedtime smoke-free home breastfeeding
After cleft palate repair
put child in side lying position **first 24 hours clear liquids only**
if trach comes out
put in obturator then insert new trach
after tonic clonic seizure
put pt in side-lying position b/c will have excess saliva the patient will be tired and want to sleep
brachytherapy
radiation therapy in which the source of radiation is implanted in the tissue to be treated -restrict time to 30 minutes per shift -visitors distance of 6' -assign client to private room w/ private bath -all staff must wear a lead apron b/c if they will be providing direct care/closer than 6' to pt -pt must remain on bedrest while on radiation therapy
with pacemaker do not
raise both arms above head use cell phone on opposite ear avoid contact sports unless you wear padding avoid heating pads and electric blankets
randomized clinical trial
randomly chosen subjects used in control and experimental groups to test an independent variable
Humalog (insulin lispro) meal time?
rapid acting insulin meal should be on tray in front of pt to eat immediately post injection
red man syndrome
rash on the upper body caused by certain anti-infectives Vancomycin comes from infusing too fast!
chest compressions for adults
rate of 100 to 120/min compress at least 2 inches (5 cm) allow the chest to recoil completely minimize interruptions
parietal lobe
receives sensory input for touch and body position
peak flow meter (PFM) recording
record highest measured reading
EMG (electromyography)
records the electrical activity of a muscle or group of muscles muscle activity
rifampin (anti-TB med)
red colored urine normal
lactulose (Cephulac)
reduce blood ammonia by excreation of ammonia by stools 2 -3 soft stools per day **IMPROVES MENTAL STATUS**
gauge
refers to the diameter of its lumen the larger the gauge, the smaller the needle
Kidneys function
regulate acid/base balance filter blood waste, excess H2O, impurities controls pH, sodium levels, and K levels in the body Produces hormones that manage RBC production & regulates BP
GERD treatment
relief from lifestyle changes (e.g. avoid problematic food, elevate head during sleep) and over-the-counter medications (e.g. antacids) is usually temporary. eat small meals with sips of water to help food passage Long-term medication may be needed such as PPI low fat small, frequent meals avoid spicy avoid tobacco, alcohol, chocolate & peppermint
polycythemia vera treatment
relies primarily on phlebotomy to reduce hematocrit - bleed them/ drain them (usually 1 or so a week or monthly)
frostbite care
remove clothing place in warm water for 20 minutes and then loosely bandage
care of minor burns
remove clothing and debris cool & cleanse wound antibacterial topical application pain management
Hypermagnesemia causes
renal failure antacids
autonomic neuropathy
damage to nerves supplying the internal body structures that regulate functions such as blood pressure, heart rate, bowel and bladder emptying, and digestion **intervention - take BP sitting & standing**
Foods high in folic acid include
dark green leafy vegetables, strawberries, beans, seeds, orange juice, fortified bread and cereals.
decreased renal function
dark, strong smelling urine elevated serum creatinine level elevated BUN decreased hemoglobin level decreased RBC
child with appendicitis
decreased bowel sounds
acute pancreatitis causes
decreased calcium
client deference
deference is submission so client deference is submission to client's wishes - can be a form of advocacy
Nurse Practice Act (NPA)
defines the scope and limitations of professional nursing practice varies from state to state
manifestation of diabetic ketoacidosis
dehydration
dehydration and sodium level
dehydration can increase sodium level
high specific gravity indicates
dehydration, concentrated urine
Delegating vs. Assigning
delegating- requires follow-through of task (evaluation that done properly; you still have the responsibility) assigning- requires no follow up; transfers the authority, accountability & responsibility to another
3rd stage of labor
delivery of placenta
febrile seizure treatment
depends on etiology and antipyretics. Antiepileptics are not indicated. Benzo (Ativan) may be used to break the seizure.
POA (power of attorney)
designates a person to act on the patient's behalf in case that person becomes incapacitated there are various types of POAs - medical, financial, etc.
Liver cirrhosis is characterized by
destruction of liver cells replaced by scar tissue decreased synthesis of proteins made in the liver, abnormal retention of fluid in the abdomen, and poor nutritional status
active acquired immunity aka artificial active immunity,
develops following direct exposure to the pathogenic agent vaccination
ACE inhibitors - "prils" are the drug of choice for
diabetics
Brat diets are contraindicated for
diarrhea
DASH (Dietary Approaches to Stop Hypertension)
diet that is - low sodium high in fruit & vegetables high fiber low to moderate fat rich in potassium, calcium & magnesium
dysphagia
difficulty in swallowing or inability to swallow
caput succedaneum
diffuse edema of the fetal scalp that crosses the suture lines. reabsorbs within 1 to 3 days
Sign of traumatic brain injury
dilated pupils
Low specific gravity of urine
dilute urine diabetes insipidus, chronic nephritis Very low specific gravity means dilute urine, which may be caused by drinking too much fluid, severe kidney disease, or the use of diuretics.
arterial insufficiency symptoms
diminished pulses cool, shiny skin absence of hair on toes pallor of lower extremities on elevation red color of lower extremities when dependent pale in color with well-defined edges and no bleeding
serum prealbumin level
directly related to patient's nutritional status normal = 23-43
external disaster
disasters outside the medical facility can be man-made or natural made
osteomalacia
disease marked by softening of the bone caused by calcium and vitamin D deficiency
Reynaud's Disease
disorder of blood vessels supplying the skin avoid excess caffeine yoga/tai chi (stress relief) refrain from tobacco products wear gloves when handling cold objects
Meniere's disease
disorder of inner ear causing vertigo, tinnitus, and hearing loss **LOW SODIUM DIET (and therefore lowered potassium)** avoiding nicotine & caffeine & alcohol avoid sudden changes
Ruptured ectopic pregnancy
dizziness low BP tachycardia (high heart rate) shoulder pain
Sputum collection
do at morning rinse mouth with water sit on side of bed or Fowler inhale deeply several times cough deeply and expectorate into sterile container
Ileostomy Care
do not add aspirin - irritates tissue empty bag when it is 1/3 full clean around stoma with warm water & soap change stoma appliance every 5-10 days assess for fluid and electrolyte imbalances
skin cancer risk factors
family hx high # of moles immunosuppressant medication use fair skin frequent sun exposure 5 major sunburns will double risk blonde hair blue eyes freckles green eyes red hair occupational (farmers, roofers) genetics
agoraphobia
fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control and panic
Zygote
fertilized egg
perineum after childbirth
first 24 hours - ice pack after 24 hours - warm sitz bath
AFTER cardiac LEG catheterization
flat and keep extremity straight keep leg straight med to relax you prior to procedure supine for 2-6 hours until doctor is sure bleeding has stopped
Macule
flat, colored spot on the skin (freckle)
raised neck veins
fluid volume excess
Obstructed Feeding Tube
flush & aspirate with warm water
How to flush a central line?
flush before and after administering med do not apply force if resistance use a syringe 10 ml or larger
contact of chemical with skin
flush with cool water first
Piaget's formal operational stage
focuses on abstract thought and problem solving
Rifampin
for TB Give on empty stomach (anti-tuberculosis) remember Rifampin causes red urine
Heimlich for infants
for child <1 back blows and chest thrusts
Valsalva maneuver
forceful exhalation against a closed glottis, which increases intrathoracic pressure and thus interferes with venous blood return to the heart STRAINING!
Maslow's Hierarchy of Needs
foundation = physiological (air, food, shelter) safety love/belonging esteem self-actualization
PICC line (peripherally inserted central catheter)
frequently used for a patient who will need IV therapy for more than 7 days
ventral
front
antecutibal
front of elbow
4th degree burn
full-thickness burn extending to muscle or bone
balance and coordination
function of cerebellum
Ketozonazole is used to treat _____.
fungi and protozoa
9th cranial nerve and function
gag reflex ability to swallow pts taught the supraglottic swallow
cancer that metastasizes to brain - changes in body
gait disturbances HA personality changes seizures
cholelithiasis
gallstones in the gallbladder
Semi-Fowler's used for
gastric feedings head injury ICP respiratory illness post-op following cranial surgery or cataract removal
GERD
gastroesophageal reflux disease
2nd trimester teaching
gestational diabetes test gain 1 lb per week abdominal U/S for fetal anatomy analysis/visualization increase consumption of iron-rich foods like dried fruit & meat anticipate light, fetal movements.
Phenytoin (Dilantin) adverse effects
gingival hyperplasia; CNS depression; skin rash; cardiac dysrhythmias; hypotension; narrow therapeutic index
Prior to suctioning what should the nurse do?
give 100% O2
Non-stress test interventions (pregnancy)
give pt glass of OJ prior seat client in a reclining chair or place in semi-fowler's or left lateral position; monitor response of fetal HR to fetal movement
glucose tolerance test (GCT) for gestation
given at 24-28 weeks pt given Glucola pt tested at 1, 2 & 3 hours if under <140 then okay >140 then dx of GD **fast 8 hours prior to test**
chlordiazexpoxide
given for pts in alcohol withdrawal to ensure no seizures & decrease anxiety
Vercuronium
given to decrease resistance to ventilator in pt with ARDS
Atropine Contraindications
glaucoma
B12 pernicious anemia signs and symptoms
glossy tongue numbness & tingling in fingers/toes hypoxemia pallor jaundice poor balance
Tier 1 infection prevention
gloves bagging laundry washing hands
Admin of a rectal suppository >3 yo
gloves place child supine with knees & feet raised against rectal wall use INDEX finger past internal and external sphincter hold buttocks together after insertion **should have result in 10-30 minutes**
Apraxia
impaired ability to carry out motor activities despite intact motor function **put coat on upside down**
infants apnea - normal level
<20 seconds
hip dysplasia treatment
<6 months = *Pavlik harness* provides for longer term positioning spica cast - for a toddler, reduction of hip Surgical intervention may be needed
Respiratory Therapist (RT)
Administers "breathing treatments" and assists with managing a patient's airway swallowing
Pancreatitis (chronic)
EtOH (adults), cystic fibrosis (kids)
formula feeding
Every 3-4 hours feed 1-2 ounces - 6-8 wet diapers a day and 2 stools a day
Hematoma treatment
Remove IV device and apply light pressure if bleeding monitor for signs of phlebitis and treat
lithium toxicity s/s
>1.5 vomiting, diarrhea, drowsiness, muscular weakness, ataxia Side FX: dizziness, HA, impaired vision, fine had tremor, reversible leukocytosis
HDL cholesterol
>40 mg/dL
Encephalopathy is defined as
any dysfunction of the brain
ARDS treatment
Remove causative factors Administration of 100% oxygen Mechanical ventilation
Rh shot
Rh- negative mother who gives birth to an Rh+ child
5 year old gross motor skills
>>Jumps rope ››Walks backward with heel to toe ›› Throws and catches a ball with ease
pt with arthritis who has pain - do this prior to exercise
apply heat to joints!
PICC line - phlebitis complication
apply low-degree heat discontinue if not resolved
4 point crutch gait
Left crutch followed by right foot, right crutch followed by left foot. Everything moves separate NOT TOGETHER!
Griseofulvin
>Give with meals-- especially high fat meals (anti-fungal) >taken for several weeks or months - take the full prescription >photosensitivity is a concern
Hirschsprung disease s/s
*Ribbon-like stool* Failure to pass meconium stool in first 24-48 hours Vomiting bile Swollen belly/distended abdomen Diarrhea Constipation/gas Refuses to feed
*Yang* foods (Chinese)
*bright, hot* foods ex. hot soup from chicken
Circumcision care
- *washing hands* before providing care - *applying petroleum jelly* to glans penis at *diaper changes* (unless plastic ring was used) for *3-7 days* to prevent adhering to diaper - site typically *heals within 7-10 days* - expect *yellow exudate* on penis after the first day, a *normal part of healing* - use *warm water (without soap)* to remove urine/feces during diaper changes or at least twice daily
Kick counts (fetal movement counting)
- 2 hours after eating, same time daily - report less then 10 movements in 3 hours -before bedtime best
Naegele's Rule
-subtract 3 months from the LMP then add 7 days and 1 year
Erickson's theory
- 8 stages of psychosocial development unfold throughout the human lifespan -each stage consists of a unique developmental task that confronts individuals with a crisis that must be faced
Abdominal Aortic Aneurysm signs and symptoms
- Abdominal pain radiating to the back - if AAA is large enough, it can be felt pulsating. - absent pulse in extremities
hydatidiform mole signs and symptoms
- Bleeding which mag range from spotting to profuse hemorrhage; cramping may be present - RAPID uterine growth and uterine size that is larger than expected for the gestation - Failure to detect fetal heart activity - Signs of HYPEREMESIS gravidarum - Very EARLY development of gestational HTN - HIGHER than expected hCG level - "SNOWSTORM" pattern on ultrasound w/no fetus
Addison's disease treatment
- High protein, high carb diet - Glucocorticoids - Weigh daily - Injectable IV fast acting steroid may be ordered or indicated for a pt experiencing an Addisonian crisis until the pt is no longer at risk for dehydration, hypotension and shock.
Hemolytic transfusion reaction
- LOW BACK PAIN! Back pain is an adverse reaction, hypotension, tachycardia
Ergotamine
- Medication that should be taken on onset of a migraine - It should be taken upon aura of headache and a max of 3 tablets should be taken in a 24 hour period. -can cause a dependence on med **not safe during pregnancy**
Fat embolism signs and symptoms
- Petechiae on upper body - Altered mental status - low arterial O2 - Tachycardia - Tachypnea - Fever - Elevated BP - SOB
Voiding in newborn
- Should void within the first 24 hours - Urine specimens are obtained with a U-bag (non-invasive)
bethamethasone (celestone)
- Surfactant. -Med for lung expansion especially used for premature infants
Alendronate (Fosamax)
- This medication is used to prevent and treat postmenopausal osteoporosis and Paget's Disease - TAKE 1ST THING IN THE MORNING ON AN EMPTY STOMACH - SIT UP & WAIT 30 MINUTES PRIOR TO EATING, DRINKING OR TAKING ANY OTHER MEDS
Alendronate (Fosamax)
- This medication is used to prevent and treat postmenopausal osteoporosis and Paget's Disease. - Alendronate must be taken first thing in the morning on an empty stomach. -take with a full glass of water! - The pt must be instructed to wait at least 30 minutes after taking Alendronate before eating, drinking, or taking other medications.
Chronic Stable Angina Pectoris
- Typically elicited by physical or emotional stress - Subsides with rest or 1 nitro medication
Plantar creases
- Useful tool in assessing gestational age of the infant - Before 28 weeks, it'll be smooth
Brachytherapy used in the treatment of
cervical and endometrial cancer
Pavlik harness teaching
-NO LOTIONS OR POWDERS -lightly massage skin under straps daily to ensure skin integrity -shirt under straps -check for red areas under strap several times a day -diaper should be placed UNDER the straps, wear 3-5 months readjust every 1-2 weeks because of infant growth, done by HCP wear knee socks to prevent skin breakdown **regularly assess skin for breakdown/skin integrity**
Autonomic Dysreflexia S/S
-Severe Pounding Headache -Hypertension -Profuse Sweating (especially forehead) -Bradycardia -Nasal Congestion -piloerection -goose flesh
admin insulin
-Subcutaneous injection: syringe/needle, pen and jet injectors abdomen for rapid absorption
intussusception s/s
-Sudden onset of severe, intermittent abdominal pain -screaming and drawing up legs with periods of calm in between episodes -pain relieved once abdomen relaxes -currant jelly stools (blood and mucus) -SAUSAGE SHAPED MASS IN RUQ
Immediate recall memory
-Temporal lobe -Give client three words or numbers and have client repeat them in a few minutes
Probable signs of pregnancy (objective)
-Uterine enlargement -Hegar's Sign -Chadwick's Sign -Goodell's Sign -Ballottement -Braxton Hick's Contractions -Positive Pregnancy Test
examples of sentinel events
-Wrong patient -Wrong site -Wrong procedure -Delay in treatment -Suicide -Operative or post-op complications -Retention of foreign body -Medication error -Perinatal death or injury -Criminal events
paracentesis
-a procedure that removes fluid (peritoneal fluid) from the abdomen through a slender needle. The collected fluid is then sent to a lab for analysis to determine what is causing the excess fluid. The most common reasons to perform paracentesis is to: Diagnose an infection.
Autonomic dysreflexia
-a syndrome in which there is a sudden onset of excessively high blood pressure. It is more common in people with spinal cord injuries that involve the thoracic nerves of the spine or above T-6 -bladder distention most common cause! - Caused by - something as simple as a full bladder or an ingrown toenail can be enough to send your nerve responses into overdrive. Others are - constipation or kidney stones
Mandatory Reporting
-abuse: child or elder abuse, domestic violence -communicable diseases (according to CDC) such as hepatitis and TB
Alcohol withdrawal symptoms
-appear within 4-12 hrs -abd cramping -vomiting -tremors -restlessness -inability to sleep -TACHYCARDIA -HTN -transient hallucinations or illusions -anxiety -increased RR, temp -tonic clonic seizures -diaphoresis
late manifestations of hypoxia & hypoxemia
-bradypnea -bradycardia -confusion and stupor -cyanotic skin and mucous membranes -hypotension -cardiac dysrhythmias
how to collect a specimen from urinary catheter
-clean collection port with an alcohol swab -aspirate urine with a sterile syringe -use aseptic technique to transfer the specimen to a sterile specimen cup **URINE SAMPLE SHOULD BE TAKEN FROM PORT ON CURRENT CATHETER**
Parkinson's risk for
-constipation -aspiration -drooling -dysphagia
Signs of true labor
-contractions are regular with increasing frequency (shortened intervals), duration, and intensity -discomfort radiates from back to abdomen -contractions do not decrease with rest -cervix progressively effaces and dilates
components of med prescription
-date & time written -med name -med dosage -route of administration -frequency of administration -primary HCP signature
assessments that indicate suctioning
-decreased O2 sat -altered mental status -increase HR -increased RR -difficulty breathing (use of accessory muscles, grunting, flaring) -adventitious breath sounds -pallor, mottled or cyanotic skin
end-stage renal disease (ESRD) treatment
-dietary restriction of protein, sodium and potassium intake -antiemetics for nausea -control of HTN example of a meal with these restrictions - chicken sandwich, applesauce
Epistaxis treatment
-direct pressure x 15 minutes with ice or cold cloth -lean forward -if still bleeding, afrin -lidocaine then silver nitrate if you can see bleeding area -nasal packing for anterior bleed -refer to ENT or ED if still bleeding -CBC and clotting times if no obvious reason -saline for dried nasal tissue
phagocytic cell disorder - pts susceptible
-eczema -recurrent abscesses -pneumonia
1 month milestones
-elevates head momentarily from prone position -tight fist grasp -responds to sounds -prefers the human face
Reverse Trendelenburg
-entire bed is tilted with the foot of the bed lower than the head -position promotes gastric emptying and prevents esophageal reflux
functions of the placenta include
-exchange of nutrients & waste between fetus & mother -Nutrient and gas exchange between the mother and fetus -Removal of waste products from the fetus -protection against bacteria
angina pectoris causes
-extreme temps (cold or hot) -tobacco use -physical exertion (training, sex, exercise) -stimulants/amphetamines/ED meds -Coronary artery narrowing (CAD, arteriosclerosis)
2-3 month milestone
-gains head control -holds rattle when placed in hand -makes cooing sounds -smiles in response to talking or smiling -recognizes familiar faces
testicular cancer signs & symptoms
-hard, painless, usually unilateral masses -testes/scrotum may be enlarged or feel heavy -dull, aching pain in lower abdomen -hydrocele or epididymitis can occur -gynecomastia may develop due to hormone secretion
restraints - pt car
-hourly NV checks -release restraints every 2 hours -offer fluids, nutrition, toileting every 2 hours
Suctioning
-hyperoxygenate client prior to suctioning -suction 10-15 seconds (rotating motion); limit 2-3 attempts -Allow 20-30 sec recovery between attempts -Document amount , color, and consistency of secretions as well as client's response
3 year old milestones
-jumps in place; balances on 1 foot -sentences of 3 - 4 words -feeds self -draws circle -feeds self -asks "why" -states own name -mostly toilet trained -draws circle -rides tricycle
Holter monitor instructions
-keep a diary of activities and symptoms while wearing for comparison later -do not bathe or shower during testing period -engage in normal activities and routine
Tracheostomy care -
-keep two extra tracheostomy tubes (one the client's size and one a smaller size) at the bedside in the event of accidental decannulation -Only suction client as clinically indicated -humidification of oxygen source is required at all times to mucosa stays moist -Tracheostomy care every 8 hours or as needed **SURGICAL ASEPSIS**
normal uterine contractions during the first stage of labor
-lasts 40-80 seconds -should not exceed 90 seconds! -resting tone should not exceed 20 mmHg -strength of contraction at height = 25-50mmHg; should not exceed 80 mmHg -2-5 contractions every 10 minutes -no more than every 2 minutes
10-12 month milestones
-may walk with help or take independent steps -crawls up stairs -uses 2 finger pincer grasp -hits 2 objects together -says 3-5 words -uses nonverbal gestures (waving bye-bye) -separation anxiety -searches for hidden objects
to administer several meds via pt feeding tube
-meds should be crushed -meds should be crushed separately and administered separately -inquire if a liquid form of the med is available and use that -flush line prior to and after admin of each med
guidelines for safe IV administration
-never admin meds through tubing being used for blood admin -implement standard precautions & follow policies -fluids should be infused within 24 hours or disgarded to prevent infection
Contraction Stress Test (CST)
-nipple stimulation or oxytocin stimulation evaluates fetal response to stress -no deceleration with a min of 3 contractions lasting 40-60 seconds in 10 min -done at 28 wks
MRSA - pts at greatest risk
-older pts -suppressed immunity -long hix of antibiotic use -invasive tubes or lines
pyloric stenosis s/s
-olive size mass in RUQ (moveable/firm) -peristaltic waves during and after feedings -projectile vomiting!** -hungry and irritable after vomiting -dehydration & metabolic acidosis
LDL cholesterol levels
-optimal: less than 100mg/dl
4-5 month milestones
-palmar grasp -rolls front to back/back to front -puts objects in mouth -begins to laugh -makes consonant sounds -sits with support -becomes calmed with parents voice
SIADH risk factors/causes
-pneumonia -malignancies -CNS illnesses (stroke, infection, trauma) -water retention -total body water increases -decreased sodium **not associated with DM** could be associated with cancer
Allen's Test (wrist)
-purpose: to ID vascular compromise -to determine ulnar patency -tests radial & ulnar arteries by compressing them -pt opens hand while pressure is maintained over the arteries -one artery is tested by releasing pressure over that artery to see if hand flushes
Right sided heart failure symptoms
-related to systemic congestion -fatigue -increased peripheral venous pressure -ascites -enlarged liver and spleen -may be secondary to chronic pulmonary problems -distended jugular veins -anorexia and complaints of GI distress -weight gain -dependent edema
bat bite/rabies
-scrub & clean bite vigorously -admin tetanus toxoid vaccine -human rabies immunoglobulin -rabies vaccine
6-9 month milestones
-sits without help -begins to crawl -may pull to a stand -moves objects between hands -uses crude pincer grasp -babbles -may say mama -may have stranger anxiety
Diet for Phenylketonuria (PKU)
-special formula and diet *low in phenylalanine* -phenylalanine free medical formula -elemental medical foods (modified protein hydrolysates where phenylalanine has been removed) -avoid high protein foods (milk, dairy, meat, fish, chicken, eggs, beans, nuts)
BP cuff too small
false high reading
Hepatitis C signs and symptoms
1. Pre-icteric: Fatigue malaise, anorexia, n/v, headache, aversion to smoking and alcohol 2. Icteric: Weight loss, jaundice, pruritus, RUQ pain, clay colored stool, dark urine - Low grade fever may be present - Hepatosplenomegaly may be present
restraining a client without a doctor's order
false imprisonment
5 Rights of delegation
1. Right person 2. Right task 3. Right circumstance 4. Right direction/communication 5. Right supervision/evaluation
low vs. high phenytoin levels
>if levels are too low = seizures >too high = the person may experience symptoms associated with phenytoin toxicity - Lethargy, confusion, hyperactivity. greater than 50 = seizures or coma
Hirschsprung disease treatment
1. The majority of children with HD require 1 of 3 operations - *child is stabilized with fluid and electrolyte replacement and colonic cleansing with enemas* and if needed, surgery is performed 2. Surgical management consists primarily of the *removal of the aganglionic portion of the bowel* to relieve obstruction, restore normal motility, and preserve the function of the external anal sphincter
ECT therapy
A patient gets anesthetic and electrodes put on their head. They produce a fit for one minute, and remember nothing of the procedure.
walking down stairs using cane
1 - cane first 2 - injured leg 3 - uninjured leg
lifting and transfer of clients - nursing interventions
1 - collect data about mobility & strength 2 - tell clients to assist when possible 3 - use mechanical lift & assistive devices 4 - avoid twisting the thoracic spine or bending at waist 5 - use major muscle groups & tighten abdominal muscles
If the umbilical cord prolapses into the vagina
1 - place client in Trendelenberg position 2 - immediately notify physician
2 drains after thoracic lobectomy
1 drain to remove excess air 1 drain to remove excess blood
6 rights of medication admin
1 right medication 2 right dose 3 right patient 4 right route 5 right time 6 right documentation
When to do breast self exam
1 week after period when breasts are not tender or swollen After menopause, check first day of every month
When does the Babinski reflex disappear?
1 year
language in toddlers
1 yr - one word sentences 300 words by 2 years 2 yr: 2-3 word sentences 3 yr: simple sentences of several words, grammatical rules
open post-op abdominal wound
1) put moist, sterile cloth over wound 2) flex knees toward chest gently
Infants urinary output
1-2ml/kg/hr
when to take antacids
1-3 hours after meals
types of colostomy
1. Ascending 2. Transverse 3. Descending 3. Sigmoid
Stages of Grief (Kubler-Ross)
1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance
Cushing's triad consists of:
1. Elevated systolic BP 2. Bradycardia 3. Irregular respirations
Prevention of DVT in bedridden patients
1. Elevation of the foot of the bed 2. Leg exercises 3. Compression hose 4. Intermittent compression devices 5. Anti-coagulation in high risk patients may be necessary
The BPP measures 5 things:
1. HR 2. Breathing 3. Body movements 4. Fetal muscle tone 5. Amniotic fluid volume
How to use an incentive spirometer
1. Hold in upright position 2. Exhale normally 3. Seal lips tightly around mouthpiece 4. Take in slow deep breaths to elevate the balls or cylinder for 2-6 seconds (start low) 5. Avoid brisk low-volume breaths 6. Remove mouth piece and exhale normally 7. Cough after the incentive effort 8. Relax and take several breaths before using again 9. Repeat the procedure several times and four to five times per hour 10. Clean mouth piece and shake it dry.
PRIORITIZATION PRINCIPLES
1. LIFE BEFORE LIMB EX: Shock over pt w limb inj 2. ACUTE BEFORE CHRONIC 3. ACTUAL BEFORE POTENTIAL 4. MASLOWS: SELSP 5. EMERGENCIES VS. EXPECTED FINDINGS
risk factors for DVT
1. Major surgical procedures (especially total hip replacement) 2. Prolonged bed rest 3. Lower extremity trauma 4. Use of OCP and HRT 5. Inherited (Factor V Leiden, Protein C, Protein S, or anti-thrombin deficiencies) 6. Cancer-associated hypercoagulable states 7. Advanced age 8. Obesity 9. Long-distance air travel 10. Multiparity 11. IBD 12. Lupus erythematosus
Nursing Process
ADPIE Assessment Diagnosis Planning Implementation Evaluation
Care after cardiac catheterization
1. bedrest 2. keep insertion site straight/MIDLINE 3. head of bed down or 30 degrees, depending on cardiologist 4. stay in bed for 2-6 hours 5. vital signs 6. assess insertion site for bloody drainage or hematoma 7. assess peripheral pulses, skin temp, and color in affected extremity with every vitals 8. monitor urine output, give oral and IV fluids to flush
NG tube insertion steps
1. check order 2. gather equipment, 3. introduce yourself, identify Pt., provide privacy, explain procedure, hand hygiene, gloves 4. place in high fowler's position 5. determine length of tube measure from the tip of the nose to the top of the ear to the xiphoid process & mark appropriately (add 20-30cm for duodenal and Jujenum) 6. apply lubricant to the tip of the tube 7. insert tube into nose with neck hyperextended & advance straight, if resistance is met increase pressure slightly continue until mark is reached 8. use a syringe to aspirate a small amount of gastric content, test the PH of the contents using using the litmus paper 9. whoosh test, 30 cc bolus of air 10. abd xray for placement check 11. secure the tube with tape or other product to hold the tube in place
NG tube insertion
1. check order, gather equipment, introduce yourself, identify Pt., provide privacy, explain procedure, hand hygiene, gloves. 2. solicit help & consider restraints prn 3. position child in fowler's position 4. (nasogastric)determine length of tube measure from the tip of the nose to the tragus of the ear to the xiphoid process & mark appropriately 5.(orogastric)determine length of tube measure from the mouth to the tragus of the ear to the xiphoid process & mark appropriately 6. apply lubricant to the tip of the tube 7. for orogastric tube insert tube into mouth with neck hyperextended & advance it toward the back of the throat, continue until mark is reached 8. nasogastric tube insert tube into nose with neck hyperextended & advance straight, if resistance is met increase pressure slightly or rotate tube, continue until mark is reached 9. use a syringe to aspirate a small amount of gastric content, test the PH of the contents using using the litmus paper ( a PH of 3 or less indicates gastric contents) 10. secure the tube with tape or other product to hold the tube in place **If cough and gag, back off a little, let calm & then advance again with pt sipping water from straw cough and gag, back off a little, let calm advance again with pt sipping water from straw**
infant formula teaching
1. keep parts of bottles as clean as possible (boil or wash in dishwasher) 2. *wash the top* of can before opening 3. keep *unused prepared formula or cans in refrigerator* after opening but *discard after 48 hours* -but throw away formula that infant left in bottle 4. *never microwave* but instead can be placed in pan of hot water to warm it, then test temp on inner wrist. should be lukewarm 5. *Never dilute or concentrate* formula
LPN scope of practice
1. monitoring RN findings 2. reinforcing education 3. routine procedures (catheterization) 4. most med administrations 5. ostomy care 6. tube patency and enteral feeding 7. specific assessments (like lung, bowel, neurovascular checks)
Piaget's Stages of Development
1. sensorimotor 2. preoperational 3. concrete operational 4. formal operational
Piaget's stages of cognitive development
1. sensorimotor 2. preoperational 3. concrete operational 4. formal operational
Braden scale categories
1. sensory perception 2. moisture 3. activity 4. mobility 5. nutrition 6. friction/shear
How to use a metered-dose inhaler:
1. shake inhaler well before use (three or four shakes) 2. remove the cap 3. exhale completely, away from inhaler 4. bring inhaler to your mouth. place it in your mouth between your teeth and close mouth around it 5. start to breathe in slowly. press top of your inhaler once and keep breathing in slowly until you have taken a full breath (three to five seconds) 6. Remove the inhaler from your mouth and hold your breath for about 10 seconds, then breathe out *wait only one minute between each puff
Erikson's stages of psychosocial development
1. trust vs. mistrust (0-2) 2. autonomy vs. shame and doubt (2-4) 3. initiative vs. guilt - preschool 4. industry vs. inferiority - school age 5. identity vs. role confusion - teen 6. intimacy vs. isolation - early adult 7. generativity vs. stagnation - 30s-40s 8. integrity vs. despair - 55+
Specific gravity of urine
1.001-1.035
CPR infant
1.5 inch compressions; 30 compressions to 2 breaths; one rescuer is 30 to 2 2 rescuers is 15 to 2 (do compressions with thumbs)
where to place hands for cpr compressions
1.5 inches above tip of xiphoid process
when does baby's cord fall off
10-14 days
Phenytoin level
10-20
Normal intraocular pressure (IOP)
10-21 mm Hg
Infant chest compressions
100 per minute
Newborn HR and RR & BP
100-180 40-60 60-80/40-50
FHR normal range
110-160 bpm
BP cuff too large
false low reading
Avg newborn head circumference
13-14" 33-35 cm
NSAIDS can exacerbate
ASTHMA symptoms. Tylenol is better
how long should nurse wait after starting a tranfusion
15 minutes
when to apply sunscreen regarding time to sun exposure?
15-30 minutes prior to going outside
Nagele's Rule
1st day of last period + 7 days - 3 months
Hep B vaccine schedule
1st dose - newborn 2nd dose @ 1-2 months 3rd dose @ 4-6 months
pinworm tape test
1st thing in the morning when a child wakes
fetal heartbeat
1st trimester = 160 - 170 bpm from 2nd trimester until term = 110 - 160 **FHR is approximately 2x mother's heart rate**
stages of labor
1st: dilating stage 3 phases: Latent (0-3cm) Active (4-7cm) Traditional (8-10cm w/ urge to push) 2nd stage: delivery 3rd: placental delivery 4th: recovery- primary goal to prevent hemorrhage from uterine atony, 1st void within 1 hour and then q2-3 hrs, Rhogam
lithium & NSAIDS
Li level will increase with inhibition of prostaglandins (ie. aspirin, tylenol) DO NOT TAKE IBUPROFEN OR NSAIDS WITH LITHIUM
RED tag
Life-threatening & requires immediate attention
Hep A vaccine schedule
2 doses 12-24 months
DTaP vaccine schedule
2 months, 4 months, 6 months, 15-18 months, 4-6 years
Hib vaccine schedule
2, 4, 6, 12-15 months
colostrum turns into milk @
2-3 days
Regular insulin peak?
2-4 hours
how long to wash hands for
20 seconds
MCH (mean corpuscular hemoglobin)
25.4-34.6 pg/cell* - is the average mass of hemoglobin per red blood cell in a sample of blood. It is reported as part of a standard complete blood count. MCH value is diminished in hypochromic anemias.
how often to change ostomy appliance
2x per week
pulse strength
3+ is full, bounding 2+ is normal 1+ is weak 0 is absent
how far up to insert enema tip
3-4"
Hepatitis B Virus (HBV)
Liver infection caused by the hepatitis B virus that is transmitted by blood, semen, or another body fluid from an infected person
Jehovah's Witness
No blood products should be used including FFP, platelet transfusion
ultrasonography
imaging of urinary tract structures using high-frequency sound waves **full bladder to do this test**
how many inches up should enema tip be inserted?
3 - 4"
Glasgow Coma Scale (GCS)
3 = least responsive 15 = most responsive 8 or less = comatose a scoring system used to describe the level of consciousness in a person following a traumatic brain injury
HPV vaccine schedule
3 dose series. Given 0,1-2, and 6 months apart. Females can receive any of the available vaccines start at 11-12 years old. Males receive Gardasil or Gardasil 9 only, usually between 13-21 years old. Duration of protection and need for booster are unknown.
3 point crutch gait
3 point: this gait pattern is used when one side lower extremity (LE) is unable to bear weight (due to fracture, amputation, joint replacement etc).
FACES pain scale
3 years and older good for ppl who do not speak the language
Albumin
3.5 - 5 protein in blood; maintains the proper amount of water in the blood
Adult CPR
30:2 compression rate of 100-120 2" deep compression
CPR adult repititions
30:2 After every 30 chest compressions, give 2 rescue breaths. Tilt the casualty's head gently and lift the chin up with 2 fingers. Pinch the person's nose. Seal your mouth over their mouth, and blow steadily and firmly into their mouth for about 1 second. Check that their chest rises. Give 2 rescue breaths.
Epiglotitis
3Ds' Drooling, Dysphonia, Dysphagia **inability to swallow - take child to ER immediately because crying may increase inability to breath/swallow**
When is varicella-zoster the most contagious?
The day before the rash appears
Endometrial cancer signs and symptoms
Abnormal, but painless bleeding between cycles Bleeding in post-menopause HIGH RISK - family hx, polycystic ovary syndrome, infertility, late menopause, early menarche, obesity, use of Tamoxifen use
Leukocytosis
Abnormally high WBC count
pincer grasp age
9 months
BNP (brain natriuretic peptide)
<100 pg/mL or ng/L desired >100 positive >400 severe HF -BNP is ordered to help determine HEART FAILURE & is a more sensitive test than ANP. It is a neurohormone secreted primarily by cardiac ventricles and increases in response to volume expansion and pressure overload.
Triglycerides
<150 mg/dL
Bowlby's theory of grief
4 stages 1. Numbing-being in a state of shock, lasts 1-2 weeks 2. Yearning and searching-phy and psy distress, seeking the lost person/object, lasts 2 wks-3 months 3. Disorganization and despair-manifestation of depression and social withdrawal, anger, retells story over and over, lasts 3-6 months 4. Reorganization-person gradually increases their level of functioning, accepts change, acquires new skills, builds new relationships, lasts 6 months-1 year
Acetaminophen (Tylenol) 24 hour limit
4,000 gram
DM 2 amt of carbs should be?
45-60% of daily calories
Kohlberg's stages of moral development
6 identifiable developmental stages of moral reasoning which form the basis of ethical behavior, the pre-conventional (level 1) contains the first stage (obedience and punishment orientation and 2nd stage (self-interest orientation), the conventional (level 2) contains the 3rd stage (interpersonal accord and conformity) and 4th stage (authority and social-order maintaining orientation) the post-conventional (level 3) contains the 5th stage (social contract orientation) and 6th stage (universal ethical principles)
Place cane about ____ inches in front of the foot and slightly to the outside
6-10" in front of and to the side of the foot
serum proteins
6-8 proteins present in serum that are indicators of the body's visceral protein status (e.g., albumin, prealbumin, transferrin)
Adolescent normal heart rate
60-100
When does the umbilical cord fall off?
7-14 days after birth
preschooler normal pulse
80-110
toddler normal pulse
80-130
Amount of amniotic fluid
800-1200ml
rheumatic fever
A bacterial infection that can be carried in the blood to the joints streptococcal throat infection previously
greater trochanter
A bony prominence on the proximal lateral side of the thigh, just below the hip joint.
Tetrology of Fallot (TOF)
A cardiac anomaly that consists of four defects; 1. ventricular septal defect 2. pulmonary stenosis 3. right ventricular hypertrophy 4. overriding aorta.
peripheral artery disease
A circulatory condition in which narrowed blood vessels reduce blood flow to the limbs. skin on legs is shiny, hairless (due to lack of bloodflow), thickened toenails cool extremities, poor pulses intermittent claudication - resolves when walking
Vaginal hematoma
A client that just delivered a term infant reports persistent, severe vaginal pain & a feeling of fullness. What does the nurse suspect?
Lugol's solution (iodine)
A common test to detect the presence of starch. It turns blue-black in the presence of starch take with OJ/citrus juice to reduce bitter taste
Kwashiorkor
A disease of chronic malnutrition during childhood, in which a protein deficiency makes the child more vulnerable to other diseases, such as measles, diarrhea, and influenza.
functional disorder
A disorder in which there is no known physiologic reason for the abnormal functioning of an organ or organ system. IT DOESN'T MEAN THE PERSON IS CRAZY - JUST THAT THEY CANNOT DETERMINE THE CAUSE - LIKE MIGRAINES and EPILEPSY
living will
A document that indicates what medical intervention an individual wants if he or she becomes incapable of expressing those wishes. (pt has determined these desires ahead of time and medical staff carries them out)
nasogastric tube
A feeding tube that is inserted into the nose and goes to the stomach.
Crepitus
A grating or grinding sensation caused by fractured bone ends or joints rubbing together; also air bubbles under the skin that produce a crackling sound or crinkly feeling. could hear from pneumothorax
Malignant hyperthermia
A hereditary condition of uncontrolled heat production that occurs when susceptible people receive certain anesthetic drugs. *watch pt for high fever & muscle stiffness*
Hemophilia
A hereditary disease where blood does not coagulate to stop bleeding
placenta abruptio
A life-threatening emergency placenta peels away from the wall of the uterus CAUSES MASSIVE BLEEDING - DARK RED PAIN!
What is sickle cell anemia?
A mutation in a gene causes a problem making the hemoglobin of the red blood cells., A genetic disorder causing red blood cells to be rod/sickle shaped. This causes them to get stuck in capillaries and the bodies cells become deprived of oxygen pain results from decreased hemoglobin which occludes blood flow and hence causes tissue ischemia and pain
heel to shin test
A neurologic test assessing lower limb coordination and position sense.
temporal lobe
A region of the cerebral cortex responsible for hearing and language.
Stevens-Johnson Syndrome
A severe, possibly fatal reaction that mimics a burn; may be due to a medication.
Chlamydia
A sexually transmitted disease, the most common in developed countries, caused by the bacterium Chlamydia trachomatis. Often producing no symptoms, it can cause infertility, chronic pain, or a tubal pregnancy if left untreated.
Bile
A substance produced by the liver that breaks up fat particles.
thrombus vs embolus
A thrombus is a blood clot that forms in a vein. An embolus is anything that moves through the blood vessels until it reaches a vessel that is too small to let it pass (think embolus - energy, travels)
NG tube - when to call your doctor
A tube that is dislodged from the nose Coughing or trouble breathing Clogged tube Dizziness or lightheadedness Vomiting Fever above 101.5°F (38.5°C) Diarrhea that lasts more than 2 days
durable power of attorney for health care
A type of advance directive executed by a competent adult that appoints another individual to make medical treatment decisions on his or her behalf in the event that the person making the appointment loses decision-making capacity. a power of attorney names the person who can make financial or health care decisions for you if you are incapacitated.
risk factors for esophageal cancer
ABCDEF: Alcohol, Achalasia Barrett's esophagus Cigarettes Diverticula Esophageal webs, Esophagitis Familial nitro-containing foods (hotdogs, smoked meats( Obesity
jaundice in a newborn in the first 24 hours
ABNORMAL
Meds that are contraindicated in OB
ACE/ARBs (for HTN) docycline isotretinoin statins! warfarin **thyroid meds and insulin are okay**
Tasks for a UAP
ADLs Ambulating Feeding Positioning VS on stable clients I&O
UAP can do what?
ADLs, hygiene, routine vitals, documenting I&Os, positioning, perineal cleaning with catheter
Fluticasone/Salmeterol
Advair used for prevention and long term control of asthma after inhalation rinse mouth with water and spit out avoid smoking/tobacco products receive flu vaccine & pneumococcal vaccine usually used 2x daily **is not a rescue inhaler & does not treat exacerbations of asthma**
Left hemisphere stroke
Affects LANGUAGE, mathematic skills, & analytic thinking --Anxiety concerning the future --Feelings of guilt --Expressive aphasia --Agnosia, Alexia (reading difficulty), agraphia (writing difficulty) --depression, anger, & quickly frustrated
RIGHT hemisphere stroke
Affects visual and spatial awareness and proprioception (sense of our body's position) --Impulsive behavior --one-sided neglect syndrome --loss of depth perception --poor judgement --left hemiplegia or hemiparesis --visual changes
BPH (benign prostatic hyperplasia)
Age-associated prostate gland enlargement that can cause urination difficulty.
BPH treatment
Alpha-adrenergic antagonists: terazosin, doxazosin 5-alpha reductase inhibitors: finasteride, dutasteride Transurethral prostatectomy Open prostatectomy
Donezepil (Aricept)
Alzheimer's admin at nightime SEs - n/v/d weight loss frequent urination muscle cramps difficulty controlling urination
Residual Volume (RV)
Amount of air remaining in the lungs after a forced exhalation
Certified Nurse-Midwife (CNM)
An APRN who is also educated in midwifery and is certified by the American College of Nurse-Midwifes highest level of midwife
arteriovenous fistula
An abnormal communication between an artery and a vein. It can also be created surgically to provide access for hemodialysis. problem - skin pallor, skin hardens, ischemia, numbness, tingling
Peptic Ulcer Disease
An abrasion or erosion of the stomach or small intestine.
EEG (electroencephalogram)
An amplified recording of the waves of electrical activity that sweep across the brain's surface. These waves are measured by electrodes placed on the scalp.
Rh immune globulin (RhoGAM)
An anti-Rh (D) gamma globulin given after delivery to an Rh-negative mother of an Rh-positive fetus or child. Prevents the development of permanent active immunity to the Rh antigen.
paradoxical blood pressure
An exaggerated decrease in systolic pressure by more than 10 mm Hg during the inspiratory phase of the respiratory cycle. Normal value is 3 - 10 mm Hg
Hypoglycemia S/S
An irregular or fast heartbeat. Fatigue. Pale skin. Shakiness. Anxiety. Sweating. Hunger. Irritability.
Pericarditis treatment
Analgesics, antibiotics if bacterial, steroids, high fowler's leaning forward or tripod position monitor for signs of cardiac tamponade
Allopurinol (Zyloprim)
Anti-gout med Inhibits uric acid production Can cause hypersensitivity reaction, renal injury, hepatitis, N/V Slows metabolism of warfarin **take with a full glass of water** ADVERSE EFFECTS - Numbness/tingling of arms/legs, easy bleeding/bruising, unusual tiredness, signs of kidney problems (such as change in the amount of urine, painful/bloody urination), yellowing eyes/skin, severe stomach/abdominal pain, persistent nausea/vomiting, dark urine, unusual weight loss, eye pain, vision changes.
Cromolyn sodium (Intal)
Anti-inflammatory (mast cell stabilizer) Inhibits release of histamine Used for chronic asthma, allergic rhinitis Safest of all asthma meds **it is given prophylactically to prevent asthma attacks not stop them***
Lorazepam (Ativan)
Antianxiety agent. Increase the efficacy of GABA to reduce anxiety. Used for generalized anxiety disorder and panic disorder, insomnia, ALCOHOL WITHDRAWAL induction of anesthesia. Side effects: CNS depression, paradoxical response (insomnia, excitation, euphoria), withdrawal symptoms, risk of abuse and potential for overdose.
Atropine
Anticholinergic
Metformin (Glucophage)
Antidiabetic - Biguanide
Amiodarone (Cordarone)
Antidysrhythmic agent. Prolongs repolarization, relaxes smooth muscles, decreases vascular resistance. Incompatible with heparin monitor for respiratory complications. no grapefruit juice!
Gemfibrozil (Lopid)
Antihyperlipidemic monitor liver function of pt
Sumatriptan (Imitrex)
Antimigraine **do not take if hx of HTN**
Clopidogrel (Plavix)
Antiplatelet
Sucralfate
Antiulcer Agent forms a gel-like substance that coats ulcers and protects
RN CANNOT Delegate the Following Tasks:
Any part of the NURSING PROCESS: -Assessments that identify needs and problems which diagnose human responses. -Any provision of teaching, health counseling, or referrals to other healthcare providers. -tasks that require nursing judgment **LPN can REINFORCE teaching but the RN does the initial teaching**
cultures that do not like eye contact
Arabic Native American Indian Asian
cultures who do not like eye contact
Arabs Asians Native Americans
Assault vs. Battery
Assault = placing a person in fear or immediate bodily harm Battery = unlawfully touching a person
paternalism
Assuming the right to make decisions for another
Extravasation
The leakage of blood, lymph, or other fluid, such as an anticancer drug, from a blood vessel or tube into the tissue around it A FLUID THAT IRRITATES THE TISSUE!
NSAIDs contraindications and cautions
Asthma Cardiovascular disease Renal disease Coagulopathies Peptic ulcer Ulcerative colitis Hypovolemic + ACE inhibitors, angiotensin receptor blockers Cardiovascular thrombotic events Myocardial infarction Stroke GI events
ovarian cancer symptoms
Asymptomatic until advanced Abdominal swelling and discomfort (abdominal girth due to bloating) Pelvic pain and possible leg pain Urinary frequency Vague pain, bloating, nausea, anorexia, heartburn
Hydroxyzine
Atarax, Vistaril is used in adults and children to relieve itching caused by allergic skin reactions. also used alone or with other medications in adults and children to relieve anxiety and tension, sedative before surgery AE - dry mouth IT'S AN ANTICHOLINERGIC
Pneumothorax manifestations
Atelectasis, ipsilateral chest pain, dyspnea, tachypnea, tachycardia, hypoxemia. Mediastinal off center
Anticholinergics
Atropine GI - Slows motility, spasm Eyes - Dilates pupils *DO NOT GIVE TO GLAUCOMA PTS* Heart - Increase HR Resp - bronchodilator (Atrovent)
normal weights for toddlers
Average weight for a 30-month-old is 28 - 30 lbs
Hepatitis A in children
Avoid aspirin & ibuprofen meds (avoid meds that inhibit platelet aggregation) no IM injections, SC only avoid contact sports dental hygiene Regular diet is fine!! Dehydration is not an issue!
iron supplement for children
BETWEEN meals (not with food) with Vitamin C - OJ take on an empty stomach DO NOT TAKE WITH MILK antacids - do not take for 2 hours post-iron supplement
TPN concerns
BG level monitor for hypoglycemia!!!!! esp if client mentions nauseau, thirst, discomfort
key point about ibuprofen!
BLOOD CLOTTING
early signs of glaucoma
BLURRED VISION increased IOP
Lithium toxicity symptoms
BLURRED VISION A PRIORITY! drowsiness, slurred speech, coarse tremors, muscle spasms, blurred vision, diarrhea, stupor, coma, convulsions, death
Complete Metabolic Panel (CMP)
BMP + Proteins (Albumin and total protein) Liver tests (ALP, ALT, AST, Bilirubin)
Furosemide (Lasix) assessments prior to admin
BP BUN potassium level
Older Adults-- BP changes?
BP increases
Saw Palmetto uses
BPH - urinary symptoms promoted as a dietary supplement for urinary symptoms associated with an enlarged prostate gland as well as for chronic pelvic pain, migraine, hair loss, and other conditions.
Late decelerations
Bad (placental insufficiency) If a fetal heart rate is showing late decelerations do LION. - L: Lay the mother on her Left side - I: Increase IV fluids - O: Apply oxygen - N: Notify physician
The Romberg test is used to assess:
Balance and coordination **drunk driving test**
lumbar puncture post care
Bed rest - supine position minimum of 2 hrs. pain meds admin Encourage fluids. Observe site. Assess VS. report parenthesis
Culture
Beliefs, customs, and traditions of a specific group of people.
retroperitoneal bleeding
Bleeding into the abdominal cavity behind the peritoneum can occur due to femoral artery puncture (after an angiography)
Universal Precautions (UP)
Blood and certain body fluids of ALL individuals were considered potentially infectious. Required part of infection control plan
Mongolian spots
Blue-ish black macules appearing over the buttocks and/or thighs of darker skinned neonates
macular degeneration s/s
Blurry vision Loss of central vision Blindness
carbidopa levadopa
Brand Name: Sinemet* Use: Movement disorders; Parkinsons decreases muscle rigidity
BUBBLEHE assessment
Breast Uterus Bladder Bowel Lochia Episiotomy Homan's sign/Hemorrhoids Emotion
Snakebite Interventions
immobilize limb at level of heart
pursed lip breathing
Breathe in for 2 seconds through your nose, keeping your mouth closed. Breathe out for 4 seconds through pursed lips. relax neck & shoulder muscles
Terbutaline
Brethine Terbutaline is in a class of drugs called betamimetics. They help prevent and slow contractions of the uterus. It may help delay birth for several hours or days.
Albuterol
Bronchodilator temp relief of asthma
Warning signs of cancer (CAUTION)
C- change in bowel habits A- A sore that does not heal U- unusual bleeding or discharge T- thickening or lump in breast or elsewhere I- indigestion or difficulty swallowing O- obvious change in wart or mole N-nagging cough or hoarseness
Oxytocin infusion can lead to
C-section fetal distress
cervical vertebrae
C1-C7; first set of seven bones, forming the neck cervical injuries- place in supine position - NO PILLOW
cotton ball rubbed on cheek test
CN 5 parietal lobe - sensory input
most concerning/important LT complication of opiods
CONSTIPATION!
cold cap
Cap that causes vasoconstriction worn to minimize hair loss in a client undergoing chemotherapy
bioterrorism agents
Category A = highest priority; threat to national security - easily transmittable; smallpox, anthrax, viral fevers (ebola) Category B = 2nd highest priority; moderately easy to disseminate; include typhus fever, ricin, diarrheagenic E coli, West Nile Category C = 3rd highest; emerging pathogens
Chvostek's sign
Cheek, facial spasm when Cheek is tapped associates with hypocalcemia
Which STDs can be cured?
Chlamydia, Trichomoniasis, Gonorrhea, and Syphylis basically the bacterial ones - give antibiotics and they are gone the viral ones are not curable
BECLAMETHASONE (BECLOVENT OR VANCERIL)
Class: Corticosteroids For: Anti-inflammatory of airways **have pt gently blow nose prior to admin**
nitroglycerin patch
Clients should remove the patch each evening for a medication free time of 12-14 hours before applying a new one
Venous Thrombosis (DVT)
Clot formation in the deep, larger veins of the legs Heparin - monitor PTT Warfarin - monitor INR
cataracts
Clouding of the lens of the eye or its surrounding transparent membranes. results in blurry vision
Pneumothorax (PTX)
Collapsed lung due to trauma or a spontaneous small rupture of the lung
sputum sample
Collect sputum before breakfast --Have been laying down all night Patient should take a deep breath and expel air with a deep cough Expectorate into a sterile container
enzymes AST/ALT
Common causes of elevated ALT and AST are viral liver infections, alcohol abuse, cirrhosis (from any chronic causes) hepatotoxicity
purulent
Containing pus or an infection that is producing pus
PPN (peripheral parenteral nutrition)
Less concentrated Short term Given in a PERIPHERAL IV nothing can be mixed with it, it has its own port and controlled with a pump tubing and bag is discarded every 24 hours
Hydrocortisone
Corticosteroid used to treat inflammatory bowel disease, enemas, foam, or suppositories Take in the morning, around half an hour before breakfast Hydrocortisone replacement therapy is usually taken twice or three times a day. It can be taken on an empty stomach or with food.
CLAS standards
Culturally and Linguistically Appropriate Services
Flat Neck Veins: What can it mean?
DEHYDRATION! or Hemothorax, shock
prenatal glucose tolerance test
DO NOT HAVE TO FAST PRIOR TO TEST; can be performed at any time of day @ 24-28 weeks gestation Diagnose for Gestational Diabetes drink 50 g of glucose blood draw 1 hour after ingestion if serum Blood Glucose level is >140 then 2, 3 or hourly exam is given
Nitroglycerin storage
DO NOT STORE IN CAR!!! store in dark, cool place
child with leukemia & taking temp
DO NOT TAKE RECTALLY
safety razor
DO NOT USE FOR PTS WITH LOW PLATELETS OR ANTI-CLOTTING THIS CAN STILL CUT - PTS WITH CONCERN OF BLEEDING SHOULD USE ELECTRIC RAZOR
sepsis
Dangerous infection of the blood a bloodstream infection
malignant hyperthermia treatment
Dantrolene *TAKE ACTION IMMEDIATELY*
oliguria
Decreased urine output
Hydrocortizone
Decreases inflammation by suppressing the immune systems response; binds with intracellular corticosteroid receptors *notify provider of any illness or stress *do not discontinue abruptly *report weakness or dizziness
Kussmaul respirations
Deep, rapid breathing; usually the result of an accumulation of certain acids when insulin is not available in the body.
Pulse Pressure (PP)
Difference between Systolic and diastolic pressure PP = SP - DP
Wheezing
Difficult breathing with a high-pitched whistling or sighing sound during expiration
Hepatitis A (acute)
Direct contact or by fecal-contaminated food or water
Schizophrenia (negative symptoms)
Disturbance of affect: expression of emotion Blunting: severe reduction in the intensity of affect expression Flat affect: no signs of emotional expression Inappropriate affect: (ex. schizophrenic starts laughing when talking about someone's death) Avolition: decreased engagement in purposeful, goal-directed actions
beneficience
Doing good or causing good to be done; kindly action
Lambskin condoms
Don't protect against STDs do not protect against HIV infection
respiratory acidosis s/s
Drowsiness Disorientation Dizziness Headache Coma ↓BP V-Fib Hyperkalemia Rapid/Irregular HR Warm, flushed skin Seizures Hypoventilation Hypoxia Cyanosis
Respiratory Alkalosis S/S
EXCITED -vasoconstriction -HA -vertigo -Carpal pedal spasm -Tetany -Parasthesias, tingling -Tinnitus
Kawasaki disease
Early stages include a rash and fever. Symptoms include high fever and peeling skin. In late stages, there may be inflammation of medium size blood vessels (vasculitis). It also affects lymph nodes, skin, and mucous membranes, such as inside the mouth. People may experience: Pain areas: in the abdomen or joints Gastrointestinal: diarrhea or vomiting Whole body: fever or high fever Skin: peeling or red rashes Also common: pink eye, enlarged neck lymph nodes, fast heart rate, irritability, red palms, swollen and bumpy tongue that's red, or swollen feet
Budesonide for Crohn's
Entocort EC decreases inflammation
epoetin alfa
Epogen, Procrit helps your body make more red blood cells. Used to treat anemia caused by chronic kidney disease, cancer chemotherapy, or HIV-therapy. It may also be used before surgery if you have anemia.
5th disease (erythema infectiosum)
Erythrovirus (parvovirus) 19 - slapped cheek disease viral disease children typically recover in 7-10 days communicable only until onset of rash appears
Opioid withdrawal symptoms
Excessive sweating, restlessness, and dilated pupils Agitation, goose bumps, tremor, and violent yawning Increased heart rate and blood pressure Nausea/vomiting and abdominal cramps and pain Muscle spasms and weight loss
Guaifenesin
Expectorant—thins respiratory secretions; does not suppress cough reflex.
Piaget's sensorimotor stage
Experiencing the world through sensrors and actions (looking touching mouthing and grasping) Age 0 - 2
Secondary intention healing
Extensive tissue loss Edges cannot be approximated Repair time is longer Scarring is greater Susceptibility to infection is greater
teletherapy radiation
External Beam RT Most common form of radiation. There is a defined outlined precise target area. They make a mold to shield and protect the surrounding areas. *protect skin from sun exposure during & after therapy *wear loose clothing *cleanse skin daily with warm water and mild soap *avoid cold packs and heating pads (heat extremes) *use only creams/lotions approved by HCP
what happens during a thyroid storm?
FEVER! a rapid heartbeat. a high temperature. diarrhea and being sick. yellowing of the skin and eyes (jaundice) severe agitation and confusion. loss of consciousness.
FAST
Face drooping Arm weakness Speech difficulty Time to call 911
Malpractice
Failure by a health professional to meet accepted standards
Piagets pre-operational stage is characterized by?
Fantasy oriented Illogical No rules
hyperextend the neck
First step in NG tube insertion is to instruct the client to?
retinal detachment s/s
Flashes of light SHADE DRAWN - a shadow with curtain across the vision
Plagiocephaly
Flattening or asymmetry of the head baby wears helmet
McRoberts maneuver
Flexing the woman's knees toward her shoulders. Assists with shoulder dystocia
SIADH treatment
Fluid restriction Oral salt tablets hypertonic saline IV (3%) vasopressin receptor antagonists strict I&Os daily weights
cohort study
Following a subset of a population over a lifetime
Vaginal hematomas are associated with what?
Forceps assisted birth, episiotomy, primigravidity.
S/S BPH (Benign Prostatic Hyperplasia)
Frequency, decreased force of urinary stream, trouble starting to void, dribbling after urination, feeling like bladder not empty, decreased or interrupted urinary stream classic sign - long, thin stream of urine
Hyperglycemia S/S
Fruity-smelling breath. Nausea and vomiting. Shortness of breath. Dry mouth. Weakness. Confusion. Coma. Abdominal pain.
varicella vaccine contraindication - if you're allergic to
GELATIN!
Pancreatitis (acute)
Gallstones, EtOH
Clear liquid diet includes
Gelatin, popsicles, tea, ginger ale, fruit juice without pulp, bouillon, chicken broth, apple juice, water juice with pulp are prohibited.
how far up to insert an enema tip
Gently insert the tip of the nozzle into the anus, and continue inserting it 10 centimeters (3-4 inches) into the rectum. Slowly squeeze the liquid from the container until it is empty, then gently remove the nozzle from the rectum.
herbal supplements that increase bleeding
Gingko Biloba Garlic Ginseng Ginger Feverfew
15/15 rule of hypoglycemia
Give 15 grams of CHO q 15 mins until BG increases
Long acting insulin
Glargine (Lantus)
Prednisone (Deltasone)
Glucocorticoid. Decrease inflammation by suppressing leukocytes and fibroblasts, and reversing capillary permeability. Provide symptomatic relief of inflammation and pain. Precautions/interactions: contraindicated in systemic fungal infection, do not administer live virus vaccines during therapy, should only be used for a short duration. Side effects: risk of infection, osteoporosis, adrenal suppression, fluid retention, GI discomfort, hyperglycemia, hypokalemia. **expect insulin dosage to increase**jaim
Vancomycin used for
Gram Positive, MSRA, C- diff
Exopthalmos (proptosis) nursing care
Graves disease tape eyelids shut if needed artificial tears raise HOB 90 degrees to decrease pressure
Gravida/Para/Abortion
Gravida = The total number of times the patient has been pregnant Para = The number of live births (VIABLE) the patient has had (past 20 weeks gestation) Abortion= The total number of miscarriages or elective abortions
endometriosis
Growth of endometrial tissue outside of uterus
HELLP syndrome stands for
H- hemolysis EL- elevated liver enzymes LP- low platelets **RUQ PAIN ALSO** IT IS A SEVERE FORM OF PRE-ECLAMPSIA EMERGENCY
Cystic Fibrosis diet
HIGH calorie, HIGH protein ,HIGH fat + fat vitamin - need higher abx dose - regular exercise - give 3 meals + snacks, pancreatic enzymes given within 30 min, increase dose if high calorie, watch 1-2 stools/day for effectiveness, can sprinkle on food - tend to have pulm infection
bacterial meningitis nursing care
HOB 30 degrees isolation for 1st 24 hours implement seizure precautions maintain hydration & airway
High Fowler's Position
HOB 90 degrees
Fowler's position
HOB raised between 45 and 60 degrees
Semi-Fowler's Position
HOB raised to 30 degrees or HOB raised 30 degrees and the knee portion is raised 15 degrees
Variable decelerations
HR up or down, cord compression = VERY BAD Prolapsed cord= push head up, change mom position
Before Dialysis what meds to hold
HTN and water soluble vitamins like B's and folic acid. Remember they become hypotension that's why no HTN (lowpressor,beta blockers) drugs before..
Graves disease
HYPERTHYROIDISM autoimmune disorder characterized by goiter and/or exophthalmos (bulging eyes)
U waves represent
HYPOKALEMIA repolarization of the purkinje fibers
spinal anesthesia side effects
HYPOTENSION HA bradycardia/asystole high spinal, nausea, urinary retention, backache, hypoventilation/dyspnea (loss of proprioception), transient neurologic syndromes, cauda equinal, epidural hematoma
Propranolol Side effects/adverse reactions
Hallucinations. Cold hands or feet. Muscle weakness. Muscle cramps. Shortness of breath. Memory loss. Fluid retention. Blood sugar changes.
Rule of 9's for burns
Head = 9% 2 Arms = 18% 1 arm = 9% Back = 18%, Front/chest 18% Legs 36% (18% each) Genitalia = 1
dilated pupils
Head injury, shock, heat stroke, hemorrhage, and/or intake of a stimulant drug
INR
Healthy people INR < 1.1 or below is considered normal. On warfarin - INR range of 2.0 to 3.0 is generally an effective therapeutic range for people taking warfarin for disorders such as atrial fibrillation or a blood clot in the leg or lung.
S3 (ventricular gallop)
Heart sound: Early diastolic sound from vibrations produced when ventricles fill rapidly; comes shortly after S2; best heard at apex with pt in left lateral position; indicates heart failure from volume overload or high CO; can be from anemia, hyperthyroidism, and pregnancy; sounds like "Kentucky"
PPI (proton pump inhibitor)
Help to prevent production of acid in the stomach *omeprazole (Prilosec) *pentoprazole (Protonix) *lansoprazole (Prevacid) *esomeprazol (Nexium) take prior to meals sit upright for 30 minutes post taking the med GET BONE DENSITY TEST REGULARLY higher risk of C-diff
TPN (total parenteral nutrition)
Highly concentrated, hypertonic solution provides calories, electrolytes, fluids & nutrients Central venous access device required you have to have a central line not a peripheral line it would burn the tissue* also you will use a filter insulin also given typically because serum glucose of this solution can be high monitor electrolytes daily weights FSBS should be assessed in 1st hour after infusion then 4-6 hours thereafter @ least 4x daily **MEDS MAY BE INFUSED INTO THE SOLUTION or given via IV**
needle lumen
Hollow tube of needle which has a hollow lumen through which medication passes
Hypermagnesemia S/S
Hypotension Bradycardia *Weak pulse* *Sweating* and flushing *Respiratory depression* Loss of deep tension reflexes Prolonged PR interval and widened QRS complex
NSAIDs meds
IBUPROFEN NAPROXEN Indomethacin Celecoxib Ketorolac
lumbar puncture contraindicated with
ICP
Newborn vitamin K injection
IM injection in thigh I mg
Widened pulse pressure is associated with
INCREASED INTRACRANIAL PRESSURE (ICP) or aortic insufficiency, fever, anemia, or complete heart block.
Coumadin (warfarin) - monitor?
INR international normalized ratio
pregnant women should increase
IRON
Kawasaki disease treatment
IV ImmunoGlobulin therapy high-dose aspirin **WATCH FOR FEVER** SKIN WILL PEEL - THAT IS NORMAL IT IS NOT SJ
infiltration
IV fluid leaks into surrounding tissue it is a fluid that does NOTirritate the tissue
respondent superior doctrine
If an agent hurts someone in the course and scope of doing their job, both the principal and agent have liability for it
Left lateral trendelenburg
If you suspect your patient has an air embolus, how do you position them?
innate immunity
Immunity that is present before exposure and effective from birth. Responds to a broad range of pathogens.
Cocaine intoxication
Impaired judgment, increased mental alertness, pupillary dilation, hallucinations (including tactile), paranoid ideations, angina, sudden cardiac death. Treatment: α-blockers, benzodiazepines. β-blockers not recommended.
POAG (primary open-angle glaucoma)
Increased IOP with optic disc/vision changes OR optic disc/vision changes gradual loss of peripheral vision
Babinski reflex
Infant reflex where if its foot is stroked, the baby's toes fan out
phlebitis
Inflammation of a vein as a result of repeated venipuncture on that vein
Insulin Aspart (Novolog)
Insulin - Rapid Acting make sure meal tray is there right away
Tracheostomy care procedure
Involves cleaning the inner cannula, suctioning, and applying clean dressings
1st degree burn (superficial)
Involves outer layer of skin and produces redness, increased warmth, tenderness, and mild pain -immerse in cool water until pain is relieved -flush chemical burns for at least 20 min - cover with clean or sterile dressing
metacarpophalangeal joint
Is the KNUCKLE between the hand and the finger
In vaso-occlusive crisis
Ischemia and pain caused by sickle-shaped red blood cells that obstruct blood flow to a portion of the body. visual disturbance, hematuria, painful swelling extremities, fever, tachy, PAIN
Tension pneumothorax S/S
JVD diminished/ABSENT lung sounds tracheal deviation towards unaffected side poor BVM compliance
Cardiac Tamponade s/s
JVD, narrow pulse pressure, hypotension ( Becks Triad)
storing insulin
Keep opened vials at room temp Discard opened vials after 1 month Refrigerate UNOPENED vials not in use between 34-36F Expiration date applies to unopened, refrigerated insulin Durable pens and dosing devices should not be refrigerated once in use Do not shake insulin; roll gently in palm of hand to warm and resuspend
ectopic pregnancy rupture
L shoulder (Kehr's sign)
Left sided heart failure symptoms
L= LUNGS - SYMPTOMS EFFECTING LUNGS pulmonary edema, coughing, shortness of breath, and dyspnea
basilic vein
LARGE VEIN ON THE INNER SIDE OF THE UPPER ARM (SMALL FINGER SIDE)
key difference between RN & LPN
LPN can care for clients whose condition is considered to be stable or chronic with an expected outcome
FTT Signs and Symptoms
Lack of appropriate weight gain. Irritability. Easily fatigued. Excessive sleepiness. Lack of age-appropriate social response (i.e., smile) Does not make vocal sounds. Delayed motor development. lack of eye contact Learning and behavior difficulties later in childhood.
1st stage of labor
Last 12.5 hours Latent phase:0-3cm active phase:4-7cm transition:8-10cm
Heparin
anticoagulant **it does not thin the blood & does not dissolve the clot** it deters the clot from growing
CKD diet
Low protein Low sodium Low Potassium Low phosphate
Hyperkalemia causes
M.A.C.H.I.N.E. M - Medications - ACE inhibitors, NSAIDS A - Acidosis - Metabolic and respiratory C - Cellular destruction - Burns, traumatic injury H - Hypoaldosteronism, hemolysis I - Intake - Excesssive N - Nephrons, renal failure E - Excretion - Impaired
Hyperkalemia S/S
M.U.R.D.E.R. M - Muscle weakness U - Urine, oliguria, anuria R- Respiratory distress D - Decreased cardiac contractility E - ECG changes R - Reflexes, hyperreflexia, or areflexia (flaccid)
Morphine side effects: MORPHINES
M: myosis (contraction of the pupil) O: orthostatic hypotension R: respiratory depression P: pneumonia (aspiration) H: hypotension I: infrequent waste release (constipation URINARY RETENTION) N: nausea E: emesis S: sedation
Live vaccines
MMR and varicella
Vancomycin
MRSA infection antibiotic
Staphylococcus aureus
MRSA, Toxic Shock Syndrome, Food poisoning
Yellow tag
Major injury & should be given attention within 30 minutes to 2 hours.
cervical cancer
Malignant cell growth in the cervix; can be caused by HPV virus
Hypomagnesemia causes
Malnutrition Diarrhea *Celiac's disease* Crohn's disease *Alcoholism* Prolonged gastric suctioning *Ileostomy, colostomy, or intestinal fistulas* Acute pancreatitis Diabetic ketoacidosis (metabolic acidosis) *Eclampsia* Chemotherapy *Sepsis*
rheumatoid arthritis interventions
Medications: leflunomide (Arava) etanercept (Enbrel) Prednisone NSAIDs Rest during acute attacks, warm, moist packs, warm baths/whirlpools, paraffin baths, physical therapy, teach - more susceptible to false cures -can use ice at times
amnion
Membrane that encloses the embryo in protective amniotic fluid
cold application
Minimizes swelling and reduces bleeding by constricting the blood vessels. Should never be done directly to the skin as it will cause cell damage. Should never be done for more than 20 minutes as damage may occur. NOT ON OPEN WOUNDS - TISSUE DAMAGE
PPIs (proton pump inhibitors)
Most effective class of drugs in inhibiting acid secretion ie omeprazole, meds ending in "prazole" or zole
4th stage of labor
Mother's recovery after birth of baby and placenta
rooting reflex response
Movement of the tongue, mouth and/or head toward the stimulus
Baclofen
Muscle Relaxant can use in children
Vercuronium (Norcuron)
Muscle relaxation during intubation and general anesthesia used to improve client/ventilator synchronization & to increase oxygenation
Hypercalcemia S/S
Muscle weakness Constipation Anorexia N/V Polyuria Polydipsia Neurosis Dysrhythmias
how to draw up NPH and Regular insulin
N R R N clean both vial tops inject air into NPH insulin inject air into Regular insulin draw up Regular insulin draw up NPH insulin cloudy, clear, clear, cloudy
placenta previa s/s
NO PAIN but BLEEDING! - BRIGHT RED BLEEDING
tonsillectomy post care
NO STRAWS!!!!
pregnant women & alcohol
NO amount of alcohol has been determined safe Potential adverse consequences of alcohol use to fetus are well known
Home oxygen therapy guidelines
NO wool! no Vaseline (water based lubricant only) no cooking with gas stove or open flame DO NOT POLISH NAILS
DONUTS
NOT OKAY FOR SKIN INTEGRITY
naproxen
NSAID can reduce clotting like aspirin
asthma patients should not take
NSAIDS! take Tylenol
Concussion Signs and Symptoms
Nausea (feeling that you might vomit) Amnesia of the event HA Brief LOC Balance problems or dizziness Double or fuzzy vision Sensitivity to light or noise Nystagmus Headache Feeling sluggish Feeling foggy or groggy Concentration or memory problems (forgetting game plays) Confusion
Hyperthyroidism symptoms
Nervousness, weight loss despite increased appetite, excessive sweating and heat intolerance, palpitations, frequent bowel movements, muscular weakness of the proximal type and tremor
Normal RR in children
Newborn: 30-60 breaths per minute Infant (1 to 12 months): 30-60 breaths per minute Toddler (1-2 years): 24-40 breaths per minute Preschooler (3-5 years): 22-34 breaths per minute School-age child (6-12 years): 18-30 breaths per minute Adolescent (13-17 years): 12-20 breaths per minute
Normal HR
Newborns 0 to 1 month old: 70 to 180 beats per minute Infants 1 to 11 months old: 80 to 160 beats per minute Children 1 to 2 years old: 80 to 130 beats per minute Children 3 to 4 years old: 80 to 120 beats per minute Children 5 to 6 years old: 75 to 115 beats per minute Children 7 to 9 years old: 70 to 110 beats per minute Children 10 years and older, and adults (including seniors): 60 to 100 beats per minute Well-trained athletes: 40 to 60 beats per minute
Newborn bathing - general
Newborns should only be bathed 1-2x/week. Bathing your baby more than this can dry out his or her skin Do not place in water for a bath until the umbilical cord has fallen off. Give your baby a sponge bath using a soft wash cloth and gentle soap until the umbilical cord has fallen off
The RN CANNOT DELEGATE
Nursing Process Client teaching (LPN can REINFORCE pt teaching only) Tasks that require nursing judgment (including care of unstable client)
without time for crossmatch-what type of blood for transfusion?
O negative think O no!
Cushing's syndrome symptoms
Obesity, wasted extremities, buffalo hump, acne, hirsutism, amenorrhea, proximal muscle weakness, striae, HTN
sickle cell anemia nursing interventions
Observe for pallor, fatigue, lethargy, irritability Encourage diet high in calories, protein, fluids Prevent infection, hand washing, avoid infected people Administer immunizations, prophylactic antibiotics Administer blood products, watch for reaction Administer pharmacologic and nonpharmacologic pain relief Ensure compliance with preventative measures Help child family with coping measures Refer to support groups
SAD PERSONS
Risk factors for Suicide Sex (more male than female) Age (teens & age >45 yo) Depression Previous attempts Ethanol loss of Rational thinking Sickness Organized plan No social support Stated future intent
subtotal thyroidectomy removes
part of thyroid
Sepsis Checklist
Obtain Cultures Initiate broad spectrum Ab Lactate level Place central line Fluids: Albumin & NS Vasopressors Inotropes
Occupational Therapist (OT)
Occupational therapy helps people with an injury, illness, or disability learn or re-learn to do everyday activities. For adults, this could include activities like getting dressed, cooking, and driving. For children, this could include activities like learning or playing.
Absence seizures (petit mal)
Occurs during childhood, stares off with little to no tonic-clonic movement
Necrotizing Enterocolitis (NEC)
Occurs in premature and newborn infants. Thought to be infection and or ischemia of the gut. Findings: Dilated bowel loops.
Urge incontinence (overactive bladder)
Occurs when the bladder contracts randomly, causing a strong, sudden urge to urinate that is followed by urine leakage.
primary intention healing
Occurs where the tissue surfaces have been approximated, and there is minimal or no tissue loss **me - after surgery**
growth hormone replacement therapy
Option for children who are not growing according to accepted standards ∙ Start as soon as delays are noted and continue until bone growth stops, around age 14 in girls and 16 in boys ∙ Despite replacement therapy, child may still be shorter than their peers ∙ SubQ injections
how to use a fire extingusher
P - pull A - aim S - squeeze S - sweep
atrial contraction and ventricular filling
P-waves
placental abruption s/s
PAIN! NO Bleeding board-like/rigid abdomen Placental abruption is often painful. If you have placental abruption, you may need to deliver your baby early and may need a cesarean delivery.
where do we take the apical pulse
PMI It is located on the left side of the chest at the 5th intercostal space (ICS) at the midclavicular line.
how to measure warfarin
PT/INR
Heparin monitor
PTT remember Heparin+PTT = HARRY POTTER
PTT
PTT measures how long the blood takes to clot (increased #=increase bleeding time) In PTT the TT looks like a H--so we use PTT as our test when using Heparin. Think Harry Potter - Heparin Protamine (sulfate) to remember the antidote. PTT normally ranges from 30-40 seconds Proper Teaching Time is 30 to 40 years old--this is how old your teachers are.
thyroid storm tx
PTU preferred 500-1,000 mg loading dose, then 250 mg PO Q4H --> ≥1 hr before iodide to block synthesis of thyroid hormone inorganic iodide therapy + BB (propranolol 40-80 mg PO Q6H + systemic Steroid (dexamethasone 2-4 mg PO Q6H + aggressive cooling w/ acetaminophen and cooling blankets and supportive treatments
Atrial paced rhythm
Pacer spike before P wave
PEG tube complications
Pain at the site Leakage of stomach contents around the tube site Dislodgement or malfunction of the tube Infection at the PEG site Aspiration ( Inhalation of gastric contents into the lungs) Bleeding and perforation ( An unwanted hole in the bowel wall)
McBurney's point
Pain in RLQ with appendicitis
breakthrough pain
Pain that occurs between doses of pain medication
Serosanguineous
Pale, red, watery: mixture of clear and red fluid
panic attack symptoms
Palpitations, perspiration tachycardia HBP chest pain, muscle tension urinary frequency hyperventilation/dyspnea nausea, feelings of choking, chills, hot flashes, and GI symptoms
Ropinirole (Requip)
Parkinson's disease SEs - dizziness, dry mouth, sweating
Psoriasis treatment
Phototherapy laser therapy topical meds
Prothrombin Time (PT)
Pills TakIN Regularly -PT and INR go together INR--I=normal is 1, but therapeutic ranges from 2 (NR, 2 letters after the I) to 3 (INR, 3 letters in total) Usually measured when on Coumadin / Warfarin Think Wiz Khalifa--Warfarin (vitamin) K to remember the antidote. test of ability of blood to clot normal PT time = 11-12.5 seconds
catheter embolus treatment
Place a tourniquet high on the extremity to limit venous flow. Prepare for removal under x-ray or via surgery. Save the catheter after removal to determine the cause.
LPN scope of practice includes:
Routine patient care under the supervision of a RN or a physician. Assess/collect data monitoring client status Admin meds Evaluate pt response to interventions
walking down stairs with crutches
Place the AFFECTED leg and the crutches down on the step below. Support weight by leaning on the crutches and the stair rail. Bring the unaffected leg down. REMEMBER AFFECTED LEG GOES DOWN FIRST and the crutches move with the affected leg
18 month old milestones
Plays simple pretend Points to show others something interesting Says several single words Scribbles on his own Walks alone Drinks from a cup Eats with a spoon temper tantrums understands ownership ("mine") imitates others
Opportunistic infection in AIDS
Pneumocystis carinii pneumonia (PCP) Renamed: Pneumocystis jiroveci (Fungus)
Ectopic Pregnancy Risk Factors
Pregnant female (HCG positive), STD (PID) ' USING AN IUD IS A BIG RISK FACTOR FOR ECTOPIC PREGNANCY
Small head circumference in newborns could indicate?
Premature suture close Chromosome abnormality Congenital infections Neuro insult
respiratory acidosis causes
Primary Cause: Hypoventilation (causes hypercapnia); Contributing Causes: COPD, Pulmonary dz, Drugs, Obesity, Mechanical asphyxia, Sleep Apnea
respiratory alkalosis causes
Primary cause: Hyperventilation (causes hypocapnia); Contributing Causes: Overventilation on a ventilator, Response to acidosis, Bacteremia, Thyrotoxicosis, Fever, Hepatic failure, Response to hypoxia, Hysteria
Licorice root; primary use + potential interaction
Primary use: ulcers Potential interaction: avoid combinations with diuretics
droplet precautions require (2)
Private room, mask if needed for irrigation, etc. - gloves, gown, shield
chronic pancreatitis
Process of progressive fibrotic destruction of the pancreas RELATED TO CHRONIC ALCOHOL USE Risk factor for pancreatic cancer
Decannulation
Process of removing tracheostomy tube
hormone that PREVENTS miscarriage
Progesterone (think P - prevent, progesterone)
Fluoxetine
Prozac Common side effects include feeling sick (nausea), HA and trouble sleeping AE - blurred vision, HA, confusion, high fever, sweating
Mass casualty/disaster triage priority
RED YELLOW GREEN BLACK
acute cholecystitis pain location
RUQ pain radiates to right shoulder
Insulin Aspart (Novolog)
Rapid acting insulin Onset: 15-30 minutes Peak: 1-3 hours Duration: 3-5 hours
reaction to contrast media
Rapid blood loss Sudden change in body temp Intense pain Stress/anxiety Shock of seeing other trauma to family members or others PE or cardiac-related reason Sepsis (septic shock) Fluid loss related to burns, vomiting/diarrhea, or trauma
Frostbite treatment
Rapid rewarming with warm water (do NOT wait, or use too hot or dry heat) Do not massage area Elevate extremities after rewarming to promote blood flow Provide continuous warm water soaks Provide analgesia Keep wounds open - do not apply dressing!
A peak flow meter measures:
Rate of airflow during forced expiration used to help monitor asthma and adjust medication accordingly
Rhonchi
Rattling noise of mucous in the lungs. Heard on auscultation of lungs.
2nd degree burn
Red, shiny skin, blisters, severe pain
REEDA assessment for episiotomy
Redness Edema Ecchymosis Discharge Approximation
Where are scabies found?
Scabies can spread rapidly under crowded conditions where close body and skin contact is frequent. Institutions such as nursing homes, extended-care facilities, and prisons are often sites of scabies outbreaks.
Bishop score
Score for induction of labor Score of 6 to 8 = induction of labor will be successful the higher the score, the more successful labor induction will be
congenital hypothyroidism (cretinism)
Severe fetal hypothyroidism due to maternal hypothyroidism, thyroid agenesis baby will be - lethargic/difficult to waken dry skin hoarse cry bradycardia constipation
Brudzinski's sign
Severe neck stiffness causes a patient's hips and knees to flex when the neck is flexed.
Diabetic Ketoacidosis (DKA)
Shortage of insulin resulting in hyperglycemia and production of ketones KUSSMAUL'S RESPIRATIONS 3 Ps blurred vision fruity breath odor decreased LOC orthostatic HTN 1. Assess for dehydration FIRST!!!
Effacement is?
Shortening and thinning of the cervix (0-100%)
2 year old milestones
Shows defiant behavior Says sentences with 2-4 words 300 word vocabulary Follows two step instructions Stands on tiptoes kicks a ball climbs up and down from furniture Throws ball overhand runs without falling begins parallel play walks up/down steps one at a time
Tetrology of Fallot (TOF) clinical manifestations
Signs and symptoms may include: -A bluish coloration of the skin caused by low blood oxygen levels (cyanosis) -SOB, rapid breathing, especially during feeding or exercise -Poor weight gain -Tiring easily during play or exercise -Irritability -Prolonged crying -Heart murmur -Sometimes, babies who have tetralogy of Fallot will suddenly develop deep blue skin, nails and lips after crying or feeding, or when agitated. These episodes are called tet spells. Tet spells are caused by a rapid drop in the amount of oxygen in the blood. Tet spells are most common in young infants, around 2 to 4 months old. Toddlers or older children might instinctively squat when they're short of breath.
epidymitis treatment
Sitz bath elevate scrotum ice packs bed rest
to test for dehydration
Skin turgor (grasp skin on clavicle to see if it springs back) mucous membranes capillary refill
Getting up from a chair with crutches
Slide forward to the edge of the chair. Hold both crutches on the injured side. Lean forward. Hold the armrest with the other hand. Push up on the handgrip of the crutch and the armrest of the chair. Stand up putting weight onto the good leg. Put crutches under the arms to start walking.
What does pursed lip breathing do?
Slows expiration keeps airways open on exhalation!!! prevents collapse of small airways controls the rate and depth of respiration
Rhonchi (sonorous wheeze)
Sonorous or coarse; snoring quality Low-pitched, continuous sounds Auscultated during inspiration and expiration Coughing may clear the sound somewhat Air passing through or around secretions
Varicella vaccine side effects
Soreness at injection site Fever Rash (rare) a couple of vesicles at the injection site - cover with a bandage or cloth to ensure they do not spread and should go away in a few days
Hepatitis C (HCV)
Spread by contaminated blood or body fluids. affects the liver
phases of labor
Stage 1 = cervical dilation A. Latent B. Active C. Transition Stage 2 = expulsion of fetus Stage 3 = expulsion of placenta stage 4 = maternal homeostatic stabilization
How to Perform the Heimlich Maneuver
Stand the patient up. Stand with your chest to their back. Place your arms under theirs. Make a fist with you dominant hand and place in the upper mid portion of the abdomen. Thrust upward and inward until the object is expelled.
Washing a newborn baby
Start by washing the face with plain warm water. Clean eyes using plain water and wiping from the corner near the nose to the outer corner. Use a washcloth (use a clean part for each eye) or two cotton balls (one for each eye) When cleaning the ears and nose, clean only the surface of the ears and nose. Do not put a cotton swab in the ears or nose to clean Wash the rest of the baby with mild soap. Do not use a perfumed soap. Rinse with warm water Leaving the diaper area for last, make sure to wash all the creases and folds Do not be hesitant about cleaning a baby girl's genitals Use a soft cloth and warm water, and wipe gently between the folds After rinsing, pat the baby dry with a clean towel Shampoo the hair while you hold the baby in the crook of your arm. Put mild soap on the hair, gently scrub and rinse out all of the soap. Don't be afraid to gently shampoo the soft spots to prevent -yellow, oily, scaly flakes from building up. This condition is known as cradle cap Towel the hair dry and then brush it with a soft baby brush Do not use any oil or lotions on your baby because they may cause a rash. Most oils and lotions are too harsh for your baby's delicate skin
infiltration treatment
Stop infusion remove peripheral catheters apply cold compress elevate extremity insert new catheter in opposite extremity
Crohn's Disease Treatment
Stress reduction Avoidance of foods that worsen diarrhea such as raw fruits and vegetables. Adequate caloric, protein, and vitamin intake, parenteral nutrition, if necessary Reduced activity
Tracheal stenosis and atresia
Structural abnormalities such as pectus excavatum or abnormalities involving the great vessels
Subcutaneous injection sites
Subcutaneous tissue is all over your body, but the most common areas for subcutaneous injections are: -the upper outer area of the arm. -the front and outer sides of the thighs. -the abdomen, except for a 2" area around the navel. -the upper outer area of the buttocks. -the upper hip.
acute angle closure glaucoma
Sudden onset of PAIN Dilated pupil Reduced central vision Ocular redness Shallow anterior chamber Halos around lights Most common in adults >50
clinical manifestations of pulmonary embolism
Sudden onset of pleuritic chest pain, dyspnea, tachypnea, tachycardia, and unexplained anxiety
pulmonary embolism (PE) s/s
Sudden onset, sharp localized pain in the chest, respiratory distress (maybe talking in 2-3 word bursts), cough, sputum coming up with cough, shock vitals
paracentesis (abdominocentesis)
Surgical puncture to remove fluid from the abdomen. This procedure is necessary to drain fluid (accumulated in ascites) from the peritoneal (abdominal) cavity. can be done in dr's office empty bladder sitting up/Fowler's position
hemorrhoids
Swollen, painful rectal veins; often a result of constipation **witch hazel**
Sickle Cell Anemia Treatment
Symptomatic treatment includes administration of analgesics, fluids, and oxygen. Treat underlying condition Increase fluid intake > Orally > Intravenously Frequently evaluate respiratory and circulatory status > Chest pain, back pain > Fever Cough, dyspnea > Administer supplemental oxygen POX 92% or less > Immediately report changes
Digoxin (Lanoxin) toxicity signs and symptoms
Symptoms - Confusion. Irregular pulse. Loss of appetite. Nausea, vomiting, diarrhea. Fast heartbeat. Vision changes (unusual), including blind spots, blurred vision, changes in how colors look, or seeing spots.
Hashimoto's disease signs and symptoms
Symptoms include fatigue and unexplained weight gain also - Skin: dryness or roughness Hair: hair loss or dryness Also common: constipation, depression, enlarged thyroid, fatigue, joint stiffness, muscle weakness, puffy eyes, sensitivity to cold, slow heart rate, swelling in extremities, or weight gain
Hydrocortisone contraindications
Systemic fungal infections Caution in patients with CHF, MI, immunocompromise
Phalen's maneuver (or Phalen's wrist test)
Test to determine the presence of carpal tunnel syndrome (CTS); a positive test for CTS cause paresthesia in the medial nerve distribution of the palm of the hand in 60 seconds.
Allen's sign
Test used to determine potency of the radial and ulnar arteries
10 day rule
The practice of waiting 10 days after a woman's menstrual flow to conduct a radiographic examination or study.
where to assess for a pulse when doing CPR
The rescuer would place their index and middle finger over the carotid or femoral artery during a pause in Cardiopulmonary Resuscitation (CPR) to see if they could palpate a pulse.
PQRST waves
The standard waveforms found on the EKG tracing. Each wave corresponds to a specific event within the heart's electrical cycle.
Antagonists (drugs)
These drugs block the actions of neurotransmitters. Meds like - haloperidol, a drug that blocks dopamine.
Early decels mean:
This is VERY BAD, this means prolapsed cord. - Stick hand in mother's vagina and push the baby's head up. - Position her knee chest (on hands and knees), with hand still on baby's head - Rush to the operating room in this position for an emergency cesarean section
Distended neck veins
This is a sign of a circulatory overload r/t blood transfusion indicates fluid overload or cardiac tamponade
Pasero Opioid-Induced Sedation Scale (POSS)
This is valid and reliable. Sedation precedes respiratory depression. S = sleep, easy to arouse. 1 = awake and alert. 2 = slightly drowsy, easily aroused. S, 1 & 2 ARE ACCEPTABLE - NO ACTION NEEDED. 3 = frequently drowsy, arousable, drifts off to sleep during conversation. UNACCEPTABLE, monitor respiratory status and sedation level until stable; decrease dose 25-50% or notify prescriber/anesthesiologist for orders. Consider administering non-sedating opioid-sparing nonopioid if not contraindicated. 4 = Somnolent, minimal or no response to verbal or physical stimulation. UNACCEPTABLE; stop opioid, consider admin Naloxone; notify HCP; monitor respiratory status and sedation level.
TORCH infections
Toxoplasmosis (litter box & pregnant women) Other Rubella Cytomegalovirus Herpes
treatment for autonomic dysreflexia
Treat the cause: Catheter, remove impaction, look for skin pressure, painful stimuli, a cold draft breeze. most commonly used agents are nifedipine and nitrates (eg, nitroglycerine paste or sublingual nitroglycerine).
Lithium toxicity
Tremors, Metallic taste, neuro symptoms besides paresthesia
albuterol (side effects/adverse reactions)
Tremors, nervousness, restlessness Dizziness, tachycardia Palpitations, cardiac dysrhythmias
dizygotic (DZ) twins
Twins who are formed when 2 separate ova are fertilized by 2 separate sperm at roughly the same time. Also called fraternal twins.
monozygotic (MZ) twins
Twins who originate from one zygote that splits apart very early in development. (Also called identical twins.) Other monozygotic multiple births (such as triplets and quadruplets) can occur as well.
Hypomagnesemia S/S
Twitching Paresthesias Hyperactive reflexes *Irritability* Confusion Positive Chvostek's or Trousseau's sign Shallow respirations Tetany Seizures Tachycardia *Tall T waves* and depressed ST segment
Adult chest compressions
Two hands in the center of the chest, keep fingers off chest, shoulders above wrists, elbows locked, compress chest at least 2 inches at a rate of 100 compressions per minute.
nosocomial infections routes in order
UTI wounds respiratory tract blood
pancreatitis pain
Upper abdomen (both quadrants); back
Filgrastim (Neupogen)
Used for neutropenia (cancer) Can cause bone pain, leukocytosis (WBC > 100,000) increases neutrophil count
Romberg test
Used to evaluate cerebellar function and balance. Tell the client to close eyes and stand upright with feet together --see if they sway
Terbutaline (Brethine)
Used to relax uterine smooth muscle to inhibit uterine activity STOPS CONTRACTIONS
Detached retina S/S
Usually acute onset like a curtain coming down on part of their visual field Flashing lights & visual fields defects Floaters "web" "tentacles" "black spots" Dilated exam excludes vitreous detachment
Fat embolism syndrome
Usually occurs 1-3 days after fractures of long bones or pelvis. More frequent in closed rather than open fractures. Can occur 3-10 days after surgery. Observe for dyspnea and neurologic decline. symptoms - neuro changes, petechial rash, hypoxemia
VEAL CHOP
V: variable decels C: cord compression Reposition, O2, notify dr E: early decels H: head compression Normal A: accels O: okay L: late decels P: placental deficiency Turn, O2, d/c Pitocin, notify dr
C. diff treatment
Vancomycin
VEAL CHOP-which relates to fetal heart rate.
Variable decels => Cord compression (usually a change in mother's position helps) Early decels => Head compression (decels mirror the contractions; this is not a sign of fetal problems) Accelerations => O2 (baby is well oxygenated-this is good) Late decels => Placental utero insufficiency (this is bad and means there is decreased perfusion of blood/oxygen/nutrients to the baby).
Hindu Dietary Restrictions
Vegetarianism encouraged, the cow is sacred beans, fish okay
pts at greatest risk for PE
Venous injury stasis of blood/hypercoagulability stasis of venous blood C-section pt is at greatest risk
pernicious anemia
Vitamin B12 deficiency red beefy tongue paresthesia in hands/feet
Nutrition needed for wound healing
Vitamin C protein!
Ketoacidosis symptoms
Weakness, drowsiness, HA, blurred vision. Sweet odor to breath Warm, dry skin (flushed) extreme thirst.
Pre-eclampsia
When a pregnant woman develops high blood pressure and protein in the urine after the 20th week (late 2nd or 3rd trimester) of pregnancy. BP of 140/90 or an increase of 30 mmHg systole or 15 mmHg diastole
Abdominal Aortic Aneurysm
When the large blood vessel (aorta) that supplies blood to the abdomen, pelvis, and legs becomes abnormally large or balloons outward.
informed consent nurse's role
Witness the client's signature on the informed consent form ensure HCP gave necessary information client understands (HCP would answer questions) ensure client is competent to sign
KUB x-ray
X-ray study of the kidneys, ureters, and bladder check for kidney stones
varicella treatment
You'll need to stay away from school, nursery or work until all the spots have crusted over. This is usually 5 days after the spots appeared. drink plenty of fluid (try ice lollies if your child is not drinking) to avoid dehydration take paracetamol to help with pain and discomfort put socks on your child's hands at night to stop scratching cut your child's nails use cooling creams or gels from a pharmacy speak to a pharmacist about using antihistamine medicine to help itching bathe in cool water and pat the skin dry (do not rub) dress in loose clothes check with your airline if you're going on holiday - many airlines will not allow you to fly with chickenpox
C. difficile
a bacterium that is spread by spores in feces that are difficult to kill; it causes symptoms such as diarrhea and nausea and can lead to serious inflammation of the colon
hydatidiform mole
a benign tumor of the placenta consisting of multiple cystic and resembling a bunch of grapes **do not get pregnant for 1 year after removal of hydatidiform mole b/c there is an increased risk of a specific cancer**
abstinence syndrome
a characteristic cluster of symptoms that results from a sudden decrease in the level of usage of a substance
Crohn's disease
a chronic autoimmune disorder that can occur anywhere in the digestive tract; however, it is most often found in the ileum and in the colon
ulcerative colitis (UC) stool
a chronic inflammatory bowel disease (IBD) primarily located in the colon and rectum watery stool with blood and mucus
Hyperglycemia Hyperosmolar State
a complication of diabetes... is an insulin deficiency and profound dehydration
Neonatal Abstinence Syndrome (NAS)
a condition in which a child, at birth, goes through withdrawal as a consequence of maternal drug use
kyphotic curve
a curvature of the spine backward, concave curve, normal in thoracic and sacral regions could be indicative of osteoporosis
medical assault
a deliberate threat with the power to carry out the threat
IV cannula
a device inserted into the body, often for the delivery or removal of fluid; provides venous access; most common access is top of hand
cardioverter defibrillator
a device placed in the chest or abdomen that attempts to correct abnormal heart rhythms pt should not lift arms above shoulders for a few weeks if pt can drive again that's up to HCP
res ipsa loquitur (the thing speaks for itself)
accident occurs due to negligence
during pregnancy - do not take - can cause teratogenic effects
ace inhibitors (prils) for HTN angiotensin II receptor blockers (statins)
aPTT
activated partial thromboplastin time 30-40 seconds It measures how long it takes your blood to form a clot.
fight or flight response
activates SNS which is core so dilates - eyes, bronchioles, increases HR, BP constricts - peripheral blood flow (legs/arms) hypoglycemic
cardiac tamponade
acute compression of the heart due to the accumulation of fluid within the pericardial cavity
What are extrapyramidal side effects?
acute dyskinesias and dystonic reactions, tardive dyskinesia, Parkinsonism, akinesia, akathisia, and neuroleptic malignant syndrome.
mononucleosis (mono)
acute, infectious illness, usually caused by the Epstein-Barr virus, and marked by an increased number of atypical lymphocytes and monocytes
baby with heart failure
add corn oil to baby's bottle
Transdermal Estradiol patch
adhere to abdomen used to treat moderate to severe hot flashes and other symptoms of menopause or low amounts of estrogen.
multiple meds in NG tube
admin each med separately flush the tube before and after each med with water helps to clear the tube of any residual med before the next one is instilled
Erythromycin ointment in newborn
admin within 1-2 hours of birth bilaterally (both eyes) starting at inner canthus going to outer canthus **okay for newborn to have initial breastfeed first**
Glucagon
administer IM or subQ repeat in 10 minutes if client doesn't respond
Open endotracheal suction
administers 100% oxygen prior to suctioning client APPLIES SUCTIONING WHILE WITHDRAWING CATHETER FROM AIRWAY USES STERILE GLOVES & TECHNIQUE THROUGHOUT THE PROCEDURE
Types of consent
admissions agreement, blood transfusion, research, surgical, special consents
Addison's disease symptoms
adrenal glands produce inadequate amounts of steroid hormones characterized by - hypoglycemia wt loss chronic fatigue hyperpigmented skin hypotension hyperkalemia (b/c sodium is not lost from urine)
hospital acquired pressure injuries - risk factors
advanced age impaired sensation nutritional deficits (anemia, low wt, decreased albumin) perfusion/oxygenation deficits skin moisture (dry skin or excess moisture, edema, incontinence, fever/infection)
newborn's first bath
after temperature stabilizes \ avoid submerging in water until cord falls off
Car seat rear facing until
age 2
Separation or stranger anxiety
age 6 months to 3 years **peaks at ages 10-18 mos**
Snellen Eye Chart Test
age 6+ pediatrics - child stands 10' away from chart ***if child wears glasses, he keeps them on for Snellen test** adults - performed (at 20ft) by covering one eye, and reading aloud the letters of each row, beginning at the top. The smallest row that can be read accurately indicates the visual acuity in that eye. The symbols on an acuity chart are known as "optotypes".
pneumothorax
air in the pleural cavity caused by a puncture of the lung or chest wall collapsed lung
continuous bubbling in water seal means
air leak, find and tape
Measles precautions
airborne place client in negative pressure isolation room N95 mask
A-B-Cs
airway, breathing, circulation
PPD skin test
aka Manntoux TB skin test read in 48-72 hrs 25g -27g needle 5-15 degree angle
transcutaneous pacing
aka external pacing. Temporary means of pacing a patient's heart during a medical emergency, accomplished by delivering pulses of electric current through the patient's chest, which stimulates the heart to contract. The most common indication for transcutaneous pacing is an abnormally slow heart rate.
lab values to determine nutritional status
albumin total serum protein
ETOH
alcohol
Pancreatitis common causes
alcoholism cholelithiasis - the formation of gallstones.
possible latex allergy
allergy to avocados & bananas
Flu vaccine contraindications
allergy to eggs infants under 6 years old
function of amniotic fluid
allows growth and movement of fetus protects the fetus from injury maintains body temp of the fetus helps measure kidney function
latex allergy risk factors
also have cross-allergies to bananas, avocado, chestnut, tomatoes, papaya, peaches & grapes health care workers, hairdressers,cleaning staff H/O of multiple surgeries clients with spinal cord injuries clients with urgogenital abnormalities children with neural tube defects
Central vein catheter
also known as a central line, is a tube that doctors place in a large vein in the neck, chest, groin, or arm to give fluids, blood, or medications or to do medical tests quickly.
3 year old
alternate feet to ascend and descend stairs, ride tricycle, emerging of hopping Feeds self well holds glass with 1 hand pulls on pants, socks, and shoes
criteria to leave PACU
ambulate independently stable BP adequate SaO2
Presumptive signs of pregnancy
amenorrhea, nausea, breast tenderness, deepening pigmentation, urinary frequency, quickening
Vital Capacity (VC)
amount of air exhaled after a maximal inspiration
microcephaly
an abnormally small head and underdeveloped brain
Vector
an animal that carries and transmits a disease (flies, bees, rabbit, racoon)
phenytoin/dilantin
an anticonvulsant used to treat & prevent seizures
epileptic client reports aura
an aura is a sensory perception indicating a complex or grand mal seizure
Hashimoto's thyroiditis
an autoimmune disorder that attacks the thyroid gland causing hypothyroidism
DM type 1 key points
an autoimmune response can trigger DM 1 usually develops before age 20 regular exercise can reduce insulin amt needed
cochlear implant
an electronic device that bypasses the damaged portions of the ear and directly stimulates the auditory nerve
PEG tube (percutaneous endoscopic gastrostomy)
an endoscopic procedure in which a tube is passed into a patient's stomach through the abdominal wall and mostly provides a means of feeding or oral intake
Protein-calorie malnutrition (PCM)
an imbalance between nutritional intake and the body's protein requirements dry, brittle hair edema poor wound healing
negative TB test
an induration (hardness) absent or less than 5 mm in diameter
Positive TB test
an induration 10 mm or greater in diameter erythema
nosocomial infection
an infection acquired during hospitalization
Phenylketonuria (PKU)
an inherited disorder of protein metabolism in which the absence of an enzyme leads to a toxic buildup of certain compounds, causing intellectual disability
venturi mask
an oxygen-delivery apparatus high flow oxygen guaranteed oxygen concentration regardless of the client's RR, depth or tidal volume
pinworms
anal itching worse at night **remember your friend had this as a child**
B6 deficiency
anemia peripheral neuropathy (tingling in feet/hands)
Pap Smears given?
annually at age 21 unless otherwise indicated
cephalic vein
anterolateral aspect of the forearm near the antecubital fossa
isosorbide mononitrate
anti-anginal med produces vasodilation change positions slowly when getting up
preterm labor prescribe
antibiotics to prevent Strep B infection if preterm infection occurs
tonsillectomy
anticipate ear pain (and admin acetaminophen PRN) pt will have bad breath post-op
to insert urinary catheter - ask client to
bear down gently as if to void
Ventral
belly side front
Propranolol
beta blocker decreases HR and BP **DO NOT GIVE TO ASTHMA PTS**
Bethamethasone
bethamethasone (celestone)=surfactant. Med for lung expansion given when woman goes into premature labor
Therapeutic INR range
between 2 and 3 **for some heart conditions can be 3.5**
uterine cancer
bimanual pelvic exam
Scotomas
blind or partially blind areas in the visual field
peripheral arterial disease (PAD)
blockage of arteries carrying blood to the legs, arms, kidneys and other organs pt will have dry, scaly, cool, hairless skin - due to lack of circulation, brittle, thick nails, possible gangrene due to lack of circulation
If a transfusion reaction occurs what should the nurse do with bag of blood?
blood bank
left to right shunting
blood from systemic redirected into pulmonary manifestations - tachypnea diaphoresis during feeding or exertion heart murmur signs of heart failure poor wt gain
Warfarin (Coumadin)
blood thinner monitor INR **CONTRAINDICATED IN PREGNANCY**
Hep B transmission
blood/body-fluids/sexual fluids (semen, vaginal secretions)
sanguinous drainage
bloody drainage
colorectal cancer
bloody stool change in bowel habits unexplained weight loss abdominal pain low hemoglobin level/anemia (due to blood in stools)
comminuted fracture
bone breaks into many fragments
compression fracture
bone is crushed
BNP
brain natriuretic peptide, elevated in CHF patients elevated would be >100 >100 indicates heart failure BNP aids in the assessment of severity of heart failure and helps distinguish cardiac from respiratory causes of dyspnea
CT scan (computed tomography)
brain-imaging method using computer-controlled X-rays of the brain **watch for shellfish allergy**
low potassium foods
breads, cereals, asparagus, cabbage, cherries, blackberries and blueberries
extracorporeal shock wave lithotripsy (ESWL)
breakdown of kidney stones using sound waves generated outside the body
macular degeneration (MD)
breakdown of the tissues in the macula resulting in loss of central vision ** a blurry spot in the center of vision***
first sign of puberty in girls
breast buds
lightening
breathing is easier for the mother more urination the sensation of the fetus moving from high in the abdomen to low in the birth canal
Theophylline
bronchodilator Therapeutic Level: 10-20 mcg/mL Toxic Level: >20 mcg/mL
theopylline
bronchodilator/anti-asthma - toxicity: anorexia, tachy, albuminuria, hypoTN
exophthalmos
bulging eyes
Milk vitamins and minerals
calcium vitamin D ***not a significant source of iron***
mag sulfate antidote
calcium gluconate 10%
aspirin overuse
can cause hearing loss
Osteosarcoma
cancer of the bone
Opportunistic infection in HIV pts
candidiasis or thrush
3 year old child
cannot hop but can stand on 1 foot for a few seconds
what would indicate sepsis
cap refill >5 seconds oliguria (excess urination) any blood discrepancy
Negative Homan's sign
cardiovascular a "negative" Homan's sign doesn't necessarily rule out a DVT
Clubfoot in infants
casting weekly recasting over 5-8 weeks
aspiration pneumonia
caused by material (food or vomitus) lodging in bronchi or lungs ***place client in side-lying (or lateral) position***
Cushing's syndrome
caused by prolonged exposure to high levels of cortisol
isoniazid
causes peripheral neuritis AE = pains/tingling in legs
Diagnostic test for pneumonia
cbc, chest x-ray blood culture if fever >101.5 sputum gram stain
blood draw
do not attempt more than 2x if unsuccessful (someone else can try but you cannot if no success after 2x) insert needle bevel up at a 15degree angle from skin if must use arm with IV, go several cm below the IV and place tourniquet in between the IV and new site
if the chest tube becomes disconnected...
do not clamp Put distal end in saline or sterile water
Tetracycline key points
do not take with dairy products use add'l contraception! use sunblock take on an empty stomach take with a full glass of water avoid antacids
varicella DON'TS
do not use ibuprofen unless advised to do so by a doctor, as it may cause serious skin infections do not give aspirin to children under 16 do not be around pregnant women, newborn babies and people with a weakened immune system, as chickenpox can be dangerous for them **MANY AIRLINES WILL NOT ALLOW YOU TO FLY WITH CHICKENPOX**
Failure to Thrive (FTT) risk factors
domestic violence in home parent with eating/food disorders poverty/food insecurity
Halo device care
don't grab device to turn pt pin care every shift!!!! clean and dry thoroughly under jacket without removing it - use side entry of jacket only 1 finger should slide between skin and jacket
Pertussis (whooping cough)
droplet precautions
Bacterial Meningitis precautions
droplet precautions, HIGHLY CONTAGIOUS, medical emergency, high mortality
Agonists
drugs which mimic the activity of neurotransmitters binds to receptors and mimics regulatory muscles hormones are agonists
Anticholinergic effects
dry mouth==can't spit urinary retention=can't pee constipated =can't **** blurred vision=can't see
xerosis
dry skin
Variant angina (Prinzmetal's angina)
due to a coronary artery spasm, often occurring during periods of rest
Hepatitis A signs and symptoms
dull RUQ pain, range from mild to severe and can include fever, malaise, loss of appetite, diarrhea, nausea, abdominal discomfort, dark-colored urine and jaundice (a yellowing of the eyes and skin).
Nonmaleficence
duty to do no harm
sign of cranial nerve dysfunction
dysphagia
cerumen
ear wax
Somogyi effect
early-morning hyperglycemia that occurs as a result of nighttime hypoglycemic episodes **monitor nightime glucose levels**
foods with vitamin B
eggs, meat, milk, dark green leafy vegetables, legumes
after mastectomy
elevate affected arm to heart level to reduce fluid retention and prevent lymphedema semi-Fowler's position arm resting on several pillows to prevent lymphedema, blood or fluid pooling
rheumatoid arthritis (RA)
elevated rheumatoid factor & erythrocyte sedimentation rate arthritis with swelling, stiffness, pain, and degeneration of cartilage in joints caused by chronic soft tissue inflammation; may result in crippling deformities; an autoimmune disease
plantar reflex
elicited touching the soles of the feet. toes curl downward. (birth to 8 months) Babinski
cachectic
emaciated, malnourished
best time for postural drainage
empty stomach if done after pt has eaten, could cause N/V
Wilms tumor (nephroblastoma)
encapsulated above kidneys...causes flank pain... DO NOT PALPATE
peripheral artery disease nursing interventions
encourage exercise! meds encourage smoking cessation
priority for pt with PTSD
encourage pt to talk about the trauma!
priority action after birth
establish airway - bulb syringe
after 1st TB injection - return when?
evaluate site 48-72 hours later!
Joint pain in hemophilia patient
eventually can cause hemophilia arthropathy
Sim's position used for
exam and treatment of the rectal areas and for enemas, rectal temperature, and rectal meds (one knee up)
some of the discomforts of pregnancy
excess salivation epistaxis breast tenderness tingling in fingers/toes
kyphosis
excessive outward curvature of the spine, causing hunching of the back.
Hyperkalemia
excessive potassium in the blood
ketoacidosis
excessive production of ketones, making the blood acidic
polyuria
excessive urination
BLACK tag
expected and allowed to die prepare for morgue
vastus lateralis
extends knee and stabilizes
FLACC scale
face, legs, activity, cry, consolability children ages 2 mos to 7 years
aplastic anemia
failure of blood cell production in the bone marrow causes a deficiency of WBCs, platelets or RBCs can be due to medicines, viruses, toxins or radiation exposure hypoxia, fatigue, pallor increased susceptibility of infection
Admin of a rectal suppository in child <3
gloves place child supine with knees & feet raised against rectal wall use PINKIE/5TH FINGER finger past internal and external sphincter hold buttocks together after insertion **should have result in 10-30 minutes**
HbA1c
glycosylated hemoglobin
PPE sequence putting on
gown mask goggles gloves
cane length is equal to the distance between the:
greater trochanter and the floor
inguinal area
groin. juncture of the lower abdominal wall and the thigh
Schizophrenia (positive symptoms)
hallucinations, delusions, disorganized speech, disorganized behavior
insert indwelling catheter in female
hand hygiene apply sterile gloves place sterile equipment between legs with nondominant hand spread labial folds with nondominant hand clean labial folds with nondominant hand cleanse urethral meatus dominant lubricate catheter tube dominant insert tube
Heberden's nodes
hard bony lumps in the joints of your fingers SYMPTOM OF OSTEOARTHRITIS Lumps grow on the joint closest to the tip of your finger, called the distal interphalangeal, or DIP joint
breast engorgement while breastfeeding
have baby feed 10-15 minutes on each breast apply warm compresses take warm showers use NSAIDS for pain do not express milk at other times!
lumbar puncture nursing interventions
have client empty bladder place client in lateral recumbent position with chin to chest and knees to abdomen encourage fluids post-procedure
3 months old motor skills
head and shoulders lift with no more grasp reflex and hands held open
2 months old motor skills
head lift 45 degree when prone with hands held open follows object past midline coos, gurgles smiles in response to other
McRoberts maneuver for shoulder dystocia
head of bed flat, exaggerated flexion of maternal legs
hip dysplasia
head of femur slips out of acetabulum **EXTRA GLUTEAL FOLDS**
Preclampsia S/S
headache, dizziness, epigastric pain, visual changes, edema, rise in BP, protein in urine, increase in weight.
APGAR
heart rate respiratory effort muscle tone reflex irritability color
Von Wilebrand Factor
helps platelets to aggregate & attach to the blood vessel wall, which is necessary for normal blood clotting
Dietary fiber good for?
helps prevent colon/colorectal cancer improves glycemic control promotes weight loss reduces risk of vascular disease regulates bowels
which STDs are incurable
hepatitis B. herpes. HIV. HPV.
Hirschsprung disease
hereditary defect causing absence of enteric nervous system HD involves missing nerve cells in the muscles of part or all of the large intestine (colon). Present at birth, it causes difficulty passing stool.
Herpes (genital herpes)
herpes simplex virus no cure c-section indicated if active lesions are present before giving birth **acylovir started at 36 weeks gestation to prevent outbreak before delivery**
Cytomegalovirus
herpes-type virus that usually causes disease when the immune system is compromised
Cirrhosis: Diet therapy
high protein, high carbohydrate , moderate-fat
Febrile seizures in a child:
high spike in temp when temp goes too high too fast (it's not the rising temp it's the swiftness that it rises)
proper swaddling technique
hips flexed and abducted to allow for movement hips should be flexed out and up to allow for movement (think like a Pavlik's harness)
Urticaria
hives with localized swelling and itching
walk upstairs with a cane
hold cane on stronger side place cane on step move weaker leg
"Palm the label"
holding bottle of liquid med with palm over the label which avoids having medicine drip down side and damaging the label
4 months old motor skills
holds head unsupported rolls back to side, puts objects in mouth reaches for toy
endometriosis treatment
hormone therapy to suppress menstrual cycle, surgery for lesions or hysterectomy
parts of a needle
hub shaft bevel lumen (opening)
nasal canula at certain levels can cause dryness - prevention?
humidify the oxygen
major complication of TPN
hyperglycemia!
CKD - pt at risk for
hyperkalemia (high potassium) & hyperphosphatemia (high phosphate)
Trousseau and Chvostek's signs observed in
hypocalcemia
rapid infusion of TPN can cause
hypoglycemia or hyperglycemia
Flattening of T waves, U wave
hypokalemia low potassium
reasons to fill out an incident report
identify the circumstances for the error and prevent it from happening again
do not take digoxin
if HR <60
Heimlich for children >1 yo
if pt can speak, ask them to cough first then abdominal thrusts - same as adult
Colostomy Types
ileum, transverse, descending, sigmoid
Vitamin K injection for newborns
injection to prevent clotting disorders given to all infants but increased risk for preemies or birth injury given IM into into the thigh muscle in the first day of life as this effectively prevents VKDB in virtually all babies. Vitamin K should be given to all newborn infants as a single, intramuscular dose of 0.5 to 1 mg. Given on the vastus lateralis
Inner canthus of the eye
inner corner of eye
central vein catheter - air embolism complication
intervention - place client in LL trendelenberg administer oxygen
Central vein catheter - lumen occlusion complication
intervention - use 10 ml syringe with a pulsing motion
PICC line - infection complication
intervention - use aseptic technique keep dressing clean & dry intervene immediately for any signs of infection
Central vein catheter - pneumothorax complication
intervention - admin Oxygen assist provider with chest tube insertion
central vein catheter - bloodstream infection complication
intervention - change entire infusion notify provider obtain culture administer antibiotics
IUD
intrauterine device; contraceptive replaced every 3-5 years if pt cannot feel string - call doctor
reasons for a contraction stress test - CST
intrauterine growth restriction post-maturity decreased fetal movement
MRSA
invasion of body tissue by methicillin-resistant staphylococcus aureus Staph skin infections, including MRSA, generally start as swollen, painful red bumps that might look like pimples or spider bites. The affected area might be: Warm to the touch Full of pus or other drainage Accompanied by a fever These red bumps can quickly turn into deep, painful boils (abscesses) that require surgical draining. Sometimes the bacteria remain confined to the skin. But they can also burrow deep into the body, causing potentially life-threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs.
Encopresis
involuntary defecation not attributable to physical defects or illness
clonus reflex
involuntary muscle spasms
toddler assessment
involve the parent continue to use comfort objects let child touch equipment use play and toys growing independence-only give choices that are truly options go from least invasive to most invasive areas
Oral Candidiasis (Thrush)
involves white curd-like growth on the mucous membranes of the mouth immunocompromised pts would get this (pt on iv antibiotics or AB therapy, AIDS pt
1st food to introduce
iron-fortified cereal such as cream of rice
Atrial Fibrillation (A-Fib)
irregular heartbeat that is too fast and increase in duration
Melanomas
irregularly shaped multi color
NAS symptoms
irritability tremors high pitched/excessive crying hyperactive vomiting diarrhea lacrimation excessive sneezing/yawning poor suck & feeding disturbed sleep difficult to console seizures
B12 deficiency anemia
is an anemia in which low red blood cell count is due to a lack of vitamin B12 aka pernicious anemia. LACK OF INTRINSIC FACTOR TO ABSORB B12!!!
Lithium
is used for mental illnesses, including bipolar disorder, depression, and schizophrenia They are primarily used to treat bipolar disorder and treat major depressive disorder that does not improve following the use of antidepressants. In these disorders, it reduces the risk of suicide lithium is taken orally.
culture and sensitivity (C&S)
laboratory test that grows a colony of bacteria removed from infected area in order to identify the specific type of bacteria and then determine its sensitivity to a variety of antibiotics UAP CAN COLLECT THIS!!
ataxia
lack of muscle coordination **MS patients**
lacto-vegetarian diet
lacto-vegetarians eat milk, cheese, and dairy foods, but avoid meat, fish, poultry, and eggs
IV device for blood transfusion
large bore catheter
position to put unconscious pt in for suctioning
lateral position so tongue won't obstruct
PMI (point of maximal impulse)
left ventricle makes this midclavicular line at 5th intercostal space
prioritization of pts
life before limb acute before chronic actual before potential Maslow's Hierarchy trends vs. transient findings (i.e. temp increasing over hours vs. a sporadic increase) emergencies and complications over expected findings determine priority action based on EBP
pt with DVT
limit sitting time
acetaminophen effects
liver
statins - test for?
liver fx
Bumetanide (Bumex)
loop diuretic
aphasia
loss of speech **Marilyn's mother**
cachexia
loss of weight and generalized wasting that occurs during a chronic disease such as cancer or AIDS
Moro reflex (startle reflex)
loud/clapping sound babies arm abduct birth-4mo **after 4 months - neuro issue**
Hyperthyroidism
low TSH
DM 2 food plan - "clean my plate"
low fat low glycemic index high fiber foods (30-35 g/day) monitor carbs reduce sodium reduce intake of sucrose limit intake of alcoholic beverages
Dumping syndrome diet
low fiber, HIGH FAT, HIGH PROTEIN small frequent meals WAIT 1 hour after meals to drink fluids LIE DOWN immediately after eating to slow down peristalsis PB okay avoid sugary desserts, empty calories
incident report required for
med error procedure/treatment error equipment related injury/error needlestick injuries client fall/injury visitor/volunteer injuries threat made to client or staff loss or property (dentures, jewelry, personal wheelchair)
newborn vomiting green
medical emergency!!! this is bile made by the liver and means an obstruction call for HCP immediately - emergency
herbal supplement for sleep/circadian rhythm
melatonin
remote memory
memory for experiences in the distant past
potential allergic reaction is
mild rash
Full liquid diet includes
milk, yogurt, custard, ice cream, pureed vegetables vegetable juice, cooked refined cereals, pudding, protein drinks/shakes
Fludrocortisone (Florinef)
mineralocorticoid check serum electrolyte levels of pt
In the chain of infection, hand washing breaks is the
mode of transmission
most effective method of sterilization
moist heat (steam)
PAD interventions
moisturize skin daily keep legs below heart level when sitting regular exercise/ROM **blood cannot move away from the heart to periphery so you want to make it easier for blood to go down**
priority during vaso occlusive crisis
monitor O2 sat secondary - antibiotics increase fluids warm compresses
PICC line - catheter dislodges complications
monitor blood return and monitor for discomfort in jaw, chest, ear contact provider
after any procedure using barium
monitor pt for constipation
IADLs (instrumental activities of daily living)
more complex activities. Laundry, shopping for groceries, using a telephone, cooking, shopping, housekeeping, finances, taking medications, preparing meals, fixing things around the house, lawn care,
sigmoid colostomy
more formed stool - left lower quadrant
stool produced in ascending & transverse colon
more liquidy/semi liquid DOES NOT NEED IRRIGATION empty pouch when 1/3 full
4 pt gait pattern
most closely resembles normal walking - for full weight baring
calcium oxalate
most common type of kidney stone limit sodium to <2,300 mg
gynecoid pelvis
most favorable pelvis for successful labor considered a typical female pelvis (although only 50% of women have it) round shape blunted ischial spines wide pelvic arch
child abusers
most grow up as been abused or witnessed abuse men & women equally abuse children teens hx of drug abuse
number of teeth at age 1
most kids have between 2-4 teeth
Hep A contracted by
mostly via fecal-oral route poor hand hygiene and improper food handling seen in developing countries **best prevention is hand hygiene before and after meals**
Pelvic tilt (inclination)
movement of the pelvis so the anterior superior iliac spine moves anteriorly or posteriorly to produce an anterior or a posterior tilt or inclination of the pelvis
Clonus
muscle spasm or twitching
Addison's disease hallmark symptom
muscle weakness Nausea / vomiting Weight loss Weakness / fatigue / lethargy craves salt! Hyperpigmentation ***CAUSES SEVERE HYPOTENSION*** -
Dilantatin (phenytoin) side effects
n/v drowsiness head spinning trouble sleeping nervousness AE = swelling & bleeding gums
pyloric stenosis
narrowing of the pyloric sphincter that blocks the passage of food from the stomach into the duodenum pyloric stenosis (HPS) is the most common abdominal surgical condition in newborns and infants **projectile vomiting**
TB precautions
negative pressure room N95 respirator mask AIRBORNE precautions
acute manic epidosde SS
neglected hygiene inadequate nutritional intake wearing bizarre clothing, jewelry insomnia flight of ideas distractibility euphoric mood private room poor impulse control delusions insomnia neglect hygiene
fixed and dilated pupil represents a
neurological emergency BLACK TAG - most likely not make it
priority for warm, tender calf
neurovascular assessment
foods for infants
no citrus fruits, eggs or meat until after 6 months no honey until after 12 months after 8 months - cheese & raw fruits
Colonoscopy prep
no food or drink 8-12 hours prior to the test smoking okay antibiotics not prescribed for most healthy pts day before test - clear liquids 1-2 days prior drinking polyethyline glycol as directed the day prior NPO midnight before day of surgery enemas, laxatives til clear (neomycin/antibiotics if pre surgery)
Colostomy irrigation
obtain colostomy irrigation set (cone tip) expel air from tubing position client near toilet instil 500-1,000 mL luke warm water hold irrigation bag 18 - 24 inches above the stoma (shoulder height) lubricate cone and insert into stoma 5 - 10 min in 35 -45 min out stop irrigation if severe cramping
colostomy irrigation
obtain colostomy irrigation set (cone tip) expel air from tubing position client near toilet instill 500-1,000 mL luke warm water hold irrigation bag 18 - 24 inches above the stoma (shoulder height) lubricate cone and insert into stoma 5 - 10 min in 35 -45 min out stop irrigation if sever cramping
Quickening
occurs week 12-14
thrombosis
occurs when blood clots block your blood vessels. 2 main types of thrombosis: Venous thrombosis is when the blood clot blocks a vein. Veins carry blood from the body back into the heart. Arterial thrombosis is when the blood clot blocks an artery.
Addison's disease
occurs when the adrenal glands do not produce enough of the hormones cortisol or aldosterone
vaso-occlusive crisis
occurs when the microcirculation is obstructed by sickled RBCs, causing ischemic injury to the organ supplied and resultant pain.
newborn feeding
offer breast immediately after birth & feed every 2-3 hours thereafter
kidney transplant rejection - 1st sign
oliguria no or low urine output
Negligence
omission of that which ought to be done
ovo-vegetarian diet
omits all meats, fish, poultry and dairy products but allows eggs
defibrillator - adult equip to use on child
one pad on front of chest one pad on back
Preeclampsia (S/S & Complications)
onset after 20 wks gestation Swelling of the face and hands PROTEINURIA 300 mg in 24 hours protein to creatinine ratio 0.3 urine dipstick 1+ HA or vision changes BP 140/90+ 4 hours apart or 2 separate occasions BP 160/110 confirmed
shingles precaution
open lesions transmit by both AIR AND CONTACT need contact precaution, airborne precaution, negative airflow
Beers Criteria
originally developed by a group headed by Dr. Mark H. Beers, listing of drugs that carry high risks for older adults and criteria for potentially inappropriate medication use in older adults
manifestations of acute otitis media
otalgia (ear pain), fever, and hearing loss, pulling on the affected ear, inability to eat tympanic membrane will be very red typically occurs in children <2 yo
chorion
outermost layer of the fetal membrane
Homan's sign
pain in *calf upon dorsiflexion* of foot and may indicated thrombophlebitis A positive Homans's sign (calf pain at dorsiflexion of the foot) is thought to be associated with the presence of thrombosis.
Ciprofloxacin (Cipro) - key point
pain in Achilles tendon area is of concern!
arthralgia
pain in a joint
hemophilia concern
pain in joints - could be bleeding in joints
infiltration of IV
pallor coolness swelling at IV site
cystic fibrosis & salt
parents should increase child's salt intake in summer/hot weather
Serotonin syndrome symptoms
• Hyperactivity or restlessness • Tachycardia → cardiovascular shock • Fever → hyperpyrexia • Elevated blood pressure • Altered mental status (e.g., delirium) • Irrationality, mood swings, hostility • Seizures → status epilepticus • Myoclonus, incoordination, tonic rigidity • Abdominal pain, diarrhea, bloating • Apnea → death
metabolic acidosis causes
• Incomplete oxidation of fatty acids. May be due to (1) diabetic ketoacidosis, (2) starvation, or (3) shock, resulting in lactic acidosis. • Abnormal loss of alkaline substances. This may be caused by deep, prolonged vomiting (leading to excessive loss of base products) or severe diarrhea and loss of pancreatic secretions. • Renal insufficiency and failure: kidneys lose ability to compensate for acid overload; thus, H⁺ ions are not excreted, nor is HCO₃⁻ retained in normal amounts. • Salicylate poisoning due to accumulation of ketone bodies produced as a result of the increased metabolic rate.
splenic sequestration sickle cell crisis
• Life threatening—death can occur within hours • Blood pools in the spleen • Signs • Profound anemia, hypovolemia , and shock, enlarged spleen on palpation
Passive immunity: Natural
• Mother to baby (placenta, colostrum and breast milk)
pertussis treatment and prevention
•Antibiotics effective during catarrhal stage; ineffective in stage 2 •Prevented with vaccine (DTaP): Booster recommended every 10 years
Signs of cataracts
•HALOS! =*Clouded, blurred* or dim vision •Difficult with vision at *night* •*Sensitivity* to light and glare •Seeing *"halos"* around lights •Frequent *changes in eyeglasses* or contact prescriptions •Fading or *yellowing* of colors •*Double vision* in a single eye
