NCLEX PN 2018
Melasma
"Mask of pregnancy" Changes in the pigmentation of women that are pregnant. Occurs in 50% of all pregnancies.
Circulatory System
(1) to conduct nutrients and oxygen to the tissues; (2) to remove waste materials by transporting nitrogenous compounds to the kidneys and carbon dioxide to the lungs; (3) to transport chemical messengers (hormones) to target organs and modulate and integrate the internal milieu of the body; (4) to transport agents which serve the body in allergic, immune, and infectious responses; (5) to initiate clotting and thereby prevent blood loss; (6) to maintain body temperature; (7) to produce, carry and contain blood; (8) to transfer body reserves, specifically mineral salts, to areas of need. The circulatory system consists of the heart, blood vessels, blood and lymphatics.
Ego Integrity vs. Despair
(Erikson) People in late adulthood either achieve a sense of integrity of the self by accepting the lives they have lived or yield to despair that their lives cannot be relived
Diagnosis of Conn's syndrome includes
+Sodium -Potassium Hypertension +Trousseau +Chovosteks
lab values with resp alkalosis
+pH, -PaC02, -K lvls, and normal or - C02 lvl
Anticoagulant
- "arin" - example: warfarin
Thrombolytic
- "ase" - example: altepase
Corticosteroids
- "asone" or "solone" - example: fluconasone
Antifungals
- "azole" - example: fluconazole
Anesthetics
- "caine" - example: lidocaine
Penicillin
- "cillin" - example: pipercillin
Antibiotic
- "cycline" or "floxacin - example: tetracycline or levofloxacin
Histamine receptor blockers
- "dine" - example: famotidine
Oral hypoglycemics
- "ide" - example: glyberide
Beta blockers
- "olol" - example: metoprolol
Benzodiazepine
- "pam" or "lam" - example: lorazepam
Bronchodilator
- "phylline" - example: theophylline
SSRIs
- "pram" or "ine" - example: citralopram or fluoxtine
Proton pump inhibitor
- "prazole" - example: pantoprazole
ACE inhibitor
- "pril" - examples: enalapril
ARBs (angiotensin II receptor blockers)
- "sartan" - example: losartan
Antilipidemics
- "statins" - examples: simvastatin
Antiulcer
- "tidine" - example: ranitidine
TCA
- "tyline" - example: amitriptyline
Antivirals
- "vir" - examples: acyclovir
Antihistamine
- "zine" - example: loratadine or dyphenhidramine
Lisinopril
- ACE inhibitor - used for HTN, MI, etc. - SE: cough and angioedema
Sertraline
- SSRI - used for depression, OCD, PTSD, and panic attacks - SE: weight changes, drowsiness, hallucinations, etc.
Hydromorphone
- analgesic for moderate to severe pain
Clopidogrel
- anti-platelet - used prevent MI and stroke - SE: bleeding and hemorrhage
Enoxaparin
- anticoagulant - used for DVT prevention - SE: bleeding and neurological impairment
Pregabalin
- anticonvulsant - used neuralgia, seizures, and fibromyalgia - SE: changes in behavior or mood, confusion, and muscle twitching
Amiodarone
- antidysrhythmic - used for a.fib, v.fib, and v.tach - SE: lung damage, heart failure, liver and thyroid toxic
Rifampin
- antimyobacterial - used for TB and other infections - SE: hepatotoxicity
Haloperidol
- antipsychotic - used for schizophrenia, psychosis, etc. - SE: neutropenia and EPS
Aripiprazole
- atypical antipsychotic - used for schizophrenia, BPD, depression, autism, etc. - SE: headache, EPS, and aggitation
Risedronate
- bisphosphate - used osteoporosis - SE: jaw problems, pain in bones and joints
Diltiazem
- calcium channel blocker - used for HTN, angina, a.fib, a.flutter, SVT, etc. - SE: HF and peripheral edema
Donepezil
- cholinsterase inhibitor - used for mild to severe AD - SE: decrease reaction time
Epoetin
- colony stimulating factor - used for anemia and preoperatively - SE: blood clots
Flucticasone
- corticosteroid - used for seasonal rhinitis - SE: nausea, dizziness, and epistaxis
Valacyclovir
- decreases the symptoms of herpes zoster
Calcium channel blockers
- dipine" - example: amlodipine
Nitroglycerin
- do not take this medication with tadalafil - it is an organic nitrate
Levofloxacin
- fluroquinolone - used for pneumonia, infections of skin, sinusitis, etc. - SE: tendonitis and photosensitivity
Aspart
- insulin (rapid-acting) - used for diabetes - SE: hypoglycemia
Furosemide
- loop diuretic - used for renal failure and heart failure - SE: hypokalemia and ototoxicity
Valsartan
- lowers blood pressure
Warfarin
- monitor INR
Glipizide
- monitor blood glucose
Levofloxacin
- monitor culture and sensitivity
Prednisone
- monitor for delayed wound healing
Olanzapine
- monitor mood
Digoxin
- monitor potassium levels
Morphine
- monitor respiratory rate
Zolpidem
- monitor sleep patterns
Acetaminophen
- monitor temperature
Lithium
- mood stabilizer - used for BPD - SE: tremors, polyuria; Toxic: GI upset, CNS changes, etc.
Fentanyl
- narcotic analgesic - used for chronic pain - SE: addiction and respiratory depression
Propranolol
- nonselective beta blocker - used for HTN, dysrhythmias, migraine, etc. - SE: bradycardia and hypotension
Piperacillin/tazobactam
- patients allergic to penicillin should not take this - SE include leukopenia
Sildenafil
- phosphodiesterase inhibitor - used for ED - SE: flushing, erection lasting over 4 hours, MI, etc.
Oxytocin
- prescribed to induce or augment labor * tocolytic agents: stop contractions
Montelukast
- prevent bronchospasm
Oxybutynin
- prevent urinary incontinence
MMR Vaccine
- prevents rubella
Methylprednisolone
- prolonged use of this medication can cause Cushing's syndrome with s/sx including moon face, buffalo hump, high sugars and sodium levels
Esomeprazole
- proton pump inhibitor - used for GERD and gastric ulcers - SE: headache, diarrhea, osteoporosis, etc.
Insulin detemir
- replaces a missing pancreatic hormone - peaks within 4-6 hours
Zolpidem
- sedative-hypnotic - used for insomnia - SE: changes in mental health, sleep walking
Varenicline
- smoking cessation - SE: change in appetite and unusual dreams
Atorvastatin
- statin - used to lower cholesterol and raise HDL - SE: rhabdomylosis and hepatotoxicity
Levothyroxine
- synthetic hormone that should be taken after rising in the morning and before eating (better absorption)
Methotrexate
- this is a DMARD: disease modifying anti-rheumatic drug - also an immunosuppressant
Pantoprazole
- this medication is used to prevent GERD
Esomeprazole
- treat GERD
Metformin
- used for diabetes - can cause buildup of lactic acid in body
Gabapentin
- used for epilepsy and neuralgia - short half-life: take 4x a day
Methylergonovine
- used for postpartum bleeding (women with twins)
Risperidone
- used to decrease hallucinations and delusions - SE include elevated glucose and cholesterol
Clopidogrel
- used to prevent MI or stroke
Budesonide/Fomorterol
- used to prevent acute asthma attacks - SE include infection and GI upset
Atorvastatin
- used to prevent heart disease
Etancercept
- used to slow the progression of arthritis
Tiotropium
- used to treat COPD
Quetiapine
- used to treat bipolar disorder
Duloxetine
- used to treat depression
Pregabalin
- used to treat neuropathy
Vancomycin
- used to treat patients with infection caused by clostridium difficile
Erectile dysfunction medications
-"afil" - example: sildenafil
Surgical Asepsis
-aka "sterile technique
Benzodiazepine
-azepam
Phenothiazine
-azine
Anti-fungal
-azole
Barbiturate
-barbital
Antibiotic
-ceph -cycline
Penicillin
-cillin
Epiglottitis S/S
-excessive drooling is the universal sign -in addition, the child will have a sudden onset of dysphagia or difficulty swallowing, stridor, and high-grade fever. -the child may also be in the TRIPOD POSITION upon arrival
Tricyclic Anti-depressant
-ipramine
Protease Inhibitor
-navir
Beta Antagonist (blockers) (antiarrhythmics)
-olol
Cardiac glycoside
-oxin
ACE inhibitor
-pril
Beta 2 Agonist
-terol
H2 Antagonist
-tidine
Pituitary Hormone
-trophin
Alpha 1 Antagonist
-zosin
Wt Conversion Table
.1mg = 1/6000 grain .2mg = 1/300 grain .5mg = 1/120 grain 1 mg = 1/60 grain 10mg = 1/6 grain 30mg = 1/2 grain 60mg = 1 grain 300mg = 5 grains 1gm = 15 grains 4mg = 60 grains 15mg = 4 drams 30mg = 1 ounce
The total apgar score can range from
0 to 10
Basic trust vs mistrust
0-2
Bilirubin direct (conjugated)
0.1-0.3
Bilirubin indirect (unconjugated)
0.1-1
Bilirubin total
0.3-1
Therapeutic level of Lithium
0.4-1.4
The normal Thyroid stimulating hormone level should be
0.4-6.0
creatinine
0.6-1.35
Therapeutic level of Digoxin
0.8 -2.0
isotonic solutions
0.9 sodium cholride this is normal saline lactated ringers solution
early crawling movements
1 M
head sags
1 M
Common Conversions
1 meter = 1000 mm 1 meter = 1 mcg .001 mg = 1 mcg 1 gram = 1000mg 1000 g = 1 kg 1tbs (T) = 15mL 1 tsp = 5 mL 20 drops = 1mL 2.2lb = 1 kg 1 lb = 453.6 gm 1 oz = 30 gm 1 mL = 1 cc 1 dL = 100 mL
Erickson's toddler stage
1 to 3 years. Autonomy vs. shame and doubt
How to treat hypokalemia
1) asses V/s 2) Diet ( foods high in potassium) 3) IV KCL on IV pump or IV controller 4) Check Mg, Cl, protein when replacing K
Newborn bilirubin
1-12 (>15 is critical)
Toddler age range
1-3
Scarlet Fever 7 signs and symptoms
1. Abrupt high fever, flushed cheeks, vomiting, headache, enlarged lymph nodes in neck, malaise, ab. pain 2. Red, fine, sandpaper-like rash develops in the axilla, groin, and neck that spreads to cover the entire body except face. 3. Rash blanches with pressure, except in areas of deep creases and folds of joints. 4. Desquamanation of skin on palms and soles appears by weeks 1-3 5. Tongue is initially coated by white, furry covering with red papillae; by fifth day, white coat sloughs off leaving red, swollen tongue (White strawberry tongue -> Red strawberry tongue) 6. Tonsils are reddened and covered with exudate. 7. Pharynx is edematous and beefy red Remember: Key is the strawberry tongue
Pertussis (Whooping Cough) 1. Agent? 2. Incubation period? 3. Communicable period? 4. Source? 5. Transmission?
1. Agent: Bordetella pertussis (Gram negative bacteria) 2. Incubation period: 5-21 days (usually 10) 3. Communicable period: greatest during the catarrhal stage 4. Source: Discharge from resp. tract of infected person 5. Transmission: Direct contact or droplet spread
Diphtheria 1. Agent? 2. Incubation period? 3. Communicable period? 4. Source? 5. Transmission?
1. Agent: Corynebacterium diptheriae 2. Incubation period: 2 to 5 days 3. Communicable period: Variable. Until virulent bacteria are no longer present (three consecutively negative cultures of pharyngeal secretions); usually 2 weeks, can be 4 weeks. 4. Source: Discharge from mucous membranes of nose and nasopharynx, skin and other lesions. 5. Transmission: Direct contact with infected person, carrier, or contaminated articles
Infectious Mononucleosis 1. Agent? 2. Incubation period? 3. Communicable period? 4. Source? 5. Transmission?
1. Agent: Epstein-Barr virus (viral) 2. Incubation period: 4 to 6 weeks 3. Communicable period: Unknown 4. Source: Oral secretions 5. Transmission: Direct intimate contact
Scarlet Fever 1. Agent? 2. Incubation period? 3. Communicable period? 4. Source? 5. Transmission?
1. Agent: Group A beta-hemolytic streprococci (Gram positive bacteria) 2. Incubation period: 1 to 7 days 3. Communicable period: About 10 days during the incubation period and clinical illness; during the first 2 weeks of the carrier stage, although may persist for months. 4. Source: Nasophayngeal secretions of infected person and carriers. 5. Transmission: Direct contact or droplet spread; indirectly by contact with contaminated articles.
Erythema Infectiosum (Fifth Disease) 1. Agent? 2. Incubation period? 3. Communicable period? 4. Source? 5. Transmission?
1. Agent: Human Parvovirus B19 (viral) 2. Incubation period: 4 - 14 days, may be 20 days 3. Communicable period: Uncertain, but before onset of symptoms in most children. 4. Source: Infected persons 5. Transmission: Unknown mode of transmission, possibly resp. secretions and blood.
Roseola (Exanthema Subitum) 1. Agent? 2. Incubation period? 3. Communicable period? 4. Source? 5. Transmission?
1. Agent: Human herpesvirus type 6 (viral) 2. Incubation period: 5-15 days 3. Communicable period: unknown, but thought to be from febrile stage to time rash appears 4. Source: unknown 5. Transmission: unknown
Rubeola (Measles) 1. Agent? 2. Incubation period? 3. Communicable period? 4. Source? 5. Transmission?
1. Agent: Paramyxovirus (viral) 2. Incubation period: 10-20 days 3. Communicable period: from 4 days before to 5 days after rash appears. 4. Source: Respiratory tract secretions, blood, or urine 5. Transmission: Airborne particles or direct contact with infectious droplets; transplacental
Mumps 1. Agent? 2. Incubation period? 3. Communicable period? 4. Source? 5. Transmission?
1. Agent: Paramyxovirus (viral) 2. Incubation period: 14-21 days 3. Communicable period: Immediately before and after parotid gland swelling begins. 4. Source: Saliva of infected persons. 5. Transmission: Direct contact or droplet spread
Rocky Mountain Spotted Fever 1. Agent? 2. Incubation period? 3. Communicable period? 4. Source? 5. Transmission?
1. Agent: Rickettsia rickettsii (Gram negative bacteria) 2. Incubation period: 2 to 14 days 3. Communicable period: NOT CONTAGIOUS 4. Source: Tick bite from mammal, usually wild rodents and dogs. 5. Transmission: Tick bite
Rubella (German Measles) 1. Agent? 2. Incubation period? 3. Communicable period? 4. Source? 5. Transmission?
1. Agent: Rubella virus (viral) 2. Incubation period: 14 to 21 days 3. Communicable period: From 7 days before to about 5 days after rash appears. 4. Source: Nasopharyngeal secretions; virus is also present in blood, stool, urine. 5. Transmission: Airborne or direct contact w/infectious droplets. Indirectly via articles freshly contaminated. Also transplacental.
Chickenpox (Varicella) 1. Agent? 2. Incubation period? 3. Communicable period? 4. Source? 5. Transmission?
1. Agent: Varicella-zoster virus (viral) 2. Incubation period: 13 to 17 days 3. Communicable period: From 1 to 2 days before the onset of rash to 6 days after the first crop of vesicles, when crusts have formed. 4. Source: Respiratory tract secretions of infected persons; skin lesions. 5. Transmission: Direct contact, droplet, contaminated objects REMEMBER: Child is no longer contagious once lesions have dried and crusts have formed.
Client Rights in healthcare
1. Be informed about all aspects of care and takes an active role in decision-making 2. Accept, refuse, or request modification to the plan of care Receive care that is delivered by competent individuals
Kubler-Ross stages of grief
1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance
Mumps 5 signs and symptoms
1. Fever 2. Headache and malaise 3. Anorexia 4. Jaw or ear pain aggravated by chewing, followed by parotid gland swelling. 5. Orchitis (inflamed testes) may occur Remember: Key is parotid gland swelling.
Rubeola (Measles) 5 Signs and symptoms
1. Fever 2. Malaise 3. The three "C's" - coryza, cough, conjunctivitis 4. Red, erythematous maculopapular eruption starting on face and spreading down towards feet; blanches with pressure and gradually turns brownish color (1 week) 5. Koplik's spots: small red spots with a bluish white center and red base, located on buccal mucosa Remember: Three "Cs" & Koplik's spots are the key for identifying measles.
Rocky Mountain Spotted Fever 2 signs and symptoms
1. Fever, malaise, anorexia, vomiting, headache, myalgia 2. Maculopapular OR petechial rash primarily on the extremities (ankles and wrists), but may spread to other areas, characteristically on the palms and soles. Key: Rash on ankles, wrists, palms and soles. Remember it is not communicable. Provide parents teaching about preventing tick bites.
Infectious Mononucleosis 3 signs and symptoms and 1 important complication to teach parents to monitor for.
1. Fever, malaise, headache, fatigue, nausea, abdominal pain, sore throat, enlarged red tonsils. 2. Lymphadenopathy and hepatosplenomegaly 3. Discrete macular rash most prominent over the trunk may occur. TEACH PARENTS TO MONITOR FOR SPLENIC RUPTURE: Marked by abdominal pain, left upper quadrant pain, referred left-shoulder pain.
Contraindications for HPV vaccine?
1. Individuals with a reaction to a previous injection. 2. PREGNANT WOMEN should not receive HPV vaccine.
Medications for bipolar
1. Mood stabilizers: lithium carbonate 2. Antiepileptic that act as mood stabilizers: valproic acid (depakote), clonazepam, gabapentin 3. Benzodiazepines used for mania: lorazepam (Ativan) 4. Antidepressants used for depression: ssri fluoxetine (prozac)
Maslow's pyramid
1. Physiological- oxygen, food, sleep 2. Safety 3. Love and belonging 4. Self-esteem 5. Self-actualizacion
Types of crisis
1. Situational 2. Transitional 3. Cultural/social
Chickenpox (Varicella) 3 signs and symptoms
1. Slight fever, malaise, and anorexia are followed by a macular rash that first appears on the trunk and scalp and move to the face and extremities. 2. Lesions become pustules, begin to dry, and develop a crust. 3. Lesions may appear on mucous membranes of mouth, genital area, or rectum.
Roseola (Exanthema Subitum) 2 Signs and symptoms?
1. Sudden high (>38.8 C / >102 F) fever of 3 to 5 day's duration in a child that appears well, followed by a rash (rose-pink macules that blanch with pressure. 2. Rash appears several hours to 2 days after fever subsides and lasts 1 to 2 days. Disease is self-limiting and treatment is supportive. Remember: fever first, then rash.
Pertussis (Whooping Cough) 3 signs and symptoms
1. Symptoms of respiratory infection followed by increased severity of cough, with a loud, whooping INSPIRATION. 2. May experience cyanosis, resp. distress, and tongue protrusion. 3. Listlessness, irritability, anorexia. Remember: Key is whooping inspirations. Child will be receiving antimicrobials. Institute airborne precautions and isolate child.
Rubella (German Measles) 4 signs and symptoms and 1 very important intervention to remember
1. low-grade fever 2. Malaise 3. Pinkish red maculopapular rash the begins on face and spreads to the entire body within 1 to 3 days. 4. Petechial, red, pinpoint spots may appear on the soft palate. Key for identification is rash covering entire body and spots on soft palate. REMEMBER: ISOLATE CHILD FROM PREGNANT WOMEN.
Diphtheria 4 signs and symptoms and 2 important interventions
1. low-grade fever, malaise, sore throat 2. Foul-smelling, mucoprurulent nasal discharge 3. Dense pseudomembrane formation of the throat that may interfere with eating, drinking and breathing. 4. Lymphadenitis, neck edema, "bull neck" Interventions: Strict isolation for hospitalized child. Administer diphtheria antitoxin only AFTER a skin or conjunctival test rules out sensitivity to horse serum.
Urine specific gravity
1.005-1.025
Mg
1.3-2.1
magnesium
1.3-2.1
brings hands together
10 M
crawls well
10 M
pulls self to standing position with support
10 M
vocalizes one or two words
10 M
What is the second stage of labor?
10 cm to delivery
When does the anterior fontanelle close?
10-12 months (before 18 months)
At what point is fetal heart rate able to be auscultated during pregnancy?
10-12 weeks.
capable of helping
10-12Y
develops beginning of interest in opposite
10-12Y
increasingly responsible
10-12Y
loves conversation
10-12Y
more selective when choosing friends
10-12Y
raises pets
10-12Y
remainder of teeth
10-12Y
uses telephone
10-12Y
BUN
10-20
Therapeutic level of Theophylline
10-20
Therapeutic level of Dilantin
10-20 mcg/mL
Therapeutic level of Phenobarbital
10-40
On heart rate or cardiac status, a 2 means that the HR is above _______ BPM.
100
LDH lactate
100-225
What is the hightes that the temp will be in appendicitis?
102 F
erect standing posture with support
11 M
PT
11-12.5 sec Therapeutic range for coag therapy is 1.5 - 2 x the control value
What is the normal fetal heart rate?
110-160 bpm
What is the normal newborn heart rate?
110-160; 100-180 if sleeping or crying
pick up bite size pieces of ceral
11M
birth weight usually trippled
12 M
eats with fingers
12 M
needs help while walking
12 M
sits from standing position without assistance
12 M
usually says two words in addition to mama and dada
12 M
Ribs and Sternum
12 pairs of ribs the two most inferior pairs do not attach anteriorly (floating ribs)
Erickson's adolescent stage
12 to 20 years. Identity vs role confusion
What is the normal leukocytosis of pregnancy?
12,000 to 15,000
What is considered normal WBC level after labor?
12,000 to 25,000
MMR
12-15 months, 4-6 years
Varicella
12-15 months, 4-6 years
Hbg women
12-16
How long should the stump be elevated to prevent post op swelling?
12-24 hours
Identity vs role confusion
13-19
LDLs should be below
130
Sodium
135-145
Na
136-145
Hgb men
14-18
The diagnosis is made when there is a weight loss of _______% or more of body weight.
15 (weigh < 85% of normal body weight), hospitalize if 30% weight loss
builds 2 blocker tower
15 M
grasps spoon
15 M
names commonplace objects
15 M
throws objects
15 M
walks alone
15 M
Apendicitis occurs most in what age group?
15 to 35
Ammonia
15-45
Platelets
150,000-450,000
Fetal heart rate depends on gestational age
160-170 first trimester 120-160
If you are the nurse starting the IV on the client with Abruptia Placenta, what guage needle should you use?
18 (in preparation to give blood if necessary)
anterior fontanelle usually closed
18 M
builds 3 block tower
18 M
climbs stairs
18 M
oral vocab 10 words
18 M
scribbles
18 M
thumb sucking
18 M
walks backward
18 M
What is the age range for early adulthood?
19 to 35 years of age
If an AIDS patient's blood contaminates a counter top, with what di you clean?
1:10 solution of bleach and water
Major conversions to know
1gr =60mg 1oz =30mL 1g = 1000mg 1L = 1000 mL
What tissue to tears extend to?
1st degree - epidermis 2nd degree - dermis, muscle and fascia 3rd degree - extends into anal sphincter 4th degree - extends into rectal mucosa
The maximum score and infant can receive on any one of the criteria is
2
Social smile first appears
2 M
able to turn from side to back
2 M
closing of posterior fontanelle
2 M
diminished moro reflex
2 M
diminished tonic neck
2 M
eyes begin to follow a moving object
2 M
Hep A
2 doses between 12-23 months
Height for school age per year?
2 inches per year
DTap
2 months, 4 months, 6 months, 15-18 months, 4-6 years
What are the urinaysis findings on AGN?
2 to 3 weeks after initial infection
At what age are accidental poisonings most common?
2 years old
Rotavirus
2, 4, 6 months
Inactivated polio
2, 4, 6 months, 4-6 years
Hib
2, 4, 6, 12-15 months
Pneumococcal
2, 4, 6, 12-15 months
When does the posterior fontanelle close?
2-3 months
doll's reflex disappears
2-3M
autonomy vs shame and doubt
2-4
How much should 3-6 years olds grow per year?
2.5-3 inches per year
Phosphorus
2.5-4.5
Erickson's young adult stage
20 to 35 years. Intimacy vs isolation
intimacy vs isolation
20-24
A CD4 count of under _______ is associated with the onset of opportunistic infections.
200
Skull
22 bones fused together
HCO3
22-26
Bicarbonate has a lab value of
22-29
300 word vocab
24 M
builds 5 to 6 block tower
24 M
early efforts at jumping
24 M
obeys easy commands
24 M
What should the total weight gain be in a "normal" weight woman during pregnancy?
25-35 lbs.
generativity vs stagnation
25-64
osmolality
280-295
How many nitro tabs can you take before you call the doctor?
3
binocular vision
3 M
can bring objects to mouth at will
3 M
head held erect, steady
3 M
laughs audibly
3 M
smiles in mother's presence
3 M
What should the fundal height be three days after a vaginal delivery?
3 finger-breadths below the umbilicus
How much do toddlers grow each year?
3 inches
Erickson's preschool stage
3 to 6 years. Initiative vs guilt
Hypertonic solutions (higher concentrations of particles)
3% sodium chloride protein solutions comes in 10, 50, 70% dextrose
CVP
3-12
Preschool age range
3-5
Phosphorous
3.0-4.5
Albumin
3.5-5
K+
3.5-5
albumin
3.5-5.5
potassium
3.5-5.5
builds 7 to 8 block tower
30 M
has sphincter control for toilet training
30 M
stands on one foot
30 M
walks on tiptoe
30 M
PTT
30-40 sec Therapeutic range for coag therapy is 1.5 - 2 x the control value
What is the normal range for newborn respirations?
30-60 breaths/min
state first and last name
30M
One oz is equal to
30ml
What is the age range for middle adulthood?
35 to 64 years of age
Erickson's middle adult stage
35 to 65 years. Generativity vs stagnation
Triglycerides females
35-135
PaCO2
35-45
carbon dioxide content
35-45
HDL men
35-65
HDL women
35-80
Hct women
37-47
900 word vocab
3Y
builds bridge w/ 3 cubes
3Y
copies a circle
3Y
learns from experience
3Y
less negativistic than toddler, decreased tantrums
3Y
may invent imaginary friend
3Y
rides tricycle
3Y
undressed without help
3Y
uses sentences
3Y
walks backward and downstairs without assistance
3Y
absent tonic neck reflex
4 M
appearance of thumb apposition
4 M
drooling
4 M
evidence of pleasure in social contact
4 M
moro reflex absent after 3-4 M
4 M
Tetralogy of Fallot (pedi)
4 heart defects that are congenital. Poorly oxygenated blood is pumped to the body's tissues. 4 factors: Rt Vent Hypertrophy Vent Septal Defect Aorta from both vent Stenosis of Pul outflow tract Sx: Poor wt gain, cyanosis, death, limited infant feeding, clubbing, SOB Tx: Surgery, small meals, limit child's anxiety Tests: CXR, EKG, Echocardiogram, Heart Cath, CBC, Heart murmur Monitor for: seizures, poor overall development, cyanosis
How long will it take for the person to see results when acne is being treated?
4 to 6 weeks
Until what age should toddlers remain in a car seat?
4 years
Initative vs guilt
4-5
HbA1c
4-6%
Rbc women
4.2-5.4
How much weight should a school aged child gain per year? (6-12 yr)
4.4-8lbs annually
How much weight should 3-6 year olds gain per year?
4.5-6.5 lbs annually.
Urine pH
4.5-8
urinary ph
4.5-8
Rbc men
4.7-6.1
Triglycerides males
40-160
What is normal blood glucose in the term neonate?
40-80
Hct Men
42-52
When is the risk of seizures usually gone in the preeclamptic patient?
48 hours after birth
drooling begins
4M
1500 word vocab
4Y
brushes teeth
4Y
climbs and jumps well
4Y
laces shoes
4Y
skips and hops on one foot
4Y
throws overhead
4Y
Birth weight usually doubled
5 M
takes objects presented to him/her
5 M
How many minutes should lapse between the nitro pills you take?
5 minutes - take one nitro tab every 5 minutes 3 times, if no relief, call MD
WBC
5,000-10,000
WBC children
5,000-13,000
Novalog insulin onset is (rapid acting)
5-10 minutes
Industry vs Inferiority
5-12
Preschool speech
5-8 words
A CD4 count of under __________ is associated with the onset of AIDS-related symptoms.
500
2100 word vocab
5Y
beginnings of cooperative play
5Y
dresses without help
5Y
gender specific behavior
5Y
jumps rope
5Y
runs well
5Y
skips on alternate feet
5Y
ties shoes
5Y
tolerates increasing periods of separation from parents
5Y
average weight gain of 4 oz per week
6 M
can turn from back to stomach
6 M
early ability to distinguish and recognize strangers
6 M
lower central incisors come in
6 M
teething may begin
6 M
Influenza
6 months initiate, annually
H1N1 Vaccine: When are children old enough to receive it?
6 months. Children younger than six months are not old enough, but family members and caregivers should be vaccinated.
Erickson's school age child stage
6 to 12 years. Industry vs inferiority
School age range
6-12
Amylase
6-160
Total protein
6-8
responds to their own name
6-8M
HDLs should be above
60
What respiratory rate in the newborn indicates that the newborn should not be fed?
60 breaths/min or more
The normal T3 ( total serum) level should be approximately
60-181
What is the age range for late adulthood?
64 years of age to death
ego integrity vs despair
65-death
appearance of first permanent teeth
6Y
begins losing temporary teeth
6Y
extreme sensitivity to criticism
6Y
self centered, show off rude
6Y
tie knots
6Y
fear of strangers begins to appear
7 M
grasps toy with hand
7 M
lability of mood (abrupt mood shifts)
7 M
sits for short periods using hands for support
7 M
What is considered a "good" APGAR score?
7-10
BUN
7-22
Blood pH
7.35-7.45
GTT fasting
70-105
glucose
70-110
What is the euglycemia goal for the diabetic patient in labor?
70-90 mg/dL
increased self reliance for basic activities
7Y
team games/ sports/ organizations
7Y
temporal perception improving
7Y
anxiety with strangers
8 M
One cup of fluid is equal to
8 oz
AST/ALT
8-40
calcium
8.5 to 10.5
PaO2
80-100
What is the normal newborn blood pressure?
80/50, but not usually measured.
eye development generally complete
8Y
friends sought out actively
8Y
movements more graceful
8Y
writing replaces printing
8Y
elevates self to sitting position
9 M
expressions like dada may be heard
9 M
responds to parental anger
9 M
rudimentary imitative expression
9 M
takes deliberate steps when standing
9-10M
Ca
9.0-10.5
NPH insulin onset is
90-120 minutes
chloride
95-108
SaO2
95-98% <86% = emergency < 70% = life threatening
What is the normal newborn temperature?
97.7-99.4
Cl
98-106
better behaved
9Y
conflict between needs for independence and dependence
9Y
conflicts between adult authorities and peer groups
9Y
likes school
9Y
skillful manual work possible
9Y
ESR
< 20
Lipase
< 200
What is considered normal maternal pulse during labor?
<100 bpm
LDL
<139
Methylxanthine
=phylline
What is considered a prolonged latent phase in a multipara?
> 14 hours
What is considered a prolonged latent phase in a nullipara?
> 20 hours
Triglycerides
>150
Cholesterol
>200
How are pinworms diagnosed? 1.) seeing the worm in the stool 2.) a blood antigen level 3.) A "Scotch tape test" in the early morning 4.) a stool laboratory examination obtained at the hour of sleep
A "Scotch tape test" in the early morning
How is fetal bradycardia defined?
A FHR below 110 bpm for 10 minutes.
What are FHR decelerations?
A decrease in FHR that can be early or late when compared to uterine contractions.
What does the physician hope to achieve with NRTI's and PI's for HIV?
A delayed onset of AIDS for as long as possible (usually can delay onset for 10-15 years)
Acromegaly
A disorder in adults in which the pituitary gland produces too much growth hormone.
Parotitis
A feature of mumps and inflammation of the parotid glands.
Sickle Cell Anemia
A human genetic disease of red blood cells caused by the substitution of a single amino acid in the hemoglobin protein; it is the most common inherited disease among African Americans.
What is the Silverman-Anderson Index?
A measure of respiratory distress where 10 is severe and 1 is okay.
Pityriasis rosea
A mild to moderate rash that starts as a single pink patch and then numerous patches begin to appear on the skin. This may lead to itching. Found primarily in ages 10-35 years old.
Lymphatic Drainage (circulatory system)
A network of lymphatic capillaries permeates the body tissues. Lymph is a fluid similar in composition to blood plasma, and tissue fluids not reabsorbed into blood capillaries are transported via the lymphatic system eventually to join the venous system at the junction of the left internal jugular and subclavian veins.
What is a reactive fetal nonstress test?
A normal result indicating good fetal health where the fetus responds to its own movements with an acceleration of 15 bpm lasting for 15 seconds after the movement, twice within a 20 minute period.
Oral Leukoplakia
A patch or spot in the mouth that can become cancerous.
Brudzinski sign
A positive sign of meningitis, in which there is an involuntary flexion of the arm, hip, and knee when the patient's neck is passively flexed.
Should a newborn have a positive or negative Babinski?
A positive unti 12-18 months of age
Neuroleptic malignant syndrome
A rare and sometimes fatal reaction to high potency antipsychotic medications. Symptoms: muscle rigidity, fever, and elevated WBC
Rosacea
A redness that covers the middle part of the face. Blood vessels in the face dilate. Most common in adults 30-50 years old. Unable to be cured, only treated. May cause long term skin damage is left untreated. Antibiotics are often prescribed.
Extrapyramidal reaction
A reversible side effect of some psychotropic drugs: muscle rigidity, drooling, restlessness, shuffling, gait, and blurred vision
Actinic keratosis
A site that can become cancerous, usually small and rough on the skin that has been exposed to the sun a lot. Usually treated with cryosurgery and photodynamic therapy.
Tonic phase
A state of muscle contraction in which there is excessive muscle tone; rigid & stiff
Grievance
A wrong perceived by an employee based on a feeling of unfair treatment that is considered grounds for a formal complaint
LT sided HF
A. Left Ventricular Heave B. Confusion C. Paroxysmal noturnal dyspnea D. DOE E. Fatigue F. S3 gallop G. Crackles H. Tachycardia I. Cough J. Mitral Murmur K. Diaphoresis L. Orthopnea
RT sided HF
A. Right Upper Quadrant Pain B. Right Ventricular heave C. Tricuspid Murmur D. Weight gain E. Nausea F. Elevated Right Atrial pressure G. Elevated Central Venous pressure H. Peripheral edema I. Ascites J. Anorexia K. Hepatomegaly
Tasks delegated to AP
ADL's Bathing Grooming Dressing Toileting Ambulating Feeding (without swallowing precautions) Positioning Routine tasks Bed making Specimen collection Intake and output Vital signs (for stable clients)
Bradyarrhythmias
AV block (primary, secondary (I,II) Tertiary Primary- >.02 PR interval Secondary (Mobitz I) - PR interval Increase Secondary (Mobitz II) - PR interval (no change) Tertiary- most severe, No signal between ventricles and atria noted on ECG. Probable use of Atrophine indicated. Pacemaker required. Right Bundle Branch Block (RBBB)/Left Bundle Branch Block (LBBB) Sinus Bradycardia- <60 bpm, with presence of a standard P wave.
What is the most common NRTI used?
AZT (zidovudine)
7 months old motor skills
Able to fully bear weight, can move objects between hands
How many calories/day does an infant need for the first six months?
About 50 calories/lb or 108 calories/kg of body weight.
What is the fourth stage?
About two hours after the delivery of the placenta
What does AKA mean?
Above the knee amputation
What is the most common retinoid given to people with acne?
Accutane
Latent Conflict
Actual conflict not yet developed, however factors are present Ex: New scheduling policy is implemented w/in the org. Nurse manager should recognize that change is a common cause of conflict
Atrial Septal defect
Acyanotic Malfunctioning foramen ovale causes shunting of oxygenated blood from L to R atrium, increased RV output and work load, may develop pulm hypertension in adulthood May be asymptomatic or may hear soft blowing, systolic murmur, have frequent episodes of pulm inflammatory diseases, poor exercise intolerance May require open heart surg with direct closure or suturing with plastic prosthesis.
Coarction of aorta
Acyanotic preductal constriction of aorta between subclavian artery and ductus arteriosis. Postductal constriction of aorta directly beyond ductus. Leads to obstructions of blood flow through the constricted segments, weak or absent pulsations in lower extremities, heart failure, may notice fatigue, headaches, leg cramps, epistaxis. Surgical resection of coarctate area with direct anastamosis or use of a graft. Must be done within 2 years of age to prevent hypertension
Patent ductus arteriosis
Acyanotic congenital defect vascular channel between the left main pulmonary artery and the descending aorta as a result of failure of the fetal ductus arteriosis to close. shunt of oxygenated blood from aorta into pulm artery. increased LV output and work load. Usually asymptomatic but may hear a machinery murmur and witness a widening pulse pressure. Administer indocin or undergo ligation of patent ductus
Ventricular septal defect
Acyanotic defect Shunt of oxygenated blood from L to R ventricle, leads to R ventricular hypertrophy, needs surgical repair, and bidirectional shunting may occur. May be asymptomatic, heart murmur heard in first week of life, growth failure, feeding problems, FTT, respiratory infections Some may close spontaneously, others require open heart surgery
Delirium tremens
Advance withdrawal that occurs 72 hours after a clients last drink of alcohol but can occur 7-10 days after.
The treatment for hypernatremia
After getting back lab values one would be able to examine sodium intakes. Assessing the vital signs will show if the heart rate is low and the pulse is high. Adminster water, possible IV of isotonic solutions
Types of Cardiomyopathy
Alcoholic- due to alcohol consumption Dilated- lt vent enlargement Hypertrophic-abnormal growth lf vent Ischemic- weakness of the myocardium due to heart attacks peripartum- found in late pregnancy restrictive- limited filling of the heart due to inability to relax heart tissue
Treatment of Conn's syndrome
Aldactone which lowers aldosterone and lowers the BP.
Aldosterone
Aldosterone is produced in the cortex of the adrenal glands, which are located above the kidneys
What does amniotic fluid do
Allows for fetal movement measure kidney function surrounds, cushions, and protects the fetus maintains body temp
Wernicke-kirsakoff syndrome
Also called wet Brain or alcoholic encephalopathy. Manifestation of thiamine (vitamin b1) deficiency. In alcohol abuse. It can cause vision changes, ataxia, and impaired memory.
Aphthous Uncler
Also known as a canker sore. A sensitive ulcer in the lining of the mouth. 1 in 5 people have these ulcers. Cause is unknown in many cases.
A major mental/emotional nursing diagnosis seen in anorexia nervosa is ___________.
Altered body image
Stevens-Johnson syndrome
An allergic reaction that can include rashes, and involve the inside of the mouth. May be due to drug sensitivity. Can lead to uveitis and keratitis. Other factors related to SJS include: pneumonia, fever, myalgia and hepatitis. SJS can be extremely similar to varicella zoster and pemphigus vulgaris conditions. There may also be the presence of herpes virus or Mycoplasma pneumoniae.
Psoriasis
An autoimmune disease mediated by T lymphocytes that can lead to arthritis. Generally, treated with UV light, tar soap and topical steroid cream. A reddish rash that can be found in numerous locations.
What are FHR accelerations?
An increase in FHR in response to stimulus (contractions, etc.). Indicates a healthy fetus.
Glaucoma
An increase in fluid pressure in the eye leading to possible optic nerve damage. More common in African-americans. Minimal onset Sx, often picked to late. Certain drugs may decrease the amount of fluid entering the eye. Two major types of glaucoma are open-angle glaucoma and angle-closure glaucoma.
What are late decelerations?
An ominous and potentially disastrous non-reassuring sign. Indicates uteroplacental insufficiency. Uniform shape of deceleration that occurs toward the end of contractions and recovery occurs after end of contraction. Decel's don't go past 100 bpm
Give 6 symptoms of HIV disease.
Anorexia, fatigue, weakness, night sweats, fever, diarrhea
What class of drugs is the client with an aneurysm most likely to be on?
Antihypertensives
a nurse is caring for a patient with RF this is confirmed by what lab result
Antisteptolysin O titer
Solid Conversions
Apothecary............Avoirdupois 2.7lb 2.2lb 1.33lb 1lb 480gr 1oz 15gr 15.4gr 1gr 1gr
Estropia
Appearance of cross-eyed gaze or internal strabismus
What five things does APGAR assess?
Appearance, Pulse, Grimace, Activity, Respiration
What immediate intervention should occur if meconium passage occurred in utero?
Arrange for immediate ET observation.
When is amniocentesis done?
As early as 14-16 weeks
How to treat Hyper K
Assess V/S Dialysis Intake/outake Calcium gluconate might be given *decrease antagonistic effects of on heart* EKG evaluation sorbitol to induce diarrhea monitor lab values monitor digitalis levels
What play stage is associated with Preschool aged children?
Associative play- playing ball, puzzles, playing pretend/dress-up, role-play, painting, seweing cards and beads, reading books
When is PKU testing done usually?
At 2-3 days of life
What would the fundal height be at 20 weeks?
At the umbilicus
Barotitis
Atmospheric pressures causing middle ear dysfunction. Any change in altitude causes problems.
Vaccinations (pedi)
Attenuated - Varicella, MMR Inactivated - Influenza Toxoid - tetanus/diphtheria Biosynthetic - Hib conjugate vaccine
Medication for schizophrenia
Atypical antipsychotics Or Typical antipsychotics
PKU Diet
Avoid meat, milk, dairy, eegs Eat fruits, juices, cereal, bread, starches
What precautions should be done when performing heel stick?
Avoid the plantar artery in the middle of the heel and wipe away the first drop with sterile gauze.
Negotiation Strategies
Avoiding/Withdrawing Smoothing Competing/Coercing Cooperating/Accommodating Compromising/Negotiating Collaborating
Number of Bones
Axial Skeleton skull 22 bones Ossicles 6 bones (malleus, incus and stapes) Vertebral Column 26 bones Ribs 24 bones Sternum 1 bone Hyoid 1 bone Appendicular Skeleton Upper extremities 64 bones Lower Extremities 62 bones
A health care provider is planning to administer a skeletal muscle relaxant to a client with a spinal cord injury. The medication is going to be administered intrathecally. Which medication should the nurse expect to be prescribed and administered by this route?
Baclofen is a skeletal muscle relaxant that can be administered intrathecally. Therefore, options 2, 3, and 4 are incorrect.
How is fetal tachycardia defined?
Baseline of greater than 160 bpm for 10 minutes.
After surgery for pyloric stenosis, the nurse could anticipate that the infant will: 1.) have nasogastric suction for 24 hours 2.) be fed clear liquids within 6 hours 3.) remain NPO for 24 to 48 hours 4.) be fed formula within 4 hours
Be fed clear liquids within 6 hours
Why is hCG taken for a year after hydatidiform mole?
Because hCG levels that do not diminish can lead to choriocarcinoma. Pregnancy must also be avoided for a year.
What is the most important intervention in treating AGN?
Bedrest - they can walk if hematuria, edema and hypertension are gone.
What instructions should be given to the woman with a threatened abortion?
Bedrest for 24-48 hours, no sex for 2 weeks.
What activity order is the client with an aneurysm supposed to have?
Bedrest. do not get these people up
How are SGA and LGA defined?
Below the 10th percentile or above the 90th percentile.
What does BKA mean?
Below the knee amputation
When is chorionic villus sampling done?
Between 8 and 12 weeks' gestation.
When do most miscarriages occur?
Between 8 and 13 weeks.
Intergroup conflict
Between two or more groups of individuals Ex: confusion as to whether it is the responsibility of the nursing unit or dietary department to pass meal trays to clients
Interpersonal Conflict
Between two or more people Ex: disagreement among nurses, clients, family members, and within a health care team
Erickson's newborn/infant stage
Birth to 1 year. Trust vs. mistrust
Hep B
Birth, 1-2 months, 6-18 months
When is the sensorimotor stage? What are the 3 components that make it up?
Birth-24 months of age; separation, object permanence, and mental representation (recognition of symbols)
What are comedones?
Blackheads and white heads
Projection
Blaming ones thoughts or actions on another person. Ex.: you made me angry so you made me hit you
How do you assess for jaundice in the infant?
Blanche forehead with thumb. If jaundiced, skin will turn yellow before normal skin color reappears. In dark-skinned infants, observe conjunctival sac and oral mucosa.
Hepatic Portal System (circulatory system)
Blood draining the alimentary tract (intestines), pancreas, spleen and gall bladder does not return directly to the systemic circulation, but is relayed by the hepatic portal system of veins to and through the liver. In the liver, absorbed foodstuffs and wastes are processed. After processing, the liver returns the blood via hepatic veins to the inferior vena cava and from there to the heart.
What should be assessed before giving methergine?
Blood pressure - withhold if over 140/90 and notify physician. Use with caution in pts with preeclampsia
Dextrostix
Blood testing for glucose
Blood
Blood volume= 5 or 6 liters (7% of body wt) Plasma constitutes about 55% of blood volume and cellular elements about 45%
Characteristics of Bone
Bone is consisting of osteocytes. Bones are encased by a periosteum, a connective tissue sheath. All bone has a central marrow cavity. Bone marrow fills the marrow cavity or smaller marrow spaces, depending on the type of bone.
Osteosarcoma
Bone tumor that is malignant and found in adolescents Sx: bone pain, fractures, swelling Tx: chemo, surgery Tests: CT scan, x-ray, biopsy, bone scan
Avoiding/Withdrawing
Both parties know there is a conflict, but they refuse to work towards a solution Lose-lose solution
Collaborating
Both parties set aside their original individual goals and work together to achieve a new common goal Win-win solution
The pulse rate of anorexics is tachycardic or bradycardic?
Bradycardic
What is cephalhematoma?
Bruising under the periosteum that does not cross suture lines and usually manifests a few hours after birth. Can cause hyperbilirubinemia.
Resp Acidosis
Build-up of carbon dioxide in the lungs that causes acid-base imbalances and the body becomes acidic Cx: COPD, Airway obstruction, hypoventilation syndrome, severe scoliosis, severe asthma Sx: Chronic cough, wheezing, SOB, Confusion, Fatigue Tests: CAT scan ABG Pulmonary Function Test Tx: Mechanical vent, bronchodilators
Nicotine withdrawal medications
Bupropion (Zyban), nicotine gum or patch
How can AGN be prevented?
By having all sore throats cultured for strep and treating any strep infections
Hyperchloremia what is it causes, sym, treatments
CAUSE: increased salt intake S/S: no specific sym are associated with hyper chloremia but usually accompany an excess of sodium. Treatments - for this you want to monitor the intake and outtake, electrolytes, and decrease salt intake.
Which test is the best indicator of the progress of HIV disease?
CD4 count
Calculate cardiac output (CO) HR: heart rate SV: stroke volume
CO= HR x SV
What drug is used to treat prolactinoma
Cabergoline (Dostinex)
The nurse is caring for a client with hyperparathyroidism and notes that the client's serum calcium level is 13 mg/dL. Which prescribed medication should the nurse prepare to assist in administering to the client?
Calcitonin, a thyroid hormone, decreases the plasma calcium level by inhibiting bone resorption and lowering the serum calcium concentration
lactose intolerance is the inability to tolerate lactose, which is the sugar that is found in dairy products removing milk from the diet
Calcium would have to be substituted
Injury at C7
Can dress legs, min assistance needed; independence in wheelchair, can drive car with hand controls
What type of oral/esophageal infections do AIDS patients get?
Candida
Name the 5 criteria that are recorded on an apgar scale
Cardiac status, respiratory effort, muscle tone, neuromuscular irritability, and color
Polyphagia
Cellular starvation cause that diabetic to increase food consumption
Cerebral palsy (pedi)
Cerebrum injury causing multiple nerve function deficits. Sx: Poor resp status, mental retardation, spasticity, speech and language deficit, delayed motor and sensory development, seizures, joint contractions Tx: PT/OT/ST, surgery, seizure meds, spasticity reducing meds
What three risk factors can lead to respiratory depression (depression) in the newborn?
Cesarean delivery, mag given to mother in labor, and/or ashyxia or fetal distress during labor
What are the nursing actions associated with variable decelerations?
Change position, stimulate fetus if indicated, d/c oxytocin, give O2 at 10L by tight face mask, SVE for cord prolapse, and the report findings to physician and document.
What are nursing implications with Procardia (nifedipine)?
Check bp for hypotension immediately before given, do not use with Mag, and dangle before rising.
The post op thoracic aneurysm is most likely to have which type of tube?
Chest tube, because the chest was opened
Typical antipsychotics
Chlorpromazine (Thorazine) Haloperidol (haldol)
Rheumatic Fever S/S
Chorea muscle twitch carditis chest pain SOB sub q nodles
Sickle Cell Anemia Symptoms
Chronic fatigue, dyspnea, joint pain, swelling chest pain
Ulcertive Colitis
Chronis inflammation of the rectum and large intestines Sx: Wt loss, jaundice, diarrhea, fever, abd pain, join pain, GI bleeding Tx: corticosteroids, mesalamine, surgery, ostomy, Azathioprine Tests: Barium edema, ESR, CRP, Colonoscopy Monitor for ankylosing spondylitis, liver disease, carcinoma, pyoderma gangrenosum, hemorrhage, perforated colon
St. Anthony's Fire
Claviceps purpurea (fungus) can cause intense pain in the extremities by causing blood vessels to constrict. Fugus produces ergotamines.
Dysfunctional grief
Client is unable to accept loss after a 24 month period
hyperkalemia
Clients who experience the cellular shifting of potassium, as in the early stages of massive cell destruction (i.e., with trauma, burns, sepsis, or metabolic or respiratory acidosis), are at risk for hyperkalemi
Atypical antipsychotics
Clozapine Olanzapine (zyprexa) Quetiapine (seroquel) Abilify Invega Risperidone (risperdal) Ziprasidone (geodon)
Neologism
Coined word with special meaning to the user
Pneumothorax
Collapsed lung due to air in pleural space. build-up of a gas in the pleural cavities Sx: SOB, Tachycardia, Hypotension, Anxiety, CXR, Poor breath sounds Tests: ABG Tx: Chest tube insertion, admin of O2
What are variable decelerations?
Common pattern with rapid decelerations that is variable in duration, depth, and fall, and timing relative to the contraction cycle.
Bone Types
Compact bone and spongy (cancellous) Compact bone: lies within the periosteum, forms outer region of bones, and appears dense due to its compact organization. Spongy Bone: consists of bars, spicules or trabeculae, which forms a lattice meshwork. Found at the end of long bones and the inner layer or flat, irregular and short bones.
Ventricular fib ((ventricular tachyarrtythmias))
Completely abnormal ventricular rate and rhythm requiring emergency intervention. No effective cardiac output
Conflict Aftermath
Completion of the conflict process Can be negative or positive
What stage of Piaget in school aged children?
Concrete operations- weight/vol unchanging, understands analogies, understands time, classifies more complex info, understands various emotions, self-motivated, able to solve problems
Waxy flexibility
Condition in which extremities remain in a fixed position for a long period of time
Stages of team formation: Storming
Conflict arises, and team members begin to express polarized views
Atrial Septal Defect (pedi)
Congenital opening between the atria Sx: dyspnea, reoccurring infections (resp), SOB, Palpitations irregular heart rhythm/sounds Tests: catheterization, echocardiography, ECG, MRI Tx: surgery, antibiotics Monitor for: HF, A fib, pulmonary htn, endocarditis
Molluscum Contagiosum
Considered a STD. Small downgrowths called molluscum bodies that include the presence of soft tumors in the skin caused by a virus. Contagious
Respiratory Alkalosis
Cx: Anxiety, fever, hyperventilation Sx: Dizziness, numbness Tests: ABG, CXR, Pulmonary function test Sx: Dizziness, numbness Tx: Paper bag tech, Increase CO2 levels
CHF
Cx: CAD, Valvular heart disease, cardiomyopathies, endocarditis, endocarditis, extracardiac infection, pulmonary embolus Sx: Skin cold or cyanotic, wheezing, mitral valvular deficits, lower extremity edema, pulses alternans, hypertension, tachypnea
Hyperventilation
Cx: COPD, panic attacks, stress, ketoacidosis, aspirin overdose, anxiety
Lung Surgery
Cx: Cancer, lung abscesses, atelectasis, emphysema, pneumothorax, tumors, bronchiectasis
Transposition of great vessels
Cyanotic Aorta originates from the RV and the pulmonary artery from the LV. two separate circulations without mixture of oxygenated/unoxygenated blood. Usually deep cyanosis shortly after birth or closing of ductus, clubbed fingers/toes, poor growth and development, heart failure. TX with prostaglandins to keep ductus arteriosis open until surgery, then repair by switching the great vessels.
Tetralogy of Fallot
Cyanotic Combo of four defects: pulm stenosis, VSD, overriding aorta, hypertrophy of RV. Obstruction of outflow of blood from the RV into the pulmonary circuit and increased pressure in the right ventricle leads to R-L shunting of oxygenated blood through the VSD directly into the aorta Severity of defect depends on degree of pulm stenosis and size of vsd. Results in acute cyanosis @ birth, cyanosis increases with activity, clubbing of fingers and toes, systolic murmur, acute episodes of cyanosis, squatting, growth retardation. Surgical tx: blalock-taussing procedures, or repair of openings.
AGN Tx
Daily Weights/ Strict I & O restriction of salt, maintenance of fluid and electrolyte balance, antipyretics(fever) diuretics(edema)
How do you assess fluid excess in the child with AGN?
Daily weight
How is placentae abruptio different from previa?
Dark red vaginal bleeding, rigid uterus, and severe pain.
What are early decelerations?
Decelerations that begin with the beginning of contractions or with contractions that symbolize a benign pattern caused by head compression. Slowly decelerates and returns to baseline.
Decision-making styles
Decisive Flexible Hierarchical Integrative
What lab findings are present in AIDS?
Decreased RBC's, WBC's and platelets
Ermatitis Stasis
Decreased blood flow the lower legs resulting in a skin irritation, possible ulcer formation.
What causes angina pectoris?
Decreased blood supply to myocardium, resulting in ischemia and pain
MD S/S
Delayed Walking Frequent Falls Easily tires when walking Trouble climbing stairs
What is the third stage of labor?
Deliver of the fetus to delivery of the placenta
What complications can occur from hypothermia?
Depletion of glucose and the use of brown fat -- ketoacidosis.
Alcohol withdrawal medications
Diazepam (Valium), lorazepam (Ativan), carbamazepine (tegretol), clonidine
SSKI
Dilute with water or fruit juice Drink through a straw to prevent staining of teeth
Secondary Tumor Effects
Direct compression/necrosis, herniation of brain tissue, Increase ICP
Cultural/social crisis
Disaster or war
Alcohol abstinence medication
Disulfiram (Antabuse), naltrexone (revia), acamprosate (campral)
PKU Screening -When is best
Done at birth (after breast feeding or formula to allow body to fail at processing) Also done at 3 weeks
Medications for Alzheimer's
Donepezil (aricept) Rivastigimine (exelon) Galantamine (razadyne) Memantine (namenda) ; Estrogen for women can help prevent
Weight changes in first year?
Doubles within first 6 months, triples in one year
Lyme disease is treated with
Doxycycline
What is the first test for HIV antibodies?
ELISA
How do you calculate 1 mL of urine when weighting diaper?
Each gram of weight of the urine is calculated as 1 mL of urine.
Compromising/Negotiating
Each party gives up something Win/lose-win/lose solution
Secondary prevention treatment modalities in mental health
Early diagnosis and treatment. Ex.: crisis intervention, partial or acute care hospitalization
What are the causes of fetal tachycardia?
Early sign of fetal hypoxia, fetal anemia, dehydration, maternal infection/fever, maternal hyperthyroid disease, and medication-induced tachycardia.
with what criteria may induced labor occur?(Preeclampsia and Eclampsia)
Eclampsia HELLP Syndrome High serum creatinine levels Prolonged elevated diastolic BP>100mmHg Thrombocytopenia Abnormal fetal growth
What is caput succedaneum?
Edema under the scalp that crosses suture lines and is usually present at birth.
"If I had to do it over again, I'd life my life just about the same," is an example of ____ ____________
Ego Integrity
What is the developmental task for later adulthood?
Ego Integrity vs. Despair
Gingko biloba
Enhance memory
Intimacy vs. Isolation
Erikson's stage in which individuals form deeply personal relationships, marry, begin families
Generativity vs. Stagnation
Erikson's stage of social development in which middle-aged people begin to devote themselves more to fulfilling one's potential and doing public service
Bullous Pemphigoid
Eruptions of the skin caused by the accumulation of antibodies in the basement membrane of the skin. Treated with cortisone creams or internally. Skin biopsy offers definitive diagnosis.
How is chlamydia treated in pregnancy?
Erythromycin and treat for gonorrhea, too (penicillin and/or erythromycin and ceftriaxone)
Phase 2: orientation phase
Establish trust, clarify clients and nurses roles, assess, make goals, make contracts, discuss about termination
Phase 4: termination phase
Evaluate goals, transfer care, separate from client, and facilitate a smooth transition.
What is the pattern of check-ups in a low-risk pregnancy?
Every 4 weeks until week 28. Every two weeks from 28 to 36 weeks. Every week from week 36 to delivery.
Bacterial Epiglottitis Symptom
Excessive drooling due to painful swallowing
MMR and allergies?
Expect to hold for Egg/neomycin Allergy
Phase 3: working phase
Explore thoughts and feelings, take action, therapeutic communication
Somatization
Expression of psychological stress through physical symptoms
Extropia
External strabismus or divergent gaze
Strabismus
Eyes are moving in different stages. The axes of the eyes are not parallel. Normally, treated with an eyepatch; however, eye drops are now used in many cases. Atropine drops are placed in the stronger eye for correction purposed. Surgery may be necessary in some cases. Suture surgery will reduce the pull of certain eye muscles.
What are severe variable decelerations?
FHR below 70 bpm lasing longer than 30 seconds, with a slow return to baseline and decreasing or absent variablity.
What is the most important indicator of fetal autonomic nervous system integrity and health?
FHR variability
Patent Ductus Arteriosus
Failure of the ductus arteriosus to close after birth, allowing blood to flow from the aorta into the pulmonary (lung) artery
Everyone with angina needs bypass surgery? t/f
False
Erythema Infectiosum (Fifth Disease) Signs and symptoms
Fifth Disease is marked by a rash that appears in three stages. Just prior to the rash appearance the child may experience mild fever, malaise, headache or runny nose. Stage 1: Erythema on face, chiefly on cheeks. "Slapped cheek" appearance. Disappears by 1 - 4 days. Stage 2: About 1 day after rash appears on face, maculopapular red spots appear, symmetrically distributed on the extremities; the rash progresses from proximal to distal surfaces and may last a week or more. Stage 3: The rash subsides, but may reappear if skin becomes irritated by sun, heat, cold, exercise, or friction. REMEMBER: Pregnant women need to avoid infected persons. Key to identification is "slapped cheek" appearance. Child is not usually hospitalized as disease is self-limiting.
Tonsilectomy risk for bleeding times
First 24 hrs 5-10 days post-op (scabs fall off)
What is the first stage of labor?
First stage: From beginning of regular contractions or rupture of membranes to 10 cm dilation with 100% effacement
Magnet Recognition Program Steps
First step: complete a self-appraisal based on a set of established standards Second step: After documentation of standards met, an on-site appraisal is conducted *Facility that meets the standard is awarded magnet status for FOUR years To maintain: Submit an annual report
How is anemia defined through the pregnancy?
First trimester: Hgb < 11; Hct < 37% Second: Hgb < 10.5; Hct < 35% Third: Hgb < 10 ; Hct < 32%
What is the #1 contracture problem after BKA?
Flexion of the knee
Suppression
Forgets or delays acts or thoughts of pain on purpose. Cancels dentist appointments over and over
Piaget stage for adolescents?
Formal operations: capable of thinking at adult level, abstract thinking, imaginative/idealistic, deductive reasoning
Stages of team formation
Forming Storming Norming Performing
How much should toddlers weight at 30 months?
Four times their birth weight
How do you calculate the frequency of contractions?
From the beginning of one contraction to the beginning of the next
Nephrotic Syndrome Dx
Frothy urine Massive proteinuria Edema Anorexia
What is the most common cause of uterine atony?
Full bladder - if patient has soft fundus displaced to the right of the umbilicus, massage uterus and then have patient empty bladder.
Onychomycosis
Fungal infection related to the fingernails or toenails. Often caused by Trichophyton Rubrum
What type of play do toddlers engage in?
Gender appropriate, parallel play
What is the developmental task for middle adulthood?
Generativity vs. stagnation.
If an aneurysm ruptures what is the #1 priority?
Get them to the operating room ASAP
Diamox
Given to reduce intraocular pressure
Name two reasons that anesthesia and analgesia should be given in the midactive phase of stage I labor.
Given too early can retard labor; given too late can cause fetal distress
Desensitization
Gradual systemic exposure of the client to feared situations under controlled conditions
What organism causes acute glomerular nephritis?
Group A beta hemolytic strep
Name three signs of placental separation.
Gush of blood, lengthening of cord and globular shape of uterus.
Tx for Sickle Cell Crises
HHOP Heat, Hydration, O2, Pain Meds
What virus causes AIDS?
HIV - Human immunodeficiency virus
Human Papillomavirus Vaccine How many injections comprise the full course of vaccination and at what age should girls receive it? What age should boys receive it?
HPV vaccine is administered in three injections over six months. First dose, then the second dose 2 months later, followed by the final dose 6 months after the first. Girls can receive it around age 11 to 12. Boys can receive it from age 9 to 18. Guards against cervical cancer and genital warts in females and genital warts in males.
When should compressions be done in a newborn?
HR < 60 bpm; do 90 compressions and 30 breaths.
Name two nursing interventions to be done prior to a first trimester ultrasound.
Have client fill bladder and lie supine with uterine wedge.
Hyperkalemia
Having too much K is due to potassium going into the cell. This is caused by salt subsitues, addisons diease *lacking corisole*kidney failure, and K sparing diuretics
1 month old Motor skills
Head lag with grasp reflex
Primary Tumor Effects
Headaches, vomiting, seizures, neurological problems, dementia, drowsiness
increased pulse, a decreased blood pressure, and increased respirations indicate shock. Shock is a result of an
Hemorrhage
Which of the following is a complication that occurs during the first 24 hours after a percutaneous liver biopsy?
Hemorrhage Position pt on puncture site.
What anticoagulant can be used in pregnancy?
Heparin
What are the 3 causative factors in acne vulgaris?
Heredity, Bacterial, Hormonal
What do high or low AFP levels mean?
High could:NTD (neural tube defect) low: could be trisomy 21.
Is there a higher or lower incidence of fetal death with Abruptio Placenta compared to Placenta Previa?
Highter
Hip Fracture (risks)
Hip fractures commonly hemorrhage (excessive bleeding), whereas femur fractures are at risk for fat emboli
Uticaria
Hives
What are nursing implications with Mag sulfate?
Hold if respirations are < 12/min or urine output is < 100 mL/4hrs; keep calcium gluconate handy
Name the 5 risk groups for AIDS
Homosexual/bisexual men, IV drug users, hemophiliacs, heterosexual partners of infected people, newborn children of infected women
Volume Conversion Table
Household Metric Apothecary 1 quart ..........1000mL....1 quart 1 pint............500mL.........1 pint 2 tbs.............30mL...........1oz 1tsp...............5mL.............1 fl dram 15 drops.......1ml..............15 minims
Liquid Conversions
Household....Metric....Apothecary 1 drop .06mL 1 Minim 1/4 tsp 1mL 15/16 minims 1 tsp 4/5mL 1 fl dram 1 tbs 15mL 4 fl dram 2 tbs 30mL 1 fl oz 1 cup 250mL 8 fl oz 1 pint 500mL 16 fl oz 1 quart 1000mL 32 fl oz
Sickle Cell Tx
Hydration, Oxygenation, Pain management (morphine, ect..), blood transfusions, bone marrow transplant- life threatening, eg. strokes
ECG changes with calcium
Hypercalcemia- makes a longer QRS segment Hypocalcemia- increases time of QT interval
ECG changes with K
Hyperkalemia- lower p wave, increases width of QRS complex Hypokalemia- lower T wave, causes a U wave
Will the client have hypo or hyper tension with AGN? Why?
Hypertension, because of fluid retention
What two diseases can cause jitteriness in the newborn?
Hypoglycemia and hypocalcemia
Labs for bulimia
Hypokalemia Hyponatremia Hypochloremia
Sheehan's Syndrome
Hypopituitarism caused by uterine hemorrhage during childbirth. The pituitary gland is unable to function due to blood loss. Sx: amenorrhea, fatigue, unable to breast-feed baby, anxiety, decreased BP, Hair loss Tx: Hormone therapy Tests: CT scan of pituitary gland, check pituitary hormone levels
A client admitted with Hashimoto's thyroiditis would exhibit what sign
Hypothyroidism Hashimoto's thyroiditis antibodies against thyroid hormone are produced, which leads to a decrease in thyroid hormone release.
Erikson's stage for adolescents
Identity vs. role confusion. Sense of personality developed that is influenced by expectations of parents
Somogyi effect
If a client fails to eat her bedtime snack she might experience the Somogyi effect. tThis abrupt drop in the client's blood glucsose level during the night is followed by a false elevation.
Rate of Elimination = Cl X concentration in plasma
If given at intervals shorter than elimination time = toxicity If given at intervals longer than elimination time = ineffective dose
When are antihypertensives given to the preeclamptic patient?
If the diastolic is greater than 110 mm Hg, and then hydralazine is given.
When do you need a gown with AIDS?
If you are going to get contaminated with secretions
Macular Degeneration
Impaired central vision caused by destruction of the macula, which is the center part of the retina. Limited vision straight ahead. More common in people over 60. Can be characterized as dry or wet types. Wet type more common. Vit C, Zinc, and Vit E may help slow progression
Borderline personality disorder
Impulsive, unpredictable, and self-destructive behaviors, manipulative, splitting behaviors, intolerance of being alone, self mutilation
Glaucoma is defined as
Increased ocular pressure of the eye. This pressure ranges from 22 mmHg - 32mmHg
Describe height changes in first year
Increases 50% in the first year
Electroconvulsive therapy
Induces a grand mal seizure. Used when medication and other measures have not responded in depressed clients. Electric current is passed through temporal and hypothalamus at 0.1 seconds. Client My have a slight grimace or plantar flexión. Treatment is 6 to 10 treatments. Three per week. Consent is required. Npo after midnight, empty bladder, short term memory lose for up to 2 months
Herpes Zoster
Infection Cx by the varicella-zoster virus. Can cause chickenpox and then shingles in later years. The virus infects the dosal root ganglia of nerves and can cause intense itching
Toxic Shock Syndrome
Infection of (S. aureus) that causes organ disorders and shock Sx: Seizures, headaches, hypotension, fatigue, muti organ involvement, F/N/V Tx: dialysis- if kidneys fail, BP meds, IV fluids, antibiotics Tests: check BP, multi organ involvement Monitor for: Renal failure, Liver failure, HF, extreme shock
Mastitis
Infection or inflammation due to bacterial infections Sx: fever, nipple pain/discharge, breast pain, swelling of the breast Tx: Antibiotics, moist heat, breast pump
Cervicitis
Infection, foreign bodies, or chemicals that causes inflammation of the cervix Tx: laser therapy, antibiotics/antifungals, cryosurgery
Conjunctivitis
Inflammation of the conjunctiva, that can be caused by viruses or bacteria. Also known as pink eye. If viral source can be highly contagious. Antibiotic eye drops and warm cloths to the eye helpful tx. Conjunctivitis can also be caused by chemicals or allergic reaction. Re-occurring conjunctivitis can indicate a larger underlying disease process.
Acute Epiglottitis
Inflammation of the epiglottitis that may lead to blockage of the resp sys and death if not treated. Often caused by numerous bacteria. Intubation may be required and speed is critical in Tx. IV antibiotics will help reverse this condition in most cases. Common symptoms are high fever and sore throat.
Erikson's stage for 3-6 years?
Initiative vs. guilt. May feel remorse when cannot complete an assigned task
Meniere's Disease
Inner ear disorder. Causes unknown. Episodic rotational vertigo, tinnitus, hearing loss, and ringing in the ears are key symptoms. Dazide is the primary med for Meniere's disease. Low salt diet and surgery are also other treatment options. Diagnosis is a rule-out diagnosis.
Type 1 Diabetes is also called
Insulin dependent, since insulin is necessary for food to be metabolized. *Destroyed pancreatic cells cant produce insulin.
What is the developmental task for early adulthood?
Intimacy vs. Isolation
Repression
Involuntary forgetting of painful feelings, memories, or actions. Ex.: denying child abuse
Tardive dyskinesia
Irreversible, involuntary tonic muscular spasms of the tongue, fingers, toes, necks, and pelvis that result from long term use of antipsychotics
RSV Tx
Isolation (contact) Antiviral agent (ribavirin aerosols)
What happens to the kidney in AGN?
It becomes clogged with antigen-antibody complexes which then cause inflammation and loss of function.
What causes physiologic jaundice of the newborn?
It begins 2-3 days after birth because the newborn liver can't keep up with the RBC destruction and to bind bilirubin. Unconjugated bilirubin is the culprit.
What is an advantage CVS has over amniocentesis?
It can be done earlier (8-12 weeks gestation) with results back within a week, allowing for a first trimester termination, if warranted.
What is Glucagon
It is a 50 percent glucose solution and is injectable form of glucose given in emergency
How is pathologic jaundice different from physiologic jaundice?
It occurs before 24 hours of age or persists for longer than 7 days.
Contact Dermatitis
Itchy, weepy reaction with a foreign substance (Poison Ivy) or lotions. Skin becomes red.
How is Flagyl used during pregnancy?
Its use is contraindicated in the first trimester and its use in the second trimester is contraversial.
Reiter's syndrome (Reactive arthritis)
Joint pain and swelling triggered by an infection in another part of the body. Sx: pain upon urination, swelling/stiffness of joints, discharge from penis, eye redness, inflamed tendons, skin rash, fever, pain in joints/back/lower back Tx: antibiotics, anti-inflammatory, steroids Doctors that Tx: rheumatologist and PCP
What is the #1 cancer that AIDS patients get?
Kaposi's sarcoma
An infant with tetralogy of Fallot is experiencing a tet attack involving cyanosis and dyspnea. Which position should the infant be placed in? 1.) Fowler's 2.) Knee-chest 3.) Trendelenburg's 4.) Prone
Knee-chest
Antisocial personality disorder
Lack of remorse or guilt, disregard for others, does not take responsibility
What are the three phases of the first stage of labor?
Latent - from beginning to 3-4 cm; Active - from 4-7 cm cervical dilation; Transition - from 8-10 cm dilation
When a client is being prepared for thoracentesis the nurse should assist the client to which position
Laying in bed on the unaffected side with the head of the bed elevated 45 degrees
Short bones
Length and width close to equal in size-- Carpal and tarsal bones
Reye's S/S
Lethargy progressing to coma vomiting hypoglycemia
What should patients be taught are signs that the doctor should be called after discharge?
Lethargy, temp > 100, vomiting, green stools, or refusal of two feeds in a row.
What is the name for an elevated WBC?
Leukocytosis
Medications that decrease levels of T4
Lithium propranolol Interferon alpha anabolic steroids methiamazole
Vitiligo
Loss of melanocytes resulting in skin turning white. Hair in regions affected will also turn white. Primarily identified in ages 10-30. Several genetic factors involved. May be associated with other more severe autoimmune disorders
ARDS (Acute resp distress syndrome)
Low O2 levels cx by build up of fluid in the lungs and inflammation of lung tissue Cx: Trauma, chemical inhalation, pneumonia, septic shock Sx: Low BP, rapid breathing, SOB, cyanosis Tests: ABG, CBC, Cultures CXR Tx: Echocardiogram, Auscultation, Mechanical Ventilation, tx underlying problem Monitor pt for: pulmonary fibrosis, multiple system organ failure, Vantilator associated pneumonia, acidosis, resp failure
Atrophic Vaginitis
Low estrogen levels cause inflammation of the vagina. Most common after menopause. Sx: pain c intercourse, itching pain, vaginal discharge, vaginal irritation after intercourse Tx: Hormone therapy, vaginal lub Tests: pelvis exam
What types of chemicals cause burns to oral mucosa when ingested?
Lye, caustic cleaners
What will prevent hip flexion contracture after AKA?
Lying prone several times a day
What is the main drug given for preeclampsia in the hospital?
Mag sulfate
primary prevention treatment modalities in mental health
Maintenance and promotion of health by teaching. Ex.: risk factors, medication management, health promotion and wellness
Loading dose (mg) = Target concentration (mg/mL) x Vd (mL)
Maintenance dose = amount given must equal amount eliminated within dosing time
Behavioral-change strategies: Normative-Reeducative
Manager focuses on interpersonal relationships to promote change
Behavioral-change strategies: Rational-Empirical
Manager provides factual info to support the change Used when resistance to change is minimal
Behavior-change strategies: Power-Coercive
Manager uses rewards to promote change Used when individuals are highly resistant to change
Reye's Tx
Mannitol for ICP control
What immediate nursing interventions should be taken when a postpartum hemorrhage is detected?
Massage fundus, notify HCP if fundus doesn't get firm with massage, count pads, assess vital signs, increase IV fluids, and administer oxytocin as prescribed.
Level I Disaster
Massive disaster that involves a signification damage and results in a presidential disaster declaration, with major fed involvement, and full engagement of fed, regional and national resources. Ex: Hurricane katrina
What are nursing implications with Yutopar (Ritodrine) and terbutaline?
Maternal pulse should not exceed 140 bpm, fetal heart rate should not exceed 180 bpm, and keep antidote (beta-blocking agent) available.
Transitional crisis
Maturational, anticipated Birth or marriage
Mastoiditis
May be caused by an ear infection and is known as inflammation of the mastoid.
Injury at C6
May use a lightweight wheelchair, feed self with devices, write and care for self, transfer from chair to bed
Injury at L3-L4
May use crutches or cane for ambulation
What is the name of the RLQ abd pain where appendicitis pain finally localizes?
McBirney's point
Clanging
Meaningless rhyming
Stages of team formation: Forming
Members of the team get to know each other Leader defines tasks for the team and offers direction
Secondary Tumors
Metastatic carcinomas
Medications that increase levels of T4
Methadone Oral contraceptives Estrogen Cloffibrate
Opiod withdrawal medication
Methadone, clonidine, buprenorphine
Alzheimer's stage 3
Mild cognitive decline: losing or misplacing objects, short term memory loss, difficulty remembering words or names, difficult in work or social situations
Level 3 Disaster
Minor disaster that involves a minimal level of damage but couls result in a presidential declaration of an emergency Ex: major earthquake Fire that threatens an extensive area of the region major criminal event involving possible loss of life widespread nuclear, chemical, or biologigal agent contamination hurricane or tornado with major damage to city/county infrastructure
Alzheimer's stage 4
Moderate cognitive decline: personality changes, withdrawal, obvious memory loss, difficult performing tasks requiring planning or organizing, difficult with complex cognition like math
What is the most common dietary restriction for AGN?
Moderate sodium restriction. Fluid restriction is #2 if edema is severe.
Alzheimer's stage 5
Moderately severe cognitive decline: inability to remember important details, disoriented to time and place
Cardiac Nerves
Modification of the intrinsic rhythmicity of the heart muscle is produced by cardiac nerves of the sympathetic and parasympathetic nervous system. Stimulation of the sympathetic system increases the rate and force of the heartbeat and dilates the coronary arteries.
Tasks delegated to PN
Monitoring findings (as input to the RN's ongoing assessment) Reinforcing client teaching Performing tracheostomy care Suctioning Checking NG tube patency Administering enteral feedings Inserting a urinary catheter Administering medication
Otitis Media
Most common caused by the bacteria (H.flu) and Streptococcus pneumonia in about 85% of cases. 15% of cases viral related. More common in bottlefeeding babies. Can be caused by Upper Resp Infections. Ear drums can rupture in severe cases. A myringotomy may be performed in severe cases to relieve pus in the middle ear.
How should suctioning be done in the newborn?
Mouth first and then nose (to prevent aspiration in the mouth)
Abruptio Placenta usually occurs in (prima/multi) gravida over the age of ____________.
Multi, 35 (HTN, trauma, cocaine)
MD Dx
Muscle biopsy
The symptoms of Hyper K
Muscle twitch cramps muscle weakness slow pulse, tall T waves, wide QRS complexes
What follows the RUQ abd pain of appendicitis?
N/V
What are complications with neonatal hypoxia?
NEC, PDA, or intraventricular hemorrhage.
The post op abdominal aneurysm repair client is most likely to have which type of tube?
NG tube for decompression of bowel
Dietary indiscretions and uncleanliness are causes of acne?
NO
Which 2 classes of drugs are given in combination for HIV sero-positivity?
NRTI's (nucleoside reverse transcriptease inhibitors) and PI's (protease inhibitors)
What is one of the first signs of hypotension occurring immediately after administration of regional block?
Nausea
Bacterial Meningitis S/S
Neck Stiffness!!! Kernig sign + Brudzinski sign
Primary Tumors
Neuromas-80-90% of brain tumors, named for what part of nerve cell affected. Meningiomas - outside of arachnoidal tissue, usually benign and slow growing Glioblastoma Multiform-50% of all primary tumors, linked to specific genetic mutations
Name two tests that show the membranes have ruptured.
Nitrazine paper turns dark blue or black; ferning under microscope
What drug treates angina pectoris?
Nitroglycerine
Toddler behavior/concepts
No concept of time Frequent Tantrums
Alzheimer's stage 1
No impairment Normal function
If in an emergency and need to admin o2
No more than 2-3 L due to unknown medical hx ex: COPD pt
Apnea
No spontaneous breathing Cx: Obstructive speep apnea, seizures, cariac arrhythmias, brain injury, nervous system dysfunction, drug overdose, prematurity, bronchospasm, encephalitis, choking
Is the newborn's head smaller than its chest?
No, it should be 2cm larger unless severe molding has occurred.
Can oral hypoglycemics be taken during pregnancy?
Nope.
What can cause problems postpartum in the cardiac patient?
Normal postpartum diuresis can increase CO.
When do you need a mask with AIDS?
Not usually unless they have an infection caused by an airborne bug
Is dietary protein limited in AGN?
Not usually, however if there is severe azotemia then it may be restricted
What interventions should be started with placentae abruptio?
Notify MD! Do not manipulate abdomen or vagina, give O2 by facemask, monitor for DIC signs, type and cross-match, side-lying position, and prepare for emergency C-section.
Centralized hierarchy
Nurses at the top of the organizational chart make most of the decisions
Adrenocortical Insuffiency or Addison's disease
Occurs as a result of long term use of steroids or the rapid cessation of corticosteroids. It can cause sepsis, surgical stress, or hemorrhage of the adrenal glands (Waterhouse-Friderichsen syndrome)
Fat Emboli
Occurs when fat globules are released into the bloodstream. Typically occur 24-72 hours after trauma. Sx: SOB, Confusion, a rash, tachycardia, fast breathing Tx: mechanical vent, O2
Intrapersonal conflicts
Occurs within the person Can involve internal struggle Ex: Nurse wants to move up on the career ladder but is finding that time with her family is subsequently compromised
Rationalization
Offering acceptable explanation for unacceptable impulses. Ex.: I failed the exam because it was a bad test
Acne Vulgaris
Oil glands become inflamed, plugged or red. May be treated in moderate to severe cases with anti-inflammatory medications or creams.
AGN S/S
Oliguria Hematuria Proteinuria Edema/HTN
Smoothing
One party attempts to "smooth" another party by trying to satisfy the other party Lose-lose solution
Competing/Coercing
One party pursues a desired solution at the expense of others Win-lose solution
Cooperating/Accommodating
One party sacrifices something, allowing the other party to get what it wants Lose-win solution
What vessels should be found in the umbilical cord?
One vein and two arteries
What are nursing implications with indomethacin?
Only give for 48 hours or less, do not use for women with bleeding potential, and give with food.
When should breastfeeding be discontinued in the patient with mastitis?
Only if pus present or antibiotics are contraindicated for neonate. However, the mother may throw away expressed milk to help condition and resume breastfeeding after the infection has cleared.
MD -onset age?
Onset between ages 2-6
Erickson's older adult stage
Over 65 years. Integrity vs despair
Name three uterine stimulants given for uterine atony.
Oxytocin, methergine, and hemabate.
What is the causative organism of acne?
P. acnes (propionibacterium acnes)
Five P's of fracture and Compartment Syndrome
Pain Pallor (pale appearance) Pulselessness Paresthesia (tingling/pins&needles) Polar (cold)
How is previa different from abruption?
Painless, bright red bleeding, soft uterus, with FHR usually normal.
Manifest Conflict
Parties involved are aware of the conflict and action is taken Ex: Nurse manager and nurses on a unit agree that the current scheduling system is causing a conflict and agree to work together to come up with a solution
Who should not get hemabate?
Patients with asthma
How is gonorrhea treated in pregnancy?
Penicillin and/or erythromycin and ceftriaxone and treat for chlamydia (erythromycin)
What is present when rebound tenderness is present?
Peritoneal inflammation
What is the most common complication of appendicitis?
Peritonitis
Ball and socket (joint type)
Permits all types of movement (abduction, adduction, flexion, extension, circumduction); it is considered a universal joint Ex: hips and shoulder joints
Hinge (ginglymus) (joint type)
Permits motion in one plane only Elbow and knee, interphalangeal joints
Condylar (condyloid) (joint types)
Permits motion in two planes which are at rt angles to each other (rotation is not possible) Metacarop-phalangeal joints, temporomandibular
Plane or gliding
Permits sliding motion Between tarsal bones and carpal bones
Nurse client phases of forming a relationship
Phase 1: pre-interaction phase 2: orientation phase 3: working phase 4: termination phase
Alcohol withdrawal syndrome
Physical manifestations occur 6-8 hours after abstinence of alcohol. Intensify and diminish 24 to 48 hours after.
CF diagnosis
Pilocarpine sweat test -> normal = 10, severe variant >60, mild=40-60 -> genetic diagnosis
The typical pneumonia of AIDS is caused by ___________ ____________.
Pneumocystic carinii
What HPV drug is contraindicated in pregnancy and what drug is recommended?
Podophyllin is contraindicated; The one with the initials is still used (TCC/BCA, idk, lol)
How should cord prolapse be managed?
Position mother to relieve pressure on the cord (knee-chest) or push presenting part off of cord until delivery is accomplished.
Congenital Dislocated hip
Positive Ortolani sign Unequal fold of skin on buttock Limited abduction of hip
During Refusal of Treatment, the client should be informed of the following:
Possible complications that could occur without treatment Possibility of permanent physical or mental impairment or disability Possibility of other complications that could lead to death
What conditions might cause uteroplacental insufficiency and late decelerations?
Preeclampsia, DM, cardiac disease, and placentae abruptio.
Name three conditions that DM patients are likely to develop in pregnancy.
Preeclampsia, hydramnios, and infection
Parietal lobe
Primary enter for sensation
Occipital lobe
Primary visual receptor center
Perceived Conflict
Problem is present though an actual conflict might not actually exist Ex: Nurse perceives that a nurse manager is unfair with scheduling. Nurse might not be aware that in reality it is only b/c the nurse manager misunderstood the nurse's scheduling request
Autism
Problems with social interaction, language, and behavior. No single cause they think might be genetic and environmental factors. No specific medications to treat.
Pyloric Stenosis feature
Projectile vomit around 14 days after birth
Why are diuretics given?
Promote excretion of sodium and water though the kidneys
If a pt has hyperthyroidism they might be on what medication
Propylthiouracil (PTU)
Erik erickson
Psychosocial development model
What are the first signs of AGN?
Puffiness of face, dark urine
What occurs to the maternal pulse after delivery?
Pulse may decrease to 50 bpm; normal puerperal bradycardia
How often are vital sign measurements taken in AGN?
Q4 hours with blood pressure
How often should you measure the vital signs, vaginal bleeding, fetal heart rate during Abruptio Placenta>?
Q5-15 minutes for bleeding and maternal VS, continuous fetal monitoring, deliver at earliest sign of fetal distress
Tx for spider bites/bleeding
RICE rest, ice, compression, and elevated extremity
Where does the pain of appendicitis finally end up?
RLQ
Behavioral-change strategies
Rational-Empirical Normative-Reeducative Power-Coercive
What insulin should be used during labor?
Regular insulin
Tertiary prevention treatment modalities in mental health
Rehabilitation, follow up to avoid permanent disability. Ex.: psychiatric day care
How do you prevent flexion contracture of the knee after BKA?
Remide the patient to straighten their knee constantly while standing
Chorionic Villus Sampling
Removal of placental tissue for analysis from the uterus during early pregnancy. Us helps guide the procedure. 1-2wks to get results. Can be performed earlier than amniocentesis Used for: Tay-sachs disease Down syndrome Other disorders Monitor for infection, miscarriage, bleeding
Newborn Vital signs -Resp -HR -BP
Resp. 40-60. HR 110-160. BP 65-85/45-55
What are signs of mag toxicity and what should be done?
Respirations < 12/min, urine output < 100 mL/4 hr, absent DTRs, Mag serum levels > 8mg/dL; Hold dose and notify provider.
What blood gas issues can be caused by hyperventiliaton?
Respiratory alkalosis.
Vesicoureteral Reflex
Result of valvular malfunction and backflow of urine into the ureters (and higher) from the bladder (severe cases are associated with hydronephrosis
What is the most common cause of uterine atony after the first postpartum day?
Retained placental fragments
Diabetic retinopathy
Retina may experience bleeding in nonproliferative stage. During the proliferative stage damage begins moving towards the center of the eye and there is an increase in bleeding. Any damage causing is non-reversible.
What complications can result from O2 toxicity?
Retinopathy of prematurity and bronchopulmonary dysplasia.
Phase 1: pre-interaction phase
Review patients history, identify location, and plan interaction
Five rights of Delegation
Right task Right circumstance Right person Right direction and communication Right supervision and evaluation
DM type 2
Risk for: obesity, elevated cholesterol levels, Htn Sx; blurred vision, fatigue, elevated appetite, frequent urination, thirst, (possibly symptom free) Tx: diet control, tiazamide, glimepiride, increase exercise levels, repaglidine/nateglinide, glycosylated hemoglobin, BUN/ECG, frequent blood sugar testing, acarbose, diabetic ulcer prevention Tests: Random blood glucose test, oral glucose tolerance test, fasting glucose test Monitor for: Neuropathy, CAD, increased cholesterol, retinopathy, PVD, Htn
Rotating or Pivot (joint type)
Rotation is only motion permitted Radius and ulna, atlas and axis (first and second cervical vertebrae)
What is the BIG danger with aneurysms of any type?
Rupture, leads to shock and death
Where do you hear S1? Where do you hear S2?
S1- Apex, S2- Base
Heart sounds
S1- tricuspid and mitral valve close S2- pulmonary and aortic valve close S3- ventricular filling complete S4- elevated atrial pressure (atrial kick)
To stop the thyroid release
SSKI and Lugols stop the release
Medication for anorexia
SSRI: fluoxetine (Prozac)
Heart wave review
ST segment: ventricles depolarized P wave: atrial depolarization PR segment: AV node conduction QRS complex: ventricular depolarization U wave: hypokalemia creates a U wave T wave: ventricular repolarization
Atopic Dermatitis
Scaling, itching, redness and excoriation. Possible lichenification in chronic cases. Most common in young children around the elbow and knees. Adults are more common in neck and knees. May be associated with an allergic disorder, hay fever, or asthma.
Eclampsia
Seizures occurring during pregnancy, Sx of preeclampsia have worsened. Factors that cause eclampsia vs. preeclampsia relatively unknown. Sx: sudden wt gain, seizures, trauma, abd pain, preeclampsia Tx: Bedrest, BP meds, Mag sulfate Tests: Check liver function tests, check BP, proteinuria presence, apnea
Narcissism
Self involvement with lack of empathy for others
What interventions are used during the labor of a cardiac patient?
Semi- or high- Fowler position, prevent valsalva, side-lying position for regional anesthesia, and avoid stirrups.
In Abruptio Placenta, the placenta _______________ from the uterine wall ____________.
Separates, prematurely
MD Lab
Serum creatine phosphokinase (CK) levels are extremely high in the first 2 years of life before onset
Alzheimer's stage 6
Severe cognitive decline: loss of awareness of events or surroundings, personality changes (hallucination, delusions), assistance with adl's needed, incontinence
What are symptoms of uterine rupture?
Sharp pains accompanied by abrupt cessation of contractions.
What interventions should be started with previa?
Side-lying position, bed rest, bp and pulse every 15 minutes, start IV, type and screen, monitor blood loss, prepare for u/s and possible c/s.
Hyperthyroidism occurs because
Since the thyroid gland is responsible for metabolism. Having an increase in the thyroid hormone causes increased BP, SV, Weight loss, and nervousness
How should an IV bolus be administered during labor?
Slowly, beginning at the start of a contraction, so that less gets to the fetus.
Sesamoid
Small bones located in tendons of muscle-- vertebrae, sphenoid, ethmoid
Joints
Some are immovable, such as the sutures between the bones of the cranium. Others are slightly movable joints; examples are the intervertebral joints and the pubic symphysis (joint between the two pubic bones of the coxal bones)
Injury at T1-T4
Some independence from wheelchair, long leg braces for standing exercises
Decentralized hierarchy
Staff nurses who provide direct client care are included in the decision-making process
Without leukopenia the AIDS patient will be on ____________ precautions.
Standard precautions or blood and body fluid precautions
What interventions should be done in patient having miscarriage?
Start IV of at least 18 gauge, give RhoGAM if indicated, and teach client to notify nurse with temp > 100.4, foul-smelling discharge, or bright-red bleeding with tissue larger than a dime.
Piaget stage of development for 3-6 years old? Misconceptions occurring at this age?
Still in preoperational. Misconceptions occur: artificialism (everything comes from humans), animism (inanimate objects are alive), Imminent justice (universal code exists that determines law and order), intuitive thought (awareness of cause and effect relationships), Time (begin to understand the concept of time), Language (enjoy talking, can identify colors and speak in sentences. Vocab jumps)
Medication for ADHD
Stimulants: Methylphenidate ( Ritalin, Concerta, daytrana), dextroamphetamine (Dexedrine, Dextrostat), amphetamine (adderall)
Hiatal Hernia
Stomach sticks into the chest through the diaphragm. Can cause reflux symptoms Tx: wt loss, surgical repair, meds for reflux Tests: EGD, Barium swallow x-ray
What are signs of endometritis?
Subinvolution, lochia returning to rubra with possible foul smell, temper of 100.4 or higher, and unusual fundal tenderness.
When do you need goggles with AIDS?
Suctioning, central line start, arterial procedures
How is toxoplasmosis treated during pregnancy?
Sulfa drugs; maybe therapeutic abortion if discovered before 20 weeks.
Vertebral Column
Supports the spine, or vertebral column, which is composed of 26 bones, some of which are formed by the fusion of a few bones. 7 cervical (neck) 12 thoracic 5 lumbar vertebrae coccyx (fusion of 4 coccygeal vertebrae
GERD (gastroesophageal reflux disease)
Sx: N/V, frequent coughing, hoarseness, belching, angina, antacid relief, sore throat Tx: wt loss, antacids, proton pump inhibitors Tests: barium swallow, Bernstein test, stool guaiac, endoscopy, limit fat and caffeine, histamine H2 blockers Monitor for: chronic pulmonary disease, barrett's esophagus, esophagus inflammation, bronchospasms
Hep C
Sx: fatigue, vomiting, urine color changes (dark), jaundice, abd pain Tests: ELISA assay, increased levels of liver enzymes, no hep A or B antibodies Tx: interferon alpha, ribavirin
DM type 1
Sx: wt loss, N/V, abdominal pain, frequent urination, elevated thirst Tests: fasting glucose test, inculin test, urine analysis Tx: Insulin, relieve the diabetic ketoacidosis symptoms, foot ulcer prevention
Reye's Syndrome
Syndrome which is an acute encephalopathy (inflammation of the brain). Usually follows a viral illness & linked to intake of aspirin. Use acetaminophen (not aspirin) to reduce fever with child with a communicable disease (virus) to prevent this.
What medication should be admin when a pt has hypothyroidism
Synthroid ( adminster 1 hr before meal for increase absorption)
Prioritization Principles in Client Care
Systemic > Local ("life before limb") Acute > Chronic Actual problems > Potential future problems Listen carefully and don't assume Trends > Transient findings Indications of medical emergencies and complications > Expected findings Apply clinical knowledge to procedural standards to determine priority action
ECG changes with MI
T wave inversion ST segment elevation Abnormal Q waves
The AIDS virus invades helper ____________.
T-lymphocytes (or CD4 cells)
What instructions do you give to a client taking tetracycline?
Take it on an empty stomach and avoid the sunlight (photosensitivity)
Stages of team formation: Norming
Team establishes rules. Members show respect for one another, begin to accomplish tasks
Stages of team formation: Performing
Team focuses on accomplishment of tasks
Decision-making style: Decisive
Team uses MINIMUM amount of data and generates ONE option
Decision-making style: Hierarchical
Team uses a LARGE amount of data and generates ONE option
Decision-making style: Flexible
Team uses a LIMITED amount of data and generates SEVERAL options
Intussesception
Telescoping of one part of intestine
Acrocyanosis
Temporary cyanotic condition, usually in newborns resulting in a bluish color around the lips, hands and fingernails, feet and toenails. May last for a few hours and disappear with warming.
Splitting
Tendency to label individuals into all good or all bad
What drugs should cardiac patients NOT get for preterm labor?
Terbutaline or Yutopar (ritodrine HCl) because of the risk of myocardial ischemia.
What is the antibiotic most commonly given to clients with acne?
Tetracycline
A clinic nurse prepares to administer an MMR (measles, mumps, rubella) vaccine to a child. The nurse should administer this vaccine by which method?
The MMR vaccine is administered subcutaneously in the outer aspect of the upper arm. The gluteal muscle is most often used for intramuscular injections. The MMR vaccine is not administered by the intramuscular route.
Availability = Amount of drug in plasma / amount of drug given
The aim is to maintan a steady-state concentration of a drug within a known therapeutic range. Steady state is achieved when the rate of elimination = rate of availability
Seborrheic keratosis
The development of skin "tags" or the barnacles of old age. Usually found in people over 30 years old. Appear to be tabs growing in groups or individually on your skin. Can be treated with Scrapping, Freezing or Electrosurgery
What is considered the newborn transitional period of life?
The first 6-8 hours.
What is the baseline FHR?
The heart rate between contractions, monitored over a 10-minute period.
What is measured in intraunterine monitoring that cannot be measured externally?
The intensity of contractions, measured by the increased IUP in mmHg (30-70 mmHg)
Appendicular Skeleton
The major internal support of the appendages (upper and lower extremities Pectoral Girdle Upper Extremities Pelvic Girdle Lower Extrimities Each of the two coxal, or hip bones comprising the pelvic girdle is formed by the sion of three bones-- illium, pubis, and ischium
What is variability?
The normal irregularity of the cardiac rhythm.
What is the most challenging aspect of combination of drug therapy for HIV disease?
The number of pills that must be taken in 24 hours can be overwhelming. The frequency also makes it hard to remember-an alarm wristwatch is used.
Hypoparathyroidism
The parathyroid glands are responsible for maintaining calcium levels at 8.8 to 10.2 mg/dL. In hypoparathyroidism, parathyroid hormone levels are insufficient to maintain adequate calcium levels. The nurse should monitor clients with hypoparathyroidism for signs and symptoms of hypocalcemia, including muscle spasms, anxiety, seizures,
What is fetal presentation?
The part of the fetus that is presenting int the inlet. Usually, the vertex, acromion, or breech.
Acanthosis Nigricans
The presence of dark velvety patches of skin around the armpit, back, neck and groin. Can occur with multiple diseases. Has been linked to pts with insulin dysfunction.
Which vital signs are most important to measure in clients with aneurysm?
The pulse and blood pressure
What is the fetal attitude?
The relationship of the fetal parts to one another. The fetal attitude can be flexion or extension.
What is fetal position?
The relationship of the point of reference on the fetal presenting part to the mother's pelvis. LOA is left occiput anterior. Left is the mother's left pelvis.
What is the fetal lie?
The relationship of the spine of the mother to the spine of the fetus. It can be longitudinal, transverse (perpendicular), or oblique.
What structures are involved in acne vulgaris?
The sebaceous glands
What is the best indicator of renal function?
The serum creatinine
Countertransference
The therapist transfers his or her feelings for significant others into the client
What is the dangerous bilirubin type?
The unconjugated, indirect type.
What muscle should be used in newborn injections?
The vastus lateralis muscle of the thigh.
What do NRTI's and PI's do?
They prevent viral replication
What type of contraceptive should diabetics use?
They should avoid estrogen. They should also avoid IUDs due to the increased risk for infection.
Flat bones
Thin flat shape-- scapulae, ribs, sternum, bones of cranium (occipital, frontal, parietal)
In what trimester does Abruptio Placenta most commonly occur?
Third
Oral candidiasis
This is a yeast infection of the throat and mouth by Candida albicans
hypophosphetemia a lil about it
This is caused by malnutrition, use of aluminum or magnesium antacids, or hyperglycemia
Hypernatremia what is it
This is when there is too much sodium in your blood. Causes would be intake too much sodium, cushings disease, renal failure, fever
Hyponatremia
This is when you have low sodium, this is caused by diuretics, wound drainage, renal disease, hyperglycemia, and CHF
What is Paget's disease
This usually affects the axial skeleton, especially the vertebrae and skull. Spine and weight bearing bones
Felt Conflict
Those involved begin to feel an emotional response to the conflict Ex: Nurse feels anger towards the nurse manager after finding out that she is scheduled to work two holidays in a row
Where is the fetal heart rate best heard?
Through the fetal back in vertex, OA positions
Toddler ability -three
Throw ball overhand at 18 months 2-3 word sentences at 2rs Toilet training 2 yrs old
When is the preoperational stage?
Toddlers, Includes object permanence, have memories, domestic mimicry, imitation but not understanding of viewpoints, egocentric
Displacement
Transferring feelings to a neutral object. Ex.: had a bad day at work, so you go home and scream at family
What is TTN?
Transient tachypnea of the newborn; commonly seen in c/s babies
Lichen Planus
Treated with topical corticosteroids. The presence of pink or purple spots on the legs and arms. Lesions are itchy, flat and polygonal. May cause hair loss.
T/F: AIDS patients get lymphomas?
True
Cushing's disease
Tumors of the adrenal cortex
What are nursing actions for late decelerations?
Turn client to left side, d/c oxytocin, give O2 10L by tight face mask, assist with fetal blood sampling if indicated, maintain IV, elevate legs to increase venous return (if possible), correct any hypotension by increasing IV or with meds, assess FHR variability, notify MD, and document pattern and response to each nursing action.
What are the nursing actions for severe variable decelerations?
Turn client to left side, d/c oxytocin, give O2 10L by tight face mask, assist with fetal blood sampling if indicated, maintain IV, elevate legs to increase venous return (if possible), correct any hypotension by increasing IV or with meds, assess FHR variability, notify MD, and document pattern and response to each nursing action.
Byetta is an injectable medication used for what
Type 2 diabetes
Disulfiram (Antabuse)
Type of aversion therapy. If alcohol is taken while of medication nausea and vomiting occur. Can not be administered until 12 hours after clients last drink. If medication is stopped they should not drink for atleast 2 weeks.
Injury at C3 and above
Unable to care for selfe, life sustaining vent support is essential
Situational crisis
Unanticipated Death, divorce, termination of a job
When can a rear-facing car seat be used until?
Until the toddler weights 20lbs
Stress Incontinence
Urethral Sphincter dysfunction Tx: surgery, meds (pseudoephedrine/ phenylpropan olamine)/ Estrogen, Pelvic floor re-training, fluid intake changes
Urge Incontinence
Urine loss caused by bladder contration Sx: frequent urination, adb pain/ distention Tx: surgery, meds- (tolterodine, propatheline, imipramine, tolterodine, terbutaline), biofeedback training, kegels Tests: pelvic exam, x-ray, cystoscopy, EMG, pad test, urinary stress test, PVR test, genital exam-mene
Strategies to promote open communication and de-escalate conflicts
Use "I" statements Understand their perspective Move a conflict that is escalating to a private location Share ground rules with participant
FeSO4 drops administration -with what drink
Use Straw to prevent teeth staining Give with Orange Juice... not Milk
St. John's wort
Used for depressing
Buck's traction -part of body
Used for fractures of the FEMUR, HIP, or KNEE contractures. How is by pulling the hip and femur into extension.
Amniocentesis
Used to check: Spina Bifida Rh Compatibility Immature Lungs Down Syndrome
Decision-making style: Integrative
Uses a LARGE amount of data and generates SEVERAL options
How is an infant delivered when Abruptio Placenta is present?
Usually C-section
Otitis External
Usually caused by a bacterial infection. Swimmer's ear. Infection of the skin with the outer ear canal that progress to the ear drum. Itching, drainage and pain are the key symptoms. Suctioning of the ear canal may be necessary. Most common ear drops (Volsol, Cipro, Cortisporin)
What can you do about treatments
V/s eat diet higher in phosphorus be alert for muscle weakness neuro asses ekg check cal levels
How to terat hyponatremia
V/s replace NA Intake output, foods high in sodium check blood count check urine specific gravity
Axial Skeleton
Vertebral Column Ribs Sternum Skull Middle ear bones (ossicles) Small U-shaped hyoid bone
Labyrinthitis
Vertigo associated with nausea and malaise. Related to bacteria and viral infections. Inflammation of the labyrinth in the inner ear.
Alzheimer's stage 2
Very mild cognitive decline, may appear to be normal age related
Alzheimer's stage 7
Very severe cognitive decline: loss of ability to respond to environment, unrecognizable speech, incontinence, decreased mobility, death
Hepatitis A
Viral infection that causes liver swelling Sx: fatigue, N/V, fever, itching Tests: increased liver enzymes, presence of IgG and IgM, antibiotics, enlarged liver Tx: rest, proper diet low in fatty food
Acute Tonsillitis
Viral or Bacterial infection that causes inflammation of the tonsils.
Accutane is an analog of which vitamin?
Vitamin A
Name 3 drugs given for acne?
Vitamin A, Antibiotics, Retinoids
What blood count is elevated in appendicitis?
WBC
development of eyes, legs, and hands
Week 5
Brain waves become detectable
Week 6
teeth begin to develop
Week 9
What test confirms the ELISA?
Western Blot
When should you notify the Doc when someone is taking synthroid
When a pt PR is 100(adult) or 120(child)
When can preterm labor be arrested?
When cervix is < 4cm dilated, <50% effacement, and membranes are intact and not bulging out of the cervical os.
Long bones
Width less than length--humerus, radius, ulna, femur, tibia
How is IUGR diagnosed?
With serial ultrasounds
When does normal cardiac output return?
Within 2 to 3 weeks postpartum
How soon after delivery should the client void?
Within four hours of delivery.
Can insulin be used in breastfeeding?
Yes
Does AIDS require a single room?
Yes - if WBC counts are low
HIV is present in all body fluids?
Yes, but not transmitted by all, only blood, semen and breast milk
Is there anything that can be done for the client with a ruptured aneurysm before they get to the operating room?
Yes, if available you can get them into antishock trousers but not if this causes a delay in getting them to the operating room
Do people recover from AGN?
Yes, the vast majority of all clients recover completely from it
Can AIDS patients leave the floor?
Yes, unless WBC's are very low
Can impaired skin integrity ever be an appropriate nursing diagnosis when poisoning has occurred?
Yes, when lye or caustic agents have been ingested
Following cardiac catheterization you have to be aware of what
You have to make sure that the limb to which the cathe was inserted has to be straight. You can lay supine but no elevation greater than 30 degrees
Rate of Elimination = COncentraion of drug in plasma (mg/mL) X Cl (mL/hr)
Zero order elimination means that the elimination rate is constant over time, regardless of the concentration of drug in the system.
Osteoclasts
________ are multinucleated cells that destroy bone.
Alveolar proteinosis
a build-up of a phospholipid in the lungs were CO2 and O2 are transferred Cx: may be associated with infection, Genetic disorder 30-50 yrs. old Sx: wt loss, fatigue, cough, fever, SOB Tests: CXR, presence of crackles, CT scan, bronchoscopy, ABG- low O2 levels, Pulmonary function tests Tx: Lung transplant, special lavage of the lungs
Pheochromocytoma is
a catecholamine-producing adrenal tumor that leads to a marked elevated BP *treatment* treating the malignant hypertension with drugs such as sodium nitroprusside (Nipride) or clonidine (Catapres)
Ventricular Septal defect
a common congenital heart defect an abnormal opening in the septum dividing the ventricles allows blood to pass directly from the left to the right ventricle; large openings may cause congestive heart failure
Pulmonary arteriovenous fistulas
a confenital defect were lung arteries and veins from improperly, and a fistula is formed creating poor oxygenation of blood Sx: SOB c activity, presence of a murmur, cyanosis, clubbing, paradoxical embolism Tests: CT scan, pulmonary arteriogram, low O2 sat levels, elevated RBC's Tx: Surgery, emolization
vaccination with alive virus, weakened immune system, and poor testing technique are factors of
a false negative
Inoculation with BCG vaccine with produce
a false positive
Pyloric Stenosis (pedi)
a narrowing of the opening between the intestine and stomach. Most common in infants. Sx: diarrhea, abd pain, belching, wt loss, vomiting Tx: surgery, IV fluids Tests: abd distended, barium x-ray, US, Electrolyte imbalance
What is thoracetesis
a procedure to remove fluid from the lung
The most common symptom of abdominal aneurysm is:
a pulsating mass above the umbilicus
Rheumatic Fever
a severe disease chiefly of children and characterized by painful inflammation of the joints and frequently damage to the heart valves
Impetigo
a skin infection caused by staph or strep that causes itchy, red skin and pustules. Treated with topical antibiotics and primarily affects children.
An important approach to the care for a 7-year-old child diagnosed with attention deficit hyperactivity disorder is to encourage: 1.) a diet high in processed foods 2.) regular use of sedatives 3.) strict discipline 4.) a structured, one-on-one environment
a structured one-on-one environment
Nephrotic Syndrome
a syndrome characterized by edema and large amounts of protein in the urine and usually increased blood cholesterol
Osteoblasts
a type of cell that is responsible for bone formation
Course of Circulation (systemic route) Circulatory system
a. Arterial system. Blood is delivered by the pulmonary veins (two from each lung) to the left atrium, passes through the bicuspid (mitral) valve into the left ventricle and then is pumped into the ascending aorta; backflow here is prevented by the aortic semilunar valves. The aortic arch toward the right side gives rise to the brachiocephalic (innominate) artery which divides into the right subclavian and right common carotid arteries. Next, arising from the arch is the common carotid artery, then the left subclavian artery. The subclavians supply the upper limbs. As the subclavian arteries leave the axilla (armpit) and enter the arm (brachium), they are called brachial arteries. Below the elbow these main trunk lines divide into ulnar and radial arteries, which supply the forearm and eventually form a set of arterial arches in the hand which give rise to common and proper digital arteries. The descending (dorsal) aorta continues along the posterior aspect of the thorax giving rise to the segmental intercostals arteries. After passage "through" (behind) the diaphragm it is called the abdominal aorta. At the pelvic rim the abdominal aorta divides into the right and left common iliac arteries. These divide into the internal iliacs, which 36 Copyright © StudyGuideZone.com. All rights reserved. supply the pelvic organs, and the external iliacs, which supply the lower limb. b. Venous system. Veins are frequently multiple and variations are common. They return blood originating in the capillaries of peripheral and distal body parts to the heart.
Ortolani sign
abducting the thighs and applying gentle pressure forward over the greater trochanter produces a 'clunk"
Formal Leader (definition)
ability of a company president to exert control over employees, which is based upon his status as president of the company
Informal Leader (definition)
ability of a person to influence the behavior of the others by means other than formal authority conferred by the organization through it's rules and procedures
School age ability -important?
able to tell time socialization with peers important
Paroxysmal supraventricular tachycardia (Supraventricular Tachyarrhythmias)
abnormal P wave, Normal QRS complex elevated bpm (160-250)
Atrial Fib (Supraventricular Tachyarrhythmias)
abnormal QRS rhythm and poor P wave appearance (>300BPM)
Paget's disease
abnormal bone development that follows bone destruction. Sx: joint pain, bow legged appearance, hearing loss, neck and back pain, headache, sharp back pain Tx: NSAIDS, calcitonin, plicamycin, etidronate, tiludronate, surgery Tests: increased alkaline phaphatase levels, x-rays- abnormal bone development, bone scan Monitor for: spinal deformities, hearing loss, paraplegia, HF, fractures
Developmental dysplasia of the hip
abnormal development of the hip joint found that is congenital Sx: fat rolls asymmetrical, abnormal leg length, AROM limited Tx: Cast, surgery, PT Tests: US (ultrasonogram), x-ray of hips, AROM testing of hips
Diverticulitis
abnormal pouch formation that becomes inflamed in the intestinal wall Sx: fever, D/N/V, constipation Tests: Barium edema, WBC count, colonoscopy, CT scan, Sigmoidoscopy
Cushing's syndrome
abnormal production of ACTH which in turn causes elevated cortisol levels Cx: corticosteroids prolonged use, tumors Sx: muscle weakness, central obesity distribution, back pain, thirst, skin color changes, bone/joint pain, Htn, headaches, frequent urination, moon face, wt gain, acne Tx: Surgery to remove tumor, monitor corticosteroid levels Tests: Dexamethasone suppression test, cortisol level check, MRI- check for tumors Monitor for: renal stones, Htn, bone fractures, DM, infections
Endometriosis
abnormal tissue outside the uterus. Sx: Spotting, infertility, LBP (low back pain), painful periods, sexual intercourse painful Tx: progesterone Tx, pain management, surgery, hormone Tx, synarel Tx Tests: pelvis US, laparoscopy
Beneficence (definition)
act in best interest of others to contribute well being to others (pt advocacy, promote good, prevent harm, remove harm/evil)
Antidote for actaminophen
actylcysteine
Ligaments
adjacent bones at a joint are connected by fibrous connective tissue bands known as this..ligaments They are strong bands which support the joint and may also act to limit the degree of motion occurring at a joint
When taking care of a pt with meta alkosis you have to
admin potassium replacements observe dysrhyhmias intake and outake neuro changes
Which principle should the nurse teach the parent concerning administering liquid iron preparations to the child with iron-deficiency anemia? 1.) allow the preparation to mix with saliva and bathe the teeth before swallowing 2.) warm the medication before administering 3) administer between meals 4.) administer in the bottle of formula
administer between meals
The cortex produces
adrenal steroids and cortcosteroids
Kawasaki disease (pedi)
affects young children primarily. Attacks the heart, blood vessels and lymph nodes Cx: unknown oridin probable autoimmune disease Sx: fever, joint pain, swollen lymph nodes, peripheral edema, rashes, papillae on the tongue, chapped/red lips Tx: Gamma globulin, salicylate Tx Tests: CBC, presence of pyuria, CXR, ECGH, Urine analysis Monitor for: coronary aneurysm, MI, Vasculitis
Define presbycusis
age related irreversible degenerative changes in the inner ear.
Lofstrand crutches
aid clients who need crutches but have limited arm strength
The major mineralocorticoid produced in the cortex is
aldosterone (this helps control the reabsorption of sodium and potassium that the kidneys excrete
Grand mal seizure
also called tonic-clonic seizures; characterized by a sudden loss consciousness, falling down, and involuntary muscle contractions. Often preceded by an aura, a peculiar sensation such as visual disturbance, numbness, or dizziness, which appears just before more definite symptoms
Cardiac Cycle
alternating contraction and relaxation is repeated about 75 times per minute; the duration of one cycle is about 0.8 secs. Three phases succeed one another during the cycle: a) atrial systole: 0.1 second b) ventricular systole: 0.3 second c) diastole: 0.4 second
List the most common gynecologic symptom of anorexia nervosa?
amenorrhea
Atrial Septal Defect
an abnormal opening between the left and right atria of the heart
The best goal to evaluate the progress of the client with anorexia nervosa?
an adequate weight gain
NRTI (nucleoside reverse transcriptease inhibitors)
an antiviral drug used against HIV (is incorporated into the DNA of the virus and stops the building process; results in incomplete DNA that cannot create a new virus; often used in combination with other drugs)
Muscular Dystrophy
any of several hereditary diseases of the muscular system characterized by weakness and wasting of skeletal muscles
Aortic Coarctation (pedi)
aorta becomes narrow at some point due to a birth defect Sx: headache, Htn c activity, nose bleeding, fainting, SOB Tx: surgery Tests: check BP, Doppler US, chest CT, MRI, ECG, CXR, cardiac cath Monitor for: stroke, HF, aortic aneurysm, Htn, CAD, endocarditis, aortic dissection
Sensible
are those that the person is aware of, such as those that occur through wound drainage, GI tract losses, and urination.
Secondary hypothroidism is also known
as myxedema, which is a result of lack of pituitary production of thyroid stimulating hormone
Dietitian duties
assists in planning dietary measures to improve or maintain a pts nutritional status
Motor skills at 18 months
assumes standing position; manages a spoon, turns pages of book
When is apgar scoring performed on infants?
at one minute and again at 5 minutes after the birth
Temporal lobe
auditory reception area
Systemic Lupus Erythemtosus (SLE)
autoimmune disorder that affects joints, skin, and various organ systems. Chronic and inflammatory. Sx: butterfly rash, wt loss, fever, hair loss, abd pain, mouth sores, ratigue, seizures, arthritis, nausea, joint pain, psychosis Tx: NSAIDS, protective clothing, cytotoxic drugs, hydroxychloroquine Tests: CBC, CXR, ANA tests, skin rash observation, coombs' test, urine analysis, test for various antibodies Monitor for: Seizure, infection, hemolytic anemia, myocarditis anemia, myocarditis, infection, renal failure
what stage are toddlers in according to Erikson
autonomy versus shame and doubt
What is Erikson's psychosocial stage for a toddler (1-3 years)
autonomy vs. shame and doubt
Pulmonary actinomycosis
bacteria infection of the lungs caused by (propionbacteria or actinomyces) Cx: Microorganisms Sx: Pleural effusions, Favial lesions, Chest pain, cough, wt loss, fever Tests: CBC, Lung biopsy, thoracentesis, CT scan, bronchoscopy Monitor for: Emphysema, Meningitis, Osteomyelitis
Bureaucratic Leadership (definition)
belief that individuals are motivated by external forces. this type of leadership focuses on rules and procedures to manage teams and projects to identify goals and direct work flow
Democratic Leadership (definition)
belief that individuals are motivated by interal drives and impulses...desires active participation in decisions and desire to get tasks done promotes participation and majority rule for goal setting
Prolonged use of aspirin and other salicylates sometimes causes
bilateral hearing loss 30-40 decibels
What is the most common side effect of accutane and Tetracycline?
birth defects
When the AIDS patient has a low platelet count, what is indicated?
bleeding precautions; No IM's, no rectal temperatures, other bleeding precautions
Pulmonary emboli
blood clot of the pulmonary vessels or blockage due to fat droplets, tumors or parasites Cx: DVT-most common Sx: SOB, chest pain, decreased BP, skin color changes, LE and pelvic pain, sweating, dizziness, anxiety, tachycardia, labored breathing, cough Tests: Doppler US, CXR, Pulmonary angiogram Tx: placement of the IVC filter, admin O2, surgery, thrombolytic therapy if clot detected Monitor for: shock, pulmonary HTN, hemorrhage, palpitation, heart failure, pulmonary perfusion test, plethysmography, ABG Check O2 sats
Pulmonary Circuit (circulatory system)
blood is oxygenated and depleted of metabolic products such as CO2 in the lungs
AIDS is trasmissible through what four routs?
blood, sexual contact, breast feeding, across placenta in utero
Chadwick's sign is a
bluish vagina associated with hormonal changes
90/90 traction -part of body
boot cast and pins surgically through distal part of femur and hip and knee
After appendectomy, document in the nurses notes the return of __________
bowel sounds (peristalsis)
Multifocal atrial tachycardia (Supraventricular Tachyarrhythmias)
bpm (>105) Various P wave appearances
Order of pubescent changes for girls
breasts bud, pubic hair appears, onset of menarche
What are cheyne strokes respirations
breating marked by pds of apnea and gasps lasting 10-60 sec.
Hypoparathyroidism causes a decrease in
calcium and inccrease in phosphorus so if normal ranges of calcium are 9-10.5 a high phosphorus would be above the 3- 4.5
Antidote for magnesium
calcium gluconate
If a child swallows a potentially poisonous substance, what should be done first?
call medical help
Intestinal Obstruction (Tumors, volvulus, impacted condition, hernia)
can a paralytic ileus/false obstruction (children) or a mechanical obstruction Sx: constipation, V/D, abd swelling, abd pain Tests: barium enema, CT scan, upper/lower GI series, poor bowel sounds
Gastritis
can be caused by various sources (bacteria, viruses, bile reflux or autoimmune diseases). Inflammation of the stomach lining. Sx: Loss of appetite, hiccups, nausea, vomiting blood, abd pain Tests: ECG, x-ray, CT scan
Cytomegalovirus
can cause lung infections and is a herpes-type virus Cx: more common in immunocompromised pts, often associated c organ transplantation Sx: fever, SOB, fatigue, loss of appetite, cough, joint pain Tx: antiviral meds, O2 therapy Tests: CMV serology tests, ABG, blood cultures, bronchoscopy Monitor for: renal dysfunction, infection, decreased WBC levels, relapses
What are the symp of hypophosphetemia
cardiomyopathy, shallow rep, deep tendon reflex, irritable.
Osteocytes
cells derived from osteoblasts that become buried in bone after it is formed
Daily weights are obtained in children with nephrosis to monitor: 1.) weight loss from a low-protein diet 2.) accuracy of fluid balance sheets 3.) changes in the amount of edema 4.) percentile on the growth grid
changes in the amount of edema
CHF (class III)
characterized by a marked limitation in normal physical activity
Charismatic Leadership (definition)
charm, persuasive person power, self confidence, extraordinary ideas and strong convictions. Leader's personality arouses affection and emotional commitment and drives and advances vision, mission, and goals
Homann sign
check of the lower extermities to check for a possible DVT
If you care for a client who is post-op for a repair of a femoral popliteal resection what assessment must you make every hour for the first 24 hours?
check the distal extremity (far from center) for color, temperature, pain and PULSE, also document
If the blood glucose is larger than 240 then you must
check the urine for glucose
Osteoarthritis
chronic condition affecting the joint cartilage that may result in bone spurs being formed in the joints Sx: joint pain, morning stiffness, limited AROM, wt bearing increases symptoms Tx: PT, Cox 2 inhibitors, NSAIDS, joint infections, aquatic exercises, surgery Tests: x-ray, passive testing of joints
Atropine is contraindicated in the client with glaucoma because it
closes the canal of Schlemm and raises intraocular pressure
Respiratory Synctial Virus
common respiratory virus that affects children.
Peripheral edama, shortness of breath, and dizziness are
common with pacemakers failure. Decreased cardiac output
Appropriate play for school aged children?
competitive and cooperative play. Peers of same gender.
addisons disease
condition of coritsole defficiency, distruction of the adreal gland, or part of the brain that stimulate the brain to make corisole, Provide a high sodium diet.
Scleroderma
connective tissue disease that is diffuse Sx: wheezing, skin thickness changes, wt loss, joint pain, SOB, hair loss, bloating Tests: monitor skin changes, CXR, antinuclear antibody test, ESR increased Monitor for: renal failure, HF, pulmonary fibrosis
Colloid solutions
contain solutes of higher molecular weight than the serum examples Plasmanate, dextra, hespan, salt poor albumin
Continuing Care Nurse duties
coordinates discharge plans for pts
Which menu selections are best for a child diagnosed with celiac disease? 1.) pizza and chocolate cake 2.) spaghetti and blueberry muffin 3.) chicken sandwich on whole-wheat bread 4.) corn tortilla and fresh fruit
corn tortilla and fresh fruit
A priority goal in the approach to a child with anorexia nervosa is to" 1.) encourage weight gain 2.) prevent depression 3.) limit exercise 4.) correct malnutrition
correct malnutrition
The most prominent glucocorticoid secreted by the adrenal cortex is
cortisol (this regulates the body's stress response, metabolism of food, emotional stability, and immune response.) Monitor glucose levels.
Social Worker duties
counsels pts and families about home care services and assists the continuing care nurse with planning discharge
Describe the pain of angina pectoris
crushing substernal chest pain that may radiate
Which vaccines would the nurse expect to be prescribed for a 2-month-old during well checkup?
d-tap, HepB HIB IPV PCV
How often should a stump be washed?
daily
Define Leukopenia
decrease in wbc, indicated viral infection
If an aneurysm is ruptured how would you know it?
decreased LOC (restlessness), tachycardia, hypotension - all signs of shock
What are the symptoms of hypernatremia
decreased myocardial control, low bp, dry and flaky skin
CHF (class IV)
defined by symptoms at rest or with any physical activity
Resp Therapist duties
delivers treatments designed to improve the pts ventilation and oxygenation status
CHF (class I)
describes a pt who is not limited with normal physical activity by symptoms
"Time is too short to start another life, though I wish I could," is an example of ___________.
despair
BUN test
determines how well kidneys are working. Urea Nitrogen is a waste product that's created in the liver when the body breaks down proteins. Increased if liver or kidneys are damaged Diagnosis....liver damage, malnutrition, poor circulation, dehydration, urinary tract obstruction, cong HF, GI bleed Antibiotics and diuretics may increase BUN levels
Hirsutism
development of dark areas of hair in women that are uncommon. Cx: Cushing's syndrome, congenital adrenal hyperplasia, hyperthecosis, PCOS, High Androgen levels, certain meds Tx: laser Tx, birth control meds, electrolysis (hair removal), bleaching
Occupational Therapist duties
develops adaptive devices that help chronically ill or handicapped pts to perform ADLs
Antidote for digitalis
digoxin immune fab
What is the action of nitro?
dilates coronary arteries to increase blood supply (O2 supply) and reduces preload.
When a stump is wrapped, the bandage should be tightest _____________ and loosest _____________.
distally (far from the center), proximally (neareast to the point)
T wave
dome shaped wave; indicates ventricular repolarization; flat when insufficient O2; elevated with increased K levels
Babies weight -two
doubles by 6 months triples by 12 months
Children at highest risk for seizure activity after ingestion are those who have swallowed _____________ and ______________.
drugs, insecticides
What are the three adult stages of development called
early adulthood, middle adulthood and later adulthood
To prevent post-op swelling, the stump should be __________.
elevated
Pulmonary hypertension
elevated BP in the lung arteries Cx: may be genetically linked, more predominant in women Sx: fainting, fatigue, chest pain, SOB c activity, LE edema, weakness Tests: Pulmonary arteriogram, CXR, ECG, Pulmonary function tests, CT scan, cardiac cath Tx: manage symptoms, diuretics, calcium channel blockers, heart/lung transplant if necessary
Sinus Tachycardia (Supraventricular Tachyarrhythmias)
elevated ventricular rhythm/rate
Transformal Leadership (definition)
emphasize interpersonal relationship and inspires followers, not concered with statue quo. focuses on merging and values generates followers
Heart valve infection
endocarditis, probable valvular heart disease. Can be caused by fungi or bacteria Sx: weakness, fever, murmur, SOB, Night sweats, joint pain, janeway lesions Tests: CBC, ERS, ECG, blood cultures, enlarged spleen, presence of splinter, hemorrhages, Tx: IV antibiotics, surgery may be indicated Monitor for: Jaundice, arrhythmias, CHF, Glomerulonephritis, emboli
What is a characteristic manifestation of Hodgkin's Disease? 1.) petechiae 2.) erythematous rash 3.) enlarged lymph nodes 4.) pallor
enlarged lymph nodes
Order of pubescent changes in boys
enlargement of testicles with looseness of scrotum, appearance of pubic hair, growth of genitalia, growth of axillary hair, downy hair on upper lip, change in voice
Cardiogenic shock
enough blood is available, however the heart is unable to move the blood in an effective manner Sx: anxiety, weakness, sweating, rapid pulse, confusion, clammy skin Tests: CBC, echocardiogram, CT scan, endoscopy, CT scan, endoscopy c GI bleeding, swan-ganz cath Tx: increase fluids via IV, Avoid hypothermia, epinephrine, norepinephrine, dobutamine, dopamine
A child with suspected bulimia should be assesed for: 1.) abnormal weight gain 2.) abnormal weight loss 3.) erosion of tooth enamel 4.) amenorrhea
erosion of tooth enamel
Physical Therapist duties
examining, testing and treating
Primary aldosteronim or Conn's syndrome is
excessive aldosterone levels possibly caused by a adrenal gland tumor
Congenital adrenal hyperplasia
excessive production of androgen and low levels of aldosterone and cortisol. (geneticially inherited disorder). Different forms of this disorder that affect males and females differently. Cx: adrenal gland enzyme deficit causes cortisol and aldosterone to not be produced. Cx male sex characteristics to be expressed prematurely in boys and found in girls Sx: Boys: small testes development, enlarged penis development, strong musculature appearance. Girls: abnormal hair growth, low toned voice, abnormal genitalia, lack of menstruation Tx: Reconstructive surgery, hydrocoristone, dexamethasone Tests: salt levels, low levels of cortisol, low levels of aldosterone, increased 17-OH progesterone, increased 17-ketosteroids in urine
Hyperthyroidism
excessive production of thyroid hormone Cx: iodine overdose, thyroid hormone overdose, graves' disease (key), tumors affecting the reproductive system Sx: skin color changes, wt loss, anxiety, possible goiter, nausea, exophthalmos, diarrhea, hair loss, elevated BP, fatigue, sweating Tests: elevated systolic pressure noted, T3/T4 (free) levels increased, TSH levels reduced Tx: radioactive iodine, surgery, beta-blockers, antithyroid drugs
Justice (definition)
fair, equitable and appropriate Tx resources are distributed equally to all
hypothroidism signs and symptoms
fatigue and lethargy decreased body temp, PR, BP Weight gain edema of hands and feet hair loss thickening of the skin
The adolescent with anorexia nervosa has a body self-image characteristically expressed by: 1.) wearing tight clothing to emphasize thinness 2.) increasing elation as weight is lost 3.) feeling "fat" even when appearing thin 4.) efforts to achieve specific figure measurements
feeling "fat" even when appearing thin
Anorexics are usually __________ under the age of _____.
females, 25
What are causes of fetal bradycardia?
fetal hypoxia (late manifestation), medications, maternal hypotension, fetal heart block, prolonged umbilical cord compression.
Otitis Media S/S
fever pulling at ear discharge from ear
Kidneys function
filter blood waste, excess H2O, impurities controls pH, sodium levels, and K levels in the body Produces hormones that manage RBC production and regulates BP
When dealing with a patient with Hyperkalemia
first you want to give an ECK Administer calcium gluconate administer insulin (drives K that is in blood back into the cell) Administer dextrose to couteract the insulin effect on blood sugar
The #1 contracture problem in AKA is ____________ of the _____________
flexion, hip
Antidote for benzodiazepines
flumazenil
Servant Leadership (definition)
focus on desire to serve others and is based on principles of caring
Transactional Leadership (definition)
focuses on the role of supervision, organization, and group performance. This style is when the leader promotes compliance of his/her followers through both reward and punishments.
Bryant's traction -age -part of body
for small children with fracture of the femur uses the weight of the child's lower body to pull the bone fragments of the fractured leg into alignment. To accomplish this, the child's buttocks should just clear the mattress and the legs should be at a 90-degree angle to the trunk.
Pharmacist duties
formulates and dispenses meds
To lessen pain place the client in ___________ position.
fowlers (a sitting position) (also use post op)
Pulmonary Aspergilloma
fungal infection of the lung cavities causing abscesses Cx: fungus aspergillus Sx: Wheezing, SOB, Chest pain, fever, cough Tests: CT scan, sputum culture, serum precipitans, CXR, bronchoscopy Tx: Surgery, antifungal meds
School age growth
gains 4-6lbs per year grows 2 inches
Primary hypothyroidism includes
genetic defects that prevent the metabolism of iodine
PKU
genetic disorder in which the body cannot metabolize their amino acid phenylalanine
Duchenne muscular dystrophy
genetically x-linked recessive type of muscular dystrophy that starts in lower extremities. Dystrophin-protein dysfunction Sx: falls, fatigue, muscle weakness, gait dysfuncation, scoliosis, joint contractures Tx: PT, braces, mobility assistance Tests: CPK levels increased, cardiac testing, EMG, muscle biopsy testing Monitor for: contractures, pneumonia, resp failure, CHF, cardiomyopathy, limited mobility
Bone Matrix
glycoproteins are the main components of the ground substance
10 months old motor skills
goes from prone to sitting by themselves, grasps a rattle
type 2
gradual onset, often managed with diet and includes weight gain. tx: oral hypoglycemia or insulin
Respiratory secretions
greater than 5.5
On the HR criteria an infant scores a "1" if their HR is _________ than 0 and ____________ 100
greater, less than
Amniotic fluid
greatest at 34 weeks gestation Functions: allows normal lung development, freedom for movement, fetus temp reg, trauma prevention
Arteriosclerosis
hardening of the arteries Cx: smoking, Htn, renal disease, CAD, stroke Sx: claudication pain, cold feet, muscle acheness and pain in the legs, hair loss on the legs, numbness in the extremities, weak distal pulse Tx: analgesics, vasodilation meds, surgery if severe, balloon surgery, stent placement Tests: Doppler US, angiography Monitor for: arterial emboli, ulcers, impotence, gas gangrene, infection of the lower extremities
Prevention of rheumatic fever can best be accomplished by: 1.) keeping children with fever home 2.) sending children with sore throats home from school 3.) having sore throats cultured as soon as possible 4.) treating all colds with antibiotics
having sore throats cultured as soon as possible
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 with hands held open
What are the top 2 side effects of nitro?
headache and hypotension
Cardiogenic Shock
heart is unable to meet the demands of the body. This can be caused by conduction system failure or heart muscle dysfunction. Sx: rapid breathing, rapid pulse, anxiety, nervousness, thread pulse, mottled skin color, profuse sweating, poor capillary refill Tx: Amrinone, norepinephrine, dobutamine, IV fluids, PTCA, Extreme cases-pacemaker, IABP Tests: nuclear scans, electrocardiogram, echocardiogram, electrocardiogram, ABG, Chem-7, chem-20, electrolytes, cardiac enzymes
Aortic Insufficiency
heart valve disease that prevents the aortic volve from closing completely. Backflow of blood into the left ventricle. Cx: Rheumatic fever, congenital abnormalities, endocarditis, marfan's syndrome, ankylosing spondylitis
Never apply __________ to the area of the appendix.
heat (it causes rupture)
An elderly client is a (high/low) risk for accidental poisoning? What about a school age child?
high - due to poor eyesight, high
Renal diet (theraputic)
high cal, high carb, low protein, low k, low sodium, and fluid restricted to intake = output + 500mL
Polyhydamnios
high levels of amniotic fluid that can cause: gestational diabetes and congenital defects. Cx: beckwith-wiedemann syndrome, hydrops fetalis, muti fetus development, anencephaly, esophageal atresia, gastroschisis
Wilson's disease
high levels of copper in various tissues throughout the body. (Genetically linked- autosomal recessive) Key organs affected: eyes, brain, liver, kidneys Sx: Gait disturbances, jaundice, tremors, abd pain/distention, dementia, speech problems, muscle problems, muscle weakness, spenomegaly, confusion, dementia Tests: bilirubin/PT/SGOT increased, albumin/uric acid production decreased, MRI, genetic testing, low levels of serum copper, copper is found in the tissues, kayer-fleisher rings in the eye Tx: Pyridoxine, low copper diet, corticosteroids, penicillamine Monitor for: cirrhosis, muscle weakness, joint pain/stiffness, anemia, fever, hepatitis
Pancreatic Cancer
higher rate in men Sx: Nausea, jaundice, abd pain, wt loss, depression, back pain, indigestion Tx: surgery, chemo, radiation, whipple procedure Tests: CT scan, biopsy, abd US, liver function test
Polymyalgia Rheumatica
hip or shoulder pain disorder in people greater than 50 yrs old. Sx: shoulder pain, hip pain, fever, anemia, fatigue Tx: pain management, corticosteroids Tests: ESR increased, CPK, Hemoglobin low
Hyperalmentation can lead to
hyperglycemia, *so if the client must be monitored for hyperglycemia and might have to have insulin added to the solution or give subcutaneously during therpy
Prolactinoma tumors are tumors that arise from
hyperplasia of the pituitary gland that are prolactin hormone based.
Lymphocytic Thyroiditis
hyperthyroidism leading to hypothyroidism and then normal levels Cx: lymphocytes permeate the thyroid gland causing hyperthyroidism initially Sx: fatigue, menstral changes, wt loss, poor temp tolerance, muscle weakness, hyperthyroidism symptoms Tx: varies depending on symptoms, may use beta blockers Tests: T3/T4 increased, increased HR, lymphocyte concentration noted with biopsy
The pathologic disturbance of pyloric stenosis results from: 1.) edema of the pyloric muscle 2.) ischemia of the pyloric muscle 3.) hypertrophy of the pyloric muscle 4.) neoplastic obstruction
hypertrophy of the pyloric muscle
CVP > 12
hypervolemia or poor cardiac contractility
calcium gluconate treats
hypocalcemia
What is common after repeated vomiting
hypokalemia and hypomagesemia, it is important to check a pts electrolyte levels
CVP <3
hypovolemia
sickle cell disease
if both parents are carriers of the gene and ask the nurse how likely it is that they will have another biological child with the diease the percent is 1/4 or 25% INTV: Admin o2 Provide fluids Monitor pain levels Provide periods of rest
Compartment syndrome
impaired blood flow and nerve dysfunction caused by nerve and blood vessel compression Sx: severe pain, weakness, skin color changes Tx: surgery, therapy Tests: muscular length test
When will phantom limb sensation subside?
in a few months
PVC (premature ventricular contraction)
in many cases no P wave followed by a large QRS complex that is premature, followed by a compensatory pause
Gastric Ulcer
in stomach
A 10 on the apgar means the baby is
in terrific health
Kernig sign
inability to fully extend the knees with hips flexed.
A client with Cushing's disease complains of
increase facial hair or hirsutism this is due to the hypersecretion of corisol
Diabetic ketoacidosis
increased levels of ketones due to lack of glucose Cx: insufficient insulin causing ketone production which end up in the urine. More common in type 1 vs. type 2 DM Sx: Low BP, abdominal pain, headaches, repid breathing, loss of appetite, Nausea, fruit breath smell, mental deficits Tx: insulin IV fluids Tests: Elevated glucose, increased amylase and K, Ketones in urine, check BP Monitor for: renal failure, MI, coma
Define Graves disease
increased production of the thyroid hormone
The administration of prednisone to children with nephrosis creates the problem of: 1.) intolerance of foods 2.) increased risk of infection 3.) increased periorbital edema 4.) weight loss
increased risk of infection
Autocratic Leader (definition)
individuals are motivaed by power, authority, need for approval, makes all decisions, uses coercion and punishment and uncollegial
what stage are school age in according to Erikson
industry v. inferiority
What psychosocial stage for 6-12 years?
industry vs. inferiority
Cleft Lip fx age/weight
infant weighs 10 lbs
When is trust vs. mistrust
infant-first year of life
TB
infection cx by mycobacterium tb Cx: due to airborne exposure Sx: fever, angina, SOB, wt loss, fatigue, wheezing, phlegm production Tests: thoracentesis, sputum cultures, presence of crackles, TB test, CXR, bronchoscopy Tx: generally about 6M, rifampin, pyrazinamide, isoniazid
Pelvic inflammation disease
infection of the fallopian tubes, uterus or ovaries caused by STD's in the majority of cases Tx: antibiotics, surgery Tests: Pelvic exam, laparoscopy, ESR, WBC, preg test, cultures for infection
An aneurysm can result from an _____________ and from ____________.
infection, syphilis
Chain of infection
infectious agent (pathogen) Reservoir Port of exit Mode of Transmission Port of entry Susceptible bost
Myocarditis
inflammation of the heart muscle Cx: bacterial or viral infections, polio, adenovirus, coxsackie, virus Sx: Leg edema, SOB, Viral symptoms, joint pain, syncope, HA (pain), fever, unable to lie flat, irregular heart beats Tests: CXR, echocardiogram, ECG, WBC & RBC count, blood cultures Tx: Diuretics, pacemaker, antibiotics, steroids Monitor for: pericarditis, cardiomyopathy
Viral pneumonia
inflammation of the lungs caused by viral infection Cx: Rhinovirus, herpes simplex virus, influenza, adenovirus, hantavirus, CMV, RSV Sx: fatigue, sore throat, nausea, joint pain, headache, muscle pain, cough, SOB Tx: Antiviral meds, IV fluids Tests: bronchoscopy, open lung biopsy, sputum cultures, viral blood tests Monitor for: liver, heart or resp failure
Pancreatitis
inflammation of the pancreas Sx: fever, vomiting, nausea, chills, anxiety, jaundice, sweating Tests: x-ray, CT san, various lab tests
Pericarditis
inflammation of the pericardium Cx: viral (coxsackie, adenovirus, influenza, rubella viruses), bacteria (various microorganisms), fungi, surgery, of often associated with TB, renal failure, AIDS, and autoimmune disorders Sx: dry cough, pleuritis, fever, anxiety, crackles, pleural effusion, LE swelling, chest pain, unable to lie down flat Tests: auscultation, MRI scan, CT scan, echocardiogram (key test), ESR, CXR, blood cultures, CBC Tx: NSAIDS, Pericardiocentesis, analgesics, pericardiectomy Monitor for: constrictive pericarditis, A fib, Supraventicular tachycardia (STV)
Peritonitis
inflammation of the peritoneum
Bacterial Meningitis
inflammation of the protective membranes covering the brain and spinal cord caused by various types of bacteria
Uveitis
inflammation of the vascular layer of the eye
Apendicitis is an _________ of the appendix due to __________.
inflammation, obstruction
Rheumatoid Arthritis
inflammatory autoimmune disease that affects various tissues and joints Sx: Fever, fatigue, joint pain and swelling, ROM decreased, hand/feet deformities, numbness, skin color changes Tx: PT, moist heat, anti-inflammatory drugs, corticosteroids, anti-malarial drugs, corticosteroids, anti-malarial drugs, Cox-2 inhibitors, splinting Tests: Rheumatoid factor tests, c-reactive protein, synovial fluid exam, x-rays of involved joints, ESR increased
Juvenile Rheumatoid Arthritis
inflammatory disease that occurs in children Sx: painful joints, eye inflammation, fever rash, temp changes (joints), poor AROM Tx: PT, Corticosteroids, NSAIDS, Infliximab, hydrochloroquine, methotrexate Tests: ANA test, HLA antigen test, CBC, physical exam of joints, x-rays of joints, eye exam, RA factor test
QRS Complex
initial downward deflection followed by large upright wave followed by small downward wave; represents ventricular depolarization; masks atrial repolarization; enlarged R potion- enlarged ventricles; enlarged Q portion- probable HA
what stage are preschoolers in according to Erikson
initiative versus guilt
A child who has diabetes mellitus asks why he cannot take insulin orally instead of by subcutaneous injection. The best response of the nurse would be that: 1.)pills are only for adults 2.) insulin is destroyed by digestive enzymes 3.) insulin can cause a stomach ulcer 4.) insulin interacts with food in the stomach
insulin is destroyed by digestive enzymes
What is the top priority in the care of the client with anorexia nervosa?
intake of enough food to keep them alive, have them gain weight
P-R Interval
interval from beginning of P wave to R wave; represents conduction time from initial atrial excitation to initial ventricular excitation; good diagnostic tool; normal < 0.2 sec.
ECG changes with quinidine
inverts T wave QT segment longer QRS segment longer
ECG Changes with Digitalis
inverts T wave QT segment shorter Depresses ST segment
Frontal lobe
involved with personality, behavior, emotions and intellect
Arrhythmias
irregular heart beats and rhythms disorder Types: Bradycardia, Tachycardia, ventricular fib, ectopic heart beat, ventricular tachycardia, woldd-parkinson-white syndrome, atrial fib, sick sinus syndrome, sinus tachy, sinus brady Sx: SOB, Fainting, Palpitations, dizziness, chest pain, irregular pulse Tx: Defibrillation, pacemakers, meds Tests: Coronary angiography, ECG, Echocardiogram, Holter monitor Monitor for: heart failure, stroke, HA, Ischemia
Atrial flutter (Supraventricular Tachyarrhythmias)
irregular p wave development (250-350 bpm)
Situational leadership
is a comprehensive approach that incorporates the leader's style, the maturity of the work group, and the situation at hand.
Pulmonary Valve Stenosis
is a condition in which a deformity on or near your pulmonary valve, the valve that influences the blood flow from your heart to your lungs, slows the blood flow. Cx: COngenital, endocarditis, rheumatic fever (A disease that can result from inadequately treated strep throat or scarlet fever) Sx: fainting, SOB, Palpitations, cuanosis, poor wt gain Tests: cardiac cath, ECG, CXR, Echocardiogram Tx: prostaglandins, dieuretics, anti-arrythimics, blood thinners, valvuloplasty
Kawasakis disease
is a disease that affects the cardiovascular system leading to fever oropharyngeal inflammation, enlarged lymph nodes
Democratic leadership
is a people-centered approach that is primarily concerned with human relations and teamwork. This leadership style facilitates goal accomplishment and contributes to the growth and development of the staff.
Define gluconeogensis
is a process in which the liver continues to produce glucose which leads to further hyperglycemia metabolic acidosis and deterioration of the client's health.
Autocratic leadership
is an approach in which the leader retains all authority and is primarily concerned with task accomplishment
Acute glomerulonephritis that is associated with beta hemoloytic step
is an immunologic disorder that is caused by beta-hemolytic step occurs 21 days after respiratory or skin infection
Taking propranolol or another beta blocker
is going to slow the heart rate and blood pressure
Acute Kidney(renal) injury
is signaled by a decrease urine output and increased BUN and creatinine levels. could need peritoneal dialysis or hemodialysis. ----could happen if pt undergoes cardiac surgery (due to poor perfusion, hemolysis, low cardiac output, or vasopressor med therapy)
A 0 on the apgar means the baby
is stillborn
Walker
is used for a client with greater or bilateral weakness who is at risk for falls
Fibromyalgia
joint, muscle and soft tissue pain in numerous locations. Presence of tender points and soft tissue pain Sx: fatigue, body aches, poor exercise capacity, muscle/joint diagnosis Tx: anti-depressants, PT, stress management, massage, support group Tests: rule-out diagnosis
2.5 years motor skills
jumps in place with both feet, stands on one foot momentarily; draws circles, has good hand-finger coordination
Motor skills 5 years old
jumps rope, walks backward with heel to toe, moves up and down stairs easily
Pavlik Harness
keep femur in acetabulum (4-5mon) wear 24 hrs a day adjust every 2 weeks because of rapid growth
A child who has had heart surgery returns to the pediatric unit with a chest tube and drainage bottles in place. What is a priority nursing responsiblity when caring for a child with chest tubes? 1.) empty the chest tube drainage bottles each shift 2.) clamp the chest tubes when turning the patient 3.) place the drainage bottles ont he bed when moving the bed 4.) keep the drainage bottle below the chest level at all times
keep the drainage bottle below the chest level at all times
Kussmaul's respirations are seen in diabetic children with: 1.) neuropathy 2.) ketoacidosis 3.) hypoglycemia 4.) retinopathy
ketoacidosis
What is found over the body of the client with anorexia nervosa?
lanugo
Laissez-faire
leadership is a permissive style in which the leader gives up control and delegates all decision making to the work group.
Hypochloremia
less than 95 typical ranges are 95-108. Causes are from excessive loss in vomits, nasogastric suction, sodium deficits, losses through renal system. excessive water within the body due to overinfusion of hypo-tonic solution.
Gastric pH
less than or equal to 4
When a pt is on hypotyroidism be sure that they
limit the soy in their diet since it can decrease the absorption.
Clients with AIDS (gain/lose) weight?
lose
symptoms of addisions
loss of energy, weight, fatigue,
Symptoms of hypochloremia are
loss of sodium but are nonspecific to chloride
Heart healthy diet (therapeutic)
low fat (less than 30% of cals should be from fat)
Oligohydramnios
low levels of amniotic fluid that can cause: fetal abnormalities, ruptured membranes and fetus disorders.
Gout Diet (therapeutic)
low purine; omit poultry (cold chicken) meds for acute episodes: colchicine maintain meds: zyloprim
Respiratory acidosis
lungs cannot remove all of the carbon dioxide the body produces. Causes body fluids, especially the blood, to become too acidic Neuro : restlessnes Respiratory: Initially increased repiratory rate, perspiration, increase heart rate, slow resp
Hematocrit
males 44-52 females 39-47
The nurse is caring for a child diagnosed with nephrosis. Symptoms that are characteristic of nephrosis include (select all that apply) 1.) massive proteinuria 2.) edema 3.) a positive antistreptolysin titer 4.) bacteriuria
massive proteinuria edema
How do you care for someone with Respiratory acidosis
matain a patent airway, encourage fluids ( this will thin secreations)
A child who is in a vasoocclusive crisis caused by sickle cell anemia is experiencing acute pain. The nurse understands that Demerol (Meperidine) is not an appropriate pain medication to administer to this child because it: 1.) is very addictive 2.) is not strong enough 3.) may induce seizures 4.) cannot be given by mouth
may induce seziures
Insensible losses
may occur without the person's awareness. Insensible losses occur daily through the skin and the lungs.
Clearance (drugs)(definition)
measure of the body's ability to eliminate a drug. An expression of the volume of plasma which is cleared of the drug per unit time (mL/hr) not the concentration of the drug cleared.
The kernig's sign is used to test for
meningitis
Thyroid is responsible for
metabolism
The adrenal gland consists of
mineralocorticoids that help control the body's levels of minerals such as sodium and potassium
Level II Disaster
moderate disaster that is likely to result in a presidential declaration of an emergency, with moderate federal assistance Ex: Severe flooding major chemical spill extensive utility outage building fire or other major structural damage
Duchenne MD
most common type of MS affecting only males
Pulmonary edema
most commonly caused by heart failure, but may be due to lung disorders Sx: restless behavior, anxiety, wheezing, poor speech, SOB, sweating, pale skin, drowning sensation Tests: murmurs may be present, echocardiogram, oresence of crackles, low O2 sat levels Tx: diuretics, O2, treat the underlying cause
Graves' disease
most commonly linked to hyperthyroidism, and is an autoimmune disease. Exophthalmos may be noted (protruding eyeballs). Excessive production of thyroid hormones Sx: elevated appetite, anxiety, menstrual changes, fatigue, poor temp tolerance, diplopia, exophthalmos Tx: beta-blockers, surgery, prednisone, radioactive iodine Tests: elevated Hr, increased T3/T4 levels, serum TSH levels are decreased, goiter Monitor for: fatigue, CHF, Depression, hypothyroidism (over0correction)
PI's (Protease inhibitors)
most potent of antiviral meds, inhibit cell protein synthesis that interferes with viral replication, does not cure but slows progression of AIDS and prolongs life, used prophylactically, used in AIDS to decrease viral load and opportunistic infections
Abduction
movement away from the body
Adduction
movement of a limb toward the body
Thalassemia major (Cooley's anemia) is treated primarily with: 1.) a diet high in iron 2.) multiple blood transfusions 3.) bed rest until the sedimentation rate is normal 4.) oxygen therapy
multiple blood transfusions
symp of hyperphosphatemia include
muscle spasms chvosteks and tousseaus signs elevated serum phosphorus levels hypocalcemia ( low lvl of calcium)
Hypercalcemia has signs and symtptoms of
muscle weakness
Antidote for opioids
naloxone
Coarctation of the aorta
narrowing of the descending portion of the aorta, resulting in a limited flow of blood to the lower part of the body
Define azotemia?
nitrogenous wastes in the blood (increased creatinine, BUN)
Are all articles used by AIDS patients double-bagged?
no - only those contaminated with secretions
COPD pt
no more than 1-3 L of O2 or it will shut their respiratory drive
If the client with aneurysm is physically unstable, should you encourage turning, coughing and deep breathing?
no, bedrest until the client is stable!
Type 2 Diabetes is called
non insulin dependent and occurs more in pts with obesity and sedentary lifestyles
CHF (class II)
occurs when ordinary physical activity results in fatigue, dyspnea, or other symptoms
A goiter is caused due to a lack MEDS: SSKI
of iodine in the diet Admin throw a straw diluted with water or juice
Helicobacter pylori (bacteria)
often associated with ulcer formation Sx: Wt loss, chest pain, heartburn, vomiting, indigestion, fatigue Tests: EGD, stool guaiac, GI x-ray Tx: bismuth, famotidine, sucralfate, cimetidine, omeprazole, antibiotics
Acute pharyngitis
often the cause of sore throats, inflammation of the pharynx
Reye's Syndrome
often, BUT NOT ALWAYS associated with ASA use -Rapidly progressing encephalopathy
A priority nursing responsibility in the care of a child with Wilms' tumor is to: 1.) maintain accurate intake and output records 2.) omit abdominal palpation during daily assessments 3.) maintain strict bed rest 4.) assess neurological function
omit abdominal palpation during daily assessments
Patent Ductus Arteriosus (pedi)
open blood vessel (ductus ateriosus) that does not close after birth Sx: SOB, Limited feeding Tx: Surgery, Indomethacin, decreased fluid volume Test: ECG, Echocardiogram, heart murmur, CXR Monitor for: surgical complications, endocarditis, HF
Ventricular Septal Defect (pedi)
opening between the ventricles of the heart. Sx: poor wt gain, labored breathing, profuse sweating, SOB, Poor color, irregular heart beat, resp infections, reoccurring Tests: auscultation, echocardiogram, ECG, CXR Tx: Digoxin, surgery, digitalis Monitor for: endocarditis, pulmonary Htn, aortic insufficiency, limited growth and development, arrhythmias, CHF
Clearance = flow (mL/min) X amount of drug removed from the blood (mg/mL) / amount of drug going into kidney (mg/mL)
or.... Cl = flow X [c]in - [c]out (amount removed) / [c] in (amount in blood
Bone Cells
osteocytes, osteoblasts, and osteoclasts
Hyperphosphatemia, what is it
overall hyperphosphatemia is when there is too much phosphorous in the body. This is caused by decreased renal function, intake of too much, or hypopharathyroidism
Lab values associated with metabolic alkalosis
pH lvl above 7.45, normal or incrased CO2, increased sodium bicarb
How is the bleeding of Abruptio Placenta different from that in placenta previa?
pain and less voluminous in abruptio
Before the client with suspected appendicitis sees the physician what should be avoided?
pain meds, enemas, laxatives, food! NPO
Dysmenorrhea
painful menses Sx: Constipation, N/V/D Tests: determine if normal, dysmenorrhea is occurring, pain relief, anti-inflammatory meds
Hypotension and hypovolemic shock are complications of a paracentesis due to removal of a large volume of fluid.
paracentesis
orthostatic hypotension due to autonomic dysfunction.
parkinsons disease
The nurse is assessing a child admitted with possible Kawasaki's disease. A characteristic sign or symptom that the nurse should observe and document would be: 1.) cardiac dysrhythmia 2.) decreased urine output 3.) peeling skin on fingers 4.) decreased level of consciousness
peeling skin on fingers
Postictal phase
period following the cessation of seizure activity; patient is confused, needs close monitoring
metabolic acidosis
ph down, co2 down, and hc3 down
respiratory acidosis
ph down, co2 up , and hc3 up
metabolic alkalosis
ph up , co2 up, and hc03 up
respiratory alkalosis
ph up, co2 down, hc03 down
If after a right BKA, the client c/o pain in his right tow, he is experiencing _____________.
phantom limb sensation (which is normal)
Secondary Cushing's syndrome is often caused by
pituitary hypothalamus or adrenal cortex problems that result in an increased ACTH
Babies ability -three
plays peak-a-boo by 6 months Sits upright w/o support by 8 months Fine pincer grasp by 10-12 months (pick up Cheerios)
Legg-Calve-Perthes Disease
poor blood supply to the superior aspect of the femur. Most common in boys ages 4-10. The femur ball flattens out and deteriorates. Sx: hip and knee pain, limited AROM and PROM, pain with gait and unequal leg length. Tx:s surgery, physical therapy, brace, bedrest Tests: x-ray hip, test ROM of hip
Hypovolemic Shock
poor blood volume prevents the heart from pumping enough blood to the body Cx: trauma, diarrhea, burns, GI bleeding
Cardiomyopathy
poor hear pumping and weakness of the myocardium Cx: Htn, HA, viral infections Sx: Chest pain, SOB, fatigue, ascites, LE swelling, fainting, poor appetite, Htn, palpitations Tx: Ace inhibitors, dieuretics, blood thinners, Left Vent Assist Device, Digoxin, Vasodilators Tests: ECG, CBC, Isoenzyme tests, coronary angiography, CXR, MRI, Auscultation
Hypothyroidism
poor production of thyroid hormone Cx: surgical thyroid removal, irradiation, congenital defects, hashimoto's thyroiditis (key) Sx: constipation, wt gain, weakness, fatigue, poor taste, hoarse vocal sounds, joint pain, muscle weakness, poor speech, color changes, depression Tx: increase thyroid hormone levels, levothyroxine Tests: decreased bp and HR, CXR, elevated liver enzymes/prolactin/cholesterol, decreased T4 levels and serum, sodium levels, presence of anemia, low temp, poor reflexes Monitor for: hyperthyroidism symptoms, following Tx, heart disease, miscarriage, myxedema coma if untreated
An increase in blood sure contributes to what
poor wound healing
Hypocalcemia exibits a pts symptoms to be
positive trousseaus sign, hyperactive bowel sounds and twitching
Ventricular Tachycardia (ventricular tachyarrtythmias)
presence of 3 or greater PVC's (150-200bpm), possible abrupt onset. Possibly due to an ischemic ventricle. No P wave present
Preeclampsia
presence of protein in the urine, and increased BP during pregnancy. Found in 8%of pregnancies. Sx: Abnormal rabid wt gain, headaches, peripheral edema, nausea, anxiety, Htn, Low urination frequency Tx: deliver the baby, bed rest, meds Tests: Proteinuria, BP check, wt gain analysis, thrombocytopenia, evidence of edema
The nurse teaches the diabetic child to rotate sites of insulin injection in order to: 1.) prevent subcutaneous deposit of the drug 2.) prevent lipoatrophy of subcutaneous fat 3.) decrease the pain of the injection 4.) increase absorption of insulin
prevent lipoatrophy of subcutaneous fat
Medical Asepsis (clean technique)
procedure used to reduce and prevent the spread of microorganisms. Hand hygiene, using clean gloves, and cleaning the environment routinely
If the patient had an AKA they should lie ____________ several times per day.
prone (to prevent flexion contracture
Antidote for heparin
protamine sulfate
If the AIDS patient has leukopenia they will be on _____________ ________________.
protective (reverse) isolation
9 months old motor skills
pulls to a standing position, has a crude pincer grasp
When administering digoxin (Lanoxin) to an infant, the medication should be withheld and the physician notified if the: 1.) pulse rate is below 60 beats/min 2.) infant is dyspneic 3.) pulse rate is below 100 beats/min 4.) respiratory rate is above 40 breaths/min
pulse rate is below 100 beats/min
Heart
pumps 72 times per minute and propels about 4,000 gals (about 15,000 liters) of blood daily to the tissues. Composed of: Endocardium (lining; epithelium) Myocardium (mid coat; cardiac muscle) Epicardium (external coat or visceral layer of pericardium; epithelium and mostly connective tissue) Impulse conducting system
Name ways to toughen a stump so it will not breakdown due to the wear of the prosthetic leg?
push the stump against the wall, hitting it with a pillow
LD50/ED50
quantal dose response curve is the relationship between the dose of the drug and the occurrence of the certain response
What is the apgar scale?
quick objective way to evaluate the vital functions of the newborn
Adolescence growth
rapid growth second only to the first year of life
The symptoms of hyponatremia
rapid pulse, weakness, lethargy, headache, polyuria, decreased urine speficic gravity, dry skin/mucous membranes, and olguria *olguria is small urine production*
C cells help with regulation of the metabolic processes of controlling the
rate of growth, oxygen consumption, contraction of the heart, and calcium adsorption
McBurney's sign is
rebound tenderness associated with appendicitis
What is the sims position commonly used for
rectal enemas or irrigations
What may indicate a need for insulin in a diabetic child? 1.) diaphoresis and tremors 2.) red lips and fruity odor to the breath 3.) confusion and lethargy 4.) headache and pallor
red lips and fruity odor to the breath
Wilm's Tumor (pedi conditions)
renal tumor found in children. Tumor will spread to other regions. Sometimes children will be born with aniridia (absence of the iris, usually both eyes volved). Do not exert pressure over the abd Cx: unknown Sx: Fever, vomiting, fatigue, Irregular urine coloration, Abd pain, Constipation, Abd mass, Increased BP Tx: Surgery, Chemotherapy, Radiation Tests: BUN, Creatinine, Analysis of the urine, X-ray, CT scan, family Hx of cancer, CBC
thyroid storm
results from an increase of thyroid hormone
Motor skills 3 years old
rides a tricycle, jumps off of bottom step, stands on one foot for a while
Preschool ability
rides tricycle at 3
What is the first sign of appendicitis?
right upper quadrant pain
When assessing an 8-year-old child with obsessive compulsive disorder, the nurse would expect to find: 1.) an intelligence deficit 2.) ritualistic behavior 3.) antisocial behavior 4.) combative behavior
ritualistic behavior
6 months old motor skills
rolls back to front, can hold a bottle
4 months old motor skills
rolls back to side, puts objects in mouth
5 months old motor skills
rolls front to back, has palmar grasp
Autogenous
scratching an infected area and it spreads
Low potassium can cause
serious cardiac events
Hypertonic solutions are used to treat
severe hyponatremia and negative nitrogen balance.
Epiglottitis
severe, life threatening infection of the epiglottis and supraglottic stuructures that occurs most commonly in children between 2 and 12 years of age.
Hep B
sexually transmitted disease, also transmitted with body fluids and some individual may be symptom free but still be carriers. Sx: jaundice, dark urine, malaise, loint pain, fever, fatigue Tx: monitor for changes in the liver, recombinant alpha interferon in some cases, transplant necessary if liver failure occurs Tests: decreased albumin levels, + antibodies and antigen, increased levels of transaminase
Kayexalate is given
since it binds to K+ and gets rid of it through the GI tract
causes of hypokalemia so potassium leaving the cell
since potassium ranges are 3.5-5.5, having hypokalemia would mean that potassium is leaving the cell. This can occur by diuretics, steroids, digoxin
12 months old motor skills
sits from standing; attempts to create a 2 block tower but fails.
8 months old motor skills
sits unsupported, has pincer grasp
Kaposi's sarcoma is a cancer of the ___________.
skin
Motor skills 4 years
skips and hops on one foot, throws a ball overhead
Priority teaching for a parent of a child who ingested a foreign body includes: 1.) encouraging the use of a mild laxative every night 2.) slicing each stool passed to observe for the foreign body 3.) encouraging a daily enema until the foreign body is passed 4.) keeping the child NPO until the foreign body is passed
slicing each stool passed to observe for the foreign body
P wave
small upward wave; indicates atrial depolarization
RSV
spread by contact, virus can survive for various time periods on different surfaces Cx: COPD, panic attacks, stree Sx: Fever, SOB, Cyanosis, Wheezing, nasal congestion, croupy cough Tx: Ribvirin, Vent in severe cases, IV fluids, Bronchodilators Tests: ABG, CXR-------a medication called PALIVIZUMAB may prevent RSV infections and protect high-risk babies from serious complications of RSV infection Monitor for: pneumonia, resp failure, otitis media
When the patient experiences apprehension and urticaria while receiving a blood transfusion, the nurse: 1.) slows the transfusion and takes the patient's vital signs 2.) observes the child for further transfusion reactions 3.) stops the transfusion, allows normal saline solution to run slowly, and notifies the charge nurse 4.) stops what he or she is doing and obtains the patient's history
stops the transfusion, allows normal saline solutions to run slowly, and notifies the charge nurse
The nurse understands that genitourinary surgery affects growth and development. When caring for a 4-year-old child postoperatively, a priority nursing responsibility would include: 1.) strategies that preserve the child's body image 2.) assurances that appearance and sexual function will not be affected 3.) providing age-appropriate toys such as tricycles 4.) preventing embarrassment by limiting visitation of family and frients
strategies that preserve the child's body image
By what route do you take nitro?
sublingual
Antidote for lead
succimer
type 1 diabetes
sudden, can be only treated with insulin and it characterized by polyuria, polydipsia, and polyphegia tx: insulin
Chorea
sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face
What is the only treatment recommended for appendicitis?
surgery - appendectomy
Tonsilectomy warning sign
swallowing repeatedly can signify bleeding
having sickle cell would show what symptoms
swollen joints pulse 120 oxygen lvl 89 pain
Carcinoid Syndrome
symptoms caused by cardinoid tumers. Linked to increased secreation of serotonin. Sx: Flush appearance, wheezing, diarrhea, onset of niacin deficiency, abd pain, decreased BP Tx: surgery, sandostatin, chemo, multivitamins, octreotide, interferon Tests: 5-HIAA test, increased levels of chromogranin A and serotonin, CT scan, MRI Monitor for Low BP, Rt side HF
Veracity (definition)
tell the truth
Dunlop's Traction -part of body
temporary skin traction used for Fx of the upper arm and for shoulder dislocations.
Which aneurysm is most likely to have no symptoms?
the abdominal is most often "silent"
What artery is widened in a thoracic aneurysm?
the aorta
How do you tell if a client has angina or an MI?
the pain of the two is similar, the way to tell the difference is if nitro and rest relieve the pain. For angina, nitro and rest relieve the pain, for MI, nitro and rest do not relieve the pain
Clonic Phase
the phase of a grand mal seizure in which the patient shows rhythmic jerking movements
Hidradenitis Suppurativa
the presence of numerous abscess in the groin and armpit region.
An aneurysm will most affect which of the following, the blood pressure or the pusle?
the pulse (many times the aneurysm will rupture and much blood will be lost before the blood pressure starts to change.
Dose response
the relationship between dose and the body's response is called a dose-response curve (DRC)
What is an important aspect of a teaching plan for the parent of a child with hypopituitarism? 1.) the child should be enrolled in a special education program at school 2.) the routine administration of growth hormone should be carried out at bedtime 3.) all family members should have an endocrine workup 4.) the routine medication should be administered before the school day starts
the routine administration of growth hormone should be carried out at bedtime
When taking a child to the ER after accidental poisoning has occurred what must accompany the child to the ER?
the suspected poison
Idiopathic pulmonary fibrosis
thickening of lung tissue in the lower aspects of the lungs Cx: response to an inflammatory, agent, found in people ages 50-70, linked to smoking Sx: cough, SOB, Chest pain, cyanosis, clubbing, cyanosis Tx: Lung trans, corticosteroids, anti-inflammatory drugs Tests: pulmonary function tests, lung biopsy, rule out other connective tissue, diseases, CT scan, CXR Monitor for: polycythemia, pulmonary HTN, Resp failure, cor pulmonarle
Metabolic alkalosis
this is caused by a gain in HCO3 or a loss of acid which results in pH lvl above 7.45
Acetylcysteine should be taken with what, and because why
this is taken when someone has an overdose of tylenol, it has a rotten smell so it should be taken with flavoring and can be drank though a straw
metabolic acidosis
this is when the body produces too much acid or the kidneys are not moving the acid out of the body. In lab values you will see a decreased Ph, decreased PaCO2, decreased serum CO2, often increased Potassium
dehydration causes hemoconcentration due to low fl vol
this means that the hematocrit the percentage of blood vol that is made up of RBCs will increase due to less vol
Cardiac Cath
threaded from groin, neck or arm to heart. ----can be used to evaluate or confirm the presence of heart disease or heart muscle function. May also determine the need for further treatment (such as interventional procedure or bypass surgery) ----keep head elevation no more than 30 degrees to prevent arterial occlusion. (keeps the affected leg straight at the groin)
What does the thyroid gland produce
thyroxine (T4) and Triiodothyronine (T3)
Q-T interval
time for singular depolarization and repolarization of the ventricles. Conduction problems, myocardial damage or congenital heart defects can prolong this
S-T segment
time from end of S to beginning to T wave- represents time between end of spreading impulse through ventricles and ventricular repolarization; elevated with HA; depressed when insufficient O2
Nonmalificence (definition)
to do no harm
Mydriatic eye drops such as Neo-Synephrine are used with cyclopegics such as Cyclogyl
to paralyze the muscles of accommodation
Thyroid storm
to treat take PTU and tapazole
When taking medication for thyroid storm make sure the juice is either
tomato or orange to increase absorption and mask the taste.
respiratory alkalosis
too much blowing off of C02 through hyperventilation
What are the total cholesterol levels
total cholesterol should be below 200
Assessment of a client with tension pneumothorax reveals what
tracheal deviations towards the unaffected side
hypotonic solutions (more dilute hypos love water)
treats edema and kidney disease and is 5% dextrose and water
Croup (pedi)
trouble breathing in infants and children that can be caused by bacteria, viruses, allergies or foreign objects. Primarily, caused by viruses. Sx: Labored breathing, Sx increase at night, noisy cough, stridor Tests: x-ray, breaths sounds check Tx: acetaminophen, steroid meds, intubation, nedulizers Monitor for: Resp arrest, Atelectasis, dehydration, Epiglottitis
Neuroblastoma (pedi)
tumor in children that starts from nervous tissue. Capable of spreading rapidly. Cx: unknown Sx: Abd mass, skin color changes, fatigue, tachycardia, motor paralysis, anxiety, diarrhea, random eye movements, bone/joint pain, labored breathing Tests: bone scan, CBC, MIBG scan, Catecholamines test, x-ray, CT scan, MRI Tx: radiation, chemo, surgery Monitor for: renal failure, metastasis, various organ sys failures, liver failure
Zollinger-Ellison Syndrome
tumors of the pancreas that cause upper GI inflammation. The tumors secrete gastrin causing high levels of stomach acid Sx: V/D, abd pain Tx: ranitidine, cimetidine, lansoprazole, omeprazole, surgery Tests: abd CT, +Calcium infusion test, +Secretin Stimulation test, elevated gastrin levels, tumors in the pancreas
How often should the client with acne wash his face each day?
twice a day
Reiter's Syndrome
type of reactive arthritis that happens as a reaction to a bacterial infection in the body. Sx: fainting, weekness, bounding pulse, angina on occasion, SOB, fatigue Tests: palpation, increase pulse pressure and diastolic pressure, pulmonary edema present, auscultation, left heart cath, aortica angiography, dopper US, Echocardiogram Tx: digoxin, dieuretics, surgical aorta valve repair Monitor for: PE, Left-sided HF, Endocarditis
Duodenum Ulcer
ulcer in duodenum
Peptic Ulcer
ulcer in the duodenum or stomach
Gout
uric acid development in the joints causing arthritis Sx: joint edema, fever, lower extremity and/or upper extremity joint pain Tests: uric acid in the urine, synovial biopsy, synovial analysis Monitor for: kidney stones and disorders
When a pt has presbycusis you have to
use low pitch tones
To check for hypoparathyroidism a nurse would
use the Chvostek's sign by tapping on the facial nerve 7 or trigeminal nerve 5 and observe for grimacing
straight leg cane
useful for client with slight weakness in one leg
Russell's traction -part of body
uses a knee sling to provide support of the affected leg. It is commonly used to treat fractures of the end of the tibia in the leg.
Ankylosing Spondylitis
vertebrae of the spine fuse Sx: limited AROM, back and neck pain, joint edema, fever wt loss Tests: x-ray spine, CBC, ESR test, NSAIDS, surgery, HLA-B27 antigen test Monitor for: pulmonary fibrosis, aortic valve stenosis, Uveitis
Pneumonia
viruses the primary cause in young children, bacteria the primary cx in adults. Bacteria: Streptococcus pneumonia, mycoplasma pneumonia Sx: fever, headache, ribavirin, SOB, COugh, chest pain Tests: CXR, Pulmonary perfusion scan, CBC, cultures of sputum, crackles Tx: antibiotics (bacterial), resp tx, steroids, IV fluids, vaccine Tx
Antidote for warfarin
vitamin K
2 years motor skills
walks up and down stairs; builds block tower of 6-7 blocks
11 months old motor skills
walks while holding onto something; can put objects in a container
Motor skills 15 months
walks without help, creeps up and down stairs, builds block towers
The symptoms of hypokalemia
weak pulse, nausea, vomiting, decrease specific gravity of urine. Depressed s-t , inverted T waves
What precaution must the nurse take when administering topical nitro paste?
wear gloves, nurse may get a dose of the med
The embryonic heart begins pumping its own blood, often a different blood type than the mother's, Week 5 includes the and
week 3
The embryonic period during pregnancy takes place from
weeks 6 to 10
Medroxprogesterone acetate side effects
weight gain
Phosphorus a little about it
when phosphorus is elevated that means that calcium levels are low. Aids in renal regulation in buffer system. The paraathyroid gland secretes parathyroid hormone in response to serum calcium lvls.
BNP or brain natriuretic peptide is a substance that opposes the action of aldosterone
when ventricular wall is stretched during CHF BNP is released
Preschool favorite word
why?
An aneurysim is an abnormal _______________ of the wall of a(n) artery.
widening (it is also weakening)
Does stress make acne worse?
yes
Treating hyperphosphatemia
you need to adminster phosphate binding medications such as aluminum hydroxide adminster calcium supp with phosphate binders hemodialysis and decrease foods and medications containing phosphorus
Treating hypocholremia
you want to replace the sodium and chloride monitor for signs of acidosis
Cleft Palate age
~1 year
