NCLEX Study Set 1-100

ventricular fibrillation

the rapid, irregular, and useless contractions of the ventricles WORST ONE

Client has the right to view medical records that pertain to ________________________

their care

Acanthosis nigricans

thickening and darkening of skin near axillary region, A/w Diabetes Type II and gastric carcinoma SHOWS INSULIN RESISTANCE

ear drops adult (3 years and over)- equal or over 3 years

up and back

Pitressin

vasopressin: diabetes insipidus

SIADH

TOO MANY LETTERS, TOO MUCH WATER syndrome of inappropriate antidiuretic hormone

positive pressure ventilation

a technique that uses a mechanism such as a mechanical ventilator to force air into the lungs to provide breathing assistance

Adrenocortical insufficiency (addison's disease)

condition in which the adrenal cortex underproduces necessary hormones see photo

parkland formula for burns

% BSA x weight (kg) x 4 give 1/2 fluids in first 8 hours. remaining 1/2 in last 16 hours. just use the formula if it is 24 hours

common herbs and what they are for

(Option 1) Evening primrose may be used for eczema or skin irritations. (Option 2) Ginseng is used to promote mental alertness and enhance the immune system. (Option 4) St. John's wort is used for treatment of depression. It has many interactions with other prescription medications.

what is the syncronization button used for?

(Option 5) Synchronized cardioversion delivers a shock on the R wave of the QRS complex and would not be appropriate for a client in Vfib (no identifiable QRS complexes). Rhythms that are ideal for synchronized cardioversion are supraventricular tachycardia, ventricular tachycardia with a pulse, and atrial fibrillation with rapid ventricular response. If the defibrillator is not synchronized with the R wave in a client with a pulse, the shock may be delivered on the T wave and can cause a lethal arrhythmia (eg, Vfib). Educational objective: The steps for defibrillation are as follows: Turn on the defibrillator, place pads on the client's chest, charge defibrillator, ensure the area is "all clear," deliver the shock, then resume compressions immediately NOT During a normal shock used during cpr for v fib

ventrical fibrillation

(V-fib) consist of rapid, irregular and useless contractions of the ventricles. Ventricular fibrillation (VF), sometimes called V fib, is the result of electrical chaos in the ventricles and is life threatening! Impulses from many irritable foci fire in a totally disorganized manner so ventricular contraction cannot occur. There are no recognizable ECG deflections (Fig. 34-14A). The ventricles merely quiver, consuming a tremendous amount of oxygen. There is no cardiac output or pulse and therefore no cerebral, myocardial, or systemic perfusion. This rhythm is rapidly fatal if not successfully ended within 3 to 5 minutes.

Kawasaki disease

(inflammation of blood vessles, hence the strawberry tongue) causes coronary artery aneurysms.

PAWP normal range

(normal, 6-12 mm Hg). Furosemide (Lasix) is an appropriate drug for the nurse to administer to decrease left ventricular preload in a client in cardiogenic shock with a PAWP of 24 mm Hg

chest tube drainage system

*returns negative pressure to the intrapleural space *used to remove abnormal accumulations of air and fluid from the pleural space Gentle, continuous bubbling in the suction control chamber of a chest tube drainage unit indicates that suction is present and the unit is functioning appropriately. The nurse should document the finding and continue to monitor. (Option 1) Subcutaneous emphysema is air that has leaked into the tissue surrounding the chest tube insertion site. A crackling sensation is felt when palpating the skin. It does not affect bubbling within the chest tube drainage unit. (Option 2) An air leak would cause bubbling in the air leak gauge (section C) or water seal chamber not in the suction control chamber. (Option 4) Turning down the wall suction would effectively negate the presence of suction in the chest tube drainage unit. Educational objective: Gentle, continuous bubbling in the suction control chamber of a chest tube drainage unit indicates the presence of suction in the system and is an expected finding.

how to mix insulin in the syringe

-draw 20 units of air into syringe -inject air into nph bottle, dont touch insulin, and keep bottle upright -then draw in 5 units of air -inject air into regular insulin vial, invert t and draw 5 units of insulin ALWAYS WITHDRAW REG INSULIN FIRST -invert nph vial and draw 20 units of insulin. CAN NOT INJECT BACK IN BOTTLE IF I TAKE OUT TOO MUCH

NSAID examples

ibuprofen (Advil, Motrin) Naproxen (Aleve, Naprosyn) salicylates (aspirin) ketorolac (Toradol) diclfenac (Voltaren) etodolac (Lodine)

explain contact precautions

1. Private room preferred: if not available, may cohort with patient with same active infection with same microorganisms if no other infection present 2. Wear gloves when entering room 3. Wash hands with antimicrobial soap before leaving patient's room 4. Wear gown to prevent contact with patient or contaminated items or if patient has uncontrolled body fluids; remove gown before leaving room 5. Transport: patient to leave room only for essential clinical reasons; during transport, use needed precautions to prevent disease transmission 6. Dedicated equipment for this patient only (or disinfect after use before taking from room)

Explain droplet precautions

1. Private room preferred: if not available, may cohort with patient with same active infection with same microorganisms if no other infection present; maintain distance of at least 3 feet from other patients if private room not available 2. Mask: required when working within 3 feet of patient 3. Transport: as for Airborne Precautions

Explain Airborne precaution

1. Private room required with monitored negative airflow (with appropriate number of air exchanges and air discharge to outside or through HEPA filter); keep door(s) closed 2. Special respiratory protection: • Wear PAPR for known or suspected TB • Susceptible people not to enter room of patient with known or suspected measles or varicella unless immune caregivers are not available • Susceptible people who must enter room must wear PAPR or N95 HEPA filter* 3. Transport: patient to leave room only for essential clinical reasons, wearing surgical mask

Measure for crutches

2 inches below axilla and 6 inches lateral of ankle...

Normal Central Venous Pressure (CVP)

2-8 mm Hg

Ventricular tachycardia (V-tach)

2nd worst, can turn into v fib

Hypothyroidism

condition of hyposecretion of the thyroid gland causing low thyroid levels in the blood that result in sluggishness, slow pulse, and often obesity. this patient would be constipated. need high fiber!

Pulmonary artery wedge pressure (PAWP) normal value

6-12 mm Hg

pharm questions

know what ends in what

5 areas for listening to the heart

All pigs eat too much AORTIC, Right 2nd intercostal space PULMONIC: Left 2nd intercostal space ERB's Point: Left 3rd intercostal space (S1 and S2) Tricuspid: 4th intercostal space, LEFT LOWER sternal boarder Mitral: left 5th intercostal space, medial to midclavicular line R2,2,3,4,5

Diabetic Ketoacidosis (DKA)

A form of hyperglycemia in uncontrolled diabetes in which certain acids accumulate when insulin is not available.

glass ampule protocol

A glass ampule is a single-dose medication container with a scored area on the neck that must be broken to withdraw the medication. When preparing medication from a glass ampule, the nurse ensures safety and prevents contamination during medication administration by: Flicking the upper stem of the ampule with a fingernail several times to ensure removal of medication from the ampule neck Using sterile gauze to break the ampule neck away from the nurse's body to prevent injury from glass shards (Option 2) Setting the ampule on a flat surface or inverting it to withdraw the medication Disposing of the ampule in a sharps container (Option 3) (Option 1) Glass shards may be present in the medication after an ampule is opened. To prevent the accidental administration of glass shards, the nurse must use a filter needle, rather than an injection needle, when withdrawing medication. (Option 4) Unlike when withdrawing medication from a vial, air should not be injected into a glass ampule; this causes the contents to spill from the container. (Option 5) Ensure that the filter needle does not touch the glass edges, which are not sterile, as this can introduce bacteria. Educational objective:When preparing medication from a glass ampule, the nurse breaks the ampule away from the body and discards it in the sharps container. The nurse withdraws medication using a filter needle to prevent the injection of glass shards, avoids touching the needle to contaminated ampule edges, and avoids injecting air to prevent spillage.

Low pressure alarm (low tidel volume alarm)

A leak within the ventilator circuitry. Either the tubing has come apart or that client has become disconnected from the ventilator tubing. Almost all low-pressure alarms are the result of a malfunction or displacement of connections somewhere between the endotracheal or tracheostomy tube and the ventilator.

What is malignant hyperthermia?

A side effect of general anesthesia - Malignant hyperthermia (MH) is a rare and life-threatening condition precipitated by certain medications used for anesthesia, including inhaled anesthetics (eg, desflurane, isoflurane, halothane) and succinylcholine (a paralytic used adjunctively for intubation and general anesthesia). Skeletal muscles become unable to control calcium levels, leading to a hypermetabolic state manifested by contracture and increased temperature. Early signs of MH include tachypnea, tachycardia, and a rigid jaw or generalized rigidity. As the condition progresses, the client develops a high fever. Muscle tissue is broken down, leading to hyperkalemia, cardiac dysrhythmias, and myoglobinuria. MH requires emergent treatment with IV dantrolene to reverse the process by slowing metabolism. Succinylcholine should be discontinued. Other interventions include applying cooling blankets to reduce temperature and treating high potassium levels.

not dead until warm and dead

A weak and thready pulse is generally detected in near-drowning victims due to hypothermia. Once the client is properly warmed, the pulse generally returns to normal. Sometimes the client is so cold that a pulse cannot be detected; this is why a client is not dead until warm and dead. Such clients may require prolonged resuscitation.

Types of Hepatitis

A: fecal/oral- think water and food B: body/blood, think healthcare C: body/blood, think needles D: body/blood E: fecal/oral- think water and food

DKA and K+

Educational objective: Hypokalemia often occurs with resolution of diabetic ketoacidosis and administration of IV insulin, which shifts potassium from the intravascular to the intracellular space. Potassium is administered even when the client is normokalemic (3.5-5.0 mEq/L [3.5-5.0 mmol/L]) to prevent life-threatening arrhythmias.

what do we do if a client is in V TACH on the monitor?

ASSESS them for a pulse. Clients in ventricular tachycardia (VT) can be pulseless or have a pulse. Treatment is based on this important initial assessment. VT with a pulse should be further assessed for clinical stability or instability. Signs of instability include hypotension, altered mental status, signs of shock, chest pain, and acute heart failure. The unstable client in VT with a pulse is treated with synchronized cardioversion. The stable client in VT with a pulse is treated with antiarrhythmic medications (eg, amiodarone, procainamide, sotalol). (Option 2) Oxygen saturation should be assessed after the presence of a pulse has been established. (Options 3 and 4) CPR and defibrillation should be initiated only in a client who is pulseless. Educational objective: The client in VT must be assessed for the presence or absence of a pulse before further assessment or treatment is initiated. The unstable (hypotensive) client in VT with a pulse is treated with synchronized cardioversion.

hyperthroidism diet

Adherence to a high calorie diet (4000-5000 calories per day). Consumption of approximately 6 full meals and snacks per day. These should be packed with protein (1-2 g/kg of ideal body weight), carbohydrates, and be full of vitamins and minerals (Option 1). Avoidance of high-fiber foods due to the constant hyperstimulation of the gastrointestinal (GI) tract. High-fiber foods may increase GI symptoms (eg, diarrhea) (Option 2). However, high-fiber diets are recommended if the client with hyperthyroidism has constipation. Avoidance of stimulating substances (eg, caffeinated drinks: coffee, tea, soft drinks). Avoidance of spicy foods as these can also increase GI stimulation.

Haloperidol (Haldol)

An antipsychotic drug thought to block receptor sites for dopamine, making it effective in treating the delusional thinking, hallucinations and agitation commonly associated with schizophrenia.

Adult AED pads on child

An automated external defibrillator (AED) should be used as soon as it is available. Adult AED pads can be used on a pediatric client if pediatric pads are unavailable. One pad is placed on the chest and the other is placed on the back ("sandwiching the heart"). 8 years or younger, place like child. over 8 years, place like adult.

Atropine

Anticholinergic used for sinus brady too

Clopidogrel (plavix)

Antiplatelet

criteria for rapid response call

Any provider worried about the client's condition OR An acute change in any of the following: Heart rate <40 or >130/min Systolic blood pressure <90 mm Hg Respiratory rate <8 or >28/min Oxygen saturation <90 despite oxygen Urine output <50 mL/4 hr Level of consciousness

abgs- what to do and not do before they get them drawn

Arterial blood gases (ABGs) indicate the acid-base balance in the body and how well oxygen is being carried to the tissues. It is common to measure ABGs after a ventilator change to assess how well the client has tolerated it. Factors such as changes in the client's activity level or oxygen settings, or suctioning within 20 minutes prior to the blood draw can cause inaccurate results. Unless the client's condition dictates otherwise, the nurse should avoid suctioning as it will deplete the client's oxygen level and cause inaccurate test results.

enteral feedings via NG tube...how do we help them no aspirate?

Educational objective: Assessing gastric residual volumes and level of sedation at regular intervals, checking enteral feeding tube placement, and administering continual rather than bolus tube feeding are interventions that help prevent aspiration in critically ill high-risk clients. i would have thought bolus because it seemed like a little here, a little there...but bolus is a large amount at once, remember.

how to self-administer nasal spray

Assume a high Fowler's position with head slightly tilted forward (Option 1) Insert the nasal spray nozzle into an open nostril, occluding the other nostril with a finger. Point the nasal spray tip toward the side and away from the center of the nose. Spray the medication into the nose while inhaling deeply. Remove the nozzle from the nose and breathe through the mouth Repeat the above steps for the other nostril Blot a runny nose with a facial tissue, but avoid blowing the nose for several minutes after instillation

Malignant hyperthermia definition

Autosomal-dominant trait characterized by often fatal hyperthermia in affected people exposed to certain anesthetic agents.

what to do if you hear the low pressure alarm and cannot find the source

BAG THE CLIENT A low tidal volume alarm indicates that the volume of air the ventilator is delivering is lower than the set volume. This is most often due to a disconnection, loose connection, or leak in the circuit. The nurse should troubleshoot the most common causes of the alarm, but if the client's condition is deteriorating clinically (eg, decreasing oxygen saturation), then the nurse should disconnect the ventilator and manually ventilate the client's lungs with a resuscitation bag device at 10-15 L/min oxygen until the ventilator alarm state can be resolved.

bipap

BIPAP involves the use of a mechanical device and facemask in a conscious client who is breathing spontaneously. BIPAP delivers oxygen to the lungs and then removes carbon dioxide (CO2). CO2 retention causes mental status changes. If the client becomes drowsy or confused, it is likely that more CO2 is being retained than what BIPAP can remove; this should be reported to the HCP. Arterial blood gas evaluation should be obtained to determine CO2 level and BIPAP effectiveness. Altered mental status poses the greatest threat to a client's survival as it can lead to decreased protective reflexes (eg, gag, swallow, cough), periods of apnea, and airway compromise. Educational objective: In a client with COPD exacerbation, it is most important for the nurse to monitor mental status frequently and report changes such as restlessness, decreased level of consciousness, somnolence, difficult arousal, and confusion to the HCP. These signs may indicate increased CO2 retention and worsening hypercapnia, which would necessitate an immediate change in therapy.

Meningitis (uworld Q)

Bacterial meningitis is an infection that causes inflammation of the membranes covering the brain and spinal cord (ie, meninges). Inflammation and bacterial growth within the meninges lead to increased cerebrospinal fluid (CSF) volume and increased intracranial pressure (ICP). Without intervention, increased ICP may lead to nerve ischemia and permanent functional impairment (eg, hearing loss, visual impairment, paralysis), brain herniation, or death. The nurse should perform the following interventions: -Maintain the head of the bed elevated at 30 degrees with the head and neck midline to reduce ICP by promoting drainage of cerebral venous blood and CSF -Implement seizure precautions due to potential neurologic irritability from increased ICP -Ensure a restful environment (eg, quiet, dimly lit, cool temperature) by reducing potentially irritable stimuli

Dantrolene

Blocks Ca2+ release from sarcoplasmic reticulum of skeletal muscle. Used in muscle spasm (cerebral palsy, multiple sclerosis, cord injury) and in emergency treatment of hyperthermia caused by malignant hyperthermia, malignant neuroleptic syndrome, and serotonin syndrome

diabetes insipidus levels in the body

Educational objective: Diabetes insipidus is a condition in which antidiuretic hormone is insufficiently produced or suppressed, resulting in polydipsia and polyuria (up to 20 L/day). Urine is copious and dilute with a low specific gravity (<1.003). Fluid volume deficit can lead to dehydration, hypernatremia, high serum osmolality, and weight loss.

endotrachial intubation

Educational objective: Endotracheal suctioning in mechanically ventilated clients should be performed based on assessment findings such as adventitious breath sounds, elevated peak airway pressure, coughing, or acute respiratory distress. Suctioning should be performed only when needed to reduce the risk of lung trauma and hypoxia.

If between 2 different answers, always pick _____________

assess

adult chest compressions

Educational objective: For high-quality adult cardiopulmonary resuscitation, compressions should be in the center of the chest... (not high or low on chest); at a rate of 100-120/min; and at least 2 in (5 cm) but no more than 2.4 in (6 cm) deep for adequate perfusion without unnecessary client injury. Compression interruption should be minimized (eg, 30 compressions to 2 rescue breaths).

Malignant hyperthermia

Educational objective: Malignant hyperthermia (MH) is a rare, life-threatening inherited muscle abnormality that is triggered by certain drugs used to induce general anesthesia. The most specific characteristic signs and symptoms of MH include hypercapnia, muscle rigidity, and hyperthermia. in u world, i choose temperature but that's not a sign

neurogenic shock

Educational objective: Neurogenic shock/distributive shock can occur from vasodilation soon after spinal injury. Classic symptoms are hypotension, bradycardia, and pink and dry skin. The hypotension must be treated with isotonic fluids to maintain vital organ perfusion. Q asks about what to do 1st...give IV fluids (C, circulation...then a neuro assesment)

tonsilitis

Educational objective: Postoperative tonsillectomy interventions include close observation for signs of bleeding (eg, frequent swallowing!!!) as well as avoidance of routine oral suctioning and the use of straws. Expected findings include white, fluid-filled exudate in the throat with halitosis, low-grade fever, and referred ear pain. don't suction throat.

Rotovirus

Educational objective: Rotavirus is a contagious infection that is easily spread via the fecal-oral route by touching contaminated objects, food, and hands. It is not treated with antibiotics as it is a viral infection. Vaccination is available for children less than 8 months old. Children with rotavirus are at risk for dehydration.

dash diet

Educational objective: The Dietary Approaches to Stop Hypertension (DASH) diet is often recommended to reduce blood pressure in clients with hypertension. The client is taught to limit intake of sugar, sodium, cholesterol, and trans or saturated fats, and instead choose healthier options (eg, fresh fruit and vegetables, low-fat dairy products).

phlebostatic axis

Educational objective: The anatomical location of the phlebostatic axis is the 4th ICS, at the midway point of the AP diameter (½ AP) of the chest wall. The stopcock nearest the transducer is placed here to assure accurate pressure measurements.

reaction after vaccine

Educational objective: The normal MMRV vaccine reactions that occur within 5-12 days after vaccination include mild fever and rash, irritability and restlessness, and swelling and erythema at the injection site. Febrile seizure is a rare but more serious reaction to the vaccine. 5-12 days is normal. ask the parents what the temp is. if it is high, give tylenol.

IM injection for Newborns

Educational objective: The preferred site for intramuscular (IM) injection in newborns is the vastus lateralis muscle in the anterolateral portion of the middle thigh. A 1-mL syringe should be used, and medication dosages should be calculated to two decimal places. A ⅝-inch, 22- to 25-gauge needle is appropriate for IM injection in a newborn.

UTI prevention in kids

Educational objective: Urinary stasis, constipation, and infrequent voiding are contributing factors to UTIs. The child should be encouraged to drink fluids and avoid holding in urine. Tight clothing and synthetic fabrics (eg, spandex, nylon, Lycra) should be avoided; cotton underwear is recommended. Scented soaps, bubble baths, and antibacterial soaps should not be used for bathing a child (the tub should be filled with water only), and the hair should be washed last.

differnt line assessments

Educational objective: When caring for a client with a radial, brachial, or femoral arterial line in place, the nurse must be able to assess for complications. These include hemorrhage, infection, thrombus formation, and circulatory and neurovascular impairment.

preventing mechanical vent complications

Clients requiring mechanical ventilation are at risk for a variety of ventilator-associated complications (eg, aspiration, pneumonia). When caring for a client receiving mechanical ventilation, the nurse should: Monitor respiratory status (eg, lung sounds, breathing pattern), airway patency, and ventilator functionality (eg, settings, alarm parameters). Maintain the head of the bed at 30-45 degrees to reduce aspiration risk (Option 1). Use the minimum amount of sedation necessary for client comfort (eg, compliant with ventilator, opens eyes to voice). Continuous IV sedation should be paused daily for evaluation of spontaneous respiratory effort and appropriateness for weaning off the ventilator (Option 3). Perform oral care with chlorhexidine oral solution every 2 hours, or per facility policy (Option 4). Perform tracheal suctioning as needed. Monitor correct endotracheal tube placement by noting insertion depth. Place emergency equipment at bedside (eg, manual resuscitation bag) (Option 5).

Diabetic foot care

Careful, daily attention to foot care can prevent long-term complications. Proper footwear - Wear shoes that are comfortable, supportive, and well-fitting (preferably leather). Avoid high-heeled, open-heeled, and open-toed shoes. Wear clean, absorbent (eg, cotton) socks. Daily hygiene and inspection - Use a mild soap and warm water; dry feet thoroughly, especially between toes. Apply lanolin lotion to prevent drying (but not between toes) (Option 1). Inspect for any break in skin integrity using a mirror or a second person to visualize the bottom of the feet. Trim toenails straight across; file edges along contour of the toes. Injury avoidance - Do not walk barefoot, use hot water or heating pads, wear restrictive shoes or clothing, or cross the legs for extended periods (Options 3 and 4). Report problems - Do not self-treat corns, calluses, or ingrown toenails. Cleanse cuts or abrasions with mild soap and water; report non-healing or infected injuries to the health care provider immediately. Educational objective: Careful, daily attention to foot care can prevent long-term complications. Clients with diabetes should be taught to wear closed-toed, leather-based shoes to prevent injury. Clients should also receive instruction regarding daily hygiene and inspection, injury avoidance, and prompt reporting of problems.

plethysmograph waveform with a patient

Educational objective: When the nurse assesses an erratic plethysmograph waveform, the first action is to assess the client's oxygenation/perfusion status and assess for a motion artifact. This assessment data guides the nurse in the correct analysis of the tracing.

when is cap refill most important?

Capillary refill time is indicated to assess poor perfusion states, and a value of >3 seconds (delayed refill time) is seen in conditions such as dehydration, shock, and peripheral vascular disease.

CSF can confirm a skull fracture and that you can't use an NG tube

Cerebrospinal fluid (CSF) rhinorrhea (or CSF otorrhea) can confirm that a skull fracture has occurred and transversed the dura. If the drainage is clear, dextrose testing can determine if it is CSF. However, the presence of blood would make this test unreliable as blood also contains glucose. In this case, the halo/ring test should be performed by adding a few drops of the blood-tinged fluid to gauze and assessing for the characteristic pattern of coagulated blood surrounded by CSF. Identification of this pattern is very important as CSF leakage places the client at risk for infection. The client's nose should not be packed. No nasogastric or oral gastric tube should be inserted blindly when a basilar skull fracture is suspected as there is a risk of penetrating the skull through the fracture site and having the tube ascend into the brain. These tubes are placed under fluoroscopic guidance in clients with such fractures. (Option 1) A bruise is an expected finding after direct trauma. It would be a concern if the ecchymosis were around the eyes (periorbital, "raccoon eyes") or postauricular (Battle's sign) as this generally indicates a basilar skull fracture, a tear in the dura, and a potential CSF leak. (Option 2) A headache is an expected finding after trauma. It would be a concern if it were unrelieved by non-narcotic analgesics or accompanied by signs of increased intracranial pressure. (Option 4) The head is highly vascular and it is not unusual to have blood oozing after trauma. This is not as concerning as a potential CSF leak. However, it can become a problem if the nurse is unable to eventually stop the bleeding as substantial total blood loss is a concern. Educational objective: A nasogastric tube should not be inserted when a basilar skull fracture is suspected. CSF leakage is an indication of this and can be evidenced by a positive halo/ring test of the blood-tinged nasal drainage (coagulated blood surrounded by CSF).

some CPR essentials

Chest compressions are performed at a rate of 100-120/min and a depth of 2.0-2.4 inches (5-6 cm), allowing complete chest recoil between compressions Defibrillator pads are placed on the right upper chest, just below the clavicle, and on the left lateral chest, near the anterior axillary line below the nipple line During CPR, compressions are paused every 2 minutes to assess the client's pulse. This pause should be no longer than 10 seconds to minimize delays between compression cycles. Manual breaths are administered at a rate of 2 breaths per 30 chest compressions in clients without advanced airways or once every 6 seconds without chest compression interruption with advanced airway placement. The team member managing the defibrillator should use firm verbal cues (eg, "stand clear!") to clear all team members from contact with the client, followed by visual confirmation before defibrillation. Educational objective: During cardiopulmonary resuscitation, chest compressions are performed at a rate of 100-120/min. Defibrillator pads are placed on the right upper chest and on the left lateral chest.

what to watch for after surgery for aortic valve replacement

Chest drainage >100 mL/hr should be reported to the HCP. Large losses of blood may indicate a compromise of the surgical suture site and may require repair. The client can quickly become hemodynamically unstable and may require a return to surgery or transfusion of blood products. (Option 2) Clients who receive a mechanical valve replacement will be started on anticoagulants. A therapeutic INR is 2.5-3.5. This client just had surgery and so has not received enough anticoagulation to get the INR to a therapeutic level. (Option 3) Although this is an abnormal temperature, it is not as high a priority as the blood loss. The nurse should continue to monitor and administer prescribed postoperative antibiotics. (Option 4) Normal urine output is 30 mL/hr. This urine level is just 5 mL below normal. The nurse should continue to monitor. Educational objective: Postoperative blood loss >100 mL/hr should be reported to the HCP immediately. The client may have a compromised suture site and can rapidly become hemodynamically unstable.

how do you initially treat and SVT?

Clients with paroxysmal supraventricular tachycardia (SVT) (regular, narrow QRS complex tachycardia) are initially treated with vagal maneuvers. The act of "bearing down" as if having a bowel movement (Valsalva) is an example of these maneuvers and may need to be attempted more than once. Vagal maneuvers work by increasing intra-thoracic pressure and stimulating the vagus nerve, which supplies parasympathetic nerve fibers to the heart, resulting in slowed electrical conduction through the atrioventricular node. (Option 2) Cardioversion (not defibrillation) is used with this type of arrhythmia when it is refractory to medication. Cardioversion delivers a synchronized electrical current to the heart. This works by stopping the electrical activity to the heart and briefly allowing a normal heartbeat to return. (Option 3) An ECG is used to diagnose SVT and can be obtained while or after the client is asked to perform the vagal maneuvers as it is not therapeutic. (Option 4) Adenosine is the drug of choice to treat SVT and has a 5- to 6-second half-life (the time it takes for the drug to be reduced to half of its original concentration). Placing the IV line as close as possible, not distal, to the heart is essential for the drug to have full effect. Adenosine is given rapidly over 1-2 seconds and then followed by a rapid 20-mL normal saline flush. Transient asystole is common, and clients often experience flushing and dizziness. Educational objective:Supraventricular tachycardia is a regular, narrow QRS complex tachycardia with a rate of around 150-220/min. The best treatment is vagal maneuvers and adenosine IV push.

Botulism

Clostridium botulinum causes it. Educational objective: Infant botulism is food poisoning causing life-threatening paralysis, which occurs after consuming Clostridium botulinum. Infants (age <1 year) with signs of botulism (eg, constipation, difficulty feeding, decreased head control, diminished deep-tendon reflexes) require prompt intervention because respiratory failure may develop rapidly.

Charting body fluids COACH

Color Odor Amount Consistency How the client is tolerating it

acromegaly

Common clinical features of untreated acromegaly: Local tumor effect: Pituitary enlargement, visual field defects, headache Musculoskeletal/skin: Gigantism, maloccluded jaw, arthralgias/arthritis, hyperhidrosis, skin tags Cardiovascular: Hypertension, heart failure Enlarged organs: Tongue, thyroid, salivary glands, liver, spleen, kidney, prostate Endocrine: Galactorrhea, decreased libido, diabetes mellitus question on Uworld said S3 and S4 heart sounds which can mean heart failure. not good for this pt.

coup-contrecoup injury

Dual impacting of the brain into the skull; coup injury occurs at the point of impact; contrecoup injury occurs on the opposite side of impact, as the brain rebounds. can cause visual disturbances

Cushing's versus Addison's

Cushing is gushing cortisol. Addison's patient's cortisol doesn't add up.

cushings from Uworld

Cushing syndrome is the result of prolonged exposure to excess corticosteroids, especially glucocorticoid steroids. The most common cause is the administration of corticosteroids, such as prednisone or hydrocortisone, for other conditions. However, pituitary adenomas can secrete adrenocorticotropic hormone (ACTH), which in turn causes the adrenal glands to produce too much cortisol. Clinical manifestations include: Androgen excess from adrenal gland stimulation can result in acne, hirsutism, and menstrual irregularities (eg, oligomenorrhea). Metabolic complications include truncal obesity (subsequently causing peripheral insulin resistance), hypertension, and hyperglycemia (ie, excess cortisol stimulating gluconeogenesis). Fat accumulation in the face (ie, moon face) and the back of neck (ie, buffalo hump) is common (Options 1, 2, and 4). Dermatological changes are possible and include easy bruising, purple striae, and skin atrophy; these result from loss of collagen. Proximal muscle weakness and bone loss (ie, osteoporosis) due to steroid catabolism on muscles and bone can develop in untreated clients. (Options 3 and 5) Hyponatremia and weight loss are associated with adrenocortical insufficiency, or Addison disease. Educational objective: Clinical manifestations of Cushing syndrome include weight gain, truncal obesity, moon face, skin atrophy, easy bruising, purple striae on the abdomen, muscle weakness, hypertension, and hyperglycemia. Associated androgen excess can result in acne, hirsutism, and menstrual irregularities.

Diabetic Insipidus

DI= diuresis ADH deficiency/ insensitivity to ADH- inability of kidney to concentrate urine--- large amounts of dilute urine -sx- polyuria, polydypsia, hypernatermia -dx- fluid deprivation test (continued dilute urine)--- desmopressin (central= reduction in urine output, nephrogenic= contuned dilute) -tx- central= Desmopressin acetate. nephrogenic= NA/protien restriction hypotonic for sx SE of lithium

Decerebrate posturing

Decerebrate posturing (arms and legs straight out, toes pointed down, head/neck arched back) usually indicates severe brain injury.

Succinylcholine

Depolarizing neuromuscular blocker

contact precautions for which diseases?

Diseases that are known or suspected to be transmitted by direct contact: • Clostridium difficile • Colonization or infection caused by multidrug-resistant organisms (e.g., MRSA, VRE) • Pediculosis • Respiratory syncytial virus • Scabies

droplet precautions for which diseases?

Diseases that are known or suspected to be transmitted by droplets: • Diphtheria (pharyngeal) • Streptococcal pharyngitis • Pneumonia • Influenza • Rubella • Invasive disease (meningitis, pneumonia, sepsis) caused by Haemophilus influenzae type B or Neisseria meningitis • Mumps • Pertussis

near-drowning victims

Emergency department care of near-drowning victims includes advanced airway management, aggressive oxygenation, establishing IV access and administering IV fluids (warmed if hypothermic), and monitoring for cardiac arrhythmias and fluid imbalances.

where do you hear S1 and S2?

Erb's point (Left 3rd intercostal space (S1 and S2) too

high pressure alarm

Excess secretions, client biting tube, kinks, cough, edema, pneumothorax, bronchospasm

FIRST thing we always do with DKA

FLUIDS...IV or Bolus...not always IV insulin 1st.

Fifth Disease

Fifth disease ("slapped face," or erythema infectiosum) is a viral illness caused by the human parvovirus and affects mainly school-age children. The virus spreads via respiratory secretions, and the period of communicability occurs before onset of symptoms. The child will have a distinctive red rash on the cheeks that gives the appearance of having been slapped. The rash spreads to the extremities and a maculopapular rash develops, which then progresses from the proximal to distal surfaces. The child may have general malaise and joint pain that are typically well controlled with nonsteroidal anti-inflammatory drugs such as ibuprofen. Affected children typically recover quickly, within 7-10 days. Once these children develop symptoms (eg, rash, joint pains), they are no longer infectious. Isolation is not usually required unless the child is hospitalized with aplastic crisis or immunocompromising condition. (Options 1, 3, and 4) These statements indicate that parent teaching regarding fifth disease was effective. Educational objective: Children with fifth disease are communicable only prior to onset of symptoms (eg, rash, joint pains). The causative agent, human parvovirus, spreads via respiratory secretions. Fifth disease is self-limiting and short-lived; treatment is given to alleviate symptoms. Isolation is not usually required for a non-hospitalized child.

treatment of frostbite

Frostbite involves tissue freezing, resulting in ice crystal formation in intracellular spaces that causes peripheral vasoconstriction, reduced blood flow, vascular stasis, and cell damage. Superficial frostbite can manifest as mottled, blue, or waxy yellow skin. Deeper frostbite may cause skin to appear white and hard and unable to sense touch. This can eventually progress to gangrene. Treatment of frostbite should include the following: Remove clothing and jewelry to prevent constriction. Do not massage, rub, or squeeze the area involved. Injured tissue is easily damaged (Option 3). Immerse the affected area in water heated to 98.6-102.2 F (37-39 C), preferably in a whirlpool. Higher temperatures do not significantly decrease rewarming time but can intensify pain (Option 5). Avoid heavy blankets or clothing to prevent tissue sloughing. Provide analgesia as the rewarming procedure is extremely painful (Option 4). As thawing occurs, the injured area will become edematous and may blister. Elevate the injured area after rewarming to reduce edema (Option 2). Keep wounds open immediately after a water bath or whirlpool treatment and allow them to dry before applying loose, nonadherent, sterile dressings (Option 1). Monitor for signs of compartment syndrome. Educational objective: Care of the client with frostbite focuses on preventing further injury and reducing pain. This includes removing items that can cause constriction or sloughing; no massaging or rubbing of the injured area; providing warm water soaks and analgesia; elevating injured areas; applying loose, nonadherent, sterile dressings; and monitoring for compartment syndrome.

Burn percentages

GENITALS: 1% CHEST: 8% BACK: 8% EACH ARM: 9% HEAD: 9% EACH LEG: 18%

gastric lavage

Gastric lavage (GL) is performed through an orogastric tube to remove ingested toxins and irrigate the stomach. GL is rarely performed as it is associated with a high risk of complications (eg, aspiration, esophageal or gastric perforation, dysrhythmias). GL is only indicated if the overdose is potentially lethal and if GL can be initiated within one hour of the overdose. Activated charcoal administration is the standard treatment for overdose, but it is ineffective for some drugs (eg, lithium, iron, alcohol). Intubation and suction supplies should always be available at the bedside during GL in case the client develops aspiration or respiratory distress (Option 3). (Option 1) GL is usually performed through a large-bore (36 to 42 French) orogastric tube so that a large volume of water or saline can be instilled in and out of the tube. (Option 2) During GL, clients should be placed on their side or with the head of bed elevated to minimize aspiration risk. (Option 4) GL should be initiated within one hour of overdose ingestion to be effective. The client's stomach should be decompressed first, but lavage should be initiated as soon as possible afterwards. Educational objective: Gastric lavage is used to remove ingested toxins and irrigate the stomach after a drug overdose. It should be initiated within one hour of overdose. The nurse should position the client to prevent aspiration and have emergency respiratory equipment at the bedside.

Propofol (Diprivan)

General Anesthetic/Sedative/Hypnotic

Guillain-Barre syndrome

Guillain-Barré syndrome (GBS) is an acute, immune-mediated polyneuropathy that is most often accompanied by ascending muscle paralysis and absence of reflexes. Lower-extremity weakness progresses over hours to days to involve the thorax, arms, and cranial nerves (CNs). Neuromuscular respiratory failure is the most life-threatening complication. The rate and depth of the respirations should be monitored. Educational objective: The most serious complication to monitor for in new-onset Guillain-Barré syndrome is respiratory compromise from the paralysis ascending into the thoracic region. Monitoring for rate/depth of respirations and measuring serial bedside vital capacity (spirometry) help to detect this early in the disease course.

acute illness and prednisone can cause what?

HYPERGLYCEMIA...high, not low like exercise

trendelenburg position is used to treat_________________

HYPOTENSION The Trendelenburg position, not the reverse Trendelenburg position, is used with clients with hypotension.

Barotrauma

High levels of PEEP (10-20 cm H2O [7.4-14.8 mm Hg]) can cause overdistension and rupture of the alveoli, resulting in barotrauma to the lung. Air from ruptured alveoli can escape into the pulmonary interstitial space or pleural space, resulting in a pneumothorax and/or subcutaneous emphysema.

hypertensive crisis

Hypertension with Angina, Pulmonary Edema, Pregnancy or signs of cerebral edema (such as usually severe headache blurred vision/visual disturbances, nausea and vomiting, altered mental status, focal neurological sign or deficits, paresthesias, dizziness, vertigo or tinnitus

what to do for hypovolemic shock

Hypotension, tachycardia, and low central venous pressure (normal: 2-8 mm Hg) may indicate hypovolemic shock. Central venous pressure is a measurement of right ventricular preload (volume within the ventricle at the end of diastole) and reflects the client's fluid volume status. This client is recovering from major abdominal surgery and has a low-grade fever, placing the client at risk for fluid volume losses (eg, blood loss during surgery, insensible losses [sweating]). This client should be treated with isotonic fluids (eg, normal saline, lactated Ringer solution) to restore adequate fluid volume status. IV boluses of isotonic fluids (ie, fluid resuscitation) increase intravascular volume, which increases blood pressure and end-organ perfusion (Option 4). (Option 1) Acetaminophen is an analgesic and antipyretic that reduces fever and pain; however, the client's hemodynamic stability should be addressed first. (Option 2) Cefazolin, a cephalosporin antibiotic, may be prescribed prophylactically to prevent intra-abdominal infection after major abdominal surgery. Medications timed "now" should be administered within 90 minutes. This intervention should be performed after stabilizing the client's hemodynamic status. (Option 3) If the client remains hypotensive following a fluid bolus, vasopressor or inotropic medications (eg, norepinephrine, dopamine) should be initiated. However, vasopressor medications are not effective without first restoring circulatory fluid volume as there is insufficient volume to compress within the vascular space. Educational objective: Hypotension, tachycardia, and decreased central venous pressure (normal: 2-8 mm Hg) may indicate hypovolemic shock. IV boluses of isotonic fluids (ie, fluid resuscitation) increase intravascular volume, which increases blood pressure and perfusion.

Hypothermia protocol

Hypothermia occurs when the core temperature is below 95 F (35 C) and the body is unable to compensate for heat loss. As the core temperature decreases, the cold myocardium becomes extremely irritable and prone to dysrhythmias. The client should be handled gently as spontaneous ventricular fibrillation could develop when moved or touched. Therefore, placing the client on a cardiac monitor is a high priority; the nurse should anticipate defibrillation in these clients. (Option 2) Covering the client's head is indicated to prevent heat loss; however, this can be done after the cardiac monitor has been attached. Depending on the severity of the hypothermia, the trunk should be warmed before the extremities to reduce the risk of afterdrop (core temperature drops further). This is due to cold peripheral blood returning to the central circulation. (Option 3) A blood draw for laboratory testing is important but should be performed after the cardiac monitor is attached. (Option 4) Two large-bore IV catheters are preferred; this can be accomplished after the cardiac monitor has been attached. Educational objective: Cardiac monitoring and gentle handling of the client are a high priority with hypothermia. The cold myocardium is extremely irritable and prone to dysrhythmias. The nurse should anticipate defibrillation in these clients.

if the transducer is misplaces

If the transducer is placed too low, the reading will be falsely high; if placed too high, the reading will be falsely low. This concept is similar to the positioning of the arm in relation to the level of the heart when measuring blood pressure indirectly using a sphygmomanometer or noninvasive blood pressure-monitoring device. The upper arm should be at the level of the phlebostatic axis.

immunocompromised and vaccines for varicella

Immunocompromised clients should not receive live attenuated vaccines (eg, varicella virus vaccine). In addition, the vaccine is not indicated for a client who has already developed immunity after recovering from VZV infection. Educational objective: Treatment for clients with varicella-zoster virus infection (chickenpox) is supportive and includes acetaminophen for fever or pain, cool oatmeal baths, and topical antihistamines for itching. Immunocompromised clients are at risk for complications (eg, severe disseminated varicella) and should receive antiviral therapy. Clients are infectious until all lesions crust over.

Impetigo

Impetigo is a highly contagious bacterial skin infection, most commonly occurring in children during hot, humid weather. Impetigo is characterized by itchy, burning, red pustules that rupture to form honey-colored crusts. When treated with antibiotic ointment and/or oral antibiotics, lesions are no longer contagious after 24-48 hours and typically heal within a week. Without antibiotics, impetigo typically resolves within 2-3 weeks but remains highly contagious until lesions heal. To care for and decrease transmission of impetigo, interventions include: Performing handwashing before and after touching the infected area (Option 1) Isolating the infected person's clothing and linens and washing them in hot water (Option 3) Keeping the infected person's fingernails short and clean to prevent bacteria from collecting under them and to deter scratching (Option 4) Avoiding close contact with others for 24-48 hours after initiation of antibiotic therapy (Option 5) Keeping the infected area covered with gauze when in contact with others (eg, while at school) (Option 2) Impetigo lesions should be soaked with warm water, saline, or Burow's solution (a skin-soothing astringent) and gently cleansed with mild antibacterial soap before applying antibiotic ointment. This helps remove infected crusts and reduce irritation. Alcohol is irritative and should be avoided. Educational objective: Impetigo is a highly contagious bacterial skin infection. Caregivers can decrease transmission by keeping the client's nails short and clean, isolating the client's linens and washing them with hot water, and preventing close contact with others while the client is contagious. Lesions are soaked and cleansed with mild antibacterial soap to remove crusts before applying antibiotic ointment.

Stages of Shock

Initial (early stages) Compensatory Progressive Irreversible (cold clammy skin, according to U world is progressive)....find a good chart...

chest pain protocols

Initial interventions in emergency management of chest pain are as follows: Assess airway, breathing, and circulation (ABCs) Position client upright unless contraindicated Apply oxygen, if the client is hypoxic Obtain baseline vital signs, including oxygen saturation Auscultate heart and lung sounds Obtain a 12-lead electrocardiogram (ECG) Insert 2-3 large-bore intravenous catheters Assess pain using the PQRST method Medicate for pain as prescribed (eg, nitroglycerin) Initiate continuous electrocardiogram (ECG) monitoring (cardiac monitor) Obtain baseline blood work (eg, cardiac markers, serum electrolytes) Obtain portable chest x-ray Assess for contraindications to antiplatelet and anticoagulant therapy Administer aspirin unless contraindicated

INR range

International Normalization Ratio for pts on warfarin/coumadin normal is 0.8-1 pts on warfarin: within 2-3 considered therapeutic find the X's range...1.5-2.5 normal? heparin too?

After laboring woman gets an epidural, you put her in what position and why?

LEFT LATERAL for perfusion of the placenta.

Trismus

LOCKJAW Inability to open the jaw due to pain

Lead Placement

Left: Smoke (Black) over Fire (Red) Right: Snow (White) over Grass (Green) Center: Chocolate (place a little off center for possible CPR)

measles information

Measles (ie, rubeola) is a highly contagious viral illness that affects people of all ages. Measles spreads when infected individuals cough or sneeze, sending the virus through the air, where it remains suspended for up to 2 hours. Widespread vaccination with the measles, mumps, and rubella (MMR) vaccine, such as in the United States, has reduced measles incidence by 99%. However, an increase in international travel and unvaccinated children have caused a resurgence of the disease. For hospitalized clients with measles, the plan of care should include the following: Recommendation of postexposure prophylaxis (ie, MMR vaccine) for eligible, susceptible (eg, unvaccinated) family members within 72 hours of exposure to decrease the severity and duration of symptoms in case they contract the disease (Option 1) Implementation of airborne precautions, including a negative-pressure isolation room and use of an N95 respirator mask, during contact with the client by health care staff (Options 4 and 5) Administration of vitamin A supplements to prevent severe, measles-induced vitamin A deficiency, which can cause blindness, particularly in clients in low-resource areas (Option 2) An erythematous, maculopapular, morbilliform rash is characteristic of measles, but it is not typically pruritic. Calamine lotion is effective for soothing pruritic rashes (eg, varicella [chickenpox]). (Option 3) A tracheostomy tray is not required for this client with measles because respiratory paralysis or emergency intubation is not expected. Educational objective: Clients with measles are highly contagious and require airborne precautions (eg, negative-pressure isolation room, N95 respirator). Susceptible family members should receive postexposure prophylaxis (eg, measles, mumps, and rubella vaccine).

diabetic diet

Monitor carbohydrate intake Manage caloric intake if weight loss is desired High-fiber foods (30-35 g of fiber per day), including whole grains, legumes, fruits, vegetables, and low-fat dairy products Use monounsaturated fats, limit use of saturated fat, and eliminate trans fatty acids Choose foods with a low glycemic index Consume total cholesterol of <300 mg per day Reduce sodium intake Limit intake of foods containing sucrose Limit intake of alcoholic beverages

mononucleosis (MONO)

Mononucleosis is caused by the Epstein-Barr virus. It is typically seen in adolescence from the sharing of drinks, kissing, or other direct exposure to saliva. Symptoms may include fatigue, fever, sore throat, splenomegaly, hepatomegaly, and swollen lymph nodes. Antibiotic treatment is inappropriate for a viral infection. Inadvertent intake of antibiotics (amoxicillin) can cause a rash. Treatment for mononucleosis is management of symptoms and includes hydration, rest, control of pain, and reducing fever as necessary. Sore throat is treated with saline gargles or anesthetic troches. Complications include airway obstruction (eg, stridor, difficult breathing) from swollen lymph nodes around the neck and severe abdominal pain (splenic rupture). These should be reported to the health care provider (HCP) immediately. (Option 2) Ibuprofen or acetaminophen is appropriate treatment to control pain and manage fever in the child with mononucleosis. Aspirin should be avoided in children due to the risk of Reye syndrome. (Option 3) Fatigue is a symptom of mononucleosis. Rest is very important in the care of a client with mononucleosis. (Option 4) Mononucleosis may cause splenomegaly or hepatomegaly. Contact sports such as soccer should be avoided to prevent injury to the spleen or liver. Educational objective: Treatment for mononucleosis is largely symptomatic. It includes rest, hydration, pain control for sore throat, and fever reduction. Clients should avoid contact sports such as soccer to prevent injury to the spleen or liver. Breathing difficulty or abdominal pain should be reported to the HCP

ICP interventions

Most nursing activities increase intracranial pressure (ICP) in brain injuries. The goal is to reduce ICP while managing basic client needs. During interventions, ICP should not exceed 25 mm Hg and should return to baseline within a few minutes. Metabolic demands (eg, pain, straining, agitation, shivering, fever, hypoxia) increase brain blood supply and raise ICP. Nursing interventions to control ICP include: Elevating the head of the bed to 30 degrees with the head/neck in a neutral position to reduce venous congestion (Option 4) Administering stool softeners to reduce the risk of straining (eg, Valsalva maneuver) Managing pain well while monitoring sedation Managing fever (eg, cool sponges, ice, antipyretics) while preventing shivering Maintaining a calm environment with minimal noise (eg, alarms, television, hall noise) (Option 3) Ensuring adequate oxygenation Hyperventilating and preoxygenating the client before suctioning; reducing CO2 (a potent cerebral vasodilator) by hyperventilation induces vasoconstriction and reduces ICP (Option 2) (Option 1) Stimulation increases oxygen metabolism within the brain, increasing the risk for irreversible brain damage in increased ICP. Limit performing interventions unless absolutely necessary and avoid performing interventions in clusters. (Option 5) The nurse should suction a maximum of 10 seconds and only as necessary to remove secretions. Prolonged suctioning increases ICP.

Pediatric Vital Signs

NCLEX folder

hypovolemic shock bed position

NOT HIGH! this will decrease the pressure. remember transdelenburg can help increase pressure

therapeutic hypothermia- why would we use this?

Neurologic injury is the most common cause of mortality in clients who have had cardiac arrest, particularly ventricular fibrillation or pulseless ventricular tachycardia. Inducing therapeutic hypothermia in these clients within 6 hours of arrest and maintaining it for 24 hours has been shown to decrease mortality rates and improve neurologic outcomes. It is indicated in all clients who are comatose or do not follow commands after resuscitation. The client is cooled to 89.6-93.2 F (32-34 C) for 24 hours before rewarming. Cooling is accomplished by cooling blankets; ice placed in the groin, axillae, and sides of the neck; and cold IV fluids. The nurse must closely assess the cardiac monitor (bradycardia is common), core body temperature, blood pressure (mean arterial pressure to be kept >80 mm Hg), and skin for thermal injury. The nurse must also apply neuroprotective strategies such as keeping the head of the bed elevated to 30 degrees. After 24 hours, the client is slowly rewarmed.

Norepinephrine (Levophed) is a vasopressor used to...

Norepinephrine (Levophed) is a vasopressor used to increase stroke volume, cardiac output, and MAP. Titrating a norepinephrine infusion upward to maintain the MAP within normal limits (>65 mm Hg) is an appropriate nursing action for a client in anaphylactic shock.

ABGs (arterial blood gases)- normal range

Normal Range-- pH: 7.35-7.45, CO2: 45-35, HCO3: 22-26

If you have to pick one answer and nothing seems right, pick which one you would choose if you could ONLY do _______________

ONE thing

PEEP range

PEEP is usually kept at 5 cm H2O (3.7 mm Hg). ???????? not sure....look up because it mentions higher levels for ARDS

Injection angles

Parenteral medications are administered via injection into body tissues using aseptic technique (eg, intradermal, intramuscular, subcutaneous, IV). Intradermal Administer injections at a 5- to 15-degree angle to reduce risk of injection into subcutaneous tissue (Option 2). Apply firm pressure to the injection site to reduce bleeding. Massaging the site introduces medication into deeper tissues and should be avoided (Option 3). Subcutaneous Administer injections at 90 degrees if 2 in (5 cm) of subcutaneous tissue can be grasped or at 45 degrees if only 1 in (2.5 cm) can be grasped (Option 1). Intramuscular Acceptable sites include the deltoid, vastus lateralis, and ventrogluteal. The ventrogluteal is preferred as fewer large blood vessels and nerves are present. Position the client supine, prone, or side-lying with the knee and hip flexed when administering ventrogluteal injections. Flexing the knee and hip reduces muscle tension, improves access, and promotes client comfort (Option 4). (Option 5) A filter needle must be used when withdrawing medication from a glass ampule to prevent aspiration and injection of glass shards. After the medication is withdrawn, the filter needle is discarded and an injection needle (eg, 20-gauge, 1-in [2.5-cm] needle) is attached to the syringe. Educational objective: Use filter needles to withdraw medications from ampules to prevent aspiration and injection of glass shards. Perform intradermal injections at 5- to 15-degree angles and avoid massaging injection sites to prevent accidental subcutaneous administration. Administer subcutaneous injections at 45 or 90 degrees, depending on the volume of subcutaneous tissue.

Pertussis (whooping cough)

Pertussis (whooping cough) is a very contagious communicable disease caused by the Bordetella pertussis bacteria. These organisms attach to the small hairs in the airway and release a toxin that causes swelling and irritation. Pertussis is spread from person to person by coughing, sneezing, and close contact. As a result, an affected client should be placed in standard (universal) and droplet isolation precautions when hospitalized. At first, symptoms similar to the common cold and a mild fever occur, but eventually these clients develop a characteristic violent, spasmodic cough. Coughing is so severe that the person is forced to inhale afterward, resulting in a distinctive, high-pitched "whooping" sound. Coughing episodes may continue until a thick mucus plug is expectorated and are sometimes followed by vomiting (posttussive emesis).

peep

Positive end-expiratory pressure (PEEP) applies a given pressure at the end of expiration during mechanical ventilation. It counteracts small airway collapse and keeps alveoli open so that they can participate in gas exchange. PEEP is usually kept at 5 cm H2O (3.7 mm Hg). However, a higher level of PEEP is an effective treatment strategy for acute respiratory distress syndrome (ARDS), a type of progressive respiratory failure that causes damage to the type II surfactant-producing pneumocytes that then leads to atelectasis, noncompliant lungs, poor gas exchange, and refractory hypoxemia. correct: High levels of PEEP (10-20 cm H2O [7.4-14.8 mm Hg]) can cause overdistension and rupture of the alveoli, resulting in barotrauma to the lung. Air from ruptured alveoli can escape into the pulmonary interstitial space or pleural space, resulting in a pneumothorax and/or subcutaneous emphysema. (Option 2) PEEP opens up collapsed alveoli and improves gas exchange at a lower fraction of inspired oxygen (FiO2), resulting in increased, not decreased, oxygen saturation. (Option 3) Hemodynamic effects of PEEP include increased intrathoracic pressure, which leads to reduced venous return, decreased preload and cardiac output, and hypotension, not hypertension. (Option 4) Keeping the alveoli open between breaths with PEEP improves gas exchange across the alveolar-capillary membrane, reduces hypoxemia, and allows for the use of a lower FiO2, which can reduce the risk for oxygen toxicity. Educational objective: High PEEP is commonly used to prevent small airway/alveolar collapse in clients with ARDS. PEEP helps to reduce oxygen toxicity. However, high levels of PEEP (10-20 cm H2O [7.4-14.8 mm Hg]) can cause barotrauma to the lung, resulting in a pneumothorax, and decreased venous return causes hypotension.

positive pressure ventilation...what can happen?

Positive pressure ventilation (PPV) delivers positive pressure to the lungs using a mechanical ventilator (MV), either invasively through a tracheostomy or endotracheal tube or noninvasively through a nasal mask/facemask, nasal prongs, or a mouthpiece. The most common type used in the acute care setting for clients with acute respiratory failure is the volume cycled positive pressure MV, which delivers a preset volume and concentration of oxygen (eg, 21%-100%) with varying pressure.

pediculosis capitis (HEAD LICE)

Preventing the spread of pediculosis capitis (head lice) may be accomplished by using hot water to launder clothing, sheets, and towels in the washing machine; these items should then be placed in a hot dryer for 20 minutes. Treatment of head lice consists of the use of pediculicides and the removal of nits (eggs). (Option 2) Head lice are not spread by oral contact with eating utensils. Instead, they are spread by direct person-to-person contact or by nits that hatch in the environment and remain on clothing, combs, and pillows. (Option 3) Spraying insecticides around children and pets in the home is not recommended due to the risk of inhalation or skin contact. (Option 4) Items that cannot be washed or dry cleaned may be placed in sealed plastic bags for 14 days to kill active lice or lice that hatch from the nits in 7-10 days. Vacuuming of furniture, carpets, stuffed toys, rugs, and mattresses is also recommended to prevent the spread of lice and nits. Educational objective: Pediculosis capitis (head lice) is a common parasitic infestation of the scalp that is typically seen in school-aged children. It is spread by contact with personal items such as clothing, combs, and bedding.

hormones related to thyroid issues

Primary hypothyroidism is an endocrine disorder identified by low circulating thyroid hormone (ie, triiodothyronine [T3], thyroxine [T4]) and high thyroid-stimulating hormone (TSH) levels. Primary hypothyroidism occurs when TSH is unable to stimulate the thyroid to produce thyroid hormones, often after trauma or autoimmune-related tissue damage (eg, Hashimoto thyroiditis). Therefore, TSH levels remain elevated as primary counterregulatory hormone (ie, T3, T4) levels remain low.

intubated pt's O2 begins to drop

Proper placement of the endotracheal tube is essential for adequate ventilation in intubated clients. If the tube becomes displaced in the hypopharynx, hypoxemia can result. Confirming the presence of equal breath sounds bilaterally via auscultation is an important initial nursing intervention.

tinea corporis

RINGWORM (of the body) capitis is of the scalp. Ringworm, or tinea corporis, is a fungal infection on the superficial keratin layers of the skin, hair, and/or nails. Ringworm is a misleading name as the condition is not caused by a worm infestation. However, it is highly contagious and spreads via contact. Management includes teaching appropriate hygiene (eg, washing hands after touching infected areas), limited contact with personal items (eg, hair brush), and treatment with the prescribed shampoos as well as topical and/or oral medications (eg, terbinafine [Lamisil], miconazole). (Option 1) Antifungal cream (terbinafine [Lamisil]) is the preferred treatment and is applied to infected areas twice a day. It may take 1-4 weeks to complete treatment depending on infection severity. (Option 2) Ringworm is spread via contact with shared surfaces (eg, bathroom floors, gymnasium mats, car seats), personal items, or pets. Important preventive measures include cleaning surfaces frequently, not sharing personal items, and practicing hand hygiene. (Option 4) This is not a dangerous condition; however, the client will be uncomfortable due to itching. Efforts should be made to discourage scratching as this facilitates spread of infection. Educational objective: Ringworm is a fungal infection that spreads via contact with infected skin, shared surfaces, and personal items (eg, hair brushes). It is treated with antifungal shampoos, creams, and oral medications. Infection spread can be limited by practicing frequent hand hygiene, cleaning shared surfaces, and refraining from sharing personal items.

Insulin types

Rapid-acting (clear) Short-acting (clear) Intermediate (cloudy) Long acting Combinations

Torsades de pointes

Rate: 120 - 200 usually P wave: Obscured by ventricular waves QRS: Wide QRS - "Twisting of the Points" Conduction: Ventricular only Rhythm: Slightly irregular give magnesium Torsades de pointes (ie, "twisting of the points") is a polymorphic ventricular tachycardia characterized by QRS complexes that change size and shape in a characteristic twisting pattern. Torsades de pointes is usually due to a prolonged QT interval (more than half the RR interval), which is the result of electrolyte imbalances, especially hypomagnesemia, or some medications. The first-line treatment is IV magnesium (Option 3). Treatment may also include defibrillation and discontinuation of any QT-prolonging medications. (Option 1) Adenosine is an antiarrhythmic used to treat supraventricular tachycardia. (Option 2) Dopamine is a vasopressor used to treat symptomatic hypotension. (Option 4) Metoprolol is a beta blocker used for heart rate control in tachyarrhythmias. Educational objective: Torsades de pointes is usually due to a prolonged QT interval, which is the result of electrolyte imbalances, especially hypomagnesemia, or some medications. First-line treatment is magnesium IV. Treatment may also include defibrillation and discontinuation of QT-prolonging medications.

extubation

Recently extubated clients are at high risk for aspiration, airway obstruction (laryngeal edema and/or spasm), and respiratory distress. To prevent complications, clients are placed in high Fowler position to maximize lung expansion and prevent aspiration of secretions. Warmed, humidified oxygen is administered immediately after extubation to provide high concentrations of supplemental oxygen without drying out the mucosa (Option 2). Oral care is provided to decrease bacteria and contaminants as well as promote comfort (Option 4). Clients are instructed to frequently cough, deep breathe, and use an incentive spirometer to expand alveoli and prevent atelectasis (Option 5). (Options 1 and 3) Clients are kept NPO after extubation to prevent aspiration. They may have either a bedside swallow screen or a more formal swallow evaluation by a speech therapist prior to swallowing any food, drink, or medication. Educational objective:Recently extubated clients are immediately placed on humidified oxygen and monitored for aspiration, airway obstruction, and respiratory distress. Clients should remain NPO until swallowing function has been evaluated. In addition, clients should be given routine oral care as well as instructions on coughing, deep breathing, and use of incentive spirometry.

Triage colors

Red = Emergency Yellow = Delayed Green = Minimal Treatment Black = Dead or Mortal Injury

Airborne precautions are for what 4 diseases?

SARS TB Measles Varicella MTVS (MTV Sucks)

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.

scabies

Scabies is a highly contagious skin infestation of the Sarcoptes scabiei mite. Scabies spreads easily via direct person-to-person contact (eg, skilled nursing facility, day care, prison). The pregnant female mite burrows into the outer skin layer to lay eggs and feces, leaving a superficial burrow track. Intense itching, especially at night, occurs due to the body's inflammatory response to the mite's eggs and feces. Treatment for scabies typically involves 1 or 2 applications of a scabicide cream (eg, 5% permethrin). For infants and children, permethrin should be massaged into all skin surfaces from the head to the feet, avoiding contact with the eyes (Option 2). Even after effective treatment, itching often continues for several weeks. All persons in close contact with the client during the lengthy 30- to 60-day incubation period (time from infestation to symptom onset) should also seek treatment (Option 1). To prevent reinfection, clothing and linens should be washed and dried on the hottest settings (Option 5). (Options 3 and 4) Discarding stuffed animals is not required. Nonwashable belongings can be sealed in plastic bags for ≥3 days because scabies mites can survive away from skin for only 2-3 days. Fumigation of living areas is not necessary. Educational objective: Scabies spreads easily through skin-to-skin contact. Clients with scabies and all persons in close contact should receive treatment with a scabicide cream applied to all skin surfaces. Potentially infested belongings should be washed and dried on the hottest settings or sealed in plastic bags for ≥3 days.

Signs of cardiac tamponade

Signs and symptoms of cardiac tamponade include: Hypotension with narrowed pulse pressure (Option 1) Muffled or distant heart tones (Option 4) Jugular venous distension (Option 5) Pulsus paradoxus Dyspnea, tachypnea Tachycardia

exophthalmos teaching (bulging of the eyes...can be from graves)

Teaching the client the following: Regular visits to the ophthalmologist are necessary to measure eyeball protrusion and evaluate condition. If recommended, anti-thyroid drugs should be taken to prevent further exacerbation of exophthalmos. Smoking cessation is necessary as smoking increases the risk of Graves' disease and associated eye problems. Restrict salt intake to decrease periorbital edema. Use dark glasses to decrease glare and prevent external irritants and infection. Perform intraocular muscle exercises (turning the eyes using complete range of motion) to maintain flexibility.

if a child is exposed to measles and they are too young for the vaccine?

The Centers for Disease Control and Prevention (CDC) recommends that the first dose of MMR vaccine be given to children between age 12-15 months to ensure optimal vaccine response. However, the vaccine is safe for children age <12 months; it could provide some protection or modify the clinical course of the disease if administered within 72 hours of the child's initial measles exposure. Immunoglobulin, if administered within 6 days of exposure, is also utilized as post-exposure prophylaxis.

CPR basics

The basic life support sequence is compressions, airway, and breathing (mnemonic - CAB). High-quality CPR is associated with improved client outcomes and begins with high-quality chest compressions (ie, 100-120/min, 2-2.4 in [5-6 cm] deep). Any unwitnessed collapse should be treated with 2 minutes of CPR, followed by activating the emergency response system and obtaining an automated external defibrillator. If no shock is advised, the nurse should resume high-quality chest compressions immediately (Option 3). (Option 1) Chest compressions should not be interrupted for more than 10 seconds when assessing for a pulse and chest rise/fall. (Option 2) Rescue breaths every 5-6 seconds (10-12 breaths/min) are given to clients who have a pulse but are not breathing normally. For clients with no pulse, the nurse should deliver cycles of 30 compressions followed by 2 rescue breaths. (Option 4) The jaw-thrust maneuver is used instead of the head-tilt/chin-lift method in clients who may have a head/spinal injury. Repositioning the jaw forward opens the airway to allow for assessment and delivery of rescue breathing. Assessing the airway is not indicated at this time. Educational objective: In basic life support for an unresponsive, pulseless client, the nurse should begin with 2 minutes of CPR in cycles of 30 high-quality chest compressions to 2 rescue breaths, followed by activating the emergency response system and obtaining an automated external defibrillator. If no shock is advised, the nurse should resume chest compressions immediately.

DVT signs

The client with DVT who is experiencing chest discomfort and cough should be seen first. This client is exhibiting possible signs of pulmonary embolism (PE), which can be a life-threatening complication. Signs and symptoms of PE include dyspnea, hypoxemia, tachypnea, cough, chest pain, hemoptysis, tachycardia, syncope, and hemodynamic instability. The nurse should elevate the head of the bed, administer oxygen, and assess the client. The health care provider should be notified of these findings.

implantable icd device and pt goes pulseless

The client with an ICD that is firing is receiving electrical shocks from the internal defibrillator to interrupt the dysrhythmia. It is still imperative that the client receive chest compressions in the form of cardiopulmonary resuscitation (CPR) to provide circulation of blood to the vital organs. The nurse should implement the pulseless arrest algorithm, allowing 30-60 seconds for the ICD to complete its therapy cycle before applying external defibrillation pads/paddles. (Option 1) Epinephrine should be administered after CPR and defibrillation. (Option 2) The ICD is firing as it was programmed to do. It should not be deactivated. (Option 4) The nurse should let the ICD work but needs to implement CPR in addition. Educational objective: The ICD is designed to defibrillate potentially life-threatening dysrhythmias. Although the device is able to sense electrical activity of the heart and respond, it is unable to sense or treat pulselessness. CPR should be initiated in the pulseless client with an ICD.

3 characteristics of ADHD

The core symptoms of ADHD include hyperactivity, impulsiveness, and inattention.

review of some eye medication protocols

The general procedure for the administration of ophthalmic medications includes the following steps in sequence: Remove dried secretions with moistened (warm water or normal saline) sterile gauze pads by wiping from the inner to outer canthus to keep eyelid and eyelash debris from entering the eye and to prevent transfer of debris into the lacrimal (tear) duct (Option 3) Place client in the supine or sitting position with head tilted back toward side of the affected eye to prevent excess medication from flowing into the lacrimal duct and minimize systemic absorption through the nasal mucosa Rest hand on client's forehead and hold dropper 1-2 cm (1/2-3/4 in) above the conjunctival sac, which keeps the dropper away from the eye globe and avoids contamination (Option 4) Pull lower eyelid down gently with thumb or forefinger against bony orbit to expose the conjunctival sac (Option 2) Instruct client to look upward and then instill drops of medication into the conjunctival sac. This minimizes the blink reflex and retracts the cornea up and away from the conjunctival sac to avoid instillation onto the cornea Instruct client to close the eyelid and move the eye around (if able). Then apply pressure to the lacrimal duct for 30-60 seconds if medication has systemic effects (eg, beta blocker, timolol maleate [Timoptic]). This will distribute the medication, prevent overflow into the lacrimal duct, and reduce possible systemic absorption (Option 1) Remove excess medication from each eye with a new tissue or gauze pad to prevent cross-contamination Wait 5 minutes before instilling a different medication into the same eye

Spine immobilization

The initial priorities for a client with a suspected cervical spine injury are to ensure a patent airway and immobilize the spine to prevent further injury. This includes applying a rigid hard collar, placing the client on a firm surface (eg, a backboard), and moving the client as a unit (logrolling) if required (Options 1, 4, and 5). A soft foam cervical collar does not provide immobilization. Further stabilization is achieved by taping down the client's head and using straps to immobilize the arms, especially if the client is not cooperating. After immobilizing the client, the nurse should obtain a baseline set of vital signs to monitor for neurogenic shock (eg, hypotension, bradycardia, poikilothermia [ie, inability to regulate body temperature]), a potential complication of spinal cord injury. The nurse should also assess the client's respiratory rate, pattern, and effort. Presence of abdominal breathing or increased work of breathing may indicate impending loss of airway and require prompt rapid-sequence intubation (Option 3). (Option 2) Movement of the neck/upper extremities should be avoided until cervical spine injury is ruled out with imaging, which is done after the spine is immobilized with a hard collar. Educational objective: The priorities for a client with a suspected cervical spine injury are maintaining a patent airway and spinal immobilization. Interventions include application of a rigid hard collar, placing the client on a firm surface, logrolling the client during movement and transfers, and continued assessment of need for an advanced airway. YES: -hard surface -immobilize C spine (collar) -log roll if you have to

The modified Allen test

The modified Allen's test includes the following steps: Instruct the client to make a tight fist (if possible) Occlude the radial and ulnar arteries using firm pressure Instruct the client to open the fist; the palm will be white if both arteries are sufficiently occluded Release the pressure on the ulnar artery; the palm should turn pink within 15 seconds as circulation is restored to the hand, indicating patency of the ulnar artery (positive Allen's test) If the Allen's test is positive, the arterial blood gas can be drawn; if negative and the palm does not return to a pink color, an alternate site (eg, brachial artery, femoral artery) must be used. Educational objective:The radial artery site at the wrist is preferred for collecting an arterial blood gas sample because it is near the surface, easy to palpate and stabilize, and has good collateral supply from the ulnar artery. The patency of the ulnar artery must be confirmed by performing a modified Allen's test to assure adequate circulation to the hand before proceeding with the arterial blood gas collection.

negatives of ADHD

The negative consequences of ADHD include: Poor self-esteem Increased risk for depression and anxiety Increased risk for substance abuse Academic or work failure Trouble interacting with peers and adults

Thyroid storm

a relatively rare, life-threatening condition caused by exaggerated hyperthyroidism increase temp, pulse, HTN

protocol for blunt force trauma

The unconscious client should first be assessed for adequate breathing and the presence of a pulse (using the rule of airway, breathing, and circulation [ABCs]) Using a rigid cervical collar, cervical spine immobilization must be maintained throughout the client assessment to minimize further injury. The client should be removed and placed on a backboard after the cervical spine has been stabilized. The nurse should also perform Glasgow Coma Scale scoring to determine the level of neurological impairment. If a client with possible spinal injuries is not breathing, or if the airway is occluded, the nurse should use the jaw-thrust technique. The head-tilt/chin-lift maneuver may hyperextend the neck, compromising the cervical spine. Educational objective: After sudden deceleration with blunt-force head injury, the nurse first checks if the client is breathing and has a pulse (using the rule of airway, breathing, and circulation [ABCs]). Spinal injury should be presumed, and the cervical spine should be stabilized (eg, cervical collar). The jaw-thrust maneuver may be used to open the airway.

Third-Spacing of Fluid

Third-spacing of fluids can occur 24-72 hours after extensive abdominal surgery as a result of increased capillary permeability due to tissue trauma. It occurs when too much fluid moves from the intravascular into the interstitial or third space, a place between cells where fluid does not normally collect (ie, injured site, peritoneal cavity). This fluid serves no physiologic purpose, cannot be measured, and leads to decreased circulating volume (hypovolemia) and cardiac output. The priority intervention is to assess vital signs as the manifestations associated with third-spacing include weight gain, decreased urinary output, and signs of hypovolemia, such as tachycardia and hypotension. If third-spacing is not recognized and corrected early on, postoperative hypotension can lead to decreased renal perfusion, prerenal failure, and hypovolemic shock Educational objective: Third-spacing can occur following extensive abdominal surgery and can lead to hypovolemia, decreased cardiac output, hypotension and tachycardia, and decreased urine output. Monitoring vital signs and urine output, and maintaining IV fluids are appropriate interventions to prevent prerenal failure and hypovolemic shock. vanessa's Q about acites... also cool extremeties

CPR for pregnant women

Two important modifications for cardiopulmonary resuscitation of a pregnant client include performing chest compressions slightly higher on the sternum and displacing the uterus to the client's left side.

Timolol (Timoptic)

Tx of glaucoma

most life threatening heart rhythm

V fib

VEAL CHOP

V- Variable C- Cord Comphression E- Early Decels H- Head Compression A- Accelerations O - OK L-Late Decels P - Placenta

ventrical tachycardia

Ventricular tachycardia (VT), sometimes referred to as V tach, occurs with repetitive firing of an irritable ventricular ectopic focus, usually at a rate of 140 to 180 beats/min or more. VT may result from increased automaticity or a re-entry mechanism. It may be intermittent (nonsustained VT) or sustained, lasting longer than 15 to 30 seconds. The sinus node may continue to discharge independently, depolarizing the atria but not the ventricles, although P waves are seldom seen in sustained VT.

Sildenafil

Viagra

metabolic syndrome

We Better Think High Glucose See Mnemonic card

Serotonin Syndrome

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

Drip Rate Formula

[ (rate = drops/ml) / (60min/hr) ] X [ total vol. to be delivered / total hours of infusion]

Milk contains ____a & b__________. Popcorn contains _______c_______

a) calcium b) protein c) fiber

Non-NSAID example:

acetaminophen

Grave's disease

an autoimmune disorder that is caused by hyperthyroidism and is characterized by goiter and/or exophthalmos

S1 is louder at the _______

apex

S2 is louder at the _______

base

Metoprolol (lopressor)

beta blocker

infant pulse check

brachial artery....upper arm

Cushing's syndrome

caused by prolonged exposure to high levels of cortisol LOOK AT IMAGE FOR MANY GOOD FACTS... remember they retain salt and fluid. they would NOT be hyponatremic. they would be hypernatremic. (edema too)

Decorticate posturing

characterized by upper extremities flexed at the elbows and held closely to the body and lower extremities that are externally rotated and extended. occurs when the brainstem is not inhibited by the motor function of the cerebral cortex.

if someone has NO PULSE....what do we NOT do?

defibrillate!

Ear drops child (under 3 years)

down and back

Statins

drugs used to lower cholesterol in the bloodstream

Diabetes insipidus (decreased ADH)

excessive UO and thirst, dehydration, weakness. ADMINISTER PITRESSIN Educational objective: DI occurs when there is insufficient production/suppression of ADH. It is characterized by polydipsia and polyuria with diluted urine. Oral and/or intravenous fluid replacement is imperative to prevent dehydration. DI is treated with ADH replacement drugs (eg, desmopressin acetate [DDAVP]). Clients should be monitored for urine output, urine specific gravity, and serum sodium.

Digoxin (Lanoxin)

for CHF

Measure for NG Tube

from tip of nose to earlobe to xipohid prosess. mark with tape, not clamp

Allen's Test (wrist)

hand relaxed, supported in supination, examiner compresses both arteries at the wrist while client clenches hand several time. with the patients hand open the examiner releases pressure on the radial artery. (normal hand coloration should return in less than 5 seconds) repeat test releasing pressure from ulnar artery. positive is un-normal coloration in hand and refill time greater than 5 seconds

Breath Sounds: Bronchial

high-pitched and longer, heard primarily over the trachea

where do we want the MAP in someone with shock?

higher than 65

NCLEX LAB VALUES

https://www.youtube.com/watch?v=Q5Q2SoN28WU

metabolic and respiratory, acid, etc

https://www.youtube.com/watch?v=URCS4t9aM5o https://www.youtube.com/watch?v=3neNB0w1P9M&t=610s

Hypoglycemia symptoms

hunger, fatigue, weakness, sweating, headache, dizziness, low bp, cold or clammy skin

if arm is higher bp= decreases if arm is lower bp= increases

if arm is higher bp= decreases if arm is lower bp= increases

heart arrhythmia

irregular heartbeat

conversions of ml, etc

look up all

apex of the heart

lower tip of the heart

serum albumin level

measures the main protein in the blood and is used to determine protein/nutritional status normal 3.5-5 cottage cheese shrimp chicken almond * wound heeling needs protein

know values for someone who might be in DKA....ph, etc.

ph: 7.30, paco2 30mm, hco3: 15

Breath Sounds: Vesicular

pitch = low amplitude = soft duration = inspiration > expiration quality = rustling, like the sound of the wind in the trees normal location = over peripheral lung fields

frothy, pink-tinged sputum

pulmonary edema Acute-onset dyspnea and cough productive of pink, frothy sputum indicate severe pulmonary edema, likely a complication from myocardial infarction. Pink sputum results from ruptured bronchial veins due to high back pressure. The mix of blood and airway fluids creates the pink tinge. On assessment, crackles can be heard at the lung bases.

fluid overload breath sounds

rales or crackles

medulla oblongata injury would effect

rate and depth of respirations

Standard Precautions

recommendations that must be followed to prevent transmission of pathogenic organisms by way of blood and body fluids

Simvastatin teaching

reduces cholesterol -Report muscle pain to provider -Avoid taking this medication with grapefruit juice -Expect therapy with this medication to be lifelong -Take medication in the evening because cholesterol production increases overnight -Flushing of the skin is an adverse effect, report to physician

arrhythmia/dysrhythmia

refer, for all practical purposes, to the same thing: an irregular heartbeat. However... Cardiac dysrhythmia: abnormal rhythm cardiac arrhythmia: absence of rhythm

ABGs (arterial blood gases)

sample of arterial blood used to determine adequacy of oxygenation

Insulin duration

see ohoto

12 lead ECG

see pic

hypovolemic shock

shock resulting from blood or fluid loss

Streptococcus pyogenes

strep throat Educational objective: Pharyngitis caused by group A β-hemolytic Streptococcus is a bacterial throat infection that can cause renal or cardiac complications if not treated. It is important to discard the child's toothbrush 24 hours after starting antibiotics, test siblings age <3 years, and complete the full course of prescribed antibiotics. don't give them a cough drop if they are too young. cold liquids may soothe.

ECG interpretation

watch youtube on counting per 6 blocks, etc