Remember This

When does a baby recognize faces?

4 months

When does a baby roll over?

4 months

Stages of Labor Active

4-7cm dilated contractions every 3-5 minutes - pain meds now

RBC

4.5-5.0 million

When do you need to induce pregnancy?

42 weeks

WBCs

5,000-10,000

IV onset

5-15 min

When do you give first influenza vaccine?

6 month

When can baby sit up with support?

6 months

When can you start implementing solid foods

6 months

When does baby recognize and respond to name?

6 months

When does baby see self in mirror?

6 months

When does stranger anxiety begin?

6 months

Glucose

70-110

When can baby stand while holding onto things?

8 months

When does baby develop object permanence?

8 months

When does baby develop pincer grasp?

8 months

When does baby move things from hand to hand?

8 months

When does baby sit without support?

8 months

When does crawling begin?

8 months

Stages of Labor Transition

8-10cm dilated contractions every 2-3 minutes

Calcium

8.5-10.5 Symptoms: Do the opposite of the prefix Hypo - Chvosteks (cheek), Trousseaus (inflated BP cuff = hand spasm) - phenytoin - aminoglycocides (-mycin)

Chloride

95-105 - loss of sodium associated with loss of chloride

LDL

< 100

Triglycerides

< 150

Cholesterol

< 200

Pain Scale Peds

< 3 = FLACC > 3 = Faces

What is considered infection fever?

> 104

Mantoux Skin Test

> 15mm = POSITIVE > 10mm = positive in immigrant, IV drug user, homeless, child < 4 > 5mm = positive in HIV/immunosuppressed

Gestational Hypertension - when is it diagnosed? - meds?

> 20 weeks Hypertensive Mothers Loves Nifedipine Hydrolatine Methyldopa Labetalol Nifedipine

HDL

> 60

Universal Recipinent

AB+

ACE/ARBs - what do they end in? - SE - pregnancy?

ACE - pril A:ngioedema C:ough E:xcess potassium I:nstead use ARBS - teratogen ARBs - sartan - hyperkalemia - teratogen

Which BP meds CANNOT be used in pregnancy?

ACEs and PRILs

-sartan

ARBs - decrease BP workload

Acetaminophen antidote

Acetylcystine

What are migranes treated with?

Acute: NSAID, Sumatriptan (Imitrex) Prevention: Propranolol

What type of bacteria is tuberculosis?

Aerobic acid-fast bacilli

TB precautions

Airborn - N95/negative pressure room

Psych Meds

Anticholinergic effects (dry eyes) Blurred vision Constipation Drowsiness Euphoria Fotosensitivity Granulocytosis (LOW WBC) MAOIs: ABCD Benzos: ABCD SSRIs (prozac, Zoloft): ABCDE Tricyclics (-il): ABCDE Phenothiazines (-zine): ABCDEFG

When is Hepatitis B vaccine administered?

Birth and 2 months

Infant Developmental Milestones

Birth-1 year Body changes (Anterior close 18mo, posterior 2mo) (weight 6 months, double, 12 months, triple) (length 1/2 to 1 inch every month) (teeth erupt 10 months) Achieving Milestones: (2 months, move head side to side, smile, verbal (coo), track with eyes, lift head while on stomach) (4 months: babble, hold and reach for toys, remember faces, roll over) (6 months: sit up with support, stranger anxiety, responds to name, when does baby see self in mirror) (8 months: sits without support, crawling, stands while holding onto things, pincher grasp, move object hand to hand, object permanence)(10-12 months: walking, put items in container, say mama, separation anxiety) B Infants (trust vs. mistrust) Eating (breastfeeding until 6mo exclusively, no cows milk or honey for first year) Social stimulation: independent play

3 Types of Headache location? duration? description? treatment?

Cluster - unilateral - 15min-3 hours, repeat, same time - sharp shooting periorbital pain, sinus drainage - O2, triptan Tension - bilateral - > 30 minutes, 4-6 hours - tight, squeezing pressure - NSAID, acetaminophen Migrane - unilateral - 4-72 hours - nausea/vomiting - phono/photophobia Acute: NSAID, -triptan Prevention: beta blockers, propanolol

Dumping Syndrome vs Hiatal Hernia - symptoms? - position? - diet? - fluids?

Dumping syndrome - gastric contents dump too quickly - move in right direction at wrong rate - cramping, stomach pain, diarrhea - treatment: want stomach to empty slower: head of bed flat, low fluids or fluids BEFORE or AFTER meals, low carbs Hiatal Hernia - regurgitation of acid - moving at wrong direction at the correct rate - same symptoms as GERD when they eat and lie down - treatment: want stomach to empty faster, raise head of bed, increase liquids, high carbs

Cranial Nerve VII

Facial - unilateral facial drooping

Cranial Nerve IX - nursing considerations

Glossopharyngeal - AIRWAY ISSUE

What position for paracentesis

High fowlers - pee before

Erikson's Stages

Infant (birth-1): trust vs mistrust Toddler (1-3): autonomy vs shame and doubt Preschool (3-6): initiative vs guilt Schoolage (6-12): industry vs inferiority Adolescene (13-20): identity vs role confusion Young adulthood (20-40): intimacy vs isolation Middle adulthood (40-60): generativity vs stagnation Older adulthood (60-death): integrity vs despair

budesonide

Inhaled Corticosteroids

What stage (Erikson's) are preschoolers in?

Initiative vs guilt

What do you give for ammonia buildup?

Lactulose

Long Acting Insulin

Lantus (glargine) - no peak - duration 12-24hrs

Rapid Insulin

Lispro O: 15min P: 30min D:3hr

Intermediate Acting Insulin

NPH (Humulin N, Novolin N) O: 6hr P: 8hr D: 12hr - cloudy

What are tension headaches treated with?

NSAID/Acetaminophen

Opioid antidote

Naloxone (Narcan)

Tetrology of Fallout

Not enough oxygen V - Ventricular septal defect O - Overriding aorta R - Right ventricular hypertrophy P - Pulmonary outflow tract obstruction any other defects that start with T = trouble

Universal Donor

O-

1-3 Cranial Nerves

Olfactory Optic Oculomotor

peripheral vascular disease (PVD) - two diseases? - risk factors?

Peripheral Artery Disease - atherosclerotic plaque - DONT elevate..they already aren't getting enough bloodflow, use gravity - pale skin, cool to touch Venous Insufficiency - obesity, standing too long, sitting - peripheral edema - dark, hot to touch

What Stage (Piagets) are preschoolers in?

Preoperational

Heparin antidote

Protamine sulfate

Fetal Positions

ROA and LOA Okay - If in OP, make mom do knee chest position

Short Acting Insulin

Regular (Humulin R, Novolin R) O: 1hr P: 2hr D: 4hrs - only IV insulin

TB MEDS

Remember PERI Pyrazinamide: (can increase uric acid, take with food) Ethambutol: (peripheral neuropathy, vision changes) Rifampin: (body fluids turn orange, birth control less effective) Isonized: (decrease vitamin B12, peripheral neuropathy, hepatotoxic)

Aspirin antidote

Sodium bicarbonate

Stages of Labor

Stage 1 - Latent - Active - Transitional Stage 2 - baby Stage 3 - placenta Stage 4 - postpartum

Airborne precautions

Standard + N95 & Negative pressire - measles - TB - varicella

Droplet Precautions

Standard + surgical mask - pertussis - pneumonia - flue - rubella - mumps

opisthotonus

The back is rigid and arching, and the head is thrown backward. - happens with hyperbilirubia - put them on their side

Lithium

Therapeutic levels 0.6-1.2 >2 = toxic - 3 Ts Tremors Taste that's metalic Too much diarrhea - may need supplemental sodium, lithium causes hyponatremia

Cranial nerve V - what region? - sensitive to? - what drug is used to treat this?

Trigeminal - Temporal region..goes to eye cheek and jawline - Sensitive to touch and temperature - carbamazepine

Ionized - What is it used for and what are it's side effects? - what do we give with it?

Tuberculosis - decrease vitamin B12, peripheral neuropathy - hepatotoixic - vitamin B6 or pyridoxine

Rifampin - What is it used for and what are it's side effects?

Tuberculosis - orange urine - birth control less effective

Ethambutol - What is it used for and what are it's side effects?

Tuberculosis - peripheral neuropathy - vision changes E = Eye

VEAL CHOP

Variable - Cord Compression Early - Head Compression Acceleration - Okay - Placental insufficiency

Which arrhythmia do you use amiodarone?

Ventricular arrhythmias

Warfarin antidote

Vitamin K

PT (prothrombin time)

WARFARIN 9.5-12.0 seconds

INR

Warfarin 2-3

-pril

ace inhibitor

Asterixis

aka Liver Flap, a flapping tremor of the hands. When the client extends the arms & hands in front of the body, the hands rapidly flex & extend.

When is DTaP vaccine administered?

always

-olol

beta blocker - lower HR and BP

Which of eriksons stage are infants in?

birth-1 trust vs. mistrust

-pine

calcium channel blocker

Magnesium sulfate antidote

calcium gluconate

-mide, -nide

diuretics

-cytosis

elevated

Sympathetic nervous system

fight or flight

When are contractions bad

if they are longer than 90 seconds and less than 2 minutes apart - fetal hypoxia

A1C

levels for 3 months - < 6% - < 8% if they have diabetes

furmoterol

long acting bronchial relaxers..like albuterol but not rescue

salmeterol

long acting bronchial relaxers..like albuterol but not rescue

What is the treatment for preeclampsia?

magnesium sulfate & delivery of fetus

Delivery Date

minus 3 months + 7 days

Quickening - when does it occur

movements felt at 16-20 weeks

aPTT

normal 30-60 seconds Heparin: 1.5x2.5 times normal range..60-80 seconds

Metformin - what is it used for - what can it cause

oral hypoglycemic - can cause lactic acidosis

Parasympathetic nervous system

rest and digest

Four point gait

right crutch then left foot

What vaccines are given at 6 months?

same as 2, also influenza

cardiac catheterization - what is it? - what is it called when you open the vessels? - where would you place a stent? - post-op?

thin, flexible tube is guided into the heart via a vein or an artery - angioplasty - groin area, femoral artery - bedrest until proper clotting - stool softer (no straining) - antiplatelet (clopidogrel + aspirin)

QRS wave

ventricle depolarization/contraction

ST wave

ventricular repolarization/relaxation

what is pyridoxine

vitamin B6

Hypotonic solution

- 0.45% saline - Rehydrate

Isotonic fluids

- 0.9 NS, LR - burns, shock

When should the posterior fontanel close?

- 2 months

Hypertonic

- 3% saline - fluid overload

When does baby change from coo -> babble

- 4 months

Restraints - how long do you need to reevaluate use in each age group

- < 9 yrs old: 1 hr - 9-17yrs old: 2hrs - 18+: 4 hours - need MD order within 1 hour of applying

Carbamazepine (Tegretol) - What is it? - Side effects

- Anticonvulsant - Steven Johnson Syndrome - Agranulocytosis

Which arrhythmia do you use atropine? (2)

- Asystole - Sinus bradycardia

HHNK

- BG > 600 - Hot, dry skin - Water, IV fluids, insulin

What drugs treat sinus tachycardia?

- Betablockers

Sumatriptan (Imitrex) - what is this given for?

- Cluster headache - Migranes

What vaccines are given at 12-18 months?

- DTaP - Hib - Polio - MMR - Varicella - Hepatitis A - Influenza

What vaccines are given at 4-6 years old?

- DTaP - Polio - MMR - Varicella - Influenza

PPE TAKING OFF

- Gloves - Goggles - Gown - Mask

PPE PUTTING ON

- Gown - Mask - Goggles - Gloves

Rules of 9's

- Groin 1% - Head 9% - Arms 9% each - Legs 18% each - Abdomen 18% for front 18% for back

what vaccines are given at 2 months (6)

- Hep B - RV - DTaP - Hib - PCV - IPV

What vaccines are given at 4 months? (5)

- RV - DTaP - Hib - PCV, - IPV

Hypoglycemia - what do you give

- Rapid carbs, juice - Glucagon

Folic Acid Deficienies - 3 types - Nursing considerations - What drug should you not take?

- Spina bifida - tuft of hair - Myelomeningocele - meninges & neural tissue protruding - Meningocele - meninges protruding - must go to surgery - cover with sterile dressing, keep moist - PHENYTOIN (cannot get pregnant)

Nitrates what are they given for? ways to take it? do not take with?

- Stable angina - Sublingual -> 3 times q 5 minutes - Pills: need to be kept in cool dark setting - Patches: need to remove when defib, use for 12-14 hours - nafils AKA viagra

Which arrhythmia do you use adenosine?

- Supraventricular tachycardia

Pyrazinamide (PZA) what is it used for and what are it's side effects?

- Tuberculosis - Raises Uric Acid - Take with food

Which arrhythmia do you use lidocaine?

- V tach - V fib

Ethosuximide (Zarontin) - When is this given? - Side effect

- absence seizures Ethosuximide Fatigue GI distress Headache Itching Steven Johnson Syndrome

Crutches

- always move weak side first - 2 fingers below axilla

Treat ventricular arrhythmias

- amiodarone - lidocaine

Atropine - which two dysrhythmias give with - what condition can you not give with

- asystole, sinus bradycardia - glaucoma

P wave

- atrial depolarization, atrium contracts

Sinus bradycardia

- atropine - pacemaker

Treat atrial flutter

- beta blockers - calcium channel blockers - digoxin

Kernicterus

- bilirubin in the brain

Tachycardia - what word used to describe it - meds used to treat sinus tachycardia - meds used to treat ventricular tachycardia

- bizarre - Sinus tachycardia = Beta blockers, calcium channel blockers, cardioversion - Ventricular tachycardia = defib, amiodarone, lidocane

Three point gait

- both crutches forward with weak leg

Contact Precautions

- c-diff - MRSA - Herpes - RSV

Complication of heart attack - which cardiac arrhythmia

- cardiac myocytes start releasing K+ - K+ = ventricular arrythmias - V-fib - DEFIB

Fibrilation

- chaotic - ventricular fibrillation = defibrillation

How to count HR

- count QRS complexes x 10

How to count HR on EKG

- count boxes between R peak, then do 300/that number

Pregnancy nausea

- crackers before getting out of bed

Apruptio placentae

- dark bleeding - painful - give O2, bedrest vasoconstrictors such as cocaine or smoking can cause it, also trauma, & history

-statins What do they do? What time do you take them? Prior to taking med what do you check?

- decrease cholesterol (< 200) - decrease triglycerides (< 150) - decrease LDL (< 100) - increase HDL (> 50) - take at bedtime because you are going into a fasting state, when you are fasting you release cholesterol (perfect time to attack them) - check ALT, AST before administer because of myopathy (myopathy, something wrong with muscles) and or rhabdomyolysis -> rhabdomyolysis = excretion of more protein = acute kidney injury -> HYDRATE - symptoms of rhabdomyolysis = muscle tenderness, pain - how to check for rhabdomyolysis BUN & creatinine

DKA

- dehydration - ketones, kussmaul, elevated K+ Treatment: IV fluid/Insulin

Cephalosporin - when cant you give

- do not give if they have a penicillin allergy

Burn Treatment (4 things)

- fluids - pain meds - topical antibiotics - high calorie

Inhaled Corticosteroids - 3 - how to administer - what med would you give if they got complications?

- fluticasone - beclamethasone - budesonide - use a spacer - rinse after every use - nystatin (NOT a statin..a fungal medication) - used if oral flush develops - swish and swallow

1 month milestone

- grasp reflex

Standard Precautions

- hand hygiene - gloves - gown - mask

Preeclampsia

- hypertension - edema - protein in urine - eclampsia = seizures

Blood Transfusion

- infusion must be started within 30 minutes of getting it from bloodbank - needs to be infused within 4 hours

Coronary Artery Bypass - normal postop findings

- itching, fever

Signs Symptoms of Hepatotoxicity

- jaundice - yellow skin - fatigue - hepatomegaly - scleral icterus

24 months milestone

- kickball - stairs - anal and urethral spinsters controlled by about 18-24 months Weight/Height - gain 4-6lbs per year, 4x their birth weight - increase 2-3 inches/year (2 year olds are about half of their adult height) - head circumference and head size same by 2-3

-mycin

- kidney/ear damage

ipratropium

- long term asthma drug - prevents constriction

tiopropium

- long term asthma drug - prevents constriction

Antacids - medication interactions

- must wait 2 hours between taking with other drugs

Asystole

- no QRS waves - Atropine - Epinephrine

Latent TB

- non infectious, no symptoms, regular chest x-ray, negative sputum - positive for blood test

Placenta Previa

- painless bleeding - give fluids and blood, magnesium, steroids, bedrest

Fundus

- palpate at 12 weeks - 22 weeks palpate at umbilicus - after 24 weeks its at same level as weeks pregnant - 24 hours after birth fundus should be back at level of umbilicus

What to give if mom is past due date

- pitocin/oxytocin - also given for postpartum hemorrhage - remember..it can have an antidiuretic effect because it stops bleeding

PPIs - what do they end in - what do they treat - adverse side effects

- prazole - GERD - increased pH may cause cdiff..watch out for nausea/diarrhea - can cause hypocalcemia, supplement with calcium and vitamin D, weight bearing exercises and bone density scan

What meds do you treat GERD with? - side effect

- prazole's

What type of play do preschoolers use?

- pretend play - animistic

Superficial 1st Degree

- redness - heat - pain - blanching - dry

Two point gait

- right crutch & left foot forward together

6 month milestone

- roll back to front - first sounds - teeth erupt

4 month milestone

- roll front to back - smile

3 years milestone

- run - draw circle

Atrial Flutter

- sawtooth appearance - vagal maneuver, cardioversion - adenosine

When would someone get an EEG?

- seizures

8 months milestone

- sits unsupported

9-12 months milestone

- start to walk

What to give if mom is giving birth preterm

- terbutaline - also can be given for variable decelerations

long acting muscarinic antagonist - 2 - what are they used for? - what are they used along with?

- tiopropium - ipratropium - prevention of constriction for long term asthma - salmeterol - furmoterol (long acting bronchial relaxers..like albuterol but not rescue) - also used with inhaled corticosteroids

Phlebitis

- treat with heat

Infiltration

- treat with ice

4 years milestone

- use scissors - pour drinks

Nitroglycerin

- vasodilator - for stable angina - x3 5 minutes apart - NO VIAGRA

Full Thickness 3rd Degree

- waxy - charred - pale - white - NO PAIN

Partial Thickness 2nd Degree

- wet - blisters - pale - pink - pain

Subarachnoid Hemmorhage - how is it described

- worst headache of my life

What is Piaget's sensorimotor stage?

0-2 years

Piaget's Stages

0-2: sensorimotor 2-6: preoperational 7-11: concrete operational 12-adulthood: formal operational

Digoxin

0.5-2 Toxic > 2 - HF - Atrial fibrillation

Creatinine

0.6-1.2

Erikson's Autonomy vs. Shame and Doubt/Guilt Ages

1-3

What age are toddlers?

1-3 years Developmental Milestones Temper Tantrums (developing autonomy, easily stressed) On the move (safety) Diaper to potty transition (most trained by 3 years) Developmental theories (Piaget birth-2yr = Sensory-motor, 2-7yr = Preoperational - egocentric, symbolic play..stick is sword, parallel play, push and pull toys) (Eriksons = Autonomy vs. Shame/Guilt Love to say no (negativism) Eating plan (small nutritious snacks) Ritualism, Rivalry, Regression

Stages of Labor: Latent

1-3cm dilated contractions 5-30min apart

Specific Gravity

1.010-1.030 - Low is caused by dilution - diabetes insipidus - High is caused by dehydration - SIADH

Magnesium - symptoms of high and low?

1.5-2.5 Symptoms: Opposite of prefix

When should first teeth show up by

10 months

When can babies put items in container?

10-12

When do babies get separation anxiety?

10-12 months

When do babies say mama/dada?

10-12 months

When should baby start walking?

10-12 months

BUN

10-20

DIlantin/Phenytoin - side effect

10-20 Toxic over 20 - DO NOT GET PREGNANT - Steven Johnson Syndrome

Theophylline

10-20 Toxic over 20 - respiratory drug, relaxes spasm

Bilirubin

10-20 elevated in newborn > 20 = elevated

Fetal HR

110-160 - if < 100 stop Pitocin and do LION Lie on side Increase IV fluids Oxygen Notify provider

Hemoglobin

12-18

When is Hepatitis A vaccine given (once)

12-18 months

When is MMR vaccine given? (2)

12-18 months 4-6 yo

When is varicella vaccine given?

12-18 months 4-6 yo

Sodium - Hyponatremia causes? - Hypernatremia cause?

135-145 Hyponatremia Causes - diuretics (thiazides) Hypernatremia - Cushings

Platelets

150,000-400,000

When should the anterior fontanel close?

18 months

When should a baby hold head up when on stomach?

2 months

When should a baby make verbal noises?

2 months

When should a baby track with eyes?

2 months

When should a. baby smile?

2 months

When would an infant move their head side to side?

2 months

When is RV vaccine administered? (three)

2, 4 & 6

When is IPV vaccine administered?

2, 4, 6

When is PCV vaccine administered? (3)

2, 4, 6

When is HiB vaccine administered? (4)

2, 4, 6, 12-18

Phosphorus

2.5-4.5 - When calcium goes up, phosphate goes down

Ear medication

3+ = up & back

Preschoolers - age - height

3-5 years - grow 3 inches/year

Albumin

3.5-5

Potassium

3.5-5.0 Symptoms: Do the same as the prefix except HR and urine output Hypokalemia - look diuretics - too much insulin - Cushing syndrome

When does insulin go bad

30 days after opening

SubQ/IM Onset

35-45 min

Hematocrit

37-52%

When does a baby grasp and reach for things?

4 months