NCLEX review

interventions for retinal detachment

dont get out of bed-risk of further detachment Patch over affected eye-reduce further detachment Lie on the side of affected eye-reduce further detachment

to new RN

dont give a new diagnosis, teaching give those in stable condition who require routine care

never in pehochromcyta

dont palpate abdomen bc can irritate adrenal gland, release cortisols and cause hypertensive crisis

after circumcision,

dont remove yellow-white exudate plate gauze pad with vaseline or A&D ointment diaper should be loosely fastened to prevent friction-no snug

sliding scale insuline

dose is based on blood sugar just bf meal higher sugar, more insulin check sugar level before doing sliding scale

watch for..n IV vancomycin

draw trough level each time infuse over at least 60 min monitor BP_hypotension assess hypersensitivity-Red man syndrome monitor for anaphylaxis monitor IV site

discharge teaching for post DVT

drink plenty fluids, limit alcohol, caffeine elevate leg, dorsiflex feet ofetn walking/swimming exercise program change position frequenlty stop smoking avoid restrictive clothing traveling allowed

meninococcal meningitis precaution

droplet

meningitis precaution

droplet mask

macrolids

drug interaction with antidepressant end in -mycin

against medical device

drugs alcohol suicidal homicidor

normal umbilica cord

dry and no red if moist and red-infection

patent ductus arteriosus

ductus arteriosus remain open after birth LHF

aortic dissection

due to HPN arterial wall intimal layer tear and allow blood flow bet inner and middle layer back pain- worst ever, tearing ripping pain can cause cardiac tamponade, or arterial rupture-FATAL EMERGENCY!

3 SS malignant hyperthermia

due to general anesthesia hypercapnia muscle rigidity hyperthermia

preventing Gastroesophageal reflus in infant

due to immautre lower esophageal sphincter burping frequently holding baby upright for 20-30 min after feeding feeding smaller but frequent feeds active play at least 30 min after feeding keep baby upright and calm after feeding

glaucoma

due to increased intraocular P (more than 22) loses peripheral vision-tunnel vision treat by decreasing P, no straining, heavy lifting drugs-beta locker drug, miotics

complication of billroth surgery (gastrojejunostomy)

dumpting sndrome sm freq meal low carb, high protein and fat high fiber

duration frequency of uterine contraction

duration-beginning of one contra to end frequency-beg of one contra to beg of another

sequential compression device

fit 2 fingers between sleeve and leg can put antiembolism stockings on bf applying sequential compression sleeve opening at knee (front) and popliteal pulse point (back)

down syndrome

flat broad nasal bridge upward, outward eyes asso with cardiac dfects, delayed development, resp infection feed to back and side of mouth bc of tongue thrust evaluate mental age

expectation after preg

flesy, musty smell lochia T elevated till 100,4 WBC elevated up to 30,000

McRoberts maneuver

flex thigh onto abdoment to straighten sacrum for shoulder dystocia

risk factors for HHS

fluid deficit dehydration diuretics

nursing intervention prior to dialysis

fluid status-weight, BP, peripheral edema, lung, heart sounds vascular access-bruit, thrill VS previous weitht if need heparin, IV heparin added to blood to prevent clotting that can occur when blood contacts foreign substance

goals for Hypertensive crisis

if too rapidly BP lowered, can cause organ damage so use IV vasodilator to lower BP slowly initial goal is to lower MAP by no more than 25% or mainatin MAP at 110-150

tooth avulsion

if tooth pulled out,, there is limited time less than 1 hr (longer if in cold milk), until death of tooth! if too long, can lose permanent tooth

dressing for chesttube

if tube comes out of chest- dry, sterile dressing on 3 sides if chest reexpanded-occlusive and petroleum jelly dressing fully covered

minimal variability

if with good reassuring pattern-check if took CNS depressants if with late deceration-utero-placental insufficienyc

when should you watch for latent TB to reoccur 6

immunocompromised malignancy chemo HIV prednisone steroid TNF inhibitor

azathioprine

immunosuppresant for IBD can cause bone marrow depr and leukopenia

high risk for thrush-oral candidiasis

immunosuppressed corticosteroids chemo/radiation AIDS high dose abx treatment dentures/infant treat with antifungal

anti viral contraindicated 3

in GI irritation-NV warfarin bc decrease flora-vit K kidney failure-receiving dialysis

acute manic epidosde SS

neglected hygiene inadequate nutritional intake wearing bizarre clothing, jeweliry insomnia flight of ideas distractibility euphoric mood

Wilms tumor

nephroblastoma kidney tumor <5 yr old unusual contour(bulging, swelling) in abdomen NEVER PALPATE ABDOMEN-can disrupt encapsulated tumor

SS methamphetamine exposed infant

neural defect cleft lip, palate irritability skeletal malformation clubfoot gastroschisis-all intestine out side body

anencephaly

neural tube defect with little brain tissue.. usually stillborn and will not survive long. Need comfort care like warmth and oxygen for impending death

romberg test

neuro test assess perception of head in space and body in space test reason for loss of coordination Stand with feet together and hands at side of body. Have them close their eyes and test ability to maintain balance. + romberg- ataxia is sensory rather than cerebellar- loss of coordination is due to sensory issue (loss of sense in self) Need assistance with ambulation

intervention for COlles' fracture

neurovascular assessment analgesia ice pack elevate extremity above heart instruct to move fingers to reduce edema and increase venous return

pursed lip

never hold breath long exhalation whistling like breath out

watch in multiple myeloma

new onset leg numbess-indicate spinal cord decompression also: chronic bone pain, elevated uric acid, Bence, Jones protein

diet for cirrhosis

no alcohol high calorie, high cab, low fat, low Na dont totally restrict protein, avoid hepatotoxic meds like tylenol avoid aspirin, NSAID (GI bleeding)

ortho jews death

no autopsy bc need complete burial to enter heaven if need autopsy, they are returned to body bf burial family stay with body, take part in postmortem care cover face with sheet

caution in sickle cell or vasoocclusive disease

no cold because vasoconstricts

hemophilia intervention

no contact sport no IM no meloxicam-NSAID 'no alcohol-interfere with platelet aggregation

role of case managers

no direct care assess, plan facilitate services decrease fragmentation of care, help coordinate communication bet HCPs, make referrls, make arrangement for home health/placement after discharge

labeling IV bag

no direct on bag ink can penetrate and get on solution do it with label or tape

change IV tubing

no earlier than q72 hr

infectious mono SS

no energy, malaise sore throat epistaxis headache

trigeminal neuralgia

no exercise give carbamazepine chew on oppo side of mouth

meal for irritable bowel syndrome

no gas-producing-banana, cabbage, beans No cafffeine, alcohol, No high fructose corn syrup No spice, hot/cold, dairy, fatty food Yes fiber Yes protein, bread, bland food

celiac disease

no gluten-BROW eat rice, corn, potato eat iron, folic acid, vit (esp fat-soluble vit)

watch when taking cyclosporine

no grapefruit juice bc increases bioavailability

recommended rate for KCL IV

no more than 10mEq over ONE HOUR peripheral no more than 40 mEq/hr central line

cervical laveration

no pain firm midline fundus increased bleeding

uterine atony

no pain uterine fundus abnormal increased bleeding

peak of glargine

no peak, continuous effect

TURP continuous bladder irrigation

no specific rate prescribed adjust irrigation so that urine remains light pink without clots then gradually decrease rate during first 24 hr bladder spasm expected

discharge planning for peptic ulcerdisease

no spicy, acidic food, black pepper no NSAID, alcohol, caffeine, chocolate, tobacco reduce stress call HCPif GI bleeding, orthohypotention, tachycardia, melema, increased pain, NV, fever take triple drug-omeprazole, amoxicillimn, clarithromycin for 7-14 days

diet for Grave's disease

no stimulant that increase MR like tea, cofffee

2 year old

no teaching or demonstrating equipment bc developmentally inappropriate=good for preschool

rehab from injury of lower extremity

no touch down to no weight bearing using 3 point gait touch down with partial weight bearing using 2 point full ewight bearing using 4 point gait

pepto bismol/Bismuth subsalicylate

no with aspirin cause stool to turn dark grn/black

calcium scoring CT exam

non invasive to visualize calcificaton of coronary artery and heart valves assess risk for future no special prep

Buerger's disease

nonatherosclerotic vasculitis involving arteries/veins of lower and upper extremities often in young men with long hx of tobacco or marijuana use cause thrombos formation intermittent claudication CEASE all TOBACCO and MARIJUANA no nicotine replacement products

magnetic resonance cholangiopancreatography MRCP

noninvasive test to visualize biliary and hepatic ducts via MRI use gadolinium-noniodine contrast watch metal implants No in preg NPO 4 hrs

extracorporeal shock wave lithotripsy

noninvasive to break up kidney stones Hematuria common-urine from bright red to pink over several hr increase fluids infection-atch septic shock

log of food in anorexia

nonono bc no obsess with food do it with bulimia

pruritis in narcotic

nor true allergy treat with atihistamine

bloody outflow in Peritoneal dialysis

nor unusual endometrial lining may be pulled thru fallopian tubes

digoxin toxicity

normal 0.5 to 2 visual disturbance-halo vision NV antidote-digibind

standards of nursing practice

professional organisms agency policies textbooks currnet literature expert consensus nurse practice act by state statutes from regularory organizations (joint commission, board of health)

testicular self exam

perform monthly same day during warm shower use both hands to feel each testis separately palpate gently using thumb and first 2 fingers report, hardend lump, scrotal swelling, dull ache

pericarddiits SS

pericardial friction rub pain with inspiration ST elevation in all leads watch for cardiac tamponade signs

pericarditis vs MI

pericarditis-inspiratory chest pain! both ST elevation. pericarditis-friction rub

calendar method

periodic abstinence from intercourse during fertile pd variable effect

hypothyroid

periorbital edema weight gain cold intolerance constipation aka hashitomo, myxedema levothyroixine, synthroid-watch tachycardia! avoid iodine

risk in PCI, stent placement

peritonial hemorrhage NEVER give antithrombic

peritoneal dialysis complication

peritonitis use aseptic technique when caring for catheter cap catheter during dwell time

complication of peritoneal dialysis

peritonitis-cloudy outflow, tachycardia, low grade fever

where to listen bruit for abd aneurism

periumbilical or epigastric area slight left of midline

...

permanent discoloration of teeth dont give to o iw<8 and preg bc retardation photosensitivity

tetracycline consideration

permanent discoloration of teeth photosensitivity no with milk/antacid no to kids<8 and preg-retardation

cerebrral palsy

permanent injury to motor center of brain persistent reflex after 6 month no parachute reflex spastic muscle, scizzor leg

vegans are risk for

pernicious anemia B12

assessment in dark-skinned pt

petechiae-conjunctivia of eye, buccal mucosa cyanosis-nailbed jaundice-palms of hand, soles of feet ulcer-sacrum, behind heels

risk factors for angina

physical exertion intense emotion T extreme esp cold tobacco use stimulant like cocaine, amphetamine artery narrowing

ECT

physical treatment using electrically induced seizures to treat severely depressed individuals anticholinegic 30 min prior muscle relaxant or anesthesia before after ECT, NV, headache, memory loss. Risk for aspiriation so place on side

Maslow

physiologic first safety/security love and belonging self esteem self actualization

degenerative joing disease

place joints in functional position

intervention for pt with Alzheimer to secure wandering and envt

place locks above or below eye level bc client with alzheimer lose peripheral vision add motion sensor place large stop sign on door exits disguise door with curtain/wall hanging use childproof doorknob vocer place black mat/strip by exit-client perceive as impassable black hole

POST LAP cholecystectomy

place on SIMS to blow off CO2

decreased mental pt, after feeding,

place on right side with HOB elevated

Radioactive implant

place shield on hallway side of bed to protect others need T, distance,, shielding

reducing risk for sudden infant death syndrom

place supine on firm surface to sleep avoid soft objects-stuffed animal, heavy blanket use thin blanket tucked into sides and bottom of mattress avoid bumper crib pads smoke free envt avoid overheating use pacifier whn placing infant to sleep

folic acid requirement preg

planning preg- 400-800 mcg folic acid daily inadequate first 8 weeks after cocneption increases risk of neural tube defect like spina bifida, anencephaly

tx guillain

plasmapheresis immunoglobulin-hydrate and make sure good renal airway, TPN recover in 1-1.5 yr

contraindication to cisplatin

platelet<100,000 Bun more than 25 WBC<4,000 creatinine<1.5 no electrolyte

complicatiosn of thoracentesis

pneumothorax hemothorax infection

preg uncontrolled glycemic control

polyhydramnio macromsia congenital anomaly of spine preeclampsia

Torsades de pointes

polymorphic ventricular tachy with QRS that change size and shape in twisting pattern Can be caused by all macrolide abx-azithromycin, erythromycin, clarithromycin also caused by amiodarone, sotalol, haloperidole, azole antifungal, ziprasidone due to prolonged QT interval due to HYPOMG... give IV MG Defib, discontinue any QT prolonging medss

fixed pupil and head injury broken neck/agonal respiration

poor prognosis black tag

food high in Vit B1

pork, beef, liver, whole grain, legume

hiatal hernia

portion of stomach herniate thru openning in diaphram due to increase in intraabdominal P (preg, ascieties, obesity, tumor) and weaken muscl of diaphragn heartburn, dysphagia, pain

position lie attitude

position-relationship of point of reference on fetal to mother pelvis-LOA lie-relationship bet spine of fetus to spine of mother-longitudinal, transverse, oblique attitude-relationship of fetal part to another-flexion (want), extension

congenital dislocated hip

positive Ortolani sign-clicking with abduction unequal folds of skin on buttocks limited abduction of hip APply Pavlik harness 24 hr 6 month surgery hip spica cast

digoxin

positive inotropic for a fib-decrease conduction thru SA node

Nitrazine paper

positive when pH strip turn blue-presence of amniotic fluid (basic with 7-7.5) indicate active labor

back pain after cardio cathe

possible retroperitoneal bleeding back pain, tachycardia, hypotension more than 1 L of blood can pool in peritoneum withou SS

fontanelle

posterior closed by 8th week anterior 12-18 month

black cohosh

postmenopausal symptomshot flash, vaginal dryness side effect: hepatic injury

postop cognitive dysfunction

postop memory impairmnet, conc prob, language comprehension risk increases with advanced age occur days-weeks following surgery resolve after complete healing

cephalosporin

potential for cross allergy with penicillin

necrotizing enterocolitis

predominantly in pretern infant due to immaturity when enteral feeding in give, bacteria can be introduced into bowel and result in inflammation and ecrosis of intestine bowel becomes congested and gangrenous with gas collection measure abd girth to note worsening swelling keep NPO and NG suction to decompress stomach give Parenteral hydration and nutrition and IV ABX avoid rectal T-risk of perforation keep supine, undiapered

mg sulfate indicate

preeclampsia slows preterm labor watch for LOC antidote-Ca gluconate

facial edema in preg

preeclampsia! intervene

suctioning catheter

preoxygenate suction no more than 10sec wait 1-2 min between passes set at medium pressure (100-120 for adult, 50-75 for children) there is usually cough as cathether enter trach. COughing is normal. Advance catheter till resistance is felt, then retract 1 cm before suction

food high in Na

prepackaged, processed

low pressure alarm for arterial line

presence of hypotension disconnected tubing hemorrhage

shoulder dystocia

pressure on supra back knee to chest position inform neonatalogist

preterm at risk of

pressure ulcer bc not suficient subQ fat store

polyethylene glycol

prevent constipation

why is IV immunoglobulin given in Kawasaki disease

prevent coronary aneurysm and occlusion GIve aspirin also SInce Kawasaki is not infectious process, immunoglobulin is not for infection

why multiple drugs for TB

prevent development of resistant strains

probenecid

prevent recurrence of goury arthritis

highest priority postop lap cholecystctomy

prevent resp complication by CO2 administration place in SIMs

post laparoscopic cholecystectomy

prevent respiratory complication place on Sims' position-movement of CO2 used during surgery to fill abdominal cavity This CO2 can irritate phrenic nerve and diaphragm, causing breathing difficulty low fat diet resume activity as tolerated incision-dressing removed day after surgery and shower can be taken. No bath-nfection

droperidol

prevent vomiting also antipsychotic

when a child breaks leg,

priority is preventing futher injury splint legs together uninjured leg can be used to splint the injured leg

carotid endarterectomy

procedure to remove plaques from carotid artery at risk for TIA and stroke so monitor BP postop-HPN can strain surgical site and trigger hematoma formation-hemorrhage and airway obstruction maintain SBP 100-150

myelodysplastic syndrome

produce inadequate blood cell low WBC, platelet, Hgb

lupus nephritis

serious complication of SLE increased creatine increased BUN abnormal urinalysis (protein, RBC, cellular cast) need early recognition to preserve renal

peritonsillar abscess

serious complication of tonsillitis- infection go beyond tonsil-cause swelling Trismus-cant open mouth due to constraction of muscle hot potato voice uvula deviation away from enlarged tonsil pooling of saliva EMERGENCY-can occlude airwway need surgery

flaccid limbs

serious irreversible neuro impairment

why foley in epidural

sesnation of bladder filling is lost so need foley

hydraulic lift

set lift base at widest position suspend pt avove bed prior to moving to give security when lowering, push gently on knees leave sling in place once seated for comfort

when a clinet becomes violent after dianosis

set limits infomr clint that injury to staff is not acceptible speak calmlyy dont send staff out-gives clinet the power

hypertensive encephalopathy

sever HPN and SS IICP high mortality due to risk of MI, stroke, kidney injury

managing morning sickness

several sm meals drinking plenty fluids-cold, carbonated beverage high protein snack bf bedtime and on awakening food/drink with ginger food high in vit B6-nut, seeds, legumes

pain for acute pancreatitis

severe Left upper quadrant or midepigastric area radiate to back

hyperemesis gravidarum

severe N and V in preg fluid and electrolyte imbalance ketouria weight loss dehydration ketouria indicate body is using fat for energy due to starvation state hypokalemia, alkalosis, weight loss, ketonuria SSdehydration

vaginal hematoma

severe pain firm midline fundus unchanged vaginal bleeding due to trauma in tissue to perineum following forcept or vacuum assisted

inversion of uterus

severe pain fundus not normal hemorrhage protruding organ

pain from renal stone

sharp excruciating raditae to groin from flank

food high in b12

shellfish liver lay meat

herpes zoster precaution

shingles thru airborne and contact N95 and gloves, gown

albuterol

short acting beta 2 agonist immediate bronchodilation side effect-tremor, tachycardia, palpitation, hypokalemia

repaglinide

short acting oral hypoglycemic meds If pt is NPO, dont give

non rebreathing mask

short term for low saturation from asthma, sepsis, pnemonia, trauma

normal urine output

should be at least 30ml/hr

ACE inhibor

side effect-dry cough if cant tolerage give angiotensin receptor blocker ARB but gooe to use ACE bc prevent ventricular remodeling

pilonidal dimple

sign of spina bifida

holosystolic murmur at left lower sternal in neonate

sign of ventricular septal defect

Asperger disorder

similar to autism but no significant delays in language, cog development, skills, curiosity, adaptive behavior

food high in vit C

similar to potassium citrus fruit, cantelope, strawberry

START method

simple triage and rapid treatment determine who can move and have them help out Breathing? if no-airway..if still no-black RR>30-red RR<30, assess circulation cap refill-if none, Red cap refill normal-check mental status if cant follow simple command-red

side effect of chlordiazepoxide

since antianxiety drowsiness, blurred vision, constipation,

activity for school age child

since industry vs inferior, give school work learning is priority as it gives accomplishment

concern in COPD

since resp drive is low O2 will go from gray/ashen to pink before going apneic or resp arrrest after giving O2 delivery after 30 min

SS inhalation injury

singed facial hair hoarse voice burned cloth around chest and neck may cause pul edema or tracheal edema need intubation to protect airway

when difficult to auscultate heart sounds

sit up and lean forward (A, P) or lie down on left side (mitral)

SBARR

situation background assessment recommendation readback

most important in traction

skin assessment and neurovascular assessment

cushing syndrome SS

skin atrophy easility bruised wide purplish striae skin hyperpigmentation hirsutism muscle weakness gluc intolerance osteoporosis

chronic venous insufficiency 3SS

skin change-thick, dark skin pain when sitting crater-like lesion on lower legs

atopic dermatitis/eczema

skin disorder with pruritis, erythema, very dry skin Give tepid bath with gentl soap no hot water, long bubble bath Skin patted dry, No rubbing, vigirously drying Nail trimmed short apply emollient after clothng soft like cotton, no wool wear long sleeves at night avoid heat and low humidity

scabies

skin infestation spread person-to-person by contact intense itching 30-60 day incubation period test all persons who had contat apply scabicide creasm (permethrin) to all body below head scabies mites dont survive away from human skin for more than 2-3 das

keeping infant warm

skin to skin warmed blanket cover with hat/cap radiant warmer with only diaper No bath if unstable-lose heat

some trigges of migraine

sleep deprivation tyramine aged chs

signs of hepatic encephalopathy

sleep disturbances lethargy, coma altered mental status asterixis elevated ammonia fetor hepaticus-musty sweet odor of breath

neonate position neck for rescue breathing

slightly extended for neutral position place blanket under shoulders Hyper or Under extension cause decreased air entry

dupuytren contracture

slow progressive contracture of palmar fascia causing flexion of 4th and 5th fingers men over 50 Scandinavian or Celtic descent/Norway

early indicator of IICP

slowing speech LOC change restlessness confusion

beta blocker

slows HR so dont give if brdycardic

epstein pearl

sm, white cysts on hard palate of newborn common, disappear in few weeks

carbon monoxide poisoning

smoke inhalation gas/fuel oil heating system gas hot water heater coal/wood stoves gas grills engine exhaust-closed garage with car running Ask if other family have similar SS sick indoor pet with sick family? what heating cooking sources CO has vague signs like dull headache, NV, fatigue, dizziness, dyspnea)

4 risk factors of COPD

smoking occupational exposure to chemical/dust air pollution genetic (alpha-antitrypsin deficiency

teaching for burn care

soak in cool water remove any clothing/jewelry cover with clean dy cloth No ice, ointment, cream on open skin

schizoid personality disorder

social detachment cant express emotion prefer to be isolated

hegar's sign

softening of lower uterine segment bimanual maneuver UTERUS

goodell sign

softening of vaginal portion of CERVIX due to vascularization from hypertrophy and engogement of vessels below growing uterus

change IV solution and tubing

solution q24 hr tubing 72 hr

Hirschsprung disease

some part of lg intestine missing nerve cells internal anal sphincter cant relax so no peristalsis Distended abd No pass meconium difficulty feeding green bilious vomit

after tonsillectomy

sore throat common

3 phases of postpartum adaptation

taking in- 24-48 hr-recovering. depends on nurse taking-hold 2-10 days-learning technical skills letting-go-10days. comfortable

introjection

taking qualities of others without thought a person may take on political views of a famous, admired actor

arteriovenous malformation

tangle of veins and arteries-causing it to be weak and dilated-seizure, headache need BP control bc risk for bleeding/rupture

BETA BLOCKER

taper over 2 weeks if discontinued-dysrhythmia, HPN< MI take with meal

adverse effect of metoclopramide

tardive dyskinesia-unusual uncontrollable movement

tx sprain

tear/stretch of ligamanet rest, ice, compression, elevation analgesia-NSAIDrehab program

absence seizure

typically in children daydreaming-staring spell no warning, no postitcal no other form of epileptic activity-tonic, clonic unresponsiveness during seizure no memory of seizure

tx ICP

want <20 mannitol, steroids, barbiturate (sedative), diuretic, phenytoin (seizure prevention), diuretic, hypervent, hypothermia, CSF drainage

A1c

want less than 7 4-6 in non diabetics

when not to give excess fluid

when fluid overload Low hematocrit high urine output high creatinine-renal insufficiency Fluid deficit is ok-BUN low, Urine specific gravity low

walking up and down with crutches

when going up, crutches and affected leg go forward, followed by strong leg when going down, crutches and then weak leg go down followed by trong leg

when to administer oxytocin after delivery

when placental has een expelled gush of blood uterus cramp umbilical cord extending out

splenic squestration crisis

when sickled cells get trapped in spleen-splenomegaly-life threatening can lead to hypovolemic shock

coughing/gagging during NG tube insertion

when tube gets coiled in throat or slips into larynx, can cause coughing/gagging. Then pull back tube a little and give time for pt to breath. After he stops coughing, advance and give sips of water to facilitate if not go in, rotate gently..if still not, take out and put in other naris. NEVER give water to drink when coughing-aspiration

leucocytosis

white cells (the leukocyte count) above the normal range in the blood. It is frequently a sign of an inflammatory response, most commonly the result of infection

Glulisine

wihtin 15 min of meal onset-15min peak 1 hr duration 2-3hr

preparing oxytocin

with 3mL syringe filter needle to draw med and another needle to inject med into IV bag No need for gloves

when to consume dexamethasone

with meal preferably breakfast

basal body T evaluation

woman T drops immediately before ovulation and increases several days after form of birth control

rehab phase of burn

wounds have fully healed and lasts about 12 months counseling gental massage with water based lotion plan reconstructive surgery pressure garment to prevnet scars ROM sunscreen

Colles' fracture

wrist fracture that causes fork-like shape of hand when clinet tries to break a fall with outstretched hand common in women osteoporosis/osteopenia

Duchenne muscular dystrophy

x-linked recessive lack of protein called dystrophin 2-5 yr onset calf muscle hypertrophy Gower sign no effective cure most wheelchair bound and die by age 20-30 due to resp failure eliminate clutter regualar gentle recreation exercise, swimming

knee socks in palivk harness

yes, alwas to prevent skin breakdown

contaminated needle stuck RN

1. thorough hand washing 2. report to occupational nurse 3. have blood test performed 4. complete and file rerpot 5. begin prophylactic drug 6. follow up for results

Vent Low pressure alarm

1. tube disconnet or leak 2. cuff leak 3. loss of airway-extubation or decannulation 4.

1 tsp = ? ml

5 ml

projection

attributing feeling/thoughts of self to others

CN VIII

auditory hearing equilibrium

meds that increase HR

beta adrenergic like albuterol atropine

what meds can contribute to asthma bronchospasm

beta blocker NSAIDs-ibuprofen, aspirin

meds that decrease HR 3

beta blocker (oral or eye drop) ca channel blocker, dogixin

complications of acute pancreatitis4

hyperglycemia hypocalcemia hypovolemia ARDS

normal carboxyhemoglobin level

less than 5% less than 10% in smokers

assessment order infant

auscultate palpate, percuss in head-to-toe order eye, ear, mouth reflexes

beta blocker in DM

beta blocker bind beta recepor site, preventing adrenaline from causing SS of hypoglycemia

St johns wort

derpession drug interaction with antidepressant, anticoag and digoxin watch HPN crisis

post-oncussion

does not show in CT no contact sports trouble remembering no recollection of events persistent headache

myelodysplastic syndrome

doesnt produce adequate blood cell low WBC< platelet, HBG

universal donor universal recipient

donor- O- recipient-AB+

lacto-vegeterian

dont eat egg dairy ok

position after amputation

first 24 hr-elevate stump after 48 hr-do not elevate place prone if can

mottling of skin

patches of pink, pale, cyanotic skin indicative of poor perfusion-dehydration

loud machine like murmur

patent ductus arteriosus

short acting insulin

peak 1-5 hr after lasts 6-10 hr

intermediate insulin

peak 6-14 hours onset 1-2 hour duration 16-24 hr

most important during barium enema

retain barium bc urge to defecate slow deep breathing helps

SIADH tachy or bradycardia

tachycardia due to fluid V excess

SS panic attach

tachycardia, HPN, palpitation decreased perceptual field fear of losing control diaphoresis

side effect of aminophylline

tachycardia, hypotension, NV

signs of puberty in order in boys

1. testicular enlargement 2. pubic, axillary, facial, body hair 3. penis increases in size, voice changes 4. increased height, weight

acute retinal detachment

"curtain coming across field of vision" lightening flashes hairnet appearance in vision field emergency

pyloric stenosis in infant

"hungry vomiter"-excessive hunger-freq feeder palpable olive shaped mass in epigastrium projectile vomiting poor weight gain dehydrated

lispro

"see food" insulin so not given till food is in site onset 15 min peak 1 hr duration 4 hr

Fifth disease

"slapped cheek"-red erythema infectiosum caused by parvovirus B19 bright red facial rash, fever, flu like harmless unless child is immunosuppressed but preg should avoid rash, joint pain, malaise Not infectious when they develop symptoms

para

# deliveries occuring after 20 weeks of gestation

what interfere with phenytoin

(anticonvulsant) interfere with product containing calcium (antacid) and enteral tube feeding

labor station

-5 to +5 above to below at station0= engaged +2- 2cm below level of ischial spines +5-crowning

SIADH common causes

-CNS disruption-stroke, infection, trauma -malignancy-small cell lung carcinoma can produce ADH -drugs-desmopressin, carbamazepine -pul disorder like pneumonia

Ca channel blocker

-dipine nifedipine, amlodipine, nicardipine vasodilator that relax smooth muscle adverse-dizziness, peripheral edema, constipation

fluoroquinolone

-floxacin cross placenta and express in milk decreases seizure threshold

over use of PPI

-prazole pneumonias C.Diff osteoporosis

best time for self breast exam

-regular periods- 5 to 7 days after menstruation -irregular menss-same day every month -taking oral contraceptive-when new package initiated -postmenopausal-same day each month

infant assessment order

auscultate record HR, RR after auscultating palpate, percuss abdomen eye, ear, mouth elicit moro reflex do head to toe

VS infant

...

avg urine output

...

incentive spirometer steps

...

oliguria vs anuria

...

pulse scale

0 absent +1 weak +2 normal +3 increased, bounding

infant

0-1 year weight double in 6mon, triple 12 mon social smile 2 mon peekaboo at 6 month separation anxiety at 6 month sit upright by 8 month crawal by 0 month pincer grasp by 10-12 mon walk with support 11 month-1 yr say few works with mama, papa 1 year solid food 5-6 month

normal erythrycyte sedimentation rate

0-20 high-inflammatory/degenerative tissue destruction

urine output for adult of avg weight

0.5 mL/kg/hr ~35 ml/hr

normal digoxin level

0.5 to 2

Lithium level

0.6-1.2

normal serum creatinine

0.6-1.3 mg/dL

normal INR

0.75 to 1.25

normal lactic acid

05-2.2

fundal height

12-13 weeks- fundus rise out of symphysis 20 weeks- fundus at umbilicus 24 to 36 weeks-fundus from symphysis equal number of weeks of gestation

immunization MMR and varicella

12-15month 4-6 yr

aDOLESCENT

12-19 rapid growth secondary sex characteristics family conflict risk taker sleep pattern change body image

diagnosing SIRS

2 or more hyperthermia (>100.4) or hypothermia (T<96.8) HR >90 RR>20 or alkalosis Leukocytosis (WBC>12,000 or 10% immature neutrophil)

steps giving TPN

1. confirm order 2. check solution for cloudiness 3. select and flush correct tubing and filter 4. thread tubing thru infusion pum 5. use aseptic tec when handling injection cap 6. connect tubing to central line 7. set infusion pump at correct rate

4 NSAID adverse effect

1. GI tox-black tarry stool, GI upset 2. kdney injury 3. HPN, HF-fluid retension 4. bleeding risk

4 manifestation of nephrotic syndrome

1. massive proteinuria 2. hypoalbuminemia 3. edema 4. hyperlipidemia-increased protein and increased lipid production by liver. DUe to glomerular injury

steps in giving enteral feeding

1. ID pt 2. elevate HOB 30-45 deg before and after 3. ensure placement of tube 4. auscultate bowel sounds 5. flush tube before and after 6. give feeding IF stomach cramp, slow feeding-due to cold feeding or fast rate

intervention for vomiting cholelithiasis pt

1. NPO 2. give promethazine for NV 3. give NS for fluid and electrolyte 4. NG tube to low suction to decompress gastric

intervention in acute ashthma

1. O2 2. high dose beta agonist-albuterol or levalbuterol and anticholinergic-ipratropium 3. sstemic corticosteroids-solu-medrol

NG tube insertion 6 steps

1. measure, mark and lubricate tube 2. instruct to extend neck slightly back 3. genetly insert tube past nasopharynx 4. ask to flex head forward and swallow 5. advance tube to marked point 6. verify placement and anchor

bed-to-chair transfer method

1 full weight bearing- No assistance or 1-person standby or observation 2. partial weight bearing- 1 person assist stand, pivot transfer with gait belt/motorized asssit device or 2 person assist with full body sling if uncooperative 3. no weight bear-motorized assist device if cooperative or 2 person assistt with full body sling if uncooperative

1 hr and 3 hr gluc test

1 hr for screening-less than 140 3 hr for diagnostic

head circumference growth

1 inch during second yr then slow to rate of 0.5 inch per year until age 5

FGAR

1 min then 5 min 7-10 good 4-6 moderate need resuscitation 0-3 severe if FGAR <6, do one more at 10 min

using time outs in young children

1 minute for each year of child age if disruptive behavior, start after calm out dont explain why act is wrong bc young cant understand views of others dont comment on it after child experiences consequences

1 gram = ml

1 ml

treat frostbite

1 remove jewelry, tight clothing 2. do not massage, rub, squeeze-damages tissue 3. immerse in water heated 3. avoid heavy blanket to prevent tissue sloughing 5. elevate after rewarm to reduce edema 6. keep wounds open after water bath. dry before applying loose, nonadherent sterile dressing 7. monitor for compartment syndrome

1 mg to ?mcg

1,000 mcg

labor and delivery of primipara mother

1-1.2 cm per hour up to 3 hr pushing

toddler

1-3 2-3word sentence 2 yr toilet training begin 2 yr no concept of time by age 2, half of adult height stack 4 blocks at 2 stack 6 blocks at 6 bow legged, pot belly kick a ball at 2 have all 20 primary teech frequent tantrum

4 stages of labor

1-latent, acive, transition 2-10cm cervical dilation to delivery 3-delivery to placenta expulseion 4-1-4 hr after birth

intradermal injection TB

1. 1mL tuberculin syringe with 27 gauge 1/4 inch needle (give 0.1ml) 2. clean gloves 3. left forearm face up 4. pull skin down with nondominant hand 5. advance tip of needle thru epidermis to dermis-bevel should be visible under skin 6. inject slowly shile raising small wheal=10 degree angle with bevel up 7. remove needle and dont rub area 8. circle area with pen

2 techniques for chest compressions neonate

1. 2 thmbs on middle third of sternum, just below nippple line 2. 2 fingers-index and middle of one hand on sternum just below nipple line 100-120/min 30:2 for 1 rescuer and 15:2 for 2 rescuer

Dx DM

1. A1c>6.5 2. fasting plasma gluc >126 3. oral gluc tolerance test >200

malpractice is found

1. nurse owed a duty to client 2. nurse didnt carry out duty 3. client was injured 4. nurse's failure to carry out duty resulted in injury

9 predisposing factors for development of delirium in hospitalized clients

1. advanced age 2. underlying neurodegenerative disease-stroke, dementia3. polypharmacy 4. coexisting medical condition like infection 5. acid-base imbalance 6. metabolic and elevtrolyte imbalance 7. impaired mobility 8. surgery-postop 9. untreated pain

stages of shock and SS

1. agitation, restlessness; increased HR, cool clammy skin 2. confusion, CPP, CO, SBP low. HR up, oliguria 3. edema, hypotension, dysrhythmia, weak thready pulse, cold clammy skin 4. hypotension, HR slow, MODS< hypoxemia, acidosis. not respond to vasopressor

when a portion of PICC breaks when removal

1. apply tourniquet to upper arm to prevent advancement of piece to RA 2. check radial pulse 3. xray

ear irrigation steps

1. assess for contraindication-fever, ear infection 2. explain procedure 3. place in side lying or sitting position with head tilted toward affected ear 4. place towel and emesis basin under ear 5. verify that irrigation solution is at body T 6. straighten ear cannal and ear up and back 7. irrrigate slowly directing syringe tip toward top of ear canal

if someone is found lying down

1. assess nonresponsiveness/breathning 2. call for help 3. check pulse 4. position flat on back 5. begin chest compression 6. open airway 7. give 2 breaths

steps for nasal spray

1. assume high Fowler with head tilted slightly FORWARD 2. insert spray into nose while occluding the other 3.point the spray tip to the SIDE and AWAY FROM CENTER 4. spray while inhaling deeply 5. remove and breath thru mouth 6. do the other nose 7. avoid blowing nose for several min

intervention in anaphylactic shock

1. call for help 2. airway, high flow O2 3. IM epi 4. elevate leg 5. IV fluids 6. bronchodilator-albuterol 7.antihistamine-diphenhydramine 8. corticosteroids

2 SS hypoMg

1. cardiac arrythmia-Torsades de pointes 2. NM-similar to hypocalcemia-tremor, hyperactive reflex

after endotracheal intubation

1. check CO2 exhale level 2. auscultate chest 3. confirm that breath sounds are equal and bilateral 4. secure tube in place 5. schedule xray

interventions for suspected air embolism in central venous cathether

1. clamp catheter 2. place in Trendelenburg on left side 3. give O2 4. notify HCP 5. stay with pt, provide reassurance

pulsus paradoxus

1. determine SBP using manual BP cuff 2. inflate BP cuff at least 20 mmHb above previous SBP 3. deflat slowly, noting first Korotkoff sounding during expiration 4. continue to slowly deflate cuff until you hear sounds thru inspi and expiration 5. determine difference between first Korotkoff during expiration and sound thru insp and expiration 6. difference is normally less than 10. If differne >10 mmHg, indicate presence of tamponade

3 signs of tube feeding intolerance

1. diarrhea-if too concentrated or too fast 2. fluid overload-rapid weight gain, peripheral edema 3. NV

Meds for HTN

1. diuretic-decrease afterload 2. ACE-vasodilates, but constant dry cough; prevent ventricle from remodeling 3. Ca channel-decrease HR, dilate artery

teaching for Addison pt who take corticosteroids

1. dont discontinue abruptly 2. report any sign of infection bc it can mask signs of infection 3. increase dose in times of stress 4. corticosteroid can cause hyperglycemia 5. costicosteroid can induce osteoporosis and muscle weakenss. Consume calcium 6. side effect of corticosteroid is cataracts-see optometrst yearly 7. can cause gastric irritation so no on empty stomach 8. report signs of cushing syndrome 9. develop exercise plan

5 concepts about CBT

1. education about specific disorder 2. self-observation and monitoring-monitor anxiety, trigger 3. physical control strategies like relaxation, deep breathing 4. cognitive restructuring-reframe thinking patterns 5. behavioral stragies-focus on situations that cause anxiety and practice new coping skills, desensitize

to control IICP

1. elevate HOB to 30 deg; maintain neutral 2. administer stool softner 3. manage pain 4. treat fever-no shiver 5. cal envt 6. oxygenate 7. preoxygenate bf suction 8. hyperventilate to reduce CO2 9. mannitol and corticosteroids 10. space out nursing in small clusters

steps for renal system assessment

1. empty bladder 2. inspect abdomen and lower back 3. auscultate-listen for renal artery bruit and in LUQ 4. percuss, palpate since exam of renal system involes abd assessment

lumbar puncture

1. empty bladder 2. position as lateral recumbent or sitting up. Never prone 3. insert needle bet L3/4 or L4/5 4. pain may be felt raditing down leg but it's temporary After, lie flat with no window for more than 4 hr increase fluid intake

when find a pt lying on floor

1. establish unresponsivenss 2. call for help. code team 3. perform chin lift 4. initiate CPR 5. tell UAP to get crash ccart

Glascoma scale

1. eye opening-1-4 motor 1-6 auditory/visual 1-5

trach care procedure with disposable inner cannula

1. gather supplies and put on semi Fowler 2. don PPE-clean gloves, mask, goggles 3. remove soiled dressing 4. don sterile gloves; remove old cannula and replace with new one 5. clean aroun d stoma with sterile water, dry and replace sterile gauze pad

intervention for hypotension and hypoxemia

1. give O2 2. assess lung sound bf and after increasing IV rate or fluid challenge 3. increase NS for hypotension 4. give acetaminophen 5. reass VSq

steps for removing indwelling cath

1. hand hygiene 2. apply clean gloves 3. place waterproof pad underneath client 4. remove any tape or device that anchor catheter 5. loosen the syringe plunger and connect empty sringe hub into inflation port 6. Deflate balloon by allowing water to flow back to syringe naturally remove 10ml or whatever size it is 7. remove cathether gently and slowly

donning PPE

1. hand hygiene 2. gown 3. mask/respirator 4. goggle/face shield 5. gloves

instilling ear drops

1. hand hygiene 2. position side lying 3. warm ear drop to room T 4. pull pinna up and back if >4 5. instill drops by holding dropper 1 cm above ear canal. No touching 6. apply gentle pressure to tragua to facilitate flow of med 7. remain side lying for at least 203 min 8. place cotton ball loosely on outermost ear canal for 15 min to absorv excess med

administering ophthalmic ointment

1. hand hygiene2. tilt head back, pull lower lid down, look up 3. squeeze thin strip of ointment onto lower lid from inner to outer 4. close eye gently for 2-3 min NO RUBBING

measure orthostatic BP

1. have lie down for at least 5 min 2. measure BP and HR 3. have client stand 4. repeat HR and BP after standing at 1 and 3 minute intervals drop in SBP >20 or DBP >10 or lightheadedness or dizziness-abnormal

when disconnecting central venous cathether, prevent air embolism by

1. have lie in SUPINE-increase central venous pressure and prevent air getting into vessel 2. tell to bear down or exhale 3. apply air occlusive dressing-tegaderm 4. pull line cautiosly and never pull harder if resistence

relieve choking in responsive infant

1. hold infant down 2. forceful 5 back slaps bet shoulder blades 3. turn infant up 4. provide 5 chest thrusts 5. repeat until object dislodges or if infant becomes unresponsive, do CPR

4 ways to facilitate airway clearance in pneumonia

1. hydration 2. hff coughing tech-while sitting, inhale thru nose, relax abd. as exhale, lean forward, exhale sharply with huff sounds and contract abdomen 3. chest PT 4. Fowler's or position with bad lung up, good lung down. Good lung down-gravity increase blood flow in good lung, good gas exchange. if bad lung down, bad lung has good blood but bad ventilation. Good lung has good ventilation and bad blood flow so not good

4 side effec of thiazide diuretic

1. hypokalemia-muscle cramp 2. hyponatremia-altered mental status3. hyperuricemia-worsen gout attack 4. hyperglycemia-adjust diabetic meds

steps lumber puncture

1. ifnromed consent 2. get tray and supplies 3. explain procedure 4. have empty bladder 5. position (side lying with knee up or sitting up and bent over) 6. label specimen as collected 7. apply bandage over insertion site

stages of group therapy

1. initial-superficial. "purpose" 2. working-real work is done-built trust relationship 3. termination-provide opportunity to learn to deal with letting go-anger

descending stairs with one cane

1. lead with cane 2. bring weaker leg own 3. step down stronger leg

to avoid prosthesis dislocation following hip arthroplasty

1. perform leg exercises isometric quadriceps and gluteal setting, leg raises Use assistive equipment when getting dressed use toilet rise or bedside commode chair to prevent hip flexion when getting on and off toilet seat Dont force hip into more than 90 deg of flexion

injecting enoxaparin

1. pinch an inch of skin up and insert needle at 90deg 2. continue to hold skinfold and remove needle at 90 deg 3. mild brusing, redness, pain common at injection site. No RUBBING site. Place ice cube on site 4. No Aspirin, NSAIDS< GInkgo, vit E 5. monitor CBC-no need for PTT monitor

removing internal jugular central line catheter

1. place in trendelenburg 2. have client take deep breath and hold 3. withdraw while applying pressure with sterile gauze

washing infant steps

1. place in warm surface 2. eyes first 3. face 4. wash body 5. place in warmed blanket 6. wash head last-bc lose most heat there

intervention for chest pain

1. place on telemetry monitor 2. monitor BP, pulse 3. obtain ECG 4. give nitroglyceine 5. BP 6. nitroglycerine 7. BP 8. nitro again 9. BP 10. morphine

possible postop infections

1. pneumonia-atelectasis prevent secretion clearance-cough, SOB< crackles 2. UTI-frequenc, urgency, dysuria 3. surgical site infection-redness, warmth, swelling, purulent drainage 4-peritonitis-rebound tenderness, boardlike abd rigidity

TO ensure accuracy of invasive arterial line for BP measure

1. position supine, flat, prone or HOB <45 2. zero reference stopcock at level of phlebostatic axis (4th intercostal space, midaxillary--level of atria), no matter what position pt is in 3. zero system with initial setup 4. square wave test/dynamic response test q 8-12 hr 5. measure pressure at end of expiration

steps removing chest tube

1. premedicate with analgesic 2. provide PCP with sterile suture removal equipment 3. breath in, hold it, bear down-Valsalva maneuver 4. apply sterile airtight occlusive dressing 5. chest xray 2-24 hr after removal

6 absolute contraindications to thrombolytic

1. prior intracranial hemorrhage 2. structural cerebrovascular lesion like AVM 3. ischemic stroke within 3 month 4. suspected aortic dissection 5. active bleeding 6. significant head trauma wthin 3 months

seizure phases 4

1. prodromal-warning signs 2. aural-may expericne visual or other sensory changes 3. ictal-pd of active seizure 4. postictal-confusion when recovering from seizure

in biochemical event

1. protect envt for others 2. donn PPE 3. decontaminate affected individuals 4. perform triage 5. report to DOH

preeclampsia

1. proteinuria- more than 300 mg/24hr 2. HPN-140/90 3. end organ failure=pul edema, thrombocytopenia, renal insufficiency, liver fail, deep tendon reflex after 20weeks swelling expected watch for placnetal abruption-placenta tear away from wall-bleeding and abd pain Facial swelling, headache, visual disturbances

3 steps of separation anxiety

1. protest 2. despair 3. detachment

z track technique

1. pull skin laterlaly away 2. hold skin taut and insert needle at 90 degree 3. inject meds slowly 4. wait10 sec after injection and withdraw needle while maintaining traction on skin 5. release hold of skin 6. apply gentle pressure but no massage ventrogluuteal in adult and vastus lateralis in childre

3 categories of PTSD

1. reexperiencing trauma-flashback, recurring nightmare 2. avoiding reminders of trauma 3. increased anxiety, emotional arousal

removing a bulb suction drain

1. release suction from bulb 2. if sutures are present, remove them using kit 3. instruct to breathe deepl and smoothly 4. use continuous motion to remove drain 5. assess site for infection then cover with gauze dressing

intervention for frost bite

1. remove from cold envt 2. give pain med bf immersing 3. immerse feet in warm water 4. apply loose dressing 5. monitor for compartment syndrome

meter dose spacer use steps

1. shake MDI and attach to spacer 2. exhale completely 3. place lips lightly around mouth piece 4. deliever single puff of med intospacer 5. take slow deep breath and hold for 10 sec 6. rinse mouth with water. Spit out water

when hypoglyceic

1. side rail-safety dizzy 2. give 4 ounce appl juice 3. receck blood gluc 4. tell HCP 5. document 5. recheck blood gluc in 15 min

steps to instill eyedrops

1. sit down and tilt haed backward 2. pull tissue beheath eye down 3. hold dropper and stabilize hand on forehead 4. have clien tlook up as instill drops 5. have client close eye and move it 6. press lacrimal duct for 1 min

what can 5 yr old do

1. skips 2. walk backward 3. uses jumprope 4. draw triangle 5. ties shoelace 6. print letter, number 7. count to 10 8. speak in full sentences 9. name coins and days of the week 10. self dress and bath 11. identify real from pretend

bwel evisceration steps

1. stay calm and stay with client 2. pul cline tin semi fowler with knee flexed 3. ccheck VS 4. have collegeu gather sterile supplies and contact physician 5. cover intestine with sterile gauze 6. prep for surgery

steps in prevening injury to fallin client

1. step slightly behind clinet and place arms under axillae or around waist 2. place feet wide with knees bend 3-place one foot behind other and extend front leg-bring client backward 4. let cliend slide down the extended leg to floor

ascending stairs with one cane

1. step with stronger 2. move cane next 3. move weaker leg

intervenson in hyperstimulation by oxytocin with fetal non reassuring

1. stop oxytocin 2. position side lying 3. give O2, 10L/min 4. give IV fluid blolus 5. maybe terbutaline subQ 6. HCP 7. document

3 phases of kawasaki disease

1. sudden high fever doesnt respond to abx or aspirin, swollen red feet/hand. swollen lips, strawberry tongue 2. skin peels 3. SS disappear slowly. T return to normal

taking off PPE

1. take off gloves ( do not want anything to contaminate hair, face..) 2. goggles 3. gown 4. N95 respirator 5. hand hygiene

Huff cough for COPD

1. upright 2. inahle thru nose and use pursed lip to prolong exhalation 3. hold for 2-3 sec following inhalation 4. deeply inhale and lean forward, use abd muscle to make huff cough X2 5. inhale deeply and give one forced huff cough

steps to irrigate ear

1. use otoscope to check eardrum 2. fill syringe with warm solution 3. place tip of syringe at angle in external canal 4. apply gentle pressure to syringe plunger 5. watch for fluid return and sign of cerumen 6. if cerumen doesnt appear, wati 10 min and do again 7. after completion, have client turn head to side to facilitate drainge

infusing thrombolytic steps

1. verify client 2 ID 2. review inclusion, exclusion criteria 3. obtain consent 4. infuse 5. provide safe handling of client 6. address psychosocial needs

BLS for unconscious, pulseless pt

1. verify unresponsiveness 2. call help 3. check carotid pulse and breathing 4. attempt CPR and chest compression CAB at 1 (100-120/min and 2-2.4 inch) 5. notify HCP

what can 4 yr old do

1. walk DOwn stairs with alternative feet 2. stand on one foot 3. catch a ball 4. draw a square 5. cut with scizzor 6. ties a simple knot 7. name 2+colors 8. likes telling a story 9. imaginative/group play 10. often focused on self

What can 3 year old do

1. walk up stairs alternating feet 2. pedal tricycle 3. jump forward 4. draw circle 5. feeds self 6. grab crayon with finger 7.3-4word sentences 8. states own age 9. why questions 10. associative play 11. toilet trained except wiping

prepping sterild field for wet-to-damp dressing change

1. wash hands 2. open sterile gauze package with ungloved hands 3. hold inverted sterild gauze package 6 inch above waterproof sterile field then drop dressing onto the field 4. place dressings more than 1 inch from edge of field 5. use sterile NS (new or that was opened less than 24 hr. if more than 24 hr, consider contaminated)

if client is found on floor,

1.. assess for adequate pulse 2. inspect for injuries 3. get help and move to bed 4. notify PCP 5. complete incident report

preop steps

1.. verify consent 2. obtain VS 3. empty bladder 4. ask to remain in bed-safety measure 5. administer preop med-DO ALL NURSING PRIOR TO PREOP MEDS

norma urine gravity

1.003 to 1.030

normal urine gravity

1.003=1.030 increase indicate dehydration/ fluid deficit

weight gain for 1st trimetster

1.1 to 4.4 lb regarless of weight

normal Mg

1.5-2.5

Mg range

1.5-2.5 mEq/L

4 occasions Lithium tox occurs

1.dehydration 2. decreased renal ftn 3. diet low in sodium=kidney reabsorption of Na also increase Li reabsorption 4. drug interaction-NSAIDS, thiazide diuretics

stesps in guaiac fecal occult blood test for colorectal cancer

1.otain supplies, non sterile glove 2. open slide flap and use applicator to apply 2 separate stool sample to slide. 3. cover and dry 3-5 min 4. open back of slide and apply 2drops of developing solution to each 5. assess color of paper after 30-60 sec. If paper turn blue-positive. Stool contains microscopic blood

steps after blood transfusion

1.stop transfusion and disconnect tubing at catheter hub 2. maintain IV acccess with NS with new tubing 3. monitor VS 4. notify HCP and blood bank 5. recheck tag, number, blood type 6. treat symptom with prescription 7. return bag of blood to blood bank 8. collect blood/urine for hemolysis 9. collect paperwork

15g of carbohydrate eg. 3

1/2 cup plain pasta 1/2 cup canned fruit 125 ml of apple juice

KCl infusion limit

10 over 1 HR when peripheal 40 over 1 hr central line

how many second suction ET tube

10 sec

infant eats using fingers

10-12 month

eat with finger

10-12 months

fundus height

10-12 week-above symphysis pubis 16 wks- midway bet symphysis and umbilicus 20-22- at umbilicus 28- 3 fingerbreadth above 36-below ensiform cartilate

when is fetal heart beat detectable by Dopplet

10-12 weeks gestation

treat hypoglycemia with how much carb

10-15 g also retest in 15min

phenytoin therapeutic serum range

10-20

normal IOP

10-21

2.2lb or 1 kg weight gain equals what ml

1000ml of fluid

HPV immunization

11-12 3 dose series

immunization tetanus, diphtheria, pertussis Tdap

11-12 yrs

normal prothrombin time PTT

11-16 sec

fetal HR

110-160

when chest drainage stops abruptly in tube

auscultate breath sounds-lung re expanded? cough, deep breath reposition client

normal A1C

120days 4.6 to 7.5

walking alone

13-15 month

14-gauge 18-gauge 20-22 gauge 24 gauge

14= giving fluids/drug in emergency/prehospital setting or for hypovolemic shock 18-stable adult for fluids or blood 20-22- give general IV fluid and meds, NOT BLOOD 24-for children and elderly with small fragile veins

MMR

15 month

what to give in hypoglycemia

15-20 g quick acting carbohydrate 4-6 oz regular soda 8-10 Life Savior candies 1tbs honey/syrup 4 tsp jelly 4-6 oz OJ 8 oz low fat milk

optimal serum vancomycin

15-20 mg/L also monitor BUN and creatine regularly due to nephrotox

normal platelets

150000-400000

Amniocentesis

16 weeks- genetic disorder 30 weeks-lung maturity RHogam

readiness for toilet training

18-24 month when neuromuscular maturiy with control of anal and urethral sphincter bowel training less complex than bladder training -ambulate and sit on toilet -remain dry for several hr -pull clothes up and down -understand 2step command -express need to use toilet -imitate toilet habits of adults -express interest in toilet training -able to communicate and follow direction

normal BMI

18.5-24.9

BMI

18.5-24.9 normal 25-29.9 overweight >30 obese >40 morbidly ovese

1 cup= ?oz 1 oz= ?ml 1 cup- ?ml

1cup= 8 oz 1 oz= 30mL 1 cup=240 mL

iron def criteria preg

1st&3rd trimester- <11 2nd trimester <10.5

stages of labor

1st-dilation, effacement. end with 100% effacement and dilation of 10cm. 3 phases of latent (0-3), active (4-7), transition (8-10 cm) 2nd-expulsion and birth of baby 3rd-placenta separated. 4th-2 hr after placental delivery

DTap vaccine

2 4 6 months

inactivated polio vaccine

2 4 month

beta blocker and ethnicity

beta blocker less effective in African AMericans than they are in Cucausiaon SAME IN ACE INHIB,

preventing community asso pneumonia

2 vacines Flu vaccine smoking cessation

bf and after lumbar punctue

bf- fetal or bent over table after-supine to prevent spinal headache

phosphorus level

2.4 - 4.4 If high P, Calcium acelate to decrease P level

systemic inflammatory response syndrome SIRS 4 criteria

2 of following T>100.4 or <96.8 HR >90 RR >20 or pCO2<32 WBC>12,000 or <4,000 treat by fluid reesuscitation and IV abx

serum P level

2.4-4.4

schizophrenia with catatonia

2 of the following: immobility-remin fixed stupor for long pd remains mute bizarre posture extreme negativism-resist instructions waxy flexibility-limb stays in same position in which they are placed by another person staring sterotyped movements Cant meet basic needs for fluid and food high risk dehydration and malnutrition

immunization rotavirus

2 mon 4 mon

Haemophilus influenza type b immunization

2 month 4 mon 12-15 month

range INR for warfarin

2-3 if INR is less, risk for atrial thrombus, embolization, stroke if excess INR, risk for bleeding-excess warafarin

feeding newborn frequenty

2-3 hour every

dolls eye reflex disapper

2-3 month

normal frequency in first stage of labor

2-5 contractions/10 min no more than every 2 min

peak of regular insulin

2-5 hr after

normal central venous pressure

2-8 if increased, increased systemic volume, right ventricular preload

transition from 2 to 3 to 4 year to 5 year old

2-temper tandrum, mood shift, food issue. 4-drama 5-calm

INR for warfarin

2.5-3.5 hold if more tgan 3,5

light gray clay colored stool

biliaray obstruction

infant

birth to 18 month

serum absolute neutrophil count

2200-7700 cell if <500-severe neutropenia-infection!

creatine clearance

24 hr urine collection measure Glomerular function indicator of renal disease progression first specimen discarded

2-3 word phrases

24 month

when does toddler call self by name

24 month

alcohol withdrawal peaks

24-48 hr after last drink

normal intensity in first stage of labor

25-50 mmHg should not exceed 80 mmHg

MAP

2DP+SP/3 should be more than 70

Humulin N

2X a day intermediat acting No IV can mix with fast acting onset 1-2 hr peak 4-12 hr duration 12-18 hr

immunization poliovirus

2mon 4mon 6-18 mon 4-6 yr

pneumococcal conjugate PCV13 immunization

2month 4month 6month 12-15 mon

recommend influenza vaccine to high risk

all >6month chronic coniitions-asthma, HF< cancer immunocompromised health care workers healthy age 6-23 month; over 65 year preg women

petechiae in hydrocodone PO

allergic rxn

immunization hep B

3 birth 1-2mon 6-18 month

side of clonidine

3 D's dizziness, drowsiness, dry mouth dont discontinue abruptly

incentive spirometer steps

5-10 breaths per session q hr 1. sitting/high fowler 2. hold at even level, seal lips tightly at mouthpiece 3. inhale deeply 4. hold breath 2-3 sec 5. exhale slowly 6. breath normally for several breaths before repeating process 7. cough at end of session

droplet precaution

3 ft

3month infant feeding

3-4 oz formula breast milk q3-4 hr

normal pupil length

3-5 mm in diameter

preschool

3-5 yr aWHYWHYWHY 5-8word sentence, make believe and imaginary friend 5lb/yr; 3 inch/yr tricycle by 3 yr,\ dominant hand decided use scizzor by 4 tie shoes by 5

allergic rxn vs hemolytic rxn in blood transfusion

allergic-urticaria, itching, rep distress hemolytic-hypotension, backache, low back pain, fever

serum albumin level

3.5-5.0 mEq/L

reading EKG HR

30 large squares on EKG paper equal 6 sec. Multiply Number of QRS by 10 If 8 QRS on the 30 large square= 8 times 10=80

child jump with both feet

30 month

Ventilator asso pneumonia prevension

30-45 deg avoid gastric over distension use cuffed ET tube ET tube cuff presssure more thn 20 regular oral care with antiseptic routine ABX prophylaxis NOT recommendd avoid stress ulcer prophylaxis

onset of regular insulin, Humulin R

30-60 min

normal urinary albumin

30mg/24 hr

jumptin with both feet

30month

1 lb =? kcal

3500 calories

how may calories in 1 lb

3500 calories result in weight loss of 1 lb.

when can fetus hear

38 weeks

normal hematocrit

39 to 50

normal hematocrit

39-50%

erb's point

3rd intercostal S2 heard best

school aged

5-12 gain 4-6lb/yr 2inch/yr socialization important periods start-diet, nutrition primary teeth come out time tell competitive permanent teeth grow secret clubs

normal bowel sound

5-15 sec high pitched gurgiling sounds bruits rarely benign

bowel sounds

5-30 sound/min=normal more than 30 sounds/min- hyperactive

Risk ffactors for Lithium tox

4 Ds dehydration decreased renal ftn diet low Na drug-drug- NSAID< tiazide diuretics

intervention for osteoporosis 6

bisphosphanate meds Ca, vit D smoking cessation alcohol avoidance weight bearing and resistance exercise prevent fall

neurogenic bladder

bladder damage by neurogenic issue incontinence, frequency, uregency, retention treat with bethanechol

infant brings object to mouth

4-6 month

normal duration in first stage of labor

45-80 sec should not exceed 90 sec

immunization DTaP

5 doses 2mon 4mon 6mon 15-18mon 4-6 yr

normal ejection frcation

55-70 decrease in CO, inability to meet O2 demand

febrile seizure

6 month to 6 years etiology unkown seizure precaution antipyretics cool, damp compresses to forehead increase air circulation loose clothing prevent shivering-no ice, bath

normal pul artery wedge pressure

6-12 incerase in cardiogenic shock

BUN

6-20 mg/dL

normal fasting blood sugar

60-110

serum amylase

60-160

infant sits along to play

7-9month

normal MAP

70-105 mmHG

normal serum fasting gluc

70-99 mg/dL

gestational diabetes

75% risk will develop type 2 diabetes in future

1 cup= ?oz 1 oz= ? ml

8 oz 30ml

transition period of birth

8-10 cm dilation emotional phase of labor increased anxeity bloody tinged mucus bloody show common give emotional support and encouragement; coaging breathing tech

pincer grasp develop at

8-10 months cheerios, cut up pieces

complication after prostatectomy

bleeding passage of blood clot decrease in urinary strem retention SS UTI

normal Ca level

8.6-10.2

legel alcohol level for driving under influence

80 mg/dL 0.08%

normal systemic vascular resistance

800-1200

normal infant T

97.7 to 99.7

pincer grip at

9month

BNP range

<100 pg.mL

dopamine effect based on dose

<5-increase kidney perfusion 5-10= + inotropic 10<-vasoconstricts

client with blindness

do not store personal items or rearrange furniture bc client needs to be used to envt-need to consistently locate items

actions to take in lateral violence

document of all incident let bully know it is not tolerated observe interaction bet bully and others report to immediate supervisor dont ignor

after above knee amputation

dont elevate limb-cause contracture use closed rigid cast to prevent bleeding, control pain-provide cast care

toys for preschoolers

enrougae imitation of adults dolls puppets imaginative toys dressup clothes medical kits, cars, plane

when nurse received unwanted sexual advances in work

first clearly indicate that nurse does not want so stop confront, report, document, support

PKU

first give maternal milk-low in phenylalanine

DKA management

Give K supplement to prevent hypokalemia whtn giving continuous insulin (K is bet 3.5 to 5) Give D5Q to IV fluid when blood gluc 250 to prevent hypoglycemia rxn When gluc<200, switch insulin drip to subQ injection

hyperMg

Give calcium gluconate may be due to magaldrate, an antacid

sepsis signs

HR>90 T>100.9 SBP<90 altered mental hyperglycemia absent bowel sounds cap refill >3-4sec

postpartum bleeding

first see uterine atony if atony, massage fundus if contracting uterine, report to PCP, unrepaired laceration

auscultate heart

A-Right 2nd intercostal P-Left 2nd Intercostal T-Left 5th intercostal M-left 5th midclavicular

hemophilia A lack hemophilia B

A-factor VIII B-Factor Xi

weight gain preg

first trimester- 1~3 kg second&third trimesters-0.5 kg/week want 25-35 lb gain

when frequent nosebleeds,

allergy? frequent use of nasal spary to relieve allergy SS result inv ascoconstriction of vessels, , atrophy of membrane and decreased integrity of blood vessel

first and second stage of labor

first-coach with patterned breathing second-pushing stage

what meds are ototoxic

furosemide indomethacin aminoglycosde

what can lead to pelvic inflammatory disease and infertility

gonorrhea chlamydia referred as silent infection

Alcoholic Anonymous Adult Children of Acholics Al-Anon Alateen National Asso for Children of Alcoholics

AA-individual with alcohol prob Adult children-provide assistance to cadult who grew up in alcoholic house Al-non-help to spouse, significant others, family, friends Alateen-support adolescent children National Asso-raise public awareness of alcoholism

management of burn injuries

ABC first high flow O2 volume replacement with lactaged ringer pain

managing SCI

ABC immobilize and stabilize traction to align steroids for first 24 hr for inflammation

skin cancer exam

ABCDE Asymmetry Border irregularity Color change/variation Diameter of 6 mm or larger (pencil eraser) Evolving (change in shape, color, size)

ankle-brachial index

ABI<0.9-concurrent PAD and need for lower level of compression therapy

acute glomerulonephritis vs nephrotic syndrome

AG-dark urine. Diuretics dont help Nephrotic-frothy urine, diuretics help

AKI vs CKI

AKI-oliguria then diuresis CKI-polyuria then oliguria...anuria (<100ml/24 hr)

permissive HPN

allow BP to remain high after ischemic stroke to perfuse pneumbra 24 -48 hr after Treat if 220/120 bc BBB not intact at this BP keep SBP above 170 only in ischemic stroke-treat HPN in hemorrhagiv stroke

llevothyroxine

good in preg begin to improve 3-4 weeks SS

phlebotomy for specimen

allow area to air dry dont use vein on ventral side of wrist-painful and high risk of nerve injury invert tube 5-10 times gently if pulsating red blood, have infiltrated artery so remove and apply pressure for 5 min

care for diverticular disease

allow colon to rest and inflammation to resolve NPO IV fluids pain relief prevnet Increased intraabdominal pressure prevent increased intestinal motility-avoid laxative, enema

GTPAL

gravid term-delivvery after 37 weeks Preterm-delivery before 37 weeks A-abortions-loss bf 20 weeks L-living

right side position after eating newborn

allow digestion feeding flow to lower end allow swallowed air to rise above fluid and thru esophagus

food high vit K

green leafy veg

contraceptive use ACHES

Abd pain Chest Pain-pul emb Headache Eye prob Severe leg pain

SS small bowel obstruction

Abrupt onset N, V colicky abd pain abdominal distension Can lead to ischemia, perforation- keep NPO, insert NG tube, IV fluids

managing RA

autoimmine, inflammation use moist heat perform ROM daily allow pd of rest in afternoon use ice on painful joints Dont sleep with pillow under knee-cause joint contracure heat for stiffness; cold for pain

meds for HF

Ace inhibitor combined with furosemide

what cause hyperK

Ace inhibotr ARB K sparing diuretic-spiron

signs of cotaminated blood

green, black, white, dusky accumulation air airbubble evidence of clottng malodor

risk factors for stroke

African American male substnace abuse smoking obesity heart murmur diabetes migrain sedandary ife oral contraceptive HX MI elevated cholesterol

risk factor for lung cancer

African American men smoking

assessment ABCDEFGHI

Airway Breathing CIrculation Disaility-glasgow coma Exposure-remove cloth, prevent heat loss Full set of VS, focused intervention Give comfort Heat to assessment/HX with SAMPLE (signs, allergies, medications, PMH, last meal, events preceding) Inspect posterior

most effective for substance abuse

Alcoholic anonymous self-help group

risk factors for preterm birth 5

hx of spontaneous preterm birth previous cervical surgery like cone biopsy infection any tobacco/illicit drug use age<17 or >35

4 meds that are held out before dialysis

Antihypertensive bc fluid removal by dialysis can cause hypotension Water soluble vit-VitB,C folic acid antibiotics, digoxin

position after total hip replacment

Avoid hip adduction Avoid hip flexionn No crossing legs HOB less than 45 deg to prevent excess hip flexion No sleep/position on operative side use abductor pillow or trochanter roll when turning

west nile virusq

mosquito borne summer avoid mosquito use repellent keep arm/leg covered

B1 B6 B9 B12

B1 - For Alcoholic Patients (to prevent Wernicke's encephalopathy & Korsakoff's synd) •B6 (pyridoxine)- For TB Patients •B9 (folic)- For Pregnant Patients •B12 - Pernicious anemia, Vegetarians.

Immunization for 6 month mnemonic

Be DR HIPHp B, DTap, RV(rotavirus), Hib, IPV(poliovirus), PCV (pneumococcal)

Sulfonylurea/Glyburide in elderly

Beers criteria risk for prolonged hypoglycemia in geriatric due to delayed elimination use metformain instead

multiple myeloma

Bence Jones Protein increased uric acid and Ca Excruciating pain Give fluid, pain management monitor bone fraction, renal failure Fluids!

acne vulgaris

Bulimia due to binging on junk food papulopustular skin eruptions

contraction stress test CST

negative result is good! no later or variable deceleration detected

OT vs PT

OT_ADL-dressing, bathing, perception issue PT-mobility, ambulation, ability transfer, use of walker-for below the waist; use of equipment

watery diarrhea

C.diff?

assessing C4-C5 C8 S1 L2=L4

C4-5 apply down pressure when shrugging shoulder C8-grasp and form fist S1-plantar flexion L2-4- resistance when lifting legs

CPR

CAB compression airway breathing

cancer warning signs

CAUTION Change in bowel/bladder A sore that doesnt heal Unusual bleeding/discharge Thicken/lump in breast Indigestion/difficulty swallowing Obvious change in wart/mole Nagging cough, hoarseness

Mg Sulfate tox

CNS depression-cardiac arrest absent/decreaseed deep tendon reflex resp depression UO<30ml/Hr serum level good if 4-7

pemoline

CNS stimulant for ADHD

side effect of methylphenidate

CNS stimulate for ADHD loss of appetiet so weight loss compare weight/height in children HPN and tachycardia

SS theophylline toxicity

CNS stimulation-headache, seizure GI disturbances-NV cardiac tox-arrythmia

intervention in v fib pulseless

CPR defib 200 J IV epi 1mg IV amiodaron 300 mg push

basilar skull fracture

CSF rhinorrhea or otorrheea can do dextrose testing to see if CSF if bloody, cant do dextrose; do halo test (bloody conjugate surrounded by CSF) Risk for infection-never stick anything to nose bc can penetrate skull periorbital raccoon eyes Batthe sign-postauricular ecchymosis

oral contraceptive put more risk for

CV thromboembolic disease

Antacid

Ca based, high Na decreases acidity

no grapefruit meds 4

Ca channel blocker statin warfarin (vitK) cyclosporine

hyperparathyroidism SS

Ca up, P down osteoposis (Ca release from storage) nephrolithiasis-stone polydipsia, polyuria-Ca is diuretic constipationbone pain, muscle pain

culture sensitivity with breastfeeding

Causacian-breastfeed right after birth South Asia, Africa, Pacific Isalnd, Native American, Hispanic-may beleive colostrum is harmful so not initiate breastfeeding till breastmilk comes in-Need TEACHING African-may breastfeed till child is 2 Arabian-value privacy so may choose to bottle feed in hospital and breastfeed in home

Rheumatoid fever

peak in school age follows after untreated Strep fever, rash, chorea, increased ESR damage heart valve Salicylates used

when client suddenly collpase,

Check responsiveness assess pulse call for pulse CPR

food high in fiber

pear pea corn rapberry

contraindication to anticogulation therpy

peptic ulcer disease alcohol use recent injury

primary indication of oversedation from opiod

Co2 in blood by capnography bc opiod depresses respiration, CO2 retains

Risk of colonoscopy

perforation abd pain, positive rebound tenderness, guarding, abd distension, tenesmus, boardlike abdomen rectal bleeding

poitive nitrate in urinalysis

indicate E.coli infection

bruit over aorta

indicate aneurysm notify PCP

persistent fetal bradycardia

indicate cord compression or placenta separation turn mom to left side give O2 IV fluids call PCP prep for C sec

preg unilateral dull abd pain

indicate ectopic preg

subdural hematoma

bleeding into subdural occur several weeks to months following mild trauma more to elderly and those taking anticoagulants SS headache, gait disturbance, memory loss, LOC

elevated antistreptolysin O titier-ASO titer

indicate glomerulonephritis

shoulder pain after lap colecystectomy

indicate henorrahge or bile leak contact PCP

ACE inhibitor

blocker enlargement of left ventricle block RAAS SHortage of Angiotensin II results in ortho hypo shortage of aldoserone cause hyperkalemia adver-cough, angioedem-adue to accumulation of bradykinin

passage of brown stool in intusseption

indicate it has resolved

acanthosis nigricans

indicator of insulin resistance DM

acute glomerulonephritis

can be cuased by strep decreased urine output decreased GFR HPN Dark urine (blood) proteinuria Low Na, Low K diet **Lack of response to diuretic! so do dialysis instead

if bloody outflow in peritoneal dialysis in women

can be menstruation due to hypertonicity, blood from uterus can be pulled in

watch out in impetigo

can cause glomerulonephritis watch periorbital edema

alcohol

can cause hypoglycemia esp i DM so monitor blood gluc alcohol withdrwal starts within 8 hr of last drink and peaks 24-72 hrs

epidural anesthesia during preg

can cause hypotension so give fluids 1st or 2nd stage increased risk for urinary retention-may need catheter

rapid or high dose IV furosemide

can cause ototoxicity esp in renal ftn decline rate should not exceed 4 mg/min in dose >120 mg rate-ototox dose-nephrotox

diaphragm

can cause pressure on bladder and cause UTI

hypoMg

can cause prolonged QT watch seizure-get benzo give banana, orange-high in Mg watch for hypocalcemia-hypoMg accompany hypoCa

antiinfective

can decrease effect of contraceptive-all abx

legal criteria for involuntary commitment

individual is danger to self or other grave disability due to mental illness-cant care basic needs

ipecac syrup

induce vomiting after accidental ingestion of poison if no Vomit occur after 20 min, repeat dose

misoprostol

induction of labor; also to deliver dead fetus

PPD age limit

infant can receive

molding

infant has bullet shaped head, resolves. by overlaping of skull bone

plays

infant-individual toddler-parallel preschool group

when giving TPN

check xray for catheter placcement-risk of PTX use filter bc TPN is hypertronic solution and increases risk for infection check baseline blood gluc use electronic infusion pump

fluorouracil

chemo cause neutropenia

tx renal cell carcinoma

chemo uneffective do surgery-nephrotomy

CPR with no pulse

chest compression 30, head tilt chin lift, ventilate 2 breath/1 sec compression-breath= 30 to 2 Defib if indicated epinephrine

appropriate toys

infant-rattle-no choking things toddler-picture book preschool-hand puppet, coloring book school-games, books,, hobby adolescent-books, videogame, boardgame

gabapentin

taken 3 divided doses treats neuropathic pain was antiseizure med approved for post herpes/shingles pain may cause drowsiness

watch out in sepsis/septic shock

DIC! vlood at venipunture blood at IV

when is phototherapy considered

total serum bilirubin greater than 15 at 72 hr of age

DKA vs HHNS

DKA-DMI. Ketone in urine. rapid. gluc>250-500 Kussmaul and abd cramping. HHNS-DMII since has some insulin, no ketone so no Kussmaul breathing or abd cramping. gradual onset but lead to guc>600. fluid deficit, so high serum osmolality; more mental-obtundation, lethargy, coma

sitagliptin

DM no fat increase grain, fruit, veg

Risk factors for pressure ulcer

DM spinal cord injury anemia weight loss decreased intake Norepinephrine infusion ypoxia unstable hemodynamic-hypotension incontinence edema infection/fever

epiglottis 4Ds and treatment

DO NOT EXAM THROAT med emergency 4 D's dysphonia (muffled voice) dysphagia (difficult swallowing) drooling distressed resp effect high fever, sore throat assume tripod position nothing in throat high fever, sore throat, tripod position IV ABX tracheostomy=emergency airway

Control delusion

DOnt drink tap water. Thhats how govt controls us

4 vaccines for 2 month old

DR HiP DTap Rotavirus Hib Poiovirus

stages of grief

Denial Anger Bargain Depression Acceptance

Upper Gi, lower GI, sm bowel series

Do lower Gi first-barium enema bc can interfere with other result Upper GI-esophagus, stomach, duodenum

pulse ox probe

Dont expose to direct light or strong light bc give inaccurate results

when something is stuck in eye

Dont pull out Dont wash-can move object cover with st

giving self eye drops

Dont squeeze eye tight bc cause drop to be expelled drop go to center of lower eyelid tilt head back

Simian crease

Down Syndrome single transverse crease across the entire palm of hand

tooth erution formula

During first 24 months of life Age in child (months) - 6=-expected number of tooth by age 30 months, all primary teeth (20) should have erupted.

first 24-72 hr after burn injury3

HYPOVOLEMIA, HYPONATREMIA, HYPERKALEMIA increased vascular permeabiliy and fluid shift fluid, protein leadk into surrounding interstitum- decreased IV pressure, decreased IV volume hypovolemia! K is released-hyperK= ECG change, tall, peaked T HCT, HGB elevated due to hypovolemia SNS activated Hyponatremia bc Na lost via fluid shift and insensible lossess

addisonian crisis

HYpotension, tachycardia, dehydration, hypoglycemia, confusion need emergency intervention-shock management, fluid resuscitation, high dose hydrocortison IV push

intervention for metoprolol 4

EEG monitor monitor gluc bc mask SS of hypoglycemia Monitor for heart block give undiluted by direct IV

Trisomy 18

Edwards syndrome life expectancy is few weeks cardiac defect multiple MS deformities

displacement

tranfer thought/feeling toward to one person or object A person angry with boss yells at spouse

tx anaphylactic shock

Epinephrine diphenhydramine prednisone albuterol

infective mononucleosis

Epstein-Barr virus from sharing drinks, kissing, saliva fatigue, fever, sore throat, splenomegaly, hepatomegaly, swollen lympth node No ABX bc viral manage SS, hydrate, rest, control pain complications: airway obstruction, abd pain

Erikson stage

infant-trust vs mistrust toddler (1-3) autonomy vs shame preschool-initiative vs guilt school=industry vs inferiority adolescent-identity vs role confusion

reassuring FHR

FHR 110-160 occassional accelerations early deceleration

postmortem care

allow family to assist with care maintain isolation precaution close eyes remove tubes/dressing straighten body wash body and change linens replace dentures place pad under perineum raise HOB consider need for autopsy or organ donation fold a towel under chin to closse mouth

position for pneumonia

GOod lung down If bad lung down, due to gravidity, blood go to bad lung, V/Q mismatch

isolette

allow infant to receie phototherapy in temperature regulated envt

terazosin

alpha 1 blocker treat BPH

synch cardioversion purpose

For v.tach with pulse, SVT, afib with rapid Ventricular synch allow delivery of shock on R wave. It is done to avoid having shock at T wave-which can lead to lethal rhythm-Vtach, Vfib

digoxin tox

GI -anorexia, NV, abd pain neuro-lethargy, fatigue, weakness, confusion visual cardiac arrythmia-bradycardia

what decreases cardiac output

GI bleeding CHF use of PEEP MI

metformin side effect

GI prob-bloating, diarrhea will go away

4 SS digoxin tox

GI_NA< anorexia Neuro-confusion, weakness, fatigue Visual Cardiac arrythmia-bradycardia/heart block

emphysema

alveoli loses elasticity barrel chest

SS large bowel obstruction

Gradual onset cramping abd pain abd distension absolute constipation

Hawthorn extract

HF

pioglitazone contraindication 2

HF pregnancy

lab value to watch when clopidogrel

HGB HCT if low, indicate bleeding clopidogrel suppress platelet aggregation (not decrease platelet)

dx HIV and AIDS

HIV-ELISA then confirmed by western PCR for neonates AIDS- CD4 <200

post craniotomy

HOB 30 deg, supine or side to side ice pack to eye-periortbital edema cool compress to forehead

digoxin in children/infant

HOld if HR<70 in children; HR<90 in infant 1-2 hr bf meal SS tox-V, diarrhea, anorexia, drowsiness give adequate K bc low K increase dig tox

garlic for

HPN side effect: heartburn, flatulence can cause hypoglycemia

Newborn VS

HR 100-160 RR 30-60 for 1 min axillary T-97.6-99 BP 73/55

neonatal resuscitation begins when

HR less than 60/min middle third of sternum below line bet nipple if remains below, epinephrine

rapid response team

HR<40 HR>130 SBP<90 RR<8 or RR>28 O2<90 UO<50ml/4 hr Level of consciousness

med for PVC

amiodarone-control ventricular rhythm

walking with cane

Hold cane on UNAFFECTED side move injured leg after moving cane

normal lab values 3rd trimester

Hgb >11 HCT >33 RBC 5-6.25 WBC 5,000-15,000 platelet 150,000-400,000

anemia dx

Hgb<10 Hct<35 RBC<4

Vent high pressure alarm

High pressure alarm 1. kink tubing 2. water in tubing 3. obstructio in tubing 4. biting ET tube 5. increased airway resistance-bronchospasm, lot of secretion 6. decreased lung compliance-PTX, Pul edema, ARDS 7. vent dyssynch-anxiety, coughing, pain

vent alarm

High-obstruction-kink, water in tubing, secretion in tubing, biting tube Low-disconnection-, leak

Thin ribbon like stool is indidicative of

Hirschsprung disease congentinal megacolon internal sphincter cant relax to obstruct bowel

Nihilistic delusion

Iit doesnt matter if i take my med. I am already dead

Tegement

interfere with oral anticoa, increases levels so more tox of dilantin, benzo, warfarin, propanol

SS of decreased tendon reflex, hypotension

HyperMg-antacid?

lab value in tumor lysis syndrome

HyperP hyper K hyper uric acid Hypo Ca

Upper GI barium radiography

interfere with xray, ultrasound, colonosocpy, tests involving iodine

5 Hs reversible causes of PEA

Hypovolemia Hypoxia Hydrogen ions (acidosis) Hypo or HyperK Hypothermia

sublimation

transformation of unacceptable thoughts into acceptable actions a person may turn to boxing to deal with aggression

tx AKI

I and O for 4 hr and whatever pt had, give in next 4 hr to replace EKG weigh fluid, lab

4 stages of chronic kidney disease

I-polyuria, nocturia II-swelling in feet/ankle; oliguria III-complications like anemia, bone disease IV-dialysis

incentive spirometer

INHALE then hold breath, not exhale

when giving K

IV never give if poor renal should not exceed 10 meq/hr and no more than 40 mEq never IV push When PO, give with food or right after meal to prevent upset drink plenty of water and sit upright after to prevent pill-induced esophagitis

intervention for DKA

IV NS, Insulin priority-start IV for bolus rehydration with NS bc hyperglycemia causes osmotic diuresis. Next, Insulin infusion. If insulin given before rehydration, insulin will result in water, K and gluc entereing the cells, worsening dehyration and electrolyte imbalances

tx DKA

IV bolus NS or 1/2 NS for dehydration then regular insulin IV bc insulin cause water, K, gluc into cell which can exaacerbate dehydration

treatment for malig hyperthermia

IV dantrolene cooling blanket treat high K

intervention for sepsis and meningitis

IV fluid give vasopressor obtain lab and blood culture give abx head CT bf lumbar punctur bc IICP contraindicated in lumbar puncture

initial treatment for kawasaki

IV gamma globulin aspirin IV globulin can cause fluid overload and pul edema-watch for HF SS

intervention for intermittent claudification

walk, if pain, rest then resume

addisonian crisis

want 3 glucose volume corticosteroids

early sign of hypoxemia

Increased HR Late sign-cyanosis

lab in sickle cell crisks

Increased bilirubin-due to hgb breakdown elevated reticulocyte-bone marrow respond to anemia acute anemia-may need transfusion hype

newborn safety

Infant car seat in the back seat facing the rear (back) use infant sleep sack when in crip (reduce suffocation risk) supine when sleeping harness snug...can use rolled blackets to support baby 45 angle position

dissociative amnesia dissociative identify depersonalization/derealization

amnesia-inability to recall important info identify- 2 or more identities depersonal-episodes of feeling detachment from selt All 3 due to trauma

6presumptive signs of pregnancy

amonenorrhea NV urinary frequency breast tenderness quickening excessive fatigue

iron in fetus and newborn

Iron received from mom ilasts 5-6 months but preterm infant, infant born in miltiples exhause their iron store by 2-3 months so give iron thru dietary or oral supplements

what maintains intracellular and extracullular

K-ICF Na-ECF

Dont give licorice with

KCl furomeside prednison

whre is lumbar puncture inserted

L3-L4 posterior iliac crest

peripheral perfusion indicator

LOC UO cap refill peripheral sensation skin color T peripheral pulse

diet for dumpting syndrome

LOW carb high fat high protein

breathing exercises in first stage, phases

Latent-deep breathing Active-patterned breathing/deep cleaning breath Transient-shallow breathing

TB endermic

Latin America Asia Middle East AFrica Carribean

hypoparathyroidism SSS

Low Ca, P up tingling, numbness Trousseau, CHvostek spasm seizure

diet for chronic kidney disease

Low K-no orange, vit C No dairy-high P Low protein-low uric acid

ectopic preg SS

Lower quadrant abd pain mild vag bleeding missed menses hypovolemic shock-dizzness, hypotension, tachycardia, decreased UO referred shoulder pain

standard precaution eg

Mono Legionnaire's pneumococcal meningitis

tramadol

anagesic

Foley for men

Men 16-18Fr penis perpendicular sterile technique insert 6-7 inch

intervention for cirrhosis

NO aspirin-bleeding risk loose fitting clothing leafy grn-vit K watch LOC, lethargy watch weight gain-edema, ascites

inserting central venous cathether

NO deep breath-do Valsalva turn head away to side Place in trendelenburg position to dilate vein

food for cholecystisi

NO fat, No gas forming chicekn, salad, potato, rice

prepping for coronary arteriogram/angiogram

NPO 6-12 hr prior feel warm/flush when injecting dye lie flat for several hrs after to ensure hemostasis in the punctured artery (femoral)-need compression can go home same day bc just diagnostic

3 strategies for acute pancreatitis

NPO-NG tube to suction Pain mnagement IV fluids

indomethacin

NSAID

Asthma medication watch

NSAID and beta blockers can cause problems Ibuprofen and aspirion can cause bronchospasm in some asthma

risk for stroke

NSAID use pheochromocytoma DM miagraine headache

Do not give in gastritis

NSAID-celecoxib, naproxen

need for spinal immobilization

NSAIDs N-neuro exam-numbness, decreased strength S-significant truma A-alertness-disorientation, LOC I-intoxication D-distracting injury-another pain distract from spinal pain S-spinal exam-point tenderness over spine/neck pain

biophysical profile 5

NST amniotic fluid volume fetal breathing movement fetal tone fetal body movement

signs of bowel obstruction 4

NV abd distention bloating decreased stool output

what to watch after abd surgery

NV, retching, heaving bc can cause wound dehiscence and evisceration Emergency so treat with antiemetic

low intstinal obstruction SS

No stool NV abd distention above level of obstruction no GI bleeding

gluten free diet

No wheat, barley, rye, oat Yes rice, corn, potato No processed food-choco, candy, hot dog, flour, bread Even sm amt of gluten damages intestine in celiac disease, causing cancer

oral contraceptive during breast feeding

No, use another method oral contraceptive suppress production of milk

position for postural drainage for CF

Need head in independdent position side lying prone kne-chest position No HOB elevation

SS cold stress

Neuro-altered mental CV-bradycradia resp-tachypnea, apnea GI-emesis, hypoglycemia MS-hypotonia, weak suck, cry

Lithium tox SS

Neuro-ataxia, confusion, NM excitability DI-polyuria, polydipsia

angina vs MI

angina-squeezing pain; relieved with NTG, exertion increases pain MI-sharp throbbing, ;pain more related with morning

no drug in 3rd trimester

No NSAID-can cause premature closing of fetal ductus arteriosus Yes Acetaminophen

warm packs in peripheral vascular disease

No bc can cause burn due to decreased sensitivity instead use glovs and socks

internal radiation treatment

No distended bladder-can dislodge implant so Foley inserted Bedrest only 1-3 days

gluten free diet for celiac

No grain eat rice, corn, potato NO BROW-barley, rye, oat, wheat

caution in inguinal hernia

No increase in intraabdominal pressure-lifting, coughing watch for strangulation

prior to paracentesis

No need for NPO void bladder assess abd girth, weight, VS place in high Fowlder's

trach suction

No need to elevate HOB preoxygenate sterile field

Good samartan Law

No payment reasonale, proffessional intervention No need to accompany to hospital; continues care until another appropriate caregivrer takes over

when caring for tracheostomy collor

No powder for trach bc can occlude airway

diet in chronic kidney disease

No protein-kidney cant breakdown into wastes increase carbohydrate

immunization influenza

annual starting from 6 month

Christian end of life

anointing forehead wit oil

hepatitis A early signs

anorexia malaise lethargy easy fatigue

priority in sickle cell crisis

O2 IV hydration pain

discharging COPD pt

O2 therapy nebulizer therapy-improve oxygenation med alert bracelet No incentive spirometer

meds for severe asthma exacerbations

O2 to sat>90 high dose short acting beta agonist-albuterol q 20 min anticholinergic agent-ipratropium q20min systemic corticosteroids-prednison

child with uncontrolled ADHD

assist in calming down and gaining control by deep breathing exerises

PAC ecg

P wave has different shape than P wave before (like goes under)ear

PASS for fire extinguisher

P-pull pin A-aim at base of fire S-squeeze handle to reliease S_sweep spra side to side

early dislodgement of PEG tube

PEG matures in 1-2 weeks and establish fully at 4-6 weeks if dislodge <7 days, Notify HCP and need replacement

PT and PTT

PTT-1/5 to 2 times normal (25-35 sec) 46-70 sec for hepatin PTT PTT>100 with heparin is critical! Stop

PVC vs PAC

PVC has wide, disorted QRS PAC-P wave is different shape thatn other P waves

infant nutrition

at 6 month, introduce solid pureed at 12 month, introduce cow's milk need gradual weaning from breastfeeding

Left to Right blood shunt

Patent ductus arteriosus atrial septal defect ventricular septal defect result in pul congestion-increased breathing acyatnotic defect-tachypnea, tachycardia, diaphoresis, heart murmur, CHF signs, poor weight gain

treat ARDS

Positive pressure ventilation PEEP-keep alveoli open for exchange Prone position

fundus after delivery

at level of umbilicus 6-12 hour after delivery begining with day1, it goes down 1 fingerbreadth perday

prevent diverticular disease

Prevnet chronic constipation! high fiver intake water exercise grain, veggie No alot of red meat, high fat

dx prostate cancer

Prostate specific antigen before digital rectum exam bc DRE can elevate PSA

R to L shnt vs L to R shunt

R to L is cyanonic. cyanosis. tetralogy of Fallot L to R-noncyanonic but sympathetic stimulation patent ductus arteriosus, atrial septal defect, ventricular septal defect

humulin R and N

R-clear N-cloudy R before N draw

RA vs osteoarthritis

RA-symmetric joint swelling, joint stiffness in morning osteoarthritis-crepitus with ROM, pain relieved by rest

what causes back labor

ROP right occiput posterior due to increased P on maternal sacrum prolonged labor Want Occipi Anterior (optimal)

acute chelecystitis

RUQ pain wit referred pain to right shoulder and scapula Fatty food ingestion bf onset of pain Murphy's sign

infant of diabetic mother

at risk of hypoglycemia and hypocalcemia esp at first 6 hr after birth watch jitterness, irritability

left to right

atrial septal efect coarctation of aorta patent ductus arteriosus ventricular septal defect

trichomoniasis

STI asymptomatic but frothy gray or yellow-grn vag discharge with fishy ordor sm red lesions in vagina/cervix pruritus give Metronidazole treat partner too

aldosterone

Saves Sodium Pushes Potassium away blocked by ACE inhibitor

Rinne vs Weber

Rinne-tuning fork over mastoid bone-bone vs air conduction Weber-fork on top of head-conductive, sensoryneural hearing loss

role of lecothyroxine in primary hypothyroidism

Since TSH is high, levothyroxine is given to inrease T3 and T 4 that lowers TSH and leads to normal state. If high level of circulating TSH, need to increase levotyroxine

S3, S4

S1......S2.S3...........................S4...S1.......S2..S3.......................S4

SS RHF

S3 sound edema distended jugular vein weight gain

S3 and S4

S3-Kentucky-LVHF S4-Tenesse-post MI both can occur in PE

hyponatremia in lung tumor may indicate

SIADH severe neuro dysfunction

shock progressiosn in sepsis

SIRS (general inflammatory response) sepsis (presence of infection with SS infection) septic shock (hypotension depite adequate fluid) MODS

Sepsis continuum

SIRS-due to insults, general inflammation-INFECTION Sepsis Severe sepsis- Septic shock-not responsive to fluid resuscitation MODS-failure of 2 or more organs WANT 2 CULTURES separate from IV

position for enema

SIms or left lateral recumbent

cold and clammy skin indicates

SNS compensatory mechanism is failing and marks progression from compensatory stage to progressive stage of shock

monitor in refeeding syndrome

SS of fluid overload and HF-edema, crackles, JVD

psychomotor retardation

SS of major depression disorder slowed speech, movement impairement, impaired cog ftn lack of facial expression downcast gaze speech impairment social interaction lacking

SS ovarian cancer

SS very subtle so often discovered late stage abd bloating pelvic pain/pressure abd girth increase GI urinary urgency/frequency leg pain

otitis media

SS-fever, plling ear, discharge from ear give abx position on affected side

intervention for acute angle glaucoma

SS-psudden excruciating pain, visual change of clored halos, blurred vision Instill miotic agent-open trabecular network and facilitate aqueous outflow give hyperosmotic aent like isosorbide=move fluid to extracellular space ool compress to forehead provide darkened, quiet, private space

phencyclidine piperidine PCP intoxication

SS=blank stare, rigid muscle, ataxia, nystagmus AKA angel dust watch for aggressive behavior-assault, suicidal may need restraint BP, T,, HR increase-HPN crisis

drugs that may induce serotonin syndrome

SSRI MAOI dextromethorphan ondansetron St Johns wort tramadol

fluoxetine

SSRI omit dose if missed sugarlesss gum to minimize dry mouth can cause dizziness use sunscreen can decrease sex drive dont stop abruptly

citalopram

SSRI for depression watch fever-Serotonin syndrome-tachy, HPN, delirium, irritability show improvemtn 1-4 weeks

Somogyi vs Dawn phenomenon

Som=rebound hyperglycemia. Too much insulin. Decrease evening insulin Dawn-too little insulin. Increase evening insulin

what can LPN do

Stable pt with chronic (COPD) IM, Po, subQ meds ABX dressing suction urinary cath ostomy care monitor drainage can take initial med hx irrigate ostomy, access bowel sounds, stoma color NO IV meds no med to unstable pt cannot evaluate response to med attaching cardiac monitor leads obtain 12 lead ECG some piggyback IV meds 24 hr postop; 72 hr after MI reinforce teaching (no initial) review medications can have contagious cannot evaluate no nursing care plan ostomy care, tube patency, enteric feeding monitor assessment finding after RN initial findings consult with dietition for modification but cant initiate consult NO IV, PICC, main IV, enteric feeding CAnt teach-preop, discharge, newly admit NO ECG? CANNOT check blood cant check blood give bolus/continuous tube feeding program feeding pump

stages pressure ulcer

Stage I -intact skin with non-blanchable redness. Stage II = partial-thickness skin loss (abrasion, blister, or shallow crater) involving the dermis or epidermis. The wound bed is red or pink and may be shiny or dry. Stage III =full-thickness loss. Subcutaneous fat is visible, but not tendon, muscle, or bone; tunneling may be present. Stage IV has full-thickness skin loss with visible tendon, muscle, or bone. Slough or char (scabbing, dead tissue) may be present; undermining and tunneling may be present. Ulcers are described as "unstageable" if the base is covered by necrotic tissue or eschar.

neonate and children CPR

TABC temperature, airway, breathing

which needs N95 respirator

TB Varicella measles

airborne precaution PPE

TB, rubeeola, varicella N95 respirator negative room No gown, face shield unless needed

TPn vs PPN

TPN only central access bc very concentrated. For those in fluid restriction and longer time PPN=can be given peripherally, more dute. shorter time

prostatis tx

TURP-lg catheter continuous bladder irrigation to remove clots and ensure drainage- 24 hr red/pink

treatment for third degree block/complete block

Temporary or permanent packing

5Ts reversible causes of PEA

Tension pneumothorax Tamponade, cardiac Toxins (narcotic, benzo) Thrombosis Trauma

APGAR

color: blue-0; blue extremities-1; pink 2 pulse: No 0; <100 1; >100 2 rxn: No 0; grimace/whimper 1; cough, sneeze 2 muscle tone: limp 0; some flexion 1; active 2 RR: No 0; slow weak cry 1; regular good cry 2

dilantin

come as suspension so shake take with food bc gastric irrigation gingival hyperplasia over time

rheumatoid fever

acute inflamamtory heart disease occur 2-3 wks after streptococcal phrayngitis delayed autoimmne rxn involving anti-streptococal antibodies Joints-arthritis carditisi noduleserythema marginatum sydenham chorea fever, elevated ESR, C reactive protein

Delirum determination

acute mental status change that fluctuate inattention with disorganized thinking (hallucination) and or altered LOC

risk factors for heat stroke

age>65 diuretic use beta blocker use anticholinergic use hyperglycemia

phlebitis

common after vancomycine, bacteria, catheter moving in vein need immediate removal of catheter

cellulitis

common skin infection treated with IV abx, in DM pt

why give beta blocker, ca channel blocker, digoxin to a fib?

To reduce ventricular rate to less than 100 (bc in afib, V rate 300-600) beta blocker-metoprolol ca channel-diltiazem

inflammatory breast cancer

aggressive form breast lymph channels are blocked by cancer cells breast tissue become red, warm and has orage peel-PEAU D'ORANGE-tiny indented, pitting appearnace on skin

TORCH

Toxoplasmosis Other-parvovirus B19/varcella-zoster Rubella Cytomegalovirus Herpes simplex Causes fetal anomalities MRSA is fine

position for air embolism

Trendenlenburg on left side (air will rise to right atrium)

albuterol effect

a beta agonist so watch tachycardia

alcohol withdrwawal syndrome

agitation, fever, tachycardia, HPN, diaphoresis, hallucinaiton,tremor, hyperreflexia tremor elevated T leg cramp, pain symptom

normal troponin

Tropinin I- <0.5 Tropinin T <0.1

parathyroid calcium phosphate

UP PT UP Ca Down P

neonate and thermoregulation

Unable to generate heat by shivering so increase heat by increasing metabolic rate thru nonshivering measures Brown adipose tissue used

bronchoscopy

Under sedation, larynx, trachea and bronchi are visualized using endoscope risk of Resp status, airway, VS NPO till gag reflex

what to watch in giving furosemide

VS-hypotension K BUN, creatine-too much diauresis can affect kidney

treatment for SVT

Vagal maneuver adenoside

opiods expected side effect

Universal constipation-give senna, docusate pruritus, flushing HYpotension and Nausea that resolve over time

chx pox transmission

airborn spread of secretions also contact by open lesions Place on mask isolation negative airflow antihistamine cut fingernail

red tag

airway obstruction long bone fracture second or other degree burns 15-40% body surface

lactovegetarian

Yes milk and dairy but No egg so consume other protein-tofuk bean, legume

IM iron dextran

Z track to large muscle No massage

dyspnea

a subjective SS common in terminally ill use non pharm and noninvasive way first nasal cannula morphine lorazepam a fan to promote circulation relaxation strategy frequent rests NO need for nonrebreather

PICC line care

a venous devide inserted via cephalic or basillic vein and terminates in superior vena cava dressing change q 48hr with gauze dressing or 7 days with transplarent semipermeable dressing or when dressing is torn, soiled, damp lnne flushed bf and after medBP/venipuncture on unaffected arm all infusing med paused bf drawing blood from PICC (except vasopressor) scrub ports with alcohol for 10-15 sec

managing near-drowned pt

airway-intubation, mech vent Careful handling bc as cold body T, cold myocardium irritable-turn to v fib continuous cardiac rewarming with warming blankets warmed IV fluids

diuretic vs albumin which is first in cirrhosis

albumin! albumin pull fluid to blood vessel, then spironolactone removes fluid

lowering K

albuterol by nebulizer Na bicarbonate-correct acidosis, K go back into cell insulin Kayasate

tyramine rich

alcohol organ meat meat cheese yogurt

alcohol with diabetes

alcohol can induce hypoglycemia pt should drink alcohol shortly after meals

when high ALT, AST

alcohol intake? OTC? herbal/diet supplement? IV illicit drug use-risk hep B, C

who is at risk for pneumonia

alcoholic surgery swallowding difficulty

leading cause of preventable mental retardation

alcoholism Fetal alcoholism syndrome

delirium tremens

alcoholwithdrawal SS Prevent with benzodiazepine agitation, fever, tachycardia, HPN, diaphoresis, hallucinaiton,tremor, hyperreflexia

treatment for a.fib

a.fib have atrial rate 300-650/min and Ventricular rate vary higher ventricular rate, more likely client will have symptoms of decreased CO so treatment-reduce V.rate <10/min and prevent stroke so use ca channel vlocker, beta blocker and digoxen

CN VI

abducens extraocular

toilet training

ability to stay dry parents have time to devote to toilet training sit for 5-10 min regular bowel movements fine motor skill to pull cloth down and up

fibromyalgia

abnomral CNS pain transmission chronic bilateral musculoskeletal axial pain, multiple tender point, fatigue, sleep prob Duloxetine-SSRI to relieve chronic pain

DIC

abnormal clotting cascade life threatening bleeding any sign should be assessed for emergent replacement of clotting factor, bloods frank bleeding, petechiae, ecchymosis, hematuria, hematemesis, bloody stool, resp distress

Pica

abnormal complsive crabng and consumption of substances not considered nutritionally valuable ice, cornstarch, chalk, clay, dirt, paper accompanied by iron def anemia so screen Hgb, HCT

cheyne-stokes breathing

abnormal irregular with alternating deep & shallow respiration followed by pd of apnea (10-20 sec) ENd of life neurologic -stroke, IICP cerebral hypoperfusion

atrial septal defect

abnormal opening bet right and left atria. Blood flow from high P LA to low P RA causes vibration-murmur systolic murmur with fixed split second heart sound Not cyanotic

waxy flexibility

abnormal posture when place hand over head, remains in that position

SCI above C8 and below C8

above-quadriplegia below-paraplegia

variability in fetal HR

absent-no amplitude minimal-<5 =CNS depressant, fetal sleep, premature, hypoxia moderate- 6-25= normal marked >25=unclear significance

preterm baby charateristics

abundant lanugo flat areolae without palpable breast bud smooth pink skin with visible veins smooth sole No or single crease undescended testes

trimethoprim/sulfamethoxazole

abx bact take empty stomach category C-risk to fetus photosensitivity risk for hepatitis

ac pc c/o

ac-bf meal pc-after meal c/o- complains of

ritual in obessive-compulsive disorder

accept client allow time for ritual

asthma exacerbation SS

accessory muscle use chest tightness diminished breath sounds hih pitched wheezing on expiration tachypnea cough prolonged expiratory phase

SS asthma exacerbation

accessory muscle use chest tightness diminished breath sounds wheezing on exp tachypnea cough prolonged expiratory phase

ibuprofen interfere with

ace inhibitor decrease effect of ace inhibitor

intervention for anorexia

achieev sense of self worth and self acceptatnce socialization and self esteem

documentation of adverse event

action taken in response and time frame interventions separate from medical record note of "continue to monitor" is meaningless

in case of salicylate toxicity

activity charcoal as initial and asymptomic and early sate then IV sodium bicarb-makes blood and urine more alkaline, promoting urinary excretion of salicylate

Steven Johnson aka TOxic epidermal necrolysis

acute skin disorder widespread erytema, large blistering lesion, epidermal shedding, keratoconjunctivitis, skin erosin can lead to sepsis, death wound care-warm compresses prevent infection-reverse isolation promote fluid/nutrition hypothermia prevent-prevent shivering pain maangement eye care-cool, damp cloths, eye lubricants

acute vs chronic pancreatitis

acute-increased lipase chronic-increased trypsin

patent ductus arteriosus

acyanotic defect in premature fetal ductus ateriosus doesn close so blood shunt from aorta back to pul arteris Loud, machine like murmur

genital herpes

acyclovir, famciclovir, valacyclovir used to treat STI caused by herpes simplex and highly contageious NO CURE remain dormant in body Use gloves when touching clean with warm water and soap During active lesion, abstinence

cold caloric test

add warm or cold water/air to ear canal if eye shows nystagmus, normal if not, brainstem damage or auditory CN damange

epinephrine effect

adequate BP adequate BP normal tissue perfusion adequate CO

best indicator for successful fluid resuscitation after burn

adequate urine output 30ml/hr

mature minor

adolescent 14-19 can give consent in STI, family planning, drug and alchol abuse, blood donation, mental health care

legionnaire disease risk factor

advanced age immunosuppresed end stage kidney Diabtes smoking pul disease will develop pneumonia by Legionella pneumophilia

neuroleptic malignant syndrome

adverse rxn to anti psychotic (clozapine) high fever muscular rigidity, altered mental statusau autonomic dysfunction -Supportive care, discontinue meds Life threatening-assess for muscle ridigity

radiation damage

affect rapidly dividing cells first-oralmucosa, GI tract, bone marrow SS_oral mucosal ulceration, vomiting/diarrhea, low blood cell counts

when is meningococcal not contagious

after 24 hr abx

grasp reflex disappear

after 3 month

SS hyperacute rejection of transplant (renal)

after 48 hr elevated T elevated BP pain at site Need immediate removal of kidney

subQ emphysema

after a surgery, insertion of chest tube expected so monitor crackling sensation of skin

Jackson-Pratte wound drainage empyting

after abd or breast surgery, prevents fluid buildup in closed space that doesnt compromise incision 1. hand hygiene-aseptic needed 2. pull plug on bulb to open and pour drainage into small container and record accurate draiange 3. empty q4-12 hr until it is 1/2 to 2/3 full bc as it fills, amt of neg pressure decrease 4-compress empty bulb by squeezing it side to side till total collapse 5. clean spout on bulb with alcohol and replace plug to restore neg pressure.

SIms position

after lap cholecystectomy to facilitate movement of CO2

fundal after delivery

after lidevery, fundus is several cm below umbilicus.. within 12 hr, fundus rise to rumbilicus. then descends 1 cm a day for 9-10 days

acute glomerulonephritis SS

after streptococcal periorbital/facial edema, teac colored urine Watch sever HPNoliguria

factors that put at high risk for resp complications 5

age abd surgery thoracic surgery smoking trama to lung

6 risk factors for developing pneumonia

age underlying lung disorder bedridden postop immunosuppresed smoking

risk factors for prostate canceer

age (over 50) African American exposure to carcinogens-fertilizer, ribber, textile, metal

separaton anxiety occur at

age 6 mon peaks 10-18 months

site for immunization for infant (<7mon)

anterolateral thigh or VASTUS LATERALIS

permethrin

anti parasite-lice and scabies leave on ahri for 10 min bf rince out used once a week can cause redness on scalp treat prutitis, itching

divalproex

anti seizure

phantom pain management

anti-seizure meds

chlordiazepoxide

antianxiety sedative for anxiety and alcohol withdrwa cause drowsiness, confusion

meds for pneumonia

antibotic expectorant mucolytic antipyretic analgesic antiinflmmatories

dicyclomine

anticholinergic promote urinary retension

manage myasthenia gravis

anticholinesterase drug-pyridostigmine before meal semi solif food over solid of liquid annual flu vaccine

what med for myasthesia gravis

anticholinesterase drug=prevent breakdown of Ach disease due to low number of Ach receptors

dabigatran

anticoag for a fib

caring for central venous lumen

anticoag heparin flush- 10 unit to 100 unit give TPN occlusive dressing changed q7days distal port (largest lumen) used to measure CV pressure

deferoxamine

antidote for iron poisoning

prochlorperazine

antiemetic

nystatin

antifungal swish and SWALLOW

promethazine

antihistamine for allergies, motion sickness, preop side effect: ortho hypotension, anorexia, dry mouth, constipation

cholestyramine

antihyperlipid

5 drugs that contribute for ortho hypo

antihypertensive antipsychotic/antidepressant diuretic vasodilator-nitro narcotic

what is held prior to dialysis 5

antihypertensive (since dialysis cause hypotension) water soluble vit (vit B, C, folic acid) abx digoxin other Bp lowering (furosemide)

antidote for neuroleptic malignant syndrome

antiparkinson meds- Danatrolene, bromocriptine but inform PCP first

ginkgo

antiplatelet CNS stimulant for dementia increased risk for bleeding with NSAIDs

pentamidine

antiprotozoal-prevent/treat pneumocystis jiroveci pneumonia-common infection in AIDS SS of pneumonia-coughing, dyspenia, crackles, weight loss improves overall condition adverse: leukemia, thrombocytopenia

chlorpromazine

antipsychotic adverse: dry moutyh, urine pink risk of neutropenia at least 6 weeks for drug to work

chlorpromazine

antipsychotic aneiemetic

beer's criteria

antipsychotic anticholinergic antihistamin antihypertensive benzo diuretic opiiods sliding insulin scale

risperidone

antipsychotic for schizo, bipolar

baclofen

antispasmodic-skeletal muscle relaxation decrease pain and cramping in MS and SCI side effect: ortho hypotension

herpes zoster

antiviral needed dermatosome on one half of body-one side of face hurts may lead to neuralgia itching

allopurinol watch for

any rash can lead to hypersensitivity rxn-Steven Johnson

clear liq diet eg.

any you can see thru tea chx bouillon apple juice popsicle (not red-bleeding)

contraindication to MRI

anything metal cardiac pacemaker defibrillator cochlear implant retained metallic foreign body prosthetic heart valve metal plate, pin, clip, joint prosthesis implanted device (insulin pump, med port) but confirm bc some device have nonferrous-MRI safe

abrupt tearing movine (upper to lower) back pain

aortic dissection contributed by HPN...can cause cardiac tamponade emergency

aphasia vs dysarthria

aphasia-impaired speech/writing. difficult with word choice dysarthria-weakness of muscle for speech

RLQ pain referred from umbilical area

appendicis

appendicitis vs gastroenteritis SS

appenditicis- pain bf NV gastroenteritis- NV before pain

Cred e maneuver

apply manual pressure blader to aid in emptying blader completely results in bladder control in SCI

pacemaker paces: Atrial paced ventricular paced atrioventricular

atrial-pacer spike before P wave only ventricular-pacer spike before a wide QRS atrioventricular-aka sequential/chamber-pace RA and RV in sequence. 2 pacer spikes one bf P and one bf QRS

pediculosis capitis intervention

apply pediculicide on head and remove nits with comb use nit comb q 2-3 days for 2 weeks carpet, rug, upholstered furniture vacummed frequently bedding washing in hot water non washable items sealed in plastic bag for 2 weeks all hairbrushes, combs, ornaments soaked in boiling water for 10 min household pet dont transmit human lice

weight gain for BMI 18.5-24.9

appropriate weight total 25-35 lb 2-3 trimester: 1lb/week

aripiprazole vs donepezil

aripiprazole-stabilize mood and SS in dementia donepezil-prevent worsening SS in allzheimer demenitia-do not decrease agitation-preventitive

decerebrate

arm and leg stratight out toes point DOWN head/neck arched back Severe brain injury

position for chest tube insertion

arm raised above head on affected side. HOB 30-6- deg to reduce injury to diaphragm

decorticate posture

arm rigidly flexed at elbow hand raised to chest legs extended

arterial vs venous disorder

arterial: thickend artery, calcification and plaque. weak, absent pulse; cool to touch; painful nonedema ulcer; ulcer usually small, circular, deep with minial xudate inter. claudification; bruit; place below heart. Ulcer/gangrene at most distal part (toes). Pain when elevate legs venous: Due to less venous return to heart that blood pool in the bottom. normal pulse, warm to touch, slight painful edema ulcer; ulcer large edematouc superficial, large amt of exudate blue/purple skin; elevate. Ulcer at ankle. leg edema at end of day.

amniotomy

artificial rupture of membrane to induce labor after, at risk of umbilical cord prolapse so assess fetal HR before and after-wil cause bradycardia note amniotic fluid color, odor, amount assess mom T q2 hr bc infection painless upright positions

middle age women pain during intercourse dyspareusia

ask about menses may indicate premenopause/menopause

children with oral meds

ask pharmacy to add flavoring mix med with jam, ice cream, pudding place infant in semi reclining position use empty nipple

assault battery emancipated minor

assault-threat that cause fear of harm without being touched battery-physical contact without permission like procedure without consent. giving med to alert pt saying it is vitamin emancipated minot-under age but has legal responsibility-enlistment in military, marriage, preg, homeless, prarent, military, financially independent, high school graduate

to find method to safety transfer client

assess whether client can bear weight whether clinet is cooperative

intervention chest pain

assess ABC positon upright apply oxygen obtain baseline VS auscultate heart and lung do 12 ECG insert 2-3 lg bore IV cathether assess pain medicate for pain initiate ECG monitor obtain blood work obtain portable chest xray

intervention to reduce aspiration for enteral tube feeding

assess for GI intolerance to feeding q4hr by monitoring gastric residual, abd distension, abd pain, bowel movement assess feeding tube placement keep HOB 30 deg keep Endotracheal cuff inflated suction secretions monitor over sedation use caution with sedative avoid bolus tube feedings

when obtaining client signature in consent,

assess for cognitive ability- any preop med that deteriorate?

IV care

assess for infiltration and patency q1-2 hr IV site changed q 3days flush saline lock q 8-12 hr

Sjogren syndrome

autoimmune moisture producing exocrine glands are attacked by WBC-mostly salivary and lacrimal glands dry eye, dry mouth, corneal ulceration, dental caries, oral thrus dry skin, rash chronic dry cough vaginal dryness No cure OTC drops for eye goggles if wind sugarless gum/candy/artificial saliva for mouth dental appointment lubricant for vaginal driness lukewarm water and mild soap when showering humidify

autonomic neuropathy in DM

autonomic NS is responsible for involuntary body fnt like BP, HR< perspiration, sexual ftn, digestion impairment to ANS cause neuropathy like postural hypotension, tachycardia, MI, bowel incontinence, diarrhea, urinary retension

marfan syndrome

autosomal dominant disorder affecting connective tissue very tall, thin, long arm, leg, fingers abnormalities of aorta, valves-aneurysm, leaky valves so no contact sports risk for scoliosis ocular prob-lens dislocation, ret detachment, cataracts, glaucoma

phenylketouria

autosomal recessive low phenylalanine diet to prevent mental retardation avoid meat, darity, aspartame containing Use fruit, juice, cereal, bread, starch Until brain fully developed GO back to same diet when preg

normal resting tone in first stage of labor

avg 10 mmHg should not exceed 20 mmHg

weight gain in toddler yr

avg weight gain yrly 4-6 lb age 30 months-4 times birth weight

circumcision care at home

avoid alcohol wipes clean with warm water, no soap apply petroleum jelly at diaper yellow exudate is normal healing after first 24 hr-do not remove bleeding less than size of a quater

pt with one kidney

avoid allll contact sports

meds to avoid bf allergy skin test

avoid antihistamine like diphenhydramine/looratadine corticosteroids

weight lifting by HPN

avoid bc can cause rise in BP due to vasovagal response

caring for manic pt

avoid competitive games bc they increase agitation do single plays-painting, walking, dancing

caution in peptic ulcer disease

avoid diet in milk, cream-stimulate acid avoid aspirin, alcohol, caffein

watch in multiple sclerosis

avoid exposure to heat/cold cause damage due to changes in ensation

intervene to prevent otis media

avoid exposure to tabacco obtain routine immunization dx use of pacifier no drinking from bottle when lying down

when on warfarin

avoid injury avoid aspirin, NSAID< alcohol wwarfarin given for 3-6 months folowing PE wear MedicAlert soft bristled toothbrush no alcohol based mouth wash

teaching for hemophilia

avoid meds like ibuprofen, aspirin avoid IM, do subQ avoid contact sports dental hygiene medic alert bracelet regular diet do RICE no need to call ENS

retina detachment discharge

avoid movement that increase intraocular pressure light work resume after 3 wks, normal activity after 6 weeks, no bending down, straining

treat sleep hygiene

avoid naps engage in physical activity at least 5 hr before bedtime at least 20 min natural sun avoid caffeine, alcohol, smoking relaxing actiity bf bed decreased stimuli avoid heavy meal, lg fluids drink cup or warm milk or sm carbo bf bed promote comfort

after rubella vaccine

avoid preg for 2-3 months

protease inhibitor

avoid protein food end in -VIR AIDS Ritonavir, Saquinavir, Lopinavir/ritonavir,

when chossing snack for toddler

avoid small, hard food that can choke nutrient dense no raw bc food borne illness cheese, whole wheat cracker, yogurt, banana slices, cooked veg, mini pizza

teaching about skin cancaer

avoid sun 10am and 4pm cloudy day doesnt block UV rays wear protective clothingdaily use of SPF 15 or 30 apply 20-30 min prior to sun exposure reapply sunscreen q2hr

baby in narcotic abstinence syndrome

avoid tactile stimulation place in calm envt

when does quickening occur

awarements of fetal movement 18-20 weeks gestation in primir 14-16 wks in multigravida

bronchiolitis

common viral from RSV starts with upper resp SS-rhinorrhea, congestion and progress to lower resp tract-tachypnea, cough, wheezing increase fluids use nose drops and suction nares

when urinary retension postop

common when anesthesia, opiod and elder men (BPH) help client out of bed provide privacy bladder scan

myxedema coma

complication of hypothyrodiism can lead to coma hypothermia, hypoventilation, decreased resp drive need life saving measure like mech vent

pancreatic abscess

complication of pancreatitis shown by abrupt increase in T or high grade fever need treatment ASAP to prevenet sepsis

scleral buckling

compress sclera to repair a detached retina watch NV-IIOP no straining

CAB

compression, airway, breathing depth 2 inch adult 100 compressions/min

common findings in newborn

babkinski-toes fan out plantar creases Epstein pearl-white cysts on gum, palate cord 2 arteries, 1 vein No jaundice-jaundice within 24 hr is pathological

comon discomforts of preg

backache, pelvic pressure earache, sinus congestion leukorrhea-vag discharge urinary frequency

trimethoprim/sulfamethoxazole

bact infection empty stomahc no preg photosensitivity watch helpatitis

if jaundice around infant eye disapper

bad sign eye band is not properly placed

food high in tyramine

banana whole wheat bread-yeast avocado

food high in K

banana, nut, orange, melon, mango, dried fruit, avocado cruciferous veg, legume, potato, tomato, raw carrot, grn leafy veg most fish/shellfish, pork, most beef whole grain, bran, granola dont give milk/milk product if have hyperkalemia

croup

barky cough viral hoarseness, resp distress support, hydrate, cool mist

platybasia

base of skull is invaginated cause brainstem problem report o HCP

why z track used

bc med is irritating to subQ and skin. prevent from leaking to subq tand skin

iron rich food

beef green bean brown rice NO coffee

guideline for Pap testing

begin at 21 women 21-65 have Pap q3 year women with uterus and cervix removed unrelated to cervical caner do not need testing women >65 who had regular cervical testing with normal results do not need testing women with hx cervical cancer should be screened for at least 20 years after initial diagnosis

reaction formation

behaving in manner opposite of true feeling a parent who is resentful of an unplanned child becomes overprotective of the child

delusion of reference

believe songs, newspaper, other events are personal and significant to them

where is ROP Fetal heart heard

below mother's umbilicus

fibroadenoma

benign breast disorder sm, round painless mobile lump with no tissue retration or discharge

circumoral cyanosis

benign localized cyanosis around mouth during first 6 hr of birth if persist, related to cardiac anomaly

strawberry hemangioma

benign tumor gradually disappear red, raised rough surfaced

lipoma

benign, fatty mass not malignant subQ, soft, mobile, asymptomatic (cancer is hard and fixed)

heparin induced thrombocytopenia

besides risk for bleeding, HIT leads to thrombosis, stroke and pul embolism monitor platelet and report if decrease more than 50% and below 150,000

epidural hematoma

blood bet skull and dura ARTERIAL hematoma (subdural is venous) fracture of temporal bone then tear/rupture of middle meningial artery **Lose consciousness at impact. then regain consciosuness quickly and feel fine (LUCID INTERVAL). BUt it can quickly progeress to decline in mental ftn and lead to coma and death

chadwick sign

bluish discoloration of cervix, vagina, labis due to increased blood flow VAGINA

SSperforation

boardlike abdomen with shoulder pain emergency

polycythemia vera

bone marrow produce too much RBC risk of blood clots elevate leg, feet, stocking, watch sign of thrombosi may need periodic phlebotomy itching common-reduce water T

filgrastim

bone marrow stimulant makes more WBC

succimer vs EDTA

both for lead poisoing succimer-PO EDTA-IM, subQ, IV

Crohn's Disease aka Regional enteritis

both sm and lg intestine all layers of intestine cobblestone appearance want to keep in remission fluids, NPO, NG tube steroids, immunosuppressants During acute, TPN and NPO bland diet, no milk, supplements

if constipation after barium enema

bowel obstruction resulting in bowel perforation and peritonitis

cushing triadd

brainstem herniation hypertension bradycardia bradypnea

BUBBLE HA

breast uterus-after lidevery, fundus is several cm below umbilicus.. within 12 hr, fundus rise to rumbilicus. then descends 1 cm a day for 9-10 days bladder bowel lochia-rubra, serosa to alba episiotomy hemorrhage attachment

protecting from sudden infant syndrome

breast feeding pacifier use during sleep up to date vaccination firm sleep surface remove loose items from bed supine sleeping Sudden death of infant

SS concussion

brief disruption in LOC retrograde amnesia headache observe closely and no strenous activity 1-2 days

placental previa

bright red vaginal bleeding soft uterine tone painless FHR normal NO leopold's, vaginal examins, internal monitor, rectal exam, enema, suppositories!

vesicular, bronchial, bronchovesicular breath sounds

bronchial-loud, high pitch bronchovesicular-med pitch vesicular-soft breezy, low pitched

side effect of aminopylline

bronchodilator palpitation, nervousness, confusion, tachycardia, seizure

Addison disease SS

bronze pigmentation of skin in sun exposed area vitiligo or pathy skin weakness, fatigue anorexia, weight tloss ortho hypotension hypoNa hyperK salt craving NV depression, irritability

education for ticks

bull-eye rash watch out avoid tall grass/wooded area use insect repellent and wear long pants remove ticks using tweezer wear light colored clothing to see ticks easily

epiglottitis cause

by Haemophilus influenza type B (HiB) covered under standard vaccination given during 2 and 4th month visit

when does toddler achieve bowel/bladder control-age?

by age 24 months

cutaneous anthrax

by bacillus anthrax transmit thru animal hair Standard precaution

superior mesenteric artery syndrome aka cast syndrome

by large body casts at risk for bowel obstruction compression of duodenum by superior mesenteric artery It decreases peristalsis and can cause paralytic ileus, bowel obstruction and bowel ischemia-EMERGENCY SS-abd pain, distention, NV

post rhinoplasty

compromise ability of pt to breath thru nose so dont put anything in mouth

cerebellum

coordination of voluntary movement maintaine balance and posture

chemical burn in eye

copious irrigation with water or NS/lactated RInger pH of eye obtained and irrigated until eye pH is 7.0-7.5

nuchal cord

cord around newborn neck assess when birth

vit deficiency in vegan

calcium vit D-bc no diary B12 iron

envt for autistic child

calming envt private room, away from nurse station quiet monotone move slowly limit visual clutter maintain minimal lighting provide with single object to focus on

left brain vs right brain damage

left-impaired speech, slow performance, know what's going on so depressed right-impaired judgement, dont know whats going on

what med for afib and why

ca channel blocker, beta blocker, digoxin decrease ventricular response to less than 100 bc high ventricular response can decrease CO

cirrhosis care

calamine lotion for pruris soft toothbrush no alcohol consume high calorie-due to malnutrition

cystic fibrosis

can develop chronic lung disease and infection chest PT after bronchodilator and nebulizer pancreatic enzymes with all meals, snacks and multiple vitamins report anorexia, weight loss, decreased activity diet high in calories, fat, protein remain activve

Obstructive sleep apnea with anesthesia/sedating/opiod

can exacerbate OSA b decreasing pharyngeal muscle tone and increasing airway closure further So keep on CPAP

alcoholism treatment

can have hypoglycemia thiamine (vit B1) deficiency- Wernicke encephalopathy give IV thiamine bf or with IV gluc liver ftn test

isoniazid

can increase dilantin level

tardive dyskinesia

can occur with metoclopramide protruding, twisting tongue lip smacking puffing cheeks chewing movement frown/blink twist finger twist necks

Group B streptococcus in preg

can transmit to newborn during labor/birth and cause complications give prophylactic abx if mom is GBS positive or has unkown status with fever, preterm or prolonged rupture of membaran

infection at pacemaker incision

can travel down lead wires to heart, causing myocarditis can disrupt pacemaker function, resulting in failure to sense SS-dizziness, infection

allopurinol

can use ibuprofen can crush increase fluid no caffeine

walking with cane

cane should eual to distance from greater tronchanter to floor hold on stronger side place cane 6-10inch in front nad side of foot move weak leg forward move strong leg past cane and weaker leg always keep at least 2 points of support on floor move weaker leg forward after moving cane

diet in chronic pancreatitis

cannot secrete lipase to digest fat so low fat diet avoid spicy and gas forming food lean meat (fish, chx), nonfat diary, veg/fruit, low fat carb

presbyopia

cant see close up old age

why bruising in Cushing syndrome

capillary is fragile leading to bruising and petechiae

caput succedaneum vs cephalhematoma

caput-spongy and crosses suture line; resolve within first week cephalomatoma-do not cross suture line

NSAIDs not in

cardiac pt higher risk for cardiovascular events like MI, Stroke, HF

NSAIDS in preg

category C in 1st and 2nd trimester category D in 3rd trimesetr-risk of premature closure of ductus arteriosus in fetus

urinary catheter size selection based on child, adult female, adult male

cath size- child-8-10 adult female-14-16 adult male-14-18 balloon size child-3 adults-5

botulism

caused by absorption of Clostridium botulinum it blocks ach and cause muscle paralysis found in soil and can grow in any food SS-descending paralysis, dyaphagia, consipation main source-improperly canned or stored food. Metal can swollen/bulging end avoided infant-avoid honey

Hantavirus pul syndrome

caused by rodents aching, nausea, fever may cause cardiopul disease watch thrombocytopenia-hematuria, bleeding, hematemesis

constipation by pregnancy

caused by slowed peristalsis of intestine, causing dry, hard stool due to progesterone

positive pressure ventiation adverse effect

causes increased Pressure reduced venous return, ventricular prefload and cardiac output hypotension fluid/sodium retension

meds used for open fracture 5

cefazolin-bone penetrating cephalosporin abx for prophylactic cyclobenzaprine-muscle relaxant tetanus, diphtheria-immunization prophylactic ketorolac-NSAID opiods No heparin, enoxaparin, aspirin in heavy bleeding area

burn injuries cause

cell destruction, leaking, fluid shift hypovolemia, hyponaturemia and hyperkalemia HCT< HGB increase cardiac watch

tumor lysis syndrome

cell lysis leads to K and P and nucleic acids release into blood. Catabolism of nucleic acid produce urinc acid. P binds Ca, lowering Ca level but producing Ca-P mixture Ca-P and uric acid deposit into kidney, causing renal injury Allopurinaol bloc nucliec acid catabolism and prevent hyperuricemia but DOES NOT AFFECT K, P, CA So expect hypouric, hypocalcemia, HyperP and HyperK with allopurinol So hypoCa, Hyper-uric acid, HyperP, HyperK in regular Tumor lysis syndrome

risk for...in African Americans

cervical cancer HPN ischemic stroke

disease prevalane tin AA

cervical cancer HPN stroke

progress of labor in primigravida

cervical effacement then descent and dilation 1 to 1.2 cm per hour effacement

symptothermal method

cervical mucus evaluationn and basal body T eval combined effectiveness high

intervention for insufficient outflow in peritoneal dialsis

cfrom constipation when distended intestine block catheter give stool softners check tubing for kinks, reposition side lying or assist with ambulation keep bag below abdomen

Cancer warning signs-CAUTION

change in bowe/bladder A sore that doesnt heal Unusual bleeding/discharge THickening in breast or elsewhere Indigestion Obvious change in mole Naggin cough, hoarseness

WHEN HAVE pacemaker

check change in pulse every day

radium implant

check for position for applicator q8hr place on low residue diet- bwowel movement can dislodge bedrest increase fluid

postop for newly tracheostomy care

check tightness of tie and allow for 1 finger to fit-risk of dislogement change inner cannula and tie not until 24 hr after frequent mouth care

when a pt with HELLP

check urine protein check deep tendon reflex

chest tube after thoracotmy

chest tube drainage 50-500 ml /q24 hr. sanguineous for several hr then serosanguineous followed by serous (red-pink -yellow) rush of dark bloody drainage from chest tube when client turned is mostly related to retained blood . If bright red draing-active bleeding so notify HCP

shaken baby syndrome

child abuse by vilent shaking of infant bleeding within brain/eyes lethargy, Vomiting, irritability, inability to suck/eat, seizure, inconsolable crying small bruises on chest/pper arm where child was held

Hirschsprung disease

child born with some lg intestine missing nerve cells No peristalsis and distal intestinal obstruction No meconium win 24-48 hr within birth vomit grn bile need surgery

exposure to MMR in infant

child less than 12 month should receive MMR vaccine when risk of exposure. then need revaccination 12-15 mon and bet 4-6 yr

foreign body aspiration tx

child over 1- abdominal thrusts/Heimlich maneuver-apply upward thrusts with a fist to upper abdomen. child less than 1-backblow, chest thrusts

resuscitation of child

child/infant HR<60 is considered pulseless 1. if breathing and pulse, wait for help 2.if abnormal breathing, yes pulse, mouth breathing 12-20/min 3. if abnormal breathing, no pulse, CPR 30com/2breath. AED

side effect of plasmapheresis

chills hypothermia

coining

chinese, vietnamese remove illness from body rounded surface is stroked on lubricated skin of back produce welklike linear lesion

cholecystitis vs cholelithiasis

cholecysttitis-acute inflammation cholelithiasis-gallstone

chronic bronchitis

chronic hypoxemia/cor pulmonale chronic sputum production, changes bronchial wall CLUBBING

risk factor for developing osteoarthritis

chronic joint and cartilage trauma to joint occupation like coal mining bone infection stress on joint like obesity

rhematoid arthritis

chronic progressive deterioration remission and exacerbation swelling joint, stiffness NO ROM< do palpate, inspect pain high ESR, positive rheumatoid factor Give aspirin or NSAIDS, DMARDS, steroids

inserting catheter Foley

clean genital area with soapand water position with perineal area exposed expose meatus clean front to back insert foley inflate balloon

administration of rectal suppository

clean glove position for less than 3 yr-supine with knee/feet raised more than 3-side lying with knees bent lubriate tip of suppository with water soluble jelly insert past internal sphincter using 5th finger of under 3 yr, index fnger if more than 3 yr guide along recctal wall hold buttocks together for several min or until urge to defecate passed if bowel movement within 10-30 min, observe if supository is present

medical asepsis

clean technique 3 min hand scrub use of hand sanitizer changing linen

ostomy

clean with mild soap and water make opening 1/8 inch larger than stoma so it hugs the stoma tissue ensures appliance fits well if in sm intestine, cincontinence and no need for irrigation change appliances q 5 to 10 days

soft diet

clear and full liq plus soup ground or minced meat/flaked fish pancake, biscuit, muffin pasta, rice, mashed potato cooked/canned fruits and veg peanut butter scrambled egg

instructions before colonoscopy3

clear liq diet the day before NPO 8-12 hr prior bowel-cleansing agent like cathartic, enema

full liq diet

clear liq plus strained/blended cream soup custard, pudding refined cooked cereals fruit juice ice cream, frozen yogurt, sherbet, milkshake

improvement after kidney injury

clear lungs UO increase normal K normal mental

normal dialysate output

clear, light yellow if clody or opaque dialyysate output, sign of peritonitis

HPN and OTC meds

client with HPN should not take OTC cold meds since many contain phenylephrine or pseudoephedrine. They activate alpha 1 adrenergic receptors, causing vasoconstriction-can lead to Hypertensive crisis

unit quality improvement committee assessess

clinical issues on unit increased infection rate, problems with system, standards like late delivery of meds sfrom pharmacy outcome should be objective and measurable

avoid antihistamine/anticholinergic in3

closed angle glaucoma-increased IOP Urinary retention-BPH bowel obstruction

genital herpes

cluster of painful blister in genital area

when caring for IICp

cluster out activities space out activities

mucosal protectant

coats GI mucosa carafate/sucralfate

codependence behaviors in addict

codependent behaviors focus on others at expense of their own keep addiction secret suffer abuse from addict not allow addict to suffer consequences of actions makes excuse for addict habit this behavior is counterproductive to both

cephalohematoma

collectiono f blood bet skull bone and periostem-several months when prolonged second stage of labor or vacuum assisted

red man syndrom

condition that can occur with rapid IV vancomycin flushing, erythema, pruritis on face, neck chest muscle pain, spasm, dyspnea, hypotension not allergic, but rate-related rxn so infuse vancomycin over min of 60 min Hives, angioedema, wheezing, resp distress are more anaphlatic rxn-STOP infusion and give IM epinephrine

narcolepsy

condition with excessive daytime sleepiness

Korsakoff psyhosis

confabulation invent happendings

placenta previa intervention

confirm by ultrasound risk for hemorrage-check hemoglobin, hematocrit type and screen blood electronic fetal monitoring if constant bleeding, emergency c-sect no vaginal delivery due to massive blood loss go Pelvic rest-no vag exam, douching, vaginal intercourse

bladder exstrophy

congenital bladder not developed in abdminal but is exposed externally place protective film over exposed bladder to keep tissue moist No petroleum jelly-irritating

hypospadis

congenital defet with urethral opening on underside of penus surgicalaly corrected 6-12 months circumcision is delayed postop-catheter or stent to maintain patency so monitor UO! absence of Uo for an hr indicate kink/obstruction watch URINE OUTPUT

who is at risk for infective endocartitis

congenital heart disease with prostehetic valve risk with oral surgery and dental work so need prophylactic abx

when child is admitted

consent to treat form is signed when pt is admitted to to hospital give general consent to routine types of procedures or treatment

common adverse effects of codeine

constipation NV-take with food ortho hypotension dizziness narcotic and treat cough

RSV precaution

contact

shingles precaution

contact

precaution for croup

contact viral

care for c diff

contact precatuion with gloves, gown private room soap and water use diluted bleach solution to disinfect surface bc alcohol is not effective

Respiratory syncytialvirus-RSV

contact precaution antiviral agent prophylaxis with palivizumab in high risk child <2yo

rotavirus

contact precaution fecal-oral

precaution MRSA

contact precaution gown, gloves

VRE and MRSA care

contact precaution private room dedicate equipment to client gloves entering room hand hygiene wear gown place door notive for visitor

group A strep cellulitis precaution

contact until 24 hr after abx

group A b-hemolytic streptococcus pharyngitis

contagious bact throat infection can lead to renal, cardiac complications soft diet, cool liquid finish all abx toothbrush replaced 24 r after starting abx can return to day care after fisniehd 24 hr of abx and afebrile

influenza

contagious viral infection Give antiviral meds (-mivir) droplet caution avoid being in 3 ft of others when coughing/sneezing watch for secondary bacterial infection like pneumonia

Rotavirus

contagious virus with leading cause of diarrhea in children <5 fecal-oral route contact with food, toy, diaper, hands transmission foul watery diarrhea, fever, vomiting watch dehydration handwashing perianal care with mild soap and water-no alcohol wipes vaccine available-no abx bc viral

Ebola care

contagious, high mortailisy standard, contacr, droplet, airborne single clinet airborn isolation visitor prohibited-keep log PPE-outer glove first cleaned with disinfectant and remved. inner glove wiped bet removal of every subsequent piece and removed last

what precauion if whooping cough

contat with resp droplet Bordetella pertussis

ambulatory electrocardiography teaching

continuous activity keep a log of activities No change in diet no bathe/shower no electric razoe use safety razor

rhonchi

continuous lung sound one xpiration indicate presence of secretions in larger airwayss Not CHF

Holter monitor

continuously record electrocardiogram rhythm for r24-48 hr keep diary of activities and SS experienced No bathe/shower engage in normal activities take monitor back to HCP office

hypothyroidism SS

contipation decreased hair cool, pale skin brittle nail/hair joint pain dementia/depression weight gain cole intolerance

Ca channel blocker contraindication

contraindicated in HF and digoxin

epoetin caution

contraindicated in HPN risk for HPN and seizure increase if hematocrit increases by more than 4%

HPV immunization

contraindicated in preg 11-12 but up to 26 Can still give if sexually active or had HPV bf

erythropoietin therapy

contraindicated in uncontrolled HPN so check BP prior to adm

Ortho jews end of life

control of life so pain control

conversion disorder hypochondriasis somatization disorder factitious disorder

conversion-pt has neurologic problem (lindness, paralysis) that cannot be explained medically hypochondriasis-obsession about having a serious illness somatization-have physical symptoms but no illness factitious-pretend to have illness by feigning symptoms

hypoNa at risk for

convulsion, seizure do seizure precation

signs of nearing death

coolness/paleness/mottling of extremities relaxed jaw, open mouth difficulty body posture eyelid half open cheyne stokes UO darkens

dopamine

corrects hemodynamic instabiliy monitor VS

most effective for quitting smoking

counsel

coup-contrecoup SS

coup-damages frontal lobe executive function, memory, speech, voluntary movement contrecoup-occipital-vision

SS pneumonia

crackles fever, chill pleuritic chest pain tactile fremitus bronchial breath sound in peripheral lung field unequal chest expansion dullness

consolidation/lobar pneumonia pul auscultation

crackles increased tactile fremitus dullness

normal finding for newborn

crackles/rales-fluid in lung dullness in hypogastric-bladder is full undescended testicle-cryptorchidism-most descend spontaneously

tartrazine and aspirin

cross sensitivity so if one alleryg, nono =food dye

Acetazolamide

cross sensitivity with sulfa diuretic treat glaucoma. edema, motion sickness

pruritis from cirrhosis

cut nail short wear cotton glove wear long sleeve wet cloths calamine lotion Take cholestyramine-increase bile salts in feces

right to left blood shunt

cyanotic result in pulflow impede clubbing of finger, cyanosis in tetralogy of fallot

tetralogy of fallot

cyanotic cardiac defect opening in septum bet ventricles, overriding aorta RV thicken and pul artery narrows will result in polycythemia as compensatory to prolonged hypoxia-increased stroke and embolism expect cardiac murmur poor weight gain TOF result in O2 sat of 65-85-normal

cystitis vs pyelonephritis

cystitis-bladder infection SS-burning on urinatiton, frequency, urgency, hematuria, suprapubic discomfort pyelonephritis-NV, fever, chills, flank pain, costovertbral tenderness

cystitis vs pyelonephritis

cystitis-most common UTI of lower urinary infection and inflammation of bladder mucosa leading to hyperemia, tissue hemorrhage and pus... burning with urination (dysuria), urinary freq and urgency, hematuria, suprapubic discomfort pyelonephritis-UTI ascends to kidney-very ill. NV, fever with chill, flank pain, costovertebral angle tenderness..can lead to septic. Dull flank pain extending toward umbilicus

post cystoscopy

cystoscopy-flexible scop to urethra into urinay bladder expect pink urine, frequency, dysuria, abd discomfort 48 hr after increase fluid, avoid alcohol, caffeine, take milkd anagesic, warm sitz bath Report ASAP, inability void, gross hematuria, blood clots, fever, chill, severe pain

right vs left cerebral prob

left-speech, math, analytical thinking right-impulsive, disorientation

preventing dehiscence wound

docusate-stool softner-avoid straining antiemetic-prevent straining apply abd binder monitor gluc if diabetic splint abd by holding pilow or blanket against abdomen to support wound when coughing or moving

giving meds priority

does it treat potential or real problem? Give st that prevent deadly side effect prophylactic meds give later PRN for non urgent-give last

eating for depressed vs manic

depressed-give favoriate food in pleasat setting-more freunet feeding manic-offer high calorie food to carry around

growth hormone replacement

daily injection sbQ try to begin early in child life cease bone growth cease final height is usually less than :normal:

preventing fall risk

dairy eating exposure to sun for vit D leg exercises

neurogenic bladder

damage to upper motor neurons urinary retention intermittent catheterization for residual V

melena indicative of

dark red black sticy stool Upper GI bleed gastritis

deceleration vs acceleraion

dec-go down acc-go up

3 electrolyte in refeeding syndrome

decline in PPM hypoMg hypoK hypoP

how does morphine work in MI

decrease blood return and decrease peripheral resistance decrease preload, afterload and cardiac work cause vasodilation

cimetidine

decrease gastric secretion side effect" constipation, headache, confusion

onset of labor SS

decrease in fetal movement rupture of membrane bloody show low backache

oral contraceptive and breastfeeding

decrease milk production

intervention preelcmapsia

decrease stimulation give Mg sulfate

side effect of stimulants (methylphenidate)

decreased appetiete weight loss HPN, Tachycardia tics restlessness, insomnia potential for abuse

long term use of PPI cause

decreased bone density-due to calcium malabsorption pneumonia-due to acid suppression-more pathogen enter Upper GT C diff

atelectus pul auscultation

decreased breath sound decreased tactile fremitus dullness

pleural effusion pul ausculation

decreased breath sound decreased tactile fremitus dullness

PTX pul ausculation exam

decreased breath sound decreased tactile fremitus hyperresolent

emphysema pul auscultateion

decreased breath sound decreased tactile fremitus hyperresonant

beta blocker adverse

decreased libido erectile dysfunction bradycardiabronchospasm depression

glaucoma

decreased visual acuiyt not corrected by eye glasses schedule appointment in mornng bc highest IOP in morning chronic, not corrected by surgery

PPI

decreases acid production protisec-inhibit liver metabolism of coumadin, benzo, dilantin

H2 blocker

decreases acid=block relaease of histamine 2 that produce acid tegement, zentac, pepcid

pulseless v.fib

defib first if no response, CPR

osteoarthritis

degenerative of synovial joint bone spurs, clacificates and ulcerations in joint space pain exacerbated by weight bearing crepitus morning stiffness for 30 min decreased joint mobility decreased ROM atrophy of muscle noninflammatory, nonsystemic

lithium warning

dehydration, hypoNa, decreased renal and drug interaction (NSAIDs, Thiazide diuretics) cause Li tox pt with dehydration and sodium loss from vomiting and diarrhea can lead to toxic Li levels. WHen kidney is holding onto Na, it is also holding onto Li (same salt). So when you are dehydrated, you hold onto Na (as well as Li) to retain water...leading to Li tox. Same when you are hyponatremia, you are holding onto Na, and Li follows-Li tox. Same with thiazide diuretic that can cuase hypoNa

wenicke syndorme

dementia from thiamine deficiency diplopia nystagmus

multiple sclerosis

demyelination of CNS bowel and bladder problem visual disturbances and gait disturburces will remission and exacerbate corticosteroids, immunomodulator, immunosuppressants, cholinergic, anticholinergic, muscle relaxant, CNS stimulant

multiple sclerosis

demyelination of Spinal cord urinary retension hyperreflexia numbness/tingling decreased memory

epi pen

designed to give thru clothing against mid-outer thigh until it clicks hold for 10 sec massage for additional 10 sec

Radioactive iodine

destroyes thyroid gland delayed response up to 3 months so use other meds (antithyroid drug until iodine has max effcect) avoid proximity to preg and children no breastfeed no share utensil or use bare hand to serve food isolate laundry and wash separately use separate toilet and flush 2-3times wash hands frequently drink plenty fluids sleep in separate bed from other

Schamroth method

detect clubbing place fingernails of ring fingers together and hold them up to light if diamond shaped, no clubbing

feeding tube med adm

determine if meds are in liquid form crush meds administer meds separately flush with sterile water before and after dont mix with feeding

steps for unconscious pt

determine unresponsiveness activate code and get defib assess carotid pulse move to flat position begin compression open airway and give 2 breaths assess cardiac rhythm

inferior vena cava filter

device entered thru femoral vein traps blood clots from lower extremity vessel to prevent them from migrating to lung and cause PE avoid crossing legs report leg pain, numbness, swelling report SS PE-chest pain, SOB

causes of m. acidosis

diarrhea DKA lactic acidosis renal failure

m.acidosis

diarrhea diabetes alcoholism starvation hemodialysis with AV shunt salicylate tox sepsis hypoperfusion pyelonephritis

causes of m. acidosis 5

diarrhea ketoacidosis lactic acidosis-sepsis, hypoperfusion renal failure salicylate tox

after pancreatitis

diet low fat, high protein, high carb may have flare ups hyperglycemia NPO during acute phase can be caused by bacteria

diet for Meniere disease

diet low in Na becase decrease fluid retention in ear

intervention to reduce hiatl hernia

diet-avoid high fat, choco, peppermine, caffeine eat sm, fr meal decrease fluid during meal no smoknng weight loss avoid lifting, straining elevate HOB 30 no tight clothes

hoarding disorder

difficulty discarding possesions-clothing, food, box, newspaper they clutter living area and can create envt and fire hazard

primary problem for schizophrenia

difficulty forming relationships

interaction w St Johns wort

digoxin nifediipine stain lexapro

mydriatics

dilates pupil

Boston brace Wilmington brace thoracolumbosacral orthosis brace Milwaukee brace

diminish progression of deformed spinal curves in scoliosis Do not cure existing spinal deformaties wear cottin tshirt undern no lotion/powder most worn 18-23 hr/day and remove for bathing/exercising

post abd surgery

diminished breath sounds normal hypoactive bowel sounds normal

postop

diminished breathsounds in lung base common hypoactive bowel sounds common after abd surgery

urine gluc test using reagent strip

dip strip t urine and compare to color chart void first then obtain specimen 10-20 min after

nose bleed

direct pressure 5-10 min continuously if not working, Gelfoam and silver nitrate

side effects of varicella immunization

discomfort redness few vesicles at injection cover vesicles with clothing/sm bandate to stop transmission and remove when vesicles are dried

if IV infiltration occur

discontinue IV and use another site continue to monitor infiltration-need to be gone win 24 hr notify HCP if site continue to appear swollen, hot, red cold compless. No heat

displacementt

displacing anger to others

moro reflex

dissapear 3-4 month

greatest risk for postpartum hemorrhage

distended bladder bc can displace uterus to side and interfere with contraction

when manic bipolar

distract pt and redirect behaviors

what meds are held before surgery

diuretic anticoag

glycerin

diuretic osmotic agent caution in DM bc can ccause hyperglycemia

chlorthalidone

diuretic watch hypoK-watch muscle cramps

triameterene

diuretic for HPN

what drugs are contraindicated in dementia

divalproex risperidone lorazepam

when high level of lead in toddler

do abdominal test to identify lead chips

women with first deg relative BRACA

do annual mammogram plus MRI

sputum collection

do at morning rinse mouth with water sit on side of bed or FOwler inhale deeply several times coughh deeply and expectorate into sterile container

when to give opiod agonist-antiagonist to laboring mom

during active phase given over peak of 2 contractions to reduce flow to fetus no more than 3 dosese due to celing effect can precipitate withdrwal in addicts

position during and after lumbar puncture

during-side lying with head,back, knee flexed-sm pillow placed bet leg and under head for comport after-supine or HOB 30 deg

Islam religion end of life

dying as facing east toward Mecca

pul edema

dyspnea cough with frothy pink sputum crackles at lung bases

Pul Emolus SS

dyspnea pleuritic chest pain tachycardia tachypnea hypoxemia apprehension/anxiety

activated charcoal

early acetylsalicylic acid toxicity-aspirin tox they bind to salicylates, limiting absorption in sm intestine

to confirm diagnosis of TB

early morning sputum specimen on 3 consecutive days for acid fast bacillli

LOC

early sign-change LOC, orientation late sign-cushing triad-BPup, HR down, RR down; change in pupil, dilation on one side, T up Cheyne-stokes keep hypervent to lower CO2

early vs late sign of lithium tox

early-NV, diarrhea late-ataxia, confusion, seizure

intervention for early vs late vs variable deceration

early-normal continue monitor late-turn to left, give O2 variable-give O2, trendenberg, knee to chest

projection

ease anxiety by assigning tht feeling to another person a husband with thoughs of infidelity who accuse of wife of being unfaithful

prevent dumping syndrome

eat multipl sm meal, low carb no fluid with meal (30 min apart)

measure to delay gatric emptying for dumpting syndrome

eat slowly avoid high carb consume high protein, fat, fiber-longer to digest no fluid with meal lie after meal

repair of abd aortic aneurysm signs of graft leakage

ecchymosis of groin, penus, scrotum increased pain in paivis/back/groin decreased UO due to increased abd girth tachycardia weak peripeheral pulse dereased HCT/Hgb inadequate perfusion to kidney

hip fractures SS

ecchymosis/tenderness over thigh and hip groin/hip pain with weight bearing muscle spasm in injured area shortening of affected abduction/adduction of extremity external rotation

evening primrose herb

eczema skin irritation

DVT SS

edema, calf pain warmth erythema No cyanoisis

food high in iron

egg yolk poultry giblets oyster, clam, scallops oatmeal, cereal chx giblets

correct fit of a sling

elbow flexed at 90 deg hand slightly above level of elbow bottom of sling ends in middle of palm with fingers visible sling supports wrist joint

7 risk factors for resp depression to opiod use for analgesia

elderly postop existing pul disease opiod naive obesity smokint (more than 20 yrs_ hx snoring

managing anaphylactic shock

ensure airway, give O2 remove insect stinger if present IM epinephrine, IM. Repeat dose q 5-15 min place recumbent and elevate legs maintain BP with IV fluids, bronchodilator antihistamine corticosteroids anticipate cricothyrotomy or tracheostomy with severe laryngeal edema

complication of Hirschsprung disease

enterocolitis-inflammation of colon can leadd to sepsis and death fever, explosive, foul smelling diarrhea worsening abd distension

hypoglycemia

epinephrine is released trembling, palpitation, anxiety, restlessness diaphoresis pallor confusion, seizure, coma (brain has no sugar)

types of delusion

erotomanic-belief that another person is in love with pt grandiose-irrational idea about self worth, power, identity or special relationship jealous-delusion that sexual partner is unfaithful persecutory-belif of being treated in malicious way somatic-delusion of having a physical defec/ disease

left-to-right vs right-to-left

left-to-right is ACYANOTIC0pul congestion RIght-to-left-Cyanotic-decreased pul circulation

electrical capture vs mechanical capture in pacemaker

electrical- P wave follower atrial spike or widened WRS following ventircular spike mechanical-palpate pulse rate and compare to rate displayed on cardiac monitor

first action in autonomic dysreflexia

elevate HOB

steps administering enteral feeding

elevate HOB 30-45 deg validate tube placement flush with 30 mL of water administer using aseptic technique

after mastectomy

elevate affected arm to heart level to reduce fluid retention and preent lymphedema

after ammputation what is priority

elevate limb then place prone edema over hip flexion

post op and post graft/suture, watch for

elevated BP can lead to graft rupture/hemorrhage so need to lower BP first

SS Kawasaki disease

elevated ESR desquamation of extremities irrritability'strawberry tongue high fever

watch out after TURP

elevated T bladder spasm incontinence hemorrhage

elevated/decreased factors in cirrhosis 5

elevated bilirubin (cant excrete bilirubin) elevated INR /PT and aPTT-bc most coag factors are produced in liver elevated ammonia-liver cant convert ammonia to urea Low albumin-liver cant synthesize albumin Low sodium-body retain water so dilute sodium in body

caput succedaneum

emeda of scalp-ocicput 3-4 days

when can we give minors treatment wo parental consent

emergency STI substance abuse prenatal caree contraception emancipated minor

when umbilical cord prolapse

emergency c sect hand-knee positionn trendenlenburg strild gloved hands to lifet part off cvord

contraception

emergency contraception should be taken within 5 days of intercourse IUD inserted upto 5 days after intercourase as emergency IUD good for monogamous women-no protection against STI diaphragm no protection against STI back up contraception required for 7 days after starting oral contraceptives

autonomic dysreflexia

emergency for injury T6 or above by exaggerated autonomic reflex by bowel or bladder distention massive HPN, bradycardia, flushing, sweating elevate HOB, relieve trigger

toxic megacolon

emergency life thretening complication of Ulcerative colitis abd distension, bloody diarrhea, fever lead to C diff and other infections may lead to perforation

testicular torsion

emergency when blood flow to testis has stopped testicle rotates and twists spermatic cord causing venous drainage obstruction that leads to swelling and severe pain testicular ischemia and necrosois short time frame till it can be treated or testis needs to be removed

position for paracentesis

empty bladder high Flower or sitting position

when taking tetracycline

empty stomach avoid antacid/dairy products take with full glass water photosensitivity decrease effect of oral contraceltives

prior to spinal anesthesia

encourage fluid to prevent hypotensive problem

NG traditional method marking

end rests in stomach measure from tip of nose, extend to earlobe then down to xiphoid process mark with tape

assessing for hepatic encephalopathy

end stage liver disease asterixis-flapping tremor confusion, lethargy check ammonia give higher dose of lactulose

foul odor lochia

endometrial infection usually fleshy or musty

endometriosis vs endometritis

endometriosis-part of uterine is found in other part of body endometritis-postpartum fever, foul smelling lochia-infection

who is most at risk for pul embolism 3

endothelial daamge venous stasis hypercoagulability of blood

teaching for hypotension

energyy conservation since hypotension can cause generalized weakness

food high in vit B2

enriched cereals soy bean milk products liver

small bowel follow through

examine anatomy and ftn of sm intestine using xray images taken n succesion barium ingest, xray q15-60min fast 8 hr prior drink plenty of fluid after to remove barium chalky stool present 24-72 hr after exam

Meniere disease

excess fluid in inner ear vertigo, tinnitus, hearing loss; nystagmus

meniere disease

excess fluid in inner ear vertigo, tinnitus, hearling loss, aural fullness falll precaution, bed in lowest position quiet, dark room no stimulation

esophageal atresia/tracheoesophageal fistula

excessive frothy mucus cyanosis suction mouth keep supine with head at least 30 deg to prevent aspiration NG tube

pursed lips

exhale like candle blowing pressue on lips will open alveoli promote CO2 elimination 1. relax neck and shoulder 2. inhale 2 sec thru nose with mouth closed 3. exhale for 4 sec thru pursed lips DO 5-10 min 4X day

hyperthyroid

exophthalmos weight loss heat intolerance diarrhea txPTU and Iodine, thyroidectomy

halo vest traction

expect headache pain with jaw movement-may indicate pins fell out onto temporal skull

water seal chamber

expect intermittent bubbling then bubbling sometimes in water seal chamber if CONTINUOUS bubbling-problem

proper care of nitrolycerin

expect slight tingling sensation under tngue if potent. If no tingling, med is outdated! expect headache/flushing due to systemic vasodilation lie down bf taking pill bc can cause dizziness from ortho hypotension

postop of barium enema

expect while, chalky stool take laxative (Mg hydroxide) drinky fluids

S3

expected in young bad in elderly-atria is pumping into noncompliant ventricle-HF

wheezing on expiration vs inspiration

expiration-asthma inspiration-aspiration

steps for ECT

explain proceduer ask to void, remove denture, glasses, jewelry give atropine 30min bf to decrease secretions orient after ECT

tonic neck reflex

extend left arm, leg when head is turned to left normal in infant

phlebostatic axis

external anatomical point on chest at level of atria 4th intercostal space at midaxillary it is where proper placement of pressure monitoring transducer is placed when measuring direct BP, CVP or cardiopulmonary pressure invasively also point for upper arm when measuring BP indirectly

developmental dysplasia of the hip

extra inguinal, thigh folds laxity of hip joint on affected side Barlow/Ortolani maneuver

Glasgow coma scale

eye, verbal, motor 3-15 LOC less than7-coma 3-4 high mortality >8 good prognosis

FLACC scale

face, leg, activity cry, consolability assess child pain level who is nonverbal facial grimacing, leg movement, bending up leg to chest, squirming, jerking,, crying, moanina, difficulty comforting

CN VII

facial facial movement, smile, frown

SS hypertensive in preg 2

facial edema headache

cranial VII

facial nerve raise eyebrow smile frown

liver

fat digestion-bile

clear liquids

fat free broth, bouillon gelatin/jello popsicle clear fruit juice carbonated beverage coffee/tea

SS anorexia

fear of weight gain F and E imbalance amenorrhea decreased metabolic rate-hypotension, bradycardi, decreased body T, cold intolerance lanugo-fine terminal hair

agoraphobia

fear/anxiety about being in situation or physical space- highly concerned about trouble escaping'avoid panic fear outside home alone fear in crowd fear bus, train, car, ship, plane, bridge, tunnel fear open spaces and enclosed space

feeding cleft palate

feed in upright position tilt bottle so nipple is always filled with formula point nipple down and away from cleft use special bottle/nipple burp often feed slowly over 20-3o min feed q 3-4hr

risk for breast cancer

female age over 50 first degree relative with hx breast cancer BRCA1,2 personal hx of endometria/ovarian cancer menarch bf 12 menopause after 55 hormone therapy with estrogen/progesterone-combined contraceptive postmenopausal weight gain and obesity since fatstored estrogen hx smoking/alcohold dietary fat intake sedentary life

fern paper test

ferning pattern of dried maniotoc fluid visualized under microscope

positive signs of preg

fetal heartbeat head with doppler fetal movement felt by HCP visualization of fetus by ultrasound

fetus at 20 weeks

fetus can suck and weigh around 11ounce

bacterial meningitis infant <2

fever irritability seizure high pitched cry poor feeding vomiting nuchal ridigity possible bulging fontanelle can lead to hydrocephalus, hearing loss, learnig disability

lanugo

fine hair on backs of preterm newborn disappear around 36 weeks

erythema toxicum neonatarum

firm white or yellow papule surrounded by erythema resemble flea bites appear first fe days after birth and resolve within 5-7 days

for persecutory delusion

focuse on feeling secondary to delusion-empathy try to understtand client feeling and meaning focus on reality and verbally reinforce it "what you're thinking is a part of your illness and not reatl" Dont try to explore meaning-encourage delusion Never argue, present evidence, confront and discredit delusions

anticonvusant can cause

folate or vit D deficiency consume milk, cantaloupe, kale grn leafy veg, legumes, tomato

managing sickle cell crisis

folic acid to help create new RBC high protein, high calorie No iron needed prevent infection oxgenationhydration pain control

community acquired pneumonia

follows influenza or viral infectio ask about flu shot

huff coughing

for COPD-uses low pressure cough to mobilize and expectorate secretions 1. position upright 2. inhale thru nose using ab breathing and prolong exhalation 3 sec thru pursed lips 3. hold breath for 2-3 sec following inhalation 4. deeply inhale and lean forward, force breath out using abd muscle while making ha sound. Repeat 2 more times 5. inhale deeply using abd breathing and give one forced huff cough ha sound

ethambutol

for TB need vision checks-decreased grn-red color discrimination

photodynamic theapy

for age related macular degeneration

kava

for anxieyt, insomnia side effect: severe liver damage

saw palmetto

for benign prostatic hyperplasia side effect: mild stomach discomfort increased bleeding risk

positron emission tomography

for bran work-epilepsy warm sensation with contrast agent empty bladder before test-takes 2 hour for test

vit K to neonate

for clotting factors 2,7,9,10 prevent abnormal bleeding

pavlik harness

for dysplasia of hip most effective during first 6 months keep slight flexed and abducted worm for 3-5 months assess skin under dress in shirt & knee socks under harness avoid lotion/powder lightly massage skin apply 1 diaper at a time apply diaper underneath straps keep it thru including diaper change

parkland formula for fluid resuscitation

for first 24 hr to stabilize burn victim 4X (weight kg) X (% body surface burned)=mL Give half in first 8 hour and other half over next 16 hr

normal AST, ALT

for male 8-40

measuring HR by ECG

for regular rhythm count number of small boxes bet 2 R waves, 1500 divided by that number=HR

hospice care

for those with terminal illness with less than 6 month to live can be done in home, hospital, nursing home can be discharged if improves cannot be done simultaneously as curative treatment covered by medicare

giving mucomyst

for tylenol tox give PO but mixed in juice/soda bc offensive odor

miconazole cream

for vulvovaginal candidis take for full dose, even if on period diaphragm can become contaminated with fungal infectio so dont use

a=fetoprotein AFP

found in mom blood, high or low-fetal anomalities

ways to promote safety when using crutches at home

free of clutter and remove scatter rugs look forward use sm bag to hold personal itens to keep hands free wear ruber or non skid slippers rest crutches upside down on axilla when not in use keep crutch rubber tips dry

aseptic

free of contamination

immunization hep A

from 12 month to 23 month- 2 dose series-separted at least 6 months

supraventricular tachycardia SVT

from bundle of His 150-220 regular R to R P often hidden QRS narrow from stimulant s(nicotine, caffeine, cocaine) tx-vagal stimulation-Valsalva, coughing, carotid massage, adenosine

pinworm infection

from food, drink eggs hatch in insteing during night, female pinworm lay egg in skinfolds around anaus, causing anal itching when infected person scratches, egg spreads to other surface

fat embolissm

from fractures (long bone, pelvis) can cause altered mental status resp distress Petechiae (pin sized red/purple) that result from sm vessel clotting across chest, axilla and in soft palate

trochanter roll

from hip to mid-thigh

SS pul edema

frothy blood tinged sputum anxiety crackles dyspnea, tachypnes hx of orthopnea, paroxysmal nocturnla dyspnea

full liq diet eg

frozen yogurt ice cream

FOUR

full outline unresponsiveness measure coma level in postop, stroke, intubated bc glascow is not reliable

full thickness vs partial thickness burn

full-charred, waxy white skin-eschar, dry to touch-need grafting partial-redness, swelling, blister, fluid filled vesicles

during transient stage of labor

fully effaced and dilated so increased urge to urinate

ringworm/tinea corporis

fungal infection of skin, hair or nails NOT A WORM INFESTATION contagious vis contact hand hygiene, limited contact wth personal items, prescribed shampoo antifungal cream Not dangerous condition itching

chorionic villi sampling

genetic and chromosomal disorder 8~12 weeks for high risk full bladder required RHogan

palpating thyroid gland

gently bc if hyoerthyroid, can cause thyroid storm stand behind or front of pt have pt swallow use both hands

prior to giving TNF

get baseline Tuberculin skin tes tand yrly skin test bc TNF cause immunosuppresion and bone marrow suppression if latent TB, need antitubercular agents treatment

phenytoin side effect 5

gingival hyperplasia-get dental check, good oral hygiene, increase in body hair rash folic acid deficiency osteoporosis

herbal supplements that increase risk for bleeding

gingko garlic ginseng ginger feverfew

if parenteral nutrition is not available,

give D10W or D20W

DKA

give D5W to prevent hypoglycemia in insulin drip Give K supplement if K is in normall range to prevent hypoK when insulin drip

SVT

give adenosine

managing anorexia at end of life

give analgesia, antiemetic, appetite stimulatns involve client in maeal planning eat with family/friendsgive food preferred regardless of nutrional value provide freqnet oral care fluids/fiber/ bowel regimen

adm iron supplement 5

give between meals bc stomach acid is higher bet meals so breakdown easily give with citrus juice place at back of mouth-use straw bc staining avoid giving with milk keep no more than 1 month supply in hand

priority in bleeding hemophillic pt

give clotting factors

school-age child

give facts

prior to epidural,

give fluid bolus with lactated ringer-replaces electrolytes

DKA intervension

give glucose if below 250-300 K drop as gluc drop monitor gluc q1 hr

caring for Candida albicans

give miconazole into vagina using applicator at bedtime avoid sexual intercourse till inflammation is resolved but do not require partner evalaution since not STI wipe front to back wear cotton underwear avoid douching

prior to cardioversion

give sedative/hypnotic Midazolam

intervention for HELLP

give steroids if preterm liver ftn test bedrest, left lateral position

giving vaccine to hemophilia child

give subQ to prevent IM hematoma use smallest gauge and put firm continuous pressure for 5 min avoid aspirin/NSAID due to increased bleeding. Use acetaminophen No rubbing use ice packs

postop infant

give tactile stimulation to thrive have parents stroke infant

surfactant

give to premature born with RDS

charcoal in aspirin tox

give wihtin 2 hr to absopb

pancreatic enzymes for Cystic fibro

give with or bf every meal enteric coated designed to dissolve only in alkaline envt like sm intestine can be sprinkled on acidic content, like applesauce, yogurt swallow hole, not crushed or chewed No with milk

CN IX

glossopharyngeal gag reflex swallow

assessing laryngeal nerve

glossopharyngeal and vagus nerves ability to swallow

2 major adverse effect of sulfonylurea meds

glyburide, glipize, glimepride weight gain hypoglycemia

tangentiality

going from one topic to next without getting to the point of original topic positive SS schizo

Green, yellow, red zone in peak flow meter

green-ashma under control yellow-caution-even on return to grn after rescue med, need further med or change in treatment red-medical alaert, call EMS if doesnt tgo to yellow immediately ater taking rescue med

dietary source of folic acid

grn leafy veg asparagus, brocoli, grn pea, fortified cereal, liver, fresh cooked beet, rice, tomato juice, orange, sunflower seed, peanut butter

prepping for electroencephalogram

hair washed to remove oil avoid accessories avoid caffeine, stimulants, CNS depressnats test not painful no food resriction except caffeine electrode is nonirritating

VAP prevention

hand hygiene closed vent system and suction HOB 30-45 deg oral care drain all water in tubing suction with aseptic-NO saline routine peptic ulcer prophylaxis Respiratory therapist will change tubing not RN

malignant lymph node

hard, fixed nonmalignant-nontender, mobile, firm

fetus at 8 weeks

has heartbeat arms,legs just start to form

when administering anticoag

have 2 nurses check bc high alert drug

intervention for noncurnal enuresis

have child assist with wet linen change avoid diapers at bed avoid punishing awaken at specif time to void each night use bed alarms that awaken child when voiding begins restrict fluid after evening meal

treating bulimia

have client keep food/feeling action journal so nurse can determine food triggers that begin binge/purge cycle

intervention to lead

have home evaluted hand washing wet dust or mopped, no vacuum bc can spread lead

prostate cancer genetic

having father/brother with prostate cancer has 50% more risk

12 month infant

head and chest circumference are equal triple birth weight can sit down from standing stranger anxiety

abnormalities in neonate

head circumference <32 or >37 jaundice (esp first 24 hr) not voiding 24 hrs nasal flaring, chest wall retraction, grunting

early decelration

head compression normal nothing to worry about-monitor

testing for cerebellum

head-to-toe finger tapping-touch each finger to hand's thumb rapid alteranating movement finger to nose testing heel-to-shin testing

after lumbar puncture

headache common

fetal tone for LSA

heart at or above umbilicus

pyrosis in pregnancy

heartburn due to increase in progesteroneca causes esophageal sphincter to relax Upright position after meal sm, freqnet meal keep HOB elevated drink smalelr amt of fluid while eating eliminate dietary trigger like fried, fatty, caffeiene/chocolate, spicy food, carbonated drink, peppermint

Bell's palsy intervention

heat on affected side no cold due to sensitive nerve ending eye shield over affected eye at bedtime

intervention for PAD

heat pad on abdomen can cause reflex vasodilation on extremity

EPOetin

held of hemoglobin exceeds 11 due to risk of thrombotic event contraindicated in uncontrolled HPN bc EPO increases BP need 2-3 month to reach targe HGB level

physiologic anemia of pregnancy

hemodiluted state in preg due to 40-45% increase in total blood volume low Hbg and hct Also WBC elevated

E.COli diarrhea

hemolytic uremic syndrome is a life threatening complication Red cell hemolysis, low platelet, acute kidney injury anemia, petechiae, purpurue

pt who have elevated T wave

hyperK liver failure-m.acidosis burn pt

autism

hyperactivity, impulsivity aggressivity self injurious, temper, repetitive mannerism, preoccupied with objects No cure language and intellectual deficit abnormality in social interaction and communication restricted pattern of behvaviors..repetitive

impending resp failure SS

hypercarbia (>50) hypoxemia (<60) paradoxical breathing change in mentation silent chest, absence of wheezing single word dyspnea

when giving heparin, watch for

heparin induced thrombocytopenia-risk for thrombosis if low heplatelets

duration of heparin and warfarin and INR

heparin- IV 2-6 hr subq 8-12 hr warfarin-PO 2-7 days INR is 1.5-2 times control value= of PTT-1.5-2 times normal range 25-35

licorice and drug interaction

herbal remedy sometimes for GI disorders not used with heart diseae or HPN if used with diuretic, can decrease K-hypoK watch hypoK and HPN

gestational HPN

high BP occur after 20 weeks of gestation wo proteinuria

fluid deficit

high BUN high hematocrit low UO low serum creatinine high urine specific gravitty

oliguric phase of AKI

high K, low Na, weight gain/fluid retention, m. acidosis

oxytocin adm to preg

high alert med use electronic infusion pump evaluate FHR, uterine contraction q15min first stage q5 min second stage give at lowest dose to achieve adequate contraction and is titrated vased on fetal tolerance and uterine activity watch water intoxication-monitor I an O use secondary IV connected to main line using proximal port CONTINUOUS FHR

benzo to peds

high alert med so need two RN to check

diet for ulcerative colitis

high calorie, high protein, low fiber No beans, no raw fruit, no raisin bran No legume No raw veg No whole grain Eat chs, milk, meat, cooked, skinless veg

acute otis media child SS

high fever ear pain irritability/restlessness loss of appetitie pulling on affected ear

Diverticular disease

high fibeer diet. if inflammation, NPO, low residue, bland. avoid lifting, tight clothing, straining no seeds-get stuck in pouch

venturi mask

high flow device that delivered guranteed O2 conc despite any resp rate, depth, tidal volume

physiologic anorexia

high metabolic demands of infancy slow down to keep pace with toddler growth so toddler get very picky aboud food choices and schedule parents may worry that child is not eating well but intake over few days meets needs

laryngeal stridor

high pitched harsh sound indicates partial airway obstruction if after thyroidectomy-need to watch airway due to hemorrhage or edema life threatening need suction, O2 and trach tray

Care for recently extubated client

high risk for aspiration, airway obstruction High fowlder warm humidified O2 Oral care incentive spirometer NPO

alarm in ventilator

high volume alarm-check for increased spontaneous effort-improvements? low volume alarm-1. secretions (suction) 2. resistance in airway-bronchospasm and mucos clot 3. circuit disconnect 4. water in circuit high inspiratory pressure-1. secretions 2. pt ventilator asynch-sedation indicated 3. circuit occlusion low inspiratory pressure-1. premature extubation (tube out) 2. cuff leak-if pt can make any sound, st is in cuff 3. circu

advanced maternal age asso with

higher incidence of trisomy 21 Down syndromesingle palmar crease short neck wit excess skin

nursing intervention for stress incontinence

highest priory-bladder training-empty q2hr to prevent skin breakdown and UTI pelvic floor exercises-kegel avoid smoking, caffeine, alcohol pessaries

meningococcal meningitis

highly contagious bact infection need immediate treatment with abx headache, fever, nuchal rigidity, photophobia, NV

cimetidine

histamine antagonist

using Doppler ultrasound device

hold at 45 degree angle from distal to proxima apply lukewarm gel mark pulse locations

when using incensitve spirometer

hold at eye level so can see ball purpose inhale thru mouthpiece and hold for 3 sec cough after use

insulin pump

holds a syringe filled with rapid acting insulin and deliver drug thru pump deliver as steady continuous 24 hr day and deliver as intermittnet dose-bolus manually at mealtime more accurate so fewer swings in blood gluc level and hypoglycemic episodes still need to check blood gluc levels 4-8 times a day

phenytoin toxicity

horizontal nystagmus gait unsteadiness followed by lethargy, confusion, coma common side effect-gingival hyperplasia

cold or hot for RA

hot for chronic

huff breathing vs pursed lip breathing

huff-forced cough to expectorate mucus pursed-prolong exhalation, reduce air trapping. Not for thinning secreion

K in DKA

hyperglycemia lead to osmotic diuresis-> dehydration-> hyperkalemia (K shift from Intracell to extracell) give continous insulin as K continue to decrease. When serum K is normal, give K suplment to prevent impending hypoalemia

Addison's disease SS

hyperpigmented skin low BP weight loss muscle weakness

exophthalmos

hyperthyroidism protrusion of eyeballs caused by increased orbital tissue IRREVERSIBLE maintain HOB raised use artificial tear to moistem tape eyelids shut during sleep teach to visit ophthalmologist smoking cessation bc it increase risk of grave's disease restrict salt intake to decrease edema use dark glassess perform intraocular muscle exercises

pyloric stenosis in detale

hypertrophied pyloric muscle-obstruction in gastric outlet emesis is nonbilious and leads to progressive dehydration-hemoconcentration elevated HT, elevated BUN due to excess vomiting, metabolic alkalosis hypokalemia

dizzy, tingling in finger, numbness in lips

hyperventilating so breathe into paper bag

hypovs hypercalcemia

hypo-muscle cramp, chvostek sign hyper-polyuria, weakness, NV

Mg DTR

hypoMg-hyper deep tendon reflex hyperMg-hypo deep tendon reflex

4 lab values of tumor lysis syndrome

hypoca hyperK hyperphosphate hyperuric acid

Trousseau sign

hypocalcemia BP cuff on arm and inflate to P more than SBP and hold for 3 min. It occluded brachial artery and induce spasm of muscle in hand and forearm if hypocalcemic

CN XII

hypoglossal stick out tongue

prolonged vomiting causes

hypokalemia acid loss ortho ypotension hyponatremia cardiac dysrhythmia

vomiting leads to

hypokalemia m. alkalosis

K ECG

hypokalemia- inverted/flat T wave; ST depression, U wave...heart block hyperkalemia-Tall, tented T wave

thiazide diuretics

hyponatremia hypokalemia hypercalcemia metabolic alkalosis-loss of H

water intoxication in infant

hyponatremia when formula is diluted too much cant excrete excess water irritabiitylethargy, hypothermia, seizure

neurogenic shock

hypotension bradycardia pink and dry skin vasodilation usually from cervical or T6 and higher injuries need fluids

heat stroke SS

hypotension (low fluid) tachypnea tachycardia skin hot and dry elevated T-105 bizarre, confused, delirious

SCI above T6

hypotension and bradycardia possible

when to give hypotonic and hypertonic solution

hypotonic- 1/2NS- cellular dehydration hypertonic-for intervascular dehydration(3rd spacing)= D50.45Ns, D5Lr, D5NS, D10W=will draw out fluid to vessel

burn injury causea

hypovolemia hyponatremia hyperkalemia

grandeur delusio

i need to get to Washington for my meeting with president

post tonsillectomy

ice collar around neck analgesic-tylenol no suction put on abdomen or side lying low fever expected chewing gun can reduce spasm in muscle around throate observe for postop bleeding

theories about schizophrenia

idental twin-genetic Neurotransmitter-dopa, serotnon, Ne, glutamate reduced size of certain brain parts prenatal factors birth trauma, epilepsy

when can client resume sexual activity

if can walk 1 block or climb 2 flights of stairs without symptoms

autopsy

if client dies by suicide, homicide, accident or within 24 hr of admission no consent needed leave all tubes/IV in place

kawasaki be careful

if exposed to chx pox-bc risk of rye syndrome due to aspirin

clinet with ICD

if goes tachy and pulseless, ICD dont detect pulselessness so initiate Chest compression, CPR to provide circulation

postop blood loss

if more than 100 mL/hr, report

giving otic meds

if more than 3-pinna up and back prone or supine warmed to room T dropper shouldnt touch entrance of ear

vaginal bleeding

if no cause known, contraindicated

nocturnal enuresis

if older than 5 and no response to behavioral apprach, can give pharm desmopressin tricyclic antidepressant to improve bladder capacity

gastrostomy

if pt cant eat in guillain barre

OCD

if ritual is stopped, experience anxiety point out the amount of time spaent on ritual and redirect client to another activity

precipitous birth

length of labor is less than 3 hr from onset of contractions to birth of infant

mal de ojo

in Latin American culture, when a stranger compliments a child, an illness occurs. This curse is manifested by vomiting, fever, crying. It is broken if admirere touches the child immediately after or while talking to the child.

silent chest

in acute asthma exacerbation, labored respiration in case of seveere obstruction, No sound of wheezing, breathing emergency priory bc air is not moving in lungs

propranolol contraindicated

in asthma cause bronchospasm beta blocker

morphine elexar

in end of life-used to relieve pain and anxiety also reduce air hunger

why void urine before blood transfusion

in event of acute hemolytic transfsion rxn, fresh urine specimen needed and sent to lab for testing hemolyzed RBC

nonrebreather mask deliver up to 95-100%

in medical emergency facemask with attached reservoir bag and one way valve that prevent exhaled air from entering Need o2 liter flow high (up to 15 L/min) to keep reservoir bag at least 2/3 inflated during inhalation and prevent CO2 buildup in bag exhalation valave ports on each side of mask should be occluded to prevent reentry of room air need reservoir bag to be in continual inflation during inhalation

early signs of impending resp failure in guillain

inability to cough shallow resp dyspnea/hypoxia inability to lift head/eyebrow

incidence vs prevalence

incidence-# of NEWLY diagnosed cases of ilness over specified pd prevalence-Total # of disorder in same pplation over same pd

corticosteroids before surgery

increase demand for corticosteroids

tx acute prostatitis

increase fluid intake no coffee/tea encourage ejaculation to decrease fluid in prostate stool softner, sitz bath, PT, antiinfective, antiinflammatory

intervention for vaso occlusive sickle cell

increase fluids, IV No activity bc o2 demand high calorie, high protein diet give narcotic for pain, not tylenol O2

increase/decrease preload

increase thru crystalloids and colloids decrease thru nitrate, diuretic, morphine

increase/decrease contractility

increase thru dopamine, dobutamine, digoxin decreas thru beta blocker, Ca channel blocker

increase/decrease afterload

increase thru vasopressor decrease thru Na nitroprusside, ACE inhibitor, Angiotenson receptor blocker

Dx DIC

increased D-dimer

sundowning

increased confsion by dementia, esp at night when lighting is inadequate wandering need frequent reality reorientation

nephrotic syndrome

increased glomerular permeability to protein loss of albumin-decreased oncotic P hypovolemia lead to salt and water retension Prone to infection!-limit social interaction massive proteinuria frothy urine decreased UO diuretic, steroids, immunosuppresants

adverse effect of positive pressure ventilation

increased intrathoracic P decreased venous return HYPOTENSIOn

fasting causes

increased stress-cortisol increase muscle damage fluid loss increased hunger depletion if essential nutrient fatigue, headache, dehydration

SSRI side effects 4

increased suicide risk sexual dysfunction weight gain serotonin syndrome

hyperthyroidism

increases metabolic rate, thus rate of O2 consumption want to increase O2

giving aspirin to children

increases risk for Reye syndrome if not immunized bc if has varicella, influenza, more risk of developing Reye

influenza period

incubation 1-4 days peak transmission starting 1 day bf SS appear and lasting 5-7 days after illness stage begins

mastitis

infection in postpartum by bacteria (staphylococcus aureaus) fever, pan, focal inflamation antistaphylcoccal abx-dicloxacillin/cephalexin analgesic breast feed q 2-3 hr for milk drainage

prior to glomerulonephritis

infection of pharynx or skin by group A strep impetigo,

complications of AV fistula

infection, thrombosis, hemorrhage No restrictiv clothing no carry heavy object on that arm no BP, draw blood on that arm check for thrill dont sleep on that arm exercise like squeezing soft ball several times a day keep site clean

bronchitis

inflammaiton of trachea, bronchi rhinitis, cough, crackles, rhonchi treat SS

diverticulitis

inflammation of diverticula of lg intestine that can lead to abscess, perforation, peritonitis, bleeding, Peritonitis-fetal complication, neeed to report to HCP pain at LUQ related to constipation diet high in bier with whole grain, fruit, veg increase fluid exercise

Bell's palsy

inflammation of facial nerve CN VII unilateral facial droop and drooling

proctitis

inflammation of lining of rectum

polyarteritis nodosa

inflammation of sm arteries deadly but cortison increases survival rate

otitis media

inflammation/infection of middle ear due to eustachian tube short, wide horizontal in children dueto ineffective drainage of resp secretions may folow a resp tract infection like influenza, RSV Also risk when fluid pools in mouth then reach eustachian tube risk: 1. exposure to tobaccco 2. regular pacifier use 3. drinking from bottle while lying down 4.lack of immunization

steps in prep paracentesis

informed consent oral meds empty bladder measure abd girth assemble equipment

cystic fibrosis

inherited disease of Caucasian children-autosomal recessive'thick mucus 1st sign-meconium ileus sweat/pilocarpine test-high sweat Cl conc-60ml is negative delayed growth give pancreatic enzymes with meats and fat soluble vitamins

what SCI result in resp reserve decrease

injuries at T1 thru T6

cauda equina syndrome

injury to lumbosacral nerve roots low back pain, cant walk, saddle anesthesia, incontinence MEDICAL emergency need urgent reduction of pressure to prevent permanent damage

SS cocaine use

insomnia facial pain rhinorrhea bc use nose to inahle

indications for diphenhydramine 4

insomnia (sleepiness is side efect) allergy rhinitis Parkinson disease (reduce muscle tremor) prevent motion sickness No use in diarrhea, nausea

intervention at home for allergic rhinitis

install air filters keep windows closed use hypoallergenic (plastic) pillow and mattress cover to prevent exposure to dust mite reduce/elimintae carpet and area rugs from home reguarly mop hard floor and damp dusting furniture

care for brachytherapy

internal radiation limit staff time in room to 30 min per shift cluster nursing care wear dosimeter film badge no preg or under 18 should go to room maintain at least 6 ft away from client private room keep door closed ensure sign is hung instruct to remain on bedrest to prevent dislodgement of implant shield with lead apron

warfarin and abx

intestinal bacterial product vit K, abx kill these bacteria, leading to vit K deficiency so most abx increase INR by causing vit K deficiency risk for bleeding

intussusception

intestinal obstruction when segment of bowel telescopes into another segment blood and mucus leak into lumen 1. abd pain 2. red currant jelly stool 3. sausage shaped abd mass 4. inconsolable crying 5. vomit followed by pd of normal behavior 6. knee up to chest

fetus at 16 weeks

intestine collect meconium lannugo can tell gender movement felt

when to apply spinal immobilization

intoxicated point tenerness over spineneck numnbess, decreaseds trength

alcohol abuse

intoxification -blood level >0.1% ask when they had last and how much depreased RR

different method of chemo delivery

intraarterial- reduce systemic toxicity with higher chemo delivered to specific tumor central venous access-dilute intrathecal or IV- pass BBB Intraperitoneal- chemo to peritoneum

intussusception vs pyloric stenosis SS

intuss-abd pain, sausage shaped mass, curant jelly, crying, drawing knee up pyloric-excess hunger, olive shaped mass, projectile vomiting

currant jelly stool indicative of

intussception

neonatal absticnce syndrome

irritability, jitterness, high pitched cry, diarrhea, vomit, poor feeding hypersensitive so swaddle baby to minimize stimulation excessive movement can place newborn at high risk for skin excoriation avoid stimulation!!

hypomagnesemia

less than 1.5 alcohol, poor absorption, adequate nutrition intake, GI and renal losses SS-ventricular arrythmia-torsades de pointes neuromuscular excitability similar to hypocalcemia NM excitability, tremor, hyperaactive reflex, seizure

precipitous labor

less than 3 hr risk for hemorrhage

normal cap refill

less than 3 sec delay -dehydration

stroke

ischemic vs hemorrhage-tpa vs surgery do FACE -face(symmetry),raise both Arms, Speak, Time (3 hr to give tPa)

3 types of EKG injury for myocardium

ishcemia-T inversion; ST depression myocardial injury-ST elevation Necrosis-pathological Q

why is lactulose given to hepatic encephalopathy

it reduce ammonia by trapping it in gut and expel it improves mental status

common after opiod

itching, nausea give histamin blocker

melatonin

jet lag fatigue from travelling across time zone

epi pen

keep always available give when fir first notice of anaphylactic symptom give mid outer thigh give thru clothing go to ER immediately

proper nitroglyccerin adm

keep in dark bottle discard open bottle after 6 months up to 3 pills in 15 min period call EMS after pain doesnt improve after first tablet has been taken no take with erectile dysfunction or alpha blocker headache, flushing common

when pt having flashback for PTSD

keep safe distance, limit stimuli

newborn care

keep warm suction mouth then nose jaundice? patho before 24 hr eye ointment within 1 hr vit K stool-black, sticky

24 month

kick ball wo falling build tower of 6 300 word vocab state first name

kidney biopsy

kidney is highly vascular so bleeding from site is major complication preop-discontinue all anticoag and antiplatelet for at least one week type and cross match blood postop-monitor VS q15 min for first hr position on affected side for 30-60 min for pressure

position for spinal in child

knee tucked in, head tucked in and back rounded out

when a pt is in status epilepticus

lGIve benzo! l ife threatening grunting/dazed appearance need to stop seizure first- gve benzodiazepine-diazepam or lorazepam

infant with PKU

lack enzyme to convert phenylalanine to trosine-mental retardation LOFENALAC-low phenylalanine but contant necessary mineral/vitamine

ulcerative colitis

large bowel and rectum mucosal layer-not all layers damages capillary so bleeding can occur. liq stool 10-20/day

if less outflow after peritoneal dialysis

last bowel movement? full bowel can create outflow problem

3 phases of stage 1 labor

latent 0-3 cm active 4-7 cm transition 8-10 cm

patient behavior in latent vs active phase

latent-excited, talking active-self-focused, breathing transient-snapping, agitated

lavage or charcoal first

lavage to remove then charcoal to facilitate excretion

gastric lavage vs gavage

lavage-irrigation gavage-food

plumbism

lead toxiciy watch for IICP and watch kidney toxicity

smoke inhalation

leading cause of death in burn clients thermal injury to upper airways, chemical injury to tracheobronchial tree and Carbon monoxide/cyanide poison Need 100% oxygen to displace CO and CN from hemoglobin

folic acid food

leafy grn citrus food

assessing a child

least invasive to most invalsive 1. interact with parent in friendly manner 2. play with child 3. height/weight 4. auscultate 5. VS-BP considered painful

if air embolism is suspected

left side and HOB low-trenden

position for GERD

left side with head elevated to prevent reflux

refeeding syndrome

lethal complication of nutritional replenishment in malnourished client with ora, enteral, parenteral feeding carb/gluc stimulat insulin production with shift of electrolytes from blood into cell PPM!!! Rapid delicne in PPM-Phosphorus, Potassium, Magnism fluid overload, Na retention, hyperglycemia, thiamine deficiency

philadelphia chromosome

leukemia

nevus flammeus

lg, irregular, flat macular on onse side of face do not fade so need laser device

licorice with digoxin

licorice increase K loss licorice decrease K cause dig toxicity

position after liver biopsy

lie on right side for min 2 hr to apply pressure to puncture site then supine for additional 12-14 hr

subdural hematoma

life threatening increased P from hematoma can lead to decreased cerebral perfusion and herniation assess SS IICP, LOC, cushing triad, Ipsilateral pupil dilation, headache

fat embolism

life threatening no specific treatment pressure in bone marrow leads to release of fat gobule into blood that combine with platelets. prevent by early stabilizatio n of injury and surgery minimize movement of injured anticoag, pneumatic compression and early ambulation DO NOT affect fat emboli

mega colon

life threatening complication of IBD< esp Ulcerative colitis abd distention bloody diarrhea fever signs of shock

malignant hyperthemia

life threatening muscle abnormality triggered by specific inhaled anesthtic and succinylcholin to induce general anesthesia Inherted skeltetal muscles cant control Ca levels, leading to hypermetabolic state-contracture, high T, tachypnea, tachycardia, rigid jaw, generalized rigidity muscle tissue broken down to hyperK, cardiac dysrhythmia treat with IV DANTROLENE-slow metabolism, discontinue succinycholine, cooling blankets

HELLP syndrome

life threatening preg complication as a variant of preeclampsia Hemolysis, ELevated Liver Enzymes, Low Platelets watch for RUQ or epigastric pain, NC, malaise can lead to placental abruption, liver failure and stroke, death.

prosthetic valve replacement

lifelong anticoag therapy

whistling sound when inhaling spacer

likely inhaling too quickly/ much

concrete thinking

literal interpretation of idea difficulty with abstract thinking positive SS schizo

food high in folic acid

liver bean peas spinach yeast

food high vit A

liver egg yolk dark green or deep orange fruit and veggie

spinal cord compression from metastic tumor in epidural

localized pain motor weakness sensory-numbness, paresthesia

Septic arthritis

localized pain, limited ROM, systemic infection causes: surgery, injection, trauma SURGICAL EMERGENCY hip joint is prone to avascular necrosis from compromised blood supply Culture synovial fluid and blood Give ABX debride

glargine(lantus) and detemir (levemir)

long acting dont mix with others Lantus: onset 1-5 hr peak plateau duration 24 hr Levemir: onset: 3-4 hr peakless duration 24 hr once a day in morning as basal insulin clear solution

detimir

long acting insulin prescribed once in evening or twice daily need additional mealtime insulin (fast acting)

non stress test

look for acceleration of FHR in relationshi to stress 2 or more fetal Hear acceleration of 15bpm lasting 15 sec in 20-min interval

ethacrynic acid

loop diuretic take early watchy ortho hypotension take with meals increase K food

homonymous hemianopsia

loss in hal fof visual field on same side-eg.. lose left side of visual field in both eyes watch for neglect on side high risk for injury

myasthenia gravis

loss of ACH receptorfatigue, weakness ocular muscle weakness-droopy eye lead weak cough/gag give anticholinesterase agent pyridostigmine bromide, steroid, immunosuppresants weakness at end of day chin down when swallowing bc it closes airway and opens esophagus

bell's palsy characteristics

loss of forehead/brow movement cant close eyes, drooping eyelides loss of nasolabial folds, lower lip droops cant smile/frown symmetrically alteration in tear production

borborygmi sounds

loud gurgling sounds suggesting increased peristalsis due to gastroenteritis, diarrhea,

death rattle

loud rattling sound with breathing that occur in actively dying pt when cannot manage airway secretions, their movement during breathing cuase noisy rattling sound resolve by ANTICHOLINERGIC med to dry client secretions- ATROPINE sublingual or transdermal scopolamine patch

liver failure lab

low albumin-ascities, weigh gain high INR )bruising, bleeding) high ammonia (leghargy, confusion) high bilirubin (jaundice, itching)

smoking preg

low birth weight

cigarette smoking in maternal linked to

low birth weight sudden infant death perinatal loss prematurity

radioactive iodine uptake test

low dose radioactive iodine for evaluating for hyperthyroidism at 2, 6, 24 hours to assess areas absorpbing iodine thyroid med should be held 5-7 days before preg test before NPO 2-4 hr before remove denture, jewlery.metal around neck drink fluids after test stay awake during no breastfeed after

GERD diet

low fat non acidic No oil, tomato, chocolate, mint, lemonade, carbonated

expected first 24 hr postop

low fever serosangu wound fine crackles in lung bases decreased UO

diet for Diabetes

low glycemic high fiber no sat fat and sodium limit alcohol

TB SS

low grade fever night swat anorexia, weight loss fatigue cough purulent/blood tinged sputum SOB

canadian bacon

low in fat

teaaching for ulceratice colitis

low residue, high protein, high calorie diet with vitamin and mineral supplement avoid raw fruit/veg, whole grain, fried, alchol increase fluid sm, freq meal

when acute blood loss, intervention? 2

lower HOB or put in supine to maintain blood perfusion to brain and other vital organs then IV access and fluid

home management of PAD

lower extremity below heart moderate exercise- walk... to promote circulation perform daily skin care-apply lotion maintain mild warthstop smoking avoid tight clothing/stress take meds-vasodilator, antiplatelet No hot pads bc risk for burn

trough

lowerst level-before giving meds

fidelity

loyalty and fulfilling commitment to patients meet responsiblity of prof nursing practice

azithromycin

macrolide antiinfective contact HCP if cause diarrhea, nausea, abd pain

risk factor for postpartum hemorrhage 5

macrosomic infant- >8lb, 13 oz prolonged labor (more than 24 hr) prolonged 3rd stage labor (more than 30 min) grand multiparity use of uterine relaxant, anesthesia

neologism

made up words/phrases meaninful only to clinet I would like to have phjinox positive SS schizo

post total joint replacement of hip

maintain abduction for 2-3month watch if outwardly rotated, shortened, cant move

why enteral feeding used over TPN

maintain integrity of gut prevent stress ulcers lower risk of infection

during CPR

maintain vertical P on chest-elbow locked, arm straight, shoulder over hand heel of hand on lower half of sternum re check pulse q1min

BROW

makes stool firm for diarrhea gluten diet

abdominal aortic aneurysm risk factor

male age>65 coronary artery and peripheral vascular disease HPN famly H Smokint H

normal hemoglobin

male 13-18 femal 12-16 child-11-12.5

Uric acid serum

male 4.4-7.6 female 2.3-6.6

coitus interruptus

man withdraws penus bf ejaculation

complication of mannitol

mannitol causes increase in lasma oncotic P and draws water into IV space-volume expansion tha t is excreted thru kidney if too high dose of mannitol-can cause pul edema so watch for crackles

antisocial personality disorder

manupulative act out so move from situation to situation for opportunity so dont be fooled by chang ein behavior

droplet precaution

mask

intervention for lymphedema

massage to mobilize fluid compression sleeve elevation of arm above heat isometric exercise avoid venipuncture, BP measure, injection prevent injury and infection

neurogenic shock

massive dilation decreased venous return, decreased SV, decreased CO, impaired perfusion Hypotension, Bradycardia warm dry skin

distributive shock

massive vasodilation

triage

maximize # survivors by sorting injured by potential for survivial and availabiliy of resources

when postop reports indigestion

may be cardiac issue deal with it first

using interpreter

may be more responsive if interpreter is same gender basic english pause ater 1-2 sentences to allow translation simple instruction on upcoming actions have client repeat back the info which is translated in Eng

blood donation bf surgery

may give up to 5 weeks before surgery 2-4 unit of blood no blood drawn at least 3 days bf surgery

when inserting IV pyelogram

may have hot feeling, skin flushed

mitral valve prolapse

may have palpitation, dizziness, lightheadedness, chest pain chest pain not relieved by nitrate, give beta blocker instead benign usually adopt healthy eating, avoid caffeint avoid ephedrine reduce stresss no alcohol

vit C and cranberry juice

may help prevent UTI by acidifying urine

dry cough in ace inhibitor

may indicate bronchospasm need to contact HCP

Native American pt

may not arrive on time bc present-oriented and dont live by time do acept western meds silent, reserved handshaking seen as aggressive

nurse coping with dying children

may result in compassion fatigue attend memorial service take time off work share personal emotion of loss with family of dying child contact with family for extended time after their loss

rubeola

measles airborne

fluorescein angiography

measure circulation in retina uses a dye a serios of photograph avoid direct sumlight after can stain skin with dye

peak flow meter reading

measure peak expiratory flow rate in mod, severe asthma exhale quickly and forcibly thru mouthpiece move indicator to lowest scale like 0 bf use use after short acting bronchodiler not corticosteroid meter dose inhaler personal best reading-highest peak flow reading pt can attain over 2 weeks

food high in vit B3

meat poultry fish peanut enriched grains

food high in vit B6

meat poultry seafood grains seeds

food rich in iron

meat (beef, lamb, liver, chx, portk) shellfish egg, grn leafy veg, brocolli, dried fruit and bean, brown rice eat with vit C rich food

neonatal heel stick

medial or lateral of outer heel. no middle heel bc can damage calcaneus (lead to osteromyelitis, osteochondriasis) warm for 3-5min can do venipucture instead bc less painful and can draw more volume use automatic lancer bc dont want to go deep

alcohol withdrwal delirium

medical emergency 48-72 hr after cessation and last 2-3 days death from myocardil infarcion, fat emboli, peripheral vascular collapse, electrolyte imbalance, MI suicide prevent with benzodiazepine

acute angle closure glaucoma

medical emergency site lost centrally can lead to permanent vision loss

ginkgo biloba

memory enhancement bleeding risk

normal hematocrit

men 42-52 women 34-37

catheter Foley sizes

men-16-18 Fr Women- 14-16 child 8-10

men vs women in angina

men-classic chest pain women-GI, shoulder pain, arm pain, indigestion, jaw pain, nausea, dizziness, cold sweats

droplet precaution

meningitis, influenza hand hygiene surgical mask private isoltaion all within 3 ft contaminated dedicated equipment

best indicator that in anorexia, balanced nutrition to meet metabolic demands

menstruation returned and regular sufficient fat to maintain FSH, LH

3 categories of serotonin syndrome

mental change- anxiety, agitation autonomic dysregulation-hyperthermia, diaphoresis, HPN< tachycardia neuromuscler hyperafctivity-tremor, rigidity, clonus

kussmaul breathing

metabolic acidosis Ketons (DKA) Uremia Sepsis Salycylates Methanol Aldehydes Lactic acidosis

4 risks for vit B12 def

metformin interfere with absorption vegan gastrectomy pernacios anemia

first line pharm tx for C diff

metronidazole oral vancomycin

what treats C diff 2

metronidazole vancomycin

fetal alcholol syndrome SS

microcephaly short palpebral fissure epicanthal folds flat midface smooth piltrum thin upper lip developmental dealyin intellectual disability

prodromal phase of labor

mild contraction dilation of 3 cm membraine intact good fetal assurance Primapara send HOME-bc lasts several days

Yes give immunization

mild illness mild fever currently on ABX mild site rxn-swelling, erythema recent infection exposure penicilolin allergy NO VAccine to immunocompromised (live_

meds for mild pain, moderate pain, severe pain

mild-acetamiophine mod-hydrocodone/acetaminophen severe-morphine

SS term baby

milia parchemne skin

miotic vs mydriatic

miotic-constrict pupil mydriatic-dilate pupil-atropine, ephedrine

diastolic murmur

mitral stenosis aortic regurgitation

nursing care for IV vancomycin

monitor BP-may cause hypotension draw trouch level prior (10-20) infuse over 60 min assess Red man syndrome monitor anaphylaxis monitor IV site q 30min since vesicant

monitor in nucleoside reverse transceiptase inhibito-NRTI

monitor lactic acidosis AIDS

monitor in NON-nucleoside reverse transceiptase inhibito-NNRTI

monitor liver tox AIDS

rituximab

monoclonal antibody for cancer and autoimmune disease can ilicit powerful immune response-bronchospasm, tachypnea, dyspnea, hypotension, angioedema treat with steroids and withheld, restart at slower rate can produce flu-like SS-treat with tylenol

monozygotic twin vs dizygotic

monozygotic-one egg, one sperm splt dizygotic-two egg, two sperm

hypercalcemia

more than 10.5

excess drainage of chest tube

more than 100mL/hr

fetal tachycardia

more than 160/min for more than 10 min

normal gluc level 1 hr after birth

more than 40

elevated blood lead level

more than 5 mcg/dL need follow up blood work

Mantoux test result in immunocompromised

more than 5 mm induration healthy-10 mm

TB PPD results

more than 5- organ transplant, HIV, immunocompromised, recent contact with TB more than 10-IV drug user, recent immigrant from high prevalence country, resident/employee of high risk envt (shelter, nursing home) more than 15-normal

BNP

more than 500 indicate LHF

if peak flow is green

more than 8-% yellow-50 to 79 red-<50

neurologic injury and treatment

most common mortality who had cardiac arrest Induce therapeutic hypothermia within 6 hr of arrest and maintain for 24 hr to decrease mortality Cool to 89.6-93.2 for 24 hr before rewarming cooling blankiets, ice on groin, axillae, sides of neck, cold IV fluids monitor cardiac monitor, body T< BP, skin, HOB>30

bladder cancer

most risk factor-cigarette smoking painless hematuria 1- tobacco; 2-occupational carcinogen exposure

latex allergy

most spinal bifida have sensitivity to latex lips swell up when blowing balloon itch/burn hands when wearing rubber gloves allergic to banana, avocado, tomato, chesnut kiwi, potato, peach, grapes, apricots

pelvic fracture

mostly from MVC< motorcycle pelvis has highly vascular stuff and abd, pelvic organs so assess INTERNAL HEMORRHAGE, paralytic ileus, Neurovascular deficit assess abd distension, absent bowel sounds!!

cranial III

motor nerve of eye track object thru fields of vision without moving head

antidote for acetaminophen

mucomyst

risk factors for cholelithiasis

multiparous age (more than 40) fasting-less gallbaldder movement

assessment on imminent birth

multiple gestation? narcotic use? preterm? meconium stained amniotic fluid?

hypokalemis

muscle cramps, weakness, paralysis that starts in legs watch with furosemide

rhabdomyolysis

muscle injury Emergency muscle fibers released into blood after exercise,heat stroke or physical trauma. leading to kidney failure due to high myoglobin level that overwhen kidney filtration ability prevent kidney damage using rapid IV fluid resuscitation to flush myoglovin from body SS-dark, bloody urine, oliguria, fatigue

isometric exercise

muscle training

gower's sign

muscular dystrophy children find it hard to stand up from sitting/lying. First pull up to hands and knees and brace themselves by walking up their hands up the legs as they rise to stand

word salad

mx of words/phrases having no meaning Here what comes table, sky positive SS schizo

SS heroin withdrawal

myalgia arthralgia abd cramp diarrhea piloerectio pupil dilation yawning restlessness rhinorrhea increased lacrimatio

med for Vtach

myocardial irritability give Lidocaine-antiarrythmic-dilute with D5W

naloxone

narcan use postop who is in over sedation due to opiod use. monitor bc narcan has shorter life span than most opiod so may need a second dose

coarctation of aorta

narrowing of aorta harder for LV to pum Left sided HF weak lower pulse strong upper extremity pulse

common physiologi changes in preg

nasal stuffness, ear fullness due to blood volume increase leading to cap engorgement colostrum-yellow breast discharge

obstructed ileostomy

nausea vomiting abd distension decreased stool production can lead to electrolyte disturbance, bowel perforation, infection, necrosis

children with myopia

nearsightedness cant see far Headache, dizziness, difficult seeing clearly performance in school affected in math, reading rubbing eyes frequent blinking, squinting to view distance

collection urinalysis

ned to be aseptic from port at catheter tubing Do not collect at collection bag clean the collection port with alcohol swab aspirate urine with sterile syringe using aseptic technique, transfer specimen to sterile specimen cup

prior to transabd pelvic ultrasound for uterine mass

need a full bladder to view less obstructed view by pushing uterus away

pressure ulcer in infant

need elevate HOB 30 degree to reduce pressure Avoid baby powder avoid donut pillow-causes increase pressure on surrounding area

acute angle closure glaucoma

need immediate intervention due to IIOP, resulting in compression of optic nerve that can lead to permanent blindness sudden eye pain reduced central vision blurred vision ocular redness halos around lights

dependent personality disorder

need to be taken care of by another, cannot make decisions on own, intense separation fear. afraid of confrontation, lac of self confidence

new onset anemia in elderly

need to be taken seriusly colorectal cancer has to be ruled out-encourage colonscopy

post abdominal aortia aneurysm repair

need to keep BP adequate for graft patency prolonged hypotention lead to graft thrombosis abd tenderness expected soft, nonditended abd expected pain expected green bile colored drinage expacted Falling BP and rising pulse indicate graft leakage pedal pulse decline after 2 day postop indicate graft occlusion

discharge neonate

need to see MD in 2 days

explaining st to preschool

need to see and play give doll with thaht condition No need to say hurt-bc frightening

anticonvulsant before surgery

needed to prevent seizure for anesthesia, may need to be decreased

pulse ox for UAP

needs additional teaching so dont delegate to new UAP

dialysis in acute kidney failure

neeed immediate access so use central venous catheter in groin No AVF/AVG bc takes weeks to mature No peritoneal dialysis bc slow rate of metabolite removal in acute kidney failure

elevated central venous P indicate

normal 2-8 measure right ventricular preload and reflect fluid volume problems elevation indicate RV failure or fuid volume overload edema, dilute UO, weight gain, JVD, S3, Crackles, dyspnea, bounding peripheral pulses

PTT

normal PTT 25-35 sec 1.5-2 times normal in hepatin so 46 to 70 sec

hypothermia after coronary artery graft

normal bc induced hypothermia and open chest causes decreased T

diet for child with diarrhea

normal diet

acrocyanosis

normal for 2-6 hr post delivery

SS bulimia

normal weight swelling of cheek due to paortid gland damage and enlargement teeth staining vomit smell hidden food, wrapper of food

pul artery wedge pressure

normal- 6-12 if high, increased left ventricular preload

SS serious brain injury from trauma

not simple concussion worsening headache, vomit sleepiness, confusion vision change weakness..numbness of part of body

nasal cannula

o2 up to 44% allow drink/eat comfortable, short term short term after postop to treat hypoventilation

weight gain for BMI >30

obese total 11-20 lb 0.5 lb/week for 2 and 3 trimesters

GERD risk factor

obesity female NG tube >45 smoking

risk for cholelithiasis 4

obesity multiparous age fasting (decrease gallbladder movement, build up bile)

cataract

objects appear distorted and blurred opacity of normally transparent lens pupil change to gray to milky

SS anorexia

obsessive about what they ear, how much, when bradycardia, hypotension, constipation, weakness, fatigue, amenorrhea binging common

anorexia

obsessive with what, how much and when they eat think about eating all the time binging bradycardia, hypotension, constipation, cold intolerance

desired fetal position

occipital anterior

new food (solid) to baby

occur 4-6 month with iron fortified infant cereal-rice/oatmeal mix cereal with breast milk, formula, water allow 5-7 days bet foods for allergy observation

pill-induced esophagitis-3

occur after taking po potassium, tetracyclin (doxycycline), bisphosphonates (-dronates_. So remain upright after ingestion to prevent

stress induced hyperglycemia

occur in hospitalized pt related to surgery, truma, acute illness, infection, critically ill due to stress It can lead to infection, increase in length of stay, AKI-so keep at 140-180 mg/dL!

modifications to preg CPR

perform compressions slightly hgiher on sternum bc growing uterus push upward, displacing heart to left display uterus to client left side manually to reduce pressure CPR for 4 min, if no work, emergency C sect

motor nerves that test eye by tracking object thru fields of vision

oculomotor trochlear abducens III, IV, VI

restraint care

offer food, nutrition, bathroom q2 hr and as needed perform neurovascular assessment q1hr release restraint to do ROM q2 hr assess need for restraint q1 hr if discontinued, need a new prescription

steatorrhea indicative of 4

oily, bulty foul smelling stool malabsoption pancreatic insufficiency cystif fibrosis celiac disease

rash after 2 days of med

ok may not be related to medication

baby apnea

ok but if apnea more than 15 sec, notify

CAT scan assess

ok with being in closed space

cranial I

olfactory identify odor

acute kidney failure divided into

oliguric phase for 2 wks-low UO, high BUN, creatine, high K, low serum Na, low pH, m. acidosis, high urine Na diuretic phase- 1 week- high Uo, low fluid volume, low K, low K,

acute kidney injury

oliguric then diuretic oliguric-fluid and diuretic dont work well. 8-15 days diuretic-2-6 weeks after onset of oliguric output up to10L/day..then recovery phase

pyloric stenosis SS

olive shaped mass nonbilious vomit- obstruction is above bilious sm, frequent stool m. alkalosis hx projectile vomit

breastfeeding

on demand 8-12 times a day 15-20 min per breast with both offered at each feeding hold tummy to tymmy grasp both nipple and part of areola insert finger to break suction

Cold stress

once brown tissue depleted in infant, nonshivering thermogenesis ineffective esp preterm bc brown fat is less hypoxia, acidema

introjection

one symbolically takes characteristics of another

levothyroxine

only T4 feel more energenic will decrease serum TSH take on empty stomach

diabetic in pregnancy

only gestational diabetes can be treated with diet and exercise if already had diabetes, need insulin (no oral glycemic)

muscular dystrophy

onset 2-6 x-linked recessive delayed walking dx by muscle biopsy-muscle fibers replaced with connective and fat. dx by serum creatine phosphokinease level high resp, cardiac problems, easily tires when walking, falls Gower's sign-children find it hard to stand up from sitting/lying. First pull up to hands and knees and brace themselves by walking up their hands up the legs as they rise to stand

aspart

onset 30 min peak 1-3 hr duration 3-5 hr

regular/humulin R

onset 30min to 1 hr peak 2-4 hr duration 5-7 hr

cataracts

opacity of transparent lens lens become dehydrated and more dense

shingles precaution

open lesions transmit by both AIR AND CONTACT need contact precaution, airborne precaution, negative airflow

ventricular septal defect

opening in septum bet ventricles backflow from LV to RV Right sided HF not cyanotic

paradoxical breathing

oppo of normal breathing inward movement of chest on insp outward movement on expiration diaphragm muscle fatigue

P. jiroveci pneumonia

opportunistic infection with AIDS causes progressive hypoxemia, cyanosis emergency

how to hold cane

opposite affected extremity

CN II

optic visual acuity

cranial II

optic nerve test fields of vision by ability to see objects in field

preventing dental carries

oral hygiene feeding practice diet intake no sugar, sweet, stick y food sugary beverage Some food have inhibitory effect on dental caries-dairy, whole grain, fruits, veg, sugar free gum

managing acute diarrhea in children at home

oral rehydration therapy continue normal diet dont use antidiarrheal monitor SS dehydration protect perineal skin using lotion

rifampin

orange secretion decrease effect of oral contraceptive watch liver

for delusional pt

orient reality

obstructive sleep apnea

partial/complete airway obstruction during sleep due to relaxation of pahrygeal muscles apnea of more than 10 sec and hypopnea of less than half normal ventilation-hypoxemia and hypercabia SS-snoring, morning headache, difficulty conc, daytime sleepiness InterventionL continuous positive airway to keep pharynx open limiting alcohol at bedtime bc alcohol relaxes muscle of oral airway weight loss avoiding sedating meds

dehydration can lead to

ortho hypotension if dehydrated, vasoconstriction has already occured so iso give IV saline.

long term perdnison therapy causes

osteoporosis, muscle wasting weakness, buffalo hump obesity slow healing mood swing

aminoglycoside

oto and nephro tox can cause complete neuromuscular block

gentamicin averse

oto and nephrotox

cisplatin side effect

otoxocity hepatox bone marrow suppression

scleroderma

overproduction of collagen that causes hardening of skin and connective tissue no cure so manage complications serious complication is renal crisis that causes malignant HPN due to narrowing vessel to kidney, so watch for HPN and headache

acromegaly

overproductionof growth hormone overgrowth of soft tissue of face, hand, feet, organs pit enlargement, visual defect gigantism, arthritis, mal-occluded jaw HPN, HF (report S3,S4) enlarged tongue, thyroid, liver, spleen, kidney, galactorrhea, decreased libido, DM

abruptio placentae

overt bleeding tense, board like uterine painful abnormal fetal

weight gain for BMI 25-29.9

overweight total 15-25 lb 0.6 lb/week for 2and 3rd trimesters

possible cause of eviscearation, dehiscence

overweight-weak abd wall poor healing due to Diabetes abd surgery most frequent

percodan

oxycodone + aspirin No in hemophilia

intervention for late decelration

oxygen reposition to right/left oxytocin stopped IV fluid bolus

caution with oxygen therapy

oxygen can cause combustion vaseline-pil based flammable- can cause flame keep 5-10 ft away from gas stove, fire place, stove, candles acetone in nail posh and remover is also combustible avoid synthetic and wool fabric-cause static electricity that can ignite fire in presence of oxygen-use cotton blankets

initial care pul edema

oxygenate diuretics to remove fluid

Acute resp failure dx 3

pO2<60 pCO2>50 pH<7.30

prior to heel stick in infant

pacifier sucrose skin to skin swaddling for comfort warm pack to facilitate blood flow

post hemorrhoidectomy

pain at anorectal area common bc surgical area-do sitz bath, ice pack may feel light headedness at sitz bath bc redirect blood-put ice on head watch urinary retention

preventing postop pneumonia

pain control ambulate within 8 hr coughing with splinting q hr deep breathing/incentive spirometer qhr Fowler swab mouth with chlorhexidine swab q12hr hand hygiene

when taking contraceptive

pain in leg-thrombophlebitis hypercoagulability headache unrelieved-clot in brain

rib fracture intervention

pain management pul gygiene-coughing, deep breathing, incentive spirometry, ambulation

phenazopyridine

pain reliever for lower part-urethra and bladder watch yellowing of skin, sclera watch damage to kidney

side effect of radiation

pain/swelling of throat fatigue diarrhea rash/redness

genital herpes simplex virus in preg

painful genital lesions can transmit to infant in utero, perinatlaly or postnataly. if neonate become infected, serious mortality so need Antiviral asap (acyclovir) need C-sect

bone scan

painless but about 1 hr tracer by IV no change in position drink lot of water

SS low hemoglobin Poikilothermia

pallor dyspnea tachycardia to maintain CO

in pheochromocytoma, DONT

palpate abdomen bc can cause hypertensive crisis

how to check pulse on infant

palpate brachial artery halfway between shoulder and elbow on medial aspect of arm

greasy, foamy, foul smelling fatty stool

pancreatitis

to avoid pushing bf cervical dilation

pant blow at peak of contractions

syphilis

papul lesion in vaginal-pt of entry use serology test to detect tx with abx

paracentesis vs thoracentesis

para-peritoneum fluid- sitting, upright thora-lean forward over bedside table

brain lobes

parietal-sensory input-touchpu frontal-executive ftn and personality-behavior temproal-auditory occipital-vision

tracheostomy with feeding-how to decrease aspiration

partially deflate cuff if unconscious, Inflate cuff if conscious and cuff inflated, uncomfortable sit upright with chin flex toward chest monitor for wet voice monitor fever

when a foreing body embeds in eye

patch/shield both eyes to prevent movement

crutch paralysis

prolonged pressure on axillae by use of crutches can cause damage to radial nerve at axilla- Weakness of arm, wrist and hand so use proper crutch by supporting weight on hands and arm, not axillae ensure 1-2 inch space between axilla and axilla crutch pad

risk factor for endometritis

prolonged rupture of membrane protracted active phase internal fetal monitor

ginseng

promote mental alertness enhance immune system risk for bleeding

foot care with diabetic pt

proper foot wear- supportive, well fitting, leather, No high heel, Open heel, Open toe- like flip flops daily hygiene and inspection- lanolin lotion in feet but not between toes avoid injury-no barefoot, hot water, heat pads

preventing dysplasia of hip in infant

proper swaddling-swaddle with hips bent up-flexion and out-abduction, allowing hip movement choose carrier/car seat with wide bases avoid any that cause hip extension with knee straight

drugs to induce labor

prostaglandin gel cervidil misoprostol

risk of UTI in men

prostate disease

skin care for teletherapyy-external beam radiation

protect skin-no rub, scratch, scrub wear loose clothing, soft cotton bed pat skin dry use mild soap dont wash off radiation marking avoid OTC cream, oil shield skin from sun, no tanning avoid extremes in skin T

cytoprotectant

protects GI mucosa cytocyt/ misoprostoral NO preg.. if child bearing age, oral contraceptive

levodopa avoid

protein vit B6

avoid in levodopa

protein and B6 but not in levo-carbidopa combo drug

cystic fibrosis

protein that transport Na and Cl is defective and secretions become thicker. The secretions block passages and ducts in GI and block pancreatic ducts, resulting in less pancreatic enzymes in bowel. Need vitamin supplements supplemental pancreatic enzymes Diet high in calories, fat and protein

watch out in lupus

proteinuria hyperlipidemia

phases of separation anxiety

protest despair denial

what to avoid in pt taking clopidogrel?

proton pump inhibitor bc it decrease meffectiveness

proximal vs distal

proximal-close

psychogenic dystonia

psychogenic movement disorder involutnary muscle contraction that cause slow repetive movements

fluphenazine decanoate

psychotherapeutic med for psychotic disorder IM or subQ q1-6 weeks if pt neglects meds

systolic ejection murmur

pulmonic stenosis

v tach

pulse and stable-amiodarone pulse and unstable-synch cardioversion pulseless-defib

SS VAP

purulent sputum positive sputum culture leukocytosis elevated T pul infiltrates on xray 2-3 days after mech vent

breast engorgement

put cold compresses wear tight bra

handling blood

put in biohazard bag hand hygiene gloves clean bag with disinfecting wipe prioimmeidate transport to lab avoid placing specimen in clean area antiseptic scrub of catheter hub prior to use if using central line, discard first blood drawn

neutropenic pt

put in positive airflow room to reduce infection

tetanus booster needed

q10yrs

brachytherapy

radiation source come into direct contact client NOT radioactive private room secretions may be radioactive

SS dumping syndrome

rapid emptying of gastric content into duodenum/s, intestine. Fluid shift from Intravascular to sm intestion, HYPOTENSION abd pain, NV< diarrhea, sweating, dizziness, palpitation

loose association

rapid shifting from one idea to another with little of no connection positive SS schizo

dialysis disequilibrium syndrome DDS

rare but life thretening complication during initial stage of hemodialysis. Prevent by slowing rate of HD. HD led to excess fluid in brain, cerebral edema, IICP. SS_ NV, headache, restlessness, seizure, change in mentation. contact HCP ASAP.

botulism

rare food poinson by improperly sterilzed canned/preservative children<1yr should not be given honey due to risk constipation, weakness, difficulty feeding, diminished deep tendon reflex. Can lead to respiratory failure, loss of neurologic ftn ldecreased gag reflex

stopping epistaxis

rarely serious tilt head forward apply direct pressure to nose for 3-10min below nasal bonehold cold/ice cloth to bridge of nose keep quiet and calm can be prevented by avoiding local trauma and maintaing hydration of mucosa with saline nasal spray or a humidifier

nonstress test

record fetal movement and HR after 28 weeks Want reactivity

Red man syndrome vs anaphylactic rxn

red man-flush, erythema, pruritus- slow the rate of infusion of vacomycin anaphylactic-hive, angioedem,a wheezing, resp distress- STOP infusion and give IM epi

food high in iron

red meat/ organs

Triage colors

red-critically wounded=>60 min yellow-wounded but can wait for help wait 1-2 hr green-can walk black-dead/ not likely to survive

petechiae, purpura

red/purple rash indicate blood dyscrasia and priority

care for acute manic epidose

reduce stimuli limit contact one to one interaction low lighting provide schedule physical activity to relieve extra energy high protein, hgigh calorie set limit on behavior

PTSD- SS

reexperience event-flashback, intesne distress avoiding reminders-feeling detached, loss of interest, amnesia, cant set goals increased anxiety-insomnia, outburst, anger, difficulty conc, hypervigilance

shoulder pain

referred pain from irritation of diaphram and intraabdominal bleeding ectopic preg spleen rupture liver laceration interstinal perforation

ARDS Dx

refractory hypoxemia-no matter how much O2 given Xray shows complete white out

active labor

regular contractions, 5 minute apart, lasting about 60 seconds For 1 hour period

what insulin is only one to be given IV

regular insulin

regular vs NPH insulin

regular-short acting so cover meal consumed 30-60 min after administration NPH-intermdiate0covers second meal...(after morning) or basal requirement thru night (igf given pm)

Reye's syndrome

related to aspirin, influenza, varicella recent viral infection-caricella/influenza causes encephalopathy hypoglycemia

laminectomy

relieve pressure by removing lamina-part of spinal vertebrae

varicella itchin

relieved by benadryl

after lumbar puncture,

remain in bed 88 hrs

gastroduodenostomy Biliroth I

removal of distal 2/3 of stomach. Remaining is anastomosed to duodenum treat stomach cancer and PUD not responsive consume frequent, low carb diet prevent dumpting syndrome DVT prophy;axis turn, cough, deep breath elevate HOB

intervention for phlebitis

remove IV apply warm soak

intervention for infiltration

remove IV elevate arm to facilitate re absoption

diaphrag

remove after 6 hr after intercourse recheck for size annually, after irth, if weith change more than 15 lb

care for bucks traction

remove boot to assess skin turn to unaffected side dorsiflex affected foot to assess nerve elevate foot on bed

anaplyactic reaction steps

remove insect stinger IM epi-repeat 5-15 min recumbent position and elevate legs IV fluids bronchodilator antihistmaine corticosteroids

when wrong med in pyrix

remove wrong drugs notify pharm place incidence report

sudden right sided flank pain radiating to groin

renal stone

perseveration

repeating same words/phrases in response to different questions positive SS schizo

echolalia

repetition of words

conversion disorder takes in

repression

mechanical prostehtic valve

require long term anticoag so take anticoag same time avoid trauma avoid NSAID limit alcohol avoid changing eating habit frequently-no vit K supplement No Ginkgo and ginseng-bleeding risk wear med alert bracelet

localized herpes zoster

require standard precatuion assign to immune caregiver

RACE

rescue alarm confine extinguish discourage using elevators

SS resp distress in peds

restlessnes RR up increased pulse rate,, tachypnea, nasal flaring, intercostal, canosis, grunting

diet for CKD

restriction in fluids, Na, K, P No dairy, banana, orange, coconut, avocado-bc high K1

Volkmann contracture

result of compartment syndrome asso with distal humerus swelling of antecubical tisssue cause pressure-restricting arterial blood flow. This ischmie leads to tissue damage, wrist contracture and cant extend fingers medical emergency!

what to do if biceps, patellar deep tendon reflex doesnt elicit

retest-bicepts with clenching teeth patellar with fingers interwine and pull against each other these are reinforement technique- contraction of other muscles can cause increased reflex reponse/activity

retinoblastoma

retinal tumor either unilateral or bilateral common childhood intraocular malignancy a white glow of pupil-leukocoria, instead of usual red reflex stabismus-misalignment of eyes some hereditary

indicator in improvement of anorexia

return of menstrual pd

Valvalsa or Vagal

reverse SVT stick thumb to mouth, close mouth and blow the thumb as if trumphet ice to face, hold breath, bear down massage carotid artery

osteomalacia

reversible bone disorder by vit D deficiency painful bone that can fracture easily Safety measure for fall risk light activity increase Ca, P, Vit D Take OTC vit D supplement

osteomalacia

reversible bone disorder caused by vit D deficiency and characterized by weak, soft and painful bones that can easily fracture Increased risk for fall implement safety encourage light activity increase Ca, P, Vit D

3 only occasion salicylates/aspirin used in children

rheumatic fever Jucenile idiopathic arthritis Kawasaki disease

2 point gait crutch

right crutch and left leg forward left crutch and right leg forward

4 point gait crutch

right crutch forward left leg forward left crutch forward right leg forward

early sign of malignant hyperthermia

rigid jaw ridigity tachypnea tachycardia

toxicity in aspirin

ringing in ear watch bleeding (GI) no in kids-cause encephalopathy

when using corticosteroids

rinse mouth-thrush

rising and sitting using crutches

rising-hold both crutches by hand grips with hand on same side, slides to edge of chair and grasp armrest with other hand. Then push down cruches and armrest and use unaffected leg for support when rising from chair. sitting-client back up to chair until seat is felt against legs. Move both crutches into hand ons ame side and hold them by handgrips. Push down crutches, reach back to armrest with other hand and use unaffected leg to support and ower body to chair

metabolic syndrome

risk factors that increase chance of developing CVD and DM 3 or more: 1. waist circumference >40men >35 women 2. triglycerides >150 3. HDL <40men <50 women 4.BP>130 systolic >85 diastolic 5. fasting blood gluc >100

polycythemia

risk for thrombus due to viscosity expect itching, ruddy face

vaginal birth after esarean risk

risk for uterine rupture due to surgical scar SS-nonreassuring fetal Heart change in uterine shape, abd pain, cessation of uterine contration

selecting IV sites with risk of cath-related bloodstream infection

risk higher in lower than upper extremities risk higher in wrist/upper arm compared to hand use hand bc most distal

intervention for placental previa5

risk ofhemorrhage so type and screen NST or biophysical profile once or twice a week Cesarean birth planned bed rest pelvic rest

when does reflexes disappear rooting moro tonic neck/fencing stepping palmar/plantar babkinski

rooting-3-4 month moro-3-4 month fencing-3-4 month stepping-3-4 month palmar-8 month babinski-12-18 month

rotator cuff injury

rotator cuff is group of 4 shoulder muscles and tendons that attach to humeral head that allow for roation of arm result of aging, repetitive use, injury to shoulder shoulder pain and weakness severe pain when shoulder arm is abducted

nursing for meningococcal meningitis

safety and comfort droplet precaution (24 hr after abx) comfort-quiet envt self-position for comfort

response to naloxone

same as opiod withdrawl] syndrome NV, tachycardia, HPN, restlessnes, abd cramp

when does child learn rules and how to play with others

school age 6-12 industry vs inferio

sunset eyes

sclera above iris late sign of IICP priority assess

hearing impairment in toddler

seem shy, timid, withdrawan inattentive when given direction speech monotone, difficult to understnad loud increased gesture and expression of fae

failure to capture in permananet pacemaker

seen as spikes not followed by QRS due to failing battery, mispositioned lead wire Do transcutaneous pacemaker

cast syndrome

seen in hip spica or body cast cast pressure causing duodenum to be compressed, distention, abd pain, NV need to cut area of cast to relieve bivalve

endocarditis

seen with IV abuser-invasion of pathogen cause vegetation and embolism IV abx

segmented and band neutrophil

segmented-mature ce band-immature cells ir predominantly more band cells, indicate bone marrow cant produce enought mature neutrophil to cope with infection

selective vs nonselective beta blocker

selective-metaprolol, atenolo, bisoprolol-for HF, HPN nonselective-propranolo, nadolol result in bronchial smooth muscle constriction-contraindicated in asthma

histrionic personality disorder

self dramatizing, exaggerated attention seeking overly friendly, seductive

implanted cardioverter defib

sense and difib life threatening dysrhythmia No lift arm on affected side over shoulder that may dislodge lead wire on endocardium firing may be painful driving ok travel not restricted

parietabl lobe

sensory ftn prioprioception-awarenesss of body posiion graphesthesia-ability to identify writing on skin, touch

tactile fremitus

sound travel faster in solid than aerated lung so increased fremitus in pnemonia and consolidation Fluid/air outside lung interrupts transmission of sound, resulting in decreased fremitus in pleural effusion and PTX

linfant allergic to cows milk

soy based, goat milk not recommended due to cross-reactivity use predigested formula

speech therapy

speech, communication swallowing, eating issues

SS cirrhosis

spidor angiomas testicular atrophy, palmar erythema jaundice

spina bifida occulta vs meningocele vs myelomeningocele

spina bifida-no external sac, resolve naturatlly- tuft of har at base of spine meningocele-sac containing meninge and spinal fluid. No nerve myelomeningocele- sac has NERVES, so defect sensory and motor, paralysis, monitor IICP, head circumference. keep prone Cover area with sterile moist dressing to decrease infection PREVENT BY MOM CONSUMING FOLIC ACID CHESK FOR LATEX ALLERGY-HIGH RISK

CN XI

spinal turn head, lift shoulder

spironolactone vs hydrochlorothiazide vs furosemide

spironolactone-potassium sparing diuretic so increases K level hydrochlorothiazide-thiazide diuretic-potassium excreting-so decreases K furosemide-K wasting diuretic

koilonychias

spoon shaped nail inidcate iron def anmia

two main teaching for school-aged

sports related injury nutrition

when taking oral estrogen cotnraceptive

spotting and breast tenderness comon increaesd risk for blood clots so watch for chest pain, leg pain, vision loss. dont smoke bc can potentiate clotting

Legionaire's Disease

spread environmental to client found in warm, stagnant water

when mom is not breastfeeding but bottle feeding, avoid

sstanding in warm water bc stimulate hormone. increases milk, causes engorgement. Wear tight fitting bra, use ice packs to relieve engorgement

pleurisy

stabbing chest pain that increase with inspiration or cough inflammation of visceral pleura and parietal pleura-usually space between them contain 10 ml fluid to help layers glide easily. When inflamed, they rub together, causing pleuritic pain. pleuric friction rub complication of pneumonia

abdominal assessment order

stand on right side auscultate,,, on RLQ percussion palpatation (can cause pain)

pneumocystis jiroveci pneumonia precaution

standard

urine collection 24 hr

start at pt first voiding (which is discarded) and end at pt first voiding the next morning keep all in same container and on ice to tet kidney ftn and urea, creatine, BUN

postop feeding

start with ice chips..then clear liq, full liq, soft diet, regular diet if any risk of GI bleeding-no red colored

when wound evisceration occurs

stay with client, notify HCP low Fowler with knees slightly flexed to relieve pressure on abd assess VS cover with sterile dressing in NS document NPO for emergency surgery

what drug interfere with insulin

steroid (prednisone0 increase gluc beta blocker mask SS hypoglycemia clarithromycin potentiate effect of hypoglycemic agent

meconium stool

sticky, black

metoclopramide

stimulate upper GI motility contraindicatted in bleeding ulcer bc possible hemorrhage

initial treatment for diverticulitis

stool test No enema, laxative or ambulation initially bc danger of perforation

intervention for extravasation

stop infusion and disconnect use syringe to aspirate drug from catheter elevate extremity to reduce edema antidote-phentolamine-vasodilator

who should avoid valsalva maneuver

straining IICP, stroke, head injury portal HPN, cirrhosis, recent eye surgery, glaucoma head injury post myocardia infarction bc vagus nerve slows heart and decrease CO

cushing syndrome SS

striae, bruising, skin atropy truncal obesity, moon like face hirsutism, acne, menstrual irregularies hyperNa, Hypertension, hyperglycemia, HypoK muscle weakness, bone loss

interventions to stimulate voiding in SCI

stroke inner thigh pull on pubic hair pour warm water over perineum tapp bladder

neonate abstinance syndrome

stuffy nose, sweating, yawning, sneezing, tachy irritability, high pitched crying, hyperactive reflex poor feeding, V, diarrhea

if miss birth control pill for two days

take 2 tabldet a day for next 2 days, continue on regular schedule or use another form of contraceptive for remainder of cycle If one dose is missed, take it as soon as rembered on same or on next day, take 2 pills that day

basal body T ovulation

take T everyday slight drop then rise in T

interventions to prevent recurrent UTI

take all abx as prescribed increase fluid wipe front to back avoid synthetic fabric-use cotton void after sexual intercourse avoid douching, feminine perineal products avoid spermicidal contraceptive jellyt

preop of barium enema

take cathartic-mg citarte, polyethylene glycol to empty stool follow clear liq diet day bf NPO 8 hr bf can experience abd cramping during

consuming bisphosphate/alendronate

take on awakening wait 30 min after consuming bc can irritate GI, cause dysphagia No with food/beverage

taking cortisols-cortisone, predinosin,

take with meal/snacks due to GI irritation

when an event of incorrect med adm

submit report to risk manager ASAP record dose administered and dose ordered response of pt contact physician chart any adverse rxn asses client

standard care for newborn after delivery

suction pharynx then nasal passage thermoregulation bathing but dont vigorousy remove vernix vit K and ophthalmic

suctioning laryngectomy tube

suction tube, then mouth apply suction when withdrawing take deep breaths before to prevent anoxia

placnetal abruption

sudden vag bleeding ab pain hypertonic uterus frequent uterine contraction tachysystole

uterine rupture

sudden vag bleeding cosntant abd pain cessation uterine contraction fetal deteriaraion

food high vit D

sun fortified or whole fat dairy fish oil

ortho hypotension parameter

supin,e sitting, standing with 2 min apart SBP drop by at least 20 DBP drop by at least 10 Pulse riske at least 20 beat/min dizziness, weakness, blurred vision, syncope

after percutaneous coronary intervention or cardiac cath

supine to prevent pressure on insertion site of major vessel

position after acute CVA

supine with HOB 15-30 facilitate venous drainage from brain and reduce ICP keep head midline

nursing action for BUck's traction

supine-max of 30 deg or can slide neurovascular status, skin integrity loosen velcro sstrap in boot if too tight give fracture pan for elimination weight free hanging staff support weight while chld is repositioned up in bed

benzonatate

suppress cough

PG phosphatidylglycerol

surfactant fetal lung maturiry from amniocentesis

time out

surgen indicate operative site nurse and surgeron agree the site nurse ID pt by name and DOB pt indicate surgery of site

vasectomy

surgery to permanenet male sterilization vasa deferntia is cut preventing sperm from entering ejaculate sperm is produced but absorbed by body it takes several months for remaining sperm to be ejaculated/absorbed so use birth control until PCP confirms that semen sample has none

droplet precaution disease

surgical mask and private room Neisseria meningitidis Haemophilus influenzae type B diphtheria mumps rubella pertussis strep throat (group A0 viral influenza can be discontinued after receiving at least 24 hr of abx

priapism

sustained painful erection often asso with sickle cell anemia bluish discoloration can indicate ischemia to penis intense pain, rigid penis, difficulty voiding, anxiety

circumcision

swaddle/wrap upper body in blanket for restraint loose fitting diaper sterile technique no feeding during circumcision-maybe sucking conc sucrose pacifier given

intervention to decrease aspiration

swallow twice thicken liquid avoid OTC cold meds-can decrease saliva brush teeth smoking cssation position chin downward when swallowing

superior vena cava syndrome

swelling of face, eye distention of neck and chest vein prob due to cancer obstruction of s. vena cavae

anaphylactic rxn

swelling of site tachypnea, impending doom hypotension,

SS anaphylactic shock

swelling, wheezing, dyspnea followed by Cardiovascular-lightheadedness due to hypotension, LOC< CV shock

bishop score

system for assessing cervical favorability and readiness for induction of labor score 0-3 on consistency, position, dilation, effacement, station. higher bishop-increased likelihood of successful induction more than 8 for nullparous indicate successful Good bishop score-soft, anterior, more than 5cm dilated, more than 80% effaced, at +1,+2 station

LHF SS 3

tachycardia dspnea crackles

signs of infection in elderly

tachycardia tachypnea confusion

moderate to sevre asthma exacerbation

tachycardia >120 tachypnea >30 O2 sat <90 use acce muscle peak exp flow < 40 Give oxygen high dose short acting beta agonist-albuterol q20min high dose short acting anticholinergic Ipratropium nebulizer q 20min systemic corticosteroids-methylprednisolone

supraglottic swallow

technique that allow pt to have voluntary control over closing vocal cords to protect from aspiration 1. inhale deeply 2. hold breath tightly to close vocal 3. place food in mouth and swallow while holding breath 4. cough to diepel remaining food from vocal cords 5. swallow second time before breathing

spinal shock

temporary loss of sensation reflex due to cord compression so relieve

extremity in term vs preterm

term-flexed preterm-extended

viral load

test to measure HIV genetic materials in blood to see response of HIV positive pt to HAART

doxycycline

tetracycline watch photosensitivity watch superinfection no within 1 hr of bedtime-cause esophageal irritation use nonhormonal birth control

doxycycline

tetracycline watch photosensivity superinfection-vaginal discharge at regular intervals-not within 1 hour of bedtime bc can cause esophagel irritation No oral contraceptive No antacid within 1-3 hour of taking oral tetracycline

miliu therapy

therapeutic social, cultural and physical envt

fentanyl patch

transdermal-fentanyl-systemic and has systemic side effects. Do not cut because damage drug delivery. takes 6-12 hr to take effect. remove old patch before applying new one. dispose it well never expose to direct heat place on area that will not dislodge like upper back-flat surface clean and hair clipped

patch transdermal vs topical

transdermal-fentanyl-systemic and has systemic side effects. Do not cut because damage drug delivery. takes 6-12 hr to take effect. remove old patch before applying new one. dispose it well never expose to direct heat place on area that will not dislodge like upper back-flat surface clean and hair clipped topical-lidocaine-side effects are local. Can be cut without damaging drug delivery. Apply it near site of pain

displacement

transfer uncomfortable feeling about one to a different person/situation

transference, countertransference

transference-client unconsciously displacing behaviors related to of different person to nurse

risk of vegan diet

they only eat plant based food and not animal protein/milk and egg no enought vit B12 risk for megaloblastic anemia and neurologic SS tingling, numbness, gait problem, memory loss/dementia need supplement Vit B12 bc B12 only from animal protein

cystic fibrosis manifestaion

thickening secretion recurrent sinus, pul infection pancreatic insufficiency-malabsoption of fat soluble vitamins-ADEK infertilit

when a client states leg spasm,

think hypocalcemia acute kidney injury-Ca is excreted faster-hypoCa Acute pancreatitis-hypoCa (PTH) prolonged immobility lessions bone reabsorption of Ca-hypoCa

thoracic vs abd aortic aneurysm

thoracic-pressure in esophagus, dysphagia, difficulty swallowing abd-back pain

drugs contraindicated for influenza vaccine

those antiviral used for influenza rimantadine zanamivir

meds to avoid after postop

those that cuase constipation morphine hydromorphone clonidine

gastric lavage

thru orogastric tube to remove ingested toxins only if overdose is potentially lethal have intubation and suction supplies at bedise bc risk of aspiration, rep distress HOB elevated do it within 1 hr of overdose

postpartum diuresis

thru sweating after 24, 72 hr of sleep lose excess fluid from preg

chlorthalidone

tiazide diuretic watch hypoK hypoNa hyperuricemia hyperglycemia

posterior tibial pulse vs dorsalis pedis

tibial-behind medial malleous bone of foot- inside ankle dorsalis pedis-top of foot

bull's eye rash

tick bite need antibiotics Lyme disease can develop

perioral paresthesia

tingling around lips hpoca

a major complication of intussusception

tissue death and perforation of bowel PERITONITIS-fever, abd rigidity, guarding, rebound tenderness

cystoscopy

to accurately diagnose interstitial cystitis

pul artery catheter

to assess LV ftn or LV end diastolic pressure balloon inflated for 10-15 sec than allowed to deflate passively. If inflated for long time can cause artery rupture/damage so lock balloon port

DASH diet

to reduce HPN emphase intake of veg, fruit, fat free, low fat dairy include whole grain, fish, poultry, bean, seeds, nut, veg oil limit Na, sweet, sugary bev, red meat low in sat and trans fat rich in K, Ca, Mg, fiber and protein

NG tube to decompress stomach

to remove air/secretions from stomach Connect main lumen of NG to suction apparatus blue pigtail lumen is air vent that facilitates removal of air/secretions from stomach so Never connect it to suction, use for flushing or plug it. Leave blue open to air Regularly flush NG tube with water to prevent clogging

if latex allergy, dont eat

tomato avocado peach nectarine apple apricot chestnut, fig grape kiwi papaya passion fruit

extrusion reflex

tongue move outward when tongue is touched disappear 3-4 month

what can cause false high BP reading

too short cuff (wide-low BP) too quick repeats brachial artery below heart deflating too quickly

dysplasia of hip SS 3

top of one knee is higher than other knee assymetric gluteal fold asymetric thigh fold

what can unlicensed do

transport bathe turn report HCP noninvasive and nonsterile VS CPR can clease superficial wound with aseptic Can do ENEMA fingerstick gluc ROM exercises oral care for vent pt oral nonsterile suctioning oral care No applying elastic bandage Can apply abd binder cannot "monitor" cant orient clinet to envt cant encourage independence cannot check gag reflex/swallowing reflex implement isoaltion precaution-display sign, stock, remind visitors to wear mask REapply restraints after toilet report changes in skin to RN Clergy work-contact dieition for consult Cant monitor for changes can empty, compress hemovac drainage and measure drainage output Cant notify xray or other dept to communicate info on pt Cant notify HCP of changes-just contact feed-but not those at aspiration risk obtain blood product from blood bank Can measuer==re ankle and rachial presusure to have ankle-rachial index but cant calculate cant check VS during exercise test Yes reapplying sequential compression devise obtain clean catch urine specimen empty urine draiange bag No Foley cathetor specimen collection bcc sterile no admission VS cannot measure to choose size for compression stockings Report changes to RN reapply pneumatic compression device cant collect specimen from Foley cath bc sterile procedure

right to left heart diseasee

transposition of great vessels tricuspid atresia truncus arteriosus tetralogy of fallot

risk factors asso with DVT

trauma major surgery prolonged immbolization preg oral contraceptive underlying malignancy smoking old age obesity/varicose veinmyeloproliferative disorder THICK STASIS, ENDOTHELIAL DAMAGE, HYPERCOAG

Belladonna-opium suppositories

treat bladder spasm in TURP procedure No urinating around catheter bc it increases spasm

vardenafil hydrochloride

treat erectile dysfunction watch interaction with nitrate, potentiate hypotensive effect of nitrates

bethanechol

treat function urinary retention

acyclovir

treat herpes dont double up no sex when lesions

sulfasalazine

treat inflammatory bowel disease increase fluid may turn urine orange administer with/after food give even when diarrhea (just symptom of ulcerative colitis)

alendronate4

treat/prevent osteoporosis take in morning bf ingestion of med, food regular weight bearing if miss a dose, skip watch photosensitivity

acute urinary retention

treated with rapid complete bladder decompression rather than intermittent urine drainage asso with hematuria, hypotension, diuresis

SS alcohol withdrawal

tremor hallucination delusion fever tachycardia bugs crawling hands

early SS alcohol withdrawal

tremor tachycardia anxiety startles easily

adverse effect of dopamine

tretas hypotension by increasing HR< BP and UO use lowest dose significant adverse=tachycardia, dysrhythmia, myocardial ischemia, NV

intervention for fecal incontinence in toddler

treward for effort, not bowel movement provide activity during toilet sitting keep diary of times, stooling, meds regularly schedule toilet sitting time

CN V

trigeminal clench teeth

CN V

trigeminal clench teeth, light touch

allergy shots/allergy immunotherapy injection

trigger an increase in body production of specific immunoglobulins to reduce clinet allergy SS when exposeed to specific allergy-pollen, cat dander, dust mites... sm dose of allergen are injected subQ on specific schedule..given every weak with dose increase every injection until target maintenance dose is reached... then every few weeks for 5 years need to stay for 30 min after for possible reaction

SLE

trigger by sun, infetion, stress, drug, preg manage painQ butterfly rash kidney involvemnt-death!!

cardiac marker values

troponin >0.2 CKMB>5 myoglobin >90

true labor vs false labor

true- pain in lower back; regular rhythmic contractions; increased intensity with ambulation false-discomfort at abdomen; no lower back pain; contraction stop with ambulation or position change

pheochromocytoma

tumor in adrenal medulla excess release of catecholamin like E, NE causes paroxysmal HPN crisks Initially give vasodilator like nitroprusside IV due to risk of stroke avoid palpating abdomen bc can manipulate adrenal gland

murmur

turbulent blood folow across diseased cardiac vaalve musical, blowing, swosshing, rasping sound

when a dirty bomb-radiation near by

turn off air conditioner, air heating unit to shield all unit that bring fresh air from outside

in confined area-incase of tornado

turn off gas heater-cause carbon monoxide levels

intervention for late decelration

turn off oxytocin position on left increase LR infusion give O2

3 point gait crutch

two crutches and normal leg forward weak leg forward

diagnosis of major depressive disorder

two key features are depressed mood and loss of interest/pleasure need one of those symptoms and 5 or more follow SS presnet almost everyday for at least 2 weeks Sleep Interest deficit Guilt (worthless) Energy deficit Concentration deficit Appetitie Psychomotor retardation Suicidality

anterolateral position of AED

two pads 1-right of sternum below clavicle 2. left anterior axilla 5-6th ICS

echinacea

tx and prevent cold and flu watch anaphylaxis

ephedra

tx cold and flu for weight loss, improving athletic performance side effect: HPN, MI, arrythmia, stroke, seizure

duloxetine

tx depression SNRI

Peptic ulcer disease

ulcer by H.plori (do helidec combo meds for 14 days) risk factor: NSAIDS, aspirin, corticosteroids, cigarette, alcohol, coffee Dx with barium, upper endoscopy watch bleeding EATING RELIEVE PAIN

mucus, pus stool

ulcerative colitis infectious colitis

risk for opid resp depression 3

underlying pul disorder opiate naive elderly

weight gain for BMI <18.5

underweight total-28-40 lb 2-3 trimester: 1 lb/week

functional disorder

undiagnosable medical issues that has been described for centuries like epilepsy, migraine not confused with psychosomatic illness

trigeminal neuralgia

unilateral excruciating facial pain along trigeminal nerve CNV triggered by touch, hot/cold air/food, talking treat with CARBAMAZEPINE

herpes zoster/shingles 2 SS

unilaterl, linear fluid filled blishter pain and itching by varicella-zoster virus

cause of clubfoot

unkonwn

characteristic of perpetrator of child abuse

unrealistic expectaiton of child perormance confusion bet punishment and discipline coping with stress and crisis low self esteem hx substance abuse, alcohol, drug child hx of punitive treatment and abuse lack of parenting skill, minimal knowledge resentment of child low tolerance for frutration

mnemonic for cane up and down

up with the good down with the bad cane always move before weaker leg

best site for adult IM

upper outer buttocs

upper vs lower GI bleeding

upper-black tarry lower-bright red bloody

transdermal nitroglcerin patch

upperarm, body rotate site daily remove patch at night keep patch at shower take no erectile dysfunction meds headaches common worn 12-14 hr/day

position for thoracentesis

upright, lean forward over bedside table with arms supported on pillow

urge vs stress incontinence intervention

urge- bladder training stress-Kegel exercises

when to use urinary catheterh

urinary obstruction, retention strict I and O in critical ill periop use for surgical procedure during prolonged immobilization when berest is essential end of life comfort facilitate healing of oepn perineal, sacral wound

UTI

urine bacteria count of 100,000 colonies per ml

common side effect of trimethoprim-sulfamethoxazole

urticaria rash

when itching under cast

use cool setting of hair dry NEVER place object, lotion, powder

24 hour urine collection

use dark jug with special powder-protect urine from light collect exactly 24 hr-record time of emptying bladder to toilet so start time coincide with empy bladder keep urine in frigerator or colled ice chest

prevnet pressure ulcer

use emollient/barrier cream to skin use foam padding on chair and other surfaces prompt incontinence care reposition q 2 hr no massage

teaching for bell's palsy

use glasses during day wear patch at affected eye to protect chew on unaffected side good oral hygiene can drive-no alteration in vision, balance

pediculosis capitis

use hot water to launder those that cannot be washed placed in sealed plastic bags for 14 days to kill lice vacuum furniture, carpet, toys, rugs

Roux-en-Y gastric bypass

use mall proximal portion of stomach to create a pouch that is attached to roux limb of sm intestine bypass most of stomach and portion of duodenum Watch for dumptimg syndrome iron def anemia may occur-take iron and Ca supplement also take cobalamin replacement

radition care

use mild soap use non medicated, non perfumed lotion no swimming allow air to radiation area avoid sun exposure

elderly checking for dehydration

use mouth, eyes no skin bc elasticity is gone by age

cast care

use palm of hand to handle cast put fan in room to dry elevate level of heart compare extremity color turn q2 hr

IV for elderly

use smallest gauge catheter use 5-15 degree angle on insertion since veins are more superficial

when giving blood

use tubing with blood filter, not standard IV tubing

ventriculoperitoneal shunt

used to treat hydrocephalus and usually at 3-4 mont blockage and infection watch out blockage result in IICP-watch cushing triad

CPAP

uses room air, not oxygen pressure to keep upper airway open cover mouth, nose with face mask

pharm nuclear stress tst

uses vasodilator to stimulate exercise they vasodilate arterties radioactive dye is injected No smoking, No eat avoid caffeine, defface products, no smoking Dont take theophylline 24-48 hr prior dont take cardiac meds unless directed like nitrate, dipyradamole, beta blocker

hysterosalpingogram

using contrast for xray of cervix, uterus, fallopian tube watch allergy to shellfish

newborn chest circumference

usually 1 inch less than head

vaginal birth cesarean

usually complete a trial of labor risk for uterine rupture when labor induced nonreassuring fetal heart pattern and change in uterine shape, cessasion of uterine contraction in uterine rupture

probable signs of pregnancy

uterine/cervical changes goodell sign chadwick sign hegar sign uterine enlargement braxon hicks ballottement fetal outline palpation uterine&funic souffle skin pigmentation-chloasma, linea nigra, areola darkening striae gravidarum positive preg tests

intervention in late deceleration

uteroplacental insufficiency fetal intolerance to labor discontinue oxytocin change to left side to relieve compression give oxygen IV bolus lactated ringer/NS notify HCP

v fib vs a fib

v fib-irregular shapes and amplitude a fib- QRS normal, many Ps

why no scarlet fever vaccine

vaccicne is for communicable viral scarlet is bacteria that respond well to abx

after cataracts, avoid

vacumming lifting too much flexion strained movement

pessary

vaginal device that provides support for bladder for pelvic organ prolapse, stress incontinence no surgery, pt can insert and remove themselves Can remain sexually active

CN X

vagus say ah

CN X

vagus say ah palate movement

NO IV push

vancomycin KCl Yes: mannitol, loop diuretic, digoxin

avoid loop diuretic with

vancomycine-cause ototox digoxin-cause dig tox

electrical alternans

variation in QRS amplitude in cardiac tamponade du to swinging motion of fluid filld pericardial sac

kawasaki disease

vasculitis more than 5 days fever nonexudative conjunctivitis lymphadenopathy mucositis hand/foot swelling rash irritability, joint pain, arthritis IV immunoglobulin and aspirin to prevent coronary artery aneurism CHECK FOR FEVER-indicate acute phase

hydralazine

vasodilator treat HPN take with food avoid OTC watch for anorexia-telll HCP

food high in vit E

veg oil salad oil nuts seeds avocado, mango

vegan lacto-ovo-vegetarian lacto-vegetaria macrobiotic

vegan-strict veggies-no milk, egg lacto-ovo-egg, milk, milk products ok lacto-milk, milk products ok (not egg) macrobiotic-wholegrain, fruit, seaweed emphasized

infective endocarditis can lead to

vegettaion can break off and embolize stroke spinal cord ischemia ischemia to extremities intestinal infarction splenic infarction-LUQ pain

what to watch for in nephrotic syndrome

venous thrombosis due to dehydration-hypercoag due to loss of antithrombin in urine (proteinuria)

post MI

ventricular dysrhythmia common

harsh systolic murmur

ventricular septal defect acyanotic defect

vertigo vs tinnitus

vertigo-dizzy tinnitus-ringing

pertussis

very contagious case swelling in throat droplet isolation violent spasmodic cough until thick mucoid plug is out and followed by emesis hymidified O2, fluids, suction, no cough suppresant

psyllium hydrophilic mucilloid

very safe, bulky forming laxative harmless-use on routine basis

horizontal violence

violence verbal or nonverbal that occur among coworkers bullying, harrassment... can occur in nursing

rabies

viral swallowimg seizure

tonsillitis

viral or bact related to strep may need surgerymonitor bleeding

Snellen letter chart

visual acuit over 6 yr old child positioned 10 ft away standard- 20 ft

what effects warfarin

vit-K food leafy grn veg, asparagus,, broccoli, kale, Brussel sprout, spinach Also grn tea, grapefruit juice, cranberry juice

causes of m. alkalosis

vomiting GI suction administration of alkali like Na bicarb

Roman Catholic pt dying

wafer-Eucharist is offered and placed on tongue

5 categories of metabolic syndrome

waist >40 men >35 women BP >130 or >85 diastolic triglyceride >150 HDL <40 men, >50 women Fasting gluc >100 We Better Think High Glucose

blood and ampho B

wait 1 hr in bet bc have same rxn type

developmental milestone 12 month

walk crawal up stairs pincer grasp 3-5words usenon verbal gesture separation anxiety

developmental milestone 2 yr

walk up and down stair alond 1 step at a time run kicks ball build 6-7 block towl turn 1 book page draw line 300+work vocab 2-3 pword phrase own name parallel play

developmental milestone 18 month

walk up and down stair with help throw ball overhand jump in place build 3-4 block towel turn 2-3 book pages scribble use cup and spoon 10+ vocab id common objects temper tantrum imitate others

developmental milestone 3 years

walk up sttair with alternating feet pedal tricycle jump forward draw circle feed self grasp crayon with fingers 3-4word sentences why Qs own age associative play toilet trained except wiping

diabetic foot care

wash feet daily test water T pat dry feet use lanolin to prevnet dry skin but not between toes inspect use cotton or lamb's wool to separate overlapping toe cut toenail straight across and file along curves avoid barefoot use mild foot powder to absorb perspiration avoid OTC on cuts No crossing legs, tight garment

routine care for uninary catheter to prevent Catheter associated infection

wash hands routine perineal care with soap and water-not antimicrobial keep drainage system off floor keep bag below level of bladder ensure each client has separate clean container to empt collection bag use sterile technique when collecting sample ensure drainage of urine avoid kinking, lamking, obstruction of catheter encourage oral fluid

care of incision after coronary artery bypass

wash with soap and water, pat dry itching, tingling, numbness around incision present for several weeks due to damage to local nerves No tub baths No powder/lotion Report redness, swelling, drainge increase wear elastic hose on leg, elevate leg while sitting

polyuria after head injury

watch DI measure urine specific gravity

thyrodectomy

watch airway watch hypocalcemia-due to parathyroid have trach set near, suction and O2

penicillin

watch allergy-ampixillin and cephalosporin injection-monitor 30 min after bc possible reaction

after gastrojejunostomy

watch dumpting syndrome lie doe after eating

Parkinsons

watch for ortho hypotension watch aspiration can use deep brain stimulation to reduce shakiness

lymphedema at high risk for

watch for redness, warmth-may be infection-high risk

when giving enteral feeding to malnourished

watch for refeedingysndrome watch electrolytes-K, P

post thyroidectomy

watch hypocalcemia-due to possible injury to parathyroid glands tingling, muscle twitching, numness

permanent pacemaker

watch if hearing aid-can affect pacemaker pllacement

caring for external fixator

watch infection-lead to osteomyelitis pin care-1/2strength hydrogen peroxide and NSS or chlorhexidine neurovascular assessment encourage ambulation

cholesterol lowering drug

watch liver monitor muscle weakness avoid grapefruit juice

allergic rxn

watch wheezing stop infusion prep epi

healther substitues for sugary beverage

water club sode sparking water with splash of fruit juice unsweetened tea/coffee low fat, non fat milk * diet beverage nor recommended-weight gain, craving for sweet, risk of metabolic sndrome

SS pernacious anemia

weakness, fatigue constipation, diarrhea sore tongue

Newborn paremeter

weight 5.5 to 9.5 lb height- 18-22 inches head circumference- 13.2-14 inch should be 1/4 body length 2 arteries, 1 vein extremies flexed major gluteal folds even creases on soles of foot

failure to thrive

weight less than 80% ideal age observe child being fed most cause is inadequate diet intake

prevent GERD or managw

weight loss sm fre mealwhat meal with sips of fluid avoid trigger-caffeine, alcohol, nicotine, high fat, spicy, peppermint, choco, carb beverage chew gum to facilitaet salivation elevate HOB refrain from eating at bedtime or lying after eating abd breathing eercise to strengthen

serotonin syndrome

when SSRI with MAOI used together 3: 1.mental change (agitation, anxeity) 2.autonomic dysregulation(hyperthermia, diaphoresis, tachycardia, HPN) 3.neuromuscular hyperactivity(tremor, rigidiyt, clonus, hyperreflexia) agitation, diaphoresis, tachycardia, autonomic instability, hypertensive, diarrhea, hyperactive bowel sounds, hyperreflexia, clonus, tremor hyperthermia, rigidiy, cognitive impairment fatal tx with propranolol, cooling blanket, diazepam

probbable time of ovulation

when a sudden drop then rise in temperature

permissive HPN

when acute stroke during first 24-48 hr after stroke allow for adequate perfusion to damaged cerebral tissue Keep SBP more than 17- but less than 220

intervention for appendicitis

when appendix gets infected or obstructed, it becomes inflamed and may rupture Ensure airway and give O2 if needed IV access and give fluids draw sample for CBC, eeletrolyte Insert indwelling urinary catheter insert NG tube if needed SInce they're at risk for rupture and may need emergency surgery, keep NPO give pain meds IV

hypothermia

when core temperature elow 95 and body cannot compensate cold myocardium becomes extremely irritable and becom e dysrhythmia handle gently as v fib can develop if touched so put on cardiac monitor cover head, draw blood, tachether insertion