UWORLD

Nonverbal cues related to coping in labor

*-Effective coping:* Vocalization (Moan, count, chant), rhythmic breathe, ability to relax between contractions, rock, sway *-Ineffective coping:* Cry, sweat, hyperventilating, tense, thrashing, wincing, inability to focus/concentrate, clawing, biting, screaming, panicked activity with contractions

GTPAL

*-Gravida:* number times been preg regardless of preg outcome *-Term:* number of preg delivered at 37wks gestation and beyond *-Preterm:* number preg delivered from 20wks through 36wks 6 days gestation *-Abortion:* number preg ended before 20wks (May be spontaneous [miscarriage], or induced abortion) *-Living:* number of currently living children

Normal Postpartum Lochia

*-Lochia Rubra:* Birth to 3-4 days postpartum. Dark or bright red blood; odor like menstrual blood; occasional small clots; qunatity decreasing each day *-Lochia Serosa:* 4th day postpartum to 10th or 14th day postpartum. Serosanguineous (Pink); brownish (old blood); quantity gradually decreasing in amount *-Lochia Alba:* 11th day postpartum to 6wks postpartum. White/yellow; creamy; light quantity

Sudden Infant Death Syndrome

*-Risk factors:* Prone or side sleep, tobacco smoke, cosleep with adult, premature birth/low birth wt, overheat during sleep, soft sleep surface, bumper pads, toys, loose pillows/blankets *-Protective factors:* Supine sleep, breastfeed, pacifier use during sleep, up to date vaccines, appropriate clothing (sleep sack), firm sleep surface, removal of loose items from bed

Approach to sinus brady in adults

*1.* Pulse <50/min and symptomatic (Dizzy) *2.* ID an & treat underlying cause. IV access, cardiac monitor to identify rhythm. Pulse OX with O2 for hypoxemia. 12 lead ECG if possible *3.* Persistent bradyarrhythmia & one of the following >Hypotension or signs shock >Acute mental status changes >Chest discomfort (cardiac ischemia) >Acut heart failure -If none of these symptoms then just monitor and observe, if yes then move on to step 4 *4.* IV atropine 0.5mg bolus, repeat every 3-5mins up to 3.0mg maximum. If still no response then step 5 *5.* Transcutaneous pacing (aka external pacing. Temporary means of pacing a patient's heart during a medical emergency, accomplished by delivering pulses of electric current through the patient's chest, which stimulates the heart to contract. The most common indication for transcutaneous pacing is an abnormally slow heart rate.) or IV dopamine 2-10ug/kg/min infusion, or IV epi 2-10ug/kg/min

Pasero Opioid-Induced Sedation Scale

*S* = sleep, easy to arouse: no action necessary *1* = awake and alert; no action necessary *2* = occasionally drowsy but easy to arouse; requires no action *3* = frequently drowsy and drifts off to sleep during conversation; decrease the opioid dose *4* = somnolent with minimal or no response to stimuli; discontinue the opioid and consider use of naloxone

Skin Cancer Assessment

-*A*symmetry -*B*order irregular -*C*olor changes and variation -*D*iameter of 6mm or larger (Size of pencil eraser) -*E*volving (Changing in shape, size, color(

Pulses

-0 absent -1+ weak -2+ normal -3 increasing, full, bounding

Deep tendon reflexes

-0 is absent -1+ is diminished -2+ is active, normal, expected -3+ brisk, slightly hyperreflexive -4+ Very brisk, hyperreflexive; clonus (Jerking of foot when pushed back from bottom of feet) may be present

Bilirubin Normal Range

-0.2-1.2 -High can cause jaundice, itching

Fitting Crutches

-1 to 2in space between axilla and pad (Prolong pressure on axilla can cause localized damage to radial nerve on axilla which lead to crutch paralyisis which manifests as muslce weak or sensory symptoms like tingling, numb of arm/wrist/hand) -30 degree elbow flexion

Toddlers and hospitalization

-1 to 3 years -Most at risk group for stressful experience -Have the most separation anxiety of any age group -Are egocentric and want autonomy and attempt to control their experiences through emotional displays (Temper tantrums, negative responses like NO) -Hospitalization results in loss of toddlers usual routines and rituals often resulting in regressive behavior -Activities should be similar to home routines like provide snacks, anticipate bedtime, give them options -they ave no grasped concept of time so giving them daily schedule wont work

Urine Specific gravity

-1.010-1.030 -High means dehydrated, more solutes in urine -Low means over hydrated, less solutes in urine

Detection of fetal heart rate is when

-10-12wks gestation

Formal Operational (Piaget's Stages of Cognitive Development)

-11 years and older -Abstract thinking and reasoning

Measuring Fundal Height

-12 wks above pubic symphasis -16 wks between symphasis pubis and umbilicus -20-22wks reaches umbilicus -36 wks reaches xiphoid process -38-40wks goes into pelvis and fundal height drops

Serum ammonia normal range

-14-45 -High can cause hepatic encephalopathy (Confusion, lethargy, asterixis, coma

BMI normal range

-18.5 to 24.9

Adult Chest Compression

-2 in chest deep and recoil completely -Center of chest, lower half of sternum (breastbone) -Compression's of 100-120/min

Dissociative Identity Disorder

-2 or more identities control pts behavior -Alternate identities are likely to develop as a response to abuse or traumatic events to serve and protect the pt from stressful memories -Goal of treatment is to integrate all the identities into one personality -Nurse should forma trusting, therapeutic relationship with each identity -During missing memories or lost time, do not force the pt to hear or attempt to recall memories as it may result in distress and regression, allow pts to recall memories at their own pace

Therapeutic INR

-2 to 3 -Can be 3.5 for heart valve disease -Antibiotics can kill intestinal bacteria the produce vitamin K therefore warfarn lvls can shoot up and place pt risk for bleed

Preoperational (Piaget's Stages of Cognitive Development)

-2 to 7 years -Improved language, poor casualty (magical thinking), egocentrism -Scraped knee was caused by earlier behavior

Absolute Neutrophil Count Range

-2,200 to 7,700 cells/mm

Postpartum Taking Hold (Rubin Phase)

-2-10 days postpartum, mom still learning technical skills of mothering but may feel inadequate -Moms focus is learning to care for infant -Nurses need to focus on providing learning opportunities and positive reinforcement

How long herbal therapy should be stopped prior surgery?

-2-3Wks

Serum Urine Osmolarity

-285-295 -Low means dehydrated and a lot of solutes in urine -High means overhydrated and less solutes in urine

Gestational Age Assessment Of Preterm

-28wks has abundant lanugo (fine downy hair found mostly on back and shoulder of pretern newborns) over most of body, disappears 36wks. -Has smooth, pink skin with visible veins as skin is thin and transparent with lack of SUBQ fat -Areolae may be barely visible with no raised breast buds. Palpable raise breast buds 5-10mm would be expected in term gestation -Feet has very smooth soles of only faint red marks or single anterior transverse crease. Creases over entire sole and or peeling skin would be expected in full or post term (40+ wks) newborn

Normal pupils sizes

-3 to 5mm -Pupil dilation can be med or neurological cause (Increased ICP, brain herniation)

Otic Meds Admin

-3 years or older, pinna up and back -Infant then pinna down and back -Prone or supine with head turned to side for child

Normal Albumin lvl

-3.5 to 5.0

Newborn respirations

-30-60/min with periodic pauses lasting less than 20 secs

fetal normal kicks per hour

-4 kicks per hour or 10 kicks every 2 hours is normal

Introduction solid foods

-4 to 6 months -Allow several (4-7) days between each new food to observe any allergic reactions -6 to 8 months can try pureed fruits/veges followed by finger foods to help develop motor skills and learn to chew before they even have teeth -Should introduce iron fortified infant cereal mixed with breast milk, formula, or water -Cows milk (Whole milk and not lowfat) given 1 year of age

Cardiac output normal range

-4 to 8L/min

Normal Hemoglobin A1C

-4% to 6% -Goal is keep it <7% in diabetics -Measures blood glucose control over period of 2-3 months

Breast exams when

-40 or older yearly

INfant ranges

-40 to 80 within first 24hr after delivery -RR is 30-60/min -Temp is 97.7-99.7

Pulse Pressure range

-40-60 -Low (Narrow) means significant blood loss -High (Wide) mean high BP

Kawasaki Disease

-5 or more days of fever, swelling -Monitor for fever and check temp orally or rectal q6hr for first 48hrs -Vasculitis (inflammation of blood vessels, hence the strawberry tongue). Causes coronary artery aneurysms (which can lead to MI and death) -Can cause skin peeling, and rash, splenomegaly, and lymphadenopathy (enlarged lymph nodes >1.5cm), irritability, temp joint pain and symptoms of arthritis -IV immunoglobulin along with aspirin given for treatment and to prevent coronary aneurysms. IVIG can cause fluid overload and pulmonary edema if given large quantity so monitor for symptoms of heart failure (decreased urine output, additional heart sounds, difficult breathe). Live vaccines should not be admin until after 11 months after IVIG was admin -If on aspirin be cautious bout reyes syndrome

Neutrophil Range

-55%-70%

Visual acuity testing in children

-6 or older uses snellen chart 10 feet away from it (The letter chart from large to small). If child wears glasses they remain in place. Referral to ophthalmologist if unable to identify 4 correct letters on the 10/15 line (Equivalent to 20/30 vision)

Pulmonary artery wedge pressure

-6 to 12mmHg -Indicates left sided heart function, increased mean left sided heart failue

Concrete Operational (Piaget's Stages of Cognitive Development)

-7 to 11 years -Able to reason if concrete objects are used to teach

Normal MAP range

-70 to 105 -Anything under 60 vital organs may be underperfused and can become ischemic

Transition Phase of birth

-8 to 10 cm dilation -Most emotionally challenging marked by increased maternal anxiety -Mixture of mucus and pink/dark brown blood (Bloody show) is observed -Nursing priorities are provide emotional support and encouragement and coach pt to breathe techniques

End stage of labor

-8 to 10cm dilated and has perineal/rectal pressure and can have N/V and trembling

Normal PaO2

-80-100 mmHg -Low not enough oxygen so acidic, high or wihtin range is hypoxemia

Systemic Vascular Resistance

-800 to 1,200 -Measure of vascular resistance -Vessel dilation or constriction

Normal Infant HR and RR

-90 to 160 HR -30 to 60 RR

Glucose control in hospitalized ill pts

-<140 fasting -<180 random

Before kidney biospy what should BP be?

-<140/90

Admin rectal suppository in children

-<3 Supine with knees raise ->3 Side lying knees flexed -Lubricate tip of suppository with water soluble jelly -Insert past internal sphincter using fifth finger if under 3 years, index finger if older than 3 -Angle suppository and guide it along rectal wall, must remain in contact with rectal mucosa anot not be buried in stool -Hold buttocks together for several mins

BPH Symptoms

->50 y/o -Urinary retention -Sensation incomplete emptying or increased urgency -Straining or hesitancy -Weak or intermittent stream -Frequent void

Physiologic Anorexia

-A decrease in appetite manifested when the extremely high metabolic demands of infancy slow to keep pace with the more moderate growth rate of toddlerhood. -Toddlers during this phase are picky about food choices and eating schedules -Parents should avoid forcing food or pressuring toddlers to eat more which can lead to poor eating habits -Set and enforce schedule for all meals and snacks. Offer child 2 or 3 choices of food items. Keep food portions small. Avoid TV and games during meals or snacks

Congenital Rubella Syndrome

-A form of birth defect that occurs when the mother becomes infected with the rubella virus in her first trimester -Congenital cataracts, deafness, heart defects, cerebral palsy

Radon

-A gas that arises from the earth where radioactive materials are present. -High levels can cause lung cancer -Levels must be tested before home can be sold

Carpel tunnel syndrome

-A health problem causing pain in the wrist due to nerve compression, often associated with overuse or incorrect of a computer system. -Use wrist immobilization splints to manage symptoms -Pain and paresthesia over first 3 1/2 fingers

Cerebral Palsy

-A loss or deficiency of motor control with involuntary spasms caused by permanent brain damage present at birth

Word Salad

-A mix of words and/or phrases having no meaning except to the pt -Here what comes table, sky, apple

Heel to shin test

-A neurologic test testing lower limb coordination and position sense -Lie down and run heel of one foot down the shin of other leg

Once restraints are discontinued

-A new prescription will be needed to reapply them -Trial discontinuations are not permitted

First 48 hrs in newborn have what?

-A physiologic heart murmur -If pathological heart murmur meaning after 48 hrs, then mean associated with congenital heart disease and can also have (abnormal vitals, cyanosis, poor feed)

Liver edge

-A pt with distinct liver edge even with right costal margin/Right rib cage is normal, an abnormal is boggy liver edge below the rib cage (Hepatomegaly)

What enzymes get released when you have hepatitis?

-ALT and AST enzymes -Hepatitis is diagnosed when these enzymes are >2-3 times the normal values

Meds that spare potassium

-ARBS (Artans) and potassium sparing diuretics (Spironlactone, Triamterene, Eplerenone), ACE (Prils) -Can cause hyperkalemia and need to be held for pts with underlying hyperkalemia

If unable to tolerate ACE inhibitots (Prils), what med are reccommended?

-ARBs like -artans

Glycoprotein (GP) IIb/IIIa receptor Inhibitors

-Abciximab -Platelet inhibitors and can cause serious bleed -No traumatic procedures (Initiation of IV sites, IM injections) should be performed unless necessary due to risk for bleed

ACHES with contraceptive use

-Abdominal pain (Ischemic bowel) -Chest pain -Headaches -Eye problems -Severe leg pain -Irregular bleed and spotting between menses are common side, breast tenderness is common too

Age related physiologic changes in older adults that places them at risk for respiratory illness and infections

-Ability to cough forcefully decreases -Chest wall less flexible -Immune system diminished -Mucous membrane drier -Number and motility of cilia decrease

Preeclampsia

-Abnormal condition associated with pregnancy, marked by high blood pressure, proteinuria (1+ or more on urine dipstick, trace proteins is negative, 300mg or more protein in 24hr urine collection), edema, and headache, blurry vision, HTN -Complications include thrombocytopenia, liver dysfunction (Elevated liver enzymes), renal insufficiency

Coarctation of the Aorta

-Abnormal narrowing of aorta that reduces cardiac output -Will have increased pulse pressure and pulses in upper extremities and diminished pressure and pulses in lower extremities

Placenta Accreta

-Abnormal placental adherence in which placetna implants directly in myometrium rather than endometrium -C section before term along with blood products is recommended -@ major life threatening complication is hemorrhage so have blood typed and cross match and 2 large bore IV (18 gauge) in case blood transfuse

Osteopenia

-Abnormal reduction of bone mass -If lactose intolerant Fish, tofu, and some green veges, and almonds are good sources of calcium -Vit D sources include egg yolks and oily fish (Salmon, sardines, tuna)

Newborn abnormal findings

-Abnormal respiratory effort (Nasal flare, chest wall retractions, grunt, tachypnea >60/min) -Jaundice especially first 24 hrs of life is pathological, yellow hues may on face or eyes and progress to trunk and extremities. -No void in 24 hrs (Newborn should void and pass meconium within 24hrs after birth)

Pica

-Abnormal, compulsive craving for and consumption of substances normally not considered nutritionally valuable or edible -Common substances include ice, cornstarch, chalk, clay, dirt, paper -Often accompanied by iron deficiency anemia

Beta Blockers

-Abrupt withdrawal can cause rebound HTN, precipitation angina, MI, and death

Shaken Baby Syndrome

-Abusive head injury due to violent shaking of an infant by arms, legs, or shoulders. Causes bleeding within eyes and brain -Can have vomit, irritability, lethargy, inablilty to eat or suck, seizures, inconsolable crying -Can lead to difficult breathing, apnea, seizures, lifelessness

Diabetic Nephropathy

-Accumulation of damage to the glomerulus capillaries (kidneys) due to the chronic high blood sugars of diabetes mellitus -Need tight control of blood glucose

Pleural effusion

-Accumulation of fluid in the pleural cavity -Can have absent breath sounds in base of lung cause the collection of fluid in the pleural space prevents lung from expanding

Lymphedema

-Accumulation of lymph fluid in soft tissue -Arm may feel heavy or painful -Interventions to manage it >Compression sleeve or intermittent pneumatic compression sleeve (Increased distal pressure and less proximal pressure), clothing need be less constrictive at proximal arm and over chest >Elevate arm above heart >Isometric exercise >Avoid veinupunture, BP on affected limb >Massage area

Providing water to child between meals

-Accustoms child to taste of water and will likely drink water than a sugary evereage -Reduce risk constipation and UTI -Helps child maintain healthy wt

Preconception Counseling

-Achieve a normal BMI (18.5-24.9). Obesity is BMI more than 30 -Folic acid at leasr 400mcg a day -Dental wellness appointments to prevent periodontal disease

Absolute Contraindications to Combined Hormonal Contraceptives

-Active breast cancer, migraines, uncontrolled HTN, heart disease, stroke, prolonged immobilization, VTE -Combined Hormonal Contraceptives can actually help regulate menstrual cycles reducing the amount of bleeding during menses

Pain, swelling, and redness of one or more extremity joints (Typically great toe)

-Acute gout attack

Renal Colic

-Acute pain in the kidney area that is caused by blockage during the passing of a kidney stone -Has excruciating sharp and stabbing pain radiating down to groin as stone travels to ureter

Non rebreather mask

-Admin 95%-100% O2 -Liter flow must be high enough (up to 15L/min) to keep reservoir bag at least 2/3 inflated during inhalation -Flutter valves open when exhaling to prevent reinhalation of exhaled air. Flutter valves close when inhaling.

Recombinant Human Erythropoietin

-Admin SUBQ -Is used in anemia associated with chronic kidney disease -Used when hemoglobin is less than 10 -Therapy should be discontinued if hemoglobin is more than 11 cause can cause VTE due to thickened blood -HTN is contraindicated in taking this

Lactulose

-Admin for pts with cirrhosis and hepatic encephalopathy to promote excretion of ammonia via fecal elim. Not soley for constipation.

Radioactive iodine uptake (RAIU)

-Admin low dose radioactive iodine -Thyroid gland is only tissue that uses iodine -Scan is performed at 2, 6, and 24hr to assess the areas actively absorbing iodine which can narrow diagnoses to hyperfunctioning thyroid disorders (Graves disease) -Intervention >Notify HCP if CT or other recent Xray using iodine contrast has been done cause the iodine may alter results >Antithyroid or thyroid hormone meds need held 5-7days prior >NPO 2-4hrs prior >Awake during procedure, do not breastfeed immediately after

Recommended rate for intermittent IV infusion of potassium chloride

-Admin through electric IV pump -No greater than 10mEq over 1 hr (100ml/hr) when infused peripheral line -No greater than 40mEq/hr (400ml/hr) when infused through central line

Dextrose (D50 IV Push)

-Admin to hypoglycemic pts who are unable to ingest simple carb -Can lead to rebound hypoglycemia by stimulating additional insulin release from the body in response to increased serum glucose lvls

Addison Disease

-Adrenocortical insufficiency, hypofunction of adrenal cortex, low cortisol -Can have brown pigmentation of skin in sun exposed areas, may have vitiligo, or patchy/blotchy skin, slow preogressive onset of weakness and fatigue, anorexia, wt loss, ortho hypo, salt crave, N/V, depression and irritability, hyponatremia -Need to be on corticosteroid therapy (Hydrocortisone, dexamethasone, prednisone). Can cause immunosupression and the anti inflammatory effects may mask signs of infection (Inflammation, red, tender, heat, fever, edema) so signs of low grade fever should be reported -Physiological stress such as infection can trigger addisonian crisis

Risk for delirium

-Advance age, underlying neurocognitive disease, acid base/ABG imbalance, metabolic and electrolyte imbalance, untreated pain, surgery, impaired mobility -Meds (Opioids, anticholingergics), hypoxia, acute infection, dehydration or malnutrition

Thick secretions in suctioning

-Aerosols of sterile normal saline can be admin via nebulizer can be used to thin secretions, but water should not be used -Aerosol therapy can induce bronchospasm in some pts and can be relieved by bronchodilator (Albuterol)

Ankylosing Spondylitis

-Affects spine and has no cure -Stiff spine leading to restricted spinal mobility -Low back pain and morning stiffness that improve with activity are classic findings -Involvement of thoracic spine and costosternal junctions can limit chest wall expansion leading to hypoventilation -Interventions: promote spine extension by proper posture, daily stretch, and spin stretch exercise (Swim) >Stop smoke, breathing exercises to increase chest expand and reduce lung complications >Manage pain NSAIDs or moist heat >Take immunosuppresants and anti inflammatory drugs >Rest during flare ups >Sleep on back on firm mattress

Postpartum Letting Go (Rubin Phase)

-After 10 days postpartum, mom becomes comfortable with new role -Moms focus is adapting to new parenting role -Nurses need to focus on following up with a phone call

Fundal Height

-After 20 wks gestation, fundal height in cm should correlate closely with the number of wks pregnant (24cm=24wks) -Should empty bladder before having fundal ht measured

Sterile saline can used for how long?

-After 24hrs following opening a bottle of sterile saline the solution is considered contaminated and must be discarded

Risk for Infertility

-After age 35 -Hormonal dysfunction (polycystic ovarian syndrome) can cause ovarian cysts and anovulatory cycles (lack ovulation during menses) which impair fertility -STI like chlamydia -Untreated PID -Endometriosis: a condition in which patches of endometrial tissue escape the uterus and become attached to other structures in the pelvic cavity

Head falling behind shoulders when raised from supine to seated position (Head Lag)

-After age 6 months of age can mean cerebral palsy or autism

Capillary Refill

-After blanching nail bed, color should return to normal within <3 secs

EpiPen

-After inject should be held for 10 secs to allow entire contents to be injected, then masssage site for additional 10 secs

Acute Compartment Syndrome

-After surgery, vessels surrounding injury site are compressed by swelling muscles and connective tissue, muscle is encapsulated by a fibrous layer of fascia which does not yield to swelling -Place extremity at heart level -Fasciotomy (Incision to open the fascia of the affected muscle compartment) may be required to relieved the compression

Toddlers

-Age 1-3 -Desire for independence, so dont ask yes or no questions -Offer limited choices for sense of control

Preschool children

-Age 3-6 -Want to take initiative and have sense of control, so let them participate

Contraindications for the live attenuated intranasal vaccine

-Age less then 2 or 50 or older -Immunosupressed pts, chronic cardiovascular, pulmonary, neurological, nueromuscular, or metabolic (Diabetes, renal insufficiency)diseases -History gullian barre following previous influenza immunization -Preg -Child/adolescent on long term aspirin

Lateral Violence

-Aggressive and destructive behavior or psychological harassment of nurses against each other -Verbal abuse like name calling, unwarranted criticism, intimidation, blaming. -Refusing to help someone, sabotage, exclusion, and unfair assignments also lateral -Should not be tolerated or ignored and cations to take include documenting and keep a file of all incidents, report to supervisor, letting bully know behavior will not be tolerated, observing interactions with bully an other colleagues, seek support from within facility or from external source

Subcutaneous Emphysema

-Air that leaks into the tissue surrounding the chest tube insertion site, amount usually small and reabsorbs spontaneously -Nurse should auscultate lung sound, assess popping sound, and palpate site for crackling sensation

Care for hypothermic pt in near drowning accident

-Airway management, hypoxia is managed and prevented via intubation or mech vent -Frequent turning them can cause spontaneous Vfib and should not be performed -Remove current clothes and provide dry clothes and warm blanker -Admin warm IV fluids and warm humidified O2

Most common causes of pancreatitis

-Alcohol and gallstones

Risk factors for esophageal cancer

-Alcohol, tobacco, obesity, GERD, barrett esophagus, N-nitroso containing foods (Pickled foods, beer), hot beverages, low fruit/vege intake

Dopamine, Norepi, Epi

-All raise BP

Angiotensin Converting Enzyme (ACE) Inhibitors and ARBS

-All the Prils -All the Artans -Avoid if planning to become preg or preg cause its teratogenic -Can cause hyperkalemia, salt substances contain high potassium and should not be consumed

Aminoglycosides

-All the-Cins -Are nephrotoxic

Urticaria

-Allergic reaction of the skin characterized by the eruption of pale red, elevated patches called wheals or hives

Elevated Eosinophils Indicate

-Allergic response or trigger -Normal his 1%-2%

Preschool Preprocedure education

-Allow parents stay during procedure -Let them know procedure not punishment -Let them voice concerns and ask questions -Let them imitate procedure on doll

Codependence

-Allow the codependent person to maintain control by fulfilling the needs of the addict first -Behaviors such as keeping the addiction secret, suffering physical or psycho-social abuse from the addict, not allowing addict to suffer the consequences of actions, and making excuses for addicts habits -If addict isn't happy, the codependent person will try to make the addict happy -Codependent persons will focus all their attention on otheres at the expense of their own sense of self

Terazosin

-Alpha adrenergic blocker -Can relieve urinary retention in BPH -It can relieve smooth muscles in peripheral vasculature which can cause orthostatic hypotension, syncope, falls. Common when drug is first started (First dose hypotension) or when dosage increased -Take at bedtime

Involuntary bedwetting

-Also called nocturnal enuresis -Limit child's caffeine, void before bed, avoid punishing or scold, encourage child assist with changing soiled PJ and linens so they have more control, Positive reinforcement to motivate child (calendar showing wet and dry nights, rewards), awaken child nightly at specified times to void

Thromolytic Agents

-Alteplase, -Plase -Break up clots in strokes -Contraindicated inactive bleed, recent trauma, aneurysm, AV malformation, uncontrolled HTN (>180/110). Admin alteplase in these conditions can cause hemorrhage and intracerebral bleed

What can high ammonia lvls cause?

-Altered mental status

Vasectomy

-Alternative birth control should be used till HCP confirms that semen samples are free of sperm

Trach tube emergency

-Always carry 2 spare tubes in case of emergency, once same size and one smaller size. If tube is not easily replaced and meets resistance, then smaller tube used

General Anxiety Disorder

-An anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal -General anxiety

Submersion Injury

-An injury resulting from being under water or other fluid. -Observe them for at least 6 hours

Activated charcoal

-An oral medication that binds and adsorbs ingested toxins in the gastrointestinal tract for treatment of some poisonings and medication overdoses. Charcoal is ground into a very fine powder that provides the greatest possible surface area for binding medications that have been taken by mouth; it is carried on the EMS unit. -But ineffective for lithium, iron, and alcohol toxicity

Low back pain and stiffness that is worse in morning and improves as day progresses

-Ankylosing spondylitis

Anorexia vs Bulimia

-Anorexia: Low wt, Intense fears of gaining wt/distorted body image. Subtypes (Binge/Purge, resticting) -Bulimia: Wt within or above normal range, preoccupied with wt and shape, binge eating and compensatory behavior (purging, exercise, fasting, laxatives)

UTI prevention

-Antibacterial soap should not be used cause it can reduce presence of normal flora -Hair should be washed last

Metronidazole

-Antibiotic -Abstain from alcohol completely and for 3 days after cause can cause disulfiram like reaction (face flush, headache, N/V, ab cramp) -Common side is metallic taste mouth and darkening urine (Brown/rust colored) -Can cause steven johnson (Rash, skin peeling) and need stop asap

Linezold

-Antibiotic for VRE and MRSA -Has MAOI type properties so concurrent use with SSRIS (Paroxetine, fluoxetine, sertraine) increases risk of serotonin syndrome

Oxybutynin, Tolterodine, Solifenacin

-Anticholinergic -Common used to treat overactive bladder -Side effects: New onset constipation, sedation, dry mouth, flushing, heat intolerance, blurred vision, drowsiness, decreased sweat production (may lead to hypothermia so cautious in hot weather and physical activity)

Benztropine

-Anticholinergic med to treat some extrapyramidal symptoms (Side effects of antipsychotic meds that affects a persons gait, movement, posture) >Pseudoparkinsonism: Resemble parkinsonism (shuffle gait, rigidity, resting tremor) >Dystonia: Abnormal muscle movements in face, neck, trunk caused by sustained muscular contractions

Dicyclomine

-Anticholinergic/antispasmodic -Manage symptoms of intestinal hypermotility in pts with irritable bowel syndrome -Contraindicated in pts with paralytic ileus, closed angle glaucoma, urinary retention

Fondaparinux

-Anticoagulant used for DVT and PE prophylaxis after knee/hip replacement or ab surgery -No admin until more than 6 hrs after any surgery and anticoagulants are not given while an epidural catheter is in place -Associated with epidural hematoma (Severe back pain, paralysis) and any bleed in the tight epidural space which does not expand, could result in spinal cord compression

PE maintenance drug

-Anticoagulants such as factor Xa inhibitors (Apixaban, rivaroxaban, dabigatran) are given as maintenance drugs once PE has resolved -Concurrent NSAID use (Indomethacin, ibuprofen, meloxicam) increases risk for bleed

Phenytoin

-Anticonvulsant for seizures -Never stop abruptly or can cause seizure -Stop if have rash and flu-like symptoms that indicates Steven Johnson syndrome which is life threatening hypersensitivity reaction which can progress to multiple organ failure -Need good oral care or else can gingival hyperplasia -Toxicity are neurological manifestations (ataxia, nystagmus, slurred speech, decreased mentation, encephalopathy) -Therapeutic range is 10-20mcg, monitor liver function -Should folic acid and calcium supplementation cause it decreases folic and calcium -Stop feed 1-2 hrs before and afer admin as products contain Ca (Antacids) and or nutritional enteral tube feeds can decrease absorption

Flumazenil

-Antidote drug to reverse sedative effects of benzos

Phentolamine

-Antidote drug used to treat norepi extravasation

Metoclopramide

-Antiemetic for N/V, and gastroparesis by increasing Gi motility and promote stomach emptying -Can cause headache that typically improves -Extended or large doses can cause tardive dyskinesia (Movement disorder characterized by uncontrolled motions like sucking/smacking lip motions, foot tap, tremor, rocking, blinking, puffing of cheeks, twisting movements ) and is often irreversible.

Miconazole

-Antifungal cream to treat vaginal candidiasis, inserted high in vag using an applicator, best applied bedtime -Sex is avoided to inflammation of candidas is resolved

Amphotericin B

-Antifungal med -Associated with severe adverse effects HTN, fever, chills, and nephrotoxicty -Should be given 1 hr after blood transfusion since they both have similar side effects

Nystatin

-Antifungal or candidal infections >Soak dentures in them, assess mouth before giving, swish in mouth for several mins and then swallow the med to allow treat of esophageal candidas, shake well before using, therapy is continued for at least 48hrs after symptoms subside

Loratadine

-Antihistamine

Closed angle glaucoma avoid which meds

-Antihistamines and anticholinergics (Can increase intraocular pressure)

Drugs commonly associated with orthostatic hypotension

-Antihypertensive meds (Metoprolol, Terazosin) -Antipsychotic meds (Olanzapine, riseperidone) -Antidepressants (SSRI)

Hydroxychloroquine

-Antimalarial drug but commonly prescribed to reduce fatigue and treat skin and arthritic (Joint inflame, pain) signs of SLE -Can help reduce lupus exacerbations but takes several months for effects -Adverse reaction are renal toxic and visual disturbances so see ophthalmologist every 6-12months -Can take with food. Osteoporosis not side so no need vit D/Calcium supp

Metronidazle

-Antimicrobial for IBD

Cisplatin

-Antineoplastic (cancer) med that can cause renal toxicity

Baclofen

-Antispasmodic, can be given to MS pts -Dizziness when attempt to stand or change position (Orthostatic hypotension) is common side effect

Influenza Meds

-Antiviral meds (Zanamivir, Oseltamivir) are given to pts with symptoms onset within 48-72 hrs

Descending aortic dissection

-Aortic dissection is tear in the inner lining of aorta which weakens aorta wall and perfusion to vital organs may become impaired, dissection can rapidly progress to cardiac tamponade or aortic rupture. HTN is contributing factor -Sings are ripping chest pain/ab that radiates to back, ripping or tearing pain. -Before surgical repair priority is to decrease risk of aorta repair by maintaining normal BP and admin IV beta blocker helps lower HR and BP

Heart Ausculation Landmarks

-Aortic, pulmonic, tricuspid, mitral hears MURMUR (Blowing, swooshing, or raspoing sounds) -Pericardial friction rub is high pitched, scratchy sound during S1 or S2at apex of heart -S3 gallop is extra heart sound and occurs closely after S2, it's a low pitched sound heard at mitral area

Positive End Expiratory Pressure (PEEP)

-Applies given pressure at end of expiration during mechanical ventilation, counteracts small airway collapse and keeps alveoli open so that they can participate in gas exchange. Increases oxygen saturation. Reduce risk oxygen toxicity/hypoxemia -Can lead to hypotension due to increased intrathoracic pressure which leads to decreased venous return -Usually kept 5cm H2O, however a higher PEEP is effective treatment strategy for ARDS -High lvls PEEP (10-20cmH2O) can cause over-distension and rupture alveoli resulting in barotrauma (too much pressure in the lungs.) to the lung. Air ruptured from alveoli can escape into pulmonary interstitial space or pleural space resulting in pneumothorax or subcutaneous emphysema (The presence of air in soft tissues, causing a characteristic crackling sensation on palpation.)

How to stop nose bleed

-Apply pressure and apply cold -Direct continuous pressure of soft compressible area below nasal bone for 5-15mins -Keep pt in quiet calm -Position upright and tilt head forward

Admin ophthalmic meds

-Apply pressure to lacrimal duct for 30-60secs if med has systemic effects (Beta blocker, timolol maleate)\ -Wait 5 mins before instilling different med into same eye

Naproxen, Indomethacin, Ibuprofen

-Are NSAIDs -Can cause GI toxicity like bleeding such as tarry stools. Kidney injury, HTN/Heart failure cause can retain sodium, Bleed risk

Full liquid diet

-Are all clears and foods that turn liquid at room temp

Allergy Immunotherapy Injections

-Are allergy shots, trigger an increase in bodys production of specific immunoglobulins to reduce pts allergy symptoms when exposed to allergen (Pollen, cat dander, dust mite) -Small doses of allergen are injected subq -Must remain for 30 mins after an injection to monitor for anaphylactic reaction -Given every week for first few months

Condylomata Acuminata

-Are angiogenital warts -Fleshy nontender bumps on genital/anal caused by HPV

Ruptured Cerebral Aneurysm

-Are asymptomatic unless they rupture, are often called silent killers -With rupture will cause abrupt onset of worst headache of my life. Can also experience LOC, neurological deficits, diplopia (Double vision), seizures, vomit, or stiff neck

Premature ventricular contractions

-Are common can be due to stress, hypoxia, electrolyte imbalance, stimulants, fever, exercise

Gastroesophageal Varicies (Peptic ulcers)

-Are distended, fragile blood vessels within stomach and/or esophagus -Risk for variceal rupture which can result in massive GI bleed, hypovolemic shock and death -Rupture can occur in sudden increase in portal venous pressure (Cough, straining, vomit) -NG tube insertion without visualization of esophagus can rupture the varicies causing hemorrhage

Vitamin K in newborn

-Are low immediately after birth and may result in vitamin K deficiency bleeding -That's why need good vitamin k supplementation to promote blood coagulation and reduce risk of life threatening hemorrhage (Circumcision, umbilical stump, brain, intestines) -That's why vitamin K IM injection is recommended for newborns in first hours of life

Full thickness burns >60%of total body surface area

-Are low priority cause gonna die

Calcium and Vitamin D

-Are nutrients in cows milk that's essential for bone development -Calcium foods: beans, dark green veges, calcium fortified cereal and juices -Vitamin D foods: fish oils, egg yolk, vitamin D fortified foods (Orange juice). enhances the absorption of calcium. Is synthesized in the skin by exposure to direct sunlight

Joint dislocations

-Are orthopedic emergencies cause bone may compress surrounding vasculature or cause limb threatening ischemia -Signs include pain, deformity, decreased ROM, and extremity parasthesia (Pins and needles). So should assess neurovascular status

Hormonal birth control pills

-Are progestin containing contraceptives are associated with decreased endometrial risk

Drug Induced Psychosis

-Are transient and mostly don't cause permanent side effects

Trichomoniasis and candidiasis

-Are yeast infections -Can lead to vaginitis

Endometrial Cancer

-Arises from inner lining of uterus and forms after development of unregulated endometrial overgrowth (Hyperplasia) -May metastasize to nearby structures and beyond pelvis -Signs are low back/ab pain and hallmark symptom is abnormal uterine bleed (Heavy, prolonged, intermenstrual, and/or postmenopausal bleed) -Prolonged estrogen exposure without adequate progesterone is greatest risk factor -Other risks are polycystic ovary syndrome (A hormonal disorder causing enlarged ovaries with small cysts on the outer edges.), infertility, late menopause, early menarche, obesity, tamoxifen

Amniotomy

-Artificial Rupture of membranes to augment or induce labor -Can cause risk for umbilical cord prolapse which can cause fetal bradycardia due to cord compression so should assess FHR before and after procedure -Assess amniotic fluid which should be clear and odorless, monitor pts temp every 2hrs -Should be upright position after procedure to promote drainage of amniotic fluid and encourage fetal head to remain firmly applied to cervix

Volkmann Contracture

-As result of compartment syndrome associated with distal humerus fractures -Causes wrist contracture and inability to extend fingers

Stairs and can

-Ascending first strong leg up stair, then cane, then weak leg -Descending First can lower step, then weak leg, then strong leg -Following total knee replacement pts can fully bear weight by time of discharge

Guillain Barre Syndrome

-Ascending symmetrical paralysis, can move upward rapidly or slowly (From hours or to days) -Can have paralytic ileus too -Absence of reflexes -Respiratory compromise is worst complication (Measurement of serial bedside forced vital capacity; spirometry is gold standard) -Autonomitc dysfunction can occur too

Sources of folic acid

-Asparagus, turnip/mustard green, fortified breakfast cereal, cook dried beans, liver, broccoli, spinach, green peas, fresh cooked beets, fortified spaghetti/pasta, rice, tomato juice, orange, sunflower seeds, peanut butter, enriched salad

Interventions to reduce aspiration risk in enteral tube feed

-Assess GI intolerance feeding q 4 hrs by monitor gastric residual, ab distend, ab pain -HOB 30-45 degrees -Keep endotrach cuff inflated -Monitor for over sedation which slows gastric emptying and reduce gag reflex -Avoid bolus feeds to pts at high risk aspiration

Intubated and Oxygen drops

-Assess lung sounds first to confirm tube placement or pneumothorax -Manual vent or increased O2 wont help if tube displaced

Intrauterine Devices (IUD)

-Assess string position weekly for first 4 wks and then after each menses, a longer, shorter or missing strong may indicate IUD no longer in uterus. SO abstain from sex unless barrier like condom is used -IUD integrity not affected by lubricants. But if guy wearing condom then use water based lubricants cause oil based can weaken condom -Copper IUD (Paragard) provides 10yrs contraception, Levonogrestrel-Releasing IUD provides 3 years -Signs of IUD complications are Period abnormal (late, missed, irregular, light, heavy). Ab pain and pain sex, infection, not feeling well (fever, chills), string longer, shorter, missing -Adolescents can have it too

Bishop Score

-Assesses and rates cervical favoribility and readiness for induction of labor -Higher the bishop score means increase in likelihood of successful induction that results in vag birth -For nulliparous women 6 or higher means induction will be successful

Unit Quality Improvement Committee

-Assesses process standards (Guidelines, systems, and operations) and clinical issues on a specific unit that affect delivery of pt care and pt outcomes >Meds prescribed STAT are not available in a timely manner >Catheter associated bacterial infection are increasing within the unit

Case Manager

-Assesses, plan, facilitate, and advocating for client health services to accomplish cost effective quality client outcomes -Case manager in hospital setting assesses pt needs, decreases fragmentation of care, helps to coordinate care and communication between HCPs, makes referrals, ensures quaity standards are being met, and arranges for home health placement after discharge -Case managers do not provide direct client care -Case managers often make daily rounds to nursing department to revoiew documentation in ptschart but do not visit pt personally

Taking care of pts with radiation exposure

-Assist victims farthest away from the exposure source first since they have more chance to live than those who were closest to exposure who are more likely to die

Play in preschoolers (age 3-6)

-Associative play where they engage in similar activities or play with the same or similar items but play is unorganized without specific goals or rules -Often borrow items from each other without directing each others play -Also enjoy involving motor activities and imaginative, pretend play

Latent TB

-Asymptomatic -Cannot transmit -Has positive tuberculin test , normal chest X-ray, negative sputum/culture -Complete full course of treatment in this phase can prevent activation of disease -If take corticosteroids (Prednisone) then increased risk for activation -Malignancy, immunosuppresant meds, chemo, prolong debilitating disease (HIV) can convert to active

Colostomy care

-At least 3,000mL/day of fluids -Eliminate foods that cause gas and odor (Broccoli, cauliflower, dried beans, Brussels sprouts) -Empty pouch when become one third full to prevent leaks due to increasing pouch wt -Stool in ascending and transverse colon is semiliquified which eliminates need for irrigation, but stool in descending and sigmoid is more formed and can benefit from irrigation

Sepsis

-At risk for developing DIC a condition that initially causes clotting within the micro-vessels. Platelet and clotting factors are consumed in clotting and become unbelievable for body use leading to bleeding complications. Signs include venipunture bleed, internal bleed (petechiae, ecchymosis, heamturia, bloody stools), and respiratory distress (bleed/clot in lungs) >Blood and platelet transfusion needed

Accidental dislodge of trach tube

-Attempt to open airway by inserting curved hemostat to maintain stoma patency and insert new tracheostomy tube with an obturator

Bupropion

-Atypical antidepressant -Is sustained release and extended release tabs so should not be chewed or crushed -Seizures are concern if pts takes high dose or toxic dose of this med -Take med same time each day, take several wks to feel effects, wt loss may occur

Ziprasidone

-Atypical antipsychotic for acute bipolar mania, acute psychosis, and agitation -Risk for QT prolong which leads to torsade de pointes so baseline ecg and potassium usually checked and also be monitored for hypotension and seizures

Clozapine

-Atypical antipsychotic for schizo -Drooling is side effect -Can cause agranulocytosis which can casue dangerously low WBC -Must have 3,500 or more WBCs and absolute nuetrophils 2,000 or more before starting this drug

Nephrotic Syndrome

-Autoimmune disease, increased permeability of the glomerulus to proteins which leads to proteinuria (Albumin, immunoglobulins), and hyperlipidemia (Due to liver producing increased lipids and proteins to compensate for protein loss) -Loss of albumin in urine leads to hypoalbuminemia which allows fluid to leak out of vascular spaces and causes edema, wt gain, loss appetite (from ascites), decrease urine output -The loss of immunoglobulins causes increased risk for infection -Treatment includes coricosteroids, loss of appetite management (Making foods fun and attractive), infection prevention (limiting social interaction till child in remission) -Sodium free diet to decrease edema, fluid restriction in cases of edema or rapid wt gain, high risk for relapse so caregiver should test daily for proteinuria and weigh weekly

Immune thrombocytopenic purpura

-Autoimmune which destroys platelets -Less then 150,000 platelets and increased risk for bleed, can cause petechiae under skin due to leakage of RBCs which are common -Reduce bleed risk: Soft bristled toothbrush and nonalcoholic mouthwash, avoid high intensity sports, use electric razors, avoid NSAIDs

Systemic Lupus Erythematosus (SLE)

-Autoimmune, has flare and remission episodes -Causes flat or raised red rash that forms butterfly shape across bridge of nose and cheeks -Avoid contact sick ppl and report if fever -Extreme fatigue, painful swollen joints, cleanse area with mild soap -Often related to sunlight exposure, stress can cause it too -Recurrent oral ulcers also common -Can affect skin, muscles, joints but in severe cases can affect kidneys, heart, lung, blood vessels, CNS -Lupus Nephritis can cause increased BUN, Creatinine, and can lead to irreversible kidney damage -Anemia, mild leukopenia are often present in SLE

Huntington Disease

-Autosomal Dominant (require only one copy of the affected gene [from one carrier parent] to cause disease 50% chance) -Hereditary disease that causes progressive nerve degeneration which results in impaired movement, swallow, speech, cognitive abilities. No cure. -Chorea (Involuntary tic like movement) is a hallmark sign -Onset of active disease is usually at age 30-50 and death from respiratory complications typically occur within 20 years of diagnosis

BPH

-Avoid caffeine and antihistamines

Heart failure and NSAIDs

-Avoid cause NSAIDs can retain sodium which retains fluid

Prevent recurrent UTIs

-Avoid spemicidal contraceptive jelly as it can suppress production of protective vaginal flora -Discontinue diaphragm use temporarily (till symptoms subside and antibiotic course is completed); diaphragm increases pressure on urethra and bladder neck which may inhibit complete bladder emptying

Macrolide Antibiotics

-Azithromycin, Erythromycin, Clarithromycin -All of them lead to prolong QT interval which may lead to sudden cardiac death due to torsades de pointes

Obesity

-BMI 30kg or more

Hypertensive Crisis

-BP >180/120 -Can develop hypertensive encephalopathy includes severe headache, confusion, N/V, and seizure -Can risk of end organ damage (hemorrhagic stroke, kidney injury, HF, papilledemia (Optic nerve swelling))

Common discomforts of preg

-Backache, pelvic pressure, earache, sinus congestion

Mitral valve Regurgitation

-Backflow of blood from left ventricle through mitral valve into left atrium. Can lead to dilation of left atrium, reduce cardiac output, and pulmonary edema -Often asymptomatic but need to report new symptoms indicative of HF (dyspnea, orthopnea, wt gain, cough, fatigue) -Can lead to HF

Droplet prec

-Bacterial meningitis (Neisseria Meningitis, Meningococcal Meningitis, Haemophilus Influenzae type B meningitis) -Diphtheria -Mumps -Rubella -Pertussis -Group A strep (Strep Throat) -Viral Influenza -Haemophilus Influenzae type B

Foods to eat during preg

-Balanced diet with folic acid, protein, whole grains, iron, and omega 3 fatty acids -Avoid unpasteurized milk products, unwashed fruits and veges, deli meats and hot dogs (Unless heated until steaming hot), and raw fish/meat. Also avoid fish high in mercury (shark, swordfish, king mackeral, tilefish), liver should be avoided cause high vitamin A which is teratogenic.

Latex in

-Banana, avocado, chestnuts, kiwi, strawberries

Cervical Cap

-Barrier method of contraceptive used with spermicide -Reusable placed over cervix before intercourse to block sperm from uterus. To allow sperm to die cap needs to remain in place for 6hrs or more after sex but should not remain more then 48 hrs -Spermicide needs to be inside cap, along the rim, and in the groove -Use during menses increase risk of toxic shock syndrome

Fetal Tachycardia

-Baseline of >160beats/min for >10min

Neutropenia Pts

-Bathe daily to remove pathogens that cause infection -Moisturizer should be applied to prevent dry skin

Insulin pump

-Battery operated size of pager -Pt will have fewer swings in blood glucose levels and hypoglycemic episodes -Will have to admin bolus dose prior mealtime manually tho -Check blood glucose at least 4 times aday

Preterm labor

-Before 34 wks gestation, uterine contractions before term gestation -Interventions include >Admin IM antenatal glucocorticoids (Betamethasone, dexamethasone) to stimulate fetal lung maturation and promote surfactant development >Antibiotics (Penicillin) to prevent group B strep in newborn if birth occurs >IV MG sulfate for fetal neuroprotection <32 wks gestation >Tocolytic meds (Nifedipine, indomethacin) to suppress uterine activity so antenatal glucocorticoids have time to take effect -Goal is to prolong preg if possible

Preterm birth

-Before 37 wks -Infection is strongly associated with it -Risk factors include history of spontaneous preterm birth in previous preg (Single largest independent risk factor), previous cervical surgery like cone biopsy, tobacco or illicit drug use, maternal age less then 17 or older 35 -Non Hispanic black women have highest risk

Rehab phase for burns

-Begins after pt wounds have fully healed and lasts about 12 months >Gentle massage with water based lotion to alleviate itch and minimize scarring >Pressure garments to prevent hypertrophic scars and promote circulation >ROM to prevent contractures >Sunscreen and protective clothing

Delusions of Control

-Belief that outside forces are controlling one's body or actions -Don't drink the tap water, that's how to government controls us

Delusions of Nihilistic

-Belief that self, part of the self, or others is non-existent -It doesnt matter if I take my medicine, I'm already dead

Ages 3-5 beliefs about death

-Believes that death is reversible -Thought may include magical thinking and fantasy (They wish that a person would die)

Persecutory Delusions (Paranoid Delusions)

-Believes they being perscuted or harmed (Spied, cheated, folllowed, poisoned) -Be empathetic and focus on pts feelings -Focus the patient to reality and reinforceit verbally todecrease time pt thinki delusions -I know it is frightening to know someone is trying to poison you, what you are thinking is part of your disease and not real -Don't explore meaning behind delusion or will cause pt to focus more on it

Lipomas

-Benign -Fatty masses are SUBQ have soft doughy feel and mobile and asymptomatic

Fibroedema

-Benign breast disorder -Small, round, painless mobile lumps

Congenital Dermal Melanocytosis (Mongolian Spots)

-Benign discoloration of skin seen in newborns o ethnicities of darker skin tones -Are bluish gray and fade over first 1-2yrs -Misidentified as bruises -Measure and document area for reference

Fibrocystic Breast Changes

-Benign, correlate to estrogen/progesterone fluctuations during menstrual cycle -May have cysts, nodules, or lumps that are more tender, swollen, and/or noticeable prior to menses -Results after menopause -Breast changes not related to menstrual cycle should be reported

Anticholinergic meds

-Benztropine, trihexyphenidyl -Treats tremors in Parkinsons -Constipation is common side effect -In pts with BPH or glaucoma caution must be taken as these drugs can precipitate urinary retention and acute glaucoma episode, so they're contraindicated

Petechiae in African American

-Best assessed in the conjunctivae of eyes and buccal mucosae

Fiber

-Binds to cholesterol in intestines and reduces serum cholesterol in bloodstream -Helps absorb and retain water which increases stool bulk and makes stool softer and easier to pass

Sensorimotor (Piaget's Stages of Cognitive Development)

-Birth to 2 years -Learning by sense and movement, exploration, early verbal skills

Infant Growth

-Birth wt doubles by age 6 and triples by 12 months -Posterior frontanelle fuses by age 2 and anterior frontanelle fuses by 18 months

By 12 months of age

-Birth wt tripled, sit to stand with no assistance, pincer grasp is develops (8-10months) and fully developed at 12 months

ChronicSubdural Hematoma

-Bleed in subdural space can occur several wks to months following mild head trauma, or elderly taking anticoags -Signs are headache, gait disturbance, memory loss, decreased LOC

Hip (joint) replacement complications

-Bleed, prosthesis dislocate, DVT, infection -Carry serious risk of blood loss so should check drainage device and dressing frequently to monitor blood loss especially during first few postop hours -Make sure dont flex affect hip more then 90 degrees

Hemophilia

-Bleeding disorder caused by deficient coagulation proteins -Bleed easily and most frequent sites of bleed are joints (hemarthrosis) especially knee -Can also risk for intracranial bleed (lethargy, headache, vomit, irritability) -Avoid procedures that causes bleed (IM, rectal temp). So cavvines are given SUBQ and continuous pressure applied for 5 mins, and avoid NSAIDs -Desmopressin stimulates release of factor VIII -Hemophilia A lacks factor VIII -Hemophilia B lacks factor IX

Testicular Torsion

-Blood flow testes (Scrotum) has stopped -Can cause swelling and severe pain and can lead to testicular ischemia and necrosis -Needs to be treated within 4-6hrs

Diarrhea caused by E.coli

-Blood streaked stool is common symptom -Fruit juices discouraged, continue pts normal diet (Solid foods)

Serum Alpha-Fetoprotein (AFP)

-Blood test to screen for fetal neural tube defects

Urosepsis

-Bloodstream infection that originates from urinary tract

Hookworms

-Bloodsucking roundworms contracted from larvae in contaminated soil -Infect intestines causing intestinal bleed and anemia

Sanguineous Drainage

-Bloody drainage (Fresh bleeding) -Bright red and thick -Damage to blood vessels, may occur due to trauma, or on anticoagulants -Should stop after few hours -If saturated a lot then is important could be hemorrhage

Multiple Sclerosis Exacerbations

-Blurred vision, weakness, Numbness and tingling -Treated with corticosteroids -Dehydration and extremes in temp causes symptom exacerbation

Myelodysplastic Syndrome

-Bone marrow disorders that are characterized by the insufficient production of one or more types of blood cells due to dysfunction of the bone marrow (Low platelets, WBC, hemogloblin)

Polycythemia Vera (PV)

-Bone marrow produces high lvls RBC and can develop blood clots -Treatment include periodic phlebotomy to remove 300-500mL blood and to achieve hematocrit <45%. Aspirin used to help relieve pain and also antiplatelet effect -Pruritis is common often after bathing so should bathe with cool water and pat dry -Venous stasis causes skin on face, hands, and feet to be ruddy (red) -Secondary Polycythermia can occur in pts with lung disease -In COPD have low oxygen and to compensate body produces more RBC to carry needed oxygen to cells

Hirschsprung Disease

-Born with some sections of distal large intestines missing nerve cells therefore no peristalsis and stool is not passed -Can have distal intestinal obstruction and will not pass meconium within the expected 24-48hrs -They have difficult feed and often vomit green bile -Surgical removal of defective section colon is necessary and colostomy may be required -Fatal complication is Hirschsprung enterocolitis (Inflammation of colon which can lead sepsis and death. Presents with fever, lethargy, explosive foul smelling diarrhea, rapid worse ab distend) -Have thin ribbon like stools

Internal Radiation Implant

-Brachytherapy -Emits radiation in or near tumor site, monitor for implant dislodgement -Used for short time (24-72hrs) -Staff should spend 30min per shift in room and wear dosimeter film badge -All visitors and staff needs to keep 6ft distance is standard, keep door closed, remain bedrest to prevent dislodgement -Must wear lead apron fro staff

What can straining while pooping cause?

-Bradycardia due to vagal response

Proper breastfeeding and latch technique

-Breastfeed every 2-3hrs (8-12 times/day) -Breastfeed on demand whenever newborn exhibits hunger (sucking, rooting reflex) -Position newborn tummy to tummy -Ensure proper latch(Grasps both nipple and part of areola -Feed for at least 15-20min per breasts -Insert clean finger beside newborn gums to break suction

Pneumothorax Lung Sounds

-Breath Sounds: Decreased or absent -Tactile Fremitus: Decreased -Percussion: Hyperresonant

Normal Lung sounds

-Breath sounds: Bronchovesicular (Hilar), vesicular (Peripheral) -Tactile fremitus (Palpable vibration): Normal -Percussion: Resonance

Emphysema Lung Sounds

-Breath sounds: Decreased -Tactile Fremitus: Decreased -Percussion: Hyperresonant -And prolonged expiration

Atelectasis (Mucus Plug) Lung Sounds

-Breath sounds: Decreased or absent -Tactile Fremitus: Decreased -Percussion: Dullness

Pleural Effusion Lung Sounds

-Breath sounds: Decreased or absent -Tactile fremitus: Decreased -Percussion: Dullness

Consolidation (Lobar Pneumonia) Lung Sounds

-Breath sounds: Increased crackles -Tactile fremitus: Increased -Percussion: Dullness

Osteogenisis Imperfecta

-Brittle bone disease due to impaired synthesis of collagen by osteoblasts. Can be easily fractured -Interventions check BP manually to over tighten cuff, lift infant by slipping one hand under broadest areas like back and buttocks reposition infant frequently using supportive devices and gel padding to avoid molding of the soft bones and skull

Raccoon eyes

-Bruising around the eyes, indicative of a basilar skull fracture and potential CSF leak

Basilar Skull Fracture

-Bruising behind ear (Battle sign), raccoon eyes, CSF rhinorrhea from nose, CSF leak from ears

Bubbling in chest tube

-Bubbling in the suction control chamber (Section A) Indicates suction is present and functioning properly -Air leak would be in Section C (Air leak gauge) or in the water seal chamber

Tick bite (Causes lime disease)

-Bulls eye like rash -Flu-like symptoms (headache, fever, myalgia, fatigue) -Prophylactic antibiotics prescribed as disseminated lyme disease can develop if untreated -Remove using tweezers -Complications are carditis, chronic arthritis, meningitis, facial paralysis)

IV opioid during labor

-Butorphanol tartate -Give birth 2-4hrs after admin so have time to wear off before the birth -Best used in active labor or those with well established contraction pattern

Bowel and bladder sphincter control

-By 24 months

Infant Botulism

-C.botulism spores in honey can release a toxin that causes botulism in infants if they ingest honey -Causes progressive paralysis and lead to respiratory failure and death -Admin IV botulism IG, mech vent, enteral feed -Signs are constipation, weak, difficult feed, decreased gag reflex, ptosis, decreased salivation, paralysis, decreased head control, diminished DTR -Dont give ig <12 months

Second generation NSAIDs

-COX-2 inhibitors (Naproxen, celecoxib) can increase risk for thrombotic events

Diet rich in protein and vitamin D helps with what absorption

-Calcium

Spinal cord compression

-Can be caused by metastatic tumor (Back pain, motor weakness, sensory changes like numbness, paresthesia). Also can cause autonomic dysfunction like bowel or bladder dysfunction

Ventilator Associated Pneumonia

-Can be caused due to sedation and impairment of natural defenses (coughing) -Interventions: elevate HOB 30-45, oral care with antiseptic solutions and suction subglottic secretions, perform daily sedation vacations (weaning), endotrach cuff pressure >20cm, avoid PPI and histamine receptor blocking agents

Placental Abruption

-Can be complication of preeclampsia related to HTN -Placenta separates prematurely from uterine wall causing hemorrhage -Signs are ab or back pain, uterine contractions, uterine rigidity, dark red vag bleed -Priority assessment is assess maternal vitals, palpate ab, and continuous FHR mpnitor -Tachysystole (excessive uterine contractions) is often present -Can decrease in placental perfusion and fetal death -Immediate C section

Peritoneal Dialysis Insufficient flow

-Can be due to constipation when distended intestines block the catheter holes. If outflow becomes sluggish the nurse should assess the pts bowel patterns and admin appropriate prescribed meds (Stool softeners) -Check for tubing kinks and reposition to side lying position or assist ambulation -Assess for clots and milk the tubing of drainage bag to dislodge or admin fibrinolytics (alteplase)

Symptoms of hyponatremia in infnat

-Can be due to water intoxication -Can show signs of irritability, lethargy and in severe cases seizures

Fine crackles

-Can be expected in pts who underwent ab surgery due to shallow breathing related to pain -Treat with ambulation, deep breathe

Fentanyl

-Can be given if allergic to codeine

PostPartum Hemorrhage

-Can be primary (<24 birth) or secondary/delayed (>24hrs birth). Secondary usually from uterine subinvolution (Uterus does not return to normal size), retained placental fragments, or uterine infection -Can occur immediately after birth of placenta or in hours or days following birth -Risk factors are grand multiparity (5 births or more), intrauterine infection, prolonged labor, use oxytocin during labor, macrosomic infant >8lbs, polyhydraminos, general anesthesia, over-distention of uterus -Perineal pad that saturates in 1 hr or less indicates excessive and heavy bleed and can be due to uterine atony (Not contracting). Must assess fundus tone, lochia amount, notify HCP -If excessive bleed persists after initial interventions (firm fundal massage, oxytocin bolus) second line uterotonic drugs (carboprost, misoprostol, methylergonovine) may be given -Methylergonovine is contra in HTN (preeclampsia, preexisitng HTN) cause vasocontrsicts and lead to further HTN, stoke, clots

IV sodium bicard

-Can be used after admin of activated charcoal for aspirin toxicity -Given to make blood and urine more alkaline

QuantiFERON-TB Blood test

-Can be used as an alternative to the TST -Advantages are fewer false positive results, only single client visit is required, results available 24hrs

Hawthorn Extract

-Can be used to treat HF

Aspirin

-Can cause GI bleed, bruising, coffee ground emesis, tinnitus (ringing in ears)

Hypetonic TPN Formulas

-Can cause N/V/D, similar to dumping syndrome so slow down the rate of administration

Spinal TB

-Can cause back pain

Poison Ivy

-Can cause contact dermatitis rash in those who are sensitive to the oily resin found on the leaves. Linear in appearance -Rash develops 24-48hrs and can last several weeks -Most important thing is to wash area thoroughly and remove resin to prevent its spread to other areas of body

High fowloers after anesthesia

-Can cause decrease in BP and dizzy

Prolonged vomit

-Can cause dehydration and decrease in sodium and potassium (Muscle cramp, muscle weak, can lead to dangerous cardiac arrythmias)

Radiation thyroiditis and parotitis

-Can cause dryness and irritation to mouth after RAI -Take sips water or use salt and soda gargle solution 3-4 times daily to relieve symptoms

Extrapulmonary genitourinary TB

-Can cause dysuria

Milk

-Can cause excessive calcium which interferes with iron absorption -Overconsumption of milk leading cause of iron deficiency in young children

Bacterial Meningitis in Infants and children

-Can cause fever, restless, high pitched cry -Common comlpication is hydrocephalus (Increase in ICP) -Bulging/tense frontanels and increased head circumference are important indicators in children

Circumcision

-Can cause hemorrhage, infection, void difficult -Clean area with warm water without soap -Site heals 5-6 days, then can use alcohol based wipes -Immediately after procedure glans penis is dark red and after 24 hrs will be covered with yellow exudate, do not wipe or remove exudate that will persists 2-3 days and is normal healing process. But redness, swelling, odor and discharge can indicate infections -Diapers changed when soiled or every 4 hrs and petroleum gauze should be applied at every diaper change -Bleeding should not exceed size of quarter -If no void within 6-8hrs then notify HCP

Heart failure

-Can cause high BNP

Parathyroidectomy

-Can cause hypocalcemia cause parathyroids regulate calcium -Trousseaus sign (Upside down Italian fingers) may indicate hypocalcemia and can be elicited by placing BP cuff on arm and inflating it to pressure higher than SBP and holding for 3 mins. This will occlude brachial artery and induce a spasm of muscles of hand and forearm when hypoglycemia is present -Chevostek sign may be elicited by tapping face at angle of jaw and observing for contraction on same side of face

Beta 2 adrenergic agonists (Albuterol, Salmeterol)

-Can cause hypokalemia and tachycardia, insomnia, N/V, mild tremor

Paracentesis effcts

-Can cause hypotension -IV albumin may be given which increases intravascular fluid which prevents hypotension and tachycardia

Cdiff

-Can cause hypovolemia (hyponatremia, Hypokalemia, elevated BUN) -Hypovolemia can cause renal fail

Glucocorticoid Meds

-Can cause increase in WBCs and blood glucose -Can cause fluid retention and worsening HTN -Slowly taper off to prevent adrenal crisis -Taken with NSAIDs can increase risk peptic ulcers

Licorice Root

-Can cause increase in potassium loss if used with diuretic

Metformin

-Can cause lactic acidosis in pts with kidney disease -Contract used to CT scan can cause kidney injury so recommended metformin held before and resumed 48hrs after CT scan -Increases sensitivity of insulin receptors in cells and reduces glucose production by liver. Does not stimulate insulin production so risk of hypoglycemia is minimal. Skipping meals would no cause drop in blood glucose and would not cause further hypoglycemia

Hypermagnesemia

-Can cause loss of DTR

Postoperative cognitive dysfunction

-Can cause memory impair and problems with concentration, language comprehension, and social interaction -Some pts may cry and become teary -Can occur days to wks following surgery and most resolve after complete healing has occurred

B12 Deficiency

-Can cause peripheral neuropathy (Tingling, numbness), nueromuscular impairment (gait problems, poor balance), memory loss/dementia (in cases of severe/prolonged deficiencies) -If vegan take vitamin B12 fortified foods (Cereals, grain products, soy and nut milks)

Amiodarone

-Can cause pulmonary toxicity which is life threatening (Dry cough, plueritic chest pain, dyspnea)

Thyroid Surgery

-Can cause respiratory distress as a complication, causes swelling which compresses airway and stridor and or difficulty breathing should be reported imediately

Increased ICP

-Can cause unexpected and projectile vomiting, vomit is due to pressure changes in cranium and not nausea, so anti nausea meds are not effective, decreases the ICP will help -HOB should be raised to 30 degrees so high enough to allow for CSF drainage but low enough for to maintain cerebral perfusion

MIgraine

-Can cause unilateral pulsating headache and sensitive to light

Hypomagesemia

-Can cause ventricular arrhythmias (torsades de pointes) which is priority -Tremors, hyperactive reflexes, positive trousseau and chvostek signs, seizures

Syphillis during preg

-Can cross placenta which can cause fetal harm or death -IM penicillin is only available treatment during preg

Substituting sodium for potassium

-Can decrease BP and fluid retention

Hypercoagulability Postpartum

-Can develop in DVT, so use anticoagulants

Pancreatitis

-Can develop respiratory complications including pleural effusions, atelectasis, and acute respiratory distress -Presence of inspiratory crackles could indicate ARDs which can lead to respiratory failure quick

Urethral catheter

-Can dislodge a visible obstruction by milking tubing

Cyanide Poisoning

-Can have bitter almond smell

Adenotonsillectomy

-Can have ear pain after which is normal finding

Chronic kidney disease and contrast

-Can have elevated creatinine and are unable to excrete iodinated contrast admin for CT scans and can cause toxicity

Ventricular Tachycardia

-Can have pulse or no pulse -If on ECG shows this rhythm, check if pulse first before any intervention -If have pulse (Stable) then treat with antiarrhythmic meds (Amiodarone, procainamide,sotalol) -If has no pulse (Unstable) then synchronized cardioversion

Blue Cyanotic Toes

-Can indicate impaired arterial blood perfusion (Arterial embolism) or severely reduced blood flow

Warm spot and odor from cast

-Can indicate infection under cast

Inconsolable crying and drawing up legs

-Can indicate intussusception or some abdominal pathology (appendicitis)

Bacterial meningitis

-Can lead to increased CSF and increased ICP and can cause hearing loss, visual impair, paralyiss, brain herniation, death -Signs are fever, severe headache, N/V, nuchal rigidity -Maintain HOB elevated at 30 degrees with head and neck midline to reduce ICP, seizure prec, reduce stimuli, droplet prec -CT scan before lumbar puncture cause if increased ICP then lumbar puncture can risk of brain herniation -Admin empiric antibiotics within 30mins admission cause will decline without antibiotic therapy -Can have nuchal rigidity and positive kernigs (Extending knee while hip is flexed causes pain) and brudzinksis sign (Flex hips and knees when neck is flexed)

Gonorrhea and Chlamydia

-Can lead to pelvic inflammatory disorder and infertility -The silent infections cause mostly asymptomatic -Infection of fallopian tubes and uterus can lead to permanent damage -Should be screened annually

A new S3 heart sound

-Can mean HF

Third Spacing

-Can occur 24-72 hrs after extensive ab surgery as result of increase capillary permeability due to tissue trauma -When too much fluid moves from intravascular into interstitial third space, a place between cells where fluid does not normally collect (Injured site, peritoneal cavity) and leads to decreased circulating volume (hypovolemia) and cardiac output -Priority is asses vitals as sings are wt gain, decreased urine output, tachycardia, hypotension

Umbilical Cord Prolapse

-Can occur after rupture of membranes -Need to inspect vag area and perform sterile vag exam to assess prolapsed cord -Emergency C section usually required -Position knee to chest or trendelenburg to relieve pressure on compressed cord

Perinatal transmission of HIV

-Can occur anytime so maternal antiretroviral therapy during preg is important for decreasing viral load and decrease risk transmission to fetus -Breastfeed contraindicated if mom HIV positive -Infants born to HIV moms need to receive ART at birth and for at least 4-6wks after birth

Delirium

-Can occur in hospitalized pts -Reversible, acute onset -Quiet, disorientation, change in LOC, memory loss, restless, agitation, hallucination, paranoia

Red Man Syndrome

-Can occur with rapid IV vanco admin -Flushing, erythema, and pruritus, typically on face, neck, and chest. Hypotension. Should slow down infusion or stop it depending on severity. -Usually related to infusion reaction and not allergic reaction -Can be reduced by infusing vanco over minimum of 60 mins -Anaphylactic reaction is hives, angioedema, wheeze, and respiratory distress. Red man syndrome does not have these. Give EPI. Slowed rate or pre med will not prevent future anaphylactic response

Thoracic Aortic Aneurysm

-Can put pressure on esophagus and cause dysphagia (Difficulty swallowing), may indicate aneurysm size has increased

Hep B in pregnant client

-Can risk infection to newborn -Most important to provide Hep b vaccine and hep b immunoglobulin within 12 hrs birth -Breastfeeding does not affect newborn and can be done

For sterile dressing change

-Can use Sterile bottle saline if opened within 24hrs if policy permits

NSAIDs and asthma

-Can worsen asthma symptoms

Multiple Myeloma

-Cancer of bone marrow causing bone degeneration and skeletal pain in spin, pelvic, and rib with physical activity

Lymphoma

-Cancer that begins in bodys lymphatic system (Lymph nodes, spleen) and causes abnormal growth of lymphocytes -There is Hodgkins (Reed Sternberg is diagnostic) which follows a predictable path of metastasis and non Hodgkins (More widely disseminated metastasis) -Most common sign of any form of lymphoma is presence of at least one painless, enlarged lymph node often in neck, underarm, or groin -May also have fever, significant unintentional wt loss, and drenching night sweats

Orthodox Judaism (Kosher dietary laws)

-Cant eat pork, shellfish, and fish without scales -Need to separate meat/poultry from dairy -When meat/Poultry consumed, at least 3-6hrs must pass before dairy product is consumed -Cannot eat gelatin so most capsules are non kosher, try to find alternate form of the drug thats non gelatin (tablets) by asking pharmacist

Pacemakers

-Carry pacemaker ID card -Avoid lift arm above shoulder on side of pacemaker until approved by HCP -Microwave ovens safe to use

Why statins taken evening

-Cause cholesterol synthesized by liver during fasting state, at night

Heparin Induced Thrombocytopenia

-Cause drastic decrease in platelets and paradoxical increase for risk of thrombosis

Human Papillomavirus (HPV)

-Cause genital warts and cervical cancer -Often asymptomiatic and painless -Prevention include vaccination before sex begins -Recommend age to vaccine is boys/girls 11-12 -Can spread through skin to skin contact even with use of condoms -Need annual papanicolaou test

Tapeworm

-Cause poor appetite, inadequate absorption of nutrients from food and wt loss

During shock why is there low urine output?

-Cause the kidneys decrease filtration and increase reabsorption to maintain BP

Lung contusion (Bruised lung)

-Caused by bunt force to lung (chest hits steering wheel) -Life threatening cause bleeding into lung and alveolar collapse can lead to ARDs -Monitor 24-48hrs as symptoms (dyspnea, tachypnea, tachycardia) are usually absent initially but develops as bruise worsens -Inspiratory chest pain can lead to hypoventilation and O2 sat of 90% indicates hypoxemia

Skin cancer

-Caused by damage to skins DNA from UV light -Avoid sun between 10am and 4pm -Pts can burn in shade or even outdoor winter activities -Use broad spectrum sunscreen -SPF 30 or more for outdoor, should be applied 15-30 mins prior sun exposure and reapplied every 2 hrs -Should be reapplied after swim even if waterproof -Avoid tanning beds

Infectious Mononucleosis

-Caused by epstein-barr virus -Sharing drinks, kissing, or other direct exposure to saliva -Signs are fatigue, sore throat, splenomegaly, swollen nodes -Treat is management of symptoms (hydration, rest is important, control pain like ibuprofen or acetaminophen, reducing fever, saline gargles) -Spleen rupture is serious complication that can present with sudden onset of upper left quadrant ab pain, so contacts sports should be avoided -Complications are airway obstruction from swollen lymph nodes

Cirrhosis

-Caused by overworking the liver trying to assimilate large amounts of alcohol which scarring of the liver -Increased risk for esophageal varicies which increases risk for hemorrhage -Can be itchy due to buildup bile salts beneath skin -Also risk skin breakdown due to edema -Give baking soda baths, calamine lotion, cool wet cloths -Cholestyramine may prescribe to increase excretion of bile salts in feces, must be mixed with food or juice and given 1 hr after all other meds -Alters blood flow though liver and decrease liver function. Can cause elevated bilirubin (Jaundice), cannot produce factors for clotting, cannot excrete ammonia and causes ammonia levels to rise (Can cross BBB and result in hepatic encephalopathy) -Will not be able to make albumin so low lvls -Spider angiomas (Small dilated blood vesselswith bright red centers), gynecomastia, testicular atrophy, palmar erythema are expected findings

Pheochromocytoma

-Caused by tumor in adrenal medulla. Results in excess release of catecholamines such as epi and norepi leading to paroxysmal hypertensive crisis -Considerations for these pts >HTN difficult to treat and often resistant to multiple drugs, avoid activities that can precipitate hypertensive crisis (Bend, lift, valsalva), ab palpation should be avoided

Megaloblastic anemia

-Caused by vitamin b12 or folic acid deficiency -Vitamin B12 is only found in animal foods -Natural sources of B12 include meat, fish, poultry, eggs, milk -Vegans pose highest risk for B12 deficiency, vegetarian asl risk too but vegan higher risk

Infective Endocarditis

-Causes formation of vegetation on valves and endocardial surfaces. Embolization to various organ sites can occur. Slurred speech could indicate emboli has caused possible stroke, can also cause ischemia to extremities (Pain, pallor, and cold arm/foot) -Can have fever, joint pain -Splinter hemorrhages can occur due to vessel damage from swelling of blood vessels or tiny clots that damage the small capillaries (microemboli) -IV antibiotics for up to 4-6wks and may need to continue receiving it when discharged home

Cold Stress

-Causes metabolism to increase and generate heat causing greater demand of O2 and glucose and release of norepi, if adequate O2 not maintained, hypoxia and acidemia occur -Signs can be altered mental (Irritability, lethargy). Bradycardia. Tachypnea, apnea, hypoxia. Hypoglycemia, emesis. Weak suck and cry.

Syphillis

-Causes painless genital ulcer

Frostbite

-Causes peripheral vasoconstriction -Superficial frostbite can manifest as mottled, blue, or waxy yellow skin -Deeper frostbite may cause skin to appear white and hard and unable to sense touch which can progress to gangrene -Treatment do not massage, immerse affected area in water heated to 98.6-102.2, avoid heavy blankets or clothing, provide analgesia as rewarmning is exrtremely painful, elevate injured hand, keep wound open after water bathand allow to dry before applying loose nonadherent, sterile dressing

Cephalosporin

-Cefazolin, cephalexin -Can experience a cross sensitivity reaction if allergic to penicillin -Need to obtain more info if pt is allergic to penicillin as it can be mild to severe, if mild then might be okay, but if anaphylactic reaction to penicillin then cephalosporin is contraindicated

Meds prescribed for open fracture

-Cefazolin: a bone penetrating cephaospirin antibiotic is active against staph aureus, given prophylacticaly before and after surgery -Cyclobenzaprine: muscle relaxant to treat pain associated with muscle spasms -Tetanus and diphtheria toxoid: immunization given prophylactilly to prevent clostridium tetani -Ketorolac: NSAID to decrease inflammation and pain -Opioids

Cyclobenzaprine

-Centrally acting skeletal muscle relaxant prescribed for muscle spasticity, rigidity, acute/chronic muscle pain/injury -Metabolized in liver, presence of liver disease can lead top buildup of med and med toxicity and increased CNS depression

Disease prevalent among African american females

-Cervical cancer -HTN -Stroke

Warning signs cancer

-Change bowel habits -A sore no heal -Unusual bleed -Thickening or lump on breast or elsewhere -Indigestion of difficult swallow -Obvious change in wart or mole -Nagging cough and hoarse

Obstructive Sleep Apnea

-Characterized by repeated periods of apnea >10 secs -Partial or complete obstruction occurs due to airway narrow that results from relaxation of pharyngeal muscles or tongue falling back due to gravity and hypoxemia and hypercapnia can occur -Causes pt to arouse easily, restless, waking up with gasping or choking sensation, morning sleepiness, headache, irritability

CPR infants

-Check brachial pulse no more 10 secs -Unwitnessed collapse a single rescuer should shout nearby help and activate emergency alarm then provide 2 ins CPR at 100 compression's/min before getting AED -Deliver compression's equal to 1/3 of chest with 2 fingers or two thumbs on sternum -If newborn then blanket or towel under newborns shoulders and head slightly flexed (Sniffing)

Chest circumference and ab circumference

-Chest circumference exceeds ab circumference after age 2

CPR in adults

-Chest compression's 100-120/min and depth 2.0-2.4 in -Defib pads placed right upper chest just below clavicle and on left lateral chest below nipple line -Compression's paused every 2 mins to check pts pulse (No longer than 10 secs)

Angina Pectoris

-Chest pain brought on by myocardial ischemia (Decreased blood flow to heart muscle) >Physical exertion (Sex, exercise) >Intense emotion (Fear, anxiety) >Temp changes (Cold exposure) >Tobacco use >Stimulants >Coronary artery narrowing

Criteria for thrombolytic therapy

-Chest pain lasting 12 hours or less, 12 lead ECG indicating ST elevation

Unstable agina

-Chest pain that occurs while a person is at rest and not exerting himself -Troponins will be normal cause no muscle injury unlike MI, but cardiac ischemia will be present so need to be cardiac monitored

Solifenacin

-Cholinergic antagonist to treat symptoms of overactive bladder (Urge incontinence, frequency) -Can cause dry mouth and constipation

Sjogrens Syndrome

-Chornic autoimmune disorder affects exocrine glands -Affects salivary and lacrimal glands leading to dry eyes and dry mouth -Dryness in these areas can lead to corneal ulcerations, dental caries, oral thrush -Other areas can be affected to >Dry skin and can cause rash >Throat and bronchi causing chronic dry cough >Vag dry and painful intercourse -No cure. OTC drops used for eyes, sugarless gum or artificial saliva for dry mouth, regular dental appointments to prevent denal caries, lubricants (K-Y jelly) helps ease vag dry, use of lukewarm water and mild soap when shower can prevent dry skin, avoid low humidity environments, use humidifiers . -Avoid decongestants as they can cause further dryness to mouth and nasal mucosa

Irritable Bowel Syndrome

-Chronic GI disorder that cause pain and altered bowel motility (Constipation, diarrhea, or combination of both) -Can have bloat, nausea, urgency and flatulence -Managed through lifestyle and diet >Keep daily record of symptoms, diet, stress level to help identify triggers >Limit intake gas producing foods (Legumes, beans, cabbage, broccoli), and fructose (honey, apples) >Reduce stress and perform regular exercise >Reduce daily caffeine -Pts with IBS should not fast or reduce oral intake (clear liquids) even during severe symptoms

Psoriasis

-Chronic autoimmune disease that cause rapid turnover of epidermal cells -Goal of therapy is to slow epidermal turnover, heal lesions, control exacerbations -No cure and need to avoid triggers (stress, trauma, infection) -Topical therapy (corticosteroids, moisturizers), phototherapy (UV light, sunlight), systemic meds like methotrexate

Fibromyalgia

-Chronic condition with widespread aching and pain in the muscles and fibrous soft tissue -Multiple tender points -Duloxetine is SNRI is used in this case to relieve chronic pain that interferes with sleep

Multiple sclerosis

-Chronic disease of the central nervous system marked by damage to the myelin sheath. Plaques occur in the brain and spinal cord causing tremor, weakness, incoordination, paresthesia, and disturbances in vision and speech -Balance exercise with rest. Should exercise when weather is cool and stay hydrated

Polycythemia Vera

-Chronic disorder of bone marrow in which too many RBC, WBC, Platelets produced -Risk for blood clots so elevate legs and feet when sit, wear support stokcings, report signs thrombosis -Adequate fluid intake during exercise and hot weather -Increasing iron intake can furture increase hemoglobin production and not recommended -Need periodic phlebotomy to remove excess blood

Myasthenia Gravis

-Chronic neurologic autoimmune disorder which results skeletal muscle weak -Muscles stronger in morning and weaker with the days activity as supply of aceytlcholine is depleted -The ocular (ptosis) and facial muscles along those responsible with swallowing and chewing are affected initially. Weakness can progress to respiratory muscles (intercostal, diaphragm). Diplopia, bulbar signs (difficult speak and swallow) -Pyridostigmine an anticholinsterase is first line drug that inhibit acetylcholine breakdown and prescribe to increase musucle strength in MG (Give before meals so pt ability to swallow is strongest during meal) -Give semi solid foods, and get flu shot -Do not affect bladder and bowel control like MS

Epilepsy

-Chronic seizure activity, need lifelong anticonvulsant med -Seizure triggers are alcohol, sleep deprive, and stress -Wear med bracelet -Phenytoin may decrease effectiveness of some meds (Oral contraceptives, warfarin) so an alternate non hormonal birth control method (condoms, copper IUD) should be used in addition or instead of the oral contraceptives. Dont stop med abruptly or seizure can occur -Phenytoin can also cause fetal abnormalities -If on pheytoin practice good hygiene cause gingival hyperplasia (Over formation of gum tissue) can occur

Atopic Dermatitis (Eczema)

-Chronic skin disorder -Pruiritis, erythema, dry skin, red crusted scaly lesions -Goal is alleviate pruritis and keep skin hydrated to reduce scratching >Should give tepid baths using gentle soap. >Skin should patted dry followed by application of ointment. >Nails be trimmed short. >Clothing should be soft (Cotton) and climate appropriate to reduce perspiration. >Long sleeves worn at night. >Avoid triggers like heat and low humidity

Parkinson's Disease

-Chronic, progressive neurodegenerative disorder that involves degeneration of dopamine which then makes it difficult to control muscles. Usually start after 60 yrs -Characterized by a delay in initiation of movement (Bradykinesia), increased muscle tone (Rigidity), resting tremor, shuffling gait, stooped posture, flexed elbow and wrists, masked facial expression, forward tilt trunk

Primary cause of bladder cancer

-Cigarette smoking or other tobacco use -Bladder cancer usually has painless hematuria -Occupational carcinogen exposure is second most common risk factor

Halo external fixation device

-Clean site pins with sterile solution -Keep vest dry use blow dryer on cool -Small pillow under pts head -Keep correct sized wrench in room -Do not grab device frame when moving or position pt cause can cause screws loosen or alter alignment

Oral Mucositis (Mouth Sores) during Chemo

-Cleanse mouth with NS after meals and bedtime -Use soft bristled brush -Lidocaine HCl to alleviate oral pain -Use water soluble lubricating agents to moisten mouth -Avoid hot/spicy foods -Avoid antiseptic mouthwash with alcohol -Admin of palifermin prevents oral mucositis but does not alleviate pain

Colonoscopy

-Clear liquid diet day before, NPO 8-12hrs prior, bowel cleanse agent day before test -Smoking cessation has no role in colonoscopy so does not need to be avoided

Serous Drainage

-Clear, watery fluid, yellow -Natural part of healing process

Centrally Acting Alpha Agonists

-Clonidine, guanfacine, methyldopa -Clonidine is highly potent anti-hypertensive, abrupt discontinue can cause rebound HTN. Can cause dry mouth.

Posterior Frontanel

-Closes at age 2 months and should no be palpable after that

Thrombolytic Therapy (Tissue Plasminogen Activator [tPA])

-Cntra if risk hemorrhage, if more than 4.5hrs from onset symptoms, recent major surgery within past 14 days, or gallbaldder surgery less then 2 months ago, thrmobocytopenia <100,000, uncontrolled HTN, stroke or head trauma within past 3 months

Atelectasis

-Collapsed lung; incomplete expansion of alveoli

Respiratory Syncytial Virus (RSV)

-Common cause of respiratory tract infection and bronchiolitis which occurs mostly winter -Causes bronchiolar swelling and excessive mucus production -In infants can cause rhinorrhea, fever, cough, lethargy, irritable, poor feed. -Severe RSV cause tachypnea, dyspnea, poor air exchange -Interventions are provide supplemental oxygen and suctioning, elevate HOB, admin antipyretics, initiate IV fluids. Contact and Droplet precautions -Palivizumad a monoclonal antibody IM once monthly during winter and spring to prevent RSV

Hepatic Encephalopathy

-Common complication of liver cirrhosis -Causes can be hypokalemia, constipation (Which can cause ammonia lvls to rise due to feces stuck), GI hemorrhage, and infection. Results from accumulation of ammonia and other toxic substances in blood -Signs are sleep disturbance to lethargy and coma, mental status altered, asterixis (flap tremors of hand by extend arms and dorsiflex wrist), and musty sweet odor of breath

Morning sickness

-Common during first trimester -Eat several small meals during day (High in protein or carbs and low in fat) -Drink fluids (Cold, carbonated beverages) between rather with meals -Have high protein snack before bed and upon awakening -Consume food/drinks with ginger -Consume food high in vitamin B6 (nuts, seeds, legumes)

Heartburn (Pyrosis)

-Common during preg due to increase of progesterone (relax smooth muscles resulting in esophageal sphincter relaxation) and uterine enlargement that displaces stomach -Lifestyle changes need to be made to decrease it >Keep HOB elevated with pillows, sit upright after meals, eat small frequent meals -Dairy does not cause heartburn and good source calcium during preg

If on immunosuppressants

-Common signs of infection may be absent (Red, swell) due to immunosuppression. So look out for Temp, cough, and changes in secretions

Third degree heart block

-Complete heart block -When electrical conduction from atria to ventricles are blocked causeing decreased cardiac output (dizzy, syncope, mental status change, HF, hypotension, bradycardia) -Treat with atropine and temporary pacing until a permanent pacemaker can be palced

Hemolytic uremic syndrome

-Complication of E.coli that results in red cell hemolysis, low platelets, and acute kidney injury. Hemolyisis results in anemia and low platelets manifest as petechiae or purpura

Graves Exophthalmus

-Complication of Hyperthyroidism which causes eyeballs to protrude caused by increased orbital tissue (Connective, muscle, adipose) and can be irreversible -Interventions include >HOB raise to drainage, Artificial tears, tape pts eye shut during sleep if not close on own, Anti-thyroid should be taken to prevent further exacerbation, smoke stop, Restrict salt to decrease periorbital edema, use dark glasses, perform eye exercise by turning eyes

Scarlet fever

-Complication of group A strep infection (Streptococcal Pharyngitis) -Red rash begins on neck and chest and spreads to extremities, resemble bad sunburn, blanches with pressure, and fine bumps like sandpaper -Will need rapid streptococcal antigen test to confirm

Thyrotoxicosis (Thyroid storm)

-Complication of hyperthyroidism -Caused by excessive thyroid hormones

Hiatal Hernia

-Condition in which a portion of the stomach protrudes upward into the chest, through an opening in the diaphragm -Conditions that causes increase in intraabdominal pressure(Preg, fat, ascites, tumor, heavy lift) can weak muscles of diaphragm and allows portion of stomach to herniate -Paraesophageal hernias are medical emergency -Interventions: Avoid high fat foods and chocolate, peppermint, tomaote, caffeine. Eat small frequent meals and decrease fluid intake during meals to prevent gastric distention. Avoid meals close to bedtime or nocturnal eating. Stop smoke, wt loss. Avoid lift and strain. HOB to 30 degrees can be done using pillows, or 4-6in blocks under the bed -Wearing girdle or tight clothes makes it worse

Congenital Hypothyroidism

-Condition present at birth that results in lack of thyroid hormones. UNtreated can cause intellectual disability -Can cause difficult awaken and lethargy, dry skin, hoarse cry caused by swelling vocal cords due to fluid retention, constipation, bradycardia

Hypospadias

-Congenital defect where urethral opening on underside of penis -Treat is surgically redirecting urethra to penis tip -Circumcision is delayed so the foreskin can be used to reconstruct urethra -Post Op pt will have catheter or stent to maintain patency, absence of urine for over hour indicates kink or obstruction

Tetrology of fallot

-Congenital heart defect that has 4 characteristics: pulmonary stenosis, right ventricle hypertrophy, overriding aorta, ventricular septal defect -Hypercyanotic episode or "tet spell" can happen when child cries, become upset, or feeding. Need to be placed knee to chest -Do not turn infant during sleep cause can cause them to wake and cry and be stressed

AV fistula

-Connects artery to vein to engorge it and thicken so 2 large bore needles can fit for dialysis -If severe or prolong edema >2wks, could indicate venous HTN and may require surgery to prevent AVF failure. But edema in beginning is normal and resolves spontaneously

Moderate sedation

-Conscious sedation, drowsy but responds to voice commands

Menopause Strategies to reduce effects of decreased estrogen levels

-Consume dietary calcium and engage wt bearing exercise to promote bone health and osteo -Monitor cholesterol lvls as increased LDL increases risk for coronary artery disease -Can cause wt gain so maintain low calorie diet rich in fruits and veges -Seek support to cope with emotional symptoms caused by changing hormone lvls

Iron Defeciency Anemia

-Consumption of cows milk before age 1 -One common cause is excessive milk intake over 24oz/day -Treatment is oral iron supps and eat iron rich foods (Green leafy veges, red meats, poultry, dried fruit, fortified ceral)

Scabies

-Contact Precautions, highly contagious -Contagious skin disease transmitted by the itch mite, commonly through sexual contact -Intense itch especially at night -Treat is scabicide cream (Permethrin) massaged into all skin surfaces from head to toe -Clothing and linens should be washed and dried on hottest setting -Nonwashable items can be sealed in plastic bags for more than 3 days

Pharyngitis Caused By Group A Strep

-Contagious bacterial throat infection that can lead to renal or cardiac problems if not treated -Children may refuse to eat due to pain so soft diet and cool liquids (ice chips) should be offered rather than solids -Toothbrush should be replaced 24hrs after starting antibiotics -May return to school after 24hrs on antibiotics and afebrile -Throat lozenges can be choke hazard for children so give acetaminophen or ibuprofen (liquid form) for pain

Rotavirus

-Contagious virus and leading cause of diarrhea -Spread fecal oral route -Can transmit contact with food, toys, diapers, and hands -Can cause watery diarrhea that last 5-7 days with fever and vomit. Can be dehydrated easily -Breastfeed and normal diet should be maintained -Wash child perineal area with water or soap

Continuous suction with Salem Sump

-Continuous suction can be applied to decompress stomach if double lumen salem sump tube is in place -Checking for residual volume is not appropriate cause salem sump is attached to the continuous suction for decompression and not being used for admin enteral feeds -The air vent (Blue pigtail) must remain open as it provides continuous flow of atmospheric air through the drainage tube at its distal ends (to prevent excessive suction force). If gastric contents reflux; 10-20mL of air can be injected into air vent. Air vent kept above level of pts stomach to prevent reflux. -Interventions: semi fowlers to keep tube from lying against stomach wall to help prevent gastric reflux. Mouth care every 4 hrs. Turn suction off briefly during auscultation as suction sounds may be mistaken for bowel sounds.

Holter Monitor

-Continuously records pts ECG for 24-48hr -DO not bathe or shower during test period, engage in normal activities to stimulate conditions that may produce symptoms that monitor can record

Flase Labor

-Contractions are irregular intervals; no increase in frequency, duration, or intensity; may dissipate over time -Discomfort located in lower ab and groin -Comfort measures (walking, position changes, hydration): Contractions may lessen or dissipate with comfort measures -Cervical changes: has no cervical changes

True Labor

-Contractions are regular intervals; frequency, duration & intensity increase over time -Discomfort begins in lower back, radiates to ab -Comfort measures (walking, position changes, hydration): Contractions increase despite comfort measures -Cervical changes increase in cervical dilation and effacement

Clamping chest tube

-Contraindicated during transport -Can cause air to accumulate in plueral cavity and lead to tension pneumothorax

Meperidine

-Contraindicated in sickle cell crisis cause large doses can cause normeperidine accumulation and can cause tremors and can result in seizures -Opioid commonly prescribed analgesia during early labor and has rapid onset (5 mins) when given IV and duration of 2-3hrs >Should be avoided within 1-4hrs of birth

Play in school aged children (age 6-12)

-Cooperative play, play with one another with specific goal (Building castle from blocks) often with a rigid set of rules

Visual acuity testing in newborns

-Corneal light reflex is tested by shining a light held 16in from child eyes, nurse observes blink response, alertness, and following light to middle

Dexamethasone

-Corticosteroid -Treats cerebral edema associated with brain tumor or injury by decreasing inflammation

Active TB

-Cough, fever, chills, malaise, wt loss, night sweats, anorexia, fatigue -Can transmit -Positive tuberculin test, abnormal chest X-ray -Positive sputum smear/culture, collected early morning on 3 consecutive days

Pneumonia signs

-Crackles, Pleuritic chest pain, increased vocal/tactile fremitus, bronchial breath sounds in peripheral lung fields, unequal chest expand, dullness

Tubal myringotomy

-Create hole in eardrum to allow fluid that is trapped in the middle ear to drain out. The fluid may be blood, pus and/or water. In many cases, a small tube is inserted into the hole in the ear drum to help maintain drainage. -1st day post op purulent drainage is expected

Strabismus

-Cross eyed -If untreated by age 4-6, permanent reduction or loss of visual acuity in affected eye (amblyopia; lazy eye) can occur. -Treat is strengthen muscles of weaker eye by wearing a patch over stronger eye

Oropharyngeal airway

-Curved devices that are temporary artificial airway devices used to prevent tongue displacement and tracheal obstruction in pts who sedated or unconscious -Inserted with distal end point upward toward roof of mouth and once it reaches soft palate rotate tip downward toward esophagus -To measure it against cheek and jaw angle -Make sure its easily removable so don't tape it -Once they start to cough or gag means conscious then can discontinue

Tetrology of Fallot

-Cyanotic congenital heart disease manifested by clubbing of fingers due to oxygen saturation between 65%-85% and irritability

What can caused delayed meconium?

-Cystic fibrosis or hirschsprung disease (Portion of colon inhibits peristalsis)

Recovering form CABG

-Daily shower incisions washed gently with mild soap and water and patted dry -Don't soak or put lotion on incisions -Light house work in 2wks but no lift >5 without HCP approve -No drive for 4-6wks -If pt able to walk 1 block or climb 2 flight of stairs without symptoms it is safe to resume sex

Common asthma triggers

-Dander -Beta blockers, NSAIDs -Chemicals, sawdust, soap/detergents -URI -Stress, GERD -Smoke, perfumes -If due to physical activity then take inhaled bronchodilator 20 mins before activity

Radiation therapy to head/neck can cause what

-Decrease pts oral intake due to mucositis (Inflame of mouth, esophagus, oropharynx) and dry mouth. These adverse effects affect speech, taste, ability to swallow -Teach to avoid irritant foods (SPicy, acidic, dry, crumbly. caffeine). Consume supplemental nutritional drunks. Use artificial saliva. Sipping water throughout day. Topical analgesics.

Infants less than 4 months of age

-Decreased gag reflex

What is lactulose for?

-Decreases intestinal ammonia absorption in pts with liver disease and hepatic encephalopathy, helps excrete ammonia in stool -Should be adjusted to ensure 2-3 soft stools per day

Vfib/Pulseless V tach

-Defib, CPR 2 min, airway, IV access, Epinephrine every 3-5mins, -Admiordarone given after 3rd defib shock

Phenylketonuria (PKU)

-Deficiency of enzyme to metabolize phenylalanine an amino acid found in protein foods -High levels phenylalanine can cause intellectual disability -Pt be on low phenylalanine diet (friuts and veges) before and during preg to prevent teratogenic effects. Avoid high protein foods (Meat, eggs, dairy) -Phenylalanine also transferred breast milk so baby need formula -Do not completely eliminate phenylalanine from diet as it is essential amino acid

Osteoarthritis

-Degenerative disorder of synovial joints (Hips, knees, fingers) that causes erosion of the articular (joint) cartilage and bone beneath cartilage -Signs: pain in wt bearing activities, crepitus, morning stiffness that subsides within 30mins of arising, decreased joint mobility and ROM, atrophy of muscles that support the joint due to disuse -No fever

Macular Degeneration

-Degenerative, gradual loss of central vision leaving peripheral vision intact

What can end stage renal disease cuase?

-Delirium due to the buildup of toxins

Venturi Mask

-Delivers guaranteed oxygen concentration regardless of pts RR, depth, tidal volume -High flow -For tachypnea, shallow breathe, hypercarbia, hypoxemia

Positive Pressure Ventilation

-Delivers positive pressure to lungs which compresses the thoracic vessels and increases intrathoracic pressure during inspiration which leads to reduced venous return and cardiac output which leads to hypotension -Hypotensive effect greater in presence of hypovolemia

Pruritic Urticarial Papules and Plaques of Pregnnancy (PUPPP)

-Dematologic condition causing discomfort but not harmful -Pruritic raised lesions form within ab striae and may spread to thighs, arms, legs, back

Rifapentine

-Derivative of rifampin. For TB -Both Rifapentine and Rifampin reduce effects of oral contraceptives. So need to be on non hormonal birth control to prevent preg during treatment -Taken with meals -Hepatoxic

Isotretinoin

-Derived from vitamin A so don't take additional Vit A supps as it can cause vit A toxicity -For severe disfiguring nodular acne, decrease sebum secretion and shrink sebaceous glands -It is teratogenic so must participate in risk management program and have 2 neg pregnancy tests before taking it along with 2 forms of contraception (1 month prior, during, and 1 month after treatment) -Blood donation discouraged too during therapy -Capsules swallowed whole -Should not take with tetracycline (Increased intracranial HTN)

Somatization

-Describes physical symptoms that cannot be explained by medical condition or disease

Meds used to treat nocturnal enuresis

-Desmopressin -Tricyclic antidepressants (imipramine, amitriptyline, desipramine)

Newborn normal findings

-Desquamation (peeling skin) is normal in some especially those born late or post term gestation. Resolves on its own -Average newborn head circumference is 13-14in (Smaller head may indicate microcephaly, hydrocephalus)

Indirect Coombs test

-Detects Rh blood incompatibility -If Rh-negative mom (O negative blood) is exposed to Rh-positive fetal blood the preg pt can develop antibodies to the Rh antigen (Rh sensitization) and can place the fetus and all other pregnancies at risk for hemolytic anemia (anemia caused by the destruction of red blood cells) -Rh immunoglobulin (Rhogam) is admin to Rh-negative preg pts at 28wks gestation and within 72 hrs postpartum as well as after any maternal trauma to prevent development of permanent Rh antibodies -Rhogam not effective once sensitization has occured

Lactic acidosis

-Develops after exhaustive muscle activity -And metformin

Implanted Cardioverter Defibrillator (ICD)

-Device implanted into the chest to treat dysrhythmias -Discharges electrical shocks directly into cardiac muscle to correct arrythmia -If ICD unable to convert arrythmia, the ICD will still continue to shock pt. Nurse should obtain a manual external def and use that

To ensure privacy of pt

-Diagnosis and test results should not be shared without permission of without a need to know (Transport don't need to know exact diagnosis but might need to tell them careful cause pt fragile) -Do not refer pt by diagnosis, nickname, or room number -Use only last names when writing down -Calling pt by first and last name in waiting room is not violation, as long as no other pertinent info is given

Atypical symptoms of MI in female, elderly, diabetics

-Diaporesis, nausea, fatigue, dyspnea, pain can radiate to jaw or back and some pts may report pain as indigestion (Epigastric pain) -May not experience chest discomfort

Pulse Pressure

-Difference between systolic and diastolic pressure

Nitrazine pH test

-Differentiate amniotic fluid (Water break) which is alkaline and vag fluid or urine which is acidic. Presence of semen can cause a falkse positive (Blue color)

Caput Succedaneum

-Diffuse edema of the fetal scalp that crosses the suture lines due to prolonged pressure of presenting part against cervix during labor. -Reabsorbes and resolves within 1 to 3 days

Boston Brace

-Diminish progression of deformed spinal curves in scoliosis. Do not cure. -Worn 18-23hrs per day and removed for bathe and exercise

Avoid antihistamines before allergy skin test

-Diphenhydramine, Loratadine, Promethazine for up to 2 wks prior test -Systemic corticosteroids can affect it too

Draw blood from central line

-Discard first blood drawn to prevent an inaccurate lab result

Cardiomyopathy

-Disease in heart muscle where reduced ability to pump blood effectively placing pts at risk cardiogenic shock (Shock caused by inadequate function of the heart, or pump failure.) which is manifested by reduced cardiac output (hypotension, narrow pulse pressure)which can lead to pulmonary edema

Psychogenic Dystonia

-Disorder that causes involuntary muscle contraction that cause slow, repetitive movements such as twisting and abnormal postures

Psychogenic gait

-Disorder that causes unusual standing postures and walking, may have knee buckling and falling or may veer from side to side as if staggering

Antisocial Personality Disorder

-Disregard and violation of others rights and rules, irresponsible behavior, blame others for their behavior -Need to set firm limits on them and have them take responsibility of their own actions -Intimidates others, manipulative others for personal gain, and lacks empathy

If on long term corticosteroid therapy what should be taught?

-Do not discontinue abruptly, could lead to addisonian crisis -S/S of infection need to be reported -Increase dose at times of stress cause can trigger cortisol lvls and cause addisonian crisis -Cause hyperglycemia -Catabolic to bones and muscle (Muscle weak) -Cataracts are side effect -Can cause GI irritation so take with food

If allergic reaction to blood

-Do not infuse NS in the same exact IV tubing that the blood was in, cause will expose pt to more of causative agents -Make sure top use a different port to infuse the NS

If taking potassium sparing diuretic

-Do not need to increase intake of potassium

Expulsion of placenta

-Do not pull on the cord or else can cause uterine inversion or cord avulsion (tear, snap) -One placental separation occurs signified by cord lengthening/a gush of blood/uterine cramp/vag pressure, the mom can bear down gently to expel placenta -Fundal massage done after expulsion of placenta

Incidence/Occurence Report

-Document events that pose unanticipated actual or potential risk to the health or safety of a pt, visitor, or eomployee.

Breech Presentation

-Does not cause back labor -Complications are ineffective dilation of cervix, increased risk umbilical cord prolapse

Oculocephalic reflex

-Dolls eyes -Is expected finding when rotating head and watching for the eyes to move simultaneously in opposite directions

Bed bugs

-Don't pose any hard except for itchiness -Launder clothing in hot water and using highest temp setting on dryer then should be put in tightly sealed plastic bags to prevent additional infestation -Do not inhabit humans unlike lice

Blood dyscrasia

-Done marrow depression caused by drug effects on the rapidly multiplying cells of the bone marrow; lower-than-normal levels of blood components can be seen

Ventriculoperitoneal Shunt

-Drains fluid from brain into ab -Can cause increased ICP due to shunt malfunction (Vomiting, headache, vision changes, mental changes) -VP shunt is tunneled under scalp and can be palpated

Stroke care

-Dress affected side first -Right side stroke has impulsive behaviors and unaware deficits -Receptive aphasia (Wernicke) impaired in verbal and written language comprehension. Is fluent talking but lacks meaning (Damage frontal lobe). Aware of deficits and frustrated easy -Broca (Expressive) Aphasia have trouble speaking and not fluent, Able to comprehend though. Not aware of their speech impairment -Global aphasia is inability to read, write, or understand speech

Prevent Sudden Infant Death Syndrome

-Dress newborn in no more than 1 more layer of clothing than an adult requires, wearable blanket (Sleep sack) can keep newborn warm and prevents head from being covered -Always supine when sleep -No loose bedding or other objects in crib -Avoid bumper pads on crib -Avoid overheating so no more than 1 layer of clothing -Breastfeed and ensure immunizations up to date -Use pacifier during sleep but should be delayed until after breastfeeding is well established

Iron rich foods

-Dried beans lentils. peanut butter, dark leafy greens, poultry/red meat

Optimize Nutritional Intake in COPD

-Drink fluids between meals to prevent stomach distension and decrease pressure on diaphragm -Eat small frequent meals, snacks, and supps that are high n calories and protein -Perform oral hygiene before meals -Exercise discouraged for 1 hr before and 1hr after meals -Gas forming foods (Broccoli, beans, cabbage) are carbonated beverages should be avoided cause they cause intestinal bloat and increase pressure diaphragm

Pertussis

-Droplet and highly contagious -Leads to rapid violent whooping cough and vomiting -Cough may continue until a thick mucus plug is expelled for following vomiting -Treat is humidified air and adequate fluids to loosen thick mucus, and oral antibiotics -Cough suppressants not used

Overflow Urinary Incontinence

-Due to compression of urethra or impairment of bladder muscle (Spinal cord injury, diabetic neuropathy, anticholingergic meds) which causes incomplete emptying of bladder and retention which can lead to frequent involuntary dribbling of urine -Should implement fixed void schedule (every 2 hours), valsalva maneuver, measure postvoid residual volumes, wait 20-30secs after void and then attempt to void second time (Double voiding)

Metabolic acidosis

-Due to diarrhea and causes decrease in bicarb -Causes hyperkalemia

Sickle Cell Crisis

-Due to inadequate oxygenation or hydration which makes RBCs sickle and clump which can cause occlusion which is very painful and can lead to ischemia, hypoxia, and organ dysfunction if not treated -Priority is to admin IV fluids to reduce blood viscosity and restore perfusion then oxygen -Managed with IV hydration, frequent IV pain med, PRN blood transfusion

Constipation during preg

-Due to increased progesterone -Ferrous sulfate (iron) supp may also cause constipation >High fiber diet (Fruits, vege, breakfast cereals, whole grain bread, prunes) >High fluid intake (10-12 cups daily fluid) >Regular exercise >Bulk forming fiber supps (Psyllium, methylcellulose, wheat dextrin) -Dairy should be consumed 2 hrs before or 1hr after iron supps as they bind to iron and decreases absorption, do not need to decrease dairy intake if on iron though. -Laxatives not recommended during preg can cause dehydration and electrolyte imbalance -Caffeine should be limited during preg

Torsades de pointes

-Due to low magnesium which can cause Vtach and end in Vfib -Prolonged QT interval -Treat is magnesium sulfate

Toxic Epidermal Necrolysis

-Due to med reaction that results in widespread erythema, blistering, epidermal shedding, and skin erosion (denuded skin which is loss of epidermis layer) -Severe form of Steven Johnson Syndrome and major cause is sepsis -Infection prevention is critical -Reverse isolation, hypothermia prevention (maintain room temp 85F or more, use passive rewarming methods, pain management, eye care like eyes drops for dryness -Massage area is contraindicated

Gout

-Due to uric acid buildup, can also lead to kidneys stones which can cause kidney damage as result -Self care: Increase fluid intake, Low purine diet meaning avoid organ meats (Liver, kidney, brain) and certain seafood like sardine, shellfish. Limit alcohol, follow healthy low fat diet, wt loss.

Metabolic Alkalosis

-Due to vomiting and loss of stomach acid

Normal Uterine contractions during first stage of labor

-Duration: lasts 45-80secs, should not exceed 90 secs -Frequency: 2-5 contractions every 10 mins, should not occur more frequently then every 2 mins -Intensity: Strength of contraction at its peak, 25-50mmHg, should no exceed 80mmhg -Resting tone: Tension in uterine muscle between contractions, allows fetal oxygenation between contractions, average 10mmhg, should not exceed 20mmhg

Newborn

-During first 3-4 days of life, wt loss of 5%-6% of birth wt expected due to fluid excretion -Wt loss >7% needs further evaluation

Infant Crying

-During first 3-4 months of life not unusual for infant to cry 1-3hrs a day in response to hungry, thirst, tired, pain, bored, or lonely

Fetal Alcohol Syndrome

-During preg can cause permanent neurodevelopmental abnormalities or dysmorphic facial features -Discontinue alcohol at any time during preg can improve future outcomes

Neonate

-During preg fetus stores large quantities of glycogen that are used during transition to extrauterine life. As result glucose lvls decreased 1 hr after birth then rise and stabilize within 2-3hrs. Optimal lvls are 70-100 but 40 or above is considered normal -Milia (White papules) form due to plugged sebaceious glands frequrntly on nose/chin and resolve without treatment -Holosystolic murmur is sign of ventricular septal defect -Single transverse crease extending across palm of hand is classic sign of down syndrome -<30 days old if rectal temp >100.4 or <96.8 is a red flag

Pregnancy effects on blood

-During preg is hypercoaguable state that provide protection from hemorrhaging after birth but also increase risk for thrombus formation -Pts who gave birth csection are at great risk for DVT which can lead to PE (Anxiety, restless, pleurtic chest pain, SOB, tachycardia, hemoptysis)

CPR modification in pregnancy

-During preg, heart displaced to left cause growing uterus pushes upward on diaphragm -So place hands on sternum slightly higher than usual for chest compression's -Uterus should be ,manually displaced to pts left to reduce pressure, can place rolled blanket or wedge under right hip to displace uterus -C section if spontaneous circulation does not occur within 4 mins, delivery should occur within 5 mins of CPR -Supine the vena cava and aorta compressed by uterus so displace it to left

Dilated Cardiomyopathy

-Dysfunctional heart muscle because of an enlarged heart

Anaphylaxis signs

-Dyspnea, Lighthead (Due to hypotension due to vasodilate of cardiac), skin rash (Hives), Wheeze

Memantine

-Ease symptoms of moderate to severe Alzheimer disease thus improving quality of life for pts and caregivers -May experience improvement in memory, thinking, language, ADL, agitation, depression, hallucinations

Prevent hypoglycemia related to evening dose of NPH

-Eat snack bedtime consisting of protein and complex carbs

Hip Fracture Features

-Ecchymosis and tenderness over thigh and hip -Groin and hip pain with wt bearing -Muscle spasm in injured area -Shortening of affected extremity cause fracture can reduce length of bone and muscles above the fracture line pull extremity upward -Abduction or adduction of affected extremity -Affected extremity externally rotated

Antihistamines, decongestants, anticholinergics can cause what

-Effect on smooth muscles and can cause urinary retention (BPH), bowel obstruction

Cognitive Behavioral Therapy (CBT)

-Effective for anxiety, eating, and depressive disorders. Also for medical conditions like smoking and insomnia. Maladaptive reactions to stress, anxiety, and conflict -CBT requires pt to learn the skill of self observation and to apply more adaptive coping interventions >Educate about pts specific disorder >Self observe an monitor (Pt learns how to monitor anxiety, identify triggers, and assess severity) >Physical control strategies (Deep breathe, and muscle relaxation exercises) >Cognitive restructuring (Learn new ways to reframe thinking patterns, challenging negative thoughts) >Behavioral strategies (Focus on situations that cause anxiety and practicing new coping behaviors, desensitize anxiety provoking situations or events)

When should allergenic foods be introduced?

-Eggs, fish, peanut products should be introduced at 4-6 months

Permanent pacmaker

-Electrical capture: ECK -Mechanical capture: Auscultation of apical or palpation of femoral pulse) -then should be compared with electrical rate to assess for pulse deficit

Reduce ICP

-Elevate head 30 degrees or with neck/head in neutral position -Admin stool softeners -Manage pain -Manage fever (cool sponges ice, antipyretics) while preventing shivering -Maintain calm environment -Adequate oxygenation -Hyperventilating to reduce CO2 and reduces ICP -Avoid performing interventions in clusters cause stimulation increases oxygen metabolism within brain which increases ICP

Erythrocyte Sedimentation Rate

-Elevated can indicate presence if inflammatory process, this is nonspecific and does not give info as to which organ is being attacked by inflammation -Normal is <3mm/hr

Cricothyrotomy

-Emergency airway procedure through an incision in the neck

JP drain

-Empty every 4-12hrs or unless its 1/2 to 2/3 full

Thiazolidinediones

-Ending -glitazone -For type 2 diabetes and improve insulin sensitivity but do not release excess insulin -Can worsen HF by causing fluid retention and increase bladder cancer. Can also lead to MI -HF or fluid overload is contraindicated

Negative pressure wound therapy

-Enhance bacteria and exudate removal promotes healing by stimulating cell growth and vessel perfusion to wound bed -Skin protectant applied around the wound to prevent breakdown and promote an air tight seal

Epoetin Alfa

-Epogen, Procrit -Stimulate RBC production from bone marrow -Combat effects of Chemo

Kidneys produce what

-Erythropoietin

Esophageal Atresia and Tracheoesophageal Fistula

-Esophagus and trachea do not properly separate or develop -Signs can be frothy saliva, cough, choke, and drool, may also have apnea and cyanosis during feed -Aspiration is greatest risk -May have distended ab -Infant should be kept supine with HOB elevated at least 30 degrees to prevent aspiration. NG tube too

Tumor Necrosis factor Inhibitor

-Etanercept, -Mab -blocks action of TNF which is a mediator that triggers cell mediated inflammatory response in body -Can help reduce manifestations of RA by inhibit inflam response and immunosupression -Due to the immunosupression effects pts should have baseline tuberculin skin test therapy cause those with latent TB should be treated before initiation of this drug or else TB can convert to active

Electroencephalogram (EEG)

-Evaluate presence of abnormal electrical charges in brain which may result in seizure -Teaching should be hair should be washed to remove oils and hair care products. avoid caffeine, stimulants, and CNS depressants prior test. Test not painful

Normal Contraction frequnecy

-Every 2-3min or 2-5 contractions/10min and duration of 60-80 secs

How often change position during labor?

-Every 30-60mins to promote fetal rotation/descent and increase maternal comfort

How often should you change PICC dressing?

-Every 48hrs with gauze dressing or every 7 days with a transparent semipermeable dressing

Ostomy bag how often cahnged?

-Every 5-10 days

Pulsus paradoxus

-Exaggerated fall in systemic BP >10 during inspiration -Difference is normally <10 but difference >10 may indicate cardiac tamponade

Menieres disease

-Excess fluid in ear and have episodes of vertigo, tinnitus, hearing loss, muffled hearing -Can cause total loss of proprioception and feel pulled to ground (Drop attacks) -Consume low sodium diet to prevent fluid buildup. Intake of potassium and other electrolytes do not need to be restricted -Treatment during acute attacks include antihistamines, anitcholingergics, benzos -Vertigo can be minimized by staying in quiet dark room and avoiding sudden head movements, not looking at TV or flickering lights

Polyhydramnios

-Excessive amniotic fluid -Risk factor for postpartum hemorrhage

Manic Episode

-Excessive psychomotor activity, euphoric mood, poor impulse control, flight of ideas and non stop talking, poor attention span, hallucinations and delusions, insomnia, wearing bizarre or inappropriate clothing, jewelry, makeup, neglected hygiene -Care plan: reduce environmental stimuli, provide quiet calm environment, limit number of ppl who come in contact with pt, one on one interactions rather than group, low light, structured schedule activities to keep them focused, physical activities to release excess energy, high protein and high calorie meals that easy to eat, setting limits on behavior

Isometric exercises

-Exercises in which one contracts muscles but does not move body parts -Like planks, hold squat, superman, side plank, etc..

Bladder spasms in prostectomy

-Expected finding in pts with indwelling urinary catheter following prostectomy, can admin analgesics and antispasmodic drugs

Transplanted heart is supposed to be?

-Expected to be tachycardic (90-110/min)

Alcohol recovery goals

-Express accountability for previous behavior and how abusing alcohol impacted personal life -Use insight to face reality -Use coping skills (Support groups, relaxation technique) -Setting goals -Maintain abstinence

Myxedema Coma

-Extreme hypothyroidism -Hypothermia, hypoventilation, bradycardia, decreased mental, psychosis, seizure, coma -Respiratory failure will need emergent endotracheal intubation and mechanical vent

Ophthalmic Surgery

-Eye surgery -Increased IOP can cause damage to blood vessels and retina and can cause blindness -Coughing, N/V and bending increase risk

Infertility

-Fail to conceive after 12 months in women younger 35 -Fail to conceive after 6 months in women older 35

Delusions of Grandeur

-False belief that one is a famous person or a powerful or important person who has some great knowledge, ability, or authority -I need to get to Washington for my meeting with the president

Persecutory (Paranoid) Delusions

-False, persistent beliefs that one is being pursued by and targeted by others

Kidney stones causes by

-Family history, dietary imbalance, immobilization, dehydration

Presbyopia

-Farsightedness -Reduced vision when viewing things close to face -Need to hold objects farther to see

SBFT

-Fast 8hrs prior -Uses Xray -Chalky stools present 24-72hrs

Early signs of colorectal cancer

-Fatigue, wt loss, anemia, GI bleed -Have regular screening colonoscopy for colon cancer starting age 50

Agoraphobia

-Fear or avoidance of situations, such as crowds or wide open places, where one has felt loss of control and panic -Fear crowds, standing in line, outside home alone, traveling in bus/train/airplane/ship, one a bridge or in tunnel, open spaces like parking lot, enclosed spaces, like stores and concerts -Fear of having trouble to escape or getting help in the event of a panic attack or panic symptoms. Primary need is to avoid panic.

Dependent personality disorder

-Fear separation and tend to be indecisive and unable to take the initiative -Preoccupied with thought of being left to fend for themselves and want others to assume responsibility fro all major decision making -They agree with everything and needs constant reassurance

Hep A

-Fecal Oral -Vaccine can prevent it should be given 1 y/o and older -Needle share and unsafe sex can cause it too

Projection

-Feeling uncomfortable with an impulse or feeling and easing the anxiety by assigning it to another person -Husband with thoughts of cheating who then accuses wife of being unfaithful

Ectopic Pregnancy

-Fertilized ovum implants outside uterine cavity most of time in Fallopian tube -Risk factors are sti, tubual damage/scar, IUD -Signs are lower quadrant anb pain on one side, mild to moderate bleed, missed or delayed menses, vag spotting -Signs of hypovolemic (hemorrhagic) shock from ruptured ectopic preg include dizzy, hypotension, tachycardia, can also have referred shoulder pain -Peritoneal signs (tenderness, rigid, low grade fever) may eventually develop

Poorly controlled maternal diabetes

-Fetus experience hyperglycemia and produce excess insulin. To compensate fetus increases metabolic activity and oxygen consumption. Fetal erythropoietin production increases to produce additional RBCs which leads to polycythemia (Hematocrite >65%) and viscous

right occiput posterior position

-Fetus is in right occiput posterior position (ROP) -Position on hands and knees helps decrease back pain and facilitates rotation into an anterior position

Bacterial Meningitis in infant signs

-Fever or hypothermia, irritability, frequent seizures, high pitched cry, poor feed and vomit, nuchal rigidity, bulging fontanel -Hydrocephalus is the most common complication can cause hearing loss, learning disabilities, and brain damage

Parvovirus B-19

-Fifth disease has slapped cheek rash on face -Transmission is person to person especially through respiratory secretions -Can cause fetal abnormal

Bowel irrigation

-Fill irrigation container 500-1000ml lukewarm water, flush irrigation tube and clamp -Hang it on hook or IV pole 18-24 inches above stoma -Sit toilet and place irrigation sleeve on stoma and extend sleeve into toilet. -Lubricate cone tipped irrigator, insert cone and attach catheter gently into stoma and hold in place -Slowly open roller clamp allowing irrigation solution to flow 5-10mins -Clamp tubing if cramping occurs until it subsides -Once amount is instilled the cone removed and feces allowed to drain through sleeve into toilet.

Implantable cardioverter defibrillator (ICD)

-Firing of it is painful -Travel is not restricted like plan. Should have ICD ID card

Postpartum Taking In (Rubin Phase)

-First 24-48hrs, mom physically recovering from birth, dependent on the health care team to help care with baby -Moms focus is on self -Nurses need to focus on anticipating the pts needs

Obstructed feeding tube

-First attempt to dislodge clogged contents by using large barrel syringe to flush and aspirate warm water in back and forth motion -If cannot unclog with warm water then use digestive enzyme solution and dwell for 30 min to 1 hr -Flushing a feeding tube with small barrel syringe can create to much pressure and rupture tube

MMR Vaccine

-First dose given between age 12-15 months -Can be given under 12 months id admin within 72 hours of child's initial measles exposure -Measles first sign is fever and rash and incubation period is 7-21 days -After receiving MMR vaccine, child can be around other children

2 forms of heparin induced thrombocytopenia

-First form (Platelets >100,000) normalizes within few days -Second form (Platelets <40,000) life threatening

Adenosine

-First line drug for supraventricular tachycardia -Half life is less than 5 secs so rapidly admin it as 6mg IV bolus over 1-2secs followed by 20ml saline flush. Repeat boluses of 12mg may be given if rapid rhythm persists -Injection site should be as close to heart as possible (Antecubital area) -A brief asystole is due to adenosine slowing impulse conduction -Monitor for flush, dizzy, chest pain, palpation's during and after admin

Clomiphene

-First line treat for infertility by stimulating ovulation -Blocks estrogen receptors -Taken orally for 5 days early in menstrual cycle (Beginning on days 3-5 of menses) -Ovulation typically occurs 5-9 days after completing the med -Frequent sex (every other day for 1 wk) 5 days after completing the med for best chance of successful conception -Risk is can cause 2 or more eggs to be released which causes multiple gestation -Side are hot flashes, mood swings, nausea, headache

Testing for rubella immunity is done when

-First trimester period -Nonimmune mothers receive the MMR vaccine immediate postpartum period

Acute glaucoma

-Fixed and mid dilated pupils

Clubfoot

-Fixed congenital defect of the ankle and foot -Feet turned inward -Weekly recasting over 5-8wks is necessary -can still continue to cradle infant to promote bonding

Asterixis

-Flapping hand tremors during arm extension due to high ammonia lvls. Lactulose used to treat it and promote amonia excretion

Positional Plagiocephaly

-Flat head -Due to infant soft pliable skull placed in same positipon for an extended time -Frequent alternate the supines infant head position from side to side -Minimize amount of time infants head rests against firm surface (Car seat) -Placing pics and toys opposite the favored (affected) side to encourage head turn -Place infant prone position for 30-60min/day (tummy time)

Asystole

-Flat line -First palpate for pulse, then call for help and initiate emergency care (CPR, oxygen vent), Epi IV, placement of airway. Defib not indicated when there is no electrical activity present (Asystole) or when heart muscle not contracting, defib converts lethal rhythms into organized rhythm -Defib cannot create an organized rhythm if there is no electrical activity in heart -Priority is to provide continuous high quality CPR and oxygen vent till circulation spontaneously returns or pt enters shockable rhythm

Cytoscopy

-Flexible fiber optic scope inserted through urethra into urinary bladder with pt in lithotomy position -Complications include urinary retention, hemorrhage, infection so need to report bright red blood when urinating, blood clots, unable to urinate, fever and chills, or ab pain unrelieved by analgesia -Pink tinged urine, frequency, dysuria are expected for up to 48hrs after -Ab discomfort and spasms may occur for up to 48hrs following procedure an taught to take mild analgesic (Acetaminophen, Ibuprofen), sitz bath

Small Bowel Obstruction

-Fluid and gas buildup proximal to obstruction produce rapid onset of N/V, colicky intermittent ab pain, ab distend -Place NPO and NG tube

Acute pulmonary edema

-Fluid filling alveoli

Tetralogy of fallot

-Following repair pts often develop chronic pulmonary regurgitation and reduces in R ventricle function and cardiac output. Decrease in forward blood flow causes blood to back up into venous circulation, resulting in HF -Can have hypercyanotic episodes, knee to chest to increase blood flow to the lungs -Experience chronic hypoxemia due to decreased pulmonary blood flow and circulation of poorly oxygenated blood. To compensate for hypoxia erythropoietin [production increases to produce more RBCs which can result in polycythemia which can risk blood clot

Vastus lateralis

-For 12 months or younger -Infants use 1in needle for IM injections

Riluzole

-For ALS -Slows disease progression

Serum carboxyhemoglobin

-For CO2 posining test -Normal in nonsmokers are <5 -In smokers it is <10

Clonidine patch

-For HTN, changed every 7 days and can be left on bathing -Applied upper outer arm or chest with no hair -Do not wear more than 1 patch at a time -Do not remove patch without HCP permission or else rebound HTN can occur

Continuous Bladder Irrigation

-For TURP -3 way foley catheter and catheter balloon applies direct pressure to the bleeding tissue while tube allows urine to drain -During first 24hrs urine color changes from reddish pink to pink -Small clots expected for up to 36hrs after surgery -Nurse should adjust irrigation rate with normal findings so urine remains light pink without clots -Belladonna-opium suppositories or antispasmodics (Oxybutynin) used for bladder spasms -Do not urinate around catheter as it can cause spasms

Defribillization

-For VFIB or pulseless Vtach -Turn on defib -Place defib pads on chest -Charge defib -Continue chest compression -All clear before deliver shock -Deliver shock -Resume chest compression -Do not need synchronization button

Colchine

-For acute gout attack which decreases inflammation and pain

Lithium

-For bipolar mania (Hyperactivity, delusions, hallucinations, granduer, poor judgement, aggressive,impulsive, hostility -Lithium toxicity has GI effects N/V/D. Tremors, anorexia, confusion, ataxia, sluggish, diabetes insipidus (Chronic), dehydration, decreased renal function, constipation -Can also increase glucose lvls -To prevent toxic then avoid sodium depletion, low sodium intake causes toxicity -Avoid dehydration so diuretic meds or substances with diuretic effects (coffee, tea, cola, alcohol) need to be avoided, drink 2-3l of fluid a day -Decreased renal function and NSAIDs can also cause toxicity -Therapeutic lvls are 0.6-1.2 over 1.5 is considered toxic -May take up to 3 wks to become effective

24 gauge catheter

-For children or older adults with small fragile veins

Fentanyl Transdermal Patch

-For chronic pain and absorbed systemically -Replaced every 72 hours -Applied flat area with intact skin (Upper back, chest) -Discard in sharps or down toile

Pavlik harness

-For developmental dysplasia of the hip (Partial or disclocation of hip joint) -Maintains infants hips slightly flexed and abducted (Legs bent and spread apart). Typically worn 3-5 months -Straps assessed every 1-2wks by HCP. Parents should no adjust straps -Make sure to assess skin 2-3 times daily, dress child in shirt and knee socks, apply 1 diaper underneath straps, leave harness on at all times, lightly massage skin under the straps to promote circulation

Buspirone

-For general anxiety disorder -Lacks CNS depressant effects and has low abuse potential. Does not cause withdrawal, dependence, or psychomotor slowing unlike benzos -Onset of symptom relief occurs after 1 week of therapy with full effects occurring between 2 and 4 wks -This med is not for relief of acute anxiety or panic attacks

Ferrous Sulfate (Iron Supp)

-For iron deficiency anemia -Avoid consuming calcium supps or antacids within 1 hr of ferrous sulfate cause decrease Ca absorption

Asynchronous Cardioversion

-For lethal cardiac arrythmias (VFIB, pulseless VTACH)

Montelukast

-For long term asthma control along with corticosteroid inhalers -Not for acute attacks

Black Cohosh

-For menopausal hot flashes -Main side effect thickening of uterine lining, liver toxicity

Gabapentin

-For neuropathic pain (Burning shooting pain)

Levothyroxine

-For ppl with thyroidectomy -Relief of symptoms start 3-4wks, may take up to 8 wks for full effect -Can experience symptoms of hypothyroidism (Extreme fatigue, bradycardia, menstrual irregularities) If not on it -Taken rest of their lives -Safe to take during preg -Best taken once daily first thing in morning on empty stomach 1 hour before or 2 hours after meals, or 4 hours before or after taking a prenatal vitamin (Iron) or antacids cause may cause decreased absorption of it

Deflate cuff

-For pts who can tolerate oral intake -First ask them to cough and expel secetions that accumulated above cuff, then suction through trach tube and then mouth. Then deflated -Inflated cuff is for pts who at risk for aspiration like unconscious or on mech vent -Chin flexed toward chest prevents asapiration

Electroconvulsive therapy (ECT)

-For severe depression, bipolar, schizo -Causes brief convulsion (15-20sec seizures) and general anesthesia (Loss of consiousness) and skeletal muscle relaxant are used -Pt feels nothing (no pain) but confusion and memory loss are common side effects -Be NPO 6-8hrs, driving not permitted during course ect treatment -Valporic acid is anticonvulsant that is for bipolar therefore would prevent the therapeutic effect of ECT, any prescribed anticonvulsant should be discontinued prior

18 gauge catheter

-For somewhat stable adult who require large amounts of fluid or blood

External Pacing/Transcutaneous pacing

-For symptomatic bradycardia (<60/min) -Temporary means of pacing a patient's heart during an emergency and stabilizing the patient until a more permanent means of pacing is achieved. It is accomplished by delivering pulses of electric current through the patient's chest, stimulating the heart to contract.

Atropine

-For symptomatic bradycardia <60/min

Prostectomy

-For up to 36 hrs after surgery, small blood clots may occur. Consistent passage of clots after this time is complication -Reduced urinary stream, urinary retention, dysuria after prostectomy are also complications -Should avoid valsalva for up 8 wks cause can injure haling tissue and cause hematuria

Clean catch or midstream

-For urinanalysis or urine culture

Paraphimosis

-Foreskin retracted and fixed behind the glans penis which can cause impaired blood flow and swelling

Kaposi sarcoma

-Form of cancer affecting immunocompromised pts who are infected with Herpes. -Develops pink or purple lesions all over skin

Epoetin (Procrit)

-Form of erythropoietin and stimulates body to makemore RBCs, for anemia

Foods rich in folic acid

-Fortified grain products (Cereals, bread, pasta) and green leafy veges

Rule of nines

-Front head is 4.5% -Back head is 4.5% -One Arm front and back is 9% total -One leg front and back is 18% total -Torso is 18% -Back is 18% -Groin is 1% -4mL x wt(kg) x total percentage -First 8 hours give 50%, the next 16hrs give the other 50%

Lobes of brain and functions

-Frontal Lobe Memory, broca speech area, voluntary movement, personality -Temporal lobe (Lateral aspect of brain): Controls hearing, and integrates sensory data (auditory, visual, somatic input) and wernickes speech area (Language comprehension -Parietal lobe is light touch (Sense of position proprioception like where body is and graphesthesia ability to identify writing on skin or by touch), somatic and sensory input

Melenoma

-Full medical workup of every mole is unnecessary -Are pink growths, blue, white, and red colors can be present too -Uneven, large, blotchy moles or any sudden changes in mole size need to be checked out

Loop Diuretics

-Furosemide (can cause ototoxicity when high doses admin in pts with compromised renal), torsemide, bumetanide

Sulfasalazine

-GI anti-inflammatory used for IBD, Ulcerative colitis (blood in stool) -Mild to moderate chronic inflammatory rheumatoid arthritis -Side are crystalluria (Cloudy urine due to crystals in urine) which causes kidney injury so drink 8 glasses water, photosensitivity, folic acid deficiency, agranulocytosis (Leukopenia), Steven Johnson -Urine and skin can turn orange yellow color and expected finding

MRI contrast

-Gadolinium contrast is used -Make sure they had no previous allergy reaction to gadolinium like rash -NPO 4 hrs prior

Herbs that increase bleed risk

-Garlic, ginger, Gingko, ginseng (GGGG)

Exploratory Laparoscopy

-General anesthesia, supine position -Surgery to look for causes of pain, abnormal growths, bleeding, or disease in your abdomen. During this surgery, small incisions are made in your abdomen. A small scope and tools are inserted through these incisions. A scope is a flexible tube with a light and camera on the end.

Von Willebrand Disease

-Genetic bleeding disorder, can cause pain and inflammation too -Deficiency of Willebrand Factor which plays important role in coagulation -For minor bleed intranasal desmopression or thombin given, if major bleed then need wellebrand factor replacement -Should wear medical bracelets -Teach notify signs of bleed, use humidifier m avoid NSAIDs, avoid high risk injury activities, maintain gum integrity (Soft toothbrush, gentle floss), report heavy menstrual bleed

Sickle cell anemia

-Genetic disorder that causes abnormal hemoglobin, resulting in some red blood cells assuming an abnormal sickle shape -Can cause spleen dysfunction which can cause increased risk infection

Metabolic alkalosis

-Gi suction, vomit -Causes hypokalemia

Accidental Epi pen stick

-Give antihypertensives

Cardiac Arrest

-Give epi every 3 to 5 mins then amiodarone -Epi admin after CPR and defib

Benzo overdose

-Give flumazenil as antidote

Biploar with mania

-Give food that are "on the go" and packed with protein and energy -High calorie snacks and finger foods that pt can carry and eat without having to sit down

Growth Hormone

-Given SubQ -Most successful if treatment beings early in childs life -Stop when growth less than 1in per year and bone age of 14yrs in girls and 16yrs in boys

Transdermal Fentanul Patch

-Given for moderate to severe chronic pain -Absorbed slow and can take up to 17 hours to reach its full effect. Therefore not recommended for acute or intermittent pain

Acetylcysteine

-Given via nebulizer to loosen and liquefy respiratory secretions -No effect on airway smooth muscles and can actually worsen or cause bronchospasms

Alcohol can cause low what?

-Glucose lvls and thiamine -Thats why all intoxicated pts need to be given IV thiamine and IV glucose

Celiac Disease

-Gluten intolerance, causes malabsorption of fats (Steatorrhea, foul smelling stools) -Need to be on gluten free diet, rice, corn, potatoes are gluten free and allowed in diet -Cannot have BROW (Barley, Rye, Oats, Wheat) not even a little. For rest of life

Tangentiality

-Going from one topic to the next without getting to the point of the original idea or topic

20-22 gauge catheter

-Good for admin general IV fluids and meds -20 gauge is acceptable for blood transfusion -However, 20-22 gauge is not preferred for blood admin

Positioning with pneuomnia

-Good lung down side lying which increases perfusion to healthy lung by gravity

Chronic Open Glaucoma

-Gradual loss peripheral vision and difficulty adjusting to different lighting -Condition develops slowly

Large bowel obstruction

-Gradual onset, cramp ab pain, ab distend, absolute constipation, lack flatus

Asthma action plan

-Green zone indicates asthma under control and PEF is 80%-100% of personal best. There no worsening cough, wheeze, or breathing trouble -Yellow zone mean caution, even on return to green zone after using rescue med, further med or change in treatment is needed (50%-79% of personal best) -Red zone indicates med alert bracelet and signals need for immediate med treatment if level does not return to yellow immediately after taking rescue med (<50% of personal best)

1 months developmental milestones

-Gross Motor: Attempts to hold head up when prone -Fine Motor: Maintains fisted hands -Language: Cries when upset -Social/Cognitive: Gazes at parents face when parent speaks

2-3 months developmental milestones

-Gross Motor: Gains head control when held -Fine Motor: Holds rattle when placed in hand -Language: Makes cooing counds -Social/Cognitive: Smiles in response to smiling & talking. Recognizes familiar faces

4-5 months developmental milestones

-Gross Motor: Rolls front to back then back to front. Sits with support -Fine Motor: Holds objects with palmar grasp. Put things in mouth -Language: Begins to laugh, makes consonant sounds -Social/Cognitive: Becomes calmed by parents voice

6-9 months developmental milestones

-Gross Motor: Sits without help. Begins to crawl. May pull to stand -Fine Motor: Moves objects between hands. Uses crude pincer grasp. -Language: Babbles and imitates sounds. May say mama -Social/Cognitive: May have stranger anxiety

PostStreptococcal Glomerulonephritis

-Gross hematuria is expected

10-12 months developmental milestones

-Gross motor: May walk with help or take independent steps, crawl up stairs -Fine motor: 2 finger princer grasp, hits 2 object together -Language: says 3-5 words, use nonverbal gestures (wave bye) -Social/Cognitive: May separation anxiety, searches hidden objects

5 years old developmental milestones

-Gross motor: Skips, walks backwards, used jump rope -Fine motor: Draws triangle, ties shoelaces, prints letters/numbers/words -Language: Counts to 10, speaks full sentences, names coins and days of the week -Social/Cognitive: Independently dresses and bathes, identifies real from pretend

4 years old developmental milestones

-Gross motor: Walks down stairs with alternating feet. Balances on 1 foot. Catches a ball -Fine motor: Draws circle, cuts with scissors, ties simple know -Language: Names 2 or more colors, likes telling stories -Social/Cognitive: Begins imaginative/group play, recognizes analogies, often focuses on self

3 years old developmental milestones

-Gross motor: Walks up sitars with alternating feet, pedals tricycle, jumps forward -Fine motor: Draws circle, feeds self no help, grip crayon with fingers instead of fist -Language: Can form sentences of 3-4 words, asks why questions, states own age -Social/Cognitive: begins associative play, toilet trained except wiping

2 years old developmental milestones

-Gross motor: Walks up/down stairs alone 1 step at time, runs with no fall, kick ball -Fine motor: Build tower 6-7 blocks, turns 1 page at time, draws line, use doorknob open door -Language: Vocab 300+ words, form phrases of 2-3 words, states own name -Social/Cognitive: Begin parallel play, begin gain independence from parents

18 months developmental milestones

-Gross motor: Walksup/down stairs with help, throws ball overhand, jumps in place -Fine motor: build tower of 3-4 blacks, turns 2-3 pages at time, scribbles, used cup and spoon -Language: Vocab of 10+ words, identifies common objects -Social/Cognitive: Temper tantrum, understand ownership (mine), imitates others

Muscular Dystrophy

-Group of hereditary diseases characterized by degeneration of muscle and weakness -Respiratory and cardiac problems are leading causes of death -Pts should take precautions to prevent respiratory infections (Pneumococcal and Influenza vaccination, avoid contact with infected individuals)

Tuberculin Skin Test Reactions

-HIV, immunosuppresed, organ transplant, recent contact with TB. Induartion of 5mm or more means positive -Children under age 4 or children and adolescents exposed to adults in high risk groups, injection drug user, recent (<5yrs) immigrant from high prevalent country, resident or employee in high risk areas. Induartion of 10mm or more means positive, -No known risk factors for TB. Induration of 15mm or more means positive

Jugular Vein Distention Angle to best view

-HOB 30-45 degree

PostOp Total Hip Replacement

-HOB 60 or lower -Avoid adduction ( move toward midline) and hip flex -Place abductor wedge pillow between legs -Should not sleep, or turned, or positioned on affected side

Causes of peripheral artery disease

-HTN, DM, Hyperlipidemia, Smoking

Clean catch female

-Hand hygiene and remove container lid with lid face up -Spread labia -Clean vulva from front to back antiseptic -Initiates stream before passing into container -Remove specimen container from stream before stop urinary flow

Car seats

-Harness fits snugly when newborn is dressed in lightweight clothing. Tucking blankets between newborn and harness or dressing them in bulky coats or sleep sack reduces car seat effectiveness -Car seat should be placed in the back seat and in the center (Away from doors) -Tilt back 45 degree angle

Celecoxib

-Has black box warning for increased risk of cardiovascular complications like MI (Nausea, upper back and shoulder pain)

Chronic Kidney disease at risk for

-Has decreased glomerular filtration rate resulting in retention of fluids and electrolytes -Fluid overload and hyperkalemia -Should avoid salt substitutes which typically contain potassium chloride and may contribute to hyperkalemia >Restrict sodium, potassium (raw carrots, tomatoes, OJ), fluid intake monitor, low protein diet to prevent progression kidney disease but if on hemodialysis then increase protein intake to prevent malnutrition, avoid foods high in phosphorus (Chicken, turkey, dairy)

Hypercalcemia

-Has diuretic effect can cause polyuria. -Can cause constipation

Septic arthritis

-Has localized (pain, limited ROM) and systemic infection symptoms (fever) -Can be caused by recent surgery, injections, trauma, or spread from adjacent infection (Cellulitis) -Septic hip is surgical emergency cause hip bone prone to develop avascular necrosis from compromised blood supply due to injury (fracture) or infection -Management is synovial fluid and blood, antibiotics, debriinginfected joint

Syrup of ipecac

-Has minimal benefit in treating aspirin overdose and not recommended due to risk of aspiration pneumonia secondary to vomiting

Postpartum Endometritis

-Has purulent lochia, uterine fundal tenderness, Fever >24hrs postpartum -Treat with antibiotics

Complete Inversion Of Uterus

-Has severe pain, uterus is not firm or at midline, Has hemorrhaging -Has large red mass protruding from vaginal canal

Patent ductus arteriosus

-Has systolic murmur with a machine sound and poor feed are expected -Usually resolves within 48 hrs

Gastroparesis

-Have delayed gastric emptying and often report persistent N/V. Treatment includes antiemetics

Hyperemsis Gravidarum

-Have excessive N/V, wt loss, dehydrated, hypotension, tachycardia, ketonuria (Due to fat breakdown from wt loss), hypona/kalemia, metabolic acidosis, often require fluid replacement and antiemetic therapy. Usually not life threatening -

Houses built before 1978

-Have high probability of containing lead based paint

Bronchitis

-Have rhonchi (Moaning or snoring wheeze) -Inflammation upper airway (Bronchi), thick secretions obstruct airflow in upper airways

Oral surgery

-Having congenital heart disease, prosthetic valves, are at risk for infective endocarditis and should receive prophylactic antibiotics prior

Pediculosis Capitis

-Head lice -Prevent spread by using hot water to launder clothing, sheets, and towels in the washing machine and then placed in hot dryer for 20 mins -Treatment is use of pediculicides and removal of nits (eggs) -Spread direct person to person contact or by nits that hatch in the environment and remain on clothing, combs, pillows -Items that cannot be washed or dry cleaned need stuff in sealed plastic bags for 14 days

STIs and nurses scope to report

-Health authorities must be notified of a reportable STI regardless of pts wishes -Authorities may report findings to sexual contacts but it is violation of privacy for the nurse to share this info to pts fam or spouse

Advance care include (Advance Directive)

-Healthcare proxy: Durable power attorney, makes decision on ps behalf, goes into effect when healthcare team determines pt lacks capacity to make own decisions -Living will: Describes type of life sustaining treatments (CPR, Inutubation, mech vent feed tube) what pt wants initiated if unable to make decisions

Low pitch wheeze (Rhonchi)

-Heard over large airways during expiration, indicates presence of secretions in larger airways and is an expected finding as pneumonia resolves

Rhuematoid Arthritis

-Heat packs for stiff joints -Ice packs for painful joints -No cure -Symmetrical pain and swelling of small joints of hands and feet -Worse symptoms in morning and can take NSAIDs -Morning joint stiffness lasting 60 mins to several hours -Take warm shower or bath first on awakening so heat can help decrease stiffness and promotes muscle relaxation and mobility so easier for them to complete morning ADLs

Cariostatic foods

-Help prevent dental caries -Dairy products, whole grains, fruits/veges,sugar free gum containing xylitol

Melatonin

-Help with jet lag -Lowest possible dose should be used and should be taken only for a short time

Saline lock

-Helps maintain IV access while preventing clotting after IV infusions are discontinued

Vitamins D

-Helps maintain bone density

Anemia During Preg

-Hemoglobin <11 in 1st/3rd or <10.5 in 2nd trimester is considered low

Normal lab values during 3rd trimester

-Hemoglobin more than 11 -Hematocrit more than 33% -RBCs 5.00-6.25 -WBCs 5,000-15,000 -Platelets 150,000-400,000

Ebola

-Hemorrhagic fever -Very contagious, need standard, contact, droplet, airborne with full face shield, double gloves, single use boot covers -Visitors prohibited unless necessary for pts well being (Parent visiting sick child) -Currently no cure, procedures with sharps/needles are limited whenever possible -Removal of PPE consists outer gloves clean first with disinfectant then removed, inner gloves then wipe between removal of every other PPE and removed last

Oxytocin

-High alert med -Admin via electric pump which prevent maternal hypotension associated with rapid oxytocin bolus -Should evaluate and document the FHR and uterine contraction pattern every 15 mins during first stage of labor and every 5mins during second stage -Continuous electronic fetal heart rate monitoring is necessary -Monitor maternal I/O to identify fluid retention which precedes water intoxication -Admin through secondary IV line connection to main IV line -Is not titrated according to cervical dilation, initiated at lowest dose and titrated until contractions are 2-3min apart and lasts for 80-90secs -Infusion discontinued if uterine tachysystole (>5 contractions in 10 min) or fetal distress occurs

Trisomy 21 (Down Syndrome)

-High incidence in advanced maternal age -Has singular palm crease and short neck with excess skin (Nuchal fold)

Vaso occlusive sickle crisis

-High lvl pain due to occlusion of small blood vessels from increased red blood sickling, causes severe pain in upper back, legs, and arms -Supportive treat include round the clock pain meds with opioids, IV fluids for hydration, bed rest to decrease oxygen demand -Need to be in relaxing environment and relaxing activities

Normal bowel sounds

-High pitched gurgling sounds

Stridor

-High pitched, vibratory, harsh sound during inspiration or expiration that indicated partial airway obstruction. Life threatening, make sure suction device, oxygen, trach tray are readily available

Left to Right shunting

-High pressure on left side of heart shunts to lower pressure on right side which increase pulmonary blood flow. Excess blood flow to lungs. -Are acyanotic -Results in pulmonary congestion, increase work of breathing and decreased lung compliance -Can cause tachypnea, tachycardia even at rest, diahphoresis during feed/exertion, heart murmur or extra heart sounds, signs of CHF, increase metabolic rate with poor wt gain -Patent ductus arteriosus, atrial septal defect (Can have systolic murmur), ventricular septal defect

Recently extubated care

-High risk aspiration or obstruction (Laryngeal edema/spasm) -Place high fowlers -Warm humidified oxygen -Oral care -Cough and deep breathe and use incentive spirometer -NPO

Preterm Newborn

-High risk cold stress -Dry newborn completely of amniotic fluid immediately following birth protects newborn from heat loss by evaporation -Should be transferred to ICU via prewarmed incubator

Testicular Self Exam

-High risk pts are undescended testes -Perform monthly on the same day -During warm shower -Use both hands to feel each testes separately -Using thumb and first 2 fingers to palpate -Report if painless hard lump, scrotal swell or heaviness, dull ache in pelvis or scrotum

Measles (Rubeola)

-Highly contagious. Erythematous morbilliform rash, koplick spots in mouth, and copious clear mucus -Spreads airborne -Not itchy -Plan of care is postexposure prophylaxis (MMR Vaccine) for eligible, susceptible (Unvaccinated) fam members within 72hrs of exposure to decrease their symptoms -Admin vitamin A supps to prevent severe measles induced vit A deficiency which can cause blindness

Impetigo

-Highly contagious. Occurs mostly hot humid weather -Itchy burning red pustules that rupture to form honey colored crusts -No longer contagious after 24-48hrs of antibiotic -Decrease transmission by hand wash before and after touch infected area, isolate pts clothing and linens and wash in hot water, keep pts nails short and clean, avoid close contact with others for 24-48hrs after initiation of antibiotic therapy, keep infected area covered with gauze when in contact with others (School) -Lesions should soak warm water, saline, burows solution and gently cleaned with mild antibacterial soap before antibiotic ointment

Ketolorac

-Highly potent NSAID -Nephrotoxic

Risks for cervical cancer

-History of STD, early onset of sex, multiple high risk partners, immunosupression, oral contraceptives, poor, tobacco, -Almost all cases result due to HPV which is primary risk factor -No previous pregnancies not risk factor but is risk factor for breast cancer

PICC line change

-Hold breath or valsalve during cap and tube changes to prevent air from entering the line, traveling to the heart, and forming air embolism -Placed supine position -If air embolism is suspected then trendelenburg and left side

Apgar Score

-How well newborn is transitioning to extrauterine life -Done at 1 and 5 mins of life -APgar of 6 during 1st min is appropriate -Apgar 7 or more after 5mins then its good, if 4-6 then supportive resuscitative measures, if 3 or less then in distress -Repeated every 5 mins for up to 20 mins

Asthma

-Hyperactive airways and chronic inflammation, results edema, hypersecretion mucus, and bronchospasms -Narrowing of airways causes increased airways resistance, air trap, lung hyperinflation -Absent breath sounds are medical emergency -Frequent cough especially at night is warning sign that child's airway is very sensitive to stimuli

Kidney disease at risk for what imbalance?

-Hyperkalemia and hypophosphatemia, decreased calcium

Cushing syndrome

-Hypersecretion of cortisol (hydrocortisone) by the adrenal gland -May need 24 hour urine collection to test for free cortisol (Increased cortisol) -Purple striae, hirsutism (increased facial and body hair), supraclavicular fat pad (Buffalo hump). Androgen excess can result in acne, menstrual irregularities. Truncal obseity (AB fat). HTN, hyperglycemia. Moon face. Skin atrophy (Decreased elasticity). Muscle weak and bone loss

Chronic allergic rhinitis

-Hypersensitivity response to specific allergic triggers (dust, mold, pollen, animal dander) -Should vacuum and mop had floors and damp dusting furniture at least once a week

Signs of depression in adolescents

-Hypersomnolence (excessive sleepiness) or insomnia, napping during daily activities -Low self esteem, withdrawal from previously enjoyed activities -Outbursts or angry, aggressive or delinquent behavior (vandalism, absent) inappropriate sexual behavior -Wt gain or loss, increased food intake or lack of appetite -Insecure about body does not correlate with onset of depression

Serotonin Syndrome

-Hyperthermia, fever, confusion, clonus, tachy, restless agitation, diaphoresis, HTN, diarrhea, tremor, hyperreflexia

Zolpidem

-Hypnotic med that induces sleep

Decreased Muscle Tone in Newborn

-Hypotonia -May indicated congenital neurological abnormality (Down Syndrome) or spinal injury -Newborns normally have increased muscle tone and should resist movements of extremities

Meds in newborn

-IM Hep b and vit k admin shorty after birth in vastus lateralis -Needle should be 5/8

Metabolic Acidoses

-INcreased in production or retention of acid or depletion of bicarb via kidneys or GI tract -Common cause are GI bicarb loss by diarrhea, ketoacidosis (Diabetes,alcohol), lactic acidosis (sepisis, hypoperfusion), renail fail

Nifedipine

-IS calcium channel blocker -Use grapefruit juice can cause severe hypotension

Milirone

-IV infusion to increase conductibility and promote vasodilation. Infused over 48-72hrs -Prescribed to pts with HF -Requires PICC cause vesicant -In home setting ensure infusion pump is there, have dressing change supplies, monitor daily wt, monitor BP for possible hypotension,

Reduce milk production in engorgement in those who do not breastfeed

-Ice packs to both breasts 15-20mins every 3-4hrs -Chilled cabbage leaves -Anti inflammatory analgesic (Ibuprofen) -Maintain firm breast support like supportive bra

NSAIDs DUring preg

-Id preg D during third trimester and should be avoided

Cardiac tamponade

-If acute pericarditis (Inflammation of membrane sac [Pericardium] surrounding exterior of heart) which can cause increase in amount of fluid in the paricardium (Pleural effusion). If pericadial effusion accumulate rapidly or are very large, they may compress heart (Cardiac tamponate) -Muffled/Distant heart sounds, hypotension, distended neck veins, pulsus paradoxus (SBP decrease >10 during inhalation -Decreased breath sounds not a sign -Might need pericardiocentesis to prevent cardiac arrest

Asymptomatic Hypoglycemia in newborns

-If age 4-24hrs ir BG 35 or less, or if <4hrs age with BG 25 or less. Treat by feeding breastfeed

Orthostatic Vitals

-If any position change produces decreased Systolic BP 20 or more or decreased DBP 10 or more or increased pulse 20 or more from supine values, the nurse should discontinue assessment, place in recumbent position and notify HCP

Compensation

-If deficit in one area, then will make up by overachieving in another

Only time you can remove impaled object

-If it obstructs airway and prevents effective CPR

Mucoid Vag Discharge Preg

-If it's blood tinged or brownish (Bloody show) is common finding in the days preceding onset of labor. Not a definitive sign of true labor though

Sex after cardiac surgery

-If pt can walk 1 block or climb 2 flights of stairs without symptoms, and if HCP approves it, then can resume sex

PostPartum Vag bleed

-If saturated perineal pad in <1hr then it's excessive -Bladder distension can cause fundus to be elevated above the umbilicus and deviated to right and prevent uterus from contracting sufficiently to control bleed at previous placenta site, should help them void. If that still does not control the bleed then oxytocin should be used

St John Wort

-If taken with other antidepressants can lead to serotonin syndrome -Interfere with absorption of iron and other minerals, can also cause photosensitivity

Babinski in adults

-If toes fan outward and upward with stimuli on sole of foot, then can indicate brain or spinal cord lesion

Wt loss calculation

-If want lose 20lbs in 16 wks, how many calories to eliminate per day? -3,500 calories results loss in 1lb >3,500 x 20 = 70,000 cal >(70,000 [16wks x 7 days]) = 625cal/day

GERD

-Immature lower esophageal sphincter -Wt loss, small frequent meals with sips water, avoid GERD triggers (Caffeine, alcohol, nicotine, high fat foods, chocolate, peppermint, carbonated beverages). Chew gum, sleep HOB elevated, refrain from bedtime eat or supine after eat -Should not minimize dairy but should choose low fat or nonfat products

Acute Glomerulonephritis

-Immune disease caused by prior group A beta hemolytic strep infection of skin or throat -Can cause periorbital and facial/generalized edema, HTN, and oliguria which are primarily due to fluid retention (Decreased kidney filtration) -Urine is tea colored and cloudy due to protein and blood -Severe HTN is anticipated complication -Avoid salt in diet and make sure daily wt

Methotrexate

-Immunosuppresant -Do not eye eye exams

Azathioprine

-Immunosuppresant drug that cause bone marrow depression -Used to treat autoimmune conditions such as, SLE, inflammatory bowel disease like crohns and prevent transplant rejection -If leukopenia then report asap

Negative Symptoms of Schizophrenia

-Impaired social functioning, inappropriate or blunt affect, apathy, regression, pacing and rocking, poor personal hygiene -Will often become anxious when around others and will seek to be alone to relieve anxiety -Interventions: make brief frequent contact, accept pt unconditionally by minimizing expectations and demands, offer positive reinforcement when pt interacts with others

Placenta Previa

-Implantation of placenta in partial or complete covering of cervical opening -Usually have painless vag bleed, can cause hemorrhage and need C section 36 wks gestation and prior to onset of labor -Additional ultrasound is performed at 36wks -Should type and cross match, continuous FHR monitor, Large bore IV access, monitor bleed via pad count -Digital vag exams are contraindicated in presence of vag bleed after -Need to be on pelvic rest

Hallucinations

-Important step to self management is for pt to recognize the hallucinations not real -Reinforce reality and acknowledge how pt feeling

Activated Charcoal

-Important treatment in early aceytlsalicytic acid (ASA) toxicity -Recommended for GI contamination in pts with clinical signs of ASA poisoning (disorientation, vomit, hypernea, diaphoresis, restless) as well as those asymptomatic -Binds to salicytates this limiting further absorption and enhance elimination

Mitral Valve Prolapse

-Improper closure of the mitral valve -Can cause dizzy, palpations, lightheaded -Chest pain may occur but dont know why it occurs -Beta blockers for palpations and chest pain and nitrates not effective -Make sure eat healthy and avoid caffeine, check OTC meds or diet pills for stimulants like caffeine or ephedrine as they can make it worse, reduce stress and avoid alcohol, stay hydrated

Acute Asthma Exacerbation

-In cases of severe obstruction, wheezing/breath sounds not heard due to lack of airflow. This silent chest is emergency. Onset of wheezing will be an improvement,

Fecal Incontinence

-In children is mostly due to functional constipation (retentive type) -Behavioral strategies used to promote and restore regular toileting habits are >Regularly schedule toilet siting times 5-10mins after meals for 10-15 mins >Provide quiet activity for child during toilet sitting which will help make experience more enjoyable and to pass time >Reward given for effort and not for success in bowel movement

Positive Tuberculin Skin Test

-In healthy pts its induration >15mm, means exposed TB, developed antibodies to disease, and has TB infection. Additional tests ned to be done to tell if latent or active -Induration (not redness) indicates a positive test

Mannitol

-In high doses or accumulates due to kidney disease, can cause fluid overload and cause pulmonary edema

Cataract Surgery

-In postop activities that increase intraocular activity should be avoided to decrease risk of damage suture sites like bending (Vacuum floors play golf), lifting more than 5lbs, sneeze, cough, straining bowels -May take 1-2wks before vision improved -Can have itchy sand in eye feeling, photophobia, mild pain several days following procedure -Sleeping on 2 pillows decrease intraocular pressure

Necrotizing Enterocolitis

-In preterm infants due to underdeveloped intestines and gut immunity -Inflammation and ischemia necrosis of intestine which while make bowel congested and gangrenous with gas collections forming inside bowel wall -Measure ab girth daily is important to note any worsening gas associated swell -Made NPO and NG suction. Parenteral hydration and nutrition and IV antibiotics given -Place supine and undiapered

Preg paitnets have increase in what?

-In total blood volume -WBC can be as high as 15,000 and is normal

Uterine atony

-Inability of the uterus to contract effectively, has boggy uterus -The most common cause of postpartum hemorrhage.

Escharotomy

-Incisions made through eschar (Burned tissue) to prevent tissue ischemia and necrosis from impaired circulation

Severe Asthma Exacerbation Treatment

-Include tachy >120/min, tachypnea (>30/min), saturation less than 90 on room air, use acessory muscles >Admin oxygen to maintain sat more than 90% >High dose SABA albuterol and anticholinergic agent (Ipratropium) nebulizer treatments every 20 mins >Systemic corticosteroids -Montelukast is used to prevent asthma attacks but not recommended as emergency rescue drug -Salmeterol is LABA admin with inhaled corticosteroids for long term control and not used for emergency rescue -Fluticasone/Salmeterol (Advair) is LABA for long term control asthma

How to cope with auditory hallucination

-Increase amount of external auditory stimulation in environment like watch TV, listening music through headphones. Makes it easier to ignore hallucinations.

Carbidopa-Levodopa

-Increase dopamine lvls in brain in parkinsons >Should fall precautions cause orthostatic hypotension common >Harmless discoloration (red, brown, black) of bodily fluids >Dyskinesia (facial or eyelid twitch, tongue protrusion, facial grimacing) may indicate overdose >Can cause involuntary movements (During prolonged use) >Helps treat bradykinesia (generalized slowing of movement) >Should not be stopped suddenley or can lead to akinetic crisis (Complete loss of movement) >Takes several wks to reach maximum effectiveness >Avoid high protein meals

Cariogenic foods

-Increase risk for cavities -Refined simple sugars, sweet sticky foods like dried fruit, candy, and sugary beverages

SIADH

-Increased in ADH -Holds on to water and not pee a lot -Decreases serum osmolarity -Increases urine specific gravity -Low Serum sodium -Can be caused by carbamezapine

Hydrocephalus

-Increased in ICP resulting from obstruction of CSF flow -Signs increased ICP in children are bulging frontanelles, increased head circumference, and sunset eyes (sclera visible above iris)

Open angle glaucoma

-Increased ocular pressure and tunnel vision -Develop gradually, slowly and include painless impairment of peripheral vision with normal central vision, difficult dim light, sensitive to glare, halos in bright light -Can lead to blindness if untreated

Pulmonic stenosis

-Increased pressure in right side of heart as ventricles push blood through narrowed pulmonary area to the lungs -High pressure in the right side can cause unoxygenated blood to travel to left side and into systemic circulation leading to chronic hypoxia and cyanosis -Loud heart murmur is expected finding in this condition -NPO 4-6hrs or longer prior surgery -Cyanosis indicates severe pulmonic stenosis with right to left shunt

Metabolic syndrome

-Increased risk diabetes and coronary artery disease -Presence obesity increase insulin production and this excess insulin leads to insulin resistance which is primary feature of metabolic syndrome -Characterized by 3 or more of following criteria >Increased waist circumference (40in or more in men and 35in or more in women) >Blood pressure (130 or more systolic, 85 or more diastolic, or drug treatment for HTN >Triglyceride more then 150 or drug treatment for elevated triglycerides >HDL less than 40 in men and less than 50 in women or on drug treatment for low HDL >Fasting glucose of 100 or more or drug treatment for elevated blood glucose

Thyroidectomy

-Increased risk for airway compromise postop due to neck swell and hypocalcemia and nerve damage -Assess hypocalcemia (tetany, tingling hands feet and mouth), stridor, changes in voice strength and quality (Hoarse or whispering) which may indicate laryngeal damage, keep airway equipment bedside, semi-folwers

Vag discharge during preg

-Increases at end of preg and can be mucoid and blood tinged (pink/brown) in days preceding labor

Hyperthyroidism

-Increases metabolic rate can lead to hunger and wt loss if not enough calories consumed -need 4,000-5,000 cals a day, Packed with protein and carbs, and 6 full meals and snacks a day, avoid high fiber foods cause can increase GI symptoms (Diarrhea)

Digoxin

-Increases myocardial contraction which increases cardiac output and improves circulation and tissue perfusion. Treats HF and afib -Apical should assess full min before giving and also kidney function cause digoxin is excreted exclusively by kidneys -If HR <60 then hold it, can result in brady or heart block (Which can lead to lightheaded and dizzy), pts check their HR and report if skipped beats -0.5-2.0 is norm range -Signs toxicity (N/V, confusion, weak, vision change, cardiac arrhythmias) -Hypokalemia can cause digoxin toxicity -So check both digoxin and potassium lvls before giving -However potassium does not need to be increased just cause on digoxin

Filgrastim (Neupogem)

-Increases neutrophils (WBCs) -Combat effects of chemo

Drugs that affect warfarin

-Increases warfarin (Increased bleed risk): Acetaminophen, NSAIDs, antibiotics, amiodarone, cranberry juice, Ginko, Vit e, omeprazole, thyroid hormone, SSRI -Decreases warfarin (Decreases effects): Rifampin, carbamezapine, ora contraceptives, ginseng, st john wort, Vit K rich food (Spinach, broccoli, liver)

Viral Meningitis

-Incubation is 1 wk -Signs are headache, fever, photophobia, stiff neck (Cannot flex chin toward chest) -Do not require droplet

Influenza Virus

-Incubation period of 1-4 days and lasting up to 5-7 days after the illness stage begins -can be transmitted during incubated and illness stage

Reactive nonstress test

-Indicates fetus is well oxygenated and establishes fetal well being

Estrogen therapy for transgender

-Induce feminine traits (Breast enlarge, reduction body hair, decrease testes size and erectile dysfunction) -But increases risk blood clots

Babinski reflex

-Infant reflex where if its foot is stroked, the baby's toes fan out -Present up to age 1-2

Cystitis

-Infection lower urinary tract -Leads to burning, frequency and urgency, hematuria

Acute Otitis Media (AOM)

-Infection middle ear can cause hearing loss, spread of infection -Signs are red and bulging tympanic membrane, inner ear pressure (which can rupture the tympanic membrane [Eardrum]), pain, fever, tugging ear, loss appetite -If tympanic membrane ruptures can cause immediate pain relief and gradually decreasing fever, purulent drain may be observed in external ear canal -Occur during winter months, has ear pain, irritability, fever, and pulling of affected ear -Treat with antibiotics and amoxicillin is standard to help prevent permanent damage. To avoid future occurrences, get the pneumococcal vaccine and influenza vaccine -If symptoms no improve 48-72hrs then see HCP cause maybe different antibiotic may be needed -Exposure to tobacco smoke, using pacifier, or drinking bottle lying down are at risk -Water in ear not effect it

Pyelonephritis

-Infection spread from bladder to kidneys, if not treated then can become septic -Flank pain, Costovertebral tenderness, N/V, chills -If preg then need IV antibiotics because increases risk preterm labor

What is hepatitis (Inflammation of liver) often caused by?

-Infection, toxins, trauma (drug use, viral hepatitis, acute poisoning) which results in impairment of liver function (bile production which is needed to break down fats will be impaired so no eat high fat foods, detox of blood, metabolism)

Nosocomial Infection

-Infections acquired in hospital and occur 48 hrs or more after admission or up to 90 days after discharge

Extravasation

-Infiltration of drug in tissue surrounding vein that can cause necrosis. Use syringe to aspirate drug. Notify HCP for the antidote phentolamine (Vasodilator) injected subq -Pain, redness, blanching swelling are signs -Noepi is vesicant, should be infused through central line

Appendicitis

-Inflammation of appendix often results from obstruction fecal matter -The appendix then traps fluid and mucus typically secreted into the colon causing increased intraluminal pressure and inflammation and as the pressure and inflammation increase, blood circulation to appendix is impaired resulting in swelling and ischemia which can increase risk for appendix perforation leading to peritonitis and sepsis. Medical emergency -Signs are continuous pain in periumbilical region that moves to right lower quadrant, anorexia, N/V, rebound tenderness and guarding -Decreases pain by avoid intraabdominal pressure (avoid coughing, sneezing, deep inhale), and lay supine with right leg flexed -Fluid resuscitation is important to prevent circulatory collapse resulting from fluid loss (Vomit, diarrhea) and NPO status -Avoid interventions that increase intestinal blood circulation like heating pad or warm blanket to abdomen -If pain has subsided can mean it ruptured and can return with full blown perontitis and sepsis

Bacterial Meningitis

-Inflammation of membranes covering brain and spinal cord. Can lead to increased ICP which may lead to hearing loss, visual impairment, paralysis, brain damage, herniation, death -Initial priority is protecting other pts from exposure cause highly contagious and droplets, after isolating pt then give antibiotics asap

Prostatitis

-Inflammation of prostate -Management is antimicrobial and anti-inflammatory meds (Ibuprofen) -Suprapubic catheterization if urine retention is severe, urethral catheterization contra due to risk of exacerbating pain and urethral inflammation -Teach to hydrate with clears and avoid coffee, tea >Complete full course anti >Engage sex or masturbation to reduce comfort >Take stool softener to reduce strain >Take sitz baths to help relieve symptoms

Bronchiolitis

-Inflammation of the bronchioles -Usually caused by RSV -Self limited illness and supportive care is main treatment. Most children can be managed at home -Breastfeed should be continued and additional fluids offered if there is risk dehydration due to cough and vomit -Use saline nose drops and then suction nares to bulb syringe to remove secretions prior to feeds and at bedtime

Diverticulitis

-Inflammation of the diverticula and causes pain in left lower quadrant -Can have fever, tachycardia, nausea, leukocytosis, bright red blood in stool, can be fetal position due to pain -Complications can be abscess formation (Continuous fever despite antibiotics and palpable mass). Intestinal perforation resulting in peritonitis (Progressive pain in other quadrants in ab, rigid, guarding, rebound tenderness -Peritonitis lie still and take shallow breath

Acute cholecystitis

-Inflammation of the gallbladder -Has RUQ pain along with shoulder and scapula -Often report fatty food ingestion prior to pain -Has low grade fever (Leukocytosis), chills, nausea, vomit, anorexia -Due to gallstone obstruction of bile duct and results in inflammation and Murphys sign (Palpation over RUQ cause pain and inability to take deep breath)

Acute pericaditis

-Inflammation of visceral and/or parietal pericardium -Has pleuritic chest pain that is sharp and worsens when inhaling and coughing -Pain relieved sitting up and leaning forward -Has friction rub -Treatis NSAIDs, aspirin -Supine or lying down worsens pain

Ulcerative Colitis

-Inflammatory bowel disease due to irritation of large intestines resulting in profuse bloody diarrhea -Management >Low residue, high calorie and high protein to prevent wt loss and muscle waste. >Multivitamins containing calcium >Oral hydration at least 2 liters/day >Dietary triggers so keep journal >Dily vitamin and mineral supps >easily digestible foods >Raw fruits/veges, whole grains, highly seasoned foods, fried foods, alcohol are avoided

Ezetimibe

-Inhibits cholesterol absorption which reduces risk atherosclerosis and helps treat coronary artery disease

Finasteride

-Inhibits further growth of prostate -Missing one dose will not cause effects since it takes months of therapy for it to see effects

Cardiac Catheterization

-Injects iodine to examine obstructed coronary arteries -Complications include >Allergic reaction to IV contrast may be premedicated corticosteroids, antihistamines, or another contrast medium >Contrast nephropathy the iodine contrast can cause kidney injury so if renal impairment then cannot receive the contrast >lactic acidosis (Metormin with IV contrast increases risk lactic acidosis so usually discontinue 24-48hr prior and restarting 48hrs after

Cauda Equina Syndrome

-Injury in L4-L5 causing motor and sensory deficits -Main symptoms are severe lower back pain, inability to walk, saddle anesthesia (Motor weak/loss of sensation to inner thighs and buttocks), and bowel/bladder incontinence (Late sign) -Is med emergency and treatment requires urgent reduction of pressure on spinal nerves to prevent permanent damage

Percutaneous lithotripsy

-Insert needle through skin to pelvis of kidney to break and remove kidney stones -Post procedure temp percutaneous nephrostomy tube placed to prevent obstruction by stone fragments and promote healing , maintain latency is crucial >If obstruction then irrigate gently with small volume sterline NS

Inferior vena cava filter

-Inserted femoral artery the filter traps clots from lower extremity vessels and prevents them from migrating to lungs causing PE -Chest pain (PE symptoms) orvascular injury (Bleeding caused back pain), or lower extremity numbness or pain are not expected findings PostOp and need reported asap

Nitrazine pH Strip Test

-Inserted in vag to see if membranes have ruptured. Amniotic fluid is alkaline and vag fluid is acidic -Yellow to green is neg rupture -And blue is positive for rupture

Liver Biopsy

-Inserted when pt in supine with right arm over head and holding breath -Full bladder is not concern -Post op is lie right side 2-4hrs to prevent bleed at site

OTC drugs and HTN

-Instructed not to take potentially high risk OTC meds such as high sodium antacids, cold and sinus preparations (Vasoconstricts) which can cause hypertensive crisis

What to give for hyperkalemia

-Insulin to lower serum potassium by pushing it intracellulary, dextrose to prevent hypoglycemia

Brachytherapy

-Internal radiation treatment that is ingested, injected into a cavity or bloodstream, or implanted (Seeds, capsules, wires) -Safety precautions >Limit time of exposure to 30min/day and cluster care and wear a designated dosimeter badge (Don't share with anyone) >Maximize distance from source (6 feet) >Use shielding (Lead apron, portable lead shields) which shields front of body so don't turn ur back to them >Remain bedrest to prevent dislodge >Dressings, linens, trash must be remained in pts room till implant removed >Bodily fluids of pts with implanted seeds in prostate generally not radioactive

Signs of imminent birth

-Involuntary pushing, bearing down with contractions, grunting, report feeling bowel movement -Assess whether birth is imminent, apply gloves and observe the perineum for bulging or crowning or presenting fetal part

Delusions of Reference

-Involve the belief that common elements in the environment are directed toward the individual -Songs, newspaper, articles, and other events are personal and significant to them (That song is a message sent to me in secret code)

Laproscopic

-Involves the use of minimally invasive techniques with small incisions and cameras or scopes for performance of the surgery as opposed to a large incision required for an open surgery. Involves only a few hours to a 24-hour hour hospital stay and a recovery period of a week. -Can experience referred shoulder pain is common

School Phobia

-Irrational and persistant fear of going to school -Have them return immediately and gradual exposure and attend for a few hours then start icnreasing it

Ventricular Fibrillation

-Irregular waveforms of varying shapes -Pt has no contraction or cardiac output, Lethal dysrthmia, unresponsive and pulseless apneic state. -Need CPR, Defib, Drugs (Epi, vasopressin, amiodarone)

Signs of increased ICP in infants

-Irritable, fever, high pitched cry, dilated scalp veins, poor feed, vomit, bulging frontanelles

Arterial Steal Syndrome

-Is AV fistula complication that occurs when the veins steal too much arterial blood causing distal extremity ischemia (skin pallor, pain, numb, tingling, diminished pulse)

Phenelzine

-Is a MAOI so need t avoid foods high in tyramine (Age cheese, yogurt, cured meats, fermented foods, beer, red wine, chocolate, avocado) to prevent hypertensive crisis

Levofloxacin

-Is a fluoroquinolone antibiotic and has no cross sensitivity to penicillin -2 hours should pass between taking this drug and consumption of aluminum/Magnesium antacids, iron supps, multivitamins with zinc, or sucralfate cause can make levofloxacin ineffective

Doxycycline

-Is a tertracycline alterantive of penicillin -Contraindicated in preg cause can permanent discolor teeth and impair fetal bone mineralization

What can bells palsy be triggered by?

-Is acute onset of unilateral facial paralysis related to inflammation of facial nerve that may be triggered by a viral illness (Herpes simplex virus)

Sleeve Gastrectomy

-Is bariatric procedure -Most of stomach is removed and the remaining portions are attached together creating a sleeve pouch to reduce stomachs capacity to hold food -Monitor for severe AB pain (Especially radiating to back/shoulder) accompanied by sepsis (restless, tachy, oliguria) may indicate anastomotic leak which occurs when gastric/intestinal contents leak through surgical connection and into intraabdominal space. Can lead to septic shock and death

Cyanosis of limbs in newborns (Acrocyanosis)

-Is benign and transient finding -Common first 24 hrs, bluish discoloration of hands and feet -Initial management is promote thermoregulation by placing newborn skin to skin with mother or under a radiant warmer

Hemorrhagic Cystitis

-Is bladder inflammation and complication of taking cyclophosphamide (Immunosuppresant, chemotherapy agent). Need to drink plenty of fluids. -May need IV hydration -Bleeding in urine usually minimal and occasionally requires blood transfusion

Diltiazem

-Is calcium channel blocker used for Afib to slow HR

Cephalexin

-Is cephalosporin which is chemically similar to penicillin

Diminished gag reflex after anesthesia and endotracheal removal

-Is common, should return when pt awakens

2-3 hour glucose tolerance test

-Is done if 1 hour glucose challenge test is 140 or higher -Requires fasting and also hourly blood samples

Spinal Immobilization

-Is done when >*N*eurological exam shows focal deficits including numbness and decreased strength >*S*ignificant traumatic mechanism of injury >*A*lertness (Pt may be disoriented or have an altered LOC) >*I*ntoxication (Pt could have impaired decision making ability or lack awareness of pain) >*D*istracting injury (Another significant injury could distract pt from spinal pain) >*S*pinal exam (Point tenderness over the spine or neck pain on movement [If there is no midline tenderness] may be present) -MS does not need spinal immobilization

Group A Strep

-Is droplet but does not pose perinatal risk -May manifest as sore throat

Guaifenesin

-Is expectorant used to facilitate mobilization of mucus

NPH (Regular) Insulin

-Is intermediate acting with duration of 12-18 hrs and usually given twice a day (Mornings and evenings)

Vaginal Contraceptive Ring

-Is not barrier method (Diaphragm, cervical cap) and requires time for absorption -Abstinence or barrier method (condom) is necessary during first 7 days -If ring is displaced (Sex, bowel movements) it can be rinsed and placed back into vag within 3 hrs, otherwise backup contraceptive needed for 1 wk -Should insert and leave in for 3 wks

Glucose (Dextrose)

-Is osmotic agent in dialysate (Peritoneal dialysis) so glucose lvls must be monitored closely

Penicillins and cephalosporins (Cephalexin, ceftriaxone) during preg

-Is safe for preg or lactating women

Gramg (g) to mL

-Is same

Sickle Cell Disease

-Ischemic Strokes are common -Can have swelling of hands and feet due to sickled RBCs blocking blood flow to hands/feet

Infant Formula

-Keep bottles, nipples, caps as clean as u can (Boil or wash in dishwasher) -Wash tops of formula cans with hot water and soap prior opening -Refrigerate unused, prepared formula or unused, open formula, but use within 48hrs -Warm bottles in a pan of hot water or under tap water for several mins -Test formula temp on inner wrist (should feel lukewarm and not hot) -Leftover milk in bottle should be discarded cause it has baby saliva in it

Care of umbilical cord

-Keep clean and dry, do not use antseptics -Clamped few mins after birth, clamp left in place till cord begins to dry usually around 24 hrs after birth, remaining cord stump turns black 2-3 days, separates automatically from umbilicus in 2-3 wks

ADHD

-Key feature is hyperactivity, impulsive, inattention, and some children behave aggressively and have difficulty controlling anger. Immediate intervention is to help settle an out of control child is deep breathing, take slow deep breaths relaxes the body and slows HR and creates distraction. So ask child blowup balloon provides easy distraction and engages in deep breathing -Negative consequences can cause poor self esteem, increased risk depression/anxiety, substance abuse, academic/work fail, trouble interact peers/adults -Interventions: Stay calm and remove child from source of anger, assist in calming down with deep breath, discuss what precipitated the behavior, discuss acceptable ways of expressing anger, provide rewards for acceptable behavior, discuss consequences of inappropriate behavior -Offering less choices will help cause if too many choices then can cause overwhelm and overstimulation -Provide calm, structured, organized, and consistent environment and a written chart or list of daily activities

Causes of high pressure alarm

-Kinked vent tubing, Condensation (water) in vent circuit tubing -Kinked endotrach tube, Obstructions (Secretions) in airway tube, Biting endotrach tube -Increased airway resistance (Bronchospasms, excessive secretions), Decreased lung capacity (Pneumothorax, atelectasis, pulmonary edema, respiratory distress), anxiety, pain, coughing

Dental Avulsion

-Knocked out permanent tooth is medical emergency. need to reinsert it and hold in place, re-implantation within 15 mins of injury reestablishes blood supply -If tooth cannot be inserted then keep it moist by submerging it in commercially prepared solution (Hanks balanced salt solution), cold milk, sterile saline, or as last resort saliva (Hold under tongue) -Do not scrub root cause can damage it -Wrapping tooth in sterile gauze will dry it out -Arrange for immediate transfer to dentist

How to check adequate perfusion in pt in shock

-LOC, urine output, capillary refill, peripheral sensation, skin color, extremity temp, peripheral pluses -Blanch should return in less than 3 secs

Scope of practice

-LPN can collect and report data (Vitals, results from CBC). and reinforce teaching

Right Occiput Transverse (ROT)

-Labor often prolong -Manual rotate may be attempted

Duchenne Muscular Dystrophy

-Lack of protein called dystropin needed for muscle stabilization -Muscles of lower extremities and pelvis affected first, a condition with symmetrical weakness and wasting of pelvic, shoulder, and proximal limb muscles -Gowers sign: use of ones hands to rise from squat or from chair to compensate for proximal muscle weakness -Walks on tiptoes and large calves, constantly trips, -No cure and wheelchair bound and die by 20-30 from respiratory failure -Do gentle recreational based exercises like swimming

!4 gauge catheter

-Large Bore for admin fluids and drugs in emergency or for hypovolemic shock

Open Abdominal Aneurysm Repair

-Large ab incision and cross clamping the aorta -PreOp should assess quality of peripheral pulses -Dorasalis pedis and posterior tibial pulse sites should be marked PostOp, a decreased or absent pulse with cool, pale, painful extremity PostOp mean embolization or graft occlusion -Hypotension, dehydration, blood loss, or emoblism can lead to decrease renal perfusion and kidney injury. So routinely monitor BUN/Creatinine and urine output at least 30ml/hr

Genu varum (bowlegs)

-Lateral bowing of legs which is common in toddlers as they learn to walk -Resolves by 18-24 months after they develop strength in their legs and lower back -After 2 years normal alignment will again progress to valgus deformity until age 4 and then will return to normal adult alignment by age 7

Latex Allergy

-Latex allergy can develop from repeated exposures like self catherizations or wearing gloves -Balloons, avocado, banana, tomato -Ace inhibitors (Prils) and shellfish not related to latex allergy

Risk factors for pelvic inflammatory disease (PID)

-Leading cause of ectopic preg and infertility, occurs when bacteria from genital tract spread upward through cervix and cause infection of female reproductive organs. Untreated STIs are the common cause -Signs are pelvic or lower ab pain menstrual irregularities or increased menstrual cramps, pain intercourse, fever, abnormal vag discharge -Multiple sex, history of STI, history of PID, partner with STI, lack of consistent barrier contraception use, age 15-25, recent abortion or pelvic surgery, placement IUD within past 3 wks

Physical assessment on toddler

-Least invasive first and play with them to establish rapport -Interact in friendly manner, play with child using finger puppet, measure ht/wt, listen heart/lung sounds, take vitals

Unconscious patient who is still breathing, what position to put them in?

-Left lateral recovery position

Cellulitis

-Leg need to be elevated and not dependent or flat -Apply warm compress can help circulation to area infection, reduce edema

Walking with cane

-Length should be equal distance from greater trochanter (Inch or 2 below hip) to floor -Place cane 6-10in in front of and to the side of the foot -When walk forward move leg past cane and weaker leg so wt divided -Move weak leg forward after moving can forward then strong legs follows

Precipitous Labor

-Less than 3 hours from onset of contractions to birth -If have history of this then can mean pt will expereince it again

Topical Analgesic Patch

-Lidocaine, Capsiucm -Deliver drug locally and not systemically. So place it near the site of pain

Toxic Megacolon

-Life threatening and commonly seen in ulcerative colitis >Ab pain/distend, bloody diarrhea, fever, signs of shock (Tachy, hypo) >Causes smooth muscle paralysis in colon which causes rapid distention and thinning of intestinal wall which can perforate

Malignant Hyperthermia

-Life threatening can be caused by anesthesia like succinycholine -Skeletal muscles unable to control Ca lvls and cause contractures and increased temp (High fever) -Early signs are hypercapnia, tachypnea, tachycardia, and rigid jaw -Muscle tissue broken down and lead to hyperkalemia, cardiac dys, myoglobinuria -Treat with IV dantrolene to reverse it by slowing metabolism, give cool blanket -Is inhertied condition

Thyroid Storm

-Life threatening form of hyperthyroidism/Graves disease -Thyroid glands release large amounts of thyroid hormone in response to stress (truma, surgery, infection) -Can include fever (up to 104-106), tachy, cardiac dysrythmias (Afib), N/V/D, altered mental, seizures -Management is reduce fever, maintain hydration, prevent cardiac compromise (HF)

Acute Respiratory Failure (ARF)

-Life threatening impairment of lungs ability to oxygenate blood and excrete CO2 -Can occur from exacerbation of acute or chronic illnesses -Signs are altered mental status, paresthesias, dyspnea, tachypnea, hypoxemia

Autonomic Dysreflexia

-Life threatening repsonse to Noxious stimuli (Potentially tissue damaging event) which pts with spinal cord injurties above T6 are unable to feel. Signs include HTN, bradycardia, pounding headache, diaphoresis, and nausea, facial flush -Raise HOB to 45 degrees or high Fowlers -Essential to assess and remove Noxious stimuli to prevent stroke -Noxious stimuli may include: Bladder distend, fecal impact, tight clothes -Once cause is removed the manifestations will decrease

Trisomy 18 (Edwards Syndrome)

-Life threatening that affects multiple organ systems -Many fetuses affected by this die in utero, Of newborns who do survive, half die within first week -No cure

Organ Transplant Teach (Heart)

-Lifelong immunosuppresive therapy. Some side eefects of it is nephrotoxicity, hepatoxicity, infection susceptibility -Endomyocardial biopsy regularly in addition to blood test to check signs infection

Antiretroviral Therapy (ART)

-Lifelong therapy -Decreases viral load and increases CD4

Herpes zoster (Shingles)

-Linear red rash on chest -Vaccination prevents shingles

Orlistat

-Lipase inhibitor that prevents breakdown and absorption of fats from intestines -For pts with obesity who have difficult losing wt or a comorbidity that makes wt loss therapeutically essential (DM heart disease) -Since it blocks absorption of fats it interferes with fat soluble vitamin uptake. Pts should offset this by taking multivitamin that contains A,D,E,K and taken 2 hours or more after orlistat -May have fecal incontinence, flatulence, oily stools -Low fat diet is essential -Take within 1 hr of meals that contain fat, if pt choose meal that does not have fat then med can be skipped

Clear Liquid Diet

-Liquids that you can see through even broth

Beers criteria

-Lists meds that may be inappropriate for geriatric population due to risk outweigh benefits -Sulfonylureas (Glyburide) stimulate insulin release and carry risk for prolonged hypoglycemia

Concrete thinking

-Literal interpretations of an idea, had difficult with abstract thinking -The phrase the grass is always greener on the other side would be interpreted to mean that the grass somewhere else is literally greener

Intrahepatic cholestasis of pregnancy

-Liver disorder exclusive to preg -Intense generalized itch but no rash of hands and feet that worse at night -Increase risk intrauteine fetal demise -Need lab test (elevated bile acids), fetal surveillance, meds (ursodeoxycholic acid) and labor induction around 37wks -Begins to resolve after birth

Before taking statins, what is essential to asses?

-Liver function tests cause the drug is metabolized by the hepatic and can cause drug induced hepatitis and increases liver enzymes

Liver Dysfunction and Laboratory Abnormalities

-Liver function: Protein synthesis >Abnormal lab seen in liver dysfunction: low serum albumin -Liver function: Detoxify ammonia >Abnormal lab seen in liver dysfunction: high serum ammonia -Liver function: coagulation production >Abnormal lab seen in liver dysfunction: elevated INR, prolonged PT time -Liver function: hepatic cell damage >Abnormal lab seen in liver dysfunction: elevated AST/ALT

Pudental Nerve Block

-Local anesthesia into areas surrounding the pudendal nerves that innervate the lower vagina, perineum, and vulva -When birth imminent this provides best pain relief with least maternal/newborn side effects -Does not relieve contraction pain but does perineal pressure

Tiotropium

-Long acting 24hr anticholinergic inhaled med for chronic COPD -Put in Vegeta device -Not rescue med

Copper IUD

-Long acting contraceptive, is highly and immediately effective and used for emergency contraception. Backup contraceptive not needed -Can cause mild cramp, discomfort, and light vag bleed.Ibuprofen recommended before and after insertion for relief of cramp/pain -Menstrual changes common, heavier bleed and increased cramp during menses common and expected -Check strings monthly to make sure not expelled

Isosorbide Dinitrate

-Long acting nitrate med to prevent angina in pts with coronary artery disease

Apraxia

-Loss of ability to perform learned movement (Whistle, clap, dress)

Amyotrophic Lateral Sclerosis (ALS)

-Lou Gehrig -Progressive loss of motor neurons -Have spasticity, muscle weak, and atrophy -Neurons involved in swallowing and respiratory function are eventually impaired leading to aspiration, respiratory failure, death -No cure and death occurs 5 years after diagnosis -If have dysarthia (Difficult speak) may also have dysphagia and respiratory distress

Borborygmi Sounds

-Loud gurgling sounds suggesting increased peristalsis due to gastroenteritis, diarrhea, and early phase of mechanical obstruction

Patent Ductus Arteriosus

-Loud machine like murmur -Failure of the ductus arteriosus to close after birth, resulting in an abnormal opening between the pulmonary artery and the aorta. Will be acyanotic -Treatment is indomethacin

Death Rattle

-Loud rattle sound with breathing that occurs when a pts actively dying and cannot manage airway secretions -Can be treated with anticholingergic meds (Atropine drops)

Diabetic Diet

-Low fat, low glycemic index, high fiber meal -Reduce sodium, limit foods in sucrose

Fidelity

-Loyal and fulfilling commitments made to oneself and others -Includes meeting expected responsibilities or professional nursing practice and provides the basis of accountability

Breast cancer

-Lump hard, irregular shape, non mobile, and nontender. -Risks: Female sex age 50 or older, H/O breast cancer first degree relative, History of cancer, menarche before age 12 or menopause after 55, hormone therapy with estrogen/progesterone (increased risk if taken after menpopause), postmenopausal wt gain

Contact Prec

-MDR organisms (MRSA, VRE) -Cdiff -Scabies

ST elevation on localized leads

-MI

Bile

-Made by liver and is green -Released in duodenum on eating to aid in digestion -When obstruction in intestines and stool cannot pass, may come back up as green vomit. Bowel obstruction is serious as can lead to bowel rupture, peritonitis, sepsis

Neoglisms

-Made up words or phrases usually of a bizarre nature -The words have meaning to pt (I would like to have a phjinox)

Rhuematic fever

-Major clinical presentations: joints arthritis, carditis, nodules, erythema, sydenham chorea (Rapid, involuntary movement of limbs and facial muscles) -Major clinical presentation: Fever, arthralgias (Pain/ache in joint), elevated C reactive protein, prolonged PR interval -Acute inflammation disease of heart -Complication that occurs 2-3wks after streptococcal pharyngitis -Affects heart, joints, and CNS -Presence of 2 major criteria or 1 major and 2 minor and evidence of preceding streptococcal infection indicate high probability of RF -Prevention is penicillin for group A strep pharyngitis

What can elevated estrogen levels cause?

-Make blood hypercoaguable like DVT

Allen Test

-Make fist, occlude radial and ulnar arteries using firm pressure.Instruct pt to open fist, palm will exhibit pallor. Release pressure on the ulnar artery and palm should turn pink in 15 secs indicating patency of ulnar artery. -If positive then ABGs can be drawn. If negative (palm does not return to pink color), an alternate site must be used

What is battery?

-Making physical contact without pts permission

Cleft Palate

-Malformation of roof of mouth -Causes opening (Cleft) in mouth into nasal cavity which leads to difficult suck and feed -PostOp need pain manage or soothing cause uncontrolled cry lead to stress surgical site and hemorrhage. Supine and upright position after feeds. Elbow restraints prevent child from disrupting site. Hard objects should not be placed in mouth as they can damage site and lead hemorrhage (Pacifier, tongue blade, etc..) -Hold upright when feed, tilt bottle so nipple is always filled with formula and point down and away from cleft, use special bottles and nipples, use squeezable bottles, need to be burped often cause these children swallow large amounts of air, feed slowly over 20-30mins, feed every 3-4 hrs cause more frequent feeds can tire mom and infant

Palliative Care

-Manages symptoms, provide psychosocial support -Interdisciplinary team works together -Can begin immediately after diagnosis of terminal disease can receive concurrent curative treatment. Hospice is is only started once pt decides to forego curative treatment -Appropriate for pts who wish to focus on quality of life and symptom management rather than life prolonging treatments

Liver

-Many coagulation factors are synthesized in liver, so liver dysfunction can cause decreased coagulation and increase bleed risk

Hearing Impairment in children

-May be shy, timid, or withdrawn, often avoiding social interaction -May look inattentive when given directions and appear dreamy, -Speech is monotone, difficult to understand and loud

Fetal movement in the womb

-May occur numerous times per hour during last trimester -Fetal movement should no decrease as fetus increases in size -Decreased fetal movement is potential warning sign of fetal compromise (impaired oxygenation) which can lead to fetal death

Asthma Exacerbation

-May require repeat nebulization every 20min or continuous nebulization for 1 hr (If SOB is unrelieved) to relieve severe bronchoconstriction until the admin corticosteroids take effect and start to reduce inflammation

Amber color urine

-Means dehydrated

Green Amniotic Fluid

-Means fetus has passed first stool (Meconium) in utero which places newborn at risk for meconium aspiration syndrome -Skilled neonatal resuscitation team should be present

ST elevation on all leads

-Means pericarditis

Peak Flow Meter

-Measures peak expiratory flow rate -Have to exhale as quickly and as forcibly as possible -Move the indicator to 0 or lowest number on scale before use -Used after a SABA MDI and not after a corticosteroid MDI

Foods rich in iron

-Meats -Shellfish -Eggs, green leafy veges, broccoli, dried fruits, dried beans, brown rice, oatmeal -Foods rich in vitamin c (Citrus, potatoes, tomatoes, green veges) will enhance iron absorption if eaten together -Coffee and tea interferes with absorption

Bilevel Positive Airway Pressure (BIPAP)

-Mechanical device and face mask used on conscious pt who is breathing spontaneously, delivers O2 to lungs and removes CO2 -CO2 retention causes mental status changes -If pt become drowsy/confused means CO2 is being retained than what BIPAP can remove -Altered mental status can cause decreased protective reflexes (gag, swallow, cough) which can cause death

Sepsis Neonatorum

-Med emergency -Not have obvios signs infection but subtle (irritability, increased sleepiness, poor feed -May have eleveated temp or hypothermic -Blood, urine, CSF cultures should be obtained asap and broad spectrum antibiotics started

Hypertensive Encephalopathy

-Med emergency -Sudden elevation in BP (Hypertensive crisis) and increases ICP -Triggers include acute exacerbation of pre-existing HTN, drug use, MAOI tyramine interact, and head injury -May report severe headache, visual impairment, epistaxis, seizure

Isoniazid (INH)

-Med for TB -Hepatoxicity (Jaundice, dark urine) and peripheral neuropathy are the 2 serious adverse effects -Interferes with vitamin B6 resulting in peripheral neuropathy that manifests in ataxia and paresthesia. To prevent this a vitamin B6 supp (Pyridoxine) at dose 25-50mg/day is recommended in high risk pts -Avoid aluminum containing substances within 1 hr of taking this -High risk pts are malnourished, diabetic, preg or breastfeed, alcoholics, children -If elevated liver enzymes then can indicate development of drug induced hepatitis

Valproate

-Med to control seizures -Cat D drug and can cause neural tube defects

Neonatal Heel Stick

-Medial or lateral of outer aspect of heel -Warm heel several mins with warm towel or comperes -Use automatic lancet which controls depth of puncture -Venipunture is less painful and less punctures especially is larger volume required.

Neomycin Enema

-Medicated enema that reduces number of bacteria in the intestine in prep for colon surgery

Chloasma

-Melasma, mask of preg -Increased pigment over bridge of nose and appears 2nd trimester, fades postpartum and benign.

Cdiff treatment

-Metronidazole or vancomycin (oral)

Common side effects of immunizations

-Mild fever and redness at injection site. Use warm compress to injection site -Children can have increased fussiness and anorexia but should not last more than 24 hrs -Notify HCP if temp higher than 100.4 (38)

Endovascular abdominal aortic aneurysm repair

-Minimally invasive, place sutureless aortic graft inside aortic anuerysm via femoral artery, does not require ab incision -Renal artery occlusion can occur due to graft migration or thrombosis so careful monitoring of urine output and kidney function should be done -Manifestations of graft leakage include ecchymosis of groin, penis, scrotum, or perinuem; increased ab girth; tachycardia; weak/absent pulses; decreased H/H; increased pain in pelvis, back, groin; and decreased urinary output -Chest tube not required since no open incision -NG tube post op would have green biled drainage, bloody drainage would be concern

Serosanguineous Drainage

-Mix of serum and red blood cells. light pink to blood tinged -Expected 2 hrs after surgery

Hydratidiform Mole

-Molar pregnancy -Growth of abnormal fertilized egg, not viable. Fetus replaced by cystic chorionic villi and will have intermittent, dark brown vag discharge until pregnancy is evacuated -Rh immune globulin required for pts with Rh-negative blood types -Uterine evacuation is recommended to reduce complications -Causes rapidly growing trophoblastic tissue to is initially benign but may lead to gestational trophoblastic neoplasia (Choriocarcinoma). If trophoblastic tissue continues to grow or metastasize after evacuation of molar preg, levels of HCG will continue to increase, so avoid pregnancy to allow HCP to monitor rising HCG levels which may indicate malignant GTN

IV Vancomycin assessments

-Monitor BP during infusion cause hypotension is possible adverse effect -Observe IV site every 30 mins for red, swell, pain cause its vesicant -Admin with central line preferred but peripheral line may be used short term therapy

Vanco trough (the point when a drug is at its lowest concentration)

-Monitored before 4th dose -15-20 is optimal -Antihistamines given if red man syndrome (blotching of face, neck, chest due to rapid admin) -Vanco should be admin over minimum of 60mins -If red man syndrome then should be slowed or stopped and restarted

Pts recovering from anesthesia can cause what?

-Mood alterations or affect (agitation, anxiety, tearfulness) that will resolve as anesthesia wears off

Corticosteroids common side effects

-Mood swings and irritability

How much urinary retention should be reported?

-More than 100mL

Excessive chest tube drainage is how much

-More than 100mL/hr -Collection chamber should be cheeked every hour for the first 8 hrs then every 8hrs until its removed -Chest tube only clamped few hours prior removal, momentarily to check air leak

Theophylline

-More than 20mcg is associated with toxicity (headache, insomnia, seizures, nausea, tachycardia, vomit, arrhythmia). So draw blood level 30 mins after dosing -Best way to prevent toxicity is to monitor levels periodically -Cimetidine and ciproflaxin can significantly increase lvls, so its contra -Bronchodilator

Repeated high Gastric residual volume

-More than 250ml repeatedly may indicate delayed stomach emptying and require adjustment to prevent N/V or ab distend

Chest drainage in children

-More than 3mL/hr for 3 consecutive hours or more than 5-10mL in 1 hour should be reported, can indicated postoperative hemorrhage and requires immediate intervention -Also, urine should be 1-2ml/hr

Chest Tube Drainage

-More than >100ml/hr drained should notify HCP cause can indicate blood loss -Immediately following thoracotomy chest tube drainage (50-500mL for 1st 24 hrs) -Rush of dark bloody drainage from chest tube from turning pt following a period of minimal drainage is most likely related to retained blood due to partial blockage, bright red would mean active bleed and concern

Inflammatory Breast Cancer

-Most aggressive form of breast cancer -Breast lymph channels are blocked by cancer cells creating breast tissue that becomes red, warm, and has an orange peel, pitting appearance on skin surface

Diarrhea

-Most are self limiting and lasts 48hrs or less -If last more than 48hr or accompanied with fever or bloody stool then should be evaluated by HCP

Calcium Carbonate

-Most avaliable elemental calcium therefore most preferred calcium supp for pts with osteoporosis -Calcium absorption impaired when taken more than 500mg at one time -Take whthin an hour meals cause foodicnrease absorption -Constipation common side effect

Diaper dermatitis

-Most common 9-12 months -Treat with zinc oxide (Topical water paermeable barrier)

Chlamydia

-Most common STI -Many asymptomatic or have minor symptoms (Spotting after sex, dysuria, ab vag discharge) -Sexually active or 25 older are screen yearly -If not treated then can ascend female genital tract causing PID and infertility -Abstain sex for 7 days after initiation drug thereapy (Single dose azithromycin, 7 days doxycycline)

Tonsillitis

-Most common cause is strep A infection -Can result to scarlet fever which manifest as sandpaper like rash

Neurologic injury

-Most common mortality in pts with cardiac arrest -Inducing therapeutic hypothermia in these pts within 6 hrs of arrest and maintaining it for 24hr has been shown to decrease mortality rates and improve neurologic outcomes. It is indicated in all pts who comatose or do not follow commands after resuscitation. After 24 hrs pt is rewarmed

Postexposure prophylaxis for HIV infection

-Most effective when given within 2 hrs

Absent seizures

-Most last less than 10 secs -May have multiple episodes a day and treated with anticonvulsant meds -Absence of warning and postictal phases -Unresponsive during seizure -No memory of seizure

Wernickes Encephalopathy

-Most serious form of thiamine deficiency in alcoholic patients -Manifest with altered mental status, oculomotor dysfunction, and ataxia

Myelomeningocele

-Most severe form of spina bifida in which the spinal cord, spinal fluid and nerves/meninges protrude through the spine typically in lumbar -Occurs when neural tube fails to fuse -High risk infection so cover area with sterile moist dressing -Also decrease absorption of CSF which places newborn risk for hydrocephalus from the excess CSF. Occiptal frontal circumference is needed as baseline measurement -Placed prone position with face turned to side to prevent rupture of Myelomeningocele

Creatine Kinase

-Muscle enzyme found in skeletal and cardiac muscle; elevated blood levels associated with heart attack, muscular dystrophy, and other skeletal muscle pathologies -Myoglobin can cause AKI cause overwhelms kidneys,urine will be very dark. SO forced saline diuresis with IV fluids help prevent blockage or renal tubules with myoglobin an necessary to prevent permanent kidney damage -Normal range is 22-198

Botulism

-Muscle paralysis, descending, dysphagia, constipation -Found in soil and can grow in any food contaminated with the spores flaccid paralysis (Starting from face) -Main source is improper canned foods, swollen or bulging end can can be caused by gases from c botulism

4-5 months old

-Muscles for rolling over develops

Large for gestational age

-Must be at least >90th percentile and commonly >8lbs 13oz -Risk factors are gestational diabetes, excessive gestational wt gain or elevated prepregnancy BMI, H/O prior newborn who was LGA, postterm gestation -Interventions are assess for birth related injuries, discuss possible feed supplementations if newborn hypoglycemic, feed newborn every 2-3hrs to prevent hypoglycemia, notify HCP if glucose <45-40

Obtaining urine specimens from indwelling urinary catheter for urinanalysis or culture

-Must be obtained aseptically cause if u collect from the bag, the urine in that bag could've been there for hrs and accumulation of bacteria -Clean collection port with alcohol swab -Aspirate urine with sterile syringe -Use aseptic technique to transfer specimen to sterile specimen cup

Kidney biopsy

-Must discontinue antiplatelet/anticoagulants 1wk prior -After procedure monitor vitals every 15 mins for first hour cause kidney is very vascular and can hemorrhage. -PostOp position them on the affected side for 30-60mins to provide pressure and prevent bleeding

Warfarin

-Must eat same amount of dark green leafy veges cause if you decrease eating it then can cause increase effectiveness in warfarin placing risk for bleed, if increase eating can decrease effect of warfarin placing risk for clot formation -Avoid NSAIDs (aspirin) and alcohol while on warfarin -Usually admin for 3-6months

What insulin is SUBQ and which can be given IV

-NPH, glargine, aspart are SUBQ -Regular can be given IV

Supportive care and support for pancreatitis

-NPO as ingestion of food will stimulate excretion of pancreatic enzymes. -Pain management -IV fluids to prevent hypovolemic shock cause inflammation of pancreas release chemicals that cause third spacing -Knee to chest fetal for pain or side lying with HOB elevated to 45 degrees

Cleansing enemas

-NS, Soapsuds, Tap Water >Place left lateral with knee flexed (sims) >Lubricate tip and insert 3-4in >Direct tubing tip toward umbilicus to prevent intestinal perforation >Tell pt to retain enema as long possible (5 to 10mins) >Open clamp and let flow gravity and if ab cramp slow admin

Ketorlac

-NSAID -Usage should not exceed 5 days -1 to 1 1/2in needle recommended

Aortic Stenosis

-Narrowing of aorta valve opening which limits ventricle ability to eject blood into aorta. -Can lead to HF, pulmonary HTN -Chest pain, SOB, and syncope worsens with exertion -Mitral is auscultate apical -Decreased ejection fraction which results in narrowed pulse pressure and weak thready pulse -Loud ejection systolic murmur over aortic area

Myopia

-Nearsightedness -Reduced vision when viewing things far away -Need to hold objects close to see -Squinting can see better

Change in chest tube suction

-Need HCP prescription -Suction over 20cmH2O is not indicated

Acute stroke (Brain attack)

-Need permissive HTN during first 24-48hrs to allow adequate perfusion -BBB no longer intact when BP >220/120 therefore mild lowering is required usually to SBP not lower than 170 -Nifecardipine (Calcium channel blocking vasodilator) takes effect within 1 min so make sure not going down too fast, must be discontinued if hypotension or reflex tachy occurs

Autism children

-Need to be in calming environment with minimal stimulation -If given too many choices can be overstimulated too -Private room away from nurses station is best -Need routine to be consistent and structured like giving pt a schedule of daily activities cause it decreases their anxiety and they'll anticipate what will happen next, and know pts usual patterns and habits for typical day. -Should be held by caregivers during invasive procedures and no restraints -Limit physical contact with them

Upper aortic dissection or congenital aortic coaraction

-Need to compare BP in each arm to help assess it

Severe Hyperkalemia

-Need urgent treatment -IV admin of 50mL 50% dextrose with 10 units of regular insulin is priority. Insulin temporarily shifts potassium from extracellular fluid back into intracellular fluid. Dextrose prevents hypoglycemia -If ECG has peaked t waves then calcium gluconate given before insulin/dextrose

Change in suction level

-Needs HCP prescription -Suction above 20cmH2O is not indicated

Acute angle glaucoma

-Needs immediate intervention -Sudden onset of severe eye pain, reduced central vision, blurred vision, ocular red, halos around lights Increases rapidly and drastically, not gradually -Glaucoma disorders are increased intraocular pressure resulting in compressed optic nerve that can lead to permanent blindness

What causes yawning, sneezing, and high pitched cry?

-Neonatal abstinence (Withdrawl) syndrome

How do neonates produce heat?

-Neonates cannot generate heat by shivering -They produce heat by increasing metabolic rates through nonshivering thermogenisis. Brown adipose tissue developed during 3rd trimester is metabolized for thermogenisis when availiable -Once brown adipose tissue is depleted, non shivering thermogenisis is less effective and neonate may experience cold stress which can lead to death

Wilms Tumor

-Nephroblastoma -Kidney tumor mostly involves one kidney and prognosis is good if tumor has not metastasized -Do not palpate abdomen cause can disrupt tumor and cause dissemination of tumor cells -If tumor has metastasized then adventitious breath sounds will be heard -Can have HTN

Spina Bifida Occulta

-Neural tube defect occurring where spinal vertebrae do not close during fetal development, potentially allows spinal cord contents to protrude through opening -Mildest form of of spina bifida -May experience bladder/bowel incontinence, sensory loss -Signs are tuft of hair, dimple along base of spine

Platelet and surgery

-Neuro and ocular surgery require platelet >100,000 -Most other surgeries can be performed when platelet is >50,000

Gestational HTN

-New onset HTN (140/90 or more) that occurs after 20wks gestation without proteinuria -Development of proteinuria with HTN indicates preeclampsia

Precipitous Birth

-Newborn delivered 3 hours or less after onset of contractions -Immediately after birth newborn should be dried and placed skin to skin to prevent cold stress which can lead to hypoglycemia or respiratory distress -If newborn stable then cord can be clamped and cut with sterile scissors after it has stopped pulsating or after placenta has been expelled

Cystic Fibrosis pts giving birth to newborn

-Newborn may have meconium ileus (Intestinal obstruction)

After passing meconium

-Newborns have thin and yellow brown or yellow green stools. -Stools of breastfed newborn progress to seedy yellow paste -Bottle fed newborns have firmer light brown stools

Cirrhosis Teach

-No alcohol, eat high calorie (3,000cals/day), high carb, low fat, low sodium diet. Do not totally restrict protein -Avoid hepatoxic meds (acetaminophen, statins). Avoid NSAIDs and aspirin when portal HTN or varicies are present (Bleeding may occur) -Avoid activities that increases intraabdominal pressure. Get adequate rest -Seek HCP when presence blood when vomit, bloody or black stool, altered mental status (Encephalopathy)

Genital Herpes Simplex Virus (HSV)

-No cure, painful lesions -Lesions should be kept clean and dry, don't put adhesive bandaging on them, sitz/oatlmeal baths to relieve itch and burn, use hair dryer on cool setting to dry lesions after shower -In preg can transfer to infant in utero (Congenital HSV). Neonatal HSV is deadly and can cause neurological deficits -Acyclovir should be admin immediately and vaginal birth not recommended if active lesions so C section

Cervical Laceration

-No pain, Uterus is firm and at midline, vaginal bleeding has increased

Uterine atony signs

-No pain, uterus not firm or at midline, Vaginal bleeding increased -Has boggy uterus on palpation

Birth to age 2 beliefs about death

-No understanding of death -Sensitive to loss and separation; may be distressed by changes in environment, caregiver, regular routines

NSAIDs and clots

-Non aspirin NSAIDs (Naproxen ) increases risk thormobotic events in pts with cardiac disease especially with long term use

Extracorporeal Shock Wave Lithotripsy

-Non invasive that uses high energy acoustic shock waves to break up kidney stones into small fragments that can be excreted in urine under general anesthesia -Temporary ureteral stents placed to facilitate passage of stone fragments, stents usually removed in 1-2wks -Teach increase fluids to flush out stones, expect bruising and pain of back, expect blood in urine and should progress bright red to pink tinged during first several hrs (Concerning if bright red >24hrs), ambulation is encouraged

Childrens bubble soap

-Non toxic

Lumbar puncture

-Normal CSF pressure 60-150 -Inserted between L3/4 or L4/5 -Pain may be felt radiating down leg but should be temporary -After procedure lie supine for 4 hrs -Elevated ICP is contraindication of lumbar puncture -Continued leaking fluid indicates that the site did not seal off and a blood patch (Autologous blood into epidural space required). Example is if insertion site dressing saturated with clear fluid postop -Can have headache postop but goes away

Babinski sign for adults

-Normal finding would be toes pointed downward, if pointed upward in adult then abnormal

Newborn with swollen labia and thin white vag discharege

-Normal in first wks life

Normal wet diapers in 24hrs

-Normal is 6-10 per 24 hrs or 1 every 4 hrs

Hemoglobin of 7

-Not life threatening and many pts can tolerate this lvl

Influenza Vaccine (Injection)

-Not live -All pts age 6 months or older should get it

Lymph nodes

-Not palpable in adults -If palpable superficial small (0.5-1cm), mobile, firm, nontender then is normal finding. Especially if they recently had mastectomy -Tender, hard, fixed or enlarged node is abnormal

Common expected newborn findings

-Number of plantar creases on bottom of feet indicates neonates age, more creases over foot more mature neonate -Babinski reflex disappear at 1 yrs, toes hyperextend and fan out when lateral surface of sole is stroked in an upward motion, absent babinkski reflex may indicate neurological defect -Epstein pearls are white pearl like cysts on gum margins and the palate are benign and disappear within few wks -Umbilical cord will dry in 24hrs and detach from body within 2 wks -Jaundice within first 24hrs is pathological usually related to problems in liver. After 24 hrs is physiological related to increased amount of bilirubin system

Gravida

-Number of times a woman has been pregnant, regardless of pregnancy outcome -Nulligravida means never preg -Primigravida meand pregnant first time or has been pregnant one time -Multigravida means been pregnant more than one time

Parity

-Number of times given birth after 20wks whether it was alive or still born -Nulliparous is never given birth -Primiparous means given birth once -Multiparous means given birth more than once

Refeeding Syndrome

-Nutrition replenishment in significantly malnourished pts -24-48hrs of therapy then fluid shifts: bradypnea, lethargy, confusion, weakness -Rapid decline in Phosphorus, Potassium, Magnesium -Can also cause fluid overload, sodium retention, hyperglycemia, and thiamine deficiency -So increase caloric intake gradually

Shoulder Dystocia

-OB emergency -Fetal head delivers first nut anterior (top) shoulder stuck under pubis symphasis -If last 5 min or more then fetal asphyxia -Document exact time of event, verbalizing passing time to guide decision making by HCP (@mins have passed), McRoberts maneuver (Legs flex ab cause rotation pelvis, alignment sacrum, and opening birth canal), apply pressure to pubis symphasis (Supra-pubic pressure), and ask for help. -No use vacuum, forceps

Topical Capsaicin

-OTC analgesic that relieves minor pain -Wait at least 30mins after massaging cream into hands before washing to ensure adequate absorption -Avoid contact with mucous membranes (Nose, mouth, eyes) or skin that is not intact -Wear gloves or wash hands immediately after application -Do not apply heat to area after application -Local irritation is normal and subsides within first week -Normally used with Acetaminophen or NSAIDs

Fish oil

-OTC supp for heart disease or at risk -Contain omega 3 fatty acids which decrease blood triglycerides

Acne Vulgaris

-Obstructed sebaceous glands which can form blackheads, whiteheads. -Can cause inflammation, pustules, papules, nodules -Treatment are topical/oral meds and oral contraceptives -Antibacterial soaps are harsh and ineffective, increase pH skin, and dry the skin. Should instead gently wash face with mild facial cleanser -Use noncomedogenic skin care products (Products that dont clog pores). Maintain healthy lifestyle to reduce stress

Group B strep

-Obtained 35-37wks gestation to determine need for antibiotics during labor to prevent neonatal infection

Fingertip blood specimen

-Obtained from the third or fourth finger on the side of the fingertip -Puncture should be perpendicular to fingerprint ridges

Febrile Seizures

-Occur commonly in children -Reassure parents cause benign and safety precautions (side lying, remove harmful environment) -Use antipyretics to control fever, after antipyretics then apply cool damp compress to forehead, increase air circulation in room, wear loose or minimal clothes -Do not need anti seizure meds, cause of seizure is temp so bring temp down. But if seizure is continuous then anti seizure meds may need to be given -Bathe in tepid water or use of ice packs causes shivering and not done. -Call 911 if seizure lasts more than 5 mins

Lead Poisoning

-Occur from repeated lead exposure via ingestion of lead based paints (walls, toys), glazes (pottery), or water from lead pipes, or by inhale of contaminated dust or soil found around older homes -Blood lead levels of 5 or more need followup blood work -Chelation therapy might be required if lvls remain elevated (Involves the intravenous introduction of EDTA and other chemicals into the body, which purportedly bind with unwanted minerals and chemicals, once they are bound they can then be removed from the body through the urine) -Home environment should be assessed for lead sources, not live in homes till its completed, handwash -Hot tap water dissolves lead from pipes, therefore cold water should be used for consumption. Taps should be flushed several min to clear out contaminated water

Stress Induced Hyperglycemia

-Occur in hospitalized pts in relation to surgery, trauma, illness, infection -Hyperglycemia >140 affects both diabetic and non diabetic hospitalized pts -Recommended glucose target for critically ill is 140-180 and non critically ill is <140 random blood glucose

Dialysis Disequilibrium Syndrome (DDS)

-Occur in pts during initial stages of hemodialysis and can be prevented by slowing rate of dialysis -During hemodialysis solutes (Urea) removed more quickly from blood than the brain cells and CSF creating concentration gradient that can lead to excess fluid in brain cells and increase ICP -N/V, headache, restless, change in mentation, seizure -Need to contact HCP if suspected -If identified during treat them slow or stop rate of dialysis

Diabetic Ketoacidosis

-Occur in type 1 and younger ppl -Symptoms include less prnounced altered mentation, more rapid onset of hyperglycemix symptoms, hyperventilate and ab pain common -LAbs will be glucose 250-500, bicarb less than 18, positive serum ketones

Hyperosmolar Hyperglycemic State

-Occur in type 2 and in older age -Symptoms include more pronounced altered mentation, gradual onset hyperglycemic symptoms, hyperventilate and ab pain less common -Labs will be glucose over 600, bicarb over 18, negative orsmall serum ketones -Produces enough insulin to prevent diabetic ketoacidoses but not HHS -Because some insulin produced no ketones and no kussmal

Autonomic Dysreflexia (Hyperreflexia)

-Occur with spinal cord injury at or above T6 -Causes uncontrolled HTN and common triggers include bladder or rectum distention and pressure ulcers -Signs can be throbbing headache, nausea, blurred vision, HTN, bradycardia, flushing of skin above lvl of injury -Raise HOB to 45 degrees or high Fowlers -Medical emergency requiring immediate intervention (Bladder catherization)

PostPartum Psychosis

-Occurs 2 wks postpartum. Severity and duration can vary. -Symptoms are hallucinations, delusions, impulsive, hyperactivity, confusion, bipolar -Treatment is emergent psychiatric hospitalization, pharmacologic intervention

PostPartum blues

-Occurs 2-3 days postpartum and resolves within 2 wks -Symptoms are emotional liability, mild sadness, irritability, and insomnia -Treat is supportive care, pt and fam education, ongoing assessment for worsening symtoms

PostPartum Depression

-Occurs 4-6wks postpartum up to 12 months postpartum, gradual improvement over first 6 months postpartum -Symptoms are extreme sad, irritability, emotional outbursts, sleep too much, severe mood swings; can present with postpartum anxiety -Treat is supportive care plus pharmacologic intervention or psychotherapy

Splenic Sequestration Crisis

-Occurs in sickle cell crisis -When large number of sickled cells get trapped in spleen causing splenomegaly and can lead to hypovolemic (hypotensive) shock

Premature Rupture of Membranes

-Occurs prior onset of labor at term gestation (37wks or less) -Does not harm fetus but if labor does not being after PROM then induction of labor may be necessary to decrease risk of infection (chorioamnionitis)

Fat Embolism

-Occurs when long bones and pelvis fractures -Develops 24-72 hrs following injury or surgical repair -Signs are respiratory problems, neurilogic changes, petechial rash (Pin sized purple spots that do not blanch with pressure) which appears on neck/chest/axilla due to microvascular occlusion, and fever -Should minimize movement of injured extremity to reduce risk for fat emboli -If paresthesia (numb, tingling) of affected extremity then may indicate compartment syndrome -Anticoag, early ambulation, compression devices helps with DVT and PE but not fat emboli

Rh alloimmunization

-Occurs when preg pt with Rh-Negative blood type is exposed to Rh-Positive fetal RBCs during preg and birth -After exposure the maternal immune system produces antibodies to the Rh antigen that can cause serious complications for an Rh-positive fetus during future pregnancies (Hemolytic anemia) -Rh immunoglobulin (RhoGAM) prevents antibody formation by suppressing maternal immune response and is effective only if pt has never developed antibodies to the Rh antigen (Rh sensitization) -Nurse should verify pt is not Rh sensitized by checking for a negative antibody screen (Indirect coombs test) and then proceeding with admin of Rh immune globulin. A positive maternal antibody screen would require further clarification from HCP -Should be admin within 72hrs of birth

Carbon Monoxide Poisoning

-Odorless and produced by burning fuel (Oil, kerosene, coal, wood) in poorly ventilated setting -Usually hard to diagnose cause nonspecific symtpoms >Headache, confusion, nausea, dizzy

Highest risk for MRSA

-Older adults, suppressed immunity, long h/o antibiotic use, invasive tubes or line, in ICU

Tumor Lysis Syndrome

-Oncologic emergency. -Can develop from chemotherapy for cancers with rapid cell turnover. It is characterized by hyperphosphatemia, hyocalcemia, hyperkalemia (EKG changes), and hyperuricemia. Prevention of tumor lysisi syndrome invovles hydration and the use of hypouricemic agents such as allopurinol or rasburicase -Develops electrolyte imbalances >Hyperkalemia, hypocalcemia, hyperphosphate -Potassium sparing diuretics can worsen hyperkalemia

Admin chemotherapy

-Only a chemo certified nurse can admin chemo drugs

Localized shingles

-Only need standard prec for pts with intact immune and contained/covered lesiosn

Cataracts

-Opaque lenses -Painless, gradual loss, blurry/cloudy vision, glares and halos which are worse at night, decreased color perception -Not medical emergency

Head tilt and chin lift

-Opens airways -Tongue may fall back and occlude airway due to muscular flaccidity after general anesthesia -Signs of airway obstruction are snore, use accessory muscles, decreases O2 sat, cyanosis

Histoplasmosis

-Opportunistic fungal infection in compromised Immunity -Inhale histoplasma capsulatum spores found in soil that contains bird or bat droppings -Usually asymptomatic and self limiting and no need treatment -Can develop chronic pulmonary infection or disseminated infection

Right Occiput Anterior (ROA)

-Optimal for birth as it allows for rotation of fetal head through birth canal

Acute diarrhea first line treatment

-Oral rehydration therapy and continue normal diet such as solid foods

Asymmetrical pain in wt bearing joints

-Osteoarthritis, also have crepitus over knee joints

Avoid treat BP in what age and range?

-Over age 60 and if BP is <150/90

Urge Incontinence

-Overactive bladder -Involuntary leakage of urine with a sudden, strong desire to urinate -Interventions: lose wt, anticholingergic meds (Oxybutynin) to decrease bladder spasms, avoidance of bladder irritants (caffeine, citrus, sweet drinks), pelvic floor exercise, bladder train (Void every 2 hrs while awake) and gradually lengthen intervals between training.

Skin Cancer Risk Factors

-Overexposure of UV light, family history, celtic ancestry (light skin, red or blond hair, blue or green eyes, many freckles), aging, high number of moles, immunosupression, -Melanomas are the most deadly skin cancer cause they grow rapidly and highly metastatic

Acromegaly

-Overproduction of growth hormone and results in overgrowth of soft tissues of face, hands, feet, and organs -Can cause joint pain, skin changes, and hyperglycemia -If have S3 or S4 heart sounds then can indicate heart problems (HF)

Percutaneous Endoscopic Gastrostomy Tube

-PEG tube -Enteral feed device placed through an opening (stoma) made between ab and stomach -Expected finding would be slight in and out movement of PEG tube (0.25in or less) especially when coughing -PEG tube are secured loosely against skin which allows tube to move and prevent pressure injuries -If resistance felt when rotating PEG tibe often indicates adherence of device to underlying tissues which requires surgical revision -Granulation tissue (red or pink skin with bumpy texture) is expected finding near stoma and indicated wound healing

Pantoprazole, Omeprazole

-PPI -For GERD and ulcer treatment and prophylaxis -Take prior meals -Long term use can decrease absorption of calcium and cause osteoporosis (So have bone density test prior) -Can cause Cdiff in hospitalized pts cause PPI suppress acid which would have prevented pathogens from more easily colonize upper GI tract. So increased risk for pneumonia too

Lansoprazole

-PPI for ulcer disease, GERD

First degree AV block

-PR interval >0.20 secs -Usually asymptomatic and do not require teratment except for stopping the causitive agent (Beta blockers, digoxin)

Signs indicating impeding respiratory failure

-PaCO2 45 or more (Hypercapnia and hypoventilation result from fatigue and labored breathing -PaO2 60 or less (Indicates hypoxia resulting from increased work of breathing, decreased gas exchange, and inability of lungs to meet bodys oxygen demand -Paradoxical breathing -Mental status change -Absence of wheeze or silent chest -Single word dyspnea (inability to speak >1 word before pausing to breathe due to SOB -PTs with respiratory failure have respiratory acidosis

Anterior Cruciate Ligament (ACL) Injury

-Pain and swelling are expected and treated with RICE for 24-48 hrs -Pain or feeling of tightness can indicate an effusion and may require aspiration

Post Hemorrhoidectomy

-Pain relief cause pain is usually severe with NSAIDs or acetaminophen. Opioids may worsen constipation -Beginning 1-2 days postop warm sitz baths are used as a means to relieve pain, decrease swell, and cleanse area -Prevent constipation so encourage high fiber diet and adequate fluids, admin stool softeners do as docusate -Oil retention enema may be used if constipation persists for 2-3 days

Pyloric Stenosis

-Palpable, epigastric, olive shaped mass and non bloody projectile vomiting -From 2-8wks of birth -Can have wet burps -Emesis is nonbilious -Constantly hungry -Have poor wt gain and dehydrated (Increased H/H) -Mothers feeding should be assessed to ensure no excessive air swallowing or overfeeding

Areas of referred pain to the abdomen

-Pancreatitis pain is beter when leaning forward and worse when lying flat, often made worse with high fat meal and N/V are common due to pain. Risk for hypovolemia (Third spacing) -Appendicitis pain in mcburneys point

Play in toddlers (Age 1-3)

-Parallel play, play next to each other and are happy in presence of peers but do not play directly with one another.

Quadriplegia (Tetraplegia)

-Paralysis of all four limbs due to injury of cervical spinal cord -Should frequently assess status of airway and oxygenation especially if newly diagnosed

Bells Palsy

-Paralysis of the facial nerve, causing muscular weakness in one side of the face. -Alteration to tear production, flattening of the nasolabial fold on side of paralysis -Eyelids do not close properly may result in eye dryness and risk corneal abrasion -Teach use glasses during day and patch or tape eyelids at night -Use artificial tears -Chew on unaffected side and maintain good oral hygiene

Toxoplasmosis

-Parasitic infection can be acquired from exposure to infected cat feces, ingest undercooked meat or soil contaminated fruits/veges -Can be transferred to fetus and cause serious fetal harm -Preg pts need to be taught to thoroughly wash all produce to decrease risk

Gastric Lavage

-Performed via orogastric tube to remove ingested toxins and irrigate stomach with NS -High risk for aspiration and only used if overdose is lethal and can be initiated 1 hr of overdose, stomach needs to be decompressed (remove contents of stomach with NG tube) first then lavage -Intubation and suction supplies should be bedside in case aspiration or respiratory distress -Large bore 36-42 -Placed on side with head elevated

Cervical Cancer risk factor

-Persistent HPV infection -Mutiple sex partners >1 lifetime partner -Smoking tobacco -Being infected with STIs -Taking or contraceptives

Delusions of Somatic

-Pertains to bodily functioning, bodily sensations or physical appearance. Usually the false belief is that the body is somehow diseased, abnormal or changed. -The doctor said I'm fine, but I really have lung cancer

MAOIs

-Phenelzine, Isocarboxazid are for depression. Increases norepi and BP and if combined with certain meds that also increase BP like pseudoephedrine or nasal decongestants, can lead to hypertensive crisis. Headache is common early symtpom of hypertensive crisis which can ultimately lead to hemorrhagic stroke or death -Admin in morning cause sleep dysfunction common

Teratogenic meds

-Phenytoin, lithium, valproate, isotretinoin, methotrexate, ace inhibitors, warfarin, doxycycline

Chronic kidney disease have high lvls of what

-Phosphorus as kidney not able to filter and excrete it and dialysis does not filter it too so phosphate binders (Calcium supps like calcium acetate) given to help excrete it through feces

Bacterial conjunctivitis

-Pink eye, very contagious and can have yellow purulent eye discharge, eyelid swell, red conjunctiva, eye discomfort, -Wash hands

Phalens Maneuver

-Place back of the hand together & bend at both wrist & 80% who have carpel tunnel syndrome will have paresthesia within 60 seconds, a positive Phalens maneuver

Cerclage

-Placed to prevent preterm delivery -Suture to keep it closed -For pts who have cervical insufficiency (Painless, premature cervical dilation and miscarriage or preterm deliver) -Discharge teach them activity restrict, and know signs preterm labor (low back aches, contractions, pelvic pressure) and rupture of membranes -Bed rest few days -Mild ab cramp after placement is common however regular contractions, pelvic pressure, and low back aches may indicate preterm labor -Remains in place until 36-37wks, early removal is if rupture of membranes to prevent infection or preterm labor

Who are at risk for DIC?

-Placental abruption and intrauterine fetal demise -Signs of DIC frank external bleed (venipunture site bleed), internal bleed (Petechiae, ecchymosis), and organ damage from blood clotting (Respiratory distress, renal fail) -Baseline labs (Coagulation studies, platelets, fibrinogen) are priority -After labs come back good then need to induce labor asap to prevent DIC

Diabetes insipudis signs

-Polydipsia (Increased thirst) -Polyuria (Increased urine) -Dehydration, wt loss, hypernatremia -Due to insuffiecent production/supression of ADH

Newborn HR is <100/min. What should you do?

-Positive pressure ventilation should be started

Tonsillectomy PostOp

-Postop bleed is main concern (frequent, increased swallow or clearing of throat, vomit bright red blood) -Expected post op findings are ear pain when swallowing, low grade fever (Can be given analgesics), superficial infection at surgical site common and causes white fluid filled exudate in throat with halitosis which is not concern. -Do not drink through straw cause causes localized pressure at back of throat and may contribute to bleed -Milk products discouraged cause it coats the throat which promotes clearing of throat -Oral mouth rinse, gargle and vigorous tooth brushing avoided -Routine suction can cause trauma to surgical site and bleed -Postop hemorrhage can occur up to 14 days after surgery so no strenuous or contact sports for at least 7-14 days after surgery

Potassium Chloride Tablets

-Potassium is very erosive and can cause pill induced esophagitis so take it with plenty of water an remain sitting upright for 30mins or more after taking it -Take it during or following meals

What electrolyte to give if on furosemide?

-Potassium to prevent or treat diuretic associated hypokalemia

Methadone

-Potent Narcotic -Early signs toxicity are N/V and lethargy -Pruritis (itch) is common side effect of narcotics

Nitropusside

-Potent vasodilator for HTN -Works within 1 min so monitor BP every 5-10min -Nitropusside metabolizes to cyanide and if kidney disease then can develop cyanide toxicity

Eclampsia

-Preeclampsia along with new onset of seizures -Right upper quadrant or epigastric pain

Preelampsia and Eclampsia

-Preeclampsia: HTN and proteinuria after 20th gestational wk -Eclampsia: Onset of convulsions or seizures that cannot be attributed to other causes in a women with preeclampsia, Delivery is the only cure for preeclampsia-eclampsia syndrome -Magnesium sulfate is used to prevent/control seizures, monitor signs toxicity (Decreased DTR, respiratory depression, decreased urine output). Therapeutic magnesium lvl of 2.3-3.5 is necessary to prevent seizures in preeclamptic pt

Warfarin contraindicated in

-Preg and is teratogen, cross placenta =resulting in fetal anticoagulation which can cause fetal bleed, intracranial hem

Suctioning

-Preoxygenate 100% O2 for 30 secs -Wait 1-2mins between passes for client to ventilate to prevent hypoxia -Suction should be set medium pressure (100-120hg)

Anticipatory Guidance

-Prepares pts and caregivers for future health needs and useful throughout life -Should be pt oriented, realistic, objective, measurable, focused on preparing for future needs -Like a pt with Alzheimer and osteoarthritis is high risk for falls with disease regression so in early stage, pt can make changes in home to promote safety in future

Bupropion, Varenicline

-Prescribed for smoking cessation -Can cause neuropsychiatric effects (Depression, suicide)

Metabolic Syndrome

-Presence of 3 or more health factors that increase a pts risk for stroke, DM, and cardiovascular disease -Ab obesity (Waist cirumference 40in or more in men and 35in or more in women) -High triglycerides, >150. Or hypertriglyceridemia treatment -Low levels of HDL cholesterol (<40 in men, <50 in women) -HTN (130/85 or more, or HTN treatment) -Fasting blood glucose 100 or higher, or hyperglycemia drug treatment

Group B Streptococcus

-Present as normal vag flora in up to 30% of preg pts -Rarely poses harm to pt but can be transmitted to newborn during labor and birth which can result in neonatal GBS sepsis or pneumonia -Receive prophylactic antibiotics during labor if positive or if status is unknown. Given membrane ruptured 18hrs or more, maternal temp more than 100.4, or less than 37wks gestation

Aortocaval Compression

-Pressure on the abdominal aorta by the heavy uterus when the woman is in supine position (increases the risk of hypotension and development of shock -So tilt them to side

Spiral femur fracture or fractures in general

-Pressure was applied to leg in opposite directions (Torsion) which is unlikely injury in nonambulatory child -Fractures in general are always a concern in nonambulatory children and suspicion of child abuse >Priority is report it to authorities

Antiplatelet meds

-Presugrel, Clopidogrel, Ticagrelor, Asprin (Not not cause liver damage or kideny damage) -Need to be stopped 5-7 days prior surgery -Should no be taken if have peptic ulcer disease cause can cause bleed -Should not take if on ginko cause gingo is also blood thinner

Goal for pt with new tracheostomy

-Prevent accidental dislodgement of tube and loss airway -Check tightness of the ties and allow 1 finger to fit under these ties -Changing inner cannula and trach ties performed 24hrs after insertion -Cuff kept inflated to prevent aspiration, not regularly deflated and inflated

Pursed Lip Breathing

-Prevent airway collapse, promote CO2 elimination, and reduce air trapping in COPD -Do this 5-10 mins 4 times daily -Inhale 2 secs through nose with mouth closed, exhale 4 secs through pursed lips

Nitroglycerin Patch

-Prevent angina -Apply once a day and worn 12-14 hrs then removed -Rotate sites each day -Can be worn in shower

Tamoxifen

-Prevent breast cancer recurrence by blocking estrogen -Taken for several (5-10) years after treatment to prevent breast cancer -Side effects are hot flashes, vag dry, menstrual irregularities -Serious sides are DVT, endometrial cancer -Irregular or excessive menstrual bleed can be sign of endometrial cancer

Scopolamine

-Prevents N/V due to motion sickness -Placed hairless, clean, dry area behind ear -Apply it 4 hours or more before starting traveling -Replace every 72 hrs

Albumin

-Prevents fluid from leaking out of the vessels -If have severe liver disease can develop hypoalbuminemia because liver manufactures albumin -When albumin is low can cause pitting edema, periorbital edema, ascites

Allopurinol

-Prevents gout attacks (Pain and inflammation in joints caused by uric acid deposits) -Takes several months to work, if not effective then continue taking NSAIDs for acute attacks -Inhibits uric acid production -Any rash is to be reported immediately, stop med immediately and notify HCP -Take full glass water and increase fluid intake to prevent formation of renal stones and promote diuresis and uric acid excretion -Alllopurinol is excreted through kidneys so liver and kidneys need to be checked daily -CBC should be checked cause it can cause blood dyscrasias -Take with food or after meals to prevent nausea

Emergency Contraception

-Prevents preg after unprotected sex and should be taken within 3 days of unprotected

ACE Inhibitors

-Prils -Drug of choice in diabetic with HTN or proteinuria -Can cause Hyperkalemia so check potassium lvls before admin -Does not affect HR unlike beta blockers -Can cause angioedema (rapid swell of lips, tongue, face, throat, larynx) and should discontinue asap and notify HCP -Contra in preg

Contraindications to thrombolytic therapy

-Prior intracerebral hemorrhage -Ischemic stroke within 3 months -Active bleeding -Known cerebrovascular lesions (AVM) -Uncontrolled HTN >180/110

DKA

-Priority is rehydration with normal saline -Can have hyperkalemia but fluids will dilute it

Aortic Root Repair with mechanical valve replacement

-Procedure often performed for pts with marfan syndrome cause they have increased risk for aortic rupture -If mechanical valve replacement is done via sternotomy (Surgical opening in the middle of the chest at the sternum), then need teach on lifestyle changes and prevention of complications >Avoid lift heavy objects >Anticoag therapy for life after mechanical valve replacement to prevent thrombotic events >S/S of HF need to be reported >Bleed precautions should be initiated >Prophylactic antibiotics before invasive respiratory and dental procedures to prevent infective endocarditis

Laparoscopic Procedures

-Procedures are used for abdominal surgeries; involves minimally invasive techniques such as several small incisions (lap sites) as opposed to one large, open incision -CO2 used to inflate and expand the ab cavity which can irritate phrenic nerve and diaphragm causing shallow breathing and referred pain to right shoulder. Early ambulation and deep breathe helps facilitate CO2 removal

4 Phases of seizures

-Prodromal Phase: Has warning signs the precede seizure (Before aural phase) -Aural Phase: Period before seizure when pt experience visual or sensory changes -Itctal Phase: Period of seizure activity -Postictal Phase: May experience confusion and headache -Difference between postical and syncope is that syncope is only brief loss of consciousness without prolonged post even confusion

B-type natriuretic peptide (BNP)

-Produced in response to stretching of the ventricles due to increased blood volume and higher lvls of extracellular fluid (Fluid overload) that accompany HF -BNP >100 helps distinguish cardiac from respiratory causes of dyspnea -Normal BNP lvl is <100

COPD

-Progressive inflammation tissue damage which eventually leads to lung scarring and airway remodeling -Leads to air trapping and reduced gas exchange -Notify HCP if increased sputum production -Should eat frequent, small, high calorie meals -Can use albuterol if SOB

Disulfiram

-Promotes abstinence from alcohol -If consume alcohol while taking this med can cause unpleasant side effects (Headache, intense N/V, flushed skin, sweat, dyspnea, confusion, tachycardia, hypotention). Can be fatal -Informed consent required -Avoid alcohol hidden in liquid cold and cough meds. aftershave lotions, cologne, sauces, vinegar, flavor extracts -Abstain from alcohol for 2 wks after last dose and wear bracelet altering others

Prevention of Developmental Dysplasia or Hip

-Proper swaddling with hips bent (flexed) and out (Abducted) -Infant carriers or car seat with wide bases -Avoid any positioning device, seat, carrier that causes hip extension with the knees straight and together -Also, the presence of extra inguinal or thigh/gluteal folds are present on affect leg. Just FYI

Nonselective Betablockers

-Propranolol, nadolol can result in smooth muscle constriction and contraindicated in asthma

Who would need prophylactic antibiotics before dental work?

-Prosthetic valve replacement, repaired valves, or history of infective endocarditis -Unrepaired cyanotic congenital defect -Given to prevent risk of infective endocarditis in those individuals

Vernix Caseosa

-Protective substance covering fetus, secreted by sebaceous glands -White, cheesy/waxy substance most likely seen in axillary and genital areas of term newborns

Misoprostol

-Protects against gastric ulcers by reducing stomach acid and promoting mucus production and cell regeneration -Prevents gastric ulcers in pts receiving long term NSAIDs (Can continue ibuprofen) -Antacids containing magnesium (Gaviscon) can increase adverse effects of misoprostol (Diarrhea, dehydration) >If need therapy with antacid, choose one that does not have MG (Calcium carbonate) -Take with food -Also used for labor induction and preg cat X, or given for postpartum hemorrhage rectally. Normally is orally or vaginally -Women childbear age educated on using birth control and possible sensation of uterine cramping while taking miso, if they suspect preg then stop taking med -Contra if receiving another uterotonic (Oxytocin), history of uterine surgey, abnormal FHR or uterine tachysystole (>5 contractions in 10 min)

Inguinal Hernia

-Protrusion of intraperitoneal contents (Bowel, Tissue) through weakened area in ab wall (Groin, Scrotum) -Can have dull pain caused by exercise or strain and palpable bulge on assessment -Can be reducible if organs can be returned to peritoneal cavity by applying pressure to bulge -Signs of mechanical obstruction (severe pain, distention, N/V) are caused by compressed loops of bowel incarcerated by hernia. Subsequent bowel ischemia and strangulation can lead to infection and death -If scrotum swell then elevate it with pillow and apply ice bag postop

Meningocele

-Protrusion of the meninges

Priority Nursing Action for anorexic patient

-Provide one on one supervision during tube feed will ensure that pt is actually receiving the feeding and prevent the pt from stopping the feeding or pulling out NG tube

Sucralfate

-Provides physical barrier against stomach enzymes and acids, forms better better protective layer at a low pH. Therefore antacids or other acid reducing meds (PPI, H2 blockers) should be avoided within 30 min of taking sucralfate -Treat and prevent stomach ulcers -1hr before meals and at bedtime on empty stomach

Somatic symptom disorder

-Psychological disorder in response to stress that results in physical symptoms (Chest pain, syncope, etc..) for which there is no identifiable medical source (MI, hypotension) -When evaluating pts responses to treatment would monitor for positive progress >ID of support systems, ID of perceived benefits of behaviors, Use stress reducing strategies rather than fixating on symptoms, Verbalizing of factors causing or worsening symptoms

Against Medical Leave

-Pt must be legally competent to make an educated decision to stop treatment

Displacement

-Pt shifts feelings or impulses about one situation or person to another person -Pt leaves stressful family meeting and immediately verbally abuses roomate

Hypothermia

-Pts should be handled gently as spontaneous Vifb can develop when moved or touched -Place cardiac monitor is high priority and should anticipate defib in these pts -Trunk should be warmed before extremities to reduce risk of aster-drop (Core temp drops further)

NSAIDs

-Pts with nasal polyps often senitive to NSAIDs -Can exacerbate asthma symptoms -Increase risk of thrombotic events especially in those with cardiovascular disease (Coronary artery disease)

Pediculosis Pubis

-Pubic lice -Most often passed via sexual contact and can cause intense itch -The nits (lice eggs) are attached to hair shafts and appear as yellow white ovals -Can also infest eyelashes, facial hair, body hair -Teach use lice shampoo (1% permethrin) >Use fine toothed nit comb to remove nits, can also use fingernails or tweezers >Wash and dry in hot water and highest heat dryer setting

Abdominal Aneurysms

-Pulsatile mass in periumbilical area slightly to left of midline and a bruit may be auscultated over the site in the periumbilical or epigastric area slightly left of midline -Back and ab pain may be present due to compression of nearby anatomical sites or nerve compression from an expanding/rupturing abdominal aortic aneurysm -If rupture can cause death in mins -AAA dissection or rupture may cause acute onset of ab pain radiating to back and has symptoms of hemorrhagic shock

Ineffective breastfeeding interventions

-Pump or hand express small amounts of colostrum that can be fed to newborn by syringe, cup, or spoon -Assess baby suck reflex, mothers breastfeed technique (position, behavior/anxiety during breastfeed), teach how express milk by hand and use electric pump to enhance milk production.

Obsessive Compulsive Disorder (OCD)

-Punctual, pay attention to rules and regulations, need to control both internal and external experiences -Very rigid and inflexible -Delay in appointment, this is unacceptable, i had my whole day planned out -Engage in rituals and behaviors that help reduce anxiety and stress, if ritual interrupted the pt will experience anxiety -Need to provide reflective feedback on pts behavior by pointing out amount of time the pt has spent performing an activity and redirecting the pt to another activity -Intial care plan includes helping pt identify circumstances that increase anxiety, provide positive feedback when they engage in non ritual behaviors, remain nonjudgemental and empathetic using reflective communication, CBT (Thought stopping)

Carbon Monoxide

-Purpose of HGB is to pick up oxygen in lungs and deliver it to right places. -Displaces oxygen from Hgb causing hypoxia that is not reflected on pulse oximeter. Priority is admin highly concentrated (100%) oxygen using nonrebreather mask at 15l/min in order to reverse the displacement -Pulse ox may be normal but severe hypoxemia and hypoxia may be present

Sit from stand with crutches

-Put both crutches on hand of affect side

Heat stroke

-Put ice packs in axilla or groin if re-hydration and moving them to cool environment still has not helped

Peritoneal Dialysis

-Put pt fowlers or semi folwlers -Catheter drainage bag should be below lvl of ab

Acute Coronary Syndrome (ACS)

-Range of cardiac events including unstable angina and MI (with or without ST elevation) -Need immediate treatment to prevent continued ischemia of cardiac muscle

Insulin action times

-Rapid (lispro, aspart): Onset (10-30mins). (Peak (0.5-3hr). Duration (3-5hrs) -Short (Regular): Onset (0.5-1hr). Peak (2-5hr). Duration (5-9hr) -Intermediate (NPH): Onset (1.5-4hr). Peak (4-12hr). Duration (12-18hr) -Long (Glargine): Onset (1-4hr). Peak (None). Duration (16-24hr)

Dumping Syndrome

-Rapid emptying of gastric contents into small intestines. Client experience ab pain, nausea, vomiting, explosive diarrhea, weakness, dizziness, palpitations & tachycardia, sweat, hypotension. -Occurs 15-30 mins after meals -So eat small frequent meals with complex carbs with high fiber, high fat and protein rich foods -Do not drink fluid with meals -Lie supine after eating

Supraventricular Tachycardia

-Rapid heart beat of 200-300/min -Can lead to life threatening congestive heart fail if untreated -Symptoms are palpations, dizzy, chest pain -Treat is vagal maneuvers if pt stable (place ice to pts face and hold breathe while bearing down (Valsalva)) -If still unstable then adenosine or synchronized cardioversion is done

Loose associations

-Rapid shifting from one idea to another, with little or no connection to logic or rationality -The world turns as the world turns on a ball at the beach, but all the worlds a stagecoach and i took the bus home

Uterine Inversion

-Rare OB emergency -Occurs after birth when uterine fundus collapses and comes out of vag, can case hemorrhage, severe pelvic pain, hypovolemic shock -Treat is manual push it back in but requires a soft, uncontracted uterus to do so, so tocolytic or inhaled meds may be needed to assist with uterine relaxation -Uterinetonic meds (Oxytocin) must be delayed or discontinued until uterine inversion is corrected, only started again once corrected

Narcissistic Personality Disorder

-Recurrent pattern of grandiosity, need for admiration, and lack empathy -They may project a picture of superiority, uniqueness, and independence that hides their true sense of emptiness -Have fragile and damaged ego resulting from childhood environment that fostered sense of inferiority, poor self esteem, and severe self criticism. Narcissistic characteristics develop as a way to regulate self esteem to protect ego

Purpura

-Reddish purple blotches on skin that do not blanch with pressure due to bleed underneath skin for any potentially serious illness like blood dyscrasia

Major Depressive Disorder

-Reduced appetite and energy and lethargy -Pt needs direction and structure in performing ADLs, waiting for pt to feel more energetic and initiate activity and interaction on one's own is not helpful. Assisting pot with ADLs convey sense of caring and helps lift self esteem -Like sating "I will help you get ready; then we can walk to the dining room together" if they refuse to eat and lay in bed. Do not reinforce their behavior.

Pantoprazole

-Reduces gastric acid secretion to prevent ulcers

Octreotide

-Reduces portal venous pressure which reduces bleed, can control UGIB related to gastroesophageal varicies

Central Venous Pressure

-Reflects fluid volume problems -Normal CVP is 2-8, elevated can indicate fluid overload can have S3 heart sounds and bounding peripheral pulses

Epidural Anesthesia

-Regional anesthesia injected into the space between the spinal cord and the vertebrae -Contraindicated in uncorrected hypotension, coagulopathies (extremely low platelets, clotting disorders) -Low plate can risk bleed at epidural puncture site, hematoma formation, spinal cord compression, neurologic dysfunction -Anemia not contraindication to epidural anesthesia

Epidural Block

-Regional anesthesia that numbs the woman's body from the waist down -Can cause peripheral vasodilation which can cause hypotension, then admin IV fluid bolus and position left lateral side

Raynauds Phenomenon

-Related to cold temps or emotional stress and causes vasoconstriction -Causes color change in appendages (fingers, toes, ears, nose) to turn white from decreased perfusion followed by bluish purple due to cyanosis -When blood flow is restored the affected area become reddened and have throbbing, aching pain, well, tingling -Treated by immersing hands in warm water -Prevention: wear gloves handle cold things, dress warm layers, avoid extremes and abrupt changes in temp, avoid vasoconstricting drugs, avoid caffeine, no tobacco, stress management (Yoga, tai chi, meditation) -Calcium channel blockers may be used if other fails

Systemic Inflammatory Response Syndrome

-Release of inflammatory cytokines which triggers vasodilation, leading to hypotension and impaired end organ perfusion -May occur in response to trauma, tissue ischemia, infection (Sepsis), and shock and can rapidly progress to respiratory failure and multiorgan failure -Signs are fever or hypothermia, tachycardia, leukocytosis or leukopenia, and tachypnea (associated with low PaCO2) -Need aggressive fluid resuscitation

Cardiac Enzymes (CK-MD)

-Released in presence of myocardial tissue, elevations are highly indicative of MI

ALT/AST

-Released when hepatic cells are injured (hepatitis) -Used to diagnose hepatic disorders -Liver injury can occur from alcohol, OTC meds, Herbs, IV illicit drug use

Fleet Enema

-Relieves constipation by infusing hypertonic solution into bowel pulling fluid into colon and causing distention and then defecation

Wavy Flexibility

-Remain in immobile posture like statue

Instill ear drop

-Remain side lying for 2-3min -Instill at room temp

Neck dissection

-Removal of cancerous lymph nodes around the neck -Chewing may be difficult after due to tissue trauma

Gastroduodenostomy (Biliroth I)

-Removal of distal 2/3 of stomach. Remaining is anastomosed to duodenum -NPO till bowel sounds return -Consume small, frequent meals to prevent dumping syndrome (Rapid emptying of stomach contents to small intestines) -Turn, cough, deep breath elevate HOB to prevent atelectasis -Clogged NG tubes should be reported, never try to flush it

Hysterectomy

-Removal of the uterus -Cannot have kids in future

Paracentesis

-Remove excess fluid from ab -Verify pt received necessary info to give consent and witness informed consent -Void prior to prevent puncture of bladder -Assess ab girth, wt, vitals -Place in high fowlers or upright as possible

Management for anaphylactic shock

-Remove insect stinger, IM epi and repeat dose every 5-15 mins (If symptoms still present), place recumbent and elevate knees, maintain BP with IV fluids, Bronchodilator, corticosteroids -Cricothyrotomy or trach is severe laryngeal edema

In Hoarders

-Removing the items will causes them great anxiety, so don't remove.

Lupus Nephritis

-Renal complication of SLE (Inflammatory autoimmune disease that leads to ESKD)

Perseveration

-Repeating the same words of phrases in response to different questions

Echolalia

-Repetition of words usually uttered by someone else

CVC lumens

-Require anticoagulation in form of heparin flush to maintain patency -Doses fo 2-3ml containing 10units/mL-100units/mL are standard -Doses of 1,000-10,000 are given for VTE -Distal port is the largest lumen tube and should be used for CVP (right atrium pressure) -Mutiple lumens used to admin incompatible drugs simultaneously

Backup Contraceptives

-Required for 7 days after starting oral contraceptives

Residual Limb due to below knee amputation positioing

-Residual limb should not be elevated especially after 24 hours cause can cause contractures -Place prone with hip extended 30 mins a day 3-4 times a day

Nursing interventions for viral hepatitis

-Rest >Alternate periods of rest and activity to avoid fatigue >Avoid hepatotoxins (Alcohol, acetaminophen) -Nutrition >Low fat, small frequent meals to decrease nausea and promote intake in pts with anorexia. Anorexia is lowest in morning so promote eating a larger breakfast >Avoid extremes in food temp >Promote 2500-3000mL/day water and diets adequate in carbs/calories

Percutaneous Coronary Intervention

-Restore coronary perfusion to prevent or treat ischemia or infarction. -Should have no chest pain at rest after procedure, if pain then mean myocardial ischemia, thrombosis, or stent occlusion -Exacerbated by anticoags -If using femoral approach then can increased risk for retroperitoneal hemorrhage (Hypotension, back pain, flank ecchymosis, hematoma, and diminished distal pulses)

Femoral Popliteal Angioplasty

-Restore perfusion to legs in pts with PAD, after procedure the pt should be able to ambulate without evidence is ischemia (leg pain)

Lactational Mastitis

-Result from inadequate milk duct drainage or poor breastfeed technique -Can cause stagnant (not flowing or running) milk -Can have fever,muscle ache, breast pain and inflammation -Staphylococcus aureus most common cause and need antibiotics >Continue breastfeed >Apply warm compress and massage to facilitate complete emptying, cool compress can be used between feeds >Use analgesics >Wash hands before feed -No underwire or tight bras during this time

Sunburn

-Result from overexposure to UV radiation -Can be superficial (red, painful) or partial thick (blistering, weeping) burns -Sunburns increases insensible fluid loss and places at risk dehydration -Symptom management >Protect burned area from further sunburn (Going out midday when sun is hottest) >Promote increase fluid intake >Provide pain relief with OTC analgesics >Reduce inflammation and pain by taking tepid baths using cool compress and applying soothing protective lotions or gels to area (aloe vera, calamine) -Corticosteroid creams not used, can cause further drying of skin

Peritonsillar Abscess

-Result from tonsillitis or pharyngitis -Have fever, hot potato muffled voice, trismus (inability to open mouth), pooling saliva, Drool), and deviation of uvula to side -Abscess can progress to life threatening airway obstruction

Trigeminal neurolgia

-Results from damage to CN V-lack of sensory or motor function -Feel pain touching, talking, hot/cold air intake. -Electric shock like pain in lips and gums

IN COPD ABGs

-Retention of CO2 (Or even normal PaCO2) is dangerous as it indicated respiratory muscle failure resulting in retention of CO2

Cardioversion

-Returning a heart to normal rhythm. Need to have a pulse to be performed -Synchronizer must be turned, if not turned on then can result in lethal -Delivers shock to R waves and avoid shock during T wave. A shock delivered on T wave can cause pt to go into Vtach or Vfib and if become pulseless, then synchronize needs to be turned off and proceed with defib -Prior to delivery of shock, oxygen should be turned off and moved away

Osteomalacia

-Reversible bone disorder caused by Vit D deficiency and causes weak, soft, painful bones that can easily fracture or become deformed -In Vit D deficiency, calcium and phosphorus cannnot be absorbed thus unavalivble to bone calicfication -Managemnet includes light to moderatea activity. Increase calcium (leafy green veges, dairy), phosphorus (milk, organ meats, nuts, fish, poultry, whole grains), vitamin D (egg yolks, saltwater fish, liver, sunlight) intake.

For frostbite or cold injury

-Rewarm affected area in warm water 104F for about 30 mins or until area turns pink -Massaging body part that sustained coldinjury is contraindicated

ABO blood group

-Rh+ can receive Rh+ or Rh- blood

What can statin meds cause?

-Rhabdomyolysis (Breakdown of muscle tissue that releases a damaging protein called myoglobin into the blood) -Myoglobin can damage the kidneys. Symptoms include dark, reddish urine, a decreased amount of urine, weakness, and muscle aches. -Early treatment with aggressive fluid replacement reduces the risk of kidney damage. -If taken with grapefruit juice, can cause myopathy (Muscle disease)

Clang assocaitions

-Rhyming words in a meaningless, illogical manner -The pike likes to hike and mike fed the bike near the tyke

Ventricular Bigeminy

-Rhythm in which every other heartbeat is a premature ventricular contraction (PVC) -PVC in the presence of MI indicate ventricular irritability and increases risk for more serious dysrhythmia (Vtach, Vfib) -Causes can be electrolyte imbalance, ischemia

Tinea Corporis

-Ringworm -Fungal infection transmitted from one p[person to another or animal to human. -Scaly, itchy rash circular or oval in shape and highly contagious and be spread via grooming tools, hats, towels, bedding -Treat with topical antifungals and clean athletic equipment regularly in locker rooms

Tinea Capitis

-Ringworm of scalp -Contagious fungal infection resulting in scaly, itchy, circular patches with hair loss -Transmitted direct contact with infected persons, pets, or objects (hairbrushes, bedding, towels, hats) -Treat is 1% selenium sulfide shampoo applied several times a week in combination with anti-fungal med (Griseofulvin) taken several wks to months should not be discontinued early and taken with high fat foods, can cause photo-sensitivity

Peptic ulcer disease

-Risk can be H.pylori, NSAIDS (aspirin, ibuprofen), Stress, diet, -Modifiable risk factors: NSAIDs, caffeine, smoke, alcohol, meal timing (eat multiple small meals throughout day or eat shortly before bed may worsen it

Colorectal Cancer

-Risk factors are over 50, colon polyps, inflammatory bowel disease (Crohns, ulcerative colitis) -Signs: Blood in stool, ab discomfort, anemia, change in bowel habits, unexplained wt loss

Large body cast

-Risk for bowel obstruction due to cast syndrome which causes decreased peristalsis and cause paralytic ileus (Bowel obstruction) which can lead to bowel ischemia

Atypical Antipsychotics

-Risperidone, Quetiapine, Olanzapine -Treat schizo, bipolar, other mental health -Side effects can include extrapyramidal symptoms like akathisia (restless, fidget) which can be treated by benzos, parkinsonism (tremors, shuffling gait). Neuroleptic malignant syndrome, anticholingeric effects, orthostatic hypotension, sedating, tardive dyskinesia (Involuntary movements like lip smack)

Accidents associated with child walkers

-Rolling down stairs -Burns since can reach higher -Drowning -Poisoning since can reach high

Where to store epi pen?

-Room temp in dark place

Rotator Cuff Tear

-Rotator cuff is group of 4 shoulder muscles and tendons that allows rotation of the arm -Characteristic symptoms are shoulder pain and stiffness. Severe pain when arm is abducted between 60-120 degrees

Rounded chest in infant

-Rounded, nearly circular chest shape with front to back (anterioposterior) diameter approximately equal to the side top side (lateral) diameter is an expected finding in healthy infant -Chest is more oval and the lateral diameter is greater than the anterioposterior diameter by age 2

Enoxoparin Therapy

-Routine PT, INR, PTT do not need to be monitored but periodic assessment of CBC is required to monitor for hidden bleed and thrombocytopenia

TPN Fingerstick

-SHoud be monitored q6hrs and should be maintined 140-180

Seraltine, fluoxetine, paroxetine

-SSRI -For major depression and anxiety -Can cause sexual dysfunction, this side effect may decrease or cease after a 2-4wk waiting period -Can cause wt gain too

Paroxetine

-SSRI for major depression and anxiety -Wt gain common side effect of long term SSRI use -Can also cause suicide risk at beginning of therapy, sex dysfunction, and serotonin syndrome -Effects in 1-2wks

ST elevation monitor

-ST elevation mens MI -Monitor for Vtach or PVC and admin antidysrythmic drugs if it occurs

Trichomoniasis

-STI, may be asymptomatic and usually seek care when frothy yellow green vag discharge is noted. -Oral metronidazle is most common drug to treat it (have metallic taste, dark colored urine) -Education includes: Abstain sex until infection cleared (1 wk after treat), avoid alcohol while taking metronidazole and for 3 days after completion therapy, have partners treated

Choosing foods for toddlers (1-3yrs)

-Safety: Small, hard, sticky, or slippery foods (hot dog, grapes, nuts, raw carrot sticks, popcorn, peanut butter,hard candy, fruit snacks)pose risk for choke -Nutrient dense: foods should contain valuable nutrients (proteins, vitamins) rather than empty calories (Sugars) -Potential for food borne illness especially given raw, unpasteurized foods (Partially cooked eggs, raw fish, raw bean sprouts) -Healthy snacks include pieces of cheese, whole wheat crackers, banana slices, yogurt, cooked veges, cottage cheese with thinly sliced fruit

Sleep

-School age (6-12) need 11 hrs sleep daily at age 5 and 9 hours at age 12

Glasgow ComaScale

-Score of 8 or lower is classified as coma and needs to be incubated -When you are 8, intubate.

Syphilis In Preg

-Screening: Universal at first prenatal visit, Third trimester and delivery (If high risk) -Treatment: IM Penicillin -Preg effects: Intrauterine Fetal Demise, Preterm labor. Congenital syphilis can be prevented with prenatal treatment -Fetal effects: Hepatomegaly, jaundice, Anemia, Long bone abnormal -If have penicillin allergy then will require penicillin desensitization (giving a medication in a controlled and gradual manner, which allows the person to tolerate it temporarily without an allergic reaction.)

1 hour oral glucose challenge test

-Screens for gestational diabetes and considered abnormal if BG >130-140 -Can be performed any time of the day and does not require fasting -Need to ingest of 50g glucose solution then nurse will draw blood in one hour

Hydrocele

-Scrotal swelling caused by a collection of fluid -Resolve by first birthday and not emergency

Car Safety Seat

-Secure seat harness to fit snugly against newborn body. No bulky jackets or blankets between newborn and the harness -Place newborn in FDA rear facing car seat in the back seat -Position newborn at 45 degree angle to prevent aspiration

Propofol

-Sedate client receiving mechanical vent to provide ventilator control, prevent accidental extubation, promote comfort, keep them calm

Chlorpheniramine

-Sedating histamine to treat allergic symtpoms and increases central nervous system effects (Drowsy, dizzy)

Neuroleptic Malignant Syndrome

-Seen with typical antipsychotics like haloperidol -Atypical anitpsychotics (clozapine) can cause it too -Causes muscle rigidity, fever, altered mental, diaphoresis, autonomic dysfunction (sweat, hypotension, tachycardai) -Most important is discontinue the antipsychotic med

Status epilepticus

-Seize 5 mins or longer, grunting and dazed appearance are common signs so give benzos (Diazepam, Lorazepam)

Compression Stoackings

-Select size knee length by measuring length from heel to popliteal (Behind knee) and circumference at widest point of calf -Free of folds/wrinkles -Wounds should be covered with occlusive dressing (hydrocolloid) before TED hose application -Should be worn continually and may be removed 1-3 times a day. Important to wear when legs in dependent position (Sit, stand, usually during day) -Do not apply a size larger than recommended based measurement or else will not provide adequate compression

Histrionic Personality

-Self dramatizing, exaggerated or shallow emotional expression -Attention seeking and needs to be center of attention -Over friendly and seductive and attempts to keep others engaged -Demands immediate gratification and has little tolerance for frustration

Chest tube removal

-Semi folwer or lying on unaffected side

Mastectomy PostOp Care

-Semi fowlers, affect limb elevated on pillow at heart level -Ice for inflammation, swell, and pain -Pneumatic compression used to facilitate lymph drainage only when lymphedema is present

A pt risk for suicide should be placed in what room?

-Semipraivate

Hospitalizations for toddlers (1-3 years)

-Separation anxiety and cant cope with stress -Thrive on rituals and routines -Visit from friends may actually cause more stress -Toddlers do not think they caused illness, preschool aged (3-5yrs) do though.

Septic Shock

-Sepsis is infection that causes impaired organ function -When sepsis causes cardiovascular collapse or impairs the body to maintain normal metabolic and cellular process >Fever or hypothermia (Fever occurs in response to infection, low body temp occur as shock worsens due tometabolic alterations and inadequte tissue perfusion) >Prolonged capillarty refill morethen 3-4secs >Tachycardia (Resting HR >90) >WBC >12,000 >Decreased urine output

Ventricular Septal Defect

-Septal opening causes left to right shunting leading to excess blood flow to lungs which places risk for congestive heart failure and pulmonary HTN -Signs are systolic murmur diarphoresis, tachypnea, dyspnea. May show increased signs of increased respiratory exertion like grunting

Cor Pulmonale

-Serious cardiac disease associated with chronic lung disorders, such as emphysema and COPD -Right sided heart failure from vasoconstriction of pulmonary vessels -treated with long term, low flow O2, bronchodilators, diuretics.

Minimally invasive direct coronary artery bypass

-Several small incisions made between ribs and a thoracotomy scope or robot used -Recovery time is shorter than if open chest CABG -May have higher lvls pain cause incision between ribs

Acute Sinusitis

-Severe facial pain, nasal congestion with purulent nasal drainage, fever -Just need antibiotics

HELLP Syndrome

-Severe form of preeclampsia -Have RUQ or epigastric pain, N/V and malaise -Complication especially if not diagnosed can lead to placental abruption, stroke, and death

Disk Herniation

-Severe lower back pain after lifiting -Can cause pain radiating down the leg below the knee

Gonorrhea

-Sexually transmitted bacterial disease caused by a gonococcus bacterium that causes inflammation of the genital mucous membrane, burning pain when urinating, and a discharge

Signs of abuse

-Shaken baby syndrome (irritable, lethargy, poor feed, emesis, seizures) -Burns in shape of household items, cigarettes -Repeated injuries in varied stages of healing -Injuries to genitals -Lapsed time between the injury and the time when care is sought

Gastric contents pH

-Should be 5.5 or below

Admin IV narcotics during labor

-Should be admin during peak of contractions to help decrease sedation of fetus -Uteroplacental blood flow reduced during contraction peaks and admin IV med at this time results in less med crossing placental barrier

Permanent pacemakeer

-Should be assessed for electrical capture of heart rhythm and mechanical capture of heart rate -Electrical is ECG -Mechanical is auscultation of apical or palpation of femoral -Then should be compared for pulse deficit

Supplemental formula and artificial nipples

-Should be avoided as it can interfere with mothers ability to exclusively breastfeed. -Are only used for medical indications (newborn hypoglycemia, dehydration, excessive wt loss) and if alternate breastfeed techniques are unsuccessful

Interveiw caregiver on child abuse

-Should be done without child present -Gather info on caregivers perspective on child's behavior, methods discipline used, caregiver stress/coping/support systems

Arm elevation with cast

-Should be elevated first 48hrs but if compartment syndrome present then should be kept lvl of heart (Not high or low)

Feeding tubes

-Should be flushed prior and after feed to keep it patent

Advance Directive Copies are given to who?

-Should be in pts med record, given to everyone listed as health care proxies, and pt should keep on in safe place -Can be completed in healthcare setting if there are 2 witnesses. Does not have to be notarized -The 2 witnesses cannot be the HCPs involved in the care of pt or individuals names as health care proxies in the document

LDL

-Should be less than 100

Baratric Surgery PostOP

-Should be low in simple carbs and high in nutrients (Protein, fiber) -Any consumption of simple carbs after surgery can lead to dumping syndrome

Pneumonectomy

-Should be positioned on surgical side to promote expansion and ventilation of remaining lung

Neonate after birth

-Should have no cranial nerve abnomalities -Ptosis (drooping of eyelid) can indicate paralysis of oculomotor nerve

Handoff report

-Should include objective info related ti pts condition -Include baseline measurements that may not be documented in the medical record (Current respiratory status) so oncoming nurse can prioritize care

Immunocompromised vaccines

-Should no receive live vaccines (Varicella zoster vaccine, MMR, rotavirus, yellow fever)

SSRI and MAOi

-Should not be given together cause increased risk serotonin syndrome -MAOI should be stopped at least 14 days before starting SSRI

Peripheral IV Catheters

-Should not be removed or replaced more frequently then every 72-96 hrs unless complications

Vaccines during preg

-Should not receive live vaccines or become preg within 4 wks of receiving live -Tdap should be given begin 27th and the end of 36th week to prevent against pertussis -Influenza injection should be given

Endotracheal Suctioning

-Should only be done if indicated (Adventitious breath sounds, cough, elevated peak pressure) and based on clinical findings -Frequent suction increases risk of tracheal and bronchial trauma, bleeding, hypoxia. -Oral suction every 2 hrs to prevent VAP -To monitor ET cuff leak, auscultate the neck to assess

Smoke before surgery

-Should stop 24hr prior

Myocardial Ischemia/Infarction Symptoms

-Shoulder pain radiating down arm, jaw/shoulder pain, dyspnea, diaphoresis, N/V, dizzy, cold clammy skin

Opioid Withdrawl

-Signs: N/VD. Cramp. Increase bowel sounds. Increase pulse/BP. Diaphoresis. Insomnia. Yawn. Pupil dilation. -Management: Reversal agent: Naloxone >Opioid Agonist (Methadone or Buprenorphine) >Non opioid (Clonidine, benzo, antiemetics, antidiarrheals)

Epiglottitis

-Sitting up, leaning forward, drooling, stridor, high grade fever -Due to haemophilus influenzae B -Can be prevented with standard immunization -Pediatric emergency and should be endotracheal intubated or tracheostomy -Can cause sudden airway obstruction

Acanthosis Nigricans

-Skin disorder. -Symmetric, hyperpigemented velvety plaques located in folds/flex regions of skin (Axilla, neck). Thickening and darkening of skin -Indicates insulin resistance and can indicate underlying DM

Ringworm

-Skin infection caused by fungus -Red scaly blistered rings on skin or scalp that grow outward as infection spreads

Cerebrospinal Fluid Rhinorrhea

-Skull fracture has occurred and transversed the dura -If drainage is clear, dextrose testing can determine if it's CSF, however if there's presence of blood then it will make test unreliable since blood also contains glucose. In this case the halo ring test should be done by adding few drops of blood tinged fluid to gauze and assessing for coagulated blood surrounded by CSF -If it is confirmed CSF then high risk for infection nose should not be packed and no NG or oral gastric tube should be inserted blindly as risk for penetrating brains due to fracture

Fifth disease

-Slapped cheek presentation -Spreads droplet before onset of symptoms, once they develop symptoms then no longer infectious. Isolation not needed -Caused by paraovirus B19 -Bright red facial rash, fever, flu like symptoms -Harmless, recover in 7-10 days and general joint and fatigue treated with NSAIDs -Preg should avoid contact with these ppl as it can transmit to fetus and cause anemia

Signs and symptoms of major depression (SIGECAPS)

-Sleep (Increased or decreased) -Interest deficit/Lack of pleasure (Anhedonia) -Guilt (Worthless, Hopeless) -Energy Deficit -Concentration Deficit -Appetite (Increased or Decreased) -Psychomotor retardation or agitation -Suicidal -Key clinical features for diagnosis of major depressive disorder is depressed mood and lost of interest or pleasure

Pseudomenstruation

-Slight blood-tinged vaginal discharge that may appear shortly after birth. It is thought to be related to the maternal hormones and disappears without any treatment

BP During Preg

-Slight decrease in first trimester and lowest around 24-32wks -Third trimester gradually returns to pre pregnancy baseline -Increase in 30 or more SBP or 15 or more DBP during early preg even in absence of HTN (More then 140/90) is deviation from norm

Post Op Bronchoscopy

-Small amount of blood tinged sputum is normal, but frank bleed or clots should be reported

Roux-en-Y gastric bypass

-Small pouch created from stomach, part of small intestine bypassed, restriction and malabsorption -Consume fluid and liquids 30 mins apart to prevent dumping -Can have iron deficiency anemia so take supps

Factors that causes COPD

-Smoke, exposure to chemicals and dust, air pollution, genetics

Signs of fetal alcohol syndrome

-Smooth philtrum, thin upper lip, and short palpebral fissures

Burn Home Care

-Soak area briefly in cool water -Remove any clothing or jewelry around the burn cause edema can develop -Cover with clean dry cloth -No ice, ointments, creams, or butter should be placed unless prescribed by HCP

Schizoid Personality Disorder

-Social detachment and inability to express emotion -Do not enjoy close relationships and prefer to be alone and isolated -Does not care about praise or criticism -Uncomfortable around ppl and lacks close friends

Fibrocystic Breast Nodules

-Soft, movable nodules that change size at various times during the menstrual cycle -Benign breast disorder

Play in infants (Birth to 1yr)

-Solitary play, focused on their own activity and will play alone in the presence of others

Transverse Myelitis

-Spinal cord inflammation -Paralysis, urinary retention, bowel incontinence -Normal muscle strength is 5 on scale 0-5. Weakened muscle strength (2+ means only able to move laterally, not able to lift up against gravity) which would be normal finding

Splenectomy

-Spleen functions as filter to purify blood and remove specific microogansims that cause infections -Overwhelming postsplenectomy bacterial infection or rapid onset sepsis are lifelong complications in pt without a spleen -Even a minor fever/infection can quickly become life-threatening

Hep B

-Spread blood, semen, and vaginal secretions -May be asymptomatic -Malaise, nausea, vomiting, ab pain in early stages -May produce jaundice, wt loss, clay colored stool, thrombocytopenia in late stages -Has a vaccine

Pinworm

-Spread by inhaling or swallowing eggs which can be found on contaminated food, drink, toys, linens -They hatch in intestines and during night female pinworm lays thousands of eggs around anus resulting anal itch and trouble sleep

West Nile Virus

-Spread to humans by the bite of an infected mosquito -Prevention is avoid mosquitoes and using insect repellent, long sleeves

External Fixation

-Stabilizes bone by inserting metal pins through skin into the bone and attaching them to a metal rod outside the skin -Perform pin site care with sterile cleaning solution -Localized pin tract infection can progress to osteomyelitis -Increasing pain at skeletal pin site can indicate infection or displaced pins which can compromise blood flow to the leg -Promote early mobilization for pts, may begin walking with physical therapy the day after surgery

Romberg sign

-Stand feet together and hands side body, close eyes and maintain balance. Loss of balance is positive romberg sign indicates ataxia is sensory in nature rather than cerebellar

Nalaxone effect

-Start to wean off within 20-40 mins after admin -So depending on the opioid dose, need to assess if the effects start to come back one nalaxone wears off, if effects do come back then may need to give nalaxone again

Moro reflex

-Startle reflex -Present until age 3-6 months and elicited by quickly lowering infants head relative to body stimulating falling sensation -Also a response to loud sudden sound -Newborn will extend and raise arms with fingers fanned out then curl fetal position -Absence mean underdeveloped or damaged brain or spinal cord

Developmental Dysplasia of The Hip

-Starts 2-3months -Has extra inguineal/gluteal or thigh folds -Laxity (loose) of hip joints on affected side -Affected leg may be shorter than opposite leg -If not corrected during infancy then can have limp, walk on toes, positive trendelenburg sign (Pelvis tilts down on affected side when standing on the affected leg). -If bilateral then waddling gait and severe lordosis (Curved inward of lower back or extreme arch)

Separation Anxiety

-Starts 6 months and peaks 10-18 months and can last till 3 years of age -Produces more stress than any other factor (pain, injury, change in surroundings)

Menopause

-Starts ages 50 to 52. Can cause osteoporosis and heart disease -When take bisphosphonates it decreases bone resorption (Osteoclasts breaks down bone to release in blood). Taken morning empty stomach will full glass water and upright for 30 min after -HRT can cause DVT -Anemia in older adults not caused due to lack iron intake, so excessive iron intake can lead to overload -Postmenopausal bleed most common sign endometrial cancer

Strep throat contagious period

-Starts at onset of symptoms and lasts through the first 24hrs of antibiotic treatment -After 24hrs of antibiotic then not contagious and okay to go out

Alcohol withdrawl

-Starts within 8 hrs after last drink and peaks 24-72 hrs

Catatonia

-State of immobility and unresponsiveness lasting for long periods of time -Refuses to move or engage in ADL -Has bizarre postures and holds it in one position -Resists instructions -High risk dehydration and malnutrition

Neurogenic shock

-State of shock (hypoperfusion) caused by nerve paralysis that sometimes develops from spinal cord injuries -Causes massive vasodilation and leads to hypotension and bradycardia, with warm dry skin.

Failure to thrive

-State of undernutrition and inadequate growth in infants and young children -Usually related to inadequate intake of calories -Nurse needs to assess child feeding so see food consumed, amount and quality of food, etc... Needs to be objective info that nurse can see and assess -Physiologic risk factors include preterm, breastfeed difficulties, GERD, cleft palate -Socioeconomic factors include poverty, social or emotional isolation, cognitive disability or mental health disorder, lack of nutrition education -Psychosocial risk factors include domestic violence, caregiver or child with negative attitudes toward food (Fear obesity, anorexia), poverty, unstructured mealtimes

Wound evisceration

-Stay with pt and have someone notify HCP and bring sterile supplies -Place in low fowlers (No more than 20 degrees) with knees slightly flexed to relieve pressure on ab incision and be on bedrest -Supine could put more tension on wound -Assess vitals and repeat every 15 mins so shock -Cover viscera with sterile dressings saturated in NS -Should be NPO in prep for surgery

Methylphenidate

-Stimulant improves attention in children with ADHD, helps maintain focus on activity -Symptom relief seen after first dose -Safe drug -Not used as PRN, admin daily in 2-3 divided doses 30-45min before meals -Can interfere with sleep so give it no later than around 6pm -Can cause decreased appetite and wt loss, HTN and tachy in adults, new tics, restless and insomnia, abuse

Oxytocin (Pitocin)

-Stimulates contraction of uterine smooth muscles to induce/augment labor and to prevent postpartum hemorrhage -Adverse effects: Cat II or III fetal heart rate patterns (Late deceleration's, bradycardia) abnormal or intermediate FHR patterns are common and may occur due to decreased blood flow to fetus during contractions. Emergency c section if persistent abnormal FHR pattern. Postpartum hemorrhage cause uterine atony/fatigue can occur if pt experiences prolong exposure to oxytocin. Water intoxication. Uterine tachysystole (>5 contractions in 10 mins)

Transfusion Reaction

-Stop and disconnect tubing -Maintain IV access with NS using new tubing to prevent hypotension and vascular collapse -Notify HCP -Check vitals

Correct late decelerations

-Stop oxytocin, reposition to left/right side, admin oxygen by face mask, admin IV bolus of isotonic fluids (Lactated ringers, 0.9 Saline)

Reduce risk for alzheimers

-Stop smoke, avoid alcohol, exercise regular, participate in mental challenging activities -Risk factors for AD are advanced age, first degree relative, trauma to brain

Croup

-Stridor, high pitched inspiratory breath sound heard without stethoscope -Can be life threatening if stridor or severe suprasternal, subcostal, and intercostal retractions

Coronary arteriogram (Angiogram)

-Studies coronary arteries and function of heart -IV line for sedating meds in femoral or radial artery -Should not >Eat/drink 6-12hrs prior >May feel warm or flushed when contrast dye injected >Compression applied to puncture site and lay flat several hours -If diagnostic study then go home same day -General anesthesia not given, sedating meds are

Disconnected chest tube or chest drainage unit breaks or cracks or malfunctions

-Submerge distal end of chest tube 1-2in below the surface of a 250mL bottle of sterile water or saline to prevent air from entering pleural space -Emergency equipment like 2 chest tube clamps, 25mL bottle of sterile water or saline solution, and antiseptic wipes should always be bedside -If chest tube disconnects with no contamination, wipe end of tube with antiseptic and immediately reconnect it -Clamping chest tube should not exceed 1 min cause can raise intrapleural pressure and can lead tension pneumothorax, clamp briefly when check air leak or when changing the disposable collection unit -Not necessary to contact HCP when replacing chest tube system unless pt develops respiratory distress -Do not need to position them left side

Chest Tube Drainage System

-Suction control chamber (Section A) maintains and controls suction to the chest drainage system; continuous, gentle bubbling indicates that suction lvl is appropriate. The amount of suction is controlled by the amount of water in the chamber and not by the wall suction. Increasing the amount of wall suction would cause vigorous bubbling but does not increase suction to the pt as excess suction is drawn out through the vent of the suction control chamber. Vigorous bubbling would increase water evaporation and therefore decrease the negative pressure applied to the system. The nurse should check the water lvl and add sterile water if necessary to maintain the prescribed lvl. -The anti-leak monitor (Section C) is part of the water seal chamber and continuous or intermittent bubbling seen here indicates an air leak. -The collection chamber (Section D) is where drainage from the client will accumulate and the nurse will assess amount and color of the fluid and record as output. -The water seal chamber contains water which prevents air from flowing into the pt, up and down movement of fluid (tidaling) in section B would be seen with inspiration and expiration and indicates normal functioning of the system, this will gradually reduce in intensity as the lung reexpands.

Call rapid response only when acute significant changes occur in

-Sudden changes in HR, SBP, RR, O2, LOC, Urine output -To get critical assistance to the bedside pts (Not in ICU) with acute significant changes in their condition

Retinal Detachment

-Sudden onset of light flashes, floaters, cloudy vision, or curtain appearing in vision, or hairnet/cobweb vision. -Is emergency and can lead to blindness if not treated -PostOp teaching >Avoid activities that increase intraocular pressure (Rub eye, straining) >Report sudden pain, flashes light, vision loss, bleed which may indicate infection or detachment >Avoid focused activity (Read, write, sewing) which causes rapid eye movements >Wear eye patch or shield to prevent rubbing/scratching eye

Trigeminal Neuralgia

-Sudden sharp pain along trigeminal nerve. unilateral in maxilla and mandibular -Can have cluster pain like period of chronic pain with periods of less severe. Pain severe, intense, burning, or shock like -Triggers can be washing face, chew food, brush teeth, yawn, talk -Primary intervention is consistent pain control and carbamezapine is drug of choice, its a seizure med but highly effective for europathic pain but can cause agranulocytosis (Leukopenia) -Use soft bristled brush, warm mouthwash, drink lukewarm water and avoid beverages too hot or cold, avoid rub/massage face, have soft diet with high calories

Foul smelling lochia

-Suggest endometrial infection (Other signs are fever, tachycardia, uterine pain/tenderness) -Odor is usually fleshy or musty

Trimethoprim-Sulfamethoxazole

-Sulfonamide antibiotic (Sulfa drug) -Treats bacterial infections (UTI) -Contra is hypersensitivity to sulfa drugs (Diuretics), preg, and breastfeed -Crystalluria are side effect of sulfa drugs so drink 2-3l of water

tPA contraindications

-Surgery within last 2 wks -Stroke or head trauma in last 3 months -Stroke symptoms started more than 4 and a half hours ago

Lithotripsy

-Surgical crushing of a stone

Thoracentesis

-Surgical puncture to remove fluid from the pleural space -Tension pneumothorax can occur and shift trachea which can cause severer respiratory distress

Laparoscopic Cholecystectomy

-Surgical removal of gallbladder through small incision -Post Op need low fat diet, can return work within wk but resume normal activity slowly or as tolerated, Dressings can be removed day after surgery and can shower but no baths until incision is fully healed

Carotid Endarterectomy

-Surgical removal of the lining of a portion of a clogged carotid artery leading to the brain -BP monitored first 24hrs cause HTN may strain surgical site and trigger hematoma formation which can cause hemorrhage or obstruction. SBP need to be maintained 100-150

Ileostomy

-Surgically created opening (stoma) in ab wall that connects small intestine to external ab -PostOp low residue low fiber diet so avoid >High fiber (popcorn, coconut, brown rice, multigrain bagel >Stringy veges (Celery, broccoli, asparagus) >Seeds or pits (Strawberries, raspberries, olives) >Edible peels (Apple slices, cucumbers, dried fruit) -But if pitted and peeled then can eat -After ileostomy heals then introduce fiber foods one at time and chew thoroughly

Priapism

-Sustained painful erectile dysfunction often (lasting 2 hrs or more) associated with sickle cell anemia, sickling of RBCs can lean to penile vascular occlusion, erectile tissue hypoxia, and necrosis -If its blue then means ischemia to penis and emergency -Trazadone can cause it too

Signs of newborn respiratory distresss

-Sustained tachypnea, nasal flare, retractions, and grunting -Can be due to amniotic fluid in lungs (Common if c section), aspiration meconium, or infection.

Formula should never be what

-Sweetened

Coronary bypass graft for a donor venous graft for leg can cause what

-Swelling in leg used for donor venous graft due to interruption of blood flow. Elevate the leg and wear compression stockings to help decrease symptoms

Gingival Hyperplasia

-Swollen, bleeding gum -Is common in pts taking cyclosporine and phenytoin and should be instructed on proper dental hygiene

Systolic Murmur

-Swooshing heard during S1 and common in preg and resolves after birth

Psychomotor retardation

-Symptom of major depressive disorder -Slow speech, decreased movement, impaired cognitive function -May not energy to perform ADL or interact -Can range total immobility and speechless (Catatonia) or slowing of speech and behavior -Movement impair, body immobility, slumping,slow move, delay motor activity, slow gait, lack facial, down gaze, speech impair, reduce voice, slur, delayed verbal response, short response, reduced or no social interact. Can also agitated symptoms.

Ovarian Cancer

-Symptoms are subtle -May have bloat, pelvic pain or pressure, ab girth increase

Reyes Syndrome

-Syndrome which is an acute encephalopathy (inflammation of the brain). Usually follows a viral illness (Varicella or Influenza) & linked to intake of aspirin. Use acetaminophen (not aspirin) to reduce fever with child with a communicable disease (virus) to prevent this. -Can lead to hepatic dysfunction, and acute fatty liver failure, elevated ammonia -Cause confusion and vomiting -Do not take aspirin or bismuth subsalicylate as it contains a salicytate and can cause reye syndrome

Desmopression

-Synthetic form of ADH which decreases urine output -Increases renal reabsorption and concentrates urine, but also increases risk fro water intoxication from decreased urine output -Need to be monitored for water intoxication/hyponatremia (headache, mental status change, weakness) because can lead to seizures -Need to be on fluid restriction -Side effect of desmopression nasal spray is nasal irritation, congestion, pain

Loperamide

-Synthetic opioid used as antidiarrheal, slows peristalsis and increases fluid absorption -Should not be used more than 2 days of if fever is present as retention of bacteria or toxins inside colon can make the process worse and cause toxic megacolon

Juvenile Idiopathic Arthritis

-Systemic autoimmune disease that involves the joints, connective tissues, and viscera -Join swell, stiff, high fever, skin rash -High risk for becoming deconditioned due to decrease muscle strength and endurance and overall capacity to exercises -Tire quick when in remission -Aerobic and anaerobic exercises can help minimize and resistance train can increase muscle and endurance -Exercise also positive for low bone density -Low impact, wt bearing, and non wt bearing exercises that involve ROM and stretch are best

Rifampin

-TB drug can cause hepatoxicty -Changes bodily fluids to red, can make contact lenses discolored and should wear eyeglasses instead of contacts -Women should use nonhormal birth control cause this drug can decrease effects of oral contraceptives

Airborne Prec

-TB, Rubeola (measles), Varicella Zoster (Chicken Pox), Herpes Zoster (Shingles)

Severe anemia can cause

-Tachycardia, SOB, Pallor -Respiratory depression does not occur

Tetracycline or other cyclines

-Take empty stomach 1 hr before or 2 hr after meals -Avoid antacids and dairy products -Take full glass water and remain upright after -Photosensitivity so use sunblock -Decreases effectiveness of oral contraceptives so take additional contraceptive -Don't take nighttime cause may cause GERD

SABA and LABA

-Take saba (albuterol) first if have symptoms. It's only a rescure med and taken as PRN basis and is not always taken with ICS -Inhaled corticosteroids (beclomethasone, fluticasone) is for long term use (LABA) and are not rescue drugs

Physical Exam of toddler

-Take time to develop rapport can be done by talking to toddler about favorite objects and slowly initiating contact -Parent involvement in assisting. Use minimal contact initially and have parent remove the outer clothing -Least to most invasive

Pancreatic enzymes

-Take with or before every meal or snack -Must be sprinkled on applesauce, yogurt, or acidic soft room temp foods -Capsules should not be taken with milk as it can cause it to curdle

Introjection

-Taking on the qualities or attitudes of others without thought or examination -Person may take on political views of a famous or admired actor

Ateriovenous Malformation

-Tangle of veins and arteries which becomes weak and dilated, usually found in brain and can cause seizures, headache, neurological deficits -Blood pressure control is crucial cause high risk intracranial bleed and veins can easily rupture. sudden severe headache, N/V can mean hemorrhage

Supraglottic swallow

-Technique for dysphagia that includes having the patient take a deep breath, hold the breath, swallow, cough on exhalation, swallow again before breathing, and then breathe again

Intussusception

-Telescoping of the intestines -Pressure can increase within bowel causing ischemia and leakage of blood and mucus -Have episodes of sudden, crampy ab pain, palpable sausage shape ab mass, red currant jelly stools, inconsolable cry with knees drawn up to chest and bilious nonprojectile vomiting (Vomiting resolves once intussusception is reduced), may appear normal and calm between painful episodes -Normally treated with contrast/Pneumatic enema (Air enema) or hydrostatic (Saline enema). -If there is passage of brown stool, it means reduction of intussusception and need to notify HCP to modify plan of care and stop all plans for surgery

Veracity

-Telling the truth or not lying

Restraint

-Temporary restraints are not physical restraints, used to help with procedure -The client situation rather than the device determines whether it is classified as a restraint

What are nose cultures for?

-Test for MRSA

First sign of puberty in boys

-Testicular enlargement, followed by pubic, axillary, facial, and body hair

Confusion Assessment Method (CAM)

-Tests for delirium -Signs are acute mental status changes that fluctuate and inattention with disorganized thinking or altered level of consciousness. Disorganized thinking includes hallucinations

Chlorthalidone

-Thiazide diuretic -Can cause hypokalemia (Muscle cramps), hyponatremia, hyperuricemia (Precipitate or worsen gout attacks), hyperglycemia, photosensitivity

Cystic Fibrosis

-Thick sticky secretions -At risk for recurrent lung infections -Risk for rupture of damaged alveoli which results in sudden onset pneumothorax (Sudden worsen dyspnea, tachypnea, tachycardia, and drop in O2 sat) A sudden drop in O2 sat may be only clue since the other findings can be seen with lung infection -Usually have blood tinged sputum as result damage blood vessels but resolves after treatment of infection -Salty skin -Physiotherapy should be done before meals to, to avoid a full stomach which can result in regurgitation and vomiting

Mucus Plugs

-Thickening buildup of mucus due to dehydration and one of most common causes of respiratory distress in trach

Progestin Only Pills (POPs)

-Thickens cervical mucus and thins endometrium -Changes only last 24 hrs so must take pill same time every day -If pill taken 3hrs or more too late a barrier method (Condom) is advised until pill is taken correctly for 2 days -Additional pill should be taken if diarrhea or vomit occurs within 3 hrs of last dose -Have low risk for HTN and DVT unlike estrogens

Cushings traid

-This refers to, Bradycardia, Widening pulse pressure along with increasing systolic pressure and Respiratory irregularities (Cheyene stokes). Assesses for increased ICP -Related to increased ICP

Dabigatran

-Thombin inhibitors to reduce clot formation, for chronic afib, PE, DVT -Capsules should be kept in their original container to prevent moisture contamination -Should not stop it unless HCP says so -Can take with food or full glass water to prevent GI effects -Should no be crushed or opened

Tympanostomy Tubes

-Tiny ventilating tubes placed through the eardrum to provide ongoing drainage for fluids and to relieve pressure that can build up after childhood ear infections -If tube falls out not emergency

Pap Smear Testing

-To detect Cervical Cancer -HPV causes most cases of cervical cancer -Initiated at age 21 and older regardless of sex -Age 21-29 need to be screened every 3 yrs -Adolescents don't need it regardless of sex history -If hysterectomy do not need pap smear test if prior test were normal -Discontinue pap test is over age 65 and if they have had nomral resutls

Beneficence

-To do good -Implement interventions to promote pts well being

Nonmaleficence

-To do no harm and relates to protecting pts from danger when they are unable to do so themselves or protect them from others like impaired nurse

Varicella Immunization

-To prevent infection of varicella zoster (Chicken pox) -Side effects of immunization are discomfort, redness, and few vesicles at injection site. Covering vesicles with clothing or small bandage will reduce risk of transmission from any exudate. Once vesicles dried or crusted, dressing no longer necessary -Unless vesicles are widespread, isolation is not necessary

Oligohydramnios

-Too little amniotic fluid -Small uterine size for gestational age or fetal outline that is easily palpated through maternal ab should indicate it. Ultrasound confirms it -Complications of this are pulmonary hypoplasia due to lack of normal alveolar distension by aspirated amniotic fluid so additional personnel should be present for possible CPR. Umbilical cord compression so continuous fetal monitoring to monitor for variable decelerations -Does not cause postpartum hemorrhage or use of foreceps or vacuum

Blood draw

-Tourniquet should be applied 3-5in above site puncture for no longer than 1 min -Invert tube gently 5-10 times to mix solution with blood

Pregnant should not be exposed to TORCH

-Toxoplasmosis, Other (Parovirus B19), Rubella, Cytomegalovirus, Herpes Simplex Virus -Can cause fetal abnormalities

Sponataneous Tension Pneumothorax

-Tracheal deviation, absent lung sounds, severe and abrupt hypotension and dyspnea -Should insert 20 gauge needle at mid axillary line for pleural aspiration

Reaction formation

-Transforming an unacceptable feeling or impulse into its opposite -pts with cancer fears dying but behaves in an overly optimistic and fearless manner about his treatment and prognosis

Sublmicaintaion

-Transforming unacceptable thoughts or needs into acceptable actions -Person may turn to boxing to deal with aggression

Zika virus

-Transmit via mosquitoes, sex, and infected bodily fluids -Can cause microencephaly (Small head and brain), developmental dysfunction, and ecephalitis (Inflammation of brain) in babies born to zika infected women -Can affect women in all stages of preg

Amnioinfusion

-Transvaginal infusion to compensate for low amniotic fluid in uterus. During labor amnioinfusion is done to relieve persistent, recurrent variable decelerations caused by cord compression -Uterine overdistention is potential complication due to infusion too much fluid, if baseline uterine resting tone is elevated (Normal is 20 or less) and minimal to absent fluid return is noted, should pause the infusion and notify to HCP immediately

Sumatriptan

-Treat migraine headaches which are thought to to be caused by dilated blood vessels -Constricts cranial blood vessels -Contraindicated in coronary artery disease and uncontrolled HTN

Sodium Polystyrene Sulfonate

-Treat mild to moderate hyperkalemia -Potassium exchanged for sodium in intestines and excreted in stool thereby lowering serum potassium -Risk for intestinal necrosis for those who do not have a normal bowel function (Post surgery, fecal impact, constipation). -Severe hypokalemia can develop (palpation's, lethargy, cramp) during therapy -Need to monitor electrolytes cause the exchange can cause excess sodium and cause pts at risk for fluid overload cause water follow sodium. Monitor pt for fluid overload (crackles, jugular vein distend, edema) and have daily wts and I/O assessments -Will have frequent loose stools in beginning of therapy

Levetiracetam

-Treat seizures

Acute urinary retention

-Treated with rapid complete decompression which can be associated with hematuria and hypotension

Justice

-Treating people fairly and equally without bias

Second degree AV block typ 1

-Treatment given only if symptomatic, if not then just monitor -If symptomatic then help them back to bed

Donzepezil

-Treats Alzheimers -Does not place elderly at increased adverse effects

Saw Palmetto

-Treats BPH

Radioactive Iodine

-Treats hyperthyroidism by destroying thyroid gland -After treatment pt emits radiation and excreted bodily fluids are radioactive -Pts should follow these precautions for up to 1 wk: limit close contact and time spent with preg and children, use separate toilet and flush 2-3 times, use disposable utensils and don't share food, isolate personal laundry and wash separately, sleep separate bedroom, do not sit near others for prolong time (Airplane, train) -Breastfeed should stop 6wks prior treat and not resumed with current child but can be resumed with future pregnancies -Make sure not preg prior procedure

Amoxicillin/Clavulanate

-Treats respiratory infections -Take with or without food -Common side are N/V/D and can be admin with food to decrease GI effects -Shake liquid well prior admin and admin at evenly spaced intervals

Posterior fontanel

-Triangle shape and smaller than anterior fontanel which is diamond shaped

Imipramine

-Tricyclic antidepressant -If overdose then extremely dangerous and fatal -Be aware if lost prescription, they might be saying that to get new prescription to stockpile it for suicide attempt

Amitriptyline

-Tricyclic antidepressant and can also treat neuropathic pain -It's anticholinergic properties may cause dry mouth, constipation, blurred vision, dysrthmias, orthostatic hypotension, drowsy

addisonian crisis

-Triggered by stress -N/V confusion, abdominal pain, tachy, extreme weakness, hypoglycemia, dehydration, hyperkalemia, hyponatremia, decreased BP, fever, can lead to shock -Will need increase in corticosteroid dose

Signs of hypocalcemia

-Trousseau (Carpal Spams like saltbae hand) and Chvostek sign (Facial Twitch) -Sustained muscle contraction (Tetany)

Potential Of Chemo

-Tumor Lysis Syndrome (Rapid release of intracellulcar components into bloodstream which results in massive release of intracullular ions (Potassium and phosphorus) and nucleic acids into bloodstream. Catabolism of nucleic acids produces uric acid resulting in hyperurocemia. Released phosphorus binds calcium, [producing calcium phosphate mixture but lowering serum calcium. Both calcium phosphate and uric acid are deposited into the kidneys causing renal injury -Allopurinol blocks nucleic acid catabolism and prevents hyperuricemia but would not affect potassium, phosphate, and calcium levels

Floppy muscle tone in newborn

-Typcial os pts with down syndrome

Varicella supportive care

-Typically crusts over within 1 week -Cool oatmeal baths and topical antihistamines applied to lesions, acetaminophen for fever or pain, antivrial agent (Acyclovir) for immunocompromised ppl and be continued until all lesions have crusted over

Percutaneous Endoscopic Gastrostomy (PEG)

-Under conscious sedation using endoscopy a gastrostomy tube inserted through esophagus into stomach and then pulled through an incision made in ab wall, to keep it secure the PEG tube has outer bumper and inner balloon bumper -Tube tract begins to mature in 1-2wks and not fully established until 4-6wks -If there is early dislodgement like less than 7 days from placements then will require surgical or endoscopic replacement

Ages 10-12 beliefs about death

-Understands death is final and eventually affects everyone -Thinks about how death will affect them personally

Ages 6-9 beliefs about death

-Understands the concrete finality of death -Difficulty in perceiving their own death; may be preoccupied with the medical or physical aspects of dying

Retinoblastoma

-Unilateral or bilateral retinal tumor -Has white glow of pupil -Light reflecting off tumor will cause pupil to appear white instead of usual red reflex -Strabismus is second most common sign -Treatment may include radiation, enucleation (removal of eye) and fitting for prosthesis -Siblings should undergo ocular screening cause some forms are hereditary

Phenazopyridine Hydrochloride (Pyridium)

-Urinary analgesic for pain -Urine will turn bright red orange and so will other bodily fluids. So wear eyeglasses instead of contacts

Organisms/mL in urine

-Urine is sterile but urethra contains bacteria and few WBCs -Less than 10,000 organisms/mL is normal for urine culture. If more than 10,000 then can indicate UTI

IV insert in older adult

-Use 24-26 gague cause they got fragile veins -Use 5 to 15 degree angle

Wound Irrigation

-Use 30 to 60mL syringe so don't have to refill frequently -Attach a 18 or 19 gauge needle to syringe and hold 1in above area -Use continuous pressure to flush wound until drainage is clear

NUrsing interventions to help prevent violence

-Use clear thorough communication, encourage active participation in care, promote low stimulating environment, provide comfort thrtough pharmacological and non pharmacological measures

Sexual activity after childbirth

-Use contraception -Ovulation can occur as early as 4wks after birth and before resumption of menses -Sex may resume once lacerations, bleed has stopped -Vaginal dryness can occur and vaginal lubrication with water soluble items can be used -Sexual arousal may stimulate leak of breast milk so feed newborn before sex

If itch under cast

-Use hair dryer on cold setting

Head injury but don't know if spine damaged but pt not breathing or have occluded airway

-Use jaw thrust technique to open airways instead of the head tilt chin left maneuver which can hyper-extend neck and cause damage to spine

HIV

-Use latex or synthetic condoms and/or dental dams during sex

Speech in kids

-Use well formed syllables such as mama and dada at around 7 months -Referral for hearing test made if absence well formed syllabus by 11 months -Intelligible speech not present until 24 months

AED

-Used asap and not to be delayed -Placed anterolateral position. One pad below the right collarbone and other pad few inches below left armpit -Additional steps are >Move pt out of large bodies of water >Dry the chest area (Entire body does not need to be dry, only the chest) >remove transdermal med patches and wiping chest of med residue before applying AED pads

Barium Enema

-Used fluoroscopy to visualize colon outlined by contrast to detect polyps, ulcers, tumors, and diverticula -Contraindicated in pts with acute diverticula -Preprocedure >Take cathartic (magnesium sulfate, polyethylene glycol) to empty stool from colon >Follow clear liquid diet the day before and avoid red/purple liquids >Do not eat or drink 8 hrs prior -Post Procedure >Chalky white stool >Take laxative to assist in barium expulsion cause retain barium can lead to fecal impaction

Glyburide

-Used for DM and lowers blood glucose -Is a sulfonylurea

Sodium polystyrene sulfonate

-Used for hyperkalemia, exchanges sodium for potassium then excreting potassium in stool

Isosorbide and Hydralazine

-Used in African Americans pts with heart failure, this combo decreases cardiac workload by reducing preload and afterload -Does not decrease excess fluid

Niacin (B3)

-Used in large doses for lipid lowering, can cause vessel vasodilation which results warm sensation first 2 hrs

Forceps and vacuum during labor

-Used only if prolonged second stage labor or fetal distress

C-Reactive Protein (CRP)

-Used to detect acute or chronic inflammation in body -Can be used to evaluate effectiveness of meds that decrease inflammation -An elevation would be expected in RA especially during flare

Glasgow Coma Scale

-Used to determine LOC -To ensure accurate score in verbal response category, nurse must differentiate if pt confused (answers 1955 to what year it is) or if pt uses inappropriate words. Like ask what day is it and they say banana -To ensure accurate eye opening score the nurse must determine whether pts eyes open spontaneously (no prompting) or if a stimulus (sound, pain) is needed. Cant speak and they open eyes -A social, verbal pt is not necessarily oriented (Pt says hi how are you as you walk into room). Nurse must assess orientation by specifically asking pts to state name, time, location -Coma is 3-8 -Mild is 13-15, moderate is 9-12, severe is 8 or less

Bucks Traction

-Used to immobilize hip/femur fractures and reduce pain and spasm until pt can undergo surgical repair of fracture -A wt (wts should be free hanging at all time. can support the wt as pt being re-positioned up in bed to prevent excessive pull on extremity) gently and continuously pulls on leg and hip helping maintain alignment of limb and should remain in straight and neutral position -Side to side reposition can cause injury and can cause neurovascular compromise -Supine position or semi fowlers (maximum of 20-30 degrees) with foot of bed raised -Can loosen velcro straps if boot too tight or tighten strap if too loose

IV Nitroglycerin

-Used to increase cardiac blood flow and provide pain relief for pts with ACS -If SBP drops to <90 or falls >30 below pts baseline, infusion rate should be stopped or decreased

Magnesium sulfate

-Used to prevent seizures in pts with preeclampsia -Hyporeflexia may indicate magnesium toxicity -Calcium gluconate is reversal agent for magnesium toxicity

Balloon tamponade tube (Sengstaken-Blakemore)

-Used to temporarily control bleeding from esophageal varices -Has 2 balloons and 3 lumens -Gastric lumen drains stomach contents and esophageal balloon compresses bleeding varices above the esophageal sphincter and gastric balloon compresses from below -Wt attached to external end of tube to provide tension and hold gastric baloon securely in place below the esophageal sphincter -If airway obstruction occurs due to displacement then cut the tube for rapid deflation -Scissors kept bedside

Trazadone

-Used to treat major depressive disorders -can also cause orthostatic hypotension and sedation therefore effective to treat insomnia associated with depression -Dont take it with other meds or substances that also cause sedation like benzos, alcohol -Priapism is serious side effect

Botulinum toxin type A (Botox)

-Used to treat wrinkles -Can also relax muscles for swallowing and breathing which can result in dysphagia and respiratory paralysis -Can also lead to constipation and urinary retention due to relaxation of smooth muscles

Operative Vaginal Delivery (Vacuum/Forceps)

-Used when prolonged 2nd stage labor, fetal heart rate abnormal, maternal contraindications to pushing, exhaustion, cardiac or cerebrovascular disease -Fetal complications of laceration, facial nerve palsy, intracranial hemorrhage, shoulder dystocia -Maternal complications of GU tract injury, urinary retention, hemorrhage -Forceps the HCP applies the blades to the sides of fetal head and locks handle in place, pulls when there's contractions to help facilitate -Nurse should never apply fundal pressure during operative vag birth cause can rupture uterine

Ethambutol

-Used with other TB drugs to treat active TB -Must have baseline and periodic eye exams cause optic neuritis (Inflammation of optic nerve) report signs of color (red green) discrimination -Hepatoxicity not common with this med

Pharmacologic Nuclear Stress Test

-Uses vasodilators to stimulate exercise when pts are unable to tolerate continuous activity -Produces vasodilation of coronary arteries in pts with suspected coronary heart disease

Visual acuity testing in Infants

-Using bright colored object or human face and have the infant focus and follow the target -3-4 months age

Rationalization

-Using excuses to explain away threatening circumstances -I did poorly on the test because questions were so tricky

Fine crackles in lungs

-Usually indicates Atelectasis (When some alveoli collapse and dont work)

DKA Acid base

-Ususally metabolic acidosis or partially compensated metabolic acidosis

Uterine Rupture

-Vaginal birth after cesarean Have increased risk for uterine rupture due to previous scarring of fetus -First sign of uterine rupture is abnormal FHR patterns, constant ab pain, loss fetal station, sudden cessation of uterine contractions, hemorrhage, mypovolemic shock, maternal tachycardia

Pessary

-Vaginal device that provide support to bladder, for pelvic organ prolapse -Can remain sexually active -Pts can insert and remove it themselves -Increased vaginal discharge is common side effect, but if there's odor then call HCP

Oxygen

-Vaseline should not be used cause flammable -O2 canisters need to be 5-10ft away from gas stoves or any other fire source

Nitroglycerin

-Vasodilator for stable angina -Stored away from light and heat sources including body heat. Keep tabs in original container. Once opened they lose potency and should be replaced every 6 months -Is chest pain at rest then no longer stable angina and need to contact HCP -Dont use with erectile dysfunction drugs (-afil) or alpha blockers (-osin) -If pain unrelieved 5mins after first dose then call 911, should have tingling sensation under tongue otherwise means med outdated, lie down before taking pill

Causes of low pressure alarm

-Ventilator tube disconnected, endotrach or trachestomy tube leak, loss of airway (Total or partial extubation, decannulation

Right to Left Shunting

-Ventricle septal defect and overriding aorta causes unoxygenated blood into the left ventricle -Are cyanotic shortly after birth and during periods of exertion

Intermittent (Bolus) enteral feeding prior

-Verify tube placement and gastric pH measurement -Gastric residual volume checked every 4 hrs without continuous feed or before each intermittent feed -Also flush tube with 30mL water before and after feeds to prevent clogging

Marfan Syndrome

-Very tall and thin with extremely long arms, legs, fingers -Abnormalities seen in cardiovascular like root of aortic valve is weakened or dilated so risk for (Aneurysms, tears like aortic dissection/rupture, and leaky heart valves) therefor contact sports are discouraged due to increased risk of cardiac injury and sudden death. musculoskeletal, and ocular systems -If preg can increase blood volume and cardiac workload which increase risk aortic dissection/rupture -Preg can have high risk maternal mortality so need to be one consistent birth control to prevent preg -Can have crowding of teeth and prophylactic antibiotics should be given prior dental work to decrease risk infect endocarditis -Increase risk scoliosis -Have eye problems like lens discoloration, retinal detachment, cataracts, glaucoma

Fremitus

-Vibration of the chest wall produced by vocalization. -Expected finding in pneumonia, concerning if decreased cause might mean pleural effusion

Adolescence beliefs about death

-Views death on an adult lvl -Understands their own death is inevitable, but it is a difficult concept for them to perceive -Able to think about the spiritual and religious aspects of death

Broncoscopy

-Visual examination of the bronchi with flexible fiberoptic bronchoscope that is passed down through nose or through mouth -Mild sedation and topical anesthetic applied to nares and throat to supress gag/cough reflex -Blood tinged sputum is common but hemoptysis of bright red blood can indicate hemorrhage

Esophagogastroduodenoscopy (EGD)

-Visual examination of the esophagus, stomach, and duodenum by placing endoscope down esophagus -Complications are perforation which can lead to peritonitis and sepsis. So look out for sudden temp spikes and increasing pain/tenderness, restless, tachycardia, tachypnea -Applies topical anesthetic to throat to pass endoscope, may take few hrs for gag reflex to return

Arthoscopy

-Visual examination of the interior of a joint

Renal Arteriogram

-Visualize renal blood vessels -Contrast medium injected into femoral artery therefore need to increase fluids after procedure to flush out dye

When is toilet training done?

-Voluntary control of anal and urethral sphincter occurs age 18-24 months -Bladder training usually achieved age 2 and a half years to 3 and a half years -Readiness also includes able to ambulate and sit on toilet, remain dry for several hrs or through nap, pull clothes up and down, understand a two step command, express need to use toilet, express interest toilet train -Having sit on toilet until urination does not facilitate bladder control cause any urination is accidental and not due to sphincter control

Giving warfarin and Heparin for DVT

-Warfarin begins to take effect in 48-72hrs and then takes several more days to achieve maximum effect. Therefor overlap of heparin and warfarin is required. Typical overlap is 5 days or until INR reaches therapeutic lvl then heparin can be discontinued

Environmental interventions to control dust mite allergy

-Wash bed linens every 1-2wks with hot water (>140 degrees) -Allergy proof pillow covers -Vacuum the mattress on regular basis -If have carpet vacuum daily, not best way is to get rid of carpets

Dysarthia

-Weakness of muscle used for speech, pronunciation and articulation are affected. Can mumble or lisp

S3 Heart Sound

-When blood from atrium is pumped to noncompliant ventricle -Normal finding in young adult and children. But a new S3 sound in older adults can indicate volume overload or HF

Hemorrhagic Stroke

-When blood vessel ruptures in brain causing bleed in brain -Can cause increased ICP and seizure -Interventions is reduce stimuli and quiet dimly lit environment and limit visitors >Admin stool softeners, reduce exertion and maintain strict bed-rest, maintain head in midline position to improve jugular venous return to heart

Ventricular Trigeminy

-When every third beat is a PVC

Rhabdomyolysis

-When muscle fibers released in blood -Acute renal fail can occur. Priority is to prevent kidney damage using rapid IV infusion resuscitation to flush the damaging myoglobin from body -Signs are dark, oftentimes bloody urine, oliguria, fatigue -With muscle injury intracellular potassium is also released in circulation so ECG and cardiac monitor needed

Diabetic ketoacidosis

-When serum glucose <250 then D5W is admin to prevent hypoglycemia until ketoacidosis is resolved. -Hypokalemia often occurs with resolution that's why potassium should be admin even if have normal potassium lvls -IV insuling can be stopped at <200

Tactile Hallucinations

-When someone experiences some perception related to touch when it is not really there

Vaginal Hematoma

-When trauma to the tissues of perineum occurs during delivery, more likely to occur following a forceps or vacuum assisted birth or episiotomy (Cut vagina opening) -Will report severe vaginal pain and feeling of fullness, vaginal bleeding is unchanged. Uterus is firm and at midline on palpation

Stress Incontinence

-When urine leaks during exercise and certain movements that cause pressure on the bladder -Highest priority is to void every 2 hrs when awake and every 4 hrs at night -Also can do pelvic floor exercises. No alcohol, caffeine, smoke. -Use of pessaries

Leukorrhea

-White discharge from the vagina during first trimester, normal. Due to increase in estrogen and progesterone -Report if accompanied with odor, red, itch

Putting child to bed

-With a bottle of milk (high in carbs) or other beverage containing sugar leads to dental caries a condition known as baby bottle tooth decay -Sucking on bottle for extended periods of time can also push jawline out of shape -Bottle containing ilk or sugar beverages should not be used as bedtime pacifiers

Neonatal abstinence syndrome

-Withdrawal from transplacental opiates due to maternal drug use -Occurs 24-48hr after birth -Manifestation: Irritable, jittery, D/V, feed intolerance, sweat, sneeze, pupil dilation, high pitch cry -Vomit is common so hold upright shortly after feed -Treat: Opioid therapy (Morphine, methadone) -Newborn risk for skin excoriation (skin picking) from excessive movement caused by hyperactivity and restless. So should swaddle with arms and legs flexed to prevent skin damage and minimize stimulation -If signs overstimulation (sneeze, arch) continue then gentle, rhythmic rocking may soothe newborn -Pacifier will help soothe the newborn and establish an organized suck patterns

First dental visit

-Within 6 months of first tooth eruption or by first birthday

Nurses role in informed consent

-Witness that pt signed consent voluntarily and was competent at time of signing -Ensure pt has received necessary info and has no remaining questions bout procedure -After obtaining the signature the nurse should document n pts medical record informed consent was given and the date/tie of signature

Subarachnoid Intercerebral Bleed

-Worst headache of my life -Onset is abrupt due to rupture of vessels -High mortality

Colles Fracture

-Wrist fracture (Distal radius fracture) that causes dinner fork deformity an usually occurs when pts try to break fall with an outstretched arm or hand and lands on heel of hand -Interventions include >Neurovascular assessment is priority >Elevate above heart >Tell pts to move fingers to reduce edema, increase venous return, and help improve ROM

Supine Hypotensive Syndrome

-Wt of ab compresses vena cava caused decreased venous return to heart -Can result in maternal hypotension and reflex tachycardia (Dizzy, pallor, cold/clammy skin) -Need to be repositioned left or right side or wedge under pts hip while in supine

Meconium stained fluid

-Yellow green gold color -May indicate fetal distress or hypoxia during labor which may require CPR

Gonorrhea reported or not?

-Yes public health will be notified and partners will be contacted to receive treatment

During seizure activity can you admin oxygen?

-Yes, if they start becoming cyanotic

When preg where to avoid traveling to

-Zika or malaria prevalent or remote areas with poor medical care and lack of sanitation -Domestic air travel is usually allowed for healthy pts at <36wks gestation

Anorexia Nervosa

-hypotension, bradycardia, decreased body temp, cold intolerance) -Can have lanugo (Fine terminal hair) can be seen in extreme cases -Remain with them 1 hr after meals to prevent purging -Establish weekly wt gain goal of 2-3lbs/wk -Do not let them continue exercise -Has decreased metabolic rate (Severe wt loss results in hypotension, bradycardia, decreased body temp, cold intolerance) -Can have lanugo (Fine terminal hair) can be seen in extreme cases

Therapeutic INR

-is 2 to 3

Urolithiasis

-kidney stones -Wavelike pain and nausea is common

Troponin

-lvls increase 4-6hrs after onset of MI and peak at 10-24hrs and return to baseline 10-14 days -Myoglobin also get released into circulation within 2 hrs of MI -Normal lvls of Troponin I is less than 0.5 and troponin T is less than 0.1

Scleroderma

-tight and hardening of skin, thick skin -No cure -Renal crisis is life threatening complication that causes malignant HTN due to narrowing of vessels that provide blood to kidneys -Raynauds phenomenon can develop secondary which requires urgent treat but not life threatening -Pulmonary fibrosis can occur (scar lung tissue which can cause reduced function, dry cough, dyspnea) not life threatening -Heartburn and dysphagia are common but not life threatening

Factor Xa Inhibitors

-xaban -Anticoagulants -Not affected by Vit K -Increases risk for spontaneous intracranial bleed or formation epidural hematomas -Contact HCP if have neurological impairment (extremity weak, altered sensation, numb)

Veal Chop

V- Variable C- Cord Comphression (turn, o2) E- Early Decels H- Head Compression (normal) A- Accelerations O - OK L-Late Decels P - Placenta insufficency (Turn, o2, d/c pitocin, notify MD)

What can septic shock cause?

Hyperkalemia due to metabolic acidosis

Live Vaccines

MMR, Varicella, Influenza nasal spray