Hurst q cards
Cane walking
** Think COAL** C= Cane O= Opposite A= Affected L= Leg *use on strong side of body
Cushing's triad
*pressure on brain stem three classic signs - bradycardia (slow, full, bounding pulse) - hypertension (widening pulse pressure) - bradypnea (irregular)
SIADH Fluid volume Blood Urine
*too many letters, too much water Fluid volume increases Blood - diluted Urine - concentrated
BiPAP vs CPAP
- BiPAP -Delivers two levels of pressure High pressure breathing in, Low pressure when breathing out Mask can be nasal or nose and mouth May be more comfortable for obstructive sleep apnea - CPAP -Delivers one constant level of predetermined pressure - no monitoring
Pre-eclampsia
- When a pregnant woman develops high blood pressure, edema, and protein in the urine after the 20th week of pregnancy. - Monitor BP and urine - monitor weight: more than 2lbs worry about this - can l/t seizures 160/110
Non-stress test (NST)
- a test that monitors fetal heart rate. - A reactive test would be in which the heart rate accelerates by at least 15 beats per minute for at least 15 seconds, with at least two acceleration episodes, in a 20 minute period.
Chest tube management
- assess dressing (tight & intact!) - listen to lung sounds - monitor vitals (pulseOx >90%) - record drainage every 1hr in 1st 24hrs then q8hrs after that - notify HCP if >100mL after 1st hr, change in color (ex. yellow to bright red) - deep breath, cough - incentive spirometer - monitor for infection - daily chest x-ray - keep below level of chest - keep tubing straight & w/o kinks
Halo vest traction education
- clean pins twice a day with q-tips - only sponge baths (as showers can guarantee the vest will stay dry) - sleep in any position for comfort - Do not use soaps, creams, lotions, or powders beneath the vest as these may irritate the skin. - never pull on any part of the vest
what to do in chest tubes if CDU falls over and water leaks out or shifts to the drainage compartment?
- do whatever you can to re-establish water seal - sit upright, check all chambers, fill water seal to 2cm of water - have client deep breathe and cough
Skin traction
- ex. Bucks traction - assess skin at least 3 times a day
lumbar puncture
- fetal position or propped over bedside table with head down - postop: lie flat or prone for 4-8hrs, increase fluids most common complication: HA, tx w/ bed rest, fluid, pain meds, blood patch
Chemotherapy precautions
- gown, 2 pairs of gloves, goggles/mask - wear PPE when handling body fluids/wastes. - Dispose of supplies used for patient care in biohazard container * think yellow for disposal! - yellow rigid chemotherapy waste container and bags
nonbreastfeeding mothers: breast care
- ice packs - breast binders or ace wraps - chilled cabbage leaves (dec inflammation and engorgement) - don't stimulate breast
neutropenic precautions
- immunocompromised - strict hand washing - private room - no raw veggies/fruits - daily baths (wash warm moist areas twice a day - groin and underarms) - visitors are restricted - no flowers or potted plants - don't share toiletries avoid crowds - no invasive procedures (IM, rectal temp/exam) - limit use of Tylenol
ICP increase treatment
- maintain oxygenation - maintain perfusion (IV fluids) - keep temp <100.4 barbiturate induced coma may be needed to decrease cerebral metabolism - mannitol, steroids, hypertonis solution - HOB elevated - keep head midline so jugular veins can drain - monitor ICP when turning as it should increase but if it hasn't come down in 15mins, the side isn't being tolerated well - avoid restraints, bowel/bladder distention, hip flexion (bending over), Valsalva, isometrics, sneezing and nose blowing - limit suctioning and coughing
breastfeeding mothers: breast care
- taking a shower before feeding can initiate the letdown response - wash hands before breastfeeding - cleanse with warm water after feeding (never use soap as it is drying!) - let air dry - wear a supportive bra - can express colostrum in area and let dry - 500 calorie increase a day - increase fluid intake
15 - 15 - 15 rule
-15 grams of carb -wait 15 minutes & check BS -repeat 15g of carb if still symptomatic if up eat a complex carb + protein
Neurovascular assessment
-Color -Temperature -Capillary refill -Pulses -Movement -Sensation
total laryngectomy post op
-Place patient in mid fowlers -NG feedings to protect suture line so NPO -Monitor drains -Watch for carotid artery rupture -Rupture of innominate artery (emergency! massive bleeding from trach) -Frequent mouth care to decrease bacteria -At risk for pneumonia since NPO -Patient will need a bib to cover trach when leaves hospital (filter) -A humidified environment -Keep powder away from trach
bleeding precautions
-draw blood when starting IV -Decrease the number of puncture sites -watch for bleeding gums, hematuria, and black stools -use an electric razor, a soft toothbrush, and no IMs -no ABGs (only puncture veins)
setting sun sign
-eyes deviate downward with white rim of sclera showing above iris -may indicate hydrocephalus
contraction test
-small dose of oytocin given -fetal heart rate is continuously monitored to if baby can handle contractions - decelerations are bad! want a negative test at 28weeks
hepatic coma patho
-when you eat protein, it transforms into ammonia, and the liver converts it to urea. Urea can be excreted through the kidneys without difficulty but when the liver becomes impaired then it can't make this conversion, so ammonia builds up in the body -Ammonia decreases the LOC (sedative) -Liver is sick so you can't use dietary protein to make albumin because ammonia will build up.
2nd trimester weight gain
1 pound per week but varies based on BMI
normal stomach pH
1-4 Gastric contents are cloudy, green, tan, or off white, bloody or brown if receiving meds that alter acidity, pH can be as high as 6 and test doesn't confirm placement as the respiratory secretions will be around 6
first trimester weight gain
1-4lbs in the entire trimester
3rd trimester HR
110-160
2nd trimester time?
14-26 weeks
2nd trimester fetal HR
140-160 <110 panic
platelets
150,000-400,000
OB Dr visit frequency
1st 28 weeks - once a month 28-36 weeks - every 2 weeks after 36 weeks - once a week until delivery
lightening is?
2 weeks b4 term when presenting part of fetus drops into pelvis urinary frequency returns client can breathe more easily d/t decrease pressure on diaphragm
school age child requires how many calories a day?
2400 calories/day
absolute neutrophil count
2500-8000
The 3rd trimester goes from week _____ to week______.
27-40
worry when H&H reaches
8 & 24
BUN (blood urea nitrogen)
8-20 mg/dL
cystic fibrosis
A autosomal recessive genetic disorder that is present at birth and affects both the respiratory and digestive systems s/s: steatorrhea (fat, frothy stools), meconium ileum, thick/sticky mucous secretions sweat chloride test have trouble absorbing fat soluble vitamins tx: pancreatic enzymes (w/ every meal/snack w/in 30mins), high fat/calorie diet, fat soluble vitamins (ADEK)
Subcutaneous emphysema
A characteristic crackling sensation felt on palpation of the skin, caused by the presence of air in soft tissues. neck, face, chest *rice krispies
total hip replacement education for discharge
AVOID FLEXION no low chairs no long distance traveling (frequent stops) no sitting for longer than 20 mins no lifting heavy objects no excessive bending/twisting (loading dishwasher or dryer) use hand rails when stair climbing
Preload
Amount of blood returning to right side of the heart
cor pulmonale
Another term for right sided HF which is caused by prolonged increase pressure to the right side (pulm htn)
Dabigatran (Pradaxa)
Anticoagulant
warfarin (Coumadin)
Anticoagulant antidote - vitamin K avoid vitamin K in diet - green, leafy vegetables INR
Enoxaparin (Lovenox)
Anticoagulant low molecular weight heparin
Fondaparinux (Arixtra)
Anticoagulant, Factor Xa Inhibitor
Rivaroxaban (Xarelto)
Anticoagulant, Factor Xa Inhibitor
Ondansetron (Zofran)
Antiemetic. Side effects: headache, EPSs. Nursing interventions: administer tablets 30 min prior to chemotherapy and 1-2 hr before radiation.
APGAR
Appearance (all pink, pink and blue, blue (pale) Pulse (>100, <100, absent) Grimace (cough, grimace, no response) Activity (flexed, flaccid, limp) Respirations (strong cry, weak cry, absent) *each one 0-2 scale want 8-10 sore done at 1 and 5 minutes
if liver is sick, what is the #1 concern?
BLEEDING
celiac disease diet
BROW: Barley Rye Oats Wheat *cannot eat! gluten is a protein found in this decrease in fiber can eat fruits, vegetables, nuts, dairy products no prepared with gluten are acceptable RCS: Rice Corn Soy
Somogyi effect vs. Dawn phenomenon
Both cause hyperglycemia in the morning in Diabetics *Dawn phenomenon*: Release of Growth hormone, coritsol, catecholamines in the early morning --> hyperglycemia ; in normal patients, insulin would be released to control this hyperglycemia, but in diabetics, its not able to control the sugars *Somogyi effect*: Nocturnal hypoglycemia --> causes release of Growth hormone, coritsol, catecholamines --> a rebound hyperglycemia check blood sugar between 2-3am If the client has decreased blood sugar between two and three o'clock in the morning, suspect Somogyi effect.
what other disease do clients with hypothyroidism usually have?
CAD so worry about MI when starting thyroid drugs
CAUTION acronym for cancer
Change in bowel/bladder habits An unhealed sore Unusual bleeding/discharge Thickening or lump in breast or elsewhere Indigestion or difficulty swallowing Obvious change in wart/mole Nagging cough or hoarseness
Cleft palate/ lip
Cleft palate repair at 1yr clean incision w/ water Cleft lip repair - 3 months pre-op: fed w/ elongated nipple or medicine dropper down side of mouth to prevent aspiration; burp frequently post-op: position supine or side-lying *never prone
What should you worry about with fractures & time frame?
Compartment syndrome which is the increased pressure in a confined/small space within 12-36hrs after injury
FVD complications
DI, diabetes, shock, ascites, burns, addisons
Too much sodium, not enough water
Dehydration (hypernatremia)
Gowers sign (Duchenne muscular dystrophy)
Difficulty rising to standing position; has to walk up legs using hands
diabetes insipidus Fluid volume Blood Urine
Diuresis Fluid volume decreases Blood - concentrated Urine - diluted *Think shock
GTPAL is?
G - gravida T - term (after 38 weeks) P - preterm (b4 38 weeks) A - abortion L - living
Rapid acting insulin
GAL Glulisine (Apidra) Aspart (Novolog) Lispr (Humalog) *GAL come on we don't have time to wait *only insulin given via SQ pump
Chest Tube Bubbles
Good! water seal chamber - intermittent suction control chamber - continuous
AKI reasons: HF, itching frost, HTN, anemia
HF - kidneys aren't working and fluid remains in Vs Itching frost - urea excess is surfacing on the skin HTN - retain fluid, inc workload on heart Anemia - kidneys are functioning properly to make Erythropoietin
Managing Chemotherapy Spills
Handle as a hazardous chemical spill Obtain a spill kit and use all protective equipment for clean up (gown, gloves, goggles/mask)
hypothyroidism s/s, dx, tx
Hashimotos disease no energy s/s - fatigue, weight gain, no expression, slow speech, GI slow, cold, amenorrhea dx - decreased T4, increased TSH tx - levothyroxine, liothyronine take on empty stomach
Hypervolemia - cause of HF: Heart, CO, Kidney perfusion, urine output
Heart is weak, CO decreases, decrease in Kidney perfusion, urine output decreases
D10W (10% dextrose in water)
Hypertonic Soloution
Too much water, not enough sodium
Hyponatremia
betamethasone in pregnancy is?
IM steroid to mature the baby's lungs
what do you need to make thyroid hormones?
IODINE - the dietary kind
Hyperkalemia tx
IV glucose/insilulin Kayexalate Loop diruetics Low K diet Calcium gluconate at bedside
AKI signs and symptoms (labs)
Inc BUN/creatinine, specific gravity Inc K, Ph Dec Ca, rbc Metabolic acidosis
AKI nutrition
Inc carbs/fats, low protein Avoid K high foods Eat phosphate high foods
calcium gluconate
Infuse slow 1.5-2 ml/min b/c rapid causes vasodilation dec BP/HR, arrhythmias, cardiac arrest antidote for hypermagnesemia tx of hypocalcemia counteracts effects of hyperkalemia (cardiac excitability) monitor for low phosphorus
Burns medications
Isotonic (NS/LR), Hypertonic (Albumin, TPN)
explain pancreatitis patho & s/s
It is an inflammation of the pancreas from an auto-digestion of the pancreas d/t a blockage of the of the pancreatic duct (gallstones, scar tissue) causing the release of enzymes inside the pancreas when food is eaten which is why pain occurs with eating s/s - pain, ascites, jaundice, rigid/boardlike abdomen, cullen/grey-turner signs, N/V, jaundice, hypotension
what is always #1 with neurological assessment?
LOC
If air gets in the central line what position do you put the client in?
Left side trendleburgs
What does calcitonin do?
Lowers blood calcium levels takes it back to the bones
hemoglobin
Male: 14-18 Female: 12-16
hematocrit
Male: 42-52% Female: 37-47%
Biophysical Profile (BPP)
Method for evaluating fetal status during the antepartum period based on five variables originating with the fetus: - HR, muscle tone, movement, breathing, amount of amniotic fluid around baby - 8-10 good score - 6 worrisome (reassess in 24hrs) - 4 immediate delivery during 3 trimester
pancreatitis tx
NPO, NG suction, bed rest, narcotics, anticholinergics, GI protectants
What happens to sodium and potassium in addisons?
Na decreases K increases bc of decrease in aldosterone production
Hyponatremia S/S
Nausea Muscle cramps Confusion coma Seizures Headache
Fluid volume excess Neck veins Peripheral edema CVP Lung sounds Urinary output Pulse BP Weight
Neck veins - distended Peripheral edema - present CVP - increased Lung sounds - wet/crackles Urinary output - increased Pulse - increased BP - increased Weight - increased
fluid volume deficit Neck veins Peripheral edema CVP Lung sounds Urinary output Pulse BP Weight
Neck veins - flat Peripheral edema - none CVP - decreased Lung sounds - dry Urinary output - decreased Pulse - increased BP - decreased Weight - decreased
First sign seen when there's a sodium problem?
Neuro changes
Glascow Coma Scale (GCS)
Neurologic assessment of a patient's best verbal response (1-5), eye opening (1-4), and motor function (1-6) 13-15 good! less than 8, think intubate
Diabetes Type 1
No insulin is produced first sign DKA 3Ps: polyuria, polyphagia, polydipsia appears abruptly
peripad rule
No more then 1 saturated peri pad an hr
diabetes type 2
Not enough insulin or the insulin is no good overweight gradual onset tx - diet and exercise then oral agents
what is particle induced diuresis (PID)
PID is the initiation of diuresis from increase in a specific particle (glucose) as the kidneys need more fluids to filter out large particles like glucose
Amputation post op care
PREVENT CONTRACTURES extension (laying PRONE can extend hip/knee joints) inspect limb daily lay limb flat on bed
5P's
Pain Pulse Pallor Paresthesia Paralysis
Cullen's sign and grey turner's sign are classic findings in?
Pancreatitis Cullen's sign - bruising around umbilical area grey turner's sign - bruising in flank area
Probable signs of pregnancy
Positive pregnancy test Chadwick's sign Goodell's sign Hegar's sign uterine enlargement pigment changes in skin
Protein breaks down into ....
Protein breaks down to ammonia. The liver converts ammonia to urea. The kidneys excrete the urea.
Traction: purpose (reduce)
Reduce muscle spasms/pain Reduce, align, and immobilize fractures Reduce deformity
Babinski reflex Plantar reflex
Reflex in which a newborn fans out the toes when the sole of the foot is touched disappears at 1yr positive: fan out negative: curl in (plantar reflex)
Short acting insulin
Regular (Humulin R, Novolin R); 30 to 60 before meals, given on sliding scale can given on continuous IV infusion w/ IV fluids
FVE complications
SIADH, HF, Cushing renal failure, hyperaldosteronism
Kernig sign
Severe *hamstrings stiffness - an inability to straighten the leg when the hip is flexed to 90 degrees. (meaning when laying supine, the leg is lifted and the knee cannot fully extend as the hamstrings stiffen and tighten)
Brudzinski's sign
Severe *neck stiffness causes a patient's hips and knees to flex when the neck is flexed.
fracture complications
Shock Fat embolism Compartment syndrome
infant weight
Should double weight by 6 months triple it by 1 year old.
pin worms
Small, visible, white parasitic worms that commonly infect the intestines of young children s/s: rectal itching, poor sleep, bed wetting spread from hand to mouth from playing in sandbox/dirt/dust w/o washing hands dx: tape test (in am b4 BM) tx: medendazole (Vermox), short fingernails washing sheets, cleaning bathroom, handwashing
clinical breast exam frequency
Starting at age 20 every 3 years Starting at age 40, yearly mammogram yearly w/ 2 views at 40yrs
stem cell transplant
Stem cells (immature blood cells) are harvested from the bloodstream of a patient and then reinfused after the patient has received chemotherapy.
epoetin
Stimulate RBC production
total laryngectomy
Surgical removal of the entire larynx (vocal cord, epiglottis, thyroid cartilage) permanent trach
Liothyronine (Cytomel)
Synthetic thyroid hormone T3
thyroid gland hormones
T3, T4, calcitonin
pap smear
Test for early detection of cervical cancer; scraping of cells removed from cervix for examination under microscope. every 3 yrs at age 21 w/o problems
Stroke volume
The amount of blood pumped out of the heart with each heartbeat
Afterload
The amount of pressure in the aorta and peripheral arteries that the LV is pumping against to get the blood out
Methimazole (Tapazole)
Thyroid hormone antagonist. Inhibits synthesis of thyroid hormone. Used for hyperthyroidism, preoperative thyroidectomy, thyrotoxic crisis, and thyroid storm.
Propylthiouracil (PTU)
Thyroid hormone antagonist. Inhibits synthesis of thyroid hormone. Used for hyperthyroidism, preoperative thyroidectomy, thyrotoxic crisis, and thyroid storm.
Location Ulcerative Colitis Crohn's Disease
Ulcerative Colitis - large intestine Crohn's Disease - mainly the ileum but can be found anywhere in the small/large intestine
VEAL CHOP
V- Variable C - Cord Compression E- Early Decels H- Head Compression A- Accelerations O - OK L-Late Decels P - Placenta insufficiency
why discontinue metformin before any surgical or contrast dye procedure?
We are worried about clients with a compromised kidney function using Metformin. IV contrast that contain iodine poses a risk of acute kidney injury which could lead to lactic acidosis.
when should pregnant client go to hospital?
When contractions are 5 minutes apart or when the membranes rupture
Pulseless ventricular tachycardia
When the lower chambers of the heart (ventricles) begin contracting at a very fast pace Defib 120-200 joules CPR for 2 mins epi 1mg IV push
Duchenne muscular dystrophy
X-linked recessive genetic disorder (specific to male children) severe muscular dystrophy in voluntary muscles s/s: lordosis, waddling gait, frequent falls, toe walking, gower's sign
Pheochromocytoma
a benign tumor of the adrenal medulla that causes the gland to produce excess epinephrine and norepinephrine screen family bc can be familial s/s - increase BP/HR, HA, flush, sweating, palpitations dx - VMA or MN test tx - surgery *avoid palpating abdomen as it may cause a sudden release of catacholamines and severe hypotension
what to worry about with IV insulin?
a decrease in K and BS as they are driven out of the VS into the cell *hourly BS check, monitor I/O, ECG, ABGs * start with NS until BS reaches 250-300 then switch to D5W (sugary water) to prevent hypoglycemia * anticipate HCP to add K in IV at some point
gestational diabetes
a form of diabetes mellitus that occurs during some pregnancies 2-3 times more insulin needed screened at 24-28 weeks complications, LGA and hypoglycemia in baby
hydrocephalus
abnormal accumulation of fluid (CSF) in the brain s/s: bulging fontanels, dilated scalp veins, sunken eyes, changes in mood, high pitched cry, setting sun sign
venous insufficiency
aching pain to none pulses normal color - normal, brown pig, petechiae temp - normal edema - present skin - brown pigmentation, thick skin, scarring gangrene does not develop use compressions
Burns immunizations
active - tetanus toxoid (last 10yrs) takes 2-4weeks to develop immunity passive - immune globulin, immediate protection
RSV (respiratory syncytial virus)
acute viral injection of the bronchioles leading cause of lower respiratory illness in children less than 2 yrs s/s: nasal drainage, fever, wheezing, nonproductive cough, tachypnea, flaring nares, dyspnea, retractions tx: IV fluids, albuterol, antipyretics, suction, O2
ACTH is?
adrenocorticotropic hormone produced in the pituitary gland stimulates cortisol production *think steroid!
newborn complications: physiological jaundice
after 24hrs d/t the release of bilirubin from excess hemolysis of RBCs and an immature liver
Presumptive signs of pregnancy
amenorrhea nausea/vomiting breast tenderness urinary frequency, quickening *are the subjective signs the client will describe
Sucralfate (Carafate)
antacid that forms barrier over GI ulcer so acid can't irritate
cirrohosis tx
antacids, vitamins. diuretics rest, I/O, daily weight bleeding precautions avoid narcotics
Infant Fontanels
anterior closes by 12-18mos posterior closes by 2-3mos
Heparin
anticoagulant antidote: protamine sulfate
serotonin antagonist
antiemetic agents
what foods can alter VMA and MN test? & how is it performed?
anything with vanilla - caffeine, vit B, fruit juices, bananas * 24hr specimen collected avoid any activities that increase stress or release epi or norepinephrine no smoking or caffeine
heparin overdose aptt
aptt >100secs normal : 30-40secs 1.5-2.5 x normal
epidural anesthesia in pregnancy assess?
assess bladder and UOP
When is Rhogam given?
at 28th weeks and by 72hrs after birth negative mom, positive baby protects the next baby not the current one
Client should eat when insulin is
at its peak and BS is at its lowest
what foods to avoid in children <4yr old?
avoid hot dogs, carrots, apples, grapes, peanuts, peanut butter, marshmallows, nuts, seeds, popcorn, hard candy, chewing gum * if so, cut up into irregular sizes, sit up in chair, and do not leave alone while eating
all long term insulin cannot?
be mixed with any other insulin
how to prevent dislodgment of internal implant?
bedrest, decrease fiber, prevent bladder distension (all help prevent dislodgment of implant)
basilar skull fracture bleeding where?
bleeding in EENT - ears, eyes, nose, throat
what is hemothorax/pneumothorax
blood or air accumulate in the pleural space and then collapses the lung s/s: SOB, Inc HR, diminished breath sounds/movement, chest pain, cough
halo test in TBI
blood will settle in a circle and CSF will form a halo around the area (like a halo)
most common body systems affected with side effects of chemotherapy?
blood, integumentary, and GI system *cells are dividing the most rapidly
Chadwick's sign is?
bluish color of the cervic d/t vasocongestion; 4th week
battle's sign
bruising over the mastoid (behind the ear) in TBI
Nagele's Rule
calculates the due date: subtract 3 months add 7 days adjust year
amiodarone effects on thyroid
can cause thyroid disfunction because the drug contains high amounts of iodine
early sign of increased ICP
change in LOC (change in attention span to coma) slurred speech slow to respond to commands drowsiness restlessness confusion
Glucocorticoids 4 main actions
change in mood alter defense mechanisms breakdown fats and proteins inhibit insulin
Decorticate posturing
characterized by upper extremities flexed at the elbows and held closely to the body and lower extremities that are externally rotated and extended. *towards the core!
vesicant
chemotherapy drug that can cause tissue necrosis and damage - s/s: pain, swelling, no blood return - stay with client the entire time
thoracentesis after procedure
chest x-ray, vitals, pain listen to lung sounds check puncture site/dressing
Meningitis signs and symptoms
chills/high fever severe HA diorientation to coma N/V nuchal rigidity photophobia seizures positive kerning and brudzinski signs
complications of burns explain why... circulation, renal, electrolyte imbalance GI, amputations common?
circulation - circulatory system can become compromised from the increased pressure; tx - escharotomy and fasciotomy renal - muscle damage occurs causing myoglobin to be released as a by product which can clog the kidneys causing renal disease; tx - mannitol (flushes the kidneys but caution as it can crystalize in the tubing; increase fluids) electrolyte imbalance - as the cell rupture, K leaves & enters the blood (hyperkalemia) GI system - could develop paralytic ileus from decrease BF; increased abdominal girth amputations common in electric burns b/x circulatory system is damaged/destroyed
how to avoid getting air in central line during tube changing?
clamp it off, valsalva, take deep breathe & hummm)
mononucleosis which virus causes it? s/s & tx
condition caused by the Epstein-Barr virus kissing disease s/s: sore throat, fatigue, swollen lymph nodes, liver/spleen enlargement spread from direct intimate contact tx: rest, analgesics, increase fluids
traction should hang how?
continuously, hang/move freely, not touching anything, knots secured
preterm labor?
contraction occur with dilation (20-37 weeks) hydrate client & place on bedrest want to stop labor
types of TBI: focal
contusion (bruise; mild to severe), hematoma (small occur fast and are fatal; massive occurs over time allowing the client to adapt), concussion
Meningitis treatment
corticosteroids - decrease inflammation antibiotics - for bacteria analgesics - pain anticonvulsants - if seizures present droplet precautions for bacterial contact precautions for viral *bacterial has a high mortality rate
Engagement (pregnancy)
decent of the fetal skull to the level of the ischial spines
Timolol Maleate
decrease aqueous humor formation
if liver is sick, do what with meds?
decrease dose of medications don't give tylenol - antidote: acetylcysteine (muscomyst)
not enough sex hormones cause
decrease in axillary/pubic hair and decrease libido
Skin Traction & Skeletal Traction purpose
decrease muscle spasms/pain immobility until surgery but skin traction is short term & skeletal traction is for long term
cirrhosis diet
decrease protein (more protein, more ammonia l/t decreased LOC) low sodium diet
peptic ulcer teaching
decrease stress, no smoking, no caffeine/spicy foods eat what you can tolerate
Potassium Iodine
decrease vascularity of the thyroid gland prior to surgery give in milk/juice w/ straw bc it can stain teeth
long term effects of steroids
decreases serum calcium l/t removal of calcium from bones (osteoporosis)
Hypoparathyroidism
deficient production of parathyroid hormone not sedated tx - IV calcium or phosphorus binding drugs
Liver 4 main functions
detoxifies body helps clot blood metabolizes drugs makes albumin
D51/2NS (dextrose 5% in 0.45 normal saline)
dextrose 5% in 0.45 normal saline hypertonic solution
D5NS
dextrose 5% in normal saline hypertonic solution
who do you not give beta blockers to?
diabetics - can make the hypoglyemic s/s such as HR increase, and jittery asthma clients - can cause attack
total hip replacement complications
dislocation - circulatory/nerve damage infection - remove any tube ASAP, prophylactic antibiotics avascular necrosis - death of tissue d/t poor circulation immobility problems
GERD (gastroesophageal reflux disease)
disorder characterized by the abnormal backward flow of the gastrointestinal contents into the esophagus tx: upright position w/ feeding and 30mins after frequent burping small more frequent feedings thickening feedings
postpartum assessment of DVT bc?
diuresis is occurs and dehydration is a possibility
precautions after radiation
don't sleep in same bed as spouse/child no public transportation can't return to work immediately don't share utensils or cook for others flush toilet 2-3 times while closed *remember client is immunosuppressed!
testicular self exams
done monthly as they grow rapidly 15-36 yr olds teach early
fetal heartbeat can be heard with the doppler and fetoscope when?
doppler: 10-12 weeks fetoscope: 17-20 weeks
viewing ear in <3yrs old...
down and back
why drawing up regular and NPH together...?
draw clear first (regular) then cloudy (NPH)
Caster care: Fiberglass pros & cons
dries w/ 30mins waterproof, lightweight, stronger can bear weight faster but difficult to mold & contour used for mainly simple fractures
before an ultrasound the client should?
drink water to push the uterus up in the abdomen from a distended bladder; easier to get a good picture
indirect vs direct Coombs
dx test for antibodies indirect done on mom's blood direct done on baby (cord)
low residue diet
eliminates or limits foods that are high in bulk and fiber
pancreatitis stomach?
empty & dry!
types of hematomas
epidural - fast bleeder under high pressure (middle meningeal artery) - tx: burr holes - injury, pass out, recovery, bleeding in head, neuro changes subdural - collection of blood b/w dura and brain (usually a venous bleed) - tx: immediate craniotomy - imitates other conditions such as stroke - bleeding and compensating
adrenal medulla hormones
epinephrine and norepinephrine
NS, LR, D5W, D5 1/4NS
examples of isotonic solutions
hyperparathyroidism
excessive production of parathormone sedated tx - partial parathyroidectomy monitor for hypocalcemia (tight/rigid muscles) postop
cord care of newborn
falls off in 10-14days cleanse with each diaper change with alcohol or NS fold diaper below cord don't immerse baby in water until it falls off watch for infection
#1 symptom clients complain of with a dx of cancer?
fatigue! (bc anemia or tumor growth fast)
what should you assess once membranes rupture in pregnancy?
fetal heart tones!
positive signs of pregnancy
fetal heartbeat fetal movement ultrasound
type of mattress for total hip replacement
firm! gives joints support
cirrhosis s/s
firm/modular liver, abdominal pain (the liver capsule is lined with nerves and it is stretched b/c its enlarged), chronic dyspepsia, change in BM, ascites, splenomegaly, increased enzymes, decreased albumin, anemia, can l/t encephalopathy/coma (b/c of inc in ammonia)
if baby born with cleft lip and palate, which do you correct first?
fix lip first around 3mos the palate is made of cartilage so surgeon wants it to develop more bone as it doesn't do well surgically correct palate before speech develops
Burn tx rule of nines types of Iv fluids monitor?
fluid replacement 2-4ml/kg x weight (kg) x TBSA burned = 24 hr fluid replacement 1/2 in 8hrs, 1/2 in next 8hrs, & 1/4 in last 8hrs start 2 large bore IV Crystalloids (LR) & colloids (albumin) monitor UOP: 30-50ml/hr but 75-100ml/hr for electric injuries
quickening? what trimester?
fluttering feeling in the abdomen when the baby is moving
pancreatitis causes
gallbladder disease and alcohol
Hirschsprung disease
genetic disease where pieces of intestines without any nerves usually the sigmoid colon s/s: constipation, ribbon-like stools, foul smell (the bowel flows well until it reaches the affected area causing a buildup, stopping peristalsis l/t obstruction) tx: surgery
what is celiac disease?
genetic disorder causing malabsorption of gluten abdominal pain and diarrhea can occur if ingesting gluten
glucagon
give IM in emergency situations of unconscious hypoglycemic patients
prednisolone (presnisone)
given twice a day in split doses for Addisons 2/3 in AM 1/3 in PM bc of body's natural cycle doses are changes with weight
Long acting insulin
glargine (Lantus) detemir (Levemir) *GD its taking a long time to work (lol)
Hypotonic solution purpose types
goes out of the vascular space into the cells/tissues D2.5W, 1/2NS, 0.33% NS watch for cellular edema
hyperthyroidism s/s, dx, tx
graves disease (running to the grave!) too much energy s/s: nervous, short attention span, increased appetite, weight loss, sweaty/hot, exopthalmos, GI upset, increase HR/BP, arrhythmias, palpitations, goiter dx: T4 increased, TSH decreased tx - antithyroid meds (methimazole, propylthiouracil), KI, beta blockers (dec anxiety), radioactive iodine therapy (1 dose, PO)
diabetes diet
high fiber (slows glucose absorption into SI and eliminates sharp rise/fall of BS) complex carbs sugar destroys vessels just like fats
Exercise when blood sugar is at its highest or lowest
highest & at the same time and amount daily
too many sex hormones cause
hirsutism, acne, irregular menstrual cycle
what to assess for after a thyroidectomy?
hoarseness (laryngeal nerve damage) can l/t vocal cord paralysis hemorrhage (increase pressure in neck) *check for bleeding at incision or behind neck for pooling
diabetic client passed out give?
honey, buccal sugar IM glucagon
Too much parathyroid hormone causes?
hypercalcemia and hypophosphatemia
HHNK
hyperglycemic hyperosmolar non ketotic coma - essentially DKA without the ketoacidosis - blood gluclose levels rise without the right amount of insulin *making enough insulin so there is no breakdown of fat tx - IV fluids for dehydration
3% normal saline
hypertonic solution
5% normal saline
hypertonic solution
D5LR (5% Dextrose in Lactated Ringers)
hypertonic solution
too little parathyroid hormone causes
hypocalcemia and hyperphosphatemia
epidural anesthesia in pregnancy complication?
hypotension monitor BP closely tx - bolus of 1000 mL of NS or LR
0.33% NS
hypotonic solution 0.33% saline in water (1/3 normal saline)
D2.5W
hypotonic solution 2.5% dextrose in water
1/2NS
hypotonic solution half-strength normal saline
pulmonary embolism (PE) signs and symptoms
hypoxemia, dec PaO2, SOB, cough, inc RR/HR, restlessness, petechiae over chest, cyanosis, hemoptysis, chest pain (sharp/stabbing), pulmonary HTN
Fracture tx & why..
immobilize bone ends & adjacent joints support above and below fracture site move extremity as little as possible *all help prevent further injury and decrease muscle spasms
what system is involved when spleen is enlarged?
immune system
mycophenolate
immunosuppressant used in transplants to keep body from attacking the organ take on empty stomach avoid sun exposure - sunburn infection - priority
Apraxia
inability to perform particular purposeful actions, as a result of brain damage.
2nd trimester nutrition
increase calories by 300 per day if adolescent, 500 per day
first trimester nutrition
increase protein to 60g/day lots of tissue growth in pregnancy
mastitis
inflammation of the breast; most commonly occurs in women who are breastfeeding around 2-4weeks s/s: rapid onset of fever/chills, breast are swollen/hard/tender, malaise tx: bedrest, support bra, binding, chilling leaves, penicillin, pain meds, heat, feed baby frequently with affected breast first
epiglottitis
inflammation of the epiglottis s/s: drooling, dysphagia, no cough, dyspnea, respiratory distress *never try to attempt to visualize the throat
laryngotracheobronchitis
inflammation of the larynx, trachea, and bronchi (the acute form is called croup) viral infection s/s: Barking or brassy cough, fever, dyspnea *sounds like a barking seal tx: usually from home - steam from hot showers - cool temp therapy like opening freezers or walking out into cold air (constricts BV in trachea decrease swelling) - nebulizer epic or corticosteroids
otitis media
inflammation of the middle ear tx: antibiotics, eat soft foods, avoid any smoke, may need tubes which can be temporary and will fall out (must wear earplugs in bathtub/ swimming)
bone marrow transplant
infusion of healthy bone marrow cells to a recipient with matching cells from a the client, donor, or sibling/twin
Traumatic Brain Injury (TBI)
injury to the brain closed or open *basilar skull fractures are the most serious s/s: battle's sign, raccoon eyes (periorbital bruising), cerebrospinal rhinorrhea, positive glucose and halo test
arterial insufficiency pulse, pain, color, temp, edema, hair, nails
intermittent claudication pulses decreased/absent color - pale on elevate, red on lowering temp - cool edema - mild/none skin - shiny, thin, no hair thick nails gangrene can develop
first trimester vitamins
iron - worry about constipation and GI upset take with vitamin C folic acid - worry about neural tube defects 0.4 mg/day
false labor is?
irregular contractions abdominal discomfort pain decreases with change in activity
what does sugar do to the vessels?
irritates the lining, decrease the size of the lumen l/t decrease BF retinopathy, nephropathy, neuropathy
Torsades de pointes
is a life threatening dysrhythmia which can occur with administration of ondansetron. Clients who are at increased risk for Torsades de pointes are those with underlying heart conditions and those with hypomagnesemia or hypokalemia.
D5 1/4 NS
isotonic solutions Dextrose 5% in 0.2% Normal Saline
esophageal varices patho
it is just like hemorrhoids but in esophagus portal hypertension forces collateral circulation in 3 places (stomach, esophagus, rectum) so when you see GI bleeding (bloody vomit) in alcoholic pt it is usually this but no problem until rupture
hypogylemic s/s
jittery, shaking, cool, clammy, confused, HA, nausea, nervous, tachycardia, hungry
what to do if tubing is disconnected in chest tube?
keep another connector at bedside reconnect as fast as you can
enema positioning?
left side to facilitate flow into colon
epidural anesthesia in pregnancy position for procedure?
lie on left side legs flexed prop up over beside table given in 3-4 dilation during stage 1
Autonomic Dysreflexia
life threatening emergency that can occur with upper spinal cord injury (above T6) also called hyper-reflexia cause: distended bladder, constipation/impaction, stimuli to skin from pain, pressure, to temp s/s: severe HTN/HA, bradycardia, nasal stuffiness, flushing, sweating, blurred vision, nausea, anxiety tx: elevate HOB (dec BP), antihypertensives, tx cause (foley, fix impaction, remove stimuli)
Amputation rehab
limb shaping important for prosthesis want shaped like a cone limb sock under prosthesis OK to massage stump - promotes circulation and decreases tenderness build/keep upper body strength b/c walker/crutches will be needed to ambulate
peptic ulcer antacids
liquid to coat take on empty stomach & at bedtime
cirrhosis patho
liver cells are destroyed and replaced by CT/scar tissue leading to altered circulation increasing BP (portal HTN)
Vitamin C foods
liver, lentils, raisins, dark chocolate, dried fruits, fortified cereal, OJ
describe lochia and time frame
lochia rubra: 3-4 days DARK RED lochia serosa: 4-10days PINKISH BROWN lochia alba: 10-28days can last up to 6weeks WHITISH YELLOW *can have clots but no larger than a nickel
types of fractures that can l/t shock and fat embolism?
long bone (femur) fracture pelvic fractures crushing injuries
cachexia
loss of weight and extreme wasting
pre-eclampsia med
magnesium sulfate IV in hospital close monitoring vasodilator and sedates acts like an anticonvulsant
facial chloasma is?
mask of pregnancy
pyloric stenosis
narrowing of the pyloric sphincter *projectile vomiting (pressure build up behind the vomit), Olive-shaped mass in epigastric area tx: hydration, electrolyte, I/O, urine SG, daily weight, surgery
Burns nutrition
need more calories (calculated by dietitian) needs protein and Vitamin C monitor albumin)
why hydration in total hip replacement important?
needed because the client will be immobile which leads to diuresis from release of ANP
Hypernatremia S/S
neuro changes swollen tongue *think dehydration
total hip replacement position
neutral rotation w/ toes pointed to ceiling extension (limit flexion) abduction (abductor pillow) *all reduce risk of dislocation
creatinine
nitrogenous waste excreted in the urine 0.6-1.3
first trimester exercise
no high impact walking and swimming good keep HR <140 bc increase can decrease CO and uterine perfusion no hot tubs or heated blankets (bc overheating can l/t increase in body temp and cause birth defects)
early signs of hemorrhage in postpartum?
no more than 500 mL loss of blood in 1st 24hrs with 10% drop of hematocrit *must have both!
3rd trimester weight gain
no more than a pound a week
2nd trimester N/V or urinary frequency?
no should not occur as the uterus rises, releasing the pressure
Addisions disease
not enough steroids s/s - extreme fatigue, N/V/D, anorexia, weight loss, hypotension, confusion vitiligo decrease Na, glucose and increased K tx - add Na to diet, I/O, daily weights (monitor for FVD) meds - prednisolone & fludrocortisone
gravida is?
number of times the client has been pregnant
pulmonary embolism (PE)
occlusion in the pulmonary circulation, most often caused by a blood clot but can be air, fat, or amniotic fluid
GVHD (graft versus host disease)
occurs when the the graft (stem cell or bone marrow) is rejected/attacked the host s/s - abdominal pain, cramps, N/V/D, jaundice, liver issues, dark (tea colored) urine, skin rash, itching, redness on skin tx - anti rejection drugs and steroids
cardinal sign of compartment syndrome?
pain disproportionate to injury (meaning the pain in unrelieved by pain meds and other therapies)
Fractures s/s
pain/tenderness unnatural movement deformity swelling shortening of extremity discoloration crepitus
oncology growth fraction
percentage of cells dividing at a given time *high is good the more cells dividing, the more cells to attack
fat embolism s/s
petechiae/rash over chest conjunctival hemorrhages snow storm on CXR (patchy infiltrates)
Cast Care: Plaster
place ice packs on side in 1st 24hrs (decreases swelling b/c cast is still wet) prevent indentions (use palms of hands & don't use fingertips) keep uncovered (for air drying) don't rest on hard surface/sharp edge rest on soft pillow; no plastic mark breakthrough bleeding (circle/date/time)
explain why the 3Ps occur in diabetes?
polyphagia occurs because the cells are starving so the body tells the client it is still hunger from lack of glucose in cells polyuria occurs because the kidneys are filtering out excess fluid from VS polydipsia occurs from the hypertonic state in the VS
Decerebrate posturing
posturing in which the neck is extended with jaw clenched; arms are pronated, extended, and close to the sides; legs are extended straight out; more ominous sign of brain stem damage. Most Severe.
How to toughen stump in amputation?
press into soft pillow, firm pillow, bed, then chair
tension pneumothorax
pressure builds up in pleural space causing a collapsed lung l/t a mediastinal shift *tracheal deviation, JVD, subcutanous emphysema, cyanosis, asymmetry tx - large bore needle (for emergency) or chest inserted into 2nd intercostal space
purpose of trochanter rolls in total hip replacement?
prevent external rotation
tonsillectomy and adenoidectomy (T&A)
procedure to remove the tonsils and adenoids position: place on side, elevate HOB or prone don't give red/brown fluids (confused w/ bleeding) frequently swallowing indicates hemorrhaging which are increased risk up to 10 days complaints: sore throat, ear pain, low grade temp, bad breath no rough foods
which hormone induces amenorrhea?
progesterone
when membranes rupture think what?
prolapsed cord unless proven otherwise
albumin (colloid) actions alerts
protein that pulls fluid from the cells and holds onto it in the vascular space watch for FVE as the fluid can overload the heart causing the CO to decrease (monitor CVP) 3.5-5.0
skeletal traction
pull exerted directly on the skeletal system by attaching wires, pins, or tongs into or through a bone monitor pins every 8hrs for infection pin care (after 72hrs) daily
Hypertonic solution purpose types
pulls fluid from the cells into the vascular space D10W, 3%NS, 5% NS, D5LR, D51/2 NS, D5NS, TPN, Albumin think sugary watery *watch for FVE tx - hyponatremia, 3rd spacing
what to do if implant dislodges & you see it? oncology
put on gloves use forceps to pick up implant place in lead lined container leave in room call radiation department
brachytherapy - what is it? sealed vs unsealed
radiation therapy in which the source of radiation is implanted in the tissue to be treated - unsealed: client & body fluids emit radiation for 24-48hrs; IV or PO radiation - sealed: client emits radiation and body fluids don't; implant temp or permanently
Which insulin can be administered by infusion pump?
rapid acting
true labor is?
regular contractions increasing in frequency and duration discomfort on back and abdomen pin increases in change in activity
esophageal varices tx
replace blood, monitor vitals/CVP, O2 Octreotide (Sandostatin) lowers BP
assess for what when giving opioids?
respiratory depression & constipation *stool softener
aldosterone fx
retain sodium and water loss potassium
Mcburney's Point
right lower quadrant (for appendicitis)
position immediately after tube feeding & why?
right side & HOB elevated (to promote gastric emptying & prevent aspiration)
hepatic coma s/s & tx
s/s - mental changes, difficult to arouse, handwriting changes, asterixis (hand tremor), decrease reflexes, fetor (smells like ammonia) tx - lactulose (decreases ammonia), enema, diet (dec protein, Na), monitor serum ammonia
cholinergic crisis
salivation, lacrimation, urination, defacation complications - resp failure, hypotension
chest tube fluctuation in water seal chamber
seen when the client breathes increase in inspiration, decrease in expiration if stopped, lung has re-expanded *constant bubbling means air leak
epidural anesthesia in pregnancy post procedure?
semi-fowlers tilted on side prevents vena cava compression change position side to side hourly
pancreatitis labs
serum lipase, amylase, WBCs, BS, ALT, AST. PT, aPTT, bilirubin all increased H/H will be up (bleeding) or down (dehydration)
Addisionian crisis
severe hypotension vascular collapse *can occur with infections, emotional stress, physical exertion, or stopping steroids abruptly
neuropathy in diabetes can cause:
sexual issues (impotence, dec sensation) foot/leg issues (dec pain, inc numb) neurogenic bladder (incontinence, retention) gastroparesis (inc risk of aspiration) infection
top hip replacement s/s
shortening of affected leg severe pain in hip and radiating to groin inability to bear weight bruising swelling external rotation
Inhalation injury indicators
singed nose/facial hair, soot on face, cough up dark specked secretions, difficulty swallowing, wheezing, blisters on mucosa, hoarseness, substernal retrations, stridor
position if appendix ruptures
sit up and right side (so the fluid can be localized in the right lower quadrant; better for when surgery is done)
Paracentesis positioning
sitting up (b/c you want the fluid to collect in one area and it will use gravity to its best advantage)
duodenal ulcer
small intestine; relieved with eating pain 2-3hrs after eating well-nourished b/c food helps pain blood in stool
Goodell's sign is?
softening of the cerix; 2nd month
Hegar's sign is?
softening of the lower uterine segment; 2nd-3rd month)
radioactive iodine therapy precautions
stay away from babies for a week don't kiss anyone for a week used to destroy thyroid cells *can cause a thyroid storm to occur as a rebound effect as some of the thyroid can be left and it begins to compensate and over make hormones
thoracentesis during procedure
stay very still (no cough/deep breaths) check vitals
Isotonic solution purpose types
stays in the vascular space LR, NS, D51/4NS don't use in HTN, renal/cardiac disease
what to do if Chest tube is pulled out?
sterile occlusive dressing taped on 3 sides
gastric ulcer
stomach, irritated with eating (1hr after eating) vomiting helps pain malnourished blood in vomit
thoracentesis pre-procedure
stop anticoagulants, Chest X-Ray and Baseline vitals/pain Position: client should be sitting up, feet supported, leaning over the bedside table or lie on unaffected side
what to do if chemotherapy does extravasate?
stop the infusion apply cold packs (dec spread to more tissue)
late signs of increased ICP
stupor to coma cushing's triad decerebrate or decorticate posture
adrenal cortex hormones
sugar - glucocorticoids salt - mineralocorticoids (aldosterone) sex - androgens (testosterone, estrogen, progesterone)
position for liver biopsy
supine with right arm behind head exhale & hold breathe to get diaphragm out of way & after - lie on right side to hold pressure & place towel/blanket monitor for bleeding
Fludrocortisone
synthetic aldosterone monitor BP
intussusception
telescoping of a segment of the intestine s/s: currant jelly stools, drawing up of knees episodes of abdominal pain, inconsolability tx: surgery or enema (enema can push out the affected area with the increase in pressure)
How long is client at risk for seizures after birth with pre-eclampsia and eclampsia?
the 1st 48 hrs
newborn complications: hypoglycemia
the baby can develop hypoglycemia after birth as the glucose supply from the mother is cut off but the baby is still producing insulin *at risk- large/small for gestational age, diabetic moms
before an ultrasound with a procedure, the client should?
the client should void
linea nigra is?
the dark line down the center of the abdomen
Leopold maneuvers are?
the how the position of the fetus is determined client should void b4 should be done between contractions helps determine the back to assess fetal HR/tone
diabetes patho
the insulin is the key to transporting glucose into the cells for energy so when the insulin is decreased, there is a build up of glucose in the blood causing hypertonic environment which pulls fluid from the cells l/t the kidneys filtering excess fluid and glucose the cells began to starve to they breakdown protein and fats creating a byproduct of ketones l/t acidosis (DKA)
nadir
the lowest point of something
if no water is in water seal chamber, what can happen?
the lung can collapse again from increase pressure
explain Rh incompatibility
the negative mother gives birth to a positive baby causing the mother to develop antibodies so when the mother becomes pregnant again the antibodies will enter the bloodstream attacking the fetus causing hemolysis l/t erythroblastosis fettles *give rhogam
parity is?
the number of pregnancies where the fetus reaches 20 weeks?
Eclampsia is?
the seizure brought on by high BP
why are the very old and very young at risk for more complications when burned?
the skin is very thin less subcutaneous fat burn can deeper BSA in young is less
why does steroids decrease serum calcium?
the steroids cause osteoporosis and Ca is excreted in GI tract
nesting in pregnancy is?
the sudden burst of energy (2 days b4 birth usually)
thoracentesis
the surgical puncture of the chest wall with a needle to obtain fluid/air from pleural cavity
what is involution?
the term describing when the funds descends and the uterus returns to pre-pregnancy size
viability of the baby is?
the term to determine when the baby can survive outside the uterus which is 24 weeks
why does the blood sugar decrease in Addisons?
there is not steroids to inhibit insulin
carbon monoxide poisoning patho, s/s, & tx
think hypoxic b/c carbon monoxide travels 200 times faster than O2 so it will bind to hemoglobin first and now O2 can't bind s/s - tx - 100% O2
Levothyroxine (Synthroid)
thyroid hormone
general radiation precautions for internal radiation include
time, distance, shielding - nurses rotated daily to decrease continual exposure - private room - restrict visitors to 30mins/day stay at least 6ft from source of radiation - no visitors less than 16yrs old no pregnant visitors or nurses - care for only 1 client w/ implant a shift - wear film badge at all times (a device containing photographic film which registers the wearer's exposure to radiation) - wear gloves
why are isometric exercises used for total hip replacement?
to maintain muscle tone & increase venous return
Cushing's Syndrome
too much steroid (cortisol) s/s - moon face, truncal obesity, buffalo hump, inc BS, thin extremities, women with male traits, acne, HTN, weight gain tx - adrenalectomy, quiet environment, avoid infection, diet (inc K/protein/Ca dec Na)
what to keep at bedside after amputation?
tourniquet
what to keep at beside after thyroidectomy?
trach set bc of decreased calcium as an adverse effect of accidentally removing the parathyroid
central line insertion positioning?
trendleburg (decreases risk of air embolus)
know levels: triglyceride HDL LDL cholesterol blood glucose
triglyceride: <150 HDL >40 LDL <100 cholesterol: <100 blood glucose: 70-110
diabetes complication in type 1 & 2
type 1 - DKA type 2 - HHNK
how to walk with crutches on stairs? weight on? measurement?
up with the good, down with the bad weight rests on hands 1-2in below axilla to prevent brachial nerve damage
external radiation therapy
uses a machine to aim high-energy rays at the cancer client not radioactive SE: erythema, shedding skin, fatigue, pancytopenia (s/s location and dose related) don't wash off or use lotion on markings protect skin from sunlight & UV exposure for 1yr after completion of therapy good skin care
how is diabetes type 2 found?
usually by accident as the client keeps coming back to the HC P for wounds that won't heal or frequent vaginal infections *bacterial loves a sugary environment!
what IM site is contraindicated in children who have been walking less than 1 year?
ventralgluteal muscle bc the muscle is not well developed
What should you monitor for post EGD?
vitals, gag reflex, pain, bleeding, trouble swallowing
how to walk with a walker
walk into a walker
TPN: temp, line needed & what can infuse? time, considerations of BS, tubing
warm b4 admin & let sit for few minutes b4 hanging central line needed & a dedicated line (nothing else but TPN goes there) d/c gradually to avoid hypoglycemia insulin may be needed check urine for glucose and ketones only for 24hrs & change tubing with every bag may be covered with dark bag to prevent chemical breakdown pump needed monitor for infection
first trimester time
week 1-13
when to discontinue oxytocin?
when contractions are too long or too often or any signs of fetal distress
why are peanuts so dangerous when aspirated?
when wet, they swell and crumble
newborn complications: pathologic jaundice
within 1st 24hrs usually means Rh/ABO incompatibility
pancreatitis insulin?
yes b/c pancreas is sick and usually on TPN
