Kaplan Nclex
lifetime prevalence
The percentage of people in a certain population who will have a given disorder at any point in their lives.
point prevalence
The percentage of people in a given population who have a given disorder at any particular point in time.
concordance rate
The probability that a person with a particular familial relationship to a patient (e.g., an identical twin) has the same disorder as the patient.
assessment
The set of procedures for gathering information about an individual's psychological state, sometimes leading to a diagnosis.
psychopathology
The study of mental disorders, or a term for the mental disorder itself.
comorbidity
The tendency for different mental disorders to occur together in the same person.
Cannabis Derivative Abuse Implementation
There really is no implementation - most effects disappear in 5-8- hours
Antipsychotic Agents Med Names
Thorazine-low, Trilafon-medium, Haldol-high
Antiemetics: Med Names
Tigan, Compazine, Reglan, Antivert, Dramine
Amyotrophic Lateral Sclerosis (ALS):S/Sx
Tongue fatigue, atrophy with fasciculation (brief muscle twitching) Nasal quality to speech, dysarthria (difficulty saying words), Dysphagia, aspiration Progressive muscular wasting, atrophy, spasticity, weakness -usually begins in upper extremities, distal portion affected first, fasciculations. Emotional lability (b/c death is outcome), cognitive dysfunction Respiratory insufficiency (usual cause of death) No alteration in autonomic, sensory, or mental function.
Interventions for Pressure Ulcers
Turn frequently Ambulate Good skin care Balanced diet with protein, vitamins, minerals
Antipyretic Med Name
Tylenol
Which type of DM is ketosis prone?
Type 1
which type of DM requires insulin injection
Type 1
Antidiabetic Agents: Uses
Type 2 diabetes
Chrons dx vs ulcerative colitis: resmissions and relapses?
UC Chrons - prolonged
causes for pyelonephritis
UTI, pregnancy, tumor, obstruction
Furadantin (nitrofurantoin) Uses
UTIs
Pyridium Uses
UTIs
Chrons dx vs ulcerative colitis: 10-20 liquid stools qday
Ulceratie Colitis 5-6 unformed stools chrons
Chrons dx vs ulcerative colitis: common rectal bleed
Ulcerative Colitis occasional in chrons
Chrons dx vs ulcerative colitis: age 30-50
Ulcerative colitis Chrons: 20-30, and 50-80
Insulin: Slow Acting Names
Ultralente Humulin U
Signs & Symptoms of Compartment Syndrome
Unrelenting pain out of proportion to injury and unrelieved by pain meds Decreased pulse strength Numbness & tingling of extremity Possible cyanosis and pale cool extremity
Antidiarrheals: Nursing Considerations
Use before chemo When used with viral infections may cause Rye's syndrome
Antineoplastic: Vinca Alkaloids Med Names
Velban (vinblastine), Oncovin (vincristine)
Anti Impotence (Erectile Dysfunction) Med Names
Viagra, Levitra, Cialis
Antibiotics: Tetracyclines Med Names
Vibramycin, Panmycin
After surgical repair for ulcers, what medication is required for life?
Vitamin B12 & iron
Cerebral Palsy: Analysis/Tx
Voluntary muscles poorly controlled due to brain damage. Etiology: unclear Predisposition:prematurity, existing prenatal brain abnormalities, trauma, axnoia, or infection at time of birth. Tx: Ambulation devices, surgical lengthening of heel cord to promote stability and function. Assist with feeding, place food at back of mouth or on either side of tongue toward cheek, apply slight downward pressure with the spoon. NEVER TILT HEAD BACKWARD WHEN FEEDING, High calorie diet. Medications:muscle relaxants, tranquilizers, anticonvulsants, baclofen (lioresal) intrathecal pump.
What lab may be elevated with a pt with suspect appendictis?
WBC >15,000-20,000
Vitamin K
Warfarin
Antidepressants: Heterocyclics Med Names
Wellbutrin, Desyrel
Antidepressants: Heterocyclics Side Effects
Wellbutrin: agitation Desyrel: sedation
Fractures
What is it? A break in continuity of bone Types of fractures: --Complete: Break across entire cross-section of bone --Incomplete: Break through portion of bone --Closed: No external communication --Open: Extends through skin S/S: Swelling, pallor, ecchymosis, loss of sensation, deformity, pain & acute tenderness, muscle spasms, loss of function, abnormal mobility, crepitus, shortening of affected limb, decreased or absent distal pulses, extremity is colder Treatment: --Provide emergency care --Splinting & Surgery --Traction --Casting
Strains
What is it? A muscle and/or tendon pull or tear S/S: Pain & Swelling Treatment: --Rest and elevation of affected part --Intermittent ice compresses for 24 hrs, followed by heat application --Apply elastic pressure bandage --Minimize use
Sprains
What is it? A torn or stretched ligament S/S: Pain & Swelling Treatment: --Rest and elevation of affected part --Intermittent ice compresses for 24 hrs, followed by heat application --Apply elastic pressure bandage --Minimize use
Joint dislocations
What is it? Displacement of joint bones so their articulating surfaces lose all contact. S/S: Pain & Deformity Treatment: --Considered an orthopedic emergency --Immobilization and reduction (ex: the dislocated bone is brought back to its normal position, usually under anesthesia) --Bandages and splints are used to keep affected part immobile until healing occurs.
Contusions
What is it? Injury of soft tissue S/S: (Ecchymosis) bluish, purple bruise, (Hematoma) swelling filled w/ blood Treatment: --Cold application for 24 hrs followed by moist heat. --Apply elastic bandage
Post-amputation Delayed Prosthesis Fitting
What is it? It is when the residual limb is covered with a dressing with figure-eight wrapping & elastic bandage or residual limb sock Treatment: Residual limb care --If penrose drain is inserted; reapply bandages Q 4-6 hrs --Observe dressings for signs of excessive bleeding; keep large tourniquet on hand to apply around residual limb in event of hemorrhage --Dressings changed daily until sutures are removed --Wrap with elastic bandage to shape, reduce edema, and keep dressing in place --Figure-eight- it prevents restriction of blood flow Positioning- If ordered, elevate residual limb by elevating foot of bed Turning- On 1st post-op day,position pt to prone position for short time, then 30 min 3x's/daily. Pt can role side-to-side Exercises- Start 1st or 2nd post-op day; Active ROM, strengthening exercises for upper extremities, hyperextension of residual limb Ambulation- 1st or 2nd post-op day, dangle & transfer to wheelchair; crutch walk as soon as pt feels strong enough
Immediate Prosthesis Fitting
What is it? Residual limb is covered with a dressing and a rigid plastic dressing; No penrose drain; Rigid dressing helps prevent bleeding Treatment: Residual limb care --Observe dressing for signs of oozing --If blood stain appears, mark area & observe Q 10 min for increase --Report excessive oozing --Provide cast care, Guard against cast slipping off Positioning- Elevation of residual limb for 24 hrs Turning- Turn pt to prone position 30 min 3x's/day Exercise- Early ambulation prevents immobilization disabilities Ambulation- 1st day- dangle & assist pt to ambulate w/ walker; increase length of ambulation each day; In PT pts use parallel bars, then crutches, then cane
Antivirals Med Names
Zovirax, AZT, Videx, Famvir, Cytovene
Alcohol is
a CNS depressant
Meningocele
a congenital anomaly of the central nervous system in which a sac protruding from the brain or the spinal meninges contains cerebrospinal fluid (but no nerve tissue); covered with a think atrophic, bluish, ulcerated skin.
Myelomeningocele
a congenital defect of the central nervous system in which a sac containing part of the spinal cord and its meninges protrude through a gap in the vertebral column (spinal fluid and spinal cord elements- no lamina in spinal cord)
nevus flammeus
a port wine stain on face or neck that is permanent birthmark of newborn
Korsakoff's Psychosis
a secondary dimentia caused by the Thiamine deficiency associated with prolong and heavy alcohol injestion
A
a sore that does not heal
Etiology 2- defect in cellular differintiation
a. oncogenes take over the normal b. cells regain fetal appearance and function c. some hormones some proteins
what are s/s of peritonitis?
ab pain - severe ridigitdy, distension increased temp leukocytosis
siezure
abnormal discharge from brain cells, altered motor, sensory, autonomic or psychic activity
Laxatives/Stool Softeners Action
absorb water increasing bulk, lubricate surface of stool, stimulate peristalsis
Mucomyst/ acetylcysteine
acetaminophen
Narcotics Action
acts on CNS receptor cells
Antipsychotic Agents Uses
acute and chronic psychoses
Antibiotics: Macrolide Uses
acute infections, acne, URI, prophylaxis before dental procedures if allergic to PCN
Antineoplastic: Antimetabolites Uses
acute lymphatic leukemia, cancer of colon, breast, pancreas
Thrombolytics Uses
acute pulmonary emboli, thrombosis, MI
oliguric phase of decreased output of <400 ml/day, HTN, anemia, PE, CHF, confusion
acute renal failure
meds for genital herpes
acyclovir, sitz bath
need to add hormones
addisons disease - play on words to remember
Antihypertensives: Alpha 1 Adrenergic Blockers Nursing Considerations
administer first dose bedtime to avoid fainting Monitor BUN, weight and edema Change position slowly
expect resistance
adolescent teaching common behavior
dobutrex and intropin
adrenergic meds to restore blood pressure in shock clients
up and back adult, down and back for child
adult and child ear drops ear positions
compression depth CPR
adults 2cm; children at least 1/2 AP diameter; infants at least 1/4 AP diameter or about 1.5 inches
who is at risk for HHNK?
adults >50yrs old (acute illness, thiazide medications, dialysis)
What is pyloric stensosi casued from in adults/infants
adults: scaring from healing ulcers (PUD) infants: obstruction hypertrophy and hyperplasia of pylorus
downstairs with cane
advance cane & weak leg, then strong leg; memory trick: the good goes up, the bad goes down
Antianxiety Actions
affect neurotransmitters (CNS depressent)
right side, back fowlers, then left side
after a intestinal is in the stomach instruct client to position change this way
specimen on ice, was client on O2 room air
after sample is collected how is it bagged and was client on this med is to be noted
1-7 years
ages for play of imitation
8-12 years
ages of games and hobbies play
0-1 years
ages of play for just holding toys
Antigout Agents: Side Effects
agranulocytosis, GI upset, renal calculi
mixing insulins properly
air into cloudy, air into regular DRAW UP CLEAR FIRST!
TB precautions
airborne precautions
about Bell's palsy
aka facial paralysis, recovery takes 3-5 wks.; inability to close eye, decreased corneal reflex, increased lacrimation, loss of taste, speech difficulty. Analgesics, avoid cold, drafts, isometric exercises for facial muscles (trmt: electrical stimulation, steroids)
Antipsychotic Agents Side Effects
akathisia, dyskinesia, dystonia, parkinson's syndrome, tardive dyskinesias, leukpenia
Antihistamines: Uses
allergic rhinitis, allergic reactions to blood
Alkylating #3 Cytoxan SE's
alppecia, bone marrow depression, hemorragi cystitis, dermatitis, hyperkalemia, hypoglycemia, amenorrhea
Cyctic fibrosis (cause, tx/diet)
alt in fat metabolism cause: absence of pancreatic enzymes leads to malabsoprtion of fat (and fat soluble vitamins) and wt loss (infection & lung dx lead to increase need for calories) tx: pancreatic enzyme replacement (cotazym pancrease) BEFORE or WITH meals HIGH PROTEIN HIGH CALORIE diet
Hepatobiliary dx (cause, tx/diet)
alt in fat metabolism cause: decrease bile leads to fat malabsorption tx: low-fat, HIGH protein diet, increase vitamins
Gout (cause, risk, tx/diet)
alteration in protein metabolism cause: error of purine metabolism risk: joint deteroration tx: low-purine diet (no FISH!)
earliest sign of inc ICP
altered LOC
30 ml of solution(NS)
amount of irrigation solution to put into cathter tube for irrigation
Antibiotics: Penicillins Med Names
amoxicillin, ampicillin, augmentin
Heberden's nodes
an abnormal cartilaginous or bony enlargement of a distal interphalangeal joint (DIP) of a finger, furthest joint. Usually occurring in degenerative diseases of the joints (Osteoarthritis).
Antibiotics: Sulfonamides Actions
anatgonize essential component of folic acid synthesis
assess for chronic renal failure
anemia, acidosis, azotemia(high urea and creatinine), fluid retention, altered urine output
spinal anesthesia (saddle block) for c-section
anesthetic injected into subarachnoid space at L3 to L5
regional lumbar epidural block, may be PCA
anesthetic most popular injected into epidural space between L4 and L5
Antihypertensives: Calcium Channel Blockers Uses
angina, hypertension, interstitial cystitis
Antianginals Uses
angina, peri-operative hypoertension, HF
Sudden onsent, emergency glaucoma?
angle-closure (closed-angle) cause by emotional distrubances, allergy, vasomotor disturbances
SIADH
anorexia, lethargy, HA, change in LOC, decreased deep tendon relfex, tachycardia, decreased urine output
what type of meds are used for glomerulonephritis
antibiotics, corticosteroids, antihypertensives, immunosuppressives
valium, dilantin, pheobarbital
anticonvulsant meds to help decrease ICP
menieres drug therapy
antihistamines (epi, Benadryl); antiemetics (Compazine); antivertigo (Antivert, valium reglan, tigan); diuretics (Dyazide)
actinomycin d considerations
antimetic
Antipyretic Action
antiprostaglandin activity in hypothalamus
meds for rubella german measles
antipyretics, analgesics
Antianxiety Uses
anxiety disorders, manic episodes, panic attacks
stroke s/s
aphasia, hemiplegia, hemianopsia (loss of half of visual field)
apical rate 100 sleep, 120-140 awake, 180 crying
apical heart rate fo newborn
LDH
appears 12-24 hrs; peaks 48-72 hrs; lasts 6-12 days
What referal may you make with a pt with gastritis?
approp agency of ETOH abuse is verified
Cullens sign
around umbilicus
stage 3 lyme disease
arthralgia- inflamed and pain in joints
NSAIDS Uses
arthritis, mild to moderate pain, fever
vaginal dark red bleeding, abdomen pain, tender, tense, fetal distress, contractions
assess abruptio placenta
confusion, disorientation, incontinent, hemiplegia, HA, aphasia, dysphagia, seizure
assess brain attack
mottled skin, cyanosis, metabolic acidosis, hypoglycemia
assess cold stress infant
fatigue, wekaness, dehydrated, hypotension, tan, alopecia, weight loss,
assess for addisons disease
HA, sweating, nasal congestion, goose bumps, bradycardia, HTN
assess for autonomic hyperreflexia
osteoporosis, muscle wasting, HTN, purple skin striations, moon face, truncal obesity, decreased resistance to infection
assess for cushings syndrome
watery discharge, irregular menstrual bleeding, menorrhagia(heavy period)
assess for endometrial cancer (uterus)
K < 3.5mEq/L, weakness, paresthesias, dysrhythmias, increased sensitivity to digitalis
assess for hypokalemia
red inflammed breast, exudate from nipple, fever, leukocytosis,
assess for mastitis
boggy uterus, lochia regresses, excessive bleeding, distened uterus
assess for postpartum hemorrhage
temp >100.4, chills, tachycardia, abd pain, lochia foul, elevated WBC, cultures
assess for postpartum infection
150-160/100-110 bp, 4+ proteinuria, HA, epigastric pain, PE, hyperreflexia
assess for severe preeclampsia
sudden fever, vomitting, diarrhea, drop in systolic BP, rash on palms and soles
assess for toxic shock syndrome
Ca > 5.2 mEq/L, sedative effect on CNS, muscle weakness, lack of coordination, constipation, abd pain, decreased deep tendon reflex, dysrhythmia
assess hypercalcemia
Mg > 2.5 mEq/L, hypotension, depressed cardiac impulse, absent deep tendon relfex, sallow respiration
assess hypermagnesemia
>145 mEq/L, disorientation, delusion, hallucination, thirst, dry, swollen tongue, sticky mucous membranes, hypotension, tachycardia
assess hypernatremia
Ca <4.5 mEq/L, tetany, trousseau's sign, chvosteks sign, seizures, confusion, irritable, paresthesias
assess hypocalcemia
jitters, irregular respirations, cyanosis, weak, high pitched cry,
assess hypoglycemia infant
Mg <1.5 mEq/L, neuromuscular irritability, tremors, seizures, tetany, confusion, dysphagia
assess hypomagnesemia
Na < 135 mEq/L, nausea, muscle cramps, confusion, increased ICP
assess hyponatremia
When assessing for Alcohol disorder, need to
assess in a non judgemental manner , need to know when and how much, impt to know when they had the last drink/drug
thin upper lip, epicanthal fold(chinese eyes), maxillary hypoplasia(underbite)
assess infant for fetal alcohol syndrome
high pitched cry, hyperreflex, tachypnea, sneezing and yawning,
assess narcotic addicted infant
hypothermia, lethargy,poor sucking, episodes of apnea
assess neonatal sepsis
malaise, fever, IUD use, smoking, multiple sex partners, STDs
assess pelvic inflammatory disease
not sutured drain, not the location, expect drainage on dressing
assess penrose drain looks like a tournaquet tube
HTN, hyperglycemia, HA, palpitations, visual disturbance
assess pheochromocytoma
bowel sounds, NPO, mouth care, stool, flatus, TED hose, SCD,
assess postop
loss of sensation below injury, spinal shock, postural hypotension, thermoregulation alteration
assess spinal cord injury
Wernicke's Syndrome
associated with Thiamine deficiency, alcohol abuse can be a cause
Furadantin (nitrofurantoin) Side Effects
asthma attacks, diarrhea
turns back to stomach
at 6 months how can infant control movment
at 4-6 months
at what age do you introduce one new food at a time every 2 weeks.
9 months
at what age of infant can say dada
30 months (2y, 6 months)
at what age of toddler is sphincter control begin for toilet training
common medical diagnoses for low fat cholesterol restricted diets
atherosclerosis, cystic fibrosis
Brudzinski's
attempts to flex neck produces flexion at knee and thigh
Antidepressants: Heterocyclics Nursing Considerations
avoid alcohol CNS depressants wean off slowly
humidify air
avoid drying of mucosa with O2 therapy
Antimetabolit 2 methtrexate 2 considerations
avoid etoh, good mouth care, monitor hepatic and renal
vintablastne considerations
avoid iv and extravastion, antiseptic, acute bronchospasm if iv, zyloprim givent ot increase excretion and decrease uric acid buildup- urates
food for stroke victim
avoid milkbased products, liquids slowly, semisolid food best, upright half hour after eating
minimal concentration or mix with room air
avoid respiratory depression with O2 therapy
avoid contact with Mono clients for this duration
avoid saliva for 3 months
Internal skin care
avoid soap, powders lotion wear cotton loose fit
no fruit juice in baby bottles due to teeth and sugar
avoid this type of bottle to give a infant juice
conjuctivitis causes n trmt
bacteria, virus, allergies, warm moist compress, topical antibiotic, hydrocortisone opht oint
LDL
bad cholesterol that should be less than 139 mg/dL (fasting for 12 hours)
what is purpose of specific diet and restrictions for acute renal failure
balance electrolytes
not allowed in a renal diet
beans, cereal, citrus fruits
what may occur if a pt has an acute diverticular spout?
bedrest NPO - iv fluids NG tube possible surgery with temporary transverse colostomy
shock positioning
bedrest w/ extremities elevated 20, knees straight,head slightly elevated (modified Trendel)
MI positioning
bedrest, allow to use bedside commode for bowel; semifowlers position
treatment for pyelonephritis
bedrest, antibiotics, analgesics
implement glomerulonephritis care
bedrest, meds, I/O, daily weight, dialysis and diet
stage 1 of labor
beginning of labor to complete cervical dilation
Rh isoimmunization
besides pre-term labor, infection, abrupto placentae what are some other complications of amniocentesis
Heroin Implementatin
besides the general care 1. Methadone for maintenance - it a. blocks euphoric effects b. eliminates craving and withdrawal c. daily urine collected to monitor for drug use 2. Treat underlying emotional problems
Migraine meds
beta blockers, triptan preparations (active serotonin receptors), acet, NSAIDS, Topiramate (Topamax), ergotamines- dihydroergotamin (DHE)--take at start of headache
CHEM)#6 Topoisomearase action
binds to an enzyme that breaks dna strands
Antibiotics: Macrolide Actions
binds to cell membrane and changes protein function
stage 3 of labor
birth to delivery of placenta
thrid stage of labor
birth to delivery of placenta, increased gush of blood, lengthen umbilical cord, check for fragments
Antihistamines: Action
block effects of histamine
open angle (primary glaucoma)
blockage of aqueous humor flow, caused by trauma, tumor, hemorrhage
Antihypertensives: Ace Inhibitors Actions
blocks ACE in lungs
Antihypertensives: Beta Blockers Actions
blocks beta-adrenergic receptors
Anticoagulant Heparin Action
blocks conversion of prothrobin to thrombin
Antipsychotic Agents Actions
blocks dopamine receptors in basal ganglia
Antihypertensives: Angiotensin II Receptor Blockers Action
blocks vasoconstriction and aldosterone effects of aniotensin II
luekemia
blood forming tissue, wbc's and platelets
transmission of Hep C- antivirals treatment
blood/body fluids
Anticholinergics Side Effects
blurred vision, dry mouth, urinary retention, change in heart rate
Carbonic Anhydrase Inhibitors Side Effects
blurred vision, lethargy, depression
Antimetab # 5-Hydrea
bone depression, gi, rash
Anti-tumor atbs SE"s
bone marrow depression nv alopecia stoatitits heart failure septic shock
Top SE's
bone marrow suppression diarrhea NV Hepatoxicity
Antineoplastic: Antitumor Side Effects
bone marrow suppression, alopecia, stomatitis
evisceration
bowel externalized and separation of wound edges
Cardiac Glycosides Side Effects
bradycardia, nausea, vomiting, visual disturbances
Antitussive Agents Side Effects
bradycardia, respiratory depression, drowsiness, dizziness, anticholinergic effects
decerebrate
brain stem injury shows this posture and is very emergent
Hormonal agents indication
breast cancer
expose to air and sun, wear loose clothing, avoid soap on nipples
breast care antepartum
larynx, trachea and mainstem bronchi, tissue biopsy, remove aspirated objects or secretions
bronchoscopy is a scope thru upper airway to these lower airways
five danger signs of glaucoma
brow arching, halos, blurry, dimin. periperhal vision, headache/eye pain
raccoon eyes
bruising of both periorbital eccymosis
battle sign
brusing behind ear after skull fracture aka
Bleomycin considerations
bserve for pulmonary complications treat fever with acetmpohinan check breath sounds frequently
superficial partial thickness
burn shows pink to red painful skin burn
common medical diagnoses for high protein diets
burns, infection, hyperthyroidism
if cleitn pregnant with herpes, this procedure is done to prevent spread to baby
c-section to prevent spread to baby
treatment for varicella
calamine lotion, nails short, avoid asa
blood clotting, skeletal muscle contraction, sedative effect on CNS
calcium is used in the body to do these
4.5-5.2 mEq/L
calcium normal range
decubitus ulcer
can cause osteomyelitis, tissue maceration & infection to prevent: turning, draw sheet, air mattress, elbow/heel pads to relieve pressure on skin; protein, vitamins & minerals
Anti Impotence Nursing Considerations
can not take with grapefruit juice call PCP if erection lasting longer than 4 h
Antineoplastic: Antitumor Uses
cancer
Antineoplastic: Vinca Alkaloids Uses
cancer
Antifungals: Uses
candidiasis, oral thrush, histoplasmosis
stage 2 lyme disease
cardiac defects, neuro disorder
TURP, 3-way continuous bladder irrigation, traction on catheter, retrain bladder
care for BPH post-op
diet, test for diabetes with average risk(obese, 25+, hx, race) test= glycosylated Hgb test or glucose tolerance test, insulin is med of choice
care for GDM
antibiotics, fluids, warm douches, rest
care for PID
airway, epi 1:1000, IV fluids, O2, meds
care for allergic reaction
rest, nutrtion, moderate activity, avoid URI, avoid public places
care for cardiac disease for pregnant mothers must find signs of heart failure.
shock, Rhogam if needed, support, surgery
care for client with ectopic pregnancy
antibiotics, fluids, educate tampon use
care for client with toxic shock syndrome
heated environment, cap on head,
care for cold stress infant
large bore IV, minimize stimuli, O2, meds, monitor seizures and FHT
care for eclampsia
use warm shower or compresses, mild analgesics, ice packs
care for engorgment by doing these
avoid pregnancy for 1 year, don't use IUD, check hCG levels for one year
care for hydatidiform mole which is a undeveleoped placenta
glucose, feedings, and monitor BS every 4 hours
care for hypoglycemia
antibiotics, warm packs for comfort, breast support
care for mastitis
home bedrest, left lateral position, well balanced diet, weights, diversions
care for mild preeclampsia
antibiotics for 7-10 days, O2, discontinue feedings temporariliy
care for neonatal sepsis
encourage feelings, assess for suicide, assist with baby care, support group
care for postpartum care
massage uterus, pitocin to produce contractions, monitor for shock
care for postpartum hemorrhage
antibiotics, early ambulation, change peripads, nutrition, fluids
care for postpartum infection
bedrest, sidelying, uterine and weights checked, nutrition, relax, meds
care for pre-term labor
call for help, push pressure off of cord, place in trendelenburg or knee chest position
care for prolapsed cord after membranes rupture
trendelenburg position for 2-3 minutes, IV increased, O2
care for severe hypotension from a regional lumbar epidural block
hospital bedrest, FHT, IO, vitals, seizure precautions, meds
care for severe preeclampsia
Rhogam, vitals, check bleeding, pain, save tissue, support
care for spontaneous abortion before 20 weeks with persistent bleeding and cramps
full thickness
carred, waxy, white and painless burn
treatment for BPH or prostatic hypertrophy
catheter, cystostomy(urine bag), continuous bladder irrigation, prostatectomy
changing hormone levels
cause of postpartum depression
Fat Emboli
caused after a fracture of long bones when fat globules move into bloodstream; may occlude major vessels
hyperbilirubinemia: hemolytic anemia
caused by blood antigen incompatability within 24 hours of birth,
hyperbilirubinemia: breast milk jaunidce
caused by breast milk factor happens within 5 days, discontinue breastfeeding for 24 hours
renal failure, cirrhosis, sodium ingesting, CHF,
causes for fluid volume overload
malignant neoplastic disease, hyperparathyroidsim, excess intake
causes for hypercalcemia
alcoholism, GI suction, diarrhea, intestinal fistulas, diuretic or laxative abuse,
causes for hypomagnesemia
Antidepressants: MAOIs Action
causes increased concentration of neurotransmitters
renal failure, potassium supplements, burns, crushing injuries
causes of hyperkalemia
diarrhea, hyyperventilation, diabetes insipidus, alka-seltzer, not enough water ingestion
causes of hypernatremia
hypoparathyroidism, pancreatitis, renal failure, steroids, loop diuretics, inadequate intake
causes of hypocalcemia
vomitting, diuretics, excess of dextrose and water IV, low sodium diet, excessive water intake
causes of hyponatremia
fever, head injury, HTN, CNS infection, brain tumor, drug withdrawal, stroke
causes of seizures are
Chemo 4 hormonal action (leuprolide)(progestin)
causes tumor cell regression by unknown mechanism
Cytoan considerations
cbc, report hematuria, force fluids, monitor for infection, give antimentics
0.3-0.6 mg/dl
ceatinine level for infant (NPO for 8 hours)
normal bump on the head
cephalohematoma or caput succadenum are normal finding of rupture blood vessels on the head that looks like this
Internal radiation
cesium, radium, gold, brachytherapy
C
change in bowel, bladder habits
Antineoplastic: Hormonal Agents Actions
changes hormone input into sensitive cells
Antihypertensives: Beta Blockers Side Effects
changes in HR, hypotension, bronchospasms
Bulsufan- Considerations
check CBC and fluids to flush system of stomach to prevent stomatitis
6(MP) antimetab considerations
check liver function tests
pacemaker teaching
check pulse daily, request hand scanning at security check points, wear loose clothing over pacemaker, place cell phone on side opposite generator
check residual
check this first before intermittent feeding and every 4 hours with continuous feeding
2 cm
chest tubes must have water seal chamber with sterile water with this amount
pneumothorax
chest xray is perfromed after lung biopsy to check for this
preschooler
child age of associative play- follow the leader
toddler
child age of parallel play-play alongside but not with another
infant
child age of solitary play- own activity
assess pylonephritis
chills, fever, flank pain, malaise
common medical diagnoses for renal diets
chronic renal failure
soap and water
clean perineum and cathter with this before self inserting intermittent self catheter
Post op ileostomy, once peristalsis returns, whats the pts diet?
clear liquids progressing to solids low residue diet for 6-8weeks
hemorrhage
client at risk for this if prolonged clotting times exist
pressure for 5 minutes, check for swelling, discoloration, pain, numbness, and tingling
client care for post ABG Allen test is this and check for these
ICP and abdominal surgery (eye, brain)
clients are encouraged to deep breath but not cough in these types of surgeries ofr condition
Tetany
clinical neurological syndrome characterized by muscular twitching and cramps and (when severe) seizures.
Chemo # 2 Antimetabolites-action
closely counterfeits foot cells, division of cells is halted
glaucoma s/s
cloudly, blurry, artificial lights seem to have rainbows/halos (increased IOP, obstruction of aqueous humor)
The stimulants thar r most often abused...
cocaine, crack cocaine, anphedipines (sp), crystal --- their motors are running, running, running
what is included for Metabolic syndrome - syndrome X?
coexisting risk factors for developing type 2 DM 1) ab obesity 2) hyperglycemia 3) HTN 4) triglyceride level >200 5) HDL <35
stool softeners
colace is this type of med to decrease ICP
sample meal items for sodium restricted diet
cold baked chicken, lettuce with sliced tomatoes, applesauce
atelectasis
collapse of part or (much less commonly) all of a lung.
main RN teaching to parents regarding surgery of herschsprung?
colostomy TEMPORARY, closed when child is 17-22lbs
hyperthermia, hypotension, respiratory depression, n/v
common side effects of anesthesia
stage 2 of labor
complete dilation to birth
eclampsia
condition of pregnancy with HTN, proteinuria, tonic-clonic seizures, coma
early signs inc ICP
confusion, restlessness, pupillary changes
sarcoma
connective tissue
bulk foods, fiber, stool softeners, fluids
constipation and hemorrhoids during pregnancy implement
Antidiarrheals: Side Effects
constipation, anticholinergic effects
Iron Preparations Side Effects
constipation, dark stools, tachycardia
Antacids Side Effects
constipation, diarrhea, acid rebound
Antihyperlipidemic: Side Effects
constipation, fat-soluble, vitamin deficiency
common medical diagnoses for high roughage, high fiber diet
constipation, large bowel disorders
Laxatives/Stool Softeners Uses
constipation, preparation for sx and procedures
Cytoprotective Agents Side Effects
constipation, vertigo
illness that require precautions due to touching inanimate objects, turning patients, touching hands, bathing
contact precautions
what precautions for hepatitis
contact precautions and rest
pertussis
contagious bacterial disease through violent coughing
serosanquineous fluid
containing or consisting of both blood and serous fluid
Etiology of cancer 1=defect in cellular proliferation
continous growth and indiscriminate, TUMOR mass, pyramid effect
frequency
contraction time in minutes of beginning of one contraction to beginning of next
HTN, thromboembolic disease, diabetes mellitus
contraindications of oral contraceptives
Antiparkinson Agents Actions
converted to dopamine, stimulates postoynaptic dopamine receptors
school age
cooperative play with organized rules
decradron
corticosteroid used to decrease cerebral edema to decrease ICP
Antitussive Agents Uses
coughs due to URI, COPD
sample meal items for high roughage high fiber diet
cracked wheat bread, minestrone soup, apple, brussel sprout
acute MI, detected in blood in 3-5 hours
creatine kinase (CK) isoenzymes detect this
0-70 U/L child
creatine kinase CK level for child
55-170 U/L man
creatine kinase CK level for man
30-135 U/L woman
creatine kinase CK level for woman
0.6-1.5 mg/dl adult
creatinine level for adult (NPO for 8 hours)
0.4-1.2 mg/dl child
cretinine level for child(NPO for 8 hours)
vagotomy
cutting of vagus nerve (10) to decrease HCl secretion)
inflammation of bladder aka
cystitis
visualization of bladder
cystoscopy purpose
linea nigra
dark line from umbilicus to symphysis during pregnancy
acoustic neuroma
deafness(partial), benign tumor needs excision
sx of choice for menieres
decompression of endolymphatic sac w/ Teflon shunt
_______ in K leads to cardiac irritability
decrease
Flexion
decrease angle of joint
1200 - 1500 cc/day
decrease fluids to decrease ICP by this amount
subdural hematoma
decreased LOC, pupil dilation, personality change, slow onset
downs syndrome
decreased levels of AFP test may indicate this syndrome
Bronchodilators Action
decreases activity of phosphodiesterase
Anticonvulsants Actions
decreases flow of calcium and sodium across neuronal membranes
Antigout Agents: Actions
decreases production and resorption of uric acid
Carbonic Anhydrase Inhibitors Action
decreases production of aqueous humor in ciliary body
Antidepressants: Heterocyclics Uses
depression and smoking cessation
Antidepressants: MAOIs Uses
depression, chronic pain
Antidepressants: SSRIs Uses
depression, obsessive compulsive disorders, bulimia
Antidepressants: Tricyclics Uses
depression, sleep apnea
Huntington's s/s
depression/temper outbursts; Choreiform movts, restlessness, facial grimacing, arm movts, irrefular leg movts, twisting, turning, tongue movts., person is in constant motion by end of disease progression. Paranoia, demanding, memory loss, dementia, psychosis seen at end stage
if hypoglycemia, and unconcious, what should u admin?
dextrose 50% IV Glucagon 1mg IM/SQ follow with 15 mins of carbs when arosed
low urine specific gravity
diabetes insipidus has these two tests and the values are these
prevents sperm entering cervix
diaphragm is this method of birth control
position on back with knees bent, hands on abdomen
diaphragmatic or abdominal breathing exercise position
Antidiarrheals: Uses
diarrhea
Antibiotics: Macrolide Side Effects
diarrhea, confusion, hepatotoxicity, superinfections
Antibiotics: Fluoroquinolones Side Effects
diarrhea, decreased WBC and hematocrit, elevated liver enzymes (AST ALT), elevated alkaline phosphatase
Laxatives/Stool Softeners Side Effects
diarrhea, dependence, abdominal cramps, hypermagnesemia
low residue diet, fluids
diet for internal radiation implants
dysphagia
difficulty swallowing
drugs that can cause dysrhythmias
digitalis, propranolol
what med do you withhold 48 hrs before cardioversion
digoxin
Anticholinergics Actions
dilates pupil, causes bronchodialtion adn decreased secreations, decreases mobility and GI secreations
dx of menieres
dilation of membrane of labyrinth, Weber, Rinne
Spina Bifida Occulta
dimple overlying skin L5-S1; vertebral arch not completely closed.
serosa - pink brown discharge
discharge color for Day 4-9 pospartum
alba - yellow-white
discharge color postpartum day 10+
Antibiotics: Tetracyclines Side Effects
discoloration of primary teeth if taken by the mother during pregnancy, glossitis, rash, phototoxic reaction
Thrombolytics Action
dissolves or lyses blood clots
catact s/s
distortion, blurring, decreased color perception, annoying glare, double vision
acute renal failure phase of output drastic increase 4-5 l/day, increased BUN, Na and K lost in urine, increased mental and physical activity
diuretic phase of acute renal failure
Antiparkinson Agents Side Effects
dizziness, ataxia, atropine like effects
H2-Receptor Blockers Side Effects
dizziness, confustion, hypotension, impotence
Diuretics Side Effects
dizziness, orth hypotension, leukopenia
Narcotics Side Effects
dizziness, sedation, respiratory depression, hypotension, constipation
abd pain, n/v, suspected appendicitis
do not use enemas in these conditions
Antidiarrheals: Nursing Considerations
do not use with abdominal pain monitor for urinary retention give 2h before or 3h after other medications
how do you get Huntington's
dominant inheritance
myringotomy
done for acute otitis media; tympanic membrane incision to relieve pressure and release purulent fluid; no water can be allowed to enter the ear
salem sump
double lumen NG tube for decompression
extracting fake eye
draw lower lid down, slip out over lower lid
illness that require precautions due to contagions from cough, sneeze, talking, suction
droplet precautions
what type of precautions for rubella
droplet precautions
Antihistamines: Side Effects
drowsiness, dry mouth, photosensitivity, bronchospasm
Cytoprotective Agents Uses
duodenal ulcer
beginning of P wave to beginning of QRS complex
duration of PR interval
exhalation should be twice as along as inhalation for COPD pt.
duration of exhalation and inhale for pursed lip beathing
cesarean section
dystocia(abnormal labor), breech, fetal distress, gonorrhea, herpes, prolapsed cord, PIH, placenta previa or abruptio placentae is and indication for this.
unaffected side down affected side up
ear drops how should pt. lie down
swelling or tenderness
ear irrigation is contraindicated for these symptoms
head is tilted and drained on affected side
ear irrigations, clients head needs to beon this side
Diet teaching for ulcers
eat 3 meals per day avoid milk, coffee, caffeinated beverages
before testing for PKU, you want to ensure what measures is done beforehand with the newborn?
eat before collection
turners sign
ecchymosis around flanks of retroperitoneal bleed
cullens sign
ecchymosis around umbilicus showing retroperitoneal bleed
noninvasive sound waves used to examine cardiac structures
echocardiogram is used for this
Dooxrubican(adria) considerations
ekg, avoid IV filtration, good mouth care, and close vitals
Electrolytes Side Effects
electrolyte imbalances
blood test to show hepatitis
elevated AST, ALT, and prolonged PT
infection
elevated WBC and temperature, positive cultures s/s of this surgery complication
Antihyperlipidemic: Uses
elevated cholesterol, reduce incidence of cardiovascular disease
Spica cast
encases a portion of the trunk & 1-2 extremities; potential complications severe impairment in mobility: skin breakdown, respiratory dysfunction, constipation, joint contractures
BPH
enlarged prostate compression on urethra for men older than 50
bed wetting aka
enuresis
urethra opening on penis dorsal, ventral
epispadias/hypospadias
carcinoma/edenocarcinoma
epithelial tissue
Celiac dx (cause, risk, tx/diet
error of wheat and rye metabolism risk: malnutrition, diarrhea, FAILURE TO THRIVE tx: Gluten-free diet (no wheat, oat, rye, barley)
Antibiotics: Macrolide Med Names
erthromycin, Cleocin (clindamycin)
lyme disease stage one from tick bites assess
erythematous papule bulls eye, flu, lymph node swelling
Bone-Reabsorption Inhibitors: Biophosphonates Side Effects
esophagitis, arthralgia
check for bruit this often for hemodialysis
every 8 hours
When is ear irrigation contraindicated?
evidence of swelling/tenderness
Hyperextension
excessive increase in angle of joint
diabetes insipidus
excessive urine output, dehydration, excessive thirst, weakness, weight loss s/s of this
what is positive TB mantoux test states
exposed and infected only
Atypical Antipsychotic Agents Side Effects
extrapyramidal, anticholinergic, sedatives, ortho hypotension
assessment findings of herchsprungs dx in child
failure to gain wait ribbion like - foul smelling stool visible peristalsis
assessment findings of herchsprungs dx in newborn:
failure to pass meconium refusal to suck ab distention
hyperopia
farsightedness
assess TB
fatigue, night sweats, purulent sputum
sample meal items for low phenylalanine diet
fats, fruits, jams, low phenylalanine milk
transmission of Hep A - no treatment
fecal/oral
unaffected side
feed brainattack victim on this side
LOA
fetus back on left side of mother pelvis facing toward the back with the head presentation is this position
lightening
fetus descending into pelvis where primipara can occur 2 weeks before delivery or multipara when labor begins
Antipyretic Uses
fever
assess glomerulonephritis
fever, chills, protein and blood in urine, edema, HTN, abdominal/flank pain
20 cm
fill suction control chamber of chest tube with sterile water with this amount
lanugo
fine hair over shoulders foread nose cheeks
CK-MB def
first enzyme tube to be elevated after MI; appears 3-6 hrs; peaks 18-24 hrs; lasts 3 days
fourth stage of labor
first four hours after delivery
stage 4 of labor
first four hours after delivery
Turners sign
flank bruising indicating retroperitoneal bleeding
detached retina s/s
flashes of light, floaters, curtain coming down, confusion
Electrolytes Uses
fluid and electrolyte imbalances, osteoporosis
One important teaching for mom with infant of pyloric stenosis surgery?
fold diaper - avoid irritate site
ET3-chemical related
food additives nitrates diet smoking phamacy-stilebestrol ETOH
green veggies, nuts, banans, oranges, peanut butter, chocolate
foods rich in magnesium
coffee, tea, vanilla, chocolate, bananas
foods that excellerate hypersecretion of catacholamines are
mutilation, encourage expressed feelings, models
for a preschooler what is taught to parents about the childs psyche before surgery
someone who has had the surgery before and talk about it helps
for adolescents this implementation is helpful before surgery to minimize fear
implement cystitis care
force 3000 ml/day fluids, acidify urine, antibiotics, void after intercourse, perineal care after defecations
antimetabolite cytrabine considerations
force fluids, oral hyigene
Cytoprotective Agents Action
forms a barrier on ulcer surface
UTI
foul smelling urine, elevated WBC, 5-8 days post op
position to place your pt with a bowel obstruction
fowlers facilitates breathing
not allowed in a clear liquid diet
fruit juices with pulp,milk
sample meal items for low fat cholesterol restricted diet
fruit, vegetables, cereals, lean meat
Nursing management #2 Radiation
gamma and beta rays alpha rays
Post op of Billroth I or II what would you see/assess?
gastric decompression via Levin or Salem Sump tube NG listen for bowel sounds, observe drainage for volume and blood
sample meal items for clear liquid diet
gelatin dessert, popsicle, tea with lemon, ginger ale, bouillon, fruit juice without pulp
hyperglycemia after 20 weeks
gestational diabetes mellitus GDM,
Hydrea considerations
gi symptoms toxic teach
Antihypertensives: Ace Inhibitors Nursing Considerations
give 1 hour before meals, or 3 hrs after Change positioning slowly Monitor VS
Antihistamines: Nursing Considerations
give w food use sunscreen avoid alcohol assess respirations
7 or less coma, 13-15 A/O,
glascow coma scale shows coma with this number and Aand O with these numbers
kidney infection of glomerulus occurs 10 days after skin or throat infection
glomerulonephritis
What meds increase risk of hyperglycemia while on insulin?
glucocorticoids thiazide diuretics thyroid agents estroge
head injury meds
glucocorticoids (Decadron), mannitol, furosemide (for ICP); barbs (decrease cerebral metabolic rate)
glucose levels for the previous three months.
glycosylated Hgb test is this
breast feeding
golden yellow stool from this feeding
HDL
good cholesterol where low levels are bad (fasting for 12 hours)
Impaired oral mucus membrane, sotmatitis
good oral hyigene
oranges, apricots, beans, potatoes, carrots, celery, raisins (CRAB COP)
good potassium rich foods are
cancer
group of many diseases of multiple causes, can arise in any cell any cell that is able to evad regulatory controls over cell proliferation
moving w/ blind pt
have client follow attendate when walking by lightly touching attendant's elbow (1/2 step ahead)
contusion head injury
head injury type that shows signs of decorticate, decerebrate
Antivirals Side Effects
headache, dizziness, GI symptoms
Anti Impotence Side Effects
headaches, hypotension, priapism
Nonunion
healing has not occurred 4-6 months after fracture; insufficient blood supply, repetitive stress on fracture site, infection, inadequate internal fixation; treated by bone grafting, internal fixation, electric bone stimulation
Delayed Union
healing of fracture is slowed; caused by infection or distraction of fractured fragments; will see increase in bone pain
phenylketonuria, hypothroidism, galactosemia (inable to metabolize sugar), sickle cell disease, HIV
health screeing for newborn, (5)
common medical diagnoses for sodium restricted diet
heart failure, hypertension, cirrhosis
kegel exercises, monitor for infection
help care for urinary frequency and UTI during pregnancy
Antimetabolite#4-cytarabine se's
hematologic abonomalities, nausea, vomiting, rash weight loss
Anticoagulant Heparin Side Effect
hematuria, tissue irritation
complications of renal transplant
hemorrhage, infection, rejection signs, check weights
Antiplatelet Agents Side Effects
hemorrhage, throbocytopenia
remove plug, empty contents, place flat, compress completely then replace plug to facilitate suction
hemovac drain is significant looks like an accordian
Antitubercular Agents Side Effects
hepatitis, peripheral neuritis
Antineoplastic: Alkylating Agents Side Effects
hepatotoxicity, bone marrow suppression
Antifungals: Side Effects
hepatotoxicity, throbocytopenia, leukopenia, hemorrhage, pruritus
Immunosuppressants Side Effects
hepatotxicity, nephrotoxicity, leukonpenia, thrombovytopenia
what kind of diet do you want to prescribe a pt w/renal failure?
high calorie, LOW PROTEIN diet alteration in protein metabolism -
what type of diet for glomerulonephritis
high calorie, low protein diet
what diet for hepatitis client
high carbohydrate, moderate fats and proteins, no alcohol
Compartment syndrome
high pressure within a muscle compartment of an extremity compromise circulation; pressure may be internal (bleeding) or external (casts); if left untreated neuromuscular damage occurs withing 4-6 hour; limb can become permanently useless within 24-48 hours; will see unrelenting pain out of proportion to injury and unrelieved by pain medications, decreased pulse strength, numbness and tingling of extremity,possible cyanosis and pale cool extremity.
Chemo 5- alakaloids indications
hodgkin's lymphoma cancers
no douching, no enemas, no sex, non stress test q 1-2 weeks
home care for placenta previa that is controlled
least allergenic to more allergenic
how are food allergies introduced and detected when introducing new foods
5 weeks
how early can pregnant client have ultrasound
2-3" then urine is flowing insert another 1 inch
how far is cathter inserted for woman
anxiety with strangers
how is 8 month child act towards others
measure with pt. flat in bed or 45* up
how is CVP measured
IM vastus lateralis, or deltoid, tender
how is Hep B immunization given and s/e
PO, little side effects
how is IPV immunization given
position on right side for 1-2 hours
how is client to be positioned after liver biopsy
potassium supplements of , <40 mEq/L IV with cardiac monitor
how is potassium supplements administered
measure at highest level of fluxuation
how is the measure of CVP perfromed
no more than 6 hours before sex best used with spermicial gel
how long may the diaphragm be placed before sex
use alternate form of birth control for 3 months
how long should a different form of birth control be used directly after vasectomy
100% 15 lpm
how much O2 for NRB maskwith resevoir bag 2/3 full
75% O2 8-11 lpm
how much O2 is partialrebreather given to client with resevoir bag 2/3 full
20 ml NS before and after each NG tube med and each feeding
how much and how often is water flushed through NG tube
no more than 1000 ml taken at one time
how much fluid is relieved for a thoracentesis
4% oxygen + room air 21%
how much oxygen % for each liter of given
dry sterile dressing, iv fluids, manometer, tubing all changed every 24 hours
how often is CVP mechanism changed
every shift
how often is drainage assessed for intestinal NG tube
yearly after age of 40
how often is mammoagrpahy done for female
lie on unaffected side
how should atelactisis client lie in bed
gradually lift head 30* first hour, 45* send 2 hours
how should head elevation be positioned post op liver biopsy
wipe meatus toward rectum with swab, sterile procedure
how should meatus be wiped for cathter of woman
store it dry in a clean container, never in a antiseptic solution
how should the self catheter be stored
three slow deep breaths slowly exhaling, breath in and cough several times during expiration,
how to cough correctly
open stopcock and fill manaometer with 18-20 cm of IV fluid
how to fill the line of CVP manometer
nose to ear to xiphoid process, mark distance
how to measure NG tube
head back and twoard affected side soe fluid will flow from inner to outer canthus
how to position client witheye irrigation
bend head forward insert in nare to opposite ear, swallow sips of water
how to position head for NG insertion
place in postions to facilitate drainage of secretion into large airways
how to postural drainage
use pillow over incsion site
how to protect incision site from cough technique
breath in nose pursed lips breathe out of mouth
how to pused lip breathing exercise
have extra cushion of hormones
how to remember cushings syndrome
verify by insert with air into tube and auscultate over stomach
how to verify placement of tube before irrigation of NG tube
autonomic hyperreflexia meddd
hydralazine (Apresoline)
hyperbilirubinemia:physiologic jaundice
hyperbilirubinemia from poor hepatic function 24 hours after birth, no treatment needed, last for 5 days
>5.0mEq/L EKG dysrhythmias, weakness, paralysis, diarrhea, nausea
hyperkalemia assess
decrease respirations and decrease urine output
hypermagnesemia shows these signs
Antihypertensives: Ace Inhibitors Uses
hypertension, CHF
Antihypertensives: Beta Blockers Uses
hypertension, angina, SVT
Antihypertensives: Alpha 1 Adrenergic Blockers Uses
hypertension, benign prostatic hypertrophy, reflex tachycardia
Antidepressants: MAOIs Side Effects
hypertensive crisis when taken with tyramine-containing foods (cheese, liver, beer, wine), photosensitivity
blood sugar 40-50 mg/dl
hypoglycemia of infant in first 24 hours
Hypoglycemic Agent: Side Effects
hypotension, bronchospasms
Antihypertensives: Calcium Channel Blockers Side Effects
hypotension, renal failure, angioedema
Antianginals Side Effects
hypotension, tachycardia, headache, dizziness
hemorrhage or shock complication of surgery
hypotensive increased pulse cold clammy skin s/s of
Thyroid Replacement Agents Uses
hypothyroidism, Graves' disease
defib first
if AED available and the client is a witnessed cardiopulmonary arrest then this is done first AED or CPR
inaccurate low reading
if BP cuff is to long or too wide what type of reading will be expected
inaccurate high reading
if BP is too short or narrow what type of reading is expected
hypervolemia or poor cardiac contractilty
if CVP measures > than 12 cm H2O this is why
no cathter is to be inserted
if blood is found on the meatus of the urethra than this is avoided
when should infant have expert eye exam?
if born before 36 wks or less than 2000 g at birth
FHT unchanged
if care for prolapsed cord is successful what is the sign of success
use alternative form of birth control
if client misses two days of oral contraceptives what is told to client
less than 3 movments in one hour
if decreased fetal movements should be reported to Dr.
hypotension
if drain more than 700ml of urine at one time may cause this
change position of client
if feel resistance of irrigationo f NG tube do this for the client to free any kinks
deep tendon reflexes
if hypomagnesemia shows this sign
hold feeding
if residual stomach contents before feeding is 100 ml what dod you do
constant bubbling
if this occurs in water seal chamber it means an air leak
encourage to speak or cough
if upper airway is obstructed encourage victim to do this
besides drugs, what can cause increase BG levels requring insulin?
illness, infection, stress
Splinting
immobilization of affected part to prevent soft tissue from being damaged by bony fragments
Antifungals: Action
impairs cell membrane
airway, elevate head 15-30*, minimize activity
implement acute phase of brain attack
informed consent, valium, sync on 25-360 joules, check monitor
implement cardioversion for rhythm disturbance
NPO, NG tube, I/O, drainage, bowel sounds, CVP, ABG's, monitor, catheter
implement care for abd injury
sitting position, catheter, check rectum for fecal mass, medication
implement care for autonomic hyperreflexia
good posture, body mechanics, good shoes, pelvic tilt exercises
implement care for backache during pregnancy
well fitting bra, and wear bra at night
implement care for breast soreness during pregnancy
assess sucking ability, airway, surgery, guard suture line
implement care for cleft lip and palate
antacids, avoid phosphorus antacids (it will decrease calcium), decrease fatty fried foods
implement care for heartburn during pregnancy
move left side position first, O2 mask, IV fluids increased, stop oxytocin
implement care for late decelerations during labor
pacifier, assess muscle tone, vitals, nutrtion, wrap snug, hold and rock tightly
implement care for narcotic addicted infant
left lateral position, increase IV, O2
implement care if mild/moderate hypotension from a regional lumbar epidural block
elevate presenting part off of the cord, call for help, knee chest position, O2, start IV
implement care to a mother with a prolapsed cord
turn mother on left, O2, check for prolapsed cord, start IV
implement care to mother if FHR is iregular
monitor shock, humidified O2, thoracentesis, chest tube
implement chest trauma
slow deliberate movements, support stockings
implement dizziness during pregnancy
tepid solution, no more than 18" above rectum, 4" inserted rectum,
implement enema
low fowlers, no coughing NPO, cover viscera with steril saline dressing, notify physician
implement evisceration
force isotonic fluids, I/O, daily weights, skin tugor, urine specific gravity assessed
implement fluid volume deficit
diuretics, restrict fluids and sodium, assess breath sounds, edema, semi-fowlers position
implement fluid volume overload
Assess LOC, Na levels, I/O, daily weight, restrict water intake 500-600/day, diuretics, hypertonic solution
implement for SIADH
NS IV, vasopressors, hydrocortisone, vitals, bedrest
implement for addisonian crisis
monitor hypoglycemia, hyponatremia, hyperkalemia, hormone replacement and specific diet
implement for addisons disease
fluid/electrolyte balance, vitals, urinary output, IV pain meds, and wound care, grafting for full thickness
implement for burn care
monitor glucose levels, specific diet, surgery for adrenalectomy or hypophysectomy(pituitary gland removal)
implement for cushings disease (the over active adrenal gland)
avoid stress, promote rest, avoid coffee and stimulating foods, postop care after adrenalectomy or medullectomy
implement for pheochromocytoma
hypotonic or isotonic solution, fluids, diuretics, calcitonin, mobilize, surgery for hyperparathyroidism
implement hypercalcemia
meds, restrict potassium intake, peritoneal or hemodialysis
implement hyperkalemia
discontinue oral or IV Mg, monitor respirations, cardiac rhythm, reflexes, IV calcium to antagonize cardiac depressant
implement hypermagnesemia
hypotonic solution, I/O, daily weight, decrease sodium in diet
implement hypernatremia
oral caclium supplements with OJ, seizure precautions, meds, seizure needs
implement hypocaclemia
monitor cardiac rhyth and reflexes, swallow ability, seizure precautions, foods rich in magnesium
implement hypomagnesemia
I/O, daily weight, increase intake sodium rich foods, water restriction, IV LR or NS
implement hyponatremia
elevate head 30-45*, glascow coma scale, vitals, avoid neck flexion and head rotation
implement icreased ICP care
swallowing, reorient, ROM skin care, communication needs, elimination needs
implement intermediat phase of brain attack
30-50 ml water, check for resistance, kinks, withdraw solution and record
implement irrigation of NG tube
CT scan, LOC, vitals, I/O, pupils PERRL), CSF leakage in nose and ears, elevate head 30*
implement monitor and reassess head injury
bedrest sidelying or Trendlenburg position, ultrasound to locate placenta, amniocentesis (lung maturity), Hgb, Hct, check bleeding
implement placenta previa care
clamp tube, deflate balloon, exhale, remove 6" every 10 minutes until stomach then remove all
implement removal of intestinal NG tube
O2, side lying, suction, reorient, meds teaching, reduce stimuli
implement seizure care
protect from injury, don't restrain, don't insert anything in mouth, monitor for onset, duration and pattern of seizure
implement seizure safety
sterioids, hyperbaric O2 therapy, bladder/bowel training, emotional support client and family teaching
implement spinal cord injury care
room temp, use pump, elevate head, check q 4 hours, mouth care, I/O
implement tube feeding for levin/salem sump
hypertonic fluid(mannitol), diuretic, hypothermic therapy, barbiturate therapy, glucocorticoids(decadron), seizure precaution,
implementation for head injury to decrease ICP
anticoagulants
implementation of DVT
second day post op, O2, anticoagulants (heparin), IV fluids
implementation of PE
antibiotics and force fluids , CS sample
implementation of UTI
second day post-op, suction, postrual drainage, antibiotics, turn and cough, deep breathing
implementation of atelactisis and pneumonia
low fowlers position, no coughing, NPO, notify physician
implementation of dehiscence post op surgery complication
monitor vitals, replace blood
implementation of hemorrhage
trach avail, croupette or mist tent, cotton clothes, humidified O2, IV fluids, meds, prop with pillow, HR for hypoxia
implementation of hospital care for croup
antibiotics, aseptic techniques, good nutrition
implementation of infection to wound from surgery
nasogastric suction, IV fluids, decompression tubes
implementation of paralytic ileus
treat cause, O2, IV fluids
implementation of shock
catheterize pt. or have client stand if tolerated
implementation of urinary retention
Malunion
improper alignment of fracture fragments; may develop with premature weight bearing
hyperoxygenate, deep breath, suction trach tube, remove dressing, open kit, sterile gloves, remove inner canula, clean canula withperoxide, rinse sterile H2O, change ties, keep old in place, sterile dressing
in order for trach care
c, f(non citrus)v, p,m,e, oj
in what order are foods with possible allergens introduced
presbyopia
inability to focus on near things w/ age
encopresis
incontinent of stool, cause of constipation
Extension
increase angle of joint
Iron Preparations Actions
increase availability of iron for hemoglobin
diet of fluid intake and high in fiber, fruits and vegetables and grains help bowel eliminations
increase peristalsis
late signs inc ICP
increased BP, decreased pulse; Cushings triad: widenening pulse pressure, increase sys. pressure, bradycardia
chloasma
increased pigmentation on face during pregnancy
what bloodwork tells signs of acute renal failure
increased potassium, Ca, Na, BUN, creatinine
Antidiarrheals: Action
increases GI motility, blocks effect of dopamine in chemoreceptor trigger zone
Cardiac Glycosides Action
increases force of myocardial contraction, slows rate
Attention Disorder Agents Action
increases level of catecholamines
Thyroid Replacement Agents Action
increases metabolic rate
I
indegestion or or difficulty swallowingg
Antibiotics: Tetracyclines Uses
infections, acne, prophylaxis for ophthalmia neonatorum
tetanus
infectious disease of the nervous system
keratitis
inflammation of cornea (steroids, except w. herpes simplex)
uveitis
inflammation of iris, ciliary body, choroid
chalazion
inflammatory cyst on eye
Antidepressants: SSRIs Actions
inhibits CNS uptake of serotonin
Antivirals Action
inhibits DNA and RNA relpications
Antineoplastic: Antimetabolites Actions
inhibits DNA polymerase
H2-Receptor Blockers Action
inhibits action of histamine and gastric acid secretions
Antitubercular Agents Action
inhibits cell and protein synthesis
Antihyperlipidemic: Actions
inhibits cholesterol and triglyceride synthesis
Antihypertensives: Calcium Channel Blockers Actions
inhibits movement of calcium across cell membrane
NSAIDS Action
inhibits prostaglandin synthesis
Antibiotics: Tetracyclines Actions
inhibits protein syntheis
Antibiotics: Aminoglycosides Action
inhibits protein synthesis in gram-negative bacteria
Diuretics Actions
inhibits reabsorption of sodium and water, blocks effects of aldosterone
Bone-Reabsorption Inhibitors: Biophosphonates Action
inhibits resorption of bone
Antidepressants: Tricyclics Actions
inhibits reuptake of neurotransmitters
Antibiotics: Cephalosporins Actions
inhibits synthesis of bacterial cell wall
Antibiotics: Penicillins Actions
inhibits synthesis of cell wall
250 ml every 2 hours
innstruct client to drink this amount of water
sucking sound when w/ open pneumo
inspiration and expiration
void before procedure do avoid aspirating bladder, and the use of ultrasound
instruct client to do this before amniocentesis
clamp tube, instruct client to exhale, remove tube
instruct client todo this when removing NG tube
Antidysrhythmics Action
interfere with electrical exciablility of heart
Antineoplastic: Antitumor Action
interferes with DNA and RNA sythesis
Antibiotics: Fluoroquinolones Actions
interferes with DNA replication in gram-negative bacteria
Chemo 3 antitumor ATB's action
interferes with RNA and DNA synthesis
Atypical Antipsychotic Agents Actions
interferes with binding of dopamine in the brain
Antineoplastic: Vinca Alkaloids Action
interferes with cell division
Chemo 5- Vinca alkaloids action
interferes with cell division
Antiplatelet Agents Actions
interferes with platelet aggregation
Antineoplastic: Alkylating Agents Action
interferes with rapidly reproducing DNA
Anticoagulant Coumadin Action
interferes with synthesis of vitamin 5-dependent clotting factors
>4 pH
intestinal aspiration pH will be this level
Iron Preparations Uses
iron-deficiency anemia
false labor
irregular contractions, discomfort is abdominal, contractions decrease with either rest or activity, no cervical changes
rubella (german measles) of rash on face thne body, who to isolate from
isolate from pregnant women
how long must a chicken pox child stay at home
isolation until vesicles are crusted
meds for TB
isoniazid INH, rifampin, pyrazinamide, ethambutol
Oncovin considerations
iv, extravation, reflex checs, sensory and motor function, zyloprim
not allowed in a full liquid diet
jam, fruit, solid foods, nuts
kegel exercises, tighten and hold muscle for a 3 count relax for 10 times, TID, avoid caffeine
kegel exercise is taught like this and avoid this beverage due to postpartum urinary incontinence
BUN/creatinine
kidney function test
Menieres disease
labyrinth dysfunction, inner ear disorder that affects balance and hearing (caloric stimulation test- tests reflexes by warming/cooling inner ear w/ water)
hyperbilirubinemia: breast feeding jaundice
lack of breast milk intake, feed more frequently
internal sealed examples
lead container and long handled forceps in room to dislodge save all dressings and bed linen till source removed urine feces and linens not radioactive dont touch rad source pt. bedrest while implant put in place position of source verified by radiography
External radiation
leave radiology markings intact on skin avoid creams and lotions, deodorants, perfumes(only vi A and D) lukewarm to clean area assess for reed adminster antimetics, analgesics observe skin, mucous membranes, and hair for se's no hot water bottle, dont expose to sun or tanning bed cotton
Cardiac Glycosides Uses
left-sided HF
increase calcium intake, dorsiflex feet, local heat
leg cramps during pregnancy
Antineoplastic: Alkylating Agents Uses
leukemia, multiple myeloma
Chemo 1- Alkylating agent Indications
leukemia, multiple myeloma
Antineoplastic: Hormonal Agents Side Effects
leukopenia, bone pain, hypercalcemia
Antithyroid Agents Side Effects
leukopenia, rash, thrombocytopenia
station
level of presenting part in relation to imaginary line bewteen ischial spine of pelvis = 0, -5= 5 cm above ischial spine, +5 is 5 cm below ischial spine
which tube decompresses stomach?
levin or salem sump
transverse
lie of fetus are crossed at right angles
longitudinal
lie of fetus is parallel
oblique
lie of fetus is slight angle off true transverse
If pt arrives at clinic with fibrous faty masses at inject site from DM whats this called?
liphypertrophy
If pt arrives at the clinic with dimpling or pitting on arm, what is this called/cuased from?
lipoatrophy - loss of subq fat and appears as slilght dimpling or serious pitting
Antimetab #3 (6-MP) Mercap SE's
liver dmage, bone depression, infection, alopecia, and bleeding
Anti-tumor's atbs Cursing considerations
look for septicemia look for extravastion at insertion site for pain, and redness after injection that lasts for 48 hours (ulcerations)
hemianopsia
loss of half of visual field
Diet for menieres?
low Na (2,000 mg), avoid caffeine, nicotine, ETOH
type of diet to prepare for surgery for hirschsprung?
low fiber high calorie high protein
What does a pale pink stoma indicate?
low hct and hgb levels
purpose of low phenylalanine diet
low protein diet to prevent brain damage from imbalance of amino acids
ET3- Genetic components
lung breast cancer leukemia uterine cancer colon cancer neuroblatoma
lymphoma
lymphoid tissue
depressant
magnesium acts as a
1.5-2.5 mEq/L
magnesium normal range
confusion
main symptom for sodium imbalance is
What is the RN Priorty if you suspect your pt has appendicitis??
maintain NPO status IV fluids to prevent dehydration No alalgesics until cause of pain determined
what type of infants are most prone to pyloric stenosis?
male, white, full-term
What are two ND with cystic fibrosis?
malnutriton failure to thrive
what test diagnose TB
mantoux skin test 10 MM positive
Close reduction
manual manipulation or traction of fracture
not allowed in a low fat cholesterol restricted diet
marbled meats, avocados, milk, bacon, egg yolks, butter
main RN assessment while preparing child for surgery for herschsprung?
measure AB girth
tonometry
measure intraocular pressure, pt will be recumbent
not allowed in a low phenylalanine diet
meat, eggs, beans, bread
internal sealed source radiation
mechanically positoined source of radioactive material placed in body or tumor
antihistamine, bronchodilator, vasopressor, corticosteroids
meds for allergic reaction
phenobaribital, methadone, paregoric, diazepam, chlorpromazine
meds for narcotic addicted infant
mag sulfate, apresoline, valium, procardia
meds for severe preeclampsia
valium, versed or demerol
meds the client will recieve before a bronchoscopy
digitalis, isuprel, quinidine, atropine
meds to improve mycardial contraction to treat for shock
mannitol and lasix
meds to maintain adequate urine output
antibiotics, cardiac glycosides, diuretics, andrenergics/sympathomimetics
meds to treat for shock
mengional sacoma
meniges
pain relief
mild-tylenonl, antimetic, glucocorticoids, antidepressants moderate- weak narcotics, coedine severe-storng narcotics
sample meal items for full liquid diet
milkshakes, soups, custard, all clear liquids
Antibiotics: Penicillins Uses
moderate to severe infections, syphilis, gonococcus infections, Lyme disease
Narcotics Uses
moderate to severe pain, preoperative, postoperative
avoid milk, stay upright after eating, semisolid foods
monitor and teach swallowing aids
Implications for Bone Dep
monitor bleeding in everyting including pee and stool. avoid im injections and rectal temps apply pressure to venous sites
investigate any redness, swelling, cracking or bleeding which shows infection
monitor breast care postpartum complications
antimetabolite considerations
monitor for infection, avoid extravastion
Luekaran Considerations
monitor for infection, avoid im injections when palteltet count is low to minimize bleed, check cbc's
Nursing considerations- antimetabolites
monitor hemopoetic fucntion good mouth care small frequent feedings counsel with wig good skin care photosensitivity precautions infection control precautions
Implications for n&V
monitor i&o, nutrition, antimetics prn, smaller meals
bulb type drain, monitor amount and character of drainage, notify bright red or increased amounts
monitor jackson-pratt drain looks like a bulb
Antigout Agents: Nursing Consideration
monitor kidney stones Give w milk, food, antacids
Bipolar Disorder: Nursing Considerations
monitor serum levels give with meals increase fluid intake
below level of insertion, clamp for only a second to check for leaks
monitor system of chest tubes for cleint
Alcohol Withdrawl implementation
monitor their puslse, elevated pulse rate r a concern - watch to see if they progress into alcohol withdrawl syndrome
observe for fluctuation in water sealchamber
monitor this occurance in the chest tube system
Antihypertensives: Calcium Channel Blockers Nursing Considerations
monitor vs caution position change monitor edema (face swelling, SOB)
Antihypertensives: Angiotensin II Receptor Blockers Nursing Considerations
monitor vs do not chew or divide sustained release tablets
continuous passive motion
motion performed by a mechanical device that moves a joint slowly and continuously through a controlled ROM, aids in recovery after joint surgery, dec tissue stiffness, prevents scar tissue
Rotation
move around central axis
Abduction
move away from midline
abduction
move away from midline (take a child away)
Adduction
move toward midline
What is a teaching you would want to give a patient taking Carafate for a Hiatal Hernia
must take 1 hour before meals - will coat the stomach
what meds to avoid w/ glaucoma
mydriatics (atropine)
VINCA #1 Vinblastine SE's
n,v, somatitis, alopecia, loss of reflexes, bone marrow depression
s/s menieres
n/v, incapacitating vertigo, tinnitus, pressure feeling in ear, progressive decreased hearing on involved side, nystagmus, headache
N
nagging cough or hoarsness
anesthesia, barbiturate injection, insulin shock, spinal cord injury
name 4 types of distributive shock of neural induction
each shot at 2, 4, 6, 15-18months, 4-6 years , (Td) booster 11-16 years
name each time needed for the DTaP immunization
1.2-4 pounds, 2.12-14, 3.8-12
name normal weight gain in every trimester.
actinomycin d
nausea bone depression
Antimetabolite 1- 5(FU)
nausea, stomatitis, gi ulceration, D, bone dep, liver dysfunction, alpoecia
Antineoplastic: Antimetabolites Side Effects
nausea, vomiting, oral ulcerations, bone marrow suppression, alopecia
Bleomycin ATB#2 SE's
nausea, vomiting, pulmonary fibrosis, fever, bone dep
myopia
nearsightedness
neuroblastoma
nerve cells
Thyroid Replacement Agents Side Effects
nervousness, tachycardia, weight loss
Antacids Action
neutralize gastric acids
Anti Impotence Contraindications
nitrates, alpha blockers
Types of nonmechical obstruction aka paralytic ileus
no mechanical blockage - absence of peristalssi ab trauma/surgery spinal injury periotonitis/ acute appendicits wound dishisence
8-20 mg/dL
normal BU levels for all under 60 yo
7-18 mg/dL over 60 y/o
normal BUN level in adult over 60 yo
15 bpm above baseline
normal FHR variability acceleration
HCO3 22-26 meq/L (renal)
normal HCO3
child 35-45%
normal Hct child percentage of RBC
man 42-50%
normal Hct male percentage of RBC
woman 40-48%
normal Hct woman percentage of RBC
PaCO2 35-45 mm Hg
normal PaCO2
80-100 mm Hg
normal PaO2
SaO2 95-98%
normal SaO2
5,000-10,000mm3
normal adult WBC
child 11-12.5 g/dl
normal child Hgb/100ml
woman 12-16 g/dl
normal female Hgb/ 100 ml
120-160 bpm
normal fetal HR
3.5-5.5 g/dl
normal levels of serum albumin
man 13-18 g/dl
normal male Hgb/100 ml
acidosis >7.35-7.45< alkalosis
normal pH
5,000-13,000mm3
normal pediactric WBC
100,000-400,000/mm3
normal platelet count(thrombocyte count)
3-7 days
normal postpartum blues occurs these days postpartum
3.5-5.0 mEq/L
normal range of potassium
135-145 mEq/L E
normal range of sodium
3-12 cm H2O
normal readings of CVP
30-60 with 15 seconds of apnea
normal resp rates for newborn
length 19-21 inches, head 13-14 inches, chest is one inch less of head, 6-9 lbs.
normal weight length and head and chest for newborn
Glucose tolerance test normal/dm
normal: <140 140-200: GTT >200 diganose - DM
purpose of full liquid diet
nutrition without chewing
observe color and gastric pH (<4.0)
observe gastric contents for this
O
obvious change in wort or mole
what are signs of kidneyrejection
oliguria, fever, proteinuria, tender kidney
s/s MI u might not remember
oliguria, low grade fever (rises to 100-103 within 24 hrs and lasts 3-7 days)
tylenol
one type of pediatric antipyretics
Carbonic Anhydrase Inhibitors Uses
open-angle glaucoma
Anticholinergics Uses
opthalmic exam, motion sickness, pre-operative
Antimetabolite #2 Mexotrexate Se's
oral and GI ulceration, liver damage, bone dep, stomitis, bloddy diarhea, fatigue
Bone-Reabsorption Inhibitors: Biophosphonates Uses
osteoprosis, paget's disease
Antibiotics: Aminoglycosides Side Effects
ototoxicity, nephrotoxicty, nausea, vomiting, diarrhea
Top indications
ovary, lung, colon, and ass cancers
What ABG would you see on DKA?
pH <7.35 HCO3 <15
dysuria
pain difficulty voiding
homans sign
pain in the calf on dorsiflexion of the patient's foot signs of DVT
s/s of urolithiasis
pain, diaphoresis, fever, chills, hematuria
S/S of Gastritis
pain/discomfort in ab hicupping anorexia, N/V
assess syphilis
painless chancre(sore), copper colored rash on palm/soles, mucous membranes
serous fluid
pale yellow and transparent, and of a benign nature
transmission of Hep B- antivirals treatment
parenteral(IV)/sexual
presentation
part of fetus that enters maternal pelvic inlet
clonic
part of seizure where client is jerky
tonic
part of seizure where client is stiff
Billroth I
partial remove (distal one third to one half) of stomach anastomosis with duodenum
mild preeclampsia
past 20th week, 140/90, 2+/3+ proteinuria,assess for this condition
Preop main concern/position of infant with TEF
patent AIRWAY supine/prone with HOB 30degrees
Alcohol Withdrawl assessment
peaks 24-48 hrs after that last drink and may last for 2-3 days - You will see 1. Tremors 2. Insomnia 3. Anxiety 4. Illusions (different from Hallucainations, in Hallucinations, they see something that isn't there, in illusions something is there, ie wallpaper, but instead of seeing butterfiles on it they see snakes and.or bugs) - illusions misinterpret things that 4 in the environment
Troponin
peaks 4-12 hrs; remains elevated for up to 2 weeks
complications with gonorrhea
pelvic inflammatory disease
meds for syphilis
penicillin G IM
Antacids Uses
peptic ulcer, indigestion, reflex esophagitis
What does a sudden cessation of pain with appendicitis indicate?
perforation - ER! High risk of pertonitis
VINCA#2 SE's Vincritstine (oncovin)
perherpial neuritis, loss of reflexes, bone del, gi symptoms
rhythm method of contraception
periodic absence of sex during fertile period of month
Antibiotics: Sulfonamides Side Effects
peripheral neuropathy, crystalluria, photosensitivity, GI upset, stomatitis
Club foot (Talipes Equinovarus):Data/Diagnose
pes: foot equino: heel is elevated like a horse's hoof Data: Plantar flexion or dorsiflexion. Inversion/adduction of forepart of foot. Diagnose: Rigid abnormality of talus bone at birth. Does not involve muscles, nerves, or blood vessels.
activated charcoal
phenobarbital
common medical diagnoses for low phenylalanine diet
phenylketonuria (PKU)
types of mechanical obstruction
physical blockage - hernia, tumors, intussusception (telescoping of bowel) volvulus (twisting of bowel)
striae gravidarum
pink or reddish streaks dueing pregnancy
placenta previa
placenta is implanted in lower uterine segment near or over cervix in 1st or 2nd trimester - spotting, 3rd tri painless bleeding
multiple myeloma
plasma
types of droplet precaution illnesses
pneumonia, meningococcal meningitis, rubella
What are the 3 p's of DM?
polyphagia (increase app) polydipsia (increase thrist) polyuria (increase urination)
on side
position client having a seizure
left side
position for enema
extremities elevated 20*, knees straight, head slightly elevated
positioning client in shock,
lateral right, left, prone, upright, or head down 5 x a day
positions for postrual drainage
late deceleration of 50% of the contractions
positive contraction stress test shows this
PEEP
positive end expiratory pressure maintained at end of expiration to open collapsed alveoli and improve oxegenation
fetal HR by 12 weeks with dopler, fetal HR by auscultation 18-20 weeks, palpate fetal movement, ultrasound visualiztion
positive signs of pregnancy confirmation
cleansing enema to remove barium, xrays
post op barium enema lower gi series
monitor for character and volume of urine, abd distention, urinary frequency, fever, pink urine
post op care for cystoscopy
out of bed after procedure, regular diet
post op care for laparoscoopy
vitals, fever or abd pain, check for hypovolemic shock
post op paracentesis
pressure to site for 20 minutes, pressure dressing, flat bedrest for 24 hours, observe for bleeding and heaturia
post op renal biopsy
vitamin B12 (cyanocobalamin) for life
post test postive schilling test for pernicious anemia
neuro assessment every 15 -30 minutes, position flat for 4-12 hours, fluids, analgesics, drainage
post-op lumbar puncture monitor for
side lying
postion of client having a seizure
common medical diagnoses for clear liquid diets
postoperative; acute vomiting or diarrhea
cardiac rhythm and nerve transmission
potassium plays a roll as a intracellular ion to do these jobs
Skin protection measures for ostomy
pouch opening 1/8 larger than stoma skin barrier under ALL tapes pat dry - DO NOT RUB
autonomic hyperreflexia s/s
pounding headache, profuse sweating (forehead esP, nasal congestion, piloerection, bradycardia, hypertension
abruptio placentae
premature separation of the placenta from cocaine abuse, or HTN causing painful vaginal bleeding,
liquid diet and laxative night before, enema that mornig before exam
prepare client for barium enema lower GI series
NPO after midnight, stool will be light colored after porcedure
prepare client for upper GI series barium swallow
bowel prep, NPO after midnight, check allergies shellfish iodine, chocolate, milk, or eggs, salty flavor during injection, xrays taken intervals
prepare for IV pyelogram
cooled, humidified air, check SaO2 every 4 hours, clean humidity jar and refill with steril water daily
prepare for croupetted or oxygen tent
bowel prep, force fluids, NPO if sedated
prepare for cystoscopy
anesthesia general, foley cath, CO2 introduced
prepare for laparoscopy
semi fowlers position or sitting upright on edge of bed, empty bladder
prepare for paracentesis
xrays, skin marked at lower bole of kidney, position prone and bend at diaphragm, hold breath during needle insertion, NPO
prepare for renal biopsy
radioactive B12 administered
prepare for schilling test
hyperoxygenate, suction 80-100 mm Hg, semi fowlers, lube cath, suction for no more than 10 seconds,
prepare for suction
vitals, shave around insertion, position arms over bed table or lying on side
prepare for thoracentesis
cover client withlight blanket and cap, raise side rails, change linen, check temperature
prepare infant/toddler in a croupetted or oxygen tent
assess fine mist, empty condensation from tubing, keep water container full, 10 lpm 24-100% O2
prepare/teach for tracheostomy collar or T-peice
allow to play with equipment
preschool and school age teaching preop
breech buttocks
presentation of buttocks
complete
presentation of buttocks and legs crossed
cephalic/vertex
presentation of head
breech frank
presentation of hips flexed/knees extended
shoulder
presentation of transverse lie
not allowed in a sodium restricted diet
preserved meats, cheese, fried foods, milk products, canned foods, added salt
Implications for Immune response
prevent by washing hands timely reporting of vs's or symptoms of infection
how is prevention of lyme disease
prevention - by cover exposed area in woods and check for ticks
Immunosuppressants Action
prevents production of T cells and their response to interleukin-2
Immunosuppressants Uses
prevents rejection for transplanted organs
ketogenic diet
prevents seizures; high fat, low carb, mimics effects of fasting and puts body in constant state of ketosis
Nursing managment internal
private room, caution sign, dosimeter filmbadge to measure exposure, no pregnant nurses, rotate staff,
contact precautions
private room, clean gloves, gown,
what is done for airborne precaustions
private room, door closed, standard precautions also
droplet precautions
private room, door open, 3 feet away, face mask, and standard
positive hCG(urine test), uterine enlarged, hegers sign(soft isthmus), chadwicks sign
probable signs of pregnancy are physical signs that the Dr. will assess
lump in the throat, n/v, weak, impending doom
prodromal response to allergen
GBS def
progressive inflamm autoimmune respnse occring in PNS, from compression of nerve roots/periph nerves; demyelination occurs and slows/alters nerve conduction
Meds for glaucoma
prostaglandin agonists, adrenergic agonists, beta blockers, cholinergic agonists, carbonic anhydrase inhibitors (sx- laser trabeculoplasty)
Casting
provides rigid immobilization of the affected area, provides stability and support to help with healing, may be plaster or fiberglass, diminishes skin problems, does not soften when wet Immediate Care: don't cover until dry, handle with palms of hands, don't rest on hard surface, keep above level of heart, check pulses, color and sensation. Watch for blueness, paleness, pain numbness or tingling sensation Intermediate care: When cast is dry pt should be mobilized After cast care: elevate limb
Anticoagulant Coumadin Uses
pulmonary embolism, venous thrombosis, prophylaxis after acute MI
Anticoagulant Heparin Uses
pulmonary embolism, venous thrombosis, prophylaxis after acute MI
xray visualize for kidney, ureters, and bladder
purpose of IV pyelogram
barium placed inrectum with xrays to observe for colon abnormalities
purpose of barium enema lower gi series
visual pelvic cavity in umbilicus incision
purpose of laparoscopy
needle aspiration of fluid in abd cavity to examine ascites
purpose of paracentesis
diagnoses for vitamin B12 deficiency
purpose of schilling test
purulent fluid
pus or infected discharge from wound or incision
kidney infection aka
pyelonephritis
Vagotomty and Pyloroplasty/gastroenterostomy
pyloric stenosis tx estbalishes gastric drainage;involves severing of vagus nerve
Vagotomy & antrectomy
pyloric stenosis tx remove of gastrin-secreting portion of stomach and severing of vagus nerve good for adults w/pud and stenosis
how often do you move ET tube to opposite side of mouth?
q24hrs
tuning fork diagnoses
qualitative hearing loss
blood analysis of TB
quantiFeron- TB gold
audiogram diagnoses
quantitative hearing loss
claustrophobia and any metal implants or pacemakers
question clients before MRI
epidural hematoma
quick onset, short periods of unconsciousness, pupil dilation, weakness in extremities, die quickly
Inserting fake eye
raise upper lid and slip in
pheochromocytoma
rare tumor of adrenal gland tissue. It results in the release of too much epinephrine and norepinephrine, hormones that control heart rate, metabolism, and blood pressure. hypersecretion of catacholamines
recessive or dominate - Pku?
recessive
Antivirals Uses
recurrent HSV, HIV infections
deep partial thickness
red to white burn with blisters, and painful
ATB chemos- Doxorubican(adria) SE's
red urine, nausea, vomtiting, stomatitis, alpoecia, cardiotoxicity, blisters, bone marrow dep
Antithyroid Agents Action
reduce vasularity of thyroid, inbibits release of thyroid into circulation
Bipolar Disorder: Action
reduces catecholamine release
Traction
reduces the fracture, alleviates pain and muscle spasm, prevents or corrects deformities, promotes healing
Antihypertensives: Alpha 1 Adrenergic Blockers Side Effects
reflex tachycardia, orthostac hypotension, nasal congestion
true labor
regular contractions, discomfort radiates from the back, intensity increases with walking, cervix effaced and dilated is true or false labor
position of fetus
relationship of fetal reference point to maternal pelvis
lie
relationship of spine of fetus to spine of mother
Antianginals Action
relaxes smooth muscle, decreases venous return
from 3-7 months
relfexes such as rooting/sucking, palmar, plantar and tonic neck reflex, moro, stepping reflex disappear at what time frame
Billroth II
remove of distal segment of stomach and antrum anastomosis with jejunum
Gastrectomy
remove of stomach and attachement to upper portion of duodenum
Electrolytes Actions
replaces needed electrolytes
unusual cramping, late period, spotting
report these abnormal signs to physician when using IUD
if problem with outflow of peritoneal dialysis do this for client
reposition cleint
balance sign
resonance over left side of abdomin signify spleen bleed
Balance's sign
resonance over spleen w/ pt on left side, indicates spleen rupture
Fatigue
rest, conserve energy
Attention Disorder Agents Side Effects
restlessness, insomnia, tachycardia, palitations
retinopathy of prematurity
retinal detachment, can occur when 02 conc greater than 40% and when used for longer than 48-72 hrs in infants
Descending or sigmoid colostomy (return, oder, drainage, appliance)
return: firm-solid odor: foul drainage: less irritating appliance: varies can be closed or open depending on stool type firm - closed liquid - open
ileostomy (return, oder, drainage, appliance)
return: liquid or semi/liquid oder: slightly odorous drainage: HIGH corrosive appliance: open-ended pouch - worn @ all times unless koch pouch (continent pouch)
where do defib and cardioversion paddles go?
right sternal and over apex of the heart
famliy hx, age >50, menopause after 55, first pregnancy after 30.
risk factors for breast cancer
advanced age, HTN, DM, smoke, obese, elevated lipids, oral contraceptives
risks for brain attack
Naegeles rule of EDB
rist day of LMP- subtract 3 months, add 7 days and one year
sample meal items for low residue diet
roast lamb, buttered rice, sponge cake, "white" processed food
meds for gonorrhea
rocephin with doxycycline, or aqueous penicilin with probenecid
what illnesses use airborne precautions
rubeola(measles), TB, varicella(chicken pox), shingles
what is a risk for a client with Mono
ruptured spleen
fever, swelling, redness, soreness
s/e of DTaP immunization injection
cramps, excess menstrual flow, infection
s/e of IUD
rash, fever, arthritis 1-2 weeks
s/e of MMR
nausea and vaginal infections
s/e of oral contraceptives
embolism
s/s dyspnea, pain, hemoptysis, restless, Low PaO2, high PCO2 (ABG)
low grade fever, CP with radiation, pulmonary edema, restless,
s/s of MI
paralytic ileus complication
s/s of absent bowel sounds, no flatus or stool,
croup
s/s of bark-like cough, dyspnea, cyanosis, inspiratory stridor
transient confusion, decreased LOC, HA
s/s of concussion
atelectasis, pneumonia
s/s of dyspnea, cyanosis, cough, tachycardia, elevated temp, pain on affected side
restless, cyanosis, anxiety, tachycardia, tachypnea
s/s of hypoxia
altered LOC, glascow coma scale, confusion, restless, pupil change, wide pulse pressure
s/s of increased ICP
fluid volume deficit
s/s of rapid weak pulse, hypotension, increased respirations, poor skin tugor, dry mucous membranes, increased Hct and increased urinary specific gravity
syncope, CP, palpitations, abnormal hear sounds, dyspnea, abnormal HR
s/s of rhythm disturbances
cool, clammy skin, cyanosis, decreased LOC, tachycardia, hypotension, shallow rapid respirations, urinary retention
s/s of shock
cyanosis, unable to talk
s/s of upper airway obstruction
hearing, vision, hieight weight, dental, medical, psycho
screeing for school age
PPD, development, sex, affect, breast/testicular, pelvic pap
screening for adolescents (6)
cystic fibrosis carrier, cholesterol, lead poisoning, neuroblastoma, DDST/Denver-II
screening for infant/child - 5
HTN, N/V
se of pitocin
bronchospasm or vagal stimulation
se of suction to watch for
second stage phase 1
second stage of labor watches movment so baby 0-+2 station,contraction 2-3 minutes apart
Antidepressants: Tricyclics Side Effects
sedation, anticholinergic effect, confusion, postural hypotension, urinary retention
Antidiarrheals: Side Effects
sedation, anticholinergic effects
Anticonvulsants Uses
seizures
dehiscence
separation of wound edges
Hormal agent indications
septecmia, and extravastion, ulceration afrter 48h
distributive shock
septic shock, toxic shock, anaphylaxis shock, neural induced loss of vascular tone
Nursing condsiderations
septicemia and extravation, redness, ulceration after 48 hours
protein malnutrtion
serum albumin test is to detect this
classic s/s of hypoglycemia
shakiness/tremor irritability nervousness
maternal hypotension, respiratory depression, fetal distress,
side effects to spinal anesthesia to mother
flail chest
sign of chest trauma affected side goes down during inspriation and up during expiration
hypotension (vasodilation), tachycardia, dysrhythmia
signs of allergic reaction in circulation
bounding pulse, HTN, dyspnea, rales/crackles, peripheral edema, decreased Hct and decreased BUN
signs of fluid volume overload
closed method of wound care
silvadene is used for these types of skin care for burns
levin NG tube
single lumen tube used for decompression or tube feeding
cantor, miller-abbott, harris tubes
single or double lumen intestinal NG with mercury filled balloon with suction
Instructions for colostomy irrigation
sit upright performed after a meal, SAME TIME each day 500-1500mL lukewarm water insert cath 3inches water flows in over 5-10mins, allow 10-15mins for return sleeve in place while pt moves around 30-45mins clean with soap water and pat dry
neutropenic precautions(prevent infection with immunosuppressed patients)
skin integrity qh8, breath sounds, temp q4 101 report, no fresh flowers! or standing water
Antidiarrheals: Actions
slows peristalsis, increases tone of sphincters
water balance,
sodium main job as an extracellular ion
not allowed in a high protein diet
soft drinks, "junk" food
keofeed/dobhoff
soft silicone NG for long term feedings
what other test confirms TB
sputum culture
care at home for croup syndromes: acute epiglottis/laryngotracheobronchitis
steamy shower, sudden exposure to cold air, sleep w/ cool humidified air
-one
steroids
Glucocorticoids Action
stimulates formation of glucose, alters immune response
Hypoglycemic Agent: Action
stimulates liver to change glycogen to glucose
Internal mouth care
stomatisis-5-4 days after s's's erythema, bleeding, ulcers oral rinse ns or sof tb avoid hot topical antifungals and anesthetics
Antineoplastic: Vinca Alkaloids Side Effects
stomatitis, alopecia, loss of deep tendon reflexes, bone marrow suppression
Antibiotics: Penicillins Side Effect
stomatitis, diarrhea, allergic reactions, renal and hepatic changes
what raises risk for reoccurance of herpes
stress, infection, menses
sucking chest wound
sucking sound with respiration, pain, decreased breath sounds and anxiety
Antidepressants: SSRIs Nursing Considerations
suicide precautions takes 4 weeks to fully work take in am turn urine pink
open method of wound care
sulfamylon is used for these types of skin care for burns
Antitussive Agents Actions
suppress cough reflex by inhibiting cough reflex in medulla, decrease viscosity of secretions
Open reduction
surgical dissection and exposure of the fracture for reduction and alignment
Glucocorticoids Side Effects
susceptible to infection and masks infection, insomnia, hypoglycemia, hypokalemia, psychoses, depression, stunted growth
Bouchard's nodes
swelling at the proximal interphalangeal joints (PIP) in osteoarthritis involving the hands
Bronchodilators Side Effects
tachycardia, dysrhythmias, palpitations, anticholinergic effects
Antidiabetic Agents: Nursing Considerations
take before breakfast Monitor glucose levels avoid alcohol
if meds cause nausea tell client to take TB meds at night
take meds at night
when you remember
take oral contraceptives same time each day but if miss one pill take it when
GBS recovery
takes months-year. Progression period of disease? 10 days
check cmc, monitor serum calcium, non-steroidal anti estrogen
tamoxifen-hormonal
chvosteks sign of hypocalcemia
tap on the side of the face and notice a musle spasm reaction in the cheek
Chvostek's sign
tapping over the facial nerve elicits abnormal muscle contraction; associated with hypocalcemia
monitor rate and rhythm, check for bleeding and infection, rest, hand scanner at airport, avoid strong magnets
teach and implement for pacemaker cleints
milk tube in direction of drainage and encourage patient tochange positions
teach chest tube to client
vitals, pulses, sensation, bleeding at insertion site and bedrest for 6-8 hours with insertion siste straight
teach client post op of cardia cath
remove jewlery, may experience nausea, flushing warmth, salty taste from dye
teach client pre angiography
NPO for 4-6 hours pre test, table will be moved during test
teach client pre myelogram
hold breath midexpiration and use of fluoroscopy with sitting over table or lying on side
teach client preparation of lung biopsy
NPO 6-12 hours, remove dentures, sore throat expected post op,
teach client these before bronchoscopy
flushed warm face and metallic taste during injection
teach experience of CT scan
arms at side, arms above, and hands on hips
teach inspection of breast exam position
relaxed, offer both breasts 5 min each, most areola into infant mouth, break suction by inserting finger
teach mother breast feeding techniques
frequent feeding every 30 minutes to every 3 hours, empty the breast with feeding, alternate starting breast, empty and save
teach mother to care for breast engorgment during brestfeeding
fluids, laxatives to prevent constipation, stool is white from barium
teach post op upper gi series barium swallow
NPO 6 hours prior, give sedative, hold breath during biopsy for 5-10 seconds
teach pre liver biopsy
expect tingling sensation with injection of anesthetic
teach the client this sensation when getting alocal anesthetic for thoracentesis
inhale, hold breath for 3-5 seconds, seal around mouthpiece, sit in semi-fowlers, max out respiration and secretions to prevent atelectasis
technique for incentive spirometer done 10 breaths per hour while awake
dont cross legs or elevate knees gatch
tell client to avoid these two positions
common medical diagnoses for low residue diet
temporary GI/elimination problems
non-stress test
test during pregnancy of mother eating a snack and recording FHR accelerations of 15 bpm to normal
cholesterol
test evaluates tendency for atherosclerosis, fasting
alpha-fetal protein test
test that is used to predict neural tube defects such as spina bifida during weeks 16-18 weeks of pregnancy
KUB, IVP, xray
tests that diagnose BPH
IM, anteroir or lateral thigh, repeat every 10 years
tetanus/diptheria TD booster is givne where and how often
thin greenish brown 3rd day
the first two days the newborn will pass meconium black tarry stool but the 3rd day
the dryer they are or dehydrated they are
the higher the Hct number and specific gravity this is what fluid imbalance
rubra - bloody
the lochia discharge from mother from day 1-3 after birth is this
during the menstrual period, check for string
the physician will insert IUD during this time of month for femal
T
thickening of or a lump in the breast or elsewhere
TORCH
this is the pneumonic for possible infections for pregnant mother and fetus
vitamin E and infant eyes...
thought to affect tissue response to 02
duration
time in seconds from beginning to end of contraction
icepacks, tight fitting bra
tips for breast care for non-breast feeding mothers
purpose of renal diet
to keep protein, potassium, and sodium low
purpose of sodium restricted diet
to lower body water and promote excretion
purpose of clear liquid diet
to maintain fluid balance
purpose of high roughage, high fiber diet
to maximize bulk in stools
purpose of low residue diet
to minimize intestinal activity
purpose of high protein diet
to re-establish anabolism to raise albumin levels
purpose of low fat, cholesterol restricted diet
to reduce calories from fat & minimize cholesterol intake
simple directions
toddler teaching preop
arm is extended wherehead is turned
tonic neck reflex is this
Antibiotics: Cephalosporins Uses
tonsillitis, otitis media, peri-operative prophylaxis, meningitis
Nutriton
tpn, monitor for anorexia
Hormonal Agent-tamoxifen
transient fall in wbc or platelets, hypercalcmeia, bone pain
trhobolytic therapy(streptokinase, t-PA), bed rest, beta blockers, morphine, dysrhythmics, anticoagulants
treatment for MI includes
phototherapy(blue light), exchange transfusion, fluids, cover eyes and genitals
treatment for hemolytic jaundice
cardiac monitor, meds, defib, pacemaker
treatment for rhythm disturbances
O2, BP > 90 mmHg, CVP, I/O, isotonic solution all to increase tissue perfusion, body temp maintained, ABG,
treatment for shock
steamy shower, sudden exposure to cold air, cool, humidified air
treatment of croup toddler
sengstaken blakemore
triple lumen NG tube used for esophageal varices
how often oral hygiene for mech vent?
twice shift
surgery within past two weeks, pregnancy
two contraindications for throbolytic therapy for an MI
antiarrythmics, antilipids
two meds for rhythm disturbances
type 1 dm @ risk for _____ type 2 dm @ risk for ____
type 1 - diabetic ketoacidosis type 2: HHNK
Halo Fixation Device (vest)
type of skeletal traction Purpose: Provides immobilization of cervical spine; Pins are used to maintain traction Treatment: --Maintain sterile technique when cleansing area around pins (1-2 times/day)
streptokinase, t-PA, beta blockers, morphine, antidysrhythmics, anticoagulants
types of meds for MI
diuretics, corticosteroids, anticonvulsants
types of meds to help decrease ICP
Antibiotics: Sulfonamides Uses
ulcerative colitis, Crohn's, otitis media, UTIs
H2-Receptor Blockers Uses
ulcers, gastroesophageal reflux
aphasia
unable to speak or use of language
urinary retention
unable to void 8-12 hours post op with bladder distention
sample meal items for renal diet
unsalted vegetables, white rice,canned fruits, sweets
Unsealed internal radation
unsealed liquide, instilled in body cavity, iodine all body fluids effected greatest danger for fluid in first 24-96 hrs
U
unsual bleeding or discharge from any orfice
diptheria
upper respiratory bacterial disease
cystitis assessment
urgency, frequency, burning, cloudy, strong odor urine
what indicates that diabetic control has deteriorated and body has started to break down stored fat for energy
urine ketones
kidney stones or renal stones aka
urolithiasis
Internal fixation
use of metal screws, plates, nails, and pins to stabilize reduced fracture
Chemo 4 hormonal action testcaolane) androgen
used for palliative care in advance breast cancer
ALkylating Agent Nursing considerations
used whith other chemo drugs, check hematopoetic function weekly. Encourage fluids, 10-12 glasses a day
isometric exercise
useful for building strength, involves a held contraction against an immovable base, alternate contraction & relaxation of muscle, maintains strength of muscle when joint is immobilized
preventing meningitis
vaccine 65+ w/ chronic diseases, revaccinate in 5 years; hib vaccine for infants
Correlated with chemical
vaginal cancer acute myelogenous leukemia non-hodgkins lymphoma multiple myeloma lung cancer
off baseline
variablilty of FHR is defined as
Antiplatelet Agents Uses
venous thrombosis, PE
xray only way, aspirate for gastric contents,
verify NG placement
NPO 12 hours before cardiac catheter, sign permit, empty bladder, pulses
verify client before cardia catheter
turn on left side
vertigo:vena cava syndrome and implement care during pregnancy
vibrating pressure is applied to chest as person exhales
vibration technique for drainage
#5 VInca alkaloid meds
vinblastine(velban) vincristine (onocovin)
strabismus s/s, trmt
visible deviation of eye, diplopia, child tilts head/squints to focus. Occlude unaffected eye to strenghten weaker eye
assess for BPH
voiding difficulty, frequent, urgent, hesitant, blood in urine, nocturia
Antidiarrheals: Uses
vomiting
warm v cool compresses for eye
w/ contusions cold compress, w/ eye infection/inflammation warm compresses
purified protein durivative
waht does PPD stand for
Preop ostomy diet
week before surgery - high calorie, high protein, high carbs, low-res (fiber) diet evening before - laxatives/enemias / NPO after midnight
implement peritoneal dialysis
weight before and after, BP, breath sounds, sterile technique
15% legs and 9.5% arm
what % of child infant is burned on arms and legs
19% head and 32% torso
what % of child/infant bursn to head and torso
low pressure and low exhaled volume
what alarms are set on a ventilator
escymia and electrolyte imbalance
what are causes for Ventricular distrubances
bladder and bowel distention, pain, or tactile over stimulation
what are causes to autonomic hyperreflexia from spinal cord injury
febrile illness, altered immune system, allergic response, recent passive immunity(blood transfusion)
what are contraindications for immunizations
long term benefits, accept regression and provide privacy
what are good tips for adolescent before procedure
allow questions, explain why, handle equipment
what are good tips for school age child
do not disconnect cathter from drainage system, don't remove more than 700 ml of urine at one time
what are not to be done with a cathater system
younger than 18 or 35 yo or older, poor nutrition, diabetes, renal or vascular disease, family hx, large fetus, proteinuria
what are risk for PIH(pregnancy induced hypertension)
UTI and toxic shock syndrome
what are risks for the use of diaphragm
irregular bleeding, nausea, skin changes
what are s/e of norplant
vomitting, diarrhea, gastric suction, diuretics, steroids, inadequate intake
what are some causes of hypokalemia
pneumothorax, air embolism, infection
what are some complications of CVP
distraction, simple explanations
what are some tips for toddlers before procedures
syphilis, strp, HEP A or HEP B, Aids
what are the OTHER infections for TORCH
head engaged, ripe cervix, mature vertex/head presentation
what are the indications to induce labor
<195 hour 1, <165 hour 2, <145 hour 3
what are the normal findings of all three hours of glucose tolerance test.
puppets, dolls, demonstrate equipment, eye level
what are tips for pre-schooler
tranquilizers, stimulants (caffiene and cigarettes) withheld
what are withheld from the client pre EEG
low Hct and low hCG levels
what blood tests will confirm ectopic pregnancy
pull up to stand with help
what can 10 month old do for movement
change masks, tubing, mouthpieces daily
what can be done to avoid infection on O2 therapy
retinopathy of prematurity
what can happen to infant if oxygen toxicity occurs
low concentrations of O2
what can prevent retinopathy of prematurity for infant
internal radiation implants, hysterectomy
what care for endometrial cancer
fetus Rh+ and mother is Rh-.
what condition is mother and fetus for mother to receive Rhogam
diabetes, postmaturity, PIH, fetal jeopardy,
what conditions of mother/fetus may induction of labor commence
O occiput, S sacrum
what do the O or S stand for position
evaluates renal function, affected by protein intake, tissue breakdown, fluid volume changes
what does BUN detect and how is the number affected
Haemophilus Influenza type B (Hib), 2,4,6, 12-15 months (4 injections)
what does Hib mean and when are the injections given
transurethral resection prostate
what does TURP stand for
liver function and bone function 30-150 units/L
what does alkaline phosphatase check which organ
specific arterial areas
what does angiography assess
FSH
what does oral contraceptives inhibit release of what hormone
avoid hypoxia and trauma to airway
what does suctioning procedure try to avoid
erythromycin/tetracycline/silver nitrate
what eye prophylactic medication for newborn to prevent infection in eyes
LR rapid infusion first 8 hours
what fluid is forced for burn patients
candy, nuts, seeds, or cut up hot dogs
what foods to avoid for infant
elevated to all WBC, ESR, CK-MB and troponin
what four blood tests prove MI
ET tube first then suction mouth
what gets suctioned first then second mouth and ETT tube
cut off contaminated tip, insert sterile connector and immerse end in 2 cm of sterile water and reinsert
what happens if tube becomes disconnected from drainage system
apply dressing tented on one side to allow for air to escape
what happens if tube is dislodged from client
gravity helps position tube
what helps position intestinal NG tube
hypovolemia
what if CVP is below < 3 cmH2O
right side of heart to manage fluid and cardiac pumping volume
what is CVP checking for
effective for 5 years, surgical insertion and removal
what is Norplant contraceptive
no, so give choices
what is a 2 year old (initiative) common to say and what is a good tip for parent.
if the head is too big such as CPD
what is a contraindication to induce labor
vitamin K IM
what is administered IM to avoid excess bleeding
diarrhea, constipation, tarry stools
what is also assessed when client on a ventilator beside respiratory status
muscle relaxant vasodilator for HTN
what is apresoline med
incision, drainage, amount and character, drains,
what is assessed at the surgical sight post op
dont squeeze eye after eye drops are placed
what is avoided when giving eye drops
clear thin and slippery
what is cervical mucus look like during ovulation
blue color of cervix
what is chadwick sign of pregnancy
temperature and volume
what is checked for humidified O2 on ventilator
hold breath
what is client instructed to do when tubing of CVP is inserted, withdrawn or tubing changed
vitals x 15 min, LOC, I/O, CVP, potassium levels, respiratory care
what is closely monitored post-op
after contraction starts to subside FHR decreases
what is considered late deceleration
between 20-37 weeks
what is considered pre-term labor
dont give asprin
what is contraindicated after DTaP injection
termination of pregnancy before viable or 20 weeks/500 g
what is definition of abortions
difficult to measure amount of O2 delivered
what is difficult to monitor for a croupetteor oxygen tent
stop anesthesia, muscle relaxant
what is done if client experiences malignant hyperthermia when receiving anesthesia
loss of independence and body image disturbance, involve in procedure, understanding and strengths
what is expected behavior of adolescence pre surgery
experience heat, palpitations, desire to cough when dye is injected
what is explained experience for acrdiac catheter
loss of control and allow choices
what is fear before surgery of a school age child and what is good implementation
check fetal heart tones, and check for prolapsed cord
what is first thing to do when membranes are ruptured during labor
head elevated 8-16 hours, neuro assessed every 2-4 hours, fluids, analgesics
what is given and monitored for myelogram
IV fluids fast to prevent maternal hypotension
what is given to mother before a regional lumbar epidural block is given
dont heat breast milk in microwave
what is good tip for reheating breastmilk
risk for bleeding
what is high risk for a liver biopsy
dry crackers in morning/ small frequent meals
what is implement for morning sickness
vitals and I/O and teaching to reduce risks
what is implementation monitor and teaching
sulfa drugs or ampicillin
what is medications used for pregnant mother with UTI
minimum 5Lpm
what is minimum Lpm of O2 for a face mask
allergy response and encourage fluids to flush dye
what is monitored and encouraged post CT scan
monitor for dyspnea
what is monitored for post test of pulmonary function test
contraceptive foam
what is needed if the condom is broken during sex
no late decelerations of 3 contractions in ten-minutes
what is negative contraction stress test result show
65/40 in arm or calf
what is normal BP of newborn
FHR acceleration
what is normal FHR response during mother contraction
cerivcal mucus is normally thick, cloudy and sticky
what is normal cervical mucus shown during nonfertile time of month
fluid fluctuates with respirations
what is normal sign of fluid fluxuation of CVP manometer
24-28 pounds
what is normal weight gain for pregnant client full term
three middle fingers to palpate, circular motion while lying down
what is part of hand is used to inspect breasts
check hemorrhage or respiratory distress, xrays, resume diet
what is post op care for colonoscopy
striking of chest wall with cupped hands over area of secretion to facilitate drainage
what is puprose of percussing chest
used with angiography to introduce catheter into heart chambers for pressures and ventricular function
what is purpose of cardiac catheter
relaxes smooth muscle for the ease of urinating
what is purpose of flomax
lung tissue removal for culture or cytology
what is purpose of lung biopsy
obtain specimen, relieve lung compression,
what is purpose of thoracentesis
prevent aspiration of fluids
what is purpose of trach tube cuff
determine esophagus patency and size, gastric walls pyloric valve and rate of passage into small bowel
what is purpose of upper GI series barium swallow
sterile dressing applied
what is put over incision after lung biopsy
neurogenic bladder
what is reason for using intermittent self-catheterization
provides fixed concentration and high humidity
what is significant of venturimasks
hyperventilate during test, kept awake night before test, eating is allowed
what is taught pre EEG test
encourage fluids, rinse mouth out with water, dont brush teeth, eat or use mouthwash
what is taught to client before taking a sputum analysis
turn, cough, deep breath, pain meds, incentive spirometer, PCA, teach mobility asap
what is taught to client post op unless dr. stated restrictions
allow rest, check hemorrhage, fluids
what is taught to client post sigmoidoscopy
sit or lie on side, NPO until gag relfex returns to avoid aspiration, monitor for respiratory difficulties
what is taught to client postop bronchoscopy
laxative night before, enema or suppository am before and NPO midnight
what is taught to client pre sigmoidoscopy
NPO 8 hours prior, numbing throat
what is taught to client pre stomach/esophagus endoscopy
no smoking 4 hours prior to exam and bronchodilators may be restricted until after test
what is taught to client preparing for a pulmonary functio test
head injury to the pituitary gland that regulates the diuretic hormone
what is the cause for diabetes insipidus or decreased ADH
pulmonary complication so Ang I is not converted to Ang II so retains water
what is the cause of the SIADH
prevents implantation of fertilized egg
what is the puropose of the contraceptive IUD intrauterine device
prevent obstruction and remove sediment
what is the purpose of catheter irrigation
bed rest, air mattress, restrict movements, foley catheter
what is told to cleint with internal radiation implants for endometrial cancer
full bladder
what is told to client before ultrasound to assist clarity of image
prevent pregnancy for 3 months
what is told to female client before a live attenuated rubella vaccine is given
clear liquid diet 24-72 hours prior, cathartic(go lightly) in evening for 2 days prior, enema am before exam
what is toldto client prepare for colonoscopy
visualizes spnal column and subarachnoid space
what is use of myelogram
pressure garments
what is used to prevent scarring from burn victim
tripled weight
what is weight of child at 12 months
phenothizines, CNS depressants and stimulants held for 48 hours pre
what is withheld form client pre myelogram
pitressin to conserve water
what med is administered for diabetes insipidus
oral hypoglycemic meds due to cause hypoglycemia in fetus
what med is avoided for GDM.
apresoline IV slowly
what med is given for autonomic hyperreflexia
calcium gluconate slow IV
what med is given iv for hypocalcemia
antimicrobial phrophylaxis antibiotic
what med is given postop cystoscopy
maalox (antacid)
what med is high in magnesium
terbutaline used to delay preterm labor
what med is used to delay preterm labor and is not used to stop preterm labor
kayexalate, calcium gluconate, sodium bicarb IV, diuretics,
what meds are used to treat hyperkalemia
allergy to shellfish or iodine
what must ask client for allergies pre CT scan
IV fluids
what must be given to mother when receiving a spinal anesthesia
parathyroid hormone and vitamin D
what organ regulates calcium
fundus from slightly tense to firm
what part of mother are contractions strength measured
supine, lateral with upper arms elevated
what position for client before liver biopsy
dorsal recumbent or sims position
what position is catheter of woman done
semi-fowlers or side lying
what position is contraction stress test for pregnant mother at 28 weeks
lateral recumbent fetal position
what position should client be in for a lumbar puncture
denver development screening test
what screening test for developmental from birth to 6 years
no vaginal or rectal exam
what should be intervened if Dr. performs these procedures on a client with placenta previa
thumb and forefinger
what should be used to palpate testicles
6-15 mg/day
what sodium amount diet should be given to fluid volume overload client
high protein, high carbohydrate, high sodium, low potassium diet
what specific diet is made for addisons disease
GTT normal 60-110 mg/dl
what test is diagnostic for diabetes mellits
platelet count
what test is for hemorrhagic disease
PT/INR
what test monitors coumadin therapy 9.5-12 seconds
PTT
what test monitors heparin therapy 20-45 seconds
tidal volume, RR, pO2(fraction of inspired O2), need for suction, mouth care
what to assess for a client on a ventilator
dressing, drainage, breath sounds, vitals
what to check for post-op thoracentesis
dimpling, discharge, or any other changes
what to look for in breast exam
NPO until gag reflex returns, check blood in vomit, respiratory distress and sore throat for 3 days
what to moniotr for postop stomach/esophagus endoscopy
bedrest 24 hours, vitals, clotting times, platelets, Hct, abd pain
what to monitor for after liver biopsy
hematoma, vitals, skin temp and color, sensation
what to monitor post angiography
separation, regression, difficult separation
what to teach parent pre-op about toddler going in for surgery
shoulder back pain from CO2 and will decrease
what to warn client post op laprascopy
silver nitrate/ silvadine
what topical ointment is used for burn victim
glucosuria, proteinuria
what two abnormal urine specimens are risk for GDM
aseptic technique
what type fo technique is used to changed post op dressing change
humidified air
what type of O2 is administered for trach collar.
hypotension
what type of blood pressure assessed for tenion pneumothorax
acid-ash diet- meat, eggs, fish, cereal, no milk or cheese
what type of diet for a preop BPH surgery
high protein, low carbohydrate, low calorie, high potassium low sodium diet
what type of diet is used for cushings syndrome
high fat low carbs
what type of diet is used for seizure client
high calorie, high carbohydrate, high protien diet
what type of diet is used to promote healing of burn victim
antipyretics
what type of meds are given for croup
sedatives or analgesics
what type of meds for a lung biopsy
clean technique
what type of risk technique is intermittent self-cathterization
aseptic technique
what type of sterile technique is followed during surgery
ischemic stroke within
what type of stroke uses thrombolytic therapy
heparin syringe
what type of syrnge is used for ABG Allen test
pacemaker
what type of unit is used to treat heart blocks of rate of 20-40 blpm
ampicillin, polymyxin and cephalothin
what types of antibiotics are used for septic shock
deep breathing, leg exercises, incentive spirometer
what types of teaching are reviewed before surgery for post-op
vitamin k,
what vitamin is administered to begin normal blood clotting in newborn
B, C, and iron
what vitamins are prescribed for burn victim
water jelly around the nares every 3-4 hours
whatcan beplaced around nares if on NC
6 months
when after birth is the birth weight doubled
use sterile container, collect in early am
when and how is sputum collected
warm shower once a month
when and where should a testicular self exam be done
12-15 months, 4-6 years, (2)
when are MMR inections
1-3 months
when can a cleft palate be fixed
until lochia flow is ceased or episiotomy is healed
when can sex reoccur after postpartum
bleeding ceases
when can sex resume after tubal ligation
no tub baths until cord falls off
when can the baby get their first bath
1-2 weeks
when does the umbilical cord fall off newborn
Kernig's
when hip flexed to 90, complete extension of knee is restricted/painful
16 weeks
when is an amniocentesis done through abdomen to the amniotic sac to detect genetic disorder
checked at 1-5 minutes
when is apgar score checked after delivery of newborn
3-5 days postop
when is infection anticipated post-op
2,4,6,12-15 months (4)
when is pneumococcal vaccine given
38-42 weeks
when is pregnancy at the "term"
drop in basal body temp before ovulation and slight rise after ovulation
when is the fertile period for the client during the month
mechanical vent, during and after eating and tube feeding, presence of oral secretions
when is the trach tube cuff inflated
valsalva maneuver and clamp chest tube, remove quickly, apply occlusive dressing
when removing chest tube have pt. do this before removal
When do you instruct the pt to change appliance?
when seal breaks or when 1/3- 1/4 full
schedule after menstrual period
when should a mammography be done for breast exam
one week after onset of menstrual period or designated day
when should breast self exam occur in the month
after 50
when should fecal blood occult test be done
IPV 2,4,6-18 months, 4-6 years (4)
when should inactivated poliovirus immunization be given
contractions last longer than 90 seconds
when should pitocin be stopped.
q 6- 8 hours each part of day
when should self-cathterization be accomplished
every 24 hours
when should the diaphragm be removed
longer than 90 seconds
when should the duration of a contraction be reported
less than two minutes apart
when should the frequency of contractions be reported
moro reflex
when the newborn loses the feeling of support by extending the arms and fingers outward
20 weeks
when would fundus of pregnant client be at the umbilicus
central line threaded into right atrium
where is CVP placed
SQ anterior/lateral thigh
where is MMR given
common bile duct 500-1000 ml/day, keep below waist, gall bladder surgery
where is a T-tube drain located and used for and checked for
IM anterior/lateral thigh
where should DTaP be injected
drainage port only and clamp below port
where should a urine sample be collected with a catheter
brachial pulse
where to check pulse of an infant in arrest
above T6
where would autonomic hyperreflexia occur from a spinal cord injury
anterior fontanelle
which fontanelle closes last posterior or anterior
fenestrated tube
which trach tube is designed for client to talk
not allowed in a high roughage, high fiber diet
white bread, pies and cakes from white flour, "white" processed foods
vernix caseosa
white film on parts of the newborn that will eventually fall off
involve family and help reinforce teaching
who can help in preop teaching for children
health care provider
who fits the diaphragm for the client
not allowed in a low residue diet
whole wheat, corn, bran
Ihair
wig
nurses responsibility for patient bill of rights of informed consent
witness signature and consent attached to chart
formula feeding
yellow to light brown stool is shown from this type of feeding
DTaP, IPV, MMR and tine
you can give these 4 immunizations at the same time
Russell's Traction
"Pulls" contracted muscles; elevate foot of bed with shock blocks to provide countertraction; sling can be loosened for skin care; check popliteal pulse. Place pillows under lower leg. Make sure heel is off the bed. Must not turn from waist down. Lift patient, not leg, to provide assistance.
Antiparkinson Agents Med Names
(-dopa) Artane, Cogentin, L-Dopa, Parlodel, Sinemet
Chemo 4- hormonal agents actions (tamofifen) (antiestrogen)
(competes with estrogen to bind at estrogen receptor sites on malignant cells)
Paget's Disease
*Breakdown of bone tissue* Data:Pain, Bowed legs/decreased height, Shortened trunk with long-appearing arms, Enlarged skull, labored/waddling gait, Kyphosis (hump back), Pathologic fractures Diagnose: Unknown etiology, excessive bone resorption (loss), Occurs more in older adults. Plan: 1. Administer analgesics, 2. Encourage rest 3. Prevent Pathological Fractures 4. Administer meds: Calcitonin (Miacalcin), biphosphonates ex. Alendronate (Fosamax); pamidronate (Aredia)
Neuromuscular disorder: Cerebral Palsy:S/Sx
*a loss or deficiency of motor control with involuntary spasms caused by permanent brain damage present at birth; poor control over muscles due to brain damage (cord wrapped around neck) Athetosis (twisting movements), spasticity, rigidity, ataxia, atonicity; repetitive, involuntary, slow, gross movements. Neonate:cannot hold head up, feeble cry, inablility to feed, body noticeably arched or limp. Infant: failure-to-thrive syndrome. Toddler/preschooler: mental retardation, delayed physical development.
Sx of Developmental Dysplasia of the Hip (DDH)
*acetabulum unable to hold head of femur* 1. Uneven gluteal folds an thigh creases (deeper on affected side). 2. Limited abduction of hip with pain. 3. Ortolani's sign (seen in infants <4 weeks old):Place infant on back, leg flexed. Click sound heard when affected hip is moved to abduction. 4. Shortened limb on affected side in older infant and child. 5. Delays in walking; limp, lordosis, and waddling gait with older child.
Neuromuscular disorder: Muscular Dystrophy: S/Sx
*any of several hereditary diseases of the muscular system characterized by weakness and wasting of skeletal muscles; degenerative disease- slowly takes away use of muscles (legs first)* Muscle weakness, lordosis/scoliosis, waddling gait, joint contractures. Stumbling and falling.
second stage phase 2
+2-+4 station, contractions 2-2.5 min apart, increase dark red bloody show, increased urgency to bear down
second stage phase 3
+4 station to birth, contraction 1-2 minutes apart, fetal head visible, urgency to bear down increased, dilvery of fetus
Complications from Fractures
- Fat Emboli - Delayed Union - Malunion - Nonunion - Sepsis - Compartment syndrome
Body response to pain
- Increase pulse, respirations - Pupil dilation - Increased perspiration and muscle tension - Altered GI motility
Complications of Fractures
--Fat emboli- (long bones) fat globules move into bloodstream. --Hemorrhage --Delayed union- healing is slowed; caused by infection or distraction of fractured fragments; Bone pain will increase --Malunion- Improper alignment of fractured fragments. May develop with premature weight-bearing --Nonunion-Healing has not occurred 4-6 months after fracture. Why? Insufficient blood supply, repetitive stress on fracture site, infection, inadequate internal fixation --Sepsis --Compartment syndrome: High pressure within a muscle compartment of an extremity compromises circulation. Pressure may be internal (bleeding) or external (casts). If left untreated neuromuscular damage occurs within 4-6hrs; Limb can become permanently useless within 24-48 hrs --Peripheral nerve damage
Beta Blockers
-lol can cause bronchspasms airway is a consideration
Antihypertensives: Beta Blockers Med Names
-lol (beats)
Antibiotics: Aminoglycosides
-mycin
Antihypertensives: Alpha 1 Adrenergic Blockers Med Names
-osin
Benzodiazepines
-pams
Antihypertensives: Calcium Channel Blockers Med Names
-pine, Cardizem
Antihypertensives: Ace Inhibitors Med Names
-pril (think arteries)
Antihypertensives: Angiotensin II Receptor Blockers Med Names
-sartan
Caution
...
ET 4- Classifications
...
Nursing Implications for All SE's
...
Nursing management #1 Chemotherapy
...
Insulin: Fast Acting Onset
.5-1h
Insulin: Combination Onset
.5h
phase one of first stage of labor(latent)
0-3 cm dilation, contraction 10-30 seconds/5-30 minutes apart, mild to moderate intensity
Digoxin Therapeutic Levels
0.5-2
normal creatinine levels
0.7-1.4 mg/dl
how often breaths given during CPR w/ advanced airway
1 breath q6-8 secs (8-10 breaths/minute)
What meds will a pt be on for ulcers? (5)
1) Antacids (maalox) admin 1 hr before meals or 2hrs AFTER meals 2) Histamine Recep site antagonists (Tagamet) take WITH FOOD 3) Anticholinergics (Pro-Banthine) 30 mins before meals 4) Cytoprotective agents (Carafate) 1 hr before meals 5) Protein Pump inhibitors (Prilosec)
What is the proper nursing care for a client in Buck's traction?
1) The nurse removes the foam boot 3 times per day to inspect the skin. 2) The staff turns the client to the unaffected side. 3) The nurse asks the client to dorsiflex the foot on the affected leg. (assessment of the perineal nerve; weakness of dorsiflexion may indicate pressure on the nerve) 4) The staff elevates the foot of the client's bed. (provides countertraction) 5) Back care should be provided Q2H to prevent pressure sores.
Self-monitoring BG teaching (4)
1) check pts eyesight - ensures able to draw up amt 2) calibrate monitor 3) check exp date of test strips 4) keep log book 5) check skin/feet talking
Sick Day Rules: 4
1) continue taking med 2) check BG & urine ketones q-3-4hrs 3) vomiting, diarrhea, or fever - contact dr 4) liquies intake .5-1hr (cola, broth, gatorade)
Name 8 risk factors of DM
1) parents/siblings w/dm 2) Obesity (20% of ideal body wt) 3) African, Hispanic, Native, Asian 4) >45yrs 5) prev imp fasting glucose 6) HTN 7) HDL <35 / triglyceride >250 8) hx of GDM or baby >9lbs
After post op of ulcer surgery, what would you teach about dumping syndrome? (6)
1) restrict fluids w/meals (1hr before/after) 2) Avoid salt, sugar, milk 3) HIGH protein, HIGH fat, HIGH fiber, LOW CARBS!! 4) small freq meals with ZERO fluid during 5) lie down 20-30mins after eating 6) Antispasmotic drugs
normal urine excreted/day
1,000-2,000 ml day
what type of drainage may you see in the ostomy 1-2 days after?
1-2 days, just mucus or serosanguneous drainage 3-6days post op: function works
Stinulant Abuse - symptoms of withdrawal
1. Apathy 2. Long periods of sleep 3. Irritability 4. Depression 5. Disorientation
Preop plan for Herniated Intervertebral Disk
1. Apply moist heat 2. Put Pt in Fowler's position with moderate hip and knee flexion. 3. Use firm mattress, bedboard, or floor for back support. 4. Isometric exercises for ABD muscle. 5. Daily exercise program. 6. Assist with exercise initiated in PT. 7. Medications:Muscle relaxants, NSAIDs, analgesics. 8. Traction: separates vertebrae to relieve pressure on nerve 9. TENS (Transcutaneous electrical neruve stimulations) 10. Log Roll when moving
Plan for Sleep Apnea Syndrome
1. Avoid alcohol and medications that depress upper airway. 2. Weight-reduction diet and activity 3. For severe cases, if client is hypoxic and hypercapnic (too much carbon dioxide), will use continusous positive airway pressure (CPAP) or bilevel positive airway pressure (BIPAP) with additional oxygen. *Air pushed thru nose or mouth into lungs to open up airway and keep them breathing. 4. Position-fizing devices used to prevent tongue obstruction and subluxation of neck 5. Surgery to correct obstruction 6. Low-flow oxygen 7. Tracheostomy if life-threatening dysrhythmias are present; unplugged only during sleep
Korsakoff's Psychosis implementation
1. Balanced diet 2. Thiamine 3. Abstinance from alcohol
Wernicke's Syndrome Assessment
1. Confusion 2. Diplopia, Nystagmus 3. Ataxia 4. Apathy
Osteoporosis: Plan/Tx
1. Diet high in Ca+, protein, and Vit D. 2. Encourage weight-bearing on the long bones (walking) 3. Fall Prevention 4. Physiotherapy 5. Teach about Medications 6. Safety precautions to prevent pathological fractures (from weakened bones) -Use back brace or splint for support -Use bedboards or hard mattress 7. Medications: calcitonin (Miacalcin), biphosphonates (ex. alendronate), selective receptor modulators (ex. raloxifen), estrogen replacement therapy.
Alcohol Withdrawal Delirium Asssessment
1. Disorientation 2. Paranoia 3. Ideas of reference 4. Suicide attempts 5. Grand mal seizures
Acute Alcohol Intoxication Assessment
1. Drowsiness 2. Slurred speech 3. Tremors 4. Impaired thinking 5. Belligerence 6. Loss of inhibitions
Patient teaching for Herniated Intervertebral Disk
1. Exercise daily but avoid strenuous exercised 2. Correct posture at all times 3. Avoid prolonged sitting, standing, walking, driving 4. Rest at intervals 5. Use hardboard or firm mattress for bed 6. Avoid prone position 7. Avoid straining or lifting heavy objects.
Transfer: Assist to Stand
1. Face to face with patient 2. Grasp each side of pt's rib cage 3. Push knee against clients knee 4. Rock pt forward to standing position 5. Pivot pt to sit in chair 6. Place chair on pts stronger side
Cannabis Derivative Abuse Assessment
1. Fatique 2. Paranoia 3. Suphoria 4. Increased appetite 4. Disoriented behavior
Cannabis Derivative Abuse symptoms of withdrawal
1. Insomnia 2. hyperactivity 3. Decreased appetitite
Stimulant Abuse Implementation
1. Maintain airway 2. Start VI 3. Check LOC and VS 4. Activated Charcoal 5. Gastric lavage 6. Monitor for suicide
Narcotic abuse Implementation
1. Maintain airway 2. control seizures 3. Check LOC and VS 4. Narcan to reverse respiratory depression 5. IV glucose 6. Hemodialysis to eliminate drug from the bdoy
Nonalcoholic Sub. Abuse - Barbiturate Abuse Implementation
1. Maintain airway 2., check LOC and VS often, can go into shock or have cardiac arrest 3.Start IV with large-gauge needle 4. may give Sodium bicarbonate 5.May use Activated charcoal 6. may do a Gastric lavage 7. May do Hemodialysis
General care for Nonalcoholic Sutstance Abuse
1. Maintain airway 2. Administer Narcan -stimulates respirations 3. May require Gastric lavage, dialysis - couple of ways to rid system of the drug 4. Seizure precautions 5. Decrease stimuli, calm environment, protect from self destructive behaviors 6. Stay with patient 7. provide rest, nutrition and 8. therapy - group, individual
Hallucinogen Abuse Implementation
1. Maintain airway 2. Control seizures 3. Check LOC and V S 4. "Talk down" client 5. Reduce sensory stimuli 6.Small doses of Valium
Postop plan for Herniated Intervertebral Disk
1. Maintain body alignment 2. Log-roll every two hours with pillow between legs 3. Calf exercises 4. Assess for sensation and circulatory status, especially of lower extremities. 5. Monitor elimination 6. Assist with ambulation 7. Support neck after cervical laminectomy 8. Straight back during ambulation.
Osteomyelitis: Plan/Tx
1. Medications: analgesics, antibiotics, antipyretics. 2. Teach about risk factors for osteomyelitis (eg. joint prostheses) 4. Support affected extremity with pillows, splints to maintain proper body alignment. 5. Provide cool environment and lightweight clothing. 6. Avoid exercise and heat application to the affected area. 7. Encourage fluid intake, monitor intake and output. 8. Asepsis with wound care 9. Provide diversionary activities 10. High-protien diet with sufficient carbohydrates, vitamins, and minerals (build bone) 11. Instruct about home wound care and antibiotics administration
Korsakoff's Psychosis assessment
1. Memory disturbances with confabulation (Making it up) 2. Learning problems 3. Altered taste and smell 4. Loss of reality testing
So implementation with either/or Alcohol Withdrawal and Delirium
1. Monitor VS, especially pulse 2. Administer sedation, anticonvulsants(usually given if has a history of seizures), thiamine (IV or IM), Glucose (IV) 3. Place in a quiet, well lighted environment(light to prevent illusions) 4. Stay with patient to inc their orientation, minimize their confusion, dec stimuli- no visitors, no TV, o phones
Transfer: Assist Out of Bed
1. Move toward stronger side 2. Use leg muscles, not back to move client 3. Use draw sheets 4. Have assistant
hallucinogen abuse assessment
1. Nystagmus 2. Confusion 3. Hyperactivity 4. Distorted body image 5. Delirium 6. Self injury 7. Flashbacks
Chronic Alcohol Dependence Assessment
1. Persistent incapacitation 2. Cyclic drinking or 'binges' 3. Others in family take over client's role - codependence 4. family violence
Characteristics of Nonalcoholic Substance Abuse
1. Physiological and psychological dependence 2. Increasing doses needed to maintain 'high' 3. Low frustration tolerance 4. Need for immediate gratification
Transfer: Assist to sit on side of bed
1. Place hand under shoulders and knees 2. Have client push elbow into bed 3. Lift shoulders and swing legs over edge of bed
Acute Alcohol Intoxication Implementation
1. Protect airway 2. Assess for injuries 3. Assess for withdrawal 4. Assess need for IV glucose 5. Counsel about alcohol use
Plan for Developmental Dysplasia of the Hip (DDH): Newborn to 6 months
1. Reduced by manipulation 2. Splinted with proximal femur centered in the acetabulum in position of flexion. 3. Pavlik harness:worn full-time for 3-6 months until hip is stable for infants <3 mos. 4. Encourage normal growth and development by allowing child to perform appropriate activites 5. Teach parent to reapply harness and explain rationale for maintaining abduction 6. Tell parents to move child from one room to another for environmental change 7. Discuss modification in bathing, dressing, and diapering with parents. 8. Tell parent to touch and hold the child to express affectopm and reinforce security Modifications: 1.Since harness is not to be removed, sponge bath is recommended 2. Put undershirt under chest straps and knee socks under foot and leg pieces to prevent skin irritation. 3. Check skin areas 2-3 times/day. 4. Massage skin under straps daily to stimulate circulation. 5. Avoid lotions and powders. 6. Place diapers under straps. 7. Pad shoulder straps as needed.
NArcotic abuse Assessment
1. Respiratory Depression 2. Hyperpyrexia 3. Seizures 4. Pinpoint pupils 5. Stupor, coma
Non alcoholic Sub. Abuse - Barbiturate Abuse Assessment
1. Respiratory depression 2. Decreased pulse and BP 3. Ataxia 4. Seizures 5. Poor coordination at the very least will see decreased mental alertness of the client
Alzheimer's Disease Plan
1. Support cognitive function: Calm, predictable environment and present change gradually. a. Establish regular routine, clear instructions. b. Give clear and simple explanations and repeat information c. Display clock and calendar d. Color code objects and areas 2. Provide for safety: Night light, avoid restraints (increases combat). Reduce anxiety and agitation: Encourage walking, keep environment simple. Promote good nutrition:One dish at a time to prevent playing with food. Promote balance of activity and rest Administer medications: Cholinesterase inhibitors, NMDA-receptor antagonists, antidepressants.
Alcohol-related Disorders: Need to Know
1. Symptoms of intoxication and withdrawal 2. Implementations for intoxication and withdrawal 3. CNS disorders associated with chronic alcohol abuse- esp substance abuse delierium
Stimulant Abuse Assessment
1. Tachycardia, Inc. BP, Tachypnea( or fast respiration) 2. Agitation, Hyperactivity 3. Seizures 4. Hyperpyrexia (elevated temperature) 5. Hallucinations
Wernicke's Syndrome Implement
1. Thiamine (IM or IV) 2. Abstinence from alcohol
Nonalcoholic Substance Abuse: Need to Know
1. Types of nonalcoholic substance abuse 2. Symptoms of abuse and withdrawal 3. Implementation for withdrawal
Nonalcoholic Sub. Abuse - Barbiturate symptoms of withdrawal
1. anxiety 2. Insomnia 3. Tremors 4. Delirium 5. Convulsions
Concepts you see with Chemical Dependency
1. loss of control over injestion of the substance 2.may not want to do it 3. Many times creates issue in their lives, relationship issues, work issues or legal issues 3. Tendency to relapse 4. Person develops a tolerance of the drug or substance- need greater and greater amts to achieve their goal with the drug/substance 5. Withdrawl - physical and psychological symptoms
Etiology 3- development of cancer (multifunctional) (a. physical)
1. radiation 2. foreign bodies 3. chronic irritation
ET3-Genetic
1. strong disposition 2. Inherited chromsomal abonormalities
specific gravity normal range
1.010-1.030
If hypoglycemic, but conscious, what should you administer?
10-15 carbs, perferably skim milk 4oz
normal BUN levels for urine
10-20 mg/dl
oliguria
100-400 ml/24 hours of urine
What is the incidence of appendictitis?
11-30yrs old
trach cuff pressure
14-20
how old should toilet training occur
18 months old
Insulin: Intermediate Acting Duration
18-26h
how often do u assess need for suctioning?
2 hrs
AMI intake rec
2,000 ml/day
Insulin: Combination Peak
2-12h
how old toilet training where regular voiding habits and bladder reflex is controlled
2-3 years old
how often is the teflon cath of an insulin pump changed?
2-3days
if taking insulin, how many times a day at a minimum should a pt check their BG levels?
2-4 times qday no insulin- 2-3wk
how long is TB client isolated for
2-4 weeks isolated until 3 negative sputum cultures
Insulin: Fast Acting Peak
2-4h
Narcotic abuse symptoms of withdrawal
2. watery eyes, runny nose 3. irritability 4. tremors, panic 5. cramps 6. shills and sweating 7. Hallucinations
holter monitor
24 hour EKG with diary of ADL's
how soon can a mom feed her baby with formula after a pyloric stenosis surgery?
24 hours
Insulin: Slow Acting Duration
24-36h
Insulin: Combination Duration
24h
Insulin: Intermediate Acting Onset
2h
When do infants usually show s/s of pyloric stenosis?
2nd-4th week after birth regurg develops into projectile vomiting
meds for lyme disease
3-4 weeks antibiotics
sample meal items for high protein diet
30 grams powdered skim milk, roast beef sandwich & skim milk
When should the pancreatic enzyme, Cotazym, be given to a child?
30 mins before meals, or with meals.
head injury position
30 to decrease ICP
compression:vent ratio children/infants
30:2 single rescuer; 15:2 two HCP
safety and infection control
34.41
independent bathroom acitivity age
4 years old
normal HbA1c
4-6%
How often do you remove contents from a Koch pouch?
4-6hrs via catheter post op: q3hr instill 10-20mls NS into pouch, drain by gravitiy, kept in place 2 wks to drain: lube cath, insert 2inches, drain into toliet if resistance, inject 20ml air or water
phase 2 of first stage of labor (active)
4-7 cm dilated, 30-40 seconds/3-5 min apart moderate to strong intensity
normal pH of urine
4.5-8.0
what can decrease # and duration of migraines?
400 mg Riboflavin (Vit B2) daily
Insulin: Slow Acting Onset
4h
night-time bladder control at what age
5 years old
Antineoplastic: Antimetabolites Med Names
5-FU, Methotrexate
tPA within how many hours of AMI?
6 hrs onset
Insulin: Intermediate Acting Peak
6-12h
Plan for Developmental Dysplasia of the Hip (DDH): >6 months
6-18 months: Gradual reduction by traction (bilateral Bryant's traction). Cast for immobilization. Older Child: Preliminary traction. Open reduction. Hip Spica Cast.
Insulin: Fast Acting Duration
6-8h
after a hernia repair, how long should pt avoid heavy activities?
6-8wks
normal fasting bg level
60-110
phase 3 of first stage of labor(transition)
8-10 cm dialted, 45-90 seconds/2-3 minutes apart, strong intensity
Insulin: Slow Acting Peak
8-20h
anuria< 100 ml/24 hours
< 100 ml/24 hours
polyuria (diabetes insipidus)
> 2000 ml/day of urine
what lab value is PKU confirmed at? What is a normal number for a newborn?
>20mg/dl confirmed PKU normal newborn = 1.2-3.4 after = 0.-1.8
when you should test for PKU?
>24hrs after birth but NOT after 7days closest to d/c as possible
Myasthenia Gravis: S/Sx
A chronic progressive disease characterized by chronic fatigue and muscular weakness (especially in the face and neck). Deficiency of acetylcholine at myoneural junction. Analysis: Deficiency of Ach at myoneural jxn Etiology: Unclear Chronic and Progressive Intellect Intact Diagnosis: based on administration of anticholinesterase; positive result evidenced by a striking increase in muscular strength 5-10 minutes after administration No muscular atrophy No loss of sensation Muscular weakness produced by repeated movements soon disappears following rest. Diplopia, ptosis, impaired speech, dysphagia. Respiratory distress. Periods of remission and exacerbation.
Multiple Sclerosis:S/Sx
A chronic progressive nervous disorder involving loss of myelin sheath around certain nerve fibers. Analysis: Demyelination of white matter throughout brain and spinal cord. Etiology: unclear Chronic and Progressive Intellect Intact Leads to paraplegia or complete paralysis Early: Vision, motor sensation changes Late: Cognitive and bowel changes, muscular incoordination, ataxia, spasticity, intention tremors, nystagmus, chewing and swallowing difficulties, impaires speech. Incontinence, emotional instability, sexual dysfunction.
post-traumatic stress disorder (PTSD)
A chronic, sometimes lifelong disorder that may follow a traumatic experience. Symptoms include dissociation, recurrent nightmares, flashbacks, and sleep disturbances.
multicausal model
A conception of how mental disorders arise that emphasizes the roles played by many different factors.
diathesis-stress model
A conception of psychopathology that distinguishes factors that create a risk of illness (the diathesis) from the factors that turn the risk into a problem (the stress).
generalized anxiety disorder (GAD)
A disorder characterized by pervasive, free-floating anxiety.
dissociative identity disorder (DID)
A disorder that results in a person developing two or more distinct personalities.
neurodevelopmental disorder
A disorder that stems from early brain abnormalities.
autism
A disorder usually diagnosed in young children, and characterized by a wide range of developmental problems, including language and motor problems.
attention-deficit/hyperactivity disorder (ADHD)
A disorder usually diagnosed in young children, and characterized by impulsivity, difficulty staying focused on a task, and a range of behavioral problems.
obsessive-compulsive disorder (OCD)
A disorder whose symptoms are obsessions and compulsions, which seem to serve as defenses against anxiety.
agoraphobia
A fear of being in situations in which help might not be available or escape might be difficult or embarrassing. See also phobia.
anxiety disorders
A group of disorders distinguished by feelings of intense distress and worry, and in many cases, disruptive and unsuccessful attempts to deal with these feelings.
mood disorders
A group of disorders distinguished primarily by changes in positive and negative affective state.
schizophrenia
A group of severe mental disorders characterized by at least some of the following: marked disturbance of thought, withdrawal, inappropriate or flat emotions, delusions, and hallucinations.
hypomania
A mild manic state in which the individual seems infectiously merry, extremely talkative, charming, and tireless.
depression
A mood disorder characterized by disabling sadness, hopelessness, and apathy; a loss of energy, pleasure, and motivation; and disturbances of sleep, diet, and other bodily functions. Also called major depression or unipolar depression.
bipolar disorder
A mood disorder in which the patient swings between emotional extremes, experiencing both manic and depressive episodes.
mixed states
A pattern sometimes observed with bipolar disorder in which the person displays a combination of manic and depressive symptoms.
explanatory style
A person's characteristic way of explaining his experiences. Consistently attributing bad experiences to internal, global, and stable causes may increase vulnerability to depression.
biopsychosocial perspective
A perspective on psychopathology that emphasizes the biological, psychological, and social factors that contribute to mental illness.
Disturbed Transmission of Nerve Impulses: Parkinson's Disease: S/Sx
A progressive disease that destroys brain cells and is identified by muscular tremors, slowing of movement, and partial facial paralysis. Deficiency of dopamine; increased acetylcholine levels. Analysis: Deficiency of dopamine Increased Ach levels Etiology: unclear Chronic and Progressive Intellect Intact Does not lead to paralysis Tremors (pill rolling motion), akinesia (loss of voluntary movement), rigidity, weakness. Motorized propulsive gait, slurred monotonous speech, dysphagia. Salvation, masklike expression, drooling. Constipation Depression Dementia
acute stress disorder
A reaction sometimes observed in individuals who have experienced a trauma, characterized by flashbacks and recurrent nightmares.
Trousseau's sign
A sign of hypocalcemia . Carpal spasm caused by inflating a blood pressure cuff above the client's systolic pressure and leaving it in place for 3 minutes.
mania
A state characterized by racing thoughts, pressured speech, irritability or euphoria, and impaired judgment. See also bipolar disorder.
dissociative fugue
A state in which someone leaves home, then, days or months later, suddenly realizes he is in a strange place and doesn't know how he got there; often understood as a means of coping with (and escaping from) extremely painful events.
panic attack
A sudden episode of terrifying bodily symptoms such as labored breathing, choking, dizziness, tingling hands and feet, sweating, trembling, heart palpitations, and chest pain.
Antidysrhythmics Uses
A-Fib and flutter, tachycardia, PVCs
Antimetabolites -indications
A-acute lymphatic leukemia R-Rhematuid arthiritis P-Psorriasis C-Cancer of colon, breast, stomach S-sickle cell anemia
-pril
ACE-Inhibitors
Attention Disorder Agents Uses
ADD, narcolepsy
false positives
AFP has a high incidence of this result
activity, pulse, grimace, appearance, respiration
APGAR from 0-2 from each of these categories with a total number = 10
-sartan
ARBs
what meds increase risk of hypoglycemia effect on PO hypoglycemic agents?
ASA ETOH Sulfonamides oral contraceptives MAOIs
what meds increase risk of hypogyclema on inusulin?
ASA ETOH Tetracycline oral contraceptives tricyclic antidepressants MAOIS
what types of vascular access can client on hemodialysis receive
AV fistula, AV graft, or subclavian catheter
Plan for Scoliosis
Abdominal muscle isometric exercise for functional type (sit-ups, pelvic tilt, push ups with pelvic tilt). Electrostimulation Surgery: Spinal fusion with Harrington rod insertion; Dwyer instrumentation with anterior spinal fusion; screw and wire (Luque) Thoracolumbosacral orthotic brace (TLSO) Boston Brace
Care after THR
Abduction pillows Don't sleep on operated side Don't flex hip more than 45-60 Don't elevate head of bed more than 45
negative cognitive schema
According to Aaron Beck, the core cognitive component of depression, consisting of an individual's automatic negative interpretations concerning himself, his future, and the world. See also explanatory style.
compensatory behavior
Actions taken to ensure that binge eating does not translate into weight gain (e.g., self-induced vomiting).
Atypical Antipsychotic Agents Uses
Acute and chronic psychoses
Glucocorticoids Uses
Addison's disease, Crohn's disease, COPD, leukemias
Myasthenia Gravis: Tx
Administer medication:Anticholinesterases, Corticosteroids, Immunosuppressants. Promote understanding of the disease a. it is neither a CNS nor a peripheral nervous system disease b. There is no muscular atrophy or loss of sensation c. It is not hereditary Good eye care Maintain optimal mobility Provide environment that is restful and free of stress Importance of taking meds on time Wear Medic-Alert band Avoid factors that may precipitate myasthenia crisis (infections, emotional upsets, use of streptomycin or neomycin (they produce muscular weakness), surgery. Be alert for myasthenia crisis:sudden inability to swallow, speak, or maintain a patent airway.
Antineoplastic: Antitumor Med Names
Adriamycin, Bleomycin, Actinomycin D
Chronic Slcohol Dependence nurse Implementation
Aim of treatment is that the person accepts responsibility for their recovery - nurse shd develop a warm caring relationship with client so he feels safe 1.Identify problems related to drinking 2. client see the problem the alcohol is causing on himself and/or family 3. Establish control of problem 4. Alcoholics Anonymous 5. Anabuse-medication that cause a strong reaction when they injest alcohol 6. Counsel spouse and children
Bone-Reabsorption Inhibitors: Biophosphonates Med Names
Alendronate (fosamax), Risedronate (actonel), Ibandronate (boniva)
Antibiotics General
Allergies, Super Infections, Organ Toxicity
-zosin
Alpha 1-Blocker
PKU (cause, risk, tx/diet)
Alteration in protein metabolism... cause: error of phenylalanine utilization risk: high levels = mental retardation tx: spec prepared milk ( Lofenalac) and LOW PROTEIN diet AVOID ASPARTAME (neutrasweet) avoid high protein foods (meats/dairy)
Bronchodilators Med Names
Aminophylline, Brethine, Atrovent, Proventil, Primatene mist
Antifungals: Med Names
Amphotericin B, Nystatin
phobia
An anxiety disorder characterized by an intense and, at least on the surface, irrational fear.
panic disorder
An anxiety disorder characterized by repeated or disabling panic attacks. See also anxiety disorders, panic attack.
anorexia nervosa
An eating disorder characterized by an extreme concern with being overweight and by compulsive dieting, sometimes to the point of self-starvation. See also bulimia nervosa.
bulimia nervosa
An eating disorder characterized by repeated bingeand- purge bouts. See also anorexia nervosa.
semistructured interview
An interview in which questions are posed in a standardized yet flexible way.
what type of med may you give to a patient with gastritis?
Antacids - often relieve pain
Furadantin (nitrofurantoin) Nursing Considerations
Anti-infective Give w food or milk Monitor pulmonary status Take w/ cranberry juice
Diet/medications for uncomplicated diverticular dx?
Antispasmodics, anticholinergic (Bentyl) Bulk Laxatives (Metamucil) HIGH FIBER AVOID foods w/seeds! Increase Fluds
Antidepressants: SSRIs Side Effects
Anxiety, gi upset, change in appetite and bowel function, urinary retention
specific phobias
Any of the disorders characterized by extreme and irrational fear of a particular object or situation.
Pt arrives with right lower quad pain, N/V, low grade fever ....what might you suspect?
Appendicitis
Amyotrophic Lateral Sclerosis (ALS):Plan/Tx
Apply principles of care f client with progressive, terminal disease. Treat self-care deficits symptomatically Maintain adequate nutrition PT Adaptive home equipment Provide psychosocial support
Antiplatelet Agents Med Names
Aspirin, Persantine, Plavix
dopamine hypothesis
Asserts that the brains of people with schizophrenia are oversensitive to the neurotransmitter dopamine. See classical antipsychotics.
Teaching ADLs
Assess client abilities Exercise muscles needed for activity Start with gross movements, follow with finer movements Extend activity according to client tolerance Give positive feedback
Rheumatoid/Juvenile Rheumatoid Arthritis(JRA): Assessment/Diagnostic tests
Assessment: Joint pain, swelling, and limitation of movement. Contracture deformities Nodules over bony prominences Ulnar deviation High fever and rheumatoid rash (seen in JRA) Salmon-pink macular rash (small, flat red dots) on chest, thighs, and upper arms. Diagnose: Systemic disease, remissions and exacerbations, bony ankylosis, progressive Diagnostic testing: Rheumatoid factor (autoantibody), C-reactive protein, ESR (sed-rate), ANA (in JRA), Aspirationof synovial fluid, X-Rays.
Gout: Assessment/Diagnostic tests
Assessment: Joint pain, swelling, limitation of movement. Contracture deformitites Tophi (buildup of urate crystals) Diagnose: Nonsystemic; disturbed purine metabolism; eleated uric acid in blood; tophi formation (deposits of urates in joints); exacerbations Diagnostic Tests" Xrays Blod Test- WBC, ESR, uric acid level Synovial aspiration
Immobility: Negative Nitrogen Balance
Assessment: Anorexia, debilitation, weight loss Implementation:High protein diet, small-frequent feedings
Immobility: Contractures
Assessment: Deformity d/t muscle stiffening Implementation: Equipment-pillows, trochanter rolls, foot board, frequently change position, exercise
Multiple Sclerosis (CNS)
Assessment: Demyelination of white matter in brain and spinal canal, changes in vision, sensation, motor function Early: vision, motor sensation changes Late: cognitive and bowel changes Implementation: Bladder and bowel training, ROM and coordination exercise Medications: muscle relaxants, immunosupressants, corticosteroids, antispasmodics
Gout
Assessment: Due to the build up of uric acids, avoid foods that are high in purines, joint pain, swelling, limitation of movement Implementation: Avoid foods rich in purines, medications-analgesics, anti-inflammatory
Hydrocephalus
Assessment: Increase in CSF withing ventricular system, Increase in fronto-occipital circumference, widened, distended fontanelles. Implementation: treated by insertion of shunt (ventriculoperitoneal shunt
Osteoarthritis
Assessment: Often associated with older age,and repetitive use of the joint, joint pain, swelling, limited movement, joint stiffness after rest
Immobility: Osteoporosis
Assessment: Pathological fractures, renal calculi (high serum Ca level: Normal Ca:8.5-10) Implementation: Weight-bearing on long bones, balanced diet, estrogen replacement therapy
Amyotrophic Lateral Sclerosis (PNS)
Assessment: Progressive, degenerative disease of motor neurons, atrophy with fascicualtions (brief muscle twitching), nasal quality to speech, dysarthria (difficulty speaking), dysphagia, aspiration Implementation: Maintain nutrition, PT, psychological support
Immobility: Thrombus Formation
Assessment: Pulmonary emboli Implementation: TED hose, leg exercises, change position, do not use bed knee gatch, no pillows behind knees, check homan's sign
Scoliosis
Assessment: Screening procedure, postural changes Implementation: Exercise for functional type, electrostimulation, braces, surgery: spinal fusion
Immobility: Increased Cardiac Workload
Assessment: Tachycardia Implementation: Use trapeze when moving in bed, teach to move without holding breath (valsalva maneuver)
Immobility: Urinary Stasis
Assessment: Urinary retention, renal calculi Implementation: Normal position to void, increase fluid intake, low-calcium diet, acidify urine.
Muscular Dystrophy
Assessment: atrophy of voluntary muscles, muscle weakness, lordosis/scoliosis, waddling gait, joint contractures, falls Implementation: Braces to help ambulation, balance activity and rest
Rheumatoid Arthritis
Assessment: contracture deformities, nodules, fever, rash, systemic disease that can worsen over time
Myasthenia Gravis (PNS)
Assessment: deficiency of acetylcholine, muscular weakness produced by repeated movement, dyphagia, respiratory distress, diplopia, ptosis (eyelid drooping), impaired speech, dysphagia. (MG crisis affects pt's airway, emergency!) Implementation: Good eye care, restful environment Medications: anticholinesterases, corticosteroids, immunosuppressants
Parkinson's Disease (CNS)
Assessment: deficiency of dopamine, tremors (pill-rolling) , akinesia (loss of automation) rigidity, "motorized" propulsive gait, slurred monotonus speech, dysohagia, salivation, mask-like expression, drooling, constipation, depression, dementia Implementation: Teach ambulation modification, ROM exercises Medications: Artane, Cogentin, L-Dopa, Parlodel, Sinement, Symmetrel
Fractures
Assessment: deformity, crepitus, absent pulses, swelling, pallor
Dislocation
Assessment: displacement of joint bones so their articulating surfaces lose all contact Implementation: considered and orthopedic emergency; treated with immobilization and reduction, eg the dislocated bone is brought back to its normal position, usually under anesthesia; bandages and splints are used to keep affected part immobile until healing occurs.
Immobility: Stasis of respiratory secretions
Assessment: hypostatic pneumonia Implementation: Turn, cough, deep breathe, postural drainage
Contusion (bruise)
Assessment: injury to soft tissue, ecchymosis. hematoma Implementation: treat with cold application for 24 hours followed by moist heat; apply elastic bandage
Fractured Hip
Assessment: leg shortened, adducted,externally rotated, pain, hematoma, ecchymosis, confirmed by x-rays Dx: commonly seen with elderly women with osteoporosis
Strains
Assessment: muscle and/or tendon pull or tear, pain, swelling Implementation: treated with rest and elevation of affected part; intermittent ice compress for 24 hours, followed by heat application; apply elastic pressure bandage; minimize use
Developmental Dysplasia of the Hip
Assessment: often found in children when the head of the femur is disloacted from the acetabulum, uneven gluteal folds and thigh creases, limited abduction of hip, Ortolani's sign, shortened limb on affected side. Implementation: (newborn to 6 mo) reduced by manipulation, Pavlik harness for 3-6 mo, teach about harness and body care (6-18 mo) traction, immobilization by cast (older child) traction and ORIF
Herniated Intervertebral disk
Assessment: pain muscle tone, poor body mechanics/posture Treatment: Meds (NSAIDs , muscle relaxers), traction, TENS DX test: CT, MRI Surgical: Laminectomy Post op care: positioning log rolling, firm mattress, make sure they have proper body alignment, assess stimulation in lower extremities, proper body alignment, erect posture, avoid prolonged sitting and standing
Osteomyelitis
Assessment: pain swelling, redness, infection caused by staphylococcus aureus, confirmed by x-ray Implementation: Medication-analgesics, antibiotics, high-protein diet
Sprains
Assessment: torn ligament or stretched ligament, pain, swelling Implementation: treated with rest and elevation of affected part; intermittent ice compress for 24 hours, followed by heat application; apply elastic pressure bandage; minimize use
Cerebral Palsy
Assessment: voluntary muscles poorly controlled due to brain damage. Spasticity, rigidity, ataxia, repetitive involuntary gross motor movements. Neonate: Cannot hold head up, feeble cry, inability to feed body noticeably arched or limp Infant: FTT Toddler: mental retardation, delayed physical development Implementation: Ambulation devices, PT and OT, muscle relaxants and anticonvulsants.
Immobility: Orthostatic Hypotension
Assessment: weakness, dizziness Implementation: Change position slowly, increase activity gradually
Osteoarthritis: Assessment/Diagnostic tests
Assessment:Joint pain, swelling, and limitation of movement. Joint stiffness after rest. Heberden's nodes of fingers and bouchard's nodes of hands. Diagnose: Nonsystemic; spur formation, closure of joint spaces; degenerative, no remission *Increase in age, obesity, no family hx, no exacerbations, Diagnostic Testing: Xays of joints show narrowing of joint spaces.
Antidysrhythmics Med Names
Atropine, Lidocaine, Pronestyl, Quinidine, Isuprel
Antidepressants: MAOIs Nursing Considerations
Avoid foods containing tyramine Monitor Output Takes 4 wks to work Do not take with cold medications or CNS stimulates
Chemo 1 Alkylating agent side effects
B-Bone marrow suppression N-Nausea, vomiting S-tomatitis A- Alopecia G-gonadal suppression R- renal toxicity (cistplain) O-(ototoxicity)
AMI meds
BBlockers, morphin (reduces preload, afterload pressures, dec anxiety), dysrhythmics (lidocaine, verapamil, solalol, propafenone), anticoags (hep, coum)
Alkylating Agents
BCCC Bulsifan chlormabucil cistiplain cyclosphosphimade
If a pt arrives, - confused, cool, clammy - what would be your initial assessment?
BG <50-60?
s/s of HHNK
BG >800 dry, seizures,
trousseaus sign of hypocalcemia
BP cuff 20 mmHg above systolic on notice the muscle contraction of the hand and wrist
prostate gland hypertrophy
BPH benign prostatic hyperplasia
what s/s would you look for with DM Ketoacidosi
BS 300-500 ph: <7.5 ACIDIC /bicarb <15 dry, warm, kussmaul (rapid) breathing, fruity oder breath,
detached retina trmt
Bedrest, don't move forward, affected eye or both eye may be patched to decrease movt,, area of detachment should be in DEPENDENT position, no hair washing for a week, admin sedatives/tranquilizers
Antitussive Agents Med Names
Benylin DM, Robitussin
Romazicon
Benzodiazepines
-pam or -am
Benzodiazepines ending
-lol
Beta Blockers
Antithyroid Agents Nursing Considerations
Bitter Taste May cause burning in mouth Give with meals Check CBC
Thrombolytics Side Effects
Bleeding, bradycardia, dysrhythmias
Antitumor Examples atbs
Blexoane, Anctinomycin D, adriamycin
Cast - Watch for these Danger Signs
Blueness or paleness, Pain, Numbness, or tingling sensations on affected area What to do? --Elevate casted area --If persists, contact Physician
Antibiotics: Cephalosporins Side Effects
Bone Marrow Depression, Superinfections, Rash
Alkylating Agent- Myleran SE
Bone marrow suppression
VInca allkaloids SE's
Bone marrow suppression Neuropathies Stomatiis
Antimetabolites examples
CFPMM Cytaarbine-(ARA_C) Flurouracil(5-FU) Pemextred(altima) Mercaptopurine(6-mp) methotrexate)(mtx)
Diuretics Uses
CHF, renal disease
Andrenergics Uses
COPD, Cardiac Arrest
Bronchodilators Uses
COPD, preterm labor
Antineoplastic: Hormonal Agents Uses
Cancer
Most widely illiceit drug used in US...
Cannabis (marijana) client is looking for euphoria, relaxation, detachment
Cytoprotective Agents Med Names
Carafate
Laxatives/Stool Softeners Med Names
Cascara, Dulcolax, Colace, MOM
Antibiotics: Cephalosporins Med Names
Ceclor, Ancef, Keflex, Rocephin, Mefoxin
Antibiotics: Cephalosporins
Ceph-, Cef, Kef
Antipsychotic Agents Nruisng Considerations
Check CBC Monitor VS Avoid alcohol and caffeine
Antineoplastic: Hormonal Agents Nursing Considerations
Check CBC Monitor serum calcium
Antitubercular Agents Nursing Considerations
Check LFT Vit B6 given for peripheral neuritis Used in combination
Antianginals Nursing Considerations
Check expiration date Teach when to take medication May take q 5 min x 3 doses Wet with saliva and place under tongue
Antibiotics: Penicillins Nursing Considerations
Check for hypersensitivity Give 1-2 h before or 2-3 h after meals Cross allergy to cephalosporins
Antiplatelet Agents Nursing Considerations
Check for signs of bleeding Give with food or milk
Antibiotics: Aminoglycosides Nursing Considerations
Checking 8th cranial nerve (hearing) Check Renal Function (BUN) Take for 7-10 days Encourage Fluids (3,000ml/day when pushing)
Antineoplastic: Alkylating Agents Nurisng Considerations
Checking hematopoietic function Force fluids Good mouth care
Antihistamines: Med Names
Chlor-Trimeton, Benadryl, Phenergan
Chrons dx vs ulcerative colitis: area of involvement ileum, R-colon
Chrons UC: rectum - L colon
Chrons dx vs ulcerative colitis: frequent steatorrhea
Chrons Dx absent in UC
Chrons dx vs ulcerative colitis: fistula
Chrons dx rare in UC
Antibiotics: Fluoroquinolones Med Names
Cipro
Antineoplastic: Alkylating Agents Med Names
Cisplatin, Myleran, Cytoxan
Sleep Apnea Syndrome Data
Client snores loudly, stops breathing for 10 secs or more, then awakens abruptly with loud snort; multiple nightime awakenings. Excessive daytime sleepiness Morning h/a Sore throat Personality an behavioral changes Dysrhythmias, hypertension, increased risk of stroke, myocardial infarction and heart failure.
Atypical Antipsychotic Agents Med Names
Clozaril, Risperdal
Antigout Agents: Med Names
Colchicine, Probenecid, Allopurinol
Mag Sulfate - Anticonvulsant
Common given in OB Deep Tendon Reflexes be evaluated SE: Resp Arrest
Types of fractures
Complete: break across entire cross-section of bone Incomplete: break through portion of bone Closed: no external communication Open: extends through skin
Lumbar Lordosis
Concavity in lumbar region
Laxatives/Stool Softeners Nursing Considerations
Contraindicated w symptoms of acute abd Monitor fluid and electrolytes Chronic uses may cause hypokalemia Encourage fluid
Kyphosis
Convexity in thoracic region
Antibiotics: Fluoroquinolones Nursing Consideration
Culture and Sensity before starting therapy Encourage Fluids (3000ml.day) Take 1 h before or 2 h after meals
if mom reports that her child tastes "salty" when kissed, what may you suspect?
Cystic fibrosis
personal-social, fine motor, language, gross motor
DDST tests these four categories of development
during treatment of a glucose disorder, which would you watch for increase icp?
DKA if blood glucose levels fall to far or too fast before the brain has time to equilibrate, water is pulled from the blood to the CSF and the brain causing cerebral edema and increase ICP
ET3- viral-incorporated in cells neogeneisis
DNA RNA virus, epstein barr virus, burkitt's lymphoma.
deptheria, tetanus, pertussis
DTaP stands for
Osteoporosis: Data/Diagnose
Data: Decreased height Low Back Pain especially in hips and spine Kyphosis Diagnose: 1. Reduction in bone mass with no changes in mineral composition. 2. Degenerative disease characterized by generalized loss of bone density and tensil strength. 3. Diagnosed by bone mineral density (BMD)[Bone Density Scan] T-score: BMD T-score <2.5 indicates osteoporosis. 4. Risk factors: a. >60 years b. Small-framed and lean body build c. Caucasian or Asian Race d. Inadequate intake of Ca+ or Vi D e. Postmenopausal f. Immobility and sedentary lifestyle g. Hx of smoking h. High alcohol intake i. Prolonged use of steriods
Spina Bifida/Neural Tube Defects: Data/Diagnose/Risk Factor/Etiology
Data: Spina bifida occulta, meningocele, myelomenignocele. Hydrocephalus increases risk Paralysis of lower extremities Musculoskeletal deformities (club feet, dislocated his, kyphosis, scoliosis) Neurogenic bladder and bowel, prolapsed rectum. Diagnose: Congenital anomly of the spinal cord characterized by incomplete closing of the embryonic neural tube. Some vertebrae overlying the spinal cord are not fully formed and remain unfused and open. Risk Factor: Maternal folic acid deficiency Previous pregnancy affected by neural tube defect. Etiology: Advanced maternal age High levels of alpha-fetoprotien at amniocentesis.
Bursitis
Data:Pain due to inflammation Decreased mobility, especially on abduction. Diagnose:Inflammation of connective tissue sac between muscles, tendons, and bone, particularly affecting shoulder, elbow, and knee. Plan: 1. Rest 2. Immobilize affected joint with pillows, splints, slings. 3. Administer pain medication, muscle relaxants (Valum), steroids. 4. Apply heat/cold packs to decrease swelling. 5. Promote exercise (ROM) 6. Assist in performance of ADL (Activities of Daily Living) by modifying activities relative to limitations. 7. Assist with cortisone injection, draining of bursae.
_____Results from reduced tissue sensitivity to insulin that usually devlops betwen 5am-8am causing prebreakfast hyperglycemia) what is its tx?
Dawn Phenomenon tx: admin evening dose (or increasing amt of current dose) of NPH at about 10pm
Myexedema/Hypothyroidism Plan
Decreased BMR, T3,T4, increased TSH Restrict use of soaps and apply lanolin or creams to skin High-protein, low-calorie diet Prevent constipation: high-fiber, high-cellulose foods, stool softeners Explain Sx are reversible with Tx Administer drug replacement therapy (synthroid, Cytomel [Liothyronine Sodium]). Administer sedatives carefully - risk of respiratory depression Instruct about causes of myxedema coma (acute illness, surgery, chemotherapy, discontinuation of medication).
Hypoparathyroidism diagnose
Decreased secretion of parathroid hormone Hypomagnesemia Diagnostic tests: Low serum calcium and parathyroid hormone (PTH), increased serum phosphorus. X-ray-bones appear dense.
Complications with immobility
Decubitus (Pressure) Ulcer: Osteomyelitis, Tissue Maceration, Infection Sensory Input Changes: confusion, disorientation (orient frequently)
Data collection for Scoliosis
Definition: Lateral deviation of one or more vertebrae commonly accompanied by rotary motion Poor posture Uneven hips or scapulae Kyphosis: lump on back Uneven waistline Visualization of deformity:bend at waist (90degrees)
which glucose disorder does acidosis occur and formation of ketones?
Diabetic ketoacidosis
Antidiabetic Agents: Med Names
Diabinese, Orinase, Dymelor, Micronase
Hydrocephalus: Diagnose/Cause/Types
Diagnose: Congenital or acquired condition characterized by increase in the accumulation of CSF within the ventricluar sysem and subsequest increase in ventricular pressure. Cause: Neoplasm Aqueductal stenosis (stenosis/obstructions in ventricular system Spina bifida Congenital cysts/vascular malformations. Types: Communicating-due to increased production of CSF or impaired absorption of CSF. Noncommunicating- due to obstruction/blockage of CSF circulation between ventricles and subarachnoid space.
Diagnoses of Herniated Intervertebral Disk
Diagnostic Procedures: 1. Computerized tomography 2. MRI 3. Myelography (encourage fluids, keep head of bed elevated 30 degrees to reduce risk of seizures) 4. Diskogram. Surgical Procedures: 1. Laminectomy (excision of a portion of the laminca to expose the affected disk for removal) 2. Laminectomy with fusion (Several disks fused using bone graft) 3. Microdiskectomy (minimally invasive surgery: removing part of the disk) 4, Interbody cage fusion
Carbonic Anhydrase Inhibitors Med Names
Diamox
Digoxin Antidote
Digibind
Digibind
Digoxin
Anticonvulsants Med Names
Dilantin, Luminal, Depakote, Tegretol, Klonopin
Pt presents with L-lower quad pain ....what may you suspect?
Diverticular Disease L-Lower quad pain usually relieved by passage of stool/flatus
Anticonvulsants Nursing Considerations
Don't d/c abruptly Monitor I&O Caution with use of meds that lower seizure thresholds (ex. MOAIs, antipyscotic) No alcohol Urine is pink/reddish
Dilantin - Anticonvulsant
Don't give too fast - cardiac arrest NEVER mix with another med Urine Pink
Hib and Neisseria meningitidis get what kinda precautions
Droplet
classical antipsychotics
Drugs (such as Thorazine and Haldol) that block dopamine receptors. These drugs seem to treat many positive symptoms of schizophrenia. See dopamine hypothesis.
After ulcer surgery, pt presents with hypotension, diaphoresis, diarrhea...what may you suspect?
Dumping Syndrome
Having type O blood and being male puts you at risk for what type of ulcer?
Duodenal Ulcer
Male pt, early 40s, arrives in the office with complaints of symtpoms occuring 2-3 hrs after a meal or often at nightime. He states that food intake tends to relieve his pain, which type of ulcer may you suspect?
Duodenal Ulcer
Andrenergics Side Effects
Dysrhythmias, Tremors, Anticholinergic Effects (dry mouth, urinary retention)
Antibiotics: Fluoroquinolones Uses
E. coli, Pseudomonas, S. aureus
records electrical activity in the brain
EEG electroecephalogram does this
what is the showck wave treatment for urolithiasis
ESWL extracorporeal shock wave lithotripsy
binge eating
Eating a large amount of food within a brief period.
Thoracolumbosacral Orthotic Brace (TLSO)
Effective for 30-40 degree curves not associated with extreme deformity. Underarm orthosis made of plastic custom molded to the body and shaped to correct or hold the deformity. Wear for 23 hours-removed 1 hour for personal hygiene. Wear protective shirt under brace. Skin care to pressure areas Reinforce teaching isometric exercises to strengthen ABD muscles.
Antidepressants: Tricyclics Med Names
Elavil, Tofranil, Norpamin
Hypoparathyroidism Tx
Emergency Tx; Calcium chloride or gluconate over 10-15 minutes. Calcitriol (Rocatrol) 0.5-2 mg daily for acute hypocalcemia. Ergocalciferol (vit d) 50,000-400,000 unites daily. Observe for tetany Low-phosphorus, high-calcium diet
Parkinson's Disease: Tx
Encourage finger exercises (typing, piano playing, etc) ROM as appropriate Teaching of ambulation a. Goose-stepping walk b. Walk with wider base c. Concentrate on swinging arms while walking d. Turn around slowly using small steps Teaching of understanding of disease: - Patient's intellect is not impaired, sight/hearing intact, disease is progressive but slow, does not lead to paralysis. Refer for speech therapy, potential stereotatic surgery. Administer dopaminegics (Sinemet); dopamine agonists (pramipexole); anticholinergic (benxtropine); antivirals (amntadine).
Antivirals Nursing Considerations
Encourage fluids Not a cure, but relieves symptoms
infant presents with excessive saliva, drooling, cyanosis, and choking/coughing. What may you suspect?
Esophagel Atresia or TEF 3 C's
Treating Pain
Establish therapeutic relationship Establish 24-hr pain profile Teach client about pain Provide comfort measures Administer analgesics Alternative methods
Main RN concern with Chron's/UC pts?
F& E balance
Preoperative concern for pyloric stenosis
F&E! - check fontanells (sunken-dehydration), U/O Correct common imbalance (alkalosis, hypokalemia)
late hypoxia, maternal drugs, prolonged cord compression, hypotension
FHR <110 bpm indicates fetal bradycardia these causes
infection, early hypoxia, anemia,
FHR >160 bpm indicates these possible causes from fetus/mother
late deceleration
FHR decelerate after contraction begin to subside caused by diabetes, placenta previa, HTN, abruptio placentae, non reassuring sign
early deceleration
FHR decelerate before peak of contraction caused by fetal head compression, 2nd stage of labor pushing
what is your main focus with HHNK besides fluid replacement?
FIND AND TX the cause!! (thiazides? acute illness? dialysis? TPN?)
What is your main RN concern with infections of the GI tract caused by E.coli, salmonella, shingella?
FVD! monitor I & O closely for pt extreme diarrhea likely
190= 1st hour, 140 = 2nd hour, 125 = 3rd hour
Fasting BS for GTT is 60-110 then what should be first three hours each after getting 75 gms of oral glucose
Hyperparathyroidism S/Sx
Fatigue, muscle weakness Caridac dysrhythmias Emotional irritability Renal calculi Back and joint pain, pathological fractures Pancreatitis, peptic ulcer
Iron Preparations Med Names
Feosol (ferrous sulfate) Imferon
Besides pain in the L-Lower quad, what may someone with diverticular dx present with?
Fever - increase WBCs Constipation alternating with diarrhea blood in stool
Antitubercular Agents Med Names
First Line -INH, Rifampin, Ethambutol, Streptomycin Second Line - PAS, PZA
Assistive Device: Walker
Flex elbow 20-30 degrees when hands are on grip, lift and move walker 8-10 in, step forward with bad leg support self on arms, follow with good leg
Functional Scoliosis
Flexible deviation that corrects by side-bending to the opposite side.
What is your major concern with diabetic ketoacidosis?
Fluid volume deficit - 1L 0.9 NaCL per hr during first 2-3hrs flw with 0.45% NaCL 200-500 ml/h then D5w
Plan for Club foot (Talipes Equinovarus)
Foot exercises: 1. Manipulation of foot to correct position every 4 hours regularly. 2. Casts and splints correct the deformity in most cases if applied early; changed every few days for 1-2 weeks, then at 1-2 weeks intervals to accommodate infant's rapid growth. 3. Surgery is usually required for older child. 4. Denis-Browne: Horizontal abduction bar with footplates.
Alzheimer's Disease Data
Forgetfulness progressing to inability to recognize familiar faces, places, objects. Depression, paranoia, combativness Unable to formulate concepts and think abstractly Impulsive behavior Short attention span Agitation and increase in physical activity Night wandering Inability to perform ADLs (unkempt appearance) Dysphagia Incontinence
what position do you want to place someone after appendictis?
Fowlers position - reileve ab pain, ease breathing
Hydrocephalus: Data
Fronto-occipital circumference increases at abnormally fast rate (from increaed CSF w/in ventricular system) Split sutures and widened distened, tense fontanelles. Prominent forehead, dilated scalp veins. Sunset eyes, nystagmus(uncontrolled movement of eyes) Irritability, vomiting, Unusual somnolence (sleepy, drowsy) Convulsions High-pitched cry
What type of surgery may be indicated for hiatal hernia?
Fundoplication
Antipyretic Side Effects
GI irritation, Liver dysfuction
common medical diagnoses for full liquid diets
GI upset
NSAIDS Side Effects
GI upset, dizziness, headaches, bleeding, fluid retention
Antihypertensives: Ace Inhibitors Side Effects
GI upset, orthostatic hypotension, dizziness
Bipolar Disorder: Side Effects
GI upset, tremors, polydipsia, polyuria
Causes of immobility
Gait Joint movement Muscle tone Skin integrity
Antibiotics: Sulfonamides Med Names
Gantrisin, Bactrim, Azulfidine
Which type of ulcer causes freq vomitting?
Gastic Ulcer
Chronic Gastritis can lead to which type of ulcer?
Gastric Ulcer
Male pt, 50s, complains of symptoms occuring 30mins-1hr after eating a meal that is relieved by only vomiting. Which type of ulcer may you suspect?
Gastric Ulcer
Which type of ulcer is most often malignant?
Gastric Ulcer
Antibiotics: Aminoglycosides Med Names
Gentamycin, Neomycin, Streptomycin, Tobramycin
What GI Tract infection can you get from containminated water via protozoan?
Giardia lamblia
Antineoplastic: Vinca Alkaloids Nursing Considerations
Give antiemetic before administration Check reflexes Given with Zyloprim to decrease uric acid
Antifungals: Nursing Considerations
Give w food monitor liver function good oral hygiene
Hypoglycemic Agent: Med Name
GlacGen (glucagon)
what meds increase risk of hyperglycemia on PO hypoglycemic agents?
Glucocorticoids Thiazide diuretics Estrogen
Antigout Agents: Uses
Gout
What is frequently present in gastric ulcers?
H. Pylori
-dine
H2 Blocker
What meds would a pt be on for a Hiatal Hernia?
H2 Receptor Blockers (zantac, tagamet) - decrease acid production Antacids (amph, milk of mg) Cytoprotective agents (carafate) coat stomac
Glucose imbalance: ketosis and acidosis do not occur but BG out of range...
HHNK
Which glucose disorder does acidosis not occur thus preventing ketosis?
HHNK
Hormonal agent SE's
HJIMSNVHVSF hypercalcemia jauncdice hunger man or female more sodium and fluid nv hot flashes dryness
-statin
HMG Co-A
stroke positioning
HOB 15-30 to prevent inc ICP
Pyridium Side Effects
Headache, Vertigo, Changes urine orange
Assessment findings of pt with Hiatal Hernia (3)
Heartburn, Dyspepsia, Regurgitation
Anticoagulant Coumadin Side Effects
Hemorrhage, alopecia
#1 birth -3 months, #2 1-4 months, #3 6-18 months
Hep B immunization schedule
Protamine Sulfate
Heparin
Diet for Chron's dx and Ulcerative Colitis?
High Protein High Calorie Low Fat Low Fiber (Baked cod, biscuit w/o butter, fruit roll up) low residue high calorie diet TPN may be needed for bowel rest
Antitumor indications atb #3 chemo
Hodgkin's diseas, Non-hodkings lymphoma Leukemia Many cancers
Insulin: Combination Names
Humulin 70/30
Diuretics Med Names
HydroDIURIL, Aldactone, Lasix, Mannitol
Antihypertensives: Angiotensin II Receptor Blockers Uses
Hypertension, heart failure, MI, diabetic neuropathy, stroke prevention
Antithyroid Agents Uses
Hyperthroidism, myxedema
Hypoglycemic Agent: Uses
Hypoglycemia
Antidiabetic Agents: Side Effects
Hypoglycemia, allergic skin reactions, GI upset
Antihypertensives: Angiotensin II Receptor Blockers Side Effects
Hypotension, dizziness, GI distress
acute renal failure implementation
I/O weights, electrolytes, bedrest IV fluids, diet restrictions
Emergency Care of fractures
Immobilize joint above and below fracture Check temperature, color, sensation, cap refill distal to fracture
Emergency Care for Fracture patient
Immobilize pt with a splint before moving them; Immobilize joint below and above fracture Open fracture- Cover wound with sterile dressings or cleanest material available; Control bleeding by direct pressure Check temperature, color, sensation, cap refill distal to fracture ER- Give narcotic adequate to relieve pain (except in presence of head injury)
what type of meds are used for renal transplant to prevent rejection of new kidney
Immunosuppressive meds
RA and Osteoarthritis
Implementation: Balance rest and activity, medications - analgesics, anti-inflammatory drugs, weight control if obese
signs
In psychopathology, what the clinician observes about a patient's physical or mental condition. See also symptoms.
symptoms
In psychopathology, what the patient reports about his physical or mental condition. See also signs.
As an RN, what do you want to monitor the pt for while being tx for DKA?
Increase ICP! If bg level falls too far or too fast before the brain has time to equilibrate, water is pulled from the blood to the cerebrospinal fluid and the brain, causing cerebral edema and increase ICP
Graves' Disease/Hyperthyroidism Plan
Increased BMR, T3/T4, high titer anti-throid antibodies Keep room cool Avoid stimulants Provide post-thyroidectomy care. Administer antithyroid meds: Methimazole, Propylthiouracil, potassium iodide (SSKI), radioactive iodine.
Thyroid storm
Increaseed Temp and pulse, HTN. Tx: hypothermia blanket, O2, sodium iodine, propylthiouracil (PTU), Inderal, hydrocortisone, Tylenol; also caused by trauma, infection, palpation, RAI (radioactive Iodine) therapy.
Ployromyotomy
Infants w/ployric stenosis incision through circular muscles of pylorus
Osteomyelitis: Data/Diagnose
Infection in bone Data: Pain Swelling, redness, warmth on affected area Fever, leukocytosis (high WBC), Elevated sed-rate (ESR) Positive C&S (culture and sensitivity) Xray of Affected Part Diagnose: Infection of the bone/marrow caused by Staphylococcus aureas, carried by the blood from a primary site of infection or from direct invasion (e.g. orthopedic procedures or Fractures). Risk Factors: a. Poorly nourished b. Elderly c. Obesity d. Impaired Immune System e. Long-term corticosteroid therapy
Antacids Nursing Consideration
Interferes with absorption of antibiotics, iron preps, INH, oral contraceptives Monitor bowel functions
Chemo 1 Antienoplastic- Alkylating Agent (action)
Interferes with rapidly producing cell dan
What is the first step during an intestinal obstruction?
Intestinal decompression & NPO status insertion of a plastic or rubber tube into the stomach via intestine via the nose/mouth. Purpose may be to dx preventive, or therapeutic. fluid or air may be removed types: NG tube (salem sump/levin) Intestinal tube (Miller-Abbot or Cantor)
Cast exercises ?
Isometric exercises- contraction of muscle without movement of joint --Maintains strength while in cast --Quadriceps setting- push back knees into bed --Gluteal setting- Push heels into bed
assess hepatitis
Jaundice, anorexia, clay-colored stool, tea urine, itching,
Antidiarrheals: Med Names
Kaopectate, Lomotil, Imodium, Paregoric
Pavlik Harness
Keeps femur in acetabulum (4-5mon). Worn 24 hrs a day. Adjust every 2 weeks because of rapid growth.
What type of ostomy is a continent ileal reservoiir?
Koch pouch
EDB August 22, 2013
LMP = november 15 2012, Naegles rule
common Hallucinagenics....
LSD, PCP
Cardiac Glycosides Med Names
Lanoxin (digoxin)
Chronic Pain
Lasts 6 months or longer. Causes fatigue, depression, immobility
Acute Pain
Lasts split second up to 6 months. Causes decreased healing, changes in vital signs
What time should you advice your DM pt to shop for shoes and why?
Later in the day, greatest time foot swells -
Scoliosis
Lateral curvature of vertebral column
ET3- Malaginacies correlated with physical factors
Leukemia Lypmhona Thyroid cancer Bone cancer Lung Cancer (asbestos-related)
Huntington meds aimed at reducing movt. and subduing behavior
Librium, Haldol, Thorazine
Antianxiety Med Names
Librium, Xanax, Ativan, Vistaril, Equanil
Antidysrhythmics Side Effects
Lightheadedness, hypotension, bradycardia, urnary retention
Bipolar Disorder: Med Names
Lithium (salt), Tegretol (mood stablizer), Depakote (mood stablizer)
psychosis
Loss of contact with reality, most often evidenced as delusions or hallucinations.
Data Collection Herniated Intervertebral Disk
Low back pain (knifelike) Lack of muscle tone Poor posture or body mechanics Sensory changes
Post thyroidectomy care
Low or semi-fowler's position Support head, neck, and shoulders to prevent flexion or hyperextension of suture line. Tracheostomy set at beside Give fluids as tolerated Observe for complications: Laryngeal nerve injust (detected by hoarseness), Thyroid Storm, Hemorrhage, Respiratory obstruction, Tetany (decreased Ca from parathroid involvement)-check Chvostek's and Trousseau's signs. Analgesics, cold steam inhalations for sore throat Adjust diet to new metabolic needs
measles, mumps, rubella
MMR stands for
Antacids Med Names
MOM, Maalox, Amphojel
example of contact precautions
MRSA
Casting
Made from plaster or fiberglass (lighter, stronger, water-resistant, porous) Immediate care: --avoid covering cast until dry (48 hrs or longer) --Handle w/ palms not fingertips --Keep affected limb elevated above heart on soft surface until dry Intermediate care: --If fiberglass cast gets wet, dry with hair dryer on cool setting After-cast care: --Swelling is common --Elevate limb and apply elastic bandage
Calcium gluconate
Magnesium
Traction Care
Maintain straight alignment of ropes and pulleys Assure that weights hang free Frequently inspect skin for breakdown areas Maintain position for countertraction Encourage movement of affected areas Investigate every complaint immediately and thoroughly Maintain continuous pull Clean pins with half-strength peroxide or saline and sterile swabs 1-2 times a day if ordered
Positive outcomes of mobility
Maintains joint mobility and function Increases muscle strength Maintains circulation and ventilation Increases appetite and maintains elimination Increase metabolic rate
Bipolar Disorder: Uses
Manic episodes
Antidepressants: MAOIs Med Names
Marplan, Parnate, Nardil
Antihypertensives: Beta Blockers Nursing Considerations
Masks signs of shock and hypoglycemia Take with meals Do not dc abruptly
Hypoglycemic Agent: Nursing Considerations
May repeat in 15 min Give carbs orally to prevent secondary hypoglycemic reactions
Assistive Devices: Crutches
Measure 2 fingers below axilla, support weight on hands, position crutches 8-10 in out to side, flex elbows 20-30 degrees Stairs: go up with the good, down with the bad
child <2yrs presents with painless rectal bleed and jelly-like stool ...what may you suspect?
Meckel's Diverticulum
which type of tube removes fluid/gas intenstine?
Miller abbot
What drug would you advice a pt with a ostomy to avoid?
Miralax
Andrenergics Nursing Considerations
Monitor B/P, Monitor Peripheral Pluses, Check Output
Bronchodilators Nursing Considerations
Monitor BP and HR When used with steroid inhaler, use bronchodilater first May aggravate diabetes
Atypical Antipsychotic Agents Nursing Considerations
Monitor Blood Work Chang position slowly Use sunscreen Monitor VS - Airway
Antitussive Agents Nursing Considerations
Monitor Cough Avoid alcohol
Antipyretic Nursing Considerations
Monitor LFT & ALT Aspirin contraindicated under 21 yo due to risk of Reye's syndrome
Anticoagulant Coumadin Nursing Considerations
Monitor PT Normal 9-12 sec Therapeutic level 1.5 times control Antagonist- Vit K Monitor for bleeding Give PO
Antineoplastic: Antitumor Nursing Considerations
Monitor VS Give antiemetic before administration
Antidysrhythmics Nursing Consideration
Monitor VS and Cardiac Rhythm
Anticoagulant Heparin Nursing Considerations
Monitor clotting time or PTT Normal 20-45 sec Therapeutic level 1.5-2.5 times control Antagonist- protmaine sulfate Give SC or IV - Do NOT aspirate or Massage!
Glucocorticoids Nursing Considerations
Monitor fluid and electrolyte balance Don't dc abruptly Monitor for signs of infection
Electrolytes Nursing Considerations
Monitor fluid and electrolyte levels
Thrombolytics Nursing Considerations
Monitor for bleeding Have amino caproic acid available - Antidote Check pulse, color, sensation of extremities Monitor EKG
Antidepressants: Tricyclics Nursing Considerations
Monitor for suicide takes 2-6 weeks to work take at bedtime monitor vital signs position slowly wean off medication no alcohol no sun- use sunscreen
Carbonic Anhydrase Inhibitors Nursing Considerations
Monitor for systemic effects
Antiparkinson Agents Nursing Consideration
Monitor for urinary retention Large doeses of Vit B6 reverse effects Avoid use of CNS depressants
Attention Disorder Agents Nursing Consideration
Monitor growth rate Monitor liver enzymes Give in am
Antineoplastic: Antimetabolites Nursing Consideration
Monitor hematopoietic function Good mouth care Discuss body image changes
Anticholinergics Nursing Considerations
Monitor output Contraindicated with glaucoma Give 30 min before meals, at bedtime or 2 hours after meals
Thyroid Replacement Agents Nursing Consideration
Monitor weight Take in am Monitor pulse and BP Enhances antideppresants and anticouglant stronger Decreases insulin and digoxin
the narcortics that r most often abused are...
Morphine, Codeine, Heroin, dilaudid and demoral
Narcotics Med Names
Morphione, Codeine, Demerol, Dilaudid, Precodan (oxycodone)
NSAIDS Med Names
Motrin, Indocin, Naprosyn
Alkylating agent #2 Leukeran SE's
N, V, bone marrow depression, depression, and sserility
Antimetabolites side effects
N-nausea and vomiting D-diareheaa O-oral ulceration H-hepatic dysfunction B-bone marrow suppression R-renal dysfunction Alpoceia
what two orders would you suspect the pt to be on post op ostomy
NG tube until peristalsis returns NPO status
Insulin: Intermediate Acting Names
NPH Humulin N
#1 RN action for gastritis
NPO (must rest stomach) then bland diet progression
Tx of HHNK
NS or 0.45% NaCL Regular insulin IV Potassium as soon as UO is adequate
Antianginals Med Names
Nitro, Isordil
Depakote - Anticonvulsant
No carbonated beverages
Antineoplastic: Hormonal Agents Med Names
Nolvadex, Testosterone
Andrenergics Med Names
Norepinephrine, Dopamine, Epinephrine, Dobutamine
Immobility: Hypercalcemia
Normal Ca: 8.5-10 Assessment: Impaired bone growth Implementation: Reduce calcium in diet, encourage fluids
Spina Bifida/Neural Tube Defects:Plan/Tx
Occulta: no Tx Meningocele/myelomeningocele: Surgical repair at 24-48 hours. Observe for irritation, CSF leakage and signs of infection, hydrocephalus. Maintain optimum asepsis; cover lesion with MOIST sterile dressing. Position patient on ABD or semiprone (on side, top knee up) with sandbags. Provide optimum skin care, especially to perineal area. Check for ABN movement of extremities, absent or ABN reflexes, incontinence, fecal impction, flaccid paralysis of lower extremities. Observe for increased intracranial pressure (h/a, changes of LOC, motor functions, and vital signs). Observe for symptoms of meningeal irritation or meningitis. Provide frequent sources of stimulation appropriate for child's age level. Provide postoperative care - vertebral fusion or surgical repair. Focus postoperative observation on detecting signs of meningitis, shock, increased intracranial pressure, and respiratory difficulty. Foster parental bonding. Reinforce family teaching on how to care for child at home. Discuss with family referral for PT, orthopedic procedures, bladder and bowel management.
Sleep Apnea Syndrome Diagnoses
Occurs in older, overweight men, elderly, people with thick necks, smokers. Polysomnography (PSG)-EEG, EMG, ECG, oxygen saturation levels; diaphragmatic movememnt monitored during sleep. Types: Obstructive=lack of airflow due to occlusion of pharynx Central=cessation of airflow and respiratiory movements Mixed=combination of central and obstructive apnea within an episode.
Osteoprosis
Occurs in postmenopausal women Prevention Safety issues Assessment: reduction in bone mass, decreased height, low back pain, kyphosis Risk factors: over 60 years old, small frame, caucasian or asian, postmenopausal, use of alcohol, smoking, sedentary lifestyle d/t lack of weight bearing on the bones Implementation: diet high in calcium, protein, vitamin D, estrogen replacement therapy, med: FOSAMAX, safety precautions to prevent fractures
What is a hiatal Hernia?
Opening in diaphragm thr which the esophagus passes becomes enlarged, part of the upper stomach comes up into the lower portion of the thorax. aggervating factor = increase ab pressure (pregnancy, obesitiy, ascities)
Hydrocephalus:Plan/Tx
Operative management: Ventriculoperitoneal shunt: connection between ventricles and peritoneal cavity. Ventricular atrial shunt: connection between ventricles and right atrium. Ventricular drainage: provides external drainage of fluid. Observation of shunt functioning. Observe for increased intracranial pressure and for signs of shunt infection (irritability, high pitched cry, lethargy). Postoperative positioning-on unoperated side in flat position; do no hold infant with head elevated. Shunt needs to be modified as child grows. Continual testing for developmental ABN/mental retardation. D/C planning teaching/referral Teach parents about increased risk allergies if myelomeningocele present
Narcan
Opiates
Electrolytes Med Names
Os-Cal, Slow Mag, K-Dur, Sodium Chloride
Hyperparathyroidism Diagnose
Oversecretion of parathroid hormone Benign parathyroid tumor Parathyroid carcinoma Neck trauma Neck radiation Diagnostic tests: increased serum calcium and serum parathyroid hormone (PTH), decreased serum phosphorus. X-ray:bones appear porous.
Pain History PQRST
P- precipitating factors Q- quality R- region/radiation S- severity T- timing
pneumococcal PCV
PCV stands for
-prazole
PPI
Rheumatoid/Juvenile Rheumatoid Arthritis(JRA): Tx/NC
Pain management, rest, activity, exercise. Weight control if obese. Heat (e.g., warm tub baths; warm, moist compresses; paraffin dips) Splints for joints. Analgesics, anti-inflammatory drugs. Disease modifying antirheumatc drugs (DMAD) Immunosuppressive drugs Antitumor necrosis drugs
Osteoarthritis: Tx/NC
Pain management, rest, activity, exercise. Weight control if obese. Analgesics, anti-inflammatory drugs, Heat application.
Gout: Tx/NC
Pain management. Diet: avoid meats rich in purines (organ meats, sardines, fish, legumes, yeast), alcohol, ketoacidosis (high ketones), dehydration. Analgesics (ASA) Medications for Gout.
Antiparkinson Agents Uses
Parkinson's Disease
Antidepressants: SSRIs Med Names
Paxil, Prozac, Zoloft
hallucinations
Perceived experiences that occur in the absence of actual sensory stimulation.
A client is in balanced suspension traction and reports pain in the affected extremity 1 hr after receiving pain medicine.
Perform a neurovascular assessment. Pain unrelieved by medication is a sign of acute compartment syndrome.
Active Resistive ROM
Performed by client against resistance 5 lb weights used Increases muscle power
Active ROM
Performed by client without assistance Maintains mobility of joints
Isometric Exercises
Performed by the client Alternate contraction and relaxation of muscle Joint remains immobile Maintains strength of muscle when joint is immobilized
Active Assistive ROM
Performed by the client with assist by RN Increases motion in joint
Structural Scoliosis
Permanent, fixed; hereditary deviation.
Antianxiety Nursing Considerations
Potential for addiction/overdose, Avoid Alcohol, Monitor LFT
Passive ROM
Preformed by the RN Maintains joint movement and circulation
inc ICP nrsg
Prevent valsalva (tell pt to exhale while turning or moving in bed), stool softeners, restrict fluid 1200-1500. meds: osmotic diuretics, cortico, antiseizure
Anticholinergics Med Names
Pro-Banthine, Atropine, Scopace
Muscular Dystrophy: Tests/Tx
Progresive muscular weakness, atrophy of voluntary muscles (no nerve effect). Etiology:genetic Diagnostic tests: CPK (creatinine phosphokinase), ABN EMG, ABN muscle Biopsy. Progressive to terminal Tx: Intensive PT, active and passive stretching and ROM. Light spinal braces or long leg braces may help ambulation. Promote safety to slips/falls Prevent contractures Discuss balance between activity and rest for the child
Amyotrophic Lateral Sclerosis (ALS)
Progressive, degenerative disease involving the lower motor neurons of the spinal cord and cerebral cortex; the voluntary motor system is particualarly involved with progressive degeneration of the corticospinal tract, leads to a mixture of spastic and atrophic changes in cranial and spinal musculature.
S/S in pyloric stenosis infants
Projectile vomiting palpable olive-shaped tumor in epigastrium irritability infant ALWAYS hungry but fails to gain weight peristatic waves
Halo Fixation Device (vest)
Provides immobilization of cervical spine; pins are used to maintain traction; care of insertional site includes cleansing area around pins using sterile technique. If prescribed by physician, clean with half-strength peroxide or saline and sterile swabs 1-2 times/d
Antibiotics: Aminoglycosides Uses
Pseudomonas, E. coli
Traction
Purpose: --Reduce the fracture --Alleviate pain & muscle spasm --Prevent or correct deformities --Promote healing Types of traction: Buck's, Russell's, Cervical (skull tongs), Balanced suspension, Halo fixation device (vest) Care: -- Maintain straight alignment of ropes and pulleys --Assure that weights hang free --Encourage movement of unaffected areas --Investigate every complaint immediately and thoroughly --Maintain continuous pull --With order, Clean pins 1-2 times a day (1/2 strength peroxide or saline & sterile swabs)
Russell's traction
Purpose: "pulls" contracted muscles Treatment: --Elevate foot of bed with shock blocks to provide countertraction --Sling can be loosened for skin care --Check popliteal pulse --Pillows under lower leg; Heels off the bed --Life client, not leg, to provide assistance ** Must not turn from waist down
Cervical (skull tongs) traction
Purpose: Realigns fracture of cervical vertebrae and relieves pressure on cervical nerves Treatment: ** Never lift weights- traction must be continuous ** No pillow under the head ever; beware during feeding, suction may be needed
Balanced suspension traction
Purpose: Realigns fractures of the femur; Uses pulley to create balanced suspension by countertraction to the top of the thigh --Thomas splint w/ Pearson attachment
Buck's traction
Purpose: Relieves muscular spasm of legs & back Treatment: --With fracture, turn pt to unaffected side --Elevate foot of bed for countertraction --Use trapeze for moving --Pillow beneath lower legs, not heels
If you pt states epigastric fullness, what may you assess for?
Pyloric Stenosis
Antihyperlipidemic: Med Names
Questran, Lipitor
4.6-6.2 = man
RBC man
4.2-5.4 = woman
RBC woman
Assistive Device: Hoyer lift
Raise and lock the bed, center straps under patient's shoulder and knees, lower arm and attach hook, one person guides the lift, another person assists the client
with Chronic Alcohol Dependence is a very predictive defensive style
Rationalization, projection and denial
Cervical (skull tongs)
Realigns fracture of cervical vertebrae and relieves pressure on cervical nerves; never lift weights- traction must be continuous. No pillow under the head during feeding; hard to swallow, may need suctioning
Balanced suspension
Realigns fractures of the femur; uses pulley to create balanced suspension by countertraction to the top of the thigh splint. Thomas splint (positioned under anterior thigh) with Pearson attachment (supports leg from knee down) frequently used.
obsessions
Recurrent unwanted or disturbing thoughts. See also compulsions, obsessive-compulsive disorder.
Insulin: Fast Acting Names
Regular - can be given IV or Pump Humulin R
Besides fluid resistation on diabetic ketoacidosis, what other meds would you admin?
Regular insulin IV 5 units/hr Potassium replacement (will be hypokalemic)
Multiple Sclerosis:Tx
Reinforce relaxation and coordination exercises Teach Progressive resistance exercises, ROM Encourage fluid intake 2000mL/day Administer medications:immunosuppressants, corticosteroids, antispasmodics, interferon beta-1a, monoclonal antibodies. Wide-based walk, use of cane or walker Use weighted bracelets and cuffs to stabilize upper extremities Bladder and bowel training (care of Foley catheter if appropriate) Self-help devices Eye patch for diplopia NO TETRACYCLINE OR NEOMYCIN because they increase muscle weakness with MS. Occupational Therapy Provide emotional support Referrals- National Multiple Sclerosis Society
personality disorders
Relatively stable, pervasive patterns of behavior and inner experience that are culturally discrepant and lead to distress or impairment; noted on Axis II of the DSM.
Hyperparathyroidism Tx
Relieve pain Prevent formation of renal calculi, increase fluid intake Offer acid-ash juices (improves solubility of calcium) Administer appropriate diet Prevent Fx Monitor K+ levels (counteracts effect of calcium on cardica muscles) Provide postparathyroidectomy care (essentially same as for throidectomy). IV Lasix and saline promote calcium excretion IV phosphorus is used only for rapid lowering of calcium level. Surgery-parathyroidectomy.
Buck's Traction
Relieves muscular spasm of legs and back; if no fracture, may turn to either side; with fracture, turn to unaffected side. 8-20 lb used; 40lb for scoliosis. Elevate foot of bed for countertraction. Use trapeze for moving, Place pillow beneath lower legs, not heel. Don't elevate knee gatch
compulsions
Repetitive or ritualistic acts that, in OCD, serve in some way to deal with the obsessions. See obsessions, obsessive-compulsive disorder.
what type of surgery may be performed for a bowel obstruction?
Resection & Anastomosis (diseased portion of bowel removed and remaining ends are joined together) Abdominal perineal resection (perm colostomy)
Anticonvulsants Side Effects
Respiratory depression, aplastic anemia, gingival hypertrophy, ataxia
Transverse colostomy (return, oder, drainage, appliance)
Return: soft to fairy firm odor: VERY foul drainage: irritatating appliance: worn at ALL times
McBurney's Point is located where?
Right lower quad between umbilicus and the right iliac crest
Attention Disorder Agents Med Names
Ritalin, Dexedrine
Myexedema/Hypothyroidism S/Sx and Tx
S/Sx: Decreased activity, sensitivity to cold, obesity, weight gain, constipation, alopecia, bradycardia, dry skin/hair. Tx:Hormone replacement (Synthroid, Levothyroid)
Graves' Disease/Hyperthyroidism S/Sx and Tx
S/Sx: Hyperactivity, Sensitive to heat, weight loss, diarrhea, tachycardia, exophthalmus, fine, soft hair Tx: Antithyroid drugs (SSRI methimazole, propylthiouracil), Irradiation, surgery.
Narcotics Nursing Considerations
Safety precautions Avoid alcohol Monitor VS Narcan
Immunosuppressants Med Names
Sandimmune (cyclosporine)
Antianxiety Side Effects
Sedatiosn, confustion, hepatic dysfunction
Antihypertensives: Alpha 1 Adrenergic Blockers Actions
Selective blockade of alpha-1 reception in peripheral blood vessels
Hypertensive Crisis
Severe Headache Palpitations Diaphoretic Stiff Neck
what GI infection is caused from fecal contamination and affects the pediatric population?
Shingella
Teaching regarding meals, position, etc for hiatal hernia? (3)
Small, freq meals Do not lie down for 1hrs after meals elevate HOB 4-8in when sleeping do not eat before going to bed
Osteomalacia
Softening of the bones due to a lack of vitamin D or a problem with the body's ability to break down and use this vitamin. Data: Bone pain and tenderness, Muscle weakness, bowed legs, Kyphosis, X-ray (porous bones). Diagnose: Decalcification of bones due to inadequate intake of Vit D, absence of exposure to sunlight, or intestinal malabsorption, chronic kidney disease/ Plan: 1. Administeration of analgesics 2. Increase sun exposure 3. Reinforce about Vit D foods (milk, eggs, Vitamin D enriched cereal/bread) 4. Administer Vitamin D, calcium, and expose to sunlight and/or ultraviolet irradiation. 5. Assist with performance of ADL to prevent pathological fractures.
Glucocorticoids Med Names
Solu-Cortef (hydrocortisone) Decadron, Prednisone
_____normal or elevated BG levels present at bedtime. hypoglycemia occurs about 2-3am but by 7am (in resp to counter-reg hormones) pt is hyperglycemia. What is its tx?
Somogyi Phenomen TX: decrease evening (predinner/bedtime) dose of NPH or increase bedtime snack
Spina Bifida
Spina Bifida is a NTD (neural tube defect) and is associated with low folic acid in mother's diet Spina Bifida Occulta: dimpling at the site or skin depression, port-wine angiomatous nevi, dark tufts of hair, soft, subcutaneous, lipomas, Meningocele: Sac like lesion filled with spinal fluid Myleomeningocele: Sac like lesion includes spinal fluids and spinal cord element Lamine of the vertebrae are gone. Implementation: - Cover lesion with moist sterile dsg - Position on abdomen or semi prone - Observe for symptoms of IICP - Observe for meningitis - Surgical repair at 24-48 hours - Observe for shock and respiratory difficulty
about trigeminal neuralgia (tic douloureux)
Stabbing/burning facial pain, unpredictable. Trmt: avoid stimuli, carbamazapine (Tegretol), ETOH inject to nerve, resection of nerve, microvascular decompression, chew on opposite side of mouth
Andrenergics Actions
Stimulates Beta-2 Receptors in Lungs (causes brochdilation)
Antidiabetic Agents: Actions
Stimulates insulin release from beta cells in pancreas
Assistive Device: Cane
Straight and quad cane. Flex elbow 30 degrees, have cane on good side to balance
Thrombolytics Med Names
Strepokinase, Urokinase, Tissue Plasminogen Activator (TPA)
Therapeutic Position
Supine: avoids hip flexion Prone: extension of hip joint Side lateral: drainage of oral secretions Fowler's: Increase venous return, lung expansion (subtract 15 degrees - High Flower's - 60-90 - Fowler's- 45-60 - Semi- Fowler's - 30-45 - Low Fowler's - 15-30 Modified Trendelenburg: used for shock, elevation of extremity increases blood to extremity and venous return (increases BP) - Feet elevated 20 - Knees straight - Head slightly elevated
what test is done to dx cystic fibrosis? what are norm values/dx?
Sweat Cl-test norm <40 dx: >60
Thyroid Replacement Agents Med Names
Synthroid, Cytomel
delusions
Systematized false beliefs, often of grandeur or persecution.
Antitubercular Agents Uses
TB, to prevent disease in person exposed to organism
toxoplasmosis(cats), Other, rubella, cytomegalovirus, herpes
TORCH stands for
post-op management after TEF?
TPN, gastrostomy, until oral feedings can be tolerated
H2-Receptor Blockers Med Names
Tagamet, Zantac
Antibiotics: Tetracyclines Nursing Consideration
Take 1 h before or 2-3 after meals Do not take antacid, mile, iron SUNBLOCK - avoid sunlight Monitor renal function Note Expiration Date - Toxic after date
Antibiotics: Macrolide Nursing Consderations
Take 1 h before or 2-3 h after meals Monitor LFT Take w full glass of water
Cytoprotective Agents Nursing Considerations
Take 1h before food Give 2h becofe or after other meds
Cardiac Glycosides Nursing Consideration
Take apical pulse Notify physician if adult <60, child <90-110 Monitor potassium level (3.5-5)
Antihyperlipidemic: Nursing Considerations
Take at bedtime or 30 mins after meals Administer 1 h before or 4-6h after other meds
Iron Preparations Nursing Considerations
Take on empty stomach Vit C increases absorption Monitor Hct and Hgb
Immunosuppressants Nursing Considerations
Take once daily in am Used with adrenal corticosteroids Monitor renal and liver function tests Take w milk or juice Stay away from sick ppl Good Handwashing
Antibiotics Teaching
Take until gone Do culture and sensitivity first Encourage fluids Check expiration date
Antibiotics: Cephalosporins Nursing Consideration
Take w food Cross allergy with PCN Avoid alcohol Obtain Culture and Sensitivity before first dose
NSAIDS Nursing Considerations
Take w food or after meals Monitor liver and renal functions Use cautiously with aspirin allergy Check for bleeding
H2-Receptor Blockers Nursing Considerations
Take w meals and hs Smoking decreases effectiveness Monitor LFT and CBC
Diuretics Nursing Considerations
Take with food or milk Take in am Monitor fluid and electrolytes
Antibiotics: Sulfonamides Nursing Considerations
Take with meals Encourage fluids Good mouth care
Pyridium Nursing Considerations
Taken with meals Urinary tract analgesic
Antithyroid Agents Med Names
Tapazole, SSKI
Hypoparathyroidism S/Sx
Tetany (involuntary contraction of muscles), muscle irritability (cramps/spasms), dysphagia, paresthesia, laryngeal spasm, anxitey, depression, irritability, tachycardia,Chvostek's and Trousseau's signs.
prognosis
The forecast of how a situation (including an illness) will improve or fail to improve in the future.
somatogenic hypothesis
The hypothesis that mental disorders result from organic (bodily) causes.
psychogenic hypothesis
The hypothesis that mental disorders result from psychological causes.
learning model
The hypothesis that mental disorders result from some form of faulty learning.
dissociative amnesia
The inability of an individual to remember some period of her life, or even her entire past, including her identity; often understood as a way of coping with extremely painful events.
Diagnostic and Statistical Manual for Mental Disorders (DSM)
The manual that provides specific guidance on how to diagnose each of the nearly 200 psychological disorders; currently in its fourth edition, text revision (DSM-IV-TR).