NCLEX-RN
Cyanotic cardiac defects
"blue" by may appear pink: unoxygenated blood mixes with oxygenated R→L shunt, concern for clots: 4 T's: Tetralogy of fallot- Truncus arteriosus- Tricuspid atresia- Transportation of the great vessels o Decreased pulmonary flow: o VSD/Pulmonic stenosis/Overriding aorta/R hypertrophy/Tricuspid Artresia, and Tetralogy of Fallot: • (PROV: pulm stenosis-r ventricular hypertrophy-overriding aorta-ventricular septal defect) • cyanosis, murmur, failure to thrive, clubbing, dyspnea • Mixed blood flow: • Transposition of the great vessels: cyanosis, cardiomegaly
macular degeneration
"central vision loss". Nursing: speak to pt when entering room, safety measures, orient pt to new surroundings, when walking offer pt an arm to lead- do not take their arm, leader walks alittle in front.
What is a Miller-Abbott tube used for?
It is inserted through the nose and advanced past the pyloric valve into the small intestine. it is used to diagnose and treat small bowel obstructions
What is referred pain?
Pain that is felt at distance from the stimulus?
cardiac conduction
SA node: "pacemaker" intrinsic rate 100 bpm AV node: 40-60 bpm Bundle branch/purkinje: 20-40 bpm
How should pancreatic enzymes be taken?
They are enteric coated - should be swallowed whole, and taken with every meal to aid digestion.
How is Hepatitis C transmitted?
Through body fluids, primarily blood.
Most effective PCA
morphine or hydromorphone (Dilaudid)
Ondansetron (Zofran)
antiemetic
Anticholinergics
atropine: bradyarrhythmias ipratropium: bronchospasm atropine: also used as ophthalmic mydriatic benztropine: management of Parkinson's disease
Systemaic Lupus Erythematosis (SLE)
autoimmune disease that affect connective tissues BUTTERFLY RASH across cheek and bridge of nose s/sx: nephritis, arthritis, and vasculitis
Guillian-Barre
autoimmune symmetric *ascending motor paralysis*, *fatal if respiratory muscles are affected*. d/t viral infection 2wks later. s/s: weakness, *bilateral, ascending*, loss of DTR, dysphagia Rx: LP (+protein in CSF) supportive, vent, IVF, immunoglobulin therapy, morphine for pain. Nursing: maintain resp status, provide communication needs
myasthenia gravis
autoimmune, progressive weakness of voluntary muscles, d/t blocked ACH s/s: fatigue, *weakness (better w/rest)*, ptosis (drooping eyelid) reduced eye closure, weak smile, diplopia, blurred vision, speech/swallowing disorders, weakness of facial muscles, restrictive lung disease. Rx: Tensilon test (injection to improve muscle strength +MG), Pyridostigmine, sterioids, immunosuppressants, thymectomy, plasmapheresis
Menieres disease
volume of endolymph expands, 40-60 yr olds/ s/s: attacks intermittent: vertigo, tinnitus, hearing loss. Rx: cholinergic blockers (atropine), diuretics, valium, epinephrine, low salt/triglyceride diet. Nursing: keep pt in quiet dark room, avoid unnecessary movement, restrict salt and water intake, avoid tobacco, caffeine
S3
walls vibrate, d/t HF, regurgitation, may be normal in under 30 year olds
hypermagnesium
weakness, hypotension, bradycardia, wide QRS
How much calcium should premenopausal women take in a day?
1,000 - 1,200 mg
What are signs and symptoms of digoxin toxicity?
Cardiac arrhythmias, nausea, vomiting, diarrhea, visual disturbances, headache, lethargy, irritability, and abdominal cramps.
What happens during the despair stage of separation anxiety?
Child begins to accept parents are not going to be around - they act sad, apathetic, and depressed
What happens during the detachment stage of separation anxiety?
Child begins to adjust and becomes more interested and active in surroundings
5 Rights of Delegation
Right task: define task and determine safety Right circumstances: pt condition, resources, equipment Right person: staff w/ necessary knowledge, skills, abilities (KSA), pt stable Right direction/communication: clear, specific, expectations, documentation Right supervision/evaluation: monitoring, evaluation, feedback
What is sinus tachycardia?
It is defined as a sinus rhythm with a rate of greater than 100 BPM.
Coumadin and Heparin
Need 5 day overlap before switch from hep to coumadin this ensures coumadin to reach therapeutic level before d/c of hep. PTT>100 is criteria for D/C Coumadin: no grapefruit or cranberry juice or green tea. Avoid vit K NOT POTASSIUM VIT K!!!
Filgrastim
Neupogen increases neutrophil count for chemo patients.
What is the tonic neck reflex?
Occurs when newborn's head is turned to the side, the arm on that side will extend while the opposite arm will contract - prepares the infant for voluntary reaching and may be a precursor to hand/eye coordination.
What is inflammatory pain?
Pain that is caused by the stretch or distention of sensitive tissue.
What is the client self-determination act of 1990?
Require all hospitals to inform patients about patients advance directives.
Ethics
Respect for others, right to make own decisions Autonomy: respect for right to self determination Nonmaleficence: do no harm Beneficence: do good Justice: fairness Veracity: telling the truth Confidentiality: respect for privacy Fidelity: loyalty, faithfulness and honoring commitments Abandonment if nurse "walks out" when staffing is inadequate
What does Aldosterone do? Angiotensin 2?
Responsible for sodium and water retention. Angiotensin 2 causes potent vasoconstriction. - Blocking both allows vasodilation and the excretion of sodium and water, lowering BP.
3rd trimester
27-40wks kick counts (10 in 2 hrs, 3x per hr) NST 32-34wks, (reactive good= accelerate 15 beats for 15 seconds) BPP: breathing movement, limb movement, tone/flex limbs, AFI (fluid pockets), reactive NST= 8-10 desired 32wks: increased chance of survival 36wks: lanugo disappears, grp B strep 40wks: full term
Normal plasma osmolality
270-300
What is done for clients in ketoacidosis?
Administer sodium bicarbonate, administer IV insulin, add potassium to replacement fluid therapy, and have IV of normal saline running.
Where is the least painful spot to inject heparin?
Administered at least 2 inches from the umbilicus - on the left or right side of the abdomen.
What does the anterior pituitary secrete?
Adrenocoritcotropic hormone (ACTH) and thyroid stimulating hormone (TSH)
How deep should IM injections be for Adults? Children?
Adults 1-1.5 inches Children - 0.5-1 inch
What are some things about multiple sclerosis?
Bladder dysfunction common - constipation common, fatigue should be managed, and patient should avoid heat and cold.
What is a factor that can affect drug absorption when doing an IM injection?
Blood flow to that area.
What foods have tyramine in them?
Caffeine, dairy products, alcohol, ginseng, and aged meat,
In assessing a patient with osteoporosis, a nurse would commonly find abnormalities in?
Calcium and phosphorus levels.
Where on an infants lips should they be latched on for proper sucking?
areola
Antidystrhythmics
assess: PFT, ECG, bp, electrolytes, LOC
Diabetes insipidus
decreased ADH and body excretes too much fluid, ^UO, low specific gravity, common in initial/acute phase of head injury
CVA
decreased blood supply to brain, d/t: HTN, smoking, obesity, ^cholesterol, a-fib. TIA=warning sign of stroke, localized ischemic event lasing mins/hr w/ full functional recovery within 48-72 hrs, progressing stroke "stroke in evolution" L side=impaired speech *Ischemic* slow onset d/t embolism *Hemorrhagic:* *Intracerebral*: abrupt blood vessel ruptures, HTN, anticoag, *Subarachnoid*: congenital aneurysms RX: thrombolytics (tPA), anticoags, antiplatelet, Plavix, steroids (decadron) BP management. Hemorragic: antihypertensives, decadron, Mannitol, anticonvulsants. Nursing: maintain airway, montor neuro status, maintain fluids, position HOB 30˚, head midline, ROM, maintain body alignment
Allopurinol (zyloprim)
decreases hyperuricemia caused by tumor lysis syndrome r/t chemotherapy normal uric acid level 4.4-7.6 (men) 2.3-6.6 (women)
spinal shock
complete but temporary loss of motor, sensory, reflex, and autonomic function immediately after injury- lasts less than 48hrs- weeks s/s: flaccid, bradycardia, hypotension, paralytic ileus
HHNC
hyperosmolar hyperglycemic state (hyperglycemic hyperosmolar nonketotic coma) rare, type 2: high mortality rate, gradual onset, BS>600, pH>7.4, no ketones, dehydration, altered LOC, retinopathy, nephropathy, neuropathy. Nursing: IVF, K
Pyloris Stenosis
hypertrophy of the pylorus -> stenosis of the passage between the stomach and duodenum s/sx: evident 2-8 weeks after birth. occasional vomiting -> forceful projectile vomiting. dehydration and lyte imbalances. Palpate the pyloric muscle and confirmed through ultrasound
Fluid volume excess
hypervolemia: water intoxication d/t excessive Na intake, IVF,CRF, CHF, SIADH, • S/s: ^HR, ^BP, distended neck veins, dysrthymias, ^RR, altered LOC, ^UO, pitting edema, diarrhea, • Rx: diuretics, restrict fluid/Na, monitor I&O, monitor daily weight
Bumetanide
loop diuretic
External fixation
monitor neurovascular q2hrs, elevated to reduce edema, assess pin sites for infection, daily pin care, isometric exercise. No alcohol/iodine- these cause corrosion of the pins. Clean with hydrogen peroxide or betadine
Osteoarthritis
more white people, degeneration of cartilage, weight-bearing joints, stiffness w/ rest, pain relieved w/ rest
Portal hypertension
s/s prominent abd wall veins (caput medusa) hemorrhoids, enlarged spleen, anemia, GI bleeding, esophageal varices. Rx: balloon, vasopressin, nitro, TIPS. Nursing: assess bleeding, no alcohol, monitor for infection
intermittent claudication (PAD)
. 6 P's: Pain-pallor-paralysis-poiklithermia (inability to regulate temp)-paresthesia-pulselessness pain w/ activity, limb=waxy, hairless, cool, pale, weak, absent pulses, non-healing wounds, impotence in men, reduced arterial-brachial index. RX: anticoag, vasodilators, antiplatelets, Trental "slippery blood" no compression, keep low. Sx: endartecetomy, bypass, amputation, angioplasty
How is Reflex irritability score in APGAR (Grimace)?
0 - absence of response to stimulation 1 - feeble cry or grimace after stimulation 2 - cry or pulls away from stimulation
How is muscle tone scored in APGAR?
0 - absent 1 - weak and irregular 2 - strong cries
How is respirations in APGAR scored?
0 - absent 1 - weak and irregular 2 - strong cries
How is the appearance section of APGAR scored?
0 - pale or blue all over 1 - blue at the extremites 2 - body and extremities are pink
How is pulse rate scored in APGAR?
0 - pulse is absent 1 - heart rate below 100 2 - heart rate above 100
How long is each box on the EKG?
0.04 seconds
PRI
0.12-0.20 beginning of P to end of PR
Creatinine
0.5-1
What is a normal range for lactate?
0.5-2.2mmol/L - it is a sign of spesis or tissue ischemia
INR
1 (with warfarin 2-3)
What is the edema scale? (1-4)
1 - 2cm, 2 - 4cm, 3 - 6cm, 4 - 8 cm
When is the APGAR score done?
1 and 5 minutes after birth.
Cellulitis
infectious infection of dermis/sub Q d/t strept bacteria, H. influenza, starts w/broken skin, HIGHLY CONTAGIOUS for days, can occur on any body part s/s: red, edema, tender, enlarged lymph nodes, fever, ha, "streaking" Rx: oral or parental abx, warm moist compresses, possible incision and drainage, monitor area by marking red area
beta blockers
-olol: slow HR, decrease vasoconstriction, decrease O2 consumption. Used in: HF, HTN, HR control, angina, migraine. AE: HF, bronchospasm, dizzy, constipation, suppresses hypoglycemia indicators. Contra: asthma, bradycardia, SSS. Nursing: check HR before giving. Teach: take med at bedtime, do not stop abruptly. Propranolol=essential tremors, Parkinsons
ACE inhibitors
-pril: HTN, HF. AD: angioedema, cough, hypotension, hyperkalemia, hepatotoxicity, neutropenia, agranulocytosis, pancreatitis, SJS. Contra: pregnancy. Nursing: empty stomach, monitor for infection, dry cough, use contraception (teratogenic), avoid sports drinks/salt substitutes (extra K)
ARB
-sartan: HTN, HF. AE: angioedema, hypotension, hyperkalemia, renal impairment. Contra: pregnancy. Nursing: may take with food, take with full glass of water
Epiglottitis
4 D's: DROOLING- DYSPHAGIA (diff swallowing)- DYSPHONIA (hoarse voice)-DISTRESSED inspiratory efforts Rx: cool air/mist, neb, abx, EPIGLOTTITIS IS AN EMERGENCY=TRACH. Nursing: NEVER ATTEMPT TO VISUALIZE EPIGLOTTIS WITH TONGUE DEPRESSOR- could precipitate laryngospasm
Normal WBC level?
4,000-10,000 cell/ml
cardiac output
4-7 L/min total volume of blood pumped through heart in 1 min CO=SV*HR measured w/ pulm artery catheter
What are the ranges for a Venturi "Venti" mask?
4-8LPM at 24-40% at low flow or 10-12 LPM at 50% o2 at high flow
MAP
>60 for adequate perfusion Normal: 70-105
What should be included in the care for a patient with acute decompensated heart failure?
Administer oxygen as ordered, administer loop diuretics, monitor O2 sat, vitals, and cardiac rhythm, and encourage the patient to sit in an upright position
What is important to include after a fracture?
Early ambulation is important, compartment syndrome can occur after 4 hours, and heparin therapy should be included to prevent thromboembolism.
What hormone abnormalities would be present in a patient with Grave's disease?
Elevated T4, diminished TSH
What are signs and symptoms of acute pancreatitis?
Elevated temperature, weight loss, abdominal pain, nausea, and vomiting
How can a nurse reduce friction and sheer in Buck's traction?
Elevating the food of the bed.
What is true about an immunoassay done shortly after conception?
Highly accurate 8-10 days after conception - detects human chorionic gonadotropin - hormone that is secreted by the developing placenta.
What are symptoms of chronic renal failure?
Hypertenison, anemia, fluid and electrolyte imbalances,
What are signs and symptoms of serotonin syndrome?
Hypertension, tachycardia, myoclonic jerking, tremor, sweating, nausea, diarrhea, confusion, and agitation.
What is the first line of defense against increasing ICP?
The patient should be hyperventilated - decreases ICP by decreasing carbon dioxide levels.
What is an ankle brachial index?
It is the blood pressure ration between the lower legs and the arms - blood pressure int he lower legs is normally higher than the arms, and abnormalities indicate narrowing of arteries. - S/S include Hx of angina with activity, intermittent claudication, and abormal (weak or absent) pedal pulses.
When is the trough of a medication measure?
It is the measurement of a drug's lowest level - commonly done immediately before the next administered dose.
What is Cullen's sign?
It is the presence of superficial edema and bruising around the umbilicus - it is suggestive of acute pancreatitis or an intraabdominal bleed.
What is the formula for an ankle brachial index?
It is the systolic blood pressure of the ankle (measured at the doralis pedis or posterial tibial) divided by the systolic pressure in the arms - it is measured on both sides, a ration under 1.0 indicates PVD.
What is tidal volume?
It is the volume of air inhaled or exhaled during each respiratory cycle.
What is forced vital capacity?
It is the volume of air that can be forcibly exhaled after full inspiration
How is Addisonian crisis treated?
It is treated with hydrocortisone, saline, and dextrose
What is Chlordiapoxide used for?
It is used for alcohol withdrawl, Ativan also might be used.
What is Ethosuximide (Zarontin) used for?
It is used to treat petit mal seizures or absence seizures.
What is Metformin?
It is used to treat type 2 DM - it decreases glucose production in the liver and glucose absorption in the GI tract - also improves GI sensitivity. - commonly causes GI upset which resolves within 2 weeks.
What is a hiatal hernia?
It is when a portion of the stomach herniates through the diaphragm, into the thorax.
What is reality orientation?
It is when the patient is continuously reminded of their name, date and current events.
What does a hypotonic solution do to fluid?
It lowers serum osmolarity and pulls fluid out of vascular space.
What is Chvostek's sign?
It occurs when the nurse taps the facial nerve at the angle of the jaw, resulting in the facial muscles contracting and twitching - indicative of hypocalcemia.
What are several ways E.Coli can be spread?
It originates in the intestinal tract of animals - avoid swimming in standing water, and cook all meat thoroughly
What occurs in aortic stenosis?
It prevents blood from passing freely from the left ventricle of the heart into the aorta. Eventually leads to hypertrophy of the left ventricle
Why should a dialysis patient avoid milk and soft drinks?
It puts them at risk for hyperphosphatemia and hypocalcemia.
What does a hypertonic solution do to fluid?
It raises serum osmolarity and pulls fluid into the vascular space
What is mechanical loading?
It refers to external resistance due to pathological changes, which the lungs must work against to breath - in COPD patients, the diaphragm muscle works against increased mechanical loads due to airflow limitation and geometrical changes of the thorax from pulmonary hyperinflation.
Should bubbling occur in the suction chamber?
It should bubble gently - if not, check to see if the tubing is connection and the suction source turned on.
When is nateglinide (Starlix) used for?
It stimulates insulin release from beta cells for a short time (1.5 duration)
What is osteroarthritis characterized by?
Join pain, stiffness, creptius, Heberden's nodes, and Bouchard's nodes. Pain occurs with prolonged or excessive use and is relieved by rest.
Three big drug categories that cause hyperkalemia
K sparing diuretics (spirolactone ACE inhibitors ("pril") Angiotensin II receptor blockers (Sartans)
Sodium Polystyrene sulfonate
Kayexalate
When changing the position of a patient with a back injury, what is most important to maintain?
Keeping the patient's head and back aligned by repositioning with a smooth, coordinated movement - this is a safe logrolling technique.
What position is used for Tetralogy of fallout?
Knee to chest
PAWP
L ventricular end-diastolic pressure 4-12 mmHg decrease= hypovolemia increase=hypervolemia, L HF, mitral regurgitation
What is the best position for a dyspneic patient to enhance respiration?
Leaning forward against a steady surface.
What serum amylase level is indicative of acute pancreatitis?
Levels 3x the normal range.
What are characteristics of Hodgkin's lymphoma?
Localized lymph node involvement, spreads continuously (from node to node), the mesenteric nodes and Waldeyer ring are rarely involved, and extra-nodal presentation is rare.
What type of fracture are fat embolisms most common in?
Long bone fractures.
What are symptoms of drug addicted newborns?
Low birth weight, nervousness, irritability, tremors, seizures, poor feeding, piercing cry, and respiratory distress.
What position should a patient be placed in after cleft palate repair?
Lying on side to facilitate drainage and maintain patent airway
neuro assessment
MSE, cranial nerves, LOC, Glasgow, sensory, motor
Dry suction
NORAML to have gentle bubbling chest tube chamber hooked to low wall suction setting
Naproxen (Naprosyn)
NSAID
How should a patient with a broken leg use crutches to get down a staircase?
The patient should first shift body weight to the unaffected leg. Then, both crutches should be advanced down to the next step. After the crutches are advanced, the affected leg is moved while body weight is shifted to the crutches. Finally, the unaffected leg is moved forward.
What is simple silicosis?
The patient was exposed to low concentrations of silica and is usually asymptomatic - abnormalities are often detected on x-ray
Autism
affects brain's normal development of social/communication skills, boys more, dx 18mo-2yrs old Rx: antipsychotics, anticonvulsant, mood stabilizers, stimulants, Diet: gluten-casein free Nursing: consistent daily schedule, limit distractions, clear/consistent rules, encourage/reward independent achievements, do not stop meds, good sleep/nutrition
Chain of infection
agent →reservoir (people, equip) → portal of exit (droplets, excretions) → transmission route (airborne, direct, ingestion→ portal of entry (broken skin, GI tract, resp tract, mucous membranes) → susceptible host (burns, CVD, DM, sx, immunosuppression)
biphosphonate
alendronate risedonate RISK for jaw necrosis educate: drink a lot of water with med admin and sit up for at least 30 minutes
Standard precautions
all pts (except sweat) to prevent spread of orgs, PPE: gloves, masks, gowns, goggles, head covering
Hypothyroidism
autoimmune, s/s: constipation, sensitivity to cold, fatigue, heavy periods, pain, dry skin, depression, thin hair/nails, weight gain, puffy face/hands/feet, slow speech, thick skin. TSH ^, T3/T4 decreased. Nursing: take synthroid in the morning on empty stomach, drink 8 oz of water, watch for cardiac dysrhythmias, do not change brands of thyroid meds, lifelong therapy
cardiac catheterization
assess for allergies, NPO 8 hrs before, height/weight for dye, lie still and quiet for 2hrs, feel "flutter" feelings w/ cath, warm flush w/ dye and desire to cough d/t heart irritability after: keep extremity extended 4-6 hrs, strict bed rest 6-12 hrs
Anticoagulants
assess: min invasive proceudres, no shaving, gentle tooth brush, avoid NSAIDS, alcohol, vit K
Antiinfectives:
assess: obtain cultures before administration, nephroptoxic/hepatotoxic, renal function test, jaundice, n/v
Anticholinergic
assess: sips of water, frequent oral care, stand assist
Loop diuretics
assess: circulatory collapse, ototoxicity, verify UO before giving, monitor F&E, edema, bp
Female hormones
assess: thromboembolic disorders, ^ breast ca, edema, perfusion
Antihypertensive
assess: vasodilators, CNS depressants, take bp and pulse daily, no caffeine, alcohol
6 things RN must document
assessment nursing dx and pt needs interventions care provided pt response to care pt ability to manage care after discharge
AICD
automatic implantable cardioverto-defribillator: SHOCKS and prevents death from cardiac arrest used for ventricular dysrhythmias, complications: infections, malfunction, batter failure. Nursing: teach findings of defib charge, limit activity, avoid strong magnetic fields—no household appliance will affect, shock may be painful.
DM autonomic, peripheral, and sensory neuropathy
autonomic controls autonomic nervous system: ortho hypo, painless MI, urinary retention, hypoglycemic unawareness, and bowel incontinence peripheral and sensory: issues effecting the extremities
Calcitonin
decrease serum calcium and increase bone density. Used in Paget's disease, osteoporosis. AF: bronchospasm, angioedema. Nursing: keep calcium gluconate avail if hypocalcemia=tetany. Teach: weight bearing exercise daily and ca/vit d rich foods
Pernicious anemia
deficiency in the production of RBC from lack of B12. s/s: hypoxia, fatigue, dyspnea, sore beefy red tongue, anorexia, diarrhea, paresthesia in hands/feet, changes in LOC, GI symptoms reversible, neuro is irreversible. Shilling test, Rx: lifelong vit B 12 therapy given parenterally, transfusions needed
Von Willebrands
deficient clotting protein, congenital, factor 8, easy brusing, nosebleeds, heavy periods, prolonged PT. no RX- avoid blood thinners
Otosclerosis
degenerative disorder that results in conduction deafness, s/s gradual hearing loss, tinnitus. Rx: hearing aid. Nursing: avoid anything that might displace prosthesis (coughing, blowing nose, swimming), keep ear dry, do not fly for 6 months
ear
earache, discharge, tinnitus, vertigo, adult auricle UP/back, peds auricle DOWN/back Tympanic membrane: translucent, shiny, light gray, taut, say "ah"=intact/vibrates Hearing: whisper, Weber (bone conduction=top of head), Rinne (sound conduction=mastoid bone) Geriatrics: ear lobes pendulous, presbycusis at 50, slowly progressive
PE
embolism-blood clot/air/fat/amniotic that blocks arteries that feed the lung=pulm infarction and decreased CO, pt breathing but no gas exchange, hypoxemia, can be fatal, d/t prolonged immobility, poor hydration, a-fib, fat embolism w/in 24 hrs after fracture. s/s: sudden onset of dyspnea, cough, low sat, pleurisy chest pain, anxiety "impending doom" cough, tachycardia, tachypnea. Rx: O2, anticoags, thrombolytic. Nursing: early ambulation, compression stockings to prevent
Personality disorders
enduring pattern of inner experience and behavior that deviates from the expectations of pts culture, pervasive, inflexible, onset in adolescent, stable over time, leads to distress,complications jail, drugs, violence, suicide More men then women, behavioral therapy, nursing: protect pt from harm, low stim, set limits, structure
BPH
enlarged prostate, narrows urethra. s/s: difficulty starting/stopping stream, frequency, dribbling, nocturia. Labs: PSA. Rx: antihypertensives, Minipress, sx (TURP). Nursing: assess for bladder distention, post void residual, orthostatic blood pressure, monitor I&O, bladder irrigation as prescribed, Kegel exercises post-op
Nursing: chest tube
ensure chest tube drainage system is closed, no leaks, connections are taped, no kinks, monitor volume (notify Dr if +100ml/hr and/or sudden bright read, free flowing drainage, keep collection device below chest level/insertion, fluctuation of water level is expected, do not strip tubing, occlusive dressing prevents air from entering pleural space, BUBBLING=AIR LEAK
Raynauds
episodic vasospasm, cyanosis bilaterally, autoimmune, triggered: stress, cold, smoking, caffeine, chocolate
TPN
hyperalimentation (artificial supply of nutrients) for pts that cannot use GI tract for absorption Infuses via central venous catheter Get labs: BUN, Cr, liver enzymes, pH, BS once per shift: assess hyper/hypo glycemic Use filter (not with lipid) to prevent microemboli, encourage coughing and deep breathing to prevent acidosis, discard after 24hrs, start slowly and titrate to tolerance
Cane walking
hold can on stronger side ascending stairs: first step with stronger leg, next bare weight on stronger leg, move cane, and finally step with weaker leg
Fluid volume deficit
hypovolemia, dehydration, diarrhea, DI. • S/s: ^HR, hypotension, dysrhythmias, ^RR, dyspnea, lethargic, weakness, decreased UO, tenting, constipation • Rx: IVF, O2
Ostomy
ileostomy (liquid), colostomy (thicker) Nursing -ostomy: empty pouches when they are 1/3-1/2 full using standard precautions, protect skin
Retinal detachment
holes or breaks/tears in retina, fluid/blood separates, d/t inflammation, trauma, hemorrhage, s/s: rapid separation "curtain being pulled over the eye" partial vision, Rx: sx, cryotherapy, scleral buckle, adrenergic drops. Nursing: proper position in bed, eye patch, sunglasses for photophobia
Lead poisoning
lead levels >5 Chelation therapy needed education: home searched for lead sources, wash children hands frequently, increased intake of iron and vit C, hard surfaces should be wet dusted or mopped weekly, use COLD water to cook if pipes are source of lead.
What are good sources of heme iron?
lean meats, whole grain breads, and lentils
LDL
less than 130
sinus brady
less then 60 O2, atropine, pacemaker, IVF
Refeeding syndrome
lethal complication to feeding someone who is malnourished LOW phosphorous, K, and Mag fluid overload, NA retention, hyperglycemia, and thiamine deficiency
Respiratory alKaLOsis s/s:
lethargy lightheadedness confusion tachycardia dysrhythmias related to hypokalemia nausea vomiting epigastric pain numbness and tingling of the extremities hyperventilation (tachypnea)
Epiglottis
life threatening r/t HiB vaccination s/x: tripod positioning, high grade fever, severe sore throat, followed by 4 D's: DROOLING, DYSPHONIA, DYSPHAGIA, and DISTRESSED AIRWAY (inspiratory stridor) Education: Do NOT ask to open mouth it will occlude airway
What are signs and symptoms of Parkinson's disease?
masklike appearance to the face, presence of drooling, slow speech, and shuffling gait.
Nephrosis/nephrotic syndrome
massive proteinuria, hypoalbuminemia, hyperlipemia, edema. In children 2-7hrs shifts of ADH and osmotic pressure increasing water absorption. s/s: weight gain, puffy face, anasarca (generalized edema) periorbital edema, loss of appetite, oligura "tea colored" foamy urine d/t increased proteinuria, lethargic. ^BUN. Diet no sodium. Nursing: monitor vs, weight, restrict fluids, position in semi-fowlers. Nephrotic syndrome involves the loss of a lot of protein= proteinuria 3.5g in 24 hrs=*frothy*, edema Nephritic syndrome involves the loss of a lot of blood= HTN
Antivirals
memory trick - many end with "CY[I]CLOVIR", including acyclovir (Zovirax), valacyclovir (Valtrex)
Myopia
near-sightedness, blurred distance
LP
needle inserted through L3-4 *NOT w/ IICP*=can cause herniation position lateral recumbent, chin to chest w/ knees up, keep flat after
Wilm's tumor
nephroblastoma, rare, usually on just 1, highest survival rate of ped cancers, occurs around ages 3-4. Impairs renal function. s/s: abd mass, firm, non-tender, fatigue, resp if metastasis. Sx removal. Nursing: DO NOT PALPATE ABDOMEN strict I&O
Wilms tumor
nephroblastoma: rare kidney cancer, children under 5. s/s: abd mass, high BP, increased growth on one side, DO NOT PUSH ON BELLY, teach to avoid injury to tumor site, prognosis 90%
Hirschsprung Disease
newborn with missing nerve cells of distal bowel s/sx: no peristalsis and stool is passes, distended abdomen and will not pass meconium within 24-48hours, vomit GREEN BILE, tx> surgical removal of defective bowel and colostomy is required REPORT: increasing abdominal girth and foul-smelling diarrhea and fever
Antianginals
nitrates: used to treat and prevent attacks of angina; acute treatment calcium channel blockers and beta blockers are used prophylactically for longer-term management
CCB
no GRAPEFRUIT JUICE
MRI
no metal objects, pacemaker, implanted defibrillator, hip prosthesis, vascular clips, no IVF, no pregnant women
a-fib
no p wave give O2, anticoags, cardioversion, antidysrhythmics
V tach
no p waves and WIDE QRS
Contact dermatitis
noninfectious "poison ivy": inflammatory reaction to substances. s/s: blisters, pruritic lesions. Rx: cold compress, topical anti-inflammatories, antipruritics
Palidermin (Kepivance)
human growth factor prevents oral mucositis in patietns dx with hematologic malgiance
autonomic dysreflexia
paroxysmal *hypertension* *bradycardia* diaphoresis, facial flushing , pilomotor responses, ha, dilated pupils, blurred vision, restlessness d/t injury *above T6* after spinal shock Triggers visceral stimulation from a *distended bladder *or impacted rectum. a neurological *emergency* and must be treated immediately to prevent a hypertensive stroke. It is also known as autonomic hyperreflexia. nursing: raise HOB, loosen tight clothing, *check bladder distention and other noxious stimulants*, administer antihypertensive meds
burns
partial thickness (1st and 2nd˚ burns), full thickness (3rd and 4th˚ burns) d/t heat, chemicals, electricity, or secondary to irradiation (hot water scalding more common in toddlers, flame related burns more common in older children), severity: minor less than 10% total BSA, moderate 10-20% total BSA, uncomplicated major more than 20% of total BSA. • Rule of 9's for Adults: 9% for each arm, 18% for each leg, 9% for head,18% for front torso, 18% for back torso. • Rule of 9's for Children: 9% for each arm, 14% for each leg, 18% for head, 18% for front torso, 18% for back torso.
Chondromalacia
patellae: progressive, degenerative softening of the bone- progressive exercise routine to strengthen muscles will help normalize the patella
hair
pediculosis capitis (lice): whitish oval specks sticking to hair shaft • Tinea capitis (ringworm): oval pattern of hair loss
Serious complication of tonsillitis or pharyngitis
pertonsillar or retropharyngeal abscess LOOK for: pot potato or muffled voice, trimus (inability to open mouth), pooling of saliva, deviation of uvula to one side. #1 MAINTAIN AIRWAY
Amputation
phantom limb pain may occur up to 3 months post-op, most common AKA, pain relief: stump desensitization, TENS, Preventing contractures BKA: lie supine with leg extended 20-30 mins 3-4 times a day, AKA: prone, extended 20-30 mins 3-4x day
Huntingtons
progressive atrophy of basal ganglia, genetic, progressive decline in cognitive function. Rx: psychotropics Nursing: foster independence in ADLs, teach nutrition, increase cal intake, support group
ALS
progressive neurological degeneration of motor neurons, etiology unknown s/s: *begin in upper body*, muscle twitching, weakness, clumsiness, atrophy, spasticity, death from resp failure 2-6 yrs. Rx: muscle relaxants, Rilutek. Nursing: resp care, safe environment, prevent complications d/t immobility
Chronic kidney disease
progressive, irreversible deterioration in renal function d/t HTN, DM, glomerulopathy, mephritis, polycystic disease, congenital. s/s: pulm edema, HTN, hyperkalemia, lethargy, hyperlipidemia, glucose intolerance, water retention, metabolic acidosis, hyperkalemia, hypocalcemia, hypermagnesemia, hypophosphatemia, anorexia, n/v, gastric ulcerations, hemorrhage, anemia,hyperpigmentation, ecchymosis) Labs: elevated BUN, Cr Phosphorus. Rx: meds for hypertension, statins, epoetin, diuretics, calcium, LOW protein, low salt, restrict K, phosphorus (no chicken, milk, legumes, carbonated drinks), dialysis. Nursing: assess fistula for thrill and bruit, edema
TBI
s/s: LOC, nasal discharge, stiff neck, restlessness, n/v, posturing (decerebrate/decorticate) CSF leakage, hyperthermia, *Cushings triad* hypertension, bradycardia, widening pulse pressure Rx: Mannitol, steroids (Decadron) IV push, barbiturate coma induced to treat refractory IICP, neuromuscular blocking agent (Norcuron) to decrease agitation, ICP monitor Nursing: *HOB 30˚, midline*, avoid flexion/extension of head, O2, avoid morphine, maintain body temp to prevent shivering (increases ICP), decrease stim, limit fluid intake to 1200ml day, avoid straining, seizure precautions, monitor for herniation: irreg breathing, irreg pulse, loss of brainstem reflexes (blinking, gagging, pupil reaction) resp/cardiac arrest
purpura
reddish-purple blotches on skin that do not blanch with pressure INDICATES bleeding underneather skin FURTHER assessment needed for potential life-threatening blood dyscrasia
Osteoporosis
reduced bone mass/strength, increased likelihood of fracture type 1: estrogen-related type 2: d/t aging or other medical conditions. Risk factors and s/s: bone density test T score -2.5 or greater, kyphosis "dowager's hump" loss of height 2 inches or more. Rx: exercise, increase calcium and vit D, estrogen, calcitonin (cannot increase bone mass but can prevent further bone loss), bisphosphonates (inhibit bone resorption, need calcium/vit d supplements, taken daily/weekly/monthy)
Albuterol, Atrovent, Ipratopium, & sole-medrol
rescue asthma drugs Albuterol & Atrovent: short acting beta agonist Ipratopium: anticholinergic agent solu-medrol: steroid to control underlying inflammation (not immediate) Admin Q20 mins NORMAL to habe tremors and palpitations
RACE
rescue, activate alarm, contain fire, extinguish flames
S4
resistance to ventricular filling, ABNORMAL d/t: hypertrophy, disease, injury
Droplet precautions
respiratory, 3 ft or less, first 24˚ strep, viruses, Neisseria, meningitis, pertussis
IICP
restlessness, irritability, confusion, lethargy, pupils ipsilaterally, blurred vision fixed, hemiparesis, decorticate then decerebrate, flaccid, abnormal reflexes: hyper- or hyporeflexia, +Babinski , *Cushing's triad* hypertension; progressively increasing systolic pressure with widening pulse pressure; bradycardia, Cheyne-Stokes, vomiting, headache, seizures, *infant "high shrill cry"* *Nursing*: HOB 30°, head midline-no flexion of neck/hips (to encourage jugular venous drainage), O2, no morphine, vent PaCO2 at 30-35 (will vasoconstrict= decreased ICP), prevent shivering (which can ^ ICP), , limit fluids 1200 mL/day, avoid straining, *Meds*: Anticonvulsants, Antipyretics and muscle relaxants, Blood pressure medication, Corticosteroids, IVF, Hyperosmotic agent) *Herniation syndrome*: Irr RR, HR Loss of brainstem reflexes (blinking, gagging, pupils)
5 rights of med administration
right pt, right dose, right time, right route, right drug
tinea corporis
ringworm contagious tx: antifungals (tolnaftate, haloprogin, miconazole, and clotrimazole)
Peptic ulcer disease
risks: NSAID/ASA, steroids, caffeine, alcohol, stress, family history, H.pylori s/s: pain, burning, gas *worse w/ food*, pain LUQ, n/v, hematemesis, hemorrhage, perforation/peritonitis (*board like abd*), paralytic ileus (obstruction). Rx: NPO, Flagyl, H2 antagonists (Tagamet/Pepcid) anticholinergic, antacids, cytoprotective (sucralfate), PPI, Reglan *Please Make Tummy Better (PMTB: ppi, metronidazole-tetracycline-bismuth subsalicylate)*
Hydrochlorothiazide
thiazide diuretics NO with lithium used: HTN SE: low K (muscle cramps) , low NA (mental status and seizures), high uric acid(worsen gout attacks), and hyperglycemia.
chlorthalidone
thiazide diuretics no with lithium SE: low K (muscle cramps and cardiac effects) low NA (mental status and seizures), high uric acid (worsen gout attacks) and hyperglycemia
Diuretics
thiazide diuretics and loop diuretics are used alone or in combination in the treatment of hypertension or edema due to CHF or other causes potassium-sparing diuretics have weak diuretic and antihypertensive properties and are used to conserve potassium in clients receiving thiazide or loop diuretics osmotic diuretics are often used in the management of cerebral edema
frostbite
tissue damage when ice crystals form in tissues s/s: blanching, decreased sensation, 2nd degree: blisters after rewarming, 3rd degree: cyanosis, local necrosis, hemorrhagic vesicles, 4th degree: complete necrosis, gangrene, amputation. Rx: cover area DO NOT massage area, rewarm gradually in 100˚F-108˚F water, give analgesics and sedatives for pain, possible sx: escharotomy
I PASS the BATON
to improve handoffs and transitions of care, opportunities to ask questions, clarify, and confirm intro, pt, assessment, situation, safety, background, actions, timing, ownership, next
Pacemaker
to keep heart beating a determined rate stims heart via electrodes that touch the myocardium, used to correct dysrhythmias- types: atrial/ventrical/a-v pacing. 3 types: asynchronous (fixed rate), demand (standby-if drops below a determined rate) synchronous: sensing circuit that detects atrial and ventricular activity. Used with symptomatic bradyarrhythmia/tachyarrhythmias, asystole. Battery lasts up to 10 yrs. Complications: infection, perforation, pneumothorax, dysrhythmias, clot, pacemaker failure, syncope, hypotension, hiccups, sob. Nursing: teach how to take pulse, pacemakers set rate, findings of pacemaker failure, wound infection, activity limitation, hazards: MRI, arc welding, avoiding contact sports (golf, hunting) follow up
SIADH
to much ADH, water is excessively retained, UO drops, specific gravity increases, more common in chronic phase after head injury
ASthma triggers
tobacco smoke, beta blockers, aspirin, and NSAIDs URI are #1 molds, pollen, dust mites, cockroaches, and animal danger
Bilirubin
total less then 1.5
Levetiracetam (Keppra)
treats seizures
Pregabalin
tricyclic antiD use: depression and fibromyalgia
Retinoblastoma
tumor of the retina, under age 6, 1 or both eyes, differing iris colrs, "cat's eye reflex" strabismus, double vision Nursing: assess eyes when parents report strange light in child's eye, teach prosthetic eye care
What is methylergonovine (Methergine) used for?
used to prevent postpartal hemorrhage. - can cause hypertension, should check BP before administering. Usually given up to 8 hours after birth to promote uterine contractions to prevent postpartal hemorrhage.
What is Bupropion used for?
used to treat depression and smoking cessation - activates the dopamine receptors in the nucleus acumbens (reward center)
Peritoneal dialysis
uses the peritoneum, CAPD (continuous ambulatory peritoneal dialysis) allows more freedom, fewer dietary and fluid restrictions, simple to use. CAPD: indwelling cath is permanently implanted in peritoneum, attaches to sterile plastic bad of dialysate solution, infuse 2 Lvia gravity for 10 mins, solution dwells in cavity for 4-6 hrs, then solution is drained into a bag via gravity, drainage time is 10-20 mins, pts average 4 exchanges per day including overnight which allows for uninterrupted sleep. Complicatons: infection, peritonitis, leakage, abnormal drainage (brown/bloody). Nursing: monitor I&O, teach warning signs of peritonitis: abd pain, cloudy peritoneal fluid, abd tenderness, malaise, fever
Bronchiolitis
usually viral (RSV) swelling/mucus buildup of the bronchioles, rare in children over 3, seasonal (fall/winter) spreads via direct contat (nose/eye) leads to edema, mucus accumulation, can progress to atelectasis. s/s: begins as URI, cough, wheezing, SOB, difficulty breathing, crackles, retractions, tachypnea, nasal flaring, fever. Rx: fluids, humidification, rest, bronchodilators, steroids, DROPLET precautions, single room or with another RSV, check immunization RSV interferes with other vaccines for 9 months, no smoking near child, rest and moist air
late decels
uteroplacental insufficiency 1.give o2 by facemask 2.reposition on right or left side 3.oxytocin stopped 4. provide IV bolus prepare for deliver is decelerations persist
hypomagnesium
v-tach/v-fib, TALL T waves, depressed ST
airborne disease
varicella, TB, measles My(measles) Chicken (varicella and shingles) Hez (herpes) TB
sickle cell disease
vaso-occlusive crisis, hypoxia, organ dysfunction, ischemia, infarction. Rx: hydration, oxygen, analgesics, abx, folic acid, IV steroids, transfusion, vaccines. Nursing: fluids, I&O, avoid triggers, keep hydrate
QRS
ventricular depolarization 0.04-0.1 (less then PRI)
hypocalcemia
ventricular dysrhythmias, prolonged ST and QT, cardiac arrest
QT
ventricular refractory time 0.32-0.5
Sildenafil
viagra no nitro or trazosin r/t bottoming out BP NO grapefruit juice
Pharyngitis
viral, bacterial, fungal, grp B strept=rheumatic heart disease/glomerulonephritis. s/s: scratchy sore throat, worse w/ swallowing, red, swollen, white exudates. Rx: abx, analgesics, encourage fluids
hemoglobin
woman 12-15, male 14-16
Vasopressor
Å and ß: Dopamine/Levophed/Epinephrine: ^HR/BP, ACLS, CO, shock, refractory HF. AE: pulm edema, arrhythmias, HTN, cerebral hemorrhage. Antidote for extravasation: Regitine ß: Dobutamine: ^CO/BP. Used in HF. AE: seizures, cardiac arrest, bronchospasm, restlessness, tremor. Nursing: monitor BP and HR q15 mins
pain
• Acute: lasts up to 6 months, d/t identifiable causes • Chronic: longer than 6 months, lasts longer then expected healing time, unknown caused often w/depression • Somatic: tissues (skin, muscle, joints, bones, ligaments) sharp, well-localized, intense: fibromyalgia, ha, arthritis • Visceral: organs (ischemia), poorly localized, vague, deep ache/cramp, referred pain: gallbladder, IBS, cystitis • Non-nociceptive/neuropathic: PNS/CNS: o Neuropathic: shooting, burning, referred pain: nerve compression/damage, sc
ADPIE
• Assessment: 1st step, subjective and objective data • Diagnosis: analysis, formulation of nursing diagnosis • Planning: prioritizing problems, determining goals, plan of care • Implementation: nursing action (rather than medical action) • Evaluating: comparing outcomes, communicate and document findings
Recovery complications and actions
• Hypothermia=warm blankets, increase temp in room, change temp obtaining options o Shivering may be d/t meds, not always hypothermic • Hemorrhage=check dressing, check for pooling, check drainage tubes, assess internal bleeding, incision site • Hypotention=give IVF, monitor vs, lung sounds, elevate as ordered
BP assumption
• If you can feel a radial pulse=at least 80 SBP • If you can feel femoral pulse= at least 70 SBP • If you can only feel carotid pulse=at least 60 SBP
Cardiac monitoring
• MAP: 70-105 • CVP: 2-8 • PAP: 15-25/8/15 • PAWP: 6-12 • Art-line BP: 100/70 • CO: 4-8 L/min (CO=HRxSV)
What should be used to unclog an NG tube?
Bicarbonate can be used to irrigate it.
What classifies a 4th degree burn?
Black, eschar, dry, painless, no blanching
How is Lyme disease diagnosed?
Blood test - not reliable until 6-8 weeks after exposure - treated with antibiotics (Doxycycline)
What is used to diagnose acute lymphoblastic leukemia?
Bone marrow biopsy
What should a patient do during a laryngoscopy procedure to reduce gagging?
Breath in and out through the nose.
What does the APGAR score assess?
Breathing effort, heart rate, muscle tone, reflexes, skin color
What is the rooting reflex?
Brushing an infant's cheek will cause the baby to turn in that direction.
What are signs and symptoms of Lyme disease?
Bullseye rash, fever, malaise, muscle soreness, and headache
Where can an Austin Flint murmur be assessed where?
By listening near the apex of the heart
What do neutrophils do? Normal %?
Defend against bacteria and fungi and produce a small inflammatory response Normal % - 55-70%
What do lymphocytes do? Normal %?
Defend against viral infections Normal % - 20-40%
Feeding tubes
complications= aspiration, diarrhea, electrolyte imbalances nursing: HOB 30˚ to prevent aspiration 1.5-2 hrs after feeding placement: x-ray, aspirate gastric contents (pH acidic), no longer accepted to inject air and listen bag and tubing change q 24 hrs no more than 300ml per hr to prevent F&E changes check residual q 4 hrs if continuous or prior to intermittent, if residual greater then 100-150ml hold feedings reinsert residual to prevent metabolic alkalosis, flush tube with 30-60 ml water after feeding Measures to improve intake: small frequent meals, adequate dentition, feeding assistance, offering preferred foods, ethnic foods
Hearing loss
conductive (sound not conducted efficiently through the outer ear to middle/inner ear d/t inflammation, obstruction, scarring, earwax buildup. Sensorineural: damage to inner ear CN-VIII. Prevention: take omega 3
Chest physiotherapy
consists of coughing, chest wall percussion, vibration, postural drainage, designed to improve airway clearance, used in retained secretions. Chest all percussion: clapping chest w/cupped hands, vibration is downward. Postural drainage: loosens mucus to be coughed out, gravitational clearance, used 10 different body positions, tapping while pt coughing. Percuss each area for at least 3 mins, avoid procedure within 2 hrs after eating.
Fluticasone/salmeterol (Advair)
contains corticosteroid and bronchodilator Long acting agonist that promotes relaxes smooth muscle over 12 hours. NOT an emergency drug for asthma. education: after inhalation, rinse mouth with water without swallowing (reduce risk of candidiasis), avoid smoking, and receive pneumococcal and flue vaccines if there is a risk of infection.
chronic bronchitis
cor pulmonale (hypertrophy/dilation of R ventricle)
CSF
cushion, aids in exchage of nutrients and wastes normal pressure 50-175 normal volume 125-150 yellow "halo" ring
Right to left shunt heart defects (yet, transposition)
cyanotic defects clubbed fingernails or cyanosis with crying
Skeletal muscle relaxers
cyclobenzaprine/Flexeril: muscle spasm, high risk Beers (elderly) d/t anticholinergic/sedation effects. Contra: heart block, HF. Nursing: collaborate with PT, avoid abrupt withdrawal, fluids/fiber
What characterizes the fourth stage of labor?
Follows placental expulsion to 1-4 hours postpartum
What characterizes the third stage of labor?
Follows the expulsion of the infant and ends with the delivery of the placenta.
What foods should be avoided in a patient with Crohn's disease?
Foods high in fiber, and milk products that may increase diarrhea should be avoided.
What is Trendelenburn position used for?
For pelvic surgery, and to treat shock.
What is a complication of using a crutch to ambulate?
Forearm muscle weakness.
Bisphosphonates
Fosamax: inhibit bone resorption used in osteoporosis. AE: dysphagia, esophageal ulcer. Nursing: take 1st thing in the morning w/o food, 8oz of water, remain upright for 30mins after taking, if dose missed-skip
amylase
25-151
hyperkalemia
causes asystole, ventricular dysrhythmias, TALL TENTED T waves, wide QRS, prolonged PRI, flat P waves
Refeeding syndrome
24-48hrs of therapy d/t fluid shifts: bradypnea, lethargy, confusion, weakness
What gauge of needle should be used for subcutaneous injection?
25 or 27 gauge needle.
What is a normal range for serum amylase?
25-120 U/L
Weight gain for preggos
25-35 pounds for normal weight first trimester: 1-5 lbs total 2nd and third: 1lb/week
normal output for infant
2ml/kg/hr 6-10 diapers/day OR 1 diaper/4hours
What classifies a deep partial thickness burn?
2nd degree - red and white, bloody blisters, moist, painful, less blanching
What classifies a superficial partial thickness burn?
2nd degree - red, clear blisters, moist, painful, blanches
stages of shock
3 stages: CPR • Compensatory (reversible "warm") hypoxia, BP drops, ^HR, decreased UO • Progressive: lactic acidosis d/t cell death, altered mental status, cerebral edema, resp acidosis, tachypnea, crackles, BP below 90, narrowing pulse pressure, tachycardia, irreg pulse, JVD, hypoglycemia, cyanotic- poor prognosis • Refractory: MODS (multi-organ dysfunction syndrome) cardiac failure, resp failure, renal shutdown, loss of consciousness Nursing care: DO NOT elevate or lower head, modified trendelenburg (legs slightly raised to increase return), monitor temp to keep from shivering, vs q 15-30 mins, monitor for LOC changes, bowel sounds, sudden chest pains.
ear exam
3+ adult auricle UP/back peds auricle DOWN/back Tympanic membrane: translucent, shiny, light gray, taut, say "ah"=intact/vibrates Hearing: whisper, Weber (bone conduction=top of head), Rinne (sound conduction=mastoid bone) Geriatrics: ear lobes pendulous, presbycusis at 50, slowly progressive
How far should an enema be inserted?
3-4 inches
What is a normal Phosphorus level?
3-4.5 mg/L
What is the normal range for phosphorus?
3-4.5 mg/dl
What is a normal Potassium level?
3.5-5.0 mEq/L
K
3.5-5.0: intracellular, neuromuscular/muscular contraction, regulated by kidney. o Foods: avocado, potatoes, spinach, strawberries, tomatoes, raisins o NEVER GIVEN IV PUSH, IM, SUBQ, max infusion 10 mEq/hr, K can cause phlebitis=assess IV site frequently, assess renal function before administering, monitor I&O o High/low=impacted heart rhythm, and muscle function w/ leg cramping o High d/t: K retaining diuretics, CRF, Addison's, tissue damage- if CRF=Kayexalate, IV glucose with insulin, Ca, dialysis, avoid salt substitutes o Low d/t diuretics/corticosteroids, vomiting, diarrhea, NG suction, CRF, -no supplements on empty stomach o Hypo=st depression Hyper=Tall T waves
When administering a SQ injection, the nurse disinfects the injection site and waits how long before administering?
30 seconds - allows site to dry.
What is a normal value for Triglycerides?
30-150 mg/dl
HDL
30-70
Up to how many milligrams of caffeine can a pregnant women consume?
300 mg
mouth
32 adult teeth, tongue symmetry, Geriatrics may be drier
PCO2
35-45
What is a normal pCO2 value?
35-45 mmHG
how many calories burn loose a pound
3500
According to bartholomew's rule of fourths, how many weeks along is a women if the fundus is at the xiphoid process?
36-38 weeks.
What classifies a full thickness burn?
3rd degree - white/brown, dry, leathery, painless, no blanching
What are symptoms of left sided heart failure?
Cough - pink or frothy sputum, oliguria, fatigue, SOB, palpitations
broca's/wernicke
broca=understands w/broken speech wernicks=unable to understand but can speak
asthma
bronchospasm, airway obstruction, narrowing, triggers: cold air, humidity, allergens, ASA, NSAIDs, infection, exercise, GERD, stress. s/s: wheeze, sob, cough, low sat, tachycardia, hyperinflation/flattening of diaphragm, PFT: decreased FEV, prolonged expiratory phase, reduced expiratory flow rate, hypoxemia/hypercapnia, absence of wheeze=emergency. Rx: LABA (flovent) w/steroid, anticholinergic, SABA (albuterol/prednisone)
What is gout characterized by?
Increased uric acid levels, swollen, red, hot or painful joints, join pain generally occurs at night.
What does Nitroglycerin do to the body?
Increases heart rate, and decreases blood pressure - helps maintain cardiac output.
emphysema
3% genetic, barrel chest
What is a unit a measure of?
A measure of effect.
What is the most common cause of hyperaldosteronism?
Adrenal adenoma
What is diphenhydramine?
Antihistamine
What is a patient at risk for after parathyroidectomy?
Hypocalcemia
Metoformin (Glucophage)
NO before CT and 48 hours after r/t kidney injury
What are complications of mitral stenosis?
Pulmonary hypertension, edema, right-sided heart failure, and reduced cardiac output.
What is an antinuclear antibody test for?
To diagnose SLE
Dextromethorphan
cough suppressant
Astigmatism
lens refracts light on 2 different points of retina
Antifungals
memory trick - most end with "AZOLE"
clopidogrel
plavix blood thinner
What can be heard over the second intercostal space on the right sternal border?
Best location for hearing aortic stenosis.
PVC
wide and distored QRS and rhythm is all over the place
APGAR
1 and 5 minutes of life Appearance -blue:0 -acyrocynosis: 1 -pink:2 Pulse -pulseless:0 -<100:1 ->100:2 Grimace: absent: 0 grimace/whimper: 1 cough/sneeze/cry:2 Activity: limp:0 some flexion:1 active spontaneous:2 Respiratory: no cry:0 weak/slow cry: 1 Strong cry: 2 Score <7: EMERGENCY!
Acyanotic cardiac defects
"pink" but can become cyanotic: hole in heart, L→R shunt: • Increase pulmonary blood flow: o ASD: asymptomatic, mild HF, murmur o VSD: HF, murmur, CHF o PDA: asymptomatic infancy, mild HF, murmur, ^pulse pressure, dyspnea, bounding pulse on exertion • Decrease pulmonary blood flow: Coarctation of aorta/Aortic stenosis/Pulmonary stenosis: increased BP in head/arms, lower BP in feet/legs, HF, c/o ha, dizzy, fainting.
crainotomy
"positions depends on procedures" infratentorial: flat supratentorial: ^HOB 30˚
Low pressure alarm for an art line
#1 check for bleeding at the tube connection low pressure indicates hypotension
Rheumatic Fever
#1 questions: have you recently had strep 2-3 weeks post infix s/sx: joint arthritis, carditis, subQ nodules, fever, prolonged PR intervals, increased sedimentation rate CAN LEAD TO mitral regard/stenosis Tx: penicillin
How long do different levels of edema take to rebound?
1+ - barely detectable impression, immediate rebound 2+ - Slight indentation, 15 seconds to rebound 3+ - Deeper indentation, 30 seconds to rebound 4+ - Greater than 30 seconds to rebound
What can be heard over the second intercostal space, on the left sternal border?
Best location for hearing pulmonic stenosis
albumin
3.5-5
How is muscular dystrophy diagnosed?
Muscle biopsy
What are 3 things done for a myocardial infarction
Nitroglycerin given, telemetry done, and TPA ordered.
How is tuberculosis diagnoses confirmed?
Positive sputum culture
Where is the spleen palpated on the abdomen?
RUQ
When is a vest restraint used?
To keep a patient in bed.
Urethritis
UTI in urethra
decorticate
flexion into body,
xxx
xxx
cardiac disorders s/s
-Chest pain: Ischemia to myocardium -Coughing at night: pulm congestion L HF -Coughing up blood: severe L HF -Dependent edema: R HF -Fatigue/weakness: poor perfusion -Intermittent claudication: obstruction of arterial vessels in legs (s/s w/ exercise, place feet down) -Nocturia: HF (L or R) -Orthopnea: L HF -Palpitations: cardiac dysrhythmias -Paroxysmal nocturnal dyspnea: L HF -SOB: L HF -Syncope: reduction of blood flow to brain -Weight loss/gain: R HR
calcium channel blockers
-dipine: HTN, angina, arrhythmias. AE: hepatotoxicity, paralytic ileus, HF, AV block. CONTRA: A-FIB/FLUTTER, SSS, cardiogenic shock. Nursing: BUN/Cr, liver enzymes. Avoid: grapefruit juice, in older=constipation
Acute glomerulonephritis
(AGN): immune disease after strept infection. Decreases GFR=excessive acculmulation of water and retention of sodium, onset appears after latent period of about 10 days. s/s: oliguria, edema, *hematuria "tea-colored"* mild HTN, lethargy, proteinuria, loss of appetite. Rx: none, spontaneous recovery, supportive-diet low in sodium, protein, K. Nursing: montor fluid, edema, rest periods. AGN is an inflammatory disease of both kidneys that usually affects children between the ages of 2 and 12. It is an inflammation of the glomeruli that typically follows a streptococcal infection of the skin or throat, or an autoimmune condition. Kidney symptoms usually begin two to three weeks after the initial infection. AGN is not contagious.
Ibuprofen
(Advil) max dose 3200mg/day, give w/ food
Chelating agent
(Cuprimine) prevents stone formation, related to pcn. Used in RA, biliary cirrhosis. AE: anemia, thrombocytopenia. Nursing: CBC, UA, monitor lymph nodes, give on empty stomach, take temp at bedtime
Hirschsprung's disease
(HER=ribbons): congenital megacolon, absence of rectum, intestine does not propel stool which builds up, risk of intestinal rupture. s/s: newborn: failure to pass stool or meconium in first 24 hrs, reluctance to ingest fluids, bile-stained vomitus, distended abd, *"ribbon like"*stools that are flat, wide, and wavy. Older: failure to thrive distended abd, constipation, signs of fecal impaction. Rx: sx, temp ostomy for 3-6 months then re-anastomose. Nursing: fluids, nutrition, colostomy, NG tube
Vesicoureteral reflux
(VUR) retrograde flow of bladder urine into the ureters during voiding. Increases chances of infection. Rx: meds, sx. Nursing: fluids, post op care, monitor I&O, all children in family should be screened
Celiac disease
(gluten sensitive) absorption issues d/t genetic- gluten is in wheat, barley, rye, oats. s/s: onset between 1-5yrs diarrhea, steatorrhea, failure to thrive, vomiting, muscle wasting, abd distention, anorexia, abd pain. Diet- gluten free w/vitamin supplements, crisis IVF, steroids. Nursing: diet high in cal, low in fat, fruits, vegetables. CAN EAT RICE, CORN, MILLET
hypoglycemia
(insulin shock) BS below 50 d/t too much insulin, too little food, exercise, rapid onset, cold/clammy=give some candy, anxiety, tremor, slurred speech, confusion, altered LOC, ha, *give 15-20g of carbs (juice, raisins, honey)
Croup
(laryngitis, trachetitis, epiglottitis) airway blocking infection, d/t: viral/bacterial, airway is narrowed and inflamed. s/s: "barky" cough, stridor, hoarseness, fever, purulent secretions, dyspnea, child looks "sicker" w/bacterial infection.
Antiangials
(nitrates) vasodilator, decreases: myocardial O2 consumption, preload/afterload. 3 doses in 15 min, patch daily AE: edema. Do not use w/ -afil meds (Viagra) IICP, keep pills away from light. Nursing: may decrease effectiveness of heparin, gradually stop, induce EHOH, nitrate-free 6-8hr q24˚
What are Erikson's stages of psychosocial development?
* Basic trust vs mistrust (0-2 yrs) *Autonomy vs shame and doubt (2-4 yrs) *Initiative vs guilt (4-5 yrs) *Industry vs inferiority (5-12 yrs) *Identity vs role confusion (13-19 yrs) *Intimacy vs isolation (20 - 24 yrs) *Generativity vs Stagnation (24-64 yrs) *Ego integrity vs despair (65-death)
What are the different risk factor scores for the Braden scale for pressure ulcer development?
*<10 - Very high *10-12 - High risk *13-15 - Moderate risk *16-23 - Mild risk
Primary assessment
*ABCDE*: objective: airway-breathing-circulation-disability (AVPU/Glasgow <8=intubate)- exposure/environment. Abnormal breathing: TWELVE: tracheal deviation (late sign) wounds-emphysema-laryngeal- venous engorgement-exclude life threatening injuries (tension pneumothorax, flail chest) *A decreased score of 2 or more indicates "neuroworsening" and a need for urgent intervention*
What factors increase the risk of prostate cancer?
*African american race *Folic acid supplementation *Increased levels of dihydrotestosterone *Hormones *Age
CARDIAc LeVeLS mnemonic for cardiac assessment:
*C*hest discomfort *A*ctivity tolerance *R*esponse to drug therapy *D*epression & anxiety *I*ncreased weight *A*rrhythmias c... *L*ightheadedness e... *V*ital sign changes e... *L*evel of consciousness decreased *S*hortness of breath
STD
*Chlamydia: most common*, "silent epidemic" d/t most don't know they are infected, s/s: abd pain, burning w/ urination, discharge. Rx: azithromycin, doxycycline, newborns=prophylactic erythromycin eye ointment. Prognosis 95% cured after abx, may lead to PID, ectopic preg, infertility. Nursing: screen yearly, safe sex *Gonorrhea: oldest* known STD, s/s: itching, burning vagina, *thick yellow-green discharge*, bleeding between periods, urinary frequency, sore throat, rectal pain/discharge. Rx: cephalosporins (Rocephin) 99% cure w/ abx, -newborns can cause blindness if untreated. Nurisng: regular pap *Syphilis: chronic STD* "great imposter" *4 stages*: primary phase: sore (*chancre*), secondary phase 4-10 wks (flu-like symptoms), dormant phase 1 yr+ after first chancre w/ relapses, tertiary phase 4-20 years after, may have lesions, cv findings, neuro findings. Rx: tetracyclines/doxycycline, prognosis in the first 2 stages cured w/abx, poor outcomes in the tertiary phase. Nursing: follow up testing *HSV: clustered painful vesicles*, can be reactivated w/stress, infection pregnancy, sunburn. Rx: acyclovir. Prognosis: lifelong viral infection. Preg=c-section, fatal to newborn. Nursing: avoid tight clothing, apply ice packs to reduce pain and swelling *Genital warts: highly contagious*, HPV, flesh colored/ grey growths around genitals/rectum, painless, itching, discharge. Rx: vaccine Gardasil, cryotherapy, topical. No cure/treatment. *HPV: d/t hepatitis B virus, more infectious than HIV*, incubation period 6wks-6months. ½ have no s/s. s/s: fatigue, n/v, itching, pain, jaundice, dark urine, pale-colored stools. Rx: vaccination. Nursing: do not share toothbrush, razor, cover open cuts, clean blood spills with bleach
DO-ABLE mnemonic for heart failure interventions
*Diuretics*- to relieve pulmonary congestion, fluid overload & return to baseline weight *Oxygen*- to correct hypoxia *ACE inhibitors*- to reduce preload and afterload, counteracting compensatory hormones *Beta-blockers*- to prevent arrhythmias and reduce heart workload *Low sodium diet*- to prevent fluid retention *Exercise as tolerated* - to monitor response to therapy and return to baseline functional status
nursing delegation
*E-A-T (do not delegate what nurse can: evaluate, assess, teach)* responsibility and authority of tasks are transferred from 1 to another who accepts responsibility o Responsibility: obligation to accomplish task, Accountability: accepting ownership, Authority: right to act or empower o UAP: no scope of practice, noninvasive, skin care, range-of-motion, ambulation, grooming, and hygiene measures o LPN: UAP and dressings, suctioning, urinary catheterization, administering meds (PO, SQ, IM, some piggyback) o RN: responsible for assessment, planning care, analyzing client data, implementing and evaluating care, supervising care, initiating teaching, and administering medications intravenously. o RN can only delegate tasks RN is responsible for, remains accountable, delegation is a contractual agreement o Steps: 5 Rights of Delegation • Right task: define task and determine safety • Right circumstances: pt condition, resources, equipment • Right person: staff w/ necessary knowledge, skills, abilities (KSA), pt stable • Right direction/communication: clear, specific, expectations, documentation • Right supervision/evaluation: monitoring, evaluation, feedback
Secondary assessment
*EFGHI*: expose, full set of vs, give comfort measures-hx/head to toe (SAMPLE)-inspect for injuries
What are signs and symptoms of pneumonia?
*Fever Productive cough *dyspnea *Increased respiratory rate *Chills
Cushings
*HYPERcortisol*, d/t steroid treatment, s/s: obesity, moon face, slow growth in children, striae, buffalo hump, excess hair, *HYPERnatremia, HYPERglycemia, hypokalemia/hypocalcemia*, lifelong treatment hyper-BP, BS, Na hypo-K, Ca
Addisons
*HYPO aldosterone*/cortisol, autoimmune, s/s: ha, weakness, confusion, lethargy, *HYPOtension*, *HYPOglycemia* *hyperkalemia,/hypercalcemia*, dark skin, Rx: give steroids, diet high in protein, carbs, sodium. Addisonian crisis-EMERGENCY-circulatory collapse, IV steroids. Nursing: daily weight, preserve pt's energy, lifelong therapy, avoid extra K, increase fluids to 3L day hypo-BS, BP, Na hyper-K, Ca
What are risk factors for endocarditis?
*History of mechanical valve replacement *Dental procedures *IV drug use *immunosuppression
What can Addisonian crisis cause?
*Hypotension *Hypoglycemia *Hyperkalemia *Hyponatremia *Weakness, weight loss, and abdominal pain
What increases a patients risk of digitalis toxicity?
*Hypothyroidism *Hypomagnesemia *Hypokalemia *Hypoxemia *Advanced heart disease
What are characteristics of ADHD?
*Inattention *Hyperactivity *Impulsiveness
What is the onset, peak, and duration of rapid-acting insulin? (insulin aspart, lispro)
*Onset - 15 min *Peak 1-3 hours *Duration 3-5 hours
Self-care instructions for heart failure: R-E-A-L
*R*eport findings of heart failure to provider - weight gain, worsening dyspnea, orthopnea, fatigue *E*xercise is important - start low & go slow to increase functional capacity, attending to symptoms *A*dherence to cardiac medications is essential to staying healthy *L*ow sodium diet - 2000 mg per day
v fib
*SHOCK* on R wave chaotic rapid rhythm fatal if not treated in 3-5 mins CPR, defib, O2, antidysrhythmics
v tach
*SHOCK* synchronized on R wave 140-250 can lead to cardiac arrest bigeminy-every other beat trigeminy-every 3rd beat give O2 if stable unstable: shocks, CPR, O2, antidysrhytmics, cardioversion
What are physical findings of an inhalation injury?
*Stridor *Dyspnea *Singed nasal or mucosal burns *Soot in the sputum *Facial burns *Wheezing
Parkinson's disease
*TRAP: tremors-rigidity-akinesia/Bradykinesia-postural instability* diminished substantia nigra, dopamine depletion, genetic. s/s: *unilateral progression to bilateral*: resting tremors, pill-rolling, Bradykinesia/akinesia, fatigue, stiffness/rigidity, mask-like facial expressions, slow shuffling gait, difficulty rising from sitting, echolalia (echoing speech). Rx: anticholinergics (Cogentin), carbidopa/levodopa. Nursing: safety, nutrition: small freq meals, soft foods, roughage, fluids, teach: "drug holidays"
Meningitis
*bacterial*: most contagious, requires isolation, meningococcal common in children/college students 25% fatal, LP (cloudy w/protein) *viral*: no isolation, usually a complete recovery, common in AIDS s/s: severe ha, sudden high fever (bacterial), altered LOC, photophobia, diplopia, nuchal rigidity, positive Kernig's (knee lift) and Brudzinski (head lift) seizures, petechial rash, bulging anterior fontanel Rx: lumbar puncture (with with IICP), abx, anticonvulsants, seizures precautions, IVF, reduce external stimuli
fracture
*complete*: bone broken in 2+ pieces *incomplete*: bone still in one piece *open*: compound, bone through skin *close*: does not break skin *linear*: parallel to bone *oblique*: d/t twisting, diagonal *spiral*: diagonal all they way up *transverse*: common pathological, across bone *avulsion*: bone fragments *comminuted*: splintered fragments w/tissue injury *compression*: lumbar squish *greenstick*: children d/t more pliable bones, bone bends *impacted*: telescoped, bone into bone *stress*: incomplete d/t repetitive trauma
hypertension
+140/+90. Malignant HTN/HTN crisis: when BP rises very rapidly= target organ damage (kidneys, retina, brain, heart). d/t: FMH, race, stress, obesity, high sodium diet, smoking, BCP, sedentary lifestyle, age, Cushings.s/s: Brain (ha, blurred vision, dizzy, TIA/CVA) eyes (retinal detachment) heart (chest pain/palpitations, dyspnea) peripheral vascular (intermittent claudication, aneurysm), kidneys (^Cr, proteinuria). DX:3 or more readings, 2 mins apart at 3 visits. RX: weight reduction, exercise, DASH diet, low sodium 2g day, no ETOH/smoking/stress. RX: diuretic, bb, O2, ACEI, antilipemics. GOALS less than 130/85. CAM: garlic, CoQ10, Omega 3. NO=licorice/ephedra, these increase bp
thyroid storm
- EMERGENCY (agitation, confusion, diarrhea, increased body temp, tachycardia, restlessness, shaking, sweating) *hyperthyroid*
myxedema crisis
- EMERGENCY (coma, below body temp, decreased breathing, low BP, low BS, unresponsive) *hypothyroidism*
What are the symptoms of high blood pressure?
- rarely has any, but can have headache, tinnitus, blurred vision, and dizziness.
growth and development
1-12 months=infancy. Rapid growth, Safety: suffocation, falls, burns. Toys: mirrors, blocks, teething, cups, push-pull *6—8 wks: posterior fontanel closes* 2—3 months: turn head up, turn side to side, cooing 4—5 months: grasps, switch and roll over, mimic sounds 5—6 months: tooth eruption 6—7 months: double birth weight, sits, crawls, waves, knows stranger, passes back and forth between hands 8—9 months: stands, plays peek-a-boo, pincer grasp 10—11 months: belly to butt, stands alone, self feeds 12—13 months: triple birth weight, 6-8 teeth, drinks from a cup, cries when parents leave, uses furniture to cruise *12—18 months: anterior fontanel closes*, walks 12-15 months, can follow simple directions
What are the ranges for a nasal cannula?
1-6LPM at 4LPM, approx 32% O2 is provided.
Water seal
NO continuous bubbling = air leak bubbling with forceful cough or expiration is fine water should rise and fall with respirations
HCO3
22-28
What is a normal bicarbonate (HCO3) level?
22-30
What is a normal Magnesium level?
1.3-2.1 mEq/L
Mg
1.5-2.5: ½ in bone, muscle and nerve function, heart rhythm o Hypermg: d/t CRF, antacids, Addisons, DM- give calcium gluconate • s/s: lethargy, n/v, slurred speech, weakness, decreased DTR, slowed cardiac conduction o Hypomg: d/t malnutrition, pre-e, ETOH, DKA, Crohn's, hyperglycemia, sepsis • s/s: tingling, twitching, tetany, delirium, convulsions, + Chvostek/Trousseau, hyperreflexia
Total knee replacement
24-48hrs apply ice to min edema, drainage can be up to 200ml for the first 48hrs, within 24hrs aggressive PT, CPM (turn off if eating/bedpan), knee immobilizer, keep leg elevated, walk 1st day post-op, PCA first 48-72 hrs, oral by 4th -5th day, monitor 6 P's. Crutches with stairs "up with good, down with bad"
lipase
10-140
ALT/AST
10-40
ammonia
10-80
sinus tachy
100-180 treat cause
According to Bartholomew's Rule of fourths, how many weeks along is a women if the fundus is at the Symphis pubis?
12 weeks
FHR
120-160 for full term. FHR decreases during contractions but should return after
2nd trimester
13-26wks: Leopold maneuvers, quickening, doppler 12-14wks, height of fundus=number of weeks preg, Quad marker (AFP 10-150) at 16wks for neural tube defects (only further assessment) Amniocentesis at 15 wks: fetal chromosomes, lung maturity, moms 35+, abnormal quad 20wks: mom can feel movement, heartbeat can be heard w/a stethoscope 24wks: external genitalia discernible, lungs produce surfactant, oral GTT (24-28) 28wks: viable as a neonate, give Rhogam (24-28 wks)
What is a normal sodium level?
135-145 mEq/L
Na
135-145: extracellular, regulates cell size and osmosis, maintains water balance, nerve impulses, muscle contraction, BP, blood volume, regulates acid-base balance, regulated by salt intake, aldosterone, urinary output o Hyponatremia: d/t burns, diarrhea, HF, diuretics, vomiting, diaphoresis, CRF, SIADH, ^BS *Lithium Tox! • S/s: mental confusion, seizures, hallucinations, brain herniation, death o Hypernatremia: HTN, edema, Cushing's, CRF, hyperaldosteronism, hormones, NSAIDS • s/s: lethargic, excitability, hypovolemia, pulm edema, muscle twitches, coma, dry flushed skin
What is a normal hemoglobin level?
14-18 g/dl (male) 12-16g/dl (female)
Normal platelet value?
150,000-400,000
platelets
150,000-400,000
According to Bartholomew's rule of fourths, how many weeks along is a women if the fundus is midway between the symphysis pubis and umbilicus?
16 weeks
potty training
18-24 months ability to communication and follow directions
What gauge needle should be used for an IM injection?
18-25 guage
1kg= __mL of fluid
1kg=1,000ml
What classifies a superficial burn?
1st degree - red, dry, painful
stages of labor
1st: dilating stage 3 phases: Latent (0-3cm) Active (4-7cm) Traditional (8-10cm w/ urge to push) 2nd stage: delivery 3rd: placental delivery 4th: recovery- primary goal to prevent hemorrhage from uterine atony, 1st void within 1 hour and then q2-3 hrs, Rhogam
How long must patients with TB be in isolation for?
2 weeks, after that period they are no longer contagious.
What is a normal neutrophil level?
2,500 - 8000 cells/mm3
Duchenne Muscular Dystrophy
2-5 years old Lower extremities affected first Gower signs: use of hands to rise from squat or from chair to compensate for weak lower muscles Wheelchair bound and die by 20-30 y/o education: prevents falls, exercise with swimming nothing more strenuous,
CVP
2-8 measures right ventricular preload and reflects fluid volume status PA catheter use the blue (right proximal port) low CVP: hypovolemia High CVP: right ventricular failure or fluid volume overload CVP is measured as a mean pressure and should be recorded at the end of expiration.
Phosphorus
2.8-4.5: cell metabolism, combines w/ Ca in bone, balanced by parathyroid gland. Ca~P (as one ^/other drops)
According to bartholomew's rule of fourths, how many weeks along is a women if the fundus is at the umbilicus?
20 weeks
aPTT
20-30 seconds
What gauge catheter should a nurse use when administering blood products?
20g catheter or larger to prevent hemolysis.
Normal hematocrit level?
42-52% (men) 37-47% (women)
WBC
5,000-10,oo0 60% Neutrophil: bacteria/fungus 40% Lymphocyte: virus/tumor 8% Monocyte: nonspecific 3% Eosinophil: allergies 0% Basophil: allergies
nursing circulation/fracture assessment
6 P's pain-pulse-pallor-paresthia-paralysis-pressure/poikilothermia (temp of limb same as the body)
What are the ranges for a simple face mask?
6-10 LPM, 40-60% O2, must be over 5 lpm to flush expired C02 from mask.
What are the rages for a nonrebreathing mask?
6-12 LPM, provides 95% O2 with flow rate of 10-12 LPM
protein
6-8
MAP
60-70 mmHg for adequate organ perfusion
pH
7.35-7.45
glucose
70-100
1st trimester
8-12 wks CVS: 10-12 wks, basic ultrasound (full bladder) gestational age/anomalies 8 wks: most critical developmental period (embryo) most vulnerable to teratogens
BUN
8-25
What is a normal pO2 value?
80-100 mmHg
PO2
80-100%
What is the normal range for calcium?
9-10.5 mg/dl.
PT
9-11 seconds
Calcium
9-11: cardiac contraction, bones, nerves, muscles, clotting o Hypercalcemia: d/t hyperparathyroidism, cancer, Paget's of bone, prolonged immobilization. s/s: weakness, paralysis, decreased DTR. Monitor for kidney stones o Hypocalcemia: d/t rickets, vit D deficiency, renal failure, pancreatitis, chelation therapy, hypoparathyroidism. • s/s: CATS: convulsions-arrhythmias-tetany-spasms/stridor, +Chvostek sign (cheek) Trousseau (BP arm) • when administering IV, warm solution to body temp
puberty for males
9.5-14 y/o testicular enlargement pubic, facial, axillary, and body hair penis increases in size voice change increase in height and weight
SaO2
96-100%
Chloride
96-106: helps balance Na, extracellular fluid
What is a safe Troponin-1 level?
<0.01 ng/ml
What do different APGAR scoes mean?
<4 - critical, may need resusicitation 5 - guarded and may need clearing of airways or supplemental oxygen 7-10 - good, baby is safe
What level should Fi02 remain below?
<50%
HbA1c goal
<7
excessive chest tube drainage for adults and children
>100ml within first hour >5-10ml/kg/hr with children
What is Bethanechol (Urecholine) used for?
A cholinergic agent that stimulates muscarinic receptors
What does hypoparathyroidism cause?
A decrease in calcium and an increase in serum phosphorus?
What is a postive Murphy's sign indicative of?
A gall bladder infection - cholecystitis.
What is pertussis?
A highly contagious bacterial infection - it causes whooping cough, and vomiting that can last 6 weeks - can be prevented with Dtap, once contracted, it is treated with antibiotics.
What is involved with schizoid personality disorder?
A lack of interest in social relationships, lack of pleasure, and introspection.
What is a common finding of an osteogenic sarcoma?
A palpable mass that is large in size.
In case of an emergency situation, what should be kept near a patient's bed that is on mechanical ventilation due to respiratory failure?
A resuscitation bag, as well as a yankauer suction tip.
What is an expected reaction after a DTaP vaccine?
A slight fever and pain at the injection site.
What is Sjogren's syndrome?
A systemic autoimmune disease that affects exocrine galnds - causes a deficiency in saliva, tears, skin lubrication, and other exocrine secretions - moisture replace usually the is treatment of choice.
nursing process
ADPIE *Assessment*: 1st step, subjective and objective data *Diagnosis*: analysis, formulation of nursing diagnosis *Planning*: prioritizing problems, determining goals, plan of care *Implementation*: nursing action (rather than medical action) *Evaluating*: comparing outcomes, communicate and document findings
Bronchodilators
AE: adrenal suppression, hyperglycemia, ha, infection. Nursing: small freq meals, take before other inhaled meds, 30-60mins before exercise. LABA has to be paired with steroid d/t black box warning *Theophylline: stims CNS. Nursing: narrow therapeutic range 5-15, toxic >20, avoid caffeine* Anticholinergic: Atrovent: AE: angioedema, glaucoma, bronchospasm. Nursing: not for rescue, rinse mouth
Antitubercular
AE: hepatotoxicity, agranulocytosis, aplastic anemia, optic neuritis, neuropathy, psychosis. Nursing: Cr, liver enzymes, eradicated after 3 - sputum cultures, Avoid ETOH, tyramine, take vit B6 for neuropathy, duration of therapy months to years 1st line: isoniazid: daily for 6-18 months. Hepatotoxic. Nursing: take on empty stomach 1st line: rifampin: daily 4-6 months. Red-orange body fluids, ^ALT/AST. Nursing: no contacts 1st line ethambutol: contra optic neuritis. Nursing: eye exam regularly 1st line: streptomycin: IM q24hrs 5-7 times weekly 2nd line: ethionamide: metallic taste, take w/food
lung sounds
AP ratio 1:2/barrel chest 1:1, peds: smaller airway • Cheyne-stokes: alter apnea/tachypnea, Kussmauls= deep labored met acidosis, Biot: quick/shallow • Crackles/rales: inflammation/infection/fluid/ARDS-CHF-atelectasis-pneumoia-fibrosis • Pleural friction rub: grating, inflammation/pleurisy (DDX: pericardial friction rub=hold breath) • Rhonchi: lower wheeze/pneumonia • Stridor: high-pitched/upper airway obstruction/tonsillar abscess/injury/croup/foreign object • Wheeze: whistle/asthma/bronchitis/COPD/narrow airway • Whispered pectoriloquy: "99" resonance/lung consolidation/pneumothorax/pleural effusion
Heart
APE to MAN aortic-pulmonic-erb's-tricuspid-mitral), apical 4/5th ICS, pulse deficit=apical ^radial • S1: closing mitral valve, heard at apex/ S2: closing aortic valve, heard over aorta • Murmur: d/t turbulent blood flow, graded 1-6 (loudest/thrill) • Pulse: strength: 0 (absent), 1+weak/thready, *2+ normal*, 3+ bounding
S1
AV valves close (tricuspid/mitral) loudest at apex
What is irritable bowel syndrome characterized by?
Abdominal pain, bloating, discomfort, and intermittent episodes of loose stools.
What is asystole?
Absence of a heart rate.
Mucolytics
Acetylcysteine: thins resp secretions/mobilizes secretions. Used in trach care, CF, acetaminophen overdose. Contra: asthma, inadequate cough. Nursing: combine w/ ambulation, cough, and deep breathing
Isotretinoin (accutane)
Acne medication NEED TWO negative pregnancy test before starting medication Educate: use two forms of brith control Can NOT donate blood for at least one month to ensure preggos do not receive donation Pregnancy X category
What value is monitored for heparin?
Activated partial thromboplastin time
What is Buspirone used for?
Acts on serotonin receptors - effective in treating anxiety but does not have sedative effects.
Where can candidiasis occur?
Adheres to the surfaces of the mucosa and tongue, occurs on the genitalia, and anus - can cause bleeding if patches are removed, will not occur if scraped with a tongue blade.
When administering lipid emulsions via piggyback to a patient required TPN, the nurse should do what?
Add the solution below the infusion filter.
How should pressure ulcers be reduced?
Adequate nutrition and hydration *Should be bathed and lotion applied *Turn q2h *keep bed <30 degrees
What is Kernig's sign?
After flexing the hip and knee at 90 degree angles, pain and resistance are noted.
What is Brudzinski's sign?
After forced flexion of the neck there is a reflex flexion of the hip and knee and abduction of the leg.
When should BSE be done?
After menstruation - if patient has irregular patterns, it should be done on the same day each month.
What are signs and symptoms of a COPD exacerbation?
Airway inflammation, mucous gland hyperplasia, mechanical loading, fibrosis, mechanical loading, fibrosis and an increased number of goblet cells.
What does the adrenal cortex secrete?
Aldosterone
What is a requirement of the Omnibus Reconciliation Act of 1986?
All hospitals are mandated to establish protocols for identifying potential tissue and organ donors.
What should a patient with pheochromocytoma be treated wth?
Alpha and beta blockers.
Terazosin
Alpha-adrenergic blocker tx: relieve urinary rentention in clients with BPH education: ortho hypotension, admin at bedtime, avoid erectile dysfunction medications that can bottom out BP
What are late signs of intracranial pressure?
Alteration in pupil size and reactivity, decorticate or decerebrate posturing, and the Cushing's Triad: widening pulse pressure, bradycardia, and change in respirations.
What may build up in severe liver disease?
Ammonia - can cause hepatic encephalopathy.
What is atrial septal deficit?
An abnormal communication between the two atria, allowing blood to shift from the left and right atrium.
What causes neuroleptic malignant syndrome?
An adverse reaction to antipsychotic medications within 4-14 days after beginning the drug or after a dose increase.
What is Carbamazepine used for?
An anticonvulsant used to treat epilepsy and bipolar disorder
What is Lamotrigine?
An anticonvulsant used to treat epilepsy and bipolar disorder - patient should be seizure free.
What is pulsation between the pubis and umbilicus indicative of?
An aortic aneurysm - medical emergency
What is Kawasaki disease?
An autoimmune disease involving the inflammation of blood vessels, lymph nodes, skin, and mucosa - initial symptom is a high fever, later symptoms include conjunctivitis, rash, peeling, and edema
What critical symptom should a patient with multiple myeloma report?
Anorexia and nausea - sign of hypercalcemia, can be life threatening - other symptoms include vomiting, polyuria, weakness, fatigue, constipation, and dehydration.
What is Goodpasture's syndrome?
Autoimmune disease that attacks the basement membranes of the lungs, alevoli, and glomerulus - it is caused by viral infections and surgery of the lung or kidneys.
What is Procainamide used for?
Antiarrhythmic agent used for ventricular and atrial arrhythmias - can cause or worsen hypotension and bradycardia - it is important to measure BP and HR
Death Rattle treatment
Anticholingeric (atropine) OR Scopolamine patch Dries up secretions that dying patient can no longer manage on their own. Helps comfort the family
Phenytoin (dilantin)
Anticonvulsant provide good ORAL CARE to prevent gingival hyperplasia (no reason to d/c) d/c: fever, skin rash, and lymphadenopathy risk for gait disturbance
Promethazine (Phenergan)
Antiemetic Do NOT use IV-- can cause damage to tissues including necrosis and gangrene IM is the preferred rout
Hydroxyxholoroquine (Plaquenil)
Antimalarial Eye checked Q 6months r/t possbile retinal damage
What test is used to diagnose SLE?
Antinuclear antibody
What is aripiprazole used for?
Antipsychotic used to treat schizophrenia and other psychotic disorders.
What valvular disorder are syncope and dyspnea on exertion hallmark for?
Aortic stenosis
What are appropriate interventions for a patient with a DVT?
Apply heat, pain medication, and elevate the leg.
How is a cerebral arteriogram done?
Arterial access is obtained via the femoral artery.
Insulin Peaks and durations Aspart,lispro,and glulisine regular NPH Detemir Glargine
Aspart,lispro glulisine -peak: 30 mins -duration: 4 hours Reg -peak: 3 hours -duration: 7 hours NPH: 4 hours -duration: 18 hours Detemir -peak: 2 hours - duration: 24 hours Glargine: -peak: 1 hour - duration: >24 hours
How would you confirm that a tube is located in the small intestines?
Aspirate that should have a pH of 7.
What should a nurse asses when a patient has an elevated potassium level?
Asses the patient's telemetry monitor reading - can cause lethal arrhythmias.
What are the signs of a malignant skin lesion?
Asymmetry Borders (ireggular outline) Color (can have multiple colors) Diameter (usually larger than 1/4 inch or size of pencil eraser) Evolving (changes in shape, size, color)
Where are chest tubes that are used to drain fluid or blood usually place?
At the lateral chest wall, near the fourth to sixth intercostal space.
Upon suspicion of an acute appendicitis diagnosis, a nurse should check when the child last did what?
Ate - surgery is done immediately to prevent complications.
cardiac arrhythmias
Atrial: Tachy/brady/arrhythmia/pvc/a-flutter/afib (needs anticoag), junctional tachy Ventricular: v-tach/v-fib (defib), asystole (no defib) Blocks: if R is from from P=1st˚ (long PRI), longer longer longer drop=Wenkeback 2nd˚, if some P's don't get through then you have Mobitz II, if P's and Q's don't agree then you have 3rd˚ Afib: ABCD: anticoag, bb, cardioversion, digoxin Nursing: treat the pt not just the monitor. SVT (too fast): vagal stim, adenosine, CCB, BB, cardioversion Ventricular arrhythmias: ABCD (airway breathing circulation disability), cardioversion AV conduction (too slow): atropine (anticholinergic that blocks vagal nerve stim), pacemaker
Abdomen assessment
Auscultate first: bowel sounds 5-30 times per min, start RLQ (sounds=no obstruction above) • Renal artery=bruit, percussion: tympany= stomach/intestines, dullness=liver, spleen, pancreas • Distention, ascites, paralytic ileus, borborygmus (grumbling), guarding
A nurse is informing a patient about postural drainage - to facilitate clearing of the lungs, the nurse should position the patient based on what assessment?
Auscultation - it will help determine which areas need to be drained.
What diet should a patient maintain for colorectal cancer screening?
Avoid fish, cantaloupe, turnips, and red meats 48-72 hrs before the procedure.
GOLD standard test for exacerbation of heart failure
B-type natriuretic peptide (BNP) BNP>100 = distinguishes cardiac from respiratory causes of dyspnea
What characterizes renal pain?
Begins in the flank area and may radiate to the lower abdomen, back, and groin.
postpartum assessment
BUBBLE-LEB—fever +100.4 *B= breast* *U= uterus*(firm or boggy) location (deviated=go to bathroom) descends 1cm a day until day 10, At umbilicus after birth, 1 finger above day 1, nonpalpable day 10 *B= bladder* (palpable?) *B= bowels* (last BM) *L= lochia*: rubra (1-3 days) serosa (3-7 days) alba (day 10) *E= episiotomy* or incision: REEDA (redness-edema-ecchymosis-discharge-approximation) *L= legs* (Homans) pain/pulses/sensation/movement *E= emotions* *B= bonding* "taking in" gazing, holding, calling baby by name
What are complications of hypercortisolism?
Bacterial or funal infections, diabetes, hypertension, obesity.
What foods increase ostomy odor?
Beans, cucumbers, radishes, alcohol, asparagus, cabbage, eggs, and fish
How is activity score on the Braden scale?
Bedfast - 1 Chairfast -2 Walks occasionally - 3 Walks frequently - 4
What can occur from a C1-C8 spinal cord injury?
C1-C8 - Quadriplegia, Respiratory paralysis in lesions above C6
cervical injuries
C2-3: fatal C4: major innervation to diaphragm by phrenic nerve, rest difficulty and paralysis of all 4 extremities C5-8 decreased resp reserve
CPR
CAB- compressions-airway-breathing, : 30:2, Start compressions within 10 seconds of recognizing cardiac arrest • Push hard and fast 100 bpm, allowing for recoil, adults 2inches 2 hands, child 2 inches 1 hand, infant 1.5 inches 2 fingers • Adults 30:2, infant/child w/ 1 is 30:2, with 2 is 15:2
Nifedipine (Procardia)`
CCB
What can be heard over the carotid arteries?
Can hear a bruit
What are signs and symptoms of pleurisy?
Causes a sharp knifelike pain that intensifies with pain - caused by pleural friction rub.
What occurs during hepatic deterioration (late stage of cirrhosis)?
Causes encephalopathy due to the increased levels of ammonia in the blood - results in a diminished level of conciousness, confusion, flapping tremor of the hands (asterixis) and a sweet odor to the breath is often noted
What happens during the protest stage of separation anxiety?
Crying and making a scene - usually will refuse comfort from anyone
What are some physical characteristics of Thalassemia?
Change in shap of skull - frontal bossing and upper teeth protrusion. Hypogonadism, pallor, and a protruding abdomen due to hepatomegaly also can occur
What is Nephrotoxicity characterized by?
Changed in urination frequency or amount, nausea, vomiting, and increased thirst.
What is cluster breathing (Biot's respiration)?
Characterized by groups of quick, shallow breaths followed by periods of apnea - usually seen in patients with medulla damage and indicates poor prognosis.
What should a nurse asses for a patient whom is post-operative for a total thyroidectomy?
Check for signs of latent tetany due to calcium deficiency - tingling of toes, fingers, and lips, muscular twitches, positive Chvostek's and Trousseau's signs, and decreased serum calcium levels. Tetany can occur 1-7 days after thyroidectomy. Asses for signs of hemorrhage - exam back of neck and shoulders for bleeding, blood tends to drain posterior in a client with thyroidectomy.
What are signs of benign moles?
Circular, flat, brown, uniform
What are symptoms of peritonitis?
Cloudy dialysate output in patients receiving peritoneal dialysis * Rebound tenderness (pain when palpating abdomen) * Rigid abdomen *Fever *malaise *Nausea
What could trigger Prinzmetal's angina (Variant angina)?
Cold, stress, tobacco use, medications, and activity.
What is breakthrough pain?
Comes on suddenly, lasts for short periods, and is not relieved by the patient's normal pain management
How is mobility scored on the Braden scale?
Completely immobile - 1 Very limited - 2 Slightly limited - 3 No limitations - 4
How is sensory perception scored on the braden scale?
Completely limited - 1 Very limited - 2 Slightly limited - 3 No impairment - 4
compartment syndrome
Condition in which pressure increases in a confined anatomical space, leading to decreased blood flow, ischemia, and dysfunction of these tissues. Initial ischemia with pain, pallor, paresthesia, muscle weakness, and loss of pulses may progress to necrosis and permanent muscle cell dysfunction.
How is moisture scored on the Braden scale?
Constantly moist - 1 Often moist - 2 Occasionally moist - 3 No impairment - 4
What should a nurse do if uterine atony is suspected/
Control hemorrhage by attempting uterine massage to encourage contraction - this will compress the vessels and reduce blood flow.
What are good sources of non-heme iron?
Dark leafy greens, soy, beans, and lentils
What is used to diagnose a DVT?
D-dimer, venous ultrasound, or venography.
dosages
D/H*V, ml/min *gtt o 1g=1000mg, 1mg=1000µ, 1g=1,000,000µ o 2.5cm=1inch, 1kg=2.2 pounds, 30ml=1ounce=2 Tbsp o C= (F-32)/1.8 F= (C+32)*1.8
What causes an oxygen-hemoglobin dissociation curve to shift right? (oxygen release)
Decreased pH, increased 2, 3-DPG, increased temperature, decreased CO, pCO2 increased
inflammation
Definition: - Inflammation is the response of living tissue to injury. It involves a well-organized cascade of fluid and cellular changes within living tissue. Cardinal features: Rubor (redness); Tumor (swelling); Calor (heat); Dolor (pain); Functio laesa (loss of function) CAUSES Etiologic agents - viruses, bacteria, fungi, parasites Hypersensitivity - body reacts against itself, there are four types of reactions Physical and chemical agents - trauma, sunburn, acid Necrosis - anoxia, trauma EFFECTS What's good about inflammation? Drugs, antibodies, mediators can get in; fibrin and then fibrosis can wall it off What's bad about inflammation? Cytokines can make you sick, tissue can get destroyed, swelling won't quit
What can trigger sickle cell crisis?
Dehydration, infection, and acidosis.
What is Duloxetine used for?
Depression, generalized anxiety disorder, neuropathy, and fibromyalgia
What is acute silicosis?
Develops with a few years after exposure to silica dust - characterized by rapid onset of dyspnea, cough, and weight loss. - E-ray reveals a ground-glass appearance.
What are modifiable risk factors for heart failure?
Diabetes, sedentary lifestyle, and obesity.
What do monocytes do? Normal %?
Differentiate into macrophages to defend against infection. Normal % -2-8%
What are the side effects of external radiation?
Dysgeusia (salty, rancid taste in mouth), stomatitis, thrombocytopenia
V fib
EMERGENCY CPR and dfib just a bunch of up downs
Acute closed-angle glaucoma
EMERGENCY: iris bulges forward against cornea, women after 45. s/s: SUDDEN blurred vision, halos, colored rings, SUDDEN frontal ha, SUDDEN severe eye pain, reddening n/v, profuse lacrimation, dilated nonreactive pupil, BLINDNESS IN 2-5 DAYS IF UNTREATED
acute closed-angle glaucoma
EMERGENCY: iris bulges forward against cornea, women after 45. s/s: SUDDEN blurred vision, halos, colored rings, SUDDEN frontal ha, SUDDEN severe eye pain, reddening n/v, profuse lacrimation, dilated nonreactive pupil, BLINDNESS IN 2-5 DAYS IF UNTREATED
What should be done for a patient with gout?
Encourage gradual weight loss, encourage the client to limited alcohol and red meat, administer regular NSAIDS as prescribed until symptoms are gone, and apply ice over the inflamed joints.
What does the adrenal medula secrete?
Epinephrine, norepinephrine, and small amounts of dopamine
What is used to confirm a diagnosis of infection mononucleosis?
Epstein Barr virus antibody test is used to confirm if the Monospot test is negative and the patient has symptoms of mononucleosis. The monospot test, or heterophile antibody test, is a quick test used by mononucleosis, but may produce false negatives.
What is it important for a patient with hyperparathyroidism to do?
Exercise regularly to increase bone resorption
What are risk factors for skin disorders?
Exposure to chemicals, radiation, and the sun, corticosteroid use, cosmetics and harsh soaps, infection, nutritional deficiencies, poor hygiene, and emotional stress.
How is Hepatitis A transmitted?
Fecal-oral route - usually through contaminated food.
What is Red man syndrome characterized by?
Fever, chills, tachycardia, rash, nausea, redness of the face, back, neck, and arms.
What is a D-Dimer test used for/indicative of?
Fibrin degradation product, indicative of DVT
How is idiopathic thrombocytopenia purpura treated?
First line of treatment is corticosteroids to dampen immune response and increase platelet count - will raise BG levels, need to be monitored.
Metronidazole
Flagyl AntiB to treat STI NO ETOH, urine can turn deep red-brown
What are signs and symptoms of peripheral kidney disease?
Flank or lower back pain, frequent UTIs, hematuria, proteinuria, calculi, and hypertension.
What position should a person be placed in after a ventriculoperitoneal shun is placed?
Flat - to avoid a rapid decrease in ICP.
What are signs and symptoms of a bulimia nervosa?
Frequent vomiting causes hypertrophy of the parotid glands and puff cheeks. Also has binge eating, inappropriate compensatory behavior present to weight gain, and excessive concern about body weight, brittle hair, and hair loss common, hypotension, electrolyte imbalances, metabolic alkalosis.
What is a stage 4 pressure ulcer?
Full thickness skin loss, exposed bone, tendon, or muscle, slough or eschar, and tunneling
What is a stage 3 pressure ulcer?
Full thickness skin loss, extends into the dermis and subcutaneous tissue. Slough and tunneling may be present
Hyperparathyroidism
GI upset, constipation, pathological fractures, kidney stones d/t ^calcium levels, blurred vision (d/t cataracts) weakness, depression→ *moans, groans, stones, bones, and psychic overtones* Rx: drink more fluids, mobility, diet rich in calcium
health assessment
General HPI: OLDCARTS ROS Physical exam Inspection, palpation (1cm=light, 5-8cm deep) percussion (dull=solid, hyperresonace=trapped air, resonance=lungs, tympany=air/stomach), osculate
What is worn for droplet precautions?
Glove, gown, and mask
Ace inhibitors, isotretinoin, and doxycycline
NO for preggos Ace: bad for fetal kidney development Isotretinion: major birth defects Doxy: impair bone maturation of fetus.
What is somatrem used for?
Growth hormone that is indicated only for the long-term treatment of children with growth failure caused by deficiency of growth hormone.
PKU
Guthrie Bacterial Inhibition test mandated, best after baby eats 2 full days/48hrs, delayed if less than 5 pounds, + req dietary control to prevent brain damage, test identifies an inherited disease, urine test 6wks
preeclampsia
HELLP (hemolysis, elevated liver enzymes, low platelets) Complications: placental abruption (vag bleeding with PAIN)
What screening tool is used for domestic violence?
HITS
Prevention of aspiartion pneumonia
HOB 30-45 avoid gastric over distention (check residuals) use cuffed teach tube with in-line suctioning cuff pressure >20 Oral care with chlorhexidine minimize sedation and wean ventilation ASAP
Medications before Dialysis
HOLD: antiHTN water soluble vits (B & C), antiB and dig GIVE: CA ACETATE r/t high phosphorus levels that dialysis can not filter out either Lispro insulin r/t fast acting and need to be given 15-30 mins before meals FAT soluble vitmins (ADEK) not affected by dialysis
Where should a nurse assess for jaundice in a patient with dark skin?
Hard palate of the mouth.
What is the most common side effect of brain tumors?
Headache, followed by vomiting, and lastly vision changes.
What characterizes meningeal pain?
Headache, nuchal rigidty, and photophobia. Pain is increased when the neck is flexed toward the chest.
What are symptoms of sinusitis?
Headaches that are worse in the morning, purulent nasal discharge, stuffiness, cough, and loss of smell
What is ototoxicity characterized by?
Hearing loss
What are signs and symptoms of GERD?
Heartburn (chestpain), regurgitation, trouble swallowing, sore throat, and nausea.
hepatitis
Hepatitis A: "infectious hepatitis" common fall/winter, fecal-oral route, person-to-person, contaminated food/utensils Preventions: hand washing, treated water, vaccine Hepatitis B: via blood, saliva, vaginal secretions, semen, breast milk, crosss placental barrier, IV drug users, hemodialysis Prevention: hand washing, screening, no unprotected sex, vaccine Hepatitis C: yr round, MOST common, any age, IV drug users, similar to Hep B, parenterally, transfusions Preventions: hand washing, needle precautions, screening S/s: anorexia, n/v, dark urine, aundice; the symptoms usually occur within 4 to 6 weeks after the transfusion. Hepatitis D: Middle Easter/Mediterranean, occurs w/Hep B, IV drug users, hemodialysis, transfusions Prevention: must coexist w/Hep B- prevent Hep B Hepatits E: waterborne, inadequate sewage, travelers to Inda/Mexico o Prevention: hand washing, don't drink water, water treatment
What lab value would indicate a corticotropin-secreting pituitary adenoma?
High cortisol and high ACTH levels
What value would indicate adrenal tumors + hyperplasia?
High cortisol levels, and low ACTH levels.
What are risk factors for hypertension?
High salt and fat intake, obesity, stress, alcohol consumption, inactivity, caffeine, and vitamin D deficiency.
What might be auscultated when assessing a patient with paralytic ileus?
Hypoactive bowel sounds Hyperactive may indicate a mechanic obstruction.
What are signs and symptoms of Myxedema coma?
Hypotension, coma, hypoglycemia, edema, bradycardia, and respiratory failure.
newborn cold stress
Hypothermia and cold stress cause a variety of physiologic stresses including: increased oxygen consumption, metabolic acidosis, hypoglycemia, tachypnea and decreased cardiac output
What are common characteristics of most personality disorders?
Impulsivity, abnormal moral development, maldaption in social situations, altered interpersonal functioning, and abnormal way of interpreting self and others.
When should levothyroxine be taken?
In the morning, before breakfast.
Where to adenocarcinomas of the large intestine most commonly occur?
In the rectosigmoid colon
What is the highest priority care for pyelonephritis?
Increase the patient's fluid intake to 3 liters daily.
What causes an oxygen-hemoglobin dissociation curse to shift left? (oxygen uptake)
Increased pH, decreased 2, 3-DPG, low temperature, increased CO, pCO2 decreased
What is Sitagliptin used for?
Increases insulin secretion and contributes to less weight gain then other oral antihyperglycemics.
How is insulin affected during pregnancy?
Increasing glucose demands of the fetus may cause the amount of insulin needed to be increased - usually after the first trimester.
What does the Epstein-Barr virus cause?
Infectious mononucleosis - played a role in the emergence of Burkitt's lymphoma and nasopharyngeal carcinoma.
Tumor Necrosis Factor drug
Infliximab, adalimumab, and etanercept suppress the inflammatory response in autoimmune disease such as RA, crohn and psoriasis education: Do NOT take these drugs if you have a current, recent, or chronic infection, need a TB skin test Q year, only get INACTIVE vaccines (flu and pneumo)
injections
Interdermal: TB test, 25-27 g 15˚ angle Sub Q: 21g, 45˚ angle, no aspiration required, back of arm, belly, lower back fat IM: 90˚ ventrogluteal ("V" at hip), vastus lateralis, (outer thigh, children) deltoid (1-2" below acromion)
medication routes
Interdermal: TB test, 25-27 g 15˚ angle Sub Q: 21g, 45˚ angle, no aspiration required, back of arm, belly, lower back fat IM: 90˚ ventrogluteal ("V" at hip), vastus lateralis, (outer thigh, children) deltoid (1-2" below acromion) IV: monitor for: edema, redness, drainage, paresthesia, pain, temp
What is involved with Thromboangitis obliterans (buerger's disease)?
It is inflammation and thrombosis of the vessels of the hands and feet, strongly associated with smoking. - patient should inspect skin regularly for signs of tissue ulceration and necrosis.
What should be done if meconium aspiration occurs?
Intubation and immediate suction of the airway is required.
What deformities occur in clubfoot?
Inversion, adduction, and equinus (plantar flexion) of the foot and ankle
What is SIADH?
Involves excessive release of antidiuretic hormone - causes fluid retention, causing edema, increased urine osmolarity (concentration) and hyponatremia
IV solutions
Isotonic: solution remains in extracellular space and increases volume (0.9 NS, LR, D5W Hypotonic: into cell- shift from intravascular→intracellular, DKA/HHMS (0.45NaCl, D2.5W) Hypertonic: out of cell water from intracellular→extracellular increases volume, cerebral edema (3%NaCl, D10W)
What is included in a living will?
It includes what circumstances are needed for the living will to be executed, documentation requirement, health care worker immunity from liability, and witness requirements.
What is involved in Mobitz type 1 heart block?
It involves prolonged PR intervals followed by blocked P waves, then the cycle repeats - usually is benign and no treatment is needed - it is also known as the Wenchebach phenomenon in which the QRS complexs are typically "grouped" into twos, threes, and fours.
What characterizes a Corrigan's pulse?
It is a bounding and forceful pulse with a rapid rise and sudden collapse. It is associated with increased stroke volume and a decrease in peripheral resistance. - it is commonly found in aortic regurgitation and often leads to a widening pulse pressure.
What are signs and symptoms of psoriasis?
It is a chronic inflammatory diseased caused by hypersensitivity of the immune system - symptoms include lesions with red and white scales that appear on the extensor surfaces of joints (elbows and knees)
What is McBurney's sign?
It is a deep tenderness or pain at McBurney's point, one-third the distance from the right anterior iliac spine and the navel. This is indicative of acute appendicitis.
What is Paget disease of bone (osteitis deformans)?
It is a disorder of bone metabolism that is characterized by accelerated rate of bone remodeling, resulting in overgrowth of bone at selected sites and impaired integrity of the bone - mainly causes pain and deformities.
What is Ortolani's sign?
It is a distinctive "clunk" heard after flexing and abducting a newborns hips - indicative of hip dysplasia.
What is Fi02?
It is a fraction of the amount of oxygen a patient is inhaling produced by an oxygen device such as a nasal cannula.
What is flail chest?
It is a life-threatening condition that involves two or more fractures of adjacent ribs - This causes a flail segment to move in the opposite direction of the other ribs, causing trauma and contusions.
What are characteristics of fibromyalgia?
It is a nonspecific condition characterized by diffuse musculoskeletal pain, fatigue, distress, sleep disturbances, and depression
What is Triamtere (Dyrenium) used for?
It is a potassium-sparing diuretic given in CHF for fluid volume overload
How does Docusate work?
It is a surfactant laxative (stool softener) - it facilitates admixture of fat and water in the stool to reduce surface tension.
What is an axillofemoral bypass used for?
It is a surgical revascularization procedure used to treat symptomatic aortoiliac occulsive disease who cannot undergo aortofemoral intervention. - The axillary artery is connected to the femoral artery via an artifical graft in order to restore perfusion to the lower extremity. - Patient should avoid belts
What is niacin?
It is a water-soluble vitamin that decreases lipoprotein and triglyceride synthesis.
What is sarcoidosis?
It is an abnormal collection of inflammatory cells that for nodules in multiple organs, including lungs.
What is Doxepin used for?
It is an antidepressant used for depression and anxiety - should not be abruptly stopped, can caused flu-like symptoms, dizziness, fatigue, and insomnia - dizziness is common side effect.
What is Cyclosporine used for?
It is an immunosuppressant used to prevent rejection in organ transplants
What is angina pectoris and when is it caused?
It is caused by increased oxygen demand and decreased oxygen supply to the heart - occurs during activity, stops when rest occurs, and pain spreads to arms and back.
What causes Addisonian crises (adrenal crisis)?
It is caused by severe adrenocortical insufficiency
What is an Austin Flint murmur?
It is described as low-pitched and rumbling and can be heard during mid to late diastole. This murmur is associated with severe aortic regurgitation.
What does a spacer device do?
May eventually lead to a decreased need in dosage or frequency of a medication
Medical asepsis/surgical asepsis
Medical asepsis: "clean technique" to reduce to # and spread of microorgs (handwashing, no nail polish, disinfectants, PPE) Surgical asepsis: "sterile technique" destroys all microorgs and spores, skin cannot be sterile, hands above elbows, no reaching over sterile field, 1-2 inch edges are contaminated (if questionable, out of range of vision, below waist, wet, prolonged exposure to air): Used in: care of sx wounds, some dressing changes, Catheterizations, Trach care, Suctioning, sx
What are non-traditional risk factors for heart failure?
Metabolic Syndrome - refers to a cluster of CVD risk factors that increase the risk of CVD including obesity, increased triglycerides, low HDL cholesterol, hypertension, and elevated fasting glucose. C-reactive Protein - independent risk factor for CVD Homocysteine - an amino acid that has been shown to be increased in people with atherosclerosis.
SVT
NARROW QRS admin adenosine FAST (half life <5 seconds) can be given twice should be given in the AC IV site NORMAL to have period of ASYSTOLE!
How would shingles be diagnosed?
Microscopic smear test.
What are foods that are high in phosphate?
Milk, eggs, chocolate, soft drinks, organ meats, dried beans, bran cereal, and beer.
What are characteristics of non-Hodgkin's lymphoma?
Multiple lymph node involvement, spreads non-continguously, mesenteric nodes and Waldeyer ring often are involved, and extra-nodal presentation is common.
What are common finding in a patient with atrial septal deficit?
Murmur heard over the pulmonic area, dyspnea and fatigue, and a second heart sound that is split and fixed.
What are early signs of neuroleptic malignant syndrome?
Muscle stiffness, fever, sweating, and tremors.
What are signs and symptoms of chronic hepatitis?
Muscle wasting, weakness, fatigue, weight loss, increased bleeding, decreased body hair, and peripheral edema, and Jaundice.
What are signs and symptoms of hyperkalemia?
Muscle weakness, arrhythmias, bradycardia, diarrhea and nausea.
What are signs and symptoms of ALS?
Muscle weakness, atrophy, fasciculations, dysphagia, and spasticity of the flexor muscles.
What are signs and symptoms of pernicious anemia?
Neuropathy of lower extremities, diarrhea, constipation, fatigue, lack of energy, light-headedness with exertion, swollen or red tongue, bleeding gums
central lines
Nontunneled central lines: ^risk for infections, directly into a superior vena cava, can be done at the bedside, lasts <1 month Pt in trendelenburg w/ towel between shoulder blades, "bear down" to increase venous pressure (prevents air) Dressing changes w/aseptic technique Tunneled: inserted into central vein w/ remainder tunneled sub Q to distant site, done in OR/IR, lasts months-yrs
What is a normal PKU level? What occurs if level is elevated?
Normal is <2 mg/dl, can result in seizures, albinism, microcephaly, and cerebral impairment.
Pericarditis
Normal: pain with deep inspiration, ST elevation (not MI), and friction rub heard on auscultation. NOT normal: cardiac tampanda s/s JVD and distant heart sounds, and decreased BP
Lactolose
Not digested or absorbed until it reaches large intestine Produces an acidic environment and hyper osmotic effect Education: can be given with water, juice or milk to improve flavor, can be administered as an enema, for faster results is can be administered on an empty stomach THERAPEUTIC effects: 2-3 soft stools/day, improved mental status, and no dehydration, hypernatremia, or hypokalemia
What oxygen rate should a patient with emphysema be set at?
Not past 2 LPM
When is it safe for a child to be out in the sun?
Not until 6 months of age.
What should a nurse do when preparing an I.V medication from an ampule?
Nurse should place a gauze around the neck to protect hand from broken glass.
blood transfusion-nursing
Nursing: baseline vs, recheck after 15 mins, and 1hr post, prime tubing w/ NS (never use dextrose d/t clumping), benign hives may occur, most reactions d/t human error, occur in the first 15 mins, infusion time: whole blood 2-4 hrs, FFP 1hr, albumin up to 10ml/min Nursing after reaction: stop transfusion, return entire set to blood bank, do not flush tubing w/saline to clear, circulatory overload=cough, SOB, crackles, HTN, tachycardia distended neck veins=place pt w/ high fowlers, diuretics, O2, monitor I&O. sepsis: get blood cultures, abx, IVF, pressors, steroids
history of present illness (HPI)
OLDCARTS (onset-location-duration-character-allieving/aggravating-time-severity)
What is Rocky Mountain spotted fever characterized by?
Occurs following a tick bite, has a headache with myalgia, a maculopapular rsh that develops 2-6 days after the onset of a fever.
What is Cheyne-Stokes respirations?
Occurs in patients with CHF, increased ICP and drug overdose - breathing becomes progressively deeper and faster, followed by periods of apnea - cycle repeats.
What is the extrusion reflex?
Occurs when an object is placed on the anterior portion of the tongue - protective reflex that prevents the swallowing of inedible substances.
What are signs and symptoms of myasthenia crisis?
Occurs when the breathing muscles become too weak - they include an increase in heart rate, blood pressure, respiratory rate, cyanosis, increased secretions, or urinary and bowel incontinence.
What is distractible speech?
Occurs when the subject changes mid speech, in response to a stimuli
How should a cane be used?
On the unaffected side - with the base about two feet from the little toe. Patient should step with the affected leg and bring the can forward at the same time - move the can and affected leg forward together.
What position will a patient lie in for a lumbar puncture?
On their side, curling forward so that the knees are flexed toward the chest with the chin touching the knees - must lie flat for 4-8 hours after.
What is the onset, duration, and peak of insulin lispro?
Onset - 15 min Peak- 30 min - 1.5 hours Duration 2-5 hours
What is methadone used for?
Opiod analgesic often used for opioid dependecy
Meperidine (Demerol)
Opioid CONTRAindicated in sickle cell r/t large frequent doses that can cause toxic metabolite (tremors -> seizure)
What is Naltrexone used for?
Opioid dependence
What is Naloxone used for?
Opioid overdose
What are symptoms that might be present in a child with cerebral palsy?
Opisthotonic posturing (exaggerated arching of the back) and rigidity, increased or decreased resistance to passive movement - sign of abnormal muscle tone, when pulled to a sitting position, the child with CP may extend their entire body, rigid and unbending at the hip and knee joints.
What are characteristic of autism?
Over responsiveness to sensory stimuli (light or sound), impairment in communication, inability to name objects, and echolalia common
What test is used to diagnose infants with HIV?
PCR - polymerase chain reaction test
PICC
PICC: longer then PIV, arm→ends in superior vena cava, at bedside, need CXR to confirm placement, lasts 1yr+, flush unused ports w/ heparin. The rapid push-pause flush technique involves rapid instillation of 1-2 mL of flush with each push of the plunger. This technique creates turbulence, which decreases the adherence of fibrin and platelets to the lumen wall and prevents occlusion. To avoid excess pressure on the catheter, a syringe barrel of at least 10 mL should be used to flush a PICC. The plunger should not be fully depressed when it's removed from the PICC because this creates negative pressure, resulting in a reflux of blood into the catheter lumen and possible thrombus formation.
General health status
PMH, FMH, social history, occupation, sleep pattern, nutrition, meds, OTC, CAM, psych
Omeprazole (Prilosec)
PPI decreases stomach acid production risk for long term use: decrease bone density (r/t decrease intestinal calcium absorption) -> increased risk of fractures decrease in acid production increases risk for pneumonias and c.diff
What value is monitored for coumadin?
PT and INR
What should a PTT value be before a nurse removes a sheath?
PTT should be 50 or less.
What is claudication?
Pain that occurs in the extremities due to limited blood flow and resultant tissue hypoxia in the legs - exacerbated by exercise
Placenta previa
Painless, bright red vaginal bleeding, soft, relaxed, nontender uterus, fundal height ^for gestational age
What are the symptoms of iron-deficiency anemia?
Pallor, dyspnea, tachycardia, malaise, fatigue, and palpitations.
cholinergic
Parasympathetic/Cholinergic/Muscarinic mimics Ach and slows (adrenergic=sympathetic=speeds up) Cholinergic Toxicity: S-salvation L-lacrimation U-urinary stasis D-dizzy/diaphoresis/defication G-gi upset E-emesis
What are signs and symptoms of hypoparathyroidism?
Paresthesia, muscle cramps and spams, fatigue, bone pain, abdominal pain, and muscle cramps.
What are ways to reduce acne vulgaris?
Patient should be instructed to use lotion, makeup, and other products labeled noncomedogenic, use oil-free moisturizer, and dont touch face.
What position should a patient be in after a lumbar fusion?
Patient should be placed flat on bedrest and be repositioned every 2 hours - using logrolling method.
How should a nurse reduce pruritus?
Patient should keep house cool, wear loose clothing, use tepid water for bathing, use mild soaps, and take antihistamines.
What are causes of urinary incontinence?
Pelvic organ prolapse, decrease in urethral closure pressure, diabetes, CVA, Parkinson's and cancer.
Percussion
Percussion: dull=solid, flat=muscle, hyperresonance=trapped air, resonance=lungs, tympany=air/stomach
What are signs and symptoms of right-sided heart failure?
Peripheral edema, ascites, jugular vein distention, ad hepatomegaly.
What are signs and symptoms of mercury posions?
Peripheral neuropathy, skin discoloration (pink), swelling, shredding of the skin, tremors, visual changes, hearing impairment, and fatigue.
Vasodilators
Persantine adjunct thromboembolism prevention. AE: bronchospasm, MI. Teach: avoid ETOH, report bruising
What is the correct position for a person after a infratentorial craniotomy/what is done?
Place small pillow under the neck + keep the head of bed flat.
What are lab findings reflective of fluid overload?
Plasma osmolarity of less than 275 mOsm/kg from hemodilution, hematocrit less than 45%, specific gravity of less than 1.010, BUN level of less than 8mg/dl, and a plasma sodium level of less than 135 mEq/L.
What are common complications of influenza?
Pneumonia, COPD exacerbations, sinusitis, bronchitis, and ear infections
What are signs and symptoms of hyperglycemia?
Polyphagia, polydipsia, polyuria, fatigue, and blurred vision - later signs include pruritis, dry mouth, confusion, fruity odor of the breath, abdominal pain, or coma.
How is meningeal infection assessed?
Positive Brudzinski's and Kernig's sign, and an inability to flex the neck forward (nuchal rigidity)
What are signs of a secondary syphilis infection?
Positive nontreponemal test, rash, and lymphadenopathy.
What is lochia rubra?
Postpartum vaginal discharged consisting of blood - there are small particles of deciduas and mucus 3 days postpartum
What are appropriate nursing interventions for a patient with emphysema?
Postural drainage, chest physiotherapy, low-flow oxygen, high fowlers position, and increased fluid intake.
What are symptoms of Klinefelter's syndrome?
Present in males - less facial and body hair, reduced muscle mass, and strength, broad hips, gynecomastia, and hypogonadism
What should be done after a cerebral arteriogram?
Pressure should be applied to the dressing site for 4 hours, patient should be placed on bed rest for 4 - 24 hours in a flat position, and the extremity should be kept straight for the length of bed rest.
What do eosinophils do? Normal %?
Primarily defend against parasitic infections and are important in allergic responses - release interleukin, not histamine. Normal % - 1-4%
At what ages do different teeth begin to appear?
Primary - have all 20 by age 3 Wisdom - age 6
levels of prevention
Primary: prevent/promotion Secondary: screen-early detection Tertiary: treat- to prevent further deterioration, rehab
prevention
Primary: prevent/promotion Secondary: screen-early detection Tertiary: treat- to prevent further deterioration, rehab
How is friction and shear scored on the Braden scale?
Problem - 1 Potential problem - 2 No apparent problem - 3
What are the 3 stages of separation anxiety?
Protest, Despair, Detatchement
What is Pantoprazole used for?
Proton pump inhibitor used to reduce gastric acid secretion in the prevention and treatment of gastric ulcers.
What are signs and symptoms of diphtheria?
Purulent nasal discharge, brassy cough, and bluish skin coloration.
acceptable prescriptions rules
QID: 4x/day ONLY zeros BEFORE decimal (0.4 NOT 4.0) ac: before meal pc: after meals
Cor pulmonale
R HF d/t sustained lung resistance in COPD, dilation/hypertrophy d/t increased PVR. s/s: fatigue, tachypnea, cough, chest pain, hemoptysis, syncope. Nursing: O2, frequent rest periods, meds: dig, diuretics, restrict fluids, pace activities
What is accelerated silicosis?
Raidly progressing symptoms and x-ray changes
insulin
Rapid acting=Lispro, Short-acting=regular, intermediate acting=NPH, long acting=glargine, insulin pump delivers insulin continuously.
What are signs and symptoms of Goodpasture's syndrome?
Related to lung and kidney damage - they include fatigue, SOB, hemoptysis, pallor, oliguria, edema, weight gain, hypertension, and hematuria.
How does Theophylline work?
Relaxes bronchial smooth muscles and stimulates the CNS and skeletal muscles
What do basophils do? Normal %?
Release histamine during an allergic or anaphylactic reaction, leads to vasodilation, increased capillary permeability, and bronchospasm Normal % - 0.5-1%
What is a hypophysectomy?
Removal of the pituitary gland - removed transphenoidally = through the nose, blood draining down sinuses into mouth and throat can cause frequent swallowing
What are risk factors for secondary hypertension?
Renal disease, Cushing's syndrome, hyperthyroidism, hyperaldosteronism, pheochromocytoma, hormonal contraceptives, and diabetes.
What are early signs of hypoxia?
Restlessness, headache, fatigue, SOB, and cyanosis.
What are a few blood transfusions that would work?
Rh negative blood can donate to Rh positive of same type. O negative is universal donar AB patients can recieve both A and B, as long as there is Rh compatibility.
signs of labor
S/s labor: lightening, bloody show, Braxton-hicks, burst of energy, backache *True labor*: contractions regular and continue, increase in strength, start lower back and move to front, effacement *False labor*: contractions irregular and sporadic, get weak, only in the front, no cervical changes
COPD levels and common dx
SAt: 90-93% Pao2: 60-70 polycythemia body tries to compensate by creating more RBC for o2 carrying capcaity
SBAR
SBAR-between members of healthcare team: situation, background, assessment, recommendation
Depression
SIGECAPS (sleep-interest-guilt-energy-concentraion-appetit-psychomotor-suicide) Rx: antidepressants: therapeutic effects may take up to 8 wks, ECT Zoloft short ½ life=depression in elderly. Prozac long half life=children Nursing: encourage participation in goal setting, avoid OTC
fifth disease
SLAPPED FACE viral illness that affects SCHOOL AGED spread via respiratory secretion MOST communicable before onset of s/sx. GOLD SIGN: SLAPPED face (rash on cheeks) spread to extremities and maculopap. rash develops from prox. to distal surfaces. s/sx: fatigue and joint pain (ibuprofen) ONCE symptoms develop they are no longer infectious. recover with 7-10 days
Bishop Score
Score for induction of labor Score cervix 0,1,2,3 Score of >8 = induction of labor
Piaget
Sensorimotor: birth-2 reflexes, explore w/mouth, separation not as important Preoperational: 2-6yrs egocentric, magical thinking, non-logical, fearful, actively involved, see/feel learning Concrete operations 7-10yrs cause and effect, concrete term/explanations, understands concepts of human body Formal operations 11-adult logical relationships, analyze, concern for moral and social issues
What is complicated silicosis?
Severe scarring and fibrosis of the lung tissue.
What are signs and symptoms of hypoglycemia?
Shakiness, anxiety, nervousness, diaphoresis, palpitations, coldness, and a headache - late signs include seizures, loss of consciousness, and death.
What is distraction?
Shifting the patients attention and energy to a more neutral topic.
What are symptoms of Down's syndrome?
Short stature, short wide neck, slanted eyes, low set ears, hypotonia, intellectual disability, and learning disabilties
What are several complications that could occurs with scoliosis?
Shortness of breath or dyspnea, and lower back pain
What type of diet should a patient with gout avoid?
Should have a diet low in purines - high purine foods include organ meats, seafood, alcohol, sardines, aged cheese, lentils, spinach, and cod.
What is a stage 1 pressure ulcer?
Skin intact, red, non-blanching, warm, painful
What is a stage 2 pressure ulcer?
Skin is not intact, loss of the dermis occurs, pink/red, open wound, shallow
What are signs of dehydration?
Skin tenting, weight loss, sunken eyes, hypotension, tachycardia, lethargy, and headache.
What are signs and symptoms of celluitis?
Skins that is red, warm, tender or painful, swollen, and with a glossy appearance. Fever may be present, there may be an open wound with or without drainage, but can also occur in area with skin that is intact.
What are physical features of fetal alcohol syndrome?
Small head and brain, sunken nasal bridge, thin upper lip, small teach, and an upturned nose - it can also cause vision difficulties, intellectual disability, short attention span, delayed mental development, and poor impulse control
What is a huge risk factor for the development of bladder cancer?
Smoking
eye exam
Snellen, Rosenbaum (12-14 inches) arcus senills=white/yellow cornea
eye
Snellen, Rosenbaum (12-14 inches) arcus senills=white/yellow cornea, presbyopia: occurs beginning at around age 40, when people experience blurred near vision when reading, sewing or working at the computer.
How should a crutch be fitted?
So there there are two to three finger widths between the axilla and top of the crutch.
What type of restraint might be used for a patient on a ventilator?
Soft limb restraints to prevent pulling of the endotracheal tube
What does SMART stand for for patient goals?
Specific Measurable Attainable Reasonable Time-oriented
What are some development success?
Standing - accomplished by age 13 months Run - 14-22 months Say 3 words - 12-20 months Put on clothing - 20-30 months Check Denver 2 Developmental Screen
What characterizes the first stage of labor?
Starts from the onset of regularly perceived uterine contracts and ends with full cervical dilation
What characterizes the second stage of labor?
Starts with full cervical dilation, and ends with birth of baby.
What is the difference between sterile and aseptic technique?
Sterile - absence and continued protection against all microorganisms. Aseptic - used to prevent the SPREAD of microorganisms if a wound is already infected.
Amblyopia
Strabismus, cataracts, Rx: glasses, patch to strengthen eye, drops
What most commonly causes cellutitis?
Streptococcus pyogenes and Staphylococcus aureus
What are signs and symptoms of a pulmonary embolism?
Sudden chest pain - most common symptoms, others include dyspnea, increased respiratory rate, hemoptysis, tachycardia, anxiety, fever, and diaphoresis.
What is a laminectomy?
Surgical removal of one more more vertebrae from the spine.
What is Rheumatoid arthritis characterized by?
Swollen and tender joints, stiffness, nodules, anemia, and join pain. Pain and stiffness generally occurs in the morning and following inactivity. Movement may relieve symptoms.
Isoniazid (INH)
TB med Hepatotoxic and peripheral neuropathy NO ETOH, take vit b6 (prevent neuropathy), NO alum-containing antacids, Report changes in vision, numbness or tingling in extremities, and yellowing of skin,
Rifampin
TB med body fluids will turn orange-red
Trendelenburg mod trendelenburg
TREN: head up ass down (crany) mod tren: head down ass up (shock)
During periods of stress, what should a patient with Addison's do?
Take addition glucocorticoid to secrete cortisol.
How can a pregnant lady reduce nausea from a prenatal pill?
Take it at night + with food.
How would a nurse assess involution?
The nurse should palpate the fundus to see if it is firm and well contracted.
newborn assessment
Temp 97.9-99.7, HR 110-160 BP 50-75 RR 30-60 glucose 40-60 bilirubin elevated:10 (preterm) 15 (full term) 1st void and stool within 24 hrs
What is peak expiratory flow?
The maximal speed of air being exhaled.
What occurs during the transition phase of labor?
The maximum cervical dilation reaches 8 to 10 cm, contraction reach their peak of intensity and occur every 2 to 3 minutes and have a duration of 60 to 90 seconds.
What would be indications for suctioning?
The presence of wet respirations, rhonchi, increased peak inspiratory pressure, bubbling in the ET tube, restlessness, and increased respiratory and heart rate
What is Forced expiratory flow?
The speed of air being exhaled.
Curvature of the spine exceeding 65 degrees in what region of the spine can lead to serious complications?
The thoracic area - can cause cardiopulmonary problems due to impaired chest expansion.
Therapeutic communication/Nontherapeutic
Therapeutic communication: acceptance, listening, empathy, silence, eye contact, clarification, restating, open-ended, focusing Nontherapeutic: giving advice, false reassurance, changing subject, social response, invalidation, over/underloading, incongruence
What occurs in pulmonary stenosis?
There is an inability of the right ventricles to evacuate blood by way of the pulmonary artery. It can eventually lead to right ventricular hypertrophy.
What is a serious side effect of hormonal oral contraceptives?
These patients have a 3 to 5 times higher risk of venous thromboembolism, S/S of a thrombosis include swelling, warmth, pain, tenderness, and redness of the affected area.
What do malignant melanomas look like?
They appear black, blue, or brown with irregular borders - usually are asymmetrical, large, and evolving.
What do squamous cell carinomas look like?
They are characterized by local invasion, grow fast, metastasize infrequently. They are usually present as red nodules with crust or ulceration.
What type of dressing should be used to cover a fasciotomy site?
They are commonly left open postoperatively to allow assessment of tissue viability and pressure release - they should be covered with a sterile saline soaked gauze
What occurs in patients with hyperosmolar hyperglycemia nonketotic syndrome?
They are often dehydrated by up to 12 L and require rapid fluid infusion to maintain cardiovasular integrity. - 6 L of fluid are given over the first 12 hours, isotonic fluid is used (normal saline)
What do lesions in Kaposi's sarcoma look like?
They are papular, nonpruritic, bilater, and pink, brown, or violet.
What do basal cell carcinomas look like?
They are translucent, raised, and smooth. Usually occur on sun exposed skin.
What are four-point restraints used for?
They are used for patients with a psychiatric illness or altered mental status that pose a risk to themselves or staff members. The use of four-point restraints are reserved for extreme situations.
What are characteristics of a breast neoplasm?
They are usually singular, hard, and irregularly shaped with poorly defined edges, they are also fixed and do not move easily.
What are signs and symptoms of scarlet fever?
They begin abruptly and include fever, sore throat, rash, and a bright red tongue - rash appears 12 to 72 hours after the onset of a fever, tonsils are inflamed and often covered with a white coating.
How are nephritis syndrome and nephrotic syndrome similar?
They both involve permeability of the glomerulus, leading to proteinuria, hypoalbuminemia, and hyperlipidemia - hematuria does not occur in nephrotic syndrome. Nephritis syndrome also often causes azotemia, oliguria,and hypertension.
What are symptoms of malinger?
They have no real physical symptoms or grossly exaggerate relatively minor symptoms - their purpose is an external incentive or outcome such as financial compensation, obtaining drugs, avoiding work, or to gain sympathy. People who malinger can stop the physical symptoms as soon as they have gained what they wanted.
What are purines?
They metabolize into uric acid, which crystallizes in the joints. This causes the local immune-mediated inflammatory reaction seen in gout.
What is tangentiality?
Thought disorder characterized by a lack of observance to the main subject of discourse - the person will deviate from the topic
What is loose association?
Thought disorder characterized by frequent shifts between ideas or subjects.
How is Hepatitis B transmitted?
Through body fluids such as blood, sexual fluids, and saliva
How is Hepatitis D transmitted?
Through body fluids such as blood, sexual fluids, and saliva. Causes infection only in the presence of Hepatits B.
How should a patient with pericarditis sit to relieve pain?
To lean forward - will pull the heart away from the lungs, preventing pericardial irritation caused by friction and contact with the lungs.
What is a craniotomy done for?
To remove a tumor, evacuate blood clots, control hemorrhage, or relieve ICP - an infratentorial craniotomy is an incision made into the nape of the neck.
What is Ropinirole (Requip) used for?
To treat Parkinson's disease
What is a healthy total cholesterol to maintain? LDL? HDL?
Total - <200 mg/dl, HDL - >60 mg/dl, LDL - <130 mg/dl
Amitriptyline (Elavil)
Tricyclic antidepressant use: antidepressant and pain relief for fibromyalgia
Erikson
Trust vs mistrust: birth-18months, based on quality of caregivers (feeding) Autonomy vs shame/doubt: 18m-3yrs, personal control (potty training) Initiative vs guilt pre-k 3-5yrs assert power and control, independence Industry vs inferiority school age 6-11yrs social actions, pride in accomplishments Identity vs role confusion adolescence 12-18yrs exploring independence and sense of self Intimacy vs isolation early adult 18-40yrs personal relationships, love Generativity vs stagnation adult 40-64yrs building careers and family Integrity vs despair older adult 65-death reflecting back on life
How are the different types of hypersensitivity reactions classified?
Type 1 - immediate allergic reaction involving IgE (anaphylaxis) Type 2 - involves IgM and IgG, leads to cell lysis (ABO incompatibility, hemolytic anemia) Type 3 - involves antigen-antibody complexes, leads to an inflammatory response (lupus) Type 4 - delayed hypersensitivity reaction involving T-cells - takes several days to develop (transplant rejection)
legal
Types of law: criminal: intentional harm civil: negligent acts that cause harm Negligence: care provided below standards, breach of duty to providing nursing care. 4 legal concepts: Duty: nurses have a legal obligation to provide nursing care to pt, in reasonable fashion, same circumstances Breach of duty: failure to provided expected, reasonable standard of care Proximate cause: breach of duty resulting in injury Damages: injury, monetary award to plaintiff Malpractice: professional negligence, unintentional failure to perform duties that reasonable person would Assault: threat Battery: intentional touching w/o consent Pt rights: Privacy: confidential information/HIPAA Advance directives: DNR: written by MD, can withdraw at any time, RN attempt at resuscitating = battery Restraints: RN doc: why, how responded, if needs continued, w/o consent or justification= false imprisonment Informed consent: HCP gets (competent adult, able to understand), RN verifies pt comprehension: Purpose of procedure and expected results, Anticipated risks and discomforts, Potential benefits, Any reasonable alternatives, Consent may be withdrawn at any time
Legal
Types of law: criminal: intentional harm, civil: negligent acts that cause harm Negligence: care provided below standards, breach of duty to providing nursing care. 4 legal concepts: Duty: nurses have a legal obligation to provide nursing care to pt, in reasonable fashion, same circumstances Breach of duty: failure to provided expected, reasonable standard of care Proximate cause: breach of duty resulting in injury Damages: injury, monetary award to plaintiff Malpractice: professional negligence, unintentional failure to perform duties that reasonable person would Assault: threat Battery: intentional touching w/o consent
Cystitis
UTI in bladder s/sx: bladder pain that is dull and continuous and may experience spasms over suprapubic area
pyelonephritis
UTI in kidney GOLD: flank dull and constant pain in the back at the costovertebral angel (lower ribs and adjacent vertebrae) may spread to the belly button dysuria, urgency, and frequency
How long should a child use a front facing care seat for?
Until the age of 2, or until the child weighs 40 pounds.
How long should a booster seat be used for?
Until the child outgrows a car seat and until they are 4 foot 9 inches talls.
How long are patients with TB on meds for?
Up to 9 months
What is a symptom of chronic renal failure?
Uremia - build up of nitrogenous waste products due to the kidneys inability to excrete.
What would a nurse monitor to asses hypothalmic function?
Urinary output and temperature.
What are signs and symptoms of hemorrhagic shock?
Urinary output less than 30 cc/hr, dehydration, dizziness, fainting, fatigue, thirst
Wedge pressure
Use distal port of PA catheter
What are ways to reduce allergic reaction to dust mites in the home?
Use impermeable covers on pillows and mattresses, keep floors and surfaces bare and avoid carpeting, wash and rinse linens in hot water.
What should a patient do during the removal of a chest tube?
Use the valsalva maneuver - patient should exhale slowly and bear down - will increase intrathoracic pressure and reduce the risk of air entering the pleural space.
What is a CBC used for?
Used to detect anemia and thrombocytopenia
What is a hepatobiliary scan used for?
Used to evaluate the function of the gallbladder
What is a erythrocyte sedimentation rate used for?
Used to measure a non-specific measure of inflammation in the body - used to help diagnosed SLE, rheumatoid arthritis, and Kawasaki's disease
What is Rifampin used for?
Used to treat TB.
What is Diltizazem used for?
Used to treat arrhythimias and hypertension
What is Rosiglitazone used for?
Used to treat type 2 DM by improved insulin sensitivity.
VEAL-CHOP
V: variable decels C: cord compression Reposition, O2, notify dr E: early decels H: head compression Normal A: accels O: okay L: late decels P: placental deficiency Turn, O2, d/c Pitocin, notify dr
Contact precautions
VRE, C-Diff (wash with water and soap), MRSA, gown and gloves, close door
How is nutrition scored on the Braden scale?
Very poor - 1 Probably inadequate -2 Adequate - 3 Excellant - 4
What are signs and symptoms of multiple sclerosis?
Visual disturbances, impaired sensation, mood swings, impaired motor function, cerebellar functions, impaired urination, constipation, and sexual impotance in males.
What is the treatment for pernicious anemia?
Vitamin B12 injections once a month for life
leukocytosis
WBC >11,000
What would be included in an early stage pregnancy class?
Warning signs and complications, nutrition, anatomy and fetal development.
What are signs and symptoms of Myasthenia gravis?
Weakness, fatigue, drooling, and ptosis.
What are several complications of pancreatic cancer?
Weight loss, blood clots, depression, infections, jaundice, pain.
What characterizes peritoneal pain?
Well-localized pain that causes rigidity of the abdominal muscles where pain increases with any pressure or motion.
What are things that might be assessed on a patient with asthma?
Wheezing, chest tightness, and dyspnea.
When does separation anxiety generally occur?
When a child is between the ages of 8 months and 3 years.
What is paternalism?
When a health care professional must decide what is best for the patient and act without consent.
What is a delusion of reference?
When a person believes that insignificant events or objects in the environment have personal meaning
When might laser surgery be used?
When all boundaries of the lesion (cancer) are visible, it is used to burn off abnormal cells, or to remove tissue for biopsy.
What is a transverse fracture?
When the bone is fractured at a right angle to the long axis.
What is a linear fracture?
When the bone is fractured parallel to the long axis
What is a comminuted fracture?
When the bone is splintered or crushed and has multiple fragments
What is an oblique fracture?
When the fracture is diagonal to the bone's long axis.
What is failure to sense?
When the pacer cannot sense the heartbeat, leads to poorly timed firing by the pacer
What is failure to pace?
When the pacer fails to fire a signal when it should - often leads to bradycardia and hypotension because the heart cannot beat at the same rate as the pacer
What is failure to capture?
When the pacer fires a signal, but the heart does not respond with a beat.
What should a nurse asses before giving heparin to a child?
Wight - dosages are calculated based on the patient's weight.
rivaroxaban
Xarelto blood thinner
Should bubbling occur in the water-seal chamber?
Yes, intermittent bubbling is expected - it will fluctuate with respirations - called tidaling, if tidaling stops, chest tube may be kinked or obstructed.
What foods help decrease ostomy odor?
Yogurt, parsley, buttermilk, and cranberry juice.
hypokalemia
^ risk of digoxin toxicity flat T wave, presence of U wave, ST depression
glaucoma
^aqueous humor, ^intraocular pressure (IOP) 4 types, loss of peripheral vision Rx: miotics to open drainage ducts. Nursing: avoid activities that increase IOP (bending, straining, coughing, laughing), routine eye exams, blurred vision for 1-2 days post-sx
What is megacolon?
abnormal dilation of the colon (large intestines) - can be confirmed with barium enema.
seizure
abnormal electrical discharge in brain. Epilepsy: chronic, recurring. *Absence*: petit mal, less than 10 seconds, blank starring, between 4-14 yrs old *Myoclonic*: jerking of 1 or more extremities, occurs in the morning *Clonic*: SHAKING violent bilateral muscle movements, hyperventilation, diaphoresis, tachycardia, excess salivation *Tonic*: RIGID loss of consciousness, contraction bilaterally, jaws clenched, loss of bladder control, apnea, cyanosis, lasts less than 1 min *Tonic-clonic*: grand mal: most common, prodromal, lasts 2-3 mins, incontinent, post ictal 5 mins after, confusion after, ha *Status epilepticus: w/o pauses, EMERGENCY* risk for hypoxia Rx: benzos (valium, Ativan) for active seizures, anticonvulsants (Dilantin) barbiturates (phenobarbital) Nursing: suction/O2 ready, help to floor, place a pillow under head, loosen clothing, observe and record seizure activity, call RRT if lasts longer than 5 mins. after: turn on side, allow to rest, document.
Acute kidney injury
abrupt loss of kidney function resulting in retention of urea and nitrogen. *Prerenal*=decrease renal blood flow s/s: hypotension, hypoperfusion *Intrarenal*=injury to renal tissue d/t toxins/ischemia s/s: edema, glomerulonephritis *Postrenal*=stop/slow urine flow down the urinary tract s/s: hx of obstruction, difficulty voiding *Oliguric/anuric*=less than 500ml UO in 24 hrs, diuretic phase 24hr UO more than 500ml and no longer rise in BUN/Cr, recovery phase months-year, scar tissue. Rx: no nephrotoxic drugs( aminoglycosides, ACEI, NSAIDS, radiocontrast), give IVF if dehydrated, hemodialysis Complications: infection, arrhythmias (hyperkalemia) electrolyte imbalances, GI bleeding, multiple organ system failure. Nursing: assess, montor I&O, daily weight, regulate protein intake, high carb diet, restrict foods high in K, Phosphorus, Na
abruptio placenta vs. placenta previa
abruptio: vag bleeding with PAIN previa: vag bleeding (bright red) WITHOUT PAIN
Therapeutic communication
acceptance, listening, empathy, silence, eye contact, clarification, restating, open-ended, focusing
Ascities
accumulation of fluid in peritoneum d/t portal htn, hypoalbuminemia, hyperaldosteronism, fluid leaks. s/s: fluid wave, distention, dull sound on percussion, dyspnea. Rx: diuretics, IV albumin, paracentesis, low sodium. Nursing: daily weight, I&O, restrict fluids, semi-fowlers
ascites
accumulation of fluid in peritoneum d/t portal htn, hypoalbuminemia, hyperaldosteronism, fluid leaks. s/s: fluid wave, distention, dull sound on percussion, dyspnea. Rx: diuretics, IV albumin, paracentesis, low sodium. Nursing: daily weight, I&O, restrict fluids, semi-fowlers
Reyes syndrome
acute encephalopathy following viral illness w/cerebral edema d/t ASA w/fever s/s: fever, n/v, lethergy, neuro deterioration, increased ammonia levels
myasthenia gravis crisis
acute exacerbation d/t triggers (stress, infection, inadequate meds) *NO ACH* s/s: *^HR, ^RR, ^BP*, sudden inability to swallow, speak or maintain airway, incontinence, absent cough Rx: vent support, ^ meds
Guillain- Barre
acute immune-mediated polyneuropathy GOLD SIGN: ASCENDING muscle paralysis and absence reflexes. #1 concern: neuromuscular respiratory failure (rate and depth of RR) GOLD STANDARD TEST: spirometry s/sx: ortho hypotension, paralytic ileus, urinary rentention, diaphoresis, absent reflexes (including gag), CN II, III, IV, and VI abnormal.
ARDS
acute lung injury, inflammation, damage to alveoli, non-cardiac pulm edema. s/s: restless, anxiety, low sat, dyspnea, tachypnea, resp failure, tachycardia, cyanosis, retractions, frothy sputum, clear-then crackles, white out CXR. Hypoxemia/hypercapnia. Nursing: abx, vent, ECMO, sedation, steroids, fluid restriction, frequent position changes, ROM, monitor O2 trends, behavioral changes
Crisis
acute temp state of emotional turmoil, usual coping mechanisms fail. Average crisis 4-6 wks. 4 phases: • vulnerable state, precipitating event, acute crisis, reorganization • rx: trazodone, alprazolam, empower, allow pt to express feelings, find support system, relaxation strategies, CBT
Naegeles rule
add 7 days to LMP, subtract 3 months, add 1 year
Pheochromocytoma
adrenal gland tumor, too much epinephrine/norepinephrine s/s: abd pain, chest pain, irritability , palpitation, tachycardia, ha, diaphoresis, weight loss, treamor, HTN. Nursing: CVP, Regitine (HTN crisis) NEVER PALPATE ABD, lifelong followup
Anemia
aplastic=not producing RBC, congenital/pregnancy, hepatits. s/s: petechiae, bruising, fatigue, ha. Rx: steroids, abx, Nursing: hemorrhage precautions
blood transfusion reactions
allergic most common w/hives/itching=give Benadryl. Febrile: d/t WBC=give Tylenol Transfusion-related acute lung injury (TRALI) dyspnea 1-2hrs (up to 72hrs) after transfusion Acute hemolytic: rare but most serious, when blood types don't match, d/t human error, s/s: chills, fever, lower back pain, nausea, hypotension, bronchospasm, vascular collapse, DIC Delayed hemolytic reaction: body attacks antigens on RBC, 4-8 days (up to 1 month), falling hematocrit, +Coombs Graft-vs-host disease (GVHD) occurs w/immunocompromised pt, WBC attack pt tissues, w/ relative donations, within a month fever, liver dysfunction, rash, diarrhea, pancytopenia (deficiency of all 3 blood components) Circulatory overload: infusion to fast: dyspnea, orthopnea, tachycardia, anxiety, pulm edema=give diuretics
What is Prinzmetal's angina?
also known as variant angina - characterized by cyclic chest pain that often occurs at rest (night0, caused by vasospams, leading to the narrowing of the coronary arteries
Nephrotoxic AntiB
aminoglycosides gentamicin and tobramycin
nitrazine pH test
amniotic fluid is alkaline: blue-green or blue-gray = positive Vaginal fluid is acidic: yellow or olive green = negative
What is Hirschprung's disease?
an absence of ganglionic innervation to the smooth muscle of the bowel - results in no peristalic waves - results in chronic constipation or ribbonlike stools
Tobramycin
antibiotic mostly used with aerosolized form to treat CF exacerbation when Pseudomonas is the predominant organism causing the lung infection
Vancomycin
antibiotic Nephrotoxic (BUN and creatinine) , monitor trough levels before the 4th dose (15-20),
Rifaximin
antibiotic used with hepatic enceph r/t to increased ammonia levels.
Oxybutynin (Ditropan)
anticholinergic tx: overactive bladder S/sx: Cant eat, pee, shit, or spit, heat intolerance, blurred vision, and drowsiness
St. Johns Wart
antidepressant herbal supplement education: do NOT take with tricyclic, MAOI, SSRI/SNRI -> increase side effects and lead to serotonin syndrome
Promethazine
antiemetic
Cisplatin
antineoplastic chemo Nephrotoxic
Clopidogrel (PLavix)
antiplatelet
Prasugrel (Effient)
antiplatelet
AriPIPIrazole (Abilify)
antipsychotic dopamine system stabilizer controls agitation and hallucinations with dementia
PTSD
anxiety disorder w/exposure to a traumatic/stressful event (acute or delayed). May have survival guilt. s/s at least 30 days 3 issues: relieving event that disturbs daily living, avoidance, hyperarousal Rx: CBT, eye movement desensitization and reprocessing (EMDR) hypnotherapy ONLY SSRI's Zoloft, Paxil, Prozac, benzos Nursing: establish trust, encourage verbalization, coping strategies, assess for suicide
OCD
anxiety disorder w/unwanted and repeated thoughts, feelings, idea, sensation, behaviors that make them driven/compulsions Trichotillomania (hair pulling) excoriation (skin picking) body dysmorphic disorder Rx: antidepressants, antipsychotics, mood stabilizers, CBT, deep brain stimulation Nursing: promote predictable structure, avoid power struggles, identify triggers, initially allow time for rituals and then begin to limit, positive reinforcement for non-ritualistic behaviors, stress management
Abuse
any recent act or failure to act that results in death, serious physical, or emotional harm, sex abuse or exploitation • Abusers: blame victim, jealous/controlling, poor impulse control, low self-esteem, unrealistic expectations, victims of abuse t • Cycle of abuse: phase 1: tension-building, phase II: acute battering incident, phase III "honeymoon" phase
Osteomyelitis
bacterial infection of the bone, staph aureus, inflammation/pus forms in bone "honeycombed" areas, s/s: pain, erythema over area, decreased ROM, fever above 101. Rx: IV abx 4-6 wks, ROM, high cal liquids, PT at home
Tonsillitis
bacterial, s/s: sore throat, fever, difficulty swallowing, halitosis, noisy respirations, ear infection. Rx: abx. Nursing: hemorrhage=frequent swallowing, use mouthwash, semi-liquid diet 48-72 hrs
Tonsilitis
bacterial/viral dysphagia and difficulty breathing d/t inflammation, "kissing tonsils" sore throat, halitosis, mouth breathing, fever. Rx: abx, fluids, rest, sx: w/ 7 or more episodes of tonsillitis in 1 year, difficulty breathing, abscess/growths on tonsils. Nursing: post-op assess for frequent swallowing (may be d/t bleeding), assess vomiting, place child onside, pain meds as needed, avoid food s that are red/brown/acidic, offer soft, bland foods, recovery takes 1-2 weeks, no school for 7-10 days, no exercise or swimming for 3 weeks
IABP
balloon helps circulate blood after heart failure, inflates with diastole and deflates with systole. Used to treat cardiogenic shock. Not for dissection, AAA, complications: site infection, bleeding, clot-general aortic dissection, perforation, thrombocytopenia, dysrhythmias, myocardial failure. Nursing: EKG, monitor LOC, pt should not bed leg w/ insertion
preop
begins w/ decision to have sx and ends when pt enters OR. Types: elective: not essential for health, urgent: necessary for health, emergency- life saving. Preanesthetic meds: sedatives, anticholinergics (atropine to decrease secretions, prevent bradycardia) tranq/antianxity (-azepam) H1 receptor antagonists (n/v), PPI (decrease stomach acid) analgesics, possible abx Preop nursing: teach coughing, deep breathing, post-op incisional splinting, comfort measures to be used post-op, movement and elimination, get baseline vs, remove nail polish, makeup, help pt to empty bladder, check ID bracelet, remove dentures/prosthesis, check informed consent, labs, allergies. -consent form and post-op teaching done before preop meds given
Brain tumors
benign or malignant, increased ICP, s/s: depends on location: • frontal lobe: personality, seizures, visual disturbances, hemiparesis, aphasia • occipital lobe: visual hallucinations, seizures • temporal lobe: seizures, ha • parietal lobe: seizures visual loss • cerebellum: coordination or walking/mobility difficulties
What is Flumazenil used for?
benzodiazepine overdose
Antianxiety agents
benzodiazepines: better for intermittent or short-term use in the management of anxiety buspirone, paroxetine, venlafaxine: better for long-term use
ventilator
bi-level positive airway pressure. • Assist-control: preset rate, preset tidal volume (The volume of air inspired or expired in a single breath during regular breathing), if pt initiates breath, machine delivers the preset tidal volume • Synchronized intermittent mandatory ventilation (SIMV): machine set to deliver a given rate at preset tidal vol, pt can breathe on their own between machine breaths but will determin own tidal volume, used to gradually decrease machine support
Celebrex
black box CV and GI bleeding. Nursing: take with 8oz of water/milk w/food, Avoid ASA or other NSAIDS
Cystocele
bladder herniates into vagina. s/s: pelvic pressure, frequency, urgency, stress incontinence, inability to empty bladder, frequent UTI. Rx: estrogen, pessary, sx, assess pain, bulge, pelvic rest for 6 weeks post-op, kegels, prevent urinary retention
Hemophilia
bleeding disorder, sex linked, s/s: prolonged bleeding. Nursing: prevent bleeding/falls, brush teeth with soft toothbrush. Genetic counseling for parents
contusions
bleeding under skin/ecchymosis. Rx: 24-48hrs ice 15mins 3x a day, wrap, heat if needed, should heal in 7-10 days, color changes from blue-yellow in 3-5 days
Heparin
blocks factor X. Assess PTT, have double RN check, Antidote: protamine sulfate. AE: hemorrhage, thrombocytopenia (low platelet), HIT
Rheumatoid arthritis
chronic inflammatory disease of the connective tissue, starts in feet/hands w/gradual irreversible destruction, *bilateral, autoimmune* disorder, ulnar deviation, swan-neck deformity of fingers, foot drop, spinal cord compression. Rx: NSAIDS, Paquenil, immunosuppressive, steroids, rest, weight reduction, calcium supplements
Laryngitis: croup/epiglottis
can be emergent, s/s: hoarse voice, swollen lymph nodes, fever. Rx: rest voice, gargle w/ warm salt water, cool moist air, steamy bathroom, outside night air
NSAID long term use
can cause MI, stroke, HTN, and possible heart failure! decrease diuretic and Bp medication effect! Increase chronic kidney disease and peptic ulcer
Ginko Biloba
can increased risk for bleeding!
endocarditis
can vegetate=embolize, d/t grp B strept, staph aureus, fungus s/s: fever, petechiae, splinter nails Rx: IV abx 6 weeks, need long term venous access
Positive inotropes
cardiac glycoside: digoxin: slows AV conduction, improves myocardial contractility, used in: HF, A-fib, PSVT conversion. AE: ventricular arrhythmias, delirium, hallucinations, n/v, visual disturbances. Contra: SSS, blocked AV, hypokalemia causes dig tox!. Nursing: Cr, K, HR at least 60 (hold if below), serum drug levels (therapeutic 0.5-2) toxicity s/s: altered rate/rhythm, visual disturbances, GI upset. Antidote: Digifab. Teach: avoid antacids, laxatives d/t decreased absorption, measure HR, daily weights (report +2 pounds in 24 hrs), irreg HR • Milrinone: blocks phophodiestrase, used for HF. AE: ventricular arrhythmias, TdP, v-tach, SVT. Contra: AMI. Nursing: BUN/Cr, CBC, change infusion solutions/tubing q24˚, infuse w/ NS only
Urinary drainage
catheter types: • intermittent: straight cath, single use, sterile technique (clean technique may be used in the home) • indwelling: double lumen w/ balloon that inflates in bladder, used for long term drainage, triple lumen w/bladder irrigation • condom: applied to penis and attached to collection system • Nursing: place pt in low fowelers/supine with legs externally rotated/bend knees, insert w/sterile technique. Care: perineal hygiene using soap and water at least twice a day, monitor for infection. Measure output, encourage fluids over 2000 ml/day, empty collection system every shift and when ½-3/4 full, keep collection system lower than level of bladder
TB
chronic infection d/t acid-fast bacillus d/t inhalation/ingestion of infected droplets, dormant-later reactivating, increased prevalence in AIDS. s/s: weakness, fatigue, anorexia, weight loss, night sweats, chest pain, productive cough (blood). Cxr: "coin" calcified lesions. TB test: Mantoux skin test positive if >10mm Rx: long term 6-24 months isoniazid, rifampin, ethambutol, high carb-high protein diet w/ small frequent meals, reportable disease. Nursing: airborne precautions, negative flow room, N95 mask, visitior wear surgical masks, obtain sputum specimen early in morning for dx, no OTC, no contacts w/rifampin (red-orange), adherence, increase B6
breast assessment
common benign causes of lumps: fibroadenoma, cystic breast changes
COPD
chronic irreversible airway obstruction w/slowed exhalation, d/t: smoking. s/s: cor pulmonate, cough, sputum production, dyspnea on exertion, use of accessory muscles, restlessness, anxiety, barrel chest, weight loss. Rx: bronchodilators, steroids, expectorants, O2 to lowest dose to keep O2 sat ~90%, pulm rehab, airway clearance (coughing, physiotherapy, postural drainage. Nursing: teach pursed lip breathing w/ exhale, rest, small frequent meals w/ nutritional supplements, avoid temp/humidity extremes and high altitudes
Bronchopulmonary dysplasia
chronic lung condition that affect newborns on vents or preemies, had RDS, lung immaturity, severe resp/lung infections. Vent presses and damages epithelium, alveolar walls become fibrotic, lungs develop atelectasis and collapse. s/s: tachycardia, tachypnea, increased work of breathing (retractions/nasal flaring) pallor, cyanosis, restlessness. Rx: O2, diuretics, bronchodilators, anti-inflammatories, increase cal formulas and hydration. Nursing: rest periods, monitor fluid overload, pulm edema, frequent resp assessment
Asthma/ reactive airway disease
chronic lung disorder, bronchospasms, hyperactivity, airway narrowing, thick excess mucous, genetic, triggers: allergies, infection, stress, exercise, medical conditions, meds. Triggers: activate mast cells EOSINOPHILS AND HISTAMINE released=bronchoconstriction s/s: hacking cough, wheeze on EXPIRATIONS, dyspnea, cough (nonproductive at first, later productive w/mucus) change in LOC, restlessness, irritability, decreased play activity. Rx: goal is to maintain normal growth and development, meds: LONG term: steroids, cromolyn, nedocromil, LABA, theophylline, leukotriene modifiers. SHORT term/rescue: SABA, anticholinergics, steroids, IVF, O2, intubation. Nursing: position semi-high fowlers, stay with child during acute phase, monitor fluids, asthma action plans (include school and parent).
SLE
chronic, systemic, inflammatory disease of collagen tissues, more in women, AA, Hispanics, Asians. Dx w/ 4 or more s/s: arthritis, butterfly rash over cheeks and nose, skin lesions, *photosensitivity*, oral ulcers, pleurisy, proteinuria, seizures, anemia. Rx: control symptoms, NSAIDS, steroids, antimalarial drugs. Nursing: pain management, rest periods, skin protection in the sun
Hemodialysis
cleansing the blood of accumulated waste products. Requires 5 things: • Assess fistula, assess machine, appropriate solution, time-12 hrs each week divided in 3 equal segments, place • Nursing: monitor hemodynamics, patency of fistula (auscultate for bruit, palpate for thrill), diet restrictions- increase protein, limit sodium, K 1500-2000mg day, maintain fluid intake 1000-1500ml a day. Complications: CVD, CHF, CVA, infection, gastric ulcers, HTN, calcium deficiencies, anemia, fatigue, depression, sexual dysfunction, suicide risk
DVT
clot in deep vein, *Virchow's triad*: hypercoagulabilty, hemodynamic changes (stasis, turbulence) endothelial injury/dysfunction. s/s: unilateral edema, warmth, tenderness, redness.
DIC
clotting and bleeding, triggered: trauma, shock, infections, hypoxia, liver disease, pregnancy. s/s: bleeding, bruising, petechiae, increased PT, decreased platelets, degraded fibrinogen. Rx: transfusion FFP, vit K, oxygen. Nursing: transfusion, heparin
cataract
cloudy lens Rx: ICCE (intracapsular cataract extraction), d/t aging, metabolic disorders, trauma, heredity. Nursing: expected feeling after sx "sand" in eye for 6-8 wks after, photophobia for months-years, use sunglasses
skin
color, moisture, temp, texture, turgor, vascularity, edema: generalized (anasarca), ascites: Edema: 1+ mild barely detectable/disappears, 2+ pitting/moderate/lasts 10sec/5mm 3+ severe/5-10mm/lasts more than 1 min, 4+ severe greater than 10mm/lasts 2-5 mins macule: flat, freckle, papule: wart, plaque: psoriasis, cyst: fluid filled, pustule: acne, impetigo vesicle: blister, bulla: burns, scale: flakes, crust: dried vesicles, lichenfication: rough/thick epidermis, scar: irreg connective tissue, keloid: excess scar tissue, fissure: linear crack
Pancreatitis
d/t alcohol, gall stones, drugs, viral, trauma. Autodigestion from enzymes. s/s: LUQ pain worse w/ food and when flat, n/v, hypovolemia, hemorrhage, ecchymosis around umbilicus, tachypnea, atelectasis, elevated amylase/lipase, hypocalcemia, prepare for ERCP. Rx: Demerol, NPO, NG tube anticholinergics, H2
SARS
d/t coronavirus, infection via direct contact. s/s: fever, aches, dry cough, dyspnea. Rx: droplet precautions, report to CDC, supportive care. Nursing: monitor for pneumonia, frequent hand washing, pt should wear a mask
UTI
d/t e.coli, women more than men. s/s: dysuria, frequency, urgency, nocturia, suprapubic pain, hematuria. Rx: Bactrim (1st line). Nursing: hygiene, contraction, pain, teach prevention: void after sex, cleanse front to back, cotton underwear, increase water intake, avoid carbonated/caffeinated fluids
Pneumonia
d/t infection, inflammation, pseudomonas, aspiration, leading cause of death from infectious causes. s/s: fever, chills, malaise, sob, decreased sat, productive cough, pleurisy chest pain, crackles, egophony/whispered pectoriloquy (indicating consolidation), *older adult=confusion, infants=lethargy*, irritability, poor appetite. Rx: abx, analgesic, expectorants, antitussives, resp support as needed. Nursing: promote hydration to liquefy secretions, teach improvement after 48-72 hrs of abx, get vaccine
Respiratory distress syndrome
d/t lack of surfactant that keeps the lungs inflated, prevents collapse. d/t premature deficiency, prolonged ROM, trauma/drowning (older children washed out) s/s: tachypnea, "seesaw" resp, nasal flaring, restrictions, grunting, cyanosis, hypoxia. Rx: O2, chest physiotherapy, vent, surfactant, abx, diuretics, inotropes. Nursing: monitor F&E, suction
pediatric IICP
d/t: aneurysm, tumor, head injury, infection, hydrocephalus, status epilepticus. s/s: infant: bulging fontanels, widened cranial sutures, high pitched cry, irritable. Child: ha, nausea, projectile vomiting, lethargy, diplopia, seizures. Rx: osmotic diuretics, antihypertensives, anti-seizures, fentanyl, versed, vecuronium, maintain airway, vent. Nursing: minimize external stimuli, neuro checks, pain management, nutrition- may require tube feeing, position HOB 30˚ and midline, cluster care to allow rest periods, may not bathe child if unstable, may need artificial tears
Renal calculi
d/t: hypercalcemia, hypercalciuria, hyperuricemia, dehydration, high purine diet (meats/yeast) cystinuria (genetic) chronic infections/obstruction w/ urinary stasis, environmental (warm/humid climate). More in men. s/s: pain, uti symptoms, n/v/ diarrhea, IVP w/ dye to determine sites. Rx: diuretics, allopurinol to prevent stones, opioids, abx, sx: lithotripsy. Nursing: assess pain, location, UTI, obstruction, pain, infection control, increase fluids, foods high in calcium (not pills)
rheumatic heart disease
damage d/t grp A strept pharyngitis, fever 104, chorea (emotional instability) jerky movements, ring-like rash on trunk/extremities, murmur
mitral stenosis/regurgitation
damage d/t rheumatic fever s/s: L HF, paroxysmal nocturnal dyspnea (sudden waking d/t sob) rx: DO-ABLE nursing: CARDIAc LeVeLS teach: REAL
heart failure
damaged pump fails, poor CO and fluid overload. L HF: lungs R HF: body. d/t: CAD, infections, tumors, arrhythmias, HTN. DO-ABLE, CARDIAc LeVeLS, REAL
MS
demyelination of white matter, unknown cause, improves and worsens unpredictably, more in women. S/s:* blurred vision*, dysphagia, diplopia, weakness, numbness, paralysis, spasticity, gait disturbances, tremor, ataxia, decreased short-term memory, urinary retention/incontinence, loss of bowel control. Rx: Avonex. Nursing: maintain functional abilities, avoid stress/fatigue, take rests, exercise regularly, avoid triggers (stress, pregnancy, temp extremes)
Bipolar disorder
depression/mania, changes Types: I (severe), II, cyclothymic (more depression) Rx: mood stablizers (*Lithium 0.8-1.2*, tox s/s: n/v, diarrhea, drowsy, weakness, tremor, blurred vision, tinnitus), anticonvulsants (Depakote) antidepressants (Prozac), atypical antipsychotics (Abilify), ECT safe and effective for depression, triggers seizure, confusion/temp memory loss expected side effect Nursing: mania: high protein/cal finger food, supplements, set limits, reduce stim.
Parkinsons
diminished substantia nigra, disorder of dopamine depletion, genetic. s/s: unilateral progression to bilateral: resting tremors, pill-rolling, Bradykinesia/akinesia, fatigue, stiffness/rigidity, mask-like facial expressions, slow shuffling gait, difficulty rising from sitting, echolalia (echoing speech). Rx: anticholinergics (Cogentin), carbidopa/levodopa. Nursing: safety, foster independent ADLs, nutrition: small freq meals, soft foods, roughage, fluids, teach: side effects, benefits of exercise, "drug holidays" safety TRAP: tremors-rigidity-akinesia/Bradykinesia-postural instability
Cancer
disease which abnormal cells divide w/o control and are able to invade other tissues d/t: physical (UV) chemical (smoking) biological (virues/bacteria), family history. Leading cause of death: lung cancer Staging: T: tumor size N: spread to nearby lymph M: metastasized to distant areas Grading: the lower the number, the more the cells look like normal tissue Stage 0=carcinoma in situ Stage 1=localized, limited to tissue of origin Stage 2=limited spread Stage 3=extensive local and regional spreading Stage 4=distant metastasis Warning signs- CAUTION: C=change in bowl or bladder habits A=a sore that does not heal U=unusual bleeding or discharge from any body part T=thickening or lump I=indigestion or difficulty swallowing O=obvious change in wart or mole N=nagging cough or hoarseness
Eating disorders
disorders: can affect every body system nursing: develop realistic body image, monitor F&E, anemia, malnutrition, dehydration, bone density *Anorexia*: severe malnutrition, low K, CV issues, , dry skin, fine hair, depression, muscle wasting, hospitalization, refeeding program, Prozac, CBT *Bulimia*: constipation, dehydration, dental, electrolyte imbalances, hemorrhoids, pancreatitis, throat swelling, esophagus tears, eat large amounts of high-cal foods in secret, force vomiting, wasting of tooth enamel, broken blood vessels in eyes, Russell's sign (small cuts/calluses on tops of finger joints from inducing vomiting), Dental exam, support grps, CBT, Prozac
CT
dye assess allergies to iodine, shellfish, contrast dyes, claustrophobia after: replacement fluids to diuresis the dye
cerebral angiography
dye, hydration for 2 days before test, NPO 6 hrs before, bed rest 12 hrs after,
Polyhydramino
excessive amniotic fluid risk for hemorrhage r/t over distention of the uterus
Anxiety disorders
excessive fear may be w/ depression and substance abuse. s/s: worry +6 months, fears stronger than appropriate, prob concentrating, fatigue, irritability, sleep, GI, SOB Rx: talk therapy, Antidepressants: Prozac, Wellbutrin, tricyclic (Tofranil) MAOI: PaNaMa (Parnate-Nardil-Marplan) anti-anxiety: Buspar, Betablockers(propranolol), benzos (-zepam), stress/relaxation techniques nursing: non-demanding environment, do not force, distract, identify triggers, encourage responsabiltiy
Renal colic
excruciating, sharp and often radiates towards the groin from the flank
decerebrate
extension away from body, pronation of arms/legs
Glasgow Coma Scale
eye 0-4 verbal 0-5 motor0-6 14-15: mild 9-13: moderate < 9-8: AIRWAY CONERN
Tracheoesophageal fistula (TEF) and esophageal atresia (EA)
failure of esophagus to develop as a continuous passage and failure of trachea and esophagus to separate into distinct structures, d/t congenital, idiopathic, VATER syndrome (combo: vertebral, anorectal, and renal abnormalities in addition to TEF). s/s: coughing, *cyanosis w/feeds*, increased oral secretions, choking. Nursing: intermittent suction, HOB 30˚, care og g-tube, observe initial oral feeding w/sterile water
Hyperopia
far-sightedness, blurred close
hematocrit
female 35-45% male 40-50%
What are causes of sinus tachycardia?
fever, emotional and physical stress, heart failure, fluid volume loss, hyperthyroidism, hypercalcemia, caffeine, nicotine, exercise, and medications.
Bowel Irrigation for colostomy
fill irrigation container with 500-1000ml of luke warm water, flushing irrigation tubing, and reclamp. hang the container on a hook to IV pole instruct patient to sit on toilet, place the irrigation sleeve over the stoma, extend the sleeve into the toilet and place place irrigation container approximately 18-24 in above the stoma lub the cone tipped irrigator, insert the cone and attach catheter gentle into stoma and hold in place slowly open the roller clamp and allow irrigation solution to flow for 5-10 mins clamp the tube if cramping occurs and until it subsides once the desired amount is instilled, the cone is removed and feces are allowed to drain through the sleeve into the toilet. IRRIGATION allows for regulated bowel regimens
cardiac tamponade
fluid fills pericardial sac s/s: Becks TRIAD: *HYPOTENSION, MUFFLED HEART SOUNDS, JVD*, pulsus paradoxus (SBP drops w/inspiration) narrowed pulse pressure (difference between SBP and DBP). RX: emergency pericardiocentesis! Nursing: HOB 45˚
GERD
gastric contents leak backwards into the esophagus risk factors: hiatal hernia, obesity, pregnancy, smoking, scleroderma. s/s: Pain w/ bending, laying down, relieved w/antacids, infant: voming/spitting up with meals, failure to thrive, irritable, cyanosis. Rx: smaller more frequent meals, no caffeine/acidic foods, do not lie down 2 hrs after eating, sleep with HOB elevated, no smoking, Tagamet, ppi
Montelukast (singulair)
given with beta agonist and steroid (fluticasone or budesonide) to provide long term asthma control
Aphasia
global: most severe (cannot read, write, understand speech), Broca's (broken language/understands) Wernicke's (jargon)
Sarcoidosis
granulomas in lungs, more in AA, s/s: dyspnea, cough, chest pain Rx: steroids. Nursing: prevent infections, take rest periods, O2, small frequent meals, activity w/ tolerance
sprain
greater than strain on ligament. 1st degree: Compress, RICE 2nd degree: ½ torn, splint, immobilize, RICE (alternate ice/heat) analgesics, PT 3rd degree: torn completely, severe edema, pain, loss of function, casting, sx (rest-ice-comression-elevation)
What are early signs of increased intracranial pressure?
headache, nausea, vomiting, decreased LOC, and blurred vision.
cardiogenic shock
heart fails to pump compromising tissue perfusion restless, confusion low: BP, UO, peripheral pulses high:HR, pulm congestion, tachypnea
Cephalohematoma
hemorrhage between skull-periosteum, may develop jaundice, hypotension- takes weeks to resolve
von Willebrand's disease
hereditary increased tendency to bleed from mucous membranes. s/s: epistaxis, gum bleeding, easy bruising, and excessive menstrual bleeding.
pulmonary edema
high fowlers O2 assess lung sounds IV diuretic foley
Hydrocephalus
imbalance of production and absorption of CSF in ventricles, d/t congenital, acquired, or idiopathic. s/s: infant bulging fontanelles, increased head circumference, separated sutures, "setting sun" eyes, pupils slow to react, eats poorly, *high-pitched cry*, variable pulse, changes in respirations. Older child: ha, dizzy, vomiting, diplopia, ataxia, confusion. Rx/nursing: VP shunt in neonates, positioned on un-operated side to prevent pressure on operative site, measure head circumference, no scalp vein IV's , observe for abd distention for possible catheter complications, NPO, feed after bowel sounds return, keep diaper off perineal dressing, teach family s/s of infection: elevated temp, poor feeding, irritability, altered LOC, and no contact sports. Child needs to lay flat for 24hrs after shunt is placed The nurse should observe for abdominal distention or a taunt abdominal wall because cerebrospinal fluid could cause peritonitis or a postoperative ileus as a complication of distal catheter placement.
Neutropenic precautions
immunocompromised, strict hand washing, private room, no raw veggies/fruits, daily baths, visitors are restricted
methotrexate (Rheumatrex)
immunosuppressant tx: RA and psoriasis s/sx: bone marrow suppression, increased risk for infection, education: avoid large groups, people with infections, receive inactivated vaccines (flue and pneumococcal) NO live (herpes voter) NO preggos, and NO ETOH r/t hepatotoxic side effects
Cyclophosphamide
immunosuppressant and chemo agent common SE: hemorrhagic cystitis (bladder inflammation) education: drink fluids, IV hydration, and mesna therapy
Hepatic encephalopathy
impaired ammonia metabolism causes cerebral edema. s/s: change in LOC, memory loss, asterixis (flapping tremor) impaired handwriting, hyperventilation w/ resp alkalosis. Rx: lactulose, low protein, safety, rest
Airborne precautions
in air over long distances, N95 respirator, MTV (measles, tb, varicella)
pediatric heart failure
in infants with severe heart defects s/s: cyanosis, ^RR, increased resp infections, tachycardia, edema, fatigue, feeding difficulties, poor weight gain. Nursing: maintain adequate oxygenation, family understanding, child will attain milestones of normal growth and development, remove accumulated fluid, decrease cardiac demands, monitor height, weight, I&O, RX: digoxin, Lasix, ACEI, conserve energy, MONITOR K, small frequent meals, may need fluid restriction, position: slanting w/ head elevated, infant seat, or knee-chest position. Teach: abx for dental work.
shock
inadequate tissue perfusion. Requirements for homeostatic regulation: CP, uncompromised vascular system, adequate blood volume, ability for tissues to use oxygen. Types: CHOD • Cardiogenic: pump (heart) failure, MI, HF o Rx: positive inotropic agents (dobutamine) vasodilators (nitro) vasopressors (Levophed), diuretics/digoxin, antidysrhythmics, IABP • Hypovolemic (volume loss) bleeding, dehydration o Rx: rapid IVF 3:1 (300ml for every 100ml fluid loss) blood, FFP • Obstructive (mechanical interference w/ ventricular filling/emptying • Distributive (vasogenic) septic (infection), neurogenic (injury to CNS), anaphylactic o Anaphylactic: epinephrine, steroids, aminophylline, albuterol o Neurogenic: depends on the cause, IVF o Septic: IVF, vasopressors, antiinfectives
ADHD
inattentiveness, hyperactivity, impulsivity=drug holidays
Antihypertensives
including, but not limited to, the following ACE inhibitors: treatment of choice for hypertension;memory trick - most end with "PRIL" angiotension receptor blockers:memory trick - most end with "SARTAN", including losartan (Cozaar), valsartan (Diovan) beta blockers calcium channel blockers
Steroids
increase blood sugar (increase insulin dose for Dm) Increase risk of peptic ulcer with NSAIDS start at a high dose and then slowly tapper to reduce the risk of sudden adrenal crisis Can cause fluid retention and worsening HTN
Ginko, ginger, garlic, and ginseng (all start with g)
increase risk of bleeding
Pelvic inflammatory disease
infection of the cervix ascending to the fallopian tubes. d/t: STD, multiple sex partners, IUD, abortion, douching. s/s: pelvic pain, fever, cervical motion tenderness, irregular cervical bleeding, n/v, dysuria, frequency. Rx: anti-infective, analgesics.
Impetigo
infectious bacterial infection d/t staph aureus, grp A strept, MRSA. Starts in area w/ broken skin-HIGHLY CONTAGIOUS for 7-10 days s/s: pustules/vesicles, honey-colored crusts, superficial erosion, bleeds easily, pruritic. Rx: use warm soapy water, abx. *Need good hand washing, no sharing towels or eating utensils
Candidiasis (Thrush)
infectious fungus, d/t birthing process, abx, inhaled steroids s/s: white patches on tongue, gums, cheeks, itching. Rx: oral antifungals, mouth rinsing after steroid-KETOCONAZOLE: MONITOR LIVER FUNCTION, AVOID ALCOHOL, AVOID SUN
Herpes
infectious oral, cold sore, fever blister, d/t HSV, CMV, Epstein Barr (mono) varicella, infects body fluids then enters broken skin or mucous membranes. HSV-1: cold sores HSV-2 genital herpes, virus lay dormant within nerve cells, then is reactivated by fever, stress, trauma, sun exposure, menstruation. s/s: prodromal period, vesicles, pain, pruritus, paresthesia, increased skin sensitivity at site. Rx: acyclovir, abx, analgesics- HIGHLY CONTAGIOUS, HSV can be deadly to fetus if untreated, HSV 2 is sexually transmitted
Tinea
infectious • Tinea "ringworm" superficial fungal infection that lives on-not in-skin, transmitted from person-to-person, animal contact, associated w/ poor hygiene and friction from tight clothing. • Tinea capitis: hair, scaly, alopecia, antifungal shampoo. • Tinea corporis: body erythematous scaling patching, round/oval, antifungal cream • Tinea crurus "jock itch" perineum pink papules, pruritus genital folds, antifungal cream/powder • Tinea pedis "athletes foot" feet/ankles, lesions, pruritus between toes, burning, antifungal spray/lotion o Nursing: meds need to be taken for several weeks/months, good hygiene, do not share clothing, hair brushes, linens, towels, avoid OTC
Appendicitis
inflammation of sac at end of cecum. d/t: viral, fecal material, parasites, foreign body, most common in school aged. s/s: colicky abd pain in RLQ, most intense pain at McBurney's point, n/v, fever, decreased bowel sounds, guarding, stooped posture, rebound tenderness. Rx: sx, IVF, abx. Nursing: position semi-fowlers, advance diet gradually when bowel sounds have returned. No heating pads
Cholecystitis
inflammation of the gallbladder, d/t gallstones, 6 F's: female-fat-fertile-forty-flatulent-fair. s/s: colicky pain in RUQ w. possible radiation to shoulder/back, after eating fatty foods, n/v, jaundice, low fever. Rx low fat diet, rest, removal, lithrotripsy (may have some hematuria after not longer then 24 hrs).
Encephalitis
inflammation of the parenchyma of the brain/spinal cord d/t: viral, bacterial, inflammatory (toxins), deat rate up to 70%. s/s: sudden fever, ha, altered loc progression to coma, seizure, nuchal rigidity, flu-like, infant vomiting stiffness, *constant crying that worsens when picking up child* bulging anterior fontanelle, + Kernigs/Brudzinski signs Nursing: acyclovir, antivirals, anticonvulsants, seizure precautions, reduce stimuli, elevated *HOB 45˚, TCDB*
Ulcerative colitis
inflammatory bowel disease, *begins in rectum*→up through the colon, abscesses. s/s: *bloody diarrhea up to 20 a day*, stools w/ pus and mucus, L sided pain, fever, weight loss, anemia, tachycardia, dehydration. Rx: steroids, anticholinergics, antidiarrheals, high calorie, high protein, LOW roughage, NO milk products. Complications: increased risk of colon cancer, toxic megacolon, and perforation.
Crohn's
inflammatory bowel disease, small intestine. s/s: diarrhea w/ steatorrhea (unprocessed fats), abd pain RLQ, fatigue weight loss, dehydration, fever. Complications: fistula, peritonitis. Rx: NPO, TPN, steroids, colectomy
Cystic fibrosis
inherited disease that causes body to produce abnormally thick and sticky mucus, malabsorption of nutrients by the pancreas, autosomal recessive trait- thick, sticky mucus builds up in lungs/digestive tract (pancreas), male reproductive, sweat glands. s/s/: GI (meconium ileus, steatorrhea, prolapsed rectum, failure to grow), resp (thick mucus causes atelectasis, barrel shaped chest, clubbing fingers and toes) - Labs: sweat test (high levels of Na and Cl in the sweat is a + result), newborn screen IRT, stool analysis. Rx: bronchodilators, abx, chest physiotherapy, high protein, vitamin supplements, yearly flu vaccine, pneumococcal (PPV). Nursing: clearing mucus should be done 1-4 times a day, drink plenty of fluids, avoid smoke, dust, fumes, mold, exercise 2-3 times each week especially swimming, running- avoid contact and endurance sports
NSAID
inhibits prostaglandins, anti-inflammatory. AF: bleeding, HTN, GI bleeding. Contra: HTN, bleeding disorders, recent sx. Nursing: CBC, liver enzymes, avoid OTC, do not crush/chew.
Anti-gout
inhibits reabsorption of uric acid. AE: anemia. Nursing: purine-restricted diet (high carbs, low protein, avoid: sardines, beer, yeast, organ meats, beans, meats, mushrooms, spinach), avoid NSAIDS, drink 3L day, avoid caffeine
neurogenic shock
injury above T6, massive vasodilation causes pooling of blood and low SVR=hypotension s/s: hypotension, bradycardia
Hypoparathyroid
injury s/s: irritability, weakness, numbness, tetany, seizures, hair loss, +Chvostek/Trousseau. Rx: calcium. Nursing: monitor tetany, airway, seizure precautions, keep calcium gluconate at bedside if ^present, teach: consume more calcium and get vit D from sun, reduce phosphorus intake (fish, eggs, cheese)
ET tube
inserted nose/mouth, ends a few cm above the carina, cuff inflates w/air to create a seal in trachea. Check for placement: listen for bilateral breath sounds, bilateral chest movement, cxr, CO2, pulse ox. Nursing: mark tube length with teeth, suction to maintain airway patency, observe secretions, apply warmed humidified air, provide oral hygiene and care for insertion site, observe for skin breakdown around tube site, observe for aspiration, pressure sores, extubation, oral/nasal damage.
myocardial infarction
insufficient oxygen supply kills myocardial tissue, total event can take 3-6 hrs. d/t: CAD/atherosclerosis. Mortality 25% s/s: crushing pain, radiates does not resolve w/ rest, fatigue, n/v, sob. ECG: ST changes, CK-MB rises 3-4 days. Troponin rises 2 weeks. "time is muscle" Nursing: temp, daily weight, I&O, S3, sex after 2 flights of stairs w/o s/s. no Viagra Meds: OH BATMAN: • Oxygen• Heparin• Beta blocker• ASA•Thrombolytics• Morphine• ACEI• Nitro Nursing care: Cardio care 6: ABCEDF: • ADL's• Best rest• Commode• Diversions• Elevate• Feelings
Myocardial infarction
insufficient oxygen supply kills myocardial tissue, total event can take 3-6 hrs. d/t: CAD/atherosclerosis. Mortality 25%/ s/s: crushing pain, radiates does not resolve w/ rest, fatigue, n/v, sob. ECG: ST changes, CK-MB rises 3-4 days. Troponin rises 2 weeks. ONAM: oxygen, nitro, asa, morphine. "time is muscle": Nursing: temp, daily weight, I&O, S3, sex after 2 flights of stairs w/o s/s. no Viagra.
Metabolic syndrome
insulin resistance yndrome high risk for diabetes and coronary artery disease We Better Think High Glucose Waist circumference - >40 inch in men >35 in women BP ->130 SBP >85 DBP Triglycerides ->150 HDL <40 in men <50 in women Glucose >100
Warfarin
interferes w/ vit K in liver, used in: mechanical heart valve sx, a-f-b/a-flutter, HF, DVT, PE. AE: hemorrhage, gangrene, hepatitis. Contra: preg, pre-e, hepatic/renal disease, recent neuro trauma, ocular sx. Nursing: PT, INR, liver enzymes, assess ∆LOC, fall risk, avoid IM injections. Antidote: vit K. Avoid/teach: ETOH, NSAIDS, razors (shaving), wear Id, take at same time, avoid herbal/foods w/ vit K
Pneumothorax chest tube on water seal suction
intermittent bubbling consistent with respirations (due to escaping from the pleural space) is expected until the lung has fully expanded
What is septic arthritis characterized by?
invasion of the joint by microbes, leading to arthritis and destruction of the joint.
Afib
irregularly irregular GOAL of treatment is to lower ventricular rate <100 CCB, BB, and dig
cirrhosis
irreversible, chronic, progressive degeneration of liver w/fibrosis. s/s: fatigue, hepatomegaly, RUQ pain, jaundice, steatorrhea, clay-colored stools, ascities, hepatic encephalopathy. Rx: steroids, vit B. Nursing: increased carbs, restrict protein, monitor for bleeding, rest periods, assess LOC, daily weight, I&O
PVC
irritability of ventricles give O2, check electrolytes (hypokalemia), amiodarone
What is Kussmaul's breathing?
is a compensation to eliminate CO2 in the body due to metabolic acidosis - described as hyperventilation with an increased rate and depth.
What is involved with a BP evaluation?
it is 2cm above the antecubital space, and should cover 75% of the limb circumference.
What is Clopidogrel (Plavix) used for?
it is an antiplatelet medication (anticoagulant) - used to prevent MI, stroke, or peripheral arterial disease during an acute myocardial infarction.
What is, and what are signs and symptoms of systemic scleroderma?
it is an autoimmune disorder that causes inflammation and sclerosis of the skin, muscles, joints, kidneys, and heart - others, weakness, pruritus, Raynaud's phenomenon, difficulty swallowing, edema, tight skin, shortness of breath, fatigue, and hypertension
What is a Myxedema coma?
it occurs from a low thyroid production - occurs after acute illness, rapid discontinuation of thyroid medication, or hypothermia
High bilirubin and jaundice symptom
itching that is intensified by HOT water (use cold water) normal 0.3-1.9
Schizophrenia
lifelong, treata NOT cured, delusions (persistently strange beliefs- unrealistic), hallucinations Rx: antipsychotics (Thorazine/Haldol) atypicals (Abilify/Risperdal), antiparkinsonism to counteract EPS (tardive dyskinesia) Long-acting injectable antipsychotic meds (LAI) "depot formulations" given once q 1-4wks to improve med compliance Nursing: build trust, be honest/dependable, avoid touching w/o warning, orient to reality, encourage ADL's, prevent injury, set realistic goals
Statin medications must haves
liver function tests HEPATOXTIC complications: rhabdomyolysis (severe muscle injury)
Torsemide
loop diuretic
SARTANS
losartan, valsartan and candesartan angiotension II receptor blockers USED with patient who can not take ACE inhibitors or have adverse reactions to ACE inhibitors
Patent ductus arteriosus
loud machine like murmur during systolic and diastolic acyanotic (lef to right)
Oligohydramino
low amniotic fluid volume Two major complications: pulomnary hypoplasia and cord compression
Troponin
lower then 0.1
Pneumothorax
lung collapse, high pressure causes mediastinal/tracheal shift AWAY from affected side compressing the heart and preventing adequate CO, results in cardiac tamponade. Rx: chest tube
respiratory failure
lungs cannot maintain arterial oxygen levels, or eliminate CO2, d/t disease. s/s: PaCO2/PaO2 50/50, hypoxemic, hypercarbic, hypoventilation, EMERGENCY, O2, cpap, intubation, vent
Kawasaki Disease
lymph node syndrome characterized by >5 days of fever, conjunctivitis, splenomegaly and extreme swelling. #1 CONCERN: cornonary artery aneurysms -> MI and death tX: IVIG with aspirin to prevent heart disease education: CPR to parents, REPORT fever!! irritability is common for first 2 month, ROM and warm baths to prevent stiffness
Substance/Addiction
maladaptive pattern of use leading to significant impairment/distress, withdrawal Rx: detox (alcohol: benzo/antipsychotics, Antabuse, Revia, Revek) (opiods: clonidine, buprenorphine), treat malnutrition, seizure precautions, chronic ETOH=malabsorption/Wernicke-Korsakoff syndrome (encephalopathy d/t lack of vit B) Delirium tremens d/t severe ETOH withdrawal, commonly occurs w/in 72 hrs of last drink, s/s seizures and severe mental status changes (agitation, confusion, delirium, hallucinations)
Melanoma
malignant tumors that originate in melanocytes, more in fair skin, blue/green eyes, red/blonde hair, live in sunny areas, have had more than 1 blistering sunburn during childhood, tanning beds, genetics. s/s: ABCDE: asymmetry, border irregularity, colr multiplicity, diameter greater than ¼ inch, evolution and change in size and shape. Rx: usually curable if treated early. Mohs sx is removal of layers, Salatron, Nursing: teach common areas are: back, legs, between toes, face, feet, scalp, fingernails, backs of hand, avoid exposure to sun, wear long sleeves, hat, sun block.
Presbyopia
middle age, lens loses elasticity
Serotonin Syndrome
mild: shivering and diarrhea severe: muscle rigidity, fever, and seizures
Glasgow coma scale
min of 3, max 15, motor: 1-6 verbal 1-5 eye opening 1-4
Esophageal varices
monitor for bleeding, melena stools, hematemesis, tachycardia, rupture is life threatening w/ high mortality
Lithium
mood stabilization to treat bipolar Worry about the D's: Dehydration, Decreased NA diet (increase NA in diet) , Decreased renal fnx (elderly), and Drug interactions (Diuretics (thiazide) and NSAIDs) therapeutic level is NARROW (0.6-1.2) >1.5 is REPORTABLE LOOK OUT FOR : ataxia, confusion,agitation, neuromuscular excitability, and DI (polyuria and polydipsia)
HIV
multi-year chronic illness, depletes *CD4 lymphocytes, when below 200=AIDS* (opportunistic infections pneumonia, toxoplasma, TB) transferred in bodily fluids (blood, semen, vaginal secretions, breast milk) into mucous membrane/injection. s/s: varies, can be w/o for 10 years, fatigue, weight loss, fevers, skin rashes, short-term memory loss, herpes sores, sob, seizures, Kaposi sarcoma (malignant tumor on endothelium of heart, skin), screen with ELISA, PCR. No known cure, antivirals, HAART, HIV is a reportable disease to CDC. Nursing: standard precautions, dies high cal and protein, low residue
Fibromyalgia
musculoskeletal pain, stiffness. s/s: chronic achy muscle pain, fatigue, sleep deprivation, ha, irritable bowel, pain w/ aggravation. Rx: heat, massage, stretching, sleep, reinforce/teach that this disorder is a real disorder and not psychosomatic
Atopic dermatitis (eczema)
noninfectious hypersensitivity reaction, long term inflammation, exacerbated by stress, foods. s/s: dry skin, itching erythema, skin color changes, lichenification (thickened/leather-like areas) macule, papule, acute weeping. Family history, allergies. Rx: goals is to manage itching, moisturize, remove irritants, wet compresses, occlusive dressing, antihistamines, barrier cream, abx.
Seborrheic dermatitis
noninfectious recurrent inflammatory reaction of skin that causes flaky white scales to form on oily areas (scalp) "cradle cap" in infants, dandruff in adults. Rx: massage scalp, use soft brush, daily shampooing, mineral oil
Delegation
not what you can E-A-T (not delegate: evaluate, assess, teach)
osmolality
number of active particles per kg of water=concentration of the solution. Normal plasma osmolality=270-300
Emergency triage
o Emergent-Red-highest: trauma, chest pain, resp distress, cardiac arrest, amputations, acute neuro deficits, chem to eye o Urgent-Yellow-complications that are not life-threatening, treatment w/in 1-2 hrs-fx, fever, abd pain o Nonurgent-Green-can wait several hrs: lacerations, sprains, cold symptoms o Black- dead or soon will be, cannot benefit from care d/t severity of injuries
Emergency preparedness
o Mitigation: actions to prevent the occurrence, awareness o Preparedness: plans for rescue, evacuation, training, gathering resources, inventory of supplies o Response: putting disaster plan services into action, safety, physical/mental health of pts o Recovery: actions taken to return to normal situation • Have: flashlight, supply of batteries, battery operated radio, extra pair of eyeglasses
Findings of pregnancy
o Presumptive/possible: subjective, amenorrhea, n/v o Probable: objective, chadwicks, hegar's, goodell's, ballottement, Braxton hicks o Positive: presence of fetus, heart tones, visualization of fetus, palpating fetal movements
What characterizes biliary pain?
occurs in the right upper quadrant and may radiate to the right shoulder.
Cranial nerve test
one: smell Two: vision three: pupil activity Four: eye movement Five: facial sensation Six: Eye movement Seven: Facial movement Eight: hearing Nine: gag reflex Ten: Say ahh Eleven: shoulder shrug twelve: stick tongue out
Diverticulitis
outpouching of intestinal mucosa, most in sigmoid, stool and bacteria retained, s/s: crampy, lower L abd pain, alternating constipation/diarrhea. Rx: high fiber, high residue, bulk laxatives, stool softners, anticholinergics, NPO rest bowel during acute phase, abx. Complications: abscess, perforation, peritonitis, fistula, obstruction, hemorrhage. Nursing: avoid straining
Capasaicin (Zostrix)
over the counter analgesic used for minor pain. Education: wait at least 30 mins after massaging cream into hands before washing them to ensure adequate absorption, avoid contact with eyes, nose, and mouth (contains pepper contents), wear gloves when applying, avoid HEATING pads (vasodilation increases absorption and can cause a chemical burn), NORMAL to have burning, stinging, or erythema and will subside in a week, and can be used with tylenol or nonsterodial anti-inflammatory drugs to effectively treat osteoarthritis pain. Use regularly (3-4x/day)for week to months.
Cholinergic crisis
overdose of Pyridostigmine *TOO MUCH ACH* (skeletal muscle neurotransmitter) s/s: *hypotension* Cholinergic Toxicity: S-salvation L-lacrimation U-urinary stasis D-dizzy/diaphoresis/defication G-gi upset E-emesis Rx: *atropine* (increases HR) may need vent. Nursing: rest periods, avoid extreme temps, people with resp infections
Scerloderma
overproduction of collagen that causes tightening and hardening of the skin and connective tissue progressive disease without a cure tx: managing s/sx #1 concern is renal crisis that causes malignant HTN due to narrowing of the vessels that provide blood to the kidneys s/sx: Raynauds phenomenon (blue and cold finger tips), pulmonary fibrosis (dry cough and dyspnea), heartburn, and dysphagia.
What is neuropathic pain?
pain caused by damage to a nerve, but is felt in the area that nerve intervates.
Flail chest
pain, dyspnea, CVP^, BP dropping d/t mediastinal flutter, heart "Swinging" and not filling/pumping
Duodenal ulcer
pain, heartburn at night or when stomach is empty, pain relieved w/food, melena (black tarry stool)
Gout
painful inflammation of joints, uric acid in blood, affects men 40-60, family history, abnormal purine metabolism/ excessive purine intake=uric acid crystals in joints. s/s: tight, red skin over inflamed joint, elevated temp, edema, pain, hyperuricemia, acute attacks begin at night and last 3-5 days (following trauma, alcohol, high purine diet, stress), flare-ups. Rx: NSAIDS, colchicine, Lopurin, heat/cold therapy, AVOID purine foods (meats, organs, shellfish, sardines, yeast, legumes), no alcohol, weight control, increase fluids, elevate limb. *lose weight slowly to prevent uric acid kidney stones- these form w/ quick weight loss
bladder cancer
painless hematuria #1 risk: smoking #2 occupational carcinogen exposure
Chest tube
placement in the: • pleural space to remove air (anterior/superior)/fluid(posterior/inferior) • medistinal tube drains fluid from heart-NO TIDALING D/T NOT IN LUNG CAVITY Chest tube device: collection chamber, water seal chamber: provides 1 way valve so that air leaves from lungs but cannot enter, check for bubbling (air leak in the lung), can be a normal finding in initial 48-72 hrs after pneumothorax, if no bubbling, check water level in chamber. Check for tidaling=expected to rise w/inspiration, fall with exhalation Suction control chamber: negative pressure to pleural space, expected finding is continuous bubbling in chamber. Types: wet chamber: suction level determined by water level, dry chamber: suction level determined by mechanical setting Nursing: position tubing on the bed so there is straight gravity drainage to collection device, DO NOT routinely strip or milk the tubing, do not clamp tube (causes: tension pneumothorax, cardiac tamponade). If tube dislodges: apply occlusive dressing (Vaseline gauze covered totally w/ adhesive tape), monitor for distress, and notify HCP. Chest tube dressings are to be occlusive and not changed. Contact HCP: if dressing has drainage, drainage vol is greater than 100ml/hr, sub Q emphysema
What can occur with a tracheoesophageal fistual?
pneumonia can develop from leakage of stomach secretions into the lungs or an electrolyte imbalance from lack of oral intake. - can also lead to aspiration
PACU
postop-postanesthesia care: ranges from a few hours to 23 hrs • Nursing: MMPPSS: o Maintain airway o Montor resp effort, rate, rhythm, depth, stabize vs o Position on side or back with head to side, keep side rails up at all times w/bed in lowest position o Provide for physical/psychological safety, give O2, pain meds o Stimulate pt to take a few deep breaths every 5-10 mins, pt to spit out airway (shows gag reflex) o Stay and check vs every 15 mins until stable, then q30 mins, restless=hypoxia
CVP
pressure in superior vena cava, pressure blood is returning to the R atrium 3-8 mmHg elevated= hypervolema d/t water/Na retention, IVF, kidney failure decreased=hypovolemia, hemorrhage, vasodilation, pooling pt needs to be supine w/ bed at 45˚
amniotic fluids two purpose
prevents cord compression and promotes lung development
Dressings
protect wound from contamination/injury/spread of microorgs, promote healing by absorbing drainage, insulation, control bleeding, comfort. Types: • gauze: most common, oldest, wicks away exudate, disadvantage: must be held in place, fibers fray, used draining wounds, tunnels, sx inscisions, burns, pressure ulcers • non-adherent gauze: Telfa pad, does not stick to wound • Transparent film: lets O2 pass and moister vaper to escape wound, used for small wounds, IV, stage I-II pressure ulcers, may have fluid retention under dressing leading to maceration • Hydrocolloid: swells to accumulate exudate, nonbreathable, used in venous/arterial ulcers, decubitis ulcers, impermeable, may stay safely for days- keeps fluid in • Hydrogel: impregnated w/water or gel, used in burns, deep/necrotic wounds, radiation damage, decreases pain, maintains humidity, does not stick to wound, must be covered with another dressing. • Composites: combinations of 2 or more types (butt pad), may be contra in stage 4 pressure ulcers • Foam: for pressure ulcers, full thickness wounds with drainages, sx, not for non-draining wounds, dry eschar • Alginates: from seaweed, for highly exudative wounds, forms gel on wound • Nursing: document, monitor for infection
What are symptoms of SLE?
proteinuria, butterfly rash, chest pain with inspiration, fatigue, fever, general discomfort, hair loss, mouth sores, photosensitivity and weakness.
Lef to right shunting heart defects (Patent ductus arteriosus, artial septal defect, and ventricular septal defect)
pulmonary congestion increased work to breath and decrease lung compliance increase RR, HR, and metabolic rate (poor wt. gain) diaphoresis during feeding, heart murmur and signs of congestive heart failure
Dumping syndrome
rapid emptying of the stomach. s/s: tachycardia, palpitation,syncope,diaporesis, diarrhea, nausea, abd distention, post-op complication, subsides after a few months, slow eating, low carbs, high protein, avoid liquids w/meals
Acute pharyngitis
rapid strept test. Rx: PCN, antipyretics, analgesics • Bacterial: strept, "sicker" onset sudden, very sore throat, HIGH fever, ha • Viral: w/tonsils, gradual onset, fever, cough, rhinitis • Nursing: monitor for rheumatic fever, acute glomerulonephritis, monitor fluids, cold/warm moist compress to neck, ice chips, cool mist humidifier
Ewing sarcoma
rare malignant bone tumor, s/s: localized pain. Rx: radiation/chemo (cyclophosphamide, doxorubicin, vincristine)
head trauma
s/s: LOC, nasal discharge, stiff neck, restlessness, n/v, posturing (decerebrate/decorticate) CSF leakage, hyperthermia, Cushings triad (hypertension, bradycardia, widening pulse pressure) • Rx: Mannitol to control IICP, steroids (Decadron) IV push, barbiturate coma induced to treat refractory IICP, neuromuscular blocking agent (Norcuron) to decrease agitation, ICP monitor • Nursing: elevate HOB 30˚, midline, avoid flexion/extension of head, O2 as ordered, avoid morphine, vent, maintain body temp to prevent shivering (increases ICP), decrease environmental stimuli, monitor F&E, I&O, limit fluid intake to 1200ml day, avoid straining (coughing, sneezing valsalva, laughing, straining stool, vomiting, anxiety) seizure precautions, monitor for herniation: irreg breathing, irreg pulse, loss of brainstem reflexes (blinking, gagging, pupil reaction) LOC, resp/cardiac arrest • Mild: only momentary loss of consciousness w/o neurological sequelae • Moderate: momentary LOC w/ neuro change after that is not permanent • Severe: decreased LOC w/ serious neuro impairment
myocarditis
s/s: S3 gallop, joint swelling Rx: DO-ABLE, dig at home (tox: anorexia, n/v, blurred vision, arrhythmias)
Hyperthyroid
s/s: fatigue, hyperphagia, weight loss, diarrhea, goiter, exophthalmos, tachycardia, palpitation, thin hair, insomnia, T3/T4 elevated, TSH decreased. Rx: tapazole, BB, radioactive iodine
cerebral aneurysm
s/s: ha, irritability, diplopia, blurred vision, tinnitus, hemiparesis, nuchal rigidity, seizures nursing:semi-fowlers, dark/quiet room, limit visitors, fluid restrictions, no straining, gentle care
Pericarditis
s/s: sharp pain relieved leaning forward, pulses paradoxes Rx: NSAIDS, steroids, abx, NO anticoags (^risk of bleeding)
Caput succedaneum
scalp swelling d/t delivery-no Rx needed, resolves in a few days
Tamoxifen
selective estrogen receptor modulator WARNING: heavy menstrual bleeding indicates ENDOMETRIAL CN and increased risk for venous thrombo. common SE: vag dryness and hot flashes
Suicide
self-harming act intended to produce death. Give liquid meds to avoid hiding/hording meds. Degrees: • completed- life ends, attempted-failed self-destructive act, ideation-thought of ending one's life • women attempt more, men more successful, 2nd leading cause of death adolescence • warning signs: previous attempt, threats, giving away possessions, gathering information, hopelessness, depression, states won't be missed, no hope for future, self-mutilation, recent loss, acute personality changes, physical symptoms, substance use • Rx: antidepressants, antianxiety, antipsychotics. Minimal precautions: visual q15 mins, Strict: 1:1, not more then arm length
S2
semilunar valves close (aortic/pulmonic) loudest at base of heart
pacemaker (ICD)
senses VF VT teach: no sports, report fever, redness, swelling, waiting n/v, weakness, syncope, during shock pt may feel faint or SOB,
Trigeminal neuralgia
sensory disorder s/s: severe sharp recurrent pain on lips, gums, nose, cheeks, triggered: cold, chewing, fluids w/extreme temps
Duloxetine (Cymbalta)
serotonin-noreip reuptake inhibitor Used: antidepressant and pain-relieving effect for fibromyalgia
Abruptio placentae
severe abdominal pain, feels hard/boardlike
fracture complications
shock (femur fx) fat embolism (24hrs after injury, common w/ pelvic and femur fx), compartment syndrome (EMERGENCY- nerves/bv compressed causing damage s/s: decreased sensation, pale, weakness, Rx: open to relieve pressure= fasciotomy), DVT/PE, joint stiffness, arthritis, myositis ossificans (hyperrophic bone/calcification), malunion, Fat embolism: Manifestations of acute confusion, hypoxia, fever and hypotension may indicate fat embolism in a client who has sustained multiple fractures, Nursing: check 6 P's pain-pulse-pallor-paresthia-paralysis-pressure/poikilothermia (temp of limb same as the body) assess Braden scale (highest=23, interventions at 18, moderate risk at 14, high risk 10-12), keep cast dry, blow cool air for itching.
hypercalcemia
short ST, wide T, AV block, tacky/brady, cardiac arrest
inhaler use
short acting beta inhaler: wash and air dry 1-2x/week Corticosteroid inhaler: wash and air dry daily rinse mouth and throat after each use (NO swallowing water) administer medications together with the SABA (short act beta) first to open the airway and the ICS (steroid) last.
traction
skin: 5-7 pounds- to immobilize and alleviate muscle spasms (Bucks/Donlops/Bryants) weights attached w/tape, cuffs skeletal: pins inserted, 25-40 pounds TRACTION: temp ropes hang freely alignment circulation type/location of fx increase fluids overbed trapeze no weights on bed/floor
Hernias
sliding: portion of upper stomach squeezes through hiatal opening in diaphragm Paraesophageal (rolling): MEDICAL EMERGENCY portion of stomach folds up along esophagus and forms a pocket s/sx: similar to GERD, pxn with increased abdominal pressure or supine positioning education: low fat, small, and frequent meals. Decrease fluid intake with meals, avoid tobacco and caffeine, no eat close to bedtime or at night. loss weight, no lifting or straining, elevate the HOB 30 degrees.
Intussusception
slipping intestine into adjacent portion. Common in CF, onset w/obstruction between 3-5yrs old. "telescopes" into itself causing obstruction. Possible mesenteric ischemia, edema, bowel necrosis, perforation, peritonitis, shock- common site ileocecal valve. s/s: sudden acute abd pain, *bilious vomiting, currant jelly stools*, sausage shaped abdominal mass, lethargy, screaming. Rx: restore bowel, non-sx: hydrostatic reduction (barium, water soluble contrast, air pressure). Nursing: monitor fluids, assess pain, brown stool means intussusception has resolved after barium- everything moves fast!
Paget's
slow progressing resorption and irregular remodeling of bone, brittle unknown cause. s/s: deformity, pain, pathological fx, fatigue. Rx: NSAIDS, bisphosphonates, calcitonin, plicamycin, increase mobility, pain management, heat. The overactive osteoclasts rapidly restore bone cells and, as a result, the bone that is formed is abnormal, i.e., enlarged, not as dense, brittle, and prone to fractures.
Osteomalacia
soft/weak bones, similar to rickets, bones have too little calcium and phosphorus, vit D deficiency, inadequate sun exposure. s/s: pain, waddling gait, deformities, curvature of the spine (kyphosis), bones break easily. Rx: calcium gluconate, vit D, diet high in protein, UV therapy
Pyloric stenosis
sphincter becomes thickened resulting in a narrowing. s/s: begins at 2-5 weeks of age, progressive *projectile non bilious vomiting* after eating, metabolic alkalosis, moveable palpable firm olive shaped mass in RUQ, irritably, crying, hunger. Rx: IVF, pre-op, NPO, sx=Fredet-Ramstedt, post-op: small frequent feedings, gradually increasing. Nursing: pre-op monitor IVF, document vomiting episodes/stools, assess patency of NG tube, position child flat. Post-op: monitor for vomiting, assess IV sites, begin feedings on clear liquids w/ glucose and electrolytes. Teach: child may vomit after sx, disorder runs in families, child discharged when able to tolerate feedings.
strain
stretched muscle 1st degree: tenderness, RICE, NSAID 2nd degree: muscle spasm, ROM causes pain, edema. RICE, NSAID, PT 3rd degree: snapping/burning, edema, cannot move. RICE, NSAID, muscle relaxant, PT (rest-ice-comression-elevation)
Neuromuscular blocking agents
succinylcholine-rapid intubation, resp depression, malignancy hyperthermia. Nursing: remain at bedside, keep emergency equip near, teaching about muscle pain, temp paralysis
DKA
sudden onset, type 1 BS >300, pH<7.35, elevated ketones causing sweet breath, metabolic acidosis (Kussmauls respirations) thirst, polyuria, drowsiness, anorexia, lead to coma. Rx: IVF, IV regular insulin
Increased ICP in infant
sunset eyes (sclera visible above the iris) wide bulging fontanelle, prominent scalp veins, increased head circumference
Oxygen
supplemental to prevent/correct hypoxia, hyperbaric for extracorporeal circulation, vent for resp failure/sx, reduce partial pressure for air embolism/decompression sickness. AE: hypoxic drive in neonates, atelectasis. Nursing: avoid 100% formore than 8-12 hrs, FiO2: low control room air, NC, SFM, medium control: venturi, NRB, high control: ET/trach/vent, precise control only with: airtight closed delivery system.
angina
supply/demand issues of O2 stable, unstable, variant (Prinzmetal's) s/s: pain mild-crushing, last less than 5 mins, relieved w/ nitro, dyspnea, sweating, syncope rx: O2, semi-fowlers, IV, nitrates decreases preload and after load (3 does in 15mins)
Antiarrhythmics
suppression of cardiac arrhythmias generally classified by their effects on cardiac conduction tissue (Class IA, IB, IC, II, III & IV) atropine and digoxin: also used as antiarrhymics
Tracheostomy
sx opening through neck, used for long term access, complications: dislodgement, subQ emphysema, bleeding, infection. Parts: outer cannula, inner cannula, obturator. Nursing: suction, provide hydration, clean inner cannula and stoma site, regular oral hygiene, watch for skin irritation/infection.
Antiemetics
used to manage nausea and vomiting due to many causes, including surgery, anesthesia, and antineoplastic and radiation therapies
Intraoperative
sx takes place. Anesthesia (general)-drug induced analgesia, amnesia, muscle relaxation, unconsciousness, stages: • Induction-start the administration, pt becomes drowsy and losses consciousness • Excitement: muscles become test and spasmodic • Swallowing and vomiting reflexes remain, may breathe irregularly • sx anesthesia: muscle relaxation occurs, breathing becomes regular, vital functions and reflexes are depressed, operation begins- complete respiratory depression • Types: inhalation (nitrous oxide) IV (methohexital) dissociative agents (no LOC- ketamine), neuroleptics (fentanyl citrate) • Regional, spinal, epidural, peripheral nerve blocks, local • Complications: hypermetabolic state, rapid progressive rise in body temp (malignant hyperthermia), fatal if not treated s/s: tachycardia, tachypnea, unstable BP, diaphoresis, muscle rigidity, familial tendency- Rx: dantrolene • Nursing: safety, surgical asepsis, emotional support, monitor for heat loss, after apply warm blankets
Meds you NEED to take a lot of water with
tetracyclines (doxycycline) bisphosphonates ("DRONATES) and PO potassium supplements
Sulfa AntiB
tx: RA and ulcerative Colitis MOA: inhibits production of prostaglandins in body SE: Crystaluria-- kidney injury EDU: drink 8 glasses of water and maintain output 1200-1500ml/day photosensitivity-- sunscreen and avoid sun Folic acid deficiency-- eat folate rich food and take 1mg folic acid sup agranulocytosis (leukopenia)-- monitored for CBC at start of therapy and report fever or sore throat ASAP Steven-johnson-- DC is rash develops EDU: pee with turn orange-yellow this is NORMAL
Black Cohosh
tx: menopausal hot flashes can cause thickening of the uterine lining and potential liver toxicity
Thiazoildinediones (GLITAZONE)
tx: type II DM improves insulin sensitivity but does NOT release excess insulin NO NO for heart failure or volume over load! increase risk for bladder cancer
DM
type 1: genetic, autoimmune. Type 2: obesity. s/s: 3 polys: polydipsia (thirst) polyuria (urine) polyphagia (hunger), weight loss (type 1) blurred vision, vaginal infections, slow wound healing
BNP
under 100 (+100=HF)
Total cholesterol
under 200
Triglycerides
under 200
A1C
under 6%
phenazopyridine hydrochloride (Pyridium)
urinary analgesic for UTi TURNS URINE BRIGHT ORANGE
Suctioning
use bulb syringe for neonates/infants, catheters outer diameter should be no larger than ½ of endotracheal lumen. Measure catheter tip of nose to base of ear to sternal notch. Use sterile procedure, suction when rhonchus is heard, suction control between 80-120mmHg, hyperoxygenate pt, insert suction catheter with suction off until resistance is met, then withdrawal catheter an inch or 2, rotate catheter during withdrawal, from insertion-spend no more than 5-10 seconds, re-establish vent and oxygenation, repeat as indicated. Nursing: explain coughing, sneezing, gagging is normal, place pt in semi-fowlers or higher, standard precautions, do NOT instill saline into airway, if secretions are thick increase humidity of inspired air and fluid intake, provide pt w/extra O2 and extra deep breaths before, during, and after procedure, if pt is on vent-use the vent, if pt is breathing spontaneously use manual resuscitation bad or instruct to deep breathe. Compare resp status before and after, do not force catheter.
Lipid-lowering agents
used as a part of a total plan, including diet and exercise, to reduce blood lipids in an effort to reduce the morbidity and mortality of atherosclerotic cardiovascular disease and its sequelae memory trick - many end with "STATIN", e.g., atorvastatin (Lipitor), simvastatin (Zocor), rosuvastatin (Crestor)
ASA
used for analgesia, inflammation, fever, decrease TIA/MI. AF: tinnitus, GI bleeding, anemia. Contra in bleeding disorders, ETOH use, Reye's syndrome in children w/viral infections. Nursing: increase anticoags.
GI tube
used for dx, decompression, irrigation, feeding. Nursing: check patency, standard precautions, remove dentures, high fowlers, measure length (adults: tip of nose to ear to xiphoid process, infants: tip of nose to earlobe to midway between xiphoid process and umbilicus), have pt bend head forward and swallow, take small sips of cold water from straw, babies can suck on pacifier, lubricate 2-4 inches, do not force, check placement xray, aspiration of stomach contents (pH less than 5), do NOT instill air
Beta blockers
used in the management of hypertension, angina pectoris, tachyarrhythmias, migraine headache (prophylaxis), MI (prevention), glaucoma (opthlalmic use), CHF (carvedilol and sustained-release metoprolol only), hyperthyroidism (management of symptoms only) memory trick - most end with 'OLOL", "ALOL" or "ILOL"
Antiulcer agents
used in the treatment and prophylaxis of peptic ulcer and gastric hypersecretory conditions, e.g., Zollinger-Ellison syndrome memory trick - most end with "PRAZOLE", including omeprazole (Prilosec), pantoprazole (Protonix), esomeprazole (Nexium)
Calcium channel blockers
used in the treatment of hypertension (amlodipine, diltiazem, felodipine, isradipine, nicardipine, nifedipine, nisoldipine, verapamil) also used in the treatment and prophylaxis of angina pectoris or coronary artery spasm (amlodipine, diltiazem, felodipine, nicardipine, verapamil) memory trick - most end with "DIPINE"
Antineoplastics
used in the treatment of various solid tumors, lymphomas, and leukemias
Nonsteroidal anti-inflammatory agents
used to control mild to moderate pain, fever, and various inflammatory conditions, e.g., rheumatoid arthritis and osteoarthritis
Oxygen delivery devices
• NC: 25-40% 1-6 lpm, hypoxemia/hypercapnia need low levels of 1-2 lpm. Nursing: assess skin, pad tubing around ears • Simple face mask: 50-60% 8-12 lpm, allows room air to enter mask, for short term O2 or emergency, poorly tolerated • Venturi mask: 24-50% 3-15 lpm, precise concentrations of O2, for COPD, keep NC on hand for meals, do oral/skin care • NRB: 60-100% 6-15 lpm, w/ reservoir bag, one way valve, highest %, sickest pts, close monitoring, bag should deflate slightly when pt inhales and expand when pt exhales
Nutrition
• Newborns: adequate hydration=6-8 wet diapers per day, protein needs 2.2gm/kg/day, breast milk/formula adequate ~6months, whole milk introduced 1yr • Pre-preg: 400 µ folic acid daily. Pregnancy add 300 cal, 15mg iron, 30g protein, 400g calcium, 400µ folic acid • Lactation add 500 cals, 2 quarts extra fluids • 65+ adequate protein to maintain immune system • Carbs CHO: sugars, starches, fibers, simple sugars easily metabolized, fuel for brain, nerves, WBC/RBC, healing, excessive carbs=stored as fat, recommended 50-60% of total cals • Lipids: essential linoleic, deficiencies lead to issues w/skin, blood, arteries, most concentrated source of energy, insulation, not exceed 30% daily cal, sat fat not more then 10% daily cals • Proteins: amino acids, all but 8 produced by body, (not: meat, fish, poultry, dairy) secondary energy source, essential for growth and wound healing, 0.8 grams per kg per day • Vitamins: body cannot make water soluble: vit C/B, cannot be stored, daily intake required, fat soluble: A,D, E, K, acts as coenzymes for chemical reactions, vision, skin health • Minerals: inorganic substances essential as catalysis, regulates acid-base balance, major (ca, mg, na, k, cl) trace (iron, copper) • Water: 60-70% total body (75% children) functions: temp regulation, transportation O2 and nutrients in blood, chem reactions, elimination of waste, lubrication, body fluids, recommended intake- 2-3 liters per day
nurse-client relationship
• Orientation: establishes trust, rapport, contract, parameters of relationship, goal setting • Working phase: boundaries, therapeutic communication (SOLER: sit square-open posture-lean in-eye contact-relax) • Termination phase: begins w/ 1st session, ends with goals met, pt may feel rejected/depressed/abandoned 5 characteristics of RN-pt relationship: mutual definition, goal direction, boundaries, therapeutic communication, pt goal
Casts
• Plaster of paris: natural materials, used in unstable fx, serial casting (multiple castings) takes 24 hrs to dry, low allergic response, offers rigid protection, gives off heat while drying, plaster casts are heavy, materials my crumble/disintegrate at edges, not waterproof, risk of skin breakdown • Fiberglass: synthetic, long term casting, lightweight, easy to apply, moisture proof, dries in 15mins, cures in 1 hr, colors and patterns, more rigid than plaster, may cause tissue breakdown, more expensive than plaster Spica: arm/hip- support bar between extremities, allow for greater stabilization Cast application: cast must extend to joint above and below the fracture, window is cute to view area (sx incision), but make crack here. Bivalving: for swelling/compartment syndrome/infection- lengthwise splitting of the cast, applied ace wrap or tape to hold together to still immobilize. Petaling: edging the cast with soft padding or moleskin to prevent irritation or skin breakdown, protects perineal area Nursing: handle fresh (first 48hrs) cast with open palms (indentations can happen with tips of fingers), do not apply pressure, do not cover- allow to air dry, do not use heat to dry. Do neuro checks (cap refill, temp, color, motion, sensation) check for drainage, teach: to keep dry and intact, avoid putting any objects, powders, lotions inside cast, -itching use cool blown air Cast removal: tell pt that it is painless, pt will feel heat/vibration, noisy, but will not cut pt, apply lotion to skin that may be scaly and dry
burns continued
• Superficial 1st degree: localized pain, dry surface area, redness • Partial thickness 2nd degree: open wound, painful, blistered, moist • Full thickness 3rd degree: tough leathery, dull, dry, pain, brown/black/red, may be life threatening, Curling's ulcer • Full thickness 4th degree: wound dull and dry, ligaments, tendons, bone exposed, not painful • Rx: superficial: cleanse, debride, antimicrobial ointment, dressing o Full thickness: ABC's weigh pt and provide IVF (Parkland formula), abx, cover to prevent infection, nutrition • (Fluid requirements=TBSA burned % x weight in kg x 4ml/1kg, 50% first 8hr, then 50% over 16 hrs • Nursing: aseptic technique, pre-medicate before dressing changes, debridement (surgial, enzymatic, hydrotherapy), cleanse wounds with mild solutions and then cover w/antimicrobial, skin grafts (donor site nursing does not change), compresson stockings, ROM. Concerns: airway, pain, shock, infection, fluids. Initial 48-72 hrs=fluid loss, after 48-72 hrs=fluid overload, longterm nutrition, pain control, contractures, wound healing, keloid, psychosocial
Wound drains
• closed drain: attached to a collection system, uses vacuum to draw drainage (JP, hemovac) expected drainage: first 24hrs: sanguinous, 24-72: serosanguinous, more than 72: serous • open drain: deposits drainage on skin (Penrose) safety pin used, protect skin, if ordered pull drain outward 1-2 inches • wound vacuum: computer controlled, requires a seal at wound site w/pressure wound packing, pt may be discharged with device
surgical complications
• dehiscence: complete separation of wound edges=cover w/dry sterile gauze and call HCP • evisceration: wound seperates and viscera protrude d/t: poor wound healing, obesity, malnutrition, steroid use, DM=cover with gauze soaked in sterile saline and report to HCP, postion pt to minimize strain on incision- flat in bad • infection • clots • F&E imblances • Urinary retention: d/t trauma on bladder or nerve supply, drugs= determine fullness with bladder scanner, to aid=encourage ambulation, run water, pour warm water over perineum, warm bath, cath if indicated • Paralytic ileus: diminished or absent peristalsis d/t stress response to sx/meds, trauma, or manipulation of abd contents. Gut the last thing to wake up after sx, bowel sounds return gradually over several days s/s: decreased/absent bowel sounds, abd distention, feelings of fullness. Nursing: withhold fluids until presence of bowel sounds, encourage ambulation, NG decompression if ordered. Return of peristalsis: presence of bowel sounds, flatus, BM • N/v: d/t: meds, sx, pain, F&E imbalance. Nursing: limit oral intake, give antiemetics, document emesis, progress food intake as tolerated (clear→regular), recored I&O, n/v increases intraocular, ICP, and cardiac workload
vent settings
• tidal vol: amount of air delivered w/each machine breath • rate: number of breaths delivered by the machine in a minute • FIO2: fraction of inspired O2 (written as 0.6) • %O2 • an FIO2 of 0.6= 60% of oxygen • Sighs: deep breaths (higher vol) delivered periodically by vent • PEEP: normal physiological PEEP is = or less than 5 cm H2O, provides baseline of positive pressure during exhalation, used to reduce airway collapse and intrapulmonary shunting • Nursing: high pressure alarm: check tube for obstruction: biting tube, secretions, tube moved into R main stem bronchus, pneumothorax. Low pressure alarm check for disconnection of tubes. HOLD: Hi pressure alarm= Obstruction Low pressure alarm= Disconnection