Tip to remember Grave's disease s/s's
"Run yourself into the Grave" - everything is up ... diarrhea, thin, hot, high BP, high HR, cold tolerance, hot intolerance
After thyroidectomy patients are at risk for
hypocalcemia, remember hypocalcemia is opposite of the prefix and anything to BP so tetany, parasthesia
Risks post op for total thyroidectomy
airway, hemorrhage for 1st 12 hours then for 12-48 hours hypocalcemia leading to tetany
Risks post op for sub total thyroidectomy
airway, hemorrage for 1st 12 hours then for 12-48 hours thyroid storm
Adrenal Cortex diseases easy way to remember
A in Adrenal stands for Addison's
C in Cortex stands for Cushing's
Addison's disease is
undersecretion of adrenal cortex, not enough hormone, BRONZE/tan, go into shock very easily. STRESS can trigger.
S/S of Cushing's syndrome
same as steroid use ... moon face, think cushman "I'm mad I have an infection", high blood sugar, losing Potassium,
Preschoolers (3-6) work on
fine motor, balance (tumbling, dance, tricycle), cooperative play, pretend
Best default order for click and drag order questions?
Hold ..... med
Assess ..... what med does
Prepare ...... the correction
Call ..... or notify
INR lab values
2-3, critical value if off, potential for patient to bleed. Use default order for order ?'s (hold all coumadin, assess for bleeding, prepare Vit K (antidote for Coumadin), Call or notify
Potassium lab values
3.5-5.3 If low it is a critical lab to worry about assess the heart and then prepare to give K
if high, hold all K, assess heart (EKG), give D5W and reg insulin, call
if really high, hold, assess, prepare, call STAT Get someone else involved! Dangerous!!
pH lab values
7.35-7.45 if pH is in the 6;s VERY dangerous remember as the patient's pH goes so goes the patient
If bad vitals, call rapid response team
If a deadly or dangerous lab value is discovered AND they have symptoms call the
rapid response team!
CO2 lab values
35-45 if in the 50's assess respiratory status and have patient do pursed lip breathing, if in 60's considered deadly and respiratory failure, need intubated
PO2 lab values
78-100 this is only obtained from an ABG if low give O2 but if really low it is respiratory failure give O2, prepare for intubation, call resp therapy and call Dr
Neutropenic precautions (low WBC)
strict handwashing, avoid crowds, private room, low bacteria diet (no raw or undercooked), no water that has been standing longer than 15 min, vital signs Q4H
Platelets lab value
150000-400000 if lower than 90000 bad if lower than 40000 REALLY bad, if they sneeze they could die. Called thrombocytopenia
no venipuncture, injection or IV, if necessary use small guage, handle patient gently, use drawsheet, no razor, no toothbrush, blow nose gently, no aspriin, no rectal temp, no hard foods
Activity post op spinal issue
do not dangle
stand, walk, lie down w/o restricitons
limit sitting to 30 min at a time
Post op complications for thoracic spinal surgery
pneumonia (no cough), paralytic illeus (gut shuts down)
Easy way to calculate appropriate weight gain during pregnancy
The week number minus 9 so if 12 weeks pregnant 12-9=3 lbs. not allowed to be off by more than 2 lbs.
not palpable until 12 weeks, 2nd and 3rd trimesters week gestation 20-22 in cm so at the navel is 20 weeks
Positive signs of pregnancy
xray, ultrasound, auscultation of fetal HR on doppler 10 weeks, examiner (not the mother) palpates fetal movement
Pattern of Office Visits for prenatal care
once a month until 28 weeks, once every 2 weeks until week 36, once a week until delivery or week 42 when induction is scheduled
normal is 12-18, first trimester falls to 11 which is okay, second trimester falls to 10.5 which is okay and then third trimester falls to 10 also okay
Easy way to remember station
has it made it through the "tight squeeze" (ischial spine) no then its a negative, yes then its a positive, 0 station is when it's at the ischial spine
Stage 1 of L&D
Labor - thinning and opening, has 3 phases, Latent, Active, Transitional, nothing to do with the baby just the cervix, no baby at the end of labor
Stage 4 of L&D
Recovery (1st 2 hrs after delivery of placenta), considered unstable patient, stop the bleeding in stage 4
Memorize 1st stage 2nd phase of L&D then you know the rest
CM dilated 5-7 cm
CXN Freq 3-5 min
Duration 30-60 sec
What to do with prolapsed cord
Push then position! Push head off cord then position in knee/chest of trendelenburg (head down)
Easy to remember interventions for complications of L&D
L left side, I increase IV, O oxygenate, N notify Dr, Pitocin
Pain meds in labor
know your peaks for IV, IM, PO, Subling. If baby is likely to be born when the pain med is peaking don't give! Why? Respiratory depression in baby
Fetal monitor patterns
if it starts with L it's bad so do LIONPit, ex; low fetal heart rate, low baseline variability, late decels
Variable Decels Cord Compression (bad)
Early Decels Head (bad)
Acels Okay (good)
Late Decels Placenta (bad)
Best answer for what to check first in fetal monitoring is
fetal heart rate, it's the ace of spades!
During the 2nd stage (delivery of baby), order of actions.
Deliver the head then stop pushing, suction the mouth first then the nose, check for nuchal cord, deliver shoulders and body, ID band
4th stage of L&D recovery stage, what do do?
4 things you do 4 times an hour in 4th stage
Vitals (assess for s/s of shock)
Fundus (want midline and firm, if boggy, massage, if displaced void/cath)
Pads (check and replace)
Roll on side (check for bleeding under patient)
Postpartum Lochia color
Rubra - Red (ruby red)
Serosa - Pink (rosa pink)
Alba - whitish (albino white)
Best way to measure DVT is
calf circumferences, NOT Homan's sign, but if select all that apply question, include Homan's sign
Way to remember difference between Cephalohematoma and Caput Succedaneum
C S in Caput Succedaneum = Crosses suture lines, both are swelling on scalp caused by bleeding and both are normal or okay.
OB medications tocolytics
stop contractions, Brethine causes maternal tachycardia, Nifedipine (dipine - CCB) causes Hypotension and headache
OB medications Fetal/Neonatal Lung meds
Betamethasone, speeds the development of the baby's lungs, given to Mom before baby is born, given IM, will increase the blood sugar of Mom
given to baby after baby is born given trastracheal through the airway develops lungs
Med hints for IM injections
Look for 1's in both parts (the 1 looks like an I), guage and length, 21 g, 1 inch means IM
Med hints for SQ injections
look for 5's in both parts (the 5 looks like an S), guage and length, 25 g, 5/8 inch means SQ
Heparin is given IV or SQ NOT PO, info re: Heparin
works immediately, labs Ptt or any clotting or bleeding time, antidote: protamine sulfate, course: 21 days, pregnancy: YES (Class C pregnancy drug, use caution)
Coumadin is given PO, info re: Coumadin
takes days to work, labs ONLY PT-INR, antidote: Vit K (think Koumadin), course: forever, prengancy: NO (never use)
muscle relaxant, think on your back loafin'! makes a patient drowsy, weak muscles, don't drink, don't drive, don't care of kids under 12
Piaget's stage Sensorimotor
age 0-2, totally present oriented, only think about what they sense or what they are doing NOW. tell them what you are doing as you are doing it
Piaget's stage Pre-Poperational
age 3-6, fantasy oriented, illogical, no rules, if they can think it it can happen, play with them, tell them what you are going to do the day of the event.
Piaget's stage Concrete Operations
age 7-11, rule oriented, live and die by the rules,only 1 way to do things, everything different is wrong, tell them days ahead what you are going to do plus skills, reading and visual tools
Piaget's stage Formal Operations
age 12-15, able to think abstractly, understand cause and effect, tell them like an adult
What 2 parts are always irrelevant in a prioritization question?
age and gender (NCLEX is testing discrimination against agism)
If it is a pediatric question the age is critical but if it is a prioritization question ...
age is not critical
Rule #1 for prioritization
Acute beats Chronic, unstable beats stable. Ex: COPD, CHF, CRF and acute appendicitis, who wins? Acute appendicitis. No ABC's, an acute gut beats a chronic COPD all day long
Prioritize patients at this very moment, not
3 seconds later or 10 minutes ago, Right NOW, right HERE, as they say it!
Rule #2 for prioritization
Fresh post op (12 hours out) beats medical or other surgical, Ex: 2 hr post op cholesysectomy beats acute appendicitis and post op one day CABG and COPD, CHF, CRF (then do ABC's)
Things that make a patient stable
the word stable, chronic, post op greater than 12 hours, local or regional anesthesia, unchanged assessment, to be discharged, lab values that aren't urgent
Stable patients are experiencing the ___________ or __________ s/s's of the disease with which they have been diagnosed and for which they are receiving treatment
Things that make a patient unstable
the word unstable, acute, post op less than 12 hours, general anesthesia, changing assessment, newly, recently admitted or diagnosed, lab values that are critical or deadly
Unstable patients are experiencing _________ or ____________ s/s's, complications
Patients who are always unstable
hypoglycemia, hemorrhaging clients, fevers over 104, pulselessness, breathlessness
Faulty reasoning, prioritizing by symptom severity
It is not how severe the symptom is, its if the symptom has changed or if its typical or expected.
Rule #4 for prioritization
Tie-breaker, ONLY use for a tie breaker, the more Vital the organ the higher the priority.
LPN's can't do
IV anything (don't assume they have IV cert unless it says so), assessments, planning, admission, discharge, transfer, teaching, taking verbal orders or 1st of anything
AIDS can do
Soap suds enema, beds, bath, ADL's VS (not the first set), Accu check (not the first one)
Options to intervene when inappropriate behavior of staff is discovered (not in order of what to do first):
Take over immediately and intervene
counsel them later
NEVER IGNORE IT
Phases of nurse patient relationship Pre-Interaction phase
How does the RN feel, own feelings about ...
Phases of nurse patient relationship Introductory (Orientation) phase
During the initial interview ...
Upon admitting the patient ...
On admission ...
At your first few meetings with ...
While assessing ...
On the day of admission ...
While formulating nursing diagnoses ...
Correct answers should be warm and fuzzy and nosey
Phases of nurse patient relationship Working Phase (Therapeutic phase)
Implementing the plan of care, these answers will seem very focused, directive, "tough", stern and slightly unfriendly
Advice words to avoid
Suggest, advise, tell the patient, if I were you, You should do, you ought to, you should not do, don't do, recommend that
Good strategy for psych if narrowed to 2 answers
ask yourself which answer will require the patient to keep on talking, it is never wrong to get your patient to keep talking
Tie Breakers in Psych
Why questions are not as good, reflection is good, open ended is good, I, me, we, us are not good, shortest answers are better, concise don't confuse the clientq
all end in 'zine Ex: Thorazine, Compazine, they are major tranquilizers so think safety
Side effects of Phenothiazines
Anticholinergic (dry mouth), Blurred vision, Constipation, Drowsiness, Extrapyramidal syndrome (parkinsons), Fotosensitivity, aGranulocytosis (low WBC's)
Side effects of Tricyclic medications
Anticholinergic(dry mouth), Blurred Vision, Constipation, Drowsiness, Euphoria HInt: Elavil starts with E so this group goes through E
Benzodiazepines are for
anti anxiety, they are minor tranquilizers, have 'zep in the name, EX: Diazepam (Valium), plus Xanax, Often given pre op, muscle relaxant, alcohol withdrawal, seizures, facilitates mechanical ventilation
Side effects for Benzodiazepines
Anticholinergic (dry mouth), Blurred Vision, Constipation, Drowsiness
Fruits and Veggies are okay except remember salad BAR, avoid Banannas, Avacados, Raisins, Grains are okay except for active yeast, no organ meats, no preserved meats, no dairy, no alcohol, tinctures, caffiene, chocolate, licorice, soy sauce
2 or greater, tremors, metallic taste, severe diarrhea, number one intervention, give fluids, if sweating give electrolytes too
Lithium monitor what levels
sodium, low sodium levels prolong lithium's half-life, causing lithium toxicity, high sodium levels decrease the effectiveness of lithium
Neuroleptic Malignant Syndrome
a potentially fatal hyperpyrexia with temp of over 104, looks like EPS except for temp
How often should WBC be drawn when pt is taking 'zap's for schizo?
1 time per week for 1 month, 1 month every month for 6 months then every 6 months
also a SSRI like prozac, antidepressant, doesn't cause insomnia so it can be taken at bedtime.
Zoloft interacts with other medications like
St John's wart (causes serotonin syndrome) - sweating, apprehension (impending sense of doom), dizziness (vertigo), headache, also with Coumadin so watch for bleeding
If you know what a particular drug does, choose a side effect in the same ______ ___________ where the drug is working.
body system Ex: heart drug - tachycardia
What is the first thing you DO in a med surg situation?
A, B, C's ok for prioritizing actions just not for prioritizing patients
Pediatrics rule of thumb for growth and development questions
always give the child more time, "don't rush growth and development", tell the family to wait a little while
Rule #2 for pediatric growth and development
when in doubt, pick the older (not oldest) age, giving them more time
Chant the following chant for pediatric growth and development when you don't know the answer
normal, older, easier
A low empathy answer is ALWAYS wrong avoid saying
don't worry, don't feel, you shouldn't feel, I would feel, Anybody would feel, nobody would feel, most people would feel
How to recognize an empathy question
They have a quote in the question and the answers contain a quote
How to answer an empathy question
be an actor, put yourself in the client's shoes, say their words as if you really meant them, ask yourself if I said those works and really meant them, how would I be feeling, choose the answer that reflects that reflects their feelings not the answer that reflects their words
Atrial Arrhythmias (same as supraventricular) medications
Adenocard (push fast)
Beta Blockers ('lol)
TRouBLe for heart defects
RL shunting is bad
Blue is bad
T starts with a T so it's bad (also Hypoplastic is bad, it's just TET)
Easy way to remember 4 defects in Tet of Fallot
VarieD Ventricular Defect
PictureS Pulmonary Stenosis
Of A Overriding Aorta
RancH Right Hypertrophy
Hallucinations have a _________ component, delusions do not.
sensory, EX: voices, tactile, visual, gustatory, olfactory
Reassure a patient with delirium that the symptoms
will go away and that they are temporary and reassure their safety
Therapeutic level for Aminophyline (airway spasms), Dilantin (anticonvulsant), Bilirubin
10-20, 20 or more is toxic