hypocalcemia, remember hypocalcemia is opposite of the prefix and anything to BP so tetany, parasthesia
numbness and tingling, first sign of electrolyte imbalance
Subtotal thyroidectomy ... subs get
S/S of thyroid storm
Extremely high vital signs, hyperpyrexia, psychotic delerium
How to treat thyroid storm
give o2, lower temp to spare brain
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
Hypothyroidism is also called
Myxedema or hypometabolism
S/S of mydexema
everything is down, constipation, heat tolerance, cold intolerance
Treatment for mydexema
give thyroid medications
Where to put the 5 ice packs to cool a thyroid storm patient
neck pits groin
If you cool a patient too fast what might happen?
Never hold the hormone for what patient?
patient who is NPO with mydexema
Addison's disease easy way to remember
Add a Sone (sone = steroid)
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.
Addison's disease treatment
give a steroid, chronic steroid therapy
Over secretion of adrenal cortex, too much hormone, too much steroid.
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,
Treatment for Cushing's syndrome
Surgery, bi or uni lateral adrenalectomy (bilateral is worse)
Donning PPE's order
Gown, Mask, Goggles, Gloves
Removing PPE's order
alphabetically inside the room
For airborne precautions the mask is removed where?
outside of the room
Avoid answers with what words for children 9 mths and younger?
build, sort, stack, construct, make
Toddlers (1-3) work on
their gross motor skills (jump, hop, throw), NO fine motor, parallel play
Preschoolers (3-6) work on
fine motor, balance (tumbling, dance, tricycle), cooperative play, pretend
School age (7-11) work on
creative, collect, competitive
Best default order for click and drag order questions?
Hold ..... med Assess ..... what med does Prepare ...... the correction Call ..... or notify
Rarely if ever answer ...
call Doctor, NCLEX wants you to think critically
Creatinine lab values
same as lithium 0.6-1.2 Not a huge worry, not a dangerous lab to worry about
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
BUN lab values
8-30 check for dehydration if elevated not a big deal, just be concerned
If a deadly or dangerous lab value is discovered AND they have symptoms call the
rapid response team!
HgB lab values
12-18 check for bleeding if low or high, if low prepare for tranfussion
HCO3 lab values
22-26 if it is abnormal so what!
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
Hct lab values
36-54 thickness of blood if abnormal not too big of a deal, assess for dehydration
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
O2 sat lab values
93-100 pulse ox, if under 93 assess resp status and give O2
BNP lab value
less than 100 is normal, good indicator of CHF, edema, if elevated assess s/s of CHF
NA lab values
135-145, if a change in LOC then evaluate for fall/safety risk
WBC lab values
5000-11000 if low assess for infection
CD4 count less than 200 equals
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
Diaphram and Arms affected, breathing, respiratory pattern
Abd muscles and gut affected, ability to cough
Bladder and legs affected, when did they last void, are they distended
#1 post op answer for spinal problems is
log roll patient
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 cervical spinal surgery
Post op complications for thoracic spinal surgery
pneumonia (no cough), paralytic illeus (gut shuts down)
Post op complications for lumbar spinal surgery
How long does temporary restrictions usually mean?
6 weeks (driving, lifting, etc.)
1st day of last period + 7 days - 3 months
Weight gain during pregnancy
28 lbs plus or minus 3 lbs
1st trimester weight gain
1 lb/month or 3 lbs for 1st trimester
2nd/3rd trimester weight gain
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
Probable signs of pregnancy
blood and urine tests, Chadwick's sign, Goodell's sign, Hegar's sign
Cervical color changes to Cyanosis See all the CCCCCC's!
All changes in cervix and vagina occur in what order?
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
Presenting part is 99% of the time the
What is bad as far as Lie?
Transverse is bad, vertical is good, parallel is good
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 2 of L&D
Delivery - pushing the baby out
Stage 3 of L&D
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
Active phase CM dilated 5-7 cm CXN Freq 3-5 min Duration 30-60 sec Intensity moderate
Contractions should not be longer than ____ seconds or closer than every _____ minutes.
OB emergency, baby will die if you don't do something
What to do with prolapsed cord
Push then position! Push head off cord then position in knee/chest of trendelenburg (head down)
on back with knees drawn up
Easy to remember interventions for complications of L&D
LIONPit L left side, I increase IV, O oxygenate, N notify Dr, Pitocin
If question says there is pitocin running and there are complications
stop pit first then LIONpit
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
V C E H A O L P
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
If the baby has to leave the delivery area, the priority is
the ID band
Umbilical cord has what in it
AVA 2 arteries and a vein
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)
Excessive Lochia is
a pad saturated in less than or equal to 15 minutes
Postpartum Uterus Tone
Firm NOT boggy
Postpartum Fundal Height
Fundal height should equal day post partum, day 5 = 5 cm below navel
Postpartum Uterus location
midline, if not void/cath
Postpartum Lochia color
Rubra - Red (ruby red) Serosa - Pink (rosa pink) Alba - whitish (albino white)
Postpartum Lochia amount
Moderage 4-6 inches on pad in one hour Excessive pad saturated in 15 min
Best way to measure DVT is
calf circumferences, NOT Homan's sign, but if select all that apply question, include Homan's sign
Postpartum assessment of extremities
Pulses, Edema, S&S of Thrombophlebitis
Postpartum assessment includes assessment of
Uterus, Lochia and Extremities
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.
makes labor more intense, Pitocin, Methergine, Cervidil
contractions longer than 90 seconds or closer than 2 minutes
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
Drawing up Insulin rules
R then N, Draw up R then N, NRRN the whole process
Pressurizing Insulin rule
put air into N then R , NRRN the whole process
If 70/30 insulin it is
70% N and 30% R, may have to make your own on boards, no 70/30 on the floor
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)
If a diuretic ends in the letter X it is a potassium
wasting drug plus Diurel
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
Child has to be at least what age for PRE op teaching?:
When can a child give themselves their own insulin shot?
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
In prioritization questions decide which patient is _________ or ____________
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
ABC's don't count for
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)
Rule #3 for prioritization
Unstable beats stable
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.
Vital organ priority list
brain lung heart liver kidney pancreas
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
AID's can't do
charting (only document what they did), assess, meds, IV, treatments, fleet enemas
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):
Tell supervisor Take over immediately and intervene counsel them later NEVER IGNORE IT
If it's illegal
If pt or staff is in danger
take over and intervene
If it's legal and not hurtful but just inappropriate
counsel them later
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
When does the termination phase of the nurse patient relationship begin?
Gift giving to psych patients
includes hugs, kisses, compliments (oh you are doing really well)
Advice giving to psych patients
DO NOT GIVE ADVICE.
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
Always say to a psych patient
what do you think you should do?
No guarantees in psych, avoid
if you... then ..., you will improve if you ..l., we can...
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 psych drugs cause
low BP and weight change (usually gain)
all end in 'zine Ex: Thorazine, Compazine, they are major tranquilizers so think safety
#1 problem or concern for patient taking Phenothiazines
Deconoate drug is
a long acting IM form given to non compliant patients
Tricyclic Antidepressants are
mood elevators to treat depression
Examples of Tricyclic anti depressants
Elavil, tofranil, aventyl desyrel
Side effects of Tricyclic medications
Anticholinergic(dry mouth), Blurred Vision, Constipation, Drowsiness, Euphoria HInt: Elavil starts with E so this group goes through E
How long does a tricyclic need to be taken before results are seen?
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
quickly, must not take for 6 weeks, keep on Valium until Elavil kicks in
How long can a person be on MAOI's and how long before they work?
rest of life, 2-4 weeks
MAOI's interact with LOTS
Avoid all foods containing Tyramine, causes fatal hypertension
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
for bipolar disorder (manic depression) it decreases mania
Side effects of Lithium
peeing, pooping, parasthesia
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
it an SSRI, similar to Elavil so same info as Tricyclic's
insomnia, so give before noon, so if BID, give at 6A and 12N NOT at bedtime
When changing the dose of Prozac for an adolescent or young adult, watch for
'zine, 'zep, 'zap
a good guess about psych med weening
decrease the dose of the old drug
just like the Thorazine's, also has a deconoate form
Dose of Haldol for elderly patient should be
half of usual adult dose
Neuroleptic Malignant Syndrome
a potentially fatal hyperpyrexia with temp of over 104, looks like EPS except for temp
'zap's, for schizophrenia
Biggest and only side effect of Clozaril
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
Zoloft with Coumadin?
Question the order if the coumadin dose wasn't lowered
pick chicken or fish
Never pick _________ for children in nutrition questions.
Never mix ___________ in children's food
Toddlers favorite food?
Preschoolers and nutrition
leave them alone, one meal a day is okay
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
If a medication is taken PO and you dont know what the drug does pick a ______ side effect
What is the first thing you assess in a med surg situation?
Level of Consciousness
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 #1 for pediatric growth and development
when in doubt call it normal
Rule #2 for pediatric growth and development
when in doubt, pick the older (not oldest) age, giving them more time
Rule #3 for pediatric growth and development
when in doubt, pick the easier (not the easiest) task
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
Rule out absolutes
always, never are bad
If two answers say the same thing ...
neither one is right EX: tachycardia and racing heart