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Mark Klimek Yellow Book
Terms in this set (896)
If the pH and the BiCarb are both in the same direction then it is?
If the pH is up it is?
As the pH goes so goes my patient except for?
If the pH is down it is?
If the pH is up my patient with show signs and symptoms of?
Increase... like tachycardia,diarrhea and borborygmi
If the pH is down my patient will show signs and symtoms of?
Decrease... like decreased output, bradycardia and constipation
If my pH is up my potassium (K+) is ?
If my pH is down my potassium (K+) is?
If my patient is overventilating I should choose?
If my patient is underventilating I should choose?
If my patient has prolonged gastric vomiting or suction I choose?
If it is not lung or prolonged vomiting or suctioning I choose?
Metabolic Acidosis ( Remember MacKussmal
Before measuing ABGs you should check what?
Allen's test. Should be positive. Pt makes a fist and pressure is applied to the ulnar and the radial arteries Ulnar pressure is released and color should return in 7 seconds (means it's positive and OK to take ABG's).
Definition of Compensation
PH is normal! It is never compensated if it is abnormal.
If PH normal
look in the direction it is going. Closer to Acidic? (7.35) acidosis.
Then look at Bicarb & figure out which is abnormal. If Bicarb is out of range, it's metabolic acidosis.
If C02 is abnormal, it's Respiratory Acidosis :)
If your pt is acidotic and you need to pick a symptom
Pick the symptom where everything is DOWN. ( And vice Versa)
Ex: 2 degree Morbitz Type 2 BLOCK. <---- Down direction
If you don't know what causes an acid base balance, pick
If in doubt in ABGs, always pick
Headache, nausea, weakness & numbness+ tingling. It can be either up or down.
High pressure alarms are triggered when?
They cannot push air in
High pressure alarms are caused by what three types of obstructions?
Kinking, Water in dependant loops and mucus in the airway.
If kinking in the tube is present you?
If water is present in the dependant loops you?
Open system and empty water.
If mucus is present you?
Turn them, cough and have them deeo breath first. If ineffective you then suction.
Don't suction unless
Coughing & deep breathing is deemed inappropriate.
In order to suction, you must be able to hear
Mucus in the lung
Low pressure alarms are triggered when?
It is to easy to push air in.
Low pressure alarms are normally caused by?
If the tubing is disconnected you?
If O2 sensor line is disconnected you?
In a vented client respiratory alkalosis means the vent setting may be too?
In a vented client respiratory acidosis means the vent may be too?
What do you do if the patients disconnected tube is on the floor?
Bag them, (call for help) get new tube and then reconnect.
First question to ask if the low pressure alarm sounds
Where is the tubing?!
H- High Pressure
Never put anything in YOUR scope of practice
On anyone else
Make sure your answer is
TAKE CARE OF YOUR PATIENT!
Don't answer based on staff, building, machine, etc.
What does wean mean?
What do you do if the patients disconnected tube is on the chest?
Reconnect ... if its above the waist its ok.
Remember is PSYCH if you are asked to Prioritize, Don't forget
3. Comfort - Includes pain
When prioritizing, always use Maslow + ABCs
For one patient. Don't if you have more than one patient.
What is the biggest problem in abuse?
To treat denial you need to?
Definition of Denial
Refusal to accept reality of their problem
How do you confront?
Point out the difference between what they say and what they do.
What is the one circumstance that you as a nurse would support denial?
Loss and Grief
Med surg first. Then Psych
What is dependency?
When the abuser gets a significant other so make decisions for them or do thing for them.
What is codependency?
When the significant other gets positive self esteem from doing things or making decisions for an abuser.
To treat dependency/codependency you ?
Set limits and enforce them.
Say NO and follow through.
Agree in advance on what requests are allowed, then enforce the agreement.
You also need to work or the self esteem of the codependent.
What is manipulation?
When the abuser gets the significant other fo do things for them that is not in the best interest of the significant other. This can be dangerous and harmful to the significant other.
How do you treat manipulation?
Set limits and enforce.
Why is manipulation easier to treat then dependency/codependency?
Because no one likes being manipulated.
Psych Needs, In order
To address a patient's psychological needs, they must be:
STABLE, safe, comfortable.
Never killed anyone. Definitely NOT the top priority, especially if there are physiological needs in the question that make the patient unstable.
What is Wernickes (Korsakoffs) Syndrome?
Psychosis induced by vitamin B1 (Thiamine) deficiency.
Symptom of Wernickes Korsakoffs syndrome?
Amnesia with confabulation.
= Loss of memory with making up stories to fill in the gaps.
Vitamin B1 helps breakdown?
So without B1 what happens?
Alcohol isn't metabolized correctly goes to the brain and causes Wernickes
Primary symptom of Wernickes?
Amnesia with confabulation (making up stories).
Is Wernickes preventable?
Yes- Take Vitamin B1
Is Wernickes arrestable?
Yes- Take Vitamin B1
Is Wernickes reversible?
What is the goal of patients dementia/organic brain syndrome?
Maintain function, Never Improve.
What is aversion therapy?
When you try and make the patient hate something.
Antabuse onset and duration is?
Teach a patient taking Antabuse to avoid what?
On top of alcohol a patient taking Antabuse should also avoid what other 7 things?
Aftershave, Cologne, Perfumes
Alcohol Prep Pads
How long does it take for Antabuse to get out of the system so they can drink Alcohol yet?
What are Elixirs?
95% of liquids. If it is not an antibiotic, assume it is an elixir, so the patient can't have it if on antabuse.
This rule applies for diabetics too (elixers also have sugar).
What happens if a person on Antabuse ingests alcohol?
Nausea, Vomiting, & Possibly Death
In Overdose VS Withdrawal, Ask yourself?
Is this drug an upper or a downer?
What are the five uppers?
Caffeine, Cocaine, Methamphetamines, PCP/LSD and ADHD Meds, Bath Salts
Everything other then the five uppers.
S/S of upper use?
Everything goes up
S/S of downer use?
Everything goes down
Then ask yourself:
Are they talking about Overdose or Withdrawal?
I have too much....
I don't have enough...
Overdose of a downer causes everything to go?
Overdose of an upper causes everything to go?
Withdrawal of an upper causes everything to go?
Withdrawal of a downer causes everything to go?
Upper withdrawal looks like
Downer Withdrawal looks like
At birth if the mother was addicted to a substance always assume the newborn is in?
Intoxication (Not Withdrawal)
If 24 hours after birth assume the baby is in?
Every alcoholic goes through what withing 24 hours after cessation?
Alcohol Withdrawal syndrome
What is Alcohol Withdrawal Syndrome?
Hyper irritability state less than 24 hours after the first drink
After 72 hours of alochol withdrawal a small minority may get?
Can Delirium Tremens kill you?
Can Alcohol Withdrawal Syndrome kill you?
Are patients with Alcohol Withdrawal Syndrome a danger to themselves or others?
Are patients with Delirium Tremens a danger to themselves or others?
N/I for Delirium Tremens?
Private room near nurses station
Restricted bed rest
Restraints, tranquilizer, multivitamin (B1 Vitamin/Thiamine)
N/I for Alcohol Withdrawal Syndrome?
Semi-private room anywhere
Up and ad-lib, no restraint
A two point restraint is?
One arm and the opposite leg.
N/I for restraints?
Rotate sites Q2H
All aminoglycosides end in?
For Aminoglycosides, think:
A Mean Old Mycin
Big gun antibiotics.
Treat serious, life threatening, resistant infections
If it has "thro" in it you?
Throw it out...Zithromycin.
It treats a minor infection
Toxic effects of aminoglycosides?
Cranial nerve 8 (vestibulocochlear nerve) which senses sound.
The one Aminoglycoside that doesn't end in Mycin?
What is another word for aminoglycoside?
In aminoglycoside use monitor?
Hearing, balance, tinnitus & creatinine (best indicator of renal function)
If you have to pick which side effect/assessment you do first, pick
Frequency of administration for aminoglycosides?
Aminoglycoside route of administration?
Im or IV
Aminoglycosides are given PO for what two reasons?
Hepatic Encephalopathy and Pre-op bowel surgery.
What is Hepatic Encephalopathy also called?
Liver Coma, Ammonia-Induced Encephalopathy
If fluid resuscitation is used in shock, there will be
Increased Urine Output
Neomycin and Kanmycin are used for what?
Can also be given for C.Diff
Who can sterilize my bowel?
If you give aminoglycosides PO, do you have to worry about side effects?
Hepatic Encephalopathy is caused by?
High ammonia levels
What raises ammonia levels the most?
Ecoli in the gut
Why do you draw TAP levels?
Narrow therapeutic Window
When do you draw a trough level?
30 minutes before the next scheduled dose.
When do you draw a sublingual peak level?
5-10 minutes after it is dissolved.
When do you draw a IV peak level?
15-30 minutes after dose is finished.
When do you draw a IM peak level?
30-60 minutes after given
If you must pick a time to draw the peak, pick the highest amount of time without going over the limits
So for IV, Pick 30 Minutes, not 15.
Category A Bio terrorism Agents
What are the Category A Bio terrorism Agents?
Hemorrhagic Fever, Such as Ebola
A big, long list.
Category C. Not very Lethal
Small Pox Early Detection Symptom
Rash that starts around the mouth
Inhalation. Pt on AIRBORNE Precautions
Dies from Septicemia. No treatment
Dies from RESPIRATORY FAILURE
Treat with Streptomycin
Anthrax spreads by
Inhalation (AIRBORNE PRECAUTIONS)
Anthrax looks like
Anthrax Dies from
Treat Anthrax with
Cipro, Penicillin, Streptomycin
Plague spreads by
3 H's of Plague
H- emoptysis - Coughing up blood
H-ematemesis - Blood in Vomitus
H-ematochezia - Bright red blood in the diarrhea
Plague people die by
DIC and respiratory Distress
Hemorrhagic Illnesses (Like Ebola)
Petechiae and ecchymoses
= Pinpoint Hemorrhage, especially on Chest & Bruising
Ingested - Most Lethal
Dies from Respiratory Arrest
3 Major Symptoms of Botulism
Descending Paralysis (Starts in face and goes down)
But is Alert
Mustard Gas, Cyanide, and Phosgine Chlorine
Mustard Gas The Chemical Agent causes
Cyanide The Chemical Agent Causes
What do you use to treat Cyanide Poisoning?
Sodium Thiosulfate IV
What does Phosgine Chloride Cause
Sarin, the Nerve Agent, Causes
Massive Cholinergic parasympathic response
Cholinergic, Parasympathetic effects cause?
D-iaphoretic + Diarrhea
Ebola (Hemorrhagic Fever) Precautions
Standard, Contact, and Droplet
All chemical agents require only soap and water except for Sarin, which requires
A WEAK Bleach
What do you do in a Chemical Attack?
Decontaminate + Treat
What is the Nurse's role in Chemical Decontamination?
Put clothes in Biohazard bag that gets burned
Put them in a Government Issued suit
They may need to be housed for a while
Biochemical Attack, what do you do?
Calcium Channel Blockers are like what for the heart?
Calcium Channel Blockers
Negative Ino, Chrono, Dromo
Calcium Channel Blockers treat what? (the 6 A's)
Antihypertensive, Anti-Anginal, Anti Atrial Arrythmia and SVTS
Calcium Channel Blocker side effects? (the 2 H's)
Headache and Hypotension
Calcium Channel Blockers treat what Arrhythmias starting with?
A, as well as SVT
What causes angina?
Chest pain due to O2 supply and demand issues.
What do Anti-Anginal Medications do?
Decrease O2 demand on the Heart
90% of Calcium Channel Blockers end in?
"dipine" and "zem"
When giving a Calcium Channel Blocker you hold and notify if?
Systolic is 100 or lower.
"QRS" refers to?
"P" refers to?
A lack of QRS repolarizations
Treatment: Epinephrine First, Then Atropine
(Think Heart Stimulants)
Atrail Flutter is?
Rapid P-wave repolarizations in a saw tooth pattern.
Nursing interventions depend upon the type of treatment modality. Pharmacological therapy, such as beta blockers, antiarrhythmics, or calcium-channel blockers, need frequent monitoring of EKG rhythm strips, heart sounds, and apical pulse rate. (Unlikely to ask this)
Atrial- Fib is?
Chaotic QRS depolarizations
Chaotic Between QRS, but QRS is still PRESENT.
HR Has to be Irregular.
Give Heparin IMMEDIATELY.
What do you do if the A-fib is unwitnessed?
1. Heparin First
3. A-denosine 8 second Push- Watch for the pt to go into Asystole
C- Calcium Channel Blockers
D- igitalis (Lanoxin)
Chaotic QRS depolarizations
You DE FIB.
Wide bizarre QRS's
Treatment: Lidocaine & Aminodorone
SVT - Subventricular Tachycardia
A-denosine 8 second Push- Watch for the pt to go into Asystole
C- Calcium Channel Blockers
D- igitalis (Lanoxin)
Periodic wide, bizarre QRS's
PVC is the deviation in the picture from the normal QRS.
Treatment is Lidocaine & Aminodorone
Be concerned about PVC's if? ( the 6, 6 T's of PVC's)
More then 6 per minute, 6 in a row
What are the 2 lethal arrythmias?
A-systole and V-Fib (Pic if V-Fib, Asystole is Flat Lining)
What are the 4 potentially life threatening arrythmias?
V-tach, A-fib, A-flutter and PVC
What are the 6 arrythmias you are tested over on the NCLEX?
V-fib, A-fib, A-flutter, PVC, A-systole and V-tach
What are the 6 arrythmias for NCLEX in order for prioritization?
A-systole, V-fib, V-tach, A-fib, A-flutter and PVC
When talking about arrythmias the word "chaotic" means?
When talking about arrythmias the word 'bizarre" means?
PVC's fall on what wave of the previous beat?
When given a prioritization question for lethal arrythmias if you are asked to prioritize and one say it happened 6 minutes ago and the other says 15 minutes ago which do you choose?
Always the one closest to the 8 minute mark. After 8 minutes the survival rate is LOW.
To treat PVC's you give?
To treat V-tach you give? (If it start with a V you use..)
To treat supraventricular arrythmias you give?
Adenocard, Beta-blocker (end in "lol'), Calcium Channel Blocker and Digitalis or Lonoxin.
To treat V-fib you ?
Defibrillate ... For V-fib you D-fib
To treat AsystolE you give?
Atropine and Epinephrine but give it in reverse.
If asked how to treat A-fib first you?
Give Heparin then ABCD.... Heparin is instant Coumadin and Plavix take time.
What is the purpose of Chest Tubes?
To re-establish negative pressure in the pleural space
Air and Blood
An Apical chest tube is placed?
High (for air) A for air
A Basilar chest tube is placed?
Low (for blood) B for blood
If you are asked about chest tubes after a surgery or trauma you can assumes it's a?
Does a pneumonectomy get a chest tube?
Patient Positioning after Chest Surgery
Keep the patient on the side up from where the lung is.
So if Left lung is left, Be on the right side so that left lung is UP
Patient Positioning after Chest Surgery
Operative side (Good lung up) Or Back (Supine)
What 4 things do you do if the water seal breaks on a chest tube?
Clamp it 1st!!
Cut broken device off of tube
Put the tube in water (NS)
What do you do if you kick over the collection bottle?
Set it back up
Tell the patient to take some deep breaths
If asked about the best thing to do if the water seal breaks and not asking the first thing to do you?
Put it in water (NS).
What 4 things do you do if a chest tube comes out?
Cover hole with a gloved hand
Put on a vaseline gauze dressing,
Put on sterile dressing and then tape on 3 sides.
How many chest tubes (and where) for a Unilateral Pneumohemothorax ?
2 chest tubes, One side (Unilateral) one apical (for air/pneumo) and one basal (for blood-hemo)
How many chest tubes (and where) for bilateral Pneumothorax?
2 on each side, apical (for air) , one on each side (Bilateral)
How many chest tubes (And Where) for post-op chest surgery?
Unilateral, pneumohemo (2 chest tubes, one side, apical and basal)
Assume Chest trauma is a gunshot wound.
Straight Catheter is to a foley catheter
Like a Thoracentesis is to a Chest Tube :)
How long can you clamp a chest tube?
No longer then 15 seconds without a doctors order.
What do you use to clamp a chest tube and why?
Rubber tipped double clamps.
Rubber because it won't pierce the tube and double because were nurses and if one is good two is better.
Is bubbling in the water seal continuously good?
No it is bad.
You need to find the air leak, tape it, report it and then record it.
Is bubbling in the water seal intermittently good?
Yes it should tidal on inhalation
Is bubbling in the suction control chamber intermittently good?
No it is bad.
You need to dial up the suction, report and record.
Is bubbling in the suction control chanber continuously good?
When picking answers, narrow it down to two, then ask yourself
If i did this, but not this, what would be the outcome? Is it better?
In routine care, do you ever clamp a chest tube?
No. In an emergency, you can.
When picking answers ask yourself ?
Which one is MOST important to leave undone. More so than the others.
All congenital heart defects that are trouble start with a ?
Which exception to the rule of congenital heart defects doesn't start with a T?
Left Ventricular Hypoplastic Syndrome
What defects have right to left shunts and are cyanotic?
What defects have left to right shunts and are acyanotic?
Not trouble defects
All congenital heart defects have what?
Murmur and an echocardiogram done
What are the four defects of Tetrology of Fellot?
Ventricular Defect, Pulmonic Stenosis, Overriding Aorta and Right Hypertrophy
What is the saying to help remember the four defects of Tetrology of Fellot?
VarieD PictureS Of A RancH
1 fingerwidth is how many cm's?
How to measure crutches
2-3 cm/fingerwidths below anterior AXILLARY FOLD to a point lateral and slightly in front of the foot
When measuring crutches, don't pick
any foot landmark like a "toe" or "heel"
When the handgrip of a crutch is properly in place the elbow felxion should be?
If crutch is not 30*, what will happen?
Crutches should be how many fingerwidths below the armpit?
Describe a 2 point gait?
1. one crutch and opposite foot together
2. Other crutch and other foor together.
2 points 2gether and the same time.
Describe a 3 point gait?
1. Move two crutches and bad leg together.
2. Move good foot.
Move all three together and then the good leg.
Describe a 4 point gait?
NOTHING moves together
1. One crutch 2. Opposite foot. 3. Other crutch. 4. Other foot.
It moves one at a time so 1,2,3,4 and 1,2,3,4, and 1,2,3,4 so crutch, foot, other crutch, other foot, and crutch,foot, other foot, other crutch etc,
Describe swing through?
Used for two braced extremeties 1. Crutches 2. Legs... they kind of hop.
Who uses Swing Through?
Use the even numbered gaits when weakness is?
Evenly distributed (bilateral)
Remember, Even for Even, Odd for Odd
When using the even gaits what one is for severe and what one for mild problems?
2 point gait for mild 4 point gait for severe.
4 point gait for what?
Fresh Post Op
If the question says "systemic disease" when it comes to crutches
Assume it impacts both legs
Use the odd numbered gait when?
The problem is affecting one leg (unilateral)
When going up the stairs or down the stairs with crutched remember?
UP with the GOOD and DOWN with the BAD
Crutches always move with what leg?
The bad leg.
What side do you hold the cane?
What side do you advance the cane with?
The weak side for a wide base support.
Step with opposites
For walkers remember you?
Pick it up, set it down and walk to it.
Remember for walkers that you
Always push, never pull
A non psychotic person has
insight and is reality based
A psychotic person has
No Insight and is Not reality based
Not all psych patients are
Psychotic. Show this in your answers!
7 Hallucinatory Words
If the question has "appear" in psych, it is
A delusion ( a belief)
What is a delusion?
A false fixed belief, idea or thought.
This has no sensory component.
What are the three types of delusions?
Paranoid or Persecutory, Grandiose and Somatic
What is a paranoid delusion?
False fixed belief that people are out to harm you (CIA, FBI).
What is a grandiose delusion?
False fixed belief that you are superior (God, the Pope).
What is a somatic delusion?
False fixed belief about a body part (X-ray vision).
What is a hallucination?
False, fixed sensory experience.
Five types of hallucinations?
Auditory, visual, tactile, olfactory and gustatory.
Most common type of hallucination?
Auditory (Especially Command)
What is an illusion?
Misinterpretation of reality.
It is a sensory experience.
How can you diffirentiate between illusions and hallucinations?
There is a referent ( something to which they refer). So the patient takes something from reality and has a sensory response.
Delusions are thoughts without a sensation (see, hear, smell)
Don't treat all Psych patients
The same/like they are psychotic
Example of an illusion?
The clock on the wall is a bomb (the clock is real, but the belief isn't)
What are the four types of functional psychosis?
Major depression/mania (bipolar).
Functional Psychotics have WHAT
The potential to learn reality
If a functional psychotic is having a delusion or illusion you?
Acknowledge the feeling ( that sound horrible), present reality (but we have no spiders in the room)
Set a limit ( were not going to talk about that lets talk about something else)
Enforce the limit ( I see you're to ill to talk about reality).
Follow with : We have medication to treat those symptoms
NEVER set limits on
Example of presenting reality positively:
Tell them what they CAN do instead of what they CAN'T do.
5 examples of psychosis of dementia?
Alzheimers, dementia, organic brain syndrome, wernickesand seniality.
When deciding whether to redirect or reassure
Pay attention to the type of patient they are.
Functional Psychotic (Schizophrenia) or Non Functional (Dementia)
Re directing is NOT
Doing a physical action
Taking what a patient is fixating on and that they are expressing inappropriately, and you get them to express it appropriately
For patients with OCD, you
Negotiate a balance
If a patient has psychotic depression
No reality. Won't get dressed because they believe they are a prisoner in Iran.
What do you do if a patient with psychosis of dementia is having a hallucination or illusion?
Acknowledge their feelings
DON'T Challenge them.
Examples of Psychosis of dementia:
Alzheimer's Disease, Senility, Organic Brain Syndrome/Post Stroke Dementia, Lewy Body Disease, Parkinson's, Wereneke's Syndrome
Patients with Psychosis of Dementia
Cannot learn reality because they have brain destruction
What causes Psychotic Delirium?
Chemical Imbalance such as electrolyte Imbalance, sepsis, UTI.
Is Psychotic Delirium permanent?
No. Assure them that it is temporary. It is a temporary dramatic, episodic onset loss of reality, caused by a chemical imbalance/illness/
What is flight of ideas?
Jump from word to word. (This room is big, I liked the movie BIG when they were on the piano, Elvis could play the piano).
What is word salad?
Jump from word to word. Bob, Car, Sleep, Foot etc..
What is neologisms?
Make up new words.
If a patient is psychotic, should you force them to do things?
NO. They will become violent.
What is a narrowed self concept?
When they refuse to leave the room or get dressed. (DON'T force them to do it)
Respond by saying " I see you are uncomfortable, when you are ready, you can do it"
What is ideas of reference?
When they think everything is about them. (Everyone is talking about me)
Type I diabetes (IJK)?
Ketosis prone ( makes ketones)
Type II diabetes? (non all of the above)
Non insulin dependant
Non ketosis prone
Polyuria, Polydypsia and polyphagia (hunger)
What is diabetes mellitus ?
An error in glucose metabolism
What is diabetes Insipidus?
Not enough ADH, pituitary gland
How do you treat type I diabetes? (DIE)
How do you treat type II diabetes? (DOA)
Oral hypoglycemic 3
(Also Obesity Reduction :) )
In a tonsellectomy, what days are most important post op?
Days 6-8, biggest risk for bleeding.
Diabetes is also what?
3 times a day
Once a day
Every other day
4 times daily
So crackles, Edema, etc.
Fluid restrictions + sodium supplements
Type II diabetics need how many calories a day?
#1 Priority in Type 1 diabetes
#1 Priority in type 2 =
Diet + Exercise
Type II diabetics need how many feedings a day?
Type 2 diabetes will do what when in acute illness?
Go to type 1 and need insulin
The peak in insulin is what?
Biggest risk for HYPOGLYCEMIA
Insulin biggest risks for hypoglycemia?
Regular: 2 hours after dose
NPH: 6 hours after dose
Humalog: 30 minutes after dose
Freezing insulin does what?
De natures it
What two drugs can increase blood sugar?
Glucagon and Epinephrine
If client exercises more they need?
Exercise does what in diabetics?
The same thing that insulin does. (potentiates it)
Best answer for a type 2 diabetic?
If client exercises less they need?
As a rule in shock
Anything that is a pressure goes down
Anything that is a RATE goes up
When a client is sick what does it do to there blood sugar?
It increases it.
Teach diabetics who are sick to?
Take insulin, take sips of water to stay hydrated and stay as active as possible.
What are the 4 types of insulin?
Regular, NPH, Humalog and Lantus
Regualr insulins all have what in them?
Regular insulin onset?
Regular insulin peak?
Regular insulin duration?
NPH insulin all have a what in them?
NPH is not so fast and not in the bag (IV)
Regualr insulin is rapid and run
With humalog when do you give it?
What is the only insulin safe to give at bedtime?
Which insulin works the fastest?
What are the three reasons that cause low blood sugar in type I diabetes?
not enough food, to much insulin (#1) and too much exercise.
What is the biggest danger with low blood sugar?
Brain damage if its less then 15
S/S of low blood sugar are?
The same S/S of shock and being drunk... clammy, weak, slurred speach etc.
For Hypoglycemia, Pick signs and symptoms of
1. Cerebral impairment (drunk) - slurred speech, judgement changes, slurred gait
If it makes you look drunk, pick it.
2. Shock symptom = pale, cold, rapid + thready pulses, etc.
If ICP is increased
Pressure goes UP
Rate goes DOWN
(Opposite of hypoglycemia)
Treatment for low blood sugar in type I diabetes?
Rapidly metabolizable carb or ideallly a carb and protein combination or carb and starch.
If a diabetic is unconscious
NPO give Glucagon IM or Dextrose IV.
Examples of rapidly metabolizing carbs?
Juice, hard candy, icing, honey, syrup
Diabetic Ketoacidosis (AKA high blood sugar in Type I diabetes) is caused by what 3 things?
Too much food
Not emough insulin
Not enough exercise
What is the #1 cause of DKA?
Viral upper respiratory infection within last 2 weeks.
So if you suspect DKA, what should you ask?
Have you had the flu lately?
K-etones in the urine and blood, Kussmaul Resp and K+
A-cidosis, Acetone breath, Anorexia d/t nausea
IV at high flow rate (150-200hr.) with insulin R (it doesnt matter what solution its in)
Treatment for low blood sugar in Type II is the same as Type I low blood sugar treatment.
High blood sugar in type II diabetes aka hyperosmolar, hyperglycemic, non-ketotic coma (HHNK) is the same as?
Same as dehydration
Treatment for HHNK is?
Rehydrate but no insulin in the bag because it is not type I diabetes. You only give insulin in the bag with type I diabetes because they burn fat and it turns to ketones.
Diabetes complications, in order of priority:
If you don't know if a bloog glucose is high or low, pick
What are the two long term problems from diabetes?
Poor tissue perfusion.
What lab is the best indicator for long term blood sugar maintenance?
HGBA1C aka glycosated hemoglobin
<7 is an ideal sign of CONTROLLED diabetes
What is the H1AC diagnosis level?
Greater to or equal to 6.5
Lithium therapeutic level?
Lithium toxic level?
Lanoxin (digoxin) therapeutic level?
Lanoxin (digoxin) toxic level?
Aminophylline therapeutic level?
Aminophylline toxic lever?
Dilantin therapeutic level?
Dilantin toxic level?
Elevated bilirubin level?
10-20 neonate only
Toxic bilirubin level?
Over 20 neonate only
Dilantin is an?
Aminophylline is an?
Lanoxin(digoxin) is for?
CHF, Atrial arrhythmia
What is Kernicterus?
When bilirubin is over 20 and in the CSF(cerebrospinalfluid)
What is Opisthotonos?
Position of hyperextension seen with kernicterus. Place them on there side if present.
ANY EXTENSION can be this. Even slight extension of the neck!
If kernicterus and opisthotonos are occuring you?
Turn baby on their side
Draw bilirubin level
Increase the IV rate and start billirubin lights.
Hiatal hernia is?
Gastric contents moving in the WRONG DIRECTION and the CORRECT RATE.
Definition of Hiatal Hernia?
Reguritation of acid into the esophagus, because upper stomach herniates upward through the diaphragm
Definition of dumping syndrome?
Post-op gastric surgery complication in which gastric contents dump too quickly into the duodenum
Dumping syndrome is?
Gastric contents moving in the RIGHT DIRECTION and the INCORRECT RATE.
S/S of hiatal hernia are?
GERD upon lying after meals
S/S of dumping syndrome are?
Acute abdominal distress= gas, ^bs, cramping, bloat
Dumping= s/s of being Drunk
Syndrome= s/s Shock
3 treatments for hiatal hernia is?
High fowlers during and 1hr after meals
Increase fluids with meals
3 treatments for dumping syndrome?
Lay flat on side during and 1hr after meals
Decrease fluids during meals(drink between meals)
Decrease carbs (aka ^ protein diet)
Kalemias do the same as the prefix except for the what?
The HR and urine output.
Calcemias do the opposite of the prefix plus all what?
So hypocalemia.. pick symptoms consistent with what?
UP... Plus BP changes
So hypokalemia... pick symptoms consistent with what?
Down... and UP HR and UP Urine Output
What is Chvosteks sign?
Push the cheek and it spasms
What is Trousseaus sign?
BP cuff inflated and causes a carpal spasm.
Magnesemias do the opposite of the prefix plus all what?
Calcium below what is a medical emergency?
If in a tie never pick magnesium. If the symptom involves nerve or skeletal pick calcemia. For any other symptom pick potassium.
What is the rule for Natremias?
The one with the E id dehydration the one with the O is overload
HypErnatremia has s/s of dehydration and HypOnatremia has s/s of fluid overload.
Earliest sign of an electrolyte overload is?
Numbnesss and tingling (AKA parasthesia)
Universal s/s of an electrolyte imbalance is?
Muscle weakness (AKA paresis)
Nere push what electrolyte?
To decrease K+ you give?
D5W with Insulin R (insulin pulls the K+ from the blood and pulls it in the cell with glucose. this buys time but doesnt solve the problem)
Kayexelate does what?
Gets rid of K+ slow and late
How much K+ can you have per liter of IV fluid?
If higher, clarify order.
In electrolyte questions, pay attention to:
Cause & effect questions. WHICH one are they asking?
What two words mean the same thing as immunosuppresion?
Agranulocytosis and neutropenia.
Hyperthyroidism (AKA graves disease) is the same as saying?
Anesthesia (total loss) is to paresthesia (partial loss) as
Paralysis (total loss) is to paresis (partial loss)
S/S of Hyperthyroidism?
Same as hypermetabolism... agitated, nervous, diarrhea, hot, ^HR, ^BP, thin, hyperactive etc.
Remember RUN yourself in the GRAVE
Graves disease treatment options are? (3)
1.Radiation with I131 (radioactive iodine) 1st 24hrs be alone and flush the toilet alot. Urine is very dangerous/radioactive
2. PTU(drug- Puts Thyroid Under) worry about immunosuppresion.
3. Surgical removal.
What are the two types of Thyroidectomys?
Total and Sub-total.
With a Total Thyroidectomy what do they need for life?
Hormone replacement (Synthroid)
What are you at risk for following a Total Thyroidectomy?
Hypocalcemia (parathyroid regulates calcium)
For a Sub-total Thyroidectomy you are at risk for what?
S/S of a Thyroid storm are?
The same as graves disease but incredibly higher. Exp: HR 180, Temp 108*, psychotic delirium.
Thyroid storm treatment?
High flow O2, 5 ice packs= 2 under each arm, 2 groin, 1 back of neck.
First thing to do in thyroid storm is?
Then cooling blanket
Post Op Thyroidectomy risks 1st 12 hrs?
Hemorrhage and airway.
After 1st 12hrs assume they are stable.
Never pick infection within
48 hours after surgery
Get cooling blankets to shut off
One degree higher than what the doctor wants
Post Op thyroidectomy risks 12-48 hrs for Total Thyroidectomy?
Tetany ( they are stable at this point so don't pick airway or hemorrgave)
Post Op thyroidectomy risks 12-48 hrs for Sub-total Thyroidectomy?
Hypothyroidism is the same as saying?
Same as hypometabolism ie, tired, sluggish etc
What is the name of the disease for hypothyroidism?
Treatment for hypothyroidism?
If asked a question and your patient is critical remember to always STAY with the patient!!
Do you sedate a patient with hypothyroidism?
No you could put them into a coma.
If a patient with hypothyroidism is NPO for surgery you still give them what?
Hormone replacement medication.
What is Addison's Disease?
Under secretion of the adrenal cortex.
S/S of Addison's Disease?
Hyperpigmentation and do not adapt well to stress.
Also becomes dehydrated easily
Addisons Disease treatment?
Chronic steroids (glucocorticoids) - think blood sugar monitoring and immunosuppression
With Addison's Disease you ADD what?
Cushing Syndrome is the oversecretion of?
The adrenal cortex.
S/S of Cushing's Syndrome?
Think of the Cush Man... Moon face, buffalo hump, thin legs and bones, striae (stretch marks), male breasts, hirstusism etc,
Wasting, thin extremities
Breasts in Men
Hair on face
Cushings Syndrome treatment?
Biliateral Adrenectomy is always worse
Pts with Adrenal cortex diseases must have
Med alert bracelet
Symptoms of cushings are side effects of what?
Contact precautions are used for what 4 types of diseases?
RSV, Herpatic infection, Staph infections and Enteric (bowel) infections
Spread by droplet, but they are on contact precautions
Contact precautions have what 5 things?
Private room - door can be open
Gown- if giving direct care
Stethoscope can be carried as long as it is cleaned
Droplet precautions are for what 2 diseases?
All meningitis and all influenza
Pertusis, Diptheria, Mumps, All Meningitis
Droplet precations have what 6 things?
Private room- door can be open
Mask- #1 in this group
Pt wears mask when leaving room
Airborne precautions are for what 4 diseases?
SARS (Severe Acute Respiratory Syndrome), TB, Measles and Varicella
Airborne precautions have what 9 things?
Private room-door closed
Special filter respirator masks
Pt wears a mask when leaving room
Negative airflow room
Gloves, gown, gogles and mask unless told otherwise.
Proper order for donning PPE?
Where do you remove PPE?
In the room.
Where do you put on PPE?
Outside the room.
Proper order for removing PPE?
In airborne precautions it is ok to remove what piece of PPE outside of the room?
What position are your hands for handwashing?
Hands below elbow
How long do you wash for handwashing?
Can the faucet have handles for handwashing?
What do you use in handwashing?
Soap and water
When do you wash your hands?
Before and after gloves, entering and exiting a room and after you soil your hands.
What position are your hands in for scrubbing?
Elbows below hands.
What is the length for hand scrubbing?
What do you use for hand scrubbing?
Cleaning agent must have the prefix "chlor"
Can the sink have handles for scrubbing?
When do you use scrubbing?
Immunosuppresion, surgery, transplant, chemo, HIV
Dry yours hands from...?
Cleanest to least clean
You can use alcohol based solution when?
Before and after gloves, entering and leaving a room
Glove Dominant Hand First
Grasp Outside of the cuff
Touch only the inside of the glove surface
Do not roll the cuff
Fingers inside of the second glove cuff
Only touch the outside of the glove with your first gloved hand
Remember with sterile gloving
Only touch the OUTSIDE of the surface glove
Glove to Glove
Skin to Skin
On nclex, when drying hands
Swipe ONE swipe per paper towel then throw it away and get another one
What can children under for not have?
If a child has O2 is use what type of toys can't be used?
Beware of Foamites
Nonliving object that harbors microorganisms
What is the best toy for a 0-6 month old?
Musical mobile (get rid of this at 6 months or when the child is sitting up)
What toy is good for an immunosuppressed patient?
Action figure. Can't harbor microorganisms
What three things should you ask yourself when choosing appropriate toys for kids?
Is it safe
Is it appropriate
Is it feasible
Remember: 9 Months in the womb
9 months until purposeful activity
What is the 2nd best toy for a 0-6 month old?
Anything soft and large
What is the best toy for a 6-9 month old?
What is the second best toy for a 6-9 month old?
Anything large that they can't swallow.
What is the best toy for a 9-12 month old?
What is the second best toy for a 9-12 month old?
Anything that is purposeful (rolling a ball back and forth)
What 5 words should you avoid when answering a question about toys for a child under 9 months old?
What is the best toy for a toddler (1-3 yr.)?
What should you work on with a toddler (1-3 yr.) ?
What is toddler (1-3 yr.) play characterized by?
Parallel play (with another child but alone)
What two things should you work on with a preschooler (3-6 yr.) ?
Fine motor (fingers)
Balance (dance, gymnastics)
What sort of play do preschoolers (3-6 yr.) prefer?
What is preschooler (3-6 yr.) play characterized by?
Co-operative play (together)
School age (7-11 yr.) is characterized by the 3 C's, what are they?
Creative (no coloring book, use blank paper)
Adolescents (12-18 yr.) "play" is?
Allow adolescents to be in each others rooms unless?
If you're being questioned over a drag and drop and you're given an option that would require a doctors order assume that you have that order. But if an option is to call the doctor, you call first then give.
Best indicator of kidney function?
INR therapeutic level?
If the INR is over 4 you?
Hold all Coumadin/Warafin
Prepare to give K+
If the potassium is below 3.5 you?
Assess the heart
Prepare to give potassium
Call the doctor
If the potassium is high (5.4-5.9 high but still within the 5's) you?
Hold potassium if in the IV
Assess the heart
Prepare to give D5W with insulin
Call the doctor
If the potassium is over 6 you?
Stop what you're doing and assess
If negative effects present you call rapid response.
If no negative effects you do the same as "high but within the 5's)
If the pH is under 6 you?
Assess vital signs
Call the doctor ASAP
If the BUN is elevated check for?
How should you prioritize labs?
Based on what the level will do to the body and not the disease it's associated with.
If you have a lab thats high and you don't know why pick?
Hgb under 8 you?
Bicarb (HCO3) norm?
CO2 is the 50's you?
Assess respiratory status
Do pursed lip breathing
^ exhale time
DON't give O2 if the above isn't working call the doctor!
Severe Acidosis means what?
Hyperkalemia! Biggest priority
CO2 in the 60's (respiratory failure) you?
Assess respiratory status
Do pursed lip breathing
Prepare for intubation
Call respiratory therapy
Call the doctor
PO2 70-77 you?
Assess respiratory status
PO2 below 60 you?
Assess respiratory status
Prepare for intubation
Call respiratory therapy
Call the doctor
O2 sat norm?
O2 sat below 93 you?
Assess respiratory status
BNP is a good indicator of what?
What is the best indicator of CHF?
ANF and BNP=
Sodium is ok if abnormal unless what occurs?
Change in LOC
Absolute neutrophil count (ANC) norm?
< 200 is AIDS
If the WBC count is high this is called?
If the WBC is low it is called?
Bone marrow supression
If the WBC is low you should?
Follow strict handwashing
Shower BID with antimicrobial soap
No fresh flowers or potted plants
Low bacteria diet- no raw fruits/veggies, no undercooked meat.
No water drinking if its been sitting for longer then 15 minutes.
Check WBC daily
Avoid reusable plates/silverware etc,
If platelets are below 90,000 you?
Check for bleeding
Place on bleeding precautions (thrombolytic precautions)
If platelets are below 40,000 you?
Prepare platelet transfusion
Call the doctor
Reason for laminectomy is?
To treat nerve root compression.
3 P's of nerve root compression (S/S) ?
Paresis= muscle weakness
Knowing the location of a laminectomy is key to getting the ? right.
Pre-op cervical laminectomy's most important assessment is?
1st breathing (rate and rhythm)
2nd arm and motor sensory
Pre-op thoracic laminectomy's most important assessment is?
1st cough (uses abdominal muscles)
2nd bowel sounds
Pre-op lumbar laminectomy's most important assessment is?
1st voiding ( when was last time, can they)
2nd leg motor and sensory.
The rule of ABC"s doesnt work in what area of health?
What is the #1 post-op answer for the NCLEX?
Log roll the patient
Activity requirements/restrictions Q8H after laminectomy surgery?
Do not dangle (AKA sit on the side of bed)
May stand, walk and ly without restrictions
Don't sit longer than 30 minutes
What post-op complication do you watch for with a cervical laminectomy?
What post-op complication do you watch for with a thoracic laminectomy?
Pneumonia. Cough & Aspiration
What post-op complication do you watch for with a lumbar laminectomy?
For a laminectomy what incision site is more painful?
For a laminectomy what incision has the most drainage/bleeding?
For a laminectomy what incision site has the highest risk for infection?
If being asked about a surgery and the length of time for restrictions your default answer should be?
Surgeons are using cadaver from bone banks. Why?
Because they only do one incision
Discharge teaching for a laminectomy?
Don't sit for longer then 30 minutes for 6 weeks
Ly flat and log roll for 6 weeks
No driving for 6 weeks
Do not lift more then 5 lb. for 6 weeks
Permanent restrictions for a laminectomy?
Do not lift by bending at the waist
No crazy activities... jerky rides, horseback riding
For a cervical laminectomy they can never?
Lift objects above the head.
Nageles rule for calculating a due date is?
1st day of the last menstrual period
Add 7 days
Subtract 3 months
Normal weight gain for pregnancy?
28 + or - 3 lb
1st trimester weight gain?
1 lb a month
2nd/3rd trimester weight gain?
1 lb a week
After week 12 you can subtract 9 to get appropriate weight gain.
Fundal height is not palpable until week?
The fundus is palpable at the naval at week?
If the fundus is not above the naval the baby is not?
Positive signs of pregnancy?
Fetal skeleton on X-ray
Fetal presence on ultrasound
Auscultation of FHR (heard at week 8, most likely at 10 and should be heard by 12)
Examiner palpates fetal movement
Probable/presumptive signs of pregnancy are?
All urine and blood tests
What is Chadwicks sign?
Cervical change to cyanosis (blue hue)
What is Goodells sign?
What is Hegars sign?
Softening movesd from the cervix to the uterus.
How long do you go to the doctor for pregnancy once a month?
For 28 weeks.
How long do you go to the doctor every two weeks for pregnancy?
From week 28-36
How long do you go to the doctor for pregnancy every week?
From week 36-42
Is it normal to be slightly anemic during pregnancy?
Normal Hgb level in women is?
Hgb level in first trimester?
Can fall to 11 and it is normal.
Hgb level in second trimester?
Can fall to 10.5 and is normal.
Hgb level in the third trimester?
Can fall to 10 and is normal.
How do you treat morning sickness? (1st trimester)
How do you treat urninary incontinence during pregnancy? (1st and 3rd trimester)
How do you treat dyspnea during pregnancy? (2nd and 3rd trimester)
Tri-pod position (sit, lean forward, elbows on knees)
How do you treat back pain in pregnancy? (2nd and 3rd trimester)
Pelvic tilt exercise
Always teach a pregnant women to pee how often from day of pregnancy to 6 weeks post partum?
Truest most valid sign of labor is?
Opening of the cervix (0-10)
Thinning of the cervix (0-100%)
This refers to the baby's presenting part (normally the head) to the mothers ischeal spine.
So if the baby is above the ischeal spine they are given a - number, if they are below they are given a + number. + numbers are positive news and - numbers are negative news.
Relationship between the spine of the baby and the spine of the mom.
Vertical (parallel) is ok,
Tranverse (perpindicular) is bad.
The part of the body that enters the birth canal first.
The first stage of labor is?
The labor part.
The second stage of labor is?
Delivery of the baby.
The third stage of labor is?
Delivery of the placenta.
The fourth stage of labor is?
Recovery (1st 2 hours after the placenta is delivered)
How often do you monitor during labor?
Q15min until the 2hr mark after placental delivery. Then Q1H.
The first stage of labor has how many phases?
What are the three phases of labor?
Latent, Active and Transition
Latent phase is?
0-4 cm dilated
Contractions are 5-30min apart
Lasting 15-30 sec.
They are mild
Active phase is?
5-7 cm dilated
Contractions are 3-5 min apart
Lasting 30-60 sec.
They are moderate
Transition phase is?
8-10 cm dilated
Contractions are 2-3 min apart
Lasting 60-90 seconds
They are strong
Contractions should be no longer then ____ and no closer then_____.
90 sec and 2 minutes
How do you assess frequency of contractions?
Beginning of one contraction to the beginning of another.
How do you assess duration of a contraction?
Beginning to end of contraction
How do you assess the intensity of a contraction?
Palpate with one hand over fundus and with the fingertips.
How do you treat painful back labor?
Knee to chest position
You use your fist and press on the patients sacrum.
How do you treat prolapsed cord? 911!! OB emergency
Push head back in
Position in knee chest position or Trendelenburg
Or elevate hips on pillows
Don't put the patient on their left side.
Cover the cord in moist saline
What interventions do you do for all other OB complications? (LION)
If Pitosin is running stop this first then LION
L-eft side position
V- Variable C- Cord Comphression
E- Early Decels H- Head Compression
A- Accelerations O - OK
L-Late Decels P - Placenta
Do not give what type of pain medication to a women in labor if the medication is liekly to peak when the baby is born?
Systemic- AKA IV, IM and oral
Low fetal heart rate is ?
Bad you LION under 110
High fetal heart rate?
160 This is ok
Low baseline variability? (aka heart rate not changing)
Bad you LION
High baseline variability?
HR changing a lot. This is ok.
Bad (placenta) you LION
Head pressed on. This is ok.
HR up or down, cord compression = BERY BAD
ACE of spades answer for OB?
Check fetal HR
If in OB its low or late you?
If variable its?
Very bad and you push and position.
The second stage of labor and delivery is all about?
So what do you do and in what order for the second stage?
Deliver the head
Suction 1st the mouth then the nose
Check for nuchle cord (cord around neck)
Deliver shoulders and body
During the third stage of labor and delivery (placental delivery) you do what two things?
Make sure it's intact( if left in hemorrhage 1st infection 2nd)
Check for three vessels (2 arteries, 1 vein)AVA
What are the 4 things you do 4 times an hour for the 4th stage of labor?
VS- check for S/S of shock
Fundus- if boggy, massage. If displaced,void/cath
Perineal pad- excessive lochia= pad saturated Q15min 911
Roll on side and check the pad for bleeding.
The uterus should be like what after delivery?
Firm not boggy
Fundal height= days postpartum (3days= 3cm below naval)
Midline- if not catheterize
Lochia color rubra?
Red- rub it red
Lochia color serosa?
pink- rose pink
Lochia color alba?
White- albino white
Moderate lochia is?
4-6 inches on pad in one hour
Excessive lochia is?
Saturated pad in 15 minutes
Extremity assessment post partum should check?
S/S of thrombophlebitis- bilateral calf circumference is the best way to check. If they are equal its ok if not its positive for whichever calf is bigger)
Post partum assessment should include what?
Distended sebacious glands which appear as tiny white spots on babys face.
Epsteins pearls are?
Small,white epithelial cysts on babys gums.
Mongolian spots are?
Bluish/black macules appearing over the buttocks and or thighs of darker skinned neonates.
Erythema toxicum neonatorum is?
Red papular rash on babys torso which is benign and disappears after a few days.
Benign tumor of the capillaries.
Swelling caused by bleeding between the osteum and periosteum of the skull. This swelling does not cross suture lines.
Caput Succedaneum is?
Edematous swelling on the scalp caused by pressure during birth. This swelling may cross suture line. It usually disappears in a few day.
Normal, physiologic jaundice appears after 24 hours of age and disappears at about one week.
Vernix caseosa is?
Whitish, cheese like substance which covers the skin on an unborn baby.
Normal cyanosis of the babys hands and feet which appears intermittently over the 1st 7-10 days.
The generic term for a birthmark.
What 2 newborn variations are you most likely to be tested on for the NCLEX?
Cephalohematoma and Caput Succedaneum
Tocolytics do what to labor?
What are the two tocolytics?
SE for Terbutaline?
This drug is not good if a heart issue is already present.
SE of Nifedipine?
Headache and Hypotension (H&H)
Oxytocics do what to labor?
What are the two oxytocic's?
Oxytocics used for PP Hemorrhage:
SE of Pitocin?
Can cause hyperstimulation (contractions longer than 90 sec. and closer then 2 min.)If FHR is less then 110 stop it, if FHR is normal you slow it.
Used also for PP Hemorrhage.
With an Epidural, give what after delivery?
Fluid Bolus to combat hypotension because they are a FALL RISK
Liquid meds in math calculations
SE of Cervidil?
Effacement which leads to contractions.
What are the two neonatal lung medications?
How do you give Betamethasone?
To the mom
SE of Betamethasone?
^ in glucose so monitor blood sugar
How do you give Survanta?
To the baby
Humulin 70/30 is what?
70% N insulin and
30% R insulin
When drawing up insulins its?
RN (regular then N) draw what you are RN)
If your are pressurizing for drawing up insulin you?
Draw what you are backwards. NR----> RN
For injections an IM needle must be?
A 1 in both gauge and length.
If not, pick the CLOSEST.
For injections SUBQ needles must have?
A 5 in both gauge and length.
What routes can you give Heparin?
IV or SUBQ
How quickly does Heparin work?
Heparin does not
Thin blood/dissolve clots.
It prevents clots from happening
What do you monitor if on Heparin?
Antidote for Heparin is?
Heparin is what pregnancy class?
How can Coumadin be given?
For Heparin, Ask:
How long have they been on it?
How long does it take for Coumadin to work?
What do you monitor in Coumadin?
Pt-INR(this is only for Coumadin)q
What is the antidote for Coumadin?
What pregnancy class is Coumadin?
Switching from Heparin to Coumadin must?
Be 14 days after heparin (5 days before coumadin) or there is a risk for DIC.
Clot busters end in what?
All K+ wasting diuretics end in?
X... If it ends in X its X's out K+ everything else it K+ sparing diuretics.
Generic for Baclofen(this will be on the NCLEX)
Lioresil or Flexeril
What is Baclofen(Lioresil, Flexeril)?
Baclofen(Lioresil, Flexeril) SE?
Muscle weakness and drowsiness
What should you teach a patient taking Baclofen(Lioresil, Flexeril)?
Don't drive/ operate machinery
Don't drink alcohol
Don't care for children under 12
Causes muscle weakness
What is the saying that can be used to help remember Baclofen(Lioresil,Flexiril)?
When you're on Baclofen you're on your back loafin.
B- Problems in Animals, Not Humans
C- Caution, if benefits outweigh the risks you can use it
A 0-2 yr old is in what Paiget stage?
A 3-6 yr old is in what Piaget stage?
A 7-11 yr old is in what Piaget stage?
Concrete operation (think of a 7-11 with concrete around it)
A 12-15 yr old is in what Piaget stage?
Piagets sensorimotor stage is characterized by?
Only think about what they SENSE or are DOING now.
As a nurse when, what and how do you teach a child in sensorimotor stage?
Teach when you're doing it
What you're doing to them
Do it verbally
Piagets pre-operational stage is characterized by?
Teaching 0-2 years old?
Teach them as it happens, verbally tell them what you're doing as you do it
Teaching 3-6 year olds?
Teach them the day of, Don't let them sleep on it.
Tell them what you're going to do - future tense.
USE PLAY. Picture book, dolls, play with equipment
Teaching, 7-11 year olds?
Teach days before.
Teach them what you're going to plus skills (they can draw up insulin)
Don't use play. Use Age Appropriate audio + visual materials
Teaching 12-15 year olds?
Teach them like an adult! They can think abstractly.
As a nurse when, what and how do you teach a child in the pre-operational stage?
Teach the day of- to avoid nightmares
What you're going to do
Do this through play
Piagets concrete operations stage is characterized by?
Live and die by the rules
As a nurse when, what and how do you teach a child in the concrete operations stage?
Teach them ahead of time
What you're going to do
Use visual and audio and use age appropriate reading
At what Piaget stage can you teach a skill like how to draw up insulin?
Piagets formal operations stage can be taught like?
Stage 1 Pressure Ulcer
Non Blanching Redness
Stage 2 Pressure Ulcer
Skin no longer intact, fleshy pink base with a break in skin integrity
This is where Blistering is
Stage 3 Pressure Ulcer
Yellow fatty tissue seen at the base
Stage 4 Pressure Ulcer
Bright Red Muscle or Bone is seen
Distended sebaceous glands which appear as tiny white spots on the baby's face.
Small, white epithelial cysts on the baby's spots
Blue-ish black macules appearing over the buttocks and/or thighs of darker skinned neonates
Erhythema Toxicum Neonatorum
Red papular rash on the baby's torso which is benign and disappears after a few days
Benign tumor of the capillaries
Swelling caused by bleeding between the osteum and the periosteum of the skull. This swelling does not cross the suture lines.
Crosses the suture lines
Normal, Physiologic Jaundice
White cheese like substance that covers the skin of an unborn baby
normal cyanosis of the baby's hands and feet. Appears intermittently over the first 7-10 days
If S1 is louder in a heart sound
It's in the tricuspid
If S2 is louder is the heart sound
For prioritization the question will give what 4 pieces of information?
For a prioritization question the most important information is?
The modifying phrase
For a prioritization question what 2 pieces of information do not matter?
Age and gender
What are the four rules of prioritization?
Acute beats chronic
Fresh post-op(12hr.) beats medical or other surgical.
Unstable beats stable
The more vital the organ the higher the priority(use only as a tie breaker)
What is the best rule out of all 4 for prioritization?
What makes a patient stable? (7)
Over 12 hr post op
Local or regional anesthesia
Phrase "to be discharged"
Lab values A or B
Typical S/S for the disease they have or what they are receiving treatment for.
What makes a patient unstable? (7)
Post-op less than 12 hr
Phrase "newly admitted" or "newly diagnosed"
Labs C & D
What 4 things are always considered unstable?
Fevers over 104*
Pulselessness and breathlessness
The more VITAL the ORGAN
The HIGHER the priority
What are the main 6 organs in prioritized order?
What do you not delegate to a family member?
Safety responsibilities-" can you watch your dad really fast while I grab something."
Family can only do what you ____ them for the patient?
Do Not Delegate These to a LPN
Starting an IV
Hanging of mixing IV Meds
Evaluating IV Site or anything
Giving IV Push Meds
Giving an Blood Transfusion
Preforming Admission, discharge, transfer assessment, or any UNSTABLE patient
Plan of Care
Developing or Preforming Teaching
Taking Verbal Orders from MD
Do not Delegate to an UAP
Chart about a Patient (They may document what they DID)
Meds/IV. They MAY apply topical lotions/creams
Treatments, except for Soap Suds Enema
You MAY delegate ADLs.
Perfect Glasgow Coma Score?
If another staff member is doing something illegal you?
Tell the supervisor.
What do you do if another staff member is placing the patient in physical or psychological harm?
Intervene and take over.
What do you do if a staff members behavior is legal, not harmful but just inappropriate?
Counsel them later at a better time.
Review Psych section. Pages 60-64
All psych medications cause what?
Weight changes and low BP.
What group of drugs is the most commonly tested on the NCLEX?
What are phenothiazines?
Phenothiazines end in?
Large doses of phenothiazines are ?
Small doses of phenothiazines are?
Major doses of phenothiazines are?
Tranquilizers..... BIG GUNS.
The SE for phenothiazines are? (ABCDEFG)
E-xtra paramital syndrome
What do you teach patients taking phenothiazines to report?
Sore throat and any signs of infection.
What is the #1 nursing diagnosis for a patient taking phenothiazines?
If a drug has the word _____ behind it, it means long IM form for noncompliance?
Long IM form given to noncompliant patients.
In 2-4 weeks
Tranquilizers shouldn't be taken?
Antidepressants can be taken?
What are the four Tricyclic antidepressants you need to know?
Tricyclic SE? (Elavil starts with E so they go through E ABCDE)
Tricyclic's do what to the mood?
Benzodiazepines are ?
Benzodiazepines are considered minor what?
Benzo's have what in the name?
Must not take Benzo's for longer than?
Benzo's can also be used for what 5 other reasons?
1. Anesthesia induction
2. Muscle relaxant
3. Alcohol withdrawal
5. Facilitates mechanical ventilation
Benzo SE? (ABCD)
What is the #1 nursing diagnosis for Benzo's?
MAOI's are the?
To avoid a severe hypertensive crisis patients taking MAOI's must avoid all foods with?
Read pg. 67 for a list of Tyramine
Lithium SE? (The 3 P's)
Lithium toxic SE?
Number 1 intervention for Lithium toxicity?
Keep them hydrated
If sweating give sodium as well as fluids
While on Lithium you must monitor the level as well as what?
Prozac has the same side effects as Elavil?
Prozac causes what?
When should you give Prozac?
Before 12 noon.
If Prozac is BID give at what times?
6A and 12N
When changing the dose of Prozac for a young adult you must monitor for?
If you don't know what a drug is and you are being asked which lab is important.... you need to remember?
What is the average dose of Haldol?
Haldol has the SE?
Elderly patients need to take what amount of Haldol?
Half the regular amount.
If an elderly patient OD's on Haldol what are they at risk for?
NMS -Neuroleptic Malignant Syndrome
Fever- really bad fever
NMS has what associated with it?
Clozaril(Clozapine) is what?
A second generation tranquilizer
Most second generation tranquilizers have what in them?
How often do you have to draw a WBC for a patient taking a second generation tranquilizer?
1 a week for 1 month
1 a month for 6 months
1Q6 months for life
Clozaril(Clozapine) is used to treat?
If a question has a drug with "zap " in it, the answer is probably?
Clozaril(Clozapine) has what SE?
Zoloft(Sertraline) is a?
Can Zoloft be taken in the evening?
Does Zoloft cause insomnia?
Zoloft decreases metabolism and can cause?
Toxic drug levels
What should you monitor with Zoloft use?
Other drugs levels
Patients taking Zoloft should NOT take what?
St. John's wort
St. John's wort and Zoloft use can cause?
What are the S/S of serotonin syndrome?
A-pprehension AKA=sense of doom
If a patient is on drug A for 10 yrs. and the doctor adds drug B which drug dose needs to be lowered?
Tx Protocol for Depression
High Calorie, FIBER FOODS.
Activities that are with others, but not interactive. Like Parallel Play.
Dangers: Suicide. If They are suggest it, BE BLUNT and ask them if they are thinking of hurting themselves.
Tx Protocol for Schizophrenia
Obvious Foods. They are suspicious. If they are on antipsychotics, think FIBER.
Activity- With people to reinforce reality
Huge homicide/suicide risk. They are the biggest risk for other-direct violence
Tx Protocol for Bipolar
Mania - Very high calorie, Finger Foods
Needs Gross Motor Activity
Let them sleep whenever they do
They are not usually self destructive
Tx Protocol for Anxiety Disorder
No special diet, more anxious = more allergies
Activity absorbs anxiety
Self destructive behavior is not an issue.
Manic but can function
Can't function in society
Stages of desensitization
Talk about it
Look At Pictures
Be Environment with it
For a phobia, the first thing you do is
Let them avoid it for now.
Goal is to de-escalate.
Walk with a pacing patient. Say "I see you are upset"
Need 5 people to control a person. 1 person charge.
For Empathy Questions
Always pick the answer that reflects the patient's FEELINGS,
Actions, or the nurses feelings.
Abdomen Organ Landmarks
Heart Ausculation Landmarks
The ACE of spades answer for nutrition is to either pick ____ or _____.
Never choose _______ as a food for children.
For a toddler pick ______ food.
For a preschooler ____ meal a day is ok!!!
If you know what a particular drug does pick a SE in the ______ body system.
If you have no idea what a drug is check to see if it is ___. If it is pick a _______ SE.
Ace of Spades answer for OB?
Check the FHR.
What is the first thing you assess in a Med-Surg situation?
L.O.C. = Bob, Bob, Bob are you ok????
What is the first thing you do in a Med-Surg situation?
For Peds when in doubt call it?
For Peds when in doubt pick?
The older age.
For Peds when in doubt pick the?
In Peds always give?
Empathy question have?
A quote in the question and a quote in the answer.
In psych choose the answer that reflects the _______ and not the _______ they said.
Warfarin, watch for?
When you get a select all that apply question, do NOT ask
What list do I remember?
When you get a select all that apply question, ask yourself:
What principle do I know that could guide me to make my selection?
When you get a select-all that apply question, ask yourself:
What does this disease/drug/procedure do to the BODY?
For example, hypocalcemia makes the body do UP.
Do not use the following words in your thought process:
Maybe, If, Possibly, Might, Could.
They lead to OVERSELECTION!
Boards love to make an answer
Right, but in the wrong direction. For example, Hyperkalemia when it should be HypOkalemia
Never select an answer on a SATA
Based on another answer you chose. Base it on the QUESTION.
Watch for opposite answers...The list will often contain a __ concept going in the ___direction.
Correct Concept in the Wrong Direction.
Make sure to decide if the question is asking what ___ the phenomenon OR what ___ from it.
Causes the phenomenon or results from it. These are often the totally opposite answer.
Absolutes. Like "Always" or "Never"
If two answers say the same thing
Neither is right "tachycardia", "racing heart"
If two answers are opposite
One of them is probably right
Pick the answer that is more
Global. (Umbrella Answer) For example, "Initiate suicide precautions" instead of "Remove belt", "Have and Aide present", etc
Don't be tempted to answer a question based on your ___ instead of your____
Ignorance instead Knowledge
If you don't know a drug in the question...
Cross it out, ignore it. Look at the route or other info about it. Like "IVPB" and base your answer on what you DO know about THAT!
If you don't know an answer
You do know the answer. Use your common sense!
If an answer seems right
It probably is. Right answers are different from wrong answers just because they are right!
Only change an answer
If you have a rationale and can answer as to why THAT answer is superior to one you originally chose
Every psych patient is a
Med-surg patient first
In order to pick a psych answer, the patient must be
Stable, Safe, and comfortable
Priorities, in Order
Physiological, Safety, Comfort(Includes Pain), Psychological, Social, Spiritual (Maslow's)
Boards try to trick you with the words
"bile stained " and "vomitus" in acid base. It is NOT from the stomach, it is from the intestine, so it means metabolic acidosis.
Patients that do NOT need interdisciplinary care
Pt with multiple med surg diagnoses. Not the sickest or the most unstable people!
Patients that do need interdisciplinary care
Patients with multidimensional needs. For example, physical, intellectual, psychological, emotional, spiritual.
Patients who need rehabilitation
Needs interdisciplinary Care Automatically
Tie breakers when deciding which patient needs interdisciplinary care more
Patient who's current treatment is ineffective, or the patient who is preparing for discharge
Best indicator of CHF
Plague is not longer commutable when?
After 48 hours of treatment
Stop beta blockers & calcium channel blockers if
Patient had MI or suspected MI
If a diabetic is unconscious
If in hospital, give dextrose IV
If at home, give Glucagon
Pt just had gastric surgery...acting drunk and in shock with ABDOMINAL distress... Think?
Dumping syndrome! Low everything!
Pt has chest pain when lying down and indigestion
Cushing's patients with an adrenalectomy need what?
A "SONE" or they will go the other way into addison's
All adrenal cortex disorders start with?
A or C
Prolapsed cord / Variable decelerations, do you turn them on their left side?
NO! Knee to chest position, tredelenburg, or elevate hips on pillows.
Also cover chord in moist saline
Draw up whole dose of air
Put air into N (equal to liquid amount ordered)
Put air into R
Draw up R
Draw up N
Wheezes are heard, what would you give?
Long acting bronchodilator
Should you massage a pressure sore if it won't blanch?
Tremors, Metallic taste, neuro symptoms besides parenthesia
High sodium levels in lithium
Decrease the effectiveness
Low sodium levels in lithium
Prolong lithiums half life
If you don't know the drug, monitor
Elderly patients on Haldol
Should be 2.5 mg (half of the regular dose of 5)
In a patient with suspected shock, how should you position them?
Nursing diagnoses must
Support the assessment data in the question
When intervening in daycare, look for task that is
Unsuitable for age group
Low bowel surgery
Low residue diet
Check for prolapsed cord
Antacids should not be given?
With meals. They interfere with absorption
After an amputation, for the first 24 hours, don't
Put the leg under s pillow, might cause contractures
Whenever a time is mentioned after a medication is given, like "a pt received morphine. One half hour later, the patient wants to ambulate"
Think about the peak times of the medication and if there are any safety risks involved! Don't ambulate if a medication is likely to peak!
In the pre interaction phase the nurse will?
Explore his/own feelings about...
If you see the words "During the initial interview"
"Upon admitting the patient"
"At your first few meetings with"
"On the day of admission"
"While FORMULATING nursing diagnoses"
Correct answers should be:
Be warm and fuzzy
This is the introductory phase. You would not set limits
If you see the words
"During the therapeutic interview"
"While implementing the care plan"
"While working on the care plan goals"
"During treatment sessions"
"In your weekly session"
"Three days after admission"
You are in the working phase, also known as the "therapeutic phase"
Be very focused, directive, "tough"
In some ways these answers will seem stern and slightly unfriendly. Enforce proper communication.
Gift giving in psych
Do not not give gift giving in psych
What shouldn't you give in psych?
Hugs, kisses, compliments, opinions, holding hands, placing arm around, etc.
Do you give advice in psych?
Rule out these words in psych
"Advise the patient to"
"Tell the patient to"
"If I were you, I would..."
"You should do"
"You ought to"
"You should NOT do"
In psych should you give guarantees?
Don't pass the buck
Don't tell a patient "refer patient to" or "have you spoken to your doctor about this?"
The best psych answers
Reflect the feelings the patient feels and not the words they said
Are open ended (not yes/no questions )
Don't have "I, me, we, us"
Shortest answers are better
Why questions are not as good
This test is not about you.
It's about the PATIENT.
Take care of your
Not the machine
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