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Capstone Round 3 > Cumulative Review > Flashcards

Cumulative Review Flashcards

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1
Q

MedSurg: Class I - IV (colored tags)

A

Penetrating head wound/Agonal breathing = black
Red = MI, chest wound
Yellow = fracture
Green = abrasion

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2
Q

Electroencephalogram Preparation

A

Wash hair

NOT NPO

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3
Q

Glasgow Coma Scale

A

15 ↑ = good
7 ↓ = bad (coma)
Motor = 6 pts

Eye spontaneous = 4 pts
Verbal = 5 pts

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4
Q

Meningitis - HiB vaccine is for which 3 people?

A

Common cause of bacterial meningitis

College kids
Diabetes Insipidus
SIADH

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5
Q

S/S Diabetes Insipidus

TX

A

Dilute (↓SG) polyuria with concentrated blood (↑ HH)

Replacement of nutrients

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6
Q

S/S SIADH
Controlled by what?

TX

A

Oliguia r/in retaining fluid. Hypervolemia and low sodium concentration (↓ Na)

Posterior pituitary

Fluid restriction, Oral Demeclocycline, and ↓ Na TX

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7
Q

FX Parkinsons

SFX Anti-Parkinson medications (Levodopa & Carbidopa, why together?)

A

↓ Dopamine, ↑ ACTh*

Shuffling gait
Abnormal movement
Tremors

Together r/in smaller dose needed

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8
Q

Medication for: Alzheimers

A

Donepezil - helps w/ short term memory loss

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9
Q

MS…?

A

Relapsing, remitting

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10
Q

2 S/S ALS (Lou Gehrig Disease)

A

Respiratory failure

Progressive weakness from bottom up

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11
Q

DX: Myastenia Gravis
ANTIDOTE:
C/B:

A

Tensilon/Edrophonium test
Atropine
↓ ACTh

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12
Q

Tensilon/Edrophonium Test

DX for:

A

Give tensilon to a pt experiencing Myastenia Gravis, if it gets worse (+), give atropine.

Cholinergic Crisis

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13
Q

FX: Atropine

A

TX Bradycardia and cholinergic FX

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14
Q

2 Medications for: Migraines
FX:
4 ADFX:

A

Sumatriptan (Imitrex)
Ergotamine
Vasoconstricts, r/in ↓blood flow to brain

N/V, headaches , photo phobia, aura

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15
Q

TX: Retinal Detachment

Is it painful?

A

Curtain over eyes

NOPE

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16
Q

2 Medications for: ↑ Increased Intra-ocular Pressure

A

Mannitol andAcetylzolamide

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17
Q

FX: Macular Degeneration

2 EDUCATION:

A

Loss of central vision*
No cure
Part of aging (common ↑ 60 y/o)

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18
Q

S/S: Open vs. Closed Glaucoma

A 
Open = common, loss of periphery w/ mild pain
Closed = SUDDEN OUCH (ICP ↑ 21 mm Hg)... results in severe pain* & Halo's around lights*.
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19
Q

4 Medications for: Open/Closed Glaucoma
1 EDUCATION:

TAMP

A

Timolol
Acetylzolamid
Mannitol
Pylocarpine

Wait 15 min between drops

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20
Q

3 S/S Meniere’s disease

2 Classes/Medications for:

A

Tinnitus, Vertigo, and Unilateral hearing loss

Anticholinergic and Antihistamine
Meclizine and Diphenhydramine

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21
Q 
Purpose of TX: Head injury
Positioning
Avoid
Maintain
Medication used:
A 
↓ ICP
Semi-Fowlers 30º, head midline
Flexion, extension, rotation
O2 levels (↓CO2 r/in ↑ICP)* = BAD
Pentobarbital
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22
Q

FX: Pentobarbital

A

Induce a coma which ↓ the metabolic demands of the body

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23
Q

FX: Stroke, LEFT vs. RIGHT

Who does swallow eval?
2 S/S Right sided to note.

A 
Left = speech, math, analytical, reading & writing*
Right = visual/spacial awareness, walking, impulse control*

It’s speech, no matter what.
Over estimating abilities, emotional stuff.

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24
Q

Key S/S Hypoglycemia

A

↓ LoC

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25
4 S/S Spinal Cord Injury (AKA)
Neurogenic Shock ALL ↓ Bradycardia, Hypotension, Bladder/paralytic ileus
26
FX: Autonomic Dysreflexia | 4 S/S:
``` Stimulation SNS (injuries above T-6 only) Extreme HTN* Blurred vision Extreme headache Diaphoresis ```
27
TX: Autonomic Dysreflexia | R/F:
Sit up, notify provider, figure cause Check full bladder or fecal impaction Retention, Impaction, and Tight Clothes can trigger
28
What to assess after a Bronchoscopy?
Gag reflex
29
FX: Thoracentesis Pt Positioning: Pt Education during:
Draining fluid out of lungs Sitting (tripod) w/ arms over table Don't COUGH or TALK
30
2 Pre-Thoracentesis
Informed consent | Drain the bladder
31
Chest Tube 3 Chambers (2, 2, 3 NOTES per)
Right Side - Drainage REPORT if ↑ 70mL/hr drainage Mark drainage at least once per shift Middle - Water seal (2cm) Tidaling = OK, stop = obstruction Continuous bubbling = leak Left Chamber - Suction Can be dry/wet If it comes out, apply occlusive U dressing If it fills, replace entire unit
32
Mechanical Ventilation: High pressure vs. Low pressure alarm ALWAYS...?
``` High = ↑ secretions, biting tubing, pulmonary edema, brochospasm, pneumothorax, or kinks in tubing Low = cuff leak, disconnection, or displacement ``` ASSESS FIRST
33
2 DZ of COPD Max O2 to give How often Physiotherapy
Chronic Bronchitis & Empysema 2 L/hr 2 hrs AFTER meals
34
3 Breathing techniques: COP 2 Diet How often to incentive spirometer
Pursed lip, abdominal, tripod Small frequent, HiCalorie 10x an hour
35
Before administering antibiotics...?
Culture first
36
Precautions: TB | 3 PPE
Airborne | Negative pressure, private room, N95
37
FX: Mantoux Skin Test
Read after 48 - 72 hours, if ↑ 10mm and hard = + | If pt has immunocompromised or has AIDS ↑ 5mm = +
38
+ Mantoux Skin Test Follow up (2) Looking for...? How often for sample?
Sputum sample + X-ray +Acid fast in sputum 2 - 4 weeks, non-infectious after 3 NEGATIVE sputum cultures
39
How long to take TB meds? | Why so many at once?
6 months - 1 year | Prevent resistance strains
40
3 Medications for: TB
Rifampine, Isoniazid, Ethambutol
41
ADFX to report: TB medications
Rifampine - Hepatotoxicity Isoniazid - Hepato/Neurotoxicity (don't drink while taking) Ethambutol - Vision problems
42
SFX Rifampine thats OK
Orange urine
43
R/F Pulmonary Embolism and 3 S/S of it.
Deep Vein Thrombosis | Unilateral swelling, redness,and pain
44
6 S/S Pulmonary Embolism
Dyspnea (SoB), Crackles, Cough, Tachycardia, Hypotension, Chest pain
45
Medication SUFFIX for Pulmonary Embolism?
- ase drugs | example: Streptokinase
46
S/S and TX Pneumothorax
Trachea deviated to unaffected side | Tube high in lung to capture rising air
47
TX Hemothorax
Tube lower to capture draining fluids
48
2 Key S/S Cardiac Tamponade
Paradoxal Pulse = ↑ 10 mmHg of BP during inhalation from exhalation Muffled ♥ Sounds
49
3 Cardiac Enzymes
Myoglobin - w/in first hour, but nonspecific to heart (general muscle damage) Troponin - lasts longest in system (3 - 21 days) CKMB - only pick if MB at end
50
4 Nurse Role: PICC Lines
Check w/ Chest X-ray before use Flush w/ 10mL NSS (NOT HEPARIN) Measure Cm exposed Lasts 12 months, assess q8hrs
51
4 S/S: IV Phlebitis | 2 TX:
Pain, lines, hardening of vein, red Stop infusion, remove IV, apply warm compress
52
2 S/S IV Infiltration | 2 TX:
Swollen, cool | Stop infusion, remove IV (ensure catheter intact), elevate extremity
53
3 S/S Air Embolism | 2 TX:
SoB, Chest pain, cofusion | Left side Trendelenburg, give O2
54
2 Times to Defibrillate | 1 Time NOT to Defibrillate
Pulseless V-Tach V-fib ALWAYS Asynchronous A-fib, use Synchronous cardioversion
55
FX: Pacemakers | Pt arm position
On demand - should always keep HR at set level (if pt HR is ↓ it means it's not working) Arm down by side after insertion and then in a sling DO NOT RAISE for 1 -2 weeks
56
4 EDUCATION: Pacemakers | REPORT?
Will set off airport alarm DO not get an MRI OK Showering/bathing OK using the microwave Hiccups (stimulating diaphragm)
57
Entrance: Percutaneous Coronary Intervention Check before OP: Diet:
Entrance at femoral artery Shellfish/Iodine allergy Increase fluid intake
58
4 Nurse Roles: Percutaneous Coronary Intervention
Patient lay flat Apply lots of pressure Check distal pulses Check for bleeding @ site
59
TX Angina 4 EDUCATION Route? 2 SFX:
Nitro Shave hair off placement spots, rotate sites, take off @ night or after 12 hrs, and reapply if it falls off. Sublingual on ONSET, it not relieved in 5 minutes call 911 (up to 3 times) Hypotension and Headaches
60
Stable vs. Unstable Angina
``` Stable = goes away w/ rest Unstable = does not and gets worse overtime ```
61
TX MI: MONA (Order ONAM)
Oxygen Nitro Aspirin Morphine
62
7 MI Medications BANKAAM!
Beta-Blockers -olols Aspirin, Nitro, -Kinases Anticoagulants/plateletes Morphine
63
Lab used to indicate Heart Failure
Basic Metabolic Panel
64
2 S/S Right vs. 3 S/S Left Sided Heart Failure
``` Right = peripheral edema and Jugular Vein Distention (JVD) Left = Pink, frothy sputum, ANYTHING LUNG related, pulmonary edema ```
65
Medication for: Heart Failure 2 ADFX (REPORT?): Diet:
Diuretics (Lasix) = ↓ preload Hypokalemia - REPORT muscle weakness Hyponatremia Increase fluid intake
66
FX: Afterload
Resistance to get out of heart, arteries dilate to decrease this
67
3 Medications for: Decreasing afterload (↓ BP)
ACE Inhibitors (-prils) Ca Chnl Blockers (-pines + Verapamil and Diltiazem) Angiotensive 2 Blockers (-sartan)
68
3 ADFX: | ACE Inhibitors
Angioedema, Cough, ↑ Potassium
69
FX: Preload | Medication for:
Fluid that returns to the heart | Diuretics
70
FX: Digoxin Check before giving: 4 S/S Toxicity:
Helps ♥ pump better Check pulse is ↑ 60 N/V, anorexia, halo vision, slow HR
71
Digoxin Therapeutic/Toxic Range | What can ↑ this?
0.8 - 2.0 (↑ 2.4 = toxic) | Hypokalemia
72
2 TX: Venous Insufficieny | Ø TX:
Exercise and TED/SCD Stockings Dangling legs will NOT help
73
TX: Arterial Insufficieny | Ø TX:
Dangling legs Exercise is PAINFUL
74
EDUCATION: Valvular Heart Disease
Use antibiotics before going to the dentist
75
TX: Vaso-occlusive Crisis
Start IV then give pain meds Otherwise, ABC
76
DX: HTN | 5 Medications ofr:
↑ 140/90 (2 readings in 1 week to DX) Beta-blockers (-olols) - vasodilate and slow HR ACE Inhibitors (-prils) ARBs (-sartans) Ca Chnl Blockers (-pines) + Verapamil and Diltiazem Diuretics
77
3 S/S HTN
Headache Visual Disturbance Dizziness
78
Class and FX: Clonidine
Alpha2-Agonist, r/in vasodilation which ↓ BP and ↓ peripheral vascular resistance
79
Class and FX: Doxazosin | 2 TX:
Alpha1-Blocker, r/in dilated arteries to TX BPH (enlarged prostate) and urinary retention Also a anti-Hypertensive
80
Medication for: Prostate Cancer
Loupron
81
FX of following Classes: | Beta1, Beta2, Alpha1, Alpha2
Heart (agonist ↑ HR, antagonist ↓ HR) Lungs (agonist dilates, antagonists constricts) Artery constriction (Dopamine) Artery dilation, used for HTN (Clonidine)
82
FX of 2 Non-Selective BetaBlockers | Contraindication
Labetalol and Propranolol, slow the heart but also constrict the lungs ASTHMA
83
3 Nurse Roles: Aneurysms
Control BP (keep low to prevent bursting) Check pulses Check urinary output
84
2 S/S Adominal Aortic Aneurysm | Nurse Role:
Flank/Backpain and sometimes a pulsating abdominal mass DO NOT PALPATE
85
2 S/S Aortic Dissection | 2 Nurse Roles:
Tearing ripping pain followed up hypovolemic shock Keep close eye on vitals Get a CT or X-Ray
86
4 Notes of: Decreasing ICP
DO NOT raise bed above 30º DO NOT turn head Calm environment Hypercapnia r/in ↑ ICP so stay oxygenated!
87
Indications of: ↑ or ↓ Hct | ♂/♀ Range
↑ Dehydrated or Polycythemia ↓ Blood loss or anemia ♂ 42- 52% ♀ 37 - 47%
88
Indications of: ↓ Hgb | ♂/♀ Range
Blood loss or anemia ♂ 14 - 18 ♀ 12 - 16
89
6 Nurse Roles: Blood Transfusions
``` ALWAYS use NSS (never D5W) ALWAYS used Y tubing with a filter Take vital signs q15mins Must be complete in 4 hours Use 20 gauge to GIVE, 16 - 18 to TAKE ```
90
3 S/S Hemolytic Reaction to blood
Low back pain, Hypotension, flushing
91
4 S/S Anaphylactic Reaction to blood | 3 TX procedure
Itching, fever, chills, flushing Stop infusion, assess vitals, send blood back to bank
92
FX: Autologous Transfusions
Donating blood 5 weeks to 72 hrs prior to surgery O can only get O AB can get ANY
93
Cow milk and children
Too much r/in iron deficiency anemia
94
Pernicious Anemia
Lack of B12
95
FX: Idiopathic Thrombocytopenic Purpura | Monitor for:
Autoimmune disorder when body destroys own platelets | Bleeding
96
7 S/S HYPOvolemia
``` Tachypnea Tachycardia Thready pulse Hypotension Diminished Cap refill ↑ HH Orthostatic Hypotension ```
97
7 S/S HYPERvolemia
``` Tachypnea Tachycardia Bounding pulse Hypertension Edema ↓ HH Distended Neck Veins ```
98
Pancreatic Enzyme Ranges (Amylase/Lipase)
56 - 90/0 - 110 If they're way out of line, probably the answer
99
Albumin/PreAlbumin Ranges
3.5 - 5.0 (↓ = malnourished and r/o pressure ulcer if elderly) 15 - 35
100
FX: High Ammonia | ANTIDOTE w/ Expected SFX
Hepatic Encephalopathy | Lactulose, a laxative which r/in pooping ammonia out (3 - 5 soft stools a day is expected)
101
2 Pre-Colonoscopy Prep
NPO | Bowel Prep
102
Nurse Role: Endoscopy (or Endogastroduodenoscopy)
Report cool clammy skin | This indicates hypovolemic shock b/c bowel perforation
103
5 Nurse Roles: Total Parenteral Nutrition
NEVER Peripheral IV, only Central lines and PICC lines ▲ tubing q24hrs Infused DW10 if next bag is not ready Monitor blood sugar (for hypoglycemia) and electrolytes regularly DO NOT USE if oily residual is in bag, should be uniform
104
4 Nurse Roles: Paracentesis
Pee beforehand (general rule if poking, EXCEPT ultrasound) Sit up Measure abdominal girth BEFORE and AFTER Watch Vitals
105
2 Nurse Roles: Dumping Syndrome
Lay down | Tiny amounts of water NOT with meals
106
3 Nurse Roles: Ostomies
Should be red, dark pink. REPORT pale pink or blue ▲ bag when 1/4 -1/2 full Eat yogurt or put a breath mint in bag to help with smell
107
Difference in output of Ileostomy vs. Colostomy
``` Ileostomy = watery b/c upper GI Colostomy = thicker b/c lower GI ```
108
6 Foods that r/in ↑ odor of an Ostomy
Fish, Garlic, Eggs | Asparagus, Dark leafies, beans
109
5 Medications Classes for: GERD | EDCUATION each:
Antacids - take 1 - 2 hours AFTER medications PPIs (-zoles) - ↓ gastric secretion, long term use r/in B12 deficiency H2-Agonists (-dines + Metoclopramide) - empties stomach quickly (useful for N/V) Prokinetic (Reglan) Sucralfate - protective coats the ulcer
110
R/F Esophageal Varices: ↑ R/F of... 2 TX:
Portal HTN Risk of bleeding Beta-Blockers and Vaso-constrictors
111
3 Types of Hernias
Hiatal - when stomach comes through diaphram r/n lung problems Inguinal Umbilicus
112
5 S/S Ulcerative Colitis
``` ↑ ESR/C-Reactive Protein High pitched bowel sounds 15 - 20 liquid bloody stools a day Fever Weight loss ```
113
3 S/S Crohn's Disease
↑ ESR/C-Reactive Protein | 5 liquid, fatty foul smelling pus stools a day
114
4 Medications for: Ulcerative Colitis and Crohn's Procedure to cure
Steroids 5-ASAs Immunosuppresants Antidiarrheals Bowel Resection
115
4 S/S Diverticulitis | Acute vs. Long term diet
LLQ pain... Tachycardia, Fever, chills, N/V ``` Acute = clear liquid, low fiber Long = high fiber ```
116
Pancreatitis Signs: Cullins and Turners
``` Culens = brusing by the umbilicus (C by belly button) Turners = turn on side to see brusing ```
117
R/F Pancreatitis: | 5 S/S
``` Alcoholism Epigastric pain that radiates to back Pain w/ eating (make NPO once admitted) Worsen when lying down, eating + drinking alcohol N/V ```
118
3 Lab Changes: Pancreatitis
↑ WBC ↑ Blood glucose (not releasing insulin) ↓ Ca and MG
119
Hep A Hep B Hep C 4 Common S/S
Oral-fecal, contaminated food, vaccine available Drugs, sex (blood/body fluids) vaccine given @ birth, 2 months, 6 months Blood, drug abuse Flu like symptoms, jaundice, dark urine, clay colored stools
120
FX: Cirrhosis 6 S/S TX Hepatoencephaloathy
Scarring of liver Spider angiomas, Fruity Breath (Fetorhepaticus0, Petechiae, Jaundice, Ascites Lactulose
121
Expected Labs with Chronic Renal Failure
ALL HIGH EXCEPT CA ↑ K, Mg, P, Na ↓Ca
122
FX: Addisons Expected S/S: 4 Lab Changes Medication for (and ADFX of):
``` ↓ ACth/Cortisol production Orange skin ↑ potassium and calcium ↓ glucose and sodium Prednisone (osteoporosis) ```
123
FX: Cushing's Disease 3 Expected S/S: 4 Lab Changes Medication for:
``` ↑ ACth/Cortisol production Round/Moon face Buffalo Hump Hirsutism ↑ glucose and sodium ↓ potassium and calcium Spironolactone ```
124
Range + 7 S/S Hypoglycemia
``` ↓ 70 mg/dL Mild shakiness ↓ LoC Sweating Palpitations Lack of coordination Blurred vision Cool, clammy skin ```
125
8 S/S Hyperglycemia
``` Polyphagia - hungry Polydipsia - thirsty Polyuria Fruity breath (DKA) Headaches, N/V, ab. pain, ↓ Loc ```
126
5 S/S Diabetic Ketoacidosis R/F, Type of Diabetes, Onset
``` Kussmaul Respirations - Deep, rapid breathing Metabolic acidosis Fruity breath ↑ 300 mg/dL blood sugar + Ketones in urine ``` Infection, TX it Type 1, Rapid Onset
127
2 S/S Hyperglycemic Hyperosmolar state Type of Diabetes, Onset
↑ 600 mg/dL blood sugar Dehyrdation r/t polyuria Type 2, Gradual Onset
128
4 Oral Medications for: Diabetes Mellitus Type 2 ADFX:
Acarbose - slows carbohydrate abosorption Metformin - stops liver from producing glucose Pioglitazone Glipizide GI issues, but Pioglitza r/in fluid retention
129
``` Diabetic Foot Care How often to inspect? Type of shoes Type of socks How to cut nails Lotion? Food Powder ```
``` Inspect DAILY Closed toed - NEVER barefoot Cotton or wool Straight across NOT between toes Mild if toes sweaty ```
130
Diabetic Education: Testing the water temperature Exercise What to watch in diet
Test with hands first ↓ BS so don't use extra insulin Carbohydrates
131
7 S/S HYPOthyroidism ▲ TSH/T3/T4 levels Medication for:
``` Dry coarse hair Periorbital Edema Bradycardia Cold intolerance HYPOtension Weight GAIN Tired ``` ↑ TSH ↓ T3/T4 Levothyroxine
132
7 S/S HYPERthyroidism ▲ TSH/T3/T4 levels 2 Medications for: Procedure for:
``` Tremors Bulging eyes Tachycardia Heat intolerance HYPERtension Weight LOSS Graves, when BAD ``` ↓ TSH ↑ T3/T4 PTU or Radioactive Iodine Thyroid Removal
133
ADFX: Thyroid Removal
Issue with parathyroid r/in ↓ Calcium levels and ↑ Phosphorus levels
134
Burns: Rule of Nine
``` 9% for anterior/posterior of... Chest Abdomen Legs 4.5% for anterior/posterior of... arms head 1% groin ```
135
``` S/S different burn Depths: Superficial Deep Partial Full Deep full ```
``` pink/red pink/red + blister, edema, pain red/white + eschar, +mild edema- pain black to white, - blisters, +severe edema - pain BLACK, - edema ```
136
Medication for: Burns | ADFX
Silvadine (Antibiotic) | Transiet Neutropenia
137
What NOT to do with a Wilm's tumor
Palpate it. | DO NOT, palpate it.
138
3 EDUCATION: ↓ WBC r/t Cancer
No fresh fruits/veggies Stay away from crowds No lemon glycerin for mouth sores... but Peroxide?
139
Prophylactic Medication for: Ulcers | Contraindication
Misoprostol | DO NOT GIVE IF PREGO
140
Lordosis vs. Kyphosis
Sway back vs. Hunchback
141
4 EDUCATION: Contraceptive Diaphragm r/t Spermicide
Keep in for 6 hours post-sex (no more, no less) Refit q2years Refit if ▲ 15 lbs Refit if have pregnancy Should be reapplied for each sex session
142
3 ADFX: The Pill 5 Contraindications
Chest pain Headaches HTN ``` Migraine Headaches Smokers Breast Cancer Clots Hx Stroke ```
143
Depo-Provera Injectectable ADFX
↓ Ca, r/in osteomalacia (softening of bones)
144
Intra-uterine Device (T device) ↑ 2 R/F: 2 REPORT:
Ectopic pregnancy and Pelvic Inflammatory Disease | Report FOUL smell or ▲ in string length
145
Check for before: Histerosalpinography | Diet:
Check for allergies to shellfish/iodine | Increase fluid intake
146
Post-Vasectomy | 2 EDUCATION:
Must have several negative checks (or wait 3 months) before unprotected sex
147
5 S/S Presumptuous Pregnancy
``` N/V Tender breasts Quickening Missed period Urinary Frequency ```
148
8 S/S Probable Pregnancy
+ Pregnancy Test Abdominal Enlargement +Hagar = softening/compression of lower uterus +Chadiwck = blue cervix +goodall = softening cervical tip Ballottement = rebound of fetus +Braxton Hicks = intermittent weak contractions
149
3 S/S Positive Pregnancy
Baby born Ultrasound to see + hear HR Feeling of baby via Professional Leopold maneuver
150
GTPAL
``` Gravida - No. pregnancies Term - Birthed ↑ 38 weeks Preterm - 22 - 37 weeks Abortion - miscariage or planned Live children ```
151
Indication for: Rhogam DX: FX:
Negative mom, Positive Baby Test @ 28 weeks. If negative, GIVE. Stop production of antibodies to protect second pregnancy
152
FX: Coombs Test | If +?
ID moms who already have antibodies | +Test = no need for Rhogam
153
Prego: When to glucose test What test: Range for Hyperglycemia:
24 - 28 weeks 1 hr glucose test ↑ 140 mg/dL
154
Prego: Postitive 1 hr glucose test?
Do 3 hour, fasting required | Gestational diabetes confirmed if 2 readings are above 140
155
Prego: Meaning of ↑↓: Alpha-Feta Protein | Length of test
↑ - neural tube defect ↓ down syndrome 15 - 22 weeks
156
Prego: When to take Group Beta-Strep test
35 - 38 weeks
157
Prego: HIV+ Mom | 3 EDUCATION:
CAN'T deliver vaginally CAN'T breast feed anti-HIV meds OK while pregnant
158
Prego: Rubella titer 2 EDUCATION: 2 SFX:
If negative, give AFTER baby is born Wait 1 month to get pregnant after vaccine Low grade fever, rash
159
``` Prego: Expected weight gain 1st trimester 2nd trimester and 3rd trimester Normal weight Over weight? Under weight? ```
``` 1st = 2 - 4 lbs 2nd/3rd = 12 lbs per Normal = 25 - 35 lbs Over = 15 - 25 lbs Under = 28 - 40 lbs ```
160
Prego: ↑ Calories per day 2nd and 3rd trimester | ↑ Calories when breastfeeding
``` 2nd = 300 - 350 cal 3rd = 450 - 500 cal Bfeeding = 300 - 400 cal ```
161
Prego: Counter to neural tube defects and N/V
folic acid and dry diet (no fluid with meals)
162
Prego: What 4 not to eat? | What to INCREASE in diet?
Alcohol, caffeine, fats, spices | Iron
163
Prego: Ultrasound | Nurse Role:
DO NOT drain blader
164
Prego: Amniocentesis | 3 Nurse Roles:
Drain bladder (getting poked) 15 - 22 weeks to determiner AFP results LS ratio tests for fetal lung maturity
165
Prego: 5 Complications w/ an Amniocentesis
``` Preterm labor Infection Leakage of fluid Amniotic Fluid emboli Hemorrhaging ```
166
Prego: FX: Chorionic Vila Sampling (CVS) When during pregnancy to do Result timing
Sample portion of placenta aspirated through abdominal wall, tests for genetic abnormalities Do at 10 - 22 weeks Results rapid
167
Prego: Scoring: Biophysical Profile (BPP) 5 things it DX:
0 - 10 (↑ 8 OK ↓ 8 = worry about fetal asphyxia) | Reactive FHR, Fetal Breathing movement, Gross body movements, Fetal tone (flexed = good), Amniotic fluid volume
168
``` Prego: FX: Non-stress test Which trimester to do Reactive Result? 2 EDUCATION: ```
``` Measures FHR in r/t fetal movement 3rd trimester FHR normal w/ moderate variability and early accelerations It's non-invasive If the baby ain't moving drink some OJ ```
169
``` Prego: FX: Contraction Stress Test Used for what 3 types of clients? Negative Results Positive Results ```
Invasive used of Oxytocin/Nipple stimulate to see how fetus will tolerate stress of labor Used for pts who are at a HIGH RISK of DM, post-term pregnancies, or had a NON-REACTIVE stress test Negative = good (no late decels on FHR) Positive = late decels w/ 50% or more contractions
170
``` Prego: Placenta Previa (Complete/Incomplete) vs. Abruptio Placenta ```
``` Previa = painless, bright red Complete = Cervix is covered by the placenta Incomplete = partially covered cervix ``` Abruptio = painful, dark red Leading cause of maternal death, IMMEDIATE C-Section/Transfusion necessary!
171
5 R/F Abruptio Placenta
HTN, drugs, tobacco, car accidents, and multi-fetal pregnancies
172
3 TX: Placenta Previa
Bedrest (monitor bleeding) | Steroids to mature babies lungs in preparation of early birth
173
``` Types of Abortions: Threatened Inevitable Incomplete Complete Missed ```
Cervix closed, spotting + cramps Cervix dilated, bulging membrane Cervix dilated, fetal tissue passed + cramps, bleeding GONE!!! Cervix closed + fetus is... still in there? Dilation and Curettage needed
174
2 S/S: Ectopic Pregnancy FX of concern Eliminates which contraceptive? Medication for:
Unilateral stabbing pain in LLQ, referred shoulder pain Fetus implants in fallopian tubes, life threatening IUD (which also ↑ R/F of this coincidentally) Methotrexate to dissolve pregnancy (it inhibits cell division)
175
4 S/S Molar Pregnancy
+Pregnany Test but NO FHR Prune discharge Excessive vomiting Rapid uterine growth
176
3 TX Incompetent Cervix
Sew it up (cerclage) Ultrasound to confirm short cervix Remove cerclage at 37 weeks or at spontaneous birth
177
``` Prego: FX: Hyperemesis 5 S/S 2 Medications: 2 TX + 2 backups: ```
Constant N/V r/in ↓ BP, weight loss, dehydration, electrolyte imbalance, and ↑ SG Ondansetron/Metoclopramide Fluids + Vit B6 Corticosteroids and TPN
178
Babies: PICA
Eating shit | paper, chalk, wood, clay
179
Gestational HTN When occurs: DX:
After 20 weeks | BP ↑ 140/90, 2 times 4 - 6 hours apart in in a 1 week period
180
Mild Preeclampsia | 3 S/S
Elevated BP Protein in Urine +1 Transient headaches
181
Severe Preeclampsia | 7 S/S
BP ↑ 160/100 Protein in Urine +3 Headaches w/ blurred vision Epigastric pain Edema, Hyperreflexia, Ankle clonus
182
Eclampisa
All other preeclampsia S/S + seizures
183
Prego: HELLP Syndrome 3 S/S
Hemolysis - jaundice/anemia Elevated Liver Enzymes - AST/ALT Low Platelets
184
HELLP Syndrome 4 Antihypertensive Medications 1 Anticonvulsant
Methaldopa Nephitopine Hydrolozone Labetolol Mag Sulfate
185
FX: Mag Sulfate Therapeutic Range: Antidote:
Prevent seizures 4 - 8 mg/dL Calcium gluconate
186
4 S/S Toxicity: Mag Sulfate
Ø deep tendon reflexes low respirations ↓ LoC ↓ Urine output
187
``` FX these meds during Pre-term labor: Nephitopine Mag Sulfate Endomethasin Betamethason Tocolytics ```
``` Ca Chnl blocker - ↓ contractions Relaxes smooth muscles of uterus NSAID - blocks uterine contractions Matures lungs ↑ HR and counters beta-blocking agents ```
188
2 DX: Premature Rupture of Membranes (PROM)
Blue result from Nitrozine paper when incontact w/ amniotic fluid +Ferning Test - fluid on slide looks like a fern
189
4 TX Progression: PROM
Check FHR Check for prolapsed cord Monitor for foul smelling discharge NO SEX, NO BATHS
190
5 TX Progression: Prolapses Umbilical Cord
``` Call for assistance Sterile glove to push head off cord Knee to Chest (all fours) Trendelenburg Sterile Saline gauze on exposed portion ```
191
FX: Hyphema
Pooing of blood inside the anterior of the eye that r/in pain
192
ADFX to REPORT: Lamotigine
Rash | Steven-Johnsons @ 2 - 8 weeks TX for a child
193
FX: Presbyopia | R/F:
Far sightedness | Occurs w/ middle/old age
194
Whistling in ear from hearing aid | What to wash it with
Caused by excessive wax obstruction or poor fitting | water
195
R/F Chronic Otitis Media
Chronic nose irritant - nose is connected to middle ear
196
4 EDUCATION: Metoprolol
Take radial pulse daily Don't suddenly stop Chew sugarless gum b/c dry mouth
197
``` Child timings: Sitting unsupported Stranger Anxiety Drinking from cup 2 Words ```
8 months 8 months 9 months 12 months
198
ADFX: Theophylline TX:
"Theo makes my ♥ race" Everything ↑ (Tachycardia) Asthma
199
Dumping Syndrome | 4 Diet ▲s:
HIGH protein and fat LOW-MOD carbohydrate LOW fiber Ø fresh fruits/veggies
200
2 R/F: Widened Pulse Pressure
Aortic Insufficiency | Hyperthyroidism
201
3 S/S ESRF
Restless Leg Syndrome Pruritus Confusion
202
Diet: Pancreatitis
LOW fat
203
TX: Gangrene in lower extremity FX:
Guilliotine | Procedure where the target is drained before amputation
204
FX: Beclomethazone (QVAR) ROUTE: ADFX:
Anti-asthmatic Inhaled White coating in mouth (Candidiasis)
205
3 EDUCATION: Plastibell circumcision
Loose diaper in front Ring will fall off in a week REPORT bleeding Ø petroleum or anything Ø wash penis warm water/mild soap unless healed for 5 - 6 days
206
ADFX: Clozapine Most common 2 Potential EMERGENCY
Tachycardia Anticholinergic + Neck rigidity Agranulocytosis
207
``` Complications of: Heroin Alcohol Cocaine Marajuana ```
Dental Caries Pancreatitis Perforation of Nasal Septum Permanent FX of short-term memory loss
208
Yogurt and OJ r/t Potassium?
HAS IT | Not frozen veggies though!
209
3 components of a Mental Status Examination
Ability to perform calculations Recall ability Level of Orientation
210
3 ADFX to REPORT: Aldronate (Fosamax) EDUCATION with taking:
Jaw Pain Blurred Vision Dysphagia Stay upright fo 30 min post taking
211
ADFX to report: Zileuton (Zyflo) | FX:
``` Anti-asthmatic Abdominal pain (r/t liver damage/hepatitis) ```
212
Child: Age that they use both feet to traverse stairs
3 years old | at 4 they can use both feet separately
213
``` ♥ DX tools for: Degree of damage of MI Location of MI Size of MI Coexistence of Pulmonary Congestion ```
Cardiaac Enzymes EKG Tomography Chest-X Ray
214
Expected urine output/kg/hr: 1 Year old Adults
2 mL/kg/hr | 15 mL/kg/hr
215
``` 5 S/S False Labor: Timing Decreases with... 4? where felt ▲ Cervix ```
Irregular, intermittent ↓ with walking, drinking water, peeing, sleeping Lower back/above umbulicus Ø significant ▲ or bloody show
216
3 Stages of ONSET (1st stage) Labor
Latent Active Transition
217
Onset Latent Labor: Cervix Behavior Breathing
0 - 3 cm Talkative/eager Slow deep
218
Onset Active LAbor: Cervix: Feeling:
4 - 7 cm | Helpless, anxiety, restlesss
219
``` Onset Transition Labor: Cervix Feelings (2) Common S/S Breathing ```
8 - 10 cm Out of control/can't continue + Urge to push/rectal pressure N/V Pattern paced
220
2nd Stage Labor: | If Baby is OP or OA
OP - mom on all fours | OA - OK!
221
3rd Stage Labor: | Delivery of...?
Baby or Placenta
222
4th Stage Labor: Deliver of...? VS ▲?
Placenta | Vitals stabilize
223
``` Labor Pain TX: Lower back pain Opiods Spinal Epidural ```
Sacral Counter pressure Monitor for respiratory depression Monitor for respiratory depression (higher than epi) Monitor for hypotension (counter w/ IV boluses) Position for L side for ANYTHING

Capstone Round 3 (7 decks)

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