extras Flashcards

Question

motion sickness

Answer 1

- anticholinergic medications (diphenhydr**amine** and scopol**amine** SCOPOLAMINE PATCH - apply over 4 hours before starting to travel - **hairless, clean and dry area BEHIND THE EARS** - replace every 72 hours as prescribed - wash hand with soap and water after disposal to avoid accident contant with eyes - keep reach out children and pets to avoid accidental ingestion

Answer 2

dependency = when the abuser get the significant other to do something.. "call my boss and tell him im sick" = abuser gets to keep abusing codependency = when the person being abused calls the boss and tell him "hes sick, he cant come to work" and the person getting abused feels good about doing something positive like "i am a good wife for making the call for him" person being abused keep getting positive self esteem out of it how to treat this: SET LIMITS AND ENFORCE THEM. TEACH THE PERSON BEING ABUSED TO SAY NO!!!

Answer 3

- **all intoxicated clients should be given IV thiamine before being given IV glucose** neuro disorder caused by difficiency in vitamin B1 thiamine ASSOCIATED WITH ALCOHOLISM. - irreversible about 70% - wernicke = encephalopathy = ACUTE - korsakoff = psychosis = CHRONIC psychosis: lose of touch with reality **TREATMENT** = THIAMINE/VITAMIN B1 - preventable & arrestable (stop it from getting worse) **VITAMIN B1 metabolizes glucose to produce energy for the brain** PREVENTABLE ARRESTABLE IRREVERSIBLE **PRIMARY SYMPTOM OF WKS** - amnesia with confabulation (making up stories: they believe the lie) You have a pt who believes he is Ronald Regan’s National Security Officer… And they want to go to a cabinet meeting… :/ WHAT DO YOU DO?!? Redirect!! (“well, why don’t you get a shower and then we’ll go watch CNN and see what the news is in Washington D.C.”)

Answer 4

- caffeine - cocaine - pcp/lsd = psychedelic hallucinogens - methaphetamines (crystal meths) - adderall SING AND SYMPTOMS??? EVERYTHING GO UP = euphoria, tachycardia, restlessmess, irritability, diarrhea, reflexes (3/4). spatic/seizure (SUCTIONING) CAUSES PUPIL DIALATION

Answer 5

- heroin - alcohol - marijuana etc SIGN AND SYMPTOMS?? everything go down. - lethargic, respiratory depression, bradycardia, reflexer 1/2 - AMBU-BAG INHALANTS = slurred speech, loss of motor coordination and nausea

Answer 6

pick ↓ things!! withdrawal on downer means THEY DONT HAVE ENOUGH DOWNER: TOO LITTLE

Answer 7

cocaine is an upper, overdose makes everything go up!! **ANTIDOTE: NALOXONE** irritability - reflex 3/4, increased temp, borborygmi (increased bowel sounds) **COCAINE WITHDRAWAL** - dysphoric mood - fatigue - insomnia or hypersonic - **psychomotor agitation** Withdrawing from cocaine.. -Make sure the RR is above 12! Need NALOXONE!!!

Answer 8

always assume intoxication NOT WITHDRAWAL AT BIRTH You are caring for an infant born to a equaline (pain killer) addicted mother… It is 24 hours after the birth… What do you expect to see.. = INTOXICATION - difficult to console - exaggerated startle reflex - seizure risk (twitching, jitteriness) - hyperactivity - shrill high pitched AFTER THE BABY IS 24 HOURS YOU CAN THEN ASSUME = WITHDRAWAL restlessness is normal for the newborn

Answer 9

every alcoholic goes through alcohol withdrawals 24 hours after they stop drinking - MONITOR FOR (similar to HYPOcalcemia) - **MONITOR FOR HYPOGLYCEMIA since alcohol brings everyhting down** - tremors - hyperactive reflexes - C and T signs - STABLE, NOT LIFE THREATENING but only a small percentage goes in DELIRIUM TREMENS (unstable) which happens a couple days after CARE - regular diet - semi-private anywhere - up ad lib (they can go anywhere they wanna go) - NO RESTRAINS DELIRIUM TREMENS (severe form of alcohol withdrawal) - **dangerous to self and others**

Answer 10

1. hand hygiene 2. withdraw air from the POWDERED vial and inject that air into the liquid and withdraw the liquid (diluent) 3. inject diluent to the powdered vial 4. roll vial between palms of the hand 5. withdraw reconstituited medication from the vial 6. label syringe with medication name and dosage

Answer 11

**WHEN MORE LIKELY TO OCCUR** birth to 3 years. theyre the most vulnerable - girls more likely ELDERLY cognitive impairment - parkison's disease - alhezeimer disease **SUSPECTED CHILD ABUSE** - report any of the following injury FIRST - long bone fracture (femur) - **avoid words like "excessive" and "suspicious" during interveiw because they sound judgemental** you are required to report your suspicions to the appropriate authorities - report them as a nurse even if provider disagrees **AREAS OF ABUSE** - back, buttocks, inside of the thighs, and genitalia. **NEGLECTED CHILD SHOULD HE EVALUATED FOR** the definition of negligence is to fail to care for properly - growth and development - malnourishment - poor hygiene - physical appearance - height and weight

Answer 12

- tension building - violence - honeymoon phase

Answer 13

behavior changes, withdrawal, depression, agitation, hyperarousal, a new display of anger, noncompliance, sexualized behavior, bowel or bladder problems, sleep problems, and unexplained/curious injuries.

Answer 14

decontamination - the solution to pollution is dilution - clothing is removed - chemicals and powders are brushed off - the burn is irrigated with copious amounts of water **immediately after a poison ivy exposure = advise client to thoroughly wash area**

Answer 15

- misaligment of the eyes (one eye deviated inward or outward) = NOT ASSOCIATED WITH IOP TREATMENT - wearing a patch over the stronger eye to develop strength in the weaker eye - **if let untreated loss of visual acuity can occur**

Answer 16

- distruct and suspicion - **they believe peoples motives are malicious and assume others are out to exploit, harm or deceive them**

Answer 17

trough administer peak DO IT FOR a drug WITH NARROW THERAPETUIC WINDOW (what works/what kills) small doses of narrow index can lead to LIFE THREATENING FUROSEMIDE: THERAPEUTI: 10-120 DONT DO TAP but will do it for digoxin and mag sulfate

Answer 18

- bottles containing milk or sugary beverages should not be used as bed time pacifiers = leads to rapid dental caries in the developing teeth - sucking a bottle for an extended periods can also push the jawline out of shape **DENTAL CARRIES** - AVOID fruit juice, simple sugars, sticky foods - rinse mouth with water after meals PROVIDING WATER IN BETWEEN MEALS FOR A CHILD = GOOD! - it accustoms the child with the taste of water - reduce risk of constipation and UTI - helps child maintain healthy weight

Answer 19

depends on the route - sublingual: 5-10 mins - IV: 15-30 mins - IM: 30-60 mins - subQ: diabetes lectures after PO: DON’T WORRY ABOUT IT SITES FOR ID INJECTION - inner forearm SITES FOR SUBCUE INJ - abdomen - posterior upper arm - thigh SITES FOR IM INJECTION - ventrogluteal = RECOMMENDED PLACE = FEWERE LESS BLOOD VESSEL AND NERVES - deltoid - vastus lateralis = KIDS **subcue can be 45 or 90**

Answer 20

continuous BIG Ms like MCDONALDS SIGN VT: WIDE QRS SVT: SKINNY QRS **THIRD DEGREE HEART BLOCK** - also called complete heart block - **decreased cardiact output (dizziness, syncope, mental status, heart failure, hypotension, brady) - any of these symtptons is a high priority

Answer 21

continuos lower case m no pattern

Answer 22

looks like normal sinus rhythym but with "v fib" in the middle

Answer 23

MANIFESTATIONS - low back pain and stiffness - similar to excess scoliosis where head is pointing down - **worse in morning and improve as the day progresses** **INTERVENTION** - promote extension of the spine with proper posture - daily stretching, swimming - **manage pain with moist heat and NSAIDS** - take immunosuppressant and antiinflammatory TREATMENT - NSAID

Answer 24

ventricular depolarization

Answer 25

ends in - TIDINE - PRAZOLE renally excreted and REQUIRES DOSAGE ADJUSTMENT FOR PATIENTS WITH RENAL PROBLEM

Answer 26

low priority - periodic bizzare wide QRS 6 pvc in a min, fall on a t wave = moderate piroity they never reach high priority

Answer 27

use lidocaine NEW: amiodarone

Answer 28

re-establish negative pressure in the pleural space - negative pressure is needed for air exchange because it makes things stick together - pneumothorax (air in pleural space = positive pressure.. put chest tube in to re-establish negative pressure!) PNEUMOTHORAX = collapsed lungs (hyperresonant) - hemothorax (blood= positive pressure.. put chest tube in to re-establish negative pressure!) - pneumohemo (air & blood = positive pressure.. put chest tube in to re-establish negative pressure) **deviated trachea is a medical emergency MANIFESTATION of pneumothorax and its a high priority** WHEN CHEST DRAINAGE STOPS ABRUPTLY - **auscultate the lungs to determine if its because the lung has re-expanded** - have client cough and deep breathe - reposition client (if they been on one position for too long, maya accumulate drainage

Answer 29

in questions like this, first identify what type of chest tube it is. in this case, the question is hemo so blood. what do you expect from a hemo chest tube: drain blood PAY ATTENTION TO THE DISEASE IT WAS PLACED you'll report the chest tube not draining if you flip it to phenumothorax, then youll report no bumbling

Answer 30

Apical = chest tube is way up high ( done to removed AIR cus air rises) Basilar: chest tube is placed at the bottom to remove BLOOD so if they say your apical is draining 300 ml per hour?? BAD - apical tube is not bubbling = BAD - basillar tube is draining 300 ml?? GOOD traumatic pneumothorax, priority is covering wound place with 3 side tapes

Answer 31

apical for the pneumo basilar for the hemo (blood) bilateral pneumo??? = 2 apical chest tubes cus apical is AIR chest trauma? =always assume its unilateral unless specified IF YOU HEARD CRACKLING SENSATION UNDER THE SKIN (crepitus) AROUND WHERE CHEST TUGE IS INSERTED = NOTIFY HCP THATS EMPHYSEMA **subcutaneous emphysema** - air leaked into tissue surrounding the chest tube insertion site - marked by crackling sensation when palpating the skin

Answer 32

NO CHEST TUBE WHY?? pneunonectomy is the removal of the lungs so theres no pleural space therefore you dont need any chest tube to restablish the negative pressure

Answer 33

CLAMP IT so that positive pressure don't get in the pleural space (DON'T CLAMP MORE THAN 15 SECONDS WITHOUT DR ORDER 2. CUT IT AWAY FROM THE BROKEN DEVICE 3. (SUBMERGE) STICK THAT TUBE UNDER STERILE WATER 4. UNCLAMP IT FIRST: CLAMP BEST THING TO DO IF IT BREAKS?? = SUBMERGE BECAUSE IT RESTABLISHES WATER SEAL

Answer 34

FIRST: place a backboard BEST: begin chest compression

Answer 35

FIRST: takes a gloved hand and cover the hole **BEST: cover the incision site with vaseline gauze!!** = TAPED 3 SIDES! NEVER 4 NEVER REINSERT CHEST TUBE = it’s not the RNs job **WHEN DOCTOR IS REMOVING CHEST TUBE = instruct patient to take TAKE A BREATHE IN, HOLD IT AND BEAR DOWN** = VALSALVA MANEUVER. post procedure chest x ray is needed

Answer 36

- appears shy, timid and **WITHDRAWN** - avoids social interaction - inattentive - **monotone loud speech**

Answer 37

- contains water which prevents air from flowing INTO the client - **up and down is seen with inspiration and expiration = normal** - intermittent is normal during coughs **continuous bubbling = bad =indicates leaky** LPN CAN DO THIS *If something is sealed, should you have a continous bubbling? NO IF THE WATER SEAL IS NOT FLUCTUATION, then there may be fit in clots in the tubing = also happens when the lungs is fully expanded - **REPORT drainage of 100 or more an hour from chest tube**

Answer 38

- irrigate daily ONLY FOR DESCENDING COLOSTOMY - wear a colostomy pouch over the stoma to collect feces from the stoma - clarify enteric coated medications with HCP poorly absorbed - tenderness surrounding colostomy may be normal immediately after surgery due to manipulation - paleness, grey tinged may indicate inadequate blood flow - **REGULAR DIET but prevent excess gas by not consuming brocolli and cauliflower. ADHERE TO LOW FIBER DIETS TOO** - pink is normal purple is necrosis and requires immediate intervention **BOWEL IRRIGATION** = CLAMP WHEN IT CRAMP (but leave cone in place) - fill container with 500-1000 lukewarm water, flush irrigation tubing and reclamp - instruct to sit on toilet, irrigation container 18-24 inches above the stoma - **never use enema to irrigate a colostomy, a cone tipped applicator is used**

Answer 39

- prevents constipation - decreases risk of colorectal cancer - promotes weight loss - improves blood glucose control - decreases serum cholesterol levels - reduces risk of coronary artery disease and stroke

Answer 40

1. do NOT clamp longer than 15 seconds without a doctor’s order…. What happens if you break the water seal? CLAMP it! How long do you have to get it under water? 15 seconds, or you gotta unclamp.. - Have sterile water bottles nearby! Use rubber tip double clamps… CLAMPING = cases intrathoracic pressure

Answer 41

- shunts blood from right to left (cyanoitc = B) - R comes before L in the letter trouble - needs surgery, delayed growth, - decreased life expectancy -needs more time in the - hospital/pediatric cardiologist **EXAMPLES OF TROUBLE DEFECTS** all starts with T EXCEPT: left ventricular hypoplastic syndrome - tetrology of fallot - truncus arteriosus - transposition on the great vessels - transposition on the great **arteries** = initiate **ALPROSTADIL** infusion - tricuspid atresia - total anomalous pulmonary venous return (TAPV), ALL HEART DEFECTS WHETHER TROUBLE OR NO TROUBLE HAS - 1. all have murmur why? = because of the shunt of the blood - 2. they all have an echo done

Answer 42

shunts blood from Left to Right (pink) - doesn’t need surgery - normal growth - normal life expectancy - only 24-36 hours in the hospital/pediatrician/NP **EXAMPLES OF NO TROUBLE DEFECTS** - ventricular septal defect = harsh systolic murmur - patent ductus arteriosis = loud machine like murmur - patent foramen ovale - **atrial septal defect = systolic murmur/ fixed split second** - pulmonic stenosis = systolic ejection - **coaractation of the aorta = weak lower and strong upper extremities** **ASD and VSD = down syndrome** **MANIFESTATION OF NO TROUBLE HEART DEFECTS (L-R SHUNT) - heart murmur - poor weight gain - diaphoresis with exertion - signs of heart failure **normal ejection fraction 55-70** ALL HEART DEFECTS WHETHER TROUBLE OR NO TROUBLE HAS - 1. all have murmur why? = because of the shunt of the blood - 2. they all have an echo done

Answer 43

4 DEFECT OF TOF **HEMO AND HEMAT INCREASES** **V**arie**D** **P**icture**S** **O**f **A** **R**anc**H** - VD (ventricular defect) - PS (pulmonary stenosis) - OA (over-riding aorta) - RH (right hypertrophy) - clients with this experiences chronic hypoxemia due to decreased pulm blod flow and curculation of pooorly oxygenated blood, as a result, RBC increases(polycethemia) and results in increased blood viscosity = **report elevated hemo or HEMATOCRIT** - polycethemia is treated with phlebotomy propranolol and sodium bicarbonate may be used much later if necessary INTERVENTION - **mag sulfate and morphine sulfate for TET SPELLS but first put infant in KNEE CHEST POSTION (like mother holding child on chest**

Answer 44

- preffered way of obtaining arterial blood gas sample - determines adequacy of ulnar artery blood flood, circulation to the extremity - **patency of ulnar artery** STEPS - instruct client to make a fist and occlude radial and ulnar arteries using firm pressure - instruct the client to open the fist; palm will exhibit pallor - release pressure on the ULNAR ARTERY. **palm should turn pink in 15 seconds indicating patency of the ulnar artery**

Answer 45

they both psychosis but DELUSIONS: - false fixed idea or belief: **NO SENSORY** COMPONENT (3 TYPES: grandiose, paranoid, somatic (x ray vision) ILLUSIONS - **a sensory experience** - misinterpretation of reality

Answer 46

**FUNCTIONAL NURSING**: involves assigning each nurse with a specific task to perform for the shift. = **FOCUSES ON TASK** **TEAM NURSING**: involves a group of nurses or STAFF being assigned to a limited number or group of patients. - involves RN LPN UAP **PRIMARY NURSING**: requires a nurse to provide care for the same patients during hospital stay **benchmarking**: when a nurse manager compares best practices from other hospitals to improve unit performance

Answer 47

error of glucose metabolism - your body cannot metabolize gluocose well - polydipsia - excess thirst - poluria - sometimes its a lack of insulin - **sometimes the cell has become resistance to insulin** **MONITOR EYES AND KIDNEY FUNCTIONS** **TWO PROBLEMS DIABETIC PATIENTS ALWAYS HAVE** - hyperglycemia - dehydration = polyuria

Answer 48

DOA - diet (most important) - oral hypoglycemic ( metformin ) - activity **DIETS MODIFICATIONS TYPE 2** - caloric restriction: 1200 calories, 1800 - 6 small meals a day **TYPE 2 DIABETES MEDICATIONS** - metformin (hold 24 hours after surgery with die) - THIAZOLIDINEDIONES = carries low risk for hypoglycemia like metformin - increased risk of cardiovascular events **when taking thiazolidediones, MONITOR AND REPORT myocardial infarction and bladder cancer** - bladder cancer = painless hematuria = primary cause is smoking and occupational exposure as second METFORMIN - risk of hypoglycemia is minimal cus it does not increase insulin secretion even when meals are skipped - SHOULD BE HELD 24 hours after a surgery that involved a contrast dye = CAN CAUSE RENAL FAILURE **OTHER NAMES FOR TYPE 2 DIABETES** - non insulin dependent, non ketosis prone - hyperosmolar hyperglycemic state

Answer 49

- polyuria (increased urine) - polydipsia (increased thirst) - polyphagia (technically means swallowing a lot but in the context of diabetes, increased eating) **can lead to retinal detachment** **LOW URINE GRAVITY AND OSMOLALITY** **HIGH SERUM OSMOLALITY** **HYPEROSMOLAR HYPERGLYCEMIC STATE** - TURN IT TO DEHYDRATION ANYTIME YOU SEE HYPERGLYCEMIC HYPEROSMOLAR = HYDRATE HYDRATE HYDRATE - sugar levels >600 - complication of TYPE 2 diabetes - older age - abdominal pain less commoin - severe hyperglycemia happens more slowly and is often not noted until neuro manifestations occur - osmotic diuresis - **more ppl die from hyperglycemic hyperosmolar but DKA is higher priority in the emergency**

Answer 50

recommended to take calcium supplements with vitamin d same way you take iron supplements with vitamin c - take iron pills on empty stomach - use straw for oral suspension to avoid staining teeth

Answer 51

- mosquito borne disease (encephalitis) - occurs mainly in summer during humid weathers INTERVENTION - insect repellent - wear long sleeved, long pants and **light colors** - **avoid outdoor activities at dawn and dusk** when mosquitoes are most active

Answer 52

manufacturer’s expiration date is only good when the bottle is closed... - after it’s open; it expires in 30 days!) *make sure you write the date on the bottle with EXP!* - You should teach patients to refridgerate their insulin at home, but it doesn’t need to be refridgerated in the hospital.

Answer 53

it potentiates insulin = does the same thing as insulin - think of exercise as another shot of insulin EXAMPLE: - the patient exercised = they got another shot of insulin - the patient is going to play soccer this afternoon = the patient is going to get another shot of insulin MORE EXERCISE = MORE INSULIN SO THEY ACTUALLY NEED LESS SHOT OF INUSLIN NOW LESS EXERCISE = NEED MORE INSULIN

Answer 54

- when a diabetic is sick, their GLUCOSE ALWAYS GO UP EVEN WHEN THEYRE NOT EATING THATS WHY THEY STILL HAVE TO TAKE INSULIN - still take insulin, even if they’re not eating - take sips of water; they get dehydrated fast - stay active as possiblme

Answer 55

- betadine is included in the indwelling cather so ASK PATIENT IF THEY ALLERGIC TO IT, if yes switch it secured lower stomach, upper thigh **NOSOCOMIAL INFECTIONS** - acquired at the hospital - most common is UTI followed by surgical site infections, pneumonia and bloodstream infections

Answer 56

- **tangential** = wandering thought but never seems to get to get to the MAIN POINT - **word salad** = mix of words and/or phrases having no meaning EXCEPT TO THE CLIENT = most extreme form of disturbed speech - **associative looseness** = rapid shifting with no connection (topic and ideas are not connected). jumping from one topic to another with no association

Answer 57

- ROA = right occiput anterior - LOA = left occiput anterior - baby front facing the posterior of the mother **FETAL STATIONS** - relationship of the fetal presenting part to the mothers ischial spine (narrowest part of the pelvis) - if the baby cannot fit there, it cannot be born vaginally - negative station: presenting part is above the tight squeeze positive station +4+3,+4,+3 = baby presenting part is below/already made it through the tight squeeze +4+3,+4,+3 can the baby be porn vaginally?? yes cus the baby already made it through the ischial spine **EFFACEMENT** - thinning of the cervix 100% - so a woman begin labor thick and 0 cm and ends labor in fully dilated and efface (10 cm and 100%) **laminaria** is used to efface the cervix **FETAL PRESENTING PART** the part of the baby that enters the birth canal first

Answer 58

kalemias do the SAME AS THE PREFIX, except for heart rate and urine output **peaked T waves** HYPER - brain: irritability, restlessness, agitation… - lungs: tychpnea - heart: low heart rate (bradycardia) - urine: oliguria - bowel: diarhhea, borborygmi - muscles: spasticity - reflexes: +3/+4 - ADDISON clonus = muscle spasm - narrow t waves - end stage renal failure - dka

Answer 59

kalemias do the SAME AS THE PREFIX, except for heart rate and urine output HYPO - brain: lethergy - lungs: bradypnea - heart: tachycardia - urine: polyuria - bowel: constipation - muscles: flaccidity, muscle cramps - reflexes: 1/2 -Cushings: immonosuppressed (needs PRIVATE room) (aldosterone; retain sodium & water; low on potassium)

Answer 60

- **immediately place on humidified oxygen and monitor for aspiration, airway obstruction, respiratory distress** - remain NPO until swallowing fucntions has been evaluated - provide routine oral care as well as instructions on deep breathing and use of incentive spirometer - **side lying prevents aspiration pneumonia** - flex neck (chin to chest when swallowing)

Answer 61

HYPER and its the oppsite of it so everything is DOWN brain: lethergy lungs: bradypnea heart: bradycardia urine: oliguria bowel: constipation muscles: flaccidity reflexes: 1/2 - what do you administer: phosphorus, calcitonin, IV biphosphonates

Answer 62

EVERYTHING GOES UP brain: irritability, restlessness, agitation… lungs: tachypnea heart: tachycardia urine: polyuria bowel: diarhhea

Answer 63

fluid loss that is outside the norm that the patient is usually not aware - insensible fluid loss occurs to every patient through the skin and the lungs DOEST NOT INCLUDE VOMITING AND DIARRHEA cus the patient is away INSENSIBLE = tachy ( with each breath, small amount of fluid is lost in the air and since the patient is not ware = ITS INSENSIBLE

Answer 64

1.3-2.1 oppsoite of prefix brain: lethergy lungs: bradypnea heart: bradycardia urine: oliguria bowel: constipation muscles: flaccidity reflexes: 1/2 **somnolence = excessive drowisness** **treatment: calcium gluconate**

Answer 65

opposite of refix HYPOmagnesium: brain: irritability, restlessness, agitation… lungs: tachypnea heart: tachycardia urine: polyuria bowel: diarhhea muscles: spasms reflexes: +3/+4

Answer 66

- HYPERnatremia: DEHYDRATION *DKA* DI… HHNK? - HYPOnatremia: OVERLOAD *Fluid volume excess* SIADH NUMBNESS & TINGLING (paresthesia) = earliest sign of any electrolyte disorder “circumoral” = numb & tingling lips UNIVERSAL sign of any electrolyte disorder = MUSCLE weakness (paresis) - SODIUM CONTROLS AND MANAGES CIRCULATING BLOOD VOLUME **HYPERNATREMIA MANIFESTATIONS** FRIED and SALTY Fever (low grade) Restlessness & agitation Increased fluid retention Edema: peripheral and pitting Dry mouth Skin flushed Altered LOC & confusion Low urinary output Thirst Elevated blood pressure Decreased energy DEHYDRATED PATIENTS SHOUKD AVOUD - sugar - caffeine - sodium

Answer 67

**FASTEST WAY** but temporary fix - **Give D5W with REGULAR insulin BUT **CALCIUM GLUCONATE IS GIVEN FIRST TO PREVENT FURTHER DYSRYHTMIA AND STABILIZE THE PATIENT** - insulin and dextrose drives potassium into the cell and OUT OF BLOOD - D50 and regular insulin in SEVERE HYPERKALEMIA (>7.0) **PERMANENT WAY** but slow - sodium polystyrene (Kayexalate) = it switches the potassium with sodium) = switching from a life threatening imbalance (HYPERkalemia) for a non-life threatening imbalance (HYPERnatremia) = JUST HYDRATE AFTER THIS!! hydrate!!* - **CLIENTS RECEIVING SODIUM POLYSTYRENE MUST HAVE NORMAL BOWEL FUNCTIONS TO AVOID THE RISK OF INTESTINAL NECROSIS = access for constipation, impacttion and recent bowel patterns**

Answer 68

GOAL IS TO REDCUE - itching - erythema - dry skin INTERVENTION - **reduce itching** - apply emollient soon after birth - give oral antihistamine before bed to relieve itching which is worse at night - keep child nails short and trimmed - **long sleeves should be worn at night in soft clothing like cotton** - rough fabrics can cause itching and sweating

Answer 69

ask a second nurse to attempt to start the IV

Answer 70

- highly effective in treating severe depression especially in thosr **HIGHLY SUICIDAL** - also used in clients that does not respond to medications DUIRNG ECT - pulses of electrical energy is sent through electrodes applied to the scalp = can cause brief convulsion - **general anesthesia and a skeletal muscles relaxant is adminstered to prevent SEIZURE and musculoskeletal injury** - medication is given with ECT for imporved outcomes SIDE EFFECTS - the patient is not supoosed to feel anything from the procedure but **confusion and memory loss are COMMON SIDE EFFECT** ELECTROENCEPHALOGRAM (EEG) = used to diagnose prescence of seizure disorder - **wash hair with shampoo before the procedure** to remove oils and other hair care products not painful and avoid caffeine - no pain is felt and no sedation is needed

Answer 71

medical emergency from partial/ subtotal thyroidectomy **MANIFESTATIONS** - super HIGH temps (105 & >) - extremely HIGH BP’s *ex: 210/180 (**stroke category**) - severe TACHYCARDIA (ex: 180-200) - **PSYCHOTIC DELIRIUM** **INTERVENTION = bring temp DOWN and oxygen UP** SEQUENCE: oxygen, cooling blanket - ice packs - cooling blanket = best - **never leave patient alone by themseleves** - OXYGEN PER MASK AT 10L PER MINUTE **DO NOT USE ACETAMINOPHEN**= it works in the hypothalamus and **isn’t going to work at this time**

Answer 72

LOW FIBER DIET - connects small intestine to the external abdomen - stools from the small intestine bypasses the colon and exit through the ileostomy = results in liquid stools **REPORT** - abdominal bloating - nausea vomiting - decreased stool - these symptoms indicate bowel obstruction or obstructed ileostomy **INTERVENTION = LOW FIBER DIETS** - it helps prevent obstruction of the narrow lumen of the stoma - client should be advised to chew food thoroughly AVOID - popcorn - brown rice - multigrain bread - fruits with seeds like strawberry, olives - **after the ileostomy heals, introduce fiber foods one at a time**

Answer 73

- **regression**: a teenager experiences episodes of wetting bed after being bullied - **sublimation**: channeling energy from unacceptable things to acceptable actions - **repression**: after going through something traumatic, person cannot remember details of the event (keeping thoughts in the unconcious - **rationalization**: using excuses to justify soemthing - **projecting**: unconsciously placing one own thoughts or feelings onto someone else - **reaction formation**: expressing opposite feelings of ones true feeling (parent becoming over protective of unwanted child) - **introjection**: a person who never liked working out dates. a personal trainer and now goes to the gym everyday -**displacement**: angry with the boss at work, comes home and yells at the spouse** - **transference**: you are just like my mother, bothering me with all these questions **PSYCH TERMS** - **splitting**: inability to view both positive and negative aspects of others as part of a whole - **histrionic**: likes to be center of attention, exagerrated emotional expression - **schizoid personality**: social detachment and inability to express emotion - agraphobia = intense fear and axiety about being in certain situations or spaces (train, crowds, outside the home alone, enclosed space) - so you either view someone as either a wonderful person or horrible person - **factitious disorder**: serious mental disorder in which someone deceives others by appearing sick **resilience**: protective factor that is strengthened by practicing positive coping skills such ass **deep breathing, journaling, muscle relaxation** **DELUISIONS** - nihilistic: it doesnt matter if i take this med, im already dead - somatic: the doctor said im fine but i have lung cancer - reference: believe that songs, newspaper articles and other events are personal and significant to them **ILLUSIONS** - falsed sensory - misinterpretation of reality

Answer 74

- progressive neuro loss of motor neurons - glutamate excess MANIFESTATIONS - difficulty breathing - limb/ muscle weakness - **dysarthria = difficulty speaking** = greatest priority - dysphagia - RESPIRATORY NO CURE but **RILUZOLE IS THE ONLY MEDICATION APPROVED FOR ALS TREATMENT** = slows down disease progression **TREATMENTS FOCUSES ON** - resp function - adequate nutrition = they have difficulty eating - quality

Answer 75

- group of infections that causes **fetal abnormalities** - **T**oxoplasmosis - **O**ther (parvirus, varicella) - **R**ubella - **C**ytomegalovirus - **H**erpes simplex virus **gonorrhea and chlamydia are leadin causes of pelvic inflammatory disease**

Answer 76

- NO SMALL TOYS for children UNDER 4 years (could put in mouth/aspirate) -NO METAL (die-cast) TOYS, if OXYGEN is in use.. (sparks!) -BEWARE of FOMITES (NON-living object that harbors micro-organisms) What toys are the worst for FOMITES = Stuffed animals cus its hard to clean What toy is the best for FOMITES? Hard plastic toys/you can disinfect it! *BEST toy for an IMMUNSUPPRESSED child? HARD PLASTIC action figure!

Answer 77

best toy: musical mobile = stimulates motor sensory 2nd best toy = something soft (so they dont hurt themselves) large (so they dont choke) they can’t sit up and reach for the musical mobiles yet **6-9 MONTHS WORST** - musical mobile, WHY? they can sit up/reach up and then can stranglate themselves but musical mobile is the best for birth to 6 months

Answer 78

**PARALLEL PLAY = PLAY ON THEIR OWN but still around eachother** - they play next to each other and are happy to be in the presence of peers but they do not play directly with one another - not interacting - independent don’t wanna play with anybody EXAMPLES - - **stacking blocks** - acitivitiws such as playing with dolls, toys cars, pushing and pulling large toys, smearing paint, digging in sand box **BEST TOY: push/pull toys** - work on GROSS MOTOR = running, jumping - imitates NORMAL OBSERVATIONS - temper tantrums is their way of relieivng stress =use time outs and offer quiet environments - they experience phenomenal growth of language skills - they say "no" to express their **independence** - picky about their food choices so expose them to new foods repeatedly - avoid forcing foods on them = poor eating habits in the future - offer food 15 minutes after play periods = promotes better eating habits NO FINGER DEXTERITY YET = cant color, use scissors - molding clay = **“Finger painting”?? yes, because they can use their HAND!** = Finger painting = HAND painting

Answer 79

- Peer Group Association (hang out with their friends) Question (pertaining to Nursing): Do you let 5-8 adolescents hang out in a room together? YES!! UNLESS these 3 things: - if anyone is fresh post-op (less than 12 hours out of surgery) - if anyone is immunosuppressed - if anyone has a contagious disease.

Answer 80

- also known as decompression surgery why do we do this?? = RELIEVE NERVE ROOT COMPRESSION - ENLARGES YOUR SPINAL CANAL TO RELIEVE PRESSURE ON THE SPINAL CORD OR NERVES - 3 LOCATIONS = cervical (neck), thoracic (upper back) & lumbar (lower back)

Answer 81

3 PS - pain -paresthesia (numbness & tingling) -paresis (muscle weakness)

Answer 82

THE LOCATION = cervical, thoracic and lumbar - cervical; diaphragm… #1 answer = check out their breathing… #2 answer = check out the function of their arms & hands. - thoracic; cough & bowels… #1 answer = check how well they cough - lumbar; bladder & legs… #1 answer = is their bladder distended or empty… #2 answer = how is the function of their legs

Answer 83

- cervical spinal cord intervates diaphragmn and arms so two things to check for #1 BREATHING #2 the functions of the arms and hands **COMPLICATION** - trouble breathing = pneumonia

Answer 84

#1 = cough mechanisms = check how well they cough #2 = bowels thoracic spinal cord intervates the abdomen and gut ONLY LAMIECTONY WE CAN USE A CHEST TUBE FOR **COMPLICATIONS** - thoracic = trouble coughing = PNEUMONIA - paralytic ILEUS (because bowels wont work)

Answer 85

#1 bladder = is their bladder distended or empty #2 legs = functions of their legs **COMPLICATIONS** - lumbar = URINARY RETENTION - problems with the legs

Answer 86

- do NOT dangle them (sit on the edge of the bed) - do NOT sit for longer than 30 minutes - they may walk, stand & lie down without restriction

Answer 87

- do NOT dangle them (sit on the edge of the bed) - do NOT sit for longer than 30 minutes - they may walk, stand & lie down without restriction

Answer 88

they take a bone graft from the iliac crest - If you remove the disc, you have to get bone from somwhere = so there isn’t bone on bone (grinding)! = So, there will be 2 incisions; spine & hip; the most pain will be at the hip IF YOU REMOVE DISK, GOTTA DO A FUSION!!!! get the brone from somewhere = commonly on the hip spine & hip; the most pain will be at the hip - most bleeding and drainage = at the hip = will have JP drain - highest risk for infection?? BOTH the spine and hips - highest risk of rejection?? THE Spine Surgeons are using bones from cadavers quite a bit to lower infection rates..

Answer 89

**TEMPORARY** - do NOT sit longer than 30 minutes (6 weeks) - lie flat & log roll (6 weeks) - NO driving (6 weeks) - do NOT anything more than 5 lbs; gallon of milk (6 weeks) IF YOU HAVE TO GUESS WHEN SOMETHING SHOULD BE RESTRCITED AND YOU DONT KNOW?? = ALWAYS PICK 6 WEEKS Remember: MOST IMPORTANT thing to pay attention to in *any* NEURO question = LOCATION! **PERMANENT** -NEVER pick up object by bending at the waist; lift with the knees!! - CERVICAL LAMIECTOMY can NEVER lift anything over your head (for life!) -NO mountain biking, jerky moving ride (rollercoasters), horseback riding, etc.

Answer 90

- HOLD all potassium - ASSESS the heart - Prepare to administer (kayexalate, D5W & regular insulin) - CALL DOC Remember: if the potassium is = or > than 6 = deadly serious; pt could DIE, in like the next 2 minutes. SO WHAT DO YOU DO?? HOLD all potassium ASSESS the heart PREPARE (kayexalate, D5W & regular insulin) CALL doc ***STAT!!! get everyone involved & YOU stay with your PT*** HAVE OTHER PPL INVOLVED CUS EVERYHTING GOTTA BE DONE STAT or they could die in the next two minutes

Answer 91

7.35 - 7.45 - pH in the 6 is a HIGH PRIORITY what to do?? (remember: hold,assess,prepare,call) but in this case, nothing to hold and give so... - ASSESS vital signs cus pH going down means patient is going down. get these first before calling the doctor cus they'll ask for it = is he breathing? is he alive? - CALL doc and get them there STAT

Answer 92

DEHYDRATION is a good answer. ALL BLOOD VALUES GO UP WHEN YOU DEHYDRATED

Answer 93

SIDE EFFECTS - itching and nausea are expected adverse effects - can lead to hypotension - **teaching about constipation is essential. to prevent long term complications** - CLIENT FALLING ASLEEP IN MIDDLE OF TAKING INDICATES OVERSEDATION AND REQUIRES INTERVENTION INTERVENTION - defecate when urge is felt - drink 2-3 L a day - high fiber diet - exercise MED: use of a stool softer(docusate) and a stimulant (senna) SIMULTANEOUSLY when a person is in pain, pick UP things MATERNITY - opiods are safe for clients who will give birth 2-4 hours after amdnistration so that the effects wear off before birth - **best for clients in active labor with well established contraction cus opiods may slow labor progression in the latent phase** - avoid in clients who are close to giving birth such as already feeling the urge to push AVOID MORPHINE IN - people with head injury cus it can lead to increase ICP

Answer 94

HEART RATE will speed up first and when the heart can no longer compensate for it, the respiratory rate go up - if you ever work CORONARY care, what are the 2 most common causes of episodic tachycardia in heart pt’s? HYPOXIA & DEHYDRATION

Answer 95

When the O2 & the CO2 are both in the 60’s **NROMAL** pO2 is 78-100 pCO2 is 35-45 **pO2 in 70s** 78-100 = this the oxygen from ABG not the pulse ox - if its low but still in the 70s - ASSESS for respiratory status - PREPARE to give oxygen ( yes you can do this without an order ) - 9/10 it'll correct it and wont need to call the DOC **pO2 in 60s** nothing to hold so - ASSESS respiratory status - PREPARE to intubate and ventilate - CALL respiratory and call the DOC **most reliable method for confirming placement is intubation is to observe for CO2 exhalation using a CO2 detector**= CHEST RADIOGRAPH you can put oxygen on them at that time and its not gonna solve the problem but it'll make them a little calm - ex: (click & drag question) = THROW on O2, ASSESS, PREPARE to intubate/ventilate & then call respiratory/doc.. **CO2 IN 60s** - medical emergency = RESPIRATORY FAILURE remember hold,assess,prepare and call so what to do?? - ASSESS respiratory status - PREPARE for INTUBATION/VENTILATE - CALL respiratory therapy first, then CALL the doc. (YOU stay with YOUR pt!!!)

Answer 96

- wound healing complication = wound separates **COLLECTING WOUND CULTURES** - apply bacitracin ointment after collecting wound culture - cleanse the wound gently by flushing it with normal saline HOW TO PREVENT DEHISCENCE AND PROMOTE WOUND HEALING - post op nausea and vomiting should be treated asap to prevent dehiscnese and evisceration - **heaving (retching) and nausea is a priority** - stool softners (docusate) to prevent straining and constipation and easy passage of stools - antiemetics to prevent the straining that occurs during vomitting - abdominal binder to support the incision during cough, moving - **ensure client has effective pain relief before performing coughing exercises** - monitor blood sugar levels to promote wound healing - splinting the abdomen by holding a pillow or folded blanket against the wound when coughing and moving - **incorportate adequate calories and protein intake** EVICERATIONS - **put them in low fowler position with knees bent/flexed** = LESSENS ABDOMINAL TENSION on the suture line to prevent further evisceration LOW FOWLER POSITION RELAXES AND REDUCES ABDOMINAL MUSCLES TENSION

Answer 97

140k-450k - less is thrombocytopenia - more is thrombocytosis - platelet count BELOW 90,000 is a priority BUT… - platelet count BELOW 40,000 is HIGHEST PRIORITY - platelets are essential for proper blood coagulation - decreased platelets = more bleeding

Answer 98

**filgrastime is prescribed to stimulate neutrophil production or when client has infection and more neutrophils are needed to fight it** - wbc below 5000 **(normal 5-11K)** - ANC below 500 (normal 1500) - CD4 below 200 (normal 500-1500) **CD4 count: needs to be above 200 = when below 200, this is when HIV goes into AIDS** what to do for such patients?? - **ASSESS for signs of infection & place them on NEUTROPENIC precautions!** NEUTROPENIC PRECAUTIONS - private room **mask on when leaving their room** - strict handwashing - avoid exposure to people who are sick **avoid all fresh fruits, vegetables and FLOWERS** - ensure that all equipments has been disinfected EVEN A LOW GRADE FEVER SHOULD BE REPORTED IN THESE POPULATION

Answer 99

- mood elevators, used for neuropathic pain - amiTRIPTYLINE = neuropathatic pain relieving effects - norTRIPTYLINE - **IMIPRAMINE (Tofranil)** - imipramine can be prescribed for nocturnal enuresis (bed wetting) **TAKE NOTE** - photosensitivity - anticholinergic effects - cardio vascuslar effects (hypotension) MONITOR SUICIDAL IDEATIONS IN CLINETS TAKING ANTIDEPRESSANTS **SIDE EFFECTS** A = anticholinergic (dry mouth) B = blurred vision C = constipation D = drowsiness E = euphoria *The pt must take these for 2-4 weeks before they see beneficial effects!*

Answer 100

- often seen in typical antipsychotic drugs (**haloperidol**, fluphenazine) MANIFESTATIONS - high fever (pyrexia) 106-108 - muscle rigidity - increased muscle enzymes - NMS can also cause anxiety & tremors; just like EPS (like Parkinsons) **Make sure that the dose for an ELDERLY pt is HALF the adult dose** TREATMENT - discontinuation the antipsychotic medication and notify HCP - supportive care **DIFFERENCE BETWEEN NMS AND EPS** TEMPERATURE (if 102 and above call RAPID RESPONSER) **extrapyramidal symptoms (EPS)** = - treated by **BENZTROPINE** - side effect (NO big deal) - anticholinergic used to treat extrapyramidal symptoms - side effects = **dystonia (abnor muscle movem) and parkinson symptoms** **NMS = medical EMERGENCY; pt could die (HUGE big deal!**

Answer 101

24-hour biological clock that is primarily one that functions best with daytime wakefulness/activit - melatonin helps the body adjust to new surroundings

Answer 102

- it interferes with the cytochrome p450 system (in the liver) responsible for breaking down and deactivating the drugs in the liver = other drugs do not get metabolized SO - **if you have a patient on sertraline & other drugs, then the other drug doses need to be lowered** - watch for interactions with ST. JOHN’s WART (can get serotonin syndrome; SADH: sweat, apprehensive (impending sense of doom!!), dizzy & headache) LIVER DISEASE = MILK IS GOOD FOR IT

Answer 103

28 pounds +/- 3 so 25-31 **ESTIMATED DUE DATE** last menstrual period + 7 days MINUS 3 months

Answer 104

1 pound each month 1st trimester is 3 months so that means she gains 3 pounds the whole first trimester. so if they give you a woman who had a sig amount of weight gain in the first semester= BAD 2ND TO 3RD TRIMESTER = she gains 1 pound every week! CALCULATING IDEAL WEIGHT: weeks of gestation - 9 **a woman is in her 28th week she has gained 22 pounds, what is your impression** - take the gestational and substract by 9. so 28-9 = 19 pounds she shouldve gain. she gained 22 pounds which is 3 more than she shouldve = ASSESS HER 3 pounds off = ASSESS HER 4 pounds off = TROUBLE **a woman is in her 31st week she has gained 15 pounds, what is your impression** - take the gestational and subract by 9 (31-9) = 22 - she should've gained 22 pounds but she gained 15 so the baby mustve died

Answer 105

it starts from the symphysis pubis and make its way towards the xiphoid process as the week progresses - **after 20 weeks the fundal height correlates to the weeks of gestation** fundus = upper part of the **uterus NOT PALPABLE UNTIL WEEK 12 (first trimester) = mother the priority** \WHEN DO YOU PALPATE THE FUNDUS 2nd trimester: the fundus is at the umbilicus (the belly button) = 20-22 WEEK OF GESTATION = mother the priority 3rd semeter: fundus is above the umbilicus = BABY THE PRIORITY **why is that important for the nurse to kno = fundal height can be used to determine lenght of pregnancy = AFTER 20 WEEKS** **FUNDAL HEIGHT POSTPARTUM** - fundal height = days postpartum MAKE SURE ITS MIDLINE - 4th postpartum day: 4 below on the 4th day..

Answer 106

during pregnancy, intense itching of the hands and feet that worsens at night but no rash is a priority = liver disorder called intrahepatic cholestasis or pregnancy **POSITIVE** - fetal skeleton on x ray - fetal presence on ultrasound - auscultation of a fetal heart rate - when the examiner palpate (NOT MOM) **PROBABLE** **C**HADWICK - cervical color change to cyanosis (blue) = ALL STARTS WITH C **GODDELL= cerivcal softening** **HEGAR = uterine softening** **all urine and blood pregnancy tests (a lot are false positive cus it just means you have the hormones** = DOESNT CONFIRM PREGNANCY **ballotement test: used to detect solid objects surrounded by fluid in the** **BRAXTON HICKS** - tighthening in your abdomen that comes and go - NOT REAL CONTRACTIONS OF LABOR

Answer 107

- CAREFULLY read your question as follows. using FETAL HEART as an example in this 1. when would you FIRST ausculate a fetal heart = 8 weeks 2. when would you MOST LIKELY = 10 weeks 3. when should you BY = 12 weeks - when they say FIRST = pick the earliest part of the range - when they say MOST LIKELY = pick midpoint of the range - when they say SOULD BY = pick the end of the range

Answer 108

16-20 week its a range question so use the range approach FIRST FEEL IT = 16 weeks MOST LIKELY FEEL IT = 18 week WHEN SHOULD YOU BY? = by 20 week

Answer 109

- once a month until week 28 (first, second and little bit into 3rd trimester) - at 28 weeks, come in every 2 weeks until week 36 - at 36 come in every week until delivery or week 42 **when a womman comes in for her 12 week check up, when should she be scheduled to come in again** - 16 weeks why? once every month until 28 weeks **when a womman comes in for her 30 week check up, when should she be scheduled to come in again at** - 32 week why? = every 2 weeks from 28th week to 36 weeks **when a womman comes in for her 37 week check up, when should she be scheduled to come in again at** - 38 weeks why? she comes in every week from week 36 to birth

Answer 110

hemoglobin levels will fall due to INCREASE IN PLASMA normal for woman is 12-16 - first trimester can fall to 11 and be perfectly normal - 2nd trimester, it can drop to 10.5 and be normal - 3rd semester, it can drop all the way to 10 and be normal if less than 9, assess them for symptoms of anemia

Answer 111

- treat with carbs BEFORE YOU GET OUT OF BED not for breakfast - FOODS OR DRINKS CONTAINING GINGER - **vitamin b6** - drink small sips of liquids throughout the day rather than large amounts with meals - **nausea and vomiting is related to high levels of estrogen and hCG** **HYPEREMESIS GRAVIDARUM** - hypokalemia/hyponatremia - **ketonuria** - hemoconcentration - metabolic alkalosis - increased urine specific gravity **GIVE VITAMIN B9(folate) prior to pregnancy to prevent neural defects**

Answer 112

1st and 3rd trimester problem - how to treat it? = VOID EVERY2 HOURS - you don't get it during 2nd trimester because at that time, the baby is up high not on the bladder **INCONTINENCE IN GEENRAL** - having them void every 2 hours is key over kegel exercises - kegel exercises takes 6 weeks

Answer 113

**DIFFICULTY BREATHING** = TEACH THEM TRIPOD POSITION 2nd and 3rd trismetser problem **BACK PAIN** - PELVIC TILT EXERCISE (lying supine and raising pelvic) - place leg on stool **BACK PAIN DURING LABORING** - position then push - what position: KNEE CHEST - what do you push: put your fist and push inside her sacrum, that applies counterpressure that relieves pains

Answer 114

- may experice cross sensitivity to cephalosporin (**cefazolin, cephalexin, ceftrixone**) antibiotics = DRUG MOLECULES ARE STRUCTURALLY SIMILAR **cefazolin(bone penetrating) is usually given before and after surgery to prevent infection** INTERVENTION **the nurse must first assess the type of reaction a client had to penecillin drugs when instructed to give a cephalosporin** **CLIENTS WITH PENICILLIN ALLERGY SHOULD BE DESENSITIZE TO RECEIVE APPROPRIATE TREATMENT** CEPHALOSPORINS - **contraindicated for clients with history of anaphylactic reactions to penicillin** - BUT CAN BE GIVEN WITH A HISTORY OF MILD ALLERGIC REACTION LIKE A RASH **TETRACYCLINES** has cycline in name - **DONT TAKE WITH FOOD, JUST FULL GLASS OF WATER** - AVOID IN PREGNANCY - **take on empty stomach. 1 hour before or 2 hours after food** - avoid antacid and diary products - DON'T TAKE AT BEDTIME - use sunblock (photosensitivity) - use additional contraceptive techniques **PROLONGED HIGH DOSE OF ANTIBIOTICS LEADAS TO ORAL CANDIDIASIS**

Answer 115

the relationship between the spine of the mother and the spine of the baby - basically position of the baby - mom spine and baby spine parallel = GOOD baby is coming out **SUPINE HYPOTENSION IN PREGNACY/ AORTOCAVAL COMPRESION** - when mom is laying supine, it causes the uterine to fall on the aorta and vena cava - treatment is elevation and support = moves the uterus to the side

Answer 116

stage 1 = labor (phases: latent, active, transition) stage 2 = delivery of the baby stage 3 = delivery of the placenta stage 4 = recovery (last for 2 hours) **POSTPARTUM** - 2 hours after the delivery of the placenta NOT WHEN THE BABY COMES OUT - first 8 hours of postpartum, orthostatic hypotension is regular = instruct client to get out of bed slowly and ask for help when ambulating **STAGE ONE: LATENT LABOR** - dilate 0-4 centimeters - frequency 5-30 minutes apart - last 15 to 30 seconds - intensity = MILD **STAGE ONE: ACTIVE LABOR** - dilation 5-7 cm - frequency: every 3 to 5 minutes - last 30-60 seconds - intensity: MODERATE (our word not mom) memorize this then anything below will be latent and anything above will be transition **STAGE ONE: TRANSITION LABOR** - dilation 8-10 cm - frequency 2-3 minutes - last: 60-90 seconds - intensity: STRONG **EXPECTED MANIFESTATIONS OF TRANSITION LABOR** - perineal/rectal pressure - nausea and even vomiting - trembling/shivering - increased pain and fear - irritability and self doubt PROVIDE EMOTIONAL SUPPORT = **provide encouragement and coaching in breathing tecniques** **contractions should not be longer than 90 seconds or closer than every 2 minutes** HOW DO YOU KNO A WOMAN IS IN TROUBLE DURING LABOR - when contractions are longer than 90 seconds and closer than every 2 minutes = WE DO NOT WANNA SEE THAT - ITS CALLED UTERINE TETANY **ASSESSMENT OF CONTRATCIONS** - if client arrives at the hospital in second stage labor, the nurse rapidly assesses whether birth is imminent = **apply gloves and assess perineal to determine if birth is imminet before applying other measures** PECIPITOUS BIRTH = **when labor lasts less than 3 hours from contraction onset** **STRENTH OF CONTRACTIONS** = 25-50 mm hg - intensity = purely subjective 25-50 mm hg - should not exceed 80mm hg RESTING TONE - average 10 mm Hg should not exceed 20 mm hg

Answer 117

treat with LION - Left Side - IV (increased IV) - O2 - Notify physician **if client expericnes nausea and lightheadness, it may inidcate hypotension but first you need to confirm before implementing LION** LPNs can do all those except increase the IV **you use LION method for any complication with the exception of PAINFUL BACK AND PROLAPSED CORD** in OB crisis, if pitocin is runnin, STOP IT. if it states pit is running, then you do that first before LION **AFTER RUPTURE OF MEMBRANE: PRIORITIZE ASSESSING THE FETAL STATUS VIA ASSESSMENT OF FETAL HEART TONES** - nitrazine paper is used to measure the ph of the fluid

Answer 118

1. deliver the HEAD 2. suction the mouth then the nose.. 3. check for a nuchal cord (around the neck) 4. deliver the shoulders & the body 5. the baby MUST have an ID band on before it leaves the delivery area **DELIVERY OF THE PLACENTA** - make sure it is INTACT - make sure the cord has 3 vessels (AVA; 2 arteries & 1 vein)

Answer 119

stage 1 = labor (phases: latent, active, transition) stage 2 = delivery of the baby stage 3 = delivery of the placenta **stage 4 = recovery (last for 2 hours)** recovery = 2 hours after the placenta comes out **you do 4 things, 4 times per hour so basically ever 15 minutes** 1. VITALS signs = assessing for sign and symptoms of shock (BP go down, rates go up, pale, cold and clammy) 2. check the FUNDUS = boggy massage it till it’s firm/// displaced = catheratize it = HAVE THEM EMPTY BLADDER FIRST - **full bladder than cause fundus to be displaced** 3. check the PADS = if she's bleeding excessively, she will saturate a pad in 15 mins or less. has to be 100% saturated 4. ROLL her over = check for bleeding

Answer 120

WEBBER TEST - tuning fork - conductive hearing loss: louder in affected ear -sensoriurineal hearing loss: louder in unaffected ear CONDUCTIVE: caused by obstruction in the ear including excessive cerumen, water, foreign body **rinne test** = CONDUCTION SENSORINEURAL: caused by prolonged exposure to noise, ototoxic substances (amninoglycosides), diabetes mellitus, presbycusis (age-related hearing loss) EAR IRRIGATION (impacted cerumen) - assess the cleint for fever, ear infection or tympanic membrane injury = **those symptoms are contraindications** - place client in sitting position with head tilted towards the affected ear - place towel and an emesis basin under the affected ear - straighten ear canal by pulling up and back the pinna - gently irrigate the ear canal with a slow, steady flow of solution **stop immediately of the client experinces severe nausea, or dizziness** **PINNA** - up and back for 3 years and older - down and back for less than 3 **have clients lay prone or supine with head turned to the appropriate side**

Answer 121

every 4-8 hours depends on if they stable or not BUBBLE HEAD (3 big things are Fundus, Lochia and Extremity check) - B: breast **Uterine fundus = needs to be FIRM *if boggy = massage* *if not midline or displaced = catheratize them. have them empty bladder first* - Bladder - Bowel - **Lochia** = rubra (1st = red) - Episiotomy (incision) - Hemoglobin/hematocrit - **Extremity check** = looking for thrombophlebitis = bilateral calf circumference measurements - Affect - Discomfort **LOCHIA** RUBRA = red SEROSA (rose) = pink ALBA (albino) = white - 4-6 inches on pad = okay saturate a pad 15 mins or less = bad

Answer 122

patient usually passes only liquid stool becuase thats the only thing that gets to pass through the impecation site PERFORATED BOWEL = RIGID BOARD LIKE ABDOMEN = PERITONITIS = MEDICAL EMERGENCY AND IS THE HIGHEST PRIORITY peritonitis = elevated wbc

Answer 123

TOCOLYTICS (terbutaline and mag sulfate) = STOPS LABOR - **terbutaline = cause maternal tachycardia (speeds moms heart rate)** - magesium sulfate = stops labor (fetal contractions) HYPERmagnesium and we know magnesiums do the oppsoite of the prefix so ehat happens?? **LOWERS heartrate, BP, reflexes, respiratory rate & LOC** **OXITOCITY (oxytocin and methylergonovine) = stimulates and strethens labor** - oxytocin = it can cause uterine hyperstimulation longer than 90 seconds and closer than every 2 minute - **methergine = can cause HBP**so its contraindicated in clients with high blood pressure **OXYTOCIN** - administered through a secondary IV line - proximal port (distal is distance towards down, proximal is going up) - electronic fusion pump - initiated at the lowest dose and titrated until contractions are 2-3 minutes and last for 80-90 seconds - prevents hypotension **UTERINE STIMULATION FROM OXYTOCIN INCREASES THE RISK OF** - placental abruption - uterine rupture - abnormal or indeterminate fetal heart rate patterns - uterine tachysystole - postpartum hemorrhage

Answer 124

**TRUE LABOR** - regular contractions, frequency, duration and intensity increase over time -**discomfort begins in LOWER BACK and RADIATES TO ABDOMEN** with contractions - contractions increase despite comfort measures **FALSE LABOR** - braxton hick - tightening in your abdomen that comes and go - **expulsion of mucous plug in days preceding labor is NOT A SIGN OF LABOR**

Answer 125

- betamethasone = STEROID - survanta/beractant = surfactant they are both given to make the baby lung mature faster **BETAMETHASONE** - it’s a steroid given to the MOTHER. - its given IM - it is given BEFORE the baby is born **SURVANTA/BERACTANT** - it is given to the BABY - it is given trans-tracheal (blown through the trachea:nebulizer) - it is given AFTER the baby is born

Answer 126

- CLEAR before CLOUDY boards uses Clear = R Cloudy = N **HUMALIN 70/30** - an insulin that combines the short action of regular human insulin (Humulin R) and intermediate of Humulin N N = 70% R = 30% N is in the Numertaor **MIXING INSULIN IN SAME SYRINGE = NRRN** - Add air to cloudy (intermediate-acting) insulin. N - Add air to clear (short-acting) insulin. R **AND FLIP** - Withdraw clear (short-acting) insulin first. R - then cloudy (intermediate-acting) insulin

Answer 127

When choosing sizes: the clue is in the abbreviation! Look at the first letter & then go find those #’s!! **I**M: 2**1**g & 1" (the "**I**” in **I**M looks like a **1**) = **VASTUS LATERALIS MUSCLE ( newborns and infants)** **S**UBQ = 2**5**g & **5**/8" (the "**S**" in **s**ubq looks like a **5** **for infants do not on the gluteal cus they dont have enough muscle there yet** **MEDICATION FROM AN AMPULE** - use filter needles to prevent aspiration and injection of glass shards - after the filter needle is discarded, 20 gauge, 1 inch is attached to the syringe **INTRADERMAL = 5-15 DEGREE ANGLE** - apply firm pressure to the injection site to prevent bleeding - dont massage site **SUBCUTANEOUS** - 90 degree angle if 2 inches of subcue tissue can be grasped (obese people) - **DO NOT EXPEL THE AIR BUBBLE PRIOR TO ADMINISTRATION IN PREFILLED SYRINGES** - 45 degrees if only 1 inch of subcue tissue can be grasped **INTRAMUSCULAR** - preffered site **ventrogluteal due to fewer large blood vessels and nerves** - position patient supine, prone or side lying with the knee and hip flexed - **flexing the knee and hip reduces muslce tension and improve access and promote client comfort**

Answer 128

- VTE, DVT = **does not dissolve clots** - HEPARIN is given IV or sub Q - works immediately - **CANNOT BE GIVEN LONGER THAN 3 WEEKS except enoxaparin (lovenox)** - lab test monitors PTT ( heparin = 7 letters, count on hand 3 fingers left (PTT) - CAN BE GIVEN TO PREGNANT WOMAN **ANTIDOTE = PROTAMINE SULFATE** CONTRAINDICATION - should be discontinued before surgery - clients with hemorrhagic stroke - **epidural and recent spinal injury** CAN BE USED WITH WARFARIN UNTIL WARFARIN EFFECT QUICKS IN

Answer 129

stay with the client, note time the seizure began and how long it last - **during active activity = call for additional help** - prepare for suctioning - turn client to the side = first thing to do - **padding the side rails** - loosen clothing around the neck and chest to promote ventilation**

Answer 130

normal troponin is <0.5 MANIFESTATIONS - dizziness - SOB - nausea vomiting PAIN RADIATION - neck - jaw - left shoulders - arms, epigastrium **pain radiating to any of these could indicate MI**

Answer 131

- muscle relaxant - **muscle relaxants are contraindicated in people with hepatitis because they are metabolized by the liver** Sign and Symptoms - fatigue/drowsiness - muscle weakness 3 THINGS YOU TEACHING - DON’T drink - drive or operate heavy machinery

Answer 132

GROWTH IN NEWBORN - **1ST 6 MONTHS** = weight doubles - **BYn12 MONTHS** = weight triples VITALS - respiratory rate = 30-60 - pulse = up to 160/min **cryptorchidism is normal until 6 months** - the nurse must prioritize any responding to perceived or reported threat to security to prevent infant abduction - **milia = white pinpoint paupules on newborn face = NORMAL** - bilateral crackles in lungs are normal during first hour of life = FLUID IS STILL BEING PUSHED OUT AND ABSORBED BY LUNGS **waitin to introdcue newborns to common allergenic foods leads risk of allergies** - **glucose levels in newborns are decreased FIRST HOUR of birth then rise and stabilize within 2-3 hours** = level of 40 or more is considered normal - first 3-4 days, weight loss approx 5-6% birth weight is expected due to fluid excretion (respirations, urine, stool) - **weight loss usually ceases around 5 days of life in healhty newborns and retun to birth weight 7-14 days** - weight loss of 7 or more indicate the need. for BREASTFEEDING SUPPORT and FORMULAR SUPPLEMENTATON and require evaluation **BOTTLE FEEDING** - leftover milk in the bottle should be discarded after feeding cus it has mixed with the childs saliva and can foster bacterial growth - unused prepared formula should be kept in the fridge and discarded after 48 hours - dont heat formula cus it can great hot spots in the milk and burn the child **after 6 months, infants should not exhibit head lag when raised from a supine to seated position** = can indicate autism and cerebral palsy FONTANELS - anterior = diamond shaped and soft in the middle - posterior = triangular shaped separeted by sutures **posterior and occipital closes by 2 months so should not be palpable after that** **skull cannot expand after the fontannels close at 18 months so anything taking up more space in the skull can cause ICP** EXPECTED - cracked and peeling of the skin around day 3 = sign of physical maturity (DESQUAMATION) - undescended testicles - **crackles and rales in lungs are expected immediately after birth** - average head circumference is 13-14 inches **ATOPIC DERMATITIS** = eczema - itching erythema - dry skin **red crusted scaly lesions in infants** = prevent scratching (cutting fingers short) DIET - feed every 2-3 hours (breastmilk is easily digested) - **breastmilk is recommended from birth to at least 6 months old** - avoid introduction of artificial nipples and supplemental formular unless MEDICALLY NECESSARY.

Answer 133

- leads to high lifelong risk of rapid sepsis - they need vaccination against several organisms **even a low grade fever should be taken serious in these clients**

Answer 134

**false fixed sensory** (hear, feel, taste, smell, see). most common hallucination: AUDITORY (voices telling you to kill yourself) , then visual, then tactile, gustatory (taste), olfactory (smell) AUDITORY HALLUCINATIONS MANAGEMENT - increasing the amount of external auditory stimulation in the environment **have them watch tv, listen to music through headphones to make it easier to ignore internal sounds from hallucinations** **clients who are alone and hearing these voiced requires IMMEDIATE INTERVENTION** priority over spouse of a client that has just called that client is suicidal. why?? client is not alone, spouse can intervene

Answer 135

malignant cancer of the lymphatic system EXPECTED MANIFESTATIONS - painless enlarged lymph nodes - fatigue - fever - itching - weight loss and - **drenching night sweats**

Answer 136

1. ACUTE BEATS CHRONIC! Acutely ill person is a higher priority than a chonincally ill patient = COPD (chronic), CHF (chronic) & appendicitis (acute: HIGHEST priority!) 2. fresh post op (12 hours) beats medical or other surgical = COPD, CHF, acute appendecitis, 2 HOUR POST OP FOR CHOLECYSTECTOMY (fresh post op: HIGHEST priority!), 2nd day post of coronary artery bypass graft? **STABLE** -stable -chronic illness -post op greater than 12 hours -local or regional anesthesia -lab abnormalities of an A or B level -“ready for discharge”, “to be discharged”, “admitted longer than 24 hours ago” -unchanged assessments (nothing new/different) -experiencing the typical expected sign & symptoms of the disease with which they were diagnosed **UNSTABLE** -unstable -acute illness -post op less than 12 hours -general anesthesia (only in the first 12 hours) -lab abnormalities of an C or D level -“not ready for discharge”, “newly admitted”, “newly diagnosed”, “admitted less than 24 hours ago” -changing or changed assessments (something new/different) -experiencing unexpected sign & symptoms of the disease with which they were diagnosis **ALWAYS UNSTABLE WHETHER EXPECTED OR NOT** - hemmorhage = **coffee ground emesis from iodized blood** can idicate hemorrhage - HIGH fevers (over 104) *seizures* - HYPOglycemia (low blood glucose) - pulselessness or breathlessness *tachycardia is an early sign of internal hemorrhage**

Answer 137

broccoli leafy greens brussle sprouts brown rice whole grain bread nuts and seeds

Answer 138

pedialyte ice chips tea without cream juice black coffee sports drink plain jello water water based or pulp free fruit popsicle basic broth when is clear liquid diet preferred clear liquid diet should always be the first to be ordered after a procedure best for patients who have not had oral intake for some time as well as for the first time a patient eats after complete bowel rest **BRAT DIET** - bananas, rice, applesauce and toast = does not provide sufficient protein or energy **SOFT DIET** - when the person has difficulty swallowing and needs food which are much easier to eat - peanut butter **HOW TO OPTIMIZE NUTRITIONAL INTAKE IN COPD** - drink fluids between meals not before or during - small frequent meals high in calories and protein - oral hygiene before meals due to their mouth breathing leading to dry mouth - avoid exercise an hour before or an hour after **LACTOSE INTOLERANCE** - can still eat cheese and yoghurt if it dont make you sick - take calcium and vitamin D supps - lactase enzyme supplement should be taken with meals containing diary

Answer 139

**STAT medications should be given immediately and ONLY ONCE! = new prescription is required to be repeated** - not needed for barium enema - **INFORMED CONSENT IS WAIVED IN LIFE THREATENING INCIDENTS WHEN THE CLIENT IT UNCONSCIOUS** = referred to as implied concent - CANNOT BE OBTAINED FROM PSYCH PATIENTS COGNITIVELY IMPAIRED ( get it from a family member )

Answer 140

asymptomatic so if they feel pain and diarrhea = NEEDS INTERVENTION = TREATMENT IS TUMOR NECROSIS FACTORS **inflammatory bowel disease treatments** - lasoprazole - metronidazole - sulfasalazine

Answer 141

urine is obtained to determine whether during the time of injury the employer was under the influence of alcohol or drug

Answer 142

should he be given a pressure relieving cushion BEFORE being educated to move buttocks every 2 hours what to do first? give cushion

Answer 143

legal documents INCLUDES living will: describes the type of life sustaining treatments such as CPR, intubation, mechanical ventilation, feeding tube) that the client want intiated if unable to make decisions - **health care proxy (durable power of attorney for healthcare or medical power of attorney)** = person who can advocate for the client as needed during times when client cannot make health care decisions for themselves **even if client has a DNR, giving oxygen by NASAL CANNULA is still allowed** **TO LEAVE AGAINST MEDICAL ADVICE** - client has to be legally competent to make an educated decision to stop treatment - **parents do not have the right to place their minor child in life threatening position. that is child abuse or neglect so as a nurse, notify the hospital adminstration about the situation if the paretns are refusing treatment for the child in life saving treatment** **CANNOT LEAVE AGAINST MEDICAL ADVICE** - altered conciousness - mental illness (danger to self or others) - chemical influcneces such as drugs or alcohol **only patients that are concious and competent can sign out against medical advice**

Answer 144

also known as a stroke - affects the opposite extremities of where the injury has occurred in the brain right sided CVA = left sided paralysis left sided CVA = right sided paralysis most important modiafiable risk factor of stroke is HYPERTENSION. over smoking - when transfering stroke patient, use transfer belt **FAST ASSESSMENT** - facial drooping - arm weakness or drift - speech difficulties - time

Answer 145

always recheck and validate the results and confirm accuracy before you decide to administer glucose **fasting blood glucose** - less than 100 is good diabetic: 125 and up (less than 140)

Answer 146

70-100 but >60 is adequate to perfuse the vital organs lower MAP is treated by nonrepinephrine = this increase vascular tone - MAP = systolic + 2(diastolic ) divided by 3

Answer 147

accumulation of bacterials produced by microorganism example using tampons, cervical caps and diaphgrams cus they lead to the build up of organisms

Answer 148

- more common in healthcare workers and hospitalized patients than the general population - **avoid oil based hand creams** FRUITS TO AVOID = rubber-like textures - bananas - kiwis - avocados - tomatoes strawberry??

Answer 149

most common cause : **S AUREUS** - bone pain - fever - swelling **REQUIRES ANTIBIOTIC 6-12 WEEKS**

Answer 150

- check with doctor before taking any medication because it might be a hepatoxic medication and will complicate delivery - AVOID MUSCLE RELXANTS ALSO CUS THEY ARE METABOLIZED BY THE LIVER **PERCUTANEOUS KIDNEY BIOPSY** - uncontrolled hypertension is a contraindication - post procedure bleeding - **after a liver biopsy, client should be placed in RIGHT SIDE LYING POSITION because the liver is located on the right side**

Answer 151

- unilateral pulsating headache INTERVENTION - pain and environmental management

Answer 152

- disregard rules - irresponsible behaviors - **blame others for their behavior** - uses numerous excuses and justifications to avoid responsibility NURSING INTEREVNTION - **set firm limits by letting them know rules and acceptable behaviors** - make them take **responsibility** for their behaviors for not following rules

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