KLIMEK Flashcards
(177 cards)
1
Q
How is bleeding of abruptio placentae different from that in Placenta Previa?
A
Usually with pain in AP but not in PP, bleeding more voluminous in PP (the one that bleeds more has less pain; the one that bleeds less has more pain).
2
Q
How often should the nurse check vital signs for unstable patients?
A
Q 15 minutes
3
Q
How is an infant delivered when abruptio placentae is present?
A
C-section
4
Q
Higher or lower risk incidence of fetal death with abruptio placentae compared with placenta previa?
A
Higher
5
Q
Name the 5 criteria that are recorded on an APGAR scale?
A
Cardiac status Respiratory effort Muscle tone Neuromuscular Irritability (reflexes) Color
6
Q
On heart rate or cardiac status in APGAR, a 2 means that the HR is above …?
A
100 bmp
7
Q
A high APGAR score of 2 is given for the respiratory effort if the newborn…?
A
Cries vigorously
8
Q
To get an APGAR score of 1 for muscle tone, the newborn must place their extremities in…?
A
flexion
9
Q
To get an APGAR score of 2 on neuromuscular reflex irritability the infant must…?
A
Cry
10
Q
To score an APGAR of 2 on color the infant must look…?
A
Totally pink
11
Q
Can you use cotton balls/washcloth to clean the eyes, nares or ears of an infant?
A
No, this is dangerous.
12
Q
What is the #1 purpose of a tepid sponge bath?
A
Lower body temperature during fever
13
Q
What body part do you begin bathing an infant?
A
eyes
14
Q
Should you retract the foreskin of a 5-week-old male, uncircumcised infant to cleanse the area?
A
No, not until foreskin retracts naturally and without resistance- then it should be retracted, cleansed, and replaced.
15
Q
T/F, you may use friction to remove vernix caseosa from an infants skin?
A
F, it causes bruising.
16
Q
How many minutes should an infant breastfeed per side?
A
20 minutes
17
Q
What side should breastfeeding begin?
A
Begin nursing on the side the baby finished last feeding.
18
Q
How long can breastmilk be refrigerated?
A
24 hours
19
Q
How long can breastmilk be frozen?
A
6 months
20
Q
Which two nutrients is breastmilk lower in?
A
Fluoride and iron
21
Q
Can a woman breastfeed on oral contraceptive?
A
Should not use OC during first 6 weeks after birth because the hormones may decrease milk supply. Estrogen is not recommended. Non-hormonal methods are recommended. Remember breastfeeding is unreliable contraceptive.
22
Q
The infant fears what most when hospitalized?
A
Separation from love object
23
Q
The toddler fears most what when hospitalized?
A
Separation from family
24
Q
The toddler and preschooler will think that illness is caused by…?
A
Something they did wrong
25
Three types of ventilator obstruction and action?
1. kinked tubing- unkink
2. H2O in tubing- empty the H2O.
3. Mucous- T(Turn)C(cough)DB(deep breathing)
26
what is psychosis induced by vitamin B1 (Thiamine) deficiency?
Wernicke's Syndrome
Primary symptom: amnesia with confabulation.
27
Aversion therapy for alcohol dependancy?
Disulfiram/Naltrexone
28
Category A Bioterrorism agents (STAPHB)
```
Small Pox
Tularemia
Anthrax
Plague
Hemorrhagic Fever
Botulism
```
29
what is xerostomia?
dry mouth
30
P Wave always refers to?
Atrial
31
QRS depolarizations always refers to?
Ventricular
32
In a pneumothorax, the chest tube removes...?
air
33
in a hemothorax, the chest tube reomves...?
blood
34
In a pneumohemothorax, the chest tube removes ...?
air and blood
35
How many chest tubes (and where) for unilateral pneumothorax?
one, apical
36
How many chest tubes (and where) for bilateral pneumothorax?
2, apical
37
How many chest tubes (and where) for post-op chest surgery?
two, apical and basilar on operated side.
38
Rule of B's related to ABG interpretations
If the pH and the Bicarb are Both in the same direction then it is metaBolic
39
Acid-Base Signs and Symptoms memorization
As the pH goes, so goes my patient. Except for potassium.
40
Causes of Acid Base imbalance
First ask yourself, "is it lung?"
If yes, then it is respiratory
Then ask yourself "Are they over or under ventilating"
If over- alkalosis
If under- acidosis
41
What symptom is associated with metabolic alkalosis
prolonged vomiting or suction
42
High pressure alarms in ventilators are caused by...
Increased resistance to air flow (obstructions)
43
What are obstructions in ventilators that cause high pressure alarms?
Kinked tubing
H2O in tubing - empty the H2O
Mucous- Turn, Cough, Deep Breathe (must do TCDB before suctioning)
44
What are low pressure alarms in ventilators caused by?
decreased resistance to air flow, can be caused by disconnections of the tubing. Reconnect the tubing. If tube falls on floor, call resp + ambu pt. If tube falls on pt chest, clean + reconnect.
45
Respiratory Alkalosis means ventilator settings may be too ...
High (hyperventilation)
46
Respiratory Alkalosis means ventilator settings may be too...
Low (hypoventilation)
47
How to treat denial
Confront it by pointing out to the person the difference between what they say and what they do. In contrast, support the denial of loss and grief.
48
When the abuser get the significant other to do things for them or make decisions for them.
Dependancy
49
When the significant other derives positive self-esteem from doing things for or making decisions for the abuser.
Codependency
50
Psychosis induced by Vitamin B1 (Thiamine) deficiency.
Wernicke's Syndrome
51
Primary symptoms of Wernicke's Syndrome
Amnesia with confabulation (making up stories that client believes)
52
Is Wernicke's Syndrome reversabile?
No
53
Things to know about Disulfiram and Naltrexone
Aversion therapy to alcohol
Onset and duration- 2 weeks
Avoid all forms of alcohol such as vanilla extract, insect repellants, aftershaves, perfumes, vinaigrettes.
54
Things to know about Delirium Tremens
```
Patients with DT's are dangerous to themselves and others.
NPO
Take Thiamine or multivitamin
Bed rest or activity restriction
Antihypertensives and antidepressants
Restraints, 2pt leather
```
55
Aminoglycosides treat ...
mean ol infections
56
Aminoglycoside Toxicity effects
Ototoxicity
| Nephrotoxicity
57
Do not give Aminoglycosides PO except in these two cases:
```
Hepatic Encephalopathy (liver coma)
Pre-op bowel surgery
```
Aminoglycosides act as a bowel sterilizer.
58
Things to know about smallpox:
Airborne precautions
| Dies from septicemia, no treatment
59
Things to know about Anthrax
Looks like resp flu
Dies from resp failure
Treat with Cipro, PCN, and Streptomycin
60
Three H's of the Plague
Hemoptysis
Hematemesis
Hematochezia
61
3 major symptoms of Botulism
Descending paralysis
Fever
Alertness
62
Sarin- Nerve Agent, what is 2B's and SLUDGE?
```
Bronchoconstriction
Bronchorrhea- massive amounts of sputum
Salivation
Lacrimation
Urination
Diaphoresis and Diarrhea
GI Upset
Emesis
```
63
Calcium Channel Blockers are like...
Valium for your heart (calming and relaxing)
64
How do Calcium Channel Blockers treat?
Antihypertensives
Antiangina
Anti Atrial Arrthmial
65
Ending of Calcium Channel Blockers
-zem, -dipine, Isoptin
66
QRS Depolarization always refers to...
Ventricular
67
P Wave always refers to ...
Atrial
68
Be concerned about PVC's if...?
More than 6 per minute
More than 6 in a row
PVC falls on T-wave of previous beat
69
Treatment for PVC and V Tach
Lidocaine & Amidarone
70
Treatment for Supra-ventricular arrthymias
Adenosine - must slam it IV push
Beta Blockers
CCB's
Digitalis or Digoxin
71
What do you do if a water seal breaks on a chest tube?
First - clamp tube, cut, submerge, unclamp
| Best- Submerge end of tube
72
What do you do if a chest tube comes out?
First- cover with vaseline gauze, DSD + tape.
| Best- vaseline gauze
73
Continuous bubbling in water seal chamber
bad- means leak
74
Continuous bubbling in suction control chamber
good
75
Intermittent bubbling in water seal chamber
good
76
Intermittent bubbling in suction control chamber
bad- turn off suction
77
Trouble pneumonic for congenital heart diseases
TRouBLe
T- diseases that start with T will be trouble
R->L = shunt right to left
B- blue, cyanotic
78
All CHD kids will have these two things...
1. Murmur
| 2. At least 1 ecchocardiogram
79
Four defects of Tetralogy of fallot - VardieD PictureS Of A RancH
Ventricular Defect
Pulmonary Stenosis
Overriding Aorta
Right Hypertrophy
80
What side do you hold a cane on?
Strong side
81
What is a somatic delusion?
False, fixed belief about a body part. Ex- x-ray eyes, hollow body, male pregnancy.
82
What is a gustatory hallucination
Hallucination of taste
83
Difference between illusions and hallucinations?
With illusions there is a referent in reality.
84
Four steps to dealing with clients with functional psychosis? (ex- Schizophrenis, schizoaffective, major depression, and manic phase)
Acknowledge feelings
Present reality
Set a limit
Enforce the limit
85
Two steps to dealing with clients who suffer from psychosis of dementia? (Alzheimers, senility, Wernickes. post-stroke psychosis)
Acknowledge the feeling
Redirect- take what the client is fixated on, that they are expressing inappropriately and get them to express the fixation appropriately.
86
What is psychotic delirium?
This is a temporary, episodic, dramatic, sudden onset loss of reality due to a chemical imbalance.
Acknowledge the feeling and reassure the client.
87
What is flight of ideas?
stringing phrases together
88
What is word salad?
string words together
89
What are neologisms?
making up words
90
What is ideas of reference?
When the client believes to be the center of the universe and causes everything.
91
Rule of refrigeration of insulin
Refrigeration of unopen insulin is required, optimal after opening.
92
Treatment of low blood sugar in a type 1 diabetic
15/15X3
Give 15 gm of glucose
wait 15 minutes, if glucose is under 100...
Give 15 gm more of glucose
wait 15 minutes, if glucose is still under 100...
Give 15 gm more of glucose
If still under 100, call HCP
If unconscious, give glucagon or IV D50
93
#1 cause of high blood glucose in type 2 diabetic
acute viral upper respiratory infection within the last week.
94
S/S of high blood glucose in type 2 diabetic (DKA)
Dehydration
Ketones, kussmal, high K+
Acidosis, acetone (fruity breath), anorexia w/nausea
95
What is high blood sugar in a type 1 diabetic ?
HHNK (Hyperosmolar, hyperglycemic, non-ketotic coma)
Treat like dehydration
96
Diabetic A1C target
below 7
97
Non-diabetic A1C target
below 6
98
Prediabetic A1C
6.3-7
99
Bilirubin elevated range
10-20
100
Bilirubin toxic level
Above 20
101
What is Kernicterus?
Bilirubin in CSF, baby dies quickly.
102
What is Opisthotonos
Hyperextension seen with Kernicterus. Lie on side.
103
What is a Hiatal Hernia?
Regurgitation of acid into esophagus because upper stomach herniates upward through the diaphragm.
Gastric contents move in the wrong direction, at the correct rate.
104
What is dumping syndrome
Complication of post-op gastric surgery in which gastric contents dump into the duodenum too quickly.
Gastric contents move in the correct direction at the wrong rate.
105
Treatment of Hiatal Hernia Vs. Dumping syndrome
Hiatal Hernia- High fowlers 1 hr after eating, High fluids with meals, High carb
Dumping Syndrome- Low fowlers 1 hr after eating, low fluids with meals, low carbs and high protein
106
Sentence to memorize with Kalemias
Kalemias do the same as the prefix, except HR and urine output
107
Sentence to memorize with Calcemias
Calcemias do the opposite the prefix, no exceptions. Does anything to BP.
108
Two signs associated with low calcium
Chvosteks sign
| Trousseaus sign- BP cuff makes clients arm spasm
109
Sentence to memorize with Magnesemias
Magnesemias do the same as the prefix & do anything to BP.
110
What is the earliest sign of an electrolyte disorder?
Numbness and tingling (parathesia)
111
What is the universal sign of electrolyte imbalance?
Muscle weakness
112
Can you push K+ IV?
Never, can stop heart and cause death
113
What to do to decrease K+ ?
```
Give D5 and regular insulin (2 different IV's)
Sodium Polystyrene (Kayexalate, "K exits Late" Takes a long time to exchange electrolytes and digest out of the body)
```
114
What is PTU?
Propylthyroid uracil- treatment for hyperthyroidism
| PutsThyroidUnder
115
Treatment of Addisons Disease?
Steroids (glucocorticoids + mineralcorticoids)
116
The proper order in which you apply PPE?
Gown
Mask
Goggles
Gloves
117
Proper order in which you remove PPE?
Gloves
Goggles
Gown
Mask
118
Synonyms for low WBC
Leukopenia
Neutropenia
Agranulocytosis
Immunosuppression
119
Neutropenic Precautions
```
Strict handwashing
shower with antimicrobial soap
Avoid crowds
Limit number of staff
Limit visitors to healthy adults
No fresh flowers or plants
Low bacteria diet (no raw fruits, veggies or undercooked meats)
Do not drink standing water (more than 15 minutes)
vitals Q4
Check WBC daily
Avoid indwelling catheter use
Use disposable eating utensils
```
120
Synonym for low platelet count
Thrombocytopenia
121
Thrombocytopenic (bleeding) protocol
```
No unnecessary venipuncture
Injections or IV should use a small gauge catheter
No electric razor
No hard foods
No flossing or toothbrush
Blow nose gently
No rectal temp, enema, or suppository
No aspirin
No contact sports
No walking in care feet
No tight clothes or shoes
Use stool softener, no straining
Notify MD of blood in urine or stool.
```
122
Reasons for Laminectomy
To treat nerve root compression
123
S/S of nerve root compression (3P's)
Pain
Parathesia
Paresis (muscle weakness)
124
Most important assessment of a post-op Cervical Laminectomy
U. Extremities + breathing function
125
Most important assessment of a post-op Thoracic Laminectomy
couch mechanism + bowel function
126
Most important assessment of a post-op Lumbar Laminectomy
bladder + lower extremities
127
1 spinal post-op answer on NCLEX?
log roll (move pt w/o moving spine)
128
Specific "activity"/mobilization strategy for spinal post-op
do not dangle pt (sit on edge of bed)
No restriction on walking, standing, and lying down
Limit sitting to 30 minutes
129
Post op complication for all spinal surgery types
Cervical - Pneumonia
Thoracic - Pneumonia or constipation or paralytic ileus
Lumbar - bladder retention
130
How long is a "restriction?"
6 weeks
131
Permanent restrictions for laminectomy clients
Lift by bending waist
Cervical laminectomy- lift objects above the head
No horseback riding, off-trail biking, jerky amusement park rides, etc.
132
Nagele's Rule
Take the FIRST day of the LMP
Subtract 3 months
Add 7 days
133
Weight gain during pregnancy
Total weight gain= 28 Ibs, +/- 3 Ibs
1st tri- 1 Ib/month
2nd & 3rd tri- 1 Ib/week
*gestation week -9 = ideal weight
134
At what week of pregnancy is the fundus palpable?
12
135
What week does the fundus reach the umbilical level?
20-22
136
Probable/Presumptive signs of pregnancy
```
All urine + blood tests
Chadwicks sign (cyanotic cervical color)
Goodells sign (Cervix softens)
Hegars Sign (uterus softens)
```
137
Pattern of office visits during pregnancy
Once a month til week 28
Once every 2 week until week 36
Every week until delivery
138
How to battle morning sickness
Dry carbohydrate upon awakening, before leaving bed in the morning
High protein snack before bed
139
what to do with a prolapsed cord during labor?
Push head off cord
| Position knee-chest or trendelenburg or elevate hips
140
Interventions for all complications of labor and delivery (LIONPIT)?
```
Left side
IV Increase
Oxygen (mask 8-10L)
Notify HCP
Pitocin Off
```
141
Fetal Monitoring Patterns
```
Low Fetal heart rate- LIONPIT
FHR Accelerations- document
Low Baseline Variability (Bad)- LIONPIT
High Baseline Variability- document
Late Decels- LIONPIT
Early Decelerations- document
Variable Decelerations- Very Bad- prolapsed cord intervention
```
142
Second Stage of Labor and delivery steps
Deliver the whole baby
Suction the Mouth then the Nose
Check for cord around the neck
Make sure an ID band is on the baby before it leaves the mothers side.
143
How to know if the fundal height is correct
The day of postpartum +/- 1.
144
Tiny white spots on babys face
Milia
145
small, white epithelial cysts on babys gums
Epsteins Pearls
146
bluish black macules appearing over the buttocks and/or thigh of darker -skinned neonates
Mongolian Spots
147
red popular rash on babys torso which is benign and disappears after a few weeks.
Erythema Toxicum Neonatorum
148
benign tumor of capillaries in babies
Hamangimas
149
swelling caused by bleeding between the osteum and periosteum of the skull. Does not cross suture lines in babies.
Cephalohematoma
150
edematous swelling on scalp caused by pressure during birth. this swelling may cross suture lines. usually disappears in a few days.
Caput Succedaneum
151
generic term for a birth mark
Nevus/Nevi
152
Size of gauge and length of IM needles
21G
| 1.5 in
153
Size of gauge and length of SubQ needles
25G
| 5/8 in
154
If the order read 50 units of 70/30 (Humulin/Novolog),how much N and R would you give?
50 x .70= 35N
| 20 x .30= 15R
155
Facts about Heparin
```
Works immediately
Given IV and SubQ
Antidote- Protamine Sulfate
Lab- PTT
Safe for pregnancy
```
156
Facts about Warfarin
```
Takes days to work
Only PO
Antidot- Vitamin K
Lab- PT
Not safe for pregnancy
```
157
K+ sparing diuretics have what ending?
-tone
158
K+ wasting diuretics have what ending?
- dine
- mide
- zide
159
What is a xenograft?
Tissue graft from animal, not a permanent fix.
160
What is a homo & allograft?
tissue from other people
161
When does the termination phase in care of psych clients begin?
On admission
162
Diet of a client with depression
High fiber and fluids
| Prepare everything for client
163
Activity of client with depression
Group activity w/o interaction
164
Watch for what in the safety of a client with depression?
Self-destructive behavior
165
Diet of a client with schizophrenia
high fiber and fluids
| prepare nothing
166
Activity of client with schizophrenia
Group activity with interaction to learn reality. Ex- boardgames, behavior group, cards, ect
167
Watch for what in the safety of a client with schizophrenia
Watch other directed behavior, they hate manics
168
Diet of a client with mania
High protein + fiber
169
Activity of client with mania
Gross Motor + no competition. Ex- punching bag, tredmill, self sports
170
Activity of client with anxiety
Gross motor with competition, action eats anxiety.
171
How to deal with violent clients?
1. Requires 5 trained staff
2. Give them a chance to deescalate
3. Only one person talks during procedure
172
Ace of Spades answers for Psych
Best- "The nurse will examine own feelings about..."
| Next- "Establish a trust relationship"
173
Ace of Spades answers for Nuturition
```
In a tie, either pic chicken or fish
Never pick casseroles for children
Never mix medications in children's food
Toddlers need finger foods
Preschoolers- Leave them alone! One meal a day is okay.
```
174
Ace of Spades answers for Pharmacology
Most commonly tested area in pharm is s/s
If you know what a particular drug does, choose side effects in the same body system where the drug is working.
If you have no clue what the drug does, look to see if its PO. If so, pick GI side effects.
Never tell a child medicine is candy.
175
Ace of Spades answers for OB
Check FHR
176
Ace of Spades answers for Med-Surg
What is the first thing you assess in a med-surg situation? LOC
What is the first thing you do in a med-surg situation? Check airway.
177
Ace of Spades answers for Pediatrics
Three rules on growth and development. They are based on the principal: always give the child more time.
When in doubt call it normal.
When in doubt, pick the older age.
When in doubt, pick the easier task.
