Lu's Study Guide Flashcards
(713 cards)
1
Q
DO NOT delegate what you can
A
EAT
E-valuate
A-assess
T-each
2
Q
Addison’s vs. Cushing’s
A
Addison's = down, down, down, up, down Cushing's = up, up, up down, up
Addison’s = hyponatremia, hypotension, decreased blood volume, HYPERkalemia, hypoglycemia
(need to “add” hormones)
Cushing’s = hypernatremia, hypertension, increased blood volume, HYPOkalemia, hyperglycemia
(have extra “Cushion” of hormones)
3
Q
Do not give potassium unless
A
have adequate urine output
no pee, no K
4
Q
for better perfusion then elevate and dangle
A
eleVate Veins
dAngle Arteries
5
Q
APGAR
A
A = appearance (color all pink, pink and blue, blue (pale) P = pulse (>100,
6
Q
Airborne precautions:
A
MTV =
Measles
TB
Varicella - chicken pox/herpes Zoster-Shingles
Private Room - negative pressure with 6-12 air exchanges/hr, Mask (N95 for TB)
7
Q
Droplet
A
sepsis scarlet fever Streptococcal pharyngitis Parvovirus B19 Pneumonia Pertussis Influenza Diptheria (pharyngeal) Epiglottitis Rubella Mumps Meningitis Mycoplasma or meningeal pneumonia An - Adenovirus
Private Room or Cohort Mask
Door Open 3 ft distance
8
Q
Contact
A
MRS. WEE
M - multi drug resistant organism R - respiratory infection S - skin infections W - wound infection E - enteric infection - clostridium difficle E - eye infection - conjuctivitis
Skin infections - VCHIPS Varicella zoster Cutaneous diptheria Herpez simplex Pediculosis Scabies
9
Q
air/pulmonary embolism
A
s/s - chest pain, difficulty breathing, tachycardia, pale/cyanotic sense of impending doom
turn pt to LEFT side and LOWER the head of bed
10
Q
Woman in labor with un reassuring FHR
A
(late decels, decreased variability, fetal bradycardia_
turn pt on LEFT side
give O2, stop Pitocin, increase IV fluids
11
Q
Tube Feeding with Decreased LOC
A
position pt on RIGHT side (promotes emptying of stomach) with HOB ELEVATED (to prevent aspiration)
12
Q
During Epidural
A
side-lying
13
Q
After lumbar puncture
A
pt lies FLAT supine (to prevent headache and leaking of CSF) for 4-12 hrs
14
Q
pt w/ heat stroke
A
lie FLAT with LEGS ELEVATED
15
Q
During continuos bladder irrigation
A
catheter is taped to thigh so leg should be kept straight
no other positioning restrictions
16
Q
after myringotomy
A
(ear tubes)
position on side of AFFECTED EAR after surgery (allows drainage of secretions)
17
Q
after cataract surgery
A
pt will sleep on UNAFFECTED side with a night shield for 1-4 weeks
18
Q
after Thyroidectomy
A
low or semi-fowler’s, support head, neck and shoulders
19
Q
infant with spina bifida
A
position PRONE (on abdomen) so that sac does not rupture
20
Q
Buck’s traction
A
(skin traction)
elevate foot of bed for counter-traction
21
Q
After total hip replacement
A
- don’t sleep on operate side
- don’t flex hip more than 45-60 degrees
- don’t elevate HOB more than 45 degrees
- maintain hip abduction by separating thighs with pillows
22
Q
Prolapsed Cord
A
knee-chest position or tredelenburg
23
Q
Infant w/ cleft lip
A
position on back or in infant seat to prevent
24
Q
to prevent dumping syndrome
A
post-operative ulcer/stomach surgeries
- eat in reclining position
- lie down after meals to decrease peristalsis
- restrict fluids during meals
- low CHO and fiber diet, small frequent dumping
- increase fat and protein
- small frequent meals
- wait 1 hr after meals to drink
25
above knee amputation
elevate for 1st 24 hrs on pillow, position prone daily for hip extension
26
below the knee amputation
foot of bed elevated for 1st hrs, position prone daily to provide for hip extension
27
Detached retina
area of detachment should be in the dependent position
28
Administration of Enema
position pt in LEFT SIDE LYING (Sim's) with knee flexed
29
After Supratentorial Surgery
(incision behind hairline)
elevate HOB 30-45 degree
30
After Infratentorial Surgery
(incision at nape of neck)
| position pt FLAT and lateral on either side
31
During internal radiation
on BEDREST while implant in place
32
Autonomic Dysreflexia/hyperreflexia
(S/S pounding headache, profuse sweating, nasal congestion, goose flesh, bradycardia, hypertension)
SITTING position (ELEVATE HOB) first before any other implementation
33
Shock
bedrest with extremities elevated 20 degrees, knees straight, head slightly elevated (modified Trendelenburg)
34
Head injury
elevate HOB 30 degrees in decrease intracranial pressure
35
Peritoneal Dialysis when outflow is inadequate
turn pt from side to side BEFORE checking for kinks in tubing
36
pain med for pancreatitis
Demoral, NOT morphine sulfate
37
myasthenia gravis
- caused by a disorder in the transmission of impulses from nerve to muscle cell
- worsens with exercise improves with rest
38
myasthenia crisis
positive reaction to Tensilon
| will improve symptoms
39
Cholinergic crisis
caused by excessive medication - stop med giving Tensilon will make it worse
40
Head injury medication:
Mannitol (osmotic diuretic) - crystallizes at room temp so ALWAYS use filter needle
41
prior to a liver biopsy its important
to be aware of the lab result for prothrombin time
42
metabolic acidosis vs metabolic alkalosis
From the ass (diarrhea) = metabolic acidosis
| From the mouth (vomitus) = metabolic alkalosis
43
Myxedema/hypothyroidism
slowed physical and mental function, sensitivity to cold, dry skin and hair
44
Grave's disease/hyperthyroidism
- accelerated physical and mental function
| - sensitivity to heat, fine/soft
45
Thyroid storm:
increased temp, pulse and HTN
46
Post-thyroidectomy:
semi-fowler's prevent neck flexion/hyperextension, trach at bedside
47
Hypo-parathyroid:
CATS - convulsions, arrhythmias, tetany, spasms, stridor (decreased calcium)
-high Ca, low phosphorus diet
48
Hyper-parathyroid:
fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium)
- low Ca, high phosphorus diet
49
Hypovolemia
increased temp, rapid/weak pulse, increased respiration, hypotension, anxiety, urine specific gravity >1.030
50
Hypervolemia
bounding pulse, SOB, dyspnea, rales/crackles, peripheral edema, HTN, urine specific gravity
51
Diabetes Insipidus
(decreased ADH)
| - excessive urine output and thirst, dehydration, weakness, administer Pitressin
52
SIADH
(increased ADH)
- change in LOC, decreased deep tendon reflexes, tachycardia, N/V, HA
- admin declomycin, diuretics
53
Hypokalemia
muscle weakness, dysrhtmias, increase K (raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery)
54
Hyperkalemia
MURDER - muscle weakness, urine (oliguria/anuria), respiratory depression, decreased cardiac contractility, ECG changes, reflexes
55
Hyponatremia:
nausea, muscle cramps, increased ICP, muscular twitching, convulsion
- osmotic diuretics, fluids
56
Hypernatremia:
increased temp, arrhythmias, tetany, spasms and stridor
57
Hypocalemia:
CATS - convulsions, arrhythmias, tetany, spasms and stridor
58
Hypercalcemia:
muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, sedative effect on CNA
59
HypoMg:
tremors, tetany, seizures, dyrshythmias, depression, confusion, dysphagia
- dig toxicity
60
HyperMg:
depresses the CNS, hypotension, facial flushing, muscles weakness, absent deep tendon reflexes, shallow respirations, emergency!
61
Addison's
hypoNa, HyperK, hypoglycemia, dark pigmentation, decreased resistance to stress, fractures, alopecia, weight loss, GI distress
62
Cushing's
hyperNa, hypoK, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN, hirsutism, moonface/buffaloe hump
63
Addisonian crisis:
N/V, confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP
64
Phechromocytoma
hypersecretion of epi/norepi, persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA
- avoid stress, frequent bating and rest breaks, avoid cold and stimulating foods, surgery to remove tumor
65
neuroleptic malignant syndrome
- you get hot (hyperpyrexia)
- stiff (increased muscle tone)
- sweaty (diaphoresis)
- BP, pulse, and respirations go up
- start to drool
66
dangerous when pregnant rubeola or rubella?
```
regular measles (rubeola) or german measles (rubella)
- never get pregnant with a German (rubella)
```
67
when drawing up drawing up insulin
regular and NPH together
remember: RN
regular comes before NPH
68
Tetralogy of fallot
```
think DROP (child drops to floor or squats)
Defect, septal
Right ventricular hypertrophy
Overriding aorts
Pulmonary stenosis
```
69
MAOI's that are used as antidepressants
(think Pirates take MAOI's when depressed and pirates say ARRR)
MAOI's used for depression all have an arrr sound in the middle
(Parnate, Marplan, Nardil)
PANAMA
(PArnate, MArplan, NArdil)
70
Autonomic dysreflexia
potentially life threatening emergency
- elevate HOB to 90 degrees
- loosen constrictive clothing
- assess for bladder distention and bowel impaction (trigger)
- admin antihypertensive meds (may cause stroke, MI, seizure)
71
With Digoxin
check pulse, if less than 60 hold, check dig levels and potassium levels
72
Amphojel
tx of GERD and kidney stones
- watch out for constipation
- long term use: binds to phosphates, increases Ca, robs the bones - leads to increased Ca resortion from bones = WEAK BONES)
73
Vistaril
tx of anxiety and itching
watch for dry mouth
commonly given preoperative
74
Versed
given for conscious sedation
watch respiratory depression and hypotension
75
PTU and Tapazole
prevention of thyroid storm
76
Sinemet
tx of parkinson
sweat, saliva, urine may turn reddish brown occasionally
causes drowsiness
77
Artane
tx of parkinson
sedative effect
78
Cofentin
tx of parkinson and extrapyramidal effects of other drugs
79
Tigan
tx of postop n/v and for nausea with gastronenteritis
80
Timolol (Timoptic)
tx of gluacoma
81
Bactrim
antibiotic
don't take if allergy to sulfa drugs
diarrhea common side effect
drink plenty of fluids
82
Probenecide (Benemid)
tx gout
83
Colchicine
tx gout
84
Allopurinol (Zyloprim)
tx gout
85
Apresoline (Hydralazine)
tx of HTN or CHF
- report flu-like s/s
- rise slowly form sitting/lying position
- take with meals
86
Bentyl
tx of irritable bowel
- assess anticholinergic s/e
87
Calan (verapamil)
Ca channel blocker
tx of HTN, angina
assess for constipation
88
Carafate
(Sulcrafate)
tx of duodenal ulcers
coats the ulcers
take before meals!!
- S/E: constipation
89
Theophylline
tx of asthma or COPD
therapeutic level 10-20
- increases the risk of digoxin toxicity
- decreases the effectiveness of lithium and Dilantin
90
Mucomyst
antidote to tylenol administered orally
91
Diamox
tx of glaucoma, high altitude sickness
don't take if allergy to sulfa drugs
- can cause hypokalemia
92
Indocin
(NSAID) tx of arthritis (osteo, rhematoid, gouty), bursitis, and tendonitis
93
Synthroid
tx of hypothyroidism
- make take several weeks to take effect
- notify MD of chest pain
- take in AM on empty stomach
- can cause hyperthyroidism
94
Librium
tx of alcohol withdrawal
- don't take with alcohol
- very bad n/v
95
Oncovin (vincristine)
tx of leukemia
-given IV only
96
kwell
tx of scabies and lice
- apply lotion once and leave on for 8-12 hrs for scabies
- lice - use shampoo and leave on for 4 mins with hair uncovered and rinse with warm water and comb with a fine tooth comb
97
Premarin
tx after menopause, estrogen replacement
98
Dilantin
tx of seizures
| therapeutic level 10-20
99
Navane
tx of schizophrenia
-assess for EPS
100
Ritalin
tx ADHD
- assess for heart related side effects report immediately
- may need drug holiday because stunts growth
101
dopamine (intropine)
tx of hypotension, shock, low cardiac output, poor perfusion to vital organs
-monitor EKG for arrhythmias, monitor BP
102
FHR patterns (remembering technique)
VEAL CHOP
V C
E H
A O
L P
```
V = variable decels; C = chord compression caused
E = early decels; H = head compression caused
A = accels; O = okay, no problem!
L = late decels; P = placental insufficiency , can't fill
```
103
For cord compression
-place the mother in TRENDELENBERG position because this removes pressure of the presenting part off the cord
(the baby is no longer being pulled out of the body by gravity)
104
If prolapsed cord then
cover it with sterile saline gauze to prevent drying of the cord and to minimize infection
105
for late decels then
turn mother to her LEFT side to allow more blood flow to the placenta
106
for any kind of bad fetal heart rate pattern, you would
give O2 often by mask
107
with epidural anesthesia what is a priority before hand
hydration
108
hypotension, bradypnea/bradycardia in pregnancy are
major risks and emergencies
109
Never do what before assessing pt
check monitor or machine as first action
- always assess pt 1st
for example, if trying to decide to check mother or baby 1st and one answer involves a machine then it is a wrong answer
110
if baby is posterior presentation the sounds are heard
at both sides
111
if the baby is anterior the sounds are heard
closer to midline, between the umbilicus and where you would listen to a posterior present
112
if the baby is breech the sounds are
high up in the fundus near the umbilicus
113
if the baby is certex the sounds are
a little bit above the symphysis pubis
114
remembering ventilator alarms
HOLD
High alarm - Obstruction due to increased secretions, kink, pt coughs, gag or bites
Low pressure alarm - Disconnection or leak in ventilator or in pt airway cuff, pt stops spontaneous breathing
115
to remember blood sugar
hot and dry - sugar high
| cold and clammy needs some candy - low sugar
116
ICP and shock have opposite vitals
ICP - increased BP, decreased pulse, increased respirations
| shock - decreased BP, increased pulse, decreased respirations
117
cor pulmonae
right sided heart failure caused by left ventricular failure
(s/s: fluid overload - so edema, and JVD)
caused by pulmonary disease: bronchitis or emphysema
118
herion withdrawal neonate
irritable, poor sucking
119
Jews food
no meat and milk together
120
test child for lead poisoning around
12 months of age
121
potassium food
bananas, potatoes, citrus fruits
122
before starting IV antibiotics need
cultures
123
pt with leukemia may have
epitaxis because of low platelets
124
best way to warm a newborn
skin to skin contact covered with blanket on mom
125
when pt comes in that is in active labor 1st thing to do
listen to fetal heart tone/rate
126
phobic disorders use
systemic desensitization
127
with lower amputations pt is placed
in prone position
128
LPN cannot give what
blood
129
amynoglycosides cause
nephrotoxicity and ototoxicity
| like vanco
130
IV push should never go over
2 mins
131
cardinal sign of ARDS
hypoxemia
| ARDS (fluid in alveoli)
132
in pH regulation the 2 organs of concern
lungs/kidneys
133
edema is in the
interstital space not the cardiovascular space
134
biggest indicator of dehydration
weight
135
aspirin when given to children can cause
Reye's syndrome (encephalopathy)
136
cold/heat for pain
cold - acute pain (sprain ankle)
| heat - chronic (rheumatoid arthritis)
137
pneumonia s/s
fever and cils usually present
| elderly - confusion
138
administering antibiotics
- always check for allergies before (especially PCN)
| - make sure culture and sensitivity has been done before
139
COPD vs pneumonia
COPD is chronic
| pneumonia is acute
140
emphysema and bronchitis are both
COPD
141
in COPD pts
the barorecptors that detect the CO2 level are destroyed
| therefore, the O2 level must be low because high O2 concentration blows the pts stimulus for breathing
142
What kind of syringe for epi
TB syringe
143
exacerbation:
acute, distress
144
cushing's syndrome
prednisone toxicity
buffalo hump, moon face, high glucose, hypertension
145
4 options for cancer management
chemo, radiation, surgery, allow to die with dignity
146
neutropenic precautions
no live vaccines, no fresh fruits, no flowers , NO MILK
147
chest tubes are placed in
the pleural space
148
angina vs. MI
angina - low oxygen to heart tissues (no dead heart tissues
| MI - dead heart tissues present
149
mevacor
(anticholesterol med)
| must be given with evening meal if it is QD (per day)
150
nitroglycerin
administered up to 3 times every 5 mins
if chest pain does not stop then go to hospital
- do not give when BP
151
preload
affects the amount of blood that goes into the R ventricle
152
afterload
is the resistance the blood has to overcome when leaving the heart
153
calcium channel blockers affect
the afterload
154
during CABG operation
the great saphenous vein is taken and turned inside out due to the valves that are inside
155
dead tissues of the heart cannot have
PVCs
156
untreated PVCs lead to
ventricular fibrillation
157
angiotension II in the lungs
angiotension II in the lungs
158
aldosterone attracts
sodium
159
reverse agent for heparin
protamine sulfate
160
reverse agent for coumadin
vitamin k
161
reverse agent for ammonia
lactulose
162
reverse agent for acetaminophen
n-Acetylcysteine
163
reverse agent for iron
deferoxamine
164
reverse agent for digoxin
digibind
165
reverse agent for alcohol withdraw
librium
166
methadone
opioid analgesic used to treat/detoxify pain in narcotic addicts
167
potassium does what to dig toxicity
potentiates
168
heparin prevents
platelet aggreation
169
what is elevated when pt on Coumadin
PT/PTT
170
cardiac output decreases with
dysryhtmias
171
dopamine increases
BP
172
med of choice for Vtach
lidocaine
173
med of choice for SVT is
adenosine or adenocard
174
med of choice for asystole
atropine
175
med of choice for CHG is
ace inhibitor
176
med of choice for anaphylactic shock
epinephrine
177
med of choice for status epilepticus is
valium
178
med of choice for bipolar
lithium
179
What is effective in both ventricular and atrial complications?
Amiodorone
180
S3 is normal in _____ but not normal in ____
S3 is normal in CHF but not normal in MI
181
When to give Carafate?
Carafate (GI med) is given before meals to coat stomach
182
Protonix
Given prophylactically to prevent stress ulcers
183
What type of line is TPN given through?
Given through subclavian line
184
Low residue diet means
Low fiber diet
185
Where is pain for diverticulitis
- (inflammation of the diverticulum in the colon)
| - pain is around the LL quadrant
186
Where is appendicitis pain
- (inflammation of the appendix)
| - pain is in RL quadrant with rebound tenderness
187
portal hypertension + albuminemia =
ascites
188
What produces insulin?
Beta cells of the pancreas
189
What is contraindicated in pancreatitis?
- morphine
- causes spasm of the sphincter of Oddi
- so give demerol
190
Trousseau and Tchovoski signs of
hypocalcemia
191
with chronic pancreaitis give what with meals
pancreatic enzymes
192
never give K+
in IV push
193
mineral corticoids are given in
Addison's disease
194
DKA
diabetic ketoacidosis
- body breaking down fat instead of sugar for energy
- fats leave ketones (acids) that cause pH to decrease
- rare in DM type II because there is enough insulin to prevent breakdown of fats
195
sign of fat embolism
petechiae
| - treated with heparin
196
fat embolism treated with
heparin
197
for knee replacement use a
continuous passive motion machine
198
give what before any invasive procedure
prophylatic antibiotic therapy
199
gluacoma pts lose
peripheral vision
| - treated with meds
200
catarat =
cloudy, blurry vision
| - treated by lens removal-surgery
201
CO2 causes
vasoconstriction
202
most spinal cord injuries are at
cervical or lumbar regions
203
autonomic dysreflexia
- life threatening inhibited sympathetic response of nervous system to a noxious stimulus - pts with spinal cord injuries at T-7
- usually caused by a full bladder
204
spinal shock occurs
immediately after spinal injury
205
multiple sclerosis =
chronic, progressive disease with demyelinating lesions in the CNA which affects the white matter of the brain and spinal cord
- myelin sheat destruction, disruption in nerve impulse conduction
- motor s/s: limb weakness, paralysis, slow speech
- sensory s/s: numbness, tingling, tinnitus
- cerebral s/s: nystagmus, ataxia, dysphagia, dysarthria
206
myasthenia gravis =
decrease in receptor sites of acetylocholine
- since smallest concentration of ACTH receptors are in cranial nerves, expect fatigue and weakness in eye, mastication, pharyngeal muscles
207
tensilon test
given if muscle are tense in myasthenia gravis
| used to cofirm the diagnosis of myesthenia gravis
208
gullain-barre syndrome
ascending paralysis
| - keep eye on respiratory system
209
parkinson's
RAT
rigidity, akinesia (loss of muscle mvt), tremors
- treat with levodopa
210
TIA
(transient ischemic attack)
| - mini stroke with no dead brain tissue
211
CVA
(cerebrovascular accident)
| - dead brain tissue
212
Hodgkin's disease
cancer of lymph is very curable in early stage
213
Rule of Nines for burns
```
Head and neck = 9%
Each upper ext = 9%
each lower extremity = 18%
Front truck = 18%
Back trunk = 18%
Genitalia = 1%
```
214
birth weight doubles by
6 months, and triples by 1 year
215
do not give dig to children if
if heart rate is
216
first sign of cystic fibrosis
may be meconium ileus at birth
| - baby is inconsolable, do not eat, and not passing meconium
217
cyanotic heart defects
3Ts - Tof, truncys arteriosus, transposition of the great vessels
- prevent blood from going to heart
- if not fix on on, or cannot be corrected surgically CHF will occur followed by death
218
right sided heart defects
look for valve problems
219
left sided heart defects in adults
look for coronary complications
220
rheumatic fever can lead to
cardiac valves malfunctions
221
cerebral palsy =
poor muscle control due to birth injuries and/or decrease oxygen to brain tissues
222
ICP should be
223
dilantin level
10-20
| can cause gingival herplasia
224
for meningitis check
for kernig's/brudzinski's sings
225
wilms tumor
above the kidneys causing flank pain
226
hemophilia is
x-linked
| -mother passes disease to son
227
when phenylalanine increases
brain problems occur
228
Buck's traction =
knee immobility
229
Russell traction =
femur or lower leg
230
Dunlap traction =
skeletal or skin
231
Bryant's traction =
children
232
when putting on traction
place apparatus first then place the weight
233
placenta should be in
upper part of the uterus
234
eclampsia is
seizure
235
a pt with a vertical c-section surgery will be more likely to
have another c-section
236
perform amniocentesis
before 20 weeks gestation to check for cardiac and pulmonary abnormalities
237
Rh- mothers recieve
rhogam to protect next baby
238
anterior fontanelles close
by 18 mo
239
posterior fontanelles close
6-8 weeks
240
caput succedaneum =
diffuse edema of the fetal scalp that crosses the suture lines
- swelling reabsorbs within 1-3 days
241
pathological jaundice =
occurs before 24 hrs and last 7 days
242
physiological jaundice =
occurs after 24 hrs
243
placenta previa =
- there is no pain
| - there is bleeding
244
placenta abruption =
pain, but no bleeding
245
bethamethasone
(celestone) = surfactant
| - med for lung expansion
246
dystocia =
baby cannot make it down to canal
247
pitocin
med used for uterine stimulation
248
magnesium sulfate
- used to halt preterm labor
- contraindicated if deep tendon reflexes are ineffective
- if pt experiences seizure during magnesium administration get the baby out STAT
249
do not use what statements when dealing with pts
why or I understand
250
milieu therapy -
taking care of pt/environment
251
cognitive therapy -
counseling
252
crisis intervention -
short term
253
5 interventions for psych pts
- safety
- setting limits
- establishing a trusting relationship
- meds
- less restrictive methods/environment
254
SSRI's
antidepressants
| take 3 weeks to work
255
Obsession vs. Compulsion
obsession - is to thought
| compulsion - is to action
256
if pt having hallucinations
redirect them
257
if pt having delusions
distract them
258
Thorazine
(haldol) - antipsychotic
| - can lead to EPS (extrapyramidal side effects)
259
Alzheimer's disease
chronic, progressive, degenerative, cognitive disorder that accounts for more than 60% of all dementias
260
drawing up insulin
(Nicole Richey, RN)
| air into NPH, air into regular, then draw up regular then draw up NPH
261
HYPERthyroidism
(Michael Jackson thriller)
| skinny, nervous, bulging eyes, up all night, heart beating fast
262
atropine
used to decreased secretions
263
phenergan
antiemetic used to reduce nausea
264
diazepam
commonly used tranquilizer given to reduce anxiety before OR
265
Demoral
pain control
| - do not give to sickle cell crisis
266
Do not give demoral to
sickle cell crisis
267
give iron IM
z track
| so they don't leak into SQ tissues
268
Heart valves assessment
(all people eat too much)
Aorta - 2nd intercostal space right sternal border
Pulmonic - 2nd intercostal space left sternal border
Erbs point - 3rd intercostal space left sternal border
Tricuspid - 4th intercostal space left sternal border
Mitral - 5th intercostal space midclavicular line
269
Cranial nerves
(S = sensory, M = motor, B = both)
```
I Olfactoary Some
II Optic Say
III Oculomotor Marry
IV Trochlear Money
V Trigeminal But
VI Abducens My
VII Facial Brother
VIII Acoustic Says
IX Glossopharyngeal Big
X Vagus Brain
XI Spinal accessory Matter
XII Hypoglossal More
```
(Oh, Oh, Oh, To Touch And Feel A Girls Vagina, AHH, Heaven)
270
Hypernatremia
```
greater than 145
think salt:
Skin flushed
Agitation
Low grade fever
Thirst
```
271
at 2-3 months developmental
turns head side to side
272
at 4-5 months developmental
grasps, switch and roll
273
at 6-7 months developmental
sit at 6 and wave bye-bye
274
at 8-9 months developmental
stands STRAIGHT at EIGHT
275
at 10-11 months developmental
belly to butt
276
at 12-13 months developmental
twelve and up, drink from a cup
277
Hepatitis
Hep A - ends in a VOWEL comes from the BOWEL
Hep B - blood and body fluids
Hep C - blood and body fluids
278
Glasgow coma scale
Max 15
below 8 your in a coma!!
Eyes - open spontaneously and uses them correctly to see then 4, if you have to yell then 3, if don't open them to pain then 1
Verbal - if orientated then 4, confused 3, inappropriate words 3, incomprehensible sounds 2, no verbal 1
Motor - good moves then 6
279
the person who hyperventilates will experience
respiratory alkalosis
280
avoid what when taking dig and k-supplements
salt substitutes - potassium based
281
signs of hypoxia
restless, anxious, cyanotic tachycardia, increased respirations
- monitor ABGs
282
precautions for herpes zoster
disseminated herpes zoster - airborne
localized herpes zoster - contact
- nurse with localized herpes zoster can care for pt as long as the pts are not immunosuppressed and the lesions must be covered!!
283
fat soluble vitamins
A, D, E, K
284
drugs given with food
NSAIDS, corticosteroids, drugs for bipolar, cephalosporins, and slufanomides
285
tx of choice for status epilepticus
ativan
286
when using bronchodilator inhaler in conjunction with a glucocorticoid inhaler admin which on first
bronchodilator 1st
287
Intal
inhaler used to tx allergy induced asthma may cause bronchospasm
- think! INto asthmatic lung
288
Isoniazed
causes peripheral neuritis
289
peptic ulcers caused by H. plyori
- tx with Flagyl, Prilosec, and Biaxin
| - tx kills bacteria and stops production of stomach acid, but does not heal ulcer
290
weighted NI
(Naso intestinal tubes)
- must float from stomach to intestine
- don't tape tube right after placement, may leave coiled next to pt on HOB
- position pt on RIGHT to facilitate movement through the pylorus
291
Diaphragm birth control
- must stay in place 6 hrs after intercourse
| - fitted and must be refitted if you lose or gain weight
292
Best time to take growth hormone
PM
293
Best time to take steroids
AM
294
Best time to take diuretics
AM
295
Best time to take aricept
AM
296
Tagamet
H2
- take with food
- messes with elderly because interacts with a lot of things!!
297
take antacids when
after meals
298
long term use of amphojel
binds to phosphates, increases Ca, robs the bones - leads to increased Ca resortion from bones = WEAK BONES
299
Cushings ulcers r/t
BRAIN injury
300
Cushings triad r/t
ICP in BRAIN (htn, bradycardia, irregular resps)
301
Thyroid storm temp
HOT - hyperthermia
302
Myxedema coma temp
COLD - hypothermia
303
Glaucoma
intraocular pressure is greater than normal (22 mm Hg)
- give miotics to constrict (pilocarpine)
- NO ATROPINE
304
non dairy sources of calcium
Rhubarb, sardines, collard greens
305
to avoid skin irritation with plaster cast
petal the rough edges with tape
306
To relieve low back aches
bend knees
307
push fluids with Allopurinol to
flush the uric acid out of system
308
koplick's spots
red spots with blue center characteristic of PRODROMAL stage of Measles, usually in mouth
309
INH can cause
peripheral neuritis, take vit B6 to prevent also hepatotoxic
310
Rifampin
for TB
- Red/orange tears and urine!
- contraceptives don't work as well
311
Ethambutol s/e
messes with your Eyes
312
applying eye drops
- apply to conjunctival sac
| - afterwards apply pressure to nasolacrimal duct/inner canthus
313
for pancreatitis pts
put them in fetal position
NPO - let gut rest
get ready for PICC because will get TPN/LIPIDS
314
trendelenburg test
for varicose veins, if they fill proximally = varicosity
315
when giving kayexalate need to worry about
dehydration!!
| K has inverse relationship with Na
316
yogurt has live cultures so don't give to
immunosuppressed pt
317
for itching under cast area
cool air via blow dryer
ice pack for 10-15 mins
NEVER use qtip or anything to scratch area
318
Murphy's sign -
pain with palpation of gall bladder area seen with cholecystitis
319
Cullen's sign -
ecchymosis in umbilical area, seen with pancreatitis
320
Turner's sign -
flank grayish blue (turn around to see your flanks)
| pancreatitis
321
McBurney's pint -
pain in RLQ indiciative of appendicitis
322
pain in LLQ -
diverticulitis, low residue, no seeds, nuts, peas
323
pain in RLQ -
appendicitis, watch for peritonitis
324
Gurthrie Test -
tests for PKU, baby should have eaten source of protein first
325
Shilling Test -
How well one absorbs Vit B12
| test for pernicious anemia
326
Allen's test -
- do prior to doing and ABG to check for sufficient
- occlude both ulnar and radial artery until hand blanches then release ulnar
- if the hand pinks up, ulnar artery is good and you can carry on with ABG/radial stick as planned
327
Peritoneal Dialysis cath (tenkhoff) ok if
abdominal cramps, blood tinged outflow and leaking around site; if cath was placed in last 1-2 weeks
328
NEVER normal for tenkhoff
(peritoneal dialysis) CLOUDY outflow
329
amniotic fluid yellow with particles =
meconium stained
330
hyper reflexes
- upper motor neuron issue
| "your reflexes are over the top"
331
absent reflexes
- lower motor neuron issue
332
Rhogam
given at 28 weeks, 72 hrs post partum, IM
only given to Rh NEGATIVE mothers
- only give if negative Coomb's test - if indirect Coomb's test is positive don't need Rhogam because she has antibody
333
Magnesium sulfate antidote
Calcium gluconate
334
Acetaminophen antidote
Mucomyst
335
TPA antidote
(given for blood clot/stroke)
| Amicar
336
Order of assessment:
Inspection, Palpation, percussion, Auscultation
| Except with abdomen! (Inspect, ausculate, percuss, then palpate (same with kids)
337
To assess for latex allergies ask if allergic to
bananas, apricots, cherries, grapes, kiwis, passion fruit, avocados, chestnuts, tomatoes, peaches
338
Amyotrophic lateral scleorsis
(ALS) degeneration of motor neurons in both the upper & lower motor neuron systems
339
Transesopheal Fistula (TEF)
esophagus doesn't fully develop
| surgical emergency!!
340
the 3 C's of TEF in newborn
1. choking
2. coughing
3. cyanosis
341
MMR vaccine is given what route
SQ not IM
342
Diaster colors
Red - unstable, ie occluded airway, actively bleeding, see first
Yellow - stable, can wait up to an hour for treatment, ie burns, see second
Green - stable, can wait even longer to be seen, "walking wounded"
Black - unstable pts that will probably not make it, need comfort measures
DOA - dead on arrival
343
Creek heritage with babies
put an amulet or protective charms around baby's neck to avoid "evil eye" or envy of others
344
4 year old kids cannot interpret
TIME
need to explain time in relationship to a known common event
"mom will be back after supper"
345
contraindication for Hep B vaccine
anaphylactic reaction to baker's yeast
346
Ask for allergy to what before flu shot?
eggs
347
Ask if what before MMR
anaphylactic reaction to eggs or neomycin
348
When on nitroprusside monitor
thiocynate (Cyanide)
| - normal value should be 1 if greater than 1 heading towards toxicity
349
if a kid has a cold what about immunizations
can still give
350
SARS isolation
(severe acute resp syndrome)
| airbone + contact (just like caricella)
351
hepatitis A precautions
contact precautions
352
Standard precautions
Tetanus, Hepatitis B, HIV
353
William's position
semi fowlers with knees flexed to relieve lower back pain
354
Signs of a fractured hip
external rotation, shortening, adduction
355
fat embolism s/s
blood tinged sputum (r/t inflammation), increased ESR, respiratory alkalosis (r/t tachypnea), hypocalcemia, increased serum lipids, "snow storm" effect on CXR
356
Complications of mechanical ventilation
pneumothorax, ulcers
357
Paget's disease
tinnitus, bone pain, enlargement of bone, thick bones
358
No what with allopurinol
vitamin C
359
IVP requires
bowl prep so they can visualize the bladder better
360
Acid Ash diet -
cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread
361
Alk Ash diet -
milk, veggies, rhubarb, salmon
362
orange tag in triage is
non emergent psych
363
Greenstick fractures
usually seen in kids
| bone breaks on one side and bends on the other
364
Insomnia is a side effect of
thyroid hormones - increased met rate, body is too busy to sleep
(hypothyroidism report somnolence - decreased met rate, body is slow and sleepy)
365
tx for strabismus
(Cross-eyed)
Botox
patch the good eye so that the weaker eye can get stronger
366
Tidal volume
7-10 ml/kg
367
COPD pts on oxygen
remember 2L NC or less (Hypoxic NOT hypercapnic drive), PaO2 of 60ish and SaO2 90% is normal for them because they are chronic CO2 retainers
368
Use what to reverse effect of pancuronium
Neostigmine/Atropine (anticholinergic)
369
Ampho B causes
hypokalemia
| - gotta premedicate before giving, pts will most likely get a fever
370
Before the administration of asparginase
test for hypersensitivity
371
Take what with high fat diet
Vermox (increases absorption)
372
kidney glucose threshold is
180
373
Amphogel and Renegal take
with meals
374
stranger anxiety is greatest
7-9 months
375
separation anxiety peaks in
toddlerhood
376
What is best for asthma and arthritis
swimming
377
If asthma has intercostal retractions
be concerned
378
Tardive Dyskinesia
- irreversible, involuntary movements of the tongue, face, and extremities
- may happen after prolonged use of antipsychotics
379
Akathisia
motor restlessness, need to keep going
| - tx with antiParkinson meds, can be mistaken for agitation
380
When drawing ABG
put blood in a heparinized tube, make sure no bubbles, put on ice immediately after drawing, with a label indicated if the pt was on room air or how many liters of O2
381
Before a pulmonary function test
a pt's bronchodilator will be with-held and they are not allowed to smoke for 4 hrs prior
382
For a lung biopsy
position pt lying on side of bed or with arms raised on pillows over bedside table, have pt hold breath in mid expiration
- chest xray done immediately afterwards to check for complication of pneumothroax
- sterile dressing applied
383
For lumbar puncture
pt position in lateral recumbent fetal position, keep pt flat for 2-3 hrs afterwards, sterile dressing, frequent neuro assessments
384
For EEG
hold meds for 24-48 hrs prior, no caffeine or cigarettes or stimulants for 24 hrs prior, pt can eat, pt must stay awake night before exam, pt may be asked to hyperventilate for 3-4 mins and watch a bright flashing light
- after EEG assess for seizures, pts will be at increased risk
385
Dexedrine
- used for ADHD
- may alter insulin needs
- avoid taking with MAOI's
- take in morning (insomnia possible side effect)
386
Cytovene
- used for retinitis caused by cytomegalovirus
- pt will need regular eye exams
- report dizziness, confusion, or seizures immediately
387
INH
- used to tx and prevent TB
- do not give with dilantin
- can cause phenytonin toxicity
- monitor LFT's
- give B6 along with
- hypotension will occur initially then resolve
388
When mixing antipsychotics with fluids (Haldol, Throazine, Prolixin)
incompatible with caffeine and apple juice
389
preferred anti-psychotic in elderly
Haldol
- but high risk extrapyramidal s/e (Dystonia, tarditive dyskinesia, tightening of jaw, stiff neck, swollen tongue - swollen airway)
- monitor for early s/s of reaction and give IM Benadryl
390
Risperdal
antipsychotic
- doses over 6mg can cause tarditive dyskinesia
- first line antipsychotic in children
391
Levodopa
- tx parkinsons
| - contraindicated in pts with glaucoma, avoid B6
392
Sinemet
- tx parkinsons
| - contraindicated with MAOI's
393
Hydroxyurea
for sickle cell
- report GI symptoms immediately
- could be signs of toxicity
394
Zocor
for hyperlipidemia
- take on empty stomach to enhance absorption
- report any unexplained muscle pain, especially if fever
395
Decorticate vs. Decerebrit
Decorticate - towards the core (cortex involvement)
| Decerebrit - the other way ( out) (cerebellar, brain stem involvement)
396
Botulin Toxin
(Botox) used with strabismus also to relax vocal cords in spasmodic dysphoria
397
Muchausen Syndrome
is a psychiatric disorder that causes an individual to self-inflict injury or illness or to fabricate symptoms of physical or mental illness in order to receive medical care or hospitalization
398
Muchausen by proxy (MSBP)
individual (typically mother) intentionally causes or fabricates illness in child or other person under care
399
Huntington's Chorea
50% genetic, autosomal dominant disorder
- s/s: chorea - writhing, twisting, movements of face, limbs, and body
- gait deteriorates to no ambulation
- no cure, just palliative care
400
WBCs and pyelonephritis
(kidney infection) WBC shift to the left, neutrophils kick in to fight infection
401
Definitive diagnosis for abdominal aortic aneurysm
CT scan
402
Don't use Kayexalate if
pt has hypoactive bowel sounds
403
Uremic fetor
smell urine on the breath
404
Hirschsprung's
- bile is lower obstruction, no bile is upper obstruction
| - ribbon like stools
405
When to take pancreatic enzymes
WITH each meal, not before or after
406
Can't eat what before occult blood test
- cantaloupe - high in vitamin C and vit C causes false positive
407
Hypospadias
- abnormality in which the urethral meatus is located on the ventral (back) surface of the penis anywhere from the corona to the perineum
- remember hypo, low (lower side or underside)
408
Epispadias
opening of the urethra on the dorsal (front) surface of the penis
409
Priapism
painful erection lasting longer than 6 hrs
410
Anticholinergic effects assessment
- dry mouth - can't spit
- urinary retention - can't piss
- constipated - can't s***
- blurred vision - can't see
411
When see coffee brown emesis think
peptic ulcer
412
Anytime see fluid retention think
heart problems first
413
an answer that delays care or tx then
is always wrong
414
For peripheral vascular disease ...
legs dependent for arterial and veins elevated
415
Never release traction unless
have an order form the MD to do so
416
If a question is about a halo then
safety first have screwdriver close by!
417
Compartment syndrome
emergency!
- paresthesias and increased pain are classic symptoms
- neuromuscular damage is irreversible 4-6 hrs after onset
418
Infancy (0-18mo) behavior motivated by
others will satisfy needs
419
Childhood behavior motivated by
learn to delay need gratification
420
Juvenile (6-9) behavior motivated by
learn to relate to peers
421
Preadolescence (9-12) behavior motivated by
learns to relate to friends of opposite sex
422
Early adolescence (12-14) behavior motivated by
learn independence and how to relate to opposite sex
423
Late adolescence (14-21) behavior motivated by
develop intimate relationship with person of opposite sex
424
fetal alcohol syndrome s/s
upturned nose
flat nasal bridge
thin upper lip
small for gestational age
425
IM admin site for 6 mo infants
vastus lateralis
426
IM admin site for toddlers above 18 mo
ventrogluteal
427
Im admin site for children
deltoid and gluteus maxims
428
OU
both eyes
429
OS
left eye
430
OD
right eye (think dominant right eye)
431
walking with a cane
(remember coal)
| Cane Opposite Affected Leg
432
Red injuries
Immediate: injuries are life threatening but survivable with minimal intervention
Ex. hemothorax, tension pneumothorax, unstable chest and abdominal wounds, INCOMPLETE amputations, OPEN fractures of long bones, 2nd/3rd degree burn with 15-40% of total body surface
433
Green injuries
Minimal: injuries are minor and tx can be delayed to hrs or days, individuals should be moved away from teh main triage area
Ex. upper extremity fx, minor burns, sprains, small lacerations, behavior disorders
434
Black injuries
Expectant: injuries are extensive and chances of survival are unlikely, separate but don't abandoned, comfort measures if possible
Ex. unresponsive, spinal cord injuries, burns with 60% body surface area, seizures, profound shock with multiple injuries, no pulse, bp pupils fixe or dilated
435
Thoracentesis prep
- take VS
- shave area around needle insertion
- position pt with arms on pillow over bed table or lying on side
- no more than 1000cc at one time
436
Thoracentesis post -
- listen for bilateral breath sounds
- VS
- check leakage
- sterile dressing
437
Before CT assess for
allergies
438
Before MRI assess for
claustrophobia, no metal, assess pacemaker
439
Cardiac cath prep
- NPO 8-12 hrs
- empty bladder
- check pulses
- tell pt may feel heart palpitations or desire to cough with dye injections
440
Cardiac cath post
- vital signs
- keep leg straight
- bedrest 6-8 hrs
441
cerebral angio prep
- well hydrated
- lie flat
- sire shave
- pulses marked
442
cerebral angio post -
- keep flat 12-14 hrs
- check site
- check pulses
- force fluids
443
Lumbar puncture
- fetal position
- neuro assessment q15-30 mins until stable
- flat 2-3 hr
- encourage fluids
- oral analgesics for headache
- observe dressing
444
Myelogram prep
- NPO 4-6 hrs
- allergy hx
- phenothiazines, CNS depressants, and stimulants withheld 48 hrs prior
- table will be moved to carious positions during test
445
Myelogram post
- assess neuro q2-4 hrs
- water soluble HOB up, oil soluble HOB down
- oral analgesics for h/a
- encourage PO fluids
- assess for distended bladder
- inspect site
446
liver biopsy prep
- admin vitamin K
- NPO 6 hrs
- teach pt that will be asked to hold breath for 5-10 seconds
- supine postion, lateral with upper arms elevated
447
liver biopsy pot
- position on right side
- frequent VS
- report severe abdominal pain stat!!
- no heavy lifting 1 week
448
Paracentesis prep
- semi fowlers or upright edge of bed
| - empty bladder
449
Paracentesis pot
- VS
- report elevated temp
- observe for signs of hypovolemia
450
laparoscopy prep
CO2 used to enhance visual, general anesthesia foley
| - post: walk pt to decrease CO2 build up for procedure
451
pyelogram prep
assess for allergies
452
Sengstaken Blakemore tube used
for tx of esophageal varices
| - keep scissors at bedside!!
453
TB key symptom
low grade afternoon fever
454
pneumonia key symptom
rusty sputum
455
Asthma key symptom
wheezing on expiration
456
Emphysema key symptom
barrel chest
457
Kawaski syndrome key symptom
strawberry tongue
458
Pernicious anemia key symptom
red beefy tongue
459
Down syndrome key symptom
protruding tongue
460
Cholera key symptom
rice watery stool
461
Malaria key symptom
stepladder like fever with chills
462
Typhoid key symptom
rose spots in abdomen
463
Diptheria key symptom
pseudo membrane formation
464
Measles key symptom
koplik's spots
465
Lupus key symptom
butterfly rash
466
Liver cirrhosis key symptom
spider like varices
467
Leprosy key symptom
lioning face
468
Bulimia key symptom
chipmunk face
469
Appendicitis key symptom
rebound tenderness
470
Dengue key symptom
petechiae or positive herman's sign
471
Menigitis key symptom
```
Kernig's sign (leg flex then leg pain on extension)
Brudzinski sign (neck flex = lower leg flex)
```
472
Tetany key symptom
hypocalemia;
| Trousseau's sign/carpopedal spasm; Chvostek sign (facial spams)
473
Tetanus key symptom
rius sardonicus
474
Pancreatitis key symptom
Cullen's sign (ecchymosis of umbilicus); Grey turner's spots
475
Pyloric stenosis key symptom
olive like mass
476
Patent ductus arteriosus key symptom
machine like murmur
477
Addison's disease key symptom
bronze like skin pigmentation
478
Cushing's syndrome key symptom
moon face appearance and buffalo hump
479
Hyperthyroidism/Grave's disease key symptom
exopthalmuse
480
Intussusception key symptom
sausage shaped mass, Dance sign (empty portion of RLQ)
481
MS key symptom
Charcot's Triad (IAN)
hyperactive deep tendon reflexes, vision changes, fatigue and spasticity
482
MG key symptom
Descending muscle weakness
483
Gullain Barre key symptom
ascending muscle weakness
484
DVT key symptom
Homan's Sign
485
Chicken pox key symptom
Vesicular Rash (central to distal) dew drop on rose petal
486
Angina key symptom
crushing stubbing pain relieved by NTG
487
MI key symptom
crushing stubbing pain which radiates to left shoulder, neck, arms, unrelieved by NTG
488
LTB key symptom
inspiratory stridor
489
TEF key symptoms
4Cs - coughing, choking, cyanosis, continuos drooling
490
Epiglotitis key symptom
3Ds - drooling, dysphonia, dysphagia
491
Hodgekin's DSE/Lumphoma key symptom
painless, progressive enlargement of spleen & lymph tissues, Reedstenberg Cells
492
Infectious Monoucleosis key symptoms
sore throat, cervical lymph, adenopathy, fever
493
Parkinson's key symptom
pill-rolling tremors
494
Fibrin Hyalin key symptom
expiratory grunt
495
Cystic fibrosis key symptom
salty skin
496
DM key symptoms
polyuria, polydypsia, polyphagia
497
DKA key symptom
Kussmauls breathing (deep rapid RR)
498
Bladder Ca key symptom
Painless hematuria
499
BPH key symptom
reduced size and force of urine
500
Pemphigus Vulgaris key symptom
Nikolsky's signs (separation of epidermis caused by rubbing of the skin)
501
Retinal Detachment key symptom
visual floaters, flashes of light, curtain vision
502
Glaucoma key symptom
painful vision loss, tunnel/gun barrel/ halo vision (peripheral vision loss)
503
Cataract key symptom
painless vision loss, opacity of the lens, blurring of vision
504
Acromegaly key symptom
coarse facial feature
505
Duchenne's Muscular Dystrophy key symptom
Gower/s sign (use of hands to push one's self from the floor)
506
GERD key symptom
Barretts esophagus (erosion of the lower portion of the esophageal mucosa)
507
Hepatic Encephalopathy key symptom
flappy tremors
508
Hydrocephalus key symptom
Bossing sign (prominent forehead)
509
Increased ICP key symptoms
HYPERtension, BRADYpnea, BRADYcardia, (chushing's triad)
510
Shock key symptoms
HYPOtension, TACHYpnea, TACHYcardia
511
Meniere's Disease key symptom
Vertigo, Tinnitus
512
Cystitis key symptom
Burning on urination
513
Hypocalemia key symptoms
Chvostek & Trosseaus
514
Ulcerative Colitis key symptom
recurrent bloddy diarrhea
515
Lyme's Disease key symptom
Bull's eye rash
516
otorrhea sign of what kind of fracture
basilar fracture
517
orbital fracture s/s
battles sign and raccoon eyes
518
Take iron elixir with
juice or water
| NEVER with milk
519
Kawaski's leads to
cardiac problems
| - coronary artery aneurysm r/t the inflammation of blood vessels
520
Dilantin
10-20
521
Theophyline
10-20
522
Acetaminophen
10-20
523
Lithium
0.5-1.5
524
Digoxin
0.5-2.0
525
Ostemyletitis
infectious bone disease
- give blood cultures and antibiotics
- if necessary surgery to drain abscess
526
Nephrotic syndrome
characterized by massive PROTEINURIA (looks dark and frothy) caused by glomerular damage
- s/s edema + hypotension
- corticosteroids are mainstay
- turn and reposition (risk for impaired skin integrity)
527
To access role relationship pattern focus on
image and relationships with others
528
Labs for renal impairment
elevated serum creatinine and decreased urine clearance
529
normal serum creatinine
men 0.8-1.8
| women 0.5-1.5
530
Atropine Overdose
Hot as a hare (TEMP), mad as a hatter (LOC), red as a beet (FLUSHED FACE), dry as a bone (THIRSTY)
531
normal hemoglobin neonates
18-27
532
normal hemoglobin 3 mos
10.6-16.5
533
normal hemoglobin 3 years
9.4-15.5
534
normal hemoglobin 10 years
10.7-15.5
535
glomerulonephritis
- take vitals q4
| - daily wts
536
vaccines for age 4-5 years old
DPT/MMR/OPV
537
cystic fibrosis tx
- low fat diet, high sodium, fat soluble vitamins ADEK, aerosol bronchodilators, mucolytics, and pancreatic enzymes
538
Zoloft s/e
agitation, sleep disturbance, and dry mouth
539
Clozapine s/e
agranulocytosis, tachycardia, and siezures
540
Blood tests for MI
Myoglobin, CK and Troponin
541
salt substitutes may contain
potassium
542
Placental abruptio
bleeding with pain
| - don't forget to monitor volume status (I&O)
543
Meningeal irritation s/s
nuchal rigidity, positive Brudzinski + kernig signs, PHTOTPHOBIA
544
Babinski sign
toes curl --- GREAT!
| toes fan --- BAD!
545
glucose tolerance test for pregnancy women
result of 140 or higher needs further evaluation
546
Assessing extra ocular eye movements check cranial nerves
3,4, and 6
547
dusky stoma means
poor blood supply
548
protruding stoma means
prolapsed
549
sharp pain and rigidity with stoma means
peritonitis
550
mucus in ileal condult with stomas
is expected
551
Dilantin s/e
- rash (Stop med)
| - gingival hyperplasia (good hygiene)
552
Dilantin toxicity
poor gait and coordination, slurred speech, nausea, lethargy, and diplopia
553
Phenobarbital vs. Dilatin during pregnancy
Phenobarbital can be taken during pregnancy but Dilatin is contraindicated
554
Tension pneumothorax trachea
shifts to opposite side
555
change in color is always
a late sign
556
amininoglycocide s/e
(MYCIN) (except erythromycine)
| - nephrotoxic to kidneys and ototoxic to ears
557
MRSA precautions
contact only
558
VRSA precautions
contact AND airborne (private room, door closed, negative pressure)
559
lithium
L-level of therapeutic affect 0.5-1.5
I - indicate mania
T - toxic level is 2-3 - N/V, diarrhea, tremors
I - increased UO and dry mouth
U - uh oh - five mannitol and Diamox if toxic s/s are present
M - maintain Na intake of 2-3g
560
Blood transfusion sign of allergies
1. flank pain
2. frequent swallowing
3. rashes
4. fever
5. chills
561
All psych meds (except Lithium) same side effects
decreased BP, Increased HR and RR (dilated bronchioles), dilated pupils (blurred vision), Decreased gut (urinary retention), GIT (constipation), constricted blood vessels, and dry mouth
562
thrombocytopenia - bleeding precautions
- soft bristled toothbrush
- no insertion of anything (suppositories, douche)
- no IM meds
563
PO iron give with
vitamin C or on empty stomach
564
pernicious anemia will take what for life
Vitamin B12
565
Degree of burns
1st degree - red and painful
2nd degree - blisters
3rd degree - no pain because of blocked and burned nerves
566
Meniere's disease
- admin diuretics to decrease endolymph in the cochlea, restrict Na, lay on affected ear when in bed
- triad: vertigo, tinnitus, N/V
567
gastric ulcer pain
occurs 30 mins to 90 mins after eating, not at night, and doesn't go away with food
568
What is an intraosseous infusion?
IN pediatric life threatening emergencies, when iv access cannot be obtained, an osseous (Bone) needle is hand drilled into a bone (usually the tibia), where crystalloids, colloids, blood products and drugs can be administered into the marrow
- is temporary, life saving measure,
- when venous access is achieved it can be dced
- isoproterenol (beta agonist) only med that cannot be administered
569
2 interventions during a sickle cell crisis
fluids and pain relief
570
glomerulonephritis should consider what to be most important assessment
blood pressure
| - dietary restrictions fluids, protein, sodium, and potassium
571
congenital cardiac defects result in
hypoxia
- labs that support - increased hamatocrit, hemoglobin, and rbc count
- body tries to compensate for with influx of immatures rbcs
572
if infant has low set ears assess
for renal anomalies
| think kidney and ears are shaped the same
573
school aged kids and surgery
kids 5 and up should have explanation of what will happen a week before surgery
574
What to do if a toddler says no to medicine
leave and come back in five mins, don't give a choice
575
first sign of pyloric stenosis in a baby
- mild vomiting that progresses to projecting vomiting
| - later may be able to palpate a mass, the baby will seem hungry often, and may spit up after feedings
576
a child with a ventriculoperitoneal shunt
- will have small upper-abdominal incision - where shunt is guided into the abdominal cavity and tunneled under the skin up to the ventricles
- watch for abdominal distention - since fluid from the ventricles will be redirected to the peritoneum
- watch for signs of increasing ICP such as irritability, bulging fontanels, and hight pitched cry in infant; toddler watch lack of appetite and headache
577
bed placement after child with ventriculoperitoneal shunt
FLAT!
- so fluid doesn't reduce too rapidly
- if see s/s of increasing ICP then raise HOB 15-30 degrees
578
What causes bronchopulmonary dysplasia?
- dysplasia - abnormality or alteration
- mechanical ventilation can cause it
- premature newborns with immature lungs are ventilated and over time it damages the lungs
- other causes could be infection, pneumonia, or other conditions that cause inflammation or scarring
579
it is essential to maintain nasal patency with children
they are obligatory nasal breathers
580
kids drinking 3-4 cups of milk each day
bad! too much milk reduces intake of other essential nutrients, especially iron
- watch for anemia with milkaholics!!
581
what can go in kids bottles for naps/overnight
nothing but water!!
| - juice or milk will rott teeth
582
What traction is used in a school aged kid with a femur or tibial fracture with extensive skin damage?
99
| - angles of the joints, pin is placed in the distal part of the broken bone, and the lower extremity is in a boot cast
583
Bryant's traction for kids
a kid's hinder should clear the bed
584
white patches from the mouth of a baby
- if can remove then its just formula
| - if cant remove then its candidiasis
585
What vaccines come later
MMR and Varicella immunizations (15 mo)
586
Cryptorchidism
undescended tesis
| - risk factor for testicular cancer later in life
587
teach boys testicular self exam starts when
12, because most cases of testicular cancer occur during adolescence
588
Give what pain relief med to kids
Tylenol!!
| - aspirin is associated with Reye's syndrome - no NSAIDS (ibuprofen)
589
CSF in meningitis will have
high protein and low glucose
590
when thinking about child abuse
always correct to report suspected abuse
591
No nasotracheal suctioning in kids with
with head injury or skull fracture
592
feed babies upright to avoid
otitis media
593
position kids how with GERD
prone with HOB elevated
| - everyone else lay kid on his bac (Back to sleep - SIDS)
594
when installing eardrops for kids
pull pinna down adn back
595
kids with RSV and nurses
no contact lenses or pregnant nurses in rooms where ribavirin is being administered by hoot/tent
596
ribavirin
for RSV
| - no contact lenses or pregnant nurses in rooms where ribavirin is being administered by hoot/tent
597
positioning with pneumonia for kids
lay on the affected side to splint and reduce pain
| - if trying to reduce congestion the sick lung goes up (think stuffy nose side goes up and then it clears)
598
a positive ppd confirms
infection, not just exposure
599
a sputum test will confirm
active disease
600
kids coughing withou other s/s is suggestive of
asthma
| - know if wheezer stops wheezing could mean its worsening
601
Before administering dig
DO VITALS
| apical pulse for one full minute
602
Tet spells treated with
morphine
603
group a strep precedes
rheumatic fever
- chorea is part of the sickness (grimacing, sudden body movements) embarrasses kids
- they have joint pain
- watch for elevated antistreptolysin O to be elevated
- Penicillin!!
604
Signs of CHF in infant
don't pick cough over TACHYCARDIA
605
tylenol poisoning
liver failure possible for about 4 days!
| - close observation required during this time frame as well as tx with Mucomyst
606
radioactive iodine
- key word FLUSH
- flush substance out of body w/ 3-4 liters/day for 2 days
- flush the toilet twice after using for 2 days
- limit contact w/ pt to 30 mins a day
- no pregnant visitors and no kids
607
main hypersensitivity reaction seen with anti platelet drugs
bronchospasm (anaphylaxis)
608
common sites for metastasis
liver, brain, lung, bone, and lymph
609
orthostatisis is verified by
a drop in pressure with increasing heart rate
610
Bence jones protein in the urine confirms
multiple myeloma
611
priority with small bowel obstruction
not reestablishing a normal bowel pattern
| maintaining fluid balance!! comes first because the pt can't take in oral fluids
612
pernicious anemia s/s
pallor, tachycardia, and sore red tongue
613
flecainide (Tambocor)
antiarrythmic
| - limit fluids and sodium intake - because Na increases water retention which could lead to heart failure
614
Basophils release histamine during
an allergic response
615
adenosine
the tx of choice for paroxysmal atrial TACHYCARDIA
616
Iatragenic means
caused by tx, procedure, or meds
617
G-tube and J-tube
usually given as a continuous feeding
618
If pt getting radiation be most concerned about?
not skin but infection because of the leukopenia caused by radiation
619
breast cancer pt tx with tamoxifen should report
changes in visual acuity because adverse effect could be irreversible
620
Pneumovax 23 gets administered
post splenectomy to prevent pneumoccal sepsis
621
potassium normal value
3.5-5.0
622
if pt on dig and lasix make sure
getting enough potassium because low potassium potentiates dig and can cause dysrhythmias
623
ask every new admission if
they have an advanced directive
| if not then explain it and ask if they want to sign it
624
if someone is going through anaphylaxis then
implement before assess
| - give epinephrine stat (especially if difficulty breathing, increasing anxiety )
625
if disaster triage who last
the person who is most likely to not survive
626
Potassium and alkalosis/acidosis
alKaLOsis - K is LOW
| acidosis - k is high
627
vital sign you should check first with high potassium is
pulse (due to dysrhythmias)
628
Neostigmine
- give to pts with myesthenia gravis about 45 mins before eating so it will help with chewing and swallowing
629
Anectine
used for SHORT term neuromuscular blocking agent for procedures like intubation and ECT
630
Norcuron
used for LONG term neuromuscular blocking agent for procedures like intubation and ECT
631
parathyroid gland relies on
vitamin D to work
632
Immediate intervention after a sucking stab wound
dress the wound and tape it on 3 sides which allows air to escape
- do not use occlusive dressing - converts the wound from open pneumo to closed one, and a tension pneumothorax is a worse situation
- after that then chest tube tray, labs, iv
633
when is an occlusive dressing used
if chest tube is accidentally pulled out
634
When see PE think
oxygen first!!
- when O2 is deprived the body compensates by causing hyperventilation (resp alkalosis)
- pt should not breathe into a paper bag)
- if paO2 is well below 80 need OXYGEN
- look at ABG values
635
adverse reaction to oral hypoglycemics
rash
| photosensitivity
636
serum acetone and serum ketones ris in
DKA
| - as treat the acidosis and dehydration expect the potassium to drop rapidly so be ready with potassium replacement
637
fluids most important intervention with
HHNS as well as DKA
| - with HHNS no ketosis, and no acidosis, potassium is low r/t diuresis
638
Atropine blocks
acetylcholine
| it reduces secretions
639
Dantrium
for spasticity
| may take WEEK to be effective
640
Decreased acetycholine is r/t
senile dementia
641
after removal of the pituitary gland must
watch for hypocortisolism and temporary diabetes insipidus
642
position how after appendectomy
on right side with legs flexed
643
Hirschsprung's
- diagnosed with rectal biopsy looking for absence of ganglionic cells
- cardinal sign in infants is failure to pass meconium, later the classic ribbon like and foul smelling stools
644
Intussusception
- common in kids with CF
- Obstruction may cause fecal emesis, currant jelly like stools (blood and mucus)
- barium enema may be used to hydrostatically reduce the telescoping
645
with omphalocele and gastroschisis
(herination of abdominal contents)
| - dress with LOOSE SALINE DRESSING covered with plastic wrap, and keep eye on temp - kid can lose heat quickly
646
After a hydrocele repair
provide ice bags and scrotal support
647
No phenylalanine with a kid positive for
PKU (no meat, no diary, no aspartame)
648
Never give potassium if
the pt is oliguric or anuric
649
Most accurate when testing for ketones and glucose
second voided urine
650
positive western blot in child
- presence of HIV antibodies
- indicates only the mother is infected
- 2 or more positive p24 antigen test will confirm HIV in kids
651
For HIV kids
- avoid OPV and Varicella vaccinations (live) but give pneumococcal and influenza
- MMR is avoided only if the kid is severely immunocompromised
- parents should war gloves for care, not kiss kids on the mouth, and not share eating utensils
652
Hypotension and vasoconstricting meds may alter the accuracy of
O2 sats
653
What if the aspirate of NG tube is
give antacid
| - aspirate should be checked at least every 12 hrs
654
ambient air contains how much oxygen
(room air) 21% oxygen
655
first sign of ARDS
increased respirations
| - later dyspnea, retractions, air hunger, cyanosis
656
normal pulmonary capillary wedge pressure (PCWP)
8-13
| -18-20 hihg
657
first sign of PE is
sudden chest pain followed by dyspnea and tachypnea
658
with carbon dioxide narcosis expect
high potassium
- hydrogen floods the cell forcing potassium out
- carbon dioxide narcosis causes increased intracranial pressure
659
pulmonary sarcoidosis leads to
right sided heart failure
660
when pt going home with NG tube teach family
to irrigate with cola
661
Digitalis
increases ventricular irritability
| could convert a rhythm to vfib following cardioversion
662
if normally lucid pt starts seeing bugs then you
should check respiratory status firs
- 1st sign of hypoxia is restlessness, then agitation then delirium, hallucinations and coma
- so check O2 sat and get abgs
663
biggest concern with cold stress and the newborn is
respiratory distress
664
ends with -ide
diuretic
665
Lasix side effect
cause pt to lose hi appetite (anorexia) due to reduced potassium
666
If water breaks and pt is at any minus station then
risk of prolapsed cord
667
CPR 5 yr old
breathe once for every 5 compressions
668
Cephalhematoma (caput succindianium)
resolves on its own in a few days
| - type of edema that crosses the suture lines
669
after g-tube placement
the stomach contents are drained by gravity for 24 hrs before it can be used for feedings
670
during the acute stage stage of Hep-A what is required
gown and gloves
| - convalescent stage no loner contagious
671
low magnesium and high cretinine signals
renal failure
672
highest priority with RA
pain
673
if TB pt is unable/unwilling to comply with tx then
may need supervision (direct observation , TB is a public health risk
674
Most important assessment with status epilepticus
LOC
675
crackles suggest
pneumonia
| - most likely to be accompanied by hypoxia - manifest as mental confusion
676
can't cough =
ineffective airway clearance
677
Absence of menstruation leads to what in the anorexic
osteoporosis
678
Toddlers need to express
autonomy (independence)
679
a pt with low hemoglobin and/or hematocrit should be evaluated for
signs of bleeding (ie dark stools)
680
What is given the night before IVP
a laxative in order to better visualize the organs
681
a pt with liver cirrhosis and edema may do what to mobilize the edema
ambulate then sit with legs elevated
682
Most important assessment with Addison's
blood pressure - severe hypotension
683
What is important thing to do with adrenal insufficiency
Managing stress because if the adrenal glands are stressed further it could result in Addisonian crisis
684
After pain relief what is most important in pancreatitis
cough and deep breathe because of fluid pushing up in the diaphragm
685
Depressed pts need what
safety over nutrition
686
prolonged hypoxemia is a likely cause of what in a child
cardiac arrest
687
Fluid volume overload and CHF can cause
a S3
688
Coarctation of the aorta causes
increased blood flow and bounding pulses in the arms
689
Depression often manifests itself in
somatic ways, such as psychomotor retardation, GI complaints, and pain
690
newly diagnosed hypertension pt should have
BP assessed in BOTH arms
691
the chief concern with CF
respiratory problems
692
TB and positive PPD if area of induration is
>5 in an immunocompromised pt
>10 in a normal pt
>15 in a pt who lives in area where TB is very rare
693
ObA1c
test to assess how well blood sugars have been controlled over the past 90-120 days
- 4-6 responds to blood sugar of 70-110
- 7 is ideal for DM and corresponds to a blood sugar of 130
694
BSA
considered the most accurate method for medication dosing with kids
695
What side to put wheel chair on
parallel to the bed on the side of weakness
696
If nurses discovers another nurse has made a mistake then
talk to her about it before going to management, if it persist then take it higher
697
Sepsis and anaphylaxis
reduce circulating volume by way of increased capillary permeability , which leads to REDUCED PRELOAD (volume in the left ventricle at the end of diastole)
698
amniotic fluid acidosis or alkaline
ALKALINE
- turns nitrazine paper BLUE
- urine and normal vaginal discharge are acidic and turn it pink!!
699
Is gonorrhea reportable
yes gonorrhea is a reportable disease
700
crutches and steps
up with the good and down with the bad
701
While treating DKA bringing the glucose down too far and too fast can result in
increase intracranial pressure r/t water being pulled into the CSF
702
vasopressin
"press in" - vasoconstricts
703
what is common with the hypercalcemia caused hyperparathyroidism
- polyuria
704
water intoxication will be evidenced by
drowsiness and altered mental status in a pt with TUR syndrome, or as an adverse reaction to desmopressin (for diabetes insipidus)
705
adveres reactions to Lugol solution
(for hyperthyroid)
| - burins sensation in the mouth, and brassy tastes and should be reported to MD
706
give synthroid
on empty stomach
707
what may be needed for pt taking prednisone
extra insulin - steroids causes increased glucose
708
nonfat milk will reduce reflex by
increasing lower esophageal sphincter pressure
709
pts with GERD should lay
on LEFT side with HOB 30 degrees
710
to prevent dumping syndrome
low fowlers during meals and limit fluids while eating
711
in emphysema the stimulus is to
breathe low PO2, not increased PCO2
- so don't give a lot of O2
- encourage pursed lip breathing to promote CO2 elimination
- encourage 3000 ml/day of fluids
- high fowlers and leaning forward
712
theophylline causes
GI upset - give with food!!
| h
713
TB drugs are liver toxic
- does the pt have hep B
| - adverse reaction is peripheral neuropathy
