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Mark k Flashcards

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1
Q

clarifying an order vs questioning

A

one of the answers is INCOMPLETE, NOT WRONG

questioning:

WILL HARM THE PATIENTS

wrong med, dose, route, amount

+

wrong documentation, wrong abbreviation (like QID, TID, qd, BID, 2.0, 2,000)

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2
Q

3 colon areas

A
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3
Q

valve locations 5

A

aoritc: 2nd right of sternal border

pulmonic: 2nd left of sternal border

tricupsid: 4th left of sternal border

mitral/apical pulse: 5th midclavicular

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4
Q

4 food rules for peds

A

NEVER casseroles for children

Don’t mix meds with food

Finger food for TODDLERS

LEAVE PRESCHOOLERS FOOD ALONE – 1 meal good

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5
Q

don and doff PPE

A

don:

gown, mask, goggle, gloves (REVERSE ALPHABETICAL + mask 2nd)

doff:

gloves, goggle, gown, mask (ALPHABETICAL ORDER)

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6
Q

3 expected vs unexpected s.s in sepsis

A

Sepsis EXPECTED s/s:

  • Inc WBC
  • Warm and flushed
  • Hyperglycemia

UNEXPECTED: DIC!!!!!

  • Bleeding
  • Low coag
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7
Q

preg weight gain calculation

A

Number of weeks of gestation minus 9

If within +- 1 or 2 then NORMAL

If within +- 3 then ASSESS patient

If within +- 4 or more – do BIOPHYSICAL PROFILE of fetus

BMI <18 -> 25-40 lbs
BMI 18-25 -> 25-35
BMI 25-30 -> 15-25

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8
Q

when can fundal height be palpated?

A

20-22 weeks when it is midway between the umbilicus and the pubic symphis

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9
Q

4 positive preg signs vs probable

A

positive:
- Fetal skeleton on xray

  • Presence of fetus on ultrasound
  • Auscultation of heart via doppler
  • EXAMINER palpates fetal movement and outline

Maybe signs are:

  • Positive pregnancy test
  • Chadwicks sign (blue cervix, vagina and vulva)
  • Goodells sign (softening of cervix)
  • Hegar sign (softening of uterus)

**these occur in alphabetical order!!!!!!

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10
Q

when first hear the fetal HR

when most likely

when should you

A

1st: 8-12

most: 10

should: by 20

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11
Q

when first notice quickening

when most likely

when should you

A

1st: 16

most likely: 18

should: by 20

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12
Q

prenatal visit frequency

A
  • 1x/month until week 28
  • Every other week between 28 – 36 weeks
  • Once a week after week 36 until delivery (or week 42 if that comes first)

If a woman comes in for her 12th week prenatal checkup, when is her next prenatal visit?

16 weeks

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13
Q

when can a patient be induced for a c section

A

42 weeks

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14
Q

what lab will decrease during pregnancy

A

Hgb - it is concerning if < 9 (need anemia assessment)

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15
Q

education for dyspnea in preg

A

get in a tripod position – hands on knees or surface of table

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16
Q

most reliable sign of labor and birth

A

regular and progressive contractions

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17
Q

labor vs false contractions

A

T: timing that INC in freq, duration, and intensity

R: radiating to abdomen

U: unable to relieve with activity

E: exam changes - cervical dilation

vs

F: fails to cause cervical change

a: activity alleviates contractions

k: keep feeling same area , no radiation

e:erratic timing of contractions

5:1:1

every 5 min, lasting 1 min for more than 1 hour = go to hospital

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18
Q

after birth what constitutes post partum infection

A

> 100.4 for 2 consecutive days

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19
Q

fetal kick count

A

counted 3x/day
If the mother has felt fewer than four movements, she should count for 1 more hour. Fewer than four movements in that hour warrant evaluation

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20
Q

station is

vs engagement

A

the relation of fetal presenting part and the mother’s ischial spines (know

this)—the narrowest part of the pelvis

  1. Engagement is station zero—this means the presenting part is at the ischial spines (smallest diameter part of the pelvis)
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21
Q

Lie

A

relationship of spine of mother and spine of baby

Desired = VERTICAL lie (mother and baby spines are parallel) -> BABY COMIN

NOT desired = TRANSVERSE lie (mother and baby spines are perpendicular (Trouble -> NEED C SECTION)

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22
Q

presentation is

A

part of the baby thats in the canal - usually ROA

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23
Q

estrogen vs oxytocin vs prostaglandin vs relaxin

A
  1. Estrogen -> makes utuerus more susceptible to oxytocin
  2. Oxytocin -> contractions
  3. Prostaglandin -> cervix softening and stretching
  4. Relaxin -> cervix relaxation
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24
Q

for laboring or preg patient who is priority

A

IF question asks what patient to check on first – patient with contractions no longer than 90 seconds and no closer than 2 minutes – STOP PTOCIN

What parameters regarding uterine contraction would make you stop Pitocin?

  • No longer than 90 seconds and no closer than 2 minutes

What is uterine hyperstimulation?

  • No longer than 90 seconds and no closer than 2 minutes

What is a sign of uterine tetany?

  • No longer than 90 seconds and no closer than 2 minutes
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25
frequency vs duration vs intensity
1. “Frequency” = beginning of one contraction and beginning of next 2. “Duration” = beginning of one to end of another 3. “intensity” = tell her to PALPATE WITH ONE HAND OVER FUNDUS WITH PADS OF FINGERS
26
painful back labor tx
– ROP or AOP (think “Oh pain”) ***LOW PRIORITY*** Tx: POSITION THEN PUSH 1. Position in knee chest 2. Push with fist into sacrum to counter pressure
27
normal FHR - tx for high, low, low baseline variablity, and high baseline variability
120-160 <110: #1 STOP PITOCIN!!!!!!!!! If running L -> left side I -> IV O -> oxygen N –> notify HCP >160: - document finding - take moms temp “low baseline variability” = BAD Not changing #1 STOP PITOCIN!!!!!!!!! If running L -> left side I -> IV O -> oxygen N –> notify HCP “high baseline variability” = GOOD Always changing -document finding
28
what to assess post partum
EVERY 4-8 HOURs BUBBLE HEAD B: breasts U: UTERINE FUNDUS -> boggy is massage, displaced is cath, HEIGHT of fundus related to UMBILICUS (fundal height should be at umbilicus after delivery and then it is equal to the day post partum) = 4 days = 4th line in the middle of the belly B/B: bladder and bowel L: LOCHIA -> vaginal drainage -> rubra (red), serosa (pink), alba (white) - Moderate lochia amount = 4-6 inches on pad in 1 hour - Excessive = 100% sat in 15 min E: episiotomy H/H: hgb/hct E: EXTEMITY -> look for thrombophlebitis -> measure the bilateral calf circumference A: affect D: discomfort
29
Cephalohematoma vs Caput succedaneum:
Cephalohematoma: - ONE side of head - Over occipital bone - Develops within 24-48 hours Caput Succedaneum: - Crosses Sutures and is Symmetrical
30
Which of the following 4 children will be able to manage his own care? A 7-year-old with Cystic Fibrosis b. An 8-year-old with Diabetes Mellitus c. A 10-year-old with a scraped knee d. A 13-year-old with Chronic Renal Failure
MANAGE not treat D!!!!! *** it is not about severity of problem, it is about age 12 OR OLDER!!!!
31
motor function ages
32
piagets stages of cog
33
congenital Heart defects + education (7)
T: trouble defects start with T – except ventricular hypoplastic syndrome R: shunts blood R to L B: patient blue - Need surgery now - Slow development - Short life - Grief - Cardiac monitor - Hospital stay - Need cardiologist referral - ALL DEFECTS WILL HAVE A MUMUR and need an echo
34
4 characterisitics of tetrology of fallot
* Pulmonary artery stenosis * RVH (right ventricular hypertrophy) * Overriding aorta * VSD (ventricular septal defect)
35
ischemic vs hemorrhagic stroke
1. Ischemic: Caused by an OBSTRUCTION Give tPA within 3 hours!!!!! 2. Hemorrhagic: Caused by HYPERTENSION NO TPA
36
earliest sign of inc ICP
irritability
37
condition with Inc IOP
glaucoma (sudden is closed angle, gradual is open angle)
38
3 examples of high pressure alarms 5 actions s/s
increased resistance Kink in tubing Condensed water in tube Mucus plug High pressure alarm going off? 1. Unkink 2. Empty water out of tubing 3. Turn patient 4. Ask them to cough, deep breathe 5. Suction AS NEEDED!!!!!! Settting is too high = resp. alkalosis (pt panting) - The physician wants to wean pt off vent in the morning. At 6 am, the ABGs say respiratory ALKALOSIS. What would you do next? IF PATIENT IS ALKALOSIS – THEY CAN BE WEANED OFF
39
low pressure vent alarm
decreased resistance Examples: MAIN Tube disconnection O2 sensor tube disconnection Low pressure alarm going off? 1. Reconnect the tubing unless tube is on the floor 2. Bag patient and call resp therapist Setting too low = resp. acidosis “respiratory = ventilate” / “acidosis= under” The physician wants to wean pt off vent in the morning. At 6 am, the ABGs say respiratory ACIDOSIS. What would you do next? NOTIFY HCP BECAUSE THEY ARE NOT READY TO BE WEANED – THEY ARE UNDERVENTILATING
40
high aPTT high PT high INR high d dimer
aPTT: high = heparin, DIC PT: high = DIC, factor deficiency INR: high = warfarin, LOW vit K Ddimer: >0.4 blood clot
41
amylase/lipase number lab for pancreatitis
>220
42
normal ESR
<20
43
shock s/s
cool, moist, pale skin, restless, scant urine need fluids
44
levels of HTN
45
6 risk factors for T2D
- Fam Hx of type 2 - >45 years old - Obesity BMI>28 - Dec HDL - HTN * NOT TYPE 1 !!!!
46
best indicator of long term glucose control
HgbA1c
47
functional psychosis
***Functional: schizophrenia, major depression, mania, schizoaffective - They CAN learn reality and we must teach them Tx: Acknowledge, present reality, set limits and enforce them
48
dementia based psychosis
senile/dementia/stroke - They CANNOT learn reality Tx: Acknowledge, redirect!!! Give them something to do
49
delirium psychosis
: SUDDEN AND DRAMATIC EPISODICdue to UTI, thyroid imbalance, adrenal crisis, electrolytes, meds Tx: Acknowledge, reassure about safety and temporariness of condition
50
tolerance vs dependence
tolerance: need higher doses for same effect, NO WITHDRAWAL dependence: need it to feel normal , YES WITHDRAWAL
51
nurse pt relationship phases
Preinteraction: GOALS Orientation: purpose, time, trust Working: problem solving Termination: achieved goals
52
if Q has quotes and all A are quotes -empathy question
· Choose the answer that reflects their FEELINGS, not their WORDS -ignore what is said and go with what is felt I see you feel angry
53
4 features of crutches (one is stairs)
- Length of crutch measured by placing tip on the ground and have 2-3 fingers widths bellow the axillary - Tip should point 6 inches side and 6 inches in front - Elbow flexion 30 degrees “up with good leg and down with the bad” + CRUTCHES MOVE WITH BAD LEG
54
types of gaits
*even number gait for even number legs affected *use odd when one leg is affected *use swing through if both legs affected OR AMPUTATION - 2 point gait for mild bilateral weakness= move 1 crutch and opposite foot together - 3 point gait – move 2 crutches and bad leg together - 4 point gait- move crutch-> move opposite foot -> move wnd crutch -> move opposite foot - Swing through for non weight bearing (amputee) -> affected leg never touches the ground
55
A pt affected with early stages of rheumatoid arthritis. What gait should the pt use?
* Both legs affected (because it is a systemic disease) * Early stage—mild * 2-point gait
56
Pt is first day postop, right knee, partial weight bearing allowed. What gait should the pt use?
* One leg affected * Odd-numbered gait * 3-point gait
57
Pt is in advanced stages of ALS. What gait should the pt use?
* Bilateral leg weakness (because it is a systemic disease) * Even-numbered gait * Advanced stages = Severe * 4-point gait
58
Pt with left hip replacement, 2nd day postop on non-weight bearing instruction. What gait should the pt use?
* Non-weight bearing of 1 leg * Swing-through gait
59
Pt with bilateral (B/L) total knee replacement first day postop. Weight bearing is allowed. What gait should the pt use?
* Even-numbered gait = Bilateral * Weight bearing * First day postop = Severe * 4-point gait
60
Pt with bilateral total knee replacement 3 weeks postop. What gait should the pt use?
* Even-numbered gait = Bilateral * Weight bearing * 3 weeks postop = mild * 2-point
61
walkers
o The walker is on the side of the pt, the pt “Picks it up … Sets it down … Walks to it” o Once the walker is in front of the pt, the pt “Holds on to chair, Stands up, Then grabs walker” ***no tennis balls or wheels on a walker **tie belongings to the SIDE of walkers
62
If patient has fractured femur or pelvic
they are at high risk for fat embolism so must assess LOC
63
cervical spinal cord tx
A. Cervical – innervates diaphragm and arms Preop assessment: - Assess breathing THEN arm and hand function Post op assessment: - Pneumonia
64
thoracic spine tx
A. Thoracic – upper back – innervates gut and abdomen Preop: - Assess cough and bowels Postop: - Pneumonia/paralytic ileus
65
lumbar spine tx
A. Lumbar – lower back – innervates bladder and legs Preop: - Urinary retention or last time patient voided then leg functions Postop: - Urinary retention and legs
66
3 nerve root compression s/s
- Pain - Parasthesia - Paresis
67
post op laminectomy 3 nursing actions
- Do not dangle patient for 10-15 min, get them up and moving - Question order for sitting for 1 hour (cannot sit for longer than 30 min) - They can walk , lay down without restrictions
68
4 discharge teaching for spinal surgery/laminectomy + 3 PERMENANT restrictions
- Don’t sit longer than 30 min for 6 weeks - Lie flat, log roll for 6 weeks - Don’t drive for 6 weeks - Don’t lift more than 5 lbs for 6 weeks PERMENANT restrictions: - Laminectomy can never bend at waist (they need to use knees) like everyone else - Cervical lams cannot lift anything over their head ever for life - No horseback riding, biking, jerking around ever for life
69
what is aortic regurgitation 2 features contraindications education
blood backed up into the L ventricle · Wide pulse pressure · Diastolic murmur · No beta blockers because it decreases diastolic BP Education: infection prevention because of infective endocarditis - Abx before dental procedures
70
what to assess for hypertonic solutions
lung sounds
71
3 fludis for shock
NS, LR, hypertonic
72
If you see patient itching but NO rash and the patient has asthma
this is an attack - give albuterol
73
peak exp rate
<50% EMERGENCY / >79% fine
74
apical vs basilar chest tubes
· Apical chest tube removes Air >80ml/hour NOT EXPECTED Bubbling EXPECTED · Basilar chest tube removes Blood or fluid (due to gravity) 200mL/hour EXPECTED Bubbling NOT EXPECTED
75
chest tube drainage device knocks over
1. -> ask patient to take a deep breath and then set device up and DO NOT CALL HCP
76
water seal of chest tube breaks
1. 1st clamp, 2nd . cut, 3rd . submerge in sterile water , 4th unclamp *****THIS MUST BE DONE IN 15 SECONDS***** aka · FIRST ACTION IS CLAMP, PRIORITY ACTION IS SUBMERGE IN STERILE WATER
77
chest tube pulled from PATIENT
1. 1st cover with gloved hand, best: sterile gauze
78
manipulation vs dependency
- Manipulating: causing harm to victim / illegal - Dependency: does not cause harm
79
wernicke and korsakoff 3 characteristics s/s tx
psychosis caused by Vitamin B1 and Thiamine deficiency 1. Preventable (can prevent it) 2. Arrestable (can stop it from getting worse) 3. IRREVERSIBLE (WILL KILL BRAIN CELLS) s/s = amnesia and confabulation (making up stories WITHOUT awareness of it) tx: redirect
80
alc withdrawal vs delirium tremens
81
dosage calculation
IV drip rates = Volume × Drop factor / Time * Micro/Mini drip = 60 drops per mL * Macro drip = 10 drops per mL

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