Mark K Flashcards
(108 cards)
1
Q
If pH and Bicarb go in the same direction its?
A
Metabolic
2
Q
As the pH goes —-
A
So does my patient except POTASSIUM
3
Q
MacKussmal =
A
Kussmaul respirations in Metabolic acidosis
4
Q
If prolonged GI, vomit or suction what acid/base disorder?
A
Metabolic alkalosis
(all other metabolic acidosis)
5
Q
What does a high pressure alarm mean?
What are 3 solutions?
A
OBSTRUCTION
1. Kink = unkink
2. Water = Empty
3. Mucous = Cough/deep breath
6
Q
What does a low pressure alarm mean?
What are 3 solutions?
A
DISCONNECTS/decreased resistence
1. Main tubing - reconnect
2. Oxygen sensor tube - plug in sensor
7
Q
Ventilator too high can cause what acid/base imbalance?
A
Respiratory alkalosis
8
Q
Ventilator too low can cause what acid/base imbalance?
A
Respiratory acidosis
9
Q
What are the 5 stages of Grief?
A
DABDA
Denial, Anger, Bargain, Depression, Acceptance
10
Q
What is Wernike (Koraskoffs) syndrome?
A
Psychosis induced by B1 vit or thiamine deficiency
-Amnesia with confabulation
11
Q
What is antabuse used for?
When to use/stop
Adverse effects
AVOID?
A
Aversion therapy
* 2 weeks before it works / stop 2 weeks before drinking
Side effects Nausea, vomit, deathin
AVOID mouthwash, perfume, aftershave, insect repellent, OTC ending in elixer, vanilla extract, hand sanitizer, unbaked icing.
12
Q
What are UPPERS?
DOWNERS?
A
- Uppers = Caffeine, Cocaine, PCP/LSD, Methamphetamines, Adderall
- Downers = everything else
13
Q
What do we give alcohol withdrawl syndrome and DTs?
A
HTN
Tranquilizer
Multivitamin
14
Q
4 Nursing interventions for AWS VS DTS
Diet?
Room?
Activity?
A
AWS
* Reg Diet
* Semi-private/anywhere
* up as needed / no restraint
DT
* NPO / clear liquid
* Privtate room near RN
* Restricted to bed rest / restraints
15
Q
Aminoglycosides
Remember?
all end in ____, what 3 that end in __ that are not aminoglycosides?
Toxic effects?
8?
Do not give which route? unless what?
A
Big gun antibiotics / A MEAN OLD MYCEN
* Mycin except Azithormycin, Clarithromycin, if it has THRO, throw it OUT
* TOXIC - Mice - Ototoxic. Monitor hearing, balance, tinnitus. Kidney - nephrotoxicity. Creatinine
* 8- Toxic to cranial nerve 8, give q 8 hours, IM or IV.
* Do not give PO unless Hepatic encephalopahty & bowel surgery (Neomycin & Kanomycin
16
Q
Calcium Channel blockers
Like what?
Negative ___
Treats?
S/S
Drug? ending in plus __ + __
Monitor?
A
Like valium for your heart
* Negative inotropic, dromotropic, chronotropic
Treat - A, AA, AAA
* Antihypertensive, AA - Anti-angina, AAA - Anti atrial arrhythmias
S/S Headache & hypotension
Drugs - anything ending in DIPINE + verapamil & Cardizem
Monitor BP and hold if SYS is under 100
17
Q
Meds for arrhythmias
For ventricular?
For supraventricular/Atrial?
For V-fib?
Asystole?
A
- Ventricular - LIDOCAINE
- Atrial - ABCD. A-denocard/adenosine, B - betablockers, C- Calcium channel blockers, D- Lanoxin, Digitalis, Digoxin
- V-fib - Defib
- Asystole - epinephrine and atropine
18
Q
CHEST TUBES
Apical for? Basilar for?
*If water seal breaks?
*If tube comes out?
Bubbling in water seal..Intermittent? Continuous?
Bubbling in suction control.. Intermittent? Continuous?
A
Apical (high) to remove air & Basilar (low) to remove blood
* If water seal breaks = Clamp. Submerge in water then unclamp
* If tube comes out - Cover with gloved hand, vaseline gauze & dry sterile dressing & tape on 3 sides
Bubbling in water seal- intermittent - good, Continuous - bad
**Bubbling in suction control **- Intermittently - bad, continuous good
19
Q
To remember congenital heart defects use TROUBLE
All CHD kids will have ___&___
what are the 4 defects of Tetralogy of Fallot?
A
TRouBLe - Right to Left shunting = Surgery, B - cyanotic, Starts with letter T
(ex. Trunkis arteriosis, transposition of great vessels, Tetralogy of fallot)
All CHD kids will have a murmur and echocardiogram
4 defects of Tetralogy of Fallot - VarifieD PictureS Of A RancH
VD - Ventricular defect
PS - Pulmonary Stenosis
OA - Overring Aorta
RH - Right hypertrophy
20
Q
Contact precautions
Used for
What to do?
A
- anything enteric (cdiff, Hep A), staph, RSV, Herpes
RSV on CONTACT precautions even though transmitted DROPLET - Private room preferred unless cohort, No mask, Yes gloves, gown, handwashing, dedicated or disposable equipment,
21
Q
Droplet precautions
Used for
What to do?
A
- Droplet - bugs that travel 3ft (meningitis & H flu)
- Private room preferred/cohort. Yes mask, gloves, handwashing, dedicated/disposable equipment. No gown, neg airflow
22
Q
Airborne precautions
Used for
What to do?
A
- Airborne - MMR, TB, Varicella
- **Private room **required/cohort, Yes Mask, gloves, handwashing, dedicated equipment, N95 (Tb only) mask when leaving room, neg airflow yes
TB on AIrborne precautions but spread by droplet
23
Q
DONNING/DOFFING
Order to take off?
Order to put on?
A
- Remove in alphabetical order - Gloves, Goggles, Gown, Mask
- On is reverse alphabetical but mask comes second - Gown, Mask, Googles, Gloves
24
Q
How to measure crutches?
A
2-3 finger widths below the anterior axillary fold to a point lateral to and slightly in front of foot
Hand grips elbow flexion about 30 degrees
25
**CRUTCH gaits**
2 point?
3 Point?
4 point?
Swing through?
When to use even? odd?
Stairs?
Cane?
2 - point. Move 1 crutch and the opposite foot together
3 - point. Moving 2 crutches and a bad leg together
4 - point. You move 1 thing at a time, Crutch, leg, crutch, leg
Swing through - non-weight bearing/amputee
* Even for even, odd for odd. Use the even gaits (2,4) when you have a weakness evenly. 2-point for mild, 4 for severe
* Use an odd gait when one leg is odd. (3)
* STAIRS - up with good, down with bad. /Crutches always move with a bad leg
* CANE - always hold the cane on the unaffected side
26
Delusion - define
3 types
**Delusions** - False fixed idea / no sensory component
* Paranoid delusion
* Grandiose delusion - think your superior
* Somatic delusion - Xray vision, the body is hollow
27
**Illusion**
**Hallucinations** - 5 types
**Illusion** - Misinterpretation of reality / referent in reality
**Hallucinations** - False fixed sensory
Auditory
Visual
Tactile
Gustatory - tasting things that are not there
Olfactory - smelling things that are not there
28
Functional Psychotic - 4 types
How to handle them - 4 steps
Narrowed self concept?
****Functional Psychotic - can function in life. Schzio, Schzio, Major, Mania
1. Acknowledge feeling
2. Present reality “I understand you see___ but I do not see them”
3. Set a limit
4. Enforce the limit
* Narrowed self-concept - when a psychotic refuses to change clothes. They are who they are by what they wear and what room they are in
29
**Psychosis of Dementia** - 4 conditions
How to handle - 2 steps?
**Psychosis of Dementia **- brain damage. Alzheimer's, Wernickes, organic brain syndrome, dementia
* Acknowledge the feeling
* Redirect
30
**Psychotic delirium** - causes
How to handle - 2 steps?
**Psychotic delirium** - Temporary episodic secondary sudden loss of reality due to chemical imbalance (UTI, Thyroid imbalance, electrolyte imbalance)
* Acknowledge feeling
* Reassure safety and temporariness
31
Diabetes Insipidus - Symptoms
Diabetes Mellitus - Symptoms
SIADH - Symptoms
**Diabetes insipidus** = Polyuria, polydipsia leading to dehydration due to low ADH
**Diabetes Mellitus** = Polyuria, Polydipsia, high blood glucose
**SIADH** = Oliguria, not thirsty
32
**Regular Insulin**
Onset
Peak
Duration
Give what route?
Onset - 1 hour
Peak - 2 hours
Duration - 4 hour
give IV
33
**NPH**
Onset
Peak
Duration
Give what route?
Onset - 6 hour
Peak - 8-10 hours
Duration - 12 hour
Cloudy / NO IV!!
34
**Humalog/Lispro**
Onset
Peak
Duration
Give what route?
Onset - 15 mins
Peak - 30 mins
Duration - 3 hour
Give WITH a meal
35
**Glargine/Lantus**
Onset
Peak
Duration
Give what route?
Onset - Slow
Peak - No peak
Duration - 12-24 hours
Give at bedtime
36
**Insulin shock/hypoglycemia**
Caused by?
S/S
Treatment
**Insulin shock/hypoglycemia** = too much insulin, not enough food, too much exercise
* “Drunk in shock” Cerebral impairment, vasomotor collapse - hypotension, tachycardia, tachypnea, cold, clammy, slow reaction time, liable
* Admin rapidly metabolized carb (candy, honey) + protein. If unconscious = iVD50, IM glucagon
37
**DKA/Diabetic Coma**
Causes
S/S
Treatment
**DKA/Diabetic Coma **= too much food, not enough insulin, not enough exercise, Viral upper respiratory infection within last 10 days
* DKA - Dehydration(dry, hot flushed), Ketones/Kussmaul breathing/high K+, Acidosis/Acetone breath/ Anorexia
* Regular insulin IV + IV fluids 200mg/hr (FAST)
38
**Type 2 high sugar / HHNK/HHNC**
S/S
Treatment
Type 2 High blood sugar - HHNK or HHNC Hyperosmolar, non-ketotic coma - Severe dehydration
* S/S Dry, increased HR, decreased skin turgor, hot, flushed
* Rehydrate
39
Long term complications of diabetes - 2
Normal Ha1C?
**Long-term complications of Diabetes** = Poor tissue perfusion (doesnt heal well, renal failure) Peripheral neuropathy (Cant feel injury, incontinent)
**Ha1C** - 6 and below is normal, 8 and higher out of control
40
What is it for? **Therapeutic & Toxic levels**
Lithium
Lanoxin (Digoxin)
Aminophylline
Dilantin/phenytoin
Bilirubin
**Lithium - Antimania**
* 0.6-1.2
* 2.0
**Lanoxin (Digoxin) -Afib & CHF**
* 1-2
* 2.0
**Aminophylline - relief of airway bronchospasm**
* 10-20
* 20
**Dilantin /Phenytoin**
* 10-20
* 20
**Bilirubin - **
* 10-20 - elevated level for newborn
* 20
41
Kernicterus?
Opisthotonos?
**Kernicterus **- is bilirubin in the CSF / bilir at 20
**Opisthotonos** - position baby assumes when bili on the brain. Hyperextension. Place on their side
42
**Hiatal Hernia **- define
S/S
Treatment
**Hiatal hernia **- 2 chamber stomach - acid regurgitation into esophagus bc upper stomach herniates upward. Moving in the wrong direction at the correct rate
* GERD - heartburn and indigestion
* Hiatal hernia if you lie down after you eat and get GERD
**TREATMENT** - High HOB, lots of fluids, high carb, low protein
43
**Dumping Syndrome** - define
S.S
Treatmetn
**Dumping syndrom**e - Gastric contents dump too quickly. Right direction incorrect rate
* DRUNK - impaired speech, liable, cerebral impairment
* SHOCK - hypotension, tachycardia, cold, tachypneia
* Acute abdominal distress - distended, guarded, hyperactive bowel sounds, diarrhea, cramping, bloating
**TREATMENT** - low HOB, low fluids during meals, low carbs, high protein
44
**Kalemias** -
Does --?
Hypo?
Hyper?
Never push?
Decrease fast? slow?
***Same as prefix, except HR and Urine output***
**Hypo** - Lethargy, Bradypnea, U wave, Ilius / constipation, Flaccidicy, Tachycardia, Increased urine / polyuria
**Hyper** - Agitated, Seizures, Tachypnea, Diarrhea, Spasticity/clonus , Bradycardia ,Oliguria
* NEVER PUSH IV / No more than 40mEq of K+/liter of IV fluid
* Give D5W & Insulin to decrease K+ **FAST** - hides K in cells
* Kayexalate - K+ exists-late **SLOW** - gets K out via poop
45
**Calemias**
(Calcium)
Does?
Hypo?
Hyper?
**Opposite as prefix**
**Hypo** - Agitation/ Irritability, Seizure, Tachycardia, Clonus, Diarrhea, Hyperactive reflexSpasicity / clonus, Polyuria Chvosteks, Trousseau
**HYPER** - Lethargy, Bradycardia, U wave, Bradypnea, Ilius / Constipation.Flaccidicy / hypoactive reflexes, Oliguria
46
**Magnesemias**
(Magnesium)
Does?
Hypo?
Hyper?
**Opposite as prefix**
**HYPO** - Agitation/ Irritability, Seizure, Tachycardia, Clonus, Diarrhea, Hyperactive reflexSpasicity / clonus, Polyuria
**HYPER** - Lethargy, Bradycardia, U wave, Bradypnea, Ilius / Constipation, Flaccidicy / hypoactive reflexes, Oliguria
47
**HypErnatermia** - Causes?
S/S
**HypOnatermia** - causes?
S/S
**HypErnatermia **
(DKA, DI, HHNK)
S/S- dehydration - Dry skin, Thready pulse, Rapid HR
**HypOnatermia**
(SIADH)
S/S - Overlaod
48
If a symptom involves nerve or skeletal pick?
For any other symptom pick?
Earliest sign of electrolyte imbalance is?>
*If a symptom involves nerve or skeletal pick - **CALCIUM**. For any other symptom pick **POTASSIUM** (generally anything affecting blood pressure)
**Earliest sign of electrolyte disorder is NUMBNESS, TINGLING (paresthesias)
49
Chadwicks sign
Color change of cervix to cyanosis
50
Goodells SIgn
Cervical softening
51
Hegar sign
Uterine softening
52
What order does Chadwick, Goodells, Hegar signs happen?
**Alphabetical order**
Chadwick
Goodell
Hegar
53
When do pregnant women come in for office visits?
1/mo until week 28
q 2 weeks until week 36
then every week
54
1st trimester problems?
Morning sickness - dry carb
Urinary incontinence - void q 2hour
55
2nd & 3rd trimester problems?
Dyspnea - Tripod position
Back pain - Pelvic tilt exercises
3rd - Urinary incontinence
56
**Define**
Dilation?
Effacement?
Station?
**Dilation** - 0-10cm
**Effacement** - thinning of cervix
**Station** - relation of fetal presenting part to moms ischial spine
- nEgative = above spine, Positive - below spine
57
**Define**
Engagement?
Lie?
Presentation?
**Engagement** - station 0 at ischial spines
**Lie** - relation between spine of baby and spine of mom
**Presentation** - part of baby that enters birth canal first. Most common ROA/LOA
58
Stage 1
Stage 2
of labor and delivery
**Stage 1** ALL OF LABOR- Dilate and phase of cervix
* **Latent phase** -
* **Active phase**
* **Transitional phase**
**Stage 2** - Delivery of baby
59
Stage 3
Stage 4
of Labor and delivery
**Stage 3** - Delivery of placenta
**Stage 4** - Recovery, first 2 hours to stop bleeding
60
**Latent phase**
CM dilated?
Contraction freq?
Duration?
Intensity?
0-4cm
Contractions freq 5-30min
Contraction duration 15-30 sec
Mild intensity
61
**Active phase**
CM dilated?
Contraction freq?
Duration?
Intensity?
5-7cm
Contraction freq 3-5mins
Contration duration 30-60sec
Moderate intensity
62
**Transition phase**
CM dilated?
Contraction freq?
Duration?
Intensity?
8-10CM
Contraction freq 2-3mins
Contration duration 60-90 sec
Strong intensity
63
Contractions should not be longer than ___ or closer than every ----Mins?
90sec
2mins
64
**Contraction**
Freq
Duration
Intensity
**Freq** - beginnign of 1 to the begining of next
**Duration** - Beginign to end of 1 contraction
**Intensity** - Strength of contraction
65
What complication is indicated if mom is having painful back pain?
Baby turned backwards
-Position knee-chest
66
What to do with a prolapsed corD?
Push head back in off cord and position in knee-chest or trendelenburg
67
Interventions for all other labor complications?
Left side/lateral
IV increase
Oxygen
Notify
Stop PIT
68
**Interventions for**
Low fetal hR
FHR accelerations?
Low baseline variability?
High baseline
Late decels
Early decels?
Variable decels>
* Low fetal HR = LION
* FHR accels = Nothing
* Low baseline - LION
* High baseline - Nothing
* Late decels - LION
* Early decels -
* Varibale - Could be prolapse cord!!
69
**Hyperthyroidism**
S/S
Radioactive iodine
Surgical removal
Total Vs Subtotal
**Hyperthyroidism** = Hyper-metabolism
* Weight loss, diarrhea, increased HR, hot/heat intolerance, cold tolerance, HTN, Exopthalmos
* Graves Disease
* Radioactive iodine - isolated for 24 hours, double flush/careful with urine, Propylthyroid utisil PTU -Knocks out WBC
* Surgical removal - total removal needs lifelong hormone replacement, at risk for hypocalcemia. Subtotal do not need hormone replacement. BUT are at risk for THYROID STORM. Totals are never at risk for this
70
**Thyroid storm** - S/S & Treatment
Post op risk for total and Sub in 1st 12 hours?
For total in 12-28hours?
For Sub in 12-28hours
**THYROID STORM** - Extremely high vital signs, extremely high fever 105^, psychotically delirious. MEDICAL EMERGENCY.
**Treatment** - oxygen and lower body temp
Total - Tetany Subtotal = Storm
* Post-op risk for total and subtotal in 1st 12 hours = Airway/breathing, bleeding
* Post op risk for a total in 12-28 hours = tetany r/t decreased CA
* Post-op risk for sub in 12-28 hours = thyroid storm
71
**Hypothyroidism** - S/S & AKA
TreatmetnT
Never -- these people?
**Hypothroidism** = Hypometabolism
* Weight gain, HTN, constipation, lethargy, cold intolerance, slow
* AKA Myexedema
* Thyroid replacement / never hold thyroid pills
* Do NOT SEDATE these people
72
Adrenal Cortex diseases start with?
**Addisons disease** - define, S/S, treatment
**Cushings syndrome** - S/S. Treatment
* Adrenal Cortex Diseases start with A or C
* Addisons disease is UNDERSECRETION of adrenal gland
**S/S** Hyperpigmented (darker), doesnt respond to stress well = go into SHOCK
**Treatment** - steroids/need to wear a medical braclet
Add-a-sone / Glucocorticoids. Ex. Betamethasone
* Cushing Syndrome is OVERSECRETION of adrenal cortex
**S/S** of cushings and SIDE effects of steroids! Moon face, hirutism (increased body hair), water retention, gynecomastia, buffalo hump, central obesity, skinny limbs, decreased bone density, easy bruising, irritability, immunosuppression
**Treatment** - adrenalectomy - replacement therapy - steroids
73
**TOYS**
0-6months
6-9 months
9-12 months
Toddlers
Preschoolers
0-6 - Music mobile
6-9 - Cover/uncover
9-12 - Verbal toy
Toddlers - Push/pull
Preschoolers - Fine motor
74
Avoid what answers for children under 9months?
BUILD, SORT, STACK, MAKE, CONSTRUCT
75
Toys/activities
School age (7-11)
Adolescents (12-18)
School age - Creative, Competitive, collective
Adolescents - Peer group association
76
**Laminectomy** - Define
S/S
3 locations
Do not
Post op complications
**Laminectomy** -Removal of vertebral spinus process / to treatment nerve root compression
* **S/S** of nerve root compression - Pain, paresthesia, paresis.
* **3 locations** - Cervical (upper extremities & breathing)
Thoracic (cough & bowel sounds)
Lumbar (urine output & legs)
* Always **LOG ROLL** your pt
* **Do NOt** dangle/sit on side of bed, allowed to walk, sit, stand, lie down, limit sitting 20-30 min at a time
*** POST OP complication** - Cervical - pneumonia, Thoracic - Pneumonia & paralytic illeus, Lumbar - urinary retention
77
D CRITICAL LABS - 5
* Potassium greater than 6
* pH in 6’s
* CO2 in 60’s (nonCOPD)
* PO2 in 60’s
* Platelets below 40,000
78
C - CRITICAL LABS - Moderate priority (10)
* INR above 4
* Potassium lower than 3.5
* Potassium between than 5.4 - 5.9
* Hemoglobin below an 8
* CO2 in 50’s (nonCOPD)
* PO2 70-77
* 02 less than 93
* Sodium - high or low
* WBC below 5,000
ANC below 500
CD4 below 200
* Platelet below 90,000
79
What is therapeutic level of
Creatinine
INR
Potassium
02 Sat
BNP
**Creatinine** - Best indicator of Kidney function / 0.6-1.2
**INR** - monitors Coumadin (warfarin) therapy / 2-3, Increased = bleed risk, 4 or greater is critial
**Potassium** - 3.5-5.0
**02 Sat **- 93-100 /Anemia & Dye procedure in last 48hours falsely elevates 02
**BNP** - Good indicator of CHF, Therapeutic range 100 or less
80
Neutropenic Precautions
**Neutropenic Precautions - Reverse/Protective isolation**
Strict handwashing
Shower BID with antimicrobial soap
Avoid crowds
Private room / limit # of staff entering & limit visitors
No fresh flowers or plants
Low bacteria diet, no raw fruits,veggies or undercooked meat
Do not drink water that has been standing 15 mins
Vitals q 4 hours
Check WBC/ANC daily
Avoid indwelling cath
Do not reuse cups
Use disposable plates, cups, etc
Dedicated items in room
81
**Phenothiazines**
-All end in___
Large doses = Small doses =
S/S
Teach
* All end in ZINE
* LARGE doses - antipsychotic, SMALL doses - antiemetic
**S/S ABCDEFG**
A-Anticholinergic
B-Blurred vision & Bladder retention
C - Constipation
D - Drowsiness
E - EPS
F - Fhotosensitivity
G - aGranulocytosis (low WBC)
* Teach to report sore throat and signs of infection. Never stop the ZINE
82
**TCA / NSSRI**
Drugs
S.S
How long does it take?
Tricyclic Antidepressants / NSSRI
* Mood elevators used to treat depression (Elavil, Trofranil, Aventyl, Desyrel)
**S/S** ABCDE- Euphoria
* Must take 2-4 weeks before effects
83
**BEnzodiazepines**
Always have -- or -- in name?
Prototype
Can also be used for
Do not take more
S/S
Benzodiazepines / Antianxiety “minor”
* Always have PAM or LAM in name
* Valium
* Can also be used as anesthetic, muscle relaxant, alcohol withdrawk, seizures
* Must NOT take more than 6wks to 3months
**S/S** ABCD
84
**MAOI**
Used for
What 3 begining of drug names
Interactions
MAOI / Antidepressants
* Depression thought to be causes by lack of NE, dopamine, serotonin.
* MAR, NAR, PAR beginning of drug names
* S/S - ABCD
* Interactions - MUST AVOID foods containing TYRAMINE or will have severe HTN. AVOID - **Salad BAR** - Bananas, avocados, raisins (any dried), grains made from active yeast, no organ meats, no preserved meats, no cheese, no alcohol, caffeine, chocolate, locorice, soy sauce. *They can have mozzarella and cottage cheese*
85
**Lithium**
S/S
Toxic?
Intervention
Monitor
Lithium / an electrolyte used to treat bipolar disorder
* S/S 3P’s - Polyuria, Pooping, Paresthesia
* Toxic - Tremors, metallic taste, severe diarrhea
* Intervention, fluid. Not water - give gatorade
* MONITOR lithium. Low sodium can make lithium more toxic. High sodium can make it less therapeutic
86
**PROZAC**
S/S
Prozac / SSRI antidepressant mood elevator
* S/S ABCD. Give before noon. Watch for suicide when changing dose in adolescent.
87
**Haldol**
S/S
NMS VS EPS
Haldol / Tranquilzer
* S/S ABCDEFG
Elderly can develop NMS from overdose - potently deadly fever with temp over 104 w/ anxiety and tremors
* EPS - side effect, no big deal - Anxiety & Tremore
NMS vs EPS is NMS has a fever!!!
88
**Clozaril **- used for
end in?
S.S
Does not have what side effecT?
Clozaril / atypical antipsychotic / used to treat severe schizophrenia /
* end in ZAPINE - new “major” antipsychotics
**S/S **Agranulocytosis (worse than cancer drugs),
* Does not have side effects ABCDE
89
**Zoloft**
- Causes
- Water for interaction with?
- S.S?
Zoloft (sertraline) . SSRI / Antidepressant
* Causes insomnia.
* Watch for interaction with St, Johns wart - Serotonin syndrome and Warfarin - bleeding
* S/S SAD head - S-sweating, A-Apprehensive, D- dizzy, Headache
90
Total weight gain for avg pregnancy?
Weight gain 1st trimester & 2/3rd trimester
Trick to determine acceptable weight gain
Total weight for AVG 28lbs + or - 3lbs (normal weight)
1st trimester - 1lb each month
2nd/3rd trimester - 1lb/week
* Take the week of gestation and minus 9
91
When is fundus palpable?
When is it at umbilicus?
* not palpable until week 12!
* At umbilicus - at 20-22 weeks gestations (date of viability / end of 2nd trimester)
92
4 positive signs of pregnancy
* fetal skeleton on Xray
* Fetal on ultrasound
* Auscultation of fetal heart
* Examiner palpate fetal movement)
93
**What to do if**
**L**ow fetal HR. Under 11-
high fetal HR over 160
**L**ow variable
High variable
**L**ate decel
Early decel
**V**ariable
**Low - LION**
High - Nothing
**Low variable - Not good**
High variable - Nothing
**Late decel - LION**
Early decel - Nothing
**Variable - VERY BAD / prolapse cord**
94
VEAL CHOP
**V**ariable - **C**ord compression
**E**arly decel - **H**ead compression
**A**cceleration - **O**K
**L**ate decel - **P**lacental insufficency
95
BUBBLEHEAD
Breasts
**Uterine Fundus** - Firm, midline, height =day postpartum
Bladder & Bowel
**Lochia** - Rubra "red", Serosa "Rosey", Alba "white" (occurs in order)
Epsiotomy
Hemotocrit & Hemoglobin
**Extremity check **- Thromboplablitis - Bilateral calf circumference
Affect
Discomforts
96
Cephalohemtoma VS Caput succedaneum
C.S - crosses sutures & symmetrical
Cephalohematoma - bleeding, does not cross sutures
97
**Tocolytics**
3 drugs and major side effects
Stop labor
**Terbutaline** - causes maternal tachycardia
**Mag sulfate ** - everything goes down, RR (below 12, titrate), reflex (+1 titrate), HR, etc
**Nifedipine** - headache & hypotension
98
**Oxytocics**
3 drugs and major side effects
Stimulate labor
**Pitocin (oxytocin)** - Uterine hyperstimulation (longer than 90sec closer than q 2min)
**Cervidil** - dialtes cervix - Uterine hyperstimulation
**Methergyne** - increase bp
99
**Fetal lung meds**
2 meds
**Betamethasone** - give to mom IM before baby born
**Survanta** - Given transtracheal to baby after born
100
Steps of drawing up insulin
(5)
Draw total dose of air
Put air in N vial
Put air in R vial
Draw up R dose
Draw up N dose
101
What do you draw up first Regular insulin or NPH?
Regular then NPH
RN
102
What needle to pick
IM?
SQ?
IM - answer with 1 in it
SQ - answer with 5 in it
103
**Heparin**
Route
Works when
Not given more than
Antidote
Lab that monitors
Pregnancy?
* Given IV or SUBQ
* Works immediatly
* No more than 3 weeks
* Antidote: protamin sulfate
* PTT
* Can use in pregnancy, Class C
104
**Coumadin**
Route
Works when
Not given more than
Antidote
Lab that monitors
Pregnancy?
* PO only
* Takes days to work
* Can take for life
*Antidote Vit K
* Lab: PT, INR
* Cannot use in pregnancy/Cat X
105
K wasting or sparing K diuretics
Any diuretic ending in X - Wastes K+ + diurel
106
**Baclofen (lisoresal) / flexoril**
Used for
S/S
teaching
Muscle relaxant
**S/S** tired and muscle weakness
**Teach:** dont drink, drive or operate machine
107
**How to teach children**
0-2years
3-6years
7-11years
12-14 years
**0-2** - teach in present as doing
**3-6** - teach slightly ahead of time (morning of/day of). Play, toys, stories
**7-11** - days ahead of time, how to do skills. Age approp reading/demo
**12-14** - teach like an adult
108
**Pressure sore**
Stage 1
Stage 2
Stage 3
Stage 4
Stage 1 - Skin intact, red
Stage 2 - Ulcerated, pink, dermis
Stage 3 - Yellow subq fat
Stage 4 - Red/white, muscle bone
