ABSN Uky > Mark K Notes Flashcards for NCLEX > Flashcards

Mark K Notes Flashcards for NCLEX

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1
Q
A
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2
Q

What is normal pH?

A

7.35-7.45

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3
Q

What is normal CO2?

A

35-45

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4
Q

What is normal HCO3 (bicarb)?

A

22-26

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5
Q

If pH and Bicarb Both move in the same direction then it is…. if they move opposite then it is…

A

MetaBolic

Respiratory

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6
Q

As the pH goes up… except for…

What does that look like?

Acidosis/alkalosis

A

As the pH goes up so does my patient except for potassium

Tachycardia, seizures, HTN, tachypnea, irritability, spastic, diarrhea, borborygmi, hyperreflexia

Alkalosis

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7
Q

As the pH goes down… except for…

What does that look like?

Acidosis/alkalosis

A

If the pH goes down, so does my patient except for potassium

Bradycardia, constipation, absent bowel sounds, flaccid, obtunded, lethargy, coma, hyporeflexia, bradypnea, hypotension

Acidosis

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8
Q

What does MAC kussmaul mean?

A

Metabolic ACiodisis is the only one with kussmaul respirations d/t compensation

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9
Q

How do you determine the causation of acid/base imbalance?

A

Ask yourself if it is lung, if it is then you know it is caused by respiratory. If it is not then you know it is metabolic

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10
Q

When it is lung (caused by respiratory) how do you know if it is acidosis or alkalosis?

A

If UNDERventilating, then pick acidosis (pH is under 7.35)

If OVERventilating, then it is alkalosis (pH is over 7.45)

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11
Q

When it is not lung (caused by metabolic) how do you know if it is acidosis or alkalosis?

A

Prolonged gastric vomitting or suction –> alkalosis

EVERYTHING ELSE (diarrhea, renal failure, burns) –> acidosis

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12
Q

What does high pressure alarms mean?

Common causes?

A

Increased resistance to airflow

Kinks, condensed water in tube, mucus plug

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13
Q

If a high pressure alarm is occurring what interventions should you preform?

A
  1. Unkink
  2. Empty water out of the tube
  3. Turn patient, cough, deep breath
  4. Suction
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14
Q

What does a low pressure alarm mean? Common causes?

A

Decreased resistance to airflow

Main tubing disconnection, O2 sensor tube disconnection

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15
Q

What acid base imbalance occurs if the setting it too high on a vent?

A

Patient is overventilated

Respiratory alkalosis (panting –> blow off too much CO2)

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16
Q

What acid base imbalance occurs if the setting it too low on a vent?

A

Underventilated

Respiratory acidosis (retaining CO2)

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17
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18
Q

Question

A

Answer

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19
Q

What is the number 1 problem with psychological problems? How do you respond/treat?

A

Denial

Confront them by pointing out the difference between what they say and what they do

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20
Q

What is DABDA?

A

Denial
Anger
Bargaining
Depression
Acceptance

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21
Q

How do you respond differently for denial in loss compared to abuse?

A

Loss –> support

Abuse –> confront

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22
Q

What is dependency vs co-dependency?

A

Dependency: when the get the significant other to do things or make decisions for them. Therefore the abuser is dependent

Co-dependency: when the significant other derive self-esteem for doing things or making
decisions for the abuser

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23
Q

How is dependency/co-dependency treated?

A

Dependent abuses need to be confronted

Co-dependent need to set limits and ENFORCE them. Say NO. Work on self-esteem

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24
Q

What is manipulation? How is it different than co-dependency?

A

Manipulation is when the abuser gets the significant other to do things or make decisions
that are not in the best interests of the significant other

Manipulation leads to harm of SO and co-dependency is not harmful/dangerous

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25
What is Wernicke Korsakoff syndrome? What is the cause?
Wernicke - encephalopathy Korsakoff - psychosis Vitamin B1 deficiency
26
What are the s/s of Wernicke Korsakoff syndrome? Treatment?
Amnesia (memory loss) and confabulation (making up stories that they believe are real) 1. Preventable … Take B1 2. Arrestable (stop it from getting worse) … Take B1 3. Irreversible (70%) … Will kill brain cells
27
What is a medication that can be used to help treat alcohol abuse? How does it work?
Antabuse and Revia (disulfiram) Works by creating a aversion. When taken and mixed with alcohol it creates a unpleasant effect leading to hatred of alcohol
28
How long does it take for disulfiram (antabuse/revia) to start working? Stop working? What should pt avoid?
2 weeks to start and 2 weeks to stop Anything with alcohol including mouth wash, cologne, perfume, aftershave, ANY med with name elixir, insect repellant, hand Sani, vanilla extract
29
What drugs are an upper?
Caffeine Cocaine PCP/LSD Methamphetamines Adderall
30
If a drug is NOT one of the 5 uppers then what is it?
A downer
31
What s/s does an upper cause? Biggest concern?
THINGS GO UP! Euphoria, seizures, restlessness, irritability, hyperreflexia (3+, 4+), tachycardia, increased bowels (borborygmi), diarrhea, spastic SIEZURES --> suction
32
What s/s does a downer cause? Biggest concern?
THINGS GO DOWN! Lethargic, respiratory depression/arrest, constipated, etc. RESPIRATORY DEPRESSION/ARREST --> intubation/ventilate
33
What does an overdose on an upper look like?
TOO MUCH Everything goes up?
34
What does an withdrawal on an upper look like?
TOO LITTLE Everything goes down. Looks like overdose on an downer
35
What does an overdose on a downer look like?
TOO LITTLE Everything goes down
36
What does an withdrawal on a downer look like?
TOO MUCH Looks like an overdose on an upper
37
When there is drug abuse in a neonate what does you assume within 24 hours of birth? After 24 hours?
ALWAYS assume intoxication in a newborn less than 24 hours ALWAYS assume withdrawal in a newborn after 24 hours
38
What will every alcoholic go through ___ hours after they have stopped drinking? Is it life threatening?
Alcohol withdrawal syndrome occurs 24 hours after drinking stops NON life threatening (reg diet, semiprivate room anywhere on unit, pt is ad lib, no restraints)
39
Less than 20% of alcoholics in Alcohol withdrawal syndrome will progress to _____ in _____ hours
Less than 20% of alcoholics in Alcohol withdrawal syndrome will progress to DELIRIUM TREMENS in 72 hours
40
Is Delirium Tremens harmful? What changes should occur?
LIFE THREATENING to self and others NPO/clears d/t seizures Private room near nurses Restraints w/ bed rest (2 point lock letter restraints)
41
What do you give both patients with Alcohol Withdrawal Syndrome and Delirium Tremens? Why these meds?
Anti-HTN meds, Tranquilizer, multivitamin with B1 Anti-HTN and tran - withdrawal on downer so everything goes up B1 - metabolize alcohol and prevent Wernicke/Korsakoff
42
What do Aminoglycosides treat?
A mean old mycin A mean and old infection such as TB, sepsis END in MYCIN
43
What drugs end fun MYCIN but are not Aminoglycosides and how do you know?
Azithromycin, Clarithromycin, Erythromycin ALL have THRO is throw them out
44
What are toxic side effects of Aminoglycosides? How do you remember?
Ototoxic - hearing, tinnitus, balance Nephrotoxic - creatinine MCYIN sound like mice. Mice have big ears. It is toxic to ears and the kidneys look like ears
45
What CN are aminogylcosides toxic to? How often do you administer them? How do you remember?
Toxic to CN8 (ear nerve) Administer every 8 hours MCYIN sound like mice. Mice have big ears. You can easily draw an 8 in the ears
46
Why are mycins given PO? What happens if they are?
They are not absorbed --> no systemic effects If given they sterilize the gut
47
What 2 situations would you sterilize the gut? What meds would you use?
Hepatic encephalopathy/hepatic coma (too much ammonia) Pre-op bowel prep "Who can sterilize my bowel? Neo Kan!" Neomycin and Kanamycin
48
What 2 routes are Aminoglycosides given?
IM or IV
49
When is a trough drawn?
30 minutes before the next dose no matter the route (at medications lowest concentration in blood)
50
When is a peak drawn for SubL?
5-10 minutes after drug dissolved
51
When is a peak drawn for IV?
15-30 minutes after a drug is finished/bag empty
52
When is a peak drawn for IM?
30-60 minutes
53
If there are 2 correct answers regarding a time frame should you big the longer time frame or shorter?
ALWAYS pick the longer time frame For example if an IM med was given and you need to draw peak, pick the answer that says it should be drawn in 60 minutes (30-60 min timeframe) OR For example a patient states they haven been on their antidepressant meds for 1 week and they were told it would work in 2-4 weeks but it still doesn't have any effect you should tell the patient it can take 3 more weeks before seeing effects
54
55
Question
Answer
56
What do Calcium Channel Blockers (CCB) do? What do they end in?
Slow and relax the heart (negative inotrope, chronotrope, and dromotrope) -DIPINE (plus diltiazem)
57
What do CCB treat?
Antihypertensives AntiAnginal drugs AntiAtrialArrythmia A, AA, AAA
58
What are the SE of CCB? What should you measure prior to giving it?
Headache and Hypotension Check BP and hold if SBP is less than 100
59
QRS depolarization means.... P wave means....
QRS depolarization means ventricular P wave means atrial
60
P wave in the form of saw tooth
Atrial flutter
61
Chaotic P Wave pattern
atrial fibrilation
62
Chaotic QRS complexes
ventricular fibrillation
63
Bizzare QRS complexes
Ventricular tachycardia
64
Periodic wide bizarre QRS complexes? When are these a low priority? When are they a moderate priority? When are they a high priority?
PVC PVCs after an MI is common and is a low priority Only a few 6 or more PVCs in a minute More than 6 PVCs in a row R on T phenomenon (a PVC falls on a T wave) Never a high priority
65
What are the 2 lethal rhythms? Why?
Asystole and V-fib Both are not giving very low or no CO --> confusion and death
66
What is a potentially lethal cardiac arrhythmia?
V-tach but only potentially b/c it has CO
67
When the pulse is present there is.... when the pulse is not present there is....
When the pulse is present there is CO, when the pulse is not present there is not CO
68
What is the treatment for PVCs and V-tach?
Amiodarone
69
What is the treatment for supra ventricular/atrial arryrthmias?
ABCDs Adenosine - push in less than 8 seconds followed by 20 mL NS Beta-blockers CCBs Digoxin/Lanoxin
70
What are the 2 treatments for A, AA, AAA?
CCB BB Both do the same thing with the same side effects
71
What is the treatment for V-fib?
Defib for V-fib
72
What is the treatment for Asystole?
Epinephrine FIRST then Atropine
73
The purpose if a chest tube is to..
Reestablish negative pressure in the pleural space so that the lung expands when the chest wall expands
74
A chest tube will remove what in a pneumothorax? Hemothorax? Hemopneumonthorax?
Removes air in a pneumothorax Removes blood in a hemothorax Removes air and blood in a hemopneumonthorax
75
An apical chest tube removes... and a basilar chest tube removes...
Apical (top) - removes air therefore should bubble Basilar (base) - removes blood or fluid therefore should not bubble
76
If the question does not specifically state that it is unilateral or bilateral what do you assume?
ALWAYS assume it is unilateral
77
If a closed drainage device (JP, hemovac, pneumovac, ect..) gets knocked over what do you do?
Ask the patient to take a few deep breaths NOT a medical emergency so DONT call the Dr
78
If the water seal of the chest tube breaks you should? How fast does this need to get done?
Clamp with rubber tooth double clamps, cut the tube, submerge tube in sterile water, unclamp Needs to be done within 15 seconds b/c tube cannot be clamped for longer than that
79
If the chest tube gets pulled out what is the first thing you should do? What is the priority if a chest tube gets pulled out?
Take a gloved hand and cover the opening (first step) Take a sterile Vaseline gauze and tape 3 sides (best step)
80
When should the water seal chamber bubble in a chest tube?
Should bubble intermittent If there is a continuous bubble then there is a leak. Find it and tape it
81
When should the suction control chamber bubble in a chest tube?
Should bubble continuously If intermittent then suction is too low so increase it on the wall
82
If a congenital heart defect is TRouBLe then that means you tell the parents..
Needs surgery now/soon to live Has slowed/delayed growth and development (failure to thrive) Has a shortened life expectancy Parents will experience a lot of grief, financial and emotional stress Pt is likely to be discharge home on a cardiac monitor After, birth, pt will be in the hospital for weeks Pediatrician or pediatric nurse will likely refer pt to a pediatric cardiologist
83
A TRouBLe congenital heart defect will shunt blood _____ to _____ leading to ______
A TRouBLe congenital heart defect will shunt blood right to left leading to blue/cyanosis
84
All TRouBLe heart defects start with the letter...
T Tetralogy of Fallot Truncus arteriosus Transposition of the great vessels Tricuspid atresia Totally anomalous of pulmonary vasculature (TAPV)
85
If a congenital heart defect does not start with a T, then what does that mean?
It is not trouble and it is a left to right shunt
86
Whether or not a child has a TRouBLe congenital heart defect or a no TRouBLe congenital heart defect they will ALWAYS have what 2 things?
A Murmur d/t shunting of blood An echocardiogram need to be done to find out the cause of the murmur
87
What are the 4 defects of Tetralogy of Fallot?
Pulmonary artery stenosis RVH (right ventricular hypertrophy) Overriding aorta VSD (ventricular septal defect) Ways to remember: PROVe, VarieD, PictureS Of A RancH
88
What diseases are on contact precautions?
Anything Enteric (GI/fecal/oral) - C.Diff, Hep A, E.Coli, cholera, dysentery Staph RSV (transmitted via droplet but pt touches object then mouth) Herpes including herpes zoster (shingles)
89
What is the PPE for contact precautions?
Private room preferred but can be in same room based on culture result NOT based on s/s Disposable supplies like paper plates Dedicated equipment (BP cuff, stethoscope) Gown, gloves, hand wash
90
What diseases are droplet precautions?
Anything traveling on large particles from coughing or sneezing less than 3 feet Meningitis H. influenza B (lead to epiglottis where nothing should be put down the throat)
91
What is the PPE for droplet?
Private room preferred but can be in same room based on culture result NOT based on s/s Handwashing, mask, goggle/face shield, gloves Disposable supply Dedicated equipment Patient wear mask when leave room
92
What diseases are airborne precautions?
MMR TB Varicella (chickenpox) Air MTV
93
What is the PPE for airborne precaution?
Private room preferred but can be in same room based on culture result NOT based on s/s Handwashing, N95 respirator, goggle/face shield, gloves Disposable supply - not essential Dedicated equipment - not essential Patient wear mask when leave room Negative airflow room
94
Order of putting on PPE
Gown Mask Goggle Gloves
95
What is the order of removing PPE?
Gloves Goggle Gown Mask
96
97
Question
Answer
98
What is the accurate way to measure the length the crutches should be?
2-3 ginger widths between the pad and the anterior axillary fold (armpit) Tip of crutch is a point lateral (6 inches) and slightly in front of foot (6 inches) Handgrip - angle of elbow is 30 degree and wrist at the level of the handgrip
99
What should you NOT use to measure crutches
ANY landmark on the foot or anything that says axilla
100
What is a 2 point gait? Uses?
Move the crutch and opposite foot together Example: right crutch and left leg Used for mild bilateral leg weakness
101
What is a 3-point gait?
Move 2 crutches and the bad leg together followed by the unaffected foot
102
What is the 4-point gait?
Move crutch, then opposite foot, then other crutch, then opposite foot VERY slow but VERY stable
103
What is the swing through? Uses?
Unaffected foot passes the tip of both crutches Amputees Non-weight bearing
104
What is the rule for which gait of crutches should be used?
Use even point gait for even and odd-point gait for odd Use even numbered gait when the weakness is bilateral - 2 point for mild and 4 point for severe Use odd numbered gait when one leg is affected
105
How do you go up the stair with crutches? How do you go down?
Up with the good, down with the bad Lead with good foot and crutches follow when going up Lead with bad foot and crutches then follow with good when going down
106
Which side should a cane be held? Where should the handgrip be?
Hold cane on the unaffected side and handgrip should be at the level of the wrist
107
What is the correct way to use a walker? Can you tie things to it? Can you have things on the feet?
Picks it up, sets it down, walks to it Holds onto chair, stands up, then grabs walker If things MUST be tied to it, tie to the side so doesn't fall over NOTHING on feet of walker including wheels and tennis balls
108
What is the first question you should ask when a psych question comes up?
Is the patient a non-psychotic patient or a psychotic patient?
109
How do you respond to you patient if they are non-psychotic?
Therapeutic communication How are you feeling, that must be overwhelming, that must be difficult, I can see you are sad, tell me more Reflection, amplification, restatement
110
What is a psychotic patient?
A patient that has no insight and is not reality based They do not think they are sick and everyone else is the problem Has delusions, hallucinations, illusions
111
What is a delusion?
A false, fixed belief or idea or thought that is all in their head
112
What are the 3 types of delusions?
Paranoid Grandiose - false belief that you are superior (I am the president, I am the smartest person ever) Somatic - false belief about your body (I have x-ray vision, there are worms in my arm)
113
What is a hallucination?
Sensory experience without external stimuli Nothing there Auditory, visual, tactile, gustatory, olfactory
114
What is an illusion?
A misinterpretation of reality There is a referent (something that both the pt and clinician can refer to) such as a cord, or people talking
115
What is function psychosis? Examples?
Can function in everyday life. D/t chemical imbalance in brain Skeezo, Skeezo, major, manic Schizophrenia, schizoaffective disorder, major depression, mania
116
What is psychosis of dementia? Examples?
Actual brain damage/destruction Alzheimers, stroke, organic brain syndrome, anything that says senile/dementia
117
What is psychotic delirium?
Temporary, sudden, dramatic, episodic, secondary to something else UTI, thyroid imbalance, adrenal crisis, thyroid store, electrolytes, medications/drugs, overdose, withdrawal, DT, ICU for a long time, infection
118
How do you approach a function psychotic patient?
There have the ability to learn Acknowledge feelings (you seem sad, you seem angry) Present reality (I know you see that demon but I don't) Set limits (We are not going to address that, stop talking about that) Enforce limits (I see you're too ill to stay in reality so our conversation is over)
119
How do you approach psychosis of dementia?
They cannot learn reality d/t brain damage so don't present it! Acknowledge feelings Redirect them - give them something that they can do
120
How do you approach psychosis of delirium?
Acknowledge feelings Reassume them of safety and temporariness of their condition
121
What are ideas of flight?
Going from thought to thought to thought rapidly. Each thought is coherent but they are not coherent together
122
What is neologism?
Make up words
123
What is narrowed self concept? What do you not want to do with these patients?
Patient refuses to change their clothes or leave their room - this is because there two things define who they are and they are scared to change them b/c they wouldn't know who they are without it Never make them change their clothes, tell them you see they feel uncomfortable and only to change when they feel comfortable doing so
124
What is idea of reference?
Thinking everyone is talking about you
125
126
Question
Answer
127
What is the difference between DM1 and DM2?
DM1 - lack of insulin DM2 - insulin resistance
128
What is diabetes insipidus?
Polyuria and polydipsia --> dehydration due to low ADH HIGH urine output LOW urine specific gravity HIGH serum specific gravity Fluid volume deficit
129
What is SIADH?
Low UO, no thirst, weight gain LOW urine output HIGH urine specific gravity LOW serum specific gravity Fluid volume overload
130
Type 1 diabetes is called.... Type 2 diabetes is called...
Type 1 - insulin dependent, ketosis prone Type 2 - non-insulin dependent, non-ketosis prone
131
What are the s/s of diabetes?
Polyuria Polydipsia Polyphagia (swallow/eat a lot)
132
Treat for DM type 1
They will DIE without treatment Diet (least important) Insulin (most important) Exercise
133
Treatment for DM type 2
They are DOA without this Diet (most important) Oral hypoglycemic Activity
134
What should the diet for DM2 look like?
Calorie restriction divided into 6 small meals a day because it keeps blood sugar more stable BUT the calorie restriction is the most important
135
What does the R stand for in Regular insulin? Onset, Peak, Duration?
R = Rapid, Run IV Clear solution O: 1 hour P: 2 hours D: 4 hours 1-2-4
136
What does the N stand for in NPH insulin? Onset, Peak, Duration?
N = not so fast (intermediate), not so clear, not in the bag O: 6 hours P: 8-10 hours D: 12 hours 6-8-10-12
137
When should Lispro (Humalog) be given? Onset, Peak, Duration?
WITH meals. Not before meals O: 15 minutes P: 30 minutes D: 3 hours
138
What kind of insulin is glargine (Lantus)? Onset, Peak, Duration?
Long acting insulin Little to no risk for hypoglycemia so only on that can safely be given at bedtime O: P: no peak D: 12-24 hours
139
What should be checked before giving insulin? Does it ever change?
Check the expiration date Once the package is open, the expiration date changes from the manufacture date to 30 days after the insulin was opened (label with OPEN date and EXP date)
140
Does insulin need to be refrigerated?
In hospital, insulin should be refrigerated prior to open and can be unrefrigerated after opening Should tell your patients to always refrigerate their insulin at home
141
What is exercise considered in a diabetic? What should you do d/t this?
Exercise is another shot of insulin Decrease dosage of insulin and give a rapidly metabolized carb
142
What 2 problems does any sick diabetic have?
Hyperglycemia and dehydration Sickness stresses out the body --> serum glucose levels increase Even if not eating, still take insulin Take sips of water
143
What does hypoglycemia look like?
DRUNK AND SHOCK Staggering gait, slurred speech, cerebral impairment (labile - emotions all over the place), slow reaction time, decrease social inhibition (loud) Tachycardia, low BP tachypnea, cold/clammy. mottled skin
144
What is the treatment for hypoglycemia?
Sugars/rapdily metabolized carbs with a starch of protein (apply juice and turkey, 1/2 cup skim milk) Glucagon IM if patient is at home Dextrose (D10 or D50) if in ER
145
DKA occurs in which patient? What is the #1 cause of it?
Type 1 diabetes - ketosis prone Upper respiratory infection within last 2 weeks
146
What are the s/s of DKA?
Dehydration (dry, poor skin elasticity, poor turgor, warm) Ketones in serum, Kussmauls, High K Acidosis, Acetone breath,, Anorexia d/t nausea
147
Does ketones in urine mean DKA?
NO Ketones in serum means DKA
148
How is DKA treated?
IV Regular insulin IV fluids - 200ml/hour
149
Which diabetic does HHNK/HHS/HHNS affect? What should you think with this acute complication? Treatment?
Type 2 diabetic Severe dehydration - skin flushed, decreased turgor, increased HR, warm Treat by rehydrating
150
Between DKA and HHNK, which has the high mortality and which is the higher priority?
HHNK has the higher mortality because it is caught too late and does not readily respond to treatment DKA is the priority because if left untreated it will kill the patient faster and it responds very quickly to insulin
151
What are the 2 reasons for long term complications of diabetes?
Poor tissue perfusion Peripheral neuropathy Examples: Renal failure, Gangrene, Heart failure, Urinary incontinence, Pt can’t feel a burn on the foot
152
What does an A1C test? What is normal? Out of control? Borderline?
Best indicator of long term blood glucose level Normal - less than 6 Borderline - 7 (pt should come in for eval) Out of control - 8 and above
153
154
Question
Answer
155
What is lithium used for? Therapeutic? Toxic?
Used for mania in bipolar disorder Therapeutic: 0.6 - 1.2 Toxic: >2.0
156
What it Lanoxin/Digoxin used for? Therapeutic? Toxic?
Treat A-fib and CHF Therapeutic: 1-2 Toxic: 2`
157
What Is Aminophylline used for? Therapeutic? Toxic?
Muscle spasm relaxer for airway Compound bronchodilator theophylline Therapeutic: 10-20 Toxic: >20
158
What is Phenytoin used for? Therapeutic? Toxic?
Seizure medication Therapeutic: 10-20 Toxic: >20
159
What is normal bilirubin in newborns? Elevated? Toxic?
Normal: <10 Elevated: 10-20 Toxic: >20
160
Why is newborns bili higher than adults? When would the doctor want to hospitalize?
Breaking down RBC from mom Hospital with levels around 14-15
161
Trick to remember toxicities
2s: Low - lithium and lanoxin 20s: High - aminophylline, dilantin, and bilirubin
162
What is Kernicterus?
Excess bili in the brain that occurs when the level is >20 in the blood DEADLY
163
What is opisthotonos?
Position the newborn will assume d/t irritation of meninges from kernicterus Hyperextended posture Should have them lay on their side
164
What is the difference between pathological and physiological jaundice?
If newborn comes out yellow, something is wrong and it is pathological jaundice If newborn turns yellow in 2-3 days, that's okay and it is physiological jaundice
165
What occurs in a hiatal hernia? S/S?
Regurgitation of gastric acid upward into esophagus Correct rate, wrong direction GERD (heartburn) and indigestion lying down after eating
166
What is the treatment for Hiatal Hernia?
High-atal Hernia.. everything is HIGH Elevate HOB during and 1 hour after meals Increase fluids with meals Increase carbs (low protein) There help the stomach empty quickly so doesn't come back up
167
What is dumping syndrome? S/S?
Gastric contents are dumped too quickly into duodenum Drunk: staggering, impaired judgement, labile Shock: Tachycardia, low BP, cool/clammy, pale Acute ABD distress: N/V, diarrhea, cramping, guarding, borborygmi, bloating, distention
168
What is the treatment for dumping syndrome?
When everything is LOW, the stomach goes SLOW Lower HOC during meals and turn pt on side Decrease fluids 1-2 before meals and after Decrease carbs (high protein) All prevent stomach form emptying quickly
169
What does protein do r/t dumping and hiatal?
Bulks gastric content, takes longer to digest, moves slow through gut High for dumping Low for hiatal
170
How do you remember the S/S of hyper/hypo kalemia?
Kalemias do the same as the prefix except HR and UO which go opposite
171
S/S of hyperkalemia
Everything goes up besides HR & UO Seizures, agitation, irritability, tented T waves, ST elevation, tachypnea, diarrhea, borborygmi, clonus, spasticity, increased tone, hyperreflexia, bradycardia, decreased UO (oliguria)
172
S/S of hypokalemia
Lethargy, bradypnea, paralytic ileus, constipation, muscle flaccidity, hyporeflexia (0, 1+), Tachycardia (HR is up), Polyuria (UO is up)
173
How do you remember the hypo/hyper calcemias?
Go in the opposite direction Hypo—Symptoms go high with hypo Hyper—Symptoms go low with hyper
174
S/S of hypocalcemia
agitation, irritability, 3+ or 4+ reflexes, spasm, seizure, tachycardia, Chvostek sign (tap the cheek), Trousseau (inflate BP cuff and hand spasms), tetany
175
S/S of hypercalemia
bradycardia, bradypnea, flaccid, hypoactive reflexes, lethargy, constipation
176
How do you remember the s/s of Megnesemia?
Goes in opposite direction of prefix Also a sedative Hypo—Symptoms go high with hypo Hyper—Symptoms go low with hyper
177
When the S/S could possibly be from several electrolyte imbalances, how do you narrow it down?
First chose which ones make sense based on the symptoms Eliminate Mg Choose calcium if nerve, muscle, or skeletal Choose potassium for anything other symptom especially heart and BP
178
How do you remember hypo/hyper natremia?
HypErnatremia = Dehydration HypOnatremia = overload
179
S/S of hypernatremia? Treatment?
Hot, flushed, dry skin, thready pulse, rapid HR Give fluid
180
S/S of hyponatremia? Treatment?
Crackles, distended neck veins Fluid restriction, Lasix
181
DKA has which types of electrolyte abnormalities?
Hypernatremia = dehydration Hyperkalemia
182
What is the earliest sign of an electrolyte imbalance?
Paresthesia
183
What is the universal sign of an electrolyte imbalance?
Muscle weakness = paresis
184
How do you treat hypokalemia?
Give potassium NEVER push potassium Make sure the order is <40mEq/L IV fluid. If >40mEq IV fluid then clarify dose with physician
185
What is the fastest way to lower potassium? Problem?
D5W and regular insulin to decrease potassium by pushing it into the cell and out of the blood Temporary solution but it is quick
186
What is the long-term solution to lower potassium? Problem?
Kayexelate By enema or ingestion, works by exchanging potassium for sodium so when you defecate it is full of potassium. Patient become hypernatremic so administer fluids Takes hours to work
187
When working with a patient with high potassium what do you do? Why?
Give D5W, Regular insulin, and Kayexalate and the same time D5W and Regular insulin work instantly Kayexalate works in a few hours
188
Why is high potassium the most problematic and dangerous electrolyte imbalance?
It can stop the heart
189
190
Question
Answer
191
What are the s/s of hyperthyroidism?
HYPERMETABOLISM Weight loss HR increase BP increased Hyperpersonality Heat intolerance b/c body is a furnace Exopthalmos
192
What is another word for hyperthyroidism?
Graves disease You are going to run yourself into the grave
193
What are 3 ways to treat hyperthyroidism?
Nuke it with radioactive iodine PTU (propylthiouracil) - Puts Thyroid Under Thyroidectomy
194
What is a consideration if you nuke the thyroid with radioactive iodine
Need a private room for the first 24 hours Visitor restriction for first 24 hours Flush 3 times after urinating Call hazmat if urine is spilled
195
What is a consideration if using PTU for hyperthyroidism?
Monitor WBC because patient is immunosuppressed
196
If a patient has a total thyroidectomy they will need ______ and it is important to watch for ______
They will need lifelong hormone replacement Watch for hypothyroidism because it can be difficult to spare the parathyroid gland when doing a total thyroidectomy
197
Does a subthyroidectomy need replacement? What are they at risk for?
No, but they many need some at first At risk for thyroid storm
198
What are the s/s of a thyroid storm?
Temp 105 or above High BP (stroke level) Severe tachycardia Psychotically delirious
199
How do you treat thyroid storm?
Get the temp down and bring oxygen up Body temp down with ice packs and cooling blanket Oxygen mark at 10L Stay with patient - usually 2:1 ratio These patients do not get medication, it is self limiting and they either come out of it or they don't
200
After a total or subtotal thyroidectomy what are the risks in the first 12 hours? The next 12-48 hours? After 48 hours?
First 12: airway d/t edema and hemorrhage because endocrine glands are very vascular Next 12-48: Total: tetany d/t hypocalcemia (could close off the airway d/t irreversible spasm) Subtotal: thyroid ström After 48: infection
201
What are the s/s for hypothyroidism?
Hypometabolism Obesity HR decreased BP decreased Personality is flat, boring, dull Intolerant to the cold b/c always cold Academically challenged
202
What is a myxedema coma?
Severe hypothyroidism that leads to decreased mental status, hypothermia, and other S/S r/t slowing of function in multiple organs
203
What is the treatment of hypothyroidism?
Levothyroxine Take in the morning 30 minutes to and hour before breakfast
204
What 2 orders should you question for your patient with hypothyroidism
Any sedative - they are already super slow so a sedative could put them into a coma NPO prior to surgery including their thyroid replacement. They are already super slow so their condition without the replacement can potentiate the anesthesia during surgery. DO NOT hold thyroid meds unless it is specifically stated and if it is call around
205
How do you know if a disease is caused by the Adrenal Cortex?
The disease will either start with an A or a C
206
What is Addisons disease? S/S
Under secretion of steroids VERY tan Does not adapt well to stress
207
What is the purpose of a stress response?
To maintain normal BP to perfuse the brain and other organs Ensure an adequate level of glucose to feed to body
208
If a patient with Addisons can't adapt to stress what happens to them under stress?
Addisonian crisis Shock Hypoglycemic crisis
209
What is the treatment for Addisons disease?
Steroids (glucocorticoids - end in -SONE) In Addison you ADD-a-SONE
210
What is Cushing syndrome?
Over secretion of the adrenal cortex If you have a cushy tushy... you got more
211
What are the S/S of Cushing/steriod med SE?
Moon face Hirsutism (lot of hair) Truncal/central obesity Muscle atrophy (skinny arms/legs) Gynecomastia Buffalo hump Retaining Na+ and water Stretch marks High glucose Easy bruising Grouchy ("roid rage" Immunosuppressed
212
Because patients with Cushings has hyperglycemia what should we do?
Accu-checks every 6 hours
213
What is the treatment for cushings? What does this result in?
Adrenalectomy Now pt has Addisons and will be given a steroid to treat (SONE) Pt will start looking like cushion Takes about a year of titration for pt to start looking normal
214
215
Question
Answer
216
What do you think about before giving a toy to a child?
Size (no small toys under 4) NO metal/dye cast if oxygen is in use Beware of fomites - non living things that harbor microorganisms like stuffed animals
217
If a patent is immunocompromised what kind of toy would you give them?
Hard plastic toy because can be disinfected
218
What are the considerations for an infant 0-6 months? Best toy? 2nd choice?
Sensorimotor Best choice: musical mobile Second choice: Large but soft toy
219
What are the considerations for an infant 6-9 months? Best toy? 2nd choice? Worst toy?
Object permanence Best toy: cover/uncover toy such as jack in the box, peaks boo, window books Second best: large but firm Worst: Musical mobile d/t strangulation
220
What are the considerations for an infant 9-12 months? Best toy? 2nd choice?
Vocalization Best: speaking or verbal toys such as tickle me Elmo, woody cowboy talking books
221
If a question has the words that indicate purposeful play, only pick for ages _____ and older
Build, sort, stack, make, construct 9 months and older
222
What are toddlers (1-3) working on? Best toy? What kind of play do they do?
Gross motor skills such as running and jumping Best toy: push/pull toy like lawn mower, wagon. CAN finger paint Parallel play - alongside each other
223
If an activity/toy takes finger dexterity, which age group is this NOT for?
NOT for toddlers and younger
224
What are preschoolers (3-6) working on? Good toys/activities? Type of play?
Fine motor skills Finger dexterity - write, draw, use pencils/scissors Balance - dance, ice skate, tricycles, tumbling Cooperative play - play with others. They are highly imaginative (you be the cop ill be the robber)
225
What are school age (7-11) working on? What 3 things do they like?
Concrete 1. Creative - they like to get involved. Don't give them a coloring book, give them a black paper to draw 2. Collective - baseball cards, stickers 3. Competitive - WANT winner/loser. DONT want to hear EVERYONE WINS
226
What are adolescents (12-18) working on? Activities? What 3 scenarios would not allow these activities to occur?
Peer group association Allow them to be in each other rooms UNLESS 1. <12 hours post-op 2. immunosuppressed 3. Contagious
227
Why preform a laminectomy? What is the MOST important question to ask about a laminectomy?
To relieve nerve root compression. Cuts away bony prominences to give the nerve more room LOCATION, LOCATION, LOCATION
228
What are the s/s of nerve root compression?
Pain Parethesia (tingly) Paresis (muscle weakness)
229
With a cervical laminectomy, what you you assess pre-op first and second? What do you watch for post-op?
Pre-op - cervical innervates diaphragm and arms First: assess for breathing Second: assess function of arms/hands Post-op: pneumonia b/c trouble breathing deeply
230
With a thoracic laminectomy, what you you assess pre-op first and second? What do you watch for post-op?
Pre-op: innervates gut/abd muscles First: cough (need to use abd muscles to cough) Second: bowels Post-op: pneumonia (b/c cant cough) and paralytic ileus
231
With a lumbar laminectomy, what you you assess pre-op first and second? What do you watch for post-op?
Pre-op: Innervates bladder and legs First: assess urinary retention/last time pt voided Second: leg function Post-op: Urinary retention and leg issues
232
How do you move a patient after a laminectomy?
log roll DO NOT dangle/have these pts. sit on edge of bed. Only long enough to overcome othrostatic Supine to walking ASAP DO NOT allow them to sit for more than 30 minutes Walk, stand, lie down without restrictions
233
What type of laminectomy will require a chest tube?
Anterior thoracic b/c have to go through the front/chest/spine so pneumothorax
234
What is a laminectomy with fusion? Where is the bone taken from?
When removing a disc, then you need to fuse so no bone on bone Taken form the hip --> two incisions
235
Which incision has more pain in a laminectomy with fusion? Which has the most bleeding? Infection? High risk for rejection?
Hip Hip (hemovac/JP will be here) Both have same risk Spine
236
What are the 4 temporary restrictions for a laminectomy?
Do not sit for >30 minutes for 6 weeks Lie flat and log roll for 6 weeks Don't drive for 6 weeks Don't life more than 5 pounds for 6 weeks
237
What are the 3 permanent restrictions for a laminectomy?
Never be allowed to lift by bending at the waist (must bend at the knees) Cervical should never be allowed to lift anything of their head No horseback right, off trail biking, jerky amusement park rides
238
239
Question
Answer
240
What does ABCD means r/t labs?
A - low priority and can be ignored for a few hours or if late at night can wait until early morning B - concerning and this lab needs to be closely monitored C - critical and you need to do something for this lab D - highest priority and you need to stay at the bedside
241
What is creatinine?
Best indicator of kidney functioning
242
What does INR test? ___ level when at ___ and above. What should you do?
Monitors warfarin Level C when at 4 and above Hold Warfarin, focus assessment on bleeding, prepare to give Vitamin K, Call HCP
243
What level is K+ is low? What do you do?
Level C if K+ is low Nothing to hold, assess heart, prepare to give K+, call HCP
244
What level if K+ is high? What level if K+ is over ____? What do you do in both situaitons?
High K+ is a level C - Hold K+, assess heart, prepare to give D5W/insulin and kayexelate, call HCP K+ >6 is a level D - Hold K+, assess heart, prepare to give D5W/insulin and kayexelate, call HCP and stay with patient
245
What pH level is considered a level D?
pH in the 6s is a level D Nothing to hold, assess VS, nothing to prepare, call HCH and do not leave patient Must treat underlying cause so doctor has to be notified to diagnose and treat
246
What does BUN test?
Waste in the blood Assess for dehydration and prepare IV fluids
247
Hemoglobin is considered a level C if _____
Level C hemoglobin <8 Nothing to hold, assess for bleeding/anemia/malnutrition, Prepare blood, call HCP
248
A CO2 of ____ is a level C. What do you do?
CO2 in the 50s is a level C Nothing to hold, assess for breathing, ask patient to preform pursed lipped breathing, call HCP
249
A CO2 of ____ is a level D. What do you do?
CO2 in the 60s or above is a level D Nothing to hold, prepare to intubate/ventilate, call RT/HCP, DO NOT leave patient
250
What is a level C for PaO2? What action?
Level C if PaO2 is between 70-77 Nothing to hold, assess for respiration difficulty and dyspnea, prepare to give oxygen, call HCP
251
What will increase first in a patient with low oxygen? What will come next?
Increased HR first when low PaO2 then when the body can no longer compensate an increase RR will occur
252
What are the 2 most common reasons for episodic causes of tachycardia in a heart patient? What should you do?
Hypoxia and dehydration Give oxygen and increase fluids
253
What is a level D for PaO2? What action?
If PaO2 is in the 60s or lower (respiratory failure) Prepare to intubate/ventilate, call RT/HCP, stay with patient
254
An O2 saturation under ____ is a level C. Action? What invalidate your reading?
Under 93% is a level C Give patient oxygen Anemia Dye procedure/contract b/c dyes the blood **both of these are falsely high so you will think your patient is actually doing better than they are
255
What does BNP test for?
Heart failure
256
When would sodium be considered a level C? Action?
If there is a change in LOC because its a safety issue Nothing to hold, assess for overload (hypo) or dehydration (hyper), prepare furosemide or IV fluids, call HCP
257
What WBC, ANC and CD4 are considered a level C? What is the action?
WBC<4,000 ANC<500 CD4<200 Put patient on neutropenic precautions
258
What are the neutropenic precautions?
Strict hand washing Vital q4 hrs Dedicated stethoscope, BP cuff Reverse/protective isolation Shower BID with microbial soap Avoid crowds Private room Limit staff/visitors No fresh flowers/potted plants No raw fruits/veggies/undercooked meat No water pitcher standing for over 15 minutes Check WBC daily No indwelling catheters Do not reuse cups or disposable plates
259
What is a level C platelet? What is a level D platelet? Action?
Level C: <90000 Level D: <40000 Bleeding precautions
260
What are the 5 deadly Ds?
K+ >6 pH in the 6s CO2 is the 60s pO2 in the 60s Platelets <40000
261
262
Question
Answer
263
What do all psychotic drugs have in common?
ALL cause low BP and weight changes (usually gain)
264
What are phenothiazines? Ending? How do they work? Use?
Frist gen/typical anti psychs, major tranquilizers end in -ZINE (Thorazine, compazine) Only reduce symptoms, don't cure Large doses: ZINEs for the ZANY (Cuckoos) Small doses: antiemetics
265
What are the S/E of Phenothiazines?
Anticholinergic (Dry mouth, urinary retention) Blurred vision Constipation Drowsiness EPS (tremors, parkinsons) Foto sensitivity aGranulocyosis (low WBC and immunosuppressed - recognize and report sore throat and s/s of infection)
266
If someone is experiencing a SE do you hold the drug?
NO only hold if patient is experiencing a toxic effect
267
What is a decanoate?
Long acting form of a drug Given IM for non compliance
268
What are Tricyclic antidepressants? What do they do? Drugs?
Non-selective serotonin reuptake inhibitor Mood elevators Elavil, Trofranil, Aventyl, Desyrel
269
What are the SE of TCA?
Anticholinergic Blurred Vision Constipation Drowsiness Euphoria
270
How long do you need to take TCA in order to have a beneficial effect?
2-4 weeks
271
What are benzodiazepines? Ending? How long do you need to take before they work? How long can you take them for?
Antianxiety/ minor tranquilizer Always have ZEP but typically end in LAM or PAM Work immediately, DO NOT take longer than 2-4 weeks
272
What are the uses of a bento?
Seizures medications Preop induction of anesthesia Muscle relaxants EtOH withdrawal medications Ventilation—medication to relax and calm down pts on a ventilator
273
What is a major and minor tranquilizer administered at the same time?
Major anti psychs take 2-4 weeks to begin working Minor anti psychs start working right away Valium (diazepam) is discontinued at 2-4 weeks once major kicks in
274
What are the SE of benzos?
Anticholinergic Blurred vision Constipation Drowsiness
275
What is a Monoamine Oxidase (MAO) inhibitor? Drugs?
Antidepressant MARplan, NARdil, PARnate
276
What are the SE of a MAO inhibitor?
Anticholinergic Blurred vision Constipation Drowsiness
277
What foods should be avoided with MAO inhibitors?
Foods that contain tyramine BAR (bananas, avocados, raisins/dried fruit) No organs like liver, kidney, heart, tripe, or preserved meats (smoked, dried, cured, pickled, hot dogs) NO cheese unless cottage cheese and mozzarella NO alcohol (elixirs, tinctures) NO caffeine (chocolate, licorice, soy sauce)
278
What is lithium used for? What does it do?
Decreases mania in bipolar Acts like an electrolyte
279
What are the SE of lithium?
Peeing Pooping Parethesias Paretheisa is the EARLIEST sign of an electrolyte imbalance
280
What are the toxic effects of lithium?
Tremors Metallic taste Servere diarrhea
281
What is the most important nursing intervention in a patient on lithium that is presenting with peeing/pooping a lot? What about if patient is presenting with metallic taste and severe diarrhea?
FLUIDS FLUIDS and notify HCP since this is toxic
282
What should be monitored with a patient on Lithium?
Monitor sodium b/c needs to be normal Low sodium --> lithium toxicity High sodium --> lithium is ineffective
283
What is an SSRI? Drugs?
Mood elevate Fluoxetine (prozac)
284
What are the SE of fluoxetine (SSRI)?
Anticholinergic Blurred vision Constipation Drowsiness Euphoria
285
When should you give fluoxetine? What should you watch for in adolescents when changing the dose?
Causes insomnia so give it early in day not at bedtime Watch for suicidal risk in adolescents when changing the dose
286
What is haldol (haloperidol)?
Frist gen/typical, tranquilizer (basically the same as thorazine)
287
What are the SE of haldol?
Anticholinergic Blurred vision Constipation Drowsiness EPS Foto sensitivity aGranulocytosis
288
What is a symptom that could develop form overdose on haldol? How do you tell the difference between this and EPS?
NMS (neuroleptic malignant syndorme) - life threatening Elderly should have 1/2 normal adult dose High fever over 105, tremors, anxiety EPS will also present with anxiety and tremors BUT only NMS will have a fever so if they have a fever call emergency response and notify HCP
289
What is clozapine? What is the advantage? SE?
Atypical antipsychotics/second gen (-ZAPINE) Advantage is that it does not cause A-F SE Does cause aGranulocytosis b/c trashes pts bone marrow (monitor WBC)
290
What is difference about ziprasidone (second gen)?
BBW of prolong QT interval --> sudden cardiac arrest Avoid in patients with cardiac conditions
291
What is sertraline? What are the SE?
Anitdepressant SAD Head Sweating Apprehension Dizzyness Headache Can cause insomnia
292
What should not be taken with Sertraline
St Johns wort --> serotonin syndrome Warfarin --> cause bleeding If taking either of these then the dose needs to be decrease b/c sertraline inhibits them from being broken down --> toxicity
293
294
Question
Answer
295
How do you date a pregnancy?
Take the FIRST day of the LMP and add 7 days to it then subtract 3 months
296
What is the first trimester weight gain? Second? Third?
First (12 weeks): 1lb/month or 3 pounds Second (13-28): 1lb/week Third (29-40): 1lb/week
297
What is the total ideal weight gain for a pregnancy?
28+/- 3 pounds SO.... 25-31 pounds
298
If weight gain is +/- 3 pounds what should you do? If weight gain is +/- 4 pounds what should you do?
+/- 3 pounds: assess her +/- 4 pounds: trouble, preform a BPP of fetus
299
When can the fundal height be palpated? When will the fundus be at the umbilicus?
Fundal height cant be palpated until 12 weeks (after first trimester and it'll be midway between pubic symphysis and umbilicus) At umbilicus at 20-22 weeks
300
In a trauma, when is mom a priority and when is baby?
Mom is in the 1st and 2nd Baby is in the 3rd
301
What are positive signs of pregnancy?
Fetal skeleton on xray Presence of fetus on ultrasound Auscultation of fetal heart Examiner palpates fetal movement
302
When is fetal heart beats heard? When is quickening felt?
Fetal heart: 8-12 weeks gestation (first: 8 weeks, most likely: 10 weeks, latest: 12 weeks) Quickening: 16-20 weeks gestation (first: 16 weeks, most likely: 18 weeks, latest: 20 weeks)
303
What are maybe signs of pregnancy?
Positive blood/urine test Chadwich (cervical/vaginal color change to cyanosis) Goodell (softening of cervix) Hegar (softening of uterus)
304
What order does Chadwick, goodells, and hegar occur?
Chadwick, goodells, and hegar Alphabetical order Move up form vulva, vagina, cervix, to uterus
305
When should prenatal visits be?
28 weeks once a month 28-36 every other week 36-42 weekly
306
What is considered a normal Hgb in first trimester? Second? Third?
First: 11 Second: 10.5 Third: 10
307
How do you treat morning sickness?
Dry carb before getting out of bed
308
When is urinary incontinence usually seen? Treat?
1st and 3rd trimester Treat by voiding every 2 hours form the day she gets pregnant until 6 weeks PP
309
When does difficulty breathing occur? Treat?
2nd and 3rd trimesters Tripod positioning
310
When does back pain occur? Treatment?
2nd and 3rd trimester Pelvic tilt exercises to treat
311
What is the most VALID sign that true labor is occurring?
Onset of regular/progressive contractions
312
What is station?
relation between fetal presenting part and mom ischial spines (narrowest part of pelvis) +3, +2, +1, 0, -1, -2, -3 0 is engaged (presenting part is at ischial spines)
313
What it the lie?
Relationship between spine of mom and spine of baby Vertical lie is what you want
314
What is the presentation?
The part that is comes out first and how baby is sitting ROA and LOA are most common
315
What 4 STAGES of labor?
1. Onset of labor - cervical dilation/effacement 2. Delivery of baby 3. Delivery of placenta 4. Recovery - 2 hours after placenta is delivered
316
What are the 3 phases of the first stage?
Phase 1: Latent. Contractions are 5-30 minute apart lasting 15-30 seconds with mild intensity. 0-4 cm dilated Phase 2: Active. Contractions are 3-5 minute apart lasting 30-60 seconds with moderate intensity. 5-7 cm dilated Phase 3: Transition. Contractions are 2-3 minutes apart lasting 60-90 seconds with strong intensity. 8-10 cm dilated
317
Uterine contractions should be no longer than ______ and no closer than _____. What is this a sing of? Would it make you stop the Pitocin?
Uterine contractions should be no longer than 90 seconds and no closer than 2 minutes Sign of uterine tetany Yes, stop pit
318
How do you palpate intensity of labor?
Palpate with one hand over fundus with pads of fingers
319
What do you do for painful back in labor?
OP position - oh pain Place mom in knee-chest position then push with fist into sacrum to use counter pressure to relieve pain
320
What do you do for a prolapsed cord?
Push head off of cord and then position mom in knee-chest or trendleburg Prep for c-section
321
What are the interventions for things like tetany, maternal hypotension, vena cava syndrome, uterine rupture, toxemia, eclampsia?
If Pitocin is running, stop if first THEN, Left side Increased IV Oxygen Notify HCP
322
In labor systemic pain medication is okay unless...
Unless baby is likely to be born when the medication peaks.
323
324
Question
Answer
325
What do you do for Low Fetal HR <110?
LION Left side IV Oxygen Notify HCP Stop Pitocin first if running
326
What do you do for High Fetal HR >160?
Document acceleration of fetal HR Not a high priority and baby is WNL
327
What do you do for Low Baseline Variability?
LION and stop Pitocin first if running
328
What do you do for High Baseline Variability?
Document findings because this is good since baby HR is changing
329
What do you do for an early deceleration?
This is normal Generally caused be head compression
330
What do you do for variable deceleration?
VERY BAD Prolapsed cord/cord compression Push baby head off the cord and then position mom in knee-chest of trundleberg position
331
What do you do for late decelerations?
BAD Placental insufficiency LION and stop Pitocin first if running
332
REMEMBER VEAL CHOP
Variable decels ...... Cord compression Early decels..... Head compression Accelerations.... OKAY Late decels..... Placental insufficiency
333
During the second stage of labor what are the order of events?
Deliver the head - mom stop pushing Suction baby mouth then the nose Check for nuchal (around the neck) cord Deliver the shoulders then body Baby MUST have ID band on before leaving L&D area
334
What should you look for in the third stage of labor?
Delivery of the placenta Make sure the placenta is complete and intact Check for 3 vessels, 2 arteries and 1 vein. AVA
335
There are ____ things you do in the 4th stage ____ times an hour. What are they?
There are 4 things you do in the 4th stage 4 times an hour. 1. VS - assess for shock, BP decreases and HR increases, pt looks cool, clammy and pale 2. Fondus - if its boggy, massage it. If its displaced, catheterization 3. Check perineal pads - excessive bleeding if pad saturated in 15 minutes or less 4. Roll patient over and check for bleeding underneath
336
What does BUBBLE HEAD stand for?
Breasts Uterine fundus Bladder Bowels Lochia Episiotomy Hemoglobin/hematocrit Extremities Affect Discomforts
337
What are you looking for in regards to uterine fondus?
Fondus should be FIRM Height of fondus should be at the navel and decrease 2 cm per day If boggy, massage it If displaced and boggy, catheterization
338
What is lochia? What should you monitor?
Vaginal discharge Rubra - red Serosa - pink Alba - white Moderate - 4-6 inches on pad in hour Excessive - saturate a pad in 15 minutes or less
339
What are you looking for in the extremities are labor?
Thrombophlebitis The best way to monitor for this is to measure bilateral calf circumference
340
What are normal variations in a baby?
Milia - white spots Epstein pearls - palatal cysts/deposits Mongolian spots - bluish discoloration Erythema toxic neoratorum - normal newborn rah. Pick each with firm yellow/white papule Hemangioma - abnormal accumulation of blood vessels in skin. Most common birth mark Vernix - white secretions Acrocyanosis - blue discoloration of hands/feet Nevi - stork bites. Easily blanched lesion and disappear by 2 Port wine stain/nevus flemus - red to purple in color and does not blanch
341
Cephalohematoma is...
Collection of blood between the periosteum of skull bone and bone itself Occurs in one or both sides of head but does not cross the midline Devleops within 24-48 hours
342
What is Caput Succedaneum?
Edema of the scalp of the neonate during birth from mechanical trauma of scalp pushing through narrow cervix Crosses the suture lines and caput symmetrical
343
What are totolytics? What are 2 that are used in labor?
Given to women in premature labor that must be stopped Terbutaline Mg Sulfate
344
What is a side effect of terbutaline?
Maternal tachycardia
345
What is a side effect of Mg sulfate?
Hypermagnesemia --> going goes down Decreased HR, decreased BP, decrease reflexes, decrease LOC Really important to monitor RR and reflexes If RR<12 then decrease dose If reflexes 0, +1 then decrease dose If reflexes +3, +4 then increase dose
346
What are oxytoxics? What are 2 commonly used in labor?
Stimulate and strengthen labor Pitocin Methergine
347
What are SE of Pitocin?
Uterine hyperstimulation - longer than 90 seconds, closer than 2 minutes If this occurs then lower the Pitocin
348
What are SE of methergine?
HTN
349
What are two medications used to to babies lung mature?
Betamethasone - given IM to mother while baby is in utero. SE: increased glucose Surfactant - given to baby after birth via transtracheal route
350
What is humalin 70/30?
Mix of N and R 70% N and 30% R The numerator is on top of so is N
351
How do toy mix insulin in the same syringe?
Clear before cloudy OR RN R before N
352
Which needle would you pick for an IM injection?
21 gauge that is 1 inch long
353
What needle would you use for an SubQ injection?
25 gauge that is 0.5 inches
354
Heparin route? Onset? How long can it be used? Antidote? Labs? Pregnancy?
IV or SubQ Works immediately but cant be used for more than 21 days (except lovenox) Antidote is protamine sulfate Labs: PTT Can be used in pregnancy
355
Warfarin route? Onset? How long can it be used? Antidote? Labs? Pregnancy?
PO Takes a few days to a week to work but can be used for entire life Antidote: vitamin K Labs: PT/INR Cant be used during pregnancy
356
What is the only antipsychotic drug that can be given in pregnant women?
Haldol
357
How do you know if a diuretic is potassium sparing or wasting?
Any diuretic that ends in X, Xes out K --> wastes K PLUS Diuril Lasix (furosemide), Bumex (bumetanide), clotrix (clotrimazole), Esidrex (hydrochlorothiazide), Demadex (thosemide), Diuril (chlorothiazide)
358
What are baclofen and cyclobenzaprine?
Muscle relaxers SE: fatigue/drowsiness and muscle weakness Teaching: don't drive, don't drink, don't operate heavy machinery
359
How do you teach a child that is in sensory motor (0-2)?
You can only teach them in the present Teach them what you are doing as you are doing it. Use words b/c they don't understand play
360
How do you teach a child that is in preoperational (3-6)?
They are fantasy oriented, imaginative, illogical, and their thinking obeys no rules but they do understand future/past Teach them what you are going to do before (morning of, day of, 2 hours before) you do it with play Don't want to teach them too far in advance because they are in the imaginative stage and can imagine the worst
361
How do you teach a child that is in concrete operations (7-11)?
Rule-oriented, live and die by rules, cannot abstract think, only one way to do things Teach then a day or two ahead of time and teach them by using age appropriate reading and demonstration (skills)
362
How do you teach a child that is in formal operations (12-15)?
Can think abstract and think about cause and effect AS SOON AS children become 12, teach them like an adult
363
When can a child first manage their own care?
at 12 years old Before 12 they can help with tasks but after 12 they can actually manage their can meaning they know you can do when you can, and seek help when you cannot
364
What are 7 principles to answering psych questions?
Know what phase of the relationship you are in Don't give/accept gifts Don't give advice Never guarantee anything (if you cry it'll make you feel better) Immediacy (between 2 answers pick the one that keeps them talking and don't refer anyone) Concreteness (psych pts take you literally so no figures of speech) Empathy (chose the answer that focuses on the patients feeling that were displayed in what the patient said, don't focus on what the patient said)
365
366
Question
Answer
367
Which part of the phrase is the most important when prioritizing patient?
The modifying phrase is the most important. When there are 2 answers that work, the tie should be broken based on the modifying phrase NOT the diagnosis
368
What are the 3 rules for prioritization?
1. Acute vs. Chronic - acute ALWAYS over chronic 2. Fresh post-op <12 hours beats medical or other surgical 3. Unstable beats stable
369
What word descriptions indicate that a patient is stable?
Stable Chronic illness Post op >12 hours Local or regional anesthesia Lab abnormalities in A/B (creatinine, BUN, hemoglobin 8-11, elevated HCT, elevated BNP, elevated Na, RBCs off) Ready for discharge, to be discharged and admitted longer that 24 hours ago Unchanged assessment Experiencing typical expected s/s of the disease they were diagnosed
370
What word descriptions indicate that a patient is unstable?
Unstable Acute illness Post op >12 hours General anesthesia <12 hours Lab abnormalities in C/D (INR over 4, K in 6s, pH in 6s, CO2 in 50s, low O2 sat, high WBC, low ANC, low CD4, low platelets) Newly diagnosed, newly admitted, not ready for discharge admitted less than 24 hours ago Changing or changed assessment Experiencing unexpected S/S
371
What 4 things ALWAYS make a patient unstable
Hemorrhage High fevers over 105 b/c seizures Hypoglycemia Pulseless or breathless (V. fib, Asystole, at scene of unwhitnessed accident pulseless and breathless are a low priority)
372
In a mass casualty what 3 things result in a black tag?
Pulseless Breathless Fixed and dilation pupils
373
If the 3 rules of prioritization result in a tie then what should you do?
the more vital the organ, the high the priority 1. Brain 2. Lungs 3. Heart 4. Liver 5. Kidneys 6. Pancreas
374
What can an LPN NOT do?
Cannot start an IV Cannot hang/mix IV meds Cannot push IV meds Cannot administer blood or deal with central lines including flushing and dressing Cannot make the care plan Cannot preform or develop teaching Cannot take care of unstable patients Cannot preform the FIRST of anything Cannot assess so no admission, discharge, transfer or first assess after a change
375
What CAN an LPN do?
Can maintain and flush an IV Can implement the care plan made by RN Can reinforce teaching Can do things such as tube feeding, post-op dressing changes, feed stroke pt, ambulate post-op patient, get VS on post-op pt AFTER the RN has done it FIRST
376
What should NOT be delegated to an UAP?
Cannot chart - they can chart what they did such as "side rail is up" but cant chart about pt "pt less anxious" Cannot give medication unless it is a topical over the counter barrier cream like A&D ointment Cannot do assessments expect vitals and accucheck for DM Cannot give treatments expect enemas
377
What can the RN delegate to the UAP?
ADL unless it is the first time then the RN must do it and the the UAP can take over from there
378
What should NOT be delegated to the family?
Never delegate any safety responsibilities to the family Example: keeping the rail down on a crib, keeping restraints off while family is there
379
How do you intervene with inappropriate behavior from staff?
If ask, is it illegal? If yes then tell supervisor If it is not allege then ask if anyone including patient, co-worker, other staff is in immediate physical/psychological harm? If yes then confront immediately and take over If no one is in harms way then ask if the behavior is simply inappropriate. If yes, then talk to that staff member at a different time about the incident
380
What is a good way to remember when to auscultate heart valves?
A (aortic) P (pulmonic) E (Erb point) T (tricuspid) M (mitral) This is how they present on chest
381
Where is the aortic valve?
2nd intercostal space, right sternal boarder
382
Where is the pulmonic valve?
2nd intercostal space, left sternal border
383
Where is the Erb point?
3rd intercostal space, left sternal border
384
Where is the tricuspid valve?
4th intercostal space, left sternal border
385
Where is the metal valve?
5th intercostal space at the midclavicular line Apical pulse is in the same location as metal valve
386
Guessing strategy for psych?
Pick answer that says "I will examine my feelings" OR "Establish a trust relationship"
387
Guessing strategy for nutrition questions for adults?
Go with baked, not fried Go with chicken If no chicken, go with fish but avoid shellfish b/c high in cholesterol
388
Guessing strategy for nutrition questions for kids? Preschoolers? Toddlers?
Never pick a casserole, stew or any dish that is slowly cooked in over DONT mix meds in kids food - always ask permission before doing so Preschooler - leave them alone, they will eat if they are hungry and one meal is okay for them Toddlers - pick finger foods like hot dogs, French fries, tofu
389
Guessing strategy for pharm questions
If you don't know the SE for the drug but you know what they drug does then pick the SE in the same body system that the drug is working If you do not know the drug at all and the drug is PO then pick a GI SE
390
What should you never tell a kids about medication?
That it is candy
391
Guessing strategy for OB?
Check the fetal HR
392
Guessing strategy for Med/Surg
First thing to assess - check for LOC (if you found patient on the floor, you would say Sir, Sir are you okay?) Firs thing to do - establish an airway
393
Guessing strategy for pediatric questions?
When in doubt.. call it normal. Example: "This is normal. Everyone is on their own pace, GIVE IT MORE TIME" When in doubt, pick the "older age" Example: when can a child pick? 12 or 14 months? Pick 14 months to give child more time When in doubt, pick the easier task. Example: At 6 months a baby can roll over or sit with support? Pick roll over because it is easier
394
What are general guessing strategies?
Rule out absolutes Avoid answer choices that say the same thing because neither is correct If tow answers are opposites, one is probably correct Use the umbrella strategy - if all answers seem correct then pick the answer that includes all of them. Example: use safety and good body mechanics
395
How do you prioritize the needs of patients?
The need that would have the WORST outcome is the higher priority Example: Which is highest priority for suicidal patient? (a) Don’t give tranquilizer. (b) Don’t orient to unit? (c) Don’t put him on suicide precautions? And (d) Don’t introduce him to staff? If you did not put the patient on suicide precautions the patient would be dead
396
What is the sesame street rule?
ONLY USE IF NOTHING ELSE WORKS Look at all the answer choices and pick the answer that look different than the rest. There is only one right answer and 3 wrong so pick the odd ball out
397
Use common knowledge/fundamental knowledge
If you don't know the answer try to pull it out of the question For example: if you are hanging piggyback Amikacin what do you need to do? If you know nothing about the medication, you do know how to hang a piggyback med and you need to use a pump for it
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