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MARK KLIMEK Flashcards

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1
Q

First generation antipsychotics: Common ending and three examples

A

Phenothaizines (-zine’s); chlorpromazine, promethazine, hydroxyzine
Small doses are antiemetics, high doses they are the MAJOR TRANQUILIZER

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2
Q

Side effects of phenothaizines

A

ABCDEFG
Anticholinergic (dry mouth), blurred vision, constipation, drowsiness, extrapyramidal symptoms, “f”otosensitivity, aGranulocytosis

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3
Q

Teaching points with Phenothaizines

A

Report sore throat and s/s of infection to doctor, never stop the -zine

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4
Q

1 nursing diagnosis for Phenothaizines

A

Safety; Risk for injury

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5
Q

What are the two classes of psych drugs that have a deaconate form? (two classes, one specific drug)

A

Phenothaizines, Haloperidol, ziprasidone (GeoDon)

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6
Q

Three examples of tricyclic antidepressants

A

amitriptyline, imipramine, trazodone

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7
Q

Side effects of tricyclic antidepressants

A

ABCDE
Anticholinergic (dry mouth), blurred vision, constipation, drowsiness, euphoria

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8
Q

How long do you have to take tricyclic antidepressants for there to be an effect?

A

2-4 weeks

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9
Q

What are benzodiazepines used to treat? Two examples

A

Antianxiety meds, MINOR TRANQUILIZER (-ZEP’s); also used for induction of anesthetic, muscle relaxant, alcohol withdraw, seizures, facilitates mechanical ventilation
lorazepam, diazepam

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10
Q

How long can you take benzodiazepines?

A

Tranquilizers work quickly, must not take for more than 2-4 weeks

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11
Q

1 nursing diagnosis for benzodiazepines

A

SAFETY; risk for injury

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12
Q

Side effects of benzodiazepines

A

ABCD
Anticholinergic (dry mouth), blurred vision, constipation, drowsiness

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13
Q

Three examples of monoamine oxidase inhibitors

A

isocarboxazid, phenelzine, tranylcypromine

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14
Q

Side effects of MAOI’s

A

ABCD
Anticholinergic (dry mouth), blurred vision, constipation, drowsiness

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15
Q

Teaching points for MAOI’s

A

To prevent severe, acute and sometimes fatal hypertensive crisis; the patient must avoid all foods containing tyramine:
BAR (bananas, avocados, raisins and all other dried fruits), no organ or preserved meats, no cheese except mozzarella and cottage, no alcohol, yogurt, elixirs, tinctures, caffeine, chocolate, licorice, soy sauce, and no OTC drugs

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16
Q

What are the three side effects of Lithium?

A

3 P’s: Polyuria, pooping (diarrhea), paresthesia (tingling/numbness)

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17
Q

What is the normal range for Lithium? What is the toxic level and toxic effects?

A

Normal is 0.6- 1.2; toxic is above 2 in which patient would experience severe diarrhea, tremors, and metallic taste

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18
Q

What other electrolyte does Lithium effect and how so?

A

1 nursing intervention is to increase fluids; watch for dehydration and sodium levels. Low sodium makes lithium more toxic; if someone is on Lithium and becomes dehydrated, give sodium as well as fluids (don’t give water!!)

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19
Q

What are the side effects of fluoxetine?

A

ABCDE
Anticholinergic (dry mouth), blurred vision, constipation, drowsiness, euphoria

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20
Q

What are some teaching points for fluoxetine?

A

Causes insomnia, must give before noon- if BID give at 6a and noon,
When changing the dose for an adolescent or young adult, there is an increased risk for suicide.

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21
Q

What is haloperidol used to treat?

A

Tranquilizer

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22
Q

Side effects for haloperidol

A

ABCDEFG
Anticholinergic (dry mouth), blurred vision, constipation, drowsiness, EPS, “f”otosensitivity, aGranulocytosis

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23
Q

What is Neuroleptic Malignant Syndrome?

A

Elderly patients may develop NMS from overdosage of haloperidol. NMS is potentially fatal hyperpyrexia, anxiety and, tremors with temperatures up to 104. Dosage for elderly patient should be half of usual adult dose.

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24
Q

What are some teaching points with haloperidol?

A

SAFETY; risk for injury
Only antipsychotic med you can use with pregnant women!

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25
Q

What is clozapine used to treat?

A

Second generation antipsychotic used to treat severe schizophrenia; NEW MAJOR TRANQUILIZER, -ZAPINE’s

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26
Q

Side effects of clozapine

A

SEVERE agranulocytosis

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27
Q

What is the generic name for GeoDon?

A

ziprasidone (prolongs QT interval)

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28
Q

What does sertraline treat?

A

antidepressant; SSRI

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29
Q

Teaching points with sertraline

A

Also causes insomnia but you can give it in the evening
Watch for interactions with St Johns Wort (serotonin syndrome) and warfarin (bleeding); sertraline increases chance of toxicity of other drugs

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30
Q

Side effects of sertraline

A

SAD Head
Sweating Apprehensive (impending sense of doom) Dizzy Headache

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31
Q

Creatinine

A

0.6-1.2

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32
Q

INR

A

Warfarin therapy: 2-3; above 4 is bad

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33
Q

Hemoglobin

A

12-18

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34
Q

Hematocrit

A

36-54

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35
Q

PO2

A

78-100

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36
Q

BNP

A

<100 (best indicator of CHF)

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37
Q

WBC

A

Total (5,000-11,000)
ANC (>500)
CD4 (>200)

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38
Q

Albumin

A

3.4-5.4

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39
Q

Calcium

A

9-11

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40
Q

Magnesium

A

1.3-2.1

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41
Q

Phosphate

A

3.0-4.5

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42
Q

Chloride

A

98-106

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43
Q

What is the earliest sign of any electrolyte disorder?

A

Numbness and tingling (paresthesia)

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44
Q

What is the universal sign of electrolyte imbalance?

A

Muscle weakness (paresis)

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45
Q

What do -kalemia’s do?

A

The same as the prefix except for urine output and heart rate.

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46
Q

Key teaching with potassium IV

A

NEVER PUSH IV K AND NEVER >40/L

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47
Q

What is the treatment for hyperkalemia?

A

D5W with regular insulin (temporary fix)
Polystyrene sulfonate (PO/Rectal) and then treat hypernatremia with IV fluids

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48
Q

What do the -calcemia’s do?

A

The opposite of the prefix; no exceptions

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49
Q

What are the two signs that indicate hypocalcemia?

A

Chvostek’s: cheek tap
Trousseau’s: hand spasm with BP cuff

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50
Q

What do the -magnesmia’s do?

A

The opposite of the prefix; no exceptions

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51
Q

What should you think of with hypErnatremia? S/s?

A

dEhydration; hot, flushed, dry, thready pulse, rapid HR

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52
Q

What should you think of with hypOnatremia? S/s?

A

Overload; crackles, distended neck

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53
Q

When would you first auscultate a fetal heart?

A

8 weeks

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54
Q

When would you most likely auscultate a fetal heart?

A

10 weeks

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55
Q

When should you auscultate a fetal heart by?

A

12 weeks

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56
Q

Nagele’s rule

A

First day of LMP, add 7 days, subtract three months

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57
Q

Weight gain in pregnancy (total and by trimester)

A

Total: 28 (+/- 3)
1st trimester: 1lb/month (3lbs)
2nd/3rd trimester: 1lb/week
**after 12 weeks, take the week and subtract 9

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58
Q

Fundal heights

A

Not palpable until week 12, will reach umbilicus by weeks 20-22

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59
Q

Time period for beginning of quickening

A

16-20 weeks

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60
Q

4 positive signs of pregnancy

A
  1. Fetal skeleton on x-ray
  2. Fetal presence on ultrasound
  3. Auscultation of FHR by doppler (8-12 weeks)
  4. Examiner palpates fetal movement/outline
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61
Q

4 probable/presumptive signs of pregnancy

A
  1. All blood and urine pregnancy tests
  2. Chadwick’s sign (blue cervix)
  3. Goodell’s sign (cervical softening)
  4. Haegar’s sign (uterine softening)
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62
Q

Office visits for pregnancy timing

A

Once a month until week 28
Every 2 weeks until week 36
Every week until delivery or week 42

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63
Q

What are five examples of aminoglycosides?

A

Streptomycin
Vancomycin
Clindamycin
Gentamycin
Tobramycin

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64
Q

What routes can aminoglycosides be given?

A
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65
Q

What routes can aminoglycosides be given?

A

IM/IV/PO*

66
Q

Under what circumstances can aminoglycosides be given PO?

A

Hepatic encephalopathy
Pre-op bowel surgery to sterilize bowel

67
Q

What are some key teaching points with PO aminoglycosides and what two drugs are used to sterilize the bowel?

A

NO toxic affects
NEO-KAN
Neomycin and Kanamycin

68
Q

What are the toxic effects of amniglycosides?

A

Ototoxicity: monitor hearing, ringing in ears (tinnitus), and balance/dizziness
Nephrotoxicity: monitor creatinine (24 hour creatinine clearance)
“8”: toxic to cranial nerve VIII and administer Q8h

69
Q

What are four examples of calcium channel blockers?

A

-dipines
amlodipine
nifedipine
PLUS verapamil and diltiazem (continuous IV drip)

70
Q

CCB’s are…

A

Negative ionotrophic (strength)
Negative chronotrophic (rate
Negative dromotrophic (conductivity)

71
Q

CCB’s are…

A

Negative ionotrophic (strength)
Negative chronotrophic (rate
Negative dromotrophic (conductivity)

72
Q

What do you have to check prior to CCB administration?

A

Always check BP first, hold if SBP <100

73
Q

What do CCB’s treat?

A

AAA
Antihypertensives
Anti-angina
Anti-atrial arrhythmic
PLUS treatment of SVT’s

74
Q

Two side effects of CCB’s

A

Headache and hypotension

75
Q

What is the only aspect that matters in trough and peak questions?

A

ROUTE

76
Q

Sublingual trough/peak

A

Trough: 30 minutes before to next dose
Peak: 5-10 minutes after drug dissolves

77
Q

IV trough/peak

A

Trough: 30 minutes before to next dose
Peak: 15-30 minutes after drug FINISHES

78
Q

IM trough/peak

A

Trough: 30 minutes before to next dose
Peak: 30-60 minutes after injecting

79
Q

PO trough/peak

A

Trough: 30 minutes before to next dose
Peak: too variable to test

80
Q

What are the five uppers?

A

Cocaine, caffeine, PCP/LSD (psychedelic hallucinogens), methamphetamines, adderall

81
Q

pH goes _____, patient goes _____. Except for _________.

A

up/up
down/down
potassium

82
Q

What sequence of questions do you ask in ABG questions?

A
  1. Is it LUNG? If so, it is respiratory.
  2. Not LUNG? Metabolic

Respiratory:
Overventing? Alkalosis
Underventing? Acidosis

Metabolic:
Vomiting/suctioning? Alkalosis
Anything else? Acidosis

83
Q

If the pH and the Bicarb are both in the same direction, then it is ___________.

A

Metabolic

84
Q

Respiratory alkalosis in a MV patient means:

A

Alkalosis = overventing; vent settings are too hgih

85
Q

Respiratory acidosis in a MV patient means:

A

Acidosis = underventing; vent setting too low

86
Q

What would cause a high pressure alarm?

A

Obstructions:
1. Kinks in tubing
2. Water in tubing
3. Mucous buildup: turn, cough/deep breathe, suction

87
Q

What would cause a low pressure alarm?

A

Disconnection:
1. Disconnection of main tubing
2. Oxygen sensing tubing

88
Q

What three medications should you give both AWS and DT patients?

A

Anti-HTN
Tranquilizer
Multivitamin (to prevent Wernickes)

89
Q

What is the onset and duration of antabuse?

A

Onset: 2 weeks
Duration: 2 weeks

90
Q

What is the normal level for Lithium? Toxic level

A

0.6-1.2, greater than 2 is toxic

91
Q

S/s of Lithium toxicity

A

N/V, tremors, polyuria, muscle weakness, ataxia, EKG changes, convulsions, coma, death

92
Q

What are the adverse effects of Lithium?

A

GI (take with food), hypothyroidism, tremors, renal damage, polyuria, birth defects (avoid in first trimester)

93
Q

What drug-drug interactions for Lithium?

A

NSAIDS, diuretics

94
Q

Normal/toxic ranges for Digoxin

A

Normal: 1-2
Toxic: greater than or equal to 2

95
Q

What must you check before adminstering digoxin?

A

Apical pulse

96
Q

What puts a patient at risk for toxicity while on digoxin?

A

Hypokalemia

97
Q

Normal/toxic ranges for Phenytoin

A

Normal: 10-20
Toxic: greater than or equal to 20

98
Q

What are some s/s of digoxin toxicity?

A

N/V, anorexia, fatigue, visual distrubances

99
Q

What are some s/s of phenytoin toxicity?

A

Nystagmus, sedation, ataxia, blurred/double vision

100
Q

Teaching points with phenytoin

A

IT IS TERATOGENIC!!
Slowly administer IV and only with NS
S/e are drowsiness, gingival hyperplasia, give with food

101
Q

What do you have to watch for with phenytoin?

A

Stevie J babaaay and toxic epidermal necrolysis

102
Q

What are the s/s of dumping syndrome?

A

DRUNK + SHOCK + ACUTE ABD DISTRESS

103
Q

What interventions for dumping syndrome?

A

HOB: LOW
Water content in meal: LOW
Carb content in meal: LOW
Protein: HIGH

104
Q

What interventions with hiatal hernia?

A

HOB: HIGH
Water content: HIGH
Carb content in meal: HIGH
Protein: LOW

105
Q

In what order do you take OFF PPE?

A

Alphabetical order :)
Gloves - Goggles - Gown - Mask

106
Q

In what order do you put ON PEE?

A

Reverse alphabetical order, “M” comes second
Gown - Mask - Goggles - Gloves

107
Q

Regular insulin

A

Onset: 1 hour
Peak: 2 hours
Duration: 4 hours
Clear solution, can be used IV drip, short acting, rapid.
Regular Rapid Run

108
Q

NPH

A

Onset: 6 hours
Peak: 8-10 hours
Duration: 12 hours
Cloudy suspension, intermediate acting, cannot use IV drip
Not so fast, Not in the bag, Not clear

109
Q

Insulin lispro

A

Onset: 15 min
Peak: 30 min
Duration: 3 hours
Must give with meals (not before!), fast acting

110
Q

Insulin glargine

A

Duration: 12-24 hours
Little to no risk of hypoglycemia, only one you can give at bedtime regardless of sugar; low acting, slow absorption

111
Q

What are the s/s of hypoglycemia?

A

DRUNK in SHOCK

112
Q

What is the treatment for hypoglycemia? What about if they are unconscious?

A

Rapidly metabolizing carbohydrates
Unconscious: Glucagon IM, D10/D50

113
Q

What are the s/s of DKA?

A

(D)ehydration
(K)etones
(K)ussmaul
High (K)
(A)cidosis
(A)cetone breath
(A)norexia related to nausea

114
Q

What is the treatment for DKA?

A

Fast rate fluids IV (200mg/hr regular insulin)

115
Q

HHS s/s

A

Severe dehydration; risk for FVD
Dry, flushed, hot, increased HR, decreased skin turgor

116
Q

What are some s/s of hyperthyroidsm?

A

“Hypermetabolism)
weight loss, tachycardia, hypertension, irritable, hyper, heat intolerance, exophthalmos

117
Q

What are the three treatments for hyperthyroidsm?

A
  1. Radioactive iodine
  2. PTU (propylthiouracil); immunosuppresion
  3. Thyroidectomy (total/subtotal)
118
Q

What are some risks of a total thyroidectomy?

A

Need lifelong HRT
Risk for hypocalcemia (everything UP + Chvosteks/Trousseaus)

119
Q

What are some risks of a subtotal thyroidectomy?

A

Risk for thyroid storm

120
Q

Postop risks with thyroidectomy?

A

First 12 hours: airway/hemorrhage
Total: between 12-48 hours tetany due to hypocalcemia
Subtotal: 12 hours thyroid storm

121
Q

S/s of hypothyroidsm

A

“Hypometabolism”
obese, flat, cold intolerance, bradycardic, hypotensive, mentally slow

122
Q

Treatment for hypothyroidsm

A

Levothyroxine

123
Q

Teaching with Levothyroxine

A

Must monitor levels, watch for s/s of hyperthyroidism, take in Am before eating, reactions with Ca, Iron, Warfarin, insulin, Dig

124
Q

Addison’s Disease s/s

A

Hyperpigmentation, do not mount stress response (so cannot raise BP or glucose in times of stress and will go into shock)

125
Q

Cushing’s Syndrome s/s (also s/e of steroids)

A

CUSH MAN
Moonface, hirsutism, truncal and central obesity, buffalo hump, gynecomastia, skinny extremities (muscle atrophy), retaining Na/H2O, Losing K, striae, grouchy, immunosuppressed

126
Q

Station

A

Relationship of fetal presenting part to mom’s ischial spine (tightest squeeze)
+ below ischial spine, already passed through
- above ischial spine, “negative news”

127
Q

Engagement

A

Station “0”, at ischial spine

128
Q

Lie

A

Relationship of spines
Vertical: parallel, uncomplicated, vaginal birth
Transverse: perpendicular; BAD
**Transverse lie that will not go positive, C-section

129
Q

What are the purpose of uterine contractions in the first stage of labor?

A

To dilate and efface cervix

130
Q

What are the three phases of stage one?

A

Latent
Active
Transition

131
Q

Latent phase

A

Dilation: 0-4cm
Frequency: 5-30 min apart
Length: 15-30 seconds

132
Q

Active phase

A

Dilation: 5-7 cm
Frequency: 3-5 min apart
Length: 30-60 seconds

133
Q

Transition phase

A

Dilation: 8-10cm
Frequency: 2-3 min apart
Length: 60-90seconds

134
Q

Contractions should NOT be:

A

Longer than 90 seconds, closer than 2 minutes apart
Can cause: uterine tetany, hyperstimulation…stop oxytocin

135
Q

Occiput positioning would be indicative of:

A

Painful back labor (Oh Pain!)

136
Q

Interventions for painful back labor:

A

Position (knee-chest)
Push (fist into sacrum)

137
Q

Interventions for prolapsed cord:

A

Push (head back off cord)
Postion (knee-chest)

138
Q

All other complications of labor use…

A

LION
(Left side, Increase IV, Oxygenate, Notify HCP)
In all crises, stop oxytocin

139
Q

What are the purpose of uterine contractions in the second stage of labor?

A

To push baby out

140
Q

What is the priority in the second stage of labor?

A

Clear baby’s airway

141
Q

Steps for second stage of labor:

A
  1. Deliver head (stop pushing during this)
  2. Suction mouth then nose
  3. Check for nuchal cord
  4. Deliver shoulders/body
  5. Make sure baby has ID band on before leaving delivery area
142
Q

What are the purpose of uterine contractions in the third stage of labor?

A

Push placenta out

143
Q

Steps for third stage of labor:

A
  1. Make sure it is all there
  2. Check for 3-vessel cord (AVA= 2 arteries, 1 vein)
144
Q

What are the purpose of uterine contractions in the fourth stage of labor?

A

To stop bleeding

145
Q

What four things do you do four times an hour in the fourth stage?

A
  1. VS; assessing for s/s of shock
  2. Fundus; boggy = massage, displaced = void/cath
  3. Check pads; excessive lochia is 100% of pad saturated in 15 minutes
  4. Roll onto side to check for bleeding
146
Q

Low fetal HR

A

Under 110
BAD
LION, stop oxytocin

147
Q

High fetal HR

A

Over 160
No biggie, check mom’s temperature

148
Q

Low baseline variability

A

FHR stays the same, does not change
BAD
LION, stop oxytocin

149
Q

High baseline variability

A

FHR constantly changing
GOOD, document

150
Q

Late decelerations

A

FHR slows down near the end of a contraction
BAD; placental insufficiency
LION, stop oxytocin

151
Q

Early decelerations

A

FHR decelerates before or at beginning of contraction
No biggie, document
Head compression

152
Q

Variable decelerations

A

VERY BAD = prolapsed cord
PUSH then POSITION

153
Q

What are the three bad fetal monitoring patterns?

A

Low/Low/Late
Low fetal HR
Low baseline variability
Late deceleration

154
Q

What are you assessing every 4-8 hours in postpartum?

A

BUBBLEHEAD
Breasts, Uterine fundus, Bladder, Bowel, Lochia, Episiotomy, Hemoglobin/Hematocrit, Extremity check, Affect, Discomforts

155
Q

What are the three big things to assess postpartum?

A

Uterine fundus (firm, midline, and cm as days PP)
Lochia (moderate is okay, 4-6 inches/hr)
Extremity check (for thrombophlebitis; bilateral calf circumference)

156
Q

What are the three tocolytics? What are tocolytics uses for?

A
  1. Terbutaline
  2. Mag Sulfate
  3. Nifedipine
    Used to stop labor, when threatening pre-term labor
157
Q

Teaching with terbutaline

A

causes maternal tachycardia, do not use with cardiac issues

158
Q

Three oxytocics

A
  1. Oxytocin
  2. Methylergometrine
  3. Prostanglandin
159
Q

What are the two fetal lung maturing meds?

A
  1. Betamethosone
  2. Beractant
160
Q

Betamethasone teaching

A

Given to mother IM before baby is born

161
Q

Beractant teaching

A

Surfactant given to the neonate transtracheal after birth

NCLEX (1 decks)

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