NCLEX Flashcards
1
Q
Hyperglycemia blood glucose range
A
Greater than 180 mg/dL
2
Q
Treatment for magnesium toxicity
A
stop magnesium immediately, administer IV calcium gluconate bolus
3
Q
Platelet reference range
A
150,000 to 400,000 mm³
If low expect petechiae, spontaneous bleeding
4
Q
What are signs and symptoms of magnesium toxicity?
A
Nausea, Flushing, headache, decreased or absent deep tendon reflexes (DTR’s), hypocalcemia, somnolence, respiratory paralysis, cardiac arrest, decreased urine output, note: mag is eliminated via kidneys
5
Q
Target blood glucose for a patient on TPN
A
140 to 180 mg/dL
6
Q
Action of warfarin/Coumadin
A
Vitamin K antagonist. Prevents blood clot formation in patients with a fib, artificial valve, history of thrombosis.
7
Q
Considerations regarding MMR vaccine for childbearing age and pregnant people
A
MMR is a live attenuated vaccine and therefore contraindicated in pregnancy. If a person is pregnant and found to be not immune, they should be offered the vaccine postpartum period for a non-pregnant person who receives the MMR vaccine pregnancy should be avoided for 1 to 3 months post vaccination.
8
Q
What are contraindications for administration of thrombolytic agents (-PLASE)
A
Active bleeding, recent trauma, aneurysm, arterial venous malformation, history of hemorrhagic stroke, uncontrolled hypertension, all contraindicated due to risk of intracerebral hemorrhage. Also do not give to pts with peptic ulcer disease d/t risk of increased ulcer bleeding.
9
Q
How can peripheral edema in children manifest?
A
Periorbital edema (puffiness around the eyes)
10
Q
Hypoglycemia blood glucose range
A
Less than 70 mg/dL
11
Q
What are warning signs of lithium toxicity
A
Excessive urination and increased thirst, nausea and vomiting, extrapyramidal symptoms. Monitor for fluid intaxe output, GI symptoms, neurological symptoms
12
Q
CD4 plus cell count reference range
A
Normal range 500 to 1200 mm³
13
Q
How long should a muscler needle be
A
1 to 1 1/2 inches
14
Q
Cows milk is rich in
A
Calcium and vitamin D
15
Q
Palpable lymph nodes post mastectomy normal versus abnormal findings
A
Normal: Palpable, superficial, small (0.5 to 1 cm), mobile, firm, non-tender
Abnormal: Tender, hard, fixed, larger than 1 cm
16
Q
Nursing considerations/teaching for warfarin/Coumadin
A
Vitamin K rich foods such as green vegetables (spinach, broccoli), and liver need to be kept CONSISTENT (not decreased/increased) while taking. Need monthly INR draws.
17
Q
What is the therapeutic range for magnesium sulfate?
A
4 to 7 mEq/L
18
Q
Warfarin is also known as
A
Coumadin
19
Q
What decreases efficacy of warfarin/Coumadin
A
Think increased clotting. Rifampin, carbamazepine, oral contraceptives, ginseng, St. John’s wort, vitamin K rich foods.
20
Q
2.2 pound/1 kg weight gain or loss is equal to how much fluid
A
1000 mL or 1 L
21
Q
What increases risk of bleeding with warfarin/Coumadin
A
Acetaminophen, NSAIDs, ABX, antifungals, Amiodarone, cranberry, ginkgo biloba, vitamin E, omeprazole, thyroid hormone, SSRIs.
22
Q
Nursing considerations/teaching around carbamazepine
A
Associated with Leukopenia due to agranulocytosis, Resulting in increased infection risk. Patient should be educated regarding infection prevention and signs and symptoms of infection.
23
Q
What is the number one priority intervention in a patient with DKA?
A
Re-hydration with normal saline
24
Q
What is the most common complication of central lines?
A
Catheter occlusion
25
What is the best intervention for a suspected central line occlusion?
See if occlusion is mechanical/non thrombotic --reposition the patient (head, arm), as catheter tip may be against a vessel wall. Then assess for kinks, closed clamps, precipitate in the IV tubing.
26
What is the appropriate sized flush for central lines?
No smaller than 10 mL. Smaller size increases intraluminal pressure and can damage the line
27
What is an important nursing consideration for IV vancomycin?
Red man syndrome is a possible side effect and occurs with rapid vancomycin administration. S/sx of RMS = flsuhing, erythema, pruritis, usually on the face, neck, and chest. Muscle pain, spasm, dyspnea, hypotension may also occur. Usually related to rate of infusion NOT an allergic reaction. Vancomycin should be infused at minimum over 60 minutes.
28
Normal serum calcium range
8.6.-10.2 mg/dL
29
Complication of thyroidectomy
Hypocalcemia d/t removal of parathyroid glands. Can lead to laryngeal spasm = life threatening.
30
S/sx of hypocalcemia
Tetany (tingling of hands, toes, circum-oral region) positive trousseau or chvostek signs.
31
Treatment for hypocalcemia
Calcium gluconate
32
What is ketorolac?
NSAID --nephrotoxic, avoid in kidney patients
33
Considerations re: NSAID prescriptions
No more than 1 NSAID should be prescribed at a time, inappropriate for CHF patietns due to sodium retention and resulting increased fluid retention
34
What is malignant hyperthermia?
Rare, inherited muscle abnormality triggered by inhaled anesthetic agents and succinylcholine (anectine. A depolarizing muscle relaxant) used in general anesthesia. Asking re: family history of reactions of anesthesia is importantant, especially if patient has never undergone anesthesia.
35
Depth of proper chest compressions
2 - 2.4 inches/5-6 centimeters
36
Rate of proper chest compressions
100-120 compressions/min
37
Therapeutic range of lithium
0.6 - 1.2 mEq/L for maintenence
up to 1.5 for acute mania
toxic over 1.5-2
38
Asterixis
flapping hand tremors in arm extension
39
What causes asterixis
Elevated serum ammonia levels
40
Treatment for elevated serum ammonia levels
Lactulose.
41
Action of albumin
Increases intravascular oncotic pressure = increased intravascular volume, helps prevent hypotension and tachycardia = more stable vital signs.
42
Normal range serum magnesium
1.5 - 2.5 mEq/L
43
What are etiology/risks of hypomagnesia
Often associated with excessive EtOH use, results in ventricular arrhythmia --specifically torsades de pointes which looks like a twisting ribbon or a sideways tornado-- and neuromuscular excitability --tremors, hyperactive reflexes, positive trousseau and chovstek signs, seizure.
44
Post operative blood loss normal range
No greater than 100 mL/hr
45
Normal urine output children vs adults
30 mL/hr or 0.5 mL/kg/hr adults
| 1 mL/kg/hr children
46
What is myasthenia gravis?
An autoimmune disease affecting the neuromuscular junction. Acetylcholine is unable to bind to the receptors. Results in fluctuating muscle weakness in skeletal muscles related to eyes and eylid movements, speaking, swallowing, breathing. Tx. is anticholinesterase drugs like pyridostigmine (Mestinon) which increases acetylcholine binding and increases muscle strength. Meds are given prior to meals to maximize swallow ability during eating. Semi-solid foods should be provided.
47
What are etiology and symptoms of myasthenic crisis?
Stress, infection, undermedication.
| S/sx = oropharyngeal and respiratory muscle weakness and respiratory failure.
48
First step in management of someone who has been impaled with an object
Stabilization of the impaling object (then assessment, IV and blood draws, fluids, etc)
49
Amiodarone toxic side effects
Antiarrhythmia drug used only when other tx have failed because it has toxic adverse effects like pulmonary toxicity which manifests as a dry cough, pleuritic chest pain, and dyspnea. Requires urgent follow up.
50
What is uterine tachysystole and what is the treatment?
Due to pitocin augmentation in labor. More than 5 contractions in 10 minutes over 30 minutes. Tx = turn off pitocin, place pt in side lying position, provide O2 8-10 L/min, give IV fluid bolus, prepare to administer terbutaline, notify provider.
51
What causes diabetes inspidius?
ADH insufficiency. Sometimes due to pituitary manipulation.
52
S/sx of diabetes insipidus
Increased thirst (polydipsia), excessive urination (polyuria). Fluid volume deficit = can lead to weight loss, HYPERnatremia, HIGH serum osmolality, copious DILUTE urine with low specific gravity.
53
What are side effects and teaching considerations of sulfa drugs
Can cause kidney damage (client should drink lots of water), photosensitivity (client should wear sunscreen), folic acid deficit (client should take folate), agranulocytosis, stevens-johnson syndrome (teach client to d/c meds if rash appears), may cause orange-yellow skin and urine which will normalize when drug is stopped
54
Key steps of chest tube removal
Pre-medicate patient, have patient Valsalva during removal, it is a sterile procedure, and a sterile, airtight occlusive dressing is applied to wound after removal. A follow up chest x-ray is indicated 2-24 hours after removal.
55
Where are the most ideal PIV sites?
Hand or forearm
56
What are the classic signs of Duchenne Muscular Dystrophy
Falls frequently, pushes up on thighs to stand, walks on tiptoes, big calves.
57
Early sign of pneumothorax
Drop in O2 sat
58
Before starting TNF (tumor necrosis factor) drugs what must be ruled out? What must be monitored when taking TNF drugs?
TB --pt must be cleared or treated for latent TB prior to starting TNF. WBC must be monitored because TNF causes immunosuppression and elevated white count may indicate active infection. Pts with active infection, or taking antibiotics for an infection, should not take TNF.
59
ABG ranges
pH 7.35 - 7.45
PaCO2 45 - 35 (represents respiratory system)
HC03 22 - 26 (represents metabolic/renal system)
PaO2 80 -100 mm Hg
60
What does full compensation look like in ABGs?
pH is normal but less than 7.40 is acidotic and more than 7.0 is alkalotic
61
what does partial compensation look like in ABGs?
All values are out of range (neither PaC02 and HC03 are in normal range)
62
What does uncompensated look like in ABGs?
PaCo2 or HC03 are in normal range
63
What is high fowlers position
HOB up at 45 degrees or higher
64
What is Sim's position
flat and side lying
65
What is the action of lactulose?
It decreases intestinal absorption of ammonia
66
Is a positive pg test a probable or diagnostic sign of pg?
It is probable --a gestational trophoblastic disease can also cause positive serum HcG
67
Normal range urine specific gravity
1.003 - 1.030
68
Procedure for 24 hour urine
Time is marked as start, urine is voided and discarded so time coincides with an emtpy bladder. Dark jug with power is provided for urine collection, refrigerated or kept on ice when not in use. If ANY void is missed, must start test again.
69
Loop diuretics can cause or worsen...
loop diuretics (like furosemide and bumetanide) can worsen hypokalemia unless they are K sparing
70
Elevated liver enzymes in a TB patient may indicate
drug induced hepatitis
71
Vanco therapeutic range
10-20 mg/L
72
Why is a vanco trough run? What else is checked?
To assess for nephrotoxicity. If trough is higher than therapeutic range, contact HCP. Also assessing BUN and creatinine. If either is high, also consider nephrotoxicity and contact HCP.
73
Normal creatinine range
0.6 - 1.3 mg/dL. Best indicator of kidney function. Elevated not that exciting unless on a nephrotoxic drug or a dye procedure in the morning.
74
Normal BUN
6 -20 mg/dL
| If elevated, assess for dehydration
75
BUN stands for
Blood Urea Nitrogen
76
Most common drugs used to treat C. Diff are?
Metronidazole and oral Vancomycin. IV vancomycin is not effective.
77
Signs of digoxin toxicity, monitoring
N/V, slow HR, change in color perception. Digoxin is secreted by the kidney so creatinine and BUN are monitored. Elevation can indicate kidney injury, which means digoxin may accumulate = toxicity risk. Pt should report GI symptoms, neurological symptoms (lethargy, confusion, fatigue), visual changes, symptoms of cardiac block (dizziness, lightheadedness)
78
Chest tube bubbling normal vs abnormal
Gentle, continuous bubbling in suction control unit is normal
Bubbling in leak gauge or in water seal chamber is not normal UNLESS the pt has pneumothorax in which case gentle intermittent bubbling in water seal chamber is expected until lung has fully expanded
79
Polycythemia
An increase in RBCs. A compensatory response to chronic low blood O2 levels. Can lead to clots/stroke. Defined as hemoglobin >22 g/dL or hematocrit >65%
80
Interventions for anaphylaxis
```
High flow O2 via non-rebreather
IM epinephrine can be repeated very 5 -15 min as needed --this is the MAIN Treatment while symptoms present, all others are supportive
Elevated legs
IV fluid resuscitation
Albuterol/bronchodilator
Antihistamine
Corticosteroids
```
81
People with hemophilia are at increased risk for
joint destruction due to frequent bleeding into joint spaces
82
What does a positive Romberg test indicate?
Pt stands up straight and closes their eyes. If they fall over, that is a positive Romberg test. Indicates impaired proprioception/sensory ataxia.
83
Normal range for potassium
3.5 - 5.3 mmol/L
if low, prepare to give KCl, call provider.
If elevated (5.4 - 5.9) hold all KCl, assess heart, call provider , give kayexsolate and regular insulin and D5W.
If 6 or greater, emergent: ECG, hold all KCl, assess heart, call provider , give kayexsolate and regular insulin and D5W, do not leave pt side
84
P wave represents
atrial contraction/depolarization
85
QRS complex represents
ventricular contraction/depolarization
86
T wave represents
re-polarization of ventricles
87
Typical "ideal" length of EKG strip
6 seconds
88
Tiny boxes in EKG represent how much time
0.04 seconds
89
A big box in EKG represents how much time
0.20 seconds
90
Prolonged PR interval is how long
greater than 0.20 seconds (more than 5 little boxes)
91
What are the sinus rhythms
Sinus brady, normal sinus, sinus tach
| All are regular rhythms, with P for every QRS and QRS for every P and regular P to P intervals, but different rates.
92
Hydrocele
Fluid filled testicular mass typically painless/bilatera. Usually resolves by pt's first birthday.
93
Acrocyanosis
blue hands/feet
94
Neonatal "normal" RR
30-60 breaths per minute
95
Therapeutic INR range
2-3 but up to 3.5 for heart valve disease. Anything over 4 is concerning but not emergent.
96
Chillblains or Pernio definition and tx
Frost bite. Redness and swelling and blanched areas of skin due to cold exposure/injury. Rewarm in warm water (104 F) for approx 30 minutes or until areas of blanching are pink again. Areas unable to be submerged in water can be rewarmed with warm compresses. After rewarming, elevate extremeties to reduce swelling, do not apply occlusive dressings, do not massage.
97
Serotonin syndrome
A risk when SSRIs are used in combination with MAOIs. If a pt has been on MAOIs, must wait 14 days before starting SSRIs.
98
Aortic stenosis typical subjective and objective findingd
Dyspnea on exertion, chest pain, syncope, weak pulses, soft of absent S2, systolic murmur over right sternal border.
99
Peak expiratory flow rate
measures max exhalation, indicates amount of airway obstruction. Increasing peak expiratory flow rate value = more exhalation = less obstruction.
100
Connection between heart failure patients and expected findings re sodium levels
Dilutional hyponatremai is expcted in heart failure patients due to excess fluid. Signs and symptoms are fatigue and headache. Na levels below 130 mEq/L is cause for concern but borderline low (low 130s) is not emergent.
101
Risk to congential heart disease/syntheic materials repair, and prosthetic valve patients in relation to dental work
Risk for infective endocarditis due to oral surgery and some dental procedures. They need prophylactic antibiotics prior to procedures.
102
Intussusception
An intestinal obstruction due to bowel folds (like a telescope) causing increase in bowel pressure, vomiting due to pyloric muscle spasms (but NOT projectile vomiting). Produces blood and mucus in stool, looks like red jelly, a sausage shaped right sided mass on palpation is expected. Anticipate air enema (pneumatic enema) or hydrostatic (saline) enema to relieve obstruction/diagnose. Risk of peritonitis (life threatening): fever, abdominal ridigity and guarding, rebound tenderness.
103
Steatorrhea
Oily or bulky, foul-smelling stool due to excess fat in stool. Results from malabsorbtion of fat may be due to pancreatic insufficiency, cystic fibrosis, celiac disease.
104
Hirschsprung's disease
congenital aganglionic megacolon, causes internal sphincter to remain rigid/not relax resulting in bowel obstruction and causes thin, ribbon-like stools or inability to pass stool in newborns first 48 hours, produces bilious vomit. Potentially fatal complication is enterocolitis which can lead to sepsis, presents as fever, lethargy, explosive foul-smelling diarrhea, and worsening distension of abdomen.
105
Neurogenic shock symptoms
Hypotension and bradycardia due to massive vasodilation
106
Thyroid storm symptoms
Rapid increase in temp, HR, BP due to stress/trauma in Grave's patients (hyperthyroid)
107
Proper administration of a nasal spray medication
High fowlers position with head slightly bowed, occlude opposite nostril, point spray tip away from center of nose, spray and inhale deeply, breathe through mouth, repeat on opposite side. Blot nose secretions but do not blow nose for several minutes post administration,
108
Normal PR interval
0.12 - 0.2 seconds
109
Normal QRS interval
0.6 - 0.11 seconds
110
Name the cranial nerves
```
I Olfactory
II Optic
III Oculomotor
IV Trochlear
V Trigeminal
VI Abducens
VII Facial
VIII Vestibulocochlear
IX Glossopharangeal
X Vagus
XI Accessory
XII Hypoglossal
```
111
What type of nerve is Cranial Nerve I, what is it responsible for? How is it tested?
CN I Olfactory is a sensory nerve, responsible for sense of smell. Have patient close eyes and identify a scent.
112
What type of nerve is Cranial Nerve II, what is it responsible for? How is it tested?
CN II Optic is a sensory nerve responsible for vision. One eye at a time, test peripheral vision and test reading vision on chart.
113
What type of nerve is Cranial Nerve III, what is it responsible for? How is it tested?
CN III Oculomotor is a motor nerve, responsible for eyeball movement and pupillary dilation/constriction. Tested together with CN IV and
CN VI. Tested by holding pen light to make figure H in air, shining pen light into eyes from each side, and bring penlight toward nose from further away.
114
What type of nerve is Cranial Nerve IV, what is it responsible for? How is it tested?
CN IV Trochlear is a motor nerve, moves eyeball down and laterally. Tested together with CN III, CN VI.
115
What type of nerve is Cranial Nerve V, what is it responsible for? How is it tested?
CN V Trigeminal is a sensory and motor nerve, responsible for mandibular and maxillary and opthalmic areas (example chewing). Tested by opening mouth against resistance.
116
What type of nerve is Cranial Nerve VI, what is it responsible for? How is it tested?
CN VI Abducens is a motor nerve, is responsible for side to side eye movement. Tested with CN III and IV.
117
What type of nerve is Cranial Nerve VII, what is it responsible for? How is it tested?
CN VII Facial is a sensory and motor nerve, responsible for facial movement and expression, helps control secretion of saliva and tears, taste. Tested by asking pt to close eyes tightly, open eyes wide, puff out cheeks, smile and frown.
118
What type of nerve is Cranial Nerve VIII, what is it responsible for? How is it tested?
CN VIII Vestibulococchlear is a sensory nerve, responsible for hearing and equilibrium. Tested by rubbing fingers next to ears.
119
What type of nerve is Cranial Nerve IX, what is it responsible for? How is it tested?
CN IX Glossopharyngeal is a sensory and motor nerve, responsible for taste, swallowing/gag, speech, saliva excretion, tested together with CN X. Tested by asking pt to open wide and say ah and observing uvula moving up, can also test gag by sticking something in back of pt's throat.
120
What type of nerve is Cranial Nerve X, what is it responsible for? How is it tested?
CN X Vagus is a sensory and motor nerve, responsible for taste, swallowing/gag, cough, speaking, senses aortic blood pressure, slows heart rate, simulates digestive organs --tested together with CN IX. Tested by observing speech --able to talk without hoarsenss, and observing ability to swallow.
121
What type of nerve is Cranial Nerve XI, what is it responsible for? How is it tested?
CN XI Accessory is a motor nerve, responsible for head, shoulder and neck movement. Controls trapezius and sternocleomastoid, controls swallow movements. Tested by asking pt to move head side to side, up and down, and shrug against resistance.
122
What type of nerve is Cranial Nerve XII, what is it responsible for? How is it tested?
CN XII Hypoglossal is a motor nerve, responsible for tongue movement, speech and swallowing. Have pt. stick out tongue and move it side to side. Should be midline when not moving side to side.
123
What is atrial flutter? What does it look like?
Atrial flutter is a self perpetuating loop of conduction, usually in the right atrium. The atrial rate is REGULAR and RAPID with a BPM of 250 - 400. Ventricular rate is 1/3 slower due to the AV node blocking some of the atrial impulses. Ventricular rate is usually regular but can also be irregular. Characterized on ECG by absense of normal p-wave and instead "flutter waves" or f-waves/ a sawtooth pattern prior to the QRS complex.
124
What is atrial fibrillation? What does it look like?
Atrial fibrillation is due to multiple electrical impulses from many ectopic sites in and around the atria, often near pulmonary vein roots. The impulses are unsynchronized and random causing atria to quiver (fibrillate) rather than contract. Most impulses do not pass to the ventricles. Atrial rate can be very fast. Ventricular rate is IRREGULAR, ranging from less than 60 to more than 100 BPM. Characterized on ECG by absent P-waves and narrow, irregular QRS complexes. Baseline may be flat or appear undulating. Flat indicates MORE conduction impulses from atria.
125
What is ventricular tachycardia? What does it look like?
V-tach is due to a single strong firing site/circuit in one of the ventricles. Usually occurs in people with structural heart problems such as scarring from a prior MI or heart muscle abnormalities. Impulses originating in the ventricles produce premature ventricular contractions that are REGULAR and FAST ranging from 100-250 BPM. Characterized on ECG with no P-wave and wide, undulating QRS complexes -- it looks like large, regular humps. Sustained V-tach longer than 30 seconds requires immediate intervention to prevent cardiac arrest. It can quickly progress to V Fib
126
What is ventricular fibrillation?
V-fib is caused by multiple weak ectopic impulses in the ventricles causing them to fibrillate/quiver rather than contract. This means no blood is being pumped out of the heart. Quickly leads to cardiac arrest . Characterized on ECG as irregular, random wave forms with no identifiable waves or complexes.
127
What are the medical/electric treatments for bradycardia
Atropine and isoproterenol
| Pacemaker
128
What are the medical/electric treatments for A-fib, SV-tach, and V-tach with pulse?
Amiodarone, adenosine, verapamil
| Synchronized cardioversion
129
What are the medical/electric treatments for pulseless v-tach, ventricular fibrillation?
Amiodarone, lidocaine, epinepherine
| Defibrillation
130
Hypoglycemia range and interventions for neonates
<40-45 mg/dL is considered the hypoglycemic range for neonates
<35 mg/dL in neonates ages 4-24 hours if asymptomatic, first line is to feed (breast or formula)
131
What is VSD
Ventricular septal defect. LEFT TO RIGHT SHUNT --A septal opening between ventricles causing left to right shunt and excess blood flow to the lungs and increased risk of CHF and pulmonary HTN. Causes pulmonary congestion, increased work of breathing, decreased lung compliance.
132
What are signs/symptoms of VSD
systolic murmur at sternal border at 3rd or 4th intercostal space, diaphoresis, tachypnea, dyspnea,poor weight gain. ACYANOTIC
133
Over how long should a blood transfusion be administered?
2-4 hours
134
What is the priority medication in EToH intoxication?
IV thiamine before or with IV glucose to prevent Wernike Encephalopathy
135
What is a consideration re: HR and beta blockers?
Beta blockers (-LOL) can sometimes worsen HF and shouldn't be given to a patient with low BP, and left sided HF symptoms
136
Aspirin is contraindicated when
there is evidence of bleeding
137
Statins are contraindicated when
there is evidence of sever liver injury or muscle injury
138
Metronidazole can cause what urinary side effect
Dark urine
139
If air embolism is suspected in a central line, what position should the patient be in
Trendelenberg (supine with feet elevated above head) to allow air to rise and trap in right atrium.
140
During injection cap and tubing changes what should the patient do
Turn head away from field, and hold breath or valsalva in order to prevent air entering line/air embolism.
141
Sjogren's Syndrome
Auto immune condition causing inflammation of the exocrine glands (lacrimal, salivary) --causes dry eyes, dry mouth. Pt needs to avoid drying things (no decongestions, harsh soaps, excessively hot water, acidic drinks , other mucosal/oral irritants like coffee, etoh, nicotine), receive regular oral care.
142
Possible side effects/interactions of St. John's wort
Increases effect of warfarin/coumadin, can cause serotonin syndrome if taken with anti-depressants, can lessen iron absorption, can cause photosensitivity
143
Treatment for acetylsalicylic acid toxicity
Activated charcoal followed by IV sodium bicarbonate.
144
Sinusoidal FHR pattern
repetitive wave-like fluctuations in HR with absent variability and no response to UCs. An ominous finding requiring immediate intervention
145
Variable decels
ABRUPT decrease (less than 30 seconds from onset to nadir) and at least 15 beats below baseline for 15 or more seconds up to 2 minutes. Usually due to cord compression, maternal position change indicated and can often correct.
146
Early decels
Mirror UCs, with apparent and gradual decrease in FHR over 30 seconds or more from onset to nadir. Indicates head compression, normal finding.
147
Late decels
Follow UCs, with apparent and gradual decrease in FHR over 30 seconds or more from onset to nadir. Indicates placental insufficiency and fetal hypoxia, indication to turn pt to left side-lying and administer O2
148
VEAL CHOP
variable - cord
early - head
accelerations -okay!
late - placental
149
After cleft palate repair what precaution should be taken?
No hard objects in mouth (pacifiers, instruments, tongue depressors, etc)
150
Reassuring fetal movement frequency
4/hour or 10/2 hours
151
Sustained fetal bradycadia/tachycardia
<110 BPM or >160 BPM for more than 10 minutes
152
Ranges for immunocompromise in children
<750 in infants up to 12 months,
<500 in children ages 1- 5,
<200 children 5 and older
153
Consideration for immunocompromised people and vaccines
People showing signs of immunocompromise (i.e. CD4+ count) should not receive live-attenuated vaccines (varicella, MMR)
154
signs and symptoms of tardive dyskinesia
```
Uncontrollable/involuntary movements in:
Mouth -lip smacking/puckering, tongue protrusion/curling
Facial grimacing
Brow twitching/furrowing
Excessive blinking
Foot tapping
Hand wringing
Tremor/shaking
Rocking
Torticollis (persistent neck flexion/extension)
```
155
Neuroleptic malignancy syndrome (NMS)
Altered mental status, muscle rigidity, fever, autonomic instability (diaphoresis, tachypnea, htn, tachycardia, dysrhythmia). A rare condition most often seen with "typical" anti-psychotics (haloperidol, fluphenazine) but can also be seen in "atypical" antipsychotics (clozapine, risperidone, olanzapine). Tx: d/c antipsychotic, request HCP follow up.
156
Teaching to avoid lithium toxicity
Drink 2-3 L H20 daily, avoid diuretics like coffee, tea, soda, maintain normal sodium intake (no low sodium diet), avoid NSAIDs
157
Rescue breaths
If Pt has pulse but no/abnormal respiratory effort, rescue breaths should be administered every 5-6 seconds = 10-12 breaths/min for 2 minutes before reassessing. If rescue breaths have been administered and the pulse is less than 60 and there is signs (i.e. grey/blue skin) that perfusion is not happening, begin chest compressions
158
Compression to breath ratio in CPR
30:2
159
If alone and pt is pulseless, how long to administer CPR
Administer 2 minutes of CPR before leaving to activate EMS and get defibrillator
160
Survival expectancy cut off for full thickness burns
Pts with full thickness burns greater than 60% of body are not expected to survive
161
OTC meds which can increase BP
Should be avoided in pts with HTN: high sodium antacids, appetite suppressants, cold and sinus preparations
162
SIADH
syndrome of inappropriate antidiuretic hormone, often caused by ectopic secretion of ADH from a malignant lung tumor. Causes an increase in water absorption, excessive intra and extra cellular fluid, HYPERvolemia, and dilutional HYPOnatremia.
163
SIADH appropriate tx
Requires HYPERtonic solition eg. 3% NaCl in small quantities to help fluid shift and correct hyponatremia
164
Examples of isotonic solutions
0.9% NaCl, lactated ringers
| Used to replace intravascular fluid, losses associated with vomiting, diarrhea, burns, trauma.
165
Examples of hypertonic solutions
3% NaCl (or more % saline)
166
Examples of hypotonic solutions
0.45% NaCl (or less % saline) or 5% dextrose solution
167
First degree heart block
Look at space between P and QRS. If it longer than 1/2 a big box, consider a 1st degree
"if the R is far from P, then you have a first degree" --in first degree block, the PR interval is longer than 0.20 seconds
168
Second degree heart block type I
"longer, longer, longer, drop! Then you have a Wenkebach" --in Mobitz Type I, the PR interval progressively lengthens until a beat is dropped, and then the process resumes again.
"March out" the P waves --they're regular because the atrial rate is regular but the P to QRS interval lengthens and then occasionally the QRS drops out entirely
169
Second degree heart block type II
"If some Ps don't get through, then you have a Mobitz II" --in Mobitz Type II, the PR interval remains constant/no lengthening but occasionally, the QRS complex doesn't happen. Look for multiple Ps in a row with no QRS complex.
170
Third degree heart block
LETHAL RHYTHM "If Qs and Ps do not agree, then you have a third degree" --Atrial signals are not getting through, ventricle is generating escape impulse independently of atria, so atria is beating 60-100 BPM and ventricles beating 30-45 BPM asynchronously. Looks like a weird P-QRST with occasional long intervals between complexes. This is a high priority finding due to risk of decompensation into cardiogenic shock or periods of asystole. Tx atropine and temp pacing until permanent pacemaker can be placed.
Ps might be hidden behind Ts making them a little larger collectively, Ps are regular.
QRS are also regular. March out both to notice where the Ps are hidden behind the Ts. The atrial and ventricular rates are not coordinated at all.
Note: easy to confuse with 1st degree
171
Congenital dermal melanocytosis AKA
mongolian spots. Fade over first 1-2 years of life, document size and location so they are not confused with bruising.
172
Linezolid (Zyvox)
Oxazolidinone antibiotic for vancomycin and methicillin resistant bacteria, pneumonia, and skin infections. Cannot be used with SSRIs or food/drink containing tyramine because of the drug's MAOI-type properties which increase risk of serotonin syndrome. SSRIs and tyramine containing foods can be started again 24 hours after stopping linezolid.
173
Considerations for gentamycin
Like vancomycin, gentamycin should be monitored for s/sx of nephrotoxicity and ototoxicity. Check BUN and creatinine and measure urine output.
174
Age range for cervical cancer screening
Screen all cervix-having people between ages 21-65 regardless of age at onset of sexual activity. Screen every 3 years ages 21-29
175
What drugs necessitate monitoring for Stevens-Johnson syndrome
Allopurinol, anticonvulsants (like carbamazepine, lamotrigine, phyenytoin), and sulfa drugs
176
S/sx of epiglottis in 3-7 year olds
acute respiratory distress, toxic appearance (sitting up, leaning forward, drooling), stridor, and high fever, tachycardia and tachypnea. This is a pediatric emergency requiring endotracheal intubation and possible tracheostomy.
177
Normal, non-therapeutic INR range
0.75 - 1.25 --mildly elevated in cirrhosis pts is to be expected due to liver damage
178
Opioid agonist-antagonist meds used in labor
Butorphanol tartrate (stadol) and Nalbuphrine hydrochloride (nubain) are appropriate for clients in active labor, not wishing to ambulate, and no contraindications (imminent birth, opioid dependence). Can result in respiratory depression of newborn because these drugs cross placental barrier. Peaks 30-60 min after administration, and lasts 2-4 hours.
179
Bell Palsy
Unilateral peripheral facial paralysis due to inflammation of the facial nerve (CN VII) in absence of a stroke or other cause. S/sx inability to completely close eye on affected side, alteration in tear production (excessive or absent), flattened nasolabial fold on nose, inability to smile/frown symmetrically, loss of taste on anterior 2/3 of tongue.
180
Trigeminal neuralgia
Affecting CN V, shock-like pain in lips, gums, severe pain along cheek bone
181
Weight loss over what percentage of birthweight in first 5 days requires follow up?
More than 7%
182
Tet spell
Hypercyanotic episode in infants or children with tetrology of fallot. Infants should be placed in knee chest position, children will often get into squatting position. This provides relief of dyspnea by reducing volume of blood being shunte through the overriding aorta and VSD.
183
Serious side effects of tamoxifen
Tamoxifen is a selective estrogen receptor modulator used in treatment/prevention of estrogen-positive breast caner. Serious side effects include thromboembolic events and endometrial cancer.
184
What is trousseau's sign and how is it elicited?
An early sign of hypocalcemia, observed by placing a BP cuff on the arm and inflating it to above the most recent systolic pressure. Leave on for 3 minutes. This obstructs the brachial artery and induces a spasm of hand and forearm muscles if hypocalcemic.
185
What is Chovstek's sign and how is it elicited.
A sign of hypocalcemia, oberved by tapping face at the angle of the jaw and observing for facial contraction.
186
IV catheter gauge
14g for administration of fluids/meds in emergency/field settings and hypovolemic shock
18g for blood or large qty fluids in adults
20/22g for general IV and meds. 20 is acceptable for blood but not ideal.
24g children and elderly pts with small fragile veins
187
Suddent onset of left upper quadrant pain can indicate
Spleen rupture --a possible complication of Epstein Barr (mononucleosis) infection
188
Abrupt cessation of central acting alpha2 agonists or -beta blockers can cause what?
Abrupt stop of clonidine or methyldopa (CAA2A) or -olol (beta blockers) can lead to rebound hypertension. Drugs should be tapered down, not stopped abruptly.
189
High levels of PEEP can lead to what complications?
High PEEP (10-20 cm H20) can cause barotrauma of the lung (overdistension or rupture of alveoli) leading to pneumothorax or subcutaneous emphysema. Decreased venous return can also cause hypotension.
190
1 TBSP = ? mL
15 mL in 1 TBSP
191
If a question asks whether an ABG is compensated or NOT compensated and the ABG is *partially* compensated what is the correct answer?
Not compensated, because it is not FULLY compensated
192
Hypertonic total enteral feeds can cause what complication? What is the treatment?
hypertonic TEF can cause N/V/D due to higher osmolality, similar to dumping syndrome. Slow the rate of administration and it will usually correct, and then you can taper up the rate to the goal rate.
193
What is crutch paralysis
Muscle weakness/sensory symptoms of forearm/wrist/hand caused by continuous/prolonged excessive pressure on axillae and radial nerve damage due to use of crutches that are too long/not ambulating correctly on the crutches.
194
Rhythms appropriate for defibrillation
Ventricular fibrillation and pulseless ventricular tachycardia, SVT if not responsive to adenosine
195
Rhythms NOT appropriate for defibrillation
Asystole
196
Ryhthms appropriate for synchronized cardioversion
Supraventricular tachycardia, ventricular tachycardia with pulse, atrial fibrillation with RVR
197
Ideal contraction strength
25 -50 mm Hg, should never exceed 80 mm Hg
198
Resting uterine tone in mm Hg
average 10 mm Hg should never exceed 20 mm Hg. After amnioinfusion, expect resting tone to remain equal to or greater than 20 mmHg and observe for fluid leaking, otherwise suspect uterine overdistension.
199
Proper technique for cane walking, up/down stairs
Cane always moves before the bad leg: cane, bad leg, good leg for flat surfaces.
Stairs: Up with the good and down with the bad --cane, good, bad for up stairs, cane, bad, good, for down stairs.
200
What are considerations re: IVPB Potassium?
it should NEVER be given by gravity --must be provided by pump. It is a vessicant so must monitor site. Monitor renal labs and function (urine output). Max PIV rate is 10 mEq/hr and max concentration is 40 mEq/L otherwise needs to be given via central line.
201
Typical developmental milestones by age 1
Can sit from standing without assistance, birth weight should have roughly tripled, pincer grasp.
202
Presbyopia
Inability to see close objects clearly
203
In elderly patients what is considered febrile?
Lower body temp means lower febrile cut off. 37.8 C / 100.2 F is considered febrile
204
Appropriate fluid resuscitation for burn victims
Lactated Ringers
205
Rheumatic fever
RF is an acute inflammatory disease of the heart, occurs 2-3 weeks after a streptococcal pharyngitis (strep throat) due to delayed onset of autoimmune reaction
206
Tumor lysis syndrome
Oncologic emergency, causes HYPERkalemia, HYPERuricemia, HYPERphosphatemia, HYPOcalcemia. Requires aggressive rehydration, electrolyte correciton (loop diruetics and phosphate binders) and hypouricemic agents (like allopurinol)
207
TB test reading
Positive: induration greater than or equal to 15 mm in a healthy person, greater than or equal to 10 mm in a potential risk person or with mild immunosuppression, greater than or equal to 5 mm in a high risk person. If positive, ask about bacille Calmette-Guerin vaccine which lessens receptivity to TB but causes false positive results.
208
1000 mcg =
1 mg
209
1000 mg =
1 g
210
Rapid acting insulins and OPD
Rapid = "logs" humalog, novolog. Onset 15 min, peak 1 hour, duration 3 hours. Give WITH meals.
211
Short acting insulins and OPD
Short = regular = R. Onset 30 min, peak 2 hours, duration 8 hours. Can be run in IV.
212
Intermediate acting insulins and OPD
Intermediate = NPH. Humulin. "N" Onset 2 hours, peak 8 hours, duration 16 hours. Never put anything cloudy in a bag.
213
Long acting insulins and OPD
Long = Levemir, lantus. Glargine. Onset 2 hours, peak NONE, duration 24 hours. Never mix with other insulins. Can be given at same time, as separate injecton. The only insulin safe to give at bedtime.
214
Neonatal abstinence syndrome s/sx
withdrawal from opiates: irritability, hypertonia, jittery, seizures, diarrhea, vomiting, feeding intolerance, sweating, sneezing, pupillary dilation
215
Drug to reverse benzodiazapine overdose
Flumazenil
216
Normal central venous pressure
2-8 mm Hg. If elevated can indicate R ventricular failure or fluid volume overload
217
Normal MAP
70 -105 mm Hg
218
Normal systemic vascular resistance
800-1200 dynes/sec/cm-5
219
Most severe complication of acute glomerulonephritis
Severe hypertension
220
Narrowing pulse pressure is a sign of
hypovolemic shock
221
Chronic mitral valve regurgitation consideration
Often asymptomatic but can develop into heart failure so s/sx of heart failure should be monitored for: pulmonary edema due to L to R backflow, causing dyspnea and orthopnea. Fatigue due to decreased cardiac output. Atrial fibrillations/palpations due to enlargement of L atria.
222
Scleroderma
Collagen overproduction causing tightening/hardening of the skin and connective tissues. Progressive disease with no cure --management of complications is only option. Renal crisis is a possible complication causing malignant hypertension --life threatening
223
Desmopressin in DM
Increased risk of water intoxication and hyponatremia. Symptoms: headache, change in LOC, muscle weakness.
224
Expected labs in cirrhosis
Elevated: ammonia, bilirubin, PTT
Decreased: albumin and sodium
225
3500 calories =
1 lb gain/loss
226
Chest pain is always considered
cardiac until proven otherwise --trumps a suspected DVT in prioritization
227
Anemia of CKD treatment
erythropoietin
228
Considerations in administration of erythropoietin
BP must be checked prior to administration as an adverse effect of erythropoetin is hypertension. Uncontrolled HTN is a contraindication of administration. Also held if Hgb is greater than 11
229
How is erythropoetin administered
subcu or IV
230
Elevted AST/ALT indicates what and is caused by?
hepatic cell injury (hepatitis). Can be due to EtOH use, OTC meds like acetaminophen, herbal/dietary supplements, IV drug use (due to Hep B and C)
231
Priapism
Prolonged, painful erection. An emergency.
232
WBC normal range
4,500 - 11,000/mL
233
Side lying in pneumonia/lung patients
Side-lying on the GOOD side decreases hypoxia by increasing perfusion to the healthy lung, but does NOT increase secretion clearance.
234
Gastric pH measurement from NG tube purpose
confirms correct placement prior to feed
235
Von Willebrand disease
Genetic bleeding disorder that decreases coagulation due to inadequate von Willebrand factor. Must monitor for signs/symptoms of bleeding and avoid medications that exacerbate bleeding (aspirin, NSAIDs)
236
Bronchodilator respiratory medications
BAM
Beta2 agonists -terols
Anticholinergics -pium (decrease mucus production)
Methyxanthines -phylline (increase heart rate, expand lungs, like caffeine)
237
Anti-inflammatory respiratory medications
SLM
Steroids -sone must taper off!
Leukast, Leukotrine receptor agonists. Leukotrines stablized so bronchi and bronchioles relax. example Singulair -montelukast sodium (Luke likes to sing)
Mast cell stabilizers -stabilizes mast cells to reduce swelling. Example Cromolyn. Think "Mass of chrome"
238
Sodium polystyrene sulfonate
Kayexolate. Helpful for mild to moderate hyperkalemia. Has risk for intestinal necrosis, requires regular bowel function assessment.
239
Supraventricular tachycardia
Looks like a regular tachycardia but with narrow QRS and shortened PR interval and possibly hidden P --look for combined P and T with fast rate. If I have something tachy and can't distinguish P from T = SVT. Can be caused by stimulants or heart disease.
240
Diseases appropriate for droplet precautions
N. Meningitidis, Influenza B, Diptheria, Mumps, Rubella, Pertussis, Group A strep (strep throa), viral influenza
241
What precautions are taken for droplet precautions
Surgical mask and private room, gown, gloves, googles/face shield used if risk for splash/body fluid contact
242
Aceytlcysteine
Loosens/liquifies respiratory secretions in CF or other respiratory patients. Has no effect on smooth muscle and can cause/worsen bronchospasm = contraindicated in asthma patients
243
Significant increase in BP in pregnancy
Equal to or greater than 30 mmHg systolic or equal to or greater than 15 mmHg diastolic. even in the absense of HTN/symptoms, assess proteinuria, HA, RUQP.
244
Abdominal aortic aneurysm
Bulge in abdominal aorta due to increased pressure. Can manifest as a pulsative periumbilical mass. Risks: male, over 65, CAD, PVD, HTN, smoking hx, family history, Manifests as acute onset abdominal pain radiating to the back, drop in systolic pressure, increase in pulse, weak pulse, pallor. Life threatening emergency.
245
Thiazide diuretics and spironolactone
Spironolactone when combined with a thiazide diuretic prevents hypokalemia in pts with normal K levels
246
Anticholinergics
Benztropine, trihexyphenidyl, used to treat Parkinsons and other diseases but can cause urinary retention and can precipitate acute glaucoma and should not be used in patients with BPD or glaucoma.
247
Pyloric stenosis
Hypertrophy of pyloric muscle causes postprandial projectile vomiting due to obstruction at gastric outlet. Palpate olive shaped mass to the right of the umbilicus. Vomiting is non-bilious (whatever is eaten is vomited) and leads to progressive dehydration and results in hypokalemic metabolic alkalosis. Hemoconcentration due to dehydration results in elevated hematocrit and BUN.
248
Hydroclorothiazide can cause
Thiazides are potassium wasting diuretics, and can cause hypokalemia
249
Physiologic compensation for metabolic acidosis
Rapid breathing to blow off more CO2
250
Loction of injury, classic symptoms and intervention for neurogenic shock
T6 and higher thoracic and cervical injuries can result in neurogenic shock which presents as hypotension, bradycardia, pink dry skin due to massive vasodilation. Treat with isotonic solution to maintain perfusion to organs, especially kidneys.
251
signs of cardiac tamponade
Becks triad: low BP, especially large decrease in systolic pressure in short period of time, JVD, quiet heart sounds. Also narrowed pulse pressure, pulsus paradoxus, dyspnea, tachypnea, tachycardia.
252
Location of the phlebostatic axis
Level of atria at 4th ICS, 1/2 anterior-posterior diameter (midaxillary line)
253
Locations of heart sounds
Aortic --2nd intercostal space, pt's right sternal border
Pulmonic --2nd intercostal space, pt's left sternal border
Erb's point --3rd intercostal space, pt's left sternal border
Tricuspid --4th intercostal space, pt's left sternal border
Mitral --5th intercostal space, mid clavicular line --this is the APEX/place for APICAL pulse/point of maximal impulse (PMI)
254
How is elevated BNP is used
BNP >100 pg/ml is used to distinguish cardiac cause of dyspnea from respiratory causes
255
Tinea corporis and tinea capitis
Ring worm. highly contagious fungal infection
Corporis -- body
Capitis --scalp
256
Mnemonic for cranial nerve functions
```
I Some (sensory)
II Say (sensory)
III Marry (motor)
IV Money (motor)
V But (both)
VI My (motor)
VII Brother (both)
VIII Says (sensory)
IX Bad (both)
X Business (both)
XI Marry (motor)
XII Money (motor)
```
257
What precautions are appropriate for varicella zoster
N95 and gloves and gown, negative pressure room until lesions are dry and crusted (no longer contagious at that point)
258
ACE inhibitors side effects
dry unproductive cough. Cough stops with med discontinuation. Hypotension, tachycardia, angioedema, hyperkalemia.
259
NCLEX position on HIV positive mothers breastfeeding
they should not in developed countries where formula is available
260
Cephalosporin administration in pts with penicillin allergies
e.g. cephalexin. Can have a cross allergic reaction. If hx of anaphalaxis d/t penicillin, cephalosporin should not be administered. If reaction was rash or other mild reaction to penicillin, HCP may decide to administer cephalosporin anyway.
261
Maximum time a bottle of solution can be open and used before it needs to be discarded
24 hours
262
Decerebrate and decorticate position
Decerebrate --the more serious of the two. Arms and legs straight out and toes pointed down, head/neck arched back
Decorticate --bent arms, clenched fists, arms bent in toward body, legs out straight
263
DKA treatment parameters
NS fluid bolus. Rehydration with normal saline and IV insulin to bring down blood glucose. IV insulin is titrated down as the blood glucose returns to an acceptable range and may be discontinued when it is below 200 mg/dl. IV potassium will be administered even if normokalemic to prevent common complication of hypokalemia d/t insulin causing shift of K from intravascular to cellular space and resulting life threatening arrythmias that can result.
264
Risks for fat embolism
Long bone fracture --look for dypnea/confusion/decreased Sp02, petichiae on trunk
265
Calcium channel blockers ending and common side effects
-ipine --vasodilators so cause decrease in blood pressure and can result in dizziness, flushing, headache, peripheral edema, and constipation. Can initially cause orthostatic hypotension so pt teaching should include slow position changes.
266
Tetracyclines teaching
Take on an empty stomach, avoid iron supplements, dairy and antacids, take with a full glass of water and remain upright after taking to reduce chances of pill induced stomach upset (i.e. don't take at bedtime), can cause photosensitivity, and it decreases the effectiveness of oral contraceptives so another method must be used while taking.
267
Upward progressing abdominal pain
is a bad sign, warrants reporting to HCP
268
Parkland formula
4 ml x body weight in kg x percentage of body burned = 24 hours fluids. 50% is given in the first 8 hours and 50% over the next 16 hours so pay attention to the question wording.
269
Rule of 9s
```
9% head and neck
18% anterior torso
18% posterior torso (36% total trunk)
9% right arm
9% left arm
1% genitals
18% right leg
18% left leg
```
270
Hospice vs palliative care
Palliative focuses on quality of life and managemnet of symptoms. Can be given even with curative or life-extending treatment in the setting of a terminal diagnosis. Involves a multidisciplinary care team for the pt and family. Hospice is started when treatment is discontinued. Palliative is not limited to a specific time frame re: life expectancy.
271
Considerations re: treatment of syphilis in pregnancy
IV penicillin is the only acceptable treatment in pregnancy. If pt is allergic, penicillin desensitization must be anticipated.
272
Crepitus
Grating noise/sensation heard or palpated with movement due to bone and cartilage fragments in joint space
273
Kussmaul breathing
Compensatory respiratory pattern for metabolic acidosis --think "MAcKussmaul"
274
If pt on ventilator and respiratory alkalosis what does that mean?
Respirator ventilation is set too high and they are being over-ventilated
275
If pt on ventilator and respiratory acidosis what does that mean?
Respirator ventilation is set too low and they are being under-ventilated
276
Calcium channel blockers are like
valium for the heart --calms things down. Good for tachycardia, tachy-arrhythmia,
277
Anything called "neg x-otrophic" =
Cardiac depressants. Calm the heart down. For the A, AA, and AAA: Antihypertensive, antianginal, anti-atrial arrythmias
278
Anything called "pos x-otrophic"
Cardiac stimulants
279
-dipine ending
Calcium channel blocker --"dipping in the calcium channel"
280
What must be measured/what parameters considered prior to Ca Channel blocker?
Measure BP, hold if systolic lower than 100. Cardizem can be given continuous IV drip and must be titrated to keep systolic BP above 100 so BP must be taken regularly.
281
Periodic wide QRS =
PVCs
Look like a normal rhythm then a sudden wide QRS complex without a P.
Unifocal --look the same (from a single ectopic source)
Multifocal --look different (from multiple ectopic sources)
282
Collection of PVCs =
short run of V-tach
283
PVCs are a low priority except when
more than 6/min or more than 6 in a row or it PVC calls on T before (R on T), then MODERATE priority. NEVER high priority. PVCs AFTER an MI is GOOD.
284
Ventricular arrythmia meds
(old) = lidocaine. Think V = L.
| (new) = amniodarone. Think V = A
285
Atrial arryhtmia meds
ABCDs (Adena-Beta-Calca-Dig)
A -Adenocard/adenosine (FAST push of 1-2 seconds followed by 20 mL saline flush)
B -Beta blockers (lols) --neg x-otrophics. SE: hypotension and headahce
C -Calcium channel blockers
D -digitalis/digoxin/lanoxin
286
V-Fib treatment
D-fib
287
Asystole treatment
Epinephrine then atropine (think AsystolE, reversed)
288
Chest tube placements
High = air (apical)
Low = blood (basilar)
Assume chest surgery or trauma is UNILATERAL unless otherwise specified
289
If something compromises chest tube, what are appropriate steps
Clamp, cut if necessary, place in sterile water, unclamp. NEVER clamp for longer than 15 seconds without an order.
290
Bubbling in water seal appropriate/inappropriate
```
Intermittent = good (document)
Continuous = bad (leak --needs tape)
```
291
Bubbling in suction control appropriate/inappropriate
```
Intermittent = bad (suction too low, increase it)
Continuous = good (document)
```
292
Congenital heart defects
All are TRouBLe or no trouble
T -all defects starting in T = trouble
RL --right to left = trouble
B --blue = cyanotic
293
4 defects of tetrology of fallot
VarieD PictureS Of A RancH
or
Valentines Day Pick Someone Out A Red Heart
Vendricular Defect
Pulmonary Stenosis
Overriding Aorta
Right Hypertrophy
294
Contact precautions
Anything enteric (fecal oral) plus RSV (which is actually droplet but contact), Staph, Herpes (including shingles)
295
Airborne precautions
MMR, TB (droplet but airborne), VZ
296
PPE order putting on
Gown
Mask
Googles
Gloves
297
PPE order taking off
Gloves
Goggles
Gown
Mask
298
Drop factor formula
V x drop factor divided by time in minutes
Micro = 60 drops
Macro = 10 drops
299
What acid base imbalance results from prolonged gastric issues (vomiting/suctioning)
Metabolic alkalosis because their acid is being depleted. But once they are dehydrated think acidosis.
300
What does the protein pad on a urine dipstick measure?
Albumin in urine
301
What is the first protein typically seen in kidney dysfunction?
Albumin
302
B6 deficiency can cause
often due to medication interactions --peripheral neuropathy such as ataxia and paresthesia (numbness, burning sesnation, tingling hands/feet)
303
What is murphy's sign
Right upper quadrant pain referring to right shoulder/scapula due to cholecystitis or cholestasis
304
What is cholecystits?
inflammation of the mucus lining and wall of gallbladder, can be due to bacterial colonization or irritation. Often experienced after eating fatty foods, low grade feer, chills, N/V/anorexia.
305
What is cholestasis?
decrease in bile flow due to obstruction or decrease in secretion
306
Functions of the parietal lobe, when impaired what is affected?
Somatic/sensory input
| when impaired, sensation deficit
307
Functions of the frontal lobe, when impaired what is affected?
Higher order processing, executive function, personality
| When impaired, behavioral change
308
Functions of the temporal lobe, when impaired what is affected?
Visual/auditory, past experiences
| When impaired, cannot understand verbal/written language
309
Functions of the occipital lobe, when impaired what is affected?
Visual images
| When impaired, visual deficit
310
When are back blows and chest thrusts appropriate vcs abdominal thrusts?
Back blows and chest thrusts for children under 1
| Abdominal thrusts for children and people over 1
311
Isotretinoin
also known as accutane. Derived from Vitamin A, The patient should not take additional vitamin A, donate blood, take with tetracycline, and must use 2 forms of birth control
312
What is important re: timing of narcotics administration in labor?
Give at peak of contraction
313
Amyotrophic Lateral Sclerosis
Aka ALS --Lou Gherig's Disease. A neurodegenerative disease without a cure. Progressive degeneration of motor neurons in brain and spinal cord. Results in progressive muscle weakness and difficulty swallowing, speaking. Eventually leads to respiratory failure. Life expectancy 3-5 years.
314
Systemic Lupus
Autoimmune disease, inflammation. Expect elevated creatinine, BUN, abnormal UA due to lupus nephritis
315
Elevated ereythrocyte sedimentation rate
>30 mm/hr = active inflammatory process, expected in inflammatory diseases
316
Positive antinuclear antibody titer
>1:40 = body is producing antibodies against its own DNA/nuclear materal. Expected in autoimmune diseases.
317
Acute pericarditis expected signs/symptoms and what to monitor for
Monitor for cardiac tamponade signs (JVD, distant heart sounds, hypotension. Expected: ST elevation, friction rub, pain on inspriation
318
What residual value may indicate urine retention
>100 mL
319
What is Reye syndrome
Follows a recent viral infection, esp. varicella zoster or influenza. Causes acute encephalophy and hepatic dysfucntion --Fever, lethargy, increased serum ammonia, vomiting, change in LOC, seizures, coma. Increased risk for Reye syndrome if aspirin used in management of tx for virus, esp in Kawasaki's patients.
320
How do you estimate Hct or Hgb from a single value
Hgb is roughly 1/3 of Hct.
321
What is the key teaching around Antabuse/Revia/Disulfiram
it is aversion therapy for EtoH treatmnet. Takes 2 weeks before it is effective and takes 2 weeks to leave the system. Must avoid ANYTHING containing ANY alcohol: mouthwash/aftershave/perfume/insect repellant/anything that is called an exlixir/vanilla extract/some cake frostings etc.
322
For expected withdrawal symptoms, what is considered?
For uppers, expect all down symptoms
| For downers, expect all up symptoms
323
For overdose symptoms, what is considered?
For uppers, looks like downer W/D (eg. seizure)
| For downers, looks like upper D/F (e.g. respiratory arrest)
324
EToH W/D vs DTs
All alcoholics experience withdrawal after 24 hours abstinence, not life threatening.
Delirium Tremens can (not for all) set in at 72 hours of abstinence, and it is life threatening.
325
aminoglycosides
"A mean old mycin" an antibiotic used only when nothing else is working. For gram negative, resistant, life-threatening infections. Not all mycin are aminoglycosides --anything called -thromycin are not mycins. Nephrotoxic and ototoxic so must monitor creatinine and BUN though 24 hour creatinine clearance is best. Think mouse ears (kidneys and ears grown on mice). Given IM or IV except for when bowel needs to be sterilized --neomycin and kanmycin. Who can sterilize my bowel? Neo Kan! Also used in hepatic encephalopathy PO, because it kills e. Coli, which decreases serum ammonia level.
326
When to draw trough
30 minutes before administration
327
Peak of medications by route
sublingual 5-10 minutes after dissolved
IV 15-30 minutes after administration is finished
IM 30-60 minutes after administration
subcutaenous --only consider for insulin, varies)
PO --too variable to generalize
328
Crutch gaits
2 point -move crutch and opposite foot simultaneously
3 point -move 2 crutches and bad leg
4 point -everything moves separately: crutch, opposite foot, opposite crutch, opposite foot.
Swing through -non weight bearing: plant crutches, swing bad leg and good leg through, plant good leg.
Think: even for even, odd for odd --when weakness is evenly distributed 2 for mild weakness and 4 for severe. Odd = 1 leg is affected = #3. Non weight bearing = swing through.
329
Where is a cane held in relation to weakness?
Cane is held on the STRONG side of the body
330
Proper use of walker
Pick up, set down away, walk to. Repeat. Tie belongings to side NOT front.
331
What does the Allens test determine
Prior to ABG, determines patentcy of ulnar artery
332
Normal albumin
```
3.5 - 5.0
if low (cirrhosis) expect fluid overload, edema, acites, weight gain
```
333
Normal BNP (B-type Natriuretic Peptide)
<100
334
What is a "harsh" systolic murmur a sign of
Ventricular septal defect
335
What is a diastolic murmur a sign of
Mitral stenosis or aortic regurgitation
336
What is a "machine-like" murmur a sign of
if heard on systole and diastole, and if pt is acyanotic, it is a sign of an open ductus arteriosis shunting blood from aorta to pulmonary arteries
337
What are adventitious breath sounds
Abnormal sounds heard over lungs and airways (i.e. crackles, wheezes, rubs, stridor)
338
What is ptosis
Drooping of eyelid
339
What is pediculosis capitus
Head lice
340
Are NG tube feeds or TPN preferable? Why?
NG preferable to TPN because maintains gut bacteria and mucosa integrity and helps prevent stress ulcers
341
NPH insulin should never be administered by
IV push. Only regular insulin can be administered by IV push.
342
Priority treatment in elevated K
D5 and regular insulin IV as temporary fix to push K into cells, kayexolate as longer term solution to remove K from body. Typically 50 mL D6 and 10 units insulin then kayexolate PO or PR. If ECG shows changes due to hyperkalemia, give calcium gluconate to stablize cardiac muscle first.
343
Test for rH sensitization of pregnant person
Indirect Coombs Test
344
Serum Alpha-Fetoprotein
screens for neural tube defects
345
Parvoviruus B-19
Fifth disease, aka Slap cheek d/t human parvovirus. A viral illness affecting mainly school age children, distinctive red rash across cheeks, spreads to extremeties. May also accompany malaise, joint pain. NSAIDs okay for treatment. 7-10 day recovery. Key: infections only BEFORE symptoms appear. Avoid pregnant people (do not allow pregnant nurses to care for these pts) because it is a TORCH infection
346
Tx for epistaxis
Lean head forward, upright, apply continuous pressure to nose 5-15 minutes, cold pack on bridge of nose, keep child calm.
347
NPH is usually administered
in morning and evening --2 x per day due to long duration of action
348
Oral care and suctioning of ET vented pt
Every 2 hours to prevent ventiliator associated pneumonia
349
Carbidopa-levodopa
Medication used to elevate dopamine in parkinsons patients and reduce physical symptoms. Teach fall precaustions d/t orthostatic hypotension, takes several weeks for effect, can cause harmless discoloration of saliva, sweat, urine (red, brown, black). Avoid high protein diet.
350
Myelomeningocele
Neural tube defect causing outpouching of spinal cord, nerves, fluid, covered by a thin membrane, usually in lumbar area. Cover with sterile moist dressing to protect until surgery is possible, place baby in prone position with head turned to side.
351
Pulsus paradoxis
Exaggerated fall in systolic blood pressure >10 mm Hg during inspiration
352
how to calculate MAP
Take diastolic blood pressure, multiply it by 2, add the systolid blood pressure, and divide the result by 3.
353
Signs of cardiac tamponade
Decrease in cardiac output, hypotension, tachypnea, tachycardia, JVD, narrowed pulse pressure, pulsus paradoxus.
354
Contradindications for cardiac catheterization
If pt has prior dye injection reaction, additional meds may be needed to prevent. Dye is excreted through kidneys so creatinine level needs to be assessed, if elevated may be contraindicated. Metformin taken in the last 24-48 hours can cause lactic acidosis.
355
Tonsilectomy post op care
monitor for signs of bleeding: frequent swallowing, throat clearing, vomiting bright red blood. Do NOT use straws. Do NOT suction. Expect: ear pain, low grade fever, superficial infection causing halitosis usually self limiting 5-10 days.
356
Hip replacement significant risk/priority assessment
Excessive bleeding --assess blood loss first.
357
Holosystolic murmur
heard throughout systole at left lower sternal border = sign of VSD
358
Single transverse palmar crease
sign of trisomy 21
359
Pursed lip breathing
inhale through nose 2 seconds, exhale through pursed lips 4 seconds. Helps decrease shortness of breath, prevent airway collapse, blow off CO2, reduce air trapped in alveoli to reduce work of breathing for COPD patients
360
Pacemaker precautions
Avoid MRI, don't place cell phone over, tell airport security, walk straight through theft detection devices in stores, don't linger. Take pulse daily, report fever/redness/swelling/draining, do not lift arm above shoulder until HCP approves.
361
Erectile dysfunction drug contraindication
if pt is taking any nitrates
362
Glargine should never be
mixed with any other type of insulin. it can be given concurrently, but only as a separate injection
363
Proton pump inibitors
-prazoles decrease calcium absorbtion = increased risk of osteoperosis and increased risk of c. diff due to supporession of acid in upper GI, and increased risk of pneumonia. Take additional calcium and Vit D.
364
Insulin expiration dates
Only good when vial is unopened. Once open, only good for 30 days. Must label date opened, and new date of expiration. Should *probably* refridgerate unopened insulin, no need to refrigerate open insulin. Must teach pts to refridgerate insulin though.
365
Hypoglycemia in DM is almost always due to
over medication. Looks like drunk + shock
366
Tx for hypoglycemia
Rapid metabolized carb plus starch or protein. Soda plus crackers, skim milk, soda and a slice of turkey.
At home, unresponsive, give glucagon IM. in ER D10 or D50 (not D5)
367
DKA
Most common cause: SUDDEN, acute viral upper respiratory infection in the past 2 weeks in younger insulin-dependent people. Dehydrated. Three Ks: ketones in blood confirms dx. Kussmal breathing. High K. Three A: Acidosis (MacKussmal). Acid breath (fruity). Anorexia due to nausea. Tx: fast 200 mL/hour NS, regular insulin in bag, monitor K.
368
HHNK
Hyperglycemic, hyperosmolar non-ketotic crisis: dehydration in non-insulin-dependent (T2DM) older people due to illness or infection. Blood glucose much higher than in DKA. More gradual onset than DKA. No ketones, no kussmal breathing --Normal blood pH (no metabolic acidosis) Mental status changes d/t dehydration/hyperosmolar state. Tx is the same as DKA --Normal saline, plus regular insulin in the bag, and monitor K.
369
HbA1c levels
6 and lower in control
7 to 7.9 need more eval
8 and higher out of control
370
Toxic range of lithium
toxic at 2 and above
371
Digoxin therapeuti range and toxic range
therapeutic 1-2,
| toxic 2 and greater
372
Aminophylline therapeutic range and toxic range
therapeutic 10-20
| toxic 20 and higher
373
Bilirubin newborn normal levels, elevated levels
normal less than 10
elevated 10-20
14-15 needs hospitalization
374
Dilantin/Phenytoin therapeutic, toxic ranges
Therapeutic 10-20
| Toxic 20 or higher
375
Kernicterus
bilirubin in the brain
376
Opisthotonus
the position a baby assumes (hyperextension) when kernicteric --position baby on their side
377
Physiologic jaundice vs pathologic jaundice
Physiologic develops a few days after birth due to breakdown of maternal RBCs. Pathologic appears at birth or within 24 hours.
378
Hypothyroidsim
Think metabolism. Hypo = everything is metabolically DOWN --slow metabolism = obese, low energy, flat affect, low pulse, low blood pressure, slow, myxedema --severely advanced hypothyroidism. Cold all the time, so heat tolerant and cold intolerant. HASHIMOTOS
Tx: thyroid hormone. Do not sedate them, never hold thyroid meds without clarifying order
379
Hyperthryroidism
Think metabolism. Hyper = everything is metabolically UP. Fast metabolism = skinny. High anxiety, high energy, fast pulse, high BP, bulging eyes (exopthalamos). GRAVES DISEASE. Run yourself into the grave.
Tx:
1. radioactive iodine --pt must be by themselves for 24 hours no visitation, flush toilet a LOT, hazmat team if urine spills.
2. Propylthyouricil (puts thyroid under) --cancer drug causes immunosuppression so watch WBC count.
3. Thyroidectomy --removal of all or part of thyroid but need thyroid replacement for life if total, and subtotal have risk for thyroid storm.
380
Post op considerations for thyroidectomy
First 12 hours airway, then hemorrhage
After 12 hours and less than 48 hours tetany is major risk for total thyroidectomy. For subtotal thyroidectomy major risk is thyroid storm.
After 48 hours, infection is biggest risk
381
Thyroid storm s/sx, tx
```
Super high temp
Super high BP
Severe tachycardia
Psychotic delirium
Tx: get temp down, get oxygen up. Put ice packs and or cooling blankets, oxygen at 10L. it is a self limiting condition, no meds given, just attempting to spare the brain until it corrects. Requires 2 nurses to manage.
```
382
Addison's Disease
UNDER secretion of adrenal cortex.
S/sx: hyperpigmentation (look tan in skin folds, buccal area, palmar creases) and or vitiligo, weight loss, muscle weakness, low BP, hypoglycemia. These pts do not adapt to stress. Normal stress response raises glucose and blood pressure to support brain. So without that support, in stress, person goes into shock.
Give steroids to treat.
ADD a SONE
383
Cushing's Disease
OVER secretion of adrenal cortex. Cushy bank account = extra
S/sx: (memorization of this gives you all signs of bushings and all side effects of steroid meds)
Draw a little man: Cush man
Moon face
Beard —hirsutism
Bump on front and bump on back
truncal obesity
Bump on the front —gynecomastia —female type breasts on men
Bump on the back —buffalo hump
Skinny arms and skinny legs d/t muscle atrophy
Water and sodium retention, potassium loss
Striae
HIGH GLUOSE —most important hyperglycemia like a diabetic
Extremely easy to bruise
Speech bubble: “I am mad, I have an infection”—grouchy/irritable, and immunosuppressed
384
Cervical laminectomy
Check diaphragm and arm movement. Risk of pneumonia and arm weakness.
385
Thoracic laminectomy
Check cough and bowels. Risk of pneumonia and ileus. Anterior thoracic laminectomy will have chest tubes
386
Lumbar laminectomy
Check bladder and leg function. Risk of urinary retention and leg weakness
387
How to move laminectomy patients
Log roll, do not dangle, no sitting longer than 30 minutes, may walk/stand/lie down without restriction
388
Relationship to pH and patient status
Where the pH goes, so goes my paitent. If pH is going down, assess vitals. pH in 6s is emergent, death imminent. Dr must come to treat underlying cause.
389
Hemoglobin normal range
12-18 to cover all humans
8-11 assess for anemia, bleeding, malnutrition
Below 8 assess for bleeding, prep for transfusion, call provider
390
CO2 normal range
35-45
46-59 assess respirations, prepare for pursed lip breathing to blow off excess
Over 60 is emergent, respiratory failure. Assess respirations, prepare for intubation/ventilation, call RT and provider.
391
Hematocrit normal range
36-54 (3 x Hgb)
| Over 54 assess dehydration
392
PO2 normal range
78 -100
Low 70s assess respirations, prepare supplemental O2
60s and lower =emergent, assess respirations, give O2, prepare for intubation/ventilation, call RT and provider.
In hypoxia, HR speeds up FIRST, then RR goes up --treat episodic tachycardia with oxygen and IV fluids
393
When does a pt need to be intubated and ventilated
when Co2 in the 60s and PO2 in the 60s
394
O2 sat range
normal 93-100%
| less than 93% is of concern, assess, give O2
395
what invalidates SpO2
Anemia makes the SpO2 look much higher than they are. Dye procedure in the last 48 hours also affects reading and falsely elevates reading.
396
Na normal range
135-145
If high, assess for dehydration
If low, assess for fluid volume overload
If sodium is abonormal AND change in LOC, a safety issue for the patient.
397
Total WBC normal range
Total 5,000 - 11,00
398
ANC normal range
Above 500
399
CD4 normal range
Above 200
| Below 200 --AIDS
400
Trigger values for thrombocytopenic precautions
Below 90,000 place on bleeding precautions
| Below 40,000 emergent
401
RBCs
4-6 million
402
The 5 critical lab values
pH in 6s
K in the 6s
Co2 in the 60s
O2 in the 60s
platelets of less than 40,000
403
During hot weather, exercise and illness, what is important for CF patients?
Increased salt. Due to CF's decreased Na and Cl absorption, increased risk of dehydration and hyponatremia.
404
Serious potential complication of statins
Rhabdomyolysis -muscle breakdown and kidney damage. S/sx muscle aches and weakness.
405
Limit blood draw attempts to
2 x before calling in someone else
406
Metabolic syndrome
AKA insulin resistance. Increased risk of DM and CAD. Increased waist circumference (35 or greater for women, 40 or greater for men), increased BP (130 or greater systolic, 85 or greater diastolic), increased triglycerides, (greater than 150), LOW HDL (less than 40 men, less than 50 women), increased fasting blood glucose, "We Better Think High Glucose"
407
Normal LDL
Less than 100
408
Normal HDL
Greater than 40 men, greater than 50 women
409
Single most modifiable risk factor for stroke
hypertension
410
Spleen size and sickle cell anemia
Regular small splenic infarctions due to sickle cells = a small spleen in most sickle cell patients = autosplenectomy
411
Splenic sequestration crisis
Trapped sickle cells in spleen cause enlargement = emergency due to risk of hypovolemic shock
412
Myxedema coma
Severe hypothyroidal state that can progress to coma. Everything is DOWN except possibly hypertension (can also by hypotensive). Need emergent endotracheal intubation and mechanical ventilation if signs of respiratory failure.
413
-pril
Ace inhibitors avoid in pregnant people and people planning to become pregnant due to teratrogenic properties
414
-sartan
Angiotensin II Receptor Blockers (ARBs) avoid in pregnant people and people planning to become pregnant due to teratrogenic properties
415
Nclex position on EToH in pregnancy
there is NO safe amount of alcohol
416
Pruritis
itching
417
ICP patient appropriate solution
HYPERtonic
418
Earliest sign of aspirin toxicity
tinnitus
419
Carbon monoxide poisioning
Pulse ox will be falsely normal. HA, dizziness, fatigue, nausea, dyspnea. Draw serum carboxyhemoglobin = normal is less than 5% for nonsmokers, less than 10% for smokers. Need to give 100% O2.
420
Mydriasis
Pupil dilation
421
Nasopharyngeal airway
Maintains upper airway patency in alert or semiconscious patients. NEVER insert a nasophayngeal airway in a patient with confirmed or suspected head trauma.
422
DVT treatment with heparin and warfarin
Will be used concurrently until INR reaches therapeutic level. Antithrombotics do not break up blood clots but prevent worsening. Antithrombolytics break up blood clots. Typical overlap of warfarin and heparin in 5 days or until therapeutic INR is reached. Warfarin BEGINS to take effect 48-72 hours after beginning treatment.
423
Flu vaccines live vs inactivated
Inactivated are given IM or ID injection. Live attenuated are given nasally. Live is considered safe for ages 2 = 49 unless immunocompromised or pregnant. People outside these parameters should receive inactivated form. No flu shots of any kind for babies under 6 months of age.
424
Refeeding syndrome
Potentiall lethal complication of nutritional replenishment in malnourished. Can happen with oral, enteral and parenteral feeding. Due to stimulation of insulin and shift in electrolytes. Key signs: decreased phosphorous, decreased K and OR decreased magnesium. May also have fluid volume overload, increased Na, hyperglycemia, and thiamine deficiency.
425
Phosphorous normal range
2.4 - 4.4
426
Location for auscultation for bruit over abdominal aorta
Above umbilicus slightly left of midline
427
If ace inhibitor cannot be tolerated, what is recommended
Angiotensin II Receptor Blocker (ARB)
428
Tiotropium vs lpratropium
Tiotropium is a long acting anticholinergic for COPD. Inhaled capsule via handihaler --looks like an oral capsule but SHOULD NOT be taken orally. Peak effect is 1 week --not a rescue med. Not a bronchodilator --relaxes airway, does not reduce inflammaton, dries airway secretions.
Ipratropium is a SHORT acting anticholinergic and IS a rescue med for COPD and asthma
429
Beta blocker side effects
Bradycardia, bronchospasm, hypotension, depression, impotence.
430
Sulfonylureas side effects
Hypoglycemia, do not combine with ETOH
431
Hypoglycemia
Think drunk + shock: diaphoresis, headache, hunger, tachycardia, confusion
432
Thyroid replacement drug (levothyroxine) side effects
Symptoms like hyperthyroidism: diarrhea, weight loss, palpitations, tachycardia, sweating, heat intolerance
433
Pill induced esophagitis
Take meds with at least 4 oz water and remain upright for 30 minutes or more after taking. Take with or immediately after meals. Upright, water, meals reduces gastric upset, risk of lodging in esophagus or refluxing from stomach. Important teaching for oral potassium, tetracyclines and bisphosphonates ("dronates")
434
1 oz = mL
30 mL
435
Dysphasia related to thoracic aortic aneurysm
Difficulty swallowing with known thoracic aortic aneurysm can indicate aneurysm growth = needs evaluation ASAP
436
Nurse only responsibilities
Assess, diagnose, plan, evaluate, teach ADPET
437
UAP can or cannot take capillary blood glucose?
They CAN
438
Sighted guide technique
If pt is legally blind, can assist them in ambulation by walking slightly ahead and having them rest their hand on your helbow,
439
Suctioning protocol
Preoxygenate with 100% O2
Catheter should be no more than 1/2 width of artificial airway
Insert catheter without suction
Cough is expected from patient.
Insert catheter until resistance is felt, retract catheter 1 cm and then apply suction
Suction pressure should be medium (100 -120 mmHg for adults, 50-75 mmHg for children)
Suction no more than 10 seconds in a pass.
Encourage deep rebreathing
Wait 1-2 minutes before applying suction again
440
Serum ammonia normal range
15-45
| If high, expect hepatic encephalopathy: confusion, lethargy, asterixis, coma
441
Normal PT
11-16 seconds
| If prolonged, expect bruising, bleeding
442
Normal PTT
25-35 seconds
443
Normal adult bilirubin
0.2-1.2
| If elevated expect jaundice, slceral icterus (yellow eyes), itching
444
"grel" or "grelor" drugs
Antiplatelets
445
"xaban"
anticoagulants
446
Expectorants
Guiafenesin (Gough-fena-zin)
Guiaf rhymes with COUGH.
Used in non-productive cough associated with respiratory infection. Reduces viscosity of secretions and helps make cough productive.
SE: GI upset, dizziness. Pt should take with full glass of water.
447
Mucolytics
Acetylcysteine
For pulmonary disorders with thick secretions like CF. Also an ANTIDOTE for ACETAMINOPHEN overdose.
Action: breaks down molecules in mucus to reduce viscosity.
SE: bronchospasm. Use cautious with asthma patients. N/V and rash. And smells like rotten eggs. “Starts with A, smells like A”
448
Decongestants
Pseudoephedrine, phenylephrine
“I am phed-up with my congestion.” Used for rhinitis (nasal congestion). Causes vasoconstriction of respiratory tract mucosa.
SE: nervousness, palpitations, weakness, insomnia, possible rebound congestion.
Pseudoephedrine is a key ingredient in meth so it is kept behind the counter.
Phenylephrine is usually in OTC cold meds that you can find on the shelf.
449
Antihistamines
1st gen: diphenhydramine
2nd gen: loratadine, cetirizine
For allergy symptoms :runny nose, itchy/watery eyes, sneezing. Also used for Motion sickness and urticaria —hives.
Block H1 receptors which reduces effect of histamine in body.
1st gen side effects are more severe: sedation, anticholinergic, photosensitivity
Remember anticholinergic SE: can’t pee, can’t see, can't spit, can’t shit.
450
Corticosteroids (respiratory)
For respiratory —locally acting. Either inhalers or intranasal.
Beclomethasone, mometasone, budesonide, fluticasone. Use for asthma, rhinitis. Decrease inflammation locally.
SE (less than systemic steroid): HA, pharyngitis (sore throat), fungal infection. Pt must rinse mouth out to prevent fungal infection.
Bronchodilator with steroid: bronchodilator administered first, wait 5 min, then corticosteroid.
451
Leukotriene receptor antagonist
Montelukast, zafirlukast
Used in asthma and exercise induced bronchoconstriction. Decrease effect of leukotrienes which reduces airway inflammation and bronchoconstriction
SE: HA, and in zafirlukast may cause increase in liver enzymes. Montelukast should be taken in PM, or 2 hours before exercise.
Zafirlukast should be taken on empty stomach.
452
Antitussives
Benzonatate, codeine, dextromethrophan
Think A: BCD
Benzonatate: has anesthetic effect on vagal nerve receptors in airway. SE: sedation, constipation, GI upset.
Codeine binds of opioid receptors in CNS and decreases cough reflex. SE: sedation, respiratory depression, hypotension, constipation, GI upset.
Dextromethorphan: suppresses cough reflex in medulla. SE: dizziness and sedation at high doses.
453
Bronchodilators
Beta2 Adrenergic Agonists: Albuterol and salmeterol
Used in asthma, COPD, alone or in combination with glucocorticoid or anticholinergics like iprotropium. Bind to beta2 receptors in the lungs (2 lungs) and result in bronchodilation, opening airways.
SE: nervousness, tremor, chest pain, palpitations.
Albuterol —short acting beta2 adrenertic agonists so used in acute asthma attacks
Albuterol in Acute!
Salmeterol —long acting, used in prevention of asthma attacks. Salmon = long life. Salmeterol = long acting.
If using with glucocorticoid, use B2AA, wait 5 min, then use steroid. B before G.
454
Xanthines
Theophylline
Long term control of asthma and COPD.
Increases C-amp, which increases bronchodilation.
SE: HA, GI upset, nervousness, dysrthymias, seizure. Not used as much due to SE. Need regular blood draws to monitor levels. Therapeutic 10-20
455
Anticholinergics
Inhaled or nasal
Ipratropium
Used in COPD, rhinitis, asthma (asthma is off label). Used alone or with albuterol, (Duaneb). Relaxes smooth muscle, and has drying effects not a bronchodilator.
SE: dry mouth, bitter taste, throat irritation depending on how administered. Increase fluids, suck on candy.
Dua-neb —do not use if peanut allergy.
456
Meds for HTN
Alpha2 Agonists
Beta1 and non selective beta blockers
Ca Channel blockers
457
Calcium channel blockers
```
Treat HTN and angina
Verapamil
Nifedipine —also treats preterm labor
Diltiazem
Remember “Very Nice Drugs"
```
Mode of action:
Block calcium channels in heart and blood vessels which causes vasodilation and decrease in HR
SE: peripheral edema, hypotension, bradycardia, headache, constipation
Important teaching: don’t take grapefruit juice, monitor BP and HR.
458
Central acting alpha2 agonist
Clonadine
Decreases sympathetic outflow to heart and blood vessels, decreases heart rate and blood pressure.
Three D’s of clonaDINE —dizziness, drowsiness, dry mouth
Teach: suck hard candy, chew gum for dry mouth
459
Beta1 Blockers
HTN, angina, heart failure, myocardial infarction
Metoprolol and atenolol
"Only have 1 M.A.”
"1 heart”: Beta1 receptors are blocked and decrease blood pressure and HR
Bradycardia, hypotension, fatigue, erectile dysfunction. Also: BLACK BOX: abrupt cessation can cause angina and MI.
Teach: orthostatic hypotension get up slowly, monitor HR and BP, can mask signs of hypoglycemia
460
Nonselective beta blockers
Affect BOTH (nonselective) Beta1 receptors in heart and Beta2 receptors in the lungs (1 heart, 2 lungs)
Propanolol, labetalol, carvedilol
“Please Listen Carefully”
Treat HTN, angina, arrhythmia, MI
Decrease HP and HR, but can cause bronchospasm due to Beta2 effect —never give to someone with asthma or issues that would be exacerbated by broncho-constriction
Fatigue, hypotension, bradycardia, ED.
461
Renin angiotensin aldosterone system
Renin is relased by the kidneys in response to reduced renal blood flow (low blood pressure). The reinin activates angiotensinogen to turn into angiotensin1 and angiotensin converting enzyme (ACE) converts angiotensin1 into angiotensin2. Angiotensin2 causes vasoconstriction of blood vessels, water and sodium re-absorption at the kidnets and signals release of aldosterone at adrenal cortex which ALSO causes re-absorption of water and sodium at kidneys.
462
Direct renin inhibitor
Aliskiren
treats HTN
Inhibits renin, prevents angiotensinogen to be activated into angiotensin1. "Alice and Karin gang up on Angie”
SE: hypotension, angioedema, and GI upset. BLACK BOX: fetal toxicity
Monitor BP
463
ACE inhibitors
—all end in -pril
When you draw an ACE you get a thrill (prill)
Block conversion of angiotensin1 to angiotensin2. Used in HTN, heart failure, myocardial infarction, diabetic nephropathy .
SE: hypotension, angioedema, dry cough, hyperkalemia. Monitor serum creatinine to adjust dose if renal impairment. Think ACE: Angioedema/Cough/Elevated potassium
Also must alter dose in renal impairment --monitor serum creatinine.
BLACK BOX: teratogen,
orthostatic hypotension change positions slowly, monitor BP.
464
Angiotensin2 Receptor Blockers
ARBs —sartans
Blood pressure drop, stomach hurt, dizziness. Treats HTN, diabetic nephropathy
Blocks effects of Angiotensin2 which causes vasodilation.
SE: hypotension, dizziness, GI upset. Black box: fetal toxicity. Orthostatic hypotension, monitor BP.
465
Aldosterone Antagonist
Eplerenone
Used in HTN and HF after MI
Blocks mineralocorticoid receptors which inhibits effects of aldosterone and causes reabsorbptio of sodium and water
Eplerenone —does an EPic job of blocking aldosterONE
SE: HYPERKALEMIA, dizziness. Monitor K levels and BP.
466
Toddler weight gain
Slows in toddler years to 4-6 lbs per year. by Age 2.5 should be roughly 4 x birth weight.
467
Tinea corpus
Ring worm --a fungus, not a worm. Tx preferred is lamisil
468
Holder monitor
Monitors heart for 24 hours. Wear continuously, normal activities, no shower. Keep diary of symptoms and activities.
469
Power of attorney
trumps spouse/next of kin (if not spouse/next of kin) in end of life decisions
470
PPV can cause hypotension by
increase in intrathoracic load and reduced venous return and reduced cardiac output
471
Don't store nitroglycerine
in the car or other places that can have wild temp shifts
472
Clozapine potential complications
Agranulocytosis. Important that WBC at or above 3500 and ANC at or above 2000 before starting medication, CBC and ANC must be monitored regularly. Can also cause prolonged QT and orthostatic hypotension so periodic ECG and BP monitoring is also indicated.
473
Reduction of aspiration risk for ICU pts on ventilators
Continuous feeds rather than bolus feeds, regular assessment (at least q4) of gastric residual volume, regular assessment of feeding tube length, using minimal possible sedation
474
Glyburide
Stimulates insulin response via pancreas for T2DM, risk of prolonged hypoglycemia --should not be used in geriatric patients per Beers Criteria
475
Site of immunizations for children under 7 months
Vastus lateralis (top of thigh)
476
Niacin side effet
Cutaneous vessel dilation = warm sensation/flushing, will abate, harmless, will reduce with continued use
477
Antitubercular drug monitoring
Optic neuritis is a possible adverse effect. May be reversible. Requires periodic examinations and pt should report decreased visual acuity and loss of red green distinction
478
"ripping" moving back pain
Aortic dissection = emergency. hypertension #1 contributing factor
479
Norepinepherine antidote
phentolamine.
480
Norepinepherine administration route
Central line preferred due to risk of skin and tissue break down if extravates, but can be run IV at reduced rate until central line established
481
Extravasation
infiltration of drug into tissues surrounding vein. Pain, blanching, swelling, redness
482
Normal troponins
Troponin I <0.5
| Troponin T <0.1
483
Hyperresonance
Percussed over a hyperinflated lung or air in pleural space (pneumothorax)
484
Filgrastim
Stimulates neutrophil production
485
Postop pneumonia prevention
Ambulate ASAP (within 8 hours, ideal), cough with splinting hourly, ICS and deep breathing hourly, fowlers position (45-60 degree HOB), adequate pain control, chlorhexidine mouth wash/swab
486
Relationship between HOB and BP
HOB up BP down. HOB down, BP up
487
Herbs that increase bleeding risk
Garlic, ginger, gingko, saw palmetto
488
Signs of neurologic emergency
Headache, gait distrubance, memory loss, change in level of consciousness.
489
Meniere disease
Endolymphatic hydrops --excess fluid in inner ear leading to episodes of vertigo, tinnitus, hearing loss, aural fullness. Nausea, vomiting, feeling of being "pulled to the ground." Priorities in tx: fall risk precautions, sedation, minimal stimulation, salt restriction
490
MERS PPE
Standard, contact, airborne, and eye protection
491
Airway opening technique in pt with possible C-spine injury
jaw thrust NOT head tilt/chin lift
492
Subcutanous injection in pt with adequate vs inadequate adipose tissue
90 degrees if 2 inches of tissue can be grasped, 45 degrees if inadequate. This ensures injection gets to subcutaneous layer, not muscle.
493
Management of actively vomiting pt with cholelithiasis
NPO, suppository of prometazine to relieve N/V/fluid loss, IV fluids and electrolyte replacement, NG tube to decompress stomach and encourage bowel rest
494
Risks for recently extubated patients and management
Aspiration, airway obstruction due to edema/spasm, respiratory distress. Place in high fowlers, warm, humidifed O2, oral care, ICS and deep breathing/coughing, keep NPO.
495
Pts with placental abruption and or IUFD are at increased risk for what? What is priority assessment
Disseminiated Intravascular Coagulation. Need baseline labs and physical assessment for s/sx of DIC first.
496
PaCO2 vs PO2 vs PaO2
PaCO2 --arterial carbon dioxide
PO2 --or sPo2 is O2 sat on peripheral monitor
PaO2 --arterial oxygen
497
Upper central lines vs lower central lines
Upper carry less risk of contamination/infection, lower are often inserted in emergencies and should be removed/replaced ASAP
498
Cerebellum functions
Voluntary movement, balance and posture
499
Rifampin decreases efficacy of
oral contraceptives
500
Creatinine clearance measured via
24 hour urine
501
An elevated BUN indicates what kind of a kidney problem
A chronic one
502
If platelets are below 90 what is implemented
bleeding precautions for thrombocytopenia
503
If platelets are below 40 what is implemented
assess for bleeding --can spontaneously bleed to death. Prepare for transfusion. Emergent
504
Chlorthalidone is what kind of med
Thiazide diuretic
505
When is first MMR given
12-15 momths. Can be given earlier within 72 hours of exposure. If given early, next dose is 12-15 months, and again 4-6 years.
506
When can measles immunoglobulin be given?
Within 6 days of exposure to measles
507
Incubation period of measles
7-12 days
508
What is wound evisceration?
Protrousion of organs through the wound/incisional wall. Most common in abdominal surgeries, 6-8 days postop. Due to poor wound healing, obesity. Medical emergency.
509
What do you do if a wound eviscerates?
Cover with normal saline dressings, place pt in low fowlers position w/ knees bent to take pressure off abdomen
510
What type of drug is methotrexate?
A disease modifying anti-rheumatic drug
511
What are vesicular breath sounds vs adventitious breath sounds?
```
Vesicular = Normal breath sounds
Adventitious = abnormal
```
512
Describe the variations of Fowlers position
```
High = 90 degrees (head of bed all the way up, pt's back is straight)
Semi = 30-45 degrees (head of bed up, but pt leaning back)
Low = 10-30 degrees (slightly elevated)
```
513
What is the ideal angle for a bolus feed?
30-45 degrees (semi fowlers)
514
Gastric pH
should be acidic 5 or lower
| If pH is high, do an x-ray to confirm placement
515
What kind of med is detemir?
A long acting basal insulin
516
What kind of med is spironolactone?
A potassium sparing diuretic
517
If a patient with T1DM has fasting hyperglycemia and no rapid acting or regular insulin has been prescribed, what should be done
Contact provider, request a prescription, hold breakfast until administered
518
At what age does the posterior fontanel close?
By 2 months
519
When does infant weight gain slow?
After 6 months
520
When does head lag in an infant disappear
After 6 months
521
What kind of med is thyophylline
A bronchodilator
522
Abnormal vs normal findings re edema after arteriovenous fistula
Edema after creation is normal and usually spontaneously resolves. Elevate extremity to encourage. Longer than 2 weeks of edema is abnormal.
523
What is aterial steal syndrome
Distal to an ateriovenus fistula, color, sensation, cap refill and pulse should be normal. If pallor, pain, diminished pulse and delayed cap refill = arterial steal syndrome. Anastamosed vein is stealing too much arterial blood and causing distal extremity ischemia and could lead to limb necrosis.
524
Diltiazem and verapamil are examples of
Calcium channel blockers
525
Metroprolo, timolol, and atenolol are examples of and when should they be held?
beta blockers --hold when HR <60
526
If HR is <60, should you give or hold dlitiazem and verapamil
hold. They can lower heart rate further
527
What is timolol opthalmic
a beta blocker absorbed through the eye. hold if HR <60`
528
when should ACE inhibitors be held?
when hypotensive
529
when is atropine administered
In symptomatic bradycardia, increases heart rate
530
What is teaching for parents around bismuth-subsalicylate?
Pepto bismol --contains salicylate (same class as aspirin) and can cause Reye syndrome if given during viral illness (Esp varicella and influenza)
531
Typical syptoms of pulmonary embolism
sharp pleuritic chest pain on inspiration, shortness of breath, hypoxemia, tachypnea, and cough (dry or bloody), tachycardia, unilateral leg swelling/erythema/tenderness
532
What kind of medication is omeprazole and what is its action
Proton pump inhibitor --suppresses gastric acid
| used to prevent stress ulcers from surgery or major illness
533
What is reglan also known as and what is it used for? action
metoclopramide. used for nausea post op, increases rate of gastric emptying.
534
What does omeprazole, and proton pump inhibitors in general, increase risk of
increases risk of c. diff with antibiotic use
535
In what circumstances can parents NOT refuse treatment for a child
In emergent life threatening situations. If parents refuse, hospital must seek court-appointed custody.
536
What is kernig sign
Sign of meningeal irritation --flexon of neck causes pain, flexion of knees/hip causes pain
537
What are the forms of Heparin induced thrombocytopenia and what should be monitored
First form --platelets over 100,000, typically normalizes within a few days
Second form --platelets less than 40,000 = life threatening autoimmune process. D/C heparin, prepare to infuse, monitor patient for signs of bleeding.
Must monitor platelet counts. If platelets decrease by 50% or are less than 150,000, d/c heparin, contact provider.
538
What is the treatment for malignant hyperthermia
d/c anesthesia, give IV dantrolene --slows metabolism, apply cooling blankets, treat hyperkalemia
539
What are the platelet thresholds for surgeries?
Neurosurgery and ocular surgery require plts >100,000
| Most other surgeries can be performed if plts >50,000
540
Appropriate solution for cleaning periurethral area
Soap and water only
541
What are the main risks of liver biopsy and appropriate nursing care
High risk of bleeding. Assess pt PT/INR and PTT before and after. Type and crossmatch blood before. Perform frequent vitals for signs of shock/blood loss. Pt should lie on affected (right side) for 2-4 hours after to splint the incision.
542
What are the first and secondary signs of shock
First signs are increase in pulse and respiratory rate.
| Second sign is decrease in blood pressure
543
Where on the body is a liver biopsy performed, what position is client in during procedure
Needle is inserted between 6th and 7th or 8th and 9th right intercostals with client supine, right arm over head, holding their breath
544
What foods can't someone with celiacs disease eat?
```
BROW
Barley
Rye
Oats
Wheat
```
545
Simple concussion signs and symptoms
Brief disruption in level of consciousness
Retrograde amnesia (can't remember the event)
headache
546
How to perform CPR for cardiac arrest in a pregnancy person
Place hands slightly high on sternum and manually displace the uterus to the pt's left or roll their right hip onto a wedge or rolled up towel to displace the uterus by gravity
547
What is meningococcal meningitis
A bacterial meningitis often caused by N. meningitios = highly infections
548
Appropriate precautions for meningococcal meningitis
Droplet isolation and seizure precautions (head of bed 10-30 degrees)
549
What is DOT therapy
Directly observed therapy --meds are provided and observed being taken by the nurse. Helpful in TB treatment.
550
Right shoulder pain/right shoulder blade pain and right upper quadrant could be
Cholesystitis
551
Where is angina felt
Substernal, midline
552
Where is appendicitis felt
On the 2/3 diagonal between umbilicus and anterior right iliac, and radiating to umbilius
553
Left upper quadrant radiating around to the left back pain could b
pancreatitis
554
Where is nephrolithiasis felt?
Left flank and down to left groin
555
What is hemonymous hemianopsia and what is the client at risk for?
Loss of half of visual field on the same side in both eyes. Due to stroked.
At risk for self neglect and injury because they can't see that half. Teach to turn head to get entire field
556
What is angioedema
Swelling of lips, tongue, larnyx, also gi, extremeties, genetalia, and can be life threatning if affecting airway. Side effect of ACE inhibitors.
557
What is green vomit indicative of
Intestinal bile -- could mean bowel obstruction
558
Phenytoin is also known as
| What needs monitoring and what reduces efficacy
Dilantin
Monitor liver function, use soft bristled tooth brush and get regular dental care due to risk of gingivial hyperplasia
Take folic acid
Calcium reduces efficacy
559
Peripheral artery disease
AKA Peripheral Vascular Disease, --thick narrow arteries cause intermittent claudation resulting in pain due to decreased blood flow. Feels like burning pain, worse on elevation, better when dependent. Critical artery narrowing. Skin is cool, dry, shiny, hairless, ulcers and gangrene at most distal sites of body. Progressive walking helps circulation.
560
Broca and wernike's aphasia
```
Broca = expressive aphasia. Can understan okay but difficulty/frustration with expression --non fluent, sparse speech.
Wernicke's = receptive aphasia. Can not really understand, can speak but is rapid and has no meaning.
```
561
Global aphasia
Cannot speak or understand
562
Contraindication to elective surgery
Recent or current infection - more likely for infection of wound
563
Acute pancreatitis patient is at risk for what complication
Respiratory --pleural effusion, atelectasis, ARDS due to activated pancreatic enzymes and cytokines causing focal or systemic inflammation.
564
What lung sound is an early indication of ARDS
Inspriatory crackles
565
Endotracheal cuff inflation
Always keep inflated --even during feeding. Low cuff pressure increases risk of aspiration
566
Characteristic manifestation of systemic lupus erythrematosus (SLE)
Butterfly shaped rash across bridge of nose/cheeks
567
Modifications for CHF lifestyle
Salt restriction, K supplementation, daily weights, moderate exercise
568
How to calculate cerebral perfusion pressure
MAP - ICP
569
Nutrition goal for infants under 6 months
110-120 kcal/kg/day
570
What does cochicine do?
Reduces pain from inflammation due to uric acid deposits in the joints of pts with gout
571
Necrotising entercolitis nursing actions
Daily abdominal girth measurements, monitor temp throughout day but never rectal, keep baby supine and undiapered, keep baby NPO, all nutrition/hydration/meds by central line or IV, may need NG suction to decompress stomach/intestines
572
Inguinal Hernia teaching/considerations
s/sx of strangulation = abdominal distension, pain, n/v.
After repair, must avoid coughing without splint --sneeze with mouth open, no heavy lifting. Stand to empty bladder, elevate scrotum and use ice for swelling.
573
Sign of developmental hip dysplasia
Extra gluteal folds on affected side (i.e. on inner thighs, should be symmetrical folds, but on affected side there will be more).
May also have decreased adduction
May also have uneven leg lengths
574
Drugs that can cause cross-sensitivity reaction to sulfa drugs
Glyburide, thiazide and furosemide
575
Feeding tube med administration
Crush separately. Dissolve separately. Administer separately. Flush before and after each administration with water. Only mix with water. Liquid meds should be used if possible.
576
What is ventricular bigeminy
every other beat is a PVC possibly due to electrolyte imbalance or ischemia.
577
PVCs after an MI indicate
ventricular irritability and increase the risk of more serious dysrhythmia
578
Define cardiogenic shock
Heart is unable to pump adequate blood to meet body's needs
579
Osteoarthritis vs rheumatoid arthritis
```
Osteo = asymmetrical pain in weight bearing joints, crepitus esp. over knees
RA = symmetrical pain and swelling in small joints (hands, feet, wrists) and morning stiffness lasting at least an hour
```
580
Monitor after mannitol administration
Assess for signs of fluid volume overload --esp crackles in lungs.
581
Method for urine collection for dipstick testing in pediatric pt with nephrotic syndrome
Place cottonballs in a dry diaper and then later squeeze saturated cotton balls over the dipstick
582
Osteomalacia
A reversible bone disorder due to vitamin D deficiency. Weak soft painful bones that are easy to fracture and deform. In Vit D deficiency, calcium and phosphorous can't be absorbed. Increase calcium, phosphorous, vitamin D, get sunlight, moderate exercise, use a cane or assistive device to prevent falls.
583
Age infants are expected to roll
4-5 months
| Be suspicious of a child injured by "rolling off" something if younger than this
584
Abuse pattern injuries in children
```
Coup-contrecoup
Long bone fractures
Subdural/epidural hemmatoma
Linear demarcation/immersion burns
Frenulum tears
Gingival lesions
Retinal hemorrhage
```
585
Rhabdomyolysis
Muscle fibers released into blood causing acute renal failure due to increase in myoglobin
Treat with rapin IV resuscitation to flush myoglobin
S/sx dark possibly bloody urine, oliguria, fatigue, monitor ECG due to increase in K circulation and possible arrythmias --IV fluids decrease this risk
586
Tidaling
is the fluctuation observed in the water seal chamber during respiration. Rises and falls, indicates proper function of the chest tube.
587
Cauda Equina Syndrome
Injury to L4-L5 nerve roots = motor and sensory deficits, lower back pain, inability to walk, "saddle anesthesia" --loss of sensation and motor weakness in inner thighs/buttocks, bowel, baldder incontinence (late sign). This is a medical emergency requiring reduction in pressure on nerves.
588
Foods to avoid in phenylketonuria
Requires a low-phenylketonuria as it cannot be entirely eliminated (essential amino acid) --probably needed for life. Avoid milk, eggs, meats, no breastfeeding.
589
Esophageal atresia and trachoesophageal fistula (EA and TEF)
Congenital malformations in esophagus and trachea when they do not separate/form properly. Most commonly, upper esophagus ends in blind pouch and lower esophagus connects to primary bronchus or trachea through a small fistula. Can usually be corrected by surgery.
S/sx distended abdomen, apnea/choking/cyanosis during feeding.
590
Mitral valve prolapse
(Mitral regurgitation) --Palpitations, dizziness, lightheadedness, chest pain does not respond to nitrates.
591
Nonmalfesience
Do not harm, protect others
592
Autonomy
Freedom for competent people to make their own choices
593
Justice
Treat all qually
594
Phenytoin aka
Dilantin
595
Phenytoin therapeutic range
10-20
596
Late decels intervention
Stop oxytocin, left side lying, supplemental O2, bolus of NS
597
Phlebostatic axis
at 4th intercostal mid axillary line (halfway between anterior and posterior chest)
598
Typical heparin flush doseage
2-3mL containing 10-100 units per mL
| 20-300 units
599
Partial and full thickness burns and fluid shifts
tissue damage leads to increased vascular permeability and fluid shifts (2nd and 3rd spacing). In first 24-72 hours, this leads to a decrease in oncotic pressure, and hypovolemia. Hyponatremia and Hyperkalemia results and causes tall peaked T-waves, shortened QT interval, and arrythmieas. Increased Hct and Hgb due to hemoconcentration.
600
Ear exam and drops adult vs infant
Ages 3 + up pull pinna up and back
| Under 3 pull down and back
601
Enema administration
Pt in left lateral position with right knee flexed, enema bag is held no more than 12 inches above rectum, lubricate enema tip, insert 3-4 inches, directing tip at an angle toward umbilicus. Encourage pt to retain solution as long as possible. Allow enema to flow by gravity, slowing rate if cramping occurs.
602
Normal PT
11-16 seconds
603
Normal PTT
25-35 seconds
604
Therapeutic PTT
1.5 - 2 x normal = 46 -70 seconds.
| Over 100 seconds is critical.
605
Teaching around hemophilia
Avoid NSAIDs, aspirin, IM injections (subcutaneous injections). Avoid contact sports and safety hazards --swimming, jogging, tennis ok. Wear helmets and pads. Dental hygeine important, medical alert bracelet worn at all times.
606
During peritoneal dialysis what is respiratory risk
Risk of respiratory distress due to instilling too rapidly, overfilling abdomen, or fluid entering thoracic cavity, or less dialysate being drained than was infused (fluid gain)
607
Progestin only pills teaching
Thickens cervical mucus, thins endometrium, prevents ovulation. Low risk for clots, mostly stops menses (breakthrough bleeding common), extra pill should be taken if vomiting/diarrhea within 3 hours of taking the pill, if pill is not taken within 3 hours of normal dose time, correct pill time and barrier method must be used for 2 days.
608
New S3 sound in older adults
Worrisome, requires immediate eval as it may indicate volume overload, or heart failure.
609
Normal gastric residual
less than 200-250 mL
610
Falling asleep during conversation when on sedatives
= unacceptable sedation level requires intervention on prescribed dosage, and monitoring of respiratory status
611
Statins reduce and increase...
Reduce LDL, total cholesterol, and triglycerides
| Increase HDL
612
S/sx addisonian crisis, monitoring in addison's disease
Crisis: LOW BP, LOW Blood sugar, dehydration, LOW sodium
HIGH Potassium, HIGH HR
Fever, weakness, confusion
Hypoglycemia, plus hyperkalemia and hyponatremia
Because corticosteroids are immunosuppressive and antinflammatory, they can mask signs of infection, and infection is also more likely so even a low grade fever is considered an emergency.
Manage with NS and D5, IV push steroids
613
Concerning side effect of statins
Muscle aches =may indicate myopathy, a serious SE.
614
Molar pregnancy
Hydatiform mole = gestational trophoblastic disease due to abnormal fertilization. Causes rapidly growing tissue which is intially benign, but can be come gestation trophoblastic neoplasia (invasive mole, choriocarcinoma). Pregnancy must be avoided for 6 - 12 months after evacuation of mole to HcG levels can be monitored. If pt is RH neg, they need rhogam after molar pregnancy.
615
Mandibular fracture risk
Airway compromise due to structural damage, excess saliva, bleeding in mouth, swelling
616
What to monitor during vanco infusion
Monitor for signs of red man syndrome, blood pressure due to risk for hypotension, respiratory status, signs of hypersensitivtiy/anaphylaxis, IV site
617
Pattern of herpes zoster
Shingles presents as linear, unilateral fluid filled blisters and extreme pain
618
Hypomagnesia range
less than 1.5
619
Treatment for hypomagnesia
Assess QT interval, monitor ECG, give IV magnesium
620
GTPAL stands for
```
Gravida
Term (37+0 and later)
Preterm (20+0 to 36+6)
Abortion (spontaneous or therapeutic before 20 wga)
Living (living children)
```
621
Preferred therapy for DI
Desmopressin --replaces ADH without vasopressive effect of pitressin
622
Tinea capitis treatment
suspension of griseofulvin (antifungal) and sulfide shampoo. Tx may last weeks or months. Do not stop treatment when symptoms go away. May cause photosensitivtiy, suspension should be taken with high fat food (like ice cream).
623
Types of VSD
Left to right VSDs shunt blood to the lungs
Patent ductus arteriosis
Atrial septal defect
Ventricular septal defect
624
Right to left congential cardiac defects
Many start with T, impede pulmonary flow and cause cyanosis.
625
Post op wound drainage in infants concerning levels
More than 3 ml/kg/hr for 3 consecutive hours, or more than 5-10 mL/kg in 1 hour = call provider
626
Kawasaki treatment
IVIG (immunoglobulin) and aspirin prevent coronary anyurisms and occlusion. Risk for reyes syndrome due to aspirin use.
627
Continued used of albuterol adds risk for
hypokalemia
628
Stage 3 vs unstagable pressure ulcer
Stage 3 = full thickness skin loss, subcutaneous fat may be visible but tendon, muscle, bone not visible
Unstagable =full thickness skin loss but eschar and/or slough in base preventing full visualization
629
Rate of K infusion IV vs central line
no more than 10 mEq and no faster than 1 hour in IV
| no more than 40 mEq and no faster than 1 hour in central line
630
ICS proper use steps
```
exhale
place mouthpiece in mouth
inhale deeply to move mechanism
hold breath 2-3 seconds
exhale slowly around mouthpiece
```
631
Blood type and Rh factor compatibility
A can receive A or O
B can receive B or O
AB can receive A, B, AB, or O
O can receive O
Rh positive can receive Rh positive or Rh negative blood
Rh negative should only receive Rh negative blood
632
Blood transfusion tubing
filtered --prevents clumps and hemolysis
633
Affect of nonnutritive sucking on teeth alignment
Prior to permanent teeth eruption, does not affect alignment
634
How to tell if a paced rhythm is atrial or ventricular
If the spike is before the P = atrial
| If the spike is before the QRS = ventricular
635
What pattern characterizes atrial fibrillation?
Not equally spaced. Irregularly spaced QRSes, missing Ps.
636
Heparin overdose treatment
protamine
637
Normal cardiac outbut
4-8 L/minute
638
Bronchiolitis
lower respiratory tract infection caused by RSV. Inflammation and obstruction of the respiratory tract. Can be mild, like a cold, or severe and cause respiratory distress. Babies may become dehydrated and have difficulty feeding. Need supportive care: fluids, oxygen, suctioning. Irritability = hypoxia.
639
Ideal angle for assessing JVD
45 degrees
640
Salt substitute and kidney pts?
Do not use. Many salt substitutes contain potassium chloride.
641
Renal diet
low sodium, low K, low phosphorous, low protein.
642
K rich foods
tomatoes, carrots, orange juice
643
phosphorous rich foods
turkey, chicken, dairy
644
Time frame for use of emergency contraceptives
72 hours after unprotected sex
645
Peritonitis warning signs
cloudy dialisate outflow, tachycardia, low grade fever. All should be reported to HCP.
646
How to assess for mechanical capture of heart rate on pacemaker?
Make sure electrical activity of the heart is corresponding to pulsatile rhythm. Assess a central pulse: apical auscultation, or paplate femoral pulse.
647
Order of drawing up NPH and regular insulin
```
Clean vials
inject air into NPH
inject air into regular
Draw up regular
Draw up NPH
```
648
Gestational diabetes can result in what blood condition?
Polycythemia of the newborn (look for elevated hematocrit)
649
Hypospadia and post op concern
when urethra is located on underside of penis.
After corrective surgery, a stent is placed. Hourly urine outflow is measured. If no outflow for 1 hour, concern re: onstruction
650
Sucralfate
Oral med, protective layer in GI mucosa against stomach acids/enzymes. Take 1 hour before meals/bedtime on empty stomach with water. Avoid antacids/PPIs/H2 blockers for 30 min after taking. Take other meds 1-2 hours after taking. Constipation common SE.
651
Opthalmic ointment application
Tilt head back, pull down lower lid, look up
Apply thin ribbon of medication to lower lid from inside to outside.
Closer eyes for 2-3 min. Do not rub.
Ointment is better at night, drops better in day.
652
Pulse ox affected by
```
Anemia
CO2 poisoning
dark nailpolish
hypotension/low cardiac output (HF)
vasoconstruction (hypothermia, vasopressor meds)
Peripheral artery disease
```
653
Glass vial medication notes
snap away from body
use filter needle to draw up
touch only the needle inside the vial, no other part of needle or syringe should touch vial
654
What OTC meds can cause bronchoconstriction in pts with asthma?
Aspirin and ibuprofen
655
Cushing's triad
Hypertension
Bradycardia
Irregular respirations
656
SIRS criteria
at least 2 of the following:
T of <36.0 or >38.0
Tachycardia of >90
Tachypnia of >20
Leukocytosis of >12,000 or leukopenia of <4,000
Also: decreased urine output (less than 0.5 ml/kg/hr)
657
Monitoring for submersion injury
Must monitor closely for 6 hours.
| Look for changes in respiratory pattern, O2 sat, LOC which can indicate impending respiratory failure.
658
Post mastectomy care priorities
Elevate affected arm at heart level on pillows, gradual exercises of finger and arm. Full ROM expected 4-6 weeks. Keep pt in semi fowlers, no BP/venipuncture/injections into affected arm
659
Hierarchy of decision making for incapcitated people
Health care proxy and alternates per advanced directive
Family
Ethics board or HCP
660
Upper limit of "normal" WBCs in pregnancy
15,000
661
Marfan syndrome
Long, slendr body, cardiac defects --prone to aortic root dilation/weakness and increased risk of aortic dissection and rupture. High risk of mortality in pregnancy, should avoid, or if intent on pregnancy, should do earlier in life. 50% chance of heritability for children.
662
What drug should be avoided before IV contrast
Metformin should be avoided for 24-48 hours before use of IV contrast dye and for 48 hours afterward to reduce risk of lactic acidosis
663
Crutch measurements
3 fingers from axilla to pad (1-2 inches), 30 degree bend in elbow when walking.
664
General guide for pediatric medication administration
Do not mix in anything. Measure with an oral syringe.
Don't give another dose if they vomit right after the first one. Give in semi-reclining position for babies. Give in cheek towards back of mouth in small bits. For preschoolers let them aid in prep, push plunger, give positive reinforcement like a sticker.
665
Macrolide abx
End in mycin but not aminoglycodies. Azythromycin, erythromiycin, clarythromycin.
666
What must be monitored for in macrolides?
Prolonged QT
| Liver function
667
Compression stockings in chronic venous insufficiency
Help with venous ulcer healing, prevent ulcer recurrence, should be worn during the day
668
Synchronization in defibrillation
Cardioversion requires synchronization. Pulsed rhythms require synchronization to avoid R on T
Pulseless do not require synchronization
669
Foods high in tyramine
Aged cheese, cured meat, fermented food, broad beans, beer, red wine, chocolate, avocados
670
Non-cycle related breast changes should...
be reported to a provider.
671
People over what age should have yearly breast exams and practice self exam?
Over 40
672
Chest tube drainage system layout
Far left = suction control chamber
Second from left = water seal chamber
Remaining 3 right chambers = collection chambers
673
Semen and amniotic fluid
Are both alkalotic and will both cause positive nitrazine tests
674
Birth weight should X by 6 months and X by 12 months
double and triple
675
Pulsation of fontanelles
Normal
| Posterior closes by 2 months, anterior by 18 months
676
BRAT diet
not recommended
677
Veracity
telling the truth
678
Benefience
Doing good
679
Fidelity
loyalty and committment
680
Influenza vaccine in okay in babies
6 months of age or older
681
Macrolytic anemia
Deficient in B12/folic acid = vegans
682
Excessive PP bleeding
1 or more pads in 1 hour
683
Stripping chest tube
Never ok
684
Looping chest tube / kinking chest tube drainage system
never ok
685
Best non-lab indicator of kidney function
Urine output
686
Acute ashtma attack treatment
Albuterol, solumetrol (or other steroid), ipratropium
687
Dysarthria
Motor speech disorder. Can indicate impending respiratory distress if new
688
Proper order of cleaning trach and replacing cannual
Remove soiled dressing
Replace cannula
Clean stoma, place new dressing
(inside to outside except soiled dressing)
689
Needle and location for infant injections
To 12 months, 1 inch needle, vastus lateralis
690
Statins are most effective when taken
At night
691
Most effective indicator of fluid resuscitation adequacy in burn injuries
Urine output
692
Blurry spot in middle of vision
macular degeneration
693
Flashes of light in vision
retinal detachment
694
Inability to see closely
Presbyopia = old age
695
Poor peripheral vision/tunnel vision
Glaucoma
696
Leukocytosis
Elevated WBCs (infection)
697
Why is the bladder emptied before a blood transfusion
In the event of an acute hemolytic transfusion reaciton, a fresh urine specimen is needed to analyze for hemolyzed RBCs, so pt needs to empty bladder just prior to starting the transfusion
698
Signs of hemolytic transfusion reaction
Red urine, hypotension, fever. Late: DIC, hypovolemic shock
699
What is "failure to capture"
If a patient has a pacemaker, an impulse is sent to the ventricle or atrium but the myocardium doesn't depolarize in response. Can be visualized by a pacer spike at the appropriate time but no responding complex following. Usually associated with pacer lead wire displacement or battery failure. Failure to capture can lead to bradycardia, asystole, and decreased cardiac output.
700
Risk for thrush is associated with
Systemic abx use in immunosuppressed people, steroid use --inhaled or systemic (NOT albuterol), dentures, infants
701
Trismus
Inability to open mouth due to tonic contraction of the muscles used to chew. Can indicate a serious complication of tonsilitis.
702
Complications of tonsilitus
Trismus, "hot potato voice" (hoarse/muffled voice), saliva pooling, deviation of uvula to one side --all may indicate an abscess forming and can impact airway.
703
Sunset eyes
Visibile sclera above the iris in an infant, a sign of ICP in hydrocephalus. Bulging fontanelles and increasing head circumference are other signs of ICP.
704
Normal range of wet diapers
6-10 per day or 1 every 4 hours
705
Babinksi
Toes fan out and big toe dorsiflexes with stimulation. Normal up to 12 months, beyond 1 year may indicate neurological disease.
706
Triple lumen catheter
Allows for incompatible meds to be given simultaneously, allows for blood draws, allows for hemodynamic monitoring, and allows for TPN
707
Enter, parenteral and Total parenteral feeding
Enteral = oral or direct to GI tract
Parenteral = does not go to GI tract, through peripheral vein
Total parenteral = goes through central line
708
Apraxia
inability to learn a new motor movement --whistling, clapping, dressing, due to neurological impairment
709
How to assess an unconscious person
Assess for medical alert devices (pacemakers, alert bracelets), prescriptive materials (med patches, contacts), remove foreign objects (tampons, jewelry) and personal belongings but LEAVE medication patches on until after consulting with HCP
710
TORCH infections
Toxcoplasmosis, other (parvo B19, variceella), rubella, cytomegalovirus, herpes simplex
711
Nasal cannula
1-6 L/min, FiO2, 24-44%
| Low flow, best for pts with adequate tidal volume and normal vital signs
712
Simple face mask
6-8 L/min, FiO2 40-60%
| Low to high flow depending on use
713
Non-rebreather mask
10-15 L/min FiO2 60-90%
Face mask with reservoir bag and two one-way vaolves which prevent exhaled air from entering reservoir bag and room air from entering mask while CO2 is released to atmosphere. Bag must remain inflated --if it is not inflated, increase O2 rate.
Used for short term in pts with low saturation due to asthma, pneumonia, trauma, severe sepsis
714
Venturi mask
2-15 L/min FiO2 24-60%
Face mask and color-coded adapters which direct specific O2 concentration. Does not vary O2 concentration with breathing pattern and appropriate if pt cannot tolerate variation in O2 concentration. Used in persistent hypercarbia, and severe hypoxemia. Precise O2 delivery but not for patients with very high O2 demand.
715
If TPN is interrupted, what is the appropritate fluid to use in the meantime
10% dextrose at the same rate the TPN was being run, until a new bag of TPN is available.
716
In hypertensive crisis, how is BP managed?
It must be lowered slowly so as not to compromise perfusion to organs. Goal is not to decrease MAP more than 25%, or maintain MAP at 110-115 and then decrease lower over then next 24 hours
717
When is external pacing implemented?
In symptomatic bradycardia
718
-xaban
Anticoagulants prevent and treat venous thromboembolism. More commonly prescribed oral anticoagulant than warfarin due to lower risk and less ongoing monitoring needed. Do NOT take with NSAIDs, garlic, ginger, which can increase bleeding risk.
719
-lam and -pam
Benzodiazepines. Anti-anxiety drugs. Taper, don't stop suddenly. Take at night due to sedative effect.
720
Dental avulsion
Adult tooth separated from mouth. Dental emergency. Rinse tooth with NS, reinsert into cavity and hold in place until stablized by dentist. Reinserting within 15 minutes re-establishes blood supply.
721
Sildenafil
Viagra. Do not use with nitrates (unstable angina patients). Do not give nitrates within 4 hours of use.
722
Vagal maneuvers
Place an ice bag on face, instruct pt to hold breath and bear down.
723
Position for pneumonia
Place patient with affected lung UP
724
Prior to starting statin therapy, what needs monitoring?
Liver function tests, ongoing liver monitoring because drugs can be hepatotoxic
725
Acathosis nigricans
Symmetric hyperpigmented velvty plaques in flexeral and intertiginous areas of skin (axilla, neck). May also have skin tags. Both indicate insulin resistance. Refer to HCP for evaluation of DM or metabolic syndrome.
726
Principles of radiation poisoning
Treat patients furthest away from exposure and those with the least symptoms. The closer to the source, the less chance of survival. Most injuries will be internal --blood cell counts low, oral mucosa ulcers, vomiting/diarrhea.
727
Right sided heart failure classic signs
JVD enlarged liver, spleen abdomen, dependent edema, generalized edema.
728
If heparin induced thrombocytopenia is suspected:
Stop heparin, assess vitals, assess neuro status, repeat blood work (CBC) and contact HCP
729
Where to listen for PMI
Mid axillary line, 4th and 5th intercostals. If lower may indicate enlarged heart.
730
"Acceptable" asthma peak flow levels
Greater than or equal to 80% of personal best
731
Anticipate for a newly comatose patient --
therapeutic hypothermia
732
Low serum albumin manifests as
Fluid shift from intravascular compartment to intersititial spaces. Causes pitting edema of lower extremeties, periorbital edema, and ascites
733
Teaching re: birth control after vastectomy
It can take months before remaining sperm are ejaculated or absorbed by body, so alternative birth control must be used until semen sample confirms absent of sperm
734
Omphalocele and gastroschisis
Congential defects of abdominal wall
Omphalcele --bowel usually covered in peritoneal sac herniates through abdominal wall via umbilical opening
Gastroschisis --bowel herneates through abdominal wall without protective sac (may be offset from umbilicus
Cover with non-adherent sterile dressing soaked in saline and covered in loose plastic, or in a plastic bowel bag
Initiate IV access
Monitor for fluid loss, fever, signs of infection
Allow baby to breastfeed, unless prepping for surgery then keep NPO
