nclex main topics Flashcards
(339 cards)
1
Q
IM needle selection (adults)
A
21 gauge, 1 in long
IM= 21 gauge, 1 in long
2
Q
SubQ needle selection (adults)
A
25 gauge, 0.5in long
S = 5
3
Q
heparin lab
A
aPTT
4
Q
warfarin labs
A
PT/INR
5
Q
antidote to warfarin
A
vitamin K
6
Q
diuretics
A
“ones that end in X, X’s out K” + Thiazides
- lasix + chlorothiazide remove K+
- Spironolacatone spares K+
7
Q
baclofen and cyclobenzaprine
A
- muscle relaxants
- s/e: fatigue, muscle weakness
- teaching: no drinking, driving, or machines
8
Q
birth - 2 years teaching
A
- sensorimotor in nature
- understands world through sense and actions
- teach NOW, verbally as they don’t think in past/future
9
Q
3-6yo teaching
A
- pre-operational teaching
- language and mental images
- think fantasy, illogical, play/use doll
- teach SHORT TERM (day of, 2 hours before) about what you’re GOING to do
10
Q
7-11yo teaching
A
- concrete operational
- logical thinking and categories
- rule oriented, rigid, only 1 way to do things
- use age appropriate reading and demonstration
- teach them a day or 2 ahead of time w/ what you’re going to do and skills
- can teach 7-11 year old skills
- they CANNOT manage their care
11
Q
12+ teaching
A
- formal operation
- hypothetical thinking, schientific reasoning
- abstract, cause/effect
- adult teaching question
- can handle abstract thought/manage care @ 12
12
Q
nurse-patient realtionship
A
- pre-interaction: professional goals
- orientation: purpose, nature, time, and trust
- working: active problem solving
- termination: achieved goals, ending relationship
13
Q
psych tips
A
- remember what phase you’re in
- don’t accept gifts
- don’t give advice
- never give gaurentees
- pick an answer that keeps patient talking, don’t refer to someone else
- don’t use slang or figurative language
- don’t choose answers with “don’t worry”, choose answer that reflects patients feelings
14
Q
hyperthyroidism
A
- hyperMETABOLISM
- s/s: weight loss, tachycardia, hypertension, hyperpersonality, heat intolerance (can tolerate cold), EXOPTHALMOS (GRAVES)
15
Q
treatment of hyperthryoidism
A
- radioactive iodine: flush 3x after using bathroom, call hazmat if urine spills, needs private room for first 24hrs, visitor restrictions in home and hospital for 24hrs
- PTU: “puts thyroid under”, monitor WBCs, immunosuppressant
- thyroidectomy
16
Q
thyroidectomy
A
- surgical removal is most common
- total: life-long hormone replacement, at increased risk of hypocalcemia (paresthesia, tetany, twitching, spasms, clonus, seizures, +Chvostek and Trosseau)
- sub-total: DOES NOT need hormone replacement, may need supplementation @ first, increased risk for thyroid storm/thyrotoxicosis
17
Q
thyroid storm
A
- temp > 105: get temp down, bring O2 up (ice packs (1), cooling blankets (2), O2 via mask 10L, stay w/ patient)
- HTN, stroke level - 210/80
- severe tachycardia (180-200)
- delirious
18
Q
first 12 hours post thyroidectomy
A
- risks are same for total and subtotal
1. AIRWAY - risk for edema d/t surgery
2. HEMMORHAGE - endocrine gland is very vascualr
19
Q
12-48hrs post thyroidectomy
A
- total: TETANY (secondary to low Ca, can close off airway w/ irreversible spasms)
- subtotal: thyroid STORM (severe)
20
Q
after 48hrs post thyroidectomy
A
- infection
any surgery, 72hours after, is when infection risk is high
21
Q
hypothyroidism
A
- HYPOmetabolism
- s/s: obesity, cold intolerance (likes the heat), low HR, low BP, flat, boring, dull, academically challenged
- DO NOT SEDATE (question Ambien night before surgery
22
Q
myxedema
A
when patient with hypothyroidism presents w/ skin involvement
23
Q
myxedema coma
A
- severe hypothyroidism
- decreased LOC, hypothermia, slowed organ function
24
Q
treatment of hypothyroidism
A
- levothyroxine: take in AM, 30-1hr before breakfast on empty stomach w/ water
25
surgery for hypothyroidism patients
must give levothyroxine in AM, w/o it can lead to myxedema coma
26
addison's disease
- under secretion of steroids (time bomb)
- s/s: hyperpigmentation (bronze skin)
- inability to adapt to stress leading to shock and hypoglycemic episodes (Addisonian Crisis)
- HYPOGLYCEMIC
27
tx for addison's
- give steroids
- glucocorticoids (-sone): prednisone, methylprednisone
- in addison's, add a -sone
28
cushing's syndrome
- oversecretion of adrenal cortex (steroids)
- s/s: moon face, hirsituism, truncal or central obesity, muscle atrophy, gynecomastia, buffalo hump, striae, HYPERGLYCEMIA, easy bruising
- increased risk of infection
- full of H2O d/t Na+ RETENTION, LOSS of K+
29
cushings tx
- adrenalectomy
- bilateral adrenallectomy leads to Addison's which leads to steroid order leading to symptoms of Cushings
- takes about 1-2 years to get back to normal
30
kids toys questions
1. is it safe?
2. is it age appropriate?
3. is it feasible?
31
safety and toys
1. size: no small toys for those <4 years old (>4 pieces are fine)
2. if O2 in use, NO METAL (dye-cast, sparks)
3. beware of fomites: nonliving objects that harbor microorganisms (STUFFED ANIMALS)
4. hard plastic toys are good, easily disinfected
32
best toy for an immunosuppressed child
plastic action figure
33
infants 0-6mo toys
- sensorimotor
- musical mobile (BEST) or LARGE, soft toy
34
infants 6-9 months toys
- object permanace
- cover/uncover, jack-inbox, peek-a-boo or LARGE but FIRM toy
- DON"T GIVE MUSIC MOBILE
35
infants 9-12mo toys
- vocalization
- speaking or verbal toys, tickle-me-elmo, woody-cowboy
36
when does purposeful play occur
@ 9 months and on
37
purposeful play
builds, sorts, stacks, makes, constructs
38
1-3 yo toys
- focus on GROSS motor skills (running, jumping)
- push and pull toys are best (lawn movers, wagon, dogs w/ floppy feet)
- painting
- PARALLEL PLAY
- don't choose answers w/ finger dexterity (scissors, colored pencils)
39
pre-schoolers (3-6yo) toys
- focus on FINE motor skills, finger dexterity (write, draw, scissors)
- work on BALANCE (dance, ice skates, tricycles, tumbling)
- cooperative play (aka pretend)
- HIGHLY IMAGINATIVE
40
school age (7-11yo) toys
- concrete, 3 Cs
- Creative: blank paper to draw, get them involved, toys like legos or transformers
- Collective: baseball cards, Webkinz, Barbies, Beanie Baby
- Competetive: winner or loser
41
adolescents (12-18yo)
- peer group association
- allow adolescents to be in each others rooms UNELSS- recently post-op for <12hrs, immunosupprssed, or contagious
42
when children are sick...
give them time to grow, choose older age
43
laminectomy
removal of vertebral spinous processes to relieve root compression
44
signs of nerve root compression
3 Ps
1. pain
2. paresthesia (tingling/numbness)
3. paresis (muscle tremors)
45
Cervical Laminectomy
- preop: diaphragm and arms (assess breathing (1), check function of arms (2))
- post-op: watch for pneumonia
46
Thoracic Laminectomy
- preop: gut + abdomen muscles (monitor cough, and bowels)
- postop: monitor pneumonia and paralytic ileus
47
Lumbar Laminectomy
- preop: bladder and legs
- monitor urinary retention, last void, and if bladder is empty, THEN leg function
- post-op: urinary retention, leg problems
48
mobilizing post laminectomy
- don't dangle or sit @ edge of bed
- supine to walking ASAP
- don't allow sitting for > 30 min
- can overcome hypotension for sitting for a few seconds
- DONT PUT IN CHAIR
- walk, stand, lie down w/o restriction
- no chest tubes unless going through chest and into spine
49
laminectomy w/ fusion
- taking bone graft from (1) iliac crest and (2) the spine to remove bone-bone
- Hip graft: MOST PAIN AND BLEEDING
- Spine graft: MOST COMMON REJECTION
50
laminectomy restrictions
- don't sit for > 30 min
- lie flat, log roll for 6 weeks
- don't drive for 6 weeks
- don't life >5lb (gallon of milk) for 6 wks
51
permanent laminectomy restrictions
1. can't lift by bending at the waist (use knees)
2. cervical laminectomy can't lift over head
3. no horseback riding, off trail biking, or jerky amusement parks
52
1 psychosocial problem in alcoholism/abuse
DENIAL
53
responding to denial
- confront by showing them difference of what they say vs what they do
- good answer has "I" not "you"
54
loss vs abuse
LOSS = support
ABUSE = confront
55
stages of grief
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
*DABDA*
56
dependency
when they get the partner to do things or make decisions for them
*abuser is dependent on SO*
57
co-dependency
when partner derives self-esteem for doing things/making decisions for abuser
*SO is co-dependent*
58
treatment for abuse/co-dependents
- abuse = confront
- co-dependent should have self-esteem issues addressed, teach them how to set and enforce limits
- agree w/ co-dependent in advance on what requests are allowed, SAY NO, work on self-esteem
59
manipulation
- when abuser gets SO to do things/make decisions that are not in best interest of SO
- nature of act is dangerous or harmful
60
wernicke/korkasoff syndrome
- wernicke is encephalopathy, korkasoff is psychosis
- thiamine (B1) definiency induced psychosis
61
symptoms of WK syndrome
- amnesia (forgetfullness, memory loss)
- confabulation (making up stories): for these patients, their lies are reality, REDIRECT
62
stages of WK syndrome
1. preventable: take thiamine (B1)
2. arrestable: take B1 to stop from getting worse
3. irreverisble: will kill brain cells (70%)
63
anti\abuse and Revia (Disulfram)
- antabuse: alcohol deterant
- revia (disulfram): antidote
- aversion therapy: makes pt sick when consuming alcohol
- teaching: avoid ALL EtoH, not stopping can lead to n/v and death, watch mouothwash, handsanitizer, colongne, perfume, aftershave, elixir, OTC meds, liquids, VANILLA (can't have cupcake w/ unbaked icing)
- red wine vinegrates do NOT have liquor
64
upper drugs
1. caffiene
2. cocaine
3. adderall
4. methamphetamines
5. PCP/LSD (hallucinogens)
65
symptoms of upper intoxication
- euphoria
- **seizures**
- restlessness
- irritablity
- HYPERreflexia (+3, +4)
- tachycardia
- borborygmi
- diarrhea
66
symptoms of downer intoxication
- respiratory depression
- lethargy
- constipation
67
highest priority for upper intoxication, downer withdrawal
SUCTION d/t seizure risk
68
highest priority for downer intoxication, upper withdrawal
intubation/ventilation d/t respiratory arrest
69
withdrawal with an upper
looks like downer OD (respiratory depression, lethargy, constipation)
70
withdrawal with a downer
looks like upper OD (tachycardia, HTN, seizures, restlessness, hyperreflexia)
71
drug abuse in newborns
- always assume intoxication NOT withdrawal @ birth
- <24hrs old = intoxication
- >24hrs old = withdrawal
72
alcohol withdrawal vs delirium tremens
- every alcoholic withdrawals 24hrs after person stops drinking
- <20% of alcoholics progress to delirium tremens
- delirium tremens occurs AFTER 72hrs of cessation
- alcohol withdrawal ALWAYS precedes delirium tremens; however not all delirium tremors come after alcohol withdrawal syndrome
73
alcohol withdrawal syndrome
- 24 hours after drinking
- non-life threatening to self or others
- nursing: regular diet, semiprivate room, anywhere, pt is up @ own desire, no restraints
74
delirium tremens
- occurs 72hrs after drinking
- life-threatening to self or others
- nursing: NPO (seizures) or clear liquid, private room near nurses station, restricted bed rest (no bathroom), restraints (vest or 2 point lock (one upper one lower)
75
meds for alc withdrawal and delirium tremens
- anti HTN
- tranquilizer
- multivitamin w/ thiamine (B1)
76
aminoglycosides
- antiobiotics used when NOTHING ELSE WORKS
- unsafe @ toxic levels and safety becomes an issue
- "mean old mycin": very bad infection, end in -mycin
77
aminoglycoside infections
- TB
- sepsis
- peritonitis
- fulminating pyelonephritis
- septic shock
- infection from 3rd wound covering >80% of the body
*normal infections will not have aminoglycoside ordered*
78
aminoglycoside examples
- gentamycin, vancomycin, clindamycin, streptomycin, cleomysin, tobramycin
79
if the antibiotic has a THRO...
throw them off the aminoglycoside list: azithromycin, clarithromycin, erythromycin
80
toxic affects of aminoglycosides
- #1 Hearing, balance, tinnitus, CNS toxicity
- #2 Kidneys, Nephrotoxicity (monitor Creatinine)
81
#1 indicator of kidney function
creatinine (if 24hr cretinine clearance is option, choose that first)
82
think of the figure 8 in ear when thinking of aminoglycosides
1. toxic to CN8
2. admin q8hr
83
route for aminoglycosides
- DONT GIVE PO, not absorbed
- give IM or IV
- only give PO for pre-op bowel prep to sterilize bowel pre-op OR hepatic encephalopathy to lower ammonia levels (abx will stay in gut, sterilize, and won't be toxic)
84
who can sterilize bowel?
Neo Kan
Neomycin, Kanamycin
85
trough
lowest concentration
86
peak
highest concentration
87
trough, admin, peak
- trough BEFORE drug
- peak AFTER drug
- drawn with drugs w/ narrow therapuetic window
88
digoxin TAP levels
- smaller dose: 0.125, larger dose: 0.25
- draw tap
89
when to draw TAP
- TAP levels are not med dependent but route dependent
- peak depends on route
90
subL peak
5-10 min
91
IM peak
30-60min
92
IV peak
15-30 min (check peak after drug is finished
93
same drug w/ 2 different routes will have
different peaks
94
LMP calculation
1st day of LMP + 7days -3months
95
weight gain during total pregnancy
28 +/- 3 lbs
96
1st trimester weight gain
1lb/mo for first 3 months
97
2nd and 3rd trimester weight gain
1lb/week for duration of pregnancy
98
3+/- weight gain
assess
99
4+/- weight gain
trouble, get BPP
100
ideal weight gain trick
wks of gestation - 9
101
fundal height
- not palpable until wk 12 (midway between umbilicus + pubic symphisis)
- if hytidaform mole pregnancy (fundal height will be much higher than gestational age)
- palpated @ 20-22wks
102
priority in 1st trimester
mother
103
fundus below belly button priority
2nd tri, mother is priority
104
fundus above belly button priority
3rd tri, baby is priority
105
positive signs of pregnancy
- skeleton on x-ray
- fetus on ultrasound
- FHR auscultation (doppler) heard 8-12 weeks
- palpation of fetal movements by examineer NOT mother
106
when is the first...
earliest
107
when is it most likely...
middle range
108
when should you...
end
109
FHR first, most likely,should
1. 8 weeks
2. 10 weeks
3. 12 weeks
110
Quickening first, most likely, should
1. 16 weeks
2. 18 weeks
3. 20 weeks
111
maybe signs of pregnancy
- urine/blood test
- Chadwicks, Goodells, Hegar
112
chadwicks signs
cervical color change to cyanosis, bluish discoloration
113
goodell sign
softening of the cervix, "good and soft"
114
hegar sign
uterine softening
115
order of pregnancy signs
1. chadwick (cervical color change)
2. goodell sign (cervical softening)
3. hegar sign (uterine softening)
116
office visits for pregnant patients
- up to 28 weeks: 1x/mo
- 28-36wks: 1x/every other week
- 36-42: 1x/week
- 42+ induced/c-section
117
morning sickness
dry carbohydrates BEFORE getting out of bed
118
urinary incontinence for pregnancy
- a problem in 1st/3rd, not the second d/t baby being off the bladder
- void q2hrs from pregnancy to 6wks post-partum
119
dyspnea
- 2nd/3rd trimester issues
- tripod positioning
120
back pain tx
2nd/3rd issue
pelvic tilt exercises
121
truest sign of labor
regular and progressive contractions
122
dilation
cervical opening (0-10cm)
123
effacement
thinning of cervix (0-100%)
124
station
relation of fetal presenting part in relation to mothers ischial spines (most narrow part of pelvis)
+ station = GOOD, baby can fit
- station = BAD, can't fit vaginally
125
engagement is station...
0, presenting part is @ ischial spine
126
lie
- relationship of baby and mothers spine
- vertical lie = GOOD for vaginal, spines are parallel
- transverse lie = BAD, needs C-section
127
presentation
ROA and LOA are most common
pick ROA first
128
stages of labor
1. Onset of Labor
- Latent PHASE (0-4cm)
- Active PHASE (5-8cm)
- Transition PHASE (8-10cm)
2. Delivery of Baby
3. Delivery of Placenta
4. Recovery (lasts for 2 hours)
129
latent PHASE
- phase 1
- 0-4cm, contraction 5-30min apart, lasting 15-30 seconds
- mild
130
active PHASE
- phase 2
- 5-7cm, contractions 3-5min apart, lasting 30-60seconds
- moderate
131
transition phase
- phase 3
- 8-10cm, contracations 2-3min apart, lasting 60-90 seconds
- strong
132
estrogen
increase causes increased sensitivity to oxytocin
133
oxytocin
signals uterus to contract, plays role in bonding
134
prostaglandins
causes cervical ripening/softening
135
relaxin
relaxes cervix, ligaments, to allow for increased flexibility of joints (increases injury risk)
136
when does post partum occur
2hrs after delivery of placenta
137
stage 1 goal
dilate and efface
138
stage 2 goal
deliver baby
139
stage 3 goal
deliver placenta
140
stage 4 goal
stop bleeding
141
contraction regulations
should be no longer than 90 seconds, and no closer than 2 min (120) apart
142
contractions >90 seconds or closer than 2 min apart
indicates hyperstimulation and tetany, stop pitocin if running, check baby
143
duration contraction
beginning to end
144
frequency of contraction
beginning of one to beginning of another
145
intensity of contractions
strength, palpate fundus with finger tips
146
painful back = OP
position knee to chest, then push fist into sacrum for counter pressure
147
prolapsed cord
- BAD
- push head in and off cord and position in knee-chest or trendelenberg
- prep for C-section
- push/position
148
interventions for all other labor complications
Left side
I VF
O xygen
N otify HCP
*if pitocin is running, stop first, then LION*
149
don't give systematic pain med if baby will be born when med peaks...
- primigravida @ 5cm who wants pain meds = yes
- multigravida @ 8cm who wants pain meds = NO
- IM peak = 30-60min
- IV peak = 15-30 min
150
bad fetal monitor
- start w L
- Low FHR
- Low Baseline variablity
- Late Decels
151
bad fetal monitor intervention
LION
152
high FHR
- >160bpm
- document accelerations
- take mom's temp
- low priority
153
high baseline variablity
- GOOD, HR always changing
- document finding
154
early decels
- occur before or after contraction
- normal
- document
155
variable decels (VERY)
- very BAD
- indicates prolpased cord
- push head, position knee to chest
156
second stage of labor L&D order
1. deliver head... mom stops pushing
2. suction out mouth, then nose (ABC order)
3. check for nucchal cord (around neck)
4. deliver shoulders, then body
5. give ID band before leaving delivery room
157
third stage of labor L&D
- placental delivery
- ensure placenta is complete and intact
- check for 3 vessel cord (AVA)
158
fourth stage of labor L&D
- recover
- 4 things to do 4x every hour
1. vitals - pale, cold, clammy, low BP, high HR
2. fundus - if boggy, massage... if displaced, catheterize
3. perineal pads - 15min or less saturation, 100% in less than 15 min
4. roll - check for pooling under the patient
159
postpartum assessment
- q4-8hrs
- Uterine Fundus: should be firm and midline (if boggy massage, if not midline, cath)
- Lochia: rubra (red, 1), serosa (pink, 2), alba (white, 3).... moderate bleeding = 4-6in on pad/hr, excessive = saturated in 15 min
- Extremities: look for DVT, measure calf circumference, Homan's sign is NOT best answer
160
normal skin variations in newborn
- millia
- epstein pearls
- eythema toxicum migrans
- mongolian spots (document to avoid speculation of abuse)
- hemangioma
- vernix caseosa
- acrocyanosis (blue hands and feet)
- nevi (stork bites, disappear by 2yo)
- port-wine stain
161
cephalohematoma
- collection of blood that does NOT cross suture lines
- develops w/i 24-48 hours AFTER birth
162
capput succedaneum
- collection of swelling d/t birth trauma that CROSSES suture lines
- disappears w/o treatment
- no pathological significance
- symmetrical
163
physiologic jaundice
- normal
- appears 24hrs after birth
- disappears within1 week
164
pathologic jaundice
- appears within first 24 hours
- ABNORMAL
165
tocolytics
- stop labor
- terbutaline (Brethine) side effects: maternal tachycardia (don't give w/ cardiac hx)
- mag sulfate side effects: low HR, low BP, hyporeflexia, low RR, low LOC (monitor RR and reflexes and adjust dose accoridngly)
166
oxytocics
- stimulate and strengthen labor
- pitocin (oxytocin) s/e: uterine hyperstimulation (>90 sec, >2min), decrease dose
- methergen s/e: increased BP (monitor)
167
fetal and neonatal lung meds
1. betamethasone: given to mom IM before the baby is born, okay to be repeated, increases glucose levels
2. surfactant: given to baby transTRACHEALLY, AFTER baby is born
168
if pH is low, K+ is
HIGH
169
if pH is high, K+ is
LOW
170
alkalosis s/s
- tachycardia
- tachypnea
- HTN
- seizures
- irritability
- spastic
- diarrhea
- borborygmi (increased bowel sounds)
- hyperreflexia (+3,+4)
171
acidosis s/s
- bradycardia
- bradypnea
- hypotension
- constipation
- absent bowel sounds
- flaccid
- obtunded
- lethargy
- coma
- hyporeflexia (0, +1)
172
priority for alkalosis
suction for seizures
173
priority for acidosis
airway/intubation/vent for bradypnea
174
high pressure alarms
- triggered by increased resistance to airflow (working too hard to push air)
- kinks in tubing (unkink), condensed H2O in dependent tube (empty it), mucous plugs (turn,cough, deep breathe, OR suction prn)
175
low pressure alarms
- triggered by decreased resistance to airflow (working too little to get air in)
- main tubing disconnection (reconnect), O2 sensor disconnection
- in both cases, reconnect unless it is on the floor, then bag patient and call RT
176
when vent settings are too high patient becomes
alkalotic
177
when vent settings are too low patient becomes
acidotic
178
what ABG result indicates the client is ready to come off the vent?
respiratory alkalosis
179
calcium channel blockers
- valium for the heart
- used when heart needs rest (antiangina, arrythmias like A-fib, A-flutter, and SVT, antiHTN)
- side effects: headache, low BP (hold if SBP <100mmHg)
180
+ inotropes, chronotropes, and dromotropes
- increased contractile force (increases CO)
- increase rate of impulse (increases HR)
- increases conduction velocity
181
-inotropes, chronotropes, and dromotropes
- decrease contraction (lower CO)
- lower rate of impulse (lowers HR)
- lowers conduction velocity
182
NSR has QRS that fall within
5 small boxes
183
v-fib
no pattern, CHAOTIC QRS
184
v-tach
sharp peaks, with pattern, BIZZARE QRS
185
chaotic means
fibrillation
186
bizzare means
tachycardia
187
periodic wide bizarre QRS
PVCs
188
slavos of PVCs
short run of VTACH
189
PVCs would only be moderate priority IF
1. 6+ PVCs/min
2. 6+ PVCs in a row
3. R on T phenomonen (PVC on T wave)
190
lethal arrhythmias that are high priority
1. asystole
2. v-fib
*both cause little to no CO leading to no brain perfusion leading to death*
191
v-tach is potentially lethal
- has CO
- amiodarone!
192
if CO is absent
no pulse
193
if CO is present
w/ pulse
194
atrial arrythmia treatment
ABCDs
A- adenosine
B- beta blocker
C- calcium channel blocker
D- digitalis/digoxin/lanoxin
195
tx for v-fib and asystole
- defib for v-fib
- epi or atropine for asystole
196
ventricular arrhythmia treatment
amiodarone
197
apical chest tube for
pneumothorax d/t rising air
198
basillar chest tube for
hemothorax d/t draining of blood
199
what lung surgeries require chest tube
- wedge resection or lobectomy
- NOT PNEUMONECTOMY
200
knocking over closed chest drainage system
tell patient to take a deep breath and set it back up (NOT AN EMERGENCY
201
if water seal breaks...
1. Clamp (FIRST)
2. Cut
3. Submerge in sterile water (BEST)
4. Unclamp
15 seconds or less
202
if chest tube gets dislodged/pulled out...
1. take gloved hand and cover opening (first)
2. take sterile vaseline gauze and tape 3 sides (best)
203
bubbling in water seal
- intermittent = good
- continuous = bad, indicates a leak
204
bubbling in suction control chamber
- intermittent = BAD, suction is too low
- continuous = good,document
205
rules for clamping tubes
- don't clamp tube for >15 seconds w/o an order
- use rubber tooth, double clamps
206
congenital heart defects
- either TRouBLe or no trouble
- a peds pt with TRouBLe needs surgery now/soon to live, has slowed/delayed development, shortened life expectancy, grief,stress, and financial issues w/ parents, d/c home on cardiac monitor, week-month long hospital stay after birth, and needs referral to peds cardiologist
207
TRouBLe
- tRoubLe shunts blood from R - L
- trouBle is Blue (cyanotic)
208
Trouble defects
- Tetralogy of Fallot
- Truncus Arteriousus
- Transposition of Great Vessels
- Tricupsid Atresia
- Totally Anomalous of Pulmonary Vasculature (TAPV)
- except Left Ventricular Hypoplastic Syndrome
209
all children w/ or w/o TROUBLE have
a heart murmur, echo must be done to find cause
210
NO trouble defects
- ventricular septal defect
- patent ductos arteriousus
- patent formen ovale
- atrial septal defect
- pulmonic stenosis
211
4 defects of tetralogy of fallot
Pulmonary artery stenosis
Right ventricular hypertrophy
Overriding aorta
Ventricular septal defect
212
contact precautions
- anything enteric (GI, fecal/oral): c-diff, E. coli, chorea, dystenery, staph, RSV, herpes (shingles)
- PPE: private room preferred, cohort based on culture, handwashing, gown, gloves, dispoasble supply, dedicated equipment
213
droplet precautions
- for bugs traveling on large particles from coughing/sneezing.
- meningitis, H. influenzae B (epiglottitis), RSV is transmitted droplet but requries contact, RUBELLA
- PPE: private room referred, cohort based on culture, handwashing, surgical mask, goggles/faceshield, gloves, disposable supply
214
airborne precautions
- MM(no R)
- TB
- Varicella
- PPE: private room required, handwashing, gloves, N95, special filter mask for TB, pt must wear mask when leaving room, keep door closed, negative airflow
215
order to put on PPE
- reverse alphabet except mask is 2
1. gown
2. mask
3. goggles/face shielf
4. gloves
216
order to take off ppe
- alphabetical
1. gloves
2. goggles
3. gown
4. mask
217
micro/mini drip
60 gtts/mL
218
macro drip
10 gtts/mL
219
lb - kg
2.2lbs/1kg
220
lithium toxicity levels
therapuetic = 0.6-1.2
toxic = >2
221
lanoxin/digoxin toxicity levels
therapuetic = 1-2
toxic = >2
222
aminophylline (muscle spasm relaxer) toxicity levels
therapuetic = 10-20
toxic = >20
223
phenytoin toxicity levels
therapuetic = 10-20
toxic = >20
224
bilirubin toxicity in newborns
elevated = 10-20
toxic = >20
- when bilirubin is 14-15, hospitalization needed
225
kernicterus
billirbuin excess in brain, occurs when bilirubin is >20, may cause sterile meningitis or encephalopathy and become deadly
226
opisthotonos
position baby assumes when bilirubin hits brain (hyperextended posture, place them on side, MEDICAL EMERGENCY)
227
pathological vs physiological jaundice
- if newborn comes OUT yellow - pathologic
- if newborn tunrs yellow over 2-3days - physiologic
228
signs and symptoms of dumping syndrome
- drunk: staggering gait, low judgement, labile, all blood gone to gut
- shock: cold, clammy, tachycardia, pale
- acute abdominal distress: n/v/d, cramping, gaurding, increased BS, bloating, distention
drunk + shock = hypoglycemia
drunk + shock + acute abdominal distress = dumping syndrome
229
tx of dumping syndrome
- lower HOB
- fluids 1hr before or 2hrs after meals
- LOW carbs
*LOW*
- increase protein
230
kalemias...
do the same thing as the prefix EXCEPT, HR and urine output goes opposite
231
calcemias...
do OPPOSITE of prefix
232
magnesias...
do OPPOSITE of prefix
233
hypokalemia
- symptoms go DOWN except HR and urine output increases
- decreased LOC
- increased HR
- polyuria
- bradypnea
- hyporeflexia
- flaccidity
- paralytic ileus
234
hyperkalemia
- symptoms go UP except HR and urine output go DOWN
- agitation
- restless
- tachypnea
- bradycardia (low HR)
- peaked T waves
- oliguria
- ST elevation
- borborygmi
- diarrhea
- spasticity
- hyperreflexia
235
hypocalcemia s/s
- agitation
- irritably
- hyperreflexia
- spasms
- seizures
- tachycardia
- Chvostek sign (cheek)
- Trosseau sign (BP cuff, hand twitch)
236
hypercalcemia s/s
- decreased LOC
- bradycardia
- bradypnea
- flaccid
- hypoactive reflexes
- lethargy
- constipation
237
K+ is to heart as calcium is to
muscle
238
hyper/hypomagnesia have the same symptoms as hyper/hypocalcemia except
Chvostek and Trosseau are only in calcemia
239
hypErnatremia
- dEhyrdation
- hot, flushed, dry skin, thready pulse, increased HR
- GIVE FLUIDS
240
hypOnatremia
- fluid volume Overload
- crackles, distended neck veins
- fluid excess
- FLUID RESTRICTION AND LASIX
241
DKA causes
- hypernatremia d/t dehydration
- hyperkalemia d/t increased glucose
242
SIADH hypo or hypernatremia
SIADH would have hyponatremia
fluid overload
243
DI... hypo or hypernatremia
DI would have hypernatremia d/t dehdyration
244
early signs of electrolyte abnormalities
- numbness/tingling = paresthesia
- circumoral parasethesia = parasthesia of lips
- paresis = muscle weakness
245
treatment for HYPOkalemia
- give K+ chloride @ <40mEq/L
- if K+ chloride >40mEq/L, call HCP
246
treatment for HYPERkalemia
- give D5W and insulin to bring K+ into cell and out of blood
- temporary solution
- kayexalate LONG TERM (given enema or pill)
247
tie breaker rule for prioritization
1. brain
2. lung
3. heart
4. liver
5. kidney
6. pancreas
248
things you always make a priority
1. hemmorhage (not bleeding)
2. increased fevers >105 (can lead to seizure)
3. hypoglycemia (can lead to brain damage)
4. pulselessness/breathlessness (v-fib/asystole)
249
acetaminophen (tyelnol) antidote
N-acetylsystine
250
oral poisonings/overdoses
activated charcoal
251
cholinergic crisis (myasthenia crisis)
atropine
252
mag sulfate antidote
calcium gluconate
253
benzodiazepines antidote
flumazenil
254
iron poisoning antidote
deforoxamine
255
dig toxicity antidote
dig immune fab
256
EPS antidote
diphenhydramine
257
beta blockers antidote
glucagon
258
methotrexate antidote (used for ectopic pregnancy)
leucovorin calcium
259
methylregonovine (methergin) use
uterine contraction to stop PPH
260
opioid antidote
naloxone
261
anticholinergic antidote
neostigmine
262
TCAs antidote
physostigmine, sodium bicarbw
263
warfarin antidote
vitamin K
264
heparin antidote
protamine sulfate
265
contact illnesses
- MRS WEE
- Multidrug resistant organisms (MRSA)
- Respiratory infections
- Skin infections
- Wound infections
- Enteric (C. diff, E. coli, cholera, dysentry)
- eye infection (conjunctivits)
266
droplet illnesses
- SPIDERMAN
- Sepsis/scarlet fever/streptococcal pharyngitis
- Parvovirus B19/pneumonia/pertussis
- Influenzae
- Diptheria
- Epiglottitis
- Rubella
- Mumps/ Meningitis/ Mycoplasma/ Meningeal Pneumonia
- Adenovirus
267
airborne illnesses
- MTV
- Measles (rubeola)
- TB
- Varicella
268
2 point gait
move a crutch and opposite foot together for bilateral leg weakness
269
3 point gait
move 2 crutches and BAD leg together, followed by unaffected leg (BAD leg is not touching the ground)
270
4 point gait
everything is moving separetly, R crutch, left foot, L crutch, right foot
271
swing-through gait
used for non-weight bearing or amputees
unaffected foot passes tip of crutches
272
even number gaits for...
even (bilateral) problems
2- moderate
4- severe
273
use odd number gaits when
1 leg is affected
3 point gait - ONE leg
if patient is NONWEIGHT BEARING - swing through
274
going up and down the stairs with crutches
- "up with the good, down with the bad"
- when going UP stairs, use good foot first
- when going DOWN stairs, use bad foot first
*no matter what, both crutches move with bad leg*
275
when standing where should crutches be
6 in in front, 6 in laterally
276
canes
- should be on STRONG/UNAFFECTED side
- advance cane with OPPOSITE side for wide base of support
- handgrips level w/ waist
277
walkers
- pick it up, set it down, walk to it
- don't use walker to get up from chair, use arm rests on chair to get up then grab walker
- don't tie belonging to walker
278
paranoid delusions
people are out to kill me
279
grandiose delusions
"im christ", "i am the president"
280
somatic delusions
i have xray vision, i have worms inside arm
281
auditory hallucinations
- 1st choice
- voices telling you to harm yourself
282
visual hallucination
- 2nd choice
- i see bugs on wall
283
tactile hallucination
- 3rd choice
- i feel bugs on my arm
284
illusion
misinterpretation of reality
people are laughing, and pt beleives they are talking about them
285
functional psychosis
- functional in everyday life
- 90% of people w/ psychosis
- chemical imbalance in brain d/t schizophrenia, schizoaffective disorder, major depression, and mania
- bipolar pts included during mania
286
psychosis of dementia
- actual brain destruction/damage d/t alzheimers, stroke, or organic brain syndrome
- anything that says senile/dementia
287
psychotic delirium
- temporary, sudden, dramatic episode, episodic secondary to something else
- loss of reality
- common w/ UTI, thyroid imbalance, adrenal crisis, electrolytes, certain meds
288
functional psychosis tx
- acknowledge feelings
- present reality
- set limits
- enforce limits
289
dementia psychosis tx
- acknlowedge feelings
- redirect
290
delirium psychosis tx
- acknowledge feeling
- reasurre safety and temporariness of condition
- redirection
- tx underlying cause
291
flight of ideas
rapid flow of thought
292
word salad
throw words together and toss out (sicker than flight of ideas)
293
neologisms
making up words
294
narrowed self-concept
when a psychotic pt refuses to change clothes or leave the room
*don't make psychotic pt do something they don't want to do*
295
idea of reference
thinking everyone is talking about you
296
diabetes insipidous
- polyuria, polydipsia, crave salt, leading to dehydration secondary to LOW ADH (fluid issue)
- HIGH urine output
- LOW URINE specific gravity (d/t excretion of water)
- HIGH SERUM specific gravity (d/t low volume)
297
SIADH
- urinary retention, FVO, oliguria, no thirst d/t HIGH ADH
- LOW urine output
- HIGH URINE specific gravity (d/t increased water retention)
- LOW SERUM specific gravity (d/t increased volume)
298
tx for type 1 dibetes (DIE)
- diet
- insulin (most important)
- exercise
299
tx for type 2 diabetes (DOA)
- diet (most important) - calorie restriction, 6 small meals/day
- oral hypoglycemics
- activity
300
R- regular insulin
- clear solution, IV drip, short-acting
- onset = 1hr
- PEAK=2hr
- duration= 4hr
- 1-2-4
301
N-NPH/Intermediate Insulin
- cloudy suspension, precipitates, can't give IV
- onset = 6hrs
- PEAK = 8-10hrs
- duration= 12hrs
- 6-8-10-12
302
lispro(humalog)
- DON'T give before a meal, GIVE WITH A MEAL
- onset = 15 min
- PEAK = 30min
- duration = 3hrs
- 15-30-3
303
glargine
- long acting
- NO peak
- duration= 12-24hrs
- little to no risk for hypoglycemia
- CAN give @ bedtime
304
what invalidates insulin
- opening it (new exp is 28 days after opening)
- unopened msut be refridgerated, open is optional
- teach pt to refridgerate @ home
305
exercise vs insulin
- insulin and exercise do the same thing =DROP GLUCOSE
- lower dose of insulin before exercise
306
illness and type 1 diabetes
- glucose rises when sick, insulin needs increase
- take insulin even when not eating
- sips of H2O d/t dehydration
- hyperglycemia+dehydration= sick
307
causes of complication of DM
- TOO MUCH insulin (#1 cause)
- TOO LITTLE food
- TOO MUCH exercise
308
signs of hypoglycemia
- "drunk pt in shock"
- drunk: staggering gait/speech, labile, cerebral impairment, low reaction time, social inhibition, and judgement
- shock: vasomotor response, tachycardia, tachypnea, HYPOtensive, cold/clammy mottled skin
309
DKA "diabetic coma" causes
- causes: increased food, too little insulin/exercise
- #1 CAUSE IS ACUTE URI W/I LAST 2 WKS
310
DKA symptoms
- Dehydration: dry skin, poor skin turgor, warm
- Ketones: in serum, Kussumals, HYPERkalemia
- Acidosis: acetone breath, anorexia d/t nausea
311
DKA tx
- regular insulin IV
- IVF (200mL/hr)
312
HHNK, HHNS
- think DEHYDRATION
- skin is flushed, dry, decreased skin turgor, tachycardia, low BP
- FLUID VOLUME DEFICIT
- #1 intervention is to REHYDRATE
313
hypoglycemia tx
- give sugars or rapidly metabolized carbs (juice, candy, soda, milk, honey, icing)
- sugar + starch or protein (apple juice + turkey, milk)
- glucagon IM if mother is @ home
- dextrose IV (D10, D50) if @ hospital
314
long term complications of diabetes
- related to low perfusion: renal failure, HF, poor healing
- related to peripheral neuropathy: gangene, ulcers, incontinence, foot injury
315
phenothiazines
- thorazine, compazine, haloperidol
- first gen
- all end in -zine
- side effects: anticholinergic (dry mouth, urinary retention), blurred vision, constipation, drowsiness, EPS, Fotosensitivity, aGranulocytosis
- worry about safety and infection
316
deconate
- long acting antipsychotic for those who are noncompliant to meds
- court ordered
317
TCAs
- amitryptilline (elavil), trofanil (imipramine, aventyl
- happy pills
- side effects: Anticholinergic effects (urinary retention, dry mouth), Blurred vision, Constipation, Drowsiness, Euphoria (happy)
- won't see effects for 2-4wks educate!
- cardiotoxic
318
benzodiazepines
- valium, diazepam, lorazepam
- anti-anxiety, minor antipsychotics
- ZEP in all names
- don't use for > 2-4wks
- work rapidly
- side effects: Anticholinergic effects, Blurred vision, Constipation, Drowsiness
319
major and minor antipsychotics
- major antipsychotics (phenothiazines) are given @ same time as minor antipsychotics (benzodiazepines) to ensure acute relief from benzos and long term relief from major antipsyhcotics
320
MAOIs
- isocarboxazid (MARplan), Phenelzine (NARdil), Trancyclopromine (PARnate)
- side effects: anticholinergic, blurred vision, constipation, drowsiness
- avoid thyrmaine rich foods (can lead to HTN crisis) - raisans, fermented food, aged cheese, yeast, banana, avacado, organ meats, smoked, dried, cured, pickled, no EtOH, caffiene, licorice, soy
- DONT TAKE W OTCs
321
lithium
- decreases mania
- side effects (3Ps): peeing (polyuria), pooping (diarrhea), and paresthesia (EARLIEST SIGN OF ELECTROLYTE IMBALANCE), and tremors (go away)
- toxic side effects: metallic taste, severe diarrhea (give fluids, notify HCP)
- monitor Na+ levels (LOW NA CAUSES TOXICITY)
- increased Na+ makes lithium ineffective
- drink gatorade when sweating
322
prozac (fluoxetine)
- side effets: anticholinergic, blurred vision, constipation, drowsiness, euphoria
- causes insomnia (give BEFORE 12pm)
- MONITOR ADOLESCENTS FOR INCREASED SUICIDE RISK
323
neuroleptic malignant syndrome
- seen in elderly and young white schizophrenics
- increased temp >105
- their dose should be 1/2 usual dose
- may be from overdose of haldol
- call rapid
324
clozaril (Clozapine)
- atypical antipsychotic
- sometimes works on BP
- side effects: aGRANULOCYTOSIS, decreases bone marrow suppression
325
ziprasidone BBW
causes QT prolongation
don't give w/ cardiac hx
326
zoloft (sertraline)
- antidepressant
- can cause insomnia
- interacts w/ St johns wort (serotonin syndrome) and warfarin (bleeding) - decrease dose in both cases
327
serotonin syndrome
- SAD Head
- Sweating
- Apprehension
- Dizziness
- Headache
328
normal pre-term vitals
HR= 120-180bpm
RR= 50-70bpm
SBP = 40-60mmHg
329
normal newborn vitals
HR = 100-160bpm
RR = 35-55bpm
SBP = 50-70mmHg
330
normal infant vitals (1mo-1year)
HR = 80-140bpm
RR = 30-40
SBP = 70-100mmHg
331
toddler vitals (1-3yo)
HR = 80-130bpm
RR = 20-30bpm
SBP = 70-110mmHg
332
preschool vitals (3-6yo)
HR = 80-100bpm
RR = 20-30bpm
SBP = 80-110bpm
333
school age vitals (6-12yo)
HR = 70-100bpm
RR = 18-24bpm
SBP = 80-120mmHg
334
adolescent vitals (12+)
HR = 60-100bpm
RR= 14-22bpm
SBP= 100-120mmHg
335
nephrolithiasis
kideny stones
336
urolithasis
stone anywhere in urinary tract
337
pyelonephritis
UTI in kidney
338
cystitis
UTI in bladder
339
glomerulonephritis
kidney inflammation post strep infection (cola colred urine, frothy urine, periorbital edema, HTN)
