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Mark Klimek Yellow Book > Yellow Book > Flashcards

Yellow Book Flashcards

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1
Q

Rule of the B’s?

A

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

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2
Q

pH 7.30 HCO3 20

A

⬇️=acidosis ⬇️= metabolic

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3
Q

pH 7.58 HCO3 (bicarbonate) 32

A

⬆️ = alkalosis ⬆️ = metabolic

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4
Q

pH 7.22 HCO3 (bicarbonate) 30

A

⬇️= acidosis ⬆️= respiratory

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5
Q

Providing care to a client with the following blood has resulted: pH 7.32, CO2 49, HCO3 29, PO2 80, and SaO2 90%. Based on these results,the client is experiencing..

A

⬇️= acidosis ; ⬆️= respiratory

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6
Q

MacKussmaul

A

The only acid base to cause Kussmaul respirations is metabolic acidosis

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7
Q

Acid

A

As the pH goes, so goes my patient except for Potassium

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8
Q

Up

A

Hypokalemia,alkalosis, HTN, Tachycardia, Tachypnea, Seizures, Irritability, Spastic, Diarrhea, Borborygme, hyperreflexia etc

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9
Q

Down

A

Hyperkalemia, acidosis, HTN, bradycardia, constipation, absent bowel sounds, flacid, bradypnea

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10
Q

Causes of acid-base imbalances

A

Is it lung? If yes, then it’s respiratory.
Ask your self..
Are they overventilating or underventilating.
If it is overventilating, pick alkalosis.
If it is underventilating pick acidosis.

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11
Q

Causes of acid-base imbalances:

A

If it is not the lung, then its metabolic. If the patient has prolonged gastric vomiting or suction, pick alkalosis.

For everything else that isn’t lung, pick metabolic acidosis. When you don’t know what to pick choose metabolic acidosis.

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12
Q

What are high pressure alarms triggered by?

A

High pressure alarms are triggered by

INCREASED resistance to air flow.

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13
Q

What are the obstructions that trigger high pressure alarms?

A

High pressure alarms are triggered by increased resistance to airflow and can be caused by obstructions of the types
(Kinked tube) unkink, (water in tube) empty, (mucus in airway) cough and deep breathe.

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14
Q

What are low pressure alarms triggered by?

A

Low pressure alarms are triggered by DECREASED resistance to airflow.

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15
Q

How are low pressure alarms triggered by disconnections?

A

Low pressure alarms are triggered by decreased resistance to airflow and can be caused by disconnection of the

Tubing (reconnect it) , oxygen sensir tube (reconnect it UNLESS tube is on the floor - bag them and call RT if this happens)

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16
Q

Respiratory Alkalosis means what?

A

Respiratory alkalosis means ventilator settings may be too HIGH

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17
Q

Respiratory acidosis means what?

A

Respiratory acidosis means ventilator setting may be too LOW

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18
Q

What does “wean” mean?

A

Gradually decreased with the goal of getting off altogether

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19
Q

What is Maslow’s highest priority to lowest priority?

A
  1. Physiological
  2. Safety
  3. Comfort
  4. Psychological (problems within the person)
  5. Social (problems with other people)
  6. Spiritual
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20
Q

Arrange from highest to lowest priority using Maslow’s

A 
Electrolyte Imbalance (Physiological) 
Fall Risk (Safety) 
Pain in elbow (Comfort) 
Denial (Psychological) 
Pathological family Dynamics (Social) 
Spiritual Distress (Spiritual)
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21
Q

What are the 5 stages of grief?

A

Denial
Anger
Depression
Acceptance

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22
Q

The #1 problem in abuse is

A

Denial

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23
Q

What is Denial?

A

Denial is the REFUSAL to accept the REALITY of their problem.

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24
Q

How to treat denial?

A

CONFRONT it by pointing out to the person the difference between what they SAY and what they DO. In contrast, SUPPORT the denial of loss and grief

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25
What is dependency?
When the ABUSER gets the significant other to do things for them or make decisions for them.
26
What is Codependency?
When the SIGNIFICANT OTHER derives positive SELF-ESTEEM from doing things for or making decisions for the ABUSER
27
How to treat dependency or codependency?
Set LIMITS and ENFORCE them. Agree in advance on what requests are allowed then enforce the agreement
28
When treating dependency/codependency?
Work on the SELF-ESTEEM of the codependent person
29
Manipulation
When the ABUSER gets the SIGNIFICANT OTHER to do things for him/her that are not in the INTEREST of the SIGNIFICANT OTHER. The nature of the act is HARMFUL or DANGEROUS to the SIGNIFICANT OTHER.
30
Treating Manipulation
Set LIMITS and ENFORCE
31
Wernicke’s (Kosakoff’s) Syndrome
PSYCHOSIS induced by vitamin B1 (thiamine) deficiency
32
Primary Symptoms of Wernicke’s (Korsakoffs) Syndrome
AMNESIA (MEMORY LOSS) with CONFABULATION (MAKE UP STUFF)
33
Wernicke’s (Korsakoff’s) Syndrome charteristics
1. Preventable (take vitamin) 2. Arrestable (take vitamin) 3. Irreversible (kills brain cells)
34
Antabuse/Revia is what?
Aversion Therapy
35
Antabuse/Revia effectiveness
The onset and duration of effectiveness of Antabuse/Revia is 2 Weeks
36
Patient tracing with Antabuse/Revia
Avoid ALL forms of ALCOHOL to avoid NAUSEA, VOMITING, DEATH
37
What are example of products that contain alcohol?
Mouth wash, cologne, perfume, aftershave, elixir, most OT liquid medicines, insect repellant, vanilla extract, vinagerettes, hand sanitizer
38
What occurs with alcoholics?
Every alcoholic goes through ALCOHOL WITHDRAWAL SYNDROME. Only a minority get DELIRIUM TREMENS
39
Alcohol Withdrawal Syndrome
ALCOHOL WITHDRAWAL SYNDROME is not life-threatening. DELIRIUM TREMENS can kill you
40
Alcohol Withdrawal Syndrome
Patients with ALCOHOL WITHDRAWAL SYNDROME are not a danger to themselves or others. Patients with DELIRIUM TREMENS are dangerous to self and others.
41
Would you place an AWS (Alcohol Withdrawl Syndrome) or DT (Delirium Tremens) patient in a semiprivate room,any location ?
AWS (Alcohol Withdrawal)
42
Would you place an AWS (Alcohol Withdrawl Syndrome) or DT (Delirium Tremens) patient in a private room near the nurses station?
DT (Delirium Tremens)
43
Which patient gets a regular diet AWS or DT?
AWS
44
Which type of diet is a DT patient have?
Clear liquid or NPO diet (risk for aspiration)
45
Which patient is up at liberty?
AWS
46
Restricted to bedrest with no bathroom privileges
DT
47
Utilizing no restraints
AWS
48
Usually restrained with either vest or 2 point (1 arm and 1 leg)
DT
49
Give anti-HTN medication
AWS and DT
50
Give tranquilizer medication
AWS and DT
51
Multivitamin to prevent Wernicke’s
AWS and DT
52
For Aminoglycosides,think
A mean old mycin
53
When are antibiotics/aminoglycosides used?
To treat serious, life-threatening , resistant infections
54
Aminoglycosides
All Aminoglycosides end in MYCIN, but not all drugs that end in MYCIN are Aminoglycosides
55
What are some examples of wannabe mycins?
Azithromycin , Clarithromycin, Erythromycin
56
What are some examples of Aminoglycosides?
Streptomycin, Cleomycin, Tobramycin, Gentamycin,Vancomycin, Clindamycin
57
When remembering toxic effects of mycins think
Mice = ears
58
What is the toxic effect of Aminoglycosides and what must you monitor?
Ototoxicity; monitor hearing, balance and tinitus
59
Toxic effect of Aminoglycosides?
The human ear is shaped like a KIDNEY so another toxic effect of Aminoglycosides is NEPHROTOXICITY so monitor CREATININE
60
Aminoglycosides and relation to Cranial nerves
The number 8 drawn inside the ear reminds you of cranial nerve 8 and frequency of administration Q8H
61
Aminoglycosides are not given PO usually unless in these two cases:
1. HEPATIC ENCEPHALOPATHY( liver coma,ammonia induces encephalopathy) ( due to high AMMONIA level) 2. Pre-op BOWEL surgery
62
Who can sterilize my bowel?
Neo Mycin | Kano Mycin
63
What is the reason for drawing trough and peak levels?
Narrow therapeutic level
64
When do you ALWAYS draw the trough?
30 minutes before next dose
65
When do you draw the Peak level of sublingual medications?
5-10 minutes after drug dissolves
66
When do you draw the Peak level of IV medications?
15-30 minutes after medication is finished
67
When do you draw the peak level of IM medications?
30-60 minutes after injecting it
68
When do you draw the Peak level of SQ medications?
Depends on type of insulin
69
When do you draw the peak level of PO medications?
Not necessary
70
What are biological agents in Category A?
``` Staph B Small Pox Tularemia Anthrax Plague Hemorrhagic illness Botulism ```
71
What are Biological Agents im category B?
All others
72
What are Biological Agents in Category C?
Nipeh Virus | Hanta Virus
73
When it comes to Biological Agents
Category A is THE WORST, Then Category B, Then Category C
74
Small Pox
Inhaled transmission/ on airborne precautions dies from septicemia - no treatment rash starts around mouth first Category A
75
Tularemia
Chest symptoms Dies from respiratory failure Treat with streptomycin Category A
76
Anthrax
``` Spread by inhalation Looks like the flu Does from respiratory failure Treat with supro, PCN, and streptomycin Category A ```
77
Plague
Spread by inhalation Has the 3 H’s: Hemoptysis (coughing up blood) Hematemesis (vomiting up blood) , Hematochezia (blood in stool) Deis from respiratory failure and DIC (bleed to death) Treat with Doxycycline and Mycins No longer communicable after 48 hours of treatment Category A
78
Hemorrhagic Illnesses
Primary symptoms are petechiae (pinpoint spots) and ecchymoses (bruising) High % fatal Category A
79
Botulism
It is ingested 3 major symptoms: Descending paralysis fever but is sleet does from respiratory arrest Category A
80
What are some examples of chemical agents that cause bioterrorism?
Mustard Gas Cyanide Phosgine Chlorine Sarin
81
What are the primary symptoms of mustard gas ?
Blisters (Vesicant)
82
What is the primary symptoms of Cyanide and how do you treat it?
Treat with Sodium Thiosulfate IV | Respiratory Arrest
83
What is the primary symptom of Phosgine Chlorine?
Choking is the primary symptom
84
What are the symptoms of Sarin? | 🔆 Hint its a nerve agent 🔆
BB SLUDGE - just remember every secretion in your body is being excreted excessively ``` Bronchoapasm Bronchorrhea Salivating Lacrimating (tears) Urination Diaphoresis/Diarrhea G.I upset Emesis ```
85
What do you use when cleansing patients exposed to chemical agents?
All chemical agents require only soap and water cleansing except Sarin which requires bleach.
86
Which agents do you isolate the patient for?
Biological Agents
87
Which agents do you decontaminate for?
Chemical agents
88
How does decontamination work?
Gather exposed people Take to decontamination center where people remove clothing, shower , dress in non-contaminated clothes, then release to other services. Put contaminated clothing in special bag and throw away( be sure not to touch it)
89
Calcium Channel Blockers
They are like VALIUM for your heart. What does that mean? | It relaxes the heart!
90
Calcium Channel Blockers
NEGATIVE inotropic,chronotropic , dromotropic
91
Inotropic
Strength of heart
92
Positive Inotropic
Strong heartbeat
93
Negative Inotropic
Weak heartbeat
94
Chronotropic
Rate of heartbeat
95
Positive chronotropic
Fast heartbeat
96
Negative Chronotropic
Slow heartbeat
97
Dromotropic
Conductivity of heart
98
Positive Dromotropic
Excitable heart
99
Negative Dromotropic
Blocks/slow conduction
100
Positive Inotropic chronotropic and Dromotropic is seen with which medications?
Atropine, Epinephrine and norepinephrine
101
Negative Inotropic chronotropic am Dromotropic is seen with which medications?
Calcium channel Blockers and Beta Blockers
102
What do calcium channel blockers treat? (Indications)
Antihypertensives (decrease BP) Anti Angina (imbalances between 02 supply and demand) Anti Atrial Arrhythmic (Atrial Flutter and Atrial fibrillation)
103
What are some of the side effects of calcium channel blockers?
Headache | Hypotension
104
Names of calcium channel blockers
I sop zem dipine in the calcium channel ( “zem”, “dipine”, “verapamil/isoptin”)
105
“QRS” depolarization always refers to
Ventricular (not atrial,junctional or nodal)
106
“P wave” refers to
Atrial
107
Asystole
A lack of QRS Deploarization (flat line)
108
Atrial Flutter
Rapid P-wave depolarizations in a saw-tooth pattern (flutter)
109
Atrial Fibrillation
Chaotic P-wave depolarizations
110
Ventricular Tachycardia
Wide bizarre QRS’s
111
Premature Ventricular Contractions (PVC)
Periodic wide, bizarre QRS’s
112
You will be concerned about PVC’s if:
More than 6 per minute 6 in a row PVC falls on T-Wave of previous beat
113
What are the lethal arrhythmias?
Asystole and ventricular fibrillation
114
What is the potentially life-threatening arrhythmias?
1. V-Tach (Venticular- Tachycardia) 2. A- Fib (Atrial - Fibrillation) 3. A-Flutter (Atrial- Flutter)
115
IV push drugs
When dealing with an IV push drug if you don’t know go SLOW except ADENOCARD
116
What is the treatment for PVC’s?
Lidocaine and Aminodarone
117
What is the treatment for V-Tach?
Lidocaine and Amiodarone
118
What are the treatments for supraventicular arrhythmias?
``` ABCD Adenocard/Adenosine Betablocker ( end in lol) Calcium Channel Blockers Digitalis/ Digoxin (Lanoxin) ```
119
What is the treatment for V-Fib
You will actual Defibrillator
120
What is the treatment for Asystole?
``` Give Epi (Epinephrine) FIRST! Then give Atropine ```
121
What is the purpose of a chest tube?
The purpose of a chest tube is to re-establish NEGATIVE pressure in the pleural space.
122
What does the chest tube remove from the pneumothorax?
The chest tube removes air.
123
What does the chest tube remove from the hemothorax?
The chest tubes removes blood.
124
What does the cheat tube remove from the pneumohemothorax?
The chest tube removes air and blood.
125
Chest Tube High
When the chest tube is APICAL(HIGH) for AIR. Aka APEX
126
Chest Tube Low
When the chest tube is BASILAR (LOW), for BLOOD. Aka BASE(BOTTOM OF LUNG)
127
How many chest tubes are needed for a patient with unilateral pneumohemothorax?
2 chest tubes are needed | 1 apical and one basilar on the side that has pneumohemothorax.
128
How many chest tubes are needed for a pt with bilateral pneumothorax?
2 chest tubes are needed | Both are placed apical
129
How many chest tubes are needed for a pat post-op chest surgery/ chest trauma?
Assume unilateral pneumohemothorax 2 chest tubes are needed 1 apical and 1 basilar on side of pneumohemothorax
130
Chest Tube Rules
In routine NEVER clamp chest tube. In emergency CLAMP the chest tube
131
What do you do if you kick over the collection bottle?
Set it back up (Not an emergency)
132
What do you do if the water seal breaks?
FIRST- Clamp it , cut tube away from device | BEST- Submerge the tube under water then unclamp
133
What do you do if the chest tube comes out?
FIRST- Cover with a gloved hand | BEST- Cover the hole with vaseline gauze put a dry sterile dressing on top tape on 3 side’s
134
If theres bubbling in the water seal intermittently what do you do?
Its is normal for this to occur
135
If there is bubbling in the water seal continuous what does it mean?
This represents a bad sign
136
If there’s bubbling in the suction control chamber intermittently what does that mean?
That is a bad sign
137
If there is bubbling in the suction control chamber continuously what does that mean?
It is a good sign
138
Tube Clamping Rules
Never clamp longer than 15 SECONDS without Dr’s order use RUBBER TIPPED DOUBLE CLAMPS
139
Congenital Heart Defect
Every congenital heart defect is either TROUBLE or NO TROUBLE
140
Shunt Flow
Right to Left Shunt
141
B
Blue
142
T
Starts with the letter T
143
What are some examples of “TRouBLe” Congenital heart defects?
Trunks arteriosis,Trans. Position of great vessels, Tetrology of Fallot, Tricuspid stenosis,TAPZ, left ventricular hyperplasmic syndrome
144
What are some examples of “No TRouBLe” Congenital heart defects?
Patent fore. Ov., ventricular septal defect,pulmonary stenosis
145
Akk CHD kids will have 2 things, whether TRouBLe or NO TRouBLe?
1. Murmurs | 2. Echocardiogram
146
Four defects present in Tetralogy of Fallot are
``` VarieD PictureS Of A RancH Ventricular Defect Pulmonary Stenosis Overriding Aorta Right Hypertrophy ```
147
How do you measure crutches for a person?
2-3 finger widths below anterior axillary fold to a point lateral and slightly in front of foot.
148
When the handgrip is properly placed,the angle of elbow flexion will be what degrees?
30 Degrees
149
2 point gait
Step 1 : move one crutch and opposite foot together Step 2: move other crutch and other foot together (remember 2 points together for a 2 point gait) used for minor weakness on both legs
150
3 point gait
``` Step 1- one crutch Step 2- opposite foot Step 3- other crutch Step 4- other foot Nothing moves together and everything is really weak ```
151
Swing through
Those whom have two braced extremities (Amputees)
152
When to use which gait?
Use the EVEN numbered gaits when weakness is EVENLY distributed. 2 point for mild problems and 4 point for severe
153
When to use which gait?
Use the ODD numbered gait when one leg is EFFECTED
154
Which foot leads when going up and down stairs on crutches?
UP with the GOOD and DOWN with the BAD. The crutches always move with the BAD leg.
155
Cane proper usage
Hold cane on the UNEFFECTED SIDE . Advance cane with the OPPOSITE side for a wide base of support.
156
What is the correct way to use a walker?
Pick it up, Set it down and walk to it
157
What is a big NO when it comes to walkers?
Do not tie by belongings to the front of walker
158
What is the correct way to get up from a chair using a walker?
Hold on to chair,stand up then grab walker
159
What is the difference between a non psychotic person and a psychotic person?
A non-psychotic person has insight (know they are sick and it is messing them up) and a psychotic person has no insight and is not reality-based.
160
Delusion
A false,fixed belief or idea or thought. There is no sensory component
161
What are the 3 typed of delusions?
Paranoid/Persecutory Grandiose Somatic
162
Paranoid or Persecutory Delusion
False | Fixed belief that people are out to harm you
163
Grandiose delusion
False | Fixed belief that you are superior
164
Somatic Delusion
False | Fixed belief about a body part
165
Hallucination
A False | Fixed sensory experience
166
What are the 5 types of hallucinations?
1. Auditory (hearing) 2. Tactile (feeling) 3. Visual (seeing) 4. Gustatory (tasting) 5. Olofactory (smelling)
167
Illusion
A misinterpretation of reality | It is a sensory experience
168
What is the difference between illusions and hallucinations?
With illusions there is a referent in reality (something to which they can refer to)
169
When dealing with a patient experiencing delusions,hallucinations or illusions,first ask yourself, “ What is their problem?” (What are the different problems that could be going on?)
Functional psychosis of dementia and psychotic delirium
170
What are the different types of functional psychosis?
Schizophrenia Schzioaffected (mood disorder thought process) Major depression Mania
171
With a functional psychosis the patient has the potential to learn reality. How can you teach reality to a functional psychotic?
1. Acknowledge feelings 2. Present reality Positive- what is reality Negative- what is reality 3. Set a limit 4. Enforce the limit
172
Psychosis of Dementia
People with Alzheimer’s, Wernicke’s, Organic Brain Syndrome and dementia. This patient has a brain destruction problem and can not learn reality.
173
How do you deal with a person with psychosis of Dementia?
1. Acknowledge feeling | 2. Redirect- get them to express the fixation that they are expressing inappropriately to appropriately
174
Psychotic Delirium
Temporary Episodic Secondary dramatic sudden onset of loss of reality due to chemicak im alance (UTI, Thyroid imbalance,electrolyte imbalance)
175
How do you deal with a patient with psychotic Delirium?
1. Acknowledge feeling | 2. Reassure them of safety and temporaryness
176
How do you deal with a person with psychosis of Dementia?
1. Acknowledge feeling | 2. Redirect - get them to express the fixation that they are expressing inappropriately to appropriately
177
Psychotic Delirium
Temporary episodic secondary dramatic sudden onset of loss of reality due to chemical im alance (UTI,thyroid imbalance,electrolyte imbalance)
178
How do you deal with a patient with psychotic delirium?
1. Acknowledge feeling | 2. Reassure them of safety and temporaryness
179
What are the different types of loosening of association?
Flight of ideas, word salad, neologisms
180
Flight of ideas
Stringing phrases together (loosely associated phrases;tangentiality)
181
Word Salad
Throw words together
182
Neologisms
Making up new words
183
Narrowed self-concept
When a PSYCHOTIC recuses to change their clothes or leave the room. 🔅Dont make a psychotic do something they don’t want to do🔅
184
Ideas of reference
You think everyone is talking about you
185
Dementia Hallmarks
Memory loss,inability to learn. | 🔅functional scan teach,dementias cannot🔅
186
Always acknowledge
Feelings
187
What are the 3 “Re’s”?
Reassure Redirect Reality
188
Diabetes Mellitus
An error of glucose metabolism
189
Diabetes insipidus
Dehydration, polyurethane, polydipsia
190
Type 1 Diabetes Mellitus
Insulin dependent (not producing insulin) Juvenile onset Ketosis prone
191
Type 2 Diabetes Mellitus
Non insulin dependent (body resisting insulin) Adult onset Non ketosis prone
192
Signs and symptoms of diabetes mellitus
Polyuria (urine a lot) Polydipsia (drink a lot) Polyphagia (eat/swallow a lot)
193
Treatment for Type 1 Diabetes Mellitus
1. Insulin 2. Exercise 3. Diet (calories from carbs)
194
Treatment for type 2 Diabetes Mellitus
1. Diet 2. Activity 3. Oral hypoglycemics
195
Diet of Diabetics
Calorie (carbs) restriction | Need to eat 6x per day smaller more frequent meals
196
Insulin
Insulins acts to LOWER blood sugar
197
Insulin Type:R
R= Regular,Rapid,Run(IV) Onset: 1hr Peak: 2hr Duration: 4hr
198
Insulin Type: N
N= NPH ,Not in the bag, Not so fast, Not clear (cloudy) Onset: 6hr Peak: 8-10hr Duration: 12hr
199
Insulin Type: Humalog
``` Insulin Lispro Fastest Onset:15 min Peak: 30min Duration: 3hrs ```
200
Insulin Type: Lantus
Long acting Slow absorption No peak Duration: 12-24hr
201
With insulin remember:
Check expiration date | Refrigerate but once open no refrigeration
202
Insulin & Exercise
Exercise POTENTIATES insulin: if more exercise, need LESS insulin. If less exercise,need MORE insulin.
203
Sick day rules for insulin
Take insulin Take sips of water Stay active as possible
204
Low blood sugar in type 1 Diabetes Mellitus (insulin shock) caused by:
Not enough food Too much insulin Too much exercise
205
Why is low blood sugar in type 1 Diabetes Mellitus (insulin shock) dangerous?
Permanent brain damage
206
Signs and symptoms of low blood sugar in type 1 Diabetes Mellitus (insulin shock):
Cerebral impairment,vasomotor collapse, cold, clammy, slow reaction time , *drink shock*
207
Treatment for low blood sugar in Type 1 Diabetes Mellitus (insulin shock)
Administer rapidly metabolizable carbohydrate (candy,honey) Ideal combination: sugar and protein If unconscious IV D5 IM glucagon
208
High blood sugar in Type 1 Diabetes Mellitus /DKA/Diabetic coma is caused by:
Too much food Not enough insulin Not enough exercise #1 cause is acute viral upper respiratory infection within the last 10 days
209
Signs and symptoms of High Blood Sugar in Type 1 Diabetes Mellitus/DKA/Diabetic Coma
Dehydration Ketones,Kussmaul Breathing,High K+ Acidosis,Acetone breath ,Anorexia
210
Treatment for High Blood Sugar in Type 1 Diabetes Mellitus/DKA/Diabetic Coma
``` Insulin IV (R) IV rate flow 200mg/hr ```
211
Treatment for low blood sugar in type 2 Diabetes Mellitus:
Adminster rapidly metabolizable carbohydrate (candy,honey) Ideal combination: sugar and protein If unconscious IV D50 IM glucagon
212
High Blood Sugar in Type 2 Diabetes Mellitus
Called HHNK or HHNC - Hyperosmolar, Hyperglycemia, Non-Ketotic Coma This is severe dehydration
213
Signs and symptoms of High Blood Sugar in Type 2 Diabetes Mellitus
Hot,dry, increased HR decreased skin turgor
214
Treatment for High Blood sugar in Type 2 Diabetes Mellitus
Rehydration
215
Long term complications of HHNC are related to
Poor tissue perfusion | Peripheral neuropathy
216
Which lab test is the best indicator of long-teem blood glucose control (compliance/effectiveness/adherence)?
Ha1c (average blood sugar over last 90 days)
217
Diabetes
Cold and clammy - Get some candy | Hot and dry - Sugar’s high
218
What is the therapeutic and toxic levels for Lithium
Therapeutic level: 0.6-1.2 | Toxic level: > or equal 2
219
What is the therapeutic and toxic levels for Lanoxin (Digoxin) ?
Therapeutic Level: 1-2 | Toxic level: > or greater 2
220
What is the therapeutic and toxic levels for Aminophylline?
Therapeutic level: 10-20 | Toxic Level: > or greater 20
221
What is the therapeutic and toxic levels for Bilirubin?
``` Therapeutic level (elevated level) :10-20 Toxic level: > 20 ```
222
Kernicterus
Bilirubin in the CSF
223
Opisthotonos
Position of slight extension in neck seem in patients with Kernicterus (bad sign)
224
Dumping Syndrome
Post-Op gastric surgery complication in which gastric contents dump too quickly into the duodenum
225
Hiatal Hernia
Regurgitation of acid into esophagus, because upper stomach herniates upward through the diaphragm
226
Hiatal Hernia or Dumping Syndrome: | Gastric contents move in the right direction at the wrong rate
Dumping Syndrome
227
Gastric contents move in the wrong direction at the right rate
Hiatal Hernia
228
Gerd like symptoms when supine and after eating
Hiatal Hernia
229
ADS S & S
Acute Dumping Syndrome Abdominal distress (cramping, N/V, hyperactive BS (borborygmil) Drunk- cerebral impairment Shock (vasomotor collapse, rapid threat HR)
230
Treatment for Hiatal Hernia
HOB during & 1 hour after meals - HIGH Amount of fluids with meals - HIGH Carbohydrate content of meals - HIGH GOAL: Get an empty stomach
231
Treatment for Dumping Syndrome
HOB during & 1 hr after meals - LOW Amount of fluids with meals - LOW Carbohydrate content of meals -low Goal: get a full stomach
232
Hyperkalemia | Hypokalemia
Kalemias do the SAME as the prefix except for HEART RATE and URINE OUTPUT Hyperkalemia = ⬆️ , HR ⬇️ , Urine output ⬇️ Hypokalemia = ⬇️, HR ⬆️, Urine output ⬆️
233
Hypercalcemia | Hypocalcemia
Calcemias do the OPPOSITE of the prefix. No exceptions. ``` Hypercalcemia = ⬇️ Hypocalcemia= ⬆️ ```
234
Two signs of neuromuscular irritability associated with
Hypocalcemia 1. Chvostek’s Sign= cheek tap➡️ facial spasm 2. Trousseau’s Sign= BP cuff➡️ carpal spasm
235
Hypermagnesemia | Hypomagnesemia
Magnesemias do the OPPOSITE of the prefix. Hypermagnesemia=⬇️ Hypomagnesemia=⬆️
236
Which to Pick
If symptom involves nerve or skeletal muscle, pick CALCIUM. For any other symptoms, pick POTASSIUM (generally anything effecting BLOOD PRESSURE)
237
HypErnatermia
dEhydration (dry skin, thready puls,rapid HR)
238
HypOnatremia
Overload (crackles, distended neck veins)
239
Electrolyte Disorder
The earliest sogn of any electrolyte disorder is NUMBNESS & Tingling (paresthesias)
240
Electrolyte Imbalance
The universal sign-symptom of electrolyte imbalance is MUSCLE WEAKNESS (paresis)
241
What medication is never IV Push
Never push POTASSIUM IV
242
Potassium w/ Fluids
Not more then 40mEq of K+per liter of IV fluid
243
How increase Potassium
Give D5W & Insulin (not permanent) to decrease K+
244
Kayexalate
K+ exists late (not as quick more of a permanent solution)
245
In a patient with hypercalcemia, which pattern would be the most likely threat?
First degree heart block with decreased ST segment and inverted T-waves
246
Hyperthyrodism
Hyper- metabolism (high metabolic rate)
247
Hyperthyroidism signs and symptoms
Weight loss,diarrhea, ⬆️HR, hot,heat, intolerance , HTN, exopthalmos (bulging eyes-Don Knopps)
248
Hyperthyroidism
Hyperthyroidism is also known as GRAVE’S DISEASE. So remember RUN yourself into the GRAVE
249
Hyperthyroidism treatment options
Radioactive iodine , propylthyroid utisil, surgical removal
250
What is the big risk with radioactive. Iodine?
Radiation risk in urine -double flush, need private bathroom
251
What does PTU do?
Propylthyroid utinsil knocks out WBC
252
What is the most common treatment for hyperthyroidism?
Surgical Removal
253
Total Thyroidectomy
Total Thyroidectomy need lifelong HORMONE replacement. At risk for HYPOCALCEMIA (difficult to spare parathyroid)
254
What are you at risk for with a Thyroidectomy?
Thyroid Storm
255
What are signs and symptoms of thyroid storm?
Extremely high vital signs, extremely high fever, psychotically delirious. this is a medical emergency
256
What is the treatment for thyroid storm?
Oxygen and lower body temperature
257
Total=T | Subtotal=S
Tetany | Storm
258
Post operation risks for toral and subtotal Thyroidectomy in first 12 hrs
Airway/breathing, bleeding
259
Post operation risks for total Thyroidectomy in 12-48 hrs
Tetany (r/t ⬇️Ca)
260
Post operation risks for sub-total Thyroidectomy in 12-48 hours
Thyroid Storm
261
Hypothyrodism =
Hypometabolism
262
Hypothyroidism signs and symptoms
Weight gain , HTN , constipation, lethargy, cold intolerance, “slow”
263
Hypothyroidism aka what?
Hypothyroidism is also known as Myxedema
264
Hypothyroidism treatment
Throud replacement (s/e: hyperthyroidism)
265
Hypothyroidism treatment caution?
Caution: with hypothyroidism treatment DO NOT SEDATE (they are already sedated)
266
Hypothyroid surgical implications?
The hypothyroid patient under anesthesia is a very high risk and do not hold thyroid pills when NPO is a surgical implication
267
What letter do Adrenal Cortex Diseases start with?
Adrenal Cortex Diseases start with letters A or C
268
Addison’s Disease is
Addison’s Disease is UNDERSECRETION of the adrenal cortex
269
Addison’s Disease signs and symptoms
Hyperpigmented (darker) doesn’t respond to stress well (JFK)
270
Addison’s Disease Treatment
Steriods (need to wear a med alert bracelet)
271
Addison’s=
Add - a - sone
272
Cushing ‘s Syndrome
Cushing’s syndrome is OVER SECRETION (cushy=more)
273
Cushing ‘s Syndromes signs & symptoms
Moon face,hirsutism (⬆️ body hair), water retention, gynecomastia (man boobs), buffalo hump, central obesity (small skinny limbs), ⬇️ bone density, easy bruising, irritability, immunosuppression
274
Cushing’s Syndrome Treatment
Adrenalectomy ➡️ replacement therapy➡️ steriods
275
What is CONTACT precautions used for?
Herpes, Enteric (Rotavirus,Shigellosus) , Staph (MRSA), RSV (transmitted via droplet but contact because kids put mouths on everything)
276
Contact Precautions
``` Private Room (most important) Gloves Goen Hand washing Disposable Supplies (BP cuff) Stethoscope can be taken from room to room as long as sterilized after use ```
277
What is droplet precaution used for?
Influenza (H1N1), meningitis, diphtheria, pertussis, mumps
278
Droplet precautions:
``` Private Room Mask ( most important) Gloves Hand washing Pt wear mask when leaving room Disposable supplies ```
279
What is airborne precautions used for?
Measles,TB (spread via droplet), chicken pox (varicella) SARS
280
Airborne precautions
``` Private room (door closed) Mask Gloves Gown Hand washing Special filter respirator masks Pt wears mask when leaving room Disposable supplies Negative air flow (most important) Everyone that entres the room must wear a mask ```
281
PPE includes this always unless noted opposite
Gloves, Gowns, Goggles and masks
282
PPE Doning & Doffing
The proper place for donning PPE is OUTSIDE the room and doffing PPE is INSIDE the room.
283
Donning PPE proper order
``` Gown Mask Goggles Gloves Start low and go high ```
284
Doffing PPE proper order
Gloves Googles (from behind to front) Gown (outside in) Mask ( from behind outside room)
285
Mask removal
In airborne and droplet precautions only the mask is removed OUTSIDE the room and the patient removes mask INSIDE the room.
286
Hand washing or scrubbing: | Position hands below elbows
Hand washing
287
Position elbows below hands
Scrubbing
288
Length seconds
Hand-washing
289
Length minutes
Scrubbing
290
Can touch handles
Hand-washing
291
Not allowed to touch handles
Scrubbing
292
Use when entering/leaving room, before/after glove use whenever hands get soiled
Hand-washing
293
Use when patient is immunosuppressed
Scrubbing
294
Soap and water
Handwashing
295
Use Chlor- (cleaning agent)
Scrubbing
296
When can you use an Alcohol-based solution?
Only substitute for handwashing, enter/leave room, before/after gloves, NEVER substitute after soiling hands
297
Can you use an alcohol based cleaner after the restroom?
No (soiled hands possibly)
298
Hand washing technique
Dry hands from CLEANEST to DIRTIEST Turn water off with NEW paper towel
299
Sterile Gloving
``` Glove DOMINANT hand first Grasp OUTSIDE of cuff Touch only the INSIDE of glove surface Do not ROLL cuff Fingers INSIDE second glove cuff Keep thumb ABDUCTED Only touch OUTSIDE surface ```
300
Putting on Gloves
SkIN touches INSIDE of glove
301
Sterile Gloves touch
Outside of glove only touched OUTSIDE of glove
302
Removal of gloves
Remove GLOVE to GLOVE. SKIN to SKIN
303
What patients do not need interdisciplinary care?
People who have multiple problems in the dame division of care Ex: COPD, arthritis, cancer of bowel (all medical problems)
304
What is the major criteria for interdisciplinary care?
Patients with multidimensional needs (physical ,intellectual,emotional,social, spiritual)- EX COPD , homelessness & schizophrenia (need medical ,SW, and psychiatrist) Patient who need rehabilitation (PT, SW, OT, Speech will be effected)
305
What is the minor criteria for interdisciplinary care?
A patient whose current treatment is ineffective | A patient who is preparing for discharge
306
What are the 3 principles to consider when choosing appropriate toys for kids?
Is it safe Is it age appropriate Is it feasible (can you actually do it? Specific childs situation)
307
What are some safety considerations when it comes to kids toys?
Size of toy (no small toys for children under 4) No metal toys if oxygen is in use (spark things ) Beware of fomites (non living object that harbors micro organisms) Worst: plush toys/stuffed animals Least: plastic toys that can be disinfected
308
What is the best toy for 0-6 month olds (sensorimotor)
Musical mobile
309
What is the 2nd best toy for 0-6 month old (sensorimotor)?
Large and soft
310
What is the best toy for 6-9 month olds (object permanence)?
Cover/uncover toy (jack in the box)
311
What is the 2nd best toy for 6-9 month olds (object permanence)?
Firm but large (wood/hard plastic allowed)
312
What is the BEST toy for 9-12 months oldd
Verbal toy (tickle me elmo)
313
9-12 month olds
Remember with 9-13 month olds PURPOSEFUL activity with OBJECTS
314
9 months and younger
Avoid answers with the following build , sort , stack, make and construct
315
What is the best toy for toddlers (1-3 years)?
Push/pull toy (wagon)
316
What skill is being worked on when toddlers play?
Gross motor skill
317
What type of play do toddlers do
Parallel play (play alongside but not with)
318
What types of toys should be avoided with toddlers?
Toys that require good finger control/dexterity
319
Preschoolers need toys that work on
Fine motor skills (fingers) and balance (dance , ice skating and tumbling)
320
Preschoolers play is characterized by
Cooperative play (play with each other)
321
Preschoolers like go do what?
Preschoolers like to play PRETEND
322
7-11 years old School age
School age (7-11 years) aka CONCRETE are characterized by the 3 C’s: 1. Created/creative (give blank paper; get them involved) 2. Competitive (winners and losers) 3. Collective (baseball cards and barbies)
323
12-18 years old Adolescents
Adolescentes (12-18 years) their “play” is PEER GROUP ASSOCIATION (hang out in groups). Allow adolescents to be in each others rooms unless one of them is: 1. fresh post-op (less than 12 hours) 2. Immunosuppressed 3. Contagious
324
Age variety choice
When given a variety of ages to choose from always go YOUNGER because children REGRESS When sick and you want to give them AS MUCH TIME TO GROW
325
Creatinine
This is the beat indicator of Kidney function
326
Creatinine lab values
0.6-1.2 | If elevatef its abnormal but not too worrisome (just means kidneys are failing )
327
INT (Intetnational Normalized Ratio)
Monitors coumadin (Warfin) therapy ( coumadin and war fare make you bleed)
328
What is the therapeutic range for INR
2-3 ⬆️INR= bleed risk > or equal too is critical
329
What do you do when INR > or equal to 4?
Hold all Coumadin Assess bleeding Prepare to give Vitamin K Call the Physician
330
What is the therapeutic range for Potassium (K+)?
3.5-5.0
331
What do you do if potassium is low?
Critical Assess heart Prepare to give Potassium (K+) Call Physician
332
What do you do if potassium is 5.4-5.9?
``` Critical (high but still in the 5’s) Hold all Potassium (K+) Asses heart Prepare Kayexalate/ D5W Call the DR ```
333
What do you do if Potassium is >or equal to 6?
Deadly Dangerous Do all of the following at once: Hold Potassium, assess heart, prepare Keyexalate/D5W, Call physician as a team is needed to address this.
334
What is the therapeutic range of pH?
7.35-7.45
335
What do you do if pH is in the 6’s?
Deadly Dangerous | Get vitals and call Physician (most important when asked in question)
336
What is the therapeutic range for BUN (blood urea nitrogen)?
8-30( 8 buns in a pack)
337
What do you do when a patient has an elevated BUN?
Be concerned | Check for dehydration
338
What is the therapeutic range for Hgb(hemoglobin)?
12-18 (teenage years)
339
What do you do when a patient has a 8-11 hgb?
Be concerned | Monitor the patient
340
What do you do if a patient has a Hgb of <8?
Critical | Assess bleeding, prepare for transfusion, Call Physician
341
What is the therapeutic range for HCO3?
22-28 | If out of range it is abnormal but not worrisome
342
What is the therapeutic range for CO2?
35-45
343
What fo you do if CO2 is in the 50’s?
Critical (sign of respiratory insufficiency) Assess respirations Do pursued lip breathing( blow out candle and exhale longer periods) DONT give O2 (it will increase CO2) 💡This does not apply to COPD (This is their “normal”)
344
What do you do if CO2 is in the 60’s?
``` Deadly Dangerous Sogn of respiratory failure Assess respirations Do pursed lip breathing (to ⬇️ anxiety) Prepare to intubate and ventilate Call respiratory therapy Call DR ```
345
What is the therapeutic range for Hct?
35-54 (if abnormal be concerned)
346
What is the therapeutic range for PO2?
78-100
347
What do you do if PO2 is 70-77?
Critical Sign of respiratory insufficiency Assess respirating Give oxygen
348
What do you do when PO2 is
``` Deadly dangerous Sign of respiratory failure Assess Respirations Give oxygen Prepare intubate and ventilate Call respiratory therapy Call Physician ```
349
What is the therapeutic range for O2 saturation?
93-100%
350
What do you do if O2 saturation is less than 93?
Assess respiration’s and give oxygen
351
BNP
Good indicator of CHF
352
What is the therapeutic range for Brain Type Natriuretic Peptide (BNP)?
<100
353
What do you do if Brain Type Natriuretic Peptide (BNP) is elevated?
Be concerned and continue to monitor patient
354
What is the therapeutic range for sodium?
135-145
355
What fo you do if sodium is abnormal in a patient?
Be concerned until theres a change in the LOC (then it becomes critical)
356
What is the therapeutic range for WBC’s?
5,000-11,000
357
What is the therapeutic range for ANC?
500 (want above 200)
358
What is the therapeutic range for CD4 count?
<200= AIDS
359
What is another name for high WBC count?
Leukocytosis
360
What are some other names for low WBC count?
``` Leukopenia Neutropenia Agranulocytosis Immunossuppression Bone Marrow Supression ```
361
What do you do when WBC id <5,000
Critical- immunosuppressed | Neutropenic precautions
362
What do you do if ANC id <500?
Critical-immunosuppressed | Neutropenic precautions
363
What do you do if CD4 <200?
Critical-immunosuppressed | Neutropenic precautions
364
What is neutropenic precautions?
AKA Reverse/Protective Isolation Strict hand washing Shower BID with antimicrobial soap Avoid crowds Private room Limit number of staff entering room Limit visitors to health stilts No fresh flowers out potted plants Low bacteria diet ( no raw fruits, veggies, salads or undercooked meat) Do not drink water that has been standing for 15 min or longer Vital signs (temp) every 4 hours Check WBC(ANC) daily Avoid use of underlining catheter Do not reuse cups (must wash between uses) Use disposable plates,cups,straws, utensils Dedicated items in room: shape,BP cuff,Thermometer,gloves
365
What is the therapeutic range for platelets?
150,000-400,000
366
What do you do if plateltes are <40,000?
Deadly Dangerous (can spontaneously bleed to death) Assess for bleeding Bleeding Precautions
367
What are bleeding precautions?
No unnecessary venipuncture-injection or IV, use small gauge ``` Handle patient gently (use draw sheet) Use electric razor No toothbrushing or flossing No hard foods Well fitting dentures Blow nose gently No rectal temp,enema or suppository No aspirin No contact sports No walking in bare feet No tight clothing or shoes Use stool softner, No straining Notify MD or blood in urine,stool ```
368
What is the therapeutic range for RBC’s?
4-6 (if abnormal be concerned)
369
What are the 5 D’s?
Remember the 6’s 1. K+>or equal to 6 2. pH ins the 6’s 3. CO2 in the 60’s 4. pO2 < or equal to 60’s 5. Platelets <40,000
370
When should you call a Rapid Response Team ?
When lab values are critical or deadly dangerous or if bad symptoms during assessment
371
Laminectomy
``` “Ectomy”= removal of “Lamina”= vertebral spinus processes ```
372
What is the reason for a laminectomy?
To treat nerve root compression
373
What are the 3 signs and symptoms of nerve root compression?
Pain Paresthesia (numbness and tingling) Paresis (muscle weakness)
374
What are the different locations for laminectomy?
Cervical (neck) Thoracic (upper back) Lumbar (lower back)
375
What is the most important assessment in a pre-op cervical lamin
Function of upper extremities and breathing
376
What is the most important assessment in a pre op lumbar laminectomy?
Urine output and legs
377
What is the #1 post-op answer on NCLEX?
Always log roll your patient
378
What is the specific “activity”/ mobilization strategy post-op?
1. Do not dangle/sit on side of bed 2. Allowed to walk ,sit,stand and lie down 3. Limit sitting 20-30 min at a time
379
Post-op complication for cervical laminectomy
Watch for pneumonia
380
Post-op complication for thoracic laminectomy
Watch for pneumonia and paralytic illeus
381
Post-op complication for lumbar laminectomy
Watch for urinary retention
382
Laminectomy
Laminectomy with fusion involved taking a BONE GRAFT from the ILLIAC CREST(HIP). Of the two incisions which site has the most pain? Hip Which site has the most bleeding/drainage? Hip Which site has a risk for infection? Hip/spine Which site has a risk rejection? Spine
383
Surgeons are using cadaver bone from bone banks. Why?
Because it gets rid of 2nd incision and cuts recovery time in half
384
What are some temporary restrictions (6 weeks) with discharge teaching?
1. Don’t sit for longer than 30 min 2. Lie flat and log roll for 6 weeks 3. Lifting restrictions: do not lift more than 5lbs
385
What are some permanent restrictions for laminectomy patients?
1. Laminectomy patients will never be allowed to lift by bending at the waist (use their needs) 2. Cervical laminectomy patients will never be allowed to lift objects above their heads 3. No horseback riding, off-trail biking, jerky amusement park rides etc.
386
What is Nagele’s rule? (Due date calculation)
Take the first day of the last menstural period (LMP) Add 7 days! Subtract 3 months
387
Total Weight gain during pregnancy
25-31 lbs
388
1st trimester weight gain
1 lb per month (3 lbs total for first trimester)
389
2nd/3rd trimester weight gain
1 lb per week
390
Fundus (top of uterus) in not palpable until week
Week 12
391
Fundus typically reaches the umbilical (navel) level at week
20-22
392
What are 4 positive signs of pregnancy?
1. Fetal skeleton on an x-ray 2. Fetal presence on ultrasound 3. Auscultation of the fetal heart (doppler) 4. Examiner palpated fetal movement/outline
393
What are some probably/presumptive signs of pregnancy?
1. All urine and blood pregnancy tests 2. Chadwicks’s sign (color change of the cervix to cyanosis) 3. Goodell’s sign (cervical softening) 4. Hegar’s sign (uterine softening)
394
Morning sickness is related to which trimester and what treatment?
1st trimester Eat dry carbs Crackers before out of bed Avoid empty stomach
395
Urinary Incontinence is related to which trimester and what treatment?
1st trimester and 3rd trimester | Void Q2H
396
Dyspnea is related to which trimester and what treatment?
``` 2nd trimester Tripod position ( lean forward with hands on knees) ```
397
Back pain is related to which trimester and what treatment?
2nd/ 3rd trimester | Pelvic tilt exercises (put foot in stool then back again)
398
What is the truest most valid sign of labor?
Onset of regular contractions
399
Dilation
Opening of cervix (0-10cm)
400
Effacement
Thinning of cervix (thick -100%)
401
Station
Relationship of fetal presenting part to mom’s ischial spine ( tightest squeeze for baby head) Negative = above spine Positive = below spine
402
Engagement
Station “0” at ischial spines
403
Lie
Relationship between spine of baby and spine of mom
404
Presentation
Part of baby that enters birth canal first
405
What is stage 1 of labor and delivery?
Labor- dilate and phase cervix (3 phase of labor- latent, active, transitional)
406
What is stage 2 of labor and delivery?
Delivery of baby
407
What is stage 3 of labor and delivery?
Delivery of placenta
408
What is stage 4 of labor and delivery?
Recovery- first 2 hours to stop bleeding
409
Transverse lie and station that won’t go positive =
C - section
410
``` Latent: CM dilated CXN freq Duration Intensity ```
CM dilated: 0-4cm CXN freq: 5-30min Duration: 15-30 sec Intensity: Mild
411
Active: CM dilated CXN freq Duration Intensity
CM dilated : 5-7 cm CXN freq : 3-5 min Duration : 30-60 sec Intensity : Moderate
412
Transition: CM dilated CXN freq Duration Intensity
CM dilated: 8-10cm CXN freq: 2-3min Duration: 60-90 sec Intensity: Strong
413
Contractions
Contractions should not be longer than 90 seconds or closer than every 2 minutes
414
Contractions Assessment: Frequency
Beginning of one contractions to the beginning of the next contraction
415
Assessment of Contractions: Duration
Beginning to end of one contraction
416
Assessment of contractions: Intensity
Strength of contraction. Palpate with fingers of one hand over the fundus.
417
What complication of labor is indicted of the mom is having painful back pain?
Baby turned around backwards Low priority Position knee-chest then put on her back
418
What should you do with a prolapsed cord?
Push head back in off cord and position in knee-chest or trendelenburg (hips up,shoulders down) pre for c-section
419
Interventions for all other complications of labor and birth
``` Left side/lateral IV increase Oxygen Notify Stop pit if in crisis ```
420
Systemic pain medication
Do Not Administer Systemic pain medication to a woman in labor if the baby is likely to be BORN when the PAIN is PEAKING(respiratory depression)
421
What do you do with a low fetal heart rate?
Bad | LION pit
422
What do you do with FHR accelerations?
No crisis
423
What fo you do with low baseline variability?
Bad | LION pit
424
What do you do with high beseline variability?
Record It
425
What do you do with late decelerations?
Bad | LION pit
426
What do you with early decelerations?
HR⬇️
427
What do you do with variable decelerations?
Can be very bad | Prolapsed cord
428
Second stage of labor and delivery - what do you do?
1. Deliver the head (stop pushing) 2. Suction mouth and nose 3. Check for nuchal cord (cord around neck) 4. Deliver shoulders and body 5. Make sure baby has ID band
429
What do you check for with the delivery of the placenta?
3 vessels (2 arteries and 1 vein) “AVA”
430
Delivery Last Stage (recovery stage)
During the 4th stage (recovery stage) (first 2 hours after delivery) what 4 things do you do 4 times an hour 1. Vital signs (assess for signs and symptoms shock) 2. Check fundus (if boggy,massage, if displaced, void/cath) 3. Check padd (excessive lochia=pad sat in 15 min) 4. Roll on to side (check for bleeding under patient)
431
What is the tone,height and location of the uterus postpartum?
Tone: Firm not boggy Height: right after delivery it is by pubis by 24 hours it is at navel. 2cm for every PP day Location: Midline(if displaced from R/L if means catherize)
432
What is the color of lochia in the first days?
Rubra
433
What is the color lochia after a week or so of postpartum?
Serosa
434
What is a moderate amount of lochia?
4-6 in on pad in one hour
435
What is an excessive amount of lochia?
Saturate pad in 15 min
436
What do you assess for in the postpartum assessment?
Uterus,lochia, extermities (pulses, edema, S7S thrombophlebitis)
437
Distended sebaceous glands which appear as tiny white spots on bay’s face
Milia
438
Small white epithelial cysts on baby’s gums
Epstein’s pearls
439
Bluish-black macules appearing over the buttock and or/ thighs of darker- skinned neonates
Mongolian spots
440
Ref papilar rash on baby’s torso which is benign and disappears after a few days
Erythema toxicum neonatorum
441
Benign tumor of capillaries
Hemangiomas
442
Swelling caused by bleeding between the ostium and periosteum of the skull. This swelling does not cross suture lines
Cephalohematoma
443
Edmatous swelling on scalp caused by pressure during birth. This swelling may cross suture lines. It usually disappears in a few days
Caput succedaneum
444
Normal physiological jaundice appears after 24 hours of age and disappears at about one week of age
Hyperbilirubinemia
445
Whitish cheese-like substance which appears intermittently over the first 7-10 days
Vernix Caseosa (caseus=cheee)
446
Normal cyanosis of baby’s hands and feet which appears intermittently over the first 7-10 days
Acrocyanosis
447
Generic term for birthmark
Nevus/ Nevi 1. Nevus Flammeus - nonblanchable port wine stain 2. Telangiectatic Nevi - blanchable pink “stork bites”
448
Tocolytics (stop contractions)
Terbutaline (Brethine) S/E- tachycardia (don’t give with cardiac disease) Nifedipine S/E- headache/hypotension (can give with cardiac disease)
449
Oxytocics- stimulate labor
Pitocin (Oxytocin) S/E- uterine hyperstimulation Cervidil (Prostaglandin) - dilates cervix S\E-uterine hyperstimulation
450
Fetal/Neonatal Lung Meds
Bethamethasone (steriod)- give to mother IM; give before baby after ciability. Can repeat S\E ⬆️BS Survanta- give to baby after baby is born (transtracheal)
451
Steps of drawing up insulin
1. Draw up the total dose in air 2. Pressurize the “N” vial (put air in) 3. Pressurize the “R” vial 4. Draw up “R” dose 5. Draw up “N” dose Nicole Richie RN
452
IM- length and guage
1 in both the guage and length (I looks like 1)
453
SQ- length and guage
5 in both party’s (S looks like a 5)
454
Heparin
- works immediately - can only take for 21 days - antidote is Protamin sulfate (heParin) - labs: PTT and all clotting a d bleeding times - http ➡️ PttHeparin - can use in pregnancy - pregnancy class C
455
Coumadin
- takes days - can take for entire life - Po only - antidote: vitamin K - labs: PT, INR - can’t use if pregnant - class x pregnancy
456
Baclofen (Lioresal)
``` Muscle relaxant 1. Cause fatigue 2. Cause paresis (muscle weak) 3. Do not drink alcohol 4. Do not drive car 5. Do not watch kids under age 13 When you are Baclofen you are on your back “loafin” ```
457
Sensorimotor
Age: 0-2 years old Characteristics: totally present-oriented. Only think about what they are sense of are doing right now Teaching Guidelines When: As it is happens What: you are doing now How: Tell them what you are doing as you’re doing it
458
Pre-Operational
Age: 3-6 y/o (preschoolers) Characteristics: fantasy oriented. Illogical. No rules. ( Can teach ahead of time but not too far) Teaching Guidelines When: slightly ahead of time ( morning of..) What: you will do How: play,toys,stories
459
Concrete operations
Age: 7-11 years old Characteristics: Rule-oriented. Live and die by the rules! Cannot abstract Teaching Guidelines When: days ahead of time What: you’re gonna do and skills How: age appropriate reading and A/V material,role play is ok
460
Formal Operations
Age: 13-14 y/o Characteristics: able to think abstractly. Understand cause-effect. Thinking like adults emotionally but physically not there but they can think like one Teaching guidelines- When: like an adult What: like an adult How: like an adult
461
Skin still intact, non blanching erythema (redness)
Stage 1 pressure sore
462
Ulcerated,superficial,pink dermis
Stage 2
463
Yellow subcutaneous (fat)
Stage 3
464
Red-white (muscle and bone
Stage 4
465
Acute beats chronic
Short rather than long term
466
Surgical
FRESH POST OP beats MEDICAL or OTHER SURGICAL
467
Stable beats unstable
Survival vs unsure on survival
468
What makes a patient stable?
1. use of the word stable 2. Chronic illness 3. Post op>12 hours 4. Local or regional anesthesia 5. Unchanged assessment 6. Phrase: “To be discharged” 7. Lab values A/B Stable patients are experiencing the expected typical signs and symptoms of the disease with which they have been diagnosed for which they are receiving treatment
469
What makes a patient unstable?
1. Use of the word unstable 2. Acute illness 3. Post op <12 hours 4. Local or regional anesthesia 5. Unchanged assessment 6. Phrase: “Newly admitted” or “newly diagnosed “ 7. Lab values C/D Undtable patients are experiencing unexpected atypical signs and symptoms complications
470
What 4 patients are always unstable?
1. hemorrhage 2. Hypoglycemia 3. Fever > or equal 104 4. Pulselessness or breathlessness
471
Organ priority
``` The more VITAL the ORGAN the higher the priority Most vital Brain Lungs Heart Liver Kidney Pancreas ```
472
Responsibilities you would delegate to an LPN
Starting an IV Hanging or mixing IV Meds Evaluating an IV site Giving an IV push/ PB meds Giving a blood transfusion Performing assessments that require inferences/judgements (can gather data)- can make observations about stable people but can not make assumptions Plan of care Developing or performing teaching (can reinforce and review) Taking verbal orders from MD or transcribing orders
473
What would you not delegate to a UAP?
Cannot chart but may document what they did Assessments-expect for VS and accucheck Meds and IV’s- may apply otc Topical lotions and creams Treatments - except for SSE. not fleets You may delegate baths,bed and ADLs
474
Delgating to Family
Do not delegate to FAMILY: Safety Responsibilities. They can only do what you TEACH them to do.
475
How do you intervene with inappropriate behavior of staff?
1. Tell the supervisor 2. Intervene immediately 3. Counsel them later on 4. Ignore it. Just let it go (never the right answer)
476
What 4 questions should you ask when dealing with inappropriate behavior from staff?
1. Is what they’re doing illegal? ( if yes tell the supervisor) 2. Is the patient or staff member in immediate danger of physical or psychological harm? (If yes intervene immediately) 3. Is this behavior legal,not harmful,but simply inappropriate? (If yes counsel them later on)
477
Pre-interaction Phase
Purpose:for the nurse to explore his/her feelings yo prevent judgemental, intolerant reactions Length: begins when you learn you are going to be caring for someone and end when you meet them Correct answer : “the nurse will explore his/her feelings about”
478
Introductory phase (Orientation Phase)
Purpose: to establish and explore/assess Length: begins when you first meet the patient and ends when a mutually agree-upon care plan is in place Correct answer: should be very tolerant,accepting,explorative,probing,”nosy”. Be warm and fuzzy
479
Working phase (therapeutic phase)
Purpose: to implement the plan of care Length: from the finished care plan until discharge Correct answer: should be focused,directive, “tough”. In some ways these answers will seem stern and slightly unfriendly set limits enforce proper communication
480
When does the termination phase begin
On Admission
481
Psych Treatment Protocol for Depression
Whenever a patient displays any notion of suicide or harm you must inquire about it Must get a safety contract 🔆activities with other people that doesnt require interaction🔆
482
Psych Treatment Protocol for schizophrenia
If paving Psych➡️ reduce stimulation (clear the room) make onservat offer presence 🔅need reality based activities but not competitive; should be with other people🔅
483
Psych Treatment Protocol for Bipolar
Mania’s can’t go to work or maintain family order whereas a hypo manic can -finger foods are best especially ⬆️ calorie -8 hrs of sleep Encourage naps 🔅 exercise the gross motor that is non competitive🔅
484
Psych Treatment Protocol for anxiety disorder
Phobia-irrational fear that limits daily life ➡️ tx: desensitization: gradually expose 1. Talk about it 2. Show pics 3. Be around 4. Interact When you move to next step make sure not anxious
485
Restraint Protocol
In Psych: need to be evaluated within 1 hour Must be constantly observed Not psych: observe every 15 min. No evaluation. Need Dr. order Q24h
486
Psych Treatment Protocol for Violent Clients
It tales 5 people to control a violent client. One for each limb and head. Only one person talks. The person is given a few seconds to deescalate
487
All psych drugs causr
Hypotension, weight changes and primary weight gain
488
Phenothiazines
All end in “zine” Ex: Thorazine , compazine Actions: large doses-antipsychotic, small doses antiemetic major tranquilizers
489
Side effects of phenothiazines
``` Remember ABCDEFG A= anticholinergic (dry mouth) B= blurred vision and bladder retention C= constipation D= drowsiness E= EPS (tremors,parkinsonian) F= “F”otosensitivity (skin burns) G= aGranulocytosis (low WBC count-immunosuppressed) ``` Teach patient to report sore throat and signs and symptoms of infection to doctor Never stop the zine Never stop the zine
490
Nursing care for Phenothiazines
Treat side effects. Number on diagnosis is safety
491
Deconate or “D”
Long acting IM form of phenothiazine given to non compliant patients
492
Tricyclic Antidepressants
*Mood elevators* to treatment depression | Ex- Elavil,Trofranil, Aventyl, Desyrel
493
Side effects of Tricyclic Antidepressants
(Elavil starts with “E” so this group goes to “E”) A= Anticholinergic (dry mouth) B= Blurred vision C= Constipation D= Drowsiness E= Euphoria (happy) Must take med for 2-4 weeks before beneficial effects
494
Benzodiazepines
Antianxiety meds (considered minor tranquilizers) Always have “Pam”/“Iam” in name Prototype:Valium Indications:Induction of anesthetic muscle relaxant,alcohol withdrawal,seizures (especially status epilepticus), facilitates mechanical ventilation Tranquilizers work quickly. Must Not take for more that 6 weeks- 3 number one nursing diagnosis is safety
495
Side effects of Benzodiazepines
A=anticholinergic B=blurred vision C=constipation D=drowsiness
496
Monoamine Oxidase (MAO) Inhibitors
Antidepressants Depression is thought to be caused by deficiency of norepinephrine, dopamine and serotonin I’m the brain. Monoamine oxidase is the enzyme responsible for breaking down norepinephrine , dopamine and neurotransmitter and thus restore more normal levels and decrease depression Drug names MARplan ,NARdil, PARnate
497
Side effects of MAO inhibitors
A=Anticholinergic B=Blurred Vision C=Constipation D=Drowsiness
498
Interactions/ Patient teaching for MAO inhibitors
Too prevent severe, acute, sometimes fatal hypertensive crisis, the patient must avoid all food containing tyramine Foods containing Tyramine: Fruits and veggies- remember salad “Bar”➡️ avoid Bananas, Avacados, raisns (any dried fruits) Grains: okay to except things made from active yeast Meats: no orgN meats-liver,kidney,tripe,heart,etc. No preserved meats- smoked,dried,cured,pickled,hot dogs Dairy: no cheese except mozzarella and cottage cheese (no aged cheese) Other: no alcohol,elixirs,tinctures(iodine/betadine), caffeine,chocolate, licorice,soy sauce
499
Lithium
``` An electrolyte (notice “iun” ending as in potassium etc) Used for trrating bipolar disorder(manic-depression)➡️ it decreases the mania ```
500
Side effects of lithium
``` The three “P’s”: Peeing (Polyuria) Pooping (diarrhea) Parsesthesis (tingling/numbness) Medically inducing A lithium/electrolyte imbalance Toxic: Tremors , metallic taste, severe diarrhea, and any other neuro sign ➡️ number one intervention: good fluid hydration. If sweating give sodium (or other electrolyte) as well as fluids NO WATER FLUIDS WITH ELECTROLYTES ``` MONITOR SODIUM LEVELS
501
Prozacc
SSRI (Selective Serotonin Reuptake Inhibitor) Similar to Elavil Antidepressant- mood elevator
502
Side effect of Prozac
A=anticholinergic B=blurred vision C=constipation D=drowsiness Causes insomnia, so gibe before 12 noon. If BID give at 6 am and 12 noon when changing the dose of prozac for an adolescent or young afult wat h for suicide
503
Haldol (Haloperidol)
Tranquilizer Also a m deconate form Long acting IM form given to non compliant patients
504
Side effects of Halfol
``` A= Anticholinergic B= Blurred vision C= Constipation D=Drowsiness E= EPS F= Fotosensitvity G= aGranulocytosis ``` Elderly patients may develop NMS from overdose. NMS IS neuroleptic Malignant Syndrome- a potentially fatal hyperplasia (fever) with temp of 104.9 Fose elderly patient should be half of usual adult dose Safety concerns r/t side effects
505
Clozaril (Clozapine)
Atypical antipsychotic Used to test severe schizophrenia Advantage: it died not have side effects A-F Do not confuse with Klonopin (Clonazepam)
506
Side effects of Clozaril
Agranulocytosis (worse than cancer drugs) | Can inky prescribe for 7 days then get WBC drawn for 4 weeks, then once a month for 6 months then every 6 months
507
Zoloft (Sertraline)
Another SSRI lIke Prozac Antidepressant Also causes insomnia but can be given in evening Watch for interaction with St. Johns worst (serotonin syndrome), and warfarin (watch for bleeding)
508
Side effects of Zoloft
``` SAD head Sweating Apprehensive Dizzy Headache ```

Mark Klimek Yellow Book (1 decks)

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