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Nclex-Study-Guide - dfghfh
Biology
High School - Canada
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DO NOT delegate what you can EAT! E - evaluate A - assess T - teach addisons= down, down down up down cushings= up up up down up
addisons= hyponatremia, hypotension, decreased blood vol, hyperkalemia, hypoglycemia cushings= hypernatremia, hypertension, incrased blood vol, hypokalemia, hyperglycemia
No Pee, no K (do not give potassium without adequate urine output)
Ele V ate V eins; d A ngle A rteries for better perfusion
A= appearance (color all pink, pink and blue, blue [pale]) P= pulse (>100, < 100, absent) G= grimace (cough, grimace, no response) A= activity (flexed, flaccid, limp) R= respirations (strong cry, weak cry, absent)
TRANSMISSION-BASED PRECAUTIONS:
AIRBORNE
My - Measles Chicken - Chicken Pox/Varicella Hez - Herpez Zoster/Shingles TB
or remember... MTV=Airborne Measles TB Varicella-Chicken Pox/Herpes Zoster-Shingles Private Room - negative pressure with 6-12 air exchanges/hr Mask, N95 for TB
DROPLET think of SPIDERMAN! S - sepsis S - scarlet fever S - streptococcal pharyngitis P - parvovirus B P - pneumonia P - pertussis I - influenza D - diptheria (pharyngeal) E - epiglottitis R - rubella M - mumps M - meningitis M - mycoplasma or meningeal pneumonia An - Adenovirus Private Room or cohort Mask
CONTACT PRECAUTION
MRS
M - multidrug resistant organism R - respiratory infection S - skin infections * W - wound infxn E - enteric infxn - clostridium difficile E - eye infxn - conjunctivitis
SKIN INFECTIONS VCHIPS V - varicella zoster C - cutaneous diphtheria H - herpez simplex I - impetigo P - pediculosis S - scabies
Air/Pulmonary Embolism (S&S: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of impending doom) --> turn pt to left side and lower the head of the bed.
Woman in Labor w/ Un-reassuring FHR (late decels, decreased variability, fetal bradycardia, etc) --> turn on left side (and give O2, stop Pitocin, increase IV fluids)
Tube Feeding w/ Decreased LOC --> position pt on right side (promotes emptying of the stomach) with the HOB elevated (to prevent aspiration)
During Epidural Puncture --> side-lying
After Lumbar Puncture (and also oil-based Myelogram)--> pt lies in flat supine (to prevent headache and leaking of CSF)
Pt w/ Heat Stroke --> lie flat w/ legs elevated
During Continuous Bladder Irrigation (CBI) --> catheter is taped to thigh so leg should be kept straight. No other positioning restrictions.
After Myringotomy --> position on side of affected ear after surgery (allows drainage of secretions)
After Cataract Surgery --> pt will sleep on unaffected side with a night shield for 1- weeks.
After Thyroidectomy --> low or semi-Fowler's, support head, neck and shoulders.
Infant w/ Spina Bifida --> position prone (on abdomen) so that sac does not rupture
Buck's Traction (skin traction) --> elevate foot of bed for counter-traction
After Total Hip Replacement --> don't sleep on operated side, don't flex hip more than 45- 60 degrees, don't elevate HOB more than 45 degrees. Maintain hip abduction by separating thighs with pillows.
Prolapsed Cord --> knee-chest position or Trendelenburg
Graves’ disease/hyperthyroidism: accelerated physical and mental function; sensitivity to heat, fine/soft hair Thyroid storm: increased temp, pulse and HTN Post-thyroidectomy: semi-Fowler’s, prevent ncek flexion/hyperextension, trach at bedside
Hypo-parathyroid: CATS – convulsions, arrhythmias, tetany, spasms, stridor (decreased calcium), high Ca, low phosphorus diet Hyper-parathyroid : fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium), low Ca, high phosphorus diet
Hypovolemia – incrased temp, rapid/weak pulse, increase respiration, hypotension, anxiety, urine specific gravity >1. Hypervolemia – bounding pulse, SOB, dyspnea, rares/crackles, peripheral edema, HTN, urine specific gravity <1; Semi-Fowler’s
Diabetes Insipidus (decreased ADH): excessive urine output and thirst, dehydration, weakness, administer Pitressin SIADH (increased ADH): change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a, HA; administer Declomycin, diuretics
Hypokalemia : muscle ewakness, dysrhythmias, increase K (raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery) Hyperkalemia: MURDER – muscle weakness, urine (oliguria/anuria), respiratory depression, decreased cardiac contractility, ECG changes, reflexes
Hyponatremia : nausea, muscle cramps, increased ICP, muscular twitching, convulsion; osmotic diuretics, fluids Hypernatremia: increased temp, weakness, disorientation/delusions, hypotension, tachycardia; hypotonic solution Hypocalcemia: CATS – convulsions, arrhythmias, tetany, spasms and stridor Hypercalcemia : muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, sedative effect on CNS
HypoMg : tremors, tetany, seizures, dyrshythmias, depression, confusion, dysphagia; dig toxicity HyperMg: depresses the CNS, hypotension, facial flushing, muscle ewakness, absent deep tendon reflexes, shallow respirations, emergency
Addison’s : hypoNa, hyperK, hypoglycemia, dark pigmentation, decreased resistance to stress, fractures, alopecia, weight loss, GI distress Cushings: hyperNa, hypoK, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN, hirsutism, moonface/buffalo hump Addisonian crisis: n/v, confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP
Pheochromocytoma : hypersecretion of epi/norepi, persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA; avoid stress, frequent bating and rest breaks, avoid cold and stimulating foods, surgery to remove tumor
Neuroleptic malignant syndrome (NMS): -NMS is like S&M; -you get hot (hyperpyrexia) -stiff (increased muscle tone) -sweaty (diaphoresis) -BP, pulse, and respirations go up & -you start to drool
I kept forgetting which was dangerous when you're pregnant; regular measles (rubeola), or German measles (rubella), so remember: -never get pregnant with a German (rubella)
When drawing up regular insulin & NPH together, remember: -RN (regular comes before NPH)
Tetralogy of fallot; remember HOPS Think DROP(child drops to floor or squats) or POSH Defect, septal Right Ventricular hypertrophy Overriding aorts Pulmonary stenosis
MAOI's that are used as antidepressants: weird way to remember, I know. pirates say arrrr, so think; pirates take MAOI's when they're depressed.
- explanation; MAOI's used for depression all have an arrr sound in the middle (Parnate, Marplan, Nardil)
Autonomic dysreflexia: potentially life threatening emergency
- elevate head of bed to 90 degree
- loosen constrictive clothing
- assess for bladder distention and bowel impaction (triger)
- Administer antihypertensive meds (may cause stroke, MI, seisure )
easy way to remember MAOI'S! think of PANAMA! PA - parnate NA - nardil MA - marplan
metallic bitter taste.
Digoxin-check pulse, less than 60 hold, check dig levels and potassium levels.
Amphojel: tx of GERD and kidney stones... out for contipation.
Vistaril: tx of anxiety and also itching.. for dry mouth. given preop commonly
Versed: given for conscious sedation.. for resp depression and hypotension
PTU and Tapazole- prevention of thyroid storm
Sinemet: tx of parkinson.., saliva, urine may turn reddish brown occassionally.. drowsiness
Artane: tx of parkinson. effect also
Cogentin: tx of parkinson and extrapyramidal effects of other drugs
Tigan: tx of postop n/v and for nausea associated with gastroenteritis
Timolol (Timoptic)-tx of gluacoma
For cord compression, place the mother in the TRENDELENBERG position because this removes pressure of the presenting part off the cord. (If her head is down, the baby is no longer being pulled out of hte body by gravity) If the cord is prolapsed, cover it with sterile saline gauze to prevent drying of the cord and to minimize infection.
For late decels, turn the mother to her left side, to allow more blood flow to the placenta.
For any kind of bad fetal heart rate pattern, you give O2, often by mask...
When doing an epidural anesthesia hydration before hand is a priority.
Hypotension and bradypnea / bradycardia are major risks and emergencies.
NEVER check the monitor or a machine as a first action. Always assess the patient first; for exmaple listen to the fetal heart tones with a stethoscope in NCLEX land. Sometimes it's hard to tell who to check on first, the mother or the baby; it's usually easy to tell the right answer if the mother or baby involves a machine. If you're not sure who to check first, and one of the choices involves the machine, that's the wrong answer.
If the baby is a posterior presentation, the sounds are heard at the sides. If the baby is anterior, the sounds are heard closer to midline, between teh umbilicus and where you would listen to a posterior presentation.
If the baby is breech, the sounds are high up in the fundus near the umbilicus. If the baby is vertex, they are a little bit above the symphysis pubis.
Also for ventilator alarms HOLD H igh alarm- O bstruction due to incr. secretions, kink, pt. coughs, gag or bites L ow press alarm- D isconnection or leak in ventilatior or in pt. airway cuff, pt. stops spontaneous breathing
to remember blood sugar: hot and dry-sugar high (hyperglycemia) cold and clammy-need some candy (hypoglycemia)
ICP AND SHOCK HAVE OPPOSITE V/S ICP-increased BP, decreased pulse, decreased resp. shock- decreased BP, increased pulse, increased resp.
cor pulmonae: right sided heart failure caused by left ventricular failure (so pick edema, jvd, if it is a choice.)
herion withdrawal neonate: irratable poor sucking
Jews: no meat and milk together
Brachial pulse: pulse area cpr on an infant.
Test child for lead poisioning around 12 months of age
bananas, potatoes, citrus fruits source of potassium
Cultures are obtained before starting IV antibiotics
a pt with leukemia may have epitaxis b/c of low platelets
best way to warm a newborn: skin to skin contact covered with a blanket on mom.
when a pt comes in and she is in active labor.. first action is to listen to fetal heart tone/rate
phobic disorders.. systematic desensitiztion.
NCLEX TIPS
When getting down to two answers, choose the assessment answer (assess, collect, auscultate, monitor, palpate) over the intervention except in an emergency or distress situation. If one answer has an absolute, discard it. Give priority to answers that deal directly to the patient’s body, not the machines/equipments.
Key words are very important. Avoid answers with absolutes for example: always, never, must, etc.
with lower amputations patient is placed in prone position.
small frequent feedings are better than larger ones.
Assessment, teaching, meds, evaluation, unstable patient cannot be delegated to an Unlicensed Assistive Personnel.
LVN/LPN cannot handle blood.
Amynoglycosides (like vancomycin) cause nephrotoxicity and ototoxicity.
IV push should go over at least 2 minutes.
If the patient is not a child an answer with family option can be ruled out easily.
In an emergency, patients with greater chance to live are treated first
ARDS (fluids in alveoli), DIC (disseminated intravascular coagulaton) are always secondary to something else (another disease process).
Cardinal sign of ARDS is hypoxemia (low oxygen level in tissues).
in pH regulation the 2 organs of concern are lungs/kidneys.
edema is in the interstitial space not in the cardiovascular space.
weight is the best indicator of dehydration
wherever there is sugar (glucose) water follows.
aspirin can cause Reye’s syndrome (encephalopathy) when given to children
when aspirin is given once a day it acts as an antiplatelet.
use Cold for acute pain (eg. Sprain ankle) and Heat for chronic ( rheumatoid arthritis)
guided imagery is great for chronic pain.
when patient is in distress, medication administration is rarely a good choice.
with pneumonia, fever and chills are usually present. For the elderly confusion is often present.
Always check for allergies before administering antibiotics (especially PCN). Make sure culture and sensitivity has been done before adm. First dose of antibiotic.
Cor pulmonale (s/s fluid overload) is Right sided heart failure caused by pulmonary disease, occurs with bronchitis or emphysema.
COPD is chronic, pneumonia is acute. Emphysema and bronchitis are both COPD.
in COPD patients the baroreceptors that detect the CO2 level are destroyed. Therefore, O2 level must be low because high O2 concentration
Med of choice for CHF is Ace inhibitor.
Med of choice for anaphylactic shock is Epinephrine
Med of choice for Status Epilepticus is Valium.
Med of choice for bipolar is lithium.
Amiodorone is effective in both ventricular and atrial complications.
S3 sound is normal in CHF, not normal in MI.
give carafate (GI med) before meals to coat stomach
Protonix is given prophylactically to prevent stress ulcers.
after endoscopy check gag reflex.
TPN(total parenteral nutrition) given in subclavian line.
low residue diet means low fiver
diverticulitis (inflammation of the diverticulum in the colon) pain is around LL quadrant.
Appendicitis (inflammation of the appendix) pain is in RL quadrant with rebound tenderness.
portal hypotension + albuminemia= Ascites.
beta cells of pancreas produce insulin
Morphine is contraindicated in Pancreatitis. It causes spasm of the Sphincter of Oddi. Therefore Demerol should be given.
Trousseau and Tchovoski signs observed in hypocalcemia
with chronic pancreatitis, pancreatic enzymes are given with meals.
Never give K+ in IV push.
mineral corticoids are give in Addison’s disease.
Diabetic ketoacidosis (DKA)= when body is breaking down fat instead of sugar for energy. Fats leave ketones (acids) that cause pH to decrease.
DKA is rare in diabetes mellitus type II because there is enough insulin to prevent breakdown of fats.
Sign of fat embolism is petechiae. Treated with heparin.
for knee replacement use continuous passive motion machine.
give prophylactic antibiotic therapy before any invasive procedure.
glaucoma patients lose peripheral vision. Treated with meds
cataract= cloudy, blurry vision. Treated by lens removal-surgery
Co2 causes vasoconstriction.
most spinal cord injuries are at the cervical or lumbar regions
autonomic dysreflexia ( life threatening inhibited sympathetic response of nervous system to a noxious stimulus- patients with spinal cord injuries at T-7 or above) is usually caused by a full bladder.
spinal shock occurs immediately after spinal injury
Multiple sclerosis= myelin sheat destruction, disruption in nerve impulse conduction.
myasthenia gravis= decrease in receptor sites for acetylcholine. Since smallest concentration of ACTH receptors are in cranial nerves, expect fatigue and weakness in eye, mastication, pharyngeal muscles.
Tensilon test given if muscle is tense in myasthenia gravis.
Guillain-Barre syndrome= ascending paralysis. Keep eye on respiratory system.
parkinson’s = RAT: rigidity, akinesia (loss of muscle mvt), tremors. Treat with levodopa.
TIA (transient ischemic attack) mini stroke with no dead brain tissue
CVA (cerebrovascular accident) is with dead brain tissue.
Hodgkin’s disease= cancer of lymph is very curable in early stage.
Rule of NINES for burns Head and Neck= 9% Each upper ext= 9% Each lower ext= 18%
Front trunk= 18% Back trunk= 18% Genitalia= 1%? 90. Birth weight doubles by 6 month and triple by 1 year of age. 91. if HR is <100 do not give dig to children. 92. first sign of cystic fibrosis may be meconium ileus at birth. Baby is inconsolable, do not eat, not passing meconium. 93. heart defects. Remember for cyanotic -3T’s( Tof, Truncys arteriosus, Transposition of the great vessels). Prevent blood from going to heart. If problem does not fix or cannot be corrected surgically, CHF will occur following by death. 94. with R side cardiac cath=look for valve problems 95. with L side in adults look for coronary complications. 96. rheumatic fever can lead to cardiac valves malfunctions. 97. cerebral palsy = poor muscle control due to birth injuries and/or decrease oxygen to brain tissues. 98. ICP (intracranial pressure) should be <2. measure head circonference. 99. dilantin level (10-20). Can cause gingival hyperplasia 100. for Meningitis check for Kernig’s/ Brudzinski’s signs. 101. Wilm’s tumor is usually encapsulated above the kidneys causing flank pain. 102. hemophilia is x-linked. Mother passes disease to son. 103. when phenylalanine increases, brain problems occur. 104. Buck’s traction= knee immobility 105. Russell traction= femur or lower leg 106. Dunlap traction= skeletal or skin 107. Bryant’s traction= children <3y, <35 lbs with femur fx. 108. place apparatus first then place the weight when putting traction 109. placenta should be in upper part of uterus 110. eclampsia is seizure. 111. a patient with a vertical c-section surgery will more likely have another c-section. 112. perform amniocentesis before 20 weeks gestation to check for cardiac and pulmonary abnormalities. 113. Rh- mothers receive rhogam to protect next baby. 114. anterior fontanelle closes by 18 months. Posterior 6 to 8 weeks. 115. caput succedaneum= diffuse edema of the fetal scalp that crosses the suture lines. Swelling reabsorbs within 1 to 3 days. 116. pathological jaundice= occurs before 24hrs and last7 days. Physiological jaundice occurs after 24 hours. 117. placenta previa = there is no pain, there is bleeding. Placenta abruption = pain, but no bleeding. 118. bethamethasone (celestone)=surfactant. Med for lung expansion. 119. dystocia= baby cannot make it down to canal 120. pitocin med used for uterine stimulation 121. Magnesium sulfate(used to halt preterm labor) is contraindicated if deep tendon reflexes are ineffective. If patient experiences seizure during magnesium adm. Get the baby out stat (emergency). 122. Do not use why or I understand statement when dealing with patients 123. milieu therapy= taking care of patient/environment 124. cognitive therapy= counseling 125. crisis intervention=short term. 126. FIVE INTERVENTIONS FOR PSYCH PATIENTS -safety -setting limits
Hyper natremia (greater than 145) S kin flushed A gitation L ow grade fever T hirst
Developmental 2-3 months: turns head side to side 4-5 months: grasps, switch & roll 6-7 months: sit at 6 and waves bye-bye 8-9 months: stands straight at eight 10-11 months: belly to butt (phrase has 10 letters) 12-13 months: twelve and up , drink from a cup
Hepatitis Hepatitis: -ends in a VOWEL , comes from the BOWEL (Hep A) Hepatitis B=Blood and Bodily fluids Hepatitis C is just like B
Apgar measures HR,RR,Muscle tone, Reflexes,Skin color each 0-2 point. 8-10 OK. 0-3 RESUSCITATE.
GLASGOW COMA SCALE. EYES, VERBAL,MOTOR!
It is similar to measuring dating skills... max 15 points -one can do it if below 8 you are in Coma.
So, to start dating you gotta open your EYES first , if you albe to do that spontaneously and use them correctly to SEE whom you dating you earn 4. But if she has to scream on you to make you open them it is only 3... 1 you dont care to open even if she tries to hurt you.
if you get good EYE contact (4 points) then move to VERBAL.
talk to her/ him! if you can do that You are really ORIENTED in situation she/he uncontiously gives you 4 points! if you like her try not to be CONFUSED (3), and of cause do not use INAPPROPRIATE WORDS (3), she will not like it)), try not to RESPOND WITH INCOMPREHENSIBLE SOUNDS (2), if you do not like her- just show no VERBAL RESPONSE(1)
Since you've got EYE and VERBAL contact you can MOVE now using your Motor Response Points.
THis is VERY important since Good moves give you 6!
The person who hyperventilates is most likely to experience respiratory alkalosis.
avoid salt substitutes when taken dig and k-supplements because many are potassium based
Signs of hypoxia: restless, anxious, cyanotic tachycardia, increased resps. (also monitor ABG's)
Addison's disease (need to "add" hormone) Cushing's syndrome (have extra "cushion" of hormones)
Dumping syndrome: increase fat and protein, small frequent meals, lie down after meal to decrease peristalsis, wait 1 hr after meals to drink.
For blood types: "O" is the universal donor (remember "o" in donor) "AB" is the universal receipient Disseminated Herpes Zoster is AIRBORNE PRECAUTIONS, as to Localized Herpes Zoster is CONTACT PRECAUTIONS. A nurse with a localized herpes zoster CAN care for patients as long as the patients are NOT immunosuppressed and the lesions must be covered!
Fat soluble vitamins are Vitamins A, D, E, K
Give NSAIDS, Corticosteroids, drugs for Bipolar, Cephalosporins, and Sulfanomides WITH food.
Ativan is the treatment of choice for status epilepticus
When using a bronchodilator inhaler inconjuction with a glucocorticoid inhaler, administer the bronchodilator first
Theophylline increases the risk of digoxin toxicity and decreases the effects of lithium and Dilantin
IN tal, an inhaler used to treat allergy induced asthma may cause bronchospasm, think... IN to the asthmatic lung
Isoniazid causes peripheral neuritis
Peptic ulcers caused by H. pylori are treated with Flagyl, Prilosec and Biaxin. This treatment kills bacteria and stops production of stomach acid, but does not heal ulcer. Weighted NI (Naso intestinal tubes) must float from stomach to intestine. Don't tape the tube right away after placement, may leave coiled next to pt on HOB. Position patient on RIGHT to facilitate movement through pylorus.
Diaphragm must stay in place 6 hours after intercourse. They are also fitted so must be re- fitted if you lose or gain a significant amount of weight.
Best time to take Growth Hormone PM, Steroids AM, Diuretics AM, Aricept AM.
Carafate (Sulcrafate) before meals (mucosal barrier; constipation)
Tagamet with food (H2; messes with elderly ppl be careful! Interacts with alot of things)
*Antacids after meals
- Long term use of amphogel (binds to phosphates, increases Ca, robs the bones.. to increased Ca resortion from bones and WEAK BONES) *Cushings ulcers r/t BRAIN injury *Cushings triad r/t ICP in BRAIN (htn, bradycard, irr. resp) *Thyroid storm is HOT (hyperthermia) *Myxedema coma is COLD (hypothermia) *Glaucoma intraocular pressure is greater than the normal (22 mm Hg), give miotics to constrict (pilocarpine) NO ATROPINE.
- Non dairy sources of calcium include RHUBARB, SARDINES, COLLARD GREENS
- You can petal the rough edges of a plaster cast with tape to avoid skin irritation. *With low back aches, bend knees to relieve
- Push fluids with Allopurinol - flush the uric acid out of system
- Koplick's spots are red spots with blue center characteristic of PRODROMAL stage of Measles. Usually in mouth.
- INH can cause peripheral neuritis, take Vit B6 to prevent also hepatotoxic
Tensilon is used in myesthenia gravis to confirm the diagnosis.
Myesthenia gravis is caused by a disorder in the transmission of impulses from nerve to muscle cell.
Amyotrophic lateral sclerosis ( ALS ) is a condition in which there is a degeneration of motor neurons in both the upper & lower motor neuron systems.
Transesophageal Fistula (TEF) - esophagus doesn't fully develop (this is a surgical emergency) The 3 C's of TEF in the newborn:
- Choking
- Coughing
- Cyanosis
The MMR vaccine is given SQ not IM.
Red--unstable, ie, occluded airway, actively bleeding, see first
Yellow---stable, can wait up to an hour for treatment, ie burns, see second
Green---stable, can wait even longer to be seen, "walking wounded"
Black--unstable clients that will probably not make it, need comfort measures
DOA---dead on arrival
Greek heritage - they put an amulet or any other use of protective charms around their baby's neck to avoid "evil eye" or envy of others
4 year old kids cannot interpret TIME. Need to explain time in relationship to a known COMMON EVENT (eg: "Mom will be back after supper").
** Anaphylactic reaction to baker's yeast is contraindication for Hep B vaccine. ** Ask for allergy to eggs before Flu shot ** Ask for anaphylactic rxn to eggs or neomycin before MMR ** When on nitroprusside, monitor thiocynate (cyanide). Normal value should be 1, >1 is heading toward toxicity **If kid has cold, can still give immunizations **SARS (severe acute resp syndrome) airborne + contact (just like varicella) ** Hepatitis A is contact precautions ** Tetanus, Hepatitis B, HIV are STANDARD precautions ** William's position - Semi Fowlers with knees flexed (inc. knee gatch) to relieve lower back pain. ** SIGNS of a Fractured hip: EXTERNAL ROTATION, SHORTENING, ADDUCTION ** Fat Embolism: Blood tinged sputum (r/t inflammation), inc ESR, respiratory alkalosis (not acidosis r/t tachypnea), hypocalcemia,increased serum lipids, "snow storm" effect on CXR. **Complications of Mechanical Ventilation: Pneumothorax, Ulcers ** Paget's Disease - tinnitus, bone pain, enlargement of bone, thick bones. ** NO VITAMIN C with Allopurinol ** IVP requires bowel prep so they can visualize the bladder better **Acid Ash diet - cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread ** Alk Ash diet- milk, veggies, rhubarb, salmon ** Orange tag in triage is non emergent Psych ** Greenstick fractures, usually seen in kids bone breaks on one side and bends on the other
Insomnia is a side effect of thyroid hormones. Saunders confirms it. Makes sense though! Increased met. rate, your body is "too busy to sleep" as opposed to the folks with hypothyroidism who may report somnolence (dec. met rate, body is slow and sleepy). Ok some more facts.
** BOTOX for strabismus. Patch the GOOD eye so that the weaker eye can get stronger. Found a cool link about its use in peds pt with strabismus. I had to look it up cuz I heard it was important ah hem ah hem
** TIDAL VOLUME is 7 – 10ml / kg ** COPD patients REMEMBER: 2LNC or less (hypoxic NOT hypercapnic drive), Pa02 of 60ish and Sa02 90% is normal for them b/c they are chronic CO2 retainers. ... ** Neostigmine/Atropine (anticholinergic) to reverse effect of pancuronium. **Ampho B causes hypokalemia (amongst many other things. premedicate before giving. Pts will most likely get a fever) ** Test 4 hypersensitivity before the administration of asparginase. ** Take Vermox with high fat diet (increases absorption) ** Kidney Glucose threshold is 180 ** Amphogel and Renegal take with meals ** Stranger anxiety is greatest 7 - 9 months, Separation anxiety peaks in toddlerhood ** MMR is a SQ shot
Lymes is found mostly in Conneticut
Asthma and Arthritis--swimming best
Asthma has intercostal retractions--be concerned
Tardive Dyskinesia - irreversible - involuntary movements of the tongue, face and extremities, may happen after prolonged use of antipsychotics
Akathisia - motor restlessness, need to keep going, tx with antiparkinsons meds, can be mistaken for agitation.
When drawing an ABG, you need to put the blood in a heparinized tube, make sure there are no bubbles, put on ice immediately after drawing, with a lable indicating if the pt was on room air or how many liters of O2.
Remember to preform the Allen's Test prior to doing an ABG to check for sufficient blood flow
Before going for Pulmonary Fuction Tests (PFT's), a pt's bronchodilators will be with-held and they are not allowed to smoke for 4 hrs prior
For a lung biopsy, position pt lying on side of bed or with arms raised up on pillows over bedside table, have pt hold breath in midexpiration, chest x-ray done immediately afterwards to check for complication of pneumothorax, sterile dressing applied
For a lumbar puncture, pt is positioned in lateral recumbent fetal position, keep pt flat for 2-3 hrs afterwards, sterile dressing, frequent neuro assessments
EEG, hold meds for 24-48 hrs prior, no caffine or cigarettes for 24 hrs prior, pt can eat, pt must stay awake night before exam, pt may be asked to hyperventilate and watch a bright flashing light, after EEG, assess pt for seizures, pt's will be at increased risk
Diamox, used for glaucoma, can cause hypokalemia
Munchausen Syndrome is a psychiatric disorder that causes an individual to self-inflict injury or illness or to fabricate symptoms of physical or mental illness, in order to receive medical care or hospitalization. In a variation of the disorder, Munchausen by proxy (MSBP) , an individual, typically a mother, intentionally causes or fabricates illness in a child or other person under her care.
Multiple Sclerosis is a chronic, progressive disease with demyelinating lesions in the CNS which affect the white matter of the brain and spinal cord. Motor S/S: limb weakness, paralysis, slow speech Sensory S/S: numbness, tingling, tinnitus Cerebral S/S: nystagmus, ataxia, dysphagia, dysarthria
Huntington's Chorea: 50% genetic, autosomal dominant disorder S/S: chorea --> writhing, twisting, movements of face, limbs and body -gait deteriorates to no ambulation -no cure, just palliative care
-WBC shift to the left in a patient with pyelonephritis (neutrophils kick in to fight infection)
-Definitive diagnosis for abd. aortic aneurysm (AAA) --> CT scan
-Don't use Kayexalate if patient has hypoactive bowel sounds.
-Uremic fetor --> smell urine on the breath
-Hirschsprung’s --> bile is lower obstruction, no bile is upper obstruction; ribbon like stools.
-Pancreatic enzymes are taken with each meal! Not before, not after, but WITH each meal.
Thank you, I finally realize why a person shouldn't have cantaloupe before a occult stool test, because cantaloupe is high in vit c and vit c causes a false + for occult blood. Now I just need to figure out why they can't have fish.
Hypospadias: abnormality in which urethral meatus is located on the ventral (back) surface of the penis anywhere from the corona to the perineum (remember hypo, low (for lower side or under side) Epispadias: opening of the urethra on the dorsal (front) surface of the penis Priapism: painful erection lasting longer than 6 hrs.
Anticholinergic effects--assessment dry mouth==can't spit urinary retention=can't **** constipated =can't **** blurred vision=can't see
When you see Coffee-brown emesis, think peptic ulcer 2 you see fluid retention. Think heart problemsfirst. 3 answer that delays care or treatment is ALWAYSwrong 4 PVD remember DAVE (Legs are Dependent forArterial & for Venous Elevated) more to come..........
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When choosing an answer, think in this manner... if you can only do ONLY one thing to help this patient what would it be? Pick the most important intervention.
If two of the answers are the exact opposite, like bradycardia or tachycardia... one is probably the answer. If two or three answers are similar or are alike, n one is correct. When asking patients’ questions NEVER use “why” questions. Eliminate all “why?” answer options. If you have never heard of it... please don’t pick it! Never release traction UNLESS you have an order from the MD to do so Questions about a halo? Remember safety first, have a screwdriver nearby. Remember compartment syndrome is an emergency situation. Paresthesias and increased pain are classic symptoms. Neuromuscular damage is irreversible 4- hours after onset. Always deal with actual problems or harm before pot ential problems Always select a “patient focused” answer. An answer option that states "reassess in 15 minute s" is probably wrong. Interpersonal model (Sullivan) Behavior motivated by need to avoid anxiety and satisfy needs
- Infancy 0-18 months others will satisy needs
- childhood >6yrs learn to delay need gratification
- juvenile 6-9 years learn to relate to peers
- preadolescence 9-12 yrs learns to relate to friends of of opposite sex
- early adolescence12-14yrs:learn independence and how to relate to opposite sex
- late adolecence 14-21yrs: develop intimate relationship with person of opposite sex is this not about communication?....
Nclex-Study-Guide - dfghfh
Subject: Biology
High School - Canada
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