COMP B STUDY GUIDE Flashcards
Stoma care:
- Should appear pink and moist
- Ischemia/purple/black is serious finding
- Apply skin barrier and creams (adhesive paste) to stoma skin and allow to air dry before applying
- Empty bag when it’s 1/3 to 1/2 full of drainage
Fiberglass leg cast:
- Are light, stronger, and water resistant.
- Dries very quickly (30 min) and are most commonly used
- Inspect the cast every 8-12 hours
- Elevate during the first 24-48 hours to prevent edema
- Room for one finger between skin and cast
- Report areas under the cast that are painful, have a hot spot, increased drainage, warmth, odor (infection)
- Report change in mobility and complications (sob, skin breakdown, constipation)
Diet for renal calculi:
- Kidney stones are made of CALCIUM OXALATE
- Contributing factors: inadequate fluid intake, elevated urine pH, excess excretion through the kidneys of oxalate, calcium, and uric acid (lean meats, organ meats, whole grains, legumes)
- A patient who has a ileostomy has an increased risk of kidney stones
- Avoid excess protein, sodium, calcium oxalates (rhubarb, spinach, beets, nuts, chocolate, tea, wheat bran, strawberries)
- Daily UP 2L/day
- INCREASE potassium
- Avoid mega doses of vitamin C
Lithium:
- Mood stabilizer for bipolar, manic episodes
- Therapeutic range 0.8-1.2
- Monitor weekly blood draws until steady and then every 3 MONTHS. Monitor LITHIUM and SODIUM.
- May take 1-3 weeks for full effect
- Teratogenic
- Monitor for LITHIUM
Leukocytosis, Increased Urination, Thirsty/tremors, Hypothyroidism, Interaction with many meds, Upset stomach, Must get levels checked - If we have low sodium in the body, the body will use lithium to take place of salt = toxicity
Amitriptiline:
- TCA antidepressant
- Blocks reuptake of norepinephrine and serotonin in the synaptic space, thereby intensifying the effects of neurotransmitters
- Can take 10-14 days or longer before it begins to work
- Monitor for ORTHOSTATIC HYPOTENSION, ANTICHOLINERGIC EFFECTS. (Dry mouth, blurry vision, photophobia, urinary retention, constipation, tachycardia, sedation, excessive sweating.
- Toxicity: dysrhythmias, mental confusion, agitation, seizures, coma, death
- Contraindications: seizures, MI
- Have an increased risk for suicide should received 1 week supply of med due to lethality of toxic doses
Thermoregulation newborn:
- Provides a neutral thermal environment that helps a
newborn maintain a normal core temp with minimal
oxygen consumption and caloric expenditure - The newborn keeps warm by metabolizing brown fat,
which is unique to newborns, but only within a very
narrow temperature range. Becoming chilled (cold
stress) can increase the newborn’s oxygen demands
and rapidly use up brown fat reserves. - Monitor for hypothermia in the newborn.
-Axillary temperature of less than 36.5° C (97.7°F)
-Cyanosis
-Increased respiratory rate
-Core temperature varies within newborns, but it
should be kept at approximately 36.5 to 37° C (97.7
to 98.6° F - Interventions: Conduction: Loss of body heat resulting from direct
contact with a cooler surface. Preheat a radiant
warmer, warm a stethoscope and other instruments,
and pad a scale before weighing the newborn. The
newborn should be placed directly on the parent’s
chest and covered with a warm blanket, and a cap
should be placed on the newborn’s head. Convection: Flow of heat from the body surface to cooler environmental air. Place the bassinet out of the direct line of a fan or air conditioning vent, swaddle the newborn in a blanket, and keep the head covered. Any procedure done with the newborn uncovered should be performed under a radiant heat source. Keep ambient temperature of the nursery or
client’s room at 22 to 26° C (72 to 78° F). Evaporation: Loss of heat as surface liquid is converted to vapor. Gently rub the newborn dry with a warm sterile blanket (adhering to standard precautions) immediately after birth. If
thermoregulation is unstable, postpone the initial
bath until the newborn’s skin temperature is 36.5° C
(97.7° F). When bathing, expose only one body part at
a time, washing and drying thoroughly. Radiation: Loss of heat from the body surface to a
cooler solid surface that is close, but not in direct
contact. Keep the newborn and examining tables
away from windows and air conditioners.
Temperature stabilizes at 37° C (98.6° F) within 12
hr after birth if chilling is prevented.
The best method for promoting and maintaining the
newborn’s temperature is early skin-to-skin contact
with the parent.
Pneumonia:
- S/S: anxiety, fatigue, weakness, chest discomfort d/t coughing, confusion from hypoxia, fever, chills, flushed face, diaphoresis, SOB, tachypnea, sharp pleuritic chest pain, yellow tinged sputum, crackles, wheezes, purulent or blood tinged or rust sputum
Pressure injuries:
- Provide adequate hydration, protein, and calorie needs. Fluid intake of at least 2500 ml/day, protein (meat, fish, poultry, eggs, dairy products, beans, nuts, whole grains)
- If blood ALBUMIN is low (< 3.5) because a lack of protein increases the the risk for a DELAY IN WOUND HEALING and infection.
- Wound cleansing and irrigation from the least contaminated (incision) toward the most contaminated (surrounding skin). Never use the same gauge to cleanse across an incision or wound more than once. DON’T use cotton balls or products that shed fibers.
- If irrigating, use a piston syringe or a sterile straight catheter for deep wounds with small openings. Apply 5-8 psi pressure, 30-60 ml surging with a 19 gauge needle provides approx 8psi.
Hepatitis characteristics:
- History of exposure to infected blood, stool, bodily fluids.
- S/S: fatigue, decreased appetite with nausea, abdominal pain, joint pain, fever, vomiting, dark colored urine, CLAY colored stool, JAUNDICE
Increased ICP care:
Elevate head at least 30° to reduce ICP and to
promote venous drainage.
Avoid extreme flexion, extension, or rotation of the
head, and maintain the body in a midline neutral
position.
Maintain a patent airway. Provide mechanical
ventilation as indicated.
Administer oxygen as indicated to maintain PaO2
greater than 60 mm Hg.
The client should receive stool softeners and avoid
the Valsalva maneuver with increased ICP.
Provide a calm, restful environment. (Limit visitors.
Minimize noise.)
Brief periods of hyperventilation for the intubated
client can be used after the first 24 hr following
injury to help lower ICP. During the first 24 hr,
hyperventilation can cause cerebral
vasoconstriction, which can cause ischemia
Sickle cell crisis interventions:
Promote rest to decrease oxygen consumption.
Administer oxygen as prescribed if hypoxia is present.
Provide intense hydration therapy while maintaining
fluid and electrolyte balance.
Monitor I&O.
Give oral fluids.
Administer IV fluids with electrolyte replacement.
Use caution with potassium replacement
dminister blood products, usually packed RBCs, and
exchange transfusions per facility protocol. Observe for
manifestations of hypervolemia and transfusion reaction.
Treat and prevent infection.
Administer antibiotics.
Perform frequent hand hygiene.
Give oral prophylactic penicillin.
Administer pneumococcal conjugate vaccine,
meningococcal vaccine, and Haemophilus influenzae type
B vaccine.
Monitor and report laboratory results.
Use an interprofessional approach.
Treat mild to moderate pain with
acetaminophen or ibuprofen. Manage severe pain
with opioid analgesics.
Apply comfort measures (warm packs to painful
joints).
Schedule administration of analgesics to
prevent pain.
Mechanical soft diet:
Ground meat, canned fruits, softly cooked veggies
Meditation:
Focuses attention to a single unchanging stimulus to become more mindful of self
Cane instructions:
- Level with greater trochanter
- Move cane first, then move weaker leg
- Hold cane on STRONG side, always keep 2 points on the floor for support at all times
- Going UP: up with the GOOD (strong leg, cane, weak leg)
- Going DOWN: down with the bed (cane, weak leg, strong leg)
Sterile field:
- Keep surfaces dry
- Discard any packages that’s torn, punctured, wet
- Hold items 6 inches above sterile field
Pulse deficit:
The difference between apical and radial pulse
Hypoxia manifestations:
- Early: Think that the body is still trying to compensate -> tachypnea, tachycardia, HTN, anxiety, confusion, pale skin, pale mucous membranes, use of accessory muscles, nasal flaring, adventitious breath sounds.
- Late: think that the body has used up all it’s energy so now it’s slowing down -> stupor, cyanotic, bradypnea, bradycardia, hypotension, cardiac dysrythmias
Skin lesions:
- Macule: freckles, petechiae
- Papule: elevated nevus (mole)
- Nodule: wart (palpable, 1-2 cm)
- Vesicle: pus filled (blisters, herpes, varicella)
- Wheal: insect bite
Transfer documentation:
Med diagnosis and care providers, demographic info, overview of health status/plan of care/recent progress, alterations that can precipitate immediate concern, notification of assessments or care essential within the next few hours
Bowlegged/knock knee:
Is a common finding for a toddler/newborn. Feet should face forward while walking.
Pulse ox locations:
Fingertips, toes, bridge of nose, earlobe, forehead with a clip or band
Indications of stress for a patient hospitalized:
Dilated pupils, speech dysfunctions, severe shakiness, severe withdrawal, inability to sleep, delusions, hallucinations (PANIC LEVEL ANXIETY)
Parkinson’s difficulty chewing and swallowing s/s:
Drooling, dysarthria, progressive difficulty with ADLS, mood swings, cognitive impairment (Dementia)
Medication abbreviations:
- Always write the full name of medication
- Don’t use trailing zeros (1.0 mg)
- Don’t use decimal points without leading zero (. 5 mg)
Priority response to a patient refusing meds:
ASSESS why
HYPOKalemia s/s “NED HAS many STRANGE SYMPTOMS”:
N/V
EKG changes
Decreased reflexes
Hypotension
Muscle weakness
Shallow breathing
Slowing of GI (constipation)
HYPERKalemia s/s “MURDER”:
Muscle cramps, weakness
Urine abnormalities
Respiratory distress
Decreased cardiac contractility (low HR, low BR)
EKG changes (tall peaked T waves)
Reflexes (decreased DTR)
Heparin complications:
HEMORRHAGE “numbers high, patients DIE. Numbers low, clots GROW”
APTT value: 1.5-2 times the baseline
Normal is 60-80 seconds
Fluid volume overload s/s:
Peripheral edema in lungs and body resulting in weight gain, distended neck veins, increased urine output, skin cool to touch with pallor. AT RISK FOR PULMONARY EDEMA
Post anesthesia complications:
- Malignant hyperthermia (temp 107F)
- Nursing actions -> apply cooling blanket, ice to armpits/groin/neck/head, ice lavage. Administer IV DANTROLENE (muscle relaxant), 100% oxygen, ice infused 0.9% NaCl, catheter to monitor output, monitor cardiac rhythm, transfer to ICU
Ferrous sulfate teaching:
- Stools can be black or dark green (Normal)
- Liquid form can stain teeth -> USE A STRAW, rinse mouth after swallowing
- AVOID antacids 1 hour AFTER iron (reduces absorption)
- Take with food to minimize GI effects
- Vitamin C increases absorption
Digoxin:
- Therapeutic level: 0.5-0.8
- Toxicity: vision changes, yellow halo, N/V/D, confusion, anorexia, bradycardia, dysrythmias
- Considerations: INCREASE POTASSIUM, monitor BUN and creatinine
Pramlintide (antidiabetic):
- Antidiabetes
- Interacts with INSULIN = increase risk of hypoglycemia
Neostigmine:
- Cholinesterase inhibitor
- Treatment for myasthenia gravis, reversal of nondepolarizing neuromuscular blocking agents
- Complications: cholinergic crisis “SLUDGE and killer B’s” -> Salivation, Lacrimation, Urination, Diaphoresis/Diarrhea, GI cramping, Emesis, Bradycardia, Bronchospasm, Bronchorrhea
- Interacts with ATROPINE-an anticholinergic (only use for toxicity)
Medication to manage nephropathy:
ARBS (-sartans) delays the progression of diabetic nephropathy
Hydroxychloroquine:
- Antimalarial
- Causes retinal damage = blindness
- Stop if visual disturbances occur, notify MD
- Have baseline eye exams and every 6 months with an ophthalmologist
Tamsulosin complications:
Hypotension, dizziness, nasal congestion.
MONITOR BP and change positions slowly!
Antitussives:
- Cough suppressants
- Ex: Benzonatate, Dextromethorphan
- Complications: mild nausea, dizziness, sedation, potential for abuse d/t euphoria
BeclomethasONE inhaler education:
Can cause oral candidiasis, hoarseness, difficulty speaking. RINSE MOUTH OR GARGLE water after use, use spacer PRN
Postop bronchoscopy:
- Continuously monitor VS, LOC
- Assess gag reflex and ability to swallow
- Mild fever in 24 hour EXPECTED
- Productive cough, hemoptysis, hypoxemia = HEMORRHAGE
- Provide oral hygiene, encourage coughing and deep breathing every 2 HOURS
- DON’T DC if gag reflex and respiratory effort not present
Antihypertensives:
AT RISK FOR FALLS!!!!
1. ACE inhibitors “prils”: monitor for ACE -> Angioedema, Cough, ELEVATED POTASSIUM
2. ARBS “sartans”
3. Beta blockers “olol”: monitor for killer B’s -> Bradycardia, Bronchospasm, Bronchoconstrictions (contraindicated with asthma, bad for HF, masks hypoglycemia)
4. CCB “dipine”, verapamil, Diltiazem: AVOID GRAPEFRUIT JUICE = severe HYPOTENSION, and CALCIUM CONSTIPATES
Left VS right side of brain:
- Left side: Language processing, Logic, and analytical thinking
- Right side: creativity, spatial awareness, and emotional processing
Different types of urinary incontinence:
- Stress: loss of small amounts of urine from increased abdominal pressure (coughing, sneezing, lifting)
- Urge: can’t reach the bathroom
- Overflow: frequent loss of small amounts of urine d/t urinary retention, can occur with spinal cord injury or MS
- Reflex: INVOLUNTARY loss of moderate amount of urine with no warning
- Functional: normal void. You go when your body tells you to go.
- Transient: reversible incontinence d/t inflammation, UTI, hyperglycemia, cognitive impairment, diuretics, anticholinergics
Actions to decrease ICP:
- HOB elevated 30 degrees to promote venous drainage
- Avoid extreme flex, extension, rotation of the head
- Body in MIDLINE NEUTRAL POSITION
- Stool softeners to avoid valsalva maneuver
- Calm, restful environment; limit noise and stimuli
CKD diet:
Restrict sodium and potassium
Pneumococcal polysaccharide vaccine:
65 years old and 12 months old
Post op liver biopsy:
- RIGHT SIDE LYING for several hours
- Assess for abdominal pain, bleeding at puncture site, assess for pneumothorax (dyspnea, cyanosis, restlessness)
- AVOID STRAINING AND COUGHING
Guiac FOBT nursing actions and patient education:
- Actions: don’t use stool from digital rectal exam to avoid false positive
- Educate: avoid red meat, anti-inflammatory meds, and vitamin C 48 hours/2 days PRIOR to testing
ABGs:
Ph: Acidosis 7.35-7.45 Alkalosis
CO2: Alkalosis 35-45 Acidosis
HCO3: Acidosis 22-26 alkalosis
Purpose of a nasogastric suction post op colectomy:
DECOMPRESSION
Head injury manifestations of increased ICP:
Cheyenne stokes respirations(cycles of apnea and hyperventilation), severe headache, N/V, deteriorating LOC, restless, irritable, dilated or pinpoint non reactive pupils, flaccid, decerebrate, decorticate, cushing’s triad (severe HTN, wide pulse pressure, bradycardia), seizures
Expected findings for herniated lumbar disc (low back pain):
Numbness/tingling (paresthesia), burning or stabbing pain in leg or foot, dull or sharp low back pain, possible stiff/flexed posture, pain aggravated by coughing/sneezing/straining, muscle spasms, cramping, stiffness, pain in buttocks, limping, reports of chills/fever/bladder incontinence
Cimetidine (Tagamet):
- Decreases acid secretion
- Take 1 HOUR BEFORE or 1 hour AFTER ANTACID
Pancreatitis:
- S/S: tetany d/t hypocalcemia, trousseaus’s sign (hand spasms when BP cuff inflated), chvostek’s sign (facial twitch when facial nerve tapped), ascites, warm/moist/fruity breath, absent or decreased bowel sounds, generalized jaundice, abominable distention/rigidity (PERITONITIS), ecchymoses on flanks, bluish grey periumbilical discoloration.
- Treatment: rest the pancreas = NPO! If severe = enteral or parenteral nutrition. Eat BLAND, low protein/fat/no stimulants (caffeine, alcohol, stress), eat small frequent meals.
Hepatitis and cirrhosis complications:
Liver cancer, hepatic encephalopathy
Monitor AST, ALT, HGB/HCT/PLATELETS (will be decreased), PT/INR (prolonged d/t decreased synthesis of prothrombin)
Peripheral VASCULAR disease VS peripheral ARTERIAL disease:
- PVD -> Edema, warm legs, achy pain; eleVate Veins.
- PAD -> no edema, cold legs, gangrene, necrosis, sharp pain; dAngle Arteries (it’s cold and necrotic cause no perfusion)
COPD nursing care:
- High fowlers
- Encourage cough, deep breathing, INCENTIVE SPIROMETER, pursed lip breathing
Post op bone marrow biopsy:
- Avoid ASA
- Apply ICE to minimize bruising and bleeding
- Monitor for infection
- Bed rest 30-60 minutes
- Dressing over biopsy site, and apply pressure to control any bleeding
Ménière’s disease:
- Episodic vertigo and tinnitus
- Decrease salt and sodium intake (processed meats, MSG)
- Avoid caffeine and alcohol
- Cluster free environments (d/t increased risk of falls)
- Restrict head movements, change positions slowly
- Provide a quiet, dark environment
Priority finding for appendicitis:
- Monitor for PERITONITIS -> rigid, broad like abdomen, N/V, redound tenderness, tachycardia, fever, decreased LOC, confusion
- Actions: fowlers or semi fowlers to promote drainage of peritoneal fluid, turn/cough/deep breathe, nasogastric suction, NPO, monitor for hypovolemia, give hypertonic IV
Levodopa harmless side effect:
Discoloration (yellow, reddish brown) of sweat and urine
Mental health primary-tertiary preventions:
- Primary: promotes health/prevention
- Secondary: Focus on early detection of mental illness/screenings
- Tertiary: REHAB
Personality disorders priority:
SAFETY! There are two types of personality disorders:
1. Borderline = danger to self
2. Antisocial = danger to others
Assertive community treatment:
Non traditional case management and treatment by an interprofessional team for patients who have a severe mental illness Assertive community treatment: EX- SCHIZOPHRENIA would benefit) and are non compliant with traditional treatment. ACT helps reduce recurrences of hospitalization and provides crisis intervention.
Somatic symptom disorder:
Expression of psychological stress through physical manifestations. Educate on ASSERTIVENESS techniques
OCD care:
Provide a structured environment for physical safety and predictability.
Cocaine intoxication manifestations:
Dilated pupils, hallucinations, seizures, EXTREME FEVER, tachycardia, HTN, cardiovascular collapse, chest pain, death
Dissociate:
Amnesia, derealization
Amytriptiline (TCA) toxicity:
Cholinergic blockade -> dysrythmias, confusion, agitation, seizures, coma, death
Bulimia nervosa:
- Binge eating
- Purging (self induced vomiting, over exercise, laxatives -> to compensate for behaviors)
- S/S: tooth erosion, injury to esophagus, bad breath, electrolyte imbalances, cardiac arrhythmias
- Labs: decreased potassium and sodium, elevated amylase from parotitis, increased BUN and creatinine
GTPAL:
Gravida: number of pregnancies, triplets/twins=1
Term births: born at > 37 weeks
Pre term: born between 20-36 weeks
Abortions
Living children
Naegele’s rule:
Date of LMP minus 3 months plus 7 days plus 1 year = EDD
Signs of pregnancy:
- Presumptive: amenorrhea, breast enlargement, n/v, quickening (mom feels baby but it could be gas)
- Probable: goodells (soft cervix), Chadwick (bluish vulva, vagina, cervix), hegar’s (lower uterine segment soft), ballottment (when uterus is pushed with fingers, fetus goes back up), positive pregnancy test (high levels of hcg)
- Positive: heard at 10-12 weeks, felt at 20 weeks, seen at 4-6 weeks
Vaccines ok during pregnancy:
Flu, covid, TDAP.
Chlamydia treatment:
1 dose of azithromycin
Biophysical profile:
Non invasive NST to assess fetal movements, fetal breathing, muscle tone, amniotic fluid, and NST (want this reactive)
Amniocentesis in pregnancy:
Done after 14 weeks to test genetic disorders, neural tube defects, fetal lung maturity
Rhogam:
Negative mom, positive baby
Hydatiform mole (molar pregnancy)
Rare condition where there’s a benign proliferation of trophoblasts that develops in the placenta.
Treatment -> SUCTION CURETTAGE
Placental abruption VS previa:
- Abruption: Detachment issue, dark red blood, abdominal pain, uterine tenderness, fetal distress
- Previa: attachment issue, PAINLESS red blood, non tender uterus, typically normal FHR
Preeclampsia:
Proteinuria, HTN, edema, severe headache, RUQ epigastric pain, visual disturbances, low urine output.
Goal: prevent eclampsia (seizures) give magnesium sulfate and monitor DTR, neuro status, RR, UO
Acrocyanosis:
Blue hands and feet during the first 24 hours (normal)
APGAR:
7-10 excellent
4-6 moderately depressed
0-3 severely depressed
Post delivery newborn meds:
Erythromycin ointment, Vitamin K, Hep B vaccine, heel stick to test for PKU, sickle cell anemia
Priority intervention for variable deceleration:
DC PITOCIN, reposition side to side, knee to chest
Ovarian cancer risk factors:
Genetic mutation for HNPCC, > 40 years, family history, DM, early menarche, late menopause, endometriosis, infertility
IUD teaching:
Monitor monthly after menstruation to ensure the presence of the small string that hangs from the device into the upper part of the vagina to rule out migration
Epidural adverse effects:
Itching, hypotension, fetal bradycardia, fever, inability to feel urge to void, urinary retention
Meds for GBS:
PCN or ampicillin
Pap test teaching:
- Schedule 6 days after period
- (Don’t put anything into vagina for 24 hours prior to exam) Refrain from using vaginal meds/douching/sex 24 hours prior to exam
- May experience mild cramping
Car seat safety:
- 45 degrees
- Shoulder harness in slots at or below shoulders
- Harness should be snug
- Retainer clip at level of armpits
Operative vaginal birth with vacuum extractor:
Check neonate for Caput succedaneum (Swelling of scalp, will disappear 3-5 days)
Post op cardiac catheterization (pediatrics):
Assess temp, color of affected extremity, assess insertion site (femoral or AC) for bleeding or hematoma, extremity STRAIGHT 4-8 hours, encourage fluids to flush out contrast dye
Congenital talipes equinovarus (clubfoot) referral:
Orthopedic, PT
Temper tantrum management:
Ritualism/maintain routines and reliability provides a sense of comfort
MMR vaccine (live vaccine) contraindications:
Immunocompromised, pregnant, blood products within 11 months
Risk factors for seizures:
Febrile episodes, cerebral edema, intracranial infection, brain tumor, anoxia, toxins, drugs, lead poisoning, tetanus, shingles, salmonella, metabolic acidosis
Factor VIII:
Used to prevent and treat hemorrhage
Mono complications:
Ruptured spleen
Hirschsprung’s disease diagnostic:
Rectal biopsy to confirm absence of ganglionic cells
Osteogenesis imperfecta (brittle bone disease) findings:
Inherited connective tissue condition that results in bone fractures and deformity along with RESTRICTED GROWTH
Glomerulonephritis UA findings:
Protein, smoky/tea colored urine, hematuria, increased urine specific gravity
Kernicterus:
Irreversible, chronic result of bilirubin toxicity.
Mastitis s/s and care:
- S/S: painful, tender, localized hard mass and red. Chills, fever, headache, body aches, fatigue.
- Care: abx, hand hygiene, air dry nipples, rest, fluids 3000ml/day, fitted bra, completely empty boobs
Pediculosis capitis (head lice):
Avoid home remedies
Bag items tightly sealed for 14 days
Boil combs and hair stuff for 10 min
Avoid sharing personal items
DC teaching for acute strep pharyngitis/GAHBS:
Replace toothbrush after taking antibiotics for 24 hours, cool liquids/ice, cool or warm compress, give -mycin ABX.
Pediatrics UTI s/s:
Enuresis (bed wetting), frequent urination, dysuria, hematuria, vomiting, constipation, fever, chills, malodorous urine, abdominal/flank pain
Reye’s syndrome:
Occurs when ASA is given to child who has a viral illness (chicken pox, flu). Administer ACTIVATED CHARCOAL, COOL BATH, IVF, GASTRIC LAVAGE
Hypospadias repair:
Good hand hygiene, NO TUB BATH 1 WEEK, limit activity
Ineffective endocarditis s/s:
NEW MURMUR, fever, malaise, arthralgia, diaphoresis, weight loss, splinter hemorrhage under fingernails
