Cumulative Review 2 Flashcards
3 Medications for:
Post-Partum Hemorrhage
OMM
Oxytocin (if contractions ↑ 90 seconds = tachysystole, d/c )
Methylergonovine - Ø give if HTN, SFX diarrhea
Misprostol - uterus contraction/ulcer prevention
IF for ulcers, do a pregnancy test first
FX: Uterine Atony
2 R/F
Non-firm (loss of tone)
Mag Sulate or retained placenta
S/S Mastitis
EDUCATION: hands, drying nipples, infant position, when to break suction.
Each feeding should... 2 What packs? Pump OK? Analgesic/Antibiotics ok? Type of bra?
Unilateral, pain, warm, tender boobs Wash before feeding Air dry Proper for latch Empty the breast, frequent on affected side Ice/Warm PUMP OK Analgesics/Antibiotics OK Well-fitted
FX: Post-Partum Depression
Length = Blues
Tearful insomnia
Feeling let down
Ø intervene
+10 days
S/S Post-Partum:
Depression
Psychosis
2 Nurse Roles:
Persistent sadness/mood swings Ø resolving w/ intervention
Attempting to harm self/infant
Monitor mom/baby and administer anti-depressants/anti-psychotics
APGAR
Scoring:
0 - 10, 2 points each A2, acrocyanosis = 1, pale blue = 0 P2, HR ↓100 = 1, Ø HR = 0 G2, reflex grimace = 1, Ø grimace = 0 A2, some flex = 1, Ø flex = 0 R2, weak cry = 1, Ø cry = 0
Normal Length and Wt Range for a Baby (kg and lbs)
Length: 45 - 65 cm
Wt: 2.5 - 4kg (5.5 - 8.8 lbs)
Infant Reflex end times
Sucking/Rooting/Moro
Babinski
4 months
1 year
4 S/S Baby Hypoglycemia Cry Type: Skin Color R/R Muscle Tone TX:
High pitched cry
↓ 40 RR
Cyanosis
Irritatble, twitching, flaccid muscle tone
↑ Breast feeding frequency
Milk Storage Timings: On table Fridge Freezer Deep Freezer
8 hours
8 days
6 months
12 months
How to Thaw milk:
EDUCATION:
Re-usable milk?
Thaw in fridge for 24 hours
DO NOT refreeze
DO NOT save used portions.
Mix w/: Baby Formula
Fridge life
Tap water
48 hours
Barlow Test
Audible click w/ aduction/shorter flexion of leg
Ortonali Test
Reduces hip back into socket by manipulation of the joint
Baby Weights
When to double? Triple? Quadruple?
6 months
1 year
2 1/2 years
Average Diapers/day for a newborn
6 - 8
Circumcision: TX of crust Use of petroleum jelly Clean with...? Diaper change q?
Leave crust, mucus fulm
Apply to prevent sticking to diaper
Warm trickling water
q4hrs
Circumcision:
When to bathe
What NOT to use to clean
NOT until healed
Moistened towelettes/alcohol
Cord Care: When is clamp removed Keep diaper...? Time to fall off How to bathe Watch for, REPORT?
Before d/c Dry and folded below 10 - 14 days Sponge bath ONLY Infection
Babies: 20 second apnea
Totaaally OK
Pre-term Baby S/S Weight Lanugo Creases Grasp Muscles
Low, ↓ fat ALOT of lanugo NO creases WEAK grasp Hypotonic muscles
Pre-term Baby S/S
Affect
Sucking/Feeding
↑ R/F
Lethargic
Trouble with…
Necrotizing Entero Colitis
FX: Hyperbilirubemia in Children
Persistence length
TX
Jaundice in sclera/mucus membranes.
Birth - Day 7, 8+ = jaundice
Phototherapy
Children Phototherapy Nurse Roles: Eyes Clothing Genitals of male Lotion use Removal/Turning timings
Cover eyes Undress baby COVER genitals NO lotion/ointments as they can cause burns from absorbing heat Remove q4hrs, turn q2hrs
Children Phototherapy:
Monitor…?
Mucular Papular Rash?
Complicaiton?
2 TX:
Temperature q4hrs
OK
Dehydration
↑ Feeds to promote excretion of bilirubin + supplement
S/S Post-Term Babies: Appearance: Skin texture: Hair/Nails: Feet: Fat: Vernix/Lanugo:
Glycemia?
Leathery Dry/Cracked Long Many creases Loss of fat Sparse vernix/lanugo
HYPOglycemia
Fibroids FX on contractions
Poor contractions
Cephalo Hematoma vs. Caput Seccededum
Cephalo - DOES NOT cross the suture line
Resolves on own, but ↑ r/o jaundice
Caput - CROSSES suture line
Often due to vaccum assisted birth
Resolves on own, but ↑ r/o jaundice
Mild - Sever Fever in Children vs. Vaccinations
Mild, low fever, congestion = OK!
Severe = Uhh… NOPE!
S/S Small for Gestational Age: Skin Abdomen Umbilical Cord Sutures
Loose, dry
Sunken
Thin, yellowish
Wide
BRAT Diet:
Diet Contraindicated in…?
Bananas, Rice, Applesauce, Toast
diarrhea
Assault vs. Battery
Threatening vs. Doing it
Beneficence Autonomy Justice Fidelity Veracity
Do good Pt knows self Fair Loyalty to patient Honesty/truth
Repression Suppression Sublimation Displacement Reaction Formation
Unconscious forgetting Voluntary avoiding Convert into appropriate behavior Emotions towards one to another Feeling against, doing anyways
Disassociation
Splitting
Denial
Rape
ALL GOOD or ALL BAD
Refusing to accept truth
Levels of Anxiety Mild Moderate Severe Panic
perform better, figety
↑ HR/RR ↓ perception
↓↓ perception, tachycardia, impending doom
HEART ATTACK
Stages of a Therapeutic Relationship
Orientation
Working
Termination
Frequency, duration, confidentiality
▲behavior, dealing w/ problems
Summarizing goals, reviewing memories, expressing feelings
Transference vs. Countertransference
Patient associates nurse w/ someone they know VS. nurse doing it
Behavioral Therapy Systematic Desensitization Aversion Therapy Operant Condition Biofeedback Guided Imagery Medication
↑ exposure until not afraid
punishment
rewards
controlling body responses (breathing, like for OB pts)
S/S Electro Convulsive Therapy
Pre-procedure Diet?
How often/number of TX:
3 Nurse Roles:
Short term memory loss
NPO
3x/week for 6 - 12 TX
Ensure gag reflex works
Position on side
TX with Succinylcholine (Anectine) which is a muscle relaxant afterwards
Psychotic Disorders:
Positive vs. Negative S/S (5As)
Affect Alogia Anergia Anhedonia Avolition
Positive = presence of extra things (behavior, speech, hallucinations) Negative = Missing something
Affect (blunt) Alogia (speech poverty) Anergia (Ø energy) Anhedonia (Ø pleasure) Avolition (Ø motivation)
Personality Disorders: Antisocial Borderline Hsitrionic Narcissistic Schizotypical Schizoid
Asshole (no leading) All good/bad (watch for self-injury) flirtatious attention seeker Grandiose views of self Magical thinking Ø interest, emotional detachement
S/S Delirium vs. Dementia
Quick onset, temporary
Electrolyte imabalances r/in confusion, ↑ ICP r/in restlesness, ↓ LoC
Progresive, long term
Substance Abuse:
Peak hours
Delirium timing
Medication for:
24 - 48 hours
2 - 3 days
Benzodiazepines
FX: Disulfiram (Antebuse)
2 Nurse Roles:
Causes people to get sick if they drink
Ask when was last drink
First a benzo… then a mood stabilizer
Substance Abuse medication FXs: Lorzepam (Ativan) Chlorodiazaproxide/Librium Carbamazapine (Tregratol)/Clonidine Propranolol Disulfiram
Anti-seizure Anti-anxiety Anti-seizure Decrease cravings Aversion Therapy
3 Key S/S Heroin
TX:
Pinpoint pupils
Dental Caries
Yawning/Insomnia
Methadone
6 Key S/S Cocaine
Dilated pupils
Hypotension
Depression, fatigue, and apathy
FX: Benzos Abuse
Monitor for (2)
Antidote:
Withdraw ↑ R/F?
Sedation
Respiratory depression/↓ LoC
Flumenazil (Romazicon)
↑ Seizure activity
FX: Cocaine/Amphetamine Abuse
Rush of euphoria which r/in HTN and tachycardia (could r/in DEATH)
FX: Opiods
Antidote
3 S/S Withdrawal
Euphoria
Naloxone
Pupil Dilation, tremors, and N/V
S/S Anorexia: Menstruation Hair Temperature Weight Heart Rate
Nurse Role:
Amenorrhea Hair loss Low temperature Loss of 30% in 6 months Bradycardia
Reward for CALORIES consumed
S/S Bulemia:
Weight
Parotid Gland
Teeth
Nurse Role:
Normal/Slightly increased
Swollen
Messed up due to stomach acid
Don’t leave alone w/ meals
For Anxiety: Benzodiazepines (ex: Diazepam) Length of TX: 3 TX: 4 Examples: How to end:
Short term (long = addictions)
DiaZEPAM, LoraZEPAM, ChlorDIAZEpoxide, ClonaZEPAM
Taper off
Alcohol withdrawal, seizures, insomnia
For Anxiety: Buspar (Busparone)
Length of TX:
R/T Sedation?
What fruit to avoid:
Long term (not addicting)
Does NOT sedate
Grapefruit
FX: Benzodiazepines
3 SFX:
ANTIDOTE:
Sedation
Dizziness, drowsiness, ↓ RR
Flumenazil
4 SFX: Tricyclic Antidepressants
REPORT SFX:
Orthostatic Hypotension
Anticholinergic
Sedation
↑ r/o seizures
URINARY RETENTION
A.C.E. Inhibitor (-pril) mneumonic
Angioedema
Coughing
Excessive Potassium
Anticholinergic mneumonic
Can’t see
Can’t pee
Can’t spit
Can’t SHIT
TX: SSRIs
4 Examples (SEFF)
Time to take FX
Monitor for…?
Depression Sertaline Escitalopram Fluoxetine Fluvoxamine
Serotonine Syndrome
S/S Serotonin Syndrome: Mental Sex Sleep Salt Teeth Weight
TX:
↓ LoC, fever, tremors dysfunction insomnia HYPOnatremia Bruxism - grinding GAIN
Taper off the drug
What can’t you eat with a MAOI (and an example med)
Tyramine (aged cheese, avocado, meats, figs, wine), r/in HTN crisis
Phenelzine (Nardil)
3 TX: Atypical Antidepressant
Example
S/S for…
Seizures, GI, Weight, Sleep, DICK?!
Nurse Role:
Depression, smoking cessation, tobacco use
Buproprion (Wellbutrin)
↑ risk of, distress, weight loss, insomnia, piaprism (PROLONGED ERECTION)
TX anticholinergic FX
FX: Lithium Toxic level FX long term use: Diet: 3 ADFX:
Mood stabilizer ↑ 1.5 Thyroid dysfunction ↑ salt and water (diuretic) GI distress, FINE HAND TREMORS, weight gain
3 Contraindications: Lithium
2 Monitors:
Anticholinergics, diuretics, NSAIDS
BUN (↑ 20) and CK (↑1.8) = BAD
French: Anti-epileptics When to TAKE: What not to DRINK: Monitor: 4 S/S
CAPHE VALET GA? Bedtime Grapefruit Liver FX Thrombocytopenia, pancreatitis, hepatotoxicity, GI FX
SFX Chlorpromazine and Haldol
(1st Gen Antipsychotics)
NEAA!
Every SFX in the world…?
Agranulocytosis
Anticholinergic
Extrapyramidial
NMS
2 SFX Risperadol and Clozapine
2nd Gen Antipsychotics
Weight gain
Diabetes mellitus
Extrapyramidal SFX: Acute Dystonia Tardive Dyskenia Akathesis NMS
Medication to TX:
↓ muscle tone
lip smacking
pacing + aggitation
Sudden high fever, dysrthymias, and ▲ LoC
Benztropine
Key SFX 2nd Gen Antipsychotics 4 Examples Blood glucose and weight WBC Temperature Cholesterol and...?
Rispiridone, Aripripazole, Seroquel, Clozapine
↑ glucose, ↑ weight Agranulocytosis FEVER Hypercholesterolemia Anticholinergics
FX: Methylphenidate, Atomoxetine
TX:
1 SFX:
CNS stimulant
ADHD
Weight loss
4 EDUCATION:
Methylphenidate + Atomoxetine
Will loss weight
Give with meal
NO BAD THINGS
NO OTC meds
Crises:
Situational
Maturational
Adventitious
TX:
Unexpected
Natural (marriage, retirement)
External disasters (hurricane)
Stay with them (1-on-1)
S/S Autism:
Eye contact
2 Speech
Behavior
Delayed
repetitive/delayed
repetitive
Conduct Disorder
Defiant
3 R/F Suicide
Giving away stuff
Saying everything’s gonna be fine
Putting in w/ roommate
4 S/S Child Abuse
Inconsistent stories
Spiral Fractures
Bulging fontanels + ↑ head circumference (shaking baby syndrome)
Small round burns
Preservation
Clang Association
Confabulation
Agoraphobia
repetition of words/ideas
batch, match, latch, cratch
Making up stuff to fill gaps in memory
Vital signs for babies/kids • HR • Temp • 5 years old temp • BP • RR
FAST Higher 98.6 ↓ 80/40 = OK HIGH
When do Anterior/Posterior Fontanels close
12 - 18 months
6 - 8 weeks
How many teeth by 1 year
How many deciduous
How many permanent
6 - 8
20
32
Reflexes End Month:
Sucking, Moro, Tonic
Babinski
4 months
1 year
Developmental Milestones: Length per month # teeth in a year Head lift Roll around sit unsupported stand
1 inch 6 - 8 2 months 4 - 6 months 8 months 9 months
When can a kid... Bang blocks Stack 2 blocks Stack 6 - 7 blocks Tricycle Skip/hop on 1 foot Jump Rope
9 months 15 months 2 years 3 years 4 years 5 years
Immunizations: When to give... Hep B (3) MMR Varicella
WHEN IN DOUBT?
birth, 1 - 2 months, 6 - 18 months
1 year
12 - 15 months
DTaP
Meningitis Vaccines are for which type of people? 3
Teenagers
Prison/Jail
Military housing
DX: Meningitis
Patient position:
Precautions: Viral vs Bacterial
Results Viral vs. Bacterial
Lumbar puncture
Side lying knees bent
Supine 4 - 8 hours post-procedure
Standard vs droplet
V = clear B = cloudy
Brudenski and Kernig Sign
Pain and flexion of hips w/ neck flexion
Knee can’t extend @ 90º lying down
Early Sign ICP
Restlessness
Putting PPE ON vs. Taking PPE OFF
Gown, mask, goggles, gloves
Gloves, goggles, gown, mask
4 S/S Menningitis Head Mental Consciousness common
TX for kids
↑ circumferences
seizure precautions
↓ (keep NPO to prevent aspiration)
Flu-like
EMLA cream!
Medication for Reye Syndrome
TYLENOL
Seizures:
Tonic
Clonic
Absence
TX meds?
Rigid
Jerky back and forth (clown)
Zoning Out
CA PHE
Seizure TX (7)
Stay with them
Lower to floor, on side
Loosen restrictive clothing
Patent airway (have O2/suction equipment nearby)
FX/TX: Strabismus
1 eye does it own thing
Patch the strong eye
Inhaler Education: Distance from mouth Breathing technique Head position Inhale speed Hold breath for...?
2 - 4 cm Deep breath/exhaling Tilt back Slowly 10 seconds
Peak Flow Meters:
How many times?
When?
Yellow/Red meaning?
3x in a row
Same time each day
Impending asthma attack/BAD, administer rescue medicaitons
Physiotherapy Education:
When
Administer before?
Med order (2):
1 - 2 hrs before meals
Bronchodilators before
Albuterol then steroid
Nurse Role: Tonsillitus Frequent swallowing Milk/red liquids Juices Types of food
REPORT
NO
NO
Soft bland only
2 S/S Epiglottis:
2 What NOT to use
What to have nearby
Drooling/Aphasia
Tongue depressor/throat culture
Intubation supplies
DX: Cystic Fibrosis
3 Nurse Roles
Chloride Sweat Test
Pancreatic enzymes per meal
Bronchodilator
Fat soluble vitamins (ADEK)
Type of DZ: Cystic Fibrosis and Sickle Cell Anemia
Steatorea (S/S)
Autosomal Recessive
Foul smelling fatty stool
Nurse Role: Cyanotic Event
Knee to Chest (such as teterology of Fallot “T”)
Polycythemia
↑ Hct in response to low O2
S/S of... VSD PDA Pulmonary Stenosis Coarctation of Aorta
Loud harsh murmur on L sternal border
Machine hum murmur
Narrow Systolic ejection murmur
Bounding pulses proximal and decreased pulses distal
4 Dz of a Tetraology of Fallot
VSD
Pulmonary Stenosis
Overriding Aorta
Right Ventricular Hypertrophy
FX of blood flow (♥ Disease) ASD, VSD, PDA Tetraology of Fallot Transposition of Great Vessels Coarctation of Aorta
↑
↓
Mixed
Obstructive
R/F Rheumatic Fever S/S... Type of nodules Joints Heart sounds 4 Key (RCCC)
TX
Strept Throat Subcutaneous Large painful swelling Muffled Rash, Corea (involuntary muscle movements), carditis, and chest pain
PCN
Medication for: Kawasaki (strawberry red stuff!)
Vaccination EDucation
2 S/S:
TX:
Aspirin in HIGH doses
No live vaccines for 1 year
♥ and red eyes w/out drainage
IV Immuneglobulin G
Medication for: Henophilia
↑ r/o
Factor 8 (NOT PLATELETS) Bleeding (no razors, avoid IVs, etc.)
What 2 not to consume: Gastroenteritis
Fruit juices and caffeine
3 Nurse Role: Cleft Lip
Soft elbow restraints
Petroleum jelly OK
Cup for drinking
4 S/S: Pyloric Stenosis
TX:
Projectile vomiting
Olive shaped mass RUQ
Throwing up
↓ K
Surgery
3 S/S: Hirschsprung Dz:TX:
Diet:
Ribbon stools, abdominal distension, ↓ motility
Resection bowel r/in colostomy
HIGH protein and calories
LOW fiber
2 S/S: Intussusception
DX/TX:
Red jelly stool
Telescoping of bowel
Barium/Air enema
Lab ▲: Appendicitis
C-Reactive Protein
ESR
WBC
↑
↑
↑
Euresis
Wetting bed at night (like nocturia)
Diaper rash on an infant indicates
a UTI
Hypospadias vs. Epispadious
DO NOT WHAT THESE 2?
meatus below glans penis
meatus above glans penis
Circumcise them.
Lab ▲: Glomerulonephritis Sodium Creatinine BUN ASO (Anti-streptolysine) titer Urine (3)
↑ ↑ ↑ \+ Cloudy, +protein, + blood
R/F/FX: Glomerulonephritis
TX:
Restrict 3
Monitor…
Medications…
Inflammation of glomerulous
Recent Strept infection
Sodium, Potassium, Fluid
Weight QD
Diuretics
4 S/S: Nephrotic Syndrome
3 Medications:
Weight gain, Edema, Ascites, Protein in urine
Steroids, Diuretics, Albumin
Lab ▲: Chronic Kidney Disease
TX:
ALL UP except Calcium
Restrict fluids, give Ca… but NOTHING ELSE
TX: Compartment Syndrome
S/S (5Ps)
Faciotomy (cutting to relieve pressure)
Pain, Pallor, Pulselessnessm Paresthesia, and Paralysis
2 Nurse Roles: Traction
Ø weights on floor
Check pin sites
2 S/S Dysplasia of the Hip
Uneven skin folds
1 leg shorter
FX: Ortolani vs. Barlow Test
Relocate hip w/ pressure
DX by adducting and listening for a click
Hip Dysplasia/Pavlik Harness Education: Placement Baby powder? No. Diapers Assess Massage Avoid?
Over diaper NO Double Skin Skin under straps Lotions/powders
DX: Scoliosis
BEND OVER
2 Nurse Roles: Spina Bifida
Assess head circumference
Abducted Legs
2 S/S: Impetigo
2 TX:
Honey crusts that’re highly contagious
Topical antibiotic, remove crust w/ Barlow solution
5 TX: Lice Belongings in... Bag for how long? Type of shampoo How to get eggs out Soak what? how long?
Hot water 7 - 14 days Commercial (Promethazine) Comb Brushes for 1 hour
3 S/S: Scabies
Medication:
Pencil marks, itchy, rashes between fingers
Permetherine cream ALL OVER BODY qWeek
Kirkland Formula of Fluid Replacement
4 mL/kg/% body burned is how much fluid to give in first 8 hours… then the rest over 16 hours
DX: Aids
2 Diet ▲s:
Sarcoma r/t:
Medications:
CD4 ↓ 200
HIGH calories HIGH protein
Kaposi
-Virs
Wilms Tumor
DON’T TOUCH
3 Counters to SIDS
Firm mattress
Put on back
Pacifier
Education: Neuroblastoma
CALL POSION CONTROL
Education: Chemo
What type of rinses
Water/Saline
ICP in kids vs adults
irritable vs restless
Stranger anxiety
6 - 18 months
TX: Lead Poisoning
Ipecac Syrup
3 Nurse Roles: TURP
Sterile technique w/ irrigation
Ensure tubing is patent
Notify surgeon if urine is bright red/has large clots
MOST effective form of Contraception
IUD
2nd trimester Pregnancy and Exercise
for circulation
amount of rest between sessions
Moderate OK!
Rest 10 minutes in between
Time it takes for Lithium to become FX
7 - 10 days
Thora vs. Paracentesis Patient position
Leaning Forward over table
High-Fowlers
3 Prego OK shots
Tetanus, Influenza, Hep B
Chemotherapy, how to N/V
↑ unsaturated fats in diet
Herpes 1 vs 2 locations
1 mouth
2 genitalia
4 S/S Dehydration Temperature Eyeballs BP Tongue
↑
Sunken
↓ Orthostatic Hypo
Swollen
