everything you need to know idk Flashcards
addisonian crisis s/s
N/V, abdominal pain, confusion, extreme weakness, hypoglycemia, dehydration, hypotension
result of probably not properly managing stress
what should neutropenic patients not receive?
fresh fruit
flowers
vaccines
treatment for spider bite/bleeding
RICE rest ice compression elevate extremity
treatment for sickle cell crises
HHOP heat hydration oxygen pain medications
how to position pt w asthma
orthopenic position where pt is sitting up and bent forward with arms supported on a table of chair arms
tripod
how to position pt post bronchoscopy
flat on bed with head hyperextended
how to position pt w cerebral aneurysm
high fowlers
how to position pt w hemorrhagic stroke
HOB elevated 30 degrees to reduce ICP and facilitate venous drainage
how to position pt w ischemic stroke
HOB flat
how to position pt w cardiac cath
keep site extended
how to position pt w epistaxis
lean forward
how to position pt w above the knee amputation
elevate for first 24h on pillow, position on prone daily for hip extension
how to position pt w below the knee amputation
foot of bed elevated for first 24 hours, position prone daily for hip extension
how to position pt w tube feedings with decreased LOC
position
patient on right side to promote emptying of the stomach with HOB elevated to prevent aspiration.
how to position pt w air/PE
turn pt to left side and lower HOB
how to position pt w postural drainage
lung segment to be drained should be in the uppermost position to allow gravity to work
how to position pt post lumbar puncture
pt should lie flat in supine to prevent H/A and leaking of CSF
how to position pt w CBI
catheter should be taped to thigh so legs should be kept straight
how to position pt after myringotomy
position on the side of affected ear after surgery (allows drainage of secretion)
how to position pt post catarats surgery
pt will sleep on unaffected side with a night shield for 1-4 weeks
how to position pt w detached retina
area of detachment should be in the dependent position
how to position pt post thyroidectomy
low or semi-fowler’s, support head, neck and shoulders
how to position pt w thoracentesis
sitting on the side of the bed and leaning over the table (During procedure); affected side up (after procedure)
how to position pt w spina bifida
position infant on prone so that sac does not rupture
how to position pt w buck’s traction
elevate foot of bed for counter-traction
how to position pt post total hip replacement
don’t sleep on operated side, don’t flex hip more than 45-60 degrees and don’t elevate HOB more than 45 degrees, maintain hip abduction by separating thighs with pillows
how to position pt w prolapsed umbilical cord
knee-chest position or trendelenburg
how to position pt w cleft-lip
position on back or in infant seat to prevent trauma to the suture line; while feeding, hold in upright position
how to position pt w cleft-palate
prone
how to position pt w hemorrhoidectomy
assist to lateral position
how to position pt w hiatal hernia
upright position
how to prevent dumping syndrome
eat in a reclining position, lie down after meals for 20-30 minutes (also restrict fluids during meals, low fiber diet, and small frequent meals)
enema administration position
position pt in left-side lying (sims) position with knees flexed
how to position pt post supratentorial surgery (incision behind the hairline)
elevate HOB 30-45 degrees
how to position pt post infratentorial surgery (incision at nape of neck)
position patient flat and lateral on either side
how to position pt w increased ICP
high fowlers
how to position pt post laminectomy
back as straight as possible, log roll to move and sand bag on sides
how to position pt with spinal cord injury
immobilize on spine board, with head in neutral position; immobilize head with padded C-collar, maintain traction and alignment of head manually; log roll patient and do not allow patient to twist or bend
how to position pt - liver biopsy
right side lying with pillow or small towel under puncture site for at least 3h
how to position pt for paracentesis
flat on bed or sitting
how to position pt - intestinal tubes
place pt on right side to faciliate passage into duodenum
how to position pt w NG tubes
elevate HOB 30 degrees to prevent aspiration, maintain elevation for congtinuous feeding or 1h after intermittent feedings
how to position pt for pelvic exam
lithotomy position
how to position pt for rectal exam
knee to chest position, sim’s or dorsal recumbent
how to position pt during internal radiation
pt should be on bed rest while implant is in place
how to position pt w autonomic dysreflexia
place pt in sitting position (Elevate HOB) first before any other implementation
how to position pt w shock
bed rest with extremities elevated 20 degrees, knees straight, head slightly elevated (modified trendelenburg)
how to position pt w head injury
elevate HOB 30 degrees to decrease ICP
how to position pt for peritoneal dialysis when outflow is inadequate
turn pt side to side before checking for kinks in tubing
how to position pt for myelogram (3 types)
Water-based dye: semi-Fowler’s for at least 8h. Oil-based dye: flat on bed for at least 6-8h to prevent leakage of CSF.
Air dye: Trendelenburg.
s/s of lead poisoning
Anemia. Basophilic stripping. Colicky pain. Diarrhea. Encephalopathy. Foot drop. Gum (lead line).
s/s neuroleptic malignant syndrome
Fever. Encephalopathy. Vitals unstable. Elevated enzymes (CPK). Rigidity of muscles.
**idiosyncratic reaction to antipsychotic drugs
how to use incentive spirometry
- Sit upright.
- Exhale.
- Insert mouthpiece.
- Inhale for 3 seconds.
- Hold for 10 seconds.
anticholinergic side effects
anorexia blurry vision constipation/confusion dry mouth sedation/stasis of urine
steps to use a metered dose inhaler
- Shake the inhaler well before use (3/4x).
- Remove the cap.
- Breathe out, away from the inhaler.
- Bring the inhaler to your mouth, place it between your teeth and close your mouth around it.
- Start to breathe slowly. Press the top of the inhaler once and keep breathing in slowly until you have taken a full breath (3-5s).
- Remove the inhaler from your mouth and hold your breath for about 10s, then breathe out.
treatment for diabetic ketoacidosis
KING UFC K+. Insulin. Nasogastric tube: if comatose. Glucose: once serum levels drop. Urea: monitoring. Fluids: crystalloids. Creatinine: monitor and catheterize.
effect of c3 and above injury
unable to care for self, life-sustaining ventilator is essential
effect of injury at c6 injury
may use a lightweight wheelchair; feed self with devices; write and care for self; transfer from chair to bed
effect of injury at c7
can dress legs; minimal assistance is needed; independence in wheelchair; can drive car with hand controls
effect of injury at T1-T4
Some independence from wheelchair; long-leg braces for standing exercises
effect of injury at L3-L4
may use crutches or canes for ambulation
left cerebrovascular accident
- Paralyzed right side hemiplegia.
- Impaired speech and language.
- Slow performance.
- Visual field deficits.
- Aware of deficits: depression, anxiety.
- Impaired comprehension.
right cerebrovascular accident
- Paralyzed left side hemiplegia.
- Spacial-perceptual deficits.
- Tends to minimize problems.
- Short attention span.
- Visual field deficits.
- Impaired judgement.
- Impulsive.
- Impaired time concept.
s/s of left side CHF
FORCED Fatigue. Orthopnea. Rales/Restlesness. Cyanosis/Confusion. Extreme weakness. Dyspnea
s/s of right side CHF
BACONED Bloating. Anorexia. Cyanosis/Cool legs. Oliguria. Nausea. Edema. Distended neck veins.
TX for CHF
(UNLOAD FAST) Upright position. Nitrates. Lasix (Furosemide). Oxygen. ACE inhibitors. Digoxin. Fluids (decrease). Afterload (decrease).
high alert medications
- Insulin.
- Opiates and narcotics.
- Injectable potassium chloride (or phosphate) concentrate. - IV coagulants (heparin).
- Sodium chloride solutions >0.9%.
narrow therapeutic range drugs
- gentamycin.
- vancomycin.
- Warfarin.
- Lithium.
- Digoxin.
- Theophylline.
- Methotrexate.
- Phenytoin.
- Insulin.
- Ciclosporin.
TB drugs
(RIPE): Rifampicin Isoniazid Pyrazinamide Ethambutol
rifampicin
causes red-orange tears and urine
ethambutol
causes problems with vision, liver problems
isoniazid
can cause peripheral neuritis; take vitamin B6 to counter
MAOIs + tyramine-rich foods
- Tyramine-rich foods may cause severe hypertension in patients who take MAOI’s.
- Tyramine-rich foods include: aged cheese, chicken liver, avocados, bananas, meat tenderizer, salami, bologna, Chianti wine, and beer.
pyridium
- Urinary tract analgesic and spasmolytic
- Not an anti-infective
- Turns urine bright orange.
nitro patch administration timeframe
up to 3x with intervals of 5 mins
when is morphine contraindicated
pts w pancreatitis bc it causes spasms of the sphincter of oddi
* meperidine (demerol) should be given *
clozapine toxic risk
associated with blood dyscrasia
digoxin info
assess pulse for full min, if less than 60 hold dose
check dig and k+ levels
haloperidol adverse effects
- Drowsiness.
- Insomnia.
- Weakness.
- Headache
- Extrapyramidal symptoms: akathisia, tardive dyskinesia, dystonia.
aluminum hydroxide
treat GERD and kidney stones
WOF: constipation
hydroxyzine
treats anxiety and itching
WOF: dry mouth
midazolam
given for conscious sedation
WOF: resp depression and hypotension
amiodarone
take missed dose any time in the day or skip entirely
do not double dose
WOF: diaphoresis, dyspnea, letharge
warfarin (coumadin)
stress importance in complying with prescribed dose and follow-up apts
methyphenidate (ritalin)
treat ADHD
assess for heart related SEs, report immediately
child may need drug holiday, since it stunts growth
dopamine
treatment of hypotension, shock and low CO
monitor ECG for arrjythmias and BP
phenytoin
enteral feedings: stop feeding 1-2 hours before and after the med admin d/t decrease in absorption w enteral feedings
flush with 30-50 mL of NaCl after admin.
common s/s of pul TB
low grade afternoon fever
common s/s of pneumonia
rust-colored sputum
common s/s of asthma
wheezing on expiration
common s/s of emphysema
barrel chest
common s/s of pernicious anemia
red beefy tongue
common s/s of cholera
rice-watery stool and wrinkled hands from dehydration
common s/s of malaria
stepladder like fever w chills
common s/s of typhoid
rose spots in the abdomen
common s/s of dengue
fever, rash, H/A; positive herman’s sign
common s/s of diphtheria
psudo membrane formation
common s/s of measles
koplik’s spots (clustered white lesions on buccal mucosa)
common s/s of systemic lupus erythematosus
butterfly rash
common s/s of leprosy
leonine facies (thickened folded facial skin)
common s/s of appendicitis
rebound tenderness at McBurney’s point; Rovsing’s sign (palpation of LLQ elicits pain in RLQ); psoas sign (pain from flexing the thigh to the hip).
common s/s of meningitis
Kernig’s sign (stiffness of hamstrings causing inability to straighten the leg when the hip is flexed to 90º); Brudzinski’s sign (forced flexion of the neck elicits a reflex flexion of the hips).
common s/s of tetany
from hypocalcemia; positive trousseau’s and chvostek sign
common s/s of tetanus
risus sardonicus or rictus grin
common s/s of pancreatitis
cullen’s sign (ecchymosis of the umbilicus); grey turner’s sign (bruising of the flank)
common s/s of pyloric stenosis
olive like mass
common s/s of ductus arteriosus
washing machine-like murmur
common s/s of addison’s disease
bronze-like skin pigmentation
common s/s of cushing’s syndrome
moon face appearance and buffalo hump
common s/s of grave’s disease
exophthalmos
common s/s of intussesception
sausage shaped mass
jelly like red bloody, mucusy stuff
common s/s of MS
nystagmus
intention tremor
dysarthria
common s/s of myasthenia gravis
descending muscle weakness ptosis
common s/s of GBS
ascending muscle weakness
common s/s of DVT
homan’s sign
common s/s of angina
crushing, stabbing pain relieved by nitro
common s/s of MI
crushing, stabbing pain radiating to left should, neck, and arms… unrelieved by nitro
common s/s of cytomegalovirus infection
owl eye appearance of cells (huge nucleus in cells)
common s/s of retinal detachment
flashes of light, shadow with curtain across vision
common s/s of basilar skull fracture
raccoon eyes (periorbital ecchymosis) and battle’s sign (mastoid ecchymosis)
common s/s of buerger’s disease
intermittent claudication (pain at buttocks or legs from poor circulation resulting in impaired walking)
common s/s of DM
polydipsia, polyuria, polyphagia
common s/s of hirschsprung’s disease (toxic megacolon)
ribon-like stool
common s/s of herpes simplex type 2
painful vesicle on genitalia
common s/s of genital warts
warts 1-2mm in diameter
common s/s of syphilis
painless chancres
common s/s of chancroid
painful chancres
common s/s of gonorrhea
gree, creamy discharges and painful urination
common s/s of chlamydia
milky discharge and painful urination
common s/s of candidiasis
white cheesy odorless vag discharges
common s/s of trichomoniasis
yellow, itchy, frothy, foul-smelling veg dishcarge
common s/s of pulmonary edema
pink, frothy sputum tachypnea use of accessory muscles crackles anxiety/restlessness TX: furosemide
st john’s wort
treats depression/anxiety.
- Interacts with SSRI.
- Causes sun sensitivity.
garlic
lowers blood pressure and cholesterol levels. - Interacts with aspirin and warfarin.
ginkgo biloba
improves memory.
- Thins the blood (don’t take with aspirin or warfarin)
don’t take w hx of seizures
echinacea
immune-boosting function
- Can cause liver toxicity in renal patients.
- Not effective with HIV.
ginger
Relieves nausea and vomiting.
- Do not take if history of deep venous thrombosis. - Interacts with blood thinners.
black cohosh
treats menopausal symptoms.
- Contraindicated in pregnancy (causes premature labor)
kava kava
treats insomnia and muscle pain.
- It’s associated with liver illnesses.
saw palmetto
used for prostate health.
- No specific patient teaching.
- If it starts with G, it thins the blood. Do not give with warfarin, aspirin and heparin
diet for acute renal disease
protein-restricted, high cal, fluid controlled, Na and K controlled
diet for addison’s disease
high sodium, low potassium
diet for ADHD and bipolar
high cal, finger foods
diet for anemic pts
high protein/iron/vitamins
diet for pts w atherosclerosis
low sat fats
diet for burn pts
high protein, high cal, high vit c
diet for pts with cancer
high cal, high protein
diet for celiac disease
gluten free
NO BROW
barley, rye, oats, wheat
diet for cholecystitis/cholelithiasis
low fat liquids, powder supplements high in protein/carb into skim milk
avoid fried food, pork, cheese, alc
*after surgery may need low fat diet for several weeks (low fat, high carb/protein)
diet for chronic renal disease
protein-restricted, low-sodium, fluid restricted, potassium restricted, phosphorus restricted
diet for stable cirrhosis
normal protein
diet for cirrhosis with hepatic insufficiency
restrict protein, fluids and sodium
diet for constipation
high-fiber, increased fluids
diet for COPD
soft, high-cal, low carb, high-fat, small freq feedings
diet for cushing’s disease
low sodium, high potassium
diet for CF
increase in fluids, pancreatic enzyme replacement before or with meals, high protein, high cal in advanced stages
diet for diarrhea
liquid, low fiber, regular, fluid and electrolyte replacement
diet for diverticular disease
high fiber, avoid seeds
diet for dumping syndrome i guess to avoid dumping syndrome
rapid passage of food: diaphoresis, diarrhea, hypotension
restrict fluids w meals, drink 1hr before or 1hr after, eat in recumbent position, lie down 20-30 mins after eating, small freqent meals, low-carb/low-fiber
diet for gallbladder disease
low-fat, cal-restricted
diet for gastritis
low fiber, bland diet
diet for gout
low purine (no fish and organ meats)
diet for hepatitis
regular, high cal, high protein
diet for hepatobiliary
low-fat, high protein, vitamins
diet for hirschsprung’s disease
low fiber, high cal/protein before surgery
diet for hypertension, heart failure, CAD
low sodium, calorie restricted, fat controlled
diet for kidney stones
increase fluid intake, calcium controlled, low-oxalate
diet for meniere’s
low sodium, avoid caffeine, nicotine and alcohol
diet for nephrotic syndrome
sodium restricted, high cal, high protein, potassium restricted
diet for obesity/overweight
cal restricted, high fiber
diet for ostomy
high cal/protein/carb, low residual before surgery
diet for ileostomy
low residual diet, no meats, corn, nuts
diet for colostomy
diet not restricted after 6 weeks
diet for pancreatitis
low-fat, regular, small frequent feedings; tube feeding or total parenteral nutrition
diet for peptic ulcer
bland diet
diet for pernicious anemia
increase vit b12 b12 shots (25-100), followed by 500-1000 shot every 1-2 months or cyanocobalamin nasal spray
diet for phenylketonuria (pku)
substitutes for infants, low protein for children
diet for pheochromocytoma
increase cals, vitamins, minerals intake; avoid coffee, tea, cola, tyramine foods
diet for sickle cell anemia
increase fluids to maintain hydration since sickling increases when pts become dehydrated
diet for stroke
mechanical soft, regular, tube-feeding
diet for underweight
high cal, high protein
diet for ulcerative colitis/crohns disease
high protein/cal, low fat/fiber
diet for ulcers
3 meals/day, avoid T degree extremes, avoid caffeine, alc, milk/cream
diet for ulcers post op
vitamin b12 parenteral for life and iron supplements
diet for vomitting
fluid and electrolyte replacement
antibiotics contraindicated in pregnancy
(MCATO) Metronidazole* ⇒ hepatic failure Chloramphenicol ⇒ gray baby syndrome Aminoglycosides ⇒ ototoxicity Tetracyclines ⇒ teeth discoloration & liver failure
drugs used to stop preterm labor tocolytics
“It’s not my time” Indomethacin (NSAID) Nifedipine (Calcium channel blocker) Magnesium sulfate Terbutaline
Hypoglycemia s/s
Shakiness Palpitations Anxiety/arousal Restlessness Diaphoresis Pallor
myasthenia gravis
autoimmune disease in which antibodies attack acetylcholine receptors
–>
weakness in skeletal muscles, esp in bulbar region (responsible for eye movement), swallowing/speaking, and breathing
–> ptosis is an expected finding
