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CAPSTONE > FINAL/EXIT/NCLEX STUDY GUIDE > Flashcards

FINAL/EXIT/NCLEX STUDY GUIDE Flashcards

1
Q

Types of IV fluids:

A
  1. HYPERtonic solution
  2. ISOtonic solution
  3. HYPOtonic solution
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2
Q

HYPERtonic solutions:

A
  1. 3% saline, 5% saline, 5% D5NS, D5 1/2 NS, D5LR, D10W
  2. Uses: cerebral edema (Increased ICP), hyponatremia, metabolic alkalosis, maintenance fluids, hypokalemia
  3. Do not administer to HF or renal failure because it can cause fluid volume overload
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3
Q

ISOtonic solutions:

A
  1. 0.9% NA, 5% dextrose in water (D5W), Lactated Ringer (LR)
  2. Uses: Blood loss (hemorrhage, burns, surgery), dehydration, fluid maintenance
  3. NS is the ONLY solution compatible with BLOOD PRODUCTS
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4
Q

HYPOtonic solutions: “HYPO think LOW numbers”

A
  1. 0.45% saline (1/2), 0.33% NS (1/3 saline), 5% dextrose in water (D5W)
  2. Uses: DKA, helps kidneys excrete excess fluids, hypernatremia
  3. DO NOT administer to increased ICP, burns, or trauma
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5
Q

Blood administration:

A
  1. Only normal saline is compatible
  2. Type and screen and cross match are good for 72 hours
  3. Blood must be hung/started within 30 MINUTES from the time the blood is picked up from the blood bank
  4. All blood must be transfused within 4 HOURS of the time the blood was hung/started
  5. The first 15 MIN are the MOST CRITICAL, must stay at bedside
  6. Vitals monitored every 30 min - 1 hour
  7. Stop the transfusion if transfusion reaction suspected
  8. S/S: tachycardia, itching, hives, rash, flushing, back pain, respiratory distress.
  9. Nursing actions: stop the infusion, change the IV tubing down to the IV site, keep the IV open with NS, administer antihistamines/steroids/vasopressors, notify provider and blood bank, do not leave the patient alone, monitor VS and continue to assess
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6
Q

Diet modifications for diarrhea:

A
  1. Decrease fiber
  2. increase fluids and electrolyte replacement
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7
Q

Diet modifications for celiac disease:

A
  1. Gluten free diet
  2. No BROW - Barley, Rye, Oat, Wheat
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8
Q

Diet modifications for burns:

A
  1. High protein
  2. High calorie
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9
Q

Diet modifications for AKI:

A
  1. Protein restricted
  2. Increase calories
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10
Q

Diet modifications for COPD:

A
  1. Small, frequent meals
  2. Increase calories and fat
  3. These patients are burning a lot of calories from trying to breath off the excess CO2
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11
Q

Diet modifications for pancreatitis:

A
  1. Small, frequent meals
  2. Low fat
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12
Q

Diet modifications for gallbladder issues (CHOLECYSITIS):

A

Low fat

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13
Q

Diet modifications for HLD:

A

LOW fat and LOW calories

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14
Q

Diet modifications for HTN:

A
  1. LOW fat and sodium
  2. Heart healthy diet
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15
Q

Diet modifications for CF:

A

Increase fluids

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16
Q

Diet modifications for kidney stones:

A

Increase fluids (flush out the stones)

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17
Q

Diet modifications for heart failure:

A

Fluid restriction

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18
Q

Diet modifications for sickle cell anemia:

A

Increase fluids

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19
Q

Diet modifications for patients with ostomies:

A

Increase fluids, decrease intake of odorous and gas forming foods; onions, broccoli, spinach

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20
Q

Diet modifications for gout:

A

Decrease intake of purine foods (shellfish, organ means, seafood)

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21
Q

Diet modifications for cirrhosis:

A

Avoid foods high in protein (milk products, broccoli, eggs, tuna, chicken breast)

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22
Q

Diet modifications for ulcerative colitis:

A

Low fiber, low residue

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23
Q

Angina:

A

Chest pain relieved by nitroglycerin

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24
Q

MI:

A
  1. Crushing pin, pressure, and tightness UNRELIEVED by nitroglycerin
  2. Elevated troponin levels > 0.7, this is the best INDICATOR for an acute MI
  3. ST segment elevation
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25
Q

Heart failure:

A

Increased BNP > 100 pg/ml

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26
Q

Left sided heart failure: think “LEFT side think LUNGS”

A

Pulmonary edema, dyspnea, crackles, nagging cough

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27
Q

Right sided heart failure: think “Right side REST of body”

A

Edema, weight gain, large neck veins (JVD), ascites, hepatomegaly

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28
Q

Peripheral VASCULAR disease:

A
  1. Edema, warm legs, dull, achy pain
  2. Educate patient to eleVate Veins
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29
Q

Peripheral ARTERIAL disease:

A
  1. NO edema, COLD legs, gangrene (necrotic), sharp pain
  2. Educate patients to dAngle Arteries
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30
Q

DVT:

A

Unilateral leg pain and redness

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31
Q

Cardiac tamponade:

A

Beck triad -> hypotension, muffled heart sounds, jugular vein distention

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32
Q

Cardiogenic shock:

A

Cool, clammy skin, increased HR, decreased BP

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33
Q

Automated External Defibrillator (AED) important facts:

A

Before placing the pads on, remove all transdermal patches and wipe chest if wet

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34
Q

Synchronized cardioversion important facts:

A

Shock must be synced and delivered with the peak of the QRS complex (the R wave)

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35
Q

Cardiac catheterization:

A
  1. Assess for allergy to shellfish or iodine
  2. Stop metformin 24-48 hours before administration of any IV contrast dye
  3. If bleeding is seen, apply direct pressure on or above the site
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36
Q

Transesophageal echocardiograpy:

A

Hold all fluids and food until gag reflex is intact, slowly introduce food and water

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37
Q

Mean arterial pressure (MAP):

A

MAP of at least 60 mmHg is required to adequately perfuse vital organs

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38
Q

Bleeding:

A
  1. Use an electric razor
  2. Soft bristled toothbrush
  3. Avoid IM injections
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39
Q

NSAIDS:

A
  1. Naproxen, ibuprofen, celecoxib
  2. Should be AVOIDED in those with a cardiovascular history (stroke, MI, CAD)
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40
Q

DM classic s/s:

A

3 p’s -> polydipisa, polyphasic, polyuria

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41
Q

DKA classic signs:

A

Acetone breath

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42
Q

HYPERthyroidism classic s/s:

A

Expothalmos (bulging or protruding eyeballs)

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43
Q

Addison’s disease classic s/s:

A

Hyperpigmentation of the skin

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44
Q

Cushing syndrome classic s/s:

A

Moon face and buffalo hump of the neck

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45
Q

Diabetes insipidus classic s/s: think “Dry Inside”

A
  1. Not enough ADH (ADH regulates and balances amount of water in your blood)
  2. Diluted urine, dehydration, decreased skin turgor, dry mucous membranes, diluted urine, concentrated blood, low urine specific gravity (< 1.005)
  3. Treatment: ADH/vasopressin synthetic replacement, desmopression (DDAVP)
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46
Q

SIADH: think “Soaked Inside”

A
  1. Too much ADH (ADH regulates and balances the amount of water in the blood)
  2. Low UOP, fluid volume overload, weight gain, HTN, hyponatremia (dilute), concentrated urine, diluted blood, high urine specific gravity ( > 1.030)
  3. Treatment: diuretics, vasopressin antagonists
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47
Q

Thyroid storm classic s/s:

A

ELEVATED temp, HR, BP, agitation, confusion in response to a stressful incident

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48
Q

Thyroidectomy:

A
  1. Monitor for hypocalcemia due to accident removal of the parathyroid glas
  2. Have an emergency trach kit at bedside
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49
Q

Pheochromocytoma (tumor of the adrenal medulla):

A

Do NOT palpate the patient’s abdomen because it can cause a hypertensive crisis

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50
Q

TSH levels:

A
  1. T3 and T4 are always OPPOSITE of TSH (negative feedback mechanism)
  2. HYPERthyroidism -> HIGH T3 & T4, LOW TSH
  3. HYPOthyroidism -> LOW T3 & T4, HIGH TSH
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51
Q

Transphenoidal hypophysectomy:

A

Monitor for clear nasal draining post op, this may include CSF fluid leakage

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52
Q

Addisonian crisis:

A
  1. Occurs mostly in times of sickness (infection), stress (hospitalization), physical exertion, or stopping steroid therapy abruptly
  2. Treatment -> fluid resuscitation and high dose hydrocortisone
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53
Q

Diabetes:

A

Extremely high amounts of glucose in the blood for long periods of time can cause vascular damage and impaired wound healing (not enough perfusion, blood too think of sugar)

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54
Q

Diabetes Mellitus I:

A
  1. There’s no insulin production
  2. Onset is abrupt, usually diagnosed in CHILDHOOD
  3. Treat with INSULIN, patient will be INSULIN DEPENDENT FOR LIDE, do NOT skip insulin when feeling sick
  4. S/S -> 3 p’s
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55
Q

Diabetes mellitus II:

A
  1. Does not produce enough insulin or produces bad insulin that doesnt work properly
  2. Onset is gradual, usually diagnosed in adulthood
  3. Treat with diet, exercise, metformin, possible insulin
  4. S/S -> 3 p’s
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56
Q

DKA:

A
  1. Happens mostly in type 1 DM
  2. KETONE build up = ACIDOSIS, Glucose 300-500, acid breath/fruity breath (fruit loops)
  3. Treatment -> IV insulin with potassium (INsulin helps sugar and potassium to go IN the cells causing HYPOkalemia unless we administer potassium with IV insulin)
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57
Q

Hyperglycemia: “HOT AND DRY, SUGARS HIGH”

A
  1. S/S -> 3 p’s, hot and dry skin, dry mouth (dehydration), deep, rapid breaths (air hunger), slow wound healing, vision changes
  2. Treatment -> test urine for ketones, administer insulin if needed
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58
Q

Hypoglycemia: “cold and clammy, needs some candy”

A
  1. Glucose < 70 mg/dl
  2. S/S -> cool and clammy, diaphoresis, fatigue, weakness, confusion
  3. CONSCIOUS treatment -> 15 grams of carbs
  4. UNCONSCIOUS treatment -> IV D50 or glucagon (IM, IV, Subq)
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59
Q

Hyperthyroidism:

A
  1. Excessive production of thyroid hormone TOO MUCH energy
  2. S/S: hyperexcitable, weight loss, hot, hair loss, warm/moist palms, HIGH t3&t4, low TSH, tachycardia, hypertension, diarrhea
  3. Treatment -> radioactive iodine therapy, thyroidectomy
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60
Q

Hypothyroidism:

A
  1. Low production of thyroid hormone, NOT enough energy
  2. S/S: no energy, weight gain, cold, dry/brittle hair, dry skin, LOW t3&t4, high TSH, bradycardia, hypotension, constipation
  3. Treatment: hormone replacement therapy-> levothyroxine (Synthroid) LIFE LONG THERAPY
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61
Q

Myasthenia gravis:

A

Descending muscle weakness, ptosis (Drooping of eyelids)

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62
Q

GBS:

A

Ascending paralysis/muscle weakness from the legs up

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63
Q

Basilar skull fracture:

A

Raccoon eyes and battle signs (bruising behind ears)

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64
Q

Meningitis:

A
  1. Positive Kernigs: pain when lying on the back and straightening the leg
  2. Positive brudzinski: when the neck is flexed, the hip and knees flex as well
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65
Q

Stroke:

A

Face drooping, arm weakness, difficulty speaking

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66
Q

Neurogenic shock:

A

Everything is DECREASED (HR, BP, CO, O2) this is the only type of shock with a decreased HR

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67
Q

Autonomic dysreflexia:

A

Above the injury ( flushed, throbbing HA), below the injury (pale, cool, clammy skin)

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68
Q

Increased ICP:

A
  1. Early: sudden vomiting without nausea
  2. Late: cushing’s triad (systolic HTN, bradycardia, irregular breathing), abnormal posturing
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69
Q

CSF leakage:

A

A halo or rung will occur when CSF is mixed with blood (commonly seen on a gauze) if CSF is present it will be positive for glucose

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70
Q

Seizure precautions:

A

THE GOAL IS TO PREVENT INJURY DURING THE SEIZURE
1. Note the time and duration
2. Maintain patent airway (have suction and oxygen available)
3. Loosen clothing
4. Bed low
5. Privacy
6. Side rails up and padded
7. Side lying position immediately post seizure
8. Pillow under head

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71
Q

Osteoarthritis:

A

Stiffness after activity subsiding within 30 minutes, asymmetrical pain

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72
Q

Rheumatoid arthritis:

A

Stiffness in the AM lasting longer than 1 hour, symmetrical pain and swelling

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73
Q

Osteoporosis:

A

Fractures, the back will be rounded (hunch back) causing height loss

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74
Q

Compartment syndrome:

A
  1. S/S:Pain, pallor, pulselessness, paresthesia, paralysis
  2. Treatment: place extremity at the heart level (NOT ABOVE), open the cast or splint, loose and remove restrictive clothing
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75
Q

Fat embolism:

A

Petechiae, confusion, respiratory distress, chest pain

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76
Q

Cast care:

A
  1. Itch in a cast: Never insert anything into the cast, to relive the itching use a hair dryer on a cool setting and direct under the cast
  2. Avoid getting it wet, elevate the affected extremities, report hot areas or foul odors
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77
Q

Traction:

A

The weights must always be free hanging (not resting on anything), make sure the patient is in supine

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78
Q

Fractures:

A

RICE = Rest, Ice, Compression, Elevate (to decrease swelling)

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79
Q

Osteomyelitis:

A
  1. Will have high fevers
  2. Patient will most likely get a PICC line to receive IV abx for weeks up to months
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80
Q

Rhabdomyolysis:

A

Medical emergency caused by muscle injury, myoglobin is released into the bloodstream and can damage the kidneys.
Treat with IV fluid to flush out the kidneys

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81
Q

Hip arthoplasty/replacement education:

A
  1. Don’t flex at the hips > 90 degrees
  2. Don’t cross legs
  3. Don’t turn the affected leg inwards
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82
Q

How to properly use a crutch:

A
  1. Support weight with the hands and arms, not axillary
  2. Should be 1-2 inches between the axillary and the crutch
  3. Going down the stairs “DOWN with the AFFECTED/BAD leg first”
  4. Going up the stairs “UP with the GOOD/UNAFFECTED leg first”
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83
Q

Types of gait:

A
  1. 2 point -> 2 points on the ground at a time (move foot and crutch at the same time)
  2. 3 point -> move both crutches and the injured leg at the same time
  3. 4 point -> similar to the 2 point gate, but each point is moving separately similar to walking normal
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84
Q

How to properly use a cane:

A
  1. Cane handle level with greater trochanter (hip)
  2. Move the cane first, then move weaker leg
  3. Hold the cane with the stronger side, always keep 2 points on the floor for support at all times
  4. Going upstairs -> up with the good (go up with stronger leg, move cane up, then move the weak leg up)
  5. Going downstairs -> down with the bad (move the cane down, move weaker leg down, then move the strong leg down)
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85
Q

TB:

A

Night sweats, weight loss, hemoptysis (bloody sputum), low grade fever

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86
Q

PNA:

A

Rust colored sputum

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87
Q

Asthma:

A

Wheezing on expiration

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88
Q

Emphysema:

A

Barrel chest

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89
Q

ARDS:

A

Refractory hypoexmia ( low oxygen levels despite receiving high amounts of O2)

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90
Q

CF:

A

S/S: Thick mucus, salty skin/sweat

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91
Q

PE:

A

SOB, tachycardia, coughing up blood, hypoxemia

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92
Q

Hypoxemia/hypoxia:

A
  1. Early: tachypnea, tachycardia, HTN, agitation, restless, confusion
  2. Late: bradypnea, hypotension, bradycardia
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93
Q

Chest tube drainage:

A

Report drainage that is > 3ml/kg/hr within 3 hours or bright red black (dark bloody drainage is normal)

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94
Q

COPD:

A

It’s typical for COPD to have lower than normal O2 but any O2 less than 60 indicates hypoxia

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95
Q

Meds that interact with Asthma:

A

We want to “BAN” -> Beta blockers, ASA, NSAIDs, can cause bronchospams

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96
Q

Inhalation injury:

A

Hair singed around face, neck, torso, trouble talking, soot in nose or mouth, confusion, anxiety

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97
Q

Airborne precautions:

A

Single room under negative pressure, door remains closed, wear N95 or respirator

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98
Q

Inhaler use client teaching:

A
  1. After inhalation, rinse mouth (Don’t swallow) to reduce the risk of oral candidiasis
  2. Using a space can also help decrease risk of thrush
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99
Q

Chest tubes:

A
  1. Keep drainage system BELOW patient’s chest
  2. NEVER strip the tubing or clamp the tubing
  3. If the tube becomes dislodged, cover insertion site with sterile dressing
  4. If the chamber becomes damaged, place tubing in sterile water while waiting for new system
  5. Suction control chamber gentle continuous bubbling in the suction control chamber is OKAY
  6. Water seal chamber/air leak gauge excessive continuous bubbling in the water seal chamber is BAD
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100
Q

Appendicitis:

A
  1. S/S: McBurney’s point: maximum tenderness at the RLQ of the abdomen upon palpation, Rosing’s sign: palpation of LLQ elicits pain in RLQ
  2. Avoid applying heat to the abdomen because it can cause rupturing of the appendix
101
Q

Pancreatitis: “Cullen’s Circle belly button”

A
  1. Grey turner’s sign: bluish discoloration at the flanks
  2. Cullen’s sign: bluish discoloration of the umbilicus
102
Q

Pyloric stenosis:

A

Olive sized mass

103
Q

Gastric ulcer:

A

Pain immediately after eating

104
Q

Duodenal ulcer:

A

Relief of pain after eating 2-3 hours after

105
Q

Abdominal hernia:

A

Lump or bulge beneath the skin at hernia site

106
Q

GERD:

A
  1. S/S: Heartburn, indigestion, dysphagia
  2. Improves after smoking cessation
  3. Sit up right after meals
  4. Don’t wear tight clothing
  5. Avoid triggers (caffeine, carbonated drinks)
107
Q

Ulcerative colitis:

A

Bloody diarrhea multiple times a day

108
Q

Crohn’s disease:

A

Cobblestone appearance of the intestines

109
Q

Cirrhosis:

A

Asterixis (liver flap), jaundice

110
Q

Hepatitis:

A

Clay colored stool, jaundice, N/V

111
Q

Stoma:

A
  1. Educate: Report if cold, pale, purple, black, grey, dusty. SHOULD BE BEEFY RED
  2. Care: should be changed every few days, empty when it becomes 1/3 full
112
Q

TPN:

A

Monitor for hyperglycemia

113
Q

Endoscopic procedures or a TEE:

A

Hold all fluids and food until gag reflex is intact

114
Q

Care of ostomies:

A
  1. Empty bag when 1/3 full
  2. Change bag every 3 days
  3. No perfumed soaps or lotions at stoma site
  4. Avoid high fiber/gas forming foods
115
Q

Bowel prep and enemas:

A

Monitor for fluid and electrolyte imbalance

116
Q

Paracentesis:

A

Monitor for signs of shock (removal of fluid from abdominal cavity)

117
Q

Esophageal varices:

A

Monitor for hemorrhage

118
Q

Dumping syndrome:

A

Prevention -> consume small meals, low carbs, separate fluids and meals 30 min apart

119
Q

UTI:

A
  1. S/S: Costovertebral angle (CVA) tenderness, Confusion (in older patients), Lethargy and new incontinence
  2. Educate -> take all prescribed meds, wipe front to back, void after intercourse, void frequently, increase fluids, wear cotton undies
120
Q

Pyelonephritis:

A

Flank pain

121
Q

Nephrotic syndrome:

A

Proteinuria, edema commonly around eyes, HLD

122
Q

Kidney transplant rejection:

A
  1. S/S: Fever, edema, weight gain, HTN, elevated WBCs, decrease in renal function, low urine output, swelling or tenderness around the transplanted kidney
  2. Within 24 hours of procedure (hyper acute) treatment requires immediate removal of kidney
  3. Few days, weeks (acute) years (chronic) treatment with immunosuppressants
123
Q

Bladder cancer:

A

Classic symptom -> painless hematuria

124
Q

Peritonitis:

A

Cloudy drainage from peritoneal dialysis, tender abdomen, tachycardia, fever

125
Q

Fistula or graft:

A
  1. Feel the thrill (palpate), hear the bruit (heard during auscultation)
  2. Educate: the arm has a vascular access so AVOID -> compression, blood draws, BP, tight clothes, carrying bags, sleeping on that arm
126
Q

Peritoneal dialysis:

A

Educate on ways to avoid infection -> Clean catheter site daily, keep supplies in a clean/dry place, good hand hygiene before and after dialysis

127
Q

Renal calculi/kidney stones:

A

Strain the urine and keep any stones -> send them to the lab to evaluate what type of stone

128
Q

Urinary incontinence:

A

Perform keel exercises (stiffen the pelvic floor muscles for 4-5 seconds and do this 10 times in a row, repeat multiple times a day)

129
Q

Bulimia:

A
  1. Binge eating following by purging, normal weight to overweight, teeth erosion, bad breath
  2. Monitor the client for 1-2 hours after each meal, this is the time they typically induce vomiting
130
Q

Anorexia:

A

Amenorrhea, constipation, lanugo, decrease weight, hypotension and bradycardia

131
Q

Delirium:

A

Sudden change in cognition, MEDICAL EMERGENCY

132
Q

Alzheimer’s:

A
  1. Decline of function that happens over months to years
  2. Speak slowly, give one direction at a time, ask simple/direct questions, don’t ask complex or open ended questions, face the client directly when speaking
133
Q

Schizophrenia:

A
  1. Positive s/s: delusions, anxiety, hallucinations, jumbled speech
  2. Negative s/s: lack of energy, bland effect, lack of social interaction
134
Q

Depression:

A
  1. S/S: Loss of interest in life, anhedonia (loss of pleasure in activities usually found enjoyable before), sleep disturbances
  2. Monitor for signs of SI (antidepressants may increase the clients energy, which could mean they now have the energy to perform act of suicide)
135
Q

Mania:

A
  1. Has A LOT of energy
  2. The nurse should offer energy and protein dense foods that are easily consumed on the go (finger foods) and offer fluids (can be dehydrated from being too excited)
136
Q

Anxiety attacks:

A

First nursing action is to decrease stimuli and provide a quiet and calm environment

137
Q

Auditory/command hallucinations:

A

First concern is SAFETY

138
Q

Alcohol intoxication:

A

IV thiamine is given to patients with alcohol intoxication because alcohol causes suppression of thiamine absorption

139
Q

Thrombocytopenia:

A
  1. S/S: Purpura, petechiae, bruising
  2. Educate patient on bleeding precautions -> no ASA, decrease needle sticks, protect form injury, use electric razor, soft toothbrush
140
Q

Iron deficiency anemia:

A
  1. S/S: Pale skin, weakness, fatigue, sob, tachycardia
  2. Consume foods high in IRON (egg yolk, apricot, tofu, legumes, oysters, tuna, seeds, potato, fish, iron fortified cereals, red meat, poultry, nuts)
141
Q

Sickle cell anemia:

A
  1. Severe pain during a sickle cell crisis
  2. Give IV fluids during a sickle cell crisis (stops the clumping of RBCs)
142
Q

Pernicious anemia:

A
  1. S/S: Beefy, red, smooth tongue
  2. Education: B12 replacement may be a lifelong treatment (must be given IV or IM, cannot be PO because lack of intrinsic factor)
143
Q

Hemophilia:

A

Bleeding into various parts of the body, hemoarthosis (bleeding into the joints)

144
Q

DIC:

A

Bleeding (petechiae, hematuria, Melina) and blood clotting happening at the same time (stroke, heart attack, DVT)

145
Q

Polycythemia:

A

Increase in number of RBCS in the body causing increased risk of thrombus forming

146
Q

Hemoglobin A1C:

A

Best reflection of blood glucose levels for the past 3-4 months

147
Q

Neutropenic/reverse/protective isolation:

A

Private room, avoid raw fruits/veggies, avoid fresh flowers, avoid undercooked meat, no live vaccines, avoid invasive procedures

148
Q

Ectopic pregnancy:

A

S/S: unilateral, dull abdominal pain, referred shoulder pain, hypotension

149
Q

Hyperemesis gravidarum:

A

S/S: severe and persistent vomiting, weight loss

150
Q

Placenta previa:

A

Painless bright red vaginal bleeding after 20 weeks of gestation

151
Q

Placental abruption:

A

Dark red blood vaginal bleeding after 20 weeks of gestation with severe abdominal pain and rigidity

152
Q

Preeclampsia:

A

HTN and proteinuria after 20 weeks of gestation

153
Q

PP hemorrhage:

A

Uterus is enlarged, soft, boggy, and not midline. Commonly cause by uterine atony and bladder distention

154
Q

PP infection:

A

Foul smelling or purulent lochia, fever > 100.4F, abdominal tenderness, tachycardia

155
Q

Fetal alcohol syndrome:

A

Thin upper lip, smooth philtrum, small for gestational age, microcephaly

156
Q

Spina bifida occulta:

A

Small tuft of hair, a dimple, or a hemangioma at the base of the spine

157
Q

Magnesium toxicity:

A

Flushing, headache, respiratory paralysis, decreased DTR, low urine output

158
Q

Neonatal abstinence syndrome:

A

Yawning, high pitched cry, sneezing

159
Q

APGAR scoring:

A

7-10: excellent condition
4-6: moderately depressed
0-3: severely depressed

160
Q

FHR:

A

110-160 bpm
Can be 180 if crying
Can be 100 if sleeping

161
Q

Fetal respiratory rate:

A

30-60 breaths per minute
Newborn breathing patterns are irregular and they are abdominal breathers

162
Q

Umbilical cord: “AVA”

A

2 arteries, 1 vein

163
Q

Normal contractions:

A

2-5 min apart with a duration of < 90 seconds and intensity of < 100 mmHg

164
Q

Fontanelles:

A
  1. Bulging -> increased ICP or hydrocephalus
  2. Sunken -> dehydration
    Fontanelles may appear to be bulging when the newborn cries, vomits, or lying down (this is normal)
165
Q

Newborn weight loss:

A

The first few days of life, weight loss if 5-6 % this is normal in the newborn due to fluid excretion

166
Q

Babinski reflex:

A

Should disappear at 1 year of age (stroking the infants foot and toes go up- not normal)

167
Q

Vitamin K injection:

A

Administered two newborn after brith this helps blood coagulation and decrease risk of hemorrhage

168
Q

Acrocyanosis:

A

Bluish tint of the hands and feet is normal in newborns

169
Q

Intussusception:

A

Currant jelly stools (bloody), palpable sausage shaped abdominal mass

170
Q

Epiglotitis:

A
  1. S/S: Drooling, dysphagia, tripod position
  2. Do not visualize the throat with a tongue blade, don’t take oral temp, don’t do throat cultures (These can cause reflex laryngospasms cutting off airway)
171
Q

Hypertrophic pyloric stenosis:

A

Projectile vomiting

172
Q

Esophageal atresia and trachesophageal fistula:

A

Coughing with feeding, Choking with feeding, Cyanosis

173
Q

Laryngeotracheobronchitis “croup”:

A

Strider, subglottic swelling (causing hoarseness in voice), seal bark cough

174
Q

Scarlet fever:

A

Strawberry tongue, sandpaper rash

175
Q

Measles:

A

Koplik spots (clustered white lesions on the buffalo mucosa)

176
Q

Hirschsprung’s disease (toxic megacolon):

A

Ribbon like stool

177
Q

Patent ductus arteriosus:

A

Very noticeable murmur, sounds like a bag of rocks or a machine

178
Q

Lyme disease:

A

Rash that resembles bullseye (think of target logo)

179
Q

Fifths disease (erythema infectiousum):

A

“Slapped face” appearance on the face

180
Q

Salicylates:

A

Don’t give products that contain salicylates to children recovering from a viral illness (flu or chickenpox) this can cause Reye’s syndrome

181
Q

Newborn urination:

A

48 hours after birth: 2-6 wet diapers per day
3-4 days after birth: 6-8 diapers per day

182
Q

Circumcision:

A

Yellow exudate on the glans penis after circumcision is a normal sign of healing and is not alarm

183
Q

Circumcision:

A

Yellow exudate on the glans penis after circumcision is a normal sign of healing and is not alarming

184
Q

CPT in children with CF:

A
  1. Do treatment 1 hour before or 2 hours after eating
  2. GI upset can be caused when treatment is done too close to meals
185
Q

Hemophilia:

A
  1. Don’t take NSAIDS
  2. Avoid IM injections
  3. Use smallest gauge needle possible
  4. Avoid contact sports
  5. Wear medical alert ID
186
Q

Liquid iron:

A
  1. Stains the teeth
  2. Use a straw
  3. Brush teeth after
187
Q

Wilm’s tumor:

A

Avoid palpation of the abdomen, could lead to rupture

188
Q

Fontanelle closure:

A

Anterior: 12-18 months
Posterior: 2 months

189
Q

Newborn weight:

A

6 months: should be doubled from birth weight
12 months: should be tripled from birth weight

190
Q

Newborn length:

A

Should be growing 1/2 - 1 inch every month

191
Q

Newborn teeth:

A

First teeth to show are the lower central incisors, usually pop out around 10 months of age

192
Q

Infant motor skills and language:

A

2 months: raises head and chest, head control improves, moves head side to side, should be smiling, coos
4 months: beings to play, rolls from prone to supine, holds and reaches for toys, head leads body when pulled to sit “Rolls on floor at four”, babbling
6 months: can sit up with support, stranger anxiety begins, tripod sit, non specific babbles
8-9 months: sits without support, crawls, stands with pulling and holds onto objects, pincer grasp, object permanence
10-12 months: walking, separation anxiety, simple words “ma ma”, “da da”

193
Q

ABGs:

A

Ph: ACIDOSIS 7.35-7.45 ALKALOSIS
CO2: ALKALOSIS 35-45 ACIDOSIS
HCO3: ACIDOSIS 22-26 ALKALOSIS

194
Q

Respiratory acidosis:

A

Ph < 7.35, co2 > 45
Lungs retaining co2
Causes: hypoventilation, opioids, pneumonia, COPD
S/S: restlessness, sleepy, coma

195
Q

Metabolic acidosis:

A

Ph < 7.35, HCO3 < 22
Unable to excrete acid/loss of bicarbonate
Causes: DKA, severe diarrhea, kidney injury
S/S: kussmaul respirations (deep, rapid breathing > 20 rpm)

196
Q

Respiratory alkalosis:

A

Ph > 7.45 CO2 < 35
Lungs are losing co2
Causes: hyperventilation, Asa toxicity
S/S: tachypnea, tachycardia

197
Q

Metabolic alkalosis:

A

Ph > 7.45, HCO3 > 26
Unable to excrete bicarbonate or loss of acid
Causes: vomiting, NGT suctioning, too many antacids
S/S: hypoventilation < 12rpm

198
Q

Disaster triage:

A
  1. Immediate/emergent (red): shock, compromised airway, chest trauma, burns 60% TBSA
  2. Urgent/delayed (yellow): open fractures with palpable pulses, open wound/lacerations
  3. Non urgent/minimal (green): closed fracture, no changes in breathing or circulation
  4. Expectant (black): severe head trauma, low GCS, high spinal cord injury, full thickness burns > 60% TBSA, no pulse
199
Q

Hypovolemic shock:

A
  1. Decreased intravascular volume
  2. Causes: hemorrhage, severe dehydration, fluid shift
  3. Tachycardia, hypotension, cyanosis, cool/pale skin
  4. Treatment: fluids and blood replacement
200
Q

Cardiogenic shock:

A
  1. The heart can’t pump enough blood to meet perfusion needs of the body
  2. Causes: acute MIC, cardiac tamponade
  3. S/S: tachycardia, hypotension, cool clammy skin
  4. Treatment: For an MI (angioplasty, thrombolytics), oxygen, vasopressors
201
Q

Septic shock:

A
  1. Caused by widespread infection or sepsis
  2. Causes: pneumonia, wound infection, invasive procedures
  3. S/S: tachycardia, hypotension, warm and flushed at first, later cool, pale, mottled
  4. Treatment: fluids, broad spectrum abx, vasopressors
202
Q

Anaphylactic shock:

A
  1. Severe allergic reaction
  2. Causes: foods, meds, insects, latex
  3. S/S: tachycardia, hypotension, respiratory distress, generalized flushing, rash, hives
  4. Treatment: epinephrine, oxygen, antihistamines, corticosteroids
203
Q

Neurogenic shock:

A
  1. Experiences parasympathetic stimulation which causes vasodilation for an extended period
  2. Causes: spinal cord injury, nervous system damage
  3. S/S: bradycardia, hypotension (only type of shock that shows bradycardia), skin dry, warm, extremities cold body
  4. Treatment: protect the spine, manage airway, vasopressors
204
Q

Burns injury depth:

A

Layers of the skin -> epidermis, dermis, hypodermis (subcutaneous tissue)
1. Superficial (1st degree burn): epidermis, pink and painful (Still has nerves), no scarring, blanching present, heals in a few days
2. Superficial partial thickness (2nd degree burns): epidermis and dermis, blisters, shiny and moist, painful, blanching present, heals 2-6 weeks
3. Full thickness (3rd degree burn): epidermis, dermis, hypodermis. May look black, yellow, red, and wet, no pain (nerve fibers are destroyed), skin will not heal (need skin grafting), Eschar (dead tissue, leathery, must be removed)

205
Q

Burns:

A
  1. Patients with burns are at risk for losing a lot of fluid. Prioritize FLUID RESUSCITATION to prevent reverse hypovolemic shock
  2. Inhalation injury (damage to the respiratory system that happens mostly in closed areas). S/S: hair singed around the face, neck, torso, trouble walking, soot in the nose or mouth, confusion, anxiety.
  3. Nursing considerations: establish IV access preferably 2, fluids, Foley catheter to monitor UOP, elevate extremities above level of heart, possible intubation, meds to decrease the chance of ulcers (h2 blockers or PPI)
206
Q

Antihypertensives:

A
  1. ACE inhibitors “pril” monitor for ACE -> Angioedema, Cough, ELEVATED POTASSIUM
  2. ARBS “Sartans”
  3. Beta blockers “olol” Monitor for bradycardia, bronchospasms, bronchoconstriction (contraindicated with ASTHMA), bad for HF, masks hypoglycemia
  4. CCB “dipine, Verapamil, diltiazem” AVOID GRAPEFRUIT JUICE = severe hypotension, eat fruits/fiber/fluids d/t CONSTIPATION (Calcium constipates)
  5. Digitalis cardiac glycosides “Oxin”
  6. Diuretics; loop, thiazide, potassium sparring
    Common side effects: orthostatic hypotension (change positions slowly -> AT RISK FOR FALLS)
207
Q

Antidotes:

A

Benzodiazepines -> flumazenil (romazicon)
Digoxin -> digibind (immunefab)
Heparin -> protamine sulfate
Warfarin -> vitamin k
Opioids/narcotics -> naloxone (narcan)
Acetaminophen -> acytylcysteine (mucomyst)
Betablockers -> glucagon
Cholinergic toxicity -> atropine
Magnesium sulfate -> calcium gluconate
Iron toxicity -> deferoxamine
Aspirin -> sodium bicarbonate
EPS symptoms -? Benztropine (cogentin)

208
Q

Therapeutic levels:

A
  1. Digoxin-> 0.5-2.0
  2. Lithium-> 0.6-1.2
  3. Theophylline-> 10-20
  4. Dilantin-> 10-20
  5. Mag sulfate-> 4-7
  6. Tylenol-> 10-20
  7. Gentamicin-> 5-10
  8. Salicylates(Aspirin)-> 100-300
  9. Vancomycin-> peak: 20-40, trough: 5-15
  10. Valproic acid-> 50-100
209
Q

TPA:

A
  1. Major risk for bleeding
  2. Avoid IM injections, unnecessary IV punctures, prevent injury, bed rest
210
Q

Statins:

A
  1. Risk for rhabdomyolysis
  2. Classic symptom -> dark urine color, tea or cocoa like urine
211
Q

Nitrates:

A
  1. Do not’ take with phosphodiesterase inhibitors -> Sildenafil (viagra) at risk for dangerously low BP resulting in death
  2. Headache is a common side effect
212
Q

Potassium chloride:

A

Never give potassium IV push or fluid bolts, KCL is always diluted and given via infusion pump

213
Q

Warfarin (Coumadin):

A
  1. Anticoagulant
  2. Blocks the production of vitamin K (which is essential for blood clotting)
  3. Monitor INR (2-3 seconds) or 1.5-2 times the control values
  4. “Numbers are HIGH the client will die (increased bleeding), numbers are too LOW the clots will GROW”
214
Q

Heparin:

A
  1. Inhibits formation of fibrin clots
  2. IV or subcutaneously
  3. Monitor aPTT (47-70 seconds) or 1.5-2 times the control values
  4. “Numbers are HIGH patient will DIE, numbers too LOW clots will GROW”
215
Q

Diuretics education:

A
  1. can cause orthostatic hypotension -> change positions slowly, sit on the side of the bed for a few minutes before standing up
  2. can cause constipation -> increase fluids and fiber
  3. Take in the morning, not at night
  4. Low sodium diet (sodium makes us retain water)
216
Q

Antibiotics:

A
  1. Finish the entire prescription even if feeling better to prevent superinfection
  2. Some antibiotics make oral contraceptives ineffective so use additional contraception (Penicillin and Tetracycline) “Penicillin bumps the pill, tetracyclines require child care”
  3. Antibiotics are hard on the liver, AVOID alcohol
  4. Some antibiotics cause photosensitivity, avoid direct sun exposure (fluoroquinolone, tetracyclines, sulfa drugs)
  5. C&S necessary prior to antibiotic administration to determine what type of bacteria is causing the infection and what antibiotic to administer
  6. Some antibiotics are hard on the kidneys (Aminoglycosides and vancomycin)
217
Q

Cephalosporins and Penicillin:

A
  1. Cross sensitivity with penicillin
  2. Ask about allergies to PCN or cephalosporins before administering the first dose
218
Q

Sulfonamides:

A
  1. Cross sensitivity with sulfonylurea (glyburide and some diuretics)
  2. Risk for Steven Johnson’s syndrome -> STOP medication if a rash occurs
219
Q

Fluroquinolones: “Floxacin”

A
  1. At risk for tendinitis and Achilles tendon rupture
  2. Contraindicated in children < 18 years
  3. Risk of damage to developing cartilage
  4. Not recommended for growing children
    “Your Achilles tendon is near the floor and can rupture due to fluoroquinolone”
220
Q

Tetracyclines:

A
  1. Think TOXIC to developing fetus
  2. Causes tooth discoloration “Tetra think Teeth”, don’t give to child < 9 years
  3. Risk for pill induced esophagitis -> Sit up for 30 minutes after taking the medication and don’t lay down
221
Q

Vancomycin:

A
  1. Infuse over at least 60 minutes
  2. Rapid administration causes red man syndrome (flushing, itching, rash on chest or extremities)
  3. Risk for nephrotoxicity (monitor BUN and creatinine)
222
Q

Aminoglycosides:

A
  1. SUPER TOXIC “A mean antibiotic”
  2. Nephrotoxic, ototoxic, neurotoxic
  3. Gentamicin
223
Q

TB meds:

A
  1. Rifampin: “Rifampin think RED fluids”
    Makes body fluids (tears, urine, sweat) turn red/orange (normal) “Rifampin Red fluids”
    Educate -> Don’t wear contacts instead wear glasses (the red tears can cause discoloration of contact lenses)
  2. Isoniazid:
    Risk for peripheral neuropathy (Take with Vitamin B6 to help)
    Hepatotoxicity (avoid alcohol and Tylenol - hepatotoxic contributors)
  3. Ethambutol: “Ethambutol think EYE issues”
    At risk for optic neuritis
    Have regular eye exams
    Report signs of blurry vision, decreased visual acuity, changes in color perception
224
Q

Antidepressants:

A
  1. Suicide warning -> all antidepressants increases the risk for suicide because they now have the energy due to the medication to carry out their plans
  2. Never stop abruptly, must taper
  3. All antidepressants cause constipation -> increase fluids, fiber, fruits
  4. All antidepressants take weeks to take effect, educate on the importance of COMPLIANCE
  5. SSRIs, SNRIs, DNRIs 4-6 weeks, TCAs 2-3 weeks, MAOIs 4 weeks
225
Q

SSRIs:

A
  1. -Oxetine, -talopram, -zodone
  2. Take this medication in the morning “SSRIs SUNRISE”
  3. Monitor for 3 S’s -> Serotonin syndrome (mental changes, muscle rigidity, tremors, tachycardia, HTN, elevated temp), sexual dysfunction, stomach issues
226
Q

SNRIs/DNRIs:

A
  1. -faxine, -zodone, -nacipram,
  2. Do not mix with TCAs or MAOIs
227
Q

TCAs:

A
  1. -triptyline, -pramine
  2. Wait 14 days after being off of MAOIs
228
Q

MAOIs:

A
  1. Tranylcypromine (Parnate), Isocarboxazid (Marplan), Phenelzine (Nardil) “TIP”
  2. Avoid tyramine, this can lead to hypertensive crisis
  3. Causes insomnia (so take in AM), drowsiness, dizziness, worsening depression, SI
  4. Tyramine foods -> aged cheese, sour cream, fermented meats/liver, yogurt, over riped fruits
229
Q

Antacids:

A
  1. Calcium and aluminum -> causes CONSTIPATION
  2. Magnesium -> causes upset stomach and diarrhea
230
Q

PPIs: think of the 4 P’s of PPI’s

A
  1. -prazole
  2. Prevents holes “stress ulcer ppx”
  3. Porous bones (causes osteoporosis long term)
  4. Possible GI infection (c diff.) from long term use. Acid helps fight infection, but this medication blocks acid secretion
231
Q

Metoclopramide:

A

Long term use increases the risk for Tardive dyskinesia (uncontrolled motions such as lip smacking, blinking eyes)

232
Q

Ondansetron:

A

Risk for torsades de pointes -> Potentially fatal heart rhythm characterized by QT interval prolongation

233
Q

Pancrealipase:

A

Must be eaten with every meal and snack, can open capsule and sprinkle on apple sauce

234
Q

Lactulose:

A

Therapeutic response -> improved nutritional status and reduction in the number of fatty stools

235
Q

Laxatives:

A

Increased the risk for dehydrations. Educate patient to increase fluid intake

236
Q

Corticosteroids:

A
  1. Hyperglycemia
  2. Soft bones (osteoporosis)
  3. Decreased immunity/sepsis
  4. Depression
  5. Salt and water retention -> HTN
  6. Decreased libido
  7. Swollen -> water gain = weight gain
  8. Risk for cataracts
  9. Don’t DC abruptly, must taper off
237
Q

Albuterol:

A
  1. Think ALBUTEROL is for ACUTE ASTHMA ATTACKS (rescue inhaler)
238
Q

Salmetrol (bronchodilator):

A

Think SALMETROL is SLOW and STEADY (long acting)

239
Q

Bronchodilator and corticosteroid:

A
  1. Bronchodilator first to help open up the airways
  2. Wait 5 minutes
  3. Administer corticosteroid
240
Q

Acetylcysteine (mucomyst):

A

Can cause or worsen bronchospasms (in clients with asthma) “Acetylcysteine Avoid Asthma”

241
Q

Tiotropium (anticholinergic):

A

Do not swallow capsules, they go in inhaler

242
Q

Theophylline:

A

Restlessness, N/V, insomnia, seizures, life threatening arrhythmias

243
Q

Teratogenic meds “TERATOWAS”:

A

Thalidomide
Epileptic meds (valproic acid, phenytoin)
Retinoid (vitamin A)
Ace inhibitors, ARBS
Third element (lithium)
Oral contraceptives
Warfarin
Alcohol
Sulfonamides

244
Q

Mixing insulin: “You are Not Retired, you are an RN”

A
  1. Regular insulin and NPH insulin
  2. Inject air -> Cloudy then clear
  3. Withdraw insulin -> clear then cloudy
245
Q

Rapid acting insulin:

A
  1. Lispro, Aspart, Glulisine (Humalog, Novolog, Apidra)
  2. Peak 30-90 minutes, onset 15 minutes
  3. Highest risk for hypoglycemia
246
Q

Short acting insulin: “regular goes right into the vein”

A
  1. Regular (Humulin R, Novolin R)
  2. Peak 2-4 hours
  3. Only insulin given IV
247
Q

Intermediate:

A
  1. NPH (Humulin N, Novolin N)
  2. 4-12 hours
  3. This type of insulin is cloudy
248
Q

Long acting insulin:

A
  1. Glargine, Detemir (Lantus, Levemir)
  2. No peak
  3. Never mix with any other insulin

CAPSTONE (2 decks)

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