FINAL/EXIT/NCLEX STUDY GUIDE Flashcards
1
Q
Types of IV fluids:
A
- HYPERtonic solution
- ISOtonic solution
- HYPOtonic solution
2
Q
HYPERtonic solutions:
A
- 3% saline, 5% saline, 5% D5NS, D5 1/2 NS, D5LR, D10W
- Uses: cerebral edema (Increased ICP), hyponatremia, metabolic alkalosis, maintenance fluids, hypokalemia
- Do not administer to HF or renal failure because it can cause fluid volume overload
3
Q
ISOtonic solutions:
A
- 0.9% NA, 5% dextrose in water (D5W), Lactated Ringer (LR)
- Uses: Blood loss (hemorrhage, burns, surgery), dehydration, fluid maintenance
- NS is the ONLY solution compatible with BLOOD PRODUCTS
4
Q
HYPOtonic solutions: “HYPO think LOW numbers”
A
- 0.45% saline (1/2), 0.33% NS (1/3 saline), 5% dextrose in water (D5W)
- Uses: DKA, helps kidneys excrete excess fluids, hypernatremia
- DO NOT administer to increased ICP, burns, or trauma
5
Q
Blood administration:
A
- Only normal saline is compatible
- Type and screen and cross match are good for 72 hours
- Blood must be hung/started within 30 MINUTES from the time the blood is picked up from the blood bank
- All blood must be transfused within 4 HOURS of the time the blood was hung/started
- The first 15 MIN are the MOST CRITICAL, must stay at bedside
- Vitals monitored every 30 min - 1 hour
- Stop the transfusion if transfusion reaction suspected
- S/S: tachycardia, itching, hives, rash, flushing, back pain, respiratory distress.
- 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
6
Q
Diet modifications for diarrhea:
A
- Decrease fiber
- increase fluids and electrolyte replacement
7
Q
Diet modifications for celiac disease:
A
- Gluten free diet
- No BROW - Barley, Rye, Oat, Wheat
8
Q
Diet modifications for burns:
A
- High protein
- High calorie
9
Q
Diet modifications for AKI:
A
- Protein restricted
- Increase calories
10
Q
Diet modifications for COPD:
A
- Small, frequent meals
- Increase calories and fat
- These patients are burning a lot of calories from trying to breath off the excess CO2
11
Q
Diet modifications for pancreatitis:
A
- Small, frequent meals
- Low fat
12
Q
Diet modifications for gallbladder issues (CHOLECYSITIS):
A
Low fat
13
Q
Diet modifications for HLD:
A
LOW fat and LOW calories
14
Q
Diet modifications for HTN:
A
- LOW fat and sodium
- Heart healthy diet
15
Q
Diet modifications for CF:
A
Increase fluids
16
Q
Diet modifications for kidney stones:
A
Increase fluids (flush out the stones)
17
Q
Diet modifications for heart failure:
A
Fluid restriction
18
Q
Diet modifications for sickle cell anemia:
A
Increase fluids
19
Q
Diet modifications for patients with ostomies:
A
Increase fluids, decrease intake of odorous and gas forming foods; onions, broccoli, spinach
20
Q
Diet modifications for gout:
A
Decrease intake of purine foods (shellfish, organ means, seafood)
21
Q
Diet modifications for cirrhosis:
A
Avoid foods high in protein (milk products, broccoli, eggs, tuna, chicken breast)
22
Q
Diet modifications for ulcerative colitis:
A
Low fiber, low residue
23
Q
Angina:
A
Chest pain relieved by nitroglycerin
24
Q
MI:
A
- Crushing pin, pressure, and tightness UNRELIEVED by nitroglycerin
- Elevated troponin levels > 0.7, this is the best INDICATOR for an acute MI
- ST segment elevation
25
Heart failure:
Increased BNP > 100 pg/ml
26
Left sided heart failure: think “LEFT side think LUNGS”
Pulmonary edema, dyspnea, crackles, nagging cough
27
Right sided heart failure: think “Right side REST of body”
Edema, weight gain, large neck veins (JVD), ascites, hepatomegaly
28
Peripheral VASCULAR disease:
1. Edema, warm legs, dull, achy pain
2. Educate patient to eleVate Veins
29
Peripheral ARTERIAL disease:
1. NO edema, COLD legs, gangrene (necrotic), sharp pain
2. Educate patients to dAngle Arteries
30
DVT:
Unilateral leg pain and redness
31
Cardiac tamponade:
Beck triad -> hypotension, muffled heart sounds, jugular vein distention
32
Cardiogenic shock:
Cool, clammy skin, increased HR, decreased BP
33
Automated External Defibrillator (AED) important facts:
Before placing the pads on, remove all transdermal patches and wipe chest if wet
34
Synchronized cardioversion important facts:
Shock must be synced and delivered with the peak of the QRS complex (the R wave)
35
Cardiac catheterization:
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
36
Transesophageal echocardiograpy:
Hold all fluids and food until gag reflex is intact, slowly introduce food and water
37
Mean arterial pressure (MAP):
MAP of at least 60 mmHg is required to adequately perfuse vital organs
38
Bleeding:
1. Use an electric razor
2. Soft bristled toothbrush
3. Avoid IM injections
39
NSAIDS:
1. Naproxen, ibuprofen, celecoxib
2. Should be AVOIDED in those with a cardiovascular history (stroke, MI, CAD)
40
DM classic s/s:
3 p’s -> polydipisa, polyphasic, polyuria
41
DKA classic signs:
Acetone breath
42
HYPERthyroidism classic s/s:
Expothalmos (bulging or protruding eyeballs)
43
Addison’s disease classic s/s:
Hyperpigmentation of the skin
44
Cushing syndrome classic s/s:
Moon face and buffalo hump of the neck
45
Diabetes insipidus classic s/s: think “Dry Inside”
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)
46
SIADH: think “Soaked Inside”
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
47
Thyroid storm classic s/s:
ELEVATED temp, HR, BP, agitation, confusion in response to a stressful incident
48
Thyroidectomy:
1. Monitor for hypocalcemia due to accident removal of the parathyroid glas
2. Have an emergency trach kit at bedside
49
Pheochromocytoma (tumor of the adrenal medulla):
Do NOT palpate the patient’s abdomen because it can cause a hypertensive crisis
50
TSH levels:
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
51
Transphenoidal hypophysectomy:
Monitor for clear nasal draining post op, this may include CSF fluid leakage
52
Addisonian crisis:
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
53
Diabetes:
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)
54
Diabetes Mellitus I:
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
55
Diabetes mellitus II:
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
56
DKA:
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)
57
Hyperglycemia: “HOT AND DRY, SUGARS HIGH”
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
58
Hypoglycemia: “cold and clammy, needs some candy”
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)
59
Hyperthyroidism:
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
60
Hypothyroidism:
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
61
Myasthenia gravis:
Descending muscle weakness, ptosis (Drooping of eyelids)
62
GBS:
Ascending paralysis/muscle weakness from the legs up
63
Basilar skull fracture:
Raccoon eyes and battle signs (bruising behind ears)
64
Meningitis:
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
65
Stroke:
Face drooping, arm weakness, difficulty speaking
66
Neurogenic shock:
Everything is DECREASED (HR, BP, CO, O2) this is the only type of shock with a decreased HR
67
Autonomic dysreflexia:
Above the injury ( flushed, throbbing HA), below the injury (pale, cool, clammy skin)
68
Increased ICP:
1. Early: sudden vomiting without nausea
2. Late: cushing’s triad (systolic HTN, bradycardia, irregular breathing), abnormal posturing
69
CSF leakage:
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
70
Seizure precautions:
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
71
Osteoarthritis:
Stiffness after activity subsiding within 30 minutes, asymmetrical pain
72
Rheumatoid arthritis:
Stiffness in the AM lasting longer than 1 hour, symmetrical pain and swelling
73
Osteoporosis:
Fractures, the back will be rounded (hunch back) causing height loss
74
Compartment syndrome:
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
75
Fat embolism:
Petechiae, confusion, respiratory distress, chest pain
76
Cast care:
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
77
Traction:
The weights must always be free hanging (not resting on anything), make sure the patient is in supine
78
Fractures:
RICE = Rest, Ice, Compression, Elevate (to decrease swelling)
79
Osteomyelitis:
1. Will have high fevers
2. Patient will most likely get a PICC line to receive IV abx for weeks up to months
80
Rhabdomyolysis:
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
81
Hip arthoplasty/replacement education:
1. Don’t flex at the hips > 90 degrees
2. Don’t cross legs
3. Don’t turn the affected leg inwards
82
How to properly use a crutch:
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”
83
Types of gait:
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
84
How to properly use a cane:
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)
85
TB:
Night sweats, weight loss, hemoptysis (bloody sputum), low grade fever
86
PNA:
Rust colored sputum
87
Asthma:
Wheezing on expiration
88
Emphysema:
Barrel chest
89
ARDS:
Refractory hypoexmia ( low oxygen levels despite receiving high amounts of O2)
90
CF:
S/S: Thick mucus, salty skin/sweat
91
PE:
SOB, tachycardia, coughing up blood, hypoxemia
92
Hypoxemia/hypoxia:
1. Early: tachypnea, tachycardia, HTN, agitation, restless, confusion
2. Late: bradypnea, hypotension, bradycardia
93
Chest tube drainage:
Report drainage that is > 3ml/kg/hr within 3 hours or bright red black (dark bloody drainage is normal)
94
COPD:
It’s typical for COPD to have lower than normal O2 but any O2 less than 60 indicates hypoxia
95
Meds that interact with Asthma:
We want to “BAN” -> Beta blockers, ASA, NSAIDs, can cause bronchospams
96
Inhalation injury:
Hair singed around face, neck, torso, trouble talking, soot in nose or mouth, confusion, anxiety
97
Airborne precautions:
Single room under negative pressure, door remains closed, wear N95 or respirator
98
Inhaler use client teaching:
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
99
Chest tubes:
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
100
Appendicitis:
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
Pancreatitis: “Cullen’s Circle belly button”
1. Grey turner’s sign: bluish discoloration at the flanks
2. Cullen’s sign: bluish discoloration of the umbilicus
102
Pyloric stenosis:
Olive sized mass
103
Gastric ulcer:
Pain immediately after eating
104
Duodenal ulcer:
Relief of pain after eating 2-3 hours after
105
Abdominal hernia:
Lump or bulge beneath the skin at hernia site
106
GERD:
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
Ulcerative colitis:
Bloody diarrhea multiple times a day
108
Crohn’s disease:
Cobblestone appearance of the intestines
109
Cirrhosis:
Asterixis (liver flap), jaundice
110
Hepatitis:
Clay colored stool, jaundice, N/V
111
Stoma:
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
TPN:
Monitor for hyperglycemia
113
Endoscopic procedures or a TEE:
Hold all fluids and food until gag reflex is intact
114
Care of ostomies:
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
Bowel prep and enemas:
Monitor for fluid and electrolyte imbalance
116
Paracentesis:
Monitor for signs of shock (removal of fluid from abdominal cavity)
117
Esophageal varices:
Monitor for hemorrhage
118
Dumping syndrome:
Prevention -> consume small meals, low carbs, separate fluids and meals 30 min apart
119
UTI:
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
Pyelonephritis:
Flank pain
121
Nephrotic syndrome:
Proteinuria, edema commonly around eyes, HLD
122
Kidney transplant rejection:
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
Bladder cancer:
Classic symptom -> painless hematuria
124
Peritonitis:
Cloudy drainage from peritoneal dialysis, tender abdomen, tachycardia, fever
125
Fistula or graft:
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
Peritoneal dialysis:
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
Renal calculi/kidney stones:
Strain the urine and keep any stones -> send them to the lab to evaluate what type of stone
128
Urinary incontinence:
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
Bulimia:
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
Anorexia:
Amenorrhea, constipation, lanugo, decrease weight, hypotension and bradycardia
131
Delirium:
Sudden change in cognition, MEDICAL EMERGENCY
132
Alzheimer’s:
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
Schizophrenia:
1. Positive s/s: delusions, anxiety, hallucinations, jumbled speech
2. Negative s/s: lack of energy, bland effect, lack of social interaction
134
Depression:
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
Mania:
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
Anxiety attacks:
First nursing action is to decrease stimuli and provide a quiet and calm environment
137
Auditory/command hallucinations:
First concern is SAFETY
138
Alcohol intoxication:
IV thiamine is given to patients with alcohol intoxication because alcohol causes suppression of thiamine absorption
139
Thrombocytopenia:
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
Iron deficiency anemia:
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
Sickle cell anemia:
1. Severe pain during a sickle cell crisis
2. Give IV fluids during a sickle cell crisis (stops the clumping of RBCs)
142
Pernicious anemia:
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
Hemophilia:
Bleeding into various parts of the body, hemoarthosis (bleeding into the joints)
144
DIC:
Bleeding (petechiae, hematuria, Melina) and blood clotting happening at the same time (stroke, heart attack, DVT)
145
Polycythemia:
Increase in number of RBCS in the body causing increased risk of thrombus forming
146
Hemoglobin A1C:
Best reflection of blood glucose levels for the past 3-4 months
147
Neutropenic/reverse/protective isolation:
Private room, avoid raw fruits/veggies, avoid fresh flowers, avoid undercooked meat, no live vaccines, avoid invasive procedures
148
Ectopic pregnancy:
S/S: unilateral, dull abdominal pain, referred shoulder pain, hypotension
149
Hyperemesis gravidarum:
S/S: severe and persistent vomiting, weight loss
150
Placenta previa:
Painless bright red vaginal bleeding after 20 weeks of gestation
151
Placental abruption:
Dark red blood vaginal bleeding after 20 weeks of gestation with severe abdominal pain and rigidity
152
Preeclampsia:
HTN and proteinuria after 20 weeks of gestation
153
PP hemorrhage:
Uterus is enlarged, soft, boggy, and not midline. Commonly cause by uterine atony and bladder distention
154
PP infection:
Foul smelling or purulent lochia, fever > 100.4F, abdominal tenderness, tachycardia
155
Fetal alcohol syndrome:
Thin upper lip, smooth philtrum, small for gestational age, microcephaly
156
Spina bifida occulta:
Small tuft of hair, a dimple, or a hemangioma at the base of the spine
157
Magnesium toxicity:
Flushing, headache, respiratory paralysis, decreased DTR, low urine output
158
Neonatal abstinence syndrome:
Yawning, high pitched cry, sneezing
159
APGAR scoring:
7-10: excellent condition
4-6: moderately depressed
0-3: severely depressed
160
FHR:
110-160 bpm
Can be 180 if crying
Can be 100 if sleeping
161
Fetal respiratory rate:
30-60 breaths per minute
Newborn breathing patterns are irregular and they are abdominal breathers
162
Umbilical cord: “AVA”
2 arteries, 1 vein
163
Normal contractions:
2-5 min apart with a duration of < 90 seconds and intensity of < 100 mmHg
164
Fontanelles:
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
Newborn weight loss:
The first few days of life, weight loss if 5-6 % this is normal in the newborn due to fluid excretion
166
Babinski reflex:
Should disappear at 1 year of age (stroking the infants foot and toes go up- not normal)
167
Vitamin K injection:
Administered two newborn after brith this helps blood coagulation and decrease risk of hemorrhage
168
Acrocyanosis:
Bluish tint of the hands and feet is normal in newborns
169
Intussusception:
Currant jelly stools (bloody), palpable sausage shaped abdominal mass
170
Epiglotitis:
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
Hypertrophic pyloric stenosis:
Projectile vomiting
172
Esophageal atresia and trachesophageal fistula:
Coughing with feeding, Choking with feeding, Cyanosis
173
Laryngeotracheobronchitis “croup”:
Strider, subglottic swelling (causing hoarseness in voice), seal bark cough
174
Scarlet fever:
Strawberry tongue, sandpaper rash
175
Measles:
Koplik spots (clustered white lesions on the buffalo mucosa)
176
Hirschsprung’s disease (toxic megacolon):
Ribbon like stool
177
Patent ductus arteriosus:
Very noticeable murmur, sounds like a bag of rocks or a machine
178
Lyme disease:
Rash that resembles bullseye (think of target logo)
179
Fifths disease (erythema infectiousum):
“Slapped face” appearance on the face
180
Salicylates:
Don’t give products that contain salicylates to children recovering from a viral illness (flu or chickenpox) this can cause Reye’s syndrome
181
Newborn urination:
48 hours after birth: 2-6 wet diapers per day
3-4 days after birth: 6-8 diapers per day
182
Circumcision:
Yellow exudate on the glans penis after circumcision is a normal sign of healing and is not alarm
183
Circumcision:
Yellow exudate on the glans penis after circumcision is a normal sign of healing and is not alarming
184
CPT in children with CF:
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
Hemophilia:
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
Liquid iron:
1. Stains the teeth
2. Use a straw
3. Brush teeth after
187
Wilm’s tumor:
Avoid palpation of the abdomen, could lead to rupture
188
Fontanelle closure:
Anterior: 12-18 months
Posterior: 2 months
189
Newborn weight:
6 months: should be doubled from birth weight
12 months: should be tripled from birth weight
190
Newborn length:
Should be growing 1/2 - 1 inch every month
191
Newborn teeth:
First teeth to show are the lower central incisors, usually pop out around 10 months of age
192
Infant motor skills and language:
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
ABGs:
Ph: ACIDOSIS 7.35-7.45 ALKALOSIS
CO2: ALKALOSIS 35-45 ACIDOSIS
HCO3: ACIDOSIS 22-26 ALKALOSIS
194
Respiratory acidosis:
Ph < 7.35, co2 > 45
Lungs retaining co2
Causes: hypoventilation, opioids, pneumonia, COPD
S/S: restlessness, sleepy, coma
195
Metabolic acidosis:
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
Respiratory alkalosis:
Ph > 7.45 CO2 < 35
Lungs are losing co2
Causes: hyperventilation, Asa toxicity
S/S: tachypnea, tachycardia
197
Metabolic alkalosis:
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
Disaster triage:
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
Hypovolemic shock:
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
Cardiogenic shock:
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
Septic shock:
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
Anaphylactic shock:
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
Neurogenic shock:
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
Burns injury depth:
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
Burns:
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
Antihypertensives:
1. ACE inhibitors “pril” monitor for ACE -> Angioedema, Cough, ELEVATED POTASSIUM
1. ARBS “Sartans”
2. Beta blockers “olol” Monitor for bradycardia, bronchospasms, bronchoconstriction (contraindicated with ASTHMA), bad for HF, masks hypoglycemia
3. CCB “dipine, Verapamil, diltiazem” AVOID GRAPEFRUIT JUICE = severe hypotension, eat fruits/fiber/fluids d/t CONSTIPATION (Calcium constipates)
4. Digitalis cardiac glycosides “Oxin”
5. Diuretics; loop, thiazide, potassium sparring
Common side effects: orthostatic hypotension (change positions slowly -> AT RISK FOR FALLS)
207
Antidotes:
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
Therapeutic levels:
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
TPA:
1. Major risk for bleeding
2. Avoid IM injections, unnecessary IV punctures, prevent injury, bed rest
210
Statins:
1. Risk for rhabdomyolysis
2. Classic symptom -> dark urine color, tea or cocoa like urine
211
Nitrates:
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
Potassium chloride:
Never give potassium IV push or fluid bolts, KCL is always diluted and given via infusion pump
213
Warfarin (Coumadin):
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
Heparin:
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
Diuretics education:
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
Antibiotics:
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
Cephalosporins and Penicillin:
1. Cross sensitivity with penicillin
2. Ask about allergies to PCN or cephalosporins before administering the first dose
218
Sulfonamides:
1. Cross sensitivity with sulfonylurea (glyburide and some diuretics)
2. Risk for Steven Johnson’s syndrome -> STOP medication if a rash occurs
219
Fluroquinolones: “Floxacin”
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
Tetracyclines:
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
Vancomycin:
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
Aminoglycosides:
1. SUPER TOXIC “A mean antibiotic”
2. Nephrotoxic, ototoxic, neurotoxic
3. Gentamicin
223
TB meds:
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
Antidepressants:
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
SSRIs:
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
SNRIs/DNRIs:
1. -faxine, -zodone, -nacipram,
2. Do not mix with TCAs or MAOIs
227
TCAs:
1. -triptyline, -pramine
2. Wait 14 days after being off of MAOIs
228
MAOIs:
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
Antacids:
1. Calcium and aluminum -> causes CONSTIPATION
2. Magnesium -> causes upset stomach and diarrhea
230
PPIs: think of the 4 P’s of PPI’s
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
Metoclopramide:
Long term use increases the risk for Tardive dyskinesia (uncontrolled motions such as lip smacking, blinking eyes)
232
Ondansetron:
Risk for torsades de pointes -> Potentially fatal heart rhythm characterized by QT interval prolongation
233
Pancrealipase:
Must be eaten with every meal and snack, can open capsule and sprinkle on apple sauce
234
Lactulose:
Therapeutic response -> improved nutritional status and reduction in the number of fatty stools
235
Laxatives:
Increased the risk for dehydrations. Educate patient to increase fluid intake
236
Corticosteroids:
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
Albuterol:
1. Think ALBUTEROL is for ACUTE ASTHMA ATTACKS (rescue inhaler)
238
Salmetrol (bronchodilator):
Think SALMETROL is SLOW and STEADY (long acting)
239
Bronchodilator and corticosteroid:
1. Bronchodilator first to help open up the airways
2. Wait 5 minutes
3. Administer corticosteroid
240
Acetylcysteine (mucomyst):
Can cause or worsen bronchospasms (in clients with asthma) “Acetylcysteine Avoid Asthma”
241
Tiotropium (anticholinergic):
Do not swallow capsules, they go in inhaler
242
Theophylline:
Restlessness, N/V, insomnia, seizures, life threatening arrhythmias
243
Teratogenic meds “TERATOWAS”:
Thalidomide
Epileptic meds (valproic acid, phenytoin)
Retinoid (vitamin A)
Ace inhibitors, ARBS
Third element (lithium)
Oral contraceptives
Warfarin
Alcohol
Sulfonamides
244
Mixing insulin: “You are Not Retired, you are an RN”
1. Regular insulin and NPH insulin
2. Inject air -> Cloudy then clear
3. Withdraw insulin -> clear then cloudy
245
Rapid acting insulin:
1. Lispro, Aspart, Glulisine (Humalog, Novolog, Apidra)
2. Peak 30-90 minutes, onset 15 minutes
3. Highest risk for hypoglycemia
246
Short acting insulin: “regular goes right into the vein”
1. Regular (Humulin R, Novolin R)
2. Peak 2-4 hours
3. Only insulin given IV
247
Intermediate:
1. NPH (Humulin N, Novolin N)
2. 4-12 hours
3. This type of insulin is cloudy
248
Long acting insulin:
1. Glargine, Detemir (Lantus, Levemir)
2. No peak
3. Never mix with any other insulin
