KLIMEK Flashcards
How is bleeding of abruptio placentae different from that in Placenta Previa?
Usually with pain in AP but not in PP, bleeding more voluminous in PP (the one that bleeds more has less pain; the one that bleeds less has more pain).
How often should the nurse check vital signs for unstable patients?
Q 15 minutes
How is an infant delivered when abruptio placentae is present?
C-section
Higher or lower risk incidence of fetal death with abruptio placentae compared with placenta previa?
Higher
Name the 5 criteria that are recorded on an APGAR scale?
Cardiac status Respiratory effort Muscle tone Neuromuscular Irritability (reflexes) Color
On heart rate or cardiac status in APGAR, a 2 means that the HR is above …?
100 bmp
A high APGAR score of 2 is given for the respiratory effort if the newborn…?
Cries vigorously
To get an APGAR score of 1 for muscle tone, the newborn must place their extremities in…?
flexion
To get an APGAR score of 2 on neuromuscular reflex irritability the infant must…?
Cry
To score an APGAR of 2 on color the infant must look…?
Totally pink
Can you use cotton balls/washcloth to clean the eyes, nares or ears of an infant?
No, this is dangerous.
What is the #1 purpose of a tepid sponge bath?
Lower body temperature during fever
What body part do you begin bathing an infant?
eyes
Should you retract the foreskin of a 5-week-old male, uncircumcised infant to cleanse the area?
No, not until foreskin retracts naturally and without resistance- then it should be retracted, cleansed, and replaced.
T/F, you may use friction to remove vernix caseosa from an infants skin?
F, it causes bruising.
How many minutes should an infant breastfeed per side?
20 minutes
What side should breastfeeding begin?
Begin nursing on the side the baby finished last feeding.
How long can breastmilk be refrigerated?
24 hours
How long can breastmilk be frozen?
6 months
Which two nutrients is breastmilk lower in?
Fluoride and iron
Can a woman breastfeed on oral contraceptive?
Should not use OC during first 6 weeks after birth because the hormones may decrease milk supply. Estrogen is not recommended. Non-hormonal methods are recommended. Remember breastfeeding is unreliable contraceptive.
The infant fears what most when hospitalized?
Separation from love object
The toddler fears most what when hospitalized?
Separation from family
The toddler and preschooler will think that illness is caused by…?
Something they did wrong
Three types of ventilator obstruction and action?
- kinked tubing- unkink
- H2O in tubing- empty the H2O.
- Mucous- T(Turn)C(cough)DB(deep breathing)
what is psychosis induced by vitamin B1 (Thiamine) deficiency?
Wernicke’s Syndrome
Primary symptom: amnesia with confabulation.
Aversion therapy for alcohol dependancy?
Disulfiram/Naltrexone
Category A Bioterrorism agents (STAPHB)
Small Pox Tularemia Anthrax Plague Hemorrhagic Fever Botulism
what is xerostomia?
dry mouth
P Wave always refers to?
Atrial
QRS depolarizations always refers to?
Ventricular
In a pneumothorax, the chest tube removes…?
air
in a hemothorax, the chest tube reomves…?
blood
In a pneumohemothorax, the chest tube removes …?
air and blood
How many chest tubes (and where) for unilateral pneumothorax?
one, apical
How many chest tubes (and where) for bilateral pneumothorax?
2, apical
How many chest tubes (and where) for post-op chest surgery?
two, apical and basilar on operated side.
Rule of B’s related to ABG interpretations
If the pH and the Bicarb are Both in the same direction then it is metaBolic
Acid-Base Signs and Symptoms memorization
As the pH goes, so goes my patient. Except for potassium.
Causes of Acid Base imbalance
First ask yourself, “is it lung?”
If yes, then it is respiratory
Then ask yourself “Are they over or under ventilating”
If over- alkalosis
If under- acidosis
What symptom is associated with metabolic alkalosis
prolonged vomiting or suction
High pressure alarms in ventilators are caused by…
Increased resistance to air flow (obstructions)
What are obstructions in ventilators that cause high pressure alarms?
Kinked tubing
H2O in tubing - empty the H2O
Mucous- Turn, Cough, Deep Breathe (must do TCDB before suctioning)
What are low pressure alarms in ventilators caused by?
decreased resistance to air flow, can be caused by disconnections of the tubing. Reconnect the tubing. If tube falls on floor, call resp + ambu pt. If tube falls on pt chest, clean + reconnect.
Respiratory Alkalosis means ventilator settings may be too …
High (hyperventilation)
Respiratory Alkalosis means ventilator settings may be too…
Low (hypoventilation)
How to treat denial
Confront it by pointing out to the person the difference between what they say and what they do. In contrast, support the denial of loss and grief.
When the abuser get the significant other to do things for them or make decisions for them.
Dependancy
When the significant other derives positive self-esteem from doing things for or making decisions for the abuser.
Codependency
Psychosis induced by Vitamin B1 (Thiamine) deficiency.
Wernicke’s Syndrome
Primary symptoms of Wernicke’s Syndrome
Amnesia with confabulation (making up stories that client believes)
Is Wernicke’s Syndrome reversabile?
No
Things to know about Disulfiram and Naltrexone
Aversion therapy to alcohol
Onset and duration- 2 weeks
Avoid all forms of alcohol such as vanilla extract, insect repellants, aftershaves, perfumes, vinaigrettes.
Things to know about Delirium Tremens
Patients with DT's are dangerous to themselves and others. NPO Take Thiamine or multivitamin Bed rest or activity restriction Antihypertensives and antidepressants Restraints, 2pt leather
Aminoglycosides treat …
mean ol infections
Aminoglycoside Toxicity effects
Ototoxicity
Nephrotoxicity
Do not give Aminoglycosides PO except in these two cases:
Hepatic Encephalopathy (liver coma) Pre-op bowel surgery
Aminoglycosides act as a bowel sterilizer.
Things to know about smallpox:
Airborne precautions
Dies from septicemia, no treatment
Things to know about Anthrax
Looks like resp flu
Dies from resp failure
Treat with Cipro, PCN, and Streptomycin
Three H’s of the Plague
Hemoptysis
Hematemesis
Hematochezia
3 major symptoms of Botulism
Descending paralysis
Fever
Alertness
Sarin- Nerve Agent, what is 2B’s and SLUDGE?
Bronchoconstriction Bronchorrhea- massive amounts of sputum Salivation Lacrimation Urination Diaphoresis and Diarrhea GI Upset Emesis
Calcium Channel Blockers are like…
Valium for your heart (calming and relaxing)
How do Calcium Channel Blockers treat?
Antihypertensives
Antiangina
Anti Atrial Arrthmial
Ending of Calcium Channel Blockers
-zem, -dipine, Isoptin
QRS Depolarization always refers to…
Ventricular
P Wave always refers to …
Atrial
Be concerned about PVC’s if…?
More than 6 per minute
More than 6 in a row
PVC falls on T-wave of previous beat
Treatment for PVC and V Tach
Lidocaine & Amidarone
Treatment for Supra-ventricular arrthymias
Adenosine - must slam it IV push
Beta Blockers
CCB’s
Digitalis or Digoxin
What do you do if a water seal breaks on a chest tube?
First - clamp tube, cut, submerge, unclamp
Best- Submerge end of tube
What do you do if a chest tube comes out?
First- cover with vaseline gauze, DSD + tape.
Best- vaseline gauze
Continuous bubbling in water seal chamber
bad- means leak
Continuous bubbling in suction control chamber
good
Intermittent bubbling in water seal chamber
good
Intermittent bubbling in suction control chamber
bad- turn off suction
Trouble pneumonic for congenital heart diseases
TRouBLe
T- diseases that start with T will be trouble
R->L = shunt right to left
B- blue, cyanotic
All CHD kids will have these two things…
- Murmur
2. At least 1 ecchocardiogram
Four defects of Tetralogy of fallot - VardieD PictureS Of A RancH
Ventricular Defect
Pulmonary Stenosis
Overriding Aorta
Right Hypertrophy
What side do you hold a cane on?
Strong side
What is a somatic delusion?
False, fixed belief about a body part. Ex- x-ray eyes, hollow body, male pregnancy.
What is a gustatory hallucination
Hallucination of taste
Difference between illusions and hallucinations?
With illusions there is a referent in reality.
Four steps to dealing with clients with functional psychosis? (ex- Schizophrenis, schizoaffective, major depression, and manic phase)
Acknowledge feelings
Present reality
Set a limit
Enforce the limit
Two steps to dealing with clients who suffer from psychosis of dementia? (Alzheimers, senility, Wernickes. post-stroke psychosis)
Acknowledge the feeling
Redirect- take what the client is fixated on, that they are expressing inappropriately and get them to express the fixation appropriately.
What is psychotic delirium?
This is a temporary, episodic, dramatic, sudden onset loss of reality due to a chemical imbalance.
Acknowledge the feeling and reassure the client.
What is flight of ideas?
stringing phrases together
What is word salad?
string words together
What are neologisms?
making up words
What is ideas of reference?
When the client believes to be the center of the universe and causes everything.
Rule of refrigeration of insulin
Refrigeration of unopen insulin is required, optimal after opening.
Treatment of low blood sugar in a type 1 diabetic
15/15X3
Give 15 gm of glucose
wait 15 minutes, if glucose is under 100…
Give 15 gm more of glucose
wait 15 minutes, if glucose is still under 100…
Give 15 gm more of glucose
If still under 100, call HCP
If unconscious, give glucagon or IV D50
1 cause of high blood glucose in type 2 diabetic
acute viral upper respiratory infection within the last week.
S/S of high blood glucose in type 2 diabetic (DKA)
Dehydration
Ketones, kussmal, high K+
Acidosis, acetone (fruity breath), anorexia w/nausea
What is high blood sugar in a type 1 diabetic ?
HHNK (Hyperosmolar, hyperglycemic, non-ketotic coma)
Treat like dehydration
Diabetic A1C target
below 7
Non-diabetic A1C target
below 6
Prediabetic A1C
6.3-7
Bilirubin elevated range
10-20
Bilirubin toxic level
Above 20
What is Kernicterus?
Bilirubin in CSF, baby dies quickly.
What is Opisthotonos
Hyperextension seen with Kernicterus. Lie on side.
What is a Hiatal Hernia?
Regurgitation of acid into esophagus because upper stomach herniates upward through the diaphragm.
Gastric contents move in the wrong direction, at the correct rate.
What is dumping syndrome
Complication of post-op gastric surgery in which gastric contents dump into the duodenum too quickly.
Gastric contents move in the correct direction at the wrong rate.
Treatment of Hiatal Hernia Vs. Dumping syndrome
Hiatal Hernia- High fowlers 1 hr after eating, High fluids with meals, High carb
Dumping Syndrome- Low fowlers 1 hr after eating, low fluids with meals, low carbs and high protein
Sentence to memorize with Kalemias
Kalemias do the same as the prefix, except HR and urine output
Sentence to memorize with Calcemias
Calcemias do the opposite the prefix, no exceptions. Does anything to BP.
Two signs associated with low calcium
Chvosteks sign
Trousseaus sign- BP cuff makes clients arm spasm
Sentence to memorize with Magnesemias
Magnesemias do the same as the prefix & do anything to BP.
What is the earliest sign of an electrolyte disorder?
Numbness and tingling (parathesia)
What is the universal sign of electrolyte imbalance?
Muscle weakness
Can you push K+ IV?
Never, can stop heart and cause death
What to do to decrease K+ ?
Give D5 and regular insulin (2 different IV's) Sodium Polystyrene (Kayexalate, "K exits Late" Takes a long time to exchange electrolytes and digest out of the body)
What is PTU?
Propylthyroid uracil- treatment for hyperthyroidism
PutsThyroidUnder
Treatment of Addisons Disease?
Steroids (glucocorticoids + mineralcorticoids)
The proper order in which you apply PPE?
Gown
Mask
Goggles
Gloves
Proper order in which you remove PPE?
Gloves
Goggles
Gown
Mask
Synonyms for low WBC
Leukopenia
Neutropenia
Agranulocytosis
Immunosuppression
Neutropenic Precautions
Strict handwashing shower with antimicrobial soap Avoid crowds Limit number of staff Limit visitors to healthy adults No fresh flowers or plants Low bacteria diet (no raw fruits, veggies or undercooked meats) Do not drink standing water (more than 15 minutes) vitals Q4 Check WBC daily Avoid indwelling catheter use Use disposable eating utensils
Synonym for low platelet count
Thrombocytopenia
Thrombocytopenic (bleeding) protocol
No unnecessary venipuncture Injections or IV should use a small gauge catheter No electric razor No hard foods No flossing or toothbrush Blow nose gently No rectal temp, enema, or suppository No aspirin No contact sports No walking in care feet No tight clothes or shoes Use stool softener, no straining Notify MD of blood in urine or stool.
Reasons for Laminectomy
To treat nerve root compression
S/S of nerve root compression (3P’s)
Pain
Parathesia
Paresis (muscle weakness)
Most important assessment of a post-op Cervical Laminectomy
U. Extremities + breathing function
Most important assessment of a post-op Thoracic Laminectomy
couch mechanism + bowel function
Most important assessment of a post-op Lumbar Laminectomy
bladder + lower extremities
1 spinal post-op answer on NCLEX?
log roll (move pt w/o moving spine)
Specific “activity”/mobilization strategy for spinal post-op
do not dangle pt (sit on edge of bed)
No restriction on walking, standing, and lying down
Limit sitting to 30 minutes
Post op complication for all spinal surgery types
Cervical - Pneumonia
Thoracic - Pneumonia or constipation or paralytic ileus
Lumbar - bladder retention
How long is a “restriction?”
6 weeks
Permanent restrictions for laminectomy clients
Lift by bending waist
Cervical laminectomy- lift objects above the head
No horseback riding, off-trail biking, jerky amusement park rides, etc.
Nagele’s Rule
Take the FIRST day of the LMP
Subtract 3 months
Add 7 days
Weight gain during pregnancy
Total weight gain= 28 Ibs, +/- 3 Ibs
1st tri- 1 Ib/month
2nd & 3rd tri- 1 Ib/week
*gestation week -9 = ideal weight
At what week of pregnancy is the fundus palpable?
12
What week does the fundus reach the umbilical level?
20-22
Probable/Presumptive signs of pregnancy
All urine + blood tests Chadwicks sign (cyanotic cervical color) Goodells sign (Cervix softens) Hegars Sign (uterus softens)
Pattern of office visits during pregnancy
Once a month til week 28
Once every 2 week until week 36
Every week until delivery
How to battle morning sickness
Dry carbohydrate upon awakening, before leaving bed in the morning
High protein snack before bed
what to do with a prolapsed cord during labor?
Push head off cord
Position knee-chest or trendelenburg or elevate hips
Interventions for all complications of labor and delivery (LIONPIT)?
Left side IV Increase Oxygen (mask 8-10L) Notify HCP Pitocin Off
Fetal Monitoring Patterns
Low Fetal heart rate- LIONPIT FHR Accelerations- document Low Baseline Variability (Bad)- LIONPIT High Baseline Variability- document Late Decels- LIONPIT Early Decelerations- document Variable Decelerations- Very Bad- prolapsed cord intervention
Second Stage of Labor and delivery steps
Deliver the whole baby
Suction the Mouth then the Nose
Check for cord around the neck
Make sure an ID band is on the baby before it leaves the mothers side.
How to know if the fundal height is correct
The day of postpartum +/- 1.
Tiny white spots on babys face
Milia
small, white epithelial cysts on babys gums
Epsteins Pearls
bluish black macules appearing over the buttocks and/or thigh of darker -skinned neonates
Mongolian Spots
red popular rash on babys torso which is benign and disappears after a few weeks.
Erythema Toxicum Neonatorum
benign tumor of capillaries in babies
Hamangimas
swelling caused by bleeding between the osteum and periosteum of the skull. Does not cross suture lines in babies.
Cephalohematoma
edematous swelling on scalp caused by pressure during birth. this swelling may cross suture lines. usually disappears in a few days.
Caput Succedaneum
generic term for a birth mark
Nevus/Nevi
Size of gauge and length of IM needles
21G
1.5 in
Size of gauge and length of SubQ needles
25G
5/8 in
If the order read 50 units of 70/30 (Humulin/Novolog),how much N and R would you give?
50 x .70= 35N
20 x .30= 15R
Facts about Heparin
Works immediately Given IV and SubQ Antidote- Protamine Sulfate Lab- PTT Safe for pregnancy
Facts about Warfarin
Takes days to work Only PO Antidot- Vitamin K Lab- PT Not safe for pregnancy
K+ sparing diuretics have what ending?
-tone
K+ wasting diuretics have what ending?
- dine
- mide
- zide
What is a xenograft?
Tissue graft from animal, not a permanent fix.
What is a homo & allograft?
tissue from other people
When does the termination phase in care of psych clients begin?
On admission
Diet of a client with depression
High fiber and fluids
Prepare everything for client
Activity of client with depression
Group activity w/o interaction
Watch for what in the safety of a client with depression?
Self-destructive behavior
Diet of a client with schizophrenia
high fiber and fluids
prepare nothing
Activity of client with schizophrenia
Group activity with interaction to learn reality. Ex- boardgames, behavior group, cards, ect
Watch for what in the safety of a client with schizophrenia
Watch other directed behavior, they hate manics
Diet of a client with mania
High protein + fiber
Activity of client with mania
Gross Motor + no competition. Ex- punching bag, tredmill, self sports
Activity of client with anxiety
Gross motor with competition, action eats anxiety.
How to deal with violent clients?
- Requires 5 trained staff
- Give them a chance to deescalate
- Only one person talks during procedure
Ace of Spades answers for Psych
Best- “The nurse will examine own feelings about…”
Next- “Establish a trust relationship”
Ace of Spades answers for Nuturition
In a tie, either pic chicken or fish Never pick casseroles for children Never mix medications in children's food Toddlers need finger foods Preschoolers- Leave them alone! One meal a day is okay.
Ace of Spades answers for Pharmacology
Most commonly tested area in pharm is s/s
If you know what a particular drug does, choose side effects in the same body system where the drug is working.
If you have no clue what the drug does, look to see if its PO. If so, pick GI side effects.
Never tell a child medicine is candy.
Ace of Spades answers for OB
Check FHR
Ace of Spades answers for Med-Surg
What is the first thing you assess in a med-surg situation? LOC
What is the first thing you do in a med-surg situation? Check airway.
Ace of Spades answers for Pediatrics
Three rules on growth and development. They are based on the principal: always give the child more time.
When in doubt call it normal.
When in doubt, pick the older age.
When in doubt, pick the easier task.
