Lu's Study Guide Flashcards
DO NOT delegate what you can
EAT
E-valuate
A-assess
T-each
Addison’s vs. Cushing’s
Addison's = down, down, down, up, down Cushing's = up, up, up down, up
Addison’s = hyponatremia, hypotension, decreased blood volume, HYPERkalemia, hypoglycemia
(need to “add” hormones)
Cushing’s = hypernatremia, hypertension, increased blood volume, HYPOkalemia, hyperglycemia
(have extra “Cushion” of hormones)
Do not give potassium unless
have adequate urine output
no pee, no K
for better perfusion then elevate and dangle
eleVate Veins
dAngle Arteries
APGAR
A = appearance (color all pink, pink and blue, blue (pale) P = pulse (>100,
Airborne precautions:
MTV =
Measles
TB
Varicella - chicken pox/herpes Zoster-Shingles
Private Room - negative pressure with 6-12 air exchanges/hr, Mask (N95 for TB)
Droplet
sepsis scarlet fever Streptococcal pharyngitis Parvovirus B19 Pneumonia Pertussis Influenza Diptheria (pharyngeal) Epiglottitis Rubella Mumps Meningitis Mycoplasma or meningeal pneumonia An - Adenovirus
Private Room or Cohort Mask
Door Open 3 ft distance
Contact
MRS. WEE
M - multi drug resistant organism R - respiratory infection S - skin infections W - wound infection E - enteric infection - clostridium difficle E - eye infection - conjuctivitis
Skin infections - VCHIPS Varicella zoster Cutaneous diptheria Herpez simplex Pediculosis Scabies
air/pulmonary embolism
s/s - chest pain, difficulty breathing, tachycardia, pale/cyanotic sense of impending doom
turn pt to LEFT side and LOWER the head of bed
Woman in labor with un reassuring FHR
(late decels, decreased variability, fetal bradycardia_
turn pt on LEFT side
give O2, stop Pitocin, increase IV fluids
Tube Feeding with Decreased LOC
position pt on RIGHT side (promotes emptying of stomach) with HOB ELEVATED (to prevent aspiration)
During Epidural
side-lying
After lumbar puncture
pt lies FLAT supine (to prevent headache and leaking of CSF) for 4-12 hrs
pt w/ heat stroke
lie FLAT with LEGS ELEVATED
During continuos bladder irrigation
catheter is taped to thigh so leg should be kept straight
no other positioning restrictions
after myringotomy
(ear tubes)
position on side of AFFECTED EAR after surgery (allows drainage of secretions)
after cataract surgery
pt will sleep on UNAFFECTED side with a night shield for 1-4 weeks
after Thyroidectomy
low or semi-fowler’s, support head, neck and shoulders
infant with spina bifida
position PRONE (on abdomen) so that sac does not rupture
Buck’s traction
(skin traction)
elevate foot of bed for counter-traction
After total hip replacement
- don’t sleep on operate side
- don’t flex hip more than 45-60 degrees
- don’t elevate HOB more than 45 degrees
- maintain hip abduction by separating thighs with pillows
Prolapsed Cord
knee-chest position or tredelenburg
Infant w/ cleft lip
position on back or in infant seat to prevent
to prevent dumping syndrome
post-operative ulcer/stomach surgeries
- eat in reclining position
- lie down after meals to decrease peristalsis
- restrict fluids during meals
- low CHO and fiber diet, small frequent dumping
- increase fat and protein
- small frequent meals
- wait 1 hr after meals to drink
above knee amputation
elevate for 1st 24 hrs on pillow, position prone daily for hip extension
below the knee amputation
foot of bed elevated for 1st hrs, position prone daily to provide for hip extension
Detached retina
area of detachment should be in the dependent position
Administration of Enema
position pt in LEFT SIDE LYING (Sim’s) with knee flexed
After Supratentorial Surgery
(incision behind hairline)
elevate HOB 30-45 degree
After Infratentorial Surgery
(incision at nape of neck)
position pt FLAT and lateral on either side
During internal radiation
on BEDREST while implant in place
Autonomic Dysreflexia/hyperreflexia
(S/S pounding headache, profuse sweating, nasal congestion, goose flesh, bradycardia, hypertension)
SITTING position (ELEVATE HOB) first before any other implementation
Shock
bedrest with extremities elevated 20 degrees, knees straight, head slightly elevated (modified Trendelenburg)
Head injury
elevate HOB 30 degrees in decrease intracranial pressure
Peritoneal Dialysis when outflow is inadequate
turn pt from side to side BEFORE checking for kinks in tubing
pain med for pancreatitis
Demoral, NOT morphine sulfate
myasthenia gravis
- caused by a disorder in the transmission of impulses from nerve to muscle cell
- worsens with exercise improves with rest
myasthenia crisis
positive reaction to Tensilon
will improve symptoms
Cholinergic crisis
caused by excessive medication - stop med giving Tensilon will make it worse
Head injury medication:
Mannitol (osmotic diuretic) - crystallizes at room temp so ALWAYS use filter needle
prior to a liver biopsy its important
to be aware of the lab result for prothrombin time
metabolic acidosis vs metabolic alkalosis
From the ass (diarrhea) = metabolic acidosis
From the mouth (vomitus) = metabolic alkalosis
Myxedema/hypothyroidism
slowed physical and mental function, sensitivity to cold, dry skin and hair
Grave’s disease/hyperthyroidism
- accelerated physical and mental function
- sensitivity to heat, fine/soft
Thyroid storm:
increased temp, pulse and HTN
Post-thyroidectomy:
semi-fowler’s prevent neck flexion/hyperextension, trach at bedside
Hypo-parathyroid:
CATS - convulsions, arrhythmias, tetany, spasms, stridor (decreased calcium)
-high Ca, low phosphorus diet
Hyper-parathyroid:
fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium)
- low Ca, high phosphorus diet
Hypovolemia
increased temp, rapid/weak pulse, increased respiration, hypotension, anxiety, urine specific gravity >1.030
Hypervolemia
bounding pulse, SOB, dyspnea, rales/crackles, peripheral edema, HTN, urine specific gravity
Diabetes Insipidus
(decreased ADH)
- excessive urine output and thirst, dehydration, weakness, administer Pitressin
SIADH
(increased ADH)
- change in LOC, decreased deep tendon reflexes, tachycardia, N/V, HA
- admin declomycin, diuretics
Hypokalemia
muscle weakness, dysrhtmias, increase K (raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery)
Hyperkalemia
MURDER - muscle weakness, urine (oliguria/anuria), respiratory depression, decreased cardiac contractility, ECG changes, reflexes
Hyponatremia:
nausea, muscle cramps, increased ICP, muscular twitching, convulsion
- osmotic diuretics, fluids
Hypernatremia:
increased temp, arrhythmias, tetany, spasms and stridor
Hypocalemia:
CATS - convulsions, arrhythmias, tetany, spasms and stridor
Hypercalcemia:
muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, sedative effect on CNA
HypoMg:
tremors, tetany, seizures, dyrshythmias, depression, confusion, dysphagia
- dig toxicity
HyperMg:
depresses the CNS, hypotension, facial flushing, muscles weakness, absent deep tendon reflexes, shallow respirations, emergency!
Addison’s
hypoNa, HyperK, hypoglycemia, dark pigmentation, decreased resistance to stress, fractures, alopecia, weight loss, GI distress
Cushing’s
hyperNa, hypoK, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN, hirsutism, moonface/buffaloe hump
Addisonian crisis:
N/V, confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP
Phechromocytoma
hypersecretion of epi/norepi, persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA
- avoid stress, frequent bating and rest breaks, avoid cold and stimulating foods, surgery to remove tumor
neuroleptic malignant syndrome
- you get hot (hyperpyrexia)
- stiff (increased muscle tone)
- sweaty (diaphoresis)
- BP, pulse, and respirations go up
- start to drool
dangerous when pregnant rubeola or rubella?
regular measles (rubeola) or german measles (rubella) - never get pregnant with a German (rubella)
when drawing up drawing up insulin
regular and NPH together
remember: RN
regular comes before NPH
Tetralogy of fallot
think DROP (child drops to floor or squats) Defect, septal Right ventricular hypertrophy Overriding aorts Pulmonary stenosis
MAOI’s that are used as antidepressants
(think Pirates take MAOI’s when depressed and pirates say ARRR)
MAOI’s used for depression all have an arrr sound in the middle
(Parnate, Marplan, Nardil)
PANAMA
(PArnate, MArplan, NArdil)
Autonomic dysreflexia
potentially life threatening emergency
- elevate HOB to 90 degrees
- loosen constrictive clothing
- assess for bladder distention and bowel impaction (trigger)
- admin antihypertensive meds (may cause stroke, MI, seizure)
With Digoxin
check pulse, if less than 60 hold, check dig levels and potassium levels
Amphojel
tx of GERD and kidney stones
- watch out for constipation
- long term use: binds to phosphates, increases Ca, robs the bones - leads to increased Ca resortion from bones = WEAK BONES)
Vistaril
tx of anxiety and itching
watch for dry mouth
commonly given preoperative
Versed
given for conscious sedation
watch respiratory depression and hypotension
PTU and Tapazole
prevention of thyroid storm
Sinemet
tx of parkinson
sweat, saliva, urine may turn reddish brown occasionally
causes drowsiness
Artane
tx of parkinson
sedative effect
Cofentin
tx of parkinson and extrapyramidal effects of other drugs
Tigan
tx of postop n/v and for nausea with gastronenteritis
Timolol (Timoptic)
tx of gluacoma
Bactrim
antibiotic
don’t take if allergy to sulfa drugs
diarrhea common side effect
drink plenty of fluids
Probenecide (Benemid)
tx gout
Colchicine
tx gout
Allopurinol (Zyloprim)
tx gout
Apresoline (Hydralazine)
tx of HTN or CHF
- report flu-like s/s
- rise slowly form sitting/lying position
- take with meals
Bentyl
tx of irritable bowel
- assess anticholinergic s/e
Calan (verapamil)
Ca channel blocker
tx of HTN, angina
assess for constipation
Carafate
(Sulcrafate)
tx of duodenal ulcers
coats the ulcers
take before meals!!
- S/E: constipation
Theophylline
tx of asthma or COPD
therapeutic level 10-20
- increases the risk of digoxin toxicity
- decreases the effectiveness of lithium and Dilantin
Mucomyst
antidote to tylenol administered orally
Diamox
tx of glaucoma, high altitude sickness
don’t take if allergy to sulfa drugs
- can cause hypokalemia
Indocin
(NSAID) tx of arthritis (osteo, rhematoid, gouty), bursitis, and tendonitis
Synthroid
tx of hypothyroidism
- make take several weeks to take effect
- notify MD of chest pain
- take in AM on empty stomach
- can cause hyperthyroidism
Librium
tx of alcohol withdrawal
- don’t take with alcohol
- very bad n/v
Oncovin (vincristine)
tx of leukemia
-given IV only
kwell
tx of scabies and lice
- apply lotion once and leave on for 8-12 hrs for scabies
- lice - use shampoo and leave on for 4 mins with hair uncovered and rinse with warm water and comb with a fine tooth comb
Premarin
tx after menopause, estrogen replacement
Dilantin
tx of seizures
therapeutic level 10-20
Navane
tx of schizophrenia
-assess for EPS
Ritalin
tx ADHD
- assess for heart related side effects report immediately
- may need drug holiday because stunts growth
dopamine (intropine)
tx of hypotension, shock, low cardiac output, poor perfusion to vital organs
-monitor EKG for arrhythmias, monitor BP
FHR patterns (remembering technique)
VEAL CHOP
V C
E H
A O
L P
V = variable decels; C = chord compression caused E = early decels; H = head compression caused A = accels; O = okay, no problem! L = late decels; P = placental insufficiency , can't fill
For cord compression
-place the mother in TRENDELENBERG position because this removes pressure of the presenting part off the cord
(the baby is no longer being pulled out of the body by gravity)
If prolapsed cord then
cover it with sterile saline gauze to prevent drying of the cord and to minimize infection
for late decels then
turn mother to her LEFT side to allow more blood flow to the placenta
for any kind of bad fetal heart rate pattern, you would
give O2 often by mask
with epidural anesthesia what is a priority before hand
hydration
hypotension, bradypnea/bradycardia in pregnancy are
major risks and emergencies
Never do what before assessing pt
check monitor or machine as first action
- always assess pt 1st
for example, if trying to decide to check mother or baby 1st and one answer involves a machine then it is a wrong answer
if baby is posterior presentation the sounds are heard
at both sides
if the baby is anterior the sounds are heard
closer to midline, between the umbilicus and where you would listen to a posterior present
if the baby is breech the sounds are
high up in the fundus near the umbilicus
if the baby is certex the sounds are
a little bit above the symphysis pubis
remembering ventilator alarms
HOLD
High alarm - Obstruction due to increased secretions, kink, pt coughs, gag or bites
Low pressure alarm - Disconnection or leak in ventilator or in pt airway cuff, pt stops spontaneous breathing
to remember blood sugar
hot and dry - sugar high
cold and clammy needs some candy - low sugar
ICP and shock have opposite vitals
ICP - increased BP, decreased pulse, increased respirations
shock - decreased BP, increased pulse, decreased respirations
cor pulmonae
right sided heart failure caused by left ventricular failure
(s/s: fluid overload - so edema, and JVD)
caused by pulmonary disease: bronchitis or emphysema
herion withdrawal neonate
irritable, poor sucking
Jews food
no meat and milk together
test child for lead poisoning around
12 months of age
potassium food
bananas, potatoes, citrus fruits
before starting IV antibiotics need
cultures
pt with leukemia may have
epitaxis because of low platelets
best way to warm a newborn
skin to skin contact covered with blanket on mom
when pt comes in that is in active labor 1st thing to do
listen to fetal heart tone/rate
phobic disorders use
systemic desensitization
with lower amputations pt is placed
in prone position
LPN cannot give what
blood
amynoglycosides cause
nephrotoxicity and ototoxicity
like vanco
IV push should never go over
2 mins
cardinal sign of ARDS
hypoxemia
ARDS (fluid in alveoli)
in pH regulation the 2 organs of concern
lungs/kidneys
edema is in the
interstital space not the cardiovascular space
biggest indicator of dehydration
weight
aspirin when given to children can cause
Reye’s syndrome (encephalopathy)
cold/heat for pain
cold - acute pain (sprain ankle)
heat - chronic (rheumatoid arthritis)
pneumonia s/s
fever and cils usually present
elderly - confusion
administering antibiotics
- always check for allergies before (especially PCN)
- make sure culture and sensitivity has been done before
COPD vs pneumonia
COPD is chronic
pneumonia is acute
emphysema and bronchitis are both
COPD
in COPD pts
the barorecptors that detect the CO2 level are destroyed
therefore, the O2 level must be low because high O2 concentration blows the pts stimulus for breathing
What kind of syringe for epi
TB syringe
exacerbation:
acute, distress
cushing’s syndrome
prednisone toxicity
buffalo hump, moon face, high glucose, hypertension
4 options for cancer management
chemo, radiation, surgery, allow to die with dignity
neutropenic precautions
no live vaccines, no fresh fruits, no flowers , NO MILK
chest tubes are placed in
the pleural space
angina vs. MI
angina - low oxygen to heart tissues (no dead heart tissues
MI - dead heart tissues present
mevacor
(anticholesterol med)
must be given with evening meal if it is QD (per day)
nitroglycerin
administered up to 3 times every 5 mins
if chest pain does not stop then go to hospital
- do not give when BP
preload
affects the amount of blood that goes into the R ventricle
afterload
is the resistance the blood has to overcome when leaving the heart
calcium channel blockers affect
the afterload
during CABG operation
the great saphenous vein is taken and turned inside out due to the valves that are inside
dead tissues of the heart cannot have
PVCs
untreated PVCs lead to
ventricular fibrillation
angiotension II in the lungs
angiotension II in the lungs
aldosterone attracts
sodium
reverse agent for heparin
protamine sulfate
reverse agent for coumadin
vitamin k
reverse agent for ammonia
lactulose
reverse agent for acetaminophen
n-Acetylcysteine
reverse agent for iron
deferoxamine
reverse agent for digoxin
digibind
reverse agent for alcohol withdraw
librium
methadone
opioid analgesic used to treat/detoxify pain in narcotic addicts
potassium does what to dig toxicity
potentiates
heparin prevents
platelet aggreation
what is elevated when pt on Coumadin
PT/PTT
cardiac output decreases with
dysryhtmias
dopamine increases
BP
med of choice for Vtach
lidocaine
med of choice for SVT is
adenosine or adenocard
med of choice for asystole
atropine
med of choice for CHG is
ace inhibitor
med of choice for anaphylactic shock
epinephrine
med of choice for status epilepticus is
valium
med of choice for bipolar
lithium
What is effective in both ventricular and atrial complications?
Amiodorone
S3 is normal in _____ but not normal in ____
S3 is normal in CHF but not normal in MI
When to give Carafate?
Carafate (GI med) is given before meals to coat stomach
Protonix
Given prophylactically to prevent stress ulcers
What type of line is TPN given through?
Given through subclavian line
Low residue diet means
Low fiber diet
Where is pain for diverticulitis
- (inflammation of the diverticulum in the colon)
- pain is around the LL quadrant
Where is appendicitis pain
- (inflammation of the appendix)
- pain is in RL quadrant with rebound tenderness
portal hypertension + albuminemia =
ascites
What produces insulin?
Beta cells of the pancreas
What is contraindicated in pancreatitis?
- morphine
- causes spasm of the sphincter of Oddi
- so give demerol
Trousseau and Tchovoski signs of
hypocalcemia
with chronic pancreaitis give what with meals
pancreatic enzymes
never give K+
in IV push
mineral corticoids are given in
Addison’s disease
DKA
diabetic ketoacidosis
- body breaking down fat instead of sugar for energy
- fats leave ketones (acids) that cause pH to decrease
- rare in DM type II because there is enough insulin to prevent breakdown of fats
sign of fat embolism
petechiae
- treated with heparin
fat embolism treated with
heparin
for knee replacement use a
continuous passive motion machine
give what before any invasive procedure
prophylatic antibiotic therapy
gluacoma pts lose
peripheral vision
- treated with meds
catarat =
cloudy, blurry vision
- treated by lens removal-surgery
CO2 causes
vasoconstriction
most spinal cord injuries are at
cervical or lumbar regions
autonomic dysreflexia
- life threatening inhibited sympathetic response of nervous system to a noxious stimulus - pts with spinal cord injuries at T-7
- usually caused by a full bladder
spinal shock occurs
immediately after spinal injury
multiple sclerosis =
chronic, progressive disease with demyelinating lesions in the CNA which affects the white matter of the brain and spinal cord
- myelin sheat destruction, disruption in nerve impulse conduction
- motor s/s: limb weakness, paralysis, slow speech
- sensory s/s: numbness, tingling, tinnitus
- cerebral s/s: nystagmus, ataxia, dysphagia, dysarthria
myasthenia gravis =
decrease in receptor sites of acetylocholine
- since smallest concentration of ACTH receptors are in cranial nerves, expect fatigue and weakness in eye, mastication, pharyngeal muscles
tensilon test
given if muscle are tense in myasthenia gravis
used to cofirm the diagnosis of myesthenia gravis
gullain-barre syndrome
ascending paralysis
- keep eye on respiratory system
parkinson’s
RAT
rigidity, akinesia (loss of muscle mvt), tremors
- treat with levodopa
TIA
(transient ischemic attack)
- mini stroke with no dead brain tissue
CVA
(cerebrovascular accident)
- dead brain tissue
Hodgkin’s disease
cancer of lymph is very curable in early stage
Rule of Nines for burns
Head and neck = 9% Each upper ext = 9% each lower extremity = 18% Front truck = 18% Back trunk = 18% Genitalia = 1%
birth weight doubles by
6 months, and triples by 1 year
do not give dig to children if
if heart rate is
first sign of cystic fibrosis
may be meconium ileus at birth
- baby is inconsolable, do not eat, and not passing meconium
cyanotic heart defects
3Ts - Tof, truncys arteriosus, transposition of the great vessels
- prevent blood from going to heart
- if not fix on on, or cannot be corrected surgically CHF will occur followed by death
right sided heart defects
look for valve problems
left sided heart defects in adults
look for coronary complications
rheumatic fever can lead to
cardiac valves malfunctions
cerebral palsy =
poor muscle control due to birth injuries and/or decrease oxygen to brain tissues
ICP should be
dilantin level
10-20
can cause gingival herplasia
for meningitis check
for kernig’s/brudzinski’s sings
wilms tumor
above the kidneys causing flank pain
hemophilia is
x-linked
-mother passes disease to son
when phenylalanine increases
brain problems occur
Buck’s traction =
knee immobility
Russell traction =
femur or lower leg
Dunlap traction =
skeletal or skin
Bryant’s traction =
children
when putting on traction
place apparatus first then place the weight
placenta should be in
upper part of the uterus
eclampsia is
seizure
a pt with a vertical c-section surgery will be more likely to
have another c-section
perform amniocentesis
before 20 weeks gestation to check for cardiac and pulmonary abnormalities
Rh- mothers recieve
rhogam to protect next baby
anterior fontanelles close
by 18 mo
posterior fontanelles close
6-8 weeks
caput succedaneum =
diffuse edema of the fetal scalp that crosses the suture lines
- swelling reabsorbs within 1-3 days
pathological jaundice =
occurs before 24 hrs and last 7 days
physiological jaundice =
occurs after 24 hrs
placenta previa =
- there is no pain
- there is bleeding
placenta abruption =
pain, but no bleeding
bethamethasone
(celestone) = surfactant
- med for lung expansion
dystocia =
baby cannot make it down to canal
pitocin
med used for uterine stimulation
magnesium sulfate
- used to halt preterm labor
- contraindicated if deep tendon reflexes are ineffective
- if pt experiences seizure during magnesium administration get the baby out STAT
do not use what statements when dealing with pts
why or I understand
milieu therapy -
taking care of pt/environment
cognitive therapy -
counseling
crisis intervention -
short term
5 interventions for psych pts
- safety
- setting limits
- establishing a trusting relationship
- meds
- less restrictive methods/environment
SSRI’s
antidepressants
take 3 weeks to work
Obsession vs. Compulsion
obsession - is to thought
compulsion - is to action
if pt having hallucinations
redirect them
if pt having delusions
distract them
Thorazine
(haldol) - antipsychotic
- can lead to EPS (extrapyramidal side effects)
Alzheimer’s disease
chronic, progressive, degenerative, cognitive disorder that accounts for more than 60% of all dementias
drawing up insulin
(Nicole Richey, RN)
air into NPH, air into regular, then draw up regular then draw up NPH
HYPERthyroidism
(Michael Jackson thriller)
skinny, nervous, bulging eyes, up all night, heart beating fast
atropine
used to decreased secretions
phenergan
antiemetic used to reduce nausea
diazepam
commonly used tranquilizer given to reduce anxiety before OR
Demoral
pain control
- do not give to sickle cell crisis
Do not give demoral to
sickle cell crisis
give iron IM
z track
so they don’t leak into SQ tissues
Heart valves assessment
(all people eat too much)
Aorta - 2nd intercostal space right sternal border
Pulmonic - 2nd intercostal space left sternal border
Erbs point - 3rd intercostal space left sternal border
Tricuspid - 4th intercostal space left sternal border
Mitral - 5th intercostal space midclavicular line
Cranial nerves
(S = sensory, M = motor, B = both)
I Olfactoary Some II Optic Say III Oculomotor Marry IV Trochlear Money V Trigeminal But VI Abducens My VII Facial Brother VIII Acoustic Says IX Glossopharyngeal Big X Vagus Brain XI Spinal accessory Matter XII Hypoglossal More
(Oh, Oh, Oh, To Touch And Feel A Girls Vagina, AHH, Heaven)
Hypernatremia
greater than 145 think salt: Skin flushed Agitation Low grade fever Thirst
at 2-3 months developmental
turns head side to side
at 4-5 months developmental
grasps, switch and roll
at 6-7 months developmental
sit at 6 and wave bye-bye
at 8-9 months developmental
stands STRAIGHT at EIGHT
at 10-11 months developmental
belly to butt
at 12-13 months developmental
twelve and up, drink from a cup
Hepatitis
Hep A - ends in a VOWEL comes from the BOWEL
Hep B - blood and body fluids
Hep C - blood and body fluids
Glasgow coma scale
Max 15
below 8 your in a coma!!
Eyes - open spontaneously and uses them correctly to see then 4, if you have to yell then 3, if don’t open them to pain then 1
Verbal - if orientated then 4, confused 3, inappropriate words 3, incomprehensible sounds 2, no verbal 1
Motor - good moves then 6
the person who hyperventilates will experience
respiratory alkalosis
avoid what when taking dig and k-supplements
salt substitutes - potassium based
signs of hypoxia
restless, anxious, cyanotic tachycardia, increased respirations
- monitor ABGs
precautions for herpes zoster
disseminated herpes zoster - airborne
localized herpes zoster - contact
- nurse with localized herpes zoster can care for pt as long as the pts are not immunosuppressed and the lesions must be covered!!
fat soluble vitamins
A, D, E, K
drugs given with food
NSAIDS, corticosteroids, drugs for bipolar, cephalosporins, and slufanomides
tx of choice for status epilepticus
ativan
when using bronchodilator inhaler in conjunction with a glucocorticoid inhaler admin which on first
bronchodilator 1st
Intal
inhaler used to tx allergy induced asthma may cause bronchospasm
- think! INto asthmatic lung
Isoniazed
causes peripheral neuritis
peptic ulcers caused by H. plyori
- tx with Flagyl, Prilosec, and Biaxin
- tx kills bacteria and stops production of stomach acid, but does not heal ulcer
weighted NI
(Naso intestinal tubes)
- must float from stomach to intestine
- don’t tape tube right after placement, may leave coiled next to pt on HOB
- position pt on RIGHT to facilitate movement through the pylorus
Diaphragm birth control
- must stay in place 6 hrs after intercourse
- fitted and must be refitted if you lose or gain weight
Best time to take growth hormone
PM
Best time to take steroids
AM
Best time to take diuretics
AM
Best time to take aricept
AM
Tagamet
H2
- take with food
- messes with elderly because interacts with a lot of things!!
take antacids when
after meals
long term use of amphojel
binds to phosphates, increases Ca, robs the bones - leads to increased Ca resortion from bones = WEAK BONES
Cushings ulcers r/t
BRAIN injury
Cushings triad r/t
ICP in BRAIN (htn, bradycardia, irregular resps)
Thyroid storm temp
HOT - hyperthermia
Myxedema coma temp
COLD - hypothermia
Glaucoma
intraocular pressure is greater than normal (22 mm Hg)
- give miotics to constrict (pilocarpine)
- NO ATROPINE
non dairy sources of calcium
Rhubarb, sardines, collard greens
to avoid skin irritation with plaster cast
petal the rough edges with tape
To relieve low back aches
bend knees
push fluids with Allopurinol to
flush the uric acid out of system
koplick’s spots
red spots with blue center characteristic of PRODROMAL stage of Measles, usually in mouth
INH can cause
peripheral neuritis, take vit B6 to prevent also hepatotoxic
Rifampin
for TB
- Red/orange tears and urine!
- contraceptives don’t work as well
Ethambutol s/e
messes with your Eyes
applying eye drops
- apply to conjunctival sac
- afterwards apply pressure to nasolacrimal duct/inner canthus
for pancreatitis pts
put them in fetal position
NPO - let gut rest
get ready for PICC because will get TPN/LIPIDS
trendelenburg test
for varicose veins, if they fill proximally = varicosity
when giving kayexalate need to worry about
dehydration!!
K has inverse relationship with Na
yogurt has live cultures so don’t give to
immunosuppressed pt
for itching under cast area
cool air via blow dryer
ice pack for 10-15 mins
NEVER use qtip or anything to scratch area
Murphy’s sign -
pain with palpation of gall bladder area seen with cholecystitis
Cullen’s sign -
ecchymosis in umbilical area, seen with pancreatitis
Turner’s sign -
flank grayish blue (turn around to see your flanks)
pancreatitis
McBurney’s pint -
pain in RLQ indiciative of appendicitis
pain in LLQ -
diverticulitis, low residue, no seeds, nuts, peas
pain in RLQ -
appendicitis, watch for peritonitis
Gurthrie Test -
tests for PKU, baby should have eaten source of protein first
Shilling Test -
How well one absorbs Vit B12
test for pernicious anemia
Allen’s test -
- do prior to doing and ABG to check for sufficient
- occlude both ulnar and radial artery until hand blanches then release ulnar
- if the hand pinks up, ulnar artery is good and you can carry on with ABG/radial stick as planned
Peritoneal Dialysis cath (tenkhoff) ok if
abdominal cramps, blood tinged outflow and leaking around site; if cath was placed in last 1-2 weeks
NEVER normal for tenkhoff
(peritoneal dialysis) CLOUDY outflow
amniotic fluid yellow with particles =
meconium stained
hyper reflexes
- upper motor neuron issue
“your reflexes are over the top”
absent reflexes
- lower motor neuron issue
Rhogam
given at 28 weeks, 72 hrs post partum, IM
only given to Rh NEGATIVE mothers
- only give if negative Coomb’s test - if indirect Coomb’s test is positive don’t need Rhogam because she has antibody
Magnesium sulfate antidote
Calcium gluconate
Acetaminophen antidote
Mucomyst
TPA antidote
(given for blood clot/stroke)
Amicar
Order of assessment:
Inspection, Palpation, percussion, Auscultation
Except with abdomen! (Inspect, ausculate, percuss, then palpate (same with kids)
To assess for latex allergies ask if allergic to
bananas, apricots, cherries, grapes, kiwis, passion fruit, avocados, chestnuts, tomatoes, peaches
Amyotrophic lateral scleorsis
(ALS) degeneration of motor neurons in both the upper & lower motor neuron systems
Transesopheal Fistula (TEF)
esophagus doesn’t fully develop
surgical emergency!!
the 3 C’s of TEF in newborn
- choking
- coughing
- cyanosis
MMR vaccine is given what route
SQ not IM
Diaster colors
Red - unstable, ie occluded airway, actively bleeding, see first
Yellow - stable, can wait up to an hour for treatment, ie burns, see second
Green - stable, can wait even longer to be seen, “walking wounded”
Black - unstable pts that will probably not make it, need comfort measures
DOA - dead on arrival
Creek heritage with babies
put an amulet or protective charms around baby’s neck to avoid “evil eye” or envy of others
4 year old kids cannot interpret
TIME
need to explain time in relationship to a known common event
“mom will be back after supper”
contraindication for Hep B vaccine
anaphylactic reaction to baker’s yeast
Ask for allergy to what before flu shot?
eggs
Ask if what before MMR
anaphylactic reaction to eggs or neomycin
When on nitroprusside monitor
thiocynate (Cyanide)
- normal value should be 1 if greater than 1 heading towards toxicity
if a kid has a cold what about immunizations
can still give
SARS isolation
(severe acute resp syndrome)
airbone + contact (just like caricella)
hepatitis A precautions
contact precautions
Standard precautions
Tetanus, Hepatitis B, HIV
William’s position
semi fowlers with knees flexed to relieve lower back pain
Signs of a fractured hip
external rotation, shortening, adduction
fat embolism s/s
blood tinged sputum (r/t inflammation), increased ESR, respiratory alkalosis (r/t tachypnea), hypocalcemia, increased serum lipids, “snow storm” effect on CXR
Complications of mechanical ventilation
pneumothorax, ulcers
Paget’s disease
tinnitus, bone pain, enlargement of bone, thick bones
No what with allopurinol
vitamin C
IVP requires
bowl prep so they can visualize the bladder better
Acid Ash diet -
cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread
Alk Ash diet -
milk, veggies, rhubarb, salmon
orange tag in triage is
non emergent psych
Greenstick fractures
usually seen in kids
bone breaks on one side and bends on the other
Insomnia is a side effect of
thyroid hormones - increased met rate, body is too busy to sleep
(hypothyroidism report somnolence - decreased met rate, body is slow and sleepy)
tx for strabismus
(Cross-eyed)
Botox
patch the good eye so that the weaker eye can get stronger
Tidal volume
7-10 ml/kg
COPD pts on oxygen
remember 2L NC or less (Hypoxic NOT hypercapnic drive), PaO2 of 60ish and SaO2 90% is normal for them because they are chronic CO2 retainers
Use what to reverse effect of pancuronium
Neostigmine/Atropine (anticholinergic)
Ampho B causes
hypokalemia
- gotta premedicate before giving, pts will most likely get a fever
Before the administration of asparginase
test for hypersensitivity
Take what with high fat diet
Vermox (increases absorption)
kidney glucose threshold is
180
Amphogel and Renegal take
with meals
stranger anxiety is greatest
7-9 months
separation anxiety peaks in
toddlerhood
What is best for asthma and arthritis
swimming
If asthma has intercostal retractions
be concerned
Tardive Dyskinesia
- irreversible, involuntary movements of the tongue, face, and extremities
- may happen after prolonged use of antipsychotics
Akathisia
motor restlessness, need to keep going
- tx with antiParkinson meds, can be mistaken for agitation
When drawing ABG
put blood in a heparinized tube, make sure no bubbles, put on ice immediately after drawing, with a label indicated if the pt was on room air or how many liters of O2
Before a pulmonary function test
a pt’s bronchodilator will be with-held and they are not allowed to smoke for 4 hrs prior
For a lung biopsy
position pt lying on side of bed or with arms raised on pillows over bedside table, have pt hold breath in mid expiration
- chest xray done immediately afterwards to check for complication of pneumothroax
- sterile dressing applied
For lumbar puncture
pt position in lateral recumbent fetal position, keep pt flat for 2-3 hrs afterwards, sterile dressing, frequent neuro assessments
For EEG
hold meds for 24-48 hrs prior, no caffeine or cigarettes or stimulants for 24 hrs prior, pt can eat, pt must stay awake night before exam, pt may be asked to hyperventilate for 3-4 mins and watch a bright flashing light
- after EEG assess for seizures, pts will be at increased risk
Dexedrine
- used for ADHD
- may alter insulin needs
- avoid taking with MAOI’s
- take in morning (insomnia possible side effect)
Cytovene
- used for retinitis caused by cytomegalovirus
- pt will need regular eye exams
- report dizziness, confusion, or seizures immediately
INH
- used to tx and prevent TB
- do not give with dilantin
- can cause phenytonin toxicity
- monitor LFT’s
- give B6 along with
- hypotension will occur initially then resolve
When mixing antipsychotics with fluids (Haldol, Throazine, Prolixin)
incompatible with caffeine and apple juice
preferred anti-psychotic in elderly
Haldol
- but high risk extrapyramidal s/e (Dystonia, tarditive dyskinesia, tightening of jaw, stiff neck, swollen tongue - swollen airway)
- monitor for early s/s of reaction and give IM Benadryl
Risperdal
antipsychotic
- doses over 6mg can cause tarditive dyskinesia
- first line antipsychotic in children
Levodopa
- tx parkinsons
- contraindicated in pts with glaucoma, avoid B6
Sinemet
- tx parkinsons
- contraindicated with MAOI’s
Hydroxyurea
for sickle cell
- report GI symptoms immediately
- could be signs of toxicity
Zocor
for hyperlipidemia
- take on empty stomach to enhance absorption
- report any unexplained muscle pain, especially if fever
Decorticate vs. Decerebrit
Decorticate - towards the core (cortex involvement)
Decerebrit - the other way ( out) (cerebellar, brain stem involvement)
Botulin Toxin
(Botox) used with strabismus also to relax vocal cords in spasmodic dysphoria
Muchausen Syndrome
is a psychiatric disorder that causes an individual to self-inflict injury or illness or to fabricate symptoms of physical or mental illness in order to receive medical care or hospitalization
Muchausen by proxy (MSBP)
individual (typically mother) intentionally causes or fabricates illness in child or other person under care
Huntington’s Chorea
50% genetic, autosomal dominant disorder
- s/s: chorea - writhing, twisting, movements of face, limbs, and body
- gait deteriorates to no ambulation
- no cure, just palliative care
WBCs and pyelonephritis
(kidney infection) WBC shift to the left, neutrophils kick in to fight infection
Definitive diagnosis for abdominal aortic aneurysm
CT scan
Don’t use Kayexalate if
pt has hypoactive bowel sounds
Uremic fetor
smell urine on the breath
Hirschsprung’s
- bile is lower obstruction, no bile is upper obstruction
- ribbon like stools
When to take pancreatic enzymes
WITH each meal, not before or after
Can’t eat what before occult blood test
- cantaloupe - high in vitamin C and vit C causes false positive
Hypospadias
- abnormality in which the urethral meatus is located on the ventral (back) surface of the penis anywhere from the corona to the perineum
- remember hypo, low (lower side or underside)
Epispadias
opening of the urethra on the dorsal (front) surface of the penis
Priapism
painful erection lasting longer than 6 hrs
Anticholinergic effects assessment
- dry mouth - can’t spit
- urinary retention - can’t piss
- constipated - can’t s***
- blurred vision - can’t see
When see coffee brown emesis think
peptic ulcer
Anytime see fluid retention think
heart problems first
an answer that delays care or tx then
is always wrong
For peripheral vascular disease …
legs dependent for arterial and veins elevated
Never release traction unless
have an order form the MD to do so
If a question is about a halo then
safety first have screwdriver close by!
Compartment syndrome
emergency!
- paresthesias and increased pain are classic symptoms
- neuromuscular damage is irreversible 4-6 hrs after onset
Infancy (0-18mo) behavior motivated by
others will satisfy needs
Childhood behavior motivated by
learn to delay need gratification
Juvenile (6-9) behavior motivated by
learn to relate to peers
Preadolescence (9-12) behavior motivated by
learns to relate to friends of opposite sex
Early adolescence (12-14) behavior motivated by
learn independence and how to relate to opposite sex
Late adolescence (14-21) behavior motivated by
develop intimate relationship with person of opposite sex
fetal alcohol syndrome s/s
upturned nose
flat nasal bridge
thin upper lip
small for gestational age
IM admin site for 6 mo infants
vastus lateralis
IM admin site for toddlers above 18 mo
ventrogluteal
Im admin site for children
deltoid and gluteus maxims
OU
both eyes
OS
left eye
OD
right eye (think dominant right eye)
walking with a cane
(remember coal)
Cane Opposite Affected Leg
Red injuries
Immediate: injuries are life threatening but survivable with minimal intervention
Ex. hemothorax, tension pneumothorax, unstable chest and abdominal wounds, INCOMPLETE amputations, OPEN fractures of long bones, 2nd/3rd degree burn with 15-40% of total body surface
Green injuries
Minimal: injuries are minor and tx can be delayed to hrs or days, individuals should be moved away from teh main triage area
Ex. upper extremity fx, minor burns, sprains, small lacerations, behavior disorders
Black injuries
Expectant: injuries are extensive and chances of survival are unlikely, separate but don’t abandoned, comfort measures if possible
Ex. unresponsive, spinal cord injuries, burns with 60% body surface area, seizures, profound shock with multiple injuries, no pulse, bp pupils fixe or dilated
Thoracentesis prep
- take VS
- shave area around needle insertion
- position pt with arms on pillow over bed table or lying on side
- no more than 1000cc at one time
Thoracentesis post -
- listen for bilateral breath sounds
- VS
- check leakage
- sterile dressing
Before CT assess for
allergies
Before MRI assess for
claustrophobia, no metal, assess pacemaker
Cardiac cath prep
- NPO 8-12 hrs
- empty bladder
- check pulses
- tell pt may feel heart palpitations or desire to cough with dye injections
Cardiac cath post
- vital signs
- keep leg straight
- bedrest 6-8 hrs
cerebral angio prep
- well hydrated
- lie flat
- sire shave
- pulses marked
cerebral angio post -
- keep flat 12-14 hrs
- check site
- check pulses
- force fluids
Lumbar puncture
- fetal position
- neuro assessment q15-30 mins until stable
- flat 2-3 hr
- encourage fluids
- oral analgesics for headache
- observe dressing
Myelogram prep
- NPO 4-6 hrs
- allergy hx
- phenothiazines, CNS depressants, and stimulants withheld 48 hrs prior
- table will be moved to carious positions during test
Myelogram post
- assess neuro q2-4 hrs
- water soluble HOB up, oil soluble HOB down
- oral analgesics for h/a
- encourage PO fluids
- assess for distended bladder
- inspect site
liver biopsy prep
- admin vitamin K
- NPO 6 hrs
- teach pt that will be asked to hold breath for 5-10 seconds
- supine postion, lateral with upper arms elevated
liver biopsy pot
- position on right side
- frequent VS
- report severe abdominal pain stat!!
- no heavy lifting 1 week
Paracentesis prep
- semi fowlers or upright edge of bed
- empty bladder
Paracentesis pot
- VS
- report elevated temp
- observe for signs of hypovolemia
laparoscopy prep
CO2 used to enhance visual, general anesthesia foley
- post: walk pt to decrease CO2 build up for procedure
pyelogram prep
assess for allergies
Sengstaken Blakemore tube used
for tx of esophageal varices
- keep scissors at bedside!!
TB key symptom
low grade afternoon fever
pneumonia key symptom
rusty sputum
Asthma key symptom
wheezing on expiration
Emphysema key symptom
barrel chest
Kawaski syndrome key symptom
strawberry tongue
Pernicious anemia key symptom
red beefy tongue
Down syndrome key symptom
protruding tongue
Cholera key symptom
rice watery stool
Malaria key symptom
stepladder like fever with chills
Typhoid key symptom
rose spots in abdomen
Diptheria key symptom
pseudo membrane formation
Measles key symptom
koplik’s spots
Lupus key symptom
butterfly rash
Liver cirrhosis key symptom
spider like varices
Leprosy key symptom
lioning face
Bulimia key symptom
chipmunk face
Appendicitis key symptom
rebound tenderness
Dengue key symptom
petechiae or positive herman’s sign
Menigitis key symptom
Kernig's sign (leg flex then leg pain on extension) Brudzinski sign (neck flex = lower leg flex)
Tetany key symptom
hypocalemia;
Trousseau’s sign/carpopedal spasm; Chvostek sign (facial spams)
Tetanus key symptom
rius sardonicus
Pancreatitis key symptom
Cullen’s sign (ecchymosis of umbilicus); Grey turner’s spots
Pyloric stenosis key symptom
olive like mass
Patent ductus arteriosus key symptom
machine like murmur
Addison’s disease key symptom
bronze like skin pigmentation
Cushing’s syndrome key symptom
moon face appearance and buffalo hump
Hyperthyroidism/Grave’s disease key symptom
exopthalmuse
Intussusception key symptom
sausage shaped mass, Dance sign (empty portion of RLQ)
MS key symptom
Charcot’s Triad (IAN)
hyperactive deep tendon reflexes, vision changes, fatigue and spasticity
MG key symptom
Descending muscle weakness
Gullain Barre key symptom
ascending muscle weakness
DVT key symptom
Homan’s Sign
Chicken pox key symptom
Vesicular Rash (central to distal) dew drop on rose petal
Angina key symptom
crushing stubbing pain relieved by NTG
MI key symptom
crushing stubbing pain which radiates to left shoulder, neck, arms, unrelieved by NTG
LTB key symptom
inspiratory stridor
TEF key symptoms
4Cs - coughing, choking, cyanosis, continuos drooling
Epiglotitis key symptom
3Ds - drooling, dysphonia, dysphagia
Hodgekin’s DSE/Lumphoma key symptom
painless, progressive enlargement of spleen & lymph tissues, Reedstenberg Cells
Infectious Monoucleosis key symptoms
sore throat, cervical lymph, adenopathy, fever
Parkinson’s key symptom
pill-rolling tremors
Fibrin Hyalin key symptom
expiratory grunt
Cystic fibrosis key symptom
salty skin
DM key symptoms
polyuria, polydypsia, polyphagia
DKA key symptom
Kussmauls breathing (deep rapid RR)
Bladder Ca key symptom
Painless hematuria
BPH key symptom
reduced size and force of urine
Pemphigus Vulgaris key symptom
Nikolsky’s signs (separation of epidermis caused by rubbing of the skin)
Retinal Detachment key symptom
visual floaters, flashes of light, curtain vision
Glaucoma key symptom
painful vision loss, tunnel/gun barrel/ halo vision (peripheral vision loss)
Cataract key symptom
painless vision loss, opacity of the lens, blurring of vision
Acromegaly key symptom
coarse facial feature
Duchenne’s Muscular Dystrophy key symptom
Gower/s sign (use of hands to push one’s self from the floor)
GERD key symptom
Barretts esophagus (erosion of the lower portion of the esophageal mucosa)
Hepatic Encephalopathy key symptom
flappy tremors
Hydrocephalus key symptom
Bossing sign (prominent forehead)
Increased ICP key symptoms
HYPERtension, BRADYpnea, BRADYcardia, (chushing’s triad)
Shock key symptoms
HYPOtension, TACHYpnea, TACHYcardia
Meniere’s Disease key symptom
Vertigo, Tinnitus
Cystitis key symptom
Burning on urination
Hypocalemia key symptoms
Chvostek & Trosseaus
Ulcerative Colitis key symptom
recurrent bloddy diarrhea
Lyme’s Disease key symptom
Bull’s eye rash
otorrhea sign of what kind of fracture
basilar fracture
orbital fracture s/s
battles sign and raccoon eyes
Take iron elixir with
juice or water
NEVER with milk
Kawaski’s leads to
cardiac problems
- coronary artery aneurysm r/t the inflammation of blood vessels
Dilantin
10-20
Theophyline
10-20
Acetaminophen
10-20
Lithium
0.5-1.5
Digoxin
0.5-2.0
Ostemyletitis
infectious bone disease
- give blood cultures and antibiotics
- if necessary surgery to drain abscess
Nephrotic syndrome
characterized by massive PROTEINURIA (looks dark and frothy) caused by glomerular damage
- s/s edema + hypotension
- corticosteroids are mainstay
- turn and reposition (risk for impaired skin integrity)
To access role relationship pattern focus on
image and relationships with others
Labs for renal impairment
elevated serum creatinine and decreased urine clearance
normal serum creatinine
men 0.8-1.8
women 0.5-1.5
Atropine Overdose
Hot as a hare (TEMP), mad as a hatter (LOC), red as a beet (FLUSHED FACE), dry as a bone (THIRSTY)
normal hemoglobin neonates
18-27
normal hemoglobin 3 mos
10.6-16.5
normal hemoglobin 3 years
9.4-15.5
normal hemoglobin 10 years
10.7-15.5
glomerulonephritis
- take vitals q4
- daily wts
vaccines for age 4-5 years old
DPT/MMR/OPV
cystic fibrosis tx
- low fat diet, high sodium, fat soluble vitamins ADEK, aerosol bronchodilators, mucolytics, and pancreatic enzymes
Zoloft s/e
agitation, sleep disturbance, and dry mouth
Clozapine s/e
agranulocytosis, tachycardia, and siezures
Blood tests for MI
Myoglobin, CK and Troponin
salt substitutes may contain
potassium
Placental abruptio
bleeding with pain
- don’t forget to monitor volume status (I&O)
Meningeal irritation s/s
nuchal rigidity, positive Brudzinski + kernig signs, PHTOTPHOBIA
Babinski sign
toes curl — GREAT!
toes fan — BAD!
glucose tolerance test for pregnancy women
result of 140 or higher needs further evaluation
Assessing extra ocular eye movements check cranial nerves
3,4, and 6
dusky stoma means
poor blood supply
protruding stoma means
prolapsed
sharp pain and rigidity with stoma means
peritonitis
mucus in ileal condult with stomas
is expected
Dilantin s/e
- rash (Stop med)
- gingival hyperplasia (good hygiene)
Dilantin toxicity
poor gait and coordination, slurred speech, nausea, lethargy, and diplopia
Phenobarbital vs. Dilatin during pregnancy
Phenobarbital can be taken during pregnancy but Dilatin is contraindicated
Tension pneumothorax trachea
shifts to opposite side
change in color is always
a late sign
amininoglycocide s/e
(MYCIN) (except erythromycine)
- nephrotoxic to kidneys and ototoxic to ears
MRSA precautions
contact only
VRSA precautions
contact AND airborne (private room, door closed, negative pressure)
lithium
L-level of therapeutic affect 0.5-1.5
I - indicate mania
T - toxic level is 2-3 - N/V, diarrhea, tremors
I - increased UO and dry mouth
U - uh oh - five mannitol and Diamox if toxic s/s are present
M - maintain Na intake of 2-3g
Blood transfusion sign of allergies
- flank pain
- frequent swallowing
- rashes
- fever
- chills
All psych meds (except Lithium) same side effects
decreased BP, Increased HR and RR (dilated bronchioles), dilated pupils (blurred vision), Decreased gut (urinary retention), GIT (constipation), constricted blood vessels, and dry mouth
thrombocytopenia - bleeding precautions
- soft bristled toothbrush
- no insertion of anything (suppositories, douche)
- no IM meds
PO iron give with
vitamin C or on empty stomach
pernicious anemia will take what for life
Vitamin B12
Degree of burns
1st degree - red and painful
2nd degree - blisters
3rd degree - no pain because of blocked and burned nerves
Meniere’s disease
- admin diuretics to decrease endolymph in the cochlea, restrict Na, lay on affected ear when in bed
- triad: vertigo, tinnitus, N/V
gastric ulcer pain
occurs 30 mins to 90 mins after eating, not at night, and doesn’t go away with food
What is an intraosseous infusion?
IN pediatric life threatening emergencies, when iv access cannot be obtained, an osseous (Bone) needle is hand drilled into a bone (usually the tibia), where crystalloids, colloids, blood products and drugs can be administered into the marrow
- is temporary, life saving measure,
- when venous access is achieved it can be dced
- isoproterenol (beta agonist) only med that cannot be administered
2 interventions during a sickle cell crisis
fluids and pain relief
glomerulonephritis should consider what to be most important assessment
blood pressure
- dietary restrictions fluids, protein, sodium, and potassium
congenital cardiac defects result in
hypoxia
- labs that support - increased hamatocrit, hemoglobin, and rbc count
- body tries to compensate for with influx of immatures rbcs
if infant has low set ears assess
for renal anomalies
think kidney and ears are shaped the same
school aged kids and surgery
kids 5 and up should have explanation of what will happen a week before surgery
What to do if a toddler says no to medicine
leave and come back in five mins, don’t give a choice
first sign of pyloric stenosis in a baby
- mild vomiting that progresses to projecting vomiting
- later may be able to palpate a mass, the baby will seem hungry often, and may spit up after feedings
a child with a ventriculoperitoneal shunt
- will have small upper-abdominal incision - where shunt is guided into the abdominal cavity and tunneled under the skin up to the ventricles
- watch for abdominal distention - since fluid from the ventricles will be redirected to the peritoneum
- watch for signs of increasing ICP such as irritability, bulging fontanels, and hight pitched cry in infant; toddler watch lack of appetite and headache
bed placement after child with ventriculoperitoneal shunt
FLAT!
- so fluid doesn’t reduce too rapidly
- if see s/s of increasing ICP then raise HOB 15-30 degrees
What causes bronchopulmonary dysplasia?
- dysplasia - abnormality or alteration
- mechanical ventilation can cause it
- premature newborns with immature lungs are ventilated and over time it damages the lungs
- other causes could be infection, pneumonia, or other conditions that cause inflammation or scarring
it is essential to maintain nasal patency with children
they are obligatory nasal breathers
kids drinking 3-4 cups of milk each day
bad! too much milk reduces intake of other essential nutrients, especially iron
- watch for anemia with milkaholics!!
what can go in kids bottles for naps/overnight
nothing but water!!
- juice or milk will rott teeth
What traction is used in a school aged kid with a femur or tibial fracture with extensive skin damage?
99
- angles of the joints, pin is placed in the distal part of the broken bone, and the lower extremity is in a boot cast
Bryant’s traction for kids
a kid’s hinder should clear the bed
white patches from the mouth of a baby
- if can remove then its just formula
- if cant remove then its candidiasis
What vaccines come later
MMR and Varicella immunizations (15 mo)
Cryptorchidism
undescended tesis
- risk factor for testicular cancer later in life
teach boys testicular self exam starts when
12, because most cases of testicular cancer occur during adolescence
Give what pain relief med to kids
Tylenol!!
- aspirin is associated with Reye’s syndrome - no NSAIDS (ibuprofen)
CSF in meningitis will have
high protein and low glucose
when thinking about child abuse
always correct to report suspected abuse
No nasotracheal suctioning in kids with
with head injury or skull fracture
feed babies upright to avoid
otitis media
position kids how with GERD
prone with HOB elevated
- everyone else lay kid on his bac (Back to sleep - SIDS)
when installing eardrops for kids
pull pinna down adn back
kids with RSV and nurses
no contact lenses or pregnant nurses in rooms where ribavirin is being administered by hoot/tent
ribavirin
for RSV
- no contact lenses or pregnant nurses in rooms where ribavirin is being administered by hoot/tent
positioning with pneumonia for kids
lay on the affected side to splint and reduce pain
- if trying to reduce congestion the sick lung goes up (think stuffy nose side goes up and then it clears)
a positive ppd confirms
infection, not just exposure
a sputum test will confirm
active disease
kids coughing withou other s/s is suggestive of
asthma
- know if wheezer stops wheezing could mean its worsening
Before administering dig
DO VITALS
apical pulse for one full minute
Tet spells treated with
morphine
group a strep precedes
rheumatic fever
- chorea is part of the sickness (grimacing, sudden body movements) embarrasses kids
- they have joint pain
- watch for elevated antistreptolysin O to be elevated
- Penicillin!!
Signs of CHF in infant
don’t pick cough over TACHYCARDIA
tylenol poisoning
liver failure possible for about 4 days!
- close observation required during this time frame as well as tx with Mucomyst
radioactive iodine
- key word FLUSH
- flush substance out of body w/ 3-4 liters/day for 2 days
- flush the toilet twice after using for 2 days
- limit contact w/ pt to 30 mins a day
- no pregnant visitors and no kids
main hypersensitivity reaction seen with anti platelet drugs
bronchospasm (anaphylaxis)
common sites for metastasis
liver, brain, lung, bone, and lymph
orthostatisis is verified by
a drop in pressure with increasing heart rate
Bence jones protein in the urine confirms
multiple myeloma
priority with small bowel obstruction
not reestablishing a normal bowel pattern
maintaining fluid balance!! comes first because the pt can’t take in oral fluids
pernicious anemia s/s
pallor, tachycardia, and sore red tongue
flecainide (Tambocor)
antiarrythmic
- limit fluids and sodium intake - because Na increases water retention which could lead to heart failure
Basophils release histamine during
an allergic response
adenosine
the tx of choice for paroxysmal atrial TACHYCARDIA
Iatragenic means
caused by tx, procedure, or meds
G-tube and J-tube
usually given as a continuous feeding
If pt getting radiation be most concerned about?
not skin but infection because of the leukopenia caused by radiation
breast cancer pt tx with tamoxifen should report
changes in visual acuity because adverse effect could be irreversible
Pneumovax 23 gets administered
post splenectomy to prevent pneumoccal sepsis
potassium normal value
3.5-5.0
if pt on dig and lasix make sure
getting enough potassium because low potassium potentiates dig and can cause dysrhythmias
ask every new admission if
they have an advanced directive
if not then explain it and ask if they want to sign it
if someone is going through anaphylaxis then
implement before assess
- give epinephrine stat (especially if difficulty breathing, increasing anxiety )
if disaster triage who last
the person who is most likely to not survive
Potassium and alkalosis/acidosis
alKaLOsis - K is LOW
acidosis - k is high
vital sign you should check first with high potassium is
pulse (due to dysrhythmias)
Neostigmine
- give to pts with myesthenia gravis about 45 mins before eating so it will help with chewing and swallowing
Anectine
used for SHORT term neuromuscular blocking agent for procedures like intubation and ECT
Norcuron
used for LONG term neuromuscular blocking agent for procedures like intubation and ECT
parathyroid gland relies on
vitamin D to work
Immediate intervention after a sucking stab wound
dress the wound and tape it on 3 sides which allows air to escape
- do not use occlusive dressing - converts the wound from open pneumo to closed one, and a tension pneumothorax is a worse situation
- after that then chest tube tray, labs, iv
when is an occlusive dressing used
if chest tube is accidentally pulled out
When see PE think
oxygen first!!
- when O2 is deprived the body compensates by causing hyperventilation (resp alkalosis)
- pt should not breathe into a paper bag)
- if paO2 is well below 80 need OXYGEN
- look at ABG values
adverse reaction to oral hypoglycemics
rash
photosensitivity
serum acetone and serum ketones ris in
DKA
- as treat the acidosis and dehydration expect the potassium to drop rapidly so be ready with potassium replacement
fluids most important intervention with
HHNS as well as DKA
- with HHNS no ketosis, and no acidosis, potassium is low r/t diuresis
Atropine blocks
acetylcholine
it reduces secretions
Dantrium
for spasticity
may take WEEK to be effective
Decreased acetycholine is r/t
senile dementia
after removal of the pituitary gland must
watch for hypocortisolism and temporary diabetes insipidus
position how after appendectomy
on right side with legs flexed
Hirschsprung’s
- diagnosed with rectal biopsy looking for absence of ganglionic cells
- cardinal sign in infants is failure to pass meconium, later the classic ribbon like and foul smelling stools
Intussusception
- common in kids with CF
- Obstruction may cause fecal emesis, currant jelly like stools (blood and mucus)
- barium enema may be used to hydrostatically reduce the telescoping
with omphalocele and gastroschisis
(herination of abdominal contents)
- dress with LOOSE SALINE DRESSING covered with plastic wrap, and keep eye on temp - kid can lose heat quickly
After a hydrocele repair
provide ice bags and scrotal support
No phenylalanine with a kid positive for
PKU (no meat, no diary, no aspartame)
Never give potassium if
the pt is oliguric or anuric
Most accurate when testing for ketones and glucose
second voided urine
positive western blot in child
- presence of HIV antibodies
- indicates only the mother is infected
- 2 or more positive p24 antigen test will confirm HIV in kids
For HIV kids
- avoid OPV and Varicella vaccinations (live) but give pneumococcal and influenza
- MMR is avoided only if the kid is severely immunocompromised
- parents should war gloves for care, not kiss kids on the mouth, and not share eating utensils
Hypotension and vasoconstricting meds may alter the accuracy of
O2 sats
What if the aspirate of NG tube is
give antacid
- aspirate should be checked at least every 12 hrs
ambient air contains how much oxygen
(room air) 21% oxygen
first sign of ARDS
increased respirations
- later dyspnea, retractions, air hunger, cyanosis
normal pulmonary capillary wedge pressure (PCWP)
8-13
-18-20 hihg
first sign of PE is
sudden chest pain followed by dyspnea and tachypnea
with carbon dioxide narcosis expect
high potassium
- hydrogen floods the cell forcing potassium out
- carbon dioxide narcosis causes increased intracranial pressure
pulmonary sarcoidosis leads to
right sided heart failure
when pt going home with NG tube teach family
to irrigate with cola
Digitalis
increases ventricular irritability
could convert a rhythm to vfib following cardioversion
if normally lucid pt starts seeing bugs then you
should check respiratory status firs
- 1st sign of hypoxia is restlessness, then agitation then delirium, hallucinations and coma
- so check O2 sat and get abgs
biggest concern with cold stress and the newborn is
respiratory distress
ends with -ide
diuretic
Lasix side effect
cause pt to lose hi appetite (anorexia) due to reduced potassium
If water breaks and pt is at any minus station then
risk of prolapsed cord
CPR 5 yr old
breathe once for every 5 compressions
Cephalhematoma (caput succindianium)
resolves on its own in a few days
- type of edema that crosses the suture lines
after g-tube placement
the stomach contents are drained by gravity for 24 hrs before it can be used for feedings
during the acute stage stage of Hep-A what is required
gown and gloves
- convalescent stage no loner contagious
low magnesium and high cretinine signals
renal failure
highest priority with RA
pain
if TB pt is unable/unwilling to comply with tx then
may need supervision (direct observation , TB is a public health risk
Most important assessment with status epilepticus
LOC
crackles suggest
pneumonia
- most likely to be accompanied by hypoxia - manifest as mental confusion
can’t cough =
ineffective airway clearance
Absence of menstruation leads to what in the anorexic
osteoporosis
Toddlers need to express
autonomy (independence)
a pt with low hemoglobin and/or hematocrit should be evaluated for
signs of bleeding (ie dark stools)
What is given the night before IVP
a laxative in order to better visualize the organs
a pt with liver cirrhosis and edema may do what to mobilize the edema
ambulate then sit with legs elevated
Most important assessment with Addison’s
blood pressure - severe hypotension
What is important thing to do with adrenal insufficiency
Managing stress because if the adrenal glands are stressed further it could result in Addisonian crisis
After pain relief what is most important in pancreatitis
cough and deep breathe because of fluid pushing up in the diaphragm
Depressed pts need what
safety over nutrition
prolonged hypoxemia is a likely cause of what in a child
cardiac arrest
Fluid volume overload and CHF can cause
a S3
Coarctation of the aorta causes
increased blood flow and bounding pulses in the arms
Depression often manifests itself in
somatic ways, such as psychomotor retardation, GI complaints, and pain
newly diagnosed hypertension pt should have
BP assessed in BOTH arms
the chief concern with CF
respiratory problems
TB and positive PPD if area of induration is
> 5 in an immunocompromised pt
10 in a normal pt
15 in a pt who lives in area where TB is very rare
ObA1c
test to assess how well blood sugars have been controlled over the past 90-120 days
- 4-6 responds to blood sugar of 70-110
- 7 is ideal for DM and corresponds to a blood sugar of 130
BSA
considered the most accurate method for medication dosing with kids
What side to put wheel chair on
parallel to the bed on the side of weakness
If nurses discovers another nurse has made a mistake then
talk to her about it before going to management, if it persist then take it higher
Sepsis and anaphylaxis
reduce circulating volume by way of increased capillary permeability , which leads to REDUCED PRELOAD (volume in the left ventricle at the end of diastole)
amniotic fluid acidosis or alkaline
ALKALINE
- turns nitrazine paper BLUE
- urine and normal vaginal discharge are acidic and turn it pink!!
Is gonorrhea reportable
yes gonorrhea is a reportable disease
crutches and steps
up with the good and down with the bad
While treating DKA bringing the glucose down too far and too fast can result in
increase intracranial pressure r/t water being pulled into the CSF
vasopressin
“press in” - vasoconstricts
what is common with the hypercalcemia caused hyperparathyroidism
- polyuria
water intoxication will be evidenced by
drowsiness and altered mental status in a pt with TUR syndrome, or as an adverse reaction to desmopressin (for diabetes insipidus)
adveres reactions to Lugol solution
(for hyperthyroid)
- burins sensation in the mouth, and brassy tastes and should be reported to MD
give synthroid
on empty stomach
what may be needed for pt taking prednisone
extra insulin - steroids causes increased glucose
nonfat milk will reduce reflex by
increasing lower esophageal sphincter pressure
pts with GERD should lay
on LEFT side with HOB 30 degrees
to prevent dumping syndrome
low fowlers during meals and limit fluids while eating
in emphysema the stimulus is to
breathe low PO2, not increased PCO2
- so don’t give a lot of O2
- encourage pursed lip breathing to promote CO2 elimination
- encourage 3000 ml/day of fluids
- high fowlers and leaning forward
theophylline causes
GI upset - give with food!!
h
TB drugs are liver toxic
- does the pt have hep B
- adverse reaction is peripheral neuropathy
