mark k Flashcards
If the pH and bicarb are in the same direction, the problem is ___
metabolic
What kind of imbalance is DKA?
met. acidosis
What is the problem when over ventilating?
alkalosis
What is the problem when under ventilating?
acidosis
When is the prob usually met alkalosis?
prolonged gastric suctioning or vomiting
What do high pressure alarms mean?
resistance
1. kinked tube
2. water condensing in tube
3. secretions
What are some interventions for high pressure alarms?
fix tubing, change position (turn, cough, deep breath)
What does low pressure alarm mean?
decreased resistance to airflow, disconnection
Wernicke-Korsakoff syndrome tx?
give vitamin b1, redirect when making up stories
Disulfuram teaching ?
onset: 2 weeks
duration: 2 weeks
-avoid all forms of alcohol (mouthwash, perfume, aftershave, uncooked icing, insect repellent, OTC elixir)
What are upper drugs?
caffeine, cocaine, PCP/LSD, methamphetamines, adderall
What is the greatest risk in upper OD/downer withdrawal?
seizure
What is the greatest risk in downer OD/ upper withdrawal?
resp arrest
Difference between alcohol withdrawal vs delirium tremens?
-alc withdrawal: always occurs after 24 hrs
-delirium tremens: progresses after 72 hrs
What are the tx for both alc withdrawal and delirium tremens?
HTN pill
tranquilizer
multivitamin B1
What do aminoglycosides tx?
TB, septic peritonitis, fulminating pyelonephritis, septic shock, third degree burns
What do aminoglycosides end in?
-mycin (ones w/ “-thro-“ in middle are not aminoglycocides)
Toxic effects of a mean old mycins?
monitor hearing (mice), tinnitus, nephrotoxic (ear shaped like kidney), CN8 toxicity (figure 8 drawn outside of ear)
When can mycins given PO?
bowel sterlization pre op and hepatic encephalopathy
Who can sterlize the bowel?
NEO KAN
neomycin & kanamycin
What is the #1 producer of ammonia?
e. coli
When to draw trough?
30 mins before next dose
When is peak for sublingual?
5-10 min after dissolved
When is peak IV?
15-30 mins after bag finished
when is peak IM?
30-60 mins
What do Calcium Channel Blockers do?
calm down heart, like valium for the heart
When to use CCBs?
Antihypertensive, Anti-anginal, anti atrial arrythmia
S/E of CCBs?
headache and hypotension (H&H)
What do CCBs end in?
-dipine (dipping into calcium channel)
-verapimil
-cardizem (given continuous IV drip)
If question mentions QRS depolarization?
ventricular
If question mentions P wave?
atrial
What are the lethal arrythmias?
v fib and asystole
What are beta blockers used for?
antihypertensive
anti-anginal
anti atrial arrythmia
S/e of beta blockers?
headache, hypotension, and bronchoconstriction
What do beta blockers end in?
-lol (funny asf)
What is the treatment for v fib?
defibrillation
Tx for asystole?
atropine and epi
What is removed by chest tube in pneumothorax?
air
What is removed by chest tube in hemothorax?
blood
What is removed by chest tube in hemopneumothorax?
air and blood
What does an Apical chest tube remove?
Air = (A)pical
What does a Basilar position chest tube remove?
Blood = (B)asilar
Nursing action if seal of chest tube breaks?
- Clamp <15 seconds
- cut the airway
- submerge stick the end of tube under sterile water
- unclamp
Interventions if chest tube is pulled out?`
- take gloved hand and cover opening
- sterilze vaseline and tape 3 sides
What do all the trouble congenital heart defects start with, what is the exception?
T, except left ventricular hypoplastic syndrome
What will all children have with CHD?
-murmur
-echocardiogram done to determine cause of murmur
What are the 4 defects that are within ToF?
think “PROVe”
P-pulmonary artery stenosis
R-right ventricular hypertrophy
O-Overriding aorta
V-Ventricular septal defect
What type of diseases are usually put into contact precautions?
GI or fecal/oral
c diff, hep a, e coli, cholera, dysentery, staph, rsv, herpes
What type of diseases usually go into droplet precautions?
meningitis, influenza, epiglottitis (bugs traveling through cough, sneezing)
What type of diseases usually go into airborne precautions?
mmr, tb, varicella mtv
order of putting ppe on?
(g’s in reverse alphabet order)
1. gown
2. mask
3. goggles
4. gloves
Take off PPE order?
alphabetical order
1. gloves
2. goggles,
3. gown
4. mask
What is a 2 point gait for crutches?
crutch and opposite foot and crutch with other foot move together mid bilateral weakness
What is a 3 point crutch gait?
move 2 crutches and bad leg together followed by unaffected leg
What is a 4 point gait?
move everything separately
crutch-opposite foot-crutch-opposite foot
When to use 2 and 4 point gait?
When weakness is EVENLY distributed (both even #s)
-2 pt for mild probs
-4 pt for severe
Up the stairs w crutches?
when going up, good foot moves up first, crutch always move with bad leg
Down stairs w crutches?
bad foot move down last
Teaching for canes?
-hold on strong side
-advance w opposite side for wider suppport
-handgrip @ level with wrist
Teaching for walker?
-walker on side of patient
-hold onto chair, stand up, grab onto walker
-tie belongings to side
What are delusions?
false, fixed belief or idea or thought with no sensory component
Example of paranoid delusion?
“people are out to kill me”
Example of somatic delusion?
“I have xray vision”
What is the difference between an illusion and delusion?
Real things are happening that are being misinterpreted in illusions, whereas with delusions nothing is reality
What are most common delusions in order?
- auditory
- visual
- Tactile
What are the steps for nursing interventions in functional psychosis?
- Acknowledge feelings
- Present reality
- Set limits
- enforce limit
What are the disorders that experience functional psychosis?
skeezo (schizo), skeezo (schizo-affective), major, manic (bipolar only during mania)
What are the 3 types of psychosis?
- functional
- dementia
- psychotic delirium (secondary to illness)
What are the steps of nursing intervention when dealing with psychotic delirium?
- Acknowledge feelings
- Reassure safety and reminder of temporariness of condition
What is Diabetes Insipidus?
FVD, polyuria & polydypsia leading to dehydration due to low ADH, high urine output (low urine Specific gravity)
What is SIADH?
FVE, oliguria, decreased urine output, decreased serum specific gravity, high urine SG
What is. DM2 diet usually?
-caloric restriction
-1200, 1400, 1600
-6 small frequent feedings per day
What is the onset, peak, and duration of reg insulin?
-1 hour
-2 hours
-4 hrs
What is onset, peak, and duration of NPH insulin?
-6 hrs
-8-10 hrs
-12 hrs
What is the onset, peak, and duration of Lispro insulin?
-15 mins
-30 mins
-3 hours
What is the onset, peak, and duration of Glargine insulin?
-no peak
-12-24 hours
What is the #1 cause of DKA?
upper resp infection within last 2 weeks
What are S/Sx of DKA?
(D): dehydration
(K): high K+, Ketones in urine, Kussumauls
(A): Acidosis, Acetone breath, Anorexia
What is HHS and what is the tx?
hyperglycemia in DM2
dehydration!!!!!!!
rehydration is tx, successful tx= increased Urine output and moist mucous membranes
What is a normal HbA1c value?
<6
What is uncontrolled A1c?
> 8
What is borderline A1c?
7
What is lithium and what are the toxic values?
-used for bipolar
- greater than or equal to 2 is toxic
What is Lanoxin/Digoxin and what are the toxic values?
-A fib and CHF
-greater than or equal to 2 is toxic
What is aminophylline and what are the toxic values?
-muscle spasms airway relaxer, compound of bronchodilator theophylline
-greater than or equal to 20 is toxic
-non-therapeutic level is <10
What is dilantin (phenytoin) and what are the toxic values?
-seizure med
-greater than 20 is toxic
What is bilirubin and what are the toxic values?
-breakdown product of RBCs
- in newborn over 20 is elevated (usually admit newborn to hospital with levels around 14-15)
What disorder can happen when jaundice level gets >20?
Kernicterus
can cause aseptic meningitis or encephalopathy
What is the position a newborn may assume when irritated meninges from Kernicterus?
hyperextended posture
tx: put newborn on side
What is hiatial hernia?
-regurg of gastric acic upward or backward into esophagus
-contents go in wrong direction at correct rate
What are the s/sx of hiatial hernia?
same as GERD; heartburn, indigestion on lying down after eating
What is tx for hiatial hernia?
raise HOB, increase fluid with meals, increase carb content
What is dumping syndrome?
gastic contents dumped too quickly into duodenum (right direction, wrong rate). low proetin
S/Sx of dumping syndrome?
DRUNK: staggering gait, impaired judgement, labile, hypolgycemia
Acute abd distress: diarrhea, cramping, guarding, borborygmi, bloating, distention
Tx of dumping syndrome?
-lower HOB during meals and put pt on side
-decrease amnt of fluid 1-2 hrs before meals
-decrease carb intake
-high protein
What direction do patients with hypo/hyperkalemia present with?
same as prefix except HR and urine output
What direction do calcemias go with patient presentation?
opposite direction as prefixes
hypocalcmia: chvostek and troussau signs, TETANY, pick muscle/bone related
What direction does mag go with patient presentation?
opposite
Patient presentaiton w/ hyponatria?
FVO
Patient presentation w/ hypernatremia?
dehydratin
What are the first signs of electrolyte imbalance?
- parasthesia (numbness and tingling in limbs)
- paresis (muscle weakness)
Tx for hyperkalemia?
give d5w, reg insulin, and kayexelate at same time (rapid repsonse, requires many healthcare members in room at once)
Hyperthyroidism s/sx?
-weight loss
-tachy
-elevated BP
-hyperpersonality
-heat intolerance
-expothalmos (run yourself into the GRAVES disease)
Hypothyroidism s/sx?
-weight gain
-brady
-low bp
-flat, boring
-cold intolerance
Tx for hyperthyroidism?
-radioactive iodine
-PTU (propylthiouracil)
-Thyroidectomy
Teaching for radioactive iodine?
-priv room for 24 hours
-flush toilet three times (call hazmat if urine spills)
-visitor restriction in hospital and @ home for first 24 hrs
What to monitor for PTU tx?
immunosuppression (PTU=Puts Thyroid Under)
What are total thyroidectomy patients at risk for?
hypocalcemia due to difficulty spare parathyroid gland
What are subthyroidectomy pts at risk for?
thyroid storm
Thyroid strom s/sx?
-temps of >105
-high BP, stroke level(210/180)
-severe tachy
-psychotically delirious
Tx of thyroid storm?
-lower temp
-increase O2
-ice pack, cooling blanket, oxygen at 10L
What are the priority risks for sub and total thyroidectomy in first 12 hrs?
- airway (edema)
- hemorrhage
What are the priority risks for sub and total thyroidectomy in next 12-48 hrs?
-total: tetany (hypocal)
-sub: thyroid STORM
What is the priority risk for sub and total thyroidectomy after 48 hrs?
infection for both
What is myexedema?
when pt with hypothyroidism presents with skin involvement
Tx for hypothyroidism?
-levothyroxine (synthroid)
taken in morning 1/2 to 1 hour before breakfast on empty stomach w water
Should you sedate hypothyroidism pts?
NOOOO
What is Addison’s disease?
-under secretion of steroids
-addisonian crisis=hypoglycemic episode
-pts hyperpigmented
-do not adapt to stress
-in addisons, you “add a -sone” (steroid therapy)
Cushing disease s/sx? `
-moon face
-hirsutism
-truncal or central obsesity
-muscle atrophy
-gynecomastia
-buffalo hump
-sodium and water retention
-losing K+ out back
-High glucose
-easy bruising
-grouchy
-immunosuppression
Tx for cushings diseae?
adrenalectomy (takes abt a year of steroids for them to look normal, now have Addisons diseae)
What are best toys for 0-6 months?
-sensorimotor
-musical mobile or something soft and large
What are the best toys for 6-9 months?
-object permanence
-cover/uncover (jack in box, peek a boo)
-large but firm toys
What are the best toys for 9-12 months?
-vocalization (tickle me elmo, woody cowboy)
-purposeful play: build, sort, stack, make, construct
Best toys for 1-3 years?
-gross motor skills (running, jumping)
-push/pull toys, paint, parallel play, lawn mowers, wagon
Best toys for 3-6 y/o?
-fine motor skills (write, draw, scissors, dance, ice skate, highly imagineable)
best toys for 7-11 y/o?
creative, collective, and competitive
Why is laminectomy performed?
relax nerve root compression, cut bony prominences to give nerves more room
S/Sx of nerve root compression?
1.pain
2. paresthesia
3. paresis
Cervical laminectomy nursing priorities?
-preop: assess for breating and functions of arms and hands
-postop complication:pneumonia
Thoracic laminectomy nursing priorities?
-assess cough and bowel preop
-pneumonia and paralytic ileus postop complication
Lumbar laminectomy nursing priorities?
-preop: urinary retention assessment (last void/ bladder empty)
-postop: urinary retention and leg function
Mobilization with laminectomy pts?
-do not dangle
-log roll
-supine-> walking ASAP
-no sitting > 30 mins
-walk, stand, lie down
What is laminectomy w/fusion?
-takes bone graft from iliac crest and the spine
-hip will have more pain & bleeding
-spine will have risk of rejection
-equal chance for infxW
What is temporary teaching after fusion/laminectomy?
(6 weeks)
-do not sit > 30 mins
-lie flat, log roll
-do not drive
-do not life > 5 weeks
What is permanent teaching after fusion/laminectomy?
-not allowed to bend at waist
-not allowed to lift over head
-no horseback riding, off trail biking, rollercoasters
What is creatinine? Normal value?
-best indicator of kidney function
-0.6 to 1.2
-Level A or B if procedure with dye is involved
What is INR normal?
2-3
When is INR level C & action?
-greater than or equal to 4
actions:
1. hold coumadin
2. focused bleeding assessment
3. prepare to give K+
4. Call hcp
When is K+ a level C?
if low or high (5.3-5.9)
When is K+ level D and action?
> 6
-hold K+
-asess heart
-prepare to give insulin/kayexelate
-call hcp
-STAY WITH PT
What to do when K+ is low?
-assess heart
-prepare to give K+
-call hcp
When is pH level D and actions to take?
-if in 6s
-assess VS
-call HCP
When is hemoglobin level C and actions to take?
<8
-assess for bleeding/anemia/malnutrition
-prepare blood
-call HCP
When is bicarb level C and actions?
in 50s
-assess breathing
-ask pt to perform pursed lip breathing
-call hcp
When is bicarb level D and actions?
60<
-Prepare to intubate/ventilate
-call resp then hcp
-DO NOT LEAVE PT
When is 02 or Pa02 level c and action?
70-77
-assess for resp difficulty & dyspnea
-prepare to give 02
-call hcp
When is 02 or Pa02 level d and action?
60s or lower
-prepare to intubate/vent
-call resp then hcp
in coronary care what are the two most common episofic causes of tachy and what is the action?
hypoxia and dehydration (give 02 and increase fluid rate)
When is 02 sat a level C and action?
-<93%
-give patient 02
What can invalidate a 02 sat reading?
-anemia
-dye procedure
When is sodium level C and actions to take?
-abnormal AND change in LOC
-assess for fluid volume overload or dehydration
-prepare furosemide or IV fluid
-call hcp
When is WBC level C and action to take?
<4,000
-assess and put on neutropenic precautions
When is ANC a level C and what action to take?
<500
-assess and put on neutropenic precautions
When is CD4 count indicative of HIV?
<500
When is CD4 count indicative of AIDS?
<200
When is platelet level C?
<90000
When is platelet level D?
<40000
What are the five deadly D drugs?
-K+ >6
-pH in 6s
-CO2 in 60s
-PO2 <60
-platelets <40,000
What do all psych drugs cause?
low bp and weight changes (usually weight gain)
What are phenothiazines?
-major tranquilizer
-end in -zine
-use zine for the zany (crazyyy)
-may be antiemetic in small doses
S/S of phenothiazines?
(A)nticholinergic (dry mouth)
(B)lurred vision
(C)onstipation
(D)rowsiness
(E)PS
-(F)oto sensitivity
a(G)ranulocytosis (low wbc, immunosupressed, teach pt to recognized and report and s/sx of infection)
What do the tricyclic antidepressants do?
-reuptake inhibitors
-mood elevators
What are the tricyclic antidepressants?
Elavil, Trofranil, Aventyl, Desyrel
S/E of tricyclic antidepressants?
(A)nticholinergic
(B)lurred vision
(C)onstipation
(D)rowsiness
(E)UPHORIA
What are the benzos?
-anti-anxiety, minor tranquilizers
-usually have zep in name and many end with “pam” or “lam”
What is the caution with benzos?
do not take >2-4 weeks, work while waiting for major tranquilizers to kick in. take both at same time
S/E of benzos?
(A)nticholinergic
(B)lurred vision
(C)onstipation
(D)rowsiness
What are the MAOIs and how to spot them on exam?
-antidepressant
-MARplan, NARdil, PARnate (beginnings rhyme)
S/E of MAOIs?
A
B
C
D
What does lithium do?
treat bipolar disorder, mania
S/E of lithium?
3 P’s
-peeing (polyuria)
-pooping (diarrhea)
-paresthesia (numbness and tingling)
Toxic side effects of lithium?
-tremors
-metallic taste
-severe dirrhea
What is the #1 nursing intervention for pts on lithium?
INCREASE FLUIDS
monitor Na+ levels
What does Prozac (fluoxetine) do?
SSRI, mood stabilizer
S/E of prozac
A
B
C
D
EUPHORIA
Things to watch out for when admin for prozac?
-give before noon, can cause insomnia
-when changing dose for young adults and adolescents, watch for suicidal ideation
What is Haldol?
tranquilizer
S/E of Haldol?
A
B
C
D
E
F
G
What to monitor when pt on Haldol?
-development of neurolyptic malignant syndrome from OD
-fever >105
What does Clozaril (clozapine) do?
atypical antipsychotic
-2nd g4n antipsychotics end in -zapine)
S/e of clozapine (clozaril)q
agranulocytosis (worse than cancer drug, can trash pt bone marrow
What is zoloft (sertraline) used for?
antidepressant
What can sertraline (zoloft) interact with?
st johns wart
warfarin
S/E of serotonin syndrome?
(S)weating
(A)pprehensive
(D)izziness
HEADache
(sad head)
What should nurse do if pt on st johns wort or warfarin w sertraline?
lower dose
How to do Naegels rule for EDD?
take 1st day of last menstrual period, add 7 days & subtract 3 months
How much weight is expected to gain each week for 1st, 2nd and 3rd trimester?
-1st: 1 lb/month (3 lbs total)
-2nd/&3rd: 1 lb/week
28 + or - 3
What to do if mom has gained + or - 3 lbs than expected?
assess her
What to do if mom has gained - or + 4 lbs than expected?
perform BPP on fetus
When can fundal heigh be palpated?
12 weeks (should be midway between umbilicus and pubic symphysis)
What can a much bigger than normal fundus indicate?
molar pregnancy
Positive signs of pregnancy?
- fetal skelton on x-ray
- presence of fetus on US
- auscultation of fetal heart
- examiner palpates fetal movement
When would you FIRST vs MOST LIKELY find fetal heart?
8 weeks
10 weeks
When would you FIRST vs MOST LIEKLY have quickening?
16 weeks
18 weeks
MAYBE s/sx of pregnancy?
(occur chronologically in alphabetical order)
1. urine blood/preg tests
2. Chadwick- cervical color changes to Cyanosis
3. Goodelll- good and soft soothening of cervix
4. Hegar sign- uterine softening
When should prenantal visits be?
-1x a month until week 28
-Every other week between 28-36
-Every week after week 36 until delivery or week 42
-delivery induction or c section at week 42
What is the abnormal lab that is normal in pregnancy?
low Hemoglobin
-1st trimester: 11
-2nd: 10.5
-3rd: 10
When is urinary incontinence seen in pregnancy and how to treat it?
-1st and 3rd trimester
-void at least every 2 hrs until 6 weeks pp
What is the most valid sign that a woman is in labor?
onset of regular/progressive contractions
What is fetal lie?
relationship between spine of mother and baby (you want vertical line)
What are the most common fetal presentations?
ROA or LOA, pick ROA before LOA
What are the names with the first stage of labor?
- Latent
- Active
- transition
Characteristics in latent stage of labor?
-cervical dilation from 0-4 cm
-contractions 5-30 mins apart lasting 15-30 seconds
-mild intensity
Characteristics of active stage of labor?
-cervical dilation 5-7 cm
-contractions 3-5 mins apart
-60-90 seconds
Characteristics of transition stage of labor?
-8-10 cms
-contractions 2-3 mins apart lasting 60-90 seconds
-strong intensity
What is stage 2 of labor?
delivery of baby
What is stage 3 of labor?
delivery of placenta
What is stage 4 of labor?
2 hours, until bleeding stops
What are the parameters for normal contractions?
90 seconds and no closer than 2 mins apart
What can be the prob if contractions are greater than parameters?
- uterine atony
- stop pitocin
- uterine hyperstimulation
Interventions for painful back pain?
-position and push
-knee chest position
-push with fist into sacrum to use counter pressure
Prolapsed chord interventions?
-push head in off chord and position knee chest or trendelenburg
-prep for c section
Interventions for all other labor complications?
(L)eft side
(I)V
(O)xygen
(N)otify HCP
stop pitocin before everything else
What to keep in mind with pain med admin during labor?
do not give med if baby is likely to be born when med peaks
What to do with fetal monitoring patterns that start with “L” (late, low baseline variablity, low fetal HR)
LION
What to do with high FHR?
> 160
-document acceleration
-take moms temp
-baby WNL
What happens in second stage of labor?
- deliver head, stop pushing
- suction baby mouth then nose
- check for nuchal chord around neck
- deliver shoulders and body
- ID band before leaving delivery area
What to check in third stage of labor?
- placenta complete and intact
- check 3 vessel cord and 2 arteries 1 vein AVA
What to do in 4th stage of labor?
(4x an hour, every 15 mins)
1. vital signs (assess s/sx of shock, decrease bp, rates increased, cold, pale, clammy)
2. Fundus (massage if boggy, catheterize if misplaced)
3. Perineal bads (excessive: saturated in 15 mins or less)
4. Roll patient over and check for bleeding underneath
What to assess in post-partum stage?
(assess every 4-8 hrs)
-Uterine fundus
-lochia (rubra red, serosa pink, alba white, moderate amount 4-6 inches in hour)
-extremities
What should the height of the fundus be after delivery?
@ umbilicus
How to check for thrombophlebitis?
measure calf circumference
What do tocolytics do and what are the med names?
mag sulfate and terbutaline
stop premature labor
S/E of terbutaline (Brethine)
maternal tachy
S/E of mag sulfate, what to monitor?
brady, hypotension, decreased reflexes, decreased RR and LOC
What do oxytocics do and what are med examples?
stimulate and strengthen labor
pitocin and methergine
S/E of oxytocin?
uterine hyperstimulation
S/E of methergine?
causes HTN d/t contraction of blood vesssels
What are the fetal/neonate lung meds and what are the examples?
help mature lungs
betamethasone (Steroid)
surfactant (survanta)
S/e of betamethasone?
-hyperglycemia
(given to mother IM before baby born)
When is surfactant given?
given to baby transtracheal after birth
What to think with subq injection questions?
“5s”
-pick answer that has 5
-25 gauge, 0.5 inch
Heparin tips and tricks?
-IV or subq
-works immediately but cannot take more than 3 weeks (exccept lovenox)
-protamine sulfate antidote
-CAN be used during pregnancy
Coumadin (warfarin) tips n tricks?
-given PO
-pts can be on it for life but can take few days to a week to work
-vit k antidote
-lab: PT/INR
-CANNOT be used during preg
What is the only tranquilizer antipsychotic safe for preg?
haldol
What is piaget stage for 0-2 years?
sensorimotor
-do not understand play
-think present tense, just tell them
What is the piaget stage for 3-6 yeares?
preoperational (preschool)
-fantasy-oriented, imaginative, illogical
-understand future & past
What is the piaget stage for 7 to 11?
concrete operational “7/11 grocery stores surrounded by concrete?
-rule oriented
-teach a day or two ahead of time
-teach what you’re going to do
What is the piaget stage for 12 to 15 years?
formal operations
-abstract and think cause and effect
-teach like adult
What are the 4 phases of psych nursing principles?
- pre-interaction
- orientation
- working
- termination
Anatomical location of aortic valve?
2nd intercostal, right of sternal border
Anatomical location of pulmonic valve?
2nd intercostal left of sternal border
Where is erb point auscultation?
3rd intercostal (between pulmonic and tricuspid)
Anatomical location of tricuspid valve?
4th intercostal, left of sternal border
Anatomical location of mitral valve?
5th intercostal at midclavicular line
