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nclex > Mark K Lectures 7-9 > Flashcards

Mark K Lectures 7-9 Flashcards

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1
Q

Treatments for hyperthyroidism and what to remember for each one

A
  • Radioactive iodine (private room for 1st 24 hrs, be very careful with urine)
  • PTU (puts thyroid under) (*watch WBC count)
  • Thyroidectomy (total or subtotal/partial) (*needs lifelong hormonal replacement, *At risk for thyroid storm, *emergency)
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2
Q

S/s of thyroid storm

A

Temp >105
Stroke level BP
Severe tachycardia
Psychotic delirium

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3
Q

Treatment for thyroid storm

A

Get O2 up (O2 mast at 10L/min)
Get temp down (ice, cooling blanket)

Pt will come out of it on their own (self-limiting)

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4
Q

Biggest concerns for 1st 12hrs post op partial and full thyroidectomy

A

1: airway

#2: hemorrhage

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5
Q

Biggest concerns for 12-48 hrs post op partial and full thyroidectomy

A

Total: tetany (low Calcium)
Partial: thyroid storm

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6
Q

Risk for 72 hrs after partial or full thyroidectomy

A

Infection

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7
Q

Another name for hypothyroidism

A

Myxedema

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8
Q

Treatment for hypothyroidism

A

Give thyroid hormone
Do not sedate (risk of myxedema coma)
Question NPO orders before surgery (*must give thyroid meds)

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9
Q

What is Addison’s disease?

A

Under secretion of adrenal cortex

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10
Q

S/s of addison’s disease

A

Hyperpigmented
Cannot adapt to stress (makes glucose and BP go down = risk of shock)

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11
Q

Treatment of addison’s disease

A

Glucocorticoids (ending in -sone)

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12
Q

What is Cushing’s syndrome?

A

Over secretion of Adrenal Cortex

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13
Q

S/s of Cushing’s syndrome

A

(Think of cushman)

Moon face
Hirsutism (hair growth)
Gynecomastia
Truncal obesity
Striae
Bruise easily
Losing potassium
Full of water
Buffalo hump
Too much glucose

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14
Q

Treatment for Cushing’s syndrome

A

Adrenalectomy
(Bilateral adrenalectomy = addison’s)

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15
Q

Key safety rules for children’s toys

A

No small parts for < 4
No metal toys if O2 in use
Beware of fomites (non-living object that harbors microorganisms)

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16
Q

Stage of 0-6 month old and best toy

A

Sensory motor
Musical mobile, soft and large toys

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17
Q

Stage and best toy for 6-9 months

A

Working on object permanence
Cover-uncover toy, hard and large toys

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18
Q

Stage and best toy for 9-12 mo old

A

Learning to speak, purposeful movements
Talking toys/books, build, sort, stack, make

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19
Q

Stage, type of play, and best toy for toddler (1-3 yrs)

A

Working on gross motor skills
Parallel play
Push/pull toys

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20
Q

Stage, type of play, and best toy for preschool (3-6 yrs)

A

Working on fine motor skills and balance
Cooperative play, pretend play
Tricycles, tumbling class

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21
Q

Stage, type of play, and best toy for school age (6-12)

A

Creative
Collective
Competitive
Enjoys collecting things

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22
Q

What is a laminectomy?

A

Removal of vertebral spinous processes to relieve nerve root compression

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23
Q

What should you assess after a pt has cervical spine surgery?

A

Diaphragm and arms (breathing and arm/hand function)

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24
Q

What should you assess after a pt has thoracic spine surgery?

A

Cough and bowels

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25
Q

What should you assess after a pt has lumbar spine surgery?

A

Bladder and legs

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26
Q

Mobilization of patients after spinal surgery

A

Must logroll
Do not dangle
Do not sit for more than 30 min
May walk, stand, and lie down without restriction

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27
Q

Main post op complication of concern after cervical spine surgery

A

Pneumonia (b/c not breathing well)

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28
Q

Main post op complication of concern for a pt after thoracic spine surgery

A

Pneumonia (b/c can’t cough)
Ileus (b/c trouble with bowel)

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29
Q

Main post op complication of concern for a pt after lumbar spine surgery

A

Urinary retention
Problems with legs

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30
Q

Discharge teaching for a pt post spinal surgery

A

For first 6 weeks:
Do not sit for more than 30 min
Lie flat and log roll
No driving
No lifting more than 5 lbs

Permanent:
Do not lift by bending at waist
Cervical: no lifting above head
No jerky movements (horseback riding, amusement park rides, etc.)

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31
Q

List of lab values what are the highest priorities

A

Potassium >6
PH in 6’s
CO2 > or = 60
O2 < or = 60
Platelets <40,000

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32
Q

Treatment for potassium >6

A

Hold potassium
Assess heart
Prepare to administer sodium polystyrene sulfonate (kayexalate)
Call provider

33
Q

Treatment for pH in 6’s

A

Assess vitals (will be going way down)
Call provider ASAP

34
Q

Treatment for CO2 > or = 60

A

Assess respiratory status
Prepare to intubate and ventilate
Call respiratory therapy
Call provider

35
Q

Treatment of O2 < or = 60s

A

Assess respiratory status
Prepare to intubate and ventilate
Call respiratory therapy
Call provider

36
Q

List of next highest priorities

A

INR >4
Potassium <3.5
Hemoglobin <8
CO2 in 50’s
SaO2 < or = 92
Abnormal sodium with change in LOC
Total WBCs < 5,000
ANC <500
CD4 count <200 (AIDS)

37
Q

Treatment for INR >4

A

Hold Coumadin
Assess for bleeding
Prepare to give vit k
Call provider

38
Q

Treatment for potassium <3.5

A

Assess heart
Prepare to give potassium
Call provider

39
Q

Treatment for potassium between 5.4-5.9

A

Hold potassium
Assess heart
Prepare to give sodium polystyrene sulfonate and D5W and regular insulin
Call provider

40
Q

Treatment for hemoglobin <8

A

Assess for bleeding
Prepare to administer blood
Call provider

41
Q

Treatment for CO2 in 50s

A

Assess respiratory status
Have pt do pursed lip breathing (usually solves problem)

42
Q

Treatment for SaO2 < or = 92

A

Assess respiratory status
Give O2 (usually corrects problem)

43
Q

Treatment for low WBC counts

A

Assess for s/s of infection
Initiate neutropenic precautions

44
Q

Main side effects of all psych drugs

A

Low BP
Weight changes (usually weight gain)

45
Q

What are phenothyazines?

A

1st gen antipsychotics

46
Q

Ending for phenothyazines

A

All end in -zine

47
Q

Actions of meds ending in -zine

A

(-zines for the Zaney)

Major tranquilizers (Do not cure, just reduce symptoms)
Large dose treats psychosis, small dose treats nausea

48
Q

Side effects for -zine drugs

A

(A-G)
A: anticholinergic (dry mouth)
B: blurred vision
C: constipation
D: drowsiness
E: EPS (extra pyramidal syndrome)
F: photosensitivity
G: aGranulocytosis (low WBC count)

49
Q

Biggest nursing diagnosis for pt taking a -zine

A

Risk for injury b/c of side effects

50
Q

Action of tricyclic antidepressants (NSSRIs)

A

Mood elevators to treat depression

51
Q

Ways to remember tricyclic antidepressants and a couple of examples

A

Ending in -triptyline, -ine or -line

Amitriptyline
Imipramine

52
Q

Side effects of tricyclic antidepressants

A

Tricycles have 5 things that make them go (3 wheels and 2 pedals) = 5 symptoms (A-E)

A: anticholinergic (dry mouth)
B: blurred vision
C: constipation
D: drowsiness
E: Euphoria

53
Q

Pt teaching for tricyclic antidepressants

A

Takes 2-4 weeks to start working

54
Q

Actions of benzodiazepines

A

Anti-anxiety
Minor tranquilizers (at Led Zeppelin, minors are on tranquilizers & Zefs and zines are tranquilizers)
*Cannot take for >2-4 weeks

55
Q

Side effects of benzodiazepines

A

(A-D)
A: anticholinergic (dry mouth)
B: blurred vision
C: constipation
D: drowsiness

56
Q

Action of MAOIs

A

Antidepressants

57
Q

Pt teaching for MAOIs

A

*Pt must avoid all foods with Tyramine

58
Q

Examples of foods with tyramine in them

A

Fruits and veggies EXCEPT (salad BAR): bananas, avocados, raisins (or other dried fruit)
No organ meat or processed meat
No preserved meat
No aged cheese or yogurt
No alcohol
No caffeine (chocolate, soy sauce)
No OTC meds

59
Q

Action of lithium

A

(Is an electrolyte)
Decreases mania (bipolar)
Stabilizes nerve cell actions (which changes its SE)

60
Q

Side effects of lithium

A

(3 Ps)
Peeing
Pooping
Paresthesia

61
Q

Toxic effects of lithium

A

Tremors
Metallic taste
Severe diarrhea

62
Q

Number 1 nursing intervention for lithium toxicity

A

Ample IV fluids
Watch sodium level and for s/s of dehydration
(Low sodium = lithium more toxic)
(High sodium = lithium ineffective)

63
Q

Example of SSRIs

A

Fluoxetine

64
Q

Side effects of SSRIs

A

(A-E) (similar to NSSRIs)
A: anticholinergic (dry mouth)
B: blurred vision
C: constipation
D: drowsiness
E: euphoria

65
Q

Nursing considerations for SSRIs

A

Causes insomnia so give before noon
Watch for suicidal ideation in adolescents and young adults only and only when dose is changed

66
Q

What type of drug is haloperidol?

A

1st gen antipsychotic
Very similar to Thorazine

67
Q

Side effects of haloperidol

A

(A-G)
A: anticholinergic (dry mouth)
B: blurred vision
C: constipation
D: drowsiness
E: EPS
F: photosensitivity
G: aGranulocytosis (low WBC count)

68
Q

What is NMS?

A

Neuroleptic malignant syndrome
From overdose
Occurs in elderly and young white pts with schitz

69
Q

How should you determine the difference between EPS and NMS?

A

Take pt’s temperature
EPS is ok but NMS is deadly

70
Q

What type of drug is Clozapine?

A

2nd gen atypical antipsychotic

71
Q

Action of clozapine

A

Treats zaney
Tranquilizer

72
Q

Side effects of clozapine

A

Agranulocytosis

73
Q

Nursing priority for pt taking clozapine

A

Monitor WBC

74
Q

What is ziprasidone used for?

A

Schizophrenia
Bipolar disorder

75
Q

Side effect of ziprasidone

A

Prolongs QT interval
Can cause sudden cardiac arrest

76
Q

What type of drug is sertraline?

A

SSRI

77
Q

Patient teaching for sertraline

A

Causes insomnia, but can give at bedtime
Taking with certain other drugs increases toxicities (St. John’s wort causes serotonin syndrome, warfarin/Coumadin dose must be lowered - watch for increased bleeding)

78
Q

S/s of serotonin syndrome

A

(SAD HEAD)
Sweating
Apprehension (impending sense of doom)
Dizziness
Headache

nclex (4 decks)

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