1. Check for unresposiveness 2. Call for help 3. Check breathing / pulse 4. Initiate CPR (30 compressions, followed by 2 rescue breaths)

M.K. Review Flashcards by Natalie Bergner

What are the nursing considerations after a hemiarthroplasty?

Abduct leg using abduction splints / wedge or 2-3 pillows between legs

Flex hip no more than 90 degrees

Elevate HOB no more than 45 degrees

Prevent complications r/t immboility with early ambulatory

Use fracture bed pan/ elevate toilet seat to prevent 90 degree flex ion.

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Steps for CPR

Check for unresposiveness
Call for help
Check breathing / pulse
Initiate CPR (30 compressions, followed by 2 rescue breaths)

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Zolpidem is also known as ______. ADRS:
Monitor for ______

Ambien

Worsen depression / sleep driving / side effects increase with prolonged use

Monitor for suicidal thoughts / behavior

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Nursing considerations: Lithium

Check serum levels 2x/week during treatment - q2-3 months on maintenance

Draw blood AM prior to dose

Take with meals to avoid GI upset

Encourage 10-12 glasses of water / day and MODERATE (6-10g/day) salt intake

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Target serum lithium levels: treatment and maintenance

How long until onset of therapeutic effects?

0.5 - 1.5 mEQ/L

0.6 - 1.2 mEq/L

1-2 weeks

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Early signs of Alzheimers

Short term memory loss
Forgetful
Cannot retain new information
Loss of concentration
Physical appearance / personal hygiene
Night time confusion

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Later signs of Alzheimers

Loss of judgement
Communication difficulties
Memory loss
Language difficulties
Personality Changes
Night time wandering
Decreased motor functioning

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Nursing considerations for Alzheimers

Safety (bathroom assist every 2-4 hrs to prevent falls)

Exercise programs to delay mobility issues

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Meds for Alzheimers

Cholinesterase Inhibitor Meds (improve cholinergic transmission)
- Donepezil
- Galatamine
- Rivastigmine

ADRs: livery toxicity + GI upset

NMDA:
- Memantine

ADRs: sleepiness and confusion + GI upset

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Why is otittis media more common in children?

Shorter eustachian tube + more narrow

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Tx for RA

NSAIDs or Salicylates

Corticosteroids

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Meds for gout + ADRs

Colchicine
Probenecid
Allopurinol

Agranulocytosis
Aplastic anemia
GI upset
Renal calculi

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Side effects of antihistamines

Drowsiness

Dry mouth

GI upset

Bronchospasm (contraindicated with acute asthma attack / hx of asthma)

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What should you do with a pt who has Wernicke’s?

How can you keep it from getting worse?

Is it reversible? Do they have to stop drinking?

Redirect them - DON’T confront them or present reality

B1 or Thiamine

Yes reversible, don’t have to stop drinking

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Two drugs for alcohol aversion therapy

Disulfiram

Naltrexone

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What pt ed for Disulfirum or Naltrexon?

Takes 2 weeks to get into the system

Avoid alcohol products including:
- Mouthwash
- Aftershave
- Perfumes/cologne
- Insect repellant
- Alcohol hand sanitizer

*** they can have red wine vinaigrette

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Should you assume intoxication or withdrawl at birth in a newborn?

Intoxication

** baby needs 24 hrs to be in withdrawal

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S/s of newborn withdrawing

Difficult to console

Exaggerated startle reflex

Seizure risk

Shrill high pitch cry

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At ____ hrs a pt withdraws from alcohol. At ___ hrs they can have DT.

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Nursing considerations DT

3 meds

NPO/clear liquids

Private room near nurses station

Strict bed rest / need bed pans and urinals

Vest or 2 point locked leathers (opposite arm and leg) - rotate q2h

Meds:
- Anti-HTN
- Tranquilizer
- B1

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Which type of meds are ototoxic ?

Amnioglycocides - mycin

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Your pt is getting an amino-glycoside, what should you monitor for?

Hearing, tinnitus, vertigo/dizziness

Nephrotoxicity

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How are aminoglycosides administered?

q8h

Route: IM or IV - DON”T GIVE PO for infection

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What two meds can be used to sterilize the bowel?

Neo can! NEOmycin and CANomycin

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When should the trough of a med be drawn that's IV/SL/IM/SQ/PO?

30 min prior to the next dose

When does an IV med peak? IM?

15-30 min AFTER drug is finished 30-60 min AFTER drug finished

What do CCB's do for your heat? How do they work?

calm your heart - weaken, slow down, depress the heart (cardiac depressant) Negative inotrope

What do CCB's treat? What does it NOT treat?

Anti-HTN Anti-angina Anti-atrial-arrhythmia (treats everything atrial) DOES NOT treat SVT

Side effects of CCBs (2) When should it be held?

HA Hypotension If systolic is below 100, hold

Names of CCBs

"dipine" Verapamil Cardizem

V-fib will look like

chaotic squigly line. NO PATTERN.

What will V-tach look like?

Sharp peak and jags

QRS depolarization, the answer ill always be ______ P wave, the answer will always be ________ Lack of P wave, answer will always be ______ Lack of QRS, the answer will be ______

Ventricular Atrial Ventricular Asystole

A flutter looks like

Saw tooth

Chaotic is always a word to describe _______ (heart) Bizarre is always the word used for _____ (heart)

Fibrillation Bizarre

What is the different between low priority and moderate priority PVCs?

LOW: - Premature ventricular contraction (PVC) - A bunch of PVC’s is like a short run of V-Tach Moderate Priority: - If more than 6 PVC’s in a minute or row and/or if PVC falls on the T wave of the previous beat. They never are high priority!

What meds are given for SVTs?

ABCD's Adenosine Beta Blockers CCBs Digoxin / Digitalis (Lanoxin)

What would you give adenosine for? What should you warn the pt about? How fast to push it?

SVT Asystole Push in 8 seconds (two nurses, one pushes quickly the other flushes quickly)

Your pt is in asystole, what meds are given?

Epi and Atropine (in that order)

What is the purpose of chest tubes? What are the 2 locations for them? And why these places? When would both locations be used?

To reestablish negative pressure in the pleural space Apical - removes Air Basilar (bottom of lungs) - removes blood For Pneumohemothorax

What should you do if you knock out a closed chest drainage device like a pneumovac or pleurevac

Set it back up and have the pt take deep breaths -- not emergency

Steps to follow if the water seal on a chest drainage device breaks? What is FIRST? What is BEST?

1. Clamp 2. Cut away 3. Submerge in sterile water 4. Unclamp because you need to reestablish the water seal

What is FIRST and BEST if a chest tube dislodges?

First = cover hole with gloved hand Best = cover with vaseline gauze

You are looking at a chest tube water chamber and there is intermittent bubbling; what does this mean?

Good ! Document

You are looking at a chest tube water chamber and there is continuous bubbling; what does this mean?

Bad - tape it (sign of leak)

You are looking at a chest tube suction control chamber and there is continuous bubbling; what does this mean?

Good! - document

You are looking at a chest tube suction control chamber and there is intermittent bubbling; what does this mean?

Bad - suction isn't high enough

Never clamp a chesttube for longer than _____ secs w/o a Dr order

What is TOF? Will you see cyanosis?

Ventricular defect Pulmonary Stenosis Overriding Aorta Right Hypertrophy YES-- R to L = cyanosis

For droplet precautions, do you need a gown?

Measles, Mumps, Rubella, TB, and Varicella = ______ precautions Meningitis, H-flu = _______ precautions

Airborne Droplet

Order for taking off PPE (doffing)

Gloves Goggles Gown Mask (Alphabetical order)

Order for donning PPE

Gown Mask Goggles Gloves

Angle of elbow flexion for crutches?

30 degrees

Which side do you hold the cane?

Strong side

Describe to a pt how to use a walker?

Pick it up, set it down, walk into it

What is a somatic delusion?

False belief about your body (ex: X ray vision)

Difference between Paranoid and Persecutory deliusion?

Paranoid = people are out to harm you Persecutory = people are treating you maliciously

Most common type of hallucination =

Auditory (then visual, then tactile)

Difference between illusion and hallucination

Illusion = something is there, but its misinterpreted Hallucination = nothing is there

Neologism = Word salad =

Making up imaginary words Random words

Narrow self concept

When a functional psychotic refuses to leave their room or change their clothing

Ideas of reference

pt thinks that everyone is talking about them

Aminophylline: Therapeutic lvl _______

10-20

________ Occurs when bilirubin gets around 20 in newborns

__________- Position baby goes in when they have kernicterus. What does this position look like?

Opisthotonus Hyperextension from irritated meninges

TX hiatal hernia

 High position HOB  High fluids, high carbs.  Everything needs to be high, except protein (low)

Dumping syndrome usually occurs after ____. What happens?

Gastric surgery  The gastric contents dump too quickly into the duodenum.

s/s of dumping syndrome?

 Drunk: Staggering gait, slurred speech, delayed reaction time, emotional labile  Shock: Hypotension, pail cold clammy skin, tachycardia  Acute abdominal distress

TX for dumping syndrome

 Low position (HOB flat)  Turn to side with head down  Low fluids (1-2hrs before or after meals, not with the meals), Low carbs.  If you want the stomach to empty slow, everything is low. Except protein

For which is protein low: Dumping syndrome or hiatal hernia?

Hiatal hernia

Which has tachycardia: Hypo or hyperkalemia?

Hypokalemia

What will the EKG of hyperkalemia look like?

Tall p waves Elevated ST waves

s/sof hyperkalemia: agitation or lethargy? Tachycardia or bradycardia? Spastic / hyperreflexia or hyporeflexia and relaxed? Diarrhea or constipation?

Agitation bradycardia, tall p diarrhea spastic muscles, hyperreflexia

Hypercalcemia s/s

bradycardia bradypnea flaccid muscles hypoactive reflexes lethargy constipation

Seizures are a risk with hypo or hypercalcemia?

Hypocalcemia

Hyper or hyponatremia lead to hot flushed skin?

Hypernatremia

Hypo or hypernatremia leads to fluid restriction and give lasix

Hyponatremia (overload fluids)

Earliest sign of any electrolyte imbalance is _________

numbness/tingling aka Paresthesia

Never give more than ____of K+ per liter of IV fluid

What is the FASTEST way to lower K+, what is a slower effective PERMANENT way?

D5W and insulin to push K+ back into the cell from the blood Kayexalate (enema or oral) - trades Na+ for K+ and you poop it out

Hyperthyroidism is also known as ______

Graves disease

3 types of tx for hyperthyroidism

1. Radioactive iodine 2. PTU 3. Thyroidectomy

How long after getting radioactive iodine for graves does a pt need to isolate?

24 hrs

When would a pt take PTU? What should you monitor on it?

Hyperthyroidism or cancer WBC monitor

subtotal thyroidectomies are at risk for ______. What would this look like?

Thyroid storm / thyrotoxicosis Very high fever 105+ Very high BP (stroke) Tachy Psychotically delirious (brain damage)

What is the FIRST, BEST and overall treatment for thyroid storm?

FIRST: Ice pack BEST: cooling blanket O2 mask @10 L 2 staff, 1 pt No meds (pt comes out of it on their own)

Your pt had a total thyroidectomy. What will they need lifelong replacement of?

Calcium (risk for hypocalcemia)

Your pt just had a total thyroidectomy and they are 12-48 hrs pot op. what should you watch for?

Tetany r/t hypocalcemia (have a airway on hand)

Your pt just had a partial / subtotal thyroidectomy and they are 12-48 hrs pot op. what should you watch for?

Thyroid storm

What type of pt can you not sedate and why?

Hypothyroidism -- go into myexedema coma

S/s of addisons

Hyper pigmented (very tan) Unable to adapt to stress - can go into shock with too much stress Hypoglycemia Hypotension

Tx for Addisons

Steroids (-sones)

Tx for cushings

Adrenalectomy

What types of toys should you NOT select for toddlers (1-3 yrs)? What type of play for this age?

Finger dexterity: cut, use pencils, color (including finger painting) Parallel

At what age do children play together?

Preschool

What are the 3 C's of play for school aged kids?

Create (drawing, legos) Compete (play games they can win) Collect (pokeman cards, beanie babies, etc)

What is the purpose of a laminectomy? What is this surgery?

Relieves nerve root compression Removal of vertebral spinal processes

After any spinal surgery, what are the 4 temporary restrictions for 6 weeks? What are FOREVER restrictions?

1. No sitting longer than 30 min 2. Lie flat / log roll 3. No driving 4. Do not lift more than 5 lbs (a gallon of milk) - Don't lift objects by bending at the waist - cervical laminectomy - never lift above their head - no horseback riding, no jerking, 6 flags