NCLEX - Kaplan Ch 2 Flashcards
Snellen test: what is it?
How is it done?
Test of visual acuity
Pt stands 20 ft from chart and covers one eye at a time reading the smallest letter visible
What does the normal eye see at 20 ft
Myopia =
Hyperopia =
Presbyopia =
Astigmatism =
Near sighted
Far sighted
Aging (after 35 yrs usually)
Uneven curve of the cornea leading to blurred vision
Tx for conjunctivitis
Warm, moist compress
Topical antibiotics
Hydrocortisone opthalmic ointment
What is Retinopathy of prematurity?
Cause of blindness is premies
High concentration of O2 cause the retinal vessels to constrict leading to blindness
Tx for strabismus
Occlusion of unaffected eye to strengthen the weaker eye (begin this before age 6)
Corrective lenses
What are cataracts
Objects look distorted / blurred
Decreased color perception
Double vision
Pupil changes color to gray / milky white
What is glaucoma?
Causes?
Abnormal increase in intraocular pressure –> visual disability / blindness
Trauma, tumor, hemorrhage, aging, allergies
Tx for glaucoma
Prostaglanin agonist
Adrenergic agonists
BBs
Cholinergic agonists
Surgery - laser traberculoplasty
When giving ear drops what is the difference in ear positioning between adults and kids?
Adults: Pull outer ear upward and backwards (3+ yrs)
Children: pull outer eary downwards and back
Pt has incapacitating vertigo, tinnitus and a pressure of fullness in the ear. They have progressively worsened hearing. What do you suspect?
Meniere’s disease
Tx Meniere’s disease
Antihistamines (epinephrine, Diphenhydramine)
Antiemetics (prochlorperazine)
Antivertigo meds (Meclizine, Diazepam)
Diuretics (thiazine, triamterene)
Bell’s Palsy s/s
Inability to close eye
Increased lacrimation
Speech difficulty
Loss of taste
Distorted single side of face
What CN does Bell’s Palsey involve?
How long does recovery take?
7th
3-5 w
In what direction does the motor loss associated with Guillan-Barre Syndrome typically occur?
Begins: lower extremities, extends upward (leading to respiratory muscle compromise)
How long does it take for GB to peak? How long is recovery?
2-4 weeks, average 10 days
several months - yr
Tx for GB
Intervention = symmtomatic
Steroids, acute phase
Plasmapheresis
IV immunoglobulins
Adrenocorticotropic hormones
Corticosteroids
Mechanical ventilation / Elevate HOB / Suctioning
What is Kernig’s sign? What is Brudzinski’s sighn?
What do positives of these indicate?
Kernigs = when hip is flexed to 90, complete extension of the knee is restricted and painful
Brudzinski = attemps to flex the neck also produces flexion at knee and thigh
Meningitis
What vaccine in infants can help prevent meningitis?
What IV antibiotic can be used to treat meningitis?
HIB
PCN, Ceph, Vanco
What meds are for migraines?
BBs
Triptans
Topiramate
Ergotamines
Normal range of FBG level:
70-99
Which should be drawn up first: Regular or NPH insulin?
What are injection sites for insulin?
Regular (clear to cloudy)
Abd
Posterior arms
Anterior thighs
Hips
What are the sick day rules for diabetics
- Take insulins as ordered
- Check BG and urine ketones q3-4 hrs
- If lots of vomitting or diarrhea, take liquids every 1/2 hr to 1 h
BG less than ____ is considered hypoglycemia
What are the s/s?
50-60
Irritability
Confusion
Tremors
Blurred vision
Hypotension
Tachycardia
Skin is COOL + CLAMMY
DIAPHORESIS
HyperG is a BG greater than ______
What are the s/s
300-800
HA
Drowsy
Weak / stupor
Skin is WARM + DRY
Elevated temp
Polyuria
Polydipsia
Polyphagia
Kussmauls (rapid and deep)
Fruity breath
HHNKS is a BG greater than _____
What type of Diabetic does this occur in?
What does NOT occur with this?
800
Type 2
NO: Ketosis or acidosis
Your pt is unconcious and they are hypoglycemic, what are the two tx for them?
Dextrose 50% IV
1mg glucagon IM or SQ
What is the Tx for hyperglycemia?
1 L of NS q 1 hr and then 0.45% NS and then D5W
Regular IV insulin 5 u/hr
K+ replacement + check q 2-4 hrs
EKG q 2-4 hrs
Asses VS q 15 min until stable
What is the tx for HHKNS? (3)
NS or 0.45% NS
Regular insulin
K+ as soon as urine output is good
What is the diet for a pt with renal failure?
High calories
Low protein
What is the tx for hiatal hernia?
H2 receptor blockers (Cimetadine, Ranitidine)
Antacids
Cytoprotective meds (Sucralfate)
PPIs (Pantoprazole)
Surgery: Fundoplication (tightens the cardiac sphincter)
Don’t lie down for at least 1 hr after meals and elevate HOB when sleeping
A pyloromyotomy can help treat what?
Pyloric stenosis in infants
When does pain occur in a pt with a duodenal ulcer vs a gastric ulcer?
What relieves the pain?
Dodenal :
- 2-3 hrs after meal / nighttime / early sleeping hrs
- Eating relieves pain
Gastric - 0.5 - 1h after food
- Relief from vomit
Meds for duodenal / gastric ulcers?
Antacids (magnesium / aluminum hydroxide)
Cimetidine / Ranitidine
Anticholinergics (Propantheline)
Sucralfate
Omeprazole
(PPI)
Chron’s vs UC:
Fatty sool?
Rectal bleeding?
Abd pain occurance?
Diarrhea?
Fatty stool = Chrohns
Rectal bleeding - UC
Abd pain:
- Chrons is after meals
- UC is pre-poop
Diarrhea = UC (often 10-20 a day and bloody)
Where is the inflammation found in Crohns vs UC?
Crohns = non-continuous segment (ileum / right colon)
UC = continuous segment (rectum, left colon)
Diet rec for Crohns and UC
High protein
High calorie
Low fat
Low fiber
Should you have heating pad for pain for appendicitis?
No - ice bag to abd
Where is pain for diverticular disease? What relieved the pain?
What will their bowel pattern be?
LLQ relieved by stool or farting
Constipation alternating with diarrhea
What is typically the cause of diverticular disease?
Deficiency in dietary fiber
What is hirschsprung in an newborn vs a child?
Newborn = failure to pass mec / refusal to suck / abd distention
Child = failure to gain weight, constipation alt with diarrhea, foul-smelling stools, abd distention and visible peristalsis
What are the s/s of intussusception?
Colicky abd pain
Causes child to bring knees to abd
Vomit
Currant jelly like stools
Palpable mass in URQ
Typically 3 m - 3 yrs old
What is the non-surgical tx for intussusception?
Contrast medium / air pressure. to push the telescoped portion out
What will the bowel sounds be above the area of intestinal obstruction? What will the pain likely be describled as?
High pitched above
colicky
At what age is it useful to allow a child to play with models of equipment and encourage them to express their feelings?
Preschool
Fears:
Toddler =
Preschooler =
School age =
Adolescent =
Toddler = separation
Preschooler = mutilation
School age = loss of control
Adolescent = loss of independence / diff from peers
What is the major risk with midazolam or diazepam?
Resp depression *** (never leave pt alone)
Apnea
Hypotension
Brady
Post op- how freq should VS be done?
q 15 x4
q 30 x 2
q1 h x2
PRN
How would you teach proper use of an incentive spirometer?
exhale normally
inhale slowly and deeply
Keep ballsor elevated for 2-3 seconds
After surgery what is a normal bowel sound?
Should the pt be NPO?
High pitched tympany
Yes NPO until bowel sounds are present
What day post op might you expect atelectasis? What are the s/s?
Day 2
dyspnea
cyanosis
Tachy
Fever
pain on affected side
Dehiscence =
When does this happen?
Evisceration =
Disrution of surgical incision or wound
5-6 days post op
Evisceration = protrusion of wound contents (days 5-6 post op)
Urinary retention is ____ hrs post op
8-12
WBC therapeutic
5,000-11,000
ANC therapeutic
500 +
CD4 therapeutic.
What does a low CD4 mean?
200+
AIDS
HCT levels
36-54
CO2 levels nml
35-45
Hgb nml
12-18
PLT nml
150,000-450,000
Angiography
contrast dye injected into the arteries and x-ray films are taken of the vascular tree
Shows: abnormalities in blood flow d/t arterial obstruction or narrowing
What should you do after obtaining an ABG sample?
Appy pressure for 5 min to prevent hematoma
Send sample on ice
What is a thoracentesis?
Asiration of fluid or air from the pleural space
Obtain specimen for analysis
Revlieve lung compression
Tissue for biopsy
Place meds into pleural space
After a cardiac cath how freq are VS done?
How long is best rest maintained?
q 15 min for 2 hrs
q 30 min for 1 hr
6-8 hrs bedrest with insertion site straight
Normal PaO2
Normal PaCo2
Normal bicarb
80 - 100 mmHg
35-45 mmHg
22-26 mEq/L
What can a pt expect with their stool after a barium swallow for an upper GI test?
Stool will be white
Normal urine specific gravity
1.010 - 1.030
