NCLEX - Kaplan Ch 2 Flashcards by Natalie Bergner

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

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Myopia =

Hyperopia =

Presbyopia =

Astigmatism =

Near sighted

Far sighted

Aging (after 35 yrs usually)

Uneven curve of the cornea leading to blurred vision

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Tx for conjunctivitis

Warm, moist compress

Topical antibiotics

Hydrocortisone opthalmic ointment

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What is Retinopathy of prematurity?

Cause of blindness is premies

High concentration of O2 cause the retinal vessels to constrict leading to blindness

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Tx for strabismus

Occlusion of unaffected eye to strengthen the weaker eye (begin this before age 6)

Corrective lenses

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What are cataracts

Objects look distorted / blurred
Decreased color perception
Double vision
Pupil changes color to gray / milky white

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What is glaucoma?

Causes?

Abnormal increase in intraocular pressure –> visual disability / blindness

Trauma, tumor, hemorrhage, aging, allergies

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Tx for glaucoma

Prostaglanin agonist

Adrenergic agonists

BBs

Cholinergic agonists

Surgery - laser traberculoplasty

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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

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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

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Tx Meniere’s disease

Antihistamines (epinephrine, Diphenhydramine)

Antiemetics (prochlorperazine)

Antivertigo meds (Meclizine, Diazepam)

Diuretics (thiazine, triamterene)

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Bell’s Palsy s/s

Inability to close eye

Increased lacrimation

Speech difficulty

Loss of taste

Distorted single side of face

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What CN does Bell’s Palsey involve?

How long does recovery take?

7th

3-5 w

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In what direction does the motor loss associated with Guillan-Barre Syndrome typically occur?

Begins: lower extremities, extends upward (leading to respiratory muscle compromise)

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How long does it take for GB to peak? How long is recovery?

2-4 weeks, average 10 days

several months - yr

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Tx for GB

Intervention = symmtomatic

Steroids, acute phase

Plasmapheresis
IV immunoglobulins
Adrenocorticotropic hormones
Corticosteroids

Mechanical ventilation / Elevate HOB / Suctioning

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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

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What vaccine in infants can help prevent meningitis?

What IV antibiotic can be used to treat meningitis?

HIB

PCN, Ceph, Vanco

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What meds are for migraines?

BBs

Triptans

Topiramate

Ergotamines

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Normal range of FBG level:

70-99

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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

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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

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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

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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

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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