Nolite te bastardes carborundorum Flashcards
1
Q
Platelet reference range
A
150,000 to 400,000 mm³
If low expect petechiae, spontaneous bleeding
2
Q
Live attenuated vaccines
A
MMR, nasal flu, varicella
3
Q
Thrombolytic agent suffix
A
-plase
4
Q
Contraindications for thrombolytics
A
Uncontrolled HTN, trauma, bleeding, malformations and aneurysms, hx hemorrhagic disease, peptic ulcer disease
5
Q
CD4+ T-cell count reference range
A
Normal range 500 to 1200 mm³
Above 200
Below 200 –AIDS
6
Q
Warfarin monitoring
A
Monthly INR
7
Q
What is the therapeutic range for magnesium sulfate?
A
4 to 7 mEq/L
8
Q
What decreases efficacy of warfarin/Coumadin
A
Think: INCREASES clotting. Rifampin, carbamazepine, oral contraceptives, ginseng, St. John’s wort, vitamin K rich foods.
9
Q
2.2 pound/1 kg weight gain or loss is equal to how much fluid
A
1000 mL or 1 L
10
Q
What increases efficacy of warfarin/Coumadin
A
Think: DECREASES clotting FURTHER. Acetaminophen, NSAIDs, ABX, antifungals, Amiodarone, cranberry, ginkgo biloba, vitamin E, omeprazole, thyroid hormone, SSRIs.
11
Q
Nursing considerations/teaching around carbamazepine
A
Associated with Leukopenia due to agranulocytosis, Resulting in increased infection risk. Patient should be educated regarding infection prevention and signs and symptoms of infection.
12
Q
What is the number one priority intervention in a patient with DKA?
A
Re-hydration with normal saline
13
Q
Vancomycin IV infusion rate
A
Vancomycin should be infused at minimum over 60 minutes.
14
Q
Normal serum calcium range
A
8.6.-10.2 mg/dL
15
Q
What is ketorolac/considerations?
A
NSAID –nephrotoxic, avoid in kidney patients
16
Q
Considerations re: NSAID prescriptions
A
No more than 1 NSAID should be prescribed at a time, inappropriate for CHF patients, due to sodium retention and resulting increased fluid retention
17
Q
Depth and rate of proper chest compressions
A
2 - 2.4 inches/5-6 centimeters and 100-120 compressions/minute
18
Q
Therapeutic range of lithium
A
0.6 - 1.2 mEq/L for maintenence
up to 1.5 for acute mania
toxic over 1.5-2
19
Q
Action of albumin
A
Increases intravascular oncotic pressure = increased intravascular volume, helps prevent hypotension and tachycardia = more stable vital signs.
20
Q
Normal range serum magnesium
A
1.5 - 2.5 mEq/L
21
Q
Risks and symptoms of hypomagnesia
A
Often associated with excessive EtOH use, results in ventricular arrhythmia –specifically torsades de pointes which looks like a twisting ribbon or a sideways tornado– and neuromuscular excitability –tremors, hyperactive reflexes, positive trousseau and chovstek signs, seizure.
22
Q
Normal urine output children vs adults
A
Adults: 30 mL/hr or 0.5 mL/kg/hr
Children: 1 mL/kg/hr
23
Q
Major risk of myasthenia gravis
A
fluctuating muscle weakness in skeletal muscles related to eyes and eylid movements, speaking, swallowing, breathing
Meds are given prior to meals to maximize swallow ability during eating.
Due to swallow/choking/aspiration risk semi-solid foods should be provided.
24
Q
Amiodarone toxic side effects
A
Antiarrhythmia drug used only when other tx have failed because it has toxic adverse effects like pulmonary toxicity which manifests as a dry cough, pleuritic chest pain, and dyspnea. Requires urgent follow up.
25
S/sx of diabetes insipidus
Increased thirst (polydipsia), excessive urination (polyuria). Fluid volume deficit = can lead to weight loss, HYPERnatremia, HIGH serum osmolality, copious DILUTE urine with low specific gravity.
26
What are side effects and teaching considerations of sulfa drugs
Can cause kidney damage (client should drink lots of water), photosensitivity (client should wear sunscreen), folic acid deficit (client should take folate), agranulocytosis, stevens-johnson syndrome (teach client to d/c meds if rash appears), may cause orange-yellow skin and urine which will normalize when drug is stopped
27
Early sign of pneumothorax
Drop in O2 sat
28
ABG ranges
pH 7.35 - 7.45
PaCO2 45 - 35 (represents respiratory system)
HC03 22 - 26 (represents metabolic/renal system)
PaO2 80 -100 mm Hg
29
What is Sim's position
flat and side lying
30
Normal range urine specific gravity
1.003 - 1.030
31
Normal creatinine range
0.6 - 1.3 mg/dL. Best indicator of kidney function. Elevated not that exciting unless on a nephrotoxic drug or a dye procedure in the morning.
32
Normal BUN
6 -20 mg/dL
| If elevated, assess for dehydration
33
Signs of digoxin toxicity, monitoring
N/V, slow HR, change in color perception. Digoxin is secreted by the kidney so creatinine and BUN are monitored. Report GI symptoms, neurological symptoms (lethargy, confusion, fatigue), visual changes, symptoms of cardiac block (dizziness, lightheadedness)
34
Chest tube bubbling normal vs abnormal
Gentle, continuous bubbling in suction control unit is normal
Bubbling in suction control
Intermittent = bad (suction too low, increase it)
Continuous = good (document)
Bubbling in water seal
Intermittent = good (document)
Continuous = bad (leak --needs tape)
Bubbling in leak gauge or in water seal chamber is not normal UNLESS the pt has pneumothorax in which case gentle intermittent bubbling in water seal chamber is expected until lung has fully expanded
35
Polycythemia
An increase in RBCs. A compensatory response to chronic low blood O2 levels. Can lead to clots/stroke. Defined as hemoglobin >22 g/dL or hematocrit >65%
36
What does a positive Romberg test indicate?
Pt stands up straight and closes their eyes. If they fall over, that is a positive Romberg test. Indicates impaired proprioception/sensory ataxia.
37
Normal range for potassium
3.5 - 5.3 mmol/L
if low, prepare to give KCl, call provider.
If elevated (5.4 - 5.9) hold all KCl, assess heart, call provider , give kayexsolate and regular insulin and D5W.
If 6 or greater, emergent: ECG, hold all KCl, assess heart, call provider , give kayexsolate and regular insulin and D5W, do not leave pt side
38
Tiny boxes in EKG represent how much time
0.04 seconds
39
A big box in EKG is how many tiny boxes and represents how much time
5 tiny boxes and 0.2 seconds
40
Normal vs prolonged PR interval
Normal 0.12 to 0.20 (3 to 5 little boxes)
| Prolonged greater than 0.20 seconds (more than 5 little boxes)
41
Neonatal "normal" RR
30-60 breaths per minute
42
Therapeutic INR range
2-3 but up to 3.5 for heart valve disease. Anything over 4 is concerning but not emergent.
43
Risk to congential heart disease/synthetic materials repair, and prosthetic valve patients in relation to dental work
Risk for infective endocarditis due to oral surgery and some dental procedures. They need prophylactic antibiotics prior to procedures.
44
Intussusception
An intestinal obstruction due to bowel folds (like a telescope) causing increase in bowel pressure, vomiting due to pyloric muscle spasms (but NOT projectile vomiting). Produces blood and mucus in stool, looks like red jelly, a sausage shaped right sided mass on palpation is expected. Anticipate air enema (pneumatic enema) or hydrostatic (saline) enema to relieve obstruction/diagnose.
45
Peritonitis
A risk of untreated Intussusception --life threatening. S/sx: fever, abdominal ridigity and guarding, rebound tenderness.
46
Steatorrhea
Oily or bulky, foul-smelling stool due to excess fat in stool. Results from malabsorbtion of fat may be due to pancreatic insufficiency, cystic fibrosis, celiac disease.
47
Hirschsprung's disease
congenital aganglionic megacolon, causes internal sphincter to remain rigid/not relax resulting in bowel obstruction and causes thin, ribbon-like stools or inability to pass stool in newborns first 48 hours, produces bilious vomit. Potentially fatal complication is enterocolitis which can lead to sepsis, presents as fever, lethargy, explosive foul-smelling diarrhea, and worsening distension of abdomen.
48
Classic symptom of pyloric stenosis
projectile vomiting of non-bilious vomit
Hypertrophy of pyloric muscle causes postprandial projectile vomiting due to obstruction at gastric outlet. Palpate olive shaped mass to the right of the umbilicus. Vomiting is non-bilious (whatever is eaten is vomited) and leads to progressive dehydration and results in hypokalemic metabolic alkalosis. Hemoconcentration due to dehydration results in elevated hematocrit and BUN.
49
Neurogenic shock symptoms
Hypotension and bradycardia due to massive vasodilation
50
Thyroid storm symptoms
Rapid increase in temp, HR, BP due to stress/trauma in Grave's patients (hyperthyroid)
51
Normal QRS interval
0.6 - 0.11 seconds
52
What are the medical/electric treatments for bradycardia
Atropine and isoproterenol
| Pacemaker
53
What are the medical/electric treatments for A-fib, SV-tach, and V-tach with pulse?
Amiodarone, adenosine, verapamil
| Synchronized cardioversion
54
What are the medical/electric treatments for pulseless v-tach, ventricular fibrillation?
Amiodarone, lidocaine, epinepherine
| Defibrillation
55
Hypoglycemia range and interventions for neonates
<40-45 mg/dL is considered the hypoglycemic range for neonates
<35 mg/dL in neonates ages 4-24 hours if asymptomatic, first line is to feed (breast or formula)
56
Over how long should a blood transfusion be administered?
2-4 hours
57
What is the priority medication in EToH intoxication?
IV thiamine before or with IV glucose to prevent Wernike Encephalopathy
58
What is a consideration re: heart failure and beta blockers?
Beta blockers (-LOL) can sometimes worsen HF and shouldn't be given to a patient with low BP, and left sided HF symptoms
59
Statins are contraindicated when
there is evidence of sever liver injury or muscle injury
60
Trendelenberg
supine with feet elevated above head
61
If air embolism is suspected in a central line, what position should the patient be in
Trendelenberg (supine with feet elevated above head) to allow air to rise and trap in right atrium.
62
Sinusoidal FHR pattern
repetitive wave-like fluctuations in HR with absent variability and no response to UCs. An ominous finding requiring immediate intervention
63
Variable decels
ABRUPT decrease (less than 30 seconds from onset to nadir) and at least 15 beats below baseline for 15 or more seconds up to 2 minutes. Usually due to cord compression, maternal position change indicated and can often correct.
64
Early decels
Mirror UCs, with apparent and gradual decrease in FHR over 30 seconds or more from onset to nadir. Indicates head compression, normal finding.
65
Late decels
Follow UCs, with apparent and gradual decrease in FHR over 30 seconds or more from onset to nadir. Indicates placental insufficiency and fetal hypoxia, indication to turn pt to left side-lying and administer O2
66
Reassuring fetal movement frequency
4/hour or 10/2 hours
67
Sustained fetal bradycadia/tachycardia
<110 BPM or >160 BPM for more than 10 minutes
68
Ranges for immunocompromise in children
<750 in infants up to 12 months,
<500 in children ages 1- 5,
<200 children 5 and older
69
tardive dyskinesia
Uncontrollable/involuntary movements
70
Torticollis
A form of tardive dyskinesia: persistent neck flexion/extension
71
Neuroleptic malignancy syndrome (NMS)
Altered mental status, muscle rigidity, fever, autonomic instability (diaphoresis, tachypnea, htn, tachycardia, dysrhythmia). A rare condition most often seen with "typical" anti-psychotics (haloperidol, fluphenazine) but can also be seen in "atypical" antipsychotics (clozapine, risperidone, olanzapine). Tx: d/c antipsychotic, request HCP follow up.
72
Teaching to avoid lithium toxicity
Drink 2-3 L H20 daily, avoid diuretics like coffee, tea, soda, maintain normal sodium intake (no low sodium diet), avoid NSAIDs
73
Rescue breaths
If Pt has pulse but no/abnormal respiratory effort, rescue breaths should be administered every 5-6 seconds = 10-12 breaths/min for 2 minutes before reassessing. If rescue breaths have been administered and the pulse is less than 60 and there is signs (i.e. grey/blue skin) that perfusion is not happening, begin chest compressions
74
Survival expectancy cut off for full thickness burns
Pts with full thickness burns greater than 60% of body are not expected to survive
75
OTC meds which can increase BP
Should be avoided in pts with HTN: high sodium antacids, appetite suppressants, cold and sinus preparations
76
SIADH causes
syndrome of inappropriate antidiuretic hormone, often caused by ectopic secretion of ADH from a malignant lung tumor. Causes an increase in water absorption, excessive intra and extra cellular fluid, HYPERvolemia, and dilutional HYPOnatremia.
77
SIADH appropriate tx
Requires HYPERtonic solition eg. 3% NaCl in small quantities to help fluid shift and correct hyponatremia
78
Examples of isotonic solutions
0.9% NaCl, lactated ringers
| Used to replace intravascular fluid, losses associated with vomiting, diarrhea, burns, trauma.
79
Examples of hypertonic solutions
3% NaCl (or more % saline)
80
Examples of hypotonic solutions
0.45% NaCl (or less % saline) or 5% dextrose solution
81
Congenital dermal melanocytosis AKA
mongolian spots. Fade over first 1-2 years of life, document size and location so they are not confused with bruising.
82
Age range for cervical cancer screening
Screen all cervix-having people between ages 21-65 regardless of age at onset of sexual activity. Screen every 3 years ages 21-29
83
S/sx of epiglottis in 3-7 year olds
acute respiratory distress, toxic appearance (sitting up, leaning forward, drooling), stridor, and high fever, tachycardia and tachypnea. This is a pediatric emergency requiring endotracheal intubation and possible tracheostomy.
84
Normal, non-therapeutic INR range
0.75 - 1.25 --mildly elevated in cirrhosis pts is to be expected due to liver damage
85
Bell Palsy
Unilateral peripheral facial paralysis due to inflammation of the facial nerve (CN VII) in absence of a stroke or other cause. S/sx inability to completely close eye on affected side, alteration in tear production (excessive or absent), flattened nasolabial fold on nose, inability to smile/frown symmetrically, loss of taste on anterior 2/3 of tongue.
86
Trigeminal neuralgia
Affecting CN V, shock-like pain in lips, gums, severe pain along cheek bone
87
Weight loss over what percentage of birthweight in first 5 days requires follow up?
More than 7%
88
Serious side effects of tamoxifen
Tamoxifen is a selective estrogen receptor modulator used in treatment/prevention of estrogen-positive breast caner. Serious side effects include thromboembolic events and endometrial cancer.
89
IV catheter gauges
14g for administration of fluids/meds in emergency/field settings and hypovolemic shock
18g for blood or large qty fluids in adults
20/22g for general IV and meds. 20 is acceptable for blood but not ideal.
24g children and elderly pts with small fragile veins
90
1 TBSP = ? mL
15 mL in 1 TBSP
91
Ideal contraction strength
25 -50 mm Hg, should never exceed 80 mm Hg
92
Resting uterine tone in mm Hg
average 10 mm Hg should never exceed 20 mm Hg. After amnioinfusion, expect resting tone to remain equal to or greater than 20 mmHg and observe for fluid leaking, otherwise suspect uterine overdistension.
93
Proper technique for cane walking, up/down stairs
Cane always moves before the bad leg: cane, bad leg, good leg for flat surfaces.
Stairs: Up with the good and down with the bad --cane, good, bad for up stairs, cane, bad, good, for down stairs.
94
Presbyopia
Inability to see close objects clearly
95
In elderly patients what is considered febrile?
Lower body temp means lower febrile cut off. 37.8 C / 100.2 F is considered febrile
96
Appropriate fluid resuscitation for burn victims
Lactated Ringers
97
1000 mcg =
1 mg
98
1000 mg =
1 g
99
Rapid acting insulins and OPD
Rapid = "logs" humalog, novolog. Onset 15 min, peak 1 hour, duration 3 hours. Give WITH meals.
100
Short acting insulins and OPD
Short = regular = R. Onset 30 min, peak 2 hours, duration 8 hours. CLEAR = Can be run in IV. THE ONLY INSULIN THAT CAN BE GIVEN IV PUSH
101
Intermediate acting insulins and OPD
Intermediate = NPH. Humulin. "N" Onset 2 hours, peak 8 hours, duration 16 hours. Typically given 2 x per day because of long duration. CLOUDY = Never put anything cloudy in a bag.
102
Long acting insulins and OPD
Long = Levemir, lantus. Glargine. Onset 2 hours, peak NONE, duration 24 hours. Never MIX in syringe with other insulins. Can be given at same time, as separate injecton. The only insulin safe to give at bedtime.
103
Normal central venous pressure
2-8 mm Hg. If elevated can indicate R ventricular failure or fluid volume overload
104
Normal MAP
70 -105 mm Hg
105
Normal systemic vascular resistance
800-1200 dynes/sec/cm-5
106
Narrowing pulse pressure is a sign of
hypovolemic shock
107
Scleroderma
Collagen overproduction causing tightening/hardening of the skin and connective tissues. Progressive disease with no cure --management of complications is only option. Renal crisis is a possible complication causing malignant hypertension --life threatening
108
Expected labs in cirrhosis
Elevated: ammonia, bilirubin, PTT
Decreased: albumin and sodium
109
3500 calories =
1 lb gain/loss
110
Considerations in administration of erythropoietin
BP must be checked prior to administration as an adverse effect of erythropoetin is hypertension. Uncontrolled HTN is a contraindication of administration. Also held if Hgb is greater than 11
111
How is erythropoetin administered
subcu or IV
112
Elevted AST/ALT indicates what and is caused by?
hepatic cell injury (hepatitis). Can be due to EtOH use, OTC meds like acetaminophen, herbal/dietary supplements, IV drug use (due to Hep B and C)
113
Priapism
Prolonged, painful erection. An emergency.
114
WBC normal range
4,500 - 11,000/mL
115
Side lying in pneumonia/lung patients
Side-lying on the GOOD side decreases hypoxia by increasing perfusion to the healthy lung, but does NOT increase secretion clearance. BAD UP GOOD DOWN
116
Bronchodilator respiratory medications
BAM
Beta2 agonists -terols
Anticholinergics -pium (decrease mucus production)
Methyxanthines -phylline (increase heart rate, expand lungs, like caffeine)
117
Anti-inflammatory respiratory medications
SL(a)M
Steroids -sone must taper off!
Leukast, Leukotrine receptor agonists. Leukotrines stablized so bronchi and bronchioles relax. example Singulair -montelukast sodium (Luke likes to sing)
Mast cell stabilizers -stabilizes mast cells to reduce swelling. Example Cromolyn. Think "Mass of chrome"
118
Sodium polystyrene sulfonate
Kayexolate. Helpful for mild to moderate hyperkalemia. Has risk for intestinal necrosis, requires regular bowel function assessment.
119
Aceytlcysteine
Loosens/liquifies respiratory secretions in CF or other respiratory patients. Has no effect on smooth muscle and can cause/worsen bronchospasm = contraindicated in asthma patients
120
Significant increase in BP in pregnancy
Equal to or greater than 30 mmHg systolic or equal to or greater than 15 mmHg diastolic. even in the absense of HTN/symptoms, assess proteinuria, HA, RUQP.
121
Thiazide diuretics and spironolactone
Spironolactone when combined with a thiazide diuretic prevents hypokalemia in pts with normal K levels
122
Anticholinergics
Benztropine, trihexyphenidyl, used to treat Parkinsons and other diseases but can cause urinary retention and can precipitate acute glaucoma and should not be used in patients with BPD or glaucoma.
123
Physiologic compensation for metabolic acidosis
Rapid breathing to blow off more CO2 (think Kussmaul)
124
signs of cardiac tamponade
Becks triad: low BP (especially large decrease in systolic pressure in short period of time), JVD, quiet/distant heart sounds.
Also narrowed pulse pressure, pulsus paradoxus, dyspnea, tachypnea, tachycardia.
125
Locations of heart sounds
Aortic --2nd intercostal space, pt's right sternal border
Pulmonic --2nd intercostal space, pt's left sternal border
Erb's point --3rd intercostal space, pt's left sternal border
Tricuspid --4th intercostal space, pt's left sternal border
Mitral --5th intercostal space, mid clavicular line --this is the APEX/place for APICAL pulse/point of maximal impulse (PMI)
126
Tinea corporis and tinea capitis
| pediculosis capitus
Ring worm. highly contagious fungal infection
Corporis -- body
Capitis --scalp
Pediculosis capitus -head lice
127
Mnemonic for cranial nerve functions
```
I Some (sensory)
II Say (sensory)
III Marry (motor)
IV Money (motor)
V But (both)
VI My (motor)
VII Brother (both)
VIII Says (sensory)
IX Bad (both)
X Business (both)
XI Marry (motor)
XII Money (motor)
```
128
What precautions are appropriate for varicella zoster
N95 and gloves and gown, negative pressure room until lesions are dry and crusted (no longer contagious at that point)
129
ACE inhibitors/side effects
-pril
affect blood pressure but not heart rate
Angioedema
Cough
Elevated K
—all end in -pril
When you draw an ACE you get a thrill (prill)
Block conversion of angiotensin1 to angiotensin2. Used in HTN, heart failure, myocardial infarction, diabetic nephropathy .
SE: hypotension, angioedema, dry cough, hyperkalemia. Monitor serum creatinine to adjust dose if renal impairment.
Also must alter dose in renal impairment --monitor serum creatinine.
BLACK BOX: teratogen,
orthostatic hypotension change positions slowly, monitor BP.
130
Decerebrate and decorticate position
Decerebrate --the more serious of the two. Arms and legs straight out and toes pointed down, head/neck arched back
Decorticate --bent arms, clenched fists, arms bent in toward body, legs out straight
131
DKA treatment parameters
NS fluid bolus. Rehydration with normal saline and IV insulin to bring down blood glucose. IV insulin is titrated down as the blood glucose returns to an acceptable range and may be discontinued when it is below 200 mg/dl. IV potassium will be administered even if normokalemic to prevent common complication of hypokalemia d/t insulin causing shift of K from intravascular to cellular space and resulting life threatening arrythmias that can result.
132
Parkland formula
4 ml x body weight in kg x percentage of body burned = 24 hours fluids. 50% is given in the first 8 hours and 50% over the next 16 hours so pay attention to the question wording.
133
Rule of 9s
```
9% head and neck
18% anterior torso
18% posterior torso (36% total trunk)
9% right arm
9% left arm
1% genitals
18% right leg
18% left leg
```
134
Neg "x-otrophic" meds
CALM the heart. Antihypertensive, antianginal, anti-atrial-arrythmia.
135
PVCs are a low priority except when
more than 6/min or more than 6 in a row, then moderate priority
136
Ventricular arrythmia meds
(new) = amniodarone. Think V = A
| (old) = lidocaine. Think V = L.
137
Atrial arryhtmia meds
ABCDs (Adena-Beta-Calca-Dig)
A -Adenocard/adenosine (FAST push of 1-2 seconds followed by 20 mL saline flush)
B -Beta blockers (lols) --neg x-otrophics. SE: hypotension and headahce
C -Calcium channel blockers
D -digitalis/digoxin/lanoxin
138
V-Fib treatment
D-fib
139
Asystole treatment
Epinephrine then atropine (think AsystolE, reversed)
140
4 defects of tetrology of fallot
VarieD PictureS Of A RancH
or
Valentines Day Pick Someone Out A Red Heart
Vendricular Defect
Pulmonary Stenosis
Overriding Aorta
Right Hypertrophy
141
Diseases appropriate for droplet precautions
MASK Pathogens transmitted by coughing/sneezing: N. Meningitidis, Influenza B, Diptheria, Mumps, Rubella, Pertussis, Group A strep (strep throat), viral influenza
142
Diseases appropriate for contact precautions
GOWN, GLOVES Anything enteric (fecal oral) plus RSV (which is actually droplet but placed on contact), Staph, Herpes (including shingles)
143
Diseases appropriate for airborne precautions
N95, neg pressure room MMR, TB (which is droplet but placed on airborne), Varicella Zoster, MERS (plus goggles)
144
PPE order putting on
Gown
Mask
Googles
Gloves
145
PPE order taking off
Gloves
Goggles
Gown
Mask
146
Drop factor formula
Volume x drop factor
divided by time in minutes
```
Micro = 60 drops
Macro = 10 drops
```
147
What does the protein pad on a urine dipstick measure?
Albumin in urine
148
What is the first protein typically seen in kidney dysfunction?
Albumin
149
Functions of the parietal lobe, when impaired what is affected?
Somatic/sensory input
| when impaired, sensation deficit
150
Functions of the frontal lobe, when impaired what is affected?
Higher order processing, executive function, personality
| When impaired, behavioral change
151
Functions of the temporal lobe, when impaired what is affected?
Visual/auditory, past experiences
| When impaired, cannot understand verbal/written language
152
Functions of the occipital lobe, when impaired what is affected?
Visual images
| When impaired, visual deficit
153
How do you estimate Hct or Hgb from a single value
Hgb is roughly 1/3 of Hct.
154
Peak of medications by route
sublingual 5-10 minutes after dissolved
IV 15-30 minutes after administration is finished
IM 30-60 minutes after administration
subcutaenous --only consider for insulin, varies)
PO --too variable to generalize
155
Crutch gaits
2 point -move crutch and opposite foot simultaneously
3 point -move 2 crutches and bad leg
4 point -everything moves separately: crutch, opposite foot, opposite crutch, opposite foot.
Swing through -non weight bearing: plant crutches, swing bad leg and good leg through, plant good leg.
Think: even for even, odd for odd --when weakness is evenly distributed 2 for mild weakness and 4 for severe. Odd = 1 leg is affected = #3. Non weight bearing = swing through.
156
Where is a cane held in relation to weakness?
Cane is held on the STRONG side of the body
157
Normal albumin
```
3.5 - 5.0
if low (cirrhosis) expect fluid overload, edema, acites, weight gain
```
158
What are adventitious vs vesicular breath sounds
Vesicular = Normal breath sounds
Adventitious = abnormal sounds heard over lungs and airways (i.e. crackles, wheezes, rubs, stridor)
159
What is ptosis
Drooping of eyelid
160
Priority treatment in elevated K
D5 and regular insulin IV as temporary fix to push K into cells, kayexolate as longer term solution to remove K from body. Typically 50 mL D6 and 10 units insulin then kayexolate PO or PR. If ECG shows changes due to hyperkalemia, give calcium gluconate to stablize cardiac muscle first.
161
Test for rH sensitization of pregnant person
Indirect Coombs Test
162
Serum Alpha-Fetoprotein
screens for neural tube defects
163
Parvoviruus B-19
Fifth disease, aka Slap cheek d/t human parvovirus. A viral illness affecting mainly school age children, distinctive red rash across cheeks, spreads to extremeties. May also accompany malaise, joint pain. NSAIDs okay for treatment. 7-10 day recovery. Key: infections only BEFORE symptoms appear. Avoid pregnant people (do not allow pregnant nurses to care for these pts) because it is a TORCH infection
164
Pulsus paradoxis
Exaggerated fall in systolic blood pressure >10 mm Hg during inspiration
165
how to calculate MAP
Take diastolic blood pressure, multiply it by 2, add the systolid blood pressure, and divide the result by 3.
166
Proton pump inhibitors
-prazoles decrease calcium absorbtion = increased risk of osteoperosis and increased risk of c. diff due to supporession of acid in upper GI, and increased risk of pneumonia. Take additional calcium and Vit D.
167
DKA
Most common cause: SUDDEN, acute viral upper respiratory infection in the past 2 weeks in younger insulin-dependent people. Dehydrated. Three Ks: ketones in blood confirms dx. Kussmal breathing. High K. Three A: Acidosis (MacKussmal). Acid breath (fruity). Anorexia due to nausea. Tx: fast 200 mL/hour NS, regular insulin in bag, monitor K.
168
HHNK
Hyperglycemic, hyperosmolar non-ketotic crisis: dehydration in non-insulin-dependent (T2DM) older people due to illness or infection. Blood glucose much higher than in DKA. More gradual onset than DKA. No ketones, no kussmal breathing --Normal blood pH (no metabolic acidosis) Mental status changes d/t dehydration/hyperosmolar state. Tx is the same as DKA --Normal saline, plus regular insulin in the bag, and monitor K.
169
HbA1c levels
6 and lower in control
7 to 7.9 need more eval
8 and higher out of control
170
Digoxin therapeutic range and toxic range
therapeutic 1-2,
| toxic 2 and greater
171
Bilirubin newborn normal levels, elevated levels
normal less than 10
elevated 10-20
14-15 needs hospitalization
172
Dilantin/Phenytoin therapeutic, toxic ranges
Therapeutic 10-20
| Toxic 20 or higher
173
Kernicterus and Opisthotonus
bilirubin in the brain and the position a baby assumes (hyperextension) when kernicteric --position baby on their side
174
Thyroid storm s/sx, tx
```
Super high temp
Super high BP
Severe tachycardia
Psychotic delirium
Tx: get temp down, get oxygen up. Put ice packs and or cooling blankets, oxygen at 10L. it is a self limiting condition, no meds given, just attempting to spare the brain until it corrects. Requires 2 nurses to manage.
```
175
Addison's Disease
UNDER secretion of adrenal cortex.
S/sx: hyperpigmentation (look tan in skin folds, buccal area, palmar creases) and or vitiligo, weight loss, muscle weakness, low BP, hypoglycemia. These pts do not adapt to stress. Normal stress response raises glucose and blood pressure to support brain. So without that support, in stress, person goes into shock.
Give steroids to treat.
ADD a SONE
176
Cushing's Disease
OVER secretion of adrenal cortex. Cushy bank account = extra
S/sx: (memorization of this gives you all signs of bushings and all side effects of steroid meds)
Draw a little man: Cush man
Moon face
Beard —hirsutism
Bump on front and bump on back
truncal obesity
Bump on the front —gynecomastia —female type breasts on men
Bump on the back —buffalo hump
Skinny arms and skinny legs d/t muscle atrophy
Water and sodium retention, potassium loss
Striae
HIGH GLUOSE —most important hyperglycemia like a diabetic
Extremely easy to bruise
Speech bubble: “I am mad, I have an infection”—grouchy/irritable, and immunosuppressed
177
Hemoglobin normal range
12-18 to cover all humans
8-11 assess for anemia, bleeding, malnutrition
Below 8 assess for bleeding, prep for transfusion, call provider
178
CO2 normal range
35-45
46-59 assess respirations, prepare for pursed lip breathing to blow off excess
Over 60 is emergent, respiratory failure. Assess respirations, prepare for intubation/ventilation, call RT and provider.
179
Hematocrit normal range
36-54 (3 x Hgb)
| Over 54 assess dehydration
180
PO2 normal range
78 -100
Low 70s assess respirations, prepare supplemental O2
60s and lower =emergent, assess respirations, give O2, prepare for intubation/ventilation, call RT and provider.
In hypoxia, HR speeds up FIRST, then RR goes up --treat episodic tachycardia with oxygen and IV fluids
181
When does a pt need to be intubated and ventilated
when Co2 in the 60s and PO2 in the 60s
182
Total WBC normal range
Total 5,000 - 11,000
183
Absolute Neutrophil Count (ANC) normal range
Above 500
184
Trigger values for thrombocytopenic precautions
Below 90,000 place on bleeding precautions
| Below 40,000 emergent
185
RBCs
4-6 million
186
The 5 critical lab values
pH in 6s
K in the 6s
Co2 in the 60s
O2 in the 60s
platelets of less than 40,000
187
Metabolic syndrome
AKA insulin resistance. Increased risk of DM and CAD. Increased waist circumference (35 or greater for women, 40 or greater for men), increased BP (130 or greater systolic, 85 or greater diastolic), increased triglycerides, (greater than 150), LOW HDL (less than 40 men, less than 50 women), increased fasting blood glucose, "We Better Think High Glucose"
188
Normal LDL
Less than 100
189
Normal HDL
Greater than 40 men, greater than 50 women
190
Myxedema coma
Severe hypothyroidal state that can progress to coma. Everything is DOWN except possibly hypertension (can also by hypotensive). Need emergent endotracheal intubation and mechanical ventilation if signs of respiratory failure.
191
ARBs
—sartans
Blood pressure drop, stomach hurt, dizziness. Treats HTN, diabetic nephropathy
Blocks effects of Angiotensin2 which causes vasodilation.
SE: hypotension, dizziness, GI upset. Black box: fetal toxicity. Orthostatic hypotension, monitor BP.
192
appropriate solution for ICP patients
HYPERtonic
193
Mydriasis
Pupil dilation
194
Phosphorous normal range
2.4 - 4.4
195
Tiotropium vs lpratropium
Tiotropium is a long acting anticholinergic for COPD. Inhaled capsule via handihaler --looks like an oral capsule but SHOULD NOT be taken orally. Peak effect is 1 week --not a rescue med. Not a bronchodilator --relaxes airway, does not reduce inflammaton, dries airway secretions.
Ipratropium is a SHORT acting anticholinergic and IS a rescue med for COPD and asthma
196
Sulfonylureas side effects
Hypoglycemia, do not combine with ETOH
197
1 oz = mL
30 mL
198
Suctioning protocol
Preoxygenate with 100% O2
Catheter should be no more than 1/2 width of artificial airway
Insert catheter without suction
Cough is expected from patient.
Insert catheter until resistance is felt, retract catheter 1 cm and then apply suction
Suction pressure should be medium (100 -120 mmHg for adults, 50-75 mmHg for children)
Suction no more than 10 seconds in a pass.
Encourage deep rebreathing
Wait 1-2 minutes before applying suction again
199
Serum ammonia normal range
15-45
| If high, expect hepatic encephalopathy: confusion, lethargy, asterixis, coma
200
Normal PT
11-16 seconds
| If prolonged, expect bruising, bleeding
201
Normal PTT
25-35 seconds
202
Normal adult bilirubin
0.2-1.2
| If elevated expect jaundice, slceral icterus (yellow eyes), itching
203
Expectorants
Guiafenesin (Gough-fena-zin)
Guiaf rhymes with COUGH.
Used in non-productive cough associated with respiratory infection. Reduces viscosity of secretions and helps make cough productive.
SE: GI upset, dizziness. Pt should take with full glass of water.
204
Mucolytics
Acetylcysteine
For pulmonary disorders with thick secretions like CF. Also an ANTIDOTE for ACETAMINOPHEN overdose.
Action: breaks down molecules in mucus to reduce viscosity.
SE: bronchospasm. Use cautious with asthma patients. N/V and rash. And smells like rotten eggs. “Starts with A, smells like A”
205
Decongestants
Pseudoephedrine, phenylephrine
“I am phed-up with my congestion.” Used for rhinitis (nasal congestion). Causes vasoconstriction of respiratory tract mucosa.
SE: nervousness, palpitations, weakness, insomnia, possible rebound congestion.
Pseudoephedrine is a key ingredient in meth so it is kept behind the counter.
Phenylephrine is usually in OTC cold meds that you can find on the shelf.
206
Antihistamines
1st gen: diphenhydramine
2nd gen: loratadine, cetirizine
For allergy symptoms :runny nose, itchy/watery eyes, sneezing. Also used for Motion sickness and urticaria —hives.
Block H1 receptors which reduces effect of histamine in body.
1st gen side effects are more severe: sedation, anticholinergic, photosensitivity
Remember anticholinergic SE: can’t pee, can’t see, can't spit, can’t shit.
207
Corticosteroids (respiratory)
For respiratory —locally acting. Either inhalers or intranasal.
Beclomethasone, mometasone, budesonide, fluticasone. Use for asthma, rhinitis. Decrease inflammation locally.
SE (less than systemic steroid): HA, pharyngitis (sore throat), fungal infection. Pt must rinse mouth out to prevent fungal infection.
Bronchodilator with steroid: bronchodilator administered first, wait 5 min, then corticosteroid.
208
Leukotriene receptor antagonist
Montelukast, zafirlukast
Used in asthma and exercise induced bronchoconstriction. Decrease effect of leukotrienes which reduces airway inflammation and bronchoconstriction
SE: HA, and in zafirlukast may cause increase in liver enzymes. Montelukast should be taken in PM, or 2 hours before exercise.
Zafirlukast should be taken on empty stomach.
209
Antitussives
Benzonatate, codeine, dextromethrophan
Think A: BCD
Benzonatate: has anesthetic effect on vagal nerve receptors in airway. SE: sedation, constipation, GI upset.
Codeine binds of opioid receptors in CNS and decreases cough reflex. SE: sedation, respiratory depression, hypotension, constipation, GI upset.
Dextromethorphan: suppresses cough reflex in medulla. SE: dizziness and sedation at high doses.
210
Bronchodilators
Beta2 Adrenergic Agonists: Albuterol and salmeterol
Used in asthma, COPD, alone or in combination with glucocorticoid or anticholinergics like iprotropium. Bind to beta2 receptors in the lungs (2 lungs) and result in bronchodilation, opening airways.
SE: nervousness, tremor, chest pain, palpitations.
Albuterol —short acting beta2 adrenertic agonists so used in acute asthma attacks
Albuterol in Acute!
Salmeterol —long acting, used in prevention of asthma attacks. Salmon = long life. Salmeterol = long acting.
If using with glucocorticoid, use B2AA, wait 5 min, then use steroid. B before G.
211
Xanthines
Theophylline
Long term control of asthma and COPD.
Increases C-amp, which increases bronchodilation.
SE: HA, GI upset, nervousness, dysrthymias, seizure. Not used as much due to SE. Need regular blood draws to monitor levels. Therapeutic 10-20
212
Anticholinergics
Inhaled or nasal
Ipratropium
Used in COPD, rhinitis, asthma (asthma is off label). Used alone or with albuterol, (Duaneb). Relaxes smooth muscle, and has drying effects not a bronchodilator.
SE: dry mouth, bitter taste, throat irritation depending on how administered. Increase fluids, suck on candy.
Dua-neb —do not use if peanut allergy.
213
Calcium channel blockers
```
Treat HTN and angina
Verapamil
Nifedipine —also treats preterm labor
Diltiazem
Remember “Very Nice Drugs"
```
Mode of action:
Block calcium channels in heart and blood vessels which causes vasodilation and decrease in HR
SE: peripheral edema, hypotension, bradycardia, headache, constipation
Important teaching: don’t take grapefruit juice, monitor BP and HR.
214
Central acting alpha2 agonist
Clonadine
Decreases sympathetic outflow to heart and blood vessels, decreases heart rate and blood pressure.
Three D’s of clonaDINE —dizziness, drowsiness, dry mouth
Teach: suck hard candy, chew gum for dry mouth
215
Beta1 Blockers
HTN, angina, heart failure, myocardial infarction
Metoprolol and atenolol
"Only have 1 M.A.”
"1 heart”: Beta1 receptors are blocked and decrease blood pressure and HR
Bradycardia, hypotension, fatigue, erectile dysfunction. Also: BLACK BOX: abrupt cessation can cause angina and MI.
Teach: orthostatic hypotension get up slowly, monitor HR and BP, can mask signs of hypoglycemia
216
Nonselective beta blockers
Affect BOTH (nonselective) Beta1 receptors in heart and Beta2 receptors in the lungs (1 heart, 2 lungs)
Propanolol, labetalol, carvedilol
“Please Listen Carefully”
Treat HTN, angina, arrhythmia, MI
Decrease HP and HR, but can cause bronchospasm due to Beta2 effect —never give to someone with asthma or issues that would be exacerbated by broncho-constriction
Fatigue, hypotension, bradycardia, ED.
217
Direct renin inhibitor
Aliskiren
treats HTN
Inhibits renin, prevents angiotensinogen to be activated into angiotensin1. "Alice and Karin gang up on Angie”
SE: hypotension, angioedema, and GI upset. BLACK BOX: fetal toxicity
Monitor BP
218
Aldosterone Antagonist
Eplerenone
Used in HTN and HF after MI
Blocks mineralocorticoid receptors which inhibits effects of aldosterone and causes reabsorbptio of sodium and water
Eplerenone —does an EPic job of blocking aldosterONE
SE: HYPERKALEMIA, dizziness. Monitor K levels and BP.
219
infant and toddler weight gain
double birth weight by 6 months, triple by one year
| Slows in toddler years to 4-6 lbs per year. by Age 2.5 should be roughly 4 x birth weight.
220
Clozapine potential complications
Agranulocytosis. Important that WBC at or above 3500 and ANC at or above 2000 before starting medication, CBC and ANC must be monitored regularly. Can also cause prolonged QT and orthostatic hypotension so periodic ECG and BP monitoring is also indicated.
221
Glyburide
Stimulates insulin response via pancreas for T2DM, risk of prolonged hypoglycemia --should not be used in geriatric patients per Beers Criteria
222
Site of immunizations and needle length for children up to 12 months
```
Vastus lateralis (top of thigh)
1 inch needle
```
223
Normal troponinsBlurry spot in middle of vision
Troponin I <0.5
| Troponin T <0.1
224
Hyperresonance
Percussed over a hyperinflated lung or air in pleural space (pneumothorax)
225
Meniere disease
Endolymphatic hydrops --excess fluid in inner ear leading to episodes of vertigo, tinnitus, hearing loss, aural fullness. Nausea, vomiting, feeling of being "pulled to the ground." Priorities in tx: fall risk precautions, sedation, minimal stimulation, salt restriction
226
PaCO2 vs PO2 vs PaO2
PaCO2 --arterial carbon dioxide
PO2 --or sPo2 is O2 sat on peripheral monitor
PaO2 --arterial oxygen
227
Cerebellum functions
Voluntary movement, balance and posture
228
When is first MMR given
12-15 momths. Can be given earlier within 72 hours of exposure. If given early, next dose is 12-15 months, and again 4-6 years.
229
When can measles immunoglobulin be given?
Within 6 days of exposure to measles
230
Incubation period of measles
7-12 days
231
At what age does the posterior fontanel close?
| At what age does anterior fontanel close?
posterior by 2 months
| anterior by 18 months
232
What kind of med is detemir?
A long acting basal insulin
233
Gastric pH
should be acidic 5 or lower
| If pH is high, do an x-ray to confirm placement
234
When does head lag in an infant disappear
After 6 months
235
when is atropine administered
In symptomatic bradycardia, increases heart rate
236
What is reglan also known as and what is it used for? action
metoclopramide. used for nausea post op, increases rate of gastric emptying.
237
What is kernig sign
Sign of meningeal irritation --flexon of neck causes pain, flexion of knees/hip causes pain
238
What are the first and secondary signs of shock
First signs are increase in pulse and respiratory rate.
| Second sign is decrease in blood pressure
239
What foods can't someone with celiacs disease eat?
```
BROW
Barley
Rye
Oats
Wheat
```
240
How to perform CPR for cardiac arrest in a pregnancy person
Place hands slightly high on sternum and manually displace the uterus to the pt's left or roll their right hip onto a wedge or rolled up towel to displace the uterus by gravity
241
What is meningococcal meningitis
A bacterial meningitis often caused by N. meningitios = highly infections
242
Appropriate precautions for meningococcal meningitis
Droplet isolation and seizure precautions (head of bed 10-30 degrees)
243
Broca and wernike's aphasia
```
Broca = expressive aphasia. Can understan okay but difficulty/frustration with expression --non fluent, sparse speech.
Wernicke's = receptive aphasia. Can not really understand, can speak but is rapid and has no meaning.
```
244
Global aphasia
Cannot speak or understand
245
How to calculate cerebral perfusion pressure
MAP - ICP
246
Nutrition goal for infants under 6 months
110-120 kcal/kg/day
247
Osteoarthritis vs rheumatoid arthritis
```
Osteo = asymmetrical pain in weight bearing joints, crepitus esp. over knees
RA = symmetrical pain and swelling in small joints (hands, feet, wrists) and morning stiffness lasting at least an hour
```
248
Tidaling
is the fluctuation observed in the water seal chamber during respiration. Rises and falls, indicates proper function of the chest tube.
249
Therapeutic PTT
1.5 - 2 x normal = 46 -70 seconds.
| Over 100 seconds is critical.
250
S/sx addisonian crisis, monitoring in addison's disease
Crisis: LOW BP, LOW Blood sugar, dehydration, LOW sodium
HIGH Potassium, HIGH HR
Fever, weakness, confusion
Hypoglycemia, plus hyperkalemia and hyponatremia
Because corticosteroids are immunosuppressive and antinflammatory, they can mask signs of infection, and infection is also more likely so even a low grade fever is considered an emergency.
Manage with NS and D5, IV push steroids
251
GTPAL stands for
```
Gravida
Term (37+0 and later)
Preterm (20+0 to 36+6)
Abortion (spontaneous or therapeutic before 20 wga)
Living (living children)
```
252
Preferred therapy for DI
Desmopressin --replaces ADH without vasopressive effect of pitressin
253
Post op wound drainage in infants concerning levels
More than 3 ml/kg/hr for 3 consecutive hours, or more than 5-10 mL/kg in 1 hour = call provider
254
Rate of K infusion IV vs central line
no more than 10 mEq and no faster than 1 hour in IV
| no more than 40 mEq and no faster than 1 hour in central line
255
Normal cardiac outbut
4-8 L/minute
256
Gestational diabetes can result in what blood condition?
Polycythemia of the newborn (look for elevated hematocrit)
257
Cushing's triad
Hypertension
Bradycardia
Irregular respirations
258
SIRS criteria
at least 2 of the following:
T of <36.0 or >38.0
Tachycardia of >90
Tachypnia of >20
Leukocytosis of >12,000 or leukopenia of <4,000
Also: decreased urine output (less than 0.5 ml/kg/hr)
259
Upper limit of "normal" WBCs in pregnancy
15,000
260
What drug should be avoided before IV contrast
Metformin should be avoided for 24-48 hours before use of IV contrast dye and for 48 hours afterward to reduce risk of lactic acidosis
261
Macrolide abx
End in mycin but not aminoglycodies. Azythromycin, erythromiycin, clarythromycin.
262
What must be monitored for in macrolides?
Prolonged QT
| Liver function
263
Chest tube drainage system layout
Far left = suction control chamber
Second from left = water seal chamber
Remaining 3 right chambers = collection chambers
264
Dysarthria
Motor speech disorder. Can indicate impending respiratory distress if new
265
Blurry spot in middle of vision
macular degeneration
266
Leukocytosis
Elevated WBCs (infection)
267
Trismus
Inability to open mouth due to tonic contraction of the muscles used to chew. Can indicate a serious complication of tonsilitis.
268
Normal range of wet diapers
6-10 per day or 1 every 4 hours
269
Babinksi/plantar reflex
Toes fan out and big toe dorsiflexes with stimulation. Normal up to 12 months, beyond 1 year may indicate neurological disease.
270
Apraxia
inability to learn a new motor movement --whistling, clapping, dressing, due to neurological impairment
271
TORCH infections
Toxcoplasmosis, other (parvo B19, variceella), rubella, cytomegalovirus, herpes simplex
272
Nasal cannula
1-6 L/min, FiO2, 24-44%
| Low flow, best for pts with adequate tidal volume and normal vital signs
273
Simple face mask
6-8 L/min, FiO2 40-60%
| Low to high flow depending on use
274
Non-rebreather mask
10-15 L/min FiO2 60-90%
Face mask with reservoir bag and two one-way vaolves which prevent exhaled air from entering reservoir bag and room air from entering mask while CO2 is released to atmosphere. Bag must remain inflated --if it is not inflated, increase O2 rate.
Used for short term in pts with low saturation due to asthma, pneumonia, trauma, severe sepsis
275
Venturi mask
2-15 L/min FiO2 24-60%
Face mask and color-coded adapters which direct specific O2 concentration. Does not vary O2 concentration with breathing pattern and appropriate if pt cannot tolerate variation in O2 concentration. Used in persistent hypercarbia, and severe hypoxemia. Precise O2 delivery but not for patients with very high O2 demand.
276
In hypertensive crisis, how is BP managed?
It must be lowered slowly so as not to compromise perfusion to organs. Goal is not to decrease MAP more than 25%, or maintain MAP at 110-115 and then decrease lower over then next 24 hours
277
-xaban
Anticoagulants prevent and treat venous thromboembolism. More commonly prescribed oral anticoagulant than warfarin due to lower risk and less ongoing monitoring needed. Do NOT take with NSAIDs, garlic, ginger, which can increase bleeding risk.
278
-lam and -pam
Benzodiazepines. Anti-anxiety drugs. Taper, don't stop suddenly. Take at night due to sedative effect.
279
Sildenafil
Viagra. Do not use with nitrates (unstable angina patients). Do not give nitrates within 4 hours of use.
