Part 2 Flashcards
Three treatments for hyperthyroidism
-radiative iodine (pt should be alone for 24 hours and after that must be careful w urine hazardous)
- PTU prumble thiouracil (Puts Thyroid Under) also a cancer drug knocks down WBC so monitor
-thyroidectomy can be total (need lifelong therapy and may have low calcium) or sub
Three treatments for hyperthyroidism
-radiative iodine (pt should be alone for 24 hours and after that must be careful w urine hazardous)
- PTU prumble thiouracil (Puts Thyroid Under) also a cancer drug knocks down WBC so monitor
-thyroidectomy can be total (need lifelong therapy and may have low calcium) or sub
for signs of thyroid storm
-very high temps
-very high BP (210/180)
- severe tachycardia
-psychotic delirium
very dangerous can harm brain bc hypoxic
How to treat thyroid storm
Temp down
O2 up
Concern for 12-48 after total or sub thyroidectomy
-totals get tetany (due to low Calcium, can close off airway)
-subs get storm
Never pick infection as an answer unless it is
Past 72 hours postop
Use caution when withholding thyroid preop (NPO) because
-any sedation could potentially kill them
Adrenal cortex disorder start with either
A or C
Addisons Disease is
Undersecretion of adrenal cortex
-hyperpigmented (tan)
- don’t adapt to stress (during stress glucose and BP go down and they do into shock)
-give steroids (add a sone addisons)
Cushing’s syndrome is ________ of the adrenal cortex
-oversecretion (cushy= more)
S/s of Cushing’s syndrome (also s/s of steroids)
-moon face
-hirsutism (increase body hair)
-water and sodium retention (losses potassium)
-gynecomastia (man boobs)
-Buffalo hump
-central obesity (small skinny limbs)
-decrease bone density
-easy bruising
- irritability
-immunosuppression
-HIGH GLUCOSE
-IM MAD I HAVE AN INFECTION
Treatment for Cushing syndrome
-adrenalectomy (then has to go on steroid therapy causing them to turn to moon man)
No small toys for children under
4 years
No metal toys for a child receiving
-oxygen
BEWARE OF FOMITES
Nonliving object that harbors microorganisms
Play for a 6-9 month old
-object permanence teaching
-jack in the box, peak a boo
When can a child have purposeful play
-9 months
-DO NOT PICK IF CHILD UNDER 9 months and HAS ANY OF THESE WORDS; build, sort, stack, make, construct
Good book for 6, 9 and 12 month olds
6 months: soft
6-9: window books (peak a boo)
-9-12: talking books
Toddler (1-2 y/o) toys
-push pull toys (mower)
-gross motor skills (running, jumping)
-no colored pencils, scissors
-parallel play
Preschoolers
-finger dexterity
-work on balance
-cooperative play
-pretend play
School age
-creative (let them do it)
-legos are great
What’s the reason for a Laminectomy
-to relieve nerve root compression
What’s the reason for a Laminectomy
-to relieve nerve root compression
3 s/s of nerve root compression
-pain
-paresthesia (numbness and tingling)
-paresis (muscle weakness)
3 s/s of nerve root compression
-pain
-paresthesia (numbness and tingling)
-paresis (muscle weakness)
3 locations for laminectomy
-cervical (neck)
- thoracic (upper back)
-Lumbar (lower back)
3 locations for laminectomy
-cervical
- thoracic
-Lumbar
Cervical spinal cord effects
Diaphragm and arms
Cervical spinal cord effects and considerations
Diaphragm and arms
-1st breathing then arms and hand function
Thoracic laminectomy effects and considerations
-cough mechanism and bowels
Lumbar laminectomy effects and considerations
-bladder and legs
-when have they last voided (bladder distended?) and then function of the arms and legs
Post Op laminectomy pts should not
-sit on side of bed with feet on the ground dangling
-not allowed to sit for longer then 30 mins
-may walk stand lie down without restrictions
When you don’t know a restriction what answer should you pick
6 weeks
Surgical laminectomy pt should NEVER again
Left something above their head
When is a high creatinine reportable?
When pt is to have a procedure with dye
INR levels above blank is a high priority
4
INR levels above blank is a high priority
4
Nursing actions for Low pH
Get a set of vitals and call the doctor
Defining characteristics for respiratory failure
-CO2 in the 60s
-02 in the 60s
-prepare to intubate and ventilate
BNP is the best indicator of
Congestive heart failure
-Should be under 100
Definitive indicator that HIV has converted to aids
CD4 count below 200
What do you do if ANC is below 500
-critical immuno suppressed
-neutropenic precautions
All psych drugs cause
Low BP
and
Weight changes (mostly weight gain, prozac can cause loss and gain)
All psych drugs cause
Low BP
and
Weight changes (mostly weight gain, prozac can cause loss and gain)
-
PHENOTHIAZINES
- all end in ZINES!!
-1st gen/typical anti-psychotics
-zines for the zany ( antipsychotics) - in small doses they are antiemetics
-considered major tranquilizers
Side effects of major tranquilizers
A- anticholingeric (dry mouth)
B- blurred visions
C- constipation
D- drowsiness
E- extrapyramidal syndromes (Parkinson’s like)
F- photosensitivity
G- aGranulocytosis (low WBC, immunosuppressive)
Decanoate
-long acting IM form given to non-compliant clients
-court ordered
-can be shortened as D
Tricyclic Antidepressants
-NSSRI
- elavil, tofranil, aventyl, desyrel
-side effects ABCD
-E is euphoria
BENZODIAZEPINES
-minor tranquilizers
- ALWAYS have zep in name
-also used preop to induce anesthesia, as a muscle relaxants, good for alcohol withdraw, seizures, help ppl fighting ventilator
If you want to put someone to sleep use the Zs
Zeps and zines and zapines (tranquilizers)
Names of MAOIs and s/s
-spot of beginning of the name
-MARplan, NARdil, PARnate
-side effects ABCD
Considerations for MAOIs
-Tyramine can cause a hypertensive crisis
- no aged cheese (can have mozzarella and cottage cheese), yogurt, cured/preserved/organ meats, alcohol, caffeine, chocolate, fermented foods, bananas, avocados (guacamole), and I need dried fruit)
-Also no OTC meds went on an MAOI
Lithium is unique from other psych drugs, because
-it does not stabilize, nerve cell membranes, but rather acts more like an electrolyte
- Three Ps: peeing, pooping and parenthesia (earliest sign of electrolyte imbalance)
What are the signs of toxic affects of lithium requiring the nurse to call the MD and hold medication
-tremors
-Metallic taste
-Severe diarrhea
Relationship of sodium to lithium
-Low sodium makes lithium more toxic
-High sodium makes lithium ineffective
PROZAC SSRIS
- same side effects as NSRI
-causes INSOMNIA give early in day
Haldol
- has decanoate form
-side effects ABCDEFaG
-1st gen/typical antipsychotic like the zines
-NEUROLEPTIC MALIGNANT SYNDROME may be evident in elderly, young, and schizophrenic pts w overdose
NMS neuroleptic malignant syndrome
- potentially fatal hyperpyrexia (fever)
-could reach 106 to 108 degrees (definitely over 105)
-Dosage for elderly patients should be half the adult dose
-also has anxiety and tremors (distinguish between EPS bc NMS has fever)
Clozapine (clozaril)
-2nd gen/atypical anti-psychotic
-these drugs generally end in ZAPINE
-slight minor side effects similar to zines (decrease in ABCDEF)
- DOES HAVE AGRANULOCYTOSIS side effect (low WBCs)
-Geodon (ziprasidone) has black box warning bc it can prolong the QT interval causing sudden cardiac arrest (avoid in cardiac pts)
Sertraline (Zoloft)
-SSRIs
-causes insomnia but can give at nighttime
-increases toxicities of other drugs bc they are not getting metabolized (adding to pts regime will require lower dosages of other meds)
-NO ST JOHNS WORT will cause serotonin syndrome
-INTERACTIONS W WARFARIN COUMADIN pt will bleed out if dose not lowered
Serotonin Syndrome
-potentially life-threatening
-Looks like the MAOIs patient that eat tyramine
-SAD Head= sweaty, apprehensive (sense of doom) dizzy and headache
Total weight gain for pregnancy
28lbs +/- 3
Weight gain in 1st trimester
1 lb/month (total 3 lbs)
Weight gain in 2nd+ 3rd Trimester
1 lb/week
-if you take the week and subtract 9 that is the weight that should be gained
-over by 1-2 lbs okay, 3 lbs need assessment, 4 lbs could be trouble
Fundal not palpable until
Week 12 (after 1st treatment)
When is the Fundus at the umbilicus
-20-22 weeks
-important to know for date of viability and know trimester the PT is in
4 positive signs of pregnancy
-fetal skeleton on x-ray
-Fetal presents on ultrasound
-Auscultation of fetal heart rate (starts beating at five weeks but you can hear it between 8 to 12 weeks)
-One examiner, palpates, fetal movement/outline but not when mom just feels it (quickening)
3 different ways to select a maternity question
when would you first = pick the earliest part of the range
When is it most likely? = pick the middle part of the range.
When should you … by? = pick the end of the range
When is Quickening
-16-20 weeks
-first feels 16 weeks
-most likely feels by 18 weeks
-when should you feel by 20 weeks
Order of Chadwick’s , Goodells and Hegars
-alphabetical order
Hegars signs
-uterine softening
Prenatal care educating
-once a month until week 28
-then once every 2 weeks until week 36
-finally once very week until delivery or week 42
Hemoglobin in pregnancy
-Will fall
-We don’t worry about it unless it gets really low
-gets lower and lower closer to birth
-acceptably low can be as low as 9
Pregnancy urinary incontinence
-1st and 3rd T problem
-treat by voiding every 2 hours (do from start of pregnancy to 6 weeks after delivery)
Treatment for difficulty breathing in pregnancy
-2nd-3rd T problem
-tripod position
How to treat back pain in pregnancy
-2nd and 3rd T problem
-gets worse and worse
-treat w pelvic tilt exercises
Effacement
Thinning of cervix
Station
-relationship of the fetal presenting part to moms ischial spines (the smallest diameter through which the baby has to fit for a vaginal birth, narrowest part of pelvis)
-negative station= head/presenting part is above the tight squeeze
- Positive station= presenting part has made it past the Tight squeeze
Engagement
Station 0
Lie
-relationship of the spine of the mother and the spine of the baby
-longitudinal lie= good! Parallel spines
-transverse lie= Bad, spines perpendicular
Olique lie= baby is diagonal to moms hip
Presentation
-the part of the baby that enters the births canals first
-when in doubt pick ROA (this first) or LOA
1st stage of labor
-1.Latent (LAT is order), 2. Active, 3. Transition
2nd Stage of Labor
-push baby out
Third stage of labor
-Push placenta out
Fourth stage of labor
-Stop bleeding by contracting the uterus
- 2 hours after delivery of placenta (then postpartum begins)
Contraction should not be longer than or closer than
-90 seconds
-Every two minutes
-If so, could indicate trouble in labor
-indicative of uterine tetany , uterine hyperstimulation, parameters to stop Pitocin
Active phase of labor
-contractions frequency= every 3-5 minutes
-Contraction duration = 30 to 60 seconds
-Contraction intensity= moderate
Frequency of contractions
-Beginning of one contraction to beginning of the next
How should a woman measure her intensity of a contraction
-teacher to palpate with one hand over the fundus with the pads of the fingers (fingertips)
-use other hand to time it
Painful Back Labour
- Occiput Posterior (OP = Oh Pain)
-position and push - (knee to chest)
-take fist and push it into her sacrum (applies counter pressure to relieve pain)
Prolapsed Cord
- HIGH PRIORITY EMERGENCY
-push-position
-push head off cord (DONT touch cord)
-Position knee chest to take compression off cord
-usually emergency C section
Interventions for ALL other complications in Labor and birth (uterine atony, uterine hypoTension, vena cava syndrome, uterine tetany etc(
-LION
-L turn on left side
-I increase IV
-O oxygenate
-N notify dr
Pitocin running in OB crisis
-STOP IT
-would be first before positioning
Pain meds in labor
Low fetal heart rate
This is bad
Do lion and if pit was running, stop it
High fetal heart rate
-Not a big deal document and take Mom’s temperature because it could be due to a fever
Low baseline variability
-when the fetal heart rate stays the same and does not change (this can be high low or in the middle)
-LION
High baseline variability
-good document it
Late decelerations
-heart rate slows down near the end or after a contraction
BAD do LION
Early Decelerations
-baby’s heart slows before or at the beginning of a contraction
-fine
Fetal Heart monitoring pattern
-3 bad start w L do LION
-1 variable do push and position
VEAL CHOP
V- variable = C- core compression
E- early Dec =H- head compression
A- acceleration= O-okay
L- late Dec = P-placental insufficiency
Stage 2 Delivery order
- Deliver head
- Suction mouth first and then nose
- Check for nuchal cord (around the neck)
- Deliver shoulders and body
BABY MUST HAVE ID BAND BEFORE LEAVING DELIVERY AREA
Stage 3 order
Delivery of the placenta
1. Make sure it’s all there
2. Check for 3 vessel cord
AVA
-2 arteries
-1 vein
Stage 4 of labor
-first 2 hours after delivery of placenta
-4 things you do 4 times an hour in the 4th stage
-vital signs (checking for signs of shock BP down, rates up cold and clammy)
-check Fundus (boggy then massage), if displaced then Catherize
-check pads (100% saturated in 15 mins bad)
-roll her over (check bleeding underneath her, can also assess perineal area)
Postpartum Uterine assessment
- firm, midline, height= day postpartum (1 cm/day)
Lochia (rubra, serosa, alba)
Rubra- 1st red (rubbing turns something red)
Serosa- pink (rosa rosey pink)
Alba- albinos are white yellowish
Postpartum Extremity Check
-thrombophlebitis
-via bilateral calf circumference measuring
-homans not very reliable
Milia
-distended sebaceous glands which appear as tiny white spots on babies face
Epstein pearls
-small white epithelial cyst on babies gums
Mongolian spots
-bluish black macules appearing over the buttocks and or size of a darker skin neonate
Erythema toxicum neonatorum
-red papular rash on babies torso, which is benign and disappears after a few days
Hemangiomas
-benign tumor of capillaries
Cephalohematoma
-swelling caused by bleeding between the ostium and periosteum of the skull the swelling does not cross suture lines
Capital succedaneum
-edematous swelling on scalp caused by pressure during birth. The swelling may cross suture line that usually disappears in a few days
-C.S may Cross Sutures, Cap is symmetrical
Vernix caseosa
-Caseus= cheese
-whitish she’s like substance which appears intermittently over the first 7 to 10 days
1.Nevus/nevi
2. Nevus flammeus
3. Telangiectatic nevi
- Generic term for birthmark.
- Non-blanchable port wine stain.
- Blanchable pink stork bites
Physiologic Jaundice
-appears after 24 hours of age and disappears at about one week
Tocolytics
- causes maternal tachycardia
-stops labor (used for premature labor)
Magnesium Sulphate
-stop labors
- high magnesium (opposite) makes everything go down (HR, BP, REFLEXES, RR and LOC goes down)
-
Methergine
-oxytocics stimulates contractions
-can cause high BP bc of vasoconstriction
Betamethasone
-steroid
- mom gets it IM
-given before baby is born
Survanta (surfactant)
-baby gets it
-given transtracheal
-after baby is born
What precautions must be taken for a client receiving radiation treatment?
-Private room in a bathroom
-Limit visitors, rotate nursing staff who provide care. Place sign at door and bedside.
What additional precautions must be taken for clients receiving sealed internal radiation?
-all bodily fluids are radioactive, use hazardous clean up gloves and gown
If a client sealed internal implant falls out, what should you do?
-pick it up with long handled forceps and put it in a lead container
