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1
Q

When the pH goes up?

A 
So does the PT
(but then K+ goes down hypoK+)
>hyperreflexia
> irritable
> tachypnea
> tachycardia
> borborygmi 
> seizure (suction)
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2
Q

when the pH goes down?

A 
so does the PT. K+ goes up
> hypo reflexia
> bradycardia
> lethargy/ obtunded
> paralytic ileus
> coma
> resp arrest (ambu bag)
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3
Q

Kussmals resps:

A

MAC Kussmal

Metabolic ACidosis

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4
Q

when will is be metabolic alkalosis?

A

with prolonged vomiting or suctioning. Lose K+

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5
Q

what to do for high pressure ventilation alarm

A

triggered to increased resistance

> unkink tubing
empty water condensation in loops
suction mucus secretions–> get them to cough, turn and change position first

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6
Q

what to do for low pressure vent alarm

A

triggered to decreased resistance (air getting in too easy)

> reconnect tubing
extubation or decannulation (loss of airway)

senses FiO2
plug sensor back into wire hole?

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7
Q

what do you do for someone who is in denial after grief and loss

A

support it. dont confront it like substance/alcohol abuse

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8
Q

a codependent person lakes what and gets what out of catering to a dependent?

A

lacks self-esteem

gets a sense of “do good” for doing for the dependent

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9
Q

warnicke-Korsakoff?

A

alcohol withdrawl

warnicke- encephalopathy
korsekoff- psychosis

amnesia with confabulation- loss memory. makes up stories and believes them.

Nurse- dont confront. they think its real REDIRECT and RECHANNEL

Prevent with Thymine B1

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10
Q

Antibuse or Revia

A

> drugs for alcohol abuse
aversion therapy
wont start working for 2 weeks
avoid everything with alcohol

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11
Q

what are all the uppers?

A 
> caffeine
> cocaine
> LSD/PCP
> methamphetamine (cough syrup)
> adderall (ADD)
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12
Q

S & S of uppers

A

everything goes up.

> watch out for seizure (have suction at bedside)

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13
Q

S & S of downers

A

everything goes down

> watch out for resp arrest (ambu bag)

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14
Q

upper withdrawals

downer wd’s

A

looks like downers S & S

looks like uppers S & S

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15
Q

which 2 situations would resp arrest and depression be highest priority?

A

upper withdrawal and downer overdose

seizures**

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16
Q

new born drug addict

A

high for 24 hrs. then withdrawal.

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17
Q

what is delirium Tremens DT

A

withdrawal up to 24 hrs
72 hrs later some get confusion with withdrawal

> very unstable and can die
NPO / restraints / strict bedrest / danger

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18
Q

what do both alcohol WD and DT PTs get?

A

antiHTN
tranquilizer
B1

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19
Q

what are aminoglycosides?

A

Antibiotics when nothing else works. Big guns. mean olg mycin

** have mycin its mean, have thomycin its average

route IM or IV

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20
Q

what toxic effects for aminoglycosides

A
  1. ototoxicity - cranial nerve 8

2. nephrotoxicity- monitor creatinine

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21
Q

what do you use for hepatic encephalopathy or pre-op bowel prep?

A

Neomycin and Canamycin

route PO bc these drugs are not absorbed PO. ppl will just poop out and with it take ammonia with it.

wont have toxic effects PO

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22
Q

what is trough and peaks?

what is narrow range?

A

trough- lowest in blood right bfr drug given
peak- drug level highest in blood

check when therapeutic range is narrow.
Ex. dig 0.125-0.25

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23
Q

when do you draw troughs?

A

30 min bfr drug is given

any route

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24
Q

when do you draw peaks?

A

depends on route:
SL- 10-15 min after given
IV- 15-30 min after given
IM- 30-60 min after given

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25
Q

how long until antidepress begin to work?

A

2-4 weeks

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26
Q

Calcium Channel Blockers

A

Like valium for the heart “dipine” verapamil, cardiazem(can be IV drip)

A- antihypertensive. relax heart and blood vessels
AA- anti-anginals. relax heart and decrease O2 demand
AAA- anti-atrial arrhythmia (wont treat ventricular stuff)

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27
Q

CCB’s side effects

A

Headache
Hypotension

Hold CCB if systolic < 100

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28
Q

what would V.Fib look like?

A

chaotic squiggle line. no pattern

Fror V.Fib you D.Fib (shock)

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29
Q

V. tachycardia

A

sharp peaks, could be up or down and there is a pattern.

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30
Q

if the question says something about a P wave then…

A

it is taking about atrial. rule out vent

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31
Q

if has a QRS

A

its ventricular

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32
Q

what heart meds for ventricular?

A

lidocane

amioderone

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33
Q

what heart meds for atrial?

A

A- adenocard. push in 8 seconds. when you slam fast they go into asystole but they come out!

B- BB’s olol

C- CCB’s

D- Digitalis (Lanoxin)

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34
Q

meds for Asystole

A

Epi and Atropine in this oder

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35
Q

if broken seal in chest tube do…?

A
  1. clamp
  2. cut tube from broken device
  3. put end of tube in sterile water (BEST)
  4. unclamp to reestablish water seal
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36
Q

when is a heart defect trbl?

A

when it starts with T
blood is shunted right to left = blue

all heart defect kids will have murmurs

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37
Q

Tetralogy of Fallot

VarieD PictureS Of A RancH

A 
VD = ventricular defect
PS = pulmonary stenosis
OA = Overriding Aorta
RH = Right hypertrophy
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38
Q

contact precautions:

A 
fecal-oral:
> C.diff
> Hep A
> staph
> RSV (kids lick toys)
> Rotavirus (infant diarrhea)

gloves/gown
private room if poss

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39
Q

dropplet

A 
travel 3 feet.
> menmengitis
> Hep-flu B (epiglottitis)
> Rubella
> mumps
> pertussis

mask
eyewear

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40
Q

airborne

A

> TB
herpes Zoster
varicella Zoster

neg pressure
N95

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41
Q

what order do you put on PPE?

A

gown
mask
goggles
gloves

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42
Q

what order do you take off PPE?

A

gloves
goggles
gown
mask

43
Q

crutches

A

up with the good leg, crutches follow.
down with the bad leg.

2-4 = even number of limbs, 4= severe
3 = odd, weight bear allowed
swing through- NWB

44
Q

what is non-psychotic?

A

someone that is reality based and has insight to their problem. all their senses are same as mine.

45
Q

nurse intervention for non-psychotic?

A

Good therapeutic communication

“I hear that you are feeling down”
can you tell me more?

PT might be feeling depression.

46
Q

Polycythemia

A

chronic myeloproliferative disorder where the bone marrow makes too many RBC’s

> can occur in someone who has COPD d/t hypoxemia

> PT can develop blood clots

> PTs receive periodic phlebotomy (remove 300-500mls of blood to get hct <45%)

47
Q

when to report platelet when on heparin infusion?

A

when platelets decrease > or = 50% from PTs baseline

HIT, heparin induced thrombocytopenia

48
Q

what to do with elevated BUN?

A

increase IV fluids

49
Q

normal Hct

A

117-173

50
Q

plt

A

150,000-400,000

51
Q

allergies caused by

A

IgE

52
Q

Von Willebrand

A

bleeding disorder from deficient vW factor which helps with clotting

> can use untranasal desmopressin or topical thrombin)

> major will need vEF replacement

53
Q

Epinephrine

A

stimulates both alpha and beta-adrenergic receptors, dilates bronchial smooth muscle (beta 2), and provides vasoconstriction (beta 1)

IM better than SC

repeat Q 5-25 min

54
Q

albuterol

A

broncodilator

55
Q

diphenhydramine

A

antihistamine

modifies the hypersensitivity reaction and relieves puritis

56
Q

why wouldnt you give nitroglycerine for anaphylacitc shock?

A

decreases BP for already low BP

morphine is also avoided bc it can make puritis and hypotension worse.

57
Q

treating hypoglycemia without checking BS

A

15-20g of quick acting carbs. repeat 15 min as needed.

> careful not too much or could rebound into hyperglycemia.

> 1 tbs honey/syrup, 4 tbs jelly, 4-6 oz juice, 8 oz low-fat milk

58
Q

metabolic syndrome

A

3 or more to diagnose
puts PTs at high risk for stroke, DM, and cardiovas disease

effects:
> waist circumference
> BP
> triglycerides >150
> HDL < 40/50
> glucose > or = 5.6

We Better Think High Glucose

59
Q

Acromegaly

A

over production of GH

60
Q

lymph node after mastectomy

A

0.5-1.0cm = normal

mobile, firm and non-tender = normal

hard and fixed could = malig

61
Q

thyroid storm

A

hyperthyroid = graves from stress

> fever
tachycardia
elevated BP
anxious, trembling, restless

62
Q

malignant hyperthermia

A

perioperative setting from anesthesia

63
Q

Seritonin syndrome

A

when PT overdose on antidepressant that would increase seritonin

64
Q

what to check after thyroidectomy if twitching and tingle around mouth

A

Calcium

normal is 8.6-10.2

tetany
+ trousseau and chvostek

65
Q

cushing

A

excess corticsteroids (esp glucocorticoids/cortisol)

> admin steroids hydrocortisone/prednise

66
Q

RAIU test

A

give low dose radioactive iodine (high dose given if cancer to kill thyroid tissues)

scan performed:
> take preg test prior
> hold thyroid meds 5-7 days prior
> NPO for 2-4 hrs prior
> remove dentures/jewlery
> drink plenty of fluids after
> will be awake
> no breastfeeding
67
Q

hyperthyroid

A

> eat high cal diet 4000-5000

> increase protein and carbs
avoid high fiber

> avoid stimulants and spicy food

68
Q

fruity breath and increased resps for PT with DM

A

DKA
> check BS
> start IV infusion reg insulin
> IV bolus of NS

nurse must start IV bolus first bc need to treat dehydration.

Insulin pulls water, K+, and glucose into cells which could exacerbate vascular dehydrate and imbalance electrolytes

69
Q

why do you give a PT a bag to breath into if hypervent

A

to decrease CO2 being lost. leads to resp alkalosis

70
Q

DKA characterized by?

A

> hyperglycemia

> ketosis (break down fat)

> acidosis

71
Q

SLE causes

A

systemic lupus erythmatosus (autoimmune) = chronic inflam

> malar rash (face) butterfly
> pleuritis/ pleural effusion
> pericarditis/ pericardial effusion
> nephrotic/ nephritis
> arthritis 
> DVT
72
Q

for hyperparathyroidism

A

regulate Ca levels in blood

73
Q

phalen’s maneuver

A

diagnose carpal tunnel in wrist

74
Q

Romberg test

A

neurological exam to assess vestibule function, and vision (balance)

75
Q

acanthosis nigricans

A

hyperpigmentation and skin thickening on neck and axilla d/t insulin resistance (diabetic dermopathy or metabolic syndrome)

76
Q

BMI

A

18.5-24.9 = normal

77
Q

fasting total cholesterol

A

< 200

78
Q

diet highest risk for macrocytic anemia

A

B12 and folic acid deficient

B12 from animal foods

Vegans- no meat

79
Q

lacto-vegaterian

A

eat milk products

lacto-ovo = eat eggs

80
Q

DI

A

insuff ADH from manipulation of pit gland

81
Q

autonomic neuropathy for DM

A

AUTO- invol body movements :

> BP, HR, perspire, sex function, digestion

nerve damage. causes posteural hypotn

> take BP sitting and standing.

82
Q

who is at greatest risk for a PE?

A

post-major surgery

83
Q

SIADH

A

d/t head injury

excess ADH = water absorption from kidneys

low serium osmolality, low serium Na, urine op decreased and concentrated = high specific gravity

84
Q

altered mental status, easy bruising and hair loss =

A

liver disease

85
Q

HHS

A

hyperosmolar hyperglycemic state

> DM2

> can produce enough insulin to prevent DKA, but not enough to prevent HHS, osmotic diureses, and extracellular fluid deficit

BS > 33.3

eventually causes neurological manifestations

86
Q

radiation exposure

A

> affects tissues with fast proliferate.

> oral mucosa, GI tract and bone marrow.

87
Q

TB info

A

a PT with Latent TB is at increased risk of conversion to active TB if they start taking prednisone (or other steroids)

88
Q

sulfasalazine

A

GI anti-inflam

for IBD

89
Q

peaked T-waves indicate

A

hyperkalemia

> would be hyper in DKA only because of extracellular shift and not because of urine loss (initially)

90
Q

epistaxis

A

nose bleed

91
Q

neutropenia is determined when ?

A

count below 1.0 x 10(9)… or 1,000

92
Q

pheochromocytoma

A

tumor in the adrenal medulla = excess catecholamines = paroxysmal hypertensive crisis

> give nitroprusside to vasodilate and bring BP down

PT risk for stroke

93
Q

Psychotic

A

< someone who does not have insight and is not reality based.

< they are either having delusions, hallucinations or illusions

94
Q

delusions

A

< false fixed beliefs.
< no sensory component

Paranoid. grandiose, somatic (body can do things that they actually cant)

95
Q

hallucinations

A

all sensory

auditory, visual, tactile

96
Q

illusions

A

also sensory. misinterpret of reality

97
Q

3 kinds of psychosis

A
  1. functional
  2. dementia
  3. psychotic delirium
98
Q

functional

A

schizo, schizo, major, manics

< (schizo-effective disorder)
< bipolar is only psych in the manic phase

< nurse: teach reality

99
Q

4 steps to teaching reality:

A
  1. acknowledge feelings
  2. presenting reality- I know that the voices are telling you, but I do not hear voices…
  3. set a limit- that topic is off limits
  4. enforce the limit- I see you are too ill to be reality based, we can try again later. only end the conversation.
100
Q

dementia

A

< brain damage, stroke, organic brain syndrome, senile
< these ppl cannot learn reality

< Nurse:

  1. acknowledge feelings
  2. redirect them
101
Q

psychotic delirium

A

< temp, sudden, often d/t chemical imbalance in body

< drugs: intox on uppers/wd from downers, overdose, post-op, UTI, thyroid storm, adrenal crisis, steroid rage

< nurse: remove harm and keep them safe

  1. acknowledge their feelings
  2. reassure them- say its temp and it will go away
102
Q

ex. those ppl over there are plotting to kill me

psychizo-

dementia-

delerium tremons-

A

P- I see that you are feeling scared, the reality is those ppl are not saying they are going to kill you. this conversation is over

D- i see that you are scared. why dont we go somewhere else.

DT- I see that you are scared. you are safe. this is a symptom of your illness and it will eventually go away.

103
Q

narrowed self-concept

A

dont want to leave there room

N: I see that you are comfortable. you can leave your room when you want.

104
Q

if depressed (not major)

A

N: I see that you are depressed, but it is time to get up and shower. breakfast is at 0900. its 0830, you have 1/2 hr.

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