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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
how long until antidepress begin to work?
2-4 weeks
26
Calcium Channel Blockers
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)
27
CCB's side effects
Headache Hypotension Hold CCB if systolic < 100
28
what would V.Fib look like?
chaotic squiggle line. no pattern Fror V.Fib you D.Fib (shock)
29
V. tachycardia
sharp peaks, could be up or down and there is a pattern.
30
if the question says something about a P wave then...
it is taking about atrial. rule out vent
31
if has a QRS
its ventricular
32
what heart meds for ventricular?
lidocane | amioderone
33
what heart meds for atrial?
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)
34
meds for Asystole
Epi and Atropine in this oder
35
if broken seal in chest tube do...?
1. clamp 2. cut tube from broken device 3. put end of tube in sterile water (BEST) 4. unclamp to reestablish water seal
36
when is a heart defect trbl?
when it starts with T blood is shunted right to left = blue all heart defect kids will have murmurs
37
Tetralogy of Fallot VarieD PictureS Of A RancH
``` VD = ventricular defect PS = pulmonary stenosis OA = Overriding Aorta RH = Right hypertrophy ```
38
contact precautions:
``` fecal-oral: > C.diff > Hep A > staph > RSV (kids lick toys) > Rotavirus (infant diarrhea) ``` gloves/gown private room if poss
39
dropplet
``` travel 3 feet. > menmengitis > Hep-flu B (epiglottitis) > Rubella > mumps > pertussis ``` mask eyewear
40
airborne
> TB > herpes Zoster > varicella Zoster neg pressure N95
41
what order do you put on PPE?
gown mask goggles gloves
42
what order do you take off PPE?
gloves goggles gown mask
43
crutches
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
what is non-psychotic?
someone that is reality based and has insight to their problem. all their senses are same as mine.
45
nurse intervention for non-psychotic?
Good therapeutic communication "I hear that you are feeling down" can you tell me more? PT might be feeling depression.
46
Polycythemia
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
when to report platelet when on heparin infusion?
when platelets decrease > or = 50% from PTs baseline | HIT, heparin induced thrombocytopenia
48
what to do with elevated BUN?
increase IV fluids
49
normal Hct
117-173
50
plt
150,000-400,000
51
allergies caused by
IgE
52
Von Willebrand
bleeding disorder from deficient vW factor which helps with clotting > can use untranasal desmopressin or topical thrombin) >major will need vEF replacement
53
Epinephrine
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
albuterol
broncodilator
55
diphenhydramine
antihistamine modifies the hypersensitivity reaction and relieves puritis
56
why wouldnt you give nitroglycerine for anaphylacitc shock?
decreases BP for already low BP morphine is also avoided bc it can make puritis and hypotension worse.
57
treating hypoglycemia without checking BS
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
metabolic syndrome
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
Acromegaly
over production of GH
60
lymph node after mastectomy
0.5-1.0cm = normal mobile, firm and non-tender = normal hard and fixed could = malig
61
thyroid storm
hyperthyroid = graves from stress > fever > tachycardia > elevated BP > anxious, trembling, restless
62
malignant hyperthermia
perioperative setting from anesthesia
63
Seritonin syndrome
when PT overdose on antidepressant that would increase seritonin
64
what to check after thyroidectomy if twitching and tingle around mouth
Calcium normal is 8.6-10.2 tetany + trousseau and chvostek
65
cushing
excess corticsteroids (esp glucocorticoids/cortisol) > admin steroids hydrocortisone/prednise
66
RAIU test
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
hyperthyroid
> eat high cal diet 4000-5000 > increase protein and carbs > avoid high fiber > avoid stimulants and spicy food
68
fruity breath and increased resps for PT with DM
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
why do you give a PT a bag to breath into if hypervent
to decrease CO2 being lost. leads to resp alkalosis
70
DKA characterized by?
> hyperglycemia > ketosis (break down fat) > acidosis
71
SLE causes
systemic lupus erythmatosus (autoimmune) = chronic inflam ``` > malar rash (face) butterfly > pleuritis/ pleural effusion > pericarditis/ pericardial effusion > nephrotic/ nephritis > arthritis > DVT ```
72
for hyperparathyroidism
regulate Ca levels in blood
73
phalen's maneuver
diagnose carpal tunnel in wrist
74
Romberg test
neurological exam to assess vestibule function, and vision (balance)
75
acanthosis nigricans
hyperpigmentation and skin thickening on neck and axilla d/t insulin resistance (diabetic dermopathy or metabolic syndrome)
76
BMI
18.5-24.9 = normal
77
fasting total cholesterol
< 200
78
diet highest risk for macrocytic anemia
B12 and folic acid deficient B12 from animal foods Vegans- no meat
79
lacto-vegaterian
eat milk products lacto-ovo = eat eggs
80
DI
insuff ADH from manipulation of pit gland
81
autonomic neuropathy for DM
AUTO- invol body movements : > BP, HR, perspire, sex function, digestion nerve damage. causes posteural hypotn > take BP sitting and standing.
82
who is at greatest risk for a PE?
post-major surgery
83
SIADH
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
altered mental status, easy bruising and hair loss =
liver disease
85
HHS
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
radiation exposure
> affects tissues with fast proliferate. > oral mucosa, GI tract and bone marrow.
87
TB info
a PT with Latent TB is at increased risk of conversion to active TB if they start taking prednisone (or other steroids)
88
sulfasalazine
GI anti-inflam for IBD
89
peaked T-waves indicate
hyperkalemia > would be hyper in DKA only because of extracellular shift and not because of urine loss (initially)
90
epistaxis
nose bleed
91
neutropenia is determined when ?
count below 1.0 x 10(9)... or 1,000
92
pheochromocytoma
tumor in the adrenal medulla = excess catecholamines = paroxysmal hypertensive crisis > give nitroprusside to vasodilate and bring BP down PT risk for stroke
93
Psychotic
< someone who does not have insight and is not reality based. < they are either having delusions, hallucinations or illusions
94
delusions
< false fixed beliefs. < no sensory component Paranoid. grandiose, somatic (body can do things that they actually cant)
95
hallucinations
all sensory | auditory, visual, tactile
96
illusions
also sensory. misinterpret of reality
97
3 kinds of psychosis
1. functional 2. dementia 3. psychotic delirium
98
functional
schizo, schizo, major, manics < (schizo-effective disorder) < bipolar is only psych in the manic phase < nurse: teach reality
99
4 steps to teaching reality:
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
dementia
< brain damage, stroke, organic brain syndrome, senile < these ppl cannot learn reality < Nurse: 1. acknowledge feelings 2. redirect them
101
psychotic delirium
< 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
ex. those ppl over there are plotting to kill me psychizo- dementia- delerium tremons-
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
narrowed self-concept
dont want to leave there room N: I see that you are comfortable. you can leave your room when you want.
104
if depressed (not major)
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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