Set 3 Flashcards
1st degree AV block
3rd degree AV block
1st. .. Prolonged PQ interval >0.2 sec
3rd. .. Atria and Ventricles contract independently
Corticosteroid therapy teaching
- Do not stop abruptly
- Infection can come on quickly, report low grade temp to HCP
- Increase dose during times of stress
- Hyperglycemia is a side effect
- Diet high in calcium and protein, low in carbs and fat is recommended for increased muscle weakness and osteoporosis
- Cataracts are side effect. See eye doc yearly
- Do not take on empty stomach. Cause gastric irritation
Expected side effects of lithium therapy
Lithium is used to treat bipolar disorder Side effects: -dry mouth -drowsiness -weight gain
Chlorthalidone
Diuretic!!
MAOI diet
What drugs are MAOI’s
No tyramine MAOI's include: -isocarboxazid -phenelzine -tranylcypromine -selegiline
Clonidine
Do not stop taking abruptly.. taper over 2-4 days. Can cause rebound HTN
Hydroxychloroquine adverse reaction
Retinal toxicity and visual disturbances
See eye doc every 6-12 months
Clopidogrel
Anti-platelet (blood thinner)
Contraceptive use adverse reactions
ACHES Abdominal pain - ischemic bowel Chest pain - PE or MI Headaches - stroke Eye problems - retinal blood vessel ischemia Severe leg pain - DVT
Vancomycin and aminoglycosides adverse reactions
Ototoxicity and nephrotoxicity
Aminoglycosides
gentamicin
amikacin
tobramycin
Specific gravity
1.005-1.030
Elevated levels indicates concentrated urine and dehydration
Calcium channel blockers
Promote relaxation of vascular smooth muscle.... decrease HTN nifedipine amlodipine felodipine nicaridipine
Sulfonylurea drugs
Diabetic meds
glyburide
glipizide
glimepiride
Manifestations of Neurogenic shock
Massive Vasodilation
- Hypotension
- Bradycardia
Warm dry skin common in neurogenic shock due to blood pooling in venous circulation
Terazosin
Medication to treat BPH Side effect: -Orthostatic hypotension Teaching: -Take medication at bedtime to avoid dizziness
Normal male hematocrit
Normal male hemoglobin
39-50%
13.2-17.3
Symptoms of increased ammonia
Confusion
Give LACTULOSE. Lactulose decreases ammonia levels, so a therapeutic outcome of lactulose would be improved mental status
Syphillis and pregnancy
STI
Crosses the placenta and can have teratogenic effects on the fetus
Prenatal treatment is IM penicillin
If pt has penicillin allergy, pt will have penicillin desensitization
Doxycycline and pregnancy
Contraindicated in pregnancy. Can impair fetal bone mineralization and discolor permanent teeth
Varicella
Chicken pox!!!
Not infectious once lesions are crusted over
Give Acyclovir
Can have a topical antihistamine such as benadryl applied to lesions
UTI prevention
Do not use bubble bath or scented soaps. They cause irritation to urethra.
No bathing in antibacterial soap - reduce presence of normal flora
Use COTTON underwear! - Absorbs moisture (No nylon or spandex or tight clothing!)
Expected weight loss for newborns after birth
5-6% of birth weight is lost within the first 3-4 days of life
Expected findings at birth
Newborns tend to have cracked, peeling skin.
Steroids and BG
Steroids such as methylprednisolone will increase blood glucose
Seizure disorders and driving
Pt’s with seizure disorders should avoid driving or operating heavy machinery until they have permission from their Dr.
Infant CPR
Deliver chest compressions with either two thumbs or two fingers on the sternum, just below the nipple line.
Check the brachial pulse for no longer than 10 seconds
Single rescuer should do a 30:2 compression to breath ratio
Two rescuers should do a 15:2 compression to breath ratio
If single rescuer to unwitnessed collapse, perform 2 min of CPR before getting AED
Agoraphobia vs social anxiety disorder
Fear or anxiety about being in or anticipating certain situations like a new job, being in a crowd, traveling on a bus or train, being in a tunnel or bridge, open or closed spaces. They are concerned about having “trouble escaping” or getting help if they have a panic attack.
Social anxiety disorder is fear of being embarrassed, observed, scrutinized in social settings.
Milk is rich in what two nutrients
Calcium and Vit D
Battery
Intentional touching of person without their consent.
Ex: administering morphine to a confused pt by telling them it is saline
Ex: putting in a needed catheter to a competent pt who is refusing it.
Tetralogy of Fallot
Put in knee chest position during hypercyanotic episodes
Tidaling occurs in what chamber of the chest tube
Water seal chamber. Tidaling occurs during the inspiration and expiration of the pt
Therapeutic magnesium level in a pt with eclampsia/preeclampsia
4.7 mEq/L
Drugs to prolong labor
Terbutaline, Magnesium Sulfate, Indomethacin, Nifedipine
Suppress uterine contractions prolonging labor for 2-7 days
Ebola (viral hemorrhagic fever
Extremely contagious disease with high mortality rate
Standard, contact, droplet, and airborne precautions
- N95
-shoe covers
-face shield
-etc
Visitors are prohibited unless necessary. All visitors are logged and monitored for symptoms
Must be in airborne isolation room. Pt doesn’t have to wear PPE but all visitors and staff do.
Low-residue diet
NO fiber
Megacolon
Common, life threatening complication of Inflammatory bowel disease Manifestations -Abdominal pain/distention -Bloody diarrhea -Shock -fever
Blood thinners and surgery
Must discontinue 5-7 days before surgery
What is clopidogrel
Anti-platelet! So blood thinner
12 mo old vaccine schedule
Hib, PCV, MMR, Varicella, Hep A
Live vaccines
MMR, Varicella, Influenza nasal spray
Children who are immunocompromised should not receive live vaccines
Pregnant women should also not receive live vaccines
Goal A1c for diabetic clients
<7%
Vancomycin adverse effect
Can cause nephrotoxicity
-Monitor creatinine levels daily
Contraindications for knee replacements
Recent or current infections!
Hemophilia
Hemophilia is a disorder characterized by a deficiency in the production of coagulation proteins
Tdap (Tetanus, diptheria, pertussis) during pregnancy
Pregnant women should receive between 27 wks and 36 wks
Epistaxis
Nose bleed
Drawing up insulin
Okay to mix NPH and regular insulin
RN- draw up REG before NPH to avoid mixing
Atropine
Treats symptomatic bradycardia.
Hepatic encephalopathy
Complication of end stage liver disease
Result of inadequate detoxification of ammonia from the blood
Manifestations
-Confusion and lethargy
-Slurred speech
-Asterixis - flapping hand tremor that is found in hepatic encephalopathy
Rifaximin
ABX used to treat hepatic encephalopathy and IBS
Thyroid storm
Life threatening! Immediately report any symptoms: - Fever - Anxiety - tachycardia
IV opioid administration in pregnant women
Do not give when birth is imminent. May cause respiratory depression in baby!
May give when birth is still 2-4 hours out
Statin drug serious adverse affect
Rhabdomyolysis (pieces of muscle break off into the blood stream… may be fatal and cause kidney damage)
Report any muscle aches or weakness immediately
Normal PTT
Therapeutic PTT
PTT is the lab value we monitor for heparin therapy
Normal 25-35
Therapeutic 46-70
Rifampin
Used to treat TB
Side effect is that bodily fluids turn red-orange
Drugs that promote uterine tone after birth
Misoprostol, carboprost, methylergonovine
Methylergonovine is contraindicated in a pt with HTN
These drugs are used second line if fundal massage and oxytocin don’t work
Carbidopa Levodopa fun fact
Turns urine and saliva colors (red, brown, black)
Dyskinesia (facial or eyelid twitching, tongue protrusion, facial grimacing) indicates an overdose of carbidopa levodopa and should be reported immediately
Theophylline
Bronchodilator with a low therapeutic index
Toxicity occurs at levels >20
Can cause seizures and life threatening arrhythmia’s
Blood transfusions and voiding
Pt should void right before transfusion because if a reaction occurs, a fresh urine specimen will need to be collected to check for blood
Continuous IV drug infusions
RN not LPN
Antipsychotic side effects
-Extrapyramidal side effects
- Acute dystonic reaction: sudden onset, sustained muscle contractions
- Akathisia: Subjective restlessness with inability to sit still
- Drug-induced parkinsonism: tremor, rigidity, masked face, brady kinesia
Antipsychotic side effects
-Tardive dyskinesia
Involuntary movement after chronic use
- lip smacking
- stiff, jerky movements of arms
- rapid blinking
Antipsychotic side effects
- Neuroleptic malignant syndrome
Fever, rigidity, mental status changes, autonomic instability
Preeclampsia
Characterized by:
-proteinuria 300 mg/24 hr period or protein to creatine ratio of 0.3
Frequent urination common in pregnancy in general, not preeclampsia
Thrombolytic therapy
used to dissolve blood clots Contraindicated in : -pt with recent surgery (within 14 days) -pt with onset of symptoms >4 hours ago. Thrombolytic therapy is not effective if not administered within a 3-4.5 hour window from onset of symptoms. -Thrombocytopenia (platelets <100,000) -coagulation disorders
Celecoxib
NSAID!
NSAIDS
Increase risk of thrombotic events (MI, stroke) especially in patients with cardiovascular diseases (such as coronary artery disease)
Nitroglycerin action
Dilates blood vessels
Headache is an expected side effect from vasodilation
Lithium toxicity
Narrow therapeutic index (0.6-1.2) Levels >1.5 considered toxic Drugs that can cause increased lithium levels: -thiazide diuretics -NSAIDS -antidepressants Low sodium precipitates lithium toxicity
ST segment elevation myocardial infarction (STEMI)
Occurs when coronary artery is completely occluded
HIV precautions
Standard
- no extra precautions are needed.
- HIV spreads when nonintact skin comes in contact with blood, breast milk, semen, or vaginal secretions
N95 mask
Should be used with tuberculosis and varicella-zoster
PaO2 levels
<60 indicates hypoxemia in COPD. Contact HCP!
Preeclampsia report to HCP
Hyperreflexia (3+ or greater) and clonus (rhythmic jerking beats of the foot) may indicate worsening and likely seizure activity
Assessing petechiae, jaundice, and cyanosis in dark skinned patients
Petechiae: conjunctiva of eyes and buccal mucosa
Jaundice: Palms of hands and soles of feet
Cyanosis: nail beds of fingers and toes
Stridor
Harsh, high pitched breathing
Due to obstruction or constriction of large upper airway
Infections that can cause fetal abnormalities
TORCH Toxoplasmosis Other - parvovirus B19/varicella zoster virus Rubella Cytomegalovirus Herpes
AED use
The quicker an AED is used, the higher the outcome. Do not delay use!
Remove transdermal patches and wipe the chest of the medication
Dry the chest area if wet before applying. The patient does not need to be completely dry. They can be lying in a small pool of water.
Care for patient with increased intracranial pressure
- Position the HOB 30 degrees (not on lots of pillows)
- Keep body midline
- Give stool softeners to prevent straining
Adenosine
Used to treat supraventricular tachycardia
Risk factors for pelvic inflammatory disease
Multiple sex partners
History of STI (specifically ghonorrhea or chlamydia) or PID
Partner with STI
Lack of consistent barrier method contraception
Age 15-25
Left or right lateral recovery position
Used for an unconscious patient who is still breathing
Hyperkalemia EKG
Hypokalemia EKG
Hyper: Tall peaked T waves
Hypo: Inverted T wave
Diabetic Ketoacidosis treatment
Administer NS first! Then insulin. DKA patients are very dehydrated and need fluid replacement
First signs of fetal movement occur when
16-20 weeks, beginning to middle of of 2nd trimester
Allen’s test
Test used to determine patency of ulnar artery to see if radial artery is good to use to draw blood gases.
Occlude both arteries, open fist, fist should be pale, release pressure from ulnar artery, if blood returns to the hand, test Is positive and radial artery is good to use.
Placental abruptions vs placental previa
Placental abruption occurs when the placenta detaches from the uterine wall causing hemorrhage.
Placental previa occurs when the placenta attaches over the cervical opening
Amnesia
Partial or total loss of memory
Gluten free foods
Rice, corn and potatoes are OKAY!
No BROW Barley Rye Oats Wheat
Cervical cancer ethnic most common
African americans
Hispanics
American Indians
HTN, Ischemic stroke and African Americans
African Americans have the highest incidence of HTN in the world. They also have higher rates of ischemic stroke.
Hodgkins lymphoma
Cancer that begins in the lymphatic system Characterized by: -enlarged, painless lymph node -fever -weight loss -night sweats -itching -fatigue
Trazadone
Treats major depressive disorder, specifically insomnia associated with MDD.
Priapism (prolonged erection) is a common side effect
Normal fasting cholesterol
<200
Breastfeeding/newborns and HIV
Contraindicated in developed countries where good formula is available.
Infants born to HIV positive clients should receive antiretroviral therapy for 4-6 wks after birth
Holter monitor
Records a clients EKG for 24-48 hours
Things to note when using:
-Keep log of activities you are doing that day with any symptoms
-No bathing or showering during test period
Serotonin Syndrome
Caused by SSRI's Manifestations: -Clonus -Tremors -Diarrhea -HTN -Tachycardia -Agitation -Diaphoresis
NSAIDS
Ibuprofen
Naproxen
Ketorolac
Indomethacin
Meloxicam
NEPHROTOXIC - do not use in pt with kidney disease
Increase risk of thrombotic events (stroke, heart attack) in pt with cardiovascular disease!
Bell’s Palsy
Just affects the face. Vision, Balance, Consciousness and extremity motor function are not affected
Rheumatic Fever
Acute inflammatory disease of the heart
Occurs 2-3 weeks after streptococcal pharyngitis
Pleural effusion
Build up of fluid between lungs and lung sac
Regular insulin
Short acting (not rapid) Peaks between 2-5 hours
Isosorbide dinitrate
Used to prevent angina in patients with coronary artery disease
Nystatin oral suspension
Soak dentures in nystatin solution
Common Respiratory tract infections in children
Croup - barking cough and stridor
Epiglottitis - dysphagia and drooling, sitting up and leaning forward
Bronchiolitis - wheezing
^^^ Common manifestations for each
Epiglottitis
Pediatric emergency
Requires intubation and possible tracheostomy
Characterized by dysphagia, drooling, sitting up and leaning forward
Croup
Characterised by barking cough and stridor
Requires nebulized epinephrine with anesthesiologist standing by
Manifestations of septic shock
- fever or hypothermia
- hypotension
- prolonged cap refill
- tachycardia
- increased WBC
- decreased urine output
Cataract surgery post op teaching
Visual acuity won't improve for 1-2 wks Common to experience itching, photophobia and pain in affected eye for several days Avoid exercises that could increase intraocular pressure -bending -lifting more than 5 pounds -straining -sneezing -coughing -rubbing or placing pressure on eye
Phenytoin
Seizure medication
Therapeutic levels are 10-20
Early signs of toxicity: Gait unsteadiness and nystagmus (eye makes repeated uncontrolled movements)
Gingival hyperplasia (puffy and red gums) is an expected side effect
Oligohydramnios
Low amniotic fluid
Complications:
-undeveloped lungs
-umbilical chord compression
Hypomagnesemia
Can cause a lethal cardiac arrhythmia called torsades de pointes
Hemorrhagic stroke
Occurs when a blood vessel ruptures in the brain causing a bleeding into the brain
Opioid withdrawal vs use/overdose
Opioid use: constipation, lethargy, constricted pupils
Withdrawal: tachycardia
Erythropoietin administration
Erythropoietin is what makes RBC’s. It is a hormone produced by the kidneys.
Major ASE is HTN, uncontrolled HTN is a contraindication for erythropoietin administration.
CPR for pregnant client
Perform compressions slightly higher on sternum than usual.
Manually move uterus to the L, you may place pillows or blankets under pt to have them laying slightly on their L side to move the uterus.
If circulation does not return with 4 minutes, emergency C section, baby should be out within 5 minutes.
Oliguria
Very low urine output!
MAOI’s and SSRI’s
Should not be given together. Increased risk of life threatening adverse reactions
Atropine and adenosine
Atropine INCREASES heart rate. Given for bradycardia.
Adenosine DECREASES heart rate. Given for SVT.
Bishop score
System that predicts if a pregnant patient will have a successful induction. A score of >6-8 indicates a successful induction.
Nonstress test
Test to determine if the fetus is well oxygenated. Reactive nonstress test means that the Fetus HR is 110-160, with moderate variability,
