yellow book Flashcards
If the pH and the BiCarb are both in the same direction then it is?
metabolic
If the pH is up it is?
Alkalosis
As the pH goes so goes my patient except for?
potassium
If the pH is down it is?
acidosis
If the pH is up my patient with show signs and symptoms of?
Increase… like tachycardia,diarrhea and borborygmi
If the pH is down my patient will show signs and symtoms of?
Decrease… like decreased output, bradycardia and constipation
If my pH is up my potassium (K+) is ?
down
If my pH is down my potassium (K+) is?
up
If my patient is overventilating I should choose?
respiratory alkalosis
If my patient is underventilating I should choose?
respiratory acidosis
If my patient has prolonged gastric vomiting or suction I choose?
metabolic alkalosis
If it is not lung or prolonged vomiting or suctioning I choose?
metabolic acidosis
Kussmal Respirations
Metabolic Acidosis ( Remember MacKussmal)
Before measuing ABGs you should check what?
Allen’s test. Should be positive. Pt makes a fist and pressure is applied to the ulnar and the radial arteries Ulnar pressure is released and color should return in 7 seconds (means it’s positive and OK to take ABG’s).
Definition of Compensation
PH is normal! It is never compensated if it is abnormal.
If PH normal
look in the direction it is going. Closer to Acidic? (7.35) acidosis.
Then look at Bicarb & figure out which is abnormal. If Bicarb is out of range, it’s metabolic acidosis.
If C02 is abnormal, it’s Respiratory Acidosis :)
If your pt is acidotic and you need to pick a symptom
Pick the symptom where everything is DOWN. ( And vice Versa)
Ex: 2 degree Morbitz Type 2 BLOCK.
If you don’t know what causes an acid base balance, pick
metabolic acidosis
If in doubt in ABGs, always pick
Headache, nausea, weakness & numbness+ tingling. It can be either up or down.
High pressure alarms are triggered when?
They cannot push air in
High pressure alarms are caused by what three types of obstructions?
Kinking, Water in dependant loops and mucus in the airway.
If kinking in the tube is present you?
unkink
If water is present in the dependant loops you?
Open system and empty water.
If mucus is present you?
Turn them, cough and have them deeo breath first. If ineffective you then suction.
Don’t suction unless
Coughing & deep breathing is deemed inappropriate.
In order to suction, you must be able to hear
mucus in the lung
Low pressure alarms are triggered when?
it is easy to push are in
Low pressure alarms are normally caused by?
disconnection
If the tubing is disconnected you?
reconnect
If O2 sensor line is disconnected you?
reconnect
In a vented client respiratory alkalosis means the vent setting may be too?
high
In a vented client respiratory acidosis means the vent may be too?
low
What do you do if the patients disconnected tube is on the floor?
Bag them, (call for help) get new tube and then reconnect.
First question to ask if the low pressure alarm sounds
where is the tubing?
HOLD
H- High Pressure
O- Obstruction
L- Low
D- Disconnections
Never put anything in YOUR scope of practice
on anyone else
Make sure your answer is
patient focused
TAKE CARE OF YOUR PATIENT!
Don’t answer based on staff, building, machine, etc.
PATIENT FIRST.
What does wean mean?
decrease gradually
What do you do if the patients disconnected tube is on the chest?
Reconnect … if its above the waist its ok.
Remember is PSYCH if you are asked to Prioritize, Don’t forget
MASLOW!
- Physiological
- Safety
- Comfort - Includes pain
- Psychological
- Social
- Spiritual
When prioritizing, always use Maslow + ABCs
For one patient. Don’t if you have more than one patient.
What is the biggest problem in abuse?
denial
To treat denial you need to?
confront them
Definition of Denial
Refusal to accept reality of their problem
How do you confront?
Point out the difference between what they say and what they do.
What is the one circumstance that you as a nurse would support denial?
loss and grief
always go
med surgery first then psych
what is dependency?
When the abuser gets a significant other so make decisions for them or do thing for them.
what is codependency?
When the significant other gets positive self esteem from doing things or making decisions for an abuser.
To treat dependency/codependency you ?
Set limits and enforce them.
Say NO and follow through.
Agree in advance on what requests are allowed, then enforce the agreement.
Work on self esteem of the codependent.
what is manipulation?
When the abuser gets the significant other fo do things for them that is not in the best interest of the significant other. This can be dangerous and harmful to the significant other.
How do you treat manipulation?
set limits and enforce
Why is manipulation easier to treat then dependency/codependency?
Because no one likes being manipulated.
DABDA
D- Denial A- Anger B- Bargaining D- Depression A- Acceptance
Psych Needs, In order
Denial
Depend
Manipulation
To address a patient’s psychological needs, they must be:
STABLE, safe, comfortable.
pain
Never killed anyone. NOT the top priority, especially if there are physiological needs in the question that make the patient unstable
What is Wernickes (Korsakoffs) Syndrome?
Psychosis induced by vitamin B1 (Thiamine) deficiency.
Symptom of Wernickes Korsakoffs syndrome?
Amnesia with confabulation.
= Loss of memory with making up stories to fill in the gaps.
Vitamin B1 helps breakdown?
alcohol
So without B1 what happens?
Alcohol isn’t metabolized correctly goes to the brain and causes Wernickes
Primary symptom of Wernickes?
Amnesia with confabulation (making up stories).
Is Wernickes preventable?
yes- take vitamin B1
Is Wernickes arrestable?
yes- take vitamin B1
Is Wernickes reversible?
no
What is the goal of patients dementia/organic brain syndrome?
maintain function, never improve
What is aversion therapy?
when you try and make the patient hate something
Antabuse onset and duration is?
2 weeks
Teach a patient taking Antabuse to avoid what?
alcohol
On top of alcohol a patient taking Antabuse should also avoid what other 7 things?
Alcohol Aftershave, Cologne, Perfumes Insect Repellent Elixirs Vanilla Extract Vinaigrettes Handsanitizer Alcohol Prep Pads Vanilla Icing
How long does it take for Antabuse to get out of the system so they can drink Alcohol again?
2 weeks
What are Elixirs?
95% of liquids. If it is not an antibiotic, assume it is an elixir, so the patient can’t have it if on antabuse.
This rule applies for diabetics too (elixers also have sugar).
What happens if a person on Antabuse ingests alcohol?
Nausea, Vomiting, & Possibly Death
In Overdose VS Withdrawal, Ask yourself?
Is this drug an upper or a downer?
What are the five uppers?
Caffeine, Cocaine, Methamphetamines, PCP/LSD and ADHD Meds, Bath Salts
downers are?
Everything other then the five uppers. Heroin Ativan Valiumn Fetanyl
S/Sx of uppers are?
Everything goes up Tachycardia Increased BP Irritability Fever Diarrhea \+4 Reflexes Pupil Dilation Excitability Seizures Borborygmi ETC.
s/sx of downers are?
Everything goes down Bradycardia Lethargy Constricted Pupils Hyporeflexia Flaccidity Respiratory Depression
with uppers and downers ask yourself?
Are they talking about Overdose or Withdrawal?
Overdose/Intoxication:
I have too much…
withdrawal:
I dont have enough
Overdose of a downer causes everything to go?
down
Overdose of an upper causes everything to go?
up
Withdrawal of an upper causes everything to go?
down
Withdrawal of a downer causes everything to go?
up
Upper withdrawal looks like
downer overdose
Downer Withdrawal looks like
upper overdose
At birth if the mother was addicted to a substance always assume the newborn is?
overdosed
If 24 hours after birth assume the baby is in?
withdrawal
Every alcoholic goes through what withing 24 hours after cessation?
Alcohol Withdrawal syndrome
What is Alcohol Withdrawal Syndrome?
Hyper irritability state less than 24 hours after the first drink
After 72 hours of alochol withdrawal a small minority may get?
delirium tremens
Can Delirium Tremens kill you?
yes
Can Alcohol Withdrawal Syndrome kill you?
no
Are patients with Alcohol Withdrawal Syndrome a danger to themselves or others?
no
Are patients with Delirium Tremens a danger to themselves or others?
yes
N/I for Delirium Tremens?
Private room near nurses station NPO/Clear liquids Restricted bed rest Restraints, tranquilizer, multivitamin (B1 Vitamin/Thiamine) Antihypertensive.
N/I for Alcohol Withdrawal Syndrome?
Semi-private room anywhere Regular diet Up and ad-lib, no restraint Tranquilizer Multivitamin (B1/Thiamine) Antihypertensive.
A two point restraint is?
One arm and the opposite leg.
N/I for restraints?
Check Q15min
Rotate sites Q2H
All aminoglycosides end in?
“mycin” Vancomycin
For Aminoglycosides, think:
a mean old mycin
Aminoglycosides treat?
Big gun antibiotics.
Treat serious, life threatening, resistant infections
If it has “thro” in it you?
Throw it out…Zithromycin.
It treats a minor infection
Toxic effects of aminoglycosides?
Ototoxicity
Nephrotoxicity
Cranial nerve 8 (vestibulocochlear nerve) which senses sound.
The one Aminoglycoside that doesn’t end in Mycin?
amikacin
What is another word for aminoglycoside?
glycopeptide
Monitor what with aminoglycoside use?
Hearing, balance, tinnitus & creatinine (best indicator of renal function)
Best indicator of aminoglycoside toxicity?
Ototoxicity (Ears)
Frequency of administration for aminoglycosides?
Q8H
Aminoglycoside route of administration?
IM or IV
Aminoglycosides are given PO for what two reasons?
Hepatic Encephalopathy and Pre-op bowel surgery.
What is Hepatic Encephalopathy also called?
Liver Coma, Ammonia-Induced Encephalopathy
If fluid resuscitation is used in shock, there will be
increased urine output
Neomycin and Kanmycin are used for what?
Bowel sterilzation?
Can also be given for C.Diff
Who can sterilize my bowel?
“Neo” “Kan”
If you give aminoglycosides PO, do you have to worry about side effects?
no
Hepatic Encephalopathy is caused by?
high ammonia levels
What raises ammonia levels the most?
ecoli in the gut
Why do you draw TAP levels?
narrow therapeutic window
When do you draw a trough level?
30 minutes before the next scheduled dose.
When do you draw a sublingual peak level?
5-10 minutes after it is dissolved.
When do you draw a IV peak level?
15-30 minutes after dose is finished.
When do you draw a IM peak level?
30-60 minutes after given
If you must pick a time to draw the peak, pick the highest amount of time without going over the limits
So for IV, Pick 30 Minutes, not 15.
Category A Bio terrorism Agents
most lethal
What are the Category A Bio terrorism Agents?
Smallpox Tularemia Anthrax Plague Hemorrhagic Fever, Such as Ebola Botulism
category B
a big ling list
Category C. Not very Lethal
Hanta Virus
Nipeh Virus
Small Pox Early Detection Symptom
Rash that starts around the mouth
small pox
Inhalation. Pt on AIRBORNE Precautions
Dies from Septicemia. No treatment
Tularemia
Inhalation
Chest Symptoms
Dies from RESPIRATORY FAILURE
Treat with Streptomycin
Anthrax spreads by
Inhalation (AIRBORNE PRECAUTIONS)
Anthrax looks like
Respiratory FLU
Anthrax death occurs from?
Respiratory Failure
Treat Anthrax with
Cipro, Penicillin, Streptomycin
Plague spreads by
inhalation
3 H’s of Plague
Blood Everywhere.
H- emoptysis - Coughing up blood
H-ematemesis - Blood in Vomitus
H-ematochezia - Bright red blood in the diarrhea
Plague patients die by
DIC and respiratory Distress
Hemorrhagic Illnesses (Like Ebola)
Petechiae and ecchymoses
= Pinpoint Hemorrhage, especially on Chest & Bruising
Botulism is
Ingested - Most Lethal
Dies from Respiratory Arrest
3 Major Symptoms of Botulism
Descending Paralysis (Starts in face and goes down)
Fever
But is Alert
Gullian Barre
Ascending Paralysis
Chemical Agents
Mustard Gas, Cyanide, and Phosgine Chlorine
Mustard Gas The Chemical Agent causes
blisters
Cyanide The Chemical Agent Causes
Respiratory Arrest.
What do you use to treat Cyanide Poisoning?
Sodium Thiosulfate IV
What does Phosgine Chloride Cause
choking
Sarin, the Nerve Agent, Causes
Massive Cholinergic parasympathic response
Cholinergic, Parasympathetic effects cause?
B-ronchorrhea B-ronchospasm S-Salivation L-acrimating U-rinating Constantly D-iaphoretic + Diarrhea G-I distress E-mesis
Ebola (Hemorrhagic Fever) Precautions
Standard, Contact, and Droplet
All chemical agents require only soap and water except for Sarin, which requires
A WEAK Bleach
What do you do in a Chemical Attack?
Decontaminate + Treat
What is the Nurse’s role in Chemical Decontamination?
Put clothes in Biohazard bag that gets burned
Put them in a Government Issued suit
They may need to be housed for a while
Biochemical Attack, what do you do?
Quarrentine
Calcium Channel Blockers are like what for the heart?
valium
Calcium Channel Blockers
Negative Ino, Chrono, Dromo
Calcium Channel Blockers treat what? (the 6 A’s)
Antihypertensive, Anti-Anginal, Anti Atrial Arrythmia and SVTS
Calcium Channel Blocker side effects? (the 2 H’s)
Headache and Hypotension
Also Bradycardia
Calcium Channel Blockers treat what Arrhythmias starting with?
A, as well as SVT
What causes angina?
Chest pain due to decreased O2 supply and demand issues.
What do Anti-Anginal Medications do?
Decrease O2 demand on the Heart, allowing more O2 to chest (dilate)
90% of Calcium Channel Blockers end in?
“dipine” and “zem”
When giving a Calcium Channel Blocker you hold and notify if?
Systolic is 100 or lower.
“QRS” refers to?
ventricular
“P” refers to?
atrial
Asystole is?
A lack of QRS repolarizations
Asystole
TX: Epinephrine
Think Heart Stimulant
Atrail Flutter is?
Rapid P-wave repolarizations in a saw tooth pattern.
Atrial Flutter
Pharmacological therapy, such as beta blockers, antiarrhythmics, or calcium-channel blockers, need frequent monitoring of EKG rhythm strips, heart sounds, and apical pulse rate. (Unlikely to ask this)
Atrial- Fib is?
Chaotic QRS depolarizations
Atrial Fibrillation
Chaotic Between QRS, but QRS is still PRESENT.
HR Has to be Irregular.
Treatment:
Heparin. IMMEDIATELY.
What do you do if the A-fib is unwitnessed?
- Heparin First
- Cardioversion
- ADENOsine 8 second Push- Watch for the pt to go into Asystole
BETA Blocker
CALCIum Channel Blockers
DIGitalis (Lanoxin)
V-fib is?
Chaotic QRS depolarizations
Ventricular Fibrillation
TX: Shock therapy.
you DE-FIB.
V-tach is?
Wide bizarre QRS’s
Ventricular Tachycardia
Treatment: Lidocaine & amniodarone
SVT - Subventricular Tachycardia
Narrow QRS. Treatment: A-denosine 8 second Push- Watch for the pt to go into Asystole B-eta Blocker C- Calcium Channel Blockers D- igitalis (Lanoxin)
PVC is?
Periodic wide, bizarre QRS’s
PVC
PVC is the deviation in the picture from the normal QRS.
Treatment is Lidocaine & Aminodorone
Be concerned about PVC’s if? ( rule of 6’s)
More then 6 per minute, 6 in a row
What are the 2 lethal arrythmias?
A-systole and V-Fib (Pic if V-Fib, Asystole is Flat Lining)
What are the 4 potentially life threatening arrythmias?
V-tach, A-fib, A-flutter and PVC
What are the 6 arrythmias you are tested over on the NCLEX?
V-fib, A-fib, A-flutter, PVC, A-systole and V-tach
What are the 6 arrythmias for NCLEX in order for prioritization?
A-systole, V-fib, V-tach, A-fib, A-flutter and PVC
When talking about arrythmias the word “chaotic” means?
Fibrillation
When talking about arrythmias the word ‘bizarre” means?
tachy
PVC’s fall on what wave of the previous beat?
T wave
When prioritizing lethal arrhythmias, if one happened 6 minutes ago and the other happened 15 minutes ago, which do you choose?
Always choose the closest to the 8 minute mark.
After 8 minutes the survival rate is LOW.
To treat PVC’s you give?
Lidocaine/Amnioderone
To treat V-tach you give? (If it starts with V you use..)
Lidocaine/Amnioderone
To treat supraventricular arrythmias you give?
Adeno
Beta
Calci
Dig (Lonoxin)
Supra means?
above
To treat V-fib you ?
Defibrillate …
For V-fib you D-fib
To treat AsystolE you give?
CPR
Epinephrine (atropine no longer given)
Oxygen
If asked how to treat A-fib first you?
Give Heparin then ABCD…. Heparin is instant Warfarin and Plavix take time.
What is the purpose of Chest Tubes?
To re-establish negative pressure in the pleural space
Pneumothorax removes
air
Hemothorax removes
blood
Pneumohemothorax
air and blood
An Apical chest tube is placed?
High (for air) A for air
A Basilar chest tube is placed?
Low (for blood) B for blood
Chest tubes after a surgery or trauma assumes it’s a?
Unilateral Pneumohemothorax
Does a pneumonectomy get a chest tube?
No..removes the pleural space
Patient Positioning after Chest Surgery
Chest Tube Up, good side down
Patient Positioning after Chest Surgery
Operative side (Good lung up) Or Back (Supine)
What 4 things do you do if the water seal breaks on a chest tube?
Clamp it 1st!!
Cut broken device off of tube
Put the tube in water (NS)
Unclamp.
What do you do if you kick over the collection bottle?
Set it back up
Tell the patient to take some deep breaths
What is the BEST thing to do if the water seal breaks?
Put it in water (NS).
the first= clamp it
What 4 things do you do if a chest tube comes out?
Cover hole with a gloved hand
Put on a vaseline gauze dressing,
Put on sterile dressing and then tape on 3 sides.
How many chest tubes (and where) for a Unilateral Pneumohemothorax ?
2 chest tubes, One side (Unilateral) one apical (for air/pneumo) and one basal (for blood-hemo)
How many chest tubes (and where) for bilateral Pneumothorax?
Bilateral- chest tubes on both sides
Pneumo- (air) Apical
= 2 apical chest tubes (one on each side)
How many chest tubes (And Where) for post-op chest surgery?
Unilateral, pneumohemo (2 chest tubes, one side, apical and basal)
Assume Chest trauma is a gunshot wound.
Straight Catheter is to a foley catheter
Like a Thoracentesis is to a Chest Tube :)
meaning less invasive, less infection risk
How long can you clamp a chest tube?
No longer then 15 seconds without a doctors order.
What do you use to clamp a chest tube and why?
Rubber tipped double clamps.
Rubber because it won’t pierce the tube and double because were nurses and if one is good two is better.
Is bubbling in the water seal continuously good?
No it is bad.
You need to find the air leak, tape it, report it and then record it.
Is bubbling in the water seal intermittently good?
Yes it should tidal on inhalation
Is bubbling in the suction control chamber intermittently good?
No it is bad.
You need to dial up the suction, report and record.
Is bubbling in the suction control chanber continuously good?
yes
When picking answers, narrow it down to two, then ask yourself
If i did this, but not this, what would be the outcome? Is it better?
In routine care, do you ever clamp a chest tube?
No. In an emergency, you can.
When picking answers ask yourself ?
Which one is MOST important to leave undone. More so than the others.
All congenital heart defects that are trouble start with a ?
“T”
Which exception to the rule of congenital heart defects doesn’t start with a T?
Left Ventricular Hypoplastic Syndrome
What defects have right to left shunts and are cyanotic?
Trouble defects
What defects have left to right shunts and are acyanotic?
Not trouble defects
All congenital heart defects have what?
Murmur and an echocardiogram done
What are the four defects of Tetrology of Fellot?
Ventricular Defect, Pulmonic Stenosis, Overriding Aorta and Right Hypertrophy
What is the saying to help remember the four defects of Tetrology of Fellot?
VarieD PictureS Of A RancH
1 fingerwidth is how many cm’s?
1
How to measure crutches
2-3 cm/fingerwidths below anterior AXILLARY FOLD to a point lateral and slightly in front of the foot
When measuring crutches, don’t pick
any foot landmark like a “toe” or “heel”
When the handgrip of a crutch is properly in place the elbow felxion should be?
30 degrees
If crutch is not 30*, what will happen?
nerve damage
Crutches should be how many fingerwidths below the armpit?
2-3
Describe a 2 point gait?
- one crutch and opposite foot together
- Other crutch and other foor together.
2 points 2gether and the same time.
Describe a 3 point gait?
- Move two crutches and bad leg together.
- Move good foot.
Move all three together and then the good leg.
Describe a 4 point gait?
NOTHING moves together
1. Right crutch 2. Left foot. 3. Left crutch. 4. Right foot.
It moves one at a time so 1,2,3,4 and 1,2,3,4, and 1,2,3,4
Describe swing through?
traditional crutching
Who uses Swing Through?
Amputees, non weight bearing (sprain/break)
Use the even numbered gaits when weakness is?
Evenly distributed (bilateral)
Remember, Even for Even, Odd for Odd
When using the even gaits what one is for severe and what one for mild problems?
2 point gait for mild 4 point gait for severe.
4 point gait for what?
Fresh Post Op
If the question says “systemic disease” when it comes to crutches
Assume it impacts both legs
Use the odd numbered gait when?
The problem is affecting one leg (unilateral)
When going up the stairs or down the stairs with crutched remember?
UP with the GOOD and DOWN with the BAD
Crutches always move with what leg?
the bad leg
What side do you hold the cane?
strong side
What side do you advance the cane with?
The weak side for a wide base support.
Step with opposites
For walkers remember you?
Pick it up, set it down and walk to it.
Remember for walkers that you
Always push, never pull
NO tennis balls on legs
If you put something on the
walker, make it the side not front
A non psychotic person has
insight and is reality based
A psychotic person has
has
No Insight and is Not reality based
Not all psych patients are
Psychotic. Show this in your answers!
7 Hallucinatory Words
Look See Listen Hear Feel Taste Smell
If the question has “appear” in psych, it is
A delusion ( a belief)
What is a delusion?
A false fixed belief, idea or thought.
This has no sensory component.
What are the three types of delusions?
Paranoid or Persecutory,
Grandiose
and Somatic
What is a paranoid delusion?
False fixed belief that people are out to harm you (CIA, FBI).
What is a grandiose delusion?
False fixed belief that you are superior (God, the Pope).
What is a somatic delusion?
False fixed belief about a body part (X-ray vision).
What is a hallucination?
False, fixed sensory experience.
Five types of hallucinations?
Auditory, visual, tactile (feel) olfactory gustatory (taste)
Most common type of hallucination?
Auditory (Especially Command)
What is an illusion?
Misinterpretation of reality.
It is a sensory experience.
How can you diffirentiate between illusions and hallucinations?
Illusion: Sensory response to something in reality [the news (reality) is talking TO them (illusion)]
Hallucination: Sensory response but nothing in reality pertains
Don’t treat all Psych patients
The same/like they are psychotic
Example of an illusion?
The clock on the wall is a bomb (the clock is real, but the belief isn’t)
What are the four types of functional psychosis?
Schizophrenia
Schizoaffective disorder,
Major depression/mania (bipolar).
(SCHIZO SCHIZO MAJOR MANIC)
Functional Psychotics have WHAT
The potential to learn reality
If a functional psychotic is having a delusion or illusion you?
Acknowledge the feeling ( I see you are upset),
Present reality (but we have no spiders in the room)
Set a limit ( we’re not going to talk about that lets talk about something else)
Enforce the limit ( I see you’re to ill to talk about reality).
Follow with : We have medication to treat those symptoms
NEVER set limits on
feelings
Present reality
positively
Example of presenting reality positively:
Tell them what they CAN do instead of what they CAN’T do.