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Mark Klimek Yellow Book > Yellow Book > Flashcards

Yellow Book Flashcards

1
Q

Rule of the B’s?

A

If the pH and the Bicarb are both in the same direction then it is metabolic.

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2
Q

pH 7.30 HCO3 20

A

⬇️=acidosis ⬇️= metabolic

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3
Q

pH 7.58 HCO3 (bicarbonate) 32

A

⬆️ = alkalosis ⬆️ = metabolic

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4
Q

pH 7.22 HCO3 (bicarbonate) 30

A

⬇️= acidosis ⬆️= respiratory

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5
Q

Providing care to a client with the following blood has resulted: pH 7.32, CO2 49, HCO3 29, PO2 80, and SaO2 90%. Based on these results,the client is experiencing..

A

⬇️= acidosis ; ⬆️= respiratory

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6
Q

MacKussmaul

A

The only acid base to cause Kussmaul respirations is metabolic acidosis

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7
Q

Acid

A

As the pH goes, so goes my patient except for Potassium

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8
Q

Up

A

Hypokalemia,alkalosis, HTN, Tachycardia, Tachypnea, Seizures, Irritability, Spastic, Diarrhea, Borborygme, hyperreflexia etc

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9
Q

Down

A

Hyperkalemia, acidosis, HTN, bradycardia, constipation, absent bowel sounds, flacid, bradypnea

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10
Q

Causes of acid-base imbalances

A

Is it lung? If yes, then it’s respiratory.
Ask your self..
Are they overventilating or underventilating.
If it is overventilating, pick alkalosis.
If it is underventilating pick acidosis.

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11
Q

Causes of acid-base imbalances:

A

If it is not the lung, then its metabolic. If the patient has prolonged gastric vomiting or suction, pick alkalosis.

For everything else that isn’t lung, pick metabolic acidosis. When you don’t know what to pick choose metabolic acidosis.

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12
Q

What are high pressure alarms triggered by?

A

High pressure alarms are triggered by

INCREASED resistance to air flow.

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13
Q

What are the obstructions that trigger high pressure alarms?

A

High pressure alarms are triggered by increased resistance to airflow and can be caused by obstructions of the types
(Kinked tube) unkink, (water in tube) empty, (mucus in airway) cough and deep breathe.

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14
Q

What are low pressure alarms triggered by?

A

Low pressure alarms are triggered by DECREASED resistance to airflow.

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15
Q

How are low pressure alarms triggered by disconnections?

A

Low pressure alarms are triggered by decreased resistance to airflow and can be caused by disconnection of the

Tubing (reconnect it) , oxygen sensir tube (reconnect it UNLESS tube is on the floor - bag them and call RT if this happens)

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16
Q

Respiratory Alkalosis means what?

A

Respiratory alkalosis means ventilator settings may be too HIGH

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17
Q

Respiratory acidosis means what?

A

Respiratory acidosis means ventilator setting may be too LOW

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18
Q

What does “wean” mean?

A

Gradually decreased with the goal of getting off altogether

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19
Q

What is Maslow’s highest priority to lowest priority?

A
  1. Physiological
  2. Safety
  3. Comfort
  4. Psychological (problems within the person)
  5. Social (problems with other people)
  6. Spiritual
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20
Q

Arrange from highest to lowest priority using Maslow’s

A 
Electrolyte Imbalance (Physiological) 
Fall Risk (Safety) 
Pain in elbow (Comfort) 
Denial (Psychological) 
Pathological family Dynamics (Social) 
Spiritual Distress (Spiritual)
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21
Q

What are the 5 stages of grief?

A

Denial
Anger
Depression
Acceptance

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22
Q

The #1 problem in abuse is

A

Denial

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23
Q

What is Denial?

A

Denial is the REFUSAL to accept the REALITY of their problem.

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24
Q

How to treat denial?

A

CONFRONT it by pointing out to the person the difference between what they SAY and what they DO. In contrast, SUPPORT the denial of loss and grief

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25
Q

What is dependency?

A

When the ABUSER gets the significant other to do things for them or make decisions for them.

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26
Q

What is Codependency?

A

When the SIGNIFICANT OTHER derives positive SELF-ESTEEM from doing things for or making decisions for the ABUSER

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27
Q

How to treat dependency or codependency?

A

Set LIMITS and ENFORCE them. Agree in advance on what requests are allowed then enforce the agreement

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28
Q

When treating dependency/codependency?

A

Work on the SELF-ESTEEM of the codependent person

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29
Q

Manipulation

A

When the ABUSER gets the SIGNIFICANT OTHER to do things for him/her that are not in the INTEREST of the SIGNIFICANT OTHER. The nature of the act is HARMFUL or DANGEROUS to the SIGNIFICANT OTHER.

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30
Q

Treating Manipulation

A

Set LIMITS and ENFORCE

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31
Q

Wernicke’s (Kosakoff’s) Syndrome

A

PSYCHOSIS induced by vitamin B1 (thiamine) deficiency

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32
Q

Primary Symptoms of Wernicke’s (Korsakoffs) Syndrome

A

AMNESIA (MEMORY LOSS) with CONFABULATION (MAKE UP STUFF)

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33
Q

Wernicke’s (Korsakoff’s) Syndrome charteristics

A
  1. Preventable (take vitamin)
  2. Arrestable (take vitamin)
  3. Irreversible (kills brain cells)
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34
Q

Antabuse/Revia is what?

A

Aversion Therapy

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35
Q

Antabuse/Revia effectiveness

A

The onset and duration of effectiveness of Antabuse/Revia is 2 Weeks

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36
Q

Patient tracing with Antabuse/Revia

A

Avoid ALL forms of ALCOHOL to avoid NAUSEA, VOMITING, DEATH

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37
Q

What are example of products that contain alcohol?

A

Mouth wash, cologne, perfume, aftershave, elixir, most OT liquid medicines, insect repellant, vanilla extract, vinagerettes, hand sanitizer

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38
Q

What occurs with alcoholics?

A

Every alcoholic goes through ALCOHOL WITHDRAWAL SYNDROME. Only a minority get DELIRIUM TREMENS

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39
Q

Alcohol Withdrawal Syndrome

A

ALCOHOL WITHDRAWAL SYNDROME is not life-threatening. DELIRIUM TREMENS can kill you

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40
Q

Alcohol Withdrawal Syndrome

A

Patients with ALCOHOL WITHDRAWAL SYNDROME are not a danger to themselves or others. Patients with DELIRIUM TREMENS are dangerous to self and others.

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41
Q

Would you place an AWS (Alcohol Withdrawl Syndrome) or DT (Delirium Tremens) patient in a semiprivate room,any location ?

A

AWS (Alcohol Withdrawal)

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42
Q

Would you place an AWS (Alcohol Withdrawl Syndrome) or DT (Delirium Tremens) patient in a private room near the nurses station?

A

DT (Delirium Tremens)

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43
Q

Which patient gets a regular diet AWS or DT?

A

AWS

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44
Q

Which type of diet is a DT patient have?

A

Clear liquid or NPO diet (risk for aspiration)

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45
Q

Which patient is up at liberty?

A

AWS

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46
Q

Restricted to bedrest with no bathroom privileges

A

DT

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47
Q

Utilizing no restraints

A

AWS

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48
Q

Usually restrained with either vest or 2 point (1 arm and 1 leg)

A

DT

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49
Q

Give anti-HTN medication

A

AWS and DT

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50
Q

Give tranquilizer medication

A

AWS and DT

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51
Q

Multivitamin to prevent Wernicke’s

A

AWS and DT

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52
Q

For Aminoglycosides,think

A

A mean old mycin

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53
Q

When are antibiotics/aminoglycosides used?

A

To treat serious, life-threatening , resistant infections

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54
Q

Aminoglycosides

A

All Aminoglycosides end in MYCIN, but not all drugs that end in MYCIN are Aminoglycosides

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55
Q

What are some examples of wannabe mycins?

A

Azithromycin , Clarithromycin, Erythromycin

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56
Q

What are some examples of Aminoglycosides?

A

Streptomycin, Cleomycin, Tobramycin, Gentamycin,Vancomycin, Clindamycin

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57
Q

When remembering toxic effects of mycins think

A

Mice = ears

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58
Q

What is the toxic effect of Aminoglycosides and what must you monitor?

A

Ototoxicity; monitor hearing, balance and tinitus

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59
Q

Toxic effect of Aminoglycosides?

A

The human ear is shaped like a KIDNEY so another toxic effect of Aminoglycosides is NEPHROTOXICITY so monitor CREATININE

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60
Q

Aminoglycosides and relation to Cranial nerves

A

The number 8 drawn inside the ear reminds you of cranial nerve 8 and frequency of administration Q8H

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61
Q

Aminoglycosides are not given PO usually unless in these two cases:

A
  1. HEPATIC ENCEPHALOPATHY( liver coma,ammonia induces encephalopathy) ( due to high AMMONIA level)
  2. Pre-op BOWEL surgery
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62
Q

Who can sterilize my bowel?

A

Neo Mycin

Kano Mycin

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63
Q

What is the reason for drawing trough and peak levels?

A

Narrow therapeutic level

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64
Q

When do you ALWAYS draw the trough?

A

30 minutes before next dose

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65
Q

When do you draw the Peak level of sublingual medications?

A

5-10 minutes after drug dissolves

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66
Q

When do you draw the Peak level of IV medications?

A

15-30 minutes after medication is finished

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67
Q

When do you draw the peak level of IM medications?

A

30-60 minutes after injecting it

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68
Q

When do you draw the Peak level of SQ medications?

A

Depends on type of insulin

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69
Q

When do you draw the peak level of PO medications?

A

Not necessary

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70
Q

What are biological agents in Category A?

A 
Staph B 
Small Pox 
Tularemia 
Anthrax 
Plague 
Hemorrhagic illness 
Botulism
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71
Q

What are Biological Agents im category B?

A

All others

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72
Q

What are Biological Agents in Category C?

A

Nipeh Virus

Hanta Virus

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73
Q

When it comes to Biological Agents

A

Category A is THE WORST, Then Category B, Then Category C

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74
Q

Small Pox

A

Inhaled transmission/ on airborne precautions dies from septicemia - no treatment rash starts around mouth first
Category A

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75
Q

Tularemia

A

Chest symptoms
Dies from respiratory failure
Treat with streptomycin
Category A

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76
Q

Anthrax

A 
Spread by inhalation 
Looks like the flu 
Does from respiratory failure 
Treat with supro, PCN, and streptomycin 
Category A
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77
Q

Plague

A

Spread by inhalation
Has the 3 H’s: Hemoptysis (coughing up blood) Hematemesis (vomiting up blood) , Hematochezia (blood in stool)
Deis from respiratory failure and DIC (bleed to death)
Treat with Doxycycline and Mycins
No longer communicable after 48 hours of treatment
Category A

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78
Q

Hemorrhagic Illnesses

A

Primary symptoms are petechiae (pinpoint spots) and ecchymoses (bruising)
High % fatal
Category A

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79
Q

Botulism

A

It is ingested
3 major symptoms:
Descending paralysis fever but is sleet does from respiratory arrest
Category A

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80
Q

What are some examples of chemical agents that cause bioterrorism?

A

Mustard Gas
Cyanide
Phosgine Chlorine
Sarin

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81
Q

What are the primary symptoms of mustard gas ?

A

Blisters (Vesicant)

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82
Q

What is the primary symptoms of Cyanide and how do you treat it?

A

Treat with Sodium Thiosulfate IV

Respiratory Arrest

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83
Q

What is the primary symptom of Phosgine Chlorine?

A

Choking is the primary symptom

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84
Q

What are the symptoms of Sarin?

🔆 Hint its a nerve agent 🔆

A

BB SLUDGE - just remember every secretion in your body is being excreted excessively

Bronchoapasm
Bronchorrhea 
Salivating
Lacrimating (tears) 
Urination 
Diaphoresis/Diarrhea 
G.I upset 
Emesis
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85
Q

What do you use when cleansing patients exposed to chemical agents?

A

All chemical agents require only soap and water cleansing except Sarin which requires bleach.

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86
Q

Which agents do you isolate the patient for?

A

Biological Agents

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87
Q

Which agents do you decontaminate for?

A

Chemical agents

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88
Q

How does decontamination work?

A

Gather exposed people
Take to decontamination center where people remove clothing, shower , dress in non-contaminated clothes, then release to other services.
Put contaminated clothing in special bag and throw away( be sure not to touch it)

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89
Q

Calcium Channel Blockers

A

They are like VALIUM for your heart. What does that mean?

It relaxes the heart!

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90
Q

Calcium Channel Blockers

A

NEGATIVE inotropic,chronotropic , dromotropic

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91
Q

Inotropic

A

Strength of heart

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92
Q

Positive Inotropic

A

Strong heartbeat

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93
Q

Negative Inotropic

A

Weak heartbeat

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94
Q

Chronotropic

A

Rate of heartbeat

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95
Q

Positive chronotropic

A

Fast heartbeat

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96
Q

Negative Chronotropic

A

Slow heartbeat

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97
Q

Dromotropic

A

Conductivity of heart

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98
Q

Positive Dromotropic

A

Excitable heart

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99
Q

Negative Dromotropic

A

Blocks/slow conduction

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100
Q

Positive Inotropic chronotropic and Dromotropic is seen with which medications?

A

Atropine, Epinephrine and norepinephrine

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101
Q

Negative Inotropic chronotropic am Dromotropic is seen with which medications?

A

Calcium channel Blockers and Beta Blockers

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102
Q

What do calcium channel blockers treat? (Indications)

A

Antihypertensives (decrease BP)
Anti Angina (imbalances between 02 supply and demand)
Anti Atrial Arrhythmic (Atrial Flutter and Atrial fibrillation)

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103
Q

What are some of the side effects of calcium channel blockers?

A

Headache

Hypotension

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104
Q

Names of calcium channel blockers

A

I sop zem dipine in the calcium channel ( “zem”, “dipine”, “verapamil/isoptin”)

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105
Q

“QRS” depolarization always refers to

A

Ventricular (not atrial,junctional or nodal)

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106
Q

“P wave” refers to

A

Atrial

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107
Q

Asystole

A

A lack of QRS Deploarization (flat line)

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108
Q

Atrial Flutter

A

Rapid P-wave depolarizations in a saw-tooth pattern (flutter)

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109
Q

Atrial Fibrillation

A

Chaotic P-wave depolarizations

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110
Q

Ventricular Tachycardia

A

Wide bizarre QRS’s

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111
Q

Premature Ventricular Contractions (PVC)

A

Periodic wide, bizarre QRS’s

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112
Q

You will be concerned about PVC’s if:

A

More than 6 per minute
6 in a row
PVC falls on T-Wave of previous beat

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113
Q

What are the lethal arrhythmias?

A

Asystole and ventricular fibrillation

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114
Q

What is the potentially life-threatening arrhythmias?

A
  1. V-Tach (Venticular- Tachycardia)
  2. A- Fib (Atrial - Fibrillation)
  3. A-Flutter (Atrial- Flutter)
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115
Q

IV push drugs

A

When dealing with an IV push drug if you don’t know go SLOW except ADENOCARD

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116
Q

What is the treatment for PVC’s?

A

Lidocaine and Aminodarone

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117
Q

What is the treatment for V-Tach?

A

Lidocaine and Amiodarone

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118
Q

What are the treatments for supraventicular arrhythmias?

A 
ABCD 
Adenocard/Adenosine 
Betablocker ( end in lol) 
Calcium Channel Blockers 
Digitalis/ Digoxin (Lanoxin)
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119
Q

What is the treatment for V-Fib

A

You will actual Defibrillator

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120
Q

What is the treatment for Asystole?

A 
Give Epi (Epinephrine) FIRST! 
Then give Atropine
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121
Q

What is the purpose of a chest tube?

A

The purpose of a chest tube is to re-establish NEGATIVE pressure in the pleural space.

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122
Q

What does the chest tube remove from the pneumothorax?

A

The chest tube removes air.

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123
Q

What does the chest tube remove from the hemothorax?

A

The chest tubes removes blood.

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124
Q

What does the cheat tube remove from the pneumohemothorax?

A

The chest tube removes air and blood.

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125
Q

Chest Tube High

A

When the chest tube is APICAL(HIGH) for AIR. Aka APEX

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126
Q

Chest Tube Low

A

When the chest tube is BASILAR (LOW), for BLOOD. Aka BASE(BOTTOM OF LUNG)

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127
Q

How many chest tubes are needed for a patient with unilateral pneumohemothorax?

A

2 chest tubes are needed

1 apical and one basilar on the side that has pneumohemothorax.

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128
Q

How many chest tubes are needed for a pt with bilateral pneumothorax?

A

2 chest tubes are needed

Both are placed apical

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129
Q

How many chest tubes are needed for a pat post-op chest surgery/ chest trauma?

A

Assume unilateral pneumohemothorax
2 chest tubes are needed
1 apical and 1 basilar on side of pneumohemothorax

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130
Q

Chest Tube Rules

A

In routine NEVER clamp chest tube. In emergency CLAMP the chest tube

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131
Q

What do you do if you kick over the collection bottle?

A

Set it back up (Not an emergency)

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132
Q

What do you do if the water seal breaks?

A

FIRST- Clamp it , cut tube away from device

BEST- Submerge the tube under water then unclamp

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133
Q

What do you do if the chest tube comes out?

A

FIRST- Cover with a gloved hand

BEST- Cover the hole with vaseline gauze put a dry sterile dressing on top tape on 3 side’s

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134
Q

If theres bubbling in the water seal intermittently what do you do?

A

Its is normal for this to occur

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135
Q

If there is bubbling in the water seal continuous what does it mean?

A

This represents a bad sign

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136
Q

If there’s bubbling in the suction control chamber intermittently what does that mean?

A

That is a bad sign

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137
Q

If there is bubbling in the suction control chamber continuously what does that mean?

A

It is a good sign

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138
Q

Tube Clamping Rules

A

Never clamp longer than 15 SECONDS without Dr’s order use RUBBER TIPPED DOUBLE CLAMPS

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139
Q

Congenital Heart Defect

A

Every congenital heart defect is either TROUBLE or NO TROUBLE

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140
Q

Shunt Flow

A

Right to Left Shunt

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141
Q

B

A

Blue

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142
Q

T

A

Starts with the letter T

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143
Q

What are some examples of “TRouBLe” Congenital heart defects?

A

Trunks arteriosis,Trans. Position of great vessels, Tetrology of Fallot, Tricuspid stenosis,TAPZ, left ventricular hyperplasmic syndrome

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144
Q

What are some examples of “No TRouBLe” Congenital heart defects?

A

Patent fore. Ov., ventricular septal defect,pulmonary stenosis

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145
Q

Akk CHD kids will have 2 things, whether TRouBLe or NO TRouBLe?

A
  1. Murmurs

2. Echocardiogram

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146
Q

Four defects present in Tetralogy of Fallot are

A 
VarieD 
PictureS 
Of A 
RancH 
Ventricular Defect 
Pulmonary Stenosis 
Overriding Aorta 
Right Hypertrophy
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147
Q

How do you measure crutches for a person?

A

2-3 finger widths below anterior axillary fold to a point lateral and slightly in front of foot.

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148
Q

When the handgrip is properly placed,the angle of elbow flexion will be what degrees?

A

30 Degrees

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149
Q

2 point gait

A

Step 1 : move one crutch and opposite foot together
Step 2: move other crutch and other foot together (remember 2 points together for a 2 point gait) used for minor weakness on both legs

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150
Q

3 point gait

A 
Step 1- one crutch 
Step 2- opposite foot 
Step 3- other crutch 
Step 4- other foot 
Nothing moves together and everything is really weak
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151
Q

Swing through

A

Those whom have two braced extremities (Amputees)

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152
Q

When to use which gait?

A

Use the EVEN numbered gaits when weakness is EVENLY distributed. 2 point for mild problems and 4 point for severe

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153
Q

When to use which gait?

A

Use the ODD numbered gait when one leg is EFFECTED

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154
Q

Which foot leads when going up and down stairs on crutches?

A

UP with the GOOD and DOWN with the BAD. The crutches always move with the BAD leg.

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155
Q

Cane proper usage

A

Hold cane on the UNEFFECTED SIDE . Advance cane with the OPPOSITE side for a wide base of support.

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156
Q

What is the correct way to use a walker?

A

Pick it up, Set it down and walk to it

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157
Q

What is a big NO when it comes to walkers?

A

Do not tie by belongings to the front of walker

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158
Q

What is the correct way to get up from a chair using a walker?

A

Hold on to chair,stand up then grab walker

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159
Q

What is the difference between a non psychotic person and a psychotic person?

A

A non-psychotic person has insight (know they are sick and it is messing them up) and a psychotic person has no insight and is not reality-based.

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160
Q

Delusion

A

A false,fixed belief or idea or thought. There is no sensory component

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161
Q

What are the 3 typed of delusions?

A

Paranoid/Persecutory
Grandiose
Somatic

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162
Q

Paranoid or Persecutory Delusion

A

False

Fixed belief that people are out to harm you

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163
Q

Grandiose delusion

A

False

Fixed belief that you are superior

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164
Q

Somatic Delusion

A

False

Fixed belief about a body part

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165
Q

Hallucination

A

A False

Fixed sensory experience

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166
Q

What are the 5 types of hallucinations?

A
  1. Auditory (hearing)
  2. Tactile (feeling)
  3. Visual (seeing)
  4. Gustatory (tasting)
  5. Olofactory (smelling)
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167
Q

Illusion

A

A misinterpretation of reality

It is a sensory experience

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168
Q

What is the difference between illusions and hallucinations?

A

With illusions there is a referent in reality (something to which they can refer to)

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169
Q

When dealing with a patient experiencing delusions,hallucinations or illusions,first ask yourself, “ What is their problem?” (What are the different problems that could be going on?)

A

Functional psychosis of dementia and psychotic delirium

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170
Q

What are the different types of functional psychosis?

A

Schizophrenia
Schzioaffected (mood disorder thought process)
Major depression
Mania

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171
Q

With a functional psychosis the patient has the potential to learn reality.
How can you teach reality to a functional psychotic?

A
  1. Acknowledge feelings
  2. Present reality
    Positive- what is reality
    Negative- what is reality
  3. Set a limit
  4. Enforce the limit
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172
Q

Psychosis of Dementia

A

People with Alzheimer’s, Wernicke’s, Organic Brain Syndrome and dementia. This patient has a brain destruction problem and can not learn reality.

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173
Q

How do you deal with a person with psychosis of Dementia?

A
  1. Acknowledge feeling

2. Redirect- get them to express the fixation that they are expressing inappropriately to appropriately

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174
Q

Psychotic Delirium

A

Temporary Episodic Secondary dramatic sudden onset of loss of reality due to chemicak im alance
(UTI, Thyroid imbalance,electrolyte imbalance)

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175
Q

How do you deal with a patient with psychotic Delirium?

A
  1. Acknowledge feeling

2. Reassure them of safety and temporaryness

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176
Q

How do you deal with a person with psychosis of Dementia?

A
  1. Acknowledge feeling

2. Redirect - get them to express the fixation that they are expressing inappropriately to appropriately

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177
Q

Psychotic Delirium

A

Temporary episodic secondary dramatic sudden onset of loss of reality due to chemical im alance (UTI,thyroid imbalance,electrolyte imbalance)

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178
Q

How do you deal with a patient with psychotic delirium?

A
  1. Acknowledge feeling

2. Reassure them of safety and temporaryness

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179
Q

What are the different types of loosening of association?

A

Flight of ideas, word salad, neologisms

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180
Q

Flight of ideas

A

Stringing phrases together (loosely associated phrases;tangentiality)

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181
Q

Word Salad

A

Throw words together

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182
Q

Neologisms

A

Making up new words

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183
Q

Narrowed self-concept

A

When a PSYCHOTIC recuses to change their clothes or leave the room.
🔅Dont make a psychotic do something they don’t want to do🔅

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184
Q

Ideas of reference

A

You think everyone is talking about you

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185
Q

Dementia Hallmarks

A

Memory loss,inability to learn.

🔅functional scan teach,dementias cannot🔅

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186
Q

Always acknowledge

A

Feelings

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187
Q

What are the 3 “Re’s”?

A

Reassure
Redirect
Reality

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188
Q

Diabetes Mellitus

A

An error of glucose metabolism

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189
Q

Diabetes insipidus

A

Dehydration, polyurethane, polydipsia

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190
Q

Type 1 Diabetes Mellitus

A

Insulin dependent (not producing insulin)
Juvenile onset
Ketosis prone

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191
Q

Type 2 Diabetes Mellitus

A

Non insulin dependent (body resisting insulin)
Adult onset
Non ketosis prone

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192
Q

Signs and symptoms of diabetes mellitus

A

Polyuria (urine a lot)
Polydipsia (drink a lot)
Polyphagia (eat/swallow a lot)

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193
Q

Treatment for Type 1 Diabetes Mellitus

A
  1. Insulin
  2. Exercise
  3. Diet (calories from carbs)
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194
Q

Treatment for type 2 Diabetes Mellitus

A
  1. Diet
  2. Activity
  3. Oral hypoglycemics
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195
Q

Diet of Diabetics

A

Calorie (carbs) restriction

Need to eat 6x per day smaller more frequent meals

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196
Q

Insulin

A

Insulins acts to LOWER blood sugar

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197
Q

Insulin Type:R

A

R= Regular,Rapid,Run(IV)
Onset: 1hr
Peak: 2hr
Duration: 4hr

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198
Q

Insulin Type: N

A

N= NPH ,Not in the bag, Not so fast, Not clear (cloudy)
Onset: 6hr
Peak: 8-10hr
Duration: 12hr

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199
Q

Insulin Type: Humalog

A 
Insulin Lispro 
Fastest 
Onset:15 min 
Peak: 30min 
Duration: 3hrs
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200
Q

Insulin Type: Lantus

A

Long acting
Slow absorption
No peak
Duration: 12-24hr

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201
Q

With insulin remember:

A

Check expiration date

Refrigerate but once open no refrigeration

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202
Q

Insulin & Exercise

A

Exercise POTENTIATES insulin: if more exercise, need LESS insulin. If less exercise,need MORE insulin.

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203
Q

Sick day rules for insulin

A

Take insulin
Take sips of water
Stay active as possible

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204
Q

Low blood sugar in type 1 Diabetes Mellitus (insulin shock) caused by:

A

Not enough food
Too much insulin
Too much exercise

205
Q

Why is low blood sugar in type 1 Diabetes Mellitus (insulin shock) dangerous?

A

Permanent brain damage

206
Q

Signs and symptoms of low blood sugar in type 1 Diabetes Mellitus (insulin shock):

A

Cerebral impairment,vasomotor collapse, cold, clammy, slow reaction time , drink shock

207
Q

Treatment for low blood sugar in Type 1 Diabetes Mellitus (insulin shock)

A

Administer rapidly metabolizable carbohydrate (candy,honey)
Ideal combination: sugar and protein
If unconscious IV D5 IM glucagon

208
Q

High blood sugar in Type 1 Diabetes Mellitus /DKA/Diabetic coma is caused by:

A

Too much food
Not enough insulin
Not enough exercise
#1 cause is acute viral upper respiratory infection within the last 10 days

209
Q

Signs and symptoms of High Blood Sugar in Type 1 Diabetes Mellitus/DKA/Diabetic Coma

A

Dehydration
Ketones,Kussmaul Breathing,High K+
Acidosis,Acetone breath ,Anorexia

210
Q

Treatment for High Blood Sugar in Type 1 Diabetes Mellitus/DKA/Diabetic Coma

A 
Insulin IV (R) 
IV rate flow 200mg/hr
211
Q

Treatment for low blood sugar in type 2 Diabetes Mellitus:

A

Adminster rapidly metabolizable carbohydrate (candy,honey)
Ideal combination: sugar and protein
If unconscious IV D50 IM glucagon

212
Q

High Blood Sugar in Type 2 Diabetes Mellitus

A

Called HHNK or HHNC - Hyperosmolar, Hyperglycemia, Non-Ketotic Coma
This is severe dehydration

213
Q

Signs and symptoms of High Blood Sugar in Type 2 Diabetes Mellitus

A

Hot,dry, increased HR decreased skin turgor

214
Q

Treatment for High Blood sugar in Type 2 Diabetes Mellitus

A

Rehydration

215
Q

Long term complications of HHNC are related to

A

Poor tissue perfusion

Peripheral neuropathy

216
Q

Which lab test is the best indicator of long-teem blood glucose control (compliance/effectiveness/adherence)?

A

Ha1c (average blood sugar over last 90 days)

217
Q

Diabetes

A

Cold and clammy - Get some candy

Hot and dry - Sugar’s high

218
Q

What is the therapeutic and toxic levels for Lithium

A

Therapeutic level: 0.6-1.2

Toxic level: > or equal 2

219
Q

What is the therapeutic and toxic levels for Lanoxin (Digoxin) ?

A

Therapeutic Level: 1-2

Toxic level: > or greater 2

220
Q

What is the therapeutic and toxic levels for Aminophylline?

A

Therapeutic level: 10-20

Toxic Level: > or greater 20

221
Q

What is the therapeutic and toxic levels for Bilirubin?

A 
Therapeutic level (elevated level) :10-20
Toxic level: > 20
222
Q

Kernicterus

A

Bilirubin in the CSF

223
Q

Opisthotonos

A

Position of slight extension in neck seem in patients with Kernicterus (bad sign)

224
Q

Dumping Syndrome

A

Post-Op gastric surgery complication in which gastric contents dump too quickly into the duodenum

225
Q

Hiatal Hernia

A

Regurgitation of acid into esophagus, because upper stomach herniates upward through the diaphragm

226
Q

Hiatal Hernia or Dumping Syndrome:

Gastric contents move in the right direction at the wrong rate

A

Dumping Syndrome

227
Q

Gastric contents move in the wrong direction at the right rate

A

Hiatal Hernia

228
Q

Gerd like symptoms when supine and after eating

A

Hiatal Hernia

229
Q

ADS S & S

A

Acute Dumping Syndrome
Abdominal distress (cramping, N/V, hyperactive BS (borborygmil)
Drunk- cerebral impairment
Shock (vasomotor collapse, rapid threat HR)

230
Q

Treatment for Hiatal Hernia

A

HOB during & 1 hour after meals - HIGH
Amount of fluids with meals - HIGH
Carbohydrate content of meals - HIGH
GOAL: Get an empty stomach

231
Q

Treatment for Dumping Syndrome

A

HOB during & 1 hr after meals - LOW
Amount of fluids with meals - LOW
Carbohydrate content of meals -low
Goal: get a full stomach

232
Q

Hyperkalemia

Hypokalemia

A

Kalemias do the SAME as the prefix except for HEART RATE and URINE OUTPUT
Hyperkalemia = ⬆️ , HR ⬇️ , Urine output ⬇️
Hypokalemia = ⬇️, HR ⬆️, Urine output ⬆️

233
Q

Hypercalcemia

Hypocalcemia

A

Calcemias do the OPPOSITE of the prefix. No exceptions.

Hypercalcemia = ⬇️
Hypocalcemia= ⬆️
234
Q

Two signs of neuromuscular irritability associated with

A

Hypocalcemia

  1. Chvostek’s Sign= cheek tap➡️ facial spasm
  2. Trousseau’s Sign= BP cuff➡️ carpal spasm
235
Q

Hypermagnesemia

Hypomagnesemia

A

Magnesemias do the OPPOSITE of the prefix.
Hypermagnesemia=⬇️
Hypomagnesemia=⬆️

236
Q

Which to Pick

A

If symptom involves nerve or skeletal muscle, pick CALCIUM. For any other symptoms, pick POTASSIUM (generally anything effecting BLOOD PRESSURE)

237
Q

HypErnatermia

A

dEhydration (dry skin, thready puls,rapid HR)

238
Q

HypOnatremia

A

Overload (crackles, distended neck veins)

239
Q

Electrolyte Disorder

A

The earliest sogn of any electrolyte disorder is NUMBNESS & Tingling (paresthesias)

240
Q

Electrolyte Imbalance

A

The universal sign-symptom of electrolyte imbalance is MUSCLE WEAKNESS (paresis)

241
Q

What medication is never IV Push

A

Never push POTASSIUM IV

242
Q

Potassium w/ Fluids

A

Not more then 40mEq of K+per liter of IV fluid

243
Q

How increase Potassium

A

Give D5W & Insulin (not permanent) to decrease K+

244
Q

Kayexalate

A

K+ exists late (not as quick more of a permanent solution)

245
Q

In a patient with hypercalcemia, which pattern would be the most likely threat?

A

First degree heart block with decreased ST segment and inverted T-waves

246
Q

Hyperthyrodism

A

Hyper- metabolism (high metabolic rate)

247
Q

Hyperthyroidism signs and symptoms

A

Weight loss,diarrhea, ⬆️HR, hot,heat, intolerance , HTN, exopthalmos (bulging eyes-Don Knopps)

248
Q

Hyperthyroidism

A

Hyperthyroidism is also known as GRAVE’S DISEASE. So remember RUN yourself into the GRAVE

249
Q

Hyperthyroidism treatment options

A

Radioactive iodine , propylthyroid utisil, surgical removal

250
Q

What is the big risk with radioactive. Iodine?

A

Radiation risk in urine -double flush, need private bathroom

251
Q

What does PTU do?

A

Propylthyroid utinsil knocks out WBC

252
Q

What is the most common treatment for hyperthyroidism?

A

Surgical Removal

253
Q

Total Thyroidectomy

A

Total Thyroidectomy need lifelong HORMONE replacement. At risk for HYPOCALCEMIA (difficult to spare parathyroid)

254
Q

What are you at risk for with a Thyroidectomy?

A

Thyroid Storm

255
Q

What are signs and symptoms of thyroid storm?

A

Extremely high vital signs, extremely high fever, psychotically delirious. this is a medical emergency

256
Q

What is the treatment for thyroid storm?

A

Oxygen and lower body temperature

257
Q

Total=T

Subtotal=S

A

Tetany

Storm

258
Q

Post operation risks for toral and subtotal Thyroidectomy in first 12 hrs

A

Airway/breathing, bleeding

259
Q

Post operation risks for total Thyroidectomy in 12-48 hrs

A

Tetany (r/t ⬇️Ca)

260
Q

Post operation risks for sub-total Thyroidectomy in 12-48 hours

A

Thyroid Storm

261
Q

Hypothyrodism =

A

Hypometabolism

262
Q

Hypothyroidism signs and symptoms

A

Weight gain , HTN , constipation, lethargy, cold intolerance, “slow”

263
Q

Hypothyroidism aka what?

A

Hypothyroidism is also known as Myxedema

264
Q

Hypothyroidism treatment

A

Throud replacement (s/e: hyperthyroidism)

265
Q

Hypothyroidism treatment caution?

A

Caution: with hypothyroidism treatment DO NOT SEDATE (they are already sedated)

266
Q

Hypothyroid surgical implications?

A

The hypothyroid patient under anesthesia is a very high risk and do not hold thyroid pills when NPO is a surgical implication

267
Q

What letter do Adrenal Cortex Diseases start with?

A

Adrenal Cortex Diseases start with letters A or C

268
Q

Addison’s Disease is

A

Addison’s Disease is UNDERSECRETION of the adrenal cortex

269
Q

Addison’s Disease signs and symptoms

A

Hyperpigmented (darker) doesn’t respond to stress well (JFK)

270
Q

Addison’s Disease Treatment

A

Steriods (need to wear a med alert bracelet)

271
Q

Addison’s=

A

Add - a - sone

272
Q

Cushing ‘s Syndrome

A

Cushing’s syndrome is OVER SECRETION (cushy=more)

273
Q

Cushing ‘s Syndromes signs & symptoms

A

Moon face,hirsutism (⬆️ body hair), water retention, gynecomastia (man boobs), buffalo hump, central obesity (small skinny limbs), ⬇️ bone density, easy bruising, irritability, immunosuppression

274
Q

Cushing’s Syndrome Treatment

A

Adrenalectomy ➡️ replacement therapy➡️ steriods

275
Q

What is CONTACT precautions used for?

A

Herpes, Enteric (Rotavirus,Shigellosus) , Staph (MRSA), RSV (transmitted via droplet but contact because kids put mouths on everything)

276
Q

Contact Precautions

A 
Private Room (most important) 
Gloves 
Goen 
Hand washing 
Disposable Supplies (BP cuff) 
Stethoscope can be taken from room to room as long as sterilized after use
277
Q

What is droplet precaution used for?

A

Influenza (H1N1), meningitis, diphtheria, pertussis, mumps

278
Q

Droplet precautions:

A 
Private Room 
Mask ( most important) 
Gloves 
Hand washing 
Pt wear mask when leaving room 
Disposable supplies
279
Q

What is airborne precautions used for?

A

Measles,TB (spread via droplet), chicken pox (varicella) SARS

280
Q

Airborne precautions

A 
Private room (door closed)
Mask 
Gloves 
Gown 
Hand washing 
Special filter respirator masks 
Pt wears mask when leaving room
Disposable supplies 
Negative air flow (most important) 
Everyone that entres the room must wear a mask
281
Q

PPE includes this always unless noted opposite

A

Gloves, Gowns, Goggles and masks

282
Q

PPE Doning & Doffing

A

The proper place for donning PPE is OUTSIDE the room and doffing PPE is INSIDE the room.

283
Q

Donning PPE proper order

A 
Gown 
Mask 
Goggles 
Gloves 
Start low and go high
284
Q

Doffing PPE proper order

A

Gloves
Googles (from behind to front)
Gown (outside in)
Mask ( from behind outside room)

285
Q

Mask removal

A

In airborne and droplet precautions only the mask is removed OUTSIDE the room and the patient removes mask INSIDE the room.

286
Q

Hand washing or scrubbing:

Position hands below elbows

A

Hand washing

287
Q

Position elbows below hands

A

Scrubbing

288
Q

Length seconds

A

Hand-washing

289
Q

Length minutes

A

Scrubbing

290
Q

Can touch handles

A

Hand-washing

291
Q

Not allowed to touch handles

A

Scrubbing

292
Q

Use when entering/leaving room, before/after glove use whenever hands get soiled

A

Hand-washing

293
Q

Use when patient is immunosuppressed

A

Scrubbing

294
Q

Soap and water

A

Handwashing

295
Q

Use Chlor- (cleaning agent)

A

Scrubbing

296
Q

When can you use an Alcohol-based solution?

A

Only substitute for handwashing, enter/leave room, before/after gloves, NEVER substitute after soiling hands

297
Q

Can you use an alcohol based cleaner after the restroom?

A

No (soiled hands possibly)

298
Q

Hand washing technique

A

Dry hands from CLEANEST to DIRTIEST

Turn water off with NEW paper towel

299
Q

Sterile Gloving

A 
Glove DOMINANT hand first 
Grasp OUTSIDE of cuff 
Touch only the INSIDE of glove surface 
Do not ROLL cuff 
Fingers INSIDE second glove cuff 
Keep thumb ABDUCTED 
Only touch OUTSIDE  surface
300
Q

Putting on Gloves

A

SkIN touches INSIDE of glove

301
Q

Sterile Gloves touch

A

Outside of glove only touched OUTSIDE of glove

302
Q

Removal of gloves

A

Remove GLOVE to GLOVE. SKIN to SKIN

303
Q

What patients do not need interdisciplinary care?

A

People who have multiple problems in the dame division of care
Ex: COPD, arthritis, cancer of bowel (all medical problems)

304
Q

What is the major criteria for interdisciplinary care?

A

Patients with multidimensional needs (physical ,intellectual,emotional,social, spiritual)- EX COPD , homelessness & schizophrenia (need medical ,SW, and psychiatrist)

Patient who need rehabilitation (PT, SW, OT, Speech will be effected)

305
Q

What is the minor criteria for interdisciplinary care?

A

A patient whose current treatment is ineffective

A patient who is preparing for discharge

306
Q

What are the 3 principles to consider when choosing appropriate toys for kids?

A

Is it safe
Is it age appropriate
Is it feasible (can you actually do it? Specific childs situation)

307
Q

What are some safety considerations when it comes to kids toys?

A

Size of toy (no small toys for children under 4)
No metal toys if oxygen is in use (spark things )
Beware of fomites (non living object that harbors micro organisms)

Worst: plush toys/stuffed animals
Least: plastic toys that can be disinfected

308
Q

What is the best toy for 0-6 month olds (sensorimotor)

A

Musical mobile

309
Q

What is the 2nd best toy for 0-6 month old (sensorimotor)?

A

Large and soft

310
Q

What is the best toy for 6-9 month olds (object permanence)?

A

Cover/uncover toy (jack in the box)

311
Q

What is the 2nd best toy for 6-9 month olds (object permanence)?

A

Firm but large (wood/hard plastic allowed)

312
Q

What is the BEST toy for 9-12 months oldd

A

Verbal toy (tickle me elmo)

313
Q

9-12 month olds

A

Remember with 9-13 month olds PURPOSEFUL activity with OBJECTS

314
Q

9 months and younger

A

Avoid answers with the following build , sort , stack, make and construct

315
Q

What is the best toy for toddlers (1-3 years)?

A

Push/pull toy (wagon)

316
Q

What skill is being worked on when toddlers play?

A

Gross motor skill

317
Q

What type of play do toddlers do

A

Parallel play (play alongside but not with)

318
Q

What types of toys should be avoided with toddlers?

A

Toys that require good finger control/dexterity

319
Q

Preschoolers need toys that work on

A

Fine motor skills (fingers) and balance (dance , ice skating and tumbling)

320
Q

Preschoolers play is characterized by

A

Cooperative play (play with each other)

321
Q

Preschoolers like go do what?

A

Preschoolers like to play PRETEND

322
Q

7-11 years old School age

A

School age (7-11 years) aka CONCRETE are characterized by the 3 C’s:

  1. Created/creative (give blank paper; get them involved)
  2. Competitive (winners and losers)
  3. Collective (baseball cards and barbies)
323
Q

12-18 years old Adolescents

A

Adolescentes (12-18 years) their “play” is PEER GROUP ASSOCIATION (hang out in groups). Allow adolescents to be in each others rooms unless one of them is:

  1. fresh post-op (less than 12 hours)
  2. Immunosuppressed
  3. Contagious
324
Q

Age variety choice

A

When given a variety of ages to choose from always go YOUNGER because children REGRESS When sick and you want to give them AS MUCH TIME TO GROW

325
Q

Creatinine

A

This is the beat indicator of Kidney function

326
Q

Creatinine lab values

A

0.6-1.2

If elevatef its abnormal but not too worrisome (just means kidneys are failing )

327
Q

INT (Intetnational Normalized Ratio)

A

Monitors coumadin (Warfin) therapy ( coumadin and war fare make you bleed)

328
Q

What is the therapeutic range for INR

A

2-3
⬆️INR= bleed risk
> or equal too is critical

329
Q

What do you do when INR > or equal to 4?

A

Hold all Coumadin
Assess bleeding
Prepare to give Vitamin K
Call the Physician

330
Q

What is the therapeutic range for Potassium (K+)?

A

3.5-5.0

331
Q

What do you do if potassium is low?

A

Critical
Assess heart
Prepare to give Potassium (K+)
Call Physician

332
Q

What do you do if potassium is 5.4-5.9?

A 
Critical (high but still in the 5’s) 
Hold all Potassium (K+) 
Asses heart 
Prepare Kayexalate/ D5W 
Call the DR
333
Q

What do you do if Potassium is >or equal to 6?

A

Deadly Dangerous
Do all of the following at once:
Hold Potassium, assess heart, prepare Keyexalate/D5W, Call physician as a team is needed to address this.

334
Q

What is the therapeutic range of pH?

A

7.35-7.45

335
Q

What do you do if pH is in the 6’s?

A

Deadly Dangerous

Get vitals and call Physician (most important when asked in question)

336
Q

What is the therapeutic range for BUN (blood urea nitrogen)?

A

8-30( 8 buns in a pack)

337
Q

What do you do when a patient has an elevated BUN?

A

Be concerned

Check for dehydration

338
Q

What is the therapeutic range for Hgb(hemoglobin)?

A

12-18 (teenage years)

339
Q

What do you do when a patient has a 8-11 hgb?

A

Be concerned

Monitor the patient

340
Q

What do you do if a patient has a Hgb of <8?

A

Critical

Assess bleeding, prepare for transfusion, Call Physician

341
Q

What is the therapeutic range for HCO3?

A

22-28

If out of range it is abnormal but not worrisome

342
Q

What is the therapeutic range for CO2?

A

35-45

343
Q

What fo you do if CO2 is in the 50’s?

A

Critical (sign of respiratory insufficiency)
Assess respirations
Do pursued lip breathing( blow out candle and exhale longer periods)
DONT give O2 (it will increase CO2)

💡This does not apply to COPD (This is their “normal”)

344
Q

What do you do if CO2 is in the 60’s?

A 
Deadly Dangerous 
Sogn of respiratory failure 
Assess respirations
Do pursed lip breathing (to ⬇️ anxiety) 
Prepare to intubate and ventilate 
Call respiratory therapy 
Call DR
345
Q

What is the therapeutic range for Hct?

A

35-54 (if abnormal be concerned)

346
Q

What is the therapeutic range for PO2?

A

78-100

347
Q

What do you do if PO2 is 70-77?

A

Critical
Sign of respiratory insufficiency
Assess respirating
Give oxygen

348
Q

What do you do when PO2 is

A 
Deadly dangerous
Sign of respiratory failure
Assess Respirations 
Give oxygen
Prepare intubate and ventilate
Call respiratory therapy
Call Physician
349
Q

What is the therapeutic range for O2 saturation?

A

93-100%

350
Q

What do you do if O2 saturation is less than 93?

A

Assess respiration’s and give oxygen

351
Q

BNP

A

Good indicator of CHF

352
Q

What is the therapeutic range for Brain Type Natriuretic Peptide (BNP)?

A

<100

353
Q

What do you do if Brain Type Natriuretic Peptide (BNP) is elevated?

A

Be concerned and continue to monitor patient

354
Q

What is the therapeutic range for sodium?

A

135-145

355
Q

What fo you do if sodium is abnormal in a patient?

A

Be concerned until theres a change in the LOC (then it becomes critical)

356
Q

What is the therapeutic range for WBC’s?

A

5,000-11,000

357
Q

What is the therapeutic range for ANC?

A

500 (want above 200)

358
Q

What is the therapeutic range for CD4 count?

A

<200= AIDS

359
Q

What is another name for high WBC count?

A

Leukocytosis

360
Q

What are some other names for low WBC count?

A 
Leukopenia 
Neutropenia 
Agranulocytosis 
Immunossuppression 
Bone Marrow Supression
361
Q

What do you do when WBC id <5,000

A

Critical- immunosuppressed

Neutropenic precautions

362
Q

What do you do if ANC id <500?

A

Critical-immunosuppressed

Neutropenic precautions

363
Q

What do you do if CD4 <200?

A

Critical-immunosuppressed

Neutropenic precautions

364
Q

What is neutropenic precautions?

A

AKA Reverse/Protective Isolation
Strict hand washing
Shower BID with antimicrobial soap
Avoid crowds
Private room
Limit number of staff entering room
Limit visitors to health stilts
No fresh flowers out potted plants
Low bacteria diet ( no raw fruits, veggies, salads or undercooked meat)
Do not drink water that has been standing for 15 min or longer
Vital signs (temp) every 4 hours
Check WBC(ANC) daily
Avoid use of underlining catheter
Do not reuse cups (must wash between uses)
Use disposable plates,cups,straws, utensils
Dedicated items in room: shape,BP cuff,Thermometer,gloves

365
Q

What is the therapeutic range for platelets?

A

150,000-400,000

366
Q

What do you do if plateltes are <40,000?

A

Deadly Dangerous (can spontaneously bleed to death)
Assess for bleeding
Bleeding Precautions

367
Q

What are bleeding precautions?

A

No unnecessary venipuncture-injection or IV, use small gauge

Handle patient gently (use draw sheet) 
Use electric razor 
No toothbrushing or flossing 
No hard foods 
Well fitting dentures 
Blow nose gently 
No rectal temp,enema or suppository 
No aspirin 
No contact sports 
No walking in bare feet 
No tight clothing or shoes
Use stool softner, No straining 
Notify MD or blood in urine,stool
368
Q

What is the therapeutic range for RBC’s?

A

4-6 (if abnormal be concerned)

369
Q

What are the 5 D’s?

A

Remember the 6’s

  1. K+>or equal to 6
  2. pH ins the 6’s
  3. CO2 in the 60’s
  4. pO2 < or equal to 60’s
  5. Platelets <40,000
370
Q

When should you call a Rapid Response Team ?

A

When lab values are critical or deadly dangerous or if bad symptoms during assessment

371
Q

Laminectomy

A 
“Ectomy”= removal of 
“Lamina”= vertebral spinus processes
372
Q

What is the reason for a laminectomy?

A

To treat nerve root compression

373
Q

What are the 3 signs and symptoms of nerve root compression?

A

Pain
Paresthesia (numbness and tingling)
Paresis (muscle weakness)

374
Q

What are the different locations for laminectomy?

A

Cervical (neck)
Thoracic (upper back)
Lumbar (lower back)

375
Q

What is the most important assessment in a pre-op cervical lamin

A

Function of upper extremities and breathing

376
Q

What is the most important assessment in a pre op lumbar laminectomy?

A

Urine output and legs

377
Q

What is the #1 post-op answer on NCLEX?

A

Always log roll your patient

378
Q

What is the specific “activity”/ mobilization strategy post-op?

A
  1. Do not dangle/sit on side of bed
  2. Allowed to walk ,sit,stand and lie down
  3. Limit sitting 20-30 min at a time
379
Q

Post-op complication for cervical laminectomy

A

Watch for pneumonia

380
Q

Post-op complication for thoracic laminectomy

A

Watch for pneumonia and paralytic illeus

381
Q

Post-op complication for lumbar laminectomy

A

Watch for urinary retention

382
Q

Laminectomy

A

Laminectomy with fusion involved taking a BONE GRAFT from the ILLIAC CREST(HIP).
Of the two incisions which site has the most pain?
Hip
Which site has the most bleeding/drainage?
Hip

Which site has a risk for infection?
Hip/spine

Which site has a risk rejection?
Spine

383
Q

Surgeons are using cadaver bone from bone banks. Why?

A

Because it gets rid of 2nd incision and cuts recovery time in half

384
Q

What are some temporary restrictions (6 weeks) with discharge teaching?

A
  1. Don’t sit for longer than 30 min
  2. Lie flat and log roll for 6 weeks
  3. Lifting restrictions: do not lift more than 5lbs
385
Q

What are some permanent restrictions for laminectomy patients?

A
  1. Laminectomy patients will never be allowed to lift by bending at the waist (use their needs)
  2. Cervical laminectomy patients will never be allowed to lift objects above their heads
  3. No horseback riding, off-trail biking, jerky amusement park rides etc.
386
Q

What is Nagele’s rule? (Due date calculation)

A

Take the first day of the last menstural period (LMP)
Add 7 days!
Subtract 3 months

387
Q

Total Weight gain during pregnancy

A

25-31 lbs

388
Q

1st trimester weight gain

A

1 lb per month (3 lbs total for first trimester)

389
Q

2nd/3rd trimester weight gain

A

1 lb per week

390
Q

Fundus (top of uterus) in not palpable until week

A

Week 12

391
Q

Fundus typically reaches the umbilical (navel) level at week

A

20-22

392
Q

What are 4 positive signs of pregnancy?

A
  1. Fetal skeleton on an x-ray
  2. Fetal presence on ultrasound
  3. Auscultation of the fetal heart (doppler)
  4. Examiner palpated fetal movement/outline
393
Q

What are some probably/presumptive signs of pregnancy?

A
  1. All urine and blood pregnancy tests
  2. Chadwicks’s sign (color change of the cervix to cyanosis)
  3. Goodell’s sign (cervical softening)
  4. Hegar’s sign (uterine softening)
394
Q

Morning sickness is related to which trimester and what treatment?

A

1st trimester
Eat dry carbs
Crackers before out of bed
Avoid empty stomach

395
Q

Urinary Incontinence is related to which trimester and what treatment?

A

1st trimester and 3rd trimester

Void Q2H

396
Q

Dyspnea is related to which trimester and what treatment?

A 
2nd trimester 
Tripod position ( lean forward with hands on knees)
397
Q

Back pain is related to which trimester and what treatment?

A

2nd/ 3rd trimester

Pelvic tilt exercises (put foot in stool then back again)

398
Q

What is the truest most valid sign of labor?

A

Onset of regular contractions

399
Q

Dilation

A

Opening of cervix (0-10cm)

400
Q

Effacement

A

Thinning of cervix (thick -100%)

401
Q

Station

A

Relationship of fetal presenting part to mom’s ischial spine ( tightest squeeze for baby head)
Negative = above spine
Positive = below spine

402
Q

Engagement

A

Station “0” at ischial spines

403
Q

Lie

A

Relationship between spine of baby and spine of mom

404
Q

Presentation

A

Part of baby that enters birth canal first

405
Q

What is stage 1 of labor and delivery?

A

Labor- dilate and phase cervix (3 phase of labor- latent, active, transitional)

406
Q

What is stage 2 of labor and delivery?

A

Delivery of baby

407
Q

What is stage 3 of labor and delivery?

A

Delivery of placenta

408
Q

What is stage 4 of labor and delivery?

A

Recovery- first 2 hours to stop bleeding

409
Q

Transverse lie and station that won’t go positive =

A

C - section

410
Q 
Latent: 
CM dilated 
CXN freq 
Duration 
Intensity
A

CM dilated: 0-4cm
CXN freq: 5-30min
Duration: 15-30 sec
Intensity: Mild

411
Q

Active:

CM dilated
CXN freq
Duration
Intensity

A

CM dilated : 5-7 cm
CXN freq : 3-5 min
Duration : 30-60 sec
Intensity : Moderate

412
Q

Transition:

CM dilated
CXN freq
Duration
Intensity

A

CM dilated: 8-10cm
CXN freq: 2-3min
Duration: 60-90 sec
Intensity: Strong

413
Q

Contractions

A

Contractions should not be longer than 90 seconds or closer than every 2 minutes

414
Q

Contractions Assessment: Frequency

A

Beginning of one contractions to the beginning of the next contraction

415
Q

Assessment of Contractions: Duration

A

Beginning to end of one contraction

416
Q

Assessment of contractions: Intensity

A

Strength of contraction. Palpate with fingers of one hand over the fundus.

417
Q

What complication of labor is indicted of the mom is having painful back pain?

A

Baby turned around backwards
Low priority
Position knee-chest then put on her back

418
Q

What should you do with a prolapsed cord?

A

Push head back in off cord and position in knee-chest or trendelenburg (hips up,shoulders down) pre for c-section

419
Q

Interventions for all other complications of labor and birth

A 
Left side/lateral 
IV increase 
Oxygen 
Notify 
Stop pit if in crisis
420
Q

Systemic pain medication

A

Do Not Administer Systemic pain medication to a woman in labor if the baby is likely to be BORN when the PAIN is PEAKING(respiratory depression)

421
Q

What do you do with a low fetal heart rate?

A

Bad

LION pit

422
Q

What do you do with FHR accelerations?

A

No crisis

423
Q

What fo you do with low baseline variability?

A

Bad

LION pit

424
Q

What do you do with high beseline variability?

A

Record It

425
Q

What do you do with late decelerations?

A

Bad

LION pit

426
Q

What do you with early decelerations?

A

HR⬇️

427
Q

What do you do with variable decelerations?

A

Can be very bad

Prolapsed cord

428
Q

Second stage of labor and delivery - what do you do?

A
  1. Deliver the head (stop pushing)
  2. Suction mouth and nose
  3. Check for nuchal cord (cord around neck)
  4. Deliver shoulders and body
  5. Make sure baby has ID band
429
Q

What do you check for with the delivery of the placenta?

A

3 vessels (2 arteries and 1 vein) “AVA”

430
Q

Delivery Last Stage (recovery stage)

A

During the 4th stage (recovery stage) (first 2 hours after delivery) what 4 things do you do 4 times an hour

  1. Vital signs (assess for signs and symptoms shock)
  2. Check fundus (if boggy,massage, if displaced, void/cath)
  3. Check padd (excessive lochia=pad sat in 15 min)
  4. Roll on to side (check for bleeding under patient)
431
Q

What is the tone,height and location of the uterus postpartum?

A

Tone: Firm not boggy
Height: right after delivery it is by pubis by 24 hours it is at navel. 2cm for every PP day
Location: Midline(if displaced from R/L if means catherize)

432
Q

What is the color of lochia in the first days?

A

Rubra

433
Q

What is the color lochia after a week or so of postpartum?

A

Serosa

434
Q

What is a moderate amount of lochia?

A

4-6 in on pad in one hour

435
Q

What is an excessive amount of lochia?

A

Saturate pad in 15 min

436
Q

What do you assess for in the postpartum assessment?

A

Uterus,lochia, extermities (pulses, edema, S7S thrombophlebitis)

437
Q

Distended sebaceous glands which appear as tiny white spots on bay’s face

A

Milia

438
Q

Small white epithelial cysts on baby’s gums

A

Epstein’s pearls

439
Q

Bluish-black macules appearing over the buttock and or/ thighs of darker- skinned neonates

A

Mongolian spots

440
Q

Ref papilar rash on baby’s torso which is benign and disappears after a few days

A

Erythema toxicum neonatorum

441
Q

Benign tumor of capillaries

A

Hemangiomas

442
Q

Swelling caused by bleeding between the ostium and periosteum of the skull. This swelling does not cross suture lines

A

Cephalohematoma

443
Q

Edmatous swelling on scalp caused by pressure during birth. This swelling may cross suture lines. It usually disappears in a few days

A

Caput succedaneum

444
Q

Normal physiological jaundice appears after 24 hours of age and disappears at about one week of age

A

Hyperbilirubinemia

445
Q

Whitish cheese-like substance which appears intermittently over the first 7-10 days

A

Vernix Caseosa (caseus=cheee)

446
Q

Normal cyanosis of baby’s hands and feet which appears intermittently over the first 7-10 days

A

Acrocyanosis

447
Q

Generic term for birthmark

A

Nevus/ Nevi
1. Nevus Flammeus - nonblanchable port wine stain

  1. Telangiectatic Nevi - blanchable pink “stork bites”
448
Q

Tocolytics (stop contractions)

A

Terbutaline (Brethine)
S/E- tachycardia (don’t give with cardiac disease) Nifedipine
S/E- headache/hypotension (can give with cardiac disease)

449
Q

Oxytocics- stimulate labor

A

Pitocin (Oxytocin)
S/E- uterine hyperstimulation
Cervidil (Prostaglandin) - dilates cervix
S\E-uterine hyperstimulation

450
Q

Fetal/Neonatal Lung Meds

A

Bethamethasone (steriod)- give to mother IM; give before baby after ciability. Can repeat
S\E ⬆️BS
Survanta- give to baby after baby is born (transtracheal)

451
Q

Steps of drawing up insulin

A
  1. Draw up the total dose in air
  2. Pressurize the “N” vial (put air in)
  3. Pressurize the “R” vial
  4. Draw up “R” dose
  5. Draw up “N” dose

Nicole Richie RN

452
Q

IM- length and guage

A

1 in both the guage and length (I looks like 1)

453
Q

SQ- length and guage

A

5 in both party’s (S looks like a 5)

454
Q

Heparin

A
  • works immediately
  • can only take for 21 days
  • antidote is Protamin sulfate (heParin)
  • labs: PTT and all clotting a d bleeding times
  • http ➡️ PttHeparin
  • can use in pregnancy
  • pregnancy class C
455
Q

Coumadin

A
  • takes days
  • can take for entire life
  • Po only
  • antidote: vitamin K
  • labs: PT, INR
  • can’t use if pregnant
  • class x pregnancy
456
Q

Baclofen (Lioresal)

A 
Muscle relaxant 
1. Cause fatigue 
2. Cause paresis (muscle weak) 
3. Do not drink alcohol
4. Do not drive car 
5. Do not watch kids under age 13 
When you are Baclofen you are on your back “loafin”
457
Q

Sensorimotor

A

Age: 0-2 years old
Characteristics: totally present-oriented. Only think about what they are sense of are doing right now

Teaching Guidelines

When: As it is happens
What: you are doing now

How: Tell them what you are doing as you’re doing it

458
Q

Pre-Operational

A

Age: 3-6 y/o (preschoolers)

Characteristics: fantasy oriented. Illogical. No rules. ( Can teach ahead of time but not too far)
Teaching Guidelines
When: slightly ahead of time ( morning of..)
What: you will do
How: play,toys,stories

459
Q

Concrete operations

A

Age: 7-11 years old
Characteristics: Rule-oriented. Live and die by the rules! Cannot abstract

Teaching Guidelines
When: days ahead of time
What: you’re gonna do and skills
How: age appropriate reading and A/V material,role play is ok

460
Q

Formal Operations

A

Age: 13-14 y/o
Characteristics: able to think abstractly. Understand cause-effect.
Thinking like adults emotionally but physically not there but they can think like one

Teaching guidelines-

When: like an adult
What: like an adult
How: like an adult

461
Q

Skin still intact, non blanching erythema (redness)

A

Stage 1 pressure sore

462
Q

Ulcerated,superficial,pink dermis

A

Stage 2

463
Q

Yellow subcutaneous (fat)

A

Stage 3

464
Q

Red-white (muscle and bone

A

Stage 4

465
Q

Acute beats chronic

A

Short rather than long term

466
Q

Surgical

A

FRESH POST OP beats MEDICAL or OTHER SURGICAL

467
Q

Stable beats unstable

A

Survival vs unsure on survival

468
Q

What makes a patient stable?

A
  1. use of the word stable
  2. Chronic illness
  3. Post op>12 hours
  4. Local or regional anesthesia
  5. Unchanged assessment
  6. Phrase: “To be discharged”
  7. Lab values A/B
    Stable patients are experiencing the expected typical signs and symptoms of the disease with which they have been diagnosed for which they are receiving treatment
469
Q

What makes a patient unstable?

A
  1. Use of the word unstable
  2. Acute illness
  3. Post op <12 hours
  4. Local or regional anesthesia
  5. Unchanged assessment
  6. Phrase: “Newly admitted” or “newly diagnosed “
  7. Lab values C/D
    Undtable patients are experiencing unexpected atypical signs and symptoms complications
470
Q

What 4 patients are always unstable?

A
  1. hemorrhage
  2. Hypoglycemia
  3. Fever > or equal 104
  4. Pulselessness or breathlessness
471
Q

Organ priority

A 
The more VITAL the ORGAN the higher the priority 
Most vital 
Brain 
Lungs 
Heart 
Liver 
Kidney 
Pancreas
472
Q

Responsibilities you would delegate to an LPN

A

Starting an IV
Hanging or mixing IV Meds
Evaluating an IV site
Giving an IV push/ PB meds
Giving a blood transfusion
Performing assessments that require inferences/judgements (can gather data)- can make observations about stable people but can not make assumptions
Plan of care
Developing or performing teaching (can reinforce and review)
Taking verbal orders from MD or transcribing orders

473
Q

What would you not delegate to a UAP?

A

Cannot chart but may document what they did
Assessments-expect for VS and accucheck
Meds and IV’s- may apply otc Topical lotions and creams
Treatments - except for SSE. not fleets
You may delegate baths,bed and ADLs

474
Q

Delgating to Family

A

Do not delegate to FAMILY: Safety Responsibilities. They can only do what you TEACH them to do.

475
Q

How do you intervene with inappropriate behavior of staff?

A
  1. Tell the supervisor
  2. Intervene immediately
  3. Counsel them later on
  4. Ignore it. Just let it go (never the right answer)
476
Q

What 4 questions should you ask when dealing with inappropriate behavior from staff?

A
  1. Is what they’re doing illegal? ( if yes tell the supervisor)
  2. Is the patient or staff member in immediate danger of physical or psychological harm? (If yes intervene immediately)
  3. Is this behavior legal,not harmful,but simply inappropriate? (If yes counsel them later on)
477
Q

Pre-interaction Phase

A

Purpose:for the nurse to explore his/her feelings yo prevent judgemental, intolerant reactions
Length: begins when you learn you are going to be caring for someone and end when you meet them

Correct answer : “the nurse will explore his/her feelings about”

478
Q

Introductory phase (Orientation Phase)

A

Purpose: to establish and explore/assess
Length: begins when you first meet the patient and ends when a mutually agree-upon care plan is in place

Correct answer: should be very tolerant,accepting,explorative,probing,”nosy”. Be warm and fuzzy

479
Q

Working phase (therapeutic phase)

A

Purpose: to implement the plan of care
Length: from the finished care plan until discharge
Correct answer: should be focused,directive, “tough”. In some ways these answers will seem stern and slightly unfriendly set limits enforce proper communication

480
Q

When does the termination phase begin

A

On Admission

481
Q

Psych Treatment Protocol for Depression

A

Whenever a patient displays any notion of suicide or harm you must inquire about it
Must get a safety contract
🔆activities with other people that doesnt require interaction🔆

482
Q

Psych Treatment Protocol for schizophrenia

A

If paving Psych➡️ reduce stimulation (clear the room) make onservat offer presence
🔅need reality based activities but not competitive; should be with other people🔅

483
Q

Psych Treatment Protocol for Bipolar

A

Mania’s can’t go to work or maintain family order whereas a hypo manic can
-finger foods are best especially ⬆️ calorie
-8 hrs of sleep Encourage naps
🔅 exercise the gross motor that is non competitive🔅

484
Q

Psych Treatment Protocol for anxiety disorder

A

Phobia-irrational fear that limits daily life ➡️ tx: desensitization: gradually expose

  1. Talk about it
  2. Show pics
  3. Be around
  4. Interact

When you move to next step make sure not anxious

485
Q

Restraint Protocol

A

In Psych: need to be evaluated within 1 hour Must be constantly observed
Not psych: observe every 15 min. No evaluation. Need Dr. order Q24h

486
Q

Psych Treatment Protocol for Violent Clients

A

It tales 5 people to control a violent client. One for each limb and head. Only one person talks. The person is given a few seconds to deescalate

487
Q

All psych drugs causr

A

Hypotension, weight changes and primary weight gain

488
Q

Phenothiazines

A

All end in “zine”
Ex: Thorazine , compazine
Actions: large doses-antipsychotic, small doses antiemetic major tranquilizers

489
Q

Side effects of phenothiazines

A 
Remember ABCDEFG 
A= anticholinergic (dry mouth) 
B= blurred vision and bladder retention 
C= constipation 
D= drowsiness 
E= EPS (tremors,parkinsonian) 
F= “F”otosensitivity (skin burns) 
G= aGranulocytosis (low WBC count-immunosuppressed)

Teach patient to report sore throat and signs and symptoms of infection to doctor
Never stop the zine
Never stop the zine

490
Q

Nursing care for Phenothiazines

A

Treat side effects. Number on diagnosis is safety

491
Q

Deconate or “D”

A

Long acting IM form of phenothiazine given to non compliant patients

492
Q

Tricyclic Antidepressants

A

Mood elevators to treatment depression

Ex- Elavil,Trofranil, Aventyl, Desyrel

493
Q

Side effects of Tricyclic Antidepressants

A

(Elavil starts with “E” so this group goes to “E”)
A= Anticholinergic (dry mouth)
B= Blurred vision
C= Constipation
D= Drowsiness
E= Euphoria (happy)
Must take med for 2-4 weeks before beneficial effects

494
Q

Benzodiazepines

A

Antianxiety meds (considered minor tranquilizers)
Always have “Pam”/“Iam” in name
Prototype:Valium
Indications:Induction of anesthetic muscle relaxant,alcohol withdrawal,seizures (especially status epilepticus), facilitates mechanical ventilation
Tranquilizers work quickly. Must Not take for more that 6 weeks- 3 number one nursing diagnosis is safety

495
Q

Side effects of Benzodiazepines

A

A=anticholinergic
B=blurred vision
C=constipation
D=drowsiness

496
Q

Monoamine Oxidase (MAO) Inhibitors

A

Antidepressants
Depression is thought to be caused by deficiency of norepinephrine, dopamine and serotonin I’m the brain. Monoamine oxidase is the enzyme responsible for breaking down norepinephrine , dopamine and neurotransmitter and thus restore more normal levels and decrease depression

Drug names MARplan ,NARdil, PARnate

497
Q

Side effects of MAO inhibitors

A

A=Anticholinergic
B=Blurred Vision
C=Constipation
D=Drowsiness

498
Q

Interactions/ Patient teaching for MAO inhibitors

A

Too prevent severe, acute, sometimes fatal hypertensive crisis, the patient must avoid all food containing tyramine
Foods containing Tyramine:
Fruits and veggies- remember salad “Bar”➡️ avoid Bananas, Avacados, raisns (any dried fruits)
Grains: okay to except things made from active yeast
Meats: no orgN meats-liver,kidney,tripe,heart,etc. No preserved meats- smoked,dried,cured,pickled,hot dogs
Dairy: no cheese except mozzarella and cottage cheese (no aged cheese)
Other: no alcohol,elixirs,tinctures(iodine/betadine), caffeine,chocolate, licorice,soy sauce

499
Q

Lithium

A 
An electrolyte (notice “iun” ending as in potassium etc) 
Used for trrating bipolar disorder(manic-depression)➡️ it decreases the mania
500
Q

Side effects of lithium

A 
The three “P’s”: 
Peeing (Polyuria) 
Pooping (diarrhea) 
Parsesthesis (tingling/numbness) 
Medically inducing A lithium/electrolyte imbalance 
Toxic: Tremors , metallic taste, severe diarrhea, and any other neuro sign ➡️ number one intervention: good fluid hydration. If sweating give sodium (or other electrolyte) as well as fluids
NO WATER 
FLUIDS WITH ELECTROLYTES

MONITOR SODIUM LEVELS

501
Q

Prozacc

A

SSRI (Selective Serotonin Reuptake Inhibitor)
Similar to Elavil
Antidepressant- mood elevator

502
Q

Side effect of Prozac

A

A=anticholinergic
B=blurred vision
C=constipation
D=drowsiness

Causes insomnia, so gibe before 12 noon. If BID give at 6 am and 12 noon when changing the dose of prozac for an adolescent or young afult wat h for suicide

503
Q

Haldol (Haloperidol)

A

Tranquilizer
Also a m deconate form
Long acting IM form given to non compliant patients

504
Q

Side effects of Halfol

A 
A= Anticholinergic 
B= Blurred vision 
C= Constipation 
D=Drowsiness 
E= EPS 
F= Fotosensitvity
G= aGranulocytosis

Elderly patients may develop NMS from overdose. NMS IS neuroleptic Malignant Syndrome- a potentially fatal hyperplasia (fever) with temp of 104.9 Fose elderly patient should be half of usual adult dose
Safety concerns r/t side effects

505
Q

Clozaril (Clozapine)

A

Atypical antipsychotic
Used to test severe schizophrenia
Advantage: it died not have side effects A-F
Do not confuse with Klonopin (Clonazepam)

506
Q

Side effects of Clozaril

A

Agranulocytosis (worse than cancer drugs)

Can inky prescribe for 7 days then get WBC drawn for 4 weeks, then once a month for 6 months then every 6 months

507
Q

Zoloft (Sertraline)

A

Another SSRI lIke Prozac
Antidepressant
Also causes insomnia but can be given in evening
Watch for interaction with St. Johns worst (serotonin syndrome), and warfarin (watch for bleeding)

508
Q

Side effects of Zoloft

A 
SAD head 
Sweating
Apprehensive 
Dizzy 
Headache

Mark Klimek Yellow Book (1 decks)

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