NR 452 AB Combo and Pharmacology (Verified Update)

NR 452 AB Combo and Pharm what is montelukast (singular) for? a leukotriene modifier, and is taken on a regular basis, once a day, and not prn, and is not used for exercise induced asthma what does advance directive ...

NR 452 AB Combo and Pharm what is montelukast (singular) for? a leukotriene modifier, and is taken on a regular basis, once a day, and not prn, and is not used for exercise induced asthma what does advance directives contain? written instructions regarding end of life care what is the greatest risk to a pt receiving hemodialysis? disequilibrium syndrome as a result of rapid loss of fluids and decrease bun what is the clinical manifestation of disequilibrium? restlessness and decreased level of consciousness what are expected findings in hemodialysis? elevated temp weight loss decreased bp what should the nurse do when a pt feels lightheaded and begins to fall? spread feet apart and extend one leg for the pt to slide down while lowering the pt to the floor what are the characteristics of a pt with dependent personality disorder? they have problems making everyday decision without input from others a pregnant pt who is bleeding is always? priority what should a pregnant pt with urgency and frequent urination do? should perform kegel exercises what should a pregnant pt with odorless vaginal mucus do? practice good hygiene, use perineal pads a pregnant pt with edema of the ankles do? avoid prolonged standing, to wear support hose, and rest through out the day with legs/hip elevated when should a colostomy bag be changed? when is 1/3 -1/2 full how large should the opening of the stoma pouch be? no larger than 1/4 inch what should the pt with a colostomy avoid? the use of moisturizers, which will decrease the adherence of the pouch to the skin what should the pt do with the pouch removing it? they should empty the pouch to avoid spilling the effluent on to the skin where should drops be instill into? into the conjuctival sac what is a positive way of dealing with a terminal illness? "remembering things they used to do together" what are normal findings after a colonoscopy? abd cramping fatigue passage of liquid stools what are unexpected finding after a colonoscopy? guarding- can indicate bowel perforation what do you do if an order is questioned? the nurse should record seeking clarification from the provider what should pt with gastritis eat? a well balanced diet, they should keep a record of foods that cause discomfort, pts can modify their diet accordingly what is the cause autonomic dysreflexia? bladder distention what are s/s of icp? restlessness change in LOC what is late s/s of ICP? widening pulse decerebrate posturing when can a child with varicella(chickenpox) return school? the child can return to school when the blisters are dry and no longer drained (scabbed over) what is an appropriate behavior of a pt with hx of violence? pt will avoid violence provoking situations what is a skin cancer prevention? pts should use sunscreen that protects against uva and uvb what is the first thing you should do with excessive lochial discharge? perform a fundal massage what is the nurse responsibility of the nurse when witnessing the pts signature on an informed consent? that the pt is fully informed and understands the procedure befor signing the consent form who are at greater risk for std? females because of increased vascularity to the vagina does trichomonas vaginalis increased the risk for cervical cancer? NO Gonorrhea can lead to? pelvic inflammatory disease and tubal scarring and can result in infertility what should you do with postmortem care? always check about religious practices prior to body preparation in order to honor fam wishes what can you not give to a pt with thickened liquids? no ice chips no water no icepops what can a pt with thickened liquids have? oatmeal what should a pt do with incentive spirometer? they should elevate the cylinder by inhaling deeply assume semi fowlers or high fowlers position in order to maintain sterile technique what should the nurse do? should open all sterile packages prior to donning sterile gloves what is psycho-motor learning? have the pt demonstrate back the procedure what places a newborn at risk for respiratory depression? administration of an opioid analgesic exa: fentanyl (sublimaze) what is an effective method of bowel retraining? anal stimulation with a gloved finger after the evening meal, it will help stimulate the gastrocolic reflex when inserting an NG tube? the nurse should insert the tube into the airway that is patent and has greater airflow what technique should be NG tube insertion? clean technique if NG tube meets resistance? the nurse should rotate the tube without forcing it past the area of resistance what kind of lubricant should be used during NG tube insertion? water- based lubricant NOT petroleum jelly what is pediculosis capitis management? store child's clothing in a separate cubicle at school boil brushes and combs in water for 10 mins dry bed lines and clothing in a hot dryer for at least 20 mins what can visual disturbances indicate? preeclampsia what is expected 24 hrs after surgery? hypo active bowel sounds pain what is an abnormal finding 24 hrs after surgery? low HGB what must be done in bucks traction? the pt must be in proper alignment boots are secured by 3 straps, around pt leg weights must hang freely footplate is resting 15.24 cm (6inches) from the footboard what does pts with delirium demonstrate? a fluctuating LOC often at night or in am pt with dementia demonstrate? difficulty finding correct words to use pt with anxiety disorders demonstrate? obsessive behavior how would the nurse determine progression of ascites? abdominal girth should be measured daily what is a food high in potassium? cantaloupe what is an indication of peripheral venous disease? brown pigmentation around ankles what is indication of peripheral arterial disease? intermittent, leg muscle pain what is some skin care for pts on radiation therapy? pat area when drying use hand to wash do not use sunscreen what can hydromorpone cause? urinary retention what does bethanechol (urecholine) causes? it stimulates urinary out put how is nystatin best absorb? if given 1 hour before or after a feeding what is a sign that a newborn has finished eating? a slowed suck/swallow pattern is a sign that the newborn is finished eating what not to do when breastfeeding? is not necessary for the entire areola be in the mouth each feeding should start at the opposite breast do not push back of newborns head-toward the nipple what should be included in a stool specimen? visible blood, pus, or mucus what is the first action in an infiltrated IV? to d/c the saline lock what is the first action when preparing to do a dressing change? to determine the pts level of pain what should a with hemonymous hemionopsia with right visual field, what will help pt eat better? the pt should turn head to the right to see all food on tray what are some side effect for theophylline (theo-dur)? is used to prevent wheezing,sob, chest tightness in asthma irregular pulse and dysrhythmias seizures anxiety urinary frequency anorexia n/v diarrhea what should you do when given enoxaparin (lovenox)? it should be injected SUBQ do not aspirate do not massage do not inject in same area what is the babinski reflex? stroke sole of the foot upward, toward the great toe what is the moro reflex? startle the infant by clapping hands` what is the stepping reflex? hold infant upright and allow one foot to touch tables surface what is the palmer grasp reflex? place an object in the palm of infant hand what should you do when catheterizing a male pt? pt should be place in supine position penis should be at 90 degree angle retract the foreskin and clean the glans prior to catherization what color is the meconium? it is the first stool passed and it is dark green and viscous what is an inportant thing to ask when pt having cardiac catherization? if pt allergic to iodine what should be done with nitroglycerin (nitrostat)? if pt continues to have pain after taking 1 tab, they should call 911 and take a second tab what is normal after taking a nitroglycerin (nitrostat) tab? h/a change positions slowly it should be kept in original, dark colored bottle to avoid light exposure what to do for restrains use? observe skin condition before applying restrains use a quick release knot to secure the restraints belt restrains should be placed over pts waist able to insert two fingers under restraints do not use all four side of rails to restrain pt what would indicate an active peristalsis? the presence of vowel sounds what does pt with COPD have? increased metabolism due to work of labored breathing they have dry mouth/thick mucus constipation decreased peristalsis how to use a cane? pt should hold cane on the stronger side of the body place it forward 6-10 inches and move his weaker leg forward to the cane distributing his weight between the cane and the stronger leg then he should move the stronger leg forward beyond the cane and distribute his weight between the cane and weaker leg what does the use of cardiac catherization required? that the pt have normal renal functions for excretion of the dye how should drops be apply? the nurse should apply gently pressure to the inner canthus of the eye for 30-60 seconds what are hyperthyroidism findings? tachycardia what are hypothyroidism findings? cold intolerance constipation brittle hair how much should infants grow? 1 inch per month, during the first 6 months they should be able to double their birth weight between 4-6 months of age and gain approximately 150-210 (about 5-7oz) per week what should you do when evaluating an infant? the nurse should measure ht/wt separately, and not combine what can reduce the anti hypertensive effect of anti hypertensives? ibuprofen (advil) or any NSAIDS what is the first action when IV pump alarm is beeping? to observe the iv site for infiltration or phlebitis how are normal bowel sounds? high pitched, irregular gurgles that occur every 5-15 seconds, in a rage of 5-30 per/min what is hypoactive? infrequent less than 5/min what is hyperactive? every 3 seconds or greater what is actinic keratosis? a pre-malignant lesion flat, scaly area with red edges what are cherry angiomas? bright red, raised spots (expected skin changes with aging) what does a change in color mole indicate? indicates skin cancer what happens in passive ROM? the pt does not actively participates the nurse should support the pts extremities distal and proximal to the joints to facilitate passive ROM what do you do when inserting a urinary catheter, and urine is seen in the tubing? the catheter should be advance another 2.5-5 cm to ensure that the balloon is inflated in the bladder what to do when addressing pt dilemma? determine the facts related to dilema identify possible solutions consider clients wishes what should a pt with peripheral vascular disease do? walk until feel pain, rest for 3 min and continue until tired should sit with legs in a dependent position what are s/s of a detached retina? photopsia= bright flashes of light what are s/s of macular degeneration? loss of peripheral vision what is a normal s/s of aging? presbyopia= difficulty focusing on close objects what should a pt with DM and influenza report? temp higher than 101.5 or greater for 24 hours what should be done with pts with closed head injury? should be log roll only suction on prn basis maintain HOB at least 30 degrees do not use an incentive spirometer ICP might go up what should a pt with cardiac catherization experience? they should drink adequate fluids may need to cough during test may experience a feeling of heat "hot flash" only need bed rest for 4-6 hours what should pt with COPD do? should perform pursed- lip breathing alternate activities with rest eat high protein snacks practice relaxation techniques turp care? monitor pt for fluid volume over load remind pt that they will feel urge while catheter is in place calculate urinary out put every 2 hours measure pain level every 2-3 hours pt should get up to a chair asap, risk for dvt how to administer ear drops to children under 3 yrs? pull pinna down and back how will ventricular fibrilation look on ekg? irregular rate without P waves, bizarre and variable QRS what are sinus tachycardia look on EKG? regular rate greater than 100/min normal P and QRS waves atrial ventricular (AV) block look on EKG? regular rate between 60-100/min with extended PR intervals premature atrial contractions look on EKG? irregular rate with ectopic atrial beats earlier than expected what are s/s of febrile transfussion reaction? chills what are s/s of circulatory overload transfussion reaction? bounding pulse and hypertension what are s/s of hemolytic transfussion reaction? lower back pain what foods are rich in iron? red meats, liver what to look for in HCTZ (Hydrodiuril)? flunctuation in weight encourage increase of potassium should be taken with food or right after a meal what are s/s of anaphalictic reactions? increased respiratory effort hypotension bronchoconstriction (laryngeal stridor) what does benzodiazepines (lorazepam/ativan) causes? lethargic and somnolent what are pt with preclampsia at risk for? seizures how should the formula be to prevent gastric cramping in an enteral feeding? administer the formula at room temp what is a s/s of bulemia nervosa? hemoptysis what is a s/s of anorexia nervosa? amenorrhea acrocynosis what are interventions for a salem sump tube? the most common ng tube it is a double lumen (two-channeled) it irrigates the stomach and removes fluid and gas from stomach. -pt should be reposition every 2 hours to promote emptiying of stomach content -set suction 80-100 -never clamp air vent pt should be NPO what might cause dry skin in older adults? a decrease in elasticity of the skin which is an expected change associated with aging what is a bronchoscope? a tube that allows the doctor to see in the lungs and airways and remove objects what are nursing interventions for pts with dementias? should encourage verbal praise do not exceed 20 mins in tub may not be able to follow direction they should not disrobe until right before entering the bath to prevent chilling what to do with ankle sprain? check for pedal edema wrap with a compression dressing apply ice elevate what promotes venous return? using sequential compression device what is an expected PR interval? should be 0.12 to 0.20 seconds it should be one P wave prior to each QRS complex an expected QRS duration is 0.04 to 0.10 second an expected ventricular rate of 60 to 100/min what are s/s of atorvastatin (lipitor) side effects? muscle weakness which can lead to rhabdomyolysis, report muscle cramps, pain or tenderness when should keflex (cephalexin) not be given? if pt has PCN allergy what will facilitate understanding in a pt with anxiety? the use of short, concise sentenses because they have difficulty concentrating what should be done to pts with expressive aphasia? give them a picture board, or pen and paper, because pt cannot verbally express needs or wants should use simple statements and speak normal voice what are risk factors for colorectal cancer? obesity high consumption of alcohol cigaret smoking high protein diet older pt fam hx of colon cancer/ polyps hx of gastrectomy and inflammatory bowel disease what is given for long term alcohol abuse? disulfiram (antabuse), which is an adversion therapy what is a bladder scan? it is a non invasive procedure, and pt should not experience discomfort not a sterile procedure no consent necessary how would the nurse explain a procedure to a school age child? using simple diagram what does concave shape nails indicate? emphysema, prolonged hypoxemia how many grams of protein does peanut butter contains? 7g what do you do with a boggy uterus? promote involution of the uterus, massaging the fundus because of hemmorhage what position is best for COPD pt? orthopnea position because it increases lung expansion phototherapy risks? dehydration report decreased urine output infant may sleep longer should be kept on a regular feeding schedule of every 3-4 hrs may have loose green stool what to teach with hepatitis B? pt should use own utensils and dishes avoid tylenol (acetaminophen) what should you teach a pt about exercising? they should warm up for atleast 5 mins first what should the nurse avoid when placing ekg lodes? avoid scar tissue post bronchoscopy care? pt should not eat until gag reflex is checked blood in sputum is expected have a ride home report horseness or wheezing what to do with a stage 5 alzheimers diasease pt? increase stress level, provide a variety of foods that the pt is able to eat by himself to maintain independence what does metoprolol affect? heart rate is a beta adrenergic antagonist car seat? should be secure with a seat belt where do we do blood draws? in the antecubital fossa crutch teaching? instruct pt to hold crutches on the side opposite the injured leg, when sitting to improve balance and prevent falls antidepressants (elavil) amitriptyline? pt may not feel better for 7 to 28 days and may not experience full effect for 6 to 8 weeks what should pt with leukemia not have in the room? fresh flowers what is an indication of hydration status? mucus membranes what is a low sodium food? canned peaches what is high sodium foods? wheat crackers lean ham cottage cheese how often is a tetanus booster? every ten years what are some risk for fall findings? the pt walks barefoot medications stored on top shelf what is the greatest risk for a thyroidectomy? hypocalcemia with tingling around the mouth what are strategies for teaching toddlers? picture books and simple words what are strategies for teaching preschoolers? role playing/ short stories what are strategies for teaching school age children? discussing and participating in hands on demonstration what are strategies for teaching adolescents? collaborative process/ problem solving what is priority in palliative care? pharmacological pain management what should peritoneal fluid in dialyses look like? bloody, clear, straw color what color should peritoneal fluid not look like? cloudy or opaque, this might means infections what is the glascow coma scale? motor response what are s/s of IV infiltration? pallor surrounding the infusion site what is a s/s of phlebitis? redness along the vein what is a s/s of an extravasation? tissue sloughing what to do with a child with rotavirus? the diaper should fit snuggly avoid using a rectal thermometer apply skin barrier they are NOT contagious where should the chest tube be placed? below the level of the pts chest what should be done with a pen rose drain? a safety pin is placed at the distal end of the drain what to do with a colonoscopy? should not take NSAIDS 1 week prior should be NPO 6-8 hours before what to report with albuterol (proventil)? tremors what should the nurse do when removing a pt IV catheter? the nurse should maintain the catheter parallel to the vein to reduce the risk of trauma to the vein what will the child need prior to an IV urography (IVP)? the child will need to have a soapsud enema administered before the procedure to assist in visualization of the kidneys, ureters, and bladder what diet should the child with nephrotic syndrome be in? low sodium diet to assist with diuresis of extracellular fluid what is normal findings in a turp? yellow urine with red sediment what is abnormal finding in a TURP? LOWER ABD CRAMPING BLOODY URINE WITH LARGE CLOTS INCREASED BLADDER SPASMS what pt should not take cephalexin (Keflex)? pts with PCN allergy what should be used to clean the inner cannula of a tracheostomy? sterile hydrogen peroxide what should the nurse consider when using an interpreter? the nurse should ensure that the interpreter and the pt speak the same dialect and share similar cultural norms and practices what should a pt with leukemia and stomatitis eat? a cold, soft, bland, and liquid foods to prevent further irritation to the oral mucosa exa: oatmeal and applesauce what should the nurse do after a pt has have a ECT electroconvulsive therapy? the pt should be reoriented frequently nursing interventions for pts in hypovolemic shock? place pt in trendelengurg position elevate legs to promote venous return to heart increase IV fluids keep pt warm nursing interventions for pts with vein ligation and stripping? elevate feet (recliner is appropriate) perform ROM walk 5 to 10 min/hr while awake for first 24 hrs the nurse should wrap legs with an elastic bandage for prevention of clots when would a pt on antidepressant (amitriptiline) feel the effect? 10-14 days and experience full effect for 4-8 weeks how is mono (infectious mononucleosis) acquired? direct contact with droplets of saliva of an infected person how long after giving insulin should a nurse check for hypoglycemia? 4-14 after administration of NPH (novolin N) insulin what should the pt do after taking iron preparation? pt should rinse mouth immediately after taking med in respiratory acidosis what is elevated? the Paco2 is elevated greater than 45 what is the first thing a pt with prosthesis do? applied immediately the prosthesis after waking what should a pt on suicide precautions be told to do? sign a no harm contract aka no suicide contract what to avoid with theophylline (theochron)? avoid caffeine due to tachycardia what would you see with dehydration? low potassium levels how can hep B be contracted? blood transfusion sexual contact sharing IV drug needles what are the risks for colorectal cancer? obesity high consumption of alcohol cigarette smoking high protein diet (red meat) fam hx of colon cancer hx of gastrectomy and IBS what are right sided heart failure s/s? edema ascites anorexia what are left sided heart failure s/s? dizziness following rupture of the membranes what is the greatest risk? fecal cord compression of prolapse, which is a medical emergency and obtaining a fetal heart tone is priority what should be done to a pt with anxiety? they will have trouble concentrating therefore the nurse should speak to the pt using simple sentenses what is a manifestation of type 2 DM? infection and poor wound healing what to monitor with timolol (Timoptic)? a decreased in BP what is inhibit with spinal cord damage at T1 and T2? it inhibits function below the waist wheel chair precautions? use a gell- filled seat cushion limit time to 2 hours at a time avoid donut-shaped pads shift weight every 15 minutes what kind of mask should pt with COPD use? a venturi mask what is priority in a child with sickle cell crisis? oxygenation what should be avoided with a mastectomy? avoid raising elbow above the shoulder until drain are removed avoid abduction return to work in 4 to 6 wks resume driving in 7 to 10 days during the initial tx of acute diverticulitis what is done? the pt receives parenteral nutrition and should be kept NPO what do do for a child with juvenile idiopathic arthiritis? use heat therapy prior to physical activities because it promotes exercise they should attend school as much as possible promote exercise eat a well balanced diet how often is a tetanus booster recommended? every ten years what to give prior to an NST? administer 4 oz (120 ML) of orange juice to stimulate fetal movement where should a cane be placed? held in the hand of the stronger side of body what is priority in a pt with anorexia nervosa? record amount of food pt consumes weight daily restrict exercing nitroglycerin (nitrostat)? take up to 3 tabs during single episode place under tongue store in original container discard on expiration date how should epoiten alfa be given? sub Q how should IM injections be given? z tract method what promotes drainage of stomach content in tubes/pumps? turning pt every two hours what should pt with cystic fibrosis eat? a diet high in calories what can long term use of corticosteroids induced? osteoporosis what should be priority when a pt with ketoacidosis come to hospital? administer a 0.9 % sodium chloride becauses it replaces sodium looses what is the greatest risk with a thyroidectomy? hypocalcemia leading to tetany by s/s of tingling around mouth what is a s/s of circulatory over load? crackles, sob, jugular vein distention, cough when taking care of a pt with meningitis what should the nurse wear? a surgical mask within 3 feet ot the pt to prevent exposure where would a pt with acute cholecystitis feel pain? RUQ radiating to back what to do first when IV pump is alarming? observe the IV site for phlebitis what should pt avoid before a colonoscopy? NSAIDs because it increases risk for bleeding when should a newborn repeat the hearing test if they fail the first time? in 3 months what helps pt with acute manic? step by step direction what is scleroderma? is a chronic disease with skin changes causes thickening, hardening, or tightening of the skin, blood vessels, and internal organs what is s/s of herpes zoster (shingles)? results from reactivation of a dormant varicella virus, inflammation of the dorsal root ganglion. localized vesicular lesions unilateral localized, nodular skin lesions genital herpes s/s? fluid-filled vesicular rash in genital region hepatitis A? fecal-oral route, uncooked food what is raynaud disease? a disorder of the blood vessel that supply blood to the skin and causes the distal extremities and the tip of nose and ear to feel numb/cool in response to cold temps or stress s/s: tingling, swelling, painful throbbing attacks may last mins to hours the pt should not smoke IGA? associated with autoimmune diseases or chronic infections IGE? allergic manifestations, anaphylaxis, and asthma IGM? antibodies against ABO blood groups IgG? antibodies to all types of infections what should the pt with SLE skin lesions do? it affects any organ in the body is a chronic autoimmune disorder, pt should monitor body temp and report any elevations promptly apply moisturizer after bathing the lesions with warm water what reduces exposure to allergens? use a dehumidifier/ NOT humidifier no carpet bed linens should be washed weekly in hot water dont apply repellent to skin what is pcp (pneumocystis carininii pneumonia? it exist as part of the normal flora of the lungs, the infection results from an impaired immune system pt may need a bronchoscopy with biopsy of lung tissue eosinophils? usually with asthma monocytes? infection and several collagen disorders lymphocytes? cancers and malnourished pts neutrophils? infection, stress, and inflammation RA s/s? bilateral pain and swelling in fingers and joints with stiffness in morning, finger joints are erythematous and warm to touch how to handle of an infant with HIV? use disposable diapers, and discard in separate plastic bags use bleach solution and gloves to clean up blood spills hand washing is important anyone changing babies diaper should wear gloves what should the pt with a desentization injection do? must remain in clinic atleast 30 minutes what are early manifestations of aids? persistent fever swollen glands diarrhea weight loss fatigue what does an elevated GFR indicate? an acute inflammatory process pt will need thermal interventions (heat or cold) what is an initial s/s of wound infection? erythema (redness) at incision site what is karposi sarcoma KS? associated with aids it looks like hyperpigmented multicentric lesions that can be firm, flat, or nodular what does histamine release causes? increases mucus secretions bronchospasms bronchial constriction what should a pt with active TB been transported wear? a mask what is early lyme disease characterized by? fever influenza like manifestation erythema migrans distinct progressive circular rash (or bulls eye rash) can pts with hepatitis a donate blood? no what does serum amylase has to do with? pancreatitis stoma care? use mild soap apply skin sealant cut it 1/8 to 1/16 larger than the size measure it at least once a week what is a early s/s of hepatitis A? anorexia what is a late s/s of hepatitis A? pale feces dark urine jaundice what to eat with peptic ulcer? no soda eat as normal as possible eat 5-6 small meals a day what foods to avoid with diverticulitis? corn, strawberries, whole grain bread what to do with spleenectomy? promoting lung aeration is important what is the position for an enema? left lateral TPN? withdrawal look out for hypoglycemia (shakiness and diaphoresis) SIADH? is caused by excessive release of an antidiuretic hormone (ADH) as a result pt retains water creating a dilutional hyponatremia what are dm type 2 manifestations of hyperglycemia? increased urination and thirst what are dm type 2 manifestations of hypoglycemia? tremors cold, clammy skin graves disease s/s? difficulty slepping, diarrhea, increased appetite, heat intolerance what does ketoacidosis causes? dehydration by s/s of n/v what are early s/s of hypoglycemia? drowsiness clammy skin diaphoresis blurred vision what are early s/s of hyperglycemia? anorexia dry mouth urinary frequency what are s/s of diabetes insipidus? polydipsia polyuria what does parathyroid hormone regulates? calcium what is the common cause of hyperthyroidism? graves disease what are s/s of thyroid storm? fever hypertension pain tachycardia what are s/s of diabetic ketoacidosis? increased blood glucose levels positive urine acetone a low bicarbonate levels what causes acromegaly? excessive production of somatropin (growth hormone) after closing of the epiphyses what is addisons disease? hormone deficiency caused by damage to the outer layer of the adrenal gland they need diet high in salt, carbs, and protein low in potassium what is primary therapy for a pt with JRA? preservation of joint function what is splitting? a primitive ego defense mechanism that places people in good/bad categories what is displacement? transfer of feelings to a less threatening person what is intellectualization? a logical aproach what is projection? attribute her faults to others what is the play mode in toddlers? parallel play with each child performing similar activities when are liver enzymes elevated? in pts with HELLP what to do with magnesium toxicity? give calcium gluconate s/s of toxicity: loss of deep tendon reflex respiratory depression oliguria if left untreated can lead to cardiac and respiratory arrest when taking iron supplement what would counteract with constipation? eating raw fruit and vegetables s/s of coarctation of the aorta? unequal upper and lower extremity pulses SSRI Side effects Side effects of SSRIs may include, among others: Nausea Nervousness, agitation or restlessness Dizziness Reduced sexual desire or difficulty reaching orgasm or inability to maintain an erection (erectile dysfunction) Drowsiness Insomnia Weight gain or loss Headache Dry mouth Vomiting Diarrhea MAOI Side effects The most common side effects of MAOIs include: Dry mouth Nausea, diarrhea or constipation Headache Drowsiness Insomnia Skin reaction at the patch site Dizziness or lightheadedness Other possible side effects include: Involuntary muscle jerks Low blood pressure Reduced sexual desire or difficulty reaching orgasm Sleep disturbances Weight gain Difficulty starting a urine flow Muscle aches Prickling or tingling sensation in the skin (paresthesia Opioid Other side effects of opioid analgesics include: Euphoria, dysphoria, agitation, seizures, hallucinations Lowered blood pressure and heart rate Muscular rigidity and contractions Nausea and vomiting Non-allergic itching Pupil constriction Sexual dysfunction Urinary retention Do not delegate What you can EAT E-evaluate A-assess T-teach Addison's & Cushings Addison's = down down down up down Cushings= up up up down up hypo/hypernatremia, hypo/hypertension, blood volume, hypo/hyperkalemia, hypo/hyperglycemia Better peripheral perfusion? EleVate Veins, DAngle Arteries APGAR Appearance (all pink, pink and blue, blue (pale) Pulse (>100, <100, absent) Grimace (cough, grimace, no response) Activity (flexed, flaccid, limp) Respirations (strong cry, weak cry, absent) Airborne precautions My chicken hez tb (measles, chickenpox (varicella) Herpes zoster/shingles TB Airborne precautions protective equip private room, neg pressure with 6-12 air exchanges/hr mask N95 for TB Droplet precautions spiderman! sepsis, scarlet fever, streptococcal pharyngitis, parvovirus, pneumonia, pertussis, influenza, diptheria, epiglottitis, rubella, mumps, meningitis, mycoplasma or meningeal pneumonia, adeNovirus (Private room or cohort mask!) Contact precaution MRS WEE Multidrug resistant organism Rresiratory infection Skin infection Wound infection Enteric infection (C diff) Eye infection (conjunctivitis) Skin infection VCHIPS Varicella zoster Cutaneous diptheria Herpes simplez Impetigo Peduculosis Scabies Air or Pulmonary Embolism S/S chest pain, dyspnea, tachycardia, pale/cyanotic, sense of impending doom. (turn pt to LEFT side and LOWER the head of bed.) Woman in labor (un-reassuring FHR) (late decels, decreased variability, fetal bradycardia, etc) Turn pt on Left side, give O2, stop pitocin, Increase IV fluids! Tube feeding with decreased LOC Pt on Right side (promotes emptying of the stomach) Head of bed elevated (prevent aspiration) After lumbar puncture and oil based myelogram pt is flat SUPINE (prevent headache and leaking of CSF) Pt with heat stroke flat with legs elevated during Continuous Bladder Irrigation (CBI) catheter is taped to the thigh. leg must be kept straight. After Myringotomy position on the side of AFFECTED ear, allows drainage. After Cateract surgery pt sleep on UNAFFECTED side with a night shield for 1-4 weeks after Thyroidectomy low or semi-fowler's position, support head, neck and shoulders. Infant with Spina Bifida Prone so that sac does not rupture Buck's Traction (skin) elevate foot of bed for counter traction After total hip replacement don't sleep on side of surgery, don't flex hip more than 45-60 degress, don't elevate Head Of Bed more than 45 degrees. Maintain hip abduction by separating thighs with pillows. Prolapsed cord Knee to chest or Trendelenburg oxygen 8 to 10 L Cleft Lip position on back or in infant seat to prevent trauma to the suture line. while feeding hold in upright position. To prevent dumping syndrome (post operative ulcer/stomach surgeries) eat in reclining position. Lie down after meals for 20-30 min. also restrict fluids during meals, low CHO and fiber diet. small, frequent meals. AKA (above knee amputation) elevate for first 24 hours on pillow. position prone daily to maintain hip extension. BKA (below knee amputation) foot of bed elevated for first 24 hours. position prone to provide hip extension. detached retina area of detachment should be in the dependent position administration of enema pt should be left side lying (Sim's) with knee flexed. After supratentorial surgery (incision behind hairline on forhead) elevate HOB 30-40 degrees After infratentorial surgery (incision at the nape of neck) position pt flat and lateral on either side. During internal radiation on bed rest while implant in place Autonomic Dysreflexia/Hyperreflexia S/S pounding headache, profuse sweating, nasal congestion, chills, bradycardia, hypertension. Place client in sitting position (elevate HOB) FIRST! Shock bedrest with extremities elevated 20 degrees. knees straight, head slightly elevated (modified Trendelenberg) Head Injury elevate HOB 30 degrees to decrease ICP Peritoneal Dialysis (when outflow is inadequate) turn pt from side to side BEFORE checking for kinks in tubing Lumbar Puncture After the procedure, the pt should be supine for 4-12 hours as prescribed. Myesthenia Gravis worsens with exercise and improves with rest Myesthenia Gravis a positive reaction to Tensilon---will improve symptoms Cholinergic Crisis Caused by excessive medication ---stop giving Tensilon...will make it worse. Liver biopsy (prior) must have lab results for prothrombin time Myxedema/ hypothyroidism slowed physical and mental function, sensitivity to cold, dry skin and hair. Grave's Disease/ hyperthyroidism accelerated physical and mental function. Sensitivity to heat. Fine/soft hair. Thyroid storm increased temp, pulse and HTN Post-Thyroidectomy semi-fowler's. Prevent neck flexion/hyperextension. Trach at bedside Hypo-parathyroid CATS---Convulsions, Arrhythmias, Tetany, Spasms, Stridor. (decreased calcium) give high calcium, low phosphorus diet Hyper-parathyroid fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium) give a low calcium high phosphorous diet Hypovolemia increased temp, rapid/weak pulse, increase respiration, hypotension, anxiety. Urine specific gravity >1.030 Hypervolemia bounding pulse, SOB, dyspnea, rales/crackles, peripheral edema, HTN, urine specific gravity <1.010. semi fowler's Diabetes insipidus (decreased ADH) excessive urine output and thirst, dehydration, weakness, administer Pitressin SIADH (increased ADH) change in LOC, decreased deep tendon reflexes, tachycardia. N/V HA administer Declomycin, diuretics hypokalemia muscle weakness, dysrhythmias, increase K (rasins bananas apricots, oranges, beans, potatoes, carrots, celery) Hyperkalemia MURDER Muscle weakness, Urine (olig, anuria) Resp depression, decreased cardiac contractility, ECG changes, reflexes Hyponatremia nausea, muscle cramps, increased ICP, muscular twitching, convulsions. give osmotic diuretics (Mannitol) and fluids Hypernatremia increased temp, weakness, disorientation, dilusions, hypotension, tachycardia. give hypotonic solution. Hypocalcemia CATS Convulsions, Arrythmias, Tetany, spasms and stridor Hypercalcemia muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, shallow respirations, emergency! Hypo Mg Tremors, tetany, seizures, dysthythmias, depression, confusion, dysphagia, (dig toxicity) Hyper Mg depresses the CNS. Hypotension, facial flushing, muscle weakness, absent deep tendon reflexes, shallow respirations. EMERGENCY Addison's Hypo Na, Hyper K, Hypoglycemia, dark pigmentation, decreased resistance to stress fx, alopecia, weight loss. GI stress. Cushings Hyper Na, Hypo K, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN, hirsutism, moonface/buffalo hump Addesonian crisis N/V confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP Pheochromocytoma hypersecretion of epi/norepi. persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA; avoid stress, frequent bathing and rest breaks, avoid cold and stimulating foods (surgery to remove tumor) Tetrology of Fallot DROP (Defect, septal, Right ventricular hypertrophy, Overriding aortas, Pulmonary stenosis) Autonomic Dysreflexia (potentially life threatening emergency!) HOB elevate 90 degrees, loosen constrictive clothing, assess for full bladder or bowel impaction, (trigger) administer antihypertensives (may cause stroke, MI, seizure) FHR patterns for OB Think VEAL CHOP! V-variable decels; C- cord compression caused E-early decels; H- head compression caused A-accels; O-okay, no problem L- late decels; P- placental insufficiency, can't fill what to check with pregnancy Never check the monitor or machine as a first action. Always assess the patient first. Ex.. listen to fetal heart tones with stethoscope. Position of the baby by fetal heart sounds Posterior --heard at sides Anterior---midline by unbilicus and side Breech- high up in the fundus near umbilicus Vertex- by the symphysis pubis. Ventilatory alarms HOLD High alarm--Obstruction due to secretions, kink, pt cough etc Low alarm--Disconnection, leak, etc ICP and Shock ICP- Increased BP, decreased pulse, decreased resp Shock--Decreased BP, increased pulse, increased resp Cor pumonae Right sided heart failure caused by left ventricular failure (edema, jugular vein distention) Heroin withdrawal neonate irritable, poor sucking brachial pulse pulse area on an infant lead poisoning test at 12 months of age Before starting IV antibiotics obtain cultures! pt with leukemia may have epistaxis due to low platelets when a pt comes in and is in active labor first action of nurse is to listen to fetal heart tones/rate for phobias use systematic desensitization NCLEX answer tips choose assessment first! (assess, collect, auscultate, monitor, palpate) only choose intervention in an emergency or stress situation. If the answer has an absolute, discard it. Give priority to the answers that deal with the patient's body, not machines, or equipment. ARDS and DIC are always secondary to another disease or trauma In an emergency patients with a greater chance to live are treated first Cardinal sign of ARDS hypoxemia Edema is located in the interstitial space, not the cardiovascular space (outside of the circulatory system) the best indicator of dehydration? weight---and skin turgor heat/cold hot for chronic pain; cold for accute pain (sprain etc) When pt is in distress. medication administration is rarely a good choice pneumonia fever and chills are usually present. For the elderly confusion is often present. before IV antibiotics? check allergies (esp. penicillin) make sure cultures and sensitivity has been done before first dose. COPD and O2 with COPD baroreceptors that detect CO2 level are destroyed, therefore, O2 must be low because high O2 concentration takes away the pt's stimulation to breathe. Prednisone toxicity Cushings (buffalo hump, moon face, high blood sugar, HTN) Neutropenic pts no fresh fruits or flowers Chest tubes are placed in the pleural space Preload/Afterload Preload affects the amount of blood going into Right ventricle. Afterload is the systemic resistance after leaving the heart. CABG Great Saphenous vein in leg is taken and turned inside out (because of valves inside) . Used for bypass surgery of the heart. Unstable Angina not relieved by nitro PVC's can turn into V fib. 1 tsp 5 mL 1 oz 30 mL 1 cup 8 oz 1 quart 2 pints 1 pint 2 cups 1 g (gram) 1000 mg 1 kg 2.2 lbs I lb 16 oz centigrade to Fahrenheit conversion F= C+40 multiply 5/9 and subtract 40 C=F+40 multiply 9/5 and subtract 40 Angiotenson II In the lungs...potent vasodialator, aldosterone attracts sodium. Iron toxicity reversal deferoxamine S3 sound normal in CHF. Not normal in MI After endoscopy check gag reflex TPN given in subclavian line pain with diverticulitis located in LLQ appendicitis pain located in RLQ Trousseau and Chvostek's signs observed in Hypocalcemia never give K+ in IV push DKA is rare in DM II (there is enough insulin to prevent fat breakdown) Glaucoma patients lose peripheral vision. Autonomic dysreflexia patients with spinal cord injuries are at risk for developing autonomic dyreflexia (T-7 or above) Spinal shock occurs immediately after injury multiple sclerosis myelin sheath destruction. disruptions in nerve impulse conduction Myasthenia gravis decrease in receptor sites for acetylcholine. weakness observed in muscles, eyes mastication and pharyngeal musles. watch for aspiration. Gullian -Barre syndrome ascending paralysis. watch for respiratory problems. TIA transient ischemic attack. mini stroke, no dead tissue. CVA cerebriovascular accident. brain tissue dies. Hodgkin's disease cancer of the lymph. very curable in early stages burns rule of Nines head and neck 9% each upper ext 9% each lower ext 9% front trunk 18% back trunk 18% genitalia 1% birth weight doubles by 6 months triples by 1 year if HR is <100 (children) Hold Dig early sign of cystic fibrosis meconium in ileus at birth Meningitis--check for Kernig's/ brudinski's signs wilm's tumor encapsulated above kidneys. causes flank pain hemophilia is x linked passed from mother to son when phenylaline increases brain problems occur buck's traction knee immobility russell traction femur or lower leg dunlap traction skeletal or skin bryant's traction children <3 y <35 lbs with femur fx eclampsia is a seizure perform amniocentesis before 20 weeks to check for cardiac and pulmonary abnormalities Rh mothers receive Rhogam to protect next baby anterior fontanelle closes by...posterior by.. 18 months, 6-8 weeks caput succedaneum diffuse edema of the fetal scalp that crosses the suture lines. reabsorbes within 1 to 3 days pathological jaundice occurs: physiological jaundice occurs: before 24 hours (lasts 7 days) after 24 hours placenta previa s/s placental abrution s/s there is no pain, but there is bleeding there is pain, but no bleeding (board like abd) bethamethasone (celestone) surfactant. premature babies milieu therapy taking care of pt and environmental therapy cognitive therapy counseling five interventions for psych patients safety setting limits establish trusting relationship meds least restrictive methods/environment SSRI's take about 3 weeks to work patients with hallucinations patients with delusions redirect them distract them Thorazine and Haldol can cause EPS Alzheimer's 60% of all dementias, chronic, progressive degenerative cognitive disorder. draw up regular and NHP? Air into NHP, air into Regular. Draw regular, then NHP Cranial nerves S=sensory M=motor B=both Oh (Olfactory I) Some Oh (Optic II ) Say Oh (Oculomotor III) Marry To (trochlear IV) Money Touch (trigeminal V) But And (Abducens VI ) My Feel (facial VII) Brother A (auditory VIII) Says Girl's (glossopharyngeal IX) Big Vagina (vagus X) Bras And (accessory XI) Matter Hymen (Hypoglossal XII) More Hypernatremia S (Skin flushed) A (agitation) L (low grade fever ) T (thirst) Developmental 2-3 months: turns head side to side 4-5 months: grasps, switch and roll 6-7 months: sit at 6 and waves bye bye 8-9 months: stands straight at 8 10-11 months: belly to butt 12-13 months: 12 and up, drink from a cup Hepatitis A Ends in a vowel, comes from the bowel Hepatitis b B= blood and body fluids (hep c is the same) Apgar measures HR RR Muscle tone, reflexes, skin color. Each 0-2 points. 8-10 ok, 0-3 resuscitate Glasgow coma scale eyes, verbal, motor Max- 15 pts, below 8= coma Addison's disease: Cushing's syndrome: "add" hormone have extra "cushion" of hormone Dumping syndrome increase fat and protein, small frequent meals, lie down after meal to decrease peristalsis. Wait 1 hr after meals to drink Disseminated herpes zoster localized herpes zoster Disseminated herpes=airborne precautions Localized herpes= contact precautions. A nurse with localized may take care of patients as long as pts are not immunosuppressed and the lesions must be covered! Isoniazid causes peripheral neuritis Weighted NI (naso intestinal tubes) Must float from stomach to intestine. Don't tape right away after placement. May leave coiled next to pt on HOB. Position pt on RIGHT to facilitate movement through pyloris Cushings ulcers r/t brain injury Cushing's triad r/t ICP (HTN, bradycardia, irritability, sleep, widening pulse pressure) Thyroid storm HOT (hyperthermia) Myxedema coma COLD (hypothermia) Glaucoma No atropine Non Dairy calcium Rhubarb sardines collard greens Koplick's spots prodomal stage of measles. Red spots with blue center, in the mouth--think kopLICK in the mouth INH can cause peripheral neuritis Take vitamin B6 to prevent. Hepatotoxic pancreatitis pts put them in fetal position, NPO, gut rest, Prepare anticubital site for PICC, they are probably going to get TPN/Lipids Murphy's sign Pain with palplation of gall bladder (seen with cholecystitis) Cullen's sign ecchymosis in umbilical area, seen with pancreatitis Turner's sign Flank--greyish blue. (turn around to see your flanks) Seen with pancreatitis McBurney's point Pain in RLQ with appendicitis LLQ Diverticulitis RLQ appendicitis watch for peritonitis Guthrie test Tests for PKU. Baby should have eaten protein first shilling test Test for pernicious anemia Peritoneal dialysis Its ok to have abd cramps, blood tinged outflow and leaking around site if the cath (tenkoff) was placed in the last 1-2 weeks. Cloudy outflow is never ok Hyper reflexes absent reflexes upper motor neuron issue (your reflexes are over the top) Lower motor neuron issue Latex allergies assess for allergies to bananas, apricots, cherries, grapes, kiwis, passion fruit, avocados, chestnuts, tomatoes and peaches Tensilon used in myesthenia gravis to confirm diagnosis ALS (amyotrophic lateral sclerosis) degeneration of motor neurons in both upper and lower motor neuron systems Transesophageal fistula esophagus doesn't fully develop. This is a surgical emergency (3 signs in newborn: choking, coughing, cyanosis) MMR is given SQ not IM codes for pt care Red- unstable, ie.. occluded airway, actively bleeding...see first Yellow--stable, can wait up to an hour for treatment Green--stable can wait even longer to be seen---walking wounded Black--unstable, probably will not make it, need comfort care DOA--dead on arrival Contraindication for Hep B vaccine anaphylactic reaction to baker's yeast what to ask before flu shot allergy to eggs what to ask before MMR allergy to eggs or neomycin when on nitroprusside monitor: cyanide. normal value should be 1. William's position semi Fowler's with knees flexed to reduce low back pain S/S of hip fx External rotation, shortening adduction Fat embolism blood tinged sputum r/t inflammations. Increase ESR, respiratory alkalosis. Hypocalcemia, increased serum lipids. complications of mechanical ventilation pneumothorax, ulcers Paget's disease tinnitus, bone pain, elnargement of bone, thick bones with allopurinol no vitamin C or warfarin! IVP requires bowel prep so bladder can be visualized acid ash diet cheese, corn, cranberries, plums, prunes, meat, poultry, pastry, bread alk ash diet milk, veggies, rhubarb, salmon orange tag in psych is emergent psych thyroid med side effects insomnia. body metabolism increases Tidal volume is 7-10 ml/kg COPD patients and O2 2LNC or less. They are chronic CO2 retainers expect sats to be 90% or less Kidney glucose threshold 180 Stranger anxiety is greatest at what age? 7-9 months..separation anxiety peaks in toddlerhood when drawing an ABG put in heparinized tube. Ice immediately, be sure there are no bubbles and label if pt was on O2 Munchausen syndrome vs munchausen by proxy Munchausen will self inflict injury or illness to fabricate symptoms of physical or mental illness to receive medical care or hospitalization. by proxy mother or other care taker fabricates illness in child multiple sclerosis motor s/s limb weakness, paralysis, slow speech. sensory s/s numbness, tingling, tinnitis cerebral s/s nystagmus, atazia, dysphagia, dysarthia hungtington's 50% genetic autosomal dominanat disorder.. s/s uncontrolled muscle movements of face, limbs and body. no cure WBC left shift pt with pyelo. neutrophils kick in to fight infections pancreatic enzymes are taken with each meal! infants IM site Vastus lateralis Toddler 18 months+ IM site Ventrogluteal IM site for children deltoid and gluteus maximus Thoracentesis: position pt on side or over bed table. no more than 1000 cc removed at a time. Listen for bilateral breath sounds, V.S, check leakage, sterile dressing Cardiac cath NPO 8-12 hours. empty bladder, pulses, tell pt may feel heat, palpitations or desire to cough with injection of dye. Post: V.S.--keep leg straight. bedrest for 6-8 hr Cerebral angio prep well hydrated, lie flat, site shaved, pulses marked. Post--keep flat for 12-14 hr. check site, pulses, force fluids. lumbar puncture fetal position. post-neuro assess q15-30 until stable. flat 2-3 hour. encourage fluids, oral analgesics for headache. ECG no sleep the night before, meals allowed, no stimulants/tranquilizers for 24-48 hours before. may be asked to hyperventilate 3-4 min and watch a bright flashing light. watch for seizures after the procedure. Myelogram NPO for 4-6 hours. allergy hx phenothiazines, cns depressants and stimulants withheld 48 hours prior. Table moved to various positions during test. Post--neuro assessment q2-4 hours, water soluble HOB UP. oil soluble HOB down. oralanalgesics for HA. No po fluids. assess for distended bladder. Inspect site Liver biopsy administer Vitamin K, NPO morning of exam 6 hrs. Give sedative. Teach pt to expect to be asked to hold breath for 5-10 sec. supide position, lateral with upper arms elevated. Post--position on RIGHT side. frequent VS. report severe ab pain STAT. no heavy lifting 1 wk Paracentesis semi fowler's or upright on edge of bed. Empty bladder. post VS--report elevated temp. watch for hypovolemia laparoscopy CO2 used to enhance visual. general anesthesia. foley. post--ambulate to decrease CO2 buildup PTB low grade afternoon fever pneumonia rusty sputum asthma wheezing on expiration emphysema barrel chest kawasaki syndrome strawberry tongue pernicious anemia red beefy tongue downs syndrome protruding tongue cholera rice watery stool malaria stepladder like fever--with chills typhoid rose spots on the abdomen diptheria pseudo membrane formation measles koplick's spots sle (systemic lupus) butterfly rash pyloric stenosis olive like mass Addison's bronze like skin pigmentation Cushing's moon face, buffalo hump hyperthyroidism/ grave's disease exophthalmos myasthenia gravis descending musle weakness gullian-barre syndrome ascending muscle weakness angina crushing, stabbing chest pain relieved by nitro MI crushing stabbing chest pain unrelieved by nitro cystic fibrosis salty skin DM polyuria, polydipsia,polyphagia DKA kussmal's breathing (deep rapid) Bladder CA painless hematuria BPH reduced size and force of urine retinal detachment floaters and flashes of light. curtain vision glaucoma painful vision loss. tunnel vision. halo retino blastoma cat's eye reflex increased ICP hypertension, bradypnea,, bradycarday (cushing's triad) shock Hypotension, tachypnea, tachycardia Lymes disease bullseye rash intraosseous infusion often used in peds when venous access can't be obtained. hand drilled through tibia where cryatalloids, colloids, blood products and meds are administered into the marrow. one med that CANNOT be administered IO is isoproterenol, a beta agonist. sickle cell crisis two interventions to prioritize: fluids and pain relief. glomuloneprhitis the most important assessment is blood pressure children 5 and up should have an explanation of what will happen a week before surgery Kawasaki disease (inflammation of blood vessles, hence the strawberry tongue) causes coronary artery aneurysms. ventriculoperitoneal shunt watch for abdominal distention. watch for s/s of ICP such as high pitch cry, irritability and bulging fontanels. In a toddler watch for loss of appetite and headache. After shunt is placed bed position is FLAT so fluid doesn't reduce too rapidly. If presenting s/s of ICP then raise the HOB 15-30 degrees 3-4 cups of milk a day for a child? NO too much milk can reduce the intake of other nutrients especially iron. Watch for ANEMIA MMR and varicella immunizaions after 15 months! cryptorchidism undescended testicles! risk factor for testicular cancer later in life. Teach self exam for boys around age 12--most cases occur in adolescence CSF meningitis HIGH protein LOW glucose Head injury or skull fx no nasotracheal suctioning otitis media feed upright to avoid otitis media! positioning for pneumonia lay on affected side, this will splint and reduce pain. However, if you are trying to reduce congestion, the sick lung goes up! (like when you have a stuffy nose and you lay with that side up, it clears!) for neutropenic pts no fresh flowers, fresh fruits or veggies and no milk antiplatelet drug hypersensitivity bronchospasm bowel obstruction more important to maintain fluid balance than to establish a normal bowel pattern (they cant take in oral fluids) Basophils reliease histamine during an allergic response Iatragenic means it was caused by treatment, procedure or medication Tamoxifen watch for visual changes--indicates toxicity post spelectomy pneumovax 23 is administered to prevent pneumococcal sepsis Alkalosis/ Acidosis and K+ ALKalosis=al K= low sis. Acidosis (K+ high) No phenylalanine to a kid with PKU. No meat, dairy or aspartame never give potassium to a pt who has low urine output! nephrotic syndrome characterized by massive proteinuria caused by glomerular damage. corticosteroids are the mainstay the first sign of ARDS increased respirations! followed by dyspnea and tachypnea normal PCWC (pulmonary capillary wedge pressure) is 8-13 readings 18-20 are considered high first sign of PE sudden chest pain followed by dyspnea and tachypnea Digitalis increases ventricular irritability could convert a rhythm to v-fib following cardioversion Cold stress and the newborn biggest concern resp. distress Parathyroid relies on vitamin D to work Glucagon increases the effects of? anticoagulants Sucking stab wound cover wound and tape on 3 sides to allow air to escape. If you cover and occlude it--it could turn into a closed pneumo or tension pneumo! chest tube pulled out? occlusive dressing PE Needs O2! DKA acetone and keytones increase! once treated expect postassium to drop! have K+ ready Hirschprung's diagnosed with rectal biopsy. S/S infant-failure to pass meconium and later the classic ribbon-like/foul smelling stools Intussusception Common in kids with CF. Obstruction may cause fecal emesis, current jelly stools. enema--- resolution=bowel movements laboring mom's water breaks? first thing--worry about prolapsed cord! Toddlers need to express independence! Addison's causes sever hypotension! pancreatitis first pain relief, second cough and deep breathe CF chief concern? Respiratory problems a nurse makes a mistake? take it to him/her first then take up the chain nitrazine paper turns blue with alkaline amniotic fluid. turns pink with other fluids up stairs with crutches? crutches first followed by good leg dumping syndrome? use low fowler's to avoid. limit fluids TB drugs are hepatotoxic! clozapine, Clozaril antipsychotic anticholinergic clozapine s/e weight gain, hypotension, hyperglycemia, agranulocytosis dehydration -hypovolemia - elevated urine specific gravity flumazenil, Romazicon benzo overdose umbilical cord compression reposition side to side or knee-chest short cord discontinue pictocin Discontinue oxypocin Discontinue oxytocin if uterine hyperstimulation occurs. Symptoms of uterine hyperstimulation include: ☐ Contraction frequency more often than every 2 min. ☐ Contraction duration longer than 90 seconds. ☐ Contraction intensity that results in pressures greater than 90 mm Hg as shown by IUPC. ☐ Uterine resting tone greater than 20 mm Hg between contractions. ☐ No relaxation of uterus between contractions Airborne Precautions My - Measles Chicken - Chicken Pox/Varicella Hez - Herpez Zoster/Shingles TB Droplet think of SPIDERMAN! S - sepsis S - scarlet fever S - streptococcal pharyngitis P - parvovirus B19 P - pneumonia P - pertussis I - influenza D - diptheria (pharyngeal) E - epiglottitis R - rubella M - mumps M - meningitis M - mycoplasma or meningeal pneumonia An - Adenovirus Private Room or cohort Mask Contact MRS.WEE M - multidrug resistant organism R - respiratory infection S - skin infections * W - wound infxn E - enteric infxn - clostridium difficile E - eye infxn - conjunctivitis Hypokalemia muscle ewakness, dysrhythmias, increase K (raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery) Hyperkalemia muscle weakness, urine (oliguria/anuria), respiratory depression, decreased cardiac contractility, ECG changes, reflexes Hyponatremia nausea, muscle cramps, increased ICP, muscular twitching, convulsion; osmotic diuretics, fluids Hypernatremia increased temp, weakness, disorientation/delusions, hypotension, tachycardia; hypotonic solution MAOI pirates say arrrr, so think; pirates take MAOI's when they're depressed. - explanation; MAOI's used for depression all have an arrr sound in the middle (Parnate, Marplan, Nardil) FHR patterns V = variable decels; C = cord compression caused E = early decels; H = head compression caused A = accels; O = okay, not a problem! L = late decels = placental insufficiency, can't fill Cord Compression place the mother in the TRENDELENBERG position because this removes pressure of the presenting part off the cord. (If her head is down, the baby is no longer being pulled out of hte body by gravity) If the cord is prolapsed, cover it with sterile saline gauze to prevent drying of the cord and to minimize infection. Late decelerations turn the mother to her left side, to allow more blood flow to the placenta ICP increased BP, decreased pulse, decreased resp shock decreased BP, increased pulse, increased resp Conversions 1 t (teaspoon)= 5 ml 1 T(tablespoon)= 3 t = 15 ml 1 oz= 30 ml 1 cup= 8 oz 1 quart= 2 pints 1 pint= 2 cups 1 gr (grain)= 60 mg 1 g (gram)= 1000 mg 1 kg= 2.2 lbs 1 lb= 16 oz Antidotes heparin= protamine sulfate coumadin= vitamin k ammonia= lactulose acetaminophen= n-Acetylcysteine. Iron= deferoxamine Digitoxin, digoxin= digibind. Alcohol withdraw= Librium. Developmental 2-3 months: turns head side to side 4-5 months: grasps, switch & roll 6-7 months: sit at 6 and waves bye-bye 8-9 months: stands straight at eight 10-11 months: belly to butt (phrase has 10 letters) 12-13 months: twelve and up, drink from a cup Hepatitis Hepatitis: -ends in a VOWEL, comes from the BOWEL (Hep A) Hepatitis B=Blood and Bodily fluids Hepatitis C is just like B Give NSAIDS, Corticosteroids, drugs for Bipolar, Cephalosporins, and Sulfanomides with food Valium is treatment of status epilepticus (Ativan may be used also) Allopurinol Push fluids. Avoide purines Avoid Vit C and Warfarin Rifampin Red orange tears and urine, also contraceptives don't work as well LLQ diverticulitis , low residue, no seeds, nuts, peas Kayexalate Don't use with hypoactive bowel sounds Anticholinergic effects dry mouth==can't spit urinary retention=can't **** constipated =can't **** blurred vision=can't see TCA end in mine, pine or line ● Therapeutic Uses ◯ Depression ◯ Depressive episodes of bipolar disorders --- Side effects: Orthostatic hypotension, Anticholinergic effects, Sedation, sweating, increased chance of seizure Avoid use of MAOI and TCA Avoid TCA and anti-histamines SSRI (ends in pram, tine, line) ● Therapeutic Uses ◯ Major depression ◯ Obsessive compulsive disorder ◯ Bulimia nervosa ◯ Premenstrual dysphoric disorders ◯ Panic disorders ◯ Posttraumatic disorder --- Decreased sex libido CNS stimulation (inability to sleep, anxiety) Weight loss / gain Serotonin syndrome Hyponatremia GI bleeding Bruxism (report to provider) --- Do not use St. Johns Wart MAOI must be discontinued for 14 days --- May increase warfarin levels or NSAID levels MAOI (zine, zid, mine, line) ● Therapeutic Uses ◯ Atypical depression ◯ Bulimia nervosa ◯ Obsessive compulsive disorder Side effects CNS stimulation, orthostatic hypotension, hypertensive crisis (with tyramine) added effects with anti-hypertensives Welbutrin ● Therapeutic Uses ◯ Treatment of depression ◯ Alternative to SSRIs for clients unable to tolerate the sexual dysfunction side effects ◯ Aid to quit smoking ◯ Prevention of seasonal affective disorder --- Weight loss, sz, headache dry mouth