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* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Ok for those of you who did not take Kaplan, this is their infamous Decision Tree (Can't say I use it a lot, but some swear by it) 1. Can you identify the Topic? Yes= proceed to step 2 No= read answers for clues, read stem, re word question identify and proceed to step 2 2. Are all answers Assessments or Implementations? Yes= proceed to step 3 No= determine from stem if assessment needed, validation needed; if so assess *if no assess in stem then you need to assess *if assess in stem, do you need validation? *if assess or validation required and there are no right assess answers, then implement 3. Does Maslows fit? Yes= Do they make sense? Apply ABC's. *eliminate psychosocial/pain (consider pain psychosocial for nclex) *don't always pick airway No= are all physical? yes..then proceed to step 4 are all psychosocial? yes..then proceed to step 5 4. Are all answers physical? Yes= apply ABC's No= proceed to step 5 5. What is outcome of each? do they make sense? why? and yes folks then you should have your answer!!!! During peritoneal dialysis- client suddenly begins to breathe more rapidly, what do you do? Elevate the HOB! Will decrease the pressure fo the dialysate on the diaphragm and increase the vital capacity of the lungs, draining the cavity will further decrease the pressure. Normal platelet = 150,000- 400,000. Decreased platelet= increase risk for bleeding. No IM injections, use sm. gauge needle to prevent trauma, apply firm pressure to needlestick site for 10 min, soft bristled toothbrush , do not floss, and no hard fards Femoral to popliteal bypass graft= report if client becomes clammy. Hypovolemic shock is caused by an inadequate volume of blood caused by hemorrhage, severe dehyradtion, or burns. skin will be cold and clammy b/c the body redirects blood from the skin, kidneys, and GI tract to the brain and heart. Urine output and B/P decreases and pulse increase Pre-op teaching of extracapsular cataract removal -post-op- activites and restrictions needs to be taught. Protect eye from ICP that will cause the suture line to rupture. To bend at the knees, avoid sneezing, coughing, blowing nose, not to strain during a BM, to avoid vomiting, and do not lie down in an dependent position Hepatic encaphalopathy occurs with profound liver disease and results from the accumulation of ammonia in the blood. Low protein and high calorie diet. mother receiving DES is at risk for development of vag. cancer cervical cancer risk factor= sex at early age WHIPPLE PROCEDURE- for pancreatic cancer= removal of head of pancreas, distal portion of common bile duct, the duodenum, and part of the stomach for tx of cancer. NG tube is connected to intermittent low suction, assess tub for kinking. Postion client in semi-fowlers. Drainage should be serosanguineous- pinkish Post-op radical neck dissectino, detect the presence of stirdor, most probable cause is laryngeal obstruction! Is identified upon auscultation of the trachea with a stethoscope. A coarse- high pitched sound can be heard on inspiration d/t edema of the larynx. Re: Anyoone up for random FACT THROWING?? PRAYERS BEFORE YOU TAKE THE EXAM Dear God, Today I will have my examinations. You know how important they are to me. So I am humbly asking Your gracious help and divine assitance. I pray to you, my dear God, please neve rlet me be at ease and give my very best. Please never let me guess nor rely on pure luck, but enlighten my mind and let me think clearly. Please never let me resort to chances nor to dishonesty, but let me work to the fullest of my ability. I pray for Your guidance that i as i think, I may find the right solutions, I may be able to correctly answer the questions, I may solve those difficult problems. I ask, O God, Your intercession, that as I write, I may not be careless nor overconfident, I may not be distracted but be more concentrated, I may not be in a hurry nor take the exams too lightly. Today, O my Lord, I will take my examinations Let me, with Your help, give my best effort. Let me, because of You, receive the best and fruitful results. This I pray in Jesus name. Amen. My tips: Stages of Dying: DABDA Denial Anger Bargaining Depression Acceptance Normal growth and development Most People Can Get Stuff BIRTH to 1 year- Mobiles 1-3 years- Push and pull toys 3-5 years - Coloring 6-12 years- Board Games 12-19 years- own Stuff Diabetic KetoAcidosis (DKA): (5-10% mortality) – Almost exclusively in Type 1 diabetics – S/S: Polyuria, dehydration, ab pain, fruity breath, AMS, ↓ Na/Mg/Phos, ↑K (↓ total body), + following: • Hyperglycemia (>250) • Metabolic acidosis (pH <7.3,> 20) • Ketonuria/Ketonemia – TX: • IV insulin bolus (0.1 unit/kg) then IV infusion with same amount per hr AFTER making sure pt is not ↓ K – Continue until acidosis corrects then taper • NS immediately upon diagnosis – Switch to D5NS when glucose < 250 • Why in the world would I give D5NS when a patient still has high glucose levels? The most important problem is the acidosis that is occurring. To reverse this we give insulin to drive glucose into the cell. Remember that K rushes into the cell along with the glucose, and wherever K can go, H+ can go. Since high levels of H+ in the blood is the cause of the acidosis, we give insulin to drive this H+ intercellularly, thereby reversing acidosis. We can't give insulin if the level of glucose is too low, so we give D5NS to keep levels around 250 so we can give insulin until the acidosis is gone. • Add KCl to IV fluids once K < 5; replenish other electrolytes as necessary; Even though K usually appears high, it most often is total body low and when you give glucose, the K is driven into the cell, and hypokalemia can develop rapidly. Hyperosmolar Hyperglycemic nonketotic syndrome (HHNS): – Severe ↑ Glucose, almost exclusively in Type 2 diabetics – Similar to DKA but usually have much higher glucose (>600) and NO acidosis or ketonuria/ketonemia – Treat with fluids and low dose Insulin infusion – An important distinction is that DKA usually occurs in Type 1 Diabetics, while HHNS most often occurs in Type 2 Diabetics. Remember this as it is a common question in the NCLEX world. Hypoglycemia: – Patho: When glucose drops to 80 = insulin levels ↓ ; 70 = Glucagon ↑; 50 = epinephrine ↑ along with s/s such as sweaty, ↑BP, ↑HR, tremors; Also around 50 CNS s/s (drowsy, h/a, confused) begin – Note: S/S from epinephrine release are absent if pt is on a BB – TX: If pt is alcoholic give Thiamine before any other treatment to prevent encephalopathy • Can eat = ↑ sugar food; • Can Not eat = ½ - 2 amps D50 IV push; (Glucagon alternative option if no IV access is available, however is of no use in prolonged hypoglycemia because stores of glycogen are depleted) Points to remember: – For high sugar (DKA, HHNS) most of the signs and symptoms are from polyuria, so look for dehydration and electrolyte imbalances...remember High and Dry – For low sugar most of the signs and symptoms are from the release of epinephrine, so look for things that would happen when someone was high on adrenaline, such as hypertension, sweating, tachycardia and tremors. – Imperative that you can recognize the difference between these two, as you are almost guaranteed to see a question relating to this difference! Re: Anyoone up for random FACT THROWING?? PULMONARY EDEMA:TX "MAD DOG" Morphine Aminophylline Digitalis Diuretics Oxygen Gases in blood(ABG'S) drugs to treat viral respiratory infections "you'd get a respiratory infection if you shoot an ARO (arrow) laced with viruses into the lungs ARO Re: Anyoone up for random FACT THROWING?? d1206,thanks for the correction back to facts: Pnuemothorax symptoms P-THORAX Pleuritic pain Trachea deviation Hyper resonance Onset sudden Reduced breath sounds(dyspnea) Absent Fremitus X-ray shows collapse Hi everyone my simple "PHARMA" facts for today from COMMERCIALS: 1)Sumatriptan (IMITREX)---an NSAID for MIGRAINE 2)Alleve---for muscle pain 3)Advair---COPD, bronchitis, emphysema 4)Lipitor--- to decrease BP, and for CAD 5)Mucinex--- expectorant, can last for 12 hours 6)Zopidem (AMBIEN)---anti-insomnia, taken at bedtime with full glass of water in an empty stomach (seen this at Saunders Q & A too) 7) Enbrel---for Rheumatoid Arthitis SE: immunosuppression, fever and bruising Oh and GLUCERNA diet for people with DM.. So far those are the drugs that Ive seen on TV ads. and 1 came up on Saunders Q &A the ambienCR. ABCDE mnemonic --CAUSE of secondary hypertension A: Accuracy, Apnea, Aldosteronism B: Bruits, Bad Kidney C: Catecholamines, Coarctation of the Aorta, Cushing's Syndrome D: Drugs, Diet E: Erythropoietin, Endocrine Disorders MASLOW'S HIERARCHY examples and contraindications by vadee Updated Oct 08, 2008 at 04:18 PM by vadee Registered User Received 162 Kudos from 39 posts Join Date: Oct 2008 Posts: 70 As we all know, Maslow's hierarchy is important to know and understand. Yet there are examples where Maslow's hierarchy is contraindicated. With that being said, here is to refresh your memory on Maslow's hierarchy. PLEASE HELP GIVE EXAMPLES. --------------------------------------------------------------------------------IMAGINE that this is the pyramid: 1st (most) important (located at the bottom of the pyramid): BASIC PHYISIOLOGICAL NEEDS: airway, respiratory effort, heart rate, rhythm, and strength of contraction, nutrition, elimination 2nd most important (located above physiological on the pyramid): SAFETY AND SECURITY: protection from injury, promote feeling of security, trust in nurse-client relationship PSYCHOSOCIAL NEEDS 3rd most important: LOVE and BELONGING: maintain support systems, protect from isolation, fear 4th: SELF ESTEEM: control, competence, positive regard, acceptance/worthiness 5th (top of the pyramid): SELF ACTUALIZATION: hope, spiritual well-being, enhanced growth. ----------------------------------------------------------------example of when it is contraindicated: -a dehydrated and extremely suicidal client: safety comes before hydration -----------------------------------------------------------example of when physiological is more important than safety -cataract client: disturbed sensory perception (visual) is more important than risk of injury related to decreased vision )In myocardial infarction...MORPHINE first BEFORE OXYGEN... 2) In sickle cell crisis...TREAT HYDRATION FIRST BEFORE OXYGEN in nclex,common sense is a key factor. you always think for the safety of the patient.I choose the extremely suicidal.For the other one,it only says "dehydrated". Offer some fluids.hehe apology..i meant to say this CLIENT was dehydrated plus suicidal....you would want to provide safety first before hydration. i reread my posting and realized that I made it sound like there were two clients involved rather than one. thanks and lets keep them coming. =) cataract client: disturbed sensory perception (visual) is more important than risk of injury related to decreased vision hhmmm physiologic need IS more important than safety/security. that being said, i believe if you can't see, (physiologic) then it'll probably lead you busting your butt along the way (safety/security) phyisiologic needs always come before safety, except in psy. When you think about these needs, you need O2, water, food. Also, think about ABC's then safety example of when oxygen is not administered first.... a client receiving parenteral nutrition with suspected air embolism. 1. First CLAMP the intravenous catheter (prevents the embolism from going through the heart to the pulmonary system). 2. Position the client to a LEFT trendelenburg position with the HOB lower (this will trap the air in the right side of the heart) 3. CONTACT the physician 4. Administer OXYGEN as prescribed 5. Take the VITALS frequently 6. document the occurrence so what i got from this is that you save the documentation for last. Before administering oxygen, you need to contact the Physician (remember that administration of oxygen requires Physician's order). usually you would want to do all that you can first before contacting the Physician. In this case which is considered an emergency, the vitals is taken after the physician is contacted and oxygen is administered. that being said, i believe if you can't see, (physiologic) then it'll probably lead you busting your butt along the way (safety/security) yes but risk for is a potential diagnosis and altered sensory perception is an actual diagnosis. Priority would be a diagnosis that is present not one that has the potential to be. Just remember that underneath that Maslow's triangle there is an imaginary "additional" line below the whole thing that is LIFE or DEATH. In other words, if the "safety" factor is a life or death issue, that takes priority over every other need. A client being hydrated isn't going to mean a hill of beans if he's dead. always draw up clear to cloudy when mixing insulin. 2. do not add potassium to the diet of someone who is taking potassium sparing diretics. 3. Give diretics in the am to avoid nocturia. 4. always check for tube placement with 10 cc of air before instilling ANYTHING in an NG tube. 5. An infant should double there birth weight by 6 months old. mother/baby stuff 1. Rh negative mom gets Rhogam if baby Rh positive. Mom also gets Rhogam after aminocentesis, ectopic preganancy, or miscarriages. 2. fetus L/S Ratio less than 2= immature lungs......2-3=borderline....greater than 3=good lung maturity dude!! may give dexamethasone to speed up maturity if baby needs to be delivered soon. 3. prolasped cord position knee chest or trend..call for help!! GET THAT BOTTOM OFF THE CORD! SUPPORT CORD WITH YA HAND 4. decelerations early vs late----always good to be early but dont ever show up late. early mirrors the contraction, late comes after the contraction 5. LOCHIA SEQUENCE...lochia rubra- red, clotty....lochia serosa...pink, brown....lochia alba..white.........SHOULD NEVER HAVE A FOUL ODOR! VEAL CHOP Variable deceleration -Cord compression Early deceleration - Head ompression Acceleration - O.k Late deceleration - Position change Pt with asthma - FIRST give bronchodilators (opens airways) and then stuff them with steroids 2. Antepartum client c/o leg cramps - teach client to dorsiflex foot 3. Pt who had thyroidectomy - assess for signs of hypocalcemia (muscle twitching: positive Chvostek's/Trousseau's sign, tetany) 4. NORMAL FINDINGS for a 6 month old child - sits up without support 5. DELEGATION/SUPERVISION RN's can assess (initial for sure, MOST IMPORTANTLY), teach, administer blood products, planning, evaluation, infusion of IV meds, LVN's can do dressing changes, administer enemas/antibiotics, oral care and routine observation, perform fingerstick glucose readings, gathering data and observations: breath sounds and pulse oximetry, set up equipment for oxygen and suctioning, checking and observing client for signs of infection, irrigating the ear, reminding client about post-op instructions given by RN, assisting with procedures in stable clients with predictable outcomes Nursing assistant's can do VS's, baths, ambulate client, brush/floss client's teeth, record intake and output, can remind client to perform actions that are already part of the plan of care, weighing the client, taking pulse and blood pressure, reinforce dietary and fluid restrictions after the RN has explained them to the client Remember that long-term corticosteroid use causes adrenal atrophy, which will decrease the ability of the body to withstand stress. Therefore, when a pt is made NPO before surgery, check with the MD because this medication may still need to be given. Sometimes you may also see the the dosage of a corticosteroid increased before surgery Re: Anyoone up for random FACT THROWING?? Burns Priority = 1-airway (ABCs), 2-Circulation (Fluids & E-lytes)= IV LR 3-Pain, 4-Infection Percaution= Cap, Gown, Mask, Gloves (use by nurse to infection. Wound Care= at least 1/day with carful Aseptic (sterile) techinique if pt with 50% burned. Meds= Morphine IV (monitor VS) Analgesic 30 min before wound care Tx= Silvadene (monitor urine for sulfa crystals) (Tx for psudomonas) Monitor= adequate fluid replacement check urinary output of 30ml/hr Lab= Hematocrit male 40-50, female 37-47 Diet= Calorie Carb protein / TPN may be used monitor BS / Sliding Scale for insulin supplments: Vit B, Vit C, Iron FyI: Most concern is a burn that does not blanch. Degree of Burns 1◦ = Pink to red; epidermis damage (superfical) ;uncontrollable painful 2◦ = red to white with blisters and edema; epidermis and dermis (partial thickness) ; painful = charred, waxy white and edema; damage skin, nerves, muscle, bones(called deep thickness burn), painless 3◦ = usually dry darkbrown or has a leathery appearence. ;damage to all the Epidermis and Dermis Skin grafting is recommended.( Full Thickness Burn) 4◦= The tissue beneath the skin is burned/destroyed. includes the muscles, tendons, ligaments and bones. Skin grafting is usually needed to close up the areas. Endocrine Glands Hypothalamus (Regulator) Pituitary Gland (Growth, Reproduction, Melanin, F&E) Pineal Gland (Melatonin, Circadan Rhythms) Thyroid (Metabolism, Energy, Growth) Parathyroid (Calcium Regulation) Thymus (Immune Response) Adrenal Glands (Stress Response, Metabolism, F&E) Pancreas (Fat, Protein, Carb Metabolism) Ovaries (Reproductive System, Sex Organs) Testes (Reproduction, Muscles, Bones, Skin, Hair) Hormones Hypothalmus (Releasing/Inhibiting Hormones) Ant. Pituitary (TSH, Growth Hormone, LH, FSH, ACTH) Posterior Pituitary (ADH, MSH, Oxytocin) Pineal (Melantonin) Thymus (Thymopoietin) Thyroid (T4, T3, Calcitonin) Parathyroids ( PTH) Adrenal Medulla (Epi, Norepi) Adrenal Cortex ( Glucocorticoids, Mineralocorticoids) Pancreas (Insulin, Glucagon) Addisson’s Disease Assessments Fatigue Weakness Dehydration Eternal tan Decreased resistance to stress Low Sodium Low Blood Sugar High Potassium Addisson’s Disease Implementations High protein, High carbohydrate, high Sodium, Low potassium diet Teach life-long hormone replacement Addisonian Crisis Assessments • Hypotension • Extreme weakness • Nausea vomiting • Abdominal pain • Severe hypoglycemia • Dehydration Addisonian Crisis Implementations • Administer NaCl IV, vasopressors, hydrocortisone • Monitor vital signs • Absolute bedrest Cushing’s Syndrome Assessments • Osteoporosis • Muscle wasting • Hypertension • Purple skin striations • Moon face • Truncal obesity • Decreased resistance to infection Cushing’s Syndrome Implementations • Low Carbohydrate, Low Calorie, High Protein, High Potassium, Low sodium diet • Monitor glucose level • Postop care after adrenalectomy or hypophysectomy Buck's traction is used to immobilize and reduce spasms in a fractured hip. Prioritizing Anyone threatening suicide/self-harm should be seen first, followed by anyone hearing command hallucinations to harm others. An infant experiencing vomiting and/or diarrhea should be seen before an older child, young adult, or adult experiencing vomiting/diarrhea. IRON-DEFICIENCY ANEMIA (IDA) * Anemia that results when iron supply is inadequate for optimal RBC formation because of excessive iron loss from bleeding, decreased dietary intake, or malabsorption Nursing assessment * Fatigue and weakness * Shortness of breath * Pallor (ear lobes, palms, and conjunctiva) * Brittle spoonlike nails * Cheilosis (cracks in the corners of the mouth) * Smooth, sore tongue * Dizziness * Pica (craving to eat unusual substances such as clay or starch) * Blood sample shows microcytic and hypochromic anemia (small RBC diameter with decreased pigmentation) and an increase in red cell size distribution width (RDW) * Decreased MCV, MCH, and MCHC; analyzed only when hemoglobin is low * Low serum iron level and elevated serum iron-binding capacity or low serum ferritin levels Therapeutic management * Examine stools for occult blood; endoscopic examination and other diagnostic procedures may be performed to detect possible sources of bleeding * Increase intake of iron-rich foods, such as organ meats, meat, beans, green leafy vegetables, molasses, and raisins * Administer iron supplements * Administer parenteral iron dextran (InFed) by deep IM route via Z-track method * Determine stool color, consistency, frequency, and amount; may appear greenish black and tarry; caution client that iron supplements usually cause constipation and client should take preventive measures (fluids, fiber) Client teaching * Take iron on an empty stomach; absorption of iron is decreased with food; ab*sorption may be enhanced when taken with an acidic beverage (such as one with vitamin C), but avoid grapefruit Mice * Foods high in iron include organ meats (beef or calf liver, chicken liver), other meats, beans (black, pinto, and garbanzo), leafy green vegetables, raisins, and molasses MEGALOBLASTIC ANEMIA * Vitamin B12, deficiency anemia * A type of anemia characterized by macrocytic RBCs Nursing assessment * Pallor or slight jaundice with a complaint of weakness * Smooth, sore, beefy red tongue (glossitis), and cheilosis (cracking of lips) * Diarrhea * Paresthesias (numbness or tingling in extremities) * Impaired proprioception (difficulty identifying one's position in space. which may progress to difficulty with balance) * Clients with this anemia tend to be fair-haired or prematurely gray Macrocytic (megaloblastic) anemia (RBC diameter >8) with increase in MCV and MCHC * Gastric secretion analysis reveals achlorhydria: absence of free hydrochloric acid in a pH maintained at 3.5 * Twenty-four-hour urine for Schilling test (a vitamin B12 absorption test th indicates if client lacks intrinsic factor by measuring excretion of orally ad-ministered radionuclide-labeled B12) confirms diagnosis of pernicious anemia Therapeutic management * Medication therapy: parenteral vitamin B12,100 to 1000 mcg subcutaneously daily for 7 days, then once a week for 1 month, then monthly for lifetime is usually prescribed; a nasal form is now available also Client teaching * Dietary sources of vitamin B12 include dairy products, animal proteins Folic acid—deficiency anemia Nursing assessment * Pallor, progressive weakness, fatigue * Shortness of breath * Cardiac palpitations * GI symptoms are similar to B12 deficiency but usually more severe (glossitis, cheilosis, and diarrhea) * Neurological symptoms seen in B12 deficiency are not seen in folic acid deficiency and therefore assist in differentiating these two types of anemia * RBC analysis shows macrocytic (megaloblastic) anemia (RBC diameter, high MCV with low hemoglobin, low serum folate level Therapeutic management * Includes dietary counseling and administration of folic acid Client teaching * Dietary sources of folic acid such as green leafy vegetables, fish, citrus yeast, dried beans, grains, nuts, and liver APLASTIC ANEMIA Nursing assessment * * * * * * * * * Pallor and fatigue Palpitations and exertional dyspnea Infections of the skin and mucous membranes Bleeding from gums, nose, vagina, or rectum Purpura (bruising) Retinal hemorrhage Blood counts reveal pancytopenia (decreased RBC, WBC, and platelets) Decreased reticulocyte count Bone marrow examination reveals decrease in activity of bone marrow or no cell activity Therapeutic management * Institute reverse isolation to protect client from infection * Monitor for evidence of bleeding * Avoid invasive procedures including rectal temperatures Client teaching * Methods to prevent infection such as avoiding crowds, maintaining good hygiene, hand washing, and elimination of uncooked foods from the diet * Methods to prevent hemorrhage such as using a soft toothbrush, avoiding contact sports, and use of an electric razor * Avoid drugs that increase bleeding tendency, such as aspirin Sickle Cell Disease Nursing assessment * Pallor and jaundice * Fatigue and possible irritability * Large joints and surrounding tissue may become swollen during crisis * Priapism (abnormal, painful, continuous erection of penis) may occur if penile veins are obstructed * Severe pain * Anemia with sickle cells noted on a peripheral smear * Hemoglobin electrophoresis to detect presence and percentage of hemoglobin is used for a definitive diagnosis * Elevated serum bilrubin levels * Elevated reticulocyte count Therapeutic management * Care of client in sickle cell crisis o Recognize that client may have severe pain and medicate accordingly, usually with opioid analgesics o Administer 02 to increase oxygenation to cells o Promote hydration to decrease blood viscosity; provide oral intake of at 6 to 8 quarts daily or IV fluids of 3 liters daily o Monitor for complications such as vaso-occlusive disease (thrombosis), hy*poxia, CVA, renal dysfunction, priapism leading to impotence, acute chest syndrome (fever, chest pain, cough, pulmonary infiltrates, and dyspnea), an substance abuse o Manage infection if appropriate Medication therapy * Narcotic (opioid) analgesics during the acute phase of sickle cell crisis, often at large doses Client teaching * Ways to prevent sickle cell crisis * Maintain an oral intake of at least 4 to 6 quarts a day; avoid conditions that might predispose to dehydration * Avoid high altitudes * Prevent and promptly treat infections * Use stress-reduction strategies * Avoid exposure to cold * Avoid overexertion Anemia * Children with persistent anemia might experience frequent bouts of otitis media and upper respiratory infections. Pernicious Anemia * For the exam, you should know the names for the various B vitamins and realize that they can be used interchangeably in test items; * B1 (Thiamine) * B2 (riboflavin) * B3 (niancin) * B6 (pyridoxine) * B9 (folic acid) * B12 (cyanocobalamin) Sikle Cell Anemia * When multiple transfusions are given, reduce iron overload and hemosiderosis with subcutaneous chelating injections of deferoxamine (Desferal) * Morphine is the drug of choice for acute pain in sickle cell anemia. Meperidine is contraindicated due to the possibility of central nervous system stimulation in these clients that could lead to seizure activity. * An easy to remember general nursing care for clients with sickle cell anemia is to remember the following * H - heat * H – hydration * O – oxygen * P – pain relief Polycythemia Vera This disorder is characterized by thicker than normal blood. There is an increase in the client’s hemoglobin to levels of 18 g/dL, RBC of 6 million/mm or hematocrit at 55% or greater and increased platelets) * With polycythemia, the client is at risk for cerebrovascular accident (CVA), myocardial infarction, (MI) and bleeding due to dysfunctional platelets. Hemophilia * Intracranial bleeding is the major cause of death in clients with hemophilia * Cryoprecipitates are no longer used for treatment of hemophilia because HIV and hepatitis cannot be removed. Transfusion Therapy * Severe reactions occur during the first 50mL of blood transfused. Stay with the patient for the initial 15-30 min of infusion Client with Burns BURN INJURY * An alteration in skin integrity resulting in tissue loss or injury caused by heat, chemicals, electricity, or radiation * There are several types of burn injury: thermal, chemical, electrical, and radiation * Thermal burn: results from dry heat (flames) or moist heat (steam or hot liq*uids); is most common type; causes cellular destruction that results in vascu*lar, bony, muscle, or nerve complications; thermal burns can also lead to inhalation injury if head and neck area is affected * Chemical burn: caused by direct contact with either acidic or alkaline agents; alters tissue perfusion and leads to necrosis * Electrical burn: severity depends on type and duration of current and amount of voltage; electricity follows path of least resistance (muscles, bone, blood vessels. and nerves); sources of electrical injury include direct current, alter*nating current, and lightning * Radiation burn: usually associated with sunburn or radiation treatment for cancer; usually superficial; extensive exposure to radiation may lead to tissue damage and multisystem injury o Nursing assessment: history of injury, estimate burn extent and depth, obtain past medical history and medication history including date of last tetanus pro*phylaxis; assess for other concurrent injuries o Systemic effects of severe burns include asphyxia from smoke inhalation that causes edema of respiratory passages; shock from fluid shifts; renal failure from shock; protein loss from open wound; potassium excess from tissue destruction and renal failure o Diagnostic and laboratory test findings: may have elevated hematocrit (Hct) and decreased hemoglobin (Hgb) caused by fluid shift, decreased sodium (Nat) and increased potassium (K+) caused by damage to capillary and cell mem*branes, elevated BUN and creatinine caused by dehydration, myoglobin in urine, and possible deterioration of arterial blood gases (ABGs) and oxygen (02) saturation readings depending on respiratory status o Therapeutic management * First aid: douse flames with water or smother them with a blanket, coat, or other similar object; cool a scald burn with cool water; flush chemical burns copiously with water or other appropriate irrigant after dusting away any dry powder if present; remove client from contact with an electrical source only after current has been shut off * Priority care is on ABCs: airway, breathing, and circulation; assess for smoke inhalation injury (singed nares, eyebrows or lashes; burns on face or neck; stridor, increasing dyspnea) and give 02 (up to 100% as prescribed), being prepared for possible intubation and mechanical ventilation if severe inhala*tion injury or carbon monoxide inhalation has occurred; assess for signs of shock caused by fluid shifts (increased pulse, falling BP and urine output, pal*lor, cool clammy skin, deteriorating level of consciousness [LOC]) * Fluid resuscitation: Brooke formula uses 2 mL/kg/% TBSA burned (3/4 crys*talloid plus 1/4 colloid) plus maintenance fluid of 2,000 mL D5W per o Medication therapy: analgesics—usually morphine sulfate IV, tetanus booster (> 5-10 years since last dose), topical antimicrobials, systemic antibiotics o Acute phase of burn management: begins with start of diuresis (usually 48 to 72 hours postburn) and ends with closure of burn wound o Therapeutic management + Wound care management includes debridement, dressing changes, hydrother*apy, and possible escharotomy, + Mafenide (Sulfamylon) may be applied in thin layer over open wound and covered with dressing + Sulfadiazine (Silvadene) may applied in thin layer over open wound and cov*ered with dressing; use with caution when impaired renal function exists; must be washed off and reapplied every 8 to 12 hours + Skin grafting may need to be done to achieve healing in full-thickness and large, deep partialthickness burns + Nutritional therapies (high-calorie, high-protein diet with vitamins and min*erals) and continue to maintain hydration status + Infection control with strict sterile technique + Maintain heated environment to prevent chilling + Physical therapy as needed + Psychosocial support # Rehabilitative phase of burn management: begins with wound closure and ends when client returns to highest level of health restoration # Therapeutic management * Prevent immobility contractures with exercises or ongoing physical therapy * Assist in returning to work. family, and social life * Client education * Environmental safety: use low temperature setting for hot water heater, en*sure access to and adequate number of electrical cords/outlets, isolate house*hold chemicals, avoid smoking in bed * Use of sunscreen to protect healing tissue and other protective skin; measures soft tissue injuries; or deep chemical or electrical + To prevent burns, hot water heaters should be set no higher that 120° Fahrenheit. Burn Classifications + Pain medication is given intravenously to provide quick, optimal relief and to prevent overmedication as edema subsides and fluid shift is resolving. + The cardiac status of a client with electrical burns should be closely monitored for at least 24 hours following the injury to detect changes in electrical conduction of the heart. + Full thickness burns can damage muscles, leading to the development of myoglobinuria in which urinary output becomes burgundy in color. The client with myoglobinuria require hemodialysis to prevent tubular necrosis and acute renal failure. Burn Measurement with TBSA + It will be beneficial to review your nursing textbooks for local and systematic reactions to burns because these injuries affect all body systems and cardiovascular and renal functions in particular. Nursing Care for Burn Victims + The eyes should be irrigated with water immediately if a chemical burn occurs. Follow-up care with an ophthalmologists is important because burns of the eyes can result in corneal ulceration and blindness. + Important Steps in treating a burn client include the following: * Treat airway and breathing – Traces of carbon around the mouth or nose, blisters in the roof of the mouth, or the presence of respiratory stridor, indicate the client has respiratory damage * Ensure proper circulation – Compromised circulation is evident by a drop in normal blood pressure, slowed capillary refill, and decreased urinary output. These symptoms signal impending burn shock. o It is important to remember that the actual burns might not be the biggest survival issue facing burn clients. Carbon monoxide from inhaled smoke can develop into a critical problem as well. Carbon monoxide combines with hemoglobin to form carboxyhemoglobin which binds to available hemoglobin 200 times more readily than with oxygen. Carbon monoxide poisoning causes a vasolidating effect causing the client to have a characteristic cherry red appearance. Interventions for carbon monoxide poisoning focus on early intubation and mechanical ventilation with 100% oxygen. The Consensus Formula o Fluid replacement formulas are calculated from the time of injury rather than from the time of arrival in the emergency room. The Intermediate Phase o Infections represent a major threat to the post-burn client. Bacterial infections (Staphylococcus, Proteus, pseudomonas, eshcerichia coil, and Klebsiella) are common due to optimal growth conditions posed by the burn wound; however, the primary source of infection appears to be the client’s own intestinal tract. As a rule, systemic antibiotics are avoided unless an actual infection exists, o Enzymatic debridement should not be used for burns greater thatn 10% TBSA, for burns near the eyes, or for burns involving muscle. Dressing for Burns o Dressing for burns include standard wound dressings (sterile gauze) and biologic or biosynthetic dressings (grafts, amniotic membranes, cultured skin, and artificial skin) o Biologic dressings are obtained from either human tissue (homograft or allograft) pr animal tissue (heterograft or xenograft). These dressing which are temporary are used for clients with partial thickness or granulating full thickness injuries. o Hemografts and allografts are taken from cadaver donors and obtained through a skin bank. These grafts are expensive and there is a risk of blood-borne infection. Heterografts and xenografts are taken from animal sources. The most common heterograft is pig skin (porcine) because of its compatibility with human skin. o Muslims and Orthodox Jews are two religious/ethnic groups who might be offended by the use of porcine grafts since the pig is considered an unclean animal. Christian groups such as Seventh Day Adventists might also reject the use of procine grafts. DIAGNOSTIC TEST AND ASSESSMENT Pulse oximetry * Monitors arterial or venous oxygen saturation ([percentage of 02] bound to he*moglobin [Hgb] compared to volume that Hgb is capable of binding); normal is usually 95% or greater in a client with no lung disease; in clients with lung dis*ease, target oxygen saturation is 90% or greater; may be measured intermit*tently (such as with vital signs or ambulation) or continuously * Uses a light spectroscopy probe attached to a finger, earlobe, or nose * Accuracy is lower with diminished peripheral perfusion, brightly lit environ*ment, acrylic fingernails, and dark skin color Laboratory Sputum analysis: specimen obtained for microbiology (Gram stain, culture and sensitivity) or cytology * Specimens for acid-fast bacilli (mycobacterium tuberculosis) may be collected * on three different days; specimen collection following a long sleep period (early morning) is desirable because of greater concentration; if unable to ob*tain a sputum specimen for acid-fast bacilli, gastric specimen may be obtained because mycobacterium tuberculosis is not altered by acidic gastric contents * Specimen processing: collect specimens in appropriate container and send to laboratory promptly Skin testing: assesses for allergic reactions to specified antigens (type I hyper- sensitivity), exposure to tuberculosis-causing organisms (type IV hypersensiti vity), or fungi * Measure area of induration (if present), not reddened area; read result 48 to 72 hrs after placement; an uncertain reading at 48 hrs may be reread at 72 * Positive result: individual has been exposed to antigen; does not mean that individual currently has active disease, only that there has been exposure/ infection * When performing skin tests to assess for type I allergies, ensure that antihict*amines, which could interfere with test results, are discontinued 72 hours prior to testing COMMON NURSING TECHNIQUES AND PROCEDURES Airway management: goal is to maintain patent airway 1. Head and jaw position * Open airway by head tilt and anterior chin lift maneuver * In individuals with suspected neck injury, open airway by anterior chin dis*placement and/or jaw thrust; do not perform head tilt * Limit suctioning to 10 seconds per catheter pass (5 in children) to reduce risk of inadequate oxygenation and cardiac dysrhythmias from hypoxia Body positioning * Acute respiratory failure a. Elevate head at least 45 decrees to increase chest exnansion * Unilateral lung disease a. Position with unaffected lung in dependent position ("good lung down") Oxygen (02) administration Nasal cannula * Typical 02 flow of 1 to 6 L/min will provide 02 concentrations of 24% to 44% * Individuals with chronic obstructive pulmonary disease (COPD) should re*ceive low flow oxygen, about 1 to 2 L/min, to prevent respiratory depression; these clients are used to high CO2 levels and low 02 levels, so increased 02 (greater than 2 L/min) can cause a loss of respiratory drive Key ventilator settings * Rate: number of breaths per minute delivered by ventilator; is a number that is combined with the mode often in clinical practice (e.g., SIMV of 6/min) * FiO2: fraction of inspired 02 or 02%; amount of 02 in air inhaled via ventilator; is expressed as a decimal instead of a percentage (e.g., Fi02 of .40 versus 40%) * Tidal volume (VT): amount of air delivered with each breath; often expressed in milliliters or liters (e.g., 700 mL or 0.7 L) * PEEP: abbreviation for positive end-expiratory pressure; the amount of posi*tive-pressure set in system at end of exhalation; keeps alveoli open during ex*halation to increase gas exchange; is expressed in terms of centimeters of pressure (e.g., 5 cm) Nursing management * Position client for maximum alveolar ventilation and comfort; maintain soft restraints to avoid accidental extubation * Monitor for any changes in respiratory status or effort * Maintain ventilator settings as ordered and remain knowledgeable about how to troubleshoot ventilator alarms (high pressure frequently indicates need for suctioning or kinking/compression of ET tube; low pressure indi*cates leak or disconnection); manually ventilate client if alarms sound with*out apparent cause * Monitor arterial blood gases (ABGs) and maintain continuous 02 satura*tion monitoring * Complete a thorough physical assessment with emphasis on cardiac, neuro*logical, and respiratory areas * Administer antibiotics, neuromuscular blocking agents, and sedatives as ordered * Maintain nasogastric suction to prevent aspiration * Supply nutritional support as ordered * Perform frequent oral care and suctioning to maintain airway patency * Provide emotional support to client and family as well as alternative commu*nication method Potential complications: pneumothorax, GI stress ulcers, hypotension caused by decreased venous return from increased intrathoracic pressure, increased in*tracranial pressure, infection Laryngectomy Postoperative care * * * * Maintain patent airway Provide pain management Provide appropriate nutritional support Teach client and family how to care for tracheostomy and feeding tube (if applicable) * Provide access to communication devices, such as writing supplies, picture or word board, speaking tracheostomy valve * Provide emotional sunnort to client and family: make annronriate referrals Respiratory Isolation * Droplet precautions (transmission-based precautions) * In addition to standard precautions, persons should wear mask when near client who has known or suspected pathogen transmitted by droplet route * Limit client transport within facility; when transport is necessary, place mask on client * Limit contamination of equipment and/or environment * Place client in private room or with a cohort (client with same diagnosis) NURSING MANAGEMENT OF CLIENT HAVING THORACIC SURGERY Preoperative period * Reduce anxiety through preoperative teaching about procedure and postopera*tive course and care * Assess client's support systems and ability to care for self after surgery * Administer preoperative medications, such as antibiotics, opioid analgesics, and anti-anxiety agents, as ordered * Obtain baseline vital signs, oxygenation status, and cognitive status for compari*son postoperatively Postoperative period * Maintain patent airway * Position client for optimal ventilation and perfusion; note any specific surgeon-s orders for positioning; be prepared to initiate respiratory support (intubation. emergency tracheostomy, mechanical ventilation) as needed * Maintain client safety * Assess for and report possible surgical complications to maintain oxygenation * Change in level of consciousness (LOC) ranging from restlessness and agitation to lethargy or unresponsiveness * Increase in respiratory rate, unequal chest expansion, decreased breath sounds, and/or use of accessory muscles for breathing * Loss of water seal drainage in closed chest drainage system * Greater than desired volume of chest drainage (75-100 mL drainage over 1 hour is an average acceptable upper limit); orders should specify volume acceptable chest tube drainage; should decrease over first 24 hours Positioning client after lung surgery: orders should specify turning parameters for indvidual client * Lobectomy: positioning includes lying on back or turned to either side * Segmental resection: positioning includes lying on back and turned onto nonl erative side; positioning on operative side may place tension on sutures and mote bleeding * Pneumonectomy * Positioning includes lying on back and turned toward operative side * Avoid complete lateral turning to either side, which changes pressure dynam*ics within chest and could lead to mediastinal shift OBSTRUCTIVE PULMONARY DISEASES Emphysema a. Progressive destruction of alveoli related to chronic inflammation Assessment * "Pink puffer" is a classic clinical description characterized by barrel chest, pursed-lip breathing (caused by forced exhalation), obvious use of accessory muscles when breathing, and underweight appearance * Exertional dyspnea progresses with advancing disease * Persistent tachycardia is related to inadequate oxygenation * Overall diminished breath sounds, and possible wheezes or crackles * ABGs: slightly decreased P02; PCO2 is not elevated until later stages * Chest x-ray: hyperinflated lungs with a flattened diaphragm; heart size is nor*mal or small * Pulmonary function tests: low vital capacity and forced expiratory volume (FEVi) Therapeutic management * Goals are to improve ventilation and promote patent airway by removing se*cretions * Remove environmental pollutants and encourage smoking cessation * Prescribed treatments include bronchodilator therapy, beta-adrenergic ago*nists, corticosteroid therapy, oxygen and nebulization therapy, chest physio*therapy, intermittent positive-pressure breathing (IPPB), possibly mechanical ventilation, and possible surgical procedures such as bullectomy, lung volume reduction surgery, or lung transplantation * Provide education and referrals for clients with behaviors (such as smoking) that increase risk for COPD * Refer clients to a structured pulmonary conditioning program and provide reinforcement as appropriate * Teach clients to avoid pulmonary irritants * Assist clients to develop appropriate nutritional plans to provide ade*quate calories Chronic bronchitis A disorder of chronic airway inflammation with a chronic productive cough lasting at least 3 months during 2 years; is a form of COPD Assessment * Frequent cough, occurring during winter season, with foul-smelling sputum * Frequent pulmonary infections * Classic appearance of "blue bloater" includes tendency for obesity and bluish-red skin discoloration from cyanosis and polycythemia * Dyspnea and activity intolerance occurs as disease progresses * Increased anterior–posterior chest diameter * Elevated red blood cell count; hemoglobin and hematocrit elevated in later stages * Chest x-ray reveals enlarged heart, congested lung fields, and normal or flattened diaphragm * Pulmonary function indicates increased residual volume, decreased vital capacity, FEVi, and FEVi/FVC ratio Therapeutic management * Includes measures previously described in section on emphysema * Provide education or referrals to clients with behaviors that increase the risk of developing COPD * Refer clients to a structured pulmonary conditioning program and provide reinforcement as appropriate * Teach clients how to avoid pulmonary irritants * Assist clients to develop appropriate nutritional plans that provide adequate calories but maintain ideal weight * Administer supplemental low-flow 02 as necessary; be prepared to initiate mechanical ventilation * Surgical interventions include bullectomy, lung volume reduction surgery, lung transplantation * Medication therapy includes immunization against pneumonia and influenza antibiotics, possible bronchodilators (beta-adrenergic agonists, anticholiner-minimal client symptoms; air leak may progress until pressure between thoracic cavity and atmosphere equalizes and client is symptomatic. * Tension: disruption of chest wall or lungs causes air accumulation in pleural space; pressure on mediastinum causes pressure on other lung and interrupts venous return to heart; is a medical emergency that requires emergency placement of chest tube to relieve increasing pressure in thoracic cavity and restore adequate cardiac output PNEUMOTHORAX AND HEMOTHORAX Assessment * * * * * * * * Dyspnea Tracheal deviation toward unaffected side Diminished breath sounds on affected side Percussion dullness on affected side Unequal chest expansion (reduced on affected side) Crepitus over chest Chest x-ray reveals pneumothorax ABG shows decreased P02 Therapeutic management * In mild cases, no chest tube is required; if pneumothorax is significant, a chest tube is inserted and attached to water seal drainage * Spontaneous pneumothorax: in otherwise healthy client, may resolve without in*vasive treatment * If spontaneous pneumothorax occurs repeatedly, may require pleurodesis, an in*stillation of an agent (such as talc or tetracycline) in pleural spaces to allow pleura to adhere together; other procedures include partial pleurectomy, sta*pling, or laser pleurodesis for pleural sealing * Care of client with a chest tube: * Monitor respiratory and oxygenation status * Provide supplemental oxygen as indicated * Maintain infection control practices * Medication therapy: analgesics and antibiotics ATELECTASIS * Incomplete expansion or collapse of the lung resulting from obstruction of air*way by secretions or a foreign body Assessment * Low-grade fever * Breath sounds diminished or absent in affected area * Diminished rate and depth of respiration PULMONARY TUBERCULOSIS * Lung infection caused by Mycobacterium tuberculosis Assessment * Frequent cough with copious frothy pink sputum; nonproductive cough devel*ops first as an early symptom (especially in early morning) * Night sweats * Anorexia * Weight loss * History may indicate recent exposure to infected individual * Positive tuberculin skin test (indicates exposure) * Appearance of characteristic Ghon tubercle on chest x-ray * Positive acid-fast bacillus sputum cultures (provides definitive diagnosis of infection) Therapeutic management * Monitor respiratory and oxygenation status * Provide adequate nutrition and hydration * Institute standard precautions (Centers for Disease Control [CDC] Tier 1) and airborne precautions (Tier 2, transmission-based precautions * Use a private room with negative air pressure that has 6 to 12 full air exchanges per hour and is vented to the outside or has its own air filtration system * Wear specially fitted mask (N95 respirator) whenever entering client's room; fit-test the mask with each use * Provide visitors with appropriate masks * Wear gown and masks if client does not reliably cover mouth during cough*ing or sneezing to reduce risk of transmission to others * Provide client with a surgical mask if it is necessary to bring client to another department; choose shortest and least busy route and alert that department ahead of time about client's status; schedule tests for least busy times of day * Administer antimicrobial therapy as prescribed * Provide supplemental oxygen as indicated * Obtain periodic sputum cultures following onset of antimicrobial therapy Client education * Infection control measures, including handwashing, coughing into tissues disposing of them in a closed bag * Teach client, family, and close contacts about mechanisms of transmission antimicrobial therapy, including need to take medication for full course of apy to prevent recurrence and/or development of drug-resistant organisrm PULMONARY EMBOLISM * Emboli lodge in pulmonary vasculature and impede blood flow through pulmonary capillaries Assessment * Restlessness, anxiety, agitation * * * * * * * * * Vital signs: tachycardia, tachypnea, hypotension, fever Chest pain Hemoptysis Mental status changes with possible decreasing level of consciousness Cyanosis Recent history of thromboembolism and/or long bone fractures Lung crackles upon auscultation Atrial fibrillation Chest x-ray may be normal Therapeutic management * Supplemental oxygen therapy; maintain patent airway * Be prepared to initiate mechanical ventilation * Maintain IV access and provide circulatory support as needed * Anticoagulant and/or thrombolytic therapy * Opioid analgesies and anti-anxiety agents as needed * Embolectomy * To prevent future pulmonary emboli, a vena cava filter may be inserted to trap emboli from a known source BRONCHOGENIC CARCINOMA * Lung cancer is leading cause of death from malignancy Assessment * * * * * * * * * * * * Symptom onset is often late in course of disease Persistent cough with or without hemoptysis Localized chest pain Dyspnea Unilateral wheeze upon auscultation Swallowing difficulty Anorexia and weight loss Enlarged neck lymph nodes Mass visible on chest x-ray CT scan or MRI of chest may better differentiate mass Sputum for cytology reveals tumor cells Bronchoscopy for direct biopsy or washings for cytology reveal tumor cells Therapeutic management * o o o o * * * * Surgical resection Pneumonectomy: removal of entire lung Lobectomy: removal of a lobe of lung Segmentectomy (segmental resection): removal of a segment or segments of a lung Wedge resection: dissection and removal of a defined area in lung Chemotherapy Radiation therapy Laser therapy Immunotherapy CANCER OF THE LARYNX * Most laryngeal tumors are benign Assessment * Hoarseness and/or change in voice characteristics * Palpable jugular nodes * Pain when swallowing * Unexplained earache * Diagnostic test results: laryngeal biopsy findings, x-ray visualization, MRI findings, barium swallow visualization Therapeutic management * Depends on stage of disease and general condition of client * Radiation therapy or brachytherapy (placement of a radioactive sow next to tumor) * Chemotherapy * Laryngectomy * Radical neck dissection * Maintain patent airway (tracheostomy performed with laryngectomy) * Pain management * Provide adequate hydration and nutrition (temporary or permanent alter route for nutrition) * Provide alternate means for communication and plan for permanent mea communication (artificial larynx or esophageal speech) * Monitor respiratory and oxygenation status * Provide oxygen supplementation as indicated * Medication therapy: opioid analgesics and antipyretics THORACIC TRAUMA * Alteration of breathing mechanics and/or gas exchange caused by respiratory. system trauma Assessment * * * * * * * Chest pain, may be severe such as with flail chest Shallow breathing with splinting Possible unequal chest expansion Tachycardia, tachypnea, hypotension Crepitus over chest Chest x-ray findings show white opacifications ABGs reveal hypoxemia Therapeutic management: same as pneumothorax and hemothorax * * * * * Ventilation support Be prepared to initiate mechanical ventilation Maintain IV access Possible placement of chest tube with water seal drainage Medication therapy: opioid analgesics, patient-controlled or epidural analgesia may be appropriate CYSTIC FIBROSIS (CF) * Multisystem disorder of exocrine glands, leading to increased production of thick mucus in bronchioles, small intestines, and pancreatic and bile ducts Assessment * Sweat test (pilocarpine iontophoresis) analyzes Na+ and C1-- content in sw e chloride concentration greater than 60 meq/L is diagnostic of cystic fibrosis.. ents often report that infants taste salty when kissed Therapeutic management * Respiratory: ensure pulmonary hygiene is performed; auscultate breath sounds before and after treatments; encourage coughing and deep breath exercises and physical activity as tolerated; administer prescribed antibiotics and bronchodilator(s) * Digestive: provide high-calorie (150% above normal recommendations). high protein diet and snacks; give infants a predigested formula such as pregestnutramigen; administer pancreatic enzymes with all meals and snacks; indi ize to achieve stools as near normal as possible; administer fat-soluble vitamins determine food preferences to encourage acceptance of diet; weigh daily: avoid pulmonary treatments immediately after meals to decrease risk of vomiting * Medications: antibiotics for treatment of pulmonary infection and purulent cretions, pancreatic enzymes for fat absorption, vitamin supplementation. immucolytics to decrease viscosity of sputum, bronchodilators to improve lung function; see Chapter 37 for overview of commonly ordered respiratory cardiac medications * High-calorie, high-protein diet is essential; give pancreatic enzymes with all meals and snacks; may need extra salt in hot weather BRONCHOPULMONARY DYSPLASIA (BPD) * A chronic obstructive pulmonary disorder occurring in infants as a sequela to prolonged 02 therapy and mechanical ventilation Assessment * Diagnosed by chest x-ray, which reveals lung changes and air trapping with or without hyperinflation * Blood gases reveal hypercapnia (increased CO2) and respiratory acidosis * Respiratory observations include tachypnea (rapid respirations), tachycardia, in*creased work of breathing, retractions, wheezing, and barrel chest (rounding of chest caused by trapped air) * Pallor, activity intolerance, and poor feeding result from chronic hypoxia Therapeutic management * Infants with BPD are cared for in intensive care units and require an artificial airway; avoid pressure or trauma to ET tube and infant's airway * Suctioning, turning, and weighing is done carefully to ensure adequate 02 sat*uration levels are maintained * Monitor respiratory status continuously; infant's condition can worsen in a short period of time * Monitor for fluid overload; infants are at increased risk for pulmonary edema; weigh daily; maintain strict I & 0 * Strict handwashing; avoid exposure to respiratory infections * Cluster nursing care to minimize 02 requirements and caloric expenditure * Plan quiet stimulation and activities to foster normal infant development and parental bonding with extended and often repeated hospitalizations of in*fants with BPD Medications * * * * Bronchodilators open airways and increase lung compliance Corticosteroids reduce airway edema and inflammation Diuretics remove excess fluid from lungs and help prevent pulmonary edema Antibiotics may be given prophylactically LARYNGOTRACHEOBRONCHITIS (LTB) * Viral infection that causes inflammation, edema, and narrowing of chea, and bronchi; usually LTB is preceded by a recent upper respira% fection (URI) Assessment * Onset is gradual after URI * Child awakens with low-grade fever, barking cough, and acute stridor; noisy breathing and use of accessory muscles increase * Child is agitated, restless, has a frightened appearance, sore throat, and rhinorrhea * Pulse oximetry is used to detect hypoxemia; anteroposterior (AP) and lateral upper airway x-rays are ordered Therapeutic management * Monitor child's respiratory effort continuously to ensure a patent airway; ob*serve for diminished breath sounds, circumoral cyanosis, diminishing noisy breathing, and drooling * Quiet respiratory effort is a sign of physical exhaustion and impending respira*tory failure * Provide humidity and supplemental 02; IV fluids prevent dehydration and help liquefy secretions * Assist child to assume upright position or any position of comfort; promote a calm, quiet environment; keep parents nearby to decrease child's stress and to lessen crying * Keep emergency intubation equipment available at bedside; readily respond to call bell or requests for assistance * Assess parental and child's anxiety level; provide emotional support * Medications * Bronchodilators decrease mucosal constriction and laryngeal edema; nebu*lized racemic epinephrine has a rapid onset with improvement of symptoms, although relapse may occur within 2 hours * Corticosteroids decrease inflammation and edema Child and family education * Cool mist humidifier and parental presence can be initial treatment of crisis; comforting measures include cuddling, rocking, singing, and any calming mea*sures until breathing becomes easier * Instruct parents to seek medical attention immediately if breathing becomes la*bored, child seems exhausted or very agitated, or if symptoms do not improve after cool air humidity treatment EPIGLOTTITIS Inflammation and swelling of epiglottis. primarily affecting children ages 2 to 8 Assessments * Child awakens with sudden onset of high fever (102°F), extremely sore and pain on swallowing * Child is very anxious, restless, looks ill, and insists on sitting upright legs and arms, with chin thrust out and mouth open (tripod position) * Dysphonia (muffled voice), dysphagia (difficulty swallowing), drooling and distressed respiratory effort are classic signs * Edematous, cherry-red epiglottis is most reliable diagnostic sign * Examination of throat is contraindicated, however, unless emergency equipment and trained personnel are available; physical manipulation of hypersensitive and irritated airway muscles may result in spasm and a obstruction * Lateral neck-x-ray confirms an enlarged epiglottis; portable x-rays are completed in examination room with child on parent's lap to minimize stress maximize child's comfort and calm behavior * Complete blood count (CBC) and blood cultures are taken once child is - stabilized Therapeutic management * Assess continuously for respiratory distress and decrease in respiratory report changes in status * Never leave child unattended; support child in position of comfort; encourage parents to hug and cuddle their child * Keep ET and tracheotomy tubes and suction equipment at bedside; assist emergency ventilation if needed before child is taken to operating room for airway insertion * Child is usually intubated for 24 hours; restraints may be necessary to prevent tube dislodgment, because swelling of epiglottis may prohibit reintubation * Provide support for child and family and alleviate anxiety; explain all procedures clearly and calmly * All invasive procedures, including starting an IV infusion, ABGs, and blot surtures are performed in OR * Keep child NPO; IV fluids provide hydration; administer antipyretics and antibotics as prescribed * After extubation, monitor child closely in intensive care unit to ensure ir*ate assessment if respiratory effort is compromised * Medications * Antibiotics treat bacterial infection (usually given for 7 to 10 days); discharged in about 3 days with oral antibiotics * Antipyretics treat fever and manage pain of sore throat * Corticosteroids may be given for 24 hours before extubation Assessment * Clinical manifestations include worsening of URI with tachypnea, retractions, low-grade fever, anorexia, thick nasal secretions, and increasingly labored breathing; older infants may have a frequent, dry cough * Auscultation of lungs reveal wheezing or crackles * Nasopharyngeal washing to obtain respiratory secretions identifies causative virus; chest x-ray may be normal or indicate hyperinflation or nonspecific inflammation Therapeutic management * Assess respiratory status hourly; provide humidified 02 to ease respiratory ef*fort; use pulse oximetry to assess 02 saturation * Clear nasal passages with bulb syringe; elevate head of bed * Cluster nursing care to allow for rest; assess anxiety level of parents and provide support; maintain a calm environment * IV fluids may be needed if oral intake is compromised; monitor strict I & 0; weigh daily to assess fluid loss * Maintain strict handwashing and contact precautions; caregivers should not care for other high-risk children * Medications: bronchodilators and steroids are sometimes used; prevention of bronchiolitis in highrisk children under age 2 may be achieved with use of palivizumab (Synagis) or IV RSV immunoglobulin FOREIGN BODY ASPIRATION * Inhalation of an object into respiratory tract, intentional or otherwise * The type and shape of object, as well as small diameter of an infant's airway, de*termines severity of problem; round objects such as hot dogs, round candy, nuts, and grapes do not break apart and are more likely to occlude airway; latex bal*loons are particularly hazardous; objects with irregular shapes may irritate air*way and partially obstruct airflow Assessment * Sudden coughing and gagging is first sign, and objects in upper airway may be expelled by coughing * Partial obstruction may cause symptoms of respiratory infection for days or even weeks; child may have hoarseness, croupy cough, wheezing, and dyspnea Therapeutic management * Assess respiratory status to determine severity of problem and degree of ob*struction; continuously monitor and provide assistance if obstruction worse * If total airway obstruction occurs, perform back blows and chest thrusts for infants and Heimlich maneuver in children older than 1 year * Keep NPO; foreign body is usually removed in surgery * Position for comfort and to optimize airway; provide emotional support to parents and child and alleviate anxiety * After removal of object, assess for additional obstruction that may result from laryngeal edema and tissue swelling Asthma * When both antibiotics and aminophylline are administered intravenously, the nurse should check for compatibility. If only one IV site is used, the nurse should use the SAS procedure (saline, administer medication, saline) for administering medications. Administer IV doses using a controller. * Clinets receiving aminophylline should be maintained or cardiorespiratory monitoring because aminophylline affects cardia and respiratory rates as well as blood pressure. Because toxicity can occur rapidly the nurse should monitor the client’s aminophylline level. Symptoms of toxicity are nausea, vomiting, tachycardia, palpitations, hypotension. In extreme cases, the client could progress to shock, coma and death. * The therapeutic range for aminophylline is 10-20 mcg/mL. Pneumonia * Some medications used in the treatment of pneumonia require special attention: * Tetracycline should not be given to women who are pregnant or to small children because of the damage it can cause to developing teeth and bones * Garamycin, an aminoglycoside, is both ototoxic and nephrotoxic. It is important to monitor the client for signs of toxicity. Serum peak and trough levels are obtained according to hospital protocol. Peak levels for Garamycin are drawn 30 minutes after the third or fourth IV or IM dose. Trough levels for Garamycin are drawn 30 minutes before the third or fourth IV dose. The therapeutic range for Garamycin is 4-10mcg/mL. Pulmonary Embolus * Remember the three Fs of fat emboli: o Fat o Femur o Football player * Most fat emboli come from fractured femurs; most fractured femurs occur in young men 18-25, the age of most football players. * Streptokinase is made from beta strep; therefore, clients with a history of strep infections might respond poorly to anticoagulant therapy with streptokinase because they might have formed antibodies. * Streptokinase is not clot specific; therefore, the client might develop a tendency to bleed from incision of injection sites. addison - bronze like skin angina- levines sign apendicitis- reboundtenderness asthma- wheezing bulimia-chipmunk face catarct-hazy vision cholecystitis- murphys sign cholera-rice watery stool cushing- moon face dengue- petechiae diptheria-pseudomembrane down syndrome-protrusion of tongue/simean creases on palms empysema-barrel chest glaucoma-tunnel like vision graves dse- exopthalmos hepatitis-jaundice kawasaki-strawberry tongue leprosy-leoning face liver cirrhosis-spider angioma malaria-chills measles- koplik spots meningitis-brudzinski/kernigs m gravis-ptosis pancreatitis/ectopic pregnncy- cullens sign /grey turners sign parkinson-pill rolling tremor pda-machine like murmur pernicious-red beefy tongue pneumonia-rusty sputum ptb-low grade fever pyloric stenosis-olive shape mass retina detachment-curtain like vision sle- butterfly rash tetanus-risus sardonicus tetralogy of fallot-clubbing of fingers icp- hyperbradybrady shock-hypotachytachy cushing- 3 S are up ( sugar salt sex) adisons-3 S are down ( sugar salt sex) more to come ^^ I would just like to say thanks to everyone who has posted here. I take my NCLEX on September 10 and I have gotten alot of great info! It is amazing how much you sort of forget once you have gotten past them ...so I just wanted to add delegation.. RN is the only one that can EAT- evaluation, assessment and teach- any patient that says, recently admitted, to be discharged, or change in clinical status! LPN- stable pts with predictable outcomes (do not go by equipment) CNA- standard UNCHANGING procedures (remember that in some areas, CNA's are permitted to do things like tube feedings, dressing changes, foley insertions- as long as it is UNCHANGING procedure) For the test remember- this is the NCLEX world, not real life....you always have time, always have an order and always have availible resources. When a questions asks about who to report to, always follow the chain of command... first your supervisor, then hosp admin When it gives you a question like..the ventilator oxygen alarm sounds what do you do FIRST- always check your patient...patient first, equipment next THIS IS THE BIG ONE THAT I WAS TOLD always remember Maslow....physiological before pyschosocial and then go by ABC's hope the tips help.. Akathsia- restless movements, pacing anhedonia- inability to experience pleasure apraxia- loss of purposeful motor movements clang association- meaningless rhyming of words echolalia- repitition by a person what is said to another person echopraxia- meaningless imitation of movement Labile- rapidly shifting emotions somatization- the expression of a psychological stress through physical symptoms word salad- spoken words wth no meaning like someone saying (dog, foil, house, sing, lake) neologism- coined word with special meaning to the user mania- unstable elevated mood flight of ideas- rapid flow of speech in which the person jumps from one idea to another without finishing the first idea premorbid- occuring before the development of the disease waxy flexibility- the extremities remain in a fixed position for a long period of time (like that guy on patch adams that holds his arm up constantly) Re: Quick Facts/nclex Infecton Control Transmission-based Precautions: ADC A - Airborne D - Droplet C - Contact AIRBORNE PRECAUTION (credit goes to the one who posted this on April thread, sorry can't remember your name) My - Measles Chicken - Chickenpox Hez - Herpes Zoster (Disseminated) TB - TB Private room Negative pressure with 6-12 air exchanges per hour UV Mask N95 Mask for TB DROPLET PRECAUTION think of SPIDERMAN! S - Sepsis S - Scarlet fever S - Streptococcal pharyngitis P - Parvovirus B19 P - Pertussis P - Pneumonia I - Influenza D - Diptheria (Pharyngeal) E - Epiglottitis R - Rubella M - Mumps M - Meningitis M - Mycoplasma or meningeal pneumonia An - Adenovirus Private room Mask CONTACT PRECAUTION MRS.WEE M - Multidrug resistant organism R - Respiratory infection - RSV S - Skin infections W - Wound infections E - Enteric infections - clostridium defficile E - Eye infections Skin Infections: V - Varicella zoster C - Cutaneous diptheria H - Herpes simplex I - Impetigo P - Pediculosis S - Scabies, Staphylococcus Private room Gloves Gown Someone mention in another thread of having a Botox question on the nclex, so Botox it is: Botulinum Toxin (Botox) Produced by the Clostridium Botulinum bacteria, which temporarily weakens/paralyzes facial muscles. Used to reduce wrinkles (facial lines), last 90-120 days. It is also used to TX strabismus (cross eye), abnormal neck and shoulder contraction and vocal spasm. May relieve migrane and tension H/A symtoms. Most common SE: H/A, nausea, brusing, flu like symtoms, ptosis (eye drooping), other SE: Temporary facial pain, redness at injection site, reduced blinking, and weakness in facial muscles. Extreme cases: muscle weakness can limit facial expressions Rare occasions: sore may develope on the white of the eye (corneal ulceration) This is GREAT! Here's some I got from a review class I went to several months ago... *Change in color is always a LATE sign! *Incentive Spirometry steps:1) Sit upright 2) Exhale 3) Insert mouthpiece 4) Inhale for 3 seconds, and then HOLD for 10 seconds *Aminoglycocide (__Mycin ; except erythromycine) Adverse Effects are bean shaped - Nephrotoxic to Kidneys and Ototoxic to Ears *MRSA - Contact precaution ONLY *VRSA - Contact AND airborne precaution (Private room, door closed, negative pressure) *LITHIUM L-level of therapeutic affect is 0.5-1.5 I-indicate mania T-toxic level is 2-3 - N/V, diarrhea, tremors H-hyrdrate 2-3L of water/day I-increased UO and dry mouth U-uh oh; give Mannitol and Diamox if toxic s/s are present M-maintain Na intake of 2-3g/day *All psych meds' (except Lithium) side effects are the same as SNS but the BP is decreased. *SNS- Increase in BP, HR and RR (dilated bronchioled), dilated pupils (blurred vision), Decreased GUT (urniary retention), GIT (constipation), Constricted blood vessels and Dry mouth. *Blood transfusion- sign of allergies in order: 1)Flank pain 2)Frequent swallowing 3)Rashes 4)Fever 5)Chills *Thrombocytopenia -Bleeding precautions! 1)Soft bristled toothbrush 2)No insertion of anything! (c/i suppositories, douche) 3)No IM meds as much as possible! *Iron deficiency anemia - easily fatigued 1)Fe PO - give with Vitamin C or on an empty stomach 2)Fe via IM- Inferon via Ztrack *Pernicious Anemia - Red, Beffy tongue; will take Vit.B12 for life! *BURNS 1st Degree - Red and Painful 2nd Degree - Blisters 3rd Degree - No Pain because of blocked and burned nerves *Meniere's Disease - Admin diuretics to decrease endolymph in the cochlea, restrict Na, lay on affected ear when in bed. Triad: 1)Vertigo 2)Tinnitus 3)N/V *Gastric Ulcer pain occurs 30 minutes to 90 minutes after eating, not at night, and doesn't go away with food CHEST TUBE DRAINAGE SYSTEM: ( I decided posting this since I tend to forget it sometimes, hope this can help someone1) Collection Chamber- This is the patient fluid Collection Chamber. Located on the Right Side. (2 things to Know): Notify Physician IF: 1. ABOVE 100 ML/Hr drainage 2. BRIGHT-RED drainage color. Water Seal- This is the Middle Chamber. Fluctuation Fluid inside chamber, indicates that client is breathing. (respirations) This is NORMAL. If the Fluid inside chamber stops fluctuating (moving up and down) this can mean 2 things: - Lung Reexpansion - Blocked Occluded Tube. PRIORITY: Always check for KINKS in the tubing BEFORE notifying the physician. - Intermittent Bubbling (On and Off) is Normal Suction Control Chamber- Left Chamber - Intermittent Bubbling (on and Off) is Normal especially for Pneumothorax patients. - Notify Physician for Continuous Bubbling. * Note: all drainage systems shouldn't have Continuous Bubbling. Notify physician if you notice this. Antacid that contains magnesium may cause diarrhea Antacid that contains aluminum may cause constipation During colostomy irrigation bag should be hung 18 inches (45 cm) above the stoma stress incontinence = involuntary leakage that is triggered by a sudden physical strain such as cough, sneeze or quick movement urge incontinence = inability to suppress a sudden urge to urinate total incontinence = continuous leakage resulting from the bladder's inability to retain urine. Right sided failure: Edema (peripheral) Liver /spleen enlargement jugular vein distention bounding pulses decrease or absent of urinary output Left Sided Failure: Cyanosis Wheezes anxiety pulmonary crackes apical murmurs decrease BP/periheral pulses increase res.p. rate s3/s4 gallop Schizophrenia Positive symptoms: 1. hallucinations 2. delusions 3. loose associations 4. agitated or bizarre behavior Negative symptoms: 1. apathy 2. anhedonia 3. poverty of speech 4. poor social functioning 5. social withdrawal Treament: Typical and atypical meds Antiparkinsonian meds Nursing Care: - protect client and other from harm including suicide prec. -administer meds as ordered -monitor s/e -establish trust and reduce anxiety -encourage or reinfore * clients sense of control * reality orientation *self care -help clients set realistic goals -provide safe environment do not.... with them.... Not sure if this stuff was allready addressed but things I learned that helped me pass in July were: In NCLEX hospital (the imaginary hospital where you pretend you are when you take your test) you HAVE: 1 AN UNLIMITED BUDGET 2 AN UNLIMITED AMMOUNT OF TIME TO SPEND WITH EACH PATIENT 3 UNLIMITED STAFFING If you have a answer as an option, YOU HAVE 1 the order to do it 2 the option to use it (Family to stay all night or delegating a person to do it) 3 the time to quietly sit with a patient for 12 hours holding their hand You CANNOT 1 Delegate upward or horizontally, you cannot have your boss start an IV. You cannot delegate a fellow nurse to do this either. 2 treat the machinery! STAY WITH THE PATIENT and treat THEM! 3 delegate aides or lpn's to ASSESS or TEACH thoracentesis- a needle inserted through the chest wall to remove air or fluid, observe for possible pneumothorax, increased pulse, pallor, chest pain, dypsnea and tachycardia legionnaires' disease- acute respiratory infection caused by gram neg. bacteria, primary entry is through the lungs, usually through air conditioners, not transmitted by person to person symptoms- fatigue, HA, dry cough, fever and chills, erythromycin drug of choice nursing care same as pneumonia Ebola virus- acute infection linked to monkeys in africa or the philippines that produces a severe illness mortality rate 2590% (not good odds) skin and mucous membrane contact transmission fever, myalgia, HA, upper res. symptoms then hemorrhagic symptoms begin a few days later mask, gown, glove precautions there is no vaccine or effective antiviral therapy Re: Anyoone up for random FACT THROWING?? Severe acute respiratory syndrome (SARS) 1st detected in china in 2003 spread by close contact and droplet dry non-productive cough and dypsnea, hypoxemia may develop and sometimes respiratory distress syndrome, the last stage of SARS is classified as atypical pneumonia put client in a neg. pressure isolation room, use airborne and contact protection there is no accepted medical treatment for SARS, but Ribavirin can be used in clients under 40, do not give ribavirin to the elderly mechanical ventilation may be necessary Colmplications of thyroid surgery: (4H) Hemmorrhage Hypothyroidism Hypoparathyroidism Hypocalcemia ** Danger signs of Pregnancy: ABCDEFGH Abdominal or chest pain Bleeding Chills and fever Decrease in fetal movement Escape of clear fluid from vagina that suddenly occur Frequent and persistent vomiting Gain in weight of over 2 lbs/week in 2nd trimeester and 1.6 lbs/week in 3rd trimester Hypertension PRIORITY: Report to physician immediately cushings syndrome- overactivity of adrenal cortex, tumor of adrenal gland moon face, buffalo hump, obese trunk with thin arms and legs fragile skin, they easily bruise assess for osteoporosis, fractures, renal stones hyperglycemia, may develop DM mood swings get infections easily muscle weakness masculine characteristics in females (facial hair) hypertension potassium depletion, sodium and water retention, metabolic alkalosis Ok my points are Priority points that i have learned over the months. Tricky points if you see a pat with blood sugar or 222 and K+ of 59 WHO do you see first. ? Also you have a patient going into a seizure do you move all the furniture away first of do you put the patient on its side First these the things and points you need to know. What do you do first. if you see a pregnant woman come into the Er with a umbilical cord protruding out the belly wht position do you put her in Just incase anyone else was as confused about triage systems as I was... listed by prioritization 1. Immediate (emergent) - seriously injured but have a reasonable chance for survival once in stable condition 2. Delayed (nonemergent) - can wait for 1-2 hours after recieving simple first aid 3. Expectant - extremely critical or dying 4. Minimal (nonemergent) - no impairment of function; can treat on their own or recieve treatment from a non-professional I hope this helps! hate to say this, but in working on Suzanne's Tip #1, I saved lab values until close to the end, as I did not do well the first time I took the practice test. In fact, I had to take it five times before I was finally able to pass the chapter test! Here are some things that helped me remember some lab values: BUN: Normal 8-25 I pictured 8 buns on one cookie sheet. For the upper limit of 25, I picture three times that many on three pans and an extra bun squeezed on the third pan, making a total of 25 buns. Calcium: Normal 8.6 - 10. I picture 8-10 cups of milk to provide calcium instead of drinking 8-10 cups of water. (We DO need our water!) Chloride: Normal 98-107 mEq/L: I picture 10 rows of 10 bottles of bleach, or Chlorox, making a total of 100 gallon jugs, making a total of 100, which is about the norm for chloride. DigOXin: Normal 0.5 - 2 ng/L: I picture half of a pair of oxen up to one pair of oxen pulling a cart (The ox is from the "ox" in Digoxin). Iron ranges from 50 to 175 in males & females, so I picture an athlete pumping from 50 pounds to 175 pounds of iron weights I haven't thought of a good way to remember lithium, but the low range is the same as for digoxin. Magnesium: 1.6 to 2.6 mg/dL (Think magnesium1.6 – 2.6 – “si” in magnesium stands for “six”) Phosphorus: Normal value: 2.7 to 4.5 mg/dL (little higher than magnesium) Serum AMylase: Normal = 25 - 151 units/L (remember 25-150 yards of AMber lace) Serum creatinine: 0.6 – 1.3 mg/dL (A specific indicator of renal function). (Think creatinine1.6, higher level about double the lower normal level) Serum Lipase: 10 -140 units/L (Lipase LIES all over the place – from 10 to 140) Serum potassium: 3.5 – 5.1 (major intracellular cation) (higher than magnesium & phosphorus) Serum protein: 6-8 g/dL (think of 6-8 protein bars = enough for just over or under a week’s supply) The following medications have normals values of 10-20. Dilantin Theophylline Acetaminophen Phenytoin Chloramphenicol Hope this helps some of you who are visual learners! Blood transfusions should not exceed 4 hours. 2. with infections the prodromal stage is the onset of the first symptoms and the Most contagious. 3. With Chronic Renal Failure diet is high in Carbohydrates. 4. with Cholecystitis pain starts in RUQ and radiates to right shoulder and scapula. 5.The 3 signs of pregnancy induced hypertension(PIH) 1. Edema above waiste. Proteinuria. BP increase of 3ommhg systolic and 15 mmhg diastolic above the basline BP.. ok hope these are helpful!! Otoscopic examination in a client with mastoiditis reveals a red, dull, thick, and immobile tympanic membrane, with or without perforation Activities that increase intrathoracic and intraabdominal pressures cause an indirect elevation of the intracranial pressure Polyuria occurs early in chronic renal failure and, if untreated, can cause severe dehydration. Clients on potassium-wasting diuretics are at high risk for hypokalemia. The most common initial symptom in pulmonary embolism is chest pain that is sudden in onset. The principle manifestations of Crohn’s disease are diarrhea and abdominal pain. A hypoglycemic reaction may occur in response to increased exercise. Patients should avoid exercise during the peak hours of insulin. A side effect specific to vincristine is peripheral neuropathy, which occurs in almost every client Special Considerations Infants Greatest risk for fluid and electrolyte imbalance Hypothermia and infections Approach them in non-threatening manner Toddler Increased separation anxiety Briefly prepare them for procedures due to short attention span Describe sensation that they may feel during procedure Preschooler Fear of physical harm Believe that illnesses is a form of punishment Explanations must be brief, honest and in natural terms Use demonstrations and play in providing health teaching Can use adult seatbelt if 40lbs or 40 inches tall, also if he could look at the window in sitting position School Age Realistic understanding of death = 9 -10 Needs more detailed teachings Allow them to make some choices Adolescence Developed abstract thinking and ability to problem solve Logic and reasoning Full and honest explanation Primary concern are with the present time Focus on appearance Elderly Nutrition is a primary concern Muscle atrophy Dec body water, BMR Dec renal, CV, GIT function Dec taste, smell, visual acuity (cataract, arcuc senilis = fatty deposits around pupil_) With multiple medications due to chronic diseases More legalese Nurse practice act: Authority is given to state boards of nursing to define the practice of nursing within broad parameters that are specified by the legislature, mandate the requisite preparation for the practice of nursing & discipline members of the profession who deviate from the rules governing the practice of nursing. Malpractice refers to a professional's wrongful conduct while performing his/her professional duties or failure to meet standards of care for the profession, which results in harm (physical, emotional or financial) to an individual entrusted to the professional's care. Example: Not giving medications properly (Liability has to be proven) Negligence is failure to provide care that a reasonable person would ordinarily provide in a similar situation. Assault: Threat to touch another in an offensive manner without having that person's permission. Battery: Actual touching of a person without that person's consent. Libel is something that was said Slander is something that is written G = patient's stated pain goal L = location A = aggravating factors D = duration of pain A = alleviating factors I = intensity on a scale from 0 - 10 D = description of pain per the patient The patient will be Glad for some Aid in pain relief! Another diagnosis Cretenism Patho: Congenital condition due to thyroid hormone deficiency due to defective physical development or mental retardation. Appears at 3-6 months of age in bottle-fed babies. Delayed in breast-fed infants. Symptoms: Large puffy eyes, thick protruding tongue, dry skin, lack of coordination If left untreated, permanently dwarfed, could be extremely mentally retarded, sterile Pericarditis – position in leaning forward while sitting Jaundice in neonate – blanch tip of nose or area above umbilicus Dehydration in adult – assess by skin turgor on the sternum Early s/s of aspirin toxicity – rapid deep breathing Jaundice in dark skinned – sclera Cyanosis in dark skinned – nail beds, palms, soles Skin turgor in adult – below clavicle, or on abdomen Skin turgor in children – fleshy part of legs, arms Nail clubbing - angle of the nail beds should form a diamond when the nail beds are approximated hypoglossal nerve - tested by the client sticking out his tongue glossopharyngeal nerve - tested by taste, gag reflex, and giving the client a drink and asking him to swallow. Phalen's maneuver - used to detect carpal tunnel syndrome Hemoglobin S - specific for sickle cell disease physical dependence occurs with opiod use Clients with inflammatory bowel disease - more susceptible to having a complication of toxic megacolon or paralytic ileus from morphine. Opiod antagonist – Narcan (naloxone) Pheochromocytoma - catecholamine-producing tumor that arises from the cells of the adrenal medulla and sympathetic ganglia; causes increased blood pressure by releasing excessive amounts of norepinephrine; therefore this client would have the highest priority for blood pressure readings. Cushing's Triad = Late signs of Increased ICP I - rregular RR C ardiac Rate Decreases P ulse pressure widens. * Tip, Notice that 1 is irregular, 1 is increased and 1 is decreased. Cardiac Rate of peds (the only thing you have to remember is 311 and fetal cardiac rate of 120-160) From that baseline rate; SUbtract 30-10-10 311 -30 = 90-130 Infant -10 = 80-120 Toddler -10 = 70-110 PreSchool. *The lower limits of these are when you will hold the dose of Digoxin Foods rich in Folic Acid: F ish O rgan Meats, Oranges L eafy green vegetables. Foods rich in potassium are very colorful, therefore remember the Colors of the Rainbow, ROYGBIV Red - Strawberries, Tomatoes NOT APPLE Orange - Orange Yellow - Banana Green - Avocados, Green Veggies Blue - (there arent really lots of blue foods out there, so remember the fish that came from the blue sea) Indigo and Violet (not much foods of these colors either but remember RAISINS) Disequilibrium Syndrome: (complication of hemodialysis) s/s: nausea vomiting headache hypertension restlessness and agitation confusion seizures notify Doc reduce environmental stimuli dialyze pt for a shorter period at reduced blood flow rates to prevent occurrence Re: Anyoone up for random FACT THROWING?? Biological warfare agent: Botulism- serious paralytic illness caused by clostridium botulinum (death can occur within 24 hours). -spread thru air or food (improper food canning) or via a contaminated wound. -CAN'T spread person to person -s/s abd. cramps, diarrhea, n/v, double vision, blurred vision, drooping eyelids, hard time swallowing or speaking, dry mouth and muscle weakness. -if dx is early, food- borne and wound borne can be trx with an antitoxin that blocks the action of the toxin circulating in the blood. -other trx= induce vomitting, enemas, penicillin -no vaccine avail. Anyoone up for random FACT THROWING?? Cardiovascular Disorders * The cardiovascular comprises the heart and the blood vessels and is responsible for the transport of oxygen and nutrients to organ systems of the body. Managing the Client with Hypertension * Calcium channel blockers are more effective for the elderly and African American because they provide a better control blood pressure without many of the side effects associated with other categories of drug. Management of a Client with Myocardial Infarction * Anticoagulants such as heparin are used to decrease the potential for clothing. The nurse should check the partial thromboplastin time (PTT). The therapeutic bleeding time should be from one and a half to two times the control. The medication should be injected in the abdomen 2” from the umbilicus using a tuberculin syringe. Do not aspirate or massage. The antidote for heparin derivatives is protamine sulfate. Anticoagulants should be stopped at least 24 hours prior to surgery and are usually restarted 12-24 hours following surgery. * If Coumadin (sodium warfarin ) is ordered, the nurse should check or prothrombin time (PT). The control level for a prothrombin time is 10-12 seconds. The therapeutic level for Coumadin should be from one and a half to two times the control. The antidote for Coumadin is Vitamin K. The international normalizing ration (INR) is done for oral anticoagulants. The therapeutic range is 2-3. If the level exceeds 7, watch for spontaneous bleeding. Echocardiography * The gag reflex is stimulated by placing a tongue blade on the back of the throat. Absence of the gag reflex increases the chances of aspirating liquids. Endocrine Disorders Diabetes Mellitus * Regular insulin is the only insulin that can be administered intravenously Genitourinary Disorders Cystitis * Although the client with interstitial cystitis experiences the same symptoms of cystitis as the client with other forms, the uterine is negative for bacteria. Back to Top... Integumentary Disorders * Remember the alphabet –ABCD- to remember the adverse changes in skin lesions that need to be reported: asymmetry, border, color and diameter Sensory Disorders Intraocular Disorders * The normal intraocular pressure ranges from 10-21mm Hg. Disorder of the Ears * Hearing loss of 50 decibels affects the client’s ability to distinguish parts of speech. Presbycusis affects the ability to hear high-frequency, soft consonant sounds (t,s, th, ch, sh, b,f, and pa) Gastrointestinal Disorders Peptic Ulcer Disease * Administer NSAIDs with food, milk or antacids to reduce the likelihood of GI upset Treatment of Ulcer * Aciphex and Protonex are enteric-coated and cannot be crushed for administration Inflammatory Bowel Disorders * Clients learn to control crampy abdominal pain (which usually occurs with food intake) associated with Chron’s disease by not eating. Management of the Client with Diverticulitis * A low-fiber diet is recommended during the acute stage of diverticulitis. * Morphine is contraindicated due to the increase in intraluminal pressure caused by this drug. Appendicitis * Rebounded tenderness can occur upon release of pressure in the epigastric or periumbilical area and indicates peritoneal inflammation. * A positive Rovsing’s sign can also occur. This happens when the client experiences pain on the right lower quadrant of the abdomen when the examiner palpates the left lower quadrant. Intestinal Obstruction * Pain medications might be withheld initially to determine the client’s problem. GERD * Due to the surgical procedures, the stomach size is smaller and cannot accommodate large meals. Caffeine and alcohol might need to be restricted or eliminated from the diet. Disease of the Liver * Remember that hepatitis A has no long term effects and is not chronic * Symptoms of hepatitis C are similar to those of hepatitis B. Some say the symptoms are mild and variable. The reason so many people are predicted to have hepatitis C is because of the lack of symptoms and vagueness. Consequently, those infected often do not seek assistance. A great deal of people with hepatitis C are carriers of the disease but do not know they have it. Treatment of Hepatitis * Not all hepatitis are reported. Hepatitis A is widespread with approximately 250,000 occurring in the US annually. Hepatitis C causes much concern because it can lead to cirrhosis and liver cancer. Due to the increased number of clients with hepatitis C, the most common type of hepatitis in the US, the need for liver transplants is increasing, as is the number of deaths from liver disease. Treatment of Cirrhosis * If the client has advanced liver disease or portal-systemic encephalopathy (PSE), protein sources are restricted due to the liver’s inability to convert protein to urea for excretion. Acute Pancreatitis * Cullen’s sign is recognized as periumbilical bluish discoloration of the skin. When the ecchymosis is noted on the flank area it called Turner’s sign. These signs may indicate intraperitoneal hemorrhage. Diagnosis of Pancreatitis * Amylase levels elevate in 12-24 hours after inflammation and stay elevated for 3-4 days. Lipase levels are more specific for pancreatitis and remain elevated for up to 2 weeks. * Hypocalcemia and hypomagnesia indicate that fat necrosis has occurred. Cholecystitis * An easy way to remember who usually develops gallstones is to remember these four Fs of gallbladder disease: o Female (sex) o Forty (normal age) o Fat (usually obese) o Fertile (usually have children) Treatment of Cholecystitis * Morphine is not given for pain because it can cause spasms of the sphincter of Oddi. * Clients with colostomies will have formed stool because the water is absorbed in the colon, whereas, ileostomy clients have liquid stools because the water has not been absorbed in this area. Hematological Disorders * The hematologic system consists of blood, blood cells, and blood forming organs. Because circulation of blood provides oxygen and nutrients to all body systems, a functioning hematological system is essential to health and well being. A disorder in the system might result from a lack of function, a reduction in production or an increase in the destruction of blood cells. Sikle Cell Anemia * The vaso-occlusive crisis is the primary crisis type that causes the client to have pain. Iron Deficiency Anemia * Intramuscular iron (Imferon) is given through the IM Z track method. Polycythemia Vera * This disorder is characterized by thicker than normal blood. There is an increase in the client’s hemoglobin to levels of 18 g/dL, RBC of 6 million/mm or hematocrit at 55% or greater and increased platelets) Transfusion Therapy * If a client is receiving blood components, assess the chart for a physician order, identify the patient by armband numbers, blood bag label, attached tag, requisition slip, and blood expiration date. Each identification should be checked by two registered nurses with documented signatures of the assessment by both. Neurological Disorders * Remember the mnemonic APQRST to trigger recall of all import points to access whenever the client has an acute onset symptom o A – any associated symptoms with chief compliant o P – what provokes (makes worse) or palliates (makes better) symptoms o Q- quality of pain o R – region and radiation o S- severity of pain on a scale of 1 to 10 o T- timing: when it stops and starts, whether it is intermittent or constant its duration * Recall that the words Kernig’s and knee both begin with K while Brudzinki’s and brain both begin with B. This will aid in recalling how to conduct each test. Neoplastic Disorders * * o o Remember to use CAUTION to recall risk factors for cancer American Cancer Society’s Seven Warning Signs of Cancer Changes in a wart or mole A sore that does not heal o o o o o Changes in bowel or bladder habits A new lump or the thickening of an existing lump A persistent cough Indigestion or difficulty in swallowing Unusual bleeding or discharge The Four Major Categories of Cancer * The different types of cancers are classified according to the tissue from which they originate. The following list identifies the major cancer groups: o Carcinoma – cancer arising from epithelial tissue (for example, basal cell carcinoma) o Sarcoma – cancer arising from connective tissue, muscle or bone (for example, osteosarcoma) o Lymphoma – cancer arising from lymphoid tissue (for example, Burkitt’s lymphoma) o Leukemia – cancer of the blood-forming cells in the bone marrow (for example, acute lymphocytic leukemia Risk Factors for Specific Cancers o Bladder- Risk factors include smoking and environmental carcinogens such as dyes, paint, rubber, ink and leather o Breast – Risk factors include a family history in first-degree relatives, the birth of the first child after age 30, abnormality in genes BRCA-1 and BRCA-2, menarche before age 12 and menopause after age 55, obesity, the use of birth control pills and hormonal replacement, alcohol intake, and a diet high in fat. o Cervical – Risk factors include early sexual activity, early childbearing, multiple partners, human papillomavirus (HPV) or human immunodeficiency virus (HIV) infection, smoking, using of DES by the mother during pregnancy and chronic cervical infections. Risk Factors for Specific Cancers * The FDA has licensed a vaccine (Gardasil) for use in girls/women ages 9-26 that protects against four HPV types responsible for 70% of all cervical cancers and 90% of genital warts. Three shots are administered over a six-month period. * Cancer of the colon is the second most common form of cancer in the United States. Breast Cancer * The TNM classification system is commonly used cancer staging system that allows description of the severity of the cancer based on the T (description of the extent of the tumor), N (the spread to lymph nodes) and M (the spread beyond the area to the other parts of the body). * It is normal for the patient to have post-surgical transient edema. This is not lymphedema. Radiation * While the implant is in place, the client emits radiation but the client’s body fluids are not radioactive Total Parenteral Nutrition * A central line is required for TPN administration * If the TPN is not immediately available and the infusion is empty, the nurse should give D10W until the solution is obtained Musculoskeletal Disorders * Use the phrase “good leg up; bad leg down” to help remember which leg to place first when going up and down stairs with crutches * Use the 5 P’s to remember the neurovascular assessment findings; pain, pallor, paresthesia, pulselessness (or decreased pulses) and paralysis * Use RICE for musculoskeletal injuries (rest, ice, compression, and elevation) Maternal and Neonatal Client * Remember to “protect the head” during the precipitous birth. Apply enough pressure to guide the descent and prevent rapid intracranial pressure changes within the infant’s molded skull * Remember that the umbilical cord could choke the fetus and is dangerous. If during delivery the umbilical cord can’t be loosened and slipped away from the infant’s neck, two clamps should be applied to the cord and the cord should be cut between the clamps. Burns The Consensus Formula * Enteral feedings help meet the client’s increased caloric needs and maintains the integrity of the intestinal mucosa, thereby minimizing systemic sepsis. The Intermediate Phase * The normal central venous pressure (CVP) is 4-12 mm H20. Increased CVP indicates fluid volume overload; decreased CVP indicates fluid volume deficit. Immunological Disorders * Human Immunodeficiency Virus (HIV) leads to depletion of the CD4 +T4 helper cells. This depletion causes an inability to fight off opportunistic infections. Infected CD4 + (T4) helper cells are targeted by Human Immunodeficiency Virus CD8+ killer cells. Acquired immune deficiency syndrome (AIDS) is caused by the HIV virus. AIDS was first identified in the 1980s, and is believed to derive from infections found in the green monkey of Africa. It is thought that some reason the virus mutated and became a virus that affects human beings. There are 2 types of HIV: o Type 1 (HIV-1) found in Western Europe and Asia o Type 2 (HIV-2) found in West Africa * HIV results in an abnormal cell that cannot fight infection. That abnormal cell duplicates producing more of the virus. The result is a decrease in the helper cells and an increase in the suppressor cells. HIV Prevention * Body fluids likely to transmit blood-borne disease include blood, semen and vaginal/cervical secretions, tissues, cerebral spinal fluid, amniotic fluid, synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid, and breast milk. * Body fluids not likely to transmit blood-borne disease unless blood is visible include feces, nasal secretions, sputum, vomitus, sweat, tears, urine, and saliva (with the exception of during oral surgery or dentistry) Legal and Ethical Nursing Practices Managing Client Care * Nursing Practice Acts varies from state to state. The nurse is responsible for knowing the laws in which he/she will practice. It is the responsibility of the nurse to contact the board of nursing to obtain a copy of the Nursing Practice Act. The state board of nursing has been authorized to take action against a nurse found guilty of failure to comply with rules and regulations set forth by the law. These examples are not a comprehensive list of all the skills registered nurses/licensed practical nurse can do. Psychiatric Disorders Dissociative Identity Disorder * The following films offer good depictions of dissociative identity disorder: the Three Faces of Eve, Sybil, and Identity. Obsessive Compulsive Disorder * The main character in the movie As Good As It Gets is an excellent example of the client with OCD Schizophrenia * This disorder is most often diagnosed in late adolescence or early adulthood, although symptoms might have been present at a much earlier age. The disorder equally affects both males and females; however, males seem to have an earlier onset of symptoms. Theories offered regarding the cause of schizophrenia include genetics, environmental factors, and biological alterations in the neurotransmitters serotonin and dopamine. * Clients with schizophrenia are best known for their odd appearance and behavior, which sometimes summarized by the 4 A's. The 4 A's include o Affect—Described as flat, blunted, or inappropriate o Autism—Preoccupation with self and a retreat into fantasy o Association—Loosely joined unrelated topics o Ambivalence Having simultaneous opposing feelings Memory Support * It is best to avoid challenging activities that can confuse and overwhelm the client. * The mainstay in the management of the client with schizophrenia is medication. * Unlike the EPSE of akathisia, akinesia and dystentonias, tardive dyskinesia is not caused by a dopamine Anxiety * Anxiety-related disorders are sometimes referred to as neurotic disorders and include the following categories: o Generalized anxiety disorder o Post-traumatic stress disorder o Dissociative identity disorder o Somatoform disorder o Panic disorder o Phobic disorder o Obsessive-compulsive disorder * Anxiety disorders are characterized by feelings of fear and apprehension accompanied by a sense of powerlessness. Anxiety-related disorders are listed on Axis I of the DSM-IV-TR. Substance Abuse * When a client has a problem with substance abuse or addiction, carefully screen for other mental health disorders as well which may be comorbidities * Use the initials of the CAGE questionnaire to trigger the memory of what each question refers to * It is just as important to screen for psychosocial data as for physical assessment data during admission for treatment for addiction * Development of an emergency plan is high priority before discharge to home so that the client is better empowered to act on own behalf when the urge to abuse occurs Thank you everyone for all of your valuable information, it has been wonderful!! We graduated in Aug. and I will be taking my NCLEX-RN on October 6th! Here are a couple of ways I remember things * To increase Venous blood flow legs up- act like the lines from the V are legs they are going up. * To increase blood flow to the Arteries- legs down- act like the long lines from the A are the legs pointing down * Never Let Monkeys Eat Bananas Neutrophils 50-60%. Lymphocytes 20-40%. Monocytes 2-6%. Eosinophils 1-4%. Basophils 0.5-1% OR Never let people between 50-70 have kids Let people between 20-40 have kids Kids act like Monkeys between 2-6 Kids learn to Eat well between 1-4 We usually eat .5-1 Banana Na – Salt is expensive now a days, it costs 135-148 per kilo. (135-148 mEq/L) K – A bananas cost 3.50 to 5.50 a bunch (3.5-5.5 mEq/L) Chloride – Since Chloride regulates BP, here it goes… Chloride said his BP is 108/98. (98-108 mEq/L) HCO3 (bicarbonate) – Bicarbonate said ten years ago he was 22 now how old is he? 32. (22-32 mEq/L) Ca – My bones started to become strong when I was about 8-10 years old. (8.5-10.3 mEq/L) Mg – Magnesium is always exercising his muscles every 1 1/2 – 2 hours. (1.4-2 I found lots of Nclex information from Skatebetty, so all of this is her work and all credit goes to her. I just happened to be skimming the NCLEX forum pages going back to 2006 and found these tips from her. So I am posting them here for us to study from. All of the credit goes to her, it is all her work. Thanks Skatebetty!!! Agnosia - I don't know what it is (when an object is placed in hand) Apraxia - My practiced skills are lost (can't carry out a purposeful activity) Procainamide - For dysrhythmias unresponsive to Lidocaine Ridaura - Gold, for arthritis (think shiny, aura) Tessalon - Anti-tussive (sounds like tuss) Cognex - for Alzheimer's (sounds like cognition) Calcium Carbonate has the most calcium of oral types Neupogen - sounds like "generates neutrophils" Epogen - sounds like "erythropoetein generator" Flomax - Improves urinary flow with BPH (urine flows) Dimetane - An antihistimine (Dimetapp) Which anti-coagulant is safe in pregnancy? Heparin is! It does not cross the placenta, so when it is ordered, give it, and when you do it is sub-q. What is a t-tube? I'd never heard of one. It drains bile from the bile duct after gallbladder sx, and there could be a lot of drainage, up to 400 cc's/day. It should be bloody initially, and then green. Count it as output. Why does skin temperature drop when someone is experiencing acute pain? Because they are sweating (diaphoretic). What's a ureteral catheter? It may be placed to drain urine from the ureter along with a foley. The foley gets d/c'd first, the ureteral one can be clamped so your patient can pee normally, and then you unclamp it to see how much residual there is! Once there is no residual it is also d/c'd. Who knew? What if you find your TURP patient in a wet bed? The catheter is either too small, or the patient is having bladder spasms, causing leakage. What's given for alcohol withdrawl? Librium. Narcotic withdrawl? Methadone. Narcotic withdrawl with respiratory depression? There you go...Narcan. Who get's c-diff? Hospitalized patients, that's who. Almost half of your patients who get diarrhea in the hospital have c-diff, and got it from somebody who works there. You've run out of tube feeding. Which solution is most like TPN while you're waiting for the pharmacy? D10W. What is the solution of choice for volume replacement in the ER? Lactated Ringers. How does acute renal failure differ in s/s from chronic? With acute there is an oliguric phase when the kidney is really sick, followed by a diuretic phase when the kidney is starting to get better and urine starts to flow again. With chronic, the kidney slowly deteriorates, and output decreases. With portal hypertension or cirrhosis think “bleeder” because of esophageal varices, and also reduced or no clotting factors being produced by the sick liver. While we’re talking about the liver, remember it is highly vascular, which means when it is injured by trauma, or even a needle biopsy it will bleed right out. Position a patient on the right side after a liver biopsy to help splint the injury. For everybody wanting to ‘Maslow’ nutrition ahead of safety with a depressed client, just toss your pyramid right out the window, and choose safety first. Suicide precautions. While we’re talking about priorities don’t think you must always choose an assessment over an intervention if both are options. Use your instincts and your logic! If the options are listed to “suction copious secretions" or "monitor O2sat" you better get the secretions out, especially if the stem says you’ve assessed the patient already and what is the next nursing action. Don’t push all those dangerous objects out of the way first when your kid is on the floor seizing. Turn him on his side. Airway first, then remove hazardous objects. Prolonged hypoxia in kids, like with tetralogy of fallot, does bad stuff. For starters the body tries to compensate for low O2 by pushing out more immature rbc’s, which hypercoagulates the blood increasing the kids risk of seizures and CVA’s. The kid is also at risk for cardiac arrest and respiratory failure. Remember, nothing’s getting oxygen. Don’t you ‘schedule frequent rest periods’ for that kid newly diagnosed with CF. He needs exercise, which is a good adjunct to the chest physiotherapy in keeping his lungs clear. Now if your CF kid is exercising with a sickle cell kid, make sure that one doesn’t get over-heated. Dehydration triggers sc crisis. Keep his fluids up. No demerol with sickle cell either. Steroids complicate things while they're reducing inflammation. They increase the risk for osteoporosis, increase glucose, and delay wound healing. They also cause weight gain (have ya’ll seen Tonya Harding lately? She says it’s the prednisone) and increase the risk of infection. Watch sore throats and fevers for pts. on steroids. Ever touched a colostomy bag? Me either. Just know to remove flatus by opening the bottom of the bag, and to empty it when it is approximately 1/3 to ½ full. These are 3 days of her tips...she has tips for another 4-5 days, so I will copy and paste them in the next few posts. Happy studying! I test this month! Yikes!!!! What is an intraosseous infusion? In pediatric life-threatening emergencies, when iv access cannot be obtained, an osseous (bone) needle is hand-drilled into a bone (usually the tibia), where crystalloids, colloids, blood products and drugs can be administered into the marrow. It is a temporary, life-saving measure, and I have seen it once! (Gruesome.) When venous access is achieved it can be d/c’d. One medication that cannot be administered by intraosseous infusion is isoproterenol, a beta agonist. (I don’t know more about that drug; it was just pointed out on a practice exam.) During sickle cell crisis there are two interventions to prioritize: fluids and pain relief. With glomerulonephritis you should consider blood pressure to be your most important assessment parameter. Dietary restrictions you can expect include fluids, protein, sodium, and potassium. Remember yesterday when I mentioned how congenital cardiac defects result in hypoxia which the body attempts to compensate for (influx of immature rbc’s)? Labs supporting this would show increased hematocrit, hemoglobin, and rbc count. Did you know there is an association between low-set ears and renal anomalies? Now you know what to look for if down’s isn’t there to choose. (just to expand on it a little, the kidneys and ears develop around the same time in utero. Hence, they're shaped similarly. Which is why when doing an assessment of a neonate, if the nurse notices low set or asymmetrical ears, there is good reason to investigate renal functioning. Knowing that the kidneys and ears are similar shapes helped me remember this). School-age kids (5 and up) are old enough, and should have an explanation of what will happen a week before surgery such as tonsillectomy. If you gave a toddler a choice about taking medicine and he says no, you should leave the room and come back in five minutes, because to a toddler it is another episode. Next time, don’t ask. The first sign of pyloric stenosis in a baby is mild vomiting that progresses to projectile vomiting. Later you may be able to palpate a mass, the baby will seem hungry often, and may spit up after feedings. We know Kawasaki disease causes a heart problem, but what specifically? Coronary artery aneurysms d/t the inflammation of blood vessels. A child with a ventriculoperitoneal shunt will have a small upper-abdominal incision. This is where the shunt is guided into the abdominal cavity, and tunneled under the skin up to the ventricles. You should watch for abdominal distention, since fluid from the ventricles will be re-directed to the peritoneum. You should also watch for signs of increasing intracranial pressure, such as irritability, bulging fontanels, and high-pitched cry in an infant. In a toddler watch lack of appetite and headache. Careful on a bed position question! Bed-position after shunt placement is flat, so fluid doesn’t reduce too rapidly. If you see s/s of increasing icp, then raise the hob to 15-30 degrees. What could cause bronchopulmonary dysplasia? Dysplasia means abnormality or alteration. Mechanical ventilation can cause it. Premature newborns with immature lungs are ventilated and over time it damages the lungs. Other causes could be infection, pneumonia, or other conditions that cause inflammation or scarring. It is essential to maintain nasal patency with children < 1 yr. because they are obligatory nasal breathers. Watch out for questions suggesting a child drinks more than 3-4 cups of milk each day. (Milks good, right?) Too much milk reduces intake of other essential nutrients, especially iron. Watch for anemia with milk-aholics. And don’t let that mother put anything but water in that kid’s bottle during naps/over-night. Juice or milk will rott that kids teeth right out of his head. What traction is used in a school-age kid with a femur or tibial fracture with extensive skin damage? Ninety, ninety. Huh? I never heard of it either. The name refers to the angles of the joints. A pin is placed in the distal part of the broken bone, and the lower extremity is in a boot cast. The rest is the normal pulleys and ropes you’re used to visualizing with balanced suspension. While we’re talking about traction, a kid’s hinder should clear the bed when in Bryant’s traction (also used for femurs and congenial hip for young kids). If you can remove the white patches from the mouth of a baby it is just formula. If you can’t, its candidiasis. Just know the MMR and Varicella immunizations come later (15 months). Undescended testis or cryptorchidism is a known risk factor for testicular cancer later in life. Start teaching boys testicular self exam around 12, because most cases occur during adolescence. Not pediatrics but have to throw it in – A guy loses his house in a fire. Priority is using community resources to find shelter, before assisting with feelings about the tremendous loss. (Maslow). No aspirin with kids b/c it is associated with Reye’s Syndrome, and also no nsaids such as ibuprofen. Give Tylenol. CSF in meningitis will have high protein, and low glucose. It is always the correct answer to report suspected cases of child abuse. No nasotracheal suctioning with head injury or skull fracture. Feed upright to avoid otitis media. Position prone w hob elevated with gerd. In almost every other case, though, you better lay that kid on his back (Back To Sleep - SIDS). Pull pinna down and back for kids < 3 yrs. when instilling eardrops. Kids with RSV; no contact lenses or pregnant nurses in rooms where ribavirin is being administered by hoot, tent, etc. Positioning with pneumonia – lay on the affected side to splint and reduce pain. But if you are trying to reduce congestion the sick lung goes up. (Ever had a stuffy nose, and you lay with the stuff side up and it clears?) A positive ppd confirms infection, not just exposure. A sputum test will confirm active disease. Coughing w/o other s/s is suggestive of asthma. Speaking of asthma, watch out if your wheezer stops wheezing. It could mean he is worsening. You better pick ‘do vitals’ before administering that dig. (apical pulse for one full minute). Tet spells treated with morphine. Group-a strep precedes rheumatic fever. Chorea is part of this sickness (grimacing, sudden body movements, etc.) and it embarrasses kids. They have joint pain. Watch for elevated antistreptolysin O to be elevated. Penicillin! Don’t pick cough over tachycardia for signs of chf in an infant. Random Tips: No milk (as well as fresh fruit or veggies) on neutropenic precautions. Tylenol poisoning – liver failure possible for about 4 days. Close observation required during this time-frame, as well as tx with Mucomyst. Radioactive iodine – The key word here is flush. Flush substance out of body w/3-4 liters/day for 2 days, and flush the toilet twice after using for 2 days. Limit contact w/patient to 30 minutes/day. No pregnant visitors/nurses, and no kids. The main hypersensitivity reaction seen with antiplatelet drugs is bronchospasm (anaphylaxis). Common sites for metastasis include the liver, brain, lung, bone, and lymph. Orthostasis is verified by a drop in pressure with increasing heart rate. Bence Jones protein in the urine confirms multiple myeloma. Don’t fall for ‘reestablishing a normal bowel pattern’ as a priority with small bowel obstruction. Because the patient can’t take in oral fluids ‘maintaining fluid balance’ comes first. Pernicious anemia s/s include pallor, tachycardia, and sore red tongue. With flecainide (Tambocor), an antiarrythmic, limit fluids and sodium intake, because sodium increases water retention which could lead to heart failure. Basophils release histamine during an allergic response. Adenosine is the treatment of choice for paroxysmal atrial tachycardia. Iatragenic means it was caused by treatment, procedure, or medication. Other than initially to test tolerance, G-tube and J-tube feedings are usually given as continuous feedings. Four side-rails up can be considered a form of restraint. Even in LTC facility when a client is a fall risk, keep lower rails down, and one side of bed against the wall, lowest position, wheels locked. Your cancer patient is getting radiation. What should you be most concerned about? Skin irritation? No. Infection kills cancer patients most because of the leukopenia caused by radiation. A breast cancer patient treated with Tamoxifen should report changes in visual acuity, because the adverse effect could be irreversible. Pneumovax 23 gets administered post splenectomy to prevent pneumococcal sepsis. Let’s say every answer in front of you is an abnormal value. If potassium is there you can bet it is a problem they want you to identify, because values outside of normal can be life threatening. Normal potassium is 3.5-5.0. Even a bun of 50 doesn’t override a potassium of 3.0 in a renal patient in priority. You better be making sure that patient on Dig and Lasix is getting enough potassium, because low potassium potentiates Dig and can cause dysrrhythmias. You will ask every new admission if he has an advance directive, and if not you will explain it, and he will have the option to sign or not. An example of when you would implement before going through a bunch of assessments is when someone is experiencing anaphylaxis. Get the ordered epinephrine in them stat, especially if they stem clearly states the s/s (difficulty breathing, increasing anxiety, etc.) In a disaster you should triage the person who is most likely to not survive last. A little trick regarding potassium: ALKALOSIS: K is LOW Acidosis is just the opposite: K is High The vital sign you should check first with high potassium is pulse (due to dysrhythmias). Give neostigmine to clients with Myesthenia Gravis about 45 min. before eating, so it will help with chewing and swallowing. Anectine is used for short-term neuromuscular blocking agent for procedures like intubation and ECT. Norcuron is for intermediate or long-term. The parathyroid gland relies on the presence of vitamin D to work. Glucagon increases the effects of oral anticoagulants. Bleeding is part of the ‘circulation’ assessment of the ABCD’s in an emergent situation. Therefore, if airway and breathing are accounted for, a compound fracture requires assessment before Glasgow coma scale and a neuro check (D=disability, or neuro check) The immediate intervention after a sucking stab wound is to dress the wound and tape it on three sides which allows air to escape. Do not use an occlusive dressing, which could convert the wound from open pneumo to closed one, and a tension pneumothorax is worse situation. After that get your chest tube tray, labs, iv. An occlusive dressing is used if a chest tube is accidentally pulled out of the patient. When o2 deprived, as with a PE, the body compensates by causing hyperventilation (resp alkalosis). Should the patient breathe into a paper bag? No. If the pao2 is well below 80 they need oxygen. Look at all your abg values. As soon as you see the words PE you should think oxygen first. A typical adverse reaction to oral hypoglycemics is rash, photosensitivity. Serum acetone and serum ketones rise in DKA. As you treat the acidosis and dehydration expect the potassium to drop rapidly, so be ready, with potassium replacement. Fluids are the most important intervention with HHNS as well as DKA, so get fluids going first. With HHNS there is no ketosis, and no acidosis. Potassium is low in HHNS (d/t diuresis). Atropine blocks acetylcholine (remember it reduces secretions). Decorticate positioning in response to pain = Cortex involvement. Decerebrate in response to pain = Cerebellar, brain stem involvement Dantrium, for spasticity, may take a week or more to be effective. Decreased acetylcholine is related to senile dementia. Hyperactive deep tendon reflexes, vision changes, fatigue and spasticity are all symptoms of MS After removal of the pituitary gland you must watch for hypocortisolism and temporary diabetes insipidus. Position on right side with legs flexed after appendectomy. Hirschsprung’s diagnosed with rectal biopsy looking for absence of ganglionic cells. Cardinal sign in infants is failure to pass meconium, and later the classic ribbon-like and foul smelling stools. Intussusception common in kids with CF. Obstruction may cause fecal emesis, currant jelly-like stools (blood and mucus). A barium enema may be used to hydrostatically reduce the telescoping. Resolution is obvious, with onset of bowel movements. With omphalocele and gastroschisis (herniation of abdominal contents) dress with loose saline dressing covered with plastic wrap, and keep eye on temp. Kid can lose heat quickly. After a hydrocele repair provide ice bags and scrotal support. No phenylalanine with a kid positive for PKU (no meat, no dairy, no aspartame). Second voided urine most accurate when testing for ketones and glucose. Never give potassium if the patient is oliguric or anuric. Nephrotic syndrome is characterized by massive proteinuria (looks dark and frothy) caused by glomerular damage. Corticosteroids are the mainstay. Generalized edema common. A positive Western blot in a child <18 months (presence of HIV antibodies) indicates only that the mother is infected. Two or more positive p24 antigen tests will confirm HIV in kids <18 months. The p24 can be used at any age. For HIV kids avoid OPV and Varicella vaccinations (live), but give Pneumococcal and influenza. MMR is avoided only if the kid is severely immunocompromised. Parents should wear gloves for care, not kiss kids on the mouth, and not share eating utensils. Hypotension and vasoconstricting meds may alter the accuracy of o2 sats. An antacid should be given to a mechanically ventilated patient w/ an ng tube if the ph of the aspirate is <5.0. Aspirate should be checked at least every 12 hrs. Ambient air (room air) contains 21% oxygen. The first sign of ARDS is increased respirations. Later comes dyspnea, retractions, air hunger, cyanosis. Normal PCWP (pulm capillary wedge pressure) is 8-13. Readings of 18-20 are considered high. First sign of PE is sudden chest pain, followed by dyspnea and tachypnea. High potassium is expected with carbon dioxide narcosis (hydrogen floods the cell forcing potassium out). Carbon dioxide narcosis causes increased intracranial pressure. Pulmonary sarcoidosis leads to right sided heart failure. An NG tube can be irrigated with cola, and should be taught to family when a client is going home with an NG tube. Happy Studying! I test soon.....yikes!!! Question is....am I ready to test or not to test? Digitalis increases ventricular irritability, and could convert a rhythm to v-fib following cardioversion. If your normally lucid patient starts seeing bugs you better check his respiratory status first. The first sign of hypoxia is restlessness, followed by agitation, and things go downhill from there all the way to delirium, hallucinations, and coma. So check the o2 stat, and get abg’s if possible. The biggest concern with cold stress and the newborn is respiratory distress. Look carefully when you have no idea. In a word like rhabdomyosarcoma you can easily ascertain it has something to do with muscle (myo) cancer (sarcoma). The same thing goes for drug names. For example, if it ends in –ide it’s probably a diuretic, as in Furosemide, and Amyloride. Lasix can cause a patient to lose his appetite (anorexia) due to reduced potassium. If your laboring mom’s water breaks and she is any minus station you better know there is a risk of prolapsed cord. In a five-year old breathe once for every 5 compressions doing cpr. After g-tube placement the stomach contents are drained by gravity for 24 hours before it can be used for feedings. Cephalhematoma (caput succinidanium) resolves on its own in a few days. This is the type of edema that crosses the suture lines. During the acute stage of Hep-A gown and gloves are required. In the convalescent stage it is no longer contagious. Low magnesium and high creatinine signal renal failure. Pain is usually the highest priority with RA If a TB patient is unable/unwilling to comply with tx they may need supervision (direct observation). TB is a public health risk. Level of consciousness is the most important assessment parameter with status epilepticus. Crackles suggest pneumonia, which is likely to be accompanied by hypoxia, which would manifest itself as mental confusion, etc. Can’t cough=ineffective airway clearance Absence of menstruation leads to osteoporosis in the anorexic. Toddlers need to express autonomy (independence) A patient with a low hemoglobin and/or hematocrit should be evaluated for signs of bleeding, such as dark stools. A laxative is given the night before an IVP in order to better visualize the organs. A patient with liver cirrhosis and edema may ambulate, then sit with legs elevated to try to mobilize the edema. Managing stress in a patient with adrenal insufficiency (Addison’s) is paramount, because if the adrenal glands are stressed further it could result in Addisonian crisis. While we’re on Addison’s, remember blood pressure is the most important assessment parameter, as it causes severe hypotension. After pain relief, cough and deep breathe is important in pancreatitis, because of fluid pushing up in the diaphragm. Safety over Nutrition with a severely depressed client. Prolonged hypoxemia is a likely cause of cardiac arrest in a child. Fluid volume overload caused by IVC fluids infusing too quickly (or whatever reason) and CHF can cause an S3 Coarctation of the aorta causes increased blood flow and bounding pulses in the arms A newly diagnosed hypertension patient should have BP assessed in both arms Depression often manifests itself in somatic ways, such as psychomotor retardation, gi complaints, and pain. Respiratory problems are the chief concern with CF speaking of TB... PPD is positive if area of induration is: >5 mm in an immunocompromised patient >10 mm in a normal patient >15 mm in a patient who lives in an area where TB is very rare. another tiP: HbA1c - test to assess how well blood sugars have been controlled over the past 90-120 days. 4-6 corresponds to a blood sugar of 70-110; 7 is ideal for a diabetic and corresponds to a blood sugar of 130. BSA is considered the most accurate method for medication dosing with kids. (I though it was weight, but apparently not) Place a wheelchair parallel to the bed on the side of weakness If one nurse discovers another nurse has made a mistake it is always appropriate to speak to her before going to management. If the situation persists, then take it higher. Sepsis and anaphylaxis (along with the obvious hemorrhaging) reduce circulating volume by way of increased capillary permeability, which leads to reduced preload (volume in the left ventricle at the end of diastole). This is a toughie…think about it. Amniotic fluid is alkaline, and turns nitrazine paper blue. Urine and normal vaginal discharge are acidic, and turn it pink. Gonorrhea is a reportable disease Remember the phrase “step up” when picturing a person going up stairs with crutches. The good leg goes up first, followed by the crutches and the bad leg. The opposite happens going down. The crutches go first, followed by the good leg. While treating DKA, bringing the glucose down too far and too fast can result in increased intracranial pressure d/t water being pulled into the CSF. Polyuria is common with the hypercalcemia caused by hyperparathyroidism. Remember the action of vasopressin because it sounds like “press in”, or vasoconstrict. Water intoxication will be evidenced by drowsiness and altered mental status in a patient with TUR syndrome, or as an adverse reaction to desmopressin (for diabetes insipidus). Burning sensation in the mouth, and brassy taste are adverse reactions to Lugol solution (for hyperthyroid). Report it to the doc. Give synthroid on an empty stomach Extra insulin may be needed for a patient taking Prednisone (remember, steroids cause increased glucose). Nonfat milk reduces reflux by increasing lower esophageal sphincter pressure Patients with GERD should lay on their left side with the HOB elevated 30 degrees. Unusual positional tip - Low-fowlers recommended during meals to prevent dumping syndrome. Limit fluids while eating. In emphysema the stimulus to breathe is low PO2, not increased PCO2 like the rest of us, so don’t slam them with oxygen. Encourage pursed-lip breathing which promotes CO2 elimination, encourage up to 3000mL/day fluids, high-fowlers and leaning forward. Theophylline causes GI upset, give with food TB drugs are liver toxic. (Does your patient have hepB?) An adverse reaction is peripheral neuropathy. Thats the end of her tips everyone! Happy Studying! I wish everyone taking it soon the very best of luck! One cause of testicular cancer... undescended testes aka cryptorchidism Bottlefed neonate's FIRST feed is with sterile water than formula Multiple Myeloma- condition in which neoplastic plasma cells infiltrate the bone marrow resulting in osteoporosis, high risk for fractures so we need to install precautions with position changes With cardiac tamponade, venous pressure rises and neck veins become distended For chest physiotherapy, percussion should only be done in the area of the rib cage Evaluation of HTN is a key assessment in the course acute glomerulonephritis Post-procedure nursing interventions for electroconvulsive therapy includes remaining with the client until he/she is oriented and able to engage in self care because when they awaken they appear groggy and confused Best method for assessing BP is in both arms Recommended age for switiching from formula to whole milk is 12 months to prevent allergies and lactose intolerance Chronic, under treated asthma can lead to lung remodeling and permanent changes in lung function If a nurse suspects domestic violence as a cause of a client's injuries, the RN should interview the client without the persons who came with the client Wish me luck this week that I pass and can move forward with my career Delegations CNAs -skin care, feeding, toileting, vital signs (not initials), height, weight, IOs, ROM exercises, ambulation, transporting, grooming, and hygiene meaures of stable clients. LPNs/LVNs -physiologically stable clients with predictable outcomes -dressings, suctionings, urinary catheterization, med administrations (only oral, subcutaneous, and intramuscular), no rectal or IV meds RN associated: -care for individual in a structured health care environment RN BSN: -care for individuals, families, groups, and communities in both structured and unstructured health settings. RN (all): -assessment/planning care, initiating teaching, IV meds RN can not delegate these tasks: -initial assessments of clients -evaluation of client data -nursing judgement -client/family educatoin/evaluation -nsg diagnosis cushing's (HYPERSECRETION OF ADRENAL CORTEX) Check vital signs esp BP Urinary output and weight monitoring Stress management High chon diet Infection precaution Na restriction Glucose And electrolytes monitoring Spousal support ADDISON'S (hyposecretion of adrenal cortex hormone) 6 A's of addison 1. avoid stress 2. avoisd strenous activity 3.avoid individuals with infection 4.avoid otc meds 5.a lifelong glucocorticoids therapy 6.always wear medic alert bracelet Parents with a child that has sickle cell disease need to be taught that the child needs to AVOID OVERHEATING during physical activities because fluid loss caused by overheating and dehydration can trigger a crisis In developmental dysplasia, it produces a CHARACTERISTIC LIMP in children who are walking Clients with BPH have overflow incontinence with FREQUENT URINATION in small amounts day and night Pneumonia causes a marked increase in interstitial & alveolar fluid, therefore, consolidated lung tissue transmits BRONCHIAL BREATH SOUNDS to OUTER LUNG FIELDS During seizure activity, it is a PRIORITY to note, and then record, WHAT MOVEMENTS are seen because the diagnosis and treatment often rests solely on the seizure description PERSISTENT COUGHING in a child discharged after a tonsillectomy should BE REPORTED to the primary care provider because it may indicate BLEEDING ( don't just think frequent swallowing) Process of dying w/ a client that is Hindu: RN should plan that after death, a Hindu priest will pour water into the mouth of the client and tie a thread around the client's wrist, family is particular about who touches the body, cremation preferred, last rites carefully prescribed Process of dying w/ a client that is Mormon: Cremation discouraged, elders may be w/ the client during process of dying and no last rites are given Process of dying w/ a client that is Islamic: family must be w/ client during process of dying and family must be the only ones to wash the body after death Process of dying w/ a client that practices Judaism: body is ritually cleansed and burial occurs as soon as possible after death RNs should limit visitors with a client that has decreased adrenal function because any exertion, physical or emotional places additional stress on the adrenal glands, which could bring on an Addisonian crisis Client with trigeminal neuralgia, the RN should offer small meals of high calorie soft food to promote more nourishment and less chewing Separation anxiety is most evident from 6 months to 30 months of age Fluorosis, a condition in which teeth have a chalky white to yellowish staining with pitting of enamel d/t repeated swallowing of toothpaste with fluoride or drinking water with high levels of fluoride Breast engorgement in newborns occurs in both sexes as a result of withdrawal of maternal hormones after birth (normal occurence) Glaucoma and prostatic hypertrophy are contraindications to use Congentin because it is an anticholinergic drug Clients taking Thorazine should avoid direct sunglight d/t sensitivity Scenario- If RN is working for a Poison Control Center and parents say that their child has drunk drain cleaner (alkaline), the RN would suggest parents to have child drink orange juice (acidic) to neutralize the substance Facts for the day... A child with t-tubes can only swim if he/she wears earplugs, water should not enter the ears and the child should not put their heads under the water Fosomax should be taken 1st thing in the morning with 6-8 oz of PLAIN water at least 30 min before other foods or meds. Client needs to be instructed to remain in an upright position for 30 min following the dose to facilitate passage into the stomach and minimize irritation of the esophagus Cyclosporin (Neoral) inhibits normal immune responses. Clients receiving this are at risk for infection. INH (isoniazid) can also cause peripheral neuropathy (extremity tingling and numbness) Contraindication to cardioversion is digoxin use 24 hrs beforehand Wellbutrin should be started at 100mg BID for 3 days and then increased to 150mg BID, if used to treat depression, can take up to 4 weeks to see results, doses should be administered in equally spaced time increments throughout the day to minimize risk of seizures SE of Clozaril is extreme salivation Elderly clients are at risk for developing confusion when taking Tagament, a drug that interacts with many other meds 1st step in delegation is to DETERMINE the QUALIFICATIONS of the person to WHOM ONE IS DELEGATING, so ASK about PRIOR EXPERIENCE w/ similar clients Xanax is a short-acting benzodiazepine useful in controlling panic symptoms quickly, therefore short-term relief can be expected NSAIDs for arthritic use should be taken 1 hour before or 2 hours after meals, it results in a more rapid effect of the med Oral anticoagulation agents (Coumadin) are contraindicated in pregnancy SE of Prozac are diarrhea, dry mouth, weight loss, and decreased libido SE of aminophylline are restlessness and palpitations, nurse needs to intervene Clients with GERD need to avoid eating 2 hours before going to sleep and an upright posture should be maintained for 2 hours after eating to allow for stomach emptying Hospitalized patients, especially those on antibiotic therapy are at high risk for getting C. difficile Remember pain is whatever the client says it is Autonomy- individuals must be free to make independent decisions about participation in research without coercion from others While assessing the vitals in a child, the RN should know the apical HR is preferred until the radial pulse can be accurately assessed at 2 years of age A newborn is expected to lose 5-10% of birth wt in 1st few days post-partum d/t changes in elimination and feeding Blood sugars... premature neonate= 20-60mg/dl neonate= 30-60mg/dl infant= 40-90mg/dl Here's my facts for the day a.INTEGUMENTARY SYSTEM 1.autograph: after the surgery the site is immobilized for 3-7 days 2.burns on the face and head: elevate the head of the bed 3.burns on the extremities: elevate the extremities above the level of the heart 4.Skin graft: elevate and immobilize the graft site B.REPRODUCTIVE 1.Mastectomy-semi fowler's 30* with the affected arm elevated on a pillow,turn only on the unaffected side and back C.ENDOCRINE SYSTEM 1.Hypophysectomy-elevate head of the bed 2.Thyroidectomy-semi fowler's- sandbags/pillows support head and neck D.GASTROINTESTINAL 1.HEMORRHOIDECTOMY-lateral side lying 2.GERD-reverse trendelenberg 3.LIVER BIOPSY-during procedure:supine right side right arm extended on the left shoulder after procedure:right lateral(side lying)place small pillow or folded towel under the punctured site 4.NG TUBEa)insertion-high fowler's b)irrigation/feeding-semi fowler's head of bed 30* 5.Rectal enemas-left sim's position E. RESPIRATORY 1.COPD-sitting position,leaning forward with clients arms over several pillows 2.Laryngectomy-semi fowler's to fowlers 3.Bronchoscopy-semi fowler's 4.Postural drainage-the lung segment should be in the uppermost position 5.Thoracentesis-during procedure:sitting the edge of the bed after procedure: fowler's position F.CARDIOVASCULAR 1.ABDOMINAL RESECTION(ANEURISM) LIMIT TO 45*(FOWLER'S) 2.Amputtion of the lower limbs-elevate foot of the bed;prone 20-30 mins 3.Arterial vascular Grafting a)bedrest 24* with extremities straight b)limit movement 4.Cardiac catherization a)bedrest 3-4 hrs,side to side after b)keep straight ang head of bed elevated no more than 30* 5.Congestive heart failure with pulmonary edema high fowler's position 6.Perpheral arterial disease-Keep legs dependent do not elevate 7.Deep vein thrombosis bed rest with leg elevation,out of bed after 24* 8.Varicose veins-leg elevation above heart level 9. Venous leg ulcers-leg elevated H.NEUROLOGICAL SYSTEM 1.Autonomic dysreflexia-elevate head of bed to fowlers 2.Cerebral aneurism-semi fowler's 3.cerebral angiography-bed rest 1. What is the most important intervention for someone with Respiratory Acidosis? 2. What is the best diet for someone with Metabolic Acidosis? 3. A Client with Respiratory Alkalosis may also experienced _______ and calcium gluconate should be prescribed..... 4. Nausea, Vomiting, and Diarrhea are signs and symptoms of ________________ 5. What test should be performed prior to obtaining an arterial speciment for ABG? CAN YOU PLEASE HELP ME ANSWER THE TWO QUESTIONS I HAVE IN RED FONTS BELOW? THANK YOU. ACID/BASE BALANCE pH- 7.35-7.45 PCO2- 35-45 mmHg PO2- 80-100 mmHg HCO3 22-27 mEq/L ACIDOSIS -decrease pH -Potassium increases AKALOSIS -increase pH -Potassium decreases ROME respiratory oppossite metabolic equals ----------------------------------------------------------------------RESPIRATORY ACIDOSIS Causes of Respiratory Acidosis (mostly airways/lungs related) -Asthma: spasms causing the brochioles to constrict -Atelectasis: excess mucus collection -Brain trauma: excessive pressure on the respirtory center -Bronchiectasis: bronchi become dilated as a result of inflammation -COPD -Emphysema: loss of elasticity of alveolar sacs, restricting airflow -Hypoventilation: Carbon dioxide is retained -Pulmonary Edema: accumulation of fluid in acute CHF -Medications Assessment for Respiratory Acidosis -headache -restlessness -drowiness/confusion -visual disturbances -diaphoresis -cyanosis as the hypoxia become acute -hyperkalemia -rapid, irregular pulse -dysrhythmias leading to VFib. Interventions for Respiratory Acidosis -monitor signs of respiratory distress -administer oxygen as prescribed -semi-fowler -encourage and assist the client to turn, cough, and breathe deeply -hydration to thin secretions unless contraindicated -suction airway if necessary -monitor for potassium (because it is high in acidosis already) -administer meds (antibiotics) and NOT meds that would place the client in more respiratory depression ----------------------------------------------------------------------RESPIRATORY ALKALOSIS Causes of Respiratory Alkalosis -Fever (increases metabolism) -Hyperventilation -Hypoxia -Hysteria -Overventilation by mechanical ventilators -Pain -Aspirin Clinical Manifestations of Respiratory Alkalosis/Assessment -headache -tachypnea (initial but decreases) (abnormal rapid respiration) -paresthesias (tingling of fingers and toes) -tetany -vertigo -convulsions -hypokalemia -hypocalcemia Interventions for Respiratory Alkalosis -encourage appropriate breathing patterns -assist with breathing techniques and breathing aids as prescribed (voluntary holding of breath, use of rebreathing mask, carbon dioxide breaths) -no deep breathing???? (not sure but please look it up in your book and let me know) -administer calicum gluconate for tetany as prescribed. ----------------------------------------------------------------------METABOLIC ACIDOSIS Causes of Metabolic Acidosis -Diabetes Mellitus or Diabetic Ketoacidosis -Excessive ingestion of acetylsalicylic (aspirin) -High-fat diet (a high intake of fat causes a much too rapid accumulation of the waste products of fat metabolism, leading to a buildup of ketones and acids. -insufficient metabolism of carbohydrates -malnutrition -renal insufficiency or renal failure -severe diarrhea -enteric dranage tubes/ileostomy -gastrointestinal disorder Clinical manifestations of metabolic acidosis/ assessments -hyperpnea with kussmaul's repirations -headache -nausea/vomitting/ diarrhea -fruitty smelling breath resulting from improper fat metabolism -CNS depression (mental dullness, drowiness, stupor, and coma) -twitching and convulsions -hyperkalemia Interventions for Metabolic Acidosis -give insulin as precribed -dialysis as prescribed -Diet: low in protein and high in calories will decrease the amouth of protien waste products (which will lessen the acidosis) ----------------------------------------------------------------------METABOLIC ALKALOSIS Causes of Metabolic Alkalosis -diuretics -excessive vomitting or gastrointestinal suctioning -hyperaldosteronism: increased rental tubular reabsorption of sodium occurs, with the resultant loss of hydrogen ions. -ingestion of excess sodium bicarbonate/antacids -massive transfusion of whole blood Assessment of Metabolic Alkalosis -nausea, vomiting, diarrhea -restlessness -numbness and tingling in the extremities -twitching in the extremities -hypokalemia -hypocalcemia -dysrhythmias: tachycarida Interventions for Metabolic Alkalosis -monitor potassium and calcium -institute safety precautions (not sure of the safety precautions, please look this up in your book and let me know) -prepare to administer medications as prescribed to promote the kidney excretion of bicarbonate. -replace potassium chloride ----------------------------------------------------------------------OTHERS -Kussmaul's respirations (found in DKA): abnormally deep, regular, increase in rate -bradypnea respirations: regular but abnormally slow -hyperpnea respirations: labored and increased in depth and rate -apnea respirations: cease for several seconds -Make sure you do an Allen's test prior to drawing blood for the arterial blood gases. The purpose of this procedure is to assess the adequacy of the ulnar circulation. -ALLEN's Test: explain procedure, apply pressure over the ulnar and radial arteries, ask client to open and close hand repeatedly, release pressure from ulnar artery, assess the color of the extremity distal to the pressure point. 1. When getting down to two answers, choose the assessment answer (assess, collect, auscultate, monitor, palpate) over the intervention except in an emergency or distress situation. If one answer has an absolute, discard it. Give priority to answers that deal directly to the patient’s body, not the machines/equipments. 2. Key words are very important. Avoid answers with absolutes for example: always, never, must, etc. 3. with lower amputations patient is placed in prone position. 4. small frequent feedings are better than larger ones. 5. Assessment, teaching, meds, evaluation, unstable patient cannot be delegated to an Unlicensed Assistive Personnel. 6. LVN/LPN cannot handle blood. 7. Amynoglycosides (like vancomycin) cause nephrotoxicity and ototoxicity. 8. IV push should go over at least 2 minutes. 9. If the patient is not a child an answer with family option can be ruled out easily. 10. In an emergency, patients with greater chance to live are treated first . 11. ARDS (fluids in alveoli), DIC (disseminated intravascular coagulaton) are always secondary to something else (another disease process). 12. Cardinal sign of ARDS is hypoxemia (low oxygen level in tissues). 13. in pH regulation the 2 organs of concern are lungs/kidneys. 14. edema is in the interstitial space not in the cardiovascular space. 15. weight is the best indicator of dehydration 16. wherever there is sugar (glucose) water follows. 17. aspirin can cause Reye’s syndrome (encephalopathy) when given to children 18. when aspirin is given once a day it acts as an antiplatelet. 19. use Cold for acute pain (eg. Sprain ankle) and Heat for chronic ( rheumatoid arthritis) 20. guided imagery is great for chronic pain. 21. when patient is in distress, medication administration is rarely a good choice. 22. with pneumonia, fever and chills are usually present. For the elderly confusion is often present. 23. Always check for allergies before administering antibiotics (especially PCN). Make sure culture and sensitivity has been done before adm. First dose of antibiotic. 24. Cor pulmonale (s/s fluid overload) is Right sided heart failure caused by pulmonary disease, occurs with bronchitis or emphysema. 25. COPD is chronic, pneumonia is acute. Emphysema and bronchitis are both COPD. 26. in COPD patients the baroreceptors that detect the CO2 level are destroyed. Therefore, O2 level must be low because high O2 concentration blows the patient’s stimulus for breathing. 27. exacerbation: acute, distress. 28. epi always given in TB syringe. 29. prednisone toxicity: cushing’s syndrome= buffalo hump, moon face, high glucose, hypertension. 30. 4 options for cancer management: chemo, radiation, surgery, allow to die with dignity. 31. no live vaccines, no fresh fruits, no flowers should be used for neutropenic patients. 32. chest tubes are placed in the pleural space. 33. angina (low oxygen to heart tissues) = no dead heart tissues. MI= dead heart tissue present. 34. mevacor (anticholesterol med) must be given with evening meal if it is QD (per day). 35. Nitroglycerine is administered up to 3 times (every 5 minutes). If chest pain does not stop go to hospital. Do not give when BP is < 90/60. 36. Preload affects amount of blood that goes to the R ventricle. Afterload is the resistance the blood has to overcome when leaving the heart. 37. Calcium channel blocker affects the afterload. 38. for a CABG operation when the great saphenous vein is taken it is turned inside out due to the valves that are inside. 39. unstable angina is not relieved by nitro. 40. dead tissues cannot have PVC’s(premature ventricular contraction. If left untreated pvc’s can lead to VF (ventricular fibrillation). 41. 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 * To convert Centigrade to F. F= C+40, multiply 9/5 and substract 40 * To convert Fahrenheit to C. C= F+40, multiply 5/9 and substract 40. 42. angiotensin II in the lungs= potent vasodialator. Aldosterone attracts sodium. 43. REVERSE AGENTS FOR TOXICITY heparin= protamine sulfate coumadin= vitamin k ammonia= lactulose acetaminophen= n-Acetylcysteine. Iron= deferoxamine Digitoxin, digoxin= digibind. Alcohol withdraw= Librium. - methadone is an opioid analgesic used to detoxify/treat pain in narcotic addicts. - Potassium potentiates dig toxicity. 44. heparin prevents platelet aggregation. 45. PT/PTT are elevated when patient is on coumadin 46. cardiac output decreases with dysrythmias. Dopamine increases BP. 47. Med of choice for Vtach is lidocaine 48. Med of choice for SVT is adenosine or adenocard 49. Med of choice for Asystole (no heart beat) is atropine 50. Med of choice for CHF is Ace inhibitor. 51. Med of choice for anaphylactic shock is Epinephrine 52. Med of choice for Status Epilepticus is Valium. 53. Med of choice for bipolar is lithium. 54. Amiodorone is effective in both ventricular and atrial complications. 55. S3 sound is normal in CHF, not normal in MI. 56. give carafate (GI med) before meals to coat stomach 57. Protonix is given prophylactically to prevent stress ulcers. 58. after endoscopy check gag reflex. 59. TPN(total parenteral nutrition) given in subclavian line. 60. low residue diet means low fiver 61. diverticulitis (inflammation of the diverticulum in the colon) pain is around LL quadrant. 62. Appendicitis (inflammation of the appendix) pain is in RL quadrant with rebound tenderness. 63. portal hypotension + albuminemia= Ascites. 64. beta cells of pancreas produce insulin 65. Morphine is contraindicated in Pancreatitis. It causes spasm of the Sphincter of Oddi. Therefore Demerol should be given. 66. Trousseau and Tchovoski signs observed in hypocalcemia 67. with chronic pancreatitis, pancreatic enzymes are given with meals. 68. Never give K+ in IV push. 69. mineral corticoids are give in Addison’s disease. 70. Diabetic ketoacidosis (DKA)= when body is breaking down fat instead of sugar for energy. Fats leave ketones (acids) that cause pH to decrease. 71. DKA is rare in diabetes mellitus type II because there is enough insulin to prevent breakdown of fats. 72. Sign of fat embolism is petechiae. Treated with heparin. 73. for knee replacement use continuous passive motion machine. 74. give prophylactic antibiotic therapy before any invasive procedure. 75. glaucoma patients lose peripheral vision. Treated with meds 76. cataract= cloudy, blurry vision. Treated by lens removal-surgery 77. Co2 causes vasoconstriction. 78. most spinal cord injuries are at the cervical or lumbar regions 79. autonomic dysreflexia ( life threatening inhibited sympathetic response of nervous system to a noxious stimulus- patients with spinal cord injuries at T-7 or above) is usually caused by a full bladder. 80. spinal shock occurs immediately after spinal injury 81. Multiple sclerosis= myelin sheat destruction, disruption in nerve impulse conduction. 82. myasthenia gravis= decrease in receptor sites for acetylcholine. Since smallest concentration of ACTH receptors are in cranial nerves, expect fatigue and weakness in eye, mastication, pharyngeal muscles. 83. Tensilon test given if muscle is tense in myasthenia gravis. 84. Guillain-Barre syndrome= ascending paralysis. Keep eye on respiratory system. 85. parkinson’s = RAT: rigidity, akinesia (loss of muscle mvt), tremors. Treat with levodopa. 86. TIA (transient ischemic attack) mini stroke with no dead brain tissue 87. CVA (cerebrovascular accident) is with dead brain tissue. 88. Hodgkin’s disease= cancer of lymph is very curable in early stage. 89. Rule of NINES for burns Head and Neck= 9% Each upper ext= 9% Each lower ext= 18% Front trunk= 18% Back trunk= 18% Genitalia= 1% ? 90. Birth weight doubles by 6 month and triple by 1 year of age. 91. if HR is <100 do not give dig to children. 92. first sign of cystic fibrosis may be meconium ileus at birth. Baby is inconsolable, do not eat, not passing meconium. 93. heart defects. Remember for cyanotic -3T’s( Tof, Truncys arteriosus, Transposition of the great vessels). Prevent blood from going to heart. If problem does not fix or cannot be corrected surgically, CHF will occur following by death. 94. with R side cardiac cath=look for valve problems 95. with L side in adults look for coronary complications. 96. rheumatic fever can lead to cardiac valves malfunctions. 97. cerebral palsy = poor muscle control due to birth injuries and/or decrease oxygen to brain tissues. 98. ICP (intracranial pressure) should be <2. measure head circonference. 99. dilantin level (10-20). Can cause gingival hyperplasia 100. for Meningitis check for Kernig’s/ Brudzinski’s signs. 101. Wilm’s tumor is usually encapsulated above the kidneys causing flank pain. 102. hemophilia is x-linked. Mother passes disease to son. 103. when phenylalanine increases, brain problems occur. 104. Buck’s traction= knee immobility 105. Russell traction= femur or lower leg 106. Dunlap traction= skeletal or skin 107. Bryant’s traction= children <3y, <35 lbs with femur fx. 108. place apparatus first then place the weight when putting traction 109. placenta should be in upper part of uterus 110. eclampsia is seizure. 111. a patient with a vertical c-section surgery will more likely have another c-section. 112. perform amniocentesis before 20 weeks gestation to check for cardiac and pulmonary abnormalities. 113. Rh- mothers receive rhogam to protect next baby. 114. anterior fontanelle closes by 18 months. Posterior 6 to 8 weeks. 115. caput succedaneum= diffuse edema of the fetal scalp that crosses the suture lines. Swelling reabsorbs within 1 to 3 days. 116. pathological jaundice= occurs before 24hrs and last7 days. Physiological jaundice occurs after 24 hours. 117. placenta previa = there is no pain, there is bleeding. Placenta abruption = pain, but no bleeding. 118. bethamethasone (celestone)=surfactant. Med for lung expansion. 119. dystocia= baby cannot make it down to canal 120. pitocin med used for uterine stimulation 121. Magnesium sulfate(used to halt preterm labor) is contraindicated if deep tendon reflexes are ineffective. If patient experiences seizure during magnesium adm. Get the baby out stat (emergency). 122. Do not use why or I understand statement when dealing with patients 123. milieu therapy= taking care of patient/environment 124. cognitive therapy= counseling 125. crisis intervention=short term. 126. FIVE INTERVENTIONS FOR PSYCH PATIENTS -safety -setting limits -establish trusting relationship -meds -leas restrictive methods/environment. 126. SSRI’s (antidepressants) take about 3 weeks to work. 127. Obsession is to thought. Compulsion is to action 128. if patients have hallucinations redirect them. In delusions distract them. 129. Thorazine, haldol (antipsychotic) can lead to EPS (extrapyramidal side effects) 130. Alzheimer’s disease is a chronic, progressive, degenerative cognitive disorder that accounts for more than 60% of all dementias 17 Readers Gave Kudos CrystalClear75 DaIsYD30 fortheloveofnursing futgirl g3n3ziz Jack_ICU jina0730 kleona kum001 lucy in the sky MartinaRN1120 Melinurse michelmybell nuberianne_RN nursy2008 pancha unadunad Report No. 454 from Joiex Registered User Years Exp: 0+ Received 23 Kudos from 5 posts Join Date: Jan 2008 Posts: 8 Jul 06, 2008, 11:28 AM Updated Jul 06, 2008 at 11:32 AM by Joiex Re: Anyoone up for random FACT THROWING?? I found this thread last night and read until I couldn't keep my eyes open. Got Re: Anyoone up for random FACT THROWING?? Originally Posted by pretty_nurse1028 hi. for those who passed the nclex rn exam? how did u make it? i mean how u review in preparing for test? also what materials did u use before u take the test? how many months u prepare for the test? hope for a reply soon... thanks I used the Random Facts Thread, Infection Control Thread, Obscure Diseases Thread, Read the Pathophysiology Sticky in the Nursing Student Assistance Forum as well as that same forums Pharmacology & Nursing Math Stickies. I watched the Drexel DVD's and sort of read Lippincott's NCLEX Reveiw book. I used NCLEX 3000 to practice questions but got such bad scores I gave up on practicing questions ( and still passed NCLEX ). GOOD LUCK!!!! Biggest help for me was AllNurses.com and their many resources in Sticky Threads!!!! Here's my tip: Look through Sticky Threads here and you'll find a wealth of valuable information, facts, tips, and memory joggers. There are lots of great educational resources here. Second fact/tip: Give yourself breaks when studying so your mind can rest and be fresh to learn and retain more info. Third: Take care of yourself, eat well, get plenty of rest and exercise, destress. This is only a test and you took lots of tests in nursing school. I wanted to stop by and give you few "ideas" that may help you for your incoming test! I hope I don't get in trouble for this. I am not discussing test questions, I am just relaying few facts regarding the general consensus out there on the NCLEX. 1. It is not a secret that NCLEX is now focusing on infection control and prioritization/delagation (For high level questions). Make sure that you know what kind of precautions (Contact, droplets, airborne) used for any specific disease. You should check my thread on infection control: http://allnurses.com/forums/f197/qui...ol314902.html 2. Know the major drug classes. At least 5 drugs from each class. Focus on the patient teaching section. 3. Spend time (if you can) learning some rare diseases such as Kawasaki disease, Fifth disease,... Know the major signs and symptoms and how you treat them. 4. Review the acid/base imbalance content. 5. Many people reported having questions on Diabetes insipidus, SIADH, Cushing's and Addison disease. Study THOROUGHLY those diseases!!! 6. Review the nursing interventions of internal and external radiations. (Oncology...) 7. Do as many questions as you can (60-100/day), always making sure that you review the rationales of missed questions. Also you should know your weak areas and focus on them when you study the content. 8. Have time to relax Good luck to all of you and if I did it, you can also do it! Value Normal Range BUN 10 – 25 or 5 - 25 Kaplan Creatinine 1.2 – 1.5 or 0.5 – 1.5 Kap Creatinine Clearance 85 – 135 Albumin, serum 3.5 – 5.0 Potassium 3.5 – 5.0 Specific Gravity 1.010 – 1.030 Sodium, serum 135 – 145 Calcium 9 - 11 Magnesium 1.3 – 2.1 Chloride 95 – 105 Phosphate 3.0 – 4.5 Serum Osmolarity 285 - 295 Glycosylated Hemoglobin 4 – 6% 3 month review of Glucose pH 7.35 – 7.45 Acid Alkaline HCO3 22 – 26 Acid Alkaline PCO2 35 – 45 Acid Alkaline PO2 80 – 100 O2 saturation 96 - 100 Metabolic Alkalosis pH , PCO2 , HCO3 Metabolic Acidosis pH , PCO2 , HCO3 Respiratory Alkalosis pH , PCO2 , HCO3 Respiratory Acidosis pH , PCO2 , HCO3 Phosphate 3.0 – 4.5 CVP 3 – 11 or 2 – 8 HGB, hemoglobin 12 – 15 HCT, hemocrit 36 – 45 Platelets 150,000 – 450,000 Neutrophils 2500 – 8000 Lymphocytes 1000 – 4000 RBC 3.2 – 5.2 WBC 5000 – 10,000 Critical < 0.5 or >3 ESR 0 – 20 PTT 20 – 45 sec. Max 112 sec. PT/INR 10 – 14 seconds Bilirubin 0.1 – 1.0 ALT/AST 8 - 20 Digoxin 0.5 – 2 Toxic > 2.5 Dilantin 10 – 20 Toxic > 30 Theophylline 10 - 20 Toxic > 20 Lithium 0.5 – 1.2 Tylenol Therapeutic. 1.5 – 2.5 times Toxic > 4000 mg/day Hey guys. I just passed the NCLEX and I can give you few ideas about preparing for NCLEX Be familiar with the NCLEX test. 2. Know your NCLEX weak areas and focus on them 3. Maintain a consistent study habit. Study at least 2-3 hours a day EVERY DAY! 4. Focus on nursing interventions. Most NCLEX questions are about what you can do for the patient 5. Do at least 60-100 questions a day. Make sure you review the rationales of missed questions and do as many questions as you can! Believe me it worked for me... 6. Focus also on the prioritization/delegation and infection control contents 7. Know the major drugs classes and at least 3-5 drugs in each class. Focus on patient teaching 8. Include Saunders in your study books. Saunders book is best to teach you what you need to know in simple and concise terms 9. Improve your critical thinking skills. NCLEX is about critical thinking 10. Develop a winning strategy and be confident 11. Do not study the night before the test 12. Make sure you breathe... 1. This thread is a very good idea. I learnt so much from it. But the "random facts" should help you to be familiar with the content. Don't just focus on memorizing them. Make sure that you know how you can "apply" those facts to any given scenario regarding patient care. NCLEX is about critical thinking... Good luck to all of you! Can anyone add to this and/or correct me if I am wrong?? Seems like these are pretty important to know, everyone seems to get a good amount of questions on this.. INFECTION CONTROL Airborne Precautions: Varicella TB Rubeola pt must wear mask when transporting what else?!? Droplet Precautions: Mennigittis Pneumonia Pertussis Rubella Mumps private room unless other pt has same organism maintain 3 feet distance unless giving care anything else?? Contact Precautions: RSV Synctial virus C Diff MRSA Ecoli Scabies Impetigo Room needs to be private unless same organism gloves/gown when in contact with secretions anything else?? Standard Precautions: CF Bronchitis Hantavirus Tonsillitis Cutaneous Anthrax Hey Kristina, This is good, thanks for posting it. For airborne, make sure the patient is in a room that has negative air pressure with at least 6-12 exchanges an hour, and N95 mask for TB. Also remember MTV Cd for airborne: Measles (Rubeola), TB, Varicella (Shingles), Chickenpox, Disseminated varicella zoster. Here are 2 links I have been using regarding infection control. Hope you find them useful. http://allnurses.com/forums/f197/qui...-314902-4.html http://allnurses.com/forums/f197/isolation-precautions-316743.html Re: Anyoone up for random FACT THROWING?? You have to know these common disease in NCLEX: hypertension provide for physical and emotional rest provide for special safety needs health teaching (client and family) dysrhythmias provide for emotional and safety needs prevent thromboemboli prepare for cardioversion with atrial fibrillation if indiated provide for physical and emotional needs with pacemaker insertion cardiac arrest prevent irreversible cerebral anoxic damage establish effective circulatio n, respiration angina pectoris provide relief from pain provide emotional support health teaching myocardial infarction reduce pain, discomfort maintain adequate circulation, stabilize heart rhythm decrease oxygen demand/promote oxygenation, reduce cardiac workload maintain fluid electrolyte, nutritional status facilitate fecal elimination provide emotional support promote sexual functioning health teaching cardiac valvular defects reduce cardiac workload promote physical comfort and psychological support prevent complications prepare for surgery cardiac catheterization & percutaneous transluminal coronary angioplasty precatheterization: provide for safety, comfort health teaching postcatheterization: prevent complications provide emotional support health teaching cardiac surgery cardiopulmonary bypass preoperative: provide emotional and spiritual support health teaching postoperative: provide constant monitoring to prevent complications promote comfort, pain relief maintain fluid, electrolyte, nutritional balance promote emotional adjustment promote early mobilization health teaching heart failure (HF) provide physical rest / reduce emotional stimuli provide for relief of respiratory distress; reduce cardiac workload provide for special safety needs maintain fluid and electrolyte balance, nutritional status health teaching pulmonary edema promote physical, psychological relaxation measures to relieve anxiety improve cardiac function, reduce venous return, relieve hypoxia health teaching (include family or significant other) shock promote venous return, circulatory perfusion disseminated intravascular coagulation (DIC) prevent and detect further bleeding pericarditis promote physical and emotionl comfort maintain fluid, electrolyte balance chronic arterial occlusive disease promote circulation; decrease discomfort prevent infection, injury aneurysms provide emergency care before surgery for dissection or rupture prevent complications postoperatively promote comfort health teaching Raynaud’s phenomenon Maintain warmth in extremities Increase hydrostatic pressure, and therefore circulation Health teaching Varicose veins Promote venous return from lower extremities Provide for safety Health teaching Vein ligation and stripping Prevent complications after discharge Health teaching to prevent recurrence Deep vein thrombosis (thrombophlebitis) Provide rest, comfort, and relief from pain Prevent complications Health teaching Iron deficiency anemia & Hemolytic anemia Promote physical and mental equilibrium Health teaching Pernicious anemia Promote physical and emotional comfort Health teaching Polycythemia vera promote comfort and prevent complications health teaching leukemia (acute and chronic) prevent, control, and treat infection assess and control bleeding, anemia provide rest, comfort, nutrition reduce side effects from therapeutic regimen provide emotional/spiritual support health teaching idiopathic thrombocytopenic purpura (ITP) prevent complications from bleeding tendencies health teaching splenectomy prepare for surgery prevent postoperative complications health teaching fluid volume deficit restore fluid and electrolyte balance-increase fluid intake to hydrate client promote comfort prevent physical injury fluid volume excess maintain oxygen to all cells promote excretion of excess fluid obtain/ maintain fluid balance prevent tissue injury health teaching common electrolyte imbalances hyponatremia obtain normal sodium level prevent further sodium loss prevent injury hypernatremia obtain normal sodium level hypokalemia replace lost potassium: increase potassium in diet prevent injury to tissues prevent potassium loss hyperkalemia decrease amount of potassium in body hypocalcemia prevent tetany prevent tissue injury prevent injury related to mediction administration in less acute condition hypercalcemia reduce calcium intake: decrease foods high in calcium prevent injury hypomagnesemia provide safety health teaching hypermagnesemia obtain normal magnesium level respiratory adidosis assist with normal breathing protect from injury health teaching metabolic acidosis restore normal metabolism prevent complications health teaching respiratory alkalosis increase carbon dioxide level prevent injury health teaching metabolic alkalosis obtain, maintin acid-base blance prevent physical injury health teaching pneumonia promote adequate ventilation control infection provide rest and comfort prevent potential complications health teaching severe acute respiratory syndrome (SARS) infection control supportive care atelectasis relieve hypoxia prevent complications health teaching pulmonary embolism monitor for signs of respiratory distress health teaching histoplasmosis relieve symptoms of the disease health teaching tuberculosis reduce spread of disease promote nutrition promote increased self-esteem health teaching emphysema promote optimal ventilation employ comfort measures and support other body systems improve nutritional intake provide emotional support for client and fmily health teaching asthma promote pulmonary ventilation facilite expectoration health teaching to prevent further attacks bronchitis assist in optimal respirations minimize bronchial irritation improve nutritional status acute adult respiratory distress syndrome (ARDS) assist in respirations prevent complications health teaching pneumothorax & hemothorax prevent damage until medical intervention available protect against injury during thoracentesis promote respirations prepare client for closed chest drainage, physically and psychologically prevent complications with chest tubes health teaching chest trauma Flail chest restore adequate ventilation and prevent further air from entering pleural cavity thoracic surgery preoperative care: minimize pulmonary secretions preoperative teaching postoperative care: maintain patent airway promote gas exchange reduce incisional stress and discomfort prevent complications related to respiratory function maintain fluid and electrolyte balance postoperative teaching tracheostomy preoperative care relieve anxitety and fear postoperative care maintain patent airway alleviate apprehension improve nutritional status health teaching burns alleviate pain, relieve shock, and maintain fluid and electrolyte balance prevent physicl complications promote emotional adjustment and provide supportive therapy promote wound healing – wound care health teaching rheumatoid arthritis prevent or correct deformities health teaching lupus erythematosus minimize or limit immune response and complications health teaching infectious diseases Lyme disease minimize irreversible tissue damage and complications alleviate pin, promote comfort maintain physical and psychological well-being health teaching acquired immunodeficiency syndrome (AIDS) reduce risk of infection; slow disease progression prevent the spread of disease provide physical and psychological support health teaching The perioperative experience Preoperative preparation reduce preoperative and intraoperative anxiety and prevent postoperative complications instruct in exercises to reduce complications reduce the number of bacteria on the skin to eliminate incision contamination reduce the risk of vomiting and aspiration during anesthesia; prevent contamination of abdominal operative sites by fecal material promote rest and facilitate reduction of apprehension protect from injury;ensure final preparation for surgery intraoperative preparation prevent complications promote comfort observe for indications of malignant hyperthermia postoperative experience promote a safe, quiet, nonstressful environment promote lung expansion and gss exchange prevent aspiration and atelectasis promote and maintain cardiovascular function promote psychological equilibrium maintain proper function of tubes and appatatus general postoperative nursing care promote lung expansion provide relief of pain promote adequate nutrition and fluid and electrolyte balance assist client with elimination facilitate wound and prevent infection promote comfort and rest encourage early movement and ambulation to prevent complications of immobilization general nutritional deficiencies prevent complications of specific deficiency health teaching celiac disease altered nutrition, less than body requirements diarrhea fluid volume deficit related to loss through excessive diarrhea knowledge deficit hepatitis prevent spread of infection to others promote comfort pancreatitis control pain rest injured pancreas prevent fluid and electrolyte imbalance prevent respirtory and metabolic complications provide adequate nutrition prevent complications health teaching cirrhosis provide for special safety needs relieve discomfort caused by complications improve fluid and electrolyte balance promote optimum nutrition within dietary restrictions provide emotional support health teaching esophageal varices: life-threatening hemorrhage provide safety measures related to hemorrhage promote fluid balance prevent complications of hepatic coma provide emotional support health teaching diaphragmatic (hiatal) hernia presurgical: promote relief of symptoms postsurgical: provide for postoperative safety needs promote comfort and maintain nutrition health teaching gastroesophgel reflux disease(GERD) promote comfort and reduce reflux episodes health teaching peptic ulcer disease promote comfort prevent/ recognize signs of complications provide emotional support health teaching gastric surgery promote comfort in the postoperative period promote wound healing promote adequate nutrition and hydration prevent complications dumping syndrome health teaching total parenteral nutrition prevent infection preent fluid and eclectrolyte imbalance prevent complications diabetes obtain and maintain normal sugar balance health teaching nonketotic hyperglycemic hyperosolar coma (NKHHC) promote fluid and electrolyte balance cholecystits/ cholelithiasis nonsurgical interventions romote comfort preoperative: prevent injury postoperative romote comfort prevent complications health teaching obesity decrease weight, initially 10% from baseline appendicitis promote comfort hernia prevent postoperative complications health teaching diverticulosis bowel rest during acute episodes promote normal bowel elimination health teaching ulcerative colitis & Crohn’s disease prevent disease progression and complications reduce psychological stress health teaching intestinal obstruction obtain and maintain fluid balance relieve pain and nausea prevent respiratory complications postoperative nursing care fecal diversion-stomas preoperative period: prepare bowel for surgery relieve anxiety and assist in adjustment to surgery postoperative period: maintain fluid balance prevent other postoperative complications initiate ostomy care promote psychological comfort hemorrhoids reduce anal discomfort prevent complications related to surgery health teaching-avoid constipation pyelonephritis (PN) combat infection, prevent recurrence, alleviate symptoms promote physical and emotional rest acute glomerulonephritis monitor fluid balance, observing carefully for complications provide adequate nutrition provide reasonable measure of comfort prevent further infection & health teaching acute renal failure (ARF) maintain fluid and electrolyte balance and nutrition use assessment and comfort measures to reduce occurrence of complications maintain continual emotional support health teaching chronic renal failure maintain fluid/ electrolyte balance and nutrition employ comfort measures that reduce distress and support physical function health teaching dialysis reduce level of nitrogenous waste correct acidosis, reverse electrolyte imbalances, remove excess fluid kidney transplantation preoperative: promoe physical and emotional adjustment encourage expression of feelings health teching postoperative: promote uncomplicated recovery of recipient observe for signs of rejection-most dangerous complication maintain immunosuppressive therapy nephrectomy preoperative ptimize physical and psychological functioning postoperative promote comfort and prevent complications renal calculi (urolithiasis) reduce pain and prevent complications health teaching lithotripsy enourage ambulation and promote diuresis through forcing fluids benign prostatic hyperplasia relieve urinary retention health teaching prostatectomy promote optimal bladder function and comfort assist in rehabilitation urinary diversion prevent complications and promote comfort health teaching laryngectomy preoperative care: provide emotional support and optimal physical preparation health teaching postoperative care maintain patent airway and prevent aspiration promote optimal physical and psychological function health teaching aphasia assist with communication Meniere’s disease provide safety and comfort during attacks minimize occurrence of attacks health teaching otosclerosis & stapedectomy preoperative health teaching postoperative promote physical and psychological equilibrium health teaching deafnessmaximize hearing ability and provide emotional support.health teaching glaucoma reduce intraocular pressure provide emotional support health teaching cataract & cataract removal preoperative prepare for surgery postoperative reduce stress on the sutures and prevent hemorrhage promote psychological well-being health teaching retinal detachment preoperative: reduce anxiety and prevent further detachment health teaching postoperative reduce intraocular stress and prevent hemorrhage support coping mechanisms health teaching blindness promote independence and provide emotional support health teaching traumatic injuries to the brain sustain vital functions and minimize or prevent complications provide emotional support and use comfort measures increased inrcranial pressure promote adequate oxygenation and limit further impairment craniotomy preoperative btain baseline measures provide psychological support prepare for surgery postoperative prevent complications and limit further impairment epilepsy prevent injury during seizure postseizure care prevent or reduce recurrences of seizure activity health teaching transient ischemic attacks reduce cerebral anoxia promote cerebrovascular function and maintain cerebral perfusion provide for emotional relaxation client safety health teaching pain immobility complications of fractures types of traction teaching crutch walking compartment syndrome recognizes early indications of ischemia prevent complications osteoarthritis promote comfort: reduce pain, spasms, inflammation, swelling health teaching to promote independence total hip replacement preoperative: prevent deep vein thrombosis or pulmonary emboli prevent infection: antibiotics health teaching postoperative prevent respiratory complications prevent complications of shock or infection prevent contractures, muscle atrophy promote early ambulation and movement prevent constipation prevent dislocation of prosthesis promote comfort health teaching total knee replacement achieve active flexion beyond 70 degrees amputation prepare for surgery,physically and emotionlly promote healing postoperatively gout decrease discomfort prevent kidney damage health teaching primary hip arthroplasty herniated/ reptured disk relieve pain and promote comfort health teaching laminectomy relieve anxiety prevent injury postoperatively promote comfort prepare for early discharge health teaching spinal cord injuries maintain patent airway prevent further damage relieve edema:anti-inflammatory medications,corticosteroids relieve discomfort,analgesics,sedatives,muscle relaxants promote comfort prevent complications health teaching posterior spinal fusion (PSF) spinal shock prevent injury related to shock autonomic dysreflexia decrease symptoms to prevent serious side effects maintain patency of catheter promote regular bowel elimination prevent decubitus ulcers hyperthyroidism protect from stress promote physical and emotional equilibrium prevent complications health teaching thyroid storm thyroidectomy promote physical and emotional equilibrium prevent complications of hypocalcemia and tetany promote comfort measures hypothyroidism provide for comfort and safety health teaching cushing’s disease promote comfort prevent complications health teaching pheochromocytoma prevent paroxysmal hypertension prepare for surgical removal of tumor adrenalectomy preoperative:reduce risk of postoperative complications postoperative promoe hormonal balance prevent postoperative complications health teaching Addison’s disease decrease stress promote adequate nutrition Health teaching Multiple sclerosis maintain normal routine as long as possible decrease symptoms-medications as ordered Myasthenia gravis promote comfort decrease symptoms prevent complications promote increased self-concept health teaching Parkinson’s disease promote maintenance of daily activities protect from injury Amyotrophic lateral sclerosis (ALS) maintain independence as long as possible health teaching Guillain-Barre syndrome prevent complications during recovery from paralysis monitor for signs of autoimmune dysfunction prevent tachycardia assess cranial nerve function maintain adequate ventilation in acute phase:check for progression of muscular weakness maintain nutrition prevent injury and complications support communication Chemotherapy assist with treatment of specific side effect health teaching Radiationtherapy External radiation: prevent tissue breakdown decrease side effects of therapy health teaching internal radiation : sealed assist with cervical radium implantation health teaching internal radiation: unsealed reduce radiation exposure of others Immunotherapy decrease discomfort associated with side effects of therapy health teaching Palliative care make client as comfortable as possible assist client to maintain self-esteem and identity assist client with psychological adjustment Types of cancer: Lung cancer Make client aware of diagnosis and treatment options Prevent complications related to surgery Assist client to cope with alternative therapies colon and rectal cancer assist through treatment protocol surgery reoperative preparefor surgery promote comfort postoperative : facilitate healing prevent complications facilitate rehabilitation health teaching breast cancer assist client through treatment protocol prepare client for surgery reduce anxiety and depression prevent postoperative complications support coping mechanisms health teaching uterine cancer prostate cancer assist client through treatment protocol prepare client for surgery assist with acceptance diagnosis and treatment prevent complication during postoperative period bladder cancer laryngeal cancer additional typers of cancer,etc. 18 Readers Gave Kudos alienRNwannabe charming7680 CrystalClear75 debi23 december2905 folashade 37 fortheloveofnursing hase2000 Jack_ICU jadu1106 JoanieDee, LPN Lil'mama Martina1120 Melinurse nursy2008 pink_girl SWEETDREAMERINSOCAL unadunad Report No. 581 from jadu1106 Registered User Years Exp: 8--Will the next attempt at the NCLEX-RN be successful?? Nursing Specialty: Postpartum/Nursery Received 699 Kudos from 337 posts Join Date: Dec 2007 Posts: 687 Jul 11, 2008, 11:34 AM Re: Anyoone up for random FACT THROWING?? Wow thanks NY2008....Thank you so much for posting this information and for posting the info about shigella!! Good luck to you!! Report No. 582 from Melinurse Registered User Years Exp: some Nursing Specialty: LTC, case mgmt, agency Received 1,953 Kudos from 1,004 posts Jul 11, 2008, 01:01 PM Drugs with these endings........ usually are in this class -caine ;local anesthetics -cillin; antibiotic -dine ;anti-ulcer ( H2 blocker ) -done; opioid analgesic -ide; oral hypoglycemics -lam; antianxiety -mide ;diuretic -mycin ;antibiotic -nium; neuromuscular blocking -olol; beta blocker -oxacin ;antibiotic -pam ;antianxiety -pril ;ACE inhibitor -sone ;steroids -statin ;cholesterol -vir; antiviral -zide; diuretic . When getting down to two answers, choose the assessment answer (assess, collect, auscultate, monitor, palpate) over the intervention except in an emergency or distress situation. If one answer has an absolute, discard it. Give priority to answers that deal directly to the patient’s body, not the machines/equipments. 2. Key words are very important. Avoid answers with absolutes for example: always, never, must, etc. 3. with lower amputations patient is placed in prone position. 4. small frequent feedings are better than larger ones. 5. Assessment, teaching, meds, evaluation, unstable patient cannot be Join Date: Apr 2008 Posts: 2,077 delegated to an Unlicensed Assistive Personnel. 6. LVN/LPN cannot handle blood. 7. Amynoglycosides (like vancomycin) cause nephrotoxicity and ototoxicity. 8. IV push should go over at least 2 minutes. 9. If the patient is not a child an answer with family option can be ruled out easily. 10. In an emergency, patients with greater chance to live are treated first . 11. ARDS (fluids in alveoli), DIC (disseminated intravascular coagulaton) are always secondary to something else (another disease process). 12. Cardinal sign of ARDS is hypoxemia (low oxygen level in tissues). 13. in pH regulation the 2 organs of concern are lungs/kidneys. 14. edema is in the interstitial space not in the cardiovascular space. 15. weight is the best indicator of dehydration 16. wherever there is sugar (glucose) water follows. 17. aspirin can cause Reye’s syndrome (encephalopathy) when given to children 18. when aspirin is given once a day it acts as an antiplatelet. 19. use Cold for acute pain (eg. Sprain ankle) and Heat for chronic ( rheumatoid arthritis) 20. guided imagery is great for chronic pain. 21. when patient is in distress, medication administration is rarely a good choice. 22. with pneumonia, fever and chills are usually present. For the elderly confusion is often present. 23. Always check for allergies before administering antibiotics (especially PCN). Make sure culture and sensitivity has been done before adm. First dose of antibiotic. 24. Cor pulmonale (s/s fluid overload) is Right sided heart failure caused by pulmonary disease, occurs with bronchitis or emphysema. 25. COPD is chronic, pneumonia is acute. Emphysema and bronchitis are both COPD. 26. in COPD patients the baroreceptors that detect the CO2 level are destroyed. Therefore, O2 level must be low because high O2 concentration blows the patient’s stimulus for breathing. 27. exacerbation: acute, distress. 28. epi always given in TB syringe. 29. prednisone toxicity: cushing’s syndrome= buffalo hump, moon face, high glucose, hypertension. 30. 4 options for cancer management: chemo, radiation, surgery, allow to die with dignity. 31. no live vaccines, no fresh fruits, no flowers should be used for neutropenic patients. 32. chest tubes are placed in the pleural space. 33. angina (low oxygen to heart tissues) = no dead heart tissues. MI= dead heart tissue present. 34. mevacor (anticholesterol med) must be given with evening meal if it is QD (per day). 35. Nitroglycerine is administered up to 3 times (every 5 minutes). If chest pain does not stop go to hospital. Do not give when BP is < 90/60. 36. Preload affects amount of blood that goes to the R ventricle. Afterload is the resistance the blood has to overcome when leaving the heart. 37. Calcium channel blocker affects the afterload. 38. for a CABG operation when the great saphenous vein is taken it is turned inside out due to the valves that are inside. 39. unstable angina is not relieved by nitro. 40. dead tissues cannot have PVC’s(premature ventricular contraction. If left untreated pvc’s can lead to VF (ventricular fibrillation). 41. 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 * To convert Centigrade to F. F= C+40, multiply 9/5 and substract 40 * To convert Fahrenheit to C. C= F+40, multiply 5/9 and substract 40. 42. angiotensin II in the lungs= potent vasodialator. Aldosterone attracts sodium. 43. REVERSE AGENTS FOR TOXICITY heparin= protamine sulfate coumadin= vitamin k ammonia= lactulose acetaminophen= n-Acetylcysteine. Iron= deferoxamine Digitoxin, digoxin= digibind. Alcohol withdraw= Librium. - methadone is an opioid analgesic used to detoxify/treat pain in narcotic addicts. - Potassium potentiates dig toxicity. 44. heparin prevents platelet aggregation. 45. PT/PTT are elevated when patient is on coumadin 46. cardiac output decreases with dysrythmias. Dopamine increases BP. 47. Med of choice for Vtach is lidocaine 48. Med of choice for SVT is adenosine or adenocard 49. Med of choice for Asystole (no heart beat) is atropine 50. Med of choice for CHF is Ace inhibitor. 51. Med of choice for anaphylactic shock is Epinephrine 52. Med of choice for Status Epilepticus is Valium. 53. Med of choice for bipolar is lithium. 54. Amiodorone is effective in both ventricular and atrial complications. 55. S3 sound is normal in CHF, not normal in MI. 56. give carafate (GI med) before meals to coat stomach 57. Protonix is given prophylactically to prevent stress ulcers. 58. after endoscopy check gag reflex. 59. TPN(total parenteral nutrition) given in subclavian line. 60. low residue diet means low fiver 61. diverticulitis (inflammation of the diverticulum in the colon) pain is around LL quadrant. 62. Appendicitis (inflammation of the appendix) pain is in RL quadrant with rebound tenderness. 63. portal hypotension + albuminemia= Ascites. 64. beta cells of pancreas produce insulin 65. Morphine is contraindicated in Pancreatitis. It causes spasm of the Sphincter of Oddi. Therefore Demerol should be given. 66. Trousseau and Tchovoski signs observed in hypocalcemia 67. with chronic pancreatitis, pancreatic enzymes are given with meals. 68. Never give K+ in IV push. 69. mineral corticoids are give in Addison’s disease. 70. Diabetic ketoacidosis (DKA)= when body is breaking down fat instead of sugar for energy. Fats leave ketones (acids) that cause pH to decrease. 71. DKA is rare in diabetes mellitus type II because there is enough insulin to prevent breakdown of fats. 72. Sign of fat embolism is petechiae. Treated with heparin. 73. for knee replacement use continuous passive motion machine. 74. give prophylactic antibiotic therapy before any invasive procedure. 75. glaucoma patients lose peripheral vision. Treated with meds 76. cataract= cloudy, blurry vision. Treated by lens removal-surgery 77. Co2 causes vasoconstriction. 78. most spinal cord injuries are at the cervical or lumbar regions 79. autonomic dysreflexia ( life threatening inhibited sympathetic response of nervous system to a noxious stimulus- patients with spinal cord injuries at T-7 or above) is usually caused by a full bladder. 80. spinal shock occurs immediately after spinal injury 81. Multiple sclerosis= myelin sheat destruction, disruption in nerve impulse conduction. 82. myasthenia gravis= decrease in receptor sites for acetylcholine. Since smallest concentration of ACTH receptors are in cranial nerves, expect fatigue and weakness in eye, mastication, pharyngeal muscles. 83. Tensilon test given if muscle is tense in myasthenia gravis. 84. Guillain-Barre syndrome= ascending paralysis. Keep eye on respiratory system. 85. parkinson’s = RAT: rigidity, akinesia (loss of muscle mvt), tremors. Treat with levodopa. 86. TIA (transient ischemic attack) mini stroke with no dead brain tissue 87. CVA (cerebrovascular accident) is with dead brain tissue. 88. Hodgkin’s disease= cancer of lymph is very curable in early stage. 89. Rule of NINES for burns Head and Neck= 9% Each upper ext= 9% Each lower ext= 18% Front trunk= 18% Back trunk= 18% Genitalia= 1% ? 90. Birth weight doubles by 6 month and triple by 1 year of age. 91. if HR is <100 do not give dig to children. 92. first sign of cystic fibrosis may be meconium ileus at birth. Baby is inconsolable, do not eat, not passing meconium. 93. heart defects. Remember for cyanotic -3T’s( Tof, Truncys arteriosus, Transposition of the great vessels). Prevent blood from going to heart. If problem does not fix or cannot be corrected surgically, CHF will occur following by death. 94. with R side cardiac cath=look for valve problems 95. with L side in adults look for coronary complications. 96. rheumatic fever can lead to cardiac valves malfunctions. 97. cerebral palsy = poor muscle control due to birth injuries and/or decrease oxygen to brain tissues. 98. ICP (intracranial pressure) should be <2. measure head circonference. 99. dilantin level (10-20). Can cause gingival hyperplasia 100. for Meningitis check for Kernig’s/ Brudzinski’s signs. 101. Wilm’s tumor is usually encapsulated above the kidneys causing flank pain. 102. hemophilia is x-linked. Mother passes disease to son. 103. when phenylalanine increases, brain problems occur. 104. Buck’s traction= knee immobility 105. Russell traction= femur or lower leg 106. Dunlap traction= skeletal or skin 107. Bryant’s traction= children <3y, <35 lbs with femur fx. 108. place apparatus first then place the weight when putting traction 109. placenta should be in upper part of uterus 110. eclampsia is seizure. 111. a patient with a vertical c-section surgery will more likely have another c-section. 112. perform amniocentesis before 20 weeks gestation to check for cardiac and pulmonary abnormalities. 113. Rh- mothers receive rhogam to protect next baby. 114. anterior fontanelle closes by 18 months. Posterior 6 to 8 weeks. 115. caput succedaneum= diffuse edema of the fetal scalp that crosses the suture lines. Swelling reabsorbs within 1 to 3 days. 116. pathological jaundice= occurs before 24hrs and last7 days. Physiological jaundice occurs after 24 hours. 117. placenta previa = there is no pain, there is bleeding. Placenta abruption = pain, but no bleeding. 118. bethamethasone (celestone)=surfactant. Med for lung expansion. 119. dystocia= baby cannot make it down to canal 120. pitocin med used for uterine stimulation 121. Magnesium sulfate(used to halt preterm labor) is contraindicated if deep tendon reflexes are ineffective. If patient experiences seizure during magnesium adm. Get the baby out stat (emergency). 122. Do not use why or I understand statement when dealing with patients 123. milieu therapy= taking care of patient/environment 124. cognitive therapy= counseling 125. crisis intervention=short term. 126. FIVE INTERVENTIONS FOR PSYCH PATIENTS -safety -setting limits -establish trusting relationship -meds -leas restrictive methods/environment. 126. SSRI’s (antidepressants) take about 3 weeks to work. 127. Obsession is to thought. Compulsion is to action 128. if patients have hallucinations redirect them. In delusions distract them. 129. Thorazine, haldol (antipsychotic) can lead to EPS (extrapyramidal side effects) 130. Alzheimer’s disease is a chronic, progressive, degenerative cognitive disorder that accounts for more than 60% of all dementias