DO NOT delegate what you can EAT! E - evaluate
A - assess T - teach
addisons= down, down down up down cushings= up up up down up
addisons=
... [Show More] hyponatremia, hypotension, decreased blood vol, hyperkalemia, hypoglycemia cushings= hypernatremia, hypertension, incrased blood vol, hypokalemia, hyperglycemia
No Pee, no K (do not give potassium without adequate urine output) EleVate Veins; dAngle Arteries for better perfusion
A= appearance (color all pink, pink and blue, blue [pale]) P= pulse (>100, < 100, absent)
G= grimace (cough, grimace, no response) A= activity (flexed, flaccid, limp)
R= respirations (strong cry, weak cry, absent)
TRANSMISSION-BASED PRECAUTIONS:
AIRBORNE
My - Measles
Chicken - Chicken Pox/Varicella Hez - Herpez Zoster/Shingles TB
or remember... MTV=Airborne Measles
TB
Varicella-Chicken Pox/Herpes Zoster-Shingles
Private Room - negative pressure with 6-12 air exchanges/hr Mask, N95 for TB
DROPLET
think of SPIDERMAN! S - sepsis
S - scarlet fever
S - streptococcal pharyngitis P - parvovirus B19
P - pneumonia P - pertussis
I - influenza
D - diptheria (pharyngeal) E - epiglottitis
R - rubella M - mumps
M - meningitis
M - mycoplasma or meningeal pneumonia An - Adenovirus
Private Room or cohort Mask
CONTACT PRECAUTION MRS.WEE
M - multidrug resistant organism R - respiratory infection
S - skin infections * W - wound infxn
E - enteric infxn - clostridium difficile E - eye infxn - conjunctivitis
SKIN INFECTIONS VCHIPS
V - varicella zoster
C - cutaneous diphtheria H - herpez simplex
I - impetigo
P - pediculosis S - scabies
1. Air/Pulmonary Embolism (S&S: chest pain, difficulty breathing, tachycardia, pale/cyanotic, sense of impending doom) --> turn pt to left side and lower the head of the bed.
2. Woman in Labor w/ Un-reassuring FHR (late decels, decreased variability, fetal bradycardia, etc) --> turn on left side (and give O2, stop Pitocin, increase IV fluids)
3. Tube Feeding w/ Decreased LOC --> position pt on right side (promotes emptying of the stomach) with the HOB elevated (to prevent aspiration)
4. During Epidural Puncture --> side-lying
5. After Lumbar Puncture (and also oil-based Myelogram)--> pt lies in flat supine (to prevent headache and leaking of CSF)
6. Pt w/ Heat Stroke --> lie flat w/ legs elevated
7. During Continuous Bladder Irrigation (CBI) --> catheter is taped to thigh so leg should be kept straight. No other positioning restrictions.
8. After Myringotomy --> position on side of affected ear after surgery (allows drainage of secretions)
9. After Cataract Surgery --> pt will sleep on unaffected side with a night shield for 1-4 weeks.
10. After Thyroidectomy --> low or semi-Fowler's, support head, neck and shoulders.
11. Infant w/ Spina Bifida --> position prone (on abdomen) so that sac does not rupture
12. Buck's Traction (skin traction) --> elevate foot of bed for counter-traction
13. After Total Hip Replacement --> don't sleep on operated side, don't flex hip more than 45- 60 degrees, don't elevate HOB more than 45 degrees. Maintain hip abduction by separating thighs with pillows.
14. Prolapsed Cord --> knee-chest position or Trendelenburg
15. Infant w/ Cleft Lip --> position on back or in infant seat to prevent trauma to suture line. While feeding, hold in upright position.
16. To Prevent Dumping Syndrome (post-operative ulcer/stomach surgeries) --> eat in reclining position, lie down after meals for 20-30 minutes (also restrict fluids during meals, low CHO and fiber diet, small frequent meals)
17. Above Knee Amputation --> elevate for first 24 hours on pillow, position prone daily to provide for hip extension.
18. Below Knee Amputation --> foot of bed elevated for first 24 hours, position prone daily to provide for hip extension.
19. Detached Retina --> area of detachment should be in the dependent position
20. Administration of Enema --> position pt in left side-lying (Sim's) with knee flexed
21. After Supratentorial Surgery (incision behind hairline) --> elevate HOB 30-45 degrees
22. After Infratentorial Surgery (incision at nape of neck)--> position pt flat and lateral on either side.
23. During Internal Radiation --> on bedrest while implant in place
24. Autonomic Dysreflexia/Hyperreflexia (S&S: pounding headache, profuse sweating, nasal congestion, goose flesh, bradycardia, hypertension) --> place client in sitting position (elevate HOB) first before any other implementation.
25. Shock --> bedrest with extremities elevated 20 degrees, knees straight, head slightly elevated (modified Trendelenburg)
26. Head Injury --> elevate HOB 30 degrees to decrease intracranial pressure
27. Peritoneal Dialysis when Outflow is Inadequate --> turn pt from side to side BEFORE checking for kinks in tubing (according to Kaplan)
28. Lumbar puncture => AFTER the procedure, the client should be placed in the supine position for 4 to 12 hrs as prescribed. (Saunders 3rd ed p. 229)
Demorol for pancreatitis, NOT morphine sulfate
Myasthenia Gravis: worsens with exercise and improves with rest. Myasthenia Crisis: a positive reaction to Tensilon--will improve symptoms
Cholinergic Crisis: caused by excessive medication-stop med-giving Tensilon will make it worse
Head injury medication: Mannitol (osmotic diuretic)-crystallizes at room temp so ALWAYS use filter needle
Prior to a liver biospy its important to be aware of the lab result for prothrombin time From the a** (diarrhea)= metabolic acidosis
From the mouth (vomitus)=metabolic alkalosis
Myxedema/hypothyroidism: slowed physical and mental function, sensitivity to cold, dry skin and hair
Graves’ disease/hyperthyroidism: accelerated physical and mental function; sensitivity to heat, fine/soft hair
Thyroid storm: increased temp, pulse and HTN
Post-thyroidectomy: semi-Fowler’s, prevent ncek flexion/hyperextension, trach at bedside
Hypo-parathyroid: CATS – convulsions, arrhythmias, tetany, spasms, stridor (decreased calcium), high Ca, low phosphorus diet
Hyper-parathyroid: fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium), low Ca, high phosphorus diet
Hypovolemia – incrased temp, rapid/weak pulse, increase respiration, hypotension, anxiety, urine specific gravity >1.030
Hypervolemia – bounding pulse, SOB, dyspnea, rares/crackles, peripheral edema, HTN, urine specific gravity <1.010; Semi-Fowler’s
Diabetes Insipidus (decreased ADH): excessive urine output and thirst, dehydration, weakness, administer Pitressin
SIADH (increased ADH): change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a, HA; administer Declomycin, diuretics
Hypokalemia: muscle ewakness, dysrhythmias, increase K (raisins, bananas, apricots, oranges, beans, potatoes, carrots, celery)
Hyperkalemia: MURDER – muscle weakness, urine (oliguria/anuria), respiratory depression, decreased cardiac contractility, ECG changes, reflexes
Hyponatremia: nausea, muscle cramps, increased ICP, muscular twitching, convulsion; osmotic diuretics, fluids
Hypernatremia: increased temp, weakness, disorientation/delusions, hypotension, tachycardia; hypotonic solution
Hypocalcemia: CATS – convulsions, arrhythmias, tetany, spasms and stridor Hypercalcemia: muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon reflexes, sedative effect on CNS
HypoMg: tremors, tetany, seizures, dyrshythmias, depression, confusion, dysphagia; dig toxicity HyperMg: depresses the CNS, hypotension, facial flushing, muscle ewakness, absent deep tendon reflexes, shallow respirations, emergency
Addison’s: hypoNa, hyperK, hypoglycemia, dark pigmentation, decreased resistance to stress, fractures, alopecia, weight loss, GI distress
Cushings: hyperNa, hypoK, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN, hirsutism, moonface/buffalo hump
Addisonian crisis: n/v, confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration, decreased BP
Pheochromocytoma: hypersecretion of epi/norepi, persistent HTN, increased HR, hyperglycemia, diaphoresis, tremor, pounding HA; avoid stress, frequent bating and rest breaks, avoid cold and stimulating foods, surgery to remove tumor
1. Neuroleptic malignant syndrome (NMS):
-NMS is like S&M;
-you get hot (hyperpyrexia)
-stiff (increased muscle tone)
-sweaty (diaphoresis)
-BP, pulse, and respirations go up &
-you start to drool
2. I kept forgetting which was dangerous when you're pregnant; regular measles (rubeola), or German measles (rubella), so remember:
-never get pregnant with a German (rubella)
3. When drawing up regular insulin & NPH together, remember:
-RN (regular comes before NPH)
4. Tetralogy of fallot; remember HOPS
Think DROP(child drops to floor or squats) or POSH Defect, septal
Right Ventricular hypertrophy Overriding aorts
Pulmonary stenosis
5. MAOI's that are used as antidepressants:
weird way to remember, I know. pirates say arrrr, so think; pirates take MAOI's when they're depressed.
- explanation; MAOI's used for depression all have an arrr sound in the middle (Parnate, Marplan, Nardil)
Autonomic dysreflexia: potentially life threatening emergency
- elevate head of bed to 90 degree
- loosen constrictive clothing
- assess for bladder distention and bowel impaction (triger)
- Administer antihypertensive meds (may cause stroke, MI, seisure )
easy way to remember MAOI'S! think of PANAMA!
PA - parnate NA - nardil MA - marplan
metallic bitter taste.
Digoxin-check pulse, less than 60 hold, check dig levels and potassium levels. Amphojel: tx of GERD and kidney stones. watch out for contipation.
Vistaril: tx of anxiety and also itching watch for dry mouth. given preop commonly
Versed: given for conscious sedation watch for resp depression and hypotension
PTU and Tapazole- prevention of thyroid storm
Sinemet: tx of parkinson...sweat, saliva, urine may turn reddish brown occassionally causes
drowsiness
Artane: tx of parkinson..sedative effect also
Cogentin: tx of parkinson and extrapyramidal effects of other drugs Tigan: tx of postop n/v and for nausea associated with gastroenteritis Timolol (Timoptic)-tx of gluacoma
Bactrim: antibiotic..dont take if allergic to sulfa drugs...diarrhea common side effect...drink plenty of fluids
Gout Meds: Probenecid (Benemid), Colchicine, Allopurinol (Zyloprim)
Apresoline(hydralazine)-tx of HTN or CHF, Report flu-like symptoms, rise slowly from sitting/lying position; take with meals.
Bentyl: tx of irritable bowel assess for anticholinergic side effects.
Calan (verapamil): calcium channel blocker: tx of HTN, angina. assess for constipation
Carafate: tx of duodenal ulcers..coats the ulcer so take before meals.
Theophylline: tx of asthma or COPD therap drug level: 10-20
Mucomyst is the antedote to tylenol and is administered orally
Diamox: tx of glaucoma, high altitude sickness. dont take if allergic to sulfa drugs
Indocin: (nsaid) tx of arthritis (osteo, rhematoid, gouty), bursitis, and tendonitis.
Synthroid: tx of hypothyroidism..may take several weeks to take effect [Show Less]