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 notify doctor of chest
pain..take in the AM on empty stomach..could cause hyperthyroidism.
Librium: tx of alcohol w/d...dont take alchol with this. very bad nausea and vomiting can occur.
Oncovin (vincristine): tx of leukemia..given IV ONLY
kwell: tx of scabies and lice...(scabies)apply lotion once and leave on for 8-12 hours. (lice) use
the shampoo and leave on for 4 minutes with hair uncovered then rinse with warm water and comb with a fine tooth comb
Premarin:tx after menopause estrogen replacement Dilantin: tx of seizures. thera drug level: 10-20 Navane: tx of schizophrenia..assess for EPS
Ritalin: tx of ADHD..assess for heart related side effects report immediately child may need a
drug holiday b/c it stunts growth.
dopamine (Intropine): tx of hypotension, shock, low cardiac output, poor perfusion to vital organs. monitor EKG for arrhythmias, monitor BP
Have trouble remembering fhr patterns in OB? Think VEAL CHOP V C
E H A O L P
V = variable decels; C = cord compression caused E = early decels; H = head compression caused
A = accels; O = okay, not a problem!
L = late decels = placental insufficiency, can't fill
For cord compression, place the mother in the TRENDELENBERG position because this removes pressure of the presenting part off the cord. (If her head is down, the baby is no longer being pulled out of hte body by gravity)
If the cord is prolapsed, cover it with sterile saline gauze to prevent drying of the cord and to minimize infection.
For late decels, turn the mother to her left side, to allow more blood flow to the placenta. For any kind of bad fetal heart rate pattern, you give O2, often by mask...
When doing an epidural anesthesia hydration before hand is a priority. Hypotension and bradypnea / bradycardia are major risks and emergencies.
NEVER check the monitor or a machine as a first action. Always assess the patient first; for exmaple listen to the fetal heart tones with a stethoscope in NCLEX land. Sometimes it's hard to tell who to check on first, the mother or the baby; it's usually easy to tell the right answer if the mother or baby involves a machine. If you're not sure who to check first, and one of the choices involves the machine, that's the wrong answer.
If the baby is a posterior presentation, the sounds are heard at the sides.
If the baby is anterior, the sounds are heard closer to midline, between teh umbilicus and where you would listen to a posterior presentation.
If the baby is breech, the sounds are high up in the fundus near the umbilicus. If the baby is vertex, they are a little bit above the symphysis pubis.
Also for ventilator alarms
HOLD
High alarm- Obstruction due to incr. secretions, kink, pt. coughs, gag or bites
Low press alarm- Disconnection or leak in ventilatior or in pt. airway cuff, pt. stops spontaneous breathing
1. to remember blood sugar:
hot and dry-sugar high (hyperglycemia)
cold and clammy-need some candy (hypoglycemia)
2. ICP AND SHOCK HAVE OPPOSITE V/S
ICP-increased BP, decreased pulse, decreased resp. shock- decreased BP, increased pulse, increased resp.
3. cor pulmonae: right sided heart failure caused by left ventricular failure (so pick edema, jvd, if it is a choice.)
4. herion withdrawal neonate: irratable poor sucking
5. Jews: no meat and milk together
6. Brachial pulse: pulse area cpr on an infant.
7. Test child for lead poisioning around 12 months of age
8. bananas, potatoes, citrus fruits source of potassium 11. Cultures are obtained before starting IV antibiotics
12. a pt with leukemia may have epitaxis b/c of low platelets
13. best way to warm a newborn: skin to skin contact covered with a blanket on mom.
14. when a pt comes in and she is in active labor...nurse first action is to listen to fetal heart tone/rate
15. phobic disorders...use systematic desensitiztion.
NCLEX TIPS
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. [Show Less]