John's wort - antidepressant, photosensitive (C/I in SULFA drugs) Garlic - antihypertensive (avoid aspirin) Ginseng - Anti stress (C/I in coumadin) Green tea - antioxidant (check if risk for calculi-oxalates) Echinacea - immune stimulant (6-8 weeks only)(C/I in SANDIMMUNE-Immunosuppressant) Licorice - cough and cold Ginger root - antinausea (C/I in Coumadin) Ginkgo - improves circulation (C/I in anticoagulant, headache side effect - check PT) Ma huang - bronchodilator, stimulant (Ephedra)

Parent teaching: Use of Infant and Car Seats Weight below 9 kg (20 lb): Use infant or convertible seat in back seat of car in backward-facing position. Keep infant reclined at a 45 degrees. Never place the infant in the front passenger seat. Fasten seat securely to car using car seat belt and following manufacturere instructions. Adjust harness to fit snugly at shoulders and legs. When using an infant seat, move to larger seat before the infant's head reaches the top of shell. When using a convertable seat from birth, use one with a 5-point restraint. Birth-18 kg (40 lb)(Some seats are designed for infants from birht to 40 lbs, others are only designed for infants up to 20 lb, therefore there are separate instructions for each type) When using a convertableseat, use reclined for rear-facing and upright for forward facing. (Infant remains rear facing until they reach 20 lb as in the prior instructions) Follow manufacturer instructions for proper positions at specfied child weights for that product (Typcially this is the "child must face rear until they reach 20 lb) When using a convertible seat, move to a high-backed child seat or booster seat when child's ears are above the seat. Always place the seat in the rear of the vehicle. (This is especially true with airbags as when they deploy in an accident they will seriously injure or kill the child) Above 13.6 or 18 kg-27 or 36.3 kg (30 or 40 lb-60 or 80 lb) (Most instructions agree on the 40 lb & 40 inch-height minimum) Use booster seat fro children who have outgrown convertible/toddler seats Follow manufacturere instructions for use and specfied child weights for the product (NCLEX questions will be based on the standards published in nursing textbooks which are those included in this post) Use booster seat until the vehicle lap and shoulder belt fit correctly Have all children 12 years and under ride in the rear seat, whether or not in a car seat. Air bags can seriously injure a child or cause death, when a child is in a car seat in the front passenger seat. Even when not in a car seat, and when the vehicle is not equipped with a passenger side air bag, the back seat is the safest for all children. From the textbook often used to write the NCLEX pediatric questions: (Ball & Bindler) Preschool child's need for autonomy and control can be met by allowing the child to choose

which snacks to pick or which finger to stick for glucose testing, or help the parent/caregiver gather necessary supplies. School-age children can learn to test blood glucose, administer insulin, and keep records. They should be taught how to select foods appropriate for dietary management and how to plan an exercise program. They need to learn to recognize the signs and symptoms of hypoglycemia and hyperglycemia, and understand the importance of carrying a rapidly absorbed sugar product. Adolescents should take on total responsibility for self-care. Although they understand explanations about the potential complications of diabetes, they are present-time oreinted and may rebel against the daily regimentation of insulin injections, blood glucose monitoring, and dietary management. Successful self-care depends in part on the adolescent's adjustment to the chronic nature of the disease and feelings of being different from peers. This same textbook defines: Preschool child, 3-6 years of age School age child, 6-12 years of age Adolescent, 12-18 years of age Primary atypical pneumonia (Mycoplasma pneumonia) is characterized as: Select all that apply: O 1 Most common cause of pneumonia in children O 2 incidence in children between the ages of 5 and 12 O 3 Occurs primarily in summer O 4 more prevalent in crowded living conditions O 5 caused by Borelia burdorferi The correct answers are: 1, 2 & 4 It occurs primarily in the fall and winter months The causative organism is M. pneumoniae M. pneumoniae is a common cause of mild pneumonia . Various studies suggest that it causes a higher percentage of pneumonia in school-aged children. People at highest risk for mycoplasma pneumonia include those living or working in crowded areas such as schools and homeless shelters, although many people who contract mycoplasma pneumonia have no identifiable risk factor. Symptoms The symptoms are generally mild and appear over a period of one to three weeks. They may progress to more severe symptoms in some people. Common symptoms include the following: Headache Fever (may be high) Chills Excessive sweating Cough Usually dry Usually without phlegm or blood Chest pain Sore throat Less frequently seen symptoms include the following: Skin lesions or rash Eye pain or soreness Muscle aches and joint stiffness Neck lump Rapid respiratory rate Ear pain

Signs and tests A physical examination may reveal enlarged lymph nodes and inflammation of the eardrum. An examination of the chest with a stethoscope (auscultation) reveals crackles. These tests help confirm the diagnosis: Blood tests for antibodies to mycoplasma Sputum culture Chest x-ray Treatment Antibiotics may be prescribed for more serious symptoms related to mycoplasma pneumonia. Home care includes rest and a high-protein diet with adequate fluids. Expectations (prognosis) Most people recover completely even without antibiotics, although antibiotics may speed recovery. In untreated adults, cough and weakness can persist for up to a month.

EPOGEN - EPOETIN ALFA RECOMBINANT Possible Test Item: A client with chronic renal failure on dialysis is to receive EPOGEN. Which of the following symptoms would warrant the nurse to hold the administration of this human recombinant? Select all that apply: O 1 the client has fever O 2 the client has hypertension O 3 heart rate 72/minute O 4 respiratory rate is 19 O 5 the client is pale O 6 client has body malaise The correct answers: 1 & 2 CNS side effect: Pyrexia, withhold the drug CVS side effect: Hypertension, withhold the drug. EPOGEN - recent question in the NCLEX-RN EPOGEN - epoetin alfa recombinant Classification Erytrhopoietin, human recombinant 1. normally synthesized in the kidney and stimulates RBC production 2. will elevate and maintain RBC level, decreasing the need for BT Uses: Treatment of anemia associated with Chronic Renal Failure in adults C/I: uncontrolled hypertension Side effects: CV - hypertension CNS - pyrexia Complication: Polycythemia What to monitor before and after: BP. TEMP & HEMATOCRITwater. 1)a young patient most likely to get lead poisining if? a. he is drinking from a ceramic pitcher. b. father referinshes old furniture at their home > ANSWER is B. probably if he refurbishes an old furniture at home.. that is, if the furniture has old paint on it and during 60's paints have lead content on it (heavy metals) and if you need to remove that, chips from the old paint may be taken by a kid that leads to Pb poisoning

2) a TB pt understands that he can reduce the risk of spreading his disease if he states? a. i wont sleep in same room w/ my wife for 1-2 months b. i will stay away from pregnant women and children c. i will use plastic utensil when i eat ****>> if the patient is already taking anti-TB drugs, it will only be 2 weeks of chemotherapy and that (+) PTB will no longer be communicable.. and 1-2 months is long! CHildren are more susceptible to acquire Primary complex and pregnant women are susceptible and almost vulnerable to all type of illnesses.. There is no need for the patient to separate their utensils since PTB is airborne and not by contact in terms of transmission.. so i go for B answer. 3) 4 years old with salmonella what u should do? a. private room b. isolation c. place in a room with 4 year old with cellulitis d. keep door closed at all times. *** the (+) salmonella kid may be placed in a private room. Salmonella is transmitted by Enteric.. therefore Enteric precaution is needed and handwashing is very important and gown and gloves, diaper or bedpan in necessary. Option B, and D are all for pulmonary tuberculosis precautions. I suppose, the answer is A. place in a private room. 4) wot herb would help with vomiting? a. ginko b. ginsing. c. ginger root d. echinacea ****> ginger root is good for nausea.. most especially in morning sickness but in moderation for pregnant women... Option C is the answer 5) allergic to sulfa wot not to take? a. ma huang b. echunacea. ...I think the answer is... geez, i forgot..i think its Echinacea..let me check again ok.. 6) mother called a nurse from home stating that her child having chicken pox..which of the following statements by the mother needs immidiate follow up? a. father of the child with liver failure b. sibling with anemia c. child just had tonsillectomy d. child has intermittent low grade fever I think the answer is C. the child that just had tonsillectomy. i think the child is immunocompromised. and varicella (Chicken pox) is a viral one.. we all know that tonsils are one of the lymph defenses we have against any infection.. Im not really sure with this answer. 7) clientwith allergy to sudafed ..which of the statments is correct? a. i will take valerian b. i will take ma huang c. i will take echinacea for acute viral inf. d. i will take black cohosh **valerian root is for cystitis and fungal infections; ma huang is for (I forgot!!),echinacea is for immune booster but not to be taken with patients with progressive systemic disorders such as AIDS, PTB, HIV, etc. black cohosh is for menopause. *** don't you think that Echinacea is the correct option?? 8)food processing a. frozen food can be defrost for up to six hours b. frozen food which has been defrost can be return back to fridge. c. cook perishible food should cover and cool d. frozen food should be defrost by hot water usually, frozen food must be thawed at cool tap water for freshness. not in the microwave because it can be cooked outside and raw inside, not in the hotwater with same principle.

so i believe, thawing it FOR UP TO 6 HOURS would be ok. returning thawed food back at fridge is ok but it is unsafe since salmonella can start thriving in.. Answer is OPTION A. 9) child in a mist tent and the parents brought him a car toy...the child was clutching the toy and the nurse refused to let him play for wot reason? a. it will get contaminated with bacteria b. it will accumalate moisture c. it could cause a fire ** The answer is OPTION C. Usually car toy have friction on it for the wheels to run.. Oxygen supports combustion.. and if friction is present together with oxygen (in a mist tent) then, fire could commence. 11) a mother reported tht her son is throwing up each time she feeds him wot would be the best question u ask? a. did u warm up the formula b. wot kind of formula did u give him c. does ur son feel hungry each time he throws up d. does r son have a jelly like stool ***>>> CORRECT OPTION is D.. Does your son have jelly like stool.. jelly like or currant like stool is a cardinal sign of Intussusception/ Telescoping or invagination of the large intestines in the Ileoceccal area.. 12) a patient had AIDS the nurse should advise? a. cook ur meat very well b. not to eat in the same table with family c. avoid crowds ***>> if you have AIDS, u are immunocompromised.. therefore you are prone to infection.. neutropenic precaution is advised and one that is a must is Avoiding Crowds.. Correct option is C.

Seasonal Affective Disorder (SAD) may affect over 10 million Americans. The typical symptoms of SAD include depression, lack of energy, increased need for sleep, a craving for sweets and weight gain. Symptoms begin in the fall, peak in the winter and usually resolve in the spring. Some individuals experience great bursts of energy and creativity in the spring or early summer. Susceptible individuals who work in buildings without windows may experience SADtype symptoms at any time of year. Some people with SAD have mild or occasionally severe periods of mania during the spring or summer. If the symptoms are mild, no treatment may be necessary. If they are problematic, then a mood stabilizer such as Lithium might be considered. There is a smaller group of individuals who suffer from summer depression. SAD is recognized in the DSM-IV (The American Psychiatric Association's diagnostic manual) as a subtype of major depressive episode. Some individuals who work long hours inside office buildings with few windows may experience symptoms all year round. Some very sensitive individuals may note changes in mood during long stretches of cloudy weather. A sign of improvement from dehydration would be a decreased urine specific gravity and a decreased/decreasing hematocrit. So the SG of 1.015 and a Hct of 46% would be the answer. It is the best answer of the two you had in you question. The normal urine SG is 1.003-1.035 (Usually between 1.010-1.025 with normal hydration and volume) (different texts give a slightly different range). SG 1.025-1.030+ (concentrated urine) SG 1.001-1.010 (dilute urine) SG 1.001-1.018 in infants under 2 years of age Specific gravity is a measurement of the kidney's ability to concentrate urine. The range of urine's SG depends on the state of hydration and varies with urine volume and the load of solids to be excreted under standardized conditions; when fluid intake is restricted or

increased, SG measures the concentrating and diluting functions of the kidney. Loss of these functions is an indication of renal dysfunction. SG values usually vary inversely with amounts of urine excreated (decrease in urine volume = increase in specific gravity). However in some conditions this is not the case. For example: a. Diabetes: increased urine volume, increased SG (High amount of glucose in urine) b. Hypertension: normal volume, decreased SG c. Early chronic renal disease: increased volume, decreased SG Hematocrit: Percentage of packed red cells in a volume of whole blood. The hematocrit will be increased in dehydration. Source: A Manual of Laboratory & Diagnostic Tests (Frances Fischbach) digitalis toxicity includes.. N - nausea A - anorexia V - vomiting D - diarrhea A - abdominal pain kasma na changes sa vision.. Digitalis toxicity is the result of the body accumulating more digitalis than it can tolerate at that time. Patient will complain visual change in color, and loss of appetite. From RAG book and memory notebook Drugs which can cause URINE DISCOLORATION Adriamycyn------ Reddish Rifabutin--------- Red orange Rifampicin------- Red orange Bactrim---------- Red orange Robaxin--------- Brown, Black or Greenish Azulfidine------ Orange yellow Flagyl------------ Brownish Dilantin---------- Pink tinged Anti Psychotic-- Pinkish to Red brown Early signs of hypoxia: R-restlessness A-anxiety T-Tachycardia Late signs of hypoxia: B-bradycardia E-extreme restlessness D-dyspnea In pediaF-feeding difficulty I-inspiratory stridor N-nares flare E-expiratory grunting S-sternal retractions Respiratory Patterns Kussmaul- fruity acetone breath odor Cheyne-stokes- near death breathing pattern CRUTCH WALKING UP STAIRS Good goes to heaven, Bad goes to hell CYSTITIS-Inflamation of the urinary bladder Manifestations: Urgency and frequency

Lab data: Culture and sensitivity tests reveal the presence of bacteremia Usually E.Coli PREVENTING CYSTITIS >Drink 8-10 glasses of fluid per day >Women should wipe from front to back >Urinate after intercourse >Avoid vaginal deodorants and bubble baths >Avoid silk underwear, cotton underwear is preferred >Maintain acid ash diet (cheese,cranberry,prunes and plums 1.Which of the following statements made by a patient reflects a need for further teaching? a. I drink a lot of fluids b. I usually go nonstop driving for 8 hours on weekends--- answer c. I should avoid bubble baths d. I love drinking citrus juices 2. Which of goal of nursing care takes priority for a female client with cystitis? a. increasing urine alkalinity b. maintaining a balanced fluid I & O c. Providing instructions on perineal hygiene--- answer d. screening urine for sedimentation Muskuloskeletal Anatomical tips TENDONS- connect muscle to bone LIGAMENTS- connect bone to bone CUSHING SYNDROME Hypersecretion of Glucocorticoids by the adrenal glands Manifestations: central type or truncal obesity with thin extremeties moonface buffalo hump hirsutism Lab data: Elevated serum cortisol levels Hypernatremia,hyperglycemia,hypertension Hypokalemia Intervention: High potassium, Low sodium diet Lifelong administration of glucocorticoid synthesis inhibitors Eg. Mitotane Inform that there will be poor wound healing Sample question: When assessing a 40-year old patient with cushing’s syndrome, the nurse should expect the person to demonstrate: A lability of mood---- answer B ectomorphism with a moon face C a decrease in the growth of facial hair D an increase resistance to bruising and bleeding EYE ABBREVIATIONS OU- both eyes OR- right eye OS- left eye LEVELS OF CONSCIOUSNESS A------ ALERT V------ VERBAL STIMULI P------ PAINFUL STIMULI U----- UNRESPONSIVE REASONS FOR UNCONSCIOUSNESS(SKIN COLOR) RED----- Stroke or increase BP

WHITE---- Shock or Hemorrhage BLUE--- Respiratory or Cardiac Arrest CIRCULATION ASSESSMENT- 5Ps Pain Pallor Pulse Paresthesia Paralysis CHOLINERGIC CRISIS S- Salivation L-Lacrimation U-Urination D-Defecation G E ADLs B-Bathing A-Ambulation T-Toileting T-Transfers E-Eating D-Dressing Instrumental ADLs S-shopping C-cooking, cleaning U-using telephone /transportation M-managing money and medications C cane O opposite A affected L leg IN CASE OF ABDOMINAL TENDERNESS Inspect, auscultate, percuss, palpate CUSHINGS (Hypersecretion of Adrenal Cortex Hormones) C = Check VS, particularly BP U = Urinary output & weight monitoring S = Stress Management H = High CHON diet I = Infection precaution N = Na+ restriction G = Glucose & Electrolytes Monitoring S = Spousal support ADDISON'S (Hyposecretion of Adrenal Cortex Hormones) Always Remember the 6 A's of Addison's disease 1.) Avoid Stress 2.) Avoid Strenuous 3.) Avoid Individuals with Infection

4.) Avoid OTC meds 5.) A lifelong Glucocorticoids Therapy 6.) Always wear medic alert bracelet IF RESPIRATORY DEPRESSION OR OVERSEDATION IS SUSPECTED: 1. CEASE the PCA 2. CEASE all other infusions that could be contributing to sedation 3. Attempt to rouse the patient 4. Call 777 [MET team] if appropriate 5. If apnoeic: administer bag & mask ventilation with 100% oxygen 6. If breathing: maintain airway, monitor oxygen saturations and administer oxygen via face mask at 8L/min 7. Check circulation. If pulseless: commence chest compressions 8. Prepare naloxone for possible administration 9. Call CPMS for urgent review Allergic: caused by sensitivity to foreign proteins. Clinical Manifestations: Urticaria, flushing, itching, no fever. Treatment: Administer antihistamines as directed. If manifestations mild and transient, transfusion may resume. Prevention: Treat prophylactically with antihistamines. Acute hemolytic: caused by infusion of ABO-incompatible red blood cells. Clinical manifestations: Chills, fever, low back pain, flushing, tachycardia, hemoglobinuria, hypotension, vascular collapse, bleeding, acute renal failure, shock, cardiac arrest, death. Management: Discontinue transfusion, removing/changing IV tubing down to IV catheter. Send blood samples for serologic testing, and send urine samples to lab. Send blood tubing to lab/blood bank. Maintain blood pressure. Give diuretics as prescribed to maintain urine flow. Insert indwelling catheter or measure hourly output. Dialysis may be needed. Prevention: Meticulously verify recipent from sample collection to transfusion. Anaphylactic reaction: caused by infusion of IgA proteins to IgA-deficient recipient who has developed anti-IgA-antibodies. Clinical Manifestations: Anxiety, urticaria, wheezing progressing to cyanosis, shock, and possible cardiac arrest. Treatment: Do not transfuse additional RBC. Initiate CPR if indicated. Have epinephrine ready for injection (0.4 ml of a 1:1000 solution SC Prevention: Give blood composnents from IgA-deficient donors or remove all plasma by washing. 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 is 8-13. Readings of 18-20 are considered high. First sign of PE (pulmonary embolism) 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. Q&As found in the NCLEX FORUM Question # 1 (Multiple Choice) History and exam indicates your 77 year old female patient has digitalis toxicity. Which drugs are contraindicated in this case? Plz provide your rationale. A) lidocaine and atropine B) adenosine and amiodarone C) magnesium sulfate and sodium bicarbonate D) bretylium and verapamil Answer::

A) lidocaine and atropine-Don't affect dig level/dig toxicity. B) adenosine and amiodarone-Amiodarone, increases serum dig levels, possibly causing dig toxicity. Adenosine doesn't affect dig toxicity. Only one of these meds is contraindicated in dig levels/toxitiy. C) magnesium sulfate and sodium bicarbonate. Neither drug affects dig levels D) bretylium and verapamil-BEST ANSWER: Verapamil, increases serum dig levels, possibly causing dig toxicity. Bretylium aggravates dig toxicity and digoxin toxic arrhytmias are exacerbated by bretylium. This answer has two meds that are should not be given to dig toxic patients. Question # 2(Multiple Choice) Regarding abruptio placentae A) Blood loss is confined within the amniotic sac B) Internal bleeding is generally minimal. C) Blood loss may be concealed between the uterine wall and the placenta D) There is always excessive external vagina bleeding what's the correct one? I just don't agree with c.

Answer:: C. is the best answer because it does describe placenta previa, most correctly. Placenta previa is premature separation of the placenta, and the blood loss can be either apparent or concealed. If the edges of the placenta remain attached to the uterus then there will be no apparent loss of blood. However the woman is still have significant internal bleeding. A. is incorect because it does not describe A.P. B. is incorrect because blood loss is usually significant, not minimal. D. is incorrect because blood loss can be hidden.

Question # 3 (Multiple Choice) The geriatric patient suffering from organic brain syndrome or dementia may not be able to make a rational decisions regarding emergency care. In these situations, you may use ____to permit you to legally render care

A) Good Samaritan Laws B) Standards of Care C) Implied Consent D) Informed Consent c is given as correct. why? Answer:: Implied consent means that the patient most likely has been found in distress and it is assumed that person wants to live. Therefore, you are within the law to treat a person who is unable to make a decision about his/her care who is in an emergency situation. Above answer to your question explains why C is the best answer. Let me point out a test taking tip to further support how you would choose this answer on an exam, like NCLEX. First look at your question and identify, the key words, i.e. what the question is asking. This question is asking which law will permit you to deliver care in an emergency situation, when the patient is unable to give consent. Now define each of the possible reponses. A) Good Samaritan Laws-This law is to protect the individual that intervene to provide care in an emergency from litigation. In other words, if a nurse stops at an accident scene and provides care, the nurse will not be held liable for their actions, if the care was provided in good faith according to practice standards. Therefore this is not the answer. B) Standards of Care-These are established guidelines for the nurse/health care provider that outline safe and effective nursing care/interventions for given diagnoses, etc. So, again this is not the answer to the question. C) Implied Consent-Best answer, the patient can't verbalize consent, due to their OBS/dementia, but they need emergency care. Because care is required then consent to provide life saving care is implied. The same principle applies when giving emergency care to unconscious patients. You can't wait for them to tell you it is OK, to save their life, the law allows you to intervene. This is implied consent. D) Informed Consent-This is when the physician describes the procedure that is to be preformed. Included in this explanation is the benefits and risks

associated with the procedure. The patient is INFORMED about the procedure and then they give their consent. Again, this is not the best answer. Try this technique when answering NCLEX-like questions, and you will find that you will get more correct.

Question: 1.)a person is holding their neck what do you do? a.)ask them can they cough. b.)immediately perform the heimlich maneuver. I got confused because I know are suppose to ask the person can they talk. 2.) an elderly client has alzheimers and wanders through out the day. To protect his safety what is the best thing to do? a.) put alarms on all the doors. b.) inform all the staff to reorient the client. c.) have the security guards to check on him. d.) family to sit with him. 3.)When teaching a pt.about urinary catheter. What is most important? a.)wear sterile gloves. b.)clean the urethra with betadine. 4.)A woman is coming in for a pap smear what is most import to follow up on before the pap smear is performed. a)I just started menstruating and it is very heavy. b) my last pap smear was abnormal. C)I never had sex before. d)I forgot this choice. Answer: These are some thoughts and rationales for the possible best answers to your questions. 1.)a person is holding their neck what do you do? a.) ask them can they cough. BEST ANSWER, because you need to confirm/rule out an obstructed airway. If the patient can cough, then they are encouraged to do so. If they can't speak or cough (no airway movement/obstructed airway) then you begin the sequence for removing an airway obstruction, in this case it would be for a conscious patient.

b.)immediately perform the heimlich maneuver. NOT THE BEST CHOICE, because you need to confirm whether or not the patient is able to move air effectively before performing this maneuver. Therefore to rule out an obstructe airway you need to select an answer that will establish if the patient can speak, cough or some other indicator of air movement. I got confused because I know are suppose to ask the person can they talk. This correct, but as you know from taking the NCLEX, the answer you want is never there. What you have to do is select the answer that best matches/fits the principles for the answer you would expect to find. You ask if the patient can speak to confirm/rule out airway movement. Asking if they can cough will accomplish the same thing. 2.) an elderly client has alzheimers and wanders through out the day. to protect his safety what is the best thing to do? Key words in this question are WANDERS, Alzheimer's patient, and to protect HIS SAFETY. a.) put alarms on all the doors. BEST ANSWER, this is for the patient's SAFETY, because Alzhiemer's patients wander and if they were to leave the healthcare facility their safety would be compromised significantly. The alarms will immediately alert all staff and the patient can be returned to the unit immediately. b.) inform all the staff to reorient the client. NO, remember the question is asking about safety. Reoriented an Alzheimer’s patient is appropriate nursing care, but they have no short term memory, so this will not ensure that they will remain on the unit. They can (and will ) still wander. c.) have the security guards to check on him. NO, this is both extreme and it is "passing the buck". On the NCLEX it is up to nursing to solve nursing problems. The patient could be injured or leave the unit between checks by the security guards. d.) family to sit with him. NO, this is "passing the buck" and putting another burden on a family that is already in crisis due to the fact they have a family

member with Alzheimer's disease. 3.)When teaching a pt.about urinary catheter. What is most important? Both answer don't match the principles of home care for a client with a catheter, so it would be interesting to know what the other options were. a.)wear sterile gloves. NO, because this is a clean procedure. b.)clean the urethra with betadine. BEST answer of the two choices, because home catheter care is a clean procedure, so A would not be the choice. Betadine is a good anti-infective agent but it can be irritating to tissues. Generally cleaning with soap and water is all that is recommended for home care. 4.)A woman is coming in for a pap smear what is most import to follow up on before the pap smear is performed. a) I just started menstruating and it is very heavy. BEST ANSWER, the best time to obtain a pap smear is two weeks after the first day of the last menstrual period and DEFINITELY NOT when the patient is menstruating, as this will affect the results. b) my last pap smear was abnormal. No, this is important to know, but not as significant as A. This is not a contraindication to performing the test. C) I never had sex before. No, this is important to know, but A is more significant d)I forgot this choice.

Question: 1. Alzheimer's patient incontinent of urine during the night times. The nursing care includes a) Offers bed pan every 2 hours b) Limit fluids during evening times c) Foley's catheter 2. After immediate post operative hysterectomy patient to observe (or) Nursing care includes

a) Observe vaginal bleeding b) Urine output c) Vital signs 3. Dilantin prescribed to the patient, instructions to patient include a) Reticulocyte counts b) Platelet counts 4. On the ECG found a straight line, first Nurse a) Assess the patient b) Cardiopulmonary resuscitation c) IV fluids 5. 15% superficial burns, 20% partial thickness burns. If the fluids adequate a) Urine output 30-40ml/hr b) BP c) Vital signs d) Skin turgor 6. 20 week pregnant most concerned a) Butterfly rash on both cheeks and nose b) Uterus palpate at the level of symphysis pubis c) Sereous fluid drain in the breasts d) Breast enlargement 7. The sterile technique is broken when: a) The sterile field and supplies are wet b) Clean the area peripheral to center 8. The metal piece is embedded on the left eye a) Pressure dressing is applied on the left eye b) Dressing is applied on both eyes c) Irrigate the eye with saline 9. After cerebral angiogram, patient is a) Encourage fluids b) obseve contrast medium in the urine c) walking

10. Using clean, non sterile gloves, care is appropriate a) wash the genitelia........YES/NO


The following possible best answers are based on the information found in nursing textbooks, and the underlying principle for safe and effective care that NCLEX is testing for. 1. Alzheimer's patient incontinent of urine during the night times. The nursing care includes a) Offers bed pan every 2 hours-NO, would be appropriate to bring the client to the toilet or commode every 2 hours during the day, but this action means you disturb the client's sleep. b) Limit fluids during evening times, BEST ANSWER-(Source: Black & Hawks, Medical-Surgical Nursing 7th edition) Specific interventions for the Alzheirmer's client with urinary incontinence: "Sometimes the client forgets where the bathroom is located. Having bright lights and frequently taking the client there may help control incontinence. Fluid intake after the dinner meal can be restricted to maintain continence during the night." c) Foley's catheter-NO, would increase risk of lower urinary tract infection, inappropriate and not necessary. 2. After immediate post operative hysterctomy patient to observe (or) Nursing care includes a) Observe vaginal bleeding b) Urine output c) Vital signs-BEST ANSWER, as this provides the best/most information about the client's response to surgery and anesthesia. 3. Dilantin prescribed to the patient, to instruct the patient that includes a) Reticulocyte counts-Yes, this will test for decreased reticulocyte count a sign that the patient is developing aplastic anemia, a potentially life threatening side effect of Dilantin therapy. b) Platelet counts-No, however Dilantin can decrease the platelet count and result in thrombocytopenia. Aplastic anemia is considered to be more serious (Davis Drug Guide) 4. On the ECG found a straight line, first Nurse a) Assess the patient-BEST ANSWER, always assess the patient to be sure there is no equipment malfunction, and/or to confirm the information on the monitor. b) Cardiopulmonary resuscitation c) IV fluids 5. 15% superficial burns, 20% partial thickness burns. If the fluids adequate a) Urine output 30-40ml/hr BEST ANSWER, the patient's fluid balance/hydration status is best evaluated by assessing urine output. Urine output should be between 0.5 and 1.0 mL/kg/hr, which for a 130 lb adult would be between 29.5 -59 mL/hr. Most nursing textbooks consider 30 mL/hr of urine output to indicate appropriate fluid balance/hydration. b) BP c) Vital signs

d) Skin turgor For b, c, and d many other factors can affect these findings. Urine output directly correlates with the patient's hydration status/fluid balance. 6. 20 week pregnant most concerned A ) Butterfly rash on both cheeks and nose-NO this is Cholasma the "mask of pregancy", result of hormonal changes in pregnancy. b) Uterus palpate at the level of symphysis pubis-BEST ANSWER this correlates with 12 weeks gestation and the patient in the question is 20 weeks. This is a significant difference. c) Sereous fluid drain in the breasts-NO, leaking of clear fluid from the breasts during pregnancy is not unusual. d) Breast enlargement-NO, the breast enlarge during pregnancy. 7. The sterile technique is broke when a) The sterile field and supplies are wet-BEST ANSWER, this would allow microorganisms to enter the sterile field through the wet surface. b) Clean the area peripheral to center-NO, this is inappropriate technique but response a, specifically describes how a sterile field can be contaminated and is an important principle in maintaining sterile fields. 8. The metal piece is embedded on the left eye a) Pressure dressing is applied on the left eye-NO, this would "push" the object further into the eye. b) Dressing is applied on both eyes-BEST ANSWER, you want to keep the left eye still, and because both eyes move together the uninjured eye must be covered to prevent movement in the injured eye. c) Irrigate the eye with saline-NO, the object is embedded, meaning deep within the eye. Irrigation will not remove the object but theoretically it could cause it to move resulting in further damage. 9. After cerebral angiogram, patient is a) Encourage fluids-BEST ANSWER, when ever contrast medium/X-ray dyes are administer the client is hydrated to facilitate excretion of the dye. b) obseve contrast medium in the urine-NO, should not be observable to patient or nurse. c) walking-NO, bedrest would be maintained for a prescribed period of time. 10. Using clean, non sterile gloves care is appropriate a) wash the genitelia........YES/NOYES, this is not a sterile procedure.

Question: A patient is receiving 1,000 ml of 5% glucose and 0.45% normal saline with 40 mEq of potassium chloride. most important for nurse to monitor the patient : A. pulse rate B. daily weight C. skin turgor Answer1: I would say, always check for urine output before commencing anything with Potassium because it can only be excreted in the urine. Hence if you are dehydrated & have decrease urine output & commenced on K+ hyperkalemia will arise leading to cardiac arrythmia. Answer2: The answer is pulse rate

Question: 1)a young patient most likely to get lead poisining if? a. he is drinking from a ceramic pitcher. b. father refurnishes old furniture at their home 2) a TB pt understands that he can reduce the risk of spreading his disease if he states? a. i wont sleep in same room w/ my wife for 1-2 months b. i will stay away from pregnant women and children c. i will use plastic utensil when i eat 3) 4 years old with salmonella what u should do? a. private room b. isolation c. place in a room with 4 year old with cellulitis d. keep door closed at all times. 4) wat herb would help with vomiting? a. ginkgo b. ginseng. c. ginger root d. echinacea 5) allergic to sulfa wat not to take? a. ma huang b. echinacea. 6) mother called a nurse from home stating that her child having chicken pox, which of the following statements by the mother needs immediate follow up?

a. father of the child with liver failure b. sibling with anemia c. child just had tonsillectomy d. child has intermittent low grade fever 7) client with allergy to sudafed ..which of the statments is correct? a. i will take valerian b. i will take ma huang c. i will take echinacea for acute viral inf. d. i will take black cohosh 8) food processing a. frozen food can be defrost for up to six hours b. frozen food which has been defrost can be return back to fridge. c. cook perishable food should cover and cool d. frozen food should be defrost by hot water 9) child in a mist tent and the parents brought him a car toy...the child was clutching the toy and the nurse refused to let him play for wat reason? a. it will get contaminated with bacteria b. it will accumalate moisture c. it could cause a fire 11) a mother reported that her son is throwing up each time she feeds him wat would be the best question u ask? a. did u warm up the formula b. wot kind of formula did u give him c. does ur son feel hungry each time he throws up d. does ur son have a jelly like stool 12) a patient had aids the nurse should advise? a. cook ur meat very well b. not to eat in the same table with family c. avoid crowds Answer: 1)a young patient most likely to get lead poisining if? a. he is drinking from a ceramic pitcher. b. father refurbishes old furniture at their home > ANSWER is B. probably if he refurbishes an old furniture at home.. that is, if the furniture has old paint on it and during 60's paints have lead content on it (heavy metals) and if you need to remove that, chips from the old paint may be taken by a kid that leads to Pb poisoning 2) a TB pt understands that he can reduce the risk of spreading his disease if he states? a. i wont sleep in same room w/ my wife for 1-2 months b. i will stay away from pregnant women and children c. i will use plastic utensil when i eat

****>> if the patient is already taking anti-TB drugs, it will only be 2 weeks of chemotherapy and that (+) PTB will no longer be communicable.. and 1-2 months is long! CHildren are more susceptible to acquire Primary complex and pregnant women are susceptible and almost vulnerable to all type of illnesses.. There is no need for the patient to separate their utensils since PTB is airborne and not by contact in terms of transmission.. so i go for B answer. 3) 4 years old with salmonella what u should do? a. private room b. isolation c. place in a room with 4 year old with cellulitis d. keep door closed at all times. *** the (+) salmonella kid may be placed in a private room. Salmonella is transmitted by Enteric.. therefore Enteric precaution is needed and handwashing is very important and gown and gloves, diaper or bedpan in necessary. Option B, and D are all for pulmonary tuberculosis precautions. I suppose, the answer is A. place in a private room. 4) wat herb would help with vomiting? a. ginko b. ginsing. c. ginger root d. echinacea ****> ginger root is good for nausea.. most especially in morning sickness but in moderation for pregnant women... Option C is the answer 5) allergic to sulfa wat not to take? a. ma huang b. echinacea. ...I think the answer is... geez, i forgot..i think its Echinacea..let me check again ok.. 6) mother called a nurse from home stating that her child having chicken pox..which of the following statements by the mother needs immediate follow up? a. father of the child with liver failure b. sibling with anemia c. child just had tonsillectomy d. child has intermittent low grade fever I think the answer is C. the child that just had tonsillectomy. i think the child is immunocompromised. and varicella (Chicken pox) is a viral one.. we all know that tonsils are one of the lymph defenses we have against any infection.. Im not really sure with this answer. 7) client with allergy to sudafed ..which of the statments is correct? a. i will take valerian b. i will take ma huang c. i will take echinacea for acute viral inf. d. i will take black cohosh

**valerian root is for cystitis and fungal infections; ma huang is for (I forgot!!),echinacea is for immune booster but not to be taken with patients with progressive systemic disorders such as AIDS, PTB, HIV, etc. black cohosh is for menopause. *** don't you think that Echinacea is the correct option??

8)food processing a. frozen food can be defrost for up to six hours b. frozen food which has been defrost can be return back to fridge. c. cook perishible food should cover and cool d. frozen food should be defrost by hot water usually, frozen food must be thawed at cool tap water for freshness. not in the microwave because it can be cooked outside and raw inside, not in the hotwater with same principle. so i believe, thawing it FOR UP TO 6 HOURS would be ok. returning thawed food back at fridge is ok but it is unsafe since salmonella can start thriving in.. Answer is OPTION A. 9) child in a mist tent and the parents brought him a car toy...the child was clutching the toy and the nurse refused to let him play for wot reason? a. it will get contaminated with bacteria b. it will accumalate moisture c. it could cause a fire ** The answer is OPTION C. Usually car toy have friction on it for the wheels to run.. Oxygen supports combustion.. and if friction is present together with oxygen (in a mist tent) then, fire could commence. 11) a mother reported that her son is throwing up each time she feeds him wat would be the best question u ask? a. did u warm up the formula b. wot kind of formula did u give him c. does ur son feel hungry each time he throws up d. does r son have a jelly like stool ***>>> CORRECT OPTION is D.. Does your son have jelly like stool.. jelly like or currant like stool is a cardinal sign of Intussusception/ Telescoping or invagination of the large intestines in the Ileoceccal area.. 12) a patient had AIDS the nurse should advise? a. cook ur meat very well b. not to eat in the same table with family c. avoid crowds ***>> if you have AIDS, u are immunocompromised.. therefore you are prone to infection.. neutropenic precaution is advised and one that is a must is Avoiding Crowds.. Correct option is C. Posted by anaski from IP on September 08, 2005 at 03:45:59: Thank you so much English RN2B Future USRNs, this for you:

PRIORITY QUESTIONS (WHO TO SEE FIRST) Sample Test Item: 1. Which of the following clients should the nurse deal with FIRST? o 1 A client who needs his daily vitamin o 2 A client who needs to be suctioned o 3 A client who needs diaper to be changed o 4 A client who is being prepared for discharge Correct Answer: 2. A client who needs to be suctioned PRIORITY (Use ABC) Obstruction in the airway – secretions Need to be suctioned 2. Delegation, RN, LVN, UAP, CNA Which of the following clients should the LPN be assigned to? o 1 A newly diagnosed patient with MYASTHENIC CRISIS o 2 An immediate post-op client in PACU o 3 A client awaiting medication for vitamins o 4 A new admission for KIDNEY Transplant Patient Correct Answer: 3-stable, A client awaiting medication for vitamins Myasthenic Crisis – Unstable, Acute Respiratory Failure Immediate Post – op – Unstable, Risk for Complications, Kidney Transplant – Unstable, needs assessment for rejection DELEGATION: Remember the 5R's, Right Task, Right Person, Right Circumstance, Right Communication & Right Feedback) RN Least stable, unstable, central catheters (hickman, broviac), admission, discharge, health teachings, patient for transfer, blood transfusion (2RNs) LPN Technical Doer, Stable, medications, wound dressing CNA Routine Care, Urine Dip Stix, Reporting to RN, Routine VS UAP turning q2H, conducting group activities, ambulation For future USRNs This is for you... from the purkinje fibers of my heart.... Room Assignment(Who to Share Room with) Check: A ge B eside the nurse's station? At the end of the hallway? Single Room/Private Room? C hain of infection/circumstance D iagnosis E nviroment (dim light, darkened, red nightlapm) Sample Test Item: The best roommate for patient with LEUKEMIA is O 1 A 9-year-old with ruptured appendix O 2 A 12-year-old with chicken pox O 3 A 2-year-old with fever of unknown origin O 4 A 5-year-old with nephrotic syndrome Correct Answer: 4. A 5-year-old with nephrotic syndrome. 1,2 & 3, manifest symptoms of infection. A client with leukemia is immunosuppressed and Patients with infection shouldn't be placed in this room. Since patient with nephrotic syndrome receives diuretics and steroids, this child will also need immunocompromised host precaution. INFECTION CONTROL: Sample Test Item:

3. Which of the following methods should the RN utilize in patient with SALMONELLA? O 1 Airborne Precautions O 2 Droplet Precautions O 3 Neutropenic Precautions O 4 Enteric Precautions The correct answer: 4. Salmonella mode of transmission is fecal oral (enteric) Handwashing Gloves must be used in handling bedpan and diapers Gown - if soiling is likely to happen. Source of infection: Contaminated food and water. Remember - Transmission Based precautions: A ir B orne, small particles are dispersed in the air like MTB, varicella C ontact, drug-resistant microorganisms D roplet, large particles are dispersed into air, resp.infections except resp syncytial E nteric, fecal-oral like hepaA & salmonella

AGE APPROPRIATE GROWTH AND DEVELOPMENT (HOPPING WITH ONE LEG) Sample test Item: 4. Which of the following is NOT a characteristic of a preschooler? O 1 predominantly "parallel play" period O 2 balances on 1 foot with eyes closed O 3 skips on alternate feet O 4 jumps rope The correct answer is: 1. Parallel play is more common in TODDLERS. Preschooler (3-6 years) Gross motor development HOPS ON ONE (1) FOOT BY 4 YEARS SKIPS & HOPS ON ALTERNATE FEET BY 5 YEARS PLAY : ASSOCIATIVE, IMAGINATIVE, MAGICAL THINKING, SUPERHEROES (Remember the movie: Jingle All The way!) FEAR: Intrusive procedures, venipunctures, IM injections, body mutilation

Toxoplasmosis, where else you can contract this (thinking of cat litter but it aint there) Sample test Item: 5. To which of the following pregnant clients will be risk for TOXOPLASMOSIS? Select all that apply: O 1 A pregnant client who eat raw meat. O 2 A pregnant client handling cat litter of infected cats. O 3 A pregnant client gardening and cultivating soil exposed to cat feces.

O 4 A pregnant client with low rubella titer O 5 A pregnant client who have undergone external radiation. O 6 A pregnant client with draining, painful vesicles in the external genitalia. The correct answers: 1, 2 & 3. TOXOPLASMOSIS How do people get toxoplasmosis? A Toxoplasma infection occurs by: Accidentally swallowing cat feces from a Toxoplasma-infected cat that is shedding the organism in its feces. This might happen if you were to accidentally touch your hands to your mouth after gardening, cleaning a cat's litter box, or touching anything that has come into contact with cat feces. Eating contaminated raw or partly cooked meat, especially pork, lamb, or venison; by touching your hands to your mouth after handling undercooked meat. Contaminating food with knives, utensils, cutting boards and other foods that have had contact with raw meat. Drinking water contaminated with Toxoplasma. Receiving an infected organ transplant or blood transfusion, though this is rare. (From the internet-Division of Parasitic Disease) Which of these statements by the nurse is incorrect if the nurse has the goal to reinforce information about cancers to a group of young adults? 1. “You can reduce your risk of this serious type of stomach cancer by eating lots of fruits and vegetables, limiting all meat, and avoiding nitrate-containing foods.” 2. “Prostate cancer is the most common cancer in American men with results to threaten sexuality and life.” 3. “Colorectal cancer is the second-leading cause of cancer-related deaths in the United States.” 4. “Lung cancer is the leading cause of cancer deaths in the United States. Yet it's the most preventable of all cancers.


Tonometry: normal (10-21 mm Hg) PR Interval: normal (0.12-0.20 seconds) Serum Amylase: normal (25-151 units/dL) Serum Ammonia: normal (35 to 65 mcg/dL) Calcium: adult (8.6-10 mg/dL) child (8 to 10.5 mg/dL) term<1week (7 to 12 mg/dL) Partial Thromboplastin Time (aPTT): normal (20-36 seconds) therapeutic 1.5-2.5 Prothrombin Time: normal (Male: 9.6-11.8 seconds) and (Female: 9.5-11.3 seconds) Platelet Count: normal (150,000-400,000 cells/uL) Albumin level: normal (3.4 to 5 g/dL) Serum Osmolality: normal (285 to 295 mOsm/kg) high value indicates dehydration Safe Suction Range: normal [Infant] 50-95 mm Hg [Child] 95-115 mm Hg [Adult]100-120 mm Hg) Serum Lithium: normal (1 to 1.5 mEq/L) acute mania (0.6 to 1.4 mEq/L) maintenance treatment Phenytoin (Dilantin): normal serum (10 to 20 mcg/mL) Digoxin: therapeutic blood level (0.8 to 2.0 ng/ml) Magnesium Sulfate: Therapeutic Range (4 to 8 mg/dl) Pregnancy Temperature: normal (36.2-37.6 celcius or 98-99.6 Farenheit) WBC’s In Pregnancy: normal (11,000 to 15,000 cells/mm3, up to 18,000 cells/mm3). Immediate postpartum period, (maybe as high as 25,000 to 30,000 cells/mm3) Stomach Capacity:  Newborn infant  1-week-old  2-3-week-old infant  1-month-old infant (10 to 20 mL) (30 to 60 mL) (75 to 100 mL) (90 to 150 mL)

Left Atrial Pressure: normal (1 to 10 mm Hg)

Fibrinogen Levels: normal (male: 180 to 340 mg/dL) and

190 to 420 mg/dL)

with Disseminated Intravascular Coagulation the fibrinogen level drops because fibrinogen is used up in the clotting process.

Insulin (Regular, Humulin R) Type: Fast acting Onset: ½ -1 hr Peak: 2-4 hr Duration: 6-8 hr

Insulin (NPH, Humulin N) Type: Intermediate acting Onset: 2hr Peak: 6-12hr Duration 18-26hr

Insulin (Ultralente, Humulin U) Type: Slow acting Onset: 4hr Peak: 8-20hr Duration: 24-36hr

Insulin (Humulin 70/30) Type: Combination Onset: ½ hr Peak: 2-12hr Duration: 24hr

Central Venous Pressure: < 3 mm Hg = inadequate fluid and >11 mm Hg = too much fluid Potassium: 3.5-5.0 mEq/L Sodium: 135-145 mEq/L Calcium: 4.5-5.2 mEq/L or 8.6-10 mg/dL Magnesium: 1.5-2.5 mEq/L Chloride: 96-107 mEq/L Phosphorus: 2.7 to 4.5 mg/dL PR measurements: normal (0.12 to 0.20 second) QRS measurements: normal (0.04 to 0.10 second) Ammonia: 35 to 65 ug/dL Amylase:25 to 151 IV/L Lipase: 10 to 140 U/L Cholesterol: 140 to 199 mg/dL LDL: <130 mg/dL HDL: 30 to 70 mg/dL Triglycerides: <200 mg/dL Bilriubin • Direct: 0 to 0.3 mg/dL • Indirect: 0.1 to 1.0 mg/dL • Total: <1.5 mg/dL Protein: 6.0 to 8.0 g/dL Uric acid: Male 4.5 to 8 mg/dL Female 2.5 to 6.3 mg/dL

Glycosylated Hemoglobin HbA1c: good control 7.5% or less Serum creatinine: 0.6 to 1.3 mg/dL

BUN: 9-25 mg/dL Normal CK is 26-174 U/L Troponin I value: normal (<0.6 ng/mL) Troponin T >0.1 to 0.2 ng/mL = MI Erythrocyte studies: 0-30 mm/hour Serum iron: Male 65-175 ug/dL Female 50-170 ug/dL RBC: Male 4.5 to 6.2 M/uL Female 4.0 to 5.5 M/uL

Theophylline levels normal (10 to 20 mcg/dl)

MOTOR DEVELOPMENT Chin up Chest up Knee push and “swim” Sits alone/stands with help Crawls on stomach Stands holding on furniture Walks when led Stands alone Walks alone 1 month 2 month 6 month 7 month 8 month 10 month 11 month 14 month 15 month

AT THE PLAY GROUND * * * * * Stranger anxiety: 0 -1 year Separation anxiety: 1 - 3 years Solitary play: 0 – 1 year Parallel play: 2 – 3 years Group play: 3 – 4 years

PSYCHOLOGICAL DEVELOPMENT AGE Infant 0 – 1.5 Toddler 1.5 -3 Pre-school 3-6 School age 6 - 11 11 - 20 20 – 25 25 – 50 50 - ? ERIKSON Trust vs. mistrust Autonomy vs. shame Initiative vs. guilt Industry vs. inferiority Identity vs. role confusion Intimacy vs. isolation Generativity vs. stagnation Integrity vs.despair FREUD Oral (trust & dependence Anal (holding vs. letting out) Phallic (Oedipus complex) latency genital PIAGET sensorimotor preoperational preoperational Concrete operational Formal operational

LABORATORY VALUES ELECTROLYTES Sodium (Na+): overhydration) Potassium (K+): Magnesium (Mg++): Calcium (Ca++): Neonate : Child: Phosphorus (PO4): Chloride (Cl-): 3.5 - 5.0 meq/L 1.5 – 2.5 meq/L 4.5 – 5.8 meq/L 7.0 to 12 mg/dL 8.0 to 10.5 mg/dL 1.7 – 2.6 meq/L 96 – 106 meq/L 135 – 145 meq/L (increase-dehydration; decrease

COAGULATION STUDIES Activated partial thromboplastin time(APTT): 20 – 36 seconds depending on the type of activator used

Prothrombin time(PT): male: 9.6 – 11.8 seconds Female: 9.5 – 11.3 seconds International Normalized Ratio(INR): 2.0 - 3.0 for standard Coumadin therapy 3.0 – 4.5 for high-dose Coumadin therapy Clotting time: 8 – 15 minutes Platelet count: 150,000 to 400,000 cells/Ul Bleeding time: 2.5 to 8 minutes SERUM GASTROINTESTINAL STUDIES Albumin: 3.4 to 5 g/dL Alkaline phosphatase: 4.5 to 13 King-Armstrong units/dL Ammonia: 15 to 45 ug/dL Amylase: 50 – 180 Somogyi U/dL in adult 20 – 160 Somogyi U/dL in the older adult Bilirubin: direct: 0 - 0.3 mg/dL Indirect: 0.1 – 1.0 mg/dL

Total: less than 1.5 mg/dL 120 – 200mg/dL 31 -186 U/L 400 – 800 mg/dL Normal range: 10 – 190 mg/dL Borderline high: 200 – 400 mg/dL High: 400 – 1000mg/dL Very high: greater than 1000mg.dL Protien: 6.0 – 8.0 g/L Uric acid: male: 4.5 – 8 ng/dL Female: 2.5 – 6.2 ng/dL Cholesterol: Lipase: Lipids: Triclycerides: GLUCOSE STUDIES Fasting blood sugar: 70 – 105 mg/dL Glucose monitoring (capillary Blood): 60 – 110 mg/dL

RENAL FUNCTION TEST Creatinine: 0.6 – 1.3 mg/dL Blood urea nitrogen (BUN): 5 – 20 mg/dL ERYTROCYTES STUDIES Erytrocyte sedimentation rate(ESR): 0 – 30 mm/hr depending on age Hemoglobin: male: 14 – 16.5 g/dL Female: 12 – 15 g/dL Hematocrit: male: 42% - 52% (increased in hemoconcentration, fluid loss and dehydration) Female: 35% - 47% ( decreased in fluid retention) Red blood cell (RBC): male: 4.5 to 6.2 million/uL Female: 4 to 5.5 million/uL White blood cell (WBC): 4500 to 11,000/uL Erytrocyte Protoporthyrin (EP) : <9ug/dL Phenylalanine Level: <2 mg/dL PKU: >25 mg/dL CRANIAL NERVES MAJOR FUNCTIONS I. II. III. IV. V. VI. Olfactory (S) Optic (S) smell vision Eye movement Facial sensation Jaw movement Eye movement

Oculomotor (M) Trochlear (M) Trigeminal Abducent (S-M) (M)

VII. Facial VIII. Acoustic

(S-M) (S)

Taste Facial expression Hearing and balance Taste Throat sensation Gag and swallow Gag and swallow Parasympathetic activity Neck and back muscles

IX. Glossopharyngeal (S-M) X. XI. XII. Vagus (S-M)

Spinal Accessory (M) Hypoglossal (M) Tongue movement

On Old Olympus’ Towering Tops, A Finn And German Viewed Some Hops Some Says Marry Money, But My Brother Says Bad Business Marry Money ARTERIAL BLOOD GAS (ABG) pH: 7.35 – 7.45 PCO2: 35 - 45 mmHg PO2: 80 - 100 mmHg HCO3: 22 - 27 mEq/L O2 saturation: 96% - 100% Acid-base “RAMS”(Respiratory Alternate, Metabolic Same) GLASGOW COMA SCALE Eye opening response Motor response Verbal response AUTONOMIC NERVOUS SYSTEM SYMPATHETIC/ ADRENERGIC Heart Bronchi GI tract Rectum Bladder Erection Ejaculation Triggers ejaculation Increased heart rate Increased conduction Increased force dilation Reduced motility Allows filling Allows filling PARASYMPATHETIC/ CHOLINERGIC Decreased heart rate constriction Increased motility Empties rectum Relaxes internal sphincter Empties bladder Relaxes internal sphincter Maintains erection

Pupils of eye Salivary glands Blood vessels

Big (mydriasis)

Small (miosis) Secretion

Depends on receptors -a contrict -b dilates

FLOW OF BLOOD THROUGH THE HEART Inferior vena cava and superior vena cava – right atrium – tricuspid valve – right ventricle – pulmonic valve – pulmonary artery – lungs – pulmonary veins – left atrium – bicuspid valve (mitral) – left ventricle – aortic valve aorta – systemic circulation CARDIAC IMPULSES Sinoatrial (SA) node – right and left atria (atria contract) – atrioventricular (AV) node – bundle his – bundle brabches – purjinje’s fibers – ventricles contract. Blood volume: 5000mL Central venous pressure: 4 to 10 cmH2O (increased in cardiac overload; decreased in dehydration) Pressure within the right atrium: 2 to 7 mmHg Capillary refill time: <3 seconds Normal sweat chloride: <40 mEq/L Normal pupil diameter: 3 to 5mm Normal ocular pressure: 10 to 21 mmHg Normal Pulmonary capillary wedge pressure (PCWP): 8 to 13 mmhg Normal cardiac output : 4 to 8 L/min. THERAPEUTIC SERUM MEDICATION LEVELS Acetaminopen (Tylenol) Amikacin (Amikin) Amitryptyline (Elavil) Carbamazepine (Tegretol) Chloramphenicol (Chloromycetin) Desipramine (Norpramin) Digotoxin ( Crystodigin) Digoxin ( Lanoxin) Disopyramide (Norpase) Ethosuximide ( Zarontin) Gentamycin (Garamycin) Imipramide (Tofranil) Lidocaine (Xylocaine) Lithium (Lithobid) Magnesium sulphate Nortriptyline (Aventyl) Phenobarbital (Luminal) Phenytoin (Dilantin) Primidone (Myoline) Procainamide (Pronestryl) 10 – 20 ug/mL 25 – 30 ug/mL 120 -150 ng/mL 5 -12 ug/mL 10 – 20 ug/mL 150 -300 ng/mL 15- 25 ng/mL 0.5 – 2.0 ng/mL 2 -5 ug/mL 40 – 100 ug/mL 5 – 10 ug/mL 150 – 300 ug/mL 1.5 – 5.0 ug/mL 0.5 -1.5 ug/mL 4 -7 mg/dL 50 – 150 ng/mL 10 – 30 ug/mL 10 -20 ug/mL 5 – 20 ug/mL 4 – 10 ug/mL

Propranolol (Inderal) 50 – 100 ng/mL Quinidine (Quinalaglute, Cardioquin) 2 – 5ug/mL Salisylate 100 -250 ug/mL Theophylline (Aminiphylline, Theo-Dur) 10 -20 ug/mL Tobramycin (Nebcin ) 5 -10 ug/mL Valproic acid (depakene) 50 -100 ug/mL

Pulmonary capillary wedge pressure: 5 to 13 mmHg Pulmonary artery pressure: systolic: 16 to 30 mmHg Diastolic: 0 to 7 mmHg Spinal pressure: 70 to 200mmH2O Morphine sulphate pediatric dose: 0.1mg/kg every 3 – 4 hour SULFONYLUREAS For treatment of NIDDM  Sulfonylureas should not be given to patients with liver or kidney failure.  Accummulation of drug will increase risk of hypoglycaemia. DURATION tolbutamide Glycburide, glipizide chlorpropamide 8h 20 h, most potent 48 h

Apothecary and Household System Grain –gr Dram – dr Ounce –oz Minim – min, M, m Quart – qt Pint – pt Drop – gtt Tablespoon – T or tbs Teaspoon – t or tsp Pound – lb 1 gr = 60 mg 5 gr = 300 mg 15 gr = 1000mg or 1g 1/150 gr =0.4 mg 1 oz = 30 mL 1 dr = 4 mL 1 T = 15 mL or 3 tsp 1 min = 1 gtt 15 min = 1mL 60 min = 1 dr 8 dr = 1 oz 1 qt = 1000mL or 1L 1 qt = 2 pt or 32 oz 1 pt = 16 oz 16 oz = 1 lb 2.2lb = 1 kg (F – 32) divide 1.8 = C 1.8 C + 32 = F

Fahrenheit to Celcius Celcius to Fahrenheit

Formula for Calculating a Medication Dosage D (desired ) = the dosage that the physician ordered A (available) =the dosage strength as stated on the medication label Q (quantity ) = the volume that the dosage strength is available in, such as tablet, capsules, or mL D A X Q = X

Formulas for Intravenous Calculations Flow Rates: Total volume x gtt factor Time in minutes Infusion Time: Total volume to infuse mL per hour being infused = gtt per min

= Infusion time

IMMUNIZATION Birth 1 months 2 months 4 months 6 months 12 months 15 months 18 months 12 – 18 months 4 -6 years 11 – 12 years 11 – 16 Hepatitis B Hepatitis B OPV, DPT, HIB DPT, HIB, OPV DPT, HIB, hepatitis B HIB, OPV MMR DPT Varicella vaccine DPT, OPV, MMR MMR ( if not administered at 4 -6 years) TD booster

SPINAL CORD INJURY Cervical Injury:  C2 to C3 injury usually fatal  C4 is the major innervation to the diaphragm by th phrenic nerve  Involvement above th C4 causes respiratory difficulty and paralysis all the four extremities  C5 or below client may have movement in the shoulder


Thoracic Level Injury:  loss of movement of the chest, trunk, bowel, bladder, and legs, depending on the level of injury  Leg paralysis (paraplegia)  Autonomic dysreflexia with lesions above T6 and in cervical lesions  Visceral distention from a distended bladder or impacted rectum may cause reactions such as sweating, bradycardia, hypertension, nasal stuffiness, and gooseflesh Lumbar and Sacral Level Injuries:  loss of movement and sensation of the lower extremities.

 S2 and S3 center on micturation; therefore below this level, the bladder will contract but not empty (neurogenic bladder)  Injury above S2 in males allows them to have an erection, but they are unable to ejaculate because of sympathetic nerve damage.  Injury between S2 and S4 damages the sympathetic and parasympathetic response, preventing erection and ejaculation. RULE OF NINE Head and neck Anterior trunk Posterior trunk Arms (9%) Legs (18%) Perineum 9% 18% 18% 18% 36% 1%

NORMAL ADULT WHITE BLOOD CELL DIFFERENTIAL Neutrophils Bands Eosinophils Basophils Lymphocytes Monocytes 56% or 3% or 2.7% or 0.3% or 34% or 4% or 18000 – 7800/uL 0 – 700/uL 0 – 450/uL 0 – 200/uL 1000 – 4800/uL 0 – 800/uL

THYROID STUDIES Thyroid –stimulating hormone (thyrotropin; THS): 0.2 to 5.4 ug/dL Thyroxine (T4): 5.0 to 12.0 ug/dL Thyroxine free (FT3) : 0.8 to 2.4 ng/dL Triiodothyronine (T3): 80 to 230 ng/dL

Normal Fribrinogen level:

for men: 180 to 340mg/dL Women: 190 to 420mg/dL Fribrinogen is used up in the clotting process. Erythrocyte Protoporhyrin (EP): < 9ug/dL Phenylalanine level: < 2mg/dL PKU: >25 mg/dL Urine specific gravity: 1.016 - 1.022 increase in SIADH; decrease in diabetes insipidus Normal CSF protein: 15 – 45 mg/dL increase in Guillain-Barre syndrome Normal CSF pressure: 5 – 15 mmHg Normal serum osmolality: 285 – 295 mOsmlkgH2O increase in dehydration; Decrease in over hydration Normal scalp pH: 7.26 and above Borderline acidosis: 7.20 to 7.25 Acidosis: < 7.15

HERBAL MEDICINE Aloe vera Gel – abrasionsand dermatologic conditions American Ginseng (Panax quinquefolius) – boost energy, relieve stress, improve concentration and enhance physical or cognitive performance. Ashwagandha (Withania somnifera) – stress arthritis Asian gingseng (Panax ginseng) – enhance health and combat stress and disease Bilberry (Vaccinium myrtillus) – vision and peripheral vascular disorders and as antioxidant Black Cohosh (Cimicifuga racemosa) – menopausal Black Currant and Borage oil (Ribes nigrum and Borago offinalis) – antiinflammatory, rheumatoid arthritis Capsicum Peppers (Capsicum spp.) – arthritis, neuralgia and other painful treatment Chamomile (Matricaria recutita) “manzanilla”- skin inflammation, colic, or dyspepsia and anxiety Chaste tree (Vitex agnus-castus) – menstrual related disorders, PMS, cyclical mastalgia Chodroitin – osteoarthritis Coenzyme Q10 – antioxidant Coltsfoot ( Tussilago farfara ) – cough and other respiratory disoders Cranberry (Vaccinium macrocarpon) – UTI Devil’s Claw ( Harpagophytum procumbers) – anti inflammatory and analgesic Echinacea (Echinacea spp.) – acute viral URI symptoms Ederberry (Sanbacus nigra) – respiratory tract infection Ephedra or Ma Huang (Ephedra sinica) Source of ephedrine and pseudoephedrine Evening Primrose Oil (Oenothera biennis) – eczema, breast pain associated with PMS and inflammatory condition Fenugreek (Trigonella foenum-graecum) – lowering blood glucose Feverfew ( Tanacetum parthenium) – migraine headache prophylaxis Garlic (Allium sativaum)- help prevent cardiovascular disease and cancer Ginger (Zingiber officinale) –nausea and motion sickness, anti-inflammatory Ginkgo (Ginkgo biloba) – dementia and intermittent claudication, memory enhancement and treatment of vertigo nad tinnitus Glucosamine – osteoarthritis Goldenseal ( Hydrastis Canadensis) – tonic and antibiotic Gotu Kola (Centella asiatica) – mental support, wound healing and venous disorders Hawtorn ( Crategus species) – CHF and related cardiovascular conditions Horebound (Marribium vulgare) – primary cough suppression and expectoration Horse Chestnut Seed (Aesculus hippocastanum) chronic venous insufficiency Ivy (Hedera helix) – coughs, rheumatic disordes and skin disease Kava ( piper methysticum) – mild psychoactive and antianxiety property Lemon Balm (Melissa officinalis) – sedative and for dyspepsia Licorice (Glycyrrhiza glabra) – respiratory disorders, hepatitis, inflammatory diseases, and infections Melatonin – insomia, jet lag Milk Thistle – hepatitis, liver desease Mints (Mentha species) – minor calcium channel antagonists, used for upper respiratory problems, irritable bowel syndrome, dyspepsia, and colonic spasm and as a topical counterirritant Nettle (Urtica dioica) – arthritis pains, allergies, BPH, or as diuretic Papaya (Carica papaya) – digestive aid, dyspepsia, and for inflammatory, topically applied to wounds Passion flower (Passiflora incarnata)- sedative-hypnotic or anxiolytic herb Pokeroot (Phytolacca Americana) – inflammatory conditions also as an emetic/cathartic Pygeum (Pygeum africanum) – mild symptoms of BPH Red Clover (Trifolium pratense) – used as a natural estrogen substitute for women’s health St. John’s Wort (Hypericum perforatum) – antidepressant effect

Tea Tree Oil (Melaleuca alternifolia) – antifungal and antibacterial Turmeric (Curuma longa ) – anti-inflammatory, anti-arthritis, anti cancer, and antioxidant Uva Ursi (Arctostaphylos uva ursi) – urinary antiseptic and diuretic Yohimbe – erectile dysfunction FOUR STRATEGIES: 1. If the question asks what you should do in the situation. Use the nursing process to determine which step in the nursing process would be next? 2. If the question asks what the client needs. Use maslow’s hierarchy to determine which need to address. 3. If the question indicates that the client doesn’t have urgent physiologic need, focus on the patient safety. 4. If the question involves communicating with a patient. Use principles of therapeutic communication. REMEMBER: AIRWAY, BREATHING,CIRCULATION AND SAFETY (ABCS) The nurse in primary care clinic is caring for a 50-year-old woman. History reveals that she had experienced on and off chest pain. After series of cardiac tests (EKG & Blood Chem), the doctor orders for THALLIUM STRESS TEST. Which of the following medications should the RN prepare if the patient needs an alternative exercise in thallium test? 1.Nitroglycerin 2.Morphine 3.Aminophylline 4.Persantin The correct answer is #4. Persantin (dipyridamole) Persantin is use as an alternative to exercise in thallium myocardial perfusion imaging for the evaluation of CAD in those who cannot exercise adequately. Purpose: to determine myocardial wall viability Other names: 1. Cardiac pooling 2. MUGA-multigated radionuclide angiographic scanning 3. nurclear scan 4. sestamibi test 5. thallium scan 6. dipyridamole or persantin stress test 7. In short, heart scan :) Loving NCLEX-RN URC 09178364589 Posted by Anaski from IP on August 23, 2005 at 21:44:00: For Future USRN's: Cervical Cancer Etiology: * Early age of sexual intercourse * Multiple sexual partners * Sexually Transmitted Disease (Venereal Wart) * Virus - HPV Cancer Carcinoma in SITU - only in epithelial linings Situ sounds like Ziru - Stage 0 Tumor marker - CEA Signs and Symptoms (3 P's) POST COITAL BLEEDING

PAINFUL INTERCOURSE PROFUSE (PERIOD IRREGULARITIEs - menorrhagia and metrorrhagia) Management: U - pera (Surgery HYSTERECTOMY) R - radiation (intracavitary cessium - remember STD - shielding, timing and distance)) C - chemotherapy to destroy the DNA,RNA & CHON synthesis.

MIKE’S NOTES (60 pp.)
O universal donor/AB universal recipient. ABO BLOOD TYPE COMPATIBILITY Can Receive from: O A,O B,O O,A,B,AB

Blood Type O A B AB

Can donate to: O,A,B,AB A,AB B,AB AB

Autologous Transfusion: • Collected 4-6 weeks before surgery • Contraindicated—infection, chronic disease, cerebrovascular or cardiovascular disease Hypotonic Solution • ½ NS (0.45% Saline) • • • • Isotonic Solution 0.9% NaCl (Normal Saline) 5% D/W (Dextrose in Water) Lactated Ringer’s 5% D/ ¼ NS (5% Dextrose in 0.225% Saline ) • • • • • • Change tubing Q72 hours Change bottle Q24 hours Infiltration • Assessment: cool skin, swelling, pain, decrease in flow rate • Implementation: discontinue IV, warm compresses, elevate arm, start new site proximal to infiltrated site IV Phlebitis, Thrmobophlebitis • Assessment—redness, warm, tender, swelling, leukocytosis • Implementation—discontinue IV, warm moist compresses, start IV in opposite extremity Hematoma • Assessment—ecchymosis, swelling, leakage of blood • Implementation—discontinue IV, apply pressure, ice bag 24 hours, restart IV in opposite extremity IV Clotting • Assessment—decreased flow rate, back flow of blood into tubing • Implementation—discontinue, do not irrigate, do not milk, do not increase rate of flow or hang solution higher, do not aspirate cannula, inject Urokinase, D/C and start on other site. Insertion of Percutaneous Central Catheters: • Placed supine in head-low position • Turn head away from procedure • Perform Valsalva maneuver • Antibiotic ointment and transparent sterile dressing • Verify position with x-ray • Change tubing Q24 hours • Nurse/patient both wear mask when dressing change 2-3x/week Adrenergics Adrenergic Adrenergics Side effects: Actions: Medications • Dysrhythmias • Stimulate the • Levophed • Tremors sympathetic nervous • Dopamine • Anticholinergic system: increase in • Adrenalin effects peripheral resistance, Adrenergics Nursing Hypertonic Solution 10% D/W (10% Dextrose in water) D15W 5% D/NS (5% Dextrose in 0.9% Saline) 5% D/ ½ NS (5% Dextrose in 0.45% Saline) 3% NaCl 5% Sodium Bicarbonate

increase blood flow to heart, bronchodilation, increase blood flow to skeletal muscle, increase blood flow to uterus • Stimulate beta-2 receptors in lungs • Use for cardiac arrest and COPD

• Dobutrex

Considerations: • Monitor BP • Monitor peripheral pulses • Check output

Anti-Anxiety Action: • Affect neurotransmitters Used for: • Anxiety disorders, manic episodes, panic attacks

Anti-Anxiety Medications: • Librium, Xanax, Ativan, Vistaril, Equanil

Anti-Anxiety Side effects: • Sedation • Confusion • Hepatic dysfunction Anti-Anxiety Nursing Considerations: • Potention for addiction/overdose • Avoid alcohol • Monitor Liver Function AST/ALT • Don’t discontinue abruptly, wean off • Smoking/caffeine decreases effectiveness Antacids Side effects: • Constipation • Diarrhea • Acid rebound Antacids Nursing Considerations: • Interferes with absorption of antibiotics, iron preps, INH, Oral contraceptives • Monitor bowel function • Give 1-2 hours after other medications • 1-3 hours after meals and at HS • Take with fluids

Antacids Actions: • Neutralize gastric acids Used for: • Peptic ulcer • Indigestion, reflex esophagitis

Antacids Medications • Amphojel • Milk of Magnesia • Maalox

Antiarrhythmics Antiarrhythmics Antiarrhythmics Action: Medications: Side effects: • Interfere with • Atropine sulfate • Lightheadedness electrical • Lidocaine • Hypotension excitability of heart • Pronestyl • Urinary retention Used for: Antiarrhythmics • Quinidine • Atrial fibrillation Nursing Considerations: • Isuprel and flutter • Monitor vital signs • Tachycardia • Monitor cardiac • PVCs rhythm Aminoglycosides Aminoglycosides Aminoglycosides (Antibiotics) (Antibiotics) (Antibiotics) Side effects: Action: Medications: • Ototoxicity and Nephrotoxicity • Inhibits protein • Gentamycin • Anorexia synthesis in • Neomycin • Nausea gram-negative • Streptomyci • Vomiting bacteria n • Diarrhea Used for: • Tobramycin Aminoglycosides (Antibiotics) • Pseudomonas, Nursing Considerations: E.Coli • Harmful to liver and kidneys • Check 8th cranial nerve (hearing) • Check renal function

• Take for 7-10 days • Encourage fluids • Check peak/trough level Cephalosporins (Antibiotics) Action: • Inhibits synthesis of bacterial cell wall Used for: • Tonsillitis, otitis media, perioperative prophylaxis • Meningitis Cephalosporin s (Antibiotics) Medications: • Ceclor • Ancef • Keflex • Rocephi n • Cefoxitin Cephalosporins (Antibiotics) Side effects: • Bone marrow depression: caution with anemic, and low PLT px • Superinfections • Rash Nursing Considerations: • Take with food • Cross allergy with PCN • Avoid alcohol • Obtain C&S before first dose: to make sure medication is effective against disease/bacteria • Can cause false-positive for proteinuria/glycosuria Fluroquinolones (Antibiotics) Side effects: • Diarrhea • Decreased WBC and Hematocrit • Elevated liver enzymes (AST, ALT) • Elevated alkaline phosphatase Nursing Considerations: • C&S before starting therapy • Encourage fluids • Take 1 hour ac or 2 hour pc (food slows absorption) • Don’t give with antacids or iron preparation • Maybe given with other medications (Probenicid: for gout)

Fluoroquinolones (Antibiotics) Action: • Interferes with DNA replication in gramnegative bacteria Used for: • E.Coli, Pseudomonas, S. Aureus

Fluoroquinolones (Antibiotics) Medications: • Cipro

Macrolide (Antibiotics) Action: • Binds to cell membrane and changes protein function Used for: • Acute infections • Acne • URI • Prophylaxis before dental procedures if allergic to PCN

Macrolide (Antibiotics) Medications: • Erythromycin • Clindamycin

Macrolide (Antibiotics) Side effects: • Diarrhea • Confusion • Hepatotoxicity • Superinfections Nursing Considerations: • Take 1hr ac or 2-3 hr pc • Monitor liver function • Take with water (no fruit juice) • May increase effectiveness of: Coumadin and Theophylline (bronchodilator) Penicillin Side effects: • Stomatitis • Diarrhea • Allergic reactions • Renal and Hepatic changes Nursing Considerations: • Check for hypersensitivity • Give 1-2 hr ac or 2-3 hr pc • Cross allergy with cephalosporins

Penicillin Action: • Inhibits synthesis of cell wall Used for: • Moderate to severe infections • Syphilis • Gonococcal infections • Lyme disease

Penicillin Medications: • Amoxicillin • Ampicillin • Augmentin

Sulfonamides (Antibiotics) Action: • Antagonize essential component of folic acid synthesis Used for: • Ulcerative colitis • Crohn’s disease • Otitis media • UTIs

Sulfonamides (Antibiotics) Medications: • Gantrisin • Bactrim • Septra • Azulfidine

Sulfonamides (Antibiotics) Side effects: • Peripheral Neuropathy • Crystalluria • Photosensitivity • GI upset • Stomatitis Nursing Considerations: • Take with meals or foods • Encourage fluids • Good mouth care • Antacids will interfere with absorption

Tetracyclines (Antibiotics) Action: • Inhibits protein sythesis Used for: • Infections • Acne • Prophylaxis for opthalmia neonatorum

TEtracyclines (Antibiotics) Medications: • Vibramycin • Panmycin

Tetracyclines (Antibiotics) Side effects: • Discoloration of primary teeth if taken during pregnancy or if child takes at young age • Glossitis • Rash • Phototoxic reactions Nursing considerations: • Take 1 hr ac or 2-3 hr pc • Do not take with antacids, milk, iron • Note expiration date • Monitor renal function • Avoid sunlight

UTIs • Medication: o Furadantin • Action: o Anti-infective • Side effects: o Asthma attacks o Diarrhea • Nursing Considerations: o Give with food or milk o Monitor pulmonary status UTIs • Medication o Mandelamine • Action: o Anti-infective • Side effects: o Elevated liver enzymes • Nursing Considerations: o Give with cranberry juice to acidify urine o Limit alkaline foods: vegetables, milk, almonds, coconut UTIs • Medication o Pyridium • Side effects: o Headache o Vertigo • Action

o Urinary tract analgesic • Nursing Consideration o Tell patient urine will be orange Anticholinergics Action: • Inhibits action of acethylcholine and blocks parasympathetic nerves (affects heart, eyes, respiratory tract, GI tract and the bladder) • Dilates pupil, causes bronchodilation and decreased secretions • Decrease GI motility secretions Used for: • Opthalmic exam • Motion sickness • Pre-operative Anticholinergic Medications: • Pro-Banthine • Atropine • Scopolamine Anticholinergic Side Effects: • Blurred vision • Dry mouth • Urinary retention • Chage in heart rate Nursing Consideration: • Monitor output • Contraindicated with glaucoma • Give 30 min ac, hs, or 2hr pc • Contraindicated: paralytic ileus, BPH

Anticoagulants Action: • Blocks conversion of prothrombin to thrombin Used for: • Pulmonary embolism • Venous thrombosis • Prophylaxis after acute MI

Anticoagulant s Medications: • Heparin

Anticoagulants (Heparin) Side Effects: • Hematuria • Tissue irritation Nursing Considerations: • Monitor clotting time or Partial Thromboplastin Time (PTT) • Normal 20-45 sec • Therapeutic level 1.5-2.5 times control • Antagonist—Protamine Sulfate • Give SC or IV Anticoagulant (Coumadin) Side Effects: • Hemorrhage, Alopecia Nursing Considerations: • Monitor Prothrombin Test (PT) • Normal 9-12 sec • Therapeutic level 1.5 times control • Antagonist—Vitamin K (AquaMEPHYTON) • Monitor for bleeding • Give PO Anticonvulsant Side effects: • Respiratory depression • Aplastic anemia • Gingival hypertrophy • Ataxia Nursing Considerations: • Don’t discontinue abruptly • Monitor I&O • Caution with use of medications that lower seizure threshold: MAO inhibitors & anti-psychotics • Good mouth care • Take with food • May turn urine pinkish-red/pinkishbrown

Anticoagulant Action: • Interferes with synthesis of vitamin K-dependent clotting factors Used for: • Pulmonary embolism • Venous thrombosis • Prophylaxis after acute MI

Anticoagulant Medication: • Coumadin

Anticonvulsants Action: • Decreases flow of calcium and sodium across neuronal membranes Used for: • Seizures

Anticonvulsan t Medications: • Dilantin • Luminal • Depakot e • Tegretol • Klonopin

Anti-Depressants Monoamine Oxidase Inhibitors (MAO) Action: • Causes increases concentration of neurotransmitters Used for: • Depression • Chronic pain

AntiDepressants (Monoamine Oxidase Inhibitors) Medications: • Marplan • Nardil • Parnate

Anti-Depressants (Monoamine Oxidase Inhibitors) Side effects: • Hypertensive Crisis (Sudden headache, diaphoretic, palpitations, stiff neck, intracranial hemorrhage) with food that contain Tyramine Nursing Considerations: • Avoid foods containing Tyramine: Aged cheese, liver, yogurt, herring, beer and wine, sour cream, bologna, pepperoni, salami, bananas, raisins, and pickled products • Monitor output • Takes 4 weeks to work • Don’t combine with sympathomometics vasoconstrictors, and cold medications Anti-Depressants Selective Serontonin Reuptake Inhibitors (SSRI) Side effects: • Anxiety • GI upset • Change in appetite and bowel function • Urinary retention Nursing Considerations: • Suicide precautions • Takes 4 weeks for full effect • Take in a.m. • May urine to pinkish-red or Pinkishbrown • Can be taken with meals Anti-Depressants (Tricyclics) Side Effects: • Sedation/Confusion • Anticholinergics affects • Postural Hypotension • Urinary retention Nursing Considerations: • Suicide precautions/2-6 weeks to work • Take at hs/Don’t abruptly halt • Avoid alcohol/OTC /Photosensitivity Insulin (Ultralente, Humulin U) Type: Slow acting Onset: 4hr Peak: 8-20hr Duration: 24-36hr Insulin (Humulin 70/30) Type: Combination Onset: ½ hr Peak: 2-12hr Duration: 24hr

Anti-Depressants Selective Serontonin Reuptake Inhibitors (SSRI) Action: • Inhibits CNS uptake of serotonin Used for: • Depression • Obsessive-Compulsive Disorder • Bulimia

Anti-Depressants Selective Serontonin Reuptake Inhibitors (SSRI) Medications: • Paxil • Prozac • Zoloft

Anti-Depressants (Tricyclics) Action: • Inhibits reuptake of neurotransmitters Used for: • Depression • Sleep apnea

Anti-Depressants (Tricyclics) Medications: • Norpramin • Elavil • Tofranil

Insulin (Regular, Humulin R) Type: Fast acting Onset: ½ -1 hr Peak: 2-4 hr Duration: 6-8 hr

Insulin (NPH, Humulin N) Type: Intermediate acting Onset: 2hr Peak: 6-12hr Duration 18-26hr

Antidiabetic Agents Action: • Stimulates insulin release from beta cells in pancreas Used for: • Type 2 diabetes (NIDDM)

Antidiabetic Agents Medications: • Diabinese • Orinase • Dymelor • Micronase

Antidiabetic Agents Side Effects: • Hypoglycemia • Allergic skin reactions • GI upset Nursing Considerations: • Take before breakfast • Monitor glucose levels • Avoid alcohol, sulfonamides, Oral Contraceptives, (MAO), aspirin because they help to make drug work better

Hypoglycemic Agent Action: • Stimulates liver to change glycogen to glucose Used for: • Hypoglycemia

Hypoglycemic Agent Medication: • Glucagon

Hypoglycemic Agent Side Effects: • Hypotension • Bronchospasm Nursing Considerations: • May repeat in 15min • Give carbohydrates orally to prevent secondary hypoglycemic reactions Antidiarrheals Side Effects: • Constipation • Anticholinergic effects (urinary retention, dry mouth) Nursing Considerations: • Do not use with abdominal pain • Monitor for urinary retention • Give 2hr before or 3 hr after other meds Antiemetics Side Effects: • Sedation • Anticholinergic effects Nursing Considerations: • Used before chemotherapy • When used with viral infections may cause Reye’s syndrome (Toxic Encephalopathy)

Antidiarrheals Action: • Slows peristalsis • Increases tone of sphincters Used for: • Diarrhea

Antidiarrheals Medications: • Kaopectate • Lomotil • Imodium • Paregoric

Antiemetics Action: • Increases GI motility • Blocks effect of dopamine in chemoreceptor trigger zone Used for: • Vomiting

Antiemetics Medications: • Tigan • Compazine • Torecan • Reglan • Antivert • Dramamine

Antifungals Action: • Impairs cell membrane Used for: • Candidiasis • Oral thrush • Histoplasmosis

Antifungals Medications: • Amphotericin B • Nystatin

Antifungals Side Effects: • Hepatotoxicity • Thrombocytopenia • Leukopenia • Pruritis Nursing Considerations: • Give with food • Monitor liver function • Good oral hygiene Antigout Agents Side Effects: • Agranulocytosis • GI upset • Renal calculi Nursing Considerations: • Monitor for renal calculi • Give with food, milk, antacids Antihistamines Side Effects:

Antigout Agents Action: • Decreases production and resorption of uric acid Used for: • Gout

Antigout Agents Medications: • Colchicine • Probenecid • Zyloprim

Antihistamines Action:

Antihistamines Medications:

Block effects of histamine Used for: • Allergic rhinitis • Allergic reactions to blood

• • •

Chlor-Trimeton Benadryl Phenergan

• Drowsiness • Dry mouth • Photosensitivity Nursing Considerations: • Give with food • Use sunscreen • Avoid alcohol Antihyperlipidemic Agents Side Effects: • Constipation • Fat-soluble vitamin deficiency Nursing Considerations: • Take at hs or 30 min ac • Administer 1hr before or 4-6 hr after other meds

Antihyperlipidemic Agents Action: • Inhibits cholesterol and triglyceride synthesis Used For: • Elevated cholesterol • Reduce incidence of cardiovascular disease Antihypertensives Types: ACE Inhibitors Action: • Blocks ACE in lungs Used for: • Hypertension • CHF

Antihyperlipidemic Agents Medications: • Questran • Lipid

Antihypertensives (ACE Inhibitors) Medications: • Capoten • Vasotec

Antihypertensives Type: Beta-Adrenergic Blockers Action: • Blocks Beta-Adrenergic Receptors • Decrease excitability/workload of heart, oxygen consumption • Decrease Used for: • Hypertension • Angina • SVT

Antihypertensives (ACE Inhibitors) Side Effects: • GI upset • Orthostatic hypotension • Dizziness Nursing Considerations: • Give 1hr ac or 3hr pc • Change position slowly Antihypertensives Antihypertensives Type: BetaType: Beta-Adrenergic Adrenergic Side Effects: Medications; • Changes in heart • Nadolol rate • Propranolol • Hypotension • Tenormin • Bronchospasm Nursing Considerations: • Timoptic • Masks signs of shock and hypoglycemia • Take with meals • Do not discontinue abruptly Antihypertensives Type: Calcium Channel Blockers Medications: • Procardia • Calan • Cardizem Antihypertensives Type: Calcium Channel Blockers Side Effects: • Hypotension • Dizziness • GI distress Nursing Consideration: • Monitor vital signs • Do not chew or divide sustainedrelease tablets

Antihypertensives Type: Calcium Channel Blockers Action: • Inhibits movement of calcium across cell membranes • Slow impulse conduction and depresses myocardial contractility • Causes dilation of coronary arteries and decreases cardiac workload and energy consumption Used for: • Angina • Hypertension • Interstitial cystitis Antihypertensives Type: Centrally acting alpha-adrenergics Action: • Stimulates alpha receptors in

Antihypertensives Type: Centrally acting alphaadrenergics Medications: • Aldomet • Catapres

Antihypertensives Type: Centrally acting alphaadrenergics Side Effects: • Sedation • Orthostatic Hypotension

medulla which causes a reduction in sympathetic in the heart Used for: • Hypertension Antihypertensives Type: Direct-acting vasodilators Action: • Relaxes smooth muscle Used for: • Hypertension

Nursing Considerations: • Don’t discontinue abruptly • Monitor for fluid retention • Change position slowly Antihypertensives Medications • Hydralazine • Minoxidil Antihypertensives Side Effects: • Tachycardia • Increase in body hair Nursing Considerations: • Teach patient to check pulse Antihypertensives Side Effects: • Depression • Orthostatic Hypotension • Brachycardia Nursing Considerations: • Give with meals or milk • Change position slowly

Antihypertensives Type: Peripheral-acting alpha-adrenergic blockers Action: • Depletes stores of norepinephrine in sympathetic nerve endings Used for: • Hypertension

Antihypertensives Medications: • Reserpine

Bipolar Disorder Action: • Reduces catecholamine release Used for: • Manic episodes

Bipolar Disorder Medications: • Lithium (1-1.5meq/L) • Tegretol • Depakote

Bipolar Disorder Side Effects: • GI upset • Tremors • Polydipsia • Polyuria Nursing Considerations: • Monitor serum levels • Give with meals • Increase fluid intake

Antineoplastic Agents Type: Alkylating Agents Action: • Interferes with rapidly reproducing DNA Used for: • Leukemia • Multiple myeloma

Antineoplastic Agents Medications: • Cisplatin • Myleran • Cytoxan

Antineoplastic Agents Side Effects: • Hepatotoxicity • Ecchymosis • Alopecia • Epitaxis • Infertility • Bone Marrow Suppression • Stomatitis • GI disturbances: Anorexic, N/V, diarrhea Nursing Considerations: • Check hematopoietic (reproduction of RBC’s by bone marrow) function • Force fluids • Good mouth care Antineoplastic Agents Antimetabolites Side Effects: • Nausea • Vomiting • Oral ulceration • Bone marrow suppression • Alopecia

Antineoplastic Agents Type: Antimetabolites Action: • Inhibits DNA polymerase Used for: • Acute lymphatic leukemia • Cancer of colon,

Antineoplastic Agents Antimetabolites Medications: • 5-FU • Methotrexate • Hydrea

breast, pancreas

Nursing Considerations: • Monitor hematopoietic function • Good mouth care • Discuss body image changes Antineoplastic Agents Antitumor Antibiotics Side Effects: • Bone marrow suppression • Alopecia • Stomatitis Nursing Considerations: • Monitor vital signs • Give antiemetic medications before therapy Antineoplastic Agents Type: Hormonal Agents Side Effects: • Leukpenia • Bone pain • Hypercalcemia Nursing Considerations: • Check CBC • Monitor serum calcium Antineoplastic Agents Type: Vinca Alkaloids Side Effects: • Stomatitis • Alopecia • Loss of reflexes • Bone marrow suppression Nursing Considerations: • Give antiemetic before administration • Check reflexes • Given with Zyloprim to decrease uric acid Antiparkinson Agents Side Effects: • Dizziness • Ataxia • Atropine-like effects: dry mouth, urinary retention Nursing Considerations: • Monitor for urinary retention • Large doses of vitamin B6 reverse effects • Avoid use of CNS depressants

Antineoplastic Agents Type: Antitumor Antibiotics Action: • Interferes with DNA and RNA synthesis Used for: • Cancer

Antineoplastic Agents Antitumor Antibiotics Medications: • Adriamycin • Actinomycin D • Bleomycin

Antineoplastic Agents Type: Hormonal Agents Action: • Changes hormone input into sensitive cells Used for: • Cancer

Antineoplastic Agents Type: Hormonal Agents Medications: • Diethylstilbestrol • Tamoxifen • Testosterone

Antineoplastic Agents Type: Vinca Alkaloids Action: • Interferes with cell division Used for: • Cancer

Antineoplastic Agents Type: Vinca Alkaloids Medications: • Oncovin • Velban

Antiparkinson Agents Action: • Converted to Dopamine • Stimulates postsynaptic Dopamine receptors Used for: • Parkinson’s disease

Antiparkinson Agents Medications: • Artane • Cogentin • L-Dopa • Parlodel • Sinemet • Symmetrel

Antiplatelet Agents Action: • Interferes with platelet aggregation Used for:

Antiplatelet Agents Medications: • Aspirin • Persantine

Antiplatelet Agents Side Effects: • Hemorrhage • Thrombocytopenia Nursing Considerations: • Check for signs of

• •

Venous thrombosis Pulmonary embolism Antipsychotic Agents Medications: • Haldol • Thorazine • Mellaril • Stelazine

bleeding Give with food or milk

Antipsychotic Agents Action: • Blocks dopamine receptors in basal ganglia Used for: • Acute and Chronic psychoses

Antipsychotic Agents Side Effects: • Akathisia (inability to sit still) • Dyskinesia • Dystonias • Parkinson’s syndrome • Tardive dyskinesias • Leukopenia Nursing Considerations: • Check CBC • Monitor vital signs • Avoid alcohol and caffeine Atypical Antipsychotic Side Effects: • Extrapyramidal effects • Anticholinergic • Sedative • Orthostatic hypotension Nursing Considerations: • Monitor blood • Change positions slowly • Use sunscreen Antipyretic Agents Side Effects: • GI irritation Nursing Considerations: • Monitor liver function • Aspirin contraindicated for younger than 21 years old due to risk of Reye’s syndrome Antithyroid Agents Side Effects: • Leukopenia • Rash • Thrombocytopenia Nursing Considerations: • Bitter taste • May cause burning in mouth • Give with meals • Check CBC

Atypical Antipsychotic Agents Action: • Interferes with binding of dopamine in the brain Used for: • Acute and Chronic psychoses

Atypical Antipsychotic Medications: • Clozaril • Risperdal

Antipyretic Agents Action: • Antiprostaglandin activity in hypothalamus Used for: • Fever

Antipyretic Agents Medications: • Tylenol (Acetaminophen)

Antithyroid Agents Action: • Reduce vascularity of thyroid • Inhibits release of thyroid into circulation Used for: • Hyperthyroidism

Antithyroid Agents Medications: • Tapazole • SSKI

Thyroid Replacement Agents Action: • Increases metabolic rate

Thyroid Replacement Medications • Synthroid • Cytomel

Thyroid Replacement Side Effects: • Nervousness • Tachycardia • Weight loss

Used for: • Hypothyroidism

Nursing Considerations: • Monitor pulse and BP • Monitor weight • Take in a.m. • Enhance action of anticoagulants, antidepressants, decrease action of insulin and digitalis Antitubercular Agents Medications: • INH • Ethambutol • Streptomycin • PAS • PYZ Antivirals Medications: • Zovirax • AZT • Videx • Famvir • Cytovene Antitubercular Agents Side Effects: • Hepatitis • Peripheral Neuritis Nursing Considerations: • Check liver function tests • Vitamin B6 given for peripheral neuritis (Pyridoxine) • Used in combination Antivirals Side Effects: • Headache • Dizziness • GI symptoms Nursing Considerations: • Encourage fluids • Not a cure, but relieves symptoms Attention Disorder Agents Side Effects: • Restlessness • Insomnia • Tachycardia • Palpitations Nursing Considerations: • Monitor growth rate • Monitor liver enzymes • Give in A.M. Bronchodilators Side Effects: • Tachcyardia • Dysrhythmias • Palpitations • Anticholinergic effects Nursing Considerations: • Monitor BP and HR • When used with steroid inhaler, use bronchodilator first • May aggravate diabetes

Antitubercular Agents Action: • Inhibits cell and protein synthesis Used for: • Tuberculosis • To prevent disease in person exposed to organism Antivirals Action: • Inhibits DNA and RNA replication Used for: • Recurrent HSV • HIV infection

Attention Disorder Agents Action: • Increases level of catecholamines Used for: • ADDH • Narcolepsy

Attention Disorder Agents Medications: • Ritalin • Cylert • Dexedrine

Bronchodilators Action: • Decreases activity of phosphodiesterase Used for: • COPD • Preterm labor (Terbutaline)

Bronchodilators Medications: • Aminophylline • Atrovent • Brethine • Proventil • Primatene

Cardiac Glycosides Action: • Increases force of myocardial contraction, slows rate Used for:

Cardiac Glycosides Medication: • Lanoxin (Digoxin)

Cardiac Glycosides Side Effects: • Bradycardia • Nausea • Vomiting • Visual disturbances Nursing Considerations:

Left-sided CHF

• • • • •

Take apical pulse Notify physician if adult <60, child <90-110, <70 in older children Monitor potassium level Dose: 0.5-1 milligram IV or PO over 24 hr period Average: 0.25 mg Cholinergics Side Effects: • Bronchoconstriction • Respiratory paralysis • Hypotension Nursing Considerations: • Give with food or milk • Monitor vital signs, especially respirations • Antidote: Atropine Sulfate • Toxicity: excessive salivation, excessive sweating, abdominal cramps, flushing Diuretics Side Effects: • Dizziness • Orthostatic Hypotension • Leukopenia Nursing Considerations: • Take with food or milk • Take in a.m. • Monitor fluid and electrolytes milk/antacids, take on empty Glucocorticoids Side Effects: • Psychoses • Depression • Hypokalemia • Stunted growth • Buffalo Hump Nursing Considerations: • Monitor fluid and electrolyte balance • Don’t discontinue abruptly • Monitor for signs of infection

Cholinergics Action: • Inhibits destruction of acetylcholine • Stimulate parasympathetic nervous system (increase bowel tone, increase bladder tone, constrict pupil) Used for: • Myasthenia gravis • Post-operative • Postpartum urinary retention Diuretics Action: • Inhibits reabsorption of sodium and water • Blocks effects of aldosterone Used for: • CHF • Renal disease

Cholinergics Medications: • Tensilon • Prostigmin

Diuretics Medications: • HydroDIURIL • Diamox • Aldactone • Lasix • Hygroton

Iron: Imferon/Feosol, use straw if liquid form, no stomach, tachycardia Glucocorticoids Glucocorticoids Action: Medications: • Stimulates • Soluformation of Cortef glucose • Decadron • Alters immune • Deltasone response Used for: • Addison’s disease • Crohn’s disease • COPD • Leukemias

Mineralocorticoids Action: • Increases sodium reabsorption • Potassium and hydrogen ion secretion in kidney Used for: • Adrenal insufficiency

Mineralocorticoid s Medications: • Florinef

Mineralocorticoids Side Effects: • Hypertension • Edema • Hypokalemia Nursing Considerations: • Monitor BP, I&O, Weight, and Electrolytes • Give with food • Low-sodium, High-protein, High-potassium diet Heavy Metal Antagonists Side Effects: • Tachycardia

Heavy Metal Antagonists Action: • Forms stable

Heavy Metal Antagonists Medications:

complexes with metals Used for: • Gold and arsenic poisoning • Acute lead encephalopathy

• • •

Desferal mesylate BAL in Oil EDTA

Pain and induration at injection site (conjunct with Procaine in syringe) Nursing Considerations: • Monitor I&O and kidney function • Administered with local anesthetic • Seizure precautions H2 Receptor Blockers Side Effects: • Dizziness • Confusion • Hypotension • Impotence Nursing Considerations: • Take with meals and hs • Smoking decreases effectiveness • Monitor liver function and CBC Immunosuppressants Side Effects: • Hepatotoxicity • Nephrotoxicity • LeuKopenia • Thrombocytopenia Nursing Considerations: • Take once daily in a.m. • Used with adrenal corticosteroids • Monitor renal and liver function tests Miotics Side Effects: • Headache • Photophobia • Hypotension • Bronchoconstriction Nursing Considerations: • Apply pressure on lacrimal sac for 1min • Avoid sunlight • May experience transient brow pain and myopia Mydriatics Side Effects: • Tachycardia • Blurred vision • Photophobia • Dry mouth Nursing Considerations: • Contraindicated with glaucoma • Apply pressure on lacrimal sac for 1min. • Wear dark glasses

H2 Receptor Blockers Action: • Inhibits action of histamine and gastric acid secretion Used for: • Ulcers • Gastroesophageal reflux

H2 Receptor Blockers Medications: • Tagamet • Zantac

Immunosuppressants Action: • Prevents production of T cells and their response to interleukin-2 Used for: • Prevents rejection for transplanted organs

Immunosuppressants Medications: • Sandimmune

Miotics (Constricts Pupil) Action: • Causes constriction of sphincter muscles of iris Used for: • Ocular surgery • Open-angle glaucoma

Miotics Medications: • Isopto-Carpine • Eserine • Carbacel

Mydriatics (Dilates Pupil) Action: • Anticholinergic actions leaves pupil under unopposed adrenergic influence Used for: • Diagnostic procedures • Acute iritis • Uveitis

Mydriatics Medications: • Atropine sulfate • Cyclogyl

Narcotics Action: • Acts on CNS receptor cells Used for: • Moderate to severe pain • Preoperative • Postoperative

Narcotics Medications: • Morphine Sulfate • Codeine • Demerol • Dilaudid • Percodan

Narcotics Side Effects: • Dizziness • Sedation • Respiratory depression • Hypotension • Constipation Nursing Considerations: • Safety precautions • Avoid alcohol • Monitor vital signs • Use narcotic antagonist if necessary (Narcan)

Antianginals Action: • Relaxes smooth muscle • Decreases venous return Used for: • Angina • Peri-operative hypertension • CHF

Antianginals Medications: • Nitroglycerine • Isosorbide

Antianginals Side Effects: • Hypotension • Tachycardia • Headache • Dizziness Nursing Considerations: • Check expiration date • Teach when to take medication • May take Q5min x3 doses • Wet with saliva and place under tongue NSAIDS Side Effects: • GI upset • Dizziness • Headache • Bleeding • Fluid retention Nursing Considerations: • Take with food or after meals • Monitor liver and renal function • Use cautiously with aspirin allergy • Check for bleeding Thrombolytics Side Effects: • Bleeding • Bradycardia • Dysrhythmias Nursing Considerations: • Monitor for bleeding • Have Amino Caproic Acid Available • Check pulse, color, sensation of extremities • Monitor EKG

NSAIDS Action: • Inhibits prostaglandin synthesis Used for: • Arthritis • Mild to moderate pain • Fever

NSAIDS Medications: • Motrin • Indocin • Naprosyn

Thrombolytics Action: • Dissolves or lyses blood clots Used for: • Acute Pulmonary Emboli • Thrombosis • MI • Contraindicated in: hemophilia, CVA, Trauma, not used in patients over 75 years old, not used in patients taking anticoagulants

Thrombolytics Medications: • Streptokinase • Urokinase • Tissue Plasminogen Activator

Anaphylaxis • Symptoms o Hives o Rash o Difficulty breathing (first sign) o Diaphoresis • Nursing care o Epinephrine 0.3 ml of 1:1000 solution SQ o Massage site o May repeat in 15-20 min.

Delayed Allergic Reaction • Symptoms: o Rash, Hives, Swollen Joints • Nursing Care o Discontinue medication o Topical Antihistamines o Corticosteroids o Comfort measures Bone Marrow Depression Symptoms: Fever, Chills, Sore Throat Back pain, Dark urine Anemia, Thrombocytopenia, Leukopenia Nursing Care: Monitor CBC Protect from infections Avoid injury Liver impairment: light stools and dark urine Renal Impairment: decrease Hematocrit Anticholinergic Effects • Symptoms: o Dry mouth, Dysphagia, Nasal Congestion o Urinary retention, Impotence • Nursing Care: o Sugarless lozenges o Good mouth care o Void before taking medication Parkinson’s-like effects • Symptoms: o Akinesia (temporarily paralysis of muscles) o Tremors o Drooling o Changes in gait o Rigidity o Akathisia (Extreme restlessness) o Dyskinesia (Spasms) • Nursing Care: o Anticholinergic and Antiparkinsonian medications o Safety measures for gait

How long should a client with tuberculosis be on medication?

6-9 Months

What are symptoms of hepatitis?

What is the transmission of Hepatitis A?

What is the transmission of Hepatitis B?

Inflammation of Liver Jaundice Anorexia RUQ pain Clay-colored stools, tea-colored urine Pruritis (bile salts eliminated through skin) Elevated ALT, AST Prolonged PT (liver involvement with clotting factor) Fecal/Oral Consume contaminated food or water Travelers to developing countries at risk Clients with hepatitis A should not prepare food for others Parenteral/Sexual contact Blood or body fluids At risk individuals are the one’s that abuse IV drugs, dialysis, healthcare workers

What is the transmission of Hepatitis C? What is the transmission of Hepa D ? What nursing care are recommended for Hepatitis?

Vaccine developed Blood or body fluids Can become chronic disease Seen in patients with hemophilia (unable to clot) Co-infects with hepatitis B Rest (mainly for liver) Contact and standard precautions Low-fat, High-Calorie, and High Protein diet (needed for organ healing) No alcoholic beverages Medications (Vitamin K, Aqua-Mephyton for bleeding problems, Anti-emetic – no compazine, use Tigan or (Dramamine). Corticosteroids to decrease inflammatory response, and anti-histamines, will use lotions or baths than systemic ones. Multi-system infection caused by a tick bite. There are three stages. Erythematous papule develops into lesion with clear center (Bull’s-eye) Regional lymphadenopathy Flu-like symptoms (fever, headache, conjunctivitis) Can develop over 1 to several months Develop after 1 to 6 months if disease untreated. Cardiac conduction defects Neurologic disorders (Bell’s palsy, temporary paralysis) Develops after 1 to several months, if reached at this stage may persist for several years. Arthralgias Enlarged, inflamed joints Cover exposed areas when in wooded areas Check exposed areas for presence of ticks Antibiotics 3-4 weeks Stage 1 use Doxicillin IV penicillin with later stages Painless chancre fades after 6 weeks Low grade fever Copper-colored rash on palms and soles of feet Spread by contact of mucous membranes, congent Treat with Penicillin G IM If patient has penicillin allergy, will use erythromycin for 10-15 days. After treatment, patient must be retested to make sure disease is gone. If female maybe asymptomatic and will be unaware of having disease. Males may have thick discharge from urethra. Some females from vagina. Spread mucous membranes, congenital IM Rocephin with Doxycycline PO, IM Aqueous Penicillin with PO Probenecid (used for gout, used with Penicillin because it delays the urinary excretion of it, makes it more effective) Complication: Pelvis Inflammatory Disease Most often affected with Chlamydia also, then treatment with PO Tetracycline No cure. Painful vesicular genital lesions Problem is exacerbations/remissions Reoccurs with stress, infection, menses Spread by contact of mucous membranes,

What is Lyme’s Disease? What is Stage 1 of Lyme’s Disease?

What is Stage 2 of Lyme’s Disease?

What is Stage 3 of Lyme’s Disease? What are some Lyme’s Disease teaching? What are some Lyme’s Disease nursing care? What are the treatment, mode of transmission, care, signs and symptoms of syphillis?

What are the treatment, mode of transmission, care, signs and symptoms of gonorrhea?

What are the treatment, mode of transmission, care, signs and symptoms of genital herpes?

What are the treatment, mode of transmission, care, signs and symptoms of Chlamydia?

What are the treatment, mode of transmission, care, signs and symptoms of Venereal Warts?

What is the difference between AIDS and HIV +?

What are some opportunistic infections of AIDS?

How is AIDS transmitted?

What are diagnostics test associated with AIDS?

congenital Treatment: Acyclovir, sitz bath Monitor pap smears regularly because of higher incidence of cervical cancer. Emotional support of client/significant others important because of no cure. Pregnant women with active disease will have C-section. Men: urethritis, dysuria Women: thick vaginal discharge with acrid odor Spread by mucous membranes, congenital Treatment with Tetracycline or Doxycycline PO Will cause sterility if left untreated. Important to notify sexually contacted. Single, small papillary lesion spreads into large cauliflower cluster on perineum, vagina, penis. May itch or burn. Spread by mucous membranes, congenital Treatment: Curettage, cryotherapy with liquid nitrogen, kerotolytic agents Avoid intimate contact until lesions heal Complication: Genital Dysplasia Cancer HIV Positive—presence of HIV in blood AIDS—has significant defects in immune function associated with positive HIV evidenced by development of opportunistic infections Syndrome where CD4 counts are below 200 P. Carinii Pneumonia: sob/dry-nonproductive cough C. Albicans stomatitis: will have difficulty swalling and white exudates in back of throat C. Neoformans: debilitating form of meningitis that may suffer seizures. Cytomegalovirus (CMV): will experience lymphadenopathy and may have visual impairment and can affect any organ. Kaposi’s Sarcoma: most common malignancy experience with AIDS, small purplish brown, nonpainful, nonpuriitc palpable lesions on the body. Contaminated blood or body fluids Sharing IV needles Sexual contact Transplacental: across placenta Possibly by breast milk ELISA test, if positive will be confirmed by Western Blot test HIV Viral culture: Leukopenia, Thrombocytopenia, Decrease CD4 counts Prevention: avoid IV drug use, precautions regarding sexual patterns, use standard precautions Contact and standard precautions High-protein and high-calorie diet, small frequent meals rather than 3 large meals Symptomatic relief Support Don’t share toothbrush/shavers Prevention most important. Treat patient first, and then the poison. Recognize signs of symptoms of accidental poison: changes in appearance, behavior, substances around mouth, empty containers, vomitous. Call poison control center. Tell them: substance, time, amount and route of ingestion, child’s condition, age, weight,

What are some nursing cares for AIDS?

What are treatments, care, prevention of poison control?

What should happen when someone is poisoned?

Why should vomit not be induced?

What medication treatment is used to induce vomiting and what other factors need to be implemented?

save vomitus, stool, urine. Don’t induce if: Danger of aspiration, decrease LOC, Ingested petroleum distillate (lighter fluid, kerosene, paint remover) Ingested corrosive (Draino) Syrup of Ipecac with small amount of water. Don’t give large amount of fluid after Ipecac, will increase gastric emptying. Don’t use milk. Position with head lower then chest. No universal antidote. Intubated if comatose Run blood gases IV fluids Cardiac Monitor Gastric Lavage (NG down to flush with NS to remove rest in stomach) Activated Charcoal May use cathartics, diuretics Tinnitus, change in mental status, Increased temperature, hyperventilation, bleeding, nausea and vomiting. Nursing care: induce vomiting, maintain hydration, reduce temperature (sponge baths), monitor for bleeding. Symptoms: nausea/vomiting, hypothermia, If no treatment, hepatic/liver involvement. If liver gets involved patient may have RUQ pain, jaundice, confusion, and coagulation abnormalities. Nursing care: induce vomiting, maintain hydration, monitor liver and kidney function with labs such as AST/ALT enzymes. Tylenol (Acetaminophen) overdosage: Antidote N-acetylcysteine (Mucomyst) Symptoms: Irritability, decreased activity, abdominal pain, Increased ICP Diagnostic tests: Blood lead levels (>9micrograms = toxic), Erythrocyte protoporphyrin (EP), X-ray long bones (lead deposits in long bones) Children engage in PICA (ingesting nonfood substances) Lead blocks formation of hemogloblin and toxic to kidneys. Nursing care: identify source, chelating agents, teaching parents Decontaminate individual Prevent spread of contamination Clean and remove contaminuated source Monitor personnel exposed If chemical poses threat to caregiver, decontaminate patient first. If chemical poses no threat or patient has been decontaminated, begin care. If immediate threat to life, put on protective garments and provide care to stabilize patient. Solitary play. Game is one sided. Like to play with body parts. Birth-3months: smile/squeal 3-6months: rattles/soft stuff toys 6-12 months: begin imitation, peek-a-boo, patty-cake Parallel play. Associative play. Dress up/imitating play.

What should happen to poison control in emergency care?

What are signs and symptoms, treatments, care, prevention of aspirin poisoning?

What are signs and symptoms, treatments, care, prevention of tylenol poisoning?

What are signs and symptoms, treatments, care, prevention of lead toxicity?

What are nursing care goals for Hazardous wastes?

What are nursing care for Hazardous wastes?

What type of play do infants (012months) use?

Play of toddlers (1-3 years) Play of pre-schoolers (3-6years)

Play 0f school age (6-12years) According to Erikson’s Developmental Task, explain the Infancy stage. According to Erikson’s Developmental Task, explain the Toddler stage. According to Erikson’s Developmental Task, explain the Preschool stage.

Talking on telephone/kitchen/tool belt Cooperative play. Conformed/organized play. Birth-18 months. Trust vs. Mistrust Positive outcome---trusts self Negative outcome---withdrawn 18months – 3 years Autonomy vs. Shame and Doubt Positive outcome---exercise self-control Negative outcome---defiant and negative 3-6 years Initiative vs. Guilt Children develop conscience at this age. Positive Outcome---learns limits Negative Outcome---fearful, pessimistic 6-12years Industry vs. Inferiority Positive---sense of confidence Negative---self doubt, inadequate 12-20 years Identity vs. Role diffusion Positive outcome---coherent sense of self Negative outcome---lack of identity 20-45 years Intimacy vs. Isolation Positive outcome---intimate relationships/careers formed Negative outcome---avoidance of intimacy 45-65 years Generativity vs. Stagnation Positive Outcome---creative and productive Negative Outcome---self centered 65+ years Integrity vs. Despair No regrets in life or Regrets Positive outcome---seems life as meaningful Negative outcome---life lacks meaning 1 month 2 months

According to Erikson’s Developmental Task, explain the School age stage. According to Erikson’s Developmental Task, explain the Adolescence stage. According to Erikson’s Developmental Task, explain the young adult stage. According to Erikson’s Developmental Task, explain the middle adulthood stage. According to Erikson’s Developmental Task, explain the Late adulthood stage. At what month does the head sag? At what month do you see closing of posterior fontanelle, turn from side to back, and see a social smile? What toys do you give for a 2 month old? At what month does a child bring objects to mouth and head erect? What toys do you give for a 4 month old? Which age does birth weight double? At what age does teething occur? What toys do you give for a 6 month old? What age for fears of strangers? When is fear strongest? Which month able to play peeka-boo? What toys do you give for 78months? What month can a child say “DADA? What month can a child crawl well?

Mobiles, wind up infant swings, soft clothes, and blankets. 3 months

Rattles, cradle gym, and stuffed animals 5 months 6 months Brightly colored, small enough to grasp, large enough for safety, teething toys 7 months 8 months is stronger 7 months Large colored, bricks, jack in the box 9 month 10 months

What month can a child stand erect with support? What happens in the 12th month of the child?

11 months Birth weight triples. Eats with fingers. Anterior Fontanelle almost close. Babinski reflex disappears. Toys: books with large pictures, push pull toys, teddy bears, a large ball, or sponge toys.

Explain introduction of solid foods.

What does a toddler do at 15 months? What does a toddler do at 18 months?

What does a toddler do at 24 months?

What does a toddler do at 30 months?

What type of toys are included for Toddlers? How do you avoid negativism during toddler ages? What can a 3 year old do?

What can a 4 year old do?

What can a 5 year old do? What toys are used for

One food at a time. Begin with least allergenic foods first. • Cereal is usually first. (Do not use cow’s milk/whole milk. After six months of age cereal can be mixed with fruit juices. Fruit juices should be offered in a cup to prevent dental carries.) • Vegetables • Fruits • Potatoes • Meats • Eggs • Orange Juice • By 12 months children should be eating table food. Don’t give honey under 12 because of botulism. Walks alone. Throws object. Holds spoon. Say 4-6 words. Understand simple commands. Anterior fontanelle closes. Climbs stairs. Sucks thumb. Say 10 + words. Temper Tantrums. 300 world vocabulary. Obeys easy commands. Go up/down stairs alone. Build towers. Turn doorknobs/unscrew lids. Increase independence. Walk tip toe. Stand on one foot balance. Has control for sphincter training. Birth weight quadrupled. State first/last name. Give simple commands. Cooking utensils, Dress-up clothes, rocking horses, finger paints, phonographs, cd players. Don’t ask no/yes questions. Offer them choices. Make a game out of the tasks. Rides tricycle. Undresses without help. May invent imaginary friend. Vocabulary 900 words. Egocentric in thoughts/behaviors. Laces shoes Brushes teeth Throws overhand Uses sentences. Independent Runs well/Dresses without help. Beginning cooperative play. Gender-specific behavior. Playground materials, Housekeeping toys,

preschool (3-5)? Which age groups has greatest number of fears? What would you expect with a 6 year old? What would you expect with a 7 year old? What would you expect with a 8 year old? What would you expect with a 9 year old?

Coloring books, tricycle with helmet. Preschool age children. Self-centered, show off, rude Sensitive to criticism Begins loosing temporary teeth Tends to lie. Team games/sports. Concept of time. Playing with same sex child. Seeks out friends. Writing replaces printing. Conflicts between peer groups and parents. Conflicts between independence and dependence. Likes school. Able to take on job duties (housework). Construction toys, Pets, Games, Electronic games, reading, books, bicycles with helmets. Anuresis (encourage before bed time) Encopresis Head lice Thin upper lip, vertical ridge in upper lip, short up turned nose, mental retardation, motor retardation, hearing disorders, microcephaly. Avoid alcohol 3 months before conception and throughout pregnancy. 16th week detects genetic abnormality 30th week detects L/S ratio: lung maturity Void before procedure Ultrasound given to determine position of placenta and fetus. Complications: premature labor, infection, Rh isommunization (if client Rh negative, will be given Rhogam) 5th week confirms pregnancy Determines position of fetus, placenta, and # of fetuses. Client must drink a lot of fluid before procedure for full bladder to have a clear image. At 28th week records FHR and fetal movement. Favorable result: 2+ FHR accelerates by 15bpm and last 15seconds in 20 minutes. Determines placenta’s response to labor. Done after 28th week. Fowler/Semi-Fowler. Given Oxytocin or Pitocin. Results: • Positive: Late decelerations indicates potential risk to fetus. • Negative: No late decelerations. Diseases that cross placenta or other events. Produce significant deformities or infant born with infectious process. Toxoplasmosis: no litter box changed, no gardening, no under cooked meats. Rubella: 1-16 titer immune for rubella, titer <18 susceptible. Cytomegalovirus: transmitted in body fluids. Herpes Simplex: Ascending infection. During pregnancy get treated with acyclovir. Delivery through c-section. UTI: may lead to pylonephritis, increase risk of premature birth. Syphillis: passes through placenta, causes 2nd trimester abortions, still birth, and congenital infection, may receive medication for her and her baby.

What toys are used for school age child? School age potential problems include: What are symptoms/indications of a fetal alcohol syndrome in a child? What happens with amniocentesis? What does it do?

What happens with an ultrasound?

What happens with a nonstress test? What happens with a contraction stress test?

What does Torch stand for? And their importance?

What concerns for clients that have UTI, Syphilis, Gonorrhea?

What are the danger signs of pregnancy?

What are the events in the onset of labor?

How does prolapsed umbilical cords happen? What do you do when a client has a prolapsed cord?

What is a early/sign of fetal hypoxia? What things should you know about the Informed Consent form?

What is early deceleration? What are interventions for late decelerations?

Gonorrhea: baby gets prophylactic eydrops. • Gush or fluid bleeding from vagina • Regular uterine contractions • Severe headaches, visual disturbances, abdominal pain, persistent vomiting (symptoms of PIH) • Fever or chills (symptoms of infection) • Swelling in face or fingers (symptoms of PIH) Lightening: (when baby drops to pelvis) • Primipara: occurs 2 weeks before delivery • Multipara: occurs during labor Softening of cervix Expulsion of mucus plug (bloody show) – pink tinged mucus secretion Uterine contractions: regular/progressive not Braxton-Hick’s type. Premature rupture of membranes. Presenting part not engaged. Fetal distress. Protruding cord. Call for help. Push up against presenting part off of the cord. Place in trendenlenberg position or knee chest position. Successful if FHT left unchanged. Early sign: fetal tachycardia >160 in >10minutes Late sign: fetal bradycardia <110 in > 10 minutes Nurse can witness patient sign form. Patient has to be age of capacity/adult and confident. No confused patient/drinking/already received preoperative medications. Consent must be given voluntarily and information understandable. Nurse must make sure questions are answered and form is attached to chart. Decrease in HR before peak of contraction. Indication of head compression. Position mother left side/trendenlenberg/knee chest Increase rate of IV Administer Oxygen 7-10 l/min DC Oxytocin Cord compression. Change maternal position. Administer oxygen. DC Oyxtocin/Pitocin Regular contractions increasing in frequency, duration, intensity Discomfort radiates from back Contractions do not decrease with rest Cervix progressively effaced and dilated. Irregular contractions, no change in frequency, duration, intesityDiscomfort is abdominal Contractions decrease with rest or activity No cervical changes Void Establish airway Check Apgar at 1 and 5 minutes Clamp umbilical cord Maintain Warmth Place ID band on mother and infant Rubra-bloody, day 1-3

What do variable decelerations indicate? What are signs of “True Labor”?

What are characteristics of a “False Labor”? Prior to Lumbar Epidural block what should the patient do? What should be implemented during the delivery of a newborn? What are the types of Lochia?

If fundus is displaced not centrally and off to the sides means? If client soaks pad in 15 minutes or pooling of blood? What are assessments and implementations for an “Ectopic Pregnancy”?

Serosa-pink-brown, day 4-9 Alba-yellow-white, 10+ days Bladder distended. Check for hemorrhage Unilateral lower quadrant pain. Rigid, tender abdomen Low Hct and hCG levels Bleeding Monitor for shock Administer RhoGAM Provide support A placenta that’s implanted in the lower uterine segment near cervical os, during pregnancy placenta is torn away causing: First and second trimester spotting Third and trimester painless, profuse bleeding Bedrest side-lying or trendelenburg position, ultrasound to locate placenta, no vaginal or rectal exams, amniocentesis for lung maturity, daily Hgb, Hct, Monitor bleeding The premature separation of a placenta that is implanted in a correct position. Painful vaginal bleeding Abdomen tender, painful, tense Possible fetal distress/Contractions Monitor for maternal and fetal distress Prepare for immediate delivery Monitor for complications: DIC, pulmonary emboli Hyperglycemia after 20 weeks Usually controlled by diet Oral hypoglycemic medications contraindicated Test for diabetes at 24-28 weeks on all women with average risk 20. Frequent monitoring of mother/fetus during pregnancy. Teach to eat prescribed amount of food daily at same times Home glucose monitoring Teach about change in insulin requirements Elevated hCG Uterine size larger than expected for dates No FHT Minimal dark red/brown vaginal bleeding with grape like clusters Nausea and vomiting Associated with PIH Curettage to remove tissue Pregnancy discouraged for 1 year Do not use IUD hCG levels monitored for 1 year Temp. 97.7-99.7 HR sleep 100, awake 120-140, 180 crying Resp 30-60 BP arm/calf 65/41 Caused by immature hepatic function Physiological Jaundice (No treatment required) • Seen after 24 hours • Peaks at 72 hours • Lasts 5-7 days Breast-Feeding Associated Jaundice (Frequent breast feeding) • Caused by poor milk intake • Onset 2-3 days • Peaks 2-3 days

What are assessments and implementations for “Placenta Previa”?

What are the assessments and implementation for “Abruptio Placentae”?

What are assessments and implementations for Gestational Diabetes Mellitus (GDM)?

What are assessments and implementation for a Hydatidiform Mole?

What are the newborn vital signs? What are assessments and implementation for Hyperbilirubinemia?

Breast Milk Jaundice (discontinue breast feeding for 24 hours) • Caused by factor in breast milk • Onset 4-5 days • Peak 10-15 days Hemolytic Disease (Phototherapy then exchange transfusion) Caused by blood antigen incompatibility (Rh or ABO incompatibility) Onset first 24 hours Peak variable What are assessments and implementations for a NarcoticAddicted infant? Assessments • High-pitched cry (Hallmark sign) • Hyperreflexia • Decreased sleep • Tachypnea (>60/min) • Frequent sneezing and yawning • Seen at 12-24 hours of age, up to 7-10 days Implementation • Reduce environmental stimuli • Administer Phenobarbital, chlorpromazine, diazepam, paregoric • Wrap snugly, rock, and hold tightly • Assess muscle tone, irritability, vital signs. Sudden-onset fever Vomiting, diarrhea Hypotension Erythematous rash on palms and soles Administer antibiotics Educate about use of tampons (change tampon Q3-Q6 hours) Immunization is a primary prevention Severe febrile illness Altered immune system Previous allergic response Recently acquired passive immunity Assessment Urticaria, rash Wheezing, Rhinitis, Conjunctivitis, Bronchospasms Anaphylactic shock Implementation Screen for sensitivity Avoid latex products: gloves, catheters, brown ace bandages, band aid dressing, elastic pressure stockings, balloons, condoms Steamy shower Exposure to cold air Cool, humidified air

What are the assessments and implementations of Toxic Shock Syndrome?

What are contraindications to Immunizations?

What are assessments and implementations for a “Latex Allergy”?

What are implementations for Croup syndromes at home?

Universal Donor Blood: Packed red blood cells (help oxygen deliver to tissue, if you use whole blood there will be a risk for fluid overload), type O, Rh-negative 5% Sodium Bicarbonate—metabolic alkalosis solution Older adults are asymptomatic when they have an infection and can lead to confusion. Mononucleosis: complication enlarged spleen; concerned for trauma if child plays dangerous sport. Lyme disease:found mainly in mid alantic states (Connecticut) Pottery is unglazed can lead to “Lead Toxicity”

Apgar Score: normal 7-10 WBC after pregnancy? Ampicillin decreases oral contraceptives efficiency. Tricuspid area: 5th intercostals space in the left sternum area Tracheostomy care: no powder, suction trachea first then mouth, use pre-cut gauze. Hip-Flexion: causes increased intra-abdominal/thoracic pressure. Injury C3 and above need respiratory ventilation. SIADH causes: lung cancer, Cisplatin (Platinol) Chest Tubes • Fill water-seal chamber with sterile water to 2 cm (middle chamber) • Fill suction control chamber with sterile water to 20 cm (chamber all the way to the right) • Air-leak if bubbling in water-seal chamber (middle chamber) • Obstruction: “milk” tube in direction of drainage • Removal o chest tube: pt. does valsalva maneuver, clamp chest tube, remove quickly, apply occlusive dressing • Dislodged: apply tented dressing • Tube becomes disconnected from drainage system, cut off contaminated tip, insert sterile connector and reinsert • Tube becomes disconnected from drainage system, immerse in 2cm of water Jackson-prat: Notify physician if drainage increases or becomes bright red Penrose: Expect drainage on dressing Tracheostomy Tube Cuff • Prevents aspiration of fluids/separates upper and lower airways • Inflated during continuous mechanical ventilation • Inflated during and after eating • Inflated during and 1 hour after tube feeding • Inflated when patient cannot handle oral secretions • • • • • NCLEX-RN exam is a “here and now” test; take care of problem now to prevent harm to client. Do not ask “why” on the licensure exam Morphine Sulfate for pancreatitis causes spasms of the sphincter of Oddi; Meperidine is drug of choice. Normal Intraocular Pressure is 10-21 mm Hg Ecchymosis (faint discoloration) around the umbilicus or in either flank indicates retroperitoneal bleeding

The parenteral form of Chlorpheniramine Maleate is use to relieve symptoms of anaphylaxis allergic reactions to blood or plasma. Herbs: Toxicities and Drug Interactions

Chamomile Uses: Chamomile is often used in the form of a tea as a sedative. Reactions: Allergic reactions can occur, particularly in persons allergic to ragweed. Reported reactions include abdominal cramps, tongue thickness, tightness in the throat, swelling of the lips, throat and eyes, itching all over the body, hives, and blockage of the breathing passages. Close monitoring is recommended for patients who are taking medications to prevent blood clotting (anticoagulants) such as warfarin. Echinacea

Uses: Largely because white blood cells in the laboratory can be stimulated to eat particles, Echinacea has been touted to be able to boost the body's ability to fight off infection. Reactions: The most common side effect is an unpleasant taste. Echinacea can cause liver toxicity. It should be avoided in combination with other medications that can affect the liver (such as ketaconazole, leflunomide (Arava), methotrexate (Rheumatrex), isoniazide (Nizoral). St. John's Wort Uses: St. John's Wort is popularly used as an herbal treatment for depression, anxiety, and sleep disorders. It is technically known as Hypericum perforatum. Chemically, it is composed of at least 10 different substances that may produce its effects. The ratios of these different substances varies from plant to plant (and manufacturer). Studies of its effectiveness by the National Institutes of Health are in progress. Reactions: The most common side effect has been sun sensitivity which causes burning of the skin. It is recommended that fair- skinned persons be particularly careful while in the sun. St. John's wort may also leave nerve changes in sunburned areas. This herb should be avoided in combination with other medications that can affect sun sensitivity (such as tetracycline/Achromycin, sulfa- containing medications, piroxicam (Feldend). St. John's wort can also cause headaches, dizziness, sweating, and agitation when used in combination with serotonin reuptake inhibitor medications such as fluoxetine (Prozac) and paroxetine (Paxil). Garlic Uses: Garlic has been used to lower blood pressure and cholesterol (Dr. Lucinda Miller notes that there is "...still insufficient evidence to recommend its routine use in clinical practice.") Reactions: Allergic reactions, skin inflammation, and stomach upset have been reported. Bad breath is a notorious accompaniment. Studies in rats have shown decreases in male rats' ability to make sperm cells. Garlic may decrease normal blood clotting and should be used with caution in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin /Coumadin. Feverfew Uses: Most commonly used for migraine headaches. Reactions: Feverfew can cause allergic reactions, especially in persons who are allergic to chamomile, ragweed, or yarrow. Nonsteroidal anti-inflammatory drugs (NSAIDs such as ibuprofen (Advil), naproxen (Aleve) or Motrin) can reduce the effect of feverfew. A condition called "postfeverfew syndrome" features symptoms including headaches, nervousness, stiffness, joint pain, tiredness, and nervousness. Feverfew can impair the action of the normal blood clotting element (platelets). It should be avoided in patients taking medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin).

Ginko Biloba Uses: This herb is very popular as a treatment for dementia (a progressive brain dysfunction) and to improve thinking. Reactions: Mild stomach upset and headache have been reported. Ginko seems to have blood thinning properties. Therefore, it is not recommended to be taken with aspirin, nonsteroidal anti-inflammatory drugs (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginko should be avoided in patients with epilepsy taking seizure medicines, such as phenytoin (Dilantin), carbamazepine (Tegretol), and phenobarbital. Ginseng Uses: Ginseng has been used to stimulate the adrenal gland, and thereby increase energy. It also may have some beneficial effect on reducing blood sugar .in patients with diabetes mellitus. (Dr. Miller emphasized that there is substantial variation in the chemical components of substances branded as "Ginseng.") Reactions: Ginseng can cause elevation in blood pressure, headache, vomiting, insomnia, and nose bleeding. Ginseng can also cause falsely abnormal blood tests for digoxin level. It is unclear whether ginseng may affect female hormones. Its use in

pregnancy is not recommended. Ginseng may affect the action of the normal blood clotting element (platelets). It should be avoided in patients taking aspirin, nonsteroidal antiinflammatory drugs (such as ibuprofen (Advil), naproxen (Aleve) or Motrin), or medications to prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Ginseng may also cause headaches, tremors, nervousness, and sleeplessness. It should be avoided in persons with manic disorder and psychosis. Ginger Uses: Ginger has been used as a treatment for nausea and bowel spasms. Reactions: Ginger may lead to blood thinning. It is not recommended to be taken with medications that prevent blood clotting (anticoagulants) such as warfarin (Coumadin). Saw Palmetto Uses: Saw palmetto has been most commonly used for enlargement of the prostate gland. (Dr. Miller emphasized that studies verifying this assertion are necessary.) Saw palmetto has also been touted as a diuretic and urinary antiseptic to prevent bladder infections. Reactions: This herb may affect the action of the sex hormone testosterone, thereby reducing sexual drive or performance. Dr. Miller states that "While no drug-herb interactions have been documented to date, it would be prudent to avoid concomitant use with other hormonal therapies (e.g., estrogen replacement therapy and oral contraceptives...") Black Cohosh Claims, Benefits: A natural way to treat menopausal symptoms. Bottom Line: Little is known about its benefits and its risks. A child with celiac disease mustn’t consume foods containing gluten and therefore should avoid prepared puddings, commercially prepared ice cream, malted milk, and all food and beverages containing wheat, rye, oats, or barley. The infant of a diabetic mother may be slightly hyperglycemic immediately after birth because of the high glucose levels that cross the placenta from mother to fetus. During pregnancy, the fetal pancreas secretes increased levels of insulin in response to this increases glucose amount that crosses the placenta from the mother. However, during the first 24 hours of life, this combination of high insulin production in the newborn coupled with the loss of maternal glucose can cause severe hypoglycemia. Frequent, early feedings with formula can prevent hypoglycemia Stump elevation for the first 24 hours after surgery helps reduce edema and pain by increasing venous return and decreasing venous pooling at the distal portion of the extremity. A platypelloid pelvis has a flat shape. A gynecoid pelvis is a normal female pelvis. An anthropoid pelvis has an oval shape, and an android pelvis has a heart shape. The pulse is the earliest indicator of new decreases in fluid volume. Adult Rickets: deficiency in vitamin D. Chronic Pain: normal blood pressure, heart rate, and respiratory rate. Normal pupils and dry skin. Acute pain: causes increased blood pressure, increased pulse, and respiratory rate, dilated pupils, and perspiration. The tip of the endotracheal tube lies 1 cm above the carina. This is positioned above the bifurcation of the right and left mainstem bronchi. Creatine Phosphokinase (CPK) is a cellular enzyme that can be fractionated into three isoenzymes.

 MB band reflects CPK from CARDIAC MUSCLE (This is the level that elevates  
with an MI.) MM band reflects CPK from SKELETAL MUSCLE BB band reflects CPK from the BRAIN

ALKYLATING AGENTS: affect ALL PHASES of the reproductive cell cycle (i.e., Cyclophosphamide [Cytoxan]) ANTIMETABOLITES: are cell cycle phase-specific and affect the S PHASE (i.e., Cytarabine [Cytosar]) VINCA ALKALOIDS: are cell cycle phase-specific and act on the M PHASE Bell’s Palsy: is a one-sided facial paralysis from compression of the facial nerve. The exact cause is unknown. Possible causes include vascular ischemia, infection, exposure to viruses such as herpes zoster or herpes simplex, autoimmune disease, or a combination of these items. McBURNEY’S POINT: is midway between the right anterior superior iliac crest and the umbilicus. This is usually the location of greatest pain in the child with appendicitis. MMR: administered SQ in the outer aspect of the upper arm. Watch for absolute words “NOT” and “ONLY” AIR EMBOLISM POSITIONING: Place the client on the left side in the trendelenburg position. Lying on the left side may prevent air from flowing into the pulmonary veins. The trendelenburg position increases intrathoracic pressure, which decreases the amount of blood pulled into the vena cava during inspiration. Trigeminal neuralgia pain medication: Use Carbamazepine (Tegretol) and Phenytoin (Dilantin). Narcotic analgesics (Meperidine Hydrochloride [Demerol], Codeine Sulfate , and Oxycodone) are not effective in controlling pain caused by trigeminal neuralgia. Grapefruit juice can raise cyclosporine (Sandimmune) levels by 50% to 100%, risk for toxicity. Fomepizole (Antizol): an antidote given IV to a client with Ethylene Glycol (Antifreeze) intoxication Phenotolamine (Regitine): antidote for hypertensive crisis Bromocriptine (Parlodel): an antiparkinsonian prolactin inhibitor, is used to treat NMS. Biophysical profile: assesses five parameters of fetal activity: fetal heart rate, fetal breathing movements, gross fetal movements, fetal tone, and amniotic fluid volume. In a biophysical profile, each of the five parameters contributes 0 to 2 points with a score of 8 being considered normal and a score of 10 perfect.

Gravidity, the number of pregnancies.

Term births, the number born at term (40 weeks).

Preterm births, the number born before 40 weeks’ gestation.

Abortions/miscarria ges

Live births, the number of live births or living children

Included in gravida if before 20 weeks’ gestation Included in parity if past 20 weeks’

gestation Therefore a woman who is pregnant with twins and has a child has a gravida of 2. Because the child was delivered at 38 weeks, the number of preterm births is 1, and the number of term births is 0. The number of abortions is 0, and the number of live births is 1.

Probable signs of pregnancy:

• • •
• • •

Uterine enlargement Hegar’s sign (Softening and thinning of the lower uterine segment that occurs about week 6) Goodell’s sign (softening of the cervix that occurs at the beginning of the second month) Chadwick’s sign (bluish coloration of the mucous membranes of the cervix, vagina, and vulva that occurs about week 6) Ballottement (rebounding of the fetus against the examiner’s fingers on palpation) Braxton Hicks contractions A positive pregnancy test measuring for human chorionic gonadotropin

Positive signs of pregnancy:
• • • Fetal heart rate detected by electronic device (Doppler transducer) at 8-12 weeks and by nonelectronic device (Fetoscope) at 20 weeks of gestation Active fetal movements palpable by examiner An outline of fetus via radiography or ultrasound

Acetazolamide (Diamox): used for management of glaucoma is a carbonic anyhdrase inhibitor that has sulfonamide properties.

Watch out for absolute words “ALL” and “ALWAYS” Before NG removal: bowel sounds have to be present.

Hyperkalemia on Electrocardiogram:
Tall, peaked T waves; prolonged PR interval; widening QRS complex

Hypokalemia on Electrocardiogram: ST segment depression; Flat T wave First-Degree Heart Block: Prolonged P-R interval Bundle Branch Block: Widened QRS complex Myocardial Necrosis in Area: Q waves present Ventricular Fibrillation: No visible P waves or QRS complexes, no
measurable rate. Irregular, chaotic undulations of varying amplitudes.

HypoCalcemia: Prolonged Q-T interval Myocardial Ischemia: ST segment elevation or depression Premature Ventricular Contractions: absence of P waves, wide and
bizarre QRS complexes, and premature beats followed by a compensatory pause

Ventricular Tachycardia: absence of P waves, wide QRS complexes,
rate between 100 and 250 impulses per minute. Regular rhythm

Atrial Fibrillation: no P waves; instead there are wavy lines, no PR
interval. QRS duration is WNL and irregular ventricular rate can range from 60-160 beats/minute.

Stable Triggered by a predictable amount of effort or emotion. Unstable Triggered by an unpredictable amount of exertion or emotion and may occur at night; the attacks increase in number, duration, and severity over time. Variant Triggered by coronary artery spasm; the attacks tend to occur early in the day and at rest. Intractable Chronic and incapacitating and is refractory to medical therapy.

Cardiac Conduction System: Sinoatrial NodeInternodal/Interatrial
pathwaysAV nodeBundle of HisR/L Bundle BranchesPurkinje fibers

Pulse rate is the earliest indicator of decrease in fluid volume.
A1-adrenergic receptors: found in the peripheral arteries and veins and cause a powerful vasoconstriction when stimulated A2-adrenergic receptors: several tissues and contract smooth muscle, inhibit lipolysis, and promote platelet aggregation. B1: Found in the heart and cause an increase in heart rate, atrioventricular node conduction, and contractility. B2: Arterial and bronchial walls and cause vasodilation and bronchodilation. PULSE PRESENT = NO DEFIBRILLATION Myxedema (a.ka. Hypothyroidism) Suggested toys a. birth to six months - mobiles, unbreakable mirrors, music boxes, rattles b. six to 12 months - blocks, nesting boxes or cups, simple take apart toys, large ball, large puzzles, jack in the box, floating toys, teething toys, activity box, push-pull toys c. Solitary play Toddlerhood (one year to three years) Play is parallel • Suggested toys: push-pull toys, finger paints, thick crayons, riding toys, balls, blocks, puzzles, simple tape recorder, housekeeping toys, puppets, cloth picture books, large beads to string, toy telephone, water toys, sand box, play dough or clay, chalk and chalkboard

Preschool age (three years to six years) • • • • • Preschool play is associative and cooperative. dress-up fantasy play imaginary playmates Suggested toys: tricycle, gym and sports equipment, sandboxes, blocks, books, puzzles, computer games, dress-up clothes, blunt scissors, picture games, construction sets, musical instruments, cash registers, simple carpentry tools

School age (six years to 12 years) Play is cooperative. 1. 2. 3. 4. 5. 6. sports and games with rules fantasy play in early years clubs hero worship cheating Suggested toys/activities: board or computer games, books, collections, scrapbooks, sewing, cooking, carpentry, gardening, painting

Tympany: Drumlike, loud, high pitch, moderate duration; usually found over spaces containing air such as the stomach Resonance:Hollow sound of moderate to loud intensity; low pitch, long duration; Usually heard over lungs Hyperresonance: Booming sound of very loud intensity; very low pitch, long duration; Usually heard in the presence of trapped air (such as emphysematous lung)Flatness: Flat sound of soft intensity; high pitch; short duration; Usually heard over muscle Dullness:Thud-like sound of soft intensity; high pitch; moderate duration; Usually heard over solid organs (such as heart, liver) body temperature o range: 36 to 38 degrees Celsius (98.6 to 100.4 degrees Fahrenheit)

St. John's wort - antidepressant Garlic - antihypertensive Ginseng - Anti stress Green tea - antioxidant Echinacea - immune stimulant (6-8 weeks only) Licorice - cough and cold Ginger root - antinausea Ginkgo - improves circulation Ma huang - bronchodilator, stimulant Anatomical Landmarks of the HEART

i. ii. iii. iv. v.

second right intercostal space - aortic area second left intercostal space - pulmonic area third left intercostal space - Erb's point fourth left intercostal space - tricuspid area fifth left intercostal space - mitral (apical) area epigastric area at tip of sternum

Range of Normal Blood Pressure i. ii. iii. iv. child under age two weighing at least 2700g: use flush technique,30-60mg Hg child over age two: 85-95/50-65 mm Hg school age: 100-110/50-65 mm Hg adolescent: 110-120/65-85 mm Hg


adult: <130 mm Hg Systolic / <85 mm Hg diastolic

Normal Range of Peripheral Pulses • • infants: 120 to 160 beats/minutes toddlers: 90 to 140 beats/minutes

• •

preschool/school-age: 75 to 110 beats/ minute adolescent/adult: 60 to 100 beats/minute

Normal Rates of Respirations • • • • • • newborn: 35 to 40 breaths/minute infant: 30 to 50 breaths/minute toddler: 25 to 35 breaths/minute school age: 20 to 30 breaths/minute adolescent/adult: 14 to 20 breaths/minute adult: 12 to 20 breaths/minute

CRANIAL NERVE FUNCTION 1. Olfactory (CN I) • • Can identify variety of smells Deviation: Inability to identify aroma

2. Optic (CN II) • • • Has visual acuity and full visual fields Fundoscopic exam reveals no pathology Deviation: Inability to identify full visual fields - total or partial blindness of one or both eyes

3, 4, 6. Oculomotor (CN III), trochlear (CN IV), and abducens (CN VI) • • • • Follows up to six cardinal positions of gaze Pupils are unremarkable Exhibits no nystagmus and no ptosis Deviation: one or both eyes will deviate from its normal position

5. Trigeminal (CN V) • • • • • • Clenches teeth with firm bilateral pressure Has no lateral jaw deviation with mouth open Feels a cotton wisp touched to forehead, cheek and chin Differentiates sharp and dull sensations on face Corneal reflex; blinks when cotton is touched to each cornea Deviation: Absent or one-sided blinking of eyelids

7. Facial (CN VII) • • • • • • • • Has facial symmetry with and without a smile Can raise the eyebrows symmetrically and grimace Can shut eyes tightly Can identify sweet, sour, salt or bitter on the anterior tongue Deviation: Irregular and unequal facial movements Deviation: Inability to taste or identify taste Deviation: Inability to taste or identify salt, sweet, sour, or bitter substances on the anterior two-thirds of the tongue Deviation: Inability to smile symmetrically

8. Acoustic (CN VIII) • • • • Can hear a whisper at 1-2 feet Can hear a watch tick at 1-2 feet Does not lateralize the Weber test Can hear AC (air conduction) better than BC (bone conduction) in the Rinne test

Deviation: Inability to hear spoken word

9, 10. Glossopharyngeal (CN IX) and Vagus (CN X) • • • • • • • Swallows and speaks without hoarseness Palate and uvula rise symmetrically when patient says "ah" Bilateral gag reflex Can identify taste on the posterior tongue Deviation: Unequal or absent rise of uvula and soft palate as the client says, "ah" Deviation: Absent gag reflex Deviation: inability to taste or identify taste on the posterior tongue

11. Spinal accessory (CN XI) • • • Resists head turning Can shrug against resistance Deviation: Weak or absent shoulder and neck movement

12. Hypoglossal (CN XII) • • • Can stick tongue out and move it from side to side Can push tongue strongly against resistance Deviation: Tongue deviates to side

Types of Coping Mechanisms

1. Compensation - extra effort in one area to offset real or imagined lack in
another area o Example: Short man becomes assertively verbal and excels in business. Conversion - A mental conflict is expressed through physical symptoms o Example: Woman becomes blind after seeing her husband with another woman. Denial - treating obvious reality factors as though they do not exist because they are consciously intolerable o Example: Mother refuses to believe her child has been diagnosed with leukemia. "She just has the flu." Displacement - transferring unacceptable feelings aroused by one object to another, more acceptable substitute o Example: Adolescent lashes out at parents after not being invited to party. Dissociation - walling off specific areas of the personality from consciousness o Example: Adolescent talks about failing grades as if they belong to someone else; jokes about them. Fantasy - a conscious distortion of unconscious wishes and need to obtain satisfaction o Example: A student nurse fails the critical care exam and daydreams about her heroic role in a cardiac arrest. Fixation - becoming stagnated in a level of emotional development in which one is comfortable o Example: A sixty year old man who dresses and acts as if he were still in the 1960's. Identification - subconsciously attributing to oneself qualities of others o Example: Elvis impersonators. Intellectualization - use of thinking, ideas, or intellect to avoid emotions o Example: Parent becomes extremely knowledgeable about child's diabetes. Introjection - incorporating the traits of others o Example: Husband's symptoms mimic wife's before she died. Projection - unconsciously projecting one's own unacceptable qualities or feelings onto others o Example: Woman who is jealous of another woman's wealth accuses her of being a gold-digger.

2. 3.


5. 6.


8. 9. 10. 11.

12. Rationalization - justifying behaviors, emotions, motives, considered
intolerable through acceptable excuses o Example: "I didn't get chosen for the team because the coach plays favorites." Reaction Formation - expressing unacceptable wishes or behavior by opposite overt behavior o Example: Recovered smoker preaches about the dangers of second hand smoke. Regression - retreating to an earlier and more comfortable emotional level of development o Example: Four year old insists on climbing into crib with younger sibling. Repression - unconscious, deliberate forgetting of unacceptable or painful thoughts, impulses, feelings or acts o Example: Adolescent "forgets" appointment with counselor to discuss final grades. Sublimation - diversion of unacceptable instinctual drives into personally and socially acceptable areas. o Example: Young woman who hated school becomes a teacher.





Elizabeth Kubler-Ross: Five Stages 1. Denial a. Unconscious avoidance which varies from a brief period to the remainder of life b. Allows one to mobilize defenses to cope c. Positive adaptive responses - verbal denial; crying d. Maladaptive responses - no crying, no acknowledgement of loss 2. Anger a. Expresses the realization of loss b. May be overt or covert c. Positive adaptive responses - verbal expressions of anger d. Maladaptive responses - persistent guilt or low self esteem, aggression, self destructive ideation or behavior 3. Bargaining a. An attempt to change reality of loss; person bargains for treatment control, expresses wish to be alive for specific events in near future b. Maladaptive responses - bargains for unrealistic activities or events in distant future 4. Depression and Withdrawal a. Sadness resulting from actual and/or anticipated loss b. Positive adaptive response - crying, social withdrawal c. Maladaptive responses - self-destructive actions, despair 5. Acceptance a. Resolution of feelings about death or other loss, resulting in peaceful feelings b. Positive adaptive behaviors - may wish to be alone, limit social contacts, complete personal business FOODS HIGH IN WATER-SOLUBLE VITAMINS A. B. C. D. E. F. G. Vitamin C - citrus fruits, cabbage, tomatoes, strawberries, broccoli Thiamine (B1) - lean meat, legumes,unrefined or enriched grains and cereals Riboflavin (B2) - enriched grains, milk, organ meats, poultry, fish Niacin - peanuts, peas, beans, meat, poultry Pyridoxine (B6) - kidneys, liver, meats, corn, wheat, eggs, poultry, fish Cyanocobalamin (B12) - kidneys, lean meats,liver, dairy products, egs Folic acid - liver, eggs, leafy green vegetables, fruits, enriched grain products FOODS CONTAINING FAT-SOLUBLE VITAMINS A. B. C. D. Vitamin Vitamin Vitamin Vitamin A - fruits, green and yellow vegetables, butter, milk, eggs, liver D - milk, fish E - green vegetables, vegetables oils, wheat germ, nuts K - liver, cheese, leafy green vegetables, milk, green tea

mucomyst: acetaminophen toxicity

Dilantin detoxified by liver. The nurse cares for a client receiving IV antibiotics every 8 hours for the past 4 days. The antibiotic is mixed in D5W. The nurse determines that a post-infusion phlebitis has occurred if which of the following is observed? 1. Tenderness at the IV site. 2. Increased swelling at the insertion site. 3. Area around the IV site is reddened with red streaks. 4. Fluid is leaking around the IV catheter. a. Tenderness occurs with phlebitis but is not specific to it. b. May indicate either infiltration or phlebitis c. CORRECT—reddened, warm area noted around insertion site or on path of vein; discontinue IV, apply warm, moist compresses, restart IV at new site d. Not indicative of phlebitis Ethacrynic Acid (Edecrin)—are considered loop diuretics and are potassium wasting; encourage client to increase intake of potassium-rich foods. Orange juice/Bananas, etc. Aminophylline (Truphylline)—is a xanthine bronchodilator; major side effects: palpitations, nervousness, rapid pulse, dysrhythmias, nausea, and vomiting. Toxic effects: confusion, headache, flushing, tachycardia, and seizure. Morphine Sulfate—decreases blood return to the right side of the heart, and decrease peripheral resistance. In other words, decreases preload and afterload pressures and cardiac workload; causes vasodilation and pooling of fluid in extremities; provides relief from anxiety. Intropin (Dopamine)—vasoactive medication are given IV to restore BP in hypotensive states; Increases blood return to the right side of the heart, and increase peripheral resistance; side effects: headache, severe hypertension, dysrhythmias; check BP q2 minutes until stabilized, then q5 minutes TPN—hang no longer than 24 hours; IV tubing and filters every 24 hours; site of catheter changed every 4 weeks. Fluoxetine (Prozac)—a selective serotonin reuptake inhibitor (SSRI) used to treat depression and obsessive compulsive disorder. Side effects: postural hypotension, dry mouth, rapid heartbeat, anorexia, weight loss, severe headache. If dose is missed, omit dose and instruct client to return to regular dosing schedule. Propanolol (inderal)—a beta-adrenergic blocker used as antihypertensive; Side effects: bronchospasm, bradycardia, depression. Take pulse before administration and gradually decrease when discontinuing. Do not give to asthmatic patients. Glipizide (Glucotrol)—an oral hypoglycemic that decreases blood sugar by stimulating insulin release from the beta cells of the pancreas; may cause aplastic anemia and photosensitivity. Prednisone (Deltasone)—a corticosteroid. Side effects: hyperglycemia Bethanechol (Urecholine)—a cholinergic or parasympathomimetic used to treat functional urinary retention; mimics action of acetylcholine. Ventricular Tachycardia—causes chest pain, dizziness, and fainting. 1 grain = 60mg Levothyroxine (Synthroid)—thyroid preparation should be administered at breakfast to prevent insomnia. Carbamazepine (Tegretol)—interferes with action of hormonal contraceptives. Side effects: photosensitivity. Aluminum Hydroxide (Amphojel)—an antacid; neutralizes hydrochloric acid and reduces pepsin activity; take one hour before and hour of sleep. Antacids most effective after digestion has started, but prior to the emptying of the stomach.

Isoniazid (INH)—Side effects: peripheral neuropathy (administer pyridoxine), rash, urticaria, and swelling of the face, lips, and eyelids. Pyridoxine (Vitamin B6, Beesix, Doxine)—required for amino acid, carbohydrate, and lipid metabolism. Used in the transport of amino acids, formation of neurotransmitters, and sythesis of heme. Prevention of neuropathy. Carbamazepine (Tegretol)—prevention of seizures and relief of pain in trigeminal neuralgia. Trigeminal neuralgia (Tic douloureux) is an agonizing pain that may result in severe depression and suicide. Clonidine (Catapres-TTS)—is a centrally acting alpha-adrenergic used to treat hypertension; Side effects: drowsiness, sedation, orthostatic hypotension, heart failure. If patch used be cautious around microwaves results in burns, dispose of carefully, and heat will increase medication absorption leading to toxicity. Phlebitis—tenderness, redness; remove iv, apply warm soaks to decrease inflammation, swelling, and discomfort. Autologous blood—may give blood 5 weeks before surgery; can give 2 to 4 units of blood; may have to take iron pills Partial-thickness burn; only part of skin is damaged or destroyed; large, thickwalled blisters develop; underlying tissue is deep red, appears wet and shiny; painful with increased sensitivity to heat; healing occurs by evolution of undamaged basal cells, takes about 21-22 days. I.E., Redness and swelling with fluid-filled vesicles noted on right arm or Blistering and blanching of the skin noted on the back. Full-thickness burn; all skin is destroyed and muscle and bone may be involved; substance that remains is called eschar, dry to touch, doesn’t heal spontaneously, requires grafting. I.E., Charred, waxy, white appearance of skin on left leg. Superficial burn; skin appears pink, increased sensitivity to heat, some swelling, healing occurs without treatment. I.E., Reddened blotchy painful areas noted on the face. Carbidopa/Levodopa (Sinemet)—used to treat symptoms of Parkinson’s disease. Take immediately before meals and high-protein meals may impair effectiveness of medication. Reduces rigidity and bradykinesis and facilitates client’s mobility. Doxycycline (Vibramycin)—a tetracycline that is taken at regular intervals but not within 1 hour of bedtime because it may cause esophageal irritation. Use another method of birth control, do not take antacids within 1-3 hours of taking medication, and may cause photosensitivity. Albuterol (Proventil)—a bronchodilator. Side effects: tremors, headache, hyperactivity, tachycardia. Use first before steroid medication so opens up bronchioles for steroid to get in. Wait one minute between puffs of the inhalers for best effect. Beclomethasone (Vanceril)—a steroid medication. Side effect: fungal infections, dry mouth, throat infections. Insulin—NPH Onset: 1.5 hours Peak: 4-12 hours Regular Onset: 0.5 hours Peak: 2.5-5 hours Topiramate (Topamax)—is an anticonvulsant. Should drink 2000-3000ml of fluid daily to prevent kidney stones. Side effects: orthostatic hypotension, ocular symptoms, blindness, and decrease effects of hormonal contraceptives. Propranolol (Inderal)—a beta-blocker that takes up beta-adrenergic receptor sites, which prevents adrenaline from causing symptoms and glycogenolysis. Inderal may mask symptoms of hypoglycemia, removing the body’s early warning system. Phenazopyridine (Pyridium)—acts on urinary tract mucosa to produce analgesic or local anesthetic effects. Side effects: bright orange urine, yellowish discoloration of skin or sclera indicates drug accumulation due to renal impairment. Trimethoprim-sulfamethoxazole (Bactrim)—most common side effect mild to moderate rash (urticaria) Aminoglycosides are ototoxic.

Butorphanol Tartrate (Stadol)—analgesic used for moderate to severe pain; Side effects include change in BP, bradycardia, respiratory depression. Infant normal resting heart rate: 120-140 Salt substitutes contain potassium When directing a UAP, the nurse must communicate clearly about each delegated task with specific instructions on what must be reported. Because the RN is responsible for all care-related decisions, only implementation tasks should be assigned because they do not require independent judgment. When applying the nursing process, assessment is the first step in providing care. The 5 "Ps" of vascular impairment can be used as a guide (pain, pulse, pallor, paresthesia, paralysis) READ THE QUESTIONS FIRST!!!!! READ THE QUESTIONS FIRST!!!!! DETERMINE THE QUESTION!!!!!! Rash and blood dyscrasias are side effects of anti-psychotic drugs. A history of severe depression is a contraindication to the use of neuroleptics. Children with celiac disease should eat a gluten free diet. Gluten is found mainly in grains of wheat and rye and in smaller quantities in barley and oats. Corn, rice, soybeans and potatoes are digestible in persons with celiac disease. The nurse instructs the client taking dexamethasone (Decadron) to take it with food or milk because Decadron increases the production of hydrochloric acid, which may cause gastrointestinal ulcers. The protest phase of separation anxiety is a normal response for a child this age (2 year-old hospitalized child). In toddlers, ages 1 to 3, separation anxiety is at its peak Signs of tardive dyskinesia include smacking lips, grinding of teeth and "fly catching" tongue movements. Verapamil, Bretylium, and Amiodarone increases serum dig levels, possibly causing Digitalis Toxicity Signs/Symptoms of Digital Toxicity: first signs include abdominal pain, anorexia, nausea, vomiting, visual disturbances, bradycardia, and other arrhythmias. In infants and small children, the first symptoms of overdose are usually cardiac arrhythmias. Restlessness, confusion, irritability and disorientation may be the first signs of fat embolism syndrome followed by a very high temperature. A Neologism is a new word self invented by a person and not readily understood by another that is often associated with a thought disorder. Pancreatic enzymes give before meals. Clinical features of delusional disorder include extreme suspiciousness, jealousy, distrust, and belief that others intend to harm. The UAP can be assigned to care for a client with a chronic condition after an initial assessment by the nurse. This client has no risk of instability of condition. Never leave your patient. For example, Ask the LPN/LVN to stay with the child and his parents while the nurse obtains phone orders from the physician. Tips for charting: don’t use inflammatory words, no nurse judgments, be as specific as possible. I.E., “Vital signs stable” is incorrect for of charting. Restraint: frame of bed, quick release ties, document need for restraint Q4 hours

Never ask “WHY” questions in the NCLEX! Gag Reflex: don’t assess gag reflex to a client that has an absent swallow reflex Nifedipine (Procardia XL): do not crush An RN that is not assigned to a patient does not have the authority to tell a nurse what to do. Refer it to nursing supervisor. If doctor has orders it should carried out unless contraindicated in nurse’s decision. Physical assessment: Inspection, Percussion, Palpation, Auscultation (Except for abdomen: Inspection, Auscultation, Percussion, Palpation) Coronary artery bypass graft (CABG)—halt medications before surgery, can do 5 at a time; will be on mechanical ventilations after surgery; chest tubes Acromegaly—monitor blood sugar, atrium—90 implant care (radioactive, nasally implanted, monitor vision) Bone marrow Aspiration---done at iliac crest; painful Postoperative care after Supratentorial surgery: maintain airway, elevate head 30-45 Position care after Infratentorial surgery: flat and lateral Orange juice does not help acidify urine it makes it more alkaline. Myelogram • Water-soluble dye—elevate head of bed 30 degrees (not removed) • Oil based dye—flat in bed (removed) Fractures:    

Immobilize joint above and below fracture Cover open fracture with cleanest material available Check temperature, color, sensation, capillary refill distal to fracture Close reduction—manually manipulate bone or use traction

Buck’s Traction  Use to relieve muscle spasm of leg and back  If used for muscles spasms only, they can turn to either side.  If used for fracture treatment, only can turn to unaffected side.  Use 8-20 lbs of weight, if used for scoliosis will use 40 lbs of weight.  Elevate head of bed for countertraction or foot bed  Place pillow below leg not under heel or behind knee. Russell’s Traction  Sling is used  Check for popliteal pulse  Place pillow below lower leg and heel off the bed  Don’t turn from waist down  Lift patient, not the leg Cervical Tongs  Never lift the weights  No pillow under head during feedings Balanced Suspension Traction  For femur realignment  Maintain weights hanging free and not on floor  Maintain continuous pull Halo Jacket  Maintain pin cleansing Casts  Don’t rest on hard surface

   

Don’t cover until dry 48+ hours Handle with palms of hands not with fingers Keep above level of heart Check for CSM

Fractured Hip • Assessments  Leg shortened  Adducted  Externally rotated • Implementation  Care after a total hip replacement • Abduction pillows • Crutch walking with 3-point gait • Don’t sleep on operated side • Don’t flex hip more than 45-60 degrees • Don’t elevate head of the bed more than 45 degrees Amputations • Guillotine (open) • Flap (closed) • Delayed prosthesis fitting  Residual limb covered with dressing and elastic bandage (figure eight) • Figure-8 doesn’t restrict blood flow, shaped to reduce edema  Check for bleeding  Elevated 24 hours (AKA-pillow, BKA-foot of bed elevated)  Position prone daily  Exercises, crutch walking  Phantom Pain: acknowledge feelings, that pain is real for them. Thiamin (Vit. B1)—carbohydarte metabolism; deficiency will cause Beri-Beri Pyridoxine (Vit. B6)—amino acid metabolism; deficiency will cause anemia, seizures Folic acid—RBC formation; deficiency will cause anemia Cyanocobalamin (B12)—nerve function; deficiency cause pernicious anemia Calcium deficiency causes Rickett’s Cultural Food Pattern’s  Orthodox Jewish (Kosher)—milk and meat cannot be eaten at same meal  Muslin—30 day fast during Ramadan  Japanese—rice is basic food, tea is main beverage  Greek—bread is served with every meal Enteral feeding held if: 150 or > cc’s aspirated or 50% given in the hour is aspirated  If cramping, vomiting occurs decrease rate of enteral feeding or keep it warm. TPN—supply nutritions via intravenous route  Peripherally or centrally  Initial rate 50/hour and can be increased to 100-125ml/hour.  A pump must be used to keep rate constant  Prevent sepsis: maintain closed system,, don’t draw blood/infuse anything in line, dry sterile dressing  Verify placement of line  Monitor Glucose, acetone  Change IV tubing/Filter Q24 hours  Solution refrigerated then warmed  If solution not available, start 10% in water.

 3/week check BUN, electrolytes (ca, mg)  When TPN Dc’d taper patient off or else will get rebound hypoglycemia (use hypotonic to do this) Specific gravity 1.010-1.030 Ph 4.5-8 1,000-1,500cc/day Crede’s Manuever—push urine out Pernicious Anemia - monthly Vitamin B12 IM injections

Metered dose inhaler - Beclomethasone (Vanceril) - Albuterol (Proventil) Guillain-Barre Syndrome - GBS often preceded by a viral infection as well as immunizations/vaccinations - Intervention is symptomatic - Acute phase: Steroids, plasmapheresis, aggressive respiratory care; prevent hazards of immobility, maintain adequate nutrition; physical therapy; painreducing measures; eye care, prevention of complications (UTI, aspiration); psychosocial support Organ Donation Criteria - No history of significant, disease, process in organ/tissue to be donated - No untreated sepsis - Brain death of donor - No history of extracranial malignancy - Relative hemodynamic stability - Blood group compatibility - Newborn donors must be full term (more than 200g) - Only absolute restriction to organ donation is documented case of HIV infection - Family members can give consent - Nurse can discuss organ donation with other death-related topics (funeral home to be used, autopsy request) Accurate way to verify NG tube position is to aspirate for gastric contents and check pH. Parkinson’s disease - Activities should be scheduled for late morning when energy level is highest and patient won’t be rushed - Symptoms: tremors, akinesia, rigidity, weakness, “motorized propulsive gait, slurred monotonous speech, dysphagia, drooling, mask-like expression. - Nursing care: encourage finger exercises. Administer Artane, Congentin, LDopa, Parlodel, Sinemet, Symmetrel. - Teach: ambulation modification - Promote family understanding of disease intellect/sight/hearing not impaired, disease progressive but slow, doesn’t lead to paralysis Normal urine output (1200-1500 cc’s/day or 50-63 cc/hr, normal voiding pattern 5-6 times/day. Green leafy vegetables contain vitamin K. Labs HbA1c (4.5-7.6%) - indicates overall glucose control for the previous 120 days Serum Amylase / Somogyl (60-160 u/dL) - elevated in acute pancreatitis Erythrocyte Sedimentation Rate (ESR) - Men (1-15)


Women (1-20) Rate at which RBC’s settle out of unclottted blood in one hour Indicates inflammation/neurosis

Hematocrit (Hct) - Men (40-45) u/mL - Women (37-45) u/mL - Relative volume of plasma to RBC - Increased with dehydration - Decreased with volume excess Creatine Kinase (CK) - Men (12-70) - Women (10-55) - Enzyme specific to brain, myocardium, and skeletal muscles - Indicates tissue necrosis or injury Serum Glucose - 60-110 mg/dL Sodium (Na+) - 135-145 mEq/L - Hypernatremia o Dehydration and insufficient water intake Chloride (Cl-) - 95-105 mEq/L Potassium (K+) - 3.5-5.0 mEq/L Bicarbonate (HCO3) - 22-26 mEq/L - Decreased levels seen with starvation, renal failure, diarrhea. Blood, Urea, Nitrogen (BUN) - 6-20 mg - Elevated levels indicate rapid protein catabolism, kidney dysfunction, dehydration Creatinine Clearance Test - normal 125 ml/min. - Lower levels reflect renal insufficiency and may influence the excretion of many drugs and toxins from the body. Lithium - targeted blood level: (1-1.5 mEq/L) Tofranil and Anafranil—OCD medications Pick physical needs over psychosocial needs!!!!!!!!!!!!!!! Focus on here and now!!!!!!!!!!!!!!!!! Oculogyric crisis: uncontrollable rolling back of eyes: side effect of Phenothiazines Moribund means dying patient. Don’t leave your patients. Stay with your patients. Assess before implementation. Manic patient: decrease stimuli and increase rest period and no competition. Lithium helps control impulsive behaviors. Fluphenazine (Prolixin): antipsychotic medication Thiamine sources: organ meats, liver, whole grain, nuts, legume, egg, and milk.

Don’t document abuse. Report suspected abuse to nursing supervisor. Never promise a patient “Not to tell.” Tonometry—measures intraocular pressure; to rule out glaucoma Myopia—nearsightedness (near clear, distance clear) Hyperopia—farsightedness (distance is clear, near vision blurry) Presbyopia—changes with aging Blind client: address by name, introduce self, keep furniture arrangement consistent, open or close doors walk ½ step ahead, identify food location on tray. Instilling ear drops lie patient on unaffected ear to absorb drops. Position patient on affected ear to promote drainage. Regular Insulin only given IV. Sick day rules: take insulin as ordered, check blood glucose q3-4 hours, soft foods, liquids Phenylketonuria—high blood phenylalanine (no enzyme), results in mental retardation; milk substitutes, low-protein diet Celiac Disease (SPrue)—intestinal malabsorption, malnutrition (unable to digest wheat/rye/oats/barley); gluten-free diet Hepatobiliary disease—decrease in ability of bile to absorb fat, fat malabsorption; low-fat high-protein diet, vitamins Cystic fibrosis—absence of pancreatic enzymes, malabsorption of fat, lung disease, pancreatic enzyme replacement, high-protein, high-calorie diet, respiratory care/suction Position right side to promote gastric emptying. Dumping syndrome prevention: restrict fluid with meals, lie down after eating, small, frequent meals, low-carbohydrate, low-fiber diet Sengstaken-Blakemore Tube—to treat pt. with esophageal varices.

Hepatitis B Vaccine Given IM to vastus lateralis or deltoid Side effects: mild tenderness at site • 1st shot – Birth to 3 months • 2nd shot – 1 to 4 months • 3rd shot – 6 to 18 months DTaP (Diptheria, Tetanus, and Pertussis) Given IM anterior or lateral thigh Side effects: fever within 24-48 hours, swelling, redness, soreness Don’t treat with aspirin, use other antipyretic. • 1st shot – 2 months • 2nd shot – 4 months • 3rd shot – 6 months • 4th shot – 15 to 18 months • 5th shot – 4 to 6 years • Only TD shot – 11 to 16 years Hib (Influenza) • 1st shot – 2months • 2nd shot – 4months • 3rd shot – 6 months • 4th shot – 12 to 18 months IPV (Inactive Polio Vaccine) Given PO, Few side effects • 1st shot – 2 months • 2nd shot – 4 months • 3rd shot – 6 to 18 months • 4th shot – 4 to 6 years

MMR (Mumps, Measles, and Rubella) Given SC anterior or lateral thigh Side effects: rash, fever, arthritis in 10 days to 2 weeks. • 1st shot – 12 to 18 months • 2nd shot – 4 to 6 years Varicella (Chickenpox) • 12 to 18 months PCV (Pneumococcal) • 1st shot – 2 months • 2nd shot – 4 months • 3rd shot – 6 months • 4th shot – 12 to 18 months TB Given intradermal Evaluated in 48 to 72 hours TD Given IM into anterior or lateral thigh Repeated every 10 years Live attenuated Rubella Given once SC into anterior or lateral thigh Given to antibody-negative women Prevent pregnancy for 3 months after receiving immunization Live attenuated mumps Given once SC Prevents orchitis

Normal Vital Signs Newborn

• • 1-4 year old

Pulse 120-160 bpm, increases with crying Respirations 30-50/min, diaphgramatic (abdomen moves), can be irregular BP 60/40 – 80/50 mmHg • • • Pulse: 80-140 Resp: 20-40 BP: 90-60 – 99/65 Pulse: 70-115 Resp: 15-25 BP: 100/56 – 110/60

5-12 year old • • • Adult

• • •

Pulse: 60-100 Resp: 12-20 BP: 90/60-140/90

Aortic Valve: Right of Sternum at the 2nd intercostal space Pulmonic Valve: Left of Sternum at the 2nd intercostal space Tricuspid Valve: Immediately left of sternal border at the 5th Intercostal Space Mitral Valve (Point of Maximal Impulse): Left of Sternum Mid-Clavicular Line at the 5th Intercostal Space Erbb’s Point: Left of Sternum at the 3rd intercostal space Infant (Point of Maximal Impulse): Lateral to sternum 4th intercostals space Obese person choking use Chest Thrusts. Tracheostomy tube placement of cuff maintained to prevent aspiration Care for patient first, equipment second Signs for hypoxia: restlessness, tachycardia CPR: Shake, shout, summon help, open airway, look, listen, feel for signs of breathing, pinch nose, give 2 full breaths (if no rise, reposition) Adults 12/min check carotid, chest compressions 80-100/min 1.5 inches Infants 20/min check brachial pulse, chest compression 100/min ½ - 1 inch 15:2 Adult 4 cycles Infant 20 cycles Reassess pulse and breathing Continue CPR until: • Victim responds • Someone else takes over • Victim is transferred • Rescuer is unable to continue MI • Chest pain radiating to arms, jaw, neck (which is unrelieved by rest or nitroglycerin) • Dyspnea • Indigestion • Apprehension • Low grade fever • Elevated WBC (5-10, ESR, CK-MB, LDH)

Implementation for MI • • • • Thrombolytic therapystreptokinase, t-PA Bedrest Beta-blockers, morphine sulfate, dysrhythmics, anticoagulants Do not force fluids (will give heart more to work with)

Defibrillation • Start CPR first • 1st attempt – 200 joules • 2nd attempt – 200 to 300 joules • 3rd attempt – 360 joules • Check monitor between shocks for rhythm Cardioversion • Elective procedure, Informed Consent • Valium IV • Synchronizer on • 25-360 joules • Check monitor between rhythm

Epidural hematoma – short period of unconsciousness, ipsilateral papillary dilation, contralateral weakness of extremities Subdural hematoma – decreased LOC, ipsilateral papillary dilation, contralateral weakness of extremities, personality changes CSF leakage – good place to look is behind the ears. Head Injury – elevate bed 30 degrees, barbiturate therapy, hypothermia, glucocorticoids (Decadron) Flail Chest Affected side goes down during inspiration and up during expiration Sucking Chest Wound (Sucking Open Pneumothorax) • Sucking sound with respiration • Pain • Decreased breath sounds • Anxiety Pneumothorax Collapse of lung due to alteration of air in intrapleural space • Dyspnea • Pleuritic pain • Restricted movement on affected side • Decreased/absent breath sounds • Cough • Hypotension Implementati on Monitor for shock Humidified oxygen Thoracentesis (aspiration of fluid from pleural space) Chest Tubes

Cullen’s Sign – ecchymosis around umbilicus Turner’s Sign – ecchymosis around either flank Balance’s sign – resonance over spleen (+) means rupture of spleen Shock Signs and Symptoms • Cool, clammy skin • Cyanosis • Decreased alertness • Tachycardia • Hypotension • Shallow, rapid respirations • Oliguria Hypovolemic Decreased in intravascular volume Cardiogenic Decreased cardiac output Distributive Problem with blood flow to cells

Implementation for shock • Monitor CVP: <3 inadequate fluid >11 too much fluid Increased ICP Assessments • Altered LOC (Earliest Sign) • Glasgow coma scale <7 indicates coma • Confusion • Restlessness • Pupillary changes • Vital sign changes – WIDENING PULSE PRESSURE Seizures: Implementations • Monitor vital signs • Monitor Glasgow Coma Scale • Elevate head 30-45 degrees • Avoid neck flexion and head rotation • Reduce environmental stimuli • Prevent Valsalva maneuver • Restrict fluids to 1200-1500 cc/day • Medications – Osmotic diuretics, corticosteroids

 do not restrain  do not insert anything in mouth
Electrolytes Potassium: Sodium: Calcium: Magnesium: 3.5-5.0 mEq/L 135-145 mEq/L 4.5-5.2 mEq/L 1.5-2.5 mEq/L

Hypokalemia Assessments • K+ < 3.5 mEq/L • Muscle weakness • Paresthesias • Dysrhythmias • Increased sensitivity to digitalis Hyperkalemia Assessments • K+ >5.0 mEq/L • EKG changes • Paralysis • Diarrhea • Nausea Hyponatremia Assessments • Na+ < 135 mEq/L • Nausea • Muscle cramps • Confusion • Increased ICP Hypernatremia Assessments • Na+ >145 mEq/L • Disorientation, delusion, hallucinations • Thirsty, dry, swollen tongue • Sticky mucous membranes • Hypotension • Tachycardia Hypocalcemia Assessments • Ca+ < 4.5 mEq/L • Tetany • Positive Trousseau’s sign • Positive Chvostek’s sign • Seizures • Confusion • Irritability, paresthesias

Hypokalemia Implementations • Potassium Supplements • Don’t give > 40 mEq/L into peripheral IV or without cardiac monitor • Increase dietary intake – oranges, apricots, beans, potatoes, carrots, celery, raisins

Hyperkalemia Implementations • Restrict oral intake • Kayexalate • Calcium Gluconate and Sodium Bircarbonate IV • Peritoneal or hemodialysis • Diuretics Hyponatremia Implementations • I&O • Daily weight • Increase oral intake of sodium rich foods • Water restriction • IV Lactated Ringer’s or 0.9% NaCL Hypernatremia Assessments • I&O • Daily Weight • Give hypotonic solutions: 0.45% NaCl or 5% Dextrose in water IV

Hypocalcemia Implementations • Oral calcium supplements with orange (maximizes absorption) • Calcium gluconate IV • Seizure precautions • Meet safety needs

Hypercalcemia Assessments • Ca+> 5.2 mEq/L • Sedative effects on CNS • Muscle weakness, lack of coordination • Constipation, abdominal pain • Depressed deep tendon reflexes • Dysrhythmias Hypomagnesemia Assessments  Mg+< 1.5 mEq/L  Neuromuscular irritability  Tremors  Seizures  Tetany  Confusion  Dysphagia Hypermagnesemia Assessments  Mg + > 2.5 mEq/L

Hypercalcemia Implementations • 0.4% NaCl or 0.9% NaCl IV • Encourage fluids (acidic drinks: cranberry juice) • Diuretics • Calcitonin • Mobilize patient • Surgery for hyperparathyroidism Hypomagnesemia Implementations  Monitor cardiac rhythm and reflexes  Test ability to swallow  Seizure precautions  Increase oral intake—green vegetables, nuts, bananas, oranges, peanut butter, chocolate Hypermagnesemia Implementations  Discontinue oral and IV magnesium

    Burns • • •

Hypotension Depressed cardiac impulse transmission Absent deep tendon reflexes Shallow respirations

Monitor respirations, cardiac rhythm, reflexes IV Calcium to antagonize cardiac depressant activity (helps to stimulate heart)

Assessments Superficial partial thickness—pink to red, painful Deep partial thickness—red to white, blisters, painful Full thickness—charred, waxy, white, painless  Medicate patient before wound care  Silver nitrate (warn patient skin will turn black)  High calorie, High carbohydrate, High protein diet  Vitamin B,C, and Iron  TPN maybe  Prevent contractures

Wound Care for Burns  Never break blisters  Isotonic fluids (Lactated Ringer’s)  Closed method (Silvadene) covered with dressings  Open method (Sulfamylon) that are not covered with dressings  IV pain medication initially: not PO takes too long, not IM circulation impaired

Addisson’s Disease Assessments  Fatigue  Weakness  Dehydration  Eternal tan  Decreased resistance to stress  Low Sodium  Low Blood Sugar  High Potassium Addisonian Crisis Assessments • Hypotension • Extreme weakness • Nausea vomiting • Abdominal pain • Severe hypoglycemia • Dehydration Cushing’s Syndrome Assessments • Osteoporosis • Muscle wasting • Hypertension • Purple skin striations • Moon face • Truncal obesity • Decreased resistance to infection

Addisson’s Disease Implementations  High protein, High carbohydrate, high Sodium, Low potassium diet  Teach life-long hormone replacement

Addisonian Crisis Implementations • Administer NaCl IV, vasopressors, hydrocortisone • Monitor vital signs • Absolute bedrest

Cushing’s Syndrome Implementations • Low Carbohydrate, Low Calorie, High Protein, High Potassium, Low sodium diet • Monitor glucose level • Postop care after adrenalectomy or hypophysectomy

Pheochromocytoma Assessments— hypersecretions of the catecholamines (epinephrine/norepinephrine) • Persistent hypertension • Hyperglycemia • Pounding headache • Palpitations • Visual disturbances

Pheochromocytoma Implementations • Histamine Test, Regitine Test, 24hour urine VMA test • Avoid emotional and physical stress • Encourage rest • Avoid coffee and stimulating foods • Postop care after adrenalectomy and medullectomy

COPD Assessments • “Blue Bloaters”

COPD Implementations • Assess airway clearance

• • • • • • •

“Pink Puffers” Weakness Change in postured day and hs (don’t sleep laying down, have to stay erect) Use of accessory muscles of breathing Dyspnea Cough Adventitious breath sounds

• • • • •

Listen to breath sounds Administer low-flow oxygen (1-2 L, not too much because your trying to prevent CO2 narcosis) Encourage fluids Small frequent feedings Use metered dose inhalers (MDI)

Pneumonia Assessments • Fever • Leukocytosis • Productive Cough (rust, green, yellow) • Dyspnea • Pleuritic pain • Tachycardia

Pneumonia Implementations • Check breath sounds • Cough and deep breath q 2 hours • Chest physiotherapy • Antibiotics • Incentive spirometer • Encourage fluids • Suction PRN • Provide oxygen • Semi-Fowler’s position • Bedrest • Medications—mucolytics (Mucomyst), expectorants (Robitussin), Bronchodilators (Aminophylline), Antibiotics (Bacterim) Cyanotic Congenital Heart Anomalies Assessments • Cyanosis • Clubbing of fingers • Seizures • Marked exercise intolerance • Difficulty eating • Squat to decrease respiratory distress • Small stature • Failure to thrive • Characteristic murmur • Frequent respiratory infections

Acyanotic Congenital Heart Anomalies Assessments • Normal Color • Possible exercise intolerance • Small stature • Failure to thrive • Heart murmur • Frequent respiratory Infections

Acyanotic Congenital Heart Anomalies Types: • Ventricular Septal Defect (VSD)—abnormal opening between right/left ventricles; hole size of pinhole or absence of septum; hear a loud harsh murmur, at age of 3 hole may close otherwise surgery such as purse-string suture • • Atrial Septal Defect (ASD)—abnormal opening between the two atria; audible murmur (if defect is severe closure is done later in childhood) Patent Ductus Arteriosis (PDA)—failure of fetal structure to close after birth; ductus areteriosis in the fetus connects the pulmonary artery to aorta to shunt oxygenenated blood from the placenta to systemic circulation (which bypasses the lungs). Once the child is born that structure should close because it is no longer needed because blood passes through to lungs; vascular congestion, right ventricular hypertrophy; murmur, bounding pulse, tachycardia; surgical to divide or ligate the vessel. Coarctation of the Aorta—narrow of aorta; high blood pressure and bounding pulse in areas that receive blood proximal to the defect. Weak and absent blood distal to aorta. Surgical end-to-end anastomosis. Pulomonic Stenosis—narrowing at entrance to pulmonary artery; causes resistance to blood flow and right ventricular hypertrophy; surgery

Aortic Stenosis—narrowing of aortic valve; causes decrease cardiac output; surgery

Cyanotic Congenital Heart Anomalies Types: • Tetralogy of Fallot—VSD, pulmonic stenosis, overriding aorta, right ventricular hypertrophy; squats/knee chest position to help breath; surgery needed • • Transposition of great vessels—pulmonary artery leaves left ventricle and aorta leaves right ventricle; oxygenated blood not going into systemic circulation Truncus arteriosus—failure of normal septation and embryonic division of the pulmonary artery and aorta; rather than two distinctly different vessels there is a single vessel that overrides both ventricles and gives rise to both pulmonary and systemic circulation; blood enters from both common artery and either goes to the lungs or to the body; cyanosis, murmur, difficult intolerance Total anomalous venous return—absence of direct communication between pulmonary veins and left atria; pulmonary veins attach directly to right atria or drains to right atria

Congenital Heart Anomalies Compensatory Mechanisms • Tachycardia • Polycythemia (increase formation of RBC’s) • Posturing—squatting, knee-chest position Congenital Heart Anomalies Implementations • Prevention • Recognize early symptoms • Monitor vital signs and heart rhythms • Medications—digoxin, iron, diuretics, potassium • Change feeding pattern Left-Side CHF • Dyspnea, orthopnea • Cough • Pulmonary edema • Weakness/Changes in mental status Right-Side CHF • Dependent edema • Liver enlargement • Abdominal pain/Nausea/Bloating • Coolness of extremities

CHF Implementations • Administer digoxin, diuretics • Low-sodium, low-calorie, low-residue diet • Oxygen therapy • Daily weight • Teach about medications and diet Arterial Peripheral Vascular Disease Assessments • Rubor • Cool shiny skin • Ulcers • Gangrene • Intermittent Claudication (pain with exercise/walking relieved with rest) • Impaired sensation • Decreased peripheral pulses Venous Peripheral Vascular Disease Arterial Peripheral Vascular Disease Implementations • Monitor Peripheral pulses • Good foot care • Stop smoking • Regular exercise • Medications—vasodilators, anticoagulants

Venous Peripheral Vascular Disease

Assessments • Cool, brown skin • Edema • Normal or decreased pulses • Positive Homan’s sign

Implementations • Monitor peripheral pulses • Elastic stockings • Medications—anticoagulants • Elevate legs • Warm, moist packs • Bedrest 4-7 days (acute phase) Anemia Implementations • Identify cause • Frequent rest periods • High protein, high iron, high vitamin diet • Protect from infection

Anemia Assessments (reduction in hemoglobin amount/erythrocytes) • Palpitations • Dyspnea • Diaphoresis • Chronic fatigue • Sensitivity to cold Iron Deficiency Anemia Assessments • Fatigue • Glossitis • Spoon fingernails • Impaired cognition Pernicious Anemia Assessments (gastric mucosa fail to secrete enough intrinsic factor for stomach to absorb) • Schilling’s Test • Fatigue • Sore, red tongue • Paresthesia in hands and feet Sickle Cell Anemia Assessments • Pain /Swelling/Fever • Schlerae jaundiced • Cardiac murmurs • Tachycardia

Iron Deficiency Anemia Implementations • Increase iron-rich foods (liver, green leafy vegetables) • Iron supplements (stains teeth) Pernicious Anemia Assessments • Vitamin B12—IM • Rest of life can’t be absorbed PO

Sickle Cell Anemia Implementations • Check for signs of infection (prevent crisis) • Check joint areas for pain and swelling • Encourage fluids • Provide analgesics with PCA pump c crisis Hemophilia Implementations • Administer plasma or factor VIII • Analgesics • Cryoprecipitated antihemophilic factor (AHF) • Teach about lifestyle changes • Non contact sports

Hemophilia Assessments (female to male gene transmission) • Easy bruising • Joint pain • Prolonged bleeding

Cancer Implementation: External Radiotherapy • Leave markings on skin • Avoid use of creams, lotions (only vitamin A&D ointment) • Check for redness, cracking • Wear cotton clothing • Administer antiemetics Cancer Implementation: Internal radiation sealed source • Lead container and long-handled forceps in room • Save all dressings, bed linen until source removed • Urine and feces not radioactive • Don’t stand close or in line with source • Patient on bed rest Cancer Implementation: Internal Radiation • Time and distance important • Private room sign on door • Nurse wears dosimeter at all times • Limit visitors and time spent in room • Rotate staff • Self-care when can do

Cancer Implementation: Internal radiation unsealed source • All body fluids contaminated • Greatest danger first 24-96 hours

Leukemia Assessments • Ulcerations of mouth • Anemia • Fatigue • Weakness • Pallor

Leukemia Implementations • Monitor for signs of bleeding: petechiae, ecchymosis, thrombocytopenia • Infections • Neutropenia (private room/limit # people, wbc done daily, no fruit, no flowers/plotted plants, clean toothbrush with weak bleach solution • Good mouth care • High calorie, high Vitamin diet (avoid salads/raw fruit/pepper/don’t reuse cup/don’t change litter box/digging in garden

Intracranial Tumors Assessments • Motor deficits • Hearing or visual disturbances • Dizziness • Paresthesia • Seizures • Personality disturbances • Changes in LOC

Therapeutic            

Positions Supine—avoids hip flexion Dorsal recumbent—supine with knees flexed Prone—extension of hip joint(after amputation) Side lateral—drainage of oral secretions Knee-chest—visualization of rectal area Sim’s—decreases abdominal tension (side lying with legs bent) Fowler’s—increases venous return, lung expansion High Fowler’s—60-90 Fowler’s—45-60 Semi-Fowler’s—30-45 Low Fowler’s—15-30 Modified Trendelenburg—used for shock;Feet elevated 20 degrees, knees straight, trunk flat, head slightly elevated  Elevation of extremity—increases blood to extremity and venous return  Lithotomy—used for vaginal exam 2 point Gait Bearing both legs RC/LF, LC/RF 3 point Gait Bearing one leg Weaker leg both crutches, then stronger leg Swing-to-swing through Partial weight bearing both legs Both crutches, one or two legs

Intracranial Tumors Implementations • Preoperative: do neurological assessment, patient head shaved • Postoperative: maintain airway, elevate head 30-45 after supratentorial surgery • Flat and lateral after infratentorial surgery • Monitor vital and neurological signs • Glascow coma scale

4 point Gait Weight bearing both legs RC, LF, LC, RF

Stairs  Going up—“good” leg first, crutches, “bad” leg  Going down—crutches with “bad” leg, then “good” leg  “Up with the good, down with the bad” Walker • Flex elbows 20-30 degrees when hands are on grips

• • •

Lift and move walker forward 8-10 inches Step forward with “bad” leg, support self on arms, follow with “good” leg Stand behind client holding onto gait belt Post-procedure • Water-soluble dye—elevate head of bed 30 degrees (not removed) • Oil based dye—flat in bed (removed) • Bedrest 24 hours encourage fluids

Myelogram—x-ray visualization of the spinal canal by injection of radiopaque dye. • Hydration done 12 hours before procedure • Cleansing enemas • Avoid seizure-promoting medications Laminectomy—excision portion of lamina to expose area of affected disc • Preopcare: moist heat • Fowler’s position • Isometric exercises for abdominal muscles • Muscle relaxants, NSAIDs, Analgesics • Traction, TENS

Postoperative care: • Assess circulation and sensation • Log roll Q2 hours with pillow between leg • Calf exercises, assist with ambulation keeping back straight • Muscle relaxants, NSAIDS, analgesics, Teaching—daily exercises, firm mattress, avoid prone position and heavy lifting • Avoid sitting long time

Dysplasia of the Hip Assessment • Uneven gluteal folds and thigh creases • Limited abduction of hip • Ortolani’s sign—place infant on back with legs flexed, clicking sound with abduction of legs • Shortened limb on affected side

Dysplasia of the Hip Implementations Newborn to 6 months • Reduced by manipulation • Pavlik harness for 3 to 6 months 6 to 18 months • Bilateral Bryant’s traction • Hip spica cast Older child • Open reduction • Hip Spica cast Scoliosis Implementations • Exercises to strengthen abdominal muscles (if functional) • Surgery: spinal fusion insertion of Herrington Rod • Milwaukee brace: used with curves 30-40 degrees • Wear 4-6 years, worn 23 hours of the day, wear undershirt to prevent irritation, teach isometric exercises Cerebral Palsy Implementations • Ambulation devices, PT and OT • Muscle relaxants and anticonvulsants • Feeding: place food at back of mouth with slight downward pressure. Never tilt head backward. • High calorie diet

Scoliosis Assessments—lateral deviation of one or more of vertebrae accompanied by rotary motion of spine • Uneven hips or scapulae • Kyphosis lump on back • Bend at waist to visualize deformity • Structural (flexible deviation corrected with bending) or functional (permanent heredirary that is seen) Cerebral Palsy Assessments • Voluntary muscles poorly controlled due to brain damage • Spasticity, rigidity, ataxia, repetitive involuntary gross motor movements

Muscular Dystrophy Assessments Atrophy of voluntary muscles Muscle weakness, lordosis, falls Parkinson’s Disease Assessments • Deficiency of dopamine • Tremors, rigidity, propulsive gait • Monotonous speech • Mask like expression

• •

Braces to help ambulation Balance activity and rest

Parkinson’s Disease Implementations • Teach ambulation modification: goose stepping walk (marching), ROM exercises • Medications—Artane, Cogentin, LDopa, Parlodel, Sinemet, Symmetrel

Myasthenia Gravis Assessments • Deficiency of acetylcholine • Muscular weakness produced by repeated movement • Dysphagia • Respiratory distress

Myasthenia Gravis Implementations • Good eye care, restful environment • Medications—anticholinesterases, corticosteroids, immunosuppressants • Avoid crisis: infection • Symptoms: sudden ability to swallow

Clear liquid • No milk • No juice with pulp

Full liquid • No jam • No fruit • No nuts

Low-fat cholesterol restricted • Can eat lean meat • No avocado, milk, bacon, egg yolks butter

Sodium restricte d • No chees e

High roughage, high fiber • No white bread without fiber

Low-residue • Minimize intestinal activity • Buttered rice white processed food, no whole wheat corn bran

High protein diet • Restablish anabolism to raise albumin levels • Egg, roast beef sandwich, • No junk food

Renal • Keeps protein, potassium and sodium low • No beans, no cereals, no citrus fruits

Low-phenylalanine diet • Prevents brain damage from imbalance of amino acids • Fats, fruits, jams allowed • No meats eggs bread

Glomerulonephritis Assessment • Fever, Chills • Hematuria • Proteinuria • Edema • Hypertension • Abdominal or flank pain • Occurs 10 days after beta hemolytic streptococcal throat infection

Glomerulonephritis Implementation • Antibiotics, corticosteroids • Antihypertensives, immunosuppressive agents • Restrict sodium and water intake • Bedrest • I&O • Daily weight • High Calorie, Low protein

Urinary Diversion: Assessments • Done for: Bladder t umors, birth defects, neurogenic bladder, interstitial cystitis • Ileal Conduit • Koch Pouch

Urinary Diversion Implementations • Nephrostomy: flank incision and insertion of nephrostomy tube into renal pelvis; penrose drain after surgery; surgical dressing • Ureterosigmoidostomy: urters detached from bladder and anastomosed to sigmoid colon; encourage voiding via rectum q 2-4 hours;no enemas or cathartics; complications—electrolyte imbalance, infection, obstruction; urine and stool evacuated towards anus. • Cutaneous Ureterostomy: Stoma formed from ureters excised from bladder and brought to abdominal wall; stoma on right side below waist; assist with alteration in body image • Illeal Conduit: Ureters replanted into portion of terminal ileum and brought to abdominal wall; check for obstruction; mucous threads in urine normal • Koch Pouch (Continent Illeal Conduit): Ureters transplanted into pouch made from ileum with one-way valve; drainage of pouch by catheter under control of client; drain pouch at regular intervals Acute Renal Failure Causes • Prerenal—reduced blood volume • Renal—nephrotoxic drugs, glomerulonephritis • Postrenal-obstruction Acute Renal Failure Implementations: • Low-output stage: Limit fluids, Kayexalate, Dialysis • High-output stage: Fluids as needed, K+ replacement, Dialysis • I&O • Daily Weight • Monitor Electrolytes • Bedrest during acute phase • IV fluids • Diet restrictions • Oliguric phase: limit fluids, TPN maybe • After Diuretic phase: high protein, high calorie diet

Acute Renal Failure Assessments: Oliguric Phase • Output <400 cc/day • Hypertensio n • Anemia • CHF • Confusion • Increased K+, Ca+, Na+, BUN, Creatinine

Acute Renal Failure Assessments: Diuretic Phase • Output 4-5 L/day • Increased BUN • Na+, K+ lost in urine • Increased mental and physical activity

Hemodialysis Implementation • Check for thrill and bruit q 8 hours • Don’t use extremity for BP, finger stick • Monitor vital signs, weight, breath sounds • Monitor for hemorrhage

Peritoneal Dialysis • Weight before and after treatment • Monitor BP • Monitor breath sounds • Use sterile technique • If problem with outflow, reposition client • Side effects: constipation

Types of Peritoneal Dialysis • Continuous ambulatory (CAPD) • Automated • Intermittent • Continuous

Ego Defense Mechanisms  Denial—failure to acknowledge thought  Displacement—redirect feelings to more acceptable subject  Projection—attributing your feelings to someone else  Undoing—attempt to erase an act, thought or feeling  Compensation—attempt to overcome shortcoming  Symbolization—less threatening object used to represent another

 Substitution—replacing unacceptable or unobtainable object to one that is acceptable or attainable  Introjection—symbolic taking into oneself the characteristics of another  Repression—unacceptable thoughts kept from awareness  Reaction formation—expressing attitude opposite of unconscious wish or fear  Regression—returning to an earlier developmental phase  Dissociation—detachment of painful emotional conflicts from consciousness  Suppression—consciously putting thought out of awareness Dying patient: Denial, Anger, Bargaining, Depression, Acceptance Bipolar Disorder Assessments • Disoriented, flight of ideas • Lacks inhibitions, agitated • Easily stimulated by environment • Sexually indiscreet • Affective disorder • Maintain contact with reality • Elation is defense against underlying depression • Manipulative behavior results from poor self-esteem Bipolar Disorder Implementations • Meet physical needs first • Simplify environment • Distract and redirect energy • Provide external controls • Set limits: escalating hyperactivity • Use consistent approach • Administer Lithium (help Manic Phase of Bipolar, keep hydrated) • Increase awareness of feelings through reflection Schizophrenia Implementations • Maintain safety—protect from erratic behavior • With hallucination—do not argue, validate reality, respond to feeling tone, never further discuss voices (don’t ask to tell more about voices) • With delusions—do not argue, point out feeling tone, provide diversional activities • Meet physical needs • Establish therapeutic relationship • Institute measures to promote trust • Engage in individual, group, or family therapy • Encourage client’s affect • Accept nonverbal behavior • Accept regression • Provide simple activities or tasks

Schizophrenia Assessments • Withdrawal from relationships and world • Inappropriate display of feelings • Hypochondriasis • Suspiciousness • Inability to test reality, regression • Hallucinations— false sensory perceptions • Delusions— persistent false beliefs; grandeur (feel higher rank); persecutory (beliefs to be a victim); ideas of reference (see people talking think talking about them) • Loose associations • Short attention span • Inability to meet basic needs: nutrition, hygiene • Regression

Schizophrenia Types • Disorganized— inappropriate behavior, transient hallucinations • Catatonic—sudden onset mutism, stereotyped position, periods of agitation • Paranoid—late onset in life, suspiciousness, ideas of persecution and delusions

Paranoid Assessments • Suspiciousness • Cold, blunted affect • Quick response with anger or rage

Paranoid Implementations • Establish trust • Low doses phenothiazines for anxiety • Structured social situations

Schizoid Assessments • Shy and introverted • Little verbal interaction • Few friends • Uses intellectualization Schizotypal Assessments • Eccentric • Suspicious of others • Blunted affect • Problems with perceiving, communicating Antisocial Assessments • Disregards rights of others • Lying, cheating, stealing, promiscuous • Lack of guilt • Immature • Irresponsible • Associated with substance abuse Borderline Assessments • Brief and intense relationships • Blames others for own problems • Impulsive, manipulative • Self-mutilation • Women who have been sexually abused • Suicidal when frustrated, stressed Narcissistic Assessments • Arrogant lack of feelings and empathy for others • Sense of entitlement • Uses others to meet own needs • Shallow relationships • Views self as superior to others Histrionic Assessments • Draws attention to self • Somatic complaints • Temper tantrums, outbursts • Shallow, shifting emotions • Cannot deal with feelings • Easily influenced by others Dependent Assessments • Passive • Problem working independently • Helpless when alone • Dependent on others for decisions • Fears loss of support and approval Avoidant Assessments • Socially uncomfortable • Hypersensitive to criticism, Lacks self-confidence • Fears intimate relationships

Schizoid Implementations • Establish trust • Low doses phenothiazines for anxiety • Structured social situations Schizotypal Interventions • Establish trust • Low doses neuroleptics to decrease psychotic symptoms • Structured social situations

Antisocial Implementations • Firm limit-setting • Confront behaviors consistently • Enforce consequences • Group therapy

Borderline implementations • Identify and verbalize feelings • Use empathy • Behavioral contract • Journaling • Consistent limit-setting • Group therapy

Narcissistic Implementations • Mirror what client sounds like • Limit-setting • Consistency • Teach that mistakes are acceptable

Histrionic Implementations • Positive reinforcement for other centered behaviors • Clarify feelings • Facilitate expression of feelings

Dependent Implementations • Emphasize decision-making • Teach assertiveness • Assist to clarify feelings and needs

Avoidant Implementations • Gradually confront fears • Discuss feelings • Teach assertiveness • Increase exposure to small groups

Obssessive-compulsive Assessments • High personal standards for self and others • Preoccupied with rules, lists, organized • Perfectionists • Intellectualize

Obssessive-compulsive Implementations • Explore feelings • Help with decision-making • Confront procrastination • Teach that mistakes are acceptable

Manipulative behavior Assessments • Unreasonable requests for time, attention, favors • Divides staff against each other • Intimidates others • Use seductive or disingenuous approach

Manipulative Behavior Implementations • Use consistent undivided staff approach • Set limits • Be alert for manipulation • Check for destructive behavior • Help client to see consequences of behavior

Acute Alcohol Intoxication • Drowsiness • Slurred speech • Tremors • Impaired thinking • Belligerence • Loss of inhibitions Alcohol Withdrawal Assessments • Tremors • insomnia • anxiety • hallucinations

Acute Alcohol Implementations • Protect airway • Assess for injuries • Withdrawal assess • IV glucose • Counsel about alcohol use After WithdrawalDelirium Tremens Assessments • Disorientation • Paranoia • Ideas of reference • Suicide attempts • Grand mal convulsions Alcohol Withdrawal Implementations • Monitor vital signs, especially pulse • Administer sedation, anticonvulsants , thiamine (IM or IV), glucose (IV) • Seizure precautions • Quiet, welllighted environment • Stay with patient

Chronic Alcohol Dependence Assessments • Persistent incapacitation • Cyclic drinking or “binges” • Others in family take over client’s role • Family violence

Chronic Alcohol Dependence Implementations • Identify problems related to drinking • Help client see problem • Establish control of problem • Alcoholics anonymous • Antabuse • Counsel spouse and children Wernicke’s Syndrome Implementations • Thiamine (IM or IV) • Abstinence from alcohol

Wernicke’s Syndrome Assessments • Confusion • Diplopia, nystagmus • Ataxia • Apathy

Korsakoff’s Psychosis Assessments • Memory disturbances with confabulation • Learning problems • Altered taste and smell • Loss of reality testing Retinopathy of Prematurity Assessment • Demarcation line with ridge • Retinal detachment

Korsakoff’s Psychosis Implementations • Balanced diet • Thiamine • Abstinence from alcohol

Retinopathy of Prematurity Implementations • Prevent by using minimum oxygen concentrations • Monitor PO2 • Eye exam (premature infants) Corrective lenses Implementations • Eye exercises • surgery

Strabismus (cross-eyed) Assessments • Deviation of eye • Diplopia • Tilts head or squints Detached Retina Assessments • Flashes of light • Loss of vision • Particles moving in line of vision • confusion

Detached Retina Implementations • Bedrest, affected eye in dependent position • Eye patched (one or both) • Surgery • Sedatives and tranquilizers • Avoid stooping, straining at stool, strenuous activity 3 months Cataracts Implementations • Postop: check for hemorrhage • Check pupil—constricted with lens implanted, dilated without lens • Eye drops • Night shield • Sleep on unaffected side Glaucoma Implementations • Administer miotics (constrict pupil, allows more area for aqueous humor to flow), carbonic anhydrase inhibitors • Surgery • Avoid heavy lifting, straining of stool • Mydriatics (dilates pupil, makes angle smaller and constrict aqueous flow) are contraindicated with glaucoma. Trigeminal Neuralgia Implementations • Medications—analgesics, Tegretol • Surgery Bell’s Palsy Implementations • Isometric exercises for face • Prevent corneal abrasions Guillain-Barre Syndrome Implementations • Medications—steroids • Aggressive respiratory care • Physical therapy • Eye care • Prevent complications: respiratory and aspiration

Cataracts Assessments • Distorted, blurred vision • Milky white pupil

Glaucoma Assessments • Abnormal increase in intraocular pressure that leads to blindness • Blurred vision • Lights with halos • Decreased peripheral vision • Pain • Headache

Trigeminal Neuralgia Assessments • Stabbing, burning facial pain • Twitching of facial muscles Bell’s Palsy Assessments • Inability to close eye • Increased lacrimation • Distorted side of face Guillain-Barre Syndrome Assessments • Paresthesia • Motor losses beginning in lower extremities • Altered autonomic function

Meningitis Assessments • Nuchal rigidity • Kerning’s sign • Brudzinski’s sign • Seizures • Bulging fontanels • High-pitched cry

Meningitis Implementations • Medications—antibiotics, antifungals • Prevent complications: droplet precautions, contagious

Thoracentesis: no more than 1000cc taken at one time. Electroencephalogram (EEG) Preparation • Test brains waves; seizure disorders • Tranquilizer and stimulant meds withheld for 24-48 hours • Stimulants (caffeine, cigarettes) withheld for 24 hours • May be asked to hyperventilate during test • Meals not withheld • Kept awake night before test; want them to lie still Electroencephalogram (EEG) Post-test • Remove paste from hair • Administer medications withheld before test • Observe for seizure activity • Seizure prodromal signs; epigastric distress, lights before the eyes

CAT Scan—dye gives flushed, warm face and metallic taste during injection (if contrast dye is used) Myelogram: Post-test • Supine 8-24 hours (Pantopaque oil-based dye used) • Head raised 30-45degrees 8-16 hours(metrizamide water-soluble dye used) Liver Biopsy Preparation • Administer vitamin K IM (decrease risk of hemorrhage) • NPO 6 hours • Given sedative • Position supine, lateral with upper arms elevated • Asked to hold breath for 5-10 seconds Liver Biopsy Post-Test • Position on operative side for 1-2 hours • Gradually elevate head of bed 30 degrees (1st hour) and then 45 degrees (2nd 2 hours) • Bedrest for 24 hours • Check Vital signs • Check clotting time, platelets, hematocrit • Report severe abdominal pain

Upper GI Series Barium Swallow: stool white from barium Tracheostomy Tube Cuff • Purpose—prevents aspiration of fluids • Inflated o During continuous mechanical ventilation o During and after eating o During and 1 hour after tube feeding o When patient cannot handle oral secretions Oxygen Administration: assess patency of nostril, apply jelly • Face mask: 5-10 l/min (40-60%) • Partial rebreather mask: 6-15 l/min (70-90%); keep reservoir bag 2/3 full during inspiration • Non-rebreather mask: (60-100%); keep reservoir bag 2/3 full during inspiration • Venturi mask: 4-10 l/min (20-50%); provides high humidity and fixed concentrations, keep tubing free of kinks • Tracheostomy collar or T-piece: (20-100%); assess for fine mist; empty condensation from tubing’ keep water container full • Croupette or oxygen tent:

o o o o o o o o

Difficulty to measure amount of oxygen delivered Provides cooled, humidified air Check oxygen concentration with oxygen analyzer q4 hours Clean humidity jar and fill with distilled water daily Cover patient with light blanket and cap for head Raise side rails completely Change linen frequently Monitor patient’s temperature

Chest Tubes Implementations • Use to utilize negative pressure in lungs • Fill water-seal chamber with sterile water to 2 cm • Fill suction control chamber with sterile water to 20 cm • Maintain system below level of insertion • Clamp only momentarily to check for air leaks • Ok to milk tubing towards drainage • Observe for fluctuation in waterseal chamber • Encourage patient to change position frequently

Chest Tube Removal: • Instruct patient to do valsalva maneuver • Clamp chest tube • Remove quickly • Occlusive dressing applied

Complications of Chest Tubes: • Constant bubbling in water-seal chamber=air leak • Tube becomes dislodged from patient, apply dressing tented on one side • Tube becomes disconnected from drainage system, cut off contaminated tip, insert sterile connector and reinsert • Tube becomes disconnected from drainage system, immerse end in 2 cm of sterile water

CVP: measures blood volume and efficiency of cardiac work; tells us right side of heart able to manage fluid • “0” on mamometer at level of right atrium at midaxilliary line • Measure with patient flat in bed • Open stopcock and fill manometer to 18-20 cm • Turn stopcock, fluid goes to patient • Level of fluid fluctuates with respirations • Measure at highest level of fluctuation • After insertion o Dry, sterile dressing o Change dressing, IV fluids, manometer, tubing q24 hours o Instruct patient to hold breath when inserted, withdrawn, tubing changed o Check and secure all connections • Normal reading—3-11 cm water • Elevated>11, indicates hypervolemia or poor cardiac contractility (slow down IV, notify physician) • Lowered<3, hypovolemia • Chest tray at bedside

Eye irrigation: tilt head back and toward affected side Eye drops: drop in center of conjunctival sac; prevent systemic absorption, press on inner angle of eye; don’t allow drops to go from one eye to the other; don’t squeeze eyes Nasogastric Tubes: • Levin-single—single-lumen, used for decompression or tube feeding • Salem sump—double-lumen, used for decompression or tube feeding • Sengstaken-Blakemore—triple-lumen, used for bleeding esophageal varices • Linton-Nachlas—4-lumen, used for bleeding esophageal varices • Keofeed/Dobhoff—soft silicone, used for long-term feedings • Cantor—single lumen with mercury-filled balloon and suction port • Miller-Abbott—double-lumen with mercury-filled balloon and suction port • Harris—single lumen with mercury-filled balloon and suction port NG tube placement: “BEST WAY” to check is to aspirate for gastric contents and check for pH of aspirate <4

Implementation of feeding: • Check residual before intermittent feeding, reinstall residual • Check residual Q4 hours with continuous feeding, reinstall residual • Hold feeding if >50% residual from previous hour (adults) or >25% (children) • Flush tube with water before and after feeding • Use pump to control rate of tube feeding • Administer fluid at room temperature • Change bag Q8 hours for continuous feeding • Elevate head of bed while feeding is running • Check patency Q4 hours • Good mouth care NG Irrigation Tubing: • Verify placement of tube • Insert 30-50 cc of normal saline into tube • If feel resistance, change patient position, check for kinks • Withdraw solution or record amount as input NG removal: • Clamp tube • Remove tape • Instruct patient to exhale • Remove tube with smooth, continuous pull Intestinal Tubes (Cantor, Mill-Abbott, Harris) • Implementations o After tube is in stomach, have patient lie on right side, then back in Fowler’s position, then left side o Gravity helps to position tube o Coil excess tube loosely on bed, do not tape o Position of tube verified by x-ray o Measure drainage QShift • Removal o Clamp tube o Remove tape o Deflate balloon or aspirate contents of intestinal tube balloon o Instruct patient to exhale o Remove 6” every 10 min. until reaches the stomach, then remove completely with smooth, continuous pull

T-Tube: 500-1000 cc/day, bloody first 2 hours Penrose: expect drainage on dressing Enema Implementation • Position on left side • Use tepid solution • Hold irrigation set no more than 18” above rectum • Insert tube no more than 4” • Do not use if abdominal pain, nausea, vomiting, suspected appendicitis Catheter insertion: 2-3” into urethra then 1” after urine flows Male catheter: insert 6-7” Catheter Urine Drainage bag: do not remove more than 700 cc at one time, clamp prior to removal Ileostomy: post-op has loose, dark green, liquid drainage from stoma Tonsillectomy: post-op frequently swallowing indicates hemorrhage External contact lenses: need fine motor movements (rheumatoid arthritis prevents this). Object in eye: never remove visible glass; apply loose cover and remain quiet. Retina detached: sleep prone with affected side down; avoid jarring movements; avoid pin point movement with eye (sewing); high fluid and roughage (prevents constipation=no straining); make light sufficient for needs (75watt+); no hairwashing Glaucoma medications: Epinephrine hydrochloride (Adrenalin Chloride) and Pilocarpine Hydrochloride (Pilocar): give Pilocar (therapeutic) first then wait 210minutes and instill adrenalin to increase absorption of adrenalin). Tympanoplasty: remain in bed 24 hours position flat in bed with the affected ear up (helps to promote insertion). Triglycerides elevation can falsely elevate glycosalated hemoglobin test. Laparoscopic Cholecystectomy post: encourage to walk to eliminate acute right shoulder pain. Impetigo: 2 year old; honey-colored crusts, vesicles, and reddish macules around mouth; don’t need to isolate; watch contact precautions. Only patient we use distractions on the NCLEX are manic patients and toddlers not for pain. Rhinoplasty (nose surgery) position post-op: want to promote drainage of oral secretions is to position on her right side. 1 cup= 240cc Pregnancy is a contraindication to an MRI. Raynaud’s disease have decreased vascularity in the extremities. Post-Parecentesis most important assessment is to obtain the blood pressure, weight the client, measure the client’s abdominal girth, and check dressing in that order. Tracheostomy tube: use pre-cut/pre-made gauze pads. Suction is always intermittent never continuous.

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