echocardiogram-used to assess heart valves.

valve disorders require prophylactic antibiotics before invasive procedures.

avoid IM injections when suspecting MI can affect CK levels

hemodynamic measurements-transducer placed @ the midaxillary line at the fourth or fifth

intercostal space phlebostatic axis.

calcium channel blockers-assess for constipation

1. Neuroleptic malignant syndrome (NMS):

-NMS is like S&M;
-you get hot (hyperpyrexia)
-stiff (increased muscle tone)
-sweaty (diaphoresis)
-BP, pulse, and respirations go up &
-you start to drool

2. I kept forgetting which was dangerous when you're pregnant; regular measles (rubeola), or German measles
(rubella), so remember:
-never get pregnant with a German (rubella)

3. When drawing up regular insulin & NPH together, remember:

-RN (regular comes before NPH)

4. Tetralogy of fallot; remember HOPS

H- hypertrophy of right ventricle
O- over-riding aorta
P- pulmonary stenosis
S- septal defect

5. MAOI's that are used as antidepressants:

weird way to remember, I know. pirates say arrrr, so think; pirates take MAOI's when they're depressed.
- explanation; MAOI's used for depression all have an arrr sound in the middle (Parnate, Marplan, Nardil)

Autonomic dysreflexia: potentially life threatening emergency

- elevate head of bed to 90 degree
- loosen constrictive clothing
- assess for bladder distention and bowel impaction (triger)
- Administer antihypertensive meds (may cause stroke, MI, seisure )

Normal ICP : 0 - 15mmHg

Pulmonary embolus: S/S

- pleuritic chest pain, dyspnea, low-grade fever, tachycardia, blood-tinged sputum.

COPD : S/S
- dyspnea on exertion, barrel chest, clubbed fingers and toes, tachypneic with prolonged
expiratory phase.
Tension pneumothorax - tracheal shift to opposite side, decreased venous return, neck vein
bulge, tachycardia and tachypnea.

--In complete heart block, the AV node blocks all impulses from the SA node, so the atria and
ventricles beat independently, b/c Lidocaine suppresses ventricular irritability, it may
diminish the existing ventricular response, cardiac depressant are contraindicated in the
presence of complete heart block.
--administrate Glucagon when pt is hypoglycemia and unresponsive
--Bromocriptine (Parlodel) or Dantrolene (Dantrium) is used for CNS toxicity
--Ibuprofen (Motrin) S/E includes epigastric distress, nausea, occult blood loss, peptic
ulceration, use cautiously with history of previous gastrointestinal disorders.
--Aminophylline (Truphylline) use with Propranolol (Inderal) may decrease metabolism and
lead to toxicity
--Antianxiety medication is pharmacologically similar to alcohol, is used effectively as a
substitute for alcohol in decreasing doses to comfortably and safely withdraw a client from
alcohol dependence
-- Tagamet decrease gastric secretion by inhibiting the actions of histamine at the H2-
receptor site, constipation is a common side effect of this med, should increase fiber in diet.
Take with meals and at bedtime.
--elderly clients and clients with renal problems are most susceptible to CNS side effects
(confusion, dizziness) of the medication

1st TRIMESTER (Chorionic villis sampling, US scan)

2nd TRIMESTER (AFP screening or Quad Screening,Amniocentesis)
3rd TRIMESTER (kick counts,Nonstress Test,Biophysical Profile, Percutaneous Umbilical Blood
sampling, Contraction Stress Test )

Ultrasound screening -can be vaginal or Abdominal (in latter make Her drink water to fill bladder)
-Confirms viability
-Indicates fetal presentation
-Confirms multiple gestation
-Identifies placental location
-Measurements can be taken to confirm/estimate gestational age
-Identify morphologic anomalies

Chorionic villis sampling

8-12 weeks
for early diagnosis of genetic, metabolic problems

Amniocentesis -13-14 weeks

Is done under US scan to obtain a sample of amniotic fluid for direct analysis of fetal chromosomes,
development, viability and lung maturity

AFP
15-18 weeks-Maternal Blood Drawn
AFP also called =Quad marker screening:
-maternal serum alpha fetoprotein (MSAFP),
-human chorionic gonadotropin (HcG),
-unconjugated estriol (UE),
-and inhibin A
low AFP-Down syndrome
high-Spina bifida
it is not an absolute test if it is abnormal -further investigation is recommended

Kick counts (tests Uretro placental capability)

Same time every day mother records how often she feels the fetus move
if mininum 3 movements are not noted within an hour's time, the mother is encouraged to call her
physician immediately!

Nonstress Test
checks FHR and mother detects Fetal movements.
Contraction Stress Test -tests perfusion between Placenta and Uterus (basically O2 and CO2 exchange)
-IV accessed and performed in a labor and deliver unit under electronic fetal monitoring
contractions initiated by Pitocin or nipple stimulation
the desired result is a "negative" test which consists of three contractions of moderate intensity in a 10
minute period without evidence of late decelerations
the test is done to detect problems so if it is Positive (persistent late decelerations
) then-CS

how is done:
The electronic fetal monitor is placed on the maternal abdomen for 20-30 minutes
Each time the fetus moves, FHR should accelerate 15 beats/min above the baseline for 15 seconds
A reactive (good) test =>2 accelerations in FHR occur with associated fetal movement
Biophysical Profile (BPP)
identification of a compromised fetus and consists of 5 components:
-fetal breathing movement
-fetal movement of the body or limbs
-fetal tone (extension or flexion of the limbs)
-amniotic fluid volume index (AFI) visualized as of fluid around the fetus
-reactive non-stress test
each component 0-2, 8-10-desirable.

Percutaneous Umbilical Blood sampling -like amniocentesis but cord punctured

-chromosomal anomalies, feta karyotyping, and blood disorders

Evrywhere where woman's abdomen is punctured informed consent is needed, and risks like amnionitis
spontaneous abortion, preterm labor/delivery, and premature rupture of membranes must be explained. If
she Rh--she may be RHoGAM given.

compartment syndrome...significant increase in pain not responsive to pain meds.

Plaquenil-tx of Rhem Arthritis...recommend eye exam every 3 mo.

Statins- tx of high cholesterol...ASSESS FOR MUSCLE PAIN...moniter liver enzymes.

Nicotinic Acid (Niacin)-tx of high cholesterol- flushing occurs in most pt. will diminish over
several weeks.

stages of shock (its more but i made it simple "KISS" keep it simple stupid lol!)
early- increase in pulse...normal urine output
intermediate-RAS (renin-angioten system), low urine output, cool skin, pallor
late-no urine output, low BP irreversible stage!

Myxedema/hypothyroidism: slowed physical and mental function, sensitivity to cold, dry skin and hair
Graves’ disease/hyperthyroidism: accelerated physical and mental function; sensitivity to heat, fine/soft
hair
Thyroid storm: increased temp, pulse and HTN
Post-thyroidectomy: semi-Fowler’s, prevent ncek flexion/hyperextension, trach at bedside

Hypo-parathyroid: CATS – convulsions, arrhythmias, tetany, spasms, stridor (decreased calcium), high
Ca, low phosphorus diet
Hyper-parathyroid: fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium), low
Ca, high phosphorus diet

Hypovolemia – incrased temp, rapid/weak pulse, increase respiration, hypotension, anxiety, urine
specific gravity >1.030
Hypervolemia – bounding pulse, SOB, dyspnea, rares/crackles, peripheral edema, HTN, urine specific
gravity <1.010; Semi-Fowler’s

Diabetes Insipidus (decreased ADH): excessive urine output and thirst, dehydration, weakness,
administer Pitressin
SIADH (increased ADH): change in LOC, decreased deep tendon reflexes, tachycardia, n/v/a, HA;
administer Declomycin, diuretics

Hypokalemia: muscle ewakness, dysrhythmias, increase K (raisins, bananas, apricots, oranges, beans,
potatoes, carrots, celery)
Hyperkalemia: MURDER – muscle weakness, urine (oliguria/anuria), respiratory depression, decreased
cardiac contractility, ECG changes, reflexes

Hyponatremia: nausea, muscle cramps, increased ICP, muscular twitching, convulsion; osmotic
diuretics, fluids
Hypernatremia: increased temp, weakness, disorientation/delusions, hypotension, tachycardia;
hypotonic solution
Hypocalcemia: CATS – convulsions, arrhythmias, tetany, spasms and stridor
Hypercalcemia: muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon
reflexes, sedative effect on CNS

HypoMg: tremors, tetany, seizures, dyrshythmias, depression, confusion, dysphagia; dig toxicity
HyperMg: depresses the CNS, hypotension, facial flushing, muscle ewakness, absent deep tendon
reflexes, shallow respirations, emergency

Addison’s: hypoNa, hyperK, hypoglycemia, dark pigmentation, decreased resistance to stress, fractures,
alopecia, weight loss, GI distress
Cushings: hyperNa, hypoK, hyperglycemia, prone to infection, muscle wasting, weakness, edema, HTN,
hirsutism, moonface/buffalo hump
Addisonian crisis: n/v, confusion, abdominal pain, extreme weakness, hypoglycemia, dehydration,
decreased BP

Pheochromocytoma: hypersecretion of epi/norepi, persistent HTN, increased HR, hyperglycemia,

diaphoresis, tremor, pounding HA; avoid stress, frequent bating and rest breaks, avoid cold and
stimulating foods, surgery to remove tumor

When the high-pressure alarm sounds on a ventilator, it is most likely due to an obstruction.
The obstruction can be caused by the client biting on the tube, kinking of the tubing, or
mucus plugging requiring suctioning

Constant bubbling occurring in the water seal chamber may indicate a leak in the system.
Among the options provided, the appropriate action is to notify the physician

CO2 acts as an acid in the body. Therefore, in a respiratory disorder with a rise in CO2, a
corresponding fall in pH occurs

Pleural friction rub is auscultated early in the course of pleurisy, before pleural fluid
accumulates. Once fluid accumulates in the inflamed area, friction between the visceral and
parietal lung surfaces decreases, and the pleural friction rub disappears.
Hemiparesis is a weakness of one side of the body that may occur after a stroke

Homonymous hemianopsia is loss of half of the visual field. The client with homonymous
hemianopsia should have objects placed in the intact field of vision, and the nurse also
should approach the client from the intact side.

Myasthenic crisis often is caused by undermedication and responds to the administration of

cholinergic medications, such as neostigmine (Prostigmin) and pyridostigmine (Mestinon).
Cholinergic crisis (the opposite problem) is caused by excess medication and responds to
withholding of medications. Too little exercise and fatty food intake are incorrect.
Overexertion and overeating possibly could trigger myasthenic crisis.

The changes in neurological signs from an epidural hematoma begin with loss of
consciousness as arterial blood collects in the epidural space and exerts pressure.

atropine is contraindicated in paralytic ileus, ulcerative colitits, obstructive GI disorders,

benign prostatic hypertrophy, myasthenia gravis and narrow angle glaucoma

withdrawal s/s of benzos: agitation, nervousness, insominia, anorexia, sweating, muscle

cramps.....basically about the same as alcohol withdrawal s/s.

thrombophlebitis s/s: redness, warmth, and induration along the vein, tenderness on
palpation of the vein.

hypokalemia-prominent U WAVE (u is down hypo), hyperkalemia-tall T wave (T is tall hyper)

superior vena cava syndrome s/s: nosebleeds, edema in the eyes, edema of hands, dyspnea,
mental status changes.

s/s of rheumatic fever: painful swollen joints, jerky movements, enlarged heart, heart
murmur, nontender lumps on bony areas, white painful lesions on the trunk

s/s of vit B12 deficiency: pallor, slight jaundice, smooth beefy red tongue, tingling hands and
feet, and difficulty with gait

good pasture syndrome affects the lungs and kidneys so expect pulmonary symptoms and
kidney symptoms (failure symptoms)

Cerebrospinal fluid (CSF) leakage after cranial surgery may be detected by noting drainage
that is serosanguineous surrounded by an area of straw colored or pale drainage. The
physical appearance of CSF drainage is that of a halo.

The major action of vasopressin is constriction of the splanchnic blood flow.

The normal serum amylase level ranges from 53 to 123 Somogyi units/dL

The normal range for the serum protein level in the adult client is 6.0 to 8.0 g/dL
Clinical signs and symptoms of portal hypertension are identical to those of heart failure and
include jugular vein distention, lung crackles, and decreased perfusion to all organs. Initially,
the client may have hypertension, flushed skin, and a bounding pulse.

Asterixis is a flapping tremor of the hand that is an early sign of hepatic encephalopathy.
The exact cause of this disorder is not known, but abnormal ammonia metabolism may be
implicated. Increased serum ammonia levels are thought to interfere with normal cerebral
metabolism. Tremors and drowsiness would also be noted

Neomycin may be prescribed for the client with portosystemic encephalopathy. It is a broad-
spectrum antibiotic that destroys normal bacteria found in the bowel, thereby decreasing
protein breakdown and ammonia production

Lactulose is prescribed for the client with hepatic encephalopathy to reduce bacterial
breakdown of protein in the bowel. The medication creates an acidic environment in the
bowel and causes the ammonia to leave the bloodstream and enter the colon. Ammonia
then becomes trapped in the bowel. Lactulose also has a laxative effect that allows for the
elimination of the ammonia.

Tacrolimus-Prograf- is an immunosuppressant medication used in the prophylaxis of organ

rejection in clients who receive allogeneic liver transplants. Frequent side effects include
headache, tremors, insomnia, paresthesia, diarrhea, nausea, constipation, vomiting,
abdominal pain, and hypertension.

A low-residue (low-fiber) diet is less irritating to the intestines than are other diets because
this type of food is easier to digest. This diet may be used for ulcerative colitis, diverticulitis,
and irritable bowel syndrome.

Diphenoxylate hydrochloride-Lomotil- with atropine sulfate is an antidiarrheal product that

decreases the frequency of defecation, usually by reducing the volume of liquid in the stools

Sulfasalazine- Azulfidine- is an anti-inflammatory sulfonamide. It can cause photosensitivity,

and the client should be instructed to avoid sun and ultraviolet light. It should be
administered with meals if possible to prolong intestinal passage.

Prepreparation for a barium enema includes maintaining a low-fiber diet for 1 to 3 days
before the test. Clear liquids or water may be allowed 12 to 24 hours before the test.
Laxatives and enemas may be prescribed before the test to cleanse the bowel. The client is
encouraged to drink liquids after the procedure to facilitate the passage of barium.

A client undergoing liver biopsy with use of a local anesthetic will be positioned supine with
the client’s right hand placed under the head

Cholecystogram-The nurse instructs the client to eat a fat-free meal the evening before the
procedure and then to avoid oral intake except for water on the day of the procedure. The
client may be given a high-fat meal or drink during the test to stimulate the emptying of the
gallbladder

Intrinsic factor is produced in the stomach but is used to aid in the absorption of vitamin B12
in the small intestine.
Vagotomy is a procedure that can reduce innervation to the stomach, thereby reducing the
production of gastric acid.

Lactulose is an osmotic laxative. The desired effect is two or three soft stools per day with
an acid fecal pH. Lactulose creates an acid environment in the bowel, resulting in a fall of
the colon’s pH from 7 to 5. This causes ammonia to leave the circulatory system and move
into the colon

The most typical finding with duodenal ulcer is pain that is relieved by food intake. The pain
is often described as a burning, heavy, sharp, or “hunger pang” pain that often localizes in
the mid-epigastric area.

Billroth I surgery involves removing one half to two thirds of the stomach and
reanastomosing the remaining segment of the stomach to the duodenum. With the loss of
this much of the stomach, development of pernicious anemia is not uncommon

Ulcerative colitis is an inflammatory disease of the large colon. The signs and symptoms of
ulcerative colitis include diarrhea with up to 10 to 20 liquid bloody stools per day, weight
loss, anorexia, fatigue, increased white blood cell count, increased erythrocyte
sedimentation rate, dehydration, hyponatremia, and hypokalemia

RENAL

The normal blood urea nitrogen level is 8 to 25 mg/dL.

The normal serum creatinine level for adults is 0.6 to 1.3 mg/dL

The diet for a client with renal failure who is receiving hemodialysis should include controlled
amounts of sodium, phosphorus, calcium, potassium, and fluids.

Following renal biopsy, the nurse ensures that the client remains in bed for at least 24
hours.

The client with uric acid stones should avoid foods containing high amounts of purines. This
includes limiting or avoiding organ meats such as liver, brain, heart, kidney, and
sweetbreads. Other foods to avoid include herring, sardines, anchovies, meat extracts,
consommés, and gravies

Bladder trauma or injury is characterized by lower abdominal pain that may radiate to one of
the shoulders. Bladder injury pain does not radiate to the umbilicus, costovertebral angle, or
hip.

Urethritis in the male client often results from chlamydial infection and is characterized by
dysuria, which is accompanied by a clear to mucopurulent discharge.

Typical signs and symptoms of epididymitis include scrotal pain and edema, which often are
accompanied by fever, nausea and vomiting, and chills. Epididymitis most often is caused by
infection, although sometimes it can be caused by trauma.

The client who experiences epididymitis from urinary tract infection should decrease intake
of acidic foods and increase fluid intake to flush the urinary system.
The client with prostatitis has a swollen and tender prostate gland that is also warm to the
touch, firm, and indurated. Systemic symptoms include fever with chills, perineal and low
back pain, and signs of urinary tract infection, which often accompany the disorder

Decreased force in the stream of urine is an early sign of benign prostatic hyperplasia. The
stream later becomes weak and dribbling. The client then may develop hematuria,
frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and
urinary retention can occur

Disequilibrium syndrome is characterized by headache, mental confusion, decreasing level

of consciousness, nausea, vomiting, twitching, and possible seizure activity. Disequilibrium
syndrome is caused by rapid removal of solutes from the body during hemodialysis. At the
same time, the blood-brain barrier interferes with the efficient removal of wastes from brain
tissue. As a result, water goes into cerebral cells because of the osmotic gradient, causing
brain swelling and onset of symptoms. The syndrome most often occurs in clients who are
new to dialysis and is prevented by dialyzing for shorter times or at reduced blood flow
rates.

Steal syndrome results from vascular insufficiency after creation of a fistula. The client
exhibits pallor and a diminished pulse distal to the fistula. The client also complains of pain
distal to the fistula, caused by tissue ischemia.

Measuring the blood urea nitrogen level is a frequently used laboratory test to determine
renal function. The blood urea nitrogen level starts to rise when the glomerular filtration rate
falls below 40% to 60%

Pain during the inflow of dialysate is common during the first few exchanges because of
peritoneal irritation; however, the pain usually disappears after 1 to 2 weeks of treatment.
The infusion amount should not be decreased, and the infusion should not be slowed or
stopped

In the client with benign prostatic hyperplasia, episodes of urinary retention can be triggered
by certain medications, such as decongestants, anticholinergics, and antidepressants

Nitrofurantoin (Furadantin) produce a harmless brown color to the urine and the medication
should not be discontinued until the client’s symptoms are alleviated or the prescribed dose
is completed

The normal urine myoglobin level is negative. After extensive muscle destruction or
damage, myoglobin is released into the bloodstream, where it is cleared from the body by
the kidneys. When there is a large amount of myoglobin being cleared from the body, there
is a risk of the renal tubules being clogged with myoglobin, causing acute tubular necrosis.
This is one form of acute renal failure.

ARF caused by glomerulonephritis is classified as intrinsic or intrarenal failure. This form of

ARF is commonly manifested by hypertension, tachycardia, oliguria, lethargy, edema, and
other signs of fluid overload.

Hemodialysis typically lowers the amounts of fluid, sodium, potassium, urea nitrogen,
creatinine, uric acid, magnesium, and phosphate levels in the blood. Hemodialysis also
worsens anemia, because RBCs are lost in dialysis from blood sampling and anticoagulation
during the procedure, and from residual blood that is left in the dialyzer. Although all of
these results are expected, only the lowered RBC count is nontherapeutic and worsens the
anemia already caused by the disease process

The client with renal failure is almost certain to have a problem with constipation as a result
of factors such as fluid restriction, fatigue that limits exercise, and dietary restrictions. In
addition, phosphate-binding antacids such as aluminum hydroxide gel cause constipation as
a side effect.

Aluminum intoxication can occur when there is accumulation of aluminum, an ingredient in

many phosphate-binding antacids. It results in mental cloudiness, dementia, and bone pain
from infiltration of the bone with aluminum

Risk factors associated with pyelonephritis include diabetes mellitus, hypertension, chronic
renal calculi, chronic cystitis, structural abnormalities of the urinary tract, presence of
urinary stones, and presence of an indwelling urinary catheter or frequent catheterization.

The normal ratio of BUN to creatinine is approximately 10:1 to 15:1. A value lower than 10:1
would indicate diminished urea concentration. A value greater than 15:1 would indicate
inadequate renal function.

An excretory urogram is an invasive test that uses contrast radiopaque dye to assess the
ability of the kidneys to excrete dye in the urine. Bowel preparation is necessary to permit
adequate visualization of the kidneys, ureters, and bladder.

Aluminum hydroxide binds with phosphate in the intestines for excretion in the feces, thus
lowering phosphorus levels. It can cause constipation, and it does not promote the
elimination of potassium.

Specific gravity evaluates the kidneys’ ability to regulate fluid balance and evaluates the
hydration status of the body. The BUN and creatinine more specifically evaluate renal
function.

Clinical manifestations associated with ARF occur as a result of metabolic acidosis. The
nurse would expect to note Kussmaul’s respirations as a result of the metabolic acidosis
because the bodily response is to exhale excess carbon dioxid

Gross, painless hematuria most frequently is the first manifestation of bladder cancer. As
the disease progresses, the client may experience dysuria, frequency, and urgency.

Kock’s pouch is a continent internal ileal reservoir. The nurse instructs the client about the
technique of catheterization. There is no external pouch.

Gross hematuria and proteinuria are the cardinal signs of glomerulonephritis.

The client with acute glomerulonephritis commonly experiences fluid volume excess and
fatigue. Interventions include fluid restriction, as well as monitoring weight, intake, and
output. The client is placed on bedrest, or at least encouraged to rest, because there is a
direct correlation between proteinuria and hematuria and increased activity levels. The diet
is high in calories but low in protein.
Foods that are allowed on an acid-ash diet include meat, fish, shellfish, cheese, eggs,
poultry, grains, cranberries, prunes, plums, corn, lentils, and foods with high amounts of
chlorine, phosphorus, and sulfur.

After ureterolithotomy, a ureteral catheter is put in place. Urine flows freely through it for
the first 2 to 3 days. As ureteral edema diminishes, urine leaks around the ureteral catheter
and drains directly into the bladder. At this point, drainage through the ureteral catheter
diminishes.

Renal artery embolization may be done instead of radiation therapy to shrink the kidney
tumor by cutting off its blood supply and impairing its overall vascularity. A secondary
benefit is that it reduces the risk of hemorrhage during surgery.

Individuals with polycystic kidney disease seem to waste rather than retain sodium. Thus,
they need increased sodium and water intake. Aggressive control of hypertension is
essential. Genetic counseling is advisable because of the hereditary nature of the disease.

After intravesical chemotherapy, the nurse increases fluids to help flush the medication out
of the bladder after the period of retention.

The client who has a radiation implant is placed in a private room and has limited visitors

After intravesical chemotherapy, the client treats the urine as a biohazard. This involves
disinfecting the urine and the toilet with household bleach for 6 hours after the treatment

Bloody or clear drainage from either the nasal or the auditory canal after trauma could
indicate a cerebrospinal fluid leak. The appropriate nursing action is to notify the physician
because this finding requires immediate intervention

Homonymous hemianopsia is a loss of half of the visual field. The client should have objects
placed in the intact fields of vision and the nurse should approach the client from the intact
side.

Normal ICP readings range from 5 to 15 mm Hg pressure. Pressures greater than 20 mm Hg

are considered to represent increased ICP, which seriously impairs cerebral perfusion.

To obtain accurate ICP pressure readings, the transducer is zeroed at the level of the
foramen of Monro, which is approximated by placing the transducer 1 inch above the level of
the ear

Hyperventilation with a PaCO2 of 25 to 30 mm Hg causes cerebral vasoconstriction, which

decreases intracranial blood volume and ICP. The PaO2 is not allowed to fall below 80 mm
Hg, to prevent cerebral vasodilation from hypoxemia.

Astereognosis is the inability to discern the form or configuration of common objects using
the sense of touch

The normal serum osmolality is 285 to 295 mOsm/kg H2O. A higher value indicates
dehydration;

The cerebellum is responsible for balance and coordination.

An ataxic gait is characterized by unsteadiness and staggering

A mydriatic medication produces mydriasis or dilation of the pupil. Mydriatic medications are
used preoperatively in the cataract client. These medications act by dilating the pupils. They
also constrict blood vessels.

Severe pain or pain accompanied by nausea is an indicator of increased intraocular pressure

and should be reported to the physician immediately.

Complaints of a sudden burst of black spots or floaters indicates that bleeding has occurred
as a result of the detachment of the retina

If the laceration is the result of a penetrating injury, an object may be noted protruding from
the eye. This object must never be removed except by the ophthalmologist because it may
be holding ocular structures in place. Application of an eye patch or irrigation of the eye may
disrupt the foreign body and cause further tearing of the cornea.

Tonometry is the method of measuring intraocular fluid pressure using a calibrated

instrument that indents or flattens the corneal apex. Pressures between 10 and 21 mm Hg
are considered within the normal range

When an eye drop and an eye ointment are scheduled to be administered at the same time,
the eye drop is administered first

Multiple myeloma is a B-cell neoplastic condition characterized by abnormal malignant

proliferation of plasma cells and the accumulation of mature plasma cells in the bone
marrow.

Findings indicative of multiple myeloma are an increased number of plasma cells in the bone
marrow, anemia, hypercalcemia caused by the release of calcium from the deteriorating
bone tissue, and an elevated blood urea nitrogen level.

Hodgkins- reed Sternberg cells

The time that the nurse spends in a room of a client with an internal radiation implant is 30
minutes per 8-hour shift. The dosimeter badge must be worn when in the client’s room.
Children younger than 16 years of age and pregnant women are not allowed in the client’s
room.

Hodgkin’s disease is a chronic progressive neoplastic disorder of lymphoid tissue

characterized by the painless enlargement of lymph nodes with progression to
extralymphatic sites, such as the spleen and liver. Weight loss is most likely to be noted.

Clinical manifestations of ovarian cancer include abdominal distention, urinary frequency

and urgency, pleural effusion, malnutrition, pain from pressure caused by the growing tumor
and the effects of urinary or bowel obstruction, constipation, ascites with dyspnea, and
ultimately general severe pain.

Abnormal bleeding, often resulting in hypermenorrhea, is associated with uterine cancer.

Conization procedure involves removal of a cone-shaped area of the cervix. Complications of

the procedure include hemorrhage, infection, and cervical stenosis
Hypercalcemia is a serum calcium level higher than 10 mg/dL, most often occurs in clients
who have bone metastasis, and is a late manifestation of extensive malignancy. The
presence of cancer in the bone causes the bone to release calcium into the bloodstream

. Vague abdominal discomfort or crampy, colicky abdominal pain is a characteristic

symptom of a right colon tumor.

Hormone therapy (androgen deprivation) is a mode of treatment for prostatic cancer. The
goal is to limit the amount of circulating androgens because prostate cells depend on
androgen for cellular maintenance. Deprivation of androgen often can lead to regression of
disease and improvement of symptoms.

A blood test is available to detect Lyme disease; however, the test is not reliable if
performed before 4 to 6 weeks following the tick bite.

Prevention, public education, and early diagnosis are vital to the control and treatment of
Lyme disease. A 3-week course of oral antibiotic therapy is recommended during stage I.
Later stages of Lyme disease may require therapy with intravenously administered
antibiotics, such as penicillin G.

Skin lesions or rash on the face across the bridge of the nose and on the cheeks is an initial
characteristic sign of systemic lupus erythematosus (SLE). Fever and weight loss may also
occur. Anemia is most likely to occur later in SLE.

The client with systemic lupus erythematosus (SLE) is at risk for cardiovascular disorders
such as coronary artery disease and hypertension. The client is advised of lifestyle changes
to reduce these risks, which include smoking cessation and prevention of obesity and
hyperlipidemia. The client is advised to reduce salt, fat, and cholesterol intake

Systemic lupus erythematosus is an inflammatory disease of collagen in connective tissue

The hallmark of stage I Lyme disease is the development of a rash within 2 to 30 days of
infection, generally at the site of the tick bite. The rash develops into a concentric ring,
giving it a bull’s-eye appearance. The lesion enlarges up to 50 to 60 cm, and smaller lesions
develop farther away from the original tick bite. In stage I, most infected persons develop
flu-like symptoms that last 7 to 10 days; these symptoms may reoccur later. Neurological
deficits occur in stage II. Arthralgias and joint enlargements are most likely to occur in stage
III.

Amikacin (Amikin) is an aminoglycoside. Adverse effects of aminoglycosides include

ototoxicity (hearing problems) confusion, disorientation, gastrointestinal irritation,
palpitations, blood pressure changes, nephrotoxicity, and hypersensitivity

Zalcitabine (ddC, Hivid) is an antiretroviral (nucleoside reverse transcriptase inhibitor) used

to manage human immunodeficiency virus infection in combination with other
antiretrovirals.

Foscarnet (Foscavir) is toxic to the kidneys. The serum creatinine level is monitored before
therapy, two or three times per week during induction therapy, and at least weekly during
maintenance therapy. Foscarnet also may cause decreased levels of calcium, magnesium,
phosphorus, and potassium. Thus, these levels also are measured with the same frequency.
Saquinavir(invirase) is an antiretroviral (protease inhibitor) used with other antiretroviral
medications to manage human immunodeficiency virus infection. Saquinavir is administered
with meals and is best absorbed if the client consumes high-calorie, high-fat meals.
Saquinavir can cause photosensitivity, and the nurse should instruct the client to avoid sun
exposure.

Stavudine (d4t, Zerit) is an antiretroviral used to manage human immunodeficiency virus

infection in clients who do not respond to or who cannot tolerate conventional therapy. The
medication can cause peripheral neuropathy, and the nurse should monitor the client’s gait
closely and ask the client about paresthesia.

Didanosine (Videx) can cause pancreatitis. A serum amylase level that is increased to 1.5 to
2 times normal may signify pancreatitis in the client with acquired immunodeficiency
syndrome and is potentially fatal. The medication may have to be discontinued. The
medication is also hepatotoxic and can result in liver failure.

Hypertension can occur in a client taking cyclosporine (Sandimmune, Gengraf, Neoral) and,
because this client is also complaining of a headache, the blood pressure is the vital sign to
be monitoring most closely. Other adverse effects include infection, nephrotoxicity, and
hirsutism.

Ketoconazole (Nizoral) is an antifungal medication. It is administered with food (not on an

empty stomach) and antacids are avoided for 2 hours after taking the medication to ensure
absorption. The medication is hepatotoxic and the nurse monitors liver function studies. The
client is instructed to avoid exposure to the sun because the medication increases
photosensitivity.

Zalcitabine(Hivid) slows the progression of acquired immunodeficiency syndrome (AIDS) by

improving the CD4+ cell count.

Frequent side effects of pentamidine(Pentam300) include leukopenia, thrombocytopenia,

and anemia

If the result of the ELISA is positive, the Western blot is done to confirm the findings. If the
result of the Western blot is positive, then the client is considered to be seropositive for the
infection and to be infected with the virus

The client with P. jiroveci infection usually has a cough as the first sign, which begins as
nonproductive and then progresses to productive. Later signs and symptoms include fever,
dyspnea on exertion, and finally dyspnea at rest.

Ocular toxicity is an adverse reaction with the use of hydroxychloroquine sulfate(Plaquinil).

An eye examination should be performed when medication therapy is started and after 6
months of therapy.

Pyrimethamine(Daraprim) is an antimalarial and an antiprotozoal medication used to treat

toxoplasmosis or Pneumocyctis jiroveci pneumonia.

Natural resistance, also called innate inherited immunity, is that immunity with which a
person is born. It does not require previous exposure to the antigen.
 Acquired immunity includes all antigen-specific immunities that a person develops during a
lifetime.

B lymphocytes have the job of making antibodies and mediating humoral immunity.

Eosinophils attack and destroy foreign particles that have been coated with antibodies of the
IgE class. Their usual target is helminths (parasitic worms).

Basophils mediate immediate hypersensitivity reactions. Dendritic cells perform the same
antigen-presenting task as that of macrophages.

Neutrophils phagocytize foreign particles such as bacteria.

The test for rheumatoid factor detects measures the presence of unusual antibodies of the
IgG and IgM type, which develop in a number of connective tissue diseases.

Measuring the ESR can confirm inflammation or infection anywhere in the body. The ESR is
particularly useful for connective tissue disease because the value directly correlates with
the degree of inflammation and later with the severity of the disease

Generally, an ESR value of 30 to 40 mm/hr indicates mild inflammation, 40 to 70 mm/hr

indicates moderate inflammation, and 70 to 150 mm/hr indicates severe inflammation

A negative result on an ELISA indicates that infection is absent. A positive ELISA result must
be confirmed with a Western blot.

A CD4+ lymphocyte count is performed to establish the stage of HIV infection, and to help
with decisions regarding the timing of the initiation of antiretroviral therapy and prophylaxis
for opportunistic infections.

Antiretroviral therapy is begun when CD4+ counts are less than 500 cells/μL or when signs
or symptoms of HIV disease appear

The client with cryptosporidiosis will present with signs and symptoms of watery diarrhea,
flatus, abdominal distention, pain, and fever. Diagnostic tests include a stool culture with a
bowel biopsy.

Toxoplasmosis manifests with signs and symptoms such as an altered mental status,
complaints of headache, and cognitive impairment.

In the client with SLE, a complete blood count commonly shows pancytopenia, a decrease in
the number of all cell types. This finding is most likely caused by a direct attack of all blood
cells or bone marrow by immune complexes

Early clinical manifestations of RA include complains of fatigue, generalized weakness,

anorexia, and weight loss.

Cryptococcosis can occur in the lungs or the gastrointestinal tract. Diagnostic tests to
confirm its presence include chest x-ray studies and sputum culture if it occurs in the lungs.

1. to remember blood sugar:

hot and dry-sugar high (hyperglycemia)
cold and clammy-need some candy (hypoglycemia)

2. ICP AND SHOCK HAVE OPPOSITE V/S

ICP-increased BP, decreased pulse, decreased resp.
shock- decreased BP, increased pulse, increased resp.

3. cor pulmonae: right sided heart failure caused by left ventricular failure (so pick edema, jvd, if it
is a choice.)

4. herion withdrawal neonate: irratable poor sucking

5. Jews: no meat and milk together

6. Brachial pulse: pulse area cpr on an infant.

7. Test child for lead poisioning around 12 months of age

8. bananas, potatoes, citrus fruits source of potassium

11. Cultures are obtained before starting IV antibiotics

12. a pt with leukemia may have epitaxis b/c of low platelets

13. best way to warm a newborn: skin to skin contact covered with a blanket on mom.

14. when a pt comes in and she is in active labor...nurse first action is to listen to fetal heart
tone/rate

15. phobic disorders...use systematic desensitiztion.

1. Clients of the islam religious group might want to avoid jello, pork and alcohol
2. Most common side effect of daunorucibin (cerubidine) for a client with leukemia is cardiotoxicity
3. Patient having a surgery on the lower abdomen should be placed in the trendelenburg position
4. Flumazenil (Romazicon) is the antidote for versed (Needless to remind you that versed is used for
conscious sedation... Say thank you Jean LOL)
5. Patients taking isoniazid (INH) should avoid tuna, red wine, soy sauce, and yeast extracts b/c of the side
effects that can occur such as headaches and hypotension
6. A Patient with gout who is placed on a low-purine diet should avoid spinach, poultry, liver, lobster, oysters,
peas, fish and otmeal
7. A patient who needs a high-iron diet should eat: sliced veal, spinach salad, and whole-wheat roll
8. Pegfilgastrin (Neulasta) is a chemotherapeutic drug given to patients to increase the white blood cells count
9. Amphoteracin B (Fungizone) should be mixed with D5W ONLY!!!
10. Pt with leukemia taking doxorubicin (Adriamycin) should be monitored for toxic effects such as rales and
distended neck veins (carditoxicity manifested by change in ECG and CHF)
11. Cardidopa/levodopa (Sinemet) is given to clients with Parkinson's disease. Watch for toxic effects such as
spasmodic eye winking
 12. Nimotop (Nimodipine) is calcium channel blocker that is given to patients with ruptured cerebral
aneurysm. Do you know why? Look it up! Vasospasm...

A possible complication of impetigo is posstreptococcal glomerulonephritis and periorbital

edema is indicative of postreptocccal glomerulonephritis.

client should weight themselves daily when taking lithium-- and after the first dose, client
should have his/her levels checked within 8-12 hours and two times a week for the first
month. Lithium also causes polyuria and dehydration. S&S of toxicity are, ataxia, vomiting,
diarrhea, muscular weakness and drowsiness.

Gurie blood test helps determine PKU for neonate.

child can return to school with Hep A, a week after onset of jaundice

bulge test is a test for confirming fluid in the knee

it's important not to touch the bed when using defibrilator in order to prevent accidental
countershock!!

Extrusion reflex means is the same meaning as tongue thrust which disappears between 3-
4mos of age.

Administer oral steroids in the morning with food to prevent ulcerogenic effects!

Increased abdominal distention, nausea and vomiting are signs of paralytic ileus that should
be reported to the physician!

It's important for a client with an internal radium implant to be on a low residue diet in order
to prevent many bowel movements because stool can dislodge it.

Heparin is not transmitted to infant from breastfeeding.

Haldol is effective for reducing assaultive behavior, for example, a pt threatening to hurt
another.

Narcotic analgesics are contraindicated for pt's with ICP because it can mask symptoms.

Pt's with SLE(lupus) should be in remission for 5 months before becoming pregnant.

Fixed and DIALATED pupil are signs of ICP and should be reported, it is an emergency.

For stabismus, the brain receives two images.

Vomiting is contraindicated for a pt/child who swallows lighter fluid(hydrocarbons) because

there's a risk of aspiration.
Change IV tubing every 48-72hourse(every time I want to choose every 24 hours!)

Extreme tearing and redness are signs of viral conjunctivits and if there is a worker with
these signs, make sure they are sent home because it is contagous!

For amputations after wound has healed..., assess for skin breakdown, wash, rinse and dry
stump daily, alcohol dries so don't apply DARN IT! , no lotion. Elevate stump 24-48 hours
after surgery, discourage semi fowler's position to prevent contractures of the hip.

Flush NG tube with 30ml of air before aspirating fluid.

Turp(transurethral resection of the prostate)--hemorrhage is a complication, bleeding should

gradually decrease to light pink in 24 hrs.

DVT: tx with compression stockings, low dose heparin, discourage sitting for prolonged
periods.

Hot and dry=sugar high(symp of hyperglycemia)

cold and clammy=need some candy(hypoglycemia)

Type one diabetes is diagnosed usually before age 15. NO insulin produced

Type 2 diabetes--INSUFFICIENT insulin production. Keto acidosis not common. Affects adults
over 40 mostly.

Diabetes insipidus--history of head injury or pituitary tumor or craniotomy...HYPOsecretion of

ADH. Polyruria,
decreased specific gravity, decreased osmolarity, HYPOvolemia, increased thirst,
tachycardia, decreased bp.

SIADH--excess ADH is released. HYPERvolemia, weightgain, administer

diuretics...Declomycin could be prescribed.

Adrenal crisis: Profound fatigue, dehydration, vascular collapse, renal shut down, decreased
NA, increased K.

Good ol' Maslow:

1st Physiologic needs
2 Security and safety
3 Love and belonging
4 Self actualization

Sterile field and procedure facts...

For sterile field--never turn your back, avoid talking , moisture barriers carries bacteria,
open pack away from field, do not reach over sterile field.

Sterile procedures--Surgical procedures, biopsies, caths, injections, infusions, dressing

changes.
In regards to surgery, aspirin, antidepressants, steroids, nsaids are drugs that put clients at
risk!

The consent for surgery--Dr. gives client explanation, consent signed by Dr., client and
witness. Signed prior to pre op meds, remains a permanent part of client chart.

For pain: PQRST

Provoking
Quality
Region
Severity
Timing

Ask if pain is stabbing, burning crushing.

Narcotics---MORPHINE, MEPERIDINE(DEMEROL), HYDROMORPHONE(DILAUDID),

OXYCODONE(OXYCOTIN).
Non-narcotics--ACETOMINOPHEN(TYLENOL), SALICYLATES.
Non steroidal(NSAIDS) TYLENOL, IBPROFEN, NAPROSYN, INDOCIN.

Clozapine(Clozaril) is used for schizophrenic patient's who don't respond to other

antipsychotic drugs.

(Benztropin)Congentin is used for the extrapyramidal effects associated with antipsychotic

agents.

Chlorpromazine (Thorazine) is used to treat hallucinations, agitation, and thought disorders.

Adenosine(Adenocard) is an antiarrhythmic drug, this drug is good for paroxysmal atrial

tachycardia...it slows conduction from av node.

Atropine for symptomatic bradycardia.

Digoxin for atrial fibrillation.

Lidocaine for ventricular ectopy.

For assessing the abdomen, correct order is INSPECTION, AUSCUTATION, PERCUSSION,

PALPATION "I Am Peed PAAAAA!" )

Cheyne strokes respirations are periods of apnea for 10-60 seconds then slowly increasing
rate and depth... occur typically with heart failure and cerebral depression.

Bulls eye rash is classic in lymes disease.

To relieve breast engorgement, pt should pump each breast for 10 minutes every 3-4 hours
and during the night if she's awake.
Anticholinergic effects(drugs that block acetylcholine) cause dry mouth, constipation, urine
retention.

5 rights of delegation
Right task
Right circumstance
Right communication
Right person
Right feed back

Cystic fibrosis is a recesssive trait, there is a one in four chance that each offspring will have
the trait or disorder.

Cushings triad is something to look out for in patient's with increased ICP which is decreased
heart rate, decreased respiratory rate BUT increased blood pressure.

1. Terbutaline a beta-2 agonist is given for preterm delivery to relaxe smooth muscle and halt
contractions
2. High circulating levels of progesterone released by the "corpus luteum" are thought to be
responsible for the immediate post-ovulation rise in body temperature
3. Geriatrics pts may increase consumption of salt and sweets b/c change in test perception...
Watch for health problems that may result from that!
4. 8 month infant => Recognizes but is fearful of strangers
5. 10-12 months infant => 3-words vocabulary1!!!
6. 12 months infant => stands alone
7. 8-12 weeks infant => can hold head up
8. Pregnant woman with "Charley horse" pain (pain in the "gastrocnemius muscle" =>the muscle in
the back part of the leg that forms the greater part of the calf; responsible for the plantar flexion of
the foot) is relieved by dorsiflexing the foot, which reduces the muscle spasm
9. The criteria used to distinguish TRUE from FALSE labor is "evidence of cervical change"...
Wow!
10. Pediatrics... Lead poisoning primarly affects the CNS, causing increased ICP. This results in
irritability and change of LOC, as well as seizure disorders, hyperactivity and learning
disabilities
11. 4 months infant => palmar grasp
12. 7-9 months infant => can bang 2 cubes together
13. 9-12 months infant => can put a block in a cup
14. 10-12 months infant => can demonstrate pincer grasp
15. Hydatidiform mole => increased HCG levels, marked nausea and vomiting

VC
EH
AO
LP
V = variable decels; C = cord compression caused
E = early decels; H = head compression caused
A = accels; O = okay, not a problem!
L = late decels = placental insufficiency, can't fill

For cord compression, place the mother in the TRENDELENBERG position because this
removes pressure of the presenting part off the cord. (If her head is down, the baby is no
longer being pulled out of hte body by gravity)
If the cord is prolapsed, cover it with sterile saline gauze to prevent drying of the cord and to
minimize infection.

For late decels, turn the mother to her left side, to allow more blood flow to the placenta.

For any kind of bad fetal heart rate pattern, you give O2, often by mask...

When doing an epidural anesthesia hydration before hand is a priority.

Hypotension and bradypnea / bradycardia are major risks and emergencies.

NEVER check the monitor or a machine as a first action. Always assess the patient first; for
exmaple listen to the fetal heart tones with a stethoscope in NCLEX land. Sometimes it's
hard to tell who to check on first, the mother or the baby; it's usually easy to tell the right
answer if the mother or baby involves a machine. If you're not sure who to check first, and
one of the choices involves the machine, that's the wrong answer.

If the baby is a posterior presentation, the sounds are heard at the sides.
If the baby is anterior, the sounds are heard closer to midline, between teh umbilicus and
where you would listen to a posterior presentation.

If the baby is breech, the sounds are high up in the fundus near the umbilicus. If the baby is
vertex, they are a little bit above the symphysis pubis

Metronidazole (Flagyl)- antiviral: no alcohol (unless you planning on vomiting for

awhile)...this drug has a metallic bitter taste.

Digoxin-check pulse, less than 60 hold, check dig levels and potassium levels.

Amphojel: tx of GERD and kidney stones....watch out for contipation.

Vistaril: tx of anxiety and also itching...watch for dry mouth. given preop commonly

Versed: given for conscious sedation...watch for resp depression and hypotension

PTU and Tapazole- prevention of thyroid storm

Sinemet: tx of parkinson...sweat, saliva, urine may turn reddish brown occassionally...causes

drowsiness

Artane: tx of parkinson..sedative effect also

Cogentin: tx of parkinson and extrapyramidal effects of other drugs

Tigan: tx of postop n/v and for nausea associated with gastroenteritis

Timolol (Timoptic)-tx of gluacoma

Bactrim: antibiotic..dont take if allergic to sulfa drugs...diarrhea common side effect...drink

plenty of fluids

Gout Meds: Probenecid (Benemid), Colchicine, Allopurinol (Zyloprim)

Apresoline(hydralazine)-tx of HTN or CHF, Report flu-like symptoms, rise slowly from

sitting/lying position; take with meals.

Bentyl: tx of irritable bowel....assess for anticholinergic side effects.

Calan (verapamil): calcium channel blocker: tx of HTN, angina...assess for constipation

Carafate: tx of duodenal ulcers..coats the ulcer...so take before meals.

Theophylline: tx of asthma or COPD..therap drug level: 10-20

Mucomyst is the antedote to tylenol and is administered orally

Diamox: tx of glaucoma, high altitude sickness...dont take if allergic to sulfa drugs

Indocin: (nsaid) tx of arthritis (osteo, rhematoid, gouty), bursitis, and tendonitis.

IF it is a depression med,
AND it look likes it's been in a commercial / you know someone on it (e.g. prozac, paxil,
celexa, zoloft)
then it is an SSRI.

IF not,
then it is either a tricylic OR a MAOI...

... common tricylics USUALLY have 3 syllables (pamelor, elavil). (remember: tri = 3)
... common MAOI's USUALLY have two (nardil marplan)

If ya can't remember, go with the syllables.

Serotonin syndrome is a risk for all depression meds, it is marked by vasoconstrictive crisis
(hypertension, temp increase, mentation).
Remember: serum toner (serotonin)... the first discovered role of serotonin was in
vasoconstriction!
This is a medical emergency, similar to NMS.

MAOI drugs have a specific risk for tyramine ingestion. Aged cheeses and wine are high in it,
fermented / moldy foods. M for munchies, A for aged.

Synthroid: tx of hypothyroidism..may take several weeks to take effect...notify doctor of

chest pain..take in the AM on empty stomach..could cause hyperthyroidism.

Librium: tx of alcohol w/d...dont take alchol with this...very bad nausea and vomiting can
occur.

Oncovin (vincristine): tx of leukemia..given IV ONLY

kwell: tx of scabies and lice...(scabies)apply lotion once and leave on for 8-12 hours...(lice)
use the shampoo and leave on for 4 minutes with hair uncovered then rinse with warm
water and comb with a fine tooth comb

Premarin:tx after menopause estrogen replacement

Dilantin: tx of seizures. thera drug level: 10-20

Navane: tx of schizophrenia..assess for EPS

Ritalin: tx of ADHD..assess for heart related side effects report immediately...child may need
a drug holiday b/c it stunts growth.

dopamine (Intropine): tx of hypotension, shock, low cardiac output, poor perfusion to vital
organs...monitor EKG for arrhythmias, monitor BP

the laxative step-ladder....to manage constipation

1. bulk-forming laxatives are first
2. stool softners
3. osmotics
4. stimulants
5. suppositors
6. enemas are last

atropine is contraindicated in paralytic ileus, ulcerative colitits, obstructive GI disorders,

benign prostatic hypertrophy, myasthenia gravis and narrow angle glaucoma

withdrawal s/s of benzos: agitation, nervousness, insominia, anorexia, sweating, muscle

cramps.....basically about the same as alcohol withdrawal s/s.

thrombophlebitis s/s: redness, warmth, and induration along the vein, tenderness on
palpation of the vein.

hypokalemia-prominent U WAVE (u is down hypo), hyperkalemia-tall T wave (T is tall hyper)

superior vena cava syndrome s/s: nosebleeds, edema in the eyes, edema of hands, dyspnea,
mental status changes.

s/s of rheumatic fever: painful swollen joints, jerky movements, enlarged heart, heart
murmur, nontender lumps on bony areas, white painful lesions on the trunk

s/s of vit B12 deficiency: pallor, slight jaundice, smooth beefy red tongue, tingling hands and
feet, and difficulty with gait

good pasture syndrome affects the lungs and kidneys so expect pulmonary symptoms and
kidney symptoms (failure symptoms)

1. Varicella (chickenpox) requires use of airborne precautions and contact precautions as

well.
2. If a patient is on contact precautions, have family members and other visitors wear a gown
and gloves as outlined by your facility (hospital).
1) Droplet room assignment: Preferably private, if not available roomate with same
illness and same pathogen. And if thats not an option 3 feet away from roomate with
the curtain pulled.

2) When transporting a patient with airborne precautions (for essential purposes

only) they must wear a surgical mask.

2) For contact precautions

diseases/conditions include: C. diff, E. coli, scabies
Room needs to be private unless room has another patient infected with the same organism

For droplet precautions

diseases/conditions include: meningitis, pneumonia, pertussis (whooping cough), rubella, mumps
Room needs to be private unless room has another patient infected with the same organism.
Maintain spacial distance of 3 feet when near patient.

Also remember standard precautions apply to ALL PATIENTS regardless of diagnosis when in
contact with any bodily fluid, blood, secretions/excretions, nonintact skin, and mucous membranes

For LP For 1 hour after the procedure, the client assumes a prone position, if able,
with a pillow under the abdomen to increase intra-abdominal pressure.

After Myelogram Headache is relatively common after the procedure, but neck
stiffness, especially on flexion, and pain should be reported because they signal
meningeal irritation.

For an EMG, needle electrodes are inserted into selected skeletal muscles to evaluate
changes and electrical potential of the muscles and the nerves that lead to them. The
test is useful in evaluating suspected lumbar or cervical disk disease, myasthenia
gravis, muscular dystrophy, and other motor neuron diseases

A method of testing for proprioception is to hold the sides of the client’s great toe
and while moving it, asking the client what position it is in.
 The normal CSF pressure is 5 to 10 mm Hg.

The therapeutic range for a serum phenytoin level is 10 to 20 mcg/mL

Cushing’s reflex is a late sign of increased ICP and consists of a widening pulse
pressure (systolic pressure rises faster than diastolic pressure) and bradycardia

In an unconscious client, eye movements are an indication of brain stem activity and
are tested by the oculocephalic response. When the doll’s eyes maneuver is intact,
the eyes move in the opposite direction when the head is turned.

Amantadine-Symmetrel- is an antiparkinson agent that potentiates the action of

dopamine in the central nervous system. The expected effect of therapy is a
decrease in akinesia and rigidity. Leukopenia, urinary retention, and hypotension all
are adverse effects of the medication.

Divalproex sodium (Depakote), an anticonvulsant, can cause potentially fatal hepatotoxicity.

The nurse should instruct the client about the importance of monitoring the results of liver
function studies and ammonia level determinations

The frontal lobe controls voluntary muscle activity including speech, and an impairment can
result in expressive aphasia.

The parietal lobe contains association areas for concept formation, abstraction, spatial
orientation, body and object size and shape, and tactile sensation.

The occipital lobe contains areas related to vision.

Auditory association and storage areas are located in the temporal lobe and relate to
understanding the spoken language.

The initial symptom of ALS is a mild clumsiness, usually noted in the distal portion of one
extremity. The client may complain of tripping and drag one leg when the lower extremities
are involved. Mentation and intellectual function usually are normal.

Early manifestations of increased ICP are subtle and often may be transient, lasting for only
a few minutes in some cases. These early clinical manifestations include episodes of
confusion, drowsiness, and slight pupillary and breathing changes. Later manifestations
include a further decrease in the level of consciousness, a widened pulse pressure, and
bradycardia. Cheyne-Stokes respiratory pattern, or a hyperventilation respiratory pattern,
and pupillary sluggishness and dilatation appear in the later stages.

Acetazolamide is a carbonic anhydrase inhibitor. It is used in the client with or at risk for
increased ICP to decrease cerebrospinal fluid production.

In early Alzheimer’s disease, forgetfulness begins to interfere with daily routines. The client
has difficulty concentrating and difficulty learning new material.

Selegiline hydrochloride is an antiparkinsonian medication. The medication increases

dopaminergic action, assisting in the reduction of tremor, akinesia, and the rigidity of
parkinsonism.
Early symptoms of Huntington’s disease include restlessness, forgetfulness, clumsiness,
falls, balance and coordination problems, altered speech, and altered handwriting. Difficulty
with swallowing occurs in the later stages

If a bacterial infection of CSF is present, findings would include a cloudy appearance, CSF
pressure over 200 mm H2O, protein level over 15 mg/dL, increased white blood cells, and
reduced glucose level.

In anosognosia, the client neglects the affected side of the body. The client either may
ignore the presence of the affected side (often creating a safety hazard as a result of
potential injuries) or may state that the involved arm or leg belongs to someone els

Global aphasia is a condition in which the affected person has few language skills as a result
of extensive damage to the left hemisphere. The speech is nonfluent and is associated with
poor comprehension and limited ability to name objects or repeat words.

CSF leakage after cranial surgery may be detected by noting drainage that is
serosanguineous (due to surgery) and surrounded by an area of clear or straw-colored
drainage. The typical appearance of CSF drainage is that of a “halo.” The nurse also would
further verify actual CSF drainage by testing the drainage for glucose, which would be
positive.

The client with hemianopsia is taught to scan the environment. This allows the client to take
in the entirety of the visual field, which is necessary for proper functioning within the
environment and helps to prevent injury to the client.

Respiratory compromise is a major concern in clients with Guillain-Barré syndrome. Clients

often are intubated and mechanically ventilated when the vital capacity is less than 15
mL/kg.

Caloric testing provides information about differentiating between cerebellar and brainstem
lesions. After determining patency of the ear canal, cold or warm water is injected into the
auditory canal. A normal response that indicates intact function of cranial nerves III, VI, and
VIII is conjugate eye movements toward the side being irrigated, followed by eye movement
back to midline. Absent or dysconjugate eye movements indicate brainstem damage.

Spinal immobilization is necessary after spinal cord injury to prevent further damage and
insult to the spinal cord. Whenever possible, the client is placed on a Stryker frame, which
allows the nurse to turn the client to prevent complications of immobility while maintaining
alignment of the spine

Clients with Bell’s palsy should be reassured that they have not experienced a brain attack
(stroke) and that symptoms often disappear spontaneously in 3 to 5 weeks.

Insomnia, agitation, mania, and delirium are due to excessive arousal of the reticular
activating system in conjunction with the cerebral hemispheres. The temporal lobe,
hippocampus, and frontal lobe are responsible for memory. The limbic system is responsible
for feelings and affect.

Recall of recent events (such as breakfast) is controlled by the hippocampus. The cerebral
hemispheres with specific regional functions control orientation. The limbic system is
responsible for feelings (affect) and emotions. Calculation ability and knowledge of current
events relate to the function of the frontal lobes of the cerebrum.

Wernicke’s area consists of a small group of cells in the temporal lobe whose function is the
understanding of language. Damage to Broca’s area is responsible for aphasia (option 2).
The hippocampus is responsible for the storage of memory (option 3). The motor cortex in
the precentral gyrus controls voluntary motor activity (option 4).

The most common earliest manifestation of bladder cancer is hematuria that is not
accompanied by pain.

#1. When wearing gown and/or gloves, make sure to take them off and properly dispose of
them, before leaving the patien'ts room.

#2. Pt's with herpes zooster (shingles) that is active should have the same precautions as a
patient with chicken pox---airborne and contact

#3. Pt's on droplet precaution can have their room door left open.

#4. Instruct visitors for pt's with droplet precautions to try to keep a distance of three feet
between them and the pt.

#5. Pt's with croup should be on contact precautions

Bacterial meningitis is transmitted via droplets, and when suctioning pt, wear goggles,
eyewear, mask, and gloves. Pt should wear a face mask when being transported.

The most common earliest manifestation of bladder cancer is hematuria that is not
accompanied by pain

The kidneys normally receive 20% to 25% of the cardiac output, even under conditions of
rest. For kidney function to be optimal, adequate renal perfusion is necessary. Perfusion can
best be estimated by the blood pressure

The most common findings with polycystic kidney disease are hematuria and flank or lumbar
pain that is either colicky in nature or dull and aching. Other common findings include
proteinuria, calculi, uremia, and palpable kidney masses. Hypertension is another common
finding and may be associated with cardiomegaly and heart failure

Acute rejection usually occurs within the first 3 months after transplantation, although it can
occur for up to 2 years after transplantation. The client exhibits fever, hypertension,
malaise, and graft tenderness. Treatment with corticosteroids, and possibly also with
monoclonal antibodies and antilymphocyte agents, is begun immediately.

Reduced outflow from the dialysis catheter may be due to the catheter position, infection, or
constipation. Constipation may contribute to a reduced outflow because peristalsis seems to
aid in drainage

High protein diet for pt's with COPD(due to increased metabolic demands.)
Document in the client's chart that an incident report was completed, but the incident report
itself is not supposed to be a part of the chart.(the situation or "incident" should be
documented with clear facts in the chart though.. but the documentation should not say
anything about the "incident report" .)

Orthostatic hypotension is common with tricyclic antidepressants.

Muscular dystrophy is atrophy of the skeletal muscles that's progressive, weaknesss occurs,
but with no neuro involvment.

Hyperparathyrodism is increased secretion of parathyroid hormone which causes

DECREASED serum phosphorus and INCREASED serum calcium levels and increased
excretion of calcium and phosphorus.

1. S/S croup (child) => hoarse voice, inspiratory stridor, barking cough
2. Client with hepatic encephalopathy => Neomycin decreases serum ammonia concentration by decreasing
the number of ammonia producing bacteria in the GI tract
3. A 2 year old can remove one garment
4. A 2 and half year old can build a tower of eight cubes and point out a picture
5. A 3 year old can wash and dry his/her hands
6. S/S perforated colon => severe abdominal pain, fever, decreasing LOC
7. Hyperglycemia => b/c polyuria assess for signs of deficit fluid volume such as rapid, thready pulse,
decreased BP, and rapid respirations
8. A child with nephrotic syndrome is at risk of skin breakdown from generalized edema
9. Tetracycline should be taken on an empty stomach. Avoid dairy products, Ca, Mg, Al and Fe (Iron)
10. Upper GI series => NPO 6-8 hrs b/f procedure
11. Mumps is the childhood infectious disease that most significantly affects male fertility
12. Client allergic to penicillin may be also allergic to cephalosporins
13. Infants and children up to age 7 are abdominal breathers
14. Placental transport of substances to/from the fetus begins in the 5th week
15. Duration of contractions => period from the onset of uterine tightening to uterine relaxation
16. Frequency of contractions => period b/t one contraction and the beginning of the next contraction
17. Erbs point => 3rd L ICS; pulmonic and aortic murmurs are best heard there

1. One of the CHF symptoms is S3 ventricular gallop

2. Hypertensive crisis => Priority in the first hour is brain damage due to rupture of the cerebral blood vessels.
Neurologic status must be closely monitored
3. Client with A-fib => a cold, pale lower leg suggests the presence of an embolus. Peripheral pulses should
be checked immediately
4. S/S anemia in a 10 months old infant => pale mucosa of eyelids and lips
5. S/S dehydration in 2 years old => sunken eyes, dry tongue, lethargy, irritability, dry skin, decreased play
activity, and increased pulse
6. Pt with anaphylaxis => The entire body may turn bright red b/c massive vasodilation
7. Teaching pt with Zollinger-Ellison syndrome => Report promptly to his/her healthcare provider any
finding of peptic ulcer (night time awakening with burning, cramp-like abdominal pain, vomiting and even
hematemesis, and change in appetite)
8. Infant with epiglottitis : 4 D's => Drooling, Dysphagia, Dysphonia and Distress inspiratory efforts
9. Niacin (Vit B) is a lipid lowering agent. Foods high in Niacin are meats, eggs, milk, dairy products
10. Child with 3 C's (Cough-Choke-Cyanosis) should be assessed for tracheoesophagial fistula
11. Gastric lavage is a priority for an infant who has been identified as suffering from botulism
12. Viral meningitis usually does not require protective measures
 13.
14. Myasthenia gravis--muscle weakness that occurs mostly in the throat and face as results from the deficits of
the nerve impulses conducting at the myoneural junction. Pancuronium and succinylcholine are
neromuscular agents that should be used with caution because of the chance of prolonging recovery.

Clients with CRF are to be on a high carbohydrate diet to prevent protein metabolism. Pt's must limit
protein, sodium and potassium and fluids because the kidneys cannot excrete an adequate amount of urine.

ABG's is the best way to monitor pulmonary status by analyzing the level of hypoxia caused by pulmonary
edema and for monitoring effects of treatment.

Cardiogenic shock--there is low cardiac output from heart pump failure such as in heart failure, sever
cardiomyopathy, acute MI.

Pancreatitis-high carb, low fat diet.

IV cimetidine(Tagamant) given as treatment for a bleeding peptic ulcer may experience hyptotention if
given too rapidly.

If the bladder irrigation solution is infusing at a sufficient rate, the urinary drainage will be
pale pink.

Epoetin alfa stimulates red blood cell production. Initial effects should be seen within 1 to 2
weeks, and the hematocrit reaches normal levels (30% to 33%) in 2 to 3 months.

Clients with oxalate stones should avoid foods high in oxalate such as tea, instant coffee,
cola drinks, beer, rhubarb, beans, asparagus, spinach, cabbage, chocolate, citrus fruits,
apples, grapes, cranberries, and peanuts and peanut butter. Large doses of vitamin C may
help increase oxalate excretion in the urine

Clients who form uric acid calculi should be placed on a low-purine diet. The intake of fish
and meats (especially organ meats) should be restricted. Dietary modifications also may
help adjust urinary pH so that stone formation is inhibited. Depending on physician
prescription, the urine may be either alkalinized by increasing the intake of bicarbonates or
acidified by drinking cranberry, plum, or prune juice.

Controlling edema is a critical aspect of therapeutic management of the client with nephrotic
syndrome. A diet high in protein may help the body restore normal plasma oncotic pressure,
thus decreasing edema. Dietary modifications may include salt restrictions and fluid
restriction and is based on the client’s symptoms. Bed rest is prescribed to promote diuresis
when edema is severe

Nephrotic syndrome describes a variety of signs and symptoms that accompany any
condition that markedly impairs filtration by glomerular capillary membranes and results in
increased permeability to protein. Hallmark signs and symptoms of this syndrome include
increased excretion of protein in the urine, decreased serum albumin levels, increased
serum lipids, and edema.

In the client with glomerulonephritis, characteristic findings in the urinalysis report are gross
proteinuria and hematuria. The specific gravity is elevated, and the urine may appear dark
and smoky
During the oliguric phase of acute renal failure, urine output is less than 100 mL in a 24-hour
period. The specific gravity of the urine is low and fixed, and the urine osmolarity
approaches that of the client’s serum level, or about 300 mOsm/L.

The diuretic phase of acute renal failure develops about 14 days after the initial insult and
lasts about 10 days. It is characterized by an increase in urine output of more than 1000 mL
in a 24-hour period

In an alkaline ash diet, all fruits are allowed except cranberries, blueberries, prunes, and
plums.

The distal tubule and the collecting duct of the nephron require the presence of ADH for
water reabsorption. The hormone increases the permeability of the membranes to allow
water to flow more easily along the concentration gradient. The glomerulus filters but does
not reabsorb. The calices are responsible for collecting the urine. The proximal tubule and
the loop of Henle reabsorb water without the assistance of ADH

The client must produce increased ADH, which will increase reabsorption of water in the
renal tubules and increase circulating volume

Diabetes insipidus results from insufficient ADH production, which causes the kidneys to
excrete large volumes of urine. Water intoxication represents the opposite problem of that
experienced with diabetes insipidus.

Clients in renal failure do not manufacture adequate amounts of erythropoietin, which is a

glycoprotein needed to synthesize red blood cells. Renin, angiotensin, and aldosterone are
substances that assist in maintaining blood pressure.

With increased potassium retention, the kidneys excrete more sodium.

Sodium is a cation. With increased retention of sodium, the kidneys also increase
reabsorption of chloride and bicarbonate, which are anions.

The stimuli for ADH release are increased serum osmolality and decreased blood volume.
Physiological stress, alcohol intake, and a cold environment all can cause the release of ADH

Using the process of filtration, creatinine is removed from the body in the glomerulus.

Furosemide works by acting to excrete sodium, potassium, and chloride in the ascending
limb of the loop of Henle.

Because of the potentially life-threatening outcomes associated with hyperglycemia,

hyperkalemia, and hypocalcemia, they are the most relevant to nursing management of the
client with chronic renal failure

CRF is a condition in which the kidneys have progressive problems in clearing nitrogenous
waste products and controlling fluid and electrolyte balance within the body. The typical
signs and symptoms of CRF include proteinuria or hematuria

Urge incontinence occurs when the client experiences involuntary loss of urine soon after
experiencing urgency. Reflex incontinence occurs when incontinence occurs at rather
predictable times that correspond to when a certain bladder volume is attained. Stress
incontinence occurs when the client voids in increments of less than 50 mL under conditions
of increased abdominal pressure

Many kidney stones are composed of calcium oxalate. Foods that raise urinary oxalate
excretion include spinach, rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and
tea.

The parietal lobe of the brain is responsible for spatial orientation and awareness of sizes
and shapes. The ability to distinguish an object by touch is called stereognosis, which is a
function of the right parietal area. The left parietal area is responsible for mathematics and
right-left orientation

The occipital lobe is responsible for reception of vision and contains visual association areas.
This area of the brain helps the individual to visually recognize and understand the
surroundings

Broca’s area in the brain is responsible for the motor aspects of speech, by coordinating the
muscular activity of the tongue, mouth, and larynx. The term assigned to damage in this
area is called aphasia.

Carbon dioxide is one of the metabolic end products that can alter the tone of the blood
vessels in the brain. High carbon dioxide levels cause vasodilation, whereas low carbon
dioxide levels cause vasoconstriction. As a result, the client may experience headache and
lightheadedness, respectively

The vagus nerve is responsible for sensations in the thoracic and abdominal viscera. It also
is responsible for the decrease in heart rate because approximately 75% of all
parasympathetic stimulation is carried by the vagus nerve.

After supratentorial surgery (surgery above the tentorium of the brain), the head of the
client’s bed usually is elevated 30 degrees to promote venous outflow through the jugular
veins.

Epidural hematomas frequently are characterized by a “lucid interval” that lasts for minutes,
during which the client is awake and talking. After this lucid interval, signs and symptoms
progress rapidly, with potentially catastophic intracranial pressure increase. Epidural
hematomas are medical emergencies.

Brown-Séquard syndrome results from hemisection of the spinal cord, resulting in ipsilateral
paralysis and loss of touch, pressure, vibration, and proprioception. Contralaterally, pain and
temperature sensation is lost because these fibers decussate after entering the cord.

Clients with Guillain-Barré syndrome have dysphagia. Clients with dysphagia are more likely
to aspirate clear liquids than thick or semisolid food

Clients with cholinergic crisis have experienced overdosage of medication. Tensilon will
exacerbate symptoms in cholinergic crisis to the point at which the client may need
intubation and mechanical ventilation. Intravenous atropine sulfate is used to reverse the
effects of these anticholinesterase medications
Buck’s extension traction is a type of skin traction often applied after hip fracture before the
fracture is reduced in surgery. Traction reduces muscle spasms and helps immobilize the
fracture

Following pin insertion for skeletal traction, a small amount of bleeding is expected. This can
be controlled with small pressure dressings;

A small amount of serous oozing is expected at pin insertion sites. Signs of infection such as
inflammation, purulent drainage, and pain at the pin site are not expected findings and
should be reported to the physician.

A casted extremity is elevated continuously for the first 24 to 48 hours to minimize swelling
and promote venous drainage.

The client is taught to hold the cane on the side opposite from the weakness. The reason is
that with normal walking, the opposite arm and leg move together (called reciprocal
motion). The cane is placed 4 to 6 inches lateral to the fifth toe.

1. Larngotracheobronchitis: inspiratory stridor and restlessness

2. Thorazine: antidote cogentine SE: akathisia(motor restlessness) dystonia(tongue
protrusion, abnormal posture) and diskinesia(stiff neck, difficulty swallowing)
3. Toddlers- parrallel play; infants enjoy company but self play.
4. IV infiltraton D/C IV and apply warm compress.
5. Urticaria= hives.
6. Graves disease: enlarged thyroid, increased metoblism and of course weight loss.
7. The goal for COPD is to improve ventilation.
8. From birth to 18 months Trust vs Mistrust
9 HbA1C- indicates BS for past 6-8 weeks(time varies with source) 2.5-6% normal.
10. myasthemia gravis: autoimmune disease of neuro jnx. destroys Acetylecholine
receptors.
11. Meniere's: Inner ear disease: vertigo, tinnitus, sensorineuro hearing loss, N/V
12. Use play therapy for children d/t inability to verbalize emotions.
13. Phenergan: Check vein patency (very important)
14. Visine: contraindicated in glaucoma d/t vasoconstriction

DONNING PPE (Personal Protective Equipment)

GOWN
Fully cover torso from neck to knees, arms to end of wrist, and wrap around the back
Fasten in back at neck and waist

MASK OR RESPIRATOR
Secure ties or elastic band at middle of head and neck
Fit flexible band to nose bridge
Fit snug to face and below chin
Fit-check respirator

GOGGLES/FACE SHIELD
Put on face and adjust to fit
GLOVES
Use non-sterile for isolation
Select according to hand size
Extend to cover wrist of isolation gown

SAFE WORK PRACTICES

Keep hands away from face
Work from clean to dirty
Limit surfaces touched
Change when torn or heavily contaminated
Perform hand hygiene

REMOVING PPE

Remove PPE at doorway before leaving patient room or in anteroom

GLOVES
Outside of gloves are contaminated!
Grasp outside of glove with opposite gloved hand; peel off
Hold removed glove in gloved hand
Slide fingers of ungloved hand under remaining glove at wrist

GOGGLES/FACE SHIELD
Outside of goggles or face shield are contaminated!
To remove, handle by “clean” head band or ear pieces
Place in designated receptacle for reprocessing or in waste container

GOWN
Gown front and sleeves are contaminated!
Unfasten neck, then waist ties
Remove gown using a peeling motion; pull gown from each shoulder toward the
same hand
Gown will turn inside out
Hold removed gown away from body, roll into a bundle and discard into waste or
linen receptacle

MASK OR RESPIRATOR
Front of mask/respirator is contaminated – DO NOT TOUCH!
Grasp ONLY bottom then top ties/elastics and remove
Discard in waste container

HAND HYGIENE
Perform hand hygiene immediately after removing all PPE!

Chicken pox(13-17 days)--prodromal, child have malaise, fever, anorexia.

Rash is pruritic, and starts out as a macule then papule then a vesicle.
 Spread by direct contact, droplet and contaminated object.

ISOLATE till all vesicles are crusted; it can be spread from 2 days before the rash
begins.

Avoid use of aspirin due to Reye's syndrome, use tylenol.

Airborne--door can be closed..measles (RUBEOLA), M. tuberculosis,

disseminated zoster(shingles), varicella(chicken pox)--again can cohort and
place in same room with the same infective organism.

Droplet--door may be open---Streptococcus pharyngitis, meningitis,

pneumonia, adeno virus, epiglottitis, influenza, mumps, mycoplasma
pneumonia, or meningococcal, parvovirus, pertussis, pneumonia,rubella,
scarlet fever, sepsis...private room or pt with same infection--involves contact with
mucous membranes of nose or mouth...happens during talking, coughing, suctioning.
MAINTAIN 3FEET between infected patients and visitors.

Rubella--there's a maculopapular rash on face and all over the body. Prodromal:
malaise and fever which is followed by cough.
Spread by droplets and contaminated objects. placed on contact
precautions, isolate child from pregnant women.

Contact- c-diff, RSV, mrsa, wound infections,skin infections, diarrhea stuff-enteric

infections

The earliest symptom of compartment syndrome is paresthesia (numbness and

tingling in the fingers). Other symptoms include pain unrelieved by narcotics, pain
that increases with limb elevation, and pallor and coolness to the distal limb.
Cyanosis is a late sign

To achieve proper traction, weights need to be free-hanging, with knots kept away
from the pulleys

When going down the stairs with crutches, the client should be instructed to move
the crutches and the affected leg, then move the unaffected leg down.

To go up the stairs, the client should first move up the unaffected leg and then move
up the affected leg and crutches.

In a three-point gait, the client is instructed to simultaneously move both crutches and the
affected leg forward and then to move the unaffected leg forward.

Edema in the extremity indicates impaired venous return.

Signs of impaired arterial circulation in the limb include coolness and pallor of the skin and a
diminished arterial pulse.

A gallium scan is similar to a bone scan, but with injection of gallium isotope instead of
technetium Tc 99m. Gallium is injected 2 to 3 hours before the procedure. The procedure
takes 30 to 60 minutes to perform. The client must lie still during the procedure. There is no
special aftercare.

A straight leg cane is useful for the client with slight weakness in one leg. A walker is
beneficial to the client with greater or bilateral weakness, or the client who is at risk for falls.
Wooden crutches often are used by clients with a leg cast. Lofstrand crutches aid clients
who need crutches but have limited arm strength.

Clients with low back pain often are more comfortable when placed in William’s position. The
bed is placed in semi-Fowler’s position with the knee gatch raised sufficiently to flex the
knees. This relaxes the muscles of the lower back and relieves pressure on the spinal nerve
root.