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with cholecystitis • • • • • • • • Cullen’s sign – ecchymosis in umbilical area, seen with pancreatitis Turner’s sign – flank grayish blue (turn around to see your flanks) pancreatitis McBurney’s Point – pain in RLQ indicative of appendicitis LLQ – diverticulitis , low residue, no seeds, nuts, peas RLQ – appendicitis, watch for peritonitis Guthrie Test – Tests for PKU, baby should have eaten source of protein first Shilling Test – test for pernicious anemia/how well one absorbs Vit b12 Allen’s test – occlude both ulnar and radial artery until hand blanches then release ulnar. If the hand pinks up, ulnar artery is good and you can carry on with ABG/radial stick as planned. ABGS must be put on ice and whisked to the lab.
Addisons & Cushings Addisons= Cushings= Na, down, up BP, down up Blood, down up K, up down BSL down up
Addisons= hyponatremia, hypotension, decreased blood vol, hyperkalemia, hypoglycemia Cushings= hypernatremia, hypertension, incrased blood vol, hypokalemia, hyperglycemia Mineral corticoids are given for Addison’s disease. 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, hypotension Managing stress in a patient with adrenal insufficiency (Addison’s) is paramount, because if the adrenal glands are stressed further it could result in Addisonian crisis. While we’re on Addison’s, remember blood pressure is the most important assessment parameter, as it causes severe hypotension. Addison's disease (need to "add" hormone) Cushing's syndrome (have extra "cushion" of hormones) ADDISON’S DISEASE – bronze like skin pigmentation. CUSHING’S SYNDROME – moon face appearance and buffalo hump.
Precautions AIRBORNE My – Measles Chicken - Chicken Pox/Varicella Hez - Herpez Zoster/Shingles TB or remember... MTV=Airborne Measles TB Varicella-Chicken Pox/Herpes Zoster-Shingles Private Room - negative pressure with 6-12 air exchanges/hr Mask, N95 for TB
DROPLET think of SPIDERMAN! S - sepsis S - scarlet fever S - streptococcal pharyngitis P - parvovirus B19 P - pneumonia P - pertussis I - influenza D - diptheria (pharyngeal) E - epiglottitis R - rubella M - mumps M - meningitis M - mycoplasma or meningeal pneumonia An - Adenovirus Private Room or cohort Mask Door open, 3 ft distance, private room or cohort, mask
CONTACT PRECAUTION MRS.WEE M - MRSA R - respiratory infection S - skin infections * W - wound infxn E - enteric infxn - clostridium difficile E - eye infxn - conjunctivitis SKIN INFECTIONS VCHIPS V - varicella zoster C - cutaneous diphtheria H - herpez simplex I - impetigo P - pediculosis S – scabies Tetanus, Hepatitis A & B, HIV Localized Herpes Zoster is CONTACT PRECAUTION A nurse with a localized herpes zoster CAN care for patients as long as the patients are NOT immunosuppressed and the lesions must be covered!
Disseminated Herpes Zoster is AIRBORNE PRECAUTIONS
**VRSA - Contact AND airborne precaution (Private room, door closed, negative pressure) **SARS (Severe Acute Resp Syndrome) – Contact AND airborne (just like varicella) Neutropenic patients = no live vaccines, no fresh fruits, no flowers/live plants No milk (as well as fresh fruit or veggies) on neutropenic precautions. Appendicitis Appendicitis (inflammation of the appendix) pain is in RLQ with rebound tenderness McBurney’s Point – pain in RLQ indicative of appendicitis The sequence of symptoms is the most reliable when assessing for possible appendicitis; the clinical symptoms with acute appendicitis are similar to those of many other medical conditions. o In acute appendicitis, the pain usually comes prior to nausea and vomiting; o Nausea and vomiting that come before abdominal pain frequently indicate gastroenteritis
Position on right side with legs flexed after appendectomy Rheumatoid Arthritis • Rheumatoid arthritis: o Move your joints as much as you can each day; maintaining mobility is a physical need; o achieved by exercises and independent ADLs; o take warm shower or tub bath to increase blood flow, decrease pain and increase joint mobility; (remember HOT = chronic pain, COLD = acute pain) o walking and swimming are good exercises; Swimming is best for arthritis patients Pain is usually the highest priority with RA GOUT - Gout is a kind of arthritis that occurs when uric acid builds up in blood and causes joint inflammation. Acute gout is a painful condition that typically affects one joint; Chronic gout is repeated episodes of pain and inflammation, which may involve more than one joint. Gout Meds: Probenecid (Benemid), Colchicine, Allopurinol (Zyloprim) Assessment Order of assessment: Inspection, Palpation, Percussion and Auscultation. EXCEPT with abdomen cuz you don’t wanna mess with the bowels and their sounds so you Inspect, Auscultate, Percuss then Palpate (same with kids) Blood For blood types: "O" is the universal donor (remember "o" in donor) "AB" is the universal receipient *Blood transfusion- sign of allergies in order: 1)Flank pain 2)Frequent swallowing 3)Rashes 4)Fever 5)Chills Basophils release histamine during an allergic response. During sickle cell crisis there are two interventions to prioritize: fluids and pain relief. Hemophilia is x-linked. Mother passes disease to son. • eleVate Veins = promotes venous return • dAngle Arteries = increases circulation; better perfusion to extremities Bleeding is part of the ‘circulation’ assessment of the ABCD’s in an emergent situation. Therefore, if airway and breathing are accounted for, a compound fracture requires assessment before Glasgow coma scale and a neuro check (D=disability, or neuro check) *Thrombocytopenia -Bleeding precautions! 1)Soft bristled toothbrush
Inferon via Ztrack *Pernicious Anemia . then if necessary surgery to drain abscess. Maintain hip abduction by separating thighs with pillows. ice pack for 10.Red.give with Vitamin C or on an empty stomach 2)Fe via IM. may indicate that skull pins have slipped onto the thin temporal plate. don't elevate HOB more than 45 degrees. bone pain. ADDUCTION After Total Hip Replacement --> don't sleep on operated side. enlargement of bone. notify physician immediately o Ok to be a little itchy.tinnitus. Itching under cast area. Neuromuscular damage is irreversible 4-6 hours after onset. will take Vit. ** Greenstick fractures. and sore red tongue Bone Stuff Remember compartment syndrome is an emergency situation. SHORTENING. give analgesic. Paresthesias and increased pain are classic symptoms. usually seen in kids bone breaks on one side and bends on the other Ottorhea s/s of basilar fracture Battles sign and racoons eyes s/s of orbital fracture Osteomyletitis is an infectious bone dz. screws are tightened so headache is expected. * You can petal the rough edges of a plaster cast with tape to avoid skin irritation. Give blood cultures and antibiotics. Buck’s Traction o Remove the foam boot 3x per day to inspect skin. douche) 3) No injections if possible Anemia PERNICIOUS ANEMIA – cardinal S/S red beefy tongue *Iron deficiency anemia .2)No insertion of anything! (c/i suppositories. if no fracture may turn to either side • . ** Paget's Disease . don't flex hip more than 45-60 degrees. a 2nd nurse should support the extremity during inspection o Turn client to unaffected side if there is a fracture. tachycardia. • Halo vest traction: o Hurts to chew = BAD! = if pain occurs with jaw movement 24 to 48 hours after traction applied. thick bones. Beefy tongue. NEVER use qtip or anything to scratch area ** SIGNS of a Fractured hip: EXTERNAL ROTATION.B12 for life! Pernicious anemia s/s include pallor.cool air via blow dryer.15 minutes.easily fatigued 1)Fe PO .
weakness upon dorsiflexion indicates pressure on the nerve o Elevate foot of the bed – provides counter-traction Buck’s traction= knee immobility Russell traction= femur or lower leg Dunlap traction= skeletal or skin Bryant’s traction= children <3y.Red and Painful 2nd Degree .No Pain because of blocked and burned nerves Cancer . Place apparatus first then place the weight when putting traction Burns Rule of NINES for burns Head and Neck= 9% Each upper ext= 9% Each lower ext= 18% Front trunk= 18% Back trunk= 18% Genitalia= 1% *BURNS 1st Degree . <35 lbs with femur fx.Blisters 3rd Degree .o Provide back care q2h to prevent pressure ulcers o Dorsiflex foot of affected leg – assess function of the peroneal nerve.
Start teaching boys testicular self exam around 12. BLADDER CA – cardinal S/S painless hematuria Undescended testis or cryptorchidism is a known risk factor for testicular cancer later in life. and lymph. lung. progressive enlargement of spleen & lymph tissues. Reedstenberg Cells A pt with leukemia may have epistaxis (nose bleed) b/c of low platelets Common sites for metastasis include the liver. multiply 9/5 and substract 40 * To convert Fahrenheit to C. Diet Jews: no meat and milk together . because the adverse effect could be irreversible. What should you be most concerned about? Skin irritation? No. and flush the toilet twice after using for 2 days. Conversions 1 t (teaspoon)= 5 ml 1 T(tablespoon)= 3 t = 15 ml 1 oz= 30 ml 1 cup= 8 oz 1 quart= 2 pints 1 pint= 2 cups 1 gr (grain)= 60 mg 1 g (gram)= 1000 mg 1 kg= 2.2 lbs 1 lb= 16 oz * To convert Centigrade to F. Flush substance out of body w/3-4 liters/day for 2 days. radiation. During Internal Radiation --> on bedrest while implant in place Radioactive iodine – The key word here is flush. Bence Jones protein in the urine confirms multiple myeloma. Wilm’s tumor is usually encapsulated above the kidneys causing flank pain. and no kids. surgery. Your cancer patient is getting radiation. bone.4 options for cancer management: chemo. Limit contact w/patient to 30 minutes/day. Infection kills cancer patients most because of the leukopenia caused by radiation. A breast cancer patient treated with Tamoxifen should report changes in visual acuity. C= F+40. brain. because most cases occur during adolescence. Hodgkin’s disease= cancer of lymph is very curable in early stage. F= C+40. multiply 5/9 and substract 40. HODGKIN’S DSE/LYMPHOMA – painless. allow to die with dignity. No pregnant visitors/nurses.
MALARIA – stepladder like fever with chills. corn. avocados. Baby is inconsolable.dont give to immunosuppressed pt TPN(total parenteral nutrition) given in subclavian line. not passing meconium. cranberries.**Acid Ash diet . chestnuts. . meat.Miscellaneous ACROMEGALY – cardinal S/S Coarse facial feature Amyotrophic lateral sclerosis ( ALS ) is a condition in which there is a degeneration of motor neurons in both the upper & lower motor neuron systems. TETANUS – risus sardonicus. grapes. DOWN SYNDROME – protruding tongue. Cystic Fibrosis: First sign of cystic fibrosis may be meconium ileus at birth. Mother passes disease to son. high sodium. We know Kawasaki disease (autoimmune) causes a heart problem. passion fruit. bread ** Alk Ash diet. poultry. No contact sports.cheese. but what specifically? Coronary artery aneurysms d/t the inflammation of blood vessels.milk. Guillain-Barre syndrome= From bottom to top. prunes. plums. Chvostek sign (facial spasm). cherries. apricots. CYSTIC FIBROSIS – S/S Salty skin Cystic Fibrosis give diet low fat. TYPHOID – rose spots in abdomen. rhubarb. fat soluble vitamins ADEK. ascending paralysis. kiwis. TETANY – hypocalcemia (+) Trousseau’s sign/carpopedal spasm. Keep eye on respiratory system. ascending muscle weakness. salmon low residue diet means low fiber Yogurt has live cultures. Lupus autoimmune disease (SLE) – cardinal S/S butterfly rashes PEMPHIGUS VULGARIS autoimmune disease – cardinal S/S Nikolsky’s sign (separation of epidermis caused by rubbing of the skin) Bacterial diseases cardinal S/S: CHOLERA – rice watery stool. do not eat. KAWASAKI SYNDROME (autoimmune) – cardinal S/S strawberry tongue Kawasaki's (autoimmune) leads to cardiac problems. Hemophilia is x-linked. veggies. Latex allergies => Assess for allergies to bananas. tomatoes. pastry. Bleeding disorder. DIPTHERIA – pseudo membrane formation LEPROSY – lioning face. peaches Diseases.
tx with antiparkinsons meds. tingling. DENGUE – cardinal S/S petechiae or (+) Herman’s sign. progressive disease with demyelinating lesions in the CNS which affect the white matter of the brain and spinal cord. Group-a strep precedes rheumatic fever. Since smallest concentration of ACTH receptors are in cranial nerves. Watch for elevated antistreptolysin O to be elevated. pharyngeal muscles. but WITH each meal. twisting.Aerosal bronchodilators. Meningeal irritation S/S nuchal rigidity. . just palliative care Viral diseases cardinal S/S: MEASLES – cardinal S/S Koplick's spots are red spots with blue center characteristic of PRODROMAL stage of Measles. Usually in mouth. fatigue and spasticity are all symptoms of MS -Multiple Sclerosis is a chronic. movements of face. DUCHENNE’S MUSCULAR DYSTROPHY – Gowers’ sign (use of hands to push one’s self from the floor LYME’S DISEASE – cardinal S/S Bull’s eye rash Rheumatic fever can lead to cardiac valves malfunctions. mucolytics and pancreatic enzymes. tinnitus Cerebral S/S: nystagmus. -Pancreatic enzymes are taken with each meal! Not before. positive Brudzinski + Kernig signs and PHOTOPHOBIA too! CSF in bacterial meningitis will have high protein & low glucose (try to remember it by thinking the bacteria are like ants that like sugar and eat up the sugar so low glucose) Multiple sclerosis= myelin sheat destruction. Motor S/S: limb weakness. Penicillin!!! Huntington's Chorea aka Dancing Disease: 50% genetic. descending muscle weakness. limbs and body -gait deteriorates to no ambulation -no cure.) and it embarrasses kids. disruption in nerve impulse conduction. not after. Hyperactive deep tendon reflexes. ataxia. mastication. Respiratory problems are the chief concern with CF Cerebral palsy = poor muscle control due to birth injuries and/or decrease oxygen to brain tissues. expect fatigue and weakness in eye. Akathisia . etc. They have joint pain. dysphagia. can be mistaken for agitation. paralysis. Brudzinski sign (neck flex = lower leg flex). joint contractions will occur as well as pressure ulcers on the sacrum and hips from difficulty positioning the patient correctly Myasthenia Gravis: worsens with exercise and improves with rest. if these spasms are not relieved. slow speech Sensory S/S: numbness. need to keep going. Chorea is part of this sickness (grimacing. autosomal dominant disorder S/S: chorea --> writhing. Myasthenia Gravis= decrease in receptor sites for acetylcholine.motor restlessness. sudden body movements. dysarthria • Multiple sclerosis – sleep on stomach as much as possible may minimize spasm of the flexor muscles of the hips and knees of a person with multiple sclerosis. CHICKEN POX – cardinal S/S Vesicular Rash (central to distal) dew drop on rose petal MENINGITIS – Kernig’s sign (leg flex then leg pain on extension). vision changes.
Myasthenia Crisis: a positive reaction to Tensilon--will improve symptoms. Tensilon test given if muscle is tense in myasthenia gravis. so it will help with chewing and swallowing. with potassium replacement.Myasthenia Gravis is caused by a disorder in the transmission of impulses from nerve to muscle cell. To remember blood sugar: Hot and dry . 46 corresponds to a blood sugar of 70-110. and no acidosis. remove plug. With HHNS there is no ketosis. Serum acetone and serum ketones rise in DKA. so get fluids going first. Diabetes Mellitus – DKA DM – polyuria.test to assess how well blood sugars have been controlled over the past 90-120 days. polydypsia.used after mastectomy. place on flat surface.sugar high (hyperglycemia) Cold and clammy . bringing the glucose down too far and too fast can result in increased intracranial pressure d/t water being pulled into the CSF. this confirms diagnosis Cholinergic Crisis: caused by excessive medication-stop med-giving Tensilon will make it worse Give neostigmine to clients with Myasthenia Gravis about 45 min. before eating. Fats leave ketones (acids) that cause pH to decrease. so be ready. HbA1c . empty when full or q8hr. compress evacuator completely . DKA is rare in diabetes mellitus type II because there is enough insulin to prevent breakdown of fats DKA – cardinal S/S Kussmauls breathing (Deep Rapid RR) While treating DKA. Tensilon is used in myasthenia gravis to confirm the diagnosis. Fluids are the most important intervention with HHNS as well as DKA. As you treat the acidosis and dehydration expect the potassium to drop rapidly. cleanse opening and plug with alcohol sponge. Drains Hemovac. polyphagia Beta cells of pancreas produce insulin. empty contents. Potassium is low in HHNS (d/t diuresis). 7 is ideal for a diabetic and corresponds to a blood sugar of 130.need some candy (hypoglycemia) Diabetic ketoacidosis (DKA)= when body is breaking down fat instead of sugar for energy.
increased HR. tremor. or as an adverse reaction to desmopressin (for diabetes insipidus). 4. n/v/a. persistent HTN.both eyes OS. diuretics Pheochromocytoma: hypersecretion of epi/norepi.v. administer Declomycin.. check system for operation. lay on affected ear when in bed. surgery to remove tumor Eyes OU. restrict Na. avoid stress. position patient with arms on pillow on over bed table or lying on side.just a tip to remember) • IOP – Intraocular Pressure Normal = 10 -21 mm Hg Assessing extraocular eye movements check cranial nerves 3. Tinnitus *Meniere's Disease . tachycardia. v. Diabetes Insipidus (decreased ADH): excessive urine output and thirst.s.right eye (dominant Right eye.left eye OD.listen for bilateral breath sounds. avoid cold and stimulating foods.semi fowlers or upright on edge of bed. frequent bating and rest breaks.Admin diuretics to decrease endolymph in the cochlea. decreased deep tendon reflexes. SIADH (increased ADH): change in LOC.. Ear MENIERE’S DSE – cardinal S/S Vertigo. HA. . observe for signs of hypovolemia.. no more than 1000cc at a one time. diaphoresis. Post. and 6. empty bladder.s.to remove air. weakness. administer Pitressin Water intoxication will be evidenced by drowsiness and altered mental status in a patient with TUR syndrome. sterile dressing. Post. pounding HA. hyperglycemia.Take v. Thoracentesis prep. Triad: 1)Vertigo 2)Tinnitus 3)N/V After Myringotomy --> position on side of affected ear after surgery (allows drainage of secretions) Endocrine – ADH – DI – SIADH The parathyroid gland relies on the presence of vitamin D to work. shave area around needle insertion. Paracentesis. release plug. check leakage. dehydration. report elevated temp.s.
Diamox. can cause hypokalemia. I had to look it up cuz I heard it was important *ah hem ah hem* ** BOTOX ** (Botulin Toxin) can be used with strabismus also to relax vocal cords in spasmodic dysphonia. blurry vision. o Cataracts are partial or total opacity of the normally transparent crystalline lens. or seizures immediately * Ethambutol . flashes of light.messes with your Eyes * Apply eye drop to conjunctival sac and after wards apply pressure to nasolacrimal duct / inner canthus *Glaucoma : intraocular pressure (IOP) is greater than the normal (22 mm Hg). contraindicated in pts with glaucoma. Detached Retina --> area of detachment should be in the dependent position RETINAL DETACHMENT – Visual Floaters. GLAUCOMA – Painfull vision loss. pt will need regular eye exams. report dizziness. anxiety. tunnel/gun barrel/halo vision (Peripheral Vision Loss) Glaucoma patients lose peripheral vision. Dehydration: weight is the best indicator of dehydration Edema is in the interstitial space not in the cardiovascular space. Hypovolemia – incrased temp. occurs because lens becomes less hydrated and more dense o Milky thing over eye Cataract= cloudy. used for retinitis caused by cytomegalovirus. confusion. Treated with meds. Wherever there is sugar (glucose) water follows. Levodopa. hypotension. the lenses of the eyes gradually lose moisture and their density increases. rapid/weak pulse. used for glaucoma. Found a cool link about its use in peds pt with strabismus. Opacity of the lens.• • Nystagmus = uncontrollable movement of the eyes Cataracts o As you age. avoid B6 RETINO BLASTOMA – Cat’s eye reflex (grayish discoloration of pupils) ** BOTOX for strabismus.030 . Patch the GOOD eye so that the weaker eye can get stronger. urine specific gravity >1. curtain vision Cytovene. blurring of vision After Cataract Surgery --> pt will sleep on unaffected side with a night shield for 1-4 weeks. for parkinsons. Electrolytes and stuff Aldosterone attracts sodium. Treated by lens removal-surgery CATARACT – Painless vision loss. give miotics to constrict (pilocarpine) NO ATROPINE. increase respiration.
dysrhythmias. absent deep tendon reflexes. celery) Hyperkalemia: MURDER – muscle weakness. Normal potassium is 3.leads to increased Ca resortion from bones and WEAK BONES) Non dairy sources of calcium include RHUBARB. oranges. sedative effect on CNS Polyuria is common with the hypercalcemia caused by hyperparathyroidism. potatoes. If potassium is there you can bet it is a problem they want you to identify. urine (oliguria/anuria). confusion. Bananas. A little trick regarding potassium: AlKaLOsis: K is LOW Acidosis is just the opposite: K is High From the mouth (vomitus) = metabolic alkalosis From the a** (diarrhea) = metabolic acidosis Hypokalemia: muscle ewakness. shallow respirations. increases Ca. because values outside of normal can be life threatening.. dyspnea. reflexes . spasms and stridor. rares/crackles. COLLARD GREENS Magnesium: HypoMg: tremors. dysphagia. respiratory depression.. decreased cardiac contractility. You better be making sure that patient on Dig and Lasix is getting enough potassium. lack of coordination. Semi-Fowler’s Fluid volume overload caused by IVC fluids infusing too quickly (or whatever reason) and CHF can cause an S3 Calcium: Hypocalcemia: CATS – convulsions. Chvostek & Trosseaus sign Hypercalcemia: muscle weakness.55. bananas. muscle ewakness. tetany. potatoes. confusion. No Pee. SARDINES. robs the bones. * Long term use of amphogel (binds to phosphates. arrhythmias.0. urine specific gravity <1. hypotension. beans.Hypervolemia – bounding pulse. apricots. emergency oAbsent reflexes (lower motor neuron issue) Potassium: Never give K+ in IV push. because low potassium potentiates Dig and can cause dysrrhythmias.0 in a renal patient in priority. depression. HTN. dyrshythmias. Never give potassium if the patient is oliguric or anuric. carrots. abdominal pain. SOB. peripheral edema. increase K (raisins. tetany.010. facial flushing. absent tendon reflexes. citrus fruits source of potassium Let’s say every answer in front of you is an abnormal value. ECG changes. seizures. dig toxicity oHyper reflexes (upper motor neuron issue “your reflexes are over the top”) HyperMg: depresses the CNS. no K (do not give potassium without adequate urine output) . Even a bun of 50 doesn’t override a potassium of 3.
When you see Coffee-brown emesis. disorientation/delusions. Hirschsprung’s diagnosed with rectal biopsy looking for absence of ganglionic cells. Cardinal sign in infants is failure to pass meconium. increased ICP. A barium enema may be used to hydrostatically reduce the telescoping. small frequent meals) Dumping syndrome: increase fat and protein. ULCERATIVE COLITIS – recurrent bloody diarrhea Peptic ulcers caused by H. muscular twitching. lie down after meals for 20-30 minutes (also restrict fluids during meals. wait 1 hr after meals to drink. Administration of Enema --> position pt in left side-lying (Sim's) with knee flexed Hirschsprung’s --> bile is lower obstruction. A GI ulcer that occurs due to brain injury. pylori are treated with Flagyl. ribbon like stools. This treatment kills bacteria and stops production of stomach acid. hypotonic solution Hyper natremia (greater than 145) – SALT: Skin flushed Agitation Low grade fever Thirst GI Give carafate (GI med) before meals to coat stomach Protonix is given prophylactically to prevent stress ulcers. hypotension. fluids Hypernatremia: increased temp. Diverticulitis (inflammation of the diverticulum in the colon) pain is around LL quadrant. . Resolution is obvious. Obstruction may cause fecal emesis. muscle cramps. with onset of bowel movements. To Prevent Dumping Syndrome (post-operative ulcer/stomach surgeries) --> eat in reclining position. currant jellylike stools (blood and mucus). lie down after meal to decrease peristalsis. but does not heal ulcer. small frequent meals. weakness. Dance Sign (empty portion of RLQ) Intussusception common in kids with CF. INTUSSUSCEPTION – sausage shaped mass. tachycardia. low CHO and fiber diet. convulsion. no bile is upper obstruction. think peptic ulcer *Cushings ulcers r/t BRAIN injury.The vital sign you should check first with high potassium is pulse (due to dysrhythmias). Prilosec and Biaxin. and later the classic ribbon-like and foul smelling stools. Sodium: Hyponatremia: nausea. GERD – Barretts esophagus (erosion of the lower portion of the esophageal mucosa) Patients with GERD should lay on their left side with the HOB elevated 30 degrees. osmotic diuretics.
Nonfat milk reduces reflux by increasing lower esophageal sphincter pressure Stomas dusky stoma means poor blood supply. sharp pain + rigidity means peritonitis.esophagus doesn't fully develop (this is a surgical emergency) The 3 C's of TEF in the newborn: 1) Choking 2) Coughing 3) Cyanosis also.PYLORIC STENOSIS – cardinal S/S olive like mass. mucus in ileal conduit is expected. Cephalhematoma (caput succinidanium) resolves on its own in a few days. protruding means prolapsed. 4) Continous Drooling Head stuff No nasotracheal suctioning with head injury or skull fracture. Transesophageal Fistula (TEF) . Cranial Nerves: 1 2 3 4 5 6 7 8 9 10 11 12 Oh Oh Oh To Touch And Feel A Girls Vagina And Hymen Olfactory I Optic II Oculomotor III Trochlear IV Trigeminal V Abducens VI Facial VII Auditory VIII Glossopharyngeal IX Vagus X Accessory XI Hypoglassal XII Sensory=S Motor=M Both=B Some Say Marry Money But My Brother Says Big Bras Matter More . Level of consciousness is the most important assessment parameter with status epilepticus. This is the type of edema that crosses the suture lines.
if you able to do that spontaneously and use them correctly to SEE whom you dating you earn 4. You should watch for abdominal distention. and high-pitched cry in an infant. and of course do not use INAPPROPRIATE WORDS (3). pt may be asked to hyperventilate and watch a bright flashing light. A child with a ventriculoperitoneal shunt will have a small upper-abdominal incision. This is VERY important since Good moves give you 6! Questions about a halo? Remember safety first.ICP ICP (intracranial pressure) should be <2 measure head circumference *Cushings triad r/t increased ICP: 1 HTN 2 Bradycardia 3 Bradypnea ICP AND SHOCK HAVE OPPOSITE V/S: ICP-increased BP. CVA (cerebrovascular accident) is with dead brain tissue. if you get good EYE contact (4 points) But if she has to scream on you to make you open them it is only 3. Shock. after EEG.max 15 points -one can do it if below 8 you are in Coma. If you see s/s of increasing icp.. assess pt for seizures. if you do not like her just show no VERBAL RESPONSE(1) Since you've got EYE and VERBAL contact you can MOVE now using your Motor Response Points. Eyes Verbal Motor So.MOTOR! It is similar to measuring dating skills. so fluid doesn’t reduce too rapidly. try not to RESPOND WITH INCOMPREHENSIBLE SOUNDS (2)... Careful on a bed position question! Bed-position after shunt placement is flat. You should also watch for signs of increasing intracranial pressure. pt must stay awake night before exam. HYDROCEPHALUS – Bossing sign (prominent forehead) Head Injury --> elevate HOB 30 degrees to decrease intracranial pressure Head injury medication: Mannitol (osmotic diuretic)-crystallizes at room temp so ALWAYS use filter needle . increased resp. EYES. increased pulse.. In a toddler watch lack of appetite and headache.. TIA (transient ischemic attack) mini stroke with no dead brain tissue Pt w/ Heat Stroke --> lie flat w/ legs elevated EEG. decreased resp. hold meds for 24-48 hrs prior. decreased pulse. such as irritability. then raise the hob to 15-30 degrees. and 1 you don’t care to open even if she tries to hurt you. have a screwdriver nearby. pt can eat. to start dating you gotta open your EYES first. This is where the shunt is guided into the abdominal cavity. Then move to VERBAL talk to her/ him! If you can do that You are really ORIENTED in situation she/he uncontiously gives you 4 points! If you like her try not to be CONFUSED (3). pt's will be at increased risk GLASGOW COMA SCALE. VERBAL. no caffine or cigarettes for 24 hrs prior. and tunneled under the skin up to the ventricles. bulging fontanels. since fluid from the ventricles will be redirected to the peritoneum.decreased BP.
Afterload is the resistance the blood has to overcome when leaving the heart. Amiodorone is effective in both ventricular and atrial complications. not normal in MI. . S3 sound is normal in CHF. Remember the action of vasopressin because it sounds like “press in”. or vasoconstrict. unrelieved by NTG Blood tests for MI: Myoglobin. Fluid volume overload caused by IV fluids infusing too quickly (or whatever reason) and CHF can cause an S3 MI= dead heart tissue present MI – Crushing stubbing pain which radiates to left shoulder. brain problems occur After Supratentorial Surgery (incision behind hairline) --> elevate HOB 30-45 degrees After Infratentorial Surgery (incision at nape of neck)--> position pt flat and lateral on either side.When phenylalanine (amino acid) increases. This is a toughie…think about it. If chest pain does not stop go to hospital. Dopamine increases BP. with R side cardiac cath=look for valve problems with L side cardiac cath=look for coronary complications Auscultate Heart Sounds: All Physicians Earn Too Much Money Or APE To Man Anytime you see fluid retention. Calcium channel blocker affects the afterload. Do not give when BP is < 90/60. Think heart problems first. neck. Med of choice for Vtach is lidocaine Med of choice for SVT is adenosine or adenocard Med of choice for Asystole (no heart beat) is atropine Med of choice for CHF is Ace inhibitor. which leads to reduced preload (volume in the left ventricle at the end of diastole). ANGINA – Crushing stubbing pain relieved by NTG Nitroglycerine is administered up to 3 times (every 5 minutes). Cardiac output decreases with dysrythmias. Sepsis and anaphylaxis (along with the obvious hemorrhaging) reduce circulating volume by way of increased capillary permeability. arms. Cardiac Preload affects amount of blood that goes to the R ventricle. CK and Troponin Angina: Angina (low oxygen to heart tissues) = no dead heart tissues. Unstable angina is not relieved by nitro.
Only given to Rh NEGATIVE mother. if airway and breathing are accounted for. If left untreated PVC’s can lead to VF (ventricular fibrillation). 72 hours post partum. a compound fracture requires assessment before Glasgow coma scale and a neuro check (D=disability. jvd. Coarctation of the aorta causes increased blood flow and bounding pulses in the arms Patent Ductus Arteriosus PDA – machine like murmur. Pregnancy – Labor – Newborn – Peds I kept forgetting which was dangerous when you're pregnant.Prolonged hypoxemia is a likely cause of cardiac arrest in a child. Readings of 18-20 are considered high. Normal PCWP (pulm capillary wedge pressure) is 8-13. A newly diagnosed hypertension patient should have BP assessed in both arms. hemoglobin. CABG operation when the great saphenous vein is taken it is turned inside out due to the valves that are inside. Rh. or neuro check) Congenital cardiac defects result in hypoxia which the body attempts to compensate for (influx of immature rbc’s)? Labs supporting this would show increased hematocrit. Adenosine is the treatment of choice for paroxysmal atrial tachycardia. so remember: -never get pregnant with a German (rubella) Perform amniocentesis before 20 weeks gestation to check for cardiac and pulmonary abnormalities. With flecainide (Tambocor). IM. dAngle Arteries for better perfusion DVT – positive Homan’s Sign (calf pain) Bleeding is part of the ‘circulation’ assessment of the ABCD’s in an emergent situation. occurs with bronchitis or emphysema. Therefore. Orthostasis is verified by a drop in pressure (hypotension) with increasing heart rate. limit fluids and sodium intake. and could convert a rhythm to v-fib following cardioversion. Heart Meds: Digitalis increases ventricular irritability. because sodium increases water retention which could lead to heart failure.) Cor pulmonale (s/s fluid overload) is Right sided heart failure caused by pulmonary disease. Cor Pulmonae Cor pulmonae: right sided heart failure caused by left ventricular failure (so pick edema. Dead tissues cannot have PVC’s (premature ventricular contraction. an antiarrythmic. regular measles (rubeola) or German measles (rubella). . if it is a choice. Rhogam : given at 28 weeks. Circulation EleVate Veins. and rbc count.mothers receive rhogam to protect next baby.
fetal bradycardia. often by mask. the baby is no longer being pulled out of the body by gravity) If water breaks while mom is in labor and she is any minus station you better know there is a risk of prolapsed cord. stop Pitocin. If the baby is anterior. place the mother in the TRENDELENBERG position because this removes pressure of the presenting part off the cord. you give O2. If you're not sure who to check first. Woman in Labor w/ Un-reassuring FHR (late decels.Rhogam only given if negative indirect Coombs test. cover it with sterile saline gauze to prevent drying of the cord and to minimize infection. for exmaple listen to the fetal heart tones with a stethoscope in NCLEX land. C = cord compression caused E = early decels. Always assess the patient first. During Epidural Puncture --> side-lying Pitocin med used for uterine stimulation Hypotension and bradypnea / bradycardia are major risks and emergencies. to allow more blood flow to the placenta. (If her head is down. and turns nitrazine paper blue. If the baby is breech. If indirect Coomb’s test is positive. Prolapsed Cord --> knee-chest position or Trendelenburg FHR patterns . the sounds are high up in the fundus near the umbilicus. decreased variability. Urine and normal vaginal discharge are acidic. and turn it pink. between the umbilicus and where you would listen to a posterior presentation. don’t need to give Rhogam cuz she has antibody Glucose Tolerance Test for preggos result of 140 or highter needs further evaluation. the sounds are heard at the sides. turn the mother to her left side. . For cord compression. increase IV fluids) For any kind of bad fetal heart rate pattern. If the baby is a posterior presentation. and one of the choices involves the machine. can't fill For late decels. etc) --> turn on left side (and give O2. they are a little bit above the symphysis pubis. the mother or the baby. O = okay. Sometimes it's hard to tell who to check on first. the sounds are heard closer to midline. that's the wrong answer. When doing an epidural anesthesia hydration before hand is a priority. H = head compression caused A = accels. If the baby is vertex. NEVER check the monitor or a machine as a first action.Think VEAL CHOP V = variable decels. Amniotic fluid yellow with particles = meconium stained = bad because baby can swallow poop Amniotic fluid is alkaline. not a problem! L = late decels P = placental insufficiency. If the cord is prolapsed. it's usually easy to tell the right answer if the mother or baby involves a machine.
babinski)] Newborn: heroin withdrawal neonate: irritable poor sucking Fetal alcohol syndrome -upturned nose -flat nasal bridge -thin upper lip -SGA Low-set ears and renal anomalies: The kidneys and ears develop around the same time in utero. o My baby is jaundiced because of an incompatibility between my blood and the baby’s blood. While feeding. Physiological jaundice: caused by immature hepatic function. Swelling reabsorbs within 1 to 3 days. • Infant w/ Cleft Lip --> position on back or in infant seat to prevent trauma to suture line. A= appearance (color all pink. there is bleeding. blue [pale]) P= pulse (>100. and lasts 5–7 days. o My baby is jaundiced because I am Rh-negative and the baby is Rh-positive. Anterior fontanelle closes by 18 months. If patient experiences seizure during magnesium adm. 0-3 RESUSCITATE. occurs after 24 hours. Posterior fontanelle 6 to 8 weeks. don't forget to monitor volume status (I&O) Eclampsia is seizure while pregnant. o My baby is jaundiced because the liver is unable to clear bilirubin from the blood. hold in upright position.RR. Placental abruptio: bleeding with pain. • Pathological jaundice: pathological jaundice occurs within the first 24 hours of birth and is caused by destruction of RBCs from an antigen-antibody reaction.Muscle tone. absent) Apgar measures HR. Caput succedaneum= diffuse edema of the fetal scalp that crosses the suture lines. o My baby is jaundiced because this was my second pregnancy. limp) R= respirations (strong cry. flaccid. pink and blue.Dystocia = baby cannot make it down to canal Placenta should be in upper part of uterus. no response) A= activity (flexed. Newborn: (+ Babinski sign): Toes fan out. absent) G= grimace (cough. Placenta previa = there is no pain. Magnesium sulfate(used to halt preterm labor) is contraindicated if deep tendon reflexes are ineffective. 8-10 OK. weak cry. if the nurse notices low set or . Get the baby out stat (emergency). Reflexes. Hence. grimace. [In normal adult they curl in :( . they're shaped similarly. peaks at 72 hours.Skin color each 0-2 point. Which is why when doing an assessment of a neonate. < 100.
The first sign of pyloric stenosis in a baby is mild vomiting that progresses to projectile vomiting. etc. The p24 can be used at any age.SIDS). Knowing that the kidneys and ears are similar shapes helped me remember this Best way to warm a newborn: skin to skin contact covered with a blanket on mom. Position prone w hob elevated with gerd. If problem does not fix or cannot be corrected surgically. or other conditions that cause inflammation or scarring. not kiss kids on the mouth. Feed upright to avoid otitis media. If you can remove the white patches from the mouth of a baby it is just formula. the baby will seem hungry often. The biggest concern with cold stress and the newborn is respiratory distress. no contact lenses or pregnant nurses in rooms where ribavirin is being administered by hood. tent. Infant: Brachial pulse used for CPR Developmental . and may spit up after feedings. Premature newborns with immature lungs are ventilated and over time it damages the lungs. MMR is avoided only if the kid is severely immunocompromised. Kids with RSV. pneumonia. If you can’t. Kid can lose heat quickly. Other causes could be infection. Transposition of the great vessels). Birth weight doubles by 6 months and triples by 1 year of age.asymmetrical ears. its candidiasis. low (for lower side or under side) Epispadias: opening of the urethra on the dorsal (front) surface of the penis With omphalocele and gastroschisis (herniation of abdominal contents) dress with loose saline dressing covered with plastic wrap. Greek heritage . you better lay that kid on his back (Back To Sleep . Prevent blood from going to heart. CHF will occur following by death. there is good reason to investigate renal functioning. and not share eating utensils. Parents should wear gloves for care. and keep eye on temp. Mechanical ventilation can cause it. For HIV kids avoid OPV and Varicella vaccinations (live). Truncys arteriosus. A positive Western blot in a child <18 months (presence of HIV antibodies) indicates only that mom is infected. Infant w/ Spina Bifida --> position prone (on abdomen) so that sac does not rupture Hypospadias: abnormality in which urethral meatus is located on the ventral (back) surface of the penis anywhere from the corona to the perineum (remember hypo. What could cause bronchopulmonary dysplasia? Dysplasia means abnormality or alteration. In almost every other case. Remember for cyanotic -3T’s( Tof.they put an amulet or any other use of protective charms around their baby's neck to avoid "evil eye" or envy of others Heart defects. Later you may be able to palpate a mass. though. but give Pneumococcal and influenza. Two or more positive p24 antigen tests will confirm HIV in kids <18 months.
because they are obligatory nasal breathers. . when IV access cannot be obtained.2-3 months: turns head side to side 4-5 months: grasps. where crystalloids.9 months. Watch for anemia with milkaholics. especially iron. right?) Too much milk reduces intake of other essential nutrients. you should leave the room and come back in five minutes. In a five-year old breathe once for every 5 compressions doing CPR. because to a toddler it is another episode. and I have seen it once! (Gruesome. switch & roll 6-7 months: sit at 6 and waves bye-bye 8-9 months: stands straight at eight 10-11 months: belly to butt (phrase has 10 letters) 12-13 months: twelve and up. blood products and drugs can be administered into the marrow. colloids. (I don’t know more about that drug. Just know the MMR and Varicella immunizations come later (15 months).) When venous access is achieved it can be d/c’d. drink from a cup Test child for lead poisoning around 12 months of age It is essential to maintain nasal patency with children < 1 yr. 4 year old kids cannot interpret TIME. School-age kids (5 and up) are old enough. Separation anxiety peaks in toddlerhood Toddlers need to express autonomy (independence) If you gave a toddler a choice about taking medicine and he says no. don’t ask. an osseous (bone) needle is hand-drilled into a bone (usually the tibia).) Watch out for questions suggesting a child drinks more than 3-4 cups of milk each day. Need to explain time in relationship to a known COMMON EVENT (eg: "Mom will be back after supper"). it was just pointed out on a practice exam. Next time. VACCINES: Age 4 to 5 yrs child needs DPT/MMR/OPV An ill child regresses in behavior Interpersonal model (Sullivan) Behavior motivated by need to avoid anxiety and satisfy needs Infancy 0-1 yr old others will satisfy needs Childhood 2-6 yrs old Learn to delay need gratification Juvenile 6-9 yrs learn to relate to peers Pre-adolescence 9-12 yrs learns to relate to friends of opposite sex Early adolescence 12-14 yrs learn independence and how to relate to opposite sex Late adolescence 14-21 yes develop intimate relationship with person of opposite sex What is an intraosseous infusion? In pediatric life-threatening emergencies. It is a temporary. ** Stranger anxiety is greatest 7 . (Milks good. a beta agonist. life-saving measure. and should have an explanation of what will happen a week before surgery such as tonsillectomy. One medication that cannot be administered by intraosseous infusion is isoproterenol.
And don’t let that mother put anything but water in that kid’s bottle during naps/over-night. no dairy. ninety. and things go downhill from there all the way to delirium. Hemoglobin Neonates 18-27 3 mos 10. (I though it was weight.7-15. What traction is used in a school-age kid with a femur or tibial fracture with extensive skin damage? Ninety. and the lower extremity is in a boot cast.5 Renal impairment: serum creatinine elevated and urine clearance decreased Norm. followed by agitation. Give Tylenol. make sure there are no bubbles. when instilling eardrops. So check the o2 stat.5 3 yrs 9. Injections: for 6 month infants vastus lateralis is IM administration site For toddlers above 18 months ventrogluteal The deltoid and gluteus maximus are appropriate sites for children No phenylalanine with a kid positive for PKU (no meat. The name refers to the angles of the joints. Eardrops: Pull pinna down and back for kids < 3 yrs. but apparently not) No aspirin with kids b/c it is associated with Reye’s Syndrome. Second voided urine most accurate when testing for ketones and glucose.5-1. you need to put the blood in a heparinized tube. A pin is placed in the distal part of the broken bone. put on ice immediately after drawing. The rest is the normal pulleys and ropes you’re used to visualizing with balanced suspension. and also no nsaids such as ibuprofen. LABS and Lab Values A patient with a low hemoglobin and/or hematocrit should be evaluated for signs of bleeding. a kid’s hinder should clear the bed when in Bryant’s traction (also used for femurs and congenial hip for young kids). hallucinations.5 (women) Norm. BSA Body Surface Area is considered the most accurate method for medication dosing with kids. such as dark stools.8-1. Urine clearance 85-135 Low magnesium and high creatinine signal renal failure. and get abg’s if possible. While we’re talking about traction.4-15. Serum creatinine 0. and coma.5 10 yrs 10.6-16. Remember to perform the Allen's Test prior to doing an ABG to check for sufficient blood flow If your normally lucid patient starts seeing bugs you better check his respiratory status first. When drawing an ABG. 0.8 (men). Juice or milk will rot that kids teeth right out of his head. with a label indicating if the pt was on room air or how many liters of O2. The first sign of hypoxia is restlessness. no aspartame). .
It causes spasm of the Sphincter of Oddi. NPO. During sickle cell crisis there are two interventions to prioritize: fluids and pain relief. In the convalescent stage it is no longer contagious LIVER CIRRHOSIS – cardinal S/S spider like varices. After pain relief. Therefore Demerol should be given. prepare antecubital site for PICC cuz they'll probably be getting TPN/Lipids. pancreatic enzymes are given with meals. With chronic pancreatitis. ** William's position . knee gatch) to relieve lower back pain. comes from the BOWEL (Hep A) Hepatitis B=Blood and Bodily fluids Hepatitis C is just like B During the acute stage of Hep-A gown and gloves are required. bend knees to relieve. seen with pancreatitis Turner’s sign – flank grayish blue (turn around to see your flanks) pancreatitis PANCREATITIS – Cullen’s sign (ecchymosis of umbilicus). HEPATIC ENCEPHALOPATHY – cardinal S/S Flapping tremors Pain Cold for acute pain (eg.Semi Fowlers with knees flexed (inc. Pancreatitis patients but them in fetal position. Hepatitis Hepatitis: -ends in a VOWEL. Pancreatitis • • Cullen’s sign – ecchymosis in umbilical area. Sprain ankle) Heat for chronic (rheumatoid arthritis) Guided imagery is great for chronic pain. NOT morphine sulfate because morphine causes muscle spasm. Demorol for pancreatitis. (+) Grey turners spots.Liver – Hepatic Portal hypotension + albuminemia= Ascites. Morphine is contraindicated in Pancreatitis. because of fluid pushing up in the diaphragm. cough and deep breathe is important in pancreatitis. . gut rest. With low back aches.
Treated with heparin. Sign of fat embolism is petechiae. Unusual positional tip . then sit with legs elevated to try to mobilize the edema. difficulty breathing. If patient is restless and central IV has disconnected place pt on Left side in Trendelenberg position placing the patient in this position increases the likelihood that the air will pass into the right atrium and be dispersed by way of the pulmonary artery. Look at all your abg values. Should the patient breathe into a paper bag? No. If the pao2 is well below 80 they need oxygen. Treat with levodopa.Low-fowlers recommended during meals to prevent dumping syndrome. Therapeutic communication. and one side of bed against the wall. Decerebrate is the other way (out) Decorticate positioning in response to pain = Cortex involvement. as with a PE. contraindicated with MAOI's PARKINSON’S – Pill-rolling tremors Embolism’s Air/Pulmonary Embolism (S&S: chest pain. Sinemet. for Parkinson’s. . o Any other position increases the chances of the embolism traveling to the heart/brain. A patient with liver cirrhosis and edema may ambulate. Limit fluids while eating. wheels locked. pale/cyanotic. keep lower rails down. akinesia (loss of muscle mvt). First sign of PE is sudden chest pain. inc ESR. sense of impending doom) --> turn pt to left side and lower the head of the bed. Decorticate is toward the 'cord'. followed by dyspnea and tachypnea. "snow storm" effect on CXR.increased serum lipids. As soon as you see the words PE you should think oxygen first. respiratory alkalosis (not acidosis r/t tachypnea). tachycardia. To access role relationship pattern focus on image and relationships with others. brain stem involvement Psych stuff Orange tag in triage is non-emergent Psych Do not use why or I understand statement when dealing with patients. tremors. • Restlessness is top sign of embolism. hypocalcemia. Decerebrate in response to pain = Cerebellar. lowest position. Even in LTC facility when a client is a fall risk. ** Fat Embolism: Blood tinged sputum (r/t inflammation). When o2 deprived. the body compensates by causing hyperventilation (resp alkalosis). Positioning Four side-rails up can be considered a form of restraint.Parkinson’s = RAT: rigidity.
and hopelessness. delirium. Dopamine GABA. Norepinephrine. first line antipsychotic in children • • • • • • • Dementia o Poor judgment. and hallucinations Dissociation o unconscious separation of painful feelings from a difficult situation.Milieu therapy= taking care of patient/environment Cognitive therapy= counseling Crisis intervention=short term. antipsychotic. irritability. FIVE INTERVENTIONS FOR PSYCH PATIENTS -safety -setting limits -establish trusting relationship -meds -leas restrictive methods/environment. haldol (antipsychotic) can lead to EPS (extrapyramidal side effects) If mixing antipsychotics (ie Haldol. tightening of jaw. Delirium o May have rapid onset due to illness o Confusion. idea. fatigue. pacing. monitor for early signs of reaction and give IM Benadryl Alzheimer Senile dementia Depression Anxiety Schizophrenia acetylcholine acetylcholine Serotonin. Serotonin . tarditive dyskinesia. Prolixin) with fluids. or blaming someone else for one’s own problems Denial . stiff neck. med is incompatible with caffeine and apple juice Haldol preferred anti-psychotic in elderly. later on swollen airway). Compulsion is to action If patients have hallucinations redirect them. but high risk extrapyramidal side effects (dystonia. Throazine. and agitation Depression o Weight loss. apathy. SSRI’s (antidepressants) take about 3 weeks to work. swollen tongue. Obsession is to thought. memory deficit. In delusions distract them. indifference. Thorazine. Norepinephrine Dopamine Risperdal. or object Regression o return to an earlier level of development and the comfort measures associated with that level of functioning Projection o attributing one’s own feelings that are unacceptable to someone else. doses over 6mg can cause tarditive dyskinesia. restlessness.
Munchausen by proxy (MSBP). Phobic disorders. gi complaints. Turn and reposition (risk for impaired skin integrity) Nephrotic syndrome s/s edema + hypotension.. an individual. . face and extremities. Turn and reposition (risk for impaired skin integrity) Nephrotic syndrome is characterized by massive proteinuria (looks dark and frothy) caused by glomerular damage. intentionally causes or fabricates illness in a child or other person under her care. Alzheimer’s disease is a chronic. and pain. o amnesia o confabulation (invented memories which are then taken as true due to gaps in memory sometimes associated with blackouts) o meager content in conversation o lack of insight o apathy • -Munchausen Syndrome is a psychiatric disorder that causes an individual to self-inflict injury or illness or to fabricate symptoms of physical or mental illness.use systematic desensitization.irreversible . W 1st then goes into K. such as psychomotor retardation.. degenerative cognitive disorder that accounts for more than 60% of all dementias Med of choice for bipolar is lithium. may happen after prolonged use of antipsychotics. Tardive Dyskinesia . in order to receive medical care or hospitalization. In a variation of the disorder. Generalized edema common. Corticosteroids are the mainstay. typically a mother. Safety over Nutrition with a severely depressed client.o unconscious refusal to admit an unacceptable idea or behavior or the feelings associated with it Wernicke & Korsakoff usually occur together. progressive. Depression often manifests itself in somatic ways. Renal Nephrotic syndrome s/s edema + hypotension.involuntary movements of the tongue. Its onset is linked to chronic alcohol abuse and/or severe malnutrition: • Wernicke’s syndrome o form of dementia that results from thiamine deficiency o Confusion o Ataxia (loss of muscle coordination) Leg tremor o Vision changes Nystagmus (abnormal eye movement) Double vision Eyelid drooping Korsakoff’s psychosis o neurological disorder caused by a lack of thiamine (vitamin B1) in the brain.
Uremic fetor is usually associated with an unpleasant metallic taste (dysgeusia). o bronchovesicular: harsh sounds heard over the mainstem bronchi. which is created in the saliva as a breakdown product of urea. Dietary restrictions you can expect include fluids. Peritoneal Dialysis when Outflow is Inadequate --> turn pt from side to side BEFORE checking for kinks in tubing (according to Kaplan) It’s ok to have abdominal craps. pleural friction rub — grating sound or vibration heard during inspiration ad expiration • Can’t cough=ineffective airway clearance The person who hyperventilates is most likely to experience respiratory alkalosis. because values outside of normal can be life threatening. and can be a symptom of chronic kidney disease. o bronchial: loud. Normal potassium is 3. sterile dressing applied • Normal breathing sounds: o vesicular: soft and low-pitched breezy sounds heard over most of peripheral lung fields. have pt hold breath in midexpiration. rhonchi — musical sounds or vibrations commonly heard on expiration. wheezes — squeaky sounds heard during inspiration and expiration. Cloudy outflow NEVER NORMAL. and potassium. Let’s say every answer in front of you is an abnormal value.With glomerulonephritis you should consider blood pressure to be your most important assessment parameter. coarse. If potassium is there you can bet it is a problem they want you to identify. Lung ** TIDAL VOLUME is 7 – 10ml / kg Before going for Pulmonary Fuction Tests (PFT's). The odor occurs from the smell of ammonia. Even a bun of 50 doesn’t override a potassium of 3. chest x-ray done immediately afterwards to check for complication of pneumothorax. Respiratory Stuff Ambient air (room air) contains 21% oxygen. Uremic fetor is a urine-like odor on the breath of persons with uremia. position pt lying on side of bed or with arms raised up on pillows over bedside table.55. WBC shift to the left in a patient with pyelonephritis (neutrophils kick in to fight infection) Renal impairment: serum creatinine elevated and urine clearance decreased Low magnesium and high creatinine signal renal failure. o caused by fluid or inflammation and include: rales — crackling or gurgling sounds (also known as crackles) commonly heard on inspiration. blowing sound heard over the trachea Adventitious (abnormal) breath sounds. a pt's bronchodilators will be with-held and they are not allowed to smoke for 4 hrs prior For a lung biopsy.0. sodium.0 in a renal patient is priority. blood tinged outflow and leaking around site if the Peritoneal Dialysis cath (tenkhoff) was placed in the last 1-2 wks. . protein.
INtal. If a TB patient is unable/unwilling to comply with tx they may need supervision (direct observation). PPD is positive if area of induration is: >5 mm in an immunocompromised patient >10 mm in a normal patient >15 mm in a patient who lives in an area where TB is very rare. Cardinal S/S inspiratory stridor INH. administer the bronchodilator first. (Ever had a stuffy nose. fever and chills are usually present. But if you are trying to reduce congestion the sick lung goes up. Cardinal sign of ARDS is hypoxemia (low oxygen level in tissues). think… INto the asthmatic lung PNEUMONIA – rusty sputum. an inhaler used to treat allergy induced asthma may cause bronchospasm. hemoglobin. pneumonia is acute. cyanotic tachycardia. ARDS The first sign of ARDS is increased respirations. retractions. etc. Asthma --swimming best When using a bronchodilator inhaler inconjuction with a glucocorticoid inhaler. dyes bodily fluids orange TB drugs are liver toxic. for TB. increased resps. *Incentive Spirometry steps:1) Sit upright 2) Exhale 3) Insert mouthpiece 4) Inhale for 3 seconds. monitor LFT's. watch out if your wheezer stops wheezing. Signs of hypoxia: restless. Speaking of asthma. . Emphysema and bronchitis are both COPD. For the elderly confusion is often present. A sputum test will confirm active disease. Later comes dyspnea. anxious. Coughing w/o other s/s is suggestive of asthma. DIC (disseminated intravascular coagulation) are always secondary to something else (another disease process). Crackles suggest pneumonia. hypotension will occur initially. TB is a public health risk TB – low-grade afternoon fever. and rbc count. not just exposure. (also monitor ABG's) Congenital cardiac defects result in hypoxia which the body attempts to compensate for (influx of immature rbc’s) Labs supporting this would show increased hematocrit. Positioning with pneumonia – lay on the affected side to splint and reduce pain. which would manifest itself as mental confusion. used to treat and prevent TB. then resolve Rifampin. give B6 along with. and you lay with the stuff side up and it clears?) With pneumonia. Asthma ASTHMA – wheezing on expiration. ARDS (fluids in alveoli). which is likely to be accompanied by hypoxia. and then HOLD for 10 seconds COPD is chronic. cyanosis. (Does your patient have hepB?) An adverse reaction is peripheral neuropathy. air hunger.A positive ppd confirms infection. do not give with dilantin. can cause phenytonin toxicity. It could mean he is worsening.
An antacid should be given to a mechanically ventilated patient w/ a NG tube if the ph of the aspirate is <5. so don’t slam them with oxygen. After that get your chest tube tray. .. Ventilator alarms HOLD High alarm. Premature newborns with immature lungs are ventilated and over time it damages the lungs. crying can obstruct the airway If your normally lucid patient starts seeing bugs you better check his respiratory status first. stops spontaneous breathing Spinal Cord Injury Most spinal cord injuries are at the cervical or lumbar regions . secretions. or other conditions that cause inflammation or scarring. Dysphagia • Epiglottitis o Is inflammation of the epiglottis and can be life-threatening.Obstruction due to incr. coughs. Encourage pursed-lip breathing which promotes CO2 elimination. Ulcers Bronchopulmonary dysplasia: Caused by mechanical ventilation. gag reflex can cause complete obstruction of the airway o When working with a child be careful to not make them cry. in COPD patients the baroreceptors that detect the CO2 level are destroyed. and things go downhill from there all the way to delirium. high-fowlers and leaning forward. O2 level must be low because high O2 concentration EMPHYSEMA – barrel chest. kink. gag or bites Low press alarm. which could convert the wound from open pneumo to closed one. iv. In emphysema the stimulus to breathe is low PO2. Ventilators Complications of Mechanical Ventilation: Pneumothorax.Disconnection or leak in ventilator or in pt. followed by agitation. o Never insert a tongue blade into the mouth of a child diagnosed with epiglottitis. Angiotensin II in the lungs= potent vasodilator.. The immediate intervention after a sucking stab wound is to dress the wound and tape it on three sides which allows air to escape. encourage up to 3000mL/day fluids. labs. Do not use an occlusive dressing. So check the o2 stat. hallucinations.COPD patients REMEMBER: 2LNC or less (hypoxic NOT hypercapnic drive).0. Aspirate should be checked at least every 12 hrs. Pa02 of 60ish and Sa02 90% is normal for them b/c they are chronic CO2 retainers. Tension pneumothorax trachea shifts to opposite side. airway cuff. The first sign of hypoxia is restlessness. Other causes could be infection. Dysphonia. Therefore. EPIGLOTITIS – 3Ds’ Drooling. and coma. pneumonia. not increased PCO2 like the rest of us. pt. and get ABG’s if possible. pt. and a tension pneumothorax is worse situation.
force fluids. // Ativan is the treatment of choice for status epilepticus Shock Shock --> bedrest with extremities elevated 20 degrees. sire shaved. knees straight.claustrophobia. goose flesh. . don't elevate HOB more than 45 degrees.patients with spinal cord injuries at T-7 or above) is usually caused by a full bladder.Administer antihypertensive meds (may cause stroke. assess pacemaker Cerebral angio prep.assess for bladder distention and bowel impaction (trigger) . pulses. position prone daily to provide for hip extension. profuse sweating. Tests -Definitive diagnosis for abd. Autonomic Dysreflexia/Hyperreflexia (S&S: pounding headache.Spinal shock occurs immediately after spinal injury Autonomic dysreflexia ( life threatening inhibited sympathetic response of nervous system to a noxious stimulus. Below Knee Amputation --> foot of bed elevated for first 24 hours. pulses marked post. nasal congestion. After Total Hip Replacement --> don't sleep on operated side. no metal.assess for allergies MRI.loosen constrictive clothing .elevate head of bed to 90 degree . increased pulse SHOCK – HYPOtension TACHYpnea TACHYcardia Med of choice for anaphylactic shock is Epinephrine Surgeries Above Knee Amputation --> elevate for first 24 hours on pillow.well hydrated. MI. increased resp. Autonomic dysreflexia: potentially life threatening emergency .decreased BP. bradycardia. seizure ) Seizure Med of choice for Status Epilepticus is Valium. Maintain hip abduction by separating thighs with pillows. hypertension) --> place client in sitting position (elevate HOB) first before any other implementation. For knee replacement use continuous passive motion machine. lie flat.keep flat 12-14hr. position prone daily to provide for hip extension. head slightly elevated (modified Trendelenberg) Shock . don't flex hip more than 45. check site.60 degrees. aortic aneurysm (AAA) --> CT scan -CT.
s. npo morning of exam 6hr. pulses. no heavy lifting 1wk. 229) For a lumbar puncture. inspect site. general anesthesia. give sedative. eggs. ** IVP requires bowel prep so they can visualize the bladder better After endoscopy. supine postion. Norcuron is for intermediate or long-term. Myelogram.walk patient to decrease CO2 build up used for procedure • Intravenous pyelogram o Uses dye o Caution with sensitivity to iodine. meals not withheld. the client should be placed in the supine position for 4 to 12 hrs as prescribed. pt may be asked to hyperventilate and watch a bright flashing light. frequent v. I finally realize why a person shouldn't have cantaloupe before an occult stool test. Thyroid Stuff Myxedema/hypothyroidism: slowed physical and mental function. no caffine or cigarettes for 24 hrs prior. check for gag reflex. empty bladder.Adm vit k . foley. and stimulants withheld 48hr prior. because cantaloupe is high in vit c and vit c causes a false + for occult blood.Vital signs keep leg straight bedrest 6-8hr.. assess for distended bladder. tranquilizer/stimulant meds held 24-48hr before.no sleep the night before. encourage po fluids. oil soluble HOB down. table will be moved to various postions during test. pt is positioned in lateral recumbent fetal position. oral analgesics for h/a. Cardiac cath. lateral with upper arms elevated.neuro q2-4.postion on right side. o assess for allergy to shellfish. cns depressants. iodine. pt must stay awake night before exam. Laparoscopy.Npo 4-6hr. allergy hx. Post. dry skin and hair *Myxedema coma is COLD (hypothermia) Give Synthroid on an empty stomach . patient may develop anaphylaxis.neuro assess q15-30 until stable. water soluble HOB up. after EEG. observe dressing After Lumbar Puncture (and also oil-based Myelogram)--> pt lies in flat supine (to prevent headache and leaking of CSF) Lumbar puncture => AFTER the procedure. Post. assess pt for seizures. encourage fluids. sensitivity to cold. tell pt may feel heat palpitations or desire to cough with dye injection. (Saunders 3rd ed p. chocolate. post. milk o A laxative is given the night before an IVP in order to better visualize the organs. keep pt flat for 2-3 hrs afterwards. Teach pt that he will be asked to hold breath for 5-10sec.fetal position. Liver biopsy. report severe ab pain stat. Now I just need to figure out why they can't have fish.CO2 used to enhances visual. phenothiazines. no stimulants for 24hr before. sterile dressing. pt's will be at increased risk Anectine is used for short-term neuromuscular blocking agent for procedures like intubation and ECT. oral analgesics for headache. Post. flat 2-3hr. hold meds for 24-48 hrs prior. frequent neuro assessments EEG. may be asked to hyperventilate 3-4min and watch a bright flashing light.npo 8-12hr.Lumbar puncture. pt can eat. EEG. Post.
woulds with anatomical organs. profound shock with multipe injuries. sensitivity to heat. sprains. your body is "too busy to sleep" as opposed to the folks with hypothyroidism who may report somnolence (dec. renal calculi. heart beating fast Thyroid storm: increased temp. can wait up to an hour for treatment. see first Yellow. Yellow---stable. INCOMPLETE amputations. Insomnia is a side effect of thyroid hormones. Ok some more facts. Post-thyroidectomy: semi-Fowler’s. Red--unstable. and 2nd/3rd degree burn with 15%-40% of total body surface. etc. tension pneumothorax. unstable chest and abdominal wounds. Saunders confirms it. fx requiring open reduction. DOA---dead on arrival Red.Minimal: Injuries are minor and tx can be delayed to hrs or days . prevent neck flexion/hyperextension. etc. tetany. Triage In an emergency. Up all night. pupils fixed or dilated. arrhythmias. most eye and CNS injuries. but can wait hrs without threat to life or limb. stridor (decreased calcium). trach at bedside Hypo-parathyroid: CATS – convulsions.Expectant: Injuries are extensive and chances of survival are unlikely.Immediate: Injuries are life threatening but survivable with minimal intervention. Ex: hemothrax. actively bleeding. low phosphorus diet Hyper-parathyroid: fatigue.Graves’ disease/hyperthyroidism: accelerated physical and mental function. muscle weakness. seizures. behavior disorders. can wait even longer to be seen. Green---stable. NERVOUS. Ex: upper extremity fx. . b. Report it to the doc. After removal of the pituitary gland you must watch for hypocortisolism and temporary diabetes insipidus. lacerations. 2nd/3rd degree burn with 60% of body surface area . Ex: Unresponsive. support head. debridement. BULDGING EYES (exopthalmus). minor burns. comfort measures if possible. met rate. sm. ie. Individuals in this group should be moved away from the main triage area. fine/soft hair HYPERthyroidism think of MICHAEL JACKSON in THRILLER! SKINNY. rate. high Ca. "walking wounded" Black. ie burns. no pulse. low Ca. Makes sense though! Increased met. patients with greater chance to live are treated first. pulse and HTN *Thyroid storm is HOT (hyperthermia) Burning sensation in the mouth. external fixation. see second Green.Delayed: Injuries are significant and require medical care. occluded airway. body is slow and sleepy). spasms. spinal cord injuries. high phosphorus diet The parathyroid gland relies on the presence of vitamin D to work. and brassy taste are adverse reactions to Lugol solution (for hyperthyroid). Ex: Stable abd wounds without evidence of hemorrhage. OPEN fx's of long bones. back and joint pain (increased calcium). neck and shoulders.p. In a disaster you should triage the person who is most likely to not survive last. Seperate but dont abandoned.
After g-tube placement the stomach contents are drained by gravity for 24 hours before it can be used for feedings. Other than initially to test tolerance. Walking – Cane – Crutches – Wheelchair 1. Don’t fall for ‘reestablishing a normal bowel pattern’ as a priority with small bowel obstruction. keep scissors at bedside. An occlusive dressing is used if a chest tube is accidentally pulled out of the patient. Lasix can cause a patient to lose his appetite (anorexia) due to reduced potassium. No other positioning restrictions. G-tube and J-tube feedings are usually given as continuous feedings. Position patient on RIGHT to facilitate movement through pylorus. may leave coiled next to pt on HOB. Urinary – Reproductive Absence of menstruation leads to osteoporosis in the anorexic. Gonorrhea is a reportable disease After a hydrocele repair provide ice bags and scrotal support. COAL (cane walking): C .cane O . need comfort measures Tubes Tube Feeding w/ Decreased LOC --> position pt on right side (promotes emptying of the stomach) with the HOB elevated (to prevent aspiration) An NG tube can be irrigated with cola. and should be taught to family when a client is going home with an NG tube.affected L – leg Place a wheelchair parallel to the bed on the side of weakness.opposite A . Because the patient can’t take in oral fluids ‘maintaining fluid balance’ comes first. Sengstaken blakemore tube used for tx of esophageal varices.Black--unstable clients that will probably not make it. BPH – reduced size & force of urine During Continuous Bladder Irrigation (CBI) --> catheter is taped to thigh so leg should be kept straight. Priapism: painful erection lasting longer than 6 hrs. Don't tape the tube right away after placement. Chest tubes are placed in the pleural space. . Weighted NI (Naso intestinal tubes) must float from stomach to intestine.
The crutches go first. followed by the crutches and the bad leg.Remember the phrase “step up” when picturing a person going up stairs with crutches. followed by the good leg. The opposite happens going down. The good leg goes up first. .
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