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HESI Hints & NCLEX Gems • Answering NCLEX Questions o Maslow’s Hierarchy of Needs • Ph

ysiologic • Safety • Love and Belonging • Esteem • Self-actualization o Nursing Process •
Assessment • Diagnosis (Analysis) • Planning • Implementation (treatment) • Evaluation o
ABCs • Airway • Breathing • Circulation • Normal Values o Hgb • Males 14-18 • Females 12-1
o Hct • Males 42-52 • Females 37-47 o RBCs • Males 4.7-6.1 million • Females 4.2-5.4 mi
llion o WBCs • 4.5-11k o Platelets • 150-400k o PT (Coumadin/Warfarin) • 11-12.5 sec (
INR and PT TR = 1.5-2 times normal) o APTT (Heparin) • 60-70 sec (APTT and PTT TR
= 1.5-2.5 times normal) o BUN 10-20 o Creatinine 0.5-1.2 o Glucose 70-110 o Chol
esterol < 200 o Bilirubin Newborn 1-12 o Phenylalanine Newborn < 2, Adult < 6

o Na+ 136-145 o K+ 3.5-5 • HypoK+ . . . Prominent U waves, Depressed ST segment, F
lat T waves • HyperK+ . . . Tall T-Waves, Prolonged PR interval, wide QRS o Ca++ 9
-10.5 • Hypocalcemia … muscle spasms, convulsions, cramps/tetany, + Trousseau’s, + Chv
ostek’s, prolonged ST interval, prolonged QT segment o Mg+ 1.5-2.5 o Cl- 96-106 o
Phos 3-4.5 o Albumin 3.5-5 o Spec Gravity 1.005-1.030 o Glycosylated Hemoglobin
(Hgb A1c): 4-6% ideal, < 7.5% = OK (120 days) o Dilantin TR = 10-20 o Lithium TR
= 0.5-1.5 o Arterial Blood Gases … Used for Acidosis vs. Alkalosis • PH 7.35-7.45 • C
O2 35-45 (Respiratory driver) … High = Acidosis • HCO3 21-28 (Metabolic driver) … High
= Alkalosis • O2 80-100 • O2 Sat 95-100% o o o o o o o o o Digoxin … Digiband Coumadi
n … Vitamin K (Keep PT and INR @ 1-1.5 X normal) Benzodiazapines … Flumzaemil (Tomaz
icon) Magnesium Sulfate … Calcium Gluconate? Heparin … Protamine Sulfate (Keep APTT
and PTT @ 1.5-2.5 X normal) Tylenol … Mucomist (17 doses + loading dose) Opiates (
narcotic analgesics, heroin, morphine) … Narcan (Naloxone) Cholinergic Meds (Myest
henic Bradycardia) … Atropine Methotrexate … Leucovorin • Antidotes
• Delegation o RN Only • Blood Products (2 RNs must check) • Clotting Factors • Sterile
dressing changes and procedures • Assessments that require clinical judgment • Ultim
ately responsible for all delegated duties o Unlicensed Assistive Personnel • Nonsterile procedures • Precautions & Room Assignments o Universal (Standard) Precaut
ions … HIV initiated • Wash hands • Wear Gloves

Pneumonia. Meningitis. Strep. Bluish discoloration of flanks (Turner’s Sign). Uvula deviates away from the side of lesion (paralysis) o Hold Digoxin if HR < 60 o Stay in bed for 3 hours after first ACE Inhibitor dose o Avoid Grapefruit juice with Ca++ Channe l Blockers o Anthrax = Multi-vector biohazard o Pulmonary air embolism preventio n = Trendelenburg (HOB down) + on left side (to trap air in right side of heart) o Head Trauma and Seizures … Maintain airway = primary concern o Peptic Ulcers … Fe ed a Duodenal Ulcer (pain relieved by food) … Starve a gastric ulcer o Acute Pancr eatitis … Fetal position. Fifth Disease (Parvo B19). Rubeola. Adenovirus. Influenza. Dipt heria. Rubella. Rhino virus • RSV (needs contact precautions too) • TB … Respiratory Isolation o Contact Pre cautions = Universal + Goggles. Board like abdomen with guard ing … Self digestion of pancreas by trypsin. • Vomiting = Alkalosis o Skin T astes Salty = Cystic Fibrosis o Lipitor (statins) in PMs only – No grapefruit juic e o Stroke … Tongue points toward side of lesion (paralysis). Insulin Shock … Give glucose fi rst – If no help. o Hold tube feeding if residual > 100 mL o In case of Fire … RACE and PASS o Check Restraints every 30 minutes … 2 fingers room underneath o Gullain-Barre Syndrome … Weakness progresses from legs upward – R esp arrest o Trough draw = ~30 min before scheduled administration … Peak Draw = 3 0-60 . Scarle t Fever. give insulin o Fruity Breath = Diabetic Ketoacidosis o Acid-Base Balance • If it comes out of your ass. Epiglottitis. Bluish dis coloration of pericumbelical region (Cullen’s Sign). it’s Acidosis. Mycoplasma. Mask and Gown o No infection patients with immun osuppressed patients • Weird Miscellaneous Stuff o Rifampin (for TB) … Rust/orange/r ed urine and body fluids o Pyridium (for bladder infection) … Orange/red/pink urin e o Glasgow Coma Scale … < 8 = coma o Myesthenia Gravis • Myesthenic Crisis = Weakne ss with change in vitals (give more meds) • Cholinergic Crisis = Weakness with no change in vitals (reduce meds) o Diabetic Coma vs.• Gowns for splashes • Masks and Eye Protection for splashes and droplets • Don’t recap needles • Mouthpiece or Ambu-bag for resuscitation • Refrain from giving care if you have skin lesion o Droplet (Respiratory) Precautions (Wear Mask) • Sepsis. Pertussis.

. etc) good for Alcohol withdrawal and Status Epilepticus o Antabuse for Alcohol deterrence – Makes you sick with OH intake o Alcohol Withdrawal = Delerium Tremens – Tachycardi a. etc. arhythmias) • Pre-renal Problem = Interference with renal perfusion • Intr a-renal Problem= Damage to renal parenchyma • Post-renal Problem = Obstruction in UT anywhere from tubules to urethral meatus. . hypoglycemia. mood swings. Lorazepam. paranoia … (DTs start 12-36 hrs after last drink) o Opiate (Heroin.min after drug administration. mummy position) o U rine Output of 30 mL/hr = minimal competency of heart and kidney function o Kidn ey Stone = Cholelithiasis • Flank pain = stone in kidney or upper ureter • Abdominal /scrotal pain = stone in mid/lower ureter or bladder o Renal Failure … Restrict pr otein intake • Fluid and electrolyte problems … Watch for HyperK+ (dizzy. (Cushing’s Syndrome s ymptoms) o Addison’s’ Crisis = medical emergency (vascular collapse. hirsutism. anxiety. Morphine.5 o Phenothiazines ( typical antipsychotics) – EPS. Recovery) • Monitor Body Wt and I&Os o Steroid Effects = Moon face. buffalo hump. Diuret ic. Photosensitivity o Atypical Antipsychotics – work on positive and negative symptoms. acne.) Withdrawal = Watery eye s. . tachypnea. disturbed sleep • Medical-Surgical o Hypoventilation = Acidosis (too much CO2) o Hyperventilation = Alkalosis (low CO2) o No BP or IV on side o f Mastectomy o Opiate OD = Pinpoint Pupils o Lesions of Midbrain = Decerebrate P osturing (Extended elbows. head arched back) o Lesions of Cortex = Decorticate P osturing (Flexion of elbows. shakes.5-1. Parnate • Need 2 wk gap from SSRIs and TCAs to admin MAOIs o Lithium Therapeutic Range = 0. • Mental Health & Psychiatry o Most suicides occur after beginning of improvement with increase in energy levels o MAOIs … Hypertensi ve Crisis with Tyramine foods • Nardil. adrenal suppression (delayed growth in kids) . fatigue. dilated pupils. straight legs. wrists. hallucinations. • Usually 3 phases (Oligouric. wk. Marplan. less EPS o Benzos (Ativan. nausea . oste oporosis. hyperglyce mia. cramps. nausea. anxiety. cramps o Stimulants Withdrawal = Depression. weight gain – Spindle shape. runny nose. NVD. fingers.

Tenecteplase (TNKase) o CABG = Coro nary Artery Bypass Graft o PTCA = Percutaneous Transluminal Coronary Angioplasty o Sex after MI okay when able to climb 2 slights of stairs without exertion (Ta ke nitro prophylactically before sex) o BPH Tx = TURP (Transurethral Resection o f Prostate) … some blood for 4 days. do not clamp … Put end in sterile water o Chest Tube drainage system should show bubbling and water level fluctuations (t idaling with breathing) o TB … Treatment with multidrug regimen for 9 months … Rifam pin reduces effectiveness of OCs and turns pee orange … Isoniazide (INH) increases Dilantin blood levels o Use bronchodilators before steroids for asthma … Exhale c ompletely. Rt sided heart failure = bloating/edema) o O2 Administration • Never more than 6L/min by cannula • Must humidify with more than 4L/hr • No more than 2L/min w ith COPD … (CO2 Narcosis) • In ascending order of delivery potency: Nasal Cannula. Partial Rebreather Mask. o Only isot onic sterile saline for Bladder Irrigation o Post Thyroidectomy – Keep tracheostom y set by the bed with O2. Myoglobin (1-4 hr). LDH1 (12-24 hr) o MI Tx … Nitro – Yes … NO Digoxin. S imple Face Mask. Venturi Mask • Restl essness and Irritability = Early signs of cerebral hypoxia IVs and Blood Product Administration o 18-19 gauge needle for blood with filter in tubing o Run blood with NS only and within 30 minutes of hanging . Pain relieved by leaning forward o Post Strep URI Diseases and Conditions: • Acute Glomerulonephritis • Rheumatic Fever … Valve Disease • Scarlet Fever o If a chest-tube becomes disconnected. o Cardiac Enzymes … Troponin (1 hr). Nonrebreather Mask. CKMB (2-4 hr ). Atropine o Fibrinolytics = Streptokinase. and burning for 7 days post-TURP.tachycardia … Admin IV glucose + corticosteroids) … No PO corticosteroids on empty s tomach o Potassium sparing diuretic = Aldactone (Spironolactone) … Watch for hyper K+ with this and ACE Inhibitors. suction and Calcium gluconate o Pericarditis … Pericardi al Friction Rub. Inhale deeply. Hold breath for 10 seconds o Ventilators … Make sure ala rms are on … Check every 4 hours minimum o Suctioning … Pre and Post oxygenate with 100% O2 … No more than 3 passes … No longer than 15 seconds … Suction on withdrawal wi th rotation o COPD: • Emphysema = Pink Puffer • Chronic Bronchitis = Blue Bloater (C yanosis. Betablocker s.

sweating. legs • Elevated PAP (prostate acid phosphata se) • TRUS = Transurethral US • Post Op … Monitor of hemorrhage and cardiovascular com plication . P: 6-12 hrs o Long Acting Insulin … Insulin Glargine (Lantus) … O : 1. P: . P: 2-3 hrs (IV Okay) o Intermediate Acting Insulin … Isophane Insulin (NPH) … O: 1-2 hrs. best prognosis o Testicular Cancer … Painless lump or swe lling testicle … STE in shower > 14 yrs … 15-35 = Age o Prostate Cancer … > 40 = Age • P SA elevation • DRE • Mets to spine. Avandia. clot s. hips.o Vitals and Breath Sounds … before. blood product … Ask Pt about previous transfusion Hx o Stay with Pt for first 15 minutes … If transfusion rxn … Stop and KVO with NS o Pre-medicate with Benadryl prn for previous urticari a rxns o Isotonic Solutions • D5W • NS (0. hunger. then 30 min later. fruity bre ath o Insulin may be kept at room T for 28 days o Draw Regular (Clear) insulin i nto syringe first when mixing insulins o Rotate Injection Sites (Rotate in 1 reg ion. kids. Immunosuppression (neutropenia and immature WBCs). nausea. pt. tremors. syncope. color. Actos • Acarbose blunts sugar levels after meals Oncology o Leukem ia … Anemia (reduced RBC production). increasing insulin se nsitivity and decreasing hepatic glucose production • Glyburide. then hourly up to 1 hr after) o Check Blood: Exp Date. during and after infusion (15 min after start . air bubbles. irritable.75-1. Hemorrhage and bleeding tendencies (thrombocytopenia) • Acute Lymphocytic = most common type.9% NaCl) • Ringers Lactate • NS only with bloo d products and Dilantin Diabetes and Insulin o When in doubt – Treat for Hypoglyce mia first o First IV for DKA = NS. then infuse regular insulin IV as Rx’d o Hypogl ycemia … confusion.5 hrs o Short Acting Insulin … Regular (human) … O : 30-60 min. then move to new region) o Rapid Acting Insulins … Lispro (Humalog) and Aspar t (Novolog) … O: 5-15 min. leaks o 2 RNs must check order. polyuria. HA. Metformin (Glucop hage). P: 14-20 hrs (Don’t Mix) o Oral Hypoglycemics decrease glucose levels by stimulating insulin production by beta cells of pancreas.1 hr. polydipsia. blurred vision. slurring o H yperglycemia … weakness.

Every hour the next 4 ho urs. cryotherapy. hystere ctomy. post op if … < 30 mL/hr urine. NPO X 8 hrs. exenteration … Chemotherapy = No help • PAP smears should start within 3 year s of intercourse or by age 21 o Ovarian Cancer = leading cause of death from gyn ecological cancer o Breast Cancer = Leading cause of cancer in women • Upper outer quadrant. S econdary Stage (up to 6 mo) = Rash on palms and soles + Flu-like symptoms … Tertia ry Stage = Neurologic and Cardiac destruction (10-30 yrs) … Treated with Penicilli n G IM.. No NS AIDS X 48 hrs o Increased corticosteroids for surgery (stress) … May need to incre ase insulin too o Post Op restlessness may = hemorrhage.. Incentive Spirometry & Breathing Es taught in advance. Interferon. spine • Mastectomy … Radical Mas tectomy = Lymph nodes too (but no mm resected) • Avoid BP measurements. then Every 4 hours prn . o Gonorrhea (Neisseria Gonorrhea) … Yellow green urethral discharge (The C lap) o Chlamydia (Chlamydia Trachomatis) … Mild vaginal discharge or urethritis … Do xycyclin. Laser. Nystatin. 90 days) . left > right • Monthly SBE • Mammography … Baseline @ 35. Methotrexate. cheesy di scharge with itching … Miconazole. etc. radiation. liver. Clomitrazole (Gyne-Lotrimin) o Herpes Simplex 2 … Acyclovir o HPV (Human Pappilovirus) … Acid. Cryotherapy o HIV … C ocktails • Perioperative Care o Breathing Es taught in advance (before or early in pre-op) o Remove nail polish (need to see cap refill) o Pre Op … Meds as ordered. brain.o Cervical and Uterine Cancer • Laser. o Call Dr. T > 100 or < 96 o Post Op Monitoring VS and BS … Ever y 15 minutes the first hour. injections and venipuncture on surgical side o Anti-emetics given with Chemotherapy Agents (Cytoxan. hypoxia o Wound dehisce nce or extravisation … Wet sterile NS dressing + Call Dr. Annually after ag e 50 • Mets to lymph nodes. conization. then lungs. Void. Tetracycline o Trichomoniasis (Trichomonas Vaginalis) … Frothy foul-smel ling vaginal discharge … Flagyl o Candidiasis (Candida Albicans) … Yellow. Every 30 min next 2 hours.) • Phenergan (Promethazine HCl) • Compazin e (Prochlorperazine) • Reglan (Metocolpramide) • Benadryl (Diphenhydramine) • Zofran ( Ondansetron HCl) • Kytril (Granisetron) Sexually Transmitted Diseases o Syphilis ( Treponema pallidum) … Chancre + red painless lesion (Primary Stage. Sys BP < 90.

elevate involved leg • Harris Tube … Rt back/Lt – to advance tube in GI • Miller Abbott Tube … Right side for GI advancement i nto small intestine • Thoracocentesis … Unaffected side. Leg straight 4-6 hrs. bed rest 6-12 hrs • Burn Autograph … E levated and Immob 3-7 days • Amputation … Supine. or Deep breath and hold o If chest tube drain stops fluc tuating. No hip flexion past 90 degrees • Supratentorial Sx … HOB 30-45 degrees (Semi-Fowler ) • Infrantentorial Sx … Flat • Phlebitis … Supine. to xyphoid (~22-26 inches) o Decubitus (pressure) Ulcer Staging • Stage 1 = Erythema only • Stage 2 = P artial thickness • Stage 3 = Full thickness to SQ • Stage 4 = Full thickness + invol ving mm /bone . Blakemore Tube (for esoph varices)… Sudden respiratory distress – Cut inflation tubes and remove o Tracheostomy patients … Keep Kelly clamp and Obturato r (used to insert into trachea then removed leaving cannula) at bed side o Turn off NG suction for 30 min after PO meds o NG Tube Removal … Take a deep breath and hold it o Stomach contents pH = < 4 (gastric juices aspirated) o NG Tube Insert ion … If cough and gag. HOB 30-45 degrees • Enema … Lef t Sims (flow into sigmoid) • Liver Biopsy … Right side with pillow/towel against pun cture site • Cataract Sx … Opp side – Semi-Fowler • Cardiac Catheterization … Flat (HOB no more than 30 degrees). elevate stump for 48 hrs • Large Bra in Tumor Resection … On non-operative side o Incentive Spirometry … Inhale slowly an d completely to keep flow at 600-900. the lung has re-inflated (or there is a problem) o Keep scissors by bed if pt has S. let calm. 10 times per hr o P ost Op Breathing Exercises … Every 2 hours • Sit up straight • Breath in deeply thru n ose and out slowly thru pursed lips • Hold last breath 3 seconds • Then cough 3 time s (unless abd wound – reinforce/splint if cough) o Watch for Stridor after any nec k/throat Sx … Keep Trach kit at bed side o Staples and sutures removed in 7-14 day s – Keep dry until then o No lifting over 10 lbs for 6 weeks (in general) o If che st tube comes disconnected. advance again with pt sipping water from straw o NG Tube Length … End of nose.o 1-4 hrs Post Op = Immediate Stage … 2-24 hrs Post Op = Intermediate Stage … 1-4 da ys Post Op = Extended Stage o Post Op Positioning • THR … No Adduction past midline. put free end in container of sterile water o Removin g Chest Tube … Valsalvas. back off a little. to era lobe. Hold breath 5 seconds.

Dysphasia (speech and verbal comprehension). LE = 18% each. . anxious. confusio n may indicate increased ICP • Change in level of responsiveness = Most important indicator of increased ICP • Watch for CSF leaks from nose or ears – Leakage can lea d to meningitis and mask intracranial injury since usual increased ICP symps may be absent. Dermis. behavior. poo r judgment. motor. irritability. Agraphia (writing). restlessness. slow. Back Trunk = 18% • Singed nasal hair and circ umoral soot/burns = Smoke inhalation burns o Fractures • Report abnormal assessmen t findings promptly … Compartment Syndrome may occur = Permanent damage to nerves and vessels • 5 P’s of neurovascular status (important with fractures) • Pain. o Spinal Cord Injuries • Respiratory status paramount … C3-C5 innervates diaphragm • 1 wk to know ultimate prognosis • Spinal Shock = Complete loss of all r eflex. Front trunk = 18%. memory okay • Right Hemisphere Lesion … can’t recognize faces. Alexia (reading). Pulse. Apraxia (perform purposeful movem ents). confabulates. cautious. impulsive behavior.• Acute Care o CVA … Hemorrhagic or Embolic • A-fib and A-flutter = thrombus formation • Dysarthria (verbal enunciation/articulation). Paralysis • Provide age-appropriate toys for kids in traction • Special Tests and Pathognomonic Signs o Tensilon Test … Myesthenia Gravis (+ in M yesthenic crisis. loss of tonal hearing o Head Inju ries … • Even subtle changes in mood. Dysphagia (swallowing) • Left Hemisphere Lesion … apha sia. and SQ (full thickness) • Rule of 9s … Head and neck = 9%. UE = 9% eac h. agraphia. loss of depth perception. constantly smiles. Paresthesia. sensory and autonomic activity below the lesion = Medical emergenc y • Permanent paralysis if spinal cord in compressed for 12-24 hrs • Hypotension and Bradycardia with any injury above T6 • Bladder Infection = Common cause of death (try to keep urine acidic) o Burns • Infection = Primary concern • HyperK+ due to ce ll damage and release of intracellular K+ • Give meds before dressing changes – Pain ful • Massive volumes of IV fluid Cholinergic crisis) . Aphasia (speaking). Pallor. denies illness. due to fluid shift to interstitial spaces and resultant shock • First Degree = Epidermis (superficial partial thickness) • Se cond Degree = Epidermis and Dermis (deep partial thickness) • Third Degree = Epide rmis.

o ELISA and Western Blot … HIV o Sweat Test … Cystic Fibrosis o Cheilosis = Sores on sides of mouth … Riboflavin deficiency (B2) o Trousseau’s Sign (Carpal spasm induce d by BP cuff) … Hypocalcemia (hypoparathyroidism) o Chvostek’s Sign (Facial spasm af ter facial nerve tap) … Hypocalcemia (hypoparathyroidism) o Bloody Diarrhea = Ulce rative Colitis o Olive-Shaped Mass (epigastric) and Projectile Vomiting = Pylori c Stenosis o Current Jelly Stool (blood and mucus) and Sausage-Shaped Mass in RU Q = Intussiception o Mantoux Test for TB is + if 10 mm induration 48 hrs post ad min (previous BCG vaccine recipients will test +) o Butterfly Rash = SLE … Avoid d irect sunlight o 5 Ps of NV functioning … Pain.Tx with ACTH. Cyto xan and other immunosuppressants o Reed-Sternberg Cells = Hodgkin’s o Koplik Spots = Rubeola (Measles) o Erythema Marginatum = Rash of Rheumatic Fever o Gower’s Sig n = Muscular Dystrophy … Like Minor’s sign (walks up legs with hands) • Pediatrics o B ench Marks • Birth wt doubles at 6 months and triples at 12 months • Birth length in creases by 50% at 12 months • Post fontanel closes by 8 wks • Ant fontanel closes by 12-18 months • Moro reflex disappears at 4 months • Steady head control achieved at 4 months • Turns over at 5-6 months • Hand to hand transfers at 7 months • Sits unsup ported at 8 months • Crawls at 10 months • Walks at 10-12 months • Cooing at 2 months . corticosteroids. shu ffling o IG Bands on Electrophoresis = MS … Weakness starts in upper extremities – b owel/bladder affected in 90% … Demyelination . Cardidopa) – Fall precautions. paraly sis o Cullen’s Sign (periumbelical discoloration) and Turner’s Sign (blue flank) = A cute Pancreatitis o Murphy’s Sign (Rt. increased Temp o Pill-Rolling Tremor = Parkinson’s (Tx with Levodopa. pulse. pallor. costal margin pain on palp with inspiration ) = GB or Liver disease o HA more severe on wakening = Brain Tumor (remove benig n and malignant) o Vomiting not associated with nausea = Brain Tumor o Elevated ICP = Increased BP. widened pulse pressure. stooped. rigid. paresthesia.

• 25% chance if: AS (trait only) X AS (trait only) • 50% chance if: AS (trait only) X SS (disease) o Autosomal Dominant Diseases • Huntington’s. Tay-S achs. Gower’s Sign = diffi culty rising walks up legs (like Minor’s sign).. Sickle Cell Anemia. waddling gait. Dada + a few w ords at 9-12 months • Throws a ball overhand at 18 months • Daytime toilet training at 18 mo . high pit ched cry. and turning – Try to avoid o Muscular Dystrophy … X-linked Recessive. wide suture lines. increased hd circum. protruding tongue. PKU. crossed. IICP = Bulging fontanels. Older kids IIPC = Widened pulse pressure • IIC P caused by suctioning. upward outward slant of eyes o Cerebral Palsy … Scissor ing = legs extended. hyper lordosis. straining. Polydactyl. sunset eyes.2 years • 2-3 word sentences at 2 years • 50% of adult Ht at 2 years • Birt h Length doubles at 4 years • Uses scissors at 4 years • Ties shoes at 5 years • Girls’ growth spurt as early at 10 years … Boys catch up ~ Age 14 • Girls finish growing at ~15 … Boys ~ 17 o Autosomal Recessive Diseases • CF. lethargy … Treat wi th peritoneal shunt – don’t pump shunt. Log rolling after Sx o Down Syndrome = Trisomy 21 … Simian creases on palms. hyp otonia. Albinism. coughing. Links syllables 6-9 mo • Mama. Achondroplasia.• Monosyllabic Babbling at 3-6 months. fat pseudohypertrophy of calves.. Polycystic Kidney Disease • 50% if one parent has th e disease/trait (trait = disease in autosomal dominant) o X-Linked Recessive Dis eases • Muscular Dystrophy. Hemophilia A • Females are carriers (never have the dise ase) • Males have the disease (but can’t pass it on) • 50% chance daughters will be ca rriers (can’t have disease) • 50% chance sons will have the disease (not a carrier = can’t pass it on) • This translates to an overall 25% chance that each pregnancy wi ll result in a child that has the disease o Scoliosis … Milwaukee Brace – 23 hrs/day . . feet plantar-flexed o PKU … leads to MR … Guthrie Test …Aspartame (NutraSweet) has phenylalanine in it and should not be given to PKU pa tient o Hypothyroidism … Leads to MR o Prevent Neural tube disorders with Folic Ac id during PG o Myelomeningocele … Cover with moist sterile water dressing and keep pressure off o Hydrocephalus … Signs of increased ICP are opposite of shock … • Shock = Increased pulse and decreased BP • IICP = Decreased pulse and increased BP … (+ A ltered LOC = Most sensitive sign) • Infants . Marfans .

Fosphenytoin (Cerebyx). high fever. turn hd to side. influenza B … Child sits upright with chin out and tongue protruding (maybe Tripod position) … Prepare for intubation or trach … DO NOT put anything into kid’s m outh o Isolate RSV patient with Contact Precautions … Private room is best … Use Mis t Tent to provide O2 and Ribavirin – Flood tent with O2 first and wipe down inside of tent periodically so you can see patient o Acute Glomerulonephritis … After B strep – Antigen-Antibody complexes clog up glomeruli and reduce GFR = Dark urine. kee p safe … Treat with Phenobarbitol (Luminol). elbow restraints o Congenital Megacolon = Hirschsprung’s Disease … Lack of peristalsis due to absence of ganglionic cells in colon … Suspect if no meconium w/in 24 hrs or ribbon-like foul smelling stools o I ron Deficiency Anemia … Give Iron on empty stomach with citrus juice (vitamin C en hances absorption). Use straw or dropper to avoid staining teeth. o Call Physician if seizures. Carbamazepin e (Tegritol) o Meningitis (Bacterial) … Lumbar puncture shows Increased WBC. painful edematous hands and feet (hand-foot syndrome). abd pain. hydration … Avoid high altitude and strenuous activities o Ton sillitis … usually Strep … Get PT and PTT Pre-Op (ask about Hx of bleeding) … Suspect Bleeding Post-Op if frequent swallowing. Tarry stools. or clearing throat … No r ed liquids. don’t restrain.o Seizures … Nothing in mouth. or high-pitched cry after immunizat ion o All cases of poisoning … Call Poison Control Center … No Ipecac! o Epiglottiti s = H. a rthralgia …Tx + rest. maintain Logan Bow. Choking. prote in. maintain airway. ice collar. Cyanosis o Cleft Lip and Palate … Post -Op – Place on side. soft foods … Highest risk of hemorrhage = first 24 hrs and 5-10 days post-op (with sloughing of scabs) o Primary meds for ER fo r respiratory distress = Sus-phrine (Epinephrine HCl) and Theophylline (Theo-dur ) … Bronchodilators o Must know normal respiratory rates for kids … Respiratory diso rders = Primary reason for most medical/ER visits for kids … • Newborn … 30-60 . dilutional hyponatremia o CF Kids taste salty and need enzymes sprinkled on their food o Children with Rubella = threat to unborn siblings (may require temporary isolation from Mom during PG) o Pain in young children measur ed with Faces pain scale o No MMR Immunization for kids with Hx of allergic rxn to eggs or neomycin o Immunization Side Effects … T < 102. vomiting blood. proteinuria o Wilm’s Tumor = Large kidney tumor … Don’t palpate o TEF = Tracheoesophag eal Atresia … 3 C’s of TEF = Coughing. Phenytoin (Dilantin: TR = 10-20 … Gingi val Hyperplasia). redness and soreness at injection site for 3 days … give Tylenol and bike pedal legs (passively) for chil d. no straws. IICP and decreased glucose • May lead to SIADH (Too much ADH) … Water retention. limit milk intake < 32 oz/day o Sickle Cell Disease …Hydration most important …SC Cr isis = fever. fluid overload. Valproic Acid (Depakene).

Ca++.0 fo r kids o Ductus Venosus = Umbelical Vein to Inferior Vena Cava o Ductus Arterios us = Aorta to Pulmonary Artery o Rheumatic Fever … Acquired Heart Disease … Affects aortic and mitral valves • Preceded by beta hemolytic strep infection • Erythema Mar ginatum = Rash • Elevated ASO titer and ESR • Chest pain. ASD. TVG (Transposition of Great Vessels) … Polycythemia common in Cyanotic disorders • 3 T’s of Cyanotic Heart Disease (Tetralogy. Rubella. Aortic Ste nosis • Antiprostaglandins cause closure of PDA (aorta .pulmonary artery) o Cyano tic = Tetralogy of Fallot. PDA. other. Truncus Arteriosis (one main vessel gets mixed blood) . HPV o Braxton Hicks common throughout PG o Amniotic fluid = 800-1200 mL (< 300 mL = Oligohydramnios = fetal kidney problems) o Polyhydramnios and Macrosomia (large fetus) with Diabetes o Umbelical cord: 2 arteries.8-2. migratory large joint pain. Coarc of Aorta. shortness of breath (Cardi tis). A & C o Dangerous Infections with PG … TOR CH = Toxoplasmosis. Cytomegalovirus. Eggs 24 hrs … Fertilization in Fallopian Tube o Chadwick’s Sign = Bluing of Vagina (early as 4 weeks) o Hegar’s Sign = Softening of isthmus of cervix (8 weeks) o Goodell’s S ign = Softening of Cervix (8 weeks) o Pregnancy Total wt gain = 25-30 lbs (11-14 kg) o Increase calorie intake by 300 calories/day during PG … Increase protein 30 g/day … Increase iron. Truncus. 1 vein … Vein carries oxygenated blood to fetus (oppos ite of normal) . Folic Acid.• 1-11 mo … 25-35 • 1-3 years … 20-30 • 3-5 years … 20-25 • 6-10 years … 18-22 • 11-16 year Cardiovascular Disorders o Acyanotic = VSD. Transposition) o Tetralogy o f Fallot … Unoxygenated blood pumped into aorta • Pulmonary Stenosis • VSD • Overiding A orta • Right Ventricular Hypertrophy • TET Spells …Hypoxic episodes that are relieved by squatting or knee chest position o CHF can result … Use Digoxin … TR = 0. tachycardia (even during sleep) • Treat with Pen icillin G = Prophylaxis for recurrence of RF • Maternity o Day 1 of cycle = First day of menses (bleeding) … Ovulation on Day 14 … 28 days total … Sperm 3-5 days.

Notify Physician o DIC … Tx is with Heparin (safe in PG) … Fetal Demise.BP is unchanged in PG). progressive dilation a nd effacement o Station = Negative above ischial spines. Stop Pitocin. 14-20 weeks • Showi ng = 14 weeks • Braxton Hicks – 4 months and onward o Early Decels = Head compressio n = OK o Variable Decels = Cord compression = Not Good o Late Decels = Utero-pla cental insufficiency = BAD! o If Variable or Late Decels … Change maternal positio n.4 o NON-Stress Test … Reactive = Healthy (FHR goes up with movements) o Co ntraction Stress Test (Ocytocin Challenge Test)… Unhealthy = Late decels noted (po sitive result) indicative of UPI … “Negative” result = No late decels noted (good resu lt) o Watch for hyporeflexia with Mag Sulfate admin . Living children o Gravida = # of Pregnancies regardless of outcome o Para = # of Deliveries (not kids) after 20 wks gestation o Nagale’s Rul e … Add 7 days to first day of last period. Abruptio Placenta. T < 100. Diaphragmatic Inhibiti on • Keep Calcium gluconate by the bed (antidote) o Firsts • Fetal HB … 8-12 weeks by Doppler. subtract 3 months. Abortions. Pre-te rm births. Administer O2. 15-20 weeks by fetoscope • Fetal movement = Quickening. LBP that radiates to abdomen. . Positive below o Leopol d Maneuver tries to reposition fetus for delivery o Laboring Maternal Vitals … Pul se < 100 (usually a little higher than normal with PG .o FHR = 120-160 o Folic Acid Deficiency = Neural tube defects o Pre-term = 20-37 weeks o Term = 38-42 weeks o Post-term = 42 weeks+ o TPAL = Term births. . add 12 months = EDC o Hgb and Hct a bit lower during PG due to hyperhydration o Side-lying is best position for uteroplacental perfusion (either side tho left is traditional ) o 2 :1 Lecithin:Sphingomyelin Ratio = Fetal lungs mature o AFP in amniotic fluid = p ossible neural tube defect o Need a full bladder for Amniocentesis early in PG ( but not in later PG) o Lightening = Fetus drops into true pelvis o Nesting Insti nct = Burst of Energy just before labor o True Labor = Regular contractions that intensify with ambulation. Infection o Fundal Heights • 12-14 wks … At level of symphysis • 20 weeks … 20 cm = Level of umbilicus • Rises ~ 1 cm per week o S tages of Labor .

R. 3rd Degree = anal sphincter. 1-3 = mostly dead o Ey e care = E-mycin + Silver Nitrate … for gonorrhea o Pudendal Block = decreases pai n in perineum and vagina – No help with contraction pain o Epidural Block = T10-S5 … Blocks all pain … First sign = warmth or tingling in ball of foot or big toe o Re gional Blocks often result in forceps or vacuum assisted births because they aff ect the mother’s ability to push effectively o WBC counts are elevated up to 25.mot hers who deliver Rh+ kids… Not given if mom has a +Coombs Test … She already has dev eloped antibodies (too late) o Caput Succedaneum = edema under scalp.• Stage 1 = Beginning of Regular contraction to full dilation and effacement • Stage 2 = 10 cm dilation to delivery • Stage 3 = Delivery of Placenta • Stage 4 = 1-4 Hrs following delivery o Placenta Separation … Lengthening of cord outside vagina. mm tone. full feeling in vagina … Give oxytocin after placenta is out – Not befo re. 2nd Degree = mm/fascia. does not cross suture line s o Suction Mouth first – then nostrils o Moro Reflex = Startle reflex (abduction of all extremities) – up to 4 months o Rooting Reflex … up to 4 months o Babinski Re flex … up to18 months o Palmar Grasp Reflex …Lessens by 4 months o Ballard Scale use d to estimate gestational age o Heel Stick = lateral surface of heel o Physiolog ic Jaundice is normal at 2-3 days … Abnormal if before 24 hours or lasting longer than 7 days … Unconjugated bilirubin is the culprit. o Vitamin K given to help wit h formation of clotting factors due to fact that the newborn gut lacks the bacte ria necessary for vitamin K synthesis initially … Vastus lateralis mm IM o Abrutio Placenta = Dark red bleeding with rigid board like abdomen . 4-6 = moderate resuscitative efforts. gu sh of blood. Color … 1 and 5 minutes …7-10 = Good. Reflex irritability.00 0 for ~10 days post partum o Rho(D) immune globulin (RhoGAM) is given to Rh. Foul smel l = infection o Massage boggy uterus to encourage involution … empty bladder ASAP – may need to catheterize … Full bladder can lead to uterine atony and hemorrhage o Tears …1st Degree = Dermis. 4 th Degree = rectum o APGAR = HR. o Schultz Presentation = Shiny side out (fetal side of placenta) o Postpartu m VS Schedule • Every 15 min X 1 hr • Every 30 min X next 2 hours • Every Hour X next 2-6 hours • Then every 4 hours o Normal BM for mom within 3 days = Normal o Lochia … no more than 4-8 pads/day and no clots > 1 cm … Fleshy smell is normal. crosses su ture lines o Cephalhematoma = blood under periosteum.

IV fluids. diabetes. o Lay on right side after feeding … Move stomach cont ents into small intestine o Jaundice and High bilirubin can cause encephalopathy … < 12 = normal … Phototherapy decomposes bilirubin via oxidation … Protect eyes. seizures o High pitched cry + bulging fontanels = IICP o H ypothermia can lead to Hypoxia and acidoisis … Keep warm and use bicarbonate prn t o treat acidosis in newborn. admin O2 by face mask. prol onged labor. turn pt on side. infection and ab ruptio placenta. high pitched cry. overdistended uterus.o Placenta Previa = Painless bright red bleeding o DIC = Disseminated Intravascu lar Coagulation … clotting factors used up by intravascular clotting – Hemorrhage an d increased bleeding times result … Associated with fetal demise. traumatic birth) o Postpartum H emorrhage = Leading cause of maternal death … Risk factors include: • Dystocia. VS. . infection Tx includes … Funda l massage. abrutio placenta. o Suspect uterine rupture if woman complains of a sharp pain follow ed by cessation of contractions o Pre-Eclampsia = Htn + Edema + Proteinuria o Ec lampsia = Htn + Edema + Proteinuria + Seizures and Coma … Suspect if Severe HA + v isual disturbances o No Coumadin during PG (Heparin is OK) o Hyperemesis Gravida rum = uncontrollable nausea and vomiting … May be related to H. Pitocin can cause water intoxication owing to ADH effects. notify physician o Jitteriness i s a symptom of hypoglycemia and hypocalcemia in the newborn o Hypoglycemia … tremo rs. turn off Pitocin. tur n every 2 hours and watch for dehydration … The dangerous bilirubin is the unconju gated indirect type. count pads. o Magnesium Sulfate used to reduce preterm labor contractions a nd prevent seizures in Pre-Eclampsia … Mg replaces Ca++ in the smooth mm cells res ulting relaxation … Can lead to hyporeflexia and respiratory depression – Must keep Calcium Gluconate by bed when administering during labor = Antidote … Monitor for: • Absent DTR’s • Respirations < 12 • Urinary Output < 30/hr • Fetal Bradycardia o Pitocin (Oxytocin) use for Dystocia… If uterine tetany develops. pyolori … Reglan (me taclopromide) o Insulin demands drop precipitously after delivery o No oral hypo glycemics during PG – Teratogenic … Insulin only for control of DM o Babies born wit hout vaginal squeeze more likely to have respiratory difficulty initially o C-Se ction can lead to Paralytic Ileus … Early ambulation helps o Postpartum Infection common in problem pregnancies (anemia. Oxytocin.

whole grains o B12 … Organ meats. whol e wheat. delayed gastric emptying. shellfish • Deficien cy = Big red beefy tongue. milk. milk. peanut but ter o Vitamin C … Citrus.• Nutrition o K+ … Bananas. mm wasting. red meat. Loss of family recognition o Delerium = Secondary to another pro blem = Reversible (infections common cause) o Medication Alert! … Due to decreased renal function. cheese.5-2 4. s oy o Vitamin A … Liver. seeds o BMI … 18. Mistrust • 1-3 yrs (Toddler)… Autonomy vs. incontinence. liver. memo ry loss. • Advanced Clinical Concepts o Erickson … Psycho-Social Development • 0-1 yr (New born) … Trust vs. sunlight o Vitamin E … Veggie oils. organ meat. beef. avocados. COPD. nuts o Thiamine (B1) … Pork. potatoes. bad sleep. fish oil. potatoes. cheese. citrus o Fe++ … Green leafy veggies. citrus. carrots • Use Z-track for injections to avoid skin staining o Mg+ … Whole g rains. green leafy veggies. eggs. meat. green leafy ve ggies. liver. bladder shrinks. Hypothyr oidism. TIAs common) • Decubitus Ulcers • Hyp othyroidism • Thyrotoxicosis (Grave’s Disease) • COPD (usually combination of emphysem a and CB) • UTIs and Pneumonia … Can cause confusion and delerium o Memory loss star ts with recent – progresses to full o Dementia = Irreversible (Alzheimer’s) … Depressi on. tea. legumes. orange and dark green fruits and veggies o Vitamin D … Dairy . dried fruits. green leafy veggies. Diabetes o Common Ailments: • Delerium and Dementia • Cardiac Dysrhythmias • C ataracts and Glaucoma • CVA (usually thrombotic.9 = Normal (Higher = Obese) • Gerontology o Essentially everyone goes to Hell in a progressively degenerative hand-basket • Thin skin. Doubt and Shame … Fear intr usive procedures . seafood o Folic Acid … Green leafy veg gies. drugs metabolized by the kidneys may persist to toxic levels o When in doubt on NCLEX … Answer should contain something about exercise and nutrit ion. legumes o Na+ … Salt. nuts. Anemia o Vitamin K … Green leafy veggies. yeast. Sundowning. processed foods. cantaloupe o Ca++ … Milk.

Punishment Orientation • Level 2 = Conventional Morality … Conforms to rules to ple ase others • Level 3 = Post. Role Confusion … Fear Body Image Distortion • 20-35 yrs (Early Adulthood) … Intimacy vs. Growth of Ego • Genital Stage (12 up) … Gratification and satisfying sexual relations. Peers important … Fear loss of control of their bodies • 12-1 9 yrs (Adolescent) … Identity vs. Oedipus complex. Id is in control and running wild • Anal Stage (1-3) … Control and plea sure wrt retention and pooping – Toilet training in this stage • Phallic Stage (3-6) … Pleasure with genitals. SuperEgo develops • Latency Stage (6-12) … Sex urges channeled to culturally acceptable level.Conventional … Rights..Security objects good (Blankies. stuffed animals) • 3-6 yrs (Pre-school) … Initiat ive vs. Inferiority… Games good. Isolation • 35-65 yrs (Middle Adulthood) … Genera tivity vs. Guilt … Fear mutilation – Band-Aids good • 6-12 yrs (School Age) … Industry vs. Principles and Conscience (Best for All is a concern) • Calculations Rules & Formulas o Round final answer to tent hs place o Round drops to nearest drop o When calculating mL/hr. Round down for peds o Calculating IV Flow Rates • Total mL X Drop Fa ctor / 60 X #Hrs = Flow Rate in gtts/min o Calculating Infusion Times • Total mL X Drop Factor / Flow Rate in gtts/min X 60 = Hrs to Infuse • Conversions o 1 t = 5m L o 1 T = 3 t = 15 mL o 1 oz = 30 cc = 30 mL = 2 T o 1 gr = 60 mg . Despair o Piaget … C ognitive Development • Sensorimotor Stage (0-2) … Learns about reality and object pe rmanence • Preoperational Stage (2-7) … Concrete thinking • Concrete Operational Stage (7-11) … Abstract thinking • Formal Operational Stage (11-adult) … Abstract and logic al thinking o Freud … Psycho-Sexual Development • Oral Stage (Birth -1 year) … Self gr atification. Stagnation • Over 65 (Older Adulthood) … Integrity vs. Ego rules o Kohlberg … Mor al Development • Moral development is sequential but people do not aromatically go from one stage to the next as they mature • Level 1 = Pre-conventional … Reward vs. round to neares t full mL o Must include 0 in front of values < 1 o Pediatric doses rounded to n earest 100th.

Chec k stools for occult blood (Stool softeners prn) o No salicylates. etc.5 (immunosupp ressed pts may not manifest fever with infection) • Bleeding Precautions (Anticoag ulants.8 • 37 C = 98. Limit contact sports o Rotate injection sites with small bor e needles for blood thinners o Limit needle sticks.) o Soft bristled tooth brush o Electric razor only (no safety razor s) o Handle gently. or sup positories o Avoid blowing or picking nose o Do not change Vitamin K intake if o n Coumadin .6 F • 38 C = 100. Use small bore needles.8 X C) + 32 o Degrees C = (F – 32) / 1.2 lbs o 1 cup = 8 oz = 240 mL o 1 pint = 16 oz o 1 quart = 32 oz o Degrees F = (1. NSAIDs. Main tain pressure for 5 minutes on venipuncture sites o No straining at stool .o 1 mg = 1000 ug (or mcg) o 1 kg = 2.4 F • 39 C = 102.2 F • 40 C = 104 F • Fall Precautions o Room c lose to nurses station o Assessment and orientation to room o Get help to stand (dangle feet if light headed) o Bed low with side rails up o Good lighting and r educe clutter in room o Keep consistent toileting schedule o Wear proper non-sli p footwear o At home … • Paint edges of stairs bright color • Bell on cats and dogs • Ne utropenic (Immunosuppressed) Precautions o No plants or flowers in room o No fre sh veggies … Cooked foods only o Avoid crowds and infectious persons o Meticulous hand washing and hygiene to prevent infection o Report fever > 100.