- Slander: character attacked and uttered in the presence of

NCLEX-RN NOTES others.

- Assault: act in which there is a threat or attempt to do bodily
TIPS:
harm.
- Deal with patients rather than with machines.
- Battery: unauthorized physical contact.
- AVOID: never, always, must, “why?”, “I understand”.
- If 2 opposites (e.g. hyper-/hypo-), one is correct.
- Do not leave the patient alone. CULTURAL CONSIDERATIONS
- Choose physical over psychological. 1. African Americans
- IDK the answer: pick the one with the most information. - Higher incidence of high blood pressure and obesity;
- High incidence of lactose intolerance.
ABC (except in emergencies, distress situations & CPR) 2. Arab Americans
Assessment vs. Implementation - May remain silent about STIs, substance abuse, and mental
Acute vs. Chronic illness;
Stable vs. Unstable - After death, the family may want to prepare the body and
Expected vs. Unexpected autopsy is discouraged unless required by law;
Real vs. Potential - Use same-sex family members as interpreters.
Odd man out 3. Asian Americans
- Believe in the yin/yang “hot-cold” theory of illness;
DO NOT DELEGATE (PACET): - Sodium intake is generally high because of salted and dried
- Planning; foods;
- Assessment (initial); - Usually refuse organ donation;
- Collaboration; - May nod without necessarily understanding.
- Evaluation; 4. Latino Americans
- Teaching. - Family members are typically involved in all aspects of
decision making such as terminal illness;
 UAP’s cannot be delegated: “EAT”, medication & unstable - May see no reason to submit to mammograms or
patients. vaccinations.
 LPN’s cannot be delegated anything related with blood and 5. Native Americans
are assigned the most stable patients. - Diet may be deficient in vitamin D and calcium because many
suffer from lactose intolerance or don’t drink milk;
- Obesity and diabetes are major health concerns.
1 tsp = 5 ml 1 pint = 2 cups (16 oz)
1 tbsp = 3 tsp (15 ml) 1 quart = 2 pints (32 oz) RELIGIOUS CONSIDERATIONS
1 oz = 30 ml 1 gr (grain) = 60 mg - Jehovah’s Witness: no blood products should be used.
1 cup = 8 oz 1 kg = 2,2 lbs - Hindu: no beef or items containing gelatin.
- Jewish: special dietary restrictions, use of kosher foods.
1 g = 1 ml (diapers) ºF = (ºC x 1,8) + 32 - Adventists: no pork nor alcohol and sometimes no meat.
Temperature normal range: 98,6ºF ±1 (37ºC - Muslims: no pork nor alcohol; people with chronic illnesses
±0,5) and women that are pregnant, breast-feeding or menstruating
MAP: (systolic + 2xdyastolic)/3 don’t fast during Ramadan.
Normal: 70-105 mmHg (>60 mmHg)
CVP: 2-8 mmHg (CVP can indicate right ORDER OF ASSESSMENT:
ventricular failure or fluid volume overload)
Inspection
Abdomen:
ETHICS & LEGAL ISSUES Palpation 1º Inspection
- Veracity is truth and is an essential component of a 2º Auscultation
therapeutic relationship between a health care provider and his Percussion 3º Percussion
4º Palpation
patient.
Auscultation
- Beneficence is the duty to do no harm and the duty to do
good. There’s an obligation in patient care to do no harm and
an equal obligation to assist the patient. ABO BLOOD TYPE COMPATIBILITY
- Nonmaleficence is the duty to do no harm.
Blood Type Can receive from: Can donate to:
- Tort: litigation in which one person asserts that an injury
(physical, emotional or financial) occurred as a consequence of O O O, A, B, AB
another’s actions or failure to act. A A, O A, AB
- Negligence: harm that results because a person didn’t act
reasonably. B B, O B, AB
- Malpractice: professional negligence. AB O, A, B, AB AB
TRACTIONS CRANIAL NERVES (Sensory=S |Motor=M |Both=B)
- Buck’s traction: knee immobility
- Russell traction: femur or lower leg Oh (Olfactory I) Some
- Dunlap traction: skeletal or skin Oh (Optic II) Say
- Bryant’s traction: children <3y, <35 lbs with femur fracture. Oh (Oculomotor III) Marry
To (Trochlear IV) Money
INFANT’S DEVELOPMENT: Touch (Trigeminal V) But
2-3 months: turns head side to side And (Abducens VI) My
4-5 months: grasps, switch & roll Feel (Facial VII) Brother
6-7 months: sit at 6 and waves bye-bye A (Auditory VIII) Says
8-9 months: stands straight at eight Girls (Glossopharyngeal IX) Big
10-11 months: belly to butt (phrase has 10 letters) Vagina (Vagus X) Bras
12-13 months: twelve and up, drink from a cup And (Accessory XI) Matter
Hymen (Hypoglossal XII) More
ERIKSON’S STAGES OF PSYCHOSOCIAL DEVELOPMENT

AGE STAGES CHARACTERISTICS Cranial nerve What it controls

Infancy Trust vs. Development of trust I Olfactory Smell test
(0-18m) Mistrust based on caregivers II Optic Visual acuity and visual fields
Autonomy vs. Development of sense Pupil constriction and extraocular
Early childhood III Oculomotor
Shame & of movements
(18m-3yrs)
doubt personal control Extraocular movements: inferior
Development of sense IV Trochlear
Preschool Initiative vs. adduction
of V Trigeminal Clench teeth and light touch
(3-5yrs) Guilt
purpose and directive
Extraocular movements: lateral
School age (6- Industry vs. Development of pride VI Abducens
abduction
11yrs) Inferiority in accomplishments
VII Facial Facial movement: close eyes, smile
Exploration of
Adolescence Identity vs. VIII Auditory Hearing and Romberg test
independence and
(12-18yrs) Role confusion IX Glossopharyngeal Gag reflex
development of self
Say “ah” – uvular and palate
Early Development of X Vagus
Intimacy vs. movement
adulthood (18- personal
Isolation Turn head and lift shoulders to
40yrs) relationships and love XI Accessory
resistance
Fulfilling goals and
Adulthood (40- Generativity XII Hypoglossal Stick out tongue
building career
65yrs) vs. Stagnation
and family
Older adult Integrity vs. Looking back on life PPE (Personal Protective Equipment)
(>65yrs) Despair with acceptance Don PPE Remove PPE
1. Hand hygiene 1. Gloves
2. Gown 2. Goggles
BURNS 3. Mask 3. Gown
4. Goggles 4. Mask
Parkland formula: 5. Gloves 5. Hand hygiene
4ml/kg/%body burned

- 1st 8h: ½ total volume TRANSMISSION-BASED PRECAUTIONS

- 2nd/ 8h: ¼ total volume
Hepatitis transmission:
- 3rd 8h: ¼ total volume
Consonants (B, C, D):
- Blood and body fluids.
Vowals (A, E):
- Fecal and oral.

Airborne: MTV
Measles
TB
Varicella (Chicken Pox/Herpes Zoster-Shingles)
Droplet: SPIDERMAN - Erythrocytes (RBC): 4.5-5.0 million/L
Sepsis - Leucocytes (WBC): 4,500-11,000 cells/mm3 (Neutropenia
Scarlet fever <1000/mm3 / Severe neutropenia: <500/mm3)
Streptococcal pharyngitis - Neutrophils: 1800-7800 cells/mm3
Parvovirus B19 - Lymphocytes: 1000-4800 cells/mm3
Pneumonia - Potassium: 3.5-5.0 mEq/L
Pertussis - Sodium: 135-145 mEq/L
Influenza - Chloride: 98-107 mEq/L
Diphtheria (pharyngeal) - Phosphate: 2.5-4.5 mg/dL
Epiglottitis - Magnesium: 1.6-2.6 mg/dL
Rubella - Phosphorus: 2.7-4.5 mg/dL
Mumps - Calcium: 8.6-10 mg/dL
Meningitis - Digoxin: 0.8—2.0 ng/ml
Mycoplasma or meningeal pneumonia - Lithium: 0.8—1.5 mEq/L
A(n)denovirus - Phenytoin: 10—20 mcg/dL
- Theophylline (Aminophylline): 10—20 mcg/dL
Contact: MRS.WEE
Multidrug resistant organisms Varicella zoster ABG VALUES & EVALUATION
Respiratory infection Cutaneous diphtheria
Skin infections (*VCHIPS) Herpes simplex - pH: 7.35—7.45 ROME
Wound infection Impetigo - HCO3: 24—26 mEq/L Respiratory – Opposite
Enteric infection (C. difficile) Pediculosis - CO2: 35—45 mEq/L Metabolic – Equal
Eye infection (conjunctivitis) Scabies - PaO2: 80%—100%
- SaO2: >95%
LABORATORY VALUES

- BUN: 5-20 mg/dL

- Creatinine: 0.6-1.3 mg/dL
- Creatinine clearance: 90-130 ml/min
- Total cholesterol: 140-199 mg/dL
- HDL: 30-70 mg/dL
- LDL: <130 mg/dL
- Triglycerides: <200 mg/dL
- Protein: 6-8 g/dL
- Albumin: 3.4-5 g/dL
- Alanine aminotransferase (ALT): 10-40 units/L
- Aspartate aminotransferase (AST): 10-30 units/L HYPOKALEMIA
- Total Bilirubin: <1.5 mg/dL
- Uric acid: 3.5—7.5 mg/dL Causes:
- CPK: 21-232 U/L “Your body is trying to DITCH potassium”
- Glucose: 70-110 mg/dL Drugs (laxatives, diuretics, corticosteroids)
- Hemoglobin A1c: Inadequate consumption of K (NPO, anorexia).
4%-5.9%: nondiabetic Too much water intake (dilutes the K).
<7%: good diabetic control Cushing’s syndrome (the adrenal glands produce excessive
7% to 8%: fair diabetic control amounts of aldosterone).
>8%: poor diabetic control Heavy fluid loss (NG suction, vomiting, diarrhea, wound
- Hemoglobin: drainage, excessive diaphoresis).
Female: 12-15 g/dL
Male: 14-16.5 g/dL Signs & Symptoms:
- Hematocrit: Everything is going to be SLOW and LOW.
Female: 35%-47% - Weak pulses (irregular and thread).
Male: 42%-52% - Orthostatic hypotension.
- Platelets: 150,000-400,000 cells/mm3 - Shallow respirations with diminished breath sounds.
- aPTT: - Confusion and weakness.
20-36 sec, depending on testing method - Flaccid paralysis.
Therapeutic (Heparin): 46-70 seconds - Decrease deep tendon reflexes.
- Prothrombin time (PT): 9.5-11.8 sec - Decreased bowel sounds.
- International Normalized Ratio (INR):
2-3: standard warfarin therapy
3-4.5: high-dose warfarin therapy
HYPERKALEMIA Signs & Symptoms:
“The body is too WEAK”
Causes: Weakness of muscles (profound).
“The body CARED too much about potassium” EKG changes.
Cellular movement of K from intracellular to extracellular Absent reflexes & minded (disorientated), Abdominal
(burns, tissue damages, acidosis). distention from constipation.
Adrenal insufficiency with Addison’s Disease. Kidney stone formation.
Renal failure.
Excessive K intake. HYPONATREMIA
Drugs (K-sparing like spironolactone, triamterene, ACE
inhibitors, NSAIDS). Causes (NO Na):
Na excretion increased (renal problems, NG suction, vomiting,
Signs & Symptoms (MURDER): diuretics, sweating, diarrhea, secretion of aldosterone).
Muscle weakness. Overload of fluid (congestive heart failure, hypotonic fluids
Urine production little or none (renal failure). infusions, renal failure).
Respiratory failure. Na intake low (low salt diets or NPO).
Decreased cardiac contractility (weak pulse, low BP). Antidiuretic hormone over secretion (SIADH).
Early signs of muscle twitches/cramp…Late profound weakness,
flaccidity. Signs & Symptoms (SALT LOSS):
Rhythm changes. Seizures & Stupor.
Abdominal cramping, Attitude changes (confusion).
HYPOCALCEMIA Lethargic.
Tendon reflexes diminished, Trouble concentrating (confused).
Causes (LOW CALCIUM): Loss of urine and appetite.
Low parathyroid hormone due (any neck surgery: check the Ca Orthostatic hypotension, Overactive bowel sounds.
level). Shallow respirations (due to skeletal muscle weakness).
Oral intake inadequate (alcoholism, bulimia etc.). Spasms of muscles.
Wound drainage (especially GI system).
Celiac’s & Crohn’s disease (malabsorption of Ca). HYPERNATREMIA
Acute pancreatitis.
Low vitamin D levels. Causes (HIGH SALT):
Chronic kidney issues (excessive excretion). Hyperventilation, Hypercortisolism (Cushing’s syndrome).
Increased phosphorus levels in the blood. Increased intake of sodium (oral or IV).
Using certain medications (Ma supplements, laxatives, loop GI feeding (tube) without adequate water supplements.
diuretics, Ca binder drugs). Hypertonic solutions.
Mobility issues. Sodium excretion decreased and corticosteroids.
Aldosterone insufficiency.
Signs & Symptoms (CRAMPS): Loss of fluids, infection (fever), diaphoresis, diarrhea, and
Confusion. diabetes insipidus).
Reflexes: hyperactive. Thirst impairment.
Arrhythmias.
Muscle spasms in calves or feet, tetany, seizures. Signs & Symptoms:
Positive Trousseau’s (happens before Chvostek’s sign and “No FRIED foods for you!”
tetany). Fever, Flushed skin.
Signs of Chvostek’s. Restless, Really agitated.
Increased fluid retention.
HYPERCALCEMIA Edema, Extremely confused.
Decreased urine output, Dry mouth/skin.
Causes (HIGH CAL):
Hyperparathyroidism (++ Ca released in the blood). HYPOPHOSPHATEMIA
Increased intake of Ca.
Glucocorticoids (suppresses Ca absorption). Causes (Low PHOSPHATE):
Hyperthyroidism. Pharmacy (aluminum hydroxide-based or magnesium-based
Calcium excretion decreased (Diuretics, renal failure, bone antacids cause malabsorption in the GI system).
cancer). Hyperparathyroidism (there is an over secretion of PTH which
Adrenal insufficiency (Addison’s disease). causes phosphate to not be reabsorbed).
Lithium usage (affects the parathyroid gland). Oncogenic osteomalacia.
Syndrome of Refeeding: causes electrolytes and fluid problems
due to malnutrition or starvation (watch for per os after TPN).
Pulmonary issues such as respiratory alkalosis.
Hyperglycemia. HYPERMAGNESEMIA
Alcoholism.
Thermal Burns. Causes (MAG)*:
Electrolyte imbalances: hypercalcemia, hypomagnesemia, Magnesium containing antacids and laxatives.
hypokalemia. Addison’s disease (adrenal insufficiency).
Glomerular filtration insufficiency (<30mL/min).
Signs & Symptoms (BROKEN):
Breathing problems (due to muscle weakness). *Hypermagnesemia is less common than hypomagnesemia. It
Rhabdomyolysis (tea-colored urine, muscle weakness/pain), typically happens when trying to correct hypomagnesemia with
Reflexes (deep tendon) decreased. magnesium sulfate IV infusion.
Osteomalacia (softening of the bones) fractures and decreased
bone density (alteration in bone shape), cardiac Output Signs & Symptoms (LETHARGIC)*:
decreased. *Happens in severe hypermagnesemia, mild one is
Kills immune system with immune suppression and decreases asymptomatic.
platelet aggregation. Lethargy (profound).
Extreme weakness, Ecchymosis. EKG changes (prolonged PR & QR interval and widened QRS
Neuro status changes (irritability, confusion, seizures). complex).
Tendon reflexes absent or grossly diminished.
HYPERPHOSPHATEMIA Hypotension.
Arrhythmias (bradycardia, heart blocks).
Causes (PHOS-HI): Respiratory arrest.
Phospho-soda overuse: phosphate containing laxatives or GI issues (nausea, vomiting).
enemas (Sodium Phosphate/Fleets enema). Impaired breathing (due to skeletal weakness).
Hypoparathyroidism. Cardiac arrest.
Overuse of vitamin D.
Syndrome of Tumor Lysis. EKG CHANGES IN ELECTROLYTE IMBALANCES
rHabdomyolysis.
Insufficiency of kidneys (renal failure is the main cause).

Signs & Symptoms (CRAMPS):

Confusion.
Reflexes hyperactive.
Anorexia.
Muscle spasms in calves or feet, tetany, seizures.
Positive Trousseau’s Signs, Pruritus.
Signs of Chvostek.

HYPOMAGNESEMIA

Causes (LOW MAG):

Limited intake of Mg (starvation).
Other electrolyte issues (hypokalemia, hypocalcemia).
Wasting Magnesium kidneys (loop and thiazide diuretics;
cyclosporine).
Malabsorption issues (Crohn’s and celiac diseases, “-prazole”
drugs, diarrhea/vomiting).
Alcohol (stimulates the kidneys to excreted Mg).
Glycemic issues (diabetic ketoacidosis, insulin administration).
FOOD SOURCES OF WATER-SOLUBLE VITAMINS
- Folic acid: green leafy vegetables, liver, beef and fish,
Signs & Symptoms (TWITCHING):
legumes, grapefruit and oranges.
Trousseau’s (positive due to hypocalcemia).
- Niacin: meats, poultry, fish, beans, peanuts, grains.
Weak respirations.
- Vitamin B1 (thiamine): pork, nuts, whole-grain cereals,
Irritability.
legumes.
Torsades de pointes, Tetany (seizures).
- Vitamin B2 (riboflavin): milk, lean meats, fish, grains.
Cardiac changes, Chvostek’s sign.
- Vitamin B6 (pyridoxine): yeast, corn, meat, poultry, fish.
Hypertension, Hyperreflexia.
- Vitamin B12 (cobalamin): meat, liver.
Involuntary movements.
- Vitamin C (ascorbic acid): citrus fruits, tomatoes, broccoli,
Nausea.
cabbage.
GI issues (decreased bowel sounds and mobility).
FOOD SOURCES OF FAT-SOLUBLE VITAMINS
- Vitamin A: liver, egg yolk, whole milk, green or orange
vegetables, fruits.
- Vitamin D: fortified milk, fish oils, cereals.
- Vitamin E: vegetable oils, green leafy vegetables, cereals,
apricots, apples, peaches.
- Vitamin K: green leafy vegetables, cauliflower, cabbage.
FOOD SOURCES OF MINERALS
- Calcium: broccoli, carrots, cheese, collard greens, green
beans, milk, rhubarb, spinach, tofu, yogurt.
- Chloride: salt.
- Iron: bread and cereals, dark green vegetables, dried fruits,
egg yolk, legumes, liver, meats.
- Magnesium: avocado, canned white tuna, cauliflower, cooked
rolled oats, green leafy vegetables, milk, peanut butter, peas,
pork, beef, chicken, potatoes, raisins, yogurt.
- Phosphorus: fish, nuts, organ meats, pork, beef, chicken,
whole-grain bread and cereals.
- Potassium: avocado, banana, cantaloupe, carrots, fish,
mushrooms, oranges, pork, beef, veal, potatoes, raisins,
spinach, strawberries, tomatoes.
- Sodium: American cheese, bacon, butter, canned food,
cottage cheese, cured pork, hot dogs, ketchup, milk, mustard,
processed food, soy sauce, table salt, white and whole-wheat
bread.
- Zinc: eggs, leafy vegetables, meats, protein-rich foods.
HEART AUSCULTATION
ADVENTITIOUS BREATH SOUNDS
- Crackles: High pitched and heard during inspiration. Not
cleared by cough. Discontinuous. Clinical examples include
pneumonia, heart failure, asthma, restrictive pulmonary
diseases; if coarse crackles: pulmonary edema and pulmonary
fibrosis and also in patients terminally ill with diminished gag
reflex.
- Rhonchi: Rumbling, course sounds like a snore. Heard during
inspiration or expiration. May clear with coughing or suctioning.
Continuous. Heard in patients with chronic bronchitis.
- Wheezes: musical noise during inspiration or expiration.
Usually louder during expiration. May clear with cough.
Continuous. Heard in patients with asthma.
- Pleural friction rub: Superficial, low pitched, coarse rubbing or
grating sound (two surfaces rubbing each other). Heard
throughout inspiration or expiration. Not cleared by cough.
Heard in patients with pleurisy.
VENTILATOR ALARMS
High-pressure alarm:
- Increased secretions are in the airway.
- Wheezing or bronchospasm is causing decreased airway size.
- The endotracheal tube is displaced.
- The ventilator tube is obstructed because of water or a kink in
the tubing.
- Patient coughs, gags, or bites on the oral endotracheal tube.
- Client is anxious or fights the ventilator.
Low-pressure alarm:
- Disconnection or leak in the ventilator or in the patient’s
airway cuff occurs.
- The patient stops spontaneous breathing.
CHEST TUBES
Suction control chamber
- Gentle bubbling indicates that there is suction and does not
indicate that air is escaping from the pleural space.
Water seal chamber
- Water oscillates (up as the client inhales and down as the
client exhales).
- Intermittent bubbling is expected in a patient with
pneumothorax.
- Continuous bubbling indicates an air leak in the chest tube
system.
ELECTROCARDIOGRAM (EKG)
 Reversible causes of asystole/pulseless electrical activity
5 Hs 5 Ts
Hypovolemia Tension pneumothorax
Hypoxia Tamponade (cardiac)
Hydrogen ions (acidosis) Toxins (narcotics,
benzodiazepines)
Hypokalemia or Hyperkalemia Thrombosis (pulmonary or
coronary)
Hypothermia Trauma

EXPECTED DATE OF DELIVERY (EDD)

1st day of the last menstrual period
Naegele’s rule: + 7 days
– 3 months

e.g. Sep 13th – Sep 20th – Jun 20th

PREGNANCY OUTCOME – GTPAL

G – gravidity
T – term births
P – preterm births
A – abortions or miscarriages
L – current living children

TORCH INFECTIONS
Toxoplasmosis They cause the
Other (Hepatitis, Syphilis, HIV) worst damage
Rubella during the 1st
Cytomegalovirus trimester.
Herpes simplex

Rho IMMUNE GLOBULIN

- It is administered (IM route) at 28 weeks of gestation and

again within 72 hours after delivery.
- It should also be administered within 72 hours after potential
or actual exposure to Rh+ blood and must be given with each
subsequent exposure to Rh+ blood.

 Folic acid should be started 3 months before the woman

becomes pregnant; it decreases the incidence of neural tube
defects.
 Warfarin is teratogenic (especially in the 1st trimester).
Heparin is not.
PREDISPOSING CONDITIONS FOR DISSEMINATED FETAL HEART RATE: 120-160bpm (variability 6-10bpm)
INTRAVASCULAR COAGULATION (DIC) CONTRACTIONS: 2-5 minutes apart with duration of <90
- Abruptio placentae seconds and intensity of <100 mmHg.
- Amniotic fluid embolism AVA: the umbilical cord has 2 arteries and 1 vein.
- Gestational hypertension
- Intrauterine fetal death NORMAL POSTPARTUM VITAL SIGNS
- Liver disease - Temperature: may increase to 100.4ºF during the first 24h
- Sepsis postpartum because of dehydrating effects of labor. Any higher
elevation may be causes by infection and must be reported.
DRUGS USED TO STOP PRETERM LABOR: TOCOLYTICS - Heart rate: may decrease to 50bpm (normal puerperal
“It’s not my time” bradycardia); >100bpm may indicate excessive blood loss or
Indomethacin (NSAID) infection.
Nifedipine (Calcium channel blocker) - Blood pressure: should be normal; suspect hypovolemia if it
Magnesium sulfate decreases.
Terbutaline - Respiratory rate: rarely changes; if it increases significantly,
suspect pulmonary embolism, uterine atony or hemorrhage.
STAGES OF LABOR
1st stage: Cervical dilation STOP
- Begins with onset of regular contractions and ends with - This is the treatment for maternal hypotension after an
complete dilation. epidural anesthesia:
- Latent (0-3cm)/Active (4-7cm)/Transitional (8-10cm) 1. Stop oxytocin if infusing.
2nd stage: Expulsion 2. Turn the client on the left side.
- Begins with complete dilation and ends with delivery of fetus. 3. Administer oxygen.
3rd stage: Placental 4. If hypovolemia is present, push IV fluids.
- Begins immediately after fetus is born and ends when the PREGNANCY CATEGORY OF DRUGS
placenta is delivered. - Category A: No risk in controlled human studies
4th stage: maternal homeostatic stabilization - Category B: No risk in other studies.
- Begins after the delivery of the placenta and continues for 1-4 - Category C: Risk not ruled out.
hours after delivery. - Category D: Positive evidence of risk.
- Category X: Contraindicated in Pregnancy.
PLACENTA PREVIA ABRUPTIO PLACENTAE - Category N: Not yet classified.
- Painless bright red - Dark red vaginal
vaginal bleeding. bleeding. ANTIBIOTICS CONTRAINDICATED DURING PREGNANCY
- Soft uterus. - Uterine pain and/or (MCATO)
- Vaginal exams are tenderness. Metronidazole*  hepatic failure
contraindicated. - Uterine rigidity. Chloramphenicol  gray baby syndrome
Aminoglycosides  ototoxicity
FETAL ACELERATIONS AND DECELERATIONS Tetracyclines  teeth discoloration & liver failure
Others  Nitrofurantoin, Quinolones & sulfonamides
Variable decelerations Cord compression *relatively contraindicated
Early decelerations Head compression
Accelerations Okay! MAGNESIUM SULFATE is used to stop preterm labor and to
Late accelerations Placental insufficiency prevent and control seizures in pre-eclamptic and eclamptic
patients. It decreases the urine output, deep tendon reflexes,
FETAL PRESENTATIONS respiratory rate and blood pressure.

APGAR
Appearance
Pulse
Grimace
Activity
Respiration

Score interventions:
8-10: no intervention required expect to support newborn’s
spontaneous efforts.
4-7: stimulate; rub newborn’s back; administer oxygen, rescore
at specific intervals.
0-3: requires full resuscitation; rescore at specific intervals.
FONTANELS COMPARTMENT SYNDROME
- Anterior: closes between 12-18 months of age. - It occurs when excessive pressure builds up inside an enclosed
- Posterior: closes between birth-2/3 months of age. muscle space in the body.
- It usually results from bleeding or swelling after an injury.
SIGNS OF A POSSIBLE HEART DEFECT (CORBIN) - The dangerously high pressure in compartment syndrome
Color: bluish skin or extremities. impedes the flow of blood to and from the affected tissues.
O2: low pulse oximetry percentage.
Rhythm: abnormal heart rate. Causes:
Breathing: heavy or labored. - Trauma, especially when it results in shock.
Increase in sweat, especially on the forehead. - Abdominal surgery, particularly liver transplant.
Nursing: trouble feeding and breathing at the same time or - Burns
poor appetite. - Sepsis.
- Severe ascites or abdominal bleeding.
IMMUNIZATIONS SCHEDULE - Pelvic fracture.
- Vigorous eccentric abdominal exercises (i.e. sit-ups on a back
Birth HepB extension machine in weight rooms).
*Vitamin K
2, 4, 6 months DTaP Five Ps of fractures and compartment syndrome:
DIHHPR (diaper) IPV (6-18 months) Pain.
HepB (2 & 4 months) Pallor.
Hib Pulselessness.
PCV Paresthesia.
Rotavirus Polar (cold).
*6 months: influenza
yearly FIVE Fs OF GALLBLADDER DISEASE:
12-15 months Hib Fair.
Harry V. Potter, MD Varicella Fat.
PCV Forty y/o.
MMR Five pregnancies.
DTaP (15-18 months) Flatulent.
*HepA (12-23 months: 2 *But it can occur in all ages and both sexes.
doses w/ at least a 4 week
interval) ADDISON’S & CUSHING’S DISEASE
4-6 y/o IPV
I did my vaccines DTaP Addison’s Cushing’s
MMR Down Hyponatremia Up Hypernatremia
Varicella Down Hypotension Up Hypertension
11-12 y/o DTaP Down Hypovolemia Up Hypervolemia
Don’t have money HPV
Up Hyperkalemia Down Hypokalemia
here Meningococcal
HPV (1st: 11-12 y/o;2 Down Hypoglycemia Up Hyperglycemia
months after 1st; 6 months
after 1st / up to age 26) Signs & Symptoms
Adult Influenza yearly
Don’t HIT the adult TDaP q 10 years Addison’s Cushing’s
Elderly Herpes Zoster (60 y/o) Dark pigmentation Prone to infection
Don’t break your HIP Influenza yearly resistance to stress Muscle wasting
Pneumonvax-23 Fractures Weakness
Alopecia Edema
Weight loss Hypertension
SAFETY PRINCIPLES REGARDING TOYS
GI distress Hirsutism
- No small toys for children under age 4 y/o.
Moonface/Buffalo hump
- No metal (dycast) toys if O2 is in use (sparks).
- Beware of fomites (they harbor bacteria - stuffed animal is a Need to ADD hormone Have extra CUSHION of hormones
fomite).
- For a child 9 months, do not pick any of the answers with the Treatment:
words: build, make, construct, sort, stack. - Addison’s: Na intake; medications include mineral corticoids.
- Cushing’s: Na intake; observe for signs of infection.
Addison’s extra:
 Managing stress is paramount, because if the adrenal
glands are stressed further it could result in Addisonian
crisis.
 Blood pressure is the most important assessment
parameter, as it causes severe hypotension.
Addisonian crisis: nausea & vomiting, confusion, abdominal
pain, extreme weakness, hypoglycemia, dehydration,
hypotension.
*Neutropenic patients should not receive vaccines, fresh fruits,
or flowers.
TREATMENT FOR SPIDER BITES/BLEEDING (RICE)
Rest.
Ice.
Compression.
Elevate extremity.
TREATMENT FOR SICKLE CELL CRISES (HHOP)
Heat.
Hydration.
Oxygen.
Pain medications.
POSITIONING PATIENTS
- Asthma: orthopneic position where patient is sitting up and
bent forward with arms supported on a table or chair arms.
- Post bronchoscopy: flat on bed with head hyperextended.
- Cerebral aneurysm: high Fowler’s.
- Hemorrhagic stroke: HOB elevated 30º to reduce ICP and
facilitate venous drainage.
- Ischemic stroke: HOB flat.
- Cardiac catheterization: keep site extended.
- Epistaxis: lean forward.
- Above knee amputation: elevate for first 24h on pillow,
position on prone daily for hip extension.
- Below knee amputation: foot of bed elevated for first 24h,
position prone daily for hip extension.
- Tube feeding for patients with decreased LOC: position
patient on right side to promote emptying of the stomach with
HOB elevated to prevent aspiration.
- Air/Pulmonary embolism: turn patient to left side and lower
HOB.
- Postural drainage: lung segment to be drained should be in
the uppermost position to allow gravity to work.
- Post lumbar puncture: patient should lie flat in supine to
prevent headache and leaking of CSF.
- Continuous Bladder Irrigation (CBI): catheter should be taped
to thigh so legs should be kept straight.
- After myringotomy: position on the side of affected ear after
surgery (allows drainage of secretion).
- Post cataract surgery: patient will sleep on unaffected side
with a night shield for 1-4 weeks.
- Detached retina: area of detachment should be in the
dependent position.
- Post thyroidectomy: low or semi- Fowler’s, support head,
neck and shoulders.
- Thoracentesis: sitting on the side of the bed and leaning over
the table (during procedure); affected side up (after
procedure).
- Spina bifida: position infant on prone so that sac does not
rupture.
- Buck’s traction: elevate foot of bed for counter-traction.
- Post total hip replacement: don’t sleep on operated side,
don’t flex hip more than 45-60º and don’t elevate HOB more
than 45º; maintain hip abduction by separating thighs with
pillows.
- Prolapsed umbilical cord: knee-chest position or
Trendelenburg.
- Cleft-lip: position on back or in infant seat to prevent trauma
to the suture line; while feeding, hold in upright position.
- Cleft-palate: prone.
- Hemorrhoidectomy: assist to lateral position.
- Hiatal hernia: upright position.
- Preventing Dumping syndrome: eat in reclining position, lie
down after meals for 20-30min (also restrict fluids during
meals, low fiber diet, and small frequent meals).
- Enema administration: position patient in left-side lying (Sim’s
position) with knees flexed.
- Post supratentorial surgery (incision behind hairline): elevate
HOB 30-45º.
- Post infratentorial surgery (incision at nape of neck): position
patient flat and lateral on either side.
- Increased ICP: high Fowler’s.
- Laminectomy: back as straight as possible; log roll to move
and sand bag on sides.
- Spinal cord injury: immobilize on spine board, with head in
neutral position; immobilize head with padded C-collar,
maintain traction and alignment of head manually; log roll
patient and do not allow patient to twist or bend.
- Liver biopsy: right side lying with pillow or small towel under
puncture site for at least 3h.
- Paracentesis: flat on bed or sitting.
- Intestinal tubes: place patient on right side to facilitate
passage into duodenum.
- Nasogastric tubes: elevate HOB 30º to prevent aspiration.
Maintain elevation for continuous feeding or 1h after
intermittent feedings.
- Pelvic exam: lithotomy position.
- Rectal exam: knee-chest position, Sim’s, or dorsal recumbent.
- During internal radiation: patient should be on bed rest while
implant is in place.
- Autonomic dysreflexia: place patient in sitting position
(elevate HOB) first before any other implementation.
- Shock: bed rest with extremities elevated 20º, knees straight,
head slightly elevated (modified Trendelenburg).
- Head injury: elevate HOB 30º to decrease intracranial
pressure.
- Peritoneal dialysis when outflow is inadequate: turn patient
side to side before checking for kinks in the tubing.
- Myelogram:
- Water-based dye: semi-Fowler’s for at least 8h.
- Oil-based dye: flat on bed for at least 6-8h to prevent
leakage of CSF.
- Air dye: Trendelenburg.
STAIRS WITH CANE/CRUTCHES: INCENTIVE SPIROMETRY STEPS
“Up with the good, down with the bad” 1. Sit upright.
- Going up: “good” leg first, crutches, “bad” leg. 2. Exhale.
- Going down: crutches with “bad” leg, then “good” leg. 3. Insert mouthpiece.
4. Inhale for 3 seconds.
LEAD POISONING S/S (ABCDEFG): 5. Hold for 10 seconds.
Anemia.
Basophilic stripping. ELEVATED INTRACRANIAL PRESSURE & SHOCK
Colicky pain.
Diarrhea. ICP SHOCK
Encephalopathy. Blood pressure  
Foot drop. Heart rate  
Gum (lead line).
Respiratory rate  
NEUROLEPTIC MALIGNANT SYNDROME (FEVER):
Fever. DIABETIC KETOACIDOSIS TREATMENT (KING UFC)
Encephalopathy. K+.
Vitals unstable. Insulin.
Elevated enzymes (CPK). Nasogastric tube: if comatose.
Rigidity of muscles. Glucose: once serum levels drop.
Urea: monitoring.
DIABETES INSIPIDUS SIADH Fluids: crystalloids.
Creatinine: monitor and catheterize.
- Low ADH, low water in - High ADH, water
body. intoxication.
VERTEBRAL INJURIES
- Polyuria. - Oliguria.
- Hypernatremia. - Hyponatremia. Vertebrae Effect
- High hemoglobin, - Low serum
C3 and Unable to care for self, life-sustaining
hematocrit and serum osmolality.
above ventilator is essential.
osmolality from - Weight gain.
dehydration. - Risk: seizures. May use a lightweight wheelchair; feed
- Risk: hypovolemic - TX: fluid restriction. at C6 self with devices; write and care for self;
shock. transfer from chair to bed.
- TX: DDAVP (ADH). Can dress legs; minimal assistance needed;
at C7 independence in wheelchair; can drive car
ANTICHOLINERGIC SIDE EFFECTS with hand controls.
"Know the ABCD'S of anticholinergic side effects" Some independence from wheelchair;
at T1-T4
Anorexia. long-leg braces for standing exercises.
Blurry vision. at L3-L4 May use crutches or canes for ambulation.
Constipation/Confusion.
Dry Mouth. BRAIN STRUCTURES AND THEIR FUNCTIONS
Sedation/Stasis of urine.

STEPS TO USE A METERED DOSE INHALER

1. Shake the inhaler well before use (3/4x).
2. Remove the cap.
3. Breathe out, away from the inhaler.
4. Bring the inhaler to your mouth, place it between your teeth
and close your mouth around it.
5. Start to breathe slowly. Press the top of the inhaler once and
keep breathing in slowly until you have taken a full breath
(3-5s).
6. Remove the inhaler from your mouth and hold your breath
for about 10s, then breathe out.
LEFT CEREBROVASCULAR ACCIDENT - Cirrhosis with hepatic insufficiency: restrict protein, fluids,
- Paralyzed right side hemiplegia. and sodium.
- Impaired speech and language. - Constipation: high-fiber, increased fluids.
- Slow performance. - COPD: soft, high-calorie, low-carbohydrate, high-fat, small
- Visual field deficits. frequent feedings.
- Aware of deficits: depression, anxiety. - Cushing’s disease: low sodium, high potassium.
- Impaired comprehension. - Cystic fibrosis: increase in fluids; pancreatic enzyme
replacement before or with meals; high protein, high calorie in
RIGHT CEREBROVASCULAR ACCIDENT advanced stages.
- Paralyzed left side hemiplegia. - Diarrhea: liquid, low-fiber, regular, fluid and electrolyte
- Spacial-perceptual deficits. replacement.
- Tends to minimize problems. - Diverticular disease: high-fiber, avoid seeds.
- Short attention span. - Dumping syndrome (rapid passage of food: diaphoresis,
- Visual field deficits. diarrhea, hypotension): restrict fluids w/ meals, drink 1h
- Impaired judgement. before or 1h after; eat in recumbent position, lie down 20-30
- Impulsive. min after eating; small frequent meals; low-carb/low-fiber.
- Impaired time concept. - Gallbladder disease: low-fat, calorie-restricted.
- Gastritis: low-fiber, bland diet.
CONGESTIVE HEART FAILURE S/S - Gout: low purine (no fish and organ meats).
- Hepatitis: regular, high-calorie, high-protein.
LEFT SIDE (FORCED) RIGHT SIDE (BACONED) - Hepatobiliary: low-fat, high protein, vitamins.
Fatigue. Bloating. - Hirschsprung's disease: low fiber, high calorie/protein before
Orthopnea. Anorexia. surgery.
Rales/Restlesness. Cyanosis/Cool legs. - Hypertension, heart failure, CAD: low-sodium, calorie-
Cyanosis/Confusion. Oliguria. restricted, fat-controlled.
Extreme weakness. Nausea. - Kidney stones: increased fluid intake, calcium-controlled,
Dyspnea. Edema. low-oxalate.
Distended neck veins. - Meniere’s: low sodium, avoid caffeine, nicotine and alcohol.
- Nephrotic syndrome: sodium-restricted, high-calorie, high-
CONGESTIVE HEART FAILURE TX (UNLOAD FAST) protein, potassium-restricted.
Upright position. - Obesity/Overweight: calorie-restricted, high-fiber .
Nitrates. - Ostomy: high calorie/protein/carb; low residue before
Lasix (Furosemide). surgery.
Oxygen. - Ileostomy: low residue diet, no meats, corn, nuts.
ACE inhibitors. - Colostomy: diet not restricted after 6 weeks.
Digoxin. - Pancreatitis: low-fat, regular, small frequent feedings; tube
Fluids (decrease). feeding or total parenteral nutrition.
Afterload (decrease). - Peptic ulcer: bland diet.
Sodium restriction. - Pernicious anemia: Vitamin B12.
Test (digoxin level, ABGs, K level). - IM B12 shot (25-100 g), followed by 500-1000 g shot
every 1-2 months or cyanocobalamin nasal spray.
THERAPEUTIC DIETS - Phenylketonuria (PKU): special milk substitutes for infants,
- Acute renal disease: protein-restricted, high-calorie, fluid- low protein for children.
controlled, Na and K controlled. - Pheochromocytoma: increase calories, vitamins and minerals
- Addison’s disease: high sodium, low potassium. intake; avoid coffee, tea, cola, tyramine foods.
- ADHD and bipolar: high-calorie and provide finger foods. - Sickle cell anemia: increase fluids to maintain hydration since
- Anemia: high protein/iron/vitamins. sickling increases when patients become dehydrated.
- Atherosclerosis: low saturated fats. - Stroke: mechanical soft, regular, or tube-feeding.
- Burns: high protein, high caloric, Vitamin C. - Underweight: high-calorie, high protein.
- Cancer: high-calorie, high-protein. - Ulcerative colitis & Crohn’s disease: high protein/calorie; low
- Celiac disease: gluten-free (no BROW: wheat, oats, rye, fat/fiber.
barley). - Ulcers: 3 meals/day, avoid Tº extremes, avoid
- Cholecystitis/Cholelithiasis: low fat liquids, powder caffeine/alcohol/milk&cream.
supplements high in protein/carb into skim milk; avoid fried - Postoperative: Vit B12 parenteral for life and iron
foods, pork, cheese, alcohol. supplements.
- After surgery may need low fat diet for several weeks. - Vomiting: fluid and electrolyte replacement.
- Low fat, high carb/protein.
- Chronic renal disease: protein-restricted, low-sodium, fluid-
restricted, potassium-restricted, phosphorus-restricted.
- Cirrhosis (stable): normal protein.
TOP NCLEX HERBS - Tetanus: Risus sardonicus or rictus grin.
St. John’ Wort: treats depression/anxiety. - Pancreatitis: Cullen’s sign (ecchymosis of the umbilicus); Grey
- Interacts with SSRI. Turner’s sign (bruising of the flank).
- Causes sun sensitivity. - Pyloric stenosis: olive like mass.
Garlic: lowers blood pressure and cholesterol levels. - Patent ductus arteriosus: washing machine-like murmur.
- Interacts with aspirin and warfarin. - Addison’s disease: bronze-like skin pigmentation.
Ginkgo Biloba: improves memory. - Cushing’s syndrome: moon face appearance and buffalo
- Thins the blood (don’t take with aspirin or warfarin). hump.
- Do not take with history of seizures. - Graves’ disease (hyperthyroidism): Exophthalmos.
Echinacea: immune-boosting function - Intussusception: sausage-shaped mass.
- Can cause liver toxicity in renal patients. - Multiple sclerosis: Charcot’s triad: nystagmus, intention
- Not effective with HIV. tremor, and dysarthria.
Ginger: Relieves nausea and vomiting. - Myasthenia gravis: descending muscle weakness, ptosis.
- Do not take if history of deep venous thrombosis. - Guillain-Barre syndrome: ascending muscle weakness.
- Interacts with blood thinners. - Deep vein thrombosis: Homan’s sign.
Black Cohosh: treats menopausal symptoms. - Angina: crushing, stabbing pain relieved by nitroglycerin
- Contraindicated in pregnancy (causes premature labor). (NTG).
Kava Kava: treats insomnia and muscle pain. - Myocardial Infarction: crushing, stabbing pain radiating to left
- It’s associated with liver illnesses. shoulder, neck, and arms; unrelieved by NTG.
Saw Palmetto: used for prostate health. - Cytomegalovirus infection: owl’s eye appearance of cells
- No specific patient teaching. (huge nucleus in cells).
* If it starts with G, it thins the blood. Do not give with - Retinal detachment: flashes of light, shadow with curtain
warfarin, aspirin and heparin. across vision.
- Basilar skull fracture: raccoon eyes (periorbital ecchymosis)
COMMON ANTIDOTES and Battle’s sign (mastoid ecchymosis).
Warfarin ........................................................... Vitamin K - Buerger’s disease: intermittent claudication (pain at buttocks
Benzodiazepines ............................................ Flumanezil or legs from poor circulation resulting in impaired walking).
Heparin ............................................... Protamine Sulfate - Diabetic ketoacidosis: acetone breathe.
Opioids ............................................................. Naloxone - Pre-eclampsia: proteinuria, hypertension, edema.
Anticholinergics ....................................... Physostigmine - Diabetes mellitus: polydipsia, polyphagia, polyuria.
Beta Blockers ....................................................Glucagon - Hirschsprung’s Disease (Toxic Megacolon): ribbon-like stool.
Methotrexate .......................... Folinic Acid (Leucovorin) - Herpes Simplex Type II: painful vesicles on genitalia.
Tricyclic antidepressants ................ Sodium Bicarbonate - Genital Warts: warts 1-2 mm in diameter.
Digoxin .......................... Digoxin Immune Fab (Digiband) - Syphilis: painless chancres.
- Chancroid: painful chancres.
COMMON SIGNS AND SYMPTOMS - Gonorrhea: green, creamy discharges and painful urination.
- Pulmonary tuberculosis: low-grade afternoon fever. - Chlamydia: milky discharge and painful urination.
- Pneumonia: rust-colored sputum. - Candidiasis: white cheesy odorless vaginal discharges.
- Asthma: wheezing on expiration. - Trichomoniasis: yellow, itchy, frothy, and foul-smelling vaginal
- Emphysema: barrel chest. discharges.
- Pernicious anemia: red beefy tongue. - Pulmonary edema: pink, frothy sputum, tachypnea, use of
- Cholera: rice-watery stool and wrinkled hands from accessory muscles, crackles, anxiety/restlessness (Tx:
dehydration. furosemide).
- Malaria: stepladder like fever with chills.
- Typhoid: rose spots in the abdomen. INSULINS
- Dengue: fever, rash, and headache; positive Herman’s sign.
- Diphtheria: pseudo membrane formation.
Type Name Onset Peak Duration
- Measles: Koplik’s spots (clustered white lesions on buccal
mucosa). Lispro
- Systemic lupus erythematosus: butterfly rash. Rapid (Humalog)
<15min 1h 3h
- Leprosy: leonine facies (thickened folded facial skin). acting Aspart
- Appendicitis: rebound tenderness at McBurney’s point; (NovoLog)
Rovsing’s sign (palpation of LLQ elicits pain in RLQ); psoas sign Short Regular
(pain from flexing the thigh to the hip). acting (Novolin R/ 1h 2h 4h
- Meningitis: Kernig’s sign (stiffness of hamstrings causing (clear) Humulin R)
inability to straighten the leg when the hip is flexed to 90º); Interme-
Brudzinski’s sign (forced flexion of the neck elicits a reflex Isophane
diate 4h 8h 12h
flexion of the hips). (NPH)
(cloudy)
- Tetany: hypocalcemia; positive Trousseau’s and Chvostek
Long Glargine Slow
sign. - 24h
acting (Lantus) absortion
MEDICATION MISCELLANEOUS HALOPERIDOL ADVERSE EFFECTS:
- Drowsiness.
HIGH ALERT MEDICATIONS - Insomnia.
- Insulin. - Weakness.
- Opiates and narcotics. - Headache
- Injectable potassium chloride (or phosphate) concentrate. - Extrapyramidal symptoms: akathisia, tardive dyskinesia,
- IV coagulants (heparin). dystonia.
- Sodium chloride solutions >0.9%.
ALUMINUM HYDROXIDE:
- Treatment of GERD and kidney stones.
NARROW THERAPEUTIC RANGE DRUGS
- WOF: constipation.
- Gentamicin.
- Vancomycin.
HYDROXYZINE:
- Warfarin.
- Treatment of anxiety and itching.
- Lithium.
- WOF: dry mouth.
- Digoxin.
- Theophylline.
MIDAZOLAM:
- Methotrexate.
- Given for conscious sedation.
- Phenytoin.
- WOF: respiratory depression and hypotension.
- Insulin.
- Ciclosporin.
AMIODARONE
- Take missed dose any time in the day or skip it entirely.
TUBERCULOSIS DRUGS (RIPE):
- Do not take double dose.
Rifampicin
- WOF: diaphoresis, dyspnea, lethargy.
Isoniazid
Pyrazinamide
WARFARIN (COUMADIN)
Ethambutol
- Stress importance of complying with prescribed dosage and
follow-up appointments.
*Rifampicin: causes red-orange tears and urine.
- WOF: signs of bleeding, diarrhea, fever, rash.
*Ethambutol: causes problems with vision, liver problem.
*Isoniazid: can cause peripheral neuritis; take vitamin B6 to
METHYLPHENIDATE (RITALIN)
counter.
- Treatment of ADHD.
- Assess for heart related side-effects and report immediately.
MONOAMINE OXIDASE INHIBITORS (MAOI’s):
- Child may need a drug holiday because the drug stunts
- Tyramine-rich foods may cause severe hypertension in
growth.
patients who take MAOI’s.
- Tyramine-rich foods include: aged cheese, chicken liver,
DOPAMINE
avocados, bananas, meat tenderizer, salami, bologna, Chianti
- Treatment of hypotension, shock and low cardiac output.
wine, and beer.
- Monitor ECG for arrhythmias and blood pressure.
PYRIDIUM:
PHENYTOIN
- Urinary tract analgesic and spasmolytic - Enteral feedings: stop the feeding 1-2h before and after the
- Not an anti-infective administration of the phenytoin because the enteral feedings
- Turns urine bright orange. decrease its absorption.
- Flush with 30-50ml of NaCl before and after the
NITROGLYCERINE PATCH is administered up to three times administration of phenytoin.
with intervals of five minutes.
*WOF: Watch Out For
MORPHINE:
- Contraindicated in pancreatitis because it causes spasms of
the Sphincter of Oddi.
- Meperidine (Demerol) should be given.

CLOZAPINE:
- A significant associated toxic risk is blood dyscrasia.

DIGOXIN:
- Assess pulses for a full minute, if less than 60 bpm hold dose.
- Check digitalis and potassium levels.