ABO

● ABO antigen system

○ Different classes of human blood
● Part of blood that is classified
○ Red blood cells
● Type O is universal donor and can be received by all donors
● If Type O can only receive Type O
● Type AB is universal recipient and receive all types

Acetylsalicylic Acid

● Aspirin
● Indication to give
○ Mild to moderate pain
● Increases the effects of methotrexate
● What is methotrexate used for
○ Chemotherapy agent and rheumatoid arthritis

Acid Reflux (GERD)

● Primary symptom
○ Heartburn (pyrosis)
● Tests that confirm
○ Barium swallow fluoroscopy
● How does GERD occur
○ Malfunction in lower esophageal sphincter
● Client teaching
○ Low fat high protein diet
○ take antacids
○ avoid lying flat after meals

Acquired Immunodeficiency Syndrome

●
● Virus that causes AIDS
○ Human Immunodeficiency Virus (HIV)
● How is it transmitted
○ Sex
○ Direct contact with body fluids
○ HIV mother passes during birth
● S/S
○ Fever
○ Weight Loss
 ○ Night sweats
○ Diarrhea
○ Fatigue
● How is presence of HIV confirmed?
○ Screening FIRST to see if HIV antibodies are present
● Screening Test
○ ELISA- identifies the specific HIV antibodies
● What confirms screening Test
○ HIV differentiation assay (No longer Western Blot)
● How does it attack body
○ Attacks immune system by destroying T-Cells (CD4 Cells)
○ Rapidly self replicates
● T Cells help immune system recognize and fight pathogens
● CD4 Range
○ 500-1500
○ Lower the count the more damage the virus has done to body
● If below 200 HIV has progressed to AIDS and at risk for opportunistic infections
○ Oral pharyngeal canidia (mouth fungus)
○ Kaposi sarcoma (skin cancer)
○ Pneumocystis pneumonia
○ Cytomegalovirus (blindness)
○ Meningitis
● Zidovudine m ​ ost important medication
● Goal of HIV meds is to interfere with virus replicating
● Isolation precautions
○ HIV-Universal precautions
○ AIDS- if low CD4 and at risk for infections
■ Private room
■ Reverse isolation
■ Gloves, gown, goggles, mask when in direct contact with blood or body
fluids
● Pt Teaching for parents
○ Clean up body fluids and blood with 10:1 water/ bleach ratio
○ Get all immuno shots
○ NOT live ones - MMR, varicella, oral polio
○ High calorie- protein diet
○ Use gloves to change diapers

Acute Renal Failure

● Definition
○ Sudden loss of kidney functions to excrete toxins and regulate fluids and
electrolytes
 ● Causes
○ Infection, obstruction and shock
● Phases
○ Oliguric, diuretic and recovery
● During Oliguric phase
○ 1-2 weeks
○ Low urine output
○ Hyperkalemia, hypertension
○ ^ BUN/ creatinine and fluid overload
● Sodium and phosphate will be elevated
● During diuretic phase
○ Urine output slowly returns
○ Hypokalemia
○ Hypotension
● During Recovery phase
○ Urine output increases and BUN is normal
● Nursing interventions
○ Dailey weights, I/O, diuretics and treat cause of renal failure
○ High carbs low protein diet

Adams Stokes Syndrome

● Heart problem
● Sudden attacks of syncope and fainting. Seizures may also be present
● What will you see on EKG
○ Asystole or ventricular arrhythmias
● No tissue perfusion during attacks
● TX
○ Internal pacemaker via surgery
● Digoxin i​ s med given after surgery

Addison’s Disease

● Low production of hormones by adrenal gland

○ Glucocorticoids and mineralocorticoids
● S/S
○ Lethargy, weakness, weight loss, bronzed color skin, weight loss
○ Low glucose and sodium levels
○ High potassium levels
● TX
○ Life long glucocorticoid therapy
Allergies

● Pts allergic to latex are also allergic to bananas, kiwi and chestnuts
● Equipment with latex
○ Blood pressure cuffs, gloves, stethoscopes, tourniquets, band aids, and
indwelling catheters
● Allergy that contraindicated for IV dye
○ Iodine, shellfish

Amputation

● Major complications
○ Infections, skin breakdown
○ Phantom limb pain- pain felt in an area that has been amputated
○ Joint contractures
● Positioning for post op care
○ Above the knee (AKA)
■ Elevate first 24 hours, prone position 2x daily to prevent hip flexion
○ Below the knee (BKA)
■ Elevate foot of bed first 24 hours, prone position 2x daily to prevent hip
flexion
● Encourage expression of feelings about lost limb

Anemias

● Aplastic Anemia
○ S/S
■ Decreased erythrocytes, bleeding mucous membrane, thrombocytopenia
○ Tx
■ Blood transfusions, bone marrow, transplantation

● Iron Deficiency Anemia

○ S/S
■ Low hgb and hct, pallor, fatigue, tissue hypoxia, tachycardia
■ Most common during pregnancy
○ Tx
■ Iron supplements, dietary changes
● Vitamin B12/ Pernicious Anemia
○ S/S
■ Pallor, beefy red tongue, fatigue, paresthesia
Aneurysm

● Dilation formed at a weak point on the wall of an artery.

● No symptoms
● Would hear a blowing bruit at auscultation
● Risk factors
○ Arteriosclerosis, infection (syphilis) smoking, HTN
● TX
○ Surgery- depends on size
○ Strict blood pressure control with meds
● S/S of rupture
○ Sever pain, N/V, tachycardia
○ Decreased LOC, hypotension
● Pt Teaching
○ Avoid straining, lifting or exerting\
○ Take meds on schedule
○ Report severe back/ flank pain

Anorexia Nervosa

● Primary symptom is starvation

● Distorted body image
● Normally during adolescence
● Personality types is usually a perfectionist, overachievers and low esteem
● Arrhythmias are major cardiac complication
● Amenorrhea is major gynecological complication
● Tx involved in recovery
○ Small frequent meals with counseling and milieu therapy

Appendicitis

● Commonly seen in ages 10-30

● S/S
○ Acute right lower abdominal pain
○ Loss of appetite, N/V, low grade temp
● Localized tenderness is found at McBurney’s point
● Tests
○ H&P with WBC
○ Should be elevated
● Tx
○ Immediate surgery to remove appendix
○ IV antibiotics and NPO to rest stomach
○ Semi fowler's position
 ● General treatment for any acute abdominal pain
○ NPO
○ No heat on abdomen
○ Asses for distention
○ IV fluid therapy

Arterial Blood Gas

● Most samples are drawn from radial artery in wrist

● Pressure held for 5 mins after collection
● Allen’s test should be performed before an ABG on client

Asperger's Syndrome

● This is form of Autism

● Treatment focuses on improving communication/ pt social skills

Asthma

● An obstructive airway disease caused by spasms and inflammation of the bronchioles

● S/S
○ SOB, tachycardia
○ Expiratory wheezes and possible cough (mostly at night)
● TX goal is to identify allergen
● Meds
○ Anti-inflammatory
○ Corticosteroids bronchodilators
○ Leukotriene modifiers
○ Metered dose inhalers
● Always give bronchodilators before steroids when treating
● Leukotriene modifiers are drugs use to block the chemical leukotriene, which reduces
inflammation

Autonomic Dysreflexia

● Occurs in pts with spinal cord injury (T6 or above)

● Causes of autonomic dysreflexia
○ Stimuli like full bladder or fecal impaction
● Life threatening due to pts becoming extremely hypertensive
● Common cause, urinary obstruction
● S/S
○ Increase BP by 40mmHG
○ Headache, bradycardia, blurred vision and sweating
 ● What should be done during episode
○ Place in high fowler's position,
○ Check for bladder distention
○ Loosen restrictive clothing
● Tx
○ Removal of stimuli
○ Pt needs to void or have BM

Bell’s Palsy

● Affects cranial nerve 7 (facial nerve)

● Suffers from temporary facial paralysis that affects chewing, eating and closing the eyes
● Tx
○ Wear an eye patch at night
○ Use artificial tears
○ Wear glasses to protect the eye
○ Steroids to reduce edema/ swelling

Benign Prostatic Hyperplasia (BPH)

● Cause is unknown but its an enlargement of the prostate gland

● Because prostate blocks urethra opening pts may strain to urinate, decreased urine
stream, urgency and/ or dribbling urine flow
● Usually in men over 50
● Best way to access is a rectal exam (pea sized nodule)
● TURP is common surgical treatment
○ Scope goes through the penis and removes parts of the prostate
○ At risk for bleeding, monitor for hemorrhage
● Before TURP clients will get a three way foley cath
○ Inflating the balloon, inflow of solution and outflow of urine
● After TURP continuous bladder irrigation using foley and isotonic sterile saline will be
ordered by Dr.
○ Goal is to reduce/ prevent blood clots
○ Urine should be light pink
○ Monitor for bladder distention, fluid overload, hyponatremia and blood loss
● If bladder spasms occur give belladonna/ opium suppositories or oxybutynin
● Best post op position for pt is lying flat so no pressure on bladder
● Discharge instructions
○ Drink 2-3 L of fluids daily
○ No lifting or straining
○ Watch for bright red clots… call Dr.
○ Do kegels to strengthen pelvic muscles
Blood Administration

● Must have signed consents before start

● Hep B is most common infection spread through blood transfusions
● To determine donor compatibility you must know type and cross match
● 18G needle with filter
● 2 nurses to confirm the unit of blood
● You have 30 mins to start transfusion after blood has been removed from blood
bank fridge
● Must stay with pt for 15 mins after transfusion has started
● 250 mls are in one unit of packed red blood cells
● Run blood at a slow rate so you don’t cause fluid overload
● S/S of adverse reaction
○ Restlessness, nausea, hives
○ SOB, fever, chills, back pain
● What to do
○ Stop blood and run normal saline
○ Do vitals
○ Notify Dr and blood bank
○ Do urine and blood culture labs
● Epoetin alfa​ is used to increase red blood cell production
○ Treats anemia
○ Should monitor for hypertension and seizures

Blood Pressure

● The force of blood flowing through the arteries

● Recommended- 120/80
● Systolic is top
○ Pressure while heart beats
● Diastolic is bottom
○ Pressure while heart rests
● Diastolic determines if person has HTN
● At risk factors
○ African american, obese, anxiety, diabetes, smoking
○ Other factors
■ Position, caffeine, activity
● S/S
○ Blurry vision headache, chest pain
● HTN is silent killer since most people don’t have symptoms
● Pulse pressure is the difference between systolic and diastolic numbers
● What is mean arterial pressure
○ Diastolic pressure + ⅓ of pulse pressure (should be more than 60)
 ● Before you give BP meds always check BP and pulse
● Hold meds if systolic is less than 100 and HR is less than 60
● Meds used for HTN
○ Diuretics, beta blockers, calcium channel blockers, vasodilators
● Meds that end in “pril” are ace inhibitors
○ Correct heart failure by decreasing after load
○ Also promote vasodilation by inhibiting the production of angiotensin
○ Angioedema is adverse reaction
■ Swelling of lips and mouth
■ Persistent nagging cough
○ SWELLING OF LIPS/ MOUTH DANGEROUS- COMPROMISED AIRWAY
● Meds that end in “olol” are beta blockers
● Pt teaching to avoid falls
○ Sit in chair or at bedside for 30 mins after taking meds to adjust to lower
circulating blood pressure
● Garlic is herbal med used to lower BP
● Pt teaching
○ Avoid hot showers, bath and weather
○ Can cause dizziness
○ Low sodium, low fat DASH diet

Breast Feeding

● Breastfeeding moms will often feel abdominal cramps while feeding due to release of
prolactin and oxytocin
● Best way to burp baby is while sitting up
● Benefits of BF
○ Passive immunity, quicker weight loss, increase in bonding, economically low
cost

Buerger's Disease (Thromboangiitis Obliterans)

● Obstruction and inflammation of blood vessels in hands and feet

● S/S
○ Pale blue cold hands and feet
○ May tingle or be painful
● Males who smoke or chew tobacco are at risk
● TX goals
○ No cure
○ Symptoms control
○ Stop smoking
○ Dress appropriate for weather
○ Reduce life stressors
Bulimia Nervosa

● Eating cycle consists of binge eating followed by purging

● Not a lot of physical changes or weight loss, usually remains normal weight
● Other methods to lose weight
○ Vomiting, enemas, drugs, diuretics, diets, and pills
● Medical complications
○ Tooth decay, electrolyte imbalances, ulcers, cardiac arrhythmias
● Safety concern for suicidal thoughts
● Tx goals
○ Encourage talking, safety and assessing suicidal potential
○ Establish diet plan
○ Supervision during meal time
○ Antidepressants

Burns

● Children and elderly are two age groups most at risk

● Types of burns
○ Chemical
○ Electrical
○ Thermal
○ Radiation
● Classification of burns
○ 1st degree- superficial partial thickness
■ Skin pink/red painful (sunburn)
○ 2nd degree- deep partial thickness
■ Skin red/white, blisters, swelling
○ 3rd degree- full thickness
■ Skin black/brown, edema, all layers of skin burned, grafting needed
● Parkland formula is used to determine fluid replacement for first 24 hours
● Do not burst a blister
● IV is best route for pain meds
● High calorie, high protein diet
● Common electrolyte problem with burn pts
○ Hypokalemia
○ Hyperkalemia
● Pt’s at risk for Curling’s ulcers due to stress
● Give pain meds before dressing changes
Cancer

● Cancer is an abnormal growth of cells

● Metastasis is when cancer cells travel from original location to a new place
● Warning signs for cancer: CAUTION
○ Change in bowel or bladder
○ Any sore that doesn’t heal
○ Unusual bleeding/ discharge
○ Thickening in breast
○ Indigestion
○ Obvious change in wart
○ Nagging cough or hoarseness
● 2 ways to describe tumor
○ Grading- describes tumor by cells
○ Staging- describes progression of a tumor by the clinical symptoms
● Types of radiation treatment
○ External unsealed
○ Internal sealed
○ Internal
● Precautions for pt receiving radiation
○ Private room/ bathroom
○ Limit visitors
○ Rotate nursing staff
○ Place sign at door and bedside
● Precautions for pt receiving sealed internal radiation
○ All body fluids are radioactive
● Sealed internal radiation is the most dangerous type of radiation
○ Solid radioactive implant is placed inside the tumor
○ Use hazardous gloves and gown when dealing with body fluids
○ If implant falls out, pick up with long handle forceps and put in a lead container
● Chemotherapy works by destroying the cell wall
● Side effects of Chemo
○ Nausea, anorexia, alopecia, sterility, decreased bone marrow and platelets
● Reglan​ is given to reduce nausea
● Sterility from chemotherapy is permanent
● Pts with cancer will also need neutropenic precautions
○ Strict hand washing
○ No visitors who are sick
○ No children
○ No raw food, no live plants
○ No free standing water
● Filgrastim ​is drug used to treat neutropenia
○ Monitor WBC’s
 ● Best time to do a breast self exam
○ One week after menstruation, but no longer recommended
● Best time to do self testicular exam
○ During or after a warm shower, same day each month
● No BP or IV on same side as mastectomy
● Pt teaching for mastectomy
○ Elevate affected extremity
○ No initial exercise after surgery
○ Encourage discussion for positive self image

Cataracts

● S/S
○ Milky white lens
○ Painless blurred vision
● No treatment until vision is severely impaired
● During surgery cataracts are removed and a new lens may be implanted
○ If no new lens vision won't be corrected must have glasses or contacts
○ After surgery, check for hemorrhage of the eye.. Semi fowler's position
● Pt teaching
○ Avoid coughing, sneezing, straining and bending over at waist
○ Rubbing eye or crying
○ No lifting over 5lbs
○ Sleep on unaffected side or on back if both eyes.. Use eye shield at night

Celiac Disease (Celiac Sprue)

● Malabsorption of fats occur

● Foods containing gluten must not be eaten
● Foods that contain gluten.. BROW
○ Barley, rye, oats, wheat
● Abdomen is often distended
● Stool is smelly, pale, bulky
○ Expect lots of gas with some diarrhea
● Best food substitutes are corn and rice

Cerebrovascular Accident (CVA)

● Reduction of cerebral blood flow and oxygen causing brain cell damage
● Most common causes of CVA
○ Embolism, hemorrhage, thrombus
● S/S
○ ℅ headache
 ○ Nausea, nuchal rigidity, HTN,
○ Slow bounding pulse
○ Cheyne stokes respirations, speech changes, facial droop
● Difference between CVA and TIA (transient ischemic attack)
○ TIA is temporary period of neurological deficit
■ Has similar signs like CVA but symptoms will all resolve
● Agnosia is the inability to use an object correctly
● Expressive aphasia occurs when client cannot communicate properly
● If left hemisphere is affected- right sided weakness
● If right hemisphere is affected- left sided weakness
● Place belonging on unaffected side
● Tests to determine
○ CT, EEG and cerebral arteriography
● Pts with hemorrhagic stroke are at risk for seizures due to possible bleeding in the
cerebral cortex
● Nursing interventions
○ Monitor VS, neuro checks, watch for seizures, monitor for increase in cranial
pressure, check ability to swallow
● Corneal abrasions is a complications that pts with CVA have
○ Lacrimal glands will not produce secretions
● Strict bed rest
● Room environment needs to be quiet, peaceful, with objects reach on unaffected side
● Turn every 2 hours on unaffected side, 20 on unaffected side, elevate affected
extremities
● Thrombolytics are given to dissolve a clot, NOT for hemorrhage
● Other meds for CVA
○ Antihypertensive, anticoagulants NOT for hemorrhage stroke
○ Anticonvulsants- only thin blood DO NOT dissolve clots

Chronic Obstructive Pulmonary Disorder

● 3 disorders that make up COPD

○ Asthma, bronchitis, emphysema
● S/S
○ SOB with activity
○ Wheezing, coughing
○ Cyanosis
● What ABG would show
○ Hypoxemia
● Barrel chest
● Clubbed fingers
● Due to SOB with activity pts may experience weight loss because of difficulty eating
 ● Why must you assess O2 pt receives
○ Pts have higher level of CO2 in their blood which breathing is controlled by this
● Pt should not receive by than 2L of O2 by NC
● To control SOB the pursed lip breathing technique should be taught

Chronic Renal failure

● Is progressive and irreversible

● S/S
○ Decreased urine output and gravity
○ Hypertension
○ Fluid overload
● Uremic frost
○ Urea crystals that come through the skin with perspiration
○ Face underarms, groin
■ Wash skin with plain water
● Nursing interventions
○ Modification of diet
○ Give diuretics, antihypertensives
○ Monitor BUN and creatinine
○ Daily weight
● Pts may need dialysis to help with waste removal
● Best diet
○ High carb low protein
○ Provides energy while decreasing protein metabolism

Compazine (Prochlorperazine)

● Belongs to what class of antipsychotics

○ Phenothiazines
● When in smaller doses can be used as antiemetic
○ Suppresses nausea and vomiting
● Will make you drowsy
● Routes are IV IM PO
○ IM lasts longest
● Since antipsychotic drugs must monitor for extra pyramidal reactions
○ Dystonia, tardive dyskinesia, akathisia
○ Anti parkinson’s drugs ​benztropine
● Herbal med that is contraindicated… Kava Kava
Corticosteroids

● Most end in “..one”

○ Dexamethasone, cortisone, prednisone
● Primary functions
○ Decrease inflammation and hormone replacement
● Pt teaching
○ Gradually decrease use do not abruptly stop
● What do you monitor while pt is taking steroid
○ Potassium level
○ glucose level
○ I/O
● May cause symptoms of cushing's syndrome
○ Will also delay wound healing
● If NPO for surgery still give steroid due to stress and illness in the body that can increase
need for corticosteroids
○ All other situations DO NOT take steroids on empty stomach

Crohn's Disease

● Inflammation on the bowels

● No cure, symptoms will frequently re occur
● Disease affects the digestive tract from mouth to anus
● S/S
○ Abdominal pain, diarrhea, weight loss
● Excessive diarrhea will cause hypokalemia
● Avoid dairy products and high fiber meals
● Disease can lead to colon cancer
● Tx goals
○ Drugs and nutrition to reduce inflammation

Cushing Syndrome

● Cause
○ High production of hormones by adrenal gland (glucocorticoids)
● S/S
○ Buffalo hump, moon face, hirsutism lethargy, weakness and weight loss
○ Fragile skin and bruises easily
● Weight gain is common
● Increased blood glucose and sodium levels
● Decreased potassium and calcium levels
● Tx
 ○ Possible hypophysectomy or adrenalectomy
○ Lifelong glucocorticoid therapy

Cystic Fibrosis

● In cystic fibrosis the mucous producing or exocrine glands are affected

○ Mucous will become more thick, sticky and cause obstructions
● 2 systems most affected
○ Respiratory- mucous gets trapped in lungs
○ Digestive- mucous blocks the pancreas and digestive enzymes, making
absorption of nutrients difficult
● Sweat test is most accurate
○ Chloride level will be >60
● Other ways to diagnose
○ Chest xray, stool analysis, pulmonary function test
● Poor absorption of fat in the digestive tract causes stool to appear steatorrhea
○ Greasy, foul smelling, pale stool
● Pancreatic enzymes are given with each meal to help with absorption of nutrients
● High calorie, high protein diet
● Postural drainage is common technique used to clear thick mucous from lungs
○ Helps prevent respiratory infections
● Parents with one child with disease should get genetic counseling since it is hereditary

Diabetic Teaching

● Type 2 is controlled by diet and exercise

● Type 1 is controlled by insulin
● Pt teach about foot care
○ Have MD cut toenails, cut straight across
○ Inspect feet daily for sores
○ Keep skin clean and dry
● If pt vomits after taking PO antidiabetic meds you should
○ Monitor blood sugar
○ Do not repeat dose (may have absorbed)
● Diabetics should get a yearly eye exam since diabetes can cause retinopathy (retina
damage)
● What is insulin lipodystrophy
○ Result of rotating SQ insulin injection sites.
○ If injected into the same place repeatedly a fatty mass will appear, decreasing
insulin absorption
○ Teach injection site rotation
● Primary injection site for insulin is the abdomen
○ No need to aspirate if injecting SQ
 ● Alcohol, oral contraceptives, aspirin, and MAOIs lower blood glucose
● Infection, dehydration, stress, and surgery increase blood glucose
● What to give when pt is hypoglycemic and unconscious
○ Glucagon IV or IM
● Insulin pumps that are wearable mimic the pancreas
○ Regular or short acting insulin
○ Delivered continuously
○ Change site every 2-3 days
○ Advise pt NOT to smoke or drink alcohol while wearing pump

Digoxin

● To treat heart failure and arrhythmias

● Is a cardiac glycoside
● Always hold if HR is less than 60
● Therapeutic range
○ 1-2
○ 2+ toxic!!
● Signs of toxicity
○ Seeing yellow spots, N/V, abdominal pain
● Tx for toxicity
○ Dose will be lowered
○ Severe cases will give activated charcoal or digiband

Diuretics

● 3 ways diuretics can be give

○ PO, IV, IM
● Why are they prescribed
○ Chronic heart failure, fluid overload, renal failure
● Should take meds in AM to prevent nocturia
● Monitor pts for dehydration, low K+, hyponatremia and weight loss
● Loop and thiazide diuretics inhibit potassium, sodium and chloride
● Furosemide is a loop diuretic
● Thiazide diuretics are contraindicated in clients that are allergic to sulfa drugs
● Osmitrol​ is an osmotic diuretic used to reduce ICP (intracranial pressure)
○ Can also be used for glaucoma
● Mannitol ​crystallizes at room temp; you will need a filter needle to draw up
● Spironolactone is a potassium sparing diuretic
○ Helps body retain potassium so at risk for hyperkalemia
● If pts K+ 3.0 and lasix and spironolactone are both ordered what do you do
○ Only give spironolactone. Potassium is low
○ Lasix will create more K+ loss
Domestic Violence

● Signs of domestic violence in children

○ Frequent bruises or burns, shrinking back when adult approaches, hitting others
● 2 factors that play part in domestic violence
○ Power and control
○ Abuser sees victim as possession
● Signs of neglect in children
○ Stealing food, lack of dental care, poor hygiene, poor school attendance, stating
no ones home
● When victim of rape shows no emotion after attack
○ Controlled pattern response
○ Shouldn’t take shower after attack, so physical evidence isn’t washed away
● Stages of domestic violence in an intimate relationship called
○ Honeymoon
○ Build up of stress
○ Anger
○ Beating
○ Reconciliation
● Nurse should help pt explore other housing options if pt comes into hospital and afraid
for life at home due to abuse
● Sexual abuse by family member is called incest

Epiglottitis

● Lap of skin at the base of the tongue. Opens and closes during breathing
○ Haemophilus influenza is the cause
● Bacteria
● 2-5 years old
● S/S…..3D’s
○ Drooling, Dysphagia, Dysphonia
● CANNOT be treated at home. Must go to hospital immediately
● NEVERRR put anything in the mouth to assess airway
● If child can’t breathe you might intubate
● Meds given
○ Antibiotic therapy
● How can it be avoided
○ Getting the H. Influenza vaccine
Genital Herpes

● Spread during sexual contact or birth

● Symptoms for males and females
○ Painful, vesicular lesions
■ Lesions come and go
■ If lesions present in pregnant woman should be delivered by C- section
● What triggers outbreaks
○ Stress, anxiety, high emotions
● Women with herpes should get a pap smear every 6 months
● No cure
● Acyclovir

Glaucoma

● How does it affect vision

○ Blurry and tunnel vision
○ Halos around eyes
● This condition can be acute or chronic due to increased intraocular pressure
● Tonometry is the simple, painless procedure used to measure intraocular pressure
● 2 types of glaucoma
○ Open and closed angled
● Closed angle is painful but it is not the most common of the 2
● Miotics is class drug used to constrict the pupil and let aqueous humor flow
○ Timolo or pilocarpine
● Diuretics can be given to decrease aqueous humor production
○ Osmitrol​ - is an osmotic diuretic
● Never give mydriatics because they dilate the pupil
● If surgery is required, you should monitor for hemorrhage post op
● Post op teaching
○ No straining, heavy lifting, crying or rubbing eyes

Hyperbilirubinemia

● What is considered elevated serum bilirubin level

○ 12 or higher
● Newborn skin will look Jaundice, usually seen on first day of life
○ Also the skin and sclera will turn yellow because bilirubin is
● Spreads from head to toe
● Tx is phototherapy
● Nursing Interventions
○ Baby should be 18 inches under lights
○ Nothing but diaper on
 ○ Cover eyes
○ Turn off lights every 8 hours for 15 mins
○ Monitor temp and turn every 2 hours

Huntington’s Disease

● Inherited disorder
● Brain is the organ most affected
○ Neurons die… control various body movements
● S/S
○ Uncontrolled movement (Chorea)
○ Behavior changes
○ Impaired judgement and cognition
● Age most affected 30-50
● No cure, disease will get progressively worse

Immunizations

● Birth
○ Hep B1
● 2 months
○ Hep B2, Dtap, Hib, IPV, PCV
● 4 months
○ All 2 months except Hep B
● 6 months
○ All 2 months
● 12 months
○ MMR 1, Hib, PCV, varicella
● Earliest age you can give tetanus and diphtheria vaccinations (optional) is 2 months
● A booster shot is an additional dose of vaccination to increase effectiveness
● Side effects of immunizations
○ Low grade fever, tenderness, swelling at site
○ Child may become irritable
○ Give acetaminophen
○ Never give aspirin to children with these effects
● Meningitis vaccine is given before going off to college
● Adult women receives MMR shot should wait 3 months before pregnancy
● Child can’t get Flu shot until 6 months old
● DO NOT give MMR if allergic to eggs or neomycin
● DO NOT give Flu shot if allergic to eggs
●
● Active immunity
○ Stimulating the body to produce antibodies by giving vaccine
 ● Passive immunity
○ Antibodies that are formed in another body but passed down for short term use
■ Breast milk

Increased Intracranial Pressure (ICP)

● Normal ICP range

○ 5-15
● Common causes
○ Trauma, hemmorrhage, edema tumors
● What do you assess
○ Level of conscious
■ Will decrease as ICP increases
● Earliest sign of ICP
○ Decreased level of consciousness
■ Will appear restless, agitated, complains of headaches
● What will babies physically present with
○ Bulging fontanelles
● Late signs of ICP
○ Unilateral pupil dilation, hypertension or hypotension, bradycardia
● Clients may complain of projectile vomit without nausea
● Vital signs
○ B/P, Temp, HR ^
○ Respirations up then down
● What is widening pressure and how is it related
○ When systolic blood pressure goes up and diastolic pressure continues to go
down so they become further apart (135/40) <<< BAD
● Cushing Triad
○ Widening pulse pressure
○ Cheyne stokes respirations
○ Bradycardia
● Initiate seizure precautions
● Elevate head of bed to 10-30 degree to promote jugular venous outflow
● Meds prescribed
○ Anticonvulsants
○ Blood pressure meds
○ Corticosteroids
○ Diuretics
● Tell pt not to strain, cough or sneeze
● Nursing Interventions
○ Decrease environmental stimuli
○ Maintain body temp
○ Limit fluid intake
 ○ Monitor I/O

Instillation of Ear Medications

● Medication should be room temp

○ Too hot or cold can have side effects
■ Nausea, dizziness, etc
● Pt should be in supine position with affected ear up
● Adult pt pull ear back and up
● Child pt pull ear back and down
● Head should remain tilted for 5 mins allowing meds to travel ear canal

Instillation of Eye Medications

● Apply pressure when giving eye meds to prevent meds going into nasal passage
● Oull the lower eye lid down and against the cheek
● Squeeze the drop in conjunctiva sac
● If more than one drop prescribed wait 3-5 mins to administer another
● Do not let med bottle touch the eyeball

IV Therapy

● IV fluids are used to quickly replace nutrients, water and electrolytes

● 3 types of IV fluids
○ Isotonic
■ Same fluid that is inside cell (0.9 NS, lactated ringer, D5W)
■ Give for DKA, burns, to replace sodium and chloride
○ Hypotonic
■ Less concentrated than cell, causing water to move into cell (0.45 NS)
■ Give for dehydration, hypernatremia; lowers blood pressure
■ Monitor closely because rapid increase in fluid into cells can cause
cellular and cerebral edema
○ Hypertonic
■ More concentrated than cell, causing water movement out of the cell (0.5
NS, D5NS, D5LR)
■ Give fluids for hyponatremia, nutrition
■ Monitor closely because it can cause electrolyte imbalance and
dehydration
● Before IV fluids assess pts IV, make sure its patent
● If infiltrated it would be cool, swollen, tender and painful at site

Laminectomy
 ● Removal of bone so spinal cord can be seen
● To move pt after surgery, log roll them

Lead Poisoning

● Highest risk factor in ingesting lead is age

○ Younger kids put things in mouth
● Lead paint chips is most likely ingested
● Mental retardation is DANGEROUS SIDE EFFECT
● S/S
○ Headache, abdominal pain, fatigue, muscle weakness, respiratory depression
○ More serious if larger amounts are ingested
● TX
○ Chelating agents
○ Given by many IM injections
● Do not give ​ipecac t​ o induce vomiting

Legal Issues

● Negligence is when a nurse does not provide appropriate care according to set
standards
● If nurse does a treatment without consent that is an example of battery
● If pt falls out of bed because you forgot to put up side rails that is neglect
● Any NCLEX question that has word “threat” think.. assault
● Advanced directives are important because they allow pt to direct how, what care they
are to receive if they are unable to make decisions for self
○ Not mandatory
● DPOA is personal to make decisions on another persons behalf
● Pt must be of sound mind to write will

Lung Sounds

● Cause of crackles
○ Also called rales
○ Fluid or secretions in airway
○ Hear on inspiration (sounds like Rice Krispies in milk)
○ Pneumonia, edema or bronchitis
● Characteristics of wheezes
○ High pitched musical sounds
○ Hear on inspiration and expiration
○ Asthma, smoking, allergic reaction
○ Can hear without stethoscope
○ Humidified air helps relieve symptoms
 ● Characteristics of stridor
○ High pitched harsh sound heard in upper airway
○ Laryngeal spasm or swelling, croup and epiglottis
○ Often confused with wheezing
○ Often seen in children

Lyme Disease

● Infection caused by bite from a tick

● 4-6 weeks after bite you can test for disease
● TX
○ Antibiotics
■ Doxycycline (​ adults)
■ Amoxicillin​ (children)

Maslow’s Hierarchy of Needs

● Physiological needs
● Safety and security
● Low and belonging
● Self esteem
● Self actualization

Mastectomy

● Removal of breast tissue or nipple

● After surgery, elevate the affected arm to prevent lymphedema
● No BP or venipuncture in affected arm
● Always assess site for signs of infection after surgery
● S/S of infection
○ Swelling, redness, fever, chills
○ Elevated WBC count
● Encourage client to do self breast exam on other breast

Medication Administration

● 6 rights of medication administration

○ Right client
○ Medication
○ Time
○ Documentation
○ Dose
○ Route
 ● 2 ways to verify pt
○ Name and birthday
● Do not give meds if you don’t know what it does
○ You will be asked
● Never give meds prepared by another nurse
● PRN meds mean to give when needed
● Do not crush sustained- release capsules or enteric coated tablets
● What to do if administers wrong med
○ Notify Dr
○ DO NOT document in pt chart
○ Complete incident form
○ Not apart of pt’s record

Meniere’s Syndrome

● Severe sudden attacks that may cause permanent hearing loss.

● S/S
○ Tinnitus, unilateral hearing loss, dizziness
○ N/V
● Causes
○ Viral, bacterial infections and allergic reactions
● Best environment for pt with syndrome
○ Best rest in quiet room
○ Moving head slowly
○ Sedatives can be given to keep calm
○ Low playing music helps with tinnitus
● Low sodium diet
● Severe cases removal of the labyrinth is performed

Meningitis

● Inflammation of arachnoid and pia mater of the brain, spinal cord

● Transmitted by direct contact and droplet
● S/S
○ Unchallenged rigidity, tachycardia, headache, N/V
● Meningitis can also cause ICP
● Two other physical signs
○ Positive kernig’s and Brudzinski
● Nursing Interventions
○ Monitor LOC, vitals, initiate seizure precautions
○ Maintain isolation, elevate HOB
● Meds prescribed
○ Antibiotics and analgesics
Mongolian Spots

● Bluish black spots on body on the back and buttocks of newborns

● Mostly seen in Asian and African Americans
● Not harmful and normally fade over time

Multiple Sclerosis (MS)

● Is a chronic, progressive degenerative disease of the nervous system

● Demyelinization of the white matter of the brain and spinal cord
● No Cure
● S/S
○ Muscle spasms, weakness, bowel and bladder dysfunction
○ Numbness in extremities
○ Visual disturbances
● Meds given for spasms… ​baclofen
● Meds given to reduce amount of time pt experiences exacerbated symptoms..
corticosteroids
● Education on MS
○ Start regular bladder bowel program
○ Avoid stressful situations
○ Eat well balanced diet
○ Initiate speech/ physical therapy
○ Remove safety hazards in home

Munchausen Syndrome

● A psychiatric disorder that causes a person to self inflict injury or harm to themselves..
may also say they have a mental disorder
● By proxy… an individual typically a mother, intentionally causes or makes up illness in
child under their care for attention
● Notes for NCLEX
○ Child will have issues with no explained etiology
○ Treatment of issue does not help
○ Assessements indicate child in healthy
○ Symptoms better when child is away from caregiver
○ Nursing priorities… protect child!
Myasthenia Gravis

● An autoimmune disease that results in extreme fatigue and muscle weakness

● The body produces antibodies that block acetylcholine receptors
● No cure
● S/S
○ Difficulty talking and chewing
○ Weak eye muscles and visual disturbances
○ Unsteady gait
■ Symptoms worsen with activity
● The tensilon test is performed to diagnosis myasthenia gravis
● If pts muscle strength is increased the test is positive for myasthenia gravis
● Meds given
○ Anticholinesterase/ plasmapheresis
● Teachings
○ Take meds 30 mins before eating
○ cough/deep breath
○ Exercise
○ Conserve energy by doing multiple short tasks
○ Decrease stressors, infections and unhealthy habits

Myocardial Infarction (MI)

● Caused by decreased oxygen supply to heart

● Pain felt substernal
○ Sudden, crushing, radiating to jaw shoulders and back
○ Last longer than 30 mins
● Pain not relieved by rest or nitoglycerin
● EKG shows ST elevation and inverted T waves
● Lab values that would be elevated
○ Ck- MB, CPK, Troponin, LDH, WBC
● Meds given (MONA)
○ Morphine
○ Oxygen
○ Nitroglycerin
○ Aspirin
● Pt on bed rest

Angina Pectoris

● Chest pain due to heart not receiving enough oxygen

● Pain in same area as MI
● Common causes
 ○ Early morning activities
○ Heavy meals
○ Stress, exercise
○ Smoking
● How is stable Angina different from MI
○ Chest pain has typical onset location
○ Lasts for 3-5 mins
○ Relieved by nitroglycerin or rest
● Unstable angina
○ Chest pain while resting
● How is angina diagnosed
○ Cardiac cath, coronary artery bypass
○ Exercise/ thallium stress test
○ EKG with no ST elevation
● Pt teachings
○ How to take nitro for pain
■ Can take up to 3 tabs SL
○ Modify diet
■ Low cholesterol
○ Exercise and stop smoking

Neomycin Sulfate

● An aminoglycoside
● Reduces the amount of bacteria in the colon
● Given for GI tract before surgery
● Treats hepatic encephalopathy when ammonia levels are elevated in the liver

Neuroleptic Malignant Syndrome

● Could occur anytime a pt is on anti psychotic meds

○ Mostly when treatment begins or doses are increased
● S/S
○ Tachycardia, extreme fever, altered LOC
○ Seizures, muscle rigidity
○ Elevated labs
■ WBC/LFT
● Tx
○ Discontinue the meds
○ Initiate safety and seizure precautions
○ Give antipyretics to reduce fever
NG Tube

● During placement pt should be in high fowler's position with head tilted forward
● NG tube goes from nose to stomach
● Salem sump
○ Double lumen of NG tube used to decompress the stomach
● Measuring points to determine length of insertion
○ Nose to earlobe to xiphoid process (low part of sternum)
● Before inserting NG tube
○ X ray, aspirate for gastric content
○ pH should be <4
● If pt starts to gag or vomits during placement
○ Wait till stop gagging/ coughing, then continue
○ Offer water to help tube go down
○ Ensure pt will feel better once NG tube placed
● If suction turn off suction when giving meds for at least 30 mins

Nitroglycerin

● systemic/ coronary vasodilation

● Treats angina, BP, CHF
● If given SL for angina pain and not relieved
○ Give additional tab
○ Can give 3 in 15 mins
○ Call EMS after first dose
● If given tablet SL and pt complains of stinging sensation that means the tab is fresh
● Number one complaint about taking med… headache
● Common side effects
○ Hypotension, tachycardia, dizziness, syncope
● To prevent skin irritation rotate site for ointment or nitro patch
● DO NOT place nitro patch over pacemaker!
● Take off patch before a MRI
● Pt should take nitro prophylactically before sex to prevent chest pain
● DO NOT take nitro if pt also taking Viagra (​sildenafil)​
● IV nitro and all IV dysrhythmics should be placed on an infusion pump
● Verapamil ​is used for blood pressure and angina

NSAIDS

● Nonsteroidal Anti Inflammatory Drugs

● Aspirin and aspirin like drugs
● Reduce pain and body temp and inhibit platelet aggregation
 ● Should take NSAIDS with a full glass of water or milk to prevent stomach irritation
● Aspirin toxicity will cause tinnitus in the ears
● Teach pts to avoid alcohol when taking nsaids to decrease stomach irritation
● NSAIDS increase bleeding potential
● Stop taking 1 week before having surgery
● Children shouldn’t take NSAIDS when having flu like symptoms due to Reye's Syndrome

Organ Donation

● Need to knows
○ Best with living donor
○ Matched by blood and tissue
○ Must be in writing and can be changed before removal
● Only authorized representative can only approach pt or family about donation

Orthostatic Hypotension

● When systolic or diastolic BP drops more than 10 mm and heart rate increases by 10-20
when changing positions
● Pt will feel dizzy, light headed, unsteady
● Tx
○ IV fluids for volume replacement

Osteoarthritis

● Degenerative disease of the joints

● #1 form of arthritis seen in the elderly
● Weight bearing joints are most affected
○ Knees, hips, fingers, back
● S/S
○ Limited joint mobility, joint pain, joint stiffness
● Pain is relieved by rest
● Heberden's nodes (hard) will develop on the joints of the fingers, creating deformities
● Meds given
○ NSAIDS
● Corticosteroids may be injected into the joints to treat
● Pt teachings
○ Exercise- stop in pain occurs
○ Try to lose weight to help take off stress of joints
○ Use hot/cold therapy to help with pain
○ Assistive devices will help with mobility (canes, braces etc)
● May require hip/knee replacements
Otitis Media

● Infection of the middle ear

● Children are more prone because eustachian tubes are shorter than adults
● S/S
○ Fever, loss of appetite, rolling head from side to side
● Tx
○ Analgesics and antibiotics

Oxygen Delivery Systems

● Range of flow for nasal cannula

○ 1-6 LPM
○ After 6 nares and mucosa dry out
● Nasal cannulas allow pt to still eat, drink and talk
○ Should be changed everyday
● Inspect skin on face, nares and ears daily
● Range of flow for mask
○ 6-10 LPM
○ Make sure fits properly
○ Covers mouth and nose
○ May feel claustrophobic
● Venturi masks allow you to control how much room air you want to mix with oxygen
○ Always use for COPD pts due to specific O2 concentration
● Partial rebreather masks look like a face mask with a reservoir bag attached
○ Allows room air to mix with pure oxygen
○ Should in inflated at all time!!!!
● Non rebreather masks does NOT allow room air to be inhaled
● Assessing oxygen delivery is effective
○ Pulse ox, respiration rate and pattern, ABG
● DO NOT use petroleum jelly for moisturizer
○ Use water soluble jelly

Pacemakers

● Conduct electrical activity and maintain HR

● Teachings
○ Check pulse daily
○ Avoid large magnetic fields
■ MRI, industrial equipment
■ Household appliances are ok
○ Avoid contact sports
○ Report dizziness, fatigue or SOB to DR.
Pancreatitis (Acute)

● Alcohol abuse is #1 cause

● S/S
○ Abdominal pain,N/V, board like abdomen
○ Skin discoloration (cullen’s and turner's sign)
● Eating makes pain worse
○ Especially fatty foods
● Lipase and amylase are elevated liver enzymes
● Nursing Interventions
○ Make NPO
○ NG tube to decrease gastric distention
○ IV fluids, antacids
○ Stop drinking
● Treat pain with ​demerol or hydromorphone
● Never give morphine for pain
○ Thought to cause spasms in pancreatic duct and sphincter of Oddi

Paracentesis

● Invasive procedure that collects fluid from peritoneal cavity of abdomen

● Make sure to pt has informed consent
● Before procedure you must
○ Measure abdomen
○ Weigh
○ Take VS
○ Void to empty bladder
● Pt should be sitting on edge of bed during procedure
● After procedure
○ Monitor VS
○ Measure fluid collected
○ Apply sterile dressing to insertion site
○ Monitor bleeding
○ Make sure urine isn’t bloody

Parkinson's Disease

● Disease caused by depletion of dopamine

● Slow and progressive
● S/S
○ Bradykinesia, tremors in hands and feet at rest
○ Rigidity, shuffling steps
○ Loss of balance
 ● Nursing interventions
○ Assess neuro status and swallowing ability
○ Safety assist with ambulation
○ Encourage fluids
○ High calorie, fiber meals with low protein diet
● Meds given
○ Anti parkinson's and anticholinergics
○ When taking anticholinergics increase fiber to avoid constipation
● Side effects of Anticholinergics
○ Blurred vision, dry mouth, photophobia and tachycardia
● Meds given to replace dopamine
○ Levodopa or Carbidopa- levodopa
● DO NOT take dopamine replacement meds with MAOI’s
○ May cause hypertensive crisis
● Low protein diet
○ Avoid vitamin B6…. blocks meds effects

Peptic Ulcer Disease

● H. pylori is bacteria responsible for most ulcers

● Mostly found gastric and duodenal (first part of small intestine)
○ Gastric
■ Stomach
■ Normal stomach acid production
■ Pain occurs mid epigastric region, with meals or after eating
■ Starve
○ Duodenal
■ Duodenum
■ Stomach acid increases
■ Pain occurs mid epigastric region, on an empty stomach
■ feed
● Vomit will look like coffee ground
● Stool will look like black tarry
● Avoid NSAIDs
○ Acetaminophen isn’t NSAID
● Meds given to decrease gastric acid production
○ H2 blockers
■ Ranitidine
■ cimetidine
○ Proton pump inhibitors
■ Generic ending in “..zole”
■ Esomeprazole
■ Pantoprazole
 ■ Omperazole
● Antacids are prescribed to neutralize gastric acid
● Pts should avoid smoking and alcohol with ulcers

Peripheral Arterial Disease (PAD)

● PAD is an occlusive disease of the lower extremities

● Damage to surrounding tissue occurs below arterial occlusion
● Wouldn’t be able to feel pulse in leg
● Leg would be cool, hairless, pale and thick toenails
● What is intermittent claudication
○ Muscle pain from decreased blood supply
○ Pain comes and goes
● Pt teachings
○ Don’ts
■ Smoke, wear tight clothes, apply direct heat to legs
○ Do’s
■ exercise , inspect skin daily, and take prescribed meds
● Surgeries that improve PAD
○ Bypass surgery and angioplasty
● Legs with venous occlusion look brown/purple discoloration with edema and weeping
fluid

Pheochromocytoma

● A tumor that produces an excessive amount of epinephrine and norepinephrine

● This is a problem with the adrenal gland
● Pts experience
○ Sustained hypertension, sweating, weight loss, hyperglycemia H/A
● Tx
○ Surgical removal of one or both adrenal glands
○ Glucocorticoid replacements

Phlebitis

● Inflammation of vein
● Looks red, warm, painful area and streaks up the arm
● Tx
○ Remove the IV
○ Apply warm towel
○ Assess for infection
Piglets Theory of Cognitive Development

● Birth to 2
○ Sensorimotor
■ Child learns about reality by interacting with his/her environment
● 2 to 7
○ Preoperational
■ Move on to pre- logical thinking
■ Learns past, present, future
■ No abstract thinking yet
● 7 to 11
○ Concrete
■ Move to logical thinking
■ Able to classify and sort facts
■ Abstract thinking available
■ Understand death by 10
● 11 to adult
○ Formal
■ Able to think and learn as an adult
■ Concrete and abstract reasoning

Placenta Previa vs. Abruptio Placenta

Placenta Previa
● The placenta is covering or near cervix, blocking opening to vagina
● S/S
○ Sudden, painless, bright red bleeding
○ Usually in 3rd trimester
● Risk Factors
○ Previous C section, multiparity, older age mother
● Dangers
○ Maternal hemorrhage
○ Premature labor
● Nursing Interventions
○ Bed rest
○ C section… if baby is term
○ Blood transfusion may be needed
Abruptio Placenta
● The placenta detaches itself from the uterine wall
● S/S
○ Sudden, painful, bleeding with contractions
○ Uterine tenderness
 ● Risk Factors
○ HTN, diabetes, smoking
○ Alcohol and drug abuse
● Dangers
○ Decreased O2 and nutrients to fetus
○ Premature birth
○ Blood clots
● Nursing Interventions
○ Bed rest
○ C section if baby is term
○ Frequent VS
○ Blood transfusion
● Both conditions will require 3 Interventions
○ Frequent VS
○ Fetal ultrasound
○ Fetal heart monitoring
● Placenta Previa has more bleeding
● Abruptio placenta will create board like abdomen
○ Also causes disseminated intravascular coagulation (DIC).. a blood disorder
● If pregnant pt is bleeding vaginally NEVER do vaginal exam

Plasmapheresis

● Removing antibodies that attack the immune system from a patients plasma
● Treatment for what kind of pts
○ Systemic lupus erythematosus
○ MS
○ Gillian barre
○ Other autoimmune diseases
● When plasma is removed it is replaced with saline or albumin
○ Whole blood is removed and then plasma is separated
○ Takes 1-3 hours
● Complications
○ Hypotension

Pleural Effusion

● Collection of fluid in the pleural space

● S/S
○ Sharp pain on inspiration
○ SOB, tachycardia, decreased breath sounds
○ X-ray needed to confirm
● Tx
 ○ Find cause
○ Monitor breath sounds
○ High Fowler’s position
○ Thoracentesis
● After thoracentesis a chest tube may be needed temporarily
● IF fluid is not large enough amount to perform procedure pt might be prescribed a
diuretic

Polycythemia Vera

● Disorder that results in increased number of erythrocytes, platelets, leukocytes and

result thick blood
● Pt will complain of headache, SOB and weakness
● Nursing assessment finds
○ Purple/red complexion, enlarged spleen, increased hemoglobin
● Clotting with be increased
● Tx
○ Blood draws several times a year

Post Traumatic Stress Disorder (PTSD)

● Causes
○ Any traumatic event
● S/S
○ Nightmares, anxiety attacks, sleep disturbances
○ Memory loss or hyper vigilance
● Pt will isolate themselves or detached
● Pt are at increased risk for substance abuse
● Tx
○ Therapy
○ Anxiety/depression meds
○ Support groups

Pregnancy Stuff

● PhoGam is given to pregnant clients who are RH negative but whose baby is RH
positive
○ Prevents mom from developing antibodies against future rh positive babies
○ Given 28 weeks gestation and within 72 hours after delivery
○ Given twice
● Give RhoGam if pt miscarries if pregnancy is >13 weeks
○ Never give to infant or to the father
● Tocolytics are drugs given to stop preterm labor
 ●
● 4 drugs used for preterm labor
○ I​t’s ​N​ot ​M​y ​T​ime
■ Indomethacin​ (NSAID)
■ Nifedipine ​(CCB)
■ Magnesium Sulfate​ - will decrease urine output, deep tendon reflexes and
respirations
■ Terbutaline -​ watch for tachycardia
○ Continuously monitor fetal heart rate and maternal VS
● Two drugs to never give pregnant pt (think 2 QT say no to OB)
○ Quinolones and Tetracylines
● Umbilical cord in newborn has 2 arteries, 1 vein

Presbycusis

● A form of hearing loss

● A natural process
● High voice tones are hardest to hear
● Communicate with pt facing them, low tones and encourage them to wear hearing aids

Pressure Ulcers

● Stage 1
○ Red, warm, intact skin that doesn’t blanche
○ Looks like a sunburn
● Stage 2
○ Superficial damage to the skin (epidermis or dermis)
○ Break in the skin
○ Abrasion, blisters, shallow craters
● Stage 3
○ Skin is deeply damaged but doesn’t extend through fascia
○ Deep crater
● Stage 4
○ Skin deeply damaged
○ Shows muscles, tissue and ligaments
● Nursing Interventions to prevent
○ Turn pt every 2 hours
○ Keep skin clean and dry
○ Proper diet and hydration
○ Inspect skin and document
Radiation Therapy

● Types
○ External - outside body
○ Beam and sealed
○ Internal - inside body
● Side Effects
○ Alopecia, fatigue, skin irritation
● Pt receiving beam radiation therapy should wash area with unscented soap, water and
pat dry
● Pt receiving radiation therapy need private room and bathroom
○ No pregnant women or small kids can visit
● Women with removed cervical implant can have sex 7-10 days after removal

Raynaud's Disease

● Vasospasms of arteries of the upper/lower extremities

● Fingers, toes and cheeks are most affected
● Feels numbness, tingling and swelling, may feel cold as well
● Tx
○ Monitor pulses, vasodilators
○ Avoid cold and stress
○ Quit smoking
○ Wear warm clothes

Retinal Detachment

● Painless, serious condition

○ EMERGENCY
● S/S
○ Blurred vision, floaters, flashes of light, black spots
● Tx
○ Surgery to reattach retina
● Nursing Interventions
○ Cover both eyes with patches
○ No coughing, sneezing
○ Strict bed rest
○ Keep head of bed elevated

Reye’s Syndrome

● Acute encephalopathy (brain disease)

 ● Also involves liver and kidneys
● Cause
○ Usually a viral infection
○ Maybe aspirin
● Tx
○ Pts usually end up in ICU for monitor and treatment
○ Nursing interventions focus on prevention

Rheumatoid Arthritis

● A chronic systemic inflammatory disease that affects the joints

● S/S
○ Fatigue, weight loss, low grade fever
● Can occur at any age
● Rheumatoid factor will be found in blood of a pt with this arthritis
● Erythrocyte sedimentation rate will also be elevated in blood
● Joints will be affected bilaterally
● Due to inflammation of the synovial membranes, which damages cartilage, joint
deformities are seen
● NSAIDS are primary drug therapy
● Encourage pt to exercise
○ Activity helps the pain

Scabies

● Itching and rash are most common symptoms

● Itching located between fingers, wrists, around waist and genitals
○ increase at night
● Contact isolation
● Tx
○ Permethrin 5% lindane (Kwell)
● Nursing education
○ Treat all family members at same time
○ Wash all bed linens in hot water
○ Itching may occur few weeks after treatment

Seizure Precautions

● Main goal while pt having seizure, keep safe

● Mark time and pt behavior
● Do not restrain
● During seizure
○ Turn head to side, lie bed flat, pad head with pillow
 ○ NEVER put anything in mouth

Sexually Transmitted Diseases

Chlamydia
● Bacteria
● Incubation 1-3 weeks
● S/S
○ F- vaginal discharge, lower abdominal pain, burning with urination
○ M- urethritis
● Tx
○ Penicillin

Genital/Oral Herpes
● virus
● Incubation 3-7 days
● S/S
○ Urethral discomfort, lesions on vagina or male genitalia
○ Transmitted even without sores present if pt is shedding virus
● Tx
○ Acyclovir

Syphilis
● Bacteria
● Incubation usually 3 weeks but can range 9 days to 3 months
● S/S
○ Chancres (sores)
○ Fever, weight loss, rash
● Tx
○ Doxycycline

Gonorrhea
● Bacteria
● Incubation for men 3-30 days… for women 3- indefinite
● S/S
○ F- yellow discharge, abdominal pain, bleeding with intercourse
○ M- urethritis, dysuria, burning yellow or green discharge
● Tx
○ Penicillin

Human Papillomar
● Virus
● Incubation 3-7 days
 ● S/S
○ Genital warts on male and female genitalia
● No Cure

Shingles (Herpes Zoster)

● Viral Infection caused by varicella

● S/S
○ Itching vesicles grouped together on top of red rash, painful to touch, low grade
fever, malaise
● Shingles are spread by vesicles that contain fluid that transmits the virus
● Rash usually located along the dermatome
○ Face, trunk, back
○ Rash and vesicles will be unilateral
● Respiratory Isolation
● Tx
○ Analgesics
○ Supportive care
○ Cool compresses
○ Trying to keep vesicles intact
○ May see scarring after vesicles heal

Sickle Cell Anemia

● Recessive autosomal trait that is most commonly seen in african americans

● Child receives the gene from both parents
● Normal RBCs live 120 days
● Sickle cell RBCs live 6-20 days
● At risk for anemia
● Tests to determine
○ Hemoglobin- shows anemia sickle testing of blood
● The acute exacerbation of sickle cell anemia is called sickle cell crisis or vaso-occlusive
crisis
○ Most common cause is dehydration
○ Causes sickled blood cells to clot
● How to treat sickle cell crisis
○ Hydrate with oral and IV fluids
○ Give O2 to increase tissue perfusion
○ Blood transfusion may be needed
○ Give pain meds…. Very painful!
○ Hydrate with IV fluids first since blood is clumped together, then give O2 will
prevent more clumping
Sterile technique

● Skin can never be considered sterile, only clean

● Never turn your back on a sterile field
● Do not adjust face mask with sterile gloves.. Breaks sterile field
● Sterile gown is only sterile from the waist to the shoulders
● If sterile wrapper become wet the entire package is no longer sterile

Tardive Dyskinesia

● Side effect of antipsychotics

● S/S
○ Chewing motion with mouth
○ Tongue sticking in and out
○ Involuntary movement of arm/leg
● Anti- Parkinson's can help decrease this effects

Total Parenteral Nutrition

● Pts nutrients supplied through veins

● TPN needed if GI tract wasn’t working properly
● Blood sugar needs to be monitored closely due to the dextrose in TPN
● If TPN suddenly increased, pt is at risk for hyperglycemia due to gradual increase rate of
infusion
● Other electrolyte imbalances TPN can cause
○ Hyperkalemia, hyper- magnesium, hyperphosphatemia
● TPN changed every 24 hours
● NEVER hang other meds with TPN tubing
● Tubing changed daily to decrease risk for sepsis
○ Increases risk for bacteria to form in tubing
● Elevation in temp is sign of infection
● TPN must gradually be decreased to prevent rebound hypoglycemia
● 10 % dextrose water can be temporarily hung if TPN unavailable

Tracheostomy

● A surgical procedure that creates an open airway in the trachea

○ For upper airway obstructions
○ Increased mucous
○ Created opening called stoma
● Always have at bedside
 ○ Obturator- stiff plastic device used for inserting the inner cannula
● Suctioning pt with trach is a sterile procedure
● Nurse should always hyperoxygenate with 100% O2 before suctioning
● Suction should NOT be applied during insertion of the catheter… can cause damage
● Always oxygenate with 100% O2 2-3 times during inhalation after suctioning
● If pt coughs hard and trach becomes dislodged nurse should first….
○ Keep airway open by reinserting obturator or grabbing retention sutures.
○ Give O2 if airway loss!!
● If pt NOT on vent but has trach inner cuff should be deflated so airway isn’t blocked

Transgender Client

● Always ask pt what they would like to be called

● If male has reassignment surgery there is no need for Pap smear
○ No cervix
● If female has reassignment surgery testicles will be present but won’t produce sperm

Trimethoprim- Sulfamethoxazole (Bactrim)

● Med is used to treat bacterial infections like UTIs

● Contraindications for taking bactrim is kidney or liver failure
● The severe inflammatory skin disorder caused by bactrim is called steven johnson
syndrome
○ Allergic reaction
○ Severe skin lesions like blisters
○ Swelling of throat lips, tongue
○ Fever, headache, rash
○ Lesions could be internally on organs as well

Tuberculosis (TB)

● Mycobacterium tuberculosis is organism that causes TB

● Active signs
○ Productive cough, night sweats, chills, weight loss, low grade fever
● The Mantoux test is administered by injecting a small amount of tuberculin intradermally
○ Considered positive if skin is raised greater than 10 mm
○ Airborne isolation
○ Pts negative pressure room should have 6 fresh air exchanges per hour
● Antibiotics used (S.T.R.I.P.E)
○ Streptomycin
○ Rifampin -​ turns urine, sweat and tears red or orange
○ Isoniazid
○ Pyrazinamide
 ○ Ethambuto​l
○ At risk for drug induced hepatitis taking these meds
● Peripheral neuritis is most common side effect of the meds
○ Others are muscle aches, GI disturbances, dizziness
● Vitamin B6 will be depleted when taking TB antibiotics
● Pt should avoid alcohol to reduce risk of hepatotoxicity
● 3 negative sputum tests need to be done before non contagious

Ulcerative Colitis

● Inflammatory bowel disease affecting large intestine/ rectum

● Cause is unknown
● S/S
○ Abdominal pain, bloody diarrhea, N/V, weight loss
● Diagnosed with colonoscopy
● Tx
○ Corticosteroids to reduce inflammation
○ Removal of large intestine and rectum
● Pt will need ileostomy after surgery
● Pt teachings
○ Low fiber diet
○ Avoid fiber, fat/greasy foods to decrease diarrhea
○ Avoid alcohol and caffeine
○ Increase fluid intake

Vitamins

● Fat soluble
○ A, D, E, K
● Water soluble
○ B (2,6,12) C, Folic Acid
○ Can not be stored in the body by liver
● Vitamin K is important for clotting blood
○ Foods source: green leafy veggies
● Vitamin A important in monitoring eye sight
○ Food source: oranges, dark green leafy veggies
● Vitamin B12 is important in pernicious anemia
○ Will see paresthesia in hand and feet
● Vitamin C and iron supplements should be taken to promote absorption

Von Gierke’s Disease

● Also known as liver glycogen disease

 ● Normally in children

● S/S
○ Hepatomegaly, acidosis, fasting hypoglycemia, delayed growth
● Tests to diagnose
○ Urine and blood tests
○ CT
● Liver will appear fatty
● Tx
○ Frequent meals
○ allopurinol ​for gout
○ Liver transplant

Wilson’s Disease

● A genetic defect that causes copper buildup in the body.

○ Body unable to remove extra copper
● Liver and brain and the 2 organs most affected
● Low copper diet
● Foods high in copper and should be avoided
○ Lamb, shellfish, veggie juice
○ Nectarines, dried beans
○ Chocolate, multivitamins

Xtra Stuff (Religion)

● Adventists
○ Saturday worship,
○ no Alcohol, no pork, no meat sometimes
○ baptisms as adult
● Muslims
○ No pork
○ do not do an autopsy
● Orthodox Jew
○ Religious leader is called rabbi
○ Only other orthodox jews can touch the dead
● Roman Catholics
○ Religious leader called priest
○ Infant baptism
○ Called before death for last sacrament
● Post Mortem Care
○ Do not give full bed bath
○ Raise HOB 30 degrees, place palms down to prevent discoloration
 ○ Put dentures in
○ ID body
○ Maintain vital organs and skin integrity
○ Remove IV/ Tubes
○ Replace bandaids

Protective Gear

ON
1. Wash hands
2. Gown
3. Maks
4. Goggles (if needed)
5. Gloves

OFF
1. Gloves
2. Goggles
3. Gown
4. Mask
5. Wash hands
6.