Marl Klimek Reviewo> quintafeira,2de abrilde2020 19:31 RULE OF THE B'S IF the pH and the Bicerb are inthe same drection | METABOLIC IF The pH and the Bicerb are in diferent drections |RESPRATORY Examples: pH 725 (WL) labole Adcosts Normal Values 003 20 (1) pH = 735-745, 721) Respratory Acidosis Normal Bicarb= 22-26 1008 38 (1) PaQ2= 8000 mmHg 1750 (7) Metabolic Alaloss PaCO2= 35-45 C03 30 (1) mmtig pH1750 (1) Respratory Akaloss (NORMAL) Sx02= 950% 108 25 (normed) Compensated = Ph is NORMAL. Pariialy compensated = Everything abnormal SIGNS & SYMPTOMS Know the principles, not the IsIs PRINOPLE: “4s the aH goes, so abes my patent, except for potassum” ALKALOSS (1 AQDOSS (1 Hyperrefiena Headache Irntabiy Hyporetiena Tachypnea Bradyoarda Tachycarda Bradyonea Borborygrn Paralyofadyname teus ‘Seures “need suction | Goma, Respiratory arrest “need ambu bag ypokelema MACkussmau's (ONLY METABOLIC ACDOSS > MAC’) compensatory mechanism HyPOkalemia HYPER Kali Heart block Causes of imbalances “is ita LUNG SCENARIO? YES. Itis RESPIRATORY. ey OVER VENTILATING UPPER VENTILATING RESPRATORY ALKALOSS RESP ¥y ACDOSSees ‘OVER VENT Examples -Pregnant woman hyperventiaing | UNDER VENT Examples |-Emphysera Ventilator seting 6 TOO HGH Drowning Pneumonia PCA puro (toxeiy) - Veniiator setting s TOO LOW ‘2 What ifit is NOT A LUNG SCENARIO? Itis METABOLIC € a PROLONGED SUGTIONNG OR VOMTING ANYTHING ELSE! vv vu METABOLIC Alkaosis METABOLIC Aedosis SUCTIONNING —-Surgery with NG tube suction for 3 days |ANYTHING ELSE |- Acute RF OR VOMTING Hyperemesis gravidum Examples -Infantie darthea Examples -3/4 degree burns over 60% of body yperemess gravidum with detyeraton Ventilatory and Alamyo> HGH PRESSURE ALARM 4.Kinks > unkink Venliator s working Too hard fo gel ar nla 2. Water condensing into dependent loops > emply lungs There is INCREASED RESISTANCE due casi 3 . et tags Tere sce 3, Mucus in arway > turn, cough and deep breathe, suction PRN LOW PRESSURE ALARM 1, Man Tubing is dsconnected -> reconnect eniiator fins thal i 8 warking foo essy 10/2. Oxygen sensor tubing, which senses F102, & dsconnected The s the black gel ar info lungs There is DECREASED coated wre > reconnect RESSTANCE dhe to LISCOMTEGTIONS 3.PRS ACTION Pay altanton to whore tubing s..(contrinstin fn oa change cut iif on chest, dean with ahd than put back on Question MD orders to dscannect ventiaior in AM @ 0900hr AI 0600hr, ABC reveals respiratory acidosis What do you do? Folow order Gal MD and hold order Cal RT Bagh to decrease setings Bis he answer because the patient § no! able fo breathe without the ventiator The settings are TOO low Patient shauid be in respratory ALKALOSS \whal do you do ff the patients dsconnecied tube on the flor? [Bag them, (call for help) get new tube and then reconnect \whal do you do f the patenis disconnected lube & on the chesI? Reconnect fils above the wat is ok Alcohelisnve> Remember is PSYCH f you are asked to Prioritize, Don't forget MASLOW!| Physologed 2 Safety 3 Comfort - nudes pain chologcal 5 Socal 6 Spiritual Ater apping MASLOW,f psychologcal poles, choose according priory psychologe problems Psych Needs, n order | Denil Depend Manpusten To adress a paionts| STABLE, psychoiogeal needs, Sve ‘nay must be comfortable Pan over kiled anjone NOT the fop pron, especialy there ere physclogeal needs n the question thal make the paint unstbio ‘H1PROBLEM DENAL - Denial is the #1 problem in all abuse situations Denial refusal to accept the realty of a problem It is #1 because how can you treat someone who can't adit that they have a problem? Trealment You Ireal denial by confronting i! by pointing out the dfference between what they say and what they do Confrontation attacks the problem Aggression allacks the person Haw do you confront? Pont out the dfference between what they say and what they do «© You say youre not an alcoho), but 1's IOAM and you akeady drank a 6-pack © You say youre not a spouse abuser, bul she has a restraning order agains! you ‘They deny, you confront Denial of foss + grief is different Stages of Grief [DABDA Denial anger, barganing, depression, and acceptance Intervention You want 1o support this type of denial Guy lost one hand and wanls to play piano You do not tel hn he can't You ask tien more about pano =YOU ASK MORE ABOUT Haw? Tel me more about... Pay attention to the question, i it oss or abuse? wih loss you support With abuse you confront +2 PROBLEM DEPENDENCY VERSUS CODEPENDENGY Dependency Abuser gels sgnficant other fo do things for therm ~The abuser is dependent on others ~Callin sick for me Co buy me this Drap me off here Codependency = Signfican! other derives postive sef-esleem from makng deesions for or dang things for the ebuser Arent | such a great wife for caling nck for you? Abuser: Life wilnout responsbily ~Signfican! Other: Posiive sef esteem Treaiment Sel mis and enforce them Teach sgnficant other fo sey NO Work on seesteem of the cadependent person fo solve Ihe issue Im saying no and tr a good person because lim saying no ~May solve the problem but may lose relalonsha +H PROBLEM: MANPULATION Manipulation ‘Abuser gals signficant other 1o do something thats notin the best inlerest of sonficant other Nature of act is dangerous or harmful[How is manipulation in both siuations, the ebuser is geting Them fo do something for them lke dependency? The difference s neutral versus negalve Look al whal they're bang asked fo do what the s/o is -A 49y/0 alcchole gets her 50y/o husband fo go To the store fo buy alcohol for her, because ths i legal beng asked fo do Last week, your slr nw cals you and says, Wo you pk up ile ly rom basketbal race a schodl? So he can spend the right al your house b/c of the snow" You have @ 4x'4 Huramer and you incon lve 3 blocks from the school, and you do it el what the s/o is A 49y/0 alcoholic gets her I7y/o daughter To go fo the store and buy alcohal for her, because This & being asked fo do is legal as she is under age harmfu/dangerous What your ssler inlaw cals you and she has the 4x44 Hummer and she Ives 3 blocks fram school toslo= and she asks you To pick_up her son and you have a KIA thal breaking down and you ive 20 mies manipulation away Ths 6 dangerous She can do i hersef more safely Trealment Sel imis and enforce ther You say NO -Easer fo Ireat because nobody kes bang manipulated Mio postive self-esteem ssue with manpulaton ike there is wih codependency/dependency How many patents do you have with DENAL? | How many patents do you have with DEPENDENCYICODEPENDENGY? 2 How many patients do you have wath MANPULATION? | Encephalopathy psychosis ‘WERNICKE- -Psychass induced by Vitamin BVihamine deicency KORSAKOFF Lose touch with really SYNDROME -Paychatic people encephalopathy -Primary symptom. amnesia with confabualion (memory loss, making up stones) because they forgot and they psyenoas believe it Memory loss is “wha! happened in the IF90's? not "| got crunk lastnight, what happened” so they make up stores of whal they were doing in the 90's Tresiment Do nol present really because they won't learn i Redirect > rechannel it nfo something they can do not teling thern what they can't do PI. "Ym going fo presdential meeting at BAM?" = Well why don't we Take a shower then watch CNN and watch what's gong on n Washinglon? ‘Characterisies Preventable > lake vlamin Bi which s @ coenzyme needed for meleboism for aoahal, f deinen, alcohol wil be stored and run bran cals Areslable -> They don't have to stop chinkng, they just have ta Take vilarin Bl Stop il from geting worse? Take wiarnn Bl ~Ireversble -> 70% rreversble (on boards, answer with major) MED FOR ALCOHOLISM - ANTABUSE ARABIA (ISULFRAM) Disufiram —|-Aversion thereny Aversion Realy sirong halred for something, gut hatred for someting, we want acoholes to realy hale abohol Works n theory better than in real fe -Onse! and Duraion Two weoks before effectiveness and two weeks off drug unt they can drink again IMPORTANT Patient Teaching - Avoid al forms of aohol 1o avoid nausea, vorniing, death including Mouthwash even f they swish and spi ~Afershaves even f they pul l on foptcaly b/c causes nausea Perfumes and colognes for the same reason Insect repelents ~Any OTC thal ends in—eloar Alcohol based hand seniizers Uncooked tongs because they have vanila extract ~ They GAN have red wine vinagretteOverdose and withdrawales QUESTION | Every abused drug & either an upper or a downer. Therefore, figure out the crug is an UPPER or LOWER drug \whal 6 the 4! most abused dass of chug that is not an upper or downer? Laxatives in the elderly \When you get a question, eslabish fis an upper or a downer? UPPERS: THERE ARE |-Caifene FVE ~Cocane -PCPILSD (psychedele halucinogen) ~Methamphetarnnes (crysla meth, pseudopheds, etc) ~Adderal (ADD crug) SIGNS & ~Euphoria SYPPTOMS: Make —Tachycarda things go up, ~Tachypnea inoreased Restlessness -Hypertenson -leneity -Darthea ~Borborygmi ~Sel4 reflexes Spastic ~Sezures > suction @ bedbide DOWNERS THERE ARE 185 Everything tha's not an UPPER So ONLY memonze the UPPERS! SCNS & SYMPTOMS) Make things go down, decreased Respiratory arrest the biggest risk Al symptoms above bul opposite Example: Patient high on cocane What sericay important to access? ‘A. Reflexes B. Make sure respratory rate is above 12 ck D. Bowel sounds Not B, because i's not a downer I's an UPPER! Do not just use ABC's QUESTION 2: After you dstinguish whether the drug is upper or downer, the second thing you ask is, are they talking about overdose or withdrawal? ‘Overdose/intoxtation: | Overdosed on upper > everything goes UP > pack the UP things Intoxication on downer > Youhave foo much everything goes DOWN -> pack the DOWN things Upper overdose > Downer withdrawal Downer overdose -> Upper withcrawal Withdrawal: You don't Withdrawal dawner > you don’t have enough dawner > pick the UP things Withdrawal upper > have enough you don't have enough upper > pick the DOWN things Which two situations woud respratory arrest be of concern? Dawner averdase Upper withckawal Which two siluaions would seizure be biggest risk? Upper overdose Downer withakawal Example: Bringng patient who is overdosed on cocaine What woud you expect 1a see, SATA | Irtabaity 2 Us reflexes 3: Resp less than 24. Difficult to arouse 5. Borborygmi 6 Increased temp Thought Process ent on UPPER dug Overdose on UPPER Therefore TOO MUCH UPPER This 6 a ONS drug not an AUTONOMG Overdosetinioxication have too much Withdkawal | donit have enough Overdose of @ downer causes everyihing fo go? Down Overdose of an upper causes everyihing To go? Up \Withdkawal of an upper causes everything To go? Down Withdrawal of a downer causes everything To go? Up Upper wathrawal looks ike Downer Overdnse Downer Withckawal looks ike Upper overdose Nrrg abuse iv tre Newbouver ‘Always assume intoxication no! withcrawal al beth Within 24 hours {intoxication After 24 hours | Withdrawal Example: Caring for nfant born fo a cuaslude accted mom 24 hours after brth, SATA Dificult to console Low core body temp Exaggerated startle reflex Respratory depression Seizure risk ‘Shri high-pitched cry oa ren Thought Process: * Downer drug * Withctawal of downer/Overdose on upper, snce i's 24 hours # Too much UPPER Alcohol withdrawal Syndrome vy Delirium, emmys Not the same thing! ~ Every alcoholic goes through alcohol withdrawal (AWS) 24 hours after they stop drinking Only a minority (under 20%) gat dolrium tremons (OT) © Occurs 72 hours ater Alcohol withcrawal aways comes frst win 24 hours Alcohol withcrawal syndrome always precedes delnum Iremans, however, dalnum tremors does not always falow alcobl vwthrawal syncrome ~ AWS is not Ife threatening DT can kil you ~ Patients with AWS are not a danger to seff or others Patiants with DT are dangerous to self and othersAws oT ‘Semi privale anywhere on unit Prwale room near nurses sialon b/c dangerous and unslable Usually on step cown unit Reguier det PO or clear ius Because RF sezure because withdrawing from downer > UP S&S Tio restraints (not a danger) ~Restranis needed ~Certan restrants are futle + Soft resirants not safe/strong enough Four paint reslranis are nat safe enough ~Restranls appropriate + Vest or Iwo point locked leathers (oppaste arm and opposite leg) Rotate azn. ‘Check every 15 min to neurovascular = What would you db fist? ‘Lock the LEG fst then the ARM, then release Up ad ib Siret bed rest No washroom privlegas Go around anywhere they want fo go BOTH RECEIVE ‘Antibypertensive. everything gang up (withdrawal of downer) Tranculleer Mattern containing Vitamin Bi 10 prevent WERNCKE KORSAKOFF we Anvineglycosidesoo * Powerful class of antbiotes, they are the BIG CLNS ‘When nothing ee works, pullout the amnogycosides © Think the folowing A MEAN OLD MYCIN ‘A) They are antibiotics used to treat A MEAN OLD INFECTION thal is RESISTANT SEROUS LFETHREATENNG RESISTANT GRAM NEGATIVE ‘Snusils? No I's not @ mean od infection TE Yes tits Meda? No Bladder infection? Na Fulnnan pyelonephniis? Yes Sepiic shock? Yes ‘Burn wounds over 85% body? Yes \Vral pharyngitis? No Sirep throat? No B) ‘Mycin’ > ALL aminoglycosides end in —mycin © Nol al rugs thal end in mycn are aminogycosdes but MOST are © There are three myeins that ere not arinoglcoscdes = Anttromyoin = Zithromyein = Cerithromycn 1 Ifilends in MYON = Amnogloosce fil ends in THROMYGN = II's NOT an amnoghycosde, which you can use for regular type infections (©) TWO TOXGC EFFECTS OF A MEAN OLD MYCN / AMNOGLYCOSDES # Think MOE > think EARS > —ofotoxicciy © Hearing" © Bingng/Tinnitus © Verigo (equibrum) © Dazzness (equibrum) Human ear 6 shaped ike a KIDNEY > nephrotoxicity © Creatinine is THE bes! induator of kidney function (do nat go for W/O, BLY)© 24 hr creatinine clearance 1s BETTER than serum creatinine © Serum creatine comes nex! over anything abe Think number 8 drawn inside the EAR © Toxic 1o Crenia Number & (ear nerve) © Adminster ther 98h # Route IM or lV * Do not gvve them PO because they are nol absorbed EXCEPT in © Hepatic Encephalopathy Oral mean old mycins wil go in your gut and kil rar negalve bacteria whch produce ammonia *= This wil help get nd of high ammons levels 1 Al the same Ime, the drug wil NOT go fo the iver (since its not absorbed) which is GOOD in ver falure Preop Bowel Surgery "ean out the gut NO OTOXOOITY OR NEPROTOXIITY in both cases because not absorbed Inboth cases > stenized bowel Therefore, ORAL MEAN OLD MYONS are ORAL BOWEL STERILIZERS NEOMYOIN and CANOMYON are the top 2 oral bowel steriizers Who CAN steriize my bowel? NEO CAN x Tough and Peak levelyoe Reason for drawing TAP lovels narrow therepeute range TAP’ TROUGH Drug al its lovest ADMNSTER PEAK: Drug af ts highest Reason for rough leves? © Merrow therapeutic widow ‘Smal dfferenoe between what works and what Kis * Draw TAPS Example: LASX ‘Smales! dose seen? Simg or 1Omg Largest dase seen? 120 mg Therefore, WIDE renge No TAPS Example: DICOXIN Lowest: 0125 Largest: 025 Therefore, NARROW range TAPS, yes ‘A MEAN OLD MYONS = TAPS DRAWN! \When shoud TAPS be drawn? What matters? THE ROUTE TROUGHlowes! point PEAK SL__| 30 mis before nex! dose | 5-0 mnutes ailer drug dssolved IV__| 30 mins before next dose |15-30 minules after drug is finshed, not when you hang i 100 mal 200 mir I wil be finshed in 30 mins You! hang it at l00dhr, fishes at 1030hr Draw peak from IO45-400he F you get Iwo correct values in range, play price is right Choose the one thats the highest without gong over Therefore, lOdhr IM | 30 mins before next dose | 30-60 mnutes afier injected Choose 60 mnutes, f both options gven PAN MEDS SC | 30 mins before next dose | SEE dabetes lecture Only SC peaks they Tak about are insuins PO | 30 mins before next dose | Forge! about i! because they don't fest it Too* venable Calcium Channel Bleckeryer © CCB are ike VALIUM for your heart © What does VALIUM do for your Body? Calms you down (CBs calm the heart down © If your heart is tachyoarde, can it stand.a ile retaxant > YES COB © If shook, does need ta relax? > NO COB © Heart black -> NO COB, © Tacharrytnmas -> YES COB © Heart allack -> YES COB COBs are negative inotropic, negative chronotropic, and negative dromotropic, I's lke VALIUM for your heart Don‘ freak out with the fancy words They relax your heert Postve ino/chrona/dromo agate ino/chrono/dromo (Cardae: sirmunis Cardiac depressant ‘Srengthen, speed up, make it work harder | Slow down and depress the heert \Whal co they treal? AAAI Antihypertensves: They relax your hear! and blood vessels ‘Anfianginas: Relax the hear! 501! uses lass oxygen, decreasing oxygen demand ‘Anti atriakarrhythmias: ONLY alril arrhythmias NOT ventnculr Treas atrial flute, al fb, paroxysmal aril tachyoarda... anything ATRIAL! © There's @ trick: supraventnculr tachycarcla Would CCB treal ths? YES Why? ‘SLPRA" means above, therefore, ABOVE THE \VENTRCLES = ATRIAL © SVT = ATRIAL ‘Side Effects HH © ypotension’ Vasodiion © Headache: Vasodlaion inthe bran = Headache is usualy aivays in SATA Always measure blood pressure due fo risk for hypotension Parameters: Hold COB # SYSTOLIC < 100 mmtig Names of COB -dpine tes fo be Dipine not PINE Two others © Verapamil © Cardizem Cardzem can be given continuous IV © F SBP < 90 mrrtlg, sow and trate the chip to keap SBP > 100 mtg Four rhythm sirp tracings, know by SITE And by verbal description ‘TERMNOLOGY © QRS: VENTRCLLAR © P WAVE ATRAL @ RHYTHMS MOST TESTED ON NCLEX Alack of (RSS = no QRS agystolo ‘Saw tooth = flutter > alrial flutter CChaote = firtation > atrial frilation with P waveiv. Chaotic = flan > ventricular fordation with ORS V. Bizarre = lachycarde > ventricur tachycarda Vi. Periodic widened QRS -> PVE, one snapshot of tachycarda 1. PVCs are LOW pronity unless... 66T 1 there are more than 6 PVCs na minute 1 Ff there are more than 6 PVCs in a row it the PVG fas on the T wave of the previous beat li. f one of the three are true, you elevate prionly of PVG cent fo MODERATE li PVCs never reach HICH print level LETHAL ARRHYTHMAS: Kill you in 8 minutes or less, HIGH PRIORITY. 1. Asysiole 2. Ventreuar Fixation No cardae output -> no bran perfusion -> dead n 8 minutes POTENTIALLY LIFE THREATENING | Ventricular Tachycerde “There IS cardiac output When the rhythrn changes, cbotor wil ask... DO YOU CET A PULSE WATH THAT? F theresa puise = THERE IS CARDIAC QUTPUT TREATMENT VENTRICULAR TACH and PVGs: Amiocerone or Idooaine ATRIAL ARRHYTHMAS/SUPRAVENTRICULAR TACHYCARDIA: ABCD's ‘Adenosne/ADENOCARD > push in less than 8 seconds > FAST IV PUSH © IV PUSH When you don't knaw, you go slow BUT THS IS ONE YOU HAVE TO KNOWIl Use BIG ven © Can go into asystoe for 30 seconds snc i's such a fast push BUT they should come back! * Belabiockers > “io! (© Negalive na/chronaidrono = they are Ike valurn for your heart © Treat AMA and AA © Therefore SE -> Hypotension & headache yust ike COB * Calum Channel Blockers > lke VALIUM for your heer!, same as Bela Blockers * Daglals > digoxin, lanoxn KNOW NAMES"* 5. VFIB: For VFB you DF Shock them! 6. ASYSTOLE: Epineptrne and atropine in thal order ae 1. Normal Sinus Rhythm There's aP wave, before every ORS, which is folowed by a T wave Baby fst, daca, them morneny Peaks of P waves are equaly dan! from one another > NOT a snus arrhythmia 2. Ventricular Fibrilation - CHAOTIC \ V MN pay © Chaotic squiggly Ine «is there a pattern? NO3. Ventricular Tachycardia ~ BIZZARE Ay VAN AV Wii YY Sharp peaks ard ags «is there a pattern? YES se Chest Tubeyoe * Re-estebishes negative pressure n pleural space so that the lung expands when the chest wall moves © Negalive pressure is good in pleural space = makes things sick fogether (vsceral and parietal ayer) + Poslve pressure puls things apart = more work, les ar, because of posive pressure ‘A. When you got a ausstion, look for reason it was placed © Pneumotnorax chest lube fo remove ar © Hemothorax: chest tube removes blood © Pneumo-hemo thorax. ches! iube removes both arr and blood Examples CT for HEMOTHORAX — what woud you report? | No bubbing CCT craned 800 mi in frst 1 hours CT is not draining > bc it's not doing what i’s supposed to do CT is intermittently bubbing sen (CT for PREUMOTHORAX — what would you report? | or 2 1. Its supposed to bubble 2. It'snot supposed fo ran! ® Location of tube placement > A for A,B for Bi Apical ches! Tube is way up high -> craning ar because arises Basiar ches! ube 6 al bottom of lungs -> cranng blood because it's subject to gravily ne Examples Your apical CT is draning 300mity -> BAD! Your basier GT NOT bubbing -> GOOD! Hema -> Baslar Pneumo > Apical Preumattemo -> BOTH How many CT and where would they be placed for unlateral pneumohemothorax? Two Apical for pneumo Basler for hemo How many GT and where would they be placed for bilateral pneumothorax? Two Both apicalHow many CT and where would they be placed for post op chest sx? Two Apical and basilar on side of sx ‘Alas assume UNLATERALITY (Only Ime youre lakng care of BILATERAL 6 when they say tow mary CT and where woud you place ther for post op right pneumonectomy? REMOVAL OF LUNG so NOME Only for lobectomy, wedge resections, ef bul NOT PNEUMONECTOMY TROUBLESHOOTING * Closed chest cranage systems (pneumovac, pleuravac, emerson — plastic canlaners wi tube connected) 1. If you knock lover > sel i back up and they need ta take deep breaths -> not a medical emergency 2. if device breaks > postive pressure can gel nfo pleurd space CLAMP it so nothing gets in b QUT the tube away from broken deve cc SUBMERCE end of tube ina sterie water d UNCLAP it bc re-estabished water seal Thal s the order (aphabelca)! £ NOTE best question is dfferent than a firs! question IL BEST = whar’s the one thng you coud do ff you only had one chowoe? ‘SUBMERCE, li, RST = what would you db fist? CLAMP. 3. if the CT gels puled out a FRST = Take a goved hand and cover the hole b BEST = Cover in vaseine gauze c Sterle dressing over d Tepe m3 sdes 4. Bubbling -> sometimes i's good sometimes is bad Ask yoursef Iwo questions-> Where i i bubbing? When i it bubbling? INTERMITTENT WATERSEAL [Always good, docurnent i CONTINUOUS WATERSEAL There isa leak, this 6 bad Find il nd tape if unl slops leaking INTERMTTENT SUCTION Bad, ths i$ nol high enough Suctian is 100 law Go to the CONTROL CHAMBER wal and Turn it up unt continuous bubbling CONTINUOUS SUCTION ‘Good Document it CONTROL CHAMBER @ TWO GOOD AND TWO BAD SCENAROS: iL Just remember one sition, and the other is opposte Ti. Continuous bubbing in water seal lke @ bottle of pop if it was continuously bubbing, would you buy if? NO There's aleak Just tke a CT RULES FOR CLAMPING TUBES * Never camp CT for more than IS seconds, without a doctor's order «Use rubber tpped double clamps © The teeth of the clamps are rubber lipped to prevent puncture of tube © Double clamps just because. Congenital Heart depecty’o> Every congenial heart defect is ether trouble or no trouble tt etther causes alot of problems or i's nat big deal at al There is no in between + Memoize OE word > TROUBLE © Nurses role in defecis -> teach about mplcations, NOT dagnosis TROUBLE DEFECT NO TROUBLE DEFECT You need surgery, now, n order To ive You db nol need surgery, you can possbiy have i, years later, Fil causes trouble, bulGrowth is Sow and delayed Life expectancy short Parents > siress, franca, gref, DG with apnea monitor Pedainc cardologst ‘Weeks in hospital after birth ‘Shunts RCHT TO LEFT because that's the ‘way TROLBLE speled TRowBLe > RCHT TO LEFT s BLUE > ‘Cyanotic, because TROUBLE is spelled that way They wil al have murmurs because of SHUNT # There are 47 heart defects # Al congental hear! defecis thal stat with T ere PEN Examples Ventnor septal defect -> no trouble Tetralogy of Falor > TROUBLE Patent foramen ovale > no trouble Truncus arlerioss > TROLBLE Transpastion oF great vessels > TROUBI Ete ‘Only ONE exception Usualy does not cause trouble Growth is normal Normal ife expectancy Perenis > average ife No apnea monvor PedarcanitP 24-36 hours after brih ‘Shunis blood LEFT TO RICHT because i$ not the ‘way TROUBLE i spelled It no Trouble ‘Acyanote (pink) They will al have EGE done fo find out why trouble TRoBLe LE © LEFT VENTRICULAR HYPOPLASTIC SNDROME © Boards wil not bring ths up FALTOR arene ees FOUR DEFEGTS OF TETRALLOGY OF “VarieD Picture OF A Ranctt VD > ventrieuar defect PS > pumonay slenass OA > overridng aorta 8H > right hypertrophy Don't memorize what tf hey ae ust memorze the names Ingection Disease & Transmission Bayed Precautions> ‘There ere 4 precautions ‘Standard/Universal - everyone should know Cont Prnale room Preferred Gohert same POSTIVE though CULTURE ance PE Dedoated Yes Stethosonpa, BF, el, oy woud be equpment ——dadksied Tegatve arly Mn ‘roars Recured urkes catering Droplet Prefer was coher POSTNE through CULTURE ~Mek Mak coves Cowes “RO gown (on when dong pant |= Can nat necessary re) Hane wasting Fad wating “Ee face held rot uns nada Ee foe sh not eros need [> Spec er rath on fr TB (eteneg) “Patent mask needed whan lng roam = Patent ask needed when avrg Yes ot necesDeer ven Diseases ‘© Acting ENTERC whch maine canbe tau fran esi fecshera) OFF ‘Hepat A (A stand for AALS = Chota sed ‘Bugs tal rave feet Meng (oF fi wheh causes epee Coca ‘oMaades ‘oMures ‘oRubes ere © Sprasd by croplt, bul arbor precaution © Vacate chicken pox Stach ifectens oes PSV ~ respraery sey eu whe fatal babes ‘How 6 transmitted? DROPLET Bul t's on CONTACT precavtion Beca.se wih ile ds, thoy gel rough contact of Contariatod cbjcts oars 0 Shnglas herpes zoster) Handwashing Handwashing versus Scrubbing Handwashing Sorubbing Position) Hands below ebows | Elbows below hand Length ‘Seconds Motes Handes | Yes, sink wath handes No sink wath hands When | Upon eniry or eaving room| When palent s Before and after glowing, | immunosuppressed for any ‘When sol hands reason Use Soap and water | Something with chioro ini Use an Alcoho!Based Solution 1. On entering or eaving a room 2. Before pulling on gves, ater taking off gloves 3. Cannot! After sol hands! What about after using the rest room?! must use soap and water + Dry from cleanest (nand) Io drtiest (ebow) + Turn water off with new paper towel Sierle Goving 41..Clove dominant hand fst 2. Crasp outside of cuff 3. Touch only the inside of gove surface 4.Do not rol cuff 5. Fingers inside of second glove cuff 6. Keep thumb abducted back. 7. Only Touch outside surface of dove '8.Skn touches inte of gove 9. Ouse of glove only touches outside of glove 10. Remove glove to glove Ppe Denning and Doyings> pul(Order | Abas put on n reverse Always take t off apbabote erder Alphabet for C's and MASK is Outs the roam Mask %& Math Problemyeo A. Dosage caleulations B lVhip rates. Forma Volume x crop factor Time in minutes Mnicripimerod’p 60qiisimi Macrodrp logis Pediatric Dose Questions 22 ibs per kg) “Amount per day vs ammount fo be gwen al one time DIV Repacement Questions Do you use leading 015? YES, as lng as it mantains place 00000003000 Boerds wil fell ou what fo round fo, Tenthsfhundreths You do not have fo wnte unts Just the numbers we Cuntchey carey and Walkeryes UTES ‘A) How do you measure the length of eruteh? © 2.3 finger widths below the anteror axlary fold to a pont lateral fo and sightly n front of the foot © You don't measure any landmark on the foot and NOT on the axle Rule these oul! B) How fo measure the hand grip? © When the handgres are properly placed, the angle of ebow flexion is about 20 degrees ©) How to teach erutch gatts There are four Two Point Three Point Fou Pont ‘Swing Through '*You move a crulch and the opposite foot together folowed by ihe other foot and crutch + Two together al every me You move Iwo crufches and bad leg logether '* Three things move together al every Ime *3 together then | **You move everything separately You have two legs and two crutches, '=You move ANY crutch, bul once you mave thal, your sequence 1s LOCKED IN| '*You then move the opposite foot folowed by Ihe other crutch folowed by the other foot Very sow bul very slable = Non weigh! bearing (amputations) '*You plant the cruiches Then you swing through "You never pul the leg down, D) When do thay use these? © ‘Even for even, oct for odd’ Therefore, ask yourself HOW MANY LECS ARE AFFECTED? 1. Use the even numbered galls (Iwo and four) when the weakness eveny dSirbuted (When you have even number af legs messed ®) * Use two pont for mid prablem (rid biateral weaknesses) * Use four pont for severe problem (severe bialeral weaknesses) Use the odd numbered gal (Three pont) when ane leg s odd IF they can't bear weght / amputation for nslance, use swing throughNOSaENs 8) Examples Eatly slages of rheumatoid arttrits Two point -> systemic dsease therefore two, LAK amputation Swng through First day post op right knee replacement, part weight bearing alowed Three pont ‘Advanced slages of arnyatrophe lateral scerass Four pont Left hip replacement, second day post op, Nw Swing through Biateral total knee replacement, rst day past op, WE alowed Four point Biateral total knee replacement, hree weeks past ap Two pont Going up and down stars (RUTOES “Up with the good, down wih the bach Upstars lead with good foot then crutches go second Dawnstars lead wih the bad foot then crutches go second Crutches alayss move with bed lag Miscetaneous CANES ‘Always hold on oppaste side of bad leg/COOD leg sie, bul advance it with the bed leg WALKER Pick them up, set it dawn, walk 1 i IF they need fo Ne ther belongngs fo, Ne 10 side nol al the front -> tip the walker over Boards does nat tke wheels on walkers or tennis bals on walkers Delusions, hallucinations, Unsionyes NON PSYCHOTIC VERSUS PSYCHOSIS: You must decte whether the palien! is non psychotic of psycho when you recewe a psycharc question! ‘© This mallers because delermnes Irealment, gods, meds, prognass, LOS, legaliies, ec NONPYSCHOTIG ‘A non-psychote person has insght and is really based Yes they are emotional il bul they are NOT psychotic ‘lasght: They know what's wrong with them They know they have a problem They know how i's messing up ther Ife ‘Really Based Therr senses (eyes, ears, mouth, nose, touch) MAKE sense Trealment Good therapeutic communication © Tak about how they feel lls he RCHT answer thal would be RICHT for every other Iype of patient who is not psychate: (med surglcommunty/OB/etc) Tel me more © Thal must be very offic. eHow are you feeing nght now. What do you meen by. oF le 11. Example: | arn depressed and | don feel ike dong anything She 1s non psychotic because she knows she's depressed eHow are you feeing nght now? Wha! is currently causing dsiress for you? eHow much energy do you have: today? oE lc 2. Therefore, hese Iype of questions are NOTHING SPECIAL SYMPTOMS OF ILLUSONS/HALLUCINA TIONS/DELUSONS PSYCHOTIC AA psychotic person has no insight and & nat really based They thnk everyone age s stk and everyone ebe has & problem They blame everybody ebe ‘*lnsght_ They don't know they are stk They may be able 10 Slale The dsease bul they don’! know haw itis afectng Iher ite ‘Not Really Based Treatment «© Good therapeutic skits do not work wih These patients ‘© Unique spectic straleges are needed«Psychotic symptoms * ONLY psychotic persons HAVE these symptoms * Example: Aice is depressed she sad, I can't slend this depression, i's runing my fe” © Dec energy evel yes © Psychomatar retardation — yes © Delusions of persecution ~ no * Delusion: False fixed (they con't change i) idea or belef There na sensory component With a delusion you're not heering/testing/seeng anything Youre ONLY thnkng i IP's jst 8 thought 1. Paranoid delusion: False fixed belef thal people are oul fo harrn you The poloa/mafiwfeyks lng/steaing/ete 2. Grandse delusion’ You think you are supencr Chnsighanciismartest/etc 3. Somatic delusion: Fase foxed bebef about a body pat | have x-ray vsion, | can melt stones with ry eyes, my bra is @ martian ‘super conducting proton accelerator There are worms nside my arm Pregnant 83y/0 rake ** Halucnation: Fate fixed sensory idea or belief You heer/feeYIaste/smelfouch these things © Five lypes of halucnahons, ane for each sense © Most coenmon s AUDITORY = Most common audiory hallucinations are voices teling you to hurt yourset © Next most common is MSUAL. © Third most common 6 TACTILE © Les! lwo are CUSTATORY (laste) and OLFACTORY are relatively rare *# llusion: Msnierpretation of realy II's a sensory expenence DIFFERENTIATION BETWEEN A HALLUCNATION AND ILLUSON ‘With an ison there is @ referent in realy © Referent: Something fo which a person refers to when they say something © There's actualy something there, they gust misnterpret what ts ‘With a haluonation, there's absoluley nothing there + Examples © “Len, | hear demon vooes” Ths is an example of an auditory halucinton because there was nothing there © A clent overhears nurses and doctors laxghng and taking af Ihe nurses salon “Lsten, | hear demon vooes” Ths is an exemple of an iluson because they were Taking, but i! was not demons © Aclent siares a! the wal and says, ‘Loak, | see a bomb” Haluoetion © Aclent slares al the fre extingusher, ‘Look, | see a bomb llison Because there s a referent, yes i! was the fre extingusher FIXED IDEA OR BELIF SENSATION | REFERENCE DELUSION YES no no HALUCCINATION - YES no ILLUSION = YES YES HOW DO YOU DEAL WITH PSYCHOTIC SYMPTOMS? Ask yourself, wha is there problem? What kind oF psychosis do they have? There ore basicaly three types of psychos Peron Chazacreasnies INTERVENTIONS c outs Thay can urcionn evry cy fa They can ave a maaga, re ic MO bran crepe, homes rraknee &nflaine cont ‘2 Four ssa a a urd 2% hs "dh, seNeO, mor, mane” i Schaopnrens is Scho affecive daordor li. aor depression (fernt from depression) Iv. Mene Dre beats funcore? Yas Ara hay as pacha? No Cry sealo phase ‘oben erage 1 Thersor, pote fo an rely “uzce Teach relly by ho aso he ou tap proce 1. Acknowrigefosing “ka the es Ly he word FEEL" nthe arower =O yeu can pect a ecg fr retarce see youre ~The must ba vary stasng for you 2 resent rey Ha al raat you tuto rot Tel hart realy, Yara rigs, he ae 2.Setaint ~The topes ff it lee ret ing aout ths Sop frg about ese lre rt gag fo ak aut se vores You cn be ts cecivatsrerg|psrc-0s, S ‘Actal bran diag occurs > phos ony cer wore ‘a. Akherere Stoke 6. Crgane tran setae Peers fe eran! f.werscke pscns, So Dever a ‘Pap aho are crazy forthe hart lr becaus l soma aa tae taueg fem fobo ay Fer eelrce, rg eacion > loa euch wth ely ‘Poop tal ae hgh on uppers © bhraweg fom downer OT woul be the) ‘Past ap poets expanaly CA ‘1U prchase a fo ere dept umn psyoron © Tired som c Ader css DELRM “I sae euro Te Ho say relly based eo ur corvrslon over Ereeg he converter Pot arg nay 3 proge > puretrent “fad answers cored ae purehmert “Sree you ce low the rds, ou bee yu eapone pve, ~The on) efercamenl nag the conersatn! xarpl: Scwopivens sys Im gong fo kd youl tarot ar st Your Peas 15.1 oe at youre upet 1. We aoa garg fe kept sale whl were here OSTIVELY STATED) rata fan, yu rere gang fe bl aoady a he appreprate (PecATNELY STATED) 17. aro rot gong ok about ha kre fst Those nds of os ae el Inyeubut ae af isn ths conversion 1. en youre ooo ave rey baad cerrsaln 0 our conversion ‘rer Wau oul some madesion fo hp you wht par? 12Shon them a he nal ther star ress Thay can ike mecca od wih ystems ane be comp wh rmecealens "Sct ran rage “Cerro! barn cealy 1s Two sop process Acknowledge that fesings 2Redrec ham ‘Chern hem fo do someting hey cand stato wha hey cnt “DONOT SET LTS. ramp, You hve pte wh dementia who ajc Sho the wang Feorm nha kby fe urs ror, al essa pls Srey You sy, Me ‘Sri youre alread up She ay Yes, haar gorra ek me ‘wae gong o ure Probl Fizber dd lor Dyers Stehasa Fatofucdbsl > DELUSON ate yous her? That eureka on exe tg fo hat core eiereing ou ve 10 ASK how he fk ou cana “Achrasiadge Sec tow thay fear expres Eagle Asking ern ect her ty doo wa a vn hte an sk abou was gang a happen a chzch Today whe we wat? “Rarforca memary which & goed wath deme > wha do you ke eo cach? hos you por? Ele han ou can ak au fara > ee Breathe alent wl ferge abou the debe (Temparay, sution arate, sory, fry '* Usa he fo sore cherea eebaree he boa “= Diferet fom freien cls lerporay and suston “sbiferent fom cement, ols lerporary, siden scertry “oho ae taco pac? Coed ras ts torporay (= Treaivent (Rarovrg uncerng case ‘Keep them se 1s Two stop process UAcknowodge fing 2. Reasure 13 That tomporry Thay wl be eet sf DONOT PRESENT REALITY DONOT REDRECT THEM BEGAUSE IT WONT WORK EXAMPLES THAT DFFERENTIATE BETWEEN 3 TYPES OF PSYCHOSIS | Berson wih schzo affective dsorder who pons 1o hwo people across the room and the , “Those people are plating to kil me” ‘What woud you saye ‘Schzo affective > FUNCTIONAL psychotl.Therefore, folow FOUR step process 1. | see that you ore frghtened 2. Those people are no! panning to kil you, we are al safe 3. Furthermore, we are not gong fo dscuss this 4. if they keep taking about ths, | see yauire too i 1o have @ conversation right naw 2 Person with Alzherer’s who poms 1o Iwo people across the room and they say, “Those people are plating fo kil ma” What would yous? Dementa > DEMENTIA psychotic: Therefore, TWO step process 1. | see thal you re frohtened 2. Why don‘t we go somewhere where you can feel sefe 3. Person with delirium remens who ponts to wo people across the room and they say, “Those peoole are plotting to kil me" ‘What would you say? Deirum tremons -> DELIRIUM psychotic Therefore, TWO slep process 1. | see thal you are frghtened 2. This s temporary, you are safe here This feelng wil go away when you get better MISCELLANEOUS Real Sick Personality D/O: Anisocias, Borderines, Narcsists can treat ike FUNCTIONAL psychotes (© Most of the others -> good therapeutic communcation| LOOSENNG OF ASSOCIATION: Your thoughts are al over the map. Fight of ideas] You go from though To thought to thought You say phrases thal are coherent bul the phrases are not tghty connected Each phase by if s coherent bul together they are nat Word Saad | They cannot make a phrase thal is eaherent They ust babble random words They are ster than fight of ideas Neologism | Making up imagnary words Youre a binsebk Youre a sebostrizak 1. Narrowed Seff Concept — When 3 psychotic refuses To leave ther room or change ther clothes Its e functional psychotic The reason whhy they are dong is because the way they define who they are is very narrow -> based on Iwo Thngs > where they are ‘wheal they are wearng a. Do not make a functional psychote get dressed > panic b. Use four step process C. ff not a psychotic > Use therapeutic communication stls and be drectvel Just ike f you were dealing with a post-op The only tme you're alowed to make decsions for patients are for thase who are depressed bul are not psychotic 2. Ideas of Reference — When they thnk paopie are always taking aboul therm Diabetesom Deena ‘Dahetos Maus Diabet ric ‘sao Gariiersie|-Carnot meebize gine — oa ah Tisai erat sas, rclaipe | Opto of cbees napa — SADH ‘cases gucoes asc or ergy bots melts Everybody brews DM bas por are peipsa — Pore Pura, poise — dityetaton die folow | Dato hat ha sar spre — “Pateea 20H ADH. he oppenie = agar ard ere rt tes Poles “he boks Ihe alot ke daboles mais bu | acai ey ro relanng waler, thay ro ha ame ng Ihe ke cabot atu wth he ad pt but othe gsen at (De May have sow une cup or ahigh we ouput? HGH pe he cbse mets Redatoreip | OP high wre ouput ow urna pacts gy [EU Rgh une cpl low une spacte gaviy | Clgua rd we ol ly because hay ae ralaneg betwen sine waier ‘ult ard une 'SADH bw ure gh urne sects aly ‘movie gory Flug voume Yes Ye 7Diabetes Melitus tyoes differences Two! fe Three raves lraun Dope, ene Gra Kelas Prove Juve erat = nal vd Three Ps oyna read re oul Poy read thes Poyphage bercarad slong ‘oe ro mean eaing 3 lteanbe asergem alr 3 hyrodctory lls ony mas eng ain dabetes In evry char conten = salu Tyan on Wea OM hy ood IE (Det > kas portant of he tres oksan™ > meet portant i mexty obec Teesinent Tigo! (Cppaserames ‘fen Feds Dapendont Adit Onset often face Prone ‘kt One at ad ore + Three Pe Padre ress une cup Pods reas nest * Bephaga Ieraead usioung Dre hay co Det > rest portato ho trae 2 O:ahypogieame acta Dit ns, Exars6 Del s rave oa focus for D2 la) scone resteen 1b) Thy ad 6 era eochgs par ey ‘2. Roop: he Hood ug lvaad > dnt hae bg peaks > rere nermogjeame Question: You have a type 2 dabei, what the best delary action fo take? Restrict calories fo an appropriate level Divide ther food ino 6 feedings a day Thought process “BEST” means youre only choosing ONE Therefore, think i through IF you choose a, you wil most ikely eal three meaks folowing ther calone restriction IF you choose b, you wil sp into 6 feedings, but they can eal 2s many calories as they want Therefore, choose A Insuin Lowers the blood glucose Four types thal you need to knaw RECULAR: Hurmuin R, Novolin R, anything with ‘Onset Ihr Peak 2 br Duraton 4 hr It's clear in the bottle so i's a solution so i can be IV crpped ‘Shor repid acing insuln (was made before lspro that's why i's classfied as short rapt acting) ® sounds for Rapid and Run a Onset 6 br Peak 810 he Duraton 12 hr True intermedate acting insuin Ghoudy > Suspension (not soliton) ‘Suspensions precipates > particles fal to the bottom Therefore, NOV drip > OD and bran death 1 stands for Not so fast (nfermedate) and Not in the bag 12,4,6,8,00,2 es = 1Prt‘They test the PEAKS! 2 and &-0 ‘3: Humalog: Lispro Onset 5 mins Peak: 30 mins Duraton 3 trs 15, 30,3 Give as they begn to eat, que WITH meals Not ac meals 4. Lantus: Clargine Onset Peak: none Duration 12-24 hours ‘So slowly absorbed it has no essential peak Thus one has low risk for hypogycaemia (ile 1 no rst) (Oniy insuin you can safaly give al bedtime: Check your expiration dates on insuin \What action by the nurse invalidates the manufacturer's expiration date on the bole? Opening it The minute you open a wie, the expration date 1s not vald The new expration date 1s 30 days after that! Make sure you wntle he date with EXP or OPENED then the date Refrigeration is optional You don't have to refrigerate in the hospital but at home, the patient does In the haspta > unopened vies should be refngerated \When you open the vie > i naw does not have fo be refngerated Exercise potentiates insuln Does the seme thing as insulin Think of exercise as another shot of sun ring a rapid metabolang cerbohycae snack Sick Days Fu, darrhea, ois media, etc: \When sick, her glucose goes up Take insun even though they're not eating ‘Siress causes ths Take sps of waler because -> dehydration Slay a acve as passble to lower the guoase Complications of Diabetes There are 3 acute complications, which you have to knowl Complication | Low blood gucase IDM or DM2 > inguin | DKA = Fich AGL in DM, debetic coma FENG HIS, HENS 3 High shock, hypogteasmia, ypogycasmic shock | Ony ype because ance names keloss prone BGL in DF Cause -Tial enough food “Foo rueh food “Toa rush food “= Too much nsulrimedeatn? ‘OFRMARY GALI > st imgassbla for ‘encugh madeaton “ot eraugh medion ot enaugh exer “not ercugh exerose ' oRDENG To Pav a low gutose without |-nane ofthese are the # case none of those ar the #4! cause bong overrnedcated “Bl causo :acule vil upper respiratory nections Too much exeresa whi the st hwo wooks wal pheryogis| Danger Bran cerrage, whch s permanent thay recover vathn 3+ dys but aller thay recover rey, hey slat gory dawnt > letharge = Theveloro, ASK F THEY HAVE HED ANFEGTION “The stass of the dnass was nol hu off > fals ware ‘ured fr fuel ‘Sgrs and = DRUK SHOCK DKA" “NON KETONG 3 OE. Symotors ‘Detyraton Vary sirpe fo understand DRUNK. “Dry, poor easy, warm skn(walerin |= Ths the exact same tinaDRUNK: “Dry, poor easy, warm skn (water n|=TNg the exact same thag -Sazero ox tol) scare aver car nanny «| a Saar sured span Shc ed NSP eT Pa poorer exter vue deh Seton tly kote ate emotes oe the plc bh cy Kato nod es? bron you too kloan your re Dose sod bon fous tron) you hve OR ed ntsay a Taste Kotrsin toad 00k ter cate ho asp -yptorsen kus repatre “Tavera asp “Tenens on co rd cry Alor ae Heh potsun Ted oxroris “ase rl ac) “hosone rsh afruty oar co Anerens dua 1 rausoa ‘They dant want fa eat Treaimnt Randy etaolzed crbaydaes ups) | oDE'WORATION > FASTIV fats “Furbr one be MF oy Juco cl ith rogue rena urd 200m -Oulearas: rerasad une Reguer pop {Man ston does mater even fits 05h | up, mast mucous © Chewed up cary (eecaso Lon hs 300 ares nf) rrarbanes ot ork DSW coas rat even sty fhe vee -> twit |S exsts CEFYDRATION ‘tay 1 eresa ypergycams uke OM er DSO Its DRA without he Ker ha ° ‘Als rytaon eerg oukm olay But you want a sug + starch 08 prota (ced stot) Crackers Ske of tukey ‘oMk:s supe and protan (ut you use SSKIM miso you dont break down the fat > ketones) “= uncansoous -> CLUGAGON M Dextrose IV (00 or C50) ‘Bath re anproprat, wha! determnes wheh route? The salirg Questions: \Which one i nsuln the most essential in treating? DKA \Which one has a higher fatally rate? HEDIR/HHS Ifa DKA or HHS comes in ER, which ane is higher priority? DKA = DKA comes in alot ler due To worse symploms thal oocur only ater in disease ~ THINK 's treated but in bed shape ~ De frst without treatment: DKA, Long Term Complications of DM Due to = Poor tssue perfusion ~ Perphera neuropaihy Rena falure, mpotence, incontinence, can! feel when they njure themselves, can't hee properly when they injure themselves, retina neuropathy \Which lab test the bes! ndcator of glucose conirc? HAlG/glycosyiated haemoglobin In control 6 and lower = Out of control 8 and above Therefore, al risk/on the border 7 © Need evaluation, work up, infection somewhere Drug toxiciti There are 5 thal you need to know!RUG THM LANOXNDICOXN AMTNOPLN DLANTRY |BLRUBR USE “Ankmenadiy = Treals APB and CHF /-Arway anipasmade “Usedior —|/-Pot acu, Used for body |-DIG"= ARB > abe) |-Techncaly nol branchoditar >it does not | sezures | byproduct of Not wed for susie the B2 agonels 1 branchodel, breakdown of seressen bul fr {us rb a spasm BCs rena ~The erway dts snoe was nerowed butt Ory testa ‘s rota broncradetor eorrs on ‘oF ar nstires, acute asta aack > nabs bronchodlaor may not work ely -Newbors have to spasm, therefore, use enispasmode. high bru (@rnrafir 1 mal sam then gue because breskng brerchadser down mom's Cs ‘Thorepouie 06-12 0-20 o-20 10-20 -Biovated vel lovet which is = 20 = 99 and os, s oral for 8 ewan Toxe lvel 20 or greater 20 greater “Und IDs ren thexapaule > need mare or 20 or 20 or greater Thera s 8 grey rea | Tharefore, 20 can be ‘a they tekng eater (2 20)-> ro books | therepoute or lone > If |=Tane lvel 20 cr greater Therelore, ‘gee lo wha 60N3 | ges you 20 you answer it 20's foxe’ nh lium! thal Yowe refer Than co ‘harapoute (lo bo so} ‘Question: A chid wath what birubin and above do you think needs fo come to the hospi? © Usualy abou! HHS where doctors slar thinking about hagpiazng these kids 1X8 can be managed with sunight Kernicterus: Birubn in the bran which usualy occurs when levels around 20 because it causes ASEPTIC (no germs) MENINGITIS end ASEPTIC ENCEPHALITIS cue to iain of bin Jeundice: Yalow colour due to birubin in the skin Opisthotonas: Pastion the baby assumes when they have kernicterus > HYPEREXTEND dhe fo rrifation of meninges with the birubn © Newborns are unbelevably flexble © When They extend, ther hees wil come and touch their ears co Pad ‘Question on NCLEX: What postion do you place an opsthotonic chit? = Put them on ther soe Physiologie Jaundice: Birubin s abnormal at brih, over the nex! 2-3 dys goes high on biirubin Pathologe Jaundice: Brun s hgh al brih, yelow af brih Therefore, f they come out yelow, SOMETHING IS WRONG If hey turn yelow, i's NORMAL NOTE. Lithium and Lanaxn both start with L Ther toxic levels 2 The rest > Dianin, birubn, amnofain are 20 's unrealsticaly preoccupied with fears of being left to take care of himself or herself % Dumping Syrdieme versus Hiatal Hemi HATAL HERA DUMPING SYNDROME Regurgiaion of aed no the esophagus bocause tha upper pat of Uanaly fans gare surgery n whe the gastae somach heres upwards through the deptragm antens cp foo quckly othe duodenum Description 0 Case conten move n the wrong drecton ‘oGacire canianis move n he night ection co Slamch emotes ata nocma rata ‘9 Stomach emptes a he wrong rato (creased) ‘0 GONG THE WRONG WAY ON A ONE WAY STREET ‘0 YOURE SPEEDS Plan GERD > Fearburn and ndgaston “Easest we fo vernerber & To lake whal you aeady “You can have GERD for mary reasrs bul GERD makes hald herna kaw ard corona fo eau durarg syncrorne “Foal herr is GERD # you la daw eer you eat Take about DRUNK “you have ndgaston and heebur, doesn’ masn you hava hatd herna Staggering gat Dames: eSurred speach ‘OTse gals upin morning, sks braakfas, passes meds, han at 100 olmared uct gets epgasire burnng pan, ndgeston ‘oDebyed reaction tena > GERD, yes HATAL co Labib ematace ERMA, no because she dhe down and dt eat ‘OBECAUSE wth drmang snckerna > (©.Co home, cat nner a 8pm, ss down walches tv, hf hour bler decreased corebrd perlusen feals coved 20 mre lair eals chs, 20 rs alr eal, hen they |. Talk about SHOCK (ge! red, hay goto bea ha hour ber > buring, epgsse p2R, | HypotensionTreatment To charge tho way he stomach erp, au Inapeston -> PIAL AL PERUA, yes, Daca cd down night eer ‘0 Techycarda ‘Sgns and Symptoms they ale (© Tachypnes ‘oP, col, darrny skin “DRUNK 4+ SHOCK > FPPOCLICEMA, = Then ats ACUTE ABDOMTAL DISTRESS ocerang Pan Guang eBarboygr Tenders Darrhoa Bbaing ‘Dslantan THEREFORE, SES OF DUVPRNG SYNDROME, FOPOGLYCEMA DRUNK + SHOCK) + ACUTE. ABDOMINAL DISTRESS You want stomach fo erply FASTER because fits emp, want refux | You want the stomach 1o empty SLOWER ‘Ligh poston — granly emphasslomach fesler 1.Law postion ~ head fl 7 2 Lead meal wl go trough he slomech faster therefor, rovessed > thoy shoul ool supine, turn tos, ae at eS untos ios She wih Rood doa coe center | _ _3:tigh cabohyate content 2.Lows igads~ oa fads between maaé (cr 2 hier sles) | in HGtefe hari, everything needs fo be HHT tes before rater mes) . 3. Low cabahyale content “when everyting is LOW, the stomach erties SLOW trough ast) \What about protein? Low proton i Natl Rela High protein n dumping snckore ‘whatever cas prota the oppostea Potassicuty You need to memorize three sentences l Prefix meening HYPO or HYPER b Hyperkalemia = Low une ouput, lw HR HYPER KALEMA HYPO KALEMA Bran Aglalion, restlessness, Imlably, decreased inhibins, loud, Lethargy, coma Lungs | Tachypres Bradypnea Heart Bradjoardha Tachycarcka T waves are peaked and tal ST will be elevated U wave (goes down) ONLY THE HEART RATE IS OPPOSTE EVERYTHNG ELSE IS SAME AS PREFIX Bowel | Borborygn, derrhes Constipation ieus, dec bowel sounds Muscle | Spastiiy, nc tone, 3+ or 4+ reflexes Frecoid reflexes Kidneys | Olgura/anura Polyura ‘Question: Your patient has hyperkdema, SATA THOUGHT PROCESS: Draw arrows (v) and (*) and draw exceptions (*) = Adynarnic lous (¥) = Objundad I+ reflexes (¥) ~ Glonus (rtabity) (9 - wave (goes down) (¥) ~ Depressed ST (¥) ~ Polura () ~ Bradyearda () Calcivte 2 Calceria's do the OPPOSITE of the prefixa HYPERcalcemia = everything goes down, b HyPOcaema = everything goes up IL GHvostek's sign = Cheek > you touch ther cheek -> spasm which i a sign of neuromuscur rnibilly assocated with alow caloun il. Troussee's sign = spasm of hand when you pul BP cuff on Maguesicuty 3. Magnesemia's do the OPPOSITE of the prefix pomp sem ani be a te, thal a symptom be caused by potassium, cabema, magnesum? Probably not magnesium because i's not a major player IF itis a skeletal muscle or nerve -> blame it on Caourn For everything else > blame il on Potassium ‘Question: Your patient has darthea hal caused if? a. Hyperkalera (passbaly) D. Hypokdemia (50) ._Hypocabema (passbily) d. Hypomagnesemia (possbity) THOUGHT PROCESS: Ths symptom is UP (") Three posses ule oul magnesium Not a sk muscle ar nerve Blame il on polassum >A ‘Question: Your patient has tetany Whal caused if? Fyperkalema (possby) rypokelema (NO) rypocabema (passtaly) typomagnesemia (postal) THOUGHT PROCESS: This symptom is LP (*) Three possbities Rule aul magnesum It IS a sk muscle or nerve Blame it calaum -> c ‘Question: Your patient has telany Whal caused 2 typerkalema (poss) rypokatema (NO) rypercalcema (NO) typomagnesema (postal) THOUGHT PROCESS: Ths symptom is LP (*) Three posstities Rule out HYPERcabema because it's the OPPOSITE Don’ Just thnk calaum = muscles/nerves Don't just think potassium = hear! Therefore, i a le breaker between magnesium and potassium -> Pick polassirn > Potassium Caleium | Magnesium Hyper | UP except FR-UO Down Down Hypo | DOWN except HUD P P TARGET Misc or nerve‘Question: A student nurse runs 1o RN -> Lust ran a whole lire of sodium n 10 minutes, | forgot to clase the damp Whal eectraiyle imbalance woud you expect 10 526? Typonalrema because of flud overioad ‘Question: Which patents put on a fd restriction and Lasx? Hyponatremia ‘Question: which one is gven ils of fads? Hypernatremia ‘Question: who has hol, fished, dy skn? Fypernatrema ‘Question: in aciion Jo HYPERKALEMA in DKA, whal other elecirlyle balance is possble? Palien! & Dehydrated -> Hypernalrema ‘Question: What nursing deanosss woudl be essen for hyponalrem? Flud vdume excess ‘Therefore: For SADH| Overload | Hyponatremia For DI_| Dehydration) Hypernatrema For HHNK | Dehydration | Hypernatremia Other Notes The earliest sign of any electrolyte imbalance = NUMBNESS AND TAYGLING © PARESTHESIA = numbness and inging Circumoral paresthesia = nurroness and linging of the Ips ‘Al electrolyte imbalances cause muscle weakness © PARESS: Muscle weakness = Oni fests potassium Hypokalemia 1. Never push potassium IV 2. Not more than 40 of K per ire of IV fad a. f more, cal MD and canfy Hyperkalemia These are ways fo lower potassium: righ patassum s bad because il stops your hear! -> cerdec arrest Therefore, HYPERkalemia isthe worst electrolyte imbalance! Intervention | Give DSW with regu nsuin Kayoroale- Kay ox ato Drives possum ra the oal end out ofthe bad \whal electrajie ches Kayexebe work wih? "KAY Kay enfers fast Potassum enters tho oak fest Does i make potessurn ener the cel ar ex the body? EX!" Doss i fast or sow? Eat orale? LATE” What it does? a. Fastes! way fo ler potassium a. Coos info your bu (ener) or ora bts the potassum n the bod that wE kl you, nt he |b ts ul of SCOUM ober ha orn jet Shes Sadun no you Boos ‘©. Doss DSW gat rdf the exta possum? NOI st | But to mantan negalve equlerurn -> polassumn s keked out of the blood nia sh fo the cals teyt “ 1d. Doos i sob tha pec fe. Trades SCOUM for POTASSUM . Why co we do? To save thar Ml! {Delonte {-Fotassum wi lesk righ bak nlo the ood lr @ gy Blod sls cut hypectakimc and ends up wh pert > pe a DEFPDRATICN i Therefore, cure the typernatvema wth acs Upside FAST AND QUGK Geldof ta exoass polassum aul of fh body > doesnt recceur Downside TEMPORARY TLiskes a ong trl ous, ad you ray nove hal ng‘THEREFORE, GIVE DSW AND REGULAR INSULIN + KAYEXELATE SIMULTANEOUSLY! x Endocrine Ovewiew ‘Thyrolds and Aarenals and youre good to go! Thyroid POPERTHORODISM roporoRa0ist Tun “TPORODSI ino" METHBOUSM — Fypee-ETABCLSM Fypo Melabalsm SCS 6 -Woupt Ess “Fis boxng, od SYPPTOMS, hjpertanaan “Cll nlrares crete “ist totrares “Hest nslerarca “Brecarca Cd tkrarce ~Shw prooassrg “Exceritains (gry ees) “Eracyanea “Tachyarda “Grave's Dssase + iperthyoxism —+ Youle gong orun youself nio.| MUMEDEMA COMA sth casa The race 7 Racracte bdo Lo enaugh herwenetherefre, GVE THEM THOROD ‘Pent shou be by theses fr 24 hous rae room) | HORMONES (yntrocevoiroxne) B. After haley hava ob vty ctu une» fh hea |2-Do no sels these pope boca theyre asc super tenes, hay Sol ure on he gourd cal ezadous tears Sv» coma NDT housekosang {a OUESTION 960 baler surgery boca. then thoy can ako Rak fo rurs0 —> RPE, thee med hoy don hava hee Parmanas erase 2.BTU (gop yo wa scorn kl am “PUTS THIROD OER b NEVER HOLD SINTFROD without expressed cds to do 50 Must beng coun thyoxd bermones Pray ube & Tor career bul one of i's speod ses & for throu Walch WEC cue fo mmurosuppresson Report mmedatel fever or sgn of fection to HOP 3. Surged Remove —+ Thyrodsetory (eve par or do the tyro) ‘Pay atiention to 18 fold cr subfol tyrodactmny, yu Weal a the same, you wi go wrengi ToTAL TreRawecToMy Lifelong harmane ceplacerr You we a rsk for HYPOGAL CEMA becausa i's dos! mpassbie 10 spe the «Paztiyrad Gnd — Low PTH low Cacurn {54S ~ caoum do the opposte ofthe prefix Paresthasa - early sel of ow oaum PARTIAL THRCDECTOMY = May ba an harmanas for abt But nat fe fg Na hypocacera wth ths, hawaver, hay areal sk for = THDROD STORM or THOROTOXICOSS (0! thyoweciomes never sf al rsk for ths) + MEDGAL EMERGENCY — BRAT DAMAGE —> FERMENT 54S FOUR REALLY BAD THNGS) ‘a SUPER hgh ferparatues of LF and above b.Extremly hgh BP —+ Strake category + 20180 (ar rstance) 6. Severe lactycardis 180s - 200 Psychos ceirous TREATMENT of Thyrotowoass. (9Gol ferparature DOWN OFRST be packs ‘BEST Caclng benkat Cet oxigen LP ‘02 par mask @ OL ‘oon can you kaap an oxygen mass on the detaus pant? The s had * OOCENFRST THEN TEMPERATURE but aways pk STAY WITH PATENT ‘0 They wil come out fit tharwales or thoy wll de ‘9 You do ro! wen fo medeale ‘oF or instace, feral wort work because the hypothdars & nt werkeg ‘0 The set Fring conden ‘owe do © SPARE THE BRAN unt they came out of TREATMENT(0 Two stall foc ONE patient (20 POST 0° RSKS Inthe fest 2 hours, no mae fis festa, 4. Aw Baer — presses on eway S.Hemacage ‘Endocrine glnd has las of BV Aor 2 hours... 'A Post op rsks B48 hous alter 8 TOTAL —» TETANY db to PCedoara B.Post ap risks HB hours ailor a SUBTOTAL —+ STORM Tswin T Ss with S After 48 hours. ggest rks fection "Never pick infection before 72 hours WITH anylhing! Dsseases start wih ether A or G (same as Actenal Cortex)! DDSONS DSEASE CUSRES SPDRO-E cer seraton of heater ore, ‘Quer ecto of th acral ores SOS & Two tgs yeu need 1 now. 1 you fave a “oy bank acount youhave a "eshy” char SRETOMS ——Hpegrenies IF you hav oy hy YOU RAVE MORE: ery fred "mera sian ol go for SS of Caching AMD ce tact They ak ey ‘GORTICOSTERODS (ne They dor ep 0 sess raw 9 elie o ile man cae CUSHMAN then you re ur ses theres ares 12 | 4 ayn tenn yor ban pipe Ripa sresraperse—raeghenoand | 2 Ae THEREFORE — Hhpopieoma rd necercen | 4-Aetanng wer ooek 8. Gymcamato, Breroned easing 7 ie aon 8. Cri obesty 9. Losngk 10. Cetecprass 11S 12 rcremad chose — Need acushecks ol Even fyouke rot be 13. iia TREATMENT Seok You favo foo much — You need o cu out —+ ADRENALECTOMY TE oy at as ‘ Bltrl acrnattany Problem s you canine son's dee (Then you hve fo fk coricaserxs (Than you er uplooting ke Castanea (Takes 8 yer or wo narra "Ths 6 te sve asypertyroder You gta tyradectory tak rad hormones gre and ayrpame ok ke rare's eae* Children'y Toys, \When you see! fos, there are usualy 3 things to conser ‘sit sate? 'sit age appropriate? 'si feasble? SAY 1. ara os unc age 4 RF eapraon CORSDERATIONS a Theyre over 4's fre 2.1o meld tos f oxygen 8 ise Be sprts a Fancy word thal maybe used + DECAST 3.Bewere of foros Fores non hing cet ha harbours miro egerrs Vectr — hing rg a harbours mie gums 2. Toys ere roeroa fertesm pedare war because kl ik her mouth ad passes nto other ks hich toys are the wers ores? STUFFED ANMALS hat ere he bes! oye? HARD PLASTIC — dervect FEASBLITY Can you do 7 Could you actly play wih fe cid n he sao? Earl suring okay or a B oer ck? YES Mee aly, common sl Age Appropriate Toys ree 9 PORTS Se rERTHERS | TODDLERS LO YEARS |FRESGHOOLERS) SOHOOL AGED | ADOLESCENTS osramts eaee Bestop seas isring nda _ ering nvocaen Ba boy Rah poy @ Wek nfrw |eGREATNE Lal «Par gos robe CREST PSMIEE Spat os ot mo [ernie | “anche sTreoksse etm pattesiton, | webd Oe Fre dey | BE GIES. | 6a ey dora? rcyrotes [een togh rca |ebapby i he waren her | P= Patra at JsSreteytt | Sot cree nt ora, CEES |asiatatte gd | Paha th rraseOTH |etarg ty urd | trgkests rg iy ee, [agers | rey amatr_|" Ste now | br he wero EE area | terra tink | of ey ge ova stort ceerng | tert Satine era USE rc roca | canna, wiper | “hasten ado faves Yau py cdive | ache = Grabink nes | gga aps Siouoet ems | tceg foetal |ehapontdacay sso sCiprave | Mupeale | Rrrona SoS pet cow Catia maria fet | aetna an | Sraprron i ‘heme! on fb winSwooay | aFegerparegs | tetera | ' har URE dele eYarcoweto ten you) ‘bas ES Sopmsenros | es |e hossyouge | rot artes sepraton cover repeat {Cou 97 meno parieg Iisterd|*Ther Heo | crs asic | EMSS score en te Siar fare S| per | ur Fer aa. t oye Sears | wemanseasrro |S rates | Ba panro They | "pate Ces tat ve ais wees Ferhat” | rigaie | RENE Tey | “ein wpa a0, mae Eig Suterdtows |p tarenee SORT he Bar | peachy Be ‘Seat yartrteporese bart! ir pck rovers th be | Sn etrarpes isco | SO «+ Socond bast for fokniro wore kskens? | Oe Shuaad Something LARGE but Fans rake tem stat | sae cease re Bd Sat Sa, + CoueSTNE etd tae Cena eects ie deta hwo mug ort Th mae |" aera sconrerTNE (noble ypu | rea hy cand ‘eri Romsesupind | Sovatgrpoata oressnars Shenguben ors oatneene cree |e The ewe Petts preorder Laminectomy Lamina: Vertebral sprus processes —* have you ever fall the bumpy bones on the back of somebody? I's not the body of the Verlebrae, I's the wingy thnges —» those are the larina Do you remove the raund bodes of them? NO You removed the wings The posterior processes of the vertebral bones WHY a laminectomy? To remove nerve roo! compression because sometimes when thay come out of the spinal cord there's cabium or herniated disks or inflammatory masses pressng on them —» cul away Ihe bone —» gve nerve mare room fo exi! —*releve compression of nerve root ‘S&S of Nerve Root Comoression Three P's Pan Peresthesa - numbness and tinglng Perass - muscle weakness ens Most imporiant thing to pay attention fo in any nerve question. LOCATION! Location determines the symptoms + Location determines the prognosis © Location determines the trealment THREE LOCATIONS OF A LAMNECTOMY 1. Cerveal — neck 2. Thorac — upper back 3. Lumbar — lower back Corveal Thorece Lumbar Most portent | Gace! meres dipiragm andarms | Therace mverles > abcirarel muscks andgut masks | Luter mrerates babi pre-op ax andigs Assessment 1.Sreahing 1. How a pint coughs 1. Last time of vod 2.Back up answer — funcon of rs ard. Pl hand on ebomen, cover your mouth, and on oy gaia. temp or fu? has fhack up answer wei you fo cough You shoud fea conection + You |Back up answer > GAN cough function of igs b. en horace spin cord yy You can no lergar contrac! your ebdomen You sre parized — You CANNOT cough You can brea 1. Back up answer —+ Bowel sounds POST OP LAMNEGTOMY Mobiizing Patients After Laminectomy. # Do not dangle * No sting a sce of bed Go from jing down mmedately to walkng around Can they sit on the sde of the bed fo overcome orthostatic hypotension? Yes They shoud not sit with feet on the groundfeet off the groundisting at sie of bed — NO! Do not si longer for 30 minutes * Question: What typical post op order woud you question with laminectomy? Up in cha for 2 hours TD ‘© Up im meas is okay because meds are only 30 mnutes They may walk, stand, le down WITHOUT restrictions RESTRICTIONS ONLY WITH SITTING. \whal worker in hospital has the highest risk of back injures? Unit clerk because they sit al day Post-p Gomplcations - Depends on location! Cervical | They won't breathe deeply afler surgery PREUMONA Thoracic ‘They won't cough so wel PNEUMONIA and ILEUS Lumbar | Lumber nnervaes biter andlegs | URINARY RETENTION folowed by PROBLEMS WITH LECS ‘Question: You are caring for patient with Lanbar oigodendocylora Whal i the number one problem? A Away B Neus © Cardac:errhythrna D. Urinary retention — Because i's LUMBAR Al you need fo know 6 the location, you don't need fo neoessanly know what is! ‘Typical you don't have chest tubes with larinectoms bul with an anterior thoracic lainectorny —* from the front, you go through the chest, 10 the spine Pheumohemothorex —» requring CTLaminectomy WITH FUSON —* fakes a bone graft from the lsc crest ‘© If you Take the disc out, you cannot have bone on bone ‘+ You take bone from hip, and pul in between to fuse i so there's no grinding ‘© Therefore they wil have TWO incsions ‘© One on hip and one on spe = OF those Iwo inessians, which one wil have more pan? THE HP = Which has the mas! bleeding and cranage? THE HP. = Which has the highest rsk for infection? THEY ARE EQUAL 1 Highest risk for rejection? THE SNE, = Therefore, HP causes mare problems = Why do surgeons want 1o get rid of hp cision? Shorter recovery, decreases RF infection, decreases pan ‘© Surgeons are using cadaver bones from bone banks To just have ane inctson need of two (© Nowadays they are moving away from cadavers to synthe bondng materials DISCHARGE TEACHING: Four lemporary restrictions and three permanent ones TeEMPoRary PERMANENT ‘A.Do nat il for lnnger than 30 mutes which apples for 6 |A.Do nol pick up objecis by bending at the wast, bend with the weeks knees! B. Lie fal and log rol for 6 weeks B. Cerveal laminectomes are not alowed to If! anying OVER THER ‘C.No chwving for 6 weeks HEAD. D.Do nat if! more than 5 pounds for 6 weeks (C. Need a step stool n the house E.A galon of mik s about 5 pounds 1D. No yerky car rides, bike rides, roler coasters, ete E. Ths lecture can be used f0 get any spinal cord questions correct! lab Values: Know which lb values are more dangerous than what ather lb value? Prientzation NORMAL LVS. PRORITY 0-2 a Phone cal worthy onl they were gang fora test thal had a ajo nt 2s 103s and above = C What do you do? Flow an order [Fst tng you do & HOLD feaumd) 2tfler you had then you asses but a FOOLED ax asad an whch body part 23 Prepare fo gue the dug (vlan K) Gal physcanRTiate 35-53 ‘ALLOW polassirm & 8 C Do you hag? NO. 2x ta heer 23 Prepare fo acranster Kt carp Bahween 54— 59886 Tidal ke 2th heat Prepare la gve Lyoce and DOW and regu rn Cal MD 6 end ae s 0D Deas eergarous Rome roel but mea sla on herds Don avo yout ad co what you can do tho occ 75-755 Binds aD ‘kx vs fe pH ps gone down! (ny way fo cat fo rest no ung cao wot gt tho pacino he cot Sa wth no psnt 8-25 ax for dehydaionHow many unis co you buyin s pack 8) 2-8 ‘B= Tis 8B pronly > ax for lw HB > Besdng or mhution arena) F< Bisa 6 do something Ax fr bieedng Prepare fo sdmnster blood Ca he MD 22-26 ‘Abporral bearb san A igh in he 508 those re Clava I's erica Not COPDers just normal Le respratry slats 2 Pursed ip breaing 3caMD) (C02 thas the 60> D (Rasp Falure) | Super igh tony {2Do rat fave fa rocrn 23 Prepare fo bala and ventilate Cal Rasp Therany and then cal MD ape rasparsa team rach be cali 160 vated Het 6 @B Ax dehycaton| Fils bow busin 705 GOTH ASSO Lx respaloy Prepare fo ernst C2 ‘when hypo ha heart wlneease FRST then resratons wl “Two common cass fr epsode lcyeaa pone (Gue angen) “Dehyeaton AV fs). fn 608 5 8D Rasoratory fale) = C02 n 60 -02 neds Both in 60's > nubs ard venitale [Theews on C2 ta rake comfortable 2axpl ‘3Preper to ntubte or ventate 4 tay sah patent SCART ‘ving ass an %B s a Ax resp Prepare 02 In padres > < 90% 83C (CCPDers run hgh on C2 an aw an 02 ‘Anema fsa elevates Sa02, herefere look for olher was fa ax oxygenation ye mlast 48 hours a0 fay elvates and vales O2 because do colours the blood <0 410 888 > CHF but youre rol gonna de, fs @ehvone condion| B5-H5 Amn saB Thigh a for detyaraton If low ax or verted F queston sys a abn and change n LOG tsa G safely ssu2 Tota WAC 500-1000 Absolute Neutrophil Coun (AC) 4 500 (CDH count 4 200 ‘Al abnormal vals sre © Ax for sgns of rfecton Pisce Ine on neuopene precautions Flow src! hand washing Shower ED wh anicrcbal soap 4 vod crocs 7 Pruata roam 170 fresh fers or potted pnts 7 Low bectana det- na raw feusvegges, no undercooked mast ‘when < 200 ADSI 7 No wer dining Bean sing for longer fren B mnuies 7 Vis OHH Chock WBC cay 7 Avo reusable plaessterwere ele, “Theertbooyfapante <90000 “Thrombocyiopanc 6 aC > bisedng precautions F< 40000" D Prepare trnsfusen an cal doctor = 6 mon Abnarrals 8B If they ge you an elevated biood value, you have no idea, dehyckaton is a good guess because when youre dehydrated, your blood cals are inc = dehydration ‘Ax before you do unless delaying whal you do before you ax woud pul your patient al higher rsk Delaying slopping the biood To do an ax -> inc nsk, therefore you do before you assess Postion first there's TWO DO'S Bul wha! ifs a RST question versus BEST question?© BEST = 02 © FIRST = Rase HOB MEMORIZE THE 5 D'S pin the 65 Potassium in the 6 (002 in the 60s PO2 in the 60's Platelets there would be 70U of NPt and 304 of Requar ~ f you gave 50U of 7080 > there woud be 35U of NPH and BU of Requer 2 Gan you mix insulins in the same syringe? Yes How? You wiant fo be an RN right? Then do itn thal order Regul then NPH Glear then cloudy Pressurzang the vie? inject the ar info he N frst then inject the ar nfo the R Then draw up the R then draw up the N REMENBER NANCY REAGAN RNY 3. injections ~ They wil gve you the name of the nection but ask whal neede you need fo use EXAMPLE f you're getting an IM injection, what need wil you use? a) 21 gauge 5/8 inch b) 22 gauge V8 inch ¢) 21 gauge | inch d) 25 gauge 5/8 inch CLUE The clue sin the abbreviation ~ IM Look at the frst eller looks Ike | Therefore, choose the answer that has both fin them ~ SC-IF youre geting a SC injection Look al the abbrevaton, SC S looks tke 5 Choose an answer that has 5 in both parts Therefore, d Heparin versus Cournacin Heparn Couradn Route No So PO onl “Therapeutic ‘Werks rmedaley Takes afew dys fo 8 wack Io work ‘Acton Onset ‘aren be gvan fer longer than 3 weeks) CaN be gven forthe esl of your le (e1osp! for Loverax) because n 21 cays YOU slat fo make hepern antbodes Li Test PIT PT which 6 whal the NR & danved romoparn = 7 ars 3fnges elt = PTT | couracn = @ trgars 2 nga tl = PT ‘Anidote Prolamre Sufala ‘erin ‘nePan > Prolare "Kouradnt Pregneney | Can be gven io pregran! wamen | Camo! be quan fo pregrant woman Cass G TEACHING: Never says they are blood thiners! It prevents fo gel bigger! What's the only major Irangulzer that can be given to pregnant women? ticol | K Wasting Diuretios = Fitends in X or + DURL > X's OUT K > itis POTASSUM WASTING. ~ Fit does not end in x and i not a duri -> it s POTASSIUM SPARING "“SEMDES are typicaly Xs° 2 Baclofen and Flexard Boards esis about these muscle relaxants POTENTIATE DOWNERS: Side Effects 1. Drowness/Faique 2. Muscle weakness Teachings 1. Don't drink acohol 2. Don! drwefoperate heavy machinery 3. Dont be responsible for the care of chicken less 4 year old Baclofen if im on my back lbafn, tm on my baclofen" IT'SA MUSCLE RELAXANT Review of Piaget's Cognitive Development Theory They never reniion Paget's name but wil ask aboul how you wil leach chitken FOUR STAGES FOR KD'S THNKING STAGE ‘ORENTATION TEAS G2 ean O05 Total pesentonenied | When A youd sersoky Youre caren senso wha iy dong owe Verb expan (nk abu when Tosh am BEFORE thoy SENSE ce ze | wlong bre Ser bore CONG ngs now | Esa "The meron a dy ol 2 hasta ‘3.6 YeaR oLps =r (Grp cla ety asf oth SEROUS oso csp or (0 Fanny ore aga None ie orig “Teogh than DAYS ALEAD 7—1yeaR OLDS Live are hades | Hau ago A oho aera Concer CPmRATIONAL Tissot sich! GRSTGESUTE ha ol yur gag 0 AO how oc als Resnoradey | Pod They wl She Youn ham every sng re Groaaretanee —OHCTE aoc Hau os erp ary naman "95 2-H vEAROLDS ‘Abseci” en GE oy Fontan ohoaronae Eonge bt ingcanmarage hr avn cas? Tank couse > [apy ot wth csi tress erect b)e yes oD 1) yr cd wih sepa ne 1B yok CF yest Tote SEVERITY of tha hes, he AGE the kd [AID ctdcarot rege he srape baz you have fo each har haw To wath 8, pokspor, and erage Vii he sao wy fr as erg Toya doa wal hy do \ahen ts scar? With pus? They wl STLL DOT Maragrg casi mam darg varying mass krewng wha hey on federal ea Meragng = 2+ Sidewe Prychotropic Dugy Note All psych crugs cause a decrease n BP and weight change Phenothzres Monoarina Onease (MAO) ereors FLUOXETIE Al endin —ane ery potent lrredateonsat 7Ex Thorne, Compszne Bia Totrank Aven Das pram, 1. “Aninaly meds (consdered mine renqulzers) Aways have par, am fate rare Prototype Dazepan (aun) Fp Nara Pirate ‘in bcrchie— rote tum ending at 9 potas ‘SSB (Aniapressen Doas rot eure dave Recuoes syrptors Lxge doses Paythote smpions (Hetertare, Sal doves PeuaeaVoring Mypr Trareuters 3 Anmdapresant reed elvan” fo raw depression TInducten of eres "i Pusee rens "Abbe wea v Seaures—aspecaly sais enkepeus \ Faollles mechan ventaton 6 Trangulzes work quekly ‘Mit rot fat’ far ore an D dys weeks mas 1 Reep an Valu unt Ea sks | Antdepressants ' Daprasion e hough 1 be ceased by acecency af rerepnepiere, copsnine nd seroann th bran Mercere ‘nts i he enzyme response fer breaking down rerepnecten pare, ad serotonin MAO Inktars prove the breakdoun These neuotareres and hus estore more orm levels a ecrease deprasson e2 weak bea or rating BPD rane cepresson) i decreas man ‘Smile to Eel (A rreyde antdepressan}—seme nfo (Carer ABODEFG...) Apistorerge eect Bled von eraser Fetes Gorceston Bronsnass Bir Pyar Sreteme (5) Fetcerity Fgandcynss (on WBC cou irunoseresson - Tesch faba eer i oa! rt fy SIS lect fo DR ABO) Basta wih E 0s gOxp gos trou) Aohshcrenge Hats Bled von eraser Fetenton Garceston Browsnass Exphora ‘80 Apictoerge Elects Birra von eraser Fetenion Gorseston Browsnass 80D [fichorerge Effie Burred von and Elser Fateron Gorsipaion Browsnase Thea Pe =Peeng Padua) Peeping Derthes) Paresresa Fest sgn of ctroyie mbes) Toxe Tremors eae taste Severe darren “hy her neuro sgne beads paresthesia oe Anichorerge Effects Blrved von ander rel sda fens Tarar ens rug dors fay ‘Secon’ ar raed aug eet lng seg (tt 2 weeks foment) fer gv neon asteie Ft ake made for 25 weak before benef fects Rarer ene rung digress safety Tabara nang danas «las “Toprevent sora co, sorta a hrperrave (stroke) cress, the patent MUST avod al feces tenlanrg DRAMTE Foo caanng TRA-TE 2 Fre and vguastmarber kd “bak) 2400 \Beeree 2 hvcacs 3 Bas ay rer) 8 Grae okay exe gs rade framacive yet crass {no agen mest Wer, key, res oe he presrved eats smoked chad Cured pled hot eos ge pled ts {ho aged cheese whe yegat Wi Gare et bek ceese 2 One {No bend ts, res, cfane choco tao, 307 8 vag rite (Tach patlers oo ake OTC ec ness hey a0 pred oop hated = aveang pre acoyle ik as vals fuse + 7ole Gel inked a saan Ponte saunas Torta rbngthurshatte, calgary figs ee dae he feces orn slo werk as preczbal Sosy tome Pravae cases rear, 2 gve before 2 roonllGD veal 6&2 lohan cangg he do of Prozac for a* A B. c. retention exiscnt cr young a2 wen ter sued Gorse see Exphora Hal idopecda) | Anipsycte “Ata ae cecal am ng | fereerbor ABODE.) reat a acts Nbr re nag ‘ing gven opis who wen ke | Amnchoherge Eficts, ceposs «fet pe Birra won oar “Ear gles may dovoopMeurcleste -Save fo as Trazne fetenton tg etre 7, clr “Vary potent re ‘ala Hperpyane foto) whe orp rece onset Gouna SF From averassa Dass ers “Dass etcire cease Bra Syand Spetome @Ps) | paent Sous be HALF of wad dose “eeaicesserlore PProtceeraty : “Lage ces Pctotesyrpirs | grandocyase (ow WBC cout (Haterator ‘rurosippresson) - Teach So ore Mase/Vorg ger | pant to repr sae oa and Trangicrs fry SS of fecton to DR Goze Conatve iedio esl saver heeprena | Dendarione Agarubsyiocs | Fr here menih need WBC cous Sezer gen apes |Adrvage i des MOT ove sc | (vere en cana dug n ‘reo WE tow TCP mirsehote ‘tls BECOE oF (ruchis) | Scope tei) Bo ot core ath KLONOA CGoraztun) Zoloft Serine Bil wok ower 28D Wal Tr reason wath SgiktoPa: — |ditboenesrearnatutGeribe | Anrarerge Etfecs St Js ware seraenn syetore ‘ven evenings Birra won oe Snr ‘end ietenion Sacsing rete + Agpreteraon reac sre Browsnass ‘som Ewphora *sDestese HetDache + Watre Courade. watch or beeing (ra nd o wer wlan bse) "han ake Zab warfare ae PR sa Maternal Newbour Ovewiew, Pregnancy due Date ~ Negele Rule Take fist day of the last menstrual period Add 7 days ‘Sublract 3 months Example Her ast menstrual period was June 1 — June 15 June 0 + 7 days = June I7 June I7 ~3 months = March 7 of the folowing year Note: June is the 6" month — 3 = 3! month which March WEIGHT GAIN ‘Average Typical pregnancy is what they are talking about here Told weoht gan 28 bs +/- 3. In the fist Irmester, she gains | pound, each month First inmester s 3 months ‘She gans a fatal of 3 pounds n 3 months In the second and third trimester, she is gaining much faster. She gains | pound, per week (On NOLEX, f they ge you a woman ina periicuer week of gestation, you have To be able fo predic! whal her weight gan should be DEAL WEIGHT GAIN CHART Week Weight Gained 2 3bs 8 Uibs 4 Sibs 6 ébs 16 7bs 7 bs 8 Abs8 bbs 20 Ulbs RULE: Difference of 4> Week - = bs gained Example: Wornan in her 28" week, she has ganed 22 bs What is your mpresson? A) Fine 8) Underweight ©) Overweight D) Do anax Example: fn 3 week ganed 5 bs -> 31-918 22 Therefore, she s underweight by more than 4 ibs -> do an ax tke a brophysica profile Faudal Heigl Fundus: Top pat of the uterus Not palpable unt week 12 Therefore, in trimester you CANNOT palpate the fundus \whal € she's ganed 10 bs in trmester, and fundus s WAY up hgh she's ether not in the F!Inmester or she has hypermoler pregnancy (Cancerous) You can palpate the fundus after the END of the F trimester 2%! and 3” Trimester > When is the funcus at the belly button/umbicus? 20 ~ 22 weeks of gestation \Why is this important for a nurse to know? You can use fundal heght to ax the age of geslalion For instance, mom comes n ER after MVC She is unable 10 tell you how far dong she 6 How can you put her in the correct trimester? Pajpate her fundus Non palpable = F tnmester Mom is the priory ‘Al or below the bely button = 2 inenester Mom the prionty ‘Above the ball bullon = 3 Inmnester Baby isthe priory. Signy of poeguameyy (Oni two categories on boards > POSITIVE and EVERYTHNG ELSE Fou Postve Signs Fetal skeleton on XRAY ‘fetal presence on ‘Auscuilaion of felal FR (@ — 2 weeks is when you can hear it ahough it starts beating at 5 weeks) Most OB information has range where i! occurs because every women s dferent Because of hal, be carefU because there coud be 3 diferent questions for every fact. ‘The frst question would be: When would you firs auscultate a feta heart? 8 ws ‘The second question would be: When would you most ikely ausculfale a fetal heart? 1 wks The third question would be: When should you auscultate a fetal hear! by? I2 wks \when the examner papates felal movement NOT the ram ‘The MAYBE Signs Probable & Presumptive together) ‘Al urine and blood pregnancy tests =A posiive pregnancy test is NOT a postive sgn of pregnancy = TRUE, because it means you have the hormonal mereases bul you may not have a felus -> fase pastive pregnancy tes! (Chadwick's, Coodel’s, Hager's ‘a. Chadwick's sgn => cervical colour change fo cyanoss (al those words start with C and so does Chadwick's) the cervix 1s dling i, the vagna is 100 b. Coodel’s sqn > cervix saftenng. Hegar's sgn > uterine softenng 4. They occur in aphabetical order @. Boards tests more on the order not necessanly whal week Patient Teaching iw Pregnancy nal ve > How often |a. Once a month uni weak 28 ( Inmestr, 2 master, up un month) ioome for .AT wack 28, nce every two weaks unl week 36 (6. Then every wack unit debvery OR week 42 ‘LAI wack 42 > C-sacton or raclon woman comes m for 2 week check up, she comes in nex! a... IPM week Than 20, then 23% then 28°; then 20" than 32, 34,36, 37,38. Nema B16 F tomoster Vand it normal 2 reser 105 ar sil rere 3 tenasler Kar tf rave Dssonfors of pregnancy ‘When thay nour and What fo do about Heraghbn wil fab ‘a. Mornng seknass LP teraster iL Tx Dry earborytates before she gets out of bod b.Unnay incontrance i. and master Ji.2* terest > no neaninerce bacaise Is nol on Bader isn adomen Tx Vo rs al tha way from the day she gast pregnant unl @ wack afer duery .Difeuty testhng 1.2 end 3 ester iT Tepod pastion + Feet fe, ars on tebe, leaning forward 1d. Bak an 1.2 end 3 nmester TiTx Pave tt exerases >t he peas ferwarc “That's for prognancy because the res! shoud be common serse > when you get a ‘question you don't know The answer 10 > pick the answer thal you woud pick for somaone alse Pregnancy is nol 8 disease! Labowr and Delivery Tuvest aud Mest Value Sigu of Labour © Onset of reguar progressive contractions, more frequent, more longer, more stronger * Diation: Opening of cervix It goes from (Hem A cervix thal § 0 = closed A cervox thal i 10 = uly diated © Effacement: Thnnng of the cervax It goes fram THCK 10 100% A cervix thal is no! effaced is described as thick A completely effaced cervoc is 10% © Station: Relationship of fetal presenting part to mom's schil spines FETAL STATION © Ischia Spines: sales! dameter thal the baby has 10 pass through in order to be birhed vagnally ft cannot fil through there, i cannot be birbed vagal © Negative station: Presenting pals ABOVE ischial spines