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Nclex study Guide from seminar
NCLEX review (Colorado State University - Global Campus)
Studocu is not sponsored or endorsed by any college or university
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Pearls of Wisdom
Consider absolutes very carefully: All, never, always
Do not remember Q’s and A’s: one word can change entire outcome
Get a whiteboard: No erasing
Minimum Q’s: 75, Maximum: 145
Need to do sample test 3&4
Answers are always an order unless dose change of a medication
NCLEX is test right here right now
Time frames ARE IMPORTANT: ABC’s , 24/48 hrs
After surgery EXPECT: Increased temp, increased swelling, Increased WBC count,
Increased pain
Pay attention to ages:
○ Infant: 30 days or less old
○ Newborn: 30 days after bither
○ Toddler: 1-4yr
○ Preschool: 4-5
○ School age: 5-12
Always keep HCP answer: Especially if 24 hours after procedure
If you have no idea between assessment and implement: Choose assessment
If HCP NEEDS assessment to treat: answer is assessment
Pain is considered psychosocial unless: acute, severe, life/limb threatening
Be careful of do nothing answers: Only will be correct if there is no problem in the
question
Priority questions: when steps do not eliminate answers: what is right?
Diaphoretic=severe distress in the body
Get rid of why questions
NCLEX does not like bandaids
First-time dosing effect:
○ Is there some kind of interaction w/ something>
○ Orthostatic hypotension?
Whenever you see a generic “check vitals”, look for something more specific
Distractions on NCLEX work for toddler, older adult pulling out tubes (confused), some
OCD and manic stage
NCLEX world: all rooms are semi-private
Clean clients go with clean, infected go with infected
Super infective clients and aggressive patients go in a private room
Blow off excess CO2: Slow, Deep breaths
Liver Biopsy: Pt needs to be on affected side to prevent hemorrhage
Retinal detachment: Needs to lay on affected side
Whenever we see a phone call: “nurse in clinic”, we are at clinic, if nonspecific: we can
be anywhere
NCLEX wants LEAST invasive
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Phenytoin clumps with protein
3 lb weight gain over 24 hrs is SIGNIFICANT for fluid overload if caused by sodium
imbalance and must be corrected immediately
When you see “treatment is effective” look for something in normal limits
Most meds are excreted in the kidneys: any kidney disease: Are they getting all of their
medications?
Know all shocks
We do NOT take care of anyone else’s patient
As the unassigned nurse: we have never gotten report on anyone in the unit
If there is a potential lige/limb threatening emergency we can do an uninformed
assessment
Whenever you see chain of command: is there a potential ACLS issue? Abuse,
confidentiality, legal, ethical issue
Chain of command: Staff nurse→ charge nurse→ house supervisor
We want clients to be as independent as possible
PCA should cover the pain if it doesn’t…SOMETHINGS WRONG
Never put in nurse note that you completed an incident report
NCLEX world: Least restrictive, loves to establish trust with patient
Presence→quiet room w/ door ajar→ put something in hand→ vest restraint→
hand restraint→ chemical restraint
As charge nurse we use delegation techniques as the following priorities: 1. Scope of
practice 2. Skill level 3. Acuity
Report of right upper quadrant abdominal pain and nausea= impending seizure
When membranes rupture #1 worry is a prolapsed cord
Bright red bleeding: Never put anything in vagina, could be placenta previa
If it says “angry client” you can have anger in the answer, do not assume
Content Deficits
Albumin level: can tell nutrition status over a period of time
Head trauma: Need to monitor fluid because pituitary releases ADH
MI: MONA: morphine, oxygen, nitroglycerin, aspirin
Don phenomenon: early morning increase in BG
Autologous: own blood, will only elicit a reaction if there is bacteria
Tourniquet needs to be 4-5 inches above IV insertion site especially in older adult
Fluids
○ Isotonic: puts fluid into vascular space. EX: LR, NS
○ Hypertonic: Enters fluid into vascular space: fluid overload. EX: TPN, D10W
○ Hypotonic: out of vascular. Never give for shock. EX: 0.45% NS, D5W: goes in
isotonic and turns into hypotonic
Post ileostomy: dehydration is a complication: Assess fluids at LEAST 4x/day
Dumping syndrome: Volume in stomach is a NO GO
○ Small frequent meals, no drinking with meal, lay down for at least 30 mins post
meal
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Tracheoesophageal fistula in a neonate: frothy sputum in mouth
Food does not cause skin infection
30 ml in an oz and 8 oz in a cup
Honey colored crust= infection
Impetigo: staph infection, very itchy, very contagious, can impact kidney
Strep: Heart/ rheumatic heart
Do not delegate teaching to videos or parents
Risk factors for sedation: Older adult, destructive sleep apnea, CPAP, smoking
Hypoxia: restless, agitated, and swallows frequently
HCO3: 22-26 PaCO2: 35-45 pH: 7.35-7.45 PaO2: 80-100
Left lateral recumbent position: pregnant women
Contraindicated w/ MRA: Metal
Complications with MRA: Metal, allergy to gadolinium (paramagnetic ion, no iodine)
MRA: “all the angio” MRI: “ All the tissue”
Raynaud’s disease: decreased circulation to the fingers and toes
UAP: “SUP” standard, unchanged procedures
Never rely on pulse ox to read pulse
Normal BP: 120/80 normal suction regulation pressure 80-120
Stomach is like a balloon : Never put NG on continuous suction without air vent
Immediately after placing NG tube: must get an x ray
Before feeding through the NG tube: must assess pH of gastric aspirate. pH will be 4 or
less
Phenytoin clumps with protein
Endotracheal cuff pressure: 20-25
Bleeding around venipuncture site: DIC… death is coming
Sickle cell treatment: HOPS: Hydration, oxygen, pain management, safety
Any O2 less than 86% is considered an emergency, <70% is life threatening
Parietal lobe: sensation, temporal lobe: hearing/balance, occipital lobe: vision
Post laryngectomy: Never use alcohol to clean
4 G’s of blood thinning: ginger, garlic, ginko, ginseng
1 baby aspirin a day decreases risk of colon cancer
Peak expiratory flow meter: 4 levels, the amount of air you can forcefully exhale at one
time green=80-100% of PR, yellow: 50-79% PR, needs treatment, red: below and is
considered an emergency
3 things to know about radiation: Time= 30 minutes a shift , distance= 3-6 feet of
separation and shielding= lead apron
Is it a sealed source of radiation= tangible
○ None of body fluids are radioactive
If it is a liquid, unsealed source and all fluids are radioactive
COAL: cane is opposite of affected leg “up with the good leg, down with the bad”
Cane should be 20-30 degrees
Stem cell transplant: intense chemotherapy and medications and radiation of the entire
body before transplant to kill bad cells in the recipient body. Need to go home if we can
prove they will enter a clean environment
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Anybody who is immunocompromised: anyone with pets should not have uncooked
meats b/c of risk of exposure to humans, no large crowds
Lead levels: >9mcg considered elevated
Succimer: medication to reverse lead poisoning→ chelation therapy
Plasmapheresis therapy: filters blood for toxins ex: acetaminophen or overdose
Toxic hepatitis: Chemical toxicity
Complications of amniocentesis: spontaneous abortions, bleedding
Rh factor: mother of baby must have negative and father has positive. Baby has positive
Coombs test: used to see if mom is building up immunity at 22 weeks
Vena cava syndrome: puts pressure on large vessels implementation: put mom on L side
VEAL CHOP MINE
○ Variable, cord compression, Move them left side
○ Early, head compression, IV fluids/O2
○ Accelerated, OK, nothing
○ Late, placental insufficiency, Emergency situation
LIONS: Treatment for late decelerations : Left side, IV fluids, Oxygen, Notify HCP, Stop
pitocin (if being induced)
MORO: 3-4 months “startle reflex”
Infant normal BP: 80/60 or 60/40
Withdrawals for infants: 12-48 hrs: high pitched, shrill cry
If a newborn is thorax breathing: Means respiratory distress
○ Belly breathers until kindergarten
1 pad/hr postpartum is normal unless it is saturated
Only massage fundus when it is BOGGY
Tardive dyskinesia: bizarre facial movements and tongue: reversible if caught soon
enough. Treatment includes withdrawing psychotic and treat with a beta blocker,
diazepines and diphenhydramine
Akathisia: pacing/ rocking EPS
Oculogyric crisis: eyes roll back; white eyes
Neuroleptic malignant syndrome: medical emergency, 107 fever severe rigid muscles.
Treat with put on ice, dantrolene anticholinergics,
Post hip replacement: do not bend knees more than 90 degrees: have someone else put
shoes on, use walker when ambulating
Kidney stones: >5mm means NPO, you will not give any fluids until they measure it
<5mm lots of IV fluids
hypothyroid: irregular periods, cold, fatigued, brittle hair, achy muscles
Kidney diet: low protein: chicken is high BV also eggs
Biological value of protein: more amino acids, the better it can be digested
Plants do not register a any BV of protein
Milk: 91% cheese 80%BV plant based drinks will turn into ammonia
Whey protein: 140% BV, too much protein which kill the kidney
Lactovegetarian: No eggs no meat
TPN has a lot of sugar: watch for hyperglycemia
Fixed urine specific gravity: Kidneys have FAILED
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For dialysate: only count the difference
RN scope of practice: EAT, evaluate, assess, teach
Admitting assessments: VS, initial assessment, coming back from procedure need to
identify if pt is stable or unstable. Same w/ discharge
LPN Scope: SPPO: Stable patients, predictable outcomes, can differentiate b/w normal
and abnormal
Hyperoxygenate before assessing gag reflex or pre-suctioning 100% O2 for AT LEAST
30 seconds
Suctioning is only PRN
Circulation: 4-6 hrs before irreversible neuromuscular damage occurs
Dehiscence wound comes apart: reason can be b/c of an infection
○ Cover with wet sterile dressings, HOB up a little to get pressure off wound
Evisceration: surgeon does it
Leukopenia precautions: Prevent infection, no rare staked, no alcohol based- products
frequently, no live plants in room, use electric razor, no leftovers unless 24 hours after
preparation, protective clothing when cooking, gardening and doing dishes
Stem cell transplant: family is up to 25% match
Day 1 of studying: 1/3/21
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Client safety with restraints:
○ supervision, documentation, quick release, tie to frame of bed, 2 fingers between
restraint and extremity, renew restraint prescription every 24 hrs, HCP must see
patient to renew rx, monitor and document physical and emotional wellbeing
related to restraints
○ Skin integrity, toileting/ reposition/ROM/food/fluids every 2 hours, monitor VS for
response, circulation every 30 minutes
Nutrition:
○ 1500-3000 kcal/day
○ BMI: <18.5=underweight, 18.5-24.9= healthy 25-30=overweight >30=obese
○ Albumin: 3.5-5.5 g/dL
○ Pregnant women should avoid raw eggs and sushi
○ Cystic fibrosis: high protein high calorie diets
○ Lactovegetarian=dairy with vegetarian
○ Lacto-ovo-vegetarian= dairy, eggs, vegetarian
NG tubes: removes gastric contents
○ Need to confirm with X-ray and measure exposed tube length
○ Aspirate gastric contents for pH testing; 0-4 indicates gastric placement, pH>6
indicates placement in lungs or intestine
○ Flush tube with NS before and after meds
○ Do not reconnect suction for 30 minutes after med administration
○ Intermittent suction only
Enteral nutrition: bypassess mouth and esophagus
○ Requires functional GI tract: listen to bowel sounds
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Risks to watch for: Aspiration, tube clog, abdominal cramping, hyperglycemia
HOB elevated at least 30
Administer feeding at room temp
Assess hang time because bacteria can grow
Change tube bag/tubing every 24/48 hours
Flush with water after feeding and before/after meds (liquids preferred)
Monitor BG, residuals, skin around tube
Gastronomy/ jejunostomy tubes: rotate tubes 360 degrees once daily, and pull in
and out ¼ inch to prevent build up of adhesions
Parenteral nutrition: for non functioning GI or increased stress metabolic state
○ Contains fat emulsion, dextrose, amino acids, electrolytes, vitamins
○ DO NOT administer meds through the same lumen as PN
○ Change filter and IV tubing every 24 hours if giving PN with lipids and every 72
hours for PN with amino acids and dextrose
○ Replace PN solution every 24 hours: date and time
○ Monitor adverse effects: hyperglycemia, infection, fluid overload, hyperosmolality
Normal urine output: 50-60 mL/hr
Osteoporosis: loss of bone density
○ Bone strength peaks 25-30 years old
○ Assessment findings: loss of height, low back pain, kyphosis
○ Risk factors: >60 yrs, small framed/lean body frames, post menopausal (lack of
estrogen), inadequate intake of calcium or vitamin D, sedentary, history of
smoking/alcoholism, prolonged use of steroids (>3 months)
○ Medications: bisphosphonates: Alendronate
■ Risk of esophagitis: take with tall glass of water, morning on an empty
stomach, sit up for 30 60 minutes
When you see an altered diet: assume that the client knows how to meet nutritional
requirements unless otherwise specified
Hydration
○ 1500-2000 mL/day
○ Minimal urine output: 30 mL/hr
○ Anuria: under 100 ml/day
○ Oliguria: 100-400 ml/day
○ polyuria : >2000 ml/day
○ Increase fluids for: diarrhea, vomiting, tachypnea, or open wounds
Dehydration s/s: thirst, decreased urination, dark urine, dry skin, dry mucous
membranes, fatigue, dizzy, light headed, high BUN “high and dry”, hypotension,
increased HR
Catheter associated UTI’s: increase by 3-10% every day
○ Do we need a catheter? 14 french is good size for adult
○ Empty drainage bag when ½ full
○ Urethritis: inflammation of urethra
○ Cystitis: inflammation of bladder
○ Pyelonephritis: inflammation of kidneys
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Pain is whatever they say it is
○ Physical when PAIN
○ P: presents due to ischemia
○ A+I: acute and intense (shock)
○ N: not relieved with treatment
Standard precautions for every client:
○ Potential to touch body fluids with hands: gloves
○ Potential to touch body fluids with body: gown
○ Potential to touch body fluids with face: mask and goggles
Contact Precautions
○ Gloves and gown
○ C-diff, rotavirus, hepatitis A, shingles, varicella zoster (chicken pox), MRSA,
vancomycin resistant enterococci (VRE)
Droplet:
○ Mask when in 3 feet of client
○ Meningococcal meningitis, rubella, influenza, mumps, pertussis
Airborne:
○ N-95 mask
○ TB, measles (rubeola), disseminated herpes zoster (shingles), chicken pox
○ TB: fever, fatigue, night sweats, cough with mucopurulent sputum
■ Positive test >5mm
Retropubic radical prostatectomy: abdominal incision, significant or all of the prostate,
removal
Umbilical hernia repair: easy surgery, stable patient
Harington rods: used for scoliosis : invasive
Liver scan procedure: client will lie still while a scanning probe is passed back and forth
over the body.
○ Client will receive trace amounts of radioactive colloid by IV infusion and will be
placed in many different positions on the table. No follow up needed
Heparin therapy: APtt
Warfarin: PT
Crutches: weight should be place on upper arms at the hand grips
Eczema: inflammatory rash caused by immune response: Milk, egg whites and wheat
are common allergens associated
Anger, withdrawal, and minimizing of the relationship are common client responses to
termination of the nurse-client relationship
Client aging: decreased sphincter reflexes/ taste perception/ smell/ appetite/ physical
activity/ muscle tone
In a calorie restricted diet: weight loss will be 1 pound per week
In an acute pain scenario expect decreased skin temperature
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Day 2
● Varicella= chicken pox= airborne= N95
● Tetanus:
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Nurse must first determine the client’s immunization hx to determine appropriate
treatment
○ If the client has received at least 3 doses of Td and it has been 5-10 years since
the last vaccination, the nurse will administer the tetanus vaccine (Td or Tdap)
○ If the client has received less than 3 doses, the nurse will administer both the
tetanus toxoid and tetanus immune globulin (TIG)
WBC count normal value: 4,500-11,000mm3
Normal serum creatinine: 0.5-1.5 mg/dL
Warfarin has a prolonged action. The duration is 2-5 days and the client should be
taught that a risk of bleeding continues for several days after the medication is
discontinued
○ Can be given for long periods of time. Given PO
Diet for multiple wound patients: High vitamin C, High Protein and high carbohydrate.
○ Vitamin C: Helps with wound healing
○ Protein: tissue growth
○ Carbohydrates: body can generate enough energy that the protein is properly
utilized for tissue repair
Vitamin A: Helps with night vision, growth of bones and teeth
○ Found in liver, fish liver oils and fortified dairy products
Infection precautions: Neutropenic (reverse isolation)
○ Immunosuppressed with neutrophil count under 500 mm 3
○ Procedure: handwashing, personal protective equipment, private / clean room,
restriction of visitors, no fresh fruits or vegetables, avoid invasive procedures,
increase fluid intake, avoid standing water in the room, avoid puncturing skin with
needles, no rectal temps/medications, clean room daily, no raw meat/food,
frequent cough and deep breathing
○ Ex of when a client will be on neutropenic precautions: transplantation surgery,
HIV infection, chemotherapy
○ If chemotherapy is causing neutropenia: give filgrastim: stimulates growth and
development of WBC;s
○ Other treatments granulocyte colony-stimulating factor and stem cell transplants
Surgical drains : keeps fluids from accumulating
○ Penrose: soft rubber tube, not sutured
○ T-tube: common bile duct
○ Jackson-Pratt drain: negative pressure drain that is a flexible plastic tube
connected to a bulb and negative pressure helps the wound to drain.
○ Hemovac: negative pressure device used for increased drainage
○ Assessment: location of drain: Bag/bulb should be lower than wound site,
sutured?, drainage, tubing, inflammation and infection
○ Implementation: secure drainage device, bag position, tubing, negative pressure,
asepsis, dressing, discontinuation
○ Dry dressing should be placed after discontinuing drain
Moderate sedation: conscious sedation that is used for short term procedures
○ Time to take to perform a colonoscopy: 20-40 minutes
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Need someone to drive him home
Monitor VS and LOC Q 5 minutes
When to use moderate sedation: Pt must be able to maintain a patent airway,
responding to verbal and physical stimuli. Will use for “oscopy’s”: bronchoscopy,
colonoscopy, fracture realignment, CVAD placement, bone marrow aspiration,
biopsy, cardioversion, pacemaker placement, dressing changes and more
During procedure use the ramsay scale or richmond scale for level of
consciousness sedation scale
Post procedure: activity restrictions for 24 hrs, increase fluids avoid D’s (driving,
decisions, dangerous activities)
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Fluids
○ Fluids are regulated by: hypothalamus, ADH, ANP and aldosterone
○ Isotonic: expands the intravascular compartment
■ Treat: isotonic dehydration, burns, mild acidosis, diarrhea
■ Ex: 0.9% sodium chloride (NS), LR
○ Hypotonic: shifts fluid out of the intravascular compartment, hydrating the cells
and the interstitial compartments
■ Treat: hypernatremia (DI), cellular dehydration associated with DKA or
hyperosmolar hyperglycemic syndrome
■ Ex: 5% dextrose in water (D5W), 0.45% sodium chloride (½ NS)
○ Hypertonic: draws fluid into the intravascular compartment from the cells and
interstitial compartments
■ Treat: balance the concentration of fluid and particles across fluid
compartments (SIADH)
■ Ex: 3% sodium chloride, 10% and 50% dextrose
○ Colloid solutions: contains solutes of higher molecular weight then serum
■ Keeps/shifts fluids into vessels
■ Treat: corrects hypotension. Replenish protein loss during a multisystem
organ failure, glomerulonephritis, renal failure, liver disease
■ Ex: Albumin, dextran, hetastarch
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Implanted Infusion Port: port into a large blood vessel via CVAD device or PICC
○ Allows for frequent administration of medications without multiple venipunctures
○ Central venous catheter that is connected to chest wall
○ Nursing care:
■ Strict aseptic technique
■ Use non-coring needle to access (huber-point needle)
○ The superior vena cava brings deoxygenated blood to the right atrium; the
central venous catheter is threaded into the superior vena cava approximately 23 cm above the veins junction with the right atrium.
Day 3: Respiratory
● Scoliosis: Lateral curvature of a portion of the spine
● Before and after administration of a blood transfusion: Isotonic saline
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Does not cause aggregation of hemolysis of RBC and is the preferred solution to
use when administering a blood transfusion
○ 0.9% NS
Cheyne-Stokes breathing is marked by a regular pattern of rapid breathing which builds
from shallow to very deep respirations and then back to shallow, followed by a period of
apnea.
Hypoparathyroidism: condition caused by decreased or absent secretions from
parathyroid glands
○ S/S: tetany, muscular irritability, carpopedal spasm, paresthesia, laryngeal
spasm, tachycardia, positive chvostek’s sign, positive trousseau's sign
○ Treatment:
■ Calcium chloride or gluconate over 10-15 minutes in emergency
■ Calcitriol for acute hypocalcemia
■ Ergocalciferol
■ Low phosphorus, high calcium diet
IVP contains iodine: Obtain client allergy history
Complications of CVP:
○ Pneumothorax
○ Cardiac dysrhythmias
○ Air embolism
○ Infection
CVP implementation: Valsalva maneuver during tubing change to prevent air embolism
Types of blood reactions
○ Allergic: hypersensitivity to donor antibodies
■ Urticaria, pruritus, fever, anaphylactic shock
■ Treatment: stop the blood, give antihistamine and restart the transfusion
slowly
○ Hemolytic: Incompatibility
■ Nausea, vomiting, lower back pain, hypotension, hematuria
■ Treatment: stop blood, obtain urine specimen, maintain blood volume and
kidney perfusion
○ Febrile: antibodies to donor platelets or leukocytes
■ Fever, chills, nausea, headache, flushing, tachycardia
■ Treatment: stop blood and administer antipyretics
○ Bacterial: Contaminated blood products
■ Tachycardia, hypotension, fever, chills, shock
○ Circulatory overload: can occur from infusion of blood being too rapid for client
size and condition
■ Cough, dyspnea, pulmonary congestion, tachycardia, headache, sudden
anxiety, hypertension, distended neck veins
■ Treatment: adjust rate of infusion, place client in an upright position and
administer oxygen and possibly diuretics
Fresh frozen plasma:
○ Plasma volume expander, high in coagulation factors
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○ For: post surgical hemorrhage and shock, coagulation replacement
○ Considerations: inffuse with a straight line IV set as fast as the client will tolerate
Transsphenoidal hypophysectomy:
○ No brushing teeth for 1-2 weeks until the incision heals. Warm saline rinse Q4
hrs
Potassium supplements are contraindicated in clients with impaired kidney functions
Chest tubes
○ Lung reexpansion indicated when:
■ Water seal will initially show intermittent bubbling and tidaling with
inhalation and exhalation
■ Once the lung is expanded you will not see these things
○ When the water seal chamber is continuously bubbling: check for an air leak
○ Used to reestablish negative pressure in pleural space
○ Placement: midaxillary between 4th and 5th ribs for draining air and fluid
○ 3 components to chest tube drainage system
■ Collection chamber: collects pleural drainage
■ Water-seal chamber: prevents air from re-entering with inhalation
● Fill to 2 cm water level
■ Suction control chamber: provide negative pressure to the chest and
promote drainage
○ Collection chamber:
■ Monitor characteristics: color and amount
■ Assess for significant increases or decreases in drainage
○ Water seal chamber:
■ Assess for bubbling - continuous or intermittent
■ Tidaling: rise of water on inhalation and falls during exhalation
○ Suction control chamber:
■ Assess for gentle bubbling in suction system : NO rigorous bubbling
○ If tube becomes disconnected:
■ Immerse tube end into a bottle of 2 cm of sterile water
○ If tube becomes dislodged:
■ Apply dressing over insertion site
■ Allow one side of dressing to be tented
COPD : emphysema, chronic bronchitis, bronchospastic airway disease
○ Airflow obstruction: inhalation or exposure of substances (tobacco)
○ Diagnostics: Pulmonary function tests, total lung capacity is increased, chest x
ray will show hyperinflation with flattening of the diaphragm and ABGs will reveal
respiratory acidosis (late in disease), pulse ox <88%
○ Risk Factors
○ Treatment/ management:
■ Smoking cessation, pulmonary rehab, oxygen therapy, surgical therapy
(bullectomy, lung transplantation)
■ Inhaled bronchodilators, anticholinergics, corticosteroids,
phosphodiesterase inhibitors, antibiotics
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■ Vaccinations: influenza and pneumonia
■ Breathing exercises: diaphragm breathing and coughing
■ Regular physical activity, nutrition , coping
■ Avoid carbohydrates
○ Findings: cough (productive or dry) worse in morning, dyspnea, weight loss,
fatigue, chest tightness (b/c bronchospasms)
■ RR may be increased, tripod position, clubbing of fingernails, barrel chest,
pursed-lip breathing, diminished breath sounds, possible ronchi
Cromolyn sodium: treatment of mastocytosis/ allergic rhinitis and bronchial asthma
○ TE may take weeks
○ 30 minutes before meals
○ SE: nasal burning, headache, dry mouth, rash, bronchospasm
Guaifenesin: relief of chest congestion by loosening mucus and bronchial secretions
○ Increase fluid intake, take with full glass of water
○ SE: Nausea, headache, dizziness anorexia
Terbutaline sulfate: Treatment of bronchospasms
○ SE: nervous, restless, tremor, palpitations, dysrhythmias, headache,
hypokalemia, hyperglycemia
Salmeterol: long acting bronchodilator for prevention of exercise induced
bronchospasms. Treatment of COPD and asthma
○ SE: headache, tremors, throat irritation, N/V, cough, palpitations,
hypo/hypertension, dry nose
Budesonide/Formoterol: prevention of bronchospasm in asthma and COPD
○ Considerations: rinse mouth with water after each use
○ SE: thrush, throat irritation, vomiting, flu symptoms, back pain, headache,
respiratory infection
Albuterol : prevention of exercise induced asthma, acute bronchospasm, bronchitis and
emphysema
○ SE: tremors, anxiety, headache, tachycardia, anticholinergic SE
Ipratropium bromide: Treatment of bronchospasms, COPD and rinorrhea
○ Increase fluids, avoid OTC meds,
○ SE: same as above
Benzonatate: Treatment of nonproductive cough
TB: mycobacterium TB, Airborne (oxygen loving bacteria): intradermal injection
○ PPD test/ tuberculin skin test/ mantoux test: all the same
■ 5mm=positive for immunosuppressed individuals
■ 10mm=positive
■ 15mm=positve
○ Interferon-gamma release assays: Blood test
○ Diagnostics: Sputum culture (diagnostic), x ray (suggestive)
○ All cases, suspected or confirmed must be reported to board of health
○ Risks: Minority groups, nursing homes, hospitals, healthcare settings, living with
someone, susceptibility of exposed persons: immunocompromised
○ Assessment findings: progressive fatigue, lethargy, ,nausea, anorexia, irregular
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menses, chest tightness with a dull pain, weight loss, low grade fever, night
sweats, cough with mucopurulent sputum, dyspnea and hemoptysis (Late)
○ Booster phenomenon: exposure occurred any time period ago, second mantoux
test is positive but first is negative
○ Treatment:
■ Latent TB: prevention of active TB
● Isoniazid and rifampin for prolonged periods
■ Active TB: eliminate TB
● Will be longer in duration
● Isoniazid, rifampin, pyrazinamide, ethambutol, rifabutin, rifapentine
● Multiresistant TB: fluoroquinolone, aminoglycoside, bedaquiline
■ Isoniazid SE:
● Peripheral neuropathy (pyridoxine may be prescribed)
● Hepatitis : no alcohol
● Hematologic: agranulocytosis and thrombocytopenia
■ Rifampin SE:
● Hepatitis
● Orange discoloration of body fluids
● Reduces effectiveness of oral contraceptives
■ Pyrazinamide:
● Hepatitis
● Hyperuricemia (Gout): drink full glass of water
■ Ethambutol:
● Ocular toxicity
● Hyperuricemia→ gout
■ Bedaquiline:
● Cardiac toxicity
● Hepatitis
■ Directly observed therapy (DOT): HCP needs to observe each medication
dose
Post laryngoscopy: voice rest for 2-4 days post op
Lubricate catheter to suction a tracheostomy with sterile water
Thoracentesis complication: subcutaneous emphysema due to air leaks into the
subcutaneous tissue which causes swelling
Blowing the nose encourages bruising and edema Post nasal surgery
Day 4: cardiology
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Shock: state of severe systemic reduction in tissue
○ Hypovolemic shock: blood vilume is inadequate to circulation leading to tissue
hypoperfusion
○ SS: hypotension, tachycardia, Pale, cyanotic, cold and clammy skin,
tachypnea (late), confusion, agitation, anxiety, hypothermia, oliguria, decresaed
bowel sounds
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Hemorrhagic:
● Traumatic: accident
● Non-traumatic: GI bleed
■ Non-hemorrhafic:
● GI losses: V/D, renal losses, DI, exudative lesions
Cardiogenic shock: problem with the heart to pump effectively. Stroke volume
and cardiac output are decreased leasing to decreased tissue perfusion
■ SS: hypotension, rapid/faint pulse, tachycardia, cool clammy skin,
tachypnea, crackles in lungs, distended neck veins, confusion, agitation,
anxiety, oliguria
■ Causes: MI, arrhythmia, HF, cardiac arrest, myocardial contusion,
myocarditis, valvular heart disease
Obstructive shock: due to obstructive flow in the cardiovascular circuit, and
characterized by either impairment of diastolic filling or excessive afterload:
results from obstruction of central blood flow due to compression of the heart or
great vessels leading to inadequate tissue perfusion
■ SS: clinical findings are based on where the blockage is ocurring
■ Causes: tumons, tension peumothorax, cardiac tampanade, PE, Bold
is most common
Distributive shock: vasodilation and loss of vasomotor tone results in venous
pooling of blood, decreased venous return, decreased cardiac output and
inadequate tissue perfusion
■ Septic: infection
● Hypotension, tachycardia , tachypnea, respiratory alkalosis
progresses to respiratory acidosis, hyper/hypothermia,
warm/flushed skin (early), cool mottled skin (Late) S/S of infection
■ Neurogenic shock: Injury/disease in spinal cord, medications,
● Hypotension, bradycardia, polokothermia
■ Anaphylactic: allergic reaction
● SS: Hypotension, tachycardia , arrhythmias, bronchospasms,
laryngeal edema, dysphagia, hoarseness, dyspnea, pruritus,
wheezing, restlessness, feeling of impending doom, N/V/D,
metallic taste
Interventions:
■ Prevention is key: identify risky patients
ECG
○ SA Node: 60-100 BPM —> atrial polarivation
○ AV node: fills ventricle with blood—> bundle of his
○ Left and right bundle branches—> purkenje fibers
Cardiac dysrhythmias:
○ Atrial dysrhythmias: an abnormality that occurs in one of the two upper chambers
of the heart, the left or right atrium. Originate from foci in the atria
○ Control of atrial dysrhythmias:
■ Amiodarone, dofetilide, flecainide, ibutilide, propafenone
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■ Electrical cardioversion, catheter ablation
■ Anticoagulation: warfarin, apixaban, dabigatran, rivaroxaban
○ Atrial fibrillation: multiple rapid impulses from many atrial foci depolarize the atria
in a totally disorganized manner
■ Ventricular response is usually 120-200 BPM
■ No P waves
■ No atrial contraction
■ Methods for diagnosis: exercise stress test, 12 lead ECG, Holter monitor
■ Irregular ventricular response→decreased ventricular
filling→reduces cardiac output
■ Pooling of blood→ clotting concerns
■ PR intervals cannot be measured
■ QRS will remain normal (<.12)
■ Treatment: Vagal stimulation and Adenosine
○ Atrial flutter: Saw tooth flutter waves
HF: MAWDS self management plan
○ Medications: avoid NSAIDs take meds prescribed
○ Activity: stay active
○ Weight: weight daily at same time of day. Report 2-3 lb weight gain in a day or 5
in a week
○ Low sodium, fluid restriction
○ Symptoms: note any new or worsening symptoms
Toxic shock syndrome: primarily results from tampon use
○ Distributive shock
Aortofemoral bypass, femoropopliteal bypass, carotid endarterectomy
○ Post op: assess for hypo/hypertension, neuro functioning, difficulty swallowing,
hoarseness
PAD
○ Pain relieves when legs dangle
○ Sharp, Rest pain, worse at night
○ Intermittent claudication: activity causes severe pain
○ Skin of lower extremity: Cool to touch, thing, dry, scaly, hairless and thick toenails
○ Poor lower extremity pulse
○ No edema
○ Ulcers : end of toes, top of feet, little drainage, little tissue granulation (pale/light
pink) or (necrotic/black), deep “punched out” look
PVD
○ Pain relieves when legs are elevated
○ Pain is heavy,dull, throbbing and aching. Pain worst when standing
○ Skin of lower extremity: thick, tough skin, brownish
○ Normal pulse in lower extremity
○ Edema
○ Ulcers: medial parts of lower legs, swollen with drainage granulation present,
edges irregular and shallow
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Digoxin: Increases strength of heart contractions, slows the rate of conduction through
the AV node
● POst op femoropopliteal bypass graft:
○ Place client in chair for 30 minutes
○ Obtain a doppler evaluation every two hours
Day 5: cardiology continued
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For shock: always correct the patient’s hypovolemia first before administering a
vasopressor
Pernicious anemia: does not produce intrinsic factor in their stomach needed for
absorption of B12
Iron: essential component needed for hemoglobin, myoglobin and many enzymes in the
body
Femoropopliteal bypass graft post-op:
○ Accurately record intake and output: potential of acute kidney injury
○ Encourage the client to cough and deep breathe: prevent atelectasis
○ Elevate clients left leg: leg that was operated on must stay straight
○ Hypovolemic shock is a potential complication: Cold and clammy skin
CPR:
○ If pt is unresponsive the first step is to call 911
○ If the pt is unresponsive and pulseless: start CPR’
○ Primary goal of CPR is to maintain circulation to vital organs
Sudden cessation of a mediastinal chest tube drainage after CABG: hallmark
manifestation of a cardiac tamponade
Angina Pain: caused by insufficient oxygen to the heart muscles
Cardioversion :procedure to depolarize myocardial cells so SA node can reestablish as a
pacemaker
○ Nursing consideration:
■ Administer diazepam IV
■ Withhold digoxin for 48 hours before procedure
○ Post procedure:
■ VS Q 15 mins for 1 hr, Q 30 mins 2 hrs , hourly 4 hours, Q 4 hrs
Angioplasty: nonsurgical invasive technique to widen vessel lumen to increase BF
○ May include balloon compression of plaque against vessel wall, stent insertion,
plaque removal atherectomy
Aneurysm: abnormal localized dilation of a blood vessel due to weakness in the area
○ Types:
■ Sacculated: weakness in one side of vessel causing a sac formation on
the side of the vessel
■ Fusiform: all walls of vessel involved causing uniform dilation of vessel
■ Dissecting: blood separates layers of the walls of the vessel tearing them
apart
○ Abdominal aortic aneurysm: wall of abdominal aorta
■ May be asymptomatic or the client may report abdominal pain, low back
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■ S/S: BP may be lower in legs than arms, bruit over aorta, pulsating mass
in periumbilical area
■ Instruct client to : avoid bending. Lifting, constipation
○ Cerebral aneurysm:
■ Caused by : trauma, HTN, congenital abnormality
■ S/S: Headache, pain in the yes, dizziness, diplopia, tinnitus, nuchal
rigidity, hemiparesis, seizure, change in LOC
● Thoracic aneurysm repair post op:
○ Monitor drainage from chest tubes
○ Perform circulatory checks
○ Assess nasogastric drainage
○ Prevent thrombophlebitis
● RHeumatic fever:
○ Group A beta-hemolytic streptococcus is responsible for the sore throat that
almost always precedes the development of rheumatic fever
● During an MI, creatinine kinase-MB is the cardiac enzyme that peaks and elevates most
rapidly
Day 6: trainer test 4 and pediatrics
● Client problem priority for a client with left-sided hemiparesis from stroke: Skin integrity
● Client has a cesarean birth:
○ Priority to prevent complications: encourage early ambulation: preventative care
for respiratory congestion resulting from any type of anesthesia and shallow
respirations due to the abdominal incision. Deep breathing and coughing are also
encouraged
● Terbutaline: maternal tachycardia is an adverse effect. Other maternal adverse effects
include: Nervousness, tremors, headache, possible pulmonary edema, fetal adverse
effects include: tachycardia and hypoglycemia
○ Terbutaline is usually preferred over ritodrine because it has minimal effects on
BP
● For peritoneal dialysis: daily weights at the same time every day is necessary with the
peritoneum empty to assess fluid volume status.
● Antipsychotic medication: primary concern is with postural hypotension caused by
medication is preventing injury from a fall; monitoring VS will provide data to address this
concern.
● Main cause of asthma is inhaled allergens
● Important for safe administration of oxytocin to client: palpate the uterus frequently
○ Oxytocin: stimulates uterus to contract, which necessitates frequent assessment
of the uterus; prolonged tetanic contraction can lead to a ruptured uterus
● Most important goal for a rape trauma syndrome initially: the client will begin to express
reactions and feelings about the assault before leaving the emergency department
○ Nurses initial priority to encourage client begin dealing with what happened by
verbalizing feelings and gaining some acceptance and perspective
● For SLE: Client should be in remission for at least 5 months prior to conceiving
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For a client that is receiving Haloperidol: monitoring VS is of utmost importance to
ensure client safety and physiological integrity
A fixed and dilated pupil represents a neurological emergency
Tetracycline: wear sunscreen and hat when outdoors b/c photosensitivity
○ Should be taken on an empty stomach
Clear fluid coming out of ear: represents rupture of meninges and presents of a potential
complication of meningitis
32 weeks gestation, complication: client’s urine test is positive for glucose and acetone:
can indicate gestational diabetes: hazard of placental insufficiency
Technique to use when changing the large abdominal dressing: remove the layers of the
dressing one at a time to avoid dislodging the drain
Lidocaine is the medication of choice for frequent PVCs occurring in excess of 6-10/min
Esophageal speech: client swallows air and then eructates it while forming words with
the mouth
Cane should be held on unaffected side
Morphine is contraindicated in a head injury because it masks the signs of increased ICP
Physical changes occur in late adulthood, causing changes in body image; constipation
is a frequent problem of the elderly
Acute hemolytic reaction is the most dangerous type of transfusion reaction
○ Pain in lower back/abdomen/chest, fever, hematuria, tachycardia, tachypnea,
dyspnea, hypotension.
■ Treatment; stop the blood, obtain a urine specimen, and maintain Blood
volume and kidney perfusion
Hepatitis B is transmitted through parenteral drug abuse and sexual contact
How to collect a specimen to be tested for pinworms: Collect the specimen in the early
morning with a piece of scotch tape touched to the child’s anus
○ Pinworms crawl outside the anus early in the morning to lay their eggs
For a vaso occlusive crisis: hydration is priority
○ After rehydration, oxygenation may be helpful
Aspirin increases bleeding time
Ibuprofen increases bleeding time
Naproxen increases bleeding time
Acetaminophen is a nonopioid, non salicylate analgesic that can be effective in treating
mild to moderate pain
Pt with AIDS with small painless, purplish/ brown spots on the leg: instruct client to
shower daily using a mild soap from a pump dispenser; pat the skin dry in order to
prevent a secondary skin infection
Most important priority in the nursing management of an assaultive client is to maintain
milieu safety by restoring the client’s self-control; a quick assessment of the situation,
psychological intervention, chemical intervention and possibly physical control
Sucralfate: used to prevent and treat duodenal ulcers: best to take on empty stomach
Medications should be separated by 2 hours for maximum absorption
Acetaminophen can cause liver damage, normal AST is 1-36
Abruptio placenta is a premature separation of a normally implanted placenta leading to
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hemorrhage; fluid volume deficit is a major nursing concern with these clients
Hyponatremia: headache, apprehension, lethargy muscle twitching, convulsions,
diarrhea, fingerprinting of skin
Withdrawals:
○ Cocaine: severe cravings, depression, fatigue, hypersomnia
○ Amphetamines: depression, distrurbed sleep, restlessness, disorientation
■ Meth, dextroamphetamine (ADHD medication)
○ Barbiturate: N/V, tachycardia, coarse tremors, seizures
○ Narcotic: like symptoms of the flu: runny nose, yawning, fever, muscle and joint
pain, diarrhea
Gemfibrozil: for hypercholesterol: Hepatotoxic, adverse effects: abdominal pain and
choleithiasis
○ Take medication 30 minutes before breakfast and dinner
For placement of NG tube: HOB elevated 60-90 degrees is best.
○ Facilitates swallowing and movement of tube through gastrointestinal tract
Blanching sign: to assess for circulation
Dawn phenomena: treatment is to adjust evening diet, bedtime snack, insulin dose, and
exercise to prevent early morning hyperglycemia
A normal reaction one month post op from a mastectomy: difficulty coping with the
surgery and cries frequently
Oral hypoglycemic agents are administered to clients diagnosed with type 2 diabetes
who are able to produce minimal amounts of insulin
Immunocompromised individuals are at risk for reactivation of the varicella zoster virus
(shingles)
Hepatitis A: contact precautions are required for diapered or incontinent clients
Rheumatoid arthritis: ROM exercises are key for the client with RA, as they reduce
swelling, increase circulation, diminish stiffness and preserve joint mobility
For a patient with an acute attack of gout: most beneficial in decreasing the client’s pain
during ambulation is to encourage partial weight bearing while ambulating
Expected finding of a school-aged child with scoliosis: child’s thoracic area is
asymmetrical
Following an appendectomy: hold incision and take three deep breaths and cough to
minimize pain
Battery: harmful or offensive touching of another’s person: unless court ordered, clients
have the right to refuse medication, even if the client is psychotic
Adverse effects of haloperidol: galactorrhea, lactation, gynecomastia
For a partial thickness burn, best way to prevent infection (before arriving to hospital):
remove clothing, and wrap the victim in a clean sheet
Food to avoid with acute gout: Red meat and shellfish
For an infant whose mother is HIV positive: antiviral therapy lasting 4 weeks should be
started as soon as possible after birth. Knowing the HIV status of the newborn is
necessary, although the infant may not show positive for HIV until up to 15 months
Strabismus: visual axes are not parallel, so the brain receives two images
Complete nursing hx: biopsychosocial data, psychosocial, physical status are evaluated
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along with an assessment of the client’s family system and social support network;
evaluation of the client’s cognitive ability is important during the physiological status
assessment
Placenta previa: characterized by painless vaginal bleeding
Nonstress test is a noninvasive test to evaluate the response of the fetal HR to the
stress of fetal movement; response will be reflected on the fetal monitor
○ Client will push a button when fetal movement is felt
Prevent N/V to prevent intraocular pressure
Post bronchoscopy: place client in semi fowler position
Ketoconazole: medication of treatment for candidiasis: mouth pain, difficulty swallowing,
white discharge in the back of the throat
Warming the bag of dialysate prior to admission can help reduce pain.
9 months of age: “Mama” and “Dada”
Initial signs of increasing cerebral edema: decreasing LOC, headache, ipsilateral pupil
dilation
Famotidine: should be taken before meals or at bedtime
In a c-section: the medication given before cesarean contains lower amounts of
narcotics than are given before general surgery
Addisonian crisis major cause: sudden withdrawal of steroids. Steroid replacement for
people with addison’s disease is essential
Fluoxetine HCL: is an “energizing” antidepressant; client begins to demonstrate a
positive response, increased energy level, and is able to participate more in milieu
Basic guidelines to teach a postgastrectomy client are measures to prevent dumping
syndrome including: lying down for 30 minutes after meals, drinking fluid between meals,
reducing intake of carbohydrates
Developmental dysplasia of the hip: uneven gluteal folds and thigh creases
○ Folds and creases will be longer and deeper on affected side
○ Decrease in length of the affected limb
Moist to dry dressing: moist gauze is packed into the incision without overlapping it onto
the skin
Transplant clients require protective isolation following surgery: no visitors are allowed
for at least 3 days
High-pitched cry is one of the first signs of an increase in the ICP in infants
Dissociative disorders characterized by either a sudden or gradual disruption in the
integrative functions of identity,, memory or consciousness; disruption may be transient
or may become well-established pattern: development of these disorders is often
associated with exposure to a traumatic event
Restlessness and increased HR are observations most indicative for anti anxiety
medications
Right sided HF S/S: fluid overload, peripheral edema and anorexia, polycythemia,
distended neck veins
Peritonitis: inflammation of membrane covering abdominal wall and abdominal organs
○ If dialysate outflow is cloudy: indicative of peritonitis
Albumin levels are best indicators of long-term nutritional status
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Hypoglycemia: confusion, cold/clammy skin, elevated pulse
Hyperglycemia: lethargy, hot/dry skin, rapid/deep respirations
Myxedema: slowing of all body functions
Benztropine: anti-parkinsonian agent
If steroids are withdrawn suddenly, client may die of acute adrenal insufficiency
Ewald tube: large, orogastric tube designed for rapid lavage; insertion often causes
gagging and vomiting, suction equipment must be immediately available
● Inflammation and reddened areas around site and up length of vein: Phlebitis
Pediatrics
● Reflexes:
○ Stepping: fades by 4 weeks old
○ Tonic neck: disappears by 3-4: arm and leg will be
○ Moro reflex: disappears by 3-4 months “startle reflex”
○ Babinski: feeties: disappears by 24 months
○ Palmar grasp: fades around 3-4
○ Rooting/sucking: disappears 4-7 months
● Tonsilitis: inflammation of palatine and and or pharyngea; tonsils
○ Occurs in children
○ S/S: fever, sore throat, foul-smelling breath, dysphagia, odynophagia, tender
cervical lymph nodes, lethargy and malaise
○ Treatment: antibiotics, liquid acetaminophen, fluid replacement, rest, warm
saltwater gargles, surgery (If recurrent or chronic)
○ Peritonsillar abscess : severe sore throat, drooling, foul smelling breath, trismus,
muffled voice quality
○ Tonsilectomy pre op:
■ No ibuprofen trype medications, herbal supplements for 2 weeks prior to
surgery
■ Diet: NPO after midnight one day before the procedure
■ Psychological support
○ Tonsillectomy post op:
■ Psychological support: regression
■ Recovery time: 7-10 days
■ Activity: return to school when off narcotics, no physical activity for 10
days
■ Hydration: no red colored juice, avoid milk
○ Complications: fever, N/V, difficulty breathing, scabs, bad breath, bleeding, pain
● Restless means: Hypoxic on NCLEX
● Epiglottitis: usually caused by bacterial infection
○ Routine Hib vaccinations for infants has decreased incidence
○ Affects breathing by obstructing passage of air to lungs
○ Commonly affects childrens between 2-5 yr of age
○ S/S: occurs suddenly: fever, and sore throat are usually first symptoms,
dysphagia, muffled voice, drooling of saliva, distinctive/large/cherry
red/edematous epiglottis, child will insist on sitting in tripod position, may appear
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restless/frightened/apprehension
○ No stress is key: need to be very calm until airway is stabilizer
○ Nurse should NOT attempt visualization with tongue depressor or obtain a throat
culture
○ Maintain droplet precautions until child has received antibiotics for 24 hours
Bronchiolitis: lower respiratory tract infection ; can be caused by RSV
○ Produces small airway obstruction and air trapping
○ Causes airway inflammation and reactivity in young child under 2
○ S/S: nasal obstruction, rhinorrhea, irritating cough,
○ 1-3 days after onset:tachypnea, and respiratory distress , increased work of
breathing
○ Management: oxygen (preferably humidified), maintain hydration, control fever,
close/ frequent assessment to monitor for deterioration ABG’s if necessary
Pneumonia: lower respiratory tract infection
○ Air sacs fill with exudate
○ More common in boys than girls
○ S/S: dyspnea, cough, tachypnea, sputum production, grunting, wheezing, sputum
production, grunting, wheezing, crackles, intercostal retractions, fever, pleuritic
chest pain, fatigue
○ Care:
■ O2 therapy, oxygenation
■ Antibiotic therapy (if caused by bacteria)
■ Rest and conserve energy
■ Adequate hydration
■ Support
Asthma: chronic inflammatory disorder characterized by airway obstruction and
bronchospasm
○ S/S: dyspnea, wheezing, coughing, chest tightness, prodromal itch
○ Diagnosis: pulmonary function tests, peak expiratory flow rate (max flow of air
that can be forcefully exhaled in 1 second) Green, yellow or red
Bronchopulmonary dysplasia (BPD): Chronic lung disease associated with respiratory
distress syndrome
○ Usually associated with prematurity
○ S/S: interstitial edema, epithelial swelling, fibrotic changes to alveolar wall:
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Tachypnea, increased WOB, retractions, nasal flaring, grunting,
diminished breath sounds, crackles, and occasional expiratory wheezing,
resp. acidosis , tachycardia
○ Management: prevention, bronchodilators, steroids, diuretics, oxygen therapy,
RSV prophylaxis with monoclonal antibody palivizumab, nutrition through NG
tube/ PO as tolerated, support, regular checkups and vaccinations, avoid lung
irritants
Cystic fibrosis: inherited disease of the exocrine glands
○ Thick mucus secretions in pancreas and lungs
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Electrolyte abnormalities in sweat gland secretions
Abnormality in chromosome 7
Testing:
■ Sweat test: detects abnormal salt concentration
■ Duodenal analysis: detects pancreatic enzymes and reveals extent of
pancreatic involvement
■ Stool analysis: analyzed for fat content and lack of trypsin in stool
■ Pulmonary testing: chest x-ray to confirm the extent of pulmonary
involvement
■ Immunoreactive trypsinogen test (IRT)
■ In utero is possible: look for 2CF mutations
■ Autosomal recessive disorder: need to inherit CFTR mutation (2 copies)
■ S/S: adventitious breath sounds: wheezing and rhonchi, chronic cough,
chest hyper-resonant with percussion, clubbing of fingers, meconium
ileus, infant in diapers: stool will have high fat content, bulk of feces
increases to 2-3 times
■ Management:
● Avoid exposure to respiratory infections
● Chest physiotherapy, postural drainage
● Monitor for hemoptysis
● Nebulizers, aerosol therapy, humidified oxygen, dental hygiene
● Nutrition: increase amount of calories by double
● High protein, high calorie diet, with fat intake
● Prescribed enzymes, supplemental fat soluble vitamins (ADEK),
extra calcium
● In hot months: increase sodium intake and monitor for overheating
which leads to excessive chloride sodium loss
Tetralogy of fallot: Four defects in the child's myocardium
○ Ventricular septal defect: opening between right and left ventricle which allows
oxygenated blood goes out to your central system
○ Pulmonic stenosis: makes it harder for blood to get oxygenated
○ Overriding aorta: receives blood from both ventricles : not all fully oxygenated
blood pumping out
○ Right ventricular hypertrophy: develops because right ventricle is working harder
○ S/S: loud murmur, cyanosis, clubbing of fingers, delayed physical growth and
development, squatting position (increases cardiovascular resistance)
○ Management:
■ Supportive: decrease oxygen demand
■ Nutrition: feed more often, soft nipple, supplemental gavage feedings
■ Surgery: performed in first year of life
Foreign body aspiration: common cause of mortality and morbidity in children
○ Highest rate in children between 1-3 yrs
General anesthesia is a common cause of atelectasis
○ Atelectasis: occurs when secretions block the bronchioles and the alveoli
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collapse, causing hypoventilation. Deep breathing exercises and coughing after
surgery can reduce the risk of developing atelectasis
A client with COPD is stimulated to breathe by a decreased level of oxygen in the blood.
If high flow oxygen is provided to the client, it will eliminate the drive to breath
Day 7
● Early ambulation post-surgery increases respiratory and circulatory function and
decreases risk of thromboembolism
● Post op of heart defect for newborn: elevate head to reduce respiratory effort
● Clonidine patch:
○ Avoid placing the patch on hairy areas to ensure contact with skin for absorption
and to lessen depilatory effect of removing the patch
○ Rotate sites to avoid scarring or irritated skin
○ Avoid foods high in sodium
● Holter monitor: worn for a period of a day or longer on an outpatient basis.
○ ECG for a day. Change battery before attaching to the client
● Makeup and nail polish is taken off before surgery so the operating room staff can watch
the color of your nails and face during surgery
● Clients experiencing aortic stenosis are at risk for fluid volume excess as a result of HF
● Change in neonate circulatory system after birth: begins pulmonary ventilation
○ Lung inflation causes pressure in the right atrium to decline while pressure is
increased in the left atrium. Foramen ovale closes which leads to the ductus
arteriosus occluding and becoming a ligament
● Rheumatic fever diagnostic: SCP
○ Presence of C reactive protein in serum
○ Occurs after group A beta-hemolytic streptococcal pharyngitis
○ S/S: carditis, polyarthritis, erythema marginatum, subcutaneous nodules, chorea,
and HF (Late)
○ Treatment: Penicillin
● Transcutaneous pacemaker: used to maintain the client’s HR until a transvenous or
permanent pacemaker can be inserted. Can be used for an atrioventricular block: delay
in the conduction of impulses within the atrioventricular system
● Pulse pressure: difference between systolic and diastolic BP. serves as an indirect
measure of CO
● Difference between the apical and radial pulse is called a pulse deficit and may reflect a
dysrhythmia
● Earliest sign of fat embolism is an altered mental status due to low arterial oxygen levels.
● With nitro: if chest pain persists despite rest and administration of nitro, the client should
go to the emergency department for further evaluation
● Cyanotic heart defects: causes poorly oxygenated venous blood to enter the systemic
sirculation
○ Clubbing of fingers, poor feeding, difficulty feeding, poor weight gain, no weight
gain, tachypnea, labored breathing, pulmonary edema, sternal retractions
● Unilateral edema indicates swelling from impaired venous return due to a venous
thrombosis
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For PE: apply O2 first and notify HCP
Pacemaker
○ Failure to sense occurs when the pacemaker fails to recognize spontaneous
atrial or ventricular activity and fires inappropriately
Flexing and pointing toes will increase venous return and maintain integrity of blood
vessels and prevent thrombophlebitis
Post CPR: side lying is recovery position
○ 1 .Establish unresponsiveness, breathing and pulse
○ 2. Activate EMS
○ 3. CPR 100/min ventilation rate 30:2
○ 4. Establish an airway by using head tilt chin lift
○ 5. Begin breaths
○ Sternum should be depressed at least 2 inches
To determine HR in an irregular heartbeat: count the number of QRS complexes in a 1
minute interval
To determine HR in a regular rhythm: count number of QRS complexes in a 6 second
interval and multiply that number by 10
A fib: atrial rate is irregular (350-600 BPM), ventricular rate is variable and irregular, P
wave is chaotic and PR interval is not measurable
Hear sounds:
○ Erb’s point: 3rd intercostal space left sternal border
○ Mitral area: site of apical impulse and point of maximum impulse
■ Left fifth intercostal space midclavicular line, apex of the heart
○ Aortic area: second intercostal space right sternal
○ Pulmonic area: second intercostal space left sternal border
○ Tricuspid: fifth intercostal space left sternal border
For MI:
○ Isoenzyme (CK-MB): increases in 4-8 hours
○ Creatine Kinase: enzyme specific to cells of the brain, the myocardium and
skeletal muscle. Increases in 3-6 hours
○ Myoglobin: increases in 1-3 hours
○ Troponin T and I: increases in 3-4 hours
Blood pressure in lower extremities:
○ BP will be 10 to 40 mm Hg higher systolic
○ Cuff placed around thigh, and stethoscope placed at the site of the popliteal
artery
○ Client will be positioned on the abdomen
Hours after cardiac catheterization: Immobilize the extremity into which the catheter was
inserted
Pacemaker: deviation of the HR above or below the preset pacemaker rate by 5BPM or
more is an early indication of pacemaker malfunction
Temporary pacemaker: it is essential to immobilize or stabilize the extremity to prevent
dislodging or kinking
MI: S3 heart sounds are heard
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S3 heart sounds also associated with valvular incompetency can be called a
ventricular gallop
Birth Weight should double at 6 months and triple at 12 for baby
○ Lengths should increase by ½-1 inch per month
Sudden infant death syndrome prevention:
○ Sleep position: back
○ Avoid tobacco smoke
○ Remove extra items from crib
○ Don’t overdress baby
○ Don’t Cosleep with baby
Immunizations
○ Birth: Hepatitis B
■ Birth: B
○ 2 months: Hepatitis B, DTaP, Hib, Polio, PCV, RV
■ “Two 6-month old Pediatric Policies Discussed Rejecting his HEPB at 4
months”
○ 4 months: Everything at 2 months except hepatitis
○ 6 months: Same as 2 month, plus annual influenza
○ 12-18 months: DTaP, Hib, PCV, MMR, Varicella, Hepatitis A (2nd shot 6 months
later)
○ 4-6 years: DtaP, polio, MMR, Varicella
Infertility: after one year of unprotected intercourse and the inability to conceive
Placenta previa: non painful vaginal bleeding
Post vulvectomy: sitz bath and keep the area clean and dry to increase circulation in the
area and promote wound healing
Day 8
● Tactile fremitus: hand held on back over lungs
○ Use ulnar and palmar surface of hands to feel vibrations
● Tracheostomy: Immediate post op elevelate client’s head and turn the head to one side
until consciousness returns
○ If less than 72 hours and the tracheostomy fell out: manually resuscitate the
client & have a staff member contact resuscitation team
○ If more than 72 hours: insert emergency outer tube that is taped to the HOB
● Croup: swelling or obstruction in the region of the larynx
○ Symptoms: bark-like cough, dyspnea, inspiratory stridor, cyanosis,
○ Treatment: cool temperatures with high humidity to constrict edematous blood
vessels
● Preterm infant is at greatest risk for developing respiratory distress syndrome because of
the underdeveloped lungs
● Asthma expiratory wheezing can be described as: high-pitched musical-like squeaky
sounds
● General anesthesia is a common cause of atelectasis
○ Occurs when secretions block bronchioles and the alveoli collapse
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●
Venturi Masks provide oxygen at specified percentages, which is how O2 should be
administered to clients with COPD or emphysema
Day 9: Neuro
● Strokes
○ Ischemic strokes: blockage to cerebral artery
■ Embolic: embolus occludes cerebral artery. Can be caused in heart
conditions such as: MI, A-fib, Infective endocarditis, rheumatic heart
disease
● Severe and sudden symptoms
■ Thrombotic: damage to cerebral wall and clot forms
● Vessel narrowing, obstruction, plaque formations
● Slow and can result in TIA (mini-stroke)
● Most common stroke
■ Management:
● TPA, preventative antiplatelets, anticoagulants, -STATINS
● Endovascular therapy: remove clots
○ Hemorrhagic: brain bleed
■ Intracerebral: bleeding in the brain
● Most common cause is HTN: poor prognosis
● Sudden onset: decreased LOC, headache, N/V
■ Subarachnoid: bleeding between pia mater membrane and arachnoid
● Commonly caused by an aneurysm
● Called the “silent killer”--> no warning
● “Worst headache of my life”, seizures, stiff neck, vomiting
● Causes: cocaine, trauma, blood thinners
■ Management:
● Manage HTN
● Surgery: evacuations
● Treatment of vasospasms: nimodipine
● Manage ICP: ventriculostomy to facilitate CSF drainage, head
midline, neutral position,, HOB 30 degrees
○ Assessment:
■ FAST: facial droop, arm weakness, slurred speech, time
■ GCS, NIH stroke scale, LOC, headache, seizures, unequal pupils
● Delirium: state of temporary, acute, mental confusion that is typically reversible and
preventable
● Dementia: neurocognitive disorder characterized by dysfunction or memory loss,
orientation, language, judgment and reasoning
○ Most patients who experience dementia have neurocognitive disorders that are
untreatable
○ Slow, insidious, progressive
● Parkinsons
○ Primary causes are unknown, genes play a factor
○ Secondary: medications, brain alterations
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Patho: dopamine deficiency
Prognosis: total disability seen in 10-20 years, pneumonia leading cause of death
4 cardinal symptoms: tremors, muscle rigidity, akinesia, postural instability
No diagnostics: S/S diagnose
S/S: mask like face, slow/ low pitched speech, dysarthria, echolalia (repetitive
speech), hypophonia (soft voice quality), drooling, dysphagia, stooped/ leaning
forward posture with slow, short, uncoordinated shuffling steps, fatigue, tremor,
bradykinesia, rigidity, OH, dizziness, constipation, urinary frequency, hesitation,
emotional lability, cognitive changes
○ Medications:
■ MAO’I’s: selegiline, rasagiline, mesylate
■ Dopamine agonists: apomorphine, pramipexole, rapinirole, rotigotine
■ Combinations** most common**: Levodopa/carbidopa
■ Anticholinergics: trihexyphenidyl, benztropine
■ Dopamine receptor agonists: bromocriptine mesylate
Best way to prevent flexion contractures post stroke: Place the client in prone position
10-20 minutes a day: this promotes hyperextension of the hip joints, which is essential
for normal gait and helps prevent knee and hip flexion contractures
Parkinsons: clients with diagnosis of parkinson’s may have difficulty with the sequence of
swallowing and may be at risk for choking. Offer semi-solids with thickened liquids. No
soups. Pt should sit upright when eating and be encourage to think through the
sequence involved in swallowing
Glascow coma scale 3: pt completely dependent
○ 15: pt completely independent
Atherosclerosis: depositing of fatty plaques in the arteries
Arteriosclerosis: thickening and sclerosis of the arterioles
TIA’s: typically cause temporary, unilateral neurologic symptoms lasting from several
minutes to several hours
Events leading to death of neurons after an ischemic stroke: accumulation of sodium
and water inside the neurons in the affected area
Myasthenia gravis: Neuromuscular disease
○ Autoimmune: antibodies attack acetylcholine receptors which prevent binding
○ Decreased acetylcholine=decreased muscle contraction
○ Not genetic
○ S/S: ptosis, transient/constant diplopia, difficulty chewing, swallowing, speech,
droopy face
○ Diagnosis: presence of anti-acetylcholine antibodies in 90% of patients, EMG,
tensilon test (injectable anticholinesterase agent will increase muscle
contractility)
○ Medications: anticholinesterase agents, corticosteroids, immunosuppressive
agents
■ Surgery: thymectomy (removal of thymus)
■ Plasmapheresis and immunoglobulin G
○ Myasthenia crisis: caused by external stress and causes exacerbation of muscle
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weakness
● The rhine test: stem of a vibrating tuning fork is held against the mastoid bone until the
client indicates sound can no longer
● For breastfeeding: consume an extra 500 calories / day
● For head lice, permethrin 1% cream rinse: repeat application of the cream rinse in 7
days if nits are present
Day 10: musculoskeletal . review trainer 1
● Post operative cataract client: do not make sudden movements or bend over to prevent
putting pressure on the ocular suture line
● Inability to cope: displaying evidence of anger and anxiety and an inability to directly deal
with concerns
● 50 year old : in the generativity versus stagnation
● Hand hygiene: most effective method of reducing infection
● “Fight or flight response”: action of epinephrine
● Cortisol: process the conversion of proteins and fats into energy sources such as
glycerol and fatty acids
● Fetal alcohol syndrome: infant with a small head circumference, low birth weight,
undeveloped cheek bones
● EPS symptoms: akathisia, dystonias, pseudoparkinsonism, dyskinesia
○ Akathisia: motor restless
○ Dystonia: protruding of tongue
○ Dyskinesia: stiff neck, difficulty swallowing
● Cholesterol screening: no food for 12 hours before, only water
● Intravenous pyelogram IVP: used to examine urinary tract by X-ray, evaluate kidney
function
● Potential complication of stroke: corneal abrasion because the client will be unable to
close their eye voluntarily; when facial nerve VII is affected, the lacrimal gland will no
longer supply secretions that protect the eye
● Best way to assess fluid balance: maintain an accurate intake and output
● Apraxia: loss of purposeful movement in the absence of motor or sensory impairment
● Cholecystitis most pertinent symptoms: right upper abdominal pain
● Ceftriaxone: monitor tongue for superinfection
● Early signs of lithium toxicity: Fine motor tremors, N/V, diarrhea
● Hemophilia: mother transmits the gene to her son
● Temporary glucose control with insulin is needed due to the inability to control diabetes
mellitus by diet and oral agents, surgically induced metabolic changes, being NPO both
before and after surgery, and the infusion of IV fluids
● Renal threshold for glucose in urine is elevated in the elderly
● For a chest tube, the lung has re-expanded when: the fluid in the water-seal chamber
does not fluctuate with respirations
● Parathyroid: controls calcium balance
○ Hypoparathyroid client diet: high calcium and low phosphorus
● Stages of grief: Denial, anger, bargaining, depression, acceptance
● Indications of preeclampsia: proteinuria and retinal vascular constriction
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SHARE: pregnancy and infant loss group
First candle: saving babies, supporting families support group for parents who had an
infant die from SIDS
Resolve: national infertility association
Candlelighters: childhood cancer support group
Toddler: 1-3: parallel play
Preschoolers 3-6: associative play
Fractured hip findings: Leg appears to be shortened and is adducted and externally
rotated
Pituitary dwarfism: delicate features
Clients with hypothyroidism is very sensitive to narcotics, barbiturates, and anesthetics
due to decreased ability to metabolize medications
Symptoms of withdrawal: tremors, elevated temperature, nocturnal leg cramps
Clomiphene citrate: induces ovulation by changing hormonal effects on the ovary
LTB or croup syndrome is characterized by edema and inflammation of upper airways.
Inspiratory stridor is often the first observable symptoms
A pacemaker acts to regulate cardiac rhythm. This can be atrial or ventricular, or both
chambers. The outcome is to increase cardiac output
Best fluid to give a toddler experiencing lead poisoning: MILK; milk contains calcium,
which binds to lead and inhibits its absorption
An elevated and taut fontanelle: indicates a bulging fontanelle and may mean increased
ICP
Circumcision: should not swell; may interfere with urination
Umbilical cord of a 5 day: should be dry and hard
NSAIDS SE: headache, dizziness, edema, gastrointestinal distress, pruritus, and rash
After an asthma exacerbation the nurse should question : enoxaparin bc can affect
platelets and cause HIT. initiate non heparin anticoagulant
Bell palsy: flattening of nasolabial fold, inability to smile symmetrically, change in
lacrimation on the affected side, inability to completely close the eye on the affected side
○ Inflammation of facial nerve VII
LPN can reinforce education
Spina bifida: neural tube defect occurring when spinal vertebrae do not close furing fetal
development, potentially allows spinal cord contents to protrude through the opening
○ Manifestations: tuft of hair, hemangioma, nevus, dimple along the base of spine
Caput succedaneum (CS= crosses suture): edema off the soft tissue of the scalp due to
prolonged pressure of the presenting part against the cervix during labor
Acute pericarditis: inflammation of the membranous sac surrounding the exterior of the
heart, which can cause an increase in the amount of fluid in the pericardium
○ Increased pericardial fluid places pressure on the heart which impairs ability to
contract and eject blood
■ Cardiac tamponade: muffled/distant heart tones, hypotension, jugular
venous distention
Peritoneal dialysis: abdominal lining is used as a semipermeable membrane to dialyze
clients with decreased kidney function.
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Use sterile technique when spiking and attaching bag of dialysate: prevent
infection (peritonitis)
Macular degeneration: progressive, incurable disease of the eye in which the central
portion of the retina, the macula, begins to deteriorate. Loss of the central field of vision
Trigeminal nerve: carries sensation from the face to the brain.
Trigeminal neuralgia: irritation of trigeminal nerve from pressure
○ S/S: stabbing or burning facial pain, twitching, grimacing of facial muscles
○ Management: avoid rubbing eye, chew on opposite side of mouth
○ Complications: hearing loss and facial paralysis
○ Do not eat anything too hot or too cold, may worsen
○ More common in women
○ Also called tic douloureux
Meniere disease: inner ear disorder characterized by vertigo, tinnitus, and fluctuating
hearing loss
○ Attacks may be preceded by a sense of fullness in the ear and muffled hearing.
Attacks may last hours to days
○ Acute attack of vertigo: have patient lie down and place pillows on either side of
the head
Myasthenia gravis: acetylcholine deficiency so the transmission of nerve impulses is
limited
○ More difficult to stimulate or initiate muscular movement
○ Client will experience tiredness with slight amount of exertion
Assessing patient support system is critical in identifying the appropriate support
persons for a client who is isolated while hospitalized
EEG: records electrical activity of the brain
○ Prep: withhold tranquilizer, cigarettes, stimulants
○ Client may be asked to hyperventilate for 3-4 minutes and watch a bright flashing
light
○ Instruct client to wash hair the night before and avoid products such as sprays or
gels
Autonomic hyperreflexia: reaction of the autonomic NS to overstimulation due to an
irritating stimulus below the site of spinal injury
○ T6 or higher is at risk for developing
○ Medical emergency
○ S/S: pounding headache, profuse sweating especially of forehead, piloerection,
HTN, bronchodilation
○ Management: place client in sitting position, catheterize or irrigate existing
catheter to reestablish patency
■ Check rectum for fecal mass, administer anti HTN medications slowly
Spinal cord injuries:
○ C3 and above: completely dependent, ventilator
○ C4: unable to care for self
CSF tests positive for glucose
Bell palsy: may not be able to close the eye on the affected side of face: put on an eye
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shield to prevent corneal abrasion
○ Artificial tears, protect head from cold and drafts
○ Isometric exercise for facial muscles, gentle massage, warm packs, sunglasses
during day, eye patch at night
● Cerebral palsy early warning sign: 4 month old infant lacks head control
● For cystic fibrosis: pancreatic enzymes should be take at the beginning of a meal or with
a snack
● Impetigo complication: developing glomerulonephritis
● DTaP: diphtheria, tetanus, pertussis
● Chronic lead poisoning: anemia, seizures and learning disabilities
● Scoliosis brace: worn for 23 hours a day
● Pyloric stenosis: characteristic of the newborns emesis: projectile and forceful
Day 11 Mental health
● Schizophrenia positive symptoms: things present in the patient that should not be there
hallucinations
○ Negative: Energia, anhedonia
● Anorexia nervosa has the highest mortality rate of all mental disorders
● An anxious individual has poor comprehension and an inability to concentrate: only part
of what the nurse says will be remembered or retained, keep explanations simple
● OCD: repetitive behavior is an attempt to control anxiety, the nurse should accept the
client’s ritualistic behavior, structure the environment and offer alternative activities
○ Repetitive behaviors:: symbolic expression of conflict and guilt
● Defense mechanismsL
○ Substitution: an unattainable or unacceptable goal, emotion, or object is replaced
by one that is more attainable or acceptable
○ Undoing: an action is an attempt to erase the action, may be expressed by
excessive apologies
○ Compensation: attempt to overcome real or imagined shortcomings
○ Denial: failure to acknowledge an intolerable thought, feeling, experience or
reality
● Time after drinking that a patient is most likely to develop alcohol withdrawal delirium:
48-72 hours after cessation of drinking
○ S/S: tremors, anxiety, panic, disorientation, confusion, paranoia, delusional
symptoms, seizures, coma, death
● 6-12 hours: symptoms of alcohol withdrawal will occur
● Manic behavior: easily distracted, flight of ideas and hyperactive activities. Client will be
in an extreme state of excitement and is easily stimulated
○ Attempt to distract and redirect the client
● Clients who abuse substances have a limited ability to tolerate anxiety and use
substances to escape difficult feelings
○ A structured and nonpermissive setting is the best environment for a client who is
a substance abuser. Goal of treatment is to have the client tolerate increasing
amounts of anxiety without the need for substances
● Conversion disorders: usually appear calm and unconcerned with their physical health
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Day 12: Maternal
● Client in 3rd stage of labor should have a firm and globular fundus
● For a pregnant pt with breasts that are sensitive and sore: apply cold compresses and
wear a well fitting, supportive bra
● Pregnant women that is choking: stand behind women and perform chest thrusts
● C section: the anesthesia is not administered until immediately prior to the incision
● Neonates can lose up to 10% of birth weight
● Meconium stained amniotic fluid can mean: fetal distress and perinatal asphyxia
● Fibrocystic breast disease: benign cysts of the breast
○ Soft, tender, freely moving cysts that enlarge during menstruation
● How to correctly palpate uterine contractions; place one hand on abdomen over fundus
and press gently with the fingertips
● After circumcision: apply petroleum gauze and observe for bleeding
● Hypertensive condition in pregnant women: angioedema, gush of fluid/ bleeding from
vagina, uterine contractions, severe aches, visual disturbances, abdominal pain,
persistent vomiting, fever, chills
● Magnesium sulfate is given to treat convulsions. Decreased deep tendon reflexes
indicates magnesium toxicity
Electrolytes
Electrolyte
Functions/ treatment
Potassium
NV: 3.5-5 meg/L
Hypokalemia: potassium
replacement, Mg replacement,
monitor ECG
Hyperkalemia: hypertonic IV
solutions, potassium-excreting
diuretics, sodium polystyrene
sulfonate (if decreased kidney
functioning), glucose, insulin,
dialysis
Hyper and causes
Hypo and causes
Heart palpitations, tingling/
numbness in the hands, feet
and around the mouth,
muscle twitching, leg
weakness, diarrhea
Weakness, vomiting,
diarrhea, muscle
weakness, anorexia,
polyuria, ileus
abdominal distension,
paresthesias, leg
cramps, decreased
reflexes
Severe: ECG changes:
ectopic heartbeats, asystole,
V Fib
Causes:
-Injuries: kidney injury, crash,
burns
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Severe:
Decrease BP, and weak/
irregular pulse. ECG
changes: flattened T
waves, prominent U
waves ST segment
depression, Prolonged
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Sodium
Priority
assessment:
Mental status/
brain
NV: 135-145
Found in
Extracellular fluid
that maintains
osmolarity of
extracellular fluid
-
Muscle contractions
Nerve impulse
transmission
Hypernatremia:
- 0.3% NaCl. Hypotonic
solution, will lower serum
sodium level
-0.9% NaCl, 5% dextrose in
water
-Furosemide, bumetanide
Hyponatremia:
- If hypovolemic, IV
isotonic solution or
small infusions of
hypertonic solutions for
severe hyponatremia
- If hypervolemic: water
secreting medications
that retain sodium
Medications: potassium
sparing diuretics, blood
transfusions, ACE inhibitors,
NSAIDS, cyclosporine
-Disorders: metabolic
acidosis, addison disease,
hypoaldosteronism
PR interval
Confusion, seizures,
hallucinations, confusion,
irritability, restlessness,
stupor, coa, extreme thirst,
dry, swollen tongue and
mucous membranes,
anorexia, N/V, elevated body
temp
Headache, confusion,
lethargy, drowsiness,
dizziness, seizures,
tachycardia,
hypotension, N/V/D,
anorexia, abdominal
cramping, muscle
cramps and weakness
Causes:
-hypertonic tube feedings
without adequate water
replacement
-corticosteroids
-cushing syndrome
-Hyperaldosteronism
-excessive sodium intake
-Diabetes insipidus
-Fluid deprivation
-Heat stroke
-Hyperventilation
-Burns
-Excessive diaphoresis
-Watery diarrhea
Causes:
-Diuretics
-excessive intake of
hypotonic fluids
-Wound drainage
-psychogenic polydipsia
-medication associated
with water retention
such as oxytocin and
some tranquilizers
-GI fluid loss
-Renal disease
Hypoaldosteronism
-Heart failure
-Hyperglycemia
-SIADH
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Causes:
-GI losses: diarrhea,
vomiting, gastric
suctioning
-Dietary: starvation,
anorexia
-Medications:
corticosteroids, digoxin
toxicity, furosemide,
thiazide diuretics, loop
diuretics, sodium
penicillin, amphotericin
B
-Disorders:
hyperaldosteronism,
magnesium depletion,
osmotic diuresis,
metabolic alkalosis
lOMoARcPSD|10399729
Magnesium
-
1.3-2.1 meq/L
Majority of Mg
found in muscles
Regulated by small
Mag is a drag
intestine through
absorption and kidney
- Skeletal muscle
through excretion
depression
“Mag is a Drag” slow
- Nerve impulse
body down if there is too
depression
much
- N/V
- Respiratory
depression
- Facial flushing
- lethargy/drowsiness
- Hypotension
- Bradycardia
-
-
-
-
Causes:
Mg sulfate IV
-Antacid overuse
-Anticholinergics, laxatives,
lithium intoxication, opioids
-Kidney failure
-soft tissue injury
Hypothyroidism
Calcium
NV: 8.6-10.2
Hormone secretion,
bones/teeth, transmission of
nerve impulses
*Calcium and phosphate are
the see-saw*
Hyper :
fatigue , weakness, nausea,
constipation, mental status
changes, kidney stones, ECG
changes: bradycardia wide/
depressed T waves, heart
blocks
Vitamin D stimulates
reabsorption of calcium
Causes:
- bone metastasis from
breast//prostate/cervical
cancer
- Hyperparathyroidism
- Blood cancers
-Excessive calcium or Vitamin
D
-Sarcoidosis
-Acidotic state
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Irritability and
behavioral
changes
Increased
neuromuscular
excitability:
Positive
chvostek sign
and positive
trousseau sign
Hyperreflexia
Muscle cramps
and tenant
Hypertension
Muscle cramps
and tetany
Cardiac
dysrhythmias ex:
torsades de
pointes
Causes: malnutrition
-malabsorption issues
-alcoholism
-renaltubular dysfunction
-Loop diuretics and PPIs
-Hyperglycemia
Hypo:
Paresthesia around
mouth/fingers/toes,
hyperreflexia, muscle
spasm, seizures
intestinal cramping,
positive chvostek sign,
positive trousseau sign,
ECG changes:
increased QT interval
Causes:
-Malnutrition
-Hypoparathyroidism
-Blood transfusions
-Wound drainage
-Diarrhea
-Malabsorption
lOMoARcPSD|10399729
-Thiazide diuretics
syndromes such as
celiacs or chrohns
Loop diuretics
Medications
Class
Medications in class
SE/ AE/ Assessments
Benzodiazepines
Midazolam,
lorazepam, diazepam
Respiratory and
cardiovascular
depression, ataxia,
dizziness,
hypotension,
bradycardia, blurred
vision
Fentanyl, morphine
Hypotension,
bradycardia,
respiratory
depression, nausea,
vomiting, constipation
Hypnotics
Propofol
Hypotension, heart
block, asystole,
arrhythmias,
bradycardia
Dissociative general
anesthetics
Ketamine
Hallucinations,
delirium,
hypertension,
tachycardia increased
ICP, tonic clonic
movements
Antidiarrheal
Loperamide
Antidote: flumazenil
Opioids
Antidote: Naloxone
What else to know
For sudden diarrhea
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“travelers diarrhea”
Inhaled bronchodilators
SABAs: Albuterol,
levalbuterol
Used for episodic
symptoms
LABAs: (maintenance
therapy): salmeterol,
formoterol,
lumecidirium
Relieve
bronchospasms,
relax smooth muscle
tone, reduce airway
obstruction, improve
exercise tolerance
Anticholinergics
Short acting:
ipratropium bromide
Long: trotropium
bromide
Mainstay of therapy,
decrease airway
smooth muscle tone
and secretions
Corticosteroids
Prednisone,
methylprednisolone
Reduces acute and
chronic inflammation
Calcium channel blockers
Verapamil, nifedipine,
diltiazem
“Very Nice Drugs”
Peripheral edema,
hypotension,
bradycardia,
headache,
constipation
Vasodilation,
decrease in the heart
rate
No grapefruit juice
Angina
Centrally acting alpha 2
agonist
Clonidine
3 D’s of cloniDINE
Decrease HR and BP
Dizziness,
drowsiness, dry
mouth
Beta blockers
Metoprolol
atenolol
Propranolol
Labetalol
carvedilol
Bradycardia,
hypotension, fatigue,
do not discontinue
abruptly, erectile
dysfunction ,
bronchospasm*
Block beta 1
receptors to decrease
BP and HR
Inhibits sympathetic
stimulation of the
heart
Contraindicated with
asthma b/c
bronchospasm
Direct renin inhibitor
aliskiren
Hypotension,
angioedema, GI
upset
Treat HTN
ACE inhibitors
-PRIL
Hypotension,
Treat HTN, MI, HF
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ARBs
Captopril, lisinopril
“ACE”
Angioedema,
Cough
Elevated potassium
-SARTAN
If you saw satan:
blood pressure drop,
dizzy and stomach
upset
Treat HTN and
neuropathy
Hyperkalemia,
dizziness
HTN and HF after MI
Losartan and valsartan
Aldosterone antagonist
Eplerenone
Blocks aldosterone
hypotension****
Cyanide toxicity
“Nitroprusside may
Thiocyanate toxicity
pruss u into the ground dizzy , GI upset
when your BP drops”
Used for HTN crisis
emergency
Antianginals
Nitroglycerin,
isosorbide
mononitrate,
isosorbide dinitrate
OH, headache, reflex
tachycardia
Sublingual nitro:
needs to be stored in
a cool and dark
place. Can only take
up to 3 tablets for
chest pain
Cardiac Glycosides
Digoxin
Dysrhythmias, dig
toxicity
Used for HF, A-fib, Aflutter
Hold dig if HR <60
BPM
Positive inotropic
effect : increase force
of contraction
Vasodilator
Nitroprusside
Direct vasodilation of
arteries and veins
TE: 0.5-2
Antidote: dig immune
fab
“When you dig a hole
you want to go slow
and deep”
Dig toxicity: GI upset
vomiting, fatigue,
vision issues**
Negative chronotropic
Monitor potassium
Antidysrhythmics: class I
-CAINE
Sodium channel blockers
Procainamide,
TE:4-8
Hypotension,
dysrhythmias, lupus,
thrombocytopenia,
leukopenia
Used for ventricular
dysrhythmias and
supraventricular
tachycardia
Hypotension,
bradycardia, cardiac
toxicity pulmonary
toxicity, liver toxicity,
For severe
dysrhythmias: V-fib,
V-tach
lidocaine
Antidysrhythmics : class III
Potassium channel blockers
amiodarone
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Antidysrhythmics: Class IV
and thyroid
dysfunction
**No grapefruit juice**
Verapamil, diltiazem
Hypotension,
peripheral edema,
bradycardia,
headache,
constipation
Treat afib, a-flutter
and SVT
Adenosine
Arrhythmias,
hypotension, SOB
Treatment of SVT
Calcium channel blockers
Class V antidysrhythmics
Slows rhythm down
Anticholinergic/antimuscarinic
Atropine
“Atropine is a
trampoline that brings
your HR up”
Anticholinergic
effects: blurred vision,
dry mouth,
tachycardia,
constipation
For sinus
bradycardia, heart
block, and
decreasing secretions
during surgery
Anticoagulants: factor Xa
inhibitor
Rivaroxoban, apixaban Bleeding, elevated
liver enzymes
“Blood flow like a river” *Do not abruptly
discontinue*
Used to prevent DVT,
stroke, PE in pt who
has atrial fibrillation
Antiplatelets
Clopidogrel
Abciximab
Bleeding,
hypotension, GI
upset rash
ABC: dysrhythmia
Used to prevent
MI/stroke in pt with
acute coronary
syndrome
Prevention of platelet
aggregation
Thrombin Inhibitors
Argatroban
dabigatran
bleeding *
Argatroban:
hypotension
Dabigatran:
angioedema and GI
upset
Treat DVT, PE,
prevention of stroke,
HIT
Bronchodilator vasopressor
Epinephrine
HTN, dysrhythmias,
angina, nervousness,
and tremor
Anaphylaxis,
advanced cardiac life
support
Increases HR,
Bronchodilation,
vasoconstriction
Adrenergic vasopressor
Norepinephrine
HTN, dysrhythmias,
Shock or severe
hypotension
Vasoconstriction,
increase CO,
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Inotropic vasopressor
Dopamine
Shock, sepsis, HF,
renal failure
“Why are you acting
like such a dope, are
you in shock?”
Adrenergic Inotropic
Colloid (volume expander)
Dobutamine
Albumin
“Al is a bum that sits
outside the grocery
story and everyone
gives him water”
Vasoconstriction,
increases cardiac
output and HR,
increases renal
perfusion (use for
renal failure
HTN ,dysrhythmias,
angina
HF, cardiogenic
shock
Monitor CWP, CVP
Increase CO, (less
effect on HR)
Fluid volume
overload, pulmonary
edema, HTN
Shock, hemorrhage
and burns
Draws fluid from
extravascular space
into intravascular
space
Contraindicated with
HF pts
Antilipemic agent:
anticholesterol Statins
-STATINS
Atorvastatin,
simvastatin
Hepatotoxicity,
muscle pain,
rhabdomyolysis, GI
upset
Control cholesterol,
prevention of
coronary heart
disease
Take with evening
meal b/c cholesterol
is synthesized at
night
Decreases LDL
“L for Lousy”
Increase HDLs
“H for Happy”
Avoid alcohol and
grapefruit juice
Cholesterol absorption
inhibitor
Ezetimibe
“Ezetimibe will help
you Zip through small
intestine to not get
absorbed”
Bile Acid sequestrants
Colesevelam and
cholestyramine
Hepatotoxicity,
muscle pain
For
hypercholesterolemia
Monitor CK and liver
Prevents absorption
of cholesterol in small
intestine
Constipation, GI
upset
For
Hypercholesterolemia
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Fibric acid derivatives
Gemfibrozil
Fenofibrate
“If you FIB on your
diet, you may need to
correct your
cholesterol”
Can interfere with fat
soluble vitamins :
ADEK
“A fat DEK of cards”
Binds to bile acids in
the intestine which
helps increase
secretion of
cholesterol and bring
down LDL
Gi upset, gallstones,
hepatotoxicity,
muscle pain
Hypercholesterolemia
30 mins before Bfast
and Dinner
Decreases
triglyceride
production and
transport
Increase HDL levels
Water soluble vitamin
Niacin
(B-3)
“My face does not look
very nice when I take
niacin because of
facial flushing”
Anti-anemic agents
Folic acid (Vit B9)
Face flushing *
Hypercholesterolemia
GI upset, pruritus,
hepatotoxicity,
hyperglycemia
Decreases lipoprotein
and triglyceride
synthesis
Use with caution in
pts with diabetes
Rash, more yellow
urine
Treat megaloblastic
anemia and
microcytic anemia,
treat neural tube
defects in developing
fetuses
Stim production of
RBC, WBC and
platelets
Higher doses of folic
acid can mask a B12
deficiency : can result
in cognitive decline
Vegetarians be
careful
Anti-anemic agents
Vit B12:
Cyanocobalamin
Hypokalemia, GI
upset,
Hypersensitivity
Treat pernicious
anemia
Need to give nasally
to be effective
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Vegetarians be
careful
Iron supplements
Ferrous sulfate (PO)
Iron dextran (IV/IM)
:Hypotension and
flushing
GI upset:
constipation, teeth
staining, dark green
stool
DO NOT give with
meals 1 hr before, 2
hr after
Iron deficiency
anemia
Vit C is important for
iron absorption
For iron dextran:
Ztrack method
Increase fluid and
fiber intake
Calcium supplements
Calcium carbonate,
calcium citrate,
calcium gluconate
Constipation,
dysrhythmias,
bradycardia
Calcium: 9-10.5
- Bone and teeth
formation
- Nerve and
muscle function
- Clotting
Beta adrenergic agonists
Albuterol,
salmeterol
Carbonate and
citrate: Used for
hypocalcemia and
prevention of postmenopausal
osteoporosis
Gluconate: used for
Hyperkalemia,
hypermagnesemia
Nervousness.
Tremors palpitations,
For asthma or COPD
can be used alone or
in combination with
othr medications
Use the
bronchodilator first
before using the
glucocorticoid
*B comes before G*
Albuterol is for acute
attacks
Salmeterol is long
acting for
preventative
measures
Xanthines
Theophylline
Risk for dysrhythmias
and seizures
Long term control of
asthma
Therapeutic levels: 10-
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20 mcg/ml
Anticholinergic inhaled
medications
Ipratropium
(inhaled/nasal)
Need regular blood
draws
Dry mouth, bitter
taste, throat/nasal
irritation
COPD, rhinitis,
asthma (off-label)
Increase fluid intake
Locally acting corticosteroids
(inhalers/ intranasal)
Beclomethasone,
mometasone,
budesonide,
fluticasone
Less than systemic:
headache,
pharyngitis,
candidiasis
Athma, rhinitis,
Decreases
inflammation locally
After administration,
rinse mouth out
Leukotriene receptor
antagonists
-LUKAST
Montelukast
zafirlukast
Headache
Montelukast should
be taken 2 hours
before exercise
Asthma, prevention
of exercise induced
bronchoconstriction
Z: increase in liver
enxxymes
Z: take on empty
stomach
Antitussives
Benzonatate,
Codeine ,
dextromethorphan
“ABCD”
B: Sedation,
Treatment of cough
constipation, GI upset
C: Decreases
patient’s cough reflex
*Opioid*, sedation,
respiratory
depression,
hypotension,
constipation, GI upset
D: supresses cough
reflex in medulla
:dizziness and
possible sedation
Expectorant
Mucolytics
Guaifenesin
GI upset, dizziness
“Gauf sounds like
cough”
Take med with full
glass of water
Thins secretions
acetylcysteine
Bronchospasm , N/V,
rash
*use cautiously in
asthma patients*
Used for pulmonary
disorders that have
thick mucous
secretions such as
(Antitode for
tylenol/actaminophen)
Used for non
productive cough
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cystic fibrosis
Smells like rotten
EGGS
Decongestants
Pseudoephedrine and
phenylephrine
Nervousness,
papitations,
weakness, insomnia,
rebound congestion
Rhinitis, nasal
congestion
Allergy symptoms,
uticaria, motion
sickness
Loratadine, cetrizine
(2nd)
1st: Drowsiness,
anticholinergic: dry
mouth, constipation,
urinary retention,
photosensitivity
-PAM
Diazepam, lorazepam,
midazolam,
chlordiazepioxide
Sedation, RD,
amnesia,
dependency, and
withdrawal
Antidote: Flumazenil
*Short term use*
Treat anxiety, alcohol
withdrawal, muscle
spasms, seizures,
induction and
maintanece of
anesthesia
“
Antihistamines
Benzodiazapines
Diphenhydramine (1st
generation)
Never discontinue
abruptly
Anxiety medication
Makes mucous less
viscous
Buspirone
Dizziness, headache,
nausea,
Vasoconstriction of
the respiratory tract
mucosa
Block H1 receptors
Increase the effect of
GABA in the CNS
For anxiety, OCD,
PTSD
Takes several weeks
before effect
Always take with or
always take without
food
Grapejuice
contraindicated
Tricyclic antidepressants
Amitriptyline and
imipramine
“Amy is walking along
the desert and trips
over her tricycle”
Sedation, OH,
anticholinergic SE
“Can’t see, cant pee,
cant spit and cant
poop”, dysrhytmias,
sweating, seizures
Chew gum, wear
Depression,
neuropathy,
fibromyalgia,
insomnia
Increases serotonin
and norepinephrine
in CNS
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sunglasses
MAOIs: monoamine Oxidasee Phenelzine,
Inhibitors
tranylcypromide
“With phenelzine you
can’t eat life’s finer
things because they
contain tyramines”
Agitation, anxiety,
OH,
*can causes a
hypertensive crisis**
Interact with MANY
medications
Depression
Inhibit MOI, which
increase dopamine,
epi, and norepi in the
body
Avioid foods rich in
tyramines: aged
cheese, smoked
meat, avacado, red
wine, chocolate
Atypical antidepressants
Bupropion and
trazadone
B: Insomnia (very
common), headache,
GI upset, weight loss,
gitation, increase risk
of seizures
Depression
Bupropion:
antismoking agent
“Be appropriate and
don’t smoke”
T: *Sedation*
B: Decrease reuptake
of dopamine and
norepinephrine
T: serotonin
antagonist and
reuptake inhibitor
SSRI’s
-TINE
Paroxetine, sertraline,
fluoxetine
Sexual dysfunction,
weight gain, insomnia
Anxiety, depression,
OCD, PTSD
*could increase
suicidal thoughts*
Inhibit serotonin
reuptake which
increase sertonin in
system
Also escitalopram
“If you live with a
TEEN, you may have
anxiety”
Monitor for serotonin
syndrome: agitation,
hallucinations, fever,
diaphoresis,
Contraindicated with
St. Johns Wort
Takes several weeks
before works
SNRI’s
-INE
Fatigue, insomnia, GI
Depression
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Serotonin and
norepinephrine reuptake
inhibitors
Duloxetine and
venlafaxine
upset, dysuria,
decreased libido
Inhibit reuptake of
botth serotonin and
*can increase suicidal norepinephrine
thoughts*
“I don’t need a deluxe
apartment to be happy,
I just need my
*Monitor for serotonin
dukixetine for my
syndrome*
depression”
Mood stabilizer
Lithium
Under 1.5
Many side effects: GI
upset, fine hand
tremors, polyuria,
weight gain*, kidney
toxicity, electrolyte
imbalances, fatigue,
hypothyroidism,
leukocytosis
LITH: leukosytosis,
Insipidus, tremors,
Hypothyroidism
Bipolar disorder
Influences reuptake
of neurotransmitters
Maintain adequate of
both sodium and
fluids*****
Avoid diuretics to
avoid toxicity**, no
anticholinergics, no
NSAIDS
Lithium toxicity:
coarse tremors,
confusion,
hypotension,
seizures, and tinnitus
Anticonvulsants
Carbamazepine,
valproic acid,
lamotrigine
Serious side effects:
Used for bipolar
disorder or seizures
Carbamazepine: key
side effect is blood
dyscrasias: Anemia,
thrombocytopenia,
leukopenia, vision
issues, SIADH, skin
rashes.
Valproic acid:
hepatotoxicity,
pancreatitis, gi upset,
thrombocytopenia
Lamotrigine:
dizziness, GI upset,
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photosensitivity, rash
Antipsychotics Typical first
generation
Chlorpromazine,
haloperidol, droperidol
EPS side effects:
dystonia, parkinson’s
symptoms, tardive
dyskinesia, akathisia
*Benztropine will help
reduce these
symptoms*.
Helps control the
positive symptoms of
schizophrenia
(hallucinations,
delusions)
Alters action of
dopamine in CNS
Neuroleptic malignant
syndrome: fever, BP
fluctuations,
dysrhythmias, muscle
rigidity
*Dantrolene will help
reduce symptoms*
More SE:
agranulocytosis
(decrease WBC),
anticholinergic, OH,
seizures and
sedation
Antipsychotics atypical 2nd
generation
Risperidone,
olanzapine, clozapine
SE: diabetes, weight
gain, increased
cholesterol, sedation,
OH, anticholinergic
effects, menorrhagia,
decreased libido
schizophrenia :
controls positive and
negative symptoms of
schizophrenia
Cloz: agranulocytosis
Monitor BG, infection
CNS stimulants
Methylphenidate and
amphetamine
SE: insomnia,
dysrhythmias,
decreased appetite
and weight loss
*Drug abuse and
dependence is
common *
ADHD
Increase mental
alertness and
increase attention
span
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Give in morning, 3045 minutes before
meals, monitor pt
weight
Maintenance medication:
alcohol abuse
Disulfiram, naltrexone,
acamprosate
Disulfiram: pt will
have unpleasant
reaction if they
consume alcohol:
vomiting, sweating,
hypotension
Long term abstinence
from alcohol
Naltrexone: reduce
cravings
Acamprosate:
decrease abstinence
symptoms such as
anxiety and
restlessness
“Camp for no alcohol”
Opioid dependence
medications
Buprenorphine and
methadone
Antidote: Naloxone
Smoking cessation
Varenicline (chantix)
CNS depressing;
same SE as opioids:
sedation, confusion,
constipation,
respiratory
depression, cardiac
depression
Used for opioid
withdrawal and
management of
patients with severe
pain
Anxiety, depression,
irritability, insomnia,
muscle pain
Promotes smoking
cessations: binds to
nicotinic receptors
Milestones for baby (DAY 3)
Age
Milestones / safety
2 month
- Posterior fontanel closes
- Lifts head off bed when prone
- Visually searches to locate sounds
- Tracts with eyes (faces)
- Coos
Safety:
- Falls
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3 month
4 month
5 months
-
Suffocation
Drowning
Supine position for sleep
Immunizations
-
Localization of sound by turning head
Vocalization
Raises head and shoulders from prone position
- Trust VS Mistrust
- Begins drooling
- Rolls from back to side
- Tonic Neck reflex absent
- Oppose thumb
- Pleasure in social contact
- Balances head when sitting
- Sits if assisted
- nabbles
- Pulls clothes and blanket over head
- Grasps with both hands
- Personality
Safety:
- Toys: rattles, cradle gym
- Introduce one food at a time for each two week period
-
6 months
8 month
Double birth weight
Moro reflex fading
Grasps object with whole hand
Simple vowel sounds
Locates sounds downward and to side by turning head and looking
down
Displeased when objects are taken away
- Teething
- Rolls from back to abdomen
- Manipulates small objects
- Stranger danger
- Responds to name
- Holds arms to be picked up
Safety:
- Pureed solid food
- Immunizations: dTaP, Hib
-
Parachute reflex
Sits unsupported
Crawls
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9 month
-
Throws objects
Stands holding furniture
Babbles
Name recognition
Pincer grasp; pick up cheerios
-
Sits steady
Can lean forward
Regains balance
May pull up to standing position
11 month
1 yr
-
Walks holding furniture
Follow simple commands
Containers
Imitates speech sounds
Sequential play
Mama dada
Separation anxiety
Tripled birth weight
50% length increase
Walking
3-5 words
Understands meaning of several words
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