Mark Klimek Yellow Book

1 ACID-BASE BALANCE VENTILATORS 1. Rule of the B's: If the ph and the bicarb are both in the same direction then it is metabolic. When it’s different directions it’s respiratory. If they are in different directions = acidosis Just look at the ph and bicarb pH = 7.35 – 7.45 acidosis / alkalosis (below 7.35) (above 7.45) HCO3 =22—26 bicarb years (the biggest decisions are done between 22 - 26) CO2 = 35-45 2. pH 7.30 down HCO3 20 down = metabolic acidosis 3. pH 7.58 up HCO3 32 up = metabolic alkalosis 4. pH 7.22 down HCO3 30 up =respiratory acidosis SIGNS & SYMPTOMS Know the principles, not the lists. PRINCIPLE 5. As the ___ph____ goes, so goes ____my patient__________________ except for __potassium___________________ ALKALOSIS (↑) ACIDOSIS (↓) Hyperreflexia Headache Irritability Hyporeflexia Tachypnea Bradycardia Tachycardia Bradypnea Borborygmi Paralytic/adynamic ileus Seizures *need suction Coma HYPOkalemia Respiratory arrest *need ambu bag MACkussmau’s (ONLY METABOLIC ACIDOSIS → “MAC”) Heart block HYPERkalmia 6. 7. Up - _____________________ - _____________________ - _____________________ - _____________________ - _____________________ - _____________________ - _____________________ - _____________________ - _____________________ - _____________________ - _____________________ - _____________________ Down - hyporeflexia - paralytic ileus - _____________________ - bradycardia - coma - _____________________ - lethargy - _____________________ - _____________________ 2 8. EXAMPLE: You are providing care to a client with the following blood gas results: pH 7.32, CO2 49, HCO3 29, PO2 80, and SaO2 90%. Based on these results, the client is experiencing: ____respirtatory acidosis _______________________ 9. MacKussmaul— _found in metabolic acidosis. Rapid RR. ______________________________________________________________ CAUSES OF IMBALANCES 1. Is it a LUNG SCENARIO? YES. It is a RESPIRATORY OVER-VENTILATING UNDER-VENTILATING ↓ ↓ RESPIRATORY ALKALOSIS RESPIRATORY ACIDOSIS Examples: - Pregnant woman hyperventilating. - Ventilator setting is TOO HIGH. Examples: - Emphysema - Drowning - Pneumonia - PCA pump (toxicity) - Ventilator setting is TOO LOW 2. What if it is NOT a LUNG SCENARIO? It is METABOLIC PROLONGED GASTRIC VOMITING OR SUCTIONING ANYTHING ELSE! ↓ ↓ METABOLIC ALKALOSIS METABOLIC ACIDOSIS Examples: Surgery with NG tube suction for 3 days Hyperemesis gravidarum Examples: Acute RF Infantile diarrhea 3rd degree burns over 60% of body Hyperemesis gravidarum with dehydration NOTE: Always pay attention to MODIFYING PHRASE rather than original statement. 10. Caused of acid base imbalances: First ask yourself, "If it’s ____lung_______?" If yes, then it's ___respiratory_____________. Then ask yourself: "Are they ____overventilated______________ or ___undervintlated______________. If ___overventilated_________________, pick ______alkalolsis________________. If ___underventilated__________________, pick _____acidosis_____________________ 11. Caused of acid base imbalances: If it's not lung, then it's ___metabolic________. If the patient has _gastric_________ _______ vomiting or suction, pick ___alkaolsis___________. For everything else that isn't lung, pick __metabolic_________ _acidosis__________. When you don't know what to pick, choose ___metabolic acidosis__________________ VENTILATORS AND ALARMS 3 HIGH PRESSURE ALARM Ventilator is working too hard to get air into lungs. There is INCREASED RESISTANCE due to OBSTRUCTIONS. [machine is pushing too hard to get air into the lungs] RESPIRATORY ALKALOSIS 1. Kinks → unkink 2. Water condensing into dependent loops → empty 3. Mucus in airway → turn, cough and deep breathe, THEN suction PRN. **in that order** LOW PRESSURE ALARM Ventilator finds that it is working too easy to get air into lungs. There is DECREASED RESISTANCE due to DISCONNECTIONS. [too easy for the machine…] RESPIRATORY ACIDOSIS 1. Main tubing is disconnected → reconnect 2. Oxygen sensor tubing, which senses FiO2, is disconnected. This is the black coated wire → reconnect Question MD orders to disconnect ventilator in AM @ 0900hr. At 0600hr, ABC reveals respiratory acidosis. What do you do? a. Follow order b. Call MD and hold order c. Call RT d. Begin to decrease settings. B is the answer because the patient is not able to breathe without the ventilator. The settings are TOO low. Patient should be in respiratory ALKALOSIS. 12. High pressure alarms are triggered by ____increased________ resistance to air flow. 13. High pressure alarms are triggered by increased resistance to airflow and can be caused by obstructions of three types: ____kink________________ action, __condensed water in the tube_________________ action, _________mucus plug_____________ action 14. Low pressure alarms are triggered by ______decrese_________ resistance to airflow. 15. Low pressure alarms are triggered by decreased resistance to airflow and can be caused by disconnections of the _____main tube____________ or ____o2 sensor tube ______________________________________________________________. 16. Respiratory alkalosis means ventilator settings may be too ____high______ 17. Respiratory acidosis means ventilator settings may be too ___low________ 18. What does "wean" mean? _______________________________________________________________ 19. What is Maslow's highest priority to lowest priority? - _________physiological___________ - _____safety_______________ - _____________comfort_______ - _____pscyhological_______________ - ___social_________________ - ____spiritual________________ 20. Arrange from highest to lowest priority using Maslow's: - Denial - ___electorlyte imbalance_________________ - Spiritual Distress - ____falls risk________________ - Pain in Elbow - __pain in elbow__________________ - Fall Risk - _____denial_______________ - Pathological Family Dynamics - __family dynamics__________________ - Electrolyte Imbalance - ___spirtual distress_________________ 21. What are the 5 stages of grief? - __denial__________________ - ____anger________________ - _______bargaining _____________ 4 - ____depression________________ - _____acceptance_______________ 22. The #1 problem in abuse is __denial___________ 23. Denial is the ___refusal_________ to accept that__they have__________ a problem 24. Treating denial: ___Confront_________ it by pointing out to the person the difference between what they __say_________ and what they __do________. In contrast, __support____________ the denial of loss and grief 25. Dependency: When the _abuse______________ gets the Significant Other to do things for them or make decisions for them 26. Codependency: When the __significant____________ ____other_________ derives positive __self-esteem______________ from doing things for or making decisions for the ______abuser__________. 27. When treating dependency/codependency: Set _limits_________ and ______enforce_______ them. Agree in advance on what requests are allowed, then enforce the agreement 28. When treating dependency/codependency: Work on the _self-esteem_________________ of the codependent person 29. Manipulation: when the _abuser____________ gets the __significant_____________ ___other______________ to do things for him/her that are not in the _____best____________ _____interest__________ of the __significant______________ ___other_______________. The nature of the act is __dangerous_______________ or ___harmful________________ to the _significant________________ ___other____________. 30. Treating manipulation: set ____limits_______________ and 31. ____enfource_______________ 32. Wernicke's (Korsakoff's) Syndrome: __psychosis__________________ induced by Vitamin __B1_____(thiamine) deficiency - Form of dementia 33. Primary symptoms of Wernicke's (Korsakoff's) Syndrome: ____amnesia_______________ with ____confabulation______________ 34. Characteristics of Wernicke's (Korsakoff's) Syndrome: - ___Preventable (take B1)__________________________ - __Arrestable (stop it from getting worse—>give b1)___________________________ - __Irreversible (70%)___________________________ 35. Disulfiram (Antabuse/Revia) is aka ___aversion therapy___________________ 36. Onset and duration of effectiveness of Antabuse/Revia: _____2 weeks____________________________ 37. Patient teaching with Antabuse/Revia: Avoid ___all____________ forms of ______alcohol____________ to avoid 38. 39. ______nausea_______________, _____vommiting_____________, ________death______________ 40. What are examples of products that contain alcohol? - _____vanilla extract - __insect repellent _ - ________________ - __uncooked icing - _OTC liquid meds - ________________ - __mouthwash - hand sanitizers - ________________ - exilirs__ - vinaigrettes (EXCEPT Red wine - ________________ - _perfumes/colognes___ vinaigrette= this one's okay. - ________________ - __aftershave______ - ________________ 41. Every alcoholic goes through _alcoholic__withdrawl____syndrome__. Only a minority get ____delerium tremens_ 42. _______alcholic withdrawal syndrom___ is not life-threatening. ____delrium tremens ___ can kill you 43. Patients with _____alcoholic withdrawal syndrom__are not a danger to themselves or others. Patients with _delrium tremens_are dangerous to self and others 44. AWS or DT: Semiprivate room, any location _AWS______ 45. AWS or DT: private room near the nurse's station __DT____ 46. AWS or DT: Regular diet _AWS_____ 5 47. AWS or DT: Clear liquid or NPO diet (risk for aspiration) ___DT___ 48. AWS or DT: Up at liberty __AWS____ 49. AWS or DT: Restricted to bedrest with no bathroom privileges __DT_____ 50. AWS or DT: No restraints __AWS_____ 51. You should restrain a DT patient with __vest or 2 point restraints. one arm and the opposite leg→2 point restraints. _________________________________________________. You should check them every ______2HR_____. You should rotate them ___q2h_______________. 52. Both AWS and DTs patients are on ______antihypertensizes_____________, ____tranquilizers______________, and _______Vitamin B1___________. 53. AWS or DT: Give anti-HTN medication _both______ 54. AWS or DT: Give tranquilizer ___both____ 55. AWS or DT: Give multivitamin to prevent Wernicke's _both_______ 56. What are the names of Uppers? 1. __cocaine_______________ 3. __PSP/LSD_______________ 5. _______adderall __________ 2. ___coffee______________ 4. ____methaphedamines______ 6. _________________ 57. What are the signs and symptoms of uppers? = everything goes up - __tachycardia_______ - ___HTN______________ - __increased RR_____ - __irritable_______________ - ____seizures_____________ - __increased BS, diarrhea___ 58. For Aminoglycosides, think " __A_____ _____Mean_________ ___Old______ ______Mysin__________" 59. When are antibiotics/aminoglycosides used? __severe___________, ___life threatening__________, ___gram negative_ infections 60. All aminoglycosides end in ___mysin___________, but not all drugs that end in __mysin_________ are aminoglycosides. 61. What are some examples of wannabe mycins? - ____________________ - ____________________ - ____________________ 62. What are some examples of aminoglycosides? - __vancomysion__________________ - ____________________ - ____________________ - ____________________ - ____________________ - ____________________ - ____________________ 63. When remembering toxic effects of mycin's think __ears____________________ 64. What is the toxic effect of aminoglycosides and what must you monitor? - ____hearing____ - __balance___ - _tennitus_(ringing of ear) 65. The human ear is shaped like a ___kidney____________________ so another toxic effect of aminoglycosides is ____nephrotoxic_________________________ so monitor ____Cr__________________ 66. What is the best indicator of fluid balance? ____Cr______________ 67. What is the best indicator of dehydration? ___Cr_______________ 68. The number "___8______" drawn inside the ear reminds you of cranial nerve ___8______ and frequency of administration ___q8hr____________ 69. What is the route of administration of aminoglycosides? ______iv________ or _____im_______ 70. Do not give aminoglycosides PO expect in these 2 cases: - __heaptic encephalopathy__ (due to high ____ammonia________________ level) - Pre-op ____bowel_____________ surgery 71. Who can sterilize my bowel? __NEO KAN (neomycin and kanamycin)_________________ 72. What is the reason for drawing Trough and Peak levels? _narrow __therapuetic__ window __________ 73. When do you ALWAYS draw the Trough? __30min before__ 74. When do you draw the Peak level of Sublingual medications? __5-10min after its dissolved 75. When do you draw the Peak level of IV medications? _____15-30min after its finished 6 76. When do you draw the Peak level of IM medications? ____30-60min 77. When do you draw the Peak level of SQ medications? ____see diabetes 78. When do you draw the Peak level of PO medications? __don’t need to know for nclex 79. What are biological Agents in Category A? - _______________________ - _______________________ - _______________________ - _______________________ - _______________________ - _______________________ - _____________________ 80. What are Biological Agents in Category B? _____________________________ 81. What are Biological Agents in Category C? _____________________ and _______________________ 82. When it comes to Biological Agents: Category ____________ is ______________, Then Category _______, Then Category __________________ 83. Smallpox - Spread? _______________________________ - Precautions? ___________________________ - Dies from? _____________________________ - Symptoms look like? _____________________ - Category? ___________ 84. Tularemia - Spread? _______________________________ - Precautions? ___________________________ - Dies from? _____________________________ - Symptoms look like? _____________________ - Treatment? ____________________________ - Category? ___________ - Precautions? ___________________________ 85. Anthrax - Spread? _______________________________ - Dies from? __________________________ - Symptoms look like? _____________________ - Treatment? ____________________________ - Category? ___________ 86. Plague - Spread? _______________________________ - Precautions? ________________________________________________________ - Dies from? __________________________________________________________ - Symptoms look like? __________________________________________________ - Treatment? _________________________________________________________ - Category? ___________ 87. Hemorrhagic illnesses - Spread? _______________________________ - Precautions? ___________________________ - Dies from? _____________________________ - Treatment? ____________________________ - Symptoms look like? _____________________ - Category? ___________ - Precautions? ___________________________ 88. Botulism - Spread? _______________________________ - Dies from? _____________________________ - Symptoms look like? _____________________ 7 Treatment? ____________________________ - Category? ___________ - 89. What are some examples of chemical agents that cause Bioterrorism? - ____________________________ - ____________________________ - ____________________________ - ____________________________ 90. What is the primary symptom of Mustard Gas? ____________________________ 91. What is the primary symptom of Cyanide and how do you treat it? - Symptom? ____________________________ Treatment? ____________________________ - 92. What is the primary symptom of Phosgine Chlorine? ____________________________ 93. What are the symptoms of Sarin (hint it's a nerve agent)? - ____________________________ - ____________________________ - ____________________________ - ____________________________ - ____________________________ - ____________________________ - ____________________________ - ____________________________ 94. What do you use when cleansing patients exposed to chemical agents? - _______________________________________________________________________________. 95. When do you commonly give anti-cholinergic? ___________________________________________. 96. Which agents do you isolate the patient for? ______________ _______________ 97. Which agents do you decontaminate for? _______________ ________________ 98. How does decontamination work? - _______________________________________________________________________________ - _______________________________________________________________________________ - _______________________________________________________________________________ 99. Calcium Channel Blockers: they are like ___valium__________ for your heart. What does that mean? __calms your heart down. Relaxes and slows down the heart. ___________ 100. Calcium Channel Blockers: __negative____________ inotropic, chronotropic, dromotropic 101. Inotropic strength of heart 102. Positive Inotropic strong heartbeat 103. Negative Inotropic weak heartbeat 104. Chronotropic rate of heartbeat 105. Positive Chronotropic fast heartbeat 106. Negative Chronotropic slow heartbeat 107. Dromotropic conductivity of heart 108. Positive Dromotropic excitable heart 109. Negative Dromotropic blocks/slows conduction 110. Positive Inotropic, Chronotropic, and Dromotropic is seen with which medications? - ___cardiac stimulants________________________________ - ___________________________________ - ___________________________________ 111. Negative Inotropic, Chronotropic, and Dromotropic is seen with which medications? - _______caclium channel blockers____________________________ - ______beta blockers_____________________________ 112. What do Calcium Channel blockers treat? (indications) - ___antihypertensives________________________________________________ - _________antianginal__________________________________________ - _____antiartial arrhymias______________________________________________ 113. What are some of the side effects of Calcium Channel blockers? - __headache_________________________________ 8 - _____hypotension______________________________ - ___________________________________ 114. Names of Calcium Channel Blockers can be remembered by calling.... - ____dipine___________________________________________________________________ 115. "QRS depolarization" always refers to __ventricular___________________ 116. "P wave" refers to ____artiral________________ 117. Asystole ______flat line___________________________ 118. Atrial Flutter _________P wave saw tooth______________________________________________ 119. Atrial Fibrillation _____chaotic p wave__________________________________________________ 120. Ventricular fibrillation ___chaotic qrs____________________________________________________ 121. Ventricular Tachycardia _____bizarra qrs__________________________________________________ 122. Premature Ventricular Contractions (PVC) _______periodic wide bizarre qrs __________________________________________ 123. Be concerned about PVC's if: - _____6 or more in a min __ - ____> 6 in a row - _PVC falls on a t wave __ - _______V fib (quiver) 124. What are the lethal arrhythmias? - ________asystole___ 125. What is the potentially life-threatening arrhythmias? - _asytole______________________________ - ______v fib__ 126. Prioritize life threatening arrhythmias? - _________________________________ - _________________________________ - _________________________________ - _________________________________ 127. When dealing with an IV push drug if you don't know go ______________ except _________________! 128. What is the treatment for PVC's? _____lidocane___________________ and ____________amiodarone _. 129. What is the treatment for V Tach? ___Lindocane_____ and ____amiodarone_______. 130. What are the treatments for Supraventricular arrhythmias? [ABCD] - ____adenocard adenosine_____________________________ - ____beta blockers_____________________________ - __calcium channel blockers_______________________________ - __digitals (digoxin) lanoxin_______________________________ 131. What is the treatment for V-fib? ___dfib=shock________________ 132. What is the treatment for Asystole? ___epinephine, atropine _ 133. asystole 134. atrial fibrillation 135. atrial flutter 136. Normal Sinus Rhythm 137. Supraventricular tachycardia 138. ventricular fibrillation 139. The purpose for chest tubes is to re-establish _negative____________________ pressure in the pleural space 140. In the pneumothorax, the chest tube removes _air__________ 141. In the hemothorax, the chest tube removes ____blood_________ 142. In the pneumohemothorax, the chest tube removes ______air_______ and _______blood__________ 143. when the chest tube is __apical________ (__top____) for _air_______. aka _________ 144. When the chest tube is ___basilar_______ (___bottom___) for __blood______ aka _________ 9 145. How many chest tubes and where for unilateral pneumohemothorax? ___; ___one apical and one basilar to remove air and blood on affected side______________________. 146. How many chest tubes and where for bilateral pneumothorax? one apical on right side and one apical on left side____; _____________________________. 147. How many chest tubes and where for post-op chest surgery/chest trauma? - 2___one apical and one basilar____________________________________________ - ___on affected side____________________________________________ - *WHENEVER CHEST SURGERY OR TRAUMA ASSUME UNILATERAL unless says otherwise* 148. In routine __________ clamp chest tube. In emergency ______________ the chest tube What do you do if you kick over the collection bottle? ______pick it back up and tell them to take a few deep - breaths___________________________________. 149. What do you do if the water seal breaks? - First- _______clamp______________________________ - Best- __submerge in sterile water___________________________________ 150. What do you do if the chest tube comes out? - First- ____cover with gloved hand______________________________________________________________ - best- _____cover with vaseline gauze tape 3 sides _____________________________________________________________ 151. If there's bubbling in the water seal intermittently it is… good ____________ 152. If there's bubbling in the water seal and it's continuous it is... ____bad_______ 153. If there's bubbling in the suction control chamber intermittently it is... __bad_________ 154. If there's bubbling in the suction control chamber continuously it is... __good__________ 155. Rules for clamping the tube: - never clamp longer than _____15 seconds__________ without Dr's order use _______rubber tooth clamps______________________ 156. Every congenital heart defect is either _____trouble_______________ or ______not trouble *all good*_____________ 157. R-L = Right to Left Shunt 158. B = Blue 159. T = starts with the letter "T" 160. What are some examples of "TRouBLe" congenital heart defects? - __tetralogy of fallot_____________________________________________ - __tricuspid atresia_____________________________________________ - _______________________________________________ - _______________________________________________ - _______________________________________________ - _______________________________________________ 161. What are some examples of "No TRouBLe" congenital heart defects? - _____ventricular septal defect__________________________________________ - _________pulmonic stenosis______________________________________ - _______________________________________________ 162. Akk CHD kids will have 2 things, whether TRouBLe or No TRouBLe... - _______murmur________________________________________ - ___________ECG to see why the murmur____________________________________ 163. Four defects present in Tetralogy of Fallot are...VarieD, PictureS, Of A, RancH - _ventrical defect______________________________________________ - __pulmonic stenosis_____________________________________________ - __overriding aorta_____________________________________________ 10 ____right ventricular hypertrophy___________________________________________ - 164. How do you measure crutches for a person? - ______2-3 fingers width from armpit anterior axillar fold (NOT AXILLA) and pad, 30 degree flexion wrist at handle level, tip point lateral (6 inches) and slightly in front of the foot (6 inches) __________________________________________________________________________ 165. When the handgrip is properly placed, the angle of elbow flexion will be ___30____________ degrees 166. 2-point gait - step one-- ______right foot and left crutch_________________________________________ - step two-- ____left foot and right crutch___________________________________________ - used for? ____mild bilateral weakness___________________________________________ 167. 3-point gait - step one-- ____both crutches and bad foot___________________________________________ - step two-- ____good foot___________________________________________ 168. 4-point gait - step one-- _____left crutch__________________________________________ - step two-- ___right foot____________________________________________ - step three-- ___right crutch____________________________________________ - step four-- ____left foot___________________________________________ 169. Swing through ___similar to 3 point, good foot goes pass the tip of both crutches. for non weight bearing and amputees____________________________________________ 170. Use the ____even_____ numbered gaits when weakness is ____evenly________ distributed. __2______ point for mild problems and ___4______ point for severe 171. Use the ____odd______ numbered gait when one leg is __affected_________ 172. Stairs: which foot leads when going up and down stairs on crutches? _up_________ with the __good________ and ____down_________ with the _____bad_______. The crutches always move with the ___bad__________ leg 173. Cane: Hold cane on the ________strong___________ side. Advance cane with the ____weak_________ side for a wide base of support - What is the correct way to use a walker? picks it up, sets it down, walks to it. - What is a big NO when it comes to walkers? ___putting stuff on the front of the walker (side is okay), having tennis ball wheels, wheels____________________________________________ 174. What is the correct way to get up from a chair using a walker? Holds the chair, stands up, holds the walke 175. What is the difference between a non-psychotic person and a psychotic person? - ______psychotic person has no insight or is in touch with reality. nonpsychotic has insight and is reality based. Nonpsychotic should be treated like a med surg patient. 176. Delusion ___false/fixed belief, thought, or idea. it is in the patient’s head. ___________________________________________________________________________. 177. What are the 3 types of delusions? __paranoid (someones after me)____________, _____grandiose (im God)_______________, _somatic (body part)________________. 178. Paranoid or Persecutors Delusion: people are out to get me/kill me 179. Grandiose delusion: im God, im christ, im president, i'm the smartest person 180. Somatic delusion: my eyes have x ray vision. there’s a worm in my arm 181. Hallucination __a sensory perception_____________, ______________________________________. 182. What are the 5 types of hallucinations? - ____autitory____________________________ - _____visual___________________________ 11 - _____tactile___________________________ - ____gustatory____________________________ ____olfactory____________________________ - 183. Illusion ____a sensory perception. real stimuli misinterpreted. 184. What is the difference between illusions and hallucinations? - _______illusions have referent- something to refer to. both patient and nurse can refer to it (i.e., a cord pt thinks is a snake, vs a snake and nothing being there) 185. When dealing with a patient experiencing delusions, hallucinations or illusions, first ask yourself, "What is their problem?" (what are the different problems that could be going on?) - - Functional psychosis o function in everyday life 90% of ppl o chemical imbalance in the brain Dementia psychosis o - actual brain damage Delirium psychosis o secondary to a cause o loss of reality o sudden, dramatic, temporary 186. What are the different types of functional psychosis? - SKEEZO, SKEEZO, MAJOR, MANICS - schizophrenia - schizoaffective disorder - major depression (not depression) - mania 187. What are the different types of Psychosis of dementia - Alzheimer - stroke - organic brain syndrome - anything that says senile/dementia 188. What are the different types of Delirium psychosis - UTI - Infection - fluid and electrolyte imbalance, dehydration - thyroid imbalance - medications, - adrenal crisis 189. How do you deal with a person with Functional Psychosis? - acknowledge feelings - present reality - set limits - enforce them 12 190. How do you deal with a person with Psychosis of Dementia? - Acknowledge feelings - Redirect- 191. How do you deal with a person with Psychotic Delirium - acknowledge feelings - provide reassurance regarding safety and the temporariness of their condition 192. What are the different types of loosening of association? - Flight of ideas, word salad, neologisms, narrowed self- concept, ideas of reference 193. Flight of ideas: rapid flow of thoughts 194. Word salad: words being thrown together then spit out. 195. Neologisms: making up new words 196. Narrowed self-concept: when a psychotic refuses to change clothes and leave their room. They only know who they are in those clothes and in that room. Can stay there forever on the NCLEX. different from a depressed person who is not psychotic. 197. Ideas of reference: you think everyone is talking to you. 198. Dementia hallmarks: memory loss, and inability to learn reality. 199. Always acknowledge feelings. 200. What are the 3 "Re's"? - _reassure - __redirect - 201. Diabetes mellitus _error in glucose metabolism 202. Diabetes insipidus - __polyuria______________________ - __polydipsia (dehydration)______________________ - _NOT DM, therefore NO sugar problem, just Fluid problem 203. Type I Diabetes Mellitus - _____insulin dependent - ___ketosis prone - ___non ketosis prone 204. Type II Diabetes Mellitus - _____non insulin dependent 205. Signs and symptoms of diabetes mellitus - __Polyuria________________________________ - __Polydipsia________________________________ - __Polyphagia________________________________ 206. Treatment for Type I Diabetes Mellitus - ____Diet (least important)______________________________ - ___Insulin (most important)______________________________ - ___Exercise_______________________________ 207. Treatment for Type II Diabetes Mellitus - ______Diet (most important)____________________________. - ______Oral hypoglycemics____________________________. - ________Activity__________________________. 208. Diet of Diabetics - _____restrict cals (1200, 1400, 1600)_____________________________. - ____6 small meals per day______________________________. __reality 13 209. Insulin acts to __decrease__________________ blood sugar 210. Insulin Type: R - Type: _____regular__________________ - Peak: ______2hr_________________ - Onset: ___1hr___________________ - Duration: ______4hr______________ 211. Insulin Type N - Type: ___intermediate____________________ - Peak: ___8-10hrs___________________ - Onset: _6hr____________________ - Duration: _____12hr______________ 212. Insulin Type: Lispro (Humalog) - Type: ___fast____________________ - Peak: ______30min_________________ - Onset: ___15min___________________ - Duration: ____3hr________________ 213. Insulin Type: Lantus (Glargine) - Type: ______long lasting_________________ - Peak: _____no peak__________________ - Onset: ____n/na__________________ - Duration: _12-24 hours___________________ 214. With insulin remember: - _____expirary date______________________ 215. - Label exp date of 30 days after opening. Exercise ______is another shot of_______________insulin: if more exercise, need __less_____________insulin. If less exercise, need ___more________insulin 216. Sick day rules for insulin - Hyperglycemic & dehydration ___________________________ - ______serum BGL levels go up due to PSR therefore insulin is needed even if they're not eating - ___need any sips of water 217. Low blood sugar in Type I diabetes Mellitus (insulin shock) is caused by: - ___not enough food_______________________________ - __too much insulin________________________________ - ___too much exercise_______________________________ 218. Why is low blood sugar in Type I Diabetes Mellitus (insulin shock) dangerous? ____too much insulin can cause permanent brain damage.___________________. 219. Signs and symptoms of low blood sugar in Type I Diabetes Mellitus [insulin shock] drunk in shock - __staggering gait - _slurred speech - ________increased HR - __cerebral impairment - ______increased RR____ - decreased social inhibition - _______decreased BP__ - slow reaction time - cold/clammy mottled skin 220. Treatment for low blood sugar in Type I Diabetes Mellitus [insulin shock] - ____sugars & rapidly metabolized carbs______________________________________________________ - ____1 sugar + 1 protein/starch______________________________________________________ - ___OJ + crackers, juice + turkey, skim milk (has both sugar and protein) 221. High blood sugar in type I diabetes Mellitus/DKA/Diabetic coma is caused by: - _too much food_________________________________________________________ - ___decreased insulin_______________________________________________________ 14 - ____decreased exercise ___ - Acute viral resp infection in the last 2 weeks __ 222. Signs and symptoms of high blood sugar in Type I diabetes Mellitus/DKA/Diabetic Coma - Dehydration- dry, poor skin turgor, decreased elasticity, dry MM, warm to touch - Ketones in serum, high K+, Kausmaul breaths - Acetone breath, Acidosis, Anorexia due to nausea 223. Treatment for high blood sugar in type I diabetes mellitus/DKA\/diabetic coma - _IV insulin (regular 1-2-4)________________________________ - _Hydration (200ml/her FAST)_____________________________ 224. Treatment for low blood sugar in Type II DM: - __sugar + protein/starch_______________________________ - ____hold hypoglycemics _____________________________ 225. High blood sugar in Type II Diabetes Mellitus - ____diet, oral hypoglycemics, activity ______________________________________________________ - __ 226. Signs and symptoms of high blood sugar in type II DM - _________________________________ - _________________________________ - _________________________________ - _________________________________ 227. Treatment for high blood sugar in type II DM ____________________ 228. Long term complications of HHNC are related to 229. - __poor tissue perfusion_______________________________ - _peripheral neuropathy________________________________ Which lab test is the best indicator of long-term blood glucose control (compliance/ effectiveness/ adherence)? ____Hb A1C___________________________________________________ 230. Cold and clammy: hypoglycemia (drunk + shock). Hot and dry: hyperglycemia (DKA-dehydration) 231. What are the therapeutic and toxic levels for Lithium? - Therapeutic level: __0.6-1.2___________________ - Toxic level: __>2_________________ 232. What are the therapeutic and toxic levels for Lanoxin (Digoxin)? - Therapeutic level: _____1-2________________ - Toxic level: ___>2________________ - Toxic level: _>20_________________ 233. What are the therapeutic and toxic levels for Aminophylline? - Therapeutic level: ______10-20_______________ 234. What is the therapeutic and toxic levels for dilantin (phenytoin) - Therapeutic level: 10-20 - Toxic level: >20 235. What are the therapeutic and toxic levels for Bilirubin in newborn? - Therapeutic level: ___0-9_ - Elevated level: 10-20 - Toxic level: ____>20______________ (therapeutic in adults is 0.2-1.2 but its not tested on NCLEX) 236. Kernicterus: _Elevated bilirubin in the brain_______________________________ 237. Opisthotonos : the position a newborn is in when they have elevated bilirubin in the brain. irritation of meanings due to kernicterus. Hyperextension posture. It is a medical emergency!! 238. Dumping Syndrome: GI contents are dumped too fast into the duodenum. Going the right way but at a fast rate. 15 239. Hiatal Hernia: Gastric contents are going backwards and upwards the esophagus. Going the wrong way at the right rate. 240. Hiatal Hernia or Dumping Syndrome: - Gastric contents move in the right direction at the wrong rate ___Dumping_ - Gastric contents move in the wrong direction at the right rate ___Hiatal_____________________ - GERD like symptoms when supine and after eating ____Hiatal___________________ 241. ADS S/S—Acute Dumping Syndrome - _DRUNK- staggering gait, slurred speech, slow reaction time, imparied judgment, labile emotion, cerebral impairment (because all the blood has gone to the gut not the brain). - _SHOCK- tachypnea, tachycardia, decreased BP, cold/clammy - _ACUTE ABDOMINAL DISTRESS- cramping, guardian, N+V, diarrhea, borborygmi, bloating, distention 242. Treatment for Hiatal Hernia - HOB during & 1 hr after meals = ___up______ - Carbohydrate content of meals = _up______ - Amount of fluids with meals = _up______ - Goal: _empty contents faster so it doesn't back up 243. Treatment for Dumping Syndrome - HOB during & 1 hr after meals = __down_______ - Carbohydrate content of meals = _down______ - Amount of fluids with meals = _down______ - Goal: slow down the emptying of contents__________________ 244. Kalemias do the __same_____________ as the prefix except for ___heart rate____________ and __urine output______________. - Hyperkalemia= high potassium - Hypokalemia = low potassium - Hyper = ↑; HR ↓; Urine Output ↓ - Hypo = ↓; HR↑; Urine output↑ 245. Calcemias do the __opposite_________________ of the prefix. No exceptions. - Hypercalcemia = high calcium - Hypocalcemia = low calcium - Hyper = ↓ - Hypo = ↑ 246. Two signs of neuromuscular irritability associated with: Hypocalcemia are chvostek sign and trousseau’s sign. - Chvostek’s sign = _neuromuscular irritability__________ → _hypocalcemia. check cheek___________ - Trousseau’s sign = _hand spasms from BP cuff__________ → _hypocalcemia. check BP___________ 247. Magnesemias do the ______same__________________ of the prefix. 248. - Hypermagnesemia: high magnesium - Hypomagnesemia: low magnesium - Hyper = ↓ - Hypo = ↑ If symptoms involve nerve or skeletal muscle, pick _calcium________________________. For any other symptom, pick ____potassium__________________ (generally anything effecting ___blood pressure__________________________) 249. HyperErnatermia= _dehydration_______________________________________________ 250. HypOnatermia = ___overload________________________________________________ 251. The earliest sign of any electrolyte disorder is ___numbless___________________ & ___tingling = Paresthesia_____________________. 252. The universal sign-symptom of electrolyte imbalance is __muscle weakness= Paresis_ 253. Never push ______potassium_________________________ IV. 254. Not more than ___40__________________ of K+ per liter of IV fluid. 255. Give _______d5w___________ & _____insulin_____________________ to decrease K+. This is a temporary solution, but quick acting. shifts K from blood to cells, hides the K in the cells. 256. Kayexalate: _exchanges Na for K. Long term/permanent treatment for hyperkalemia. After the exchange, it helps the body get rid of the K for good in stool. Takes hours, “K EXITS LATE” 16 *Also giving the pt fluids as kayexalate will cause hypernatremia which also is dehydration. therefore treatment involves d5w, insulin, and kayexalate simultaneously, as well as IV fluids to correct dehydration* 257. In a patient with hypercalcemia, which monitor pattern would be the most likely threat? a) Paroxysmal atrial tachycardia with decreased ST segments b) Bradycardia with 2nd degree Mobitz type II block & elevated ST segment c) Frequent PAC’s with multifocal coupling of PVC’s and tall T-waves d) First degree heart block with decreased ST segment and inverted T-waves ▪ Hypercalcemia= everything goes low! ▪ therefore no tachycardia, no elevated ST segment, no tall T waves. 258. Hyperthyroidism = __hypermetabolism_______________________________________________ 259. Signs & Symptoms of Hyperthyroidism 260. - heat intolerance, cold tolerant - Bulging eyes (exophthalmos) - weight loss - Increased HR - Increased BP - Hyper-personality Hyperthyroidism is also known as _Graves disease_________________________. So, remember ____run__________ yourself into the __Grave_____________. 261. The problem is hyperthyroidism. Treatment options: - Nuke it in radioactive iodine o no visitors in hospital or home for 24 hours o private room for 24 hours o must flush the toilet 3 times after urinating o if you get your urine on the floor, hazmat deam must be called to clean it - PTU (put thyroid under) Propylthiouracil (medication) - Thyroidectomy (total and sub) 262. What is the big risk with radioactive iodine? _Cancer- monitor WBC 263. What does PTU do? __put thyroid under 264. What is the most common treatment for hypothyroidism? _Thyroidectomy 265. Total thyroidectomy—need lifelong _hormone_________________replacement. At risk for ___hypocalcemia due to not being able to save parathyroid glands. 266. What are you at risk for with a subtotal thyroidectomy? ___thyroid storm____________________________. 267. What are signs and symptoms of thyroid storm? - _Temp-fever_________________________________ - __High BP___(210/180)_____________________________ - ___Tachycardia - Psychotically delirious _______________________________ _(180-210) 268. What is the treatment for thyroid storm? Bring the temperature down and give oxygen. ice packs is the first intervention, but cooling blanket is the best intervention. 269. Total = Tetany_________________ Subtotal = Storm __________________ 17 270. Post operation risks for total and subtotal thyroidectomy in first 12 hours - airway (due to edema) - hemorrhage (due to endocrine being very vascular) 271. Post operation risks for total thyroidectomy in 12-48 hrs? Tetany 272. Post operation risks for sub-total thyroidectomy in 12-48 hrs? Thyroid storm 273. Post operation risks for total and subtotal thyroidectomy after 48 hours? - infection 274. Hypothyroidism = Hypometabolism______________________ 275. Signs and symptoms of hypothyroidism - weight gain - cold intolerant, can tolerate heat - decreased HR - dull flat personality, boring_ - decreased BP - academically challenged 276. Hypothyroidism is also known as __myxedma (hypothyroidism with skin involvement) 277. What are the 3 reasons for accuchecks? - __________________________ - __________________________ - __________________________ 278. Treatment for hypothyroidism _thyroid meds-synthroid/levothyroxine 30min-1hour ac breakfast. take on empty stomach with water. _____________________________________________ 279. Caution: with hypothyroidism treatment DO NOT _sedate these patients. 280. Surgical implications for they hypothyroid patient - ______________________________________ and ________________________________________. 281. Adrenal Cortex Diseases start with letters __A__________ or ____C_________ 282. Addison’s Disease is ____undersecreation______________________- of the adrenal cortex 283. Signs and symptoms of Addison’s disease - __hyperpigmented______________________________ - __can’t adapt to stress (can't maintain BGL=hypoglycemia, can’t maintain BP therefore perfuse brain and organs therefore other symptoms can be present that represent this) 284. Treatment for Addison’s Disease __steriods/corticosteroids -SONE 285. Addison’s = add-a-sone 286. Cushing’s Syndrome is __oversecretion_________________________- of the adrenal cortex 287. Signs and symptoms of Cushings syndrome (same as side effects of steroids) - __moon face - __gynecomastia big breasts - _increase in sodium and water retention - __hirsuitism - _buffalo hump - bruise easily - _central obesity - _increase in glucose - _stretch marks Striae - _muscle atrophy - _potasium leaving the back - grouchy and immunosuppressed 288. Treatment for Cushings Syndrome : adrenalectomy → addisons→ on steroids→ start looking like Cush-man (S&S of addison's/SE of steroids) → takes about a year to titrate and get the right dose. 289. What are CONTACT precautions uses for? - _Enteric-anything GI- hep A, e.coli, c.diff, cholera, dysentery - _Staph____________________________________ - __RSV___________________________________ - __Herpes___________________________________ 18 290. CONTACT PRECAUTIONS: Select all that apply: __Y___ private room _____ mask _Y____ gloves _____ special filter respirator masks __Y___ handwashing 291. What is droplet precaution used for? - ____Meningitis_ - ____H.influenza B __ 292. DROPLET PRECAUTIONS: select all that apply: __Y___ Private room __Y___ Mask __Y___ gloves _____ special filter respirator masks __Y___ handwashing 293. What are airborne precautions used for? _____ Pt wear mask when leaving room _____ eye/face shields _Y____ disposable supplies _____ negative air flow ___Y__ gown - - _____ pt wear mask when leaving room ____Y_ Eye/Face shields __Y___ Disposable supplies _____ Negative Air Flow _____ Gown - - ___Mmr (measles, mumps, rubella)________________________________ - ___TB________________________________ - ___Varicella________________________________ - ___________________________________ ______epigolotis 294. AIRBORNE PRECAUTIONS: select all that apply: __Y___ Private room _____ Mask ___Y__ gloves __Y___ special filter respirator masks __Y___ handwashing 295. Unless otherwise specified, assume that PPE includes: - __Y___ pt wear mask when leaving room _____ Eye/Face shields __Y___ Disposable supplies __Y___ Negative Air Flow _____ Gown - ___gloves____________________ - _____goggles__________________ - _____mask__________________ - ____gown___________________ 296. The proper place for donning PPE is __outside___________ the room and doffing PPE is ____in________ the room. 297. The proper order for donning PPE is - ___Gown______________ - ___mask______________ - ___goggles______________ - ____gloves_____________ - REVERSE ALPHABETICAL ORDER, MASK SECOND 298. The proper order for removing PPE is: 299. - ___gloves______________ - ____goggles_____________ - _____gown____________ - ______mask___________ - ALPHABETICAL ORDER In airborne and droplet precautions only, the mask is removed _______________ the room and the patient remove mask _______________ the room 300. Handwashing or scrubbing position hands below elbows ___________________ 301. Handwashing or scrubbing position elbows below hands ___________________ 302. Handwashing or scrubbing length seconds ___________________ 303. Handwashing or scrubbing length minutes ___________________ 304. Handwashing or scrubbing can touch handles ___________________ 305. Handwashing or scrubbing not allowed to touch handles ___________________ 19 306. Handwashing or scrubbing use when entering/leaving room, before/after glove use, whenever hands get soiled ___________________ 307. Handwashing or scrubbing use when patient is immunosuppressed (beginning of stuff) ________________ 308. Handwashing or scrubbing soap and water ___________________ 309. Handwashing or scrubbing use “Chlor—” ___________________ 310. When can you use an Alcohol-based solution? - ______________________________________________ - ______________________________________________ - ______________________________________________ - ______________________________________________ 311. Can you use an alcohol-based solution after using the restroom? ___________________________ 312. Dry hands from______________ to _________________. Turn water off with __________ paper towel 313. Sterile Gloving: - Glove _______________ hand first - Grasp _______________ of cuff - Touch only the _______________ of glove surface - Do no _______________ cuff - Fingers ______________ second glove cuff - Keep thumb ________________ - Only touch _________________ surface of glove 314. Skin touches ________________ of glove 315. OUTside of glove only touches _______________ of glove 316. Remove _______________ to __________________. __________________ to __________________ 317. What patients do NOT need interdisciplinary care? - ____________________________________________________________ o Example: ___________________________________________________________ 318. What are the major criteria for interdisciplinary care? - _________________________________________________________________________________ - _________________________________________________________________________________ o Example: ___________________________________________________________________ 319. What is the minor criteria for interdisciplinary care? - ______________________________________________ - ______________________________________________ 320. What are the 3 principles to consider when choosing appropriate toys for kids? - _____safe_________________________________________ - ___age appropriate___________________________________________ - _____feasible_________________________________________ 321. What are some safety considerations when it comes to kids’ toys? - Don’t give small toys to under 4 year olds, over 4 they can have smaller toys - Don't give metal toys to kids on Oxygen (sparks) - Hard plastic toys can be sanitized- give these to immunosuppressed kids - Fomites on stuffies INFANTS (0-6mo, 6-9mo, 9-12mo) 322. What is the BEST toy for 0-6-month olds (sensorimotor)? ______musical mobile 323. What is the 2nd BEST toy for 0-6-month olds? ___large and soft_ 324. What is the BEST toy for 6-9 months (object permanence)? ____cover/uncover- jack in a box, peek-a-boo 20 325. What is the 2nd best toy for 6-9-month olds? ____Large and hard (worst toy is musical mobile due to risk of strangulation) 326. What is the BEST toy for 9-12 months olds? Vocalization- talking toys and books. 327. Remember with 9-12-month olds __purposeful play. 328. Avoid answers with the following words in them for children 9 months and younger - ____build___________, ___make_____________, ____sort____________, ____stack____________ & _____construct__________ Toddlers (1-3yr) 329. What is the best toy for toddlers (1-3 yrs)? push/pull toys- wagon, dog on wheels 330. What skill is being worked on when toddlers play? __Gross motor skills- running, jumping, hand paint. 331. What type of play do toddlers do? _Parralell play- play alongside each other not with each other Preschoolers (3-6) 332. Preschoolers need toys that work on: Fine motor skills & finger dexterity- drawing, writing, scissors. As well as balance- skating, bike riding, and dance. 333. Preschoolers play is characterized by: Highly imaginative 334. Preschoolers like to play: cooperative play- play with each other. Schoolage (7-11) 335. School age (7-11 yrs) aka __Concrete___________________ are characterized by the 3 C’s: - _Collective- baseball cards, beanie babies - _Competitive- winners and losers - _Creative- wanting to draw, legos _ Adolescents (12-18) 336. Adolescents (12-18 yrs) their “play” is peer group association. Allow adolescents to be in each other’s rooms unless one of them is: __post up less that 12 hours_____________________________ 337. - ___immunosupressed ____________________________ - ___contagious____________________________ When given a variety of ages to choose from always go ___younger_______________________ because children ____regress_______________ when sick and you want to give them ____time to grow________________________________ 338. Creatinine is the → _best indicator of kidney function__ 339. Creatinine lab values: __________________________ - If elevated: _ INR (International Normalized Ratio) (what does it monitor?) - _measures coumadin (warfarin) and reflects PTT (time it takes blood to clot) 340. What is the therapeutic range for INR? - Normal: ______________ - ↑ INR = _______________ - Critical: _______________ 341. What do you do when INR is > 4? ______________________________ - ______________________________ - ______________________________ - ______________________________ 342. What is the therapeutic range for Potassium (K+)? _______________________ 21 343. What do you do if Potassium is low? LEVEL C - ______________________________ - ______________________________ - ______________________________ - ______________________________ 344. What do you do if Potassium is 5.4-5.9? __LEVEL C_ - ______________________________ - ______________________________ - ______________________________ - ______________________________ 345. What do you do if Potassium is > 6? ___LEVEL D - Do the following at once: - ______________________________ - ______________________________ - ______________________________ - ______________________________ 346. What is the therapeutic range of pH? ______________________________ 347. What do you do if pH is in the 6’s? LEVEL D - ______________________________ - ______________________________ - ______________________________ 348. What is the therapeutic range for BUN? _8-25 LEVEL A ______________________________________________ 349. What do you do when a patient has an elevated BUN? - ______________________________ - ______________________________ 350. What is the therapeutic range for Hgb? _______________________________________________ 351. What do you do when a patient has 8-11 Hgb? LEVEL B - ______________________________ - _____________________________ 352. What do you do if a patient has a Hgb of < 8? LEVEL C - ______________________________ - ______________________________ - ______________________________ - ______________________________ 353. What is the therapeutic range for HCO3? - ____________________________________ - ____________________________________ 354. What is the therapeutic range for CO2? _______________________________________________ 355. What do you do if CO2 if in the 50s? LEVEL C - __________________________________________ - __________________________________________ - __________________________________________ 356. What do you do if the CO2 is in the 60s? LEVEL D - __________________________________________ - __________________________________________ - __________________________________________ 22 - __________________________________________ 357. What is the therapeutic range for Hct? - __________________________________________ - __________________________________________ 358. What is the therapeutic range for PO2? _______________________________________________ 359. What do you do if PO2 is 70-77? LEVEL C - __________________________________________ - __________________________________________ - __________________________________________ 360. What do you do when PO2 is < 60s? LEVEL D - __________________________________________ - __________________________________________ - __________________________________________ - _________________________________________ 361. What is the therapeutic range for O2 saturation? _____ 362. What do you do if O2 saturation is less than 93? _ 363. BNP _Brain Natriuretic Peptide. 364. What is the therapeutic range for BNP? ________________________ 365. What do you do if BNP is elevated? _______________________________________________ 366. What is the therapeutic range for Sodium? ________________________ 367. What do you do if sodium is abnormal in a patient? LEVEL B, LEVEL C if changes in LOC - __depends if it's hyponatremia or hypernatremia. (overload=lasix, dehydration=IV fluids) 368. What is the therapeutic range for WBC’s? LEVEL C ____________________________ 369. What is the therapeutic range for ANC? LEVEL C ____________________________ 370. What is the therapeutic range for CD4 count? LEVEL C ____________________________ 371. What is another name for high WBC count? ____________________________ 372. What are some other names for LOW WBC count? - ____________________________ - ____________________________ - ____________________________ - ____________________________ - ____________________________ 373. What do you do when WBC is < 5,000? - _____________________________________ - _____________________________________ - _____________________________________ - _____________________________________ 374. What do you do if ANC < 500? - _____________________________________ 375. What do you do if CD4 <200? - _____________________________________ 376. What are neutropenic precautions? - ___strict hand washing - __no fresh flowers/potted plants - _vs q4h - _no raw fruit/veggies/meat - _designated stethoscope and BP cuff - _no standing pitcher of h20 more than 15 min - _reverse/precaution isolation - No catheterization - _avoid crowds - Shower BID with microbial soap - _private room _ - don't reuse cups or disposable plates - _restrict staff and visitors - Check WBCs daily - Dedicated items in room: __stethoscope, BP cuff 377. What is the therapeutic range for platelets? _150k-450k___________________________________ 378. What do you do if platelets are < 90,000? LEVEL C - ______________________________ 23 - ______________________________ - ______________________________ 379. What do you do if platelets are < 40,000? LEVEL D - ______________________________ - ______________________________ - ______________________________ 380. What are bleeding precautions? - ____________________________________ - ____________________________________ - ____________________________________ - ____________________________________ - ____________________________________ - ____________________________________ - ____________________________________ - ____________________________________ - ____________________________________ - ____________________________________ - ____________________________________ - ____________________________________ - ____________________________________ - ____________________________________ 381. What is the therapeutic range for RBC’s? - _4-6million_____________________________ - ____LEVEL B__________________________ 382. What are the 5 D’s? [remember the 6’s] - K+: _6 or above - PO2: _60s or less - pH: _in the 6s - Plt: _<40K _ - CO2: _in the 60s 383. When should you call a Rapid Response Team? - ___________________________________________________________________________________ 384. Laminectomy - ______________________________ - ______________________________ 385. What is the reason for a laminectomy? __________________________________________________ 386. What are the 3 signs and symptoms of nerve root compression? - _____________________________________ - _____________________________________ - _____________________________________ 387. What are the different locations for a laminectomy? - __________________________, _________________________, __________________________ 388. What is the most important assessment in a pre-op cervical laminectomy? - __________________________________________________ 389. What is the most important assessment in a pre-op thoracic laminectomy? - __________________________________________________ 390. What is the most important assessment in a pre-op lumbar laminectomy? __________________________ 391. What is the # 1 post-op answer on NCLEX? ____________________________________________ 392. What is the specific “activity”/mobilization strategy post-op? - _____________________________________ - _____________________________________ - _____________________________________ 393. Post-op complication for cervical laminectomy _____________________________________________ 394. Post-op complication for thoracic laminectomy _____________________________________________ 395. Post-op complications for lumbar laminectomy _____________________________________________ 396. Laminectomy with fusion involves taking a______________________ _____________________ from the __________________ _________________. Of the two incisions, which site has the most: 24 - Pain? _________ - Bleeding/Drainage? ____________ - Risk for Infection? _____________ - Risk for rejection? _____________ 397. Surgeons are using cadaver bone from bone banks. Why? - ________________________________________________________________________________ 398. What are some temporary restrictions (6 wks) with discharge teaching? - ____________________________________________ - ____________________________________________ - ____________________________________________ 399. What are some permanent restrictions for laminectomy patients? - ________________________________________________________________________________ - ________________________________________________________________________________ - ________________________________________________________________________________ 400. Nagele’s Rule (calculating due date) - _________________________________ - _________________________________ _________________________________ - 401. Total weight gain during pregnancy ___________________________________ 402. 1st Trimester weight gain ____________________________________________ 403. 2nd/3rd trimester weight gain _________________________________________ 404. Fundus (top of uterus) is not palpable until week _____________. 405. Fundus typically reaches the umbilical (navel) level at week ______________. 406. What are 4 positive signs of pregnancy? - _____________________________________ - _____________________________________ - _____________________________________ - _____________________________________ 407. What are some probably/presumptive signs of pregnancy? - ____________________________________________ - ____________________________________________ - ____________________________________________ - ____________________________________________ 408. Morning Sickness: Which trimester and what treatment? - _____________________________________ - _____________________________________ - _____________________________________ 409. Urinary incontinence: Which trimester and what treatment? - _____________________________________ 410. Dyspnea: Which Trimester and what treatment? ___________________________________________ 411. Back Pain: Which trimester and what treatment? - ______________________________________ - ______________________________________ - ______________________________________ 412. What is the truest, most valid sign of labor? ______________________________________ 413. Dilation ______________________________________ 414. Effacement ______________________________________ 415. Station ______________________________________________________________________________ - Negative = _____________________ - Positive = ______________________ 25 416. Engagement: ________________________________________________ 417. Lie: ________________________________________________________ 418. Presentation: ________________________________________________ 419. What is stage 1 of labor and delivery? - __________________________________________________________________________________ 420. What is stage 2 of labor and delivery? ________________________________________________ 421. What is stage 3 of labor and delivery? ________________________________________________ 422. What is stage 4 of labor and delivery? ________________________________________________ 423. Transverse lie and station that won’t go positive = ______________________ 424. Latent: - CM dilated: ___________ - Duration: ____________ - CXN freq: ____________ - Intensity: ____________ - CM dilated: ___________ - Duration: ____________ - CXN freq: ____________ - Intensity: ____________ 425. Active: 426. Transition: - CM dilated: ___________ - Duration: ____________ - CXN freq: ____________ - Intensity: ____________ 427. Contractions should not be longer than __________ seconds or closer than every __________ minutes. 428. Assessment of contractions: Frequency _____________________________________________________ 429. Assessment of contractions: Duration _____________________________________________________ 430. Assessment of contractions: Intensity _____________________________________________________ 431. What complications of labor is indicated if the mom is having painful back pain? - _____________________________________________________ - _____________________________________________________ - _____________________________________________________ 432. What should you do with a prolapsed cord? - _____________________________________________________ - _____________________________________________________ - _____________________________________________________ 433. Interventions for all other complications of labor and birth 434. - ____________________ - ____________________ - ____________________ - ____________________ - ____________________ Do not administer a SYSTEMIC pain medication to a woman in labor IF the baby is likely to be __________ when the _______________ is ______________________. 435. What do you do with a low fetal heart rate? - ____________________ - ____________________ 436. What do you do with FHR accelerations? ______________________ 437. What do you do with low baseline variability? - ____________________ - ____________________ 438. What do you do with high baseline variability? ______________________ 439. What do you do with late decelerations? - ____________________ - ____________________ 440. What do you do with early decelerations? ______________________ 26 441. What do you do with variable decelerations? - ____________________ - ____________________ 442. Second stage of labor and delivery—what do you do? - ________________________________________________ - ________________________________________________ - ________________________________________________ - ________________________________________________ - ________________________________________________ 443. What do you check for with the delivery of the placenta? ____________________________________ 444. During the ____________ stage (recovery stage) (first 2 hours after delivery) what ____________ things do you do _________________ times an hour. - ________________________________________________ - ________________________________________________ - ________________________________________________ - ________________________________________________ 445. What is the tone, height and location of the uterus postpartum? - Tone: _______________________ - Height: __________________________________________________________________ - Location: ________________________________________________________________ 446. What is the color of lochia in the first days? ___________________ 447. What is the color of lochia after a week or so postpartum? _____________________ 448. What is a moderate amount of lochia? _____________________________________ 449. What is an excessive amount of lochia? _____________________________________ 450. What do you assess for in the post-partum assessment? - ________________________________________ - ________________________________________ - ________________________________________ 451. Distended sebaceous glands which appear as tiny white spots on baby’s face ___________________ 452. Small white epithelial cysts on baby’s gums ____________________________ 453. Bluish-black macules appearing over the buttock and/or thighs of darker-skinned neonates - _________________________ 454. Red popular rash on baby’s torso which is benign and disappears after a few days - ______________________________________ 455. Benign tumor of capillaries ____________________________ 456. Swelling caused by bleeding between the ostium and periosteum of the skull. This swelling does not cross suture lines. ______________________________________ 457. Edematous swelling on scalp caused by pressure during birth. This swelling may cross suture lines. It usually disappears in a few days. ______________________________________ 458. Normal, physiologic jaundice appears after 24 hours of age and disappears at about one week of age - ______________________________________ 459. Whitish, cheese-like substance which appears intermittently over the first 7-10 days - ______________________________________ 460. Normal cyanosis of baby’s hands and feel which appears intermittently over the first 7-10 days - ______________________________________ 461. Generic term for birthmark - ______________________________________ - ______________________________________ - ______________________________________ 462. Tocolytics [stop contractions] 27 - _____________________________________________ - _____________________________________________ - _____________________________________________ - _____________________________________________ 463. Oxytocics—stimulate labor - _____________________________________________ - _____________________________________________ - _____________________________________________ - _____________________________________________ 464. Fetal/Neonatal Lung Meds - ______________________________________________________________________ - ______________________________________________________________________ - ______________________________________________________________________ 465. Steps of drawing up insulin - 1. _____________________________ - 4. _____________________________ - 2. _____________________________ - 5. _____________________________ - 3. _____________________________ 466. IM—length and gauge ________________________________________________________ 467. SQ—length and gauge ________________________________________________________ 468. Heparin - ____________________________________ - ___________________________________ - ____________________________________ - ___________________________________ - Antidote: ____________________________ - ___________________________________ - Labs: _______________________________ 469. Coumadin - ___________________________________ - Antidote: _____________________________ - ___________________________________ - Labs: ________________________________ - ___________________________________ - _____________________________________ - ___________________________________ - _____________________________________ 470. Baclofen [Lioresal] - ___________________________________ - _____________________________________ - ___________________________________ - _____________________________________ - ___________________________________ - _____________________________________ - ___________________________________ 471. Sensorimotor - Age: ________________ - Characteristics: _____________________________________________________________________ - Teaching Guidelines— o When: ____________________________________ o What: ____________________________________ o How: _____________________________________ 472. Pre-Operational - Age: ________________ 28 - Characteristics: _____________________________________________________________________ - Teaching Guidelines— o When: ____________________________________ o What: ____________________________________ o How: _____________________________________ 473. Concrete Operations - Age: ________________ - Characteristics: _____________________________________________________________________ - Teaching Guidelines— o When: ____________________________________ o What: ____________________________________ o How: _____________________________________ 474. Formal Operations - Age: ________________ - Characteristics: _____________________________________________________________________ - Teaching Guidelines— o When: ____________________________________ o What: ____________________________________ o How: _____________________________________ 475. Stage 1 pressure sore _______________________________________________ 476. Stage 2 pressure sore _______________________________________________ 477. Stage 3 pressure sore _______________________________________________ 478. Stage 4 pressure sore _______________________________________________ 479. __________________ beats ______________________ 480. ________________ _______________ beats ________________ or _______________ ______________. 481. _________________beats ____________________ 482. What makes a patient stable? - ___________________________________ - ___________________________________ - ___________________________________ - ___________________________________ - ___________________________________ - ___________________________________ - ___________________________________ - ________________________________________________________________________ ________________________________________________________________________ 483. What makes a patient unstable? - ___________________________________ - ___________________________________ - ___________________________________ 29 - ___________________________________ - ___________________________________ - ___________________________________ - ___________________________________ - ________________________________________________________________________ 484. What 4 patients are always unstable? - ________________________________________ - ________________________________________ - ________________________________________ - ________________________________________ 485. The more ________________ the _________________, the higher the priority - Most vital → _________ → __________ → _________ → _________ → _________ → _________ 486. What responsibilities would you not delegate to an LPN? - _______________________________ - _______________________________ - _______________________________ - _______________________________ - _______________________________ - _______________________________ - _________________________________________________________________________________ - _________________________________________________________________________________ - _________________________________________________________________________________ 487. What would you not delegate to a UAP? - ___________________________________ - ___________________________________ - ___________________________________ - ___________________________________ 488. Do not delegate to _________________: __________________ responsibilities. They can only do what you _______________________ them to do 489. How do you intervene with inappropriate behavior of staff? (4 options) - ___________________________________ - ___________________________________ - ___________________________________ - ___________________________________ 490. What 4 questions should you ask when dealing with inappropriate behavior from staff? - _________________________________________________________________________________ - _________________________________________________________________________________ - _________________________________________________________________________________ - _________________________________________________________________________________ 491. Pre-interaction phase - Purpose: ___________________________________________________________________________ - Length: ____________________________________________________________________________ - Correct answer: ____________________________________________________________________ 492. Introductory phase (orientation phase) - Purpose: ___________________________________________________________________________ - Length: ____________________________________________________________________________ 30 Correct answer: ____________________________________________________________________ - 493. Working phase (therapeutic phase) - Purpose: ___________________________________________________________________________ - Length: ____________________________________________________________________________ - Correct answer: ____________________________________________________________________ 494. When does the termination phase begin? ______________________________ 495. Psych treatment protocol for depression - _________________________________________________________________________________ - _________________________________________________________________________________ - _________________________________________________________________________________ 496. Psych treatment protocol for schizophrenia - _________________________________________________________________________________ - _________________________________________________________________________________ 497. Psych treatment protocol for bipolar - _________________________________________________________________________________ - _________________________________________________________________________________ - _________________________________________________________________________________ - _________________________________________________________________________________ 498. Psych treatment protocol for anxiety disorder - ____________________________________ - ____________________________________ - Tx: _________________________________ - ____________________________________ - ____________________________________ - ____________________________________ - ____________________________________ 499. Restraint protocol - In psych: _________________________________________________________________________ - Not psych: _______________________________________________________________________ 500. Psych treatment protocol for violent clients - ___________________________________ - ___________________________________ - ___________________________________ - ___________________________________ 501. All psych drugs cause… - _____________________________ - _____________________________ - _____________________________ 502. Phenothiazines - _major tranquilzers, end in “zine”_______________________________ - Example: __thoraZINE, compaZINE______________________________________ - Actions: o Large doses: _antipsyc, decreases symptoms but does not cure it _ o Small doses___antiemtic ________________________________ 503. Side effects of phenothiazines [Remember ABCDEFG…] - A = __anticholingeric (dry mouth, urinary retention)__ - B = ___blurry vision__________________________________________ - C = __constipation___________________________________________ - D = __drowsiness___________________________________________ - E = _EPS (parkinsons, tremors, pill rolling)____________________________________________ - F = __foto sensitivity ___________________________________________ - G = __aGranulocytosis___________________________________________ 504. Nursing care for phenothiazines __#1 for ABCDEF= safety education, #1 for G= infection education_________________________________________________________ 505. Deconate or “D” - IM court ordered long acting for non compliant patients _ 506. Tricyclic Antidepressants Type: _NSSRI__________________________________ Example: Elavil, tofranil, avently, desyrel_ 31 507. Side effects of: Tricyclic antidepressants (Elvail starts with “E” so this group goes to “E”) A = __anticholingeric (dry mouth, urinary retention)__ - B = ___blurry vision__________________________________________ - C = __constipation___________________________________________ - D = __drowsiness___________________________________________ - E = __euphoria___________________________________________ Take for how long? _2-4 weeks to kick in but can be taken long term. 508. Benzodiazepines Type: anti-anxiety minor tranquilizers always have “ZEP Prototype: valium, induction of anesthesia, muscle relaxant, alcohol_______________________________ Indications: o __seizures_____ o ETOH withdrawal o _Pre op induction of anesthesia o ventilation- muscle relaxant for ppl on ventilators o _muscle relaxants______ Number 1 nursing teachings: kicks in right away but cannot be taken for longer than 2-4 weeks. Taken at the same time as Tricyclic antidepressants. i.e. take valium and elavil at same time. Valium works right away, by the time elavil kicks in (2-4 weeks), valium can be discontinued, as it cannot be taken longer than 2-4 weeks. 509. Side effects of Benzodiazepines A = __anticholingeric (dry mouth, urinary retention)__ - B = ___blurry vision__________________________________________ - C = __constipation___________________________________________ - D = __drowsiness___________________________________________ 510. Monoamine Oxidase (MAO) Inhibitors Type: antidepresants __________________________ Drug Names: __starts with MAR, NAR, PAR__________________________________ ____I.e., MARplan, NARdil, PARnate 511. Side effects of MAO inhibitors A = __anticholingeric (dry mouth, urinary retention)__ - B = ___blurry vision__________________________________________ - C = __constipation___________________________________________ - D = __drowsiness___________________________________________ 512. Interactions/ patient teaching for MAO inhibitors ___teach pts to avoid foods containing tyramine, or else they were enter hypertensive crisis. Foods containing tyramine: o Fruits & veggies—_BAR- bananas, avocados, raisins, o Grains: _yeast, everything else is okay. o Meats: organs and preserved meets (cured, smoked, dried, pickled, hot dogs) o Dairy: mozza and cottage cheese is okay, avoid other cheeses o Other: ETOH, elixiris, soya sauce, caffeine, chocolat, licorice, iodine/betadine 513. Lithium decreases mania in bipolar patients, not depression. 514. Side Effects of Lithium The three “P’s” o _peeing o _pooing - Toxic: o ___metalic taste__ o _tremors_ o __severe diarrhea # 1 intervention: ____give fluids________________________________________ - If sweating → ___give fluids___________________________________________ - - Monitor __sodium_________________________________ 515. Prozac __ mood elevator__________________________________________ 516. Side effect of Prozac A = __anticholingeric (dry mouth, urinary retention)__ - B = ___blurry vision__________________________________________ - C = __constipation___________________________________________ - D = __drowsiness___________________________________________ o _parethesia (first sign) 32 - E = __euphoria___________________________________________ Causes:___insomnia, take at noon. if BID take at 6am and noon. _________________________________________________________________________ Changing doses? _careful in changing doses in adolescents (12-18 years) as this can cause suicidal risks. 517. Haldol (Haloperidol) same as phenothiazines ____________________________________________ __deconate__________________________________________ 518. Side effects of Haldol A = __anticholingeric (dry mouth, urinary retention)__ B = ___blurry vision__________________________________________ - C = __constipation___________________________________________ - D = __drowsiness___________________________________________ - E = _EPS (parkinsons, tremors, pill rolling)____________________________________________ - F = __foto sensitivity ___________________________________________ - G = __aGranulocytosis___________________________________________ - Monitor for: NMS. Patients may develop NMS (neuroleptic malignant syndrome) from an overdose of haldol. S&S: fever, tremors. Seen in elderly and young white shizo pts, doses should be half than normal adults. It is life-threatening. *the difference between NMS and EPS is that EPS is non life-threatening and it does not include a fever like NMS* 519. Clozaril (clozapine) _Atypical antipsyc_ ”ZAPINE” don’t confuse with clonazepam (benzo) 520. Side effects of Clozaril G: aGranlucytosis 521. Zoloft (Sertraline) _anti depressant___________________________________________ ___can cause insomnia_________________________________________ _interacts with st john’s wort and warfarin. be prepared to decrease the dose of sertraline if pt is on warfarin. __ 522. Side effects of Zoloft SAD Head o __sweating__________________ o apprehensive (impending doom) o _dizzy___________________ o __headache__________________

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