Best study guide (my notes)

Aug 24, 2009 10:22 AM

by Newgradq

OK .. SO I passed NCLEX on the 1st try with the dedication and devotion other NCLEX takers/preparers have helped with on this site…so I thought I’d do my part by designing a study guide to help lessen the burden and frustrations of studying for NCLEX for future test takers… and to those of u taking the test soon…just try and your best, breathe, and pray!! Oh and I borrowed some material from other people’s postings, my NCLEX review class, and Nursing classes… And don’t listen to what other ppl say … it is a totally COMPREHENSIVE test… I heard there wasn’t much pharm and didn’t study as well as I should have and out of 75 questions I had like 35-40 pharm ?s and well let’s just say it’s a miracle I passed!!

Lov ya all ….happy studying!! (PS sorry for random order but content will def help)

Cardiac Rate- Peds

Remember: 311

(Fetal HR 120-160)
RR
-30 90-130 Infant 30-60

-10 80-120 Toddler 20-30

-10 70-110 Preschooler 16-22

Temperature

ºF = (1.8 * ºC) + 32
(Think of them as being ~ 2º apart)

37ºC = 98.6º F
38ºC=100.4º F
39ºC=102.2º F
40ºC =104 º F

Labs

á BUN/CR = Dehydration
â BUN/CR = Overhydration

El: Na (135-145) K (3.5-5) Mg (1.5-2.5) Ca (9-11) Cl (96-106) Phos (3-4.5)

Endocr:

BUN (7-22 or to remember put the buns in the oven for 10-20 min)
Cr (0.5-1.5)
Urine Spec Gravity (1.005-1.030)

Glucose:

Nml 80-110
Fasting <110
Infant BG 50-90 (<45=hypoglycemia-high pitch cry)
HgbA1c= 4-6% (or <7%)

Thyroid:

T3 (60-180)
T4 (5-11)
TSH (0.5-5) or 0.5-2 for hypothyroid pts
Free T4: 0.8-2.7 ( I remember it .8-2.8 easier to memorize)

Hypothyroid: TSH ;¯ T3 & T4
Hyperthyroid: ¯ TSH ; T3 &T4

ABGs:
PH 7.35-7.45
pO2 80-100
pCO2 35-45
HCO3 22-26

ROME:
With Acidosis the PH is always ¯ and PH is always in Alkalosis
Respiratory Opposite; Metabolic Equal

RESP OPP:
PH ¯ PCO2 = Resp Acidosis
PH PCO2 ¯ = Resp Alkalosis

METABOLIC =
PH ¯ HCO3 ¯= Metabolic Acidosis
PH HCO3 = Metabolic Alkalosis

Blood:

RBC 4.2-6.1 million WBC 5000-10000 (or 4500-11000) Plt 150,000 – 450,000

Hgb F: 12-16 M: 14-18 Hct F: 37-47% M: 42-52%

Amylase: 53-123 Albumin: 3-4.3 Alk Phosphate: 14-100 NH3 (35-65)
Blood Osmol 280-300 Lipase 14-280

Bilirubin (Total: 0.3-1; Indirect: 0.2-0.8; Direct 0.1-0.3)
Phenylalanine: Newborn < 2 Adult < 6

Antidotes

Digoxin ® Digiband
Tylenol ® Mucomist (17 doses + loading dose)
Heparin® Protamine Sulfate
Benzodiazepine ® Flumzaemil (Romazicon)
Coumadin®Vit K

DI ®¯ ADH, u/o, ¯ Urine Specific Gr, Na (think Na = urine spec gr)
SIADH® think syndrome of ed diuretic hormone ADH, ¯ u/o, urine spec gr

Insulins

Rapid Reg Interm Very Long Long Acting

5-15m 30-60m 1-3h 1h 6-8h

1-2h 2-4h 6-12h peakless action 12-16h

4-6h 5-7h 16-20h 18-24h 20-30

Novolog Novolin R NPH Lantus Ultra Lente \
Humalog Humulin R Lente

Vaccines

Hep B 0, 1-2, 6-18mo

Hib 2, 4, 6, 12-15

Pneumo 2, 4, 6,12-15

Dtap 2, 4, 6, 15-18, 4-6yrs; Td q 10 yrs

IPV 2, 4, 6-18, 4-6yr

Varicella 12-15, 4-6yr

MMR 12-15, 4-6yr

Hep A 12-23 mo (2 doses, 6 mo apart)

Mening 9-11 yrs

Rota 2, 4, 6

Influenza at 6 mo and then yearly after

Random Stuff

Thiazides BG
Neupogen = Neutrophil
Epogen = RBC/Erythocyte
Lofenalac Formula = for PKU infants
Ototoxic drugs = loop diuretics (Lasix) and Platinol-AO

TB Meds (RISE)

Rifampin

INH
Streptomycin
Ethambutol

GCS

Eyes (4 points)

Verbal (5 points)

Motor (6 points)
Max = 15 (<8=coma)

APGAR Score

At 1 and 5 min after birth
(1st score is the transitional score and 2nd is planning care of newborn)
8-10 = ok
2 1 0
Appearance [All pink, pink&blue, blue/pale]

Pulse [> 100, < 100, No Response]
Grimace [cough, grimace, no response]
Activity [flexed, flaccid, limp]
Resp [strong cry, weak cry, no cry]

INFECTION CONTROL

Contact Precautions:

MRS WEE

VCHIPS
Alex Hez 5 Coins HeRe

M-MRSA
R-Resp Infections (those not listed in other categories below)
S-Skin Infections
W-Wound Infections

E-Enteric Infections (C.Diff, Shigella)
E-Eye Infections (Conjunctivitis)

SKIN INFECTIONS:
V-Varicella
C-Cutaneous Diptheria
H-Herpes Simplex
I- Impetigo
P- Pediculosis (lice)
S-Scabies

Alex = AIDS
Hez= Herpes Zoster
5=5th Dx
Coins=Croup
HeRe= Hepatitis and RSV

Droplet Precautions:

SPIDERMAN

Sepsis
Scarlet Fever
Streptococcal Pharyngitis
Parovirus B19 (virus that causes 5th dx)
Pertussis
Pneumonia
Influenza
Diptheria
Epiglottidis
Rubella (Measles)
Measles
Meningitis
Mycoplasma
AdeNovirus

Also Rhinovirus and RSV

FETAL © Strips

REMEMBER: VEAL CHOP

Variable is Cord
Early is Head

Acceleration is Ok
Late is Placental Insufficiency

Hypoventilation => Resp Acidosis ( CO2) “Retain CO2”
Hyperventilation=> Resp Alkalosis (¯ CO2) “Blow off CO2” (think of preg breathing)

Lasix/Bumex = K+ Wasting (can cause hypokalemia)
Aldactone = K+ Sparing (can cause hyperkalemia)

Tx of DIC = Heparin (safe during preg)

Post Masectomy Care: BREAST

BP NOT on affected side

Reach Recovery
Elevate affected side
Abduction and external rotation – no initial exercise (initial is extension/flexion)
Self Breast Exam (1x month – 7 day after period)
Try to promote a (+) self-image

Autosomal Recessive: Cystic Fibrosis, PKU, Tay-Sachs, Albinism, Sickle Cell Dx, Alpha Anti-Trypsin Deficiency, Galactetsemia

Autosomal Dominant: Huntington’s Disease, Marfan’s, Polydactly, Achandrophic Dwarfism, Polycystic Kidney Disease

X-Linked Recessive: Duchenne’s Muscle Dystrophy, Hemophilia A (Females are carriers in these diseases and males are affected by the disease)

At Term:

Nml = wt: 6-9lbs, head circumference: ¼ body length, 13-14 in, chest: 12-13in
Umbilical cord falls off in 1-2 weeks
Stool: 1st stool (Mecconium) – black + tarry (passes w/in 12-24 hrs), thin/green/brown day 3, formula feedings (1-2 pale yellow/light brown stools) or breast feeding (loose golden yellow stools with sour milk odor)

Hypokalemia: Flat T wave, Depressed ST, and Prominent U wave
Hyperkalemia: Tall T wave, Wide QRS, Long PR Wave

5 P’s of Fracture: Pain, pallor, pulseless, paresthesia, paralysis

Cushing’s Triad: (Indicates ed ICP) ¯ HR, ¯RR, BP

CONVERSIONS:

1 lb = 16 oz 1 T = 3 tsp = 15 mL
1c = 8 oz = 240 mL 1 t = 5 mL 1 lb = 454 g = 16 oz
2 c = 1 pt = 16 oz 1 oz = 30 mL= 8 drams 1 mg = 1000 mcg
2 pt = 1 qt= 32 oz 1 g = 15 gr
4 qt =1 gal=128 oz 1 gr = 60 mg

Med Trivia

§ Talwan and Stadol=> Avoid (opoid agonist antagonists) – much less effective then opoid agonists
§ No Tagamet with Warfarin
§ Erogostat => For Migraine
§ No Quinolones/Tetracyclines with pregnancy
§ No ASA/NSAIDS in Hemophilia A patients
§ Lipitor = PM ONLY, no grapefruit juice
§ tPA= dissolves clots (heparin does not)
§ SLE Tx
o Cytotax, Imuran (Immunosupressants)
o NSAIDs
o Plaquinil (also an anit-malarial drug)

More Maternity

§ Fundal Height
o Top of Symphis Pubis to top of fundus
o Gross estimate of dates
o Use a non-stretchable tape measure
o 12-14 wks (at level of symphis)
o show after week 14 (can tell preg)
o 20 wks (~ 20cm) at level of umbilicus
o rises 1 cm/wk till 36 weeks then varies
§ Quickening = fetal movement; 16-20 weeks
§ Fetal Heartbeat = 8-12 weeks (by Doppler) and 18-20 weeks by auscultating with stethoscope
§ Preterm: 20-37 weeks
§ Term: 38-42 weeks
§ Post-term: 42 weeks plus
§ Total preg weight gain: 11-14 kg (25-35 lb)
§ 300 cal during preg (DAILY) and 200-500 cal during breastfeeding (DAILY)
§ Caffeine < 300 mg/day (500-750 mL/day => risk of spontaneous abortion or fetal intrauterine growth restriction
§ Uterine contractions can be felt after 4th month = Braxton Hicks Contractions facilitate uterine blood flow through placenta and promote O2 delivery to fetus
§ Amniotic Fluid:
o Nml: 800-1200 mL (transparent/clear, no odor)
o <300 mL = Olighydrimanos (low amniotic fluid)
§ Kidney problems
o Polyhydrimanos (too much amniotic fluid)
§ Umbilical Cord: 2 arteries and 1 vein
§ Placenta: Fetal lungs in utero
§ Alcohol, caffeine, nicotine, meds = easily cross placenta (viruses can cross, bacteria cannot; exs of viruses (HIV, AIDS, Herpes, Measles, Toxoplasmosis, Hep)
§ AFP Test: measured at 16-18 weeks
o ed Levels = risk of neural tube/abd wall defects (ex. spina bifida)
o ¯ed Levels: risk of Down Syndrome
§ Fetal Distress
o HR < 110 or > 160
o Fetal hyperactivity or no activity
o Fetal Blood pH < 7.2

Other Stuff

§ Immed after put pt on a Mech Vent check BP (hypotension)
§ Lesions of midbrain = decerebrate positioning
§ Morphine Toxicity = Pinpoint pupils
§ Corticosteroid Effects: Acne, Hirituism, Mood Swings, ostoporosis and adrenal suppression (in kids = delayed growth)
§ No Paxil with MAOI)
§ Beta Blockers = Mask Effect Of Hypoglycemia
§ SOMogyi Effect = BG sometimes up and sometimes down
§ Dawn Phenomenon = high BG in DAWN hrs (5-8am)
§ AFTER
o Post tracheostomy: keep O2 and Suction at bedside
o Post pleural biopsy: chest tube and drainage system at bedside
o Post parathyroidectomy: tracheostomy at bedside
o Tonic Clonic Seizures: Suction apparatus at bedside
o Paracentesis: BP Cuff at Bedside
§ RACE-Priority in a fire
o R-Rescue
o A-Alarm
o C-Confine
o E-Extinguish
§ PASS – To use a fire extinguisher
o P-Pull Pin
o A-Aim at Base Fire
o S-Squeeze Handle
o S-Sweep fire from side to side
§ Folic Acid Rich Foods (FOL)
o F= Fish
o O=Organ Meats, Oranges
o L=Leafy green veggies
§ K+ Foods (ROYGBIV-Rainbow colors)
o Red= Strawberries, Tomatoes (not apples)
o Orange= Oranges
o Yellow=Banana
o Green= Avocado, green veggies
o Blue= Fish from the BLUE sea
o Indigo/Violet= Raisins
§ Cretenism = Congential Hypothyroidism (appears 3-6 mo in bottlefed infants and later in breastfed infants)
§ Hepatitis: low fat, high cal/carbs/protein, no alcohol
§ Hypothryoid: High Protein, low cal diet
§ Cystic Fibrosis: High Protein Diet and Pancr enzyme replacement
§ Hital Hernia: Fundopliction (tighten cardiac sphincter on stomach) don’t lie down for 1 hr after meals, HOB 4-8 in when sleepy, no food before bed
§ Papable olive shaped tumor in epigastrim = pyloric stenosis (projectile vomiting)
o In adults from peptic ulcers; in infants from hypertrophy of pylorous (symp 2nd-4th wk after birth)
§ Toddler: Fear of separation (give simple directions)
§ Preschooler: Fear mutilation (Allow to play with equipment)
§ School Agers: Fear loss of control (allow to play with equipment)
§ Adol: Fear loss of independence

§ Pneumothorax Symp (P-Thorax)
o P-Pleurtic Pain
o T-Trachea Deviation
o H-Hyperresonance
o O-Onset Sudden
o R-Reduced breath sounds (dyspnea)
o A-Absent Fremitus
o X-X-Rays show collapse
§ Pul Edema Tx (MAD DOG)
o M-Morphine
o A-Aminophylline
o D-Digitalis
o D-Diuretics
o O-O2
o G-Gasses in blood (ABGs)

§ Cholecystisis: Gallbladder inflammation (RUQ pain)
§ Cholelithiasis: Gall Stones
§ Pancreatitis
o TURNER’S SIGN: Flank echymosis
o CULLAN’s SIGN: Bluish periumbical (around the belly button)

Who needs Dialysis?

Vowels: AEIOU

A: Acid/Base Problems
E: Electrolyte Problems
I: Intoxications
O: Overload of fluids
U: Uremic Symptoms

§ Cushing’s Dx
o (Cushion – too much Cortisone)
o (3 S’s = high Steriods, high Sugars (hyperglycemia), high Sodium
o Moon Face, Buffalo Hump, Trunkal obesity, thin skinny extremities, slow wound healing, osteoporosis, HTN, muscle wasting
o ¯ K+
§ Addison’s Dx
o Need to ADD steroids
o (3 S’s = Low Steroids, Low Sugars, Low Sodium)
o Low vascular volume (Not holding salt and H20 like in Cushing’s), low BP
o Hyperkalemia ( K+)
o Bronze Skin, Hyperpigmentation
§ ALLEN TEST
o B4 drawing ABGs do an Allen’s Test
o Compress both radial and ulnar arties (wrist) at same time on 1 hand
o Release the ULNAR side (pinky side) and hand should turn discolored and should be able to see blood flow back into it
§ (Radial – is located on the thumb side and ulnar is on the pinky side)
o Minutes of press on the ABG site after drawing blood?
§ 5-10 min or 15-20 min if on anti-coagulants
§ After a liver biopsy place patient on the RIGHT Side
§ Mobility
o Cane
§ COAL = Cane Opp Affected Leg
o 2 point gait
§ One leg and 1 crutch touch ground at same time
§ Weight bearing
o 3 point gait
§ Both crutches and 1 foot are on the ground
§ Non-weight bearing
o 4 point gait
§ Both legs and both crutches touch the ground
§ Weight bearing
o Swing through gait
§ Advancing both crutches, then both legs, and requires weight bearing
§ Not as stable as other gaits
§ Laminectomy = removal of 1 or more vertebral laminae – need straight back after = LOGROLL and KEEP BACK STRAIGHT (so flat bed)
§ Intussceptation
o Seen in Non-Hodgkin’s Lymphoma
o Hot dog mass in RUQ
o Red Currant Jelly Like mucous and bloody stool
§ Sweat Chol
o > 60 = CF
o 40-60 = Borderline CF
§ Ostomy = pouch opening 1/8 in larger than stoma

§ Macule = flat and round
§ Papule = rounded and red
§ Vesicle = filled with fluid

§ Impetigo = 1:20 Burrow’s Soln, honey colored crusts
§ Permethrin [NIX] => 10% for lice tx and 5% for Scabies tx
o (Scabies = mites bury under skin)

RUQ: Right upper quadrant

§ Cholelithiasis (gallstones)
§ Cholecystitis (inflamm of gallbladder)
§ Hepatitis
§ Pancreatitis (severe knifelike pain; worse with eating/lying down; some relief with fetal position)

RLQ:

§ Crohn’s Dx (Ileum, Rt Colon; pain after meals)
§ Appendicitis
o Pain at McBurney’s Point
§ (1/2 b/w umbilicus and right iliac crest)

LLQ:

§ Ulcerative Colitis (Rectum, left colon; pain pre-defecation)
§ Diverticulitis
o Relieved by passage of stool/flatulus

Duodenal Ulcer: Pain 2-3 hrs after meals and nighttime (relieve pain with FOOD INTAKE)

Gastric Ulcer: Pain 1 hr after meal/when fasting; relieve pain with vomiting, not with food intake

(Starve the gastric ulcer and feed the duodenal)

Diverticular Dx: Cramping in LLQ relived by passage of stool and flatus (constipation alternates with diarrhea (from def in diet fiber) high fiber diet

Meckel’s Diverticulum: congen sac or pouch in ileum, symp seen by age 2; painless rectal bleeding, abd, hematechezia, (currant jelly like stool), s/s of appendicitis (tx = remove diverticulum)

Cirrhosis:
§ Biliary obstruction, alcohol, Hepatitis
§ Early stage: high protein/carbs and Vit B
§ Adv stage: low fiber/salt/fat/protein, high cal, fluid restriction
§ Esophageal Varices
o Sengstaken Blakemore Tube or Minnesota Tube
§ Balloon on Esophagus and stomach to apply direct press on bleeding veins
o TIPS (transesophegal intrahepatic post systemic shunt)
§ Balloon Catheter inserted via jugular vein with angiography to create a metal stent b.w portal vein to vena cava channel (provides a pathway for blood b/w portal vein and hepatic vein = bypasses cirrhotic liver) and relieves press on esoph varicies

Jaundice (Icterus)

§ Hemolytic
o RBCs are destroyed (release bilirubin)
§ Hemolytic transfusion rxn
§ Hemolytic Anemia
§ Sickle Cell Crisis
§ Hepatocellular
o The impaired liver cell (hepatocyte) doesn’t allow bilirubin to convert from the unconjugated to the conjugated form
§ Obstructive
o Bile flow is obstructed
§ Cholelithias (Gall Stones)
§ Tumors
EKGS

§ Nml Sinus
o 60-100
o PQRST nml EKG Strip
§ Sinus Brady
o < 60
o Tx: Atropine
o (can be nml in physically fit/trainer person = then no tx needed)
§ 1st degree AV © Block
o Prolonged PR interval
o Nml PR interval: 0.12-0.20
o Conduction Problem
o Drugs (Dig, Beta Blockers, Ca Channel Blockers) can cause by slowing conduction system (slows conduction from SA node to AV node to Purnjee Fibers = see slowed PR (Atrial Response)
o Usu don’t see symp, so usu not treated
§ Atrial Flutter
o Saw Tooth Appearance
o Atrium racing away, blood pools and can throw a clot => stroke
o Treat with Cardioversion 20-50 Jules (NURSE must hit Synchronize button)
o Ventricle beats are regular
§ Atrial Fib
o Ventricle beats are irregular
o Atrium quivers, not good pump
o Cardiovert 50-100 Jules
o If in hospital and were stable b4 going into a fib = give cardizem drip and beta blockers b4 cardioversion
§ V-Tach
o Wide QRS complexes
o V Tach and awake drugs I must take (Amiodarone or Lidocaine)
o V Tach and a nap (unconscious) zap zap zap (defibrillate)
o Can only stay in for 2-3 min (can die)
§ V Fib
o Irreg makes no sense
o Only way to tx = defribillate start at 360 Jules
o Epi (to HR)

Stroke

Right Sided: Impatient, easily distracted, impulsive, less concerned about life events, safety is a big issue (impulse)

Left Sided: Slow, cautious, particular, very aware of deficits, greater depression/anxiety

(Think rt brain = creative, left brain = logical, math, science)

ujones00 · Aug 24, 2009, 10:46 AM