I Passed the NCLEX-RN!

  1. 0 So I passed the NCLEX-RN Yay! Over half my test was select all that apply and my test cut off at 77. The Pearson Vue trick works I came straight home after taking my test and got right on the computer and the pop up box diplayed "Our records indicate that you have recently schedule... Blah blah blah" but I was still wanting to see something on the board of nursing website to ease my stress. The very next morning at 9 am my license number was listed in my dhp account (department of health professions). My school required one kaplan test to pass almost every class and my last class required passing three kaplans and we were given the Kaplan Review course so I had been used to doing NCLEX-like test throughout school (Kaplan will help you pass the NCLEX I strongly suggest using it)I was so nervous I was freaking out and kept rescheduling my test! When I finally put my foot down I took my test a month and a half after I completely finished school I took NCLEX question trainer 7 the day before my NCLEX and I about died sitting there for 265 questions lol I got bored I kept getting up but I made a 63 (above 60 predicts you will pass the NCLEX) and the day of my test I listened to the kaplan review content videos while showering and getting ready When I arrived to take my test I told myself that no matter what I will NEVER have to go to nursing school again and that I had 6 whole hours to take the NCLEX haha RELAX because if you walk in wanting to throw up its not going to be pretty lol I am also going to post a very helpful study tool a friend sent me its long but its very helpful!!!!!
  2. Visit  mnm12 profile page

    About mnm12

    From 'Virginia Beach, VA, US'; Joined May '12; Posts: 6; Likes: 1.

    4 Comments so far...

  3. Visit  iheartNICU89 profile page
    1
    Congrats!! I'm also preparing for nclex. Please post the study tool anything will be helpful!

    Thanks.
    mnm12 likes this.
  4. Visit  mnm12 profile page
    0
    [font=verdana-bold]do not delegate what you can eat!
    [font=verdana-bold]e - evaluate
    [font=verdana-bold]a - assess
    [font=verdana-bold]t - teach
    addisons= down, down down up down
    cushings= up up up down up
    addisons= hyponatremia, hypotension, decreased blood vol,hyperkalemia, hypoglycemia
    cushings= hypernatremia, [color=#008100]hypertension, incrased blood vol, hypokalemia, hyperglycemia
    no pee, no k (do not give [color=#008100]potassiumwithout adequate urine output)
    ele[font=verdana-bold]vate [font=verdana-bold]veins; d[font=verdana-bold]angle [font=verdana-bold]arteries for better perfusion
    [font=verdana-bold]a= appearance (color all pink, pink and blue, blue [pale])
    [font=verdana-bold]p= pulse (>100, < 100, absent)
    [font=verdana-bold]g= grimace (cough, grimace, no response)
    [font=verdana-bold]a= activity (flexed, flaccid, limp)
    [font=verdana-bold]r= [color=#008100]respirations [font=verdana-bold](strong cry, weak cry, absent)
    [font=verdana-bold]transmission-based precautions:
    [font=verdana-bold]airborne
    [font=verdana-bold]my - measles
    [font=verdana-bold]chicken - chicken pox/varicella
    [font=verdana-bold]hez - herpez zoster/shingles
    [font=verdana-bold]tb
    [font=verdana-bold]or remember...
    [font=verdana-bold]mtv=airborne
    [font=verdana-bold]measles
    [font=verdana-bold]tb
    [font=verdana-bold]varicella-chicken pox/herpes zoster-shingles
    [font=verdana-bold]private room - negative pressure with 6-12 air exchanges/hr
    [font=verdana-bold]mask, n95 for tb
    [font=verdana-bold]droplet
    [font=verdana-bold]think of spiderman!
    [font=verdana-bold]s - sepsis
    [font=verdana-bold]s - scarlet fever
    [font=verdana-bold]s - streptococcal pharyngitis
    [font=verdana-bold]p - parvovirus b19
    [font=verdana-bold]p - pneumonia
    [font=verdana-bold]p - pertussis
    [font=verdana-bold]i - influenza
    [font=verdana-bold]d - diptheria (pharyngeal)
    [font=verdana-bold]e - epiglottitis
    [font=verdana-bold]r - rubella
    [font=verdana-bold]m - mumps
    [font=verdana-bold]m - meningitis
    [font=verdana-bold]m - mycoplasma or meningeal pneumonia
    [font=verdana-bold]an - adenovirus
    [font=verdana-bold]private room or cohort
    [font=verdana-bold]mask

    [font=verdana-bold]contact precaution
    [font=verdana-bold]mrs.wee
    [font=verdana-bold]m - multidrug resistant organism
    [font=verdana-bold]r - respiratory infection
    [font=verdana-bold]s - skin infections *
    [font=verdana-bold]w - wound infxn
    [font=verdana-bold]e - enteric infxn - clostridium difficile
    [font=verdana-bold]e - eye infxn - conjunctivitis
    [font=verdana-bold]skin infections
    [font=verdana-bold]vchips
    [font=verdana-bold]v - varicella zoster
    [font=verdana-bold]c - cutaneous diphtheria
    [font=verdana-bold]h - herpez simplex
    [font=verdana-bold]i - impetigo
    [font=verdana-bold]p - pediculosis
    [font=verdana-bold]s - scabies
    1. [font=verdana-bold]air/pulmonary embolism (s&s: chest pain, difficulty breathing, tachycardia,pale/cyanotic,
    sense of impending doom) --> turn pt to [font=verdana-bold]left side and [font=verdana-bold]lower the head of the bed.
    2. [font=verdana-bold]woman in labor w/ un-reassuringfhr (late decels, decreased variability,fetal
    bradycardia, etc) --> turn on [font=verdana-bold]leftside (and give o2, stop pitocin,increase iv fluids)
    3. [font=verdana-bold]tube feeding w/ decreased loc --> position pt on [font=verdana-bold]rightside (promotes emptying of the
    stomach) with the [font=verdana-bold]hobelevated (to prevent aspiration)
    4. [font=verdana-bold]during epidural puncture --> [font=verdana-bold]side-lying
    5. [font=verdana-bold]after lumbar puncture (and also oil-based myelogram)--> pt lies in [font=verdana-bold]flat supine (to prevent
    headache and leaking of csf)
    6. [font=verdana-bold]pt w/ heat stroke --> lie [font=verdana-bold]flat w/ [font=verdana-bold]legs elevated
    7. [font=verdana-bold]during continuous bladderirrigation (cbi) --> catheter is taped tothigh so leg should be
    kept straight. no other positioning restrictions.
    8. [font=verdana-bold]after myringotomy --> position on side of [font=verdana-bold]affected ear after surgery(allows drainage of
    secretions)
    9. [font=verdana-bold]after cataract surgery --> pt will sleep on [font=verdana-bold]unaffectedside with a night shield for 1-4
    weeks.
    10. [font=verdana-bold]after thyroidectomy --> low or semi-fowler's, support head, neck andshoulders.
    11. [font=verdana-bold]infant w/ spina bifida --> position [font=verdana-bold]prone (on abdomen) so that sac does not rupture
    12. [font=verdana-bold]buck's traction (skin traction) --> elevate foot of bed forcounter-traction
    13. [font=verdana-bold]after total hip replacement --> don't sleep on operated side, don't flex hip morethan 45-
    60 degrees, don't elevate hob more than 45 degrees. maintain hipabduction by separating
    thighs with pillows.
    14. [font=verdana-bold]prolapsed cord --> knee-chest position or trendelenburg

    15. [font=verdana-bold]infant w/ cleft lip --> position on back or in infant seat to preventtrauma to suture line.
    while feeding, hold in upright position.
    16. [font=verdana-bold]to prevent dumping syndrome (post-operative ulcer/stomach surgeries) --> eat in
    reclining position, lie down after meals for 20-30 minutes (alsorestrict fluids during meals, low
    cho and [color=#008100]fiber diet, small frequent meals)
    17. [font=verdana-bold]above knee amputation --> elevate for first 24 hours on pillow, positionprone daily to
    provide for hip extension.
    18. [font=verdana-bold]below knee amputation --> foot of bed elevated for first 24 hours, positionprone daily to
    provide for hip extension.
    19. [font=verdana-bold]detached retina --> area of detachment should be in the dependentposition
    20. [font=verdana-bold]administration of enema --> position pt in [font=verdana-bold]leftside-lying (sim's) with knee flexed
    21. [font=verdana-bold]after supratentorial surgery (incision behind hairline) --> elevate hob 30-45degrees
    22. [font=verdana-bold]after infratentorial surgery (incision at nape of neck)--> position pt [font=verdana-bold]flat and lateral on
    either side.
    23. [font=verdana-bold]during internal radiation --> on [font=verdana-bold]bedrestwhile implant in place
    24. [font=verdana-bold]autonomicdysreflexia/hyperreflexia (s&sounding headache, profuse sweating, nasal
    congestion, goose flesh, bradycardia, [color=#008100]hypertension)--> place client in [font=verdana-bold]sitting position(elevate
    [font=verdana-bold]hob) first before any other implementation.
    25. [font=verdana-bold]shock --> bedrest with extremities elevated 20 degrees, kneesstraight, head slightly
    elevated (modified trendelenburg)
    26. [font=verdana-bold]head injury --> elevate hob 30 degrees to decrease intracranialpressure
    27. [font=verdana-bold]peritoneal dialysis when outflowis inadequate --> turn pt from side to side before
    checking for kinks in tubing (according to kaplan)
    28. [font=verdana-bold]lumbar puncture => after the procedure, the client should be placed inthe supine
    position for 4 to 12 hrs as prescribed. (saunders 3rd ed p. 229)
    demorol for pancreatitis, not morphine sulfate
    [color=#4b0083]myasthenia gravis: worsens with exercise and improves with rest.
    [color=#4b0083]myasthenia crisis: a positive reaction to tensilon--will improve[color=#008100]symptoms
    [color=#4b0083]cholinergic crisis: caused by excessive medication-stopmed-giving tensilon will make it worse
    [color=#008100]head injury [color=#4b0083]medication:mannitol (osmotic diuretic)-crystallizes at room temp so always use
    [color=#4b0083]filter needle
    [color=#4b0083]prior to a liver biospy its important to be aware of the labresult for prothrombin time
    from the a** (diarrhea)= metabolic acidosis
    from the mouth (vomitus)=metabolic alkalosis
    [font=verdana-bold]myxedema/hypothyroidism:slowed physical and mental function, sensitivity to cold, dry skin
    and hair

    [font=verdana-bold]graves’ disease/hyperthyroidism: accelerated physical and mental function; sensitivity to
    heat, fine/soft hair
    [font=verdana-bold]thyroid storm: increasedtemp, pulse and htn
    [font=verdana-bold]post-thyroidectomy: semi-fowler’s,prevent ncek flexion/hyperextension, trach at bedside
    [font=verdana-bold]hypo-parathyroid: cats– convulsions, arrhythmias, tetany, spasms, stridor (decreased
    calcium), high ca, low phosphorus diet
    [font=verdana-bold]hyper-parathyroid:fatigue, muscle weakness, renal calculi, back and [color=#008100]joint pain (increased
    calcium), low ca, high phosphorus diet
    [font=verdana-bold]hypovolemia – incrasedtemp, rapid/weak pulse, increase [color=#008100]respiration, hypotension, anxiety,
    urine specific gravity >1.030
    [font=verdana-bold]hypervolemia – boundingpulse, sob, dyspnea, rares/crackles, peripheral [color=#008100]edema, htn, urine
    specific gravity <1.010; semi-fowler’s
    [font=verdana-bold]diabetes insipidus (decreased adh): excessive urine output and thirst, dehydration,
    weakness, administer pitressin
    [font=verdana-bold]siadh (increased adh): changein loc, decreased deep tendon reflexes, tachycardia, n/v/a,
    ha; administer declomycin, diuretics
    [font=verdana-bold]hypokalemia: muscleewakness, dysrhythmias, increase k (raisins, bananas, apricots, oranges,
    beans, potatoes, carrots, celery)
    [font=verdana-bold]hyperkalemia: murder –muscle weakness, urine (oliguria/anuria), respiratory depression,
    decreased cardiac contractility, ecg changes, reflexes
    [font=verdana-bold]hyponatremia: nausea,muscle cramps, increased icp, muscular twitching, convulsion; osmotic
    diuretics, fluids
    [font=verdana-bold]hypernatremia: increasedtemp, weakness, disorientation/delusions, hypotension, tachycardia;
    hypotonic solution
    [font=verdana-bold]hypocalcemia: cats –convulsions, arrhythmias, tetany, spasms and stridor
    [font=verdana-bold]hypercalcemia: muscleweakness, lack of coordination, abdominal pain, confusion, absent
    tendon reflexes, sedative effect on cns
    [font=verdana-bold]hypomg: tremors, tetany, seizures,dyrshythmias, depression, confusion, dysphagia; dig toxicity
    [font=verdana-bold]hypermg: depresses thecns, hypotension, facial flushing, muscle ewakness, absent deep
    tendon reflexes, shallow respirations, emergency
    [font=verdana-bold]addison’s: hypona,hyperk, hypoglycemia, dark pigmentation, decreased resistance to stress,
    fractures, alopecia, [color=#008100]weightloss, gi distress
    [font=verdana-bold]cushings: hyperna,hypok, hyperglycemia, prone to infection, muscle wasting, weakness,
    edema, htn, hirsutism, moonface/buffalo hump
    [font=verdana-bold]addisonian crisis: n/v,confusion, abdominal pain, extreme weakness, hypoglycemia,
    dehydration, decreased bp
    [font=verdana-bold]pheochromocytoma:hypersecretion of epi/norepi, persistent htn, increased hr,
    hyperglycemia, diaphoresis, tremor, pounding ha; avoid stress,frequent bating and rest breaks,
    avoid cold and stimulating foods, surgery to remove tumor
    1. neuroleptic malignant [color=#008100]syndrome(nms):
    -nms is like s&m;
    -you get hot (hyperpyrexia)
    -stiff (increased [color=#008100]muscle tone)
    -sweaty (diaphoresis)
    -bp, pulse, and [color=#008100]respirationsgo up &
    -you start to drool

    2. i kept forgetting which was dangerous when you're [color=#008100]pregnant; regularmeasles (rubeola), or
    german measles (rubella), so remember:
    -never get pregnant with a german (rubella)
    3. when drawing up [color=#008100]regularinsulin & nph together, remember:
    -rn (regular comes before nph)
    4. tetralogy of fallot; remember hops
    think drop(child drops to floor or squats) or posh
    defect, septal
    right ventricular hypertrophy
    overriding aorts
    pulmonary stenosis
    5. maoi's that are used as antidepressants:
    weird way to remember, i know. pirates say arrrr, so think;pirates take maoi's when they're
    depressed.
    - explanation; maoi's used for depression all have an arrr soundin the middle (parnate, marplan,
    nardil)
    autonomic dysreflexia: potentially life threatening emergency
    - elevate head of bed to 90 degree
    - loosen constrictive clothing
    - assess for bladder distention and bowel impaction (triger)
    - administer antihypertensive meds (may cause stroke, mi, seisure)
    [font=verdana-bold]easy way to remember maoi's!
    [font=verdana-bold]think of panama!
    [font=verdana-bold]pa - parnate
    [font=verdana-bold]na - nardil
    [font=verdana-bold]ma - marplan
    metallic bitter taste.
    digoxin-check pulse, less than 60 hold, check dig levels andpotassium levels.
    amphojel: tx of gerd and kidney stones....watch out forcontipation.
    vistaril: tx of anxiety and also itching...watch for dry mouth.given preop commonly
    versed: given for conscious sedation...watch for resp depressionand hypotension
    ptu and tapazole- prevention of thyroid storm
    sinemet: tx of parkinson...sweat, saliva, urine may turn reddishbrown occassionally...causes
    drowsiness
    artane: tx of parkinson..sedative effect also
    cogentin: tx of parkinson and extrapyramidal effects of otherdrugs
    tigan: tx of postop n/v and for nausea associated withgastroenteritis
    timolol (timoptic)-tx of gluacoma

    bactrim: antibiotic..dont take if allergic to sulfadrugs...diarrhea common side effect...drink plenty
    of fluids
    gout meds: probenecid (benemid), colchicine, allopurinol(zyloprim)
    apresoline(hydralazine)-tx of htn or chf, report flu-like [color=#008100]symptoms, rise slowlyfrom sitting/lying
    position; take with meals.
    bentyl: tx of irritable bowel....assess for anticholinergic sideeffects.
    calan (verapamil): calcium channel blocker: tx of htn,angina...assess for constipation
    carafate: tx of duodenal ulcers..coats the ulcer...so take beforemeals.
    theophylline: tx of asthma or [color=#008100]copd..therap drug level: 10-20
    mucomyst is the antedote to tylenol and is administered orally
    diamox: tx of glaucoma, high altitude sickness...dont take ifallergic to sulfa drugs
    indocin: (nsaid) tx of [color=#008100]arthritis(osteo, rhematoid, gouty), bursitis,and tendonitis.
    synthroid: tx of [color=#008100]hypothyroidism..may take several weeks to take effect...notify doctor ofchest
    pain..take in the am on empty stomach..could causehyperthyroidism.
    librium: tx of alcohol w/d...dont take alchol with this...very badnausea and vomiting can occur.
    oncovin (vincristine): tx of leukemia..given iv only
    kwell: tx of [color=#008100]scabies and lice...(scabies)apply lotion once and leave on for8-12 hours...(lice) use
    the shampoo and leave on for 4 minutes with hair uncovered thenrinse with warm water and
    comb with a fine tooth comb
    premarin:tx after menopause estrogen replacement
    dilantin: tx of seizures. thera drug level: 10-20
    navane: tx of schizophrenia..assess for eps
    ritalin: tx of adhd..assess for heart related side effects reportimmediately...child may need a
    drug holiday b/c it stunts growth.
    dopamine (intropine): tx of hypotension, shock, low cardiacoutput, poor perfusion to vital
    organs...monitor ekg for arrhythmias, monitor bp
    have trouble remembering fhr patterns in ob? think veal chop
    v c
    e h
    a o
    l p
    v = variable decels; c = cord compression caused
    e = early decels; h = head compression caused
    a = accels; o = okay, not a problem!
    l = late decels = placental insufficiency, can't fill

    for cord compression, place the mother in the trendelenbergposition because this removes
    pressure of the presenting part off the cord. (if her head isdown, the baby is no longer being
    pulled out of hte body by gravity)
    if the cord is prolapsed, cover it with sterile saline gauze toprevent drying of the cord and to
    minimize infection.
    for late decels, turn the mother to her left side, to allow moreblood flow to the placenta.
    for any kind of bad fetal [color=#008100]heartrate pattern, you give o2, often bymask...
    when doing an epidural anesthesia hydration before hand is apriority.
    hypotension and bradypnea / bradycardia are major risks andemergencies.
    never check the monitor or a machine as a first action. alwaysassess the patient first; for
    exmaple listen to the [color=#008100]fetalheart tones with a stethoscope innclex land. sometimes it's hard to
    tell who to check on first, the mother or the baby; it's usuallyeasy to tell the right answer if the
    mother or baby involves a machine. if you're not sure who to checkfirst, and one of the choices
    involves the machine, that's the wrong answer.
    if the baby is a posterior presentation, the sounds are heard atthe sides.
    if the baby is anterior, the sounds are heard closer to midline,between teh umbilicus and where
    you would listen to a posterior presentation.
    if the baby is breech, the sounds are high up in the fundus nearthe umbilicus. if the baby is
    vertex, they are a little bit above the symphysis pubis.
    also for ventilator alarms
    [font=verdana-bold]hold
    [font=verdana-bold]high alarm- [font=verdana-bold]obstruction due to incr. secretions,kink, pt. coughs, gag or bites
    [font=verdana-bold]low press alarm- [font=verdana-bold]disconnection or leak in ventilatioror in pt. airway cuff, pt. stops spontaneous
    breathing
    1. to remember blood sugar:
    hot and dry-sugar high (hyperglycemia)
    cold and clammy-need some candy (hypoglycemia)
    2. icp and shock have opposite v/s
    icp-increased bp, decreased pulse, decreased resp.
    shock- decreased bp, increased pulse, increased resp.
    3. cor pulmonae: right sided heart failure caused by leftventricular failure (so pick [color=#008100]edema, jvd, if
    it is a choice.)
    4. herion withdrawal neonate: irratable poor sucking
    5. jews: no meat and milk together
    6. brachial pulse: pulse area cpr on an infant.
    7. test child for lead poisioning around 12 months of age
    8. bananas, potatoes, citrus fruits source of [color=#008100]potassium
    11. cultures are obtained before starting iv antibiotics

    12. a pt with leukemia may have epitaxis b/c of low platelets
    13. best way to warm a newborn: skin to skin contact coveredwith a blanket on mom.
    14. when a pt comes in and she is in active labor...nursefirst action is to listen to fetal heart
    tone/rate
    15. phobic disorders...use systematic desensitiztion.
    nclex tips
    1. when getting down to two answers, choose the assessment answer(assess,
    collect, auscultate, monitor, palpate) over the interventionexcept in an
    emergency or distress situation. if one answer has an absolute,discard it.
    give priority to answers that deal directly to the patient’s body,not the
    machines/equipments.
    2. key words are very important. avoid answers with absolutes forexample:
    always, never, must, etc.
    3. with lower amputations patient is placed in prone position.
    4. small frequent feedings are better than larger ones.
    5. assessment, teaching, meds, evaluation, unstable patient cannotbe
    delegated to an unlicensed assistive personnel.
    6. lvn/lpn cannot handle blood.
    7. amynoglycosides (like vancomycin) cause nephrotoxicity andototoxicity.
    8. iv push should go over at least 2 minutes.
    9. if the patient is not a child an answer with family option canbe ruled
    out easily.
    10. in an emergency, patients with greater chance to live aretreated first
    11. ards (fluids in alveoli), dic (disseminated intravascularcoagulaton)
    are always secondary to something else (another disease process).
    12. cardinal sign of ards is hypoxemia (low oxygen level intissues).
    13. in ph regulation the 2 organs of concern are lungs/kidneys.
    14. edema is in the interstitial space not in the cardiovascularspace.
    15. weight is the best indicator of dehydration
    16. wherever there is sugar (glucose) water follows.
    17. aspirin can cause reye’s syndrome (encephalopathy) when givento
    children
    18. when aspirin is given once a day it acts as an antiplatelet.
    19. use cold for acute pain (eg. sprain ankle) and heat forchronic (
    rheumatoid arthritis)
    20. guided imagery is great for chronic pain.
    21. when patient is in distress, medication administration israrely a good
    choice.
    22. with pneumonia, fever and chills are usually present. for theelderly
    confusion is often present.
    23. always check for allergies before administering antibiotics(especially
    pcn). make sure culture and sensitivity has been done before adm.first dose
    of antibiotic.
    24. cor pulmonale (s/s fluid overload) is right sided heart failurecaused
    by pulmonary disease, occurs with bronchitis or emphysema.
    25. copd is chronic, pneumonia is acute. emphysema and bronchitisare
    both copd.
    26. in copd patients the baroreceptors that detect the co2 levelare
    destroyed. therefore, o2 level must be low because high o2concentration
    blows the patient’s stimulus for breathing.
    27. exacerbation: acute, distress.
    28. epi always given in tb syringe.
    29. prednisone toxicity: cushing’s syndrome= buffalo hump, moonface, high
    glucose, hypertension.
    30. 4 options for cancer management: chemo, radiation, surgery,allow to
    die with dignity.
    31. no live vaccines, no fresh fruits, no flowers should be usedfor
    neutropenic patients.
    32. chest tubes are placed in the pleural space.
    33. angina (low oxygen to heart tissues) = no dead heart tissues.mi=
    dead heart tissue present.
    34. mevacor (anticholesterol med) must be given with evening mealif it is
    qd (per day).
    35. nitroglycerine is administered up to 3 times (every 5minutes). if
    chest pain does not stop go to hospital. do not give when bp is< 90/60.
    36. preload affects amount of blood that goes to the r ventricle.
    afterload is the resistance the blood has to overcome when leavingthe heart.
    37. calcium channel blocker affects the afterload.
    38. for a cabg operation when the great saphenous vein is taken itis
    turned inside out due to the valves that are inside.
    39. unstable angina is not relieved by nitro.
    40. dead tissues cannot have pvc’s(premature ventricularcontraction. if
    left untreated pvc’s can lead to vf (ventricular fibrillation).
    41. 1 t (teaspoon)= 5 ml
    1 t(tablespoon)= 3 t = 15 ml
    1 oz= 30 ml
    1 cup= 8 oz
    1 quart= 2 pints
    1 pint= 2 cups
    1 gr (grain)= 60 mg
    1 g (gram)= 1000 mg
    1 kg= 2.2 lbs
    1 lb= 16 oz
    * to convert centigrade to f. f= c+40, multiply 9/5 and substract40
    * to convert fahrenheit to c. c= f+40, multiply 5/9 and substract40.
    42. angiotensin ii in the lungs= potent vasodialator. aldosteroneattracts
    sodium.
    43. reverse agents for toxicity
    heparin= protamine sulfate
    coumadin= vitamin k
    ammonia= lactulose
    acetaminophen= n-acetylcysteine.
    iron= deferoxamine
    digitoxin, digoxin= digibind.
    alcohol withdraw= librium.
    - methadone is an opioid analgesic used to detoxify/treat pain in
    narcotic addicts.
    - [color=#008100]potassium potentiates dig toxicity.
    44. heparin prevents platelet aggregation.
    45. pt/ptt are elevated when patient is on coumadin
    46. cardiac output decreases with dysrythmias. dopamine increasesbp.
    47. med of choice for vtach is lidocaine
    48. med of choice for svt is adenosine or adenocard
    49. med of choice for asystole (no heart beat) is atropine

    50. med of choice for chf is ace inhibitor.
    51. med of choice for anaphylactic shock is epinephrine
    52. med of choice for status epilepticus is valium.
    53. med of choice for bipolar is lithium.
    54. amiodorone is effective in both ventricular and atrialcomplications.
    55. s3 sound is normal in chf, not normal in mi.
    56. give carafate (gi med) before meals to coat stomach
    57. protonix is given prophylactically to prevent stress ulcers.
    58. after endoscopy check gag reflex.
    59. tpn(total parenteral nutrition) given in subclavian line.
    60. low residue diet means low fiver
    61. diverticulitis (inflammation of the diverticulum in the colon)pain is
    around ll quadrant.
    62. appendicitis (inflammation of the appendix) pain is in rlquadrant with
    rebound tenderness.
    63. portal hypotension + albuminemia= ascites.
    64. beta cells of pancreas produce insulin
    65. morphine is contraindicated in pancreatitis. it causes spasmof the
    sphincter of oddi. therefore demerol should be given.
    66. trousseau and tchovoski signs observed in hypocalcemia
    67. with chronic pancreatitis, pancreatic enzymes are given withmeals.
    68. never give k+ in iv push.
    69. mineral corticoids are give in addison’s disease.
    70. diabetic ketoacidosis (dka)= when body is breaking down fatinstead of
    sugar for energy. fats leave ketones (acids) that cause ph todecrease.
    71. dka is rare in diabetes mellitus type ii because there isenough
    insulin to prevent breakdown of fats.
    72. sign of fat embolism is petechiae. treated with heparin.
    73. for knee replacement use continuous passive motion machine.
    74. give prophylactic antibiotic therapy before any invasiveprocedure.
    75. glaucoma patients lose peripheral vision. treated with meds
    76. cataract= cloudy, blurry vision. treated by lensremoval-surgery
    77. co2 causes vasoconstriction.
    78. most [color=#008100]spinal cord injuries are at the cervical or lumbar regions
    79. autonomic dysreflexia ( life threatening inhibited sympatheticresponse
    of nervous system to a noxious stimulus- patients with spinal cordinjuries
    at t-7 or above) is usually caused by a full bladder.
    80. spinal shock occurs immediately after spinal injury
    81. multiple sclerosis= myelin sheat destruction, disruption innerve
    impulse conduction.
    82. myasthenia gravis= decrease in receptor sites foracetylcholine. since
    smallest concentration of acth receptors are in cranial nerves,expect fatigue
    and weakness in eye, mastication, pharyngeal muscles.
    83. tensilon test given if muscle is tense in myasthenia gravis.
    84. guillain-barre syndrome= ascending paralysis. keep eye onrespiratory
    system.
    85. parkinson’s = rat: rigidity, akinesia (loss of muscle mvt),tremors.
    treat with levodopa.
    86. tia (transient ischemic attack) mini stroke with no dead braintissue
    87. cva (cerebrovascular accident) is with dead brain tissue.
    88. hodgkin’s disease= cancer of lymph is very curable in earlystage.
    89. rule of nines for burns
    head and neck= 9%
    each upper ext= 9%
    each lower ext= 18%

    front trunk= 18%
    back trunk= 18%
    genitalia= 1% ?
    90. birth weight doubles by 6 month and triple by 1 year of age.
    91. if hr is <100 do not give dig to children.
    92. first sign of cystic fibrosis may be meconium ileus at birth.baby is
    inconsolable, do not eat, not passing meconium.
    93. heart defects. remember for cyanotic -3t’s( tof, truncysarteriosus,
    transposition of the great vessels). prevent blood from going toheart. if
    problem does not fix or cannot be corrected surgically, chf willoccur
    following by death.
    94. with r side cardiac cath=look for valve problems
    95. with l side in adults look for coronary complications.
    96. rheumatic fever can lead to cardiac valves malfunctions.
    97. cerebral palsy = poor muscle control due to birth injuriesand/or
    decrease oxygen to brain tissues.
    98. icp (intracranial pressure) should be <2. measure headcirconference.
    99. dilantin level (10-20). can cause gingival hyperplasia
    100. for meningitis check for kernig’s/ brudzinski’s signs.
    101. wilm’s tumor is usually encapsulated above the kidneyscausing flank
    pain.
    102. hemophilia is x-linked. mother passes disease to son.
    103. when phenylalanine increases, brain problems occur.
    104. buck’s traction= knee immobility
    105. russell traction= femur or lower leg
    106. dunlap traction= skeletal or skin
    107. bryant’s traction= children <3y, <35 lbs with femur fx.
    108. place apparatus first then place the weight when puttingtraction
    109. placenta should be in upper part of uterus
    110. eclampsia is seizure.
    111. a patient with a vertical c-section surgery will more likelyhave
    another c-section.
    112. perform amniocentesis before 20 weeks gestation to check forcardiac
    and pulmonary abnormalities.
    113. rh- mothers receive rhogam to protect next baby.
    114. anterior fontanelle closes by 18 months. posterior 6 to 8weeks.
    115. caput succedaneum= diffuse edema of the [color=#008100]fetal scalp thatcrosses the
    suture lines. swelling reabsorbs within 1 to 3 days.
    116. pathological jaundice= occurs before 24hrs and last7 days.
    physiological jaundice occurs after 24 hours.
    117. placenta previa = there is no pain, there is bleeding.placenta
    abruption = pain, but no bleeding.
    118. bethamethasone (celestone)=surfactant. med for lungexpansion.
    119. dystocia= baby cannot make it down to canal
    120. pitocin med used for uterine stimulation
    121. magnesium sulfate(used to halt preterm labor) iscontraindicated if
    deep tendon reflexes are ineffective. if patient experiencesseizure during
    magnesium adm. get the baby out stat (emergency).
    122. do not use why or i understand statement when dealing withpatients
    123. milieu therapy= taking care of patient/environment
    124. cognitive therapy= counseling
    125. crisis intervention=short term.
    126. five interventions for psych patients
    -safety
    -setting limits

    -establish trusting relationship
    -meds
    -leas restrictive methods/environment.
    126. ssri’s (antidepressants) take about 3 weeks to work.
    127. obsession is to thought. compulsion is to action
    128. if patients have hallucinations redirect them. in delusionsdistract
    them.
    129. thorazine, haldol (antipsychotic) can lead to eps(extrapyramidal side
    effects)
    130. alzheimer’s disease is a chronic, progressive, degenerativecognitive
    disorder that accounts for more than 60% of all dementias
    1. to remember how to draw up insulin think:
    [font=verdana-bold]nicole [font=verdana-bold]richie [font=verdana-bold]rn (a teacher taught us this is school, thought it was
    funny and never forgot it!!!)
    air into nph, then air into regular, draw up regular then draw upnph
    2. hyperthyroidism think of [font=verdana-bold]michaeljackson in thriller!
    [font=verdana-bold]skinny, nervous, buldging eyes, up all night, heart beating fast
    atropine used to decrease secretions
    phenergan an antiemetic used to reduce nausea
    [color=#008100]diazepam is a commonly used tranquilizer givento reduce anxiety before or
    demerol is for pain control
    do not give demerol to pts. with sickle cell crisis.
    iron injections should be given z-track so they don't leak into sqtissues.
    [font=verdana-bold]all
    [font=verdana-bold]physicians
    [font=verdana-bold]earn
    [font=verdana-bold]too
    [font=verdana-bold]much
    [font=verdana-bold]money
    or [font=verdana-bold]ape to [font=verdana-bold]man
    [font=verdana-bold]cranial nerves: *i am sorryif this vulgar for some, but hey, it sticks
    sensory=s motor=m both=b
    oh (olfactory i) some
    oh (optic ii) say
    oh (oculomotor iii) marry
    to (trochlear iv) money
    touch (trigeminal v) but
    and (abducens vi) my
    feel (facial vii) brother
    a (auditory viii) says
    girls (glossopharyngeal ix) big
    vagina (vagus x) bras
    and (accessory xi) matter
    hymen (hypoglassal xii) more

    [font=verdana-bold]hyper natremia (greater than 145)
    [font=verdana-bold]skin flushed
    [font=verdana-bold]agitation
    [font=verdana-bold]low grade fever
    [font=verdana-bold]thirst
    [font=verdana-bold]developmental
    2-3 months: turns head side to side
    4-5 months: grasps, switch & roll
    6-7 months: sit at 6 and waves bye-bye
    8-9 months: stands [font=verdana-bold]straightat [font=verdana-bold]eight
    10-11 months: belly to butt (phrase has 10 letters)
    12-13 months: twelve and [font=verdana-bold]up, drink from a [font=verdana-bold]cup
    [font=verdana-bold]hepatitis
    hepatitis: -ends in a [font=verdana-bold]vowel, comes from the [font=verdana-bold]bowel (hep a)
    hepatitis b=blood and bodily fluids
    hepatitis c is just like b
    [font=verdana-bold]apgar measures [font=verdana-bold]hr,rr,muscle tone, reflexes,skin color
    each 0-2 point. 8-10 ok. 0-3 resuscitate.
    [font=verdana-bold]glasgow coma scale. eyes, verbal,motor!
    it is similar to measuring dating skills...[font=verdana-bold]max 15 points -one can do it
    if [font=verdana-bold]below 8 you are in [font=verdana-bold]coma.
    so, to start dating you gotta [font=verdana-bold]openyour [font=verdana-bold]eyes first, if you albeto do
    that spontaneously and use them correctly to see whom you datingyou earn 4. but if she has to
    scream on you to make you
    open them it is only 3....and 1 you dont care to open even if shetries to hurt you.
    if you get good eye contact (4 points) then move to [font=verdana-bold]verbal.
    talk to her/ him! if you can do that you are really oriented in
    situation she/he uncontiously gives you 4 points! if you like hertry not to be confused (3), and
    of cause do not use
    inappropriate words (3), she will not like it)), try not torespond with incomprehensible
    sounds (2), if you do not like herjust
    show no verbal response(1)
    since you've got eye and verbal contact you can [font=verdana-bold]move now using your motor response points.
    this is very important since good moves give you 6!
    the person who hyperventilates is most likely to experiencerespiratory alkalosis.
    avoid salt substitutes when taken dig and k-supplements becausemany are potassium based
    [color=#483d8c]signs of hypoxia: restless, anxious, cyanotic tachycardia,increased resps. (also monitor abg's)
    [color=#008100]addison's disease [color=#483d8c](needto [color=#483d8c][font=verdana-bold]"add" [color=#483d8c]hormone)
    [color=#483d8c]cushing's syndrome (have extra [color=#483d8c][font=verdana-bold]"cushion"[color=#483d8c]of hormones)
    [color=#483d8c]dumping syndrome: increase fat and protein, small frequentmeals, lie down after meal to
    [color=#483d8c]decrease peristalsis, wait 1 hr after meals to drink.
  5. Visit  mnm12 profile page
    0
    [color=#483d8c]for blood types: "o" is the universal donor (remember [font=verdana-bold]"o" indonor)
    [color=#483d8c]"ab" is the universal receipient
    disseminated herpes zoster is airborne precautions, as tolocalized herpes zoster is
    contact precautions. a nurse with a localized herpes zoster cancare for patients as long as
    the patients are not immunosuppressed and the [color=#008100]lesions must becovered!
    fat soluble vitamins are vitamins a, d, e, k
    give nsaids, corticosteroids, drugs for [color=#008100]bipolar,cephalosporins, and sulfanomides with food.
    ativan is the treatment of choice for status epilepticus
    when using a bronchodilator inhaler inconjuction with aglucocorticoid inhaler, administer the
    bronchodilator first
    theophylline increases the risk of digoxin toxicity and decreasesthe effects of lithium and dilantin
    [font=verdana-bold]intal, an inhaler used to treat allergyinduced asthma may cause bronchospasm, think… [font=verdana-bold]into the
    asthmatic lung
    isoniazid causes peripheral neuritis
    peptic ulcers caused by h. [font=verdana-italic]pyloriare treated with flagyl, prilosec andbiaxin. this treatment kills
    bacteria and stops production of stomach acid, but does not healulcer.
    weighted ni (naso intestinal tubes) must float from stomach tointestine. don't tape the tube
    right away after placement, may leave coiled next to pt on hob.position patient on right to
    facilitate movement through pylorus.
    * diaphragm must stay in place 6 hours after intercourse. they arealso fitted so must be refitted
    if you lose or gain a significant amount of weight.
    * best time to take growth hormone pm, steroids am, diuretics am,aricept am.
    * carafate (sulcrafate) before meals (mucosal barrier; [color=#008100]constipation)
    * tagamet with food (h2; messes with elderly ppl be careful !interacts with alot of things)
    *antacids after meals
    * long term use of amphogel (binds to phosphates, increases ca,robs the bones...leads to
    increased ca resortion from bones and weak bones)
    *cushings ulcers r/t brain injury
    *cushings triad r/t icp in brain (htn, bradycard, irr. resp)
    *[color=#008100]thyroid storm is hot (hyperthermia)
    *myxedema coma is cold (hypothermia)
    *glaucoma intraocular pressure is greater than the normal (22 mmhg), give miotics to constrict
    (pilocarpine) no atropine.
    * non dairy sources of [color=#008100]calciuminclude rhubarb, sardines, collardgreens
    * you can petal the rough edges of a plaster cast with tape toavoid [color=#008100]skin irritation.
    *with low back aches, bend knees to relieve
    * push fluids with allopurinol - flush the uric acid out of system
    * koplick's spots are red spots with blue center characteristic ofprodromal stage of measles.
    usually in mouth.
    * inh can cause peripheral neuritis, take vit b6 to prevent alsohepatotoxic

    * [font=verdana-bold]rifampin - [font=verdana-bold]red orange tears and urine, also contraceptives don't workas well
    * [font=verdana-bold]ethambutol - messes with your [font=verdana-bold]eyes
    * apply eye drop to conjunctival sac and after wards apply pressureto nasolacrimal duct / inner
    canthus
    * pancreatitis patients but them in fetal position, npo, gut rest,prepare antecubital site for picc
    cuz they'll probably be getting tpn/lipids
    * trendelenburg test - for varicose veins. if they fill proximally= varicosity.
    rule of nines, 9 = head, 18 = arms, 36 = torso, 36 =legs, and 1=perineum = 100%
    [font=verdana-bold]when giving kayexalate we need to worry about dehydration ( k haineverse
    [font=verdana-bold]relationship with na)
    [font=verdana-bold]yogurt has live cultures- dont give to immunosuppressed pt
    [font=verdana-bold]itching under cast area- cool air via blow dryer, ice pack for 10-15 minutes. never use
    [font=verdana-bold]qtip or anything to scratch area
    murphy’s sign – pain with palpation of gall bladder area seen withcholecystitis
    cullen’s sign – ecchymosis in umbilical area, seen with pancreatitis
    turner’s sign – flank grayish blue (turn around to see yourflanks) pancreatitis
    mcburney’s point – pain in rlq indicative of appendicitis
    llq – diverticulitis , low residue, no seeds, nuts, peas
    rlq – appendicitis, watch for peritonitis
    guthrie test – tests for pku, baby should have eaten source ofprotein first
    shilling test – test for [color=#008100]perniciousanemia/ how well one absorbs vit b12
    allen’s test – occlude both ulnar and radial artery until handblanches then release ulnar. if the
    hand pinks up, ulnar artery is good and you can carry on withabg/radial stick as planned. abgs
    must be put on ice and whisked to the lab.
    oit’s ok to have abdominal craps, blood tinged outflow and leakingaround site if the peritoneal
    dialysis cath (tenkhoff) was placed in the last 1-2 wks. cloudyoutflow never normal.
    oamniotic fluid yellow with particles = meconium stained
    ohyper reflexes (upper motor neuron issue “your reflexes are overthe top”)
    oabsent reflexes (lower motor neuron issue)
    orhogam : given at 28 weeks, 72 hours post partum, im. only givento rh negative mother.
    also if indirect coomb’s test is positive, don’t need to giverhogam cuz she has antibody only give
    if negative coombs
    ovit k is to coumadin as protamine sulfate is to heparin as ca gluis to mgso4 as mucomyst is to
    acetominophen as amicar is to tpa…get it? antidotes/treatments foroverdose
    order of assessment: inspection, palpation, percussion andausculation. except with abdomen
    cuz you don’t wanna mess with the bowels and their sounds so youinspect, auscultate, percuss
    then palpate (same with kids, i suppose since you wanna go fromleast invasive to most invasive
    sine they will cry blood murder ! gotta love them kids !)
    latex [color=#008100]allergies => assess for allergies to bananas, apricots, cherries,grapes, kiwis, passion fruit,
    avocados, chestnuts, tomatoes, peaches

    tensilon is used in myesthenia gravis to confirm the diagnosis.
    myesthenia gravis is caused by a disorder in the transmission ofimpulses from nerve to muscle
    cell.
    amyotrophic lateral sclerosis ( als ) is a condition in whichthere is a degeneration of motor
    neurons in both the upper & lower motor neuron systems.
    [color=#000081][font=verdana-bold]transesophageal fistula (tef) [color=#000081]- esophagus doesn't fully develop (this is a surgical emergency)
    [color=#000081]the [color=#000081][font=verdana-bold]3 c's of tef [color=#000081]in the newborn:
    [color=#000081]1) choking
    [color=#000081]2) coughing
    [color=#000081]3) cyanosis
    the mmr vaccine is given sq not im.
    red--unstable, ie, occluded airway, actively bleeding, see first
    yellow---stable, can wait up to an hour for treatment, ie burns,see second
    green---stable, can wait even longer to be seen, "walkingwounded"
    black--unstable clients that will probably not make it, needcomfort measures
    doa---dead on arrival
    [color=#9a32cd]greek heritage - they put an amulet or any other use ofprotective charms around their baby's
    [color=#9a32cd]neck to avoid "evil eye" or envy of others
    [color=#9a32cd][font=verdana-italic]4 year old kids cannot interpret time[color=#9a32cd]. need to explain time in relationship to a known common
    [color=#9a32cd]event (eg: "mom will be back after supper").
    ** anaphylactic reaction to baker's yeast is contraindication forhep b vaccine.
    ** ask for [color=#008100]allergy to eggs before flu shot
    ** ask for anaphylactic rxn to eggs or neomycin before mmr
    ** when on nitroprusside, monitor thiocynate (cyanide). normal valueshould be 1, >1 is heading
    toward toxicity
    **if kid has cold, can still give [color=#008100]immunizations
    **sars (severe acute resp syndrome) airborne + contact (just likevaricella)
    ** hepatitis a is contact precautions
    ** tetanus, hepatitis b, hiv are standard precautions
    ** william's position - semi fowlers with knees flexed (inc. kneegatch) to relieve lower [color=#008100]back
    [color=#008100]pain.
    ** signs of a fractured hip: external rotation, shortening,adduction
    ** fat embolism: blood tinged sputum (r/t inflammation), inc esr,respiratory alkalosis (not
    acidosis r/t tachypnea), hypocalcemia,increased serum [color=#008100]lipids, "snowstorm" effect on cxr.
    **complications of mechanical ventilation: pneumothorax, ulcers
    ** paget's disease - [color=#008100]tinnitus, bone pain, enlargement of bone, thick bones.
    ** no vitamin c with allopurinol
    ** ivp requires bowel prep so they can visualize the bladderbetter
    **acid ash [color=#008100]diet - cheese, corn, cranberries, plums, prunes, meat, poultry, pastry,bread
    ** alk ash diet- milk, veggies, rhubarb, salmon
    ** orange tag in triage is non emergent psych
    ** greenstick fractures, usually seen in kids bone breaks on oneside and bends on the other

    insomnia is a side effect of thyroid hormones. saunders confirmsit. makes sense though!
    increased met. rate, your body is "too busy to sleep" asopposed to the folks with hypothyroidism
    who may report somnolence (dec. met rate, body is slow andsleepy). ok some more facts.
    ** botox for strabismus. patch the good eye so that the weaker eyecan get stronger. found a
    cool link about its use in peds pt with strabismus. i had to lookit up cuz i heard it was important
    *ah hem ah hem*
    ** tidal volume is 7 – 10ml / kg
    ** copd patients remember: 2lnc or less (hypoxic not hypercapnicdrive), pa02 of 60ish and
    sa02 90% is normal for them b/c they are chronic co2 retainers....
    ** neostigmine/atropine (anticholinergic) to reverse effect ofpancuronium.
    **ampho b causes hypokalemia (amongst many other things..gottapremedicate before giving.
    pts will most likely get a fever)
    ** test 4 hypersensitivity before the administration ofasparginase.
    ** take vermox with high fat diet (increases absorption)
    ** kidney glucose threshold is 180
    ** amphogel and renegal take with meals
    ** stranger [color=#008100]anxiety is greatest 7 - 9 months, separation anxiety peaks intoddlerhood
    ** mmr is a sq shot
    lymes is found mostly in conneticut
    asthma and [color=#008100]arthritis--swimming best
    asthma has intercostal retractions--be concerned
    tardive dyskinesia - irreversible - involuntary movements of thetongue, face and extremities,
    may happen after prolonged use of antipsychotics
    akathisia - motor restlessness, need to keep going, tx withantiparkinsons meds, can be mistaken
    for agitation.
    when drawing an abg, you need to put the blood in a heparinizedtube, make sure there are no
    bubbles, put on ice immediately after drawing, with a lableindicating if the pt was on room air or
    how many liters of o2.
    remember to preform the allen's test prior to doing an abg tocheck for sufficient blood flow
    before going for pulmonary fuction tests (pft's), a pt'sbronchodilators will be with-held and they
    are not allowed to smoke for 4 hrs prior
    for a lung biopsy, position pt lying on side of bed or with armsraised up on pillows over bedside
    table, have pt hold breath in midexpiration, chest x-ray doneimmediately afterwards to check for
    complication of pneumothorax, sterile dressing applied
    for a lumbar puncture, pt is positioned in lateral recumbent fetalposition, keep pt flat for 2-3 hrs
    afterwards, sterile dressing, frequent neuro assessments
    eeg, hold meds for 24-48 hrs prior, no caffine or cigarettes for24 hrs prior, pt can eat, pt must
    stay awake night before exam, pt may be asked to hyperventilateand watch a bright flashing
    light, after eeg, assess pt for seizures, pt's will be atincreased risk
    diamox, used for [color=#008100]glaucoma, can cause hypokalemia

    dexedrine, used for adhd, may alter insulin needs, avoid takingwith maoi's, take in morning
    (insomnia possible side effect)
    cytovene, used for retinitis caused by cytomegalovirus, pt willneed regular eye exams, report
    dizziness, confusion, or seizures immediately
    inh, used to treat and prevent tb, do not give with dilantin, cancause phenytonin toxicity,
    monitor lft's, give b6 along with, hypotension will occurinitially, then resolve
    rifampin, for tb, dyes bodily fluids orange
    if mixing antipsychotics (ie haldol, throazine, prolixin) withfluids, med is incompatible with
    caffine and apple juice
    haldol preferred anti-psychotic in elderly, but high riskextrapyramidal side effects (dystonia,
    tarditive dyskinesia, tightening of jaw, stiff neck, swollentongue, later on swollen airway),
    monitor for early signs of reaction and give im benadryl
    risperdal, antipsychotic, doses over 6mg can cause tarditivedyskinesia, first line antipsychotic in
    children
    levodopa, for parkinsons, contraindicated in pts with glaucoma,avoid b6
    sinemet, for parkinsons, contraindicated with maoi's
    hydroxyurea, for sickle cell, report gi [color=#008100]symptoms immediately,could be sign of toxicity
    [color=#008100]zocor, for hyperlipidemia, take on emptystomach to enhance absorption, report any unexplained
    musle pain, especially if fever
    decorticate is toward the 'cord'. decerebrit is the other way(out)
    ** botox ** (botulin toxin) can be used with strabismus also torelax vocal cords in spasmodic
    dysphonia.

    -[font=verdana-bold]munchausen syndrome is a psychiatric disorder that causes an individual toself-inflict injury
    or illness or to fabricate [color=#008100]symptomsof physical or mental illness, inorder to receive medical care
    or hospitalization. in a variation of the disorder, [font=verdana-bold]munchausen by proxy (msbp),an individual,
    typically a mother, intentionally causes or fabricates illness in achild or other person under her
    care.
    -[font=verdana-bold]multiple sclerosis is a chronic, progressive disease with demyelinatinglesions in the cns which
    affect the white matter of the brain and spinal cord.
    [font=verdana-bold]motor s/s: limb weakness,paralysis, slow speech
    [font=verdana-bold]sensory s/s: numbness,tingling, tinnitus
    [font=verdana-bold]cerebral s/s: nystagmus, [color=#008100]ataxia, dysphagia,dysarthria
    [font=verdana-bold]huntington's chorea: 50%genetic, autosomal dominant disorder
    s/s: chorea --> writhing, twisting, movements of face, limbs andbody
    -gait deteriorates to no ambulation
    -no cure, just palliative care
    -wbc shift to the left in a patient with pyelonephritis(neutrophils kick in to fight infection)
    -definitive diagnosis for abd. aortic aneurysm (aaa) [font=verdana-bold]--> ct scan
    -don't use kayexalate if patient has hypoactive bowel sounds.
    -uremic fetor [font=verdana-bold]--> smell urine on the breath
    -hirschsprung’s [font=verdana-bold]--> bile is lower obstruction, no bile is upper obstruction;ribbon like stools.
    -pancreatic enzymes are taken with each meal! not before, notafter, but [font=verdana-bold]with each meal.

    thank you, i finally realize why a person shouldn't havecantaloupe before a occult stool test,
    because cantaloupe is high in vit c and vit c causes a false + foroccult blood. now i just need to
    figure out why they can't have fish.
    [color=#000081][font=verdana-bold]hypospadias: [color=#000081]abnormalityin which urethral meatus is located on the ventral (back) surface of
    [color=#000081]the penis anywhere from the corona to the perineum [color=#000081][font=verdana-bold](remember hypo, low (for lower side or
    [color=#000081][font=verdana-bold]under side)
    [color=#000081][font=verdana-bold]epispadias: [color=#000081]opening ofthe urethra on the dorsal (front) surface of the penis
    [color=#000081][font=verdana-bold]priapism: [color=#000081]painful [color=#008100]erection [color=#000081]lastinglonger than 6 hrs.
    anticholinergic effects--assessment
    dry mouth==can't spit
    urinary retention=can't ****
    constipated =can't ****
    blurred vision=can't see
    when you see coffee-brown emesis,think peptic ulcer
    2.anytime you see fluid retention. think heart problemsfirst.
    3.an answer that delays care or treatment is alwayswrong
    4.for pvd remember dave (legs are dependent forarterial & forvenous elevated)
    more to come..........
    -
    when choosing an answer, think in this manner… if you can only doonly one thing to
    help this [color=#008100]patient what would it be? pick the most important intervention.
    i f two of the answers are the exactopposite, like bradycardia or tachycardia... one is probably
    the answer.
    if two or three answers are similaror are alike, none is correct.
    when asking patients’ questions neveruse “why”
    questions. eliminate all [color=yellow]“why?”answer options.
    if you have never heard of it… pleasedon’t pick it!
    never release traction unless youhave an order
    from the md to do so
    questions about a halo? remembersafety first, have
    a screwdriver nearby.
    remember compartment [color=#008100]syndrome isan emergency situation. paresthesias and increased pain
    are classic [color=#008100]symptoms. neuromuscular damage is irreversible 4-6
    hours after onset.
    always deal with actual problems orharm before potential problems
    always select a “patient focused”answer.
    an answer option that states"reassess in 15 minutes"
    is probably wrong.
    [color=#000081]interpersonal model (sullivan)
    behavior motivated by need to avoid [color=#008100]anxiety and satisfy needs
    1. infancy 0-18 months others will satisy needs
    2. childhood >6yrs learn to delay need gratification
    3. juvenile 6-9 years learn to relate to peers
    4. preadolescence 9-12 yrs learns to relate to friends of ofopposite sex
    5. early adolescence12-14yrs:learn independence and how to relateto opposite sex
    6. late adolecence 14-21yrs: develop intimate relationship withperson of opposite sex
    is this not about communication?....

    fetal alcohol [color=#008100]syndrome
    -upturned nose
    -flat nasal bridge
    -thin upper lip
    -sga
    vastus lateralis is im administration site for 6month infants
    for [color=#008100]toddlers above 18 months ventrogluteal
    the deltoid and gluteus maximus areappropriate sites for children
    ou- both eyes
    os- left eye
    od- right eye ( dominent right eye- just a tip to remember)
    1. [font=verdana-bold]coal (cane walking):
    [font=verdana-bold]c - cane
    [font=verdana-bold]o - opposite
    [font=verdana-bold]a - affected
    [font=verdana-bold]l - leg
    red- immediate: [color=#008100]injuries are life threatening but survivable with minimalintervention. ex:
    hemothrax, tension pneumothorax, unstable chest and abdominalwounds, incomplete
    amputations, open fx's of long bones, and 2nd/3rd degree burn with15%-40% of total body
    surface, etc.
    [color=#ffa600]yellow- delayed: [color=#008100]injuries[color=#ffa600]are significant and require medicalcare, but can wait hrs without threat
    [color=#ffa600]to life or limb. ex: stable abd wounds without evidence of hemorrhage,fx requiring open
    [color=#ffa600]reduction, debridement, external fixation, most eye and cnsinjuries, etc.
    green- minimal: injuries are minor and tx can be delayed tohrs or days . individuals in this group
    should be moved away from the main triage area. ex: upperextremity fx, minor burns, sprains,
    sm. lacerations, behavior disorders.
    black- expectant: injuries are extensive and chances of survivalare unlikely. seperate but dont
    abandoned, comfort measures if possible. ex: unresponsive, [color=#008100]spinal cord injuries,woulds with
    anatomical organs, 2nd/3rd degree burn with 60% of body surfacearea , [color=#008100]seizures, profound
    shock with multipe injuries, no pulse, b.p, pupils fixed ordilated.
    thoracentesis prep- take v.s., shave area around needle insertion,[font=verdana-bold]position patient with arms
    [font=verdana-bold]on pillow on over bed table or lying on side, no more than 1000cc at a one time. post- listen
    for bilateral breath sounds, v.s., check leakage, steriledressing.
    ct- assess [color=#008100]allergies
    mri- claustrophobia, no metal, assess pacemaker
    cardiac cath- npo 8-12hr, empty bladder, pulses, tell pt may feelheat palpitations or desire to
    cough with dye injection. post- vital signs keep leg straightbedrest 6-8hr.
    cerebral angio prep- well hydrated, lie flat, sire shaved, pulsesmarked
    post- keep flat 12-14hr, check site, pulses,force fluids.
    lumbar puncture- fetal postion. post- nuero assess q15-30 untilstable, flat2-3hr, encourage
    fluids, oral anlgesics for headache, observe dressing

    eeg- no sleep the night before, meals not withheld, no stimulantsfor 24hr before,
    tranquilizer/stimulant meds held 24-48hr before, may be asked tohyperventilate 3-4min and
    watch a bright flashing light.
    myelogram- npo 4-6hr, allergy hx, phenothiazines, cns depressants,and stimulants withheld 48hr
    prior, table will be moved to various postions during test. post-neuro q2-4, [font=verdana-bold]water soluble hob
    [font=verdana-bold]up, oil soluble hob down, oralanalgesics for h/a, encourage po fluids, assess for distended
    bladder, inspect site.
    liver biopsy- adm vit k , npo morning of exam 6hr, give sedative, [font=verdana-bold]teach pt that he will be
    [font=verdana-bold]asked to hold breath for 5-10sec, supine postion, lateral withupper arms elevated.
    [font=verdana-bold]post- postion on right side, frequent v.s., report severe ab painstat, no heavy lifting 1wk.
    paracentesis- semi fowlers or upright on edge of bed, emptybladder.
    post- v.s., report elevated temp, observe for signs ofhypovolemia.
    laparoscopy- co2 used to enhances visual, general [color=#008100]anesthesia,foley. [font=verdana-bold]post- walk patient to
    [font=verdana-bold]decrease co2 build up used for procedure.
    pyelogram- assess allergies
    sengstaken blakemore tube used for tx of esophageal varices, [font=verdana-bold]keep scissors at bedside.
    hemovac- used after mastectomy, empty when full or q8hr, removeplug, empty contents, place
    on flat surface, cleanse opening and plug with alcohol sponge, [font=verdana-bold]compress evacuator completely
    [font=verdana-bold]to remove air, releaseplug, check system for operation.
    common signs and symptoms
    01. ptb – low-grade afternoon fever.
    02. pneumonia – rusty sputum.
    03. asthma – [color=#008100]wheezing on expiration.
    04. emphysema – barrel chest.
    05. kawasaki syndrome – strawberry tongue.
    06. pernicious anemia – red beefy tongue.
    07. down syndrome – protruding tongue.
    08. cholera – rice watery stool.
    09. malaria – stepladder like fever with chills.
    10. typhoid – rose spots in abdomen.
    11. diptheria – pseudo membrane formation
    12. measles – koplik’s spots.
    13. sle – butterfly rashes.

    14. liver cirrhosis – spider like varices.
    15. leprosy – lioning face.
    16. bulimia – chipmunk face.
    17. appendicitis – rebound tenderness.
    18. dengue – petechiae or (+) herman’s sign.
    19. [color=#008100]meningitis – kernig’s sign (leg flex then [color=#008100]leg pain onextension), brudzinski sign (neck flex =
    lower leg flex).
    20. tetany – hypocalcemia (+) trousseau’s sign/carpopedal spasm;chvostek sign (facial
    spasm).
    21. tetanus – risus sardonicus.
    22. pancreatitis – cullen’s sign (ecchymosis of umbilicus); (+)grey turners spots.
    23. pyloric stenosis – olive like mass.
    24. pda – machine like murmur.
    25. addison’s disease – bronze like skin pigmentation.
    26. cushing’s syndrome – moon face appearance and buffalo hump.
    27. hyperthyroidism/grave’s disease – exopthalmus.
    28. intussusception – sausage shaped mass, dance sign (emptyportion of rlq)
    29. ms – charcot’s triad (ian)
    30. mg – descending muscle weakness
    31. guillain barre syndrome – ascending muscle weakness
    32. dvt – homan’s sign
    33. chicken pox – vesicular rash (central to distal) dew drop onrose petal
    34. angina – crushing stubbing pain relieved by ntg
    35. mi – crushing stubbing pain which radiates to left shoulder,neck, arms, unrelieved by ntg
    36. ltb – inspiratory stridor
    37. tef – 4cs’ coughing, choking, cyanosis, continous drooling
    38. epiglotitis – 3ds’ drooling, dysphonia, dysphagia
    39. hodgekin’s dse/[color=#008100]lymphoma– painless, progressive enlargementof spleen & lymph tissues,
    reedstenberg cells

    40. infectious mononucleosis – hallmark: sore throat, [color=#008100]cervical lymphadenopathy, fever
    41. parkinson’s – pill-rolling tremors
    42. [color=#008100]fibrin hyalin – expiratory grunt
    43. cystic fibrosis – salty skin
    44. dm – polyuria, polydypsia, polyphagia
    45. dka – kussmauls breathing (deep rapid rr)
    46. bladder ca – painless hematuria
    47. bph – reduced size & force of urine
    48. pemphigus vulgaris – nikolsky’s sign (separation of epidermiscaused by rubbing of the
    skin)
    49. retinal detachment – visual floaters, flashes of light,curtain vision
    50. glaucoma – painfull vision loss, tunnel/gun barrel/halo vision(peripheral vision loss)
    51. cataract – painless vision loss, opacity of the lens, blurringof vision
    52. retino blastoma – cat’s eye reflex (grayish discoloration ofpupils)
    53. acromegaly – coarse facial feature
    54. duchenne’s muscular dystrophy – gowers’ sign (use of hands topush one’s self from
    the floor)
    55. gerd – barretts esophagus (erosion of the lower portion of theesophageal mucosa)
    56. hepatic encephalopathy – flapping tremors
    57. hydrocephalus – bossing sign (prominent forehead)
    58. increase icp – hypertension bradypnea bradycardia (cushing’striad)
    59. shock – hypotension tachypnea tachycardia
    60. meniere’s dse – vertigo, tinnitus
    61. cystitis – burning on urination
    62. hypocalcemia – chvostek & trosseaus sign
    63. ulcerative colitis – recurrent bloody diarrhea
    64. lyme’s dse – bull’s eye rash
    ottorhea s/s of basilar fracture
    battles sign and racoons eyes s/s of orbital fracture

    take iron elixir with juice or water.... never with milk
    kawasaki's leads to cardiac problems
    dilantin 10-20
    theophyline 10-20
    acetaminophen 10-20
    lithium 0.5-1.5
    digoxin 0.5-2.0
    osteomyletitis is an infectious bone dz. give blood cultures andantibiotics, then if necessary
    surgery to drain abscess.
    nephrotic syndrome s/s edema + hypotension. turn and reposition(risk for impaired skin
    integrity)
    to access role relationship pattern focus on image andrelationships with others.
    renal impairment: serum creatinine elevated and urine clearancedecreased
    norm. serum creatinine 0.8-1.8 (men), 0.5-1.5 (women)
    norm. urine clearance 85-135
    atropine overdose
    hot as a hare (temp), mad as a hatter (loc), red as a beet(flushed face) and dry as a
    bone (thirsty)
    hemoglobin
    neonates 18-27
    3 mos 10.6-16.5
    3 yrs 9.4-15.5
    10 yrs 10.7-15.5
    glomerulonephritis: take vs q 4 hrs + daily weights
    age 4 to 5 yrs child needs dpt/mmr/opv
    cystic fibrosis give [color=#008100]dietlow fat, high sodium, fat solublevitamins adek. aerosal bronchodilators,
    mucolytics and pancreatic enzymes.
    airborne precautions: measels, chicken pox and tb.
    private room, negatvie pressure w/ 6-12 air exchanges, mask n95.
    droplet precautions:sepsis, scarlet fever, streptococcalpharyngitis, parovirus b19, pnuemonia,
    pertusis, influenza, diptheria, epiglottis, rubella, mumps, [color=#008100]meningitis,mycoplasma and adenovirus.
    door open, 3 ft distance, private room or cohort, mask
    contact precautions: multidrug resistant organism; respiratory,skin, wound enteric and eye
    infections
    [color=#008100]zoloft s/e agitation, sleep disturb, and drymouth
    clozapine s/e agranulocytosis, tachycardia and siezures
    [color=#008100]blood tests for mi:myoglobin, ck and troponin

    salt substitutes may contain pottasium
    placental abruptio: bleeding with pain, don't forget to monitorvolume status (i&o)
    an ill child regresses in behaviors
    meningeal irritation s/s nuchal rigidity, positive brudzinski +kernig signs and photophobia too!
    babinski sign - toes curl great! toes fan bad
    glucose tolerance test for preggies result of 140 or highter needsfurther evaluation.
    assessing extraocular eye movements check cranial nerves 3, 4, and6.
    stomas
    dusky stoma means poor blood supply, protruding means prolapsed,sharp pain + rigidity means
    peritonitis, mucus in ileal conduit is expected.
    dilantin s/e rash (stop med), gingival hyperplasia (good hygiene)
    toxicity-->poor gait + coordination, slurred speech, nausea,lethargy, and diplopia.
    phenobarbital can be taken during pregnancy but dilatin iscontraindicated.
    tension pneumothorax trachea shifts to opposite side.
    this is great! here's some i got from a review class i went toseveral months ago...
    [font=verdana-bold]*change in color isalways a late sign!
    *[font=verdana-bold]incentive spirometry steps:1) sit upright 2) exhale 3) insert mouthpiece 4)inhale for 3
    seconds, and then hold for 10 seconds
    [font=verdana-bold]*aminoglycocide (__mycin; except erythromycine) adverse effects are bean shaped -
    nephrotoxic to kidneys and ototoxic to ears
    [font=verdana-bold]*mrsa - contact precaution only
    [font=verdana-bold]*vrsa - contact and airborne precaution(private room, door closed, negative pressure)
    [font=verdana-bold]*lithium
    [font=verdana-italic]l-level of therapeutic affect is 0.5-1.5
    [font=verdana-italic]i-indicate mania
    [font=verdana-italic]t-toxic level is 2-3 - n/v, diarrhea, tremors
    [font=verdana-italic]h-hyrdrate 2-3l of water/day
    [font=verdana-italic]i-increased uo and dry mouth
    [font=verdana-italic]u-uh oh; give mannitol and diamox if toxic s/s are present
    [font=verdana-italic]m-maintain na intake of 2-3g/day
    [font=verdana-bold]*all psych meds' (except lithium) side effects are the same as snsbut the bp is
    [font=verdana-bold]decreased.
    [font=verdana-bold]*sns- increase in bp, hr and rr (dilatedbronchioled), dilated pupils (blurred vision), decreased
    gut (urniary retention), git (constipation), constricted bloodvessels and dry mouth.
    [font=verdana-bold]*blood transfusion- signof allergies in order:
    1)flank pain
    2)frequent swallowing
    3)rashes
    4)fever
    5)chills
    [font=verdana-bold]*thrombocytopenia -bleedingprecautions!
    1)soft bristled toothbrush
    2)no insertion of anything! (c/i suppositories, douche)

    3)no im meds as much as possible!
    *iron deficiency [color=#008100]anemia - easily fatigued
    1)fe po - give with vitamin c or on an empty stomach
    2)fe via im- inferon via ztrack
    [font=verdana-bold]*pernicious anemia -red, beffy tongue; will take vit.[color=#008100]b12for life!
  6. Visit  mnm12 profile page
    0
    [font=verdana-bold]*burns
    1st degree - red and painful
    2nd degree - [color=#008100]blisters
    3rd degree - no pain because of blocked and burned nerves
    [font=verdana-bold]*meniere's disease -admin diuretics to decrease endolymph in the cochlea, restrict na, lay on
    affected ear when in bed. triad:
    1)vertigo
    2)tinnitus
    3)n/v
    [font=verdana-bold]*gastric ulcer pain occurs30 minutes to 90 minutes after eating, not at night, and doesn't go
    away with food
    *think positive and you can achieve great things. think of presentand future, the past is gone.
    [font=verdana-italic]*forget your past mistakes and focus on your successes encouragingyourself to greater
    [font=verdana-italic]achievements in the future.
    [font=verdana-italic]*always do your best so you can be proud that you gave it yourbest shot.
    [font=verdana-italic]*focus on your achievements rather than your failures. if you dofind yourself thinking about how
    [font=verdana-italic]you failed then look at what you managed to do right and how youcould correct what you did
    [font=verdana-italic]next time.
    [font=verdana-italic]*a mind that is troubled with doubt won't be able to focus on thevictory to be had.
    *take it one day at a time.
    *take time for yourself. a fried mind can't focus or learn.
    pediatric tips:
    what is an [font=verdana-bold]intraosseousinfusion? in pediatric life-threateningemergencies, when iv access
    cannot be obtained, an osseous (bone) needle is hand-drilled intoa bone (usually the tibia),
    where crystalloids, colloids, blood products and [font=verdana-bold]drugs can be administered into the marrow.
    it is a temporary, life-saving measure, and i have seen it once!(gruesome.) when venous access
    is achieved it can be d/c’d. one medication that cannot beadministered by intraosseous infusion
    is [font=verdana-bold]isoproterenol, a beta agonist. (i don’t know more about that drug; itwas just pointed out on
    a practice exam.)
    during [font=verdana-bold]sickle cell crisis there are two interventions to prioritize: [font=verdana-bold]fluids and pain relief.
    with [font=verdana-bold]glomerulonephritis you should consider [font=verdana-bold]bloodpressure to be your most important
    assessment parameter. dietary restrictions you can expect includefluids, protein, sodium, and
    potassium.
    remember yesterday when i mentioned how congenital cardiac defectsresult in [font=verdana-bold]hypoxia which
    the body attempts to compensate for (influx of immature rbc’s)?labs supporting this would show
    [font=verdana-bold]increased hematocrit, hemoglobin, and rbc count.
    did you know there is an association between [font=verdana-bold]low-set ears and [font=verdana-bold]renal anomalies?now you
    know what to look for if down’s isn’t there to choose. (just toexpand on it a little, the kidneys and
    ears develop around the same time in utero. hence, they're shapedsimilarly. which is why when
    doing an assessment of a neonate, if the nurse notices low set orasymmetrical ears, there is
    good reason to investigate renal functioning. knowing that thekidneys and ears are similar
    shapes helped me remember this).

    school-age kids ([font=verdana-bold]5 and up) are old enough, and should have an [font=verdana-bold]explanation of what willhappen
    a week before surgery such as tonsillectomy.
    if you gave a toddler a [font=verdana-bold]choice about taking medicine and he says no, you should leave theroom
    and [font=verdana-bold]come back in five minutes, because to a toddler it is anotherepisode. next time, don’t ask.
    the [font=verdana-bold]first sign of pyloric stenosis in a baby is [font=verdana-bold]mild vomiting that progresses to projectile
    [font=verdana-bold]vomiting. later you may be able to palpate amass, the baby will seem hungry often, and may
    spit up after feedings.
    we know [font=verdana-bold]kawasaki disease causes a heart problem, but what specifically? [font=verdana-bold]coronary artery
    [font=verdana-bold]aneurysms d/t theinflammation of blood vessels.
    a child with a [font=verdana-bold]ventriculoperitonealshunt will have a small upper-[font=verdana-bold]abdominal incision.this is
    where the shunt is guided into the abdominal cavity, and tunneledunder the skin up to the
    ventricles. you should watch for [font=verdana-bold]abdominaldistention, since fluid from the ventricleswill be redirected
    to the peritoneum. you should also watch for signs of increasing [font=verdana-bold]intracranial pressure,
    such as irritability, bulging fontanels, and high-pitched cry inan infant. in a toddler watch lack of
    appetite and headache. careful on a bed position question!bed-position [font=verdana-bold]after shunt placement
    [font=verdana-bold]is flat, so fluid doesn’t reduce toorapidly. if you see s/s of increasing icp, [font=verdana-bold]thenraise the hob to
    15-30 degrees.
    what could cause [font=verdana-bold]bronchopulmonarydysplasia? dysplasia means abnormality oralteration.
    [font=verdana-bold]mechanical ventilation cancause it. premature newborns with immature lungs are ventilated
    and over time it damages the lungs. other causes could beinfection, pneumonia, or other
    conditions that cause inflammation or scarring.
    it is essential to [font=verdana-bold]maintainnasal patency with children < 1 yr.because they are obligatory
    nasal breathers.
    watch out for questions suggesting a child drinks more than 3-4cups of milk each day. (milks
    good, right?) too much milk reduces intake of other essentialnutrients, especially iron. watch for
    [font=verdana-bold]anemia with milk-aholics.and don’t let that mother put anything but water in that kid’s bottle
    during naps/over-night. juice or milk will rott that kids teethright out of his head.
    what traction is used in a school-age kid with a femur or tibialfracture with extensive [font=verdana-bold]skin
    [font=verdana-bold]damage? [font=verdana-bold]ninety,ninety. huh? i never heard of it either.the name refers to the angles of the
    joints. a pin is placed in the distal part of the broken bone, andthe lower extremity is in a boot
    cast. the rest is the normal pulleys and ropes you’re used tovisualizing with balanced
    suspension. while we’re talking about traction, a kid’s [font=verdana-bold]hinder should clear the bed when in
    [font=verdana-bold]bryant’s traction (alsoused for femurs and congenial hip for young kids).
    if you can remove the white patches from the mouth of a baby it isjust formula. if you [font=verdana-bold]can’t, its
    [font=verdana-bold]candidiasis.
    just know the [font=verdana-bold]mmr and varicellaimmunizations come later (15 months).
    undescended testis or [font=verdana-bold]cryptorchidismis a known risk factor for [font=verdana-bold]testicular cancer laterin life.
    start teaching boys testicular [font=verdana-bold]selfexam around 12, because most cases occur during
    adolescence.
    not pediatrics but have to throw it in – a guy loses his house ina fire. priority is using community
    resources to find shelter, before assisting with feelings aboutthe tremendous loss. (maslow).
    [font=verdana-bold]no aspirin with kids b/cit is associated with reye’s syndrome, and also no nsaids such as
    ibuprofen. [font=verdana-bold]give tylenol.

    [font=verdana-bold]csf in meningitis willhave [font=verdana-bold]high protein, and low glucose.
    it is always the correct answer to [font=verdana-bold]report suspected cases of child abuse.
    [font=verdana-bold]no nasotracheal suctioning with head injury or skull fracture.
    [font=verdana-bold]feed upright to avoidotitis media.
    position [font=verdana-bold]prone w hob elevated with [font=verdana-bold]gerd. in almost every other case, though, you better lay that
    kid on his back (back to sleep - sids).
    pull pinna [font=verdana-bold]down and back forkids < 3 yrs. when instilling eardrops.
    kids with rsv; [font=verdana-bold]no contact lensesor pregnant nurses in rooms where [font=verdana-bold]ribavirin is being
    administered by hoot, tent, etc.
    positioning with pneumonia – lay [font=verdana-bold]onthe affected side to splint and reduce [font=verdana-bold]pain. but if you are
    trying to reduce congestion the sick lung goes up. (ever had astuffy nose, and you lay with the
    stuff side up and it clears?)
    a [font=verdana-bold]positive ppd confirms [font=verdana-bold]infection, not just exposure. a [font=verdana-bold]sputumtest will confirm [font=verdana-bold]active
    [font=verdana-bold]disease.
    [font=verdana-bold]coughing w/o other s/sis suggestive of [font=verdana-bold]asthma. speaking of asthma, watch out if your
    [font=verdana-bold]wheezer stops wheezing.it could mean he is worsening.
    you better pick [font=verdana-bold]‘dovitals’ before administering that [font=verdana-bold]dig. (apical pulse for one full minute).
    [font=verdana-bold]tet spells treated with [font=verdana-bold]morphine.
    [font=verdana-bold]group-a strep precedes rheumatic fever. [font=verdana-bold]chorea is part of this sickness (grimacing, sudden
    body movements, etc.) and it [font=verdana-bold]embarrasseskids. they have [font=verdana-bold]joint pain. watch forelevated
    anti[font=verdana-bold]streptolysin o to be elevated. penicillin!
    don’t pick cough over [font=verdana-bold]tachycardiafor signs of [font=verdana-bold]chf in an infant.
    random tips:
    [font=verdana-bold]no milk (as well as fresh fruit or veggies)on [font=verdana-bold]neutropenic precautions.
    [font=verdana-bold]tylenol poisoning –liver failure possible for about [font=verdana-bold]4 days. close observation required during
    this time-frame, as well as tx with mucomyst.
    [font=verdana-bold]radioactive iodine – thekey word here is [font=verdana-bold]flush. flush substance out of body w/3-4 liters/day
    for 2 days, and flush the toilet twice after using for 2 days.limit contact w/patient to 30
    minutes/day. no pregnant visitors/nurses, and no kids.
    the main [font=verdana-bold]hypersensitivity reaction seen with [font=verdana-bold]antiplateletdrugs is [font=verdana-bold]bronchospasm
    (anaphylaxis).
    common sites for [font=verdana-bold]metastasisinclude the [font=verdana-bold]liver, brain, lung, bone, and lymph.
    [font=verdana-bold]orthostasis is verified bya [font=verdana-bold]drop inpressure with [font=verdana-bold]increasing heart rate.
    [font=verdana-bold]bence jones protein in theurine confirms [font=verdana-bold]multiple myeloma.
    don’t fall for ‘reestablishing a normal bowel pattern’ as apriority with small [font=verdana-bold]bowel obstruction.
    because the patient can’t take in oral fluids ‘maintaining [font=verdana-bold]fluid balance’ comesfirst.
    [font=verdana-bold]pernicious anemia s/sinclude pallor, tachycardia, and [font=verdana-bold]sorered tongue.
    with flecainide ([font=verdana-bold]tambocor), an antiarrythmic, [font=verdana-bold]limitfluids and sodium intake, because sodium
    increases water retention which could lead to heart failure.
    [font=verdana-bold]basophils release histamine during an allergic response.
    [font=verdana-bold]adenosine is thetreatment of choice for paroxysmal atrial [font=verdana-bold]tachycardia.
    [font=verdana-bold]iatragenic means it was [font=verdana-bold]caused by treatment, procedure, ormedication.
    other than initially to test tolerance, [font=verdana-bold]g-tube and j-tube feedingsare usually given as
    [font=verdana-bold]continuous feedings.
    [font=verdana-bold]four side-rails up canbe considered a form of [font=verdana-bold]restraint. even in ltc facility when a client is a
    fall risk, keep lower rails down, and one side of bed against thewall, lowest position, wheels
    locked.
    your cancer patient is getting [font=verdana-bold]radiation. what should you be most concerned about? skin
    irritation? no. infection kills cancer patients most because ofthe [font=verdana-bold]leukopenia caused by radiation.
    a breast cancer patient treated with [font=verdana-bold]tamoxifen should reportchanges in [font=verdana-bold]visual acuity, because
    the adverse effect could be irreversible.
    [font=verdana-bold]pneumovax 23 getsadministered [font=verdana-bold]post splenectomy to prevent pneumococcal sepsis.
    let’s say every answer in front of you is an [font=verdana-bold]abnormal value. if [font=verdana-bold]potassium is there youcan bet it
    is a problem they want you to identify, because values outside ofnormal can be [font=verdana-bold]life
    [font=verdana-bold]threatening. normalpotassium is 3.5-5.0. even a bun of 50 doesn’t override a potassium of 3.0
    in a renal patient in priority.
    you better be making sure that patient on [font=verdana-bold]dig and lasix is getting [font=verdana-bold]enough potassium,because
    low potassium potentiates dig and can cause dysrrhythmias.
    you will ask [font=verdana-bold]every new admissionif he has an [font=verdana-bold]advance directive,and if not you will explain it,
    and he will have the option to sign or not.
    an example of when you would implement before going through abunch of assessments is when
    someone is experiencing [font=verdana-bold]anaphylaxis. get the [font=verdana-bold]orderedepinephrine in them stat, especially if
    they stem clearly states the s/s (difficulty breathing, increasinganxiety, etc.)
    in a disaster you should [font=verdana-bold]triage the person who is most likely to [font=verdana-bold]not survive last.
    a little trick regarding potassium:
    al[font=verdana-bold]ka[font=verdana-bold]losis: k is low
    acidosis is just the opposite: k is high
    the vital sign you should check first with [font=verdana-bold]high potassium is[font=verdana-bold]pulse (dueto dysrhythmias).
    give [font=verdana-bold]neostigmine to clients with myesthenia gravis about 45 min. beforeeating, so it will help
    with [font=verdana-bold]chewing and swallowing.
    [font=verdana-bold]anectine is used for [font=verdana-bold]short-term neuromuscular blockingagent for procedures like intubation
    and ect. norcuron is for intermediate or long-term.
    the [font=verdana-bold]parathyroid gland relies on the presence of [font=verdana-bold]vitamin d to work.
    [font=verdana-bold]glucagon increases theeffects of oral [font=verdana-bold]anticoagulants.
    [font=verdana-bold]bleeding is part of the‘[font=verdana-bold]circulation’assessment of the [font=verdana-bold]abcd’s in an emergent situation.
    therefore, if airway and breathing are accounted for, a compoundfracture requires assessment
    before glasgow coma scale and a neuro check (d=disability, orneuro check)
    the immediate intervention after a [font=verdana-bold]sucking stab wound isto dress the wound and tape it on
    three sides which allows air to [font=verdana-bold]escape. do not use an occlusive dressing, which could convertthe
    wound from open pneumo to closed one, and a tension pneumothoraxis worse situation. after
    that get your chest tube tray, labs, iv.
    an [font=verdana-bold]occlusive dressing is used if a [font=verdana-bold]chesttube is accidentally pulled out of thepatient.
    when o2 deprived, as with a [font=verdana-bold]pe, the body compensates by causing hyperventilation (resp
    alkalosis). should the patient breathe into a paper bag? no. ifthe pao2 is well below 80 they
    need [font=verdana-bold]oxygen. look at all your abg values. as soon as you see thewords pe you should think
    oxygen first.
    a typical adverse reaction to [font=verdana-bold]oralhypoglycemics is [font=verdana-bold]rash, photosensitivity.
    [font=verdana-bold]serum acetone and serum ketones rise in [font=verdana-bold]dka. as you treat the acidosis and dehydration
    expect the [font=verdana-bold]potassium to drop rapidly, so be ready, with potassium replacement.
    [font=verdana-bold]fluids are the most important interventionwith [font=verdana-bold]hhns as well as [font=verdana-bold]dka, so get fluids going first.
    with hhns there is no ketosis, and no acidosis. potassium is lowin hhns (d/t diuresis).
    [font=verdana-bold]atropine blocks acetylcholine (remember it reduces secretions).
    de[font=verdana-bold]corticate positioning in response to pain = [font=verdana-bold]cortex involvement. [font=verdana-bold]decerebrate in response to
    pain = cerebellar, [font=verdana-bold]brainstem involvement
    [font=verdana-bold]dantrium, for spasticity, may [font=verdana-bold]take a week or more to beeffective.
    [font=verdana-bold]decreased acetylcholine isrelated to senile [font=verdana-bold]dementia.
    hyperactive deep tendon reflexes, vision changes, fatigue and [font=verdana-bold]spasticity are allsymptoms of [font=verdana-bold]ms
    after removal of the [font=verdana-bold]pituitarygland you must watch for [font=verdana-bold]hypocortisolism andtemporary
    diabetes insipidus.
    position on [font=verdana-bold]right side with legs flexed after [font=verdana-bold]appendectomy.
    [font=verdana-bold]hirschsprung’s diagnosedwith rectal biopsy looking for [font=verdana-bold]absenceof ganglionic cells. cardinal
    sign in infants is failure to pass meconium, and later the classicribbon-like and foul smelling
    stools.
    [font=verdana-bold]intussusception commonin kids with [font=verdana-bold]cf. obstruction may cause fecal emesis, [font=verdana-bold]currant jellylike
    [font=verdana-bold]stools (blood and mucus). a barium enema maybe used to hydrostatically reduce the
    telescoping. resolution is obvious, with onset of bowel movements.

    with [font=verdana-bold]omphalocele and gastroschisis (herniation of abdominal contents) dresswith [font=verdana-bold]loose saline
    [font=verdana-bold]dressing covered withplastic wrap, and keep eye on temp. kid can lose heat quickly.
    after a [font=verdana-bold]hydrocele repair provide [font=verdana-bold]icebags and scrotal support.
    [font=verdana-bold]no phenylalanine witha kid positive for [font=verdana-bold]pku (no meat, no dairy, no aspartame).
    [font=verdana-bold]second voided urine mostaccurate when testing for [font=verdana-bold]ketones and glucose.
    [font=verdana-bold]never give potassium ifthe patient is [font=verdana-bold]oliguric or anuric.
    [font=verdana-bold]nephrotic syndrome ischaracterized by massive [font=verdana-bold]proteinuria (looks dark and frothy) caused by
    glomerular damage. corticosteroids are the mainstay. generalizededema common.
    a [font=verdana-bold]positive western blot in a child <18 months (presence of hiv antibodies)indicates only that
    the [font=verdana-bold]mother is infected. two or more positive [font=verdana-bold]p24 antigen tests willconfirm hiv in kids <18
    months. the p24 can be used at any age.
    for [font=verdana-bold]hiv kids [font=verdana-bold]avoid opv andvaricella vaccinations (live), but givepneumococcal and influenza.
    mmr is avoided only if the kid is severely immunocompromised.parents should wear gloves for
    care, not kiss kids on the mouth, and not share eating utensils.
    [font=verdana-bold]hypotension andvasoconstricting meds may alter the accuracy of [font=verdana-bold]o2 sats.
    an [font=verdana-bold]antacid should be given to a mechanically ventilated patient w/ anng tube if the ph of the
    [font=verdana-bold]aspirate is <5.0.aspirate should be checked at least every 12 hrs.
    ambient air ([font=verdana-bold]room air) contains [font=verdana-bold]21% oxygen.
    the first sign of [font=verdana-bold]ards is [font=verdana-bold]increasedrespirations. later comes dyspnea, retractions,air hunger,
    cyanosis.
    normal [font=verdana-bold]pcwp (pulm capillary wedgepressure) is 8-13. readings of 18-20 are considered
    high.
    first sign of [font=verdana-bold]pe is [font=verdana-bold]sudden chest pain, followed by dyspnea and tachypnea.
    [font=verdana-bold]high potassium isexpected with [font=verdana-bold]carbon dioxide narcosis (hydrogen floods the cell forcing
    potassium out). carbon dioxide narcosis causes increasedintracranial pressure.
    pulmonary [font=verdana-bold]sarcoidosis leads to [font=verdana-bold]rightsided heart failure.
    an [font=verdana-bold]ng tube can be irrigated with [font=verdana-bold]cola, and should be taught to family when a client is going
    home with an ng tube.
    [font=verdana-bold]digitalis increases [font=verdana-bold]ventricular irritability,and could convert a rhythm to v-fib following
    cardioversion.
    if your normally lucid patient starts [font=verdana-bold]seeing bugs you bettercheck his [font=verdana-bold]respiratory status first.
    the first sign of hypoxia is restlessness, followed by agitation,and things go downhill from there
    all the way to delirium, hallucinations, and coma. so check the o2stat, and get abg’s if possible.
    the biggest concern with [font=verdana-bold]coldstress and the newborn is [font=verdana-bold]respiratory distress.
    look carefully when you have no idea. in a word likerhabdomyosarcoma you can easily ascertain

    it has something to do with muscle (myo) cancer (sarcoma). thesame thing goes for drug
    names. for example, if it ends in –ide it’s probably a diuretic,as in furosemide, and amyloride.
    [font=verdana-bold]lasix can cause a patient to lose hisappetite ([font=verdana-bold]anorexia) due to reduced potassium.
    if your laboring mom’s water breaks and she is any [font=verdana-bold]minus station you betterknow there is a
    risk of [font=verdana-bold]prolapsed cord.
    in a [font=verdana-bold]five-year old breathe once forevery 5 compressions doing cpr.
    after [font=verdana-bold]g-tube placement the stomach contents are drained by gravity for [font=verdana-bold]24 hours before it can
    be used for feedings.
    cephalhematoma ([font=verdana-bold]caputsuccinidanium) resolves on its own in a few days.this is the type of
    edema that [font=verdana-bold]crosses the suture lines.
    during the acute stage of [font=verdana-bold]hep-agown and gloves are required. in the convalescentstage it is
    no longer contagious.
    [font=verdana-bold]low magnesium and high creatinine signal renal failure.
    [font=verdana-bold]pain is usually the highest priority with [font=verdana-bold]ra
    if a [font=verdana-bold]tb patient is unable/unwilling to [font=verdana-bold]comply with tx they may need supervision(direct
    observation). tb is a public health risk.
    level of [font=verdana-bold]consciousness is the most important assessment parameter with [font=verdana-bold]status epilepticus.
    [font=verdana-bold]crackles suggest pneumonia,which is likely to be accompanied by [font=verdana-bold]hypoxia, which would
    manifest itself as mental confusion, etc.
    [font=verdana-bold]can’t cough=ineffective airway clearance
    [font=verdana-bold]absence of menstruation leadsto [font=verdana-bold]osteoporosis inthe anorexic.
    [font=verdana-bold]toddlers need toexpress autonomy ([font=verdana-bold]independence)
    a patient with a [font=verdana-bold]lowhemoglobin and/or hematocrit shouldbe evaluated for signs of
    [font=verdana-bold]bleeding, such as dark stools.
    a [font=verdana-bold]laxative is given the night before an [font=verdana-bold]ivp in order to better visualize theorgans.
    a patient with liver [font=verdana-bold]cirrhosisand edema may [font=verdana-bold]ambulate, then sit with legs elevated to try to
    mobilize the edema.
    [font=verdana-bold]managing stress ina patient with adrenal insufficiency ([font=verdana-bold]addison’s) is paramount, because if
    the adrenal glands are stressed further it could result inaddisonian crisis. while we’re on
    addison’s, remember blood pressure is the most importantassessment parameter, as it causes
    severe [font=verdana-bold]hypotension.
    after pain relief, [font=verdana-bold]coughand deep breathe is important in [font=verdana-bold]pancreatitis, because offluid
    pushing up in the diaphragm.
    [font=verdana-bold]safety over nutrition with a severely [font=verdana-bold]depressed client.

    [font=verdana-bold]prolonged hypoxemia isa likely cause of [font=verdana-bold]cardiac arrest in a child.
    [font=verdana-bold]fluid volume overload causedby ivc fluids infusing too quickly (or whatever reason) and chf
    can cause an [font=verdana-bold]s3
    [font=verdana-bold]coarctation of the aorta causesincreased blood flow and [font=verdana-bold]bounding pulses inthe arms
    a [font=verdana-bold]newly diagnosed hypertension patient should have bp assessed in [font=verdana-bold]both arms
    [font=verdana-bold]depression oftenmanifests itself in [font=verdana-bold]somatic ways, such as psychomotor retardation, gi
    complaints, and pain.
    [font=verdana-bold]respiratory problems arethe chief concern with [font=verdana-bold]cf
    speaking of tb... ppd is positive if area of induration is:
    >5 mm in an immunocompromised patient
    >10 mm in a normal patient
    >15 mm in a patient who lives in an area where tb is very rare.
    another tip:
    hba1c - test to assess how well blood sugars have been controlledover the past 90-120 days. 4-
    6 corresponds to a blood sugar of 70-110; 7 is ideal for adiabetic and corresponds to a blood
    sugar of 130.
    [font=verdana-bold]bsa is considered the [font=verdana-bold]most accurate method formedication dosing with kids. (i though it was
    weight, but apparently not)
    place a [font=verdana-bold]wheelchair parallel to the bed on the [font=verdana-bold]side of weakness
    if one nurse discovers another nurse has made a [font=verdana-bold]mistake it is always appropriate to [font=verdana-bold]speak to
    [font=verdana-bold]her before going to management. if thesituation persists, [font=verdana-bold]then take it higher.
    [font=verdana-bold]sepsis and anaphylaxis (alongwith the obvious hemorrhaging) reduce circulating volume by
    way of increased capillary permeability, which leads to [font=verdana-bold]reduced preload (volumein the left
    ventricle at the end of diastole). this is a toughie…think aboutit.
    [font=verdana-bold]amniotic fluid is alkaline,and turns nitrazine paper [font=verdana-bold]blue. urine and normal vaginal discharge
    are acidic, and turn it pink.
    [font=verdana-bold]gonorrhea is a [font=verdana-bold]reportable disease
    remember the phrase [font=verdana-bold]“step up”when picturing a person going up [font=verdana-bold]stairs with crutches. the
    good leg goes up first, followed by the crutches and the bad leg.the opposite happens going
    down. the crutches go first, followed by the good leg.
    while treating [font=verdana-bold]dka, bringing the glucose down [font=verdana-bold]too far and too fast canresult in increased
    [font=verdana-bold]intracranial pressure d/twater being pulled into the csf.
    [font=verdana-bold]polyuria is common withthe [font=verdana-bold]hypercalcemia caused by hyperparathyroidism.
    remember the action of [font=verdana-bold]vasopressinbecause it sounds like “press in”, or[font=verdana-bold]vasoconstrict.
    [font=verdana-bold]water intoxication willbe evidenced by [font=verdana-bold]drowsiness and altered mental status in a patient with
    tur syndrome, or as an adverse reaction to desmopressin (fordiabetes insipidus).
    [font=verdana-bold]burning sensation inthe mouth, and brassy taste are adverse reactions to [font=verdana-bold]lugol solution (for
    hyperthyroid). report it to the doc.
    give [font=verdana-bold]synthroid on an [font=verdana-bold]empty stomach
    [font=verdana-bold]extra insulin may be neededfor a patient taking [font=verdana-bold]prednisone (remember, steroids cause
    increased glucose).
    [font=verdana-bold]nonfat milk reduces [font=verdana-bold]reflux by increasing lower esophagealsphincter pressure
    patients with [font=verdana-bold]gerd should lay on their [font=verdana-bold]left side with the hob elevated 30 degrees.
    unusual positional tip - [font=verdana-bold]low-fowlersrecommended [font=verdana-bold]during meals to prevent [font=verdana-bold]dumping
    [font=verdana-bold]syndrome. limit fluids while eating.
    in [font=verdana-bold]emphysema the [font=verdana-bold]stimulus to breathe is [font=verdana-bold]low po2, not increased pco2 like the rest of us, so
    don’t slam them with oxygen. encourage [font=verdana-bold]pursed-lip breathing whichpromotes [font=verdana-bold]co2
    [font=verdana-bold]elimination, encourage upto 3000ml/day fluids, high-fowlers and leaning forward.
    [font=verdana-bold]theophylline causes [font=verdana-bold]gi upset, give with food
    [font=verdana-bold]tb drugs are [font=verdana-bold]liver toxic. (does your patient have hepb?)an adverse reaction is [font=verdana-bold]peripheral
    [font=verdana-bold]neuropathy.





    im not sure exactly where this review came from but it was sent to me and it helped! sorry it was in adobe reader so when i pasted it the formatting came out weird lol


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