Passed NCLEX on 6/26/13 with 75 questions! Here's my Advice/Notes!

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    First of all let me start off by telling you a little bit about myself.... I went through the nursing program and the entire time I was fearing this brutal exam we all know as the NCLEX. This website helped me manage my stress and I want to truly thank everyone that posted their experience up to and post exams. I spent sleepless nights browsing this website for tips and advice about how people study, I followed a few of their tips and now itís my turn to share what I did to help me pass.

    When I finished the nursing program I created a schedule that I made myself follow! There is no time to slack when you are studying for the nclex, that comes afterwards! I started with Saunders and read certain units a day after reading those units I would take the exam questions at the back of the chapter and then I would do questions on the LaCharity Book that pertain to the chapter that I just read on Saunders. I also used the book by Lippincott and did questions on those pertinent chapters. I made it a point to follow systems for example if I read G.I. in Saunders I would do questions from LaCharity on G.I. as well as in Lippincott. I tried to focus on a particular system at a time and if the chapters were short enough I would study as many systems as I could that day. But I would make it a point to learn everything there is to learn about that particular system. I also wrote notes about the chapters as I read them. This really helped me a great deal! I never felt truly ready for the nclex but I continued to study like this until I finished all of Saunders and all of LaCharity. I was not able to finish Lippincott because itís way too many questions however; I did manage to do about 3000 to 4000 questions in a three-week period! I also did flashcards for the lab and ABG
    values, and for certain medication prefixes.

    I basically had no life for those three weeks but boy am I glad I did what I did because I took the NCLEX and stopped at 75 questions and through the grace of God I passed! I was so nervous taking this exam that almost after every question I would say a prayer! LOL! I told my husband that the people at pearson were probably saying ďthis girl came here to pray, not to take an exam!Ē LOL! Oh well it worked for me, and it helped calm my nerves.

    After I finished reading Saunders and LaCharity I reviewed my handwritten notes. And those notes were very thorough so what I did was I typed my notes and made them as short as I possibly couldÖ. Putting everything that I thought was important about a particular illness, disease, or disorder but limiting it to the minimum of one or two sentences. Yes I know this is very repetitive but in order to pass the nclex you need repetition repetition repetition.

    This website helped me get through this very stressful part of my life which is why I am writing my experience here. I want you to know that if I can do it you can do it too! I studied hard, I worked hard and in the end it paid off. I am now a registered nurse and itís such a wonderful feeling! I have attached my notes to this post and forgive me if you find them absurd or useless, please donít bash them as I am posting them because I want to help anyone that wants a little extra help. So, a little info about my notesÖ.. If you know the core content about a particular illness my notes are only here to add small pinpoints that will refresh your memory. Thatís how I used them, just as a refresher. For example if I knew something about Buergers Disease, I would use my notes to refresh my memory and remind me that part of the treatment includes: stop smoking, hydration, and avoid cold temps.

    Yes I studied very hard and I worked very hard but the day before the exam I used it as a ME day! I studied nothing at all!!! I pampered myself a little bit, I went to get a pedicure and a foot massage and I got my eyebrows doneÖ J The morning of the exam make sure you eat something that has protein and sugars. Your brain needs food to process everything thatís going on on the day of the exam. I had a bagel with peanut butter and jelly and coffee. Although I donít recommend the coffee, I would recommend a glass of milk however if I donít have coffee I get a headache and I did not want to have a headache taking my exam. If youíre religious, PRAY! I prayed so much and I know it helped!!! I still pray today, just to thank him for everything he did for me. He put me through school and gave me the extra push I needed to pass the NCLEX.
    I wish you the best of luck and feel free to ask me any questions, I will help with anything I can.

    Regards,
    CeleneRN

    Ok apparently I cant figure out how to "attach" them so i am going to copy and paste them on the following post....
    holinurse, Analea, maydaysvp, and 2 others like this.
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  3. 13
    Airborne:
    Measels
    Chicken pox/ varicella
    Herpes zoster/ shingles
    TB
    Bird flu
    Private room, negative pressure, 6-12 air exhanges per hour with HEPA filter, respiratory protection device N95. Talk minimum, wet mask doesn’t protect.

    Droplet:
    Scarlet Fever
    Streptoccocal Pharyngitis
    Pneumonia
    Pertussis
    Influenza
    Diptheria
    Respiratory suncytial virus
    Rubella
    Meningicocal disease
    Mumps
    Private room or cohort client, mask or respirator required

    Contact:
    MRSA
    RSV
    VRE
    C DIFF
    Scabies
    Hep A if pooping
    Herpes simplex
    Salmonella
    Shigellosis
    Staph
    Private room or cohort clients, gloves, gowns

    Standard:
    HIV
    HEP B
    HEP C
    Rotavirus

    Protective Enviroment
    Neutropenic patients
    Private room , positive pressure with 12 or more air exchanges per hour, HEPA filtration, respirator mask gloves and gowns


    Don’t delegate what you can EAT (Evaluate, asses, teach)

    PVD- Remember DAVE- Dependent Arterial, Venous Elevated

    1 gram of diaper weight= 1mL of fluid


    Multiply weight in kilograms by 30 to get the amount of fluid people need daily

    BMI: 18.5-25 is normal

    Sterile procedure- open away from body first

    Surgical asepsis- scrub nails 15 strokes and fingers with 10 strokes per side. Rinse from finger to elbow

    Wash hands and rinse for 15 seconds in warm water

    Koplik spots- small red spots with blue center. Measles.

    Anthrax- tx with abx x 60 days

    Mag Sulfate- monitor UO, don’t give 2hr before delivery

    Postpartum- Temp elevated x24hrs, HR decreased x1 wk

    Forceps- can lead to hematoma

    BPP- checks breathing, body movements, fetal tone, reactive FHR, Amniotic fluid volume

    Amniocentesis- Check for fetal anomalies (down syndrome, Trisomy 13&18), Fetal maturity and LS ration to assess fetal lung
    maturity. Give rhogam if pt Rh negative

    Chorionic Villi Sampling- check for fetal anomalies and genetic defects can be done at 18wks

    Maternal Alphafetoprotein Samplin- Low levels= Down Syndrome, High= Neural tube defects. Done at 16-28 weeks gestation

    Contractions should be 2-3min apart for 60 sec. If < 2-3 min and >90 sec d/c PIT call dr.

    Birth weight doubles by 6 months and triples by 1 year

    Physiological jaundice- ok noted after 25hrs, peaks on day 5

    Pathological jaundice- bad- noted before 24hrs after birth

    Hyperbilirubenia: = is a level >12mg/dL

    Neonate FBS levels: 40-60 first 24hr, then 50-90 after 25hrs.

    NL UO for infant- 1-2ml/kg/hr

    Acute infectious diarrhea (infectious gastroenteritis)- is a result of various bacterial, viral, and/or parasitic infections. The onset of gastroenteritis is often abrupt with rapid loss of fluids and electrolytes from persistent vomiting and diarrhea

    Infant born with RDS at r/f pneumothorax, give Exosurf (surfactant) to prevent

    Reyes syndrome- acute encephalopathy- Dx with liver bx. Linked to aspirin in children.

    Spinal bifida- neural tubes didn’t close. No diapers, prone position

    Bacterial meningitis- cloudy CSF with increased protein and decreased glucose.

    Goodells sign- softening of cervix

    Chadwicks- purpleish color of vagina

    Fetal HR PMI- breech: above BB midline. Cephalic and Face presentation: lt or rt side of uterus below BB. Transverse: below
    BB midline. Vertex near symphysis pubis
    Saturate 1 pad per hour= hemorrhage

    Epiglottitis- secondary to flu or strep. Abrupt onset. Medical emergency. Kid drools. Tripod position. Put Nothing in mouth. Give cool moist oxygen

    Laryngotracheobronchitis- RSV. gradual onset, cool vaporizer.

    Cystic fibrosis- resp failure. Deficient in Vit A,D,E,K. give lots of calories and protein

    Rheumatic fever- preceded by strep

    Status epilipticus- child may need intubation

    Scoliosis- gradual curvature change of the vertebrae that may go unnoticed by parents.

    CPT- in children should be done 1hr before meals. Give albuterol before doing it.

    Rubella virus- can cause cleft lip

    Cleft lip- suction stuff at bedside. Elbow restraints post op

    Transesophageal fistula- 3 c’s: chocking, coughing, cyanosis. Frothy saliva. R/f ASPIRATION. NPO. IV fluid

    Hypertrophic pyloric stenosis- visible peristalsis. Projectile vomiting. Olive mass on right side.

    Celiac disease- give iron, folic acid, vit ADEK

    Appendicitis- pain in RLQ. Perforated= relief of pain then more pain. NO HEAT! Can rupture

    Appendectomy- post op- no pain meds or heat and no enema or laxative. Apply ice only. Lay on R side. NPO until BS return

    Hirschprung aka megacolon- watery explosive diarrhea. Ribbony stools. No meconium. Give low fiber.

    Chrons- no bleeding. Pt needs diet high in protein and calories and low in fiber

    DKA- rehydration with NS!

    Glomerolunephritis- STREP! Cloudy, smoky, brown urine.

    Nephrotic- massive proteinuria. Don’t give salt.

    Sickle cell anemia- NO DEMEROL! Give morphine or dilaudid. Treat crisis with O2, hydration, pain med and rest

    Aplastic anemia- bone marrow not making WBC’s, platelets, and/or RBC’s. s/s: hypoxia, fatigue, pallor, increased infection, hemorrhage, ecchymosis, petechiae, Pancytopenia. Give immunosuppressive (prednisone and cyclosporine, or Cytoxan) and bone marrow transplant. Protective isolation.

    Pernicious anemia- Vit B12 deficiency. Diagnosed through a Schillings test, measures UO of Vit B12. Will get Vit B12 shot once a a week for 1 month then monthly for life.

    Hemophilia- give factor VIII

    Hodgkins disease- reed strenberg cells. Painless node near clavicle first sign.

    Wilms tumor- measure abdominal girth daily. No palpation

    Spider bite- ice

    Snake- no ice. Level below heart. No movement of extremity

    Burns- low Na and High K occurs. S/S shock. Fast HR low BP and Low CO. Hct high initially. Will gain 20lbs the first 3 days. Antacids daily. Wt qd. Use sterile sheets

    Cellulitis- warm compresses

    Brachytherapy- pt emits radiation to others

    Cancer- high temp is always serious!!

    Mastectomy- pt should wear gloves on the affected side .

    Multiple myeloma- abn plasma invades bone marrow. Produce abnormal antibody called bence jones protein. High uric acid and Ca lead to renal failure. Get osteoporosis. Give fluids. Move carefuly.

    Tumor lysis syndrome- tumor cells destroyed and uric acid and K leak into blood. Give IV fluids and diuretics. Give allopurinol.

    Give insulin and glucose to treat hyperkalemia. Emergency! Leads to electrolyte imbalance and renal failure!

    Aldosterone- always think Sodium and Water

    ADH- think water only

    Adrenocorticotropin Hormones (ACTH) and cortisol= same thing. Hormones of adrenal cortex.

    Addisons- too little Aldosterone, pt has low sugar and Na with high K and Ca. Aldosterone makes you retain Na and Water but they don’t have any so they’re loosing Na and H2O… fatigue, muscle pain, weakness, joint pain, chronic diarrhea, N&V, diminished libido, hyperpigmentation, low BP, Pt is fluid volume deficient. At risk for anemia need lifelong glucocorticoids(Florinef). High protein & carb.

    Addisonian crisis-severe hypotension and vascular collapse. Sudden extreme weakness, severe abd, back, & leg pain, hyperpyrexia, coma, death. Secondary to infection, trauma, surgery, stress, PG. goal is to prevent irreversible shock and severe hypotension. May require IV steroids and respiratory support.

    Cushings- too much aldosterone. pt has high sugar and Na with low K and Ca. Pt has HTN, upper body obesity, thin extremities, moon face, buffalo hump, neck fat, hirsutism, ammenorhae, high triglycerides, Fragile skin with purple striae, bruise easily osteoporosis. Meds: parlodel, Lysodren, Cytadren. High protein, low carb. Put in quiet environment.

    Hyperpititurism- too much GH.aka- acromegaly. Pt has lg hands, feet, deep voice. Oily skin. Need transphenoidal hyposphectomy. Meds: sandostatin, somavert, or permax. Lower GH.

    Transphenoidal Hyphospectomy- removal of pituitary tumor. Check for SIADH post op

    Diabetes Insipidus-fluid volume deficit on vassopresors for life. Cant concentrate urine. have very concentrated blood.

    SIADH- s/s fluid over load. They have Low Na. give hypertonic solution. Have concentrated urine & Diluted blood. Restrict fluids. Seizure precautions. Sodium infusions, loop or osmotic diuretics. Meds: vasopressin receptor antagonist:s IF NA <125 - conivaptan, Tolvaptan.

    Hyperaldosteronism aka CONNS- too much aldosterone. Pt has Low K and high Na. give Aldactone and Inspra.

    Parathyroids- secrete PTH which pulls calcium from bones to put it in the blood.

    Hypoparathyroidism- low calcium and high phosphorus. s/s parasthesia, muscle cramps, alopecia, dry brittle hair and nails,
    chovsteks, trosseaus painful menstruation. Keep in quiet environment. Give IV calcium gluconate. Or oral calcium salt s and vitamin D

    Hyperparathyroidism- high calcium and low phosphorus. Kidney stones and hyperuricemia, osteoporosis, polyuria, polydipsia, HTN. Force fluids, prevent constipation, strain urine. Give Plicamycin or calcitonin, give Lasix

    Hypothyroidism- low T3 and T4 high TSH can lead to Myxedema coma-can occur due to rapid withdrawal of thyroid meds (synthroid, proloid, cytomel). Pt has low BP, sugar, Na, HR. Leads to coma and resp failure

    Hyperthyroidism- high T3&T4- thyroid hormones gives us energy, pt has too much energy. (Graves disease)- the clinical manifestations are known as thyrotoxicosis. Give PTU, Propacil, Tapazole to stop making TH’s. Give Inderal . Pt irritable with soft skin and hair, keep in quiet environment.

    Thyroid storm- life threatening. s/s hyperpyrexia, tachycardia, systolic hypertension. Give PTU, beta blockers. SSKI before surgery to prevent this from happening.

    Thyroidectomy- need lifetime levothyroxine and calcium. Keep trach tray, suction and O2 and IV calcium gluconate at bed side.

    Thalassemia- pt has low Hgb. Give blood transfusion. Pt is green/yellow. Has wide set eyes. Big forehead

    Polycythemia vera- too many RBC’s. thick blood. r/f stroke. Give fluids

    Regular insulin- is the only insulin that can be give IV.

    DKA- BS >300. Give IV regular insulin. Start with a bolus first then a drip. Watch K, it will drop.

    Hyperosmolar hyperglycemic nonketoic syndrome- BS>800. NS alone may treat it.

    Pheocromocytoma- benign tumor of adrenal medulla. The adrenal medulla produces cathecolamines epi and norepi, with this tumor pt is producing too much which leads to- HTN!. Do 24hr urine to dx called Vanylmandelic Test, no coffee or exercise before test. Don’t palpate tumor/abdomen. Quiet environment.

    Esophageal varices- due to portal HTN. Can kill if ruptured.

    Pancreatitis- NPO. Put in lying knee-chest position.

    Ulcerative colitis- Vit K deficient. No milk, fiber or fruits. Patient bleeds.

    Diverticulitis- give low fiber

    Evisceration- put in semi fowlers position with knees bent, cover with NS gauze, call dr stat!

    Dumping syndrome- early signs sweaty and pallor. Avoid sugar, salt, milk. Eat protein and fat & low carb.

    Hepatic encephalopathy- eat low protein. And high cal and carb.

    Barium swallow dye- causes bowel obstruction. Give lax and fluid. Chalky poop.

    Gastric lavage- patient put on left side

    NG insertion- pt put on high fowlers position

    NG decompression or feedings- Semi fowlers position

    Paracentisis- pt voids before procedure, don’t want to puncture bladder.

    Liver bx- put on left side during. check PT, PTT and platelets before bx. Post put on right side.

    Cirrhosis- limit exercise. Limit sodium intake

    Nonrebreather- gives highest concentration of O2. For pt needing ventilation.

    Venturi mask- most precise

    PEEP- greater than 15 can cause barotrauma or tension pneumothorax

    Mechanical ventilator- pt at risk for infection esp pneumonia

    ARDS- fluid in alveoli. Cardinal sign is HYPOXEMIA. treat the cause. restrict fluids. Give O2 and diuretics
    Patient have Severe hypoxemia despite administration of 100% oxygen A systemic inflammatory response injures the alveolar-capillary membrane. It becomes permeable to large molecules, and the lung space is filled with fluid. A reduction in surfactant weakens the alveoli, which causes collapse or filling of fluid leading to worsening edema.

    COPD- ABG’s show respiratory acidosis. Max O2 is 2l/min. give high cal and protein and lots of fluid.

    Sever acute resp syndrome- caused by coronavirus. Contagious.

    Air Embolism- treat with IV heparin

    Fat embolism- early symptom: confusion. Late: petechiae over neck, upper body, chest and abdomen. treat with heparin

    Compartment- 6P’s pain, pressure, paralysis, pallor, pulselessnes, paresthesia. Meds don’t help.

    TB- treatment for 2-3wk then no longer contagious.

    Isoniazid INH- not given to pt with liver problems

    Rubeola/measles- 3C’s coryza, cough, conjunctivitis. Small red spots with blue center. Airborne pct.

    Rubella /German measles- keep away from PG women. Airborne precautions

    Mumps- parotid glandular swelling. Droplet/contact pct

    Diptheria- bullneck-lymphadenitis. Humidified oxygen.

    Mononucleosis- monitor for splenic rupture

    CVP: normal 5-10= pressure in right atrium. High CVP= hypervolemia low CVP= hypovolemia. To measure pt needs to be supine on high fowlers. You can measure CVP on patients that are receiving bolus fluids to ensure you’re not over loading them with fluid.

    PAWP- NL 4-12. Measure right atrial pressure. Elevations may indicate left ventricular failure or mitral regurgitation, intracardial shunt, or hypervolemia. Decreased means hypovolemia.

    MAP- must be at least 60 for adequate organ perfusion.- SBP+2DBP/3

    Pulmonary capillary wedge pressure: NL 6-12. measured when balloon inflates. Indicates Left ventricular end-diastolic pressure. High means hypervolemia or left ventricular failure and low means hypovolemia.

    Sinus bradycardia- give atropine if it doesn’t work transcutaneous pacemaker. Don’t give too much atropine because pt will get tachycardia

    Sinus tachycardia- HR 100-180 rhythm normal. Eliminate cause.

    CD4/T4- normal levels 800-1200. 500 ok in HIV patients. <500 is bad. <200 = AIDS.

    ECG READINGS:
    P wave- 0.06-0.12
    PR interval- 0.12-0.20
    QRS interval- <0.12
    ST segment- 0.12
    T wave- 0.16
    QT interval- 0.34-0.44

    CO- think left ventricle.

    CABG- post op restrict fluids to 1500-2000/d.

    Coarctation of aorta- BP higher in UE than LE. Cool LE

    Hypercianotic spells- put in knee chest. Give 100 O2, give morphine sulfate and IV fluids. In calm place.

    PVC- due to caffeine, stress or low O2 (hypoxemia) or low K. giveO2, Lidocaine , monitor potassium.Untreated PVC’scan lead to VFib

    V Tach- HR 140-250, decreased CO. can lead to cardiac arrest. Tx: if pt has pulse and no s/s of decreased CO: give O2. If pt has pulse and s/s of decreased CO give O2 and prepare for cardioversion, ask patient to cough hard every 1-3 seconds for cough CPR. If patient has No pulse: defibrillate and CPR. Give Amiodarone or Lido

    V Fib- is fatal if not treated within 3-5 minutes, pt has no pulse, BP, heart sound or respirations. O2, CPR and defibrillation

    A fib- disorganized impulses at 350-600bpm. can lead thrombi formation causing stroke or heart failure. No P wave visible. QRS is visible. Tx : Oxygen, Cardioversion, beta blocker, digoxin and warfarin
    MI- ECG shows ST elevation and T wave inversion. Permanent abnormal Q wave.
    Right ventricular failure- avoid St Johns Worth and Licorice
    Cardioversion- pt on heparin 4-6 wks pre. Synchronized to R wave.
    Defibrillating- turn of O2 first!
    Asynchronous/fixed pacemaker- for asystole or severely bradycardic pts.
    Left ventricular failure- leads to pulmonary failure- emergency!
    Cardiogenic shock- failure of the heart to pump adequately. Pts BP will be lower than 90 systolic and UO <30. Tachy, cold clammy skin, poor peripheral pulses. Give Dobutamine, morphine, diuretics, nitrates. SWAN Gans insertion. Reading will show increased pulmonary capillary wedge pressure and decreased CO. maintain transducer at level of right atrium.
    SWAN Ganz- complications: air emboli or pulmonary infarction
    Systemic Intra-Arterial Line- measures BP continuously.
    Hypovolemic shock- decreased circulating blood volume
    Distributive- vasogenic shock. ( Neurogenic, Anaphylactic, septic)
    Septic shock- systemic vasodilation due to infection. Initially warm, flushed skin and fever.
    Anaphylactic- hypersensitivity reaction
    Neurogenic- increased size of vascular bed due to loss of vascular tone
    Shock manifestations: are due to decreased tissue perfusion. Tachycardia with hypotension. Tachypnea, Oliguria, Cold moist skin, color ashen and pallor, metabolic acidosis, decreased LOC. Position in modified trandelenburgs, large IV 16-18 gauge, O2, VS q5min, monitor UO
    Chronic constrictive pericarditis- give abx, diuretics and digoxin
    Cardiac tamponade- pt has JVD and clear lungs
    Prosthetic valve- lifetime anticoagulants
    Thrombophlebitis- elevate extremity above level of heart
    Venous insufficiency- elevate. Clean wounds wit NS NOT betadine or hydrogen peroxide, destroys tissue
    Buergers disease- inflammation of veins/arteries causes vasoconstriction. extremity red and cold when in dependent position. Tx: stop smoking, hydration, avoid cold
    Thrombolityc therapy- contraindicated in severe HTN.
    Acute renal failure- reversible. Monitor I&O qhr and wt qd. Low protein. No K or Na in diet
    Oliguric- lasts 8-15 days. no pee. s/s FVE. Kussmauls. High K. give Lasix
    Diuretic- pees more. 4-5L daily. Give fluids
    Recovery- lasts 2-3 yrs. Pees normal. Memory improves
    Chronic renal failure- cardiac monitor due to high K. don’t give Aldactone or Dyrenium they retain K.
    Disequilibrium syndrome- decrease stimuli. Give hypertonic sol or albumin. Slow or stop infusion.
    Dialysis encepholapathy- give aluminum chelating agents
    Bladder trauma- pt has pain bellow umbilicus that radiated to shoulder
    Glaucoma- central visual field unaffected. They lose peripheral vision, its painful. Take meds(miotics) whole life. Meds cause pain and blurred vision.
    Primary open angle glaucoma- painless, slow vision changes, “tunnel vision”
    Primary angle closure glaucoma- blurred vision, halos, ocular erythema.
    Acute angle closure glaucoma- medical emergency. Pt has N&V and pain
    Cataract extraction- severe pain reported to MD stat! means hemorrhagic bleeding
    Retinal detachment- pt see flashes of light and floaters, “curtain drawn over eye”. Painless.
    Conductive hearing loss- external or middle ear obstruction. Hearing aids
    Sensorineural hearing loss- pathological process of the inner ear. Usually permanent. Cochlear implants. The hearing aids only make the sound louder not clearer
    Presbycusis- a sensorinueral hearing loss that happens with age. Pts hear mumbling.
    Menieres- don’t give fluid or sodium. Give niacin
    LP- contradicted in pt with IICP
    ICP- early sign is altered LOC. Don’t flex legs or knees.
    Head injury- elevate HOB to prevent IICP
    Spinal shock- pt has paralitic ileus
    Autonomic dysreflexia- occurs after spinal shock. An emergency! s/s HA, HTN, stuffy nose, flushing. Elevate HOB, loosen clothing, check for bladder distention. Give HTN meds. To prevent hypertensive stroke!
    Right CVA- pt has left sided neglect
    CVA- keep BP at 150/100 for purfusion.
    Myasthenia gravis- monitor for aspiration.
    Tensilon test- puts pt at r/f Vfib or cardiac arrest. Have atropine at bed side.
    Parkinson disease- depleted dopamine. Rock back and forth to move. Lay prone with pillow. Avoid vit B6
    Trigeminal neuralgia- face pain. Avoid extreme temps of food.
    Guillian barre- ascending paralysis. Sensitive to pain. Monitor breathing!- resp arrest is possibility.
    Lou gerrighs- involves motor system. No mental changes. No cure. Leads to paralysis then Resp arrest then death.
    IICP- s/s High temp and BP, low RR and HR
    Halo devices- no driving at all.
    Goodpasteurs- involve lung and kidneys
    Nephrostomy tube- never clamped. Report UO <30/hr STAT
    Tracheostomy- Deflate cuff before inserting decannulation plug or pt will die!
    Hemodyalisis- the excess removal of fluid can cause hypernatremia. Monitor Na.
    Tonsillectomy- post op lay on side, no milk products.
    Trachea-innominate artery fistula-trach pulsating with heart. Remove stat! medical emergency.
    Cane- held on good side (COAL- cane opposite affected leg)
    LE amputation- 1st 24 hr elevate to reduce edema, bed flat to prevent contracture. After 24hr put prone to extend/stretch and no elevation to prevent contracture.
    Sprain- RICE 1st 24hrs then heat
    Arthroscopic surgery- nurse can apply ice post op
    Radiation- delayed until 8yo
    Floater RN acts as LVN
    DVT- warm moist compresses, promotes blood flow.
    Pulse Ox is not accurate in CO poisoning cases because it cant distinguish between CO vs oxygen attached to Hgb
    Total protein- 6-8gm/dL
    3500calories= 1 lb of weight
    When pt starts on beta blocker sx of CHF will initially get worse that’s ok. Ie crackles, fatigue, wt gain
    COPD- caused by emphysema or chronic bronchitis. Low O2 via NC 2L/min.
    K- is excreted by the kidneys so if the kidneys aren’t working the K cant get out so pt gets hyperkalemia
    Calcitonin decreases calcium by grabing it and putting it back in the bones
    Use weight to measure fluid volume adequacy, except with burns, youll measure I&O
    Tetanus toxoid takes 2-4wks to develop antibodies, the immunoglobulin provides immediate protection.
    Hyperkalemia happens after burns because the cells ruptured and K spills out. Monitor pt!
    Electrical injury- put patient in heart monitor immediately! Pt at r/f Afib
    Lobectomy- surgical side up so left over lobes can expand
    Pneumonectomy- surgical side down so left over lung wont fill with water
    Total laryngectomy- removal of vocal chords, epiglottis, and thyroid cartilage. Pt will have a tracheostomy. Position in semi fowlers and provide NG feedings. Have obturater at bedside. Watch for carotid artery rupture! Aka innominate artery, youll see the trach pulsating at the heart beat rhythm, a medical emergency!
    Tracheostomy care- suctioning is sterile and hyperoxygenate before and after. Intermittent suction on the way out, suction for 10 seconds with 60 seconds in between times. The vagus nerve is stimulated so the HR drops, monitor for bradycardia.
    Colon cancer- diagnosed with colonoscopy. Most common signs are rectal bleeding, changes in bowel habits and anemia
    Prostate cancer- most pts will initially have s/s of BPH. The most common sign is painless hematuria. Check PSA, should be <4ng/ml. diagnose with biopsy. Dr may do “watchful waiting”
    BPH signs are no FUN: Frequency, Urgency, Nocturia





    Ventilator alarms: HOLD
    High pressure: Obstruction due to increased secretions in airways, bronchospasms, ET tube displacement, pt fighting ventilator, pt gagging, coughing or bitting tube
    Low pressure: Disconnection or leak in the ventilator or in the pts airway cuff or pt stops breathing!

    Developmental
    2-3 months: turns head side to side
    4-5 months: grasps, swith and roll
    6-7 months: sits at 6 and waves bye bye
    8-9 months: stands straight at eight
    10-11 months: belly to butt
    12-13 months: tweleve and up drink from a cup

    Autonomythe right to self-determination
    Beneficence – taking positive actions to help others
    Nonmaleficence – avoidance of harm or hurt
    Justice – fairness
    Fidelity – agreement to keep promises
    Veracity in general means accuracy or conformity to truth

    Thiazides- not for pt with renal failure or allergies to sulfa drugs
    Nicotinic acid- to lower cholesterol . causes flushing. Give NSAID 30 min before to reduce it.
    TPN- used for: pancreatitis, ulcerative colitis, chrons disease, burn injury, cancer, AIDS, starvation. Its maintained in the fridge when not in use. Hypertonic solution that should be weaned off, never shake it, and room to warm temp priori to use
    Oxazepam- Benzodiasepine given to pt with alcohol withdrawal symptoms.
    Amphojel- causes constipation and tastes chalky
    Amphothericin B- nephrotoxic
    Adenosine- IVP 6mg FAST flush with NS. Brief asystole OK. For paroxysmal SVT
    Benadryl- can be give to patients with parkinsons for tremors
    Levodopa with MAOI= hypertensive crisis
    Anticholinergics- contradicted in pt with glaucoma
    Anticonvulsants- not taken with food or antacids
    Dilantin- decreases contraceptive effect. NL level 10-20. Don’t give faster than 25-50mg/min. causes Leukopenia! Monitor WBC’s
    Allopurinol and colchicine- not taken with aspirin. Take lots of fluid
    Synthroid- increases effects of anticoagulants
    Dopamine- for shock and heart failure. Increases CO and renal perfusion. Pt will pee more.
    Librium- given for alcohol withdrawal
    Methadone- used to detoxify narcotic addicts.
    SSKI- given pre thyroidectomy to decrease vascularity. Give in milk or juice and use a straw .
    Radioactive Iodine- for hyperthyroidism. Given in 1 dose. Stay away from babies X24hr. watch for thyroid storm as it could be a rebound effect from iodine
    Tetracycline- avoid sun exposure, don’t take with milk.
    Carbamazepine (Tegretol)- toxic levels cause diplopia, HA, and vertigo
    Metformin with alcohol= lactic acidosis
    Glucocorticoids- taken with meals or antacids, may cause ulcers
    Furosemide- causes ototoxicity
    Priscoline- causes severe hypotension
    Haldol, thorzine, mellaril are typical antipsychotics
    Zyprexa, Seroquel, abilify, clozaril are atypical antypsychotics
    Oral potassium should never be taken on an empty stomach
    IV K should never exceed 20 mEq/hr. don’t give K if pt has low UO.
    Gentamycin- ototoxic, do vestibular check 4wks after discontinuation
    Nitroglycerin- causes decreased preload and afterload. Pt will get a HA- give Tylenol.
    Parnate- not given with Demerol
    Byetta- causes pancreatitis
    Isoniazid for TB should be taken for 6months
    Doxycycline- should be avoided in pregnancy because it stains the neonates teeth
    Salmeterol- is a maintenance drug for asthma.
    Clozapine(clozaril)- causes severe tachycardia dont give if HR >140. Causes HTN and hyperglycemia. Causes agranulocytosis so monitor WBC’s
    Diltiazem- IVP over 2min, can repeat in 15 min. for Afib or Aflutter
    Depo-provera injection in women can cause depression if theyre already depressed
    Nafcillin (Unipen)- AE’s-vomitting, diarrhea, sore mouth, fever
    Methimazole/Tapazole- for thyroid storm. No more than 8 wks. Causes agranulocytosis check CBC’s.
    Pentamidine (pentam)- causes FATAL hypoglycemia
    Interferon alfa 2-a- for hep C cause flu like symptoms in the beginning.
    Digoxin (in children)- don’t mix with food or fluids. Signs of toxicity = poor feeding, vomiting
    Sandostatin/ocreotide- for acromegaly. GI upset and gallstones.
    MTX toxicity- treat with Leucovorin (wellcovorin)
    Levothyroxine- on an empty stomach in the AM.
    Cobalamin/ Vit B12- dose is 1000mcg Im qd x2 wks, then weekly when Hct is ok then monthly for life
    Varicella Zoster immunoglobin can prevent varicella on immunocompromised pts. Usually given.
    Atrovent or Spiriva not given to pts with peanut allergies.
    Anticoagulants are high alert meds that need to be double checked by other nurses
    Prozac doses greater then 40mg should be divided in two doses
    Defroxamine- antidote for iron poisoning
    Phenobarbital: 10-30mcg/mL
    Vancomycin- not mixed with other medications
    Neupogen- increases neutrophils WBC’s in patients undergoing chemo.
    Fluoroquinulones- given with lots of water to prevent crystalluria
    Accutane- check triglycerides because it elevates them. It’s a vit A derivative so avoid food with vit A
    Cytoxan- give without food and lots of fluids to prevent cystitis
    Hypokalemia ECG changes- ST depression, Inverted T wave, prominent U wave
    ADH- AKA vasopressin
    Ditropan- give for bladders spasms



























    DEFECTS WITH INCREASED PULMONARY BLOOD FLOW- CHILD SHOWS SYMPTOMS OF CHF
    Atrial septal defect- opening between atria, causes too much oxygenated blood to go to rt side. So rt atrium and ventricle get enlarged. Close with cardiac cath.
    Atrioventricular canal defect- common in down syndrome. Child get cyanotic whit crying. Murmur present. Child develops CHF.
    Patent ductus arteriosus- failure for the artery connecting the aorta and pulmonary artery to close. Machinery like murmur, wide pulse pressure and bounding pulse present. Give Indomethacin/ Indocin to close it. Or with cardiac cath.
    Ventricular Septal Defect- abn opening between lt and rt ventricles. Murmur present. Close on its own.

    OBSTRUCTIVE DEFECTS- CHILD SHOWS SYMPTOMS OF CHF
    Aortic stenosis- the narrowing doesn’t let the blood from the lt ventricle pass through the aorta. Results in decreased CO, lt ventricular hypertrophy and pulmonary vascular congestion. s/s of exercise intolerance, chest pain and dizziness when standing for long. Dilation during cath or valve replacement.
    Coarctation of aorta- narrowing near ductus arteriosus. BP higher in UE. s/s of CHF and decreased CO. also headaches, dizziness, fainting, and epistaxis from HTN. Resection of coarted portion with anastomosis or Ballon angioplasty. Restenosis can reoccur.
    Pulmonary stenosis- narrow entrance of pulmonary artery. Causes right ventricular hypertrophy. NB are cyanotic. Dilataion of the artery with cardiac cath.

    DEFECTS WITH DECREASED PULMONARY BLOOD FLOW
    Tetralogy of fallot- VSD, pulmonary stenosis, overriding aorta, right ventricular hypertrophy. Infants are cyanotic at birth and progresses the 1sr year of life. They have hypercyanotic blue spells “tet spells” when they cry, feed, or poop. With increasing cyanosis squatting, clubbing of fingers, and poor growth may occur. Tx with palliative shunt, Morphine. Or complete repair after 1yo.
    Tricuspid artresia- no tricuspid valve, so no communication between rt atrium and rt ventricle.

    MIXED DEFECTS
    Hypoplastic left heart syndrome- Underdevelopment of lt side of heart. Fatal if not treated. May need heart transplant.

    Rheumatic Fever- autoimmune inflammatory disease. Proceeds strep A infection. Can cause rheumatic heart disease which affects cardiac valves particularly the mitral valve. Jones criteria diagnoses RF. Major criteria: carditis, arthralgia, chorea, erythema marginatum, subQ nodules. Minor Criteria: Fever, arthralgia, high ESR, positive CRP level . Assessment: low grade fever that spikes in the PM. High ESR, +CRP, Aschoff bodies, + antistreptolysin O titer. Give Abx and seizure precautions.

    Kawasaki disease- aka mucocutaneous lymph node syndrome. Its an acute systemic inflammatory disease. Cause unknown. Affects the heart, aneurysms can develop. s/s ACUTE: fever, red throat, red eye, swollen hands, lg lymph nodes. SUBACUTE: crackling lips, peeling fingers and toes, joint pain, thmbocytosis. CONVALESCENT stage: child appears nl but signs of inflammation present. Give fluids that are not too hot or cold. Wt daily. Monitor I&O. passive ROM. IV immunoglobulin. Avoid MMR and varicella for 11 months after IgG therapy. Put in quiet environment. They are very irritable.

    Early signs of CHF: tachycardia, especially at rest and slight exertions. Tachypnea, scalp diaphoresis, fatigue, irritability, sudden weight gain, respiratory distress. – For all these heart probs - PROVIDE REST!

    Hemolytic-uremic syndrome: toxins, chemicals, viruses cause acute renal failure in children 6mos to 5yo. S/S: triad of anemia, thrombocytopenia, renail failure, proteinuria, hematuria, urinary casts, elevated BUN and creatnine and decreased Hgb and Hct. Do hemodyalisi or peritoneal dialysis.
    Bladder Exstrophy- bladder outside the body through defect in lower abdominal wall. Cover bladder with non-adhering plastic wrap. Surgery done.
    Von Willebrands disease- hereditary. Bleeding from mucous membranes. Tx similar to hemophilia.




















    S/S of IICP: NL ICP= 5-15
    Altered LOC- first sign
    Headache
    Abnormal respirations
    Rise in BP with widening pulse pressure
    Slowing of pulse
    Elevated temperature
    Vomiting
    Pupil changes
    Late Signs: (cushings triad- bradycardia, HTN, wide pulse pressure)
    Increased systolic BP
    Widened pulse pressure = increased systolic and low diastolic
    Slowed heart rate
    Non- reactive pupils
    Positive Babinski reflex-stroke side of foot and big toe dorsiflexes and others extend
    Decorticate or decerbrate posturing

    Seizures
    Don’t give morphine sulfate. Mechanical ventilation to maintain Paco2 at 30-35mm Hg will result in vasoconstriction of the cerebral blood vessels, decreased blood flow, and therefore decrease ICP. Maintain BP. Prevent shivering. Decrease stimuli. Limit fluid intake. Avoid coughing and stuff. Elevate HOB. Do a ventriculoperitoneal shunt. HOB no more then 30 degrees elevation because the hip flexion causes an increase in ICP.

    ICP increases with:
    Suctioning
    Coughing
    Sneezing
    Straining
    Frequent positioning
    Knees flexed
    Neck flexion

    CVA
    Right side:
    Left side paralysis (hemiplegia)
    Left side neglect
    Spatial-perceptual deficits
    Short attentions span
    Impaired judgment

    Left Side:
    Paralyzed on right side
    Impaired speech/language-aphasias
    Slow performance
    Depression
    Place patient in quiet environment to avoid an IICP.
    Hypertensive disease in pregnancy is divided into clinical subsets of the disease based on end-organ effects and progresses along a continuum from mild gestational hypertension, mild and severe preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome.


    Vasospasm contributing to poor tissue perfusion is the underlying mechanism for the signs and symptoms of pregnancy hypertensive disorders.


    Gestational hypertension (GH), which begins after the 20th week of pregnancy, describes hypertensive disorders of pregnancy whereby the woman has an elevated blood pressure at 140/90 mm Hg or greater, or a systolic increase of 30 mm Hg or a diastolic increase of 15 mm Hg from the prepregnancy baseline. There is no proteinuria or edema. The client’s blood pressure returns to baseline by 12 weeks postpartum.


    Mild preeclampsia is GH with the addition of proteinuria of 1 to 2+ and a weight gain of more than 2 kg (4.4 lb) per week in the second and third trimesters. Mild edema will also begin to appear in the upper extremities or face.


    Severe preeclampsia consists of blood pressure that is 160/100 mm Hg or greater, proteinuria 3 to 4+, oliguria, elevated serum creatinine greater than 1.2 mg/dL, cerebral or visual disturbances (headache and blurred vision), hyperreflexia with possible ankle clonus, pulmonary or cardiac involvement, extensive peripheral edema, hepatic dysfunction, epigastric and right upper-quadrant pain, and thrombocytopenia.


    Eclampsia is severe preeclampsia symptoms along with the onset of seizure activity orcoma. Eclampsia is usually preceded by headache, severe epigastric pain, hyperreflexia, andhemoconcentrations, which are warning signs of probable convulsions.


    HELLP syndrome is a variant of GH in which hematologic conditions coexist with severe
    preeclampsia involving hepatic dysfunction. HELLP syndrome is diagnosed by laboratory
    tests, not clinically.
    H – hemolysis resulting in anemia and jaundice
    EL – elevated liver enzymes resulting in elevated alanine aminotransferase (ALT) or aspartate transaminase (AST), epigastric pain, and nausea and vomiting
    LP – low platelets (< 100,000/mm3), resulting in thrombocytopenia, abnormal bleeding and clotting time, bleeding gums, petechiae, and possibly DIC


    Gestational hypertensive disease and chronic hypertension may occur simultaneously Gestational hypertensive diseases are associated with placental abruption, acute renal failure, hepatic rupture, preterm birth, and fetal and maternal death

    Administer IV magnesium sulfate, which is the medication of choice for prophylaxis or treatment. It will lower blood pressure and depress the CNS.

    Place the client on fluid restriction of 100 to 125 mL/hr, and maintain a urinary output of 30 mL/hr or greater.
    maryjoii, cupcake8, Analea, and 10 others like this.
  4. 0
    thank you so much for this notes! will definitely print this out.
  5. 0
    This is from the helpful document from this site thats been floating around, but it looks like you really organized it. Anyway you can email me your formatted copy? borgqn@gmail.com
  6. 3
    Hi I used that document to get the safety precautions and some mnemonics that helped me! The rest are my notes... I didnt use that one just because I needed to write and write and write so it could stick in my head!LOL. But the document you are talking about was also helpful.
    EarlyRN, mul7371, and oklahomagal like this.
  7. 0
    Congrats!! Thank you for sharing. Love to hear the words of encouragement!
  8. 0
    wow, thank you for sharing!

    congratulations!!
  9. 1
    No problem! and Thank you! I hope my notes are helpful.
    BorgQueen1701 likes this.
  10. 1
    This is AWESOME!!!!! CONGRATULATIONS!!!!!!! I thank you so much for sharing
    celeneRN likes this.
  11. 2
    Thank you!!! and no problem, I hope I can help someone here because that test is brutal! but with hard work and determination you can do it!!!
    EarlyRN and BorgQueen1701 like this.


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