Anybody interested in an online NCLEX study group

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I believe one of the best ways to study for the NCLEX is through getting help and feedback in a social group. I have plenty of notes and important content to share with anyone.

Please let me know if you are interested. Thank You so much.

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Very interested just PM or email me [email protected]

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I would like to join! Been looking for one. Email me [email protected]

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Great!! I am planning on breaking down the review into sections. We can just use this forum to share our (personal) notes on each systems/sections. I want to begin with the Neuro System : )

Here are some of My NOTES:

Quick Overview of the Cranial Nerves[h=3]1 The Olfactory Nerve[/h]- Transmits the sense of smell from the nose

2 The Optic NerveThe optic nerve is a sensory nerve responsible for vision. [h=3]3 The Oculomotor Nerve[/h]-Transmits signals from the brain that result in eye movements.

[h=3]4 The Trochlear Nerve[/h]- Causes the eye to move in the downward and inward directions.

[h=3]5 The Trigeminal Nerve[/h]- The motor portion of the trigeminal nerve is responsible for jaw movement and chewing, while the sensory portion of the nerve provides the sensation of touch over the face.

6 The Abducens NerveThe abducens nerve is a motor nerve that is responsible for lateral or outward eye movement.[h=3]7 The Facial Nerve[/h]- Responsible for facial movements and expression, as well as some muscles deep in the neck.

8 The Auditory Nerve

- Responsible for hearing.

[h=3]9 The Glossopharyngeal Nerve[/h]- Innervates muscles of the neck responsible for swallowing and speech. A portion also transmits taste and touch as well as sensation of a portion of the ear.

[h=3]10 The Vagus Nerve[/h]-. Responsible for the gag reflex.

[h=3]11 The Spinal Accessory Nerve[/h]- Responsible for the movement of the sternocleidomastoid muscle in the neck and the trapezius muscle in the upper back resulting in shrugging.

12 The Hypoglossal Nerve- Innervates the muscles of the tongue responsible for tongue movement. It traverses the skull through the hypoglossal canal.

GLASCOW COMA SCALE

  • SCALE METHOD OF ASSESSING A CLIENT'S NEUROLOGICAL CONDITION

  • THE SCORING SYSTEM (ONE TO FIFTEEN (1-15) PTS.)

  • LOWER THAN EIGHT INDICATES COMA.

It is based on:1. Eye Opening2. Motor Response3. Verbal Response

NEURO DIAGNOSTIC TESTS

These are some of the diagnostic tests that helps in diagnosing Neurological Diseases.

  • COMPUTED TOMOGRAPHY (CT) SCAN 

  • CEREBRAL ANGIOGRAPHY

  • MAGNETIC RESONANCE IMAGING (MRI)

  • LUMBAR PUNCTURE

  • ELECTROENCEPHALOGRAPHY (EEG)

  • MYELOGRAPHY

INCREASED INTRACRANIAL PRESSURE

- Increase in pressure within the cranium.

CAUSES:EdemaTraumaHemorrhage

Normal ICP: 5- 15 mm Hg.

INTERVENTIONS:

  • * NO VAGAL STIMULATION W/ PATIENT

  • IMPLEMENT SEIZURE PRECAUTIONS

  • MAINTAIN PATENT AIRWAY

ASSESSMENT

  • EARLIEST SIGN: DECREASE IN LOC, RESTLESSNESS AND CONFUSION

  • PROJECTILE VOMITING

  • CHANGES IN VITAL SIGNS (MAY BE A LATE SIGN).

  • SYSTOLIC BLOOD RISES WHILE DIASTOLIC PRESSURE REMAINS THE SAME.

  • ELEVATED TEMPERATURE

Remember: PATIENT WOULD HAVE:

  • HIGH blood pressure,

  • LOW respiration and pulse,

  • HIGH temp.

Nursing Care

  • MAINTAIN FLUID BALANCE: FLUID RESTRICTION (if possible)

  • POSITION CLIENT: BED ELEVATED 30-45 DEGREES

  • MAINTAIN A PATENT AIRWAY.

  • HYPEROSMOTIC AGENTS (MANNITOL, OSMITROL)

  • CORTICOSTEROIDS (DEXAMETHASONE)

  • DIURETICS (FUROSEMIDE, LASIX): REDUCE CEREBRAL EDEMA

  • ANTICONVULSANTS (PHENYTOIN, DILANTIN): PREVENT SEIZURES.

HEAD POSITION:MIDLINE OR NEUTRAL POSITIONAVOID FLEXING OR EXTENDING.

IMPORTANT:

  • PATIENT CAN ALSO MANIFEST THE CUSHING'S TRIAD) WHICH ARE VITAL SIGN CHANGES THAT WILL SHOW A DECREASE IN RESPIRATIONS AND PULSE RATE BUT INCREASE IN BP.

FOR AN INFANT*(SYMPTOMS*)

  • BULGING FONTANELS

  • RESTLESSNESS & IRRITABILITY

  • HIGH PITCHED CRY

ANEURYSM

- outpouching of a vessel

Types of Cerebral Aneurysm:

  • SACULAR (BERRY)

  • FUSIFORM

  • MYCOTIC

CAUSES OF ANERYSM INCLUDES:Congenital, Atherosclerosis, Trauma

  • PERSON CAN BE ASYMPTOMATIC, UNI ANEURYSM, RUPTURES.

  • HEMORRHAGIC STROKE.- Aneurysm does not rupture, but bleeds.

ASSESSMENT FOR PATIENTS:

  • HEADACHES *(SEVERE SUDDEN HEADACHES)

  • VOMITING

  • PTOSIS

  • DIPLOPIA

  • DECREASED LOC

INTERVENTIONS:

  • SEIZURE PRECAUTIONS

  • ASSESS LOC AND NEUROLOGICAL STATUS

  • CORTICOSTEROIDS (DEXAMETHASONE) reduce inflammation

  • ANTICONVULSANTS (reduce risk of seizures)

  • STOOL SOFTENER (reduce straining)

SEIZURES

- abnormal chaotic electrical discharge within the neuron system of the brain.

Types of Seizures:

  • GENERALIZED SEIZURES (TONIC CLONIC, ABSENT SEIZURES)

  • PARTIAL SEIZURES (SIMPLE, COMPLEX)

*Never use a tongue blade. Do not restrain the patient.*Pad the siderails.

Dilantin (Phenytoin): (Anticonvulsant Drug)- Side Effects includes: Ataxia, slurred speech, blurred vision, mental confusion.- DO NOT WITHDRAW SUDDENLY (SEIZURES CAN OCCUR).- Administer this drug with Nornal Saline- Therapeutic Level: 10- 20 mcg/ ml.- When taking Dilantin, teach pt. to have good dental hygiene (can cause gingival hyperplasia)

Phenobarbital (Barbituate)- Side Effects: Lethargy, Drowsiness & Respiratory depressionTegretol (Carbamazepine)

MENINGITIS

- inflammation of the brain and the spinal meninges.

Note: Droplet precaution have to be maintained until antibiotic therapy is given.

Causes:- Head Trauma- Skull Fracture- Bacteria: Haemophilus Influenzae, Neissria Meningitidis- Viruses

DIAGNOSIS:Lumbar Puncture Procedure - (increased CSF pressure and increase in WBC count .POSITION: SIDElying with head down to the chest w/ legs pulled up.Needle is inserted at Lubar area (L4-L5)

Pre-Op- Let pt. empty bladder- Position: Lateral recumbant w/ knees flexed

ASSESSMENT (Meningitis):- Confusion- Lethargy- Fever- Nuchal Rigidity/ Stiff Neck

Tests for MeningitisBrudzinski's Sign

  • INVOLUNTARY FLEXION OF THE HIP AND KNEE WHEN THE NECK IS FLEXED.

Kernig's Sign

  • LOSS OF THE ABILITY OF A SUPINE CLIENT TO STRAIGHTEN THE LEG WHEN FLEXED AT THE KNEE AND HIP.

TREATMENT:- Bed Rest- Antibiotics- Diuretics- Corticosteroids

Lou Gehrig's Disease/ Amyothropic Lateral Sclerosis (ALS)

Degeneration of the nerves that controls the voluntary muscles.

ASSESSMENT:Muscle Weakness and TwitchingFatigue- Lowe extremities are usually involved late in the disease.

Treatment:Riluzole (Rilutek)

Interventions:Conserve energy by spacing activities.Small frequent feedings.

STROKE

  • CEREBROVASCULAR ACCIDENT (CVA) CAN BE A REDUCTION IN CEREBRAL BLOOD FLOW AND OXYGEN OR A BLEEDING OR HEMORRHAGING OF A BLOOD VESSEL.

TWO TYPES OF STROKE:* ISCHEMIA

When a patient has HEMIPARESIS (one side is paralyzed): Place the patient in the affected side in order to prevent airway obstruction and reduce the risk of aspiration.

HOMONYMOUS HEMIANOPSIA- loss of vision in half of the visual field can occur following a stroke.

DIAGNOSIS:

  • DIAGNOSIS CAN BE DETERMINED BY A CT SCAN, CEREBRAL ARTERIOGRAPHY, ELECTROENCEPHALOGRAPHY, AND MRI.

  • CAROTID ENDARTERECTOMY

  • A SURGICAL INTERVENTION USED IN A STROKE MANAGEMENT AND CAN BE USED AS A STROKE PREVENTION.

Important Assessments:

  • HEADACHE, NAUSEA, VOMITING

  • FACIAL DROOPING

  • APHASIA, SPEECH CHANGES

  • NUCHAL RIGIDITY

ENCEPHALITIS

Encephalitis is irritation and swelling (inflammation) of the brain, most often due to infections.

- Enchephalitis is usually caused by a viral agent.- Does not respond to antibIotic therapy.

ASSESSMENT:

  • FEVER

  • HEADACHE

  • LOW APPETITE

  • LOW ENERGY

Diagnosis:- A CSF examination- Blood Tests

Treatment- Decrease ICP- Anticonvulsants

MULTIPLE SCLEROSIS

- a chronic degenerative disease of the CNS- demineralization of the neurons.- exacerbation and remissions.

Causes:- An autoimmune response- Virus infection- Stress related that can precede an onset.

Assessment for patients with MS

  • FATIGUE AND WEAKNESS

  • BLADDER AND BOWEL DISTURBANCES (LATER STAGE)

  • RESPIRATORY PARALYSIS AND FAILURE (LATER STAGE)

  • * POSITIVE BABINSKI REFLEX.

Meds:Cholinergic Drug: Bethanechol (Urecholine)Glucoccorticoides: Demathesone, PrednisoneMuscle Relaxants: Baclofen

INTERVENTIONS

- Assess the patient's Neurological Status.- Make sure to assess gag reflex before feeding.

MYASTHENIA GRAVIS

- Neuromuscular disease: weakness and fatigue of the voluntary muscles.- Is usually due to insufficient amount of Acetycholine.

CAUSES:- An autoimmune response- Inadequate release of Ach.

ASSESSMENT

  • WEAKNESS AND FATIGUE

  • DIFFICULTY CHEWING

  • DYSPHAGIA, PTOSIS

  • DIFFICULTY BREATHING (RESPIRATORY)

Diagnostics;Tensilon Test- used for diagnosing Myasthenia Gravis.- used to defferntiate cholinergic crisis from myasthenic crisis.

How the test is done:An IV injection of edrophonium or neostigmine causes some quick relief of muscle weakness.

Cholinesterase Inhibitor is used for Myasthenia Gravis- Cholinesterase Inhibitor can intensify transmission at muscarinic and neuromuscular junctions.

Atropine- antidote for cholinergic crisis.

TREATMENT:Cholinergic Medications (Anticholinesterase.

  • Neostigmine (Prostigmin)

  • Pyridostigmine (Mestinon)

Side effects of Medications:- increase GI motilioty- bradycardia

- increased salivation

TRIGEMINAL NEURALGIA (Tic Douloureux)

Painful disorder of the fifth cranial (trigeminal nerve)Extreme and excruciating facal pain.Pain is stimulated by pressure and temperature.

TREATMENTAnticonvulsants (Tegretol)Phenytoin (Dilantin)* watch out for gingival hyperplasia, hypotension

Surgical InterventionSevering of the sensory root in the nerve.

Bells Palsy (Facial Paralysis)

A paralysis that usually occurs in one side of the face.There is an inflammation in the seventh (facial) nerve.* Affects the facial Nerve (Cranial nerve VII)

ASSESSMENT

Difficulty ChewingFacial PainIncreased lacrimation

Medications:PrednisoneAntivirals

BRAIN TUMORS

- a brain tumor is an abnormal mass found in the brain that results from unregulated cell growth and division.

The presence of lesions can cause:

  • compression of blood vessels

  • producing edema

  • ischemia

  • increase in intracranial pressure

GENERAL ASSESSMENT:

  • SEIZURES

  • VISUAL CHANGES

  • SYMPTOMS OF ICP

SURGICAL PROCEDURES:

  • CRANIOTOMY

  • GAMMA KNIFE SURGERY

Diagnostic Evaluation:CT Scanning and MRI can show the location and the size of the tumor.

Intervention*Post-op, position a pt. after a supratentorial surgery in a semi to low fowlers position.

PARKINSONS DISEASE

- degenerative disease caused by the decrease and lack of dopamine in the brain.Assessment:

  • TREMORS IN HANDS AND FINGERS (PILL ROLLING)

  • AKINESIA

  • BRADYKINESIA

  • BLANK FACIAL EXPRESSION

  • SHUFFLING STEPS AND GAIT

  • RESTLESSNESS

Antiparkinsonian Agents

Cholinergic Medications (Anticholinesterase)

  • Pyridostigmine (Mestinon)

  • Neostigmine (Prostigmine)

  • Edrophonium Chloride (Tensilon)

  • - Used for Myasthenia Gravis

DopaminergicsLevodopaCarbidopa/ Levodopa

SPINAL CORD INJURY

- a trauma in the spinal cord (partial or complete) that traumatize and disrupt the nerve tracts and neurons within our system. A spinal cord injury can be classified as either complete or incomplete

PATIENT WITH SPINAL CORD INJURY ASSESSMENT:ACUTE RESPIRATORY FAILURECOMPROMISED RESPIRATORY FUNCTIONSENSORY AND MOTOR PARALYSIS WITHIN OR BELOW LEVEL OF INJURY.

Spinal Shock- is also called a neurogenic shock.

Assessment includes:

  • DECREASE OR LOSS OF REFLEX ACTIVITY, FLACCID PARALYSIS, BRADYCARDIA.

  • USUALLY OCCURS WITHIN SEVERAL HOURS RIGHT AFTER INJURY.

  • LOSS MOVEMENTS OF MUSCLES (FLACCID PARALAYSIS), BOWEL AND BLADDER.

Autonomic Dysreflexia

- also known as autonomic hyperrefelexia.- caused by stimulus to the bladder or bowel- Try to limit the catheterization of spinal cord patients to once every 12-14 hrs.

Asessment includes:

  • HYPERTENSION (SEVERE)

  • HEADACHE (THROBBING)

- also known as autonomic hyperrefelexia.

HEAD FRACTURES

Basillar Fracture- A leakage of CSF or cerebrospinal fluid can accompany a basillar fracture. CSF will show yellow ring called the halo sign and it will test positive for glucose.

SIDE NOTE: REMEMBER FOR THE NCLEX- Guillain–Barré syndrome: Patient will have an increase in protien but a normal cell count.- Guillain–Barré patient: usually has a previous virus illness.- With Meningitis: There is an increase in WBC. And with bacterial meningitis, there is an increased protien & decreased glucose.- For pt. with a stroke and has a fever: Tylenol can be givin. Not Aspirin or Advil.- Patients w/ Multiple Sclerosis: give Biological Response Modifiers, Steroids, Immunosupressants and Muscle Relaxers

  • BIOLOGICAL RESPONSE MODIFIERS: AVONEX, BETASERON, COPAXONE.

- Earliest indication of Increased Intracranial Pressure: RESTLESSNESS.

MEDICATIONS FOR NEUROLOGICAL DISEASES

- ANTIPARKINSONIAN MEDICATIONS:

  • RESTORES THE PRODUCTION OF DOPAMINE AND SUPPRESSION OF ACETYLCHOLINE.

♣ Dopaminergic Medications:

  • CARBIDOPA (SINEMET)

  • BROMOCRIPTINE (PARLODEL)

  • (MIRAPEX), (CARBEX)

Â¥ Anticholinergic Medications:

  • BENZTROPINE MESYLATE (COGENTIN)

  • TRIHEXYPHENIDYL HYDROCHLORIDE

♣ ANTICONVULSANTS

♦OSMOTIC DIURETICS♥ CHOLINESTERASE INHIBITOR♣ SKELETAL MUSCLE RELAXANTS♦ ANTIGOUT MEDICATIONS

ScoliosisA lateral curvature of the spine that usually occurs more often in girls than in boys.

There are two types:- Nonstructural Scoliosis- Structural Scoliosis

Nonstructural Scoliosis - The curve in the spinal column disappears when the child tries to bends at the waist and touches the toes. On the other hand when you assess a child with structural scoliosis, you will see a failure of the spinal curve to straighten when the child tries to bend forward with the knees straight. For these patients, bracing can help slow the progression of the condition.

Note: If a child is wearing a brace. Inform and educate the parents that the brace must be worn 16 to 23 hours each day. Examine the skin daily to evaluate for any skin breakdowns.

Diagnosis:X- Ray

Guillian Barre Syndrome

ASSESSMENT:- ascending weakness, beggining with the legs- paresthesia with the limbs

PATIENT WILL BE AT RISK FOR RESPIRATORY (Make sure intubation tray is at hand)

More NERVOUS SYSTEM DRUGS

Cholinergic Medications- Stimulates the parasymphatetic SystemInitiates action of Ach and stimulates cholinergic receptors

Used to treat:Bladder functionsGlaucomaMyasthenia GravisAlzheimer's Disease

Medications

Pilocarpine (Pilocar)Bethanicol Chloride (Duvoid)

Adverse ReactionAs a result of (overstimulation of the parsympahtetic Nervous system)HeadacheHypotensionFlushingBradycardia

Notify if patient has shortness of breath

ANTICHOLINERGIC MEDICATIONS- Prevents the cholinergic effects by blocking the action of the Ach

Used For:decreases GI spasmshelps alleviate symtpoms of Parkinson's Disease.Reducces gastric and ssalivary secretions

MedicationsAtropineBenztropine (Cogentin)Scopolamine

Interventions

Contranindicated with:narrow angle glaucomamyasthenia gravis

Glaucoma

Glaucoma: there is an increased of intraocular pressure in the eye.

There are two types:

  1. Open Angle Glaucoma or Primary” Glaucoma

  2. Primary Angle Glaucoma.

Open angle glaucoma is slow in onset and chronic, while the primary angle glaucoma needs immediate treatment.

Open Angle GlaucomaBilateral

Acute Angle-closure GlaucomaUnilateral

TREATMENTBeta Adrenergic BlockersCholinergic Agents (Pilocarpine)AVOID ANTICHOLINERGICS (Atropine)

Cataracts

Complete or partial opacity of the eye lens.

Types of Cataracts:Senile: associates with agingTraumatic: associates with injurySecondary: Those that followed after othe reye diseases.

Assessment:PainlessDecrease in visual acuity

Remember:If there is severe pain, its a sign of increased occular pressure (call physician)

Cataract Surgery:Removal of the opacified lens.DO NOT ADMINISTER MORPHINE (causes miosis)

Detachment of RetinaUsually no painPerson feel like there is a curtain or shadowPerson might complain of floating spots.

Opthalmic, otic and nasal agents treat, prevent and inhibitconditions affecting the eyes, ears and the nose.

Miotics causes the pupit to contract (constrict)Miotics include:Carbachol (intraocular) (Miostat)Pilocarpine (Piloptic)

Conditions treated with miotics includes:Primary Open- Angle glacaumaMiotics are also administered to create pupillary miosis (contraction) during ocular surgery

MydriaticsMydriatics dilate the pupil. Sometimes the pupil must be dilated during treatment to prevent adhesion of the pupils.

Mydriatics includes:

  • Atropine Sulfate

  • Cyclopentolate hydrochloride (mydrilate)

  • Epinephrine hydrochloride (glaucon

Conditions used treated with mydriaticsOpen angle glacauma

Opthalmic Vasoconstricorsconstrict the blood vessels of the pupil in the eyes

  • Naphazoline Hydrochloride (Allerest)

  • Oxymetazoline Hydrochloride (Visine)

Conditions treated with opthalmic vasoconstricorsAllergiesEye irritations

EAR DISORDERS

Otitis MediaInfection of the middle ear.Infants and children is common (eustachian tube is shorter)

AssessmentPain from pressureFever

MEDICATIONSAntypyreticAnalgesic

Menierre's Disease

Ear disease that affects the vestibular and semicircular canals.Produces severe vertigo.

ASSESSMENT:HeadacheVertigoNauseaTinnitis

DIAGNOSTICSAuditory TestWeber Test

TREATMENT:Antihistamine

Otics are used and administered to treat conditions of the ear.

Examples:Carbamide Peroxide (Murine Ear)Boric Acid Solution (Ear dry)

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How confident are you guys with you Neuro Pharmacology

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Hello,

just seeing king your post. I'm interested in the study group. Please email me at [email protected]. Thanks

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I am interested to study as group! here is my email [email protected] Thanks.

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not much! Neuro pharmacology i am not strong but I am very strong in cardiology or cardiac pharmacology :)

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Here is my notes for skills hope it helps you guys!!

EDUCATIONAL OBJECTIVE: During a weather-related emergency, home care visits are classified as:

  1. High priority - unstable client who need care and are at risk for hospitalization if not seen
  2. Moderate priority- client who re moderately stable and will suffer no harm if a visit is postponed; telephonic care management can be provided to these clients.
  3. Low priority- clients who are stable and can engaged in self-care and/or have a caregiver who can provide or assist with care.

** Occlusion of CVAD can be related to mechanical,medication, precipitate, thrombotic causes. Thinners first attempts remove the occlusion by eliminating a possible mechanical obstruction before notifying the HCP.

** Steps for removing an indwelling catheter:

  1. Perform hand hygiene
  2. Ensure privacy and explain the procedure to the client
  3. Apply clean gloves
  4. Place a waterproof pad underneath the client
  5. Remove any adhesive tape or device anchoring the catheter
  6. Follow specific manufacturer instruction for balloon deflation
  7. Loosen the syringe plunger and connect the empty syringe hub into the inflation port
  8. Deflate the balloon by allowing water to flow back into the syringe naturally, removing all 10 mL, or applicable amount of water does not flow back naturally, use only gentle aspiration.
  9. Remove the catheter gently and slowly; inspect to make sure it is intact and fragments were not left in the client.
  10. If any resistance is met, stop the removal procedure and consult with the urologist for removal
  11. Empty and measure urine before discharging the catheter and drainage bag in the biohazard bin or according to hospital policy
  12. Remove gloves and perform hand hygiene

**Always verify blood products, type and crossmatch results, and client identifiers with another nurse prior to transfusion. Obtain vitals signs before, during, and after blood administration. Using Y tubing primed with NS and an IV pump for administration. Watch for transfusion reaction and stop the transfusion immediately if a reaction occurs.

** Initial management of epistaxis includes tilting the client's head forward; apply direct, continuous pressure to the nose for 5-10 minutes; and holding a cold cloth to the nasal bridge. Epistaxis can often be prevented by avoiding local trauma and maintaining hydration of the mucous with saline nasal spray or a humidifier.

**Following thoracentesis, the nurse should monitor for signs of pneumothorax, inducing respiratory rate, respiratory effect, oxygen saturation and lung sounds.

**Emergency self-injection of epinephrine (EpiPen) can be done through clothing into the mid-outer thigh when the client first notices any anaphylactic symptoms.

**To insert an indwelling urinary catheter on a female client, perform hand hygiene; position; open the urinary catheter kit; place sterile drape under the hips; apply sterile gloves; empty lubricant into tray and place tip of catheter in lubricant; spread labia with the non dominant hand and cleanse front to back, outer to inner with meatus last during a new swab each time; insert catheter until urine is visualized and then advance 1-2”, and inflate ballon. Maintain sterile technique throughout the procedure is imperative.

** weight in lb 8+9oz/16 oz = 0.5625 = 8.5625 lb

weight in kg 8.5625 lb/ 2.2 lb = 3.8920 kg

**1 cup= 8 ounces 1 ounes= 30 mL 1 cup=240 mL

** The Hemlich maneuver is the primary rescue intervention for children over age 1; back blows and chest thrusts are appropriate interventions for choking infant under age 1.

** Education Objective:

Teach client the following steps for self-administration of ophthalmic ointments

  1. Perform hand hygiene
  2. Tilt the head back, putt the lower lid down, and look upward
  3. Squeeze a thin strip of ointment onto the lower eyelid, from the inter to the outer edge
  4. Close the eyes gently for 2-3 minutes after applying the ointment

** A central line or CVC is used to administer fluids, for simultaneous infusion of incompatible drugs, for parenteral nutrition, and for hemodynamic monitoring. The nurse should always handle the lumen ports and hubs aseptically with facility approved antiseptics to prevent catheter-associated infections.

** Purpura- refers to reddish purple blotches on the skin that do not blanch with pressure due to bleeding underneath the skin. Further assessment must be done to evaluate for a potentially serious etiology, such as a blood dyscrasia.

**Tidaling is the fluctuation that occurs in the water seal chamber in relation to the client's respiratory movements. The level of sterile water will rise with inspiration and descend with expression, indicating appropriate function of the chest tube drainage system.

** Icentive Spirometry:

  1. Exhale normally and place the mouthpiece in the mouth
  2. Seal lips tightly on mouthpiece
  3. Inhale deeply, until piston is elevated to predetermined level
  4. Hold breath for at least 2-3 seconds
  5. Exhale slowly around the mouthpiece

**Steps for inserting a nasogastric tube for gastric decompression:

Key steps when insetting a large-bore nasogastric tube include using clean gloves; inspecting nares; measuring; marking; and lubricating tube; instructing client to extend the neck back slightly; inserting tube past the nasopharynx and continuing advancement until just above oropharynx; asking the client to flex the head forward and swallow; advancing tube to marked point; and verify tube placement using abdominal x-ray and anchoring.

**Steps to promote safety and reduce infection risk when initiating IV therapy:

  1. Cleanse selected site using antiseptic swab
  2. Anchor vein by holding skin taut
  3. Insert needle bevel side up until blood return is observed
  4. Advance catheter hub while retracting stylet
  5. remove Stylet and attach extension or infusion set
  6. Apply a transparent dressing

**When administering oral medication to children, flavorings can be added to mask the taste or the mediation can be mixed with jam or pudding. The child is held in the semi-reclining position to prevent aspiration. An infant nipple may be used to administer medication, but a plastic disposable syringe or plastic medication spoon are preferred for accuracy.

**The proper positioning and administration of nasal sprays allow the medication to reach the nasal passages.

  1. Assume a high flower's position with head slightly tilted forward
  2. Insert the nasal spray nozzle into an open nostril, occluding the other nostril with a finger
  3. Point the nasal spray tip toward the side and away from the center of the nose
  4. Spray the medication into the nose while inhaling deeply
  5. Repeat the above steps for the other nostril
  6. Blot a runny nose with a facial tissue, but avoid blowing the nose for several minutes after insulation

** IM epinephrine is the single most important medication to be given in anaphylactic shock. The dose should be repeated every 5-15 minutes if symptoms are still present. Antihistiamines, corticosteroids, and I V fluids are other supportive treatments.

**The term decompression is used to describe the removal of air secretion from the stomach. An NG tube can facilitate the removal of secretion when it is connected to suction. After NG insertion, the nurse should connect the main lumen of the NG tube.

The blue pigtail lumen in the air vent that facilitates removal of air or secretions from the stomach. The nurse should never connect the air vent to suction, use it for flushing, or clamp/plug it. If plugged, the tube may adhere to the side of the stomach or esophagus and cause tissue breakdown. The nurse should never use the pigtail air vent to flush and should not plug or clamp it.

** These nursing actions can help prevent injury if a client is falling while the nurse is assisting with ambulation: step slightly behind the client with feet wide apart and knees bent, place arms under the axillae or around the client's waist, place one leg behind the other and extend the front leg, and let the client slide down the extended leg to the floor.

** While waiting for the rapid response team to respond to an adult client with acute respiratory distress, the nurse implements the following actions: positioning, suctioning to clear the airway, administering high concentration oxygen; assessing lung sounds; and notifying the HCP.

** For medical procedures, the nurse should ensure that the client:

  1. Has an empty bladder and sits up for paracentesis
  2. Lies with the head down on the left side for suspected air embolism
  3. Has monitoring of puncture site for CSF leakage after a lumbar puncture
  4. Lies supine and on the right side after a liver biopsy
  5. Remains supine for at least 3-4 hours after a PCI

**Muffled heart tones in a client with pericardial effusion can indicate the development of cardiac tamponade. This results in the build-up of fluid in the pericardial sac, which lead to compression of the heart. Cardiac output begins to fall as cardiac compression increases, resulting in hypotension. S/S of tamponade include tachypnea, tachycardia, jugular venous distention, narrowed pulse pressure and the presence of pulsus paradoxus. Pluses paradoxus is defined as exaggerated fall in system BP>10 mm Hg during inspiration.

** Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive diagnostic test used to visualize the biliary and hepatic ducts via MRI. ContraIndications to the procedure include pregnancy, presence of metal in the body, and an allergy to gadolinium ( a non done contrast agent)

** Full—> Independent, no assistance required, 1 person standby assistance or observation for uncooperative or high fall risk clients.

** Partial—> 1 person assist stand & pivot transfer with gait belt or motorized assist device if cooperative. 2 person assist with full body sling if uncooperative.

** None —> Motorized assist device if client is cooperative & has upper body strength. 2 person assist with full body sling if client is uncooperative & or has no upper body strength.

** African Americans have the highest incidence of hypertension in the world as well as increased incidence of stroke and cervical cancer. Whites have a high incidence of osteoporosis and skin cancer (melanoma)

**Safe blood transfusion includes the checking of at lest 2 client identifiers by 2 qualified health professionals, using normal saline to prime, and giving the infusion in 2-4 hours. The UAP can take vital signs during the later part of the transfusion. O- is the universal donor blood type and AB+ is the universal recipient.

** When obtaining blood from a client, insert the needle at 15 degree angle, limit attempts to 2, and avoid the side of a mastectomy. A capillary specimen should be obtained at the side of the finger pad. Never draw a specimen above an IV infusion.

** The suction control chamber, which is usually set at -20 cm H2O to main negative pressure in the system

** The water seal, which is filled with sterile water. Bubbling is observed in this area when the drainage system is first connected to suction. This indicates that air is being removed from the client's lungs. As the lungs re-expands, the bubbling will stop.

**The drainage collection chamber where fluid from the client's lung will collect. The nurse will assess the color and amount of drainage.

  1. ** To administer otic medications in an adult client, follow these steps: 1. Perform hand hygiene, 2. position the client side-lying with the affected ear up, 3. pull pinna up and back, 4. administer prescribed number of eat drops, 5. instruct the client to remain side-lying for 2-3 minutes, and 6. place cotton ball loosely in the outer ear canal for 15 minutes if needed.

** Common clinical manifestations in a client with a fractured mandible are pain, edema of the face and jaw, difficulty speaking, doodling, and bleeding. Appropriate nursing interventions include oral suction to main airway patency, administration of oxygen and analgesia, and application of ice to the face.

** Insert the foley urinary catheter further if drops appear in the tubing to ensure that the tip to ensure that the tip with the balloon is in the bladder. Inflating the balloon before advancing the catheter could result in urethral trauma.

**Neuro—> Normal pupil are 3-5 mm in diameter. Normal strength is 5/5. The neck should be supple and flex easily, allowing the chin to touch the chest.

oculocepharic reflex (doll's eyes) is an expected finding that indicates an intact brain stem eye roll in opposite direction when turing head side to side.

** Ongoing enternal feedings into the stomach require elevation of the client's head of the bed, a residual PH 2500 mL), return of aspirated residual volume to the stomach, and flushing of the tubing before and at the end of the bolus intermittent feeding.

**Ztrack injection Pull, hold the skin, Inject the medication, wait 10 seconds, release the hold on the skin, apply gentle pressure at the injection site.

** In children age less than 3, suppositories are inserted with the fifth figer of the nurse's gloved hand. Age appropriate explanations and or distractions are implanted to reduce distress.

** in clients with HIV, who have had an organ transplant, are immunocompromised, or have been exposed to active TB, even a >5 mm of induration is considered positive. Client who do not belong to either the >5 mm group or the >15 mm group (healthy individuals) like are in the >10 mm positive group. Erythema is not considered in the interpretation of TST results.

** The collection of a sputum specimen by expectoration is a sterile procedure that requires the client to be able to breathe deeply and cough effectively. Sputum is best obtained early in the morning after mouth care because the secretions collect at night time.

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