OK I know this sounds stupid but I have a friend that gets really freaked out before big tests like finals, HESI, NCLEX, and usually we get together and a few days before I start throwing out random facts at her. On 2 different tests she said the only way she got several questions was from the random facts that I threw at her that she never would have thought of!
SOOOOO..... I thought that if yall wanted to do this we could get a thread going and try to throw out 5 random facts or "things to remember". NCLEX is coming and the more I try to review content the more I realize that I have forgotten so......here are my 5 random facts for ya:
OH and BTW these came from rationales in Kaplan or Saunders no made up stuff:
1️⃣ A kid with Hepatitis A can return to school 1 week within the onset of jaundice.
2️⃣ After a patient has dialysis they may have a slight fever...this is normal due to the fact that the dialysis solution is warmed by the machine.
3️⃣ Hyperkalemia presents on an EKG as tall peaked T-waves
4️⃣ The antidote for Mag Sulfate toxicity is ---Calcium Gluconate
5️⃣ Impetigo is a CONTAGEOUS skin disorder and the person needs to wash ALL linens and dishes seperate from the family. They also need to wash their hands frequently and avoid contact.
Oh, ohh, one more...
? Vasopressin is also known as antidiuretic hormone
Does anybody know why there is sodium loss rather then retention in polycystic kidney? I don't get it, because the symptoms are also hypertensia and oliguria. I have tried to find the answer but I am confused:uhoh21:. please
1. smoke and inhalation injuries result from inhalation of hot air or noxious chemicals.
2. the resulting effect of burns is influenced by the temperature of the burning agent, the duration of contact time, ad the tissue type burned.
3. burn treatment is related to injury severity determined by depth. the extent is calculated by the percent of the total body surface area (tbsa), location, and patient risk factors.
4. causes
a. radiation: x-ray, sun, nuclear reactors
b. mechanical: friction
c. chemical: acids, alkalies, vesicants. chemical burns alter tissue perfusion and lead to necrosis.
d. electrical: lightening, electrical wires. severity depends on type and duration of current and amount of voltage - they follow the path of least resistance (muscles, bone, blood vessels and nerves)
e. thermal: flame, steam, frostbite, scald. these cause cellular destruction that results in vascular, bony, muscle, or nerve complications; thermal burns can also lead to inhalation injury if the head, neck or chest area is affected.
5. burns are defined by degrees: first degree (superficial partial thickness burn), second degree (deep dermal partial thickness burn), and third degree (full-thickness burn)
a. superficial partial-thickness burn (first degree): sunburn type. involves only the dermal layer. s/s: erythema, edema, pain, blanching.
b. deep dermal partial-thickness (2nd degree): involves the epidermal and dermal layers. s/s; pain, oozing, fluid filled vesicles, erythema, shiny wet subcutaneous layer after vesicles rupture.
c. full-thickness burn (3rd & 4th degree): involves epidermal, dermal, and subcutaneous layers, and nerve endings, muscle, tendons and bone. s/s: eschar, edema, little or no pain.
6. second and third degree burn extent can be determined using a total body surface area based on two guides: lund-browder chart and rule of nines. burn extent is often revised after edema subsides and demarcation of injury zones occurs.
a. rule of nines
head= 9% arms = 18%( 9% each) -
back= 18% legs= 36%( 18% each)
genitalia= 1%
b. lund-browder chart: this method accounts for changes in body proportion that occur with age. its greater accuracy can be used to help determine a patient’s exact fluid replacement requirements after a burn injury.
7. hands, feet, and eye burns may make jeopardize future function. buttocks or genitalia burns are more susceptible to infection. circumferential burns to the extremities can cause circulatory compromise distal to the burn.
8. patient usually tetorifice and immune globulin.
9. burn management is organized chronologically into 3 phases: emergent (resuscitative), acute (wound healing), and rehabilitation (restorative)
a. emergent: period of time required to resolve immediate, life-threatening problems. phase may last from time of burn to 3 or more days, but usually lasts 24- 48 hours.
1. priority care is on abc’s. assess for smoke inhalation (singed nares, eyebrows, or lashes; burns on the face or neck: stridor, increasing dyspnea) and give oxygen at 100% as prescribed. be prepared for emergency intubation and mechanical ventilation if severe inhalation injury or carbon monoxide inhalation has occurred.
2. assess for signs of shock caused by fluid shifts (increased pulse, falling b/p and urine output, pallor, cool clammy skin, deteriorating level of consciousness.
3. initial fluid shift/fluid resuscitation: occurs in first 24 hours after burn.
a. fluid seeps out of the tissue because of increased capillary permeability. the majority of this leaking occurs within the first 24 hours. fluid deficit = shock.
b. h & h is elevated due to loss of fluid volume and fluid shift into interstitial space (third spacing)
c. sodium is decreased due to third spacing.
d. potassium is increased due to cell destruction.
e. common rule: calculate what is needed for the first 24 hours and give ½ of the volume calculated during the first 8 hours (parkland formula)
1. brooke formula: uses 2 ml/kg/% tbsa burned (¾ crystalloid plus ¼ colloid) plus maintenance fluid of 2,000 ml d5w per 24 hours.
2. parkland formula: uses 4 ml formula uses 4 ml/kg/tbsa burned per 24 hours = total fluid requirements for the first 24 hours.
a. 1st 8 hours = ½ of total volume
b. 2nd 8 hours = ¼ of total volume
c. 3rd 8 hours = ¼ of total volume
3. no matter what formula the doctor uses, the formula will tell the amount of fluid the patient will get per hour.
4. medication therapy: pain therapy, tetorifice prophylaxis, topical antimicrobial as well as systemic antibiotics.
5. primary concern is the onset of hypovolemic shock and edema formation. toward the end of the phase, if fluid replacement is adequate, the capillary membrane permeability is restored.
6. fluid loss and edema formation cease. the interstitial fluid gradually returns to the vascular space.
7. diuresis occurs with low urine specific gravities.
8. manifestations include shock from the pain and hypovolemic. areas of full thickness and deep partial-thickness burns are initially anesthetic because the nerve endings are destroyed. superficial to moderate partial-thickness burns are painful.
9. shivering occurs as a result of chilling and most patients are alert.
10. complications
a. cardiovascular system: dysrhythmias and hypovolemic shock.
b. respiratory system: vulnerable to upper airway injury causing edema formation and/or obstruction of airway and inhalation injury.
c. renal system: if patient is hypovolemic, kidney blood flow may decrease, causing renal ischemia. if it continues, acute renal failure may develop.
d. with full-thickness burns, myoglobin and hemoglobin are released into the bloodstream and occlude the renal tubules.
11. diet: high protein, high calorie with increased fluids, high calorie high protein drinks.
12. if fingers/toes are burned, wrap each finger/toe separately.
13. monitor urine output - if less than 30 ml/hour, assess for renal failure.
b. acute phase
1. begins with the start of diuresis (usually 48 to 72 hours post-burn) and ends with closure of the burn wound. phase concludes with burned area is completely covered with skin grafts or when wounds are healed.
2. margins of full-thickness eschar take longer to separate. as a result, they require surgical debridement and skin grafting for healing.
3. because the body is trying to reestablish fluid and electrolyte homeostasis, it is important for the nurse to follow the patient’s serum electrolyte levels closely (hypo - or hypernatremia, or hypo- or hyperkalemia).
4. complications include wound infection progressing to transient bacteremia as a result of manipulation (after hydrotherapy and debridement). same cardiovascular and respiratory system complications as in emergent phase may continue.
5. patient can become extremely disoriented, withdraw, or be combative. this is a transient state lasting from a day to several weeks. rom may be limited and contractures can occur. paralytic ileus results from sepsis.
6. management involves wound care with daily observation, assessment, cleansing, debridement, and dressing reapplication.
1. use sterile technique when handling burn.
2. give pain killer before dressing changes and hydrotherapy. pain control is usually opioid analgesics required.
c. rehabilitative phase
1. begins with wound closure and ends when the client returns to the highest level of health restoration.
2. goals are to assist the patient in resuming a functional role in society and accomplish functional and cosmetic reconstructive surgery.
3. provide support and management. use preventive measures to prevent contractures
10. nursing interventions
a. ensure airway patency and provide oxygen
b. monitor v/s, laboratory findings, capillary refill, adequate tissue perfusion.
c. keep patient npo and administer h2 antagonist to prevent curling (stress) ulcer.
d. elevate clients extremities (increase venous return).
e. use pressure dressings to prevent scarring and edema.
f. give pain medication prior to any treatment and especially before dressing changes.
g. nutritional requirements are increased with burns.
h. encourage rom. neutral positions are best to prevent contractures, unless neck is burned, then hyperextend.
i. maintain warm environment during acute phase.
j. monitor for shock symptoms. maintain protective precautions. reverse isolation.
k. if client underwent grafting, keep pressure off donor side to maintain blo
Let me know if you pass. Praying you do. Take mine on May 18, 2nd try. Having to do in depth studying and it helps to type all the info. If you know of any better way to do it please let me know cuz i haveta pass this time. Last time i made a near passing standard whatever that means, lol. Do you know if we have to pass on EVERY category?
Specializes in Medical and general practice now LTC.
Let me know if you pass. Praying you do. Take mine on May 18, 2nd try. Having to do in depth studying and it helps to type all the info. If you know of any better way to do it please let me know cuz i haveta pass this time. Last time i made a near passing standard whatever that means, lol. Do you know if we have to pass on EVERY category?
Yes you have to pass in all categories to pass the exam
2. Pernicious Anemia: Need vitamin B12 injections on monthly basis
3. Hematocrit: Should not increase by more than 4 points in 2 weeks. This is relevant when a patient is on epoetin alpha. Would need to decrease the dose.
4. AIR EMBOLISM:
S/Sx: pale, dyspneic, tachycardic, and coughing
Common with central line disconnect and with TPN
#1 priority is turn patient on left side and lower the HOB (trendelenberg) for 20-30 mins
#2 priority is to administer O2
5. Risk factors for colorectal cancer:
-50 years or older
-history of chronic inflammatory bowel disease (crohn's or ulcerative collitis especially)
-HIGH protein, HIGH fat, LOW fiber diet
-family history (1st degree relative)
6. Foods that contain high levels of potassium (cuz I can NEVER seem to remember):
here is a little info on the thyroid gland - hope this helps
disorders of the thyroid gland
1. graves disease - hyperthyroidism - too much energy
a. increased synthesis of thyroid hormone from overactivity.
b. excessive secretion of thyroid hormone
1. leads to increased basal metabolic rate (bmr).
2. increased cardiovascular function, ^'ed gi function, ^'ed neuromuscular function, weight loss, and heat intolerance.
3. thyroid hormone affects metabolism of fats, carbohydrates, and proteins.
4. calcitonin inhibits mobilization of calcium from bone and -'s blood calcium levels
c. an autoimmune disorder.
d. etiology: excess secretion of tsh from pituitary gland. thyroiditis, tumor, goiter. physiological or psychological stress, infections,
f. s/s: nervousness, weight loss despite increased appetite, sweaty/hot (heat intolerance), exophthalmus (no cure for this), hyperactivity (cant sit still), ^'ed appetite, b/p 'ed, flushed smooth skin, oliogomenorrhea or amenorrhea, palpitations, insomnia. all v/s are ^'ed - think of patient as being hyperactive.
g. diagnosis: serum t3 and t4 are increased. radio-iodine uptake is increased. thyroid scan shows enlarged thyroid gland or nodules.
h. treatment/nursing interventions
1. monitor v/s & i & o - determine presence of thyroid storm.
2. lifelong antithyroid medication.
3. surgical removal of thyroid.
a. radioactive iodine 131
1. the thyroid gland absorbs the i-131 which destroys some of the thyroid cells over a period of 6 to 8 weeks. rule out pregnancy first.
2. advise patient against close contact with other people, avoid kissing for 24-hours.
3. test females for pregnancy. pregnancy should be delayed 12 months.
4. advise patient to drink with straw
b. thyroidectomy or partial thyroidectomy
1. instruct patient to hold hands behind neck when coughing, sitting, turning, or getting up/back into bed to reduce post-op pain and decrease tension on suture line.
2. position semi-fowlers with head and neck supported. ice collar to wound to prevent edema.
3. monitor for hemorrhage, edema, exudates over upper chest, upper back, shoulders, back of neck.
4. promote patent airway - keep hob elevated 30 degrees. keep sterile oral suction and emergency tracheotomy tray within reach. avoid hyperextension of the neck
5. keep phone, personal items, call bell, remote control within reach.
6. diet: increase calories
7. assess for laryngeal nerve damage: assess for hoorificeness. could lead to vocal cord paralysis. if there is paralysis of both cords, airway obstruction will occur requiring immediate trach. bilateral nerve damage = breathing difficulties and aphonia (inability to speak)
8. instruct patient to report any signs of pressure on neck.
9. give eye care for exophthalmus: moisten eyes frequently with artificial tears to prevent irritation corneal infection. protect eyes from photophobia with glasses. sleep with hob elevated to minimize pressure on optic nerve and eye patches to protect eyes during sleep if lids do not close. soothe eyes with cool compresses.
10. prevent tetany by identifying hypocalcemia - numbness or tingling of toes, extremities, and lips, muscle twitches, positive chvostek's & trousseau.
i. thyroid storm/thyroid crisis
1. life threatening emergency that occurs in extreme hyperthyroidism.
a. thyrotoxicosis, and thyrotoxic crisis and thyroid storm are the same.
b. it is hyperthyroidism multiplied by 100.
c. results from a sudden surge of large amounts of thyroid hormones into the bloodstream causing a greater in body metabolism
2. s/s: temperature > 102 up to 106 (hyperthermia). tachycardia, systolic hypertension, abdominal pain, n/v, diarrhea, agitation, tremors, confusion, seizures, delirium to psychosis. triad s/s of thyroid storm: tachycardia, hyperthermia, agitation. all hyperthyroid manifestations are ^'ed.
3. may be precipitated by stress - surgery or infection, etc.
4. treatment
a. focuses on reducing circulating thyroid hormone levels by drug therapy.
b. inhibition of thyroid hormones with propranolol (inderal), corticosteroids, and thioamides (ptu)
c. treat hyperthermia with cooling blankets, tylenol (acetaminophen). aspirin is contraindicated -it releases thyroxin, provide cool sponge baths or ice packs to axilla and groin to decrease fever.
d. treat dehydration with iv fluids and electrolytes.
e. treatment of precipitating event.
f. administer insulin for hyperglycemia. b-blockers (-lol) for tachycardia
2. myxedema - hypothyroidism - not enough energy/ cretinism
a. occurs when there is an insufficient amount of thyroid hormone (th) being secreted by the thyroid gland causing a -'ed metabolic rate, decreased heat production. cretinism: hypothyroidism present at birth
b. hyposecretion of thyroid hormone results in overall decrease in metabolism.
c. etiology: an autoimmune disorder (hashimoto's thyroidism)causing destruction of the thyroid gland. external irradiation of the thyroid gland, infections, iodine deficiency. lithium therapy.
1. hashimoto's thyroidism: the immune system attacks the thyroid gland.
e. cretinism: hypothyroidism that is present at birth. is very dangerous and can lead to slowed mental and physical development if undetected.
1. state of severe hypothyroidism in infants. infants do not produce normal amounts of thyroid hormone.
2. their skeletal maturation and cns development are altered resulting in retardation of physical growth, mental growth, or both.
f. treatment/nursing interventions
1. diet: high fiber, high protein, low calorie, ^'ed fluid intake (2000 ml/day)
2. because of altered metabolism, patients do not tolerate barbiturates or sedatives. therefore cns depressants are contraindicated.
3. give medication in the am one hour before food or 2 hours after.
4. do not give beta blockers to asthmatics or diabetics - hides symptoms of hypoglycemia.
5. start thyroid medications at lowest dose and graduate to larger doses.
a. dosage is increased every 2-3 weeks until the desired response is achieved. advise patient that treatment is lifelong requiring constant monitoring by md. if thyroid drug is discontinued, it must be tapered.
b. teach patient s/s of hyperthyroidism which can occur with overmedication.
6. caution patient against electric blankets, extra clothing because of vasodilation.
g. myxedema coma: life threatening crisis state of hypothyroidism.
1. myxedema coma/crisis occurs as a result of long-standing or untreated hypothyroidism who experience significant stress as infection, medication, exposure to a cold environment or systemic disease.
a. can be precipitated by infection, drugs - especially opioids, tranquilizers, and barbiturates.
2. myxedema is an accumulation of hydrophilic mucopolysaccharides in the dermis and other tissues. this causes characteristic signs of hypothyroidism: puffiness, periorbital edema, and mask-like affect. thinning eyebrows.
a. the overall treatment is restoration of euthyroid state (having a normal thyroid gland as rapidly and safely as possible with hormone replacement. levothyroxine (synthroid) is the drug of choice - give slowly
b. maintain airway patency.
c. maintain circulation with iv therapy and ecg monitoring.
d. monitor v/s, abg, i & o, patient temperature.
e. keep patient warm
f. administer corticosteroids as ordered. assess for infections.
g. patient at risk for cad - monitor
h. assess for skin alterations - apply lotion, etc.
i. with rapid administration of thyroid hormone, plasma t4 levels may initiate adrenal insufficiency, hence steroid therapy may be ordered.
6. medications
a. synthroid (thyroxin- t4) - contraindicated in patients with mi, use cautiously in elderly and patients with diabetes, diabetes insipidus.
1. when starting thyroid replacement therapy, care must be taken with older patients and those with cad to avoid coronary ischemia because of increased o2 demands of the heart. start with lower doses first then .
2. teach to take at same time each day 1 hour before meals/2 hours after. 3. advise to take with plenty water or milk. optimal time is before breakfast.
4. withhold medication if heart rate above 100 or notify md.
5. report weight gain of 5 pounds.
b. cytomel (liothyronine sodium {t3}) - use cautiously in elderly patients and those with angina, renal insufficiency or ischemia.
1. long term use causes bone loss.
2. monitor b/p and pulse.
3. do not give im or subcutaneously.
c. ptu - propylthiouracil (propyl-thyracil)
1. inhibits oxidation of iodine in thyroid gland, blocking ability of iodine to combine with tyrosine to form t3. may prevent formation of t4
1. advise patient that iodized salt and shellfish should not be eaten because they alter drugs effectiveness.
2. instruct patient to take with meals to reduce gi reaction.
3. monitor lab values, especially cbc and hepatic function.
d. radioactive iodine (sodium iodide 131)
1. limits thyroid hormone secretion by destroying thyroid tissue
2. s/e: n/v, skin rash, urticaria, pruritus, pain on swallowing.
3. interventions
a. all antithyroid drugs must be stopped 1 week before 1st dose.
b. not used on patients younger than 30.
c. institute full radiation precautions. isolate patient, advise to avoid close contact with other people for at least 24 -48 hours
d. advise patient to fast overnight before therapy and to force fluids
e. monitor thyroid hormone levels
e. potassium iodide (sski, lugol solution, thyrosafe, thyroshield)
1. inhibits thyroid hormone formation, limits iodide transport into the thyroid gland and blocks thyroid hormone release.
2. used to prepare patient for thyroidectomy: given tid after meals for ten days before surgery.
3. s/e: periorbital edema, n/v, diarrhea, inflammation of salivary glands, burning mouth and throat, sore teeth and gums, potassium toxicity, acne- type rash. do not give ace inhibitors or potassium sparing diuretics with drug; may cause hyperkalemia.
f. propranolol (inderal) "olol"- a adrenergic blocker. relieves the adrenergic effects of excess thyroid hormone (sweating, palpitations, tremors)
g. interventions
1. dilute oral solution in water, milk, or juice and give after meals.
2. give through straw to avoid teeth discoloration.
3. earliest signs of delayed hypersensitivity reactions caused by iodides are irritation and swollen eyelids.
4. signs of iodide hypersensitivity are: angioedema, cutaneous and mucosal hemorrhage, fever, arthralgia, lymph node enlargement, and eosinophilia.
5. monitor patient for iodism which can cause a metallic taste, burning in mouth and throat, sore teeth and gums, increased salivation, sneezing, eye irritation with swelling of eyelids, severe headache, rash or soreness of the pharynx, larynx, and tonsils, gi irritation.
6. advise patient that sudden withdrawal may cause thyroid crisis.
7. teach patient s/s of k+ toxicity: confusion, irregular heartbeat, numbness, tingling, pain or weakness of hands and feet & tiredness.
8. advise patient not to increase potassium in diet.
9. advise patient not to eat iodized salt or shellfish.
i. thyroidectomy care
1. o2 therapy, suction secretions.
2. monitor for signs of bleeding and excessive edema
3. elevate hob 30º. support head and neck to avoid tension on sutures
4. check dressing frequently, check behind the neck, shoulders for bleeding.
5. assess for signs of respiratory distress, hoorificeness (laryngeal edema or damage.
6. keep tracheostomy set in patient's room for emergency use.
7. administer food and fluid with care (dysphagia is common).
8. encourage client to gradually rom of neck.
9. teach about medications, frequent follow-up. if thyroidectomy - life long replacement of medication (t5, t4). subtotal thyroidectomy - careful monitoring of return of thyroid function.
10. think bow tie:
b = bleeding
o = open airway
w = whisper
t = trach set
i = incision
e = emergency
11. be alert for post op complications
a. tetany: due to hypocalcemia caused by accidental removal of parathyroid gland. assess for numbness, tingling, or muscle twitching. monitor for chvostek's sign and trousseau's sign. give calcium gluconate iv slowly.
b. hemorrhage: monitor for hypotension, tachycardia, other signs of hypovolemia. irregular breathing, swelling, choking - possible hemorrhage and tracheal compression. early signs of hemorrhage: repeated clearing of throat, difficulty swallowing.
c. thyroid storm: life threatening. sudden increased release of thyroid hormone. assess for fever, tachycardia, 'ing restlessness, agitation, and delirium.
love2banurse
53 Posts
Thank you very much for all the posting that you have done.
You are the best:dancgrp: