hello everyone, i seen this on one of the thread that a recent nclex rn just took and passed her exam good luck everyone..... chest tubes -continuous bubbling= air leak -bubbling with inspiration= okay -continuous bubbling in suction chamber= okay -up and down in water seal= okay types of insulin -rapid acting (lispro, humalog) -onset= 5 minutes -peak= 30 minutes -short acting (novolog, regular) -onset= 30 minutes -peak= 2 hours -intermediate acting (nph) -onset= 1 hour -peak= 6-12 hours -long acting (humulin) -onset= 4 hours -peak= 16-18 hours -maslows= physiologicàsafetyàlove & belongingàesteem & recognitionàself actualization -piaget= sensorimotor (birth-2)àpreoperational(2-7)àconcrete operational(7-11)àformal operations(11-death) -eriksons=trust vs. mistrust(birth-1)àautonomy vs. shame and doubt(1-3)àinitiative vs. guilt(3-6)àindustry vs. inferiority(6-12)àidentity vs. role confusion(12-18)àintimacy vs. isolation(early adulthood)àgenrativity vs. stagnation(middle adult)àego integrity vs. despair(older adult) airborne precaution (sars is airborne/contact) my - measles chicken - chickenpox hez - herpes zoster (disseminated) tb - tb -private room -negative pressure with 6-12 air exchanges per hour -uv -mask, standard precautions (gown,gloves) -n95 mask for tb -put own eyewear-->mask-->gown-->gloves and take off in opposite order (this applies to all infection control) droplet precaution think of spiderman! s - sepsis s - scarlet fever s - streptococcal pharyngitis p - parvovirus b19 p - pertussis p - pneumonia i - influenza d - diptheria (pharyngeal) e - epiglottitis r - rubella m - mumps m - meningitis m - mycoplasma or meningeal pneumonia an - adenovirus -private room -mask and standard precautions contact precaution- standard precautions mrs.wee m - multidrug resistant organism r - respiratory infection - rsv s - skin infections w - wound infections e - enteric infections - clostridium defficile e - eye infections skin infections private room, gloves, gown v - varicella zoster c - cutaneous diptheria h - herpes simplex i - impetigo p - pediculosis s - scabies, staphylococcus cranial nerves 1) olfactory 2) optic 3) oculomotor 4) trochlear 5) trigeminal 6) abduchens 7) facial 8) acoustic 9) glossopharyngeal 10) vagus 11) spinal accessory 12) hypoglossal triage red-unstable, but fixable, see first yellow-stable, can wait for up to an hour for treatment, see second green- stable, can wait for a while, "walking wounded" black- unstable clients that probably won't make it, comfort measures doa- dead on arrival antidotes -heparin- protamine sulfate -coumadin- vitamin k -meg sulfate- calcium gluconate -morphine- narcan -anaphylaxis- epinephrine -tensilon-atropine sulfate -tylenol= mucomist -benzodiazapines= romazicon lab values coagulation -pt = 10-13 seconds, 1.5-2 times the control for coumadin therapy -aptt= 20-35 seconds, 1.5-2.5 times the control for heparin therapy -ptt = 60-70, 1.5-2.5 times control in anticoagulant therapy -inr= 2-3 electrolytes -na+ = 135-145 -k+ = 3.5-5.0 -cl- = 95-105 -ca+ = 8-10 -mg+ = 1.5-2.0 -protein = 3.5-5.5 hematology -wbc = 5000-11000 -neutrophils = 45-75% -rbc = 4.5-6 million -hgb = 12-16 (women), 13-18 (men) -hct- 36-46% -platelet = 150000-400000 renal function -bun= 7-20 -creatinine= 0.5-1.5 -urine specific gravity= 1.010-1.030 cholesterol -total= -ldl = liver -ast = 10-40 -alt= 5-35 electrolytes -hyponatremia- hypervolemia, edema, increased urine output, lethargy, dizziness, diarrhea, use isotonic solutions, give loop diuretics(excess water) -hypernatremia- tachycardia, hypertension, hypovolemia, seizures, decrease na+ intake, assess i&o, loop diuretics( excess sodium) hypokalemia- flattened t wave, u wave appearance, weak shallow respiratations, paresthesias, give k+ hyperkalemia-bradycardia, narrow/peaked t waves, widened qrs, flattened p waves, muscle cramps, diarrhea, give k+ wasting diuretics hypocalcemia-chvostek's sign (cheek twitching), trousseau's sign , diarrhea, bone fractures, give calcium gluconate, multivitamin hypercalcemia- decreased deep tendon reflexes, lethargy, coma, nausea/vomiting, give loop diuretics hypomagnesemia- chronic alcoholics, laryngeal stridor, inverted t wave,confusion, associated with hypokalemia hypermagnesemia- decreased deep tendon reflexes, hypotension, bradycardia, elevated t wave, weakness hpochloremia- tremors/twitching, shallow breaths, associated with hyponatremia/hypokalemia, give oral salt tablets hyperchloremia- weakness, lethargy, seen with cystic fibrosis, renal failure, diabetes insipidus hypophosphatemia- associated with hypercalcemia, slurred speech, tetany, parathesias, increased breathing rate, hypoactive bowel sounds hyperphosphatemia- associated with hypocalcemia, oliguria, corneal haziness, tachycardia, circumoral parathesias, tetany acid-base imbalances respiratory acidosis- copd, hypoventilation, etc. respiratory alkalosis- hyperventilation metabolic acidosis- dka, lactic acidosis, starvation, diarrhea, renal failure, shock metabolic alkalosis- vomiting, nasogastric suctioning, diuretic therapy, excess licorice intake iv solutions isotonic- normal saline, lactated ringers, 5% dextrose in water hypotonic- 0.45% ns, 0.225% ns hypertonic- 5% dextrose in 0.45% ns, 5% dextrose in 0.9% ns med-calc vol (ml) / time (minutes) x drop factor = flow rate dose order / dose on hand x amount available = amount to give random -vasopressin is for diabetes insipidus -duodenal ulcers= pain relieved by eating -gastric ulcers-pain exacerbated/unrelieved by food -hypoparathyroid- low calcium, high phosphorus, s/s: parathesias -hyperparathyroid- high calcium, low phosphorus, s/s: decreased deep tendon reflexes -5 rights of delegation- right task, right circumstance, right person, right direction/communication, right supervision/evaluation -normal serum osmolality= 275-295 -therapeutic digoxin level= 0.5-2 -therapeutic theophylline level= 10-20 -therapeutic lithium level = 1-1.5 -fetal heart strips: veal chop (variable is cord, early is head, accelerations is ok and late is placental insuffenciency) - 60 mg= 1 gr -autonomic dyreflexia- check foley first! -mi treatment= mona (morphine, oxygen, nitro, aspirin) -hyperglycemia = dry and drowsy, hypoglycemia = wet and wild -pulse paradoxus- pulse is weak on inspiration and strong on expiration -hypothyroidism: decreased t3 +t4, but increased tsh -hypertyroidism: increased t3 + t4, but decreased tsh