In delegation, nurses must take patients where there is...
Evaluation
Assessment
Teaching
Dont delegate what you can EAT
Addison disease vs Cushings disease
Addisions: down down down up down
(hyponatremia, hypotension, decreased blood volume, kyperkalemia, hypoglycemia)
Cushings: up up up down up
(hypernatremia, hypertension, increased blood volume, hypokalemia, hyperglycemia)
When do we hold potassium
Do not give potassium without adequate urine output
"No Pee, No K
APGAR
Appearance (color all pink, pink and blue, blue/pale)
Pulse (>100, <100, none)
Grimace (cough, grimace, none)
Activity (flexed, flaccid, limp)
Respirations (strong cry, weak cry, none)
For what diseases do we use airborne precautions
My (measles)
Chicken (chicken pox/varicella)
Hez (disseminated herpes zoster, shingles)
TB (TB)
When implementing airborne precautions, what do we have to do
Private, negative pressure room
Must wear mask
Can cohort with patient who has same organism, but not if they have different organisms
Place mask on client when they are being transported
For what diseases do we use droplet precautions
Think SPIDERMAN
S:sepsis
S:scarlet fever
S: streptococcal pharyngitis
P:Parvovirus B19
P:Pneumonia
P:Pertussis
I:Influenza Type B
D: Diptheria (pharyngeal)
E: Epiglottitis
R: Rubella
M:mumps
M:Mengitis
M:Mycoplasm or meningeal pneumonia
An: Adenovirus
When implementing droplet precautions, what do we have to do
Private room or cohort them with a client with the same infection
Wear a mask
Door may remain open
For what diseases do we use contact precautions
MRS.WEE
M:multi drug resistant organism
R: Respiratory infection (RSV)
S: Skin infections (varicella zoster, cutaneous diptheria, herpes simplex, impetigo, pediculosis, scabies)
W:wound infection
E: Enteric infection (C Diff)
E: eye infection (pink eye)
Signs and symptoms of air/pulmonary embolism
Chest pain
Difficulty breathing
Tachycardia
Pale/Cyanotic
Sense of impending doom
What do we do as the nurse for air/pulmonary embolism
Turn patient to the LEFT side and LOWER the head of the bed
Signs and symptoms of a woman in labor with a baby who has an unreassuring FHR
Late decels
Fetal bradycardia
Decreased variability
What do we do for a woman in labor who has an unreassuring FHR
Turn to the LEFT side
Give O2
Stop the Pitocin
Increase IV fluids (LR and NS)
What position is someone in for an epidural puncture
Side-lying
What position is the patient in AFTER a lumbar puncture (and also oil-based myelogram)
Have the pt lie Flat and Supine to prevent CSF from leaking out and prevent a headache
What do we do if a patient has decreased LOC during tube feeding
Position the patient on the RIGHT side (to increase gastric emptying) and RAISE the head of the bed to at least 30 degrees (to prevent aspiration)
Position for a patient with a CBI
The catheter is taped to the patients leg so the leg should be kept straight, but there are no other positioning limitations
Position of a patient after a myringotomy
Position the patient on the side of the AFFECTED EAR after surgery to allow for drainage of secretions.
This procedure is surgical incision into the eardrum (tympanic membrane), to relieve pressure or drain fluid.
Position of a patient after cataract surgery
Patient should sleep on the UNAFFECTED side and have a night shield for 1-4 weeks
Position of a patient after a thyroidectomy
Low or semi-fowlers. Support the head, neck, and shoulders. Have a trach at the bedside
Position of an infant with spina bifida
Prone! So their sac does not rupture
Position of a patient with bucks traction
Elevate the food of the bed for counter traction
Position of a patient after total hip replacement
Do not sleep on the operated side. No flexing the hip more than 45-60 degrees. Don't elevate the HOB more than 45 degrees. Keep the hip abducted by separating legs with a pillow or abductor
Position for a mom with a prolapsed cord
Knee-chest position or trendelenburg
Position for an infant with a cleft lip
On their back or in an infant seat to prevent trauma to the suture line. If feeding, hold in an upright position
Position for an ABOVE the knee amputation
Elevate for the first 24 hours on a pillow. Position prone daily to help with hip extension
Position for a BELOW the knee amputation
Foot of bed elevated for the first 24 hours. Position prone daily to help with hip extension
Position for a detatched retina
Area of detachment should be in the dependent position
Position for administration of an enema
Patient should be LEFT side laying with the knee flexed (Sims position)
Position during internal radiation
On bedrest while the implant is in place
Position if the patient has autonomic dysreflexia/hyperreflexia
Place the client in a sitting position (elevate the HOB to 90) FIRST before any other implementation
S&S include: extreme HTN, pounding headache, profuse sweating, nasal congestion, goose flesh, bradycardia,)
Position for a patient in shock
Modified trendelenberg (extremities elevated 20 degrees) with the knees straight and head slightly elevated
Position for a patient with a head injury
Elevate the HOB 30 degrees to decrease ICP
Position for a patient with peritoneal dialysis when the outflow is inadequate
Turn the patient from side to side BEFORE checking the tube for kinking
When someone has a head injury, what medication are we likely to give
Mannitol. An osmotic diuretic that decreases ICP and increase urine output. This crystallizes at room temperature so ALWAYS use a FILTER NEEDLE
What is myasthenia gravis
Muscular weakness produced by repeated movements. Disappears when the patient rests. No problems with CNS or PNS just random. We see diplopia, ptosis, impaired speech, dysphagia, respiratory distress
As the nurse, what do we do for myasthenia gravis
Administer meds before eating (anti cholinesterase, corticosteroids, immunosuppressants)
Optimal eye care (to prevent and help diplopia)
Maintain optimal mobility
Avoid things that precipitate myasthenia crisis (infections, stress, neomycin/streptomycin,
What S&S will show if it proceeds to a Myasthenia crisis
Sudden inability to swallow, speak, or maintain a patent airway
What test do we use to diagnose people with Myasthenia Gravis
Tensilon test. Where we inject tensilon and ask you to do activities like stand up and sit down and stand up and sit down. If you get tired we inject another dose. If you can stand up again, you probably have MG. MG is susceptible to the Tensilon test
What lab value do we need to be aware of prior to a liver biopsy
PTT
S&S of myxedema (hypothyroidism)
Slowed physical and mental fx
Sensitivity to cold
Dry skin and hair
Weight gain/obesity
S&S of graves disease (hyperthyroidism)
Accelerated physical and mental fx
Sensitivity to heat
Fine/soft hair
Weight loss
Thyroid storm
Caused by untreated Hyperthyroidism.
Increased temp, pulses and BP
Give hypothermia blanket, O2, PTU, potassium iodine
Hypoparathyrodism
CATS: convulsions, arrythmias, tetany, spasms, stridor
Too little calcium
Hyperparathyroidism
Fatigue
Muscle weakness
Renal calculi
Back/joint pain and pathological fractures
Too much calcium
Hypovolemia
Increased temp
Rapid/weak pulse
Increased respirations
Decrease BP
Anxiety
Urine specific gravity >1.030
Hypervolemia
Fluid overload
Bounding pulse
SOB
Dyspnea
Rales/crackles
Peripheral edema
HTN
Urine specific gravity <1.010
Diabetes insipidus
Decreased ADH
Excessive urine output and thirst
Dehydration
Weakness
We always get a urine specific gravity to tell the doctor how aggressively to treat it
What drug do we use for DI
Pitressin
Anti diuretic hormone
ADH is a hormone made by the hypothalamus in the brain and stored in the posterior pituitary gland. It tells your kidneys how much water to conserve.
ADH constantly regulates and balances the amount of water in your blood.
SIADH (Syndrome of Inappropriate Anti-Diuretic Hormone)
Increased ADH
Change in LOC
Decreased DTRs
Tachycardia
N/V/A
Headache
What drugs do we give for SIADH
Declomycin or diuretics
Hypokalemia
Muscle weakness
Dysrhythmias
Increase K intake (raisins, bananas, apricots, oranges, beans, potatos, carrots, celery)
Hyperkalemia
MURDER
Muscle weakness
Urine (oliguria/anuria)
Respiratory depression
Decreased cardiac contractility
ECG changes
Reflexes depressed
Hyponatremia
Nausea
Muscle cramps
Increased ICP
Muscle twitching
Convulsions
Hypernatremia
Increased temp
Weakness
Disorientation/delusions
Hypotension
Tachycardia
Hypocalcemia
CATS
Convulsions
Arrythmias
Tetany
Spasms
Stridor
Hypercalcemia
Muscle weakness
Lack of coordination
Abdominal pain
Confusion
Absent DTRs
Sedative effect on CNS
Hypomagnesemia
Tremors
Tetany
Seizures
Dysrhythmias
Depression
Confusion
Dysphagia
Hypermagnesemia
Depress the CNS
Hypotension
Facial Flushing
Muscle weakness
Absent DTRs
Shallow respirations
Emergency
If we suspect digoxin toxicity, what lab value should we check as a hidden sign
Magnesium could be low causing this!
When drawing up regular insulin with NPH, which order do you draw them up?
RN!!
Regular before NPH
Which disease should you avoid when you are pregnant?
German measles! AKA Rubella
S&S of Neuroleptic Malignant Syndrome
Think of S&M
You get hot (hyperpyrexia)
You get stiff (increased muscle tone)
You get sweaty (diaphoresis)
BP, Pulse and Resp inrease
Start to drool!
What do we do as the nurse for neuroleptic malignant syndrome
Immediately withdraw anti-psychotic meds (like Haldol)
Control hyperthermia
Hydration
Give Dantroline and Bromocriptine
Which MAOIs are used to treat depression
Pirates who say "arrrrr" take MAOIs when they are depressed
Parnate (Tranylcypromine)
Nardil (Phenylzine)
Marplan (Isocarboxazid)
and then Selegeline (Emsam)
Or the Depressed pirates too a ship to PANAMA
Parnate
Nardil
Marplan
How to remember the four defects in tetralogy of fallot
HOPS
Hypertrophy of right ventricle
Overriding aorta
Pulmonary stenosis
Septal defect
What do we do as the nurse for autonomic dysreflexia
Elevate the HOB to 90
Loosen constrictive clothing
Assess for bladder distention and bowel impaction (trigger!)
Administer antihypertensive meds
Pneumonic to remember high vs low blood sugar
Hot and dry? Sugar is high
Cold and clammy? Need some candy
Pneumonic to remember ventilator alarms
HOLD
High alarm? Obstruction in the tube (increased secretions, kink, patient coughs/gags/bites)
Low alarm? Disconnection or leak in the ventilator or patient airway cuff. Patient spontaneously stops breathing
ICP vs Shock vital signs
ICP: High BP, low pulse, low respirations
Shock: Low BP, high pulse, high respirations
What sign and symptom will we see in an infant that has a mom on heroin
Irritable, poor sucking
For Jewish people, what do we have to remember about their diets
No meat and milk together (must be 6 hours apart, but they have two meals with dairy and one meal with meat). Meat must be Kosher (drained of blood)
For Muslim people, what do we have to remember about their diets
No Pork, Alcohol, fermented fruits/veggies
Meat must be Halal (drained of blood)
Foods with special value: Figs, olives, dates, honey, milk and buttermilk
For Hispanic people, what do we have to remember about their diets
Basic foods are dried beans, chili peppers and corn
Use small amounts of meat and eggs
Saturated fat in prep is common
For Puerto Rican people, what do we have to remember about their diets
Main food is Viandos (Starchy veggies and fruits like plantains and green bananas)
Large amounts of rice and beans
Main beverage is Coffee
For African American people, what do we have to remember about their diets
Minimal use of milk in the diet
Frequent leafy greens (turnips, collards, mustards)
Common use of pork, fats, cholesterol, and sodium
Diet of a premature infant
100-200 kcal/kg/day
Need more sodium, calcium, and protein than full term infants
Supplements: Vitamin A, C, D, and iron. Sometimes Vitamin E. Vitamin K to prevent clotting problems
How many diapers for a full term infant
6-8 wet diapers and one stool daily
Diet of a full term infant
120 cal/kg/day
Human milk is ideal for first 0-12 months
IF using formula, should me for 12 months, before going to regular cows milk
Introducing a child to table foods: 1-4 months they can have
Liquid vitamins only (A, C, D, and fluoride if indicated)
Introducing a child to table foods: 4-5 months they can have
Cereal (usually rice cereal first)
Strained fruits next
Introducing a child to table foods: 5-6 months
Strained veggies
Strained meat
Introducing a child to table foods: 7-9 months:
Chopped meat, hard breads and "finger foods", baked potato and mashed potato
Diet for toddler through adolescent should be
High protein and high calcium
Allow the toddler to pick foods to avoid an argument (we just want them to eat! Anything!)
Diet for adolescent
Caloric, protein and calcium is high!
For adolescent girls that are menstruating, we need to increase their iron
Must have high minerals and high vitamins
Where do we get pulses for CPR in an adult and infant
Adult: Neck (sternoceidomastoid)
Infant: Arm (Brachial)
What is Cor Pulmonale
Abnormal enlargement of the right side (right HF) of the heart as a result of disease of the lungs or the pulmonary blood vessels (left heart failure).
Choose Edema or JVD if its a choice
Additional calories needed for a pregnant woman, and then for a lactating woman
Extra 300/day for a pregnant woman
Extra 500/day for a lactating woman
Difference between Enteral nutrition and Parenteral nutrition
Enteral goes to the stomach via G-tube or something
Parenteral goes through the heart straight into the cells
What do we do if the Parenteral nutrition needs to be stopped immediately or the new feeding bag is not ready on the unit
Hang D10% so we can keep the patients sugars in check and they don't suddenly go hypoglycemic
Anuria vs oliguria vs polyuria vs dysuria vs enuresis
Anuria = <100 ml in 24 hours (basically nothing)
Oliguria = 100-400 ml in 24 hours
Polyuria = >2000 ml in 24 hours (too much!)
Dysuria = painful or difficult voiding
Enuresis = bed wetting in a child over 5 (usually have small bladder and more common in m
Kegel exercises
Used to strengthen muscles of pelvic floor
Tighten pelvic muscles for a count of 3, then relax for a count of 3. Do this lying down, sitting, and standing for a total of 45
Toilet training time schedule
Never begin before 18th month
2-3 years: bladder control reflex achieved
3 years: regular voiding habits establisted
4 years: independent bathroom activity
5 years: night time control expected
Neprolithiasis
Kidney stones
Uterolithiasis
Stones in the ureter
Causes of kidney/ureter stones
Obstruction and urinary stasis
Hypercalcemia
Dehydration
Immobility
Gout
What do we do as the nurse for kidney stones
Monitor I&O and temp
Avoid over hydration and under hydration
Strain the urine and check the PH
Give analgesics
Diet for prevention of stones
Low calcium
Low sodium
Low in oxylates (spinach, cola, tea, chocolate)
No vitamin D (increases calcium absorption)
Low organ meats
Drugs for stones
Broad spectrum antibiotics
Thiazide diuretics
Allopurinol
Vitamin B6 (pyridoxine)
Extracorporeal Shock wave therapy
Non-invasive treatment of the kidney using an acoustic pulse.
Teach patient to report fever, decreased UO and pain
Hematuria is expected but should clear within 24 hours
Cystitis
Inflammation of the bladder
Urinary frequency, burning on urination, cloudy/foul smelling odor
What do we do as nurses for cystitis
Get a clean catch for testing
Encourage 3000ml of fluid a day
Give cranberry juice / urinary acidifiers
Void every 2-3 hours
Teach females to void after intercourse and to wipe from front to back
Pyelonephritis
Inflammation of the kidney caused by a bacteria
Chills, fever, malaise, flank pain, urinary frequency, dysuria, CVA tenderness
What do we as nurses do for Pyelonephritis
Bedrest during the acute phase
Antibiotic therapy, antiseptics, analgesics
Encourage 3000ml/day
Glomerulonephritis
Damage to the glomerulus caused by an immunological action that results in proliferative and inflammatory changes within the glomeruli
Acute glomerulonephritis = Group A beta hemolytic strep infection that is somewhere else in the body(like a skin or thro
What do we do as a nurse for glomerulonephritis
Give meds to treat the infection
Treat volume overload and hypertension
(Antibiotics, corticosteroids, antihypertensives, immunosuppresives, diuretics)
Restrict sodium intake
Daily weights
Assess I&O and serum potassium
Bed rest
Diet for someone with glomerulonephritis
High calorie, low Protein
What is benign prostatic hypertrophy
Enlargement of the prostate gland that causes urinary flow obstruction, incontinence, and possible infection
How do we diagnose it
BUN and creatinine
PSA (Prostate specific antigen) (should be less than 4mg/ml)
Transabdominal/transrectal ultrasound
Prostate biopsy
What do we usually see with BPH S&S
Hesitancy (dribbling, weak urinary system)
Frequency, dysuria, urgency, nocturua
Hematuria before or after voiding
Retention
What do we do as the nurse for BPH
Administer meds (5-alpha reductive inhibitor and alpha-blocking agents)
Suprapubic cystostomy (mini urostomy to drain bladder)
Prostatectomy (TURP, Suprapubic resection through bladder, retropubic resection through abdomen)
Assess for Shock and hemorrhage
Phases of acute kidney injury
Oliguric
Diuretic
Chronic
Oliguric phase of AKI
UO less than .5 ml/kg/hr
N&V
Increased Serum K, BUN, and creatinine
Increased Ca, Na
Decreased PH
Anemia
Pulmonary edema, CHF
Hypertension
Albuminuria
Diuretic phase of AKI
UO 4000-5000 ml /day
Increased BUN
Loss of Na and K in urine
Increased mental and physical activity
Chronic phase of AKI
Anemia
Azotemia
Acidosis
Fluid retention
Urinary output alterations
What do we do as the nurse during the oliguric stage
Limit fluids
Diet adjustment (restrict protein, sodium, and potassium)
Meds as needed (Kayexalate for high K)
Dialysis (hemodialysis or peritoneal)
What do we do as the nurse during the diuretic phase
Fluids need to be replaced
Diet adjustment (high carb, restrict protein, potassium and sodium)
Replace K
Dialysis (hemodialysis or peritoneal)
Continuous ambulatory peritoneal dialysis
Client performs self-dialysis 7 days a week 24 hours a day
Dialysis is warmed (using heat pad), then infused and then dwell time is 4-8 hours
Tubing and bag is disconnected or rolled up and worn under the clothing
After the dwell time, the fluid is draine
Automated peritoneal dialysis
Uses a machine with a warming chamber for the dialysate infusion, dwell and outflow
The times and volumes are preset (10 mins infusion, 10 mins dwell, 10 min outflow) and they do this for 8-10 hours
Intermittent peritoneal dialysis
4 days a week for 10 hours a day
Can be automated or manual
Continuous peritoneal dialysis
Automated machine used at night
Final exchange is left in place for the next day and then drained at night
Sleep apnea syndrome
The client snores loudly, stops breathing for 10 seconds or more and then awakens abruptly with a loud snort (multiple times throughout the night)
Often in older, overweight men, elderly, and people with thick necks, smokers
Obstructive sleep apnea
Lack of airflow due to the occlusion of pharynx
Central sleep apnea
Cessation of airflow and respiratory movements
What do we do as the nurse for sleep apnea syndrome
Avoid alcohol and meds that depress the upper airway
Talk about weight loss and diet
CPAP or BiPAP
Surgery
Low-flow O2
Position (fixing devices are used to prevent subluxation of the neck and tongue obstruction)
What is Alzheimers disease
Progressive, irreversible, degenerative neurological disease characterized by loss of cognitive function and disturbed behavior. Forgetfulness progressing to inability to recognize familiar faces, places and objects
Why does death occur with Alzheimers
It occurs secondary to complications like
Pneumonia
Malnutrition
Dehydration
Complimentary therapy/alternative therapy for Alzheimers
Ginkgo biloba
Fish high in Omega3 fatty acids
1000 international units Vitamin E 2xday
What meds do we give for Alzheimers
Cholinesterase inhibitors
NMDA receptor antagonists antidepressants
Can an LVN do blood?
No
When a patient has a phobic disorder, what is the best thing to do for them
Systematic desensitization
When a mom comes in in active labor, what is the first thing we do for them?
Listen to fetal heart sounds
Med of choice for V tach
Lidocaine
Med of choice for SVT
Adenosine or Adenocard
Med of choice for asystole
Atropine
Med of choice for CHF
Ace inhibitor "pril
Med of choice for status epilepticus
Valium
Med of choice for bipolar disorder
Lithium
When is S3 a normal sound
CHF it is normal, but NOT in MI
What is a low residue diet
Low fiber
Where is TPN given
Subclavian vein
What must we do after an endoscopy
Check the gag reflex
Where is insulin produced
The beta cells of the pancreas
When we have appendicitis, where is the pain
Right lower quadrant. Rebound tenderness
What is the only insulin that can be given IV
Regular. All others must be given sub Q
Onset of Lispro
15-30 mins
Onset of Aspart
15-30 mins
Onset of Glulisine
10-15 mins
Onset of Regular
30-60 min
Onset of Isophane (NPH)
1-2 hr
Onset of Glargine (Lantus)
3-4 hr
Duration of Lispro
3-6 hours
Duration of Aspart
3-5 hours
Duration of Glulisine
3-5 hours
Duration of Regular
6-10 hr
Duration of Isophane (NPH)
16 hours
Duration of Glargine (Lantus)
24 hours
List cranial Nerves 1-12
Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Acoustic
Glossopharnygeal
Vagus
A Accessory (spinal)
Hypoglossal
Function of olfactory nerve
Sense of smell
Function of optic nerve
Sense of vision
Function of oculomotor nerve
Pupils constrict
Raising of eyelids
Function of trochlear nerve
Downward and inward movement of eye
Function of trigeminal nerve
Motor: jaw movement
Sensory: sensation on the face and neck
Function of the abducens nerve
Lateral movement of the eye
Function of the facial nerve
Motor: facial muscle movement
Senesory: Taste on the anterior 2/3 of the tongue
Function of the acoustic nerve
Sense of hearing and balance
Function of the glossopharyngeal nerve
Motor: pharyngeal movement and swallowing
Sensory: taste on the posterior 1/3 of tongue
Function of the vagus nerve
Swallowing and speaking
Function of the accessory nerve
Motor: Flexion and rotation of the head, shrugging of the shoulders
Function of the hypoglossal
Motor: Tongue movements
How do we test to make sure the olfactory nerve is working
Have client smell a non-irritating substance like coffee through each nostril seperately
How do we test to make sure the optic nerve is working
Snellen chart for far vision
Read the news paper for near vision
Opthalmoscopic exam
How do we test to make sure the oculomotor nerve AND the trochlear nerve AND the abducens nerve are working
Instruct client to look up, look down, look inward
Observe for symmetry and eye movement
Shine penlight into the eye as the client stares straight ahead
How do we test to make sure the trigeminal nerve is working
Test with a pin and a wisp of cotton over each division of both sides of the face
Ask the client to move the jaw laterally against pressure, to open and to bite down
How do we test to make sure the facial nerve is working
Observe for symmetry when the client frowns, smiles, raises eyebrows, closes eyelids, whistles, and blows
Place a sweet, salty, sour, and bitter item on tongue
How do we test to make sure the acoustic nerve is working
Watch ticking into ear, Rinne test, Weber test, and rub fingers together
Test posture and standing with eyes closed
Otoscopic exam
How do we test to make sure the glossopharyngeal nerve is working
Place a sweet, salty, sour, and bitter item on tongue
Note ability to swallow and handle secretions
Elicit gag reflex
How do we test to make sure the vagus nerve is working
Inspect soft palate when client goes "ahhhhh"
Observe uvula is midline
Rate quality of voice
How do we test to make sure the accessory nerve is working
Ask client to move head side to side and shrug their shoulders with resistance
How do we test to make sure the hypoglossal nerve is working
Inspect tongue
Ask client to stick out tongue and move it side to side
Observe midline, symmetry, and rhythmic movements
Position of a patient after a laminectomy
Keep the body straight
Pillow should be placed longitudinally between the legs to prevent adduction and spinal torque
Correct positioning for a trochanter roll
From the lateral aspect of the hip to the mid-thigh. Trochanter roll is a positioning device that is placed under the greater trochanter to prevent prevent external rotation of the hip joint and prevents the femur fro rolling
What is the FIRST thing we do when a patient has constipation
Increase their fresh fruits, veggies, and cereal
Asking for a stool softener or laxative is a last resort
When a patient has a thyroidectomy, what is MOST important to assess
If the parathyroid accidentally gets nicked during thyroidectomy surgery, there can be a decrease in serum calcium.
Must look for tingling around the mouth, toes, fingers, and also for muscular twitching
How to use a cane
Hold cane in the opposite hand of the affected extremity
Advance the cane with the affected/hurt extremity. Lean on the cane when advancing the good leg
How to go up and down stairs with a cane
up with the good, down with the bad"
Going up: Step up on the good extremity, then place the cane and affected extremity on the step
Going down: Step down on the bad extremity with the cane, and follow with the good leg
When you have a cast, which type of exercises should be performed
isometric exercises
Contraction of the affected muscle without movement of the joint
Why is tea a problem in graves disease
It is a stimulant and in graves disease your body is already in hyperactive hyper metabolism mode
How to get a client to sit on the side of the bed
Place hands under knees and shoulders of client
Have client push elbow into bed, while at the same time the nurse lifts the clients shoulders with one arm and swings the legs around with the other arm
How to get a client from sitting to standing
Face client and firmly grasp rib cage
Push nurses knees against one of clients knees
Rock client forward until they come to a standing position
Pivot client to position him/her into chair (chair should be on clients strong side)
Why do we do passive range of motion
Retention of joint range of motion and maintenance of circulation
Performed by the nurse without assistance from the client
Why do we do active assistive range of motion
Increases motion of the joint
Performed by the client with the assistance of then nurse
Why do we do active range of motion
Maintains mobility of joint and increases muscle strength
Performed by client without assistance
Why do we do active resistive range of motion
Provision of resistance to increase muscle strength
5 lb weights or bags may be used
Performed by the client against manual or mechanical resistance
Why do we do isometric exercises
Maintenance of muscle strength when the joint is immobilized
Performed by the client. Alternate contraction and relaxation of the muscle without moving the joint
What do we do as the nurse to prevent thrombus formation
Leg exercises: flexion, extension of toes for 5 mins every hour
Fruits and veggies that are high in potassium
Fruits: Bananas, cantelopes, oranges
Veggies: Broccoli, spinach, potatoes
What is a tilt table and what is it used for
For weight bearing on long bones to prevent de-calcification and bone weakess
Use elastic stockings to prevent postural hypotension
Board can gradually be tilted in 5-10 degree increments
BP needs to be checked during procedure
Rules for crutches
Measure two fingers below axilla
Client should support weight on handpick not axilla
Crutches are kept 8-10 inchses out to the side
Elbows are flexed at 20-30 degrees
Stop and rest if diaphoretic and short of breath
Things to note about using a walker
The nurse should be behind the client with hold of their gait belt
The client should sit down by grasping the armrest on the affected side and then shift weight to the good leg and hand and then lower themselves into the chair
When do we assume a baby has developmental hip dysplasia
When the head of the femur does not fit in the acetabulum
Uneven gluteal folds and thigh creases
Infant lays on back with legs flexed
Click sound when legs are moved to abduction
Delays in walking/limping with older children
Hip dysplasia in newborn to 6 months
Reduction by manipulation
Pavlik harness: worn from 3-6 months FULL TIME. Do not remove!
Sponge bath is recommended
Check skin 2-3 times a day
Avoid lotions and powders
Gently massage under skin to stimulate circulation
Place diapers under straps
Place sh
Hip dysplasia in 16-18 months
Gradual reduction by traction (using bilateral Bryants traction
Cast for immobilization
Hip dysplasia in an older child
Preliminary traction
Open reduction
Hip spica cast
Gemfibrozil
Helps reduce cholesterol and triglyceride levels
Must monitor liver function! AST and ALT
Take 30 mins before breakfast/dinner
If you are having a bad reaction to a DtAP vaccine, when will you see the side effects
You will see a low-grade fever and it will be about 48 hours after the injection
Fluoxetine
It is an energizing anti-depressant. Clients should be more energized and can participate in milieu if they are having a positive response to this medication
When you have medication-induced Cushing syndrome, what is causing this
Steroids! they need to be tapered off! Never stop them automatically even when you are having a bad reaction because you can die from acute adrenal insuffiency
When administering anti-psychotics, what do we need to monitor for?
Hypotension. Ask them to sit and stand while you take their BP two times to make sure they aren't hypotensive before you give the med
What do we need to remember about Prochlorperazine
We must draw it up in a separate syringe than all other medications
It is an anti-psychotic and treats schizophrenia and anxiety as well as N&V
What do we do when a baby has club foot
Reposition the foot to normal position Q4
Casts and splints correct the deformity if placed early (change casts every few days for the first 1-2 weeks and then every 1-2 weeks after that)
Surgery is usually required for older children
Gout
A high level of uric acid that leads to joint deterioration
Put on a low purine diet (no fish or organ meats)
You do not need rest and activity and exercise like you do in RA and osteoarthritis, you just need to manage the pain
S&S of phelbitis
Redness in the area and red streaks
When are we going to administer an anti anxiety
When a client is restless and has an increased heart rate
Ranitidine
H2 histamine antagonist that is used to prevent stress ulcers
It reduces the acid production in the stomach
Promethazine
An anti-emetic
Complication of pneumonia would look like:
A cough producing thick yellow mucous
S&S of R sided heart failure
Peripheral edema and anorexia
Distended neck veins
Polycythemia
What is placenta previa
First and second trimester bleeding
Third trimester bleeding that is sudden, bright red, profuse and PAINLESS
This is where the placenta is implanted in the lower uterine segment usually near or over the cervical opening
No vaginal or rectal exams
What is the priority when a client returns from a scleral bucking procedure
Make sure the client is not nauseated or vomiting as this can increase intraocular pressure and mess up the surgery
What is abruptio placentae
The premature separation of the placenta which leads to hemorrhage. Biggest concern is fluid volume deficit related to bleeding
What is battery
Harmful or offensive touching of another person
Clients can refuse medication, do not force them, even if they are psychotic
What is the priority for a patient with sickle cell crisis
Adequate hydration
What is an ewald tube
A large orogastric tube that is designed for rapid lavage and often causes gagging and vomiting. Always have suction equpiment at the bedside
What drug do we give for PVCs
Lidocaine
What do we give for bradycardia
Atropine
S&S when a client is withdrawing from heroin
Runny nose
Yawning
Fever
Muscle and joint pain
Diarrhea
(A lot like S&S of the flu)
When undergoing a transplant, what do we need to remind visitors of
They can't be in the room for the first 72 hours
When walking with a cane, what is the sequence of steps
Cane first
Then weak foot
then good foot
Normal field of vision for each eye
50 up
60 in
70 down
90 out
Define tonometry
Measures intraocular pressure
Pressure is increased in glaucoma
Myopia
Hyperopia
Presbyopia
Astigmatism
Myopia: nearsightedness (can see near things well)
Hyperopia: far-sightedness (can see things far well)
Presbyopia: blurry vision of near things due to age
Astigmatism: Blurry vision from an uneven curving of the cornea
What do we do for non-penetrating abrasions
Eye patch for 24 hours
What do we do for non-penetrating contusions
Cold compresses, analgesics
What do we do for penetrating eye injuries (pointed or sharp objects)
Refer to a surgeon
Cover the eye with a patch
What do we do for conjunctivitis
Warm, moist complexes
Topical antibiotics
Hydrocortisone ophthalmic ointment
Caused by virus, bacteria, and allergies
What do we do for styes
Warm compresses
Antibiotics
I&D
Caused by a staphylococcal organism
What is a chalazion and what do we do for it?
Inflammatory cyst leading to a duct obstruction
Must I&D
What is keratitis and what do we do for it
Inflammation of the cornea
Antibiotics
Hot compresses
Steroids, except with Herpes Simplex
What is uveitis and what do we do for it
Inflammation of the iris, ciliary body, and choroid
Warm compresses
Dark glasses
Antibiotics, analgesis, sedatives
What is retinopathy of prematurity
A cause of blindness in premature infants because when they are premature, we slam them with O2, but this its much causing the retinal vessels to constrict and leads to blindness
How do we prevent retinopathy of prematurity
Have experts look at the eyes in all premature babies (less than 36 weeks or 2000g)
Use minimal O2
Keep sats 95-100
What is strabismus
The eyes do not function as a unit because there is an imbalance of extra ocular muscles
What do we do for people with strabismus
Close good eye to strengthen bad eye
Eye exercises
Surgery on rectus muscle of eye
What is a detached retina
Separation of the retina from the choroid caused by trauma, gain, diabetes or tumors
Patient will see flashes of light, floaters, curtain coming down, confusion/apprehension
What do we do for a patient with a detached retina
Bedrest (don't bend forward, no excessive movements)
Area of detachment needs to be in dependent position
Surgery to reattach the retina to the choroid (gas or air bubble used to apple pressure the the retina)
No hair washing for 1 week
Avoid strenuous ac
What are cataracts
Partial or total opacity of the normally transparent lens
(Caused by: congenital, trauma, again, diabetes, drugs like steroid therapy, exposure to radioactivity)
What do we do for a patient with cataracts
Extracapsular extraction (cutting through anterior capsule to expose opaque lens)
Intracapsular extraction (removal of entire lens/capsule,easier for us, more harmful to client)
Then implant a new lens
What is glaucoma
Abnormal increase in Intraocular pressure leading to visual disabilities and blindness
Cloudy, blurry vision or loss of vision
Artificial lights have rainbows or halos around them
Decrease in peripheral vision
Two types of glaucoma
Angle closure: sudden onset, emergency from allergy, vasomotor problems, and emotional disturbances
Open angle: blockage of aqueous humor flow from trauma, tumors, hemorrhage, aging
What do we do for a patient with glaucoma
Meds! (Prostaglandin agonists, adrenergic agonists, beta-adrenergic blockers, cholinergic agonists, carbonic anhydrase inhibitors)
Surgery (laser trabeculoplasty)
Avoid tight clothing
Avoid use of mydriatics (Atropine)
What are the 5 dangers we need to educate the public on for S&S of glaucoma
Brow arching
Halos around lights
Blurry vision
Diminished peripheral vision
Headache or eye pain
What is conductive hearing loss
Disorder in the auditor canal, ear drum, or ossicles from infection, inflammation, foreign body, trauma or ear wax
What is a complication from conductive hearing loss
Meningitis
Audiogram vs tuning fork
Audiogram: quantitates the degree of hearing loss
Turning fork: qualitates : the type of loss
How do we properly instill eardrops
Put the affected ear up
Pull the ear up and back for an adult (greater than 3)
Pull the ear down and back for children under 3
What do we do if we note bleeding after an ear procedure
Do not put pressure!! Call the HCP immediately
Possible complications from ear surgery
Facial nerve damage
Infection
Vertigo, tinnitus
What is sensorineural hearing loss (perceptive)
Due to a disorder of the organ of Corti or the auditory nerve caused by congenital things (mother being exposed to a communicable disease), infection, drug toxicity, trauma, Menieres disease
What is acute otitis media
Ear infection in the middle of the ear from a pathogenic organism (bacteria or virus)
What do we do as the nurse for otitis media
Antibiotics (organism specific)
Antihistamines for allergies
Nasal decongestants
Ventilatory tubes (inserted in the eustachian tube for continuous ventilation)
Tympanoplasty (reconstruction of the ossicles and tympanic membrane)
Myringotomy (incision to t
What is Menieres disease
Dilation of the membrane of the labyrinth
There is recurrent attacks or vertigo and sensorineural hearing loss that can occur multiple times a week and go into remission for years at a time
How do we diagnose Menieres disease
Weber and Rinne test
CT scan
S&S of Menieres disease
N&V
Intolerable vertigo and tinnitus
Pressure / fullness in the ear
Fluctuating/progressive decreased hearing on the involved side
Nystagmus/headache
Diet for a patient with Menieres disease
Low sodium (2000mg/day)
Avoid caffeine, nicotine, and alcohol
What do we need to teach the client about Menineres disease
To slow down their body movements as jerking or sudden movements can cause an attack
Need to lie down when an attack occurs
If driving, pull over and stop the car
What meds are we giving to someone with Menieres disease
Antihistamines
Anti emetics
Antivertigo
Diruetics
What is trigeminal neuralgia
A cranial nerve disorder where there is stabbing/burning facial pain that is excruciating and unpredictable
Often will be twitching and grimacing of the facial muscles
What do we do as the nurse for trigeminal neuralgia
Identify and avoid what causes this
Avoid rubbing of the eye
Chew on the unaffected side
Treatment: Carbamazepine, alcohol injection to the nerve, resection of the nerve, microvascular decompression
What is bells palsy
A 7th cranial nerve disorder where there is an inability to close the eye, decreased corneal reflex, increased lacrimation, speech difficulty, loss of taste, distortion of one side of the face
What do we do as the nurse for bells palsy
Protect the head from cold or drafts
Administer analgesics
Teach isometric exercises for the facial muscles
Emotional support for body image disturbance
Full recovery takes 3-5 weeks
What is acoustic neuroma
A benign tumor of the 8th cranial nerve that causes deafness (partially initially) and dizziness
What do we do as the nurse for acoustic neuroma
Pre and post op care for posterior fossa craniotomy
Assist with turning of the neck for comfort measures
Treatment: surgical removal of tumor
What is guillen barre syndrome
Progressive inflammatory autoimmune response resulting in a loss of motor fx symmetrically, starting from the lower extremities and working its way up. Also paresthesias and too much or too little autonomic dysfunction (hypotension, tachycardia, flushing,
How long to GB symptoms last for
Progress for 10 days and then last for 10 days
How long is the GB recovery period
Several months to a year, normal loss of fx is 10% at the end of recovery
As the nurse, what do we do for GB patients
Steroids in acute phase
Mechanical ventilation, elevate HOB, suctioning
Plasmapheresis treatment! High dose IV immunoglobiluns
Physical therapy and ROM
Paid reducing measures
Eye care
Prevent complications (URI, aspiration, constipation, urinary retention
S&S of meningitis
Headache, fever, photophobia
Nuchal rigidity
Kernigs sign, Brudinskis sign,
Change in LOC
Seizures
In infants: Refuses feedings, vomiting/diarrhea
Bulging fontanelles
Vacant stare, high pitched cry
Causes of meningitis
Infection (virus, bacterial, fungal)
Neurosurgical procedures
Basilar skull fractures
Otitis media, mastoiditis
What do we do as the nurse for meningitis
IV antibiotic therapy
Monitor ABGs, arterial pressures, body weight, serum electrolytes, urine volume, specific gravity, osmolality
Droplet precautions
Prevent it! Give vaccines for those 65+ and revaccinate every 5 years. Hib vaccine for infants
When we are admitting a psych patient, what type of admission history do we need to get
Biopsychosocial so we are encompassing all of them, not just a psych approach
When a client with parkinsons is experiencing extrapyramidal side effects, which med should we administer
Biperiden
What is the main cause of asthma
Inhaled allergens like animal dander, mold, pollen, and dust
Glipizide is given to what type of client
A client with Type 1 diabetes where they produce none of their own insulin
What do we do for patients with rheumatoid arthritis
Apply heat and do ROM exercises
This reduces swelling, increases circulation and decreases stiffness while preserving joint mobility
Correct way to cough and deep breathe
Take three deep breaths, hold your incision, and cough
Sucralfate
Used to treat duodenal ulcers
Best results if taken on an empty stomach
When does "stormy" behavior onset?
Age 11
Terbutaline
Bronchodilator and anti-contraction
Used to stop contractions in preterm labor and delay the process
Side effects are maternal and fetal tachycardia, tremors, nervousness, headache, and pulmonary edema
Continuous Ambulatory Peritoneal Dialysis
Should check weight daily
Do not milk catheter, drain by gravity
Eat a high protein diet as CAPD has taken out protein while flushing out the cells
Use strict aseptic technique
Use of aspirin during pregnancy
Aspiring can cause fetal hemorrhage, do not use this during pregnancy
Glucose levels during and after pregnancy
Because of hormone levels and a baby in you, glucose rises during pregnancy. Glucose will drop after delivery
Drug of choice for treatment of candidasis
Ketoconazole
Drug of choice for treatment of TB
Rifampin
Drug of choice for trichromonias, IBD, and intestinal amebiasis
Metronidazole
If we have a client who is withdrawing from alcohol, and their vital signs continue to creep up, what do we do
We need more sedation, these patients are approaching delirium tremens
When we have a bunch of clients getting blood transfusions, all with reactions who is the most crucial to see first
Vomiting is first
JVD second
Itching third
Headache fourth
What is the best lab value to look at for long term nutritional status
Albumin
Side effects of Haldol
Galactorrhea
Lactation
Gynecomastia
How often do we assess for suctioning with a vent
Q2
How often do we move the ETT from one side of the mouth to the other
Q24 hr to prevent ulcers
How often do we provide oral hygeine for someone with an ETT
Twice a shift
When can we give TPA in an MI
Within 6 hours
First test to show evidence of an MI
CK MB (appears in 3-6 hours)
Then
Troponin (appears in 4-12 hours)
Treatment for sinus tachycardia
Treat underlying problem
Beta blockers
Calcium channel blockers
or Cardioversion
Treatment for sinus bradycardia
Atropine or possible pacemaker
Treatment for Premature atrial contraction
Treat the underlying cause (alcohol, tobacco, caffeine)
Treatment for Atrial Flutter
Vagal maneuvers
Adenosine
Cardioversion/ablation
Treatment for A Fib
Calcium channel blockers
Digoxin
Beta blockers
Cardioverson
Warfarin
Treatment for PVC
Amiodarione
Betablockers
Procainamide
Treatment for V-tach
If monomorphic: give Procainamide, Sotalol, Amiodarone)
If polymorphic: give Mag, Isoproterenol
If Pulseless: give CPR, defib, epic, amiodarone
Treatment for V fib
CPR
When someone has a permanent pacemaker, what is something that we have to be sure they do
Check their pulse for a full one minute every day at the same time of day
What patient needs Fluvoxamine
OCD
Side effect dry mouth
Do we hear S3 in left sided or right sided heart failure
Left
If someone was hurt and now is returning to the job but they are impaired forever (walk with a limp, hurt back can't lift) what do we do for them
Try to reassign them a job that is more feasible and fitting for them
Can we ever remove bucks traction weights?
No!
Not without a doctors order. We must reposition the client in bed with the weights still on. If we take them off we are inturrupting the line of pull
Time frame for checking pedal pulses when coming back from a cardiac cath
Pulses need to be checked immediately. And then every 15 minutes for the first few hours
Orders and re-evaluation for wrist restraints
Wrist restraints need to be re-evaluated every 4 hours and a new order for a wrist restraint needs to be obtained every 4 hours
What is Raynauds phenomenon
Chronic connective tissue disease that causes inflammation, fibroids, and sclerosis of the skin and vital organs
Pain and color changes of the extremities when exposed to the cold
Arterial peripheral vascular disease
Care of the patient with Peripheral Artery disease
Monitor peripheral pulses
Good foot care
Do not cross legs
Stop smoking/regular exercise
Care of the patient with peripheral venous disease (varicose veins or thrombophlebitis)
Monitor peripheral pulses
Thrombectomy
Avoid extreme temps
SCDs/tedhose/elastic stockings
Bedrest 4-7 days
Elevate legs
Warm moist packs
Anticoagulants
When should a baby umbilical cord fall off
1-2 weeks after birth
No tub baths until them
Should be drying up and getting more hard to the touch
Things to remember about Native American culture
Native americans do not rely on the clock, they used to complete their days by the sun, so they may be late to an appointment
Diet for a patient after an appendectomy
We need wound healing so we need high protein and high vitamin C and high calories
What is the Somogyi effect
When blood glucose levels drop too low in the middle of the night, the body tries to compensate by rebounding into hyperglycemia, so you think you are high blood sugars in the morning when it is all just a facade
What is an EARLY symptom of hepatic encephalopathy
Impaired thought process and forgetfulness
What to know about an EEG
Painless test that records electrical activity of the brain
Wash hair before test to remove oils
Restrict tranquilizer meds and stimulants 24-48 hours befit (stimulants include coffee, tea, smoking, soda)
Instructed to stay awake late the night before so
Barium enema
During the test, patient is instructed to take slow deep breaths so they can retain the enema without blowing it all out
Table will tilt in various positions, and the stool might be a different color for 2-3 days following, but this is not the most import
What can long term steroid therapy cause
Osteoporosis and pathological fractures as well as muscle wasting
Diet for a patient with abdominal aortic aneurysm
Increased fiber and increased fluid intake so you don't have to strain when you are having a bowel movement which can increase pressure and lead to rupture of the aneurysm
With injury to T1-T6 what do we most need to worry about
Respiratory function
What best detects fluid gain/retention in an infant
Daily weights
When someone has a spinal cord injury, what is very important
Keeping the spine in alignment. Prevent flexion or hyperextension
What are Eriksons developmental stages and the ages for each
Trust/mistrust=birth to 1 year
Autonomy/Shame and doubt = 1 yr to 3 yrs
Initiative/Guilt = 3 to 6 yrs
Industry/Inferiority = 6 to 12 yrs
Identity/ Role confusion = 12 to 20 yrs
Intimacy/Isolation = 20 to 45 yrs
Generativity/Stagnation = 45 to 65 yrs
Integ
Most important way to see if diuretic therapy is working
Daily weights and decreased edema
K+ and Na are not the best way
How long does an MRI ususally last for
90 minutes
When does a depressed client have the highest level of functioning and activity
In the morning hours right after they wake up
When taking lithium, what lab value do we need to monitor
Sodium
The excretion of lithium is dependent upon normal sodium levels in the body. If there is too low sodium, lithium will not excrete and we can get lithium toxicity
Early stage of dementia vs late stage
Early: impaired concentration and memory loss
Late: Disorientation to person, place and time
If someone has a gastric ulcer, when are they going to experience the most pain
About 30 mins to one hours after eating
How do we know that our suctioning of an ETT was effective?
Listen to breath sounds when you are done and make sure it is clear and that there are no more adventitious breath sounds
When does the Babinski reflex disappear
1 year
When does the Moro reflex disappear
3-4 months
When does the Grasp reflex disappear
3 months for palmar
8 months for plantar
When does the Tonic Neck reflex disappear
3-4 months
Describe the RH incombatibility
Only RH negative mothers have a problem is their baby is positive and they are negative
If there is a low potassium level, why do we need to hold the digoxin
Because hypokalemia can lead to dig toxicity. We have to call the HCP and ask for a potassium supplement before giving the dig
What is imipramine
Antidepressant and nerve pain medication
Side effects include: fever, dry mouth, vomiting/diarrhea, fatigue, sore throat
What scale do we use to detect the presence of tradeoff dyskinesia
Abnormal Involuntary Movement Scale (AIMS)
Insulin with a fetus right after birth
The fetus produces insulin to match the mother during pregnancy (which is high). When the baby comes out, it is still producing a lot of insulin which can cause hypoglycemia. Must monitor for hypoglycemia
How often do we need to rinse and change a bag of continuous tube feeding
Every 4 hours to minimize the growth of organisms
Describe an electromyography
A noninvasive procedure that takes about 30 minutes. Electrodes are attached to the legs and impulse transmission is measured
What suggests that a client has an inguinal hernia
A buldge in the lower right quadrant
What suggest a client has a hiatal hernia
Heartburn because of reflux
What do you NOT take tetracycline with
Milk or antacids
It inhibits the med from working
What do you need to caution a client about when taking tetracycline
Sun is HOT and skin is sensitive so wear hats and sunscreen
When does a child have an actual concept of death
Age 9
Contraindication to administering the flu vaccine
Allergy to eggs
Dumping syndrome
10-30 mins after eating you get diarrhea and rapid gastric emptying
Pt should lay down after eating to delay gastric emptying time, should not drink 1 hour before, during, or 2 hours after meals and should eat smaller meals more frequently
Butorphanol Tartate
A narcotic pain reliever similar to morphine
Monitor rate and depth of respirations
Position for a patient during the acute phase of a stroke
Supine with the head elevated 15-30 degrees
Facilitates venous drainage from the brain and decreases ICP
What is important to tell the patient before a PET scan
You must empty your bladder before this test
What is a flourescin angiography
A series of photographs taken that detail the circulation of the eye. The clients eyes are dilated with mydriatic eyedrops before the exam and have to protect their eyes from the sun after the exam.
What to remember when someone is in a crisis psychologically
We have to ask them what they have done in the past to cope, since this is a crisis.
If it is just a normal situation, we do not focus on what has worked in the past because the past is the past
What is anxiety
An unconscious conflict of needs
It is a conflict between expressing unacceptable impulses and the need to hold onto social approval
Main two signs of meningitis
Nuchal ridigity
Photophobia
When a patient says something like "Someone is trying to kill me tonight" what do you do
Don't go along with their delusion like you support it. Just acknowledge how they are feeling and move on. Say something like "It must be frightening to think someone is trying to kill you
What is the primary problem for a client diagnosed with schizophrenia
They have difficulty forming relationships
Korsakoff syndrome
orsakoff syndrome causes problems learning new information, inability to remember recent events and long-term memory gaps. Memory problems may be strikingly severe while other thinking and social skills are relatively unaffected. For example, individuals
What is aluminum hydroxide gel
A medication to prevent epigastric pain. Take it one hour after a meal to neutralize stomach acids. Contains sodium so check if the patient is on a sodium restricted diet
What lab values to we expect to see with adrenocortical insuffiency
Low sodium and glucose
High potassium
What to remember about feeding an infant with Tetralogy of Fallot
Increase the size of the hole in the bottle so the infant can get as much nutrition as possible. Do feedings every 3 hours. Feed the infant soon after awakening so the infant doesn't cry
Risk factors for colorectal cancer
Chronic inflammatory bowel disease
Over 50 years of age
First relative with polyps or colorectal cancer
Diet high in fat and low in fiber
If you have a cervical cancer radium implant in, how long do you need to abstain from sex and tampons for?
About 6 weeks, whenever your followup with your primary care physician is
After having an MI, when can sexual activity be resumed
When the client can walk two flights of stairs or one city block with no SOB or chest pain
Corticosteroids and surgery
During the few weeks leading up to surgery, we need to increase the dose of corticosteroids because surgery requires more. Nurse must monitor for side effects of too much corticosteroids
S&S of a hemolytic reaction
Low back pain
Fever
Bach ache
Hypotension
Chills
What medical / surgical procedure can often lead to dumping syndrome
Gastrojejunostomy
Have the patient lay down after eating!
When you have a colostomy, what are the restrictions of your new activities
No restrictions
You can return to all normal activities after the stoma/incision is healed
What type of syringe to we use to aspirate an NG tube
Large Barrel syringe
Is it okay to instill 30 ml of air into the stomach before aspirating fluid out of an NG tube?
Yes
PH of gastric contents should be:
Between 1 and 4
Hep B vaccine series
One shot, then additional shots at 1 and 6 months
When a baby has increased ICP, what S&S will they display?
High pitched cry
S&S of a preschooler who overdosed on aspirin
Tinnitus and gastric distress
Where should the nurse be positioned when helping a client learn to walk with a cane
Slightly behind the client on the good leg side
Hantavirus
It is a disease from rodents/rodent droppings that can cause hematuria, hematemesis, bleeding gums, etc
S&S of syphillis
A papule - like lesion in the vaginal area
When do we give glucagon
for SEVERE hypoglycemia or if the client cannot take oral fluids
Trachea deviation signifies what
Increased pressure on one side of the lungs aka pneumothorax
How long does a diaphragm need to be left in the vagina after intercourse
6 hours
Rate for potassium infusion
No faster than 10 MEQ per hour
Parietal lobe of the brain is responsible for
Perception of touch, pressure, temperature and pain
Frontal lobe of the brain is responsible for
Reasoning, planning, speech, movement, emotions and problem solving. Our personality and voluntary movements are here
Occipital lobe of the brain is responsible for
Vision
Temporal lobe of the brain is responsible for
Perception and recognition of auditory stimuli and memory (hippocampus)
Left side of the brain controls:
Analytical thinking
Math skills
Speech
Right side of the brain controls:
Orientation to person place and time
Behavior (impulsive or not)
What is a positive sweat test significant for
Child has CF (need replacement enzymes, high calorie, high protein diet)
If you have carpal tunnel, what exercise do we recommend for you
Put the back of your hands together and bend both wrists at the same time
Max time for the grieving process is
3 years
Once we start mag on a pregnant client with hypertension, what do we do
Assess for their deep tendon reflexes
Why are salt substitutes bad?
They contain a lot of potassium
Do we aspirate the syringe when administering Heparin?
No, it can cause bruising
What do we need to remember about potassium and people on "-pril" meds
They want low potassium! No bananas, no salt substitutes, etc
If an african american needs a blood pressure med, which are we likely to prescribe
A thiazide diuretic
Not a beta blocker or an ACE inhibitor (pril)
When giving a client Lithium, what do we need to remember about their diet
Restrict their sodium
Tartarazine and aspirin
Cross sensitivity, do not give together
Aminophylline
Bronchodilator
If an infant if allergic to cow milk, what do we do
Try soy milk formula first
Then try a predigested formula
If you are doing an autologous blood donation, when can you donate to yourself
Five weeks away from your surgery up to three days before
S&S of opioid withdrawal
N&V
Restlesness
Abdominal cramping
Do we massage the site after IM shots
NO
Aluminum hydrozide
Antacid
Take it one hour after meals
Age for imaginary play
4-6
What will increase the absorption of iron
Acidic foods! Take with orange juice
When a woman is pregnant and having breast discomfort, do we recommend that the massage them?
No
When a mom chooses to bottle feed, what do we need to recommend for her
Don't use a breast pump because your body will think that you need to continue to produce milk. The milk will subside on its own in 5-7 days
Average head circumference of a newborn
32-36 cm
When would we hold off on a polio vaccine (IPV)
If the client is allergic to neomycin, streptomycin, or polymyxin B
When will thumb sucking go away
24 months