NCLEX study from Mark Klimek

NCLEX study from Mark Klimek Hyperthyroidism is also called - ANS Grave's disease or hypermetabolism Tip to remember Grave's disease s/s's - ANS "Run yourself into the Grave" - everything is up ... diarrhea, thin, hot, high BP, high HR, cold tolerance, hot intolerance Treatment for Grave's disease - ANS Radioactive Iodine, PTU (put thyroid under), surgically remove Total thyroidectomy ... totals get - ANS tetany, need lifelong hormone replacement After thyroidectomy patients are at risk for - ANS hypocalcemia, remember hypocalcemia is opposite of the prefix and anything to BP so tetany, parasthesia parathesia - ANS numbness and tingling, first sign of electrolyte imbalance Subtotal thyroidectomy ... subs get - ANS storm S/S of thyroid storm - ANS Extremely high vital signs, hyperpyrexia, psychotic delerium How to treat thyroid storm - ANS give o2, lower temp to spare brain Risks post op for total thyroidectomy - ANS airway, hemorrhage for 1st 12 hours then for 12-48 hours hypocalcemia leading to tetany Risks post op for sub total thyroidectomy - ANS airway, hemorrage for 1st 12 hours then for 12-48 hours thyroid storm Hypothyroidism is also called - ANS Myxedema or hypometabolism S/S of mydexema - ANS everything is down, constipation, heat tolerance, cold intolerance Treatment for mydexema - ANS give thyroid medications Where to put the 5 ice packs to cool a thyroid storm patient - ANS neck pits groin If you cool a patient too fast what might happen? - ANS Heart arrythmias Never hold the hormone for what patient? - ANS patient who is NPO with mydexema Addison's disease easy way to remember - ANS Add a Sone (sone = steroid) Adrenal Cortex diseases easy way to remember - ANS A in Adrenal stands for Addison's C in Cortex stands for Cushing's Addison's disease is - ANS undersecretion of adrenal cortex, not enough hormone, BRONZE/tan, go into shock very easily. STRESS can trigger. Addison's disease treatment - ANS give a steroid, chronic steroid therapy Cushing's syndrome - ANS Over secretion of adrenal cortex, too much hormone, too much steroid. S/S of Cushing's syndrome - ANS same as steroid use ... moon face, think cushman "I'm mad I have an infection", high blood sugar, losing Potassium, Treatment for Cushing's syndrome - ANS Surgery, bi or uni lateral adrenalectomy (bilateral is worse) Donning PPE's order - ANS Gown, Mask, Goggles, Gloves Removing PPE's order - ANS alphabetically inside the room For airborne precautions the mask is removed where? - ANS outside of the room Avoid answers with what words for children 9 mths and younger? - ANS build, sort, stack, construct, make Toddlers (1-3) work on - ANS their gross motor skills (jump, hop, throw), NO fine motor, parallel play Preschoolers (3-6) work on - ANS fine motor, balance (tumbling, dance, tricycle), cooperative play, pretend School age (7-11) work on - ANS creative, collect, competitive Best default order for click and drag order questions? - ANS Hold ..... med Assess ..... what med does Prepare ...... the correction Call ..... or notify Rarely if ever answer ... - ANS call Doctor, NCLEX wants you to think critically Creatinine lab values - ANS same as lithium 0.6-1.2 Not a huge worry, not a dangerous lab to worry about INR lab values - ANS 2-3, critical value if off, potential for patient to bleed. Use default order for order ?'s (hold all coumadin, assess for bleeding, prepare Vit K (antidote for Coumadin), Call or notify Potassium lab values - ANS 3.5-5.3 If low it is a critical lab to worry about assess the heart and then prepare to give K if high, hold all K, assess heart (EKG), give D5W and reg insulin, call if really high, hold, assess, prepare, call STAT Get someone else involved! Dangerous!! pH lab values - ANS 7.35-7.45 if pH is in the 6;s VERY dangerous remember as the patient's pH goes so goes the patient If bad vitals, call rapid response team BUN lab values - ANS 8-30 check for dehydration if elevated not a big deal, just be concerned If a deadly or dangerous lab value is discovered AND they have symptoms call the - ANS rapid response team! HgB lab values - ANS 12-18 check for bleeding if low or high, if low prepare for tranfussion HCO3 lab values - ANS 22-26 if it is abnormal so what! CO2 lab values - ANS 35-45 if in the 50's assess respiratory status and have patient do pursed lip breathing, if in 60's considered deadly and respiratory failure, need intubated Hct lab values - ANS 36-54 thickness of blood if abnormal not too big of a deal, assess for dehydration PO2 lab values - ANS 78-100 this is only obtained from an ABG if low give O2 but if really low it is respiratory failure give O2, prepare for intubation, call resp therapy and call Dr O2 sat lab values - ANS 93-100 pulse ox, if under 93 assess resp status and give O2 BNP lab value - ANS less than 100 is normal, good indicator of CHF, edema, if elevated assess s/s of CHF NA lab values - ANS 135-145, if a change in LOC then evaluate for fall/safety risk WBC lab values - ANS if low assess for infection CD4 count less than 200 equals - ANS AIDS Neutropenic precautions (low WBC) - ANS strict handwashing, avoid crowds, private room, low bacteria diet (no raw or undercooked), no water that has been standing longer than 15 min, vital signs Q4H Platelets lab value - ANS if lower than 90000 bad if lower than 40000 REALLY bad, if they sneeze they could die. Called thrombocytopenia Bleeding precautions - ANS no venipuncture, injection or IV, if necessary use small guage, handle patient gently, use drawsheet, no razor, no toothbrush, blow nose gently, no aspriin, no rectal temp, no hard foods RBC lab values - ANS 4-6 million abnormal doesn't really matter Reason for laminectomy - ANS treat nerve root compression S/S of nerve root compression - ANS Pain Parasthesia (numbness & tingling) Paresis (muscle weakness) Cervical - ANS Diaphram and Arms affected, breathing, respiratory pattern Thoracic - ANS Abd muscles and gut affected, ability to cough Lumbar - ANS Bladder and legs affected, when did they last void, are they distended #1 post op answer for spinal problems is - ANS log roll patient Activity post op spinal issue - ANS do not dangle stand, walk, lie down w/o restricitons limit sitting to 30 min at a time Post op complications for cervical spinal surgery - ANS pneumonia Post op complications for thoracic spinal surgery - ANS pneumonia (no cough), paralytic illeus (gut shuts down) Post op complications for lumbar spinal surgery - ANS urinary retention How long does temporary restrictions usually mean? - ANS 6 weeks (driving, lifting, etc.) Nagele's Rule - ANS 1st day of last period + 7 days - 3 months Weight gain during pregnancy - ANS 28 lbs plus or minus 3 lbs 1st trimester weight gain - ANS 1 lb/month or 3 lbs for 1st trimester 2nd/3rd trimester weight gain - ANS 1 lb/week Easy way to calculate appropriate weight gain during pregnancy - ANS The week number minus 9 so if 12 weeks pregnant 12-9=3 lbs. not allowed to be off by more than 2 lbs. Fundal Height - ANS not palpable until 12 weeks, 2nd and 3rd trimesters week gestation 20-22 in cm so at the navel is 20 weeks Positive signs of pregnancy - ANS xray, ultrasound, auscultation of fetal HR on doppler 10 weeks, examiner (not the mother) palpates fetal movement Probable signs of pregnancy - ANS blood and urine tests, Chadwick's sign, Goodell's sign, Hegar's sign Chadwick's sign - ANS Cervical color changes to Cyanosis See all the CCCCCC's! Goodell's sign - ANS Cervical softening Hegar's sign - ANS Uterine softening All changes in cervix and vagina occur in what order? - ANS alphabetical order Pattern of Office Visits for prenatal care - ANS once a month until 28 weeks, once every 2 weeks until week 36, once a week until delivery or week 42 when induction is scheduled Pregnancy hemoglobin - ANS normal is 12-18, first trimester falls to 11 which is okay, second trimester falls to 10.5 which is okay and then third trimester falls to 10 also okay Easy way to remember station - ANS has it made it through the "tight squeeze" (ischial spine) no then its a negative, yes then its a positive, 0 station is when it's at the ischial spine Presenting part is 99% of the time the - ANS head What is bad as far as Lie? - ANS Transverse is bad, vertical is good, parallel is good Stage 1 of L&D - ANS Labor - thinning and opening, has 3 phases, Latent, Active, Transitional, nothing to do with the baby just the cervix, no baby at the end of labor Stage 2 of L&D - ANS Delivery - pushing the baby out Stage 3 of L&D - ANS Placenta delivery Stage 4 of L&D - ANS Recovery (1st 2 hrs after delivery of placenta), considered unstable patient, stop the bleeding in stage 4 Memorize 1st stage 2nd phase of L&D then you know the rest - ANS Active phase CM dilated 5-7 cm CXN Freq 3-5 min Duration 30-60 sec Intensity moderate Contractions should not be longer than ____ seconds or closer than every _____ minutes. - ANS 90, 2 Prolapsed cord - ANS OB emergency, baby will die if you don't do something What to do with prolapsed cord - ANS Push then position! Push head off cord then position in knee/chest of trendelenburg (head down) Lithotomy position - ANS on back with knees drawn up Easy to remember interventions for complications of L&D - ANS LIONPit L left side, I increase IV, O oxygenate, N notify Dr, Pitocin If question says there is pitocin running and there are complications - ANS stop pit first then LIONpit Pain meds in labor - ANS know your peaks for IV, IM, PO, Subling. If baby is likely to be born when the pain med is peaking don't give! Why? Respiratory depression in baby Fetal monitor patterns - ANS if it starts with L it's bad so do LIONPit, ex; low fetal heart rate, low baseline variability, late decels V C E H A O L P - ANS Variable Decels Cord Compression (bad) Early Decels Head (bad) Acels Okay (good) Late Decels Placenta (bad) Best answer for what to check first in fetal monitoring is - ANS fetal heart rate, it's the ace of spades! During the 2nd stage (delivery of baby), order of actions. - ANS Deliver the head then stop pushing, suction the mouth first then the nose, check for nuchal cord, deliver shoulders and body, ID band If the baby has to leave the delivery area, the priority is - ANS the ID band Umbilical cord has what in it - ANS AVA 2 arteries and a vein 4th stage of L&D recovery stage, what do do? - ANS 4 things you do 4 times an hour in 4th stage Vitals (assess for s/s of shock) Fundus (want midline and firm, if boggy, massage, if displaced void/cath) Pads (check and replace) Roll on side (check for bleeding under patient) Excessive Lochia is - ANS a pad saturated in less than or equal to 15 minutes Postpartum Uterus Tone - ANS Firm NOT boggy Postpartum Fundal Height - ANS Fundal height should equal day post partum, day 5 = 5 cm below navel Postpartum Uterus location - ANS midline, if not void/cath Postpartum Lochia color - ANS Rubra - Red (ruby red) Serosa - Pink (rosa pink) Alba - whitish (albino white) Postpartum Lochia amount - ANS Moderage 4-6 inches on pad in one hour Excessive pad saturated in 15 min Best way to measure DVT is - ANS calf circumferences, NOT Homan's sign, but if select all that apply question, include Homan's sign Postpartum assessment of extremities - ANS Pulses, Edema, S&S of Thrombophlebitis Postpartum assessment includes assessment of - ANS Uterus, Lochia and Extremities Way to remember difference between Cephalohematoma and Caput Succedaneum - ANS C S in Caput Succedaneum = Crosses suture lines, both are swelling on scalp caused by bleeding and both are normal or okay. OB medications tocolytics - ANS stop contractions, Brethine causes maternal tachycardia, Nifedipine (dipine - CCB) causes Hypotension and headache OB medications oxytocics - ANS makes labor more intense, Pitocin, Methergine, Cervidil Uterine Hyperstimulation - ANS contractions longer than 90 seconds or closer than 2 minutes OB medications Fetal/Neonatal Lung meds - ANS Betamethasone, speeds the development of the baby's lungs, given to Mom before baby is born, given IM, will increase the blood sugar of Mom Survanta (surfactant) - ANS given to baby after baby is born given trastracheal through the airway develops lungs Med hints for IM injections - ANS Look for 1's in both parts (the 1 looks like an I), guage and length, 21 g, 1 inch means IM Med hints for SQ injections - ANS look for 5's in both parts (the 5 looks like an S), guage and length, 25 g, 5/8 inch means SQ Drawing up Insulin rules - ANS R then N, Draw up R then N, NRRN the whole process Pressurizing Insulin rule - ANS put air into N then R , NRRN the whole process If 70/30 insulin it is - ANS 70% N and 30% R, may have to make your own on boards, no 70/30 on the floor Heparin is given IV or SQ NOT PO, info re: Heparin - ANS works immediately, labs Ptt or any clotting or bleeding time, antidote: protamine sulfate, course: 21 days, pregnancy: YES (Class C pregnancy drug, use caution) Coumadin is given PO, info re: Coumadin - ANS takes days to work, labs ONLY PT-INR, antidote: Vit K (think Koumadin), course: forever, prengancy: NO (never use) If a diuretic ends in the letter X it is a potassium - ANS wasting drug plus Diurel Baclofen/ Flexoril - ANS muscle relaxant, think on your back loafin'! makes a patient drowsy, weak muscles, don't drink, don't drive, don't care of kids under 12 Piaget's stage Sensorimotor - ANS age 0-2, totally present oriented, only think about what they sense or what they are doing NOW. tell them what you are doing as you are doing it Piaget's stage Pre-Poperational - ANS age 3-6, fantasy oriented, illogical, no rules, if they can think it it can happen, play with them, tell them what you are going to do the day of the event. Piaget's stage Concrete Operations - ANS age 7-11, rule oriented, live and die by the rules,only 1 way to do things, everything different is wrong, tell them days ahead what you are going to do plus skills, reading and visual tools Piaget's stage Formal Operations - ANS age 12-15, able to think abstractly, understand cause and effect, tell them like an adult Child has to be at least what age for PRE op teaching?: - ANS 3 When can a child give themselves their own insulin shot? - ANS 7 What 2 parts are always irrelevant in a prioritization question? - ANS age and gender (NCLEX is testing discrimination against agism) If it is a pediatric question the age is critical but if it is a prioritization question ... - ANS age is not critical In prioritization questions decide which patient is _________ or ____________ - ANS sickest, healthiest Rule #1 for prioritization - ANS Acute beats Chronic, unstable beats stable. Ex: COPD, CHF, CRF and acute appendicitis, who wins? Acute appendicitis. No ABC's, an acute gut beats a chronic COPD all day long ABC's don't count for - ANS acuity Prioritize patients at this very moment, not - ANS 3 seconds later or 10 minutes ago, Right NOW, right HERE, as they say it! Rule #2 for prioritization - ANS Fresh post op (12 hours out) beats medical or other surgical, Ex: 2 hr post op cholesysectomy beats acute appendicitis and post op one day CABG and COPD, CHF, CRF (then do ABC's) Rule #3 for prioritization - ANS Unstable beats stable Things that make a patient stable - ANS the word stable, chronic, post op greater than 12 hours, local or regional anesthesia, unchanged assessment, to be discharged, lab values that aren't urgent Stable patients are experiencing the ___________ or __________ s/s's of the disease with which they have been diagnosed and for which they are receiving treatment - ANS Typical, expected Things that make a patient unstable - ANS the word unstable, acute, post op less than 12 hours, general anesthesia, changing assessment, newly, recently admitted or diagnosed, lab values that are critical or deadly Unstable patients are experiencing _________ or ____________ s/s's, complications - ANS unexpected, atypical Patients who are always unstable - ANS hypoglycemia, hemorrhaging clients, fevers over 104, pulselessness, breathlessness Faulty reasoning, prioritizing by symptom severity - ANS It is not how severe the symptom is, its if the symptom has changed or if its typical or expected. Rule #4 for prioritization - ANS Tie-breaker, ONLY use for a tie breaker, the more Vital the organ the higher the priority. Vital organ priority list - ANS brain lung heart liver kidney pancreas LPN's can't do - ANS IV anything (don't assume they have IV cert unless it says so), assessments, planning, admission, discharge, transfer, teaching, taking verbal orders or 1st of anything AID's can't do - ANS charting (only document what they did), assess, meds, IV, treatments, fleet enemas AIDS can do - ANS Soap suds enema, beds, bath, ADL's VS (not the first set), Accu check (not the first one) Options to intervene when inappropriate behavior of staff is discovered (not in order of what to do first): - ANS Tell supervisor Take over immediately and intervene counsel them later NEVER IGNORE IT If it's illegal - ANS tell supervisor If pt or staff is in danger - ANS take over and intervene If it's legal and not hurtful but just inappropriate - ANS counsel them later Phases of nurse patient relationship Pre-Interaction phase - ANS How does the RN feel, own feelings about ... Phases of nurse patient relationship Introductory (Orientation) phase - ANS During the initial interview ... Upon admitting the patient ... On admission ... At your first few meetings with ... While assessing ... On the day of admission ... While formulating nursing diagnoses ... Correct answers should be warm and fuzzy and nosey Phases of nurse patient relationship Working Phase (Therapeutic phase) - ANS Implementing the plan of care, these answers will seem very focused, directive, "tough", stern and slightly unfriendly When does the termination phase of the nurse patient relationship begin? - ANS on admission Gift giving to psych patients - ANS includes hugs, kisses, compliments (oh you are doing really well) Advice giving to psych patients - ANS DO NOT GIVE ADVICE. Advice words to avoid - ANS Suggest, advise, tell the patient, if I were you, You should do, you ought to, you should not do, don't do, recommend that Always say to a psych patient - ANS what do you think you should do? No guarantees in psych, avoid - ANS if you... then ..., you will improve if you ..l., we can... Good strategy for psych if narrowed to 2 answers - ANS ask yourself which answer will require the patient to keep on talking, it is never wrong to get your patient to keep talking Tie Breakers in Psych - ANS Why questions are not as good, reflection is good, open ended is good, I, me, we, us are not good, shortest answers are better, concise don't confuse the clientq All psych drugs cause - ANS low BP and weight change (usually gain) Phenothiazines - ANS all end in 'zine Ex: Thorazine, Compazine, they are major tranquilizers so think safety 'Zines for the - ANS Zanny In large doses Phenothiazines are - ANS anti-psychotics In small doses Phenothiazines are - ANS anti-emetics Side effects of Phenothiazines - ANS Anticholinergic (dry mouth), Blurred vision, Constipation, Drowsiness, Extrapyramidal syndrome (parkinsons), Fotosensitivity, aGranulocytosis (low WBC's) #1 problem or concern for patient taking Phenothiazines - ANS SAFETY Deconoate drug is - ANS a long acting IM form given to non compliant patients Tricyclic Antidepressants are - ANS mood elevators to treat depression Examples of Tricyclic anti depressants - ANS Elavil, tofranil, aventyl desyrel Side effects of Tricyclic medications - ANS Anticholinergic(dry mouth), Blurred Vision, Constipation, Drowsiness, Euphoria HInt: Elavil starts with E so this group goes through E How long does a tricyclic need to be taken before results are seen? - ANS 2-4 weeks Benzodiazepines are for - ANS anti anxiety, they are minor tranquilizers, have 'zep in the name, EX: Diazepam (Valium), plus Xanax, Often given pre op, muscle relaxant, alcohol withdrawal, seizures, facilitates mechanical ventilation Benzodiazepines works - ANS quickly, must not take for 6 weeks, keep on Valium until Elavil kicks in Side effects for Benzodiazepines - ANS Anticholinergic (dry mouth), Blurred Vision, Constipation, Drowsiness Number one nursing concern for patient taking Benzo's is - ANS also safety MAOI's - ANS antidepressants, happy pills Depression is caused by a deficiency of - ANS norepinephrine, dopamine and serotonin in the brain Names of MAOI's - ANS MAR, NAR, PAR: Marplan, Nardil, Parnate Side effects of MAOI's - ANS Anticholinergic (dry mouth), Blurred vision, Constipation, Drowsiness How long can a person be on MAOI's and how long before they work? - ANS rest of life, 2-4 weeks MAOI's interact with LOTS - ANS Avoid all foods containing Tyramine, causes fatal hypertension Tyramine foods - ANS Fruits and Veggies are okay except remember salad BAR, avoid Banannas, Avacados, Raisins, Grains are okay except for active yeast, no organ meats, no preserved meats, no dairy, no alcohol, tinctures, caffiene, chocolate, licorice, soy sauce Lithium - ANS for bipolar disorder (manic depression) it decreases mania Side effects of Lithium - ANS peeing, pooping, parasthesia Lithium Toxicity - ANS 2 or greater, tremors, metallic taste, severe diarrhea, number one intervention, give fluids, if sweating give electrolytes too Lithium monitor what levels - ANS sodium, low sodium levels prolong lithium's half-life, causing lithium toxicity, high sodium levels decrease the effectiveness of lithium Prozac - ANS it an SSRI, similar to Elavil so same info as Tricyclic's Prozac causes - ANS insomnia, so give before noon, so if BID, give at 6A and 12N NOT at bedtime When changing the dose of Prozac for an adolescent or young adult, watch for - ANS suicide 'zine, 'zep, 'zap - ANS all tranquilizers a good guess about psych med weening - ANS decrease the dose of the old drug Haldol - ANS just like the Thorazine's, also has a deconoate form Dose of Haldol for elderly patient should be - ANS half of usual adult dose Neuroleptic Malignant Syndrome - ANS a potentially fatal hyperpyrexia with temp of over 104, looks like EPS except for temp Clozaril (Clozapine) - ANS 'zap's, for schizophrenia Biggest and only side effect of Clozaril - ANS aGranulocytosis How often should WBC be drawn when pt is taking 'zap's for schizo? - ANS 1 time per week for 1 month, 1 month every month for 6 months then every 6 months Zoloft (sertraline) - ANS also a SSRI like prozac, antidepressant, doesn't cause insomnia so it can be taken at bedtime. Zoloft interacts with other medications like - ANS St John's wart (causes serotonin syndrome) - sweating, apprehension (impending sense of doom), dizziness (vertigo), headache, also with Coumadin so watch for bleeding Zoloft with Coumadin? - ANS Question the order if the coumadin dose wasn't lowered Nutrition questions - ANS pick chicken or fish Never pick _________ for children in nutrition questions. - ANS casseroles Never mix ___________ in children's food - ANS medications Toddlers favorite food? - ANS Finger-food Preschoolers and nutrition - ANS leave them alone, one meal a day is okay If you know what a particular drug does, choose a side effect in the same ______ ___________ where the drug is working. - ANS body system Ex: heart drug - tachycardia If a medication is taken PO and you dont know what the drug does pick a ______ side effect - ANS GI What is the first thing you assess in a med surg situation? - ANS Level of Consciousness What is the first thing you DO in a med surg situation? - ANS A, B, C's ok for prioritizing actions just not for prioritizing patients Pediatrics rule of thumb for growth and development questions - ANS always give the child more time, "don't rush growth and development", tell the family to wait a little while Rule #1 for pediatric growth and development - ANS when in doubt call it normal Rule #2 for pediatric growth and development - ANS when in doubt, pick the older (not oldest) age, giving them more time Rule #3 for pediatric growth and development - ANS when in doubt, pick the easier (not the easiest) task Chant the following chant for pediatric growth and development when you don't know the answer - ANS normal, older, easier A low empathy answer is ALWAYS wrong avoid saying - ANS don't worry, don't feel, you shouldn't feel, I would feel, Anybody would feel, nobody would feel, most people would feel How to recognize an empathy question - ANS They have a quote in the question and the answers contain a quote How to answer an empathy question - ANS be an actor, put yourself in the client's shoes, say their words as if you really meant them, ask yourself if I said those works and really meant them, how would I be feeling, choose the answer that reflects that reflects their feelings not the answer that reflects their words Rule out absolutes - ANS always, never are bad If two answers say the same thing ... - ANS neither one is right EX: tachycardia and racing heart If two answers are opposite, one of them is - ANS probably right (consider one of them) Names of uppers - ANS caffiene, cocaine, PCP/LSD, Amphetamines/meth, adderol/ritalin Do give aminoglycocides via PO in - ANS hepatic encephalopathy & pre-op bowel surgery Hepatic encephalopathy - ANS liver coma, crazy movements, high amonia level, don't give protien Peak level for sublingual - ANS 5-10 minutes after disolved Peak level for IV - ANS 15-30 min after finished Peak level for IM - ANS 30-60 min after drug is in Peak level for SQ - ANS diabetes peak levels apply here Peak level for PO - ANS who cares! Asystole - ANS no QRS A Fluttter - ANS Rapid P waves A fib - ANS Chaotic P wave V fib - ANS Chaotic VTach - ANS Bizarre Top priority arrhythmias - ANS VFib & Asystole, die in 8 minutes over 8 minutes not a priority anymore Vtach could become - ANS life threatening Ventricular gets what med - ANS Lidocane (think of the V turning sideways to an L) & Amiodorone AsystolE gets what med - ANS A for Atropine and E for Epinephrine ... Epi is first though Atrial Arrhythmias (same as supraventricular) medications - ANS ABCD Adenocard (push fast) Beta Blockers ('lol) CCB's Digoxin Water Seal bubbling intermittently or a suction control chamber bubbling continously is - ANS GOOD Water Seal bubbling continuously or a suction control chamber bubbling intermittently is - ANS BAD A Seal should not be - ANS bubbling. What to do first if a water seal breaks? - ANS clamp What is best to do if a water seal breaks? - ANS submerge TRouBLe for heart defects - ANS RL shunting is bad Blue is bad T starts with a T so it's bad (also Hypoplastic is bad, it's just TET) Easy way to remember 4 defects in Tet of Fallot - ANS VarieD Ventricular Defect PictureS Pulmonary Stenosis Of A Overriding Aorta RancH Right Hypertrophy Crutches - even numbered gate if - ANS 2 legs are affected Crutches - odd numbered gate if - ANS 1 affected leg Hold a cane - ANS on good side advance a cane - ANS with Bad side Hallucinations have a _________ component, delusions do not. - ANS sensory, EX: voices, tactile, visual, gustatory, olfactory Psychosis patients (schizo, depression, mania) can learn - ANS reality, enforce limits, teach reality Dementia (alzheimers, Wernicke's) can not learn - ANS reality, redirect Delirium is sudden onset and - ANS temporary Reassure a patient with delirium that the symptoms - ANS will go away and that they are temporary and reassure their safety Diabetes is a ________ ____________ problem. - ANS glucose metabolism Diabetes Insipidus is a dificiency of - ANS ADH Treating Type 1 diabetes - ANS Insulin, Diet Exercise Treating Type 2 diabetes - ANS Diet, Activity, Oral Hypoglycemia Regular Insulin onset peak duration - ANS onset 1 peak 2 duration 4 NPH insulin onset peak duration - ANS onset 6 peak 8-10 duration 12 Regular insulin rules - ANS Rapid, Run IV, Regular NPH insulin rules - ANS Not so fast, Not IV, NPH Insulin does what to blood sugar? - ANS it lowers it When will a patient go hypoglycemic? - ANS when insulin is at its peak If you exercise you need ______ insulin? - ANS less For a diabetic if they have sick days - ANS hydrate, take insulin What priority are hypoglycemic patients? - ANS #1 or #2, they are always a high priority DKA - ANS Hyperglycemia in Type 1 patients HHNS - ANS Hyperglycemia in Type 2 which is really just dehydration Treatment for HHNS - ANS High flow rehydration, IV 150 or more Therapeutic level for Aminophyline (airway spasms), Dilantin (anticonvulsant), Bilirubin - ANS 10-20, 20 or more is toxic Therapeutic level for Lanoxin or Dig - ANS 1-2 (2 or more it toxic) Kernicterus - ANS billirubin in CSF Opisthotonos - ANS hyperextension of neck BAD, put on side Diet for Hiatal Hernia - ANS High Carbs, Low Protien Diet for Dumping Syndrome - ANS Low carb, High Protien Kalemias - ANS same as prefix except HR and UO Calcemias - ANS Opposite of prefix anything to BP Chvostek's sign - ANS Cheek, facial spasm when Cheek is tapped associates with hypocalcemia Trousseau's sign - ANS arm/carpal spasm associated with hypocalcemia Magnesemias - ANS opposite of prefix anything to BP, in a tie don't pick magnesemia's Natremias - ANS hypErnatremia = dEhydration hypOnatremia = Overload King K lives in the ... - ANS Kastle of the cell while Sir Sodium lives outside Earliest sign of any electrolyte disorder is - ANS parathesia or numbness and tingling Universal sign of any electrolyte imbalance is - ANS paresis or muscle weakness Fast but temporary solution to decrease K is to - ANS give D5W w/regular insulin Never give more than ____ of K/liter of IV fluid - ANS 40 mEq, question the order of more is ordered