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Do not delegate What you can EAT E-evaluate A-assess T-teach
Addison's = down down down up down
Cushings= up up up down up
Addison's & Cushings hypo/hypernatremia, hypo/hypertension, blood volume, hypo/hyperkalemia,
hypo/hyperglycemia
Better peripheral perfusion? EleVate Veins, DAngle Arteries
Appearance (all pink, pink and blue, blue (pale)
Pulse (>100, <100, absent)
Grimace (cough, grimace, no response)
APGAR Activity (flexed, flaccid, limp)
Respirations (strong cry, weak cry, absent)
Airborne precautions My chicken hez tb (measles, chickenpox (varicella) Herpes zoster/shingles TB
Airborne precautions protective equip private room, neg pressure with 6-12 air exchanges/hr mask N95 for TB
spiderman! sepsis, scarlet fever, streptococcal pharyngitis, parvovirus, pneumonia,
pertussis,
influenza,
diptheria,
epiglottitis,
Droplet precautions rubella,
mumps, meningitis, mycoplasma or meningeal pneumonia, adeNovirus (Private room
or cohort mask!)
MRS WEE
Multidrug resistant organism
Rresiratory infection
Skin infection
Wound infection
Contact precaution Enteric infection (C diff)
Eye infection (conjunctivitis)
VCHIPS
Varicella zoster
Cutaneous diptheria
Herpes simplez
Impetigo
Skin infection
Peduculosis
Scabies
S/S chest pain, dyspnea, tachycardia, pale/cyanotic, sense of impending doom. (turn pt
Air or Pulmonary Embolism to LEFT side and LOWER the head of bed.)
(late decels, decreased variability, fetal bradycardia, etc) Turn pt on Left side, give O2,
Woman in labor (un-reassuring FHR) stop pitocin, Increase IV fluids!
Pt on Right side (promotes emptying of the stomach) Head of bed elevated (prevent
Tube feeding with decreased LOC aspiration)
pt is flat SUPINE (prevent headache and leaking of CSF)
After lumbar puncture and oil based
myelogram
Pt with heat stroke flat with legs elevated
during Continuous Bladder Irrigation (CBI) catheter is taped to the thigh. leg must be kept straight.
After Myringotomy position on the side of AFFECTED ear, allows drainage.
After Cateract surgery pt sleep on UNAFFECTED side with a night shield for 1-4 weeks
after Thyroidectomy low or semi-fowler's position, support head, neck and shoulders.
Infant with Spina Bifida Prone so that sac does not rupture
Buck's Traction (skin) elevate foot of bed for counter traction
don't sleep on side of surgery, don't flex hip more than 45-60 degress, don't elevate
Head Of Bed more than 45 degrees. Maintain hip abduction by separating thighs with
After total hip replacement pillows.
Prolapsed cord Knee to chest or Trendelenburg
position on back or in infant seat to prevent trauma to the suture line. while feeding
Cleft Lip hold in upright position.
(post operative ulcer/stomach surgeries) eat in reclining position. Lie down after meals
for 20-30 min. also restrict fluids during meals, low CHO and fiber diet. small, frequent
To prevent dumping syndrome meals.
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AKA (above knee amputation) elevate for first 24 hours on pillow. position prone daily to maintain hip extension.
BKA (below knee amputation) foot of bed elevated for first 24 hours. position prone to provide hip extension.
detached retina area of detachment should be in the dependent position
administration of enema pt should be left side lying (Sim's) with knee flexed.
After supratentorial surgery (incision behind hairline on forhead) elevate HOB 30-40 degrees
After infratentorial surgery (incision at the nape of neck) position pt flat and lateral on either side.
During internal radiation on bed rest while implant in place
S/S pounding headache, profuse sweating, nasal congestion, chills, bradycardia,
Autonomic Dysreflexia/Hyperreflexia hypertension. Place client in sitting position (elevate HOB) FIRST!
bedrest with extremities elevated 20 degrees. knees straight, head slightly elevated
Shock (modified Trendelenberg)
Head Injury elevate HOB 30 degrees to decrease ICP
Peritoneal Dialysis (when outflow is turn pt from side to side BEFORE checking for kinks in tubing
inadequate)
Lumbar Puncture After the procedure, the pt should be supine for 4-12 hours as prescribed.
Myesthenia Gravis worsens with exercise and improves with rest
Myesthenia Gravis a positive reaction to Tensilon---will improve symptoms
Cholinergic Crisis Caused by excessive medication ---stop giving Tensilon...will make it worse.
Liver biopsy (prior) must have lab results for prothrombin time
Myxedema/ hypothyroidism slowed physical and mental function, sensitivity to cold, dry skin and hair.
Grave's Disease/ hyperthyroidism accelerated physical and mental function. Sensitivity to heat. Fine/soft hair.
Thyroid storm increased temp, pulse and HTN
Post-Thyroidectomy semi-fowler's. Prevent neck flexion/hyperextension. Trach at bedside
CATS---Convulsions, Arrhythmias, Tetany, Spasms, Stridor. (decreased calcium) give
Hypo-parathyroid high calcium, low phosphorus diet
fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium) give a
Hyper-parathyroid low calcium high phosphorous diet
increased temp, rapid/weak pulse, increase respiration, hypotension, anxiety. Urine
Hypovolemia specific gravity >1.030
bounding pulse, SOB, dyspnea, rales/crackles, peripheral edema, HTN, urine specific
Hypervolemia gravity <1.010. semi fowler's
Diabetes insipidus (decreased ADH) excessive urine output and thirst, dehydration, weakness, administer Pitressin
change in LOC, decreased deep tendon reflexes, tachycardia. N/V HA administer
SIADH (increased ADH) Declomycin, diuretics
muscle weakness, dysrhythmias, increase K (rasins bananas apricots, oranges, beans,
hypokalemia potatoes, carrots, celery)
MURDER Muscle weakness, Urine (olig, anuria) Resp depression, decreased cardiac
Hyperkalemia contractility, ECG changes, reflexes
nausea, muscle cramps, increased ICP, muscular twitching, convulsions. give osmotic
Hyponatremia diuretics (Mannitol) and fluids
increased temp, weakness, disorientation, dilusions, hypotension, tachycardia. give
Hypernatremia hypotonic solution.
Hypocalcemia CATS Convulsions, Arrythmias, Tetany, spasms and stridor
muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon
Hypercalcemia reflexes, shallow respirations, emergency!
Tremors, tetany, seizures, dysthythmias, depression, confusion, dysphagia, (dig
Hypo Mg toxicity)
depresses the CNS. Hypotension, facial flushing, muscle weakness, absent deep
Hyper Mg tendon reflexes, shallow respirations. EMERGENCY
Hypo Na, Hyper K, Hypoglycemia, dark pigmentation, decreased resistance to stress
Addison's fx, alopecia, weight loss. GI stress.
Hyper Na, Hypo K, hyperglycemia, prone to infection, muscle wasting, weakness,
Cushings edema, HTN, hirsutism, moonface/buffalo hump
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Do not delegate What you can EAT E-evaluate A-assess T-teach
Addison's = down down down up down
Cushings= up up up down up
Addison's & Cushings hypo/hypernatremia, hypo/hypertension, blood volume, hypo/hyperkalemia,
hypo/hyperglycemia
Better peripheral perfusion? EleVate Veins, DAngle Arteries
Appearance (all pink, pink and blue, blue (pale)
Pulse (>100, <100, absent)
Grimace (cough, grimace, no response)
APGAR Activity (flexed, flaccid, limp)
Respirations (strong cry, weak cry, absent)
Airborne precautions My chicken hez tb (measles, chickenpox (varicella) Herpes zoster/shingles TB
Airborne precautions protective equip private room, neg pressure with 6-12 air exchanges/hr mask N95 for TB
spiderman! sepsis, scarlet fever, streptococcal pharyngitis, parvovirus, pneumonia,
pertussis,
influenza,
diptheria,
epiglottitis,
Droplet precautions rubella,
mumps, meningitis, mycoplasma or meningeal pneumonia, adeNovirus (Private room
or cohort mask!)
MRS WEE
Multidrug resistant organism
Rresiratory infection
Skin infection
Wound infection
Contact precaution Enteric infection (C diff)
Eye infection (conjunctivitis)
VCHIPS
Varicella zoster
Cutaneous diptheria
Herpes simplez
Impetigo
Skin infection
Peduculosis
Scabies
S/S chest pain, dyspnea, tachycardia, pale/cyanotic, sense of impending doom. (turn pt
Air or Pulmonary Embolism to LEFT side and LOWER the head of bed.)
(late decels, decreased variability, fetal bradycardia, etc) Turn pt on Left side, give O2,
Woman in labor (un-reassuring FHR) stop pitocin, Increase IV fluids!
Pt on Right side (promotes emptying of the stomach) Head of bed elevated (prevent
Tube feeding with decreased LOC aspiration)
pt is flat SUPINE (prevent headache and leaking of CSF)
After lumbar puncture and oil based
myelogram
Pt with heat stroke flat with legs elevated
during Continuous Bladder Irrigation (CBI) catheter is taped to the thigh. leg must be kept straight.
After Myringotomy position on the side of AFFECTED ear, allows drainage.
After Cateract surgery pt sleep on UNAFFECTED side with a night shield for 1-4 weeks
after Thyroidectomy low or semi-fowler's position, support head, neck and shoulders.
Infant with Spina Bifida Prone so that sac does not rupture
Buck's Traction (skin) elevate foot of bed for counter traction
don't sleep on side of surgery, don't flex hip more than 45-60 degress, don't elevate
Head Of Bed more than 45 degrees. Maintain hip abduction by separating thighs with
After total hip replacement pillows.
Prolapsed cord Knee to chest or Trendelenburg
position on back or in infant seat to prevent trauma to the suture line. while feeding
Cleft Lip hold in upright position.
(post operative ulcer/stomach surgeries) eat in reclining position. Lie down after meals
for 20-30 min. also restrict fluids during meals, low CHO and fiber diet. small, frequent
To prevent dumping syndrome meals.
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AKA (above knee amputation) elevate for first 24 hours on pillow. position prone daily to maintain hip extension.
BKA (below knee amputation) foot of bed elevated for first 24 hours. position prone to provide hip extension.
detached retina area of detachment should be in the dependent position
administration of enema pt should be left side lying (Sim's) with knee flexed.
After supratentorial surgery (incision behind hairline on forhead) elevate HOB 30-40 degrees
After infratentorial surgery (incision at the nape of neck) position pt flat and lateral on either side.
During internal radiation on bed rest while implant in place
S/S pounding headache, profuse sweating, nasal congestion, chills, bradycardia,
Autonomic Dysreflexia/Hyperreflexia hypertension. Place client in sitting position (elevate HOB) FIRST!
bedrest with extremities elevated 20 degrees. knees straight, head slightly elevated
Shock (modified Trendelenberg)
Head Injury elevate HOB 30 degrees to decrease ICP
Peritoneal Dialysis (when outflow is turn pt from side to side BEFORE checking for kinks in tubing
inadequate)
Lumbar Puncture After the procedure, the pt should be supine for 4-12 hours as prescribed.
Myesthenia Gravis worsens with exercise and improves with rest
Myesthenia Gravis a positive reaction to Tensilon---will improve symptoms
Cholinergic Crisis Caused by excessive medication ---stop giving Tensilon...will make it worse.
Liver biopsy (prior) must have lab results for prothrombin time
Myxedema/ hypothyroidism slowed physical and mental function, sensitivity to cold, dry skin and hair.
Grave's Disease/ hyperthyroidism accelerated physical and mental function. Sensitivity to heat. Fine/soft hair.
Thyroid storm increased temp, pulse and HTN
Post-Thyroidectomy semi-fowler's. Prevent neck flexion/hyperextension. Trach at bedside
CATS---Convulsions, Arrhythmias, Tetany, Spasms, Stridor. (decreased calcium) give
Hypo-parathyroid high calcium, low phosphorus diet
fatigue, muscle weakness, renal calculi, back and joint pain (increased calcium) give a
Hyper-parathyroid low calcium high phosphorous diet
increased temp, rapid/weak pulse, increase respiration, hypotension, anxiety. Urine
Hypovolemia specific gravity >1.030
bounding pulse, SOB, dyspnea, rales/crackles, peripheral edema, HTN, urine specific
Hypervolemia gravity <1.010. semi fowler's
Diabetes insipidus (decreased ADH) excessive urine output and thirst, dehydration, weakness, administer Pitressin
change in LOC, decreased deep tendon reflexes, tachycardia. N/V HA administer
SIADH (increased ADH) Declomycin, diuretics
muscle weakness, dysrhythmias, increase K (rasins bananas apricots, oranges, beans,
hypokalemia potatoes, carrots, celery)
MURDER Muscle weakness, Urine (olig, anuria) Resp depression, decreased cardiac
Hyperkalemia contractility, ECG changes, reflexes
nausea, muscle cramps, increased ICP, muscular twitching, convulsions. give osmotic
Hyponatremia diuretics (Mannitol) and fluids
increased temp, weakness, disorientation, dilusions, hypotension, tachycardia. give
Hypernatremia hypotonic solution.
Hypocalcemia CATS Convulsions, Arrythmias, Tetany, spasms and stridor
muscle weakness, lack of coordination, abdominal pain, confusion, absent tendon
Hypercalcemia reflexes, shallow respirations, emergency!
Tremors, tetany, seizures, dysthythmias, depression, confusion, dysphagia, (dig
Hypo Mg toxicity)
depresses the CNS. Hypotension, facial flushing, muscle weakness, absent deep
Hyper Mg tendon reflexes, shallow respirations. EMERGENCY
Hypo Na, Hyper K, Hypoglycemia, dark pigmentation, decreased resistance to stress
Addison's fx, alopecia, weight loss. GI stress.
Hyper Na, Hypo K, hyperglycemia, prone to infection, muscle wasting, weakness,
Cushings edema, HTN, hirsutism, moonface/buffalo hump
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