Mark Klimek Lecture Outlines

Mark Klimek Lecture Outlines If the pH and the BiCarb are both in the same direction then it is? - ANS Metabolic If the pH is up it is? - ANS Alkalosis If the pH is down it is? - ANS Acidosis As the pH goes so goes my patient except for? - ANS Potassium If the pH is up my patient with show signs and symptoms of? - ANS Increase... like tachycardia,diarrhea and borborygmi If the pH is down my patient will show signs and symtoms of? - ANS Decrease... like decreased output, bradycardia and constipation If my pH is up my potassium (K+) is ? - ANS Down If my pH is down my potassium (K+) is? - ANS Up If my patient is overventilating I should choose? - ANS Respiratory Alkalosis If my patient is underventilating I should choose? - ANS Respiratory Acidosis If my patient has prolonged gastric vomiting or suction I choose? - ANS Metabolic Alkalosis If it is not lung or prolonged vomiting or suctioning I choose? - ANS Metabolic Acidosis High pressure alarms are triggered when? - ANS They cannot push air in High pressure alarms are caused by what three types of obstructions? - ANS Kinking, Water in dependant loops and mucus in the airway. If kinking in the tube is present you? - ANS Unkink If water is present in the dependant loops you? - ANS Open system and empty water. If mucus is present you? - ANS Turn them, cough and have them deeo breath first. If ineffective you then suction. Low pressure alarms are triggered when? - ANS It is to easy to push air in. Low pressure alarms are normally caused by? - ANS Disconnection If the tubing is disconnected you? - ANS Reconnect If O2 sensor line is disconnected you? - ANS Reconnect In a vented client respiratory alkalosis means the vent setting may be too? - ANS High In a vented client respiratory acidosis means the vent may be too? - ANS Low What do you do if the patients disconnected tube is on the floor? - ANS Bag them, (call for help) get new tube and then reconnect. What do you do if the patients disconnected tube is on the chest? - ANS Reconnect ... if its above the waist its ok. What is the biggest problem in abuse? - ANS Denial To treat denial you need to? - ANS Confront How do you confront? - ANS Point out the difference between what they say and what they do. What is the one circumstance that you as a nurse would support denial? - ANS Loss and Grief What is dependency? - ANS When the abuser gets a significant other so make decisions for them or do thing for them. What is codependency? - ANS When the significant other gets positive self esteem from doing things or making decisions for an abuser. To treat dependency/codependency you ? - ANS Set limits and enforce them. You also need to work or the self estreem of the codependent. What is manipulation? - ANS When the abuser gets the significant other fo do things for them that is not in the best interest of the significant other. This can be dangerous and harmful to the significant other. How do you treat manipulation? - ANS Set limits and enforce. Why is manipulation easier to treat then dependency/codependency? - ANS Because no one likes being manipulated. What is Wernickes (Korsakoffs) Syndrome? - ANS Psychosis induced by vitamin B1 (Thiamine) deficiency. Vitamin B1 helps breakdown? - ANS Alcohol Primary symptom of Wernickes? - ANS Amnesia with confabulation (making up stories). Is Wernickes preventable? - ANS Yes Is Wernickes arrestable? - ANS Yes Is Wernickes reversible? - ANS No What is aversion therapy? - ANS When you try and make the patient hate something. Antabuse onset and duration is? - ANS 2 weeks Teach a patient taking Antabuse to avoid what? - ANS Alochol On top of alcohol a patient taking Antabuse should also avoid what other 7 things? - ANS Elixirs, Vanilla Extract, Aftershave/Perfumes, Alcohol based hand sanitizer, Insect repellant, Mouthwash and Vinagerette. What are the five uppers? - ANS Caffeine, Cocaine, Methamphetamines, PCP/LSD and ADHD Meds Downers are? - ANS Everything other then the five uppers. S/S of upper use? - ANS Everything goes up...Tachycardia, increased BP etc. S/S of downer use? - ANS Everything goes down...Bradycardia, decreased BP etc. Overdose of a downer causes everything to go? - ANS Down Overdose of an upper causes everything to go? - ANS Up Withdrawal of an upper causes everything to go? - ANS Down Withdrawal of a downer causes everything to go? - ANS Up At birth if the mother was addicted to a substance always assume the newborn is in? - ANS Intoxication If 24 hours after birth assume the baby is in? - ANS Withdrawal Every alcoholic goes through what withing 24 hours after cessation? - ANS Withdrawal syndrome After 72 hours of alochol withdrawal a small minority may get? - ANS Delirium Tremens Can Delirium Tremens kill you? - ANS Yes Can Alcohol Withdrawal Syndrome kill you? - ANS No Are patients with Alcohol Withdrawal Syndrome a danger to themselves or others? - ANS No Are patients with Delirium Tremens a danger to themselves or others? - ANS Yes N/I for Delirium Tremens? - ANS Private room near nurses station, NPO/Clear liquids, Restricted bed rest, restraints, tranquilizer, multivitamin (B1 vit.) and antihypertensive. N/I for Alcohol Withdrawal Syndrome? - ANS Semi-private room anywhere, regular diet, up and ad-lib, no restraint, tranquilizer, multivitamin (B1) and antihypertensive. A two point restraint is? - ANS One arm and the opposite leg. N/I for restraints? - ANS Check Q15min. and rotate sites Q2H All aminoglycosides end in? - ANS "mycin" Vancomycin If it has "thro" in it you? - ANS Throw it out...Zithromycin Toxic effects of aminoglycosides? - ANS Ototoxicity, nephrotoxicity and cranial nerve 8 (vestibulocochlear nerve) which senses sound. In aminoglycoside use monitor? - ANS Hearing, balance, tinnitus & creatinine (best indicator of renal function) Frequency of administration for aminoglycosides? - ANS Q8H Aminoglycoside route of administration? - ANS Im or IV Aminoglycosides are given PO for what two reasons? - ANS Hepatic Encephalopathy and Pre-op bowel surgery. Neomycin and Kanmycin are used for what? - ANS Bowel sterilzation? Who can sterilize my bowel? - ANS "Neo" "Kan" Hepatic Encephalopathy is caused by? - ANS High ammonia levels What raises ammonia levels the most? - ANS Ecoli in the gut When do you draw a trough level? - ANS 30 minutes before the next scheduled dose. When do you draw a sublingual peak level? - ANS 5-10 minutes after it is dissolved. When do you draw a IV peak level? - ANS 15-30 minutes after dose is finished. When do you draw a IM peak level? - ANS 30-60 minutes after given Drugs DON't determine peak and trough times, the ROUTE does. - ANS ... Calcium Channel Blockers are like what for the heart? - ANS Valium Calcium Channel Blockers treat what? (the 6 A's) - ANS Antihypertensive, Anti-Anginal, Anti Atrial Arrythmia and SVTS Calcium Channel Blocker side effects? (the 2 H's) - ANS Headache and Hypotension What causes angina? - ANS Chest pain due to O2 supply and demand issues. 90% of Calcium Channel Blockers end in? - ANS "dipine" and "zem" When giving a Calcium Channel Blocker you hold and notify if? - ANS Systolic is 100 or lower. "QRS" refers to? - ANS Ventricular "P" refers to? - ANS Atrail Asystole is? - ANS A lack of QRS repolarizations Atrail Flutter is? - ANS Rapid P-wave repolarizations in a saw tooth pattern. A-Fib is? - ANS Chaotic QRS depolarizations V-fib is? - ANS Chaotic QRS depolarizations V-tach is? - ANS Wide bizarre QRS's PVC is? - ANS Periodic wide, bizarre QRS's Be concerned about PVC's if? ( the 6, 6 T's of PVC's) - ANS More then 6 per minute, 6 in a row What are the 2 lethal arrythmias? - ANS A-systole and V-Fib What are the 4 potentially life threatening arrythmias? - ANS V-tach, A-fib, A-flutter and PVC What are the 6 arrythmias you are tested over on the NCLEX? - ANS V-fib, A-fib, A-flutter, PVC, A-systole and V-tach What are the 6 arrythmias for NCLEX in order for prioritization? - ANS A-systole, V-fib, V-tach, A-fib, A-flutter and PVC When talking about arrythmias the word "chaotic" means? - ANS Fibrillation When talking about arrythmias the word 'bizarre" means? - ANS Tachy PVC's fall on what wave of the previous beat? - ANS T wave When given a prioritization question for lethal arrythmias if you are asked to prioritize and one say it happened 6 minutes ago and the other says 15 minutes ago which do you choose? - ANS Always the one closest to the 8 minute mark. After 8 minutes the survival rate is LOW. To treat PVC's you give? - ANS Lidocaine/Amnioderone To treat V-tach you give? (If it start with a V you use..) - ANS Lidocaine/Amnioderone To treat supraventricular arrythmias you give? - ANS Adenocard, Beta-blocker (end in "lol'), Calcium Channel Blocker and Digitalis or Lonoxin. Supra means? - ANS Above To treat V-fib you ? - ANS Defibrillate ... For V-fib you D-fib To treat AsystolE you give? - ANS Atropine and Epinephrine but give it in reverse. If asked how to treat A-fib first you? - ANS Give Heparin then ABCD.... Heparin is instant Coumadin and Plavix take time. An Apical chest tube is placed? - ANS High (for air) A for air A Basilar chest tube is placed? - ANS Low (for blood) B for blood If you are asked about chest tubes after a surgery or trauma you can assumes it's a? - ANS Unilateral Pneumohemothorax Does a pneumonectomy get a chest tube? - ANS No What 4 things do you do if the water seal breaks on a chest tube? - ANS Clamp it 1st!! Cut broken device off of tube, put the tube in water (NS), unclamp. If asked about the best thing to di if the water seal breaks and not asking the first thing to do you? - ANS Put it in water (NS). What 4 things do you do if a chest tube comes out? - ANS Cover hole with a gloved hand, put on a vaseline gauze dressing, put on sterile dressing ands then tape on 3 sides. How long can you clamp a chest tube? - ANS No longer then 15 seconds without a doctors order. What do you use to clamp a chest tube and why? - ANS Rubber tipped double clamps. Rubber because it won't pierce the tube and double because were nurses and if one is good two is better. Is bubbling in the water seal continuously good? - ANS No it is bad. You need to find the air leak, tape it, report it and then record it. Is bubbling in the water seal intermittently good? - ANS Yes it should tidal on inhale. Is bubbling in the suction control chamber intermittently good? - ANS No it is bad. You need to dial up the suction, report and record. Is bubbling in the suction control chanber continuously good? - ANS Yes All congenital heart defects that are trouble start with a ? - ANS "T" What defects have right to left shunts and are cyanotic? - ANS Trouble defects What defects have left to right shunts and are acyanotic? - ANS Not trouble defects All congenital heart defects have what? - ANS Murmur and an echocardiogram done What are the four defects of Tetrology of Fellot? - ANS Ventricular Defect, Pulmonic Stenosis, Overriding Aorta and Right Hypertrophy What is the saying to help remember the four defects of Tetrology of Fellot? - ANS VarieD PictureS Of A RancH 1 fingerwidth is how many cm's? - ANS 1 When the handgrip of a crutch is properly in place the elbow felxion should be? - ANS 30* Crutches should be how many fingerwidths below the armpit? - ANS 2-3 Describe a 2 point gait? - ANS 1. one crutch and opposite foot together 2. Other crutch and other foor together. 2 points 2gether and the same time. Describe a 3 point gait? - ANS 1. Move two crutches and bad leg together. 2. Move good foot. Move all three together and then the good leg. Describe a 4 point gait? - ANS 1. One crutch 2. Opposite foot. 3. Other crutch. 4. Other foot. It moves one at a time so 1,2,3,4 and 1,2,3,4, and 1,2,3,4 so crutch, foot, other crutch, other foot, and crutch,foot, other foot, other crutch etc, Describe swing through? - ANS Used for two braced extremeties 1. Crutches 2. Legs... they kind of hop. Use the even numbered gaits when weakness is? - ANS Evenly distributed (bilateral) When using the even gaits what one is for severe and what one for mild problems? - ANS 2 point gait for mild 4 point gait for severe. Use the odd numbered gait when? - ANS The problem is affecting one leg (unilateral) When going up the stairs or down the stairs with crutched remember? - ANS UP with the GOOD and DOWN with the BAD Crutches always move with what leg? - ANS The bad leg. What side do you hold the cane? - ANS Strong side. What side do you advance the cane with? - ANS The weak side for a wide base support. *Step with opposites* For walkers remember you? - ANS Pick it up, set it down and walk to it. What is a delusion? - ANS A false fixed belief, idea or thought. This has no sensory component. What are the three types of delusions? - ANS Paranoid or Persecutory, Grandiose and Somatic What is a paranoid delusion? - ANS False fixed belief that people are out to harm you (CIA, FBI). What is a grandiose delusion? - ANS False fixed belief that you are superior (God, the Pope). What is a somatic delusion? - ANS False fixed belief about a body part (X-ray vision). What is a hallucination? - ANS False, fixed sensory experience. Five types of hallucinations? - ANS Auditory, visual, tactile, olfactory and gustatory. What is an illusion? - ANS Misinterpretation of reality. It is a sensory experience. How can you diffirentiate between illusions and hallucinations? - ANS There is a referent ( something to which they refer). So the patient takes something from reality and has a sensory response. What are the four types of functional psychosis? - ANS Schizophrenia, Schizoaffective disorder, Major depression/mania (bipolar). If a functional psychotic is having a delusion or illusion you? - ANS Acknowledge the feeling ( that sound horrible), present reality (but we have no spiders in the room), set a limit ( were not going to talk about that lets talk about something else), enforce the limit ( I see you're to ill to talk about reality). 5 examples of psychosis of dementia? - ANS Alzheimers, dementia, organic brain syndrome, wernickesand seniality. What do you do if a patient with psychosis of dementia is having a hallucination or illusion? - ANS Acknowledge and Redirect. What is flight of ideas? - ANS Jump from word to word. (This room is big, I liked the movie BIG when they were on the piano, Elvis could play the piano). What is word salad? - ANS Jump from word to word. Bob, Car, Sleep, Foot etc.. What is neologisms? - ANS Make up new words. What is a narrowed self concept? - ANS When they refuse to leave the room or get dressed. (DON'T force them to do it) What is ideas of reference? - ANS When they think everything is about them. (Everyone is talking about me) Type I diabetes (IJK)? - ANS Insulin dependant Juvenile onset Ketosis prone ( makes ketones) Type II diabetes? (non all of the above) - ANS Non insulin dependant Adult onset Non ketosis prone Diabetes S/S? - ANS Polyuria, Polydypsia and polyphagia (hunger) How do you treat type I diabetes? (DIE) - ANS Diet 3 Insulin 1 Exercise 2 How do you treat type II diabetes? (DOA) - ANS Diet 1 Oral hypoglycemic 3 Activity 2 Type II diabetics need how many calories a day? - ANS 1,200-1,800 Type II diabetics need how many feedings a day? - ANS 6 What two drugs can increase blood sugar? - ANS Glucagon and Epinephrine If client exercises more they need? - ANS Less insulin If client exercises less they need? - ANS More insulin When a client is sick what does it do to there blood sugar? - ANS It increases it. Teach diabetics who are sick to? - ANS Take insulin, take sips of water to stay hydrated and stay as active as possible. What are the 4 types of insulin? - ANS Regular, NPH, Humalog and Lantus Regualr insulins all have what in them? - ANS R Regular insulin onset? - ANS 1 hour Regular insulin peak? - ANS 2 hours Regular insulin duration? - ANS 4 hours NPH insulin all have a what in them? - ANS N NPH onset? - ANS 6 hours NPH peak? - ANS 8-10 hours NPH duration? - ANS 12 hours NPH is not so fast and not in the bag (IV) - ANS ... Regualr insulin is rapid and run - ANS ... With humalog when do you give it? - ANS With meals Humalog onset? - ANS 15 minutes Humalog peak? - ANS 30 minutes Humalog duration? - ANS 3 hours What is the only insulin safe to give at bedtime? - ANS Lantus/Glargine Which insulin works the fastest? - ANS Humalog What are the three reasons that cause low blood sugar in type I diabetes? - ANS not enough food, to much insulin (#1) and too much exercise. What is the biggest danger with low blood sugar? - ANS Brain damage if its less then 15 S/S of low blood sugar are? - ANS The same S/S of shock and being drunk... clammy, weak, slurred speach etc. Treatment for low blood sugar in type I diabetes? - ANS Rapidly metabolizable carb or ideallly a carb and protein combination or carb and starch. If they are unconcious NPO give glucagon IM or dextrose IV. Examples of rapidly metabolizing carbs? - ANS Juice, hard candy, icing, honey, syrup Diabetic Ketoacidosis (AKA high blood sugar in Type I diabetes) is caused by what 3 things? - ANS Too much food Not emough insulin Not enough exercise What is the #1 cause of DKA? - ANS Viral upper respiratory infection within last 2 weeks. DKA S/S? - ANS D-ehydration K-etones in the urine and blood, Kussmaul Resp and K+ A-cidosis, Acetone breath, Anorexia d/t nausea DKA treatment? - ANS IV at high flow rate (200hr.) with insulin R (it doesnt matter what solution its in) Treatment for low blood sugar in Type II is the same as Type I low blood sugar treatment. - ANS ... High blood sugar in type II diabetes aka hyperosmolar, hyperglycemic, non-ketotic coma (HHNK) is the same as? - ANS Dehydration HHNK S/S? - ANS Same as dehydration Treatment for HHNK is? - ANS Rehydrate but no insulin in the bag because it is not type I diabetes. You only give insulin in the bag with type I diabetes because they burn fat and it turns to ketones. What are the two long term problems from diabetes? - ANS Peripheral neuropathy and poor tissue perfusion. What lab is the best indicator for long term blood sugar maintenance? - ANS HGBA1C aka glycosated hemoglobin Lithium therapeutic level? - ANS 0.6-1.2 Lithium toxic level? - ANS over 2.0 Lanoxin (digoxin) therapeutic level? - ANS 1-2 Lanoxin (digoxin) toxic level? - ANS Over 2.0 Aminophylline therapeutic level? - ANS 10-20 Aminophylline toxic lever? - ANS Over 20 Dilantin therapeutic level? - ANS 10-20 Dilantin toxic level? - ANS Over 20 Elevated bilirubin level? - ANS 10-20 neonate only Toxic bilirubin level? - ANS Over 20 neonate only Dilantin is an? - ANS Anticonvulsant Aminophylline is an? - ANS Airway antispasm Lanoxin(digoxin) is for? - ANS CHF, Atrial arrhythmia Lithium decreases? - ANS Mania What is Kernicterus? - ANS When bilirubin is over 20 and in the CSF(cerebrospinalfluid) What is Opisthotonos? - ANS Position of hyperextension seen with kernicterus. Place them on there side if present. If kernicterus and opisthotonos are occuring you? - ANS Call doctor, drae bilirubin level, increase the IV rate and start billi lights. Hiatal hernia is? - ANS Gastric contents moving in the WRONG DIRECTION and the CORRECT RATE. Dumping syndrome is? - ANS Gastric contents moving in the RIGHT DIRECTION and the INCORRECT RATE. S/S of hiatal hernia are? - ANS GERD upon lying after meals S/S of dumping syndrome are? - ANS Acute abdominal distress= gas, ^bs, cramping, bloat Dumping= s/s of being drunk Syndrome= s/s shock 3 treatments for hiatal hernia is? - ANS High fowlers during and 1hr after meals Increase fluids with meals Increased carbs 3 treatments for dumping syndrome? - ANS Lay flat on side during and 1hr after meals Decrease fluids during meals(drink between meals) Decrease carbs (aka ^ protein diet) Kalemias do the same as the prefix except for the what? - ANS The HR and urine output. Calcemias do the opposite of the prefix plus all what? - ANS BP changes What is Chvosteks sign? - ANS Push the cheek and it spasms What is Trousseaus sign? - ANS BP cuff inflated and causes a carpal spasm. Magnesemias do the opposite of the prefix plus all what? - ANS BP changes If in a tie never pick magnesium. If the symptom involves nerve or skeletal pick calcemia. For any other symptom pick potassium. - ANS ... What is the rule for Natremias? - ANS The one with the E id dehydration the one with the O is overload HypErnatremia has s/s of dehydration and HypOnatremia has s/s of fluid overload. Earliest sign of an electrolyte overload is? - ANS Numbnesss and tingling (AKA parasthesia) Universal s/s of an electrolyte imbalance is? - ANS Muscle weakness (AKA paresis) Nere push what electrolyte? - ANS K+ To decrease K+ you give? - ANS D5W with Insulin R (insulin pulls the K+ from the blood and pulls it in the cell with glucose. this buys time but doesnt solve the problem) Kayexelate does what? - ANS Gets rid of K+ slow and late K-exits-late How much K+ can you have per liter of IV fluid? - ANS 40 mEq What two words mean the same thing as immunosuppresion? - ANS Agranulocytosis and neutropenia. Hyperthyroidism (AKA graves disease) is the same as saying? - ANS Hypermetabolism S/S of Hyperthyroidism? - ANS Same as hypermetabolism... agitated, nervous, diarrhea, hot, ^HR, ^BP, thin, hyperactive etc. Remember RUN yourself in the GRAVE - ANS ... Graves disease treatment options are? (3) - ANS 1.Radiation with I131 (radioactive iodine) 1st 24hrs be alone and flush the toilet alot. 2. PTU(drug) worry about immunosuppresion. 3. Surgical removal. What are the two types of Thyroidectomys? - ANS Total and Sub-total. With a Total Thyroidectomy what do they need for life? - ANS Hormone replacement (Synthroid) What are you at risk for following a Total Thyroidectomy? - ANS Hypocalcemia (parathyroid regulates calcium) For a Sub-total Thyroidectomy you are at risk for what? - ANS Thyroid storm S/S of a Thyroid storm are? - ANS The same as graves disease but incredibly higher. Exp: HR 180, Temp 108*, psychotic delirium. Thyroid storm treatment? - ANS High flow O2, 5 ice packs= 2 under each arm, 2 groin, 1 back of neck. Post Op Thyroidectomy risks 1st 12 hrs? - ANS Hemorrhage and airway. After 1st 12hrs assume they are stable. Post Op thyroidectomy risks 12-48 hrs for Total Thyroidectomy? - ANS Tetany Post Op thyroidectomy risks 12-48 hrs for Sub-total Thyroidectomy? - ANS Thyroid storm Hypothyroidism is the same as saying? - ANS Hypometabolism Hypothyroidism S/S? - ANS Same as hypometabolism ie, tired, sluggish etc What is the name of the disease for hypothyroidism? - ANS Myexedema Treatment for hypothyroidism? - ANS Hormone supplement If asked a question and your patient is critical remember to always STAY with the patient!! - ANS ... Do you sedate a patient with hypothyroidism? - ANS No you could put them into a coma. If a patient with hypothyroidism is NPO for surgery you still give them what? - ANS Hormone replacement medication. What is Addison's Disease? - ANS Under secretion of the adrenal cortex. S/S of Addison's Disease? - ANS Hyperpigmentation and do not adapt well to stress. Addisons Disease treatment? - ANS Chronic steroids (glucocorticoids) With Addison's Disease you ADD what? - ANS ADD-A-SONE Cushing Syndrome is the oversecretion of? - ANS The adrenal cortex. S/S of Cushing's Syndrome? - ANS Think of the Cush Man... Moon face, buffalo hump, thin legs and bones, striae (stretch marks), male breasts, hirstusism etc, Cushings Syndrome treatment? - ANS Adrenalectomy Contact precautions are used for what 4 types of diseases? - ANS RSV, Herpatic infection, Staph infections and Enteric (bowel) infections Contact precautions have what 5 things? - ANS Private room - door can be open Gloves Gown- if giving direct care Handwashing Disposable supplies Droplet precautions are for what 2 diseases? - ANS All meningitis and all influenza Droplet precations have what 6 things? - ANS Private room- door can be open Gloves Mask- #1 in this group Handwashing Pt wears mask when leaving room Disposable/dedicated equipment Airborne precautions are for what 4 diseases? - ANS SARS, TB, Measles and Varicella Airborne precautions have what 9 things? - ANS Private room-door closed Mask Gloves Gown Handwashing Special filter respirator masks Pt wears a mask when leaving room Disposable/dedicated supplies Negative airflow room PPE contains? - ANS Gloves, gown, gogles and mask unless told otherwise. Proper order for donning PPE? - ANS 1. gown 2. mask 3. goggles 4. gloves Where do you remove PPE? - ANS In the room. Where do you put on PPE? - ANS Outside the room. Proper order for removing PPE? - ANS 1. gloves 2. goggles 3. gown 4. mask In airborne precautions it is ok to remove what piece of PPE outside of the room? - ANS Mask What position are your hands for handwashing? - ANS Hands below elbow How long do you wash for handwashing? - ANS 15 seconds Can the faucet have handles for handwashing? - ANS Yes What do you use in handwashing? - ANS Soap and water When do you wash your hands? - ANS Before and after gloves, entering and exiting a room and after you soil your hands. What position are your hands in for scrubbing? - ANS Elbows below hands. What is the length for hand scrubbing? - ANS 3-7 minutes What do you use for hand scrubbing? - ANS Cleaning agent must have the prefix "chlor" Can the sink have handles for scrubbing? - ANS No When do you use scrubbing? - ANS Immunosuppresion, surgery, transplant, chemo, HIV Dry yours hands from...? - ANS Cleanest to least clean You can use alcohol based solution when? - ANS Before and after gloves, entering and leaving a room What can children under for not have? - ANS Small toys If a child has O2 is use what type of toys can't be used? - ANS Metal What is the best toy for a 0-6 month old? - ANS Musical mobile (get rid of this at 6 months or when the child is sitting up) What three things should you ask yourself when choosing appropriate toys for kids? - ANS Is it safe Is it appropriate Is it feasible What is the 2nd best toy for a 0-6 month old? - ANS Anything soft and large What is the best toy for a 6-9 month old? - ANS Cover/uncover toy What is the second best toy for a 6-9 month old? - ANS Anything large that they can't swallow. What is the best toy for a 9-12 month old? - ANS Talking toy. What is the second best toy for a 9-12 month old? - ANS Anything that is purposeful (rolling a ball back and forth) What 5 words should you avoid when answering a question about toys for a child under 9 months old? - ANS Build Make Construct Sort Stack What is the best toy for a toddler (1-3 yr.)? - ANS Push/pull toy What should you work on with a toddler (1-3 yr.) ? - ANS Gross motor What is toddler (1-3 yr.) play characterized by? - ANS Parallel play (with another child but alone) What two things should you work on with a preschooler (3-6 yr.) ? - ANS Fine motor (fingers) Balance (dance, gymnastics) What sort of play do preschoolers (3-6 yr.) prefer? - ANS Pretend play What is preschooler (3-6 yr.) play characterized by? - ANS Co-operative play (together) School age (7-11 yr.) is characterized by the 3 C's, what are they? - ANS Creative (no coloring book, use blank paper) Collecting Competitive Adolescents (12-18 yr.) "play" is? - ANS Peer associated Allow adolescents to be in each others rooms unless? - ANS Contagious Immunosupressed Fresh post-op If you're being questioned over a drag and drop and you're given an option that would require a doctors order assume that you have that order. But if an option is to call the doctor, you call first then give. - ANS ... Best indicator of kidney function? - ANS Creatnine Creatnine norm? - ANS 0.6-1.2 INR monitors? - ANS Coumadin/Warafin therapy INR therapeutic level? - ANS 2-3 If the INR is over 4 you? - ANS Hold all Coumadin/Warafin Assess bleeding Prepare to give K+ Call doctor Potassium norm? - ANS 3.5-5.3 If the potassium is below 3.5 you? - ANS Assess the heart Prepare to give potassium Call the doctor If the potassium is high (5.4-5.9 high but still within the 5's) you? - ANS Hold potassium if in the IV Assess the heart Prepare to give D5W with insulin Call the doctor If the potassium is over 6 you? - ANS Stop what you're doing and assess If negative effects present you call rapid response. If no negative effects you do the same as "high but within the 5's) pH norm? - ANS 7.35-7.45 If the pH is under 6 you? - ANS Assess vital signs Call the doctor ASAP BUN norm? - ANS 8-30 If the BUN is elevated cheack for? - ANS Dehydration How should you prioritize labs? - ANS Based on what the level will do to the body and not the disease it's associated with. If you have a lab thats high and you don't know why pick? - ANS Dehydration Hgb norm? - ANS 12-18 Hgb under 8 you? - ANS Assess bleeding Prepare blood Call doctor Bicarb (HCO3) norm? - ANS 22-26 CO2 norm? - ANS 35-45 CO2 is the 50's you? - ANS Assess respiratory status Do pursed lip breathing ^ exhale time DON't give O2 if the above isn't working call the doctor! CO2 in the 60's (respiratory failure) you? - ANS Assess respiratory status Do pursed lip breathing Prepare for intubation Call respiratory therapy Call the doctor Hct norm? - ANS 36-54 PO2 norm? - ANS 78-100 PO2 70-77 you? - ANS Assess respiratory status Give O2 PO2 below 60 you? - ANS Assess respiratory status Give O2 Prepare for intubation Call respiratory therapy Call the doctor O2 sat norm? - ANS 93-100 O2 sat below 93 you? - ANS Assess respiratory status Give O2 BNP norm? - ANS <100 BNP is a good indicator of what? - ANS CHF What is the best indicator of CHF? - ANS ANF ANF and BNP= - ANS CHF Sodium norm? - ANS 135-145 Sodium is ok if abnormal unless what occurs? - ANS Change in LOC WBC norm? - ANS 5,000-11,000 Absolute neutrophil count (ANC) norm? - ANS 500 CD4 norm? - ANS < 200 is AIDS If the WBC count is high this is called? - ANS Leukocytosis If the WBC is low it is called? - ANS Leukopenia Neutropenia Agranulocytosis Immunosupression Bone marrow supression If the WBC is low you should? - ANS Follow strict handwashing Shower BID with antimicrobial soap Avoid crowds Private room No fresh flowers or potted plants Low bacteria diet- no raw fruits/veggies, no undercooked meat. No water drinking if its been sitting for longer then 15 minutes. Vitals Q4H Check WBC daily Avoid reusable plates/silverware etc, Platelets norm? - ANS 150,000-400,000 If platelets are below 90,000 you? - ANS Check for bleeding Place on bleeding precautions (thrombolytic precautions) If platelets are below 40,000 you? - ANS Prepare platelet transfusion Call the doctor RBC norm? - ANS 4-6 Reason for laminectomy is? - ANS To treat nerve root compression. 3 P's of nerve root compression (S/S) ? - ANS Pain Paresis= muscle weakness Parasthesia Knowing the location of a laminectomy is key to getting the ? right. - ANS ... Cervical = - ANS Neck Thoracic = - ANS Upper Lumbar = - ANS Lower Pre-op cervical laminectomy's most important assessment is? - ANS 1st breathing (rate and rhythm) 2nd arm and motor sensory Pre-op thoracic laminectomy's most important assessment is? - ANS 1st cough (uses abdominal muscles) 2nd bowel sounds Pre-op lumbar laminectomy's most important assessment is? - ANS 1st voiding ( when was last time, can they) 2nd leg motor and sensory. The rule of ABC"s doesnt work in what area of health? - ANS Neuro What is the #1 post-op answer for the NCLEX? - ANS Log roll the patient Activity requirements/restrictions Q8H after laminectomy surgery? - ANS Do not dangle (AKA sit on the side of bed) May stand, walk and ly without restrictions Don't sit longer than 30 minutes What post-op complication do you watch for with a cervical laminectomy? - ANS Pneumonia What post-op complication do you watch for with a thoracic laminectomy? - ANS Pneumonia Paralytic ileus What post-op complication do you watch for with a lumbar laminectomy? - ANS Urinary retention For a laminectomy what incision site is more painful? - ANS Hip site For a laminectomy what incision has the most drainage/bleeding? - ANS Hip site For a laminectomy what incision site has the highest risk for infection? - ANS 50/50 equal If being asked about a surgery and the length of time for restrictions your default answer should be? - ANS 6 weeks Discharge teaching for a laminectomy? - ANS Don't sit for longer then 30 minutes for 6 weeks Ly flat and log roll for 6 weeks No driving for 6 weeks Do not lift more then 5 lb. for 6 weeks Permanent restrictions for a laminectomy? - ANS Do not lift by bending at the waist No crazy activities... jerky rides, horseback riding For a cervical laminectomy they can never? - ANS Lift objects above the head. Nageles rule for calculating a due date is? - ANS 1st day of the last menstrual period Add 7 days Subtract 3 months Normal weight gain for pregnancy? - ANS 28 + or - 3 lb 1st trimester weight gain? - ANS 1 lb a month 2nd/3rd trimester weight gain? - ANS 1 lb a week After week 12 you can subtract 9 to get appropriate weight gain. - ANS ... Fundal height is not palpable until week? - ANS 12 The fundus is palpable at the naval at week? - ANS 20-22 If the fundus is not above the naval the baby is not? - ANS Viable Positive signs of pregnancy? - ANS Fetal skeleton on X-ray Fetal presence on ultrasound Auscultation of FHR (heard at week 8, most likely at 10 and should be heard by 12) Examiner palpates fetal movement Probable/presumptive signs of pregnancy are? - ANS All urine and blood tests What is Chadwicks sign? - ANS Cervical change to cyanosis (blue hue) What is Goodells sign? - ANS Cervical softening What is Hegars sign? - ANS Softening movesd from the cervix to the uterus. How long do you go to the doctor for pregnancy once a month? - ANS For 28 weeks. How long do you go to the doctor every two weeks for pregnancy? - ANS From week 28-36 How long do you go to the doctor for pregnancy every week? - ANS From week 36-42 Is it normal to be slightly anemic during pregnancy? - ANS Yes Normal Hgb level in women is? - ANS 12-16 Hgb level in first trimester? - ANS Can fall to 11 and it is normal. Hgb level in second trimester? - ANS Can fall to 10.5 and is normal. Hgb level in the third trimester? - ANS Can fall to 10 and is normal. How do you treat morning sickness? (1st trimester) - ANS Dry carb How do you treat urninary incontinence during pregnancy? (1st and 3rd trimester) - ANS Void Q2H How do you treat dyspnea during pregnancy? (2nd and 3rd trimester) - ANS Tri-pod position (sit, lean forward, elbows on knees) How do you treat back pain in pregnancy? (2nd and 3rd trimester) - ANS Pelvic tilt exercise Always teach a pregnant women to pee how often from day of pregnancy to 6 weeks post partum? - ANS Q2H Truest most valid sign of labor is? - ANS Regular contractions Dilation is? - ANS Opening of the cervix (0-10) Effacement is? - ANS Thinning of the cervix (0-100%) Station is? - ANS This refers to the baby's presenting part (normally the head) to the mothers ischeal spine. So if the baby is above the ischeal spine they are given a - number, if they are below they are given a + number. + numbers are positive news and - numbers are negative news. Engagement is? - ANS Station 0 Lie is? - ANS Relationship between the spine of the baby and the spine of the mom. Vertical (parallel) is ok, Tranverse (perpindicular) is bad. Presentation is? - ANS The part of the body that enters the birth canal first. The first stage of labor is? - ANS The labor part. The second stage of labor is? - ANS Delivery of the baby. The third stage of labor is? - ANS Delivery of the placenta. The fourth stage of labor is? - ANS Recovery (1st 2 hours after the placenta is delivered) How often do you monitor during labor? - ANS Q15min until the 2hr mark after placental delivery. Then Q1H. The first stage of labor has how many phases? - ANS 3 What are the three phases of labor? - ANS Latent, Active and Transition Latent phase is? - ANS 0-4 cm dilated Contractions are 5-30min apart Lasting 15-30 sec. They are mild Active phase is? - ANS 5-7 cm dilated Contractions are 3-5 min apart Lasting 30-60 sec. They are moderate Transition phase is? - ANS 8-10 cm dilated Contractions are 2-3 min apart Lasting 60-90 seconds They are strong Contractions should be no longer then ____ and no closer then_____. - ANS 90 sec and 2 minutes How do you assess frequency of contractions? - ANS Beginning of one contraction to the beginning of another. How do you assess duration of a contraction? - ANS Beginning to end of contraction How do you assess the intensity of a contraction? - ANS Palpate with one hand over fundus and with the fingertips. How do you treat painful back labor? - ANS Knee to chest position You use your fist and press on the patients sacrum. How do you treat prolapsed cord? 911!! OB emergency - ANS Push head back in Position in knee chest position or Trendelenburg What interventions do you do for all other OB complications? (LION) - ANS L-erft side position I-ncrease IV O-2 N-otify doctor If Pitosin is running stop this first then LION Do not give what type of pain medication to a women in labor if the medication is liekly to peak when the baby is born? - ANS Systemic- AKA IV, IM and oral Low fetal heart rate is ? - ANS Bad you LION under 110 High fetal heart rate? - ANS 160 This is ok Low baseline variability? (aka heart rate not changing) - ANS Bad you LION High baseline variability? - ANS HR changing a lot. This is ok. Late decelerations? - ANS Bad (placenta) you LION Early decelerations? - ANS Head pressed on. This is ok. Variable decelerations? - ANS HR up or down, cord compression = BERY BAD ACE of spades answer for OB? - ANS Check fetal HR If in OB its low or late you? - ANS LION If variable its? - ANS Very bad and you push and position. The second stage of labor and delivery is all about? - ANS Order So what do you do and in what order for the second stage? - ANS Deliver the head Suction 1st the mouth then the nose Check for nuchle cord (cord around neck) Deliver shoulders and body ID band During the third stage of labor and delivery (placental delivery) you do what two things? - ANS Make sure it's intact( if left in hemorrhage 1st infection 2nd) Check for three vessels (2 arteries, 1 vein)AVA What are the 4 things you do 4 times an hour for the 4th stage of labor? - ANS VS- check for S/S of shock Fundus- if boggy, massage. If displaced,void/cath Perineal pad- excessive lochia= pad saturated Q15min 911 Roll on side and check the pad for bleeding. The uterus should be like what after delivery? - ANS Firm not boggy Fundal height= days postpartum (3days= 3cm below naval) Midline- if not catheterize Lochia color rubra? - ANS Red- rub it red Lochia color serosa? - ANS pink- rose pink Lochia color alba? - ANS White- albino white Moderate lochia is? - ANS 4-6 inches on pad in one hour Excessive lochia is? - ANS Saturated pad in 15 minutes Extremity assessment post partum should check? - ANS Pulses Edema S/S of thrombophlebitis- bilateral calf circumference is the best way to check. If they are equal its ok if not its positive for whichever calf is bigger) Post partum assessment should include what? - ANS Uterus Lochia Extremities Milia is? - ANS Distended sebacious glands which appear as tiny white spots on babys face. Epsteins pearls are? - ANS Small,white epithelial cysts on babys gums. Mongolian spots are? - ANS Bluish/black macules appearing over the buttocks and or thighs of darker skinned neonates. Erythema toxicum neonatorum is? - ANS Red papular rash on babys torso which is benign and disappears after a few days. Hemangiomas is? - ANS Benign tumor of the capillaries. Cephalohematoma is? - ANS Swelling caused by bleeding between the osteum and periosteum of the skull. This swelling does not cross suture lines. Caput Succedaneum is? - ANS Edematous swelling on the scalp caused by pressure during birth. This swelling may cross suture line. It usually disappears in a few day. Hyperbilirubinemia is? - ANS Normal, physiologic jaundice appears after 24 hours of age and disappears at about one week. Vernix caseosa is? - ANS Whitish, cheese like substance which covers the skin on an unborn baby. Acrocyanosis is? - ANS Normal cyanosis of the babys hands and feet which appears intermittently over the 1st 7-10 days. Nevus/Nevi is? - ANS The generic term for a birthmark. What 2 newborn variations are you most likely to be tested on for the NCLEX? - ANS Cephalohematoma and Caput Succedaneum Tocolytics do what to labor? - ANS Stop it What are the two tocolytics? - ANS Terbutaline= Brethine Nifediopine= Procardia SE for Terbutaline? - ANS Maternal tachycardia This drug is not good if a heart issue is already present. SE of Nifedipine? - ANS Headache and Hypotension (H&H) Oxytocics do what to labor? - ANS Start it What are the two oxytocic's? - ANS Pitocin=Oxytocin Cervidil= Prostaglandin SE of Pitocin? - ANS Can cause hyperstimulation (contractions longer than 90 sec. and closer then 2 min.)If FHR is less then 110 stop it, if FHR is normal you slow it. Used also for PP Hemorrhage. SE of Cervidil? - ANS Effacement which leads to contractions. What are the two neonatal lung medications? - ANS Betamethasone Survanta How do you give Betamethasone? - ANS To the mom Before delivery IM SE of Betamethasone? - ANS ^ in glucose so monitor blood sugar How do you give Survanta? - ANS To the baby After delivery By inhalation Humulin 70/30 is what? - ANS 70% N insulin and 30% R insulin When drawing up insulins its? - ANS RN (regular then N) draw what you are RN) If your are pressurizing for drawing up insulin you? - ANS Draw what you are backwards. NR----> RN For injections an IM needle must be? - ANS A 1 in both gauge and length. For injections SUBQ needles must have? - ANS A 5 in both gauge and length. What routes can you give Heparin? - ANS IV or SUBQ How quickly does Heparin work? - ANS ASAP What do you monitor if on Heparin? - ANS PTT Antidote for Heparin is? - ANS Protamine Sulfate Heparin is what pregnancy class? - ANS C How can Coumadin be given? - ANS Oral only How long does it take for Coumadin to work? - ANS 3-5 days What do you monitor in Coumadin? - ANS Pt-INR(this is only for Coumadin)q What is the antidote for Coumadin? - ANS Vitamin K What pregnancy class is Coumadin? - ANS X All K+ wasting diuretics end in? - ANS X... If it ends in X its X's out K+ everything else it K+ sparing diuretics. What is Baclofen(Lioresil, Flexeril)? - ANS Muscle relaxer Baclofen(Lioresil, Flexeril) SE? - ANS Muscle weakness and drowsiness What should you teach a patient taking Baclofen(Lioresil, Flexeril)? - ANS Don't drive/ operate machinery Don't drink alcohol Don't care for children under 12 What is the saying that can be used to help remember Baclofen(Lioresil,Flexiril)? - ANS When you're on Baclofen you're on your back loafin. A 0-2 yr old is in what Paiget stage? - ANS Sensorimotor A 3-6 yr old is in what Piaget stage? - ANS Pre-operational A 7-11 yr old is in what Piaget stage? - ANS Concrete operation (think of a 7-11 with concrete around it) A 12-15 yr old is in what Piaget stage? - ANS Formal operations Piagets sensorimotor stage is characterized by? - ANS Present oriented Only think about what they SENSE or are DOING now. As a nurse when, what and how do you teach a child in sensorimotor stage? - ANS Teach when you're doing it What you're doing to them Do it verbally Piagets pre-operational stage is characterized by? - ANS Fantasy oriented Illogical No rules As a nurse when, what and how do you teach a child in the pre-operational stage? - ANS Teach the day of- to avoid nightmares What you're going to do Do this through play Piagets concrete operations stage is characterized by? - ANS Rule oriented Live and die by the rules Cannot abstract As a nurse when, what and how do you teach a child in the concrete operations stage? - ANS Teach them ahead of time What you're going to do Use visual and audio and use age appropriate reading At what Piaget stage can you teach a skill like how to draw up insulin? - ANS Concrete operations Piagets formal operations stage can be taught like? - ANS An adult For prioritization the question will give what 4 pieces of information? - ANS Age Gender Disease Modifying phrase For a prioritization question the most important information is? - ANS The modifying phrase For a prioritization question what 2 pieces of information do not matter? - ANS Age and gender What are the four rules of prioritization? - ANS Acute beats chronic Fresh post-op(12hr.) beats medical or other surgical. Unstable beats stable The more vital the organ the higher the priority(use only as a tie breaker) What is the best rule out of all 4 for prioritization? - ANS #4 What makes a patient stable? (7) - ANS Chronic illness Over 12 hr post op Local or regional anesthesia Unchanged assessment Phrase "to be discharged" Lab values A or B Typical S/S for the disease they have or what they are receiving treatment for. What makes a patient unstable? (7) - ANS Acute illness Post-op less than 12 hr General anesthesia Changed assessment Phrase "newly admitted" or "newly diagnosed" Labs C & D Unexpected S/S What 4 things are always considered unstable? - ANS Hemorrhage Hypoglycemia Fevers over 104* Pulselessness and breathlessness What are the main 6 organs in prioritized order? - ANS 1. Brain 2. Lung 3. Heart 4. Liver 5. Kidney 6. Pancreas What do you not delegate to a family member? - ANS Safety responsibilities-" can you watch your dad really fast while I grab something." Family can only do what you ____ them for the patient? - ANS Teach If another staff member is doing something illegal you? - ANS Tell the supervisor. What do you do if another staff member is placing the patient in physical or psychological harm? - ANS Intervene and take over. What do you do if a staff members behavior is legal, not harmful but just inappropriate? - ANS Counsel them later at a better time. Review Psych section. Pages 60-64 - ANS ... All psych medications cause what? - ANS Weight changes and low BP. What group of drugs is the most commonly tested on the NCLEX? - ANS Psychotropic What are phenothiazines? - ANS Psychotropic drugs Phenothiazines end in? - ANS "zine" Large doses of phenothiazines are ? - ANS Anti-psychotic Small doses of phenothiazines are? - ANS Antiemetics Major doses of phenothiazines are? - ANS Tranquilizers..... BIG GUNS. The SE for phenothiazines are? (ABCDEFG) - ANS A-nticholinergic SE B-lurred vision C-onstipation D-rowsiness E-xtra paramital syndrome F-otosensitivity aG-granulocytosis What do you teach patients taking phenothiazines to report? - ANS Sore throat and any signs of infection. What is the #1 nursing diagnosis for a patient taking phenothiazines? - ANS Safety If a drug has the word _____ behind it, it means long IM form for noncompliance? - ANS Deconoate Deconoate means? - ANS Long IM form given to noncompliant patients. Tranquilizers work? - ANS ASAP Antidepressants work? - ANS In 2-4 weeks Tranquilizers shouldn't be taken? - ANS Long Antidepressants can be taken? - ANS Long What are the four Tricyclic antidepressants you need to know? - ANS Elavil Tofranil Aventyl Desyrel Tricyclic SE? (Elavil starts with E so they go through E ABCDE) - ANS A-nticholinergic effects B-lured vision C-onstipatioh D-rowsiness E-uphoria Tricyclic's do what to the mood? - ANS Elevates it Benzodiazepines are ? - ANS Antianxiety meds. Benzodiazepines are considered minor what? - ANS Tranquilizers Benzo's have what in the name? - ANS "zep" Must not take Benzo's for longer than? - ANS 6 weeks Benzo's can also be used for what 5 other reasons? - ANS 1. Anesthesia induction 2. Muscle relaxant 3. Alcohol withdrawal 4. Seizures 5. Facilitates mechanical ventilation Benzo SE? (ABCD) - ANS A-nticholinergic effects B-lured vision C-onstipation D-rowsiness What is the #1 nursing diagnosis for Benzo's? - ANS Safety MAOI's treat? - ANS Depression MAOI's are the? - ANS Mar-plan Nar-dil Par-nate MAOI SE? - ANS A-nticholinergic effects B-lured vision C-onstipation Drowsiness To avoid a severe hypertensive crisis patients taking MAOI's must avoid all foods with? - ANS Tyramine Read pg. 67 for a list of Tyramine - ANS ... Lithium SE? (The 3 P's) - ANS Peeing Pooping Parasthesia Lithium toxic SE? - ANS Metallic taste Severe diarrhea Number 1 intervention for Lithium toxicity? - ANS Keep them hydrated If sweating give sodium as well as fluids While on Lithium you must monitor the level as well as what? - ANS Sodium Prozac is? - ANS An SSRI Prozac has the same side effects as Elavil? - ANS ABCDE Prozac causes what? - ANS Insomnia When should you give Prozac? - ANS Before 12 noon. If Prozac is BID give at what times? - ANS 6A and 12N When changing the dose of Prozac for a young adult you must monitor for? - ANS Suicide If you don't know what a drug is and you are being asked which lab is important.... you need to remember? - ANS ALT A L-iver T-est What is the average dose of Haldol? - ANS 5 mg Haldol has the SE? - ANS ABCDEFG Elderly patients need to take what amount of Haldol? - ANS Half the regular amount. If an elderly patient OD's on Haldol what are they at risk for? - ANS NMS -Neuroleptic Malignant Syndrome Hyperprexia is? - ANS Fever- really bad fever NMS has what associated with it? - ANS Hyperprexia Clozaril(Clozapine) is what? - ANS A second generation tranquilizer Most second generation tranquilizers have what in them? - ANS "zap" How often do you have to draw a WBC for a patient taking a second generation tranquilizer? - ANS 1 a week for 1 month 1 a month for 6 months 1Q6 months for life Clozaril(Clozapine) is used to treat? - ANS Severe schizophrenia If a question has a drug with "zap " in it, the answer is probably? - ANS Infection related Clozaril(Clozapine) has what SE? - ANS Agranulocytosis Zoloft(Sertraline) is a? - ANS SSRI Can Zoloft be taken in the evening? - ANS Yes Does Zoloft cause insomnia? - ANS Yes Zoloft decreases metabolism and can cause? - ANS Toxic drug levels What should you monitor with Zoloft use? - ANS Other drugs levels Patients taking Zoloft should NOT take what? - ANS St. John's wort St. John's wort and Zoloft use can cause? - ANS Serotonin Syndrome What are the S/S of serotonin syndrome? - ANS S-weating A-pprehension AKA=sense of doom D-izziness H-eadache If a patient is on drug A for 10 yrs. and the doctor adds drug B which drug dose needs to be lowered? - ANS Drug A The ACE of spades answer for nutrition is to either pick ____ or _____. - ANS Chicken Fish Never choose _______ as a food for children. - ANS Casserol For a toddler pick ______ food. - ANS Finger For a preschooler ____ meal a day is ok!!! - ANS 1 If you know what a particular drug does pick a SE in the ______ body system. - ANS Same If you have no idea what a drug is check to see if it is ___. If it is pick a _______ SE. - ANS PO GI Ace of Spades answer for OB? - ANS Check the FHR. What is the first thing you assess in a Med-Surg situation? - ANS L.O.C. = Bob, Bob, Bob are you ok???? What is the first thing you do in a Med-Surg situation? - ANS Airway For Peds when in doubt call it? - ANS Normal For Peds when in doubt pick? - ANS The older age. For Peds when in doubt pick the? - ANS Easier task. In Peds always give? - ANS More time Empathy question have? - ANS A quote in the question and a quote in the answer. In psych choose the answer that reflects the _______ and not the _______ they said. - ANS Feelings Words